HomeMy WebLinkAboutM101509JEFFERSON COUNTY BOARD OF HEALTH
MINUTES
Thursday, October 15, 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, Kristen Nelson, David
Sullivan, Sheila Westerman
Excused: Chuck Russell
Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin
Guest: Frances Joswick, Substance Abuse Advisory Board (SAAB)
A quorum was present.
APPROVAL OF AGENDA
Frances Joswick requested the addition of SAAB announcements, which was placed
under Old Business. Member Austin moved and Member Sullivan seconded for
approval of the agenda. The agenda was approved unanimously.
APPROVAL OF MINUTES
John Austin moved and David Sullivan seconded for approval of the minutes of
September 17, 2009. The minutes of September 17, 2009 were approved, as
presented.
PUBLIC COMMENTS
Chair Westerman welcomed Mindy Sayer, a nursing graduate student, who was attending
as an observer.
Page 1 of 9
OLD BUSINESS and INFORMATIONAL ITEMS
Discovery Bay Area Beaches Closed to the Recreational Harvest of Shellfish due to
Marine Biotoxins
An October 7 News Release was included in the packet. Dr. Locke said that biotoxin
levels are quite high, about 5-10 times the threshold levels. This time of year is normally
a low point recreational shellfish harvesting, when low tides occur during the night.
Chair Westerman asked for clarification on why commercially harvested shellfish are not
included in this warning. Dr. Locke explained that commercial harvesting has a different
notification process and is actually more closely monitored. The wording of the release
means that shellfish already on the market are safe, since they would have been harvested
prior to this determination and/or from a non -affected area. The Department of Health
notifies the commercial fisheries directly. It was noted that conditions can change very
quickly. Member Sullivan added that organisms in an affected location may survive a
replanting process and will flush themselves out once the toxic conditions have
dissipated.
National Survey of Local Health Departments
Jean Baldwin discussed the results of the 2009 national LHJ (Local Health Jurisdiction)
Survey, as it applies to Washington State. The packet contains an October 5 article about
the study, and bottom line data for budget cuts and staff reductions. She noted that there
have been 333 FTEs cut from the 31 local jurisdictions responding to the survey.
Jean Baldwin said that, with the added workload due to H IN 1 preparation and response,
the Health Department is at capacity and is stretched to its limit. There was discussion
that the public should be made aware of the County's tight resources; the possibility of
disseminating this information to the public was discussed. Member Austin suggested
that an upcoming article by Allison Arthur of the Leader may be an opportunity for
inclusion of this type of information. Dr. Locke said that Ms. Arthur had also contacted
him in regards to H 1N 1 preparations and vaccine exemptions.
Correspondence
Jean Baldwin reviewed a letter to the BOCC from Sally Robins (that had been published
in the Leader) regarding the importance of maintaining the Senior Foot Care program.
Ms. Baldwin explained that this was in response to a rumor that the program may be cut.
She said that the program is relatively inexpensive and provides a great deal of benefit for
what it costs. Nurse Myrtle Corey sees patients on a quarterly basis; the program covers
about 2500 visits per year. About $5,000 of General Fund money supplements fees of
$20 per person. Volunteers provide appointment and billing services at no cost. There
has been a sliding scale for fees, but Julia Danskin said most patients are willing to pay
the full $20. Member Sullivan noted that the program is very worthwhile because it also
affects mobility and has other potential health benefits.
Page 2 of 9
Chair Westerman said that she planned to call Ms. Robbins to enlist her help in ensuring
that seniors who use and appreciate the foot care service understand the implications of
the upcoming referendum on government spending.
SAAB Announcement
Ms. Joswick said that an SAAB sub -committee had been formed to gather and analyze
substance abuse clean up (collateral) costs, as discussed at the previous BOH meeting.
She said that this is a formidable task, but very important in terms of showing the
community the high costs of addiction and hopefully in steering the legislature toward
funding where it does the most good, i.e. not toward clean up but towards more effective
preventive measures. Ms. Joswick said the study will follow the Columbia University
model in pursuing a valid, scientific, well -credentialed study. She said she had visited
four Jefferson County departments thus far. She believes this will lead to better
understanding by administrators of what data is needed.
With regard to the program at the jail, she has been asked to meet with Jenifer Jackson of
the Peninsula Daily News to provide information for a follow up article on the program.
In response to an inquiry from Member Austin, Ms. Joswick said that she has set up an
appointment with an SAAB candidate for the following week.
NEW BUSINESS
Board of Health Bvlaws Revision: Action Item
Chair Westerman noted that the revised bylaws had been distributed more than ten days
earlier, and asked if there were any comments or questions.
Member Austin said he had reviewed the RCW regarding BOH composition, and noted
that the Bylaws appear to be in concert with that.
Member Nelson said she had not been present at the previous meeting and had a few
questions. She asked why the BOCC, and not the BOH, removes BOH members (page 2
— Absences). Chair Westerman explained that since the BOCC appoints, it should also be
within their power to remove members for cause. Ms. Nelson also questioned the use of
the inserted word "regular" (page 4, section 2), which is not defined or referenced
elsewhere. She suggested that the term "regular member" be used/referenced in the
section where members are first mentioned on page 2, or that the term "voting member"
be used on page 4. After a brief discussion, Member Austin moved that the term
"voting member" be substituted for "regular member" on page 4, Section 2.
Member Nelson seconded. The motion was approved unanimously.
Member Nelson also asked, with regard to appointment of Health Officer and/or
Administrator, if the distinction in the Bylaws between "shall" and "may" is based on the
RCW; Chair Westerman confirmed that is the case.
Page 3 of 9
Member Austin moved for adoption of the BOH Bylaws as revised, and Member
Frissell seconded. The revised Bylaws were approved unanimously. Chair
Westerman signed the revised document on behalf of the BOH.
Pre -Adoption Briefing: Draft 2010 Fee Schedule
Jean Baldwin introduced Veronica Shaw and Linda Atkins, who were on hand to explain
the proposed fee schedule provided in the packet. Ms. Shaw explained the proposed fee
schedule format and the meaning of column headings. She noted a correction under On
Site Sewage — Septic Permit with SPAAD (alternative); the fee is $388, not $328.
Jean Baldwin pointed out the addition of a fee to cover costs of an Administrative
Hearing appeal. Chair Westerman inquired as to how the exact fee of $287 was
determined. Ms. Shaw said that that fee was calculated several years ago and has been
adjusted per the CPI (Consumer Price Index) in September of every year, per the RCW.
The adjusted figure is rounded to the nearest dollar. The fees for 2010 will be
recalculated as soon as the updated CPI is available. In order to prepare for publishing
and using the new fees in January, the BOH is briefed in advance. Jean Baldwin noted
that most increases are small, and pointed out the increased fees for boundary line
adjustments to cover the staff costs per lot.
Member Austin inquired about the Installer, Pumper License/renewal fees and the
duration of the original license. Ms. Atkins explained that the initial $387 license fee is
good for one year. The $273 renewal fee covers the costs of reviewing/verifying
continuing education, processing the certificates, and the cost of education, notifications,
and newsletters throughout the year.
Member Nelson inquired whether these fee increases will fully, or only partially, cover
the General Fund shortfalls. Ms. Shaw said that the fee increases will provide about
$18,000 to $20,000, depending on volume of permits, which is not adequate to cover the
deficits. Jean Baldwin added that there will be further discussions in 2010 regarding
other fees related to water quality and green water catchment, etc. and compensating for
services dropped by the State Department of Health. Some services will be local instead
of State -provided. Member Nelson asked if this was the limit of increases that
could/should be made. Ms. Baldwin recalled that a thorough market analysis had been
made last year. This year there is not a major overhaul; it is an adjustment and addition
of those things that had been previously overlooked. In 2010, the food program and
temporary workers will be reviewed in terms of cost recovery.
There was a brief discussion about the upcoming schedule and venue for the public
hearing. It was noted that, historically, there has not been a large turnout for the annual
fee hearing, but that a larger space will be available if needed. The next regularly
scheduled BOH meeting will fall on the Thanksgiving holiday. In order to put new fees
into effect in January, the new schedule must be approved by mid-December. There was
a preference for setting the hearing on December 17, 2009 and for canceling the
November meeting unless pressing new business arises.
Page 4 of 9
Member Austin moved for canceling the November BOH meeting; Member Nelson
seconded. The motion was approved unanimously.
Member Frissell moved that the public hearing on the proposed Environmental
Health fee schedule, based on the CPI update to be released, be set for December 17,
2009. The motion was seconded by Member Sullivan. The motion to set the
Environmental Health fee schedule hearing date for December 17, 2009 was
approved unanimously.
Port Townsend Water Sunaly Undate
Jean Baldwin reported that Lords Lake reserves had fallen from 20 days to 9 days in the
preceding weeks, but had risen again slightly after a period of rain. Photographs in the
packet taken about one week previously show new installations that would allow the City
to pump down to lower levels of the lake. There is increased risk of turbidity which must
be closely monitored, since it can render chlorination to be ineffective.
There was a discussion about the relative volumes of water used by Port Townsend Paper
and the City, as well as the bases for declaring a water emergency. Dr. Locke said that
the situation had been thoroughly explored in 2004, when levels were even worse. At
that time, Health officials had brought the State DOH, the City of Port Townsend and the
paper mill together to working out a response plan. At that time, the mill voluntarily
agreed to alter their production schedules to conserve water. (The mill uses about 10
million gallons per day for full production and at least 1 million per day just to keep
running.) At that time, there was pumping from a barge that, if moved off center, could
result in large amounts of sediment and turbidity. If chlorination becomes ineffective due
to high turbidity, it becomes mandatory to boil water. However, some businesses, such
as restaurants and hospitals cannot use this method — they must close.
Jean Baldwin said that the mill has been slowing their water intake (down to about
2,000,000 gallons per day) but this has not prevented further reduction of the reserves.
She said that the City and State DOH are conferring regularly and there is obvious need
to keep careful watch over the turbidity levels. Member Nelson added that the City has
applied to DFW for permission to draw directly from river waters in an emergency; Ms.
Baldwin said that that may be too lengthy process to help in this situation. She said that
this situation of low reserves is about one month earlier than normal. She said that the
contingency plans may need to be refined to include more incremental actions as water
levels fall. Meanwhile, it is hoped that seasonal rains may resolve the situation, provided
that no heavy rains cause excess turbidity. In response to a question about calling for
citizen conservation of water, Ms. Baldwin said that since the City uses only about one
tenth the amount of water as the mill, the relative impact would be small. However,
BOH members agreed that it would be well to make citizens aware of the situation.
Page 5 of 9
Pandemic H1N1 Preparedness Update: Communitv Vaccination Strategies
Dr. Locke provided an H1N1 update from an epidemiological view. He said that each
year there is a flu outbreak curve that is based on a number of factors. In the Southern
Hemisphere this year, because it was a new virus, there was no vaccine and very low
supplies of anti-viral drugs, H1N1 moved rapidly through the population and the curve
rose and fell rapidly.
There is reason to believe the curve for North America will be quite different. In the
USA, including Washington State, there is widespread influenza activity, which is very
unusual for this time of year. Virtually all confirmed cases of influenza are being caused
by HIN1, but we are not seeing large numbers of people experiencing illness at one time.
This is the second wave of the pandemic. Those areas that were exposed earlier, in the
spring, are seeing lower levels now. Population immunity that has already developed
slows down the outbreak and "flattens the curve". In addition, since April health
authorities have been working with hospitals, schools and businesses to promote infection
control: staying home when sick, washing hands frequently, wearing masks, covering
coughs, etc. The third factor is the availability of the vaccine -- available supplies have
been inadequate to affect transmission of the virus, but may help in reducing the
incidence of disease in those at greatest risk for complication. There are confirmed cases
of H IN 1 flu all over the State, including Port Townsend. There are hospitalizations of
children and adults, some schools are above the 10% absentee rate and the upswing of the
epidemic has begun.
The first shipment of vaccine for Jefferson County (300 doses of nasal vaccine), which is
appropriate for healthy individuals from age 2 through 49, was received during the week
of October 5. This was administered to health care workers and emergency medical
personnel. The second shipment contains a small amount of the injectable vaccine. Dr.
Locke said that, hopefully, with the second and third shipments, all healthcare and
emergency personnel will be covered, and vaccination of parents of infants, pregnant
women, and young children will be the next focus of vaccination efforts.
Ms. Baldwin stated that coordination, prioritization and Federal reporting on the available
vaccines presents a tremendous challenge, and staff is attempting to optimize the use of
available vaccines. Dr. Locke described weekly meetings in October where planning is
taking place to allocate and reallocate vaccines to the five priority groups. He said he
expects that sufficient vaccine will not be available until the end of October or later to
vaccinate all five priority groups. There is also a special problem for pregnant women,
who may only take the injectable form of the vaccine. A legislative ban prohibits use of
preservative containing vaccine for pregnant women and children under the age of 3.
The Secretary of Health has suspended that ban for H1N1 vaccine, and the vaccine may
be given under the condition that the patient is informed that the vaccine exceeds the
threshold of mercury content that the legislature had determined to be safe. There was a
brief discussion about the continuing opposition to this type of vaccine, based on the fact
that it contains mercury. Member Austin mentioned that representatives of anti -
vaccination lobby groups had testified before the State Board of Health the previous day.
Dr. Locke said that the confirmed death toll from H1N1 as of the previous week was 775;
of those, 6% were pregnant women. This issue will delay the vaccination of pregnant
women by 2 or 3 weeks. His recommendation to providers is to offer the Thimerosal -
Page 6 of 9
containing vaccine to pregnant women as soon as it is available. If they refuse it, they
should be vaccinated with the preservative -free vaccine as soon as it is available.
Ms. Baldwin noted that logistically the administration of the vaccine is a rationing
system. Each week there must be a quick assessment, ordering process and then very
rapid administration of what is actually received to the highest priority groups. Dr. Locke
noted that information changes rapidly; it must be distilled and communicated to health
care providers as quickly and efficiently as possible. Ms. Baldwin noted that medical
practices must be reminded to treat this situation from a public health perspective, rather
than their normal doctor -patient view, in terms of prioritization and doing what is best for
the community.
Dr. Locke sees three waves of vaccinations. First, there are those at high risk, who are in
the priority groups, and who are ready to be vaccinated as soon as they possibly can; they
are now being given the vaccine as soon as it arrives. Second, there are those who are
candidates but can wait until it is convenient for them to be vaccinated; these will be done
via mass vaccination events, possibly at special clinics or at the schools. The third group
are those who initially may not want the vaccine but who change their minds; these will
likely be done in November or later. He said that, by that point, we will have gone from
shortage to surplus of vaccine.
Member Austin asked if Dr. Locke would be doing an interview on local television. Dr.
Locke said that he had taped a session with Jim Fritz during the third week in September.
In response to a question, Jean Baldwin said that the mass clinics would be publicized via
websites, the newspapers, local television, and other venues/lists that are available, such
as school lists, etc. Member Austin said that Katherine Baril has a local version of
Facebook that could be used.
In response to a question, Dr. Locke said that in Washington, with one exception, for the
past ten years seasonal flu has peaked in late January to March. In the Southern
Hemisphere, the H1N1 occurrence seems to have displaced the regular flu in most
countries. In the Northern Hemisphere, the planning assumptions about a one month
peak have not borne out, and it is expected that H1N1 levels will rise significantly higher
than they are now. If the efforts at prevention are successful, the curve will be flattened
out, which reduces the burden on the health care system.
It was noted that there has been a local shortage of seasonal flu vaccine, although
Safeway and some other pharmacies have adequate supplies. Ms. Baldwin offered
seasonal flu shots to those present who had not yet received them.
Dr. Locke said that, although many people are ill now, based on the most recent rapid test
samples (30 individuals) about 80% of those with flu-like symptoms do not have
influenza. He also noted that this has been a fairly mild pandemic. Most people who are
ill have symptoms for a few days and return to normal. However, there are some high
risk people who become very seriously ill and can die from the flu.
Page 7 of 9
Green Business Award: Printery Communications, Inc.
A copy of a staff letter to the BOH and the Green Business Award for Printery
Communications, Inc. was included in the packet. Chair Westerman signed the award on
behalf of the BOH.
Jean Baldwin noted that she would be presenting an update on the Green Business
program in December. There are changes in the processes for Green Business and
EnviroStars. The department is doing greater outreach and education. It is also exploring
improvements in its procurement planning and in ensuring its own "green" practices.
ACTIVITY UPDATE
Jean Baldwin noted that this year the Washington Association of Public Health Officials
Commitment to Excellence Award for Outstanding Achievement to Public Health was
given to every public health department's staff. She said she was pleased to see staff
recognized in this way by the larger public health community.
AGENDA PLANNING
Jean Baldwin said that school-based clinic data is available and will be available on the
website. This item will be on the agenda for December.
Chair Westerman stated that she would not be present at the next meeting. She asked that
staff notify Vice Chair Russell so that he could be prepared to chair that meeting.
There will be an H1N1 Update in December.
As mentioned earlier in the meeting, the Environmental Health fee schedule hearing will
be scheduled for December 17.
ADJOURNMENT
Chair Westerman adjourned the meeting at 4:04 PM.
Page 8 of 9
JEFFERSON COUNTY BOARD OF HEALTH
Excused
Sheila West , Chair
xc se
Chuck Russell, Vice -Chair
Roberta F issell, Member
Kristen Nelson, Member
Page 9 of 9
qPhilhns n, Member
�'..
J Austin, Member