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HomeMy WebLinkAbout11 November JEFFERSON COUNTY BOARD OF HEALTH MINUTES November 19, 1998 BOARD MEMBERS Dan HnrJ"'lt, chAirman - county Commissio/ltr District 1 Gltn J-1Mti'l'iford, Member - county Commissio/ltr District 2 Riehard woJt, Member - county Commissio/ltr District 3 Ted slwulbe~q, Member - port Townsend city cOWlcil Jill Buhltr, Vice chAirman - HJJ>yittd District #2 commissioner slteiM wesftrman, Member - citizen at Large (City) RobertA FrisseU, Member - cWzen at LIlYge (county) STAFF MEMBERS David syecfer, Htalth DeJ'artment Director Jean Baldwin, Director of Nursi'(ij services Larry Ft1J, Director of Environmentlll Htlllth ThomllS Locke, M.D., Htalrh officer The meeting was called to order by Vice-Chairman Jill Buhler. All Board and staff members were present with the exception of Commissioner Harpole, Member Shoulberg, and Member Frissell. APPROVAL OF MINUTES Commissioner Huntingford moved to approve the minutes of October 16, 1998 as presented. Commissioner Wojt seconded the motion. Jean Baldwin suggested that the minutes be revised (Page 4, BREAST AND CERVICAL HEALTH PROGRAM SUMMARY UPDATE) in order to clarify the amended motion and identify the individual amending the motion. The minutes were approved by a unanimous vote as corrected. PUBLIC COMMENT PERIOD Mark Gordon stated that Dr. Locke provided him with a copy of the draft letter to the State Board of Health regarding HNI AIDS name reporting. The letter is only one step in dealing with this issue. Prevention and providing support is a large responsibility as well. He urged the Board of Health to conduct a workshop in the near future where various aspects of this issue can be discussed. CONSENT AGENDA Member Westerman moved to approve the letter to Governor Gary Locke regarding the State Secretary of Health Appointment. Commissioner Huntingford seconded the motion which carried by a unanimous vote. HEALTH BOARD MINUTES - NOVEMBER 19, 1998 Page: 2 OLD BUSINESS LINDA SEXTON UPDATE: Larry Fay reported that he and David Specter recently met with Deputy Prosecutor Paul McIrath to discuss the status of the case against Linda Sexton and to discuss other enviromnental health enforcement issues. The attorney currently representing Ms. Sexton is Crad Verser. Approximately a month ago Mr. Verser contacted Mr. Mclrath regarding resolving this matter without going to court. Mr. Mclrath provided Mr. Verser with a copy of a compliance agreement drafted a year ago for Ms. Sexton requiring her to either clean up her property and discontinue the practice of collecting solid waste or apply for a solid waste permit in order to comply with current regulations. Since there has been no response from Ms. Sexton or her attorney, the Prosecutor's office will be scheduling a court date. Mr. McIrath is leaving his position with the Prosecutor's office at the end of the year, so the court date will most likely be scheduled for March or April 1999 to allow the new Prosecutor time to review the case. Additionally, there is an issue of whether or not Ms. Sexton was properly served because she was served through her attorney, stated Larry Fay. It is Mr. Mclrath's opinion that they may have waived the right of being served personally, due to the fact that they acknowledged receipt of the notice and had taken further action. If the case is dismissed without prejudice, they will just file and serve again. Larry Fay reported that he and Mr. Mclrath discussed at length the issues about enforcement of environmental health violations in relation to the priorities of the Prosecuting Attomey's office. Specifically, nuisance issues such as individuals living in recreational vehicles which are not in compliance with zoning and health regulations. Prosecuting these types of offenses may take a great deal of time and resources. It is believed that amending Jefferson County's solid waste ordinance would be helpful in dealing with these types of complaints and problems. They reviewed a Grays Harbor County ordinance which defines nuisances and clearly states the repercussions for violations and non-compliance, and they discussed the possibility of making various violations civil matters rather than criminal matters which would allow for the issuance of civil infractions to get them into the court system without inundating the Prosecutor's office. Mr. Mclrath commented on the volume of compliance issues which have come in from the Permit Center and Health Department regarding building and zoning violations. Many have more to do with bookkeeping and closure on permits, than they have to do with threatening public health and safety. There needs to be another method in dealing with these types of issues, rather than just referring them to the Prosecuting Attorney's office. Larry Fay concluded by stating that more discussion needs to occur with the Prosecuting Attomey Elect Julie Dalzell. Discussion ensued regarding the Health Board members' concerns about waiting until March or April for a court date for Ms. Sexton. It was agreed that Health Department staff will meet with Prosecuting Attorney Elect Julie Dalzell to see if it is possible for her to review this case and bring it to court sooner than March. Commissioner Huntingford cautioned that they must draw the line for what types of violations or non- compliance issues are going to be pursued, or the Prosecutor's office will be swamped. David Specter stated that the policies need to deal with balancing violations and non-compliance issues with public health concerns. In regard to swamping the Prosecutor's office, he stated that the solid waste program is funded through a grant from the State on a cost reimbursement basis. Jefferson County has the opportunity to bill the State for legal fees. lfthe Prosecutor's office is unable to take on various cases, there is an option to obtain outside legal council which would be paid for in part by the State (65%), with a match of35% from the County. HEALTH BOARD MINUTES - NOVEMBER 19, 1998 Page: 3 Commissioner Huntingford stated that he is torn over this issue. On one hand individuals that want to comply with the law are held to one level by the County and yet other individuals are living in yurts and recreational vehicles which are not in compliance with health and zoning regulations, but the County doesn't do anything to bring them into compliance. There are several such individuals in the County and should they be kicked out of their homes because they are not in compliance? It's not fair to the individuals abiding by the law, but how far should this go? Larry Fay stated that during every community meeting concerning the draft onsite sewage code, the issue of individuals living in the woods has come up. The individuals who have gone through the permitting process are angry that they have spent money to put in a septic system which meets code and yet they have neighbors up the road which live in a bus or yurt and have not had to do anything. They want to know when the Health Department is going to go after those individuals. Larry Fay stated that he does not care if an individual lives in a bus or yurt, so long as they are taking care of their garbage and sewage adequately and appropriately. Member Westerman added that there is not enough staff or resources to bring every single individual into compliance. Focusing on problem areas and repeated reports or complaints is the logical approach. HIY REPORTING; LETTER TO STATE BOARD OF HEALTH: Dr. Locke presented the letter he drafted for the Chairman's signature on behalf of the Health Board to the State Board of Health regarding HIV Reporting in Washington State. In October the State Board of Health directed the Department of Health to draft rule revisions which made HIV reportable and do everything within the statutory authority of the Board to assure that confidentiality would be maintained and that access to anonymous testing would be assured. Due to the time frame in which this occurred it only allowed four (4) days for public comment which was not adequate. Dr. Locke noted that there will be several more months of public meetings and discussions regarding rule revisions. He asked if any of the Board members had any comments or changes to the letter? Vice-Chairman Buhler stated that she thinks the letter is excellent. She asked if there is a way to implement an education process if this rule goes into effect, that would educate individuals who are not HIV positive about the disease so as to allay the fears of name reporting? Dr. Locke stated that the issues surrounding HIV I AIDS are far more complex than just HIV name reporting. The understanding of the disease process and what needs to be done to effectively control it, has really evolved over the past ten (10) years. However, public programs have not evolved as much. A workshop type setting could be considered for discussing ways to educate the community to prevent discrimination. This controversy is forcing people to deal with the complex issues that surround HIY! AIDS. On the issue ofHIV reporting linked to discrimination, it is Dr. Locke's opinion that this is a false argument. The evidence is overwhelming that confidential reporting never leads to involuntary disclosure. It literally has not ever happened in this State, and is not the reason that people undergo disclosure and are discriminated against. It is everything but confidential reporting. It is mainly friends, family, and individuals disclosing their medical history, or medical care systems and insurance forms which result in disclosure. Member Westerman asked Dr. Locke if he knows for certain that name reporting to health officials has!1fD!IT resulted in a violation of disclosure in the whole country? Dr. Locke replied that during all of this discussion there has not been a single instance where that has occurred. There is a case where it almost happened in Florida, in which a disgruntled employee took several names and attempted to release them but the person was caught before they could actually do it. Dr. Locke stated he is unable to say it has never happened, but he can say that there are no reports of it happening in the country. As for Washington State, he can factually say that it has never happened. The number one cause is self-disclosure. HEALTH BOARD MINUTES - NOVEMBER 19, 1998 Page: 4 Member Westerman stated that she feels Dr. Locke's letter is very good, and she suggested the following formatting changes: 1) Words such as "We know" could be changed to "We trust"; 2) Adding the word "strict" to the last paragraph, "As Jefferson County's Board of Health we are committed to maintaining an active partnership with HIV/AIDS advocates within our community and continuing are strong advocacy of accessible high quality mental care and strict confidentiality protections. " Additionally, Member Westerman stated that she recalls a discussion during the Board of Health meeting held last month about expressing how critical it is to develop rules at the State level regarding confidentiality for rural communities. Dr. Locke stated that her recollection is correct, however, he struggled with how to address that based on the following issues: 1) The Authority of the State Board of Health to write confidentiality rules is very limited. It is the Legislature which has the authority to pass confidentiality statues. The State Board of Health is unable to expand what exists under statute, but, it can apply statutory responsibilities to particular conditions for clarification; and 2) What kind of evidence is available to indicate that rural standards should be different from urban standards. Both standards should be as high as possible. The goal is to have a uniform standard. Dr. Locke stated that the issue is that no matter how strict and uniform the standard is, the consequences of involuntary disclosure in rural areas can be more severe than in urban areas. He added that in terms of actual rule development, the State Board of Health can only write rules when it has clear statutory authority. Member Westerman asked if there are consequences to health care providers or insurance agencies if information is involuntarily disclosed? Dr. Locke answered that liability is civil not criminal. Agencies can be sued for damages due to negligence or malpractice. Unlike other breeches of confidentiality, the law defines specific monetary penalties for the involuntary disclosure ofHIV/AIDS and STD's. After further discussion the Board concurred to reformat the letter using bullets and stating what scientific literature was used as a basis for their conclusions. Dr. Locke will prepare the letter for Chairman Harpole's signature at the Board of Health meeting in December. TOBACCO SETTLEMENT/JEFFERSON COUNTY ACTIVITIES: David Specter presented to the Board three (3) documents from the Attorney General of Washington regarding the proposed tobacco settlement: 1) Attorneys General Announce Tobacco Settlement Proposal; 2) Tobacco Settlement - Proposed Settlement Summary; and 3) Tobacco Settlement Distribution among each State, 1998-2007. He reported that Public Health Department Directors and Health Officers from around the State met yesterday and were briefed on the settlement by Dr. Fisher who is the Health Officer for Kitsap County and who has served on the Attorney General's task force for tobacco. He explained how the settlement will be distributed. Washington State will receive $49,278,196.65 for 1998, however, the deadline for distributing those funds is June 30, 2000. Therefore, it will be a while before Jefferson County will get a portion of the settlement. Discussion ensued regarding enforcement of tobacco laws with regard to juveniles. David Specter noted that Washington State's Attorney General Christine Gregoire has approached this from a public health standpoint. She and the Governor both want to protect the public health portion of this settlement to insure that the money is not used to deal with other issues. Protection efforts include convening a task force to prepare a plan for tobacco prevention and control. There are many competing interests for this money and there is a desire to fill the gap in basic health which costs $50,000,000 to $60,000,000 per year. Ultimately, the legislature will decide where the money will be spent. HEALTH BOARD MINUTES - NOVEMBER 19, 1998 Page: 5 David Specter reported that Jefferson County received a small grant from the State Department of Health (Project Assist) to be used for tobacco prevention. A tobacco summit will be held sometime next year. 1999 BUDGET UPDATE: David Specter stated the Health Department has submitted their budget for 1999 to the Budge1 Manager who is recommending $85,000 in reductions. David Specter will be meeting with the Budget Manager next Monday to discuss the matter. In the event of budget cuts, the Board of Health may be called upon for assistance with prioritizing various programs. NEW BUSINESS PROGRAM EVALUATION: Youth Tobacco Program: In the absence ofKelli Ragan, Jean Baldwin reported that the Health Department receives $3,500 from the State to fund the tobacco prevention program which focuses on youth tobacco use. In the past the Health Department has held a "tobacco road show" involving Health Department staff conducting presentations in classrooms. More recently the Health Department purchased a curriculum recommended by an anti-tobacco coalition group titled "Asset". The curriculum was reviewed by the drug and alcohol advisory boards of the Chimacum, Port Townsend, and Quilcene high school districts. She explained how it works and reported that all the school districts are very pleased with it. Kelli Ragan coordinates this program which touches on substance abuse issues, enabling her to integrate it with the substance abuse curriculum. Jean Baldwin showed the Board the supplies from the Health Department's tobacco program lending library. These bulletin boards, posters, videos, and various other items are checked out regularly to the schools. Jean Baldwin noted that tobacco is a very complicated issue and prevention is just a small part of it. There are many issues surrounding treatment and support as well. In looking at the written program evaluation reports, Member Westerman asked if the staff would spell out the names of agencies and programs the first time they are mentioned and write the acronyms in parentheses after them, so that it is easy to understand what the acronyms stand for from that point on? Jean Baldwin stated they will. Foot Care Program: This program was initiated in 1984 in response to the complaints of senior citizens and medical care providers due to the lack of foot care services in the County. It is an outreach program to increase access to care for senior citizens. Jean Baldwin reported that hiring assistants for this program has been difficult. There is a high demand for this program and the coordinator has a waiting list of approximately two (2) weeks. AGENDA CALENDAR REVIEW Commissioner Huntingford suggested that at the next meeting the Board discuss fee waivers for non-profit organizations. Since the County Commissioners will be meeting with State representatives on Thursday, December 17, 1998 in Port Angeles, Dr. Locke will look into the possibility of the representatives meeting with the Clallam and Jefferson Counties Health Board members to discuss health issues following the Commissioners meeting. HEALTH BOARD MINUTES - NOVEMBER 19, 1998 Page: 6 The Jefferson County Board of Health meeting is also scheduled for the aftemoon of Thursday, December 17, 1998. If the representatives are willing to meet with the Boards of Health, it was agreed that the December Board of Health meeting will be canceled or changed to another day in the event a pending appeal must be scheduled. Meeting adjourned. After the meeting a video tape on contaminated water was viewed. Until further notice, the next meeting will be held on Thursday, January 21,1999 at 2:30 p.m. JEFFERSON COUNTY BOARD OF HEALTH /" ./ ~k1 VL ill~0v~ Sheila Westerman, Member (Excused Absence) Roberta Frissell, Member (Excused Absence) Ted Shoulberg, Member .Jf' ~ JEFFERSON COUNTY BOARD OF HEALTH November 19, 1998 Governor Gary Locke Legislative Building PO BOX 40002 Olympia, W A 98504 Dear Governor Locke: As members of Jefferson County's Board of Health, we are writing to express our concern regarding the lack of a appointed Secretary for the Washington State Department of Health. We note the recent temporary appointment of Ms. Mary Selecky as Acting Secretary and feel that this is a very positive step forward but does not replace the need for selection of a permanent Secretary. Since its formation in 1989, the Department of Health has played a crucial leadership role in the development and implementation of Washington State's Public Health Improvement Plan. This Plan has been hailed as a national model for public health reform and is based on an ambitious vision of a fully functional statewide public health system capable of steadily improving the health of Washington State's residents. The Jefferson County Board of Health is strongly committed to this vision and has devoted considerable time and resources to making it a reality. True public health improvement requires a solid, long-term partnership between local and state health agencies sustained by committed leadership at all levels of government. The current lack oflong-term leadership within the Department of Health threatens this partnership and the functional integrity of the State's public health system. Effective public health protection requires state and local health departments to maintain a broad range of essential services necessary to deal with immediate health threats, develop long-term preventive strategies, and anticipate future public health needs. We are concerned that the multiple leadership vacancies within the Department of Health (Secretary, State Health Officer, and State Epidemiologist); ifleft unfilled for an extended period, will seriously effect both the morale and performance of the Department. This leadership void has the potential to seriously impair our statewide ability not only to respond to immediate public health crises, but also to sustain legislative funding for the process of public health improvement begun in 1995. We appreciate your appointment ofa highly qualified local health official to serve as Acting Secretary. This action will help address the many urgent backlogs which have developed within the Department of Health. As 1998 enters its final quarter and the legislative session approaches, we strongly urge you to redouble your efforts to recruit and appoint a new Secretary of Health. We appreciate the difficulty of the task and the many conflicting demands on your time and attention. As members of a local board of health, we are frequently reminded that public health protection is among the most 615 Sheridan. Castle Hill Center. Port Townsend. W A (360) 385-9400 -~ 't Governor Gary Locke Page 2 fundamental responsibilities of government. We trust that you will give this responsibility a high priority and we, as a active partners in public health improvement, can continue to move forward in creating our vision for a healthier Washington State. Sincerely, Dan Harpole, Chairman - Jefferson County Commissioner District 1 Glen Huntingford, Member - Jefferson County Commissioner District 2 Richard Wojt, Member - Jefferson County Commissioner District 3 Ted Shoulberg, Member - Port Townsend City Council Jill Buhler, Vice Chairman - Hospital District #2 Commissioner Sheila Westerman, member - Citizen at Large (City) Roberta Frissel~ member - Citizen at Large (County) cc. Senator Jim Hargrove Representative Jim Buck Representative Lynn Kessler ..,. " DRAFT Date Dennis Braddock Chair, Washington State Board of Health P.O. Box 47990 Olympia, W A 98504-7990 Re: HIV Reporting in Washington State Dear Mr. Braddock: The Jefferson County Board of Health has been carefully considering the issue ofHIV reporting for much ofthe past year in light of its statutory obligation to "provide for the control and prevention of... infectious disease within the jurisdiction of the local health department." As you and the other members of the State Board of Health are well aware, the debate over HIV reporting has been highly contentious, pitting medical and public health providers against passionate advocates for the privacy rights of those infected with HIV. This debate has raged for over two years at a state and national level and prompted resolutions from many local boards of health and specific action from the Pierce County Board of Health declaring HIV reportable within its jurisdiction. The Jefferson County Board of Health is acutely aware of the responsibility we share with the Washington State Board of Health to carefully balance the life and death imperatives of communicable disease control with the privacy rights of individuals. These privacy concerns are of particular importance in small towns and rural populations where improper public disclosure of an individuals HIV positive status can lead to social stigmatization and discrimination. We can well understand the intense fears and anxieties that members of our community who are living with HIV I AIDS have felt when confronted with the inflarmnatory rhetoric of the public debate over HIV reporting. We also appreciate the urgent concerns of public health officials and health care providers who must confront the human reality of the HIV epidemic and strongly believe that our current preventive efforts can and must be improved. Infectious disease epidemics have powerfully shaped human history and have always sparked intense fears. The fundamental challenge for public health policy makers is to separate fears from facts and chose epidemic control measures that are based on sound scientific research. As we approach the 3'd decade of the HIV epidemic, we are fortunate to know much about the nature and treatment of the disease, the effectiveness of different preventive interventions, and the impact of HI V reporting methods on human behaviors. From this research, we know that confidential reporting ofHIV to public health officials does not lead to public disclosure of private medical information. We know that name- based reporting systems do not discourage individuals from being tested for HIV infection. We know that notifYing sexual and needle-sharing partners who have been exposed to HIV leads to increased testing and earlier detection of HI V infection. And we ~ . ~ know that maintaining access to anonymous testing is important in promoting early diagnosis of HI V infection. In the final analysis, epidemics are not brought under control by fearful speculation but instead by accurate, verifiable scientific knowledge translated into effective treatment and prevention efforts. We commend the State Board of Health for taking up the difficult task of revising Washington State's communicable disease health codes to more effectively respond to the ongoing HIV epidemic. We support the Board's goal of creating uniform, statewide reporting requirements that are protective of individual confidentiality while allowing public health officials to carry our their statutory responsibilities to prevent person-to- person spread of this deadly infectious disease. In reviewing specific changes to these health codes, we urge you to carefully consider the impact of these regulations on rural as well as urban populations and to study the potential costs to local health jurisdictions of implementing enhanced HIV surveillance. As Jefferson County's Board of Health we are committed to maintaining an active partnership with HIV I AIDS advocates within our community and continuing our strong advocacy of accessible, high quality medical care, confidentiality protections, and the prohibition of HI V-related discrimination. We are hopeful that in the months ahead the public policy debate over HIV reporting will shift from impassioned advocacy of entrenched positions to a thoughtful consideration of how best to deal with the ongoing public health threat posed by Washington State's HIV epidemic. We stand ready to support and assist the State Board of Health in carrying out its mission to preserve, protect, and promote the health of all of Washington State's citizens. Sincerely, Dan Harpole Chair, Jefferson County Board of Health Jefferson County Commissioner, District 1