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HomeMy WebLinkAboutM071708JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, July 17, 2008 2:30 PM — 4:30 PM Masonic Hall, 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, Chair, County Commissioner, District #3 Andrew Shogren, Environmental Health Director Chuck Russell, Hospital Commissioner, District #2 Julia Danskin, Nursing Services Director 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 Masonic Temple, 1338 Jefferson Street, Port Townsend, WA. Members Present: John Austin, Roberta Frissell, Chuck Russell, David Sullivan, ex -officio member, Frances Joswick, Substance Abuse Advisory Board Members Excused: Phil Johnson, Sheila Westerman Staff Present: Jean Baldwin, Dr. Thomas Locke, Andrew Shogren, A quorum was present. APPROVAL OF AGENDA Member Chuck Russell moved and Dr. Locke seconded the approval of the agenda. The motion to approve the agenda, as written, was passed by unanimous vote. APPROVAL OF MINUTES Member David Sullivan moved for approval of the minutes for June 12, 2008. Roberta Frissell noted a missing item: She said that during the June BOH meeting, following the presentation by Andy Brastad, a question had been asked regarding the amount of money Clallam County had spent thus far on the new sewage regulations process. She recalled that his response was "over $200,000", and requested that that should be reflected in the minutes. Dr. Locke said that the amount was uncertain, and offered to have staff check the recording. Chair Austin suggested that the approval of the minutes be postponed until the data item was verified, which was accepted by Member Sullivan. Chair Austin indicated that approval of the June 12 minutes would be on the agenda for final approval at the August meeting. Jefferson County Board of Health page 1 of 11 July 17, 2008 PUBLIC COMMENTS Chair Austin read aloud the rules of order for the'Public Comment period. OLD BUSINESS Presentation - Tobacco Prevention T -Shirt Design Contest Awards Karen Obermeyer of the Tobacco Prevention and Control Program, Public Health Department, gave a brief update on the program. There are four main areas of focus. The first is to increase the capacity for tobacco control. The next meeting of the Tobacco Control Coalition is August 13 at 4:00 PM at the Health Department. The second area of focus is to promote tobacco use cessation and referred to the Quit Line and stated this is a free State service including counseling and products to help smokers quit. The tobacco prevention program also works with physicians to help them get tobacco use treated as a vital sign. The third area of focus is elimination of second hand smoke exposure. The fourth area of focus is prevention of the initiation of tobacco use. For example, the program monitors tobacco retailers regarding sales to minors; she said there is a 90% compliance rate in the County. She discussed the TATU (Teens Against Tobacco Use) high school program, which includes peer education training. Ms. Obermeyer then introduced Helen Pilling, who presented the awards for the Tobacco Prevention T-shirt Design Contest. Heather King and Emily Rose Strickland, both from Port Townsend, received awards for their designs "Killing You Slowly" and "Tobacco Facts", respectively. Media Releases Dr. Locke spoke briefly about the Washington State Department of Health's Shellfish Health Advisory regarding Vibriosis risk. The intention is to warn the general public of the risk in eating shellfish harvested when temperatures are very warm and naturally occurring marine bacteria rise to toxic levels. The release provides a list of tips to recreational shellfish harvesters. Correspondence Jefferson County Public Health's Traveler's Immunization Clinic — Jean Baldwin briefly discussed the letter from Lisa McKenzie, Communicable Disease Program Coordinator, to Jefferson County Primary Healthcare Providers. This is an information packet for providers to clarify clinic services and the increasing number of vaccines provided. The Traveler's Clinic is part of the Immunization Clinic and Communicable Disease Team. Septic Tank Inspections — Letter from Davis Steelguist and reply from Dr. Locke Copies were included in the packet. There were no comments or discussion. WA WIC Nutrition Program 2007 Annual Report Julia Danskin spoke briefly about the state-wide annual WIC report and information specific to Jefferson County. She reviewed pertinent statistics regarding the number of women, infants, and children served by the Health Department, and the federal dollars spent at local grocery stores/farmer's market, under the Farmers Market Nutrition Program. She said WIC authorized Jefferson County Board of Health Page 2 of 11 July 17, 2008 stores, including Safeway, QFC, Food Coop and the Quilcene Grocery Store, to accept WIC vouchers distributed by the Health Department. She said the total dollars dropped slightly in 2007 but is again rising in 2008, both state-wide and locally. The challenge is to distribute the block grant funds equitably, although demands and needs for families may rise and fall. She said that thus far it has not been necessary to place any families on a waiting list. Member Sullivan asked for clarification on the statistic regarding percentages of families living in poverty. Julia Danskin explained that 60% of WIC families are working families and 65% of WIC families are living in poverty (that is, a family of four with $1721 or less monthly income). The WIC program is funded from federal and County (General Fund) monies. Ms. Danskin also noted that about $2,000 is given to families annually to be spent at the Farmer's Market; this year there will be an effort to ensure that more dollars are spent there. WIC is seeking more farmers to be authorized vendors in the program and there is no waiting period. However, to be authorized, a Farmer's Market must have a requisite number of local vendors selling local produce; arrangements are made through the market manager. Region 2 Public Health Newsletter Dr. Locke reminded the Board that the target audience for this newsletter is healthcare providers. This issue focuses on the disposition of the modest increase in funding from the legislature intended for increasing immunization rates and improving communicable disease control. Provider participation is especially needed in the CHILD profile system, an electronic registry used for immunizations and other preventive health services; 100% child enrollment is sought. Currently 70% of the children in the State are registered. Jean Baldwin briefly described a technical problem with the system resulting in only 25% of County children's records being included. She said that data interfaces with that system, at an added cost, may become mandatory in order to receive the State sponsored vaccines. Hood Canal Dissolved Oxygen Program Update Andrew Shogren briefly noted the set of articles in the packet relating to Hood Canal dissolved oxygen assessment and modeling studies. There was no further discussion. NEW BUSINESS Jefferson County On-site Sewage Code: Review of Homeowner Inspection Programs in 6 Washinnton Counties and Proposals for Jefferson County Homeowner Inspection Program Andrew Shogren introduced this agenda item. Angela Pieratt, Environmental Health Specialist, walked the Board through a PowerPoint presentation entitled "What's New with the Jefferson County Operations and Monitoring (O & M) Program?" She recalled that the previous BOH meeting had included a status report from Clallam County about their Homeowner Inspection Program (HIP) programs. She discussed changes to the existing Jefferson County program and code, the history and background, program challenges, and future planned improvements. She also addressed several questions that had been raised previously. Jefferson County Board of Health Page 3 of 11 July 17, 2008 Recent changes — In 2007, the inspection frequency changed to three years for gravity systems and annually for all others. In addition, a monitoring agreement is required for any site where a system is permitted. Inspections may be done by County O & M specialists ($274) or private industry. The intention is to update the code for the Homeowner's program to allow homeowner inspections. History — The Inspection Program began in 1987. Successive changes to the program are outlined in the handout entitled "Septic Monitoring in Jefferson County 1983-2008". Ms. Pieratt noted that, as with many technologies, there has been a shift from simplicity (conventional gravity systems) to more complexity (alternative systems). State and county regulations have evolved accordingly over the years. In terms of internal challenges, in January 2008, the Jefferson County Public Utility District (PUD) discontinued performing automatic inspections, and had stopped creating contracts. Meanwhile, the State Code increased the required frequency of inspections. Professionals are now completing the majority of home inspections but, for those previously done by the PUD, a number of systems are now "falling through the cracks". Since 2000, the County code requires that all systems must be monitored. Registration is triggered at the sale of a property or building permit application. Ms. Pieratt said that the number of certified professionals will rise from 6 to 9 this year, in addition to designers who work within the County. The Health Department and the PUD may also perform inspections. Member Russell asked how many of the certified professionals work for pumping companies. She said she knows of two owners and two employees of pumping companies. There was agreement that it would be desirable for pumpers to be trained inspectors. There was also clarification that there a two reports: the monitoring report, which qualifies a system and drain field, etc. and verifies that the system is in good operational order; the pumping report deals only with the tank, and amount of material pumped. The cost of the inspection was estimated at between $150 — $300, depending on the complexity and the amount of time required. Vision — The vision for the future is to update and improve the existing program, as well as to pursue the homeowner inspection component. Emphasis will be on action through education, outreach and incentives. The inspection schedule will remain at every three years for conventional systems and annually for all others, which is consistent with State code. At this time, sensitive areas do not have additional inspection requirements, but will be considered. For time of sale and building permits, a professional inspection will continue to be required. The existing filing fee is $39. Other sources of funding expected include permit fees, the Clean Water Assessment program and operational certificate fees. Implementation — Ms. Pieratt briefly listed the components of Implementation. Education offered includes free TLC for your Septic classes; there have been five classes to date this year. A variety of brochures are available in the office and online. Trained staff is now available in the office five days per week. Future education will likely include Homeowner Septic O & M, 101 and 102, and mailings to targeted communities. She noted that other counties have had good success with market based solutions and financial incentives. Funding would be required in order to offer rebates for timely inspections or the like. Jefferson County Board of Health Page 4 of 11 July 17, 2008 A phased implementation would likely begin with PUD contract holders, then properties with a boundary within 200 feet of the shoreline. (Board Member Russell requested clarification of whether the property line or drain field location would determine this priority group. Staff explained that this decision would require further consideration and would need to be consistent with the Shoreline Master Plan updates.) Homeowner notification would be handled through bulk mailings to targeted communities, direct mailings and compliance reminders. Phase 1: 2008-2012 — Ms. Pieratt provided an outline of plans for Homeowner Training and Inspections. Ideally, training (five hours of field and classroom work) would be offered free and taught by County Public Health staff. Only conventional systems would be eligible for Homeowner Inspection. It is estimated that about 10,000 of the 13,000 on site septic systems in the County are conventional, gravity systems. Requirements for shoreline systems are yet to be determined. Other conditions include: the septic system must be a permitted system; only residential systems may be homeowner inspected. Professional inspection is required at time of sale and for certain types of building permits. In response to a question about the appropriate process during sale of properties (or building permit application) with previously unpermitted systems, Ms. Pieratt said that a careful inspection would be done and a record would be established. Unless the system is clearly failing, a new system would not be required. Dr. Locke added that the septic permit is an installation permit not an operating permit. It does not make sense to issue an installation permit has been in use for decades. Member Sullivan mentioned that he was aware of anonymous handbills with misinformation about this program recently distributed in Port Hadlock. Staff was not aware of any increase in recent inquiries related to that "publicity". Ms. Pieratt summarized the additional sources of information related to State and County regulations and plans that are available online. She noted that paper copies of septic permits are being scanned for inclusion in a reference database. Currently, applications/permits from 1979 to 2004 are already online. To access them, the parcel and septic permit number can be obtained from the County web site. She also described the eOnsite program which, when fully implemented, will allow a streamlined process for entering septic system evaluations online and making them accessible to others. A special interface will allow the Health Department to review the reports electronically. Ms. Pieratt described the ShoreBank Septic Loans program, which provides excellent financing arrangements for repair or replacement of residential systems, with zero out-of-pocket expenses. Board Chair Austin added that, in many cases, recipients will not need to repay the cost of the loan until the sale of the property. There was agreement that this is a great resource for County residents. Contact and web information for the County Public Health Department and ShoreBank organizations was provided: www. JeffersonCountyPublicHealth.org and www.sbseptic.com. Ms. Pieratt addressed a question that had been asked by Member Westerman at the previous meeting about the Kitsap program. She said she had obtained information from the person currently responsible for the program. The previous Kitsap homeowner program was not based on certification. Homeowners were allowed to take a test, and were then expected to report inspections. Apparently, over 200 people had taken training and been tested, but less than 0.5 % had turned in a report. Kitsap then changed their regulations to ensure that people passed a Jefferson County Board of Health Page 5 of 11 July 17, 2008 certification exam (for $150) and paid a certification fee ($336), as well as met additional requirements (proof of necessary equipment; waiver from inspection contract; etc.). Homeowners were not permitted to inspect others' systems, presumably because of liability concerns. At present, there are no certified homeowner inspectors. [Chair Austin called a short recess to allow reconfiguration of furniture and presentation equipment at 3:35 PM. The meeting resumed at 3:45 PM.] Appeal of Solid Waste Administrative Hearing Decision Dated April 24, 2008 Regarding Notice and Order to Correct Violation on Parcel #901253002, Property of Ms. Linda Sexton Chair Austin opened the hearing for the appeal. He explained that the BOH was asked to review this decision, and that proper protocol was to be followed. He read the rules of order appropriate to this gathering. He said it was important to note that this is a closed record appeal, meaning that no new information could be presented. He said the purpose was to review the propriety of the administrative hearing that was conducted on April 24. "Since it is a quasi-judicial hearing it is important that we have all the elements of fairness. The hearing must be fair in all respects, meaning in form, in substance and in appearance." He then asked if any Board Members had any interest in this property or if any should stand to lose or gain any financial benefit as the result of the outcome of this hearing, or if any member had any disclosures to make about any special interest in this property. Chair Austin and each of the Board Members stated that they had no such interests, nor did they stand to gain or lose any financial benefit. He then asked if there was anyone in the audience who had objections to any Board Member participating in the proceedings. There were no objections voiced. He said that the purpose of the hearing was to hear the appeal and to take action related to the prior administrative appeal. The order of speaking to be followed was previewed: staff presentation; argument from the appellant, Ms. Linda Sexton; testimony from any proponents of the appeal; testimony from any opponents or those neutral to the appeal; any argument from the appellant in response to the opposition to the appeal; response from staff; and any questions from the members of the BOH. Chair Austin then introduced Dr. Tom Locke, who made the staff presentation. Dr. Locke said he would begin by identifying each of the set of documents relevant to the appeal that had been included in the packet. Dr. Locke explained that all BOH codes (on-site, food safety and solid waste) have appeal processes. The solid waste code stands apart from some of the other BOH codes. Other codes are based on State BOH or State Department of Health rules. The solid waste code is based on the State Department of Ecology rules and local health departments have been mandated to enforce those rules. He said many of the rules in the code do not have a direct health bearing, and decisions about enforcement are not made strictly based on health considerations. The emphasis is upon definitions in the State codes and what the local health jurisdictions is required to do in enforcing them. Dr. Locke briefly reviewed each of the documents: 1. Letter to Ms. Sexton informing her of the appeal scheduling dated June 19, 2008. It included a request of Ms. Sexton to resubmit materials that had not seemed to be in logical order. He noted Jefferson County Board of Health Page 6 of 11 July 17, 2008 that the packets contained the original materials and that the resubmitted materials were also available for this meeting. 2. Dr. Locke's memorandum to the BOH dated July 10, 2008. He said he would return to this document in presenting his analysis and argument. 3. Document dated April 24, 2008 representing the result of the administrative hearing. He said the format was standard for administrative hearings and included findings of fact as well as conclusions of law. He noted that these findings are the subject of the appeal at hand. 4. Case summary of complaint #1069. This is a chronology of this case prepared by Margie Boyd, the Solid Waste Code enforcement staff involved in this case. 5. Letter to Ms. Sexton from Ms. Boyd dated September 18, 2007 requesting permission to visit her property. 6. Letter to Ms. Sexton from Ms. Boyd dated January 14, 2008 informing of the open complaint and again asking permission to enter the property. 7. Notice and Order to Correct Violation (NOCV) to Ms. Sexton dated January 14, 2008. This was the subject of the appeal at the administrative hearing. 8. Supporting documents included at the administrative hearing, including maps, reports and photographs taken by Fire Rescue and staff. 9. Documents submitted by the appellant, including letters and arguments submitted by Ms. Sexton at the time of the administrative hearing. Dr. Locke returned to the document numbered 2 above. He said that the case before the Board focuses on the administrative hearing of March 13, 2008. He said that it is easy to become confused in this appeal due to the decade of complicated solid waste enforcement actions by various county agencies. He recommended that the Board stay focused on the NOCV issued in January 2008 (document 7) and the subsequent administrative hearing on March 13. Dr. Locke said he believed that there are three key areas that are raised in this appeal: 1. Ms. Sexton disputes the legality of entry to the property by the building inspectors and therefore argues that if their entry was improper, then any observations they made would be void or inadmissible. 2. Ms. Sexton disputes the legal definition of several solid waste code terms, specifically the definitions of "discarded commodities" and "bulky waste", which were cited in the violation. 3. Ms. Sexton asserts a first amendment right for a religious exemption to solid waste code based on strongly held religious beliefs. Dr. Locke said that in Washington State laws, there are certain public health codes that do allow religious exemptions. He cited the examples of public health codes where exemptions are permitted for vaccinations or to refuse treatment for tuberculosis. However, he said that to his knowledge there are no religious exemptions to solid waste codes. Dr. Locke said that, in the administrative hearing, he had attempted to deal primarily with the two issues, i.e. the legality and appropriateness of staff acting on the complaint they had received. His determination and reasoning was that the legality of the entry by the fire department and subsequently by the building inspectors was a moot issue, in terms of the complaint. Complaints are not a form of evidence; complaints are not ruled admissible or inadmissible. A complaint is essentially an unconfirmed allegation, which anyone can make. From the standpoint of the Health Department, a standard of reasonableness is followed. If a complaint seems to be reasonable, an investigation is conducted, during which evidence is gathered. All decisions, in terms of whether or not a violation has occurred, are based on that evidence. That evidence must follow all rules of evidence, be legally gathered, and be admissible in both Board of Health hearings and court hearings. Rules of evidence definitely Jefferson County Board of Health Page 7 of 11 July 17, 2008 apply to the evidence gathered by the Health Department, but Dr. Locke had determined that a complaint in itself is not a form of evidence. The second issue for which Dr. Locke made a determination was that definitions of solid waste are not a matter of individual prerogative. Under Washington State codes, each individual does not define what is or is not solid waste. The definitions contained in the state and local codes as understood by the enforcement agencies determine what those agencies are required to enforce. He said that his determination was that the definitions of discarded commodities and bulky waste are reasonably clear in the State codes. When applied to the evidence (photographs) that had been submitted, those photographs confirmed the presence of those types of solid waste on the property. With regard to the present BOH hearing, Dr. Locke asked the Board to make determinations in the three key areas. He said that if all three of these components are not present, then the administrative hearing conclusions should be reversed by the Board. At a minimum, there is the issue of whether the solid waste code violation filed by the Jefferson County building inspector in conjunction with a site visit on February 7, 2006 was sufficient to warrant a site inspection or complaint inspection by the solid waste code enforcement staff. Did the department act properly in gathering evidence about this site? Secondly, was the evidence, i.e. photographs obtained with the permission of a neighboring property owner from a neighboring property, gathered in a legal manner? Thirdly, does this photographic evidence constitute proof that a solid waste code violation was occurring and justified issuance of the NOCV on January 14, 2008? He said these were the key issues pertinent to the appeal in the present hearing, and concluded the staff presentation. Chair Austin then asked Ms. Sexton to make her presentation to the BOH and asked that she limit her remarks to about five minutes. Ms. Sexton said that she thought the time allotment of five minutes was very unfair, but that she would comply. She mentioned that it was probably more (time) than she got previously. She said Public Health staff hadn't discussed any issues in particular that she was concerned about related to solid waste definitions. Ms. Sexton also mentioned that she was not a solid waste county facility or a solid waste recycling center. Ms. Sexton said that, as a responsible land owner, she was submitting a copy of a document that is an accounting of her receipts for the last year for solid waste disposal. Ms. Sexton next discussed an administrative hearing in August 2007, over another violation, which she said had eventually been voided, based upon illegal entry. She said she was trying to provide some historical context because the same issue had been going on since the 1980s. She mentioned a letter she had written to Senator Hargrove in 1988 seeking clarification on the issue of solid waste, and distributed copies of that document. Ms. Sexton said she was contacted by the Health Department in 1996 about her problems. She said that since she was bed ridden with a knee injury, she had agreed to meet with staff in her home. At that time, the staff person asked to see her property, and she escorted him while on crutches. She said that she was unaware that he was intending to do a site investigation and take photographs, which were then presented a hearing. She said she had not been shown the photographs. Ms. Sexton said she had been told that she had "too much stuff' and had not been given a reasonable explanation or clear definition of what was too much. She then received a Jefferson County Board of Health Page 8 of 11 July 17, 2008 notice of violation that referred to her property as an unpermitted solid waste facility and/or recycling center, which she disputed. In seeking clarity and guidance, Ms. Sexton said she contacted the Department of Ecology and obtained copies of a 100 page document with solid waste related definitions. She noted that the definition of "discarded commodities" (items that are no longer usable for their intended purpose) had not been added until 1988. Ms. Sexton protested the definition, stating that it is completely unclear and ambiguous as to meaning. She said she wishes to define her own intent, and to have her own choice as to what items are "in use". Ms. Sexton said that she had been told that she had no "private property". She mentioned dump trucks, excavators and back hoes, and fear of violence upon her property. She mentioned considerable correspondence with the Governor's office. Chair Austin interjected briefly, indicating that the procedure would be to allow for another three minutes for a proponent of the appeal. He said that Ms. Sexton could take that time herself or allow someone else to speak. Ms. Sexton indicated that she would like to take the time herself. Chair Austin then asked the attendees if anyone else had come to speak as a proponent. No one voiced that intention. Chair Austin indicated that Ms. Sexton could continue for that additional time. Ms. Sexton described hearing discussions about the definition of the term `solid waste'. She said that she was told to "sign here, we want to monitor everything that you collect, that you get, where you're going to put it, how you are going to use it, how long you're going to store it there, what is your intention." She said she was falsely accused of violating the rural residential storage ordinance in 2004. She also mentioned having been warned or cited for building too close to the property line. She said her property and her house were entered by County employees without her permission when she was out of town, but witnessed by her tenants. She mentioned a Notice of Violation that she did not understand because the document did not make clear what the violation was for. She mentioned fencing in connection with County employees entering her property, and stated that she had offered to raise the height of fences on her property. Ms. Sexton mentioned that her privacy had been invaded on several occasions. Chair Austin informed Ms. Sexton that she had one more minute to speak. Ms. Sexton said she would discuss the fire incident, which occurred in 2006. She explained that her tenant had called 911 about a chimney fire caused by a special clean out log. She said that the fire department had said everything was okay, but that the DCD (Department of Community Development) staff had appeared two hours later. She said they made an error in not contacting her. She pointed out that there was no damage, and she did not know what the emergency was. Chair Austin informed Ms. Sexton that her time had been expended. He asked if there were any persons present who wished to speak in opposition to the appeal. There were none. He asked if there were any other persons who wished to speak about the appeal, for any reason. There were none. Since there were no comments regarding the appeal, Chair Austin invited Board members to ask any questions about the appeal, either of Ms. Sexton or the staff. There were no questions from the Board. Jefferson County Board of Health Page 9 of 11 July 17, 2008 Chair Austin said that since there was no further comment, he would close this portion of the hearing. He stated that it was now in order for the BOH to discuss the matter. He reminded that, although a number of other issues had been raised, that the focus of this hearing were the elements of the order to correct violation. He restated the three key questions: 1) Was the complaint that was issued sufficient to warrant a site inspection, 2) Was the photographic evidence, taken from the adjacent property, obtained in a legal manner, and 3) Was this photographic evidence sufficient proof that a solid waste code violation occurred. With regard to the first question, Member Sullivan stated that anyone can make a complaint. Member Russell said that he believed it would be logical to have a motion on the floor as the basis for discussion. Chair Austin verified that while that was not an essential part of the protocol, it was certainly permissible. Member Russell moved for denial of the appeal. Member Sullivan seconded the motion. Chair Austin asked for any discussion on the motion to deny the appeal. Member Frissell addressed the third question. She said that in her opinion the photographic evidence was sufficient to prove that a solid waste violation occurred, and that she was in favor of the motion on the floor. There was no further discussion. Chair Austin called for the question. The Board of Health unanimously passed the motion to deny the appeal. Chair Austin then directed staff to operate in accordance and closed the public hearing on this matter. ACTIVITY UPDATE Chair Austin invited staff to add any comment to the materials provided in the packet. Jean Baldwin stated that staff was involved in budget preparations. As a department, they are in the process of preparing 2009 budget proposals. She said a strategic planning process is underway with the intent of determining internal prioritizations before involving the Board of Health. AGENDA PLANNING Jean Baldwin noted that there are a number of items that staff will bring forward in the next few months. She said that staff would like to discuss fees. A cost analysis is underway, by program, by service provider, and by unit. She explained that they can analyze their costs and look at the market rates, but may be not be able to charge accordingly. School-based clinic (general health, family planning and mental health) is another topic for the agenda within the next two months. The next BOH meeting is scheduled for Thursday, August 21, 2008 from 2:30 to 4:30 PM; location (Courthouse) is to be confirmed. Jefferson County Board of Health Page 10 of 11 July 17, 2008 ADJOURNMENT Member Frissell moved for adjournment. The motion was seconded by Member Russell and passed unanimously. Chair Austin adjourned the BOH meeting at 4:30 PM. JEFFERSON COUNTY BOARD OF HEALTH Excused o Austin, Chair Sheila Westerman, Vice Chair Roberta Frissell, Member 4u�L ck Russell, MeLo mber Excused Phil Johnson, Member David S livan,ber Absent Michelle Sandoval, Member Jefferson County Board of Health Page 11 of 11 July 17, 2008