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HomeMy WebLinkAboutM082009JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, August 20, 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 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 2:33 PM. Members Present: John Austin, Roberta Frissell, Kristen Nelson, Chuck Russell, David Sullivan, Sheila Westerman Members Excused: Phil Johnson RECEIVED Staff Present: Jean Baldwin, Julia Danskin Guests: Frances Joswick, SAAB A quorum was present. JEFFERSON R O u N T Y CDM SI � ERS APPROVAL OF AGENDA Member Austin moved that the Swine Flu update be moved to the first item under Old Business for the convenience of the press; Kristen Nelson seconded. Frances Joswick requested that an SAAB Update be added to the agenda. Member Sullivan moved and Member Austin seconded for approval of the agenda, as amended. The agenda was approved unanimously. APPROVAL OF MINUTES Member Austin moved for approval of the minutes of July 16, 2009; Member Sullivan seconded. The minutes of July 16, 2009 were unanimously approved, as presented. Page 1 of 10 PUBLIC COMMENTS There were no public comments. OLD BUSINESS and INFORMATIONAL ITEMS West Nile Virus Detected in Mason County Crow Jean Baldwin referred to the public health announcement in the packet, which included the August 7 State update on West Nile virus. In addition to one horse with West Nile virus in Island County about 2 years ago, a crow in Mason County has been confirmed with the disease. Ms. Baldwin said that there have been no human cases on the Peninsula. Public education messages have been issued. The educational message to horse owners is to have their horses vaccinated. The County staff continues to culture dead birds and then ship specimens to DOH. She said that DOH has a new GIS based tracking system this year; they make decisions on which birds are to be cultured for West Nile virus depending on where they are found. In response to a question about whether to expect massive bird fatalities, Ms. Baldwin said that the pattern has been different in Washington than in other states. She said that the density of mosquitoes and weather conditions may be factors. Although there are mosquito carriers here and cases have been detected in horses, as well as birds, the disease has not spread to humans. State Board of Health Summary Member Austin referred to the July 8, 2009 approved minutes for the State BOH meeting held in Jefferson County. He pointed out the item regarding the presentation that had been given by Quen Zorrah, Jefferson County Public Health Nurse, and the positive comments about it from Chair Katz. Member Austin reported that Chair Katz, who is retiring, had been recognized for his able leadership and contributions over the years. He also discussed the passage of the School Rules by the State BOH. It is significant that the document includes the proviso that, section by section, the School Rules become effective as the State Legislature approves and funds them. This was based on the bill stating that no rules can be passed by the BOH until they are approved by the State Legislature. Local school boards will be notified as each set of rules goes into effect; particular sections are scheduled to go into effect over the period from 2010 to 2014. He said that the rules are reasonable and allow for discretion of local Health Officers with regard to implementation. These rules provide requirements for a wide range of safety and health related matters, such as mold conditions, water testing frequency and thresholds, requirements for where and how new schools may be constructed, and notification of parents for certain conditions. He said that development of the Rules has Page 2 of 10 been going on for about 8 years. They have been thoroughly reviewed by the State BOH, particularly by the Environmental Health committee of which John Austin is a member. Septic Community Education Update Jean Baldwin briefly reviewed the BOH historical background and explained that the department would be approaching requirements in a different way. She said that the plan is to work collaboratively with other Counties. She asked BOH members to view the websites provided. Staff is meeting with other Puget Sound health departments that are conducting O & M training for home owners: Island, Clallam, Whatcom, Skagit and Snohomish. There is a home owner training CD developed by Island County and available on their web site. JCPH, Environmental Health Department, will begin to make use of this as a basic septic education tool. She mentioned that she has received calls from citizens who attended Septic 101 at the Grange Hall stating that the current class was extremely informative and worthwhile. JCPH will start education within watershed areas such as Snow Creek and shorelines. This will provide education for the highest risk systems (in terms of pollution). Linda Atkins will conduct a series of on-site presentations, in the neighborhood. Baldwin said after several of these have been completed, she will return to the BOH for guidance on how to proceed with O & M. O & M inspections have been added to the data base. She said the department is enforcing the State law but is not actively helping homeowners inspect. She said she hoped this gradual approach would make the transition easier and less contentious. She estimated that BOH discussions about O & M would resume in about six months. Chair Westerman asked about enforcement. Ms. Baldwin said that enforcement of failing systems continues as it always has. Such systems are identified by observation, shoreline surveys and from complaints. When systems are installed, homeowners are informed what processes they must follow, but there is no active enforcement to ensure that systems are regularly inspected and maintained. There was brief further discussion about timing and the benefit of learning from other counties who are in the process of implementing new homeowner O & M procedures. Member Sullivan mentioned that Jefferson County has been requiring inspections at the time of property sales. There was a brief review of the web application that allows access to all records for a parcel, including septic permits. Member Austin asked what the percentage of total County septic systems are entered in the database. Jean Baldwin said she believes this is nearly all the County systems, except for an unknown number of un -permitted systems. Member Austin asked if Jefferson county citizens are welcome to attend Clallam trainings on septic system maintenance. Ms. Baldwin explained that Clallam had received a $350,000 grant from Ecology and presumed this was for Clallam County residents only. Chair Westerman asked for clarification on the use of the Island County CD. She was in favor of making it available immediately. Jean Baldwin said that staff resources are Page 3 of 10 assigned to work on this beginning in October, at which time a detailed plan and press releases etc will be developed. BOH members were in favor of the approach Ms. Baldwin had described. SAAB Update Report Frances Joswick noted that September is Substance Abuse Recovery month. The SAAB Public Relations subcommittee is working with Kelly Matlock to prepare special items for National Alcohol and Drug Recovery Month. (John Austin is a member of the subcommittee.) Conner Daley's term on the Substance Abuse Advisory Board is expiring in September. Ms. Joswick requested BOH approval to invite him to serve for a second term. Member Austin moved that the BOH invite and endorse Mr. Conner Daley to serve a second term. Member Sullivan seconded and the BOH approved the motion unanimously. Ms. Joswick noted the continuing success of the Relapse Prevention Program at the County Jail. She said she has learned of a possible funding source through the State Department of Commerce. Ms. Joswick has conveyed the requested information to Mr. Queen who will attempt to have any unspent funds allocated and to place the program in line for future funds. The SAAB subcommittee on Community Issues will explore the options for a Medications Disposal Program in Jefferson County, and plans to seek participation from local pharmacies. Jean Baldwin supported the idea and noted that there is opportunity for sharing of the costs with Clallam County for secure transportation of the drugs to Eastern Washington. She said that there is additional work and expense for the participating pharmacies, but that Julia Danskin would be available to help plan and implement. There was a brief discussion about the Clallam pharmacy procedures that would likely serve as a model for Jefferson County pharmacies. Pandemic H1N1 Preparedness Update: Jean Baldwin referred to the press release that was sent out August 27, which provides common sense guidelines for businesses, households and the community in assessing readiness and preparing for the H1N1 virus (swine flu). She said that Secretary of Health and Human Services Kathleen Sebelius and former Governor Locke had appeared on several television programs advising businesses to make pandemic plans and preparations. Julia Danskin said she is beginning to do outreach by visiting local businesses, to provide basic information and advice to decrease the spread of disease. Chair Westerman asked if seasonal flu shots are advised for everyone. Jean Baldwin said that is the case. Page 4 of 10 Julia Danskin is working with a group of volunteers to alert and inform businesses and service organizations with heavy people traffic, such as banks, transit, restaurants, grocery stores etc. They will urge people to stay home when they are ill. Fran Joswick added that former Governor Locke urged businesses to not require people to present physician excuse forms when they return to work after illness, as this would overburden the system. According to the CDC, people may return to work or school 24 hours after their fever stops, without the use of anti -fever medications. Guidelines are different for healthcare workers and are expected to change. Currently healthcare workers can return to work 7 days after the onset of symptoms. Other details may be found in the brochure. As the situation evolves, the latest changes and updates will always be available on the JCPH website. There was discussion about evolving recommendations for health care workers and schools. Jean Baldwin summarized by noting that there is an internal plan, and each staff member has assigned responsibilities. The department is participating in regular conference calls with regional partners and State Department of Health. There are evolving plans for schools; it is not recommended that school buildings be closed this year. Ms. Baldwin mentioned a series of meetings that have been held with Jefferson Healthcare and other providers regarding screening and treating sick people and implementation of mass clinics. Dr. Locke and Lisa McKenzie are lead staff in all discussions with local providers. Member Austin asked if Health Department staff would be vaccinated for seasonal flu. Ms. Baldwin said she had ordered 100 doses and is unclear whether there will be adequate supplies for employees. She said that Safeway, Costco, physician offices, and Jefferson Healthcare will all have supplies, and it is likely that the total supply for the community will be adequate. It is hoped that this year's vaccine will be a good match for the seasonal flu, but its effectiveness will not be known in advance. Chair Westerman asked for reasons that people may not wish to be vaccinated for swine flu, and if fears are based on any evidence. Ms. Baldwin said testing is still in process, there is really no definitive information available yet. Member Austin mentioned studies that have shown that certain subcultures of the population are more reluctant to vaccinate than others. There will be a limited supply of vaccine initially, so the vaccine will only be designated for those 24 years and younger. Coordination of messaging about the disease at all levels will continue to be very important. Member Russell asked how any remaining vaccine would be prioritized beyond the first five groups on the list. Ms. Baldwin said that local health officers may have discretion regarding local supplies, but the State Department of Health and CDC will have final say. Page 5 of 10 Jean Baldwin said that meetings with hospital and physician groups have yielded very important information on preferred means of communications and updates, i.e. how to let physicians know of evolving information without overwhelming them. They requested a separate section on the web site for physicians/providers, which would include daily updates and bulletins. The Health Department will continue to fax communications to physician offices, but also add a web enhancement. Green Business Award — Port Townsend Computers Port Townsend Computers has been given the Green Business award. Member Westerman said she was pleased about the addition of this computer business and hopes that this will be posted in the newspaper. Jean Baldwin said that a press release has been sent to local newspapers. She said that the Health Department is updating plans and promoting this program, which is well regarded in the business community. WIC (Women, Infants and Children) Annual Report Julia Danskin reviewed the report, which is published by the State DOH. She noted that WIC vouchers used at local grocery stores and for local farmers amounted to $307,718 and $1,682 respectively. Jefferson WIC continues to serve higher numbers of women, infants and children than the State average. Ms. Danskin expressed her satisfaction and approval of the program. Ms. Danskin said the WIC program is changing on October 1 to support healthier lifestyles. For example, it includes fresh fruits and vegetables and more whole grains, with less juice, cheese and eggs. There is an accompanying educational program about healthier diets. A portion of the program is funded through the General Fund. 2009 Budget Update Jean Baldwin described the purpose and content of the budget documents in the packet. "How is Public Health Different from Health Care", she said that Phillip Morley, County Administrator, had asked her to explain "What is Public Health?", "and "how is it governmental?" She noted that Public Health is primarily monitoring communicable disease. She said perhaps it is a document that should be shared with the City and the Hospital. It is necessary to understand the nature of Public Health before discussing budgets. Veronica Shaw explained the set of color graphs which show all revenue sources for Community Health, Environmental Health, and Department Administration. Within those divisions, the data is broken out by program, analogous to the way Performance Measures are organized. The intention is to show how each program is funded and to provide a sense of scale and relativity for programs versus revenue sources. Ms. Shaw discussed the amount of County dollars to matching grants. Page 6 of 10 Member Austin said that it would be helpful to know the full impact of any proposed cuts in the General Fund for particular programs. Jean Baldwin listed the programs and services that fall under the major headings. Family Support includes MCH (Maternal Child Health), the Child Abuse Prevention Team, WIC, Early Childhood Care. Population and Prevention includes: Tobacco and Substance Abuse Prevention, i.e. population based education which is largely grant funded. Communicable Disease includes communicable disease coordination and tracking, epidemiology, immunizations, and STD/HIV testing counseling. Communicable Disease has more State money in 2009, but that will decrease next year. Board members commended staff on the graphs and requested that the high level headings be explained and expanded in future versions, for the benefit of reviewers. Member Sullivan stated that with regard to the County General Fund budget process, it appears that about $500,000 will need to be cut each year for the next three years in order to balance the overall budget. He said that both mandated (level of service) and un- mandated services will need to be reviewed. There was further discussion about other County programs and services and their relationship to Public Health. Member Nelson asked how the budget process works for Public Health. Chair Westerman said that the BOH reviews and recommends the proposed budget to the BOCC, who has final authority to approve or amend. Member Nelson suggested that, in the spirit of a fair share approach, it would be reasonable to adjust permit fees for various services to cover the costs to the County. Chair Westerman agreed and said that the County has been moving in this direction. However, since fees have previously been held steady for many years, the gap was wide and had to be closed over a period of time, rather than by dramatic increases in one or two years. That goal had almost been attained. Ms. Shaw added that programs that had been sustaining themselves no longer are, because of the economic climate and downturn in permit applications; fee revenues are down almost 50%. The department has already responded to that through various staff reductions. Member Austin asked when parcel fees would be collected; Ms. Shaw stated that would begin in January. However, she explained that Water Quality grants were once required to go through a public health department, i.e. DOE would not contract with Water Quality directly because they didn't recognize them as a County department. Therefore, Public Health was signatory to the contracts and the money came in to the 127 fund, which is Public Health. Public Health was managing the grant funds and reimbursing Water Quality for their services. However, in 2010, DOE will contract directly with Water Quality. There was clarification that the approximately $88,000 from parcel fees will be part of the Water Quality budget, not Public Health. Member Russell questioned why Water Quality reports to the JCPH. Jean Baldwin responded that it is because of the many public health related issues and policies, e.g. shellfish and drinking water. She said there are also non -health related issues, e.g. salmon recovery, stream flow, water quantity, etc. that in a larger county would reside in a separate department. Page 7 of 10 Member Sullivan stated that in the past the City had contributed to some of these programs, and has a choice to do so. More than a third of the services go to the City, which requires that a balance must be worked out among the numerous shared services and costs. Ms. Shaw returned to the earlier discussion regarding departmental responses to the loss of revenues. She said that a RIF (reduction in force) was done in Environmental Health in 2008 due to the situation, and adjustments will continue. For example, multiple departments may share the hours and services of a particular FTE, with budgets reflecting that arrangement. She also confirmed that staffing salary and benefit costs are by far the greatest portion of the budget. In 2009, Public Health was asked to cut $57,200 from the General Fund. This involved further adjustments in staffing; a decision to not fill one vacancy, and voluntary reductions in hours. Jean Baldwin stated that the following reductions have been done: $48,000 in Public Health and $26,000 in Water Quality in 2008; $60,000 in 2009. Return to county general fund of $100,000 in cash carried forward has been requested as of September 2009. Ms. Shaw pointed out the chart showing the FTEs and who is actually working on the Onsite Septic System Program, down from 5.14 to 2.05 in 3 years. One impact is the length of time needed to process a permit application. Within this complex budget structure and process, State money is unpredictable. The DASA (Division of Drug Alcohol) contract was described, as an example. Jean Baldwin stated that she has begun a process of looking at what is funded, what are the highest mandates, and what must be done to change service ratios. In some cases, services will need to be dropped or reduced in some way, as staffing is shifted. Member Russell suggested that volunteers could possibly be utilized for some activities. Ms. Baldwin said that volunteers are used in some programs but noted the need to supervise volunteers; expansion of this practice may require a new coordinator position. Member Austin pointed out the risk and liability if volunteers are not properly trained and supervised. Ms. Baldwin described several other areas where adjustments are being considered, i.e. STD clinic; Aids Case Management; additional voluntary hour reduction; BCHP; Breast and Cervical Cancer Screening, and reduction of appointment and office hours on particular days of the week. Member Austin pointed out Mr. Morley's presentation of the background and rationale for the budget shortfalls. He suggested that perhaps citizens will begin to reconsider the I% growth limit and impacts on services. He noted that other counties are now pursuing levy lid lifts to address revenue shortfalls. Jean Baldwin pointed out the citations from the Royer Report in the packet, which is helpful in presenting the historical context for the present budget situation. Member Sullivan added that there are several lawsuits at the State level regarding the cuts made in the last budget, which may delay implantation of those cuts and/or cause budget Page 8 of 10 adjustments in other programs. The status of citizen initiatives to cap tax revenues was briefly discussed. Member Nelson asked for information on the percentage of the total property tax revenue that is paid by the City of Port Townsend. Jean Baldwin said that she would follow up on that request. Ms. Nelson mentioned new legislation that requires reassessment of properties county -wide annually. Chair Westerman and BOH members indicated their appreciation and support for the work staff is doing on budget trimming and adjustments. Baldwin will continue to decrease staffing hours and try to maintain services. Veronica Shaw introduced Lana McGinn, who has been on staff for about six months and has been assisting with the budget process. Member Sullivan stated that he plans to attend the intergovernmental meeting on Mystery Bay on Friday, August 28. ACTIVITY UPDATE There were no additional updates. BOH Bylaws and Budgeting will be discussed at the September 17 meeting. Jean Baldwin will work with Phillip Morley on public announcements about budget adjustments. Jean Baldwin will present materials on County demographics in October. ADJOURNMENT Member Austin moved for adjournment; Member Frissell seconded. Chair Westerman adjourned the meeting at 4:35 PM. Page 9 of 10 JEFFERSON COUNTY BOARD OF HEALTH Sheila Westerman, Chair / Chuck Russell, Vice -Chair Rob a Fri Kristen Nel Page 10 of 10 Excused Phil Johnson, Member Jth Austin, Member Dav'd Sul ivan, Member