PROCEEDINGS OF THE MONTROSE COUNTY BOARD OF HEALTH

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1 The Board of County Commissioners met in special session held at the County Administrative Office Board Room at 10:30 11:00 a.m. Those present: Ronald Henderson, Chairman; David White, Vice-Chairman; Gary Ellis, Commissioner; Robert Hill, County Attorney; Jesse Smith, County Manager; Marie Simons, Deputy Clerk to the Board. A. Pledge of Allegiance WELCOME ROLL CALL: Ronald Henderson District 1 Present Gary Ellis, District 2 Present David White, District 3 Present CALL TO THE PUBLIC: The Call to the Public agenda item was a time when the citizenry brought forth items of interest or concern. Please note that no formal action was taken on these items during this time due to the open meeting law provision; however, they may be placed on future posted agenda if action was required. Note: The remainder of the meeting commenced immediately after the Call to the Public. None B. HEALTH & HUMAN SERVICES, Peg Mewes: 1. Food Inspection Difficulties to Internet (power point presentation Richard Thompson/Joe Ficco) Richard Thompson of Health & Human Services noted that food inspections were public information. In addition, as food safety inspections are implemented it was the goal of H&HS that the inspection process would not be interrupted. It was also important that local inspectors and not someone from Denver complete the inspections. Until recently, two software systems were used for food safety inspections; however, these programs are not compatible and any interfacing must be done manually. Problems were soon discovered with the software when the software reported food inspections that had never been completed. CDPHE (Colorado Department of Public Health & Environment) will eventually make food inspections available to the public on their website along with Montrose County s website; however, uploading the food inspection information is very time consuming, which takes away from the time needed to perform the inspection. Due to a shortage of H&HS personnel, performing food inspections in 2010 was a challenge; however, H&HS was able to perform seventy percent of the ninety percent inspections required by CDPHE. Because Montrose County Environmental Health Specialist Vera Stauffer and Mr. Thompson were experiencing major health issues, Mr. Thompson predicted that only forty percent of the food safety inspections would be completed in More staffing was needed to keep up with the demand for food inspections. Commissioner White asked whether private contractors could perform food inspections. Mr. Thompson acknowledged he was not aware of contractors that made food inspections and speculated there would be regulation issues with CDPHE. Commissioner Ellis then asked when the food inspections would be available on line. Mr. Thompson asserted he did not know. Jesse Smith, County Manager, asked if food inspections were mandated by the State. Mr. Thompson responded that food inspections were one of the most important functions performed by H&HS; however, he acknowledged he did not know whether the function was State mandated. Mr. Smith pointed out that some Colorado counties 10

2 11 choose not to perform food inspections. Commissioner White countered that Montrose County performs food inspections for many of those counties that do not. Peg Mewes informed the Board that Montrose County began food inspections in 1990; however, later on, food inspections were stopped for one year. Subsequently, H&HS resumed performing food inspections because when food inspections were completed by CDPHE, only one food inspection was completed per year per food establishment. Now that H&HS has local control over food inspections, fewer reports of food poisoning have been reported. Commissioner Ellis asserted his belief this was a public safety issue and the County was obligated to provide the service. Ms. Mewes also asserted that if the County allowed CDPHE to perform the inspections, the County was responsible for investigating all violations. At Commissioner Henderson s inquiry, Mr. Thompson asserted two additional full time employees were needed to make food inspections; however, it takes several months to train new individuals, which would cause delays in all the food inspections that are needed at this time. Commissioner Henderson expressed the Board s sympathy to the position Mr. Thompson and H&HS were in regarding staff shortages, and he asserted their belief the issue needed to be addressed. He then suggested scheduling discussion at the Commissioners next planning meeting regarding this matter. At that time, Mr. Thompson conveyed his frustration that it sometimes takes staff over five hours to synchronize their software with CDPHE s database. He acknowledged, however, that he had been informed that this issue might be resolved soon. Commissioner White asked whether the issue could be resolved by the County s IT Department or by the State. Joe Ficco who was also in attendance, asserted his belief that increasing bandwidth would help resolve this issue; however, he noted this would take place once radios were installed and he was unsure of the status of this project. Commissioner Ellis then agreed with Commissioner Henderson s suggestion of scheduling discussion of the issue in a planning session. Ms. Mewes asserted the issue was on the next work session s agenda scheduled the following week. 2. Discussion of proposals regarding regulation of Body Art; Rabies; and Recreational Swimming Ms. Mewes informed the Board that Assistant County Attorney, Carolyn Clawson, had been drafting proposals regarding the regulation of body art, rabies and recreational swimming. Ms. Clawson reported that the Board of Health had the authority to issue an order requiring that dogs, cats, other pets and mammals in the County must be vaccinated against rabies. An increase of rabies has been reported in the State, and some have been reported as close as Mesa County. Commissioner Henderson acknowledged the problem was real. Ms. Clawson asserted that in the past the County issued an order, which required rabies immunizations of pets and other mammals. Commissioner White asked whether rabies immunizations were prohibited in certain types of mammals. Commissioner Henderson and Ms. Clawson asserted all animals could receive the vaccination, unless otherwise instructed by a veterinarian. Bob Hill, County Attorney, noted that the term mammal was a broad category. Commissioner Henderson explained that mammals provide the necessary background for the life cycle of rabies and limiting the type of mammal would be unwise. Ms. Clawson noted that the State s Veterinarian and the Brand Inspection Division of the Colorado Department of Agriculture handles the requirements for the vaccination of livestock. Ms. Clawson asserted that certain working mammals (i.e. lamas and goats) that work with sheep were part of other categories other than the pet category and should be considered under the requirement of rabies vaccinations. Commissioner Ellis asked whether the animals that were susceptible to acquiring rabies should be identified in the resolution. Ms. Mewes and Mr. Thompson expressed their belief that vaccination of dogs and cats should definitely be mandated. Commissioner Henderson noted that skunks, raccoons and bats were the major culprits in spreading rabies in this area. Ms. Mewes added that feral cats were also guilty of spreading rabies to humans. Commissioner Henderson then asked Ms. Mewes and Ms. Clawson to provide recommendations for the Board to be presented at the next H&HS work session. Commissioner White added that it might be necessary to identify (for public education) what the term mammal meant. Ms. Mewes asked for clarification whether the Board desired the word mammal or a list of specific

3 12 animals to be included in the resolution. Ms. Clawson reminded the Board this was addressed under the Colorado State Veterinarian, the Brand Inspection Division and the CDPHE public health requirements. The rabies statute specifically addressed cats, dogs, pet animals, ferrets and other mammals. At Commissioner Ellis inquiry, Ms. Clawson asserted the mammal definition under State statute was broader and more inclusive than the rabies statute specification. Normally, pets are not considered livestock. Commissioner White asked whether stores selling pets should be required to vaccinate. Ms. Clawson countered that an animal must be vaccinated at a certain age. Mr. Smith pointed out that enforcement of this requirement would be difficult. Commissioner Henderson suggested asking Kristen Modrell, County Public Relations, to include information regarding this issue in the County s upcoming newsletter. Ms. Clawson responded that she, Ms. Mewes, and Rachel Hicks, Animal Control Officer, have discussed possible avenues to educate the public regarding the issue. Commissioner Ellis pointed out that this issue probably would not come to the public s attention until an event occurred involving a dog bite and the possibility of rabies. Ms. Clawson countered that discussion had taken place regarding utilizing a lack of rabies vaccination as a primary offense in the prosecution of an offender. Commissioner Ellis expressed his uncertainty how this could be made into a primary offense unless another primary offense was involved. After making a telephone call to Ms. Modrell, Commissioner Henderson reported that Ms. Modrell would discuss the issue with Ms. Mewes so that the rabies threat and the importance of rabies vaccinations would be included in the upcoming County newsletter. At Commissioner White s inquiry, Ms. Clawson suggested listing (according to State statute) dogs, cats, pet animals and other mammals of a certain species as those animals threatened by rabies including any animal that is working livestock. Commissioner Henderson suggested listing the animals as dogs, cats, household and family pets. At that time, discussion took place whether including certain types of livestock in the resolution was necessary. Mr. Thompson suggested listing only pets and work animals in the resolution. Regarding body art, Commissioner Ellis asked whether this regulation included licensing protocol. Mr. Thompson responded that currently, Colorado has a state law that Montrose County has not adopted which allows Montrose to require a certificate of inspection annually. A charge of this inspection would also be required. Montrose County would also be allowed to perform a plan review and opening inspection of body art facilities inspection. The following week, CDPHE will provide H&HS training regarding this matter. Commissioner White asked whether the State required a list of those who patronize body art shops, in the event of an outbreak of Hepatitis B or C. Mr. Thompson responded that State statute requires body art shops to retain records of people who patronize their business; however, he was doubtful that records were kept because no one was performing inspections or the enforcement of the State statute. At Commissioner White s inquiry, Ms. Clawson informed him that the State did not require a database of those who had received body art. Mr. Thompson then referenced an article he read titled Ink Well that suggested providing inmates with body art, rather than letting them perform body art on themselves. This would assist in the prevention of HIV and AIDS in jails and prisons. Mr. Thompson submitted the article for their review. Mr. Thompson reported that a resolution had been prepared that adopted the State s law. Commissioner Ellis asked what would happen if a body art establishment failed to obtain a certificate of inspection or failed an inspection. Ms. Clawson responded that State regulations have no enforcement mechanism; however, State statute permits counties to assess penalties and fines. Because State regulations have no enforcement mechanism, Ms. Clawson did not recommend adopting all State regulations. Mr. Thompson asserted that enforcement would require that fines and penalties be given to body art establishments. In addition, if a health hazard were found at a body art establishment, H&HS would immediately bring the offender before the BOCC with the request to close the establishment. Mr. Hill added that the BOCC has the authority to suspend or revoke a license in the food business; however, he was unsure what authority the Board had in the body art industry. In addition, he expressed doubt whether H&HS had enough staff to handle inspections and enforcement. Mr. Smith pointed out a difficulty in enforcement was that the County does not issue licenses to body art establishments.

4 Ms. Clawson noted it could be enforced under State regulations that state, constitutes a public health nuisance. It would require a due process hearing. Under the State statute you can assess a penalty not to accede $250 for each day of a violation of the appropriate resolution or ordinance. The Board of Health, as a quasi-judicial body can enforce this penalty in a due process hearing. Mr. Smith pointed out the resolution stated, Montrose County Department of Health and Human Services may charge fees for environmental health services applicable to body art establishments necessary to offset the costs in implementing and carrying out body art rules. Ms. Clawson affirmed this was correct and that the rules were listed under State CDPHE or the County can draft its own ordinance or resolution based on State statute and regulations. In addition, State statute allows the County to impose a penalty for performing body art on a minor without the express consent of the parent. Commissioner White clarified that these resolutions were only in draft form and that H&HS would adjust and complete the resolutions and would then return to the Board later for finalization and implementation of the resolutions. Ms. Clawson affirmed this was correct. Regarding swimming pools and mineral baths, Mr. Thompson reported that the salmonella outbreak in Alamosa, Colorado was the largest source of water-borne illness in Colorado in the past ten years. In Montrose County, there are approximately forty pools and hot tubs. A State law mandates that plans must be approved before these commercial pools and hot tubs can be built. In addition, these pools and hot tubs must have certain water conditions and must be operated by a certified operator. Federal rules would also be included that prevent children and adults from being caught in the plumbing system. Mr. Thompson suggested that performing one or two inspections per year of each pool and hot tub were necessary. Commissioner Henderson agreed that the issue was serious and suggested collaboration with Ms. Modrell to educate the public regarding all three matters listed in this meeting s agenda. Mr. Thompson suggested that the County be prepared to begin inspections of pools and hot tubs the spring of Because Mr. Thompson was the only individual who was trained to perform the inspections, he suggested training several other individuals to perform inspections. Commissioner White noted that people have drowned in hot tubs due to drain issues and asked whether hot tub equipment should be inspected. Mr. Thompson responded that this was a separate issue and he had been unable to get an answer from CDPHE regarding the issue. Currently, CDPHE has no program to address the issue. Children often drown in hot tubs due to lack of fencing or covering; high temperatures contribute to drowning as well. 3. Campylobacter in Montrose National recognition (Power point presentation Lynda Stack) Lynda Stack reported that the April 2009 incident in Montrose County regarding campylobacter and raw milk drew national attention due (in part) to the way the Montrose County Public Health Department and the Department of Health and Nursing collaborated to investigate and mitigate the issue. Ms. Stack proceeded to present the following power point to the Board. Raw Milk is a Raw Deal o Campylobacter and Raw Milk: Montrose County Communicable Disease Incident April 2009 Some Background o Large dairy outbreaks in 1800 s, as dairies more centralized o Pasteurization invented late 1800 s o Ultimately 2 techniques adopted: o Certification verifying sanitary practice o Pasteurization o Large decline in infant deaths and outbreaks due to milk 13

5 14 Was it Pasteurization? o Heat treatment with specific time and temperature combinations o Rapid cooling o Destroys pathogens o Does not sterilize milk o Not confused with Homogenation Fortification (vitamins A and D) Milk s potential to be organic Pathogens that can be found in Unpasteurized Milk o Brucella o Campylobacter can cause severe gastrointestinal symptoms and can cause disease in the elderly and young children. This can also cause geombre syndrome, a progressive, neurological syndrome that can last a lifetime. o E. Coli 0157 Recently on the eastern slope of Colorado, two infants ingested raw milk and developed renal failure and were hospitalized due to E. Coli infection. o Listeria o Mycobacterium bovis o Rabies virus (maybe) o Salmonella o Staph. Aureus o Streptococcus o Yersinia (These pathogens are easy to control with pasteurization.) Colorado Cow Share Statute o Cow shares may distribute raw milk to shareholders o Must register with CDPHE o Prominent warning label on milk container or delivered with milk o Not inspected by CDPHE o No requirements for milk testing o Cow share operator may not make claims that imply approval or endorsement by CDPHE Montrose County April 2009 o Operating standards (per local dairy) closely match the requirements of a Grade A Dairy and could, if necessary, meet the scrutiny of the Colorado Department of Health o Milking Parlor: The milking parlor will have adequate lighting, properly distributed. There will be adequate ventilation to prevent condensation and to minimize odors. Gutters and floors will be made of good quality concrete and graded to drain. Walls and ceilings will be made of a suitably impervious material to ensure they are easily cleaned. Any feed storage area will be separated from the milking parlor by dust-tight doors. All areas of the milking parlor will be kept clean, free of manure and in good repair. Ms. Stack informed the Board that Linda Van dehay, the Communicable Disease Nurse for H&HS checks a State website twice a day to determine whether there are any reported communicable diseases. When a campylobacter outbreak was reported in April of 2009, she investigated the dairy that was reported to have campylobacter in their milk. At that time, there were twelve confirmed cases of campylobacter and sixty-nine unconfirmed cases.

6 All of these cases were connected with this one dairy, either through direct purchasing of the raw milk or from sharing their milk with individuals who were not members or shareholders. When questioned, the dairy owner countered that his dairy closely matched the operations of a Grade A dairy and could meet the requirements of CDPHE listed above. However, the pictures below show the milking parlor, milk house and the method of milk distribution that indicated otherwise. Milking Parlor Milk House Milk Distribution 15

7 Example of a Grade A Dairy Montrose County Incident presented at CDC Conference Kate Lujan, State Field Epidemiologist, presented this case at the International Conference on Emerging Infectious Diseases o An example of first-rate collaboration between environmental health, public health nursing and state epidemiology. o Used as an example of how to investigate and mitigate communicable disease. Ms. Stack reported that the Environmental Health Department collaborated with the State to educate the offending dairy farmer how to make his dairy a clean, healthy place for milking cows, milk storage and distribution. Subsequently, testing of the milk showed the milk to be free of campylobacter. The bottom line o Raw milk is inherently an unsafe product and must be pasteurized o If it will be consumed raw Clear labeling as unpasteurized Consumers well informed of risks o This issue will continue to grow Cow share advocates may try to expand to additional milk products o Outbreaks will continue Bob Hill asked why people wished to drink raw milk. Ms. Stack responded that some people believe that pasteurization of raw milk eliminates the minerals and vitamins from the milk; however, Ms. Stack maintained this belief had not been scientifically proven. Commissioner White asked whether the content of the milk was partly determined by what the cow eats. Ms. Stack agreed but countered it was also determined by the cleanliness of the dairy and noted that hand washing and treatment of the milk jars were also a problem at the offending dairy causing an unsterile environment in which bacteria could grow. Commissioner White asked if these standards and issues applied to goat milk. Ms. Stack affirmed they did apply to goat milk. Ms. Mewes informed the Board that one of the reasons they were making this presentation to the Board was to inform them of upcoming legislative initiatives that intend to expand the raw milk industry to yogurt and cheese. It was also the intent of the legislation for these raw milk products to be sold at roadside stands and farmers markets. According to the Colorado Public Health Alliance (on September 17, 2010), there have been so many outbreaks of problems from the ingestion of raw milk, this legislation has been stalled. 16

8 With no further business coming before the Board, the Board of County Commissioners adjourned at 12:01 p.m. ATTEST: Francine Tipton-Long, County Clerk & Recorder By: Marie Simons Deputy Clerk of the Board BOARD OF MONTROSE COUNTY COMMISSIONERS Ronald D. Henderson, Chairman David S. White, Vice Chairman Gary Ellis, Commissioner Verbatim recordings of the Commissioners Proceedings of September 20, 2010 are on file in the Montrose County Administration office. 17