Board of Health

Meeting Minutes
February 9, 2010

12:00 Noon
Rice Conference Room

Present:	Mr. Brooke Greenhouse; Dr. James Macmillan, President; Mr. Michael McLaughlin, Jr.; Ms. Janet Morgan; 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; and Mrs. Patty Stamm, Administrative Assistant
Guests:	Gina Giambattista-Cesari, City Health Club; Tammy Rochford, Owner, Lou’s Carry Out; Steven Kern, Sr. Public Health Sanitarian; and Carol Chase, Sr. Public Health Sanitarian
Excused:	Mr. Frank Proto
Absent:	Mr. Jonathan Wood, County Attorney

 

Dr. Macmillan called the regular meeting of the Board of Health to order at 12:09 P.M.

Privilege of the Floor: 

No one was present to speak for Privilege of the Floor.

Approval of Minutes: 

Mr. Greenhouse moved to approve the minutes of the January 12, 2010 Board of Health meeting as written; seconded by Ms. Morgan. 

Mr. Greenhouse requested a correction on Pg. 5. The first sentence in the first paragraph should read as follows: “Following a short discussion regarding the best plan of action, it was decided to move forward with interviewing physician applicants.”    

The minutes, as amended, were approved unanimously.

Financial Summary: 

Mrs. Grinnell Crosby reported there was no financial summary for this month.  She added they were still filing 4th quarter claims, including the final 4th quarter State Aid claim. 

She gave a brief update on the fall deficit reduction plan, highlighting that the Immunization Action Plan Grant, as well as the Tobacco (Community Partnership) Grant will not be cut.  The only cut, at this point, is a $19,000 cut which was taken from the Water Grant.

Administration Report: 

Mrs. Cole:

• Passed around an information sheet regarding the Governor’s proposed budget, adding there are some significant proposed cuts for Certified Home Health Agencies (CHHA).  She stated this will have a significant impact on our Home Care Program and added that if anyone is interested in lobbying State Assembly members or Senators, the Home Care Association has shared some talking points.  Mrs. Cole also stated they are working with the state organization, NYSACHO, to oppose these cuts.

Medical Director’s Report:

Dr. Klepack requested a change to his February BOH report.  Under “Comment” in his Tuberculosis Update, the sentence should be changed to read as follows: “Overall, controlling the importation of tuberculosis is a major burden for public health.”

Dr. Klepack stated currently H1N1 is still “smoldering” without any major burden on the health care system.  He discussed the fact that Cayuga Medical Center, as part of their annual report, plans to feature the community coordination surrounding H1N1.  In an interview with Cayuga Medical Center, where Dr. Klepack spoke on behalf of the Health Department, he spoke about the importance of clear, accurate, and honest public health information and the difficulty in updating that information and keeping it current so that it doesn’t appear the Health Department is contradicting its messages.  Dr. Klepack added the CDC is currently predicting there will be a third wave of H1N1 later this year, which is the driver behind continuing the recommendation that people get the H1N1 vaccine. 

Dr. Klepack also spoke briefly about individuals, some sick, as well as orphans, being transferred out of Haiti.  He added that Ithaca is a community where people are often brought in from other countries, i.e. adopted or fostered.  He spoke about the high rates for tuberculosis and infectious diseases in people coming out of Haiti and the possibility of less than adequate screening for these individuals.  Mrs. Connors stated that, to date, they have seen one child with no vaccination history who needed vaccinations. 

Dr. Klepack announced an upcoming forum regarding public health and Marcellus Shale which he will be moderating.  This open forum will be held on Tuesday, February 23rd, 7:00 P.M., at TC3.  Dr. Klepack pointed out he will be using his title as Medical Director at the forum and in publications; however, the Health Department will not be portrayed in any way as a director sponsor of this forum.  He added he felt the speakers would seek to only share information to the extent that it serves the public good and, as moderator, Dr. Klepack plans to help set the tone of that.

Division for Community Health:

Mrs. Connors announced:

• To date, staff has immunized 7,562 individuals for H1N1.
• There is still plenty of vaccine available.  Large quantities of vaccine have been accepted from local providers and then redistributed to requesting providers within the county, but most of it has been picked up by the State Health Department since we do not have the capacity to store large quantities.
• The Health Department will continue to vaccinate through the month of February and then will reevaluate during the last week in February to see if there is a need to continue vaccinating into March.
• To date, they have not heard from the State regarding the Plan of Correction for the CHHA Statement of Deficiencies.  She added the State generally calls if they have any questions regarding the Plan of Correction and this hasn’t happened yet, which she feels is good news. 

Children with Special Care Needs:

Mrs. Allinger reported:

• A nursing student from Upstate Medical Center through Cayuga Medical Center will be doing a 45-day clinical rotation in the CSCN Program.  They will have a nursing student from TC3 for a 3-week rotation at some point this spring.
• NYS has proposed 31 pages of projected regulatory changes to the Early Intervention Program for this budget year which will have a significant impact if everything is passed.  There is a six-week public comment period which ends on March 8th.  Mrs. Allinger added that almost every policy and form will have to be amended in some way.  Staff is currently in the process of reviewing and commenting on the proposed changes. 
• There are some significant proposals in the Governor’s Executive Budget regarding the way the Early Intervention Program and Preschool Special Education Program are funded.  These are listed under the mandate relief for local government.  If passed, these proposals will have a significant impact on the way these programs are run.   
• They have been alerted there will be rate changes for all of their services, effective April 1st.  Mrs. Allinger added they will not know what the rate changes will be until the end of February.  She did state that she knows the rates will decrease for all of their contract service providers; however the rates for service coordination, evaluations, facility-based services, group services, and parent-child education will be increasing.  She stated it appears there will be a shift in how early intervention services are delivered in NYS by moving towards more facility-based services.  Transportation needs to be provided for each baby-toddler-child that goes to a facility.  Also, Mrs. Allinger stated there are not enough available facilities, such as in larger cities.  She added during this past year she worked hard to cut back on facility-based services to save almost $100,000 in transportation costs in Early Intervention and now it might all come back and cost even more than before. 
• One of their clients is a two-year old toddler with Cerebral Palsy with an above-average cognitive ability.  This toddler is now reading and spelling through the ability of augmented communication devices.  One particular device – the Dynvox is being explored through Ithaca College where they have recently hired someone who is an expert in this area.     
• The Franziska Racker Centers and TC3 are sponsoring an autism resource fair on Tuesday, February 23rd.  The CSCN Division will be one of the presenters at the resource fair.
• They received a report from the NYSDOH regarding federal indicators.  As previously mentioned, Mrs. Allinger stated they have struggled with several of the indicators due to the lack of agency support in terms of available evaluators or enough providers.  She will share this report with Board members in her next BOH report.  Mrs. Allinger stated she has a call into the NYSDOH to see exactly what data they used to arrive at these numbers.  She added her program continues to improve all of the time; however they can’t make the indicators because they need additional evaluators and therapists in the county. 
• Mr. McLaughlin suggested that the Board, as representatives of the public, make some sort of statement regarding the proposed regulatory changes during the public comment period.   Dr. Macmillan requested that Mrs. Allinger present an executive summary to Board members of the proposed regulatory changes and how these changes might impact the Early Intervention and Preschool Special Education Programs.  This would help Board members decide if a statement from them would be useful or not.    

County Attorney’s Report:  

Mr. Wood was absent from today’s meeting, so there was no report.

Environmental Health Report: 

Mrs. Cameron reported:

• W. Danby has a leak in their water supply system, leaving the community without water.  The City of Ithaca has leak detector equipment and is currently trying to help W. Danby find the leak. 
• Steve Maybee, Rick Ewald, and Mrs. Cameron met with representatives from the Ulysses Town Board and Cayuga Lake Inter-municipal Watershed on February 8th regarding Ulysses’ interest in implementing a sewage system inspection program.
• As a reminder, the unwanted medications disposal day is Saturday, March 6th.  

Approval of candidate for consumer vacancy:

Mr. Greenhouse reported they have one more upcoming interview for the physician seat.  He added after reviewing all of the applicants for the consumer seat, there was one outstanding candidate, whom they would like to recommend, Patrick McKee.  Mr. Greenhouse confirmed that Mr. McKee is interested in this position.  This recommendation will go the Health and Human Services Committee and then on to the full Legislature.  Mrs. Cole added that Mr. McKee is the Director of Challenge Industries, holds a Masters Degree in Public Health, and is very interested in serving on the Board of Health.           

Mr. Greenhouse moved to appoint Mr. Patrick McKee to the Board of Health Consumer Seat, seconded by Mr. McLaughlin, and carried by a unanimous voice vote.

Approval for revisions to the Rabies Post-Exposure Vaccination Authorization, Billing, & Documentation Procedure:

Mr. Greenhouse moved to accept the revisions to the Rabies Post-Exposure Vaccination Authorization, Billing, & Documentation Procedure as submitted; seconded by Dr. Tyler, and carried by a unanimous voice vote. 

Carina Cesaro, Owner/Operator, City Health Club, C-Ithaca; Violation of Part 6-1 of the NYS Sanitary Code (Swimming Pools): 

Mrs. Cameron reviewed the fact that the spa pool was observed by her staff to be operational and available for patron use without a valid operating permit issued by the Health Department.  Staff called the City Health Club before the permit expired; told them the spa pool needed to be closed and someone would be out to check that this had been done.  When staff visited the City Health Club, the spa pool was operating without a valid permit.  Staff posted a closure notice by the spa pool.

Gina Giambattista-Cesari, representing the City Health Club, addressed the Board.  She stated she had been working with Skip Parr from the Environmental Health Division over the past year trying to get the pool recertified.  She explained there was a breakdown in communication between the desk staff at the City Health Club and herself.  Ms. Giambattista-Cesari said the failure to renew the permit was an issue of  financial planning, adding that two significant events around the holiday time had drastically affected their cash flow, so even though they planned to apply to renew their permit, they couldn’t meet the January 1st deadline.  She said not closing the Jacuzzi was an oversight.  Ms. Giambattista-Cesari added she had worked very hard with Mr. Parr during the previous year to come into compliance with the spa pool and would never have knowingly done anything to jeopardize that. 

Mrs. Cameron stated Mr. Parr did acknowledge that there appeared to be some miscommunication issues at the City Health Club.

At the request of Board members, Ms. Giambattista-Cesari tried to explain the timing and communication breakdown which resulted in the spa not being closed.  She stated that currently the spa remains closed while the City Health Club goes through a reorganization process, part of it having to do with leadership, management, and communications.        

Dr. Tyler moved to decrease the penalty to $200, seconded by Ms. Morgan.  Further discussion ensued resulting with Mr. Greenhouse offering an amendment to the Stipulation Agreement and Orders that a second item be added that the spa needs to remain closed until a permit is in place; seconded by Mr. McLaughlin.  Dr. Tyler was agreeable to the friendly amendment. 

Resolution, as amended, was carried unanimously.    

Tammy Rochford, Owner/Operator, Lou’s Carry Out, T-Groton; Violation of Part 14-21 of the NYS Sanitary Code (Food Service):

Mrs. Cameron reviewed the fact that Tammy Rochford failed to submit a complete Food Service Application for permit renewal and subsequently, on January 4th, was observed operating Lou’s Carry Out without a valid permit and continued to operate after notice of closure was posted at the facility.

Ms. Morgan moved to accept the resolution as written; seconded by Mr. Greenhouse. 

Mrs. Cameron stated that permit applications are sent out to anyone requiring a permit renewal for them to return.  In addition, when the permit application is not returned, her division takes extra effort to try to get the permit application returned. 

Ms. Rochford addressed Board members stating she received a phone call December 31st from Ms. Daum of the Environmental Health Division reminding her that her permit was going to expire that evening.  Ms. Rochford stated that she would be closed over the weekend.  According to Ms. Rochford, Ms. Daum told her to come to the Health Department at 8:30 Monday morning, January 4th, to take care of the permit application.  Mr. Rochford stated she thought it was OK to open her restaurant Monday morning, adding that when she arrived at the Health Department she did not have all of the required information.  She went back to the restaurant and was in the process of serving customers who were already there when Ms. Daum arrived at the restaurant and posted a notice of closure.  Ms. Rochford stated she was unaware that there was a problem with her Workers’ Comp Insurance.  She added she had a sick child and had not been at the restaurant or paying attention to the fact that her permit was going to run out.  A 60-day permit was issued on January 12th to allow Ms. Rochford time to obtain and submit acceptable Workers’ Compensation and Disability Insurance as part of a complete application for a Food Service Establishment permit.

Since some of the Board members expressed their confusion over the events of January 4th (the facility continued to operate without a permit, as well as remaining in operation after the closure notice was posted at the facility), Mrs. Cameron reminded them that the fine was for operating without a permit and not for whether they stayed open after the closure notice was posted at the facility.

Mr. McLaughlin offered an amendment to the draft resolution that the 3rd “WHEREAS” be deleted, suggesting that the complete statement appeared to suggest a declaration of defiance.  Ms. Morgan and Mr. Greenhouse were both agreeable to this friendly amendment.  Mr. McLaughlin offered a further amendment that the penalty be reduced to $200.  Ms. Morgan was also agreeable to this friendly amendment.  Mr. Greenhouse expressed his discomfort with this amendment, stating that he felt lowering the fine defeats the purpose of the penalty considering that the department was very willing to try to work with Mrs. Rochford.  Mrs. Morgan then withdrew her original motion.   

Mr. McLaughlin moved to accept the resolution with the following amendments: that the penalty be reduced to $200; and that the 3rd “WHEREAS” in the Draft Resolution be changed to read, “WHEREAS, on January 4, 2010, at 12:00 pm, the Tompkins County Health Department found a violation of Part 14-1 of the New York State Sanitary Code for operating Lou’s Carry Out without a permit;” seconded by Dr. Tyler. 

A voice vote on the resolution resulted as follows: Ayes – 4; Noes – 1 (Greenhouse). Resolution Adopted.

George Michelis, Owner/Operator, A-1 Pizzeria, T-Dryden; Violation of Part 14-1 of the NYS Sanitary Code (Food Service): 

Mr. Greenhouse moved to accept the resolution as written, seconded by Mr. McLaughlin.  Resolution carried by a unanimous voice vote.

 A lengthy discussion ensued between Board members and staff regarding establishments operating without a permit, as well as some of them continuing to operate after closure of notice being posted at the facility, particularly in this instance A-1 Pizzeria.     

Further discussion continued involving the Board’s consideration of reducing fines at the request of establishment representatives and thereby presenting the possibility of making staff feel undercut.  The option of increasing fines was also discussed. 

Adjournment: 

Mr. Greenhouse moved to adjourn the meeting at 2:12 P.M.; seconded by Mr. McLaughlin; and carried unanimously.

Reminder:

Board members should plan on coming to the current location for the March BOH meeting since the 55 Brown Road facility still isn’t ready for occupancy.