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HomeMy WebLinkAboutM031909JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, March 19, 2009 2:30 PM — 4:30 PM Health Department Conference Room, 615 Sheridan Street, Port Townsend Board Members Staff Members Phil Johnson, County Commissioner District #I Thomas Locke, MD, Health Officer David Sullivan, County Commissioner, District #2 Jean Baldwin, Public Health Services Director John Austin, County Commissioner, District #3 Julia Danskin, Nursing Services Director Michelle Sandoval, Port Townsend City Council Sheila Westerman, Chair, Citizen at large (City) Chuck Russell, Vice Chair, Hospital Commissioner, District #2 Roberta Frissell, Citizen at large (County) Chair Westerman called the meeting of the Jefferson County Board of Health to order at 2:30 PM. Members Present: John Austin, Roberta Frissell, David Sullivan, Sheila Westerman Excused: Phil Johnson Absent: Chuck Russell, Michelle Sandoval Guest: Frances Joswick, SAAB Staff Present: Jean Baldwin, Dr. Thomas Locke, Julia Danskin A quorum was present. APPROVAL OF AGENDA Member Austin suggested that, under New Business, item 6 be moved to item 1. Member Frissell moved and Member Sullivan seconded for approval of the agenda with that change. The agenda was approved unanimously, as amended. APPROVAL OF MINUTES Correction - page 3, section on 2008 State Board of Health Annual Report, paragraph 1: The second sentence should read "Member Austin stated that the State Board of Health is not on the list to be eliminated, while the Ferry Advisory, EcoSystem Council and many other Boards/Councils will be eliminated". Member Austin moved for approval of the minutes, as amended; Member Frissell seconded. The minutes of February 19, 2009 were approved, as amended. Page 1 Of 9 PUBLIC COMMENTS There were no public comments. OLD BUSINESS Remional Influenza Activity Dr. Locke stated that the flu season was at its peak in the northwest, and that the peak was persisting on the East coast, particularly in the Southeast. During the previous week, there had been a slight drop off but there was no certainty that incidence would not rise again. Reports from schools and hospitals indicate higher than usual seasonal changes. The figures are not yet available on the percentage of people who were vaccinated, although the amount of vaccine produced was the largest amount on record. The type of flu circulating in the Northwest is the HIN1 strain that is highly resistant to oseltamivir phosphate (Tami-flu), the widely used anti- viral medication. This year influenza B is also prevalent; this is a milder form of flu which does not produce pandemics. Dr. Locke expected that within a month the peak would be past. However, full data about mortality levels and vaccination rates would not be available until mid- summer. There was a brief follow up discussion on how flu incidence and mortality data is collected and interpreted. Death with Dignity Act and Vital Records Registrars Dr. Locke noted that one of the more obscure functions of Health Officers is to serve as Vital Records Registrars for the County. This includes certification of death certificates and issuance of burial transit permits. One requirement of the Death with Dignity Act is that suicide may not be listed as the cause of death. In response to a question with regard to tracking the number of suicides over time, Dr. Locke said that he believes there are such provisions in the Act, but that the statistics are definitely not tracked via the death certificates. Public Health Funding Letter Jean Baldwin referred to the copy of the letter in the packet to Senator Jim Hargrove from the BOH. There was a discussion about the status of funding overall. Jean Baldwin said that in her understanding Lynn Kessler supported retaining current funding. Dr. Locke said that legislative deliberations were still going on and that the final budget forecast was in progress. There were expectations of up to a $9 billion dollar State deficit/gap in revenue. He understood that there would be about $2.5 billion in federal stimulus funding in the budget. Jean Baldwin reported that maternity support (Nurse Family Partnership) appears to be safe through June 2009. She also discussed the County shortfall of tax, investment revenue, and timber dollars. Department heads are meeting with the County Administrator to review the long and short term prognoses. Mr. Morley is seeking to implement some action in April to address the shortfall, which may include personnel changes. Certain departments may also be asked to stop spending General Fund allocations for this fiscal year. She said that once the implications for the Public Health Department are clear, she will bring the options forward to the BOH. Page 2 of 9 There was additional discussion acknowledging the complexity and dynamic nature of evolving budget information at the federal and state level. Ms. Baldwin said she was pleased to see that the Obama Administration has given some priority to Nurse Family Partnership as part of a national program of long range prevention. She also sees the appointment of Seattle Police Chief Gil Kerlikowske to head the Office of National Drug Control Policy as a positive sign; Mr. Kerlikowske has a reputation for supporting drug use prevention in addition to enforcement. Member Sullivan also pointed out that elimination of a particular government department does not necessarily mean that the associated services will be unfunded. Our Kids: Our Business Julia Danskin referred to the packet materials, noting one change to planned events for March and April. Seattle Police Chief Gil Kerlikowske, who was one of two planned speakers at the March 27 Kick Off luncheon, will be in Washington DC at the time. Laura Wells, Director of Fight Crime: Invest in Kids and assistant to Chief Kerlikowske will speak in his place. Dr. Claudia Black, writer and researcher on the effects of drugs and alcohol on families, will also speak. Member Sullivan will be accepting an award on behalf of the Board of Health. She also invited BOH members to sign the Our Kids: Our Business Call to Action pledge; names of those who sign will be published in the Leader in May. Chair Westerman suggested that individual member names appear together under Board of Health. Members Austin and Sullivan moved and seconded that Chair Westerman's suggestion be adopted, which was approved unanimously. Ms. Danskin also pointed out the two planned training sessions on Adverse Childhood Experiences scheduled for April 14 and April 20. Jean Baldwin said that this is an excellent opportunity to hear about issues and concerns from the community. It may be the last time that funding is available for this type of educational session. More information on all events and activities can be found at www.ieffcocommunitynetwork org_. NEW BUSINESS Substance Abuse Advisory Board Appointments Member Austin spoke on behalf of the SAAB subcommittee in presenting the recommendation to approve the membership of Raymond Hunter and Tony Hernandez to the Substance Advisory Board. He provided brief background information on Mr. Hunter, a long time active Jefferson County resident. Tony Hernandez, formerly Undersheriff, has a great deal of relevant experience and knowledge, and was recently appointed by the BOCC to replace retiring Sheriff Mike Brasfield. Member Austin moved that both appointees, Sheriff Hernandez and Mr. Hunter, be approved for SAAB membership; Member Sullivan seconded. The motion was unanimously approved. Page 3 of 9 Substance Abuse Advisory Bylaws — Request for Review and Aunroval This item was moved up on the agenda in order to accommodate Ms. Joswick's schedule. Chair Westerman acknowledged the importance for regular review and update of the bylaws for any organization, and commended SAAB Chair Joswick for having undertaken this update. Ms. Joswick noted that the SAAB had found and corrected omissions and necessary changes; they requested BOH approval of the updated bylaws. She said the revised document (copy included in packet) had been reviewed by Deputy Prosecutor Alvarez. Jean Baldwin pointed out a correction (page 1, Article III: Duties), i.e., that the SAAB nominates to the BOH, not the BOCC. Member Sullivan pointed out that the change must also be made on page 2, in the first sentence under Article IV: Membership. The extra period following the last sentence on page 1 was identified for removal. In response to a question, Ms. Joswick confirmed that the current composition of the SAAB is 12 members, including the two new appointees. Member Austin moved to approve the bylaws as amended by the BOH. Member Sullivan seconded the motion. Jean Baldwin sought clarification regarding the Article VII section on Resignations. Ms. Joswick explained that the SAAB recommends having resignations and removals to be approved by the BOH, just as appointments are. There was also clarification on the responsibility of SAAB for maintaining the master copy of the bylaws and of providing copies to the BOH and BOCC. The motion to approve the updated SAAB bylaws, as amended, was unanimously approved. Ms. Joswick said she would process the changes through the SAAB Secretary, and send amended copies to Jean Baldwin for official processing and filing. Ms. Joswick then provided a brief status report on SAAB activities. She said she is proud of the work of the board subcommittees in three areas: community education, resource brochure, as well as intervention, treatment and aftercare. The relapse prevention program at the jail is flourishing. Pat Wiggins continues to communicate with Ms. Joswick on a regular basis. Her only concern is that the program is currently underfunded, but she is optimistic that the County Administrator and the City of Port Townsend will be successful in obtaining stimulus funds that are available for this type of program Meanwhile, there have been no returns, to date, of people who have been through the drug anti - recidivism program, which began on October 1, 2008. The recidivism rate (%) was in the high 60s. The program is totally voluntary; participants get appropriate after care education and support with AA (Alcoholics Anonymous). That is, AA representatives visit the jail three times per week to establish contact and provide information prior to release from jail, so the support system is already in place when inmates leave. Jean Baldwin added that Pat Wiggins is paid from the 1/10th of one percent fund. Page 4 of 9 Julia Danskin referred to the copy of the March 12 letter in the packet from the SAAB to the BOH. She noted that item 2 requests the removal of Nicole Black from the SAAB. Member Austin moved that the BOH remove Nicole Black from the SAAB because of her failure to meet her obligations as a Board member, and that a letter acknowledging her past work on the Board be sent to her. It was agreed that the letter would be signed by the Board of Health. Julia Danskin agreed to write the letter indicating the BOH action and include appreciation of Ms. Black's SAAB work. Roberta Frissell seconded the motion. The BOH approved the motion unanimously. 2008 Jefferson County Public Health Performance Measures Julia Danskin reviewed the 2008 reports for performance measures. This year there is an additional section Study/Analysis of Results, which provides department reflections on the results. This was motivated by the Public Health Standards Review last year, which indicated that perhaps there had been insufficient attention to the Study portion of the Plan, View, Act, Study cycle. She said staff, particularly Environmental Health, employees found the exercise to be worthwhile. Jean Baldwin noted that this material could show certain economic indicators. The recession started to be seen in 2007, as Environmental Health permits dropped off, and then dropped more drastically in 2008. She noted that other areas did not show the same indications until later. For example, the total number of people in WIC rose early and continued to rise. Child Protective Services referrals to PH rose from 30 to 40 and continue to rise. She also pointed out the sharp rise in confirmed communicable disease reports from 2007 to 2008. Member Austin raised the topic of the percentage of people opting out of vaccinations. Chair Westerman reviewed the past attempts of the BOH to address this problem through education and work with the schools. She said that there is a fairly large group of parents who are convinced that their children are better off without vaccinations. She said that some people are not acknowledging their responsibility to the community. There was acknowledgement that Jefferson County has one of the lowest vaccination rates in the State. Member Sullivan added that lack of trust in the health care system and government are also a factor. Member Frissell noted that policy changes were occurring at the national level and that it would be prudent to take advantage of that shift. Member Austin suggested that perhaps the matter should be taken up again with the State Board of Health. Dr. Locke said that this is a priority issue for the Washington State Medical Association. Both the National and State Academies of Pediatrics are attempting to promote discussions between parents and their most trusted health advisors. He reviewed the passage of a new bill through the House. It requires a medical certificate indicating that one has been fully informed of benefits and risks of vaccination and is hoped to have a significant impact on reducing "convenience exemptions". It is believed that about half of the exemptions are convenience exemptions, i.e. not based on philosophical objections to vaccinations but rather done because easy access to vaccinations is lacking. There was further discussion about the ongoing efforts of the Health Department to keep school personnel up to date regarding the purpose and process for exemptions. Jean Baldwin said that Page 5 of 9 the hospital and all the clinics participate with the Child Profile database system, allowing all shots in Jefferson County to be tracked. Dr. Locke suggested that the new legislative actions should be publicized to draw attention to the issue throughout the County. Another idea is to meet with or set up a presentation to groups of parents that are opposed to vaccination. Jean Baldwin noted that progress is being made with some vaccines, including HPV. She said that funding through Bill 5930 to increase immunization rates has been well used, and that details of the overall program would be shared with the BOH in the future. Chair Westerman referred to the on site sewage program statistics. She briefly reviewed the history of this issue within the BOH, noting that monitoring had not worked out as planned. The report (page 2 of 2 — Onsite Sewage Program) shows that implementation will now focus on coordination with private contractors. There has been a decrease in monitoring inspections which is likely related to the fact that the PUD had been charging only $50 for monitoring; the charge is now cost -based at about $200. She said that, in her understanding, relatively infrequent testing is being offered due to staffing constraints. She inquired if it would be possible to offer the test more frequently, by finding ways to minimize the direct staff oversight of the test. Jean Baldwin said that that area of the department had been reduced by two staff members last year, and that the test was being offered every two months. She said that staff was looking into other options. Chair Westerman said that she believed the BOH and Health Department should strive to find ways to facilitate the success of private entrepreneurs in this area, presenting a better face to the public. She offered to assist by monitoring the testing herself, particularly for those being retested. Dr. Locke mentioned training offered by WOSA, as well as the possibility of reciprocity across counties. There was agreement that every attempt should be made to move forward on this issue. If at all possible, the retesting should be offered on a more frequent basis. Jean Baldwin provided a brief overview of what would be involved in developing a reciprocal arrangement among neighboring counties. This will require extended planning with the Kitsap and Clallam Boards of Health, and some forms of standardization. 2009 Activities Update Jean Baldwin explained the set of Program Service Activity graphs and charts for WIC, Family, Maternity Support, Immunization, and On -Site Septic services, dated March 12, 2009. She noted that the scales and parameters differed among the various graphs and services. Julia Danskin pointed out the steep increase in WIC activity in the second half of 2008 over the previous months and over 2007. The increase has continued into January and February of 2009. Ms. Baldwin briefly reviewed the results for other services. Family Planning is showing a modest rise in client visits. Maternity Support has dropped off in February 2009, which is not fully explained as yet. Immunization Services showed a slight 2008 increase over 2007. Traveler Immunization tracked closely with the previous year in 2008 and is down in 2009. On -Site new septic permits are Page 6 of 9 down 40% in 2009 over previous years. However, other septic permits, such as modifications and remodels, are actually up in 2009. Ms. Baldwin pointed out that these sets of services, which are most volatile during the economic downturn, are being tracked monthly. Not shown on these charts, Food Service has shown a decrease in the number of restaurants, and an increase in food workers, likely due to turnover. License renewal fees are down in 2009. Legislative Update Dr. Locke referred to the packet document, House Bill Report ESHB 1703, regarding childhood immunization exemptions. He noted that Representative Cody's bill was in response to national and state decreasing immunization trends. It requires parents/guardians to provide an explanation of the reason for an exemption request. He said there are critical numbers for each of the vaccines. In dropping below certain thresholds the population becomes susceptible to outbreaks, and that point has been reached. He said this measure would represent a significant change in Washington's personal exemption law. There does not seem to be serious support for repealing the exemption, as some states have done. The only other immunization bill still under active consideration is a pilot project for flu vaccination in schools, which is indirectly aimed at reducing personal exemptions. Although influenza vaccine is not mandatory in this State, experience in other states shows that offering vaccinations in the schools would improve immunization rates, in general. A few initial bills aimed at further regulating vaccines have been dropped. Dr. Locke mentioned two examples: one bill required notification that vaccination represented exposure to hazardous substances; another bill required pharmaceutical manufacturers to take back unused drugs for proper disposal. He said removal of drug compounds from public water treatment systems and from private septic systems remains unresolved. One important goal is to stop people from flushing pills down their toilets. Dr. Locke mentioned a plan by two pharmacists in Sequim to collect unused drugs (not including controlled substances) and transfer them to the Sheriff for transportation to Spokane for incineration. Jefferson County does not have pharmacies willing to offer this service. There was a brief discussion about special disposal containers for drugs. Jean Baldwin said that the Solid Waste Advisory Committee had considered but not funded that measure due to limited funds. She reviewed other educational activities that had been done related to water quality. In summary, Dr. Locke stated that the key to legislative outcomes is budgets. He said the session is scheduled to run through the last Sunday of April. All bills must be passed by April 17. Health Heroes Award Nominations Roberta Frissell reported that ten Health Hero applications were received. The subcommittee (Julia Danskin and Roberta Frissell) is recommending that six awards and four honorable mentions be granted in 2009. Referring to the written report to the BOH included in the packet, Page 7 of 9 she stepped through each of the awards and read laudatory excerpts from the application documents. 1. Community Supporters of Jefferson County School Based Health Centers including the Boeing Blue Bills, Peninsula Floors and Furnishings, Assoc. Student Body Port Townsend HS, McCrorie Carpet One, J. Dean Burton and Kevin Nighswonger — for their contributions to the Health of School Age Children. 2. Marilyn Brown, Quilcene — for her role in creating and sustaining the South County Playgroup. 3. Gary Fell — for 6 years of service as volunteer Communication Coordinator at Jefferson County Emergency Operation Center and Coordinator/trainer for the local HAM radio group. 4. Judith Rubin — for community tree planting over the past 5 years involving school kids and restoration of fish/wildlife habitat. 5. Nancy Speser — for her Public Health promotion through water safety classes and water exercise for adults, and commitment to the community to improve safety and health for all. 6. All of Jefferson County — for 10 years of support for the local Nurse Family Partnership Program. Member Frissell said that, if the awards are approved by the BOH, the first five will be awarded at the BOH meeting on April 16. David Sullivan has been invited to receive the sixth award on behalf of the citizens of Jefferson County at the "Our Kids: Our Business" Luncheon on March 27, 2009. Member Frissell also announced the list of Honorable Mentions: 1. Carrie Lennox, Jefferson County Parks and Recreation for her promotion of healthy activities and diet for young families; 2. Duke (John) Shold — for his contributions to community health and wellness in his role as installer of onsite sewage systems over the past 35 years 3. JoAnn Porter — for her spirit, enthusiasm and work helping others as a Vista Volunteer 4. Scott Swantner — for his work as plumber, contributing to the community by ensuring access to clean water and plumbing services. Member Austin moved that the BOH approve the above nominations for awards; Member Sullivan seconded the motion. The motion was approved unanimously. Julia Danskin confirmed that the nurses from Nurse Family Partnership Program and some families will be present for the luncheon awards. Roberta Frissell said that there will be certificates for both the Health Hero and the Honorable Mention award recipients, all of whom will be invited to the April BOH meeting. Newspaper coverage including photos of recipients will also be arranged. The Elks Club Luncheon event will be televised. Member Austin offered to arrange a BOCC proclamation regarding Public Health Week, April 6-14. If possible, a banner celebrating the Public Health Heroes will also be obtained. Page 8 of 9 Agenda Planning Health Hero Awards will be given at the beginning of the April 16 meeting. Budget updates and related County issues will also be on the agenda. Chair Westerman requested that a copy of the BOH bylaws be included in the packet to enable a review of rules, requirements and procedures. Adiournment Chair Westerman adjourned the meeting at 4:18 PM. JEFFERSON COUNTY BOARD OF HEALTH Sheila Westerman, Chair Absent Chuck Russell, Vice -Chair Roberta Frissell, Member Jo Austin, Member Page 9 of 9 Excused Phil Johnson, Member Absent Michelle Sandoval, Member David ullivan, Member'