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HomeMy WebLinkAbout07 July JEFFERSON COUNTY BOARD OF HEALTH MINUTES July 15, 1999 BOARD MEMBERS Dan Harpole, Member - County Commissioner District #1 Glen Huntingftrd, Member - County Commissioner District #2 Richard Wojt, Chairman - County Commissioner District #3 Geoffrey Masci, Member - Port Townsend City Council Jill Buhler, Member - Hospital Commissioner District #2 Sheila Westerman, Member - Citizen at UI1;ge (City) Roberta FrisseU, Vice-Chairman - Citizen at La1:!Je (County) STAFF MEMBERS Jean Baldwin, Nursing Services Director Larry Fay, EnPironmental Health Director Thomas Locke, MD., Health 0fJicer Chairman Wojt called the meeting to order at 2:02 p.m. All Board and staff members were present with the exception of Commissioner Harpole and Member Masci. APPROVAL OF MINUTES Member Westerman moved to approve the minutes of the May 20, 1999. Member Buhler seconded the motion which carried by a unanimous vote. PUBLIC COMMENT Leslie Locke introduced Joanna Sanders as the new Scribe for the Board of Health. OLD BUSINESS JEFFERSON COUNTY DRAFT ON-SITE SEWAGE SYSTEM REGULATION: Larry Fay reported that Draft #3 captures comments, questions and changes resulting from the two previous workshops held in June. Deputy Prosecutor Shirley Waters Nixon reviewed Draft #3 and addressed questions from the workshops as follows: ::: Appeal/Hearing. Page 17, Section 8.15.180. Whether an aggrieved person has the ability to appeal a decision made by the Health Officer to the Board of Health. The recommendation was to change the language to read" Appeals may be made by a person aggrieved of a decision." A separate policy statement would disclose who is aggrieved. ::: Notice to Title. Page 20, Section 8.15.190 subsection (d). When there is an ongoing, unresolved violation, Deputy Prosecutor Waters Nixon felt Notice of Title could be used. The concern has to do with placing a Notice of Title, advising that a violation exists, and then failing to remove the notice if the violation is corrected. She suggested it be written that "you have to exhaust your administrative remedies before a Notice of Title is done. The notice would be filed with the Jefferson County Auditors Office as a notice of potential uncorrected violation." She offered to work on a standard, reproducible notice as an appendix referencing the same information. HEALTH BOARD MINUTES - July 15, 1999 Page; 2 * Section 8.15.160 Page 13, Operations and Maintenance. There was a question of "should" versus "shall." Deputy Prosecutor Waters Nixon said that while "should" does not have the same strength as "shall" in regulations, it is still useful. In subsection (k) on Page 14, there were questions about an O&M specialist identifying needs for maintenance. She suggested the language revert to "should" and remove "and verified by Health and Human Services." Her concern is that every recommendation of the O&M specialist would become appealable to the County and staff would ultimately perform the inspection. Member Westerman agrees with the logic, but expressed concern that "should" cannot be verified. Larry Fay said he doesn't know if "shall" will help the County a lot, however, he feels that since the real goal is to inspect systems regularly and identify problems, the new regulation is going to be a major improvement over past procedures. Most issues are relatively small and easily remedied. Regarding Section 8.15.190, Larry Fay said he and Deputy Prosecutor Waters Nixon talked about enforcement procedures and were satisfied with the section. There is an interest in looking at the enforcement procedures document that was put together with the solid waste ordinance and make it a separate document. The enforcement document would outline the process so that almost anyone could perform the appropriate notification using the standardized form. The downside is that the enforcement procedure would have to be followed once it is established. 8.15.090 Page 6, Design (4). Larry Fay agreed to clarify this item. 8.15.080 (16) (b), "No application shall be extended more than once." Member Buhler asked if there is a way for the Health Officer to grant another extension if necessary. Larry Fay responded that Section (b) deals with applications before a permit is issued. The original application has a l2-month time limit. One extension would allow a total of a year and half to act. In the few instances where an extension is needed, the decision could be appealed to the Board of Health. Dr. Tom Locke said if a timeline isn't clearly established up front, there is no incentive to get it done. Notice To Title. Deputy Prosecutor Waters Nixon is investigating the possibility of charging a fee to remove a Notice to Title as is being done in Pierce County. The fee could recover some of the administrative costs involved in the hearings, investigations, etc. 8.15.150 Page 13, (9) Bond/Insurance. Larry Fay said more research is needed to see what other counties are requiring. He indicated bonding is oflimited utility and does not do much to protect the consumer. Most on-site sewage installers have to be licensed in the State of Washington and maintain a contractor's bond. Commissioner Huntingford said his concern is that the liability for a failed system could reside with the County if it performed the inspection and did a final sign off. 8.15.180 Page 17, (4) (b) Member Buhler suggested changing "which affirmatively establish" to "which allege." Larry Fay agreed. Larry Fay indicated that Draft #4 will incorporate these changes and the suggested changes of Deputy Prosecuting Attorney Waters Nixon. Following a report of comments received at public meetings, the final rule could be ready for adoption in October. HEALTH BOARD MINUTES - July 15, 1999 Page: 3 ANTI-SMOKING CAMPAIGN: Vice Chairman Frissell reported she has received permission to use the anti-smoking television commercial created for the Great American Smoke Out. She will work with Jean Baldwin on the format needs. NEW BUSINESS HEALTH DIRECTOR RESIGNATION and BOARD OF HEALTH IMPLICATIONS: Dr. Tom Locke reported that the Board of Health By-Laws state that the Health Director is the Administrative Officer for the Board of Health. The Health Officer is the default for that position until a new Health Director is appointed. Dr. Locke said the Health Director duties will be delegated in the interim to himself and Mary Ann Preece-Rushton as they have the greatest flexibility in taking on new responsibilities. Dr. Locke will be working an additional day a week during this interim period. Jean Baldwin and Larry Fay will also have additional responsibilities, but not at the expense of their existing duties. Staff members will be filling a rotating position called the Administrative Office Lead to handle staff-level administrative support functions. Additional capacity to deal with any serious, unexpected situations would come from the expertise of other jurisdictions and from the State. Jean Baldwin said six vacancies have now been filled and the staff is trained and working on their own. Regarding budgetary changes, Deputy Director of Public Services David Goldsmith is assisting with job descriptions and classifications during the interim. HIV REPORTING IN WASHINGTON STATE: IMPLEMENTATION OF NEW RULES IN JEFFERSON COUNTY AND TIMELINE FOR ADDITIONAL RULE DEVELOPMENT: Dr. Locke reported that the State Board of Health voted unanimously to institute a name-based reporting system for local health department officials. The board also voted to retain the 90-day record destruction policy for the HIV identification information. The rules are scheduled to go into effect in September. Dr. Locke reported that a small group called, "Resist the List" attended the State Board of Health meeting. The group feels that any list for communicable disease would impact civil rights. Dr. Locke believes it will be an uphill battle to make a civil rights case when there is so much evidence showing the effects to be beneficial. He said, from an epidemiological standpoint, there is really no purpose served by state or federal lists. The coding system that the State used for federal reporting purposes is being moved down to a local level. Dr. Locke explained how disease reporting turns into disease prevention. Partner notification, which the County is currently doing, leads to earlier diagnosis and risk reduction efforts. Early diagnosis also leads to earlier initiation of therapy which doesn't completely prevent the risk of transmission but appears to reduce it. It also leads to improved risk reduction behavior. Dr. Locke said one of the most important issues about confidentiality is that the whole system operates on trust. The only reason that someone identifies their partners is that you have established a relationship of trust and they believe that something good will come from sharing that information. Dr. Locke said that overshadowed slightly by the HIV controversy is that the entire reportable disease system is being revised, with dozens of diseases being added or deleted. Jean Baldwin said gunshot wounds are now reportable by hospital and medical providers. HEALTH BOARD MINUTES - July 15, 1999 Page: 4 JOINT MEETING OF THE JEFFERSON COUNTY BOARD OF HEALTH AND JEFFERSON GENERAL HOSPITAL COMMISSIONERS: Dr. Locke said a joint meeting with the Board of Health and the Hospital Commissioners is scheduled during the September Health Board meeting. The location for the meeting has been set for the lower-level conference room at the courthouse from noon until 5 p.m. An information packet and an agenda will be mailed later this month. Dr. Locke said the meeting was originally called a Report Card session, where community indicators would be reviewed. AGENDA CALENDAR AGENDA PLANNING - 1999: Chairman Wojt suggested several items for future agendas which include: _ Decline of Group Health Coverage/Local Providers: Discuss whether to take a pro-active stance on the decline of providers and difficulties getting insurance _ Preparedness Plan for Major Epidemics/Emergency Preparedness Plan _ On-Site Sewage report: Who can appeal? Who has standing? _ Budget Priorities _ Mental Health Community Update _ Long-Term Prevention Strategies and Yippee Component Meeting adjourned at 4:25 p.m. The next meeting will be held on Thursday, August 19, 1999 at 2:30 p.m. (Excused Absence) Geoffrey Masci, Member ()~'j/0~ ~lE;;:hler, Member 2)~kWOhW~ Sheila Westerman, Member (Excused Absence) Dan Harpole, Member Human Services July 8, 1999 To: Jefferson County Board of Health From: Tom Locke, MD, MPH, Jefferson County Health Officer @ Re: Adoption ofHIV Reporting Rules and Implementation in Jefferson County The Statewide Process: On July 14, 1999 the State Board of Health will hold its adoption hearing for changes to WAC 246-100 that will make HIV infection a reportable disease in Washington State. The rule will take effect 60 days after adoption unless the Courts intervene to block implementation. A copy of the draft rule that is being proposed for adoption is included in this packet. Washington State rule making procedures allow only minor "technical" amendments to such rules during their adoption hearings. Any changes that are judged to be "substantial" require an addition period of public comment and would extend the rule adoption process by a minimum of 60 days. It is unlikely that any substantial changes will be made in the draft rules following the July 14 public hearing. With adoption of these rules, Washington State will become the 31 st state with some form of HI V reporting. AIDS, an advanced stage ofHIV infection, is reportable in all states. Public health officials have long advocated confidential reporting ofHIV infection as a critical step in improving our national response to the HIV epidemic. Our current inability to track the number of new cases ofHIV infection makes it difficult, if not impossible, to evaluate the effectiveness of HI V prevention programs and target limited resources towards populations at greatest risk for infection. Lack of HIV reportability also prevents public health workers from using traditional methods of communicable disease control such as contact tracing to reduce transmission of infection. The public process that has lead to HIV reporting in Washington State has been protracted and controversial. Extensive public testimony before the State Board of Health has detailed both the overwhelming scientific evidence supporting confidential disease reporting as an effective means of communicable disease prevention and the intense fear that exists about the potential misuses that "government lists" might be put to. Appropriately, this public debate has also taken place before a number of Local Boards of Health in Washington State, including the Jefferson County Board of Health. Several Boards adopted resolutions in support of confidential, name-based HIV reporting. The Tacoma-Pierce County Board of Health adopted a county code implementing confidential HIV reporting effective January 1, 1999. King County, where 65% of HEALTH DEPARTMENT 360/385-9400 ENVIRONMENTAL HEALTH 360/385-9444 DEVELOPMENTAL DISABILITIES 360/385-9400 ALCOHOL/DRUG ABUSE 360/385-9400 FAX 360/385-9401 Washington State's AIDS cases have been reported over the past decade, was the site of a particularly long and complex public debate. The Seattle-King County Board of Health convened a "common ground" workgroup representing a diverse range of health officials and HIV/AIDS advocates. In the end, a consensus set ofrecommendmions were made to and adopted by the Board of Health. This "common ground" proposal was then presented to the State Board of Health and strongly shaped the current draft rules. The essential feature of the "common ground" position on HIV reporting involves name- based reporting on a local health department level followed by use of coded identifiers for subsequent reporting to state and national health authorities. An additional feature of this proposal calls for the destruction of identifying information by local health jurisdictions after 90 days. This latter feature was opposed by the majority of County Health Officers due to its lack of scientific basis and its potential for jeopardizing local communicable disease control efforts. In a 5-3 vote, the State Board of Health decided to . keep the 90 day destruction requirement while mandating a I year evaluation of the impact of this aspect of the rule. Mandatory destruction ofHIV reporting information, when enacted, will put the rules already adopted by the Tacoma-Pierce Board of Health (which do not mandate name destruction) in direct conflict with the State Board of Health rules. Jefferson County Response: Mandatory reporting of HIV infection will create additional responsibilities for Jefferson County's communicable disease control specialists. While the mechanics of reporting and encoding are relatively straightforward, the partner notification and behavioral risk reduction efforts that are initiated by an HIV case report can be very time and labor intensive. Interrupting the cycle of transmission ofHIV infection requires early diagnosis of the infection, long before it has caused signs of chronic illness. Identification, contact with., and appropriate counseling and testing of individuals who have been exposed to HIV infection is critical to achieving this goal of early diagnosis and improved prevention. It is estimated that over 200,000 people in the United States are infected with HIV but do not know it. Using simple population projections this would suggest that at least 4,000 people in Washington State and as many as 20 in Jefferson County have undiagnosed HIV infection. This is a high priority group for public health interventions. Jefferson County already has a well developed system for confidential reporting and partner notification that is used for all reportable sexually transmitted diseases as well as AIDS reports. Efforts are underway to expand Jefferson County's policies and procedures to accommodate the new information that will be provided by Washington State's unique form of HI V reporting. Future Issues: HIV reporting was only the first of three major public health policy issues involving this epidemic infection. The next policy debate will involve the rules that govern partner notification The third policy issue will likely prove the most controversial of all. It involves the rare but very serious problem of"conduct endangering the public health" - situations in which a person with an active sexually transmitted disease (including HlV) intentionally exposes another person to the infection. Washington State has had a convoluted set of rules dealing with this problem for the past 10 years. However well intentioned, they are widely regarded by public health practitioners to be ineffective. Efforts to make them more effective ,viI! likely ignite the same passions that inflamed the HIV reportability debate. In the final analysis, public health policy makers, including local boards of health, must lo'fllpple with the grim reality of HIV as both a national and global epidemic. Within the U.S. there have been impressive gains in treatment of HI V infection and its complications. There is disturbing scientific evidence that these gains may well prove temporary unless a continuing stream of new and effective treatments can be developed. While the death rate due to AIDS has dramatically fallen, there is no evidence that the incidence of new cases of HIV is decreasing. Worldwide, the problem borders on hopelessness. Over 23 million people are HIV infected, the overwhelming majority of whom have no access to effective treatments. The public debate over HlV is complex and involves many issues besides the virus itself As an infectious disease, however, its essential nature is brutally clear - in the global battle between HIV and the human race, the human race is losing on a catastrophic scale.