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HomeMy WebLinkAboutM041609JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, April 16, 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 #1 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 Sheila Westerman notified staff that she was delayed due to a court appearance. In the absence of both Chair and Vice Chair, Member Austin moved that Member Sullivan be designated Chair Pro Tempore for this meeting. The motion was seconded by Member Frissell, and approved unanimously. Member David Sullivan called the meeting of the Jefferson County Board of Health to order at 2:30 PM. Members Present: John Austin, Roberta Frissell, Chuck Russell (arrived at 2:47 PM), Michelle Sandoval, David Sullivan Excused: Phil Johnson, Sheila Westerman Guest: Frances Joswick, Substance Abuse Advisory Board (SAAB) Staff Present: Jean Baldwin, Dr. Thomas Locke, Julia Danskin A quorum was present. APPROVAL OF AGENDA Member Austin suggested an addition, under New Business, of a Request to appoint Laura Blake to the SAAB. Member Austin moved and Member Sandoval seconded for approval of the agenda with that change. The agenda was approved unanimously, as amended. APPROVAL OF MINUTES Member Sandoval moved for approval of the minutes; Member Frissell seconded. The minutes of March 19, 2009 were approved unanimously. There were no public comments. PUBLIC COMMENTS Page 1 of 7 OLD BUSINESS and INFORMATIONAL ITEMS Public Health Heroes — Awards Jean Baldwin noted that April 6-12 had been designated as National Public Health Week. She urged everyone to view the website www.nphw.org, which includes a 3 minute video about Public Health entitled "Healthiest Nation in One Generation". She noted that Public Health is not merely an agency, but a system that encompasses the actions of citizens, everyday. She recognized Julia Danskin and Roberta Frissell for their work in organizing Public Health Heroes, which is now in its third year. She said that the applications/nominations for the awards had been inspiring and compelling, and that the evaluation team felt it appropriate to accept them all. Julia Danskin said that this year, in particular, many great nominations had been received from a wide variety of the community. The quality of the applications led them to create an Honorable Mention category, to ensure that no one was left out. Jean Baldwin also noted that the Health Department had received an award from Washington State Law Enforcement: Fight Crime, Invest in Kids, for Nurse Family Partnership services. That award had been passed on to the community as a Health Hero Award as part of the Our Kids, Our Business kickoff luncheon two weeks earlier. Roberta Frissell and Julia Danskin then described each of the six Health Hero Awards and presented the certificates to recipients: • Community of Supporters of Jefferson County School Based Health Centers including Boeing Blue Bills, Peninsula Floors and Furnishings, McCrorie Carpet One, J. Dean Burton, Kevin Nighswonger, Port Townsend Assoc. Student Body, and Friends of Chimacum Schools • Marilyn Brown — Volunteer in Quilcene; for initiating and sustaining the South County Playgroup • Gary Fell — Volunteer at Jefferson County Emergency Operation Center • Judith Rubin — Massive tree plantings and habitat restoration involving kids, schools, and families • Nancy Speser — For Public Health promotion through water safety and water exercise classes • All of Jefferson County for 10 years of extraordinary and unwavering support for our local Nurse Family Partnership (NFP) Program The Honorable Mention awards were given to: • Carrie Lennox — JC Parks Recreation Aide Supervisor • Duke (John ) Shold — Onsite Sewage system installer • JoAnn Porter — Vista Volunteer • Scott Swantner — Plumber, provider of clean water access and trouble free plumbing Page 2 of 7 Public Health Proclamation by BOCC Member Sullivan pointed out the copy of the proclamation regarding National Public Health Week, signed by the BOCC on April 6, 2009. There was no further discussion. Multi County Public Health Mutual Aid Agreement Jean Baldwin referred to the copy of the Mutual Aid Agreement in the packet. She noted that the Board of Health had seen an earlier draft. This final version has been signed by the BOCC as of April 4, 2009. Ms. Baldwin explained that the agreement is between all the Health Departments in the State. The Secretary of the State Department of Health is encouraging all counties to participate. Dr. Locke added that Clallam County was in the process of signing it, as well. Dr. Locke said that the related project involving an agreement with seven tribes of the Olympic and Kitsap Peninsulas is going well. Following a recent meeting at La Push, he and colleagues met with Hoh Tribal representatives, who now seem willing to join in the agreement. In response to a question from Member Austin, Dr. Locke said that the Quinault/Queets Tribe is aligned with Grays Harbor, and would thus be involved in a second stage of the State-wide prof ect. Letter for SAAB Membership Removal Jean Baldwin indicated that a copy of the letter had been included as informational only. Tobacco Cessation Classes Jean Baldwin referred to the bulletins provided in the packet about Tobacco Cessation Classes and Tobacco Support Groups. The project is jointly sponsored by Jefferson Hospital and Public Health staff. There is a waiting list for positions in the classes. Flyers will be posted in workplaces, public offices or other visible locations. Appointment of Laura Blake to the Substance Abuse Advisory Board Member Austin reported that a SAAB sub -committee (Fran Joswick, Julia Danskin and John Austin) had met earlier in the day to interview Laura Blake. He said Ms. Blake, owner of the Bay View Restaurant, would complement the existing SAAB, adding new ideas and enthusiasm. Member Austin nominated Ms. Blake to the Substance Abuse Advisory Board. The nomination was seconded by Member Sandoval, and approved unanimously. This appointment brings the SAAB to 13 members. NEW BUSINESS BOH Bylaws for Review Review of the Bylaws was postponed until the next meeting. Page 3 of 7 JCPH Immunization Program Jean Baldwin noted that the BOH had requested an update on the immunization program. Jean updated the Board on the 5930 project work with the schools, and immunization changes. Jane Kurata, Immunization Coordinator, introduced herself and Lisa Mackenzie, Communicable Disease Coordinator. They work with schools, particularly secretaries, to ensure that Kindergarten and 6`h grade immunization entry requirements are understood, and to provide schedule updates each year. Exemption rates for Jefferson County are very high. They encourage the schools to use the State-wide web -based Child Profile immunization database. In Quilcene, there is effective collaboration with the school nurse. She said they have been working with the school nurse and the South County clinic. During this month, they have visited all local vaccine providers and clinic directors to provide new information and to sign new contracts for state supplied vaccines. Lisa discussed the 5930 performance measures. In return for State funds, the required deliverables include tracking of HPV, Rotavirus, Varicella and Influenza Vaccine doses for 2008 compared to 2007. Actual administration of vaccine must be recorded in the Child Profile database and compared with the vaccine ordered/received. Ms. Kurata provided training to clinics and providers in 2008. She mentioned the increases in vaccinations for HPV and Rotavirus, and the drop in Varicella. The latter is believed to have been caused by refrigerator incidents where supplies were ruined. Regarding influenza, if the flu season is early, there are more requests for vaccine. This year the season was relatively late. She mentioned that another grant has been available for hepatitis prevention, with free Hepatitis A/B combination vaccine and Hepatitis C test kits. This is being offered to treatment groups at Safe Harbor. In addition, fliers have been posted throughout the city. In response to an inquiry, she said Pat Wiggins, County jail nurse, is also aware of the program and refers exiting inmates for vaccinations or testing. Lisa also mentioned recent federal studies on autism and vaccines, which showed no evidence of a relationship. She said that they had expected the State to publish a press release but that has not happened. Therefore, the Health Department may do some education on this. Jean Baldwin said that the 5930 funds were originally given to the County for infrastructure. They indicated that the first use of the funds must be for communicable diseases and immunization, and added the requirement for counts on new vaccine uptake. The funds have allowed assignment of one additional nurse in the community. Member Sandoval inquired as to the extent of outreach to parents, and about the rates of vaccinations versus exemptions in various age levels. Ms. Baldwin indicated that the Health Department has always taken a multi-level, multi -faceted approach. She explained how staff works with the mothers at the breast feeding teas, and with all school levels. She characterized the problem as continually low immunizations rates across all age levels. She said rates of exemptions are higher in the Port Townsend School District. Dr. Locke added that the research indicates that the most effective education practice is to have parents speak with their most Page 4 of 7 trusted health advisor, usually a personal physician or nurse practitioner. He mentioned other issues such as the difficulty of tracking exemption rates. If the bill before the legislature passes, parents will be required to provide a letter acknowledging that they have been counseled on the benefits of vaccination and the risks of not being vaccinated. Jean Baldwin stated that the staff is very sensitive to parent fears and always strives to gain trust in conjunction with providing information and advice. She believes this County will continue to be under -immunized and will experience periodic outbreaks in communicable diseases such as pertussis. Dr. Locke said another serious challenge stems from the fact that the State of Washington is going to stop doing universal distribution of vaccine due to budget constraints. This presents a problem of higher cost and greater work for primary care providers. There was discussion about the number of vaccines that are now required. Dr. Locke pointed out that vaccines are required only for certain diseases that have outbreak potential in schools. There are several recommended childhood vaccines that are not mandatory for school admission. He also explained that the amounts of antigens in vaccine shots are relatively small compared to what a child encounters from natural infections. He said an important issue we are asking people to consider is that the personal health choice to avoid vaccination has a very real community health consequence. County Budget Changes Jean Baldwin recapped the status of the County budget shortfall. She said that State budget cuts and eventual impacts to the Health Department are still evolving Veronica Shaw reported that each County department has been asked to develop a cost saving plan, and to return a portion of the General Fund in May of 2009. For the Health Department this amounts to $57,000. In addition, agreements are being negotiated with the unions for hour reductions. The Health Department is not solely funded by the General Fund as many other departments are; other income is generated from grants and fees. JCPH was able to make reductions through voluntary staff hour reductions, by not filling a vacant position, and other measures. She said that the staff understands that these are challenging times for the entire County. The budget is being watched closely and may still be subject to changes from DSHS and the Department of Health. Jean Baldwin stated that a set of spreadsheets has been developed with four variations on hours reductions and furloughs in the event that State revenue drops substantially. She has polled staff for their suggestions on other cost savings. Member Sandoval suggested that BOH meeting packets be streamlined or mailed electronically. BOH members said they would be willing to receive electronic packets, with the understanding that paper copies would be available on request. Member Austin reminded that a few paper copies would be needed due to the Open Meeting Act requirements. Member Sandoval said that the City is moving to a paperless system and now has only a few copies of each document available for Council meetings, depending on the extent of public interest in the topic. Page 5 of 7 Member Austin noted the importance of properly conveying to the public that these reductions will affect services, and are not simply eliminating slack. He said that there will be functions and services, such as clinic hours or monitoring/analysis, where fewer staff resources will be available. There was a brief discussion about the closure of Family Planning on Wednesdays and other impacts that will be visible. Ms. Baldwin and Ms. Shaw explained the complexity of these decisions and the analysis required to select the most appropriate reductions. Legislative Update Dr. Locke reported on information from the State Medical Association Inter -specialty Medical Council legislative update on April 11. He noted that the overwhelming issue is the State budget, while most of the policy bills have died or are of minor consequence at this point. He said that the cuts in social service programs are huge, and will be of noticeable impact. The Basic Health Plan coverage may be cut in half, with many people losing or becoming ineligible for coverage. In addition, there is consideration of a referendum for a 0.3% sales tax increase for three years. Dr. Locke said there are three major sources of funding for public health. Although all three were preserved in the Governor's budget, various cuts were made by the House and Senate related to the 5930 funding. This would mean $104,000 reduction for Jefferson County Public Health. However, there is recent news that $64 million of $68 million will be preserved for Public Health. He mentioned other bills that would initiate new surcharges and fees for services such as restaurant inspections, professional licenses, and birth/death certificates. Ms. Baldwin added that according to a recent letter from WASAC, many of the public health funds that seemed to be in jeopardy are being preserved. She said that there are many announced cuts for which the actual impacts are difficult to pinpoint in terms of programs as yet. Additionally, there are reductions to Puget Sound Partnership and the Department of Ecology. The next step will be for the House and Senate to come to agreement on the budget package, which will then be subject to the Governor's veto. Dr. Locke also reviewed State health care reform and the process which began in 2008. The only bill still under consideration establishes the goal of near universal health insurance by 2014 and sets up a multi -agency advisory committee. He said it is now more likely that reform at the federal level will precede any major Washington State initiative. Julia Danskin also announced that Dr. Locke would make a Health Care Reform presentation at Peninsula College in Port Angeles on Wednesday evening, April 22. The forum is sponsored by the League of Women Voters. Dr. Locke said he will summarize the current status of reform options and probable community impacts, as well as explain how those interested can get involved. Public health will have a significant role, because it is now generally understood that prevention can save money. Activity Update There were no additional items to present or discuss. Page 6 of 7 Agenda Planning Permit Appeal Hearing — Dr. Locke alerted the Board that an appeal hearing is scheduled for the \ May 21" BOH meeting. This appeal is in regards to an onsite sewage permit that was denied, then appealed and again denied in an administrative hearing. Dr. Locke said he would speak with Chair Westerman to determine the time allotted for the appellant, and for the summary of the reasons for denial. He has notified the appellant that any materials relevant to the hearing must be submitted at least one week in advance of the hearing. He advised the Board that there is likely to be a large number of documents to review. Adiournment Member Sullivan, Chair Pro Tempore, adjourned the meeting at 4:10 PM. JEFFERSON COUNTY BOARD OF HEALTH Excused Sheila Westerman, Chair Excused Phil Johnson, Member Not Available for signature Chuck sell Vic hair Michelle Sar oval, Member Roberta Frissell, Member DavWSullivtn, Member John stin emb r Page 7 of 7