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HomeMy WebLinkAbout03 March JEFFERSON COUNTY BOARD OF HEALTH MINUTES MARCH 19, 1998 BOARD MEMBERS DilJl Haryole, chairman - counly Commissioner District I Glen HuntinLJford, Member - counly OJmmissionlr District 2 Richard wojt, Member - counly Commissioner District 3 Ted shoulberg, Member - pori TOW/l5ena Cily council Jill Buhler, Vice chAil1/lilJl - H05]'ftal District #2 Commi55loner sheila westerman, Member - Citizen ai Law (Clly) Robert! Frl5sell, Member - Citizen ai Lmge (OJunly) STAFF MEMBERS David sfecter, Health Dl}'artment Director Jean Baldwin, Director of Nursing 5erviw Larry Fay, Director of EnvircnmentJll Health Thomas Lcdee, M.D., Health officer Vice Chairman Jill Buhler called the meeting to order in the temporary absence of Chairman Harpole. All other Board and staff members were present. APPROVAL OF MINUTES Commissioner Wojt moved to approve the minutes ofPebruary 19, 1998 as presented. Member Prissell seconded the motion which carried by a unanimous vote. PUBLIC COMMENT PERIOD No public comments. OLD BUSINESS PRlV A TIZA TION OF DRUG AND ALCOHOL PROGRAMS: David Specter reported that the Health Department has sent out "Requests for Proposals" to nine (9) different agencies, with a deadline set for the end of March. A "Bidders Conference" was held two weeks ago which resulted in a good response from agencies with extensive experience in contracting with public entities. The Health Department is developing a panel to review the proposals as they are received. The panelists include Ted Shoulberg, City Council member/Health Board member, Vic Dirksen, Jefferson General Hospital, two members of the Alcohol and Drug Abuse Services Advisory Board, and a County Alcohol and Drug Abuse Program Coordinator. It is anticipated that the Health Department will have a recommendation by the end of April and contracts in effect by June. David Specter stated that he has some audio cassettes regarding high risk communications that were recorded by a P.H.D. who runs an institute at Columbia University in New York. The cassettes are excellent and very informative. Anyone involved in public health leadership would benefit from listening to them. Dr. Locke added that listening to the cassettes changed the way he approached making public announcements about enviromnental health threats. All the Board members expressed interest in hearing the cassettes. David Specter will copy them for distribution to the members. HEALTH BOARD MINUTES - MARCH 19, 1998 Page: 2 TOBACCO BANS: David Specter reported that the Tacoma-Pierce County and King County Health Districts passed a ban on outdoor tobacco advertising. This past week the Southwest Washington Health District passed the same ban. The ban was appealed in the Tacoma-Pierce County Health District and was subsequently dismissed by a Court ruling. REOUEST FOR HEARING: FLOYD HEFFERLINE: Larry Fay explained that in January a letter was sent to Mr. Hefferline stating his request for a hearing was reviewed by the Board of Health and it was determined that the issue is not appropriate for hearing, however public comments are welcome. Mr. Hefferline wrote a letter to the Prosecuting Attorney questioning the Board of Health' s determination (See attached). The Prosecuting Attorney's office responded to Mr. Hefferline in a letter dated March 16, 1998 (see attached) stating that they would review his request and reconsider the earlier determination. Larry Fay will update the Board of future developments. LINDA SEXTON UPDATE: Larry Fay reported that earlier this week he reviewed a complaint that was completed by the Prosecuting Attorney's office. The complaint against Ms. Sexton is soon to be filed with Superior Court. Chairman Harpole noted that the Governor's office forwarded a copy of a proclamation declaring the week of April 6-12, 1998 as "Public Health Week". A similar proclamation will be adopted by the County Commissioners during their regular meeting next week. NEW BUSINESS USE OF STATISTICS IN PUBLIC HEALTH DECISION MAKING: GIARDIA CLUSTER STUDY: Dr. Locke reported that statistics used in Public Health is a powerful tool in looking at events, studying disease patterns in populations, and drawing conclusions. However, there are parts of statistics that can lead you to believe that things are connected, when in reality they are not. This can cause unfair targeting of problems. These associations or connections are known as confounders or biases. There is potential for both of these to appear in this study - (Example of confounder: If individuals who were reported to have Giardia had received better medical care than the rest of the population. There may have been many more individuals that contracted Giardia, however, only the individuals with medical insurance could afford to get tested, diagnosed and reported. Therefore, the rates of Giardia may be skewed based on the association with medical diagnosis). The other term known as bias, does not mean deliberately prejudiced. It relates more to how the cases are selected or analyzed that may change the relationship between the variables. Dr. Locke stated that "reporting bias" is the biggest problem with regard to the Giardia study. There is no way of knowing if the number of cases that were reported to the Health Department accurately reflects what is taking place in the population. Dr. Locke stated that all this means is that reviewing the studies must be done carefully. This is a very interesting study and is an example of the capabilities and technologies of health jurisdictions. Chairman Harpole stated the report says that "For the last 10 years, Jefferson County has consistently had a reported Giardia rate more than twice the state average." He asked if this is an example of case bias? Dr. Locke stated that the fact that the Giardia rate has been consistently higher than the state average, suggests that there is some factuality to the statistics. He noted however, that there are many potential confounders HEALTH BOARD MINUTES - MARCH 19, 1998 Page: 3 and biases. Part of reason Jefferson County has such a high rate of Giardia is largely due to the proximity to a national park, and the awareness and ability of physicians and health care providers to recognize, diagnose, and report this disease due to the frequent occurrence. Dr. Locke added that Clallam and Yakima Counties also have very high rates of Giardia. Commissioner Huntingford asked how the proximity to a national park relates to this study? Dr. Locke explained that Jefferson County has large areas of wild habitat with wild animals and a large population of individuals who use this habitat for recreation purposes (ie. camping, backpacking, etc.) and drink surface water that has been contaminated with Giardia by waste from wild animals. Drinking surface water in parks or wild habitats is the biggest risk in being exposed to Giardia. Dr. Locke added that this explanation is a theory derived from studies, it has not been proven. Larry Fay stated that the Health Department began looking into this because the rate of Giardia in Jefferson County has been so high. In response to a question from Vice-Chairman Buhler, Larry Fay explained that the cases were higher in 1990 and 1991 due to a breakout of Giardia which occurred in a daycare center and then recurred the following year. He explained that if water systems were not a factor, the cases of Giardia would be randomly distributed throughout the County's population. The Health Department identified all the known cases over the last 10 years, located them on maps, conducted a water surface area overlay, and conducted a comparative analysis of the frequency ofthe cases in and outside the water surface area. Through 1992, there is a very strong relationship between location and Giardia cases, however, as Dr. Locke stated, there may be a variety of reasons for this. When the study is reviewed from 1992 to the present, that relationship disappears. Member Westerman suggested communicating with the other counties that also have high rates of Giardia, to find out if there are any common factors to focus on. She asked how to prioritize this issue based on the fact that Jefferson County has limited resources and many problems? Larry Fay replied that it depends on the likeliness of being able to do anything about it. Chairman Harpole asked ifClallam County has conducted any kind of a study? Dr. Locke replied, no. Clallam County did not have the capability until just recently. As Larry Fay stated, it is a very significant issue if it is associated with public water systems. Otherwise, it is an issue of general health education, which is something the Health Department has been doing for a long time. Member Frissell stated that she and Jean Baldwin discussed over the years the many auto-immune diseases in Jefferson County. She began the discussion of Giardia when she read an article which referenced a book of theories on the issue. The book theorizes about a condition called "leaky gut syndrome", which is believed to be caused by Giardia. In another study conducted in California, several individuals with chronic fatigue were studied over a period of several years and the one thing that these individuals had most in common was that they all had Giardia at some point in the past. Member Frissell stated that in 1991 she had Giardia and in 1992 she and her neighbor were diagnosed with Fibermyalgia. So while the statistics are not going to show cause, there may be ramifications beyond just having the obvious symptoms of Giardia. Dr. Locke stated that Member Frissell's point is very important. The conventional wisdom about infectious diseases over the period of history, usually proves to be wrong. Sometimes diseases that are believed to be relatively benign, are later found to be very serious. Giardia is regarded as a nuisance disease, however, it may be a major cause of auto-immune diseases. Member Frissell suggested that there may be researchers who would be very interested in conducting studies on these types of issues in Jefferson County. HEALTH BOARD MINUTES - MARCH 19, 1998 Page: 4 Member Shoulberg asked about getting base line figures? Dr. Locke replied that it is unlikely that there will be any base line data for non-reportable diseases. It is something that would have to interest a well funded research oriented foundation. In conclusion Larry Fay stated that the Health Department reviewed the data available and determined that at this point there does not appear to be any risk associated with the distribution of surface water. INTRODUCTION TO ENVIRONMENTAL HEALTH REGULATIONS REVISION: Larry Fay reported that there are two sets of regulations in need of revision which were adopted in 1997 and are encompassed in one County ordinance #2-77: 1) The Onsite Sewage Regulations; and 2) The Solid Waste Regulations. On site Sewage Regulations: Larry Fay stated that the need to revise the onsite sewage regulations was a result of the State Board of Health's revisions to state regulations and more specifically, the provisions requiring counties to develop operations and maintenance programs for all onsite sewage systems by the year 2000. The state regulations do not provide much guidance for the development of an operations and maintenance program, therefore, it will be up to the counties to establish definitions, priorities, roles, and penalties. He presented a copy of Jefferson County's existing regulations, a copy of the state code and a summary of the issues that require revision. The Health Department has been working on this over the past two years and anticipates having a draft document ready to go through the public process by May. Larry Fay stated that a committee was established last year to begin the development of an operations and maintenance program. Members of this committee included a designer, installer, builder, septic tank manufacturer, water system operator, licensed operations and maintenance specialist, and individuals representing the following industries or agencies: Real Estate, shellfish, PUD #1, and Jefferson County Health and Human Services. Larry Fay stated that these regulations include the licensing of installers, pumpers, and operations and maintenance technicians. The licensing of designers may eventually be done by the state. The state licensing program for designers is being developed this year and will go before the legislature next year. Commissioner Huntingford asked if once a state licensing program is in effect, will there still be a need for the County to spend their time reviewing engineers' designs? It seems to be a duplication of work to review the designs oflicensed designers/engineers who have already met state requirements. Larry Fay stated that it is desirable to trust that individuals have the qualifications, expertise, and integrity to do a proper job of designing sewage systems, however, one of the problems with engineers is that the Health Department does not have any regulatory authority over them. If an engineer has poor practices, the Health Department is unable to do any1hing about it, except make a decision whether or not to issue a permit. The state committee developing the licensing program is attempting to clearly identify the responsibilities, liabilities, and penalties for designers/engineers. Commissioner Huntingford stated that applicants would probably prefer to pay one fee for County personnel to design and approve a sewage system, rather than having to pay a fee for an outside engineer to design a sewage system and then pay another fee for the County to review the engineer's design. Larry Fay agreed, and stated that there would be efficiencies gained if the County hired additional staff to conduct designing/engineering functions. It would be faster than the current system, however, years ago it HEALTH BOARD MINUTES - MARCH 19, 1998 Page: 5 was decided at the state level to privatize the designing/engineering of sewage systems. It is the responsibility of the Health Department to review the quality of work of the designers/engineers. A member from the audience stated that he is a registered professional engineer in the State of Washington and he suggested that if there are engineers performing poorly, the County should inform the State Registration Disciplinary Board. This Board will take action if necessary by imposing fines or revoking licenses. While there may not be any regulatory authority, counties can use this process as an enforcement tool. Larry Fay agreed that counties can and do report individuals to the Disciplinary Board, however, it can take years for some of the cases to be resolved and in the meantime, the licensed designers/engineers are still allowed to practice. Counties are in need of an effective form of enforcement. Discussion ensued regarding inspections conducted by the County, and the responsibilities of individual agencies with regard to various County ordinances which relate to each other. It was agreed by the Board that the Health Department will prepare a draft for the Board's review and comment at the meeting to be held in May. Chainnan Harpole asked staff to clearly denote the revisions on the draft document for easy reference by the Board. Larry Fay stated that it will be an entirely new document, so he will submit the existing regulations at the same time for comparison purposes. Vice-Chainnan Buhler stated she would also like to have a copy of the State law governing this topic. Solid Waste Regulations: Larry Fay presented a copy of the ordinance along with a copy ofthe State regulations. The solid waste regulations and minimum function standards are adopted and set forth by the Department of Ecology rather than the Department of Health. However, local health jurisdictions are responsible for permitting and enforcement. He identified the issues to be revised or added to the regulations. Again, State regulations provide technical standards but no guidance for establishing a process. The Health Department will work on developing a process and integrating it into the land use ordinances. The law provides counties the option to enter into an agreement with the Department of Ecology for the enforcement of solid waste regulations, although he does not know if any counties have opted to do that. Larry Fay stated that Jefferson County has an active Solid Waste Advisory Committee (S.W.A.C.) that will be working on community and public involvement in the development of the document which will ultimately be adopted by the local Board of Health. Member Westerman stated that she feels the S.W.A.C. should review the draft document before beginning the public process. Larry Fay stated that the Health Department will review the draft regulations with the S.W.A.C. for comment and input and then bring the recommendations back to the Board of Health for review. The Board of Health will conduct hearings when a final draft has been prepared. Larry Fay added that two solid waste bills were approved this year that should be considered when developing this ordinance. HEALTH BOARD MINUTES - MARCH 19, 1998 Page: 6 There is no specific time line for completion of this ordinance, however, the Health Department anticipates its completion by the end ofthe year. David Specter stated that the Health Department will be reviewing its fees this year and expressed concern about the possible impact these ordinances may have on fees. Discussion continued regarding the generation offees and funding. LEGISLATIVE UPDATE: Dr. Locke stated that the legislature recessed last week and there is some legislation pending decision by the Governor. This year many bills were introduced but not many made it though the legislature. The Child Health Initiative was a major disappointment from a public health standpoint. This initiative was to use funding derived from tobacco taxes for medical insurance for children. In many states the funding is being used to expand medicaid up to 200% of the federal poverty level. Since Washington is already at that level, it had the option of expanding up to 250%. This would have had the potential to affect approximately 15,000 children in Washington, however, it required a minimum of $1,000,000 in matching funds, to secure $49,000,000 in federal funding, which did not happen. Jean Baldwin stated that Washington could have increased to just 205% and still have received the same revenue. Dr. Locke stated that essentially, Washington lost its share of the Child Health Initiative and it will be distributed to other states. Members of the Board questioned why this initiative failed. Dr. Locke replied that he believes it was because the legislature could not justify increasing the poverty level to 250% (or an annual income of $36,000 for a family of four) and using taxpayers' money to pay for insurance for those families. The fact that it was a state subsidy for individuals who do not really need it, was a big issue. There was also strong opposition to expanding entitlements at the state government level, because they create future obligations. Dr. Locke reported that the following legislation passed: A bill making it illegal for minors to purchase or possess tobacco; a bill allowing administrative search warrants which will give the Health Department the option to inspect property of individuals who are violating health codes in situations that involve potential contamination of fresh or salt water; and a comprehensive watershed management bill. Dr. Locke concluded his report with a discussion oflocal public health funding. An initiative will be going to voters to reduce the motor vehicle excise tax (M.V.E.T.) which is partially used to fund local public health. If passed, the initiative will not have much of an impact on funding, however, there is a petition being circulated for an initiative to eliminate the M.V.E.T. If that initiative passes, it will significantly impact funding for criminal justice, transit, local public health and ultimately all County programs. Dr. Locke will update the Board on future developments. WASHINGTON STATE HEALTH REPORT: Dr. Locke stated that this bi-annual report is not yet available and will be discussed at the next meeting. AGENDA CALENDAR: The Board reviewed the following tentative agenda schedules: April Meeting Grays Harbor Board of Health Visit Washington State Public Health Report HIV Position Statements Needle\Syringe Exchange Program as a Public Health Strategy HEALTH BOARD MINUTES - MARCH 19, 1998 May Meeting Secretary of Health Visit Environmental Health Ordinances L.E.G. Report Communicable Disease Program Reorganization Health Access in Jefferson County Preliminary H.l.V. Reporting Discussion Page: 7 The Board concurred to discuss Health Department programs and priorities prior to discussion of the budget. Meeting adjourned. The next meeting will be held on Tuesday, April 14, 1998 at 2:30 p.m. JEFFERSON COUNTY BOARD OF HEALTH ~fu~~ ;, / :1__/_ ~- 7' ~, /' SheIla Westerman, Member /) if' /tdv r;ti/ /lLd..l/ J!L Roberta Frissell, Member OjtJI.. mber C::', \i~: ._Xlv . ed Shoulberg, Mem r