Michele Thomas, Nurse Coordinator, provided an overview of the
School Nurse Program to the Board. Handouts were in the Board Packet.
Michele explained the role of a school nurse includes linking the
students and often their parents to community health providers. The
image of a school nurse who was there to put a band-aid on a scraped
knee is long gone. In June 1999, a school nurse definition was adopted
by the National Association of School Nurses. The school nurse can see
the child, assess, treat as needed, and return them to class instead
of automatically sending the child home.
To illustrate how valued this program is, Michele related how the
secretaries and school personnel within Harper Creek rallied when
there was talk of a potential cutback. There has also been interest in
support from service clubs; Michele passed around several student
drawings that were presented to the Battle Creek Rotary Club upon
their request for a “hands-on” reason for the school nurse program.
During the 2002/2003 school year, 29,132 students were seen by a
school nurse and 8,125 students were seen by BCCHS Adolescent Health
Center.
One new focus for the school nurse program this next year will
include asthma training (providing educational materials, training to
teach children how to control their asthma, etc., and collecting
outcome data).
Byron stated that he feels this program has done the most for the
children in Calhoun Co. and knows that this is bigger than other
counties around Calhoun.
Ben Miller commended the Health Department staff for this program.
In response to a question from Larry about the impact of school
budget cuts, Michele explained that Battle Creek Public School System
changed their student nurse ratio. It has now become evident to the
schools how important and valuable the school nurse program is, and
schools within Calhoun County are looking for ways to increase the
nurse to student ratio.
Jeff Mitchell asked what was before this program (approximately 8
years ago). Michele and Heidi answered that a previous Public Health
Nurse model was followed that specified a territory for each nurse to
complete immunizations, communicable disease control, etc. These
territories would include the schools. Jeff also asked, since this
program is funded primarily by the schools, what makes this program
“go.” Heidi answered that it is more practical for the health
department to employ school nurses due to standards that are imposed
upon the schools who employ their own nurses. Many schools do not want
to be in that position.
Jeff asked in many schools, the school secretaries dispense
medication to the students. What training or certification must the
secretaries receive in order to dispense? Michele answered: The
Michigan Department of Education has established guidelines for
schools and staff to follow for medication administration. The
Michigan Association of School Nurses has a program that teaches
school staff on medication administration following Michigan
Department of Education guidelines. Within Calhoun County, BCPS and
CISD provide training to school staff with the assistance of the
Health Department school nurses.
Environmental Health Report
Ted Havens, Environmental Health Director, presented the
Environmental Health (EH) Fee proposed changes and the Sanitation Code
Amendment.
Ted explained that all environmental fees were reviewed and
revisions are proposed for the upcoming budget year based on time
records and the services provided over the fiscal year, budget, and
known costs for EH. EH received other fee schedules from surrounding
and comparative counties as indicators for comparison (enclosed in the
Board packet). However, he can not be certain of what other counties
include in their fees. He explained that one county hires a consultant
to review their costs; however, other counties may just adjust fees
based on budgets and services or by a percentage.
Larry asked when fees are recalculated, did we complete in the same
manner as previous years. Ted responded yes. Jean explained that there
aren’t many changes and she would support. Larry asked if the Board
needed further explanation.
Greg Purcell asked about the proposed food service fees. Ted
explained the changes in the food inspection program are due to
changes in the law from the state health department and the Department
of Agriculture. Food inspections have been changed entirely. There is
no longer a checklist and inspections are now very
extensive/inclusive. The current food inspections include critical
points on handling food (e.g., preparation, receipt, refrigeration and
reheating practices). We provide food training for food service
operators and employees currently. However, it is voluntary. The food
training is intended to help prevent an outbreak of foodborne disease.
We believe that our training efforts are paying off as we have not had
a foodborne disease outbreak. Our recent accreditation commended our
training efforts.
Menu classifications have been developed to include simple and
complex menus. Simple may include very little hazardous food (e.g.,
Taco Bell – all items come in a bag) whereas Complex includes homemade
items (Clara’s on the River, Schuler’s, etc.). The type of
restaurant/food preparation determines the amount of time for an
inspection. This is the reasoning for the proposed change/increase in
food inspection fees. The fee is proposed at $300 flat rate for Simple
Menu and $500 flat rate for Complex Menu per year. Both rates include
unlimited employee training during the year. NOTE: Food safety
training certification is good for three years. Paul Makoski and other
EH staff have reviewed Calhoun County establishments, including menu,
and determined which are Complex or Simple.
Food training classes are a critical part of these proposed fees. A
portion of the fees include a food training program for restaurant
managers. As part of the sanitation code, this will include a
restaurant manager on duty while the restaurant is open for business.
The new regulations require an individual certified in food safety and
preparation to be on-site during food service operations. Some
establishments may need additional certified staff due to their hours
of operation. The certified individual will oversee the food operation
(e.g., handling, temperature, and possible contamination) and could
make an appropriate and timely decision on what to do (throw away or
serve).
Paul is certified by the National Restaurant Association to conduct
the trainings.
The amendment presented in the Board packet addresses the reasoning
for these changes.
Ben asked what differentiates Simple and Complex. Would a pizza
parlor be classified as Simple? Paul Makoski answered yes, generally.
Hazardous Analysis Critical Control Point (HACCP) was developed to
support the increasing educational information needs of industry and
foodservice professionals in implementing HACCP programs to reduce
assumptions about the food. Food preparation is divided into seven
classes.
Clara’s, Schuler’s, Old Country Buffet, for example, will fall
under Complex. They prepare many items from scratch. There is a
written definition in the Food Code, as adopted by the State of
Michigan, Act 92, P.A. 2000 explaining Simple and Complex. The
definition is provided by the state, but each county has the right to
change or add on to as long as we aren’t in opposition of the written
code. Calhoun County has approximately 550 restaurants. The split
between Simple and Complex is approximately 50/50.
Heidi Oberlin asked if the definition is clear-cut. Paul answered
“Yes.” Larry asked about the Calhoun County McDonald’s for example.
Paul stated that all McDonald’s managers have been trained for many
years and indicated that the McDonald’s restaurants in Calhoun County
are some of the cleanest.
Ben asked approximately how many of the 550 restaurants in Calhoun
County currently have people on-staff that are food service trained.
Paul answered that due to turn-around of people within the restaurant
industry, it is hard to provide an estimate. However, certifications
remain good for three years, therefore, if a manager moves to another
restaurant, their certification remains effective. The employer pays
the employee’s wages, but the inspection fee covers the training. The
fee that a restaurant currently pays for an employee is on top of
their license fee per employee.
Ben asked about stores like Meijers that prepare food. Ted stated
that all grocery stores are governed and inspected by the Department
of Agriculture. We do, although, inspect school cafeterias.
Byron asked what the current fee is. Paul answered $212 to $352
(determined by the number of seats). Paul: We have a basic fee and
fines are issued on top of that.
Larry asked about caterers. The rules for caterers are the same as
restaurants (e.g., Paula’s catering in Marshall is considered complex
because all items are homemade).
Jeff asked if an employee leaves, does a restaurant owner have a
window to replace and train another individual. Ted answered that yes
there is a 60-day window, however, an additional fee is added to the
next license if they don’t replace/train another individual after
those 60 days.
Paul explained that we are looking into changing the availability
and times of Manager classes [morning (2) & afternoon(2)] and
shortening the training length. The current class length is eight
hours. Therefore, we could provide two trainings per day.
Byron: What do we generate now for license? And what will we
generate? Our current revenues are $95,000 and a rough estimated of
the new fee is $155,000. Paul stated that the Health Department now
has adequate staff to thoroughly inspect all the restaurants in
Calhoun County.
Larry suggested that we have a public hearing at the August Board
of Health meeting and a notification/letter go out to all restaurant
owners. Ted indicated that in past years we have set up mini-meetings
and comments were brought back to the Board of Health. Byron added
that every restaurant should receive a mailing/notification of the
proposed changes.
Nancy asked if there is a law that states the Health Department can
impose fines issued? Nancy’s concern is even though it allows for
administrative remedies, the only remedies we are acting on, are court
imposed.
Ben asked if our costs increased significantly. Paul Makoski
answered that the number of staff has increased and the time it takes
to inspect each restaurant four times per year. The gross increase in
restaurant fee revenue as proposed is $60,000.
Jim Latham asked when setting fees, why you would have cases where
the costs are different and what are the factors for setting fees. Ted
answered that it was the theory of the Health Department in previous
years to capture about 50% of the costs. Paul Makoski stated that in
past years we have never had a fee that reflected real-time costs.
Compared to other counties, we have a high rating of food inspections.
Ben asked if there is a need to differentiate between Simple &
Complex and if the need to go beyond is state mandated. Paul provided
an example. He recently did an inspection in a restaurant where a
laid-off electrician was temporarily working in a friend’s restaurant.
Greg applauded EH for completing inspections and raising the fees.
He feels that EH will take some heat, but is a good approach facing
the environmental conditions that we work under. Greg feels that EH
has not been charging what EH is spending.
Greg referenced the comment “we are the second in the state to
implement such fees.” Paul and Ted answered that Oakland County and
Genesee County are others.
Ben is concerned about the requirement that a trained certified
person on staff at all times will be a burden to the smaller
restaurant. Paul answered since we currently have about 50% of
restaurants have process in place now and it should not be an issue.
Jean reminded the Board that it is our mission to protect citizens
of Calhoun County. We should have a Public Hearing giving them an
opportunity to speak.
Greg: Could we back off of this now? If Ted and Paul are interested
in getting feedback, August may be too soon to act. Heidi commented
that these fees will be implemented October 1, 2003. The certified
food manager portion will be phased in over a two year time period
(2005).
Ben: How will we implement so soon (public hearing, etc) Send
letter out, meet, have official Public Hearing following Board of
Health meeting, then two days later for BOC meeting? Byron suggested
that we have meetings in and around the community (Marshall, Battle
Creek, etc.)
Larry: This is pending legal review.
Kathy: There is about an $80,000 difference with increased
inspection fee.
Upon the Board’s review of the proposed fees, Jeff asked why is it
acceptable to charge less than what it costs.
Greg commented, particularly looking at the temporary food license
fee. Ted replied that if temporary licenses are too high, this will
eliminate establishments participating in events.
Jeff asked do we charge what our cost is or an area average. Paul
answered for example, the Boy Scouts – if we charge too high of a fee,
they would not be able to hold an event/fundraiser. Jeff suggested a
tiered system. We have a fee for nonprofits and a fee for others. Ted
replied that there is a fee for nonprofit (Boy Scouts, etc.) and all
others.
Greg asked about the mobile license fee. Paul: We have three in
county and they get inspected once a year. Two mobiles are at the zoo.
Therefore, when they are inspecting other items within the zoo, they
will also complete a food inspection as it reduces our costs.
Greg asked about the water sample fee. Our calculated cost is $92
but we are only charging $50. Ted responded that we do not believe
that people would pay $100 for a water sample analysis. Also, there
are private companies competing for water sample and loan evaluation
services, and they are charging less than the Health Department. Ted
believes that we need to be competitive. We do about 400 samples per
year. Our current budget for water samples is $51,000; however, this
also includes other water services we conduct such as inspection of
newly installed wells.
Larry: Consensus is to proceed with a letter going out to
communities, August Public Hearing, and Board adoption of the code
changes and fees.
Resolution 22-2003 Approval of the Board of Health adopted
Executive Limitation Policies 1 through 7.
Larry clarified that these policies are adopted by the Board and
can be changed.
Jeff moved to support, Jean seconded. Passed with one abstention
(Byron MacDonald).
Resolution 23-2003 Approval of the Board of Health adopted
Governance Process Policies 1 through 9.
Jeff moved to support, Jean seconded. Passed with one abstention
(Byron MacDonald).
Resolution 24-2003 Approval of the Board of Health adopted
Management Linkage Policies 1 through 5.
Greg Purcell stated that in response a question to page 23, the
County policies will be applicable to the Health Department. The
Health Department can make more restrictive policies but not
less-restrictive.
Moved by Jeffrey Mitchell, seconded by Jean Cook-Hughes. Passed
with one abstention (Byron MacDonald).
Larry Anderson, Erv Brinker, Jane DeVries, and Heidi Oberlin met
regarding primary ends. The Board will have an opportunity to review
and make suggestions and additions.
As discussed at the Board Retreat, we will have notebooks for all
meetings to handout for reference.
Move to adjourn made and supported by Jeffrey Mitchell, Jean
Cook-Hughes, and Ben Miller.
Meeting adjourned at 10:02 a.m.
Minutes Archive
Several photos included in this 
