e e good afternoon today is Wednesday April 10th 2024 this is the Oklahoma City Board of Appeals um may we have a roll call please here so next on the agenda is a motion to elect the board chair I have any mo motions um I nominate Kyle Lombardo second so I have a motion in a second you want to call a vote I I next order of business is um the vote for the vice chair do I have a motion I nominate Tommy I have a motion may I have a second second you want to take the vote i i i i i congratulations ation congratulations the next order of business is the approval of the bylaws um I assume everybody received a copy of the bylaws in their packets and has had a chance to review them yeah I would like to make a a motion on this several years ago we had talked about uh looking at the bylaws and maybe uh coming up with some different um terminology on some of the items and so if it's if it pleases the board I'd like to see if we can maybe have a committee of maybe three of us on the on the board who who uh get together everybody else can write comments after they've reviewed the bylaws and then we can report back to the uh to you Scott and everybody on what we've come up with with some of the items on there that uh that have been a concern to some of us for a while so I would like to say that we don't vote on it uh this this meeting and uh postpone it till a future meeting so I have a motion to table well uh I thought we'd take that too separate so motion to table till the either the next meeting or whatever meeting we think is appropriate after the committee gets done looking at it so do you want to take a vote or do we need a second I'll second the first Ron made the motion to table take a vote I I I I I so there was a motion to create a committee uh sub commmittee yeah for us to do we have to do that by motion and second or can we just uh I think they'll say that it's the chair's responsibility to form the committee so I can either do that now or postpone yeah so since there will be no Motion in no second um I'll take it upon myself to get with you Scott and we'll form the committee so the next order of business is item five approval of the minutes from August 9th to 2023 uh I assume everybody has seen the minutes and had a chance to review them do we have any questions I'll make a motion to approve the minutes as written I'll second so we have Ron and Tom Tommy ready for a vote I yes yes I I I so the next order of business is the approval or let's see the um sorry new cases our first case is case number boab 2024 [Music] 0000001 uh an appeal of Melanie Compton Reese Associates from a decision of the code official for non-compliance with chapter 11 section 117.5 point3 of the international building code 2015 is adopted by the City of Oklahoma City pertaining to the requirement for accessible showers in sleeping units for 4300 West Memorial Road Scott you want to read the uh staff review uh the staff analysis is this uh uh see this involves the property at Mercy's Women's Center up on Memorial Road uh they're seeking a variance from the language of the 2015 IBC and the ICC ancy 2009 is adopted by Oklahoma City which relates to the re for requirement for the accessible shower seats within an I2 Hospital sleeping unit uh the 2015 IBC requires that I2 hospitals must provide a minimum of 10% of their sleeping units uh as constructed as accessible type units under the ansy uh the I ansy for accessible type units uh requires that at least one bathing room with each of these units complies with Section 608 and uh this section in particular list the detailed requirements to the layout and Arrangements of such items as grab bars entry path seating uh within either the transfer or Rollin type shower compartment uh the applicant wishes to conduct construct a Rollin type shower compartment does not wish to comply with the requirement to add either the folding seat required for a standin roller shower nor the permanent seat required for the uh alternate Rolland shower as described by the ICC an um of course figures are attached uh in addition the applicant has provided alternate plan proposals presenting the option of a transfer size shower compartment uh but still shown without the similar seating as required under ANC uh yeah the city has determined that the proposed plan layout shown with the shower will not be compliant with the code language so so as a point of disclosure I am uh an employee of ree Associates so I will not I will be recusing myself during this um the um in the past for the past 10 years since we are a particular board that deals with Specialties in terms of each of our positions we have uh not uh recused ourselves from participating in discussions or asking questions so I intend to uh maintain the precedent that's been set for the last 10 years and uh I might ask a question or two during the uh course of this so um is there a representative from the applicants party would you approach the podium and state your name and address for the record please Melanie Compton I am with re Associates 9211 Lake Hefner Parkway sweet 300 Oklahoma City zip 73120 almost gave you my home address would you mind telling us a little bit of about your case please yes um would you mind if I made some introductions of who is also joining me here today certainly that would be okay um and just a little bit more about myself I am a vice president of Bree um I have been specializing in healthc care design for the last 30 years at Bree associates also with me today is Steven Lawson he is the principal in charge and architect of record representing Merc Hospital Oklahoma City is Kate Blake director of strategic operatives she is the operational Project Lead for the love family Women's Center and then we also have Jessica bratcher she is the regional coordinator of the safe patient handling and Mobility first of all thank you for taking your time today and for this opportunity that allows us to share a little bit more information about um this task at hand um we are seeking a variance for the patient room showers at the Mercy Hospital Oklahoma City Campus and it is referred to as the love family women Center we would like to highlight today a few things that kind of build upon the information that you have reviewed in your packet and um and demonstrate that we believe we not only meet meet the intent of a codee but we feel like we exceed it just for some clarification um the the ICC code is referencing people that have you know physical deficiencies the uh the showers that we're talking about are on in our patient units so the inpatients so that kind of moves into into a different C category than just your general public into more of a patient who is under supervised care of a licensed medical facility so the in the matter of the shower design um we would like to walk you through Mercy's safe patient handling and Mobility assessment process and steps just really quickly to give you an idea of the process that they have in place which they feel like it even extends beyond what the requirements of ICC require and even make it a better situation for not only patients but staff as well so if you wouldn't mind Jessica bratcher want to join us and again she is the coordinator for the safe patient handling and Mobility hello good afternoon oh sorry Jessica bratcher um 4300 West Memorial Road Oklahoma City Oklahoma 73120 okay so we have a process in place and have for years um that is a Mobility assessment that is performed by the nurse taking care of that patient upon admission and any changes if a patient falls or anything that happens they have to reassess that patient through these steps we have six different steps I do have copies if you guys wanted to see this um this is our clinical practice bulletin but all nursing is taught on this and it is basically a guideline for them to help them be safe so the patient doesn't fall get injured or the cooworker doesn't get injured because that's my main uh focus in my position is to prevent patient and cooworker injury um by handling the patients so we have a step one which um has these um progression so if the patient can respond to verbal stimulus follow some commands all of the things if they cannot then they are they need to be using a piece of equipment on those patients and the love family women Center was graciously enough they purchased tons of equipment so they have everything they need um to progress these patients and um utilize via the mobility assessment so then we have a step two so if they can't um sit with Min assist at least two minutes um or fully extend the leg Against Gravity 3 to 5 seconds then they need to utilize a lift um which we have readily aail available for those co-workers um then if you need to go keep going on we have a level three which sits and stands one to two times with men assist if they cannot then they need to use a Sit toand piece of equipment um which is readily available they have they have 16 pieces of equipment throughout this hospital um and then going on you go to step four and then five and then if they can ambulate independently then there's that but Mercy's um best and safe practice um for this process is to I know that they were wanting to put a shower a fold down shower chair in the shower but that's not our safe practice um because then we would have to mobilize that patient in a wet environment and so moving having a wheed shower chair transferring them in a clean dry area in the room and then rolling them into the shower and bathing them is the best practice and then drying the floor taking them back to the bed using a lift per Mobility assessment that I just discussed any questions so your patients then are assessed to whether they are ambulatory essentially or not and with different differing degrees of uh Mobility you have differing degrees of assistance that you provide 100% okay so I hear you're correctly they do the mobility assessment no matter because the patient can change within a matter of second so they need to be doing they it's required documentation to their eh are their electronic health record so it's documented in their electronic health record and it has to be documented it's required documentation so is there a reason why the fold down chair would be um in the way or anything or is it just you don't want it to be in there for people to accidentally use I sorry I think that it would be a barrier um it would be in the way especially if the patient would we don't want would fall in the shower that would be another barrier we would have to work around to get that patient safely out of the restroom when you're uh bringing a patient into the shower and I know that you have wheels that lock that down yes does the patient have the option to stand up or are they always in the sitting position uh they're per their Mobility status it depend like you know if they're going to be utilizing an ADA room I'm assuming they're going to need that assistance in the shower with per nursing staff um so they we would leave them seated so the the the mobile device is actually locked down it can't move the shower chair yes yes ma'am so if you call that shower chair a mobile shower seat uhuh that becomes a shower seat now I'm asking you this would it become a shower seat to where they could sit if they had to if they wanted to stand up they could stand up but they would always have the shower seat there to provide the same uh accessibility as a pull down shower seat yes ma'am okay it's just mobile and so it's not in the way it's not stuck so we can move it where we need to move it are the shower controls in the same place if there was a shower seat there that's the only thing we're really concerned about here is the shower seat the controls and the valves everything is in the same position the same requir would height distance yes on the document that is pulled up on the screen the diagram a is pulled straight out of the ICC and you can see that there is what we call a wing wall but it's referenced as a seat wall and that supports that fold down shower chair seat if you can go to our diagram B this is the layout that is constructed in place and you can see we eliminated that Wing wall that supports that fold down seat and we want to roll the mobile shower chair directly in that exact spot and the controls are located in the correct spot as well between diagram a and diagram b as with the handicap bars and such and handicap yes okay all right thank you I think one thing that might help for people to understand that's not a part of this industry if you will is maybe to I don't know if you I'll answer this or if this woman would but when you have a patient come in you have to do an initial assessment of that patient correct because when you start talking about these different steps and levels and all of that that you've identified then um it's very important to understand how much assistance going to need and all that and you predetermine that now it doesn't mean it can't change because it may change and especially if people if their health doesn't improve and it gets worse then you may have to go to a different level and all am I kind of leading that correctly that's correct yeah cuz I own an assisted living and so I understand oh yeah all these different processes and I'm not a big fan of fold down shower seats especially if you have very large people they scare me and I like solid things and and that is the risk they want to control right by their yeah nursing drives it the whole key is to is to try to prevent Falls fall when injuries occur depending on the age Falls can result in uh early death for lack of a better phas yes and um currently you know before the Women's Center our nurses were following that criteria of the mobility assessment and the mobile shower chairs when needed and I want to knock on all of the wood in this room but we have not had a fall on that unit in a long long time that's good so that helps yeah too well you've got some longevity and experience and all that that's so important because you know I've had my facility for 20 years and then people get into it real new and they just don't understand the import of some of the uh assistance issues and so but it sounds to me like you're covering all those now also I you all deal with CMS correct yes jco Oklahoma State Department of Health all of these different state to federal agencies that now this is nothing against my City Oklahoma City born and bred grew up downtown I know you know I I love the city but I'm just saying sometimes uh there are there are other places that override that other organizations I don't what you call agencies if you will that would override that and so I'm sure you researched and been through all of that because they all these that are mentioning they do annual audits at least and maybe the Medicare Medicaid CMS they probably do it more often I'm not a nursing home so I don't we we're private pay but um but I know the Oklahoma State Department of Health you know they'll they like to be on the war path and I'll go on record to say no another thing guys um on the equipment that I was discussing all staff has to be checked off initially before they get a new device they have to have that hands on interaction with the equipment and we do it annually on top of that so they're constantly being trained on this equipment right that's great that's great we got a lot of Co devices anybody wants to have a baby sorry when you're uh in this Mobility device it's pushed into the shower it's stabilized where it can't move the shower takes place now an an attendant comes and removes that person from that area they never get up and walk away from that right that is correct yes yeah and we're no and so and if they're in an ADA room our staff is going to stay with that patient is going to stay with that patient because they are going to need more care than like say if I were you know had a baby you know I'm more independent but they are not um so the staff would have to stay with them okay and that's if they're using the bathroom shower any of that they would not leave them alone and clarify too if we can I'm not trying to dominate this I just think there's some things that need everybody needs to understand if you're not familiar with all this um even though even though Mercy checks off each employee nurse aid nurses whoever it is that's assisting resident uh I call them residents but I mean patients yes uh you're still going get surveyed and all that and those agencies are going to make sure they're they they can ask for employee files and they can they can stay there for a couple of weeks and drive you crazy looking at records and uh so you're Ducks all have to be in a row because the last thing he wants an IG and be shut down and so it's uh and when joint when Joint Commission comes in they do ask for certain education they'll pull random files somebody that's been their 30 or somebody that's a new hire a volunteer you know random files um so we make sure it's all documented uh via like LMS learning management system um I actually do all that documentation um so it is documented so if Joint Commission walked in tomorrow they're like hey did this person complete this education I would just get on our electronic learning management system pull their transcript and here you go right but they have to be documented and I run reports to make sure that they're doing making sure that they are done as well in addition incident reports all of those things are just vital to yes to not only protect the patient but to protect the hospital or Community yeah I would like to mention this facility is not just a one-off facility um Mercy Health Systems developed women's guidelines and this facility is actually the fifth new women's center over the last 12 years that have these exact designs right um so it's it's proven that you know it's it's a process throughout the ministry and it's not just a localized you know case yes so so help me understand um has the Joint Commission already reviewed this and and uh I guess credited your facility based on this design is that am I hearing that right hello everyone my name is Kate Blake 4300 West Memorial Road Oklahoma City 73120 again operational Project Lead for Mercy hospital um so this hospital um and all of the facilities that Melanie is speaking about so those five women centers that we have built across Mercy have all gone through Joint Commission accreditation so Joint Commission is our Healthcare accrediting body um for our hospital so that is the accrediting body so the authority having jurisdiction over our health care regulations and so all of our hospitals so those five women centers that Melanie is mentioning have all gone through those surveys for those hospitals MTI multiple times um and they do meet the specifications for Authority having jurisdiction um they do require us to meet Ada guidelines and so that is what the guidelines that we're meeting here um do recommend and that is what they are requiring us to meet is the Ada guidelines um for that Authority having jurisdiction osdh has come and surveyed um our Hospital we've become very very good friends with our healthc care um friend at OS and done many walks with him and we do have our lure we are seeing patients just not in those Ada rooms right now because of this and so we're just not able to serve that patient population right now because of that um so CMS um is obviously the overarching uh Authority having jurisdiction when it comes to healthcare but Joint Commission resources is who we use to meet that CMS guidelines so that really is who we need to answer to when it comes to healthc care authorities having jurisdiction we do meet all of those things um it's just this that we're lacking right now okay thank you so so Scott the reason that it was um so originally the building permit was filed and everything on it was approved I'm just saying I'm trying to understand it and then it came out to the I'm assuming the final inspection or one of the inspections and that's when it came up that this was not in accordance with what uh the code was saying correct I believe it was our uh plumbing inspections team that discovered the missing seats and that's what brought it to our attention for their uh I believe they're trying to get their final at the moment so but the original plans didn't ever show us a a uh shower seat in there when it was approved that way I'm not trying to point fingers or anything I'm just trying to get it all over my head I don't recall if it was on there or not to be honest I've slept since I looked at it last would you would you say that in some defense though the the shower seat that is shown the therapeutic shower seat might have been misconstrued is is the seat that the city reviewed okay now what are the can you explain those shower seats for us the therapeutic seats I'd be happy to explain what we're operationally using those therapeutic shower seats for so in the shower so um which version am I looking at I'm looking at diagram B here you'll be able to see uh the arrow that's pointing to the therapeutic massage um bench with the water jets so that's a little bit further back from where you see kind of the shower controls that therapeutic massage jet is really for mama having her baby um so moms sometimes have back labor and so really that is meant to be a the therapeutic massage so that Mom can have a rest and labor in the shower if she passes the mobility assessment if she is healthy enough to be able to do that we do have to meet have her meet clinical guidelines to be able to do that um with the nursing staff and then if she is healthy enough she can labor in that shower until she goes into actually pushing the baby out um to get some relief from that back labor and that is what that is operationally designed to do for us okay thank you so um for the record I do believe the seat was missed okay so looking at that then they're say they looked at it as being their interpretation was if it isn't exactly like this and it's not it's not acceptable um in our uh codes I know there's there's language that says if there's something that exceeds it is or or equal or exceeds it then then it could be uh it could be approved and I'm assuming that's why you're here saying you guys are saying this not only meets it in your opinion it exceeds what the what the code says okay yeah they're arguing alternate means and methods and materials right okay thank you and I'd like to remind the board as well we do have Scott Ellis here as our accessibility consultant if you need to ask him any questions as well I would like to hear what Scott has to say but I would also like to say on behalf of our city that um just because I served I've served on the long Governor's longterm Care Facility Advisory Board it's got a long name for 14 years and so we learn a lot about that but all of these plans and everything had to get approved through uh the architectural part of the State uh Department of Health and it seems to me Scott that the city is relieved of any liability because of these they're not Superior agency the agencies that have authority over that and uh and so I feel like that we're protected from not uh if this is approved from placing any kind of liability if there ever was an injury or anything on the city and that I feel like that's my responsibility to sit on this board is to protect our city from liability issues but I'd also like to hear what Scott has to say would you state your name and address please Scott my name is Scott Ellis I am here on behalf of the Oklahoma City mayor's committee on disability concerns um 6108 Northwest 63rd Street Oklahoma City 73132 uh before I make a comment I'd like to preface that I uh work for the Paralyzed Veterans of America I've been there over 20 years and I'm highly knowledgeable about people with disabilities and their needs uh I am not an expert in leas bit on ansy codes I deal more with Ada issues um what I could say about this case having been around and assisted severely disabled people in the shower and other locations that the space that you have to move in that area especially depending on the size of that person you're assisting the more room you have the better it is because it can get cramped even in a 5 foot area uh when you have water or sometimes times two people depending on the person's needs take you know trying to give them a shower or uh take care of them and I in my opinion having a bench mounted to the wall while people are trying to move around somebody with a disability uh would only impede that person's ability to take care of that individual um if you're moving around and you run into that and slip you know you could fall on to that person that's already there for Recovery uh for whatever issues they're having so I'm sorry I can't offer you anything on the ANC code itself just my professional opinion on care of uh people with disabilities and and my opinion that I think that bench mounted to the wall would impede um Quality Care to that uh person that needs the care anybody have any questions for me got what do you think the difference would be because um we use a lot of shower seats and they're put in one spot they're not moved around I mean our our showers are not designed like a barber shop where you get your hair cut and spin all the way around but um it's kind of in my mind I'm thinking that would be the same thing is a stationary bench like on the sketches here and uh what what do you think about that because if the bench wasn't there then uh the chair would be put in place the chair could be removed but on the other hand if they do their assessment properly then they're not going to be putting somebody in a room that has uh a bench like that because you know that's where we've got to trust their professionalism as caregivers well I I know from again being in the shower with people that um having a portable movable uh shower chair like they proposed is by far superior to having a fixed area where you have to transfer somebody into that seat on a wet floor try and and clean them the best of your ability cuz there's areas that are very difficult to clean when somebody's sitting down and you don't have the ility to move them around yes you know without risk being on a bench of falling off the bench right you know so my opinion what they're doing is is the right thing and uh having that on the wall would just you know impede quality care more than it would benefit yeah and I understand what you're saying too and I also you know that the levels they were talking about because you you and I both know that certain people people are going to need lifts and different things like that to even begin to give them a decent bathing experience if you will yes and so yeah that's good all right thank you thank you Scott I do have a picture of the specially designed shower chair you can see that that could help in that showering process and I'm I'm here for any additional questions or or comments do we have any more questions for the applicant P do we have anything that we would want to hear from Mike Wilson I'm always about the fire Marsh I don't think the I know you notice he sat on the back row almost and usually sitting right up here by Scott I I do have to admit um I would be interested in hearing just Mike's opinion about the difference this is an I2 occupancy correct the difference between I2 and other occupancies and how the code might whether it makes exceptions for the um U eye occupancies over others and maybe what those things are Mike Wilson with fire Marshall's office um also here on capacity that I've been the clerk of this board before for about 20 years um and the history that the board has gone through in the past we've they have actually approved uh in previous editions have approved possibility of a portable chair that can be moved to different rooms when they're needed to be this the the what I'm hearing anyway is is a much better uh alternative and and everyone knows that the I2 facilities are better monitored than any other type um I'm not going to say they're always excellent but because I've been in some that aren't excellent but uh we we allow on the fire side we allow more secure Hardware in some places you're allowed uh to not actually not have uh notification devices in patient rooms because typically they're not able to do anything by themselves anyway you know they're bedridden or whatever so the alarm goes off with the nurses station in the common areas so and the nurses station is part of their uh operations or manual have duties to do to make sure their area is clear make sure everybody is taking care of um in this case I I just my own opinion my wife had three hip surgeries and she's been in a wheelchair a number of times uh and the the uh the the small inside the shower transfer is really not that good for a wheelchair bound person um it really isn't because it it's not in the right location where the the seat of the chair is and uh so a roll in shower is much better has always been much better um used to we had a lot of problems with people when we would to require a Rollin shower they would only want to provide a little 3×3 you know shower with a bench in it uh and not a large area that you could get the whole sh the whole wheelchair in the shower so anyway and there is uh obviously justification that there is a lot more U monitoring of these facilities because it's an I2 use uh obviously it's not a fire issue uh so on the as far as the fire department goes we don't have it uh I would say any U recommendation one way or the other uh it's up up to the board to decide if this is equivalent or uh better or just another alternative to what the code requires and and should be acceptable or not I think I would like to make a motion to approve the variance H as requested um let's see to use the preferred plans would that be correctly stated the I think there were a couple preferred uh the third floor preferred plan or the I think that was the one that can you bring that is that one up there are you you're looking for a variance for both preferred plans or one yes sir both both preferred plans okay one and three second and third yes yes so if you want to um go to the next and then one more there you go yeah so there you see the ICC diagram above and then you see our layout constructed in place and it is the same scenario of rolling a shower chair into that position and the shower controls again are currently located in the correct position I will second uh Tommy's motion to approve both both plans yeah you want to take a vote approved K Lombardo is refused Austin Barton is absent uh Jim mcmurder yes Ron Roi yes Tomy Willis yes and Patrice simmerman yes the vote passes congratulations your variance is granted thank you all thank you so the next order of business is any continued cases and I see we have none that's correct Scott M correct and then um the last bit of business uh item eight is adjournment do I have a motion to adjourn motion to adjourn second second all in favor I who was the second u p p was the second for
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