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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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