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HomeMy WebLinkAboutM121808JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, December 18, 2008 2:30 PM — 4:30 PM Pope Marine Building, 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 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. Members Present: John Austin, Phil Johnson, Chuck Russell, David Sullivan, Sheila Westerman Members Excused: Michelle Sandoval, Roberta Frissell Staff Present: Jean Baldwin, Dr. Thomas Locke, Julia Danskin, Veronica Shaw A quorum was present. APPROVAL OF AGENDA Chair Austin noted that he would not be present for the January meeting and suggested an addition to the agenda, item 5 under New Business: election of new Chair and Vice Chair, to be effective January 1. The agenda was unanimously approved, as amended. [The Public Hearing portion of the meeting was subsequently placed as item 5 on the Agenda, to allow for the arrival of any members of the public who might attend.] APPROVAL OF MINUTES Correction, page 5: The full committee name mentioned by Member Sullivan is Washington State Association of Counties, Coastal Counties Committee. Member Westerman moved for approval of the November 20, 2008 minutes, as amended. The motion was seconded by Member Russell and approved by unanimous vote. PUBLIC COMMENTS There were no public comments. OLD BUSINESS Flu View 2008-09 Influenza Surveillance Data Dr. Locke discussed the influenza surveillance report included in the Board's packet, noting that this is representative of the type of weekly data available about influenza activity. Of the many viruses associated with upper respiratory infection, influenza is of special public health concern due to its ability to cause serious illness and death. The annualized excess mortality rate for influenza is 36,000 per year in the US; the great majority of these are elderly patients. Influenza activity is low nationwide. Dr. Locke noted many factors contribute to the seasonal rise in flu cases: time spent indoors, cooler temperatures, and extensive travel over the winter holidays. School -aged children are an especially important factor is influenza outbreaks — the virus is spread in school settings among children and then passed on to adult family members. There has been significant change in the antigenic character of the flu strains circulating. This year all three components of the flu vaccine had to be modified. Thus far, the choice of isolates seems to be a good match for circulating strains. The bad news is that H 1N 1 virus stain (which made its first appearance as the "Spanish Influenza" pandemic of 1918) continues to circulate throughout the world and has become resistant to the widely used antiviral medication oseltamivir ("Tamiflu"). This is the same medication that is being stockpiled to protect against a future influenza pandemic. The message is that antiviral medications are not a reliable defense against influenza. Vaccines and respiratory precautions are the best defense. Member Westerman inquired as to "normal" flu rates for various regions of the USA. That is, what are considered to be normal and abnormal number of cases. Dr. Locke explained the chart on page I of the FluView report and also referred to the graph on page 4, which shows the normal distribution of seasonal mortality rates as well as the epidemic threshold levels for the past four years. He described the data collection process, which includes ILI (influenza -like illness) counts from sentinel physicians to the Centers for Disease Control (CDC). If the count on any given week is higher than expected, that would be a possible indicator of a flu outbreak. School absenteeism rates in excess of 10% are also used as markers for influenza activity. Chair Austin asked for status on flu shot participation in Jefferson County this year. Jean Baldwin said that the amount of State supplied vaccine is tracked, but this is not the total supply. The vaccines administered by Safeway, QFC and some others are not included. There has been greater emphasis on flu vaccination for children by the CDC. However, this year Washington State chose to purchase most childhood influenza vaccine in the injectable form rather than the increasingly popular intranasal mist form ("F1uMist"). Since an injection is required, that has been a factor in decreasing the numbers of children vaccinated. The percentage of hospital health care and health department employees in Jefferson County that were vaccinated was very high. Unfortunately, there is no real- time system for tracking influenza vaccination rates and most information is only available after flu season when total doses distributed and administered are finally known. EPI -Trends — Washington Surveillance for Severe Influenza Disease Dr. Locke discussed how the public health system deals with severe influenza. First, there is surveillance in key areas, such as childhood deaths associated with influenza and adult mortality rates. The immunization strategy in the past was to vaccinate everyone who was at risk for influenza complications. However, the vaccine was not very effective in the elderly and cannot be given to infants under the age of six months. The current strategy is to surround those at high risk for influenza complications with caretakers and family members who are vaccinated. People with healthy immune systems are the primary targets for immunization since they are far more likely to develop protective immunity after influenza vaccination. Emergency Preparedness Mutual Aid Agreements: Multi -County and Multi -Tribe Dr. Locke noted that development of mutual aid agreements as part of emergency preparedness activities. He noted that these agreements have been standard for government agencies such as police, fire and emergency medical services but that they have not been widely used by public health jurisdictions. There is now recognition that for pandemic or other emergency public health problems, local resources would be quickly exhausted and there would be the need to bring in fully trained reinforcements. He described two processes that have grown out of this recognition. The "Public Health Inter jurisdictional Mutual Aid Agreement" is an agreement between Kitsap County, Seattle/ King Public Health, Snohomish Health District, Tacoma/Pierce Health District, and others. It was developed as a model with the expectation that other districts would join in. From a policy standpoint, consideration should begin with the Board of Health, but the County Commissioners would likely be the responsible signers of the document. Dr. Locke suggested that the question as to the appropriate signatories could be answered by county attorney David Alvarez. Member Westerman said she found the document to be quite comprehensible and rational. Dr. Locke noted that the Counties that are already party to this agreement have registered all employees as emergency health workers in the State database. This allows efficient automatic payment for resources expended. Otherwise, financial reconciliation following an emergency can take considerable time. Chair Austin also noted the value of having an agreement in place, including the avoidance of uncontrolled costs. Chair Westerman moved that the BOH make a recommendation to the BOCC for approval of this agreement, subject to review by the County Attorney and determination as to the appropriate signatories. Member Russell seconded the motion. The motion was approved unanimously. Dr. Locke described the second mutual aid agreement in development involving the Tribal Health Jurisdictions. There is considerable legal uncertainty about the overlapping jurisdictions of local health departments/districts and sovereign tribal governments. Approximately six months ago Region 2 (Jefferson, Kitsap, Clallam) public health officials were asked if they wished to apply for some unused pandemic influenza preparedness funding. He said that the three counties share borders with 7 Tribes and have a history of close working relations with them, making the region an ideal place to develop a draft agreement for mutual aid in health emergencies between tribes and local health jurisdictions. The lawyer who negotiated the first agreement was hired to assist with this process. A grant of $140,000 was awarded to pursue this project; Kitsap County, as the lead county in the Region, will administer it. Dr. Locke reported that he and Dr. Scott Lindquist had contacted tribal leaders, who were all enthusiastic about the project. Coastal tribes in particular experience power outages, flooding and other emergencies frequently. He noted that there are a number of informal aid agreements in place, but nothing formal and binding. Chair Austin questioned why the Quinault tribe was not included and was informed that the Quinault tribe works with Gray's Harbor County and are considered to be outside of Region 2, as is the Queets tribe. It is hoped that the model agreement developed by Region 2 will be used in the future by tribes and counties statewide. There was additional discussion about the scope and purpose of this agreement. The first meeting will be held on January 7 in Port Angeles, with subsequent meetings to be held at different locations. The goal is to finalize the agreement by August, 2009 including identification and resolution of any contentious issues. Dr. Locke said he would keep the BOH posted on developments and will bring the completed document forward when ready. Department of Health Proposed Budget Cuts for Remainder of 2007-2009 Biennium Jean Baldwin noted that the Governor had released her 2009-2011 budget and the 2009 supplemental budget, which includes cuts of $6.1 million by June 2009. None of the cuts affect the Health Department directly. No contracts within the Department are in jeopardy at this time. Detailed budgets can be viewed on the Governor's page of the OFM website. There are cuts to Healthcare, DSHS, Ecology and CTED, which are the main funding sources for the department. Ms. Baldwin described proposed changes to the State program of buying vaccines. The State spends $49 million annually on vaccines to assure that all children have access to needed immunization. This supplements the federal Vaccines for Children (VFC) program that provides free vaccine for children who meet federal eligibility criteria (about 60% of kids). The vaccine is distributed free of charge and insurance companies pay for the cost of administering the shots. Since the children receiving state sponsored vaccine are mostly insured, the rationale for these budgets cuts is to shift the cost of these vaccines from the states to the health insurance plans. There is a form of cost shifting, but there are no cuts to local public health or local government funding and no change to flexible spending. She said that there is likely to be strong opposition to the cuts in the vaccine program. Ms. Baldwin reported small cuts to the Health Department in the Passport program, which is a DSHS contract program. Some cuts, such as General Assistance for the Unemployable (GAU) will seriously impact the community. GAU is a Medicaid -like program that is entirely state funded. Mental health related decreases appear to be about 5 to 7%; substance abuse funding will drop about 2%. There is also a 5% reduction in the First Step program, which has shown success in dealing with infant mortality, and reshifting of funds to only high risk cases. She said the MCH (Maternal Child Health) staff is concerned about the possible lack of funding for their program, as other counties have decreased funding. Ms. Baldwin asked the Board to consider the draft letter to the Governor in support of the First Steps program. She said that she believes both Governor Gregoire and Representative Lynn Kessler need to hear from local officials about the value of this program for their communities. She expects there will be vigorous lobbying about budget cuts by the start of the New Year, and fears that the voice for maternal health may not be heard otherwise. She added that Lynn Kessler needs to know the importance of maternal funding for Jefferson County, which includes both the Hospital and the Health Department. She noted that this program has positively changed birth outcomes and is also the funding stream for Nurse Family Partnership. Member Westerman said she was supportive of the draft letter, and suggested corrections including: addition of commas; correction to "Secretary of Health (from Secretary of State), and deletion of the second "will be" at the end of the third paragraph. She suggested "health ramifications" in the first sentence of paragraph four. She also suggested addition of a final sentence to paragraph four: "Not doing so is a clear case of Penny wise and pound foolish." She emphasized that the BOH should make clear that it believes such cuts would not result in savings. Member Johnson moved to direct the Chair to sign the amended letter; Member Sullivan seconded. The motion was approved unanimously. It was agreed that the Jefferson Hospital Board would be copied on the letter. There was additional discussion acknowledging that the Puget Sound Partnership is likely to take up portions of the funding related to water quality and monitoring. However, there is still uncertainty about the net impact on important programs. Jean Baldwin also distributed materials from the National Association of County and City Health Officials (NACCHO) regarding their recommendations to the Presidential Transition Team on Health Policy and Reform Goals for funding/rebuilding of infrastructure and modernization of systems. NACCHO wishes to ensure that local public health issues are considered in the broader national discussion. As part of the effort to collect community input nationwide, designated teams will be holding local forums on health care reform. There will be one held on December 20 from 1:00 to 3:00 PM at the Port Townsend Community Center. Other sessions are planned for December 27 and January 10. Sessions are open to all. Jefferson County Public Health Strategic Planning: Follow -Up Jean Baldwin outlined a project undertaken by the management team and lead staff to determine priorities and goals, and internal capacities needed to reach those goals. The packet materials are copies of draft web site pages which link to specific goals and capacities. Ms. Baldwin said she was seeking BOH input on the goals, which are foundational to the remaining planning work. She said she hopes to use this approach in developing priorities and plans in the coming year. Chair Austin noted that "Supporting Economic Health" is a general goal for virtually every department. Ms. Baldwin explained that child care services and family services for unintended pregnancy are both aimed at keeping people in the work force, hence the linkage to economic health. Member Westerman suggested that "Building Capacity for Sustainable Public Health" should become the key goal with "Supporting Economic Health" as a supporting element. She also suggested that "Reducing Cost Burden..." could be in a subordinate position to Supporting Economic Health, Jean Baldwin explained that, in working through this exercise, staff realized how the same generic process and prioritization is applied for dealing with on site environmental health complaints as for child abuse referrals to CPS. Further, it makes clear why some functions "belong" under Public Health, and not elsewhere. However, there is still uncertainty as to how this process will lead to prioritizations that can be applied when expected budget cuts must be made. She explained that this is merely a beginning. She would like to place this on the agenda for BOH discussion early in the year. Election of BOH Chair and Vice Chair for 2009 Chair Austin asked for nominations for the position of Chair. (He said that, for purposes of public disclosure, he had asked Chuck Russell if he would be willing to be nominated for Vice Chair.) Chair Austin nominated Sheila Westerman for BOH Chair, which was seconded by Member Russell. There were no other nominations. BOH members unanimously approved Member Westerman as Chair, effective January 1, 2009. Member Johnson nominated Member Russell for the position of Vice Chair, which was seconded by Member Sullivan. Member Russell was unanimously elected as Vice Chair. Public Hearing: Jefferson County Public Health Fee Revisions Veronica Shaw explained the updates and changes that had been made to the Fee Schedule documents since the previous meeting. She noted formatting changes and expansion of acronyms for ease of reading. She also explained that the CPI of 4.9% had been applied to the 2008 figures to arrive at the 2009 fees. Ordinance language was updated per the BOH recommendations at the previous meeting. Member Westerman suggested that the term "Permit Fees" be added under Food Service Establishments, Immediate Consumption and Not For Immediate Consumption. Under "Other Food Fees, Reinspection", she requested that First Inspection and Second Inspection be changed to First Reinspection and Second Reinspection. Member Westerman also inquired as to how the license fees for Onsite Sewage Disposal — Installer, Pumper, etc are determined. Jean Baldwin said that these fees had been cost based and found to be very close to CPI derived figures. In general, Jefferson County fees are lower than other counties. Member Westerman said she appreciated the larger, easier to read format. Member Russell asked why Jefferson County fees are lower than other counties. Jean Baldwin said this was due to the fact that labor costs and overhead are less. However, she said that in the future certain additional costs such as apportioned management costs should be included in the fees. There was a brief discussion as to the effects of operational scale on the fees and the impact of decreasing volumes for permits due to the general economy. There were no comments from the public; Chair Austin closed the public portion of the hearing. There was clarification that an Ordinance number would be assigned following approval by the BOH. Member Westerman moved for approval of the Ordinance Establishing a Fee Schedule for Jefferson County Health, as amended. Member Johnson seconded the motion. The motion was approved unanimously. Activity Update Julia Danskin noted that a check for $225 had been given to the Health Department by Port Ludlow Yacht Club Women's Group, from the sale of their cookbooks. A letter of thanks will be mailed. Agenda Planning The next BOH meeting is scheduled for Thursday, January 15 and will be held at the Jefferson County Health Department. Agenda will include continuation of the discussion on strategic planning, goals and capacity. Adiournment Member Johnson moved for adjournment; Member Sullivan seconded. Chair Austin adjourned the meeting at 3:59 PM. JEFFERSON COUNTY BOARD OF HEALTH JohP Austin ,Chair Excused Roberta Frissell Member Phil Johns , Member Excused Michelle Sandoval, Member Sheila Westerman, Vice Chair Chuc ussel , M ben 4d Davi ullivan, Member