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HomeMy WebLinkAboutM112008JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, November 20, 2008 2:30 PM — 4:30 PM Pope Marine Building, Port Townsend Board Members Staff MembeLs Phil Johnson, County Commissioner District #1 Thomas Locke, MD, Health Officer David Sullivan, County Commissioner, District #2 Jean Baldwin, Public Health Director John Austin, Chair, County Commissioner, District #3 Julia Danskin, Nursing 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 Pope Marine Building, Port Townsend, WA. Members Present: John Austin, Chuck Russell, David Sullivan, Sheila Westerman Members Absent: Roberta Frissell, Phil Johnson, Michelle Sandoval Ad Hoc Member Present: Frances Joswick, Substance Abuse Advisory Board Staff Present: Jean Baldwin, Dr. Thomas Locke, Julia Danskin, Veronica Shaw A quorum was present. APPROVAL OF AGENDA Chair Austin stated that there had been an addition to the agenda, number 7. Health Department Personnel Report. Member Russell moved to approve the agenda, as amended, which was seconded by Member Sullivan and approved unanimously. APPROVAL OF MINUTES Corrections: On page 6, first sentence under Substance Abuse Advisory Board Presentation, insertion of word, i.e. ".... reported on the new relapse prevention program..." On page 2, insertion of word in first paragraph under Public Health Funding News, "The larger counties have been urging .....". On page 2, insertion in third paragraph, "Member Westerman asked about current levels ...". Member Sullivan moved for approval of the minutes, as corrected, and Member Westerman seconded. The minutes of October 16, 2008 were approved unanimously as corrected. Page 1 of 9 Board of Health - November 20, 2008 PUBLIC COMMENTS A resident of the Dabob Bay area asked for information on any plans or changes in regulations and fees related to water quality and residential wells. Member Sullivan said that under the most recent in -stream flow rules, there may be metering of new wells but that existing water rights are protected. He said there would be an informational meeting at Fort Worden on December 2. Dr. Locke added that with regard to water quality monitoring, single home residential wells are exempt from the public health codes and regulations for drinking water systems, which apply only to public water systems with two or more connections. OLD BUSINESS Substance Abuse Relapse Prevention Program — Jefferson County Jail Frances Joswick distributed copies of a fact sheet from Pat Wiggins, nurse at the Jefferson County jail. She pointed out that there is already awaiting list for the relapse prevention program. Jean Baldwin suggested that these reports be included in the regular BOH distribution process. Chair Austin inquired as to how the recent PDN article about the relapse prevention program was initiated. Ms. Joswick said that she was contacted by reporter Jennifer Jackson and interviewed along with Steve Richmond, Pat Wiggins, and other members of the SAAB (Substance Abuse Advisory Board). Main Street Program Letter Julia Danskin reported that the Port Townsend Main Street Program had raised $3,140 for women's health screenings during the Girl's Night Out event. Sheila Westerman moved and David Sullivan seconded that Chair Austin sign the draft thank you letter to the Main Street Program on behalf of the BOH. The motion was approved unanimously. NEW BUSINESS Public Health Fee Review Jean Baldwin stated that the draft fee ordinance provided in the packet contains two changes from previous versions. She noted that this draft has been simplified and excludes extraneous detail, such as how the cost analysis is done. She said that other counties' health departments and past Jefferson County practice had been reviewed. By moving to the DSHS cost analysis method, the department will be able to set rates based on its own costs. She pointed out that Environmental Health has also gone through this process and found that actual costs are very close to what they were before. This puts both Community Health and Environmental Health on the same framework, but does not change sliding scale or other policies. Veronica Shaw reviewed with the Board her November 14, 2009 memo, 2009 Fees, and two fee spreadsheets. A data column for Service Utilization (Frequency) had been added as requested. The analysis is based on a full year of service, 12 months of 2007. The spreadsheet on Client Page 2 of 9 Board of Health - November 20, 2008 Impact data presents projected revenue for three scenarios, i.e. 50%, 75% and 100% of cost recovery, along with the corresponding fee increases by client groups: private insurance, full fee and partial fee. There are currently about 45 different insurers in the system. Private insurance does not include Medicaid. Ms. Shaw pointed out that the average fee increases to clients would be reasonably low, even at the 100% level. She noted that only 30% of what is billed is actually collected. Member Westerman expressed her appreciation and commended Ms. Shaw on the compilation and presentation of this information. She said she was in favor of adopting the 100% option, provided that sliding scale policy remains in place. Ms. Shaw and Ms. Baldwin responded to specific questions from the Board. They explained the reason for certain blank data cells, which are service items that are provided free by the State labs for qualifying clients. Where Medicaid rates are actually higher than the calculated cost, the Medicaid rate will be charged. Ms. Baldwin noted that the draft ordinance provides for billing at the maximum allowable Medicaid reimbursement rate. She also observed that the overall impact to clients is not very large, and is greater for privately insured patients. There was clarification that the 100% cost rate had been used to generate the draft fee schedule provided. The ordinance language provides for future automatic updates to the fees based on cost changes, publication of new Federal Poverty Level Guidelines, or changes to Medicaid reimbursement rates. Member Russell questioned the construction of the sentence comprising the fourth paragraph on page 2 of the draft Ordinance. Dr. Locke provided a written sentence revision for the draft. The remaining process for adoption and implementation was reviewed. The BOH will choose the percentage of cost variance, and a date will be set for a public hearing on the Ordinance. If the Ordinance is adopted, as long as it is in effect the fees will be updated per the provisions of the Ordinance as summarized above. Veronica Shaw pointed out that changes in the Environmental Health fees only are based on the Consumer Price Index (CPI), based on policy originally established in 1996 and are referenced in the draft ordinance. Member Westerman asked if the CPI method is appropriate and accurate. Staff confirmed that their cost analysis of a 20 case sampling had shown very good correspondence between the actual cost analysis and the CPI adjusted rates. A cost analysis for Environmental Health will be done every two years. Member Westerman expressed her preference for this smaller and more frequent incremental approach, rather than the necessity of large, less frequent fee increases. Jean Baldwin then introduced the Environmental Health fees. As indicated in the November 13, 2009 memorandum from Andrew Shogren, Environmental Health sets fees that seek to cover 100% of direct costs. Ms. Baldwin said that not all Environmental Health services are covered, citing certain solid waste costs as example. After doing a cost analysis and finding great similarity, staff has recommended continuing with use of the CPI -based fee revision policy. Ms. Baldwin also recalled that a comparison of fees with four other counties had been presented at the previous meeting. One challenge is the variation in service bundling among various Page 3 of 9 Board of Health - November 20, 2008 entities. However, the comparison showed that generally Jefferson County fees were lower than those of other counties. Board members suggested two changes to the Environmental Health Fee chart. One was to make the fees as readable and understandable as possible. The examples discussed involved expanding acronyms such as SPAAD or G.P.D., at least the first time they appear, or footnoting them to clarify their meaning. SPAAD is an acronym for Site Plan Advanced Approval Determination and is sometimes associated with land divisions or subdivisions. G. P. D. is an abbreviation for gallons per day. The second request was to adjust the formatting and indentation under Sewage Disposal Permits, so that "Conventional", "Alternative" and "Repair/Upgrade" can be clearly seen as subordinate to "New Commercial >I 000 G. P D". Staff confirmed that the fee schedule would be an attachment to the Ordinance and will also be accessible via the website for reference. Chair Austin asked what the typical charge is currently for conventional system inspections by commercial services. Susan Porto cited one example, $250 for an evaluation that was done in conjunction with pumping out of tanks. Sheila Westerman moved to set a hearing date of December 18 for the proposed Ordinance Establishing a Fee Schedule for Jefferson County Public Health. The motion was seconded by David Sullivan and approved unanimously. Staff confirmed that there will be a press release and proper notice in advance of the hearing. The fee schedule will be posted on the web along with the notice. Member Russell questioned whether there was need for him to recuse himself from the actual vote on December 18. There was a brief discussion regarding the personal nature of a recusal decision, and a suggestion to check with County Attorney Alvarez if there is uncertainty. Dr. Locke indicated that the appropriate process would be to announce the issue to the BOH and to examine whether there would be undue influence or prejudice in the vote or an appearance of a conflict of interest. A key issue is whether a person will be affected financially by the outcome of a vote. Before moving to the next agenda item, there was a brief discussion confirming that no additional motion or vote was needed on the choice of cost percentage since the proposed ordinance already embeds the assumption of 100%. Puget Sound Partnership: Draft Action Plans for the Strait of Juan de Fuca and Hood Canal Neil Harrington, Water Quality Manager, reviewed the Introduction to the Draft 2020 Action Agenda for Puget Sound. He noted that the entire document is about 95 pages in length. Mr. Harrington provided a brief background and history of the Puget Sound Partnership, established by the Governor to implement a clean up of Puget Sound by the year 2020. Neil reviewed the major strategies of the Action Plan. He pointed out that the intention to have a feedback loop of action, accountability and learning what is working and not working. He noted Page 4 of 9 Board of Health - November 20, 2008 that there are many itemized actions to be taken under each strategy. He sees the strategies as good for a rural county such as Jefferson, which has significant opportunities for protecting water quality and effecting restoration of Puget Sound. The Action Agenda also identifies many gaps where further research is needed. The Puget Sound Partnership is not the "doer", but is a conductor and coordinator. Jefferson County has also submitted comments through several avenues including the Straits of Juan de Fuca Workgroup, of which John Austin and Neil Harrington are participants. David Sullivan added that comments have also been submitted through the Hood Canal Coordinating Council and the State Association of Counties Coastal Committee. Mr. Harrington mentioned that there are eight action areas defined for the Sound and Jefferson County spans both the Straits and Hood Canal working groups. Mr. Harrington indicated that he would like to review with the BOH the comment letter drafted by Andrew Brastad on behalf of the 12 Puget Sound County Environmental Health Directors. Jean Baldwin explained that there had been a 12 -county committee that had produced an earlier letter of recommendations. Mr. Harrington explained that item number references in the letter refer to planned actions in the Action Agenda; he read selected action items aloud. He pointed out items of particular importance to Jefferson County, such as in -stream flow rules, water law reform, and water reuse. He pointed out concerns about pharmaceuticals making their way into surface water, ground water and the marine environment. Member Westerman asked for clarification on the ultimate disposition of household refuse processed by the County, which is the source of some unused pharmaceuticals. Staff verified that solid waste is trucked to landfills outside the County. Jean Baldwin reported on studies and ongoing debates about the most efficacious means of disposing of drugs, depending on their particular compositions. Formerly, best practice was to flush unused medications, but land fill disposal may be shown to be better. There were several comments related to septic system issues. Expansion of the Shorebank model was recommended as a means of assisting homeowners in paying for septic system repairs/ replacements or connecting to municipal sewer systems. Mr. Harrington said that one of his comments to Puget Sound Partnership was to maintain funding for Jefferson County's Clean Water District which performs pollution identification/correction work and to identify failing septic systems. Chair Austin added that that is one of the top priorities for the Straits and Hood Canal Action Areas. Member Westerman asked for clarification on C.4.2, i.e., whether this comment was clearly intended and adequately worded to urge State law changes. Dr. Locke noted that Washington State has some of the strongest property rights protection laws in the nation. All entry to private property must have the permission of the land owner unless a search warrant is obtained. A current state law allows for pursuit of an administrative search warrant if there is probable cause that fresh or marine water is being impacted by a failing septic system. There was a brief discussion about the entire comment process and schedule, and the acknowledgement that Puget Sound Partnership itself has no regulatory authority of its own. John Austin suggested an abbreviated review of the letter. He summarized the Puget Sound Partnership structure and process for development of the Action Agenda and its Page 5 of 9 Board of Health - November 20, 2008 recommendations to the Legislature, noting that this letter was a fairly low level request in a complex process. Jean Baldwin noted that the issues around septic systems have been well covered by the Environmental Health Directors, who are concerned that they have some voice in any regulatory changes. Mr. Harrington said this letter encapsulates where the Board of Health jurisdiction and interests intersects with the Puget Sound Partnership's agenda. Mr. Harrington then covered items dealing with toxic clean up standards, as well as funding for programs that deal with algal bloom and shellfish monitoring. Following Mr. Harrington's summary of the remaining items, Member Westerman requested clarification on the statement referring to a new method of reporting. Mr. Harrington discussed the Partnership's emphasis on accountability and increased reporting requirements. A brief discussion ensued regarding the balance between local control versus State standards. Jean Baldwin said that she and Dr. Locke would be involved in writing a follow up letter from the parent organization endorsing more State-wide accountability and standardization as appropriate. Mr. Harrington confirmed that the deadline for edits to the letter had passed. Chair Austin thanked Mr. Harrington for his presentation and participation in the Action Agenda review. 2008 Solid Waste Program Margie Boyd reported on the overall status of the Solid Waste program. She noted that after code changes in 2005, the Health Department had closed 135 solid waste enforcement cases last year and maintained that rate in 2008. Historically, there have been about 35 open cases on average. Having dealt with the majority of cases, what remain are more difficult situations that require more resources to address. Last year, 701 vehicles were recycled. Towing was paid by a grant from the Department of Ecology. Two of the major sites had 300 and 100 vehicles respectively. This year there were 264 junk vehicles, owing partly to the high prices for scrap metal. Ms. Boyd said that there had been several community partners that were very supportive of the Health Department programs and quite helpful in closing very difficult cases. Last year, 49 citations for Solid Waste violations were issued, and only 17 were committed. Ms. Boyd noted that the number of recalcitrant cases tends to remain constant. Approximately 300 tons of tires were removed last year. Special Department of Ecology grants were used to clean up five large business sites. This year was aimed at households, including a free tire recycle event. About 2500 tires were collected in one day through an Ecology grant, representing 221 households. She said that staff is actively seeking grants to fund these types of infrequent but high yield events. In terms of trends, she expects less focus on enforcement related to households; there has been progress in several neighborhoods. There will be more emphasis on hazardous waste, which has a bigger environmental impact. She briefly described increasing efforts with local source Page 6 of 9 Board of Health - November 20, 2008 control, working with businesses such as dentistry, metal machine shops, and others that are most likely to produce hazardous waste. She pointed out that this can actually save money for small businesses that are able to reduce hazardous waste generation and improve their efficiency. Member Westerman inquired about the possibility of extended hours for the hazardous waste facility. Ms. Boyd said that the first priority is to provide a facility in South County, which would be able to collect florescent light bulbs, etc. Also, the transfer station is now accepting florescent bulbs. She referred everyone to the Solid Waste website for information on proper disposal and/or clean-up procedures for these bulbs, which contain minute quantities of mercury. Emergency Preparedness Mutual Aid Agreements: Multi -County and Multi -Tribes This item was deferred until the next meeting, due to time constraints. Expedited Partner Therapy Program This item was deferred until the next meeting, due to time constraints. Potential Appointment of Substance Abuse Advisory Board (SAAB) Member Frances Joswick said that the SAAB has been seeking to increase the size of its Board. Earlier in the day, John Austin, Julia Danskin and Ms. Joswick had interviewed two individuals, Doug Daniels and Molly Force. She proposed that they be considered by the BOH for the open positions. Doug Daniels is a former massage therapist who has studied at the Port Townsend School of Massage and is a musician. Molly Force is a naturopathic physician, new to the community, and is very interested in SAAB activities. John Austin said that both candidates had indicated they had the time for serving on the SAAB, including additional committee work. Ms. Joswick and Mr. Austin confirmed that both people were talented and certainly met their expectations. Inclusion of Mr. Daniels and Ms. Force would bring the SAAB Board size to ten members out of a desired 11 to 13 members. Members Westerman and Sullivan moved and seconded to accept Doug Daniels and Molly Force as members of the SAAB. The motion was approved unanimously. Health Department Personnel, Planning and Budgeting Update Jean Baldwin pointed out a misstatement in a recent newspaper article about Health Department growth. There has been some growth over the last five years to accommodate such services as water quality monitoring and emergency preparedness. However, budget increases have been very gradual until last year, when a $160,000 increase was necessary for union negotiated salaries and benefits. An additional $150,000 will be needed this year to bring compensation, particularly nursing, in line with the market rates. This, along with County paid Clean Water District match expenses, will come from the General Fund. Rent and other expenses such as inter -fund transfers will cause a rise of about $66,000 this year. Page 7 of 9 Board of Health - November 20, 2008 Ms. Baldwin mentioned the sadness and difficulty of the DCD layoffs. She said that based on a forecast of the 2008 Health Department budget that had been done in June, all new spending had been stopped. Certain vacancies had not been filled. Therefore, staff cuts had been done sooner and in a different manner. Also, staff had been asked to reduce their hours voluntarily; five people had reduced their hours from 40 to 36 per week. She noted that she had been working closely with Phillip Morley, County Administrator, on budgeting and forecasting. However, any program cuts that become necessary will be decided by the Board of Health. In addition, demands on the WIC program have been increasing rather significantly in recent weeks. Service needs and community impact are being monitored closely. The net staff reduction is five employees. The position of Deputy Administrator formerly held by Andrew Shogren is also vacant. Ms. Baldwin noted that the State is expecting a $5 billion shortfall for the next Biennial budget. She said she did not expect to see the impact of those cuts until about April 2009. Ms. Baldwin said the shortfall is so large that she anticipates significant cuts for departments and programs that do not fall mainly into the State mandates to "educate, incarcerate or medicate". She said that she believes the Board will need to review and prioritize programs and expenditures. Internally, efforts are underway to review service priorities and cross -training, etc. That information will be brought to the BOH in early 2009 to help prepare for likely program cuts. In response to a follow up question about the Leader article, Ms. Baldwin said that she had been out of town at the time. Therefore, clarifying information about the Health Department budget and measures taken previously were not included in the article. John Austin noted that Health Department administrators had given a report to the County Budget committee on November 19, and should be commended for anticipating the economic problems and taking early measures to mitigate the impacts. Member Westerman noted that serious outreach efforts will be necessary to educate the public regarding the reasons for any service cuts that occur. Ms. Baldwin said that the Legislature may be taking up the issue this year of allowing Health Departments to become junior taxing districts or other funding solutions, but implementation would be far in the future. ADJOURNMENT David Sullivan moved to adjourn; Sheila Westerman seconded. Chair Austin adjourned the meeting at 4:28 PM. Page 8 of 9 Board of Health - November 20, 2008 JEFFERSON COUNTY BOARD OF HEALTH �C-Y'—i" Z-� Jo Austin, Chair Absent Roberta Frissell, Member Absent Phil Johnson, Member Absent Michelle Sandoval, Member Sheila) :,rman,Yice Chair Chuck Russell, Member � J1 David Sullivan, Member Page 9 of 9 Board of Health - November 20, 2008