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HomeMy WebLinkAboutM021711JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, February 17, 2011 - 2:30 PM — 4:30 PM Public Health Conference Room, 615 Sheridan Street, Port Townsend Board Members Staff Members Phil Johnson, Vice Chair, County Commissioner District #1 Thomas Locke, MD, MPH 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 Roberta Frissell, Citizen at large (County) Stuart Whitford, Environmental Health Services Director Kristen Nelson, Chair, Port Townsend City Council Sheila Westerman, Citizen at large (City) Jill Buhler, Hospital Commissioner, District #2 Chair Kris Nelson called the meeting of the Jefferson County Board of Health to order at 2:34 pm. A quorum was present. Members Present: David Sullivan, John Austin, Roberta Frissell, Kristen Nelson, Sheila Westerman Members Excused: Phil Johnson and Jill Buhler Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin APPROVAL OF AGENDA It was moved and seconded for approval of the agenda. The agenda was approved unanimously. APPROVAL OF MINUTES Member Austin moved to approve the minutes of the January 20, 2011, Board of Health meeting. Member Russell seconded the motion, which carried unanimously. PUBLIC COMMENTS Mr. Thomas Brotherton, a resident of Quilcene, asked if it was cost-effective to keep the Quilcene clinic open or would it be more efficient to have those medical services provided by other medical clinics? He proposed changing to a voucher system for Quilcene residents to receive needed medical care. Page 1 of 6 BOH Minutes February 17, 2011 OLD BUSINESS and INFORMATIONAL ITEMS Letter to the Editor: American Journal of Public Health Ms. Baldwin reported that Dunia Faulx, who is working with Jefferson County Public Health (JCPH) as an AmeriCorp student, co -wrote a letter with four staff to the American Journal of Public Health regarding Adverse Childhood Events (ACES). The letter has been accepted for publication. Issue Brief: Responding to Vaccine -Hesitant Parents Dr. Locke updated the Board on a provider briefing prepared by the Seattle & King County Public Health on the issue of "vaccine -hesitant parents". The letter reviewed the history of Andrew Wakefield's 1996 article linking the MMR vaccine and autism and its subsequent determination to be fraudulent. The issue brief offers excellent advice to practitioners on how to counsel vaccine hesitant parents and to inform them that the alleged links between MMR and autism have been conclusively disproved. This letter was sent out to all providers in Jefferson County last week. Dr. Locke is hopeful that a bill currently before the Washington State legislature will make it mandatory for vaccine -hesitant parents to receive risk -benefit counseling by a licensed health care provider before they can exempt their children from school entry vaccination requirements. Letters to Legislative Delegation: Medication Take Back and Vaccine Exemption Letters to legislators expressing the Jefferson County Board of Health's support for the medication take -back program and the vaccine exemption were provided in the packet. NEW BUSINESS Community Health Services in South County Quen Zorrah presented a report of Community Health Services in South County focusing on public health priorities and the data supporting those priorities. The services in South County are targeted services based on the needs of two different populations: Giving children a healthy start in life through Women, Infants, and Children (WIC) and Maternity Support Services and reducing the cost burden of health care in our community by decreasing the number of unintended pregnancies through consistent family planning services. Ms. Zorrah reported that the data collected has shown improvements in areas such as reduced child abuse referrals, lower teen birth rates, and decreased smoking during pregnancy. There are also areas which need continued work such as first trimester prenatal care. Ms. Zorrah listed the goals to support these priorities and the target population for these services. There was discussion on the importance of WIC services in South County because JCPH is the only provider of WIC in Jefferson County. Not only does WIC provide food vouchers but also provides medical screening, developmental screening, screening of pregnant women, education Page 2 of 6 BOH Minutes February 17, 2011 for pregnant women and parenting families and referrals to other community services. Weekly drop in hours in South County have improved the enrollment in WIC. Margie Boyd, Jefferson County Public Health Nurse, commented on the community health services in South County. Ms. Boyd expressed her concern that the Jefferson County Public Health Clinic in South County is providing services such as WIC that are not and cannot be provided by other clinics. They are seeing high risk patients who do not have the means to travel to another city for services or prescriptions, so without this clinic they simply would not be receiving the care they need. Ms. Boyd maintains that this clinic is serving a different population with different needs than other medical clinics in the south county area. Ms. Baldwin pointed out that all other services that have been provided in South County by other agencies are no longer there. JCPH and Jefferson Health Care are last of the original five service providers that remain in South County. Member Nelson raised the question whether signage would increase the amount of people using the clinic. Ms. Zorrah responded that they have relied on word of mouth, community referrals, an ad in the Leader and posting fliers. This is a clinic targeted at people needing family planning, pregnant women, and children under age 5. Board of Health Guidelines for Adoption of Policies, Procedures, and Protocols Dr. Locke stated that Jefferson County Public Health has been going through a standards review process over the past several months. Part of this has involved the review and updating of current policies. In addition to BOH policies, there are also administrative policies and various procedures and protocols. Dr. Locke clarified that the only policies that the Board has to formally review and approve are those that have to do with the Boards authorities and responsibilities. The role the Board wants to take in the development of other types of policies, procedures, and protocols is open for discussion. Member Westerman asked for an explanation of the difference between policy and a protocol. Dr. Locke defined policy as a governing board's statement of intent on how to carry out its specific powers and duties. Dr. Locke defined a protocol as a standardized sequence of actions that are performed to achieve a particular outcome. He stated that protocols typically based on current science and seek to improve quality be assuring best practices are followed in performing specific activities. Finally, he defined a guideline as an educational document that explains and clarifies specific issues. Member Nelson requested a clarification of the title of the document being Policies, Procedures and Protocols, because the explanation was on Policies, Protocols and Guidelines. Dr. Locke agreed and suggested that a better title for this document would be Guideline for Adoption of Policies, Protocols and Guidelines. Member Frissell moved to adopt Guideline for Adoption of Policies, Protocols and Guidelines. Member Westerman seconded the motion. The motion was approved unanimously. Page 3 of 6 BOH Minutes February 17, 2011 JCPH Strategic Planning and Quality Improvements: Past, Present and Future Ms. Baldwin presented the materials and graphs that were included in the packet on the Past, Present and Future of the Jefferson County Public Health Strategic Planning and Quality Improvement. Ms. Baldwin reviewed the JCPH Planning History Graph, which shows the who, what, when and where of different trainings and models used in the past. Ms. Baldwin described how the staff has been reorganized into teams, with a lead staff for each team. Teams are based on shared work, performance based budgeting and the end of the year performance measures. There are trainings for the leads so that they can become technical experts in their areas of responsibility. Ms. Baldwin addressed the Mission Statement. She pointed out that in 2004 and 2006 priorities of JCPH were recommended by BOH to be based on the State Standards Review. Those standards are; Assessment of local needs and health indicators, Communicable Disease Prevention and Control, Environmental Health and Safety, Public Policy Development. Ms. Baldwin in 2008 looking at the JCPH personnel roster, found a large percentage of the staff that would retire within the next 10 years. Team leaders and staff met to discuss strategies for JCPH to mentor internal leadership, develop regional partnerships, and provide services by using the concept maps. The goals teams identified as most important were brought back to the Board. In 2009 the C -mapping JCPH strategic goals were discussed, and the list of the steps that are being taken to achieve these goals. A copy of the JCPH Strategic Goals graph was provided in the packet for reference. Next Ms. Baldwin addressed what is being done presently to achieve these goals in the time of a continuing recession. She explained the process teams use to build performance measures and quality review into the County budget process. Teams also must use a Quality Assurance approach while they respond to emergencies, identified problems or performance measures deficiencies are addressed with a Plan -Do -Study -Act model. The JCPH Plan -Do -Study -Act model describes how a problem is approached and how JCPH will evaluate the effectiveness of this approach. A copy of a sample Plan -Do -Study -Act project was provided in the packet to show how a Chlamydia outbreak problem is reviewed by two technical nursing teams, what will be done in the future to resolve the issue and review the outcomes. Finally Dr. Locke addressed the future of JCPH continuing to fulfill its core mission while dealing with budgetary constraints, the retirement of a highly skilled workforce and the political uncertainties of health care system reform. He stressed the importance of a Community Health Improvement Plan (CHIP) by doing strategic planning with hospitals and medical providers to identify the gaps in the community's needs, and develop a plan to address the gaps. Dr. Locke stated an option is to do strategic planning in the context of a broader community partnership. Ms. Baldwin stated the unknowns of legislative action will change state and federal funding make long term planning difficult. The BOH must monitor the level of expertise and funding needed to have the Health Department and their different programs maintain quality. Ms. Baldwin recommended not doing a new strategic plan in this uncertain environment. She does Page 4 of 6 BOH Minutes February 17, 2011 feel that it is important to prioritize the services, and maintain a level of expertise while engaging other community partners when looking at these priorities. WA State 2010-11 Supplemental Budget Update Dr. Locke stated that Legislative passage of the supplemental budget for the current fiscal year has not yet occurred. Ms. Baldwin stated that there are many programs whose funding levels are still uncertain. Legislative action is expected in the near future. Legislative Update Dr. Locke reported that a bill that expands the powers and duties of the local Boards of Health to allow Boards to assess fees to fund operation and maintenance programs for onsite sewage systems has been introduced. Mr. Whitford addressed other Environmental Health bills. The first being a septic utility which would take the place of existing funding fees, which he explained is a more stable funding source. The second bill addressed is that onsite inspectors must be certified through Department of Licensing to inspect septic systems, there are several health jurisdictions that are not in favor of this program so there is a compromise bill that reduces fees, reduces continuing education requirements, but keeps the program in place. Another bill allows members of the restaurant association to do their own food card testing. Environmental Health Directors are against this bill. Dr. Locke stated that the Board has already taken a stand on the two important bills; the medication take -back bill and the vaccine exemption bill. Influenza Update Dr. Locke reported that influenza activity has been slowly increasing in Washington State for the past several weeks. Jefferson Healthcare and Olympic Medical Center now have policies in place that require unvaccinated health care workers to wear masks when influenza is circulating in the community. One of the responsibilities of the local health officer under this new policy is to advise the respective hospitals when influenza activity reaches the point where masks should be worn and when those masks are no longer necessary. That point has not yet been reached but is likely in the next week or two. ACTIVITY UPDATE Data Steering Committee, February 24, 2011: Health Care Access Ms. Baldwin announced that the Data Steering Committee will be meeting next Thursday February 24, 2011. She has released the health care access data to all of the committees early so that they can be sued for program changes. Next module is death and birth numbers and birth outcome. Page 5 of 6 BOH Minutes February 17, 2011 AGENDA PLANNING CALENDAR Board of Health Meeting Calendar for 2011 The next scheduled BOH meeting will be held Thursday, March 17, 2011 from 2:30-4:30 pm at the Health Department, 615 Sheridan Street, Port Townsend, WA. Ms. Baldwin stated they need to work on performance measures for the next meeting. ADJOURNMENT Chair Nelson adjourned the meeting at 4:30 pm. JEFFE ON COUNTY B OF HEALTH Excused Kristen Nelson, Chair Phil Johnson, Vice -Chair Jo n Austin, Member Davi Sul ivan, Member Excused Roberta Frissell, Member Jill Buhler, Member � b', 4 , W b-) �4 "-_ Sheila Westerman, Member Page 6 of 6 BOH Minutes February 17, 2011