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Department of Health and Mental Hygiene
Codified Title: 
Title 24: Department of Health and Mental Hygiene

Adopted Rules: Closed to Comments

Adopted Rules Content: 
 
 

Statement of Basis and Purpose

Background

Adoption of schedule for transfer of vital records

            Birth and death records are considered private records.  During a person’s life and for an appropriate period after death, birth and death records are protected from being accessed by the general public because they contain individually identifiable information. These records, however, eventually become historical documents of interest to family members and persons researching their ancestries. For these reasons, the Board of Health recently fixed schedules for making these records public and transferring them to the Department of Records and Information Services (“DORIS”):  section 207.21 of the Health Code now makes birth records public records after 125 years after birth, and death records public records after 75 years after death.

           The schedule set in section 207.21 of the Health Code drew numerous comments from the public. Many of these comments emphasized a keen community interest in third parties being able to access birth and death records prior to their transfer to DORIS.  The comments also made a variety of different suggestions, from making all birth and death records immediately available to the public, to releasing birth and death records to family members prior to the records becoming public, to creating a special category for release of records to genealogist. The Department agreed that certain family members should have access to birth and death records prior to the records becoming public, and therefore proposed amending section 207.11 of the Health Code for this purpose.  The Board now adopts those amendments. The Department believes these new provisions will allow family members to access information while protecting the confidentiality of vital records for appropriate periods of time. 

Current Administrative and Health Code provisions allowing release of birth and death records

Section 17-169(a) of the Administrative Code delineates who may access birth records.  While section 17-169(a)(1) restricts who may obtain a certified copy of a record of birth, section 17-169(a)(2) authorizes the Department to honor requests for certifications of birth when providing the information is “necessary or required for a proper purpose.”  As noted below, the Department believes that ascertaining facts related to one’s family history is a proper purpose.

            Section 17-169(b) of the Administrative Code provides for access to death records when “necessary or required for a proper purpose.”  Section 207.1(b) of the Health Code provides that death records can be made available to the following persons:

(1) the spouse, domestic partner, parent, child, sibling, grandparent or grandchild of the decedent;

(2) the legal representative of the estate of the decedent, or the individual identified on a death certificate filed with the Department as the person in control of the disposition;

(3) a party with a property right who demonstrates to the Department that information beyond the fact of the death of the decedent is necessary to protect or assert a right of that party;

(4) a funeral director who requests the record or information within twelve (12) months of when the death of his or her client was registered; or

(5) persons or government agencies who otherwise establish that such records are necessary or required for a judicial or other proper purpose, or to prevent the misuse or misappropriation of City, state or federal governmental funds.    

Health Code Amendment

            The Board is expanding the group of family members who can access birth and death records prior to their public release.  This new group is within a close degree of consanguinity (blood relation) to the individual whose records are sought.  Specifically, the Board is expanding the list of relatives given in Health Code section 207.11(b)(1) who can request a death certificate to also include great-great grandchildren, nephews, nieces, aunts, uncles, grandnephews, and grandnieces. The Board is also expanding access to allow spouses, domestic partners, parents of children over the age of 18, children, siblings, nieces, nephews, aunts, uncles, grandchildren, great grandchildren, grandnieces, and grandnephews to request of the certification of birth of a deceased individual.  The Board finds that allowing such access is within the meaning of “proper purpose” as used in the Administrative and Health Codes. 

            Most of the comments on the proposed rule requested that the Board give additional categories of individuals access to birth and death records prior to their transfer to DORIS.  Some comments suggested that professional researchers with no family connection to the people’s histories they are researching should have broad access to birth and death records. Other comments requested that additional family and social relationships be added to the list of individuals with such access.  The Department believes that the amendment appropriately balances the privacy and historical interests at stake, does not agree that any additional changes should be made to the amendment.  The Board is making these amendments effective January 1, 2019.

Statutory Authority

Pursuant to section 556(c) of the Charter and section 17-166 of the Administrative Code, the Department is responsible for supervising and controlling the registration of births and deaths that occur in New York City. Section 558(c) of the Charter requires the Board to include in the Health Code provisions related to maintaining a registry of births and deaths, as well as provisions related to changes or alterations of any birth or death certificate upon proof satisfactory to the Commissioner of Health and the manner in which these certificates may be issued and otherwise examined.  Administrative Code section 17-169 and Health Code sections 3.25 and 207.11 make birth and death records confidential and restrict access to these records beyond certain classes of specified people.  Section 207.21 of the Health Code sets the time periods by which birth and death records are transferred to DORIS and become public records.  Section 558(b) of the Charter specifically authorizes the Board to add to, alter, and amend the Health Code.

           

 

Effective Date: 
Tue, 01/01/2019

Adopted Rules: Closed to Comments

Adopted Rules Content: 
 
 

Statement of Basis and Purpose

 

Statutory Authority

The Board’s authority to codify these proposed amendments is found in Sections, 556, 558, and 1043 of the New York City Charter (the “Charter”). Sections 558(b) and (c) of the Charter empower the Board to amend the Health Code and to include all matters to which the Department’s authority extends. Section 556 of the Charter provides the Department with jurisdiction to protect and promote the health of all persons in the City of New York. Section 1043 grants the Department rule-making authority.

Background

Article 43 of the New York City Health Code governs school-based programs for children aged three through five. The Board is amending Article 43 to add requirements for maintaining epinephrine auto-injectors on site and for certain teacher training. The basis for the changes is set forth below.

 

Emergency Medical Care and Epinephrine Auto-Injectors

The Centers for Disease Control and Prevention estimates that four to six percent of children nationally have a food allergy; such food allergies include ones that are life-threatening. Rapid administration of an epinephrine auto-injector following a life-threatening allergen exposure is critical to preventing significant negative outcomes, including death. Having epinephrine auto-injectors on the premises at all times can save the lives of children with life-threatening food allergies who do not bring an epinephrine auto-injector with them to the school-based program, and of children who have life-threatening food allergies identified for the first time while the child is there.

In 2016, the New York State Public Health Law was amended[1] to allow certain entities, including child care providers, to obtain non-patient specific epinephrine auto-injectors and to administer them in an emergency. This new State law creates the opportunity for such programs to have this critical, lifesaving program enrolling a child whose enrollment is paid for by federal child care subsidies.

The rule language is modified to include training regarding prevention of and response to emergencies related to food or allergic reaction, and prevention and control of infectious diseases (including immunization).

 

Other requirements

            In order to come into alignment with federal requirements and state policy regarding the vulnerabilities and special needs of children who are homeless or in foster care and thus require accommodations for compliance with certain rules, the proposed language has been modified to provide for a reasonable grace period for certain provisions pertaining to providing medical records.

Tooth Brushing

The provisions regarding tooth brushing that were included in the original proposal are not included in these amendments. The Department has determined that further consideration is warranted.

The Department’s authority to promulgate these proposed amendments is found in Sections 556, 558, and 1043 medication available. Accordingly, the amendments clarify requirements for emergency medical care and add a mandate that school-based programs maintain on site at least two unexpired epinephrine auto-injectors in each dosage appropriate for children who may be in the program, stored so they are easily accessible to staff and inaccessible to children. Whenever children are present, programs are required to have at least one staff person on site trained to recognize signs and symptoms of anaphylactic shock and to administer epinephrine as appropriate. The amendments also require programs to monitor the auto-injectors’ expiration dates and call 911 after any administration, as required by the medication directions; to obtain parental consent at the time the child is enrolled in the program; and to have all staff trained in preventing and responding to emergencies related to food allergies. 

The proposed language is modified to require that epinephrine auto-injectors have retractable needles and to clarify storage requirements.

Training requirements

The amendments expand teacher training requirements to enhance child safety and assure alignment with the health and safety training requirements in the federal Child Care Development Block Grant Act (CCDBG) Act of 2014. Sections 558(b) and (c) of the Charter empower the Board to amend the Health Code and to include all matters to which the Department’s authority extends. Section 556 of the Charter provides the Department with jurisdiction to protect and promote the health of all persons in the City of New York. Section 1043 grants the Department rule-making authority.

                                                                 




[1][1] NYS Public Health §3000-C. Epinephrine Auto-injector devices. Effective March 28, 2017.

 
Effective Date: 
Thu, 07/12/2018

Proposed Rules: Closed to Comments (View Public Comments Received:9)

Agency:
Comment By: 
Monday, July 9, 2018
Proposed Rules Content: 
 
 

Statement of Basis and Purpose of Proposed Rule

 

Introduction

At its meeting on March 16, 2010, the Board of Health amended section 81.51 of the New York City Health Code and authorized the Department of Health and Mental Hygiene (DOHMH) to establish a letter grading program for restaurants. The Board determined that providing restaurant grading information will inform consumer choice and will improve restaurants’ compliance with the Health Code and promote high food safety standards. Rules implementing letter grading for restaurants were promulgated in Chapter 23 (Food Service Establishment Sanitary Inspection Procedures and Letter Grading) of the Department’s rules.

Since July 2010, the Department has been grading restaurants to provide New Yorkers with information about the results of sanitary inspections. A restaurant’s grade A, B or C depends on how well the restaurant follows food safety requirements.

Local Law 108 of 2017 requires the Department to extend the grading program to mobile food vending units. It requires the program to be consistent with the restaurant grading program where practicable. These proposed rules comply with those directives by amending Chapter 6 (Mobile Food Vending) of the Department’s rules.

Additional amendments are being proposed to Chapter 6 to update and clarify certain other provisions as described below.

Mobile Food Vending Unit Grading Program Amendments

Mobile Food Grading System

The proposed amendments create a program to grade mobile food vending units to indicate their degree of compliance with the New York City Health Code, New York State Sanitary Code, and these rules at the time of inspection. Section 17-325.3 of the Administrative Code, as added by Local Law 108, requires the Department to design and implement a program consistent with restaurant grading to the extent practicable. The restaurant grading program incentivized New York City restaurants to improve food safety practices and led to greater compliance with the New York City Health Code and New York State Sanitary Code, including a 41 percent drop in sanitary violations in fiscal 2017 from the peak in fiscal year 2012. As elaborated below, and as consistent with restaurant grading program as possible, the program incorporates a prescribed cycle of inspections that generate scores, a scoring system that determines the grade, and the process for posting grades at various points in the inspection cycle.

The scoring system that will determine the grade for mobile units is the same as for restaurants: a score of less than 14 points earns an “A” grade, a score between 14-27 points earns a “B,” and a score of more than 27 earns a grade of “C.”

The annual inspection cycle begins when a unit undergoes an initial inspection. If the unit receives an A grade, the Department will immediately post the A grade on the unit. If the unit fails to earn an “A,” no grade will be assigned and the Department must reinspect the unit seven or more days later. If, at the reinspection, the unit receives an A grade, the Department will immediately post the A grade on the unit. If the unit again fails to earn an “A,” a grade pending card will be posted on the unit by the Department while the unit appeals the grade to the Office of Administrative Trials and Hearings (OATH). (The unit’s operator may choose to post the grade of “B” or “C” earned at the reinspection instead of a grade pending card, in which case the unit must be brought to the Department for it to post the appropriate letter grade.[1]) A unit with a “grade pending” will be required to post its final grade following the opportunity for adjudication at OATH. This inspection scheme is the same for restaurants.

 

Locating Mobile Food Vending Units

Unlike restaurants, which exist at a fixed location, mobile units move and are not required to operate on a set schedule. If the Department cannot locate all of the mobile units that require grades, the grading program will fail; not every unit will be graded and the grades that are posted may not be current. The successful implementation of the mobile food vending grading program, and the ability to mirror restaurant grading as closely as possible, requires adhering to the prescribed inspection schedule and ensuring that accurate and current grades are posted and timely on all units. That necessitates the Department being able to find and inspect units across the City.  To accomplish this and to check for compliance with grade posting requirements, the Department requires each vending unit to be equipped with a location sharing device that will enable the Department to pinpoint the unit’s location when it is to be inspected.

The ability to locate a mobile food vending unit is necessary to implement the mobile food vending unit grading program.  If the Department cannot find a unit to conduct an initial inspection or a reinspection, that unit will not have a current grade. The Department’s historical data reveals that it currently is only able to locate and inspect approximately 80% of the units that have permits to vend food in the City. For about one of every five units, the Department has been unsuccessful at predicting where the unit can be found, based solely on information it has about each unit’s vending locations. The inability to locate units will undermine the purpose of a grading system if a significant number of units are not graded or are posting grades that are inaccurate or out of date, which could degrade the reliability of the mobile food grades and the public’s confidence in the program.  By requiring all units to install location sharing devices, the Department will be able to inspect and grade a sufficient number of units to ensure the integrity of the grading program.

Grading promotes high food safety standards by leveraging consumer purchasing power, which, in turn motivates vendors to comply with food safety rules and achieve A grades. That system -- harnessing consumer interest in A grades to motivate vendors to comply with food safety rules to promote high food safety practices to protect public health -- is only achieved if the grade are accurate and reliable. In order to conduct inspections and keep grades accurate and reliable, the Department must be able to locate the vending units.

Additional Mobile Food Vending Grading Amendments

Amendments related to grading include additional definitions in section 6-02 and new sections 6-16 to 6-21, using a scheme similar to the one in Chapter 23 of the Department’s rules for grading restaurants. New appendices 6-A and 6-B are being added to Chapter 6 to implement scoring of inspection results. Appendices 6-C, 6-C-2 and 6-C-3 set out penalties for civil violation summonses for mobile food vending violations that are adjudicated and sustained at OATH, using a schedule similar to that of Chapter 23 Appendix C (Food Service Establishment and Non Retail Food Service Establishment Penalty Schedule). These new appendices will replace the current penalty schedules for the same violations currently in OATH’s rules.

Other Proposed Amendments to Chapter 6

Amending paragraph (3) of subdivision (b) of section 6-04 to require all mobile food vending units to have a permit-decal space that is a flat, smooth metal surface, which is the best material for the permit decal adhesive.

Amending subdivision (f) of section 6-04 to clarify and extend the deadline for water tank upgrades, and include a new requirement for a mechanical or electronic device to allow vendors to monitor water levels.

Repealing paragraphs (1) and (2) of subdivision (a) of section 6-06 to remove expired provisions related to with the allowable sizes for units other than trucks.

Amending section 6-07(a) to remove the requirement that decals be placed on two sides of a green cart.

Amending section 6-07(b) to remove the requirement of a green cart umbrella.

Amending subdivisions (d) and (h) of section 6-11 to delete the references to reinspection.

Amending section 6-11(l) to allow for revocation or denial of a permit for failing to have or tampering with grade cards or location sharing devices.

Statutory Authority

Section 17-325.3 of the Administrative Code requires the Department to “establish and implement a system for grading and classifying inspection results for each vending vehicle or pushcart using letters to identify and represent a vending vehicle or pushcart’s degree of compliance with laws and rules that require such vending vehicle and pushcart to operate in a sanitary matter to protect public health.”  In addition, section 17-311 of the Administrative Code authorizes the Department to issues rules related to affixing permit plates and letter grades to mobile food carts, and section 17-324 provides authority for any rules necessary pursuant to the mobile food vending requirements in the Administrative Code.

 


[1] Unlike at a restaurant inspection, the Department is requiring operators that choose to post a “B” or “C” grade following a reinspection to bring the unit to the Department to post the grade because the vendor staffing a unit at the time of the reinspection may not be the permit holder with the authority to make the decision. Based on experiences in the preferences of restaurant owners, the Department proposes to immediately post the “grade pending” sign following a reinspection that does not result in an “A” grade as the default, and allow permit holders who would prefer a letter-grade to arrange for it to be posted on the unit by the Department. 

 
 
Subject: 

Proposal to adopt rules governing the grading of mobile food vending units as provided in section 17-325.3 of the Administrative Code of the City of New York. Additional amendments to update and clarify other provisions related to mobile food vending are also proposed.

Location: 
New York City Department of Health and Mental Hygiene, Gotham Center
42-09 28th Street, 3rd Floor, Room 3-32
Queens, NY 11101
Contact: 

Svetlana Burdeynik, (347) 396-6078, ResolutionComments@health.nyc.gov

Download Copy of Proposed Rule (.pdf): 

Adopted Rules: Closed to Comments

Adopted Rules Content: 
 
 

Statement of Basis and Purpose

Introduction

Smoking is a leading cause of preventable premature death in New York City, increasing the risks of lung cancer, heart disease, and many other health hazards. To counter this threat, in 1988 the City enacted the Smoke-Free Air Act (SFAA), which has been amended several times.  The 2002 amendments restricted tobacco smoking in various indoor and outdoor public places. Despite the substantial progress in reducing both environmental smoke exposure and smoking, hookah smoking has been increasing in popularity as more establishments serve hookah, and its prevalence has been increasing, in particular, among the City’s youth.

Hookah or water pipe smoking involves heating “shisha”, which is typically composed of tobacco and/or other flavored or unflavored herbal substances, over burning charcoal, to create smoke that travels through a pipe immersed in cooling water, and that is inhaled by the smoker through a mouthpiece.  Regardless of whether the shisha contains tobacco, hookah smoking poses significant health risks to smokers and nonsmokers, including employees, at establishments that serve hookah. Hookah smoking produces emissions from burning both charcoal and shisha. Burning charcoal creates health hazards by emitting carbon monoxide, fine particulate matter, and various toxicants. Burning shisha has also been shown to emit multiple harmful substances regardless of its tobacco content, including carbon monoxide, polycyclic aromatic hydrocarbons, fine particulate matter, tar, and volatile aldehydes.

While risks associated with non-tobacco hookah smoking are established, air quality in the City’s hookah establishments is further compromised by evidence that many of them have been found to be serving shisha that contains tobacco. Tobacco-containing shisha has been shown to emit phenols, nicotine, and NNAL, a tobacco-specific nitrosamine. Therefore, patrons of hookah establishments may be smoking tobacco unwittingly, in addition to inhaling the harmful substances emitted by charcoal and shisha. To address these concerns, Local Law 187 of 2017 amended the SFAA to ban the smoking of non-tobacco shisha except at existing establishments that require a permit from the Department.  Local Law 190 of 2017 also requires establishments that obtain a permit for serving non-tobacco shisha to post signage developed by the Department that warns of its risks. These proposed amendments implement these laws.

Furthermore, given the health risks posed by non-tobacco smoking, Local Law 191 increases the minimum age for legal sales to 21 years of age for non-tobacco smoking products, including shisha that does not contain tobacco, pipes, water pipes, rolling papers, and herbal cigarettes. 

No Changes Made in Response to Comments Received by the Department

Approximately 20 people commented on the proposed rule at the public hearing held on March 14, 2018. Nearly all of the comments related to the requirement that an establishment generate at least 50% of its annual gross sales from the on-site sale of non-tobacco smoking products in order to obtain or renew a permit to operate as a non-tobacco hookah establishment. However, Local Law 187 already added this requirement to the Administrative Code:

To obtain and renew a permit issued pursuant to this section for a non-tobacco hookah establishment, a person shall demonstrate that: 1. Such non-tobacco hookah establishment generated 50 percent or more of its total annual gross sales during the preceding calendar from the on-site sale of non-tobacco smoking products. . . .

See Administrative Code § 17-513.5(g)(1). The Department does not have the authority to eliminate this requirement.  Thus, no changes are being made to the definition of a non-tobacco hookah establishment in subdivision (bb) of section 10-01 or to the requirement in section 10-18 that a non-tobacco hookah establishment generated 50% or more of its total annual gross sales during the preceding calendar year from the on-site sale of non-tobacco smoking products in order to obtain a permit.

The Department has made two additional changes to the proposed rule to clarify their application.

Section 10-21(c) has been amended to provide that the required warning signs, which will be provided by the Department and will vary in content, must contain two of four possible warning statements.

Section 10-23(b) has been amended to provide that a person is responsible for expert costs incurred by the Department only in the event that the Department proves at a hearing that such person violated subdivision (a) of section 17-508 of the New York City Administrative Code or subdivision 1 of section 1399-s of the New York State Public Health Law.    

Statutory Authority

The Department’s authority for these rules is found in section 1043 of the New York City Charter and sections 17-513 and 17-706 of the New York City Administrative Code.

Amendments

The Department amends subdivision (p) of section 10-01 of Title 24 of the Rules of the City of New York, adds paragraphs (aa) through (ee) to section10-01, and adds new sections 10-18 to 10-24. The Department also amends section 13-06 of Title 24 of the Rules of the City of New York.

 
 
Effective Date: 
Thu, 05/10/2018

Proposed Rules: Closed to Comments (View Public Comments Received:22)

Agency:
Comment By: 
Monday, April 23, 2018
Proposed Rules Content: 
 
 

Statement of Basis and Purpose

Introduction

            Birth and death records are considered private records during a person life and for an appropriate period after death, and are protected from access by the general public because they contain individually identifiable information. However, they are also historical documents of interest to family members and persons researching their ancestries. For these reasons, the Board of Health recently fixed schedules for making these records public and transferring them to the Department of Records and Information Services (“DORIS”).  Section 207.21 of the Health Code makes birth records public records after 125 years after birth, and death records public records after 75 years after death.

           

            The schedule set in section 207.21 of the Health Code drew numerous comments from the public. Many of these comments emphasized a keen community interest in third parties being able to access birth and death records prior to their transfer to DORIS.  The comments also made a variety of different suggestions, from making all birth and death records immediately available to the public, to releasing birth and death records to family members prior to the records becoming public. The Department agrees that certain family members should have access to birth and death records prior to the records becoming public, and is therefore now proposing amendments to section 207.11 of the Health Code for this purpose.  The Department believes these new provisions will allow family members to access information while protecting the confidentiality of vital records for appropriate periods of time. 

Current Administrative and Health Code provisions allowing release of birth and death records

The proposal is consistent with Administrative Code section 17-169(a), which delineates who may have access to birth records.  While section 17-169(a)(1) restricts who may obtain a certified copy of a record of birth, section 17-169(a)(2) authorizes the Department to honor requests for certifications of birth when providing the information is “necessary or required for a proper purpose.”  As noted below, the Department believes that ascertaining facts related to one’s family history is a proper purpose.

         Section 17-169(b) of the Administrative Code provides for access to death records when “necessary or required for a proper purpose.”  Section 207.1(b) of the Health Code provides that death records can be made available to the following persons:

    (1) the spouse, domestic partner, parent, child, sibling, grandparent or grandchild of the decedent;

    (2) the legal representative of the estate of the decedent, or the individual identified on a death certificate filed with the Department as the person in control of the disposition;

    (3) a party with a property right who demonstrates to the Department that information beyond the fact of the death of the decedent is necessary to protect or assert a right of that party;

    (4) a funeral director who requests the record or information within twelve (12) months of when the death of his or her client was registered; or

    (5) persons or government agencies who otherwise establish that such records are necessary or required for a judicial or other proper purpose, or to prevent the misuse or misappropriation of City, state or federal governmental funds.

 

Proposed amendments to expand vital records access to certain family members 

            The Department is proposing to expand the group of family members who can access birth and death records prior to their public release.  The proposed group is within a close degree of consanguinity (blood relation) to the individual whose records are sought.  Specifically, the Department proposes to expand the list of relatives given in Health Code section 207.11(b)(1) who can request a death certificate to also include great-great grandchildren, nephews, nieces, aunts, uncles, grandnephews, and grandnieces, and to allow spouses, domestic partners, parents of a children over the age of 18, children, siblings, nieces, nephews, aunts, uncles, grandchildren, great grandchildren, grandnieces, and grandnephews to request of the certification of birth of a deceased individual. As noted in the comments received related to the proposed adoption of Health Code section 207.21, this group often seeks such documents for genealogic and various official purposes.  The Department proposes that allowing such access is within the meaning of “proper purpose” as used in the Administrative and Health Codes. 

Statutory Authority

Pursuant to section 556(c) of the Charter and section 17-166 of the Administrative Code, the Department is responsible for supervising and controlling the registration of births and deaths that occur in New York City. Section 558(c) of the Charter requires the Board to include in the Health Code provisions related to maintaining a registry of births and deaths, as well as provisions related to changes or alterations of any birth or death certificate upon proof satisfactory to the Commissioner of Health and the manner in which these certificates may be issued and otherwise examined.  Administrative Code section 17-169 and Health Code sections 3.25 and 207.11 make birth and death records confidential and restrict access to these records beyond certain classes of specified people.  Section 207.21 of the Health Code sets the time periods by which birth and death records are transferred to DORIS and become public records.  Section 558(b) of the Charter specifically authorizes the Board to add to, alter, and amend the Health Code.

 
Subject: 

Proposed amendment to Article 207 (General Vital Statistics Provisions) of the New York City Health Code to allow certain direct descendants and other family members to access the birth and death records of their deceased relatives prior to those records becoming public.

Location: 
New York City Department of Health and Mental Hygiene, Gotham Center
42-09 28th Street, 3rd Floor, Room 3-32
Queens, NY 11101
Contact: 

Svetlana Burdeynik, (347) 396-6078, resolutioncomments@health.nyc.gov

Download Copy of Proposed Rule (.pdf): 

Proposed Rules: Closed to Comments (View Public Comments Received:18)

Agency:
Comment By: 
Wednesday, April 18, 2018
Proposed Rules Content: 
 
 

Statement of Basis and Purpose

 

 Article 47 of the Health Code governs center-based child care. The Department proposes to clarify the Article’s requirements by simplifying terminology and reorganizing certain provisions, and to add requirements for tooth brushing, maintaining epinephrine auto-injectors on site, and for training of staff. The basis for the proposed changes is set forth below.

Clarifying Requirements    

The Department proposes several amendments to clarify requirements and facilitate compliance. For example, the proposed clarifying changes include adding definitions for “certified group teacher” and “corporal punishment,” and adding details to current definitions, including for “assistant teacher” and “education director.”

Currently, the Code requires that documentation be provided under certain provisions but not under others. The proposed changes create uniformity and enable the Department to effectively evaluate compliance with documentation requirements.

The Department is also proposing to add specificity to certain requirements, such as those regarding program capacity, supervision, and response to medical emergencies.  

Tooth Brushing

The Department is proposing to mandate that child care programs and family shelter-based child supervision programs assist children aged two or older with brushing their teeth at least once each day. Tooth decay (caries) is the most common chronic childhood disease. Consequences of early childhood caries include a higher risk of developing additional caries in both primary and permanent teeth,[1] difficulty eating and speaking,[2] increased hospitalizations and emergency room visits[3] and greater risk for delayed physical growth and development.[4] National data show that nearly one in four preschool-age children has had caries.[5] The Department’s 2014 Child Dental Health Survey (CDHS) found that at least 15 percent[6] of children in New York City child care programs had experienced caries and 45 percent of children consumed between-meal sugary snacks or sugary drinks four or more times a day, a major risk factor for caries. Caries prevalence increases as children get older, with 42 percent of third grade children having experiencing caries.[7]

Caries is a preventable disease. Relatively simple measures such as tooth brushing can significantly reduce risk. The American Dental Association recommends that tooth brushing twice per day begin at the eruption of a child’s first tooth. Despite the established benefits of tooth brushing, the oral hygiene practices of young children in New York City remain inadequate.  According to the CDHS[8], among those surveyed, 40 percent of children aged 0 to 6 years brushed their teeth only once a day or less frequently, and 45 percent of children ages 0 to 2 years did not use fluoride toothpaste. 

Requiring tooth brushing while in child care or child supervision programs will promote tooth brushing and help prevent caries. CDHS findings indicate that children with at least one tooth who are enrolled in Early Learn centers—which are required under the federal Head Start program to have a daily tooth brushing routine—are two and a half times as likely to brush their teeth the recommended two or more times per day than children in other programs. Including tooth brushing requirements in Article 47 will set children up for a lifetime of good oral hygiene practices.

Epinephrine Auto-Injectors

The Centers for Disease Control and Prevention estimates that four to six percent of children nationally have a food allergy; such food allergies include ones that are life-threatening. Rapid administration of an epinephrine auto-injector following a life-threatening allergen exposure is critical to preventing significant negative outcomes, including death. Having epinephrine auto-injectors on the premises at all times can save the lives of children with life-threatening food allergies who do not bring an epinephrine auto-injector with them to child care or shelter-base child supervision programs, and of children who have life-threatening food allergies identified for the first time while the child is in such programs.

In 2016, the New York State Public Health Law was amended[9] to allow certain entities, including child care providers, to obtain non-patient specific epinephrine auto-injectors and to administer them in an emergency. This new State law creates the opportunity for such programs to have this critical, lifesaving medication available. Accordingly, the Department is proposing to add a mandate that child care and child supervision programs maintain on site at least two unexpired epinephrine auto-injectors in each dosage appropriate for children who may be in the program, stored so they are easily accessible to staff and inaccessible to children. Programs would be required to have at least one staff person on site, whenever children are present, trained to recognize signs and symptoms of anaphylactic shock and to administer epinephrine as appropriate. The proposal also requires the program to monitor the auto-injectors’ expiration dates and call 911 after any administration, as required by the medication directions. Programs would be mandated to obtain parental consent at the time the child is enrolled in the program. All staff would be required to be trained in preventing and responding to emergencies related to food allergies.

Training requirements

The Department is proposing to expand staff training requirements to promote high quality learning environments, enhance child health and safety, and align with the health and safety training requirements in the federal Child Care Development Block Grant (CCDBG) Act of 2014, which apply to any program enrolling a child whose enrollment is paid for by CCDBG subsidies.

First, the Department is proposing to require that trainings currently required only for assistant teachers be mandated for all teaching staff. These core trainings address fundamental issues including preventing, recognizing signs and reporting injuries, infectious disease, lead poisoning and asthma; scheduling and conducting guided and structured physical activity; and childhood growth and development.

The Board’s authority to codify these proposed amendments is found in Sections, 556, 558, and 1043 of the New York City Charter (the “Charter”). Sections 558(b) and (c) of the Charter empower the Board to amend the Health Code and to include all matters to which the Department’s authority extends. Section 556 of the Charter provides the Department with jurisdiction to protect and promote the health of all persons in the City of New York. Section 1043 grants the Department rule-making authority.




[1] Al-Shalan TA, Erickson PR, Hardie NA. Primary incisor decay before age 4 as a risk factor for future dental caries. Pediatr Dent 1997;19(1):37-41.

[2] American Academy on Pediatric Dentistry; Policy on early childhood caries (ECC): classifications, consequences, and preventive strategies. Pediatr Dent. 2008-2009;30 (7 Suppl):40-3.

[3] Ladrillo TE, Hobdell MH, Caviness C. Increasing prevalence of emergency department visits for pediatric dental care 1997-2001. J Am Dent Assoc 2006;137(3):379-85.

[4] Acs G, Lodolini G, Kaminsky S, Cisneros GJ. Effect of nursing caries on body weight in a pediatric population. Pediatr Dent 1992;14(5):302-5.

[5] Dye BA, Thornton-Evans G, Li X, Iafolla TJ. Dental caries and sealant prevalence in children and adolescents in the United States, 2011–2012. NCHS data brief, no 191. Hyattsville, MD: National Center for Health Statistics. 2015.

[6] This is likely underreported as it is self-reported information and children may have had undiagnosed caries (of which parents were unaware) when parents responded to the survey.

[7] New York State Department of Health Third Grade Survey.

[8]DOHMH’s Oral Health Program conducted a survey to determine risk and protective behaviors for tooth decay among children in New York City group daycare centers. Over 1,800 parents and caregivers from 67 daycare centers reported risk and protective behaviors for tooth decay of their children and themselves.

[9] NYS Public Health §3000-C. Epinephrine Auto-injector devices. Effective March 28, 2017.

 
Subject: 

Proposed Amendment to Child Care Programs and Family Shelter-Based Drop-off Child Supervision Programs (Article 47 of the NYC Health Code) to promote the health and safety of children under six years old attending child care programs or family shelter-based drop-off child supervision programs.

Location: 
New York City Department of Health and Mental Hygiene, Gotham Center
42-09 28th Street, 3rd Floor, Room 3-32
Queens, NY 11101
Contact: 

Svetlana Burdeynik, (347) 396-6078, resolutioncomments@health.nyc.gov

Download Copy of Proposed Rule (.pdf): 

Proposed Rules: Closed to Comments (View Public Comments Received:14)

Agency:
Comment By: 
Wednesday, April 18, 2018
Proposed Rules Content: 
 
 

Statement of Basis and Purpose

Article 43 of the New York City Health Code governs school-based programs for children aged three through five. The Department of Health and Mental Hygiene proposes to add requirements for tooth brushing, for maintaining epinephrine auto-injectors on site and for certain teacher training. The basis for the proposed changes is set forth below.

 

Tooth Brushing

The Department is proposing to mandate that school-based programs for children aged three through five assist children with brushing their teeth at least once each day. Tooth decay (caries) is the most common chronic childhood disease. Consequences of early childhood caries include a higher risk of developing additional caries in both primary and permanent teeth,[1] difficulty eating and speaking,[2] increased hospitalizations and emergency room visits[3] and greater risk for delayed physical growth and development.[4] National data show that nearly one in four preschool-age children has had caries.[5] The Department’s 2014 Child Dental Health Survey (CDHS) found that at least 15 percent[6] of children in New York City child care programs had experienced caries and 45 percent of children consumed between-meal sugary snacks or sugary drinks four or more times a day, a major risk factor for caries. Caries prevalence increases as children get older, with 42 percent of third grade children having experienced caries.[7]

 

Caries is a preventable disease. Relatively simple measures such as tooth brushing can significantly reduce risk. The American Dental Association recommends that tooth brushing twice per day begin at the eruption of a child’s first tooth. Despite the established benefits of tooth brushing, the oral hygiene practices of young children in New York City remain inadequate.  According to the CDHS[8], among those surveyed, 40 percent of children aged 0 to 6 brushed their teeth only once a day or less frequently, and 45 percent of children aged 0 to 2 did not use fluoride toothpaste. 

Requiring tooth brushing for school-based programs will promote tooth brushing and help prevent caries. CDHS findings indicate that children with at least one tooth who are enrolled in Early Learn centers—which are required under the federal Head Start program to have a daily tooth brushing routine—are two and a half times as likely to brush their teeth the recommended two or more times per day than children in other programs. Including tooth brushing requirements in Article 43 will set children up for a lifetime of good oral hygiene practices.

Epinephrine Auto-Injectors

The Centers for Disease Control and Prevention estimates that four to six percent of children nationally have a food allergy; such food allergies include ones that are life-threatening. Rapid administration of an epinephrine auto-injector following a life-threatening allergen exposure is critical to preventing significant negative outcomes, including death. Having epinephrine auto-injectors on the premises at all times can save the lives of children with life-threatening food allergies who do not bring an epinephrine auto-injector with them to the school-based program, and of children who have life-threatening food allergies identified for the first time while the child is there.

In 2016, the New York State Public Health Law was amended[9] to allow certain entities, including child care providers, to obtain non-patient specific epinephrine auto-injectors and to administer them in an emergency. This new State law creates the opportunity for such programs to have this critical, lifesaving medication available. Accordingly, the Department is proposing to add a mandate that school-based programs maintain on site at least two unexpired epinephrine auto-injectors in each dosage appropriate for children who may be in the program, stored so they are easily accessible to staff and inaccessible to children. Programs would be required to have at least one staff person on site, whenever children are present, trained to recognize signs and symptoms of anaphylactic shock and to administer epinephrine as appropriate. The proposal also requires the program to monitor the auto-injectors’ expiration dates and call 911 after any administration, as required by the medication directions. Programs would be mandated to obtain parental consent at the time the child is enrolled in the program. All staff would be required to be trained in preventing and responding to emergencies related to food allergies.

Training requirements

The Department is proposing to expand teacher training requirements to enhance child safety, and assure alignment with the health and safety training requirements in the federal Child Care Development Block Grant Act (CCDBG) Act of 2014, which apply to any program enrolling a child whose enrollment is paid for by federal child care subsidies.

The Department’s authority to promulgate these proposed amendments is found in Sections, 556, 558, and 1043 of the New York City Charter (the “Charter”). Sections 558(b) and (c) of the Charter empower the Board to amend the Health Code and to include all matters to which the Department’s authority extends. Section 556 of the Charter provides the Department with jurisdiction to protect and promote the health of all persons in the City of New York. Section 1043 grants the Department rule-making authority.




[1] Al-Shalan TA, Erickson PR, Hardie NA. Primary incisor decay before age 4 as a risk factor for future dental caries. Pediatr Dent 1997;19(1):37-41.

[2] American Academy on Pediatric Dentistry; Policy on early childhood caries (ECC): classifications, consequences, and preventive strategies. Pediatr Dent. 2008-2009;30 (7 Suppl):40-3.

[3] Ladrillo TE, Hobdell MH, Caviness C. Increasing prevalence of emergency department visits for pediatric dental care 1997-2001. J Am Dent Assoc 2006;137(3):379-85.

[4] Acs G, Lodolini G, Kaminsky S, Cisneros GJ. Effect of nursing caries on body weight in a pediatric population. Pediatr Dent 1992;14(5):302-5.

[5] Dye BA, Thornton-Evans G, Li X, Iafolla TJ. Dental caries and sealant prevalence in children and adolescents in the United States, 2011–2012. NCHS data brief, no 191. Hyattsville, MD: National Center for Health Statistics. 2015.

[6] This is likely underreported as it is self-reported information and children may have had undiagnosed caries (of which parents were unaware) when parents responded to the survey.

[7] New York State Department of Health Third Grade Survey.

[8]DOHMH’s Oral Health Program conducted a survey to determine risk and protective behaviors for tooth decay among children in New York City group daycare centers. Over 1,800 parents and caregivers from 67 daycare centers reported risk and protective behaviors for tooth decay of their children and themselves.

[9][9] NYS Public Health §3000-C. Epinephrine Auto-injector devices. Effective March 28, 2017.

 
Subject: 

Proposed amendment to School Based Programs for Children Ages 3-5 (Article 43 of the NYC Health Code)

Location: 
New York City Department of Health and Mental Hygiene, Gotham Center
42-09 28th Street, 3rd Floor, Room 3-32
Queens, NY 11101
Contact: 

Svetlana Burdeynik, (347) 396-6078, resolutioncomments@health.nyc.gov

Download Copy of Proposed Rule (.pdf): 

Adopted Rules: Closed to Comments

Adopted Rules Content: 
 

Statement of Basis and Purpose

Introduction

            Birth and death records are protected from access by the general public because they contain individually identifiable information, which is considered private.  A birth certificate contains the first and last name of the person whose birth is being registered, date of birth, sex, home address, and mother’s maiden name.  In addition to information about the decedent, a death certificate contains the first and last name of parents, surviving spouse, and individual reporting the death.  This is individually identifiable information within the meaning of Health Code section 3.25 that, as the notes accompanying that section’s adoption state, “will be treated with the utmost confidentiality.”  Yet, birth and death records are also important historical documents that at some point should be available to historians and families researching their ancestries.  For this reason, Administrative Code section 17-170(b) charges the Board with deciding when the original records of births and deaths filed with the Department, and the indexes to such records, should become public records and transferred to the Department of Records and Information Services (“DORIS”).

This Health Code amendment establishes fixed schedules for making birth and death records public and transferring them to DORIS. Specifically:

  • a birth record become a public record on January 31st of the year following 125 years after the date of birth, and
  • a death record becomes a public record on January 31st of the year following 75 years after the date of death.

The Department believes that these schedules balance the need to protect the personal information of people who may be alive, especially as it relates to the problem of identity theft as well as other privacy issues, with the public’s right to access historically important records, including the specific interests of families, genealogists and other researchers.  The schedules also avoid the transfer of records to DORIS that are, in the Department’s experience, still subject to amendment by the individual to whom the record pertains, the Office of Chief Medical Examiner, the courts, or family members. 

Background

Birth and death records

In New York City, as in most vital records jurisdictions nationwide, the certificate of birth collects a wealth of information, pertaining both to the person registered on the record and their family members. On the birth record, this includes: the registrant’s date of birth, location of birth, and sex; the mother’s and father’s names prior to first marriage, places of birth, and dates of birth; as well as the number of children delivered at the time of birth, and a home address.  Death certificates, in addition to presenting date and cause of death, include date of birth, location of death, names of parents, as well as information on the surviving spouse and the living person known as the  informant, including their name, relationship to decedent and mailing address.  This type of personal identifying information (“PII”) is protected in other contexts under multiple federal[i], State[ii], and local[iii] privacy laws.

Necessary and appropriate use of birth and death certificates and information

Information included in birth records and birth certifications is required by multiple governmental agencies and private entities to receive a benefit or service, or to support the issuance of other documents often used for identity purposes, such as obtaining a driver’s license. Birth records are considered “foundational documents,” meaning they are often the first document obtained that enables the holder to then obtain other important documents.  For example, the information contained in a birth certificate can also be used in the process of getting a U.S. passport or Social Security card and accessing public benefits such as Medicaid.

 

Death records and the PII included in them are used to open or close decedents’ bank accounts, notify federal agencies such as the Internal Revenue Service and the Social Security Administration of a death, and to start the probate process in court.  They are also needed to access payments such as life insurance and survivor’s benefits in pensions and other programs. 

 

Amendment and correction of birth and death records/issuance of new birth certificates

Birth and death certificates are considered “living” documents in that their content can be changed in certain circumstances.  Pursuant to Article 207 of the Health Code, the content of a birth or death certificate may be amended or corrected, or a new birth certificate issued, to correct errors made in the originals or to reflect changes in circumstances, such as adoption or change in gender.  These are common requests from Vital Records customers.  During the five-year period from 2012 to 2016, the Department processed 1,030 birth record corrections and amendments for individuals born in 1940 and earlier, including 24 delayed registrations of birth and amendments for individuals aged 90 and above.  During the same five year period, the Department also processed 257 death record corrections and amendments for individuals who died in 1970 and earlier.  These are legal changes to records requested by living New Yorkers or their survivors.  Pursuant to Health Code § 207.01(a), the Commissioner of Health or his or her designee may make these changes to the actual records. 

 

When such changes are made to birth certificates, Administrative Code section 17-167(c) requires the substitution of the new birth record for the one on file.  If a record has been transferred to DORIS and made public, the ability for the Department to substitute a new record for it is substantially compromised.  For these reasons, it is important that the Department not make birth and death records publically available while they still may be subject to corrections and amendments.  The Board declines to issue “For Information Only” or similar uncertified documents related to birth and death records, as many comments suggested.  The Board believes that there is a similar risk of misuse of the information on copies of birth and death records, whether the records are certified or not. 

Privacy concerns

Privacy concerns also attest to the importance of maintaining the confidentiality of birth and death certificate PII during a person’s lifetime and for an appropriate period after.  For example, a teenage mother named on the death certificate of an infant may still be alive 75 years after her infant had died or the birth certificate of a transgender person may reveal information that person may prefer to keep private, especially if the certificate has not been amended. 

New Yorkers are living longer

New Yorkers are living longer than ever before. The 2010 US Census showed that almost a half-million New York City residents were over the age of 75.

 

Age

Total

75 – 79

178,019

80 – 84

142,272

85 – 89

90,375

90 – 94

37,270

95 – 99

11,665

100+

2,096

Total

461,697

 

Another half million were between the ages of 65 and 74.[iv]  Since 2010, the American Community Survey estimates that the total number of New York City residents age 75 and over had increased to more than 492,000, with more than 1.25 million over the age of 65.[v]  In 2005, 585 New Yorkers died between the ages of 100 and 114.  In 2014, that number rose to 806 deaths between the ages of 100 and 114, a 38% increase, and in 2015 the number rose to 901.  Birth and death data should be protected to adequately reflect these trends to guard against identity theft and fraud. 

Fraudulent and inappropriate use of birth and death certificates and information

            The PII found on birth and death certificates has the potential to be used in various fraudulent ways, including identity theft.  Identity theft involves appropriating PII and, in the name of that person, incurring debt, taking money from financial accounts, opening new accounts, accessing medical information or services, or receiving a tax refund, among other things.[vi]  Indeed, in addition to “foundational documents,” birth certificates are also referred to as “breeder documents” because they can be used to obtain other valid forms of identity.[vii]  Information from death certificates can be used in a similar manner, sometimes referred to as “ghosting.”[viii]  
 

Health Code Amendment

The Board is amending the Health Code to establish a fixed schedule for making birth and death certificates public and transferring them to DORIS. A birth record will become a public record on January 31st of the year following 125 years after the date of birth, and a death record will become public on January 31st of the year following 75 years after death. This schedule balances the need to protect the personal information of people who may be alive with the public’s right to access historically important records, including the specific interests of families, genealogists and other researchers.  The schedule also precludes the transfer of records to DORIS that are still subject to amendment by the individual to whom the record pertains, the Office of Chief Medical Examiner, the courts, or family members. This schedule was supported in comments submitted by both the New York State Department of Health and the National Association for Public Health Statistics and Information Systems (NAPHSIS), the national nonprofit membership organization representing the 57 vital records and public health statistics offices in the United States.

 

The Board recognizes there is a keen interest in accessing birth and death records for the sake of tracing genealogy and family health issues, as evidenced by the many comments received on the topic.   The Board will therefore consider an amendment to the Health Code to allow direct descendants and other close relatives to access birth and death records before they become public.    

 

Statutory Authority

Pursuant to section 556(c) of the Charter and section 17-166 of the Administrative Code, the Department is responsible for supervising and controlling the registration of births and deaths that occur in the City of New York. Section 558(c) of the Charter requires the Board to include in the Health Code provisions related to maintaining a registry of births and deaths, as well as provisions related to changes or alterations of any birth or death certificate upon proof satisfactory to the Commissioner of Health and the manner in which these certificates may be issued and otherwise examined.  Administrative Code section 17-169 and Health Code sections 3.25 and 207.11 make birth and death records confidential and restrict access to these records beyond certain classes of specified people.  Section 17-170(b) of the Administrative Code authorizes the Board to determine when birth and death records are transferred to DORIS.  Section 558(b) of the Charter specifically authorizes the Board to add to, alter, and amend the Health Code.

 




[i] See, e.g., the Privacy Act of 1974 as amended (5 U.S.C. § 552a); the Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191, 110 Stat. 1936 (1996)) Privacy Rule (45 C.F.R. Part 160 and Subparts A and E of Part 164); the Driver’s Privacy Protect Act (18 U.S.C. § 2721 et seq.); and the Identity Theft and Assumption Deterrence Act of 1998 (18 U.S.C. § 1028). 

[ii] See, e.g., the Personal Privacy Protection Law (NYS Public Officers Law Article 6A) and 10 NYCRR §§ 35.2 and 35.4 making birth and death records maintained by NYS agencies confidential except in limited circumstances.  Also see NYS Public Officers Law §§ 87(2)(b) and 89(2)(b), which protect date of birth information from public release.

[iii] See, e.g., NYC Charter § 2604(b)(4) prohibiting City employees and officials from disclosing any confidential information obtained as a result of his/her official duties and NYC Administrative Code Title 10, Chapter 5 concerning disclosures of security breaches. 

[vi] See, e.g., NYS Penal Law Article 190; Bureau of Justice Statistics, Office of Justice Programs, U.S. Department of Justice, “Identity Theft,” accessible online at https://www.bjs.gov/index.cfm?ty=tp&tid=42; U.S. Federal Trade Commission Consumer Sentinel Data Book for January – December 2016 (“FTC 2016 Data Book”), accessible online at https://www.ftc.gov/system/files/documents/reports/consumer-sentinel-network-data-book-january-december-2016/csn_cy-2016_data_book.pdf.

[vii] Birth Certificate Fraud, U.S. Department of Health & Human Services, Office of Inspector General (OEI-07-99-00570 September 2000). 

[viii]See, e.g., NYS Department of State, Division of Consumer Protection, “After Death” accessible online at https://www.dos.ny.gov/consumerprotection/scams/afterdeath.html.

 
Effective Date: 
Wed, 04/18/2018

Adopted Rules: Closed to Comments

Adopted Rules Content: 


Statement of Basis and Purpose

 

 The Department’s Division of Disease Control conducts disease surveillance and control activities for most of the diseases listed in Article 11 (Reportable Diseases and Conditions) of the Health Code. The Division of Disease Control also enforces Article 13 (Clinical Laboratories) of the Health Code, which regulates how laboratory tests must be performed and the reporting of test results. In addition, the Department must comply with various provisions of Part 2 of the New York State Sanitary Code, found in Title 10 of the New York Codes, Rules and Regulations, with respect to control of communicable diseases.

To conduct more effective, timely, and complete disease surveillance and control, the Board is amending Health Code Articles 11 and 13 as follows:

Hepatitis B Reporting

The Board is amending Health Code §13.03(b)(3)(B) (previously §13.03(b)(3)(A)) to require laboratories to report all hepatitis B virus (HBV) DNA test results, including negative results. The Health Department previously required laboratories to report only positive HBV DNA results, in addition to other positive HBV test results.

HBV DNA testing is performed on individuals who have tested positive for HBV. HBV DNA tests measure viral load and whether the patient has chronic (active) HBV, requiring treatment. For patients already diagnosed with chronic HBV, DNA test results provide important information regarding infectiousness, treatment eligibility, and risk for development of liver cancer. For patients being treated for HBV, DNA test results provide information regarding treatment outcome (i.e., the extent to which the patient cleared the infection).

The number of HBV cases is rising nationally and in New York City. More than 100,000 New Yorkers are estimated to be living with chronic HBV, with 8,439 new cases diagnosed in 2016, an increase of 18.8% since 2013. The majority of individuals infected with HBV as adults will clear the virus on their own, but many New Yorkers will develop chronic HBV. Chronic HBV can lead to serious health issues, including cirrhosis and liver cancer. All persons with chronic HBV infection require linkage to care and regular monitoring for liver damage and other complications; a subset require treatment with antiviral medications.

Without negative HBV DNA test results, the Health Department would have limited knowledge regarding whether patients who have tested positive for HBV are receiving appropriate follow-up testing and treatment. Mandated reporting of negative HBV DNA test results will allow the Health Department to estimate the proportion of New Yorkers infected with HBV who are appropriately tested and linked to care; identify gaps in access to care; develop targeted interventions to increase linkage to care and improve provider knowledge of HBV testing and treatment guidelines; and increase monitoring to reduce HBV-related morbidity and mortality.

In consideration of a comment received, the proposed amendment has been modified to exempt blood bank laboratories and other laboratories that perform hepatitis B DNA tests on donated blood from the requirement to report negative and indeterminate hepatitis B DNA test results for such donated blood.

Carbapenem-resistant Enterobacteriaceae Reporting

The Board is amending Health Code §11.03(a) to require laboratories to report carbapenem-resistant Enterobacteriaceae (CRE), an emerging bacterial threat. CRE are a family of bacteria that are difficult to treat because they have high levels of resistance to many antibiotics including carbapenem antibiotics. Carbapenem antibiotics are often used as the last line of treatment for infections caused by highly resistant bacteria, including those in the Enterobacteriaceae family.

As explained by the Centers for Disease Control and Prevention (CDC): “The emergence and dissemination of carbapenem resistance among Enterobacteriaceae in the United States represents a serious threat to public health. These organisms cause infections that are associated with high mortality rates and they have the potential to spread widely. Decreasing the impact of these organisms will require a coordinated effort involving all stakeholders including healthcare facilities and providers, public health, and industry.”[1] CDC has designated CRE an “urgent” threat, the highest threat level in its list of antibiotic resistant threats in the United States.[2]

CRE infections are common in hospitals, nursing homes, and other healthcare settings. Patients whose care requires devices like ventilators, urinary catheters, or intravenous catheters, and patients who are taking long courses of certain antibiotics are most at risk for CRE infections.[3] In 2015, hospitals in NYS reported 3,618 CRE cases via the CDC’s National Healthcare Safety Network (NHSN); 1,727 of these were reported by the 51 participating New York City facilities.[4] As only hospitals submit CRE data to the NHSN, the number of CRE infections in New York is probably significantly larger.

Mandated reporting will provide vital epidemiological information regarding incidence and evolution of CRE and assist in the identification of new strains, clusters, and outbreaks. This will enable the Department to help ensure infection control precautions are being taken. Mandated reporting of CRE is also aligned with recently released Council of State and Territorial Epidemiologists guidelines.[5] Based on a 2016 survey, 27 jurisdictions require some form of CRE reporting.[6]

Minor changes to other parts of §11.03(a) are being made for purposes of consistency.

 

Statutory Authority

The Board’s authority to promulgate these proposed amendments is found in Sections 556, 558, and 1043 of the New York City Charter (the “Charter”). Sections 558(b) and (c) of the Charter empower the Board to amend the Health Code and to include all matters to which the Department’s authority extends. Section 556 of the Charter provides the Department with jurisdiction to protect and promote the health of all persons in the City of New York. Section 1043 grants the Board rule-making authority.

 




[1] Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases. Facility Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE). November 2015 Update – CRE Toolkit. https://www.cdc.gov/hai/pdfs/cre/cre-guidance-508.pdf.

[2] Centers for Disease Control and Prevention. Antibiotic Resistant Threats in the United States, 2013. https://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf.

[3] Centers for Disease Control and Prevention. Carbapenem-resistant Enterobacteriaceae in Healthcare Settings. CDC website. https://www.cdc.gov/hai/organisms/cre/index.html.

[4] NYS Healthcare Associated Infections in New York State, 2015. Part 2: Technical Report. March 2017.

[5] Council of State and Territorial Epidemiologists. Infectious Disease Committee Position Statement 17-ID-04: Public Health Reporting and National notification of Carbapenemase Producing Carbapenem-Resistant Enterobacteriaceae for E. coli, Klebsiella spp. and Enterobacter spp. July 2017.

[6] Council of State and Territorial Epidemiologists. State Reportable Conditions Assessment (SRCA). http://srca.querytool.cste.org/.

Effective Date: 
Wed, 04/18/2018

Proposed Rules: Closed to Comments

Agency:
Comment By: 
Wednesday, March 14, 2018
Proposed Rules Content: 
 
 

Statement of Basis and Purpose of Proposed Rule

 

Introduction

Smoking is a leading cause of preventable premature death in New York City, increasing the risks of lung cancer, heart disease, and many other health hazards. To counter this threat, in 1988 the City enacted the Smoke-Free Air Act (SFAA), which was amended in 2002 to restrict tobacco smoking in various indoor and outdoor public places. Despite the substantial progress in reducing both environmental smoke exposure and smoking, hookah smoking has been increasing, especially among the City’s youth.

Hookah or water pipe smoking involves heating “shisha”, which is typically composed of a wad of tobacco and/or other flavored or unflavored leafy substances, over burning charcoal, to create smoke that travels through a pipe immersed in cooling water, and that is inhaled by the smoker through a mouthpiece.  Regardless of whether the shisha contains tobacco, hookah smoking poses significant health risks to smokers and nonsmokers, including employees at establishments that serve hookah. Hookah smoking produces emissions from burning charcoal. The charcoal creates health hazards for smokers and those exposed to secondhand smoke by emitting carbon monoxide, fine particulate matter, and various toxicants. In addition, smoking non-tobacco shisha has been shown to emit harmful substances equal to or greater than quantities emitted by smoking tobacco-containing shisha, including carbon monoxide, polycyclic aromatic hydrocarbons, fine particulate matter, tar, and volatile aldehydes.

While risks associated with non-tobacco hookah smoking are established, air quality in the City’s hookah establishments is compromised further by evidence that many of them have been found to be serving shisha that contains tobacco. Tobacco-containing shisha has been shown to emit phenols, nicotine, and NNAL, a tobacco-specific nitrosamine. Therefore, unsuspecting patrons of hookah establishments may be smoking tobacco unwittingly, in addition to the harmful substances emitted by charcoal and shisha. To address these concerns, Local Law 187 of 2017 amended the SFAA to ban the smoking of non-tobacco shisha except at existing establishments that require a permit from the Department.  Local Law 190 of 2017 also requires establishments where non-tobacco shisha may be smoked to post signage developed by the Department that warns of its risks. These proposed amendments implement these laws, which prohibit smoking of tobacco-containing shisha at any existing non-tobacco hookah smoking establishment and only allow the smoking of non-tobacco shisha at establishments permitted by the department.

Furthermore, given the health risks posed by non-tobacco smoking, Local Law 191 increases the minimum age for legal sales to 21 years of age for non-tobacco smoking products, including shisha that does not contain tobacco, pipes, water pipes, rolling papers, and herbal cigarettes. 

Proposed Amendments

These proposed amendments implement Local Laws 187 and 190 and set forth requirements for obtaining a permit to operate a non-tobacco hookah establishment in the City. The rules address the significant health hazards posed by hookah smoking by:

(1) protecting the integrity of the City’s Smoke-Free Air Act, which was intended to provide all New Yorkers with access to clean air in public places and workplaces by discouraging smoking and reducing exposure to secondhand smoke for nonsmokers;

(2) continuing the City’s efforts to de-normalize smoking and reduce tobacco dependence; and

(3) restricting access to establishments where non-tobacco hookah smoking can take place to persons over 21 years of age.

These proposed amendments also implement Local Law 191 and set forth the required language for a sign regarding the minimum legal sales age of 21 for the sale of tobacco products, electronic cigarettes, non-tobacco smoking products, and smoking paraphernalia that must be posted in a place of business where such products are sold.

Statutory Authority

The Department’s authority for these rules is found in section 1043 of the New York City Charter and sections 17-513 and 17-706 of the New York City Administrative Code.

  

Subject: 

Proposal to amend Chapter 10 of Title 24 (“Smoke-Free Air Act”) to establish requirements for a business to obtain a permit to operate a non-tobacco hookah establishment in the City.

Location: 
New York City Department of Health and Mental Hygiene, Gotham Center
42-09 28th Street 14th Floor, Room 14-31
Queens, NY 11101
Contact: 

Svetlana Burdeynik at (347) 396-6078 or resolutioncomments@health.nyc.gov

Download Copy of Proposed Rule (.pdf): 

Pages