ALLEGHENY COUNTY BOARD OF HEALTH

Transcription

1 ALLEGHENY COUNTY BOARD OF HEALTH MINUTES March 3, 2014 Present: Lee Harrison, MD, Chair William Youngblood, Vice Chair Karen Hacker, MD, Secretary Anthony Ferraro Joylette Portlock, PhD Edith Shapira, MD Ellen Stewart, MD Donald Burke, MD Kotayya Kondaveeti, MD Absent: Joan Cleary, RN 1. Executive Session A. To discuss possible enforcement action for violation of provisions of Article XXI regarding discharge of pollutants. 2. Call to Order The meeting was held at the Clack Health Center, 39 th and Penn Avenue, Pittsburgh. Dr. Harrison called the meeting to order and announced that the Board held an executive session under the litigation exception and that no formal action was taken. 3. Approval of Minutes from Jan. 8, 2013 Dr. Harrison asked for a motion to approve the minutes. Action: Mr. Youngblood moved for approval, Dr. Shapira seconded. 4. Public Comments on Agenda Items A. John Graf commenting on the restaurant grading system Dr. Harrison pointed out that Mr. Graf is a member of the Restaurant Grading System Working Group. Mr. Graf stated that he was the immediate past president of the Pennsylvania Restaurant and Lodging Association. The Association is opposed to restaurant grading, it feels that grading is not an effective means of ensuring food safety. The PRLA is very concerned about the promotion of food safety. Though opposed to the letter grading system, the PRLA would like to be involved rather than to be obstructionist to help ensure the system is the most effective,

2 fair, and consistent as possible. Mr. Graf quoted Ross Perot in stating that The Devil is in the details and explained his position stating that the PRLA does not know what the details of the grading system are, and he doubts that the Board does either. Mr. Graf expressed his concern that the Board s decisions were going to have a real effect on real people s lives and expressed particular concern about the effect on amateur kitchens such as church basements and little league snack bars. Important issues moving forward include robust re-inspections to be conducted before a grade is publicly posted, which point totals will be assigned to which types of violations, the allocation of appropriate resources such as the hiring of new inspectors, consistency in the application of the grading system, and fairness to all parties. Dr. Harrison thanked Mr. Graf for his comments. B. Jeff Cohen commenting on the restaurant grading system Mr. Cohen was not present to comment. At this time, Dr. Harrison took the opportunity to thank Allegheny County Councilman John Palmiere for attending the Board s meeting. C. Vince Sanzotti - commenting on the restaurant grading system Dr. Harrison pointed out that Mr. Sanzotti is a member of the Restaurant Grading System Working Group. Mr. Sanzotti pointed out that he has been a member of the hospitality industry in Pittsburgh for over 35 years. Mr. Sanzotti assured the Board that the members of the industry have only the best interests of their community at large in mind. This restaurant grading system only provides means to penalize those with good intentions. As an industry representative, Mr. Sanzotti feels he has yet to be presented with accurate and pertinent data proving that a restaurant grading system can improve public safety or public health safety. Mr. Sanzotti feels that the industry representatives have brought many points to the attention of the Restaurant Grading System Working Group that have fallen on deaf ears and feels their participation may be for show purposes. Dr. Harrison thanked Mr. Sanzotti for his comments. 5. Old Business A. Update on restaurant grading system Dr. Harrison gave a presentation about the rationale for the system. Dr. Harrison presented the Board with a list of members of the Restaurant Grading System Working Group. The group was composed of members of industry, Mr. Palmiere from County Council, several Board members, and Virginia Dato from the Pennsylvania Department of Health. According to CDC data, in 9,000 foodborne outbreaks, approximately half were associated with restaurants. Norovirus is the most commonly associated pathogen with foodborne outbreaks in restaurants. Salmonella and E. coli were also common. Dr. Harrison then

3 presented additional data from Seattle-King County and Minnesota showing the increased risk for foodborne outbreaks as a result of improper practices in restaurants. Dr. Harrison then presented data showing an increase in restaurant grades after implementation of an inspection system. In Tennessee, restaurants with an initial score of less than 60 saw their scores rise by 20% on subsequent inspections. In New York City, six months after implementation of a grading system, 65% of restaurants were receiving an A grade. That percentage increased to 72% after 18 months. In addition to the rise of restaurants grades after implementation, there was also a decrease of foodborne illnesses. For example, Los Angeles County saw a 13% decrease in foodborne disease hospitalizations in the year following implementation of a grading system. Dr. Harrison then gave a brief overview of the basic principles of Allegheny County s proposed restaurant grading system. The focus is on critical violations that impact food safety. The goal of the system is to improve food safety. Dr. Harrison believes the system is a win-win, with the public benefitting from improved food safety and restaurants being able to tout their grades. Lauren Torso, an ACHD Epidemiology Research Associate, then gave a brief presentation about enteric infections and foodborne outbreaks in Allegheny County. Ms. Torso presented the number of cases of reportable enteric infections that are commonly associated with foodborne outbreaks. The CDC estimates that for every reported case, there are twenty unreported cases. Ms. Torso reported that there were eighteen foodborne related outbreaks in Allegheny County from Fourteen of these outbreaks were associated with eating at a restaurant, with the remaining four being associated with a catered event. When a pathogen was identified in these outbreaks, norovirus was the most commonly identified pathogen. Dr. Kondaveeti expressed concerns regarding why all of the number of cases of campylobacteriosis were associated with restaurants as opposed to possibly dogs or cats. Dr. Kondaveeti also expressed concern as to how Salmonella illnesses could always be attributed to eating at a restaurant. Dr. Kondaveeti stated that it could be possible for a person to catch Salmonella from consuming raw eggs as a result of a home cure approach for an alcohol hangover. Dr. Harrison, Dr. Hacker, and Ms. Torso acknowledged Dr. Kondaveeti s point that it is certainly possible to acquire a foodborne illness outside of a restaurant setting and explained that an epidemiological outbreak investigation determines if a foodborne illness is restaurantrelated. Dr. Burke asked if there are fatalities associated with foodborne illnesses acquired from restaurants. Dr. Harrison responded that Salmonella acquired from restaurants has caused deaths in the United States. Ms. Torso was not able to confirm, without additional data review, if there have been deaths in Allegheny County caused by infections from a restaurant. Glenda Christy, a consultant to ACHD, then gave a presentation regarding details about Allegheny County s proposed grading system. Ms. Christy confirmed that the food inspection

4 program, public access to inspection reports online, and enforcement actions will all continue as before. Ms. Christy explained the type of facilities (restaurants with and without a bar, banquet halls, social clubs, mobiles, adult and child food services, university food services, church kitchens, fire halls with and without bars, pool snack bars with and without liquor, snack and seasonal snack bars, caterers, retail convenience stores, packaged foods, bakeries, community service facilities, and hospitals, governments, and other institutions) that will be included in phase one of the restaurant grading system. This list encompasses over 80% of the food facilities that are currently inspected and permitted in Allegheny County. The restaurant s grade will be calculated based on a scale beginning at 100. Points will then be deducted from 100 in accordance with the level of violation. Eleven points will be deducted for an imminent hazard, which could lead to immediate closure or other enforcement action; five points will be deducted for a high-risk violation; three points will be deducted for a medium-risk violation; and one point will be deducted for a low-risk violation. The letter grades will then be assigned based on the point grade. An A will be awarded for points, a B for points, and a C for points. Action, such as consumer alerts or permit suspensions, may be taken for scores below 70. The grading system will also include diamond recognition. If restaurants score an A, and meet criteria for diamond recognition, their diamond recognition for excellence will be reflected on their inspection report, online, and on their grade placard. Ms. Christy then informed the Board of the timeframe regarding the system. In February, industry was met with as part of the Restaurant Inspection Grading System Working Group, the proposed system was revised, revisions to Article III were developed and submitted for legal review, violation matrices were developed, and a file survey was completed. Presently, in March, the Board is having this information presented to it. In May, revisions to Article III and the details of the Grading System Proposal will be presented to the Board for approval. Other County approvals will be acquired, forms will be revised, and computer programs and hardware need to be updated. Through all of this, Ms. Christy hopes to continue to work with industry as part of the Working Group to ensure fairness to both the industry and the public. In June, staff would be retrained and an industry awareness campaign would be conducted. In July and August, a pilot program would be done in the field and any further training would be given. In September, implementation of the grading system would begin. Dr. Harrison reiterated to the Board that working with industry as part of the Working Group is integral to the program, and that approval was being sought today for the framework for the system and not for the specific details. Dr. Kondaveeti again expressed his concern for the economic effect on restaurants not receiving an A grade. Dr. Harrison reminded Dr. Kondaveeti that the restaurant inspection reports are already publicly available online and that the posted grades are a transparent consumer tool. Dr. Burke asked if there was any data available on the economic impacts following the introduction of a restaurant grading system in

5 other jurisdictions. Dr. Harrison was not aware of any convincing data of economic damage following a grading system and pointed out that New York City still has one of the most dynamic food service industries in the country. Ms. Christy pointed out that in Los Angeles, facilities that received an A score saw a 5% increase in their business. Dr. Harrison again stated that this is not meant to be detrimental to the industry, but is meant to be a win-win for everybody. Mr. Ferraro, who is a member of the Working Group and also a distributor in the food service industry, expressed concern that it was too early to vote on the draft of the grading system. He feels additional work needs to be completed by the Working Group regarding the finer details of the proposal. Mr. Ferraro believed that the additional work would not interfere with the implementation timeline. Dr. Harrison agreed with Mr. Ferraro that many details did need to be worked out, but that he was seeking a vote today to approve moving forward with the general framework of the system. Action: Dr. Stewart motioned to approve the continued activities of the Working Group to stay on the timeline to be able to implement the restaurant grading system in September with the details to be worked out with the Working Group. Dr. Shapira seconded the motion. Dr. Portlock and Mr. Ferraro expressed their desire for the Board to be informed of the planned grading system s details before the Board votes on them. B. Update on heroin issue Dr. Hacker reported that in the month of January there were a total of 17 individuals who died from overdoses from a combination of fentanyl and heroin. The rapid rate of the overdose death caused tremendous concern. ACHD became involved and coordinated efforts between the emergency services in the City of Pittsburgh, Allegheny County Police, and Prevention Point Pittsburgh. Dr. Hacker believes that lives were saved in the long-run. Dr. Hacker would like ACHD to be able to monitor street-level information and is working with Emergency Medical Services to be able to acquire data about the number of incidents requiring the administration of Narcan. Dr. Burke asked about the current status of the distribution of Narcan in Allegheny County. Dr. Hacker answered that all paramedics have Narcan in their ambulances, physicians who prescribe opioids are able to prescribe Narcan, and Prevention Point Pittsburgh writes prescriptions for Narcan for IV drug abusers. There possible legislation at the state level that would enable first responders to administer Narcan. The Board expressed their support for the state s action in this regard.

6 6. New Business A. Approval Policy & Procedure for the Environmental Health Fund and Clean Air Fund Projects Jim Thompson reported to the Board that there was a meeting of the Fund Review Subcommittee that was formed at the previous Board meeting. The Subcommittee is comprised of Mr. Ferraro, Ms. Cleary, Mr. Youngblood, and Dr. Portlock. The meeting focused on outlining and developing policies and procedures for disbursements from the funds. The Subcommittee intends to present the policies and procedures developed to the Board in May. Action: Ms. Stewart motioned to form a Funds Review Subcommittee comprised of Mr. Ferraro as head, Mr. Youngblood, Ms. Cleary, and Dr. Portlock; to screen requests for proposals for funding and to fund Grow Pittsburgh with monies from the Environmental Health Fund at the level of funding they received last year, with receipt of additional funds contingent upon review by the Funds Review Subcommittee. Ms. Cleary seconded the motion. B. Air Quality 1. Minor Regulation Modifications Requesting Public Comment Period a. Nonattainment New Source Review Modeling Requirements Jayme Graham explained that this request was to re-insert words that had been previously redacted into an air quality regulation in order to comply with Federal law. Action: Dr. Burke moved to go to a public comment period to re-insert the words into the regulation. Mr. Youngblood seconded the motion. b. Coke Oven Pushing Regulations Removal of 1997 PM2.5 NAAQS SIP Contingency Measure Ms. Graham explained that this request was to delete a phrase that was part of a contingency measure that is no longer used. Action: Mr. Youngblood moved to go to a public comment period to delete the phrase. Dr. Shapira seconded the motion. c. Title V Emission Fees Ms. Graham stated that this regulatory change was to change the ACHD regulation to refer to the fee charged by the State, as opposed to continually updating the regulation by listing the exact fee.

7 Action: Dr. Shapira moved to go to a public comment period to update the regulation. Dr. Stewart seconded the motion. At this time, Dr. Kondaveeti excused himself and left the meeting. 2. Federal Implementation Plan for Incinerators Requesting Public Comment Period Ms. Graham explained that the Federal government modified the Clean Air Act s provisions regarding medical infectious waste incinerators. Ms. Graham stated that ACHD is required to comply with Federal regulations, and thus ACHD would like to adopt the Federal implementation plan for incinerators. Action: Mr. Youngblood moved to go to a public comment period to adopt the federal implementation plan for incinerators. Dr. Shapira seconded the motion. 3. Clean Air Fund Requests a. Clack #7 Replacement Boiler Up to $40,000 Mr. Thompson explained that the boiler in Building 7 of the Clack Health Center was recommended to be replaced by engineers. Action: Dr. Stewart motioned to authorize up to $40,000 to replace the boiler in Building 7 of the Clack Health Center. Mr. Youngblood seconded the motion. b. Climate Change Health Effects Workshop Up to $10,000 Mr. Thompson stated that this request was to fund the Climate Change Workshop that Dr. Portlock was spearheading. The funding would cover costs such as travel and lodging expenses for the guest speakers, food and refreshments, and printing and advertising fees. Action: Mr. Ferraro made a motion to fund the Climate Change Health Effects Workshop for up to $10,000. Dr. Shapira seconded the motion. The motion passed unanimously. Dr. Portlock abstained from voting on the motion NAAQS PM2.5 SIP Addendum Ms. Graham explained that this plan was submitted for the Board s final approval. The plan was submitted last year and went through a public comment period. The comments all questioned why modeling was based on the CSAPR Rule. Ms. Graham

8 assured the Board that the plan is based on actual Air Quality data and that the plan is scientifically-based. Dr. Burke temporarily excused himself and left the room before a motion was made. Dr. Harrison verified that a quorum of the Board was still present. Action: Mr. Youngblood made a motion to approve the 2006 NAAQS PM2.5 SIP Addendum. Dr. Stewart seconded the motion. The motion passed unanimously. Dr. Burke had not yet returned to the conference room, and hence did not vote. C. Live Well Allegheny Campaign Obesity Subcommittee At this time, Dr. Burke returned to the conference room. Dr. Hacker reported that the Live Well Allegheny website has been launched, and it is in the process of being updated. A strategic planning meeting, held in conjunction with partners, will be held in April. Dr. Hacker also reported that the Live Well campaign has been approached by the Hillman Foundation, which may be interested in contributing to support the campaign. D. Climate Change Dr. Joylette Portlock Dr. Portlock spoke about the workshop she is planning regarding the health effects of climate change and ways that the BOH might better prepare for such effects. Dr. Portlock would like to invite several speakers to the workshop. The workshop will be held on May 19 th, from 1-5:30 in the auditorium at Pitt s Graduate School of Public Health. E. Update on Measles case Dr. Hacker reported that there has recently been one case of measles. The afflicted individual had been previously vaccinated. This was the first measles case in Allegheny County since ACHD made a number of recommendations, in the interest of protecting vulnerable populations such as immunocompromised individuals, small children, and pregnant women. There were no additional cases reported as of yet. Dr. Hacker thanked UPMC, and staff from ACHD s Epidemiology and Infectious Disease departments, for their assistance. Dr. Harrison commended the ACHD for its response to this case. Mr. Ferraro excused himself and temporarily left the room. 7. Director s Report Dr. Hacker reported that ACHD did submit a grant, along with a large coalition, to the Department of Health & Human Services on promoting the population to access well-care. At this time, Mr. Ferraro returned to the conference room. Dr. Hacker stated that ACHD will know about the funding in July. The submission of the grant by the coalition set the stage for future work that the coalition can engage in. An additional grant was submitted to the State to continue Safe & Healthy Communities. A number of foundations have also combined resources

9 and are interested in providing ACHD with an integrated grant to support IT assessments and upgrades and also to support the accreditation process. 8. Announcements There were no announcements. 9. Public Comments on Non-Agenda Items There were no public comments on non-agenda items. 10. Adjournment Mr. Youngblood moved to adjourn the meeting, and Dr. Harrison seconded.