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WC CWF Health District Board Minutes - 12/19/2014WICHITA FALLS- WICHITA COUNTY PUBLIC HEALTH BOARD MINUTES December 19, 2014 Wichita Falls- Wichita County Public Health District 1700 Third Street - Parker Conference Room MEMBERS PRESENT: Scott Plowman, Chair Julie Gibson, D.V.M, Vice -Chair David Carlston, Ph.D. Robin Moreno, MHA -HAS, ACHE Keith Williamson, M.D. MEMBERS ABSENCE EXCUSED: Jane Leach, R.N., Ph.D., Secretary Larry Rains, D.D.S. Lou Kreidler, R.N., B.S.N. Amy Fagan, M.P.A. Kevin Hugman Ray Gonzalez Wichita Falls, Texas Board Members Director of Health Assistant Director of Health Assistant City Manager County Commissioner I. CALL TO ORDER Scott Plowman called the Health Board meeting to order at 12:15 pm after a quorum of members was attained. II. NEW MEMBERS INDUCTION Appointment of new Health Board members was conducted by Janice Flores, Notary. Dr. David Carlston was reinstated as the County appointed Citizen At -Large representative for another term. Dr. Keith Williamson was inducted into the City appointed Practicing Physician vacancy left by Dr. Michael Lamar. III. APPROVAL OF MINUTES AND ABSENCES Scott Plowman called for the review and approval of minutes from the meeting held on Friday August 22, 2014. Robin Moreno introduced a motion to approve the minutes as presented and Dr. Carlston seconded the motion. The motion passed unanimously. At this time it was noted the excused absence of Dr. Jane Leach and Dr. Larry Rains. Lou Kreidler noted that the meeting today was Dr. Leach's last but was unable to attend so her appreciation of service plaque would be mailed to her. Dr. Diane Stewart the Chief Nursing Officer at Kell West Regional Hospital would be appointed into the vacancy at the next meeting. IV. MOBILE FOOD ORDINANCE Susan Morris, Environmental Health Administrator discussed changes to the proposed food code since the last meeting. Stake Holder meetings had been held with Downtown Development once, Restaurant Managers /Owners twice, and Mobile Food Vendors once then met individually with property owners interested in future development. Collaboration was made with Community Development and the Legal Department to ensure consistency throughout the City with the ordinance. Changes to the Food Ordinance followed: o Updated, changed and deleted definitions to be consistent with FDA rules. o Very High Risk category additions: • Any Foods requiring Hazard Analysis Critical Control Point (HACCP) • Foods for highly susceptible populations • Foods determined by the Health Department to be a High Risk food Susan Morris clarified the very high risk category additions. Foods that require HACCP are those not shelf stable such as sushi or the use of time in place of temperature as a control point when not refrigerated only kept out flour hours then at the end of that time disposed. Highly susceptible populations are those individuals in Nursing Homes, preschool to 2nd graders, hospitals, immunocompromised systems, etc. The potential risk of the influx of new foods would be determined by the Health Department. Additional Changes: o Changed number of temporary permits from 5 to 7 a year per requested from some public event planners. o Addition of seasonal permits for businesses that only operate seasonally for no more than 6 months and do not fall in the very high risk category such as snow cone vendors, sports concession stands, etc. o Changed requirement for engineered plans to be consistent with Community Development. o Allowed to collect fees for reviewing plans. o Allowed to collect fees for re- inspection for suspension and revocation of permits. Susan Morris explained that plans of a certain square footage or percentage of change would be submitted to Building Inspection with an allowance to collect fees for the review and disseminate of the plan. As a one stop encounter the City of Wichita Falls would be perceived as a friendly place for development. Soft serve Changes: • Changed from the mandated 3 samples a year to one sample a year. • Required training is good for 2 years in place of one year. Susan Morris stated local yogurt shop owners requested a 2 year certificate to be consistent with the food handler certificate. The soft serve boost of growth with yogurt stores had become overwhelming. Lou Kreidler added another reason was due to an email had been sent to other Health Departments in the State asking who did soft serve sampling and many used to but discontinued the service. It was under consideration to remove but it was perceived as important enough to do an annual sample for the health of our community since enough facilities failed the first time round. Food Handlers Changes: • To only issue one temporary receipt good for 30 days. • No longer to issue "lifetime" food handlers cards. PA Susan Morris said currently 3 temporary receipts can be issued that allows 90 days operation without a food handler card. They are difficult to track and many times the client continues to get a temporary card never to take the course. Lou Kreidler added that was not the intent of the ordinance it was to provide food handler training. The 30 day temporary was to allow the client to start work then arrange to take the training course within that 30 day period. Susan Morris stated when the program was initiated that after 4 cards the client was issued a lifetime card that exempt them to return some being 30 years old a lots changed it is important that client get the education. Lifetime holders do need a refresher they can come in at no charge to take the training class. o Food Protection Manager Certificate will be required for the Person in Charge or the must have knowledge "based on the risks of foodborne illness inherent to the food operation" they are employed in. The Restaurant owners and managers at the meeting disagreed with the required certificate that it would be too much of a burden to have someone with the certificate on duty all the time. The concession was to either have knowledge based on the risks of foodborne illness inherent to the food operation employed in. Dr. Carlston questioned how they would demonstrate knowledge. Susan Morris answered they would be asked State issued questions. A yogurt shop manager does not need to know how to run a full service restaurant. The yogurt shop owner opens, sets up the machines and closes at the end of the day so the owner would need to have a Food Protection Manager Certificate, Dr. Carlston asked when an inspection is done would you ask the person in charge the questions, if right good and what if wrong? Susan Morris replied they would get written up with a point violation. Scott Plowman mentioned what the restaurateurs disagreed was to have one person with the certificate you would be unable to leave the restaurant and the certificate cost money not the same as a $20 health card. In addition Lou Kreidler stated DSHS was in the process to reform the Texas State Establishment Rules which implements a new inspection that abolishes the current inspection. Our proposed changes are consistent with those rules if not done now it would have to be done when finalized in June or July. Susan Morris continued on to the Mobile Food Vendors to explain the section was deleted and rewrote to require the vendor to supply more information to the Health Department; driver license, insurance, vehicle description, food truck location. The Health Department ordinance offers the mobile food vendors some exemptions of the rules without violation to any health codes to operate in outdoor food courts. The ordinance made an allowance for outdoor food courts in collaboration with the Planning and Zoning Ordinance allowance of food courts in certain parts of town the two coincide. The intent of a mobile food vendor is to be mobile with no outside seating and only signage on the truck. When parked in a parking lot an agreement is needed with the persons parking lot that allows access for all employees to the business restroom at all times if closed the truck cannot be parked in the lot since there would be no 3 access to a restroom. The Health Department must be furnished the written agreement. When a food court contains an operating commissary the truck does not have to leave at days end to return to the home commissary to restock and dump the grease trap. There are all kinds of exemptions made easier for the mobile food vendor truck when the mobile food vendor court contains an operating commissary with water, electricity, utilities and a grease trap. The downtown area central business district has been contemplated for something unique and different to draw business such as the mobile food vendor court. Another change without any objection is the increase in fees that had not been done since 2007. Fee Changes Permits: 1) Process 1 (low to moderate risk): $426.99 $150.00 2) Process 2 (high risk): $150.00 $175.00 3) Process 3 (very high risk); $475-00 $200.00 4) Temporary Events: Non Profit $30.00 - Profit $50.00 5) An additional permit fee of $60.00 $75.00 will be charged to a food establishment for each of the following activities at the establishment: a) Meat market b) Catering c) Bakery d) Snack bar /Deli e) Fish market f) Commissary g) Produce 6) Season Permits $125.00 Environmental Health has been going through the process to be standardized by the FDA which entails tracking inspections, violations, and risk levels in certain categories separately. The produce market was added since it was one of the areas tracked. Retail food, food service, and institutional are to be the three separate categories tracked. As an example the retail food tracked would be the meat market, catering, and bakery. Scott Plowman asked if they have to pay for each category they have. Susan Morris responded yes that the food establishment is charged for each of the categories at the establishment. Lou Kreidler continued that Seasonal Permits had been added for seasonal openings such as a concession or Snow Cone stand for $125 with a 6 month restriction. Susan Morris stated the Food Handlers training certificate has not changed it remains at $20.00. Replacement of a lost food handier certificate changed from $4.00 to $5.00 which covers the cost to print and the database record. The addition of the Food Manager's registration of certification will be $5.00 that covers the registration and database record. An addition of re- inspection fees is to be $75.00 per inspection and $25.00 remains per soft serve sample. Addition of Plan review fees are New Construction $100.00, Extensive remodel that requires construction $75.00, Concept change that requires change of equipment $75.00, and $25.00 for each requested site visit. Frozen dessert establishment certification remains $100.00 with a deletion of the included training for one employee. Frozen dessert operator certification deletes the additional employees but remains $20 for each employee with an addition of good for 2 years. 4 Lou Kreidler added that the changes in the ordinance will not change the work flow of what the inspectors currently do. In this budget year we received money to move forward with an electronic program so that the inspectors now have tablets, When the inspectors are out in the field inspections are electronically entered, signed, automatically posted, and emailed to the restaurant manager. Previously the inspectors came in at the end of the day linked to the system then did all the data entry. The electronic program has streamlined the process from a workflow perceptive. Some restaurant chains have requested the inspections also be emailed to the corporate office. Real strives have been made in some restaurants with continual issues because corporate immediately knows the issues in their store which has been a benefit. Lou Kreidler asked for a recommendation of approval or not on the ordinance to present at Council on January 6, 2015 it has always been preferable to have the Board's recommendation. Scott Plowman asked for a motion to recommend the ordinance to City Council on January 6, 2015. The motion was made by Dr. Carlston and seconded by Dr. Williamson. Motion passed unanimously. V. EBOLA INFORMATION UPDATE Lou Kreidier stated since the last meeting with everything that has gone on with the Ebola situation and Dallas cases it would be a suitable time to update the Board on what has been done locally to get prepared. Amy Fagan presented since Lou had been out of town when the first case was diagnosed in Dallas. The Health District does have a Public Health Preparedness program that the staff are comprehensive to cover and do plan for situations of this type. After the initial case in Dallas was diagnosed all the medical partners, EMS providers, hospitals were called together to be included in what was called a RAC (Regional Area Council) meeting for all the counties trauma service area. That was important since a lot of people from the counties come into United Regional, EMS, and the hospital systems the discussion covered basic assurances some specifics such as protocol, cleaning. The dispatch system was discussed and modifications made as a precaution to ensure who responds has some inclination on whether or not the person had traveled. Dispatch worked out special codes for fire, police, and the hospital then a month later got together after other situations had arisen made a final change to some of the plan and it did work well. The 9 -1 -1 responder AMR are screening with additional questions to the protocol about travel and fever. Lou Kreidler added the Health District has a process in place with the hospital as well, if they have something that comes into the ER she is contacted by their Chief Medical Officer. The testing that needs to be done by the hospital to confirm a case cannot be done unless the request comes from Public Health so the Chief Medical Officer being the first notification from the hospital begins the process in place getting patient information to determine if it meets the case definition. The process is important and it works. It is important that our community know we have put plans and a process in place. We are now at the point where there are no active cases in Dallas and no longer following any of the contacts to those cases. There are 5 airports that people from the 4 countries enter the United States those travelers are monitored. They are screened at the airport and can continue to travel on public transportation until they reach their final destination but are connected with the State Department of the final destination. The Texas DSHS are notified when those travelers are to enter into a Texas county informed of the planes arrival time at the final airport for notification to the local Health Department. An initial meeting was conducted with the City Transportation Division then visited the Airport to identify some rooms to use if needed to screen a traveler or travelers. The course of action is to gather everyone together for a tabletop exercise on the process to work through any issues. Currently there are 5 no travelers in the area being monitored but two response teams have been organized that includes a RN, LVN, and clerical person on both teams. A 24/7 Epidemiology phone line enables us to be notified when the front desk number is called it goes to an afterhours answer service that contacts Epi. Dr. Gibson asked about traveling with an animal which was a big issue in Dallas. Lou Kreidler replied it was an issue that some animal guidance was furnished we probably would quarantine the animal at Animal Services or possibly at a vet of the traveler's choice. There has been no prevalent evidence that Ebola is transmitted to animals but they are taking precautions because they do not really know. That scenario needs to be added to the table top exercise. The travelers are categorized as high risk, some risk, or low risk based on the risk determines the amount of contact and /or monitoring done. The high risk require two in person and one phone monitoring, some risk one in person and one phone monitoring, and low risk two phone monitoring. The State sends out a weekly report that reveals the number of cases and those monitored in each local health jurisdiction. Dr. Carlston asked if there was a reason the travelers are screened at their final destination and not the point of entry. Lou Kreidler answered the travelers are screened at the point of entry and given one of the three risk rankings then rescreened because some people give different answers when questioned again. The high risk are issued do not board orders not allowed for 21 days to take public transportation. Fear is someone would develop symptoms in route being the reason for an initial screening upon arrival at the airport. At the table top exercise all scenarios are to be executed a traveler with no symptoms, fever body aches symptoms, and full blown symptoms to be comfortable with the process in place. Scott Plowman asked had it been thought about to put out the information to the public it is not known of the tracking that is amazing but to mention Ebola scares the public. Lou Kreidler replied there had been no press releases probably after the table top exercise has been done. Dr. Williamson, Medical Director of Midwestern State University (MSU) worked closely with the Health District upon the arrival of Ebola. The MSU student body consists of many foreign students he worked diligently in the determinations he explained the process and outcome at MSU. Dr. Williamson contacted the International student office Director Dr, Randy Glean whom gave him a list of all international students with their country of origin and none were from the three now four countries. Another concern was the recently nationalized citizens from Liberia who attend school tend to live in the Dallas ethnic enclaves and gravitate toward the Nursing classes. Dr. Williamson visited the Nursing classes informed them of the situation with advise not to put themselves at risk to become quarantined and miss class because that is an imminent danger to Nursing students. Everybody at his office to this day gets screened with the hope to avoid any loopholes. Those that call for an appointment are screened then again screened by the Nurse at check -in and lastly he screens them. Lou Kreidler asked if there are any questions. Commissioner Ray Gonzalez asked if travelers are tracked when they go to a Liberian country and come back here. Lou Kreidler replied it is unknown of travelers that leave Liberia travel to Ireland then enter the States from Ireland whether the airlines track that point of origin or an intermediate stop. M. Amy Fagan stated she neglected to mention the Health District's constant dialogue with area Physicians and Medical Providers that was where it was missed at that initial medical screen as soon as it came through immediate communication began with the area Providers. All Providers have the screening questions it would be advantageous for the practice to be continued regardless of the traveler origin. Lou Kreidler added we have made sure as we have gotten new guidance because as with anything for a while it is coming out daily sometimes hourly that we have continued to send out the latest information to our health care providers. Dr. Gibson question whether or not there continues to be active cases in New York. Lou Kreidler answered that presently there are no active cases anywhere in the United States. There had been one active case in New York of a physician with the "Does without Borders" on return was monitored then after the development of symptoms admitted. At present everyone that had been in the hospital either recovered or passed on. Scott Plowman adjourned the meeting. VI. NEXT MEETING February 27, 2015 Vil. ADJOURN The meeting adjourned at 12:50 pm. Signature Print Name WFWC Public Health Board Title P/ nw vt, �-,L) 7