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HomeMy WebLinkAboutM121709JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, December 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) Vice Chair Chuck Russell 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, Chuck Russell, and David Sullivan Excused: Sheila Westerman, Chair Non-voting Member: Frances Joswick, Substance Abuse Advisory Board (SAAB) Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin, Veronica Shaw A quorum was present. APPROVAL OF AGENDA Frances Joswick requested the addition of one item, approval of SAAB Mission Statement, which was placed under New Business item 7. David Sullivan requested discussion about City funding from the Liquor Excise Tax, which as placed under 2010 Budgets: Public Health Impacts. Member Frissell moved and Member Austin seconded for approval of the agenda. The agenda was unanimously approved, as amended. APPROVAL OF MINUTES Member Johnson moved and Member Nelson seconded for approval of the minutes of October 15, 2009. The minutes of October 15, 2009 were approved, as presented. PUBLIC COMMENTS There were no public comments and no members of the public present. Page i of 11 OLD BUSINESS and INFORMATIONAL ITEMS An Epidemic of Fear: One Man's Battle against the Anti -Vaccination Movement Dr. Locke referred to the cover article by Amy Wallace from Wired Magazine, November 2009, included in the packet. This article has received national attention. He discussed the anti -vaccination movement and the issues of misinformation and rising exemption rates. He said that he has been informed that the Washington State legislature will address these issues in 2010 by tightening requirements for ensuring that those seeking vaccine exemptions have been counseled by a licensed healthcare provider on the benefits and risks of vaccinations. Member Austin requested the web site address or electronic copy. Board of Health Correspondence Julia Danskin briefly discussed the letter signed by Chair Westerman thanking the Main Street Program for the $3,010 raised for health screenings during Girls' Night Out. Letter to Governor Gregoire re: Maternity Support Services Jean Baldwin discussed the December 1 letter from Nurse -Family Partnership to Governor Gregoire expressing concern about potential budget cuts and urging protection of those funds. NEW BUSNESS Public Hearing: Proposed 2010 Environmental Health Fee Schedule Chair Russell opened the public hearing on the proposed 2010 Environmental Health Fee Schedule at 2:40 PM. Seeing no members of the public in attendance, Chair Russell closed the Public Testimony portion of the hearing. There were no written comments or questions submitted. Veronica Shaw referred to the revised Fee Schedule in the packet, where changes had been shown in blue. She noted that the Consumer Price Index (CPI) had decreased in 2009. The applicable Ordinance states that if the CPI falls, the Health Department is permitted to retain the same fees from the previous year, rather than adjust them downward. Her recommendation was to retain the same fees. Member Nelson requested clarification on the "Temporary Permit — Multiple Events" and "Temporary Permit — Single Day Event" items. Veronica Shaw confirmed that a Single Day Event is for one event, but which may last for several days. A Multiple Events permit applies to recurring events. After a brief discussion, Jean Baldwin mentioned that Page 2 of 11 certain changes to food establishment inspections and other processes/fees would come before the BOH in March. She mentioned that restaurants will be required to have an emergency water plan for situations such as the recent water main break. Ms. Baldwin also noted that the inspection reports for local food establishments are posted on the web within one week of the inspection. Dr. Locke said that federal, state and local food safety codes are interlinked. Food codes focus on the commercial sales of potentially hazardous foods, i.e. food that can promote the growth of dangerous infections. Pre-packaged, dry foods such as snacks and baked goods are generally exempt from these regulations. Dr. Locke said the fee structure is designed to recover costs of staff time and the cost of inspection/administration — a multiple event permit requires less staff time than a comparable number of single event permits (each requiring a separate inspection) and can thus be provided for a lower fee. Member Austin moved for approval of the proposed 2010 Environmental Health Fee Schedule, as amended to clarify single event temporary permits. Member Johnson seconded. The motion was unanimously approved. School-based Clinic End of Year Report Jean Baldwin referred to the 2009 Report on School Based Health Centers, and a copy of an article that had appeared in the Jefferson Health Care Newsletter on the program. She pointed out that the data in the report is preliminary since the program only started in February 2009 and analysis of data is ongoing. The rise in visits was discussed. Ms. Baldwin noted that Chimacum has more uninsured children. The impacts of recent reductions in the State's Basic Health insurance program are not yet clear. Ms. Baldwin noted that the use is highest by tenth and eleventh graders. She said that for many health indicators, Chimacum and Port Townsend Districts are quite similar but the percentage of uninsured students is significantly higher for Chimacum. A high percentage of students do not have a "dental home". There was a brief discussion about the screening questions. Ms. Baldwin said that the phrasing and terminology have been designed to employ the concepts of medical home, dental home and mental health home in order to reduce any stigma associated with mental health care. She pointed out that mental health issues are the reason for a high number of visits in both school districts. In response to a question about the high percentage of pregnancy/sexually transmitted infection health education visits, Ms. Baldwin pointed out that although they have attended classes on these topics, the clinic provides a safe and private opportunity for students to ask and discuss personal questions. Ms. Baldwin stepped through the categories of data. She noted that the alcohol, marijuana and tobacco substance use data is quite low and not consistent with other Page 3 of 11 confidential screenings. She said that the department will continue to refine the data gathering and analysis. Member Russell agreed that the Hospital Board would like to receive these reports when final. Ms. Baldwin noted that the schools have been very involved and supportive of these programs and see the high value. In response to a question, she explained the protocol for use of the clinics, which are staffed only two days per week. A student may leave a note for the providers indicating they wish to have a clinic visit. The providers then schedule an appointment or have the students called out of class when they can be seen. She said it is done in such a way as to maintain student privacy. Dental needs: Public Health Impacts Member Austin expressed concern regarding a recent decision to postpone the opening of the OlyCap Port Townsend Oral Health Center because of budget issues. He mentioned that there is a new incoming Treasurer. The plans are on hold for at least six months while work is proceeding to ensure financial viability. Mr. Austin requested that the BOH consider possible ways to communicate their concerns to OlyCap. Ms. Baldwin suggested inviting Tim Hockett, OlyCap Executive Director, to a Board of Health meeting or a joint BOH/Hospital Board meeting. Vice Chair Russell noted that the hospital specifically excludes mental and dental care from their mission. There was a brief discussion regarding Health Care Authority funding to OlyCap through the Hospital. Julia Danskin mentioned that Jefferson Healthcare has a contract with OlyCap to provide oral health care access. After additional discussion, the BOH asked staff to invite Mr. Hockett to the January or February meeting to discuss the eventual plans. Vic Dirksen, Hospital CEO, will also be invited to attend. Julia Danskin added that nursing staff had identified the need for dental care in the schools last spring. Through the Public Health oral health care program, she arranged for a dental hygienist to be present at the school based clinics one day per month beginning the fall of 2009. She provides screening, assessments and fluoride treatment. She assists those with more serious problems to get dental care under the state Medicaid programs. Jean Baldwin said this topic should be included in the discussion with OlyCap. In response to a question regarding when the six month OlyCap hold period begins and ends, Julia Danskin said that in her understanding, Tim Hockett had stated that OlyCap needs to complete financial obligations for the dental facility in Port Angeles before moving ahead with the Port Townsend plans. She said he intends to apply for ADA funding and is also interested in meeting with the hospital commission. She said that Mr. Hockett believes that access to dental care will lessen the demand for hospital emergency care and reduce unreimbursed costs to the hospital. Ms. Joswick suggested the idea of renting local dental offices on days those facilities are otherwise unused, particularly on an interim basis until more funding is available. Ms. Baldwin said her department had made similar arrangements for Family Planning in Hadlock and Quilcene. Page 4 of 11 2010 State, County and City Budgets: Public Health Impacts Washington State Budget: Jean Baldwin referred to the packet materials: a press release from the Governor's office regarding the 2010 supplemental budget and a spreadsheet from the State Department of Health. She noted that it is difficult to interpret the implications of the spreadsheet. She called particular attention to the line item, Local Fund Adjustments. She said that the Health Department has three sources of State non - categorical money: backfill MVET (motor vehicle excise tax) - $87,000 locally; 5930 Blue Ribbon panel — for County communicable disease needs; and local capacity money. She said this fund pays for administrative salaries and non program work.. The Governor's budget did not cut these local non -categorical funding sources, but they may be vulnerable in future revisions. The status of $60-80,000 DSHS funding is as yet unknown. Because of the deficit, there will be budget cuts, but the exact targets are not known. She said she had not been able to determine the Basic Health funding impact as yet. The details available, particularly with regard to DSHS cuts, are very difficult to read and to interpret local impact to individual programs. Ms Baldwin also recalled that there is a lawsuit pending on a prior budget cut that has not gone into effect, meaning that the overall budget deficit may be higher than $2.6 billion. In response to a question about the State level process, Ms. Baldwin said that this budget, if passed or amended by the legislature, should go into effect in July 2010 or sooner. But an example of possible department changes include moving the date up, a panel assigned to deal with the immunization cuts has recommended that those changes go into effect in March or April. County Budget: Jean Baldwin referred to the copy of the Public Hearing presentation materials in the packet. She pointed out the prior reductions for Public Health on page 9: staff hour reductions equivalent of 3 to 5 FTEs and a General Fund reduction of $100,000. She noted highlights of the budget process related to Public Health on page 10 and page 12, slide 24. She said that the information on cuts by individual departments is misleading, particularly page 16. Ms. Baldwin stated that in the midst of a recession, the County is trying to do a 5 -year projection and to address a $1.9 million gap. She said she is concerned that the funding shortfalls will continue for three to five years and the goal of closing the entire gap immediately may be unrealistic. There was a brief discussion as to the necessity of severe cuts immediately. Veronica Shaw added that the many of the populations public health serves are in great need right now, increasing the adverse impact any reductions in those services will have. She said that she had asked to speak directly to the BOH because of her role in managing and balancing the budget. She said that she recalls BOH letters to the Governor and past actions taken in an effort to preserve critical health services. However, the County is now cutting huge amounts of funding that will severely impact these services. Ms. Shaw presented the reductions that had been applied to the Health Department. Page 5 of 11 For 2009, the approved Public Health General Fund budget was $772,774. By year end, the actual received will be $ 615,774 The total reduction will be $ 157,000 Ms. Shaw noted that this is a 20% reduction, far more than the 4.7% average reduction or dollar reduction experienced by other departments. She recalled that when the need first arose, the department had taken immediate steps that included the temporary withdrawal of the application for an Environmental Health Director for one year. For 2010, in accordance with directions, the department submitted the same base budget as in 2009, $772,774. There were subsequent directions to reduce by 4.7% and more, up to a final number of $607,000; i.e. $165,000, a 21.4% total reduction. Ms. Baldwin said that Mr. Morley considers this to be cash carry over that the department is unlikely to need. However, she said, this was achieved through layoffs, furloughs and by making maximal use of all possible funds. Ms. Shaw says that she has consistently postponed spending in anticipation of pending federal and state funds. She said it is important that the BOH be consistent in working to preserve County public health related funding just as it has done when faced with threatened reductions from other sources. Ms. Baldwin added that the funds are there only because of good management and scrupulous monitoring of every expense. Ms. Baldwin said the department cannot find the additional $108,000 nor continue to operate at the current level of service without it. They are seeking guidance from the BOH on a workable solution. She said she does know where to make the State cuts but not where to make the General Fund cuts. She is very concerned about Environmental Health being understaffed and continuing to function without a Director. She said this is dangerous, particularly in any crisis situation that may arise. Ms. Shaw added that she is very frustrated by the omissions of important facts and the misrepresentation in the Budget presentation to the BOCC. She added that she had been told that another $50,000 of county general fund will be taken from the Health Department in July. It was noted that, with a $4 million total budget, it is obviously necessary to manage cash flow; outgoing funds average over $300,000 per month, without regard to large projects. Ms. Shaw said that withdrawal of cash now is premature, since State funding is not yet final. Other issues include a need to postpone further staffing reductions for 2010, because many individuals have been unable to take vacation time due to continuing high workloads and thin staffing of 2009. Member Johnson asked for the FTE reduction from 2008 to 2010 and from 2005 to 2008; the former was 5 FTEs. Ms. Shaw said she would check on the latter number. Member Austin pointed out the staffing chart within the Budget packet. Ms. Baldwin confirmed that the Environmental Health Director had been vacant for about 18 months. She noted that the reason for not filling the position was that fees were down considerably. However, the regulatory requirements and workload has not decreased. There was a brief discussion regarding fees and collaboration between the Health Department and DCD to improve the nexus between these functions. In the past, the majority of the Environmental Health budget (75-80%) has been funded by the General Fund. Ms. Page 6 of 11 Baldwin noted that the Director position has not been tightly linked to fee revenue, and should have an independent perspective. Member Russell noted that when popular public programs are threatened, the possibility of generating tax revenue to save those services rises. Member Nelson pointed out that the most needed and appreciated health services are for those who have fewest resources and least influence. After a final review of the total cuts, Ms. Baldwin stated that the Health Department would not be able to sustain the lower budget over three years. She asked the BOH to consider the situation and make other suggestions. These issues will be updated in future meetings. City Budget issues: Jean Baldwin reported on recent City budget changes affecting County funding. Based on a Leader article and on the televised December 7 City Council Budget Hearing, she said there had been a reallocation of $20,000, derived from the Liquor Excise Tax, from the County Prevention Services to Big Brothers/Big Sisters (BBBS) program. She said she had not had advance notice and was unaware of any problem. David Timmons had met with the staff who do the Prevention work twice last year. The former Port Townsend branch of the BBBS program was closed due to lack of funding within the last two months. 20 supporters attended the City Council meeting to request help from the City in reinstating a look-alike BBBS program. The $20,000 represents about one quarter of the Liquor Excise Tax. Ms. Baldwin said that during the City Council hearing, an out of date (2008) report was read aloud, although the 2009 report had been properly submitted. Ms. Baldwin noted that in hard times when there are many more needs than resources, these decisions are difficult, especially when there is strong public testimony. Member Nelson, who is also a City Councilor, noted that she was present at the City hearing, that the idea to reallocate the Prevention funds had not been pre -announced, and that only one City Councilor and Mr. Timmons were aware of that proposal in advance of the hearing. Ms. Baldwin explained that the Health Department had written the original federal grant that brought the BBBS to the community and provided funding for six years. She said BBBS had then done well in raising their own funding for three years but could not sustain themselves through the recession. She said she expects that other non-profit groups will also "tumble" and need to seek help from the County and City. She noted that, related to the City funding, Mr. Morley had asked her to convene a group to discuss priorities for Youth services. She said she had put together a data framework related to Youth: Poverty/Housing; Education; General Health, Mental Health, Reproductive Health; Violence/Neglect, Jail/Crime, etc. that she would like to share with the City and County to plan for Youth services. In her opinion, the issues and solutions extend beyond the City and County. She said UGN, schools and non-profit organizations have a role. A brief discussion ensued about apparent misperceptions and the need for a shared list of priorities to guide decision making about application of limited funds. Page 7 of 11 Member Nelson conveyed her understanding that the City budget had been approved with two funds placed on hold pending more specific plans: Boiler Room and County Health funds. Member Johnson inquired about the request from the Boiler Room. Member Nelson said that their funds are on hold until overall organizational issues are resolved. She noted that the majority of non-profit organizations clearly present their mission, goals, and budgets and show how success is measured. She said that City Council was informed that this type of information was specifically requested of the Health Department on multiple occasions, but has never been received. Ms. Baldwin said she had never been contacted by Mr. Timmons asking for information but there has been a separate regional support contract that negotiated these funds for many years. Ms. Nelson said that the program under discussion had been assigned to the Police Department, which had not produced adequate information or justification for the request to continue funding. Member Nelson mentioned that there are eight programs such as Main Street, Chamber of Commerce and others that plead their case each year for continued or increased funding. These groups first present their cases to a Financial Committee and then sometimes directly to the City Council. Ms. Baldwin suggested that perhaps she should attend the next City Council meeting, as a citizen, and express her concerns about youth services and seek clarification on the funding request process. Member Sullivan stated that, in his opinion, Ms. Baldwin should operate in her official capacity, while coordinating with Mr. Morley, County Administrator. Ms. Nelson suggested that Ms. Baldwin copy City Council members on correspondence with the City Manager. Member Sullivan pointed out that there is already a plan for the 2010 funds and decisions about adjustments must be made to align with reductions in funding. In summary, there is uncertainty as to the finality of the $20,000 reduction of City funding to the Prevention program and with regard to how the remaining funds should be spent. There was further discussion acknowledging confusion about the City's process for funding. Ms. Nelson suggested a letter to David Timmons regarding the $20,000 Prevention funding. Member Austin suggested that a more effective approach may be for Jean Baldwin to present the program plan to the City Council and to show what cannot be included as a result of the reduction that was made. Member Sullivan agreed that it will be necessary to prioritize the needs within the Prevention program to determine how the remaining funds are best applied. Julia Danskin pointed out that staffing is woven through many programs and activities. When funding that pays for staff drops below a critical mass level, it becomes increasingly difficult to manage both quality and hours to meet target deliverables. There was a brief discussion acknowledging that at some point it is better to close whole programs than to further reduce hours in all programs. Page 8 of 11 After further discussion, Jean Baldwin summarized what she would include in a letter to the City Manager and City Council, emphasizing that she had not understood the City's process; she will attach the report previously submitted for 2009. Member Nelson said that, if she had been aware of the process and exact information requirements, as a BOH member and City Councilor she would have contacted Jean Baldwin in advance of the City Budget meeting to ensure all was in order. She also explained that initially during the Budget Hearing there had been a proposal from Councilor Robinson to fund Big Brothers Big Sisters from the City General Fund, but that motion was subsequently changed to take the $20,000 from the County program, and passed by a vote of 5 to 2. In addition to the letter to the City, Jean Baldwin will draft a funding priority list to the January BOH meeting for discussion. Vice Chair Russell moved that the BOH direct Ms. Baldwin to prepare a prioritized list of programs that would need to be cut if expected funding levels are not achieved. Ms. Baldwin said she would prepare a draft for the BOH to review and approve. Member Sullivan said that the list must be correlated with funding sources. Member Austin seconded the motion. The motion was approved unanimously. Pandemic H1N1: The Second Wave Ebbs and Unrestricted Vaccination Begins Dr. Locke said that the second wave of the HIN1 pandemic is almost over. Incidence levels have dropped back, almost to the base line. It is unknown if there will be a third wave of H 1N 1 influenza, and/or a seasonal influenza outbreak this year. Reports from around the world show that this has played out differently in different locations. What is known is that there is a growing supply of vaccine. As of Monday, December 13, Jefferson, Clallam and Kitsap Counties opened vaccination to the general public, removing all eligibility barriers. This has resulted in greater demand. Jean Baldwin noted that each of the locations is seeing 60-70 patients per day. Dr. Locke noted that if the full US supply of 150 million doses is administered, that will almost certainly prevent any third wave of HIN1. He noted that for Public Health agencies, despite the workload, immediate response and full attention to emergencies such as this is a necessary and standard practice. Ms. Baldwin noted the need to track nine different types of vaccine, by age, and to simplify the overall process for providers. She said that more than 10% of the population had been vaccinated in the initial phase directed at priority groups. She praised the partnerships with Jefferson Healthcare, Safeway and all those involved. Health Care Worker Vaccination: Legal and Ethical Arguments for Mandate Dr. Locke suggested that this item be tabled for a future meeting. He said that although it is not time -critical, this issue has growing public health implications. Page 9 of 11 Vice Chair Russell noted that the hospital had adopted the policy that employees must be vaccinated or wear a mask at all times. He added that one Seattle hospital had gone further, indicating they would dismiss employees who refused a vaccination. Green Business Environmental Award Certificates Jean Baldwin said there would be a presentation on Green Business in January. The Health Department itself intends to become a Green Business, as part of a Global Warming project. A new staff member is actively working with the marinas and many businesses at the Port of Port Townsend. Vice Chair Russell signed three new awards on behalf of the BOH. They are to recognize: St. Paul's Episcopal Church, SOS Printing and Naturally Green Cleaning. In response to a question, Ms. Baldwin said that St. Paul's qualifies as a Green Organization by virtue of their processes such as dishwashing, reusable dishes/utensils, electronic mailing, types of supplies used and many other practices. Substance Abuse Advisory Board Mission Statement Ms. Joswick said that the SAAB believes it necessary to have a contemporary, accurate statement to meet its own needs and when recruiting new members. She distributed copies of a proposed Mission Statement that had been approved by the SAAB at its December meeting. The text of the Mission Statement is as follows: "Under the direction of the Board of Health, the Substance Abuse Advisory Board, per the RCW 70.96A.300, aims to protect public health within the community by increasing awareness of the impacts of alcohol, substance abuse and chemical dependency on all citizens of Jefferson County. The Board develops and implements cost-effective strategies that prevent, intervene, treat and provide aftercare to reduce the significant impacts on our community. This is accomplished by networking within the community and presenting timely and pertinent information." (created December 8, 2009) Ms. Joswick requested that the BOH approve the statement. Member Austin moved for acceptance of the SAAB Mission Statement as written. Member Frissell seconded. Member Sullivan inquired as to the accuracy of the RCW reference within the Statement; Ms. Joswick verified that it was an accurate citation. The motion to accept the SAAB Mission Statement was approved unanimously. Page 10 of 11 ACTIVITY UPDATE Member Frissell reported that she has been hearing very positive comments and opinions about the Health Department from throughout the community. She quoted citizens as saying "We have a wonderful Health Department." and "I'm very impressed with our Health Department." Jean Baldwin thanked Ms. Frissell and credited the "amazing staff' of the department. AGENDA PLANNING The next scheduled BOH meeting will be on January 21, 2010. The January meeting will include: draft priority list for budget cuts; Green Businesses; vaccination policy for health care workers; and follow up on any other open items. Elections for Chair and Vice -Chair will be held. ADOURNMENT Vice Chair Russell adjourned the BOH meeting at 4:34 PM. JEFFERSON COUNTY BOARD OF HEALTH Excused Sheila W terman, C r J Chuck Russell, Vice -Chair 0 Roberta Frisseell±5 M ,,Member Kristen Nelson, Member Page 11 of 11 P ' ohnson Member a��t J Austin, Member David §711iv e, ber