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HomeMy WebLinkAboutM021810JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, February 18, 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) Vice Chair Kristen Nelson called the meeting of the Jefferson County Board of Health to order at 2:38 PM. Members Present: Roberta Frissell, Phil Johnson, Kristen Nelson, David Sullivan, Sheila Westerman, John Austin Members Excused: Chuck Russell, Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin Guest: Frances Joswick, SAAB A quorum was present. APPROVAL OF AGENDA Vice Chair Nelson requested for any corrections or revisions to the agenda. Member Frissell moved and Member Johnson seconded for approval of the agenda. The agenda was approved unanimously, as written. APPROVAL OF MINUTES Member Sullivan moved for approval of the minutes; Member Frissell seconded. The minutes of January 21, 2010, were approved, as submitted, with Member Austin abstaining because he had not attended the January meeting. Jefferson County Board of Health — February 18, 2010 PRESENTATION OF RESTAURANT OUTSTANDING ACHIVEMENT AWARDS FOR 2008-09 Dana Fickeisen, Food Safety Program, gave a brief introduction about the awards, noting that the Board of Health had established these awards to recognize and honor full-service complex menu food establishments that have demonstrated the highest standards for safe food handling. She thanked those who were present to receive the awards. Packet materials included an information memorandum from Ms. Fickheisen to the BOH, the February 4 Press Release announcing the Awards to 38 Jefferson County restaurants and a copy of a Food Inspection Report form. Ms. Fickeisen explained that the awards are based on meeting criteria as specified and rated on Food Establishment Inspection Reports for 2008-09. She noted that the "red' categories deal with the most important factors such as hand washing, storage and cooking temperatures, food protection from contamination, etc. "Blue" factors are less critical and can be addressed over time. She noted that points are assigned for violations, so the fewer the points the better. Vice Chair Nelson presented award certificates to owner/operators (or their representatives) of the following restaurants. She congratulated and expressed her thanks to all of them for their achievement. Blue Heron Middle School Cafeteria Brinnon Senior Nutrition Camp Parsons Food Service The Coop Deli Jordini's on the Water Port Townsend Senior Nutrition QFC 870 Deli, Port Hadlock QFC 106 Deli, Port Townsend Tri -Area Senior Nutrition The Upstage Uptown Custom Catering T's Restaurant Photographs of the Award recipients were taken following the presentation. PUBLIC COMMENTS Libby Palmer, Port Townsend, referred to an article she had seen in the PDN about two weeks earlier, regarding the disposal of unused medications and their impact on the entire watershed ecosystem. She said that in following up on the article, she had been in touch with Clallam County and with Jean Baldwin. She had learned that the BOH and the Health Department have also been very concerned and interested in setting up a more Jefferson County Board of Health — February 18, 2010 2 eco -friendly disposal system, analogous to the Collection/Incineration process used by Clallam County. Fran Joswick explained that the SAAB has become involved with this. She said Conner Daly, Port Townsend Police Chief, has been working with Clallam County on an arrangement; although the problem is complex and law enforcement must be involved, the process is moving along. She said that the funding for training etc. is being worked out and she is hopeful a process can be in place in about 60 days. Jean Baldwin said that an additional complexity is that Jefferson County does not have the same transportation and disposal contracts as Clallam County. Also, pharmacists will need to temporarily store the drugs. Jean Baldwin mentioned that a related state-wide bill had failed for the third time. Dr. Locke said that bill would have required pharmaceutical manufacturers to take back and dispose of the drugs, but was successfully defeated PhRMA, the main pharmaceutical lobbying group. OLD BUSINESS AND INFORMATIONAL ITEMS 2009 State of the Sound Report Online Dr. Locke referred to the press release in the packet announcing the 2009 State of the Sound report. He said the 140 page report contains a significant amount of Jefferson County data and is a worthwhile source of information, particularly with regard to water quality. It is a state of the art compendium on what is known, what the problems are, what is in progress, and what more needs to be done to protect and restore Puget Sound. Jean Baldwin mentioned an outstanding EPA grant jointly submitted with Clallam County, the Conservation District and WSU for O & M and septic education; report filing, etc; the awards will be announced during the summer of 2010. There was a brief discussion about the pending legislation for a tax on toxic waste, but which would not be used for clean up for five years. Member Westerman proposed a letter to the state legislature endorsing the tax, but restricting the use to toxic clean up only. Member Sullivan said he would need to know more about the proposed legislation. After a brief discussion, Member Johnson suggested that, if a letter is sent, it should "urge" rather than "insist", in which case he would second the motion. The motion carried by a vote of 4 in favor and 2 opposed. It was agreed that staff would draft the letter, and Member Westerman offered to assist, as necessary. Statewide H1N1 Situation Report Dr. Locke reviewed the Washington State DOH report dated February 8, 2010. He said this would likely be the final tally for the first and second waves of the pandemic. He pointed out the 92 deaths reported, which likely under represents mortality due to H IN 1 by a factor of 10. The report also contains vaccine distribution statistics. A total of 2.2 million doses were ordered, less than the amount available (enough to cover 50% of the population). He estimated that about 90% of the doses ordered were actually Jefferson County Board of Health — February 18, 2010 3 administered. Those figures will ultimately be determined by the inventory of what is left over. The shelf life varies, depending on the manufacturer and type of vaccine; some batches have already expired and some will be useable for many more months. In response to a question, Jean Baldwin explained Incident Command. This is an emergency response protocol followed for public health emergencies, similar to the emergency management system used by the County Sheriff's office. She said the department followed the command structure but did not open an Incident Command center and did not have any declarations of emergency. The structure was followed for communications, for press releases, for daily briefings, etc. and was known as Incident Command "Lite". Jean Baldwin referred to a recent article in the Seattle Times on February 15, 2010, a review of what worked and what can be learned from this pandemic. She said that in Seattle, some healthy, pregnant women, some sick children and health care workers could not get vaccine. Throughout the state, there were numerous variations in supply and demand for the vaccine; this occurred at the national level as well. She said that the Health Department, in conjunction with the Hospital, will review their own performance and evaluate how well the overall process worked among all health system components in the County. She said that although the communication from the federal level on down was clearer than in the past, there were still many areas that could be improved. The Jefferson County statistics were not included in the packet. Jean Baldwin said the information could be found at: http://www.kitsgpcountyhealth.com/hlnl/InfluenzaSurveillanceReport.pdf . Dr. Locke confirmed that there were no deaths attributed to H 1 N 1 in Jefferson County. There was a brief discussion about the inevitable under -reporting of deaths associated with H1N1. Public Health Report for Region 2, Winter 2010 Dr. Locke briefly reviewed the contents of the report, which covers a three county area (Jefferson, Clallam, and Kitsap) and noted the change in format to a one page color report. Providers prefer the one page e-mail to the previous two-page mailed report. The graph displays the incidence of all circulating viruses for the reporting period and a chart showing the symptoms and characteristics of the viruses. He pointed out the tally of the most commonly reported notifiable conditions, such as Salmonella, Giardia, Hepatitis A, etc. He clarified that Campylobacteriosis is a food -borne, bacterial intestinal infection that is often associated with raw poultry. Jean Baldwin added that the total list of reportable diseases is provided annually. There was a brief discussion about the relatively lower rates of Chlamydia and Gonorrhea in Jefferson County. Dr. Locke said the rate (cases per 100,000) has been significantly lower in Jefferson County than in neighboring Kitsap and Clallam counties for several years. He did not believe the risk behaviors were significantly different and that the reason for the difference is the work of the Health Department and health care providers to screen at -risk populations, treat those found to be infected, and treat all of their sexual contacts. Key rates for Chlamydia are for the group 15-24 years of age when comparing among counties. Jefferson County Board of Health — February 18, 2010 4 NEW BUSINESS Olympic Community Action Program (OlyCap) Presentation — Oral Health Access in Jefferson County Tim Hockett, Executive Director of OlyCap, stepped through a slide presentation about OlyCap, with a focus on their oral health programs. Mr. Hockett described the OlyCap mission which involves determining "where the community hurts" and "what can we do about it". This involves development of a community needs assessment and strategic plan. He says access to health care has always been a major issue and it is closely related to poverty. Illness can prevent people from earning a living and health care can be so costly as to lead to bankruptcy. He discussed the long term need for free clinics and the network of volunteer providers that has evolved over time. Mr. Hockett described the origins of the Oral Health Care Access program during the mid 1990s, when OlyCap took over dental services from the Health Department. Under the Health Department at that time, it provided 21 days of service with a budget of $30,000 for all of Clallam and Jefferson Counties. They had contract providers and only portable equipment, which was set up at churches or other community locations for one or two days at a time. With the help of grants, they were able to expand to over 70 days of service per year. Dental care was limited to mainly routine cleanings and fillings. Plans were then laid to establish a fixed location for a two to three chair clinic. At the same time, OlyCap was working with Clallam County to develop a free medical clinic. An opportunity arose to partner with the Pierce College for their dental hygiene instruction program. After overcoming funding and organizational obstacles, a partnership was developed among OlyCap, Pierce and Peninsula Colleges; the mission was to help the community and to train dental hygiene students. Upon graduation from a two year program, students are able to qualify for living wage jobs. Mr. Hockett showed floor plans and photos for the dental clinics and described how he was able to raise $300,000 in a six month period. The 7 -chair clinic with a lab opened in September 2005. He described the challenge of opening and operating a full service clinic and coordinating the schedules for the academic program. Other partners were Washington Dental Service Foundation; First Federal Bank; City of Port Angeles; as well as others. As an indicator of service, Mr. Hockett mentioned that the clinic dealt with over 110 emergencies in 2009. The target population is low-income and uninsured; patients would normally have sought help at the hospital E/R. He pointed out that the costly E/R bills would not be paid and would need to be written off. He said that the program had received a State award because of the number of patients (one/third of those treated) that had been enrolled in a regular routine care program. He estimates that the savings for the hospital is about $30,000 per month. With regard to the financial aspects, patients do pay for services on a sliding scale. The average cost of an appointment is $85, which may include assessment, x-rays and Jefferson County Board of Health — February 18, 2010 5 extraction. The comparable fees at a private dental office are about $500. They do bill Medicaid, if appropriate. Mr. Hockett presented statistical information on the program. For 2009, the clinic saw 243 patients from Jefferson County (12% of patient encounters); there were 8% from the West End. The majority of service provided was for Clallam residents representing 78 % of the patient encounters. Mr. Hockett then described plans for a small clinic (3 chairs) in Jefferson County (Port Townsend). It is expected that the clinic will see over 1,000 patients annually. The operations model will be patterned after the OlyCap Oral Health Center in Port Angeles with volunteer providers and sliding fees, but will not include an academic program for dental hygiene students. He said he has a floor plan for the building next to Working Image, but is also considering the larger space vacated by the Food Bank. The cost estimate is $300 — 400,000. Grant funding is anticipated; application has been already been made to the Washington Dental Foundation for $150,000 and to a First Federal source. However, he said the OlyCap agency is struggling to continue all of its services under the impacts of the economic downturn and in consideration of the State budget problems. It will lose $150,000 in funding as of July 1, 2010. It has therefore halted its progress on the Port Townsend Dental Center. Mr. Hockett said that the OlyCap team will review and restructure its entire budget, and seek to find additional income. They will consider a limited private pay mix, possibly allowing its own insured employees to use the dental clinic. He said that when it is time to mobilize the community, he will need support to obtain loans and to implement the Dental Center plans. He said he is determined to establish an everyday dental care presence here. Jean Baldwin noted that Jefferson County is somewhat under -served in proportion to the population. She said that until a new dental center is built in Jefferson County, (which could be up to 5 years), transportation to the Port Angeles site is needed. Mr. Hockett noted that changing the mix would impact the bottom line. She said that Member Russell had been particularly eager to discuss this matter in relation to ER needs. There was further discussion about transportation options, such as acquiring van services. Member Westerman added that enabling greater patient encounters would also help build a stronger case for a Port Townsend dental center. Mr. Hockett said that the Community Needs Assessment, done in 2009, was a strong call for access to dental care in Jefferson County. He also indicated that since the first dental center was built in six months, after one year of planning, it may not take five years to do this. Meanwhile he is willing to investigate interim transportation options. He also mentioned that some patients have been willing to drive from Brinnon to Port Angeles. Member Sullivan offered that the County will help organize a transportation system. Jean Baldwin added that both OlyCap and Peninsula College are two -county organizations, and should provide services for Jefferson. Fran Joswick asked about the Dental Center capacity. Mr. Hockett said that it is operating at full capacity. He also noted that the academic program has been reduced to Jefferson County Board of Health — February 18, 2010 one class every other year, with a break between two classes in the summer months. This would provide some open chairs. He added that the center has been able to hire part-time dentists who also benefit by being eligible for tuition reimbursement for community service. Member Westerman asked if the Port Townsend dental center could be viable financially without the academic component. Mr. Hockett said it would actually work better without the student component, since the colleges do not pay their full share of space. Jean Baldwin inquired as to the usual sources of funds. Mr. Hockett said the Healthcare Authority awards service grants through the hospital. The dental component (for Jefferson County) is $37,000; that provides the portable dental equipment. OlyCap staff also helps to staff the Smile Mobile. In conclusion, Mr. Hockett said he firmly intends to do this project, but it has been slowed down by the economy. Members expressed their thanks for the presentation and the desire to work with Mr. Hockett on transportation in the short term. Member Frissell discussed a related matter, the upcoming accreditation review for Peninsula College in April. The accreditation team is soliciting letters from the community regarding what is needed, what is being delivered currently, and feedback about Peninsula's performance in this community. Member Frissell urged the BOH, County Commissioners and individuals to take this opportunity to provide feedback on declining services and to influence future educational services for Jefferson County. She noted that Peninsula College had spent $50 million to build on the Port Angeles campus, while virtually nothing has been done locally. There was mention that there is only one Peninsula Board member from Jefferson County, although there should be two based on population size. Member Frissell also noted that our local extension program is now being run from Port Angeles. Syringe Exchange Program Annual Report Jean Baldwin referred to the 4 -page 2009 Syringe Exchange Program (SEP) Annual Report in the packet. She said that syringe exchange numbers are down slightly. Secondary exchanges have decreased; she mentioned that there had been two known deaths in this group. In general, the SEP continues to see about the same numbers of individuals. During the last 12 to 18 months there has been much more education and disease prevention work. Free Hepatitis C testing and free Hepatitis A and B vaccine is offered at every visit. There is also continuing effort to reduce expenses in an already inexpensive program. Ms. Baldwin said there is a survey in progress about drug users and usage, with gift certificates as incentive. Referrals into treatment are increasing. Staff is also working at the treatment center doing Hepatitis C testing and Hepatitis A & B vaccine. There was discussion about the continuing need for outreach, including at the treatment center and at the jail; reuse of syringes was reported at 14 out of 75 client visits. The SEP Jefferson County Board of Health — February 18, 2010 7 tends to be used more by Port Townsend clients. The survey is also asking drug of choice, since this determines the way syringes are used/reused. Ms. Baldwin noted that patterns are changing, and monitoring will continue. 5930 (Enhanced Funding for Immunization and Notifiable Condition Reporting Programs) Work Plan Dr. Locke and Jean Baldwin described the background to this funding, which was established by the State after a failed effort to provide stable funding for the public health system at large. Jefferson County received about $100,000 annually for a set of specified services. This report delineates actions and accomplishments for two years, 2008-09 and what is proposed for the next year. This is about half of communicable disease funding; it has already been cut by 20% this year. She pointed out the level and range of activities that are provided under this funding, including HPV vaccinations; school-based clinics; and enhanced use of standardized software systems for tracking and reporting. There was a brief discussion about the anti -vaccine movement and the continuing problem for public health in successfully refuting erroneous information. Universal Vaccine Purchase Program Update Dr. Locke reported that the State's vaccine program which provides 30-40% of children's vaccine was due to end in May. This would have caused problems for providers in ordering and inventorying certain vaccines. However, a coalition of insurance companies and health care providers have negotiated a plan to continue the current system. Under this "universal purchase" plan, the federal programs will pay for about 70% of vaccine cost and the health insurers will pay the remaining amount. This will allow all childhood vaccine to be purchased at the federal discount rate. Ms. Baldwin noted that the collaboration among all interested parties is a major achievement and positive outcome for all involved, particularly children. Dr. Locke pointed out the packet materials which contain statistical details about vaccine use for Jefferson County. 2010 Leaislative Session Update Dr. Locke reported that, as discussed earlier, the pharmaceutical return bills are dead. The vaccine exemption bill has passed the House and has strong support in the Senate. This bill would require a parent claiming a philosophical/personal exemption from vaccinating their child to have a certificate from a licensed health care provider stating that they have been counseled on risks and benefits of immunization. Naturopaths are included in the types of providers. Dr. Locke said the intention is not to coerce parents who have strong objections, but to reduce what have become known as "convenience exemptions", i.e. parents who are not opposed to vaccination but find it more convenient to sign the exemption form than get their children vaccinated before school entry. The two mechanisms for increasing funding for public health are still alive: tax on bottled water and carbonated beverages and candy tax. However, this revenue may also be used Jefferson County Board of Health — February 18, 2010 8 for the General Fund. Member Johnson noted that the candy tax is likely to be defeated because of ambiguous definitions of candy versus food, due to strong lobbying efforts. Green Business Award for February, 2010 Vice Chair Nelson recognized a new Green Business Award for the month. Charles Kanieski, CPA, and two new Enviro- Star Awards, Taku Marine and Port Townsend Rigging. Jean Baldwin noted that Lori Clark has been recruiting successfully in the marine businesses, particularly those who sell to the Seattle markets. AGENDA PLANNING CALENDAR A Board of Health annual calendar and a form to assist in scheduling future agenda items have been included in the packet. Agenda planning was held for Chair Russell's return. Jean Baldwin noted that the March agenda and packet will include the 2009 annual performance measure reports. The next scheduled BOH meeting will be held on March 18, 2010 from 2:30 to 4:30 PM. ACTIVITIES UPDATE Member Westerman referred other members to the ongoing blogging discussion stemming from an original article on juvenile detention. Vice Chair Nelson reported that she had informed City Council that the BOH was interested in presenting a quarterly report, which was very well received. She said scheduling could be done through City Clerk Pam Kolacy. In addition, at a recent City Council retreat, the decision was made that each City Councilor will give a brief report on the committees that each is involved in. Ms. Nelson said she would welcome suggestions from other BOH members each month on what BOH items she should highlight for the next City Council meeting. Syringe exchange and Green Business/EnviroStar Awards were mentioned. Jean Baldwin and Sheila Westerman plan to present the Quarterly Report beginning in March. ADJOURNMENT Vice Chair Nelson adjourned the BOH meeting at 4:30 PM. Jefferson County Board of Health — February 18, 2010 9 JEFFERSON COUNTY BOARD OF HEALTH J-, Excused Chuck ussell, Chair Phil Johnson, ember e Kristen Nelson, Vice -Chair J hn Austin, Member Roberta Frissell, Member David Sul ]van, Member vj�- t4- �t,�u W-6, Sheila Westerman Jefferson County Board of Health — February 18, 2010 10