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Proposed Rules: Closed to Comments

Agency:
Comment By: 
Tuesday, July 24, 2018
Proposed Rules Content: 
 
 

Statement of Basis and Purpose of Proposed Rule

Background

In 1971, the Board of Health amended section 207.05 of the New York City Health Code to allow the Department to file a new birth certificate with a corrected gender marker of male or female for a person who both obtained a court order changing his or her name and who underwent “convertive” surgery.  The Department had, generally but not exclusively, interpreted the requirement for convertive surgery to mean genital surgery.  As a result, transgender applicants requesting new birth certificates were required to submit medical records demonstrating that they had undergone genital surgery to change sex and the number of requests for a corrected birth certificate was relatively small.  For example, in 2012, the number of new birth certificates approved and issued to transgender applicants was 20 and, in 2013, only 22 new birth certificates were issued.

In 2014, the Board of Health amended Section 207.05(a)(5) to eliminate the requirement for convertive surgery.  This amendment allowed the Department to issue a new birth certificate with a changed gender marker of male or female based on an affirmation from a physician licensed to practice in the United States, or an affidavit from a doctoral-level psychologist clinical social worker, physician assistant, nurse practitioner, marriage and family therapist, mental health counselor, or midwife, licensed to practice in the United States.  Eliminating the surgery requirement led to a dramatic increase in requests for new birth certificates; from January 2015, when the amendment became effective, through February 2018, the Department issued 1,047 new birth certificates to transgender applicants.

Proposed Amendment

The Department is now proposing to eliminate the requirement that a person requesting a change to the sex designation on a birth certificate present proof from a health professional.  Instead, applicants would be able to self-attest as to their gender.  Additionally, the Department is proposing that the Board approve “X” as an additional sex designation for persons who do not identify as exclusively female or male.

The Department, in discussion with other states and advocates, has found that having practitioners affirm or attest to a person applicant’s gender identity is both a potential barrier for persons without access to a practitioner and does not add sufficient value in the process of deciding whether a new birth certificate should be issued.  Anecdotal evidence suggests that practitioners simply comply with their patients’ requests when asked to affirm or attest to a patient’s request for a change of gender.  Consequently, the Department proposes to rely on the applicant’s attestation that would require notarization.

The Department is also proposing that the Board approve “X” as an additional sex designation option that is not exclusively female or male for birth certificate sex change requests.  The sex designation on the US Standard Certificate of Live Birth is completed by the hospital or attendant at the time of birth.  The four choices are male, female, unknown and undetermined.  These are “sex” categories and not gender categories. The original public health data reported by the hospital is not changed under this proposal.

“Gender” categories are only applied on the birth certificate during an amendment process.  When the gender on a birth certificate is amended the original record is placed under seal and a new record is created.  There is no indication on the record of the amendment history.  The Department is proposing to allow “X” for those applicants who want a designation other than female or male on their birth certificate.

 
 
Subject: 

Proposed resolution to amend Section 207.05 of Article 207 (General Vital Statistics Provisions) of the New York City Health Code to eliminate the requirement that a person requesting a change to the sex designation on a birth certificate present proof from a health professional, and instead require self-attestation.

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:8)

Agency:
Comment By: 
Monday, July 16, 2018
Proposed Rules Content: 
 
 

Statement of Basis and Purpose

 

Section 274 of the federal Atomic Energy Act of 1954 [42 USC §2021 et seq.] (“Atomic Energy Act”) authorizes “Agreement States” to regulate byproduct material, source material and special nuclear material in quantities not sufficient to form a critical mass.  New York State is an “Agreement State” within the meaning of the Atomic Energy Act, and the New York City Department of Health and Mental Hygiene (“Department” or “DOHMH”) operates a component of the New York State Agreement.  Under this Agreement State structure, the DOHMH, through its Office of Radiological Health (“ORH”), regulates radioactive material for medical, research and academic purposes within the five boroughs of New York City.

New York State (NYS) Public Health Law §§225(5)(p) and (q) allows the NYS Commissioner of Health and the NYS Public Health and Planning Council to establish regulations with respect to ionizing radiation and nonionizing electromagnetic radiation and to authorize appropriate officers or agencies to register radiation installations, issue licenses for the transfer, receipt, possession and use of radioactive materials, other than special nuclear materials in quantities sufficient to form a critical mass, render such inspection and other radiation protection services as may be necessary in the interest of public health, safety and welfare. The NYS regulations are set out in Part 16 of the NYS Sanitary Code.

The Sanitary Code, in 10 NYCRR §16.1(b)(3), allows New York City to establish its own radiation licensure requirements in place of State regulations, so long as the local requirements are consistent with Sanitary Code requirements. 

New York City Charter (“Charter”) Section 556(c)(11) authorizes the Department to supervise and regulate the public health aspects of ionizing radiation, the handling and disposal of radioactive wastes, and the activities within the city affecting radioactive material.   

 

Background

Article 175 of the New York City Health Code (“Health Code”) applies to all radiation-producing equipment and radioactive material within NYC.  The Article contains general provisions applicable to both radiation equipment registrants and radioactive materials licensees, and specific requirements for such equipment and materials. The purpose of Article 175 is to protect the public, as well as workers in radiation installation facilities, from the potential hazards of ionizing radiation.  The Article’s requirements for radiation control reflects the coordination of radiation control activities with the U.S. Nuclear Regulatory Commission (“NRC”), the U.S. Food and Drug Administration, the NYS Department of Health and the NYS Department of Environmental Conservation, and other relevant city, state and federal agencies.  

The proposed reenacted Article 175 of the Health Code incorporates federal requirements contained in Title 10 of the Code of Federal Regulations (“CFR”) and reflects and is consistent with state regulations contained in the NYS Sanitary Code [10 NYCRR Part 16], and sets forth ORH-specific best practices requirements.   By law, the City must maintain compatibility with applicable federal requirements and consistency with applicable state regulations.  The Health Code may, and Article 175 as proposed does, in certain instances, mandate more stringent requirements as to health and safety radiation control measures than those required by federal and state authorities.

In NYC, there are about 6500 registered facilities with radiation-producing machines and 375 licensed sites with radioactive material for medical, academic and research purposes. Of the registered facilities, approximately 6440 are diagnostic X-ray facilities and 60 are therapeutic X-ray facilities. ORH inspects these facilities at varying frequencies depending on the type of usage.  Current inspection fees are unchanged under this proposed reenactment.

Radiation equipment

Prior to this rulemaking, Article 175 of the Health Code has not been substantially updated, particularly as to its radiation equipment requirements, since its last enactment in 1994.  Similar to that last reenactment, the Department has based much of this proposed reenacted text on the model code maintained by the Conference of Radiation Control Program Directors (CRCPD). The CRCPD is a 501(c)(3) nonprofit professional organization whose primary membership is made up of radiation professionals in state and local government that regulate the use of radiation sources in their jurisdictions.  CRCPD's mission is "to promote consistency in addressing and resolving radiation protection issues, to encourage high standards of quality in radiation protection programs, and to provide leadership in radiation safety and education".[1]  Since the reenactment of Article 175 in 1994, improved best practices have been developed and implemented for radiation control measures.  Many of these measures are reflected in the current CRCPD model code, which has provided the basis for much of the text related to radiation equipment in the new proposed Article 175.

Radioactive materials

As noted above, Article 175 of the Health Code incorporates federal requirements from Title 10 of the CFR.  New York State is an Agreement State with the U.S. NRC which means that the NRC has delegated authority to NYS to regulate radioactive material at non-reactor sites within its jurisdiction.  The New York State Agreement is comprised of the regulatory programs of three agencies:

1. the New York State Department of Health,

2. the New York State Department of Environmental Conservation, and

3. the New York City Department of Health and Mental Hygiene.

Under the NYS Agreement and § 16.1 of the State Sanitary Code, the Department, through its Office of Radiological Health (ORH), regulates radioactive material for medical, research and academic purposes within the five boroughs of New York City.  Each Agreement State program is required to maintain compatibility with the NRC regulatory program. The NRC regulatory program utilizes Compatibility Categories to specify the type of wording to be used in the corresponding State program regulations.[2]

 

As noted above, the last significant revision of Article 175 requirements occurred over 20 years ago.  Since then, NRC has made numerous updates of its requirements contained in Title 10 of the CFR.  In order for the Department to maintain its compatibility status with the NRC regulatory program, each time the NRC has updated its regulations in Title 10 of the CFR, the Board has had to make corresponding updates to Article 175, which has been an inefficient and time–consuming process.  In many instances, and because of the compatibility designations, the Board updated Article 175 by reproducing the actual CFR text directly into its requirements. The Board believes that continuing to update its rules this way is redundant and unnecessary and that it makes more sense to incorporate by reference the relevant CFR regulations, which will still provide the same legal force and effect as if the Board had actually reproduced such requirements directly into Article 175.  This incorporation by reference process avoids duplication and provides uniform, accurate guidance to the regulated community, as well as making for a less unwieldy and more manageable Code.

Accordingly, the Department proposes the Board repeal and reenact Article 175 primarily to:

  • update the quality assurance requirements to reflect industry-wide best practices for the installation, operation and maintenance of  both diagnostic and therapeutic radiation equipment required to be registered with the Department, and which is used for medical, academic and research purposes, and
  • more efficiently adopt and enforce NRC requirements for the possession and use of radioactive materials required to be licensed by the Department by incorporating by reference applicable federal regulations contained in Title 10 of the CFR for radioactive materials.

Statutory Authority

This repeal and reenactment of Article 175 of the Health Code is proposed pursuant to Sections 556, 558 and 1043 of the Charter and applicable state and federal law.  Section 556 of the Charter grants the Department jurisdiction to regulate matters affecting health in New York City.  Specifically, Section 556(c)(11) of the Charter authorizes the Department to supervise and regulate the public health aspects of ionizing radiation within the five boroughs of New York City.  Sections 558(b) and (c) of the Charter empower the Board of Health to amend the Health Code and to include in the Health Code all matters to which the Department’s authority extends.  Section 1043 of the Charter grants rule-making powers to the Department.

 




[1] See, http://c.ymcdn.com/sites/www.crcpd.org/resource/collection/665D6792-2EB4-4AF6-8134-1173A394FE28/Constitution10-25-04.pdf (describing the goals of the CRCPD to, among other things, promote radiological health in all aspects and phases and to promote and foster uniformity of radiation control laws and regulations).

[2] See, https://scp.nrc.gov/procedures/sa200.pdf  (providing NRC compatibility categories and health and safety components assigned for determining whether an agreement state is maintaining a compatible radiation safety control program with NRC).

 
 
Subject: 

Proposed resolution to repeal and reenact Article 175 (Radiation Control) of the New York City Health Code

Location: 
New York City Department of Health and Mental Hygiene, Gotham Center
42-09 28th Street 14th Floor, Room 14-43
Queens, NY 11101
Contact: 

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

Download Copy of Proposed Rule (.pdf): 

Proposed Rules: Closed to Comments

Agency:
Comment By: 
Thursday, July 12, 2018
Proposed Rules Content: 
 
 

Statement of Basis and Purpose 

Statutory Authority

These amendments to the Health Code are promulgated pursuant to §§ 558 and 1043 of the Charter. Sections 558(b) and (c) of the Charter empower the Board of Health to amend the Health Code and to include in the Health Code all matters to which the authority of the Department of Health and Mental Hygiene (the “Department” or “DOHMH”) extends. Section 1043 grants the Department rule-making authority.

Background

The Department is responsible under the Charter for supervising matters affecting the health of New Yorkers. This includes supervision of the reporting and control of chronic diseases and conditions hazardous to life and health.[1] The Department also has specific responsibilities with regard to mental health.  Pursuant to section 552 of the Charter, the Department’s Division of Mental Hygiene (MHy) is the local government unit (LGU) for the City of New York under New York State Mental Hygiene Law, and the executive deputy commissioner who directs the Division is the City’s director of community services.  As the LGU, MHy is responsible for administering, planning, contracting, monitoring, and evaluating community mental health and substance use services within the City of New York. It also is charged with identifying needs and planning for the provision of services for high-need individuals, such as persons with schizophrenia and other psychotic illnesses. In 2013, the Board of Health amended the Health Code to require hospitals to report when persons between the age of 18 and 30 are first admitted with a psychotic illness so that DOHMH can make appropriate linkages to services through the NYC Supportive Transition and Recovery Team (NYC START).  The Department of Health and Mental Hygiene has successfully implemented hospital reporting with time-limited linkage to care for individuals 18 – 30 years of age with a first-episode psychosis hospital admission. However, in order to best account for and intervene in episodes of early psychosis and address health disparities, it is necessary to expand the age criteria for the reporting requirement to those aged 16 and over, collect data on race and ethnicity, and retain collected information past the current 30 day time limit.

 

Current Linkages to Care for First-Episode Psychosis

When the Health Code was amended in 2013 to address inadequate linkages to care for people with first-episode psychosis, we pointed out that New Yorkers with psychotic illnesses often do not seek care or become disengaged from care in part due to:

  • Fragmentation in the current mental health treatment system (patients being lost to care in transitions from hospitalization);
  • Exchange of patient information unsupported by technology infrastructure or current administrative practices;
  • Mental health treatment providers lacking resources to ensure links are established between patients and community supports; and
  • Challenges such as stigma, denial, fear, lack of support, and confusion related to benefits and insurance

 

While NYC START has improved these linkages to care for those who are reported with first-episode psychosis and accept services, we seek to further amend the Health Code to improve the health of all New Yorkers with first-episode psychosis. In particular, there are three areas that need to be addressed in order to more fully account for the needs of individuals with psychosis:

  1. Currently, the Department may only retain identifiable information of individuals reported with first-episode psychosis for 30 days unless they accept care through NYC START, making psychosis the only reportable illness that places a limit on the amount of time the information can be seen by the Department. After 30 days, this information must be de-identified and cannot be used to follow up with the individual or to identify possible re-reporting. Given the many reasons that people with first-episode psychosis disengage from care, it is necessary to retain this information past 30 days to ensure that outreach can continue to those who have been unreachable during the initial 30-day period, to comprehensively assess the needs of communities, and to work with providers to develop successful interventions.
  2. DOMMH estimates that approximately 2,000 new cases of psychotic illness develop each year in New York.[2],[3]  Our analysis of NYC hospital admissions found that 6 % of probable first-episode admissions occurred among persons between 16 and 17 years of age.[4]  There has been an expansion in the availability of specialized services for individuals 16 to 30 years of age.  However, due to restrictions in the Health Code limiting the reporting age to between 18 and 30, we do not currently account for individuals who develop first-episode psychosis before the age of 18. 
  3. Race and ethnicity are currently not among the list of required information that hospitals must identify when making a report of first-episode psychosis. Because there are racial disparities in the diagnosis and treatment of psychotic disorders, however, this information is especially pertinent to collect and utilize to improve interventions and address health inequity.[5]

Proposed Rule

To improve interventions, linkages to care, and outcomes for New Yorkers experiencing first-episodes of psychosis, the Department proposes that the Board of Health amend Article 11 of the Health Code. The proposed changes would facilitate participation in early intervention services by requiring hospitals to report when individuals over 16 and under 31 years of age are admitted with a first-episode of psychotic illness. The proposed changes would further facilitate the creation of a database of reported cases of first-episode psychosis that would permit the Department to monitor trends of the illness.

Evaluating these trends can be used to:

  • Develop targeted, culturally-competent interventions in the NYC START program
  • Measure outcomes of first-episode psychosis care, and thereby direct more efficient interventions to health care institutions, health care providers and people with psychosis.

Reporting will continue to be required within 24 hours of admission and will include hospital name, patient name, age, gender, address, telephone, date of admission, insurance type, diagnosis, race, and ethnicity. All patient information reported to the Department will be kept confidential and will not be shared with anyone other than the patient or treating provider.

 


[1] Charter §556(c)(2).

[2] Kirkbride JB et al.  Int J Epi.  2009; 38-1255-64.

[3] Bladwin P et al. Schiz Bull 2005 31;3, 624-38.

[4] DOHMH internal analysis of NYC hospital admissions in 2009 for probable first-episode psychosis among 16 – 29 year olds.

[5] Schwartz, R et al. World J Psychiatry. 2014 4(4): 133-140

 
 
Subject: 

Proposed resolution to amend Article 11 (Reportable Diseases, Conditions) of the New York City Health Code regarding first episode psychosis.

Location: 
New York City Department of Health and Mental Hygiene, Gotham Center
42-09 28th Street 14th Floor, Room 14-43
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

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 47 of the Health Code governs center-based child care. The Board is amending the Article’s requirements by adding requirements pertaining to epinephrine auto-injectors, and training, and by clarifying requirements. 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 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[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 medication available. Accordingly, the amendments clarify requirements for emergency medical care and add a requirement 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 will be required to have on site, whenever children are present, at least one staff person trained to recognize signs and symptoms of anaphylactic shock and to administer epinephrine as appropriate. The amendment also requires programs to monitor the auto-injectors’ expiration dates and call 911 after any administration, as required by the medication directions. Programs will be required to obtain parental consent at the time each child is enrolled in the program, and to train all staff in preventing and responding to emergencies related to food allergies.

The proposed language has been modified to require that epinephrine auto-injectors have retractable needles and to clarify storage requirements; and to allow all staff to administerasthma inhalers, nebulizers, and epinephrine auto-injectors to children whose parent or guardian has provided written consent, medical authorization, and training.

Training

The amendments 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 amendments provide that trainings currently required only for assistant teachers be mandated for all teaching staff. These core trainings address fundamental issues including preventing, recognizing signs of, and reporting injuries, infectious diseases, lead poisoning, and asthma; scheduling and conducting guided and structured physical activity; and promoting childhood growth and development.

The proposed language has been 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); and to require that at least five of the required 15 hours of training in certain topics take place each year.

Clarifying Requirements    

A number of the amendments clarify requirements and facilitate compliance with the Health Code. For example, some definitions have been added or clarified.

The Health Code previously required that documentation be provided under certain provisions. The amendments articulate more uniform requirements across additional provisions.  They also clarify, to the regulated community, that review of such documents will occur at least once a year.

            The amendments also articulate more precise requirements regarding program capacity, level of supervision, response to emergencies, response to medical emergencies, and the administration of some medications.  Various other technical edits have been made to the text for consistency. 

            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 implementation of 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.




[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: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): 

Adopted Rules: Closed to Comments

Adopted Rules Content: 
 
 

Statement of Basis and Purpose

 

Statutory Authority

Section 556 of the New York City Charter (“Charter”) authorizes the Department of Health and Mental Hygiene (“Department”) to regulate all matters pertaining to the health of the City, and Section 1043 grants the Department rulemaking authority. Moreover, Local Laws 5, 7 and 8 of 2015, as amended by Local Laws 53 and 55 of 2015, added a new Chapter 17 and amended Chapters 3 and 8 of Title 17 of the Administrative Code regarding the sale of dogs and cats in pet shops. The Department is authorized to promulgate rules necessary for implementation of these local laws.

Background

As a result of the local laws cited above, the Administrative Code now requires that pet shops selling dogs or cats acquire them only from holders of the United States Department of Agriculture (“USDA”) Class A licenses. Additionally, pet shops must document and maintain information about the sources, sales, health and breeding histories of the dogs and cats they sell. The shops must sterilize dogs and cats that are at least eight weeks old and two pounds in weight, and implant microchips into such animals prior to their being sold.

The Department is now adding a new Chapter 5 to its rules (codified at Title 24 of the Rules of the City of New York) to implement these recently enacted provisions of the Administrative Code.

In compliance with §§1043(a) and 389(b) of the Charter, a notice of public hearing and notice of intent to add a new Chapter 5 (“Pet Shops”) to Title 24 of the Rules of the City of New York were initially published in the City Record on January 31, 2017, and a public hearing was held on March 2, 2017. No written comments were received and no individuals testified at the hearing.

Subsequent to the public hearing, however, the Department decided to revise the proposal because relevant information regarding Class A licensees has been removed from the USDA website.  As a result, the proposal has been revised to clarify the means of complying with Administrative Code §§17-1702(a) and 17-1703.

The revised proposed amended rules were published in the City Record on November 8, 2017, and a public hearing on was held on December 11, 2017.

In response to comments received, the Department has further revised the amendment to address concerns about the timing of affidavits required to be provided to pet shops by breeders and the methods by which the pet shops obtain USDA reports. The Department has also made other changes to clarify the means of complying with Chapter 17 of the Administrative Code.

Amendments Adopted

To implement the recordkeeping and consumer disclosure requirements of the Administrative Code, the rules require pet shops to collect and maintain required information, and to provide it to prospective purchasers as mandated, using forms provided by the Department to the extent applicable. The forms are listed on the checklist below. Requiring standardized forms promotes compliance by assuring that pet shops completing the documents will have collected all of the information required by the Administrative Code, and facilitates Department review and pet owners’ understanding of records.

The Administrative Code directs the Department to set fees that a pet shop may collect for providing prospective purchasers with USDA inspection reports. These rules set nominal copying fees of up to $.25 per page.

To enable the Department to promptly issue dog license tags to people purchasing dogs at pet shops, the rules require that a pet shop submit any dog license application completed in paper copy to the Department within 10 business days of the sale. Pet shops enrolled in the Department’s online dog licensing system can avoid this paperwork.

Dogs and cats offered for adoption at pet shops by permitted animal shelters and incorporated not-for-profit animal rescue groups are not subject to these new laws to the extent that they are registered with the New York State Department of Agriculture and Markets and are exempted from the definition of “pet dealer” set forth in New York State Agriculture and Markets Law § 400.4. To assist enforcement officers in determining when this is the case, the rules require pet shops to maintain, on site and available for inspection, a copy of the animal shelter’s permit issued by the Department or the rescue group’s proof of not-for-profit status, and such registration and exemption, at any time such organizations are using the pet shop’s space.

Moreover, the requirements of the new laws do not apply to breeders that sell or offer to sell cats and dogs directly to the public, as long as such breeders sell or offer to sell fewer than a total of 25 dogs and cats per calendar year, and such animals are all born and raised on the breeder’s residential premises and sold directly from such premises.

Finally, the law establishes penalties of $500 per violation per day, enforceable by officers and agents of the Department and officers of the New York City Police Department.

Below is a summary checklist of the documents that satisfy the requirements of the rule.

 

Checklist of Required Documents

 

DOHMH Form Number

Document

Recordkeeping, Subject to Inspection

(Maintain for 5 years unless otherwise noted)

Provide to Purchaser

USDA, Animal and Plant Health Inspection Service (APHIS)

201-D-USDA 7001

Form 7001

201-D-USDA 7006

Form 7006

 

n/a

Copy of source’s USDA APHIS inspection reports from last 3 years

NYS Agriculture and Markets, Division of Animal Industry

204-D-AGMKT-Form A

Veterinary Health Certificate

Pet shop to keep original

 

205-D-AGMKT-Form C

Receipt

206-D-AGMKT-Form E

Information Statement

207-D-AGMKT-Form H

Pedigree (for animal capable of being registered)

(if applicable)

(if applicable)

208-D-AGMKT-Form I

Consumer Rights/NYS Article 35-D

New York City-Only Documents

209-D-VPHS-Purchaser Statement

Purchaser Statement

Maintain statement for 10 years and attachments for 5 years

n/a

Microchip usage instructions provided by the manufacturer or registration company

n/a

Sterilization Certification

(Record from the veterinarian of sterilization procedure performed on dog or cat)

n/a

Receipt log showing sale of dog license (if the pet shop does not use the online dog license system and the dog will live in NYC) 

 

213-D-VPHS-Source Affidavit

Affidavit from source

 

214-D-VPHS-38

Self-inspection of Animal Holding Facilities

 

203-D-AGMKT-Vet Care Plan

Veterinary Care Plan

 

215-D-VPHS

Pet Shop statement regarding diligent check of the USDA website

 

 
Effective Date: 
Thu, 04/05/2018

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