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HomeMy WebLinkAboutM061809JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, June 18, 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 called the meeting of the Jefferson County Board of Health to order at 2:30 PM. Members Present: John Austin, Roberta Frissell, Phil Johnson, Chuck Russell, David Sullivan, Sheila Westerman Absent: Michelle Sandoval Guest: Frances Joswick, SAAB Staff Present: Dr. Thomas Locke, Jean Baldwin A quorum was present. APPROVAL OF AGENDA Member Austin moved and Member Sullivan seconded for approval of the agenda. The agenda was approved unanimously. APPROVAL OF MINUTES Member Austin moved for approval of the minutes of May 21, 2009; Member Frissell seconded. The minutes of May 21, 2009 were approved unanimously. PUBLIC COMMENTS Dr. Locke introduced Rebecca Pfaff. Ms. Pfaff is a second year medical student who grew up in Joyce, WA. She is doing a research project on health care disparity and working this summer with various health care professionals in the County including Dr. Locke. Member Austin referred her to the State Health Disparities Board, but cautioned that he did not know if it would survive budget cuts. Page 1 of 10 OLD BUSINESS and INFORMATIONAL ITEMS First West Nile Virus Identification Dr. Locke referred to the press notice in the packet. He said that it is notable that this is the earliest in the season that West Nile virus has been detected in the State since monitoring began in 2001. For this to become a state wide problem, the virus must be present in the bird population, which then moves around the State. The two species most at risk for this infection are horses and humans which acquire the virus from mosquitoes that have fed on infected birds. We have also learned that one of the predominant forms of mosquito in the State actually shifts from feeding on birds to humans late in the summer. In response to a question about spraying and other control measures, Dr. Locke said there is a detailed plan, with a local option for spraying. "Adulticiding" is the term used to refer to the spraying of pesticides to kill adult mosquitoes. He said there is evidence from the Midwest that this practice does cut down on the number of human cases. Jean Baldwin explained that Mosquito Districts with taxing authority can respond quickly, as the need arises. Other jurisdictions must relay on State Agencies or County Commissioners to make decisions, which takes more time. There was a brief discussion about how risks of spraying are weighed against threats of the disease, depending on the location, conditions and past patterns of illness and deaths. Review of Jefferson County Board of Health Bylaws Chair Westerman noted that it had been quite some time since the Bylaws had been reviewed and that this item had been deferred from earlier meetings. The BOH stepped through the document, noting the following issues and possible changes: 1. Regarding the attendance policy, Member Austin recalled the recent action taken by the substance Advisory Board. Jean Baldwin noted that the BOH had not taken similar action in response to repeated absences in the past. 2. Signing of minutes — Usual practice has been for all members who attended a meeting to sign the minutes; any corrections are made before the final version is signed. Member Sullivan suggested revised wording: "Minutes shall be signed by all members after approval by the Board." Dr. Locke cited three points from Robert's Rules of Order: Members who are not in attendance at a meeting may sign the minutes for that meeting, although they are not required to do so; it is also allowed for the Chair to sign on behalf of the Board; and there need not be a vote on the approval of minutes — the Chair may declare that if there are no objections, the minutes are approved. He suggested that it is not necessary to hold up approval due to the absence of some members, as has been past practice. 3. Reference to the Jefferson County Health and Human Services Department: References throughout the Bylaws should be updated to Jefferson County Public Health. 4. Public Testimony: The option of the Chair for setting time limits for testimony was reviewed and retained without change. The section Comments on Action Items was reviewed and changed Page 2 of 10 to "Prior to voting on any item requiring action by the Board, the Chair may call for comments by persons interested in or affected.....", rather than shall call.... 5. Executive Session: Members reviewed the purpose of the provision for Executive Sessions, i.e. they may be called for discussion of sensitive matters such as pending litigation, possible property acquisition, or personnel matters. There was no change to text. 6. Ethics — Conflict of Interest: The Board reviewed this section, noting that the language is broad, and should be more specific. The issues of "appearance of conflict of interest" and "appearance of fairness in quasi-judicial situations" should be clarified. Dr. Locke offered to research and suggest alternative language, including clear definitions. 7. Tape Recordings: Members suggested a change to the second sentence: "Any person may make a formal request for a copy, per policy." Direct reference to tape recordings will be changed to a more generic term, such as "electronic recording media". 8. Meeting Notification: Members reviewed the policy and practice, and decided not to add specific information about the meeting notification process. Members also distinguished between the original version of the Bylaws and a revision draft with certain sections in boldface type that had been distributed at the meeting in the following two sections, Vacancies and Article VII, Administrative Officer. 9. Article VII. Administrative Officer: Dr. Locke explained that the Health Officer is by default the Administrative Officer and Executive Secretary of the Board of Health. In very small rural counties where the Health Officer is present only a few hours per month, the legislature has provided the option for the local BOH to appoint an Administrative Officer who could perform some of the duties of the Health Officer, but not all. He said it is in the power of the Board to appoint the Health Department Director as the Enforcement Officer, for example. However, some of the duties of the Health Officer may only be fulfilled by a physician, as specified by law. The BOH agreed that the word "may" should be substituted for "shall". 10. Returning to Absences on page 2, members discussed the provision that the County Commissioners may remove a member for lack of attendance. Chair Westerman suggested that that authority should reside in the BOH. John Austin suggested that the State Constitution should be consulted as to whether that is permissible. Dr. Locke stated that in statute there is the provision that in an expanded Board, the County Commissioners appoint the members. He said the logic of this that the appointing body would also have the authority to remove members. Member Frissell noted that does not preclude a recommendation from the BOH to the BOCC regarding appointment or removal. Dr. Locke said he believed the statute is silent on removal, and that the BOCC could delegate the authority to appoint or remove members. He said he would research that issue further. Chair Westerman suggested that based on her experience with other Boards, it is better to have a clear, simple policy and process in place for excessive absences. 11. Amendments to the Bylaws: Member Austin recommended that the BOH change "by two- thirds (2/3) vote" to "by two-thirds (2/3) vote of total members", which had been suggested by Page 3 of 10 David Alvarez. In addition, Member Austin noted that, as currently written, proposed changes must be distributed at least ten days prior to the meeting when the vote is taken. Members agreed that the changes would be on the agenda for the August meeting. Dr. Locke also noted that placeholders were inserted in 2006 for proposed new sections that would address public hearings and appeals processes. He said he would draft language as procedures to address those issues. 12. Quorum: Chair Westerman recalled that there had been many discussions in the past as to the definition of a quorum. It was agreed that a County Ordinance would need to be changed to alter the definition of a quorum. Chair Westerman said that she believes it is appropriate to give every member of the BOH equal weight, and asked the Commissioners to consider supporting that change. Member Sullivan noted that that would present the possibility of the entire BOCC being out voted on a funding issue. (There were no changes.) Jean Baldwin noted that the composition of the BOH has been very successful, particularly as it enabled strong partnerships between the County, City and Hospital. It was agreed that full Board attendance and participation is very important to maintain strong partnerships and continuity. She also noted that the design of the BOH has become a model for other counties. Substance Advisory Board Update Report Fran Joswick reported that the Advisory Board membership is now at twelve members, all engaged and applying their skills in support of various projects. Ms. Joswick also reported on the Relapse Prevention Education Program at the County Jail. She said that seventy (70) inmates had participated from October 1 through May 30. Of those, there have been 14 who have re -offended, or 20%. The goal at the start was to reduce the recidivism rate by 10% within one year. She said that success in this program is important in terms of cost to the County, and ancillary costs such as Child Protective Services and other indirect costs associated with incarceration of an individual. Of the 70, 17 went directly from jail into treatment; 7 are currently in treatment and 2 are awaiting dates for entrance. Ms. Joswick said that Safe Harbor, which has donated the education staff and the clerical staff for data processing has experienced significant budget cuts. It is uncertain whether Safe Harbor will be able to continue in this capacity. The County and City decided to use available funds for projects other than the Relapse Prevention Program. She said that she has contacted Norm Dicks' office, which is searching for alternative funding, and plans to speak with Lynn Kessler as well. She asked the BOH to convey any other possible sources of funding to her. An informational packet is available for prospective funding agencies. Ms. Joswick said that an additional assessment will be done for new inmates that will identify specific information needed for funding applications. She mentioned that Sheriff Tony Hernandez has given excellent support to the SAAB in their efforts to maintain this program. Approximately $50,000 is the amount needed. There was a brief discussion about data gathering in the jail. Jean Baldwin advised that there are three different data programs that should be coordinated. She said the "one tenth of one percent" funds are paying for two data projects in the jail, and will be pulled together for the inmate Page 4 of 10 histories. This source also pays 100% of Nurse Wiggins' salary and provides some funds for Ford Kessler for services in the community that could include this work. Ms. Joswick said she would forward a copy of Mr. Kessler's budget. Ms. Baldwin said there is additional money coming into the County as one of the early adopters of the "one tenth of one percent" program, i.e. $200,000 for Safe Harbor and Mental Health in conjunction with the Drug Endangered Children Policy. There are also some new funds in the community for methamphetamine - related programs. Ms. Joswick noted that this recidivism reduction demonstration project has shown its value and repeated that it is very important to continue funding for it. Member Sullivan stressed the importance of keeping the BOCC informed of funding efforts. Member Johnson added that he had met with a district staff member for Norm Dicks; Member Johnson and Ms. Joswick agreed that he had been very helpful. NEW BUSINESS Influenza A/SWHI ("Swine Flu") Lessons Learned, Preparedness and Response Challenges Dr. Locke stepped through a slide presentation of Pandemic Preparedness and Response: Influenza A/SWH1 Virus ("Swine Flu"). He noted that swine flu would continue to present workload challenges in coming months now that a pandemic has been declared. The disease will spread rapidly in the southern hemisphere during their flu season. He noted the likelihood that swine flu would return in the fall, at lease in its present form, and with concern of a more virulent form. Dr. Locke explained the "H" (hemagglutinin) and "N" (neuraminidase) significance, roles and structures within the A virus. There are 16 types of hemagglutinin and 9 types of neuraminidase identified, with 144 types of viruses discovered in birds; only a small subset affects humans. The genetic material is contained in 8 internal segments that are swappable within species. He showed the life cycle of influenza A, noting the combination of human, bird and swine strains that have been re -assorted into a unique new virus. He said that its ability to mutate and its instability are characteristics that make it so dangerous. The history of Influenza A pandemics was reviewed. Dr. Locke indicated that the triple reassortment viruses like the new swine flu strain are not well understood, and have only been closely monitored for about the last five years. It is not known exactly where the current virus arose, but it is believed that a close relative of this type has been circulating among swine populations for several years. He showed the worldwide distribution of this virus. The apparent absence of cases in much of Africa is likely due to lack of reporting. There are six levels of pandemic alert by the World Health Organization; stage 6 has been declared for this new strain. Dr. Locke noted that the regular flu season for the USA has been atypically late and long in 2008-09. He summarized the first four weeks of the swine flu pandemic in Washington State, i.e. from April 26 to May 23, 2009, in terms of numbers of cases, symptoms, severity, age Page 5 of 10 distribution, and sampling/reporting protocols. There is an age-related susceptibility; people born before 1957 appear to be less at risk. The median age of confirmed cases is 13 years of age. In response to a question about the smaller number of cases in those under the age of four, Dr. Locke said that is not likely to be due to transfer of maternal immunity, but more likely due to less exposure than school age children have. There have been a few cases detected in Jefferson and Clallam County, but Dr. Locke indicated that there are likely many more that have not been detected. He noted that this flu strain is presenting like seasonal flu except there is an unusually high rate of vomiting and diarrhea. The rate of hospitalization is much higher than with seasonal flu. There is a rapid test for Influenza A available locally, and most people with swine flu do test positive for this. Dr. Locke also discussed the strategic national stock pile. Anti-viral drugs from the federal stock pile were distributed at stage 4 of the pandemic alert. Jefferson County has a total allocation amount sufficient to treat 15% of the population. In the first distribution, 25% of that allocation, or about 1000 treatment courses, was received: 80% of that was in the form of oral medication, and 20% was in the form of inhalants. There are also supplies of personal protective equipment. There have been very low levels of use. Don's Pharmacy, QFC Pharmacy, Hadlock and the Hospital accepted supplies for distribution under the direction of the Health Department. The strongest treatment priorities are for hospitalized patients and those with risk factors for complication. In summary, this includes: those under age 5 and over 65; chronic lung, heart or metabolic disease; pregnant women; and those with suppressed immune systems or those taking medications with that effect. There have been three deaths thus far in Washington State. It is not yet known if the risk of death from swine flu is greater than it is for seasonal flu for those in the high risk categories. Dr. Locke noted that the anti-viral drugs do not work very well. According to the best published studies on Influenza A, statistically for every 100 people treated with these drugs, there were six fewer lower respiratory tract infections, and one less hospitalization. In other words, for every 100 people treated with these drugs, 99 had no benefit in terms of hospitalization. It is not known how effective the drugs are in preventing death. With regard to preparation plans, Dr. Locke mentioned that there had been a meeting of the Emergency Response Team earlier in the day. With regard to direction and planning, Dr. Locke said there continues to be surveillance at all levels. In terms of prevention, the big issue is vaccine production. It is not known how much vaccine can be produced quickly. The US has not committed to purchase a supply as yet. The most optimistic view is that 40 million courses can be produced, which will not cover the entire population, particularly since two doses are needed for each child. Jean Baldwin said there must be discussions with partners/schools to work out how all children could be vaccinated, which is a large challenge. Medical/surgery capacity is also a significant challenge for the health care system; alternate care sites for medical services are being sought. The business community should also be informed as to what steps they can take in preparation and in the event of outbreaks. Jean Baldwin said she has requested medical reserve personnel to perform trainings this summer at businesses and establishments in Jefferson County modeled after what was done in Kitsap County. Dr. Locke discussed the lingering question of whether or not to buy more anti-viral medications. In addition to the 15% stockpiled, the federal government will allow purchase of an additional 10% at a subsidized rate ($14 per dose versus a market rate 4 times higher). He said that he and Page 6 of 10 Dr. Scott Lindquist are not recommending that, based on technical reasons. The drug is of limited effectiveness, the possibility of resistance is high; and even at $14 per treatment course, the cost for thousands of extra doses is high. In response to a question, he said that brand new oseltamivir phosphate has a seven-year life. However, the pediatric batch received expires at the end of June 2009. He affirmed the desire to use Medical Reserve Corps to assist with education and medical services. Fran Joswick suggested advertising for qualified volunteers, such as retired physicians and nurses. Jean Baldwin agreed that outreach must be stepped up. In addition, there is hope that the federal government will provide financial support, since most of the effort in May and June has been paid for by local funds. Dr. Locke added that there are also steps being taken to ensure coordination between the County, Red Cross and Medical Reserve Corps. Washington State Department of Health Budget Cuts: Impacts on Local Health Jurisdictions Jean Baldwin referred to the packet item summarizing budget cuts on Local Health Jurisdictions and stated the amount of the reduction for each item as it affects Jefferson County. Tobacco Prevention — 20% reduction; $2,935 starting July 1, 2009 Public Health Enhancement 5930 — This was new money for staff associated with immunizations; 20% reduction, $20,600 starting January; there has also been a huge change in the Immunization Vaccine Program which shifts costs from the State program to insurance companies and individuals and the federal Vaccine for Children program. The greatest impact is in workload is to shift the accounting from the existing to the new system. State Family Planning Grant — Approximately 10% or $6,000 reduction sometime in 2009. In response to a question about a 70% reduction in State family planning in 2011, Jean Baldwin said that the federal funds are expected but not guaranteed. Colon Screening — No impact because this program has not yet begun in Jefferson County. Group B Water Systems — No direct financial impact since Jefferson County had relied on the State; there is an open question as to whether the County will need to pick this up. AIDSNET Grants — 7% reduction, $3,000, starting July 1, 2009 WIC -- No large impact, approximately $2,000 Jean Baldwin said the largest cuts, through DSHS, are not listed. She said that about 45 community health contracts come through the division, which is the bidder for DSHS, State Department of Health and others. Jefferson DSHS funding is about equal to DOH money. She explained that while DOH money is mostly block grants, the DSHS money is billed for those eligible for various services. Maternity Support is run by DSHS based on deliverables designed by DOH. There has been a redesign of the program and the net result is about a 30% reduction, or $7500. The goals of the program have changed and there will be differences in the ways Page 7 of 10 clients are qualified and served. The funds may no longer be used to serve all young families as in the past. The overall reduction for the year, beginning in January, will be about $17,000. Ms. Baldwin said the DOH cuts are specified, while the DSHS cuts are still somewhat soft. The Alternative Response Services and Early Intervention Program contracts through Child Protective Services will be renewed. The Health Department is considering options for staff reassignments and hour reductions and will have additional changes beginning July 1. Ms. Baldwin suggested that the County and City may wish to work out a joint solution to maintaining the Maternity Services as it is now. She also discussed the uncertainty of the DSHS deliverables at this time, with the result that exact dollar reductions are very difficult to determine. She also stressed that the Health Department has always decided which services are really needed, and does not add or subtract services based solely on whether funding is available. If necessary, some services will be decreased due to the reductions. Chair Westerman asked for clarification on the decreases in the Tobacco Prevention program. Ms. Baldwin said that the changes are population based, and noted that the funds were not moved entirely out of health care. She said that her priority is to get through the next two years with the hope that federal health care reform will come through in the meantime. There was a brief discussion about the ongoing Mystery Bay water quality and mooring buoy issues. Some members questioned the State resources being expended there while much more serious issues are pending. Member Sullivan said that he appreciated the approach that the Health Department is taking, and agreed that the Maternity Support program cannot be dropped because of the $20,000 needed to maintain it. National Health Reform: A Role for Local Health Policy Makers Dr. Locke referred to the copy of the joint letter from the Clallam County BOH and Hospital Boards written to the White House Office of Health Reform. He noted the importance of conveying the rural perspective in the national health reform deliberations. He said the number one priority for rural Washington is the ability to recruit and maintain qualified workforce. He inquired whether the BOH would be interested in drafting a similar letter. There was a brief discussion about the possibility of working with the Jefferson Hospital Board. Member Russell said that he plans to attend a meeting of rural hospitals in Chelan in July, and will report back to the BOH on this matter. Activity Update Washington State Board of Health Meeting, Port Hadlock, July 8, 2009 -- BOH members are invited to attend this meeting. The State Board staff has been coordinating with staff with regard to a presentation. The agenda will include school safety rules as well as clean water issues and other items. The meeting is scheduled from 9:00 AM to 4:00 PM. The agenda will be published on the web site about 7-10 days in advance of the meeting. Dr. Locke said that the Health Department has been allocated about one hour on the agenda; they plan to present on overview Page 8 of 10 of the Jefferson County Health Department and a highlight of the Nurse Family Partnership program. Member Austin suggested that the Relapse Prevention program at the County Jail should be mentioned. Chair Westerman will not be in town; Vice Chair Chuck Russell, Members Austin, Johnson and Frissell, and Dr. Locke plan to attend. Electronic Meeting Packets—Chair Westerman stated that electronic packets had been proposed as a cost saving measure at the last meeting and piloted for this meeting. Member Austin said he believes this arrangement is very inconvenient and is actually a false economy. He said he prefers that packets are printed centrally rather than individuals coping with reading online or making individual requests or printing documents at home. Several members expressed their agreement, noting the difficulty of reading lengthy documents online and not having printed support materials at the meeting. Member Austin moved to resume printing and mailing of packets; Member Johnson seconded the motion. The motion was approved by a vote of 5 to 1. There was a brief discussion about posting materials on the web site. Agendas will be posted prior to the meetings. Minutes will be posted after they have been approved. Some packet materials may be posted, but there are copyright issues for others. Requests for agenda items will be e-mailed or sent via post card. Atzenda Planning The next meeting of the BOH is scheduled for Thursday, July 16, 2009 from 2:30 to 4:30 PM in the Health Department Conference Room, 615 Sheridan Street, Port Townsend. Adjournment Chair Westerman adjourned the meeting at 4:35 PM. Page 9 of 10 JEFFERSON COUNTY BOARD OF HEALTH Sheila We terman, Chair J Chuck Russell, Vice -Chair Roberta Frissell, Member Absent Michelle Sandoval, Member Page 10 of 10 Phil Johnson, Member i�a J Austin, Member Davi Sullivan, Member