TETON DISTRICT BOARD OF HEALTH MEETING
July 10, 2012
I. Call to Order D. Forman, in the absence of D. Shlim, called the meeting to order at 9:07 a.m.
II. Quorum Pronouncement by Chair The Chair declared a quorum present with S. Owens, T. Riddell, W. Holmes, B. Blue present. P. Perry, K. Gingery, and T. Gregory were in attendance.
III. Approval of Minutes of April 10, 2012 – The Chair called for approval of the minutes; B. Blue moved to approve with correction of the date from January 31, to April, 2012, on the minutes; T. Riddell seconded, motion passed with the change of date.
IV. Adoption of Agenda - Agenda was adopted
V. Discussion of Correspondence - Dr. Jim Little’s letter of request for a one year leave of absence and appointing Dr. Travis Riddell as County Health Officer. K. Gingery stated that the issue came to the County Commissioners. He stated that the Bylaws do allow the BOH to appoint a CHO with the approval of the County Commissioners. K. Gingery advised the Board that there were three different policy decisions that the Board could make at this meeting – the first policy decision is in regard to whether or not the Board accepts a leave of absence, if the absence is accepted you move in one direction; if the absence is not accepted and the request is determined to be a resignation, then, a selection process for a new CHO is determined. The full Board could interview or a small committee, then you pick one. The second policy decision relates to accepting the leave of absence; if a leave of absence is accepted, the position remains the current CHO and the CHO could appoint his deputy in the interim. The term is for four years. B. Blue asked if this was a state position from the state board of health. K. Gingery stated the contract is with the commissioners; there is a second contract related to all hazards. The direction to the CHO is from the State Health Department. The last contract renewal was discussed as well as how the contracts had been handled. There were questions and answers to clarify the process with K. Gingery. T. Riddell stated that he had a conflict of interest in regard to the decision as did B. Blue. D. Forman asked for discussion from all members. W. Holmes stated that he had accepted a leave of absence of one year and stated that it was usual and customary to go for a year; he stated he was inclined to say a collective “thank you very much” and move on. S. Owen stated he would be comfortable with a leave of absence up to one year, but not more than that, and that the Board needs to find out if Dr. Greenbaum is willing to continue as deputy, and if not appoint who would be acting health officer. T. Riddell stated that it was unfortunate that Dr. Little was absence, but felt the Board needed to make a move; he stated that he had too much of a conflict of interest to state whether the leave of absence should be granted. S. Owens stated that a leave of absence does need to be addressed as a policy. B. Blue stated that he was uncomfortable with the current deputy fulfilling the role, he stated the possibility that the CHO might stay longer than a year was significant and that he would consider a resignation as opposed to a leave of absence. T. Gregory stated that the deputy designation was informal. There ensued a discussion on how to reach all the physicians in the community regarding a potential opening. D. Forman asked for more representation with the two absence board of health members. D. Forman stated that Dr. Little’s intentions were clearly spelled out in his letter, stating that everyone had great respect for him, and that Dr. Little having been CHO for 35 years, his request should be respected and that he recommended Dr. Little’s wishes be followed with the stipulation that if the leave was longer than a year, that he would resign at that time. D. Forman further stated that Dr. Little has served the community for a long time, 35 years by chronological standards, but in dog years in Teton County is it like 200 years. K. Gingery suggested that another meeting be set with the full board as a Special Meeting with this one item on the agenda; he stated that another thing to consider is that legally having a CHO in place is extremely important and that his concern that without a CHO there would not be consistency in decision-making. B. Blue raised the question of a CHO appointment necessitating that person to come off the BOH – did that apply if the appointment was temporary. K. Gingery stated the appointee would definitely have to come off the Board, since the decision of a CHO could be appealed to the BOH. B. Blue asked if the BOH could defer the decision for who would be appointed to the BCC; P. Perry stated that the BCC wanted the BOH to make the decision since the BOH was more qualified. S. Owens asked the Board to answer the question on leave of absence, the term limit question and the final question is the process for a CHO and deputy CHO. D. Forman called for a Special Meeting in 10-14 days; the meeting was set for July 12, 2012, 9:00 a.m.
VI. Public Comment No comment.
VII. Old Business
A. Local Boards of Health Discussion – Karl Killmer, Chair Natrona County Health Department, and Janet Gerken, Director Sweetwater County Health Department, were joined by conference call to the BOH meeting. There had been two declines from Cheyenne-Laramie County Health Department and Campbell County Health Department.
D. Forman asked K. Killmer to introduce himself, and J. Gerken to introduce herself. Dr. Forman asked both how long their respective boards have been in existence.
Sweetwater was established in 1998 so that Environmental Health could have more local control over enforcement of regulations; at that time the Department functioned as a component unit as part of the County, utilizing the Clerk and other county services. This year the Commission stated that they support the Board of Health but they needed to act like a Board, so beginning in January, 2012, the transition to operating independently began and currently everything is handled in house. D. Forman asked J. Gerken if they had a public health officer, she answered in the affirmative. He then asked if any of the County Commissioners or other elected on the Board. J. Gerken stated they do, there is a liaison at every meeting and also the Chair of the Commission frequently inquires about the activities of the Board; there are 7 members – 3 from the Commission, 2 Green River and 2 from Rock Springs with no lay people on the Board. J. Gerken stated that although there is Green River and Rock Springs representatives on the Board, they have not been financially supportive over the years, so last year funding was sought with Rock Springs contributing last year and beginning this year, Green River is contributing; overall the funding has come from the County.
K. Killmer responded to the question stating that the Board has been in about 1992; they are a five member appointed board, 2 from the City of Casper and 2 from the County and one public member. The Board has himself, a CPA, a dentist, a doctor, and a veterinarian. D. Forman asked if members were rotated off or if the members could be reappointed; K. Killmer stated that reappointments were approved with 5 year terms. J. Gerken stated there is a large turnover on the Board because of time constraints, but would be allowed. There are monthly meetings, she stated.
T. Gregory asked both if they were managing their finances through the Board of Health. The answer was affirmative. K. Killmer stated that their major funding source is from the City $550,00 with like amount from the County; they have tried to keep like amounts from both the City and County, so he stated that the support has been very good, although they have seen a flattening of that revenue. Another source of revenue has been grants. Prior to last year the Board had an arrangement with the State for State Nurses where the State supplied Nurses and the Board paid some of that cost. That agreement was terminated about a year ago, partially because it had operational issues, two administrative systems, causing more problems than benefit, so the staff are now all County employees. K. Killmer stated that the operational issues are easier to handle and there was an interruption in funding that they braced themselves for; there was a reserve of funding that pulled the Board through that period and the Administrator is trying to get back with the State to get a grant arrangement rather than a staff sharing system in place so the Board can maintain control over the employees and get a funding stream in place for what is now being paid. Both Boards stated that no key positions have been cut, but have not filled vacant positions.
D. Forman asked both participants if they had any questions or comments. T. Gregory reviewed the chronology of the Teton District Board of Health, citing specifically the efforts with the Smoke Free Rule; operating with a Board of 7, quarterly meetings, utilizing the County Clerk and Treasurer for financials through the general fund, terms of 4 years with reappointment possible. T. Gregory stated that the City of Jackson does not participate in funding, has declined participation on the Board, so funding streams include the County general fund, grants, Department of Agriculture license sharing, and fees.
D. Forman asked both participants what their biggest challenges have been. J. Gerken stated that breaking away from the State was difficult, affecting six State positions, then with a new City Council and County Commission have had to continue explain the reasoning for the breaking of the contract, so the financial support was lacking. The Commission then would fund the Department, the approval lying with the Commission rather than the Board which created some problems. Now that the Board is autonomous, the finances are being resolved and controlled by the Board; working out the vouchers, salaries, etc. has been a challenge. J. Gerken states that there is still support from the State and has been able to maintain the same level of services. J. Gerken stated that most of the hurdles have been resolved and continue to receive support from the County. K. Killmer states that the Board has been independent from the County for a number of years, continue to be part of the local government from a tax-exempt standpoint. K. Killmer stated that their funding has successful and been at the level which allowed them to remain functional. K. Killmer stated that annually they have sent someone to the NALBOH annual conference, which has borne fruit for them, and has energized and put them in a place to begin talking about strategic planning. They have been able to start programs, try them out, stop if necessary. He stated they have a very successful mosquito control program that is shared with Fremont County. He stated there are no real roadblocks. He stated the good news is they do not get a lot of interference from the City and County and the bad news is that they don’t get a lot of interference from the City and the County; it has been pretty easy for them to leave them alone because they can perpetuate themselves on their own. They have a tight working relationship with the County Attorney; they have a medical director who attends meetings and workshops. The Board is appointed. He reviewed the Board’s activity in regard to smoking, with the effort going to the voters through the City of Casper. K. Killmer then stated they also severed their relationship with the State for State Nurses about a year ago, because of operational issues which was causing more problems. D. Forman asked J. Gerken for feedback on the efforts on smoking bans; she stated that they were going through so many changes there was little discussion. S. Owens asked K. Killmer if Smoke Free Natrona County was an NGO that took up the issue; K. Killmer stated yes, they were the driving force 24 months ago, spearheaded the efforts to the City Council, and they will continue to be active. B. Blue stated that the issue is more than smoking, but the rule making and enforcement; he stated as an example that if Teton District Board of Health and a mosquito infected pond and a rancher that didn’t want to put any mosquito control chemicals into the area because he wanted to remain organic, and thus presenting a public health hazard, the Board would have great difficulty in any enforcement or actions against anyone in that situation, so the difficulty is that the Boards of Health throughout the State really cannot do much and has no enforcement abilities. He stated that this is important to the Boards in the State to lobby the State legislature to try to get some sort of enabling legislation. K. Killmer stated that there were some areas where they were given the right, although he did not know how. As an example they have authority over tattoo parlors. He gave an example of the food regulations and impact on the county, potlucks. He stated that he feels they do have authority in certain areas. B. Blue reiterated the concern with lack of authority to enforce rules if the rules were challenged.
K. Gingery asked what the relationship with the Department of Agriculture is, stating that Teton County does the inspections for a facility, the MOA now includes the fact that if a facility is granted a variance from the food safety rule, the variance must be cleared with the Department of Agriculture. He asked if their Boards have signed the agreement with the Department of Agriculture and do they have a good relationship with them. K. Gingery stated that he has had few problems with Department of Health, but more issues with the Department of Agriculture. K. Killmer stated that there is a good working relationship with the Department of Agriculture, stating an example of word clarification with their agreement. B. Blue stated that all the issues can only be resolved with some action at the State level. J. Gerken stated that there have been no problems with the Department of Agriculture. T. Gregory announced that the Virginian has now gone smokefree, who had been a party to the suit again the Board.
D. Forman stated that one of the questions is whether we are a reactive or proactive Board. D. Forman summarized rule making and proactive efforts regarding food, pool/spa, tattoo, fracking. D. Forman asked how much communication occurs with other Boards in the State. J. Gerken stated not much at all; K. Killmer stated Administrators communicate regularly and Natrona has had consistent conversation with Laramie County. Both Board representatives related the monthly reporting, including traditional financial reports, from the departments and both felt monthly meetings were critical. Funders, community groups, etc also attend meetings; reporters do attend when issues are being discussed.
K. Gingery asked if it would be helpful to have a meeting in the fall for all the boards of health to attend; there was general consensus that would be helpful. D. Forman stated the conversation has been beneficial. The response from K. Killmer that the conference suggestion was ideal, breaking out into work groups, joint task forces, etc. with efforts to make the session successful. T. Gregory asked both Boards if they were considering mil levies as part of funding and is there an interest to do something toward changes at the legislature. J. Gerken did look at the mil levy but determined they were better off without; she stated the Board has not discussed legislative efforts, concentrating on a service contract with the State. Natrona County has not explored a mil levy and is interested in coordinating and synergizing efforts to examine current laws to see if they make sense. K. Gingery stated that the Labor, Health and Social Services Legislative Committee is meeting at the end of August and this issue is on their agenda.
K. Killmer expressed appreciation for the opportunity to meet and expressed interest in further discussions. D. Forman thanked them for attending and their interest. J. Gerken expressed appreciation and an interest in further discussions as well.
Quorum was lost with B. Blue leaving at 10:39 a.m. K. Gingery recommended a joint local boards of health meeting at the Wyoming WACO or WPHA annual conferences.
B. Sharps Disposal Program 6 Month Review – T. Gregory reviewed the Disposal Program which has been successful with a positive response from the community. A Kiosk has been budgeted; T. Riddell stated that the new CEO at SJMC may be interested and offered to speak to the CEO on behalf of the Board.
VIII. New Business
A. 2012 Changes to Wyoming Public Meeting Law K. Gingery reviewed the information provided to the Board highlighting clarification of the what a meeting was which is anytime that the Board gets to together is a meeting including by any means such as cell phone. Sequential communications are no longer allowed, essentially making a phone call from one person to another person to another and making a decision outside the meeting. The criminal penalty has been taken away and is now a civil penalty. Reasonable notice for a special meeting is now eight hours, notice to those who have requested notice in writing.
IX. Matters from Board, County Health Officer and County Manager – T. Gregory announced that she would be giving her resignation to the County, taking a position at the State in Cheyenne with responsibilities over five counties. The Board expressed appreciation. T. Gregory stated that the State will post and hire the Nurse Manager replacement; the Administrator portion of the role will need to be filled by the County. T. Gregory also drew attention to the NACCHO information on the Affordable Care Act included in the Board packet. T. Riddell stated this was important information to watch since there are some new grants that will be available with a lot of public health legislation.
There was general discussion regarding posting of food facility ratings on the web, front door of the facility, or other options and the manner in which the publications should be set up. K. Gingery stated that the Department of Health was set up to do a community meeting on July 31 at 5 pm to 7 pm at the Commission Chambers regarding Medicaid. The meetings had been set up across the state and with enough people in Jackson interested, they are offering in Jackson as well. Medicaid has contracted with Community Builders out of Douglas to hold the public meetings. K. Gingery encouraged BOH members and local physicians to attend, since cutting of Medicaid is a topic of discussion. T. Riddell will distribute the information to medical staff at the hospital. D. Forman stated that he gets the veterinarian notices from Karl Musgrave and offered to distribute the information to Board Members since there are many notices of illnesses attributed to raw milk. K. Gingery informed the Board that the MOU with the Department of Agriculture was not signed due to an issue on who grants variances – the Department of Agriculture or the local board of health. There was general consensus that the Board preferred to continue with the issue.
X. Adjournment The Chair called for adjournment; W. Holmes motioned to adjourn with B. Blue seconding the motion; motion passed unanimously and the meeting was adjourned at 11:06 a.m.
Approved: ___________________ Date: ____________
Next Meeting Scheduled for July 12, 2012 as a Special Meeting