FILED: ROCKLAND COUNTY CLERK 04/04/2019 11:45 AM INDEX NO.

031784/2019
NYSCEF DOC. NO. 10 RECEIVED NYSCEF: 04/04/2019

SUPREME COURT OF THE NEW YORK

COUNTY OF ROCKLAND
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W.D., on behalf of his minor children, et al. Index No.: 031783/2019

Petitioners,

-against-

COUNTY OF ROCKLAND,

Respondent.

AS AND FOR A PROCEEDING BROUGHT PURSUANT

TO ARTICLE 78 OF THE CPLR

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JANE DOE., as the parent and guardian of her minor Index No.: 031784/2019
Unvaccinated daughter, BABY DOE,

Petitioner,

-against-

ED DAY (in his official capacity as County Executive)

and the COUNTY OF ROCKLAND,
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MEMORANDUM OF LAW IN OPPOSITION TO

PETITIONER’S ORDER TO SHOW CAUSE/TRO
.

THOMAS E. HUMBACH
COUNTY ATTORNEY
By: Thomas E. Humbach
County Attorney
11 New Hempstead Road
New City, NY 10956
(845) 638-5180

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PRELIMINARY STATEMENT

This abbreviated memorandum of law is submitted on short notice, in opposition

to the Orders to Show Cause in the matters of W.D. on behalf of his minor children, et al.,

v. County of Rockland and Jane Doe, as the parent and guardian of her minor

unvaccinated daughter, Baby Doe et al. v. County of Rockland, each of which seeks a

temporary restraining order, enjoining the Declaration of a State of Emergency made by

the County Executive of the County of Rockland and an injunction against the Rockland

County Commissioner of Health’s order to exclude unvaccinated children from the

school the Petitioners attend.1

The temporary restraining orders should not be granted because:

 With respect to the claims regarding the Declaration of a State of Emergency,

Petitioners have failed to show a likelihood of success on the merits. There

arguments are wholly conclusory and simply seek to substitute the judgment of

the Petitioners for that of the County Executive. Executive Law § 24 explicitly

permits the County Executive to respond with such a declaration in the case of a

crisis such as the one the County faces under the current measles outbreak.

 With respect to the claims regarding the Commissioner of Health’s order, The

Petitioner’s claims should be dismissed pursuant to CPLR 3211(a)(4) as they are

currently being litigated in the Southern District of New York.

 Moreover, Petitioners have not established that the injunction would not prejudice

the County or others by causing harm to other interested parties, or that the public

interest would be furthered by the injunction.

1 Respondents reserve the right to submit further legal and factual briefing on the grounds expressed
herein and any other suitable grounds in response to further argument on the Petitioners' motions for
preliminary injunction or in the Petition for Article 78 relief proper.

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For the reasons set forth above, it is respectfully requested that the Court deny the

injunction sought in the Order to Show Cause and for such other relief as may be just

proper and equitable under the circumstances herein.

FACTUAL BACKGROUND

From October 2018 to date, Rockland County has seen 166 cases of measles

during an outbreak, the magnitude of which has not been seen for decades. The County,

and the United States in general are protected by what is known as ‘herd immunity’ as the

result of the generally high rate of vaccinations for measles in the population. Essentially

there are so few susceptible persons, that the disease is ‘starved’ of hosts and cannot

spread. However, in Rockland County there are geographic areas where the vaccination

rates are low, resulting in a lack of herd immunity, providing a rich ground for the disease

to spread. The Plaintiffs’ schools are located in that geographic area.

As a result, upon the detection of the outbreak, the County Commissioner of

Health, in consultation with the New York State Department of Health, determined to

protect the public health by taking steps to prevent the spread of the measles. That course

of action included, among other things, issuing an order excluding unvaccinated children

from attending schools, where collections of unvaccinated children would provide a

breeding ground for rapid spread of the disease.

This has been a stepped process. Initially, the order was applied only to schools

where there were known exposures to the measles and vaccination rates were below 70%

of the student body. Schools are the primary target of the restrictions because, in

Rockland it is demonstrated that young people are the primary victims of the measles.

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However, as cases continued to increase and the initial restriction was deemed to be

insufficient to stem the spread of the measles, it was observed that all of the cases were

occurring in a limited geographical area within the County, which included the location

occupied by the Plaintiffs’ schools.

At that time, the order was extended to all schools in the geographic area, public

and private, and presently affects approximately 60 schools. Due to the failure of less

restrictive means to hold back further infections and spread of the measles, the

Commissioners have become more restrictive. Presently, all schools in the subject

geographic area, with less than 95% vaccination rates are required to exclude all

unvaccinated children until 21 days after the last known case. That time may be

increased to 42 days based upon advice of the Center for Disease Control, but that ruling

by the Commissioner has not been made.

Following the Commissioner’s efforts, the number of cases in the County

continued to increase. On February 22, 2019, the State declared the County to have an

imminent threat to health. Through the middle of March 2019, the infections continued

to increase.

On March 26, 2019, the County Executive determined to make further efforts to

stem the tide if exposures to the disease and resulting infections. On that date, he

declared the County to be in a State of Emergency, pursuant to his powers under

Executive Law § 24. As a part of the declaration, he gave a directive that, generally

speaking, required parents and guardians to keep all children and infants, unvaccinated

for any but a medically determined reason, away from places of public assembly,

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including schools, houses of worship, shops, restaurants, etc. The Declaration will expire

on April 25, 2019.

It is upon this background of disease and epidemic, and the protection of public

health that requires, that the Plaintiffs are excluded from attending their schools.

ARGUMENT

POINT I

PLAINTIFFS HAVE FAILED TO STATE FACTS OR LAW SUFFICIENT

TO SUSTAIN THEIR CLAIM FOR A TEMPORARY RESTRAINING ORDER

Plaintiffs have not sufficiently addressed the elements of a temporary restraining

order.

Pursuant to CPLR § 6301, to obtain a temporary restraining order, the Petitioners

must show that they are entitled to a preliminary injunction, plus where it appears that

immediate and irreparable injury, loss or damage will result unless the defendant is

restrained before the hearing can be had.

“To be entitled to a preliminary injunction, plaintiffs had to show a probability of

success, danger of irreparable injury in the absence of an injunction, and a balance of the

equities in their favor.” Aetna Ins. Co. v. Capasso, 75 NY2d 860, 862 [1990].

The Appellate Division Second Department has followed this reasoning, further

stating that,

"[p]reliminary injunctive relief is a drastic remedy which will not be

granted unless a clear right thereto is established under the law and the
undisputed facts upon the moving papers, and the burden of showing an
undisputed right rests upon the movant.

As a general rule, the decision to grant or deny a preliminary injunction

lies within the sound discretion of the Supreme Court.

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In exercising that discretion, the Supreme Court must determine if the

moving party has established: (1) a likelihood of success on the merits, (2)
irreparable harm in the absence of an injunction, and (3) a balance of the
equities in favor of the injunction.

[A]bsent extraordinary circumstances, a preliminary injunction will not

issue where to do so would grant the movant the ultimate relief to which
he or she would be entitled in a final judgment. Emanuel Mizrahi, DDS,
P.C. v. Angela Andretta, DMD, P.C., ___AD3d___, 2019 NY Slip Op
02315, *2-3 [2019] (internal citations omitted).

In this case, the Petitioners fail to meet the standards required. They seek a

temporary restraining order in an Article 78 action challenging the administrative

decision to implement a State of Emergency, containing a directive restricting the

assembly of unvaccinated persons in certain indoor venues.

A. A temporary restraining order is inappropriate as the grant of this

injunction would grant movants the ultimate relief of the action.

As an initial matter, we point out to the Court that the State of Emergency

declaration has a 30-day limited duration, expiring April 25, 2019. That date is only 21

days from the present. The pendency of most cases, even though the initial stage of an

order granting a preliminary injunction, is typically more than three weeks.

As such, in contravention of the rule set forth in Emanuel Mizrahi, DDS, P.C., in

this matter concerning the declaration of a state of emergency, the ultimate relief sought

in the suit, termination of the emergency directive, would result from the grant of the

restraining order.

Thus, the grant of the restraining order should be denied.

B. Petitioners fail to show a likelihood of success on the merits.

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For Petitioners to show a likelihood of success on the merits, they must present

some proof, legal or factual, in support of their claims under Article 78, that the County

Executive's actions were beyond his powers, or arbitrary and capricious.

The State of Emergency was declared, on March 26, 2019. It is scheduled to last

through April 25, 2019. It is declared in response to the largest outbreak of measles in

this county since 2000. Measles is a highly communicable disease, which may have both

long and short-term effects, including death, brain injury, and seizures, some of which

effects may occur months or years after the original infection. It can be transmitted by air

or on surfaces by the action of sneezing or coughing in an area, with the virus staying

contagious for two hours following the exposure.

The effect of the measles is so pernicious and communicable, that an entire

Article of the Public Health law is dedicated to the detection, reporting, and response to

outbreaks of such diseases. See Public Health Law Article 21. That law is in effect even

in the absence of any outbreak of the disease, to preclude consequences of the disease

arising in the first place.

New York and many other states further require vaccines for some teachers and

child care workers, health care workers and other sectors. The US Military mandates

vaccines for all personnel.

The primary method used by the public health authorities to contain a measles

infection is isolation of persons with the disease or exposed to it. Since the beginning of

this outbreak in October 2018, deliberate steps have been taken by the County's public

health officials, in cooperation with the State Department of Health, to increasingly

isolate greater number of those most vulnerable to the disease, unvaccinated children.

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This has been done through orders of the County Commissioner of Health excluding

children from schools in areas that are observed to be the center of the outbreak.

However, that measure has not proven to be a complete solution. The outbreak

has continued for over six months, with cases continuing to increase. Persons with

measles or with recent exposures continued to frequent public venues, potentially causing

the spread of the outbreak to other areas of the County. It has become a matter of a

public emergency that may engulf the entire County.

As such, On March 26, 2019, the County Executive, Edwin J. Day, declared a

State of Emergency, and directed that all minors (persons under 18 years of age) that are

physically able to be vaccinated but have not, must stay away from places of public

assembly. The effort is to further isolate the infected and exposed, to allow the infection

to run its course, and snuff itself out.

Petitioners disagree with the County Executive. In contradiction to the science

and public heath expertise that has been adopted by the State through legislation and rule-

making by State and local agencies, the Petitioners believe that measles is, at most, an

inconvenience, and that the vaccinations against this disease are more harmful than the

disease itself. As such, they disagree with the findings and the actions by the County

Executive.

By their Petitions, they seek to replace the judgment of the current establishment,

and the County Executive, with their own. That position is insufficient grounds upon

which to grant a temporary restraining order or a preliminary injunction.

C. The County Executive has not acted beyond his powers

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Executive Law § 24 gives broad authority to declare a State of Emergency, by

local officials. Section 24 states that,

in the event of a disaster, rioting, catastrophe, or similar public emergency

. . . or in the event of reasonable apprehension of immediate danger
thereof, and upon a finding by the chief executive thereof that the public
safety is imperiled thereby, such chief executive may proclaim a local
state of emergency within any part or all of the territorial limits of such
local government.

Following such proclamation and during the continuance of such local

state of emergency, the chief executive may promulgate local emergency
orders to protect life and property or to bring the emergency situation
under control.

Under the definitions contained in Executive Law § 21, a “disaster” includes an

“epidemic”.

Such orders may include, “the establishment of a curfew and the prohibition and

control of pedestrian and vehicular traffic;” “the designation of specific zones within

which the occupancy and use of buildings and the ingress and egress of vehicles and

persons may be prohibited or regulated;” “the regulation and closing of places of

amusement and assembly;” and “the prohibition and control of the presence of persons on

public streets and places.” Executive Law § 24.

With respect to the constitutionality of the Executive Law itself, the Supreme

Court of the United States has held that, “[t]he right to travel within the United States is

of course also constitutionally protected, cf. Edwards v. California, 314 U.S. 160. But

that freedom does not mean that areas ravaged by flood, fire or pestilence cannot be

quarantined when it can be demonstrated that unlimited travel to the area would directly

and materially interfere with the safety and welfare of the area or the Nation as a whole.”

Zemel v. Rusk, 381 US 1, 15-16 [1965].

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Moreover, exclusion of persons in order to protect the public health has been held

by the Supreme Court to be a valid exercise of the police power. See Jacobson v.

Massachusetts, 197 US 11 [1905], and if the state chose, it could mandate vaccines for all

those who may, physically, take them without providing any sort of exemptions. In

Phillips v. City of NY, 775 F.3d 538 (2d Cir. 2015), the Second Circuit Court of Appeals

held that mandatory vaccination was within the State's police power. [internal citation

omitted]. The [Supreme] Court rejected the claim that the individual liberty guaranteed

by the Constitution overcame the State's judgment that mandatory vaccination was in the

interest of the population as a whole. Jacobson, 197 U.S. at 38.2

Article 78 Standard

Article 78 proceedings are governed by CPLR § 7803. N.Y. C.L.S. C.P.L.R. §

7803 (emphasis added).

“[A] fundamental tenet of CPLR article 78 review[,] is that [j]udicial review of

administrative determinations is confined to the facts and record adduced before the

agency.” ABN AMRO Bank N.V. v. Dinallo, 40 Misc.3d 180, 197, 962 N.Y.S.2d 854,

867 (Sup. N.Y. 2013) (citations & internal quotation marks omitted). “In other words,

the court may not consider evidence concerning events that took place after the agency

made its determination [ ] and can only review the grounds presented by the agency at the

time of its determination.” Id. (citations & internal quotation marks omitted).

In addition, "[t]he court may not substitute its judgment for that of the

2
 The Supreme Court and the Second Circuit Court of Appeals continue to cite approvingly to
Jacobson in cases beyond Phillips, see Gonzales v. Carhart, 550 U.S. 124, 163 (2007) (for the premise
that “[t]he [Supreme] Court has given state and federal legislatures wide discretion to pass legislation in
areas where there is medical and scientific uncertainty.”); Cruzan ex rel. Cruzan v. Dir., Mo. Dep't of
Health, 497 U.S. 261, 278, 110 S. Ct. 2841, 111 L. Ed. 2d 224 (1990) (referring to Jacobson's ruling
that "protected liberty interest in refusing unwanted medical treatment" yielded to "State's interest in
preventing disease"); and Caviezel v. Great Neck Pub. Schs, 500 F App'x 16, 19 (2d Cir 2012).

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[administrative agency]. The [administrative agency’s] interpretation of the statutes and

regulations it administers, if reasonable, must be upheld.” Matter of Kripalani v. State of

N.Y. Div. of Hous. & Community Renewal, 126 A.D.3d 904, 905, 5 N.Y.S.3d 508, 510

(2d Dep’t. 2015), leave to appeal denied, 27 N.Y.3d 901 (N.Y. 2016) (citation & internal

quotation marks omitted). “[A] reviewing court’s function is limited to whether the

record contains sufficient evidence to support the rationality of the ... determination.”

Aquinas Inst. of Rochester v. Cerone, No. 14/11987, 2014 N.Y. Misc. LEXIS 5912, at *5

(Sup. Monroe Oct. 31, 2014) (citation & internal quotation marks omitted). The

“reviewing court’s scope of inquiry is extremely limited.” Id. at *6 (citation & internal

quotation marks omitted).

Further, “[a] petitioner bears the heavy burden of proving that the decision was

not grounded upon a rational basis.” Id. at *5 (citation & internal quotation marks

omitted). “Bare conclusory statements in a petition supported only by hearsay allegations

by a person not a party to the proceeding are insufficient.” Matter of Trotta v. Kirwan, 47

A.D.2d 685, 686, 364 N.Y.S.2d 236, 237 (3d Dep’t. 1975) (citations omitted).

Lastly, “[u]nder CPLR 7803(3), judicial review of an administrative punishment

is guided by the abuse of discretion standard, which translates into a circumscribed

judicial inquiry: the administrative penalty must be upheld unless it shock[s] the judicial

conscience.” Lin Del Transmissions, Inc. v. N.Y. State Dep’t of Motor Vehicles, 256

A.D.2d 1176, 1176, 684 N.Y.S.2d 392, 393 (4th Dep’t. 1998) (citation & internal

quotation marks omitted).

Arbitrary and Capricious or Abuse of Discretion Standard

“The arbitrary or capricious test chiefly relates to whether a particular action

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should have been taken or is justified ... and whether the administrative action is without

foundation in fact.” Matter of Pell v. Bd. of Educ. of Union Free School Dist. No. 1 of

the Towns of Scarsdale and Mamaroneck, Westchester County, 34 N.Y.2d 222, 231, 356

N.Y.S.2d 833, 839 (N.Y. 1974) (citation & internal quotation marks omitted). “Arbitrary

action is without sound basis in reason and is generally taken without regard to the facts.”

Id. “In regard to an alleged abuse of discretion, it is the same test as the arbitrary and

capricious standard.” Id. (citation omitted).

Violation of Lawful Procedure Standard

“The lawful procedure ground can emanate from either statutorily conferred

procedure or constitutional due process considerations.” Aquinas Inst. of Rochester, 2014

WL 9859197, at *2 (citation omitted). “To determine whether an agency has violated

lawful procedure, reference must be made to the statutes, rules and regulations governing

the particular agency and its area of regulatory competence. The legality of the

procedure will often turn on the nature of the action taken.” N.Y. C.L.S. CPLR § 7803,

Practice Commentaries by Vincent C. Alexander entitled “C7803:1 Issues That May Be

Raised in an Article 78 Proceeding, In General” (emphasis added & citations omitted).

Error of Law Standard

The “meaning [of the error of law standard] is rather clear cut and most often

involves an allegation that the agency improperly interpreted or applied a statute or

regulation.” Atlas Henrietta, LLC v. Town of Henrietta Zoning Bd. of Appeals, 46 Misc.

3d 325, 332-333, 995 N.Y.S.2d 659, 666 (Sup. Monroe 2013), aff’d, 120 A.D.3d 1606

(4th Dep’t 2014) (citation omitted). The Practice Commentaries state:

Courts seldom single out “error of law,” by name, as the

question for consideration in an Article 78 proceeding. This

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question is often implicit, however, in the nature of the

grievance, such as an allegation that the agency improperly
interpreted or applied a statute or regulation. In this regard,
courts will uphold the interpretation of statutes and
regulations by the agencies responsible for their
administration if such interpretation is reasonable.

N.Y. C.L.S. CPLR § 7803, Practice Commentaries by Vincent C. Alexander entitled

“C7803:1 Issues That May Be Raised in an Article 78 Proceeding, In General” (emphasis

added & citations omitted); see also Atlas Henrietta, LLC, 46 Misc.3d at 333, 995

N.Y.S.2d 659, 666 (citation omitted). “Thus, the arbitrary and capricious and error of

law standards are very similar.” Id. at 332, 995 N.Y.S.2d 659, 66.

“Moreover, in questions relating to its expertise, the [agency’s] interpretation of

the statute’s terms must be given great weight and judicial deference, so long as the

interpretation is neither irrational, unreasonable nor inconsistent with the governing

statute.” ABN AMRO Bank N.V., 40 Misc.3d at 196, 962 N.Y.S.2d 854, 866 (citations &

internal quotation marks omitted). “By contrast, where the question is one of pure

statutory reading and analysis, dependent only on accurate apprehension of legislative

intent, there is little basis to rely on any special competence or expertise of the

administrative agency ... In such circumstances, the judiciary need not accord any

deference to the agency’s determination, and is free to ascertain the proper interpretation

from the statutory language and legislative intent.” Id. (citations omitted).

As such, the County Executive is on firm ground in his authority to issue this

directive and, based upon the facts and circumstances surrounding the matter, it was not

arbitrary and capricious.

Petitioners have no likelihood of success on the merits of their claims.

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D. In balancing the prejudices, the Petitioners fail to recognize the prejudice

to the general public

With respect to the balancing of the prejudices in this case, we must weigh

the good of these students, against the good of the general public. In that balance, the

interests of the Petitioners must bow.

On the issue of prejudice, Citizens for Responsibility & Ethics in Washington v.

Cheney, 577 F. Supp. 2d 328, 334 [DDC 2008], relates the prejudice element in a manner

applicable in this case, stating that the court must determine, “[] whether an injunction

would substantially injure other interested parties; and [] whether the public interest

would be furthered by the injunction.”

Today, the County Executive and Commissioner of Health are attempting to

stymie one of the worst outbreaks of measles in the United States in twenty years. If the

Court were to enjoin the County Executive and the Commissioner from enforcement of

their orders, which still contains a substantial number of susceptible residents, it would

give leave to wholly ignore the public benefit of isolating cases of measles.

Today, the number of cases of measles in the County are still rising. The efforts

made to date have had a beneficial effect, preventing an even wider and faster spread of

the disease, but have not eradicated it. The outbreak still continues.

Other interested parties include all the persons in the County, as well as nearby

areas. Despite the fact that vaccines are available, there are persons, infants, persons who

are immune compromised, and the elderly, who are vulnerable populations. If the

measles contagion spreads those people will be hurt.

As a matter of fact, were the Court to increase the burden upon the County

Executive or the Commissioner of Health, who has already been sensitive to the increase

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of regulation, or if the Court were to hold that they do not have the power to control this

outbreak in a well-reasoned and calculated manner, it would be to the detriment of the

public as a whole.

Upon the case law cited in this brief, from Jacobson v. Massachusetts to Phillips

v City of New York, over one hundred years of jurisprudence, it is held that the control of

communicable disease is within the authority of the government to control it and, where

possible, eradicate it. That authority and duty, is for the good of the general public.

Therefore, Respondents submit that the prejudices in this matter weigh in favor of

the government and the general public, over the interests of the individuals, and that

Plaintiffs' have not asserted sufficient facts to overcome that burden, much less provided

the heightened proof required for a preliminary injunction seeking a mandate, and the

request for injunction should be denied.

E. Petitioners' claims are not supported by law or fact

The Petitioner's claims that the religious exemptions that they have for attendance

at schools are unavailing in this case. We have gone far beyond the everyday regulation

of communicable disease prevention at schools, and entered an era of countywide

epidemic, mostly as a result of unvaccinated persons being exposed to the disease and

passing it on to other, unsuspecting victims.

The religious exemption provided under Public Health Law § 2164, is wholly

overshadowed, in this case, by the enactment of the emergency directive under Executive

Law § 24. The Emergency directive provides a broader restriction for a broader and

more acute problem.

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Moreover, the Petitioners' opinions about measles and measles vaccines is wholly

irrelevant in this matter. Perhaps one day, their points of view will be heard in the State

Legislature, and reflected in the State's laws and regulations, but that day is not today.

Today, measles is known to be the potentially deadly and disabling disease it is; and

vaccines are known to be the solution.

E. The Green Meadows claims regarding the Commissioner or Health's

order should be dismissed

Lastly the claims by the students of Green Meadows seeking relief concerning the

County Commissioner of Health's order should be dismissed pursuant to CPLR §

3211(a)(4).

This very order is presently being challenged in court in the Southern District of

New York in the matter of M.A. et al. v. County of Rockland, Docket No. 19 CV 02066

(VB). Section 3211(a)(4) precludes this court from hearing a matter when “there is

another action pending between the same parties for the same cause of action in a court of

any state or the United States”.

Frankly, pursuant to the transcript that Mr. Sussman has provided with his

Petition, and order to show cause, he argued quite eloquently that the State Courts were

inappropriate to determine his Article 78 case on the Commissioner's order because they

were too “parochial”.

There is no reason for Mr. Sussman's view to have changed on that matter.

Although the facts may have developed since that time, the case is still in the pre-answer

stage, with plenty of time to produce facts in discovery or amend pleadings if needed.

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CONCLUSION

For all of those reasons set forth above, the Defendants hereby request that the

Court deny the application for a temporary restraining order and preliminary injunction

and for such other relief as may be just proper and equitable under the circumstances

herein.

Dated: April 4, 2019

New City, New York

THOMAS E. HUMBACH
County Attorney
Attorney for Defendants,
11 New Hempstead Road
New City, Ne York 10956

. i

By:
THO AS E. HUMBACH

County Attomey

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WTo?ORK
Departnient
°"°"""""
of Health

ANDREW M. CUOMO HOWARD A. ZUCKER, M.D., J.D. SALLY DRESLIN, M.S., R.N.
Govemor . Commissioner Executive Deputy Commissioner

February 22, 2019

ROCKLAND COUNTY
DEPARTMPrr ')F ríEALTH

Patricia Schnabel Ruppert, D.O., M.P.H.

Commissioner of Health
Rockland County Department of Health
50 Sanatorium Road, Building D RECEIVED
Pomona, New York 10970

Dear Commissioner Ruppert:

I am writing in response to your letter of February 5, 2019 regarding a measles outbreak

in Rockland County.

Since October 1, 2018, Rockland County Department of Health (RCDOH) has faced one
of the longest measles outbreaks in the United States, with the highest number of cases in New
York State since 1989. RCDOH staff have been diligeñtly investigating cases and providing
immunizations in an effort to end the outtireak of such a contagious and serious infectious
disease.

This unanticipated outbreak is exceeding the scale and extent of what would routinely be
expected by RCDOH. Since additional cases of measles are still occurring and based upon the
sigiiificant risk that is posed to health, I have determined that an Imminent Threat to Public
Health (ITPH) exists in Rockland County, pursuant to Public Health Law § 621.

Accordingly, RCDOH may request reimbursement at fifty percent (50%) of the allowable
public-health costs related to the measles outbreak investigation, prevention and control
activities, including expanded efforts to promote and increase access to vaccination, during the
response period of the declaration, which is October 1, 2018 through June 30, 2019. These
funds will be made available only after all funds in the appropriate program categories of the
approved 2018 and 2019 State Aid Applications and all state and federal as well as other forms
of aid that might become available have been expended.

Please work
closely with the Department's Office of Public Health Practice (OPHP) to
establish the
eligibility costs for reimbursement and the process to claim such reimbursement.
Please contact OPHP at (518) 473-4223 with questions regarding reimbursement or if the need
to request an extension to the response period arises.

Sincerely,

Howard A. Zucker, M.D., J.D.

. Commissioner of Health

cc: L. Santilli
J. Chytilo

Empire State Plaza, coming Tower 'Albany, NY 12237|health,ny.gov

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FILED: ROCKLAND COUNTY CLERK 04/04/2019 11:45 AM INDEX NO. 031784/2019
NYSCEF DOC. NO. 10 RECEIVED NYSCEF: 04/04/2019

D. Blog
S. Ostrowski
E. Rausch-Phung
B. Hutton
A. Mazeau
C. Johnson
M. O'Donnell

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