Board of Health

Meeting Minutes
October 13, 2009

12:00 Noon
Rice Conference Room

Present:	Mr. Brooke Greenhouse; Dr. James Macmillan, President; Mr. Michael McLaughlin, Jr.; Ms. Janet Morgan; Dr. Jeffrey Snedeker; Mr. Greg Stevenson; and Dr. William Tyler;
Staff:	Mrs. Sylvia Allinger, Director of CSCN; Mrs. Liz Cameron, Director of Environmental Health; Mrs. Alice Cole, Public Health Director; Dr. William Klepack, Medical Director; Mr. Steve Flash, Assistant County Attorney; and Mrs. Patty Stamm, Administrative Assistant
Guests:	Steven Kern, Sr. Public Health Sanitarian; Carol Chase, Sr. Public Health Sanitarian; Rick Ewald, Sr. Public Health Sanitarian; Adam Hartwig, BT Coordinator; Pam Mackesey, Tompkins County Legislature; Ken Deschere, South Hill Resident; Gregg Townsend, NYSDEC; Karen Cahill, NYSDEC; and Jessi Pollack, Green Café
Excused:	Dr. Francis Fox; Mrs. Sigrid Connors, Director of Patient Services; Mrs. Brenda Grinnell Crosby, Public Health Administrator; and Mr. Jonathan Wood, County Attorney

 

Call to order

Dr. Macmillan, President, called the regular meeting of the Board of Health to order at 12:07 P.M.

Approval of Minutes: 

Dr. Tyler moved to approve the minutes of the September 08, 2009 Board of Health meeting, seconded by Mr. Stevenson, and carried unanimously.

Mrs. Cole introduced Adam Hartwig, the new BT Coordinator.  Board members gave Adam a hearty welcome.

Financial Summary: 

Mrs. Grinnell Crosby was unable to attend today’s meeting, however Mrs. Cole offered to answer any questions in her absence.

Administration Report:

Mrs. Cole:

• Passed around letters she had received from Senator Kirsten E. Gillibrand and Maurice D. Hinchey in response to letters Mrs. Cole had written on various topics concerning health care reform.
• Announced that the Health Department has been approved to sponsor the WIC Program for the next five years.
• Reported that last week the Health Department had an unannounced inspection from the State of its Diagnostic and Treatment Center.  She added that there was only one small deficiency (a new regulation which staff was unaware of) - Dr. Klepack has to be re-credentialed as the Health Department’s Medical Director every two years.  Mrs. Cole thanked the Prevention staff for doing such a great job, adding that the Diagnostic and Treatment Center survey went very well.  At the exit survey, the inspectors extended “Kudos” to everyone, stating they plan to use Tompkins County as a model county.  The survey was done in less than five hours.        
• Reported that there will be several openings on the Board of Health in 2010, so a Nominating Committee may need to be formed to fill those vacancies. 
• Reported the Health Department has received a small shipment of H1N1 nasal mist, as well as injectable vaccine.  Currently the Health Department is holding clinics for health care workers, first responders, and law enforcement personnel.  Mrs. Cole asked that the word be spread to anyone in those target groups who might like be vaccinated for H1N1.  Mrs. Cole added currently Cayuga Medical Center and the Health Department are the only providers receiving the H1N1 vaccine.  Eventually, within the next few weeks, the providers who have signed up and are authorized will start receiving their vaccine.  Mrs. Cole stated that Karen Bishop and her staff are busy planning for school clinics, which will be the next round of clinics.

Medical Director’s Report:  Dr. Klepack discussed an article he had just recently read in the NY Times which discussed the perceived risks and misconceptions of the H1N1 vaccine.  He stated he felt it was a good reference article Board members could use when talking to constituents about vaccination and H1N1.  Dr. Klepack stated so far there has been nothing that has come up in usage that would indicate other concerns, although he added the very rare side-effects only become evident in extended use.  He added this is not any different for vaccines than it is for drugs, stating that medications are subject to the same sorts of issues.

Division for Community Health:

Due to Mrs. Connor’s absence from today’s meeting, there was no additional report.

Children with Special Care Needs:

Mrs. Allinger stated the Early Intervention Program will be receiving $31,000.00 in stimulus funds.  She added they are currently exploring ways to use this money since there is such a narrow focus of what the funds can be used for.  She added that anticipates knowing by the next Board of Health meeting how these funds will be used. 

County Attorney’s Report:

Mr. Flash stated he had nothing to report.

Environmental Health Report:

Mrs. Cameron:

• Reported that NYSDOH did respond to their request to finalize Article VII (changes to the local public water systems which are not subject to the State law); however they did not accept the proposed changes to the Sanitary Code.  She added that, although this is not a current priority, she will be contacting them to try to discuss their comments.
• Attended the Environmental Health Directors Conference in mid-September.  She reported that the NYSDOH is being pressured to be more aggressive with childhood lead poisoning prevention.  The change they have proposed is that they would require abatement in all residences.  Currently, Environmental Health often uses risk reduction measures.  Mrs. Cameron stated if this proposal takes place, a certified lead abatement contractor would need to be used; currently, there are none in Tompkins County.  Mrs. Cameron expressed concern about possibly having to take enforcement action against homeowners, the financial implications, and the additional time involved.  She stated they submitted comments to the NYSDOH urging them not to require abatement in all residences and to continue with the current program which works effectively.  She also added that all of the other counties in the State had the same position. 
• Reported another area that was discussed at the Environmental Health Directors Conference was the Workers Comp requirement issue.  She added the State is having trouble regulating this implementation and plans to revise their guidance.  A short discussion ensued regarding Workers Comp regulations. 
• Reported the NYSDEC released their draft Supplemental Generic Environmental Impact Statement regarding gas drilling in the Marcellus Shale.  She added this weekend there was an article in the Ithaca Journal stating that the local health departments will be responsible for monitoring water testing in the area of the gas wells.  Mrs. Cameron stated they are receiving more calls and inquiries which are taking up more of their time.  She added she is Chair of the Water Resource Council Gas Drilling Committee and will be preparing comments on the document to DEC.  Dr. Macmillan asked Mrs. Cameron for a summary of anything that might be pertinent for Board members to review from the NYSDEC Environmental Impact Statement.  A short discussion ensued regarding the issue of gas drilling and water testing. 
• Announced that Karen Cahill and Greg Townsend from the NYSDEC will be attending today’s meeting to present information on the contamination at South Hill.  
• Requested that the enforcement action for Green Café be added to today’s agenda.

For Discussion:

South Hill Contamination – Presentation by NYSDEC:
Summary of South Hill Discussion at Oct 2009 BOH Meeting:

Karen Cahill and Gregg Townsend from the New York State Department of Environmental Conservation (NYSDEC) gave a presentation and addressed questions pertaining to subsurface contamination with volatile organic compounds (VOCs) in the South Hill area of Ithaca.  These chemicals have been used in the past at the Emerson, Axhiohm, and Therm facilities. The discussion focused on soil vapor contamination with volatile organic compounds (VOCs) that is transmitted along sewer pathways.

The sewers were identified as a potential pathway for transmitting contaminated soil vapors to homes about 4 to 5 years ago. The local geography makes testing and remediation of this contamination difficult because, in most cases, the sewers are set in rock with no bedding material. Emerson has committed to remediating contamination along their sewer lines. State funding will be used to address contamination in areas that Axiohm and Therm are not willing to address. 

Homes are tested for soil vapor contamination during the heating season, the time when the highest concentrations are expected to be detected indoors. Homes have been tested for contamination in phases since 2004. Phases I to V were conducted by Emerson, who offered remediation systems to occupants if contaminants were detected at levels lower than the State guidance values.  Future testing will be conducted by the NYSDEC. Remediation systems will be offered to homes when contamination is found above guidance levels established by the NYSDOH.  The NYSDEC has requested funding for Phase VII testing and is waiting for funds to be released.

Pam Mackesey expressed her concern that she feels there is still a lot of work that needs to be done, as well as this being a public health issue since there are people living in an area that potentially has some high pollution levels.

Mrs. Cameron stated at this point there is no set role for the Board; adding that her department was approached by Pam Mackesey and subsequently Board members asked for information of the South Hill contamination, which was the reason for today’s presentation.  She added one of the concerns the community has raised is that they would like blanket mitigation in some of the areas affected by chemicals.  Due to time constraints, Pam Mackesey was asked to attend a future meeting for further discussion on this issue.  In the meantime, Mrs. Cameron will speak with Pam Mackesey and Ken Deschere and summarize the community’s concerns and bring them back to the Board of Health. 

Charles B. Park, Owner/Operator, Greene Café, C-Ithaca;
Violation of Part 14-1 of the NYS Sanitary Code (Food Service):

Mrs. Cameron briefly reviewed the history of the Greene Café, which has been in operation since April 2009.  During this time of operation, critical violations were found on the initial inspection as well as the re-inspection in April 2009, again in August 2009 during a re-inspection, and then again in October 2009 during another re-inspection.  All of these violations involved food temperatures.  Mrs. Cameron stated they did not want to wait until November to bring this issue back to the Board for their consideration. 

Mrs. Cameron stated temperature logs have not been maintained as required by Board of Health Orders of September 8, 2009, so Environmental Health staff is requesting Green Café to develop some kind of plan to educate their staff.  She added that staff turnover, as well as language issues, could be contributing factors in these violations.  Mrs. Cameron also stated Green Café has restaurants in New York City that operate with a slightly different way of enforcing the code, which may be adding to the confusion.  She added her staff has many concerns about the continued out-of-temperature violations and the lack of response to Board of Health Orders.  Orders were delivered to the owner on October 7th, at which time EH staff met with the owner, his accountant, and David Park.  At the time of the meeting they indicated they were bringing a person with more food expertise/code knowledge from one of their restaurants in New York City to assist with this restaurant; they anticipate his arrival in about 10 days.         

Jessie Pollack, Cashier for Greene Café, came before the Board today to advise them that since their last meeting with EH staff, the temperature logs have been kept on a consistent basis.  She also stated they had applied for a food waiver which would allow them to have prepared food (at the correct temperature) set out for a three-hour period and if there is any food remaining at the end of the three hours, it needs to be replaced.  Mrs. Cameron stated at this time Green Café has not yet applied for the waiver, adding that may be one of the areas where they are experiencing language difficulties.  Mrs. Cameron stated both she and Mrs. Chase had told Mr. Park they would not support a waiver until he can show that they are maintaining their food temperatures.  Ms. Pollack stated Mr. Park would like to postpone any further action until their new manager arrives. 

Dr. Tyler moved to accept the resolution as written, seconded by Mr. Stevenson.  Mr. Greenhouse stated he thought it would be beneficial to have two management staff members or a cook and management staff member required to attend and successfully complete a Serv-Safe Course rather than one as stated in the BOH Orders.  This would provide more opportunity for someone to be on site who has been trained.  Mrs. Chase reported that she has contacted Cornell to see if they have any students who would be interested to work as an intern as part of their course work with helping the staff conform with some of the requests EH staff have made.

Mrs. Cameron had two minor edits to make to the Draft Resolution: Page 2, #4) – remove bottom bullet – “a summary of times when food was out of temperature and corrective actions taken.”  Based on communication issues, Mrs. Cameron felt this was too much to ask of staff at this time, adding that this information can be obtained from the temperature logs.  Also, Page 2, #6) – change to read as follows: “Pay a penalty of $2500 for these violations of the New York State Sanitary Code…..”   

Mr. Greenhouse offered another edit, Page 2, #5) – delete “Understand that” in the beginning of the sentence.  Then take the rest of the sentence in #5) and add it under #6) so that #6 now becomes #5 and reads as follows: “Pay a penalty of $2500 for these violations of the New York State Sanitary Code and Board of Health Orders of September 8, 2009, following a Board of Health Resolution. (do not submit penalty until notified by the Tompkins County Health Department)  If Critical Item Violations continue to occur and/or temperature log/s are not maintained and available during hours of operation that the Division will recommend that your Food Service Establishment Permit to Operate be revoked.  It was also recommended that on the Staff Training form, in the first sentence the words “hereby swear that I” be eliminated.

Draft Resolution, as amended, passed unanimously.

Approval of Revised Policy: Rabies Post-Exposure Vaccination Policy:

Mr. Greenhouse moved to accept the Revised Rabies Post-Exposure Vaccination Policy as written, seconded by Dr. Snedeker, and carried by a unanimous voice vote.

Approval of New Policy: 2009 H1N1 Influenza Vaccine Policy:

Dr. Snedeker moved to accept the policy as written, seconded by Mr. Greenhouse, and carried by a unanimous voice vote.

Approval of Revised Employee Health Program Procedure:

Mrs. Cole announced that this procedure had been previously approved.  The reason for this revision is that healthcare workers in the Health Department are now mandated by New York State Law to have available flu vaccine shots.

Dr. Snedeker moved to accept the Employee Health Program Procedure as revised, seconded by Mr. McLaughlin, and carried by a unanimous voice vote.

For Discussion:

Open Burning in Freeville – Request to speak to the Board:

Mrs. Cameron made reference to the memo included in the original BOH packet where open burning has been an issue in Freeville for several years.  There has been much success bringing residents into compliance in part due to an effective educational approach, however there are some residents who defy the regulations and continue to burn.  One of the Freeville residents has requested to come and address the Board because he feels he has a right to burn garbage and would like to see the Sanitary Code changed.  Mrs. Cameron stated she has also been contacted by another resident who is interested in more enforcement of the burning regulations in Freeville and is willing to come before the Board to state her case.  Mrs. Cole stated currently the Board of Health does not have a formal “Privilege of the Floor” and she has received some criticism that this is not offered to the public.

Mrs. Cameron added the NYSDEC has released their revised open burning regulations so that it is now illegal to burn in a barrel state-wide as of October 14th.  Mrs. Cameron also stated that something the NYSDEC prohibits which is not in the Tompkins County Sanitary Code is the burning of agricultural plastics.  She stated she will be looking at revising the local Sanitary Code to make it more consistent with the NYSDEC regulations.  Currently, Environmental Health staff can enforce local Sanitary Code regulations; however staff cannot enforce the NYSDEC law.  Those complaints would need to be referred to the DEC. 

Following a discussion amongst Board members and staff regarding the local Sanitary Code, NYSDEC, burning regulations, compliance and enforcement, and privilege of the floor, it was decided to invite both speakers to an upcoming BOH meeting and limit their floor time to three minutes per person.  We will add a “Privilege of the Floor” section to the agenda for future meetings. 

Adjournment:

Dr. Tyler moved to adjourn the meeting at 2:25 P.M.; carried unanimously.