PUBLIC HEALTH & WELFARE COMMITTEE
PUBLIC HEARING TO CONSIDER THE FORMATION OF
A HEALTH DISTRICT
COMMON COUNCIL CHAMBERS
MAY 26, 2005

ATTENDANCE: Rev. Jeannette Olmstead-Sawyer, Chair; Peter Wien; William
Krummel; Richard McQuaid; Leona Williams, Douglas Sutton.

STAFF: Tim Callahan, Director of Health, City of Norwalk

OTHERS: Tom Hamilton, Finance Director, City of Norwalk; Tom
Berstone, Facilitator for State of Connecticut, UConn.;
Ken Lalime, Member of the Norwalk Board of Health;
Laura Epstein, Senior Service Council; Ed Tracey;
Betty Karkut, Director, Honey Hill Care Center; Diane
Lauricella, League of Women Voters & Independent
Environmental Health Consultant, Bill Gerrish, State of
Connecticut Department of Public Health, Hartford;
Jacqueline M. Lubell, Norwalk NAACP; Shirley Mosby,
Norwalk NAACP, James Cole, New Canaan Health Task
Force, Ed Musante, Norwalk Chamber of Commerce, Dr.
David Reed, Health Director, Town of New Canaan,
David Kennedy, C.E.O, United Way

CALL TO ORDER AND OPENING OF PUBLIC HEARING

The public hearing was called to order at 7:40 p.m. by the chair. The public was invited to sign up at the podium if they wished to speak.

OVERVIEW OF PROPOSED HEALTH DISTRICT

Mr. Tim Callahan, the Director of Health for the City of Norwalk, opened the meeting with a slide presentation that reviewed the proposal for the Norwalk- New Canaan Health District. He stated that the State of Connecticut is comprised of 169 towns. The current population of the state is almost 3 and a half million people. Nearly 90% of the population of the State are served by full time Health Departments. Out of those 169 towns, 31 have full time municipal Health Departments. There are currently 19 Health Districts in Connecticut. There are still 46 part time Health Departments in the State. These serve between 10, almost 11% of the population. The majority of the people of the State are served by Health Departments that are full time and offer a broad category
of services.

The Health Districts are governed by Connecticut State Statute 19a-241, which has very specific guidelines for communities to follow. These include: a public hearing and legislative body vote; the district becoming an extension of the municipalities; governed by a Board of Directors with a Health Director and must adopt reasonable rules and regulations.

The statutes are very specific about full time employees who move from the City to the District are guaranteed their jobs. Also by statute, those employees have the right to remain with the pension plan at the town or State where they were working. If a town withdraws from a district or the district is dissolved, those employees have the right to go back to the city from which they came. No district has ever shut down. There have been a couple instances where towns have moved from one district to another geographically. At the time, they decided to join the District, there was only one and subsequently additional Districts were formed and it made more sense for them to
join one of the newly formed Districts.

The other very important item that is outlined in the statute is the state of reimbursement. Health Departments receive some funding from the State at set rates per capita. The State reimburses full-time Health Departments .94¢ per capita. New Canaan currently is reimbursed at .49¢ per capita. A District, however, receives $1.66 per capita. That is the incentive the State can offer us. For Norwalk and New Canaan, if we form a Health District that means additional $84,000 per year.

Emergencies and disasters do not stop at town borders. Towns need to be prepared. The State has pushed us in that direction because they have said, “Norwalk and New Canaan, you are the regional area for the smallpox response.”

In addition, efficiency is greatly increased. Obviously, there are emerging health problems. We know that a big study in Norwalk last year found that an alarming number of children in our school system who are considered obese or becoming obese.
We need to develop interventions or plans. If we went to New Canaan with that same study, we would discover that childhood obesity doesn’t understand town borders.
In developing intervention, it takes alot of resources. With a District, we could develop an intervention that would go across a broad based population.

Savings would be around 9% for the first year of operation. After talking with other directors of Health Districts, they have all found that once they got going, the savings were much bigger than they ever thought they would be.

Senate Bill 978 will require that all part time Health Districts become full time Health Departments. There is a possibility that this will not be implemented before the legislative session is over. In the event that it doesn’t happen this year, it will happen within the next few years.

How will this affect Norwalk and New Canaan. A Task Force was appointed, 6 representatives from Norwalk and 5 from New Canaan for a total of 11. We took a very thorough look at the laws, at service levels and statute requirements and the budgets. We met with other Health District leaders to hear their experiences and had input from the State Department of Health.

What the Task Force found was that Norwalk meets the statutory required levels of services. However, New Canaan was not able to meet these requirements and must improve their levels of service. It was also discovered that regard to emergency response that both Norwalk and New Canaan are already working together, as a result of the smallpox response mandate. By working together, Norwalk and New Canaan can maximize services to the area. The Task Force determined that current staffing levels are sufficient and that the costs would be reduced for both the City of Norwalk and the Town of New Canaan.

The Task Force concluded that forming a District would improve services in both communities and reduce the local public health care costs. Also, implementing a Health District would make us the fourth largest District in the State and give us potential to influence legislation. We would also be unique in that Norwalk and New Canaan would be the first to form a District composed of a city and a town. The combined population of the two towns would allow the District to apply for grants and funding for which we have not previously been eligible The CDC is already talking about requiring accreditation, so by forming now, we would determine our own course of action and strategically position ourselves.

The Task Force therefore recommended that City and Town Leaders and Administrators move the project forward, start working with the collective bargaining unions and review the budget forecasts.

Mr. Callahan then reviewed the Finances, and reiterated the savings of 9% overall. He also indicated there would be a consistent rate fee schedule and that New Canaan would pick up the services that are not currently available to them.

Mr. Callahan then reviewed four memos: a Memorandum of Understanding Employees, a Memorandum of Understanding Offices - which assured the residents that their records would remain in their towns, a Memorandum of Understanding Costs and a Memorandum of Understanding Compliance.

Mr. Callahan concluded his report with the recommendation for approval of a Norwalk-New Canaan Health District.

Chairwoman Olmstead-Sawyer thanked Mr. Callahan for his presentation.

PUBLIC COMMENTS

Chairwoman Olmstead Sawyer opened up the meeting to public comments at 8:04 p.m.

Mr. Thomas Hamilton, Finance Director for the City of Norwalk
125 East Avenue, Norwalk, CT.

Mr. Hamilton apologized to the Committee and the public for the delay of the hearing as the Finance Department had not completed their evaluation and review.

Mr. Hamilton then distributed a three page Financial Benefits to Norwalk of the Proposed Norwalk-New Canaan Health District report.

He indicated that a Norwalk-New Canaan Health District would be eligible for additional State grant revenues estimated at $83,660 per year which would be received beginning June, 2005.

Also a Norwalk-New Canaan Health District would be in a better position to secure more State, Federal and or Private Foundation grants than either town alone.

The creation of a Health District would open up new opportunities for the District to generate greater revenues from fees for services.

The City has performed its due diligence to identify outstanding financial and other issues associated with the creation of a District.

The creation of a Health District will save Norwalk taxpayers money starting this year and increase in the future.

Mr. Hamilton concluded his report with the recommendation for approval of a Norwalk-New Canaan Health District.

Mr. Thomas Berstone, Consultant for the State of Connecticut - UConn
95 Rimsfield Drive, South Windsor, CT 06074

Mr. Berstone stated that he was a facilitator for the State of Connecticut and the University of Connecticut.

He reviewed the process that was utilized with the committee in viewing the entire project. It was a two phased project. First, a meeting was held initially with Dr. Reed in New Canaan and did a general fact finding overview and put together a business plan for viability. Based on that, it was felt that the project was worthwhile and significant savings would be realized. The second phase was a series of meetings with the committee in which facilitated guidance decision making was needed. The committee members discussed it and put forward a proposal that was felt to be workable for each of the services. This was done with each of the aspect of the project: staffing, structure of district, etc. In the latter three meetings there were alot of aspects, looking at what the current budgets were, and projecting budgets for 2006 so that the committee could see what it would look like individually and what it would look like combined. This information was analyzed and resulted in the conclusion that the committee recommends that this project go forward. It is notable that the State thought highly enough of this project to bring in assistance for both Norwalk and New Canaan in this process.

Mr. Berstone thanked the Committee for their time.

Mr. Ken Laline, Member of the Norwalk Board of Health
137 Partick Avenue, Norwalk, CT 06850

Mr. Laline greeted the Committee and identified himself as a Norwalk resident and a member of the Norwalk Board of Health for the last 10 years and a member of the Task Force. There were also members from the Council, the community, and reciprocal representation from New Canaan.

Mr. Laline stated that he had heard a great deal about the finances and why the plan would work, but he had a different context. He sees three different strategic advantages for the area.

First, working on a daily basis in the health world as a liaison between managed care companies and physicians, he is acutely aware of current issues and trends. Health care is an extremely personal issue, regardless of whether it is a private or public health issue. Relationships that are built in the development of health issues are very important. Good relationships are vital. These basic relationships were developed on the Task Force and are key to the success of a program.

Secondly, the financial advantages, which were covered thoroughly by Mr. Hamilton and need not be reiterated again.

Thirdly, there is the possibility of strategic alliances for the future. There are other communities that are also beginning to work towards forming a Health District and are looking toward other communities that are doing similar things as possible partners for them. We would be the first to form a District in the southwestern portion of the state.
The State Health Department is looking to increase the number of Health Districts in the State and to minimize the number of independent Departments. We saw this with the flu vaccine shortage last year with only half the supply of flu vaccine disappearing virtually overnight. On a State-wide basis, there was a network of some 7,000 physicians statewide. The State had a very difficult time determining where would be the best place to move the supply of vaccine that it did have to get it to the general public.
Perhaps if the State had 25 districts set up ahead of time, that process would have been much easier to distribute the vaccine and make sure that those who were in need really got what they needed.

Legislation is certainly on our side. Mr. Callahan has gone through those pieces that will come through in fruition in the next couple of years. Consolidation in the health care industry is happening all the time whether it be health insurers or physician organizations or physician practices. Sometimes it is done for financial reasons, sometimes for other reasons. Accreditation processes are becoming extremely important nationally as the world turns to the private sector, where employers and the government are looking at this. There is a new term out there called “pay for performance”. Virtually every employer is looking at this for their own employees. But in the health care sector, everything is being looked at as performance based. Medicare this year is starting is starting to look at paying physicians not just on a fee for service no matter what is done, but they are starting to look at whether there is a quality outcome. Every sector of health care is going to be under that same scrutiny. They are going to be looking for quality outcome. Those that put themselves in strategic positions to put a foundation here are vital. It starts with the employees. They will make those quality outcomes for us. Those quality outcomes will be easily measured in the next five to ten years. The districts that form properly will be, he thinks, advantaged - not just financially - but by positioning. Regional strategic alliances such as the Westport-Weston area prove that the development of this type of project will benefit everyone. Thank you.

Ms. Laura Epstein, Senior Service Council
8 Wake Robin Road, Norwalk, CT

Last year, you will remember the shortage of the flu vaccine. That really was a crisis. We had many calls from seniors who were really upset, worried and had many questions. Because there are 91 local health departments in Connecticut, it took the State more than seven days to come up with a response. So the number of Health Departments is an issue in the State and it impacted all population. Also, it is about time that Norwalk stopped being treated like a way station between Bridgeport and Stamford. People forget that we are the 6th or 7th largest city in the state. If we were part of a District, with a population of over 100,000, we would definitely have more of an impact.
Also, please realize that the senior population is frail. We really have to have a system in place that allows us to respond quickly and to have the State respond to us quickly.
The senior population is particularly vulnerable. Establishing a Health District would be a positive move.

Mr. Ed Tracey
14 Birchside Drive, Norwalk, CT

Many of the facts and figures have already been said. In the past years, public health issues has been complicated and it will only get more so in the future. We all remember public health concerns such as the Oyster Festival food poisoning incident, an outbreak of TB in the Norwalk schools, the anthrax scare just east of us in New Haven County, the smallpox vaccine concerns and the problems of West Nile Virus. The Task Force studied these issues and at the of the process voted unanimously to form a Health District.

Ms. Betty Karkut, Director, Honey Hill Care Center
34 Midrocks Drive, Norwalk, CT

Ms. Karkut stated that she was involved with the Task Force for the District and is the Director of Honey Hill Care Center. She explained that her service area is not just Norwalk, although the majority of her patients are Norwalk residents. There is an emerging public health crisis as Mr. Callahan has mentioned and one of the resources to be able to deal with this is the State of Connecticut. Even though we speak about the fact that we are a city and a town, we all know that public health crosses borders. Hopefully the Common Council will see that there are significant advantages to this and support this measure.

Ms. Diane Lauricella, League of Women Voters and Independent
Environmental Health Consultant, 249 Chestnut Hill Road,
Norwalk, CT

Ms. Lauricella greeted the Committee and stated that she was representing the League of Women Voters and as a Norwalk resident. The LWV has done a study over the past several years on environmental management in the city. One of the aspects of the study was to make sure that there are environmental management and services that are incorporated by the City. The LWV included in their study several city agencies. The Health Department is one of several agencies that have not been included in the study. But we do feel that this proposal is positive, but there are several questions that still need to be answered.

The League issue is that the City needs to address the Environmental Health and Environmental Protection issue more than they are currently through the budget, the staffing and the like. That includes the Health Department in many issues.

The League is also concerned on the issue of structure. The League feels that elected officials have a more direct input with the citizens of both towns. Elected officials of both towns should be on the Board’s structure. One thing that we do not see in preparing for this meeting is an organizational chart of the Board of Directors. State statute requires a certain kind of board put together. If at all possible, I would encourage the Committee not to allow this merger to occur unless and until there is at least one City Councilman representative on this Board from Norwalk. We need to have some public oversight of this kind of District Board because right now we have that check and balance with this committee. They are all elected and there is direct contact. There needs to be that check and balance. Otherwise, because the City of Norwalk and the Town of New Canaan are so demographically different, there may not be all of the issues.

Lastly, as far as the League of Women Voters, we very much encourage a move such as this. However, we wish that the public hearing had taken place in some form earlier. There has been alot of hard work by the Task Force members. Yet, there is pressure because of the June 15th deadline. The League is concerned that the Committee will not have the time and energy to discuss any interesting information you may acquire at this meeting. It is too late for this particular issue, but we really encourage this committee to plan according. Information needs to be prepared at a public hearing and the hearing needs to take place early on, so that the public can be involved.

As an environmental consultant expert for the last 20 years. When I worked with the Department of Environmental Protection and as a Hazardous Material Management Senior Investigator, I was often asked to help Health Directors around the State of Connecticut. My focus is in southwestern Connecticut and there are alot of very fine Health Directors in this area. It is not easy being a public employee. I should know, because I was one until 1980. As a private consultant, I work on public health issues, especially environmental health issues related to ground water, air quality, hazardous material, and some anti virus.

This is a very complicated and important issue before us tonight. I am a regional thinker and I agree that pollution knows no boundaries. Air quality, bioterrorism, they don’t respect town boundaries. I like the concept of forming a Health District. It is the details surrounding this that I put before you, for consideration of Dr. Reed and the Task Force. I love the concept, the details need to be checked.

First is the Structure of the Board of Directors. It is important to have a direct line to the elected officials on the Board. We are very lucky to have good CEOs in the towns of Norwalk and New Canaan. However, as elections go, so do CEOs. They will change over time. Is the Board large enough to represent a city as diverse as Norwalk?
Secondly, Staffing structure. New Canaan currently has two full time people. I personally know that Rick Getz is a fine, professional person. He is ready to retire and that will be quite a bit of wonderful intellectual capacity that will be lost. Their other full time position is currently vacant. These factors need to be considered carefully in light of the budget.

Ms. Lauricella reiterated her concerns about the importance of check and balances on the Board. She also expressed that in regards to senior staff and senior employees, she disagrees with the current system of not having written reviews. This new merger may be an opportunity to run this District like a business. Written reviews allow the employee to know whether or not they are doing a good job. The job descriptions need adjustment. It needs to be examined to see if we have all the staff needed for both towns. It is an opportunity to restructure the job descriptions and possibly after that to do a search to be sure we have the in all the senior staff the best people we can. We know that we have very good people. She thinks we should investigate to ensure the
quality of the staff.

Will the merger allows us to do better? Ms. Lauricella believes so, particularly as there are health issues in Norwalk that are just not being addressed. The town of New Canaan is primarily served by private wells and septic tanks. In Norwalk, 20% of the population of 83,000 are on private wells or septic tanks. With numbers like these, it will be important to have educational programs to inform the public why it is important to manage their septic systems in the right way.

We should remember that Norwalk has a federal Superfund site in the city based upon the historic foundation of the Kellogg well fields. People in the Health Department should be aware of this. The site is being managed well at the present time, but without a system of checks and balances, the staff could be spread so thin that the site management is neglected. Watching the First Taxing District and maintaining the level of excellence in monitoring the site correctly needs to be done. This doesn’t mean throwing the reports in a file, but analyzing them carefully to maintain the level of excellence. That well was contaminated by human carcinogens. Currently, there is no contamination of the public supply as long as the First Taxing District is managing and maintaining it.

We have had several environmental justice issues that have come up with the City that haven’t been examined at this time. Situations like the Hatch and Bailey air quality problem on South Main Street in South Norwalk were very frustrated at first with the response that their committee got under two mayors. We have learned from that example. It was not proper public health, safety and environmental protection response.
I am not necessarily opposed to the merger, but these are issues that did come up and I didn’t see addressed in the report dated February 9th.

I am concerned as to whether the Town of New Canaan are doing enough food inspections. Will their lack of food inspections affect our decisions particularly as Norwalk has a greater number of restaurants than New Canaan? Dumpster maintenance issues, which probably occur in New Canaan as well as here in Norwalk, are a concern in terms of fat getting in the storm drains and affecting the shellfish beds. These are issues that require a response and I hope that we have learned from. It is important to note these things so that the people who live here know about them. These are environmental health issues and I don’t think that these have been considered properly.
It is important to have non-governmental organizations like the League of Women Voters and others involved in these issues.

There should be public outreach, education and interdepartmental discussion. I have been alarmed that when the issues come up in the Conservation Commission, sometimes they are not considered a Health Department problem. They are City issues. I want to make sure that the Health Department is included in all of these stages of any issues about ground water protection. Luckily, I approached the Health Department on some of these issues and they were very open to helping with that issue, but no one else in the City approached them.

Lastly on public outreach, more committee meetings are needed for both towns. Obviously, the demographics in Norwalk is very different from New Canaan. It doesn’t mean that we can’t merge, but there is a fear that because the income levels in New Canaan will bump up the median income, we will not be able to get as many grants. While it increases our population regionally with the incorporation of New Canaan and Darien, it also increases the income level. Will this diminish our chances of obtaining some of the programs Norwalk needs? I can’t answer that, however, I fear that we will not. Aside from these issues, I do think that a merger is a good idea. Thank you.

Mr. Bill Gerrish, State of Connecticut Department of Public Health
40 Capitol Avenue, Hartford, CT

Mr. Gerrish greeted the Committee and thanked them for the opportunity to speak. He is the communication director for the Connecticut State Department of Public Health. He works directly with the Department Commissioner, who has made the establishment of full time Health Departments and Districts across the State a priority. Mr. Gerrish is part of the team that will be facilitating that. He is also a former council for the City of Groton and the town council. From his perspective of a former council member, he believes that forming a Health District was one of the most important actions that the City of Groton took during his terms of service. It is a lasting legacy to the residents of the Groton area. They have added towns in the regions and are providing better and more efficient service to the people of southeastern Connecticut.

As you all know, both Health Departments and Districts are critical providers of essential public services at the local level. That is why this is such an important issue. We have already heard about a number of issues like the flu vaccine situation as well as the per capita funding that the State provides to the Health Departments. Certainly there is an incentive built in there because the State feels that there is more efficient service and more effectiveness in a regional approach. While it was a whopping challenge to distribute the vaccine that was available, we feel that we were ultimately effective in getting it out to the people who were at most risk. It was challenging working on that project for the State Health Department. The more distance you have, certainly the more fear that when you look at the issues, such as Mr. Callahan raised tonight, whether it be obesity or a virus or another emerging illness like a pandemic flu virus, the difficulty of dealing with individual towns becomes apparent.

Certainly after 9/11 and the anthrax attack here in Connecticut, we worked very closely with the State Board of Health on building preparedness. This will shine a light on local health, particularly public health that hadn’t been there before. Public health officials have been aware of this for a long time, but it is now in the public awareness.

When Dr. Gallian (?) the Director of State Department of Health started with the agency in late 2003, this was one of his first priorities. He certainly sees the value of legislation. However he wanted to make sure that the resources were there to help communities who were interested in merging, to try to help them along and strengthen them in the public health area. When we heard that New Canaan and Norwalk were interested in merging, we were very excited and wanted to bring some resources to help that process along. And so we did and worked with the Task Force to bring this process to where we are today. There has been alot of effort to perform the tasks. Moreover, a District will strengthen your impact on the health of the constituents that you serve by providing more critical services, whether it be providing health intervention or dealing with a crisis. I don’t know if you happened to follow the fire a few weeks ago in eastern Connecticut, but it had an enormous event that involved a number of first responders, providers and agencies, including the government, and the local Health Department played a very key role. That might not have happened if they hadn’t had a Health District there. It really served the effort well, they were able to coordinate and have a strong voice for public health in that crisis, which had enormous public health issues. So I would just say that the State Department of Health strongly supports the formation of a Norwalk-New Canaan Health District and we hope that you come to the same conclusion, as the folks I worked with back in the 90’s in Groton as well as other municipal legislators representing the various towns of each and every Health District partnership throughout the State. Forming a Health District is an invaluable asset for your communities. Thank you.

Ms. Jacqueline M. Lubell, Norwalk NAACP

Ms. Lubell introduced herself to the Committee and stated that she was speaking on behalf of the NAACP Health Committee.

The NAACP is deeply concerned about the proposition to make the Norwalk Department of Health form a Health District with New Canaan. Since 9/11, we understand that communities need to be prepared in the event of bioterrorism. We have no problem with these issues that concern bioterrorism. At the same time, we are concerned about the fact that there has been no input from the community. Ask the concerns of the community. We share a common health vision but overall the Health Board feels that this particular decision does not address the local health problems. If these problems are ignored, what will the consequences be? There has been numerous Norwalk health problems, such as gun violence, and unintentional violence by youth. Although these are public health issues, both health and environment, we don’t have the leadership to implement intervention now. If such issues do not effect New Canaan or the health factors related to those, what will happen? Norwalk is diverse. It has different income levels and issues that may not be of interest to the residents of New Canaan, unless they are concerned with being their brother’s and sister’s keepers. There is a strong trend in the U.S. towards outsourcing various resources. We do not want to see our health care services outsourced.

I have some added comments related to the eleven members of the Task Force. In the Task Force report, it states that Norwalk meets the statutories required by the State and that New Canaan does not. For the City of Norwalk, this is not so. Regarding the Task Force conclusion that there will no reduction in local public health. Not so. The needs of Norwalk will not be met with a reduction in local public health. We need to have more public hearing on this. Another concern is that the average median income of the two towns is not listed in the reports. The staffing would be far less than they were previously. Regarding the savings by combining the two towns into District Health coverage, a standard fee schedule would not fairly meet the different needs. In regard to the various services in Norwalk, the Social Services Department is closed. This impacts citizens with great needs and limited resources to travel to another state. An attempt was made to close down Youth Services, and the services for Home Care.

On page five, there is a wide difference in full time staff between Norwalk and New Canaan, which will be reduced to zero soon, shows the majority work in Norwalk.
With a combined budget from the two towns, Norwalk will pay.

Regarding the “Memorandum of Understanding Offices”, it was mentioned that one project was to put the health care information on a website. The people with the greatest needs do not have access to websites.

Regarding the “Memorandum of Understanding Costs” on page six, different income levels in the two towns may result in unfairness. Environmental services might be very different in Norwalk than New Canaan. The concern should be for adequate health care, not saving money. The current budget in Norwalk does not cover all the health needs.

Ms Lubell concluded by asking why the Committee thinks that New Canaan has enough in common with Norwalk? So much needs to be done here in Norwalk and if New Canaan wishes to jump in and help Norwalk, fine. But as seeing as the difference between the two towns is so glaring, that combining them would be not be in Norwalk’s best interest.

Ms. Shirley Mosby, Norwalk NAACP

Ms. Mosby greeted the Committee and identified herself as the first Vice President of the Norwalk NAACP.

Ms. Mosby stated that she was present to address concerns about the community regarding the proposed merger of the Norwalk Health Department with the New Canaan Health Department to form a centralized Health District. It is difficult to understand how this would affect those of us living in Norwalk. While New Canaan and Norwalk share some common health issues, our concern is that over the long term if the governing board feels that this health issues are of no interest to them or to New Canaan because it is a Norwalk problem, what would be the consequences of such a decision? For example, currently our community is plagued by gun violence and unintentional injuries by our youth. Although this is a public health indicator caused by environmental factors, we don’t have the Health Department leadership intervention plans to combat youth violence. A case in point is that if such issues do not affect New Canaan then health issues will never be addressed. Norwalk is a diverse community with a fair share of urban community problems. There are already high levels of uninsured and underinsured residents along with greater health disparities. By merging New Canaan with Norwalk, we may divide our own community. Norwalk demographics and income levels are much lower than New Canaan. The population that will be most effected will be the poor and minority populations. Who will represent the interests of the poor?

The mission of the Common Council is fulfilling society’s interest in establishing a situation in which people can be healthy and to generate an organized community to address the public health. The core functions are assessment, policy development and assurance of protecting the environment. The Health Department role should not fair accountability delegated to one arm of government. Norwalk Health Department issue is to prevent disease, assure a healthy environment and promote the highest quality of life that we can reach. Involving us the a provision of a wide range of services is the means by which this provision is met. In a large city with the population of 83,000, the Public Health Department should be municipal and not a Health District. There is no record of any city with a population of over 50,000 forming a Health District in Connecticut. Health Districts are formed in areas with sparse population or scarce resources. That is more appropriate, where Health Districts are affecting populations that are more similar, such as Westport-Weston Health District, which has similar incomes and similar demographics. Before we move into something of this magnitude, we need every individual in Norwalk to see how this merger will benefit Norwalk, not just New Canaan. We need the type of leadership that cares about our community and not serve group interests at the expense of the entire community. It is imperative that we keep our limited resources from spreading beyond our boundaries.

As Common Council members, you are responsible to Norwalk residents and to the City of Norwalk. Thank you.

Mr. James Cole, New Canaan Task Force.

Mr. Cole introduced himself to the Committee and stated that he was a resident of New Canaan and Chairman of the New Canaan Police Commission and Director of Emergency Preparedness.

Mr. Cole stated that to him, the numbers don’t make a total case. It is not about the numbers, but about health care. Back in early April, health officials had a simulation of an emergency in New London with toxic chemical involved and there was a simultaneous simulation in New Jersey that involved bioterrorism. All the state and federal resources in the State of Connecticut went to New London. We felt a little left out, since the fourteen towns in the southwestern Connecticut in the greater Bridgeport area had their own simulation. And for a day, we were able to coordinate thirteen town’s resources and what the ripple effect would be if there was a large scale emergency. What we concluded was that there was a typical model of when there is an emergency, it deletes the resources of any town. The next place that one looks to is the State and the resources there. One thing that we learned with the simulation is that it is quite likely if we look to the State resources in a large emergency, there may be nothing there. The only way that we are going to be able to see our way through several days or before the Federal government provides resources, is to do that on our own. The only model that actually worked would be if all the towns worked together to take care of each other and work with each other’s needs. The model of a Norwalk-New Canaan Health District would be just a start of a regionalization effort in this area that would eventually include more towns. There are towns that are watching us to see how it will work, and if it does, this Health District will grow and will grow for the better. It’s not just grants and it’s not just numbers, nor is it just savings - it’s care and the best care possible. Thank you.

Dr. David Reed, Health Director, City of New Canaan

Much has been said tonight about numbers, economics and differences in numbers. It is not about that. One of the reasons that we are here tonight would be worded differently. Most of the other parts of the country are organized differently, they are organized county wide. The states then can organize in a much more efficient way certain services. It goes back to the concept of when you think of all the services that have to be provided: health education, environmental, dealing with the problems of domestic violence, gun violence in the community, these are some of the larger issues that can be addressed better and more effectively in a larger venue. So if you have a health district, then things like bioterrorism, you can get the critical mass because you have enough people, enough grants, funding and other things to benefit the entire community. Locally, that can benefit each town, each entity with local services but still have enough critical mass on a larger level to provide these overarching services that aren’t being provided in the most cost effective way. We are currently organized on an evolutionary way, because we are from New England, but it is not the most effective way and I would like to see implementing something more effective for public health. Public health is for everyone, no matter what your income level. Thank you

Mr. Ed Musante, Norwalk Chamber of Commerce
101 East Avenue, Norwalk, CT

Mr. Musante greeted the committee and identified himself as the President of the Norwalk Chamber of Commerce.

The Greater Norwalk Chamber of Commerce supports the results of the Task Force study calling for the merger of the Norwalk Department of Health and New Canaan Department of Health into a Health District.

There have been alot of questions that have been asked tonight and many of the answers are in the papers that were given but an aspect that is important to remember is that when you take two resources and combine them, often times the results are that the sum is greater than the parts. In that, a combined Health District will allow for specialization by having more staff, developing special expertise in various matters. One example is the merger of the Norwalk Tourism into Fairfield County Tourism, which has been quite successful. Thank you.

Mr. David Kennedy, C.E.O., The United Way
182 Wolfpit Avenue, Norwalk, CT

Mr. Kennedy introduced himself to the Committee and identified himself as the C.E.O of the Norwalk Wilton United Way.

One of the things that was very apparent was the value of regionalization because of the potential of shared resources. Programs like the HAZMAT program and how the shared resources gave a very special opportunity for the region to respond. It is never a good idea to pit one community against another. It almost always results in problems. The question really is: what is best for the most people. The emergency services provided out of Norwalk Hospital is actually regional and those services meet the needs of the of Wilton and Westport. Lastly, one comment from the perspective of how do you create a board that will serve all the needs. My experience in the Not For Profit sector, which is the Human Services sector, indicates that the quality of the services is almost always determined by the quality of the oversight of the board. Therefore, the key to success is that the board, is not interest or who is on it, but the quality of the oversight.

As there were no more speakers, Chairwoman Olmstead-Sawyer concluded the Public Comment portion of the Public Hearing to Consider the Formation of a Health District
at 9:20 p.m. She thanked the attendees for providing the Committee with such a wide spectrum of information.

Chairman Olmstead-Sawyer then opened the meeting to questions from the Committee to those who were in attendance.

Mr. Krummel asked Mr. Callahan about whether meetings have been scheduled with the collective bargaining units. Mr. Callahan replied that the meetings were being scheduled for the upcoming week. Mr. Callahan promised that the Committee would have the results of the meetings before the next Council meeting on June 14th.

Mr. Krummel stated that the committee was very concerned with their fiduciary responsibility. In the February 9th District Task Force Findings and Recommendations, the next step is a thorough review of the Finance Department of the respective towns needs to be done and may review unforeseen income and expenses. Mr. Krummel asked Mr. Hamilton if the financial report that Mr. Hamilton had presented earlier in the meeting was a full and thorough review.

Mr. Hamilton stated that the Financial Department had conducted a thorough review and that the report that was present at this meeting was just a summary of the financial benefits. In the sections of his report where he spoke of due diligence, there were a number of meetings and also members of his staff with Mr. Callahan, Dr. Reed and several others, going over the issues such as debt services, system building and other items. A number of issues that previously had been not been identified in the initial projections, such as the provision of IT support services and debt services were not in the original budget. There were a number of adjustments that were made to the budget to pick up those items. The Financial Department completed that review and the results of that review in the final proposal that is before you.

Mr. Krummel stated that a number of questions had been raised about services that are currently provided by the City to its Health Department and how those health services would be performed when you have a separate Health District, such as legal assistance, human relations, etc. etc., all these functions that the City provides now. How will that be handled with the combined District?

Mr. Callahan replied that the Department did discuss those issues, some will be handled by the City, as they are now, others will be handled outside. The legal issues around matters such as enforcement, will basically be handled out of City Hall. Certain issues would be in contract, such as personnel issues.

Mr. Krummel then asked Mr. Hamiltion if the full financial analysis would be available to the Council.

Mr. Hamilton replied that neither he nor Mr. Callahan had been sure of how much detail the Committee or the Council wanted, but that a line item budget had been prepared. That budge would be available.

Mr. Callahan added that all the services that provides for and all the services currently available are on that budget.

Mr. Krummel reiterated that he was concerned about what the costs would be, which is why he would like to see the detailed budget. He then requested that the full, detailed budget be made available to the Council.

Mr. Wien asked Mr. Callahan to clarify the issues surrounding the fact that as Health District with a population of over 100,000, we would be eligible for more grants. Mr. Wien asked if there was a possibility of us losing grant money because of the higher median income.

Mr. Callahan replied that there are grants that we can not apply for because we do not have sufficient population. Having a combined population puts the City into a position where we can apply for some programs that we currently can not. As far as the issue of a higher median income, none of the grants that we receive in the Health Department are based on income of the residents. Our grants are based on other criteria. Many of the grants that we receive, like the WIC program, a nutritional program for women with children, the AIDS program, and similar ones, those programs when we sign the contract, we are promising the State that those services will be available to anyone who walks through the door. With programs like the STD program, we serve anyone who fits the criteria.

Mr. Wien stated that by forming a District that more money would be available, and more services. If someone from New Canaan came in to Norwalk now, wanting some services, they would get it, correct? So that wouldn’t affect that, the District wouldn’t make that more accessible or less accessible.

Mr. Callahan replied that an example of how that would work: Norwalk operates a Travel Immunization Program. When someone goes to a country where they require a vaccine, they come to the Norwalk Health Department. That is a profit making venture for us. Now, we know where our customer’s location is. We are pretty confident that when we start to market that program we will have alot more visibility. We get a fair number of customers already and we are confident that those numbers will increase, which will then generate more income, since we have more people coming in. That money goes back into the operation and ultimately, reduces the costs of the program.

Mr. Wien was curious about the population number of 100,000. He wanted to know what the growth rate of the City of Norwalk was currently.

Mr. Hamilton replied that Norwalk was growing, but not rapidly. In the 2000 census it was about between 82,000 and 84,000. The number is generated by the State Health Department, not the City. It held steady at 82,000 for a few years.

Mr. Sutton asked if there had been an analysis of the components of the district.

Mr. Callahan replied that there had been a rather thorough analysis.

Mr. McQuaid stated that he had been serving on the Task Force with Rev. Olmstead-Sawyer and that there were numerous points that needed to be considered. It is not just health issues. One of the concerns is for the employees of both Norwalk and New Canaan. Mr. McQuaid stated that he would have been happy to have representatives of the unions or their attorneys here to be heard.

Mr. McQuaid then recommended that on June 6, in the New Canaan Town Hall, the town will be discussing this issue at a public hearing. We have heard some much information, it’s arrived by email and regular mail, but not much from New Canaan. Many people have talked about how different New Canaan is from Norwalk. Mr. McQuaid encouraged people to attend that Town Hall meeting in New Canaan to hear their vision and see what they have to say. He hoped that tonight, that even if there was disagreement on the health issues and questions that have not yet been answered, that we move that on to the full Common Council. On June 8th at 7:30 p.m., the New Canaan Town Selectmen will have a meeting to vote on the proposal.

Mr. McQuaid asked Mr. Callahan what would happen if the City decided to wait a year.

Mr. Callahan replied that we do run a risk of having the surrounding towns form a district. If there is legislation that doesn’t pass this time, there is a chance it will pass next time. There will be a full time Health Department in the City of Norwalk, and there will be Health Districts, like Westport-Weston. The idea of forming Districts in a region is going forward and towns will pull together and form districts.

Rev. Olmstead-Sawyer asked Mr. Callahan whether there were staffing level problems already and what will happen to employees in our own Health Department, which would cause more of a problem going into a District type situation.

Mr. Callahan replied that goals and schedules have been set during the past two years, We will be adding to the staff.

Rev. Olmstead-Sawyer asked for clarification about the regular health care needs of individuals. She mentioned the public nurse at the shelter that was dropped.

Mr. Callahan responded that two things happened, one was that the city made the decisions in 1992 to move out of the primary health providership. In doing so , the City made sure that there were agencies in place that could provide the same services the City was no longer offering. The Health Department should not be a primary care provider.

Rev. Olmstead-Sawyer requested clarification on the fee schedules, as to whether or not there would be a sliding fee scale or a standard fee.

Mr. Callahan explained that there are various fees that are charged, both as a Department and as a District. Permits for wells, septic systems, spas, salons, restaurants and the like would have a standard fee, which covers the cost of operating that service. Clinic programs are based on ability to pay.

Mr. Wien was curious as to why New Canaan decided to form a District with Norwalk rather than one of the communities in the area that was more similar in demographics.

Mr. Cole replied that he wasn’t for similar demographics but a partner that had the infrastructure, that had experience, that had depth, and was willing to grow and share expertise. This could be a first step to providing local services to localities that need it and combine the larger services such as are needed such as bioterrorism, since small towns simply can’t manage them alone.

Rev. Olmstead-Sawyer asked if Mr. Cole could outline what services New Canaan could provide for Norwalk.

Mr. Cole explained that when he came to New Canaan, they were providing about one quarter of the inspections for restaurants .They were not providing inspections to pools, salons and thorough job with our septic tank inspections because the senior staff was very knowledgeable. That was basically the extent of our system. New Canaan had outsourced the public health nursing, nursing home care and only doing flu clinics sporadically. There was some screening of children for hearing and vision. Clearly we did not meet the State mandate for public health. Realistically, New Canaan has the same problems in our community: HIV, alcoholism, drug addiction, - these exist in New Canaan, too. It may come as a surprise because it is not as transparent, but it is there.
Public health is public health and New Canaan needs to have the same kind of services.

Ms. Williams asked for clarification regarding the benefits of having a board versus being a municipality in terms of checks and balances.

Mr. Callahan replied that a board is based on the number of representatives calculated by the population. An appointment to the board is similar to the way we appointment of Commissioners here in Norwalk, which are nominated by the Mayor and approved by the Common Council. The same process holds true for the board. They would serve a three year term. Mr. Callahan also commented that he has worked for a number of Boards and in Norwalk, it is non-partisan and professional.

Ms. Williams also expressed concerns about fees and having people turned away.

Mr. Callahan explained that he has not yet seen a grant based on fees, but there are programs that participation is based on income, like WIC. People who are eligible for WIC if their income falls in a under a certain level. But grant programs are usually based on need or population.

Mr. Krummel stated that there had been many community needs in Norwalk for health services expressed. In the new district how would these expressed to the Board. Will there be elected officials, such as the Council. Who will have input into the operation and direction of the Health District?

Mr. Callahan stated that the meetings would be public but, usually, when people need a service, they contact their local Health Department. That would not change. Monthly meeting with the Health Department would not change. However, Mr. Kennedy will need some kind of conduit to the City for input.

Mr. Krummel commented that in the Mr. Hamilton’s report the last paragraph noted that the savings to Norwalk will grow over the next two and a half years as Norwalk phases in to straight per capita funding of the municipal contributions. Mr. Krummel was curious as to what the starting savings would be if it is not straight per capita contributions.

Mr. Hamilton replied that the Task Force had developed a budget and determined what the total savings in terms of the reduction of the municipal contribution would be and arrived at a figure that would be a savings of 9% or 9.07% overall savings. That 9.07% would then be carried across the board for Norwalk and New Canaan.

Mr. Krummel questioned as to whether the contributions for Norwalk and New Canaan right now at the start are not per capita, if it was phased in over two and a half years with straight per capita funding. Therefore, the implication is that it is not per capita funding at the start.

Mr. Callahan explained that if Norwalk by population and calculate per capita funding, they would not be the same number, but that the City would be moving towards the goal of 9.07% savings.

Mr. Krummel asked if Norwalk would be higher than New Canaan at the start.

Mr. Callahan confirmed that this was so, but it would be lower than if Norwalk remained independent.

Mr. Krummel reiterated the fact that Norwalk would start out the program by making a greater contribution than New Canaan.

Mr. Callahan reminded Mr. Krummel that the service levels in Norwalk are higher, especially in the beginning. It will take Norwalk a while to implement the other programs that will increase the savings. Initially, Norwalk will pay more with the understanding that as the service levels go up, our savings will increase.

Rev. Olmstead-Sawyer asked Mr. Reed what the concerns that New Canaan has about this proposed merger.

Mr. Reed replied that many of the same concerns that were being expressed here in the public hearing have been expressed in New Canaan. There is the perceptions that the people in Norwalk are different and it was surprising to hear it here, also. People are concerned about the Board, with six people from Norwalk and only five people from New Canaan, does that mean that New Canaan will never get their way? It really comes down to trust, when we talk with the mayor, we have an idea of who is on the Public Health Board and that tends to be the kind of people that he appoints. The point is that the people who are going to be on that board are people who are interested in public health. It is not a plum job with money, it is for people interested in public health. We must count on the board members to do the right thing. Public health is public health.

Rev. Olmstead-Sawyer wondered if people in New Canaan saw the same need that Norwalk is expressing as to why Norwalk should be forming a Health District.

Everyone has concerns about getting their piece of the pie, Mr. Reed, explained. Mr. Callahan and Dr. Reed look at it as an opportunity for grants to increase the kind of expertise and if more towns can be brought in, a sphere of activity can be created around Norwalk and New Canaan. The biggest concern in New Canaan is that the records remain in the individual towns, and the services that need to be local will remain local.
The things that are more global like education, nurse that do a flu clinic, these are things that can be spread out over a large area. So the focus should be on having local services and doing those well and spreading those other services over an area, particularly with people who have expertise.

Mr. Wien was still concerned about the board and whether it would be elected officials or an appointed board. Will these Board members be volunteers?

Dr. Reed replied that they would be appointed by the town, by the mayor or the first selectman. They could be elected, they could be appointed by the City - however they want.

Mr. Wien reiterated that Norwalk would have five members, New Canaan would have 2 members and if Darien popped in , they would have 2 members, which is based on population. Every time we added somebody, the board would grow by a certain number. Is there a limit on how many people could be on the board? What allegiance do they owe to the person appointing them as opposed to the public that elected them.
Without getting into details, I am aware of a board right now that has private meetings occurring with the Mayor and certain board members and not with others, so that is a very disturbing concept. When I try to apply that to a larger, overall concept of a board, I would be very upset. This is one of my stronger concerns, not having elected oversight.

Mr. McQuaid agreed that Mr. Callahan had made a good point earlier that this would be clearly mapped out. This board should be like all the other City Boards.

Mr. Krummel stated that he respects the integrity and honesty of board, having served on several himself, but that ultimately budget controls. When there is a money crunch, as there is now, in the health care field, poor people suffer. They certainly aren’t being fully served now, and they deserve every means, both now and in the future. These people are underprivileged, and they are far removed from the people who are serving on the board. How will they be heard? Board members, in all their honesty and integrity, decide who is to be served and who is not to be served. This is a concern. In the Memorandum of Understanding, “Compliance” - making certain the scope of services meets the needs of the residences of the City of Norwalk and the Town of New Canaan. That’s nice, on the surface, but looking a little bit further, what will “needs” mean to a member of the board who hasn’t been on Welfare, or a single parent. There is no floor or guarantee or some measure of protection which is particularly important in a city like Norwalk. We have serious problems here and they need to be addressed and they cost money. This money comes out of something else because we are limited in resources.

Dr. Reed stated that there was the Compliance memorandum was written by another Council and that the Task Force had nothing to do with it. However, Dr. Reed wished to address the fact that a board needs to be in compliance with all the State mandates and services for a town. Health Districts do not provide direct health care services, Health Districts only provide public health services as mandated by the State.

Mr. Krummel said that he was referring to testimony from at least two people who were here at the hearing, pointing out problems in our own community of Norwalk, which they feel will be exacerbated when Norwalk move into a regional area where there will be less emphasis on or attention paid to serious problems here in Norwalk.

Dr. Reed reiterated that health care services are limited to public health issues. The District will have State mandates to follow and those define the spectrum of services offered. One can always work to change the law. Local community health care centers would be the way to address some of the concerns raised in the testimony.

Mr. Wien expressed concern for those who are employed by the Health Department at this time. He inquired about possible loss of benefits and the aspect of the benefits continuing. He was curious as to whether the council would know in advance before the vote whether the employees would continue to have their benefits.

Mr. Hamilton pointed out that the Memorandum of Understanding outlines that the wages and benefits stay in place until a successor agreement is reached. That successor agreement will then set the terms for employment.

Mr. Wien explained that in that successor agreement, they could lose benefits.

Mr. Hamilton explained that Norwalk’s labor unions regularly negotiates their contracts, as does any given city. Whenever contract talks begin, there is always a possibility of loss of benefits in some form or other. There is no greater risk for the Health Department employees by being in a Health District than they would be as City employees.

Rev. Olmstead-Sawyer asked if a small group of people in the audience sitting in her line of view were Health Department employees. When the employees confirmed that by nodding their heads, Rev. Olmstead-Sawyer went on to ask if the Committee had addressed areas of their particular interest.

One of the employees then stated that the head of her union is currently on vacation, but right up until Friday afternoon before he had left, he had not received any emails informing him about this.

Mr. Krummel asked when her representative would be back from vacation.

The employee replied she believed he would return on the eighteenth.

Mr. McQuaid pointed out that as Council members, they understand that the squeaky wheel get the oil. The Council must receive input and concerns from the unions and they will be receiving letters from the Task Force. Mr. McQuaid said that he would have liked someone here from her particular union, representing that union, whether it was a lawyer or union representative to explain their concerns., Presently, the Task Force and the Committee don’t know their concerns.

The employee said that there had not been enough information, that each time they sent a memo to Personnel, that there they told that they didn’t have any information.

Mr. McQuaid said that Personnel will not be making the ultimate decision on this issue. The Common Council will be making the final decisions. Mr. McQuaid also requested that any letter that the employee’s union rep sends to Personnel, there should also be copies sent to the Committee.

The employee said that she would pass along that information to her representative.

Mr. McQuaid thanked her.

Ms. Lauricella asked the Committee from the audience why the Town of New Canaan will not be paying as much as Norwalk in the beginning, particularly since they currently have more needs. The State Health Department has found them deficient in several areas. She reiterated several of the points she had made earlier about New Canaan’s public health care needs. She repeated her inquiry as to why they are not paying in to the system to bring their community up to speed. She stated that she felt that New Canaan should be paying more money to get everyone up to speed and then and then we will all be in the same boat. There is a real problem. Norwalk is currently providing an adequate level of service. It doesn’t make sense financially that we are going to pay the same rate.

Mr. Krummel commented that we would actually be paying more.

Ms. Lauricella acknowledged that and agreed with Mr. Krummel. She then went on to state that as a League member, she is upset with the City council and some of the staff that we finally are in a group and I am questioning a gentleman that I don’t know from Adam, who was brought in as a consultant. I am not impressed that they would not ask for input from the constituency or bring them in. There was no constituency invited, not the League of Women Voters, the NEON community was not, nor was the NAACP. There were several communities, probably in both towns, that were never asked formally for input. I am sorry, but this isn’t right.

Dr. Reed replied from the audience that many of those meetings were public and open to all.

Rev. Olmstead-Sawyer thanked the audience and said that the Committee had certainly learned a great deal tonight. Rev. Olmstead-Sawyer said that she was sorry that the meeting was scheduled so late “week-wise” and that they had not started earlier in order to get more input from people, such as the union representatives. She stated that she would have been happy to see more people from the community in attendance, though she was happy to see the NAACP representatives present. People from both ends of the scale need to be present to discuss this particular issue that is before the Committee.

Chairwoman Olmstead-Sawyer formally closed the public hearing at 10:35 p.m.

Respectfully submitted

Sharon L. Soltes
Telesco Secretarial Services

Back to Previous Page	Back to Home Page