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WC CWF Health District Board Minutes - 10/23/2009a WICHITA FALLS - WICHITA COUNTY PUBLIC HEALTH BOARD MINUTES October 23, 2009 Wichita Falls - Wichita County Public Health District 1700 Third Street - Parker Conference Room Wichita Falls, Texas MEMBERS PRESENT: Richard Sutton, M.D., Chair Kathy Sultemeier, D.V.M., Secretary Lauren Jansen, R.N.C. Robin Moreno, M.T. Tracy Hill, D.D.S. MEMBERS ABSENCE EXCUSED: David Carlston, Ph.D. MEMBERS ABSENCE UNEXCUSED: Bryan Press, Vice -Chair Lou Franklin Amy Cone Not Present Not Present Dorothy Roberts -Burns Ray Gonzalez Board Members I Director of Health Assistant Director of Health Health Authority Assistant City Manager Council Liaison County Commissioner 1. CALL TO ORDER & INTRODUCTIONS Chair Dr. Sutton called the Board of Health meeting to order at 12:15 pm after a quorum of members was obtained. II. APPROVAL OF AUGUST 2009 MEETING MINUTES AND ABSENCES Dr. Sutton called for the review and approval of minutes from the last meeting held on August 28, 2009. Dr. Sultemeier introduced a motion to approve the minutes as presented and Dr. Hill seconded the motion. Motion passed unanimously. At this time it was noted the excused absence of Dr. Carlston and the unexcused absence of Bryan Press. Introduction of guest Rati Gandhale a Midwestern State University student working on her masters in Health Administration doing an internship at the Health District under the supervision of the Assistant Director of Health, Amy Cone. III. FOOD ORDINANCE Mr. Tezaguic, Environmental Health Administrator informed the Board that the food regulation s 0 o 9 __r r Director of Health Assistant Director of Health Health Authority Assistant City Manager Council Liaison County Commissioner 1. CALL TO ORDER & INTRODUCTIONS Chair Dr. Sutton called the Board of Health meeting to order at 12:15 pm after a quorum of members was obtained. II. APPROVAL OF AUGUST 2009 MEETING MINUTES AND ABSENCES Dr. Sutton called for the review and approval of minutes from the last meeting held on August 28, 2009. Dr. Sultemeier introduced a motion to approve the minutes as presented and Dr. Hill seconded the motion. Motion passed unanimously. At this time it was noted the excused absence of Dr. Carlston and the unexcused absence of Bryan Press. Introduction of guest Rati Gandhale a Midwestern State University student working on her masters in Health Administration doing an internship at the Health District under the supervision of the Assistant Director of Health, Amy Cone. III. FOOD ORDINANCE Mr. Tezaguic, Environmental Health Administrator informed the Board that the food regulation ordinance had not undergone revision since 1999. The proposed changes are straight forward taken from 10 years of knowledge that enabled reorganization to reduce repetition and collapse five divisions into four. Established risk base inspections to comply with the Centers for Disease Control (CDC) recommendations to exclude focus on what does not cause food borne illness. Increase of employee time due to inspection frequency and the economy warranted the revision of the fee structure. Restaurants were mailed notification of the public hearing held on October 6, 2009 to address changes to the ordinance that governs retail food operations. The Health Department offered draft copies of the ordinance for pick up, a link to the website to download, and /or their attendance at the hearing. Those in attendance understood, agreed and thought the regulation changes reasonable. CHAPTER 26. ARTICLE VI. FOOD AND FOOD VENDORS AND ESTABLISHMENTS. DIVISION 1. GENERALLY. Sec. 26 -421. Definitions. Additions and update of definitions tightened and set forth different requirements. Broadened the explanation of what constitutes a food establishment with the focus on higher risk. In accordance with the Texas Administrative Code an establishment that offers only prepackaged foods being non potentially hazardous is now excluded. Sec. 26 -422 — 425. These sections adopt rules of the State Board of Health, National Sanitation Foundation, and the American National Standards Institute and define who is compliant and the penalties for violation of these sections. Sec. 26 -423. Cleaning standards for commercial cooking equipment adopted. Addresses the requirements for cooking equipment, clean ability, material design, and construction. This section adopts State standards to better ensure the safety of food prepared in outdoor cookers. DIVISION 2. FOOD SERVICE ESTABLISHMENTS. Subdivison II. Permit Sec. 26 -477. Application and renewal. Addition of renewal and the applicable must be submitted with the applicable fee. Sets the requirement to receive applications each time billing is sent out to help keep track of ownership of establishments especially when a franchise changes hands. Defines when the permit fee is due and allows assessing a late fee when it is not paid prior to the permits expiration date. Sec. 26 -478. Inspection. Addition of a food establishment to comply with the applicable laws and states rules. Sec. 26 -479. Compliance required; posting; term; fee. A big change is the proposed ordinance moves from four categories of permits to three permits based on the process that occurs in each facility to allow a permit based on the risk of food borne illness associated with each process. Previous permits had been issued as Category 1, 2, 3, or 4 with 1 the lowest risk (non - potentially hazardous foods) and 4 the highest risk (high potential for cross contamination or detailed food preparation). The removal of the establishment type revised to process steps allows clarity to the applicants to better understand their placement in that process. Anything in the establishment potentially hazardous that requires refrigeration or known to cause illness would automatically place them into a process this excludes non - potentially hazardous foods. a) Only persons who comply with the requirements of this division shall be entitled to receive and retain a permit required by this subdivision. Such permit shall be posted in a conspicuous place in public view in or on the food establishment. All permits issued under this subdivision remain in force one year from the date of issuance unless revoked or suspended. b) The following permits will be issued under this subdivision: 6 1) Process 1: low to moderate risk. This process involves food sale with or without preparation and includes no cooking. Generally, the steps in this process are: Receive > Store > Prepare > Hold > Serve > Vend > Stock. Excludes non - potentially hazardous foods otherwise those prepackaged such as cokes, chips, candy are no longer in a process and not required to be permitted. 2) Process 2: high risk. This process involves food preparation for same day service. Generally, the steps in this process are: Receive > Store > Prepare > Cook > Hold > Serve. Science has shown if you prepare food and send it out there is a dramatic decrease in the likely hood for food borne illness that with time and temperature considered there is not enough time for enough bacteria to grow to make somebody ill. 3) Process 3: very high risk. This process involves complex food preparation. Generally, the steps in this process are: Receive > Store > Prepare > Cook > Cool > Reheat > Hot Hold > Serve. Food preparation for multiple day service. Food may be cooked and served one day, cooled, reheated the next day for consumption. Full service potential for disease transmission you have time and temperature with a longer period of time for bacteria to grow in the food and contamination issues play in if a ill food handler prepares food on one day to be served the next day there is plenty of time for that bacteria count to build high enough to cause food borne illness. 4) Temporary Events. These events last no more then seven consecutive days and applicants are limited to five temporary event permits per year. No annually permitted establishment shall allow temporary event food vending at their site unless a temporary event application has been submitted to the regulatory authority. Permit allowance per person /organization increased from three to five per year due to a big increase of fund raisers that limited vendor participation. Through history no problems had been associated with the temporary events which made the increase reasonable. Sec. 26 -480. Review of plans. Any construction, conversion or extensive remodel requires plans and specifications to be prepared by an architect or engineer. Additional plan requirements for a business acting as a commissary for a mobile unit to show the refrigerated and dry storage areas reserved for the mobile unit use. Businesses that close and reopen under new management are required to submit new equipment specifications and floor plans. Subdivision 111. Frozen Dessert Regulations. Sec. 26 -511— 516. The section was amended to provide adequate regulation of both soft serve and frozen yogurt. Division 4. Mobile Food Vendors. Sec. 26 -570. Annual inspection required. Sec. 26 -571. Central preparation facility and records required. A mobile unit is required to operate in conjunction with a commissary the central preparation facility it is suppose to be an extension of the restaurant. Requires each mobile food unit to record daily service of the water system, sewage system and cleaning of the interior of the unit. Sec. 26 -572. Mobile food establishment restrictions. Mobile food vendors are not allowed to set up tables or any type of seating within 20 feet of the mobile establishment. Any alterations or change to the unit in any manner to reduce the mobility of the unit can not be made. 3 Chapter 48 Article VIII Health Department Fees Division 1. Food Vendor and Establishment Fees. Sec. 48 -81. Creation of a chapter to establish a fee ordinance not only for the departments that offers a single location for citizens to find all City fees. The Proposed Classifications and Fee Schedules as follows; Process I (low to moderate risk) Process II (high risk) Process III (very high risk) Temporary Events Additional Permit Fee Current $100 > Proposed $125 Current $125 > Proposed $150 Current $150 > Proposed $175 Current $20 > Proposed $30 Current $50 > Proposed $60 Health department but all City Food Handlers Certificate Current $10 > Proposed $20 Handlers Replacement Certificate Current $2 > Proposed $4 Frozen Dessert Establishment Certificate Current $50 > Proposed $100 includes One Operator Certification Additional Operator Certification Proposed $20 Re- Inspection /Re- Sample Fee Proposed $25 Late Charge on Expired Permits Proposed $25 /Month The Health Department worked closely with the Legal Department to amend the food ordinance in a manner to better serve and protect the health of the public. Dr. Sutton asked for a motion to recommend the ordinance to go to Council for passage. The motion was made by Ms. Jansen and seconded by Dr. Hill. None opposed unanimously passed. IV. RESTAURANT SCORE UPDATE Mr. Tezaguic stated to post the restaurant scores appeared easy but soon discovered the challenges. Information Systems (IS) remains in the creating process not just to post the score but the actual inspections. Hard thing is there will have to be several different pieces of information that link together the primary identifier which will be the restaurants site number. The site number will have to associate with the report that has to associate with the date all these things are in process to be worked out. The system will have quarry capability by date, restaurant, City, violation, and key word search, questions may be asked that will quarry to reports associated to the question. It will be labor intensive to add the reports on a daily basis to the data base that will be on the City server accessible from the City website. Standard operating procedures will need to be written for the formality of posting the inspections. Create quality assurance process to verify accuracy of the reports before posting. Although working primarily on getting the food inspections worked out in addition it will allow the system to support all types of inspections. V. H1N1 OVERVIEW Ms. Kea explained each year they manufacture the live virus for the seasonal flu and H1N1 as well. The flu mist is given to children under 18 years, for both the seasonal and H1N1 it is not recommended for anyone with a respiratory disease, pregnant women, or any individual that lives in a house with someone compromised, everyone is screened prior to issuance. 4 The mist is a nasal spray that goes in each nostril with the only side effects being a mild runny nose, muscle aches, and fever where with the flu vaccine the side effects are a sore arm, redness, tenderness to the site. Clinical trials of the H1 N1 saw the same side effects as the seasonal flu with no additional side effects so far. Both are to be as effective, suppose to work in the same way and fashion. Ms. Kea stated due to the State not getting out as many doses as originally anticipated the target population has changed recommended for pregnant women as previously, children 24 to 59 months, children aged 5 to 15 years with risk from complications with the flu, and health care workers that provide care for those individuals. Currently the only samples being sent to the State are those hospitalized for greater than 48 hours, women that are pregnant with flu like illness, those with influenza flu like symptoms, or a specimen obtained within 30 minutes after death. Ms. Kea replied to Dr. Sutton that since the tracking started September 20th approximately 25 people with H1N1 have been hospitalized with no serious accounts or deaths within our county. Those hospitalized mostly younger the 6 to 12 year old age group a couple of older, typically affecting those 39 years and younger. It was recommended to Ms. Moreno that immunocompromised chemo therapy patients should get the injected H1 N1 inactivated vaccine. Ms. Kea responded to Dr. Sultemeier that she thought Tamiflu is available again that the State had done a good job of getting it to chain pharmacy's and since there are no pediatric doses across the State it has to be compounded for the pediatric population. Dr. Sultemeier asked if the Health District now had some of the inactivated and live vaccine. Ms. Franklin advised there are 100 doses of each not enough doses to effectively do anything with so the decision was made to start with the first responders our fire fighters. Once they are vaccinated we will see how much vaccine is left depending on how many of them want it then look at some of the other health care providers and workers and go from there. First we heard we would receive enough vaccine for a mass clinic then we are not, so the secondary back up plan if not enough doses are received for a Saturday Mass Vaccination clinic a phone bank will be set up to take weekly appointments but still there is the wait to see how much and what kind of vaccine will be sent. Any vaccine we get in after that we will just have to figure out the distribution without a massive number of people on the door step. The State of Texas with an entire population of 15 million only received 147 thousand doses for the entire State the first week the vaccine was available. We just wait it has been very slow, very frustrating for the Press and the public. VI. NEXT MEETING DATE December 18, 2009 VII. ADJOURN Dr. Sutton requested a motion to adjourn. The motion was made by Dr. Sultemeier and seconded by Lauren Jansen. The motion carried and the meeting was adjourned at 1:15 p.m. Richard Sutton, M.D., Chair, Bryan Press, Vice Chair, or Kathy Sultemeier, D.V.M., Secretary Public Health Board 5