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HomeMy WebLinkAbout07 July JEFFERSON couNTI( BOARD OF HEALTH MINUTES JULY 16, 1998 BOARD MEMBERS Dan Hill)'oIe, Chairman - county Comm~sioner District! Glen HuntinLJfonl, Member - county Commissioner D~trict 2 Richard wojt, Member - county Commissioll<Y District 3 Ted shoulberLJ, M""ber - port Townsend City cOlmetl Jill Buhlrr, Vi", Chairman - Hospital District #2 Commissioner sheila westmnafl, Member - citizen at LarLJe (City) Roberta Frissdl, Member - Citizen at IarLJe (county) STAFF MEMBERS David syeeter, Health Deyartmenl Director Jeall Baldwin, Director of NursinLJ services Lany Fay, Director of EnvironmentJ1l Health ThomilS Locke, M.D., Health o,~cer Chairman Harpole called the meeting to order. All Board and staff members were present with the exception of Commissioner Huntingford, Jean Baldwin and Sheila Westerman. APPROVAL OF MINUTES Commissioner W ojt moved to approve the minutes of May 21, 1998 as presented. Member Shoulberg seconded the motion which carried by a unanimous vote. Member Shoulberg stated that he would like to add a discussion and possible action item on a Board of Health Rule to the agenda under new business. PUBLIC COMMENT PERIOD Kelly Scott stated that he is here to comment during the Board's discussion of HI V position statements and named reporting. He has served on the Governor's Advisory Council on AIDS since 1993, on the task force which studied the AIDS issue, and he is currently the Chair of a public policy committee which is made up of individuals across the State of Washington living with H.LV. OLD BUSINESS STATUS REPORT ON ALCOHOLIDRUG PROGRAM PRIV A nZA nON: David Specter reported that on July 1, 1998, the alcohol and drug program was taken over by Sound Recovery Center, under their new title Jefferson Community Recovery Center. There has been good response from community members who interact with the administrator Richard Weiss and good relationships are being established between providers. With regard to the transition of patients, David Specter reported that there have not been any negative comments. All the active clients were contacted and the transition has been very smooth. HEALTH BOARD MINUTES - JULY 16, 1998 Page: 2 NEEDLE/SYRINGE EXCHANGE PROGRAM UPDATE: Dr. Locke explained that the Health Department is pursuing a needle exchange program due to requests from community members and the local HIV community based organization "JAZZ", and because of the Health Department's own concern about blood borne pathogens. Needle exchange is a recognized method of reducing the risk of transmitting diseases such as Hepatitis B, Hepatitis C and HlV. The first stage in the initiation of the program was a briefing which took place several months ago. The second stage is to review regional models and coordinate advocacy groups to provide presentations. While the Health Department has made contact with various groups, they have not yet scheduled any presentations. Dr. Locke noted that there are five (5) main syringe programs in the State of Washington with Walla Walla County being the first rural county to begin a program. He believes the most effective way for the Board to approach this is to hear directly from the advocates. A quantitative approach would not be effective for Jefferson County as there is simply a lack of data on the problem. After a presentation is given, the Board may decide to consider some type of needle exchange program. At that time the specifics of the program would be discussed. Chairman Harpole asked if the Clallam County Board of Health has discussed this issue? Dr. Locke answered no, and stated that there has not been an interest expressed by the community. Chairman Harpole said he would be interested in information on the initiation and status of Walla Walla County's program. He added that the Municipal Research Services Center (MRSC) may be a resource for obtaining that information. Dr. Locke stated that getting an advocacy organization to come and make a presentation should not be difficult since it was the community that requested the issue be brought up. In the mean time the Health Department will continue to look at various program models. Commissioner W ojt asked about the easy access to syringes. Dr. Locke stated that anyone can purchase syringes, however, establishing a program is meant to 1) discourage syringe sharing; 2) pull discarded syringes off the streets, as they become valuable when they can be traded for new syringes; and 3) get public health messages out and individuals into treatment programs as a result of relationships being formed between the syringe users and the individuals who are distributing the syringes. Julia Danskin, Health Department Nurse, stated that occasionally the Park Service has called about children who have pricked themselves with discarded needles. While the Health Department has a protocol for dealing with these types of incidents, there is a real risk to the community when discarded needles are found. Sheri NeSmith, added that a needle exchange program is way to get addicts into health care and treatment. Typically, addicts do not buy their needles. OTHER PROGRAM UPDATES: Ban on Tobacco Advertising: David Specter reported that Snohomish County Board of Health passed regulations on tobacco advertising by a vote of 13 to O. Their program was modeled after Pierce County's which bans advertising visible from public streets and walkways except for tombstone advertising. It also bans advertising within 1000 feet of schools, playgrounds, public parks, and licensed child care centers. HEALTH BOARD MINUTES - JULY 16, 1998 Page: 3 Chairman Harpole asked if the Board of Health could get a copy of their policies to decide if they want to take up the issue? Jefferson County Fair: Julia Danskin reported that the Health Department is changing their protocol on dealing with head lice. Since this has become such a big issue, the Health Department will be focusing on head lice during the County Fair next month to provide education and information to the community. Lisa McKenzie added that their motto will be "You Ought To Have Your Head Examined". She stated that head lice has been an increasing problem in Jefferson County over the past two years. There have been many calls from the schools requesting assistance from the Health Department because many children are missing school due to repeated outbreaks. Dr. Locke stated that for many years lice was not thought of as a public health problem, which has resulted in a growing epidemic of insecticide resistant lice. While lice are not a threat to human life, the cost is in disruption oflife and sometimes severely damaged education. It has only recently been perceived as a public health problem. Onsite Sewage Ordinance: Larry Fay presented the Board with copies of "Table X", the draft monitoring/maintenance schedule for onsite sewage systems, which was not included in the draft Onsite Sewage Ordinance he presented during the Board of Health meeting in May. He asked the Board review the following three (3) options which are approaches used by various Counties that currently have a maintenance program: Option 1) The first inspection and inspections required at time of sale must be completed by a Certified Operations and Maintenance Specialist. All other inspections may be completed and submitted by the homeowner on forms supplied by the Health Department. Option 2) All inspections must be completed by a Certified Operations and Maintenance Specialist. Option 3) The first inspection and inspections required at time of sale must be completed by a Certified Operations and Maintenance Specialist. All other inspections may alternate between the homeowner and Certified Operations and Maintenance Specialist. Secretary of Health Position: Chairman Harpole asked if the Govemor has taken any action on the vacant Secretary of Health position? Dr. Locke answered no. Three nominations were made by a selection committee. The Governor interviewed them, however, he has not made an official appointment. Linda Sexton Update: Larry Fay reported that the complaint against Ms. Sexton has been filed in Superior Court. The Health Department is awaiting a hearing date. Chairman Harpole suggested that Superior Court be contacted, before the next Board of Health meeting, to inquire when the hearing will take place. Invitations to Board of HeaIth Meeting: Chairman Harpole asked if the State Representatives have been invited to attend a Board of Health meeting? David Specter replied no, but stated he will contact them to inquire about their possible attendance in the near future. HEALTH BOARD MINUTES - JULY 16, 1998 Page: 4 NEW BUSINESS BOARD OF HEALTH RULE: Member Shoulberg presented the following information for the Board to review to provide some background on the issue: 1) Draft Administrative Rules Implementing the Amended Jefferson County Interim Critical Areas Ordinance No. 14-0626-95; 2) Letter dated July 15, 1998 to the Planning Commission from the City of Port Townsend, Department of Public Works regarding Proposed Administrative Rule on Asphalt Batch Plants; 3) Letter dated July 15, 1998 to the Planning Commission from Eric Toews, Attorney at Law regarding Asphalt Batch Plant Administrative Decision; and 4) Proposed Resolution ofthe Jefferson County Board of Health supporting the findings and conclusions of the Planning Commission and recommending the Board of County Commissioners reject the proposed administrative rule change. Member Shoulberg explained that he has brought this issue to the Board of Health because it deals with the protection of aquifers and water quality. The proposed resolution is an advisory vote to the Board of County Commissioners, since they will be making a determination on the administrative rule. He reported that during the Planning Commission meeting held last night (Wednesday, July 15, 1998), it was voted 5 to 1 to deny the administrative rule, based on the letters from Eric Toews and the City of Port Townsend, Public Works Department. After the Board reviewed the four (4) documents presented by Member Shoulberg, Commissioner Wojt asked if the Planning Commission's findings and conclusions were available? Member Shoulberg replied that they have not yet been printed. Chairman Harpole questioned whether or not the Board of Health should be discussing this matter due to the fact that there are two (2) County Commissioners present, who may have to make a final determination on this matter at some point in the future? Commissioner Wojt explained that when the Board of Health was made up of only the three (3) County Commissioners, they made recommendations to the County Commissioners. Member Shoulberg explained that approximately three (3) year ago the City of Port Townsend, through the State Growth Management Hearings Board, asked the County to rewrite the Critical Areas Ordinance section on aquifer recharge protection. When the County passed the ordinance they needed to implement "Best Management Practices" (BMPs) which are the rules on how to deal with specific technical issues. No best management practices have been written with regard to aquifer recharge protection. The City of Port Townsend knew about the batch plant which is a separate permit issue, continued Member Shoulberg. They knew batch plants were prohibited in critical aquifer recharge areas so they were not concerned about the issue. It was just last Friday and only through the "grapevine" that the City heard about the proposed administrative rule which is the reason for the short notice on this agenda item. Member Shoulberg explained that the proposed administrative rule declares that an asphalt batch plant is not asphalt manufacturing or treatment. Which is not the case according to the City. The City contends that regulations must be conservative with regard to aquifer recharge areas and special protection areas such as well head protection zones. The Planning Commission agreed with City in a vote of 5 to 1. These areas are extremely vulnerable and risks should not be taken by allowing asphalt batch treatment plants in these areas. It is also the position of the City that the Administrator can only act upon the rules if they are vague and incomplete. This rule is not vague and incomplete. It is very clear. The letter from the City outlines the legislative history of all the different drafts that were written by the City and the County as they worked through the process. This issue was never brought up for discussion as being vague, incomplete or confusing HEALTH BOARD MINUTES - JULY 16, 1998 Page: 5 during the legislative history, which is why the City is so concerned about the proposed administrative rule. The administrative rule says that in a portion of the Critical Areas Ordinance dealing with mineral extraction, asphalt batch plants will need to develop performance standards or best management practices. If asphalt batch plants are prohibited, what is the reason for best management practices? Larry Fay explained that this issue was brought up as a result of one application and a pre-application meeting with a project proponent. During the County's initial review of the Critical Areas Ordinance the asphalt manufacturing and treatment provision section was to include asphalt batch plants in the definition. It was the County's position that in a critical aquifer recharge area batch plants are prohibited with no option for appeal or design standards, unless it can be proven by a geotechnical analysis that the maps used to identifY critical aquifer recharge areas are not accurate. The second application submitted raised a question of whether or not the County was appropriately classifying batch plants as a manufacturing process. The applicant presented some reasonable arguments to make a distinction between a batch plant as a manufacturing process compared to manufacturing asphalt. Asphalt itself, is the product of manufacturing and it is used to combine with aggregate to make asphalt cement. Also, in reviewing the level of risk that is associated with batch plants relative to the manufacturing of asphalt itself, it is found that they are two different types of functions. The applicant pointed out that the ordinance states that the County was to develop performance standards containing ground water protection, best management practices pertaining to the operation of gravel screening, gravel crushing, cement concrete batch plants, and asphalt concrete batch plants. This wording suggests that there is a distinction between batch plants and manufacturing and that the intent of the ordinance was to allow concrete batch plants, once BMP's or standards were established. In reviewing other city and county ordinances in the region there was not another ordinance, including the City of Port Townsend's, which prohibits batch plants in a critical aquifer recharge area. The State Department of Ecology's guidelines relating to critical aquifer recharge areas were reviewed to get their perspective on batch plants. The Department of Ecology believes a batch plant is a mitigatable operation and not something that has to be outright prohibited. Larry Fay stated that the Critical Areas Ordinance includes a provision for the Administrator to develop administrative rules to address vague and incomplete sections of the ordinance. He stated it is the County's opinion that the conflict over the definition of batch plants versus manufacturing is vague and incomplete. Staff was unable to answer the question posed by the applicant. The ordinance allows the Administrator to adopt the rule, which must be reviewed by the Planning Commission, and finally reviewed by the Board of County Commissioners. The rule was proposed to make the distinction between batch plants and asphalt manufacturing. Concerns have been expressed by the City of Port Townsend as well as members of the community with regard to the placement of such a batch plant. Generally, batch plants are sited where gravel resources are located, however, gravel resource areas, by their nature, are considered critical aquifer recharge areas. Larry Fay added that the proposed rule was reviewed by the Planning Commission last night and their recommendation will go to the Board of County Commissioners for a final decision. Member Shoulberg stated that amendments to the ordinance should go through the amendment process, which includes public notification and public hearings. This a significant issue which should not be addressed by a proposed rule from the County Administrator. The City is very concerned about the substance ofthe issue and the process. There needs to be public involvement. Batch plants are not prohibited in these areas if the applicant can make a good case. The law is designed to protect the ground water and it is specifically very conservative so unnecessary risks are not taken. A batch plant uses solvents. These solvents are deadly and can get into the ground water. HEALTH BOARD MINUTES - JULY 16, 1998 Page: 6 In answer to a question posed by Vice-Chairman Buhler, Member Shoulberg stated that the Administrator only has the authority to address definitions. The Administrator did not state in the findings that the ordinance was vague and incomplete. The Administrative Rule is being used as a way to amend a legislative act. Larry Fay stated that the County argues that it is vague and incomplete, as there is no definition, which is why the administrative rule was proposed. Discussion continued regarding projects in vulnerable and susceptible areas. Member Shoulberg added that these types of uses are prohibited in special protection areas which are defined as wellhead protection zones. Larry Fay clarified that these types of uses are only prohibited within wellhead protection zones where there is susceptibility. Member Shoulberg replied that the intent of the ordinance is to protect the ground water and the County must be conservative. Commissioner Wojt brought up the necessity of batch plants for the construction and maintenance of roadways. Member Shoulberg stated that batch plants can be placed in other areas in the County. Member Frissell stated that public health is this Board's main concern. She doesn't feel the Board of Health members have enough information about what is involved in a batch plant operation with regard to chemicals used. She stated she would like to see the findings and conclusion of the Planning Commission, and that she is in support of the proposed resolution recommending that the proposed administrative rule not be approved at this time. Vice-Chairman Buhler added that she feels public input is very important as well, and if there has not been enough time to allow for that, then it should be addressed. She is also in favor of the resolution. Chairman Harpole stated that if in fact the ordinance needs clarification, it should be recognized and should go through a very thorough public process. While he does believe there are some distinctions, he does not feel that they are certain or refined enough for simply an administrative rule on a critical issue. He stated he is also in support ofthis resolution. Commissioner Wojt added that with mitigations the risk to an aquifer by a batch plant is very low. He feels the dust and fumes are the main concern of area residents. Member Frissell moved to approve the resolution. Vice-Chairman Buhler seconded the motion. Commissioner Wojt abstained from voting. All other members present voted in favor of the motion. The motion passed. RURAL HOSPITAL CONFERENCEIHEAL TH ACCESS REPORT: Member Buhler reported that the hospital and other organizations concerned with health care in the community have identified an issue with access primarily for the uninsured and under insured members of the community. The hospital among others, is investigating methods of assuring access to health care for everyone. There are many questions as to why there is a lack of health care, and these questions were the focus during the Rural Hospital Association conference held in June. The local hospital board members are looking at several options in providing health care access. One option is for the hospital to employ physicians. Independent physicians are currently faced with diminishing insurance returns. Insurance premiums are rising and yet coverage for what insurance companies will pay is going down. In talking with other hospitals that employ physicians it was discovered that for some it works well and for others it does not. The hospitals which are ceasing to employ physicians cite problems such as maintaining incentives to keep the practices full and the fact that physicians unions are being established. HEALTH BOARD MINUTES - JULY 16, 1998 Page: 7 Another option is to form a pool of resources between the hospital and interested physicians by pooling the income generated by all the physicians. Costs would be prorated on a fee-for-service basis. The insurance income scale would be used to come up with an average rate. The same rate would then be paid to physicians for every patient they take and there is no disincentive not to take the under insured or uninsured. The program would have to be subsidized in the beginning, however, it is believed that over time they would increase their market share and eventually break even in terms of dollars. In terms of community health access, they believe they will come out way ahead. Member Buhler stated this type of program is not being done anywhere else, but the physicians they have talked with, like the idea. In response to a question by Member Shoulberg, Vice-Chairman Buhler stated that for a fee a third entity would handle the billing of clients. Virginia-Mason already has a billing system in place and is willing to work with Jefferson County on this option. Member Frissell noted that having a third party do the billing will decrease costs of operating a practice. Vice-Chairman Buhler reported that there is a task force made up of employees from the Health Department, hospital, DSHS, CAC, J.C. MASH, physicians and others related to the medical community, who also recognize and are attempting to address the problem of health care access. She stated that Dr. Locke has volunteered to assist the group with a survey which will assess physicians. He has agreed to come to a medical staff meeting at the hospital to talk with the physicians about their case loads and their willingness to take new patients. Once the information has been gathered and assessed, they will make a decision on a solution. Vice-Chairman Buhler advised that the hospital is currently in negotiations with a husband and wife, pediatricianlintem team to replace a local physician who wants to be a consulting physician rather than a practitioner. Discussion ensued regarding HMO's, group health, and networking between agencies. HIV POSITION STATEMENTS/NAMED REPORTING: Dr. Locke stated that there are two primary issues. One deals with whether or not HIV infection should be a reportable disease under Washington State Law. Currently, it is not a reportable disease. Only the late stage ofHIV infection or the disease of AIDS is required to be reported. The second issue involves how sexual or needle sharing partners who have been exposed to HlV infection should be notified of that exposure. Ultimately, named reporting is within the rule making authority of the State Board of Health and the communicable disease codes are up for review beginning in September/October. First the legislature, and then the Governor's office proposed establishing a task force to study this issue, however, that has not yet occurred. Dr. Locke presented the positions adopted by the AIDSNET Council last December. He explained that the six (6) AlDSNET's were established in Washington State in 1988. They are multi-county organizations which coordinate HIV and AIDS related services. Dr. Locke, David Specter and Jean Baldwin are very involved in a statewide organization of public health officials titled WSALPHO, which adopted the AlDSNET policies. The Washington State Medical Association did not adopt the AIDSNET policies but they did adopt their own. It was ten years ago that the Washington State Legislature passed the Omnibus AIDS Bill which created much of the existing laws. While the law mandated the reporting of AIDS, it was thought that if HIV was reportable, individuals would not get tested. Partner notification was mandated by state law, but it was the responsibility of the individual diagnosed with the infection to notify their partner(s). The diagnosing health HEALTH BOARD MINUTES - JULY 16, 1998 Page: 8 care provider is required to assist the individual with the notification. It is only if the diagnosed individual is unable or unwilling to notify their partner(s), that the health care provider can report the individual to the local health department for assistance. The current laws are difficult to enforce in rare circumstances where there is intentional exposure to HIV. This is a felony offense under Washington State Law and is known as conduct endangering public health or behaviors presenting imminent danger to public health. The laws are well intended, but do not work very well. For the last 2-3 years the number of AIDS cases has decreased as well as the number of deaths from AIDS. This is good news, however, evidence shows this is a result of the what is called the "treatment effect". The treatment effect is the success that new treatments have had on delaying the onset of AIDS. The critical measure of the effectiveness of prevention programs, is incidents ofHIV. The information available suggests that the rate is unchanged or possibly increasing. Dr. Locke stated that HIV is definitely increasing among women and minorities. In the United States the effectiveness of programs in controlling the epidemic are uncertain. Worldwide the efforts to control the epidemic have failed. Dr. Locke stated that the treatments available may be difficult to tolerate and are very expensive. Computer models of available information show that the spread of HIV occurs early on or during the primary phase. So individuals recently infected are inadvertently infecting others. Vice-Chairman Buhler asked what is considered recent? Dr. Locke stated potentially the first 12 weeks of infection is the most active phase, but it can extend up to 4 to 6 months. Member Shoulberg asked about reportable cases of individuals receiving treatment, and if those individuals on medication can still spread the infection? Kelly Scott replied yes. Dr. Locke added that there are ongoing studies attempting to address that issue. It is clear that the level of infectious bions is dramatically decreased when medications are taken, however, total elimination can only be determined by precise measurements and epidemiologic studies. Member Frissell asked how early HIV can be detected? Dr. Locke believes it is within 1 to 2 weeks from initial exposure. There are several new tests which can directly detect the virus in the blood. Current strategies for dealing with this ongoing and spreading epidemic are just a holding action and more needs to be done with regard to HIV prevention, while continuing with the efforts to treat the infection and if possible, cure it. HIV surveillance needs to be improved. It is difficult to track an epidemic when it is unknown who has the infection. It is difficult to measure treatment and prevention efforts unless the epidemic can be tracked. Dr. Locke stated that local and state agencies agree that there needs to be HIV surveillance, however, there is controversy over how it is going to be done. There are two proposed methods ofHIV surveillance. The first is named reporting. With this method the names and identifying information of infected individuals are given confidentially to public health authorities who do contact tracking when necessary. Twenty-Eight (28) states currently use named reporting, although they are not the large populous states where the majority of the epidemic is occurring. These states account for less than 25% of HIV and AIDS cases in the country. The second method is called unique identifier, which two (2) states are using. In this method individuals infected with HIV are assigned a code generated by a medical provider. That code is then reported to health authorities. With this method the medical provider knows the translation between the unique identifier and the individual, but the government does not know. HEALTH BOARD MINUTES - JULY 16, 1998 Page: 9 The remaining states are now addressing the issue. Most medical professionals and public health authorities are strongly in favor of named reporting. Most doctors feel that there is no reason to treat this disease different than any other reportable disease. The National Center for Disease Control supports named reporting, although, they do not link it to the issue of partner notification which public health officials in Washington State feel is very connected. Dr. Locke stated that he does not presume to know all the reasons for the opposition to named reporting, however, he does believe it is primarily an issue of privacy rights and concerns about the government keeping lists of individuals with the disease, that if released, could have devastating personal effects with regard to jobs and discrimination. There has not been much progress over the last ten years with regard to the stigma ofHIV. Fundamentally, there are concerns about human rights. From a public health standpoint, Dr. Locke stated that privacy rights and confidentiality are a main concern. Aside from the ethical and human rights issues for maintaining confidentiality, it is also essential for a reportable disease system to even work. If confidentiality is breached, so is the trust with the individuals for which relationships are trying to be formed. The only reason an individual provides names of partners they may have exposed is because of trust. Partner notification is not coercive. There is no way to get names out of an individual who does not want to divulge them. Dr. Locke stated that he feels it important for Boards of Health to take a position on this issue. The Health Officer in Pierce County is recommending that their Board of Health make HIV a notifiable condition in Pierce County. Health Officer's and Board's of Health have this authority, however, Dr. Locke does not feel that individual counties should do it on their own. It involves state and national systems. He also feels there should be a public debate on the issue. The concern of privacy protection is not in the area of public health but rather in the area of medical treatment and insurance. Insurers have a strong financial incentive to discriminate against individuals with HIV as it is a very expensive disease to treat. Dr. Locke presented the following options to the Board of Health for action: 1) Endorse the AIDSNET Council policies and make a recommendation to the State Board of Health with regard to reporting and notification of HIV; 2) Take no action at this time and gather more information. Kelly Scott stated that the Governor's Advisory Council on AIDS set up task force in June of 1997 which held five forums around the state to study the issue of named reporting. After holding the forums the task force prepared a report for the council which contained a position statement in favor of named reporting, a position statement in favor of unique identifier reporting and consensus statements which everyone agreed on. All the community members serving on the council voted for unique identifier reporting. Public Health officials voted for named reporting. The report and the council's recommendations were forwarded to the Governor for review. Mr. Scott stated that over the last ten years it has been learned that certain kinds of prevention such as population based prevention are very useful if done effectively. HIV is a relatively selective disease in terms of where it is or where certain behaviors take place. It is highly concentrated among gay men, intravenous drug users, and now women. Education needs to be targeted toward communities at high risk. The debate is how to move to a new system of reporting without damaging prevention efforts. It was learned from the forums that there is a fear of government having lists of names of individuals with HIV. There is not a fear of accidental release of the information, there is a fear of authorized state legislated release of the information. In 1996 a bill passed the legislature which was vetoed by the Governor that would have mandated public health agencies to turn their case management files over to criminal justice when it HEALTH BOARD MINUTES -JULY 16, 1998 Page: 10 thought that anyone was engaging in the behavior of endangering public health. It is not the inadvertent breach that worries some individuals, it is what the authority of the legislature. Public health would not have a voice in the matter and they would be forced to turn over the files of not only the individuals with HIV, but also the files of their partners. In the debate on this the Prosecutor's Association was asked if it is a behavior of endangering public health if an individual with HIV engages in sexual intercourse with a condom? Existing law states that it is illegal or a felony if an individual intends transmittal. Member Shoulberg asked how law enforcement personnel viewed this bill? Mr. Scott stated that law enforcement personnel would have difficultly with investigating because they are unable to say what they are investigating due to the questions surrounding who can be told that someone has HIV? It is very complicated when it comes to dealing with individuals who are acting irresponsibly, but who aren't necessarily intending to do so. Individuals acting irresponsibly can be physically contained, but not in an ordinary jail, and the duration of containment is unknown. This can be very expensive and could bankrupt most smaller counties. Dr. Locke stated that others may characterize this law very differently. It was his understanding that the Northwest Aids Foundation and public health supported the law which actually passed. Washington State law states that exposure is illegal not just the intent to expose. It is a tough law which has been on the books for ten years. The only portion the Governor did not veto on the bill is a clause that made it an even higher class felony to expose another individual. Mr. Scott recommends that this Board of Health request the State Board of Health take action on the matter of HIV case surveillance without necessarily requiring names or unique identifiers. It would be better for the Board of Health to take action on this issue rather than the legislature. Discussion ensued regarding the duty to warn and the potential of lawsuits. David Specter asked about home testing kits for HIV. Dr. Locke stated that there is a home test kit where the sample is taken at home and sent to a lab anonymously, but he is not aware of a commercial kit. Anonymous testing should not be prohibited, in Dr. Locke's opinion. With anonymous testing, named reporting would occur at the point the individual entered the medical system for treatment. In fact, it is at this point that the information is available to government entities that may want to use it. When an individual gets their first prescription and submits their first bill for AIDS or HIV related service, that information can legally be obtained by the legislature. Chairman Harpole stated he agrees that it is time to address this issue, however, he feels that there could be some serious ramifications. Based on the concerns which were raised, perhaps named reporting is not the best answer. He supports addressing the issue rather than outlining the specific strategy of how it will be addressed. Dr. Locke agreed that it may be premature to choose one system without thoughtfully considering other alternatives. After discussing population based statistics, Member Shoulberg moved to support the development of an information/data base for case management and recognition of individuals with HIV. Vice-Chairman Buhler seconded the motion for discussion. Chairman Harpole added that as more information becomes available, the Board may be able to be more specific in a resolution. He called for a vote on the motion which carried by a unanimous vote. HEALTH BOARD MINUTES - JULY 16, 1998 Page: 11 ENVIRONMENTAL HEALTH PROGRAM EV ALUA nON: Larry Fay presented a summary of the four (4) basic areas of Environmental Health. 1.) FOOD SERVICE 2.) LIQUID WASTE 3.) SOLID WASTE 4.) DRINKING WATER Discussion in more detail will continue during the next meeting. Chairman Harpole suggested that staff designate specific time frames for the agenda items, to help keep everyone on track and to insure all the agenda items are covered. AGENDA CALENDAR: Chairman Harpole suggested that at some point in the future the Board look into two-way video conferencing. The Board discussed the possibility of meeting at the hospital for a presentation. Meeting adjourned. The next meeting will be held Thursday, August 20, 1998 at 1 :30 p.m. JEFFERSON COUNTY BOARD OF HEALTH {' ^ i '"J.1d i .. ,.n.., .1/ '/~. . ;1 ( . ., ",v /- 11. "i. '.. ~.'" ,_ ~'. '.~.. Jj'n Buhler, Vice Chairman (Cix.U.u\ 0 d.itVJs.Pvt(' 2;) Sheila Westerman, Member . {j -4-3;' . I -{;<<:'.!.3:':-r.._ A"..::ML~f'_ Roberta Frissell, Member C>-(' Ted Shoulberg, Mem er Resolution of the Jefferson County Board of Health July 16, 1998 Whereas the Board of Health is responsible for policy guidance in matters pertaining to public health; and Whereas the protection of the public water supply for the Iri-Area is one of utmost concern to the Board of Health; and Whereas the administrator of the Critical Areas Ordinance has proposed a rule change which would remove the outright prohibition of asphalt batch plants within Vulnerable Aquifer Recharge Areas and Special Aquifer Protection Areas; and Whereas the Jefferson County Planning Commission on July 15, 1998 voted and made fmdings and conclusions which recommended to the BOCC that the above administrative rule change be denied; and now Therefore be it resolved that the Board of Health supports the fmdings and conclusions of the Planning Commission and strongly recommends that the BOCC rejects this proposed administrative rule change in order to reduce the risk of damage to the aquifer. _ (Excused Absence) Glen Huntingford, Member (Excused Absence) Sheila Westerman, Member (j u--d/L --i.Abstained) Richard Wojt, Member , '. POSITION STATEMENTS FROM THE AIDSNET COUNCIL POSITION PAPERS 1) HIV Infection as a Reoortable Condition The AIDSNETS Council supports changes in regulation during 1998 that will require named HIV reporting by providers and laboratories in Washington State while maintaining current laws which require access to anonymous testing in the public sector. 2) Notifying Sexual and Needle Sharina Partners Public health will work with HIV-infected persons to sensitively and appropriately identify sexual and needle sharing partners and provide HIV counseling/testing and referral to care services. Barriers to provider reporting of HIV-infected persons and of partners of HIV-infected persons in regulations, policies or procedures should be revised or eliminated. 3) HIV Education in Washinaton State Public Schools The AIDSNET Council supports a change in state law to mandate medically accurate, comprehensive kindergarten through 12th grade health education including grade-level appropriate sexuality education on sexually transmissible diseases and HIVlAIDS, in public schools in Washington State. Until such time that the above occurs, the AIDSNET Council supports the continuation of mandated AIDS education in grades 5 through 12 in all publicly-funded schools which has been reviewed for medical accuracy by the Department of Health (DOH). treatment. This information is especially re'levant in children when: this information could assure proper care, ea.....fy life-saving treatment and appropriate follow-up.3.4 . DISEASE SURVEILLANCE Currently the full impact of HIV infection on a co=unity can only be estimated by methods like "back-calculation: which is based on cases of AIDS that are often diagnosed ten years or more after initial infection. Estimates of the numbers of persons with HN infection in Washington State range between 9,000 and 14,000 persons.s However, given the increasingly effective treatments noted above, which are capable of substantially or even permanently postponing AIDS, these statistical methods will cease being useful, further reducing the ability to measure the effects of disease contI:ol .programs or identify shifts in the epidemic. Without HN reporting, HN incidence, perhaps the best measure of prevention program effectiveness, can only be estimated indirectly, although such data would provide a much more complete picture of current transmission trends and the future impact of HIV. . PREVENTION OPPORTUNITIES The ability to detect and aggressively treat HIV infection early in the course of infection may dramatically improve the course of infection,6.7 reducing' virus levels and potential infectiousness. Additionally, several studies now show that perhaps 70% of all new HIV infections develop from exposure to persons-with recent infections,8 potentially enhancing the value of partner notification, now made difficult by the absence of HIV reporting. In the case of primary HIV infection. and generally, HIV named reporting could facilitate HIV prevention by ensuring that co=unity care providers, (who provide the majority of HIV testing) refer their HIV sero- positive persons to public health for notification of exposed partners, as is done routinely with other communicable diseases. Currently. HN-infected persons identified in such co=unity settings and their providers are inconsistent in their partner notification efforts, since such patients can only be referred for public health follow-up or partner notification if they refuse to notify partners themselves. However, studies show that such "patient referred" partner notification is much less successful than professional notification.9 Thus, HN reporting could assure that more exposed persons would be notified of their need for testing, and more HIV positive persons would learn their HN sero-status and be able to begin early treatment for HIV infection_ . ANONYMOUS TESTING The availability of HIV home tests can now be one way to assure access to anonymous testing; however, even though HN infection should become reportable -- to assure access to HIV testing to persons who may not be able to afford these expensive kits - public health clinics must still make anonymous testing options accessible. HIV positive persons identified by anonymous testing must be counseled about the importance of early treatment and assisted with partner notification. These persons should also referred to treatment where it is unlikely that anonymous options can be maintained. ] Ccaten fot Diacuc Control aad. Prevention. R.cc........ '" -"''0""' oftbc u.s. Public Heallb $crvice Tuk Force on the Use of Zidowdi.nc to Reduce Pcl'inatal Tnamaiuioa. afHUIIWlJmmunode6cicac:y V'1tUL MMWR 1994;43(ao. RR.l1):1-20. 4 Barnhart ax. ct.L Natural hiIIory aChurnaa immunoddicic:ncyvirUll d,-", in pc:rinatally inf~ dWdrca.: an analyail from. the: Pediatric Spectnrm ofDiscuc I'n>j.... Pod..1rica 1996;97(S):71~. 'SaUlc Kine Couoty Dep<ofPubUc Heald..... the Wubia.... S,,",OcportmeotofHeaIlh: lUV/AIDS Eainuta.... F_ Oct, 1996 'Ho David D. ct.L Rapid turuoYa'ofplaanaviriona _ad CD4lympboeytc:l inHIV.1 infccUoo.. N.tun: Ian 12. 199:5; 373:123.126. 7 WcviU.de. ^ ct .l Effccl.l of. Combiru.tion of Zidovudinc, DidaROlinc., aad t..&mivudinc on Prima.ry HIV Type 1 Infcctioa. Journal oCInfcctious {)itc.ucI 1997;m,10Sl-'. . Koopman, JS. ct al The Role oCEarly mv Infecti.on tn the Spread ofHIV thmugh Populationl. Joum of AIDS A. Human R.ctrovir. 1997;14(3):249--$8. , Haffinan R ct..l Com~rison ofpolrtncrnotilic.ation.lt .InonymouJ ..nd confidential HI\' lat .itel; in Colondo. JOW'" AIDS ..nd Human RetruYir. 199'~8:406~IO. 2 AIDSNET POSmON PAPER ON NOTIFYING SEXUAL AND ~LESHARING PARTNERS AID5NET Council Statement of Position: Public health will work with HIV-infected persons to sensitively and appropriately identify sexual and needle sharing partners and provide HIV counseling/testing and referral to care ~ces. Baniers to provider reporting of HIV-inf~ed persons .and of partners of HIV-infected persons in regulations, policies or procedures should be revised or eliminated. . , Rationale: Partner notification as a tool for disease control and prevention has been clearly demonstrated to find new cases of HIV infection and be cost-effective. In light of currently available and expected medical treatments, which address both progression of disease and likely reduc;tion in infecti!lusness, identification of HIV infection should occur sooner rather than later. Partner notification is currently not being used to' its full potential as a prevention tooL . Discussion: Partner no'tification has been a required part of regional HIV / AIDS prevention service plans in Washington State since the enactment of the Omnibus AIDS law of 1988, RCW 70.24.400. RCW 70.24.022 provides authority to the State Board of Health to establish procedures for notification of exposed partners. WAC 246-100-209 requires providers to inform the infected person, "the tested individual" of the need to notify partners_ In Washington State and some other jurisdictions, provider assisted partner notificatitm has not been used as a disease control strategy to the same degree as with some other sexually transmitted diseases. Reasons for this difference have included: lack of therapeutic or prophylactic treatment for HIV; concerns regarding confidentiality; and, lack of named HIV reporting to public health. As a result, many local health jurisdictions have relied upon patient partner notificatirm as the primaxy strategy, with an offer of provider assistance only when necessary. This strategy is best exemplified by the policy established in WAC 246-100-{)72, where the names of partners may be released to the health officer only if the infected person refuses or is unable to notify partners. Many studies have shown that compared to provider referral (where the provider or public health notifies partners), patient referral (where patients say they will notify) is much less successful Finally, HIV-infected persons and their sexual and needle sharing partners. were identified by the Washington Statewide HIV Prevention Community Planning Group as having the highest UIIIrlet needs for HIV prevention services for 1998. The target audience for partner notification programs is HIV-infected persons and their sexual and needle sharing partners. Currently published studies and resean:h findings indicate that provider assisted partner notificatimt, Le., performed by well-trained professionals, is far more effective than leaving notification of sexual and needle sharing partners to the infected individual. · Provider assisted HIV partner notification and refena1 has high partner acceptance of new testing (65%), identifies previously undetected infections (15% of partners notified), and has a high (7.2) benefit-cost ratio (Spencer, N., Raevsky, c., Wolf F., 1989)_ 101:l0197 (finaQ 1 . , AIDS Education.in Washington State Public Schools Position Statement: I) The AIDSNET Council supports a change in state law to mandate medically accurate, comprehensive kindergarten - 12th grade health education including grade-level appropriate sexuality education on sexually transmissible diseases and HIV/AIDS, in public schools in WashingJon State. 2) Until such time that #1 occurs, the AIDSNET Council supports the continuation of mandated AIDS education in grades 5-12 in all publicly-funded schools which has been reviewed for medical accuracy by the Department of Health (DOH). Rationale: Public school mY/AIDS education is an essential disease prevention component which should be included in a school's comprehensive health education curriculum. Children must receive factual, non-judgmental information during their most formative years in order to make informed decisions and adopt healthy behaviors. Background: RCW 28A.230.070 states "The life-threatening dangers of acquired immunodeficiency syndrome (AIDS and its prevention shall be taught in the public schools of this state. AIDS prevention education shall be limited to the discussion of the life-threatening dangers of the disease, its spread, and prevention. Students shall receive such education at least once each' school year beginning no later than the fifth grade." Additionally, "Curricula and materials developed for use in the AIDS education program. . .are developed by the school district and approved for medical accuracy by the office on AIDS established in RCW 70.24.250." Discussion: Throughout the years, there has been a small, but vocal, number of individuals who have opposed mandated AIDS education in the public classroom, including the provisions for review for medical accuracy and parental review of the curriculum before student exclusion. Numerous bills have been introduced which would have altered course content and student exclusion processes. Some of these bills directly eroded the mandates for AIDS education. Other bills were broader in scope (e.g., charter or voucher schools) that could threaten the requirements for AIDS education. To date, none of these have become state law. Rationale for those who oppose the existing requirements focus on the parent's responsibility, not the schools, to provide this information or that the course content is in conflict with their personal values. Current law allows parents to "opt out" students from classroom presentations. Historically, an average of I % of parents choose to exclude their children, with most of these occurring in grades 516_ Discussions have surfaced on who should approve curricula-potentially eliminating the DOH role and delegating review to local public health agencies. Shifting review from DOH to the local level would result in duplication of setvices throughout the state and raises questions regarding adequate staffing and appropriate expertise in each county. Another 1