February 22, 2012 - Meeting Summary (PDF: 166KB/12 pages)

Meeting Summary
Delegation Agreement Advisory Council
February 22, 2012
Snelling Office Park, St. Paul
10:00 a.m. – 1:00 p.m.
Environmental Health Division
Environmental Health Services Section
Attendees
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Pauline Amundson, Pine County
Debra Anderson, Hennepin County
Liz Auch, LPHA and Countryside
Dawn Beck, Olmsted County
David Benson, Nobles County
Sarah Berry, Waseca County
Sue Blaisdell, Winona County
April Bogard, MDH, EH, EHS, PWDU
Jeff Brown, City of Edina
Linda Bruemmer, MDH, EH Division
Director
Jill Bruns, Redwood-Renville
Counties
Debra Burns, MDH, Office of
Performance Improvement
Manny Camilon, City of St. Louis
Park
Mark Clary, Ramsey County
Maggie Edwards, MDH, EH, EHS,
PWDU
Sherry Engelman, City of Edina
Matt Finkenbiner, Le Sueur County
Chris Forslund, City of St. Cloud
Allie Freidrichs, Meeker-McLeodSibley County
Pete Giesen, Olmsted County
Cris Gilb, Southwest Health and
Human Services
Diana Graning, Benton County
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Bill Gunther, City of St. Paul
Lisa Gyswyt, City of Wayzata
Zack Hansen, Ramsey County
Brian Hoffman, City of St. Louis Park
Tom Hogan, MDH, EH Assistant
Division Director
Janet Howard, Nobles County
Duane Hudson, Hennepin County
Dan Huff, City of Minneapolis
Tim Jenkins, City of Minneapolis
Jill Johnson, Winona County
Keith Jullie, City of Brooklyn Park
Larry Kittelson, Pope County
Jason Kloss, Southwest Health and
Human Services
Nicole Koktavy, MDH, EH, EHS,
PWDU
Tim Langer, Faribault-Martin
Counties
Kris Lee, Countryside Public Health
Aggie Leitheiser, MDH, Assistant
Commissioner, Health Protection
Bureau
Cheri Lewer, Waseca County
Gwen Lewis, Waseca County
Jeff Luedeman, City of Bloomington
Becky Malone, City of Wayzata
Lynne Markus, MDH, EH, EHS,
PWDU
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Tim Martin, Benton County
Dan McElroy, Hospitality Minnesota
Michelle Messer, MDH, EH, EHS,
PWDU
Jason Newby, City of Brooklyn Park
Mike Nordos, MDH, EH, EHS, PWDU
Susan Palchick, Hennepin County
Bonnie Paulsen, Morrison County
Colleen Paulus, MDH, EH, EHS
Manager
Spencer Pierce, Anoka County
Linda Prail, MDH, EH, EHS,
Regulatory Operations
Julie Ring, Association of Minnesota
Counties
Hank Schreifels, Stearns County
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Barbara Skoglund, MDH, EH, EHS,
PWDU
Pam Steinbach, MDH, EH, EHS,
Regulatory Operations
Amanda Strommer, Washington
County
Karen Swenson, Brown-Nicollet
Counties
Sandy Tubbs, Horizon Community
Health Board
Bev Wangerin, McLeod County
John Weinand, City of Minnetonka
Chris Wenisch, Kandiyohi County
Susie West, Wabasha County
Julie Wischnack, City of Minnetonka
Note: all of the handouts mentioned in the meeting summary may be found at:
www.health.state.mn.us/divs/eh/food/pwdu/delegationagreement.html
Under “Handouts from the February 22, 2012 meeting.”
Introduction and Purpose
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Linda Bruemmer, MDH Environmental Health Division Director, welcomed and thanked
everyone for taking the time to attend. Linda also thanked original Delegation
Agreement Advisory Committee (DAAC) members for their previous hard work.
All attendees introduced themselves.
Linda gave a brief overview of the original committee’s work. The DAAC met throughout
2008 to develop the new delegation agreement. The new agreement was implemented
in 2009 and 2010.
Legislative Update Review
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SF 0743/HF1442 deals with recycled water. There is swimming pond language included
in the bill that would require natural swimming ponds to comply with public pool
regulations when possible and directs the MDH commissioner to develop specific rules
for natural swimming ponds.
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SF 1701/HF1755 as amended by the Senate Health and Human Services Committee on
2/23/12, includes language relating to local fees. It also divides the $60 private sewer or
water fee into a $30 fee for private sewer and/or $30 for private water. The bills contain
various other provisions related to the restaurant industry. It has been forwarded to the
Senate Jobs and Economic Growth Committee.
SF 1190/HF1523 defines vacation home rentals. This issue repeatedly comes up in the
legislature.
HF 2302/SF1637 requires background checks and fingerprinting for all lodging facility
staff and prohibits those previously convicted of some crimes from working in lodging
establishments. There have been two recent cases involving the conduct of lodging
employees.
HF 1417/SF 1176 concerns special event camping fees in MDH jurisdiction. It reduces
fees for events with more than 2000 camp sites.
What have MDH & Delegated Agencies been doing since Summer 2009?
Self-assessments and program evaluations
April Bogard, MDH/EH/EHS Partnership and Workforce Development Unit Supervisor, reviewed
the Program Evaluation Schedule (Handout 1). Program evaluations were conducted first with
delegated agencies that volunteered and then the rest of the schedule was determined by a
random drawing. Copies of the completed evaluations were available for review at the meeting.
All of the Delegation Agreement Materials may be found on our website at:
http://www.health.state.mn.us/divs/eh/food/pwdu/delegationagreement.html
Q: What do the terms acceptable, conditionally acceptable, unacceptable mean? How does an
agency ask for a reconsideration of its rating?
A: The terms were determined by the original 1987 agreement. Those agencies that do not
meet minimum standards must develop an action plan to address issues uncovered during the
evaluation. The MDH evaluators who conduct the evaluations work with the delegated agencies
to continuously improve environmental health programs.
Delegated programs should contact the Partnership and Workforce Development staff to
request a reevaluation when they have improvements that they want reviewed. Scheduling of a
reevaluation would be based on the nature of the program improvements needed, the
prioritization of reevaluations and first time evaluations, MDH staffing availability and other
issues. MDH will convene a group to develop a process for re-evaluation.
Trends and lessons learned from program evaluations
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Michelle Messer R.S., one of the program evaluators from PWDU, reviewed the Trends and
Lessons Learned from Program Evaluations: Opportunities for Continuous Improvement
(Handout 2). Michelle encouraged agencies to elaborate on their program and toot their own
horns during the self-assessment process. The evaluators are only there a short time so give
them all the information you can.
Each program evaluation begins with a self-assessment. Delegated agencies submit the selfassessment 30 days before the scheduled evaluation visit. There was discussion about the
current evaluations, program ratings, what those terms mean, how they are changed and what
process the agency goes through to get reevaluated.
Q: Have you found the self-assessment process helpful? Can MDH be more specific about what
they are looking for during the evaluation? MDH was asked to inform delegated agencies
regarding any changes to the evaluation criteria. Can MDH update delegated agencies on
trends and lessons from the evaluation process more frequently? What were some positive
findings?
A: Yes, both MDH and various program representatives commented on the value of the selfassessment process. The self-assessment is available for any agency to complete at any time.
There are five evaluation survey tools (food, lodging, MHPs/RCAs, pools and youth camps)
available online at
http://www.health.state.mn.us/divs/eh/food/pwdu/delegationagreement.html. Programs do
not have to wait for their formal evaluation to conduct a self-evaluation. MDH recommends
agencies conduct a complete self-assessment, including scoring each item and calculating a
final score. Comments on the self-assessment should include more than “yes/no” answers.
There is an annual meeting to specifically review the assessment process. It is scheduled for
April 25, 2012. MDH indicated there have been no changes to the evaluation process or criteria
after the first pilot evaluations. Programs are evaluated against the minimum program
standards in Minnesota statutes, rules and the delegation agreement. The structure of the
evaluation is based upon the FDA Voluntary National Retail Food Regulatory Program
Standards. The evaluation tools are available online at
http://www.health.state.mn.us/divs/eh/food/pwdu/delegationagreement.html. The tools to
complete the self-evaluation are the same tools used by the MDH evaluators.
MDH publish any new tips and trends updates in the PWDU newsletter,
http://www.health.state.mn.us/divs/eh/food/pwdu/pwdunewsletter/index.html. The PWDU
newsletter is sent to all delegated agencies and interested parties, posted online and included
in the CHS mailbag which goes to community health board commissioners. The new PWDU
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communications staff member, Barbara Skoglund, will also develop additional information on
trends as part of the EHS website revisions.
Copies of Characteristics of Successful Environmental Health Programs (Handout 3) were
available next to the completed program evaluation materials.
Trainings, newsletter, FSP/FSP+
Colleen Paulus, EHS section manager, reviewed MDH/EHS Training, Newsletters, Workshops,
2008-2012 (Handout 4). She encouraged delegated agencies to read the newsletter and
participate in as many training events as possible. She pointed out that all FSP and FSP+ are
available via video conferencing and web streaming.
(See http://www.health.state.mn.us/divs/eh/food/pwdu/fsp/index.html.)
Community Health Boards and Delegated Agency Changes
Deb Burns, MDH Office of Performance Improvement director presented information on
community health boards (CHB). There are currently 52 community health boards across the
state. Two thirds are multi-county boards. Deb has worked with community health boards for
10 years and during the first eight there was only one change in their configuration. During the
last two years there have been many changes as local government has undergone rapid
changes. Over a quarter of Minnesota counties are considering new community health board
arrangements. The Minnesota Community Health Boards (Handout 5) map was distributed.
Because many of the environmental health delegation agreements are with community health
boards, these rapid changes impact the delegation of food, beverage, lodging, MHP/RCA, pools
and youth camp licensing, inspection and enforcement. It takes up to a year to dissolve a
community health board. Some of the proposed new community health boards want to ensure
they will have a delegation agreement prior to changing the make-up of their CHB. This is
causing a conflict because MDH cannot approve delegation agreements to boards that don’t
exist. The systems that exist to form and approve delegation agreements were not set up for
these types of rapid changes and the situation is raising a lot of issues at the local and state
level. The County Delegation Map of Food, Beverage and Lodging and Mobile Home
Park/Recreational Camping Area Jurisdiction map (Handout 6) was distributed.
Managing Delegation Agreements
Colleen Paulus, EHS section manager, reviewed a document illustrating the different
environmental health programs (Handout 7, “Eat, Sleep, Swim” Document). The EHS delegation
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agreement covers where people eat, sleep and swim. The ultimate authority and responsibility
for maintaining these statewide programs (food, lodging, MHPs/RCAs, pools and youth camps)
comprised of state and local programs, lies with the Commissioner of MDH.
There are two other EH programs for which there are delegations: Well Management and NonCommunity Water Supply. In addition, there are numerous additional environmental health
programs administered by MDH. (See http://www.health.state.mn.us/divs/eh/.) They are not
part of the delegation agreement from EHS. The handout also identifies other programs and
services that fall under the generic environmental health term; which are administered by
other state agencies and/or local government.
Several participants commented positively about the handout and explanations of the wide
variety of environmental health programs/services.
Discussion of Issues around Environmental Health and Environmental Health Services
Delegation
Colleen Paulus praised state and local environmental health professionals and agencies for their
ability to shine and work well together during crisis situations. She stressed the need for us to
work more collaboratively in the day to day work of protecting public health and sought ideas
for developing models to help us work together more. How can we have a consistent statewide
public health protection program for Food, Beverage, and Lodging (FBL) services?
Before the discussion of the regional team concept, some general comments were offered.
There was concern that there was no agreement on the big picture or the vision and that there
should be a higher level policy discussion. The suggestion was offered that a SCHSAC committee
be assigned to address environmental health. Some members offered that SCHSAC had already
written reports on Environmental Health in 1980, 1993 and 2002. They did not want to repeat
something that had already been done but not implemented.
The question was also raised about whether we should involve industry. Some felt that industry
should not be involved in policy setting, but it’s good to involve them in implementation.
A specific question was asked why MDH denied a request to contract with another organization
for licensing, inspection, and enforcement services. MDH knew the contract question was not
handled very well. The issue for MDH is if the delegation agreement work is under contract with
another governmental unit, there appears to be a lack of direct accountability. If there is an
issue in the county, is it an appropriate response to direct MDH to contact the adjoining
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contracted county to deal with it? There have been gaps and no one has been available at times
in a delegated agency and MDH had to fill in. Some counties have a 24/7 coverage agreement
to help each other.
With the discussion of the evaluations, someone asked when MDH will be evaluated. MDH and
Anoka County participated in the pilot. They are scheduled for full evaluation at the end of the
cycle.
As part of the proposal for a Regional Team, MDH offered that EH leadership visits regional
offices annually; perhaps there should be an open house to meet with local government and
delegated agencies at the district offices. This would also increase the visibility of district
offices.
Small Group Dialogue
Each table was asked to respond to some questions regarding the idea of creating regional
teams.
a.
What are the “pros” of the Regional Team concept?
b.
What are the “cons” of the Regional Team concept?
c.
What are your ideas for modifying the Regional Team Concept to make it better
and more workable?
d.
Are there any alternative(s) to the Regional Team Concept that would result in
the same outcomes?
e.
What are your recommendations for next steps?
Each table shared the highlights of their discussion.
TABLE 1
Pros:
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Implementation
LPHA Region/SCHSAC (increase participation of commissioners)
Relationship building
Enhance SCHSAC system
Consistency
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Delegated/non-delegated involvement
Time/travel – another meeting
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Other:
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Higher level policy group (SCHSAC Directors), regional to follow
Revolving responsibility for calling/facilitating meetings
Increase participation at all levels – continuity of staff
TABLE 2
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Why not use regions already designated (SCHSAC, LPHA) – there are too many regions
already
What is the problem? What are we trying to solve?
Who is attending (i.e., directors? Staff?)
Consistent answers across the state
Counties have different issues
Don’t/can’t get rid of grey area, broader goal/code interpretation
Where on the Program Evaluation list are the Counties the State inspects?
TABLE 3
Pros:
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Will help make delegated programs more uniform
o Similar policies
o Trainings/code interpretation
Sounding board for inspectors
Cons:
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Who will lead group?
Impact of this reaching front line of PH
Will efforts meet the needs of a diverse community?
Other:
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What’s up with contracting?
Identify expectations
Expanding delegation agreements per CHB
MDH organize into regions 1st meeting; then change as needed with EH local changes
and see how things work
Trainings-Regional
o Hot topics pertaining to that region
o Recognition of differing issues
o Consistent training throughout all regions
TABLE 4
Pros:
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MDH liaison to local EH
No consistent training for local inspectors/sanitarians
Develop best practices
What does MDH require specifically?
Where is the EH handbook?
Isolated EH entities would like the support of health in regional meetings
Need consistency between MDH/Regions/Locals
Regional leadership needs to take charge of agenda, issues of meetings
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Regions should be consistent with 8 MDH regions?
Too large a region for Metro agencies – need manageable size group meetings
Unless specific measureable goals, this is a waste of time
Why not invite industry even though to compelling reason – promotes transparency
Other:
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FSP model has worked; don’t reinvent; use this to coordinate activities
Web/audio/video conference
Expand existing mutual aid agreements to Regional
TABLE 5
Pros:
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Leads to more consistency and understanding of “ripple” effect between agencies
Identify regional trends that could lead to statewide impacts
Have EH consultant assigned to each region – like the PH Nurse consultants. One per
region
More possible to have face-to-face to discuss issues/create policies
An advocate for local programs/liaison for state/local issues
Regional consultant would know and understand local variances and programs – quality
improvement and policy
Cons:
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Admin are more used to LPHA regions
Some partners are dissimilar
How do different regions talk to each other?
Look at where counties have the most synergy/partnerships already
State needs more resources for consultation - SHF
Other notes:
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Technology – integrated and accessible for entire state
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Emergency notification system – more use by locals
Notifications – who belongs on which list? Operational vs. policy
TABLE 6
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Real questions
Need to share a common goal (SCHSAC workgroup)
o We were there at end of DA process; not there now
Locals and state need to be nimble and innovative
o Contracts
o MOUs
o Timeliness
Regional teams would work for operational issues; not shared vision/administrative
Solution for a different question
TABLE 7
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Better communication
Prepare for evaluation
Idea sharing
Need mechanism for inter-regional information sharing
Based on regional needs
Facilitates sharing of resources
Who decides on boundaries for resources?
Boundaries don’t match between delegated programs and new regional team
Why were the boundaries chosen? Population?
Good brainstorming but might not be efficient
Everyone – county/city/MDH is unique with enforcement etc.-PH is 1st priority
Will regions promote stability?
Current agreement crosses boundaries
Will sharing be effective according to group size?
TABLE 8
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Other issues need to be worked out
Clear expectations
Better and consistent communication between MDH and locals
Forum for policy development
Recognize the need for flexibility
Stronger ties to CH system
Greater efficiency
Use technology
TABLE 9
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Pros:
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Existing relationships
Forum for sharing best practices and challenges
Rural areas have limited resources and need to share resources
Cons:
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Proposed regions do not align with the broader regions of LPHA
May not be of value if regions lack a clear charge
Other:
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Regional team needs way to connect to bigger picture
Need forum for regional and MDH communication and training
Emphasis on MDH-Local TEAM ATMOSPHERE
Potential for region to be advisory to MDH
Proceed with regions and clear charges
Parking Lot issues for further discussion included:
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Meeting Frequency/Newsletter
Procedures for re-evaluation
• Look at existing models
• Move more swiftly to re-evaluate
• Prioritization: new evaluations vs. re-evaluations
Self-assessment timing
Healthcare/hospital inspections
Contracting
200 establishments in jurisdiction
Multi-county – consistency gaps
Staff capacity
24/7 coverage
Business/industry input
Aggie Leitheiser and Linda Bruemmer appreciated everyone’s attention and effort and thanked
them for coming.
Next Steps and Update (3/9/2012)
It appears that there are two tracks of discussion that have emerged. The first is about all of
environmental health, not just the environmental health services delegation. Two of the three
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SCHSAC reports of past on Environmental Health have been located. The only one that is on the
internet is the following:
February 2002, “Strengthening Environmental Health in Minnesota – Final Report and
Recommendations of the State Community Health Services Advisory Committee Environmental
Health Work Group.” www.health.state.mn.us/divs/cfh/ophp/resources/docs/ehfinal2002.pdf
January 1993. “Environmental Health in Minnesota – Strengthening Public Health Leadership in
Environmental Health.” MDH, State Community Health Services Advisory Committee Environmental Health Work Group. Hard copy is available in MDH files.
March, 1980. “Final Report of the Environmental Health Policy Study Advisory Committee. A
Joint Project of the Minnesota Department of Health and the Association of Minnesota
Counties.” Not in MDH files.
At the SCHSAC meeting on February 24, an addition to the SCHSAC annual work plan for an
environmental health committee of some form was accepted. A charter will be written for
inclusion in the annual work plan.
For follow-up to the concerns about the EHS delegation agreement, the annual meeting to
specifically review the assessment process is scheduled for April 25, 2012.
Other information will be distributed as it becomes available.
For more information contact Linda Bruemmer, MDH Environmental Health Division Director, at
[email protected] or 651-201-4739.
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