HomeMy WebLinkAbout08-14-23 Planning Commission Minutes
Commissioners Present: AJ Schrantz, Vice-Chair; Frank Neice; Kevin Meyer, Chairman; Terry Hale, Van Taylor; and Rachel Arthur
Commissioners Absent: None
Town Staff: Summer Bork, Town Planner, and Spencer Rygas, Town Attorney
Call to Order
Chairman Meyer called the Planning Commission to order at 6:01 p.m.
Roll Call of Commission
A quorum was determined with all commissioners present.
Review and Approval of Minutes
Mr. Myer asked if any edits should be made to June 12, 2023, and commented that Mr. Schrantz should sign for the June 12, 2023 minutes as he presided. (The acceptance of June’s minutes
had been tabled during the last meeting). After commission members had commented on typographical errors and needed edits, Ms. Arthur motioned to accept June 12, 2023, with revisions
to the record. Mr. Schrantz seconded, and the motion passed unanimously.
Mr. Schrantz moved to accept July 10, 2023, minutes into the record with edits, and Mr. Hale seconded this motion; the voting was as follows:
Ayes: Mr. Meyer, Mr. Hale, Mr. Niece, Mr. Schrantz, Ms. Arthur
Nay: NA
Abstain: Mr. Taylor
Public Hearing—NA
5. Old Business-- Council’s Request to Revisit Language “Substance Abuse Disorder Services” in Medical Office Definition
Mr. Meyer commented to this effect during a previous meeting.
Ms. Bork agreed that he had but that council’s request was independent of that.
Mr. Rygas explained that the primary concern that a particular member of the council expressed was that they felt that the phrase needed to come from somewhere else or from a specific
set of guidance rather than not adopting anything, they adopted the “Medical Office” definition and sent these comments back for further review to make it more legally defensible.
Mr. Meyer stated that the most recent example the town had was a practice that was a medical office practice where the doctor prescribed medication but was not going to dispense onsite.
He believed that this falls directly within the realm of acceptable practice as this is something that doctors are licensed to do by the state. In many areas, this can be done by right,
and in other parts of town, just not in that location, and questioned if it was legally defensible, and the town can do better, and why he recommended Mr. Rygas be at the commission
meeting that evening.
He was concerned that the word “abuse” had a negative connotation and that the recognized term was “substance use disorder” that the industry has made, and he recommended that the commission
do so.
Mr. Taylor asked how the change would fit the staff’s recommendation for addressing the council’s comments.
Ms. Arthur requested that previously, she had commented that we might be reinventing the wheel and what other health organizations have regarding definitions on this topic since it is
very clearly defined for billing purposes and could we use some of their terms.
Ms. Bork replied had looked at how the State of Virginia defined “Substance Abuse.” How the state defines these terms depends on how it is defined on an individual's medical insurance
policies. She looked at NIH and the definition provided to staff as initial language was crafted using information from that organization.
Mr. Meyer stated that the commission needed to decide what to allow. Then, develop the language around that.
Ms. Arthur mentioned Mr. Niece’s idea from a couple of meetings ago to limit the number of facilities using a boundary or “distance between” limitation within the regulation to limit
the number of facilities. She then asked if this was the town's official decision or…
Mr. Meyer clarified that we are taking the definition the Commission recommended for the Medical Office and Town Council has adopted. They have asked the Commission to examine the phrase
“substance abuse disorder services” and clarify its meaning. He said that the Commission needed to work with those words and recommend to the Council whether to change that wording
and define what that is.
Mr. Taylor asked Ms. Bork who made the motion.
Ms. Bork said she could look that up but didn’t have those minutes with her.
Ms. Arthur continued the conversation to clarify the goals of what should be done regarding the medical office and what factors might play into the working and definitions required for
the commission to consider.
Mr. Meyer stated that he didn’t know if the town could set a numeric limit on the type of medical providers within the town. He knew some things could be located within x ft.
Mr. Rygas, this developed its seemingly in the weeds. Still, we are trying to create a definition for something in the zoning ordinance that did not have a definition in doing so, another
item that doesn’t necessarily have a definition. He suggested that it might be wise to take a step back and consider that medical offices are only in a minimal number of zones. The
thirty thousand-foot view of hospitals and that they require a special expectation everywhere there are a lot of restrictions.
Because we have medical offices, having a definition is “safer” than leaving it. The Commission had been tasked with clarifying the language to satisfy the concerns raised by Councilman
Reis. The other way of approaching this is to hold that we don’t have a definition of something that falls in a definition, but it at least provides general guidance.
Mr. Meyer asked if the commission was to place a period after the “and they offer minor surgical care” period. Delete the rest of it. The three things listed after are what we are prohibiting
if we don’t list it at all, and the use is stating here is what you can do that the town has defined as a medical office, it goes along with school, gas station and other uses. Right?
We do not have to exclude a school as being a medical office.
Ms. Arthur questioned the concern in this case that the definition of outpatient basis can incorporate many things.
Mr. Meyer responded that an outpatient basis means you bill it as an outpatient visit, so less than 24 hours in a bed.
Ms. Arthur stated that if the commission has particular things that, with the knowledge, they want to exclude…
Mr. Meyer, then we don’t include them. If we state that “a medical office is an establishment that …” “doctors, dentists, and other practitioners licensed by the state,”
we have eliminated anything not health care related and those not licensed by the state to practice medicine. Therefore, I can’t have a medical office because the state has not licensed
me to practice medicine. “…including medical health-related physical and massage therapy,” …
Ms. Arthur rejoined that is including but not limited to, right? This is an in-the-weeds question, but we are there. For example, if we stop for the comma after “client,” does the methadone
clinic not qualify as what that is? They are “physicians licensed by the commonwealth to provide services to clients.” That statement has no exclusions, which means it includes the
very thing that seems to be the point of contention and concern of the residents who have voiced their opinions on other occasions. She asked Mr. Rygas, if we don’t specify, you can
do that. Is it such a broad statement by default? Does it include it?
Mr. Rygas replied that it is arguable that it is permitted if it broadly fits within the definition. One of our other wrinkles is not only is it named but how to approach what you are
trying to convey legitimately. And if the hospitals have special expectations in every zone, why do we have any medical office definition that is by-right anywhere? He mentioned that
when you have a special exception, a process opens up a conversation where that lack of specificity is clarified.
Ms. Arthur states that she doesn’t think it is an exhaustive list. She says she believes the commission has a specific thing that should be limited within the town.
Mr. Meyer stated that, like in most towns, we are trying to limit medication-assisted treatment for substance use disorders, which is the primary contention.
Ms. Arthur said she was willing to play devil's advocate momentarily. Appalachia has been, for the most part, disproportionately negatively impacted by the opioid epidemic, so for us
to prohibit an entire way of addressing this whether we agree with how they go about doing it. It seems that we are not doing a service to a fair chunk of people who need help. Are
we penalizing them by not allowing services to be made available to them? I am not saying this should be without conditions, but we must frame the issue. We need to define substance
abuse disorder treatment and determine where it goes within the town.
Mr. Meyer stated that he was trying to remember there is a distinction between what the clinic by Shelor does and how they are allowed to do it. To do what they are doing, they have
to have counseling programs for clients, have meetings, and dispense methadone and other drugs. There are also practices where they do not administer medications on site like a hospital;
instead, a doctor writes a prescription, and you go to a pharmacy to fill it.
A physician who wishes to write a prescription but not dispense it is a medical office and should be allowable, so you must go to the pharmacy to get it. How should we deal with
these different types of establishments? With the present definition, even if it is ended before the word “but,” an establishment would not be able to do what that clinic is doing.
Ms. Arthur asked how so.
Mr. Meyer replied that there are other limiting factors that the state and other entities set.
Mr. Taylor asked Mr. Rygas if there is a defense that should be taken in a court setting that would allow a town to prohibit or limit what the commission would like to limit.
Mr. Rygas responded that the question becomes whether the law or ordinance is deemed invalid because you have discriminated in some way. What you want versus taking stuff out is to do
different things. In me saying what do you mean to put in there, it isn’t to shorten the sentence. It is intended to lengthen the paragraph to describe precisely what is permitted.
The current language is very broad. The general rule with zoning ordinances is that if it’s not in there, it is not approved. With the current language, broadening the definition is
less in line with limiting some concerning factors and more in line with not discriminating against anything. Still, you are opening up many interpretations about the type of use that
could fit a limited district. The Commission seems to be defining a medical office as a small medical clinic and is building a lengthy definition of the uses you expect, for instance,
ortho, pediatrics, etc. The primary concern seems to be a particular type of care. As Mr. Meyer mentioned, many practices prescribe and offer substance use care. Mr. Rygas said that
the commission's primary concern was those businesses that distributed counteractive medications to narcotics. There are probably other ways to address the issue, and it is likely easier
to manage if this comes through a special exception process, as there is a way to address concerns on a case-by-case basis by right would not allow this option.
Ms. Arthur asked whether composing a definition to have a definition wherever that definition as the town had done for a special exception and prohibited uses.
Ms. Bork replied that we can, but the town has not applied that broadly, and where it is applied, it usually appears as accessory uses. It can be done, but the town, up to this point,
hasn’t.
Mr. Arthur mentioned that she wondered if we shouldn’t have deliberately had a broad definition and then applied zone-specific conditions regarding the use.
Mr. Rygas stated that he has a way of opening up cans of worms, and he had done that tonight. He reminded the commission that the goal of the evening was to get a definition that has
a basis in some other regulation and use that here. The challenge I am considering beyond the scope of what we are doing is whether you mean to have a medical use anywhere by right
because previous decisions placed most medical uses within the town as a special exception. The current by-right medical office appears to be another relic from our zoning or a copy
from someone else’s ordinances, but it is in the
ordinance. Should you separately address the definition of a medical office that has started to clean up, and is their cleaner up to do later? Should it be by right? Should it not be
by right? This allows you some flexibility in how much you build into the definition vs. whether the definition is more general. It is easier to defend the generality if someone needs
to apply for a special exception than if you leave it open in a definition with a by-right, then you limit the ability to defend why we have a single place like the methadone clinic.
Ms. Arthur clarified, so we need to make the definition board by revisiting where the definition is used or moving it to a special exception; it allows us the oversight to ask questions
and make decisions. Make it easier for the town to defend.
Mr. Rygas replied that you only do the broader definition if you do the special exception. I am not saying that is the starting point; I am saying decide what you want to do about having
any permitted medical use, then determine whether you want a broader definition and how it flows.
Mr. Meyer stated that we can save ourselves by using special expectations and should allow this to apply. We only have so many ways to say, “We deny you,” right? We need to have specific
reasons that are available to use.
Mr. Rygas stated that you have those criteria you review in any special exception, allowing you to ask those questions. Is this a stand-alone situation or a holistic approach? It enables
the exploration of it. To Ms. Arthur’s point, the commission wants the ability to handle circumstances. However, the commission is trying to find a counter-balance for your experience
with something far from what most would appear to believe is a medical practice.
Mr. Meyer said he was convinced that the town needs exclusions somewhere because that is how we got the issue. It fits the definition technically, even though the town didn’t think it
did and could argue it did but probably wouldn’t have won if it had gone to court.
Mr. Schrantz asked if we could remove the term “medical office” altogether as a permitted use and not define it. Then, they would need to come to a special exception.
Mr. Rygas said you have this definition, and the only reason you have a definition is because the word already existed. It was easier to define something vs. modify where it is in a
zone. When you define, it may impact multiple things, but when altering a zone, you are obligated to the notice and everything. Focus on the definition as the council had requested,
but as a longer-term project, consider how these fit in with everything else. I more or less what I meant. 1) You need to address the definition as the council requested, and 2) Figure
out if that is how you want that to be implemented after it is fixed.
Ms. Arthur asked if the town accepted the definition; it has to hold it over until we have established where we want it in the zoning.
Ms. Bork said that If you put the medical office under a special exception, a commission opens itself up to any time anybody starts any medical clinic, whether it is a general practice,
dentist, or another medical office. They must come before the commission and council to get a special exception. It’s not just substance use clinics you limit if you do that.
Mr. Taylor asked if the risk is that they won’t want to pay the fees and medical practice services won’t be located in the town.
Ms. Bork responded yes.
Ms. Arthur asked how much the fee was for a special exception.
Ms. Bork replied that it’s $650.00.
Ms. Arthur said that starting up a practice she didn’t know if it was a burden in the medical industry.
Ms. Bork responded that it was a consideration.
Mr. Taylor states that the more significant issue is likely the time factor.
Mr. Meyer stated that an existing space is okay for twelve months once it closes, so they would have to return after that. It wouldn’t cost them extra if they were located in a recently
vacated space, but it is a burden.
Mr. Neice asked the methadone clinic where they fall within the zoning and whether they fall under the definition of a medical clinic.
Mr. Rygas said he wouldn’t even speculate about that because that existed before the town defined pain management clinics.
Mr. Niece replied that this is what he is saying. That’s what he was wondering.
Mr. Meyer stated that he was on the commission when that happened, and Mr. Rygas was a planning commissioner at the time as well.
Mr. Rygas stated that he didn’t remember and asked Mr. Meyer how long it had been since he had been on the planning commission.
Mr. Meyer thought maybe ten or twelve years ago.
Mr. Meyer thought the commission already had a definition of a medical clinic, but what the town didn’t have if you look at a document in the agenda pack from a similar issue in 2012.
Mr. Meyer stated that he believed there was no reference to mental health services as part of that discussion, which is why that language was added.
Mr. Rygas added that even before that, the issue revolved around “pain management clinics” because what was going on was that you had specific doctor’s offices that stopped doing regular
practice and were scripting pills.
Mr. Meyers interjected, which created the need for the treatment clinic, which is presently attempting to address.
Mr. Rygas continued that first iteration of trying to limit the definitions. Still, it wasn’t effective at restriction because it was here before anyone realized it was an issue, so
when the regulations were implemented, it was only for whoever was next.
Mr. Meyer requested that the commission agree on most of the things we want to allow or not allow and could determine where these entities should be located in town, either by permitted
or conditional use. I don’t know that I want to spend the time to hash out wording that will satisfy everybody. I am requesting that we table this discussion.
Ms. Bork mentioned that she provided the commission with preliminary language, which I utilized terminology from the NIH and the conversations that the commission had had, we haven’t
discussed the proposed definition as of yet this evening, and I don’t know that it is the direction you want to go, but I think it is close. If you all could react to it in terms of
direction, it might benefit Mr. Rygas and me trying to determine how to make this happen.
Mr. Taylor comments that points 2 and 3 follow along closely with what Ms. Arthur had mentioned earlier in the evening of where we would put it.
Ms. Arthur isn’t sure that RO is an ideal substance use treatment clinic location.
Mr. Niece states that he likes that if you are not providing “substance abuse…” but then put “substance abuse disorder services” in another definition. You can’t do this because it
meets the definition of this other use.
Ms. Bork replies exactly the town can still have medical offices by right your pediatrician can go into a RO zone, no questions asked, but if we get a “we want to do something substance
abuse related,” it triggers the other use and “yes or no” you are allowed to go there. Still, it’s a special exception if you can go there, and the commission can ask questions and
set conditions.
Mr. Meyer mentioned that we don’t cover either of these treatment centers in town. What does that mean?
Ms. Bork replied that they are already here.
Mr. Meyer said I know.
Mr. Taylor and Ms. Arthur mentioned that per this definition, another business could not distribute controlled substances under this definition.
Ms. Bork stated that the distribution of controlled substances seems to be one of the major hang-ups that the commissioner has regarding substance abuse treatment.
Ms. Arthur said they don’t want to become Philadelphia, the place with the walking zombies. The town has a reputation that has to be addressed, and if the town pretends it doesn’t exist.
The issues will only get worse. I would much rather have the label of a place trying to do something positive for residents than ignoring its residents. These businesses pose certain
risks that we may not want in certain neighborhoods for some reason. One and two take the weight off one and two, so three is the next turn. What are the concerns and parameters to
attach to this?
Ms. Bork, if you decide this is the route you want to take, you must amend the language of your medical office definition and move to hearing a new use definition. (Ms. Bork addresses
Mr. Rygas) Do we need to move to a public hearing for a one-word text change?
Mr. Rygas replied I don’t think you would put clinics like that because it doesn’t read
right. And you would need a public hearing to adopt the other two. If you leave the terminology the same. Mr. Reis stated he wanted something that attaches to something else. If you
don’t have to switch it, you go in and define the term. You might not need to modify anything about the medical office definition as is and as expected, so much as to clean up what
you mean by the service.
Ms. Arthur states that she thinks that by adopting a definition of “substance abuse disorder treatment.” We are clarifying a definition and fixing the issues. Except that if it somehow
does not address the methadone clinic. Reading that would address the methadone clinic, but this is my opinion.
Mr. Taylor mentioned that if we left the definition of “medical office” alone, the council wouldn’t need to revote on it.
Mr. Rygas continued if you are going to make a change to the “medical office”, do that with your phase two by doing a more holistic consideration of the definitions and how substance
abuse fits into the town’s ordinances. This solution is a band-aid because we recognize that we listed it as a use but failed to define it. The town is wide open. You have done a good
job of narrowing the meaning of “medical clinic”. However, some of the language in narrowing this definition was not as specific as was preferred by town council members.
Ms. Arthur clarified that defining what the town means by “substance abuse disorder services” would address these concerns.
Mr. Meyer mentioned that the word “services” vs. “clinics” messes with this solution, as things are typically defined. The commission is requested to define “the clinic is” rather than
what services are offered at an establishment. It makes it awkward that’s why Ms. Bork wanted to change the word.
Ms. Arthur commented that we are defining the services within the definition.
Mr. Meyer asked if you would have a “substance abuse disorder clinic,” why they need to be referred by a primary care physician, and why you couldn’t directly accept them as a patient.
Ms. Bork stated that I specified “primary care physician” because you limit traffic to and from the clinic. It’s limiting how a patient is seen, just like I get referred by my primary
to see a specialist.
Mr. Meyer added a lot of these people needing these services will not see a primary care physician. They will get referred by someone else.
Ms. Bork stated that she realizes that, but the tenor of the previous discussions that the commission had centered around mediating public welfare concerns. By writing the definition
this way, a more traditional medical model operation is implied without specifying “you must be a 9-5 operation,” which could be done.
Ms. Arthur said what if we eliminated referred by a primary care physician. “An outpatient establishment where patients may receive…” then it doesn’t matter how they got there. This
is a legalese question: “Is this a double negative?” If we say substance abuse disorder clinics, “these establishments shall not…” should we say these establishments may administer
controlled substances? Will we get ourselves into a situation where we do all these things but don’t do this? We are just defining it,
Mr. Meyer added that the definition left out drug dispensing, too.
Mr. Rygas said that he sees what she means by the double negative. If we are saying here’s what a substance abuse clinic is, you don’t want to say that they don’t administer controlled
substances when this is what it does, that you want to limit. Added an “also.” Outpatient care does administer controlled substances, so the dispensing needs to be specified more than
the administration.
Mr. Meyer posited the devil’s advocate. Well, do we come here and watch you take it, and then you can leave?
Ms. Arthur stated that not dispensing is administering. If a doctor writes a prescription, and the patient takes it to the pharmacy, it is from that point on dispensed to them. If it
is given to them by a provider during care, it is then administered to them.
Mr. Rygas stated that the best way to draft this language is to describe and include what you want rather than exclude what you don’t want.
After further discussion and edits, the commission arrived at the following definition.
Substance Abuse Disorder Services: An outpatient establishment where patients may receive diagnosis, assessments, treatments, and follow-up care for suspected cases of substance use
disorders, which establishments dispense or administer controlled substances on the clinic premises.
Mr. Meyer, with the commission's agreement, requested that Ms. Bork have Mr. Reis (a member of the Town Council) review the definition to ensure that the commission had addressed the
concerns of the Council before moving to a public hearing.
Mr. Taylor motioned to take the following definition of substance abuse disorder services to a public hearing, contingent on Mr. Reis’ feedback.
Substance Abuse Disorder Services: An outpatient establishment where patients may receive diagnosis, assessments, treatments, and follow-up care for suspected cases of substance use
disorders. These establishments dispense or administer controlled substances on the clinic premises.
Mr. Taylor withdraws his motion. Further discussion of wording occurred, and Mr. Taylor made a new motion to move the following definition of substance abuse disorders to a public hearing,
Substance Abuse Disorder Services: An outpatient establishment where patients may receive diagnosis, assessments, treatments, and follow-up care for suspected cases of substance use
disorders, which dispense and/or administer controlled substances on the clinic premises.
Mr. Schrantz rapidly seconded the motion. The motion passed unanimously.
Mr. Meyer called for a 5 min. Recess.
6. New Business-- New Definition for “Gas Station”
Ms. Bork provided the commission with a staff report upon request from Mr. Meyer. Staff had discovered no definition for using a “gas station” within the zoning ordinances.
Staff had briefly discussed this need with the Commission at a previous meeting. The commission was interested in options regarding alternative fuel sources and how they might be defined
within the zoning ordinances. Ms. Bork explained that she had asked a fellow member of staff with a background in transportation engineering and research. This staff member told her
that gas stations and alternative fuels should have their definitions. Ms. Bork recognizes the commission's wish to address alternative energy
uses and industry within the town and suggests adding alternative fuel to the energy package.
Ms. Bork proposed the adoption of the following definition.
Gas Station—A building, lot, structure, or facility with pumps and storage tanks where fuel, gasoline, oil, or other similar products are dispensed, sold, or, offered for sale at retail.
Care washes, automobile service stations, and convenience stores may be accessory uses. Such a building, lot, structure, or facility shall not operate as an automobile graveyard.
Ms. Arthur made the motion to adopt the motion as written. Mr. Taylor seconded the motion. The motion passed unanimously.
7. Other Business --NA
8. Staff Report
Ms. Bork informed Commission of long-range plans and work that is underway long-range. She reviewed mixed-use standards and explained some of the decisions that the planning commission
must make to establish robust mixed-use zoning. She also recommended that the commission reconsider its site plan standards in light of more mixed-use development being integrated into
the town.
Ms. Bork also updated the commission on the revisions underway with the Comprehensive Plan to address VDOT’s comments and that she would keep the commission updated as that process proceeded.
Mr. Meyer reminded Ms. Bork of the McGill Park parcel that he believed had been changed without the commission's knowledge and should be conservation instead of residential land use.
Ms. Bork stated that she would ask Ms. Fancon about the change.
9. Adjournment
With no further business to discuss, Mr. Taylor motioned to adjourn, and Mr. Meyer seconded the motion. With no objections, the meeting adjourned at 8:25 p.m.
Kevin Meyer, Chair
ATTEST:
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Summer Bork, Town Planner