Board of Health

Meeting Minutes
December 8, 2009

12:00 Noon
Rice Conference Room

Present:	Dr. Francis Fox; 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; Mrs. Sigrid Connors, Director of Patient Service; 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; Carol Chase, Sr. Public Health Sanitarian; and Dr. Jamie Loehr, MD, Cayuga Family Medicine

 

Call to order:

Dr. Macmillan called the regular meeting of the Board of Health to order at 12:10 P.M.

Privilege of the Floor: 

No one was present for Privilege of the Floor.

Approval of Minutes: 

Mrs. Morgan moved to approve the minutes of the November 10, 2009 Board of Health meeting as written; carried unanimously.

Financial Summary: 

Mrs. Grinnell Crosby distributed the Financial Summary for November 2009, which is at about 92% of the year.  She reported that Home Care has exceeded their projected revenues for this year.  She added this will help since billing is somewhat behind in Community Health Services (CHS) due to H1N1 clinics.  The Medical Examiner Mandate Program has exceeded the total budgeted amount for this year and costs continue to go up.  Regarding the State Budget, a 12.5% cut is being projected in un-dispersed funds as of November 1st in some categorical grants, i.e. water grant and potentially WIC, immunization, and lead.  Mrs. Grinnell Crosby stated at this time they have not heard which grants will be impacted, however she projected potential cuts will be at around $131,500, with this figure subject to change as she gets more information from the State.

Payment for Public Health Work (Article VI funding) for 2009 has not been made by New York State. Mrs. Grinnell Crosby reported that through three-quarters of 2009 the State of New York owes the Health Department $1,110,050.35.  She added the good news is we do not anticipate the 12.5% cut in Article VI funding.

Administration Report: 

Mrs. Cole:

• Announced she would be retiring at the end of June, 2010.  Since Mrs. Cole’s position is an appointment of the County Administrator, Mr. Mareane will be forming a search committee to find her replacement.  Board members offered their congratulations.

Medical Director’s Report:

Dr. Klepack discussed tobacco control programs which have also taken a cut in funding due to State cutbacks.  He pointed out that monies from the Tobacco Settlement Grant have been used for various state-wide functions and not always public health.

Dr. Klepack also discussed flu vaccinations.  He mentioned his office had recently received a shipment of seasonal flu vaccine, however was advised there would not be any opportunity to order additional seasonal flu for this season.  Dr. Klepack stated this would limit the extent to which the local population can be vaccinated; he felt this would be somewhat the same situation for most practitioners.  Dr. Snedeker suggested that one of the reasons for this could be the conversion of some of the manufacturing facilities over to the production of H1N1 vaccine.

Mrs. Cole announced the Health Department would be receiving an additional supply of the seasonal flu vaccine; however she was unsure of what the allotment would be.  She added that as soon as they receive this vaccine, they will send out a blast-fax to the local physicians advising them the Health Department has a supply of seasonal flu vaccine for redistribution at the request of the physician.

Division for Community Health:

Mrs. Connors:

• Reported on the Newfield Central School District POD (Point of Dispensing) on November 10th.  It was the Health Department’s first H1N1 clinic for schools.  Mrs. Connors thanked the Children with Special Care Needs Program, Environmental Health, Planning and Coordination, the Ithaca Rotary Club, and the staff of Newfield Central School for helping to make the clinic such a success.  498 children were vaccinated at an average of 120 students an hour.  Mrs. Connors stated currently their vaccination rates (when fully staffed) are up to about 180 students per hour.  Mrs. Connors added that under the BT deliverables, they are required to hold one POD clinic in the grant year using full incident command mode. 
• Reported that H1N1 clinics are continuing to be held almost every day.  They have vaccinated 3,000 total including children, health care workers, and other persons in the priority groups.  She added they are going to as many of the schools as possible.  Mrs. Connors reported that staff is doing a great job.  She also added they really appreciate all of the help that internal staff has provided in order to help CHS staff focus on their objective.  Planning for these clinics is done pretty much on a daily basis since they do not know how much vaccine they will be receiving and when.
• Reported the Home Care Program is converting to a new OASIS-C document on January 1, 2010.  Every Certified Home Care Agency in the country has to be using this as of January 1st.  It’s an assessment every client is asked on admission and upon discharge.  A measurement is then taken on the difference between admission and discharge.  The OASIS-C document has lots of formulas in it that will then be translated into how much the Health Department will get paid for that work which is called Pay for Performance.  The better you do, the more you get paid.  This will also be tied to quality measures which will expand the quality measures that the public will be able to see.  Mrs. Connors stated it will require approximately 35 hours work time for the Systems Analyst to update the computer system to this new program between now and January 1st.  It will take as much time for the clerical staff as well.   

Children with Special Care Needs:

Mrs. Allinger stated she had nothing to add to her written report.

County Attorney’s Report:

Mr. Wood stated he had nothing to report. 

Mr. Wood did recommend that, in light of Mrs. Cole’s announced retirement, the Board might want to think about what role they would like to play in the selection of the next Public Health Director and then communicate this as soon as possible to the County Administrator. 

Environmental Health Report:

Mrs. Cameron:

• Reported Dr. Klepack received a call yesterday from the Director of Emergency Services at Cayuga Medical Center that approximately six students from the Beverly J. Martin School had been admitted to CMC for facial and oral burning and swelling.  All students were subsequently discharged.  The only thing in common was they all had eaten kiwi about an hour prior to admission.  Dr. Uphoff was made aware of the incident and went to the school to check out students experiencing a reaction and diagnosed that there was an allergic reaction to the kiwi.  Also, about 20 students were seen by the school nurse that weren’t included in the group seen at the hospital with the allergic reaction.  Mrs. Cameron reported her Division has been investigating this incident. 
  
  Mrs. Chase stated they had received the official diagnosis from the Emergency Department at the hospital and there appeared to be some irritation of the mouth and mucosa, probably from a food that was ingested.  However, there was no specific food noted.  Mrs. Chase added there is an enzyme in kiwi which will cause a mild allergic reaction or response (one child had hives).  Dr. Uphoff felt the symptoms the students were experiencing were from an allergic reaction to the enzymes in the kiwi.  Mrs. Chase added the reactions occurred within five minutes to half an hour after eating and lasted for one to two hours.  Dr. Klepack reported that Dr. Richard Murray saw eight students in the Emergency Room (which may have been another set of students) with no findings. 
  
  Mrs. Chase reported the head of dining for the Ithaca City School District is checking with all of the other elementary school dining units to see if any other children came to the nurse’s office with similar complaints.  She added over 1,000 students were served the fruit at lunchtime.  Mrs. Chase also reported one of the eight students who went to the Emergency Department experiences multiple food allergies.   

Appreciation Ceremony: Dr. Francis Fox, Dr. Jeffrey Snedeker, and Greg Stevenson:

Mrs. Cole first thanked all of the Board members for volunteering their time throughout the year.  She then expressed gratitude to those departing members of the Board: Mr. Greg Stevenson for two years of service; Dr. Jeffrey Snedeker for 10 years of service; and Dr. Francis Fox for 24 years of service.  All three Board members were presented with Certificates of Appreciation and Dr. Fox was also presented with a gift card from Wegman’s, as well as a standing ovation from those present at the meeting.

Report from Nominating Committee – Selection of Officers and filing of vacancies:

Mrs. Cole reported the vacancies have been posted on the County Website and the Human Services List Serve.  She added she has received several phone calls, but at this point has received only one actual application.  It was determined a deadline of December 31, 2009 would be set for submitting applications.  Dr. Macmillan offered to work with Mr. Greenhouse and Mr. McLaughlin in the selection process for the vacant seats on the Board.    

Mrs. Cole stated she has indicated to the County Administrator that filling the Legislative position on the Board needs to be a priority item due to quorum issues.  Mrs. Cole reminded the five remaining Board members to call Patty if they would not be able to make a meeting since the meeting would have to be cancelled if a quorum was not present.

Revision of Board of Health Bylaws:

Mrs. Cole stated the Bylaws are generally reviewed on a yearly basis.  Following the survey for the Diagnostic and Treatment Center earlier this year, the Health Department was advised that Dr. Klepack needed to be re-credentialed every two years.  In light of this, Mrs. Cole suggested that on pg. 4 of the Bylaws, Section VIII. Medical Director, Section 8.00, the first sentence should be changed to read as follows: “There shall be a Medical Director who shall be appointed every two years by the Public Health Director with confirmation by the Board of Health.” Mrs. Cole reported she has received credentialing materials on Dr. Klepack from Cayuga Medical Center so she plans to bring this forward to this Board for their approval at the January 2010 meeting , which will be good for two years. 

Mrs. Connors said she had some proposed changes; however they needed to go through the Professional Advisory Board (PAC) before being brought before the Board of Health. 

Dr. Tyler felt that Section 7.00 under VII. Public Health Director needed to be reworded.  After some discussion, it was decided that sentence should read as follows: “The Board shall advise the County Administrator on the selection of a Public Health Director as provided in Section 356 of the Public Health Law, and pursuant to the Tompkins County Charter Section C-9.00, whose duties are set forth in Section C-9.01.”  Mrs. Cole will check the charter and the law to make sure this wording is appropriate. 

Mrs. Cole asked Board members to contact her with any other suggested changes or comments and stated she would bring back a revised draft in January for the Board’s approval. 

Approval of Revised Alternative Signature Policy:

Dr. Tyler moved to accept the revised policy with the following edits; seconded by Mr. Greenhouse:

• B. Definition, #1, c. — change to ‘Secure Electronic Computer Transmissions.’
• C. Acceptability, #2 — add to end of sentence (ex: completion of Physician Signature Attestation [Attachment A]. 
• C, #3, b. — change to ‘Secure electronic computer entries in place of hard copy records is acceptable if:’
• Attachment statement changed to ‘Physician Signature Attestation’
• Attachment statement changed to ‘I attest that the signature below represents my authorized signature.’

Policy, as amended, was unanimously approved.

Violation of Part 14-1 of the NYS Sanitary Code (Food Service Violation):

Issam Chafee, Owner/Operator, Sammy’s Italian Buffet, C-Ithaca;

Ms. Morgan moved to accept the resolution as written, seconded by Dr. Snedeker, and carried by a unanimous voice vote. 

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

Mrs. Cameron stated that two resolutions on the Draft Supplemental Generic Environmental Impact Statement (GEIS) were included in the Board of Health packets – one (on Health Department letterhead) for the Board to review and approve, and the other one (replaced at today’s meeting with a more updated version) was included as a FYI as a resolution being prepared which compiles all of the comments from the Tompkins County departments and advisory councils that have been actively involved.  This last resolution will go to the Health and Human Services Committee, then on to the Planning, Development and Environmental Quality Committee, and lastly on to the Legislature for approval and submission to the NYSDEC.  Mrs. Cameron stated there would be some additional language added to the resolution coming from the Legislature.  She pointed out that the resolution going before the Legislature was broader in scope than the Health Department draft resolution.  The resolution coming from the Health Department focuses on water resource and public health issues.  Since last month, the language has been expanded and refined, but the main points are still the same: (1) a concern with the role of the local health department in responding to the water wells that are proposed to be tested around natural gas wells; (2) a concern with the disposal of the flow back water; (3) proposing that the use of centralized surface impoundments be prohibited.

Ms. Morgan moved to accept the Board of Health resolution regarding gas drilling in the Marcellus Shale Formation as written, seconded by Dr. Snedeker.

Mrs. Cameron stated she had some minor wording edits to be made to the resolution:

• pg. 1, 10th Whereas, - change Publically to Publicly
• pg. 2, Therefore Be it Resolved, etc., #3. – change to ‘That covered tanks rather than centralized surface impoundments be required for storage of flowback water, and’
• Mrs. Cameron also asked for the Board’s consideration regarding the distribution list for the resolution.  She stated she would like to use the expanded distribution list that is being used for the proposed Tompkins County Legislature resolution.  It was proposed that this expanded list be referenced as ‘Attachment A.’

Additional edits recommended by Board members and staff were:

• Pg. 2 under ‘Therefore Be it Resolved….’.  This sentence will now read – ‘Resolved, on recommendation of the Tompkins County Board of Health, That:’ 
• Other recommended edits on page 2 were the removal of “That” in #3, #6, #7, #8, and #9 under ‘Resolved,…’
• Pg. 2, #2 – change to ‘Fees from the permit holder be used to provide full funding to local health departments for responding to water quality issues resulting from the testing conducted near gas wells, and’
• Pg. 2, #1 - change ground water to groundwater
• Pg. 2, #4 – change waste water to wastewater

Resolution, as amended, was unanimously approved.

Announcement

Mrs. Cole announced that the 55 Brown Road facility isn’t ready for occupancy just yet, so advised Board members to plan on coming to the current location for the January BOH meeting. 

Adjournment: 

Dr. Snedeker, as his last action on the Board of Health, moved to adjourn the meeting at 1:30 P.M.; carried unanimously.