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HomeMy WebLinkAbout122007JEFFERSON COUNTY BOARD OF HEALTH MINUTE S Thursday, December 20, 2007 Board Members: Phil Johnson- County Commissioner District # 1 David Sullivan — County Commissioner District #2 John Austin, Vice Chairman — County Commissioner District #3 Jill Buhler — Hospital Commissioner District #2 Geof`Masci — Port Townsend City Council Sheila Westerman — Citi .Zen at Large (City) Roberta Frissell, Chair— Citizen at Large (County) Sta Members: Thomas Locke, MD, Health Ofcer Jean Baldwin, Public Health Services Director Julia Danskin, Nursing Programs Director Meeting was called to order at 2:30 pm on December 20, 2007 by Chair Frissell in the conference room of Jefferson County Public Health. Members present: Chair Frissell, Member Austin, Member Johnson, Member Westerman and Member Buhler. Members absent: Member Sullivan and Member Masci. Staff present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin, Neil Harrington and Cathy Avery. A quorum was present. APPROVAL OF AGENDA Board Member Buhler moved to approve the agenda as written. Member Johnson seconded the motion, which carried by a unanimous vote. Member Austin suggested adding staff to the attendance list. APPROVAL OF MINUTES Board Member Buhler motioned to approve the minutes of October 18, 2007 as written. Board Member Austin seconded the motion, which carried by a unanimous vote. PUBLIC COMMENTS Community member, Steve Evans, addressed the Board regarding the petition of the Port Townsend Paper Corporation, which referenced the economic contributions the mill makes to the community. He and several acquaintances in the community feel that their health has been negatively affected by the mill's airborne discharges. He noted that there are laws that relate to pollution in this county and these laws are there for a reason. He also stated that those who are having their health affected by the mills plume are not Jefferson County Board of Health, December 20, 2007 Page 1 of 8 automatically trying to deprive people of their jobs. He hopes that jobs and a healthy environment can co- exist. Jerome Schnell, community member, said that before he moved to PT he was aware of the existence of the paper mill but was assured by a real estate agent that he would not have to worry about emissions due to the location of his home. But it has affected his wife's health. About three years ago when the emissions were bad, he contacted the paper mill via their website for comments and discovered that his emails were not being read. He and neighbors formed a concerned citizens group and contacted the County Commissioners to express their concern. He remains concerned and says that technology is available to reduce emissions to a safer level. OLD BUSINESS Rezion 2 Public Health Newsletter Dr. Locke referenced the quarterly regional newsletter and stated that its primary audience is healthcare providers. The cover photo is of a mass vaccination exercise that occurred in Sequim. Last weekend there was a mass vaccination exercise in Jefferson County using the nasal influenza spray for kids. Also included in the publication are the regional communicable disease statistics. Tire Pile Cleanup Jean Baldwin reported that the Department of Ecology spent $64,206 on tire clean up in Jefferson County. 242 tons of tires were removed from three sites. There are several more sites pending cleanup plans. Jean reported that the solid waste team is currently working 70 active cases. Port Ludlow Yacht Club Women's Group Gift Julia Danskin reported that Jefferson County Public Health received an additional contribution from the Port Ludlow Yacht Club Women's Group in the amount of $644.90, which comes from the ongoing sale of their cookbook, "A Culinary Cruise with the Port Ludlow Yacht Club ". These funds will be used for the Breast and Cervical Health Program providing exams and mammograms to women in the county. Port Townsend Paper Corporation Employee Petition Response Jean Baldwin referenced the letter in the packet concerning the response to the petition from the Port Townsend Paper Corporation employee's petition. Jean said there is a discussion going on right now with the Department of Ecology (DOE), Department of Health (DOH) and the Port Townsend Paper Mill regarding the Mill's permit. Two sets of petitions have been forwarded to DOE and DOH. On December 11, 2007, DOH met with Port Townsend Paper Mill officials. DOH sent Jefferson County Public Health a draft health assessment for review and comment. Dr. Locke noted that extensive comments were made on the DOH's draft. Our regional Epidemiologist, Siri Kirschner, went over the numbers and made recommendations regarding statistical analysis. The timeframe for the completion of the report is undetermined or how they plan to release the document to the public but JCPH will be involved in the process. Jefferson County Board of Health, December 20, 2007 Page 2 of 8 Dr. Locke pointed out that the local BOH is the appropriate arena for discussion of community health concerns, but the BOH has no authority to regulate industrial air pollution. It is exclusively a state and federal authority. He reviewed the regulatory process. Clean Air standards are set by the Federal Government and enforced by the EPA (and, within Washington State, by DOE). DOH works under a contract with the federal government with the Agency for Toxic Substances and Disease Registry to perform community health assessment relating to air pollution and other potential toxic exposures. Currently, there is insufficient data to make any kind of determinations of community health impact from Mill emissions. Performing health impact studies of air pollution is a very expensive and time consuming process. Dr. Locke recommended that the current community focus should be on appropriate monitoring to determine the specific chemicals that are being emitted by the PT Mill and whether these emissions exceed legally permitted levels. If the mill is exceeding legal standards there is a clear cut remedy that can be rapidly implemented. Substance Abuse Advisory Board Minutes Jean Baldwin reported that the Substance Abuse Advisory Board minutes will now be included in the BOH packet and will be posted on Jefferson County Public Health's web page. Methicillin Resistant Staph Aureus (MRSA) Press Release Dr. Locke stated that he and Dr. Scott Lindquist met with the school superintendents regarding concerns about potential MRSA transmission in the schools. JCPH and Kitsap Health District will continue to work with the schools around facility cleaning and maintenance, standardization of policies and prevention of communicable disease transmission. Dr. Locke said he and Dr. Lindquist made specific recommendations to the schools. MRSA transmission in schools is rare, however, and this and other antibiotic resistant infections are a problem throughout the community. The most deadly form of MRSA is the type associated with health care facilities healthcare associated MRSA. Another type, known as Community- associated MRSA, has been a growing problem in non - health care facilities but is easier to treat than its hospital associated counterpart. This issue was widely publicized in Washington state. The governor has asked the Secretary of Health to intiate a voluntary system for hospital reporting of MRSA cases and a science panel is working on specific MRSA - related recommendations. Dr. Locke went on to say that colonization by MRSA is relatively common. 25 -30% of people carry Staph Aureus bacteria on their skin at any given time. About I% of the population appears to be colonized with MRSA. Most of these people never have any symptoms or problems caused by these colonizing bacteria. When problems do occur they are usually mild skin and soft tissue infections that are readily treatable. Jefferson County Board of Health, December 20, 2007 Page 3 of 8 Budget: Chair Frissell asked Jean about JCPH budget. Jean said the budget was released and adopted. In the final budget there is a $100,000 reduction in County funding for JCPH. There will be an update in January. NEW BUSINESS Olympic Area Agency on Aging: Victoria House and Long -Term Care Roy Walker, Director of Olympic Area Agency on Aging (03A) spoke to the Board regarding long term care access in Jefferson County. 03A is a four county council of governments. There are over 650 Area Agencies on Aging across the country, 13 of which are in Washington State. He spoke briefly about the planning and service coordination, federal and state funds available to conduct planning activity needs of older people in Washington and younger adults with disabilities. 03A is also involved in `in- home care' under the Medicaid system. 03A sponsors the long -term care Ombudsman program, which consists of a core of volunteers who go to residential facilities on a regular basis and respond to residents concerns about those facilities. 70 -80% of long- term care (LTC) in this country is provided by family members or friends. In Washington work has been done to provide a variety of service options outside of nursing homes. High quality nursing homes are needed in our community but not as replacement for paid LTC. Adult family homes and boarding homes are a growing option. Victoria Home and Seaport Landing are assisted living facilities. They are licensed as boarding homes with DOH and receive an assisted living contract through DSHS in order to receive payment under the Medicaid program. Assisted living is not a licensure issue, it is a contract issue. And the only entities that can receive those contracts are entities that are licensed as boarding homes. Jefferson County has one nursing home, two assisted living facilities (one of which, Victoria House, is ending their Medicaid contract), and two adult family homes, neither of which accept Medicaid as a payment source. 03A provides support for over 170 in -home care Medicaid clients. Jefferson County has one of the highest percentages of people 65 or older in the nation. Jefferson County will continue to need a strong focus on a variety of LTC options in order to continue to be responsive in needs of older people. Because of the need vs. the availability of LTC access in Jefferson County it is not uncommon for residents needing LTC services to have to leave the area to receive residential care. By doing so, the client will likely loose the daily contact they once had with friends and family at home, which is a significant issues and impacts their quality of life. The current supply of LTC options does not meet the existing need. Victoria House is not an isolated incident. There has been discussion whether or not Medicaid rates were adequate to keep assisted living facilities viable. There has been a lot of advocacy around that issue. The Governor's proposed budget that came out yesterday shows a projected increase in the rates for Medicaid payments to nursing homes. Assisted living is a different service format than nursing homes, in that it provides more of a social model or home life environment. Jefferson County Board of Health, December 20, 2007 Page 4 of 8 Mr. Walker spoke about the development of a new service delivery model, which was borrowed from Oregon's work on improving assisted living. One of the key issues is the use of nurse delegation and how it relates to the nurse practice act. In Washington, the nurse practice act was amended to provide flexibility in providing services by someone who isn't a RN or LPN. Jean Baldwin commented that this was a healthcare access issue and impacts us all. She noted that there were legislative things that we need to pay attention to. Boards of Health have traditionally not paid attention to aging issues but yet this is aging and disability and we are uniquely placed to have it be a bigger problem in Jefferson County. Member Westerman expressed her concern about the media coverage and the potential it has on the public perceptions of blame for facilities like Victoria House when Medicaid does not pay enough to take care the residents in that setting. Appointment of Substance Abuse Advisory Board Members Member Austin reported that he and Jean Baldwin interviewed two applicants for the Substance Abuse Advisory Board. They met with Frances Joswick, recently retired who has moved here from Maui where she has extensive experience working with chemical dependency treatment programs. Also interviewed was Nichole Black, who is getting her Masters Degree in public administration. Elizabeth Harmon, who currently sits on the Substance Abuse Advisory Board, submitted her letter of intent for reappointment. Both Jean and Member Austin expressed their enthusiasm for all of the applicants. Member Austin moved to accept the three applicants for membership. Member Buhler seconded the motion, which passed by unanimous vote. Jefferson County Septic Code 8.15: Pre - adoption briefing on proposed changes regarding Operation and Monitoring Plan Implementation Neil Harrington, JCPH Water Quality Program Manager, walked the Board through the new changes to the Jefferson County Septic Code 8.15. The majority of changes have to do with the addition of the Operation and Monitoring Program for septic systems administered through JCPH. Jefferson County PUD #1, which has been doing O &M for many years, is opting out of this service as of January 1, 2008. As a result of state regulatory changes, JCPH code will need to change to reflect the increase of monitoring requirements for most systems. A homeowner with a septic system will get a notice that states they are now required to have their on -site sewage system checked and maintained every 1 -3 years (depending on the system type). The roll out will begin with PUD customers first and then progress to the rest of the county as we obtain information on their systems. Jefferson County Board of Health, December 20, 2007 Page 5 of 8 The homeowner has four options: hire an independent O &M Specialist each time an inspection is needed, sign a 5 -year contract with an O &M Specialist, become certified to monitor their own septic system, or stay with PUD. Most PUD contracts don't contain an opt -out clause, as a result PUD has raised their fee from $50 to $200, which will probably be more than most O &M Specialists will charge. With these changes to the code, there were additions /changes to some of the definitions. Some of the code was clarified during the recent review process. Pieces of policy were brought in where it wasn't specifically spelled out in code. Neil pointed out that homeowners will need a certificate for each system they own. For instance, a homeowner operator certificate allows the certificate holder to inspect one OSS serving the property that he /she owns regardless of the quantity of properties owned. Neil briefed the Board on the process of applying for the Homeowner Operator Certificate. Neil asked for the Board's guidance on how to handle the rental or multiple property owners in regards to operation and maintenance requirements. There is always a question about stewardship when dealing with rental properties. Neil walked the Board through the process of professional O &M inspection and required criteria. Member Buhler inquired why a homeowner who is qualified or certified to look at their own system must get a homeowner operator certificate for each system. There were discussions regarding ways to handle owner operators who are out of compliance. There were questions raised about other counties our size and the percentage of homeowners who monitor their system. Jean said other counties who require homeowners to maintain contracts with private vendors spend a lot to employee time, court time and money on enforcement. We have a number of citizens who prefer we not enter their property. We still want to make sure that their system is not failing. This is an opt -out program with some enforcement. Initially, it is likely that 200+ homeowners will sign up to do their own monitoring but as time passes we expect to see less homeowner operators. By letting people opt -out we are promoting compliance with the new rules and at the point of sale of the property it is all documented. Jean gave a quick overview of the process and tracking when an owner contracts with an O &M vendor. The vendor will do the inspection and file electronically. Currently the county has seven O &M Specialists and one company that has bid for 4000 systems. Triggering a professional O &M inspection and JCPH Policy 04 -01 was discussed. Inquires were made regarding the point at which a septic inspection is needed. It was pointed out that at the time you do substantial remodeling that increases occupancy or water use. The other important rationale for this is when people do expansions, it is important to determine where their drainfield is located so building is not done over the drainfield or the drainfield's reserve area. A building permit would also trigger an inspection. Jefferson County Board of Health, December 20, 2007 Page 6 of 8 Susan Porto, Environmental Health Specialist, commented that JCPH's intent is to put together informational handouts so that new requirements and their public health rationale are clear to the public. Jean added that enforcement issues are similar to all of the other enforcement codes now within Environmental Health. There was discussion about the State definition of surface water. Concerns were expressed regarding the broad language. Dr. Locke stated that it was written specifically to allow reasonable judgment on the part of those enforcing the code. Discussion resulted in the proposal that draft language be developed to allow one class one certificate per system with the certificate being valid for 3 years at the cost of $98 per homeowner certification. It was decided that these two options would be presented for discussion at the public hearing. Member Westerman moved to hold a public hearing on revisions to the Septic Code 8.15 at the next Board of Health meeting January 17, 2008. Chair Frissell seconded the motion, which carried by unanimous vote. Member Austin moved to discuss amending the fee schedule to include certain fees as a result of revisions to the Septic Code 8.15 at the public hearing at the next Board of Health meeting on January 17, 2008. Member Johnson seconded the motion, which carried by unanimous vote. 2007 Hood Canal Environmental Achievement Award — JCPH Neil Harrington told the Board that JCPH was awarded the 2007 Hood Canal Coordinating Council Environmental Achievement Award. This award was presented to JCPH for work being done on clean water projects in Hood Canal, acquisitions along the Dosewallips River, salmon restoration, shellfish protection and solid waste disposal. Green Business Award: Blue Heron Middle School Blue Heron Middle School was presented with the Green Business Award for their efforts to reduce waste, save energy, reduce water use, and increase recycling. ACTIVITY UPDATE Jean Baldwin reported that The Royers Groups will be setting up a series of interviews as they enter the second phase of their feasibility study and will be contacting members of the Board. Member Austin told the Board that he was a member of the State Board of Health and asked the members to let him know if there was a topic of interest they would like to hear about. He said that the State Board of Health will be meeting in Jefferson County in November 2008. Jefferson County Board of Health, December 20, 2007 Page 7 of 8 Neil reported that JCPH received a grant from Department of Ecology in the amount of $30,000 to study the county's lakes. This funding will allow better characterization of seasonal variations in cyanobacteria toxin levels and hopefully guide remedial actions if problems are found. AGENDA PLANNING None Meeting was adjourned at 4:35 p.m. Next Board of Health meeting is January 17, 2008 JEFFERSON COUNTY BOARD OF HEALTH Roberta Frissell, Chair Jo Austin, Vice Chair not available for signature Jill Buhler, Member `1 r Phil Johns , Member i Sheila Westerman, Member Excused Geoff Masci, Member Excused David Sullivan, Member Jefferson County Board of Health, December 20, 2007 Page 8 of 8