Health

John Cincar uses the eye-tracking iPad device in Stony Brook. Photo from Long Island State Veterans Home

Two eyes and an iPad is all Vietnam veteran John Cincar needs to completely transform his day-to-day life.

Cincar, a resident at Stony Brook’s Long Island State Veterans Home, lost his ability to move his arms and hands, but only needs his eyes to operate a $12,000 iPad the home helped him secure this week as part of its mission to enhance residents’ independence. With help from the device and the home, Cincar said he could open the door to a world he had not been able to access on his own for years. By looking at control keys or cells displayed on the iPad screen, Cincar said he can generate speech, activate functions such as turning on a light or television, and even surf the internet.

“It’s very easy for me to use,” he said. “It does everything. I can get in touch with the world again.”

The eye-tracking device, which the veterans home referred to as an “eye gazer,” was a by-product of a donation from Bowlers to Veterans Link Chairman John LaSpina, a Long Island native and owner of various bowling alleys across the Island. The BVL is a not-for-profit organization that works to support American veterans, raises about $1 million per year through bowlers and bowling centers nationwide, and has a working relationship with the Long Island State Veterans Home, LaSpina said.

John Cincar, center, accepts the eye-tracking iPad device in Stony Brook thanks to a donation from The Bowlers to Veterans Link. Photo from Long Island State Veterans Home
John Cincar, center, accepts the eye-tracking iPad device in Stony Brook thanks to a donation from The Bowlers to Veterans Link. Photo from Long Island State Veterans Home

“An opportunity like this just seemed so incredibly great that we couldn’t say no to it,” he said. “We’re talking about a facility totally dedicated to veterans. The place is immaculately clean. They do wonderful things.”

The BVL donation to the Long Island State Veterans Home was made possible from the proceeds of the “PBA50 Johnny Petraglia BVL Open,” which was held at the Farmingdale Lanes from Saturday, May 7 through Tuesday, May 10.

With the Vietnam era now more than four decades old, the Long Island State Veterans Home has been seeing more veterans who served in that war coming through its doors. And with each war comes a different kind of ailment that staff must combat.

“Many of these guys, their brains are fully intact, but their bodies are shot. They’re trapped,” said Jonathan Spier, deputy executive director for the Long Island State Veterans Home.

Just five years ago, Spier said, the home had only two Vietnam veterans living there. That number skyrocketed to more than 50 by 2016, he said, with former combat men suffering from specific injuries like exposure to Agent Orange and other muscle-related difficulties.

Fred Sganga, executive director of the veterans home, said the addition of the eye-tracking device only furthered his group’s mission to enhance the quality of life of more than 6,000 Long Island veterans.

“The goal is to maximize every veteran’s independence,” he said. “We want to be strategically ready for the next generation of veterans coming here, and this technology is transformational for someone who is a paraplegic.”

When asked how he planned on harnessing the power of the iPad to his benefit, Cincar said he hopes to study new languages, like Romanian — the language of the land he was born in.

Artist Jo-Ann Corretti and Huntington Hospital Board of Directors Chairman William Frazier unveil the painting. Photo by Alex Petroski

People don’t often get to celebrate a 100th birthday, but on May 5 the Huntington Hospital community came together to do just that.

The hospital cared for its first patient in May 1916. To commemorate the centenary, staffers unveiled a commissioned painting of the original, smaller facility and a display of photos and artifacts that spanned the 100-year history.

Hospital equipment from the 1930s. Photo by Alex Petroski
Hospital equipment from the 1930s. Photo by Alex Petroski

“This is a big day,” Huntington Hospital Board of Directors Chairman William Frazier said in the hospital’s main lobby prior to the unveiling. “You think back 100 years and how modest this institution was — now think where it is today.”

Artist Jo-Ann Corretti was commissioned by the hospital to create a likeness of the building. She used acrylic paint to do the job, which took her about three months.

“They gave me all of these old pictures, anything they could find for me to work from,” Corretti said after the painting was revealed. “I had to lay them all out and I had to take a little from here and a little from there.”

Hospital Executive Director Gerard Brogan spoke about the institution’s mission and how it has remained constant despite many changes to the building and surrounding area.

“I think it’s important just to think about what was the genesis of the hospital,” Brogan said. “It was a 70-year-old woman who was about 5-foot-1 [and] decided that this community needed to have the very best in medical care; care that rivaled any where else in the New York City area or anywhere else on Long Island. That was the spirit that started Huntington Hospital. It was not just to have a hospital, but to have a facility that served the community and provided them the best care that you could find anywhere.”

Hospital equipment from the 1930s. Photo by Alex Petroski
Hospital equipment from the 1930s. Photo by Alex Petroski

Brogan also detailed many of the awards and accolades the hospital has received in recent years, which he credited to the dedicated and caring staff.

“You do not need to leave your area to go into New York City to get outstanding, cutting-edge care,” Brogan said. “That is the commitment of this institution and all of the people that work in it. Everybody here is titled ‘caregiver,’ because everybody impacts the patient experience.”

The Huntington Historical Society helped to amass artifacts, like obstetrician/gynecologist equipment from the 1930s and a bill from 1960 with substantially lower prices than today, to be displayed around the hospital’s lobby.

The painting will be auctioned off in November at the hospital’s annual benefit gala. Prints are also for sale.

Congressman Lee Zeldin, joined by Suffolk County Police Commissioner Tim Sini, health professionals, community groups, parents, expresses his support for the package of bills coming to the House floor this week. File photo from Jennifer DiSiena

By Phil Corso

Congress is taking unprecedented steps to fight heroin and opioid abuse, and U.S. Rep. Lee Zeldin (R-Shirley) brought the battle to Kings Park to spread the word.

In the company of other lawmakers and activists, Zeldin spoke at VFW Post 5796 last Thursday to discuss a package of bipartisan legislation the congressman has been pushing that addresses different angles of the disturbing upward trend in heroin and prescription opioid abuse on Long Island and across the country. The momentum from his stumping also helped propel several pieces of such legislation to a vote on the House floor by the following week.

The proposed legislation would review and update guidelines for prescribing opioids and pain medication, and require a report to Congress on the availability of substance abuse treatment in the country, among other provisions.

In his remarks last week, the congressman cited an alarming statistic from the Centers for Disease Control: more than 28,000 overdose deaths were recorded in 2014 as a result of heroin or opioid abuse — the highest number on record. Zeldin, who joined the Bipartisan Task Force to Combat the Heroin Epidemic in November, said Suffolk County recorded one of the highest rates of overdose deaths across the state, and needed a multi-pronged approach to address it.

“Next week, the House of Representatives is dedicating a full week to passing legislation aimed at addressing this epidemic, with a package of several bills to combat the growing heroin and opioid crisis,” Zeldin said. “Addiction and overdose deaths on Long Island and across our country are skyrocketing as a direct result of the increase in heroin and opioid abuse.”

In a phone interview, Zeldin said this was the first time the House had taken such unified measures to combat the problem, as its consequences were becoming impossible to ignore. The congressman used strong language when outlining the heroin addiction problem to drive it home.

“The rates that overdoses are increasing, and the fact that it’s not isolated to any one kind of community, has led many to describe this as an epidemic,” he said.

Joining Zeldin was Suffolk County Police Commissioner Tim Sini, who has been working on the front lines of the addiction problem, as Suffolk County suffered 103 fatal heroin overdoses in 2015 alone — more than double its neighboring Nassau County, which recorded 50. Sini also used the term “epidemic” to describe the fight he and his fellow officers have been facing.

“The heroin epidemic that our nation is facing is the number one public health and public safety issue here in Suffolk County,” Sini said. “Partnerships between local law enforcement and our federal representatives is a crucial tool in the battle against this scourge.”

And North Shore natives who felt the hurt of that “epidemic” stood beside Zeldin and Sini to throw their support behind legislative resolutions. Kim Revere, president of the Kings Park in the kNOw Community Coalition, and Linda Ventura, founder of the Thomas’ Hope Foundation, both said there were several different approaches lawmakers must take to address addiction, from prevention to rehabilitation.

“I believe wholeheartedly that prevention should begin at home,” said Revere, referring to the legislation as a wakeup call. “I am seeing many adults abusing alcohol and [prescription] drugs and that does not bode well for our children. I would like to see permanent evidence-based prevention programs implemented in school grades kindergarten through 12.”

Ventura, whose son Thomas died at age 21 from a drug overdose four years ago, said measures like Narcan, a medication which is administered to help reverse the effects of a heroin overdose, were important but not the only tool emergency responders should lean on.

“The United States needs to commit every resource imaginable to fight this insidious disease. The lifesaving tool Narcan needs to be accessible to all concerned to help save a life in the interim of an overdose to find treatment,” she said. “Treatment needs to be the appropriate level of care at the earliest intervention possible. Prevention — we must start educating and empowering our youngest of children with coping skills, relaxation techniques and communication skills.”

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By L. Reuven Pasternak, M.D.

For many patients who come to the hospital, their medical team — physicians, nurses and other health care professionals — serves as a lifeline. Skilled and compassionate, these dedicated caregivers help to ensure patients receive the care they need both physically and emotionally.

So it is with great pleasure that we celebrate and salute our nurses, physicians and all our health care professionals during National Nurses Week (May 6 to 12) and National Hospital Week (May 8 to 14). While we are grateful all year long for the jobs they do, these special weeks remind us to let these dedicated individuals know how much they are respected and appreciated.

Because Stony Brook Medicine is an academic medical center and the region’s only tertiary care center, unique medical issues confront our caregivers on a regular basis. Each day a new patient or situation challenges us to take the best ideas in medicine and turn them into practical solutions for our patients. With our nurses frequently on the front line of care, it is often up to them to lead those efforts.

But a hospital runs on more than care. From those who work to keep our hospital clean, to those who prepare nourishing food, from the experts who maintain our technology, to the landscapers who maintain our grounds, from first-year nurses to the most seasoned medical specialists, every single person at Stony Brook makes a meaningful contribution.

We are proud of all of the individuals who contribute to Stony Brook — proud of the expertise they offer and the compassionate care they deliver. They are the people behind our mission to always strive for excellence as a world-class institution, recognized for outstanding patient care, research and health care education.

Please join me in extending thanks to all of those who contribute to the exceptional care to our community and beyond.

L. Reuven Pasternak, M.D., is  CEO, Stony Brook University Hospital and Vice President for Health Systems, Stony Brook Medicine

Coldwell Banker offices across Long Island, like the office in Setauket, are helping veterans residing at the United Veterans Beacon House. Photo by Giselle Barkley

The Coldwell Banker Residential Brokerage typically help residents find a place to call home. But now, the company is on a mission to help veterans in need, with its Hometown Heroes Linen Drive.

Associate Broker Lorraine Marotta of the Coldwell Banker Residential Brokerage in Setauket said the company started the drive earlier this year in January. Coldwell Banker offices across Long Island are participating in this initiative. Their goal is to collect 3,700 sets of linens including twin sheet sets and standard pillowcases, new pillows, new bath towels and new comforters. They hope to collect 700 of each by July 4 of this year.

The linens will go toward the veterans living in homes provided by the United Veterans Beacon House in Bay Shore. Many of these veterans can’t live on their own, Marotta said. Hall-Lane Moving and Storage, which provided each office with large collection boxes, is responsible for picking up and delivering the supplies to Beacon House the associate broker added.

The Beacon House mission is to provide temporary and permanent housing for homeless veterans as well as “emergency, transitional and permanent residence for families” and single individuals. The organization strives for privacy when it comes to its veterans. Some of these veterans are housed discreetly throughout Long Island communities.

Of the organization’s more than 20 housing locations, around nine  homes are designated for veterans. One of these homes is dedicated to female veterans while another is for the frail and elderly, according to the organization’s site.

This isn’t the first time Coldwell Banker has worked with Beacon House and assisted veterans utilizing Beacon House services. In the past they’ve scheduled appointments to visit and provide new flags and a Thanksgiving meal among other items, to these veterans.

On April 14 the organization met with the Coldwell Banker Residential Brokerage of Long Island and Queens in Huntington to collect the first donations for the drive.

For Marotta caring for veterans hits close to home as her husband is a veteran as well. But her passion for the drive also stems from the fact that it’s a great cause.

“It’s nice to be able to recognize veterans,” Marotta said. “I feel like they’ve just been forgotten. Not only are they lonely they’re so appreciative.”

The community can drop off new linens at their local Coldwell Banker. For more information about the Hometown Heroes Linen Drive call 516-864-8104.

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Consult with your veterinarian at your dog’s annual exam as to which tick preventative is best for them. Stock photo

By Matthew Kearns, DVM

The weather warms and the ticks are hungry. There are many new options available for tick control: topical preventative, newer and more effective collars, and, most recently, oral tick preventatives. Also, many of the older products that used to only be available by prescription are now over the counter.

Which is most effective for our pets?   Although there are tick-borne diseases (infections and diseases specifically passed through the bite of a tick) in cats, we do not see them in this part of the country. This article will focus on tick-borne diseases in dogs.

Ticks feed during each stage of their life cycles, and it is during feeding that the tick will ingest a variety of bacteria that cause tick-borne diseases. The bacteria is then able to stay in the tick’s gut, the mouthparts or both until it feeds again. Each time a tick feeds, the tick attaches its mouthparts to the host and injects saliva directly into the skin. In the saliva is a sort of topical anesthetic to alter the host’s immune and inflammatory response during feeding.

During feeding, the tick not only ingests blood (its main source of nutrition) but also takes large amounts of fluid. In order not to explode while feeding, the tick is forced to intermittently regurgitate fluid. It is during the injection of saliva and intermittent regurgitation that the tick will transmit bacteria that cause disease. 

The big question is how long does a tick need to feed to transmit disease? This very much depends on the tick itself.

Ixodes scapularis, the deer tick, which can carry Borrelia burgdorferi (the bacteria that causes Lyme disease) and Anaplasmosis spp (the bacteria that causes anaplasmosis), will definitely transmit within 72 hours but could be as short as 24 hours.

Dermacentor variabilis, the American dog tick, and Amblyomma americanum, the Lone Star tick, which can carry Rickettsia rickettsii (the bacteria that causes Rocky Mountain spotted fever), will definitely transmit within 48 hours but could be less than 24 hours.

Rhipicephalus sanguineus, the brown dog tick, which can carry Ehrlichia spp (the bacteria that causes Ehrlichiosis), and Babesia spp (the bacteria that causes babesiosis) can be transmitted within 24 hours or less.

First and foremost for almost all of the pet owners that walk through my doors their main concern is not only how effective each product is but also how safe is it to themselves, their family members and other pets in the household. Questions I recommend when choosing a preventative to your dog are:

• Is the tick preventative a repellent or does the tick have to attach and feed to be killed?  If so, how long does the tick have to feed before it dies?

• How long does the product work before I need to administer again?

• Do I need to isolate my dog from other pets and members of my family?  If so, how long?

• Is this product safe if I have cats in my household?

• Is this product safe if my dog has special health needs such as seizures?

It is nice to have more options, but this also can raise more questions. Consult with your veterinarian at your dog’s annual exam as to which tick preventative is best for them.

Dr. Kearns practices veterinary medicine from his Port Jefferson office.

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St. Catherine of Siena Medical Center nurses picket Thursday on behalf of patient care through safe staffing as they negotiate a new contract with the hospital. Photo by Alex Petroski

Smithtown residents driving on Route 25A Thursday afternoon likely couldn’t miss the lively, noisy demonstration by countless picketers all dressed in red.

More than 100 nurses from St. Catherine of Siena Medical Center in Smithtown gathered on the grounds just outside of the Route 25A entrance to the hospital on Thursday for an informational picket and as a sign of solidarity in their ongoing contractual negotiations. Their previous contract expired in March 2015. Nurses at St. Catherine’s are members of the New York State Nurses Association.

“St. Catherine nurses have worked without a contract for a year, during which time the problem of understaffing has become a crisis,” an April 20 press release announcing the demonstration said. “The nurses are calling for a fair contract, including enforceable staffing ratios and quality protections for patients.”

Lorraine Incarnato, a nurse in St. Catherine’s intensive care unit for nearly 30 years, said the two parties have been meeting only once a month since November. Several nurses at the demonstration said they don’t think St. Catherine’s administration is negotiating in good faith, though Heather Reynolds from the hospital’s public and external affairs department refuted that assessment in an email Friday.

“St. Catherine of Siena Medical Center is in negotiations with the New York State Nurses Association (NYSNA),” Reynolds said. “The hospital continues to negotiate in good faith and has made progress in the negotiations. St. Catherine will negotiate directly with NYSNA.”

Incarnato shed some light on the goal of Thursday’s demonstration.

“The mission today is, we’re trying to show the hospital that they need to settle with the nurses,” Incarnato said. “The contract has been negotiated for a year, but since November, they’ve only been meeting once a month. We need staffing ratios that are better adhered to because too many times, we’re very short-staffed, and the mantra in the building right now is ‘do more with less.’”

Incarnato said the ICU needs six nurses to be run effectively, though these days they often have to make do with five, or even four, during a given shift.

“It’s causing a lot of friction between administration and staff,” Incarnato said. “When you have staff working always short [staffed], always extra, and then knowing that there’s not the respect factor there, they’re unhappy. Unhappy staff doesn’t keep patients happy. We try to put on a really happy face, because the patients come first.”

Dawn Bailey, a registered nurse and labor bargaining unit executive committee member of the New York State Nurses Association, said working a shift without adequate staff can be dangerous not only for patients, but for nurses as well.

“You can’t have two people lifting a patient all the time because there’s not that other person available,” Bailey said. “When people are going out with back injuries, then [members of hospital administration] wonder why.”

Other than staffing concerns, the nurses are also unhappy about changes and cutbacks to health care and other benefits.

A similar demonstration occurred on April 8 near St. Charles Hospital in Port Jefferson, where nurses also represented by the New York State Nurses Association tried to voice the same message.

Thanks to the efforts of Angela’s House Founder and Executive Director Bob Policastro, the Angel of Hope statue has been in Eisenhower Park since 2008. The Angel of Hope: A Walk to Remember event on May 7 will conclude at the statue. Photo from Angela’s House

By Alex Petroski

The pain of losing a child may never go away, but it can be soothed by the support of others who know what it is like. Parents will have that opportunity on May 7 when the Hauppauge-based nonprofit organization Angela’s House, which was founded in 1992, hosts the first Angel of Hope: A Walk to Remember.

Thanks to the efforts of Angela’s House Founder and Executive Director Bob Policastro, the Angel of Hope statue has been in Eisenhower Park since 2008. The Angel of Hope: A Walk to Remember event on May 7 will conclude at the statue. Photo from Angela’s House
Thanks to the efforts of Angela’s House Founder and Executive Director Bob Policastro, the Angel of Hope statue has been in Eisenhower Park since 2008. The Angel of Hope: A Walk to Remember event on May 7 will conclude at the statue. Photo from Angela’s House

The walk will take place Mother’s Day weekend at Eisenhower Park in East Meadow, where the nonprofit’s Angel of Hope statue has stood since 2008 as a comforting symbol to parents who have lost children.

Angela’s House assists families caring for children with special health care needs that are medically fragile, chronically ill or living with a life-threatening illness, according to their website. Founder and Executive Director Bob Policastro said the event would be a nonreligious, yet spiritual gathering.

“I would say different from our support group or even a counselor, the difficulty of those environments [is] you have to be ready and have to talk about your pain and that kind of brings about peace as you talk it through,” Policastro said in a phone interview Friday about the walk and what those interested in attending should expect. “This one I feel has kind of an easier tone to it in the sense that you’re coming to a ceremony and the comfort of seeing others that have also gone through all of this will give people great peace knowing that they’re not alone. They can talk to people if they want to but if they don’t want to that’s fine.”

The purpose of the event is not to raise funds, according to Policastro, though there is a $25 charge per person to participate.

Policastro said the date was a strategic choice by Angela’s House trustees and volunteers.

“Mother’s Day is always one of those potentially difficult times of the year,” he said. “That will be a good way to kind of help try to bring them peace, almost like a support group. To get together and be around others that have also experienced loss, it’s very comforting.”

Policastro and his wife Angie started the foundation after the death of their daughter Angela. The Angel of Hope is a reference to the book “The Christmas Box” by Richard Paul Evans in which a character frequently visits the grave of her daughter, which is marked with an angel statue. Statues like the one in Eisenhower Park popped up across the country after the release of the book in 1993, Policastro said. He was instrumental in bringing the statue to Eisenhower Park.

The walk is less than a mile long and will follow a path around Salisbury Lake in the park, concluding at the statue. The New Apostolic Church and the Willow Interfaith Woman’s Choir will lead those in attendance in a song, and a nondenominational spiritual ceremony will also be held.

Those seeking more information are instructed to visit www.angelashouse.org/angel-of-hope/.

St. Johnland Nursing Center in Kings Park is celebrating a milestone this year. File photo by Rachel Shapiro

For a century and a half, the name St. Johnland has been synonymous with helping people from all walks of life. Established in 1866, the Society of St. Johnland is celebrating its 150th anniversary in 2016.

In 1866, the Society served as a home for veterans and orphans from New York City, but eventually developed into a self-sustaining industrial village.

Today, the St. Johnland Nursing Center is located on the North Shore near Smithtown Bay in Kings Park and serves as a long-term skilled nursing facility caring for about 300 people every day.

Over the course of 150 years, the role of the facility has changed, but their mission remains the same, according to a press release about the anniversary: “To create a caring and supportive environment committed to the highest standards of quality health care … to uphold the principles of human dignity and worth … affirm the right of every individual to maintain the optimum quality of life.”

St. Johnland Director of Development Cathie Wardell, who has been at the nursing center for 13 years, reflected on the impact St. Johnland has had on the community and people in need.

“The level of care for the people whose care is entrusted to us is very high and it’s amazing to see everyday,” Wardell said in a phone interview.

The nursing center shifted its focus from children to the elderly in the 1950s. Today, their primary focuses are providing care for people with Alzheimer’s, dementia and traumatic brain injuries.

“The fact that this institution has survived and persisted for 150 years focusing on different demographics, the fact that we are 98 to 99-percent full all the time, that we have evolved over the years to make the changing needs of the community with our specialty units and adult day care programs is significant and noteworthy,” Wardell added.

In honor of the anniversary, the society will hold four events during 2016. For all of June, historical photographs of St. Johnland will be on display at the Kings Park Library.

On June 18, people who grew up at the facility around 70 years ago will gather for a reunion.

On Oct. 27, a dinner will be held at Watermill in Kings Park to honor the Fire Department and EMT Squad, and on Nov. 18, town historian Brad Harris will deliver a lecture on the history of the Society.

For more information about the anniversary or any of the events, call 631-663-2457 or visit www.stjohnland.org.

Suffolk County Legislator Kara Hahn is among the lawmakers hoping to use the #MeToo moment not only to change culture, but to change laws. File photo

One North Shore lawmaker is cleaning up the language of Suffolk County’s dry cleaners.

Dry cleaning businesses will no longer be allowed to advertise their services as organic when describing the solvents or methods used in production, thanks to recently approved legislation from Suffolk County Legislator Kara Hahn (D-Setauket). And if they get caught, business owners could face fines of $500 on the first offense to $1,000 on the second, the legislator said.

“A consumer chooses an ‘organic’ cleaning method with the belief that this option is better for his or her health and our environment,” Hahn said in a statement. “Without a universally accepted definition of what constitutes organic services, consumers go through the wringer when making their decisions based upon subjective standards that, in some cases, can be completely contrary to their intentions.”

Under Majority Leader Hahn’s bill, no professional garment cleaning establishment operating in the county will be allowed to describe its services as “organic” in advertising or signage. In a statement, Hahn said the term organic is found in many industries, including dry cleaning, and has come under increased public scrutiny as regulators have not established clear criteria governing the word’s usage in consumer goods and services.

“It is very important that customers understand terms used in dry cleaning advertisements,” said Beth Fiteni, owner of Green Inside and Out Consulting, an advocacy organization committed to empowering the public to find healthier alternatives to common toxins, also in a recent statement. “Organic in this context is a technical term, and does not mean chemical-free. This legislation in Suffolk County helps address possible confusion.”

In her legislation, Hahn said one of the most harmful chemicals used in the dry cleaning industry, perchloroethylene — also known as perc — contains carbon molecules. Carbon is a naturally occurring element and perc is sometimes advertised as being organic, despite its detriment to the environment.

“In some instances there is a significant disconnect between the term organic that has become part of the vernacular and the scientific definition used by industry,” Hahn said. “I want to ensure that Suffolk consumers are making decisions based on intention rather than semantics.”

The state Department of Environmental Conservation has already approved several alternatives to perc for use in non-vented, closed-loop dry cleaning machines that are equipped with a refrigerated condenser, conform to local fire codes and meet the additional specifications required by the alternative solvent manufacturer.

Suffolk’s bill would be nullified should a standard be adopted by state or federal regulatory agencies.

The only thing preventing the bill from becoming official is the absence of a signature from County Executive Steve Bellone (D). Once signed, cleaners would have approximately 60 days to come into compliance.