Norwalk- New Canaan Health District Task Force
Findings and Recommendations
February 9, 2005

Norwalk Mayor Alex Knopp and New Canaan First Selectwoman Judy Neville charged this Task Force with preparing a proposal for the development of a joint New Canaan and Norwalk Health District. Since November 2004 the Task Force has met six times to review available information including the state statutes specific to Health Districts and to recommend appropriate services and staffing levels to serve the public health needs of both communities. The Task Force carefully assessed the financial implications of each town remaining independent and contrasted those projections to joining together as a health district. Finally operating guidelines, by laws and a budget under which the health district will work were considered.

An organizational meeting was convened on November 4, 2004. On December 2, 2004, Jim Rokos, Health Director of the Torrington Area Health District and Steve Huleatt, Health Director of the West Hartford-Bloomfield Health District discussed in detail the formation and operations of their respective organizations. The focus of the December 16, 2004 meeting was on a review of the local public health services that are mandated by Connecticut General Statue 19a-76-2 and the level of compliance with the regulation by Norwalk and New Canaan. On January 13, 2005 the Task Force reviewed financial information including current income and expenses for Norwalk and New Canaan, the cost of operating a health district and opportunities for revenue enhancements and cost savings if a health district were to be formed. On January 27, 2005 a health district budget (in 2004 dollars) was reviewed, proposed by laws were considered and findings and recommendations were drafted. The sixth meeting of the Task Force took place on February 9, 2005. Proposed budgets for Norwalk, New Canaan and the Health District were reviewed, projected per capita rates for each member entity were agreed upon and the findings and recommendations were approved.

Task Force Findings:

Services
According to Connecticut General Statute 19a-76-2, the components of a local public health program are environmental services, communicable and chronic disease control, maternal and child health, health education, emergency response, public health statistics, nutrition services and community nursing services. The Norwalk Health Department meets this mandate by directly providing services and through collaboration with community agencies that provide the services. New Canaan directly provides environmental services. However the scope of services falls short of state requirements, as food establishments are not inspected in a timely manner and inspection programs for salons, public pools and day care centers are not in place. New Canaan recently contracted with Norwalk for food establishment inspections. Emergency response planning, a new public health program area, is already a joint undertaking of the towns. Gaps in health education were also identified.

Staffing
According to Connecticut General Statute 19a-244 full time employees of towns joining health districts become employees of the district. These employees remain in the pension plan of the town by which they were employed. The staffing levels of both towns when combined appear to be sufficient to meet the needs of the health district.
The City of Norwalk employees are members of various collective bargaining units and as such, benefits for current employees who join the district and retirement benefits other than pension issues require the involvement of the City’s Personnel Department to fully resolve.

Financial
Income sources include fees from permits, licenses and clinic and laboratory services, grants and local contributions. Additional revenue is expected from expanding influenza and travel services to New Canaan, instituting a consistent fee schedule for environmental services and from an increase in state grant funds. The formation of a health district will increase the per capita grant by nearly $84,000 per annum. A reduction in contractual nursing services in New Canaan will reduce expenses. An additional sanitarian will not need to be hired to bring basic service levels into compliance with state requirements. The Health District budgets reviewed by this Task Force are preliminary. The analysis indicates that each town will reduce their respective public health costs for FY 06 by forming a health district. A thorough analysis by the Finance Departments of each town may reveal additional cost items.

Conclusions

The formation of a health district will be to the benefit of the residents of Norwalk and New Canaan for the following reasons.

1. Service levels will improve in both communities. In New Canaan, for example, with only two sanitarians, there will no longer be gaps in service due to vacation or illness, now that there will be a larger pool of six professionals to provided fulltime coverage for the district. Also the ability to more evenly distribute the new and significant workload in the very important area of emergency response is greatly enhanced. Health Education and promotion will now be available to New Canaan

2. The local cost for public health services will decrease because:
a. Increase in state per capita funding from $.49 for New Canaan and $.99 for Norwalk to $1.66 for the health district.
b. Enhanced revenue from expanding existing clinical programs, travel and influenza immunizations, laboratory services, water testing, and uniform fees for environmental services and institution of inspection and permits for salons and public pools in New Canaan.
c. Grant monies would be increased by the per capita rate to account for New Canaan. More and different types of grant proposals may be possible with a district.
d. New Canaan becomes eligible for Homeland Security and other money that it is not eligible for currently.

3. This unique entity will have the potential ability to influence legislation and programming to the benefit of its constituents. This Health District, with a population of 103,861, will be the fourth largest district in Connecticut, offering the most comprehensive local public health program of any district and will be the only district comprised of a city and a town. Darien currently attends meetings and is expressing potential interest in joining the district. If they were to join the district it would become the 2nd largest district in the state.

4. Acting now preempts the movement to require all towns with population less than 40,000 to be part of a health district. Legislation has been introduced again this year towards this end because of the difficulties the State has working with so many small entities, many of which it knows are not meeting the core mandates. Acting now allows the towns to choose their preferred partner and to negotiate the exact nature of the relationship rather than face imposition by the state. This also protects Norwalk form the isolation that might result if the surrounding towns form one or more health districts.

Reccommendation

The City of Norwalk and Town of New Canaan should negotiate to determine the feasibility of moving the Health District concept to a functional entity.

Next steps are:

1. Collective bargaining units must be brought into the discussion and potential issues resolved.
2. Allocation of costs for capital projects and the use of office space must be considered.
3. Unforeseen costs and revenues may need to be factored into the financial models. A thorough review by the Finance Departments of the respective towns need to be done and may reveal unforeseen income and expenses.

We the undersigned members of the Norwalk-New Canaan Health District Task Force approve of these Findings and Recommendation.
Dated Wednesday February 9, 2005 at the Norwalk Health Department

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David M.Reed, MD, MPH Tim Callahan, RS, MPH
Director of Health, Town of New Canaan Health Director Norwalk
Co-Chair Co-Chair

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James Cole, New Canaan Betty Karkut, Norwalk

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Cheryl Jones, New Canaan Ken Lalime, Norwalk

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John Laird, New Canaan Richard McQuaid, Norwalk

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Carol McDonald, New Canaan Jeanette Olmstead-Sawyer, Norwalk

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Edward Tracey, MD, Norwalk