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HomeMy WebLinkAboutM051508JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, May 15, 2008 2:30 PM — 3:45 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, Chuck Russell, David Sullivan, Sheila Westerman Members Excused: Michelle Sandoval Staff Present: Jean Baldwin, Dr. Thomas Locke, Julia Danskin, Susan Porto, Veronica Shaw, 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 APRIL 17, 2008 Member Westerman moved for approval of the minutes of April 17, 2008 as written; the motion was seconded by Member Sullivan and approved, unanimously. PUBLIC COMMENTS Chair Austin opened the meeting to public comment and explained the rules regarding this portion of the meeting. There were no public comments. Page 1 of 6 OLD BUSINESS AND INFORMATIONAL ITEMS Note from Jill Buhler Dr. Locke read a note from Jill Buhler to the Board of Health expressing her warm regards and appreciation for the Public Health Hero award presented to her at the April meeting. Rabies from a Puppy Imported from India to Jefferson County Jean Baldwin referred to the journal article "Rabies in a Puppy Imported from India to the USA, March 2007" published in Zoonoses and Public Health, 2008, which she had co-authored, and a related short communication entitled "Importation of dogs into the United States: risks from rabies and other zoonotic diseases" from the same journal. She briefly summarized the case and how Jefferson County had become involved in it. She and Dr. Locke explained that the two articles point to the risks involved in the importation of dogs from areas of the world where rabies is common. The State of Washington does not require rabies immunization for pets. Federal regulations require that dogs from rabies -enzootic areas must be vaccinated. However, puppies under the age of three months are too young for vaccination. They are to be confined until vaccinated, and then confined for an additional 30 days. Dogs in the incubation stage of rabies infection may appear clinically normal at the time of importation. According to the short communication, the CDC (Centers for Disease Control) is currently considering "whether federal regulations regarding the importation of companion animals should be strengthened to prevent the importation of foreign canine rabies variants and other zoonoses." There was a brief discussion about the possibility of universal inoculation. It was noted that this would be hard to justify in dogs, given the effective controls and success of eradication on the local level. However, there are inadequate protections internationally and this remains a serious problem. Bats are the only significant vector for rabies in Washington State. Locally, bat bites require expensive post -exposure vaccination unless the bat has been captured and can be tested. NEW BUSINESS Jefferson County Public Health Heroes Jean Baldwin and Julia Danskin presented Public Health Hero awards to Shirley Williams and Geoff Masci on behalf of the Board. Shirley Williams received the Public Health Leadership Award. The following text of the nominating citation was read aloud: "Shirley has been a nurse -volunteer for the American Red Cross for many years. She teaches classes in First Aid, CPR, and Emergency Preparedness. She responds to local and national emergencies. She supervises Red Cross Nurses as they work for local emergency preparedness or travel to the neighborhoods destroyed by Katrina, or even working here with Public Health emergency drills. She maintains the Red Cross' RN trainings, protocols and response team. She works without compensation or expectation of any recognition. It is impossible to measure how many people have been touched directly and indirectly by her years of dedication to the Public Health of the Community. We would love to see her recognized as a behind the lines hero. Shirley also Page 2 of 6 coordinates the Master Gardener winter lecture series; these are attended by hundreds of people. Shirley beautifies our community through educating gardeners and nurses." Dr. Geoff Masci received the Special Recognition Award. The text of the nominating citation was read aloud: "Dr. Geoff Masci served on the Jefferson County Board of Health for many years. His understanding of the many, varied issues facing the Board of Health fostered clarity and helped generate solutions. Geoff moved city and county governments to see citizens in their common needs. He mobilized many policy makers to review health data before making public decisions. Dr. Masci served as the Board of Health liaison to the Port Townsend City Council but he served all the citizens of Jefferson County. He added an alternative medicine point of view to the Board of Health. His perceptiveness and ability to articulate complex situations and suggest workable solutions to difficult problems were among his many contributions to the public health of the county." Feasibility Study on Converting the Jefferson County Public Health Department to a Jefferson County Public Health District Gregory Kipp, a Royer Group partner, presented a summary and key findings of the study to the Board. Mr. Kipp said that his company had been commissioned to study the feasibility of converting the county health department to a public health district. The Board of Health (BOH) had sought a third party to identify and consider key issues. The RFP (Request for Proposal) specified that the scope should include political and financial feasibility. The Royer Group had also provided their findings on operational feasibility. Mr. Kipp reviewed the methodology employed for the study. This included review of the JCPH (Jefferson County Public Health) budgets and the Jefferson County budgets for the years 2003- 2008, particularly administrative costs charged to JCPH and fees charged by JCPH for Environmental Health regulatory services. The Royer Group (TRG) also conducted interviews with the Jefferson County BOH, the BOCC, the County Administrator, the JCPH Director, the JCPH Health Officer, three sitting and one former Port Townsend City Council members, the Port Townsend City Administrator, and five representatives from Jefferson Healthcare, including the CEO, COO, Chief of Staff and two Hospital Commissioners. Additional interviews were done with the Administrators and/or Health Officers from eight Local Health Jurisdictions throughout Washington, six of which operated as health districts and two as county health departments. He noted that two of the county health departments had reverted from health districts within the last decade. Also interviewed was the Acting Director for the Washington State DOH Office of Public Health System Planning and Development, who serves as the liaison between the DOH and local health districts throughout the state. Mr. Kipp briefly discussed the options for constituting a local health jurisdiction. He noted that, under State law, the Board of Heath membership requirements for a health department or a health district are essentially the same. The report states that the current make up of the Jefferson County BOH, which includes the three County Commissioners, an elected representative from the City of Port Townsend, an elected Jefferson Healthcare Hospital Commissioner, and two citizen members, meets the requirements for becoming a health district as currently constituted. He added that the BOCC may expand the BOH, but it may not have a majority of non -elected members. Page 3 of 6 Mr. Kipp summarized the conclusions: transitioning to a health district is politically and operationally feasible, but is considered risky for financial reasons, at this time. Of those interviewed, only one person was not in favor of the health district notion. Others were in favor or preferred to wait for additional information. Generally speaking, a health district allows more of an independent stance and purpose, and would not be diverted by larger county issues and operations. It would allow greater flexibility and ability to meet public health demands as they evolve. In discussing the financial aspects, Mr. Kipp said there were significant risks. In view of the current economic climate and declining revenues, it is feared that if the department is converted to a health district, the County may step back and no longer consider itself fully responsible. Other revenues would need to be identified or increased. More participation would be needed from the City and Hospital, which are continuing to face their revenue issues. It was noted that the financial challenge is not unique to this area and statewide efforts have been ongoing to provide a stable, predictable source of public health funding. Mr. Kipp noted that there is appreciation for the high quality of work of the department and that it is considered to be a solid public health agency. A common theme that emerged from the interviews is that the current level of service should be maintained. The department is seen as doing a good job on obtaining grants and pursuing its current options for funding. JCPH is positioned to make the conversion if the financial future would be more secure. Board Member Russell asked if Mr. Kipp could name one change that would be needed to make this fully feasible. Mr. Kipp said that several changes would be required: strengthening local partnerships and dealings with stakeholders; identification of overlapping missions, and agreement on the long term vision for governments and financing from the three entities — County, City and Hospital. Member Westerman added that the School District should also be involved. She acknowledged the extreme challenge of the situation because each of the entities faces continually rising costs and declining revenues. There was a brief discussion of the possible benefits of a health district over a health department. Member Westerman said she believed the de -politicization was the most important thing. Ms. Westerman also commented that she had seen many RFP processes and was particularly pleased with this process and report. She said it was the most direct and clearest in its findings and presentation. Member Sullivan sought clarification on the entities interviewed which had converted back to their former structures. Mr. Kipp noted that in the case where multiple counties had formed a health district, the largest county was providing 90% of the funding and the BOH had equal representation from all the counties. Ultimately, the primary contributor wished to exercise control of the dollars it spent. In the second case, there were financial control issues between the County and City, as well as some political issues. BOH members discussed possible next steps. Ms. Westerman suggested a letter to legislators describing that this process had been undertaken to foster local partnerships, but has been thwarted by the lack of stable state wide funding sources. Ms. Frissell suggested that a face to face meeting may be more effective. Member Sullivan mentioned the CTED (Community Trade Page 4 of 6 and Economic Development) report and suggested that these concerns could be put in the context of structural funding issues that exist for Public Health. Member Westerman moved and Member Frissell seconded that the BOH draft and send such a letter/invitation to our three legislative representatives. Dr. Locke suggested it would be most effective to coordinate this letter with statewide efforts to ask the State Legislature to act on the recommendations of its Joint Select Committee on Public Health Funding. The Joint Select Committee proposed the appropriation of $100 million for the 2007-08 Biennium. Only $20 million was appropriated in 2007. It was also noted that State Board of Health will be meeting at the Inn at Port Hadlock in November, and that may be a good time to present these issues. The motion was restated, as modified, and passed unanimously. ACTIVITY UPDATE State BOH Meeting — Chair Austin reported that he had attended the May 14 State Board of Health meeting on Orcas Island. He said that there had been a public hearing with regard to Vibriosis Control Plan rules. Vibriosis is caused by a marine bacteria and proliferates in warm water and contaminates shellfish. The maximum time for transitioning shellfish from their water habitat to cold storage will be reduced; there will be different restrictions for coastal areas versus Puget Sound. Rule changes will be publicized on the State Board of Health website. There had also been intense discussion about school environmental rules and physical safety. This was primarily related to balancing child safety and costs, and balancing local versus state control. One of the suggested rules was to provide shower facilities for those who participate in sports at the sixth grade level and above. He said the State Board of Health would not be making that change, primarily because of the expense involved. There was also considerable concern about possible effects from exposure to chemicals, such as those found in copier machine supplies and in new construction. Member Austin said that there is considerable passion both on the side of those promoting additional safeguards and by those who wish to control costs. He mentioned one proposal to provide natural light to every individual working in a school environment. Member Westerman mentioned studies that indicate that a certain amount of exposure to dirt and microbes is necessary for proper immune system development and function. Jean Baldwin requested clarification on next steps related to the Royer Report. She verified that the Supplemental Budget request would be discussed a later date. She said she would inform staff that, based on the Royer Report findings, there will be no further action toward forming a health district at this time. There was also agreement that a letter from the Chair of the BOH would be sent out to all who had participated in the study. AGENDA PLANNING June Meeting rescheduled — Jean Baldwin stated that due to a schedule conflict for the County Commissioners and Mr. Russell, the June meeting had been tentatively rescheduled for June 12 at the Masonic Hall. BOH members who had not already done so were requested to confirm their availability for that date. Page 5 of 6 There was a brief discussion about how the proposed septic code draft would be formatted for future meetings. Dr. Locke recommended that the document clearly shows current code language and what is being proposed for addition, deletion or modification. At the point the BOH believes the draft is ready for public hearing, there would be a call for the hearing and the process of public review would be started. The next step in the process is to develop code language that authorizes homeowner inspection of on-site systems to fulfill the periodic operation and monitoring requirements of the State on-site code. Homeowner inspection will be the focus of the June Board of Health meeting and will include presentations on what other local health jurisdictions are doing to fulfill the new inspection mandate. ADJOURNMENT Member Sullivan moved for adjournment and Member Johnson seconded. Chair Austin adjourned the meeting at 3:45 PM. JEFFERSON COUNTY BOARD OF HEALTH Jo Austin, air Sheila ste an, ice Chair I V Roberta Frissell, Member Chuck Russell, Member Phil Johnso , Member David Sullivan,ember Excused Michelle Sandoval, Member Page 6 of 6