HomeMy WebLinkAboutM041708JEFFERSON COUNTY BOARD OF HEALTH
MINUTES
Thursday, April 17, 2008 2:30 PM — 4:30 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 to order at 2:30
PM in the First Floor Conference Room of the Jefferson County Courthouse, Port Townsend.
Members Present: John Austin, Roberta Frissell, Phil Johnson, Michelle Sandoval, Chuck
Russell, David Sullivan, Sheila Westerman
Staff Present: Jean Baldwin, Dr. Thomas Locke, M.D., Julia Danskin, Susan Porto, Sarah
Murphy, 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 passed unanimously.
APPROVAL OF MINUTES OF MARCH 20, 2008
Roberta Frissell noted a correction on page 5, third paragraph: It should read: "The deputy
prosecutor, Mr. Alvarez, has ...." Chuck Russell pointed out that the date of the Minutes is
March 20, not April 17, 2008.
Member Westerman moved for approval of the minutes of March 20, 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 and explained the rules regarding this
portion of the meeting.
Kristen Marshall, Environmental Manager at Port Townsend Paper Corporation, was recognized
to speak. She said she had attended the last several BOH meetings, anticipating the Washington
State DOH Public Health Consultation report, and intending to hear the BOH comments on that
Page 1 of l l Jefferson County Board of Health, April 7, 2008
process. Ms. Marshall said that PT Paper is involved in three public processes at this time. The
first is the Public Health Consultation draft, which came out on April 8; PT Paper is reviewing it
and plans to submit comments by May 8. The second is the Industrial Footprint Project through
the Department of Ecology. She provided correction to certain comments from the previous
BOH meeting: She said that the project is more than a carbon footprint; it is a sustainability
footprint involving three categories: economic, social and environmental impacts. Health
concerns and health benefits fall under the social tier of that process. If there are any health
issues that are not addressed through the Health Consultation, the open format of the footprint
project can allow those issues to come forward there. She said her company has begun to look at
the Health Consultation, and noted that the statistics in the report do not show a statistical
difference between Jefferson County and the rest of the state over the five year period studied for
cancer rates, respiratory and cardiac issues. Ms. Marshall said that the report will be reviewed
more thoroughly; some issues are being identified. She noted that this is a learning process for
PT Paper, and the thoughts and comments of the BOH are appreciated. She requested that the
Board contact her office if there are any questions.
Mr. Michael Belinsky was recognized to speak. He commented on his concerns regarding
adequate notice of the change of the Board of Health meeting site from 710 Harrison Street to
the County Courthouse, fire code issues with the meeting room at the Health Department, and
rules governing time limits for public testimony
Chair Austin thanked the speakers and closed the Public Comment period.
OLD BUSINESS
Tobacco Prevention Efforts
Julia Danskin reported that Karen Obermeyer had been working with the Health Department as
Prevention Specialist since September on the Tobacco Prevention Program. Ms. Obermeyer has
been working with Jefferson Health Care on the Quit Line and the Tobacco Prevention programs
that can be implemented by nursing staff. She has commended the Hospital on their smoke-free
campus program. She has also been working with success at Port Townsend High School on the
TATU, Teens Against Tobacco Use program. Additionally, she has been promoting the
Washington State Quit Line throughout the community. The Board was encouraged to refer any
businesses or organizations with interest in an employee quit smoking program to contact Ms.
Obermeyer or Ms. Danskin for assistance. She said the department wishes to support the
community in efforts to cease smoking and not start smoking. The hospital is offering a free
smoking cessation class that will run from April 16 to May 28. More information can be
obtained from Jefferson Health Care or the Health Department.
Jefferson County Restaurant Awards
Sarah Murphy reported that the Outstanding Achievement Awards for restaurants had been
announced in the newspaper the week prior. The awards are given according to criteria
developed by the Food Service Advisory Committee: inspection scores; preparation and sale of
complex food; same owner for at least one year; responsiveness to correcting violations;
cleanliness and attention to detail. Chair Austin asked if there were any restaurants that did not
Page 2 of 11 Jefferson County Board of Health, April 7, 2008
pass muster. Ms. Murphy said that about half of the eligible restaurants did not receive the
award. She verified that no establishments had been closed for health violations recently.
NEW BUSINESS
Public Health Heroes
Julia Danskin reported that in honor of National Public Health Week (April 6-12), awards were
given for local Public Health Heroes. Nominations were requested from the community in
March. Four awards were announced last week, and two winners were present at the BOH
Meeting to receive them: Dennis Crawford and Jill Buehler.
Julia Danskin read a citation for Dennis Crawford and his work in Emergency Management as
Disaster Preparedness Education and Outreach Coordinator. Mr. Crawford has worked to create
over ten separate emergency community groups that focus on different aspects of emergency
preparedness. He also works with Local 20/20 Emergency Preparedness Action Committee and
Disaster Animal Welfare Group (DAWG). He has greatly helped Bob Hamlin, Program
Manager, with preparing the community for emergency conditions. Mr. Crawford has worked at
the grass roots level and has started 144 neighborhood emergency preparedness groups in
Jefferson County. He is credited with being a highly dedicated and effective leader. Julia
presented the Public Health Hero to Mr. Crawford on behalf of the community.
For more than 10 years, Jill Buehler was an outstanding, contributing member of the Jefferson
County Board of Health. She was a dedicated and involved Board member who could look at a
problem from many angles and fully participated in problem solving. She has led a vision that
our public health department and public hospital share: the need to coordinate services, know the
needs of citizens and work together. She has a positive attitude and faces challenges with a can
do attitude. Jill serves as a liaison between the Board of Health and Jefferson Health Care where
she is an elected Hospital Commissioner. She helped clarify the mission and services of the
respective public agencies to both Boards. She fostered a number of cooperative projects and
recognizes strengths of both organizations. The health of the citizens of Jefferson County has
been enhanced and served by her efforts for many years. Julia Danskin presented Ms. Buehler
with the Public Health Hero award on behalf of the community.
Since the other two award recipients were unable to be present at this meeting, they will be
honored at a future meeting.
Port Townsend Paper Mill Health Consultation Report
Dr. Locke noted that the document had been in draft form for about three months. He said it had
undergone several revisions and was improved with each draft. He said the statistics in the
current report have gone through careful review and represent the best available information on
the respective health measures.
The format is fairly standardized. The Agency for Toxic Substances and Disease Registry is the
principle federal agency for human health impacts of environmental contaminants. In most
states they contract with the state Department of Health to perform specific evaluations. These
evaluations review the known information about the specific area of concern: e.g. the health
Page 3 of 11 Jefferson County Board of Health, April 7, 2008
effects from air pollution in general or a specific source of industrial air pollution. The report
that is before the Board compiles known facts about emissions in Port Townsend statistics and
available health statistics that might be connected to air pollution.
Dr. Locke said that reports like this often raise more questions than they answer. He explained
that determining specific health impacts is very expensive and sometimes impossible. For
example, to relate cancer studies and air pollution there is a need for very precise information
about duration and severity of exposure to specific contaminants. Modern populations tend to
reside in many locations throughout their lives and are therefore exposed to many different
environments. Lifetime exposure to carcinogens is extremely complex and it may not be
possible to determine all relevant data. Environmentally -induced cancer can occur as long as 40
years after the exposure making it very difficult to research.
These reports attempt to assemble available information and present it in a factual way. He
pointed out that there are no precise measurements of what is being released. The law requires
that the emitters of industrial air pollutants specify the maximum amount that would be emitted.
As the report points out, industries tend to estimate high, because there is a penalty for emitting
more than the threshold but no penalty for underestimating pollution. Measuring what leaves the
stack on a daily basis is seldom done. The only public monitoring station as relates to air quality
in Port Townsend is a monitoring station located at the Blue Heron School. Commissioner
Johnson said that location was chosen because of the wood burning stove emissions that tend to
hang in the valley. Dr. Locke said that the state Olympic Region Clean Air Agency (ORCAA) is
responsible for monitoring and enforcing particulate matter guidelines.
Dr. Locke said it is not his intention to walk through the document in any detail. He said it raises
a number of questions that would require considerably more information. He noted that
Jefferson County Public Health staff made some specific recommendations and they were
incorporated in the report. Regarding health effects, the starting point is good air quality data.
One wants to know what is in the air and its relationship to what is legally permitted. If it is in
excess of the permitted level, there is a clear legal remedy. If what is emitted does not exceed
the limits, the process for reducing emissions is much more complicated and involves changes of
state and federal law.
Minimizing human health impacts can be done in a number of ways. He discussed the need to
know age groups, distribution in the community, and factors that increase/decrease exposure.
Computer models can take in prevailing wind currents and weather patterns and predict exposure
levels. Hospitalization and death rates are not good measures for air quality. Dr. Locke
mentioned an asthma study in Port Angeles where asthmatic children and their parents were
asked to maintain diaries of their asthma activity which were then correlated with mill emissions
and meteorological data. The study technique was developed at Harvard University. He noted
that it is very difficult to establish a cause and effect relationship between air pollution and
specific health effects.
Dr. Locke said the data on death rates is similar to age adjusted rates for the state. He pointed
out that hospitalization rates for ischemic heart disease and for lower respiratory tract disease
(for one year) was statistically higher in Jefferson County compared to Washington States.
Page 4 of 11 Jefferson County Board of Health, April 7, 2008
He noted that some cancer rates that are not normally associated with air pollution are relatively
common in Jefferson County, such as prostate cancer. Even factoring in the age composition,
prostate cancer rates are significantly higher in Jefferson County than elsewhere in the state, but
the death rate is not any higher. It is possible that this is due to better access to health care and
appropriate screening for prostate cancer. Early detection of prostate cancer increases cancer
rates but also promotes better treatment outcomes.
With regard to ischemic heart disease and lower respiratory disease, the data is insufficient to
analyze more deeply. Dr. Locke cited several possible explanations/interpretations such as better
access to hospital care, or that the threshold for admissions to rule out heart disease is lower, or
actual higher rates.
Member Westerman referred to page 27, Public Health Action Plan and read the section. She
asked what the difference is between collecting air emissions data and air monitoring. She also
asked for clarification of the phrase: "the best locations to establish air monitoring". Dr. Locke
said that in his interpretation, the report recommends setting up one or more monitoring stations
that can analyze periodic air quality samples. Picking appropriate sites begins with a preliminary
analysis that can include vacuum bottle samples taken in locations where air quality concerns
have been reported. Another method is to site monitoring stations based on meteorological
predictions of air currents.
Ms. Westerman summarized her understanding by saying that there are three types of activities
that could be done over time: collecting, monitoring and modeling. She said that this was a very
good report, but it does not mention anything about funding mechanisms and this was a concern
to her. Dr. Locke said that the regulatory responsibility typically lies with the Department of
Ecology. They are responsible for data collection, analysis and ongoing monitoring. Health
assessments are the role of the Department of Health and involve considerable interpretation of
the data. The DOE work is paid for by industry taxes and permit fees. Ms. Westerman asked
where our particular situation might fall in terms of Ecology's priorities.
Jean Baldwin explained the process. After the Department of Health releases the draft report,
they may or may not hold public hearings, depending on public comment/reaction. The
Department of Ecology has already started the Footprint project; it is led by the same person who
is responsible for permitting and emissions, and works with ORCAA around air monitoring. Ms.
Baldwin said the priority will likely be based on the Carbon Footprint project and air monitoring
outcomes. She said it would not be entirely based on this Health Consultation and will involve a
larger community process which is not predictable at this time. Ms. Westerman asked how the
report would be disseminated to the public. Ms. Baldwin said that the report has been sent to the
libraries, to the Air Watchers group, to the newspapers via press releases; it will be placed on the
Department of Health website.
Dr. Locke said that although he does not know what priority Ecology will assign, that tends to be
based on the level of concern expressed by the public.
Board member Russell said that paper products will still be produced somewhere in the world, if
not here locally. The result would be more pollution, not less, and he believes it better to keep
this mill operating, with appropriate controls.
Page 5 of 11 Jefferson County Board of Health, April 7, 2008
Dr. Locke noted that air quality involves not just industrial emissions, but also auto emissions,
household and business chemicals, etc. The air is shared by all and contaminated by all. A
community program to improve air quality should address all the inputs.
Member Johnson mentioned that he had learned about the reason for selection of the Blue Heron
monitoring station in his work with ORCAA.
There was further discussion about the great complexity of the issues and the extreme difficulty
of effective modeling considering local/regional weather patterns, air currents and the myriad of
factors involved.
Meth Action Team White Paper
Ann Winegar is Program Manager for the Jefferson County Community Group and consultant to
Jefferson County Public Health working on methamphetamine prevention, education and
outreach. In addition, she is the convener of the Jefferson County Meth Action Team. She
presented the final draft version of the "Methamphetamine in Jefferson County" white paper.
The paper has been developed by the members of the Meth Action Team (MAT), all listed
within the document.
Ms. Winegar explained the extent of the meth use problem for this community. She noted that
this is every person's problem, if only by virtue of its cost to taxpayers and to major health, legal,
school and law enforcement agencies. The purpose of the document is to increase community
awareness, and provide information and guidance about methamphetamine use/abuse in
Jefferson County to the BOH, BOCC and City Council for future policy decisions.
Ms. Winegar called attention to the graphs included in the packet, which highlight some of the
statistical information about meth use currently in the county.
Member Sullivan commended the Team on the report. He said the one thing he would add
(under Treatment, page 6) would be the local funding provided by the County and recent state.
This would help people understand the impact locally.
Jean Baldwin noted that the MAT (Meth Action Team) had been getting ready to disband and
resume Substance Abuse Committee work. At the same time, meth treatment money was
coming from the State Office of Financial Management (OFM). MAT decided to write a
summary of the work done and recommendations for the staff treatment money. The first year of
OFM money ends June 30; there is will be one more year of funding; renewal for the next
biennium is uncertain. The funds are to treat 12 individuals for 8 months. Ms. Winegar said the
treatment has already started and the mental health component will begin within the next week.
She said she had been meeting with Jefferson Mental Health and Safe Harbor about the
implementation, and was very encouraged by the progress and process. Member Sullivan noted
that the extra $100,000 for three years was an incentive for the County to adopt the 1/10`" of 1%
sales tax and thanked Ms. Winegar for her efforts.
Member Sandoval referred to the summary statistics, inquiring whether they included all of
Jefferson County, including Port Townsend. The statistics do include the City and its schools,
Page 6 of I I Jefferson County Board of Health, April 7, 2008
although the Port Townsend School District is not participating on the MAT. The background of
the Team and funding was reviewed briefly.
Member Westerman pointed out a textual repetition on page 6 under Impact on the Legal
System. Referring to the list of addictive substances on page 7, she also expressed her hope that
these education and treatment programs would not simply lump all drugs together. She noted the
potential loss of credibility that can result.
Member Johnson added that when he attended a National Association of Counties meeting in
Washington, D.C. two years ago, they did distinguish among drugs and methamphetamine was
the number one issue for virtually every county in the nation. Ms. Winegar said that it is also the
number one fear, particularly for law enforcement agencies.
Chair Austin called attention to the first bullet under the Legal System on page 6. He asked if the
dollar amounts cited were correct and what costs it is referring to. Ms. Winegar said she would
follow up on those questions.
Draft DEC (Drug Endangered Children) Document
Ms. Winegar next discussed this document, which is in early draft form and has not yet been
permanently titled. She explained that both this and the Meth white paper are collaborative
efforts of many view points. While still in process, there have been sign offs from Law
Enforcement, Child Protective Services, Public Health and the Prosecutor's Office.
Medical Response Recommendation, page 4, is the final item to be developed. She said that
currently there is a chain of custody protocol which is being reviewed for improvements with
Jefferson Health Care and law enforcement representatives.
Quen Zorrah provided her perspective. She noted that for many years, the problem of drug
endangered children was not fully acknowledged. She noted that it has taken time for the
community to understand and define what a drug endangered child is and the extent of the
problem in this county. She said collaboration among many agencies and organizations has
increased as a result of this project and in efforts to meet the increasing complexity and intensity
of needs of families. She stated that despite the coordination and collaboration, the problem is
not going away. More funding is needed to actually implement plans and take necessary actions.
Ms. Zorrah noted the importance of the chain of custody protocol.
Ms. Zorrah said that this work of the MAT had started when the focus was on meth labs. Since
that time, the problem has shifted away from the safety and environmental issues of meth labs to
children and families exposed to continuing drug use. The consequences of direct drug exposure
and severe neglect are now better understood. She said that this community, despite its small
size, has done amazing work, and more quickly than many other parts of the state.
Member Sullivan added that denial plays a large role in this issue. He said that in doing
interventions and getting people into treatment, he has often found that the child has been the
most powerful person once they were heard. He also noted the abuse cycles that start in
childhood. Ms. Zorrah agreed that wanting their children to escape the addiction cycle is a
powerful motivator for parents to seek or accept treatment.
Page 7 of 11 Jefferson County Board of Health, April 7, 2008
Our Kids: Our Business
Ann Winegar reported on the local programs that are part of National Child Abuse Prevention
and Sexual Assault Awareness month. Packet handouts include a description of the campaign, a
list of sponsors and the range of associated activities for the month of April, as well as Call to
Action leaflets and Business pledge sheets. Ms. Winegar mentioned that many organizations,
such as The Leader and Jefferson County Parks and Recreation, are doing wonderful publicity
and outreach efforts. She gave credit to Kelly Matlock for her vision in bringing this idea to the
fore. The original group decided to start small and then grow the program annually. However,
many other organizations would have wished to be included at the outset. She said that the
'principles before personalities' ethic has been clearly demonstrated. Additional ads and articles
will appear in the Leader throughout April. Although the emphasis has been on prevention, the
program will also honor survivors of child abuse and neglect with a candlelight vigil at Haller
Fountain on April 27.
Members Sandoval and Westerman, who had both attended the Compassion/Dalai Lama event in
Seattle, shared related highlights. Chair Austin mentioned the excellent document that had been
distributed at the Town Meeting, which gives guidance on what to say if/when you observe a
parent who appears to be abusing or neglecting a child. Ms. Winegar said that information will
be published in the Leader and appear on the Public Health web site. She said the information is
also appearing on the Food Coop and Jefferson County Public Safety Network websites. The
campaign costs have been extremely low — about $2500 for 20 weeks of ads and thousands of
pinwheels, etc. — thanks to community contributions and discounts.
Protocol for Responding to Public Meeting Disruptions
Chair Austin recalled that at a previous meeting there had been a request for a protocol for
responding to public meeting disruptions. At that time, he had promised to consider what he
could do as Chair. He had then drafted a statement to be read at each meeting. He said this is not
a formal protocol, but is what he plans to do as Chair. He will read the introduction to the public
as he did prior to the Public Comment portion of the meeting on this date. He said he did not
think it necessary to remind the public each time that disruptions will lead to certain responses.
However, if it appears to be necessary, in his judgment as Chair, he will read the statement that a
disruption of this meeting constitutes disorderly conduct and is a misdemeanor, and persons
causing a disruption will be asked to leave — based on RCW 84.030.
Member Westerman asked whether the statement would be read after the disruption had
occurred; he indicated that was the case. If the person(s) are asked to leave and do not,
Courthouse Security will be called upon to assist. Member Westerman, who is Vice Chair, said
she wished to use the same procedure and desired clarification on the following points. She
questioned whether it is necessary to include "Please confine your comments to issues that
pertain to public health". She pointed out that the BOH also deals with environmental health
issues. She said she is willing to read this whole statement, but she would like to say that we ask
that statements are civil, and not delineate what is not considered civil. Chair Austin said he
could accept that. Member Frissell suggested that the Chair (or Vice Chair) also state that the
Board is not going to respond to public comments. Member Johnson said that the BOCC states
Page 8 of 11 Jefferson County Board of Health, April 7, 2008
that they typically won't respond to public comments. Member Sullivan noted that it is also not
the time to ask questions, that there are other venues for that.
Jean Baldwin said she wished to verify that the ordinance adopted for courthouse behavior only
applies to the BOCC; Commissioners said that is the case. Chair Austin said the protocol under
discussion for the BOH is from the RCW for public meetings.
There was a brief discussion regarding the need to limit comments to the topic of public health.
Member Westerman said she did not wish to monitor and enforce the appropriateness of every
comment. Chair Austin agreed that she would not need to do so.
Jean Baldwin asked whether the statement should be printed on the meeting agenda. Chair
Austin said that would be helpful, and noted that he had added the word typically, as suggested.
Member Frissell said she wished to address the apparent confusion about meeting venue
changes. She said she had seen the announcement in the newspaper twice before receiving the
meeting packet. She suggested that perhaps when the meeting is not being held at the Health
Department, a notice should be posted there the day of the meeting indicating the location of the
meeting. Jean Baldwin said that the notice of adjournment had been posted at the Courthouse
and at the Health Department, but not at Pope Marine because of the notice in the paper.
Member Westerman said it was especially important to post if the meeting location is changed.
Ms. Baldwin confirmed that a notice was posted at the Fire Hall on April 17. She added that this
venue (First Floor Conference Room, Courthouse) may be the permanent location.
ACTIVITY UPDATE
Public Health Standards Review — The Department is undergoing a 3 -year review by the State as
to compliance with 12 public health standards. The review covers communicable disease, food
safety, and maternal/child health. The Health Department will be rated along with every other
health department in the State. Reviewers will be on site for one day. Julia Danskin is leading a
team in preparation for the visit. She mentioned that as a small county, Jefferson has not had the
infrastructure and funds to maintain every aspect up to the level that would be desired. She said
that the funding for Emergency Preparedness has been of considerable help in related areas. She
said they had done very well six years ago with Assessment, but ratings dropped three years ago
due to the loss of various sources of funds. Jean Baldwin said that it is similar to performance
standards, but it involves testing a whole state wide system. The State Department of Health
does not fund for many of the things they are testing, i.e. it is not tied to their money. Funding is
all from local dollars. Jean Baldwin noted the inherent challenge of ensuring state-wide
standards when many local systems receive no state funding. This entire process is the attempt
to establish a common infrastructure across the state. However, the measurement process can be
onerous.
Dr. Locke said that the department had gone through identical audits in 2002 and 2005, and the
comparison over the three year period was informative. The current audit is structured
differently and focuses on a subset of an expanded set of standards, so that direct comparison
with 2002 and 2005 assessments will not be possible. Infrastructure standards such as methods
of contracting and business management will be measured across the state. For other areas,
Page 9 of 11 Jefferson County Board of Health, April 7, 2008
various counties will be measured for different combinations of standards. Dr. Locke said that
the most useful comparison of this data is to measure the department's own performance,
strengths and weaknesses over time.
Home Owner Inspection Data — Dr. Locke said that data from other counties is being collected.
Clallam County is scheduled to attend the May BOH meeting to make a presentation. The
Clallam Work Group has just completed new documents on site certification and home owner
inspection.
AGENDA PLANNING
Member Westerman suggested that the Homeowner Inspection presentation be scheduled at a
different meeting from the Royer Report to allow sufficient time for full discussion. After a brief
discussion, it was agreed that the Clallam Work Group presentation would be postponed.
Jean Baldwin said she would also like to schedule a School Based Clinic briefing soon. The
hope is to begin the program for the 2008-2009 school term, so action would be needed in the
near future.
NEXT SCHEDULED MEETING
The next BOH meeting will be held Thursday, May 15 from 2:30 to 4:30 PM in the Courthouse,
First Floor Conference Room.
ADJOURNMENT
Member Johnson moved to adjourn and Member Westerman seconded, with all in favor. The
meeting was adjourned at 4:29 PM.
Page 10 of II Jefferson County Board of Health, April 7, 2008
JEFFERSON COUNTY BOARD OF HEALTH
Robert& ell, Member
Phil Jo on, Member
Michelle Sandoval, Member
Sheila Westerman, Vice Chair
U 40*
Chuck Russell, Member
David Sullivan, Member
Page 11 of I1 Jefferson County Board of Health, April 7, 2008