HomeMy WebLinkAboutM071609JEFFERSON COUNTY BOARD OF HEALTH
MINUTES
Thursday, July 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
Kristen Nelson, 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, Kristen Nelson, Chuck Russell, David Sullivan, Sheila
Westerman
Members Excused: Roberta Frissell, Phil Johnson
Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin
Guest: Frances Joswick, SAAB, was present for a portion of the meeting.
A quorum was present.
APPROVAL OF AGENDA
Chair Westerman welcomed Kristen Nelson, Port Townsend City Council member, who is
succeeding Michelle Sandoval as the City of Port Townsend representative.
Chair Westerman noted that there may be a report from Fran Joswick, Substance Abuse
Advisory Broad, at the end of the meeting as time permits.
Member Russell 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 June 18, 2009; Member Sullivan
seconded. The minutes of June 18, 2009 were unanimously approved, as presented.
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PUBLIC COMMENTS
There were no public comments.
OLD BUSINESS and INFORMATIONAL ITEMS
Washington Breast, Cervical, and Colon Health Program Report
Julia Danskin referred to the report in the packet. She said that Jefferson County has done a
great job in screening women for breast and cervical cancer through this program. The total
number of women screened in 2008 was 108. Three abnormal pap smears were found, but no
cases of cervical cancer were found. There were 72 mammograms done through this program.
This year, there will be a mobile mammogram screening in Quilcene, utilizing the Swedish
Hospital van, on October 10. In response to a question, she explained that "the percentage of
eligible served" is based on an estimate of the number of women in Jefferson County who are
low income without health insurance. Jean Baldwin added that the poverty in this county is not
primarily in that age group (40-64).
Pandemic H1N1 Update: Medical Surge Capacity, Business Preparedness and School
Infection Control Planning
Jean Baldwin said that Dr. Locke and Julia Danskin would provide the most recent information
on pandemic preparations. There have been several conference calls this week with the state and
local public health agencies to discuss topics related to swine flu (H1N1). A number of tasks
need to be accomplished this summer concerning education for physicians, schools and
businesses. She mentioned previous problems with people returning to work while still ill, and
not wearing protective masks etc. It will be possible to use other counties' educational materials
with some modification.
Dr. Locke said that there has been intensive planning for the next influenza pandemic starting in
2005. He noted that this is the first flu pandemic of the 21 st century. It presented differently than
expected: it began in North America, and, fortunately, at a time of year that is not favorable for
transmission. Despite the fact that we are well into summer, there is still a significant amount of
swine flu activity in the US. The problem is greatest where children and adolescents gather, such
as summer camps.
In the Southern Hemisphere where winter weather is more favorable for flu transmission the new
H1N1 virus is behaving exactly as a pandemic strain is expected to behave. In a pandemic
everyone is generally susceptible; even with a mild strain of influenza, many people get sick.
Generally, in a pandemic, at least 25% of the population gets sick during the first wave. It has
been noted that not all cases of the pandemic HIM strain are as mild as initially thought. It is
different than seasonal flu but is not a replay of the Spanish Flu of 1918. It is capable of
infecting the lower respiratory tract, a trait not shared by seasonal influenza. A virus that causes
a viral pneumonia is a more serious health threat. There are higher levels of hospitalization and
needs for intensive respiratory therapy, including ventilator support. The mortality rate is
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significant. Nationwide, it is estimated that there have been more than 1,000,000 cases already.
The risk of widespread outbreaks will start to increase as soon as schools are back in session.
In response to a question, Dr. Locke said that the respirator capacity throughout the Peninsula is
low. Operating room respirators are not the right type of equipment for prolonged mechanical
ventilation, and it is not feasible to significantly increase the supply of respirators. Vaccines are
being produced and administration of these vaccines will be a major workload issue. He said it
would be a challenge for Health Department and the entire medical care system. The workforce
requirements far exceed the available resources. Dr. Locke said that Public Health and the
medical care system are set up to work independently in most circumstances, but it will be
necessary to have them work together seamlessly. During the summer, pandemic preparations
will continue to be a significant work priority.
Dr. Locke said that triple reassortment viruses, the category the new H1N1 strain falls into, have
not been the subject of much study. The research focus has been directed at avian flu and the
risk of a virus jumping directly from birds to humans. The degree of contagion for the swine flu
virus was unexpected, previous swine flu strains had difficulty spreading from person to person.
He said the stability of the new virus is unknown. Will it stay in its current genetic configuration
or will it further combine with other flu viruses? Swine flu is already acquiring resistance to one
of the main anti-viral drugs. It is also unknown if it will be the same flu that began in North
America once it has cycled through the Southern Hemisphere and returns.
Chair Westerman inquired as to what factors are common to humans, birds and pigs. Dr. Locke
said that Influenza A is primarily a bird disease; there are 144 different kinds of Influenza A for
birds. Most are mild infections, some are lethal for birds. A number of other species are at risk
of being infected with avian influenza depending on how susceptible they are to particular
strains. There are strains that affect dogs, whales, horses, swine, and other mammals. He said,
however, that it all stems back to birds. He said it is not known if a triple reassortment virus
could spread back to the bird population. It has been observed that the new human "swine flu"
can spread from humans to swine.
Member Nelson asked for more information about the plans being developed. Dr. Locke said
that influenza is very difficult to control. It can easily be spread up to 48 hours before symptoms
are seen or felt. The outline of the plan is scaled to 5 different severity levels. Currently, the
pandemic status is a category one or two, similar to seasonal flu. Preparation is focused on
containing the spread of the flu once it is contracted. Isolation, hand washing, sanitizing, etc. is
very effective in preventing flu transmission, but Dr. Locke said it is not done very well in either
health care facilities or in society in general. Jean Baldwin noted that there is great effort now
focused on the schools because of the age of those getting sick and because viruses spread
quickly there. She said that discussions with school administrators and staff will be set up for
August.
Member Austin inquired about working with local camps. Jean Baldwin said that messages had
been sent to all known local camps with instructions on screening, responding to sick children,
etc. Camp Parsons has an organized Boy Scout contingent in Seattle with whom staff is
working. She requested that members send information on any other camps in the vicinity that
may not have been included.
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Member Austin also asked if there is possible help from the State or Federal government to hire
temporary workers or other assistance. Jean Baldwin said that $8,000 from the State had been
received for the initial outbreak work, and that they may try to build some staff time into plans.
She said the Health Department will receive about 3300 vaccine doses, which must be tracked by
the department. The actual dispensing of vaccines will also be done by the hospital and
practices, but the logistics are very complicated. There are liability and insurance issues to work
through.
In response to a question about work that would not be able to be completed, Jean Baldwin said
that she and staff had prepared a tentative list, which could be reviewed by the BOH. There was
also a brief discussion about providing adequate backup for services and the possible loss of
revenue, as well.
Julia Danskin discussed training and confirmed that training would be done in the schools. In
seeking volunteers, she has contacted the Red Cross to locate nurses who can help with training
in the community. Regarding vaccines, a minimum of 3360 doses will be received by October;
planning for storage of vaccines and syringes is in progress. Staff includes those who have
participated in mass immunizations in the past. She is awaiting decisions on the exact timing of
the two -shot immunization and the priority group for vaccination.
NEW BUSINESS
Group B Water System Regulation in Jefferson County
Jean Baldwin noted that this topic was discussed at the recent State Board of Health meeting, and
would be under consideration for the next year as State rules change. Susan Porto,
Environmental Health Specialist, said there had been a short presentation at the State Board of
Health meeting the previous week, where some of the changes had been introduced.
Ms. Porto said she would present what is presently done in Jefferson County with regard to the
drinking water systems. She stepped through a slide presentation regarding the changes that are
occurring with this program. A handout entitled "Group B Feedback, Survey of Environmental
Health Directors" was provided. She also provided copies of a position paper by Dave
Christianson (former employee of Jefferson County) on DOH direction in the next several
months.
She began with a background of public supply water systems in Washington State. By State
Law, a public water supply is defined as all systems except one single family residence or less
than 5 residences on a family farm, i.e. anything other than a single domestic source. Public
water supplies are divided into two main categories, Group A and B. Group A have more than
15 residential connections, 25 or more people, greater than 60 days per year or are federally
mandated program. Group B systems have 15 or less connections, less than 25 people, less than
60 days per year, and are not federally mandated. This was modified in 1995 by the State to
exempt two-party connections provided that counties take on some duties. There was a brief
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discussion as to how camps fit into one of these two categories. Ms. Porto said that most camps
are Group A, while bed & breakfasts usually fall under Group B.
For Group B, most counties have a joint plan of operation with the State DOH, but vary widely
on specific arrangements. Seven counties have no service whatsoever. Twelve, including
Jefferson, have limited agreements. Twenty, including Clallam, have active programs mostly in
permitting new systems. Jefferson County, until 2001, had very limited authority over public
water supplies. It did inspections, with fees, for proposed sources for new public water supplies,
A and B, and provided some technical assistance. The State Legislature then asked DOH to
inventory systems, inspect them and determine risk. The County staff became involved in doing
some of the assessment in Jefferson County. As of January 2009, the DOH said it would no
longer provide potable water adequacy on building permits. She said that the State database is
available but is usually not current. She has contacted DOH and adjusted the contract so that the
County can maintain its own database, which now contains 165 entries which will be tracked.
The objectives in 2004 to assess risk included: inventory, contact the owner, do site visits, take
photographs, determine how to address any inadequacies, ensure that operators are aware they
need to do water quality monitoring. Emphasis was on voluntary compliance. There were 42
systems were on the State's list: 37 inventoried; one refused inspection; 2 could not be found;
one was inactivated, and for one there was a conflict in scheduling. They found that 57% had
potential contaminants within 100 feet of the well; 46% had improperly constructed well vents
and openings in the well cap; 50% of open storage reservoirs had unprotected openings;
inadequate water quality monitoring -about one third were not monitoring and about 26% were
incorrectly sampling the water. She showed photographs of various problems and risk situations.
Ms. Porto said that the educational benefit to these well operators was significant and most were
appreciative.
As of early 2009, the Legislature eliminated all funding for DOH to oversee Group B regulations
but did not rescind the RCW; the DOH is in a holding pattern, which is described in the handout.
An RCW change is planned for 2010 which will establish design requirements for initial design
and construction of a water system, eliminating the existing monitoring requirements. It will
also allow the State BOH to waive some or all requirements for fewer than 5 residential
connections. There are associated zoning/land area questions to be resolved. The DOH will
continue to survey what counties plan to do.
Jean Baldwin stated that as of July 1, due to lack of funding, Susan Porto will move to Septic
Systems and Linda Atkins will work on Clean Water grants. Other plans for the future are
uncertain. Chair Westerman said that every possible effort has been made in the past to staff
these areas without adequate funding, but it is not possible any longer. She mentioned the
unfinished work with septic systems. There was a brief discussion about fees in other
jurisdictions and about the remaining problem of existing systems, mostly unpermitted, left to
the Counties to deal with. Possible solutions are to link water system permits with building
permits, or with sales of properties.
There was mention that there is no longer water service at the U.S. Forest Service campground in
Quilcene due to new federal regulations regarding use of surface water.
Page 5 of 10
Mystery Bay Commercial Shellfish Classification Change and Adiudicative Hearing
Option
Neil Harrington noted that the BOH has the authority to seek an appeal regarding this decision
by the Department of Health. He said he would provide a brief history and a recommendation
regarding this matter.
There are two types of shellfish area closures: one is based on water quality data; another is a
categorical closure based on use. In this case, there were indications that this body of water may
meet the definition of marina. In the spring of 2008, the State BOH indicated that a
reclassification order was under consideration due to the number of boats anchored at Mystery
Bay. He discussed the County's mooring buoy application process, which requires a shoreline
development permit to place the structure and permission of the landowner, Washington
Department of Natural Resources (DNR), for assignment of State bed lands and WA Dept. of
Fish and Wildlife (DFW) approval. A series of meetings ensued, dealing with types of buoys
and the range of boats there, including legal, illegal and grandfathered instances. Participants
included the Department of Community Development (DCD), DNR, DFW, DOH, Tribes, State
Parks, Neil Harrington, and MRC (Marine Resources Committee) representation. During 2008,
much of the work involved data gathering, sorting out the status and ownership of the buoys, and
determining if this body of water meets the definition for marina. The possibility of a
conditional winter -only harvest was considered, but this was not particularly good news to the
shellfish growers. The process stalled somewhat in the spring of 2009. Representative Kevin
Van De Wege then called a meeting in May with shellfish growers which helped to move the
process forward. After a public meeting at Fort Flagler, an agreement was worked out that
limited the number of boats in the inner bay, exempting the local shoreline owners. DNR also
marked undocumented buoys for removal. The outer harbor will be conditionally approved.
Most parties see this as an interim measure.
Mr. Harrington said that this seems to be a good solution, with all parties fairly satisfied. The
possible next steps include decrease of the conditionally approved area, if more buoys can be
moved. DNR and DCD are working on which buoys could be moved more in the vicinity of the
State Park, and in shaping a management plan to ensure that transient boats drop anchor closer to
the State Park. The Jefferson County MRC has a grant for placing marker buoys between the
outer and inner bay to establish a voluntary no anchor zone for eel grass and shellfish protection.
The number of boats has decreased and DOH will continue to monitor there. If a management
plan is approved, the outer bay will likely be approved for shellfish harvesting. He
recommended that, unless there is other extenuating information, there should not be an appeal.
He feels the interested parties (DNR, County, DOH, etc.) will continue to work on the issue.
Member Sullivan inquired about the DOH suggestion of a moratorium on new buoy permits. Mr.
Harrington said that there are only two permits pending, and that DCD may bring that forward.
He said those cases may be placed in the area that will always be conditionally approved.
Shoreline landowners may be able to get permits by signing an affidavit that they will not
discharge from the boat.
Chair Westerman said that, in her reading, all four measures (page 2 of synopsis) must be done.
She asked who will ensure that these steps are done, including the management plan. Mr.
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Harrington noted that DNR had stated that if a community group or entity wished to lease the
entire bed lands of Mystery Bay and run it like a mooring buoy field that would be possible.
State Parks will likely manage the area near the Park. Measure 1, removing unauthorized buoys,
has been undertaken and will likely be followed by another round; measure 2, relocation of
buoys, is in process by DCD and DNR; measure 3, management system, is still under discussion;
measure 4, moratorium, would be done by the County and DNR. Member Sullivan said that it is
likely that all of the above would be shared responsibilities of the County and DNR. He said that
a meeting where all entities could be represented will be scheduled for August or September,
which he will attend. Also, DNR and DOH were interested in the help of volunteers in a
management plan. Member Sullivan said he had referred them to the Marrowstone Island
Community Association for monitoring tasks. He said that will likely be negotiated among the
affected parties.
Chair Westerman stated that this seems like a good solution, but was concerned that there may
not be follow through in the long term. She believes that there must be a single agency taking
responsibility; if no other entity takes the lead, the County will need to do so. Jean Baldwin
noted that the County is in an unusual position since it is a shellfish issue but there is not a water
quality problem. It is a partial closure and DCD does the permitting. She said that a
recommendation from the BOH about how we track the plan to the BOCC may be appropriate.
Member Sullivan suggested that he attend the planned meeting and report back to the BOH.
Member Austin asked how vested buoy rights would be handled; would a declaration of
emergency supersede those rights. It was noted that this has never been a water quality issue, but
that there is a need to see the situation through to resolution and ongoing monitoring. Mr.
Harrington and Member Sullivan said they would continue to work with all the parties.
Members agreed that the process and progress thus far has been very good. Member Sullivan
stated that he would take responsibility for following up on open issues.
Position Papers and Draft Resolution Re: Affordable Health Choices Act
Dr. Locke referred to the significance of health care reform legislation being developed in
Washington D.C. He said that the Public Health community is trying to link needed public
health reforms to health system reform, and that there is legislation pending in this regard. The
national public health organizations, e.g. American Public Health Organization and National
Association of County and City Health Officials, are asking local Boards of Health to weigh in
on these issues. A copy of their resolution, with draft Jefferson County modifications, is
included in the packet. It now appears that action by the House and Senate before the August
recess is not realistic. There are two bills being considered, the Senate Health bill and the House
Health bill, as well as a Senate Finance bill still in development. The process of reconciliation
will be extremely complicated. There is an acknowledgement in all three bills that changes to
the Public Health system are crucially important. In order to provide guaranteed health care to
everyone, it is necessary to do everything possible to prevent illness. In addition, if costs are to
be controlled, there must be attention to evaluating which medical therapies are effective and
which are not.
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In Washington State, there is a meeting being scheduled during the week of August 10 with
legislators during the August recess to discuss health reform. He said our legislators are all
supportive. The purpose of a Jefferson BOH resolution would be to add our voice to all the
others in the country. Jean Baldwin said that the Kennedy bill carries a clear statement about
the need for Public Health funding and infrastructure, and delineates several programs as
essential parts of the health care system. She said that Katherine Sibelius has stated that
discussion of prevention, outcomes and public health funding streams are essential components
of health care reform. She said that if things change quickly, she will notify the BOH via e-mail.
Member Austin suggested that although there is no urgency, it would be well to take action on
the resolution, which requests very basic provisions. Member Austin moved to adopt the
draft resolution and member Russell seconded. Chair Westerman proposed the following
edits:
• First Whereas — change "health system" to "health care system";
stn Whereas — change "see all " to "serve all...";
• Page 2, item 3 — change "health promotion....." to "promotion of good health and
prevention of disease and injury...."
Member Austin accepted the changes as friendly amendments. The draft resolution No.
2009-1 was approved unanimously, as amended. Jean Baldwin said she would also send a
copy with a cover letter to the Hospital Board. Chair Westerman will sign the amended version.
Tribal Mutual Assistance Agreement: Draft Open for Comment
Dr. Locke stated that this document is part of a first ever national pilot project, for three counties
and seven Tribes, developing a Public Health Mutual Assistance Agreement. When finalized, it
will be considered for adoption by County Boards of Commissioners and Tribal Councils.
However, it is first presented to the BOH since it very much affects the mission of the Health
Department, and expands our capability as a local jurisdiction. In practice, it gives the Tribes the
ability to formally seek help in public health emergencies from other tribes and county health
departments. Jean Baldwin noted the level of respect that exists for Dr. Locke and Dr. Lindquist,
who have been working closely with the Tribes. This agreement will allow better clarity and
cooperation than in the past with regard to provision of services.
Member Sullivan inquired whether this may open up other funding sources. Dr. Locke said that
is anticipated, and that services are paid for, not donated. However, the services are given when
needed, with payments reconciled at a later date.
Member Austin suggested that the agreement be shared with the Department of Emergency
Management for their information. Jean Baldwin said that could be done regionally, with a
cover letter.
Dr. Locke said that the language can be modified and any missing elements can be added. He
said that there had been a deliberate attempt to address all issues, including those that are
sensitive or potentially problematic. He noted that the County has no authority within the Tribal
jurisdictions. Member Austin noted that recent Sheriff's Deputy Agreements allow some greater
flexibility and that traditional restrictions may be loosening. Member Russell inquired about
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food service inspections. Dr. Locke said that if requested, that service could be provided. For
example, should there by an outbreak associated with a Casino, the Tribe could ask for
assistance. Jean Baldwin said that Tribal run food businesses are not subject to State inspection,
although many of them have contracted with local Health Departments.
Member Westerman expressed her concern that local Boards of Health are not even mentioned in
the agreement. Dr. Locke said that that issue will likely be dealt with in the next phase. One of
the issues was the fact that there are no comparable agencies (to Boards of Health) within the
Tribal government. He said that they have been encouraging Tribes to create BOHs and Health
Officers, and similar structures. Jean Baldwin added that the Tribes wanted to bind the partners
at the highest level of government possible. Chair Westerman said that she has long worked to
expand the Board beyond politics and political affiliations. She noted the representation from
the City and Hospital, as well as the County. Member Nelson noted that some counties do not
have a separate Board of Health from the Commissioners, and that the BOH members serve at
the pleasure of the BOCC. Chair Westerman recalled that the intention of allowing an expanded
Board of Health eleven years ago was to create a body that was focused on public health issues,
but not politically driven. She said that Jefferson was the first county to do this and it has been
encouraged by the legislature. She noted that both Republican and Democratic Commissioners
with whom she has worked on the BOH have recognized the need for Public Health to be outside
of partisan politics. She said the body needs to be bigger than the three Commissioners.
Dr. Locke and Ms. Baldwin reaffirmed their request that BOH members review the document
and make suggestions. It was agreed that Deputy Attorney Alvarez would also be asked to
review it.
AGENDA PLANNING
An SAAB update from Fran Joswick was tentatively scheduled for the August meeting, at her
option. (This agenda item was deferred from this meeting, July 16, since Ms. Joswick was not
able to stay for the duration.)
The Bylaws, as edited, will be ready for review and approval at the August meeting.
Jean Baldwin added that Member Austin was selected as one of a small group to speak with the
Pew Charitable Trust to discuss Nurse Family Partnership and its importance to the community.
Adiournment
Member Austin moved for adjournment; Member Sullivan seconded. Chair Westerman
adjourned the meeting at 4: 26PM.
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JEFFERSON COUNTY BOARD OF HEALTH
Sheila Westerman, Chair
A 4 1
Chuck Russell, Vice -Chair
Excused
Roberta Wissell, Men
Kristen Nelson, MemvU1.
Page 10 of 10
Excused
Phil Johnson, Member
Jo Austin, Member
I'L4 f
David Sullivan, Member