CATTARAUGUS COUNTY BOARD OF HEALTH PublicHea1th Prevent. Promote. Protect. 1 Leo Moss Drive, Olean, NY 14760, Tel. (716) 373-8050, Fax (716) 701-3737 Established 1923 Andrew Klaczynski, MD, President Joseph Bohan, MD, Vice-President Giles Hamlin, MD Joseph Eade Sondra Fox, RN Richard Haberer James Lapey Georgina Paul, FNP MINUTES James Snyder August 1,2012 The 80ih meeting of the Cattaraugus County Board of Health was held at St. Bonaventure Clubhouse Restaurant, Route 417, Allegany, N ew York on August 1, 2012. The following members were present: Andrew Klaczynski, MD Richard Haberer Joseph Bohan, MD James Lapey Joseph Eade Georgina Paul, FNP Sondra Fox, RN James Snyder Also present were: Kevin D. Watkins, MD, MPH, Public Health Director Thomas Brady, County Attomey Paula Stockman, County Legislator Linda Edstrom, County Legislator Susan Labuhn, County Legislator Gilbert Witte, MD, Medical Director Karen Manners, Secretary to Public Health Director Henry Storch, MD, Clinic Physician Eric Wohlers, Environmental Health Director Raymond Jordan, Sr. Sanitarian Susan Andrews, Director of Patient Services Rick Miller, Olean Times Herald The meeting was called to order by Dr. Klaczynski. The roll was called and a quorum declared. Mr. Eade made a motion to approve the minutes of the June 6, 2012 Board of Health meeting. It was seconded by Dr. Bohan and unanimously approved. Director's Report: Dr. Watkins welcomed Dr. Storch to the meeting. Dr. Storch recently retired from the Olean Medical Group and has offered his expertise to the Health Department. He completed his residency at Charity Hospital in Louisiana and his cardiology fellowship at the University of Florida in Gainesville and served as the Chief Medical Officer in the Army in Oklahoma City, Oklahoma. He also had private practices in Jacksonville, Florida; Sanford, Maine; and Olean from 1986 until he retired this year. He is the recipient of multiple awards and it is a Cattaraugus County Board of Health Meeting August 1,2012 Page Two pleasure to have him at the Health Department. Dr. Watkins stated that the Health Department is applying for a Community Transformation Grant which will implement changes within our community to reduce childhood obesity. Obesity among children and adolescents has tripled over the past three decades and currently a third of children in New York are obese/overweight. This grant is sponsored by the Centers for Disease Control and Prevention (CDC). New York State Department of Health will be the lead applicant and Cattaraugus County Health Department along with Chautauqua and Broome County Health Departments have been asked by the State to participate in this joint application process. The changes that will be implemented will be to increase physical activity in early child care and school settings, increase early child care center nutritional programs, restrict the sale of sugar sweetened beverages in schools and municipal buildings, restrict the use of tobacco products at school events that are not on school grounds, and to reduce the exposure to second hand smoke in multi-unit housing settings. The schools that have been identified to participate in this grant are Salamanca, Gowanda and the Olean school districts. The two-year grant is for $500,000 and we will involve the participation of our municipalities, the school superintendents and the community as well. This is a positive initiative to implement changes that we need to see within our community. Dr. Watkins stated that we continue to monitor the outbreak of Whooping Cough (Pertussis). As of 7119112 there have been 18,000 cases reported in the United States this year which is more than twice as many as last year. According to the CDC if it continues at this rate, the outbreak will be worse than in 1959 where there were more than 40,000 cases ofWhooping Cough. In New York State, the number of cases has increased to approximately 1,217 so far and the incidence of Pertussis in New York State outside of New York City is about 11 per every 100,000 individuals, but the national incidence is about 5 per every 100,000 individuals. There have been no deaths in New York State secondary to Pertussis so far this year. We continue to be vigilant and warn our residents ofthe need to get a Tdap booster. The hospital has been working with us to assure that all mothers that have recently delivered are offered the vaccine. We have had two confirmed cases and two probable cases within Cattaraugus County this year. All ofthose cases have been treated and families have received the appropriate prophylaxis. We are working with the State to see if these vaccines can be made available at no cost to the public but at this particular time there has been no movement by the State on that effort. Today in the Journal of American Medical Association there was an interesting article (enclosed). stating that the nwnber ofindividuals that are part ofthis epidemic ofWhooping Cough is secondary to the type ofvaccine that is currently being used. The acellular pertussis vaccine, which is currently being used may not have the same effective immune response as when the whole cellular pertussis vaccine was being used. The vaccine was switched in the 1990's and that is when the epidemic seems to have began to flourish around 2000 or so when there was an increase in Whooping Cough. Their study shows that ifwe switch back to the whole cellular Pertussis vaccine we will probably not see the high nwnber of individuals redeveloping or coming down with Whooping Cough. The treatment for Pertussis has not changed at all, we continue to treat those individuals with the macrolide agents such as Azithromycin, Clarithromycin or Erythromycin and if they are allergic to any ofthose, then they are given Bactrium as an alternative. Children are still vaccinated at 2,4, Cattaraugus County Board of Health Meeting August 1,2012 Page Three and 6 months of age, at 15-18 months of age and between 4 - 6 years of age as well. Dr. Watkins reported that we continue to watch the public health and health planning council minutes and agendas to monitor the approval ofhome health agencies that have applied to expand or become certified home health agencies. Their last meeting was on July 26,2012 and there were several applications for the Certified Home Health Agency licensure expansion on their agenda for upstate and downstate New York. There was one application for review from our area; however the panel denied their request to expand into our area, which leaves four other applicants whose decision is still pending by this particular board. We will continue to update the Board on future outcomes. Dr. Watkins also reported that on July 25, 2012 the County Legislature overwhelming supported a resolution to encourage the State legislators to pass a State law to ban the manufacture, distribution, sale and possession ofdangerous, unregulated synthetic drugs like bath salts. These designer drugs are specifically synthesized with a similar modified structure ofa Schedule 1 controlled substance in order to avoid existing drug laws and can be continually chemically modified to avoid legal repercussions while maintaining their intended effects and usages. That schedule one controlled substance is amphetamine. The resolution urges the State Legislators to prohibit the use of cathinones; the parent compound for the designer drug bath salts. Amphetamines and cathinones are very similar in structure, adding methyl groups or non-metals (i.e. fluorine) to the cathinones allow manufacturers to get around the current order, which list the components ofthe drugs. Bath salts are frequently made up ofone ofseveral types ofdesigner drugs. Mephedrone, methylone and Methylenedioxyprovalerone are the three most popular types ofbath salts. Dr. Watkins handed out a copy ofthe chemical structures. Bath salts stimulate the body's central nervous and has similar effects to cocaine and amphetamines. Dr. Watkins stated that some of the side affects of the synthetic drugs include increased heart rate and blood pressure, hallucinations, paranoia, suicidal thoughts, violent behavior, nausea and vomiting. In Cattaraugus County the sale or production of this product is prohibited, but there should be a nationwide law that would ban the sale and use of synthetic drugs. Dr. Watkins stated that there was discussion at the last meeting regarding the Clean Indoor Air Act waivers for establishments that will be requesting renewals at the end of the year. At that time, Dr. Bohan requested information on how long each establishment has had a waiver to determine ifthese establishments have recouped their investments that they made (building a separate area to accommodate smokers in their establishments) in order to be in compliance with the regulations that granted them the waiver. Dr. Watkins handed out a copy of that information. Mr. Eade made a motion to move into Executive Session to seek advice from Mr. Brady, County Attorney. It was seconded by Dr. Bohan and unanimously approved. After moving out ofExecutive Session, it was noted that no actions were taken; advice was obtained from Mr. Brady, County Attorney. Mr. Snyder explained that the Board has discussed the Clean Indoor Air Act waivers several times in the past and he feels that currently there is 99.9% compliance with the Clean Indoor Air Act from establishments. He believes ifthese establishments are not granted waivers they will go out ofbusiness. Dr. Bohan asked ifwe can get information from Cattaraugus County Board of Health Meeting August 1,2012 Page Four other counties on whether they have had any legal issues when disapproving waivers, whether they have been successful in discontinuing waivers and if other Off Track Betting (OTB) offices allow smoking before any decisions are made. Mr. Brady agreed to do the legal research to answer that question.