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HomeMy WebLinkAboutM091709JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, September 17, 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 2:30 PM. Members Present: John Austin, Roberta Frissell, Phil Johnson, Chuck Russell, David Sullivan, Sheila Westerman Excused: Kristen Nelson Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin Guest: Frances Joswick, SAAB A quorum was present. APPROVAL OF AGENDA Frances Joswick requested the addition of SAAB announcements which was placed under New Business Item 3. Member Austin moved and Member Sullivan seconded for approval of the agenda. The agenda was approved unanimously. APPROVAL OF MINUTES John Austin moved and Roberta Frissell seconded for approval of the minutes of August 20, 2009. Phil Johnson abstained, due to absence from the August meeting. The minutes of August 20, 2009 were approved, as presented. PUBLIC COMMENTS There were no public comments. Page 1 Of 11 OLD BUSINESS and INFORMATIONAL ITEMS West Nile Virus Update A September 11, WA DOH News Release was included in the packet. Dr. Locke said that this is the time of year when the vector mosquito, Northern House Mosquito, shifts from feeding on birds to feeding on humans. Most cases of West Nile Virus (WNV) in Washington occur in September and October, before the onset of cold weather and mosquito die offs. Dr. Locke noted that WNV-positive mosquito pools were detected earlier this year in Eastern Washington; now there is a cluster of human cases there, none of them severe. The public education message has been out for years; focus is now on surveillance. He said the one Mason County crow with the disease seems to be an aberration. Dr. Locke mentioned that he had just been notified of a 100 sea bird die off at LaPush. West Nile virus was ruled out; hypothermia associated with a naturally occurring marine algae bloom is believed to be the cause. Correspondence from Senator Murray A letter of response to the BOH letter regarding health care reform was received from Senator Murray; a copy is included in the packet. Substance Abuse Advisory Board (SAAB) Update Frances Joswick reported that Robert Archibald has resigned his SAAB position due to relocation. She said Mr. Archibald will be missed. She also reported that Julia Danskin and Jean Baldwin have been successful in their efforts to secure funds to support the educational aspect of the jail program. The funding will be in effect from January through December 2010. Efforts will continue to seek additional funding for the program. In recognition of September being designated as Alcohol and Drug Recovery Month, the Leader is doing a feature article. Ms. Joswick said two of the most important issues are the Relapse Prevention Program at the jail and determining the real cost of addiction. She cited the study from Columbia University which indicates that 96% of every State and Federal dollar is for "clean up costs"; only 4% is for treatment, and a miniscule amount is for research and prevention. The purpose is to develop new thinking that will lead to more effective legislation and budget priorities for prevention and treatment rather than clean up. Clean up costs include incarceration and legal costs, costs of lost jobs, etc. She said the intention is to apply the Columbia model to Jefferson County, using actual dollars spent on various programs as related to addiction. Ms. Joswick said she expects to have figures to share by the end of the year. Jean Baldwin said that Ms. Joswick was referring to the OFM (Office of Financial Management) meth treatment money that can be allocated for the jail. The 1/10th of one Page 2 of 11 percent tax funds are already paying for the jail nurse; her time is augmented from Safe Harbor OFM dollars. Ms. Joswick commended Ford Kessler for allocating education staff for this program for 15 months. At the end of September 2009, the demonstration phase will be completed, and will show success. NEW BUSINESS Board of Health Bylaws Revision Chair Westerman questioned the phrasing of the second bullet under Representation on page 2. She said that in her understanding, the City Council and Hospital District may appoint their representatives, who may be City or County residents. She said the requirements for two City and two County appointees do not apply to these particular seats. She suggested a wording change (after " ....at large community representatives."): "One of the at -large representatives shall be a resident of the City of Port Townsend and one shall be a resident of unincorporated Jefferson County." There was a discussion about the phrase "Four members of the Board of Health shall be appointed by the County Commissioners." Dr. Locke pointed out that the Ordinance specifies this appointment requirement, but not the appointment process. The authority to appoint cannot be delegated, for example, to the City Council or the Hospital Commissioners. The text of the Bylaws was left unchanged regarding this point. Under Vacancies, Member Sullivan noted that 30 days may be too short a period for advertising and determining a nominee. Dr. Locke suggested the following language: "....thirty days or as soon as practical", which was accepted by the Board. Dr. Locke pointed out the new phrasing in Ethics, Section 3 under Article IX. He explained that the important thing is to bring out any real or perceived conflict of interest for discussion. Either the Board or the Member may determine that the conflict of interest is significant. Member Sullivan added that if refraining from participation would affect the quorum, it is necessary to weigh that factor in, as well. Dr. Locke also pointed out the appeal hearing process (Section 6) may vary, depending on the specific public health code that governs the matter. Jean Baldwin noted that Section 5 appears to be under Section 4, Public Testimony, and asked if that should be a separate section. Dr. Locke said that Section 5. should be a section under Article IX and include the title, Public Hearings. Ms. Joswick noted the absence of explicit mention regarding special attendance by non- voting members, such as representatives of the SAAB. Chair Westerman noted that in the past both the Public Utility District member and the SAAB member have attended regularly, which simply involved agreement by the majority of the Board. There was a brief discussion about voting/non-voting and ex officio membership. Ex officio means that if your membership on a board is a condition of holding an office, you are automatically Page 3 of 11 appointed; that is, your membership is derived from your office. Ex officio members may be voting or non-voting. Chair Westerman said she was in favor of allowing non-voting members of other community organizations as members, if they are approved by majority vote. She suggested adding a statement that is flexible enough to cover other organizations. Member Austin wondered if there would be any advantage to adding non-voting members to the Board, and whether such an amendment would necessitate amending other areas of the bylaws for clarity. For example, where the bylaws refer simply to board members, they would need to be made more specific, i.e. voting members or ex officio members, etc. Chair Westerman said that changing all instances of "member" to "voting member" where appropriate would be a straight forward change. She said that the de facto practice has always been to have a quorum of the voting members and that should be explicitly stated. If the board expands by one or more (non-voting) members, it will be clear that the quorum is not affected. Member Austin noted that Article X would be changed to read "... two-thirds (2/3) vote of total voting members ... ". In addition, there was a change to Section 2. Voting: "Each regular member of the board shall be entitled to one vote." There was a discussion about absences under Article III. Ms. Baldwin asked if staff should notify the Board of County Commissioners (BOCC) if/when 3 unexcused absences occur. Chair Westerman said she believed the BOCC should be notified, with the understanding that they will determine whether or not a member is removed or other action is taken. She noted that absences are considered unexcused when the Chair is not notified and given a reason for an absence. The minutes will show clearly whether absences are excused or unexcused. Dr. Locke suggested the following language regarding non-voting members: "The Board, by majority vote, may appoint non-voting members to the Board for a defined term." The Board agreed that staff would provide a final draft to be reviewed and approved at the next meeting. The revisions will be mailed out at least 10 days in advance of that meeting. There was also an agreement that each member will be responsible for keeping his/her own copy of the BOH board member notebook up to date. Dr. Locke noted that the number of board members needed to vote in favor of a bylaws change (2/3 of the Board) is 5. Page 4 of 11 Nurse Family Partnership (NFP): State Board of Health Correspondence and Local Funding Options Jean Baldwin said she wishes to ask the BOCC to enact an Ordinance, allowing certain funding to be applied to the NFP program, and would like to walk through the matter with the BOH. She referred to the set of packet materials and reviewed the history of the issue. The BOCC, per Senate Bill 5763, had raised the sales tax 1/10`h of 1% in July 2006 for chemical dependency and mental health treatment. The local ordinance provides for an Oversight Committee to manage that money (about $385-400,000 per year), with representation from the Law and Justice Council, Substance Abuse, one County Commissioner and the BOH. She said that Jefferson County is different from other counties in that it does not have a Humans Services Department, so this committee advises on the allocations for this pool of money. As an early adopter, the County received $200,000 for meth treatment with another $100,000 to come. The BOCC priorities were treatment for individuals and children for mental health and chemical dependency. She reviewed the list of purposes for which the funds can be used. She noted that adoption was slow in order to verify the amount of funding and the actual local needs. The intent of the original law is not to supplant, and to ensure it is the last source of revenue. Each vendor must have a contract which is monitored by the Department of Health. This year the legislature passed Senate Bill 5433, which allows counties to supplant 50% of the funds raised in 2010 for existing programs that are no longer funded. Ms. Baldwin referred to the interpretation from David Alvarez in the packet. That is, 50% of the money raised may be used for supplanting in 2010, and reduced by 10% each year until 2014, when only 10% may be used for supplanting. She also referred to "Program Design & Evaluation" and "Program Elements", provided in the packet to review what is being done with the money currently. According to this document, application of these funds could also be for "Ongoing home visits to families by Infant Mental Health and Public Health Nurses for young families and Nurse Family Partnership visitation". She said she would like to ask the BOCC for a levy lift and apply for $35-40,000 for the program that had been cut, to supplant out of the carry over fund, which now has about $150,000. She explained that the BOCC would need to adopt an Ordinance to take advantage of Bill 5433. Chair Westerman said it has been of concern to her to ensure that the 1/10`h of 1% tax revenue only be used for mental health and chemical dependency, as was the original intent of this expanded taxing authority. She said she would support expanding the use of the money provided it addresses those original intentions. She added that the Oversight Committee would not support using it for purposes such as the Parks, since that is clearly not what was intended by the Bill or the voters. She said Nurse Family Partnership is clearly an appropriate purpose, and that she does not believe this constitutes a significant expansion of the program. Several members stated that the Bill does not actually allow Page 5 of 11 supplanting for other than mental health/substance abuse programs. Member Sullivan said he had testified for WASAC on this subject and that Nurse Family Partnership does qualify. He said that the committee must assess and recommend the wisest way to spend the funds that will benefit the whole community and what should be left as a balance. Ms. Baldwin said she had asked Quen Zorrah to attend this meeting to talk about the Nurse Family Partnership (NFP) program and its relationship to mental health/chemical dependency. Ms. Zorrah noted that the national NFP program had been in existence for 25 years, and Jefferson County's program is 10 years old. She said that developments nation-wide are reflected in the report to the BOH in the packet. Ms. Zorrah highlighted significant items in the report. She reviewed the findings of the Washington State Institute for Public Policy and other research groups, which show that NFP ranks very high in savings for every dollar invested in the program. She said it is clear from local and national data that NFP is having significant positive effects on the community. She reviewed statistics indicating the effectiveness of the program. She summarized the current budget and the 33% decrease in DSHS funding as of 07/01/09. In response to a question, Ms. Zorrah and Ms. Baldwin confirmed that NFP works closely with Child Protective Services. Ms. Zorrah briefly discussed a new assessment process for families that is being done for all families of pregnant women and those that have office or home visits. It has not yet been expanded to the WIC program. This is a fairly lengthy process, but provides a much more comprehensive mental health screening. Eventually, this will provide much more data that will be included in the NFP analysis. Member Austin inquired whether there has been any reduction in Fetal Alcohol Syndrome (FAS) through this program. Ms. Zorrah said that FAS diagnosis is difficult and that there is a long waiting list for evaluations at UW. Member Frissell stated that Ms. Zorrah had done an excellent presentation to the State Board of Health, and said she wished to recognize her for that and her continuing efforts in the NFP program. There was a brief discussion about the funding for the NFP program and Ms. Baldwin's proposal to the BOCC. Member Sullivan said that the recommendation would be considered at the October 6 meeting of the Oversight Committee. Member Austin moved that the BOH support and encourage the Health Department to secure funds from the 1/101h of 1 percent tax revenue pool for NFP; Member Sullivan seconded. The motion was approved unanimously. Fran Joswick said that she would carry this information to the SAAB. Page 6 of 11 Pandemic H1N1 Preparedness Update Member Russell noted that Dr. Locke had made an outstanding presentation on H1N1 to Hospital staff; a second presentation is planned. Dr. Locke stated that a small subset of the available material on HIN1 had been included in the packet. He noted that there is an increasing volume of information coming out and that it has been changing rapidly. For example, a recent study published in the New England Journal of Medicine stated that one dose of the vaccine would suffice, rather than two, which had been the working assumption. Member Austin noted the inevitable rumors that arise, as well, and suggested that perhaps the Leader could publish a rumor suppression box weekly. Dr. Locke reported that communication efforts had been focused on the schools during the summer, and were now aimed at the general public. With physicians and other health care providers, the information is very specific and technical. He said that there are many speaking invitations and that he would be doing a piece for PTTV the following week. Dr. Locke said he had given a technical presentation for hospital staff in Port Angeles, reviewing what had been learned about H1N1 from the first wave in the US. He said that the virus never actually left Washington State. The news from the Southern Hemisphere is mostly good news, and the virus has apparently not mutated thus far. He explained the two types of mutation, drift and shift. Drift involves very subtle changes and requires changes to the flu vaccine to accommodate those changes. Shift is a big change of some kind. He said that so far H1N1 is not even drifting; the genetic sequence is unchanged from when first observed. That means that the severity of cases this fall will likely be the same as those in this past spring. In addition, the vaccine that was based on the earlier outbreak strain should be highly effective for what comes back. It appears that this outbreak may behave much like seasonal flu. He said that pandemics can have a very long peak (2 to 3 months), but that did not happen in the Southern Hemisphere. He added that treatment, infection control, and prevention efforts would be expected to modify that sustained peak to some degree. In the countries of New Zealand, Australia, South Africa, and Argentina, their epidemic peak was virtually identical to that of seasonal flu, i.e. two -three weeks; this is good news in terms of anticipated stress on the health care system. However, of those who do become ill, some people become extremely ill. About 15% of those hospitalized require ICU care. He mentioned that ARDS (Acute Respiratory Distress Syndrome) can be life threatening and patients are usually placed on a respirator. The impact is chiefly on those 50 years old and younger. The danger is greatest for those with risk factors for complication, particularly chronic lung disease and asthma, cardiovascular disease, and diabetes. The risk for pregnant women is extreme; hospitalization rates for this group are 4 times higher than for non -pregnant women. The number one goal is to get as many pregnant women vaccinated as possible; this also helps Page 7 of 11 to address the number 2 priority, parents/caretakers of young children. It helps to protect the families with young children and provides some protection for the infant during the first six months of life when vaccination is not effective. Dr. Locke said that those infants under 6 months are the highest risk group; vaccinating the mother before the infant is born is the best option. Jean Baldwin noted that because of the complications of reaching all of that population, staff is meeting with various groups of hospital staff weekly. There is a Flu Response team within the hospital and she reported a high level of collaboration between the Health Department and Jefferson Health Care in planning for outreach, administering vaccinations and treatment. The first H1N1 vaccine shipment is expected in early October. In response to a question, Dr. Locke confirmed that it is possible to get both shots at the same time. He said there are some issues with the spacing of live virus vaccines in that the first dose may induce an immune response that stops subsequent live viruses from replicating. Therefore, live viruses flu vaccines should be given at least one month apart. A live virus vaccine can be used at the same time as an inactivated virus vaccine and two inactivated flu virus vaccines can be given at the same time. Dr. Locke stated that the live virus, which is relatively new, has not been a popular vaccine, but may be better for children. It does not require an injection and induces immunity at the mucous membrane level as well as the blood stream. The Health Department will be receiving this type of vaccine as part of the federally funded allocation. Dr. Locke briefly described the licensing issues that determine which populations get what vaccines. Seasonal live virus flu vaccine is for healthy individuals those who are two years to 49 years of age and not pregnant; it has not been tested for ages groups beyond 50 years of age. The injectable, inactivated virus vaccines are licensed for ages 6 months and older. Ms. Joswick asked why pharmacies have supplies of seasonal flu vaccine available before the Health Department. Ms. Baldwin said that the federal supplies were delayed and clinics will be scheduled as soon as possible. Dr. Locke explained that this is a private marketing system, with certain commercial bulk orders having highest priority. He said in his understanding about 100 million doses of seasonal flu vaccine have been produced, which is the usual volume for the annual flu season. About 300 million doses of H1N1 vaccine have been ordered for the United States, which would be enough for all who want a vaccination, but not all at the same time. What could compromise the seasonal flu vaccine production is if fertilized eggs are diverted for production of H IN 1 vaccine. Ms. Baldwin noted that it is not possible to predict if the shipments will arrive all at once or if there will be multiple smaller shipments over time. The Health Department is developing alternative plans, based on priority groups, so they can handle the logistics in any case. Member Austin inquired about outreach to the schools and if the school-based clinics would be involved in administering shots. Ms. Baldwin and Dr. Locke said that children Page 8 of 11 are a priority group. Older children would be vaccinated in school. However, children under 5th grade are not vaccinated without parents being present. Member Austin asked if women would be advised to avoid pregnancy because of the risk. Dr. Locke said he is not aware of that being done; rather, the focus will be on vaccination or early treatment with anti-viral medications if they do contract H IN 1. Member Austin also asked what the Hospital's capacity is to deal with ARDS. The Hospital has 8 ventilators. However, Dr. Locke explained that type of ventilators used to treat conditions like ARDS, are in very short supply. Jefferson Healthcare has only 2 or 3 of this type. Ms. Baldwin mentioned the Emergency Plans for the Hospital, for Public Health and for national disasters. She said that most of the local emergency medical services (EMS) are very good and that there has been collaboration with Kitsap and Clallam EMS. The Hospital Plan includes Jefferson, Olympic Medical Center, Harrison Hospital and the U.S. Navy. She said that while meeting the need for ventilators in an extreme situation may not be possible, that discussion continues. Dr. Locke said that while systems/inventories may have been stressed, hospitals in the Southern Hemisphere were able to cope with the demand. He said that a category 4 or 5 pandemic would be a serious challenge and may require activation of altered standards of care. One big difference between the Southern Hemisphere experience and the current US situation is the availability of vaccine here. However, the biggest challenge is preventing outbreaks in the schools in advance of the vaccine availability. At least 3600 doses should be delivered for Jefferson County by mid-October, and about 1600 every week thereafter. He said this is about as fast as the vaccine can be administered, due to the workload. There was a brief review of the precautions and practices that businesses and individuals are encouraged to put in place: frequent hand washing; personal hand cleaners/wipes; wiping down surfaces; use of masks; staying home when sick, etc. In response to a question about vaccine safety and possible side effects, Dr. Locke said that although studies of the new H1N1 vaccine have included thousands, not millions, of people, there is every reason to believe that the risk profile is identical to seasonal flu vaccine. It is made in the exact same way in terms of technology, method, purification, etc. He said HIN1 is not very different structurally from seasonal flu and it would be very surprising if the side effects were any different. He said that all vaccines have the rare potential for causing exaggerated immune activity, where the immune system does not turn itself off as it should. However, that process occurs much more strongly with natural infection. He said that in only about 1 case in 1,000,000 of the autoimmune neurologic disease, Guillaine-Barre Syndrome, occurs with vaccines, while about 20-30 per million cases occur in the population, presumably due to natural infections. In response to a question, Dr. Locke said that it takes about one to two weeks to develop immunity to H1N1, which is the same as for seasonal flu. This is preliminary information. Page 9 of 11 Member Johnson mentioned that he had recently travelled to London, expecting to encounter signs of the pandemic but had seen nothing, and noted that there seemed to be no fear or concern. Chair Westerman described her experience of spending several days with thousands of college students, and becoming extremely ill and feverish with the flu when she returned home. The symptoms, although intense, lasted only 24 hours. Dr. Locke said that 25% of people who have seasonal flu do not become sick enough to realize they have it, but may still be spreading the virus. This may also be the case with H1N1. BOH and Hospital Board of Commissioners Collaboration Dr. Locke said he had met with Hospital CEO, Vic Dirksen, who explained the new governance policy of the hospital. Essentially, the Hospital Commissioners adopt policy and the CEO is responsible for interpretation and implementation. This model provides more independence for both the Board and for Hospital CEO to act within these guidelines. With regard to the BOH and Hospital Board collaboration, Dr. Locke said he had been considering a revival of the joint Board process. The Hospital's new governance model encourages direct Board to Board interaction. Instead of communicating through the Hospital CEO, the BOH's Hospital Board member would serve as the main conduit. He said that this type of governance structure encourages direct interactions with the Hospital Board of Commissioners, rather than going through hospital management. Member Russell added that his title is no longer Hospital Board Chair; he is now Chief Governance Officer. The Board sets broad policies and goals for what should be accomplished. Instead of specifying how this is accomplished, they indicate what the CEO cannot do, and establish definite reporting requirements. He said the Board is pleased with this approach and finds it more efficient. Board members cannot be experts on every subject and cannot be involved in a myriad of details and committees. A major intention is finding the best ways of supporting the CEO in meeting overall goals. Dr. Locke noted that much of the collaboration between the two boards has been concerned with health care access issues, which is now in a volatile state. He said he believes that when congress does act with regard to health care reform, the community will need to develop its own plan for transitioning from the current situation to the new system, whatever it is. He said that there are many likely topics for consideration by the two boards. Ms. Baldwin added that she has compiled a set of demographic/health indicators, as well as other data, which she feels would be of interest to both the BOH and the Hospital Board. Page 10 of 11 Member Austin suggested an annual meeting. Chair Westerman recalled that for a time in the past, the two boards met monthly, considered major strategies and, at that stage, brought in experts on a variety of topics. She said that ultimately they realized that they were constrained by the overall context in which small town small county health care must operate. She said she would be willing to resume ongoing meetings provided there is a clear purpose and agenda. She said she is interested in hearing about the new governance model. Green Business Award — Computer.Fix Chair Westerman signed the letter of recognition for this latest Green Business. AGENDA PLANNING The next Board of Health meeting is scheduled for October 15, 2009. The agenda will include a vote on Bylaws revisions; members are welcome to suggest other agenda items. Member Russell requested that he be excused from the October meeting due to another commitment. ADJOURNMENT Chair Westerman adjourned the meeting at 4:31 PM. JEFFERSON COUNTY BOARD OF HEALTH Sheila Werm , Chai ,gq ,,a Chuck Russell, Vice -Chair Roberta Frissell, Member Excused Kristen Nelson, Member Page 11 of 11 PNJoson, Member Jo Austin ,ember f a David Sullivan, Member