AQ-2017-003_REPORTTOBOARDOFSUPERVISORS_2017-10-03.PDF

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Executive Summary
of the Report to the Board of Supervisors
Prepared by the Maricopa County Air Quality Department
Board Hearing Date: December 13, 2017
Case #/Title: AQ-2017-003-Rule 317 (Hospital/Medical/Infectious Waste
Incinerators)
Agenda Item: (Pending)
Supervisor Districts: All Districts
The Maricopa County Air Quality Department (department) complied with all statutory and county policies
throughout this rulemaking process. Per the Enhanced Regulatory Outreach Program (EROP) Policy: “In addition
to the required staff report, an executive summary of the report including an overview of stakeholder input and staff
responses will be provided to the Board of Supervisors at least one week prior to any Board of Supervisors’ public
hearing.”
Overview of the Report to the Board of Supervisors: The purpose of this rulemaking is to rescind Rule 317
(Hospital/Medical/Infectious Waste Incinerators). Rule 317 was adopted to control emissions of air pollutants from
hospital/medical/infectious waste incinerator(s) (HMIWI). There are currently no HMIWI in Maricopa County and
the department’s records indicate the last HMIWI permit was closed (source was removed) in 1998. Most
hospital/medical/infectious waste is now treated using alternative technologies such as thermal treatment
(microwave technologies), steam sterilization (autoclaving) and chemical and mechanical treatment. The
department does not anticipate any new HMIWI will locate to Maricopa County.
Overview of Stakeholder Input and Staff Responses: No comments were received concerning this rulemaking.
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Report to the Board of Supervisors
Prepared by the Maricopa County Air Quality Department
Board of Health Meeting Date: July 24, 2017
Board Hearing Date: December 13, 2017
Case #/Title: AQ-2017-003-Rule 317 (Hospital/Medical/Infectious Waste
Incinerators)
Agenda Item: (Pending)
Supervisor Districts: All Districts
Applicant: Staff
Request: Approve rescission of Maricopa County Air Pollution Control Regulation
Rule 317 (Hospital/Medical/Infectious Waste Incinerators). The purpose
of Rule 317 is to control emissions of air pollutants from
hospital/medical/infectious waste incinerator(s) (HMIWI). There are
currently no HMIWI in Maricopa County and the department’s records
indicate the last HMIWI permit was closed (source was removed) in 1998.
Most hospital/medical/infectious waste is now treated using alternative
technologies such as thermal treatment (microwave technologies), steam
sterilization (autoclaving) and chemical and mechanical treatment. The
department does not anticipate any new HMIWI will locate to Maricopa
County.
Support/Opposition: No comments concerning the proposed rulemaking were received.
Staff
Recommendation: Approve
Board of Health
Recommendation: Approve per Staff recommended language
Additional
Comments: This regulatory change is following the Enhanced Regulatory Outreach
Program (EROP) Policy and workflow process. The County Manager
briefed the Board of Supervisors regarding this rulemaking in May 2017.
A Stakeholder workshop was held on June 15, 2017. A Notice of Proposed
Rulemaking was published in the Arizona Administrative Register on
August 18, 2017 and a 30-day comment period was held from August 18
through September 18, 2017; no comments were received. On July 24,
2017, the Board of Health approved this regulatory change for the
Expedited Process. A newspaper notice of the Board of Supervisors public
hearing will be published on November 1st, 2nd, 8th and 9th in the Arizona
Business Gazette and the Record Reporter. This regulatory change will
take effect immediately upon approval by the Board of Supervisors.
Presented By: Philip A. McNeely, R.G., Director
Prepared By: Planning and Analysis Division
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Attachments: Summary of the proposed regulatory change (See Item 6 of the Draft
Notice of Final Rulemaking)
Analysis of input received during the process and how that input was
responded to (No comments were received. See Item 13 of the Draft
Notice of Final Rulemaking)
Language of proposed regulatory change or amendment (See Item 17 of
the Draft Notice of Final Rulemaking)
Preamble required by Arizona Revised Statutes (A.R.S.) § 49-471.05 (See
Draft Notice of Final Rulemaking)
Minutes from Board of Health meeting
Copies of all written and electronic Stakeholder input (No comments were
received)
Signed copy of the Maricopa County Resolution “Moratorium on
Increased Regulatory Burdens”
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DRAFT NOTICE OF FINAL RULEMAKING
MARICOPA COUNTY AIR POLLUTION CONTROL REGULATIONS
REGULATION III – CONTROL OF AIR CONTAMINANTS
RULE 317: HOSPITAL/MEDICAL/INFECTIOUS WASTE INCINERATORS
PREAMBLE
1. Rule affected Rulemaking action
Rule 317: Hospital/Medical/Infectious Waste Incinerators Rescind
2. Statutory authority for the rulemaking:
Authorizing statutes: A.R.S. §§ 49-474, 49-479, and 49-480
Implementing Statute: A.R.S. § 49-112
3. The effective date of the rule:
Tentative date of adoption: December 13, 2017
4. List of public notices addressing the rulemaking:
Notice of Briefing to Maricopa County Manager: May 15, 2017
Notice of Stakeholder Workshop: June 15, 2017
Notice of Maricopa County Board of Health Meeting: July 24, 2017
Notice of Proposed Rulemaking: 23 A.A.R. 2218, August 18, 2017
5. Name and address of department personnel with whom persons may communicate regarding the
rulemaking:
Name: Greg Verkamp or Hether Krause
Maricopa County Air Quality Department
Planning and Analysis Division
Address: 1001 N Central Avenue, Suite 125
Phoenix, AZ 85004
Telephone: (602) 506-6010
Fax: (602) 506-6179
Submit Comments At: http://maricopa.gov/FormCenter/Regulatory-Outreach-17/Citizen-Comments-94
6. Explanation of the rule, including the department's reasons for initiating the rulemaking:
The Maricopa County Air Quality Department (department) is proposing to rescind Rule 317
(Hospital/Medical/Infectious Waste Incinerators) adopted April 7, 1993 and revised six times thereafter.
The purpose of Rule 317 is to control emissions of air pollutants from hospital/medical/infectious waste
incinerator(s) (HMIWI). There are currently no HMIWI in Maricopa County and the department’s records
indicate the last HMIWI permit was closed (source was removed) in 1998. The department does not
anticipate any new HMIWI will locate to Maricopa County and is proposing to rescind Rule 317.
Hospital/medical/infectious waste incineration was initially regulated under Rule 313 (Incinerators),
however; county representatives determined Rule 313 lacked the necessary provisions to adequately
characterize HMIWI and to adequately control their emissions. HMIWI differ from other incinerators in
Return to list of attachments
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that they regularly burn large amounts of plastic (i.e. containers, bags, wrappings, and syringes). Rule 317
was adopted, in part, to add new temperature and residence time requirements to ensure effective
combustions of the plastics. In addition, Rule 317 added emission limits, burning restrictions and
monitoring requirements that were not part of Rule 313.
In 1997, the U.S. Environmental Protection Agency (EPA) promulgated new source performance
standards (NSPS) and emission guidelines (EG) to reduce air emissions from HMIWI. The Department
revised Rule 317 in 1999 to incorporate the new emission guidelines and bring the rule into conformity
with the Clean Air Act. The August 1997 EPA fact sheet associated with the emission guidelines predicted
the costs of complying with the new guidelines would force many facilities to choose alternative methods
to treat and dispose of hospital/medical/infectious waste. The EPA predictions have proven to be true as
the number of HMIWI in the United States has decreased significantly since the new standards and
guidelines were promulgated. Most hospital/medical/infectious waste is now treated using alternative
technologies such as thermal treatment (microwave technologies), steam sterilization (autoclaving) and
chemical and mechanical treatment.
7. Demonstration of compliance with A.R.S. §49-112:
Under A.R.S. § 49-479(C), a county may not adopt a rule or ordinance that is more stringent than the rules
adopted by the Director of the Arizona Department of Environmental Quality (ADEQ) for similar sources
unless it demonstrates compliance with the applicable requirements of A.R.S. §49-112.
§ 49-112 County regulation; standards
§ 49-112(A)
When authorized by law, a county may adopt a rule, ordinance or regulation that is more stringent than or
in addition to a provision of this title or rule adopted by the director or any board or commission authorized
to adopt rules pursuant to this title if all of the following requirements are met:
1. The rule, ordinance or regulation is necessary to address a peculiar local condition.
2. There is credible evidence that the rule, ordinance or regulation is either;
(a) Necessary to prevent a significant threat to public health or the environment that results from a
peculiar local condition and is technically and economically feasible.
(b) Required under a federal statute or regulation, or authorized pursuant to an intergovernmental
agreement with the federal government to enforce federal statutes or regulations if the county rule,
ordinance or regulation is equivalent to federal statutes or regulation.
3. Any fee or tax adopted under the rule, ordinance or regulation does not exceed the reasonable costs of
the county to issue and administer the permit or plan approval program.
§ 49-112(B)
When authorized by law, a county may adopt rules, ordinances or regulations in lieu of a state program that
are as stringent as a provision of this title or rule adopted by the director or any board or commission
authorized to adopt rules pursuant to this title if the county demonstrates that the cost of obtaining permits
or other approvals from the county will approximately equal or be less than the fee or cost of obtaining
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similar permits or approvals under this title or any rule adopted pursuant to this title. If the state has not
adopted a fee or tax for similar permits or approvals, the county may adopt a fee when authorized by law in
the rule, ordinance or regulation that does not exceed the reasonable costs of the county to issue and
administer that permit or plan approval program.
The department is in compliance with A.R.S. §§ 49-112(A) and (B). The department is proposing to
rescind Rule 317.
8. Documents and/or studies referenced and/or reviewed for this rulemaking:
Not applicable
9. Showing of good cause why the rule is necessary to promote a statewide interest if the rule will
diminish a previous grant of authority of a political subdivision:
Not applicable
10. Summary of the economic, small business, and consumer impact:
The following discussion addresses each of the elements required for an economic, small business and
consumer impact statement under A.R.S. § 41-1055.
An identification of the rulemaking.
This rulemaking is proposing to rescind Rule 317 (Hospital/ Medical/Infectious Waste Incinerators).
An identification of the persons who will be directly affected by, bear the costs of or directly benefit
from the rulemaking.
This rulemaking is proposing to rescind Rule 317. There are currently no sources subject to Rule 317 in
Maricopa County and the department does not anticipate any new sources will come to Maricopa County
that would potentially be subject to Rule 317.
A cost benefit analysis of the following:
(a) The probable costs and benefits to the implementing agency and other agencies directly affected
by the implementation and enforcement of the rulemaking.
Because this rulemaking does not impose any new compliance burdens on permitted regulated entities
or introduce additional regulatory requirements, the department does not anticipate this rulemaking
will have an economic impact on either the department or any other agency.
(b) The probable costs and benefits to a political subdivision of this state directly affected by the
implementation and enforcement of the rulemaking
Because this rulemaking does not impose any new compliance burdens on permitted regulated entities
or introduce additional regulatory requirements, the department does not anticipate this rulemaking
will have an economic impact on any political subdivision of this state.
(c) The probable costs and benefits to businesses directly affected by the rulemaking, including any
anticipated effect on the revenues or payroll expenditures of employers who are subject to the
rulemaking.
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Because this rulemaking does not impose any new compliance burdens on permitted regulated entities
or introduce additional regulatory requirements, the department does not anticipate this rulemaking
will have an economic impact on any businesses.
A general description of the probable impact on private and public employment in businesses,
agencies and political subdivisions of this state directly affected by the rulemaking.
Because this rulemaking does not impose any new compliance burdens on permitted regulated entities
or introduce additional regulatory requirements, the department does not anticipate this rulemaking
will have an impact on private and public employment for any businesses, agencies or political
divisions.
A statement of the probable impact of the rulemaking on small businesses.
Because this rulemaking does not impose any new compliance burdens on permitted regulated entities
or introduce additional regulatory requirements, the department does not anticipate this rulemaking
will have an economic impact on any small businesses.
(a) An identification of the small businesses subject to the rulemaking.
There are no small businesses subject to Rule 317.
(b) The administrative and other costs required for compliance with the rulemaking.
This rulemaking is proposing to rescind Rule 317; there are no costs required for compliance. There
are no sources subject to Rule 317.
(c) A description of the methods that the agency may use to reduce the impact on small businesses.
(i) Establishing less costly compliance requirements in the rulemaking for small businesses.
This rulemaking is proposing to rescind Rule 317 and there are no compliance costs required for
small businesses.
(ii) Establishing less costly schedules or less stringent deadlines for compliance in the
rulemaking.
This rulemaking is proposing to rescind Rule 317 and there are no compliance costs required for
small businesses.
(iii) Exempting small businesses from any or all requirements of the rulemaking.
This rulemaking is proposing to rescind Rule 317 and there are no compliance costs required for
small businesses.
(d) The probable cost and benefit to private persons and consumers who are directly affected by the
rulemaking.
This rulemaking does not impose any new compliance burdens on regulated entities that are permitted
or introduce additional regulatory requirements and will not impose increased monetary or regulatory
costs on any permitted business, persons, or individuals so regulated. As such, there are no costs to
pass through to consumers, which means there are no impacts on consumers.
A statement of the probable effect on state revenues.
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The rulemaking will not impose increased monetary or regulatory costs on other state agencies,
political subdivisions of this state, persons, or individuals so regulated. Without costs to pass through
to customers, there is no projected change in consumer purchase patterns and, thus, no impact on state
revenues from sales taxes.
A description of any less intrusive or less costly alternative methods of achieving the purpose of
the rulemaking.
This rulemaking is proposing to rescind Rule 317 and there are no compliance costs associated with
the rulemaking.
11. Name and address of department personnel with whom persons may communicate regarding the
accuracy of the economic, small business, and consumer impact:
Name: Greg Verkamp or Hether Krause
Maricopa County Air Quality Department
Planning and Analysis Division
Address: 1001 N Central Avenue, Suite 125
Phoenix, AZ 85004
Telephone: (602) 506-6010
Fax: (602) 506-6179
Submit Comments At: http://maricopa.gov/FormCenter/Regulatory-Outreach-17/Citizen-Comments-94
12. Description of the changes between the proposed rule, including supplemental notices and final rule:
No additional changes are being proposed, since the Notice of Proposed Rulemaking was published on
August 18, 2017 (23 A.A.R. 2218).
13. Summary of the comments made regarding the rule and the department response to them:
No comments were submitted during the 30-day comment period – August 18-September 18, 2017.
14. Any other matters prescribed by statute that are applicable to the specific department or to any
specific rule or class of rules:
Not applicable
15. Incorporations by reference and their location in the rule:
Not applicable
16. Was this rule previously an emergency rule?
No Return to list of attachments
17. Full text of the rule follows:
REGULATION III – CONTROL OF AIR CONTAMINANTS
RULE 317
HOSPITAL/MEDICAL/INFECTIOUS WASTE INCINERATORS
INDEX
SECTION 100 – GENERAL
101 PURPOSE
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102 APPLICABILITY
103 AVAILABILITY OF INFORMATION
SECTION 200 – DEFINITIONS
201 BATCH HMIWI
202 BIOLOGICALS
203 BLOOD PRODUCTS
204 BODY FLUIDS
205 CHEMOTHERAPEUTIC WASTE
206 CO-FIRED COMBUSTOR
207 CONTINUOUS HMIWI
208 CREMATORY
209 DIOXINS/FURANS
210 HOSPITAL
211 HOSPITAL/MEDICAL/INFECTIOUS WASTE INCINERATOR
212 HOSPITAL/MEDICAL/INFECTIOUS WASTE INCINERATOR OPERATOR
213 HOSPITAL WASTE
214 INFECTIOUS AGENT
215 INTERMITTENT HMIWI
216 LARGE HMIWI
217 LOW-LEVEL RADIOACTIVE WASTE
218 MAXIMUM CHARGE RATE
219 MAXIMUM DESIGN WASTE BURNING CAPACITY
220 MEDICAL/INFECTIOUS WASTE
221 MEDIUM HMIWI
222 PATHOLOGICAL WASTE
223 PYROLYSIS
224 SHUTDOWN
225 SMALL HMIWI
SECTION 300 – STANDARDS
301 HMIWI STANDARDS
302 HMIWI EMISSIONS GUIDELINES
303 OPACITY
304 LARGE HMIWI OPACITY
305 NIGHT BURNING
306 INCORPORATION BY REFERENCE
307 EXEMPTIONS
SECTION 400 – ADMINISTRATIVE REQUIREMENTS
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401 COMPLIANCE SCHEDULE
SECTION 500 – MONITORING AND RECORDS
501 PROVIDING AND MAINTAINING MONITORING DEVICES
502 RECORDKEEPING AND REPORTING
503 HMIWI MONITORING REQUIREMENTS
Adopted 04/07/93
Revised 04/07/99
Revised 11/19/03
Revised 03/15/06
Revised 12/17/08
Revised 09/16/09
Revised 07/07/10
MARICOPA COUNTY
AIR POLLUTION CONTROL REGULATIONS
REGULATION III – CONTROL OF AIR CONTAMINANTS
RULE 317
HOSPITAL/MEDICAL/INFECTIOUS WASTE INCINERATORS
SECTION 100 – GENERAL
101 PURPOSE: To control emissions of air pollutants from Hospital/Medical/Infectious Waste incinerators.
102 APPLICABILITY: A Hospital/Medical/Infectious Waste Incinerator (HMIWI) commenced on or before
June 20, 1996, or for which construction commenced on or before June 20, 1996, shall comply with this
rule unless it fits any one of the following exceptions:
102.1 A combustor is not subject to this rule when only pathological waste, low-level radioactive waste,
and/or chemotherapeutic waste is burned, provided the owner or operator of the combustor:
a. Notifies the Control Officer of an exemption claim; and
b. Keeps records on a calendar quarter basis of the periods of time when only pathological
waste, low-level radioactive waste, and/or chemotherapeutic waste is burned.
102.2 Any co-fired combustor is not subject to this rule if the owner or operator of the co-fired
combustor:
a. Notifies the Control Officer of an exemption claim; and
b. Provides an estimate of the relative weight of hospital waste, medical/infectious waste, and
other fuels and/or wastes to be combusted; and
c. Keeps records on a calendar quarter basis of the weight of hospital waste and
medical/infectious waste combusted, and the weight of all other fuels and wastes combusted
at the co-fired combustor.
102.3 Any combustor required to have a permit under Title 42, United States Code (U.S.C.), Section
6925, Section 3005 of the Solid Waste Disposal Act is not subject to this rule.
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102.4 Any combustor which meets the applicability requirements under 40 CFR 60, Subparts Cb, Ea, or
Eb (standards or guidelines for certain municipal waste combustors) is not subject to this rule.
102.5 Any pyrolysis unit is not subject to this rule.
102.6 Cement kilns firing hospital waste or medical/infectious waste are not subject to this rule.
102.7 Physical or operational changes made to an existing HMIWI unit solely for the purpose of
complying with emission guidelines under this rule are not considered a modification and do not
result in an existing HMIWI unit becoming subject to the provisions of 40 CFR 60, Subpart Ec.
102.8 HMIWI subject to this Section are not subject to Rule 313.
a. A crematory whose incinerator burns only human remains is not a HMIWI and is not subject
to this rule. It is subject to Rule 313. However, if the incinerator burns 10 percent or less of
hospital waste and medical/infectious waste, it is a co-fired combustor subject only to
notification and recordkeeping requirements, as specified in Section 102.2.c of this rule. If the
incinerator burns more than 10 percent hospital waste and medical/infectious waste, it is
subject to all of the requirements of this rule.
b. Any co-fired combustor or combustor that is not subject to this rule is still subject to Rule
313. (See Applicability, Sections 102.2, 102.3 and 102.4 of this rule.)
103 AVAILABILITY OF INFORMATION: Copies of the CFR referenced in this rule are available at the
Maricopa County Air Quality Department, 1001 N. Central Ave., Phoenix, AZ, 85004, or by calling (602)
506-0169 for information.
SECTION 200 – DEFINITIONS: See Rule 100 of these rules for definitions of terms that are used but not
specifically defined in this rule. For the purpose of this rule, the following definitions shall apply:
201 BATCH HMIWI – An HMIWI that is designed such that neither waste charging nor ash removal can
occur during combustion.
202 BIOLOGICALS – Preparations made from living organisms and their products. This includes vaccines,
cultures, etc., intended for use in diagnosing, immunizing, or treating humans or animals or in research.
203 BLOOD PRODUCTS – Any product derived from human blood, including, but not limited to, blood
plasma, platelets, red or white blood corpuscles, and other derived licensed products, such as interferon,
etc.
204 BODY FLUIDS – Liquid emanating or derived from humans and limited to blood; dialysate; amniotic,
cerebrospinal, synovial, pleural, peritoneal and pericardial fluids; and semen and vaginal secretions.
205 CHEMOTHERAPEUTIC WASTE – Waste material resulting from the production or use of
antineoplastic agents used for the purpose of stopping or reversing the growth of malignant cells.
206 CO-FIRED COMBUSTOR – A unit combusting hospital waste and/or medical/infectious waste with
other fuels or wastes (e.g., coal, municipal solid waste) and subject to an enforceable requirement limiting
the unit to combusting a fuel feed stream, 10 percent or less of the weight of which is comprised, in
aggregate, of hospital waste and medical/infectious waste as measured on a calendar quarter basis. For
purposes of this definition, pathological waste, chemotherapeutic waste, and low-level radioactive waste
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are considered “other” wastes when calculating the percentage of hospital waste and medical/infectious
waste combusted.
207 CONTINUOUS HMIWI – An HMIWI that is designed to allow waste charging and ash removal during
combustion.
208 CREMATORY – An incinerator used for the cremation of human and animal bodies, their body parts, and
for the incineration of associated animal bedding.
209 DIOXINS/FURANS – The combined emissions of tetra-through octa-chlorinated dibenzo-para-dioxins
and dibenzofurans, as measured by the EPA Reference Method 23, found in 40 CFR Part 60, Appendix A.
210 HOSPITAL – Any facility which has an organized medical staff, maintains at least six inpatient beds, and
where the primary function of the institution is to provide diagnostic and therapeutic patient services and
continuous nursing care primarily to human impatience who are not related and who stay on average in
excess of 24 hours per admission. This definition does not include facilities maintained for the sole purpose
of providing nursing or convalescent care to human patients who generally are not acutely ill but who
require continuing medical supervision.
211 HOSPITAL/MEDICAL/INFECTIOUS WASTE INCINERATOR OR HMIWI OR HMIWI UNIT –
Any device that combusts any amount of hospital waste or medical/infectious waste.
212 HOSPITAL/MEDICAL/INFECTIOUS WASTE INCINERATOR OPERATOR OR HMIWI
OPERATOR – Any person who operates, controls or supervises the day-to-day operation of an HMIWI.
213 HOSPITAL WASTE – Discards generated at a hospital, except unused items returned to the
manufacturer. The definition of hospital waste does not include human corpses, remains, and anatomical
parts that are intended for interment or cremation.
214 INFECTIOUS AGENT – Any organism (such as a virus or bacteria) that is capable of being
communicated by invasion and multiplication in body tissues and capable of causing disease or adverse
health impacts in humans.
215 INTERMITTENT HMIWI – An HMIWI that is designed to allow waste charging, but not ash removal,
during combustion.
216 LARGE HMIWI:
216.1 Except as provided in Section 216.2:
a. An HMIWI whose maximum design waste burning capacity is more than 500 pounds per
hour; or
b. A continuous or intermittent HMIWI whose maximum charge rate is more than 500 pounds
per hour; or
c. A batch HMIWI whose maximum charge rate is more than 4,000 pounds per day.
216.2 Each of the following is not a large HMIWI:
a. A continuous or intermittent HMIWI whose maximum charge rate is less than or equal to 500
pounds per hour; or
b. A batch HMIWI whose maximum charge rate is less than or equal to 4,000 pounds per day.
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217 LOW-LEVEL RADIOACTIVE WASTE – Waste material which contains radioactive nuclides emitting
primarily beta or gamma radiation, or both, in concentrations or quantities that exceed applicable federal or
state standards for unrestricted release. Low-level radioactive waste is not high-level radioactive waste,
spent nuclear fuel, or by-product material as defined by the Atomic Energy Act of 1954 (42 U.S.C.
2014(e)(2)).
218 MAXIMUM CHARGE RATE:
218.1 For continuous and intermittent HMIWI, 110 percent of the lowest 3-hour average charge rate
measured during the most recent performance test demonstrating compliance with all applicable
emission limits.
218.2 For batch HMIWI, 110 percent of the lowest daily charge rate measured during the most recent
performance test demonstrating compliance with all applicable emission limits.
219 MAXIMUM DESIGN WASTE BURNING CAPACITY:
219.1 For intermittent and continuous HMIWI, C = PV × 15,000/8,500
Where:
C = HMIWI capacity, lb/hr
PV = primary chamber volume, ft3
15,000 = primary chamber heat release rate factor, Btu/ft3 /hr
8,500 = standard waste heating value, Btu/lb.
219.2 For batch HMIWI, C = PV × 4.5/8
Where:
C = HMIWI capacity, lb/hr
PV = primary chamber volume, ft3
4.5 = waste density, lb/ ft3
8 = typical hours of operation of a batch HMIWI.
220 MEDICAL/INFECTIOUS WASTE – Any waste generated in the diagnosis, treatment, or immunization
of human beings or animals, in research, or in the production or testing of biologicals that is listed in
Sections 220.1 through 220.7 of this rule. The definition of medical/infectious waste does not include
hazardous waste identified or listed under the regulations in 40 CFR Part 261; household waste, as defined
in 40 CFR 261.4(b)(1); ash from incineration of medical/infectious waste, once the incineration process has
been completed; human corpses, remains, and anatomical parts that are intended for interment; cremation;
and domestic sewage materials identified in 40 CFR 261.4(a)(1). Medical/infectious waste does include:
220.1 Cultures and stocks of infectious agents and associated biologicals, including: cultures from
medical and pathological laboratories; cultures and stocks of infectious agents from research and
industrial laboratories; wastes from the production of biologicals; discarded live and attenuated
vaccines; and culture dishes and devices used to transfer, inoculate, and mix cultures.
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220.2 Human pathological waste, including tissues, organs, and body parts and body fluids that are
removed during surgery or autopsy, or other medical procedures, and specimens of body fluids
and their containers.
220.3 Human blood and blood products including:
a. Liquid waste human blood;
b. Products of blood;
c. Items saturated and/or dripping with human blood; or
d. Items that were saturated and/or dripping with human blood that are now caked with dried
human blood; including serum, plasma, and other blood components, and their containers,
which were used or intended for use in either patient care, testing and laboratory analysis or
the development of pharmaceuticals. Intravenous bags are also included in this category.
220.4 Sharps that have been used in animal or human patient care or treatment or in medical, research, or
industrial laboratories, including hypodermic needles, syringes (with or without the attached
needle), pasteur pipettes, scalpel blades, blood vials, needles with attached tubing, and culture
dishes (regardless of presence of infectious agents). Also included are other types of broken or
unbroken glassware that were in contact with infectious agents, such as used slides and cover
slips.
220.5 Animal waste including contaminated animal carcasses, body parts, and bedding of animals that
were known to have been exposed to infectious agents during research (including research in
veterinary hospitals), production of biologicals or testing of pharmaceuticals.
220.6 Isolation wastes including biological waste and discarded materials contaminated with blood,
excretions, exudates, or secretions from humans who are isolated to protect others from certain
highly communicable diseases, or isolated animals known to be infected with highly
communicable diseases.
220.7 Unused sharps including the following unused, discarded sharps: hypodermic needles, suture
needles, syringes, and scalpel blades.
221 MEDIUM HMIWI:
221.1 Except as provided in Section 221.2:
a. An HMIWI whose maximum design waste burning capacity is more than 200 pounds per
hour but less than or equal to 500 pounds per hour; or
b. A continuous or intermittent HMIWI whose maximum charge rate is more than 200 pounds
per hour but less than or equal to 500 pounds per hour; or
c. A batch HMIWI whose maximum charge rate is more than 1,600 pounds per day but less than
or equal to 4,000 pounds per day.
221.2 The following are not medium HMIWI:
a. A continuous or intermittent HMIWI whose maximum charge rate is less than or equal to 200
pounds per hour or more than 500 pounds per hour; or
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b. A batch HMIWI whose maximum charge rate is more than 4,000 pounds per day or less than
or equal to 1,600 pounds per day.
222 PATHOLOGICAL WASTE – Waste material consisting of only human or animal remains, anatomical
parts, and/or tissue, the bags/containers used to collect and transport the waste material, and animal bedding
(if applicable).
223 PYROLYSIS – The endothermic gasification of hospital waste or medical/infectious waste using external
energy.
224 SHUTDOWN – The period of time after all waste has been combusted in the primary chamber. For
continuous HMIWI, shutdown shall commence no less than 2 hours after the last charge to the incinerator.
For intermittent HMIWI, shutdown shall commence no less than 4 hours after the last charge to the
incinerator. For batch HMIWI, shutdown shall commence no less than 5 hours after the high-air phase of
combustion has been completed.
225 SMALL HMIWI:
225.1 Except as provided in Section 225.2:
a. An HMIWI whose maximum design waste burning capacity is less than or equal to 200
pounds per hour; or
b. A continuous or intermittent HMIWI whose maximum charge rate is less than or equal to 200
pounds per hour; or
c. A batch HMIWI whose maximum charge rate is less than or equal to 1,600 pounds per day.
225.2 The following are not small HMIWI:
a. A continuous or intermittent HMIWI whose maximum charge rate is more than 200 pounds
per hour; or
b. A batch HMIWI whose maximum charge rate is more than 1,600 pounds per day.
SECTION 300 – STANDARDS
301 HMIWI STANDARDS: An existing HMIWI covered by this Section shall comply with 40 CFR 60,
Subpart Ec, and all accompanying appendices, as modified by this subsection. 40 CFR 60, Subpart Ec
“Standards of Performance for Hospital/Medical/Infectious Waste Incinerators for Which Construction is
Commenced After June 20, 1996” is incorporated by reference in Rule 360 of the Maricopa County Air
Pollution Control Regulations. Each owner or operator of an affected facility shall comply with the
requirements of 40 CFR 60, Subpart Ec, as adopted and, where applicable, revised herein.
302 HMIWI EMISSIONS GUIDELINES: An HMIWI shall comply with the emissions guidelines listed in
Table 317.1 below:
Table 317.1. Emission Limits for Small, Medium, and Large HMIWI.
Emission Limits (by HMIWI size)
Pollutant Units (7% oxygen, dry basis) Small Medium Large
Cadmium Milligrams per dry standard cubic 0.16 (0.07) 0.16 (0.07) 0.16 (0.07)
meter (grains per thousand dry or 65% or 65% or 65%
14

standard cubic feet) or percent
reduction
Carbon monoxide Parts per million by volume 40 40 40
Dioxins/furans Nanograms per dry standard cubic 125 (55) 125 (55) 125 (55)
meter total dioxins/furans (grains or 2.3 (1.0) or 2.3 (1.0) or 2.3 (1.0)
per billion dry standard cubic feet)
or nanograms per dry standard cubic
meter TEQ (grains per billion dry
standard cubic feet)
Hydrogen chloride Parts per million by volume or 100 100 100
percent reduction or 93% or 93% or 93%
Lead Milligrams per dry standard cubic 1.2 (0.52) 1.2 (0.52) 1.2 (0.52)
meter (grains per thousand dry or 70% or 70% or 70%
standard cubic feet) or percent
reduction
Mercury Milligrams per dry standard cubic 0.55 (0.24) 0.55 (0.24) 0.55 (0.24)
meter (grains per thousand dry or 85% or 85% or 85%
standard cubic feet) or percent
reduction
Nitrogen oxides Parts per million by volume 250 250 250
Particulate matter Milligrams per dry standard cubic 115 (0.05) 69 (0.03) 34 (0.015)
meter (grains per dry standard cubic
foot)
Sulfur dioxide Parts per million by volume 55 55 55
303 OPACITY: No owner or operator of an HMIWI shall cause to be discharged into the atmosphere from the
stack of that HMIWI any gases that exhibit greater than 10 percent opacity (6-minute block average) or
darker than 20 percent opacity for an aggregate of more than 30 seconds in any consecutive 60 minutes.
304 LARGE HMIWI OPACITY: A large HMIWI shall comply with the opacity requirements as specified in
40 CFR 60, Sections 60.52c(c), (d), and (e).
305 NIGHT BURNING: No person shall operate a medical waste incinerator between sunset and the
following sunrise unless a continuous opacity (particulate) recorder is operating at all times when there is
any combustion within the incinerator. Such recorder shall be in compliance with Section 501.1 of this rule.
306 INCORPORATION BY REFERENCE: All CFR references as of July 1, 2009 that are listed below and
in various sections of this rule are adopted and incorporated by reference. These adoptions by reference
include no future editions or amendments. Copies of these CFR references are available at the Maricopa
County Air Quality Department, 1001 N. Central Ave., Phoenix, AZ, 85004, or by calling (602) 506-0169
for information.
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40 CFR 60, Subpart Ec
40 CFR 60, Sections 60.52c(c), (d), and (e)
40 CFR 60, Section 60.56c
40 CFR 60, Section 60.57c
40 CFR 60, Sections 60.58c(b), (c), (d), (e), and (f)
40 CFR 60, Appendix A and Appendix B
40 CFR 70
SECTION 400 – ADMINISTRATIVE REQUIREMENTS
401 COMPLIANCE SCHEDULE: On the effective date of an EPA approved operating permit program under
Clean Air Act Title V and the implementing regulations under 40 CFR 70 in Arizona, whichever date is
later, designated facilities subject to this rule shall operate pursuant to a permit issued under the EPA-
approved operating permit program.
SECTION 500 – MONITORING AND RECORDS
501 PROVIDING AND MAINTAINING MONITORING DEVICES: Except as provided in Section 502,
all requirements for compliance and performance testing listed in 40 CFR 60.56c shall be required of each
HMIWI, excluding the fugitive emissions testing requirements under Sections 60.56c(b)(12) and (c)(3).
501.1 Any person subject to Section 304 of this rule shall operate and maintain all of the following
continuous data recording systems. All required systems shall be completely and properly
operating during all periods of combustion within the incinerator, and each shall include a real-
time recording device that creates a clear, legible record at all times of operation.
501.2 Opacity of stack emissions or other indicator of particulate matter which is approved by the
Control Officer. Pursuant to Section 305 of this rule, any incinerator burning after sunset must be
equipped with a continuously recording opacity monitor, regardless of capacity. The opacity
monitor shall be located after (downstream of) all control equipment, prior to the stack exit, and
prior to any dilution with ambient air. The opacity monitor shall at all times comply with the EPA
Performance Specification 1 (40 CFR 60, Appendix B) and shall be calibrated no less than once
each day.
502 RECORDKEEPING AND REPORTING: Each HMIWI shall comply with the requirements listed in 40
CFR 60.58c(b), (c), (d), (e), and (f), excluding 40 CFR 60.58c(b)(2)(ii) (fugitive emissions) and (b)(7)
(siting).
503 HMIWI MONITORING REQUIREMENTS: An existing HMIWI shall comply with the monitoring
requirements of 40 CFR 60.57c.
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MARICOPA COUNTY BOARD OF HEALTH MEETING
MINUTES Monday, July 24, 2017
301 W. Jefferson Street, 10th Floor
Phoenix, Arizona 85003
Board of Supervisors Conference Room
Vice President Hughes called the meeting to order at 3:00 p.m.
ROLL CALL:
Members Present: Members Excused:
Don Cassano Kip Steill
Henri Cournand
Robert MacMillan
Francisca Montoya
Nedra Halley (via phone)
Don Hughes
Debra Baldauff
Bill Gates
Ex-Officio: Bob England, M.D.
CALL TO THE PUBLIC:
Vice President Hughes announced it was time for a call to the public and requested public comment forms for
those who wanted to speak or who wanted to address any action items.
DISCUSSION/ACTION ITEMS
1. Approval of Minutes:Vice PresidentHughes asked for a motion to approve the minutes from theBOH
DRAFT Meeting held on April 24, 2017. Motion was made by Ms. Montoyato approve the BOH minutes as
presented. Motion was seconded by Mr. Cournandand all were in favor. The motion passed unanimously.
a. Fee Waiver Applications Ms. Jeannie Taylor
Ms. Jeannie Taylor presented thirty-eight (38) fee waiversfor review and consideration of approval. A
summary sheet document was provided.
Ms. Montoya stated there are a lot of applications for Southern Arizona Arts and Cultural Alliance out of
Tucson, AZ, is there a reason they do the fee waiver here not in Tucson.
Ms. Taylor responded they are headquartered in Tucson and the special events are in Maricopa County.
Vice President Hughes asked Ms. Taylor if all applications meet the qualifications for fee waivers.
Ms. Taylor responded that all questions have been answered on all of the applications. Qualification of
hardship is left up to the board’s discretion.
Motion to approve the thirty-eight (38) Fee Waiver applications was made by Mr. Cassano, seconded by Ms.
Montoyaand all were in favor. The motion passed unanimously.
2. Approval of the Expedited Process for four (4) Air Quality Department rulemakings Mr. Philip A.
McNeely
AQ-2017-003-Rule 317, AQ-2017-004-Rule 325, AQ-2017-005-Rule 334and AQ-2017-006-Rule 339
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Mr. Greg Verkamp and Mr. Philip A. McNeely presented the four (4) Air Quality Department rulemakings. A
PowerPoint slide-deck document was provided.
Mr. McNeely stated that he brought Greg Verkamp senior planner to go over all rules. Mr. McNeely explained
that they are going through all there rules and updating or removing rules no longer in use. They have
identified 4 rules that are no longer being used. Greg will give you a presentation on the 4 rules.
Mr. Verkamp began stating, as Philip said we are looking to rescind 4 rules right now. We want to give you a
presentation, background on the purpose of each of the rules and what happens if… scenarios.
The four (4) rules are:
• Rule 317 – Hospital/Medical/Infectious Waste Incinerators
• Rule 325 – Brick and Structural Clay Products (BSCP) Manufacturing
• Rule 334 – Rubber Sports Ball Manufacturing
• Rule 339 – Vegetable Oil Extraction Processes
Three (3) of the four (4) rules, 325, 334 and 339 were all drafted with one source in mind. The 4th rule 317
only had one on the books. The rules haven’t had any source subject - Rules 317 and 229 from the 90’s, 334
from 2009 and 325 from 2012. It has been 5 years since any source was subject to these rules and very few
sources subject to any of these rules.
Rule 317
• Purpose: To control emissions of air pollutants from hospital/medical/infectious waste incinerators
(HMIWI)
• Adopted on April 7, 1993 and revised 6 times thereafter
• Drafted to strengthen emission controls for medical waste incineration
– Initially regulated under Rule 313 (Incinerators, general incinerator rule)
• Later incorporated Emission Guidelines promulgated by the EPA in 1997
• Department drafted rule 317 to be more stringent on hospital/medical/infectious waste incinerators. Due
to the high pollutants in plastic that a lot of the hospital and medical waste are made of. At the same time
DRAFT
EPA was drafting regulations on a Federal level, the 1990 clean air act. In 1997 EPA came out with new
source performance standards as well as emission guidelines.
• Since 1997 the number of HMIWI has decreased significantly nationwide
• 1997 – 2,400 HMIWI
• 2009 – 57 HMIWI
• Last HMIWI permit with MCAQD was closed in 1998
• Alternative technologies to incineration include: autoclaving, thermal treatment and chemical mechanical
systems
• What Happens if . . . a new HMIWI is interested in establishing operations in Maricopa County?
• The new source would be subject to New Source Performance Standards Subpart Ec
• Maricopa County Rule 360 (New Source Performance Standards).
Mr. MacMillian asked if there was still 1 source Mr. Verkamp responded no, the last one was in 90’s and it
was closed in 1998. Mr. MacMillian asked if a new federal rule came out that was less stringent what you
would do, would you write/adopt a new rule. Mr. McNeely responded we would just incorporate the new
Federal rule in any permits they would reference the Federal rule in the permit itself.
Rule 325
Mr. Verkamp gave a few miles stone for context with this rule.
 1990 clean air act designated Maricopa County as moderate for PM10 unattainment. Because of that they
had to submit revisions to the state implementation plan stating how we are going to obtain PM10
standard. In the revision we were supposed to demonstrate attainment by 1994. They were unable to do
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so. In 1996 we were designated as serious unattainment area. Again required to submit revision to the
state implementation plan. They were not able to obtain by December 2001 PM10 and we had to submit
another revision and have had to submit several revisions thereafter. Rule 325 was part of one of those
revisions thereafter.
• Purpose: To limit particulate matter emissions from the use of tunnel kilns for curing in the brick and
structural clay product (BSCP) manufacturing processes
• Adopted on August 10, 2005 and never revised
• Drafted to incorporate commitments the State made in Salt River State Implementation Plan
– Implement Best Available Control Measures (BACM)/Most Stringent Measures (MSM) for all
significant sources of PM10 in the Salt River Area
• Within the Salt River Area there was one brick manufacturer, Phoenix Brick Yard, that needed to
implement BACM/MSM
– Phoenix Brick Yard ceased manufacturing bricks in 2012 due to market conditions and
production costs
• What happens if . . . a new BSCP is interested in establishing operations in Maricopa County?
– The new source would be subject to the National Emission Standards for Hazardous Air
Pollutants (NESHAP) for BSCP Manufacturing (Subpart JJJJJ)
• Maricopa County Rule 370 (Federal Hazardous Air Pollutant Program)
No source subject since 2012.
Mr. Cournand asked are any of these rules more stringent that the federal rules are? Mr. McNeely
responded, they are not, no.
Vice President Hughes asked what if the federal rules are reduced and are less stringent. Mr. McNeely
responded it would be the same as the last rule, rule 317, we would just incorporate the new federal rule
Vice President Hughes asked if the rules are less stringent and it has an effect on the air quality what
would you do?
DRAFT
Mr. McNeely responded - that’s a good point, these rules are in our state implementation plan. We will
have to write a letter to the EPA. These will be taken out of the implementation plan.
Vice President Hughes these rules did not put the businesses out of business; they have been taken to
other places (China for example). Where operating costs less. Mr. MacNeely, yes, that is correct. Mr.
MacMillian was this rule written to control PM10 correct? Mr. Verkamp said yes, that is correct.
Rule 334
• Purpose: To limit emissions of volatile organic compounds (VOCs) from natural and synthetic rubber
adhesives used in the manufacture of non-inflatable rubber balls
• Adopted on August 2, 1993 and revised 3 times thereafter
• Drafted to comply with requirements of the 1990 Clean Air Act Amendments
– Reasonable Available Control Technology (RACT) “Fix-up” – required ozone nonattainment areas
classified as marginal or above to adopt and correct RACT rules as previously requested by the EPA
before the Clean Air Act was amended in 1990
– The new major source of VOCs would be subject to Major New Source Review (NSR) – Lowest
Achievable Emission Rate (LAER)
• With 334 you need to understand the ozone issues we’ve had here at the County. Likewise with 339,
to give you some context, the County was designated none attainment for ozone in 1978.
• 1990 the clean air act.
• Rules 334 and 339 were drafted to comply with the clean air act. In 1984 and 1988 the EPA sent
letters to the Governor requesting that we submit revisions so we can see that you’re going to be able
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to obtain and maintain ozone standards. Those requests in those letters became law, the 1990 clean
air act.
• Included the adoption of rules for major sources of VOCs for which Control Techniques Guidelines
(CTG) had not been issued
• Penn Racquet Sports
• The facility moved operations to China in 2009
• Very unique industry unlikely to appear in the County again
• What happens if . . . a new Rubber Sports Ball Manufacturer is interested in establishing operations in
Maricopa County?
Rule 339
• Purpose: To limit the emissions of volatile organic compounds (VOCs) from the extraction of vegetable
oil using solvents
– Applicable to major sources only (those facilities emitting more than 100 tons of VOCs per year)
• Adopted on November 16, 1992 and revised 1 time thereafter
• Like in rule 334, drafted to comply with requirements of the 1990 Clean Air Act Amendments
– RACT “Fix-up” – required ozone nonattainment areas classified as marginal or above to adopt and
correct RACT rules as previously requested by the EPA before the Clean Air Act was amended in
1990
• Included the adoption of rules for major sources of VOCs for which Control Techniques
Guidelines (CTG) had not been issued
• Western Cotton Services – produced cottonseed oil
• Permit closed in 1999
• What happens if . . . a new Vegetable Oil Extraction facility is interested in establishing operations in
Maricopa County?
– The new source would be subject to the NESHAP for Solvent Extraction for Vegetable Oil
Production (Subpart GGGG)
• Maricopa County Rule 370 (Federal Hazardous Air Pollutant Program)
DRAFT
Tentative step for the proposed rule revisions
1-County Manager Briefed Board of Supervisors - May 15, 2017
2-County Stakeholder Workshop - June 15, 2017
3-Stakeholder Notification 2 Weeks before Board of Health Meeting - July 10, 2017
4-Board of Health Meeting To Initiate Regulatory Change - July 24, 2017
5-Specific Departmental Processes (Includes Comment Period) - August 18, 2017 - September 18, 2017
6-Stakeholder Notification 2 Weeks Prior To Board of Health Meeting - Not Required - Expedited Process
7-Board of Health Meeting to Make Recommendations to Board of Supervisors - Not Required Expedited
Process
8-Schedule Board of Supervisors’ Public Hearing - October 4, 2017
9-Board of Supervisors’ Public Hearing - November 29, 2017
10-Item Adopted - November 29, 2017
Currently on step 4, next major step is step 5, including a 30 day comment period. At any point in time in
the process anyone can make comments.
Motion to approve four (4) Air Quality Department rulemakings: AQ-2017-003-Rule
317(Hospital/Medical/Infectious Waste Incinerators), AQ-2017-004-Rule 325(Brick and
Structural Clay Products (BSCP) Manufacturing), AQ-2017-005-Rule 334(Rubber Sports Ball
Manufacturing) and AQ-2017-006-Rule 339(Vegetable Oil Extraction Processes) was made by
Mr. Cassano, seconded by Dr. Baldauff and all were in favor. Motion passed unanimously.
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Discussion Items:
1. Public Health Report Dr. Bob England
I. Healthcare Reform
II. Funding Outlook
III. Human Resources
IV. Communication
V. Infrastructure
VI. Strategic Planning
VII. Programs
VIII. Disease Update
IX. Future Topics
Dr. Bob had several items to review with them.
Health Care Reform – the senate is going to hold a vote tomorrow. Keep in mind with all of this, is they are using
the budget reconciliation process which means they can’t repeal the whole thing, only the pieces that affect the
federal budget. The other requirements that were built in the original affordable care act, like requiring first dollar
coverage for preventative services, incentives built in for keeping people out of the hospital. So however this gets
changed it’s going to be a morph. The version of the budget reconciliation that the senate was proposing would
have both direct and indirect consequences. Indirect – elimination of the expansion of AHCCCS. Direct – the
elimination of the prevention public health fund which 13% of all CDC activities, 9 million a year.
Stay tuned; just know it’s going to change the way we do business going forward.
Other funding issues:
- $1.2 cut to WIC
- Transfer of Health Care to the Homeless to a community partner. This is a good thing for the community, in
the long run.
- DRAFT Teen pregnancy program is ending. It was intended to be a 5 year program and we are currently in year 3.
Every grantee has been told the funding will end.
- Refugee clinic numbers are way down. The acceptance of refugees is in flux.
A lot of things up in the air.
One item I want to ensure you understand is the changes to the Vital Registration System. The State is moving
towards an electronic death registration system. A good thing in the abstract, better efficiency, better in ease of
operation, more convenient for customers to get death certificates. There are a few things here in how this is
different that attempted in other states. There is no backup system. Every other state that has implemented this
has some sort of paper backup system for when things go wrong.
Question – Do you have any idea how many states have adopted this? Dr. Bob responded this particular system, I
believe is 11 states. New Mexico being the first, they implemented in 2006.
There is no back up system so there is no way for a physician to certify a death other than to go through an on-line
training which takes 20-30 minutes and get a login number and then directly enter the information themselves.
There is no backup in the sense that current law and our practice expedites people’s ability to get their loved ones
in the ground ahead of getting all the information on the death certificate. Mother’s maiden name, how many
years did someone live in the state, county, occupation, stuff that families usually know but may want to look up.
In this system there’s no back up, there’s no work around. All of that has to be entered before burial can move
forward. Because we will not even be able to the death certificate and process it until it’s all entered.
New Mexico has had this system in place for 11 years and they have 62% of the physicians on board.
Question - So what happens with the other 38%? Dr. Bob responded they have a backup system.
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The thing is things are not going to work perfectly the first week, you’re not going to get every doctor in the state
to go on-line and register. We were told we are to be on 24/7 to help physicians when the time comes, we are on
24/7 now. But that’s going to continue because that’s going to change. Right now we do all sorts of work arounds
to make things work for people. Every day you have got families with religious or other requirements for burials
within 24 hours of the death. We make it work for them. As long as we get the statutorily minimal information to
record, we get them the disposition transit permit and then by law the funeral home has 7 days to get the rest of
the information. All of that is going out and it’s going to happen all at once. Target date is late September, 2017.
I’m scared to death that within the first couple of weeks of this program we’re going to have dozens if not
hundreds of people unable to bury their loved ones by the scheduled funeral date.
This is the state implementing this, the State Health Department. We have lobbied and we’re continuing to do it.
I’m not giving up but I’ve already lobbied pretty hard.
Vice President Hughes commented from electronic medical records, you still don’t have that thing working. Bob
responded that’s what I use as my example.
The other thing that complicated it, the third and final thing is that this is a fee based system. We function off the
fee ADHS is changing the way people, as part of this, again a good thing so people can go online and order death
certificates, it’s online completely without having to go to the County. That will be a State controlled operation;
the State will keep the fees. So we have been told that there will be a mechanism in place for revenue sharing but
we haven’t seen anything yet. And the way you hear the vitals folks from ADHS talk they think there will be much
less need for County staff. Because it will be so efficient, it will be all automated.
Vice President Hughes commented except that you have to be on call 24/7.
Dr. Bob responded in reality it’s going to cause us a lot more work early on. Now they may be right overtime this
may be much more efficient and that will be great if we can cut staff in the long run and make things easier for the
families during the worst possible times, then that will all be a good thing.
We are working with the other Counties to submit suggestions for funding. I’m going to propose we get out of the
DRAFT
fee base and we turn it into a contract system. That way ADHS will be at risk for the fees coming in. And we’ll have
a contract at least to start. Hopefully for enough to keep us going the way we are and we will build in mechanisms
by which that will go down. Where they pay us extra for some of the extra work we’re doing beyond what they
think is reasonable baseline. We’ve got a lot to negotiate here.
What I’m going to do, I’m doing to have to do board briefings. Because all of you guys need to understand what’s
going to happen. So that if we can’t prevail on ADHS to change their mind about this before it’s too late then you
at least know how to handle the calls because you’re going to get them. And I’ll be looking to you in terms of how
aggressively you want me to fight with ADHS. I have a wonderful relationship with the director at ADHS. I think
she’s getting really bad advice.
Question – Can you quantify net impact?
Dr. Bob responded last year we took in 6.2 million in Vital Registration. Of that we returned 1.5 million. We give
them $1.00 charge on everything that is issued.
What we’re proposing to them is a contract for about 3.5 million. We are estimating that each month we will get
about a thousand amendments and adjustments to process and they are estimating that will be zero. Each
amendment or adjustment we have to process we will charge them $75.00 per transaction.
Question – Just to make sure I understand what you mean when you are talking backup system you don’t mean it
in the sense that they have them in a server in one location.
22

Dr. Bob responded I’m talking paper, something you can revert to when a doctor who just refuses to do the thing
online. You will have a lot of those, there are a lot of older docs that don’t want to use electronic for anything.
They believe they will get 100% compliance week one and that the pressure from within the system will force
them to comply.
I’ll be looking for some guidance in terms of how much hard ball to play here, because I don’t want to blow my
relationship with ADHS over this.
Supervisor Gates asked Dr. Bob, have you talked to the Governor’s office about this?
Dr. Bob responded that’s where I thought and wanted guidance.
Supervisor Gates stated that would make sense. I can see the appeal in this, it sounds truly great. If you could
move all of this to electronic and the fact have 100% compliance.
Dr. Bob responds even if you can get almost 100% compliance but you have to have something to fall back on.
You can’t expect 100% compliance day one.
Every existing modification that every state has made as they are adopting this has been made at no additional
cost to them so we could have adopted that New Mexico’s work around or any other state’s work around. The
state chose to not go with any; they went with the base model.
What I’m still trying to avoid is that first week, when people can’t put their loved one in the ground.
Question – Is this targeted for January 1 implementation?
Dr. Bob responds September.
Question – Of 2018?
Dr. Bob responds 2017; we’ve been struggling with this for awhile.
Last few things in case you see them on the news.
DRAFT
CDC is changing some of their recommendations related to Zika. Especially testing, the problem with testing is the
testing isn’t that good and their scaling back.
School drinking water testing will be expanding the water testing program to include child care centers.
From a budget perspective just know that our multi drug resistant TB issues are not going away. We may have
one patient who we still can’t convince to comply that may result in that person being locked up in a hospital
room at Maricopa Medical Center. Which costs us a ton of money and I don’t know where the budget will come
from.
So expenses like that is always a threat. These are very uncertain times. That is all I have for you.
ANNOUNCEMENTS AND CURRENT EVENTS
 Next meeting is October 23, 2017
ADJOURNMENT: There being no further business, motion to adjourn the meeting was made by Mr. Cassano,
seconded by Ms. Montoya and motion was passed unanimously. The meeting was adjourned at 4:45p.m.
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