HomeMy WebLinkAboutM121610JEFFERSON COUNTY BOARD OF HEALTH
MINUTES
Thursday, December 16 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
Sheila Westerman, Citizen at large (City) Stuart Whitford, Environmental Services Director
Kristen Nelson, Vice Chair, Port Townsend City Council
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 2:30 PM. A quorum was present.
Members Present: John Austin, Roberta Frissell, Phil Johnson, Kristen Nelson, Chuck
Russell (arrived 2:45 PM), David Sullivan, Sheila Westerman
Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin, Veronica Shaw,
Stuart Whitford
Guests: Phillip Morley, County Administrator
APPROVAL OF AGENDA
Jean Baldwin suggested a brief discussion about plans for meeting minutes in 2011; this
item was added at the bottom of New Business. She also added a handout for the packet
on teen pregnancy that was in response to public comments at the previous meeting. The
agenda was approved unanimously, as amended.
APPROVAL OF MINUTES
Member Austin moved for approval of the October 21, 2010 BOH meeting minutes,
as written; Member Westerman seconded. The minutes of October 21, 2010 were
approved unanimously, as written.
PUBLIC COMMENTS
Mr. Tom Brotherton, Quilcene, requested that the BOH consider establishing a noise
ordinance in Jefferson County. He noted that the City of Port Townsend has a noise
ordinance. He quoted RCW 70.107.010: "The legislature finds that inadequately
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controlled noise adversely affects the health, safety and welfare of the people, the value
of property and the quality of the environment." He stated that the RCW authorizes local
jurisdictions to regulate noise. Enforcement would be the responsibility of the Sheriff's
Department. He listed a number of health issues related to noise identified by the World
Health Organization. He recommended that the Health Department sponsor a study of
health problems related to noise and coordinate among other departments including the
Sheriff's Department,
Mr. Brotherton also referred to the agenda item on tobacco use in Jefferson County. He
urged the BOH to do more on tobacco awareness, particularly through "free" media, such
as press releases.
Members Austin and Sullivan noted that noise issues had been considered in the past by
the BoCC, and that State standards are followed. Member Westerman noted the dilemma
of providing more services in a time of shrinking revenues and without voter
endorsement of tax increases.
Davis Steelquist, Quilcene, said he wished to talk about agendas and minutes, an issue he
had previously raised in June 2010. He pointed out that, on November 17, the meeting
information posted on the web site referred to the September BOH meeting. He said that
no minutes had been posted since July. He added that he had not received a response to
an e-mail on that subject that he had sent to the director of the Health Department and the
BOH. He said that by December 4, a special hearing notice for December 16 had been
posted. As of December 14, the agenda for December 16 appeared, along with a set of
minutes for the October meeting, which were not actually approved until earlier in
today's meeting. He said that he was further confused about the heading date on the
posted minutes, which appeared to be for July 15, 2010. Mr. Steelquist stated that these
types of administrative errors and the lack of a response to an e-mail inquiry reflect badly
on the BOH and the Health Department. He suggested that the BOH have its own e-mail
address through which the public can reach members directly.
Member Nelson explained that she had been out of town for a month which may have
contributed to the delay in signing and publishing minutes.
OLD BUSINESS and INFORMATIONAL ITEMS
Chimacum Smile Mobile Event Report
Julia Danskin briefly reviewed highlights of the December 6 report on Smile Mobile
activity during the period November 8-12, 2010 that was provided in the packet.
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Governor's Executive Order 10-06 Suspending Non -Critical Rule Development and
Adoption
Jean Baldwin referred the letter notifying State Agency Directors and other authorities of
Governor Gregoire's Executive Order regarding suspension of development and adoption
of rules for the next 12 months. She said it will impact many government activities and
services. It directs that no unnecessary rule making will occur. She noted that the State
Board of Health, of which John Austin is a member, may continue to make some rules
but there will likely be delays in others under consideration because of the lack of staff in
key supporting agencies such as the Department of Health and Department of Ecology.
There was a brief discussion about the interpretation of "non critical rule making".
Member Austin mentioned that, based on a recent meeting of the Policy subcommittee of
the State Board of Health, the State Board has stopped working on all but a small subset
of the rules in progress. He noted that the number of sessions per year will decrease. Dr.
Locke mentioned updates to the food code, which are linked at the Federal, State and
local levels. The 2009 federal version is now available while the State code is still linked
to the 2001 version. There was a brief discussion about the types of activities that are
considered essential to public health versus what is funded.
Tobacco Use in Jefferson County
Karen Obermeyer, Tobacco Prevention Coordinator, presented an update on the tobacco
program in Jefferson County. She referred to summary materials included in the meeting
packet. Ms. Obermeyer clarified that, in accordance with standard practice, smoking
rates are combined/averaged over three years. Although rates may vary year to year due
to small survey samples, the trend from 2003 to 2009 is downward. There was a jump in
2008 which affected the 2007-2009 three year rates. She explained the use of 30 day,
age-adjusted rates. Two areas of concern are the smoking rates for adults and pregnant
women, which are higher than State and national rates. Rates are higher among
populations age 18 to 34, and among low income and low education populations.
Progress has been made in certain areas. In the State of Washington, indoor air pollution
has decreased 88% in bars and restaurants. In Jefferson County, smoking is prohibited in
95% of homes and Tobacco Quit Line calls have risen from 67 to 143 calls from 2007 to
2009.
Ms. Obermeyer discussed program elements that are designed to save lives and money.
She noted her work with Headstart and other organizations to educate clients and
employees about the risks of second hand smoke. She also trains retailers and performs
compliance checks to ensure they follow laws prohibiting tobacco sales to minors. In
2010, 85% of retailers who had compliance checks were found to be compliant. The
program also includes training other organizations to screen and refer clients for help in
quitting, and working to increase the number of smoke free environments.
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Funding for the Washington Tobacco Control Program has just been cut by $3,000,000
for the current fiscal year. This means that tobacco contracts for Jefferson County will
end at the end of December 2010. The Quit Line and tobacco retail education will
continue.
Julia Danskin thanked Ms. Obermeyer for her contributions to tobacco prevention, noting
that reduced funding would prevent her from spending as much of her time on the
tobacco program in the future. Jean Baldwin noted that services in the schools would
also be affected; the regional City/County contract will end as of January 1. The
enforcement of the local No Smoking Ordinance (901) is now without a source of
funding. No smoking signs and other materials will still be available. On a positive note,
there was recognition that behaviors have already been changed by education and
monitoring. On the other hand, tobacco corporations continue to develop new products
that are not yet regulated but may still be health risks, such as electric cigarettes and
forms of nicotine -containing snacks.
Public Hearing: Environmental Fee Revisions 2011
Stuart Whitford, Environmental Health Director, explained that the fee schedule that had
been presented in October was largely unchanged from 2010, except for a few
clarifications. He said that certain fees had been added for plan reviews. He asked for
any questions from the BOH. Stuart Whitford noted that the fees are structured so as to
cover the cost of staff time for tasks.
Vice Chair Nelson open the public hearing and invited public comments. Mr. Davis
Steelquist stated that in his observation of County regulations, he has found cases of
ambiguity due to the lack of explicit definitions for key terms. Mr. Whitford said that the
definitions are covered in policies and in the food code, and could be referenced in the
fee schedule. There was a brief discussion in which it was noted that the fee schedule is
available online.
Baldwin explained that a number of internal administrative policies and procedures do
exist and, depending on the topics they cover, are approved by Dr. Locke, Ms. Baldwin
or Mr. Whitford. In addition, certain policies are set by the BOH.
Mr. Brotherton asked how the fees are determined. Member Westerman provided a
summary of the process from several years earlier, with participation of a cross section of
the community, that had led to the decision to establish fees that are cost -based, i.e. the
staff cost on average to provide each service. The fees are updated as costs rise.
Vice Chair Nelson closed the public hearing.
Member Sullivan mentioned that the law does not allow public agencies to charge more
than the cost of providing the service. There was a brief discussion about the appropriate
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process for separate approval for the Fee Schedule ordinance and for the associated
policies.
Member Austin moved for approval of the Fee Schedule Ordinance; the motion was
seconded by Member Westerman. Member Russell stated that he would abstain from
voting because it directs affects him as a food service establishment owner. Member
Nelson noted that the ordinance affects her as well, but that she had no objections to it.
The BOH approved the motion by a vote of 6 in favor, none opposed, with 1
abstention.
Environmental Health Policy Revisions: Food Safety Program
Stuart Whitford, Environmental Health Director, referred to policies in the packet that are
undergoing development/revision. This is a periodic process to assure that existing
policies are up to date and determine whether new policies need to be developed. The
intention of including them in this month's board packet is to show what is in progress;
there will be additional items later. He invited BOH members to comment or pose
questions.
Dr. Locke said that in the course of these policy revisions, a 1988 policy about policy
remains in effect until the Board amends or repeals it. He said he would like to propose
updating the 1988 document to define/establish which policies the BOH reviews and
formally adopts, and clarifies the other categories such as administrative policies, clinical
protocols, and guideline documents. He explained that enforcement involves authority
contained in BOH policies, local public health codes and state public health codes. He
said that for policies, the process used for the adoption of an ordinance is not required; a
policy can be reviewed and approved by a majority of members in one BOH meeting.
Stuart Whitford invited the BOH to forward any comments on the materials in progress to
Susan Porto or him.
There was a brief discussion about the posting of food establishment inspection results on
the web and how patrons can ensure that food has been kept at safe temperatures.
Re -appointment to Substance Abuse Advisory Board (SAAB)
A letter of application for term renewal on the SAAB from Frances Joswick was
provided in the packet. Member Austin commended Frances Joswick for her leadership
of the SAAB. He moved that the BOH re -appoint Ms. Joswick to the Substance
Abuse Advisory Board for a second term; the motion was seconded by Member
Russell. The motion was approved unanimously.
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2011 Jefferson County Budget: Jefferson County Public Health Impacts
Jean Baldwin noted that staff had several issues to discuss with BOH regarding the
budget in light of State and County budget reductions. First, she requested that the BOH
consider conducting executive sessions for discussion of personnel impacts due to budget
cuts, particularly in cases if the regular meeting schedule does not permit timely
consideration and action. She mentioned the loss of $56,000 for the tobacco program.
Ms. Baldwin said that she and Dr. Locke had exploratory discussions about
regionalization of some health services with other Health Departments and the public
hospital district. She said that there are no obvious solutions. She added that other
counties are not in any better positions than Jefferson County.
She noted that, in addition to aggressively managing its current income sources and
expenses, the Health Department had applied for 5 other grants that did not come
through. Some layoffs are dependent on the City/County contract, i.e. funding for the
school tobacco prevention programs.
JCPH management has internally, focused on maintaining core services and preserving
public health technical expertise; there is also attention on transitional plans and support
for staff.
Ms. Baldwin referred to the staff letter of November 19 to the BOH regarding the budget
and a letter dated December 2 from Roberta Frissell to the BOCC and Phillip Morley.
She referred to previous discussion about the possibility of returning $50,000 or $100,000
to the General Fund in the third quarter of the fiscal year. She explained the background
of the situation in which the Health Department had accumulated a cash balance. Some of
the factors are conservation of staff hours, aggressive pursuit of stimulus funds, and
delayed receipt of H IN 1 funds. She stressed that in planning for next year, it must be
realized that the current situation is unique. Veronica Shaw explained how the State
Department of Health directives regarding cash flow have contributed to the cash
balance. She also mentioned discussions with County Administration about possible
changes to cost allocations including overhead cost. She said she was not in favor of a
special arrangement for the Health Department versus other County departments.
Member Westerman said that she was in complete agreement with the points made in
Member Frissell's letter. She said she believes the Health Department is doing its job in
planning and maintaining a reserve for shortfalls and emergencies. She said she feels they
are being punished for doing a great job in managing their resources. She also believes
that the full $100,000 should be returned to them. She said that the department and BOH
have worked for 15 years to build a culture and ability to take care of its responsibilities,
for example a natural disaster or other terrible emergency. She said that while it may be
too late to change the budget for this year, she does not wish to see the Health
Department subjected to this type of process in future years.
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Veronica Shaw added that other counties she has contacted have emergency reserves in
the range of 14 to 23%.
Phillip Morley, County Administrator, said that he would like to provide more on the
background of this situation. He acknowledged the need to be prepared for any public
health emergencies. He also noted the information emerging during the previous 48
hours from the State legislature as it is in the process of attempting to balance the budget.
He said he recognizes the gravity of the situation and how all County offices share in
these impacts. He recalled that during the adoption of the 2010 budget, his office had
been monitoring historic trends of various fund balances and had considered but deferred
steps to rebalance certain funds relative to the General Fund. Late in 2010, he had
proposed the $50,000 transfer from the Health Department to the County General Fund,
which was followed by the November 19 letter of response from Health Department
administrators. Mr. Morley said that since that time, he has reviewed the two sets of
internal projections and decided to wait at least until the end of the year, when more
financial information is available. Secondly, he acknowledged the existing climate of
scarcity that affects all parties. He said he agreed that any rebalancing should be
consistent with clear facts and within a policy framework. While local funding cannot
fully supplant declining State funds, it may be possible to ease the transition. He said that
there was no intention to act unilaterally, but rather to propose and discuss.
Member Sullivan stated that he is in agreement with the need for surge capacity, and the
General Fund could be source for that purpose. Staff noted that the BOH and Health
Department had not been operating with that assumption historically. There was a brief
discussion as to the meaning of surge capacity, i.e. major emergencies necessitating
unbudgeted expenditures versus loss of funding sources.
Member Sullivan also suggested that care must be taken in calling an Executive Session,
based on the subject matter, and that Atty. Alvarez should be consulted. He also
mentioned that he had spoken with Mary Selecky and that she is also trying to protect the
surge capacity at the State level. He reminded that Public Health is a mandated service
per the State constitution.
Veronica Shaw said she wished to clarify one other point regarding the 2008 budget year.
Although the Health Department had received a contribution after the budget had already
been approved, that money ($265,000) has since been given back to the General Fund.
Member Austin observed that everyone present shares a certain passion, dedication and
sense of responsibility for the health of the County. He expressed hope that all parties
will continue to work together for the benefit of the entire community.
Jean Baldwin noted that her staff is fully aware of the risk to the whole community with
the losses of services, and education. On a positive note, she reported that Adult
Pharmacy appears to have been reinstated in the State budget. Its loss would have
severely impacted the hospital, mental health programs, and other critical services, such
as those for HIV.
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Member Johnson acknowledged the needs and position of public health and recognized
the many other County needs and priorities to be considered and weighed by the BOCC
in a period of declining resources.
Washington State Budget Update
Jean Baldwin referred to a letter to public health officials from the Governor's office. It
discusses flexible funds for County governments to allow more local discretion for
services chosen as the highest priorities. She mentioned that communicable disease
funding was preserved and tobacco prevention funding was lost. Ms. Baldwin said that at
this point in time the Health Department had lost $153,000 in funds, but there will be a
series of other cuts in the coming months. The Family Planning and MSS planned cuts
have not been as drastic as first suggested. She and Member Sullivan noted the full
impact will not be known until the end of the legislative session. Ms. Baldwin said she
would return to the BOH with information about the extent of cuts as they are known.
2011 WSALPHO (Washington State Association of Local Public Health Officials)
Agenda
Dr. Locke said that WSALPHO membership had been asked to think ahead and identify
Board of Health priorities for the 2011 legislative session. He mentioned preserving
flexible funding and the options for developing long-term stable funding sources. Dr.
Locke also mentioned identifying and eliminating expensive low value regulations and
promoting programs that are highly cost effective. In addition, he mentioned reshaping
public health and deciding what the "new normal" will look like. He encouraged
everyone to read "An Agenda for Change" which had been included in the packet. He
said this represents some of the best thought in the State about the direction governmental
public health is going in. Ms. Baldwin particularly recommended the section on
visioning/guiding principles on page 5 as a starting point for discussion at the January
BOH meeting.
Ms. Baldwin also called attention to the document describing the CDC's Winnable
Battles imitative. She noted that there is a new director who has experience as Public
Health Director in New York City. His vision is to focus on those areas where significant
progress can be made in a relatively short time frame. Ms. Baldwin briefly reviewed and
noted the disconnect between State and federal priorities and the local impacts of that.
Mr. Morley added that since it may be some time before the State is in a position to
restore former funding levels, it is important to identify the most critical services locally
and how they will be paid for. He said the County will begin a visioning process in
January, looking out 4 or 5 years, and suggested this should be linked with the process
that the BOH is undertaking. He said he plans to attend BOH meetings in the future.
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February 2011 Standards for Public Health Practice Audit: "Basic" Standards
Option
Jean Baldwin briefly described the review process that takes place every three years. A
consulting group visits each health department to perform a standards audit and assigns a
grade. The department has always done well. Much of the focus is on internal standards
and work. This year the review is in February; many State cuts will take effect in March.
She noted that several other counties have decided not to participate, while larger
counties will participate as a practice for national accreditation. Jefferson County has
selected the modified standard, a compromise which has been offered to all small and
moderate size health departments. This option represents about half the volume of
reports, and requires about three weeks of work for senior administrators Baldwin and
Danskin. It will allow the department to see if it has improved over earlier audits. The
department has the option to select the full standard in the future if economic and time
pressures change.
Julia Danskin clarified that this performance review is tied to a local capacity
development fund starting in 2011. The statement of work will reflect that the
department meets this standard. The basic review involves 76 items instead of the 140 in
the full standard. She said it involves much documentation, including BOH minutes as
evidence of decision making and oversight processes.
Transition Plans for BOH Meeting Recording and Minutes
Gail Bernhard has announced plans for retirement and will no longer be available for
meeting recording, transcription, and minute's preparation. Jean Baldwin asked BOH
members to consider a shorter, action/task-focused, summary format. This may allow
internal staff to perform this function, with some potential savings over the current
contract arrangement. A digital recording would still be available. Member Nelson
noted that the current method is particularly helpful to members when they are unable to
attend a meeting. However, all members agreed that they were willing to work with
piloting a more condensed version.
Member Frissell and other members commended Ms. Bernhard for the work she has done
for the BOH and Health Department.
ACTIVITY UPDATE
Julia Danskin announced the upcoming Region 2 Public Health Emergency Preparedness
and Response Statewide Exercise: January 25-27, 2011. She said she would report on the
results in February.
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AGENDA PLANNING CALENDAR
The next scheduled BOH meeting will be held Thursday, January 20, 2010 from 2:30 to
4:30 PM at the Department of Public Health, 615 Sheridan Street, Port Townsend, WA.
Vice Chair Nelson listed possible agenda items mentioned during this meeting. There
was agreement that public health priorities should be discussed. Members were not in
favor of further discussion on a noise ordinance in the near future nor on the creation of a
special BOH e-mail arrangement. The election of BOH officers will also take place at
the January meeting.
ADJOURNMENT
Vice Chair Nelson adjourned the BOH meeting at 4:37PM.
JEFF SON C UNTY BOARD OF HEALTH
Chuck R se 1, air P*Johnsomber
Kristen Nels , Vice -Chair Jo A�bstin, Member
Roberta Frissell, Member David Sullivan, Member
Sheila Westerman
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