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HomeMy WebLinkAbout011603 JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, January 16, 2003 Board Members: Dan Titterness, Member - County Commissioner District #1 Glen Huntingford, Member - County Commissioner District #2 Wendi H. Wrinkle, Member - County Commissioner District #3 Geoffrey Masci, Vice Chairman - Port Townsend City Council Jill Buhler, Member - Hospital Commissioner District #2 Sheila Westerman, Chairman - Citizen at La",e (City) Roberta Frissell, Member - Citizen at Large (County) Staff Members: Jean Baldwin, Nursing S eroices Director Larry Fay, Environmental Health Director Thomas Lacke, MD, Health Officer Chairman Westerman called the meeting to order at 2:38 p.m. All Board and Staff members were present, with the exception of Commissioner Huntingford (who joined at 2:45 p.m.). There was a quorum. Members welcomed newly elected Commissioner Wendi Wrinkle. APPROVAL OF AGENDA Member Frissell moved to approve the Agenda as presented. Member Buhler seconded the motion, which carried by a unanimous vote. ELECTION OF BOARD OF HEALTH CHAIR AND VICE CHAIR FOR 2003 Chairman Westerman called for nominations for the position of Chair. Member Frissell nominated Member Masci. There being no further nominations, Member Frissell moved to elect Member Masci as Chair. Member Buhler seconded the motion, which carried by a unanimous vote. In response to the call for nominations for Vice Chair, Member Masci nominated Commissioner Wrinkle. There being no further nominations, Chairman Masci moved and Member Westerman seconded the motion to nominate Commissioner Wrinkle as Vice Chair. The motion carried by a unanimous vote. APPROVAL OF MINUTES Member Westerman moved to approve the minutes of November 21, 2002 (No meeting was held in December). Member Frissell seconded the motion, which carried by a unanimous vote. PUBLIC COMMENT Charles Chase asked for a status report on the County's action to address the health-related concerns associated with his neighbor on Egg and I Road. Mr. Fay reported that the two notices of civil infraction ....- HEALTH BOARD MINUTES - January 16, 2003 Page: 2 issued to Mr. Gaikowski, having failed to elicit a response, have gone to collections. Pursuant to the civil infraction ordinance adopted last year, a third notice would be sent before beginning a process with the County Prosecutor. He noted that the downside to civil infractions is that there is no further action beyond collections if the person ignores the ticket. However, if Mr. Gaikowski were to come before the judge on another matter, or attempted to obtain a new driver's license, he would be required to pay the tickets. He noted that when a certain threshold is met, communication among these other agencies is a court-initiated action. Member Westerman inquired if there is a policy limiting the time that can elapse between l't and 3'" tickets and if not, why? Mr. Fay noted that Staff had not proposed a time frame when submitting the draft enforcement procedures to the Board in July 2002. Once Staff issues a notice of infraction, whether it is the first, second or third, the person receiving the infraction has a certain period in which to respond by pleading guilty, paying the fine, or pleading guilty with mitigating circumstances, in which case the respondent would appear in front of a judge to plead not guilty and contest the ticket. Mr. Gaikowski has chosen a fourth option which is to ignore the ticket, that may result in a default ruling by the County and all three infractions would then be in collections. At the Board's urging, Mr. Fay agreed to issue the third ticket to the property owner, who would be given the opportunity to respond. It was felt that this would not necessarily reset the ticket process. PUD Commissioner David Sullivan, noting the close interface of Board of Health and PUD issues, such as public water, sewage, and septic, said the PUD is interested in either having a seat on the Board of Health or fmding an alternative for coordinating efforts. He recognized that the creation of a new seat would require an ordinance change. The PUD intends to raise this issue with the County Commissioners in a general discussion stressing the need for open communication among the agencies. There was Board support for placing this discussion item on the next agenda. Dr. Locke noted that only the County Commissioners can change the membership ofthe Board of the Health. Mr. Fay noted that the County Commissioners had received a letter from the PUD Manager on January 9th asking for consideration of participation on the Board of Health. Reminding that the PUD is a subcontractor, Chairman Masci suggested that the proposed arrangement be reviewed for any potential conflict of interest. Conditions for ADDroval of On-site Sewae:e Permits: Michael Belenski: Mr. Fay introduced Mr. Belenski and provided background on his permit application for property on Mats Mats Bay in Port Ludlow adding that with the exception oflanguage in the ordinance, Mr. Belenski's concerns have been resolved. His remaining concern is that the monitoring requirements in the ordinance are unconstitutional. Referring to a December letter to the Board in which he outlined his thoughts and rationale, Mr. Belenski said that until someone is subjected to such capricious and arbitrary decisions by government officials, they cannot understand the impact of this situation. The pie-shape of his property made it impossible to meet the Code's requirement that 4 holes shall be dug, even though he understands other people have been granted septic permits having dug just two holes. After eight (8) years of confronting the County about these arbitrary requirements and fighting his way through the system, he is finally able to install his septic system but is left frustrated with the lack of a clear complaint procedure. The only remaining issue is whether the County has the right to come onto his property for exploratory reasons related to his septic system, an act which he considers an invasion of his privacy. He does not feel he can be required to sign a contract giving the PUD or another monitoring entity permission to come on to his property. He is bothered by a Code that is so detailed regarding the ramifications of a lack of compliance, yet provides the homeowner with no method to correct the problem. Although it says the HEALTH BOARD MINUTES - January 16, 2003 Page: 3 individual has 90 days to correct the problem and that the County would work with the individual to sort through the problem, there should be some policy that will ensure fair treatment. The ordinance states the homeowner has ultimate responsibility, so it seems redundant to have to pay a third party inspector of the system. Dr. Locke issued a decision on April 23, 2002, which Belenski appealed to the Board of Health on May 3, 2002. The ordinance specifies there will be a response from the County within 35 days advising him of his hearing date. Not until he went to finalize a permit for a shop he is building on the same piece of property did the building department advise him that they would not permit the structure until the septic is approved. Although Mr. Fay provided a temporary occupancy permit, Belenski said he keeps having to prod the system to keep it moving. He understands this is his final administrative appeal. Dr. Locke said that, as Administrative Officer, he has to decide whether the request for appeal is appropriately directed. His opinion is that the constitutionality of either this Board's on-site regulations or the State Board of Health's regulations is not an appropriate issue for appeal to the Board of Health, but instead an issue for the courts. The application or interpretation of the law is appealable. The technical issues were all resolved in the administrative phase, the system is permitted and there is an ability to use it. The question of the legal authority to tell someone to enter into an operation and maintenance agreement is a legal issue on which the Board could obtain a legal opinion. This has not yet been done because of the desire to let Mr. Belenski directly address the Board. There is not an outstanding appeal to the Board on the issue related to the use ofthe on-site system. Mr. Belenski noted that those who approved the on-site septic code also have the authority to revoke it. Although Dr. Locke questioned in his letter whether the appeal process was the proper venue for this issue, Mr. Belenski said he would have appreciated a response that informed him ofthe more appropriate course of action instead of leaving him hanging. Member Westerman recognized the Board's significant work on this ordinance and pointed to the State's response in which it concurred that the ordinance was consistent with the intent ofW AC 246-272 and was approved. She agreed with Dr. Locke's interpretation of the limits of the Board's authority regarding the legal question of the constitutionality of requiring the monitoring of septic systems. She apologized for the lack of thorough communication in response to Mr. Belenski's concerns. She believes that until the Board is told by the legal department - or the State - that it is unconstitutional, we are obliged to go forward with the laws as written. Member Buhler recommended this issue be forwarded to legal counsel. Asked by Commissioner Titterness whether the County had responded within the 35 days, Mr. Fay said that Dr. Locke's response of May 22 indicated that the issue of constitutionality is not one that can be appealed to the Board. Mr. Fay did recognize that it would have been more helpful to state the intent not to schedule a hearing. Mr. Belenski called attention to WAC 246-272 (passed in 1995) and the subsequent passing ofRCW 70.118.30 (1998) regarding the procedure to be followed for obtaining a search warrant to gain access to property for the purpose of checking for a failed septic system. Chairman Masci confirmed there was consensus among the Board to direct Staffto write a letter to Deputy Prosecutor Alvarez regarding his reading ofRCW 70.118.030. HEALTH BOARD MINUTES - January 16, 2003 Page: 4 Mr. Belenski asked that this correspondence include all his letters to the Health Department. OLD BUSINESS AND INFORMATIONAL ITEMS Public Health Fundin!!: for 2003-04 Biennium Governor's Bud!!:et and Tri-Association ProDosal: Jean Baldwin reported that, as Chair of the Washington Association of Public Health Officials, she attended the Governor's press conference on the release of the State's budget. Due to budget challenges, the passage of two education initiatives without an associated funding stream will strain other areas of the budget, including Public Health. The motor vehicle excise tax, which was expected to end in June, will remain in the budget, as will several of the State Department of Social and Health Services/Public Health partnership programs, but with the many legislative demands, the future of this funding remains uncertain. Dr. Locke noted that, although less severe than this year, there was also a budget deficit last year. While there is still no guarantee that public health funding will be maintained, it has become a higher priority, which means that public health officials have made their case to the Governor. Although finding a stable source of funding has been discussed over the past five years, a statewide, predictable funding source is now becoming a concrete proposal and a priority of an organization called the Tri-Association. It may be the first time associations of cities and counties have joined to come up with a common legislative agenda. Commissioners Titterness and Huntingford provided a brief explanation of the following organizations: Washington State Association of Counties (WSAC) is made up of county commissioners, and Washington Association of County Officials (WACO) is other elected and some appointed county officials. It was noted that while the Cities and Counties have often been at odds, they have held joint legislative meetings in the last few years. Dr. Locke, referring to page 3 of the Local Government Joint Legislative Proposal, noted a proposal specifically related to public health funding. It states, "The Tri-Association recognizes the need to enhance local government revenues with a focus on securing additional resources for criminal justice and public health expenses. The Tri-Association will advance legislative solutions that assist both cities and counties and will seek $200 million - $250 million in additional annual revenue options for cities and counties. The Tri-Association will also work to ensure that cities and counties are provided adequate flexibility in the use of current revenue sources." Dr. Locke noted that the group has proposed that 25 cents of the unused property tax authority of the State (.65 per 1,000 property valuation), be used to support local public health. This would amount to more than $100 million, an increase over the current state and county funding sources. Member Buhler asked how the hospitals fit into "local public health?" She believes more collaboration between the Hospital and Health Department is needed in order to identify ways to economize. In response to Jean Baldwin's doubts that this could bring many more efficiencies, Member Buhler pointed to the many changes at the hospital over the last five years: employment of physicians, budget constraints, critical access and rural clinic designations. While there has been a lot of work done by both boards, she proposed the Hospital Board and Health Board get together again to discuss ideas, possibly after a meeting between Dr. Locke and Hospital Director Vic Dirksen. HEALTH BOARD MINUTES - January 16,2003 Page: 5 In response to a question about who would approve a tax increase, Dr. Locke noted that while it is within the legislature's authority, it may not have the political will. The legislature could vote to raise taxes or they could pass the decision on to the public by means of a referendum. Either option would be supported by Public Health. Jean Baldwin noted that a tax increase is not very popular, however, if approved, would provide ongoing funding. Ifthe Governor's budget passes, it would provide protection for only another year. Under the Governor's budget, Basic Health would receive cuts and a number of individuals would lose care through the State Department of Social and Health Services. While this public health funding would mean $75K, the majority of the Department's income comes from the State Department of Social and Health Services. She said it is confusing what to ask for from the legislators. Chairman Masci noted that since the session has just opened, this Tri-Association proposal is being presented to different legislative caucuses. The Board could certainly bring this issue up in 30 days, with the legislature still in session. Commissioner Huntingford said from the County Commissioner's discussions with the legislative group, it is likely there would be legislative support for some of the proposals as long as it is up to the local jurisdictions to ask the voters for approval. Chairman Masci asked that Staff provide a budget update next month. NEW BUSINESS Sta!!:e 1 SmallDox Vaccination Liability. Consent. and Unintended Consequence Issues: Dr. Locke reported that on December 13, 2002 the President announced the National Smallpox Vaccination Plan calling for moving forward with Stages 1 and 2. Stage 1 involves the vaccination of nearly 7,000 public health and hospital-based workers in Washington. Stage 2 involved a larger group of health care workers and law enforcement personnel - in excess of 10 million nationwide. Washington State has a Stage 1 plan and has been educating healthcare providers and public health workers on the issues, such as choosing whether or not to become vaccinated and management of adverse reaction. He and Scott Lindquist organized a multi-media talk about smallpox on December 13, which was also videotaped. The military has already begun some vaccination in Washington State and on February 18, Stage 1 vaccinations will begin. There are systems for monitoring adverse vaccine reactions. Although it is believed that the issues around inadvertent secondary transmission of the virus would be much less than in 1972, there are unresolved issues among counties and hospitals about liability. There is some question whether the Homeland Security Act fully covers hospitals or county governments for any side effects or injury. There is not currently a standardized consent and screening form, although Washington State has requested that it be nationwide because of the interest in everyone being screened on the same criteria. Unintended consequences are perhaps some of the biggest issues because smallpox planning has not only taken over bio-terrorism preparedness but all efforts to produce hazard response plans are essentially on hold. In many Health Departments, this issue has crowded out other core programs and has disrupted delivery of service. Another issue is that while Stage 1 is a constrained, focused program, albeit disruptive, Stage 2 is a different matter. The federal plan is for Stage 2 to immediately follow Stage 1. At a cost of about $84 dollars per vaccine, vaccinating 10 million people would cost in excess of a billion dollars, equaling the entire federal funding for bio-terrorism planning. HEALTH BOARD MINUTES - January 16, 2003 Page: 6 Jean Baldwin added that there is no reimbursement for doing this smallpox vaccination service. The bio- terrorism money, when received, is to be used to prepare a multi-threat plan. Regarding the criteria for who gets vaccinated, Dr. Locke said that Stage 1 involves vaccinating public health response teams - those who would do disease investigations or be involved in jump-starting massive vaccination clinics. In hospitals, it would be care teams - those involved in the initial recognition and care of small pox cases. Those who would not be directly exposed to smallpox would not need to be vaccinated in advance of an outbreak. Jean Baldwin noted that the Centers for Disease Control has an excellent web page with good information and contraindications (CDC.gov) and added that news releases have gone out in Bremerton and Port Angeles and by the end of next week information would be released in Jefferson County. The "What Should You Know" information sheet from the agenda packet is also available on the County website. 2003 Jefferson County Board of Health Retreat Planninl:: Jean Baldwin recognized that at the last meeting, the Board expressed its desire to have a focused retreat with clear goals and objectives. Staff requested input from the Board on planning the agenda. Chairman Masci and Member Buhler agreed to assist with planning and there was consensus of the Board not to focus on legislative issues. Jean Baldwin said she wanted to talk more in-depth about Health District vs Health Department. She noted that the Board has in the past also discussed yearly goals and objectives. Staff would also report on County scores on the statewide standards. The full day of March 20 was identified as a tentative date, contingent upon the agenda that is created over the next month. In response to a request for the latest data from the Data Steering Committee, Jean Baldwin noted that Dr. Chris Hale will be bringing the census work to the committee next week, and that the Board would receive this information at the February meeting. They will release a hard copy and also make the information available on a CD in the spring. Chairman Masci noted this could generate some retreat items. ACTIVITY UPDATE Civil Penalties ComDliance Procedures: Dr. Locke noted the Activity Update is intended to be used for recurring agenda items on which the Board requests updates. Universal Home Visitin!!:: The report is in the packet. AGENDA CALENDAR I ADJOURN February Agenda Items: Dr. Chris Hale presenting Census Information. Member Westerman moved to postpone the discussion about creating a PUD position on the Board until the March retreat. Commissioner Titterness seconded the motion, which carried by a unanimous vote. HEALTH BOARD MINUTES - January 16, 2003 Page: 7 Commissioner Huntingford moved to invite the pun to come to the retreat. Commissioner Titterness seconded the motion, which carried by unanimous vote. Commissioner Wrinkle voiced her concerns about being nominated Vice Chair at her first meeting of the Board. The meeting adjourned at 4:00 p.m. The next meeting will be held on Thursday, February 20 at 2:30 p.m. at the Jefferson County Health and Human Services Conference Room. JEF,FEft8QN COUNTY BOARD OF HEALTH ../' , 1~7 ~/ ~~y Masci, Chairman ~-- Ov~~W~ Wendi H. Wrinkle, Vice-C an -!JL- A~ti"g "' , {)JI61L :;fu Buhler, Member L)WU--- ~Qa,-rlj~ Sheila Westerman, Member It ,1 {<ACt dE<' JA~'tJi:.c( Roberta Frissell, Member