MINUTES OF THE BOARD OF HEALTH MEETING FOR THE NEWTOWN DISTRICT DEPARTMENT OF HEALTH, TUESDAY, JUNE 23, 2009 AT 10:00 A.M., NEWTOWN HEALTH DISTRICT, 31 PECKS LANE, CONFERENCE AREA, NEWTOWN, CT 06470
PRESENT: Donna McCarthy Culbert - Director of Health, Dr. Robert Grossman, Chairman; Board Members: Joan Crick, Audrey Grasso, Bernard Meehan, Herb Rosenthal. Dr. Draper, Medical Advisor
PUBLIC PARTICIPATION: None
Herb Rosenthal made a motion to accept the meeting minutes from December 9, 2008. Bernie Meehan seconded. Motion approved.
Reports of Officers and Director of Health
Ms. Culbert informed the Board members that in January 2009 she contacted Mr. Silvaggi, First Selectman, Town of Brookfield, and shared with him what the Town of Brookfield needed to accomplish in order for them to move forward in their pursuit of membership to the Newtown Health District. Ms. Culbert explained that she worked with the Brookfield Task Force, which was organized to look at the needs of the Town of Brookfield with regard to public health issues and problems only to learn at the time of Brookfield’s budget negotiations that they were not in a position financially to commit to becoming a member of the Newtown Health District.
Ms. Culbert explained that while this was frustrating, it will be an item of concern that will be looked at more carefully in the future should another town want to consider joining the Newtown Health District. Ms. Culbert addressed the fact that while they are good neighbors and part of the HVCEO system, it was her hope that they would grow in their understanding of what their real public health needs and concerns are. Ms. Culbert explained that the Town of Brookfield has hired a part-time health director, Dr. Sullivan, who is a retired physician and also the part-time Director of Health for Middlebury.
Mr. Stuart shared with the Board members that he was at a recent HVCEO meeting in Brookfield concerning the redistricting of probate courts and it appeared that the first selectmen for both Brookfield and Newtown were very motivated to have the Town of Brookfield join the Newtown Health District. Mr. Stuart felt that Mr. Silvaggi was not clear in his understanding of where the Newtown Health District stood. Ms. Culbert replied that the investigative process with Brookfield is done and the District will not accept Brookfield into the Newtown Health District.
Ms. Culbert reiterated that the Town of Brookfield has not been willing or able to do what they need to do to bring a proposal to the table. Ms. Culbert noted that the Brookfield Board of Selectman originally agreed and made a motion to hire a full-time Director. Ms. Culbert explained that as budget deliberations continued the Selectman for the Town of Brookfield removed the funding in the budget to hire a full-time director. Ms. Culbert went before the Board of Finance for the Town of Brookfield, because it was her understanding that often they will put monies back in the budget. Ms. Culbert stated that she and Brookfield resident Maureen Farrell made the same presentation to them and that they seemed receptive but only allocated $10,000 for a health director. Ms. Culbert concluded
that the Town of Brookfield was not ready at this time to commit and make public health a priority and as a result the Newtown Health District will not consider their membership. It was suggested by the Board members that a copy of these meeting minutes be shared with the Town of Brookfield so they know where they stand.
Mr. Rosenthal made a motion to no longer accept Brookfield into the Newtown Health District as a member. Joan Crick seconded. Motion approved.
Ms. Culbert explained to the Board members that the Newtown Health District invoiced and received payment from the Town of Brookfield for services rendered in the amount of $12,000.
Ms. Crick suggested that Ms. Culbert be compensated for her time and effort. Mr. Stuart asked how Ms. Culbert arrived at the $12,000 figure. Ms. Culbert explained that they had $10,000 in their budget for a part-time health director, and that she broke that figure down to approximately $1,000/month even though her services ran to a year and a half. Mr. Rosenthal asked the Board members to consider a stipend rather than an hourly rate as it would be more appropriate.
Ms. Crick asked Ms. Culbert what the $12,000 what would be used for. Ms. Culbert responded she would place those monies in the fund balance, explaining that she was not sure where the District stands with the Governor’s proposed budget and what the per capita funding will be. Dr. Grossman made the recommendation that those monies be split in half between Ms. Culbert and the Health District.
Dr. Grossman made a motion to split the monies in half and award Ms. Culbert a stipend of $6,000. Bernie Meehan seconded. Motion approved.
Bernie Meehan made a motion to approve Resolution #1 (see attached). Audrey Grasso seconded. Motion approved.
William Stuart made a motion to approve the Resolution #2 (see attached). Seconded by Mr. Meehan. Motion approved.
Budget (Budget Amendments Detail Sheet attached)
Ms. Culbert explained to the Board members that budget amendments and line item changes traditionally take place at the June BOH meeting. Ms. Culbert noted that a bookkeeping error has been made for the past three years in calculating the pension plan for Keith Vaughn, Assistant Sanitarian. Ms. Culbert explained that it was clarified for her in recent months and that she sent it to our attorney for review.
Ms. Culbert explained that when Mr. Vaughn began his employment with the Newtown Health District he retained his rights and the benefits of the town’s pension system by which he was employed and continues to retain active participation until he retires, which is his right by state statute. Mr. Vaughn pays into that pension system the contributions required of him for his class and membership. The language of the retirement plan said it was an employer contribution and not an employee contribution. Ms. Allingham, Bridgewater Treasurer asked for clarification; Ms. Culbert called the state but did not receive clear direction. She then contacted Newtown Town Attorney, Dave Grogins, who referred her to Greta Soloman, an associate attorney with Cohen and Wolf, who is their pension specialist.
Ms. Soloman reviewed the retirement plan, the statute and what the Newtown Health District had been doing and it turned out the calculation was incorrect. The District was over withholding Mr. Vaughn’s pay and needed to correct that problem. Ms. Culbert explained that Mr. Vaughn is entitled to receive the same percent contribution the other Health District employees receive from the Town of Newtown. The employees provide their percentage out of their pay check, which is 2%, and the Town of Newtown has provided, this year, 3.2%, which goes towards the pension plan. Mr. Vaughn is entitled to that same percentage.
Ms. Culbert calculated the figure that was over withheld for the years 2006, 2007 and 2008 and reconciled it in 2009. Ms. Culbert noted that those three years of over withholding have been rectified and Mr. Vaughn was given a check for those monies. Ms. Culbert informed the Board members that that figure now needed to be accounted for in the budget and some line item transfers were required.
Ms. Culbert presented the line item transfers as follows: Under the Salary line item the bookkeeper monies and the environmental health services have not been utilized for budget year 08-09. The bookkeeper amount is $4,000.00 and environmental services is $1,691.09. Ms. Culbert requested that these monies be transferred to the Assistant Sanitarian line item to cover the over withholding payment for Mr. Vaughn.
Ms. Stuart inquired about fund balances and transfers. Mr. Stuart asked Ms. Culbert if there were any limits on the amount of monies the Board was allowed to transfer or if it was open-ended. Ms. Culbert replied that she did not believe there were any limits in the NHD by-laws. Ms. Culbert explained that when a line item transfer is proposed the monies stay within the budget and do not increase the budget figure. Mr. Stuart asked if there was a contingency fund in the budget. Ms. Culbert replied yes. Mr. Stuart asked if there were any limits on taking money out of contingency. Ms. Culbert replied no and that the figure is small - $2,500.
Mr. Stuart reiterated that the funds were within the NHD budget and were not exceeding it. Ms. Culbert concurred. Mr. Stuart asked if there was a carryover contingency in the budget system. Ms. Culbert responded that there is a fund balance. Mr. Stuart asked if there is a fund balance that is carried over by the District. Ms. Culbert replied yes. Mr. Rosenthal explained that it is not really a carryover but just like the general fund that the Town has. Mr. Rosenthal compared it to the Town budget explaining that if the Town comes in under budget at the end of the year, those funds are held onto and carried over.
Ms. Culbert shared her concern that this year the NHD is unsure of the per capita figure because it is dependent upon what the legislature comes up with. Ms. Culbert noted that the NHD originally budgeted a figure of $70,000. Ms. Grasso noted that the NHD has never been in this position before. Mr. Stuart asked what the fund balance was. Ms. Culbert stated she thought it was about $70,000 or $80,000. Ms. Crick asked if any of those monies are used towards the budget. Ms. Culbert replied that they have been used in the past, but have not been used in the last few years. Mr. Rosenthal added that those monies would have to be appropriated because they are not part of the annual budget. Mr. Rosenthal further added that the Board would have to make a special
appropriation from the fund balance. Mr. Rosenthal explained it as sweeping it out at the end of the year and placing those monies into the fund balance, just like a municipality would, so the Board would have to appropriate it, except that the NHD would not have to go to a town meeting for it. Ms. Culbert explained that depending upon what happens with the state funding, fund monies may have to be utilized.
Ms. Culbert stated that the second line item transfer request was to place the monies from the Operating Field Equipment line item in the amount of $400 into clothing. Ms. Culbert explained that in the employee’s contract a generic statement is made that should additional funds become available at the end of the year, the NHD could provide an additional piece(s) of logoed clothing, i.e., shirt, jacket, etc.
Ms. Culbert’s last request was to appropriate fund balance monies. Ms. Culbert explained that an increase in this year’s budget was necessary due to the NHD’s responsibility for paying for CIRMA which provides coverage for workman’s compensation, liability, and automobile rather than the Town of Newtown. Ms. Culbert noted that when proposed, the figure was $7,0000 for that line item. Ms. Culbert stated that the NHD has received four bills totaling $26,000. Ms. Culbert went to the Finance Director and the Town paid the first bill in the amount of $7,000, but that the rest of that amount is $19,735 and needs to be accounted for. Ms. Culbert concluded by stating that the District did not have enough money in the budget to do a line item transfer to cover those monies.
After some discussion by the Board members it was noted that the District could not change the budget without a special appropriation. It was agreed by the Board members that the monies should be appropriated, identified as a separate category and reflected as such in the budget. The end result would be an increase in the Health District budget.
Mr. Stuart made a motion to transfer the three line items as requested. Motion seconded by Herb Rosenthal. Motion approved.
Herb Rosenthal made a motion to make a special appropriation from the fund balance to cover the increased cost for CIRMA in the amount of $19,735.00. Mr. Stuart seconded. Motion approved.
Mr. Stuart asked what the reason for the increased costs for CIRMA were associated with. Mr. Rosenthal explained that the CIRMA account is an umbrella account that covers Workman’s Comp, liability, and auto insurance. Mr. Rosenthal noted that NHD used to be covered under the Town of Newtown but that when CIRMA realized that the NHD was really no longer an agency of the town of Newtown but now covered three municipalities, it had to be covered separately and was split off from the Town. Mr. Rosenthal explained that as a result it was a separate policy and the cost was greater. Mr. Stuart expressed his concern that as presented, it appears that the District had a claim that made the policy go up, but appreciated the explanation that it covered liability and vehicle insurance and shared his
opinion that it should be reflected as such in the budget. Ms. Culbert suggested she could modify the CIRMA line item by breaking it down into those categories. Both Mr. Rosenthal and Mr. Stuart agreed it would be more appropriate and more easily understood.
Dr. Grossman asked the Board members if they were in favor of re-identifying the CIRMA line item for ease of understanding. Having no further comments, Dr. Grossman made a motion to approve. All Board members were in favor. None opposed. Motion approved.
Ms. Culbert explained that the second page of the Budget amendment for 2008-2009 reflected the grant funds that were received after the current budget was approved and the new fiscal year began. Ms. Culbert reminded the Board members that when the budget is prepared, the per-capita grant figure is unknown. The 2008-2009 figure used was $61,148.15, but the NHD actually received a figure of $67,446.00 grant. Ms. Culbert noted the increase as $6,297.85.
Moving onto grant monies, Ms. Culbert identified the Preventative Health Block Grant as being $4,676.00 and the 2008-2009 Public Health Emergency Response and Preparedness Grant in the amount of $64,109. The increase due to the appropriated fund balance is $19,735 and was placed in the Revenue account. Ms. Culbert identified the increase in the 2008-2009 budget as going from the approved $610,935.80 to $705,753.65.
Mr. Stuart asked about Ms. Culbert’s accounting for increases and decreases in the NHD budget when it came to grants, actual tax monies from the towns, and monies from the State. Mr. Stuart noted from his experience that when Towns receive additional appropriations and increases in their annual budgets they are reflected as increases to the actual budget and if not realized/received in the following years budget are looked at as a decrease in that years budget. The increases and decreases can be confusing to the taxpayer reviewing the budget. Ms. Culbert explained that Block Grants and the Public Health Emergency Preparedness Grants are also unknown at the time of the next year’s budget preparation.
Mr. Rosenthal explained that though some towns do appropriate grants, Newtown does not. Mr. Stuart noted that certain grants that are received on a regular basis should be considered on the revenue side of the budget but not one time grants. Mr. Stuart noted that grant monies received for budget year 2008-2009 increased the budget from $630,670 to $705,753.65.
Ms. Culbert responded to Mr. Stuart and explained that every year she does include the per capita grant in the proposed budget because it has been a recurring grant ever year but that a modification to the actual figure is sometimes necessary due to population figures and the actual amount realized which in the instance of the 2008-2009 budget was an increase of $6,297. Ms. Culbert noted that per capita grant monies were included in the 2009-2010.
Mr. Meehan asked about the $64,000 PHERP grant and how it was spent. Ms. Culbert replied that it was used primarily for equipment and for contractual services for planning and exercises. Ms. Culbert stated that it could not be used to pay salaries or other routine District operational costs.
Mr. Rosenthal suggested to Ms. Culbert that she contact the accountant to help formulate a budget that includes re-occurring grants from the town and the state. Mr. Rosenthal also recommended that special grants be accounted for separately and not as part of the operating budget because it has an effect on the overall budget presentation.
Mr. Stuart asked if there is specific tracking account when special grant money is received. Ms. Culbert replied that those expenses are tracked to that grant using existing Quickbooks software. Mr. Stuart, Mr. Rosenthal and Mr. Meehan agreed that a separate accounting system should be used for the purposes of special grant monies.
The Board members questioned if the grant monies would have to be paid back if not used. Ms. Culbert stated that the per capita funds could be carried over but the block grant and the PHERP could not.
The Board members were in agreement that Ms. Culbert should contact the accountant and seek a way to resolve the issues surrounding the accounting of grant funds.
Ms. Culbert shared with the Board members the recent events surrounding the emergence of the H1N1 virus and its effect on the community. Ms. Culbert noted that at the onset of the H1N1 virus there was a lot of media activity because the virus was unknown. Ms. Culbert shared that it is a milder flu and is on-going.
Ms. Culbert stated that she has worked with and continues to work with the school systems. The Reed Intermediate School in Newtown closed from June 22, June 24, with only teachers reporting. Ms. Culbert explained that the collaborative decision to close Reed school came about because sick children were still attending school sick and/or symptomatic. Ms. Culbert noted that there has been one confirmed case in Newtown. Confirmation means a swab test was analyzed for H1N1 and came back positive. Ms. Culbert stated that there are probably many more residents who have contracted H1N1 but they are not confirmed; they have likely stayed home and gotten better. Ms. Culbert stated that the H1N1 virus is anticipated to remain throughout the summer and the healthcare community does not know
what to expect for the fall.
Dr. Draper and Dr. Grossman explained that at the present time there is on-going work to develop a vaccine, which includes all kinds of testing and that decisions about administration of the vaccine and how it would be administered are yet to be determined. Both agreed it was an on-going process. Dr. Draper stated the healthcare community initially did not predict that the H1N1 virus would go on throughout the summer because the seasonal flu season usually ends or disappears and it was anticipated that this would as well. Dr. Draper added that this is not happening.
Dr. Draper commented that the severity of this particular infection appears to be mild and does not seem to be as severe as seasonal flu in terms of fatality across the country. Dr. Draper noted that if this virus spreads in the southern hemisphere, it may mutate and that is part of the dilemma with developing a vaccine. Dr. Draper shared that if the virus mutates it will come back and infect people in a different way and that the original immunity would not be effective in fighting the re-emerging possible new virus.
Dr. Draper further shared that the healthcare community has learned from an epidemiological position that it tends to affect younger people more rather than older people. Dr. Draper explained that this is because older people have confronted similar viruses in the past and thusly have an immunity. Dr. Draper added that there is some benefit in that as well as the fact that the severity thus far seems to be very modest.
Dr. Draper noted that future vaccination plans may require two different vaccines. Dr. Draper stated they would include a vaccine for seasonal flu, which generally begins somewhere in the Pacific and Asia and then moves to our west coast and then to the east coast. Dr. Draper stated the healthcare community is awaiting word from the CDC, which he was told is making significant progress.
A question as to the origin of H1N1 was raised and the possibility that it was the same virus that emerged in 1976. Dr. Draper replied it was not the same virus as the one in 1976. Dr. Draper added that the H1N1 virus was originally thought to have originated in Mexico but the genome was studied and wasn’t revealed to be related to the pigs at all but related to the avian bird flu, so it is a mixture.
Mr. Meehan brought up the issue of people attending meetings and the congregation of large numbers of people. Ms. Culbert responded that when you encourage people to congregate it does become an issue of concern and again standard protocols should be used. The public health prevention message remains that if you are sick you should remain home.
Mr. Meehan also addressed his concerns about the notification of major health facilities becoming aware through communications about potential health concerns. Ms. Culbert agreed that communication is a big issue. Ms. Culbert noted that it is difficult to parcel out information in the beginning of any healthcare situation. Ms. Culbert noted that the Health District developed very close coordination between the school systems and the state public health department through daily teleconferences, e-mails. Mr. Meehan noted that there was a lot of redundancy in the daily conference calls.
Ms. Culbert added that communication was an issue with the community in the last week regarding the efforts to encourage parents to keep their children out of school. Ms. Culbert stated that as the illness started to emerge last week at the Reed School the effort to get it under control and manageable was too elusive by the end of the week. Ms. Culbert stated if there was more time available, the District and school nursing staff would have worked more closely with parents and screening children. It was agreed that because it was the end of the school year, this was a difficult task and hard to monitor and achieve compliance.
Tick Borne Disease
Ms. Culbert informed the Board members that the NHD has adopted the BLAST program along with the other towns in the 10 town region. Ms. Culbert noted that the BLAST Program was developed by the Ridgefield Health Department through a grant. Ms. Culbert stated that the NHD continues its efforts to educate and inform the community. Mr. Meehan asked what the Lyme Disease figures were for the current year. Dr. Draper answered that they are about the same as last year, no greater. Dr. Draper noted that the third agent is becoming more prevalent – Babesiosis. Dr. Draper added that it is a far more serious disease. Mr. Rosenthal questioned if Babesiosis could be confused with Lyme Disease. Dr. Draper stated they are quite different.
Water Supply Safety
Ms. Crick asked if the water supply in the borough was or is tested. Ms. Culbert replied that it is tested regularly and at 5 or 7 locations throughout the distribution system as required by CT DPH. Ms. Culbert explained that the water company tests at the well site and sampling points throughout the community.
Ms. Crick asked how old the pipes were and if that could be a problem with water quality issues. Ms. Culbert answered that when water mains are operating and under constant pressure, turbidity remains low and water quality should be good. A problem will be evident when a water main breaks and pressure drops and sediment is dispersed into the water. The turbidity is an aesthetic issue.
Mr. Meehan added that the homeowner’s pipes could be the problem and not the water system. Ms. Culbert agreed and reiterated that all water distribution systems are required to have certain sampling points throughout their systems depending on how large they are and the number of users.
Dr. Draper asked if there were any increase in wells failing because of one contamination or another. Dr. Draper noted that well failures are sort of our guide to the ground water. Ms. Culbert stated that the District has not seen a lot of contaminated wells or replacement wells. Ms. Culbert further stated that the District is more concerned about people who have buried well heads and possible surface or ground water infiltration contamination.
Mr. Stuart brought up the inclusion of the Executive Session on the agenda and suggested that it appear as a possible Executive Session. Mr. Stuart advised that when it does appear in advance, it must have an agenda so people can know what you are taking up. Mr. Rosenthal agreed.
Mr. Rosenthal reminded the Board members that at special meetings, under FOI rules agenda items cannot be added. Mr. Rosenthal added that at regular meetings agenda items may be added and if you had to have an Executive Session that would be allowable.
Ms. Grasso asked if the BOH need to set a BOH meeting agenda. Ms. Culbert replied that the BOH was required by statute to hold four meetings per year. Ms. Culbert added that it would be ideal to set meeting dates, but the Board members felt this was not necessary and should meet on an as needed basis.
Dr. Grossman asked the Board members if there was any further business. The Board members did not have any and Dr. Grossman made a motion to adjourn the meeting. Seconded by Joan Crick. Meeting adjourned at 11:30 A.M.
Maureen C. Schaedler