HomeMy WebLinkAboutM032008JEFFERSON COUNT BOARD OF HEALTH
MINUTES
Thursday, March 20, 2008 2:30 PM — 4:40 PM
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, Chair, County Commissioner, District #3 Julia Danskin, Nursing Services Director
Chuck Russell, Hospital Commissioner District #2
Michelle Sandoval, Port Townsend City Council
Sheila Westerman, Vice Chair, Citizen at large (City)
Roberta Frissell, Citizen at large (County)
Chair John Austin called the meeting of the Jefferson County Board of Health (BOH) to order at 2:33
PM in the Pope Marine Building, Port Townsend.
Members Present: John Austin, Roberta Frissell, Phil Johnson, Michelle Sandoval, David Sullivan,
Sheila Westerman
Members Excused: Chuck Russel
Staff Present: Jean Baldwin, Dr. Thomas Locke, Julia Danskin, Susan Porto, Neil Harrington, Gail
Bernhard (Recorder)
A quorum was present.
APPROVAL OF AGENDA
Chair Austin recognized a motion to approve the agenda and a second. The motion to approve the
agenda, as written, was approved all in favor.
APPROVAL OF MINUTES OF FEBRUARY 21, 2008
Sheila Westerman noted that at the top of page 2, the motion for approval of the minutes of January 17,
2008 should include "as amended". Also, on page 8 (line 2 and 3) the minutes should read "Member
Westerman stated that the whole Board should ....", not the whole committee.
Chair Austin, under Public Testimony, provided the surname for Denver Shoop. He also pointed out
the typographical error in the spelling of "Sandoval" under Board Members, page 1.
Member Westerman moved for approval of the minutes of February 21, as amended; the motion
was seconded by Member Sullivan and approved, all in favor.
PUBLIC COMMENTS
Chair Austin opened up the meeting to public comment. There were none.
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OLD BUSINESS
Port Townsend Air Quality Health Assessment Update
Jean Baldwin stated that the report from the State Department of Health was due out on March 10. It
was pulled on March 9, apparently due to a statistical error, and staff was informed that there would be
an additional two or three weeks for review before release. Public hearing(s) will be scheduled
approximately two weeks after the release date. They will be conducting education/public outreach
and have ads in the newspaper to announce the meeting. Member Baldwin said she would notify the
Board as soon as specific information becomes available. She mentioned that the Department of
Ecology had been in the area twice within the past month working on the carbon footprint and emission
plan for air quality. She said that although these are different projects, this had been confusing to some
people.
Dr. Locke said that staff would plan to bring this to the Board as a special presentation, with an
opportunity for questions and discussion. He noted that the report contains quite a bit of statistical
analysis. He said one of our regional epidemiologists has been reviewing and critiquing the state's
analysis. He said that although the delay is regrettable, it is important that the analysis be correct.
There was acknowledgement that it may not be possible for the Board to review the report before the
public hearing process, depending on the date it is released. Member Westerman expressed concern
that there may not be opportunity for input. Jean Baldwin noted that there had been input along the
way, that there had been comments on a number of technical issues.
Dr. Locke said, having seen a series of drafts, that this is not something the BOH would be unlikely to
want to comment on during the drafting process. The report is a compilation of available
environmental health information using a nationally standardized methodology. The role of the BOH
and interested community members is to address where we go from here, based on the starting point of
assembled facts. The report in itself takes no action, but does discuss options, which can be followed,
modified or rejected.
Jean Baldwin noted that the carbon footprint workgroup and this report may have some of the same
recommendations. There may be overlap between the two, such as advocating continued air quality
monitoring.
Rover Group Report Update
Jean Baldwin reported that the Royer Report was on hand for a first draft read; the executive summary
is being written and is nearly ready for submission to the BOH. She said she had invited the consultant
to the April meeting, but that he was unable to attend at that time. The final version should be
available within two weeks. She asked the Board's preference for scheduling a presentation/review.
After a brief discussion, it was agreed that the presentation, with the consultant, would be scheduled for
the May BOH meeting; copies of the report will be provided in advance.
Letter re: SB6620
Page 2 of 13
Dr. Locke referred to the letter in the packet, which expressed BOH opposition to S136620. He
reported that the bill had not passed. He said that a bill by the same sponsor had almost passed, but
was held up in committee.
Member Westerman said that she was pleased at the outcome and felt that the local health departments
were pivotal in stopping this measure. The bill would have required the installation of a costly specific
system for septic systems in certain locations, which would have been very expensive for the home
owner. There is inadequate scientific evidence that this process has been effective in reducing nitrate
levels. The proposal had gotten through the House and into the Senate, and was expected to pass.
However, it was defeated at the last minute, with the help of opposition letters, such as the one from the
Jefferson County Board of Health.
Region 2 Public Health Newsletter
Dr. Locke reported that there had been considerable publicity about the rather poor match between flu
vaccine formula and circulating influenza strains this year. He said there was still some influenza
activity in Washington state; typically, it does not disappear until about April, but the peak seems to
have passed. The CDC and WHO are planning to reformulate the vaccine for next year.
He also called attention to the Communicable Disease Surveillance Data for 2007. He noted the local
statistics for Chlamydia and Gonorrhea. According to a federal report, one out of every four female
teenagers women has had an STD. Although the general trend is upward, the rate in Jefferson County
has been reduced significantly. This is the beginning of the second year where the rate is significantly
lower than for neighboring counties. He said he hoped that that is related to aggressive STD screening
and partner treatment strategy. He said that it may be well to have a more in depth presentation at a
future meeting.
Dr. Locke also noted that Jefferson County leads the region in the number of Giardia cases, which may
be due to the amount of recreational activity and wilderness area. In addition, local physicians are
quite familiar with the presentation of Giardia, so they tend to look for and identify it. It is a very
treatable infection if correctly diagnosed. Chair Austin asked what the latency time is between
exposure and onset of symptoms. Dr. Locke said that, particularly with intestinal infections, that varies
with dose. A very large exposure may show up more rapidly, i.e. in a week or two. For Giardia, a one
cyst exposure can take a month or more to present as illness. In response to a question, he said that not
all Giardia infections cause symptoms. A mild infection may naturally resolve, but can be spread to
others. Chair Austin said he wondered about the rate of unreported infection, particularly for tourists
whose symptoms may not manifest until weeks after they leave the county. Dr. Locke said that there is
little known regarding the number of cases that spontaneously resolve. Often, physicians are alerted to
Giardia when symptoms have persisted past two weeks, or when investigating causes for mal-
absorption syndromes, with weight loss and chronic diarrhea.
Chair Austin asked how statistics are reported, with regard to location. Dr. Locke said that the
reporting is by county of residence, and if not given, by county where diagnosed rather than where
treated. Jean Baldwin gave other examples such as highway deaths and HIV incidence where
interpretation of data depends on understanding the location information.
Michelle Sandoval said that, with regard to the paper mill footprint project, citizens have been asking
questions about cancer rates, for example. She asked how tracking is related to treatment location. Dr.
Locke explained that the Tumor Registry tracks a great deal of information about each case of cancer.
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It is based on county of residence when diagnosed, and also linked to the facility where the cancer is
diagnosed and treated. He briefly explained the challenges of cluster analysis and attempting to
associate cause and effect relationships. He said that with most environmental cancers there are
latency periods of thirty to forty years, and estimates of the dose of exposure are nearly impossible.
The best cancer data comes from occupational statistics, where the length of exposure and the levels of
exposure can be determined.
Member Westerman asked if levels of MRSA are likely to reach levels such that the incidence would
be reported on this chart. Dr. Locke said that a Science Panel had been convened by the Governor in
December 2007 and had recommended against mandatory MRSA reporting. The State is now tracking
all the MRSA cultures out of hospitals and labs.
Jean Baldwin said that she believes there should be two other reports to the BOH in the future. One is
the Expedited Partner Therapy program and the other is on HPV vaccines.
National Public Health Week
Julia Danskin referred to the March 6 press release in the packet, noting the highlights. National Public
Health Week begins April 7. This is a nationwide campaign with a national website. The theme this
year is "Climate Change and the Nation's Health". In conjunction with this event, for the second year,
Jefferson County will recognize and honor Public Health Heroes. These are people who live or work
in Jefferson County and promote Public Health in their daily lives. She said nominations should be
received by March 27. The nominations will be evaluated by the committee: Roberta Frissell and Julia
Danskin. Public Health Heroes will be honored at the next BOH meeting on April 17. Jean Baldwin
urged members of the BOH to nominate candidates for this honor.
NEW BUSINESS
Proposed Revisions to Jefferson County Septic Code 8.15
Chair Austin referred the Board to the document containing line in/line out revisions to the Septic Code
8.15 based on the last meeting. Dr. Locke explained that, as directed by the Board, staff had continued
to revise the language, reconcile definitions with other regulations, and to translate policy language into
code language, per the recommendations from county attorney David Alvarez. This makes it easier for
people to understand what the rules are and gives the policies greater legal standing.
Dr. Locke described three options for the Board with regard to the code. The first would be to do
nothing at this time, but to revisit it at a future time when the homeowner inspection concept and
standard have been fully developed and there is community consensus. There would also be some
homeowner inspection models from other communities available for review.
The second option, which he did not recommend, would be to adopt the document as of this meeting.
He said that the hearing requirements have been met and the Board has the authority to do that,
although he did not believe Board members were inclined to take that option. He noted that having
further public involvement would be desirable and hoped many good ideas would be brought forth.
The third option is to pursue these proposed changes to the current on-site code and continue the public
hearing process. He noted that David Alvarez has made a few additional minor changes in the draft
code language. Further public hearings would entail finalizing the draft changes, publishing this draft
on the web, and scheduling facilities with adequate space. This would mean moving ahead on the non -
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DRAFT
controversial changes to the code, while continuing to work on development of a homeowner
inspection program. He said that the one and three year inspection cycles are not at the discretion of
the BOH; it is in the state code and is a state mandate. However, the implementation schedule is up to
local discretion. It had never been the plan to implement everything at once. Dr. Locke said that the
implementation priorities are laid out in the on-site sewage plan: to look for failing systems and to look
at the most sensitive areas, like marine recovery areas. The strategy is to put resources where they will
do the greatest good in the shortest time.
Referring to the latest draft, Dr. Locke said staff has been wrestling with the issue of how to
incorporate existing BOH policy into the code. Citing various options, he said Kitsap County has a
section in their code where they adopt all the policies into the ordinance by reference. His feeling is
that this practice tends to blur the distinction between policy and code. From an environmental heath
law perspective, a BOH ordinance is a quasi -legislative act while a policy interprets authority that
already exists and is a quasi -executive function. If the policy is actually creating new regulations, then
it belongs in the ordinance. The advantage of keeping policy separate is flexibility.
The Deputy Prosecutor, Mr. Alvarez has categorized the process options as 1. most desirable —
transform all policies into text in the onsite sewage plan; 2. middle ground — have an onsite sewage
code section that discusses adopting policies, lays out the rules for who has authority to adopt the
policies and list the current policies (the Kitsap Health District has code language along those lines.); 3.
least desirable — make no reference to policies in either the paper copy of the Jefferson County code or
the 81.5 version on the web.
Dr. Locke said that the approach taken is between option 1 and 2. Policies that seem to have regulatory
aspects have been written into the code. An appendix has other policies so they are easy to find.
Member Westerman asked whether a citizen requesting a copy of the ordinance would automatically
receive the policies referenced in the appendices. Dr. Locke said yes, they would; and on the web site,
a policy addressed in the code would be in the same document, eliminating the need to look for it
elsewhere.
Chair Austin pointed out a typographical error on page 55: Policy 94-01 should be Policy 04-01. Others
noted that notification of the error had been previously e-mailed.
Chair Austin asked for clarification on the opinion of Attorney Alvarez regarding policies referred to in
the appendices of the code: would that be virtually the same as being part of the code? Dr. Locke said
that was not addressed in his memo, but in conversations; he feels that legally the highest standard is if
it is in code language. However, for some of the policies, it would be cumbersome to put the entire
policy document in code since they are written in different styles. Code language is often technical
and follows the format set by state administrative codes (WAC) and statutes (RCW). Policy
documents are written to explain the interpretation and enforcement of state regulations, plus any
additional requirements imposed by the local BOH. They are written to be understandable to as many
people as possible.
He said his recommendation was to keep both: to reference policies in the code when appropriate and
incorporate policy language in the code when possible. A case in point is the discussion we have had
over reserve areas or what triggers a sanitary survey assessment. Those are things that naturally mesh
in with the code language. Policies referenced should be placed in the appendices, which is a new
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thing not done previously. Reducing the number of policies and consolidating them whenever possible
is a desirable goal as well. Jean Baldwin said that updating them as other state and county laws change
around us is also desirable. So, if they are in the code that means more frequent changes to the code, as
opposed to simply a policy change.
Dr. Locke also clarified that policies are adopted by the Board in a public process. They are not simply
an administrative action; it is an action of the Board.
Sheila Westerman said she would like to go over a few proposed revisions in the spirit of refining and
improving the document, time permitting. She said certain items are substantive and may require more
Board discussion.
Page 2 of 55, bottom of page under the Design paragraph: she suggested that the acronym JCPH be
written out the first time it appears in the document. Subsequently, it was agreed that the full
designation should be written out, followed by the acronym, the first time the acronym is used.
Page 5 under O & M Inspection: she suggested stating where "in these regulations" the criteria are
listed.
Page 5 under Ordinary High Watermark, B: she suggested defining the term "Mean High Water" in
the definition section.
[Chair Austin invited other Board members to make comment about any item along the way. Jean
Baldwin also asked staff Susan Porto and Neil Harrington to provide additional background or other
information about items in question. ]
Page 9, number (3): Member Westerman asked if the "minimum land area requirement" is described
anywhere in the document; she said a reference should specify where the definition appears, whether it
is within a Policy, in the appendix, or other.
Page 12, number (3) a: Member Westerman noted that the definition was cumbersome and unclear,
and asked why the term "bedrooms" could not be used instead of a list of exclusions. A discussion
ensued about the rationale, which is to determine how many people are residing in the house and using
the septic system. Dr. Locke noted that the goal is to accommodate both current and probable future
uses so that people do not inadvertently overload their systems. The significance of the presence of
closets and ADUs was also discussed. One suggestion was to include the phrase "number of rooms
used for sleeping" followed by explanatory information. Staff explained that they shared the concern
about the language and would continue to attempt to simplify/clarify it.
Page 21, (9), bottom of page: Member Westerman asked for the meaning of "....is in a marine
recovery area or other area identified by the Jefferson County Board of Health." After a brief
discussion about how to clarify it, Dr. Locke noted that David Alvarez, County Attorney, had
suggested the language "identified by the BOH in a public meeting". Dr. Locke said staff would add
language to clarify why such a designation would be needed to be made by the Board. Member
Westerman requested that this be corrected wherever it occurs in the document.
Page 23, top of page: misspelling of '!floatation"; should be "flotation".
Page 6 of 13
Page 24, 8.15.40 (3) d: Is the 16 hours state -mandated; if so, can the reason be explained? After a
brief discussion, Dr. Locke noted that the state gives the local boards discretion over the amount of
training for an O & M Specialist. Jean Baldwin noted that the requirements are similar to what other
counties require. Member Westerman asked if this could be considered a standard. Audience member
Chuck Molisky was recognized to speak. He said that based on his experience in the septic business,
16 hours seemed like the very minimum to be expected. He questioned the verbiage about
recertification, noting the lack of differentiation between certification and recertification. The term
"education contract hours" was explained. Dr. Locke said that any out of state training would be
reviewed on a case by case basis. Member Sullivan added that ""recertification" is explained on page
26 (11) and staff added that "continuing education is explained in (9).
[An audience member questioned the need for so many hours for a simple home system. Staff clarified
that this requirement is for a specialist and does not apply to homeowners.]
Page 25 (4) b vii: Member Westerman questioned whether this means "... as approved by the Health
Officer" or whether it means Jefferson County BOH? Jean Baldwin explained that Health Officer is
correct, and this could be a designee. Dr. Locke said the intention is to provide flexibility to handle
this maintenance in some other way.
Page 26 (6): Member Westerman asked if Jefferson County has designated some other authorized
agency. Susan Porto said that the intention is to leave this open to work with a web based data
base/collection system, if possible. The suggestion that the language for that item could be made
clearer was accepted.
Page 36 (b) vii: This is another instance of "other area as designated" discussed above (page 21 (9)).
Page 37 (7) iv 8: This is another instance of "other area as designated" discussed above (page 21 (9)).
Page 37 IV: Wording change suggested: "evidence" in place of "identification.
Page 38 (10) b v: This is another instance of "other area as designated" discussed above (page 21 (9)).
Page 40 (4) d: Is the timeline of 35 days too tight? Dr. Locke explained that this is in the current code.
If there is an appeal, there would be need to be a special meeting or, if the appellants agree, there can
be a continuance.
Chair Austin referred to page 2, Critical Areas. He noted that Chapter 18.15 should now be Chapter
18.22. Staff noted that that change had also been noted by Attorney Alvarez.
Member Sullivan mentioned that there are still a number of references to homeowners. And, if they are
removed for the time being, he cautioned that these references should not be lost. Susan Porto noted
the difference between Maintenance and Operations and Monitoring. She said there are still a number
of items dealing with maintenance for the homeowner. She said all the homeowner O & M should
have been stricken but possibly a few were missed. Dr. Locke noted that homeowner maintenance
does not require BOH permission.
Member Sullivan referred to page 35 (5) a. iii, where he pointed out one such reference.
He pointed out another reference on page 38 (10) a.
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Member Sandoval stated that she had spoken with staff about changes, but did not have her copy with
her. She said she would forward any comments/changes not already mentioned during the meeting.
Member Westerman asked if there were steps in progress for developing a home owner inspection
program. Staff noted that they were contacting other counties for program ideas . Dr. Locke said that
if the Board wished to accept these proposed changes and proceed with a public hearing, he thought
there would be good attendance and an opportunity to review what other counties are doing. The
public would be able to hear what ideas and options are available in the state and which ideas have the
most support. He said that could be done at any point. Representatives from the Clallam County work
group process would be happy to speak at one of the Jefferson BOH meetings.
There was a brief discussion about timing and process: should this be a workshop or a hearing? Several
members were in favor of a workshop approach.
Jean Baldwin said that this document could be corrected /updated and brought back quickly. Member
Westerman said that she thought the entire document should be adopted at one time. Member
Sandoval said she would like to explore the pros and cons of both approaches more fully. A member
of the audience was recognized to speak. He suggested that a group of 8 to 12 should be formed with
representation of: staff, industry professionals, and concerned citizens. This group would hold a series
of workshops/meetings with efficient process, open to the public, similar to the way the BOH is run.
He suggested that one or two months would be adequate time.
Mr. Bergeron (audience) noted his agreement with that suggestion and recalled his own comments at
the last meeting. He also said he did not believe that Clallam County is as far ahead in the process as
might be imagined. He said he was quite familiar with their process and it was not a panacea. He said
their next workshop would be held on Monday, March 25.
Dr. Locke commented that a work group process was not likely to be completed over a short time
period, noting that the Clallam group had been meeting for over two years, first on code revisions and
now on homeowner issues. Experience says that this is not a fast, easy or cheap thing to do.
A septic system expert, Chuck Molisky, recognized all that had already been done, and said he foresees
it moving quickly only if it can be seen as legitimate in the eyes of the public and if all interests are
included.
A suggestion that staff use discretion in inviting knowledgeable citizens to assist in the process was
considered. Member Sandoval spoke in favor of the BOH, rather than staff, taking the responsibility
for assembling a group of experts, citizens and support staff, thereby accepting any negative fall out.
She also said that the next steps should focus on workshops, not action meetings; public comment
should be deferred until after the workshops, so that questions can be asked and answers from the
experts can be heard and digested by all. Citing City Council experience, she advised such a two step
process and that there should be a citizen involved committee. She cited the Sign Code process, which
began with a citizen committee, which is followed by Planning Commission hearings and then City
Council hearing. The process takes preparation and a longer duration, but results in more citizen good
will, more information and ideas, and a well developed and better product in the long run. She said
that it is important for there to be a real directive in terms of who is involved, how many people, and
the length of time allotted, even if the result is "no agreement".
Page 8of13
Member Sullivan noted that the topic is the home owner option, and that there are implications for
staff, budget, format, etc. He said he believed the workshop approach would work well.
Member Sandoval asked what the pros and cons would be of passing the non -homeowner inspection
parts of the document immediately. Sheila Westerman said that the ordinance is actually in effect. One
important negative is the likelihood that it would be misconstrued, if it is passed, even if the BOH
makes clear that the controversial parts have been removed in order to work on them. She said that she
is worried about the perception that has persisted from the outset. Phil Johnson said that he also
thought the BOH action of passing this draft of the document could be misconstrued.
Member Westerman suggested that the Board should continue to make the draft better, including trying
to figure out a better way to define a bedroom, as well as recognize that a citizen work group is needed.
She said she agrees with Member Sandoval that the Board should name the work group, not staff,
although staff should come to the meetings. She also said that since there are many repercussions, she
was not proposing that all planning decisions should be made at this meeting. She said that the Board
needs to decide a calendar, the location, the number of participants, and the process for determining the
particular participants, etc.
Dr. Locke said that as a recommendation to the Board, he would propose that staff bring back this issue
to the next BOH meeting. At that time, they would review what other Counties are doing. He noted
that if there is any shortcut, that would be where it would be found. He suggested that the experience of
the Clallam work group would be worth hearing, including the amount of time and money involved.
Jean Baldwin noted that the idea of homeowner inspection came from the community but was then
taken away by other individuals in the community. She asked if there is some way to bring back
homeowner inspection in a simple way, e.g. gravity systems at first, following up with investigating the
requirements for more complex systems.
Member Sullivan said that the focus for much of the public comment was cost, and the other was due
to misinformation. Once the information was clarified, everything came back to cost. He said he
would certainly want feedback but does not know if it is necessary to have a committee formed to work
on the process of putting together a fully defined program, with specific training time, cost and
processes.
Chair Austin stated that he would like to have a workshop, as had been previously discussed.
Ms. Westerman asked for clarification on the next steps of the process.
Dr. Locke said that staff would bring this subject back for presentation to the Board, which would
include a review of what other counties, including Clallam County, have done and are doing. Jean
Baldwin added that they would also explore a possible schedule, realizing that while this is not urgent,
it should continue to move forward.
NEW BUSINESS
Jefferson County Public Health Performance Measures
Page 9 of 13
Jean Baldwin referred to the packet item, 2007 End of Year Report. Julia Danskin explained that this
report is done annually and is part of the budget process. All of 2007 the staff has worked under these
performance measures and is now reporting back to the BOH on them. The four areas cover all of
community health; she noted that Public Health performs a wide variety of services.
Three years of actual statistics are available. Family Planning unduplicated client numbers are down
slightly. About six years ago, a huge increase was associated with extra dollars for a program called
Take Charge. Since then the number of clients has leveled off. However, positive news is that the
number of adolescents being seen is fairly constant.
The Breast and Cervical Health program is fairly constant.
She mentioned that Myrtle Corey had done almost 3000 foot care contacts in the community in the past
year. There was a question about how the patients (in the report) related to the 3000 foot care contacts.
Ms. Danskin said that the contact records collected while out in the community are not integrated with
the computerized patient database, so that it is not possible to determine how many patients are seen by
Myrtle Corey. Member Sullivan noted the importance of foot care. Jean Baldwin added that it is one
of the services that is hardest to staff.
School aged population is slowly decreasing. The screening statistics are low, partly due to the
discontinuance of the scoliosis and other screenings formerly required by state law. John Austin noted
that the recommendation to drop the scoliosis screening had not passed the legislature. Jean Baldwin
said that the department had been slowing down on screenings that have not proven to be effective, so
that resources could be better applied elsewhere in the schools.
She noted some changes in staffing in school health classes and in drug and alcohol prevention classes.
The numbers have stabilized and are now coming back up. She anticipates the numbers to rise during
this next year with changes in staff in the Alcohol and Tobacco staff and more information coming out
about the Quit Line.
Communicable Disease — Vaccine distribution numbers are rising; most of the shots are given in
physician offices.
Jean Baldwin commented about the figures for Family Support. She said that although most of the
figures have remained within a predictable range over time, the number of families served through
CPS/DSHS has risen from 15 to 30 from 2005 to 2007. She said this represents 2-3 hours per week per
family, a significant demand on resources. The reason(s) are not well understood, but may include
drug use, the recession, population shift or other. However, there is higher acuity and more referrals.
2007 Jefferson County Syringe Exchange Program Report
Jean Baldwin pointed out the number of clinics and the number of syringes and the number of referrals.
Julia Danskin said that they believe they are seeing a lot of secondary exchangers, i.e. persons coming
in on behalf of other users in the community. This indicates a degree of safety and trust in the
program. The increase in the syringes could mean people understand the importance of not sharing
and/or it could mean the numbers of users are growing. Jean Baldwin noted the number of clients seen
is not rising.
Page 10 of 13
Member Westerman said she was glad that the Board has supported this program. Julia Danskin said
the staff very much appreciates the continuing support of the Board for this program. Dr. Locke noted
that as of 2006 there were only about 150 needle exchange programs in the United States. Of them, 15
are in Washington State. He said that Washington state's rates of needle transmitted communicable
diseases are among the lowest in the nation.
Remarkably, this program is very inexpensive at less than $10,000 per year. Julia Danskin noted that a
group of very well trained nurses allow the program to operate during office hours 5 days a week,
rather than restricting the exchange period to a 2 hour period one day a week. Jean Baldwin said that a
work group has been started which will look at how to reach actual users directly to do referrals for
treatment, to administer Hepatitis A or B vaccine or other medical services.
Policy Regarding Disruption of Public Meetings
Chair Austin said that the BOCC had adopted a resolution regarding policy and protocol for dealing
with disruptive persons during its meetings. He said that one of its primary intentions was to provide
guidance to security personnel in the Courthouse as to how to respond. He said Jean Baldwin had
requested that the BOH examine the issue and this policy to determine if a similar process should be
available for its meetings.
Jean Baldwin said that traditionally the BOH meetings have been held at the Health Department
offices, and more recently at larger venues such as Pope Marine Building, the Fire Department, etc.
Typically, meetings are not held in a place protected by sheriffs or police. There are no existing
standard protocols for dealing with disruptive behavior, and it may be well to adopt such a policy and
procedure.
Member Westerman noted that, other than the most recent history, the BOH has had no problems in
nine years; she said it had been very civilized. She said she would rather not adopt anything unless it is
determined to be a recurring problem.
Member Sandoval said that she believes the ground rules should be set, at least amongst the Board, if
not in a resolution form. At any public hearing or meeting, everyone should acknowledge and the
Chair should supervise behavior; there should be no clapping, cheering, booing or demonstrations of
any kind. This set of rules should be imposed by the Chair. Otherwise, she believes individuals can be
urged on by the crowd. She said that it important that the public is made aware of this formally, even if
not in resolution form. There should be an agreement as to appropriate behavior. She said if it is clear
at the outset that the rules of order will be upheld, everyone attending can feel safe. She said that
shortly after incidents at City Council and the BOH meeting in Chimacum, several citizens had
approached her asking whether there were metal detectors or emergency buttons in Council Chambers.
She suggested that it be very clear what the rules are amongst he BOH members so that everyone can
back up the others and enforce the rules.
A brief discussion ensued. Jean Baldwin said she believed that having rules about
convening/reconvening, posting and scheduling, such as number 6 in the BOCC policy, would help
those responsible for the meeting. It was also noted that knowing what the options are for dealing with
disruption will help to alleviate anxiety. Member Sullivan noted that the Chair needs to know his/her
options and the plan that will be followed.
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Member Westerman said that if a majority of Board members wish to pursue this matter, she would
certainly be willing to have that happen. Member Frissell recalled the recent hearing at Chimacum.
She noted that perhaps a statement could have been read before the meeting to set expectations of the
audience and make clear what steps would be taken in the event of disruption. There needs to be some
way of communicating rules of order and expectations to attendees.
Chair Austin said, if desired, the Commissioners could bring a statement to the BOH similar to the one
the BOCC has pronounced at the beginning of each session. He said that the particulars of the
resolution 14-08 were made to meet a request by the County Sheriff, who provides security at the Court
House. It may not be necessary to have the exact same resolution for meetings that take place
elsewhere in the City/County. He said this is covered by the procedure in the RCW, although the
writing could be made clearer. He asked if the BOH would like to have a rephrased version read
before each hearing, and there was agreement that a BOH version should be prepared. Jean Baldwin
said that perhaps, since meetings are usually held in Port Townsend, she should also have a discussion
with Police Chief Conner Daily to get his input on this issue; all agreed.
Substance Abuse Advisory Committee Appointments
John Barth reported that there had been two letters received regarding possible appointments to the
Substance Abuse Advisory Board. Both individuals were well qualified. For one person, there may be
a Conflict of Interest issue; that letter is on hold. Dr. James Rotchford sent a letter of resignation. One
other member who is a student, now residing in Seattle, has resigned. Board members were urged to
suggest other possible candidates for application.
After a brief discussion, the motion was moved and Member Sullivan seconded that Robert
Archibald be appointed to the Substance Abuse Advisory Committee. The motion was approved,
all in favor.
Correspondence
There was no discussion.
ACTIVITY UPDATE/ AGENDA PLANNING
Jean Baldwin said that Julia Danskin had verified that the Royer Report could be scheduled for the
May BOH meeting.
The Meth Action Team wishes to schedule the Meth White Paper for review by the BOH meeting in
April.
The Washington State Board of Health will visit Jefferson County in November, 2008.
NEXT SCHEDULED MEETING
The next scheduled Board of Health Meeting is April 17, 2008 at the Fire Hall. (The location was
subsequently changed to the County Court House, First Floor Conference Room.)
ADJOURNMENT
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Chair Austin adjourned the BOH meeting at 4:35 PM.
Next Board of Health meeting is April 17, 2008
JEFFERSON COUNTY BOARD OF HEALTH
John s%ti Chair
Roberta Frissell, Member
Phil Johnson, Member
Michelle Sandoval, Member
Sheila Westerman, Vice Chair
Chuck Russell, Member
4'-4
David Sullivan, Member
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