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HomeMy WebLinkAboutM071510JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, July 15, 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, Roberta Frissell, Chuck Russell, David Sullivan Members Excused: Phil Johnson, Kristen Nelson, Sheila Westerman Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin Guests: Frances Joswick, SAAB; David Alvarez, Deputy Prosecuting Attorney APPROVAL OF AGENDA Member Austin requested the addition of an item under New Business: action and correspondence concerning removal of an SAAB Board member. The agenda was approved unanimously, as amended. APPROVAL OF MINUTES Member Austin pointed out a spelling correction on page 3 for the name, Davis Steelquist. Member Austin moved for approval of the June 10, 2010 BOH meeting minutes, as amended; Member Sullivan seconded. The minutes of June 10, 2010 were approved unanimously, as amended. PUBLIC COMMENTS - None Page 1 of 11 OLD BUSINESS and INFORMATIONAL ITEMS Correspondence from EH Directors and Puget Sound Partnership Jean Baldwin referred to correspondence in the packet, noting the receipt of an additional letter received earlier in the day from the Director of the State Department of Ecology (DOE). She explained that the Washington State Environmental Health Directors had approached Puget Sound Partnership about continuation of the Shore Banks Loan program for septic repair. Mr. David Dicks' response is included in the materials. He urged the EH Directors to speak with DOE. Basically, although all are nominally in favor of the idea, there has been no commitment or action on this. She said that the first Shore Bank program had arisen from private foundations and Ecology grants; the next funding will come from Puget Sound Partnership and possibly other sources. Ms. Baldwin noted that the public - private program must be funded to manage 15 to 30 -year loans. She mentioned the possibility that this will become a national program. State Furloughs (DOH, DSHS) Jean Baldwin reviewed this informational item regarding the schedule for temporary closures (one lay off day per month) of State Offices in accordance with ESSB 6503, which is intended to reduce spending by an estimated $70,000,000. The packet contains two examples of communications announcing this measure. Health and Human Services Programs in Washington Counties Ms. Baldwin presented another informational item, a matrix showing those Washington Counties that have Health and Human Services combined in some form. For each county, its population and organization of services in indicated. Jefferson County Public Health is the only entity that has some Chemical Dependency services ("prevention contracts with DSHS for substance abuse and review of private housing contracts"), but not all. Counties not included in the matrix are those with separate Public Health and Human Services departments. Packet given to City of Port Townsend June 21 Presentation Jean Baldwin referred to the copy of the Regional Service Agreement on Public Health and Animal Services between Jefferson County and the City of Port Townsend. The agreement/document is up for renewal; it expires in December, 2010. She noted the importance of allowing adequate time for renewal of terms and for the County services to be re -included in the City budget, after an inadvertent lapse. Julia Danskin reported that the City has initiated a process whereby private non -profits and other agencies apply for City funds, but assumes a different process is appropriate for County/City service Page 2 of 11 contracts. Jean Baldwin said that Member Nelson, in anticipation of her absence, had asked Jean to convey to the Board: 1. two pending liquor excise tax initiatives would drop the liquor excise tax income for the City and County; and 2. expression of gratitude to Julia Danskin and her team for their excellent presentation on substance abuse to City Council. Ms. Nelson had noted that the City Council now understands how their funds are being applied. Julia Danskin then briefly reviewed the packet materials and content of the City Council presentation. She noted the challenge of providing meaningful annual reports for programs and goals of long term impact. She pointed out the item entitled: JCPH — Substance Abuse Prevention Program and Funding, Overview Flow Chart, June 21, 2010. She noted that there had been a question from City Council about the Hospital's role. She and other presenters had explained Chuck Russell's membership on the BOH, and the Hospital's collaboration with the County on Tobacco Prevention. She said such revisions would be made for future versions of the Flow Chart. NEW BUSINESS Olympic Regional Tribal -Public Health Mutual Assistance Agreement — Board of Health Roles and Responsibilities David Alvarez, Deputy Prosecuting Attorney, was present for this agenda item. Dr. Locke referred to the copy of the Agreement between three counties and seven Tribes, which is the first such agreement in the nation. He said it provides a structure for offering mutual assistance in emergency conditions or in certain non -emergency situations where one or more jurisdictions need help. He noted that this will be used for the first time beginning in the following week, when Clallam County sends two environmental health specialists and one public health nurse to Neah Bay for the Tribal Journeys, where an additional 7,000 - 9,000 people are expected to gather for the events. The agreement was passed in the fall of 2009 as an inter -governmental agreement, under the legislative authority of the respective Counties/Health Districts and Tribal governments. Following adoption, a detailed Operational Plan has been in development for a number of months and is near completion. As part of that process, a meeting was held in June to address legal issues; it was attended by attorneys from Jefferson, Clallam and Kitsap counties and legal advisors for the Suquamish and Jamestown S'Klallam Tribes. One of the chief issues, command and control (page 5 and 6 of the Agreement), was considered; i.e. when a local health department is called in for a local emergency, whose laws apply? Dr. Locke noted that Washington State has detailed laws and protocols, while the Makah Nation has none. The agreement provides for two options: 1. the Makah Tribal Council would agree that under certain circumstances, Washington law would apply within their district for a specified period and for certain conditions; 2. if the Makah had their own public health code and protocols, then those would be enforced. The latter is the targeted future direction, particularly with regard to food safety. In Page 3 of 11 option #1, there is intermingling of BOH authority as well as Health Officer authority. The authority to take police actions, such as quarantine people, close restaurants, etc. flows from the State legislature through state and local Boards of Health to Health Officers and their designees. Dr. Locke said that the Kitsap attorney, Alan Miles, had drafted a resolution for discussion: By resolution, the Board of Health would delegate the Health Officer to make a decision in an emergency regarding Tribal jurisdiction, and the BOH would subsequently affirm or not affirm that decision. The BOH would receive status reports on the situation; it would hold the ultimate authority. There was a brief discussion about the current lack of structure and authority for the County to assist or intervene in emergencies, such as in the event of a contagious outbreak on a tribal reservation bordered by State lands and communities. Dr. Locke noted that originally the federal public health authority would have filled that role, but that federal involvement except in felony level instances has greatly diminished over time. Furthermore, there are insufficient public health resources available to assume that role at the federal level. Dr. Locke cited examples of how these situations have been dealt with in the past. [Recorder's Note: The following was partially inaudible and should be reviewed by David Alvarez:] Mr. Alvarez also spoke about jurisdictional authority and granting of authority. A "grant of authority" from the governing Tribal Council would mean that whatever authority is carried as/by a local health officer, that same authority could be used on the reservation. He described several items from the June 21 meeting. He mentioned a list of specific non-native local health code regulations that the Tribe would invoke as applicable to its persons or its facilities. The _ of its due process rights and appeal and notice that would probably be parallel tracks between a tribal and non -tribal persons. There would be a request of the local health jurisdiction to observe cultural differences. There would be a start date and end date. There would be a list of designated tribal representatives as contacts. There would be an option for a delegation of authority from the Tribal Governing Body to their Executive Director. They may also cross deputize LHO (Local Health Officer) and his/her designees and statements about their authority if they had to appear in tribal court. Mr. Alvarez said that he would also prefer to see an agreement that the Tribal Council would publicize the terms of any emergency agreement or grant of authority throughout the tribal jurisdiction in order to prepare their members and promote cooperation. He noted that the due process to be followed could be different for tribal versus non -tribal members, as for example in a quarantine situation. There may be different appeal rights; different notice and different notice rights. In addition, a situation may likely arise on a holiday or time when the BOH can't easily convene. He listed policy issues for the BOH to consider: 1. Does the County BOH need to ratify the LHO's decision to accept the Grant of Authority, and if so, how soon? Does the County BOH want regular status reports, and if so how often? Does the County BOH retain the right to rescind the acceptance of the Grant of Authority? Dr. Locke and Mr. Alvarez had been asked to Page 4 of 11 obtain a comment or policy decision on the three items from the BOH by July 20 and bring them back to the facilitator of this process, Susan Ferguson. Member Russell requested and received clarification about the ad-hoc, specific situational and temporary nature of a grant of authority. There was also discussion about insurance, and involvement of the Office and School authorities. [Note: This was largely inaudible.] Mr. Alvarez noted the complexity of this type of agreement. In response to a question about initiation, Dr. Locke noted that the details of who is authorized to make a request and who may respond are spelled out in the Operational Plan. He acknowledged that the Tribes may have some resources including facilities that the Counties may need at some point. Dr. Locke said that he was seeking some sense of the BOH regarding the approach and to obtain feedback on any additional questions or issues that should be researched or resolved. He mentioned again that he and the other Health Officers are encouraging the Tribes to develop their own public health code, or adopt state or national health codes by reference. They are also encouraging the tribes to have local health officers or deputy health officers, who would serve as additional resources particularly in an emergency. Most of the tribes now hire physicians, who could be trained to handle public health functions, with Dr. Lindquist and Dr. Locke serving as advisors. Dr. Locke commented that the Alan Miles proposal seems most reasonable with regard to Option 1. He said he would ask that he be given the authority to respond to a Grant of Authority as needed, but that in most cases, an emergency meeting of the BOH would be called as soon as possible thereafter. He added that another expectation is that all three County Boards of Health would eventually adopt similar policies and procedures to the extent possible. Member Sullivan added that it would be essential to publicize this agreement and its provisions in advance and to iron out issues and implications in advance. Dr. Locke and Mr. Alvarez also pointed out that any services exchanged would be paid for by the receiving entity and would not represent an unreimbursed drain on County resources; the provisions are found on page 8, article 12. There was a brief discussion as to the Tribes that are party to this agreement and the fact that the parent agreement limits participation to federally recognized Tribes. Each tribe enrolls and records its own membership. After further discussion, Member Austin, acknowledging that the BOH is in general agreement with the draft resolution, moved to await a formal recommendation from the Health Officer(s) and a final draft of the resolution Establishing the Health Officer's Authority to Accept Tribal Grant of Authority under Mutual Aid Agreement. Member Sullivan seconded the motion, which was approved unanimously. Page 5 of 11 Environmental Protection Agency Grant Award to Jefferson County Public Health and Clallam County Public Health Jean Baldwin introduced Linda Atkins to describe the first rollout of this project to the public. Ms. Baldwin said it will come before the BOCC for signatures within a few weeks. She noted that the initial EPA press release was misleading in that it was unclear that the one million dollar grant is shared among 4 entities for 4 years. She also noted that, per the BOH request, Linda Atkins and Neil Harrington had prepared the grant application and had been successful in obtaining the award. Ms. Atkins said that this project had been envisioned as a coordinated effort between Clallam and Jefferson County, which share many concerns about shellfish and surface waters, and have similar mandates from the State. She said this joint grant was seen as a good way to bring multiple elements under the same umbrella with greater coordination both internally and with regard to the public. She said that they are looking at identifying and addressing issues that are resulting from changing patterns of development, the cumulative impacts of past development and the effects of seasonal inundation and flooding. The goal is to maintain enhanced water quality and safeguard the available resources, as well as support the recreational enjoyment of our waterways. Work in both Jefferson and Clallam Counties will focus on areas designated as a Marine Resource Area (MRA). Work will be done in the entire eastern Jefferson County Clean Water District; the Clallam area is more narrowly defined. She pointed out the MRA on a map: from Tallah Point in Port Ludlow Bay to the southern boundary of Jefferson County. There are other water quality grants that have been covering this rather large area, as well. Other aspects include development of a low interest loan program in Clallam County, similar to the Shore Bank program in Jefferson County. The lack of access to those monies has been a hindrance to Clallam County in the past. The Conservation Districts will continue to work with land owners on updating their management plans and implementing best management practices for waste management and protection of water ways. The Jefferson County Conservation District will also continue to do fresh water sampling along a number of streams to identify long term trends. For Jefferson County Public Health, the intention is to strengthen its operations and monitoring program and to coordinate with the Water Quality program's efforts. A list of the elements is included in the packet. The overall goal is to strengthen and to provide support to the professionals in the On Site Sewage industry (designers, installers and operations and monitoring specialists) so that they may provide consistent information, service and communication with the public. The intention is to reconvene an advisory group consisting of OSS professionals, property owners, utility owners and others to provide input and feedback regarding evolving policies and procedures. Page 6 of 11 With regard to technical assistance, Ms. Atkins cited the Clallam County initiative to develop a home owner inspection program, which includes an instructional video. She noted that it is extremely costly to provide individual training in a classroom setting. The Jefferson County goal would be to model that approach, and do so at a reasonable cost. . Ms. Atkins also spoke about an incentive approach for property owners, either by installing riser systems and monitoring ports on septic systems, or by having their first inspection done by a professional. Jefferson County will also continue to improve public access to OSS records and status of O & M inspection. Public access to the E -Onsite system is now available. Another important element is to identify systems (unknown systems) for which there are no current records and to provide information about operating and maintaining OSS systems. In addition, they will develop standard operating procedures and support to track failures and violations identified during the inspections process. In addition, through this and other grants, the goal is to coordinate with other counties to use similar messages, and to share resources, outreach/informational materials and tools. In closing, Ms. Atkins noted that the preceding summary represents the scope of work over four years, and that staff will return to the BOH with code revisions, matters of policy and implementation in the future. Ms. Baldwin recalled that the grant and implementation plan was in response to requests from the BOH to move the On Site Septic program forward. She suggested that Linda Atkins, Conservation District representatives and Andy Bradstad attend the upcoming BOCC meeting for signing of a memorandum of understanding. In response to a question from Member Russell, Linda Atkins said that by State mandate, septic systems with pumps are required to have annual inspections. Conventional gravity systems must be inspected every three years. Administrative details must be managed internally, and will be developed with the help of the advisory group mentioned earlier. Ms. Atkins said the department recognizes the need to help keep cost manageable for home owners. There was a brief discussion about how to verify the locations of septic tanks. She said that it is rarely necessary to uncover drain fields unless there are obvious failures. Member Austin inquired as to the need for additional staff to be hired. Ms. Baldwin said that a decision would be made before October 2010; some additional staff resources will likely be needed and would be covered by the grant. Ms. Baldwin recalled that the staff complement had previously dropped from 5 to 2. Member Austin also inquired about possible use of existing training materials from Island or Clallam Counties. Ms. Atkins said that to the extent possible, their materials would be "borrowed", but that some customization would be necessary. Ms. Baldwin also briefly explained tentative plans developed by DCD and Public Health for the stewardship resource center staffing. She Page 7 of 11 said that Public Health is looking at filling a vacancy and/or a grant funded position, and that some relief is expected for the DCD permitting functions. Ms. Atkins also discussed the issue of requirements for a complete septic permit. That is, how can staff facilitate providing the most complete information for an application; where can reference material be found and how to use it. She said she plans on coordinating professionals and in-house staff in this regard. Ms. Baldwin also noted that a checklist would be very valuable in this process. In conclusion, Ms. Atkins noted that the On-site Inspection Program concepts are now more fully developed and the public is now more informed and less apprehensive about expected changes. The Public Health department will continue to seek better ways to educate home owners and move the program forward. National Health Care Reform: Nurse Family Partnership in Washington State Jean Baldwin introduced Quen Zorrah who reported on the Nurse Family Partnership program in the context of National Health Care Reform. She pointed out the synopsis of a feasibility study that had been included in the packet. Ms. Zorrah noted that according to the Federal Health Care Reform funding criteria, preference will be given to those states that have a state wide implementation plan for home visiting. Washington State does not have such a plan at this point. In order to prepare for federal funds, this feasibility study was initiated, not by DOH, but by a group, (NFP consortium and CHLF), who work in collaboration with DOH. The part of the Health Care Reform legislation that applies directly to Public Health in Jefferson County is the Maternal, Infant, Early Childhood home visiting program. The vision is to create a comprehensive cross -agency continuum of services for children, pre- natal through age eight to address a range of health issues. First, state governments had to submit their intention to apply for the funds. Washington State was initially undecided but upon learning of ties to other funding did submit the application. The next step is a needs assessment, which is being done by the DOH MCH team. Ms. Zorrah noted that the assessment makes use of health indicators, including identifying communities with high concentrations of certain risks, such as are reflected in the feasibility study. She mentioned as examples: low birth weight babies, poverty, crime rate, domestic violence, and high school drop-out rate. The needs assessment must address all these issues on a community wide basis and, somewhat surprisingly, must also assess the community's need to serve families with substance abuse issues. Jean Baldwin noted that she had chosen to include the data for a selected group of counties: Jefferson, Clallam, Mason, Kitsap and King. She pointed out some of the apparent similarities and differences in these populations. Page 8 of 11 Ms. Zorrah said that under consideration for the State needs assessment is the possibility of breaking out the data by communities within counties. This is because at an aggregated level the degree of need may not be apparent. However, the federal criteria for the assessment have not yet been released, although the data must be complete and submitted by September 1. Meanwhile, based on formula projections from the State DOH, Washington would be eligible for $1.3 million for FY 2010. If benchmarks are met, based on outcome assessments, the allocation can increase in following years. Ms. Zorrah said it still unclear whether that would be on a calendar program -wide basis or a state-wide basis. The current plan is for DOH to take $500,000 to do the needs assessment plus 25% for administrative costs, leaving about $800,000. There would be $400,000 for evidence -based home visiting for the entire State; therefore Jefferson County may receive some "trickle-down" benefit. Additionally, DOH has decided to split the program among four agencies: DOH will take the fiscal administration role and serve as the lead agency for Nurse -Family Partnership; Early Learning will have all the other programs Council for Children and Families will do the evaluation; DSHS will coordinate billing. In summary, the amount of funding and the plan may not provide significant benefit for this county. Ms. Zorrah said that the likelihood for the State to receive funding this year may be low, due to a lack of leadership and coordination among many competing agencies. However, Ms. Zorrah cited the department's 11 -year experience with Nurse -Family Partnership, without a State-wide infrastructure. She said that if funding is received, hopefully it will enable the establishment of some infrastructure that could be well leveraged for better data analysis, report writing, etc. Jean Baldwin noted that Jefferson County's teen pregnancy rate is significantly better than neighboring counties and the State; the drop-out rate is also much better. These are examples of services that are measurably effective. In addition, those in need receive Medicaid to deliver babies. Poverty rates are similar to surrounding counties, with the exception of Kitsap's, which is lower. Ms. Zorrah said that staff continues to seek ways to improve the program with minimal resources, such as partnering with Clallam and Kitsap to increase capacity. She added that, throughout the State, those who have Nurse - Family Partnership programs wish to prioritize resources to sustain current sites. Member Frissell noted the high Maternal Smoking during Pregnancy rates and requested more information on possible reasons and solutions. Ms. Baldwin said that the Tobacco Program continues to work on this, along with the Hospital and physicians. She said the Tobacco program has only one more year of State funding. Julia Danskin said that due to reduced funding for maternity support services, nursing staff is not able to see many of the pregnant women receiving medical assistance, as in the past. Ms. Zorrah added that a percentage of women in this group are recovering from alcohol or drug addiction, and/or related depression that is often untreated. Although the smoking is of concern, it is one among several serious risks. She also said that the NFP data shows that from the time of intake to the time of delivery, there is a reduction in the rate of smoking. She said that this is a very high risk population and staff works very hard on this issue. Page 9 of 11 Green Business Certificates On behalf of the BOH, Chair Russell signed EnviroStars awards for five businesses: Point Hudson, Boat Haven, Marketech Inc./ J & S Fabrication, Pleasant Harbor Marina, and All City Autobody & Towing. Removal of SAAB Member Member Austin explained that a member of the Substance Abuse Advisory Board, Laura Blake, who had been appointed about one year ago, had not attended a high percentage of SAAB meetings. According to the SAAB Bylaws, three consecutive unexcused absences constitute reason for removal. Therefore, Member Austin, a member of both the BOH and SAAB, requested that the BOH remove Ms. Blake from the SAAB. Member Austin moved and Member Sullivan seconded a motion to remove Ms. Laura Blake from the SAAB based on lack of attendance, and to inform Ms. Blake of this action by letter signed by BOH Chair Russell. The motion was approved unanimously. (Chair Russell signed the letter to Ms. Blake on behalf of the BOH, dated July 15, 2010.) There was mention that Mike Blair was leaving the SAAB and acknowledgement that a letter of appreciation would be sent to Mr. Blair for his service. ACTIVITY UPDATE Member Frissell reported on her experience on an Alaska cruise where there was an outbreak of an unidentified intestinal virus. She noted the communications to passengers and the extent of sanitizing and precautionary measures taken by the crew. AGENDA PLANNING CALENDAR There were no items discussed. NEXT SCHEDULED MEETING Dr. Locke requested that he be excused from the next scheduled BOH meeting on August 19 due to personal business. He also suggested that the August meeting might be cancelled entirely, since there were no action items yet scheduled for August. Ms. Baldwin noted that typically there is a budget presentation and discussion at the August meeting, but that it could be done in September. She mentioned that the annual fees analysis had been completed and could be presented at either time. Page 10 of 11 Member Austin moved for cancellation of the August 19, 2010 BOH meeting; the motion was seconded by Member Frissell, and approved unanimously. ADJOURNMENT Member Austin moved for adjournment; the motion was seconded by Member Sullivan. Chair Russell adjourned the Board of Health meeting at 4:10 PM. JEFFER N COUN Y BOARD F HEALTH Chuck Russell, Chair Excused Kristen Nelson, Vice -Chair Roberta Frissell, Member Excused Sheila Westerman Page 11 of 11 Excused Phil Johnson, Member Jo ustin, Member Davi Sullivan, Member