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HomeMy WebLinkAbout10 October v JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, October 21,1999 Board Members: Dan Harpole, Member - County Commissioner District #1 Glen Hunting/ord, 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 (City) Roberta Frissell, Vice-Chairman, Citizen at Large (County) Staff Members: Jean Baldwin, Nursing Services Director Larry Fay, Environmental Health Director Thomas Locke, MD, Health Officer Vice Chairman Frissell called the meeting to order at 2:30 p.m_ All Board and staff members were present with the exception of Chairman Wojt. APPROVAL OF MINUTES Member Buhler moved to approve the minutes of the August 19, 1999 meeting. Commissioner Huntingford seconded the motion which carried by a unanimous vote. OLD BUSINESS - None NEW BUSINESS NOVEMBER BOH MEETING DATE: Due to lack of a quorum, the November meeting has been changed to Tuesday, November 23 at 1:00 p.m. The meeting with legislators is tentatively set for Thursday, December 16 during the regular meeting. NEEDLE EXCHANGE PROGRAM INTERVENTION PLAN: Jean Baldwin said that although the statement in the agenda information says that" State AIDS Omnibus funds are available to help local health jurisdictions undertake the planning process necessary to assess ..., "the sentence does not say this is money the County has always received and used for services. The state is demanding a re- prioritization of services based on high risk prevention, but there is no new money. Dennis Langlois provided background and an overview of the prevention plan which he wrote with Kelly Ragan_ Jean Baldwin said the County's resistance to the program in the past was that the County did not want to be the needle exchange site for the entire region. Clallam County is now in the partnership with Jefferson County. ~ HEALTH BOARD MINUTES - October 21, 1999 Page: 2 Dr. Tom Locke said more information needs to be collected before the Board can determine how acceptable, effective and costly it is going to be for the community. The idea behind the planning process is to answer those questions and then give the Board an opportunity to make an informed choice. Member Masci said budgeting for 50 users seems inadequate. Jean Baldwin responded that this budget is for the year 2000 and covers just the first few start-up months of the program. Mernber Masci rnoved to approve the Needle Exchange Program Intervention Plan. Member Buhler seconded the motion for discussion. Commissioner Huntingford asked if the program is fully funded with grant dollars? Jean Baldwin responded that the planning process is fully funded and will identify what the program will mean to the County financially. The program is a partnership with the Jefferson AIDS Society, which has minimal community money and some federal Ryan White money. Jill Buhler asked if these other groups are involved in the plan? Jean Baldwin said yes. Member Masci asked if there is a certain obligation that the raw data gathered in this program would be shared with law enforcement. Dr. Tom Locke responded that as in other programs, there is a certain amount of utilization of the public information. As long as sharing does not compromise the goals of the program, it may be an appropriate way for the community to know the impact of the IV drug use program. Some of the information generated will be available to those who want to use it, including law enforcement, but it will be anonymous in terms of the users. The Chair called for a vote on the motion. Cornmissioner Huntingford abstained from voting. The motion carried. IMMUNIZATION LEVELS OF JEFFERSON COUNTY CHILDREN: Jean Baldwin reported some of the flu clinics are being rescheduled because of vaccine shipment delays. The shipment is expected by next week. Priorities were established for the remaining vaccines. Lisa McKenzie reviewed three types of immunization exemptions for children: medical, religious and personal. In the event of an outbreak for which children are not immunized, those children will be excluded from school for the duration of the outbreak. Reports from the State reflect Jefferson County is still high in exemption rates, second only to San Juan County. The County also received the raw data from each school indicating immunizations for which families declined. The exemptions are not. HEALTH BOARD MINUTES - October 21, 1999 Page: 3 restricted to one district and of great concern is the number of students opting out of the measles vaccination. In response, a letter has been drafted to propose increased cooperation with schools to assess the types of reasons for exemption. Jean Baldwin said the question is how to track two-year olds until they are of school age? A few years ago, a county-wide survey found immunization rates among two year olds improved with better services, lowered fees, increased clinic hours and outreach. Vice Chairman Frissell said she is aware of the spread of bad information in the community. This information is being used as a basis for deciding not to immunize. She believes better education is the solution. Parents who think they are doing the best for their children need to understand the potential consequences of not being immunized compared to the risks of immunization. Horne schoolers might be a place to start and a letter to local physicians to raise their consciousness and ask for cooperation. Jean Baldwin said Clallam, Kitsap and Jefferson form a coalition with KPS as the chair. The goals of the coalition are community education and tracking. Member Buhler asked if the County tracks segments of the population more prone to exemptions? Jean Baldwin responded that the base numbers are the only thing tracked. Commissioner Harpole suggested taking this opportunity to do a press release with information on immunizations. Jean Baldwin agreed that this small education outreach could also help strengthen the coalition. Member Masci said the information that is being circulated as a reactionary movement is bad science based on the premise that there is a certain risk to immunizing children and that no risk is acceptable. In the alternative practice groups, there tends to be a certain element of the practitioners - maybe 20% - that are reacting emotionally and are not compiling the data. Communication with alternative practitioners may help. Member Buhler asked about DSHS networking? Jean Baldwin stated that in her opinion the messages were already getting through on the two year olds. Since the immunizations come out of the Health Department to the private providers, the Child Health Profile could track immunizations of children not yet of school age. Lisa McKenzie said an additional benefit of Child Health Profile is that parents receive newsletters on health, nutrition and immunizations. Member Buhler suggested including information clearing the misconception that the diseases have been eradicated. Jean Baldwin agreed. '. HEALTH BOARD MINUTES - October 21, 1999 Page: 4 Commissioner Harpole suggested an article or press release printed in The Peninsula Daily News or The Leader could include contact information, to let the parents know who to contact. Member Masci asked about incentives. Providing health information on the public access cable channel is also an option. Jean Baldwin feels the next step is to work on how to do a school assessment. Member Westerman said families should have immunizations for the health of the community. It is a personal decision that affects the whole community. PROPOSED STANDARDS FOR PUBLIC HEALTH IN WASHINGTON STATE: Dr. Tom Locke reported that the development of statewide standards was discussed in the early 1990s and became a State mandate with the Health Improvement Plan legislation in 1995. Two goals of the process were to create 1) a minimum standard of public health protection and a method of measuring the accountability of public health agencies. Health Departments are field testing the standards and will respond to the State. There is a concern about setting minimum standards, but the general consensus is that it is better to have some floor than no floor at all. Jean Baldwin said minimum standards in Jefferson County have already been determined, but there could be some general housekeeping. Larry Fay sees some minor organizational changes that would occur. The difficulty is having an objective measure of performance in meeting the standards. Dr. Locke believes the State Department of Health has the authority to pass rules to address these issues. If the local jurisdictions do not comply, the State can step in and do the work and charge the local jurisdiction for the cost, MINIMUM LAND REOUlREMENT OF ON-SITE SEWAGE SYSTEM PERMITTING: Larry Fay reviewed a hypothetical waiver application for an area with lot densities of 'h acre. If a property owner acquires an easement for a drain field from an adjacent landowner with five acres, a waiver could be granted using the lot averaging concept. When two adjacent lots are needed to meet the land area requirement, a waiver cannot be issued for two building sites. The options are to keep the two lots together and apply for one permit or apply for a boundary line adjustment. Does the ownership provision need to be the first criteria in order to qualify for a waiver or does the County want to broaden the policy? Commissioner Harpole stated that a change was created by the adoption of the Comprehensive Plan and the original intent may not be adequately reflected in this policy. Member Westerman expressed concern about an easement when there are changes in property ownership. . HEALTH BOARD MINUTES - October 21, 1999 Page: 5 Commissioner Huntingford stated that he sees no reason to address land use issues if the property owner is able to meet the health standards. Larry Fay responded that land area requirements go with the issues of the septic permit. Under the current policy, an owner would not be able to do an easement for two contiguous conforming lots. Member Masci said if the ownership element is excluded and the property owner is able to meet the minimum standards, either through adjacent ownership or easement, it should be allowed. Larry Fay noted that the County has never addressed existing lots of record in the Comprehensive Plan. There is no definition of a buildable lot. Member Masci said language could be added that says "easement or ownership of requisite number of square feet to provide on-site sewage treatment to meet the minimum health standard...." Larry Fay feels that the current policy reflects this. He does not have a problem with using lot size averaging to meet septic requirements. He suggested a clearer policy where it is easy for staff to say yes or no. Conceptually, if an off-site easement approach accomplishes the same thing as a boundary line adjustment, he would work on amending the policy and bring it back to the Board. An owner with two half acre lots has buildable lots. The reason the waiver is given is to provide some relief to people who own unbuildable property. If this rule is going to be expanded, the County needs to look carefully at setting precedents that create easement problems. Member Westerman is concerned that with a policy amendment will come more requests for waivers. It is her opinion that most of the cases will involve waterfront lots. There will be a considerable number of lots under issue in the Tri Area. Larry Fay said the County establishes the densities and a concern is the current capacity for areas without sewage systems. We have not done a good job of setting the maximum septic density if we do not go into other structured development. He agreed to work on the policy language and will bring a sampling of easements. Commissioner Harpole excused himself from the meeting at 4:00 p.m. MYSTERY BAY SHELLFISH: Larry Fay reviewed the information on the recent inspection and evaluation of Mystery Bay. The concerns of the State Department of Health are that the number of mooring buoys and increasing boating population might force restrictions on shellfish harvesting. Although no Board action is required, a recommendation would ensure that the Department of Community Development, which has jurisdiction over permitting through the shoreline program, understands the impacts when they are considering these applications. Vice Chairman Frissell asked if the buoys are permitted? HEALTH BOARD MINUTES - October 21,1999 Page: 6 Larry Fay will contact DCD and report findings back to the BOCC and the Board. Member Masci suggested defining the levels of environmental degradation. The Board could recommend a ceiling. Larry Fay said although the shellfish growers have not identified water quality problems, there are concerns about the number of boats, potential spills, live aboards and degradation. He will investigate whether there are state standards available. BREAST AND CERVICAL CANCER HEALTH SCREENING PROGRAM: Jean Baldwin explained that the Board voted for the Health Departrnent to become the screening coordinator. Member Buhler previously made a motion that if it costs the County money, she has to be notified because the hospital may need to be involved. Although the County was asked to continue to do public outreach, the screening and enrollment is now completed through Seattle King County. Jefferson General has dropped their contract to do mammograms for The Breast and Cervical Cancer Women and the Soroptomists. Jean Baldwin is working to see if the Seattle and King County mobile van will come here. Mammography contracts are also held with breast clinics in Seattle, Poulsbo, Bremerton, and Port Orchard and while quality of care is not an issue, traveling is inconvenient. Jill Buhler agreed to follow up with Jefferson General Hospital regarding their position on this contract. HEALTH CARE ACCESS: Group Health has rejected all Clallam County residents as of December 31 and it appears that Jefferson County residents will be next. It is unclear whether the hundreds of people who travel to Kitsap for Group Health services will have Group Health as of January 1. Dr. Tom Locke said this topic will be covered more thoroughly on next month's agenda. On November 9, there will be a rural health summit. Vice Chairman Frissell said rural areas are being discriminated against by the insurers. AGENDA CALENDAR / ADJOURN 1. HEALTH ACCESS - November (Dr. Tom Locke) 2. JEFFERSON GENERAL BREAST AND CERVICAL CANCER SCREENING - Gill Buhler) 3. MINIMUM LAND REQUIREMENT OF ON-SITE SEWAGE SYSTEM PERMITTING (Larry Fay) 4. MYSTERY BAY SHELLFISH & MOORING BUOYS (Larry Fay) 5. MARY SELECKY VISIT - January 6. MEETING WITH LEGISLATORS - (Dr. Tom Locke) 7. LICENSING PROCEDURES - Rescheduled to December . . HIV Reaion VI Proposed Intervention Plan Needle Exchanae Proaram Agency Name/lD: Jefferson County Health and Human Services Counties Served: Clallam and Jefferson General description of intervention: A needle exchange program will be initiated by December 1, 2000. Services to be offered will include one-for-one needle exchange and treatment referrals, along with provision of condoms, sharps containers, and educational materials for clients, including secondary exchangers. (Will also consider provision of alcohol pads, triple antibiotic cream, cotton, sterile water, and Band-Aids, pending budget capabilities). Prior to start-up, the following planning activities will take place: 1. Local and national data to support the need for a needle exchange program will be collected. Stakeholders, including prosecuting attorneys and law enforcement and substance abuse treatment providers will be identified, and support strategies developed to counter objections. Collaboration with Clallam County will be expanded, with the goal to develop an affordable, sustainable program: possible private and public funding sources will be identified. (June 2000) 2. Consultation with other active needle exchange programs regarding costs, range of services, suppliers, staffing and training needs, policies and operating procedures will take place. Options for fixed-site vs. mobile, and subcontracting, directly providing services, or jointly providing services will be reviewed. Information will be elicited from IDUs regarding perceptions of barriers, appropriate locations for sites, methods, incentives, and confidentiality issues. Options will then be presented to the Board of Health. (Nov. 2000) 3. Following approval by the Board of Health, an overall operating plan will then be established, including services to be offered, oversight/management responsibilities, data collection and evaluation pan, and preliminary budgets for each service option. (Nov. 2000) 4. Exchange site protocols and procedures will be developed, including ground rules for clients, self-care contracts for workers, security, confidentiality, and staff/volunteer training materials will be developed. Recruit outreach worker(s), paid and volunteer. (Dec. 2000) Process Objectives: 1. In 2000 JCHHS will hold at least 8 meetings with community stakeholders, including Law and Justice and chemical dependency providers, to plan and implement a syringe exchange program for an estimated 50 IDUs in Jefferson and Clallam counties. , Needle Exchange Page 2 2. The Health Department Prevention Team will provide HIV risk reduction education and community outreach to 20 MSM and IDUs at the county jail and Boiler Room. 3. By December 1, 2000, initiate needle exchange services at sites in Clallam and Jefferson counties that have been identified by IOU sources as appropriate and likely to be utilized. 4. During 2001, serve 50 individuals at exchange sites. (Numbers based on Thurston County's start-up experience, pro-rated by population served). 5. During 2000, exchange 100 syringes between all sites. 6. During 2000-2001, offer referrals for drug treatment and HIV counseling and testing with every client. Offer referrals for other healthcare services as appropriate. This intervention plan is effective, and the targeted population is consistent with those prioritized in the HIV Prevention Plan. (Vogt et al. (I 998); Des Jarlais et al. 1995; Hurley et al. 1997) Demographic description of clients to be served: Demographic descriplion of clients to be served: <24 Years >24 years Tolal American Indian/Alaskan 1 1 2 Native Asian/Pacific Islander 0 0 0 Black (non-Hispanic/Latino/ 0 0 0 Latina) Hispanic/Latino/ 0 0 0 Latina White (non-Hispanic/Latino/ 17 31 48 Lalina\ Total 18 32 50 Resources: Federal prevenlion dollars (CDC through consolidated contract) $5.000 Slate prevention dollars (AIDS Omnibus and other state dollars) County General Fund Other (Local. privale. fees, etc.)