Board of Health

Meeting Minutes
November 10, 2009

12:00 Noon
Rice Conference Room

Present:	Mr. Brooke Greenhouse; Dr. James Macmillan, President; Mr. Michael McLaughlin, Jr.; Ms. Janet Morgan; 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; Mrs. Brenda Grinnell Crosby, Public Health Administrator; Dr. William Klepack, Medical Director; Mr. Jonathan Wood, County Attorney; and Mrs. Patty Stamm, Administrative Assistant
Guests:	Steven Kern, Sr. Public Health Sanitarian; Cindy Schulte, Public Health Sanitarian; Janice Koski, Public Health Sanitarian
Privilage of the Floor:	Robert Warfield; Cheryl Nelson; and Mary Warfield
Excused:	Dr. Francis Fox; Dr. Jeffrey Snedeker; and Mrs. Sigrid Connors, Director of Patient Services

 

Call to order

Dr. Tyler, briefly filling in for Dr. Macmillan, called the regular meeting of the Board of Health to order at 12:10 P.M.

Privilege of the Floor:

Robert Warfield, Cheryl Nelson, and Mary Warfield all spoke under Privilege of the Floor on the topic of open burning.  They each expressed their frustrations regarding the personal impact, as well as the health and environmental impacts.  In addition, each speaker offered personal suggestions that might help the situation. All of the speakers provided a copy of their statements which are available upon request. 

Approval of Minutes: 

Mr. Stevenson moved to approve the minutes of the October 13, 2009 Board of Health meeting, seconded by Mrs. Morgan, and carried unanimously.

Financial Summary: 

Mrs. Grinnell Crosby distributed the Financial Summary for October 2009, which is at about 83% of the year.  She reported that the costs for the Medical Examiner Mandate Program will exceed, if they haven’t already this month, the total budgeted amount.  Since this is a Class A Mandate, the County is required to pay those expenses.  Mrs. Grinnell Crosby added that she notified the County Administrator and the County Director of Finance in mid-October that there is a potential for this account to be from $25,000 to $50,000 over budget.  These expenses include autopsy expenses, as well as removals, and are reimbursable at approximately 36% from the State.

Mrs. Grinnell Crosby also commented that she is monitoring revenues in the Community Health Services Division.  Depending on the volume of work required responding to H1N1 clinics over the next couple of months, billing might tend to slide.   

Mrs. Grinnell Crosby reported that payment for Public Health Work Article VI funding for the period ending 12/08 was received on August 3rd and 4th of 2009.  The third quarter claim was recently filed, although no payment for 2009 services has been received as yet.  Further discussion ensued between staff and Board members regarding payment from Medicaid with regard to educational related programs, grant reimbursement, and Article VI State Aid funding.      

Administration Report: 

Mrs. Cole:

• Reported the Legislature expects to vote on the 2010 Budget next Tuesday, November 17th.  She added that some of the OTR’s have been proposed for funding.  Unfunded OTR’s are an Account Clerk Typist (ACT) in the CSCN Program, as well as the request for an Evaluation Team in CSCN.  Mrs. Cole expressed hope that maybe with last minute lobbying efforts the ACT position will be funded.  Mrs. Allinger discussed how the loss of the ACT position will affect her division.  She also discussed how the current economic situation has increased the demand for services from programs within her division.  As far as having an Evaluation Team in place, Mrs. Allinger stated that this team is specifically for the Early Intervention Program.  Mrs. Allinger discussed the fact that children in this program need to be evaluated in their natural environment, which means the team has to go into the child’s home.  Tompkins County only has one evaluation team for Early Intervention which is the Franziska Racker Centers.  She added they cannot meet the requirement of 45 days from point of entry to evaluate and write the Service Plan.  Mrs. Allinger stated she had informed members of the Legislature she is not meeting the regulatory requirement of 45 days.  She added the Director of the Bureau of Early Intervention in NYS is aware of this dilemma and steps that have been taken by Mrs. Allinger to mitigate this problem.  Mrs.  Allinger stated she had informed the Legislature the 4th year she is cited for not meeting this regulation, they will be fined.  Mrs. Allinger stated she can go one more year, 2010, without the Evaluation Team, however if she goes into 2011 without this team, there will be financial implications.  She added the team has been made cost neutral in terms of money they would bring in.  Mr. Stevenson stated Mrs. Cole, Mrs. Grinnell Crosby, Mrs. Allinger, and the entire Health Department staff made a good case to the Legislature for the addition of an Evaluation Team, but added that other departments made cases for people and equipment that were somewhat as compelling when Legislators were trying to look at the big picture.  He stated things that appear cost neutral on the surface sometimes aren’t for many reasons.  Mrs. Grinnell Crosby added currently the Evaluation Team is budget neutral on a piece of paper; but long-term it’s not, due to retirement expenses after someone leaves.  Further discussion ensued regarding contracting for an Evaluation Team and Mrs. Allinger reported she had pursued this avenue to no avail since private contractors did not feel the level of reimbursement was adequate for their time involved.
• Reported today was the first H1N1 school clinic at the Newfield School District.  She added they have initiated the Incident Command System and Mrs. Connors is the Incident Commander in charge of the Point of Distribution Clinic (POD); Ms. Lyczko is the Public Information Officer; and Adam Hartwig, the new BT Coordinator, is in charge of Logistics.  Mrs. Cole added they hope to continue weekly school clinics, depending on vaccine supply.  She stated they are not firming up clinics until they have the vaccine on hand. 
• Reported on the Diagnostic & Treatment Center survey.  A Corrective Action Plan was submitted for the one deficiency and this was accepted by the State.
• Reported that construction is about 99% completed at the new Brown Road facility.  Furniture is scheduled to start arriving shortly.  She stated there is a tentative December move in date.

Medical Director’s Report:

Dr. Klepack reported on a Pandemic Flu meeting he attended this morning.  In attendance were representatives from CMC, Cornell University, Ithaca College, as well as the Medical Staff President of CMC.  He reported currently the H1N1 is the only influenza strain circulating with the exception of one or two cases of seasonal flu reported around the State.  Dr. Klepack stated in late-September/early-October, Cornell was dealing with 300+ calls/contacts per day; that number dropped down to around 150 calls for a number of days and continues to drop.  Currently they are dealing with approximately 25 calls per day of influenza-like illness.  Ithaca College, with a much smaller population, reports having only 2-3 calls per day regarding influenza-like illnesses.  Medical offices have seen a bit of an upswing over the last week or two with influenza-like illnesses.  Convenient Care Centers reported a 28% increase in September over the usual volume of care delivered; about a 15% increase noted in the Emergency Room.  They anticipate higher data for October as compared to previous years. 

Dr. Klepack expressed and discussed concerns he had regarding seasonal flu vaccine delivery.  One concern is that there will be a lower vaccination rate for seasonal influenza due to the delayed vaccine delivery.  Another concern is that the H1N1 virus could collide with the seasonal flu virus. 

Dr. Klepack reported there have been no adverse reactions out of the ordinary for the H1N1 vaccine, which is important for the public to know.  A short discussion ensued regarding nasal mist vs. injectable vaccine.  Also discussed was the fact that pharmacies were receiving large doses of the seasonal flu vaccine when health care entities were not; also discussed was the fact that the CDC, through some glitch, starting sending H1N1 to pharmacies prior to health departments.

Division for Community Health: 

Mrs. Cole stated there was nothing to add to Mrs. Connors’ report.  She addressed questions from Board members relating to items in Mrs. Connors’ report: (1) Hoarding; (2) State mandate for health care workers for seasonal flu and H1N1 vaccine; and (3) the necessity for Board members to receive the level of detail for TB cases. 

Children with Special Care Needs:

Mrs. Allinger reported:

• The Children with Special Care Needs Early Intervention Administration Grant Annual Report will be included in the December report.
• 125+ children in the program in 2009.
• Discussed the need for the Account Clerk Typist (ACT) position currently out as an OTR.
• Discussed the OTR requested Evaluation Team.

County Attorney’s Report:

Mr. Wood stated he had nothing to report.

Environmental Health Report:

Mrs. Cameron:

• Reported that today her staff will be meeting with a representative from the NYSDEC, Cortland Office, who handles open burning complaints. 
• Reported that Environmental Health staff, along with a NYSDEC representative, will be meeting with local fire chiefs on November 19th to discuss their respective programs. 

Formation of Nominating Committee:

Dr. Macmillan asked for volunteers to form the Nominating Committee.  Mr. Greenhouse offered to Chair the committee and Mr. McLaughlin offered to assist Mr. Greenhouse.  Dr. Macmillan stated he would be available for guidance if needed.   

Mrs. Cole stated there would be three vacancies for the upcoming year: (1) Mr. Stevenson (County Legislature) - this slot will be appointed by the Chair of the Legislature; (2) Dr. Snedeker (Physician Member) - who does not plan to return to the Board; and (3) Dr. Fox (Consumer Member) - his term is up and he has already served two terms - a waiver would be required from the full Legislature for him to continue to serve on the Board.  Dr. Fox is willing to stay on, but would not feel bad if his term is not renewed.

Mrs. Cole advised Board members if they knew of anyone who was interested in sitting on the Board to encourage them to apply.  She has applications forms, as well as a write up about the Board of Health.  Dr. Macmillan stated he might have an interested physician for that particular slot.  Mrs. Cole added they still had potential candidates from the applicants who were interviewed at the time of Mrs. Morgan’s appointment to the Board.  Mr. Stevenson made the suggestion that for the “Consumer” seat, the Nominating Committee not just look at past applicants.   

Following a short discussion between staff and Board members regarding upcoming vacancies, it was decided that the Nominating Committee would seek new applicants, as well as reviewing the list of former applicants, and propose a Slate of Officers for 2010.

Approval of Proposed Resolution:

Authorization to ‘Declare 2010 the International Year of the Nurse in Tompkins County’ and to support a proposal to the United Nations to ‘Declare 2011 to 2020 the United Nations Decade for a Healthy World’:

Mrs. Cole stated that Deb DiBartolo, Tompkins County Jail Nurse, wanted to be at today’s meeting to present this proposed resolution, but was unable to attend. 

Dr. Tyler moved to approve the proposed resolution, seconded by Mr. Stevenson, and carried by a unanimous voice vote.

Proposed change to 2010 fees – for approval:

Mrs. Cameron reported she was not present when the proposed fees for 2010 were adopted.  She asked the Board to consider increasing permit fees for sewage system replacements from $80 to $100 for 2010.  She added this would not have an impact on calculated revenue for the Division.

Mr. Greenhouse moved to accept the proposed resolution, seconded by Dr. Tyler, and carried by a unanimous voice vote.

Resolution Regarding the Draft Supplement Generic Environmental Impact Statement on Gas Drilling in the Marcellus Shale Formation:

Mrs. Cameron stated the gas drilling resolution was prepared in a very short time frame.  The day after this resolution was submitted, the DEC gave a 30-day extension for submitting comments.  Mrs. Cameron asked permission of the Board to withdraw the current resolution and bring a revised resolution back to the Board at the December meeting when they are able to address the issues more thoroughly. 

Mrs. Cameron pointed out key issues that have been identified so far with the gas drilling: (1) “Flow back” water is the water that comes back to the surface after fluid has been injected into the ground (between 5% and 30% comes back).  The proposal for this water is that it goes to publicly owned treatment plants if the plants have approval.  Mrs. Cameron stated publicly owned treatment plants do not have the processes or approvals to treat this fluid and so this should not be allowed; there should be specific treatment plants constructed by the gas companies and permitted by the DEC. This will be one of the main comments that her staff will be addressing. (2) Centralized surface impoundment –this happens when there are several gas drilling well pads and they are all bringing this fluid up and it’s taken to a central impoundment which can be as large as 4 acres.  Mrs. Cameron stated this also does not seem to be a good idea since there are air emissions, water concerns, monitoring concerns.  (3) It will be required that private water wells in the vicinity of a gas well be tested for water quality concerns.  Mrs. Cameron stated her staff would like to see actual monitoring wells installed so that ground water contamination can be determined before reaching individual wells.  She expressed additional concern because local health departments are being earmarked as the key reviewers of this information which has a lot of resource implications for her Division. 

Mrs. Cameron stated yesterday staff had a conference call with NYSDOH about this.  She added the State is proposing a program where they would handle complaints that are specific to gas drilling waste.  However, all of these wells would be required to be tested and would be tested for coliform.  Mrs. Cameron expressed her concern that in other counties where wells are being tested, their basic complaint workload is increasing to a point where it’s difficult to handle just basic bacteriological well water quality.  She added that with gas drilling there is not a reason to test for coliform.

A short discussion ensued between staff and Board members regarding gas drilling, testing of wells, water quality issue, and funding issues. 

Mrs. Cameron concluded by stating she planned to bring back a revised resolution to the Board that addresses the general issue and then submit detailed comments from the Division/Health Department.  She added if the Board desired, she would bring back detailed comments for their review.  Dr. Macmillan stated he felt Board members were more interested in a general resolution.  He added that any Board member who was interested in additional details should approach Mrs. Cameron independently

Adjourn to Executive Session:

Mrs. Morgan moved to adjourn to Executive Session to discuss a personnel issue at 1:46 P.M.; carried unanimously.

Out of Executive Session:

Executive Session was adjourned at 1:53 P.M.

Adjournment: 

Dr. Macmillan moved to adjourn the meeting at 1:55 P.M.; carried unanimously.