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HomeMy WebLinkAbout2011- January File Copy • Jefferson County Board of 3-CeaCth ,Agenda W inutes • January 20, 2011 • JEFFERSON COUNTY BOARD OF HEALTH • January 20, 2011 Jefferson County Public Health 615 Sheridan Street Port Townsend, WA 2:30—4:30 PM DRAFT AGENDA I. Approval of Agenda II. Approval of Minutes of December 16, 2010 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. February 2011 Standards for Public Health Practice 2. Presentations to the City of Port Townsend 3. MMR Vaccine Study Fraud Update 4. Jefferson County BOH 2009-2010 Thumbnail of Board Activities • 5. SBOH Notifiable Conditions Rule Filed for February 4, 2011 V. New Business 1. Election of New BOH Officers for 2011 2. Adoption of Policies and BOH Role 3. Environmental Health Policy Revisions: Food Safety Program 4. Public Records Requests 2010 Volume and Time 5. 2011 WSALPHO Legislative Agenda VI. Activity Update: Region 2 Public Health Emergency Preparedness and Response Statewide Exercise: January 25-27, 2011 VII. Agenda Planning Calendar: Board of Health Meeting Calendar for 2011 VIII. Next Scheduled Meeting: February 17, 2011 2:30—4:30 PM • f JEFFERSON COUNTY BOARD OF HEALTH 0 MINUTES Thursday, December 16 2:30 PM—4:30 PM Public Health Conference Room, 615 Sheridan Street, Port Townsend Board Members Staff Members Phil Johnson, County Commissioner District#1 Thomas Locke,MD,Health Officer David Sullivan, County Commissioner,District#2 Jean Baldwin,Public Health Services Director John Austin, County Commissioner,District#3 Julia Danskin,Nursing Services Director Sheila Westerman, Citizen at large(City) Stuart Whitford,Environmental Services Director Kristen Nelson, Vice Chair,Port Townsend City Council Chuck Russell, Chair, Hospital Commissioner,District#2 Roberta Frissell, Citizen at large(County) Vice Chair Kristen Nelson called the meeting of the Jefferson County Board of Health to order at 2:30 PM. A quorum was present. Members Present: John Austin, Roberta Frissell, Phil Johnson, Kristen Nelson, Chuck Russell (arrived 2:45 PM), David Sullivan, Sheila Westerman Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin, Veronica Shaw, Stuart Whitford • Guests: Phillip Morley, County Administrator APPROVAL OF AGENDA Jean Baldwin suggested a brief discussion about plans for meeting minutes in 2011; this item was added at the bottom of New Business. She also added a handout for the packet on teen pregnancy that was in response to public comments at the previous meeting. The agenda was approved unanimously, as amended. APPROVAL OF MINUTES Member Austin moved for approval of the October 21, 2010 BOH meeting minutes, as written; Member Westerman seconded. The minutes of October 21, 2010 were approved unanimously, as written. PUBLIC COMMENTS Mr. Tom Brotherton, Quilcene, requested that the BOH consider establishing a noise ordinance in Jefferson County. He noted that the City of Port Townsend has a noise 1111111 ordinance. He quoted RCW 70.107.010: "The legislature finds that inadequately Page 1 of 10 R controlled noise adversely affects the health, safety and welfare of the people, the value of property and the quality of the environment." He stated that the RCW authorizes local • jurisdictions to regulate noise. Enforcement would be the responsibility of the Sheriff's Department. He listed a number of health issues related to noise identified by the World Health Organization. He recommended that the Health Department sponsor a study of health problems related to noise and coordinate among other departments including the Sheriff's Department. Mr. Brotherton also referred to the agenda item on tobacco use in Jefferson County. He urged the BOH to do more on tobacco awareness, particularly through"free" media, such as press releases. Members Austin and Sullivan noted that noise issues had been considered in the past by the BoCC, and that State standards are followed. Member Westerman noted the dilemma of providing more services in a time of shrinking revenues and without voter endorsement of tax increases. Davis Steelquist, Quilcene, said he wished to talk about agendas and minutes, an issue he had previously raised in June 2010. He pointed out that, on November 17,the meeting information posted on the web site referred to the September BOH meeting. He said that no minutes had been posted since July. He added that he had not received a response to an e-mail on that subject that he had sent to the director of the Health Department and the BOH. He said that by December 4, a special hearing notice for December 16 had been posted. As of December 14,the agenda for December 16 appeared, along with a set of • minutes for the October meeting,which were not actually approved until earlier in today's meeting. He said that he was further confused about the heading date on the posted minutes,which appeared to be for July 15, 2010. Mr. Steelquist stated that these types of administrative errors and the lack of a response to an e-mail inquiry reflect badly on the BOH and the Health Department. He suggested that the BOH have its own e-mail address through which the public can reach members directly. Member Nelson explained that she had been out of town for a month which may have contributed to the delay in signing and publishing minutes. OLD BUSINESS and INFORMATIONAL ITEMS Chimacum Smile Mobile Event Report Julia Danskin briefly reviewed highlights of the December 6 report on Smile Mobile activity during the period November 8-12, 2010 that was provided in the packet. Page 2 of 10 • Governor's Executive Order 10-06 Suspending Non-Critical Rule Development and Adoption Jean Baldwin referred the letter notifying State Agency Directors and other authorities of Governor Gregoire's Executive Order regarding suspension of development and adoption of rules for the next 12 months. She said it will impact many government activities and services. It directs that no unnecessary rule making will occur. She noted that the State Board of Health, of which John Austin is a member, may continue to make some rules but there will likely be delays in others under consideration because of the lack of staff in key supporting agencies such as the Department of Health and Department of Ecology. There was a brief discussion about the interpretation of"non critical rule making". Member Austin mentioned that, based on a recent meeting of the Policy subcommittee of the State Board of Health,the State Board has stopped working on all but a small subset of the rules in progress. He noted that the number of sessions per year will decrease. Dr. Locke mentioned updates to the food code, which are linked at the Federal, State and local levels. The 2009 federal version is now available while the State code is still linked to the 2001 version. There was a brief discussion about the types of activities that are considered essential to public health versus what is funded. Tobacco Use in Jefferson County • Karen Obermeyer, Tobacco Prevention Coordinator, presented an update on the tobacco program in Jefferson County. She referred to summary materials included in the meeting packet. Ms. Obermeyer clarified that, in accordance with standard practice, smoking rates are combined/averaged over three years. Although rates may vary year to year due to small survey samples, the trend from 2003 to 2009 is downward. There was a jump in 2008 which affected the 2007-2009 three year rates. She explained the use of 30 day, age-adjusted rates. Two areas of concern are the smoking rates for adults and pregnant women, which are higher than State and national rates. Rates are higher among populations age 18 to 34, and among low income and low education populations. Progress has been made in certain areas. In the State of Washington, indoor air pollution has decreased 88% in bars and restaurants. In Jefferson County, smoking is prohibited in 95% of homes and Tobacco Quit Line calls have risen from 67 to 143 calls from 2007 to 2009. Ms. Obermeyer discussed program elements that are designed to save lives and money. She noted her work with Headstart and other organizations to educate clients and employees about the risks of second hand smoke. She also trains retailers and performs compliance checks to ensure they follow laws prohibiting tobacco sales to minors. In 2010, 85%of retailers who had compliance checks were found to be compliant. The program also includes training other organizations to screen and refer clients for help in quitting, and working to increase the number of smoke free environments. • Page 3 of 10 Funding for the Washington Tobacco Control Program has just been cut by $3,000,000 for the current fiscal year. This means that tobacco contracts for Jefferson County will • end at the end of December 2010. The Quit Line and tobacco retail education will continue. Julia Danskin thanked Ms. Obermeyer for her contributions to tobacco prevention, noting that reduced funding would prevent her from spending as much of her time on the tobacco program in the future. Jean Baldwin noted that services in the schools would also be affected; the regional City/County contract will end as of January 1. The enforcement of the local No Smoking Ordinance(901) is now without a source of funding. No smoking signs and other materials will still be available. On a positive note, there was recognition that behaviors have already been changed by education and monitoring. On the other hand,tobacco corporations continue to develop new products that are not yet regulated but may still be health risks, such as electric cigarettes and forms of nicotine-containing snacks. Public Hearing: Environmental Fee Revisions 2011 Stuart Whitford, Environmental Health Director, explained that the fee schedule that had been presented in October was largely unchanged from 2010, except for a few clarifications. He said that certain fees had been added for plan reviews. He asked for any questions from the BOH. Stuart Whitford noted that the fees are structured so as to cover the cost of staff time for tasks. • Vice Chair Nelson open the public hearing and invited public comments. Mr. Davis Steelquist stated that in his observation of County regulations, he has found cases of ambiguity due to the lack of explicit definitions for key terms. Mr. Whitford said that the definitions are covered in policies and in the food code, and could be referenced in the fee schedule. There was a brief discussion in which it was noted that the fee schedule is available online. Baldwin explained that a number of internal administrative policies and procedures do exist and, depending on the topics they cover, are approved by Dr. Locke, Ms. Baldwin or Mr. Whitford. In addition, certain policies are set by the BOH. Mr. Brotherton asked how the fees are determined. Member Westerman provided a summary of the process from several years earlier, with participation of a cross section of the community,that had led to the decision to establish fees that are cost-based, i.e. the staff cost on average to provide each service. The fees are updated as costs rise. Vice Chair Nelson closed the public hearing. Member Sullivan mentioned that the law does not allow public agencies to charge more than the cost of providing the service. There was a brief discussion about the appropriate S Page 4 of 10 process for separate approval for the Fee Schedule ordinance and for the associated • policies. Member Austin moved for approval of the Fee Schedule Ordinance; the motion was seconded by Member Westerman. Member Russell stated that he would abstain from voting because it directs affects him as a food service establishment owner. Member Nelson noted that the ordinance affects her as well,but that she had no objections to it. The BOH approved the motion by a vote of 6 in favor, none opposed,with 1 abstention. Environmental Health Policy Revisions: Food Safety Program Stuart Whitford, Environmental Health Director, referred to policies in the packet that are undergoing development/revision. This is a periodic process to assure that existing policies are up to date and determine whether new policies need to be developed. The intention of including them in this month's board packet is to show what is in progress; there will be additional items later. He invited BOH members to comment or pose questions. Dr. Locke said that in the course of these policy revisions, a 1988 policy about policy remains in effect until the Board amends or repeals it. He said he would like to propose updating the 1988 document to define/establish which policies the BOH reviews and • formally adopts, and clarifies the other categories such as administrative policies, clinical protocols, and guideline documents. He explained that enforcement involves authority contained in BOH policies, local public health codes and state public health codes. He said that for policies,the process used for the adoption of an ordinance is not required; a policy can be reviewed and approved by a majority of members in one BOH meeting. Stuart Whitford invited the BOH to forward any comments on the materials in progress to Susan Porto or him. There was a brief discussion about the posting of food establishment inspection results on the web and how patrons can ensure that food has been kept at safe temperatures. Re-appointment to Substance Abuse Advisory Board (SAAB) A letter of application for term renewal on the SAAB from Frances Joswick was provided in the packet. Member Austin commended Frances Joswick for her leadership of the SAAB. He moved that the BOH re-appoint Ms. Joswick to the Substance Abuse Advisory Board for a second term; the motion was seconded by Member Russell. The motion was approved unanimously. s Page 5 of 10 A 2011 Jefferson County Budget: Jefferson County Public Health Impacts Jean Baldwin noted that staff had several issues to discuss with BOH regarding the • budget in light of State and County budget reductions. First, she requested that the BOH consider conducting executive sessions for discussion of personnel impacts due to budget cuts, particularly in cases if the regular meeting schedule does not permit timely consideration and action. She mentioned the loss of$56,000 for the tobacco program. Ms. Baldwin said that she and Dr. Locke had exploratory discussions about regionalization of some health services with other Health Departments and the public hospital district. She said that there are no obvious solutions. She added that other counties are not in any better positions than Jefferson County. She noted that, in addition to aggressively managing its current income sources and expenses,the Health Department had applied for 5 other grants that did not come through. Some layoffs are dependent on the City/County contract, i.e. funding for the school tobacco prevention programs. JCPH management has internally, focused on maintaining core services and preserving public health technical expertise; there is also attention on transitional plans and support for staff Ms. Baldwin referred to the staff letter of November 19 to the BOH regarding the budget and a letter dated December 2 from Roberta Frissell to the BOCC and Phillip Morley. • She referred to previous discussion about the possibility of returning $50,000 or $100,000 to the General Fund in the third quarter of the fiscal year. She explained the background of the situation in which the Health Department had accumulated a cash balance. Some of the factors are conservation of staff hours, aggressive pursuit of stimulus funds, and delayed receipt of HIN1 funds. She stressed that in planning for next year, it must be realized that the current situation is unique. Veronica Shaw explained how the State Department of Health directives regarding cash flow have contributed to the cash balance. She also mentioned discussions with County Administration about possible changes to cost allocations including overhead cost. She said she was not in favor of a special arrangement for the Health Department versus other County departments. Member Westerman said that she was in complete agreement with the points made in Member Frissell's letter. She said she believes the Health Department is doing its job in planning and maintaining a reserve for shortfalls and emergencies. She said she feels they are being punished for doing a great job in managing their resources. She also believes that the full $100,000 should be returned to them. She said that the department and BOH have worked for 15 years to build a culture and ability to take care of its responsibilities, for example a natural disaster or other terrible emergency. She said that while it may be too late to change the budget for this year, she does not wish to see the Health Department subjected to this type of process in future years. • Page 6 of 10 Veronica Shaw added that other counties she has contacted have emergency reserves in the range of 14 to 23%. Phillip Morley, County Administrator, said that he would like to provide more on the background of this situation. He acknowledged the need to be prepared for any public health emergencies. He also noted the information emerging during the previous 48 hours from the State legislature as it is in the process of attempting to balance the budget. He said he recognizes the gravity of the situation and how all County offices share in these impacts. He recalled that during the adoption of the 2010 budget, his office had been monitoring historic trends of various fund balances and had considered but deferred steps to rebalance certain funds relative to the General Fund. Late in 2010, he had proposed the $50,000 transfer from the Health Department to the County General Fund, which was followed by the November 19 letter of response from Health Department administrators. Mr. Morley said that since that time, he has reviewed the two sets of internal projections and decided to wait at least until the end of the year, when more financial information is available. Secondly, he acknowledged the existing climate of scarcity that affects all parties. He said he agreed that any rebalancing should be consistent with clear facts and within a policy framework. While local funding cannot fully supplant declining State funds, it may be possible to ease the transition. He said that there was no intention to act unilaterally, but rather to propose and discuss. Member Sullivan stated that he is in agreement with the need for surge capacity, and the General Fund could be source for that purpose. Staff noted that the BOH and Health • Department had not been operating with that assumption historically. There was a brief discussion as to the meaning of surge capacity, i.e. major emergencies necessitating unbudgeted expenditures versus loss of funding sources. Member Sullivan also suggested that care must be taken in calling an Executive Session, based on the subject matter, and that Atty. Alvarez should be consulted. He also mentioned that he had spoken with Mary Selecky and that she is also trying to protect the surge capacity at the State level. He reminded that Public Health is a mandated service per the State constitution. Veronica Shaw said she wished to clarify one other point regarding the 2008 budget year. Although the Health Department had received a contribution after the budget had already been approved, that money ($265,000) has since been given back to the General Fund. Member Austin observed that everyone present shares a certain passion, dedication and sense of responsibility for the health of the County. He expressed hope that all parties will continue to work together for the benefit of the entire community. Jean Baldwin noted that her staff is fully aware of the risk to the whole community with the losses of services, and education. On a positive note, she reported that Adult Pharmacy appears to have been reinstated in the State budget. Its loss would have severely impacted the hospital, mental health programs, and other critical services, such • as those for HIV. Page 7 of 10 Member Johnson acknowledged the needs and position of public health and recognized the many other County needs and priorities to be considered and weighed by the BOCC in a period of declining resources. Washington State Budget Update Jean Baldwin referred to a letter to public health officials from the Governor's office. It discusses flexible funds for County governments to allow more local discretion for services chosen as the highest priorities. She mentioned that communicable disease funding was preserved and tobacco prevention funding was lost. Ms. Baldwin said that at this point in time the Health Department had lost $153,000 in funds, but there will be a series of other cuts in the coming months. The Family Planning and MSS planned cuts have not been as drastic as first suggested. She and Member Sullivan noted the full impact will not be known until the end of the legislative session. Ms. Baldwin said she would return to the BOH with information about the extent of cuts as they are known. 2011 WSALPHO (Washington State Association of Local Public Health Officials) Agenda Dr. Locke said that WSALPHO membership had been asked to think ahead and identify Board of Health priorities for the 2011 legislative session. He mentioned preserving flexible funding and the options for developing long-term stable funding sources. Dr. • Locke also mentioned identifying and eliminating expensive low value regulations and promoting programs that are highly cost effective. In addition,he mentioned reshaping public health and deciding what the "new normal" will look like. He encouraged everyone to read"An Agenda for Change" which had been included in the packet. He said this represents some of the best thought in the State about the direction governmental public health is going in. Ms. Baldwin particularly recommended the section on visioning/guiding principles on page 5 as a starting point for discussion at the January BOH meeting. Ms. Baldwin also called attention to the document describing the CDC's Winnable Battles imitative. She noted that there is a new director who has experience as Public Health Director in New York City. His vision is to focus on those areas where significant progress can be made in a relatively short time frame. Ms. Baldwin briefly reviewed and noted the disconnect between State and federal priorities and the local impacts of that. Mr. Morley added that since it may be some time before the State is in a position to restore former funding levels, it is important to identify the most critical services locally and how they will be paid for. He said the County will begin a visioning process in January, looking out 4 or 5 years, and suggested this should be linked with the process that the BOH is undertaking. He said he plans to attend BOH meetings in the future. Page 8 of 10 February 2011 Standards for Public Health Practice Audit: "Basic" Standards Option Jean Baldwin briefly described the review process that takes place every three years. A consulting group visits each health department to perform a standards audit and assigns a grade. The department has always done well. Much of the focus is on internal standards and work. This year the review is in February; many State cuts will take effect in March. She noted that several other counties have decided not to participate, while larger counties will participate as a practice for national accreditation. Jefferson County has selected the modified standard, a compromise which has been offered to all small and moderate size health departments. This option represents about half the volume of reports, and requires about three weeks of work for senior administrators Baldwin and Danskin. It will allow the department to see if it has improved over earlier audits. The department has the option to select the full standard in the future if economic and time pressures change. Julia Danskin clarified that this performance review is tied to a local capacity development fund starting in 2011. The statement of work will reflect that the department meets this standard. The basic review involves 76 items instead of the 140 in the full standard. She said it involves much documentation, including BOH minutes as evidence of decision making and oversight processes. • Transition Plans for BOH Meeting Recording and Minutes Gail Bernhard has announced plans for retirement and will no longer be available for meeting recording,transcription, and minute's preparation. Jean Baldwin asked BOH members to consider a shorter, action/task-focused, summary format. This may allow internal staff to perform this function, with some potential savings over the current contract arrangement. A digital recording would still be available. Member Nelson noted that the current method is particularly helpful to members when they are unable to attend a meeting. However, all members agreed that they were willing to work with piloting a more condensed version. Member Frissell and other members commended Ms. Bernhard for the work she has done for the BOH and Health Department. ACTIVITY UPDATE Julia Danskin announced the upcoming Region 2 Public Health Emergency Preparedness and Response Statewide Exercise: January 25-27, 2011. She said she would report on the results in February. S Page 9 of 10 A AGENDA PLANNING CALENDAR • The next scheduled BOH meeting will be held Thursday, January 20, 2010 from 2:30 to 4:30 PM at the Department of Public Health, 615 Sheridan Street, Port Townsend, WA. Vice Chair Nelson listed possible agenda items mentioned during this meeting. There was agreement that public health priorities should be discussed. Members were not in favor of further discussion on a noise ordinance in the near future nor on the creation of a special BOH e-mail arrangement. The election of BOH officers will also take place at the January meeting. ADJOURNMENT Vice Chair Nelson adjourned the BOH meeting at 4:37PM. JEFFERSON COUNTY BOARD OF HEALTH Chuck Russell, Chair Phil Johnson, Member Kristen Nelson, Vice-Chair John Austin, Member Roberta Frissell, Member David Sullivan, Member Sheila Westerman I Page 10 of 10 ,. r JEFFERSON COUNTY BOARD OF HEALTH • MINUTES Thursday, December 16 2:30 PM—4:30 PM Public Health Conference Room, 615 Sheridan Street, Port Townsend Board Members Staff Members Phil Johnson,County Commissioner District#1 Thomas Locke,MD,Health Officer David Sullivan,County Commissioner,District#2 Jean Baldwin,Public Health Services Director 0 John Austin,County Commissioner,District#3 Julia Danskin,Nursing Services Director Sheila Westerman, Citizen at large(City) Stuart Whitford,Environmental Services Director Kristen Nelson, Vice Chair,Port Townsend City Council Chuck Russell, Chair,Hospital Commissioner,District#2 Roberta Frissell, Citizen at large(County) Vice Chair Kristen Nelson called the meeting of the Jefferson County Board of Health to order at 2:30 PM. A quorum was present. Members Present: John Austin, Roberta Frissell, Phil Johnson, Kristen Nelson, Chuck Russell (arrived 2:45 PM), David Sullivan, Sheila Westerman Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin, Veronica Shaw, Stuart Whitford Guests: Phillip Morley, County Administrator APPROVAL OF AGENDA Jean Baldwin suggested a brief discussion about plans for meeting minutes in 2011; this item was added at the bottom of New Business. She also added a handout for the packet on teen pregnancy that was in response to public comments at the previous meeting. The agenda was approved unanimously, as amended. APPROVAL OF MINUTES Member Austin moved for approval of the October 21,2010 BOH meeting minutes, as written; Member Westerman seconded. The minutes of October 21,2010 were approved unanimously, as written. PUBLIC COMMENTS Mr. Tom Brotherton, Quilcene, requested that the BOH consider establishing a noise ordinance in Jefferson County. He noted that the City of Port Townsend has a noise IIordinance. He quoted RCW 70.107.010: "The legislature finds that inadequately Page 1 of 10 controlled noise adversely affects the health, safety and welfare of the people, the value of property and the quality of the environment." He stated that the RCW authorizes local • jurisdictions to regulate noise. Enforcement would be the responsibility of the Sheriff's Department. He listed a number of health issues related to noise identified by the World Health Organization. He recommended that the Health Department sponsor a study of health problems related to noise and coordinate among other departments including the Sheriff's Department. Mr. Brotherton also referred to the agenda item on tobacco use in Jefferson County. He urged the BOH to do more on tobacco awareness, particularly through "free" media, such as press releases. Members Austin and Sullivan noted that noise issues had been considered in the past by the BoCC, and that State standards are followed. Member Westerman noted the dilemma of providing more services in a time of shrinking revenues and without voter endorsement of tax increases. Davis Steelquist, Quilcene, said he wished to talk about agendas and minutes, an issue he had previously raised in June 2010. He pointed out that, on November 17,the meeting information posted on the web site referred to the September BOH meeting. He said that no minutes had been posted since July. He added that he had not received a response to an e-mail on that subject that he had sent to the director of the Health Department and the BOH. He said that by December 4, a special hearing notice for December 16 had been posted. As of December 14, the agenda for December 16 appeared, along with a set of minutes for the October meeting, which were not actually approved until earlier in • today's meeting. He said that he was further confused about the heading date on the posted minutes, which appeared to be for July 15, 2010. Mr. Steelquist stated that these types of administrative errors and the lack of a response to an e-mail inquiry reflect badly on the BOH and the Health Department. He suggested that the BOH have its own e-mail address through which the public can reach members directly. Member Nelson explained that she had been out of town for a month which may have contributed to the delay in signing and publishing minutes. OLD BUSINESS and INFORMATIONAL ITEMS Chimacum Smile Mobile Event Report Julia Danskin briefly reviewed highlights of the December 6 report on Smile Mobile activity during the period November 8-12, 2010 that was provided in the packet. • Page 2 of 10 Governor's Executive Order 10-06 Suspending Non-Critical Rule Development and • Adoption Jean Baldwin referred the letter notifying State Agency Directors and other authorities of Governor Gregoire's Executive Order regarding suspension of development and adoption of rules for the next 12 months. She said it will impact many government activities and services. It directs that no unnecessary rule making will occur. She noted that the State Board of Health, of which John Austin is a member, may continue to make some rules but there will likely be delays in others under consideration because of the lack of staff in key supporting agencies such as the Department of Health and Department of Ecology. There was a brief discussion about the interpretation of"non critical rule making". Member Austin mentioned that, based on a recent meeting of the Policy subcommittee of the State Board of Health, the State Board has stopped working on all but a small subset of the rules in progress. He noted that the number of sessions per year will decrease. Dr. Locke mentioned updates to the food code, which are linked at the Federal, State and local levels. The 2009 federal version is now available while the State code is still linked to the 2001 version. There was a brief discussion about the types of activities that are considered essential to public health versus what is funded. Tobacco Use in Jefferson County • Karen Obermeyer, Tobacco Prevention Coordinator, presented an update on the tobacco program in Jefferson County. She referred to summary materials included in the meeting packet. Ms. Obermeyer clarified that, in accordance with standard practice, smoking rates are combined/averaged over three years. Although rates may vary year to year due to small survey samples, the trend from 2003 to 2009 is downward. There was a jump in 2008 which affected the 2007-2009 three year rates. She explained the use of 30 day, age-adjusted rates. Two areas of concern are the smoking rates for adults and pregnant women, which are higher than State and national rates. Rates are higher among populations age 18 to 34, and among low income and low education populations. Progress has been made in certain areas. In the State of Washington, indoor air pollution has decreased 88% in bars and restaurants. In Jefferson County, smoking is prohibited in 95% of homes and Tobacco Quit Line calls have risen from 67 to 143 calls from 2007 to 2009. Ms. Obermeyer discussed program elements that are designed to save lives and money. She noted her work with Headstart and other organizations to educate clients and employees about the risks of second hand smoke. She also trains retailers and performs compliance checks to ensure they follow laws prohibiting tobacco sales to minors. In 2010, 85% of retailers who had compliance checks were found to be compliant. The program also includes training other organizations to screen and refer clients for help in quitting, and working to increase the number of smoke free environments. • Page 3 of 10 Funding for the Washington Tobacco Control Program has just been cut by $3,000,000 for the current fiscal year. This means that tobacco contracts for Jefferson County will • end at the end of December 2010. The Quit Line and tobacco retail education will continue. Julia Danskin thanked Ms. Obermeyer for her contributions to tobacco prevention, noting that reduced funding would prevent her from spending as much of her time on the tobacco program in the future. Jean Baldwin noted that services in the schools would also be affected;the regional City/County contract will end as of January 1. The enforcement of the local No Smoking Ordinance (901) is now without a source of funding. No smoking signs and other materials will still be available. On a positive note, there was recognition that behaviors have already been changed by education and monitoring. On the other hand,tobacco corporations continue to develop new products that are not yet regulated but may still be health risks, such as electric cigarettes and forms of nicotine-containing snacks. Public Hearing: Environmental Fee Revisions 2011 Stuart Whitford, Environmental Health Director, explained that the fee schedule that had been presented in October was largely unchanged from 2010, except for a few clarifications. He said that certain fees had been added for plan reviews. He asked for any questions from the BOH. Stuart Whitford noted that the fees are structured so as to cover the cost of staff time for tasks. • Vice Chair Nelson open the public hearing and invited public comments. Mr. Davis Steelquist stated that in his observation of County regulations, he has found cases of ambiguity due to the lack of explicit definitions for key terms. Mr. Whitford said that the definitions are covered in policies and in the food code, and could be referenced in the fee schedule. There was a brief discussion in which it was noted that the fee schedule is available online. Baldwin explained that a number of internal administrative policies and procedures do exist and, depending on the topics they cover, are approved by Dr. Locke, Ms. Baldwin or Mr. Whitford. In addition, certain policies are set by the BOH. Mr. Brotherton asked how the fees are determined. Member Westerman provided a summary of the process from several years earlier, with participation of a cross section of the community,that had led to the decision to establish fees that are cost-based, i.e. the staff cost on average to provide each service. The fees are updated as costs rise. Vice Chair Nelson closed the public hearing. Member Sullivan mentioned that the law does not allow public agencies to charge more than the cost of providing the service. There was a brief discussion about the appropriate • Page 4 of 10 process for separate approval for the Fee Schedule ordinance and for the associated • policies. Member Austin moved for approval of the Fee Schedule Ordinance; the motion was seconded by Member Westerman. Member Russell stated that he would abstain from voting because it directs affects him as a food service establishment owner. Member Nelson noted that the ordinance affects her as well, but that she had no objections to it. The BOH approved the motion by a vote of 6 in favor, none opposed,with 1 abstention. Environmental Health Policy Revisions: Food Safety Program Stuart Whitford, Environmental Health Director, referred to policies in the packet that are undergoing development/revision. This is a periodic process to assure that existing policies are up to date and determine whether new policies need to be developed. The intention of including them in this month's board packet is to show what is in progress; there will be additional items later. He invited BOH members to comment or pose questions. Dr. Locke said that in the course of these policy revisions, a 1988 policy about policy remains in effect until the Board amends or repeals it. He said he would like to propose updating the 1988 document to define/establish which policies the BOH reviews and • formally adopts, and clarifies the other categories such as administrative policies, clinical protocols, and guideline documents. He explained that enforcement involves authority contained in BOH policies, local public health codes and state public health codes. He said that for policies, the process used for the adoption of an ordinance is not required; a policy can be reviewed and approved by a majority of members in one BOH meeting. Stuart Whitford invited the BOH to forward any comments on the materials in progress to Susan Porto or him. There was a brief discussion about the posting of food establishment inspection results on the web and how patrons can ensure that food has been kept at safe temperatures. Re-appointment to Substance Abuse Advisory Board (SAAB) A letter of application for term renewal on the SAAB from Frances Joswick was provided in the packet. Member Austin commended Frances Joswick for her leadership of the SAAB. He moved that the BOH re-appoint Ms. Joswick to the Substance Abuse Advisory Board for a second term; the motion was seconded by Member Russell. The motion was approved unanimously. • Page 5of10 2011 Jefferson County Budget: Jefferson County Public Health Impacts Jean Baldwin noted that staff had several issues to discuss with BOH regarding the 11/ budget in light of State and County budget reductions. First, she requested that the BOH consider conducting executive sessions for discussion of personnel impacts due to budget cuts, particularly in cases if the regular meeting schedule does not permit timely consideration and action. She mentioned the loss of$56,000 for the tobacco program. Ms. Baldwin said that she and Dr. Locke had exploratory discussions about regionalization of some health services with other Health Departments and the public hospital district. She said that there are no obvious solutions. She added that other counties are not in any better positions than Jefferson County. She noted that, in addition to aggressively managing its current income sources and expenses, the Health Department had applied for 5 other grants that did not come through. Some layoffs are dependent on the City/County contract, i.e. funding for the school tobacco prevention programs. JCPH management has internally, focused on maintaining core services and preserving public health technical expertise; there is also attention on transitional plans and support for staff. Ms. Baldwin referred to the staff letter of November 19 to the BOH regarding the budget and a letter dated December 2 from Roberta Frissell to the BOCC and Phillip Morley. . She referred to previous discussion about the possibility of returning $50,000 or$100,000 to the General Fund in the third quarter of the fiscal year. She explained the background of the situation in which the Health Department had accumulated a cash balance. Some of the factors are conservation of staff hours, aggressive pursuit of stimulus funds, and delayed receipt of H 1 N 1 funds. She stressed that in planning for next year, it must be realized that the current situation is unique. Veronica Shaw explained how the State Department of Health directives regarding cash flow have contributed to the cash balance. She also mentioned discussions with County Administration about possible changes to cost allocations including overhead cost. She said she was not in favor of a special arrangement for the Health Department versus other County departments. Member Westerman said that she was in complete agreement with the points made in Member Frissell's letter. She said she believes the Health Department is doing its job in planning and maintaining a reserve for shortfalls and emergencies. She said she feels they are being punished for doing a great job in managing their resources. She also believes that the full $100,000 should be returned to them. She said that the department and BOH have worked for 15 years to build a culture and ability to take care of its responsibilities, for example a natural disaster or other terrible emergency. She said that while it may be too late to change the budget for this year, she does not wish to see the Health Department subjected to this type of process in future years. i Page 6of10 Veronica Shaw added that other counties she has contacted have emergency reserves in • the range of 14 to 23%. Phillip Morley, County Administrator, said that he would like to provide more on the background of this situation. He acknowledged the need to be prepared for any public health emergencies. He also noted the information emerging during the previous 48 hours from the State legislature as it is in the process of attempting to balance the budget. He said he recognizes the gravity of the situation and how all County offices share in these impacts. He recalled that during the adoption of the 2010 budget, his office had been monitoring historic trends of various fund balances and had considered but deferred steps to rebalance certain funds relative to the General Fund. Late in 2010, he had proposed the $50,000 transfer from the Health Department to the County General Fund, which was followed by the November 19 letter of response from Health Department administrators. Mr. Morley said that since that time, he has reviewed the two sets of internal projections and decided to wait at least until the end of the year, when more financial information is available. Secondly, he acknowledged the existing climate of scarcity that affects all parties. He said he agreed that any rebalancing should be consistent with clear facts and within a policy framework. While local funding cannot fully supplant declining State funds, it may be possible to ease the transition. He said that there was no intention to act unilaterally, but rather to propose and discuss. Member Sullivan stated that he is in agreement with the need for surge capacity, and the General Fund could be source for that purpose. Staff noted that the BOH and Health • Department had not been operating with that assumption historically. There was a brief discussion as to the meaning of surge capacity, i.e. major emergencies necessitating unbudgeted expenditures versus loss of funding sources. Member Sullivan also suggested that care must be taken in calling an Executive Session, based on the subject matter, and that Atty. Alvarez should be consulted. He also mentioned that he had spoken with Mary Selecky and that she is also trying to protect the surge capacity at the State level. He reminded that Public Health is a mandated service per the State constitution. Veronica Shaw said she wished to clarify one other point regarding the 2008 budget year. Although the Health Department had received a contribution after the budget had already been approved, that money ($265,000) has since been given back to the General Fund. Member Austin observed that everyone present shares a certain passion, dedication and sense of responsibility for the health of the County. He expressed hope that all parties will continue to work together for the benefit of the entire community. Jean Baldwin noted that her staff is fully aware of the risk to the whole community with the losses of services, and education. On a positive note, she reported that Adult Pharmacy appears to have been reinstated in the State budget. Its loss would have severely impacted the hospital, mental health programs, and other critical services, such • as those for HIV. Page 7of10 Member Johnson acknowledged the needs and position of public health and recognized the many other County needs and priorities to be considered and weighed by the BOCC in a period of declining resources. Washington State Budget Update Jean Baldwin referred to a letter to public health officials from the Governor's office. It discusses flexible funds for County governments to allow more local discretion for services chosen as the highest priorities. She mentioned that communicable disease funding was preserved and tobacco prevention funding was lost. Ms. Baldwin said that at this point in time the Health Department had lost $153,000 in funds, but there will be a series of other cuts in the coming months. The Family Planning and MSS planned cuts have not been as drastic as first suggested. She and Member Sullivan noted the full impact will not be known until the end of the legislative session. Ms. Baldwin said she would return to the BOH with information about the extent of cuts as they are known. 2011 WSALPHO (Washington State Association of Local Public Health Officials) Agenda Dr. Locke said that WSALPHO membership had been asked to think ahead and identify Board of Health priorities for the 2011 legislative session. He mentioned preserving flexible funding and the options for developing long-term stable funding sources. Dr. • Locke also mentioned identifying and eliminating expensive low value regulations and promoting programs that are highly cost effective. In addition, he mentioned reshaping public health and deciding what the "new normal" will look like. He encouraged everyone to read "An Agenda for Change" which had been included in the packet. He said this represents some of the best thought in the State about the direction governmental public health is going in. Ms. Baldwin particularly recommended the section on visioning/guiding principles on page 5 as a starting point for discussion at the January BOH meeting. Ms. Baldwin also called attention to the document describing the CDC's Winnable Battles imitative. She noted that there is a new director who has experience as Public Health Director in New York City. His vision is to focus on those areas where significant progress can be made in a relatively short time frame. Ms. Baldwin briefly reviewed and noted the disconnect between State and federal priorities and the local impacts of that. Mr. Morley added that since it may be some time before the State is in a position to restore former funding levels, it is important to identify the most critical services locally and how they will be paid for. He said the County will begin a visioning process in January, looking out 4 or 5 years, and suggested this should be linked with the process that the BOH is undertaking. He said he plans to attend BOH meetings in the future. • Page 8 of 10 • February 2011 Standards for Public Health Practice Audit: "Basic" Standards Option Jean Baldwin briefly described the review process that takes place every three years. A consulting group visits each health department to perform a standards audit and assigns a grade. The department has always done well. Much of the focus is on internal standards and work. This year the review is in February; many State cuts will take effect in March. She noted that several other counties have decided not to participate, while larger counties will participate as a practice for national accreditation. Jefferson County has selected the modified standard, a compromise which has been offered to all small and moderate size health departments. This option represents about half the volume of reports, and requires about three weeks of work for senior administrators Baldwin and Danskin. It will allow the department to see if it has improved over earlier audits. The department has the option to select the full standard in the future if economic and time pressures change. Julia Danskin clarified that this performance review is tied to a local capacity development fund starting in 2011. The statement of work will reflect that the department meets this standard. The basic review involves 76 items instead of the 140 in the full standard. She said it involves much documentation, including BOH minutes as evidence of decision making and oversight processes. • Transition Plans for BOH Meeting Recording and Minutes Gail Bernhard has announced plans for retirement and will no longer be available for meeting recording, transcription, and minute's preparation. Jean Baldwin asked BOH members to consider a shorter, action/task-focused, summary format. This may allow internal staff to perform this function, with some potential savings over the current contract arrangement. A digital recording would still be available. Member Nelson noted that the current method is particularly helpful to members when they are unable to attend a meeting. However, all members agreed that they were willing to work with piloting a more condensed version. Member Frissell and other members commended Ms. Bernhard for the work she has done for the BOH and Health Department. ACTIVITY UPDATE Julia Danskin announced the upcoming Region 2 Public Health Emergency Preparedness and Response Statewide Exercise: January 25-27, 2011. She said she would report on the results in February. S Page 9 of 10 AGENDA PLANNING CALENDAR The next scheduled BOH meeting will be held Thursday, January 20, 2010 from 2:30 to • 4:30 PM at the Department of Public Health, 615 Sheridan Street,Port Townsend, WA. Vice Chair Nelson listed possible agenda items mentioned during this meeting. There was agreement that public health priorities should be discussed. Members were not in favor of further discussion on a noise ordinance in the near future nor on the creation of a special BOH e-mail arrangement. The election of BOH officers will also take place at the January meeting. ADJOURNMENT Vice Chair Nelson adjourned the BOH meeting at 4:37PM. JEFF /; SON CI UNTY BOARD OF HEALTH `` 0Fri Chuck R se 1, air Phil Johnso s, ember -......0 fy), rfir AM Kristen Nels• , Vice-Chair Jo Austin, Member / / i . Z---Z-7:1 ietele-4.14;--'f: Roberta Frissell, Member David Sullivan, Member qt.,r14-. ei-ArAi 0.1V-"\-----` Sheila Westerman 110 . Page 10 of 10 • Board of 3-fealth Old Business & InformationaCltems .agenda Item # 1"V, 1. • ,Te6ruary 2011 Standards for Public .9feaCth Practice January 20, 2011 • FROM THE PUBLIC HEALTH ACTIVITIES & • PHIP SERVICES WORKGROUP CO-CHAIRS The Public Health Activities and Services Workgroup was charged by the 2007 legislature to identify and count public health activities and NEWS services of statewide significance consistently and over time. The public health activities and services inventory was created and reviewed extensively to identify counts which are meaningful, represent public health work and are readily countable. The workgroup is responsible for identifying these activities to be counted, overseeing the collection of data, and approving the final report. Public health does many useful things that are not easy to count. For example, how does one count an increase in effective collaboration among important players in the local health care and social services PUBLIC HEALTH community? There are ways to do this, but they are more complex ACTIVITIES& SERVICES than counting activities and services. Yet this is no argument against 2009 Inventory Results counting the countable. The activities and services inventory does not pretend to include everything important in public health, but it does provide a very basic and critical form of accountability to decision ACTIVITIES & SERVICES makers and the public. 2010 Inventory Planning The 2008 pilot inventory was the first attempt to capture a sample • of public health activities and services provided across the state by all 35 local health jurisdictions and to present a baseline of how INDICATORS many of these activities and services were done in 2008. The main 2011 Data Update purpose was to answer basic questions on what public health does in Washington State. In 2009, the inventory was considerably expanded to include STANDARDS additional questions (nearly 200). Data was collected from two 2011 LHJ Review sources - directly from the 35 LHJs using a survey tool, and from the Department of Health (DOH) programs. Every local health jurisdiction Quality Improvement in the state participated in both years this inventory was conducted. Health Improvement Plans The activities and services inventory effort will continue in the years to come. It will help better communicate what local public health does, and how much of it is done. This information can be used to raise awareness and increase understanding of the importance of governmental public health. For examples of how the inventory data can be used to share public health messages and stories as well as more information on the 2009 Public Health Activities and Services Inventory, please visit www.doh.wa.gov/phip/intiative/phas/2009.htrn OCT-DEC 2010 1.; w. G t-1162-1' Gregg Grunenfelder Barry Kling, Administrator DOH/Deputy Secretary Chelan-Douglas Health District ACTIVITIES & SERVICES ' INDICATORS V ` STANDARDS Data from the 2009 Inventory "; A survey on the use of they - - 1 641i 0 have been used to develop one- Public Health Indicators was In November the Partnership pagers to tell public health " ,A;. conducted during the Fall of (. : approved the adoption of a 2010. Results from the survey 1 `Basic' Set of Standards. This stories: �a4 344441'1;:v, Foodborne Illness .. show that indicators are used .4,10 option was developed to frequently bylocal health: ° `, enable all local health agencies H 1 N 1 �`�:'�``. TB To compare with others to participate in the 2011 These are intended to be simple For planning purposes Standards Review; and thereby meet the requirements to receive examples for use by anybody To identify or confirm issues Local Capacity Development when talking about what public For community education funds. The LHJ Review will take health does. Many suggestions were place between March and June In 2011, the workgroup will: offered for additional 2011. Explore a web based option indicators which the Public that would allow LHJs and Health Indicators Workgroup The nine Multi-State Learning DOH to enter their data will consider for the 2011 Collaborative (MLC) Grant directly beginning with the update. Additionally, the 2010 inventory workgroup will consider QI projects (prenatal care, Review the list of questions adding data to align with immunizations, physical • and revise definitions for CDC's winnable battles: activity) presented their culmination projects at a clarity. In general, the Tobacco Learning Congress in early questions asked at the 2009 Nutrition, physical activity December. inventory are good; the data and nutrition A MLC-sponsored training are relevant and useful and . a HIV . focusing on QI tools and important over time ' * Healthcare associated strategies is now available Begin to identify performance infections for viewing on the web. measures. The "5930" Motor vehicle injuries legislation that established Teen pregnancies The Community/State Health this work requires the For more information, visit Improvement Plans Learning identification of performance www.doh.wa.gov/phip/ Collaborative teams received measures to help improve intiative/phi/201 1.htm kick-off training in November health. • and are all working on the To view the data, look at the required elements of their plans. examples and for more For more information on any of information,visit S these activities, visit www.doh.wa.gov/phip/ www.doh.wa.gov/phip/ intiative/phas/2009.htm Mintiative/phs.htm • Board of 3fealth Old Business & Informational Items .agenda Item # IT., 3 • NO/IR/Vaccine Study Fraud'Update January 20, 2011 • Autism and 1v1NIK vaccine tuay an 'Lianorate rraua, unarges tsivu sprinter-rrienaiy) rage i ui 3 t www.medscape.com Authors and Disclosures ,na list Deborah Brauser is a freelance writer for Medscape. Deborah Brauser has disclosed no relevant financial relationships. From Medscape Medical News > Psychiatry scape Autism and MMR Vaccine Study an 'Elaborate Fraud,' Charges Medical News BMJ Deborah Brauser January 6, 2011 —BMJ is publishing a series of 3 articles and editorials charging that the study published in The Lancet in 1998 by Andrew Wakefield and colleagues linking the childhood measles-mumps-rubella (MMR) vaccine to a "new syndrome" of regressive autism and bowel disease was not just bad science but"an elaborate fraud." According to the first article published in BMJ today by London-based investigative reporter Brian Deer, the study's investigators altered and falsified medical records and facts, misrepresented information to families, and treated the 12 children involved unethically. In addition, Mr. Wakefield accepted consultancy fees from lawyers who were building a lawsuit against vaccine manufacturers, and many of the study participants were referred by an antivaccine organization. .Q.. , • ., r In an accompanying editorial, BMJ Editor-in-Chief Fiona Godlee, MD, Deputy BMJ Editor Jane Smith, and Associate BMJ Editor Harvey Marcovitch write that there is no doubt that Mr. Wakefield perpetrated fraud. "A great deal of thought and effort must have gone into drafting the paper to achieve the results he wanted: the discrepancies all led in 1 direction; misreporting was gross." k 4,, ' Although The Lancet published a retraction of the study last year right after the UK General Medical Council (GMC) announced that the A great deal of thought and 3 investigators acted"dishonestly"and irresponsibly,"the BMJ editors effort must have gone into note that the journal did not go far enough. drafting the paper to achieve the results he wanted:the Dr. Fiona Godlee "The Lancet retraction was prompted by the results from the [General discrepancies all led in 1 Medical Council] hearing and was very much based on the concerns direction; misreporting was about the ethics of the study," Dr. Godlee told Medscape Medical News. gross. "What we found was that it was definite fraud and that is a very important thing for the world to know. This article shows that the science was falsified and should be discounted," continued Dr. Godlee. This evidence "should now close the door on this damaging vaccine scare,"the editorial authors add. Damage to Public Health Although it included only 12 patients, faced almost immediate criticism, and never had its findings replicated, the study received wide media coverage and set off a panic among parents, with the result that MMR vaccinations decreased dramatically. 003 to 2004 vaccination rate of 80% has now recovered slightly in the United Kingdom, but it is still well below the recommended 95 o level recommended to ensure "herd immunity."A measles epidemic was also declared in England and Wales in 2008. "Perhaps as important as the scare's effect on infectious disease is the energy, emotion, and money that have been diverted away from http://www.medscape.com/viewarticle/735354.print 1/12/2011 Autism and MMR Vaccine Study an 'Elaborate rrauct,' Charges I3MJ (printer-trienaly) rage z or efforts to understand the real cause of autism and how to help children and families who live with it,"the editorialists write. Mr. Deer did his first investigative stories on the Wakefield paper in 2004 for the Sunday Times in London and a UK television network. On the basis of his findings, the GMC's Fitness to Practice panel convened in 2007 and heard from 36 witnesses during a period of 2 and a half years. • j At the end of January last year, as reported by Medscape Medical News , the panel used strong language in condemning the study's methods and noted that Mr. Wakefield and 2 other colleagues had broken guidelines. The Lancet issued its retraction 5 days later, citing the panel's findings that the participants were not consecutive patients seeking treatment and that the study had falsely reported being approved by an ethics committee. Mr. Brian Deer Although the GMC later found that Mr. Wakefield and coauthor John Walker-Smith committed serious misconduct and struck them off the medical register, Mr. Wakefield has repeatedly denied doing anything wrong. In addition, he was not among the 10 of 13 coauthors who disavowed the study's findings in 2004. "Instead, although now disgraced and stripped of his clinical and academic credentials, he continues to push his views. Meanwhile, the damage to public health continues,"the editorialists write. Multiple Discrepancies Found Last spring, the BMJ went to Mr. Deer to ask if there was more to this story. In this newest article, he reports that"multiple discrepancies" were found, including the following: • Only one of the studied 9 children actually had clear regressive autism and 3 did not have a diagnosis of any autism type; • Five had preexisting development concerns—although all 12 were classified in the study as"previously normal"; and • The exclusion of important allegations helped create "the appearance of a 14-day temporal link." In addition, none of the 12 patients were"free of misreporting or alteration," he writes. • "My number 1 takeaway is that it cost a tremendous amount of time and money to penetrate the It cost a tremendous amount veil of confidentiality that surrounded just these 12 children. So how on earth would anybody of time and money to penetrate the veil over other larger medical research?When Wakefield did what he did, it was penetrate the veil of on the assumption that no one would ever be able to find out the truth," Mr. Deer told Medscape confidentiality that Medical News. surrounded just these 12 BMJ fact-checked Mr. Deer's article against the 6 million–word transcript of the GMC panel's children. So how on earth hearing. Dr. Godlee said she is now calling for reexamination of all of Wakefield's past studies to would anybody penetrate the determine whether others should be retracted. "Past experience tells us that research veil over other larger medical research?When Wakefield misconduct is rarely isolated behavior," she writes. did what he did, it was on the But how did a small case-control study like this set off such a panic in the first place? "I think a assumption that no one lot of people would like to know the answer to that," said Dr. Godlee. would ever be able to find out the truth. "I think Andrew Wakefield is a terrifically good publicist. He managed to convince his institution to run a press conference for this very small piece of research. The media attention for this grew, and concerns were raised with his subsequent publications." In addition, she said that many parents have questions about why their children have developed autism and are looking for reasons to explain the onset of its behavioral symptoms. "MMR is a very common intervention, it seemed to fit the picture, and it's very hard to prove that something is safe despite overwhelming evidence that there is no link. "If you're looking for an explanation, this may seem plausible, although the science is nonsense. Overall, I think it's a combination of AO desperate parents looking for answers and a very clever man who was willing to lie and cheat, who was willing to try to advance his own career and financial benefits," noted Dr. Godlee. http://wvvw.medscape.com/viewarticle/735354___print 1/12/2011 AAutism and MMK Vaccine Study an 'blaborate Fraud,' Charges 1:5MJ (printer-triendly) rage i of i I Editor's Dread With questions raised almost from the start, how culpable is The Lancet?And how can other journals protect themselves from publishing falsI d studies? "Tha is the dread of any editor," said Dr. Godlee. "I think editors' main responsibility is to make sure that what is published is valid in terms of being good research. And I think The Lancet's decision to publish this is the first place was a very questionable decision, especially as it dealt with such a serious issue. "Why publish research that is not going to advance science and is going to create a vaccine scare? I think there is culpability there. But as for fraud, that is very tricky because science is based on trust,"she added. "None of us go back and ask for the case records of patients involved. But we need to become aware that any article that comes in could be fraudulent. And we have to be absolutely vigilant and investigate properly when concerns are raised. It's a constant cycle of oversight that needs to be done." Medscape Medical News contacted The Lancet for its reaction to the BMJ series of articles, but officials there had "no comment on this." Dr. Godlee said that she would also hope that coauthors would serve as backup for honesty in reporting and that all of this study's investigators "failed in their duties as authors"—especially since there were only 12 patients involved. "Adding a name to a paper carries a responsibility to ensure that no fraud has been committed. This should serve as a wake-up call for other researchers in the future. It's their reputation that Adding a name to a paper can be damaged if they are found to be associated with someone else's failures of integrity." carries a responsibility to ensure that no fraud has Diversion of Research Funds been committed. This should The editors write that although a breach of trust this large is"almost certainly rare," it raises serve as a wake-up call for q �ns about what could have been done earlier, what further inquiry is needed, and what other researchers in the can 6e done to keep it from happening again. future. It's their reputation that can be damaged if they Future BMJ articles in the series, to be published during the next 2 weeks, will deal with these are found to be associated questions and The Lancet's actions from study publication through retraction. with someone else's failures of integrity. "We wanted to also look at what motivated Andrew Wakefield, looking at the commercial schemes he established to exploit the MMR scare, and then we examine what happened when the issues of concern were first raised back in 2004 and why it was not taken more seriously at that time," explained Dr. Godlee. "To people who might ask why we're interested in all of this now, the answer is that what Brian Deer has unearthed is much more substantial than what most of us knew or what came out in the GMC hearing. This study was not only bad research but fraudulent as well. And it's taken an enormous amount of time and effort and money away from legitimate lines of inquiry," she concluded. Mr. Deer's original investigation was funded by the Sunday Times of London and the Channel 4 television network. The current articles were funded by the BMJ. He reported receiving no other funding except for legal costs from the Medical Protection Society on behalf of Mr. Wakefield. The editorial authors have disclosed no relevant financial relationships. BMJ. Published online January 6, 2011. Medscape Medical News©2011 WebMD, LLC Send comments and news tips to news©medscape.net. S http://www.medscape.com/viewarticle/735354_print 1/12/2011 Vaccine study's author vela reiatea patent, meaica>i journal reports - LININ.com rage t 01 t The Asian secret f ,,, . s How to ski for ,, ;\ . uto insurance too o stron lush u _�11 free at Park t" r.. , i , ex'ensive?How to cut hair City.,Utah ty �� our cost 1* CM1 r,", PRINTTHIS •c o $4, Powered by [lickability Vaccine study's author held related patent, medical journal reports By the CNN Wire Staffs:d =- i/div= v Wakefield did not immediately respond to a request for comment from CNN.But in an interview on an Internet radio site Tuesday,Wakefield again defended his research and called the BMJ series"utter nonsense" He said the patent he held was not for a test or an alternative to the MMR vaccine,as BMJ reported,but an"over-the-counter nutritional supplement"that boosts the immune system And he blasted allegations that he used the cases of the 12 children in his study to promote his business venture. "The children were not exploited."he said."They were seen because they were sick.They had clinical referrals.They came to us.We responded to a crisis." He also repeated his attack on the author of the BMJ report,freelance journalist Brian Deer,whom he has accused of being paid by the pharmaceutical industry.In financial disclosure forms. Deer has stated that he has received no such payments. Dr.Max Wiznitzer a pediatric neurologist at Rainbow Babies and Children's Hospital in Cleveland.said that if true.the latest BMJ allegations would indicate a major ethical breach "Assuming the facts Deer lays out are correct,it is disappointing that Wakefield in his book casts aspersions on others for all their purported conflicts of interests and failures of disclosure,yet does not examine the same issues in himself,"Wiznitzer said."Therefore.those who are trying to objectively evaluate the situation have up to this point not been given all the facts." reported the business venture failed to launch after Wakefield's superiors at University College London's medical school raised concerns in 1999 about a"serious conflict of interest" en his research and the company formed to launch his new product. "This concern arose originally because the company's business plan appears to depend on premature,scientifically unjustified publication of results,which do not conform to the rigorous academic and scientific standards that are generally expected,"a letter stated.But the university offered him a year's paid absence and help in replicating his original research with a larger group of 150 children in the name of"good scientific practice." The follow-up study never occurred,and no other research has duplicated Wakefield's original findings.BMJ reported.He left the university in 2001,and BMJ quotes his former boss as saying the school"paid him to go away." The BMJ pieces area series of investigative reports.not a clinical study.The journal's editor-in-chief,Fiona Godlee,said last week that of the 12 children Wakefield examined in his 1998 Lancet paper,five showed developmental problems before receiving the MMR vaccine and three never had autism, According to BMJ,Wakefield received more than 435,000 pounds(about$674,000)from lawyers trying to build a case against vaccine manufacturers--a serious conflict of interest he failed to disclose Most of his co-authors abandoned the study in 2004,when those payments were revealed. The now-discredited paper panicked many parents and led to a sharp drop in the number of children getting the vaccine that prevents measles.mumps and rubella Vaccination rates dropped sharply in Britain after its publication,falling as low as 80%by 2004 Measles cases have gone up sharply in the ensuing years. n the United States,more cases of measles were reported in 2008 than in any other year since 1997,according to the Centers for Disease Control and Prevention.More than 90%of those ,nfecied had not been vaccinated or their vaccination status was unknown.the CDC reported. CNN's Miriam Falco contributed to this report. Find this article at: http://www.cnn.com/2011/HEALTH/01/11/autism.vaccineslndex.html?hpt=Sbin Check the box to include the list of links referenced in the article. ©2008 Cable News Network i http://cnn.site.printthis.clickability.com/pt/cpt?expire=&title=Vaccine+study%27s+author+held+related+p.,. 1/12/2011 • Board of 3Cealt(1 Odd Business & Informational Items .agenda Item # 1V., 4 • Jefferson County B03-f 200.9-2010 Thumbnail of BoardActivities January 20, 2011 • 9 © t 5 3 9 CO 9 9 NJ /% \ / / % % CO 2 2 CO \ [12:3 6 G 6 e G G 6 Q G G e• / / / / / / / / / / / « 0 0 0 0 0 o e e o o m CD S. 0 > 0 2 < 2 m = 2 I \ e 0 O Z r 0 f co \ \ Cr / % \ k & § \ ° CI) . 5 = 0 6 5. 2 -. 3 / o- Ed \ cn 0 \\ o Cr \ Co o 5:. / \& R / y 5. ¥ m ] g O - o m m. 7 0 7 5 = 3 2 m = § °\ \ ƒ 3 i ( 0 ° 8 3 ° co \ o §. m = _ < < r e _ CD 0) m m m a � m_ / \ I- � _ CO ° \ ƒ % 0 \ / > \ o k \ \ / § A a) % 0 \ \ \ f - o co 0 / = _\ < m I c e a \ % \ Co N 0 » < q 7 ° 7 § _ C 7 _ » ° ® Cl) m / / / \ o -13 c : = k 0 5' J J a S = D m CO e = 2 - 0 H m m I -0 0 \ c @ 0 / CO / ƒ $ / § k I / oc \ § m / \ co _\ a =SU ( e ® ° 0 0 co III \ ° \ \ 71 C C__ k 3 \ 2 2 m E c 73 @ — _ / % § e (0 ° 2 0 / CD \ o CD k ® k CD / = CD 3 co > 2 2 \ I I Z E E I co r 0 e > o _\ o ° 0 o o ° i C � 0 6 5. 5 5 o \ / CCD .2. = 3 = 5 = _ = a E / 0 g 5 0 o o 0 / c 0 \ , a! g k % % co $ m A) CD / $ a k \ k $ k k k c m m 0 \ 0 \ c 5 \ < = m C \ 0- 0 \ /. 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The revised rule has been adopted by the State Board of Health and filed with the Office of the Code Reviser. The changes will be effective February 4, 2011. Thank you for your participation and feedback in improving notifiable conditions reporting in Washington State. This rule revision process involved making updates necessary to address new conditions and new laboratory methods. On October 21, 2010, we sent notice of the proposed rule revisions. Since that time, only clarifying changes were_made to the rule. The final revised rule language is attached to this email, and will also be available at http://www.doh.wa.gov/Rules/adoptedrules.htm by January 17, 2011. The Communicable Diseases Epidemiology Section of the WA Department of Health is coordinating communications regarding rule change. We will be publishing additional information and guidance via the following sources: • Updated Public Health Investigation Guidelines will be posted to • http://www.doh.wa.gov/notify/forms/ before the February 4 effective date. • New notifiable conditions posters for health care providers, clinical laboratories, health care facilities, and veterinarians, will be distributed to local health departments to share with their communities. • The upcoming issues of the EpiTrends and ELaborations newsletters will address notifiable conditions rule revisions. The following is a summary of key changes made to the rule: For health care providers and facilities, a few notifiable conditions have been added (prion disease, lab-confirmed influenza-associated death, and varicella-associated death) . Two conditions have been removed (typus and hemolytic uremic syndrome, to be addressed by reporting of Shiga-toxin producing E. coli) . Rare diseases that must be reported immediately are listed individually (e.g. anthrax, Burkholderia, smallpox, etc) . For clinical laboratories, the list of notifiable conditions is now consistent with the list of notifiable conditions for health care providers and facilities. Some specimen submission requirements have been added (most notably, any available cultures of pertussis, Listeria, and Cryptococcus other than known v. neoformans) . While not part of the rule revisions, the public health laboratories would like to remind clinical laboratories that specimen labels and forms must include two identifiers: patient name AND a second identifier, e.g. date of birth. For veterinarians, reporting requirements have been coordinated between the Department of Health and the Department of Agriculture. Veterinarians are to report only suspected human cases of specific zoonotic diseases, based on the human's exposure to a confirmed animal case of the disease, to local public health. Animal cases of these diseases are to be reported to the Department of Agriculture, which will then share information with public health. Reporting timeframes have been modified. A new category, reportable within 24 hours, was created, and some conditions have been shifted from immediate reporting and 3 business days lip reporting. The system for locating reported cases has been improved. The revisions to the rule specify that health care providers and facilities must provide patient identifying information, including at least zip code of residence, to clinical laboratories when ordering lab tests for a notifiable condition. By January 1, 2013, laboratories must have databases capable of storing and retrieving this information. For any questions or comments, please contact Tracy Sandifer, Department of Health project coordinator (tracy.sandifer@doh.wa.gov) or one of us. Best regards, Dr. Anthony Marfin and Dr. Diana Yu Co-Chairs of the ad hoc advisory panel • • 2 • Board of 3feaCth Wow Business .agenda Item #17., 2 � .adoption of Policies and BOAC Role January 20, 2011 • JEFFERSON COUNTY BOARD OF HEALTH • Guidelines for adoption of Policies, Procedures,and Protocols (Repeals and Replaces Jefferson County Health Department Environmental Health Service Policy Statement Number 2-88 (adopted June 22, 1988) Purpose: The development and adoption of policies, procedures, and protocols is an essential part assuring quality, accountability, and consistency in the provision of public health services. The following guidelines establish criteria for determining when a policy, procedure, protocol, or guideline should be developed. Definitions: Generally defined, a policy is a plan or course of action intended to influence and determine decisions, actions, and other matters. Policy:Two major types of policy statements are utilized by Jefferson County Public Health: Board of Health policy: a statement of intent by the local Board of Health involving its statutory authority as outlined in RCW 70.05. These areas of authority include, but are not limited to, enforcement of the rules and regulations of the State Board of Health, interpretation and enforcement of ordinances and codes adopted by the Local Board of Health, and the enumerated powers and duties of a local board of health (RCW 70.05.060). Board of Health policies may also contain specific procedures for carrying out the policy intent of the Board (e.g. • Policy on the Minimum Lot size for an on-site sewage system) Administrative policy: a plan, standardized practice, code of conduct, or course of action established by Jefferson County Public Health administrators to promote the quality, efficiency, and consistency of program services. Administrative policies may also contain specific procedures (i.e. a series of steps to accomplish a defined goal) (e.g. Policy on Public Health Employee Vaccinations) Protocol: A step-wise plan,generally based on evidence-based standards and expert opinion that specifies actions taken to respond to an incident, carry out a medical procedure, or otherwise perform a series of actions in a highly consistent fashion. (e.g. Protocol for Responding to Potential Exposure to a Bloodborne pathogen) Guideline: An education document produced to explain existing policies, regulations, or other health- related codes. A guideline does not create new policies, procedures, or protocols but merely explains them in a manner designed to assist community members in understanding the purpose and requirements of specific health regulations. (e.g. Guideline on Disposal of Household Hazardous Waste) Adoption of Policies: • Board of Health policies are adopted at the direction of the Board or in response to a specific need to clarify existing public health authority. Board of Health policies may be adopted, amended, or repealed at any regular public meeting of the Board of Health. 111 615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368 (360)385-9400 • Administrative policies are developed and adopted by the Health Director or Environmental • Director, with the concurrence of the Health Officer,when appropriate. At a minimum, administrative policies sufficient to fully meet the "Standards for Public Health Practice" as promulgated by the Washington State Department of Health are adopted and regularly reviewed by Jefferson County Public Health directors. • Protocols and Guidelines are developed by program staff, reviewed and approved by appropriate managers, and distributed to employees or the general public as appropriate. Protocols and guidelines are scheduled for periodic review for updates. Jefferson County Board of Health, Chair Date • Board Members Chuck Russell, Chair,Hospital Commissioner,District#2, Kristen Nelson, Vice Chair,Port Townsend City Council Phil Johnson,County Commissioner District#1, David Sullivan,County Commissioner,District#2, John Austin,County Commissioner, District#3, Sheila Westerman,Citizen at large(City), Roberta Frissell, Citizen at large(County) • 615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368 (360) 385-9400 • Board of 3CeaCth Netiv Business .agenda Item #17., 3 • Environmental fealth Policy Revisions: Tooc(Safety Program January 20, 2011 • JEFFERSON COUNTY BOARD OF HEALTH • Department: Division: Section of Procedure Manual: Jefferson County Public Health Environmental Health Food Program Title: Food Establishment Inspection Frequency Policy Subject: Inspection schedule requirements Effective (date): Replaces (date): Review due (date): Page: 1 of: 2 01/01/11 E.H. Policy Statement 01/01/13 Food Establishment Inspection Frequency Purpose: -WAC 246-215 (Working document section 8-401.10 - B 2) allows local health jurisdictions to assign inspection frequency based on risk. -WAC 246-215 (Working document section 8-405.20) does not address specific criteria for re-inspection when red-point violations have occurred. This policy defines this issue. Routine Inspection Frequency: ✓ All Limited Menu (includes bakery, B&B, concession stand, espresso stand, grocery, meat/fish market) establishments shall be on an inspection schedule of at least 1 inspection every 12 months. ✓ All Complex Menu (includes complex mobile unit, complex restaurant, caterer) establishments and school kitchens shall be on an inspection schedule of at least one inspection every 6 months. ✓ All Temporary food establishments shall be inspected at least once during the permit period. (Limited menu temporary food establishments that have a history of no red point violations may be exempted for 1 year.) Re-inspections: ✓ A Food Establishment with violations totaling 35 to 104 points shall be re-inspected within the timeframe specified for correction on the inspection report and charged a first re-inspection fee. ✓ A Food Establishment that fails to correct all of the violations noted in the first re-inspection report shall be re-inspected and charged a subsequent re-inspection fee for each re-inspection after the first. Failure to correct violations at this time may be grounds for suspension of permit. ✓ A Food Establishment with violations totaling 105 points or above shall have their operating permit suspended. (See WAC 246-215 working document section 8.601.11 for regulations regarding suspension of permit). ✓ A Food Establishment may be required to have an increased inspection frequency, at the discretion of the Health Officer. Fees shall be charged for these additional inspections. i 615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368 (360)385-9400 11, Pre-opening Inspections: V An inspection of a food establishment shall occur prior to opening for the first time, or at any time an establishment goes through a remodel, menu change, service change, ownership change, etc. A pre-opening inspection fee will be charged. Re-opening Inspections: ✓ A re-opening inspection may be required for establishments that have had their operating permit suspended, or have been closed by the Health Officer for operating without a valid permit ,or were closed due to fire, power outages, sewer back up or lack of water, or were closed at the sole discretion of the owner. This policy shall remain in effect until amended or repealed by action of the Jefferson County Board of Health. Health Officer Date Chairperson, Jefferson County Board of Health Date • S 615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368 (360)385-9400 JEFFERSON COUNTY BOARD OF HEALTH • Department: Division: Section of Procedure Manual: Jefferson County Public Health Environmental Health Food Program Title: Destruction of Potentially Hazardous Foods Policy Subject: Time and temperature relationships, exceptions & procedures for potentially hazardous foods Effective (date): Replaces (date): Review due (date): Page: 1 of: 2 01/01/11 10/09 01/01/13 Destruction of Potentially Hazardous Foods Refer to WAC 3-701.11 Based on evidence and information provided by the Person in Charge, the inspector shall determine the appropriate course of action regarding temperature abuse of potentially hazardous foods. The following time and temperature relationships shall guide the inspector, but the decision shall be at the sole discretion of the inspector(the regulatory authority). The following time and temperature relationships shall be followed concerning the destruction of potentially hazardous foods. Potentially hazardous foods shall include (but not be limited to) any food which consists in whole or in part of milk products, eggs, meat, poultry, fish, shellfish, edible crustacean, or other natural or synthetic ingredients capable of supporting rapid and progressive grown of infectious or toxigenic micro-organisms. • See definition of potentially hazardous foods in WAC 246-215.P 1. Foods found between 41 F and 60 F shall be rapidly cooled to a temperature of 41 F or below. 2. For foods found between 60 F and 70 F, the following guidelines shall be used: a. less than 3 hours- rapidly cool to 41 F or below b. greater than 3 hours -discard all portions 3. Foods found between 70 F and 110 F shall be discarded unless in the process of being rapidly cooled or heated. 4. Foods found between 110 F and 120 F, the following time guidelines shall be used: a. less than 3 hours - reheat to 165 F and hold at 140 F or above b. greater than 3 hours -discard all portions 5. Foods found between 120 F and 140 F shall be rapidly reheated to 165 F and maintained at 140 F or above. Exceptions 1. Discard large volumes of food (i.e. using 5 gallon containers) when the temperature is 50 F or more and the Health Officer or their representative suspects the food has been cooling from 140 F for • longer than 8 hours. 615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368 (360)385-9400 2. Rare roast beef a. Rare roast beef shall be discarded if found displayed for more than 3 hours at 100 F or less. b. If the roast is at 110 F or more and it has been out of the cooking process for not more than 1 hour, then it shall be further cooked to 130 F and then served. c. If the roast is at 110 F or more and has been out of the cooking process for more than 1 hour but not more than 3 hours, then it shall be immediately divided and cooled to 45 F or immediately reheated to 165 F. Enforcement 1. The Health Officer or their representative shall always attempt to obtain voluntary condemnation of food in violation. The "Jefferson County Health Department Voluntary Condemnation Agreement" form shall be used for this purpose. 2. If the operator refuses, then the inspector will complete a "Certificate of Diversion, Destruction or Waiver". Examples on prescribing mandatory diversion or destruction are: a. Diversion -"remove from premises" ... "feed to non-commercial" ... "take home, not to be serviced to public". b. Destruction - "place in dumpster, etc. and denature with bleach/cleanser, etc... 3. If the operator refuses to cooperate, the inspector will consult the Health Officer, Environmental Health Director, or Administrator to decide one of the following: a. Issue a hold order on the food and require a hearing, or • b. Suspend the permit due to an imminent health hazard. This policy shall remain in effect until amended or repealed by action of the Jefferson County Board of Health. Health Officer Date Chairperson, Jefferson County Board of Health Date 41, 615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368 (360)385-9400 JEFFERSON COUNTY BOARD OF HEALTH • Department: Division: Section of Procedure Jefferson County Public Health Environmental Health Manual: Food Program Title: Mobile Food Service Establishments Policy Subject: Clarification of WAC 246-215 (Food Code Chapter 9-1) Effective (date): Replaces (date): Review due (date): Page: 1 of: 3 01/01/11 E.H. Policy Statement 01/01/13 Mobile Food Service Establishments Purpose: This policy provides clarification of WAC 246-215 (Food Code Chapter 9-1). Since a mobile unit is defined in the food code as a readily movable food establishment, the mobile unit must: 1. Retain its wheels 2. Be readily movable within a matter of a few hours A mobile unit may locate routinely at the same location if the Commissary Base of Operations Plan is approved by the Health Officer and the Planning Department, and the operator adheres to all applicable codes. Mobile Unit Categories: Listed below are the general categories of mobile food vendors and the additional requirements needed to be a permitted food establishment. 1 Mobile, Limited Menu: No cooling or reheating, hot holding OK. Examples include hot dogs, commercially canned chili/soup, pizza, espresso, cook and serve burritos, cook and serve burgers, etc. 2. Mobile, Complex Menu: Cooling OK in commercial kitchen, reheating OK on board. When reheating on board, food must be reheated for hot holding from 41° F to 165° within 1 hour. Note: If food is from a commercial food processing plant, reheat to 140° F is OK. This policy shall remain in effect until amended or repealed by action of the Jefferson County Board of Health. Health Officer Date Chairperson, Jefferson County Board of Health Date • 615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368 (360)385-9400 JEFFERSON COUNTY BOARD OF HEALTH • Department: Division: Section of Procedure Jefferson County Public Health Environmental Health Manual: Food Program Title: Waiver from a Temporary Food Service Permit Policy Subject: Policies for waivers temporary food service permit for non-potentially hazardous foods Effective (date): Replaces (date): Review due (date): Page: 1 of: 1 01/01/11 10/09 01/01/13 Waiver from a Temporary Food Establishment Permit Effective this date, the following policy shall be adopted concerning a waiver from a temporary food service permit for non-potentially hazardous foods. WAC 246-215 "Temporary Food Establishment" definition p. 10 WAC 246-215 8-301.2 "Exempt from Permit" p. 74 The Health officer, when no health hazard will result, may waive or modify requirements of these regulations. 1) A waiver from a temporary food service permit may be issued for the preparation and serving of . non-potentially hazardous foods at temporary events as defined in WAC246-215 "Temporary Food Establishment", p. 10. The waiver shall expire at the end of the calendar year. 2) Applications for a waiver shall be filed in person on forms provided by the Jefferson County Public Health a minimum of two working days before the event. 3) A fee shall be charged. This policy shall remain in effect until amended or repealed by action of the Jefferson County Board of Health. Health Officer Date Chairperson, Jefferson County Board of Health Date • 615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368 (360)385-9400 • Board of.9' CeaCth New Business Agenda Item #T., 4 • Public Records Requests 2010 'Volume and�ime January 20, 2011 1 • • 7cc D 0,-121,, yID,D vt r_ r m 1,.. KIA O < 01.- n O , 0 .-- Dlv to to 1 1 m m v 2 n n n i ,z 2 N < Olp r < p 1 � z z D D D m m = n .,, m e x n O x x x m D DI3 3 x to o _ F; m 0 m ,�, <I G mlm 2 0 0 0 z Z < m m 0 v<, v D x �, 3 z O D O r^ 0 0 = G1 `n �c - - z �c n x D x� F' T O p 0 > m Iz AIZI➢'➢ -y 1= to 5 m D DD m N N < m D D v r'ir Z mv+ Ll - gym IA m = ml C RTI n = ml Sc ➢ ri inlin I 1 1 I Ho� i� m vii m - 1 f I ! i 1 I I 1 1 1 1 O v v I I 1 I I z Z °� mm' I I I I I 1 I I 1 I -1 0 0 3 , 11111 I me • oo.N . p m o r' 1 ! l 1 0;n,m A . m',O'G7�j m to elm D 7 m.'X D y,A1 O mt rO--E pi m .44: i._<� �.-_. L _.I v K n w D *. m p .p G K W v m�m I,,3 -,g1›.1. vinl<niA O aoW w 2 w v mv, = fi m m C�.. 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D it 1 N Z 2 I '� I .v, z m- I IDI i D I i DAi 11 I [n 1 f co C i O n' ISI1,-:, < 5 d m Z n < to Z - �ml 1 A Pa v Z m to �1 O pm to 1 1. m I f,,, z1 G mi m O i 'm' m.0 z w 3 v z.'-I. o m Z In tni 1 'pi IN I�� 1 i D in -�'� v a o -m a n, j 1 Imi j zl I 1 z n n. 5. m m m I mI I 'p I G � < 0i1� ' 1 ; 111 I�iI a I ' M J 0, I I I I I I I 0 1 1 1 1 1 I l 1 1 III c 1 �' I ! I 1 I I 1 I 1 1 1 1 l i 1 1 lII I I L I_ I 1 �_ � 1 �- 1 , f 1 i i,.. ,_. W 0 Board of 3fealth Netiv Business .Agenda Item #17., 5 • Zoii '14/SA1P.7C0 LegisCative .agenda January 20, 2011 • 0 • • rage ► oti Cathy Avery From: Bob Lutz [teamab@msn.com] •Sent: Tuesday, January 11, 2011 8:32 AM To: Cathy Avery Subject: board of health information Attachments: 2011 WSALPHO Legislative Agenda.pdf Ms.Avery Would you please forward this to your Board of Health members? Thank you Bob Lutz Dear Local Boards of Health members, Attached,please find a copy of the Washington State Association of Local Public Health Officials'(WSALPHO)legislative agenda for 2011. With the many public health issues confronting Washington and its residents,it's important that local Boards of Health have a voice in concerns affecting their constituents and coordinate their efforts around critical funding issues. I would like to invite you to consider additional opportunities to coordinate efforts among local Boards of Health.While there are issues that may be unique to your jurisdiction,there are also many commonly shared concerns.There is currently an on-going effort to facilitate communication between Boards of Health across the State.If this is something of interest,please feel free to contact me and I, or others in a work group,will be in contact. Respectfully, RB Lutz,MD MPH Member,Spokane Regional Board of Health eamab@msn.com • 1/11/2011 2011 WSALPHO Legislative Agenda • Maintain Public Health funding,including: • • Retain non-categorical funding(flexible funding) • Sustain"5930 funding"(funded from the Tobacco Control Account that is exhausted 7/1/2011). :• Support efforts of WSAC and others to provide counties with more funding tools;help to develop public health funding solutions while balancing local-level needs and budget constraints. • Eliminate costly or unfunded programs with requirements that do not further public health protections,including: • On-site inspector certification • Land fill inspector certification • Promote Public Health policies that improve the quality of life for Washingtonians,yet don't require a substantial investment of financial resources,including: • Drug take-back programs • Increase immunization rates(tighten exemption criteria) • Identify priorities for the next Public Health funding investment or other funding opportunities (e.g.:grants)that are aligned with WSALPHO priorities,such as: • Core functions • Align with Reshaping Governmental Public Health efforts • Public Health Standards review/National Accreditation • WSALPHO Budget Principles • Build a budget that emphasizes effective and efficient public health services to save lives and long term costs. Prevention strategies to control and reduce the cost of medical care are critical as we look toward the 2014 implementation of health care reform and expansion of coverage. • Ensure local public health jurisdictions retain flexible funding to respond to their community's unique needs,while implementing performance-based contracting that ensures payment is based on meeting consistent standards and performance measures. Maintain the basic,statewide public health infrastructure that is ready to protect public health safety; respond to disease outbreaks, bioterrorism and other disasters. S Board of Health 314edia Reyort • January 20, 2011 • f Jefferson County Public Health December 2010/January 2011 NEWS ARTICLES 1. "Easing the transition to parenthood," Peninsula Daily News, December 15th, 2010. 2. "Finally: An owner's manual for kids," Port Townsend Leader, December 15th, 2010. 3. "Secure disposal of old drugs to become easier," Peninsula Daily News, January 12th, 2011. 4. "Majority of U.S. adults had troubled childhoods: CDC," USA Today, December 17th, 2010. • • r !asing the transition to parenthoo {. Child-rearing TO D - ; 1, ; t�.Q i�,. k X248 h+��F +. ;� er Ph steal i- t I' y d"� :ojp� aft s ,t4,1 guide created JenniJacksfer Y Y } A" Y ` 3fe� ` s Therapy. i / t� `;:VM4 - '�4 1-" , i'l-Rt aT y t v!ssa After Soren7a i f Ti` t z by 3 mothers �w was born,she , ,4' ,, ( s � 4 ` t , 4Tyi' �-�� , 2 xx discovered n ' a # ti e� : another social €, A,I.�`" ¢�7 t 3 "�, �1 .� ze e*n tf WHICH CHURCH 7 , outlet the 4 � 4 OFFERS free child care at a Breastfeeding ' a.k d'', :145V4):'', ..` "mow's Time Out"from 9:30 a.m. . Tea on A to 11:15 a.m.Monday mornings? b Wednesdays r g« "t ' ;� re - bw Whichgourmet, ' t "� i., ""� ' t it.'2..."-<.•::".•,--::;5,'-',..;:',-.",-" g from 1:30 p.m. xttl ... y�s ' � r y 52����ur.. r restaurant welcomes families �,,," to 3 p.m.at the ,,- ' x � .r x r ,„ , f r,, r • and has a"kids eat free night Jefferson ` Tf r , r 'dr,#',f .,4 ,z,. a' f "�' 1 Wednesdays? County Public a T N ,1S ' n ,' ,c ,�, And where in Jefferson Health Department in Port > ,%"",4 r. ' ., :„,,,,,,,,47.,,,,„:44.** County can you buy a diaper Townsend. v s?�.' si a g r <4• k ”"%`s. ' cake? "It was my lifeline,the thing I :.„ ' �It " 7= " • ..4` ': If you know what a diaper looked forward to once a week," `,...,..e-,,,,,,2i,,..%0,w ,,,' y ,, cake is,you may also be in the Randall said."You could get out 7 ' , :,, ;3,s , market for the latest accessory of the house with your kid" I,,,,./ a , ` � a for new parents:The Little Guide That's why the Breastfeeding l r `} c.1,701'...,., *�- ` for Little Ones(and Their Fami- � ,t r ;. r t, " '"� Tea is the first thing listed in T/ce , „� � ,� E � � ��� � �.� lies)—Birth to Five Resources in Little Guide,under the"Connect- h. "°sir�7 ; �" c ,..._2„ Jefferson Jefferson County. ing with People"heading in the ' a ,7 x� .` .,�� — ,,, Created by three mothers,the "Getting Acquainted"section. 31 r s , E,. .x` E .`t- "�; guide—which made its debut at Another example is a weekly "4414 — t' , ' .f a book release party Saturday— drop-in parenting group in Quil- m z,.w k f -� ? � `s is designed to ease the shock of a cene on Wednesdays from 10 a.m. ; 1 z t.4a >..4 p. ,' .4:,,,....,..41,..-„v4-ti life-changing event. to 2 p.m.—where kids play t _ :.; s ,r#'mr ,. JENNIFER Jncuwn eon "I had no idea of what it was while parents exchange war sto- E iatttw DAILY 1r to have child,"said Shelly Opie ries,discuss concerns with a pub- IMom Sarah Rubenstein,right,helps to hold the book,but 17-month-old Yemaya dali,a writer/editor who lic health nurse,browse the (Rubenstein,center,does most of it on her own as she leafs through The Little Guide for ped compile the guide. resource library or exchange Little Ones at Saturday's book release party.Noah Isenberg,2,left,plays with a maze. "It took awhile to find a corn- books and children's clothing. :Sarah McNulty,Noah's mother,is behind him.The third adult is Shelly Randall,one of munity of other moms." Another resource:the First The Little Guide creators. Teacher program's free monthly Three creators newsletter and development about the Port Townsend Cooper- Grant Street School offers a mother,Randall said,because A year in the making,the guides for children from 3 ative Playschool,where she now series of three free classes called that's when she has the time to guide was the brainchild of months to school age. goes with her daughter,Norma. "Ready for Kindergarten."A local read it. Robin Mills,a teacher in Chi- The Little Guide also lists Norma Avila,who has two dentist offers free"happy visits" The Little Guide is$10 and is nacum School's Pi program. playgrounds,pools,parks and sons,Carlos and Daniel,said to familiarize young children available at Henery's Hardware The mother of Ruby,then 4, beaches in Jefferson County,as the Cooperative Playschool was with the dental office and the stores in Port Townsend and an important resource at a time importance of dental hygiene.At Quilcene,Sport Townsend and and Bailey,2,Robin came up well as Sequim and the Silver- when she had a huge change in a local grocery store,kids can Seams to Last. with the guide as a fundraising dale area,and play spots near her life. sign up for a card that entitles To order a copy by mail or idea for the Port Townsend Coop- ferry terminals and airports as Both Gregg and Avila brought them to a free apple,banana or support the project by buying erative Playschool,which is afHli- part of the"Out and About"sec- their children to the book release carrot at each visit. copies to be distributed,send a ated with Peninsula College's tion. party,.which was held at Ran- And on Page 21,under"Dia- check to the Port Townsend Family Life Education program. The"Events and Activities" dall's house,as did Luke Cher- pering Resources,"you can find Cooperative Playschool,P.O.Box Mills recruited graphic section offers five pages of classes ney,who brought daughter Eve- out where to order a diaper cake, 768,Port Townsend,WA 98368. designer Tonya Cole,whose and camps,grouped by type lyn and her friend Aurora. the ultimate centerpiece for a You can designate where you twins,Ana and Jack,were 2 (music,art,exercise,etc.),that "It's nice to have something baby shower. want the copies to go and in years old at the time,and Ran- include age eligibility. like this,where you're not relying People whose children are whose name. dall,,whose son,Soren,was a just on word-of-mouth,"Cherney grown can buy a guide to be For more information.e-mail year old. • Options offered said of the guide. placed in a church,public health Robin Mills at ptcpjundr-aisingr All donated,their time to ere- "One thing about the guide is center,women's shelter or other gmoil.coni or phone 360-385- ate the book. the different options,like two More births community outreach program, 2517. "It's been a long haul in our pages of preschools,"said Sarah When Evelyn was born,Cher- the editors suggest. For more information about limited spare time—a project of McNulty,mother of Noah Isen- ney said,the nurses told him and Having the guides available at Port tolTownsend il PTCP Cooperative Play- the heart,".Randall said. berg,2."If you Google Port spouse Audrey Cherney,a the three WIC(Women,Infants Randall•had lived and worked Townsend and preschool,you get childbirth educator who is and Children)clinics would be a menibersliip@gninil.coni or phone in Port Townsend for 10 years two." expecting again,that Jefferson natural way to reach mothers of Dana Maya,360-301-6626. but discovered that once she gave For Bridget Gregg,the first County was experiencing a b birth her social options nar- connecting point was the Port in the number of babies beingump young children throughout Jef- ferson County,she said. rowed. Townsend Library's Baby Hour. born.So a resource guide for par- "The conduit is there,"Randall Jennifer Jackson writes about Pon But she had a place to start Gregg moved to Port Ludlow ents is an idea whose time has said. Townsend and Jefferson County every f expanding it:the women she had..from.Seattle.five.yeai•s ago after come. And the guide,sized to fit into Wednesday.To contact her with items or iet in the Fit Momma classes her son,Riley,was born. Other"Did You Know?"list- a diaper bag,makes a great baby this column,phone 360-379-5688 or �r expectant mothers at Discov- At Baby Hour,she learned ings:When your child turns 4, shower gift for an expectant e-mail jjackson@olypen.com. • • /a/rs/o 1 ii � ��.8 o a ° ''' 'lA c c i.0 n `�m C ° i o-o 0 �,�PV p C-1 N • ,.f :,„ -_,0,. ----- _ rip. "^�j 1 N y U.) V p 'V i O Y V a� a m 11 (lllllllfllll 0 A ui o 3 y }V'{ 0 •a c-o ma y'. ' • J CO 0 - L, 'fl O ~~W.. V n• CC r ^,fid T . L d "4-.~ aU '.�c, A wLLy OC J. 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Cr,s? = m4"4 •[ w .9-0 a a"i .4 o c w U 3 U v Q o 4 o v o f ` Format Dynamics :: UleanFrint :: http://www.usatoday.com/yourlite/parenting-tamilyizU 1... gage 1 or 2 0 II • children, nearly 15% had been physical abused, and M aj o ri ty of U.S. more than 12%—more than one in 10—had been sexually abused as a child. a d u I is had troubled Since the data are self-reported, Edwards believes that the real extent of child abuse may be still childhoods: CDC greater. "There is a tendency to under-report rather than over-report,"she said. The findings are published in the Dec. 17 issue of the CDC's journal Morbidity and Mortality Weekly Updated 4h 4m ago Report. By Steven Reinberg Health Day For the report, researchers used data from the Behavioral Risk Factor Surveillance System,which surveyed 26,229 adults in Arkansas, Louisiana, New Mexico,Tennessee and Washington. Edwards is cautious about extrapolating these results, but ., r based on other data they probably are about the s same in other states, she said. • x � While there were few racial or ethnic differences in ,.<, • ' b reports of abuse, the report confirmed that women �� were more likely than men to have been sexually abused as children. In addition, people 55 and £ -ii-.' older were less likely to report being abused as a �A By Pixiand Ge>ty inn agesiPixland child compared to younger adults. . Many parents say They hide their stress from their One theory why older people did not report as much children,but psyci�aiogicai esearchers say kids are rchildhood abuse is that since these takes a toll on more aware than adults thinkhealth in adulthood, many of these older abuse victims may have died early, Edwards said.The CDC report, for example, notes that adverse childhood experiences are associated with a higher risk of Almost 60% of American adults say they had difficult depression, heart disease, diabetes, cancer, childhoods featuring abusive or troubled family substance abuse and premature death. "So members or parents who were absent due to (childhood abuse) may be associated with years of separation or divorce, federal health officials report. Advertisement In fact, nearly 9%said that while growing up they underwent five or more"adverse childhood experiences"ranging from verbal, physical or sexual abuse to family dysfunction such as domestic violence, drug or alcohol abuse,or the absence of a parent, according to the U.S. Centers for Disease Control and Prevention (CDC). "Adverse childhood experiences are common,"said study coauthor Valerie J. Edwards,team lead for the Adverse Childhood Experiences Team at CDC's National Center for Chronic Disease Prevention and Health Promotion. "We need to do a lot more to protect children and help families,"she said. About a quarter of the more than 26,000 adults surveyed reported experiencing verbal abuse as • Print Powered By =-EA _. .,r, d:::,` http://www.usatoday.com/cleanprint/?1292624924231 12/17/2010 rormat uynamics :: uteanrrtni :: nup://www.usatouay.wm/yuuritteiparettung-tatuity/Lvt... rage zr, low Via * life lost,"she said. this problem, Sanders said. S There was no difference in the number of people "These interventions are important not just because reporting childhood abuse in any other age group, abuse is so common, but because of the lifelong Edwards added. health implications,"Sanders said. "There is a connection of these events to lifelong implications, Adverse childhood experiences included in the not just for mental health for adults, but also for report included verbal abuse, physical abuse, s physical health." exual abuse, incarceration of a family member, family mental illness,family substance abuse, For example, a person who has several of these domestic violence and divorce. events is more likely to get cancer and heart disease, Edwards said. "This is serious and it's not According to the report, about 7.2% had had a just a quirk of statistics. It's a real relationship." family member in prison during their childhood and 16.3% had witnessed domestic violence in the family home. In addition, about 29%grew up in a home where someone abused alcohol or drugs."These cases occur across all racial groups and ethnicities,"Edwards noted. Almost one in five respondents (19.4 percent) had lived as a child with someone who was depressed, mentally ill or suicidal,the report noted. Although the volume of abuse and dysfunction is significant, such traumatic experiences cannot be used to describe a person or determine what that person will be,the researchers cautioned. Instead, they said, keeping track of these abusive • experiences is important to gain a better understanding of them and their effect on society. In addition, it's crucial to work harder to prevent abuse and household stress as well as finding better ways to identify and treat children at risk,they said. "For adults who have had these experiences and feel Advertisement they are still causing them problems,they are not alone and there is help available," Edwards said. Dr. Lee M. Sanders, an associate professor of pediatrics at the University of Miami Miller School of Medicine said that"one of the things we don't realize when we look around at our neighborhoods and communities is that these problems are so common." "That's something to be concerned about.That's something to take communal action on," he added. Identifying and treating abuse early can prevent many serious health consequences later in life. Programs that provide quality care for children, as well as home visitation programs in early infancy and parenting programs, are part of the solution to Print Powered By ei http://www.usatoday.com/cleanprint/?1292624924231 12/17/2010 King County 11/ State cuts hit hard : service reductions and layoff notices Thursday, January 13, 2011 Critical support for mothers, newborns slated for reduction KING COUNTY, WA--As a result of the state budget crisis and cuts to Medicaid-funded services, Public Health -Seattle & King County will have to reduce services for thousands of vulnerable patients in King County. Today, Public Health sent layoff notices to 123 staff, mostly due to a 50 percent funding reduction to Maternity Support Services (MSS). MSS serves low-income pregnant women and their infants to ensure the best health outcomes possible. Furthermore, if reductions in reimbursement rates for Medicaid services are not reversed by the Legislature over the next few weeks, additional lay-offs will occur and more than 100,000 patients may lose access to care. "These cuts, as proposed, are devastating. We recognize the challenge that state leaders face in closing the budget gap, but these cuts will have enormous implications for our community, and may lead to the additional loss of federal funds," said King County Executive Dow Constantine. "We want to work with the state to reinvent how we protect public health so we can mitigate the impact of these cuts." "Even in this budget crisis, cutting proven life-saving and cost-saving programs for our most vulnerable residents makes no sense," said Dr. David Fleming, Director and Health Officer for Public Health - • Seattle& King County. "Instead, we need to work with the state to develop creative and innovative solutions that allow us to save money while providing services to as many people as possible." The MSS cut combined with a proposed reduction in Medicaid reimbursement for federally qualified health centers (FQHCs)will strip more than $23 million from Public Health - Seattle & King County in 2011. These cuts are on top of 2009-2011 reductions totaling $32.9 million and 344 staff positions. More about staff lay-offs In response to the MSS reduction, Public Health is eliminating 123 staff positions and nine vacant positions, effective Feb. 28, 2011, including: • Direct service staff- 87 (includes nurses, social workers, dentists, dental assistants, interpreters, and education specialists) • Clinic support staff-24 (includes patient services representatives and health program assistants) • Central administrative staff and program management- 12 (includes nurse supervisors, administrative supervisors and assistants, program administrators and managers, a finance officer, and an IT system engineer) MSS provides critical support to at-risk mothers, helping babies start healthy by reducing low birth weights, which can result in long and expensive hospital stays, life-long health problems or even death. In 2009, more than 30,000 women and their babies were served by MSS in King County. Additional program cuts and lay offs possible • In the December special session, the state cut by one-third its reimbursement for Medicaid services for FQHCs, which are designated clinics that primarily serve Medicaid recipients and people without http://www.kingcounty.gov/healthservices/health/news/2011/11011301.aspx?print=1 1/14/2011 insurance. In addition to Public Health Centers, there are six other FQHC systems in King County (HealthPoint, Neighborcare Health, SeaMar, Country Doctor, Seattle Indian Health Board and International Community Health Services.) If this FQHC reduction remains in place, critical health services will be eliminated, clinics will close and • additional providers will be laid off. Without public health and community clinics to provide health care, tens of thousands of people will be forced to forgo medical care or go to emergency rooms. Other state cuts to public health services include the elimination of state tobacco prevention funds, reduction in core state support for public health, and reductions in other Medicaid programs, including adult dental and family planning. Providing effective and innovative health and disease prevention services for over 1.9 million residents and visitors of King County, Public Health - Seattle & King County works for safer and healthier communities for everyone, every day. Home 'Privacy 'Accessibility 'Terms of use Search Links to external sites do not constitute endorsements by King County. By visiting this and other King County web pages, you expressly agree to be bound by terms and conditions of the site ©2011 King County i • http://www.kingcounty.gov/healthservices/health/news/2011/11011301.aspx?print=1 1/14/2011 perspective • Where's accountability for county communications? By Davis Steelquist of Quilcene Last week I attended a board attempted to rationalize the delay; meeting for one of our county however,no one took responsibility departments, because normal to rectify the situation. These are communications were not work- your leaders at work. ing; in fact, based on its actions, There are obvious solutions to the department deems commu- this; however, this department nications with the public are does not listen to the public.The beneath it. two community advocate board This department has decided members appear to no longer rep- to utilize the Internet to publish resent the community and have i if both agendas and minutes as the become defenders of the depart- 1 i primary means of keeping the ment practices, not public advo- public involved.Yet, it has failed cates.(Personally,I believe public to put the processes in place to representatives should be limited ensure timely postings. Then it to five years) complains that the public rarely When simple tasks cannot be comes to its meetingsand hear- accomplished with accuracy and ings=duh! consistency, can the department In June, I visited the depart- management be trusted with ment because it was neither more complex processes? . posting agendas nor minutes to Part of this lackadaisical atti- its meetings. I was assured it tude also rests on the public for was a temporary lapse due to an not paying attention. Nobody • employee absence. In November_ showed up for the posted hear- the department website still ing on the new department ser- showed the September agenda; vice fees and increases, so they the October agenda never was were passed without public input. posted. The last minutes post- When public hearings are sched- ed were for July. Spotting this uled between 2 and 4 p.m. on lapse,I sent an email to both the weekdays, are departments real- department director and to the ly seeking public involvement? BOCC.I received no response. Also noted: This depart- On Dec. 4 there was still meat has also been building a no update; however, a sepa- cash reserve for some "impend- rate special hearing notice on ing environmental or epidemic rate increases was posted in an disaster." How it does this with obscure column. On Dec. 14, the tight budgets is beyond me, the Dec. 16 agenda appeared. unless the projected budgets are Also, the October minutes were padded, its fees are higher than published, but not those for needed to cover costs, or ... ? August or September. However, County government departments the published minutes had not are not to be independent profit been approved (approval was on centers at the public expense.The the December agenda), and the two public representatives to the department stated the meeting board were party to the funds occurred in July. establishment, and as far as I After presenting my observa- could tell,it may be spent without tions, the three county commis- either the board or BOCC concur- sioners, the department director, rence. This came to light when the board vice chair, and the two the county administrator requisi- community representatives just sat tioned $50,000-$85,000 from the there looking sheepish.One person reserve for the general fund. II/ . ,------_, i___ I • ->