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HomeMy WebLinkAboutM012110JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, January 21, 2010 2:30 PM — 4:30 PM Health Department Conference Room, 615 Sheridan Street, Port Townsend Board Members Staff Members Phil Johnson, County Commissioner District #1 Thomas Locke, MD, Health Officer David Sullivan, County Commissioner, District #2 Jean Baldwin, Public Health Services Director John Austin, County Commissioner, District #3 Julia Danskin, Nursing Services Director Kristen Nelson, Vice Chair, Port Townsend City Council Sheila Westerman, Citizen at large (City) Chuck Russell, 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 2:37 PM. Members Present: Roberta Frissell; Phil Johnson, Kristen Nelson, Chuck Russell, David Sullivan, Sheila Westerman Members Excused: John Austin Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin Guest: Frances Joswick, SAAB A quorum was present. APPROVAL OF AGENDA Chair Westerman said she would like to have time under Draft Letter to Port Townsend City Manager to offer a handout and discuss it. Member Frissell moved and Member Sullivan seconded for approval of the agenda. The agenda was approved unanimously, as written. ELECTION OF CHAIR AND VICE CHAIR FOR 2010 Chair Westerman reviewed the process that had been followed in the past for election of Chair and Vice Chair positions. The Vice Chair normally assumes the Chair position and a new Vice Chair is elected. Member Nelson nominated Chuck Russell to the Chair position. The nomination was seconded by Member Johnson. Member Russell indicated that he would accept the nomination and assume the Chair position if elected, with two conditions: he wished to be able to offer motions and he Page 1 of 13 Board of Health - January 21, 2010 wished to review the agenda planning process for possible improvements. Members were in agreement that the Chair is free to fully participate in meetings, including offering motions. There was additional discussion about agenda planning. Member Russell suggested that a sub -committee consisting of the Chair, Vice Chair and former Chair would meet to consider tentative agendas prepared by Jean Baldwin. Member Westerman said that, due to work obligations, she would not be able to attend a separate monthly meeting. Member Russell was not in favor of an e-mail process instead of a meeting. Dr. Locke noted that this idea had been considered in the past. He said the agenda planning would need to be done about two weeks in advance. He suggested the means used by the State BOH: the Board creates a three to six month roster/calendar of topics, while leaving open agenda time for additional ad hoc items. The option of making better use of the Agenda Planning item was suggested. Jean Baldwin noted that she and Dr. Locke maintain a rolling outline of topics several months in advance, but would prefer to have more input from the BOH. After further discussion of several ideas, members agreed that members do have the option to participate in planning agendas. Member Frissell noted that the staff solicits input on the agenda via e- mail every month, as well. They also supported Member Westerman's suggestion to include a tentative calendar updated monthly in the packet as the basis for discussion and feedback. Member Russell said he would bring this up again if it did not work out well and withdrew his request for special planning meetings. Member Johnson nominated Kristen Nelson for Vice Chair, with a second by Member Frissell. Members Russell and Nelson were unanimously elected for the positions of Chair and Vice Chair, respectively. Member Westerman passed the gavel to Chair Russell who presided over the remainder of the meeting. Members and staff thanked Member Westerman for her term as Chair. APPROVAL OF MINUTES Member Johnson moved for approval of the minutes; Member Sullivan seconded. The minutes of December 17, 2009, as submitted, were unanimously approved. PUBLIC COMMENTS There were no public comments and no members of the public present. Page 2 of 13 Board of Health - January 21, 2010 OLD BUSINESS AND INFORMATIONAL ITEMS Healthcare Associated Infections Go Online Dr. Locke referred to the press release from the Washington Department of Health in the packet, and recommended that BOH members visit the website, www dob wa o_� v/ehsphl/hai/0 hai default.htm. This is in response to a legislative mandate in 2007 that requires hospital infection rates to be publicly accessible on a state government website. Starting this year, surgical site infections will be shown, in addition to data already published in this manner. Dr. Locke said he has been involved with the group responsible for implementing the legislation. He said it is a huge public education project to explain this data. For example, one key point that must be conveyed is that rates will be different for small community hospitals compared to those facilities handling more complex procedures. He said he would appreciate feedback on whether or not the information is clear and understandable. In response to a question, Dr. Locke said that this is an appropriate step to push hospitals to invest more resources in infection control. However, the data is very difficult to understand because it is impossible to fully adjust it for risk. Also, surgical site infections can be very expensive in terms of data collection/reporting, There is a lengthy report that needs to be filed for every surgical case, not just the small percentage that are complicated by post surgical infection. Work will continue to streamline the process. Member Sullivan noted that historically nursing was most responsible for infection control. More recently there has been a trend to greater use of disposables and antibiotic resistance has been a growing problem. Draft Letter to Port Townsend City Manager Jean Baldwin referred to the draft letter in the packet. She said she had not submitted the letter, at the request of the County Administrator. Ms. Baldwin said that since the last BOH meeting she had found a copy of the Regional Services Agreement, signed by the City and Jefferson County, which remains in effect until December 31, 2010. This document commits the City to current funding levels through the remainder of 2010. Member Westerman distributed a document she had prepared for discussion and requested that the Board review her document. Ms. Baldwin reported that she had heard from Catherine Robinson that David Timmons intended to continue the contract. She said that she had no other information about the status of the contract and was therefore uncertain as to the most appropriate next step. She said she assumed that it is still appropriate to bill the City under the terms of the contract for services provided. Ms. Westerman said she was concerned about the lack of clear communication. She noted the difference between this intergovernmental contract and City/non-profit groups Paye 3 of 13 Board of Health - January 21, 2010 seeking City support. She stressed the importance of ensuring better communication between the City and County. Jean Baldwin said that as the administrator overseeing public health services for the City of Port Townsend, she did not currently have a clear communication link to the City and sees that as a problem. Member Westerman noted that the City Council representation on the BOH was intended to fill that role. She wondered if a staff level link may be more effective. She said she was open to any of several options that would get the job done effectively. Member Nelson offered to distribute relevant information from the BOH meetings to the other City Council members. She noted that, as a new BOH member, she is still learning about the functions and processes of this body. She suggested that relevant reports and statistics could be included in City Council packets monthly and/or noticed on the City Council agendas. Ms. Baldwin stated that the issues are multi -faceted and that perhaps several steps need to be taken. She noted that Ms. Westerman, as a City citizen representative on the BOH, could possibly attend City Council meetings to present information. Member Westerman said that she could represent the BOH if authorized, but would not do so without their approval. She added that City Councilors are entitled to clear information in order to make decisions. There was further discussion about the withdrawal of funds that occurred during the December 7 City Council meeting. Member Sullivan noted that the action had been a mistake and that it is most important to prevent a reoccurrence. He said that he understood that the situation had been acknowledged and corrected. He said that the City has recognized that a 90 day notice is necessary to amend the contract. He agreed that there could be better communication, and that remains a challenge for both the City and County. Member Sullivan acknowledged the difficulty of keeping everyone fully updated on relevant information at all times. There was further discussion about the fact that the County is providing services to the City under contract via the Liquor Excise Tax, but that the City Council apparently is unaware of those services. Member Nelson suggested that regular updates to the City Council, perhaps with an annual presentation, would be effective. Ms. Baldwin suggested that a regular written report or update could be sent to the City Council and interested Boards. Ms. Westerman added that she would be willing to attend City Council meetings with Ms. Baldwin as needed to present relevant reports. Member Westerman noted that paper reports included in an already voluminous packet may be overlooked, and that in-person updates may be most effective. The intention is that she and Jean Baldwin will prepare and present to the City Council in the near future. During further discussion, there was clarification that there is just one contract with the City that covers both Public Health and Animal Services, and that it is very important that Page 4 of 13 Board of Health - January 21, 2010 City Council understands the full extent of service the City receives for its funding. Member Nelson noted that most of the Council is now aware of the contract and would never break such a contract. Member Westerman said she was more concerned with the improving the flow of information and ensuring that City Council receives clear, timely information. There was agreement of the importance that trust be maintained, and that future reports should convey the full extent of services being provided to all the citizens of the City and County. Members Sullivan and Johnson stressed that there is good cooperation and trust between the City and County over a broad range of mutual interests, committees and working relationships. 2009 Jefferson County Board of Health Activity Timeline Jean Baldwin referred to the summary of formal actions (motions carried) taken by the BOH in 2009 included in the packet. She indicated that such a summary is prepared each year for the Board's information. 2010 Census Preparation Member Phil Johnson and Julia Danskin serve on the Everybody Counts committee for Jefferson County. Member Johnson gave a brief overview of the 2010 Census process/schedule and mentioned a planning meeting with representatives from all areas of the County. He stressed that there is a constitutional requirement for absolute confidentiality of information. Julia Danskin said that Jefferson County Public Health is going to contract for a US Census worker to be on site from March 19 through April 19 during working hours to answer questions. (Census representatives will also be stationed at the City and County libraries.) Member Johnson noted that the committee will be utilizing many different ways of disseminating information about the census and encouraging full participation. Department Update Jean Baldwin reported that Tim Hockett, executive director of the Olympic Community Action Program (OlyCAP), had accepted her invitation to attend the February 2010 BOH meeting. He will provide an update on the OlyCAP funding situation and respond to any questions from the BOH. Ms. Baldwin also reported on the federal audit of Family Planning Services that had taken place in the previous week. This represents only $18,000 of funding. Six federal and one State auditor were on site for one day. The purpose was to evaluate Jefferson and King Counties as well as the State's abilities to conduct their work in the field. She said the process was very intensive, but the outcome was very positive. The department received A+ with regard to clinical services, staff training, skills of charting, medical record completeness, fiscal management and other areas. There were no significant Page 5 of 13 Board of Health -January 21, 2010 "findings". She said some suggestions were received with regard to communications, and a few other specific areas, which were immediately corrected. Web Link to: an Epidemic of Fear The online reference for the Wired magazine article that had been requested during the previous BOH meeting was included in the packet: http://www.wired.com/magazine/2009/10/ff waronscience/ NEW BUSINESS Solid Waste Program: Designation of Green Business Lori Clark and Margie Boyd from the Environmental Health staff were on hand to provide an update of the Solid Waste program. Lori Clark stepped through a slide presentation on Green Business, which is defined as "Any business or organization that uses environmentally friendly practices and operations." This is a voluntary program and is designed to recognize existing efforts, as well as provide free technical assistance to improve in any areas that are lacking. There is a checklist to guide businesses and organizations in preparing for certification. The main benefit for participants is free advertising, which includes display decals, an online directory, and public recognition. Other benefits are free technical assistance, appreciation of employees, reduction of environmental footprint and likely reduction of operational costs. She displayed a list of the current Jefferson County businesses, which are also available on the web site. The newest business to qualify will be Jefferson County Public Health, as of this date. Ms. Clark noted that the process of achieving this status has been going on for almost two years. She noted in particular paper reduction and discussed the Waste Reduction and Recycled Product Procurement Policy that had been developed. She pointed out that this is an opportunity for governmental agencies/departments to lead by example. Annual renewal process — Ms. Clark discussed the renewal process, which is a means to help businesses reach a higher level of environmental awareness and responsibility, as well as help track the program success over time. EnviroStars — This program is geared to those businesses that deal with hazardous waste. Ms. Clark mentioned the 3 R's of Green Business: reduce, reuse, recycle. EnviroStars deals with proper storage and disposal of hazardous waste. An Enviro-Star business may also be a Green Business, but not all Green Businesses are applicable EnviroStars. There are numerous types of advertising, including newspapers, brochures, quarterly newsletters, and state, regional and local directories. The rating system begins with two stars, setting a goal, with additional stars awarded up to 5 stars for qualifying as a leader/educator in the community of how to reduce Page 6 of 13 Board of Health - January 21, 2010 hazardous waste. BOH members were impressed that the current list of EnviroStars includes so many of the most challenging businesses in this community. Ms. Clark noted the partnership with the Puget Soundkeeper Alliance, Clean Marina Program, which jointly verifies marina related businesses. Local Source Control is a partnership between local health jurisdictions and the Department of Ecology, which focuses directly on assisting small businesses to prevent polluted runoff to Puget Sound and local waters. This is voluntary but local jurisdictions are supported in providing technical assistance to local businesses. Ms. Clark said that the Health Department decided to streamline its efforts for the three programs discussed: Green Business, EnviroStars and Local Source Control, particularly in working with the Port of Port Townsend. The Port itself has been certified with EnviroStars and will become a Clean Marina this month. There will now be a focus on the individual businesses within the port/marina. Those that have hazardous waste will be encouraged and supported to become EnviroStars, while those that do not can become Green Business. If they are not interested in either, they will be approached for Local Source Control assistance and participation. The Port and marina areas are a high priority due to their location on the waterfront and potential environmental impact. She noted the variety of activities where there is regular use of potentially hazardous materials and processes. Ms. Clark noted that the grants supporting these programs provide for promotion and advertising for certified businesses so that the community is aware they are doing business in an environmentally responsible way. She then responded to questions from BOH members about the application/certification process. Ms. Clark noted that there are specific checklists for different types of businesses, such as printers, auto repair, dental practices, etc. She explained that in the case of a building with multiple businesses, she would be work with certifying each individual business before recognizing the property overall. It was noted that certification of one or two of a certain type of business tends to incentivize others to follow suit. In addition, as public awareness grows, this also tends to motivate individual businesses to be certified. Margie Boyd added that under the Local Source Control program, it is their practice to contact all businesses of a certain type at about the same time. She noted that Local Source Control acts as an on ramp to Green Business and EnviroStars. Ms. Boyd also mentioned that a local church had heard of the program and invited her to speak at an inter -denominational meeting, which further publicized the program. Jefferson County Public Health Waste Reduction and Recycled Product Procurement Policy Jean Baldwin referred to the policy document in the packet. She said that either she could implement this policy at the department level or the BOH could endorse the policy, thereby making a stronger statement. That is, the Board would be making a policy decision that the Health Department and other departments will model what they are Page 7 of 13 Board of Health - January 21, 2010 asking other businesses to do, with regard to waste reduction, recycled product procurement and environmental responsibility. The policy provides that this will be followed provided it is feasible and financially affordable. Staff noted that once adopted, they will work with other County departments to commit to similar policies and practices. Staff members explained some of the steps that had already been put in place for cost savings, as well: double -sided printing; use of scrap paper for draft documents; attention to shutting off equipment and lights when not in use; avoiding printing unneeded copies, etc. Member Westerman moved that the BOH request the Health Department to adopt the draft Waste Reduction and Recycled Product Procurement Policy. Member Nelson seconded. The BOH unanimously approved the motion. Jean Baldwin said she would post this document on the website. Tobacco Prevention and Control Update Karen Obermeyer, Tobacco Prevention Program, began by discussing the health effects of tobacco smoking and second hand smoke. She reviewed the negative health effects of second hand smoke: when a non-smoker is exposed to second hand smoke, blood platelets are activated and raises the risk of a heart attack. She cited a study that revealed a correlation between a smoking ban in a community and lowered rates of heart attacks. When the smoking ban was overturned, heart attack rates returned to former levels. When the ban was re -instated, heart attack rates fell again. She also noted that one of the best preventative measures against H1N1, seasonal flu and pneumonia is to quit smoking. In the tobacco program, there are four main areas of focus: increase community coordination and capacity for tobacco use prevention; prevent youth and young adults from using tobacco; increase the quitting and prevent exposure to second hand smoke. Ms. Obermeyer distributed copies of Jefferson County Tobacco Use Statistics. She reviewed the smoking rates for various age groups, and discussed the applicable confidence intervals and sampling size. The Washington State smoking rate of 15% (adults) is the 6th lowest in the nation. According to a relatively small sample in 2009, the rate for Jefferson County was 24%. Looking at the data for 2006 to 2008, she said that 17% (based on much larger sampling sizes) seems to be a better estimate for Jefferson County. Rates for 10th graders fell from 24% to 13.6% in Jefferson County. Rates for 8th graders dropped, as well. The smoking rate of 22.5% for pregnant women is particularly alarming. This statistic is self-reported and may actually understate the problem. Ms. Obermeyer said that the national goal for Healthy People 2010 (U.S. Department of Health and Human Services) is 12%. She noted there is significant work to be done locally in terms of education and programs to reduce smoking rates. She described the media outreach, presentations to community and business groups, and work with schools. Page 8 of 13 Board of Health - January 21, 2010 She said she is working on strategies for groups at greater risk to use tobacco, such as those at lower income and lower education levels. Ms. Obermeyer talked about her outreach work with youth and youth prevention, notably with the Boiler Room and with Teens Against Tobacco Use. She said she also does tobacco retailer education and compliance checks, as well as promotion of the Quit Line, staffed by trained tobacco cessation counselors. This is a subsidized service; people who call this line have a 50% greater chance of quitting smoking. Beginning in July, all publicly funded substance abuse treatment facilities are required to include nicotine addiction treatment. More people involved in substance abuse are dying from tobacco than from other forms of substance abuse. She also provides technical assistance in writing policies for multi -unit housing administrators. For the Great American Smoke Out, she wrote a press release for the newspaper, and targeted church bulletins as another way to disseminate information. Ms. Obermeyer works with school based clinics to ensure they offer Tobacco Cessation help as well. The final draft of the procedure for regulation of smoking in public places has recently been completed. Since September, there have been four complaints regarding smoking in public places; she said the rate usually rises in the summer months. Providing education to businesses about their responsibilities is another aspect of her work. Ms. Obermeyer noted that one of the most effective ways of preventing/reducing tobacco use is increasing the price of tobacco products; it also motivates smokers to quit. The federal tobacco tax increased in June and there is a proposal in process for a State increase as well. Jean Baldwin asked the BOH to consider whether additional areas of the County and City should be designated as smoke free. The hospital is now smoke-free, as are County in- door facilities and within 25 feet of entrances. Smoking in the parks, at the Fairgrounds, and other public places is not prohibited. Ms. Obermeyer said she had received complaints about smoking at the Fairgrounds. Member Westerman noted that Denmark is attempting to pass legislation that would prohibit smoking entirely throughout that nation. However, lawsuits are being brought forward from tobacco companies. Member Nelson said that the City has received complaints about smoking in parks and on sidewalks. There was discussion about how 25 foot perimeters are not always maintained. Member Westerman said that raising taxes on products and citizen enforcement are effective means of tobacco use control. Priority Setting for Public Health Services Jean Baldwin recalled that, at the January meeting, Chair Russell had requested that she prepare a candidate list of services that could be cut or closed if funding drops further. She sees this as a multi -step process, and suggested that the BOH first consider: what work is being done, who is the work being done for, and how it is being done, all of which leads to the outcomes. The Performance Measures, published and reviewed by the BOH every March, show the activities and the outcomes for each program. She believes Page 9 of 13 Board of Health - January 21, 2010 the appropriate questions are whether these outcomes can be given up or provided in some other way or by some other agencies. For example, can Family Planning services be dropped or will it need to be taken over by the hospital or other clinical care facility? She also discussed the external forces/environment: general economic climate giving rise to unemployment, decreased federal, state and local funding, and more pressures on families, i.e. increased needs and fewer resources. She noted that accounting for increased needs is not easily translated to a prioritization process. The federal and state cuts are easily identifiable, but are associated with particular programs. Historically, changes in program funding have simply resulted in service changes within those programs. She noted that logically this method would be followed for local money as well. However, local money has been used as backfill in all the other programs; it is woven into many programs and services, such as Family Planning; Communicable Disease; Maternal Child Health, etc. These are the programs and services that were previously identified as the most important to continue, while dropping, for example, HIV case management or other services that were being done by other agencies. She said that it is possible to provide the list of how much local funding goes to each program. There is also great uncertainty about State funding, since the Governor has released another budget that would reinstate many of the programs that had been cut in the earlier budget draft. She mentioned the $80,000 funding for Child Protective Services as an example. Ms. Baldwin said that because of the above, she had not prepared the priority list, but came prepared with a discussion topic instead. She referred to copies of Guide. to Prevention in Jefferson County, noting that it had been jointly endorsed by the County, City, Hospital, BOH and many other agencies. She said Tobacco program and Enviro- Stars are good examples of programs that affect community norms. Currently, they are only funded by State dollars. She said that this shows how prioritization has already been done. The prevention checklist in this brochure is a way to determine and measure if programs are worth doing. A second method is outlined in the Guide for Establishing Health Priorities (packet materials). Dr. Locke said this had been included for informational purposes. He noted that this is a mathematical way to prioritize public health services. However, it works best where a specified amount of funding is available, and there is a desire to figure how best to use it. Instead, in the present context, there are many categorical and fragmented lines of funding, often with requirements for local matches or subsidies. He said this type of method could possibly be helpful to compare two worthy programs. Ultimately, priorities should be based on the severity of the problem, the effectiveness of intervention, and the numbers of community members impacted. He said that much of what is now being done is addressing serious problems with highly effective interventions that are relatively common. That is, they are already focused on the highest priority tier. Lower tiers have already been cut, and do not have local funding lines Page 10 of 13 Board of Health - January 21, 2010 attached. The budget actions of the legislature will be of great importance in these considerations. He noted that the buy-back provisions of the most recent State budget draft are conditioned on $788 million of new revenue. Dr. Locke said it is highly likely that there will be changes/cuts to federal and State funds at the program level within the next few months. Ms. Baldwin said the challenge is how to frame the problem and discussion. One framing, for example, is elimination of the Health Department and privatizing its service, regionalizing everything else. She pointed out that the degree of uncertainty is extremely high. Chair Russell said that, despite the explanations above, he believes that a priority list is needed primarily as a means of making the public aware of what is at risk. Ms. Baldwin said she can provide the list of how local funds are being used, but not what should be cut. She and Member Westerman noted the complexity of the issues. Chair Russell said that he believes the BOH message must be somewhat simplistic in order to convey the gravity of the situation to the public. Member Sullivan suggested that this discussion could be tabled until March, when the legislative process is further along. Member Westerman noted that over the past many years, all lower priority programs have been culled, and all that is left is of the highest priority. She said she does not believe it possible to create a meaningful list. Member Johnson mentioned that the legislature is considering a higher sales tax on candy. He said he did not understand why a penny tax on cans of soda pop or on plastic bottles cannot be implemented. Jean Baldwin suggested the possibility of a few BOH members working with Dr. Locke and her to better frame the problem and the list. Julia Danskin pointed out that better methods of helping the public understand the essential work and contributions of the Health Department are needed. After further discussion about the broader social, political and economic context, Members agreed to continue the discussion in future meetings. Tribal Mutual Assistance Agreement: Next Stens Dr. Locke reported that the Agreement had been signed by all seven counties and three Tribes. The next step is to develop an operational plan. This is the first such agreement in the USA and will be used as model for others. The State plans to issue a press release. H1N1 Seasonal Flu Update Dr. Locke said that the second wave of H1N1 appears to have passed, and it is uncertain whether there will be a third wave. This depends on the total number of people who are immunized. About 50% are needed to stop an epidemic; currently the rate is estimated at 45% in Washington State. There is plenty of vaccine now, and there are continuing promotional efforts. He said it is difficult to get people to be vaccinated at this time of Page 11 of 13 Board of Health -January 21, 2010 year. There is also little seasonal flu activity thus far. However, there is concern that the winter Olympics in Canada will bring flu to the Northwest. Jean Baldwin pointed out Jefferson County immunization statistics in the packet materials. 24% of six month to 24 years of age individuals got the vaccine early, which is much higher than that for the State as a whole. She credited the excellent partnerships with the Hospital, private vendors, and caretakers. Safeway, QFC and walk-in clinics are still providing the immunizations. Vaccinations are still being administered and further reporting is forthcoming. Legislative Update Dr. Locke mentioned that a public health funding bill, i.e. a "candy tax", is pending. The bill is in the hearing stage and appears to have significant support. There is also a bill aimed at saving the current immunization system, which otherwise would end in May. Under this plan, participating insurance plans would absorb the difference (former State subsidy) in cost, and would receive the vaccines per the CDC price lists. Member Johnson mentioned that there is also a proposal to extend the 1/10`" of one percent arrangement indefinitely. Member Westerman noted that altering the original intent for this money will further threaten the government's credibility with voters. AGENDA PLANNING Member Sullivan stated that the semi-annual WASAC conference is held every year in June (and November), and conflicts with the BOH meeting in June. He suggested this meeting be rescheduled or cancelled. Member Nelson said the second Thursday between 3 and 5 PM is a conflict for her but can be arranged with adequate notice. There was agreement to reschedule the June meeting to the second Thursday of the month and to cancel the November meeting. The next scheduled BOH meeting will be held on February 18, 2010 from 2:30 to 4:30 PM. ADJOURNMENT Chair Russell adjourned the BOH meeting at 4:42 PM. Page 12 of 13 Board of Health - January 21, 2010 Kristen Nelson, Vice -Chair /Wm Roberta Frissell, Member Sheila Westerman HEALTH Page 13 of 13 Phil John n, Member Excused John Austin, Member Davi Sullivan, Member Board of Health - January 21, 2010