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HomeMy WebLinkAboutM061010JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, June 10, 2010 2:30 PM — 4:30 PM Public Health 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 Chuck Russell called the meeting of the Jefferson County Board of Health to order at 2:37 PM. A quorum was present. Members Present: John Austin, Phil Johnson, Kristen Nelson, Chuck Russell, David Sullivan, Sheila Westerman Members Excused: Roberta Frissell Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin Guest: Frances Joswick, Substance Abuse Advisory Board (SAAB) APPROVAL OF AGENDA Member Austin suggested the addition of an item under New Business: Appointment of Anne Dean to the SAAB. Member Austin moved and Member Russell seconded for approval of the agenda, as amended. The agenda was approved unanimously, as amended. APPROVAL OF MINUTES Member Westerman noted a typographical correction at the top of page 3: "through the local ...." . Member Sullivan moved for approval of the May 20, 2010 BOH meeting minutes, as amended; Member Nelson seconded. The minutes of May 20, 2010 were approved unanimously, amended. Page 1 of 10 Board of Health - June 10, 2010 PUBLIC COMMENTS Chair Russell asked speakers to limit their comments to three minutes or less. Tom Brotherton noted that, because of the placement of the Public Comment period at the top of the agenda, it is difficult for any member of the public to comment on the business of the meeting. He said that it would be easier to comment if that was permitted following the presentation of information for any agenda item. In addition, Mr. Brotherton referred to an agenda item from the May meeting during which accreditation was discussed. He noted that there had been no discussion of the benefits expected from attaining national accreditation, and believes that should be part of the discussion and consideration before spending money and resources in that regard. David Steelquist stated that he had sent an e-mail to the Board of Health and the BOCC. He stated that the publication of the BOH meeting agenda had not been timely: the May agenda was never posted and the June 10 agenda did not appear until June 9. He referred to the relevant RCW noting that the agenda is to be published 10 days in advance of the meeting. He also noted that minutes are to be published within 10 days after approval, if there were decisions made. However, he said that the minutes for February, March and April 2010 were missing from the web site. He quoted RCW 42.30 with regard to the obligation to keep the public informed of government actions and decisions. Mr. Steelquist also noted that, since he had not seen the minutes, he did not know the background of the agenda item "Why are we not spending enough on Public Health". He expressed concern about the availability of metrics that show where we are succeeding and where we need to do better. He cited reports from the State Board of Health indicating that Jefferson County is average or below average performance in some areas. He requested that the BOH or BOCC publish relevant metrics. In addition, Mr. Steelquist expressed his concern and cautioned that, with regard to treating people or providing services, "we are becoming more of an enabling organization than one that is solving some of our problems". Jacob Johnson introduced himself as a life long resident of Jefferson County and owner of several businesses which employ people locally. He noted the slow economy and the fall off in construction work. He said that he was representing a client of his excavation business who had a drain field designed by a licensed designer in 2003; she had intended to build but, because of a boundary line dispute and the economy, the project was delayed. The permit expired in 2006. She is now unable to renew the permit because the regulations have changed. Mr. Johnson said he has verified, with the help of a licensed designer, that the soils and conditions at the site have not changed. Mr. Johnson and his client are seeking a reconsideration of the situation and the permission to construct the drain field as originally designed, without the undue expense of a whole new design and permitting process. He urged County officials and staff to work with the community toward solutions, particularly in these difficult economic times. Jean Baldwin requested that Mr. Johnson provide the client name in writing for staff follow up. Page 2 of 10 Board of Health - June 10, 2010 With regard to timely publication of meeting agendas and minutes, Ms. Baldwin noted that a staff member had been on medical leave for 8 weeks, but that those duties had been reassigned temporarily. She was concerned that some data/documents may have been deleted from the web recently and said that she would attempt to restore that. She also noted that the metrics are published, appearing under the Standards for Public Health by County. [Mr. Steelquist added, at this point, that the minutes for the Substance Abuse Advisory Board and Developmentally Disabled Advisory Board are also not available on the web.] OLD BUSINESS and INFORMATIONAL ITEMS Puget Sound Septic System Repair Loan Program Dr. Locke referred to the letter in the packet from the 12 Washington coastal county Environmental Health directors to the Puget Sound Partnership seeking help in establishing a regional septic system repair loan program. The letter calls attention to the need for resources to repair failing septic systems once they are identified. Jean Baldwin added that Jefferson County has been fortunate to have Shore Bank funding through the Hood Canal Regional Septic Loan Program. Clallam and other non -Hood Canal Counties have not had benefit of such a program. Member Sullivan noted that up front capitalization is the biggest hurdle for such programs, since they do eventually pay for themselves. Correspondence Jean Baldwin referred to the letter in the packet, addressed to her, from Mr. Brotherton (and Mr. Whitaker) dated April 2, 2010, along with her April 23 letter of response, which included an invitation to attend a BOH meeting. She noted that she does not routinely share with the BOH correspondence addressed directly to her. However, she had done so at this time because a very similar letter had appeared in the Leader from Mr. Steelquist dealing with the same issues. She said she wished to address the misinformation that had appeared in the Leader and other places. She said there is confusion about the quality of services provided by our local Health Department compared to other counties. One source is a University of Wisconsin study that discusses the physical environment, such as number of liquor stores, availability of produce and air quality. She explained that these particular measures are not valid measures of the Health Department and that the department has no control over these quality of life factors. For other quality of life indicators, Jefferson County rated in the top third of the State. Regarding another issue, per capita funding of Health Departments, Ms. Baldwin said that there are major differences in accounting methods, in categorization of programs, how overhead is spread, and many other factors that complicate comparisons between local health departments. Some Health Departments do not include Environmental Health — as Jefferson County does. In fact, Jefferson County Public Health has an Page 3 of 10 Board of Health - June 10, 2010 unusually large number of different programs, such as Environmental Health, Water Quality, Developmental Disabilities, Substance Abuse, and Community Health, organized under one department. This is one of the reasons that per capita expenditures for "public health" are not readily comparable from county to county. In addition, Ms. Baldwin noted that the source document cited is old and had been shown to be erroneous in a number of aspects. Member Austin noted that a significant number of services provided by this Health Department are not covered in other jurisdictions. Exemption to New Bottled Water Tax Dr. Locke discussed the provisions of the recently enacted tax on bottled beverages including bottled water. He said many people had not realized that this includes the large 5 gallon containers of water used by some people as their main source of drinking water. However, for those drinking bottled water for health reasons or for those who do not have access to a safe source, there is an exemption. One such health reason for drinking bottled water is for those who suffer from a serious immune system disorder and have been advised not to drink water from any surface water source (e.g. the Port Townsend municipal water system). This is because it is not possible to assure that unfiltered surface water is free from Cryptosporidium, a parasite that can cause chronic infections in those with severe immune deficiency. In order to obtain the exemption, an individual must have a prescription or letter by a licensed health care practitioner recommending avoidance of unfiltered surface water or some evidence that they have no access to a source of potable water. Ms. Joswick inquired whether the information regarding Cryptosporidium and auto- immune disease is available on the web site, and whether people understand they can get information and help from the Health Department. Ms. Baldwin said that there had been several notices sent to providers, who would be aware of patients with severe autoimmune disease. The process for obtaining special tax exemptions is also available on the website. New Low Cost Health Coverage Offered Julia Danskin briefly described the new low-cost health coverage program announced in May by the Washington State Health Care Authority (HCA). There is a waiting list of over 100,000 people for the state's Basic Health program, which provides coverage for 65,000 Washington residents. The new program, Washington Health Program, is a non - subsidized version of Basic Health; enrollees pay the full premium, plus a small amount for administrative costs, and there are caps on annual costs. There are no income limitations on enrollees. Community Health Plan of Washington is under contract with the HCA to provide this health plan coverage. Ms. Danskin noted that children under the age of 19 continue to be eligible for the Basic Health subsidized coverage. Page 4 of 10 Board of Health - June 10, 2010 Dr. Locke noted that few states have programs like Basic Health. The Washington Health Program is, in effect, Washington's own "public option" for health insurance access. "Why We Don't Spend Enough on Public Health" Dr. Locke discussed an article by David Hemenway that appeared in the May issue of the New England Journal of Medicine. He noted that there is a great deal of national discussion about investing more in Public Health as part of the health reform initiatives. He said that compared to other countries the United States spends only a fraction of its health care budgets on Public Health. This is a major reason for the high incidence of many preventable health conditions in the United States as compared to other industrialized nations. The article lays out 4 major reasons that this under -spending on Public Health has occurred historically. Effectively addressing these issues is part of the the challenge in trying to promote greater investment in public health infrastructure as part of National Health Reform. NEW BUSINESS Annual Review of Jefferson County Shellfish Growing Areas Follow Up Alison Petty, registered sanitarian and member of the water quality staff, distributed copies of the 2010 Shellfish report and provided an update for the BOH based on this report. She explained that accreditation is based on the FDA regulated National Shellfish Sanitation requirements. There are four classifications for shellfish growing areas: Approved, Conditionally Approved, Restricted, and Prohibited. The Washington State Department of Health now has a Concern status, as well, to provide an early warning for shellfish growers. Dabob Bay: Ms. Petty displayed a map showing the area of Station 296. She explained the evaluation scheme, noting that a count of "23" (fecal coliform per 100 ml) is the value at the 90'h percentile. This means that of all samples for the last five years, 10% or more are greater than or equal to 23, which is higher than it should be. A count from 20 to 30 places the station in Concern status; from 31 to 43 is Threatened; anything above 43 is Prohibited. She pointed out that there are no other water quality concerns in Dabob Bay. In examining the detailed sample data, Ms. Petty indicated that one very high sample of 1600 in the past has greatly skewed the average. That instance was likely caused by storm water runoff during a period of very heavy rain, 4" in one day. Another factor is that there is little flushing in this bay. In response to a question, she acknowledged that mistakes can also happen, such as an erroneous value being reported, but that is fairly rare. Hood Canal #3: There are four stations of concern: 136, 137, 140, and 143. From 1988 through 2001, this area was rated as Prohibited due to seal activity. After erection of page 5 of 10 Board of Health - June 10, 2010 fencing, the conditions improved and the area was upgraded to Approved. However, Ms. Petty noted that there are occasionally some high readings, likely stemming from the Duckabush River. She said this may always be an area of concern. She also pointed out the reading at Station 143 at the Fulton Creek. Ms. Pettie said that the Water Quality team spends considerable time doing sanitary surveys, visiting property owners and doing water quality sampling. There have been some high hits prompting follow up with home owners on septic systems. Mats Mats: Station 10 is Conditionally Approved; it has had some high readings. There is a commercial grower here, Mats Mats Oysters. Ms. Petty noted that the Mats Mats Bay project is underway. She said that there is frequent monitoring/sampling and active efforts by the Health Department in talking with property owners about their septic systems. She said that the source of any persistent problem would be identified and corrected. Ms. Petty said she does not believe flushing is very good in this location either. Mystery Bay: There are four stations in Threatened status due to boat moorage; there are no water quality problems. However, as discussed at length in previous BOH meetings, a collaborative effort by the County and many other agencies and shellfish growers has led to development of a management plan to implement a no anchoring zone, reduce the number of boats and ensure proper water conditions. Port Townsend: Station 33, which is actually in Port Hadlock, is in Threatened status due to boat moorage. Ms. Petty said the water quality samples have shown absolutely no water quality issues. DNR has begun tagging boats, with the hope of moving or removing some of them. If this is not successful, the area may be downgraded. In response to a request from a member of the audience, Ms. Petty displayed data for Mystery Bay, where water quality is excellent. She said that data for other areas, such as Kilisut Harbor, is available online under the website for the Office of Shellfish and Water Protection (www.doh.wa. og v/ehp/sf/). Community Leadership Letter Revisions Dr. Locke noted that the draft in the packet reflects a series of revisions based on the discussions of the previous meeting, with specific input from Member Westerman and then further modifications by Jean Baldwin and Dr. Locke. He explained that it has become clear to them that a two stage process, at a minimum, is necessary. Considerable groundwork will be needed before making application for federal and community transformation grants. Furthermore, grant application for national health reform grants is not really an option until 2011 at the earliest. The first stage of the proposed community assessment project likely involves a smaller group to work on data collection, updating ongoing measurements, and identifying gaps and missing information. Page 6 of 10 Board of Health - June 10, 2010 Jean Baldwin added that the data discussions originated in the Healthcare Access Committee. Members include Vic Dirksen, Dr. Locke, Jean Baldwin, Julia Danskin, and OlyCap, O3A, and Mental Health representatives. They had realized that the new census will not provide the depth of information compared to previous censuses. There are common issues of concern, particularly homelessness and hunger. Mr. Dirksen also wished to delve into healthcare access issues and behavioral work with regard to tobacco, domestic violence, etc. A second issue is that some shift in the membership will occur due to the transitions of several school and agency administrators and the retirement of Mr. Dirksen. She mentioned UGN, Domestic Violence, Mental Health and the Community Foundation, most of which have expressed great interest in pursuing data collection/analysis, collaboratively. Economic Development will engage consultants to look at broad economic indicators, but will not do in depth demographic analysis targeting family income, housing and healthcare; this would need to be done by the Data Working Group. Ms. Baldwin said, however, that she would track the results from the Economic Development study and from the joint County/City/Port planning effort. Ms. Baldwin recalled that in an earlier process, a community group had narrowed a list of nine in-depth issues to three, and these still rise to the top: families with children have more health problems; economic development to increase family wage jobs; and substance abuse is a problem across the age span. She noted that the intention is to reexamine key issues in depth, through a non-political community partnership including the County, Hospital and, hopefully, the City. BOH members are welcome; she asked for Ms. Nelson's help in finding other City representatives. With regard to the draft, Member Nelson suggested that, if possible, a synonym should be found for "kickoff'. Later in the meeting, Member Westerman suggested several other options: "introductory meeting, initial meeting, first meeting or startup meeting". Ms. Baldwin said that the letter would be mailed to the distribution and that she would follow up with phone calls. Chair Russell indicated that he had signed the letter, as presented. Emergency Water Plans for Licensed Food Service Establishments Jean Baldwin discussed the letter and Guidelines document that had been mailed to food service establishments in December 2009, requesting each to submit a proposed water emergency plan; copies of documents are in the meeting packet. She said that some restaurants had responded and their plans had been approved. The Health Department will continue to follow up on this issue in discussions with food service establishments as part of the regular licensing process. An important component is to update records with emergency alternative contact numbers and e-mail addresses. Member Austin suggested a presentation to the Chamber of Commerce. Dr. Locke said that in the event of a water supply problem or Boil Water Advisory, the public health goal is close a minimum of food service establishments. For those with a plan in place, it should be possible to keep operating, using bottled water, disinfection, Page 7 of 10 Board of Health — June 10, 2010 boiled water, and other emergency procedures. This applies to any licensed food service establishments: restaurants, filling stations, grocery stores, etc. He said that health clubs and shower facilities etc. are not regulated. Member Nelson said that, as a business owner, she found the letter to be very appropriate and helpful. Dana Fickheisen, Food Inspector, noted that in the event of such an emergency, she would like to be able to contact a manager who can verify that an approved plan is being followed. Dr. Locke noted the process will depend on the seriousness of the situation and the type of contamination. There are minimal contamination situations where the process can be streamlined. For serious cases, there are additional precautions and steps that must be taken. Jean Baldwin also noted that the food service rules and fees are being reviewed to ensure that all is clear, complete, simple and unambiguous. In response to a question from the audience, she verified that all changes would be properly noticed and reviewed through a public hearing process. New Jefferson County Public Health Web Page Jean Baldwin reported on the transition to the redesigned web site, which has been in process for about five months. It will soon be possible to track usage/number of hits per item. An important design goal is making the information readable, clear, easily accessible and meaningful. She said that decisions on placement, navigation and linkage are challenging. Some of the headings are changed, and there are a number of specialty pages and links for providers only, WRIA-17 only, and other specific users. These pages are not secured from other users but are intended to be as convenient as possible for physicians, etc. In the future, targeted e-mails will contain embedded links to new information. Ms. Baldwin noted that, as indicated earlier in the meeting, certain material had been inadvertently dropped and would be restored. She invited everyone to tour the website and inform her of any problems or things that should be corrected or improved. The new site will not be announced until it has been finalized and reviewed more thoroughly. SAAB Re -appointment — Anne Dean Member Austin commended Anne Dean for her work on the recently completed substance abuse cost study and with the One tenth of One Percent Advisory Group. He moved that the BOH re -appoint Anne Dean as an SAAB member. Member Westerman and Francis Joswick expressed their enthusiastic support; the motion was seconded. The BOH unanimously approved the reappointment of Anne Dean to the SAAB. Page 8 of 10 Board of Health - June 10, 2010 ACTIVITY UPDATE Member Austin reported on the State Board of Health meeting in Snohomish County on June 9. He mentioned that Snohomish has two full time statisticians. He noted a presentation on health statistics for that county that included mortality rates for young people. The number one cause of death is car accidents. Death from poisoning, associated with overdoses or lethal combinations of prescription drugs, an apparent "recreational" trend, is a close second. In addition, there is a petition for a rule change on State regulations regarding fluoride. Dr. Osmundsen, a cosmetic dentist, and an attorney, James Deal, testified against community water fluoridation. They wish to see fluoride widely advertised as a poison. They also wanted the Food and Drug Administration (FDA) to regulate fluoride added to drinking water as a medication. However, the Environmental Health committee advised that the Board to not act on the petition since the FDA has already decided not to regulate fluoride in water and that it lies within the jurisdiction of the Environmental Protection Agency. The school rules have still not been funded. Discussions are in progress on Class B water systems, those having 14 or fewer connections. The Board is considering exceptions for systems with only two connections, in an attempt to allow flexibility for local health jurisdictions. Member Nelson noted that Jean Baldwin and Sheila Westerman will present their quarterly report to City Council on June 21. AGENDA PLANNING CALENDAR The next scheduled meeting is on Thursday, July 15, 2010. Member Westerman will be unable to attend. ADJOURNMENT Chair Russell adjourned the BOH meeting at 3:52 PM. Page 9 of 10 Board of Health - June 10, 2010 JEFFER N C NTY B ARD OF HEALTH �� �._._ C ck ssell, Chair Phil Johnso , Member Kristen Ne ice -Chair Jo Austin, Member i; I Excused Roberta Frissell, Member David Sullivan, Member J ��a Sheila Westerman Page 10 of 10 Board of Health - June 10, 2010