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JEFFERSON COUNTY BOARD OF HEALTH
MINUTES
Thursday, February 20, 2003
Board Members:
Dan Tit/erness, Member - County Commissioner District #1
Glen Huntingford, Member - County Commissioner District #2
Wend! H. Wrinkk, Member - County Commissioner District #3
Geoffrey Masci, Vice Cbairman - Port Townsend City Council
Jill Buhler, Member - Hospital Commissioner District #2
Sheila Westerman, Chairman - Citizen at LA",e (City)
Roberta Frissell, Member - Citizen at La",e (County)
S ta(f Members:
Jean Baldwin, Nursing Services Director
Larry Fay, Environmental Health Director
Thomas Lacke, MD, Health Officer
Vice Chairman Wrinkle called the meeting to order at 2:38 p.m. All Board and Staff members were
present, with the exception of Chairman GeoffMasci. Commissioner Huntingfordjoined the meeting at
2:40 p.m.
APPROVAL OF AGENDA
Commissioner Titterness moved to approve the agenda as presented. Member Buhler seconded
the motion, which carried by a unanimous vote.
APPROVAL OF MINUTES
Member Buhler moved to approve the minutes of January 16, 2003. Member Frissell seconded
the motion, which carried by a unanimous vote.
PUBLIC COMMENT -- None
OLD BUSINESS AND INFORMATIONAL ITEMS
Commissioner Wrinkle noted that the Healthy Youth Coalition is meeting this afternoon at the Tri-Area
Community Center to provide the opportunity for Chimacum students to discuss the issue ofthe recent
teen death.
Member Westerman noted that there has been much publicity in the newspaper about the awarding of
the recycling contract. The newspapers have not reported on the letter from the Developmental
Disabilities Board to the Commissioners in support of awarding the recycling contract to Skookum.
HEALTH BOARD MINUTES - February 20,2003
Page: 2
NEW BUSINESS
Community Health Assessment UDdate {corrected handouts of af!enda vacket revort!: Dr. Chris Hale
provided background of data previously reported to the Board: in 1990, the 1990 US Census and school
survey data; in January 2001, 20 years of birth-related health indicators and mortality rates and
preliminary short-form US Census data; and in March 2002, the Behavioral Risk Factor Survey data.
She then prefaced her presentation of the 2000 long-form Census, by noting that a somewhat longer
report looking at socio-demographic data would be offered at a community meeting tentatively planned
for May 13th. The survey primarily focused on six areas: Port Townsend, Port Hadlock/Irondale, Port
Ludlow, Marrowstone Island, Brinnon and Quilcene. She noted that only fragmentary information is
available for the West End. This assessment was guided by Healthy People 20 I 0, an ongoing
international effort to improve health of communities, targeted at improving the number of years people
live and the quality of those years and at reducing disparities. It is unlikely that life expectancy in
Jefferson County can go much higher, having nearly reached the biological limits. Quality of life
conclusions can be drawn from Behavioral Risk Factor Data and other data. She believes the reduction
of disparities is where the commnnity would be focusing its efforts. The report focuses on two classes of
disparity: differences in age composition (which will drive differences in the demand for health care)
and differences in poverty.
In reviewing the data in each ofthe report's, she offered the following comments:
1. Jefferson County's Population is significantly older than Washington State. Jefferson
County's percentage of people 65 and over is nearly twice that of the State (21.5% compared
with 11.2%). The implications of this are enormous because half of all health care expenditures
are consumed by this group. As a result, any constraint at the national level in Medicare or other
programs that benefit older people will hit this community twice as hard as it hits Washington
State. The 85+ segment which is nearly twice what it is in the State, has been growing
dramatically since about 1990 and is the most expensive to care for due to healthcare costs and
the assistance they need if they stay in their own homes. Other analyses indicate that this is
almost solely in-migration.
2. Age composition of places within the County are different. The major factors in changes over
the last 20 years are: 1) in-migration of 40-50 year olds and 85+, 2) normal aging of existing
residents, and 3) low birth rate. She noted that Port Townsend, Port Hadlock and Quilcene look
similar to the County overall, whereas Marrowstone, Brinnon and Port Ludlow look similar to
each other, but different from the County. The vastly different age composition within each of the
six communities would argue for different kinds of programs. She then reviewed the map in the
back of the report, which overlays the Census Bureau delineation of these community
populations with the postal zip code boundaries. These differences are important when
considering socio-economic information. Dr. Hale talked further about census tracts and noted
that Cape George, Kala Point and Shine were not represented. In summary, she noted that
Jefferson County, with a median age of about 43, is old, even compared to the State figures.
There are big differences in age composition among the commnnities, with the highest
percentage of kids living in Port Townsend, Port Hadlock/Irondale and Quilcene.
HEALTH BOARD MINUTES - February 20,2003
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3. Poverty rates in Jefferson County in 1999 were generally higher than in the state, but rates
varied from place to place within the County. She pointed out that while Jefferson County's
Median Household Income (MHI) in 1999 was $37,869, the data from Port Ludlow, representing
10% ofthe total households and whose MHI is nearly $57K, distorts upward the County's figure.
For the past two decades, Jefferson County's MHI has remained at about 80% of the state
average. Looking at those below 100% of the Federal Poverty Level, the County rate is 11.3%,
which is higher than the State rate. However, when excluding Port Ludlow (1.2%), Marrowstone
(4%), and Brinnon (13.8%), other commnnities reflect a higher poverty rate than the State. It was
noted that of the 593 people shown as below poverty in the West End, over 300 are on the Hoh
Reservation and some might also be in Queets.
4. The universe of people in poverty consists of three segments: children younger than 18 and
their parents or guardians, people age 18-64, and people age 65+. Nearly one quarter of the 2900
people in the county who qualify as having incomes below poverty are children and female heads
of household, with no spouse present. Nearly one in five are kids in married couple households.
The next largest group is people 18-64 living in non-family households with no children under
18. Together, these groups account for % of all the people in poverty in Jefferson County. The
other groups that account for the remainder are family households - 18-64 with no children under
18, and two groups of people 65+.
5. Poverty rate$ among children are higher in Jefferson County than in Washington State, and
rates differ sharply by place. One in six children younger than 18 in Jefferson County lives below
poverty. This compares with the national rate of one in four. Dr. Hale said that two confounders
in looking at this data are housing costs and the rates of disability in those 65 and older, which
may be a better indicator of program need than their income. The concept of poverty in rural
communities is different. Even though incomes in a certain area may be lower, program
utilization is also lower. People do not necessarily think ofthemselves as poor. Commissioner
Huntingford noted that at one point there was school information that showed the number of
children in the Brinnon School that are actually living with grandparents.
6. Jefferson County mothers are significantly more likely to be unmarried and to have their
pregnancies and deliveries paid for by Medicaid than in the State. Medicaid pays for 55% of the
births in Jefferson County as opposed to 36% statewide. Dr. Hale said she is concerned about the
dependence in this County on Medicaid as a payment source for deliveries.
7. Adults in Jefferson County households that included children younger than 18 reported
higher rates of health risk behaviors than did adults in households that did not include children.
8. Poverty rates are higher among people age 18-34 and may be associated with the lack of
advanced education. Jefferson County's poverty rate in this age group is about 18%, compared
with 14% in the State. There again is a lot of variability by place, with 0% on Marrowstone and
6.5% in Port Ludlow, whereas in the rest of the county it is about one in four or five, except in
the West End, where it is over half. To look more closely at the poverty rates, they split the
population into two groups: 18-24 and 25-34. Of the 18-24, about 1/3 have not completed high
school or have a GED (compared to the State's Yo), another 1/3 have completed high school or
GED, and another 1/3 have some post secondary education. She believes there is a huge potential
to improve the educational attainment, such as with mentoring programs (youth 14+ with an
HEALTH BOARD MINUTES - February 20,2003
Page: 4
adult to help in transition to adulthood).
9. People age 18-34 have lower rates of healthcare access and higher rates of risk behaviors than
the adult population as a whole. Dr. Hale noted the rates of access to healthcare are lower in the
County than they are in the State for this group.
10. Poverty rates in Jefferson County among people 65-74 are lower than they are in the State
(2.3% vs. 6.5%). However, the poverty rate among people 75+ in the County is higher than in the
State (10.6% vs. 8.6%). She noted that on Marrowstone, out of 152 people, 10.5% are below the
poverty level- the highest rate in the County. She believes we are seeing people with relatively
low incomes but who may be sitting on valuable property, and may qualify for the property tax
exemption program.
11. Healthcare access indicators are better among people age 65+ than the County average, but
this group has significant health risk behaviors. This does not answer other access-related
questions such as how far they have to travel, what is excluded, etc. This group is more likely to
be overweight and less likely to be physically active, but is less likely to smoke. It is most
surprising th'lt there is no difference in the alcohol consumption rates among people 65+ and
other adults in this county. The State alcohol consumption rate is a little over 60% for all adults
and 46% for those 65+. Member Frissell asked whether the Census asks question about
prescription coverage, which Dr. Hale said it does not.
12. Poverty rates in Jefferson County probably underestimate need because they are based on an
assumption that 1/3 of income is for housing, 1/3 for food, and 1/3 is for everything else. Dr.
Hale, in considering the median house price relative to median income, pointed out the
"affordability gap," (the difference between the price of a house people could afford based on
median income and the actual price of the average or median house in the county.) The Census
data on annual income spent on housing revealed that one in five spend more than 35% of their
income on housing, which is about the same as the State. However, in Port Hadlock!Irondale, one
in four spend more than 35% on housing. Statewide, about 1/3 of all renters are spending more
than 35+% of their income on housing, but in the County this is roughly 40%, although no one in
Port Ludlow or Marrowstone falls into this category. Not represented are those who spend more
than 50% of their income on housing. Housing prices are the most likely to affect the younger
segment of the population. Poverty rates are really not a measure of program need.
13. Disability rates for Connty residents (male and female) age 65-74 and men 75+ are lower
than they are in the State. In women age 75+, the disability rates are higher. However, if you look
at the population of people 65+, one third have some significant disability. The combination of
disability and poverty rates points to a need for increased publicly funded services among people
age 65 and older. Dr. Hale noted the Health Department will be issuing a detailed report on
disabilities. There is relatively little difference in disability rates place by place.
Jean Baldwin noted that the Data Steering Committee, with its various representatives from the hospital,
City Council, Health Department, 03A, OlyCap, WSU, law enforcement, and citizens, has been working
for two and a half years. This group has discussed making the data available to the public, community
and policy makers by creating a book and a compact disc. They also plan to hold a summit on May 13 to
present the data and indicators to senior managers and community leaders and to confirm whether we
HEALTH BOARD MINUTES - February 20,2003
Page: 5
want to track them for the next 15-20 years. They are uncertain what policymakers need to know in order
to support program providers and change or improve services. She also solicited recommendations on
who else needs to attend the summit.
Member Westerman spoke ofthe specific need for policymakers to attend the summit. She would like to
find a way for summit attendees to focus on the big picture and not just advocate their specific interests.
Member Frissell said she believes managers need to receive the information.
Dr. Hale noted that Jefferson is the first County to have completed this type of detailed analysis. Clallam
and Kitsap are doing identical analysis, in part because of their sense that their demands look similar and
because of their desire for a more regional approach.
Dr. Locke also spoke of the need for a coordinated process to address these 'multi-jurisdictional
problems." These are not city and county-based problems, but are national problems and are not solvable
by local government alone.
Member Buhler said we might not realize the value of this information until specific needs arise, adding
that the data will have to be indexed and accessible so that the desired information can be found.
Bringing different interests together at a summit provides an opportunity for collaboration.
There was Board support for holding a May summit.
Lee:al Opinion Ree:ardine: O&M Ins{)ections on Private Property: Larry Fay reported that after the
last Board meeting, he and Dr. Locke drafted a memorandum to Deputy Prosecuting Attorney David
Alvarez with the five key questions from Mr. Belenski.
Deputy Prosecutor Alvarez said that his written opinion addressed the current regulatory scheme, Mr.
Belenski's objections, the general rules that apply to search and seizure, and Washington State's
protection of privacy as compared to federal courts. He believes the WAC sections related to Operation
and Maintenance supports conditioning an on-site sewage permit on third party monitoring and allows
requiring someone who obtains an on-site sewage permit to sign an operation and maintenance contract.
Mr. Alvarez believes Mr. Belenski is correct about the Fourth Amendment issues raised. There is either
consent to access the property or a warrant is issued. He noted that there is a state statute (70.118.130)
but it only applies in very limited situations. Particularized evidence would be needed to get on the
property. The Board is also faced with what he called a substantial quandary because while there is an
obligation to monitor, a person with private property can refuse entry to the person doing the inspecting.
That is where Bill 5108 comes into play, which he hopes would create an exception to the trespassing
statute for people enforcing a permit. He said the Board might want to support this bill, which recognizes
there are certain times when criminal trespassing should not pertain to the obligation to go on the
property and fulfill a public duty. He then reviewed what changes Thurston County has made regarding
the enforcement regulations for residential on-site sewage systems. He noted that there are points of
view, statutes and aspects of constitutional law that conflict with the WACs as well as public policy that
conflicts with the Fourth Amendment. He said he hoped to highlight the issue, answer the Board's
questions and confirm that Mr. Belenski has been heard.
HEALTH BOARD MINUTES - February 20,2003
Page: 6
Mr. Fay reviewed this issue with the adoption of the On-Site Sewage Ordinance in 2002. The Board has
followed a set of State directives and regulations, but the County is not in a position to compel someone
to let us onto his/her private property.
Commissioner Titterness stated that Jefferson County's ordinance, adopted per the WAC, is probably
not consistent with the Constitution of either the U.S. or the State of Washington. He then inquired
whether to ask for a court decision on this matter?
Member Westerman noted that the memorandum states that you can also surrender part of your Fourth
Amendment rights in exchange for a privilege. She argued that the privilege of receiving a permit for an
on-site septic system, which comes with the requirement that it be monitored, is similar to the privilege
of obtaining a driver's license and consenting to undergo a breath or blood alcohol content test if
requested while under arrest. Mr. Alvarez said he does not believe anyone has ever used this analogy to
argue his or her point in a Washington court.
Mr. Fay said the ordinance states if you have an on-site sewage permit, you are subject to being on an
inspection schedule.
Mr. Belenski said there has to be probable cause to entangle someone and invade his or her privacy.
While the County may be mandated to enforce public safety, the WACs as written begin to infringe on
people's rights. There is nothing in the WAC that says you have to access someone's property. He said
WACs are rules and the RCW is the law and neither one can step on your constitutional rights. Mr.
Alvarez noted that a WAC also goes through a rule-making process and does have the effect of law,
albeit a lesser level than the state statute or federal constitution.
Commissioner Huntingford said he is interested in what Thurston County is doing. He asked Dr. Locke
about a similar bill that failed before the legislature two to three years ago? Mr. Fay noted that in the
early 90s Thurston County adopted an ordinance requiring both installation and operational permits for
on-site sewage systems, permits that are renewable on some frequency depending on the complexity of
the system. Before it could be renewed, they provide proof of passing an inspection by a qualified
person. Rather than mandating an inspection frequency, they attached it to a permit. In practice, they
have found something less than 40% compliance on renewals and they are largely not enforcing it.
Mr. Alvarez said he understands Thurston County has changed their structure for regulating and would
suggest Mr. Fay talk with his counterpart in Thurston County about their regulations. Mr. Fay, being on
the State Board of Health's Rule Development Committee, is currently involved in updating the on-site
sewage code. Among the members of this committee, there is strong interest in prescriptive state
standards on operation and maintenance. He will be sharing with them Mr. Alvarez's opinion, because it
has significant influence on the policy direction for the State.
Dr. Locke noted that while there was an administrative search bill that failed four to five years ago, he
believes three to four years ago another one passed (RCW 70.118.030), which is very specific and says
you have to prove that freshwater or marine water contamination is at risk.
Commissioner Huntingford said it appears that without permission to access property, you have to prove
just cause. Instead of trying to monitor every system in the County, encourage people to talk to the
County when they have a problem and provide access to the Revolving Loan fund for help. Member
HEALTH BOARD MINUTES - February 20,2003
Page: 7
Westerman, referring to the Gaikowski situation, said that while most people do not want to pollute the
environment, there needs to be a mechanism for addressing these situations. Commissioner Huntingford
stated that a mandatory inspection on a regular basis is different than a visible health problem, which the
County should have the authority to fix.
Mr. Belenski cited a case where the City of Seattle police were pulling drivers over and checking them
for intoxication. This practice eventually went to court and was ruled unconstitutional. Neighbors can
fabricate conditions on which the government would base its just cause. If a septic system fails, it is
known 300 feet away. He believes there should be some proof of a hazard before you can invade his
pnvacy.
Mr. Alvarez said the Board should discuss whether there could be off-site monitoring. Mr. Belenski
pointed out that the smell test helps and he also noted that a person who has a huge monetary investment
in their system is unlikely to let it collapse.
Mr. Fay recommended reviewing the Operation and Maintenance program with the basic operating
principle remaining, which is that the homeowner is responsible for the system. We could also retain the
program around authorizing certified people to work on systems at the homeowner's request. He noted
there is interest across the state and county in operation and maintenance systems. He said onsite sewage
systems have become increasingly complex because we are relying on technology rather than the site to
provide treatment, with the tradeoff being that more systems can now be placed on marginal sites that
would not have been permitted 10-20 years ago. We have recognized that with these systems, operation
and maintenance is necessary to keep them functioning properly over the long run. If they fail, there
would be environmental degradation, public health threat and impacts to shellfish, etc. With the
objective of operation and maintenance being the prevention of failures, maybe the focus ofthe
ordinance should be on failed systems and having tools in place to correct failures, with the policy goal
of working with individuals to the extent possible to get problems corrected. It may be that the only way
to get proper operation and maintenance in Washington State is to increase outreach and education
around the consequences of failures. Not wait until there is a public health threat or shellfish problem in
order to deal with failed septic systems. He noted that over the years, the strong prevention program has
resulted in several shellfish upgrades.
Member Frissell said if the County was to back down from monitoring, she would less likely vote in
favor of exemptions. To protect public health, she might vote against making exceptions if no one is
going to look at the system after installation.
Member Buhler said a remodel, building permit, or sale of the property could trigger an inspection of the
system.
In response to a question whether the County can ignore the Washington Administrative Code for
monitoring, Mr. Alvarez said the County could allocate resources as they see fit.
Dr. Locke said the requirement to have an operation and maintenance agreement is sound, but what is
not allowed is an involuntary search of the property. Since the County is not in the business of coercive
searches, the requirement to do operation and maintenance agreements stands, but the homeowner has
the ability to refuse access. The consequence may be that their system would fail and they would have to
bear the expense.
HEALTH BOARD MINUTES - February 20, 2003
Page: 8
The Board recessed into Executive Session at 4:35 p.m. and came back into open session at 5 :07 p.m.
Given the discussion with Mr. Alvarez and considering the issues raised by Mr. Belenski, Mr. Fay
recommended the Board take three administrative steps to resolve the problem:
1) Modify a condition of the permit dealing with the contracts to include some language that
recognizes people's constitutional right;
2) Incorporate similar language in the PUD's contract recognizing peoples' right to deny access, and
3) Create a written consent form for these inspections.
Member Westerman moved to approve Staff's recommendation. Commissioner Huntingford
seconded the motion, which carried by a unanimous vote.
ACTIVITY UPDATE - None
AGENDA PLANNING
It was noted that the Board of Health Retreat would be held in lieu of the Board's Regular Meeting on
Thursday, March 20,2003 at Fort Worden from 9:00 a.m. to 3:00 p.m. Dr. Locke reported that
accountability standards for local health departments would be presented at the retreat, along with
bylaws information and a possible PUD seat on the Board. Other retreat topics were solicited.
NEXT MEETING
The meeting adjourned at 5 :09 p.m. The next regular meeting will be held on Thursday, April 17 at 2:30
p.m. at the Jefferson County Health and Human Services Conference Room.
JEFFERSON COUNTY BOARD OF HEALTH
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Geoffrey Masci, Chairman
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Wendi H. Wrinkl an
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Dan Tl erness, Member
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Sheila Westerman, Member
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Roberta Frissell, Member
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