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JEFFERSON COUNTY BOARD OF HEALTH
MINUTES
Thursday, April 17, 2003
Board Members:
Dan Tit/erness, Member - County Commissioner District # 1
Glen Huntingford, Member - County Commission" District #2
Wendi H. Wrinkle, Vice Chairman - County Commissioner District #3
Geoffrey Masci, Chairman - Port Townsend City Council
Jill Buhler, Member - Hospital Commissioner District #2
Sheila Westerman, Member - Citizen at LlW (City)
Roberta Frissell, Member - Citizen at Ll",e (County)
Sta(fMembers:
Jean Baldwin, Health & Human Services Director
Llrry Fay, Environmental Health Director
Julia Danskin, JVursing SeroiceJ Director
Thomas LAcke, MD, Health Officer
Ex-otficio
David Sullivan, PUD #1
Chairman Masci called the rneeting to order at 2:30 p.m. All Board and Staffrnernbers were
present. There was a quorum.
APPROVAL OF AGENDA
Commissioner Huntingford moved to approve the Agenda as presented. Commissioner
Titterness seconded the motion, which carried by a unanimous vote.
APPROVAL OF MINUTES
Commissioner Titterness moved to approve the Retreat Summary and Minutes of
February 20, 2003. Member Buhler seconded the motion, which carried by a unanimous
vote.
PUBLIC COMMENT
Jean Camfield of the Beckett Point Fisherman's Club presented a request for a letter of support
for Public Utility District #1 (PUD #1) to construct a community drain field systern at Beckett
Point. The letter, if provided, would be submitted to the PUD and accompany their application
for loan funds for the project.
Commissioner Titterness moved that the Board direct Staff to submit a letter of support
for Public Utility District #1 to construct a community drain field at Beckett Point.
Member Westerman seconded the motiou, which carried by a unanimous vote. It was
understood that the Chairman would sign the letter.
HEALTH BOARD MINUTES - April 17, 2003
Page: 2
OLD BUSINESS AND INFORMATIONAL ITEMS
Board of Health Field Trips: As a follow-up to the Board's retreat, Board members were
asked to contact Larry Fay or Julia Danskin if they are interested in observing environmental
health and public health activities.
Jefferson Countv and Washinl:ton State WIC Report: The Board received copies of the
2002 Washington WIC Annual Report, which includes a fact sheet on those served in Jefferson
County. Julia Danskin reported that this federally-funded Women, Infant and Children (WIC)
prograrn is subsidized 34 % by Jefferson County. The extimated cost to provide the WIC
prograrn at the Jefferson County Health and Human Services is $90,562, of which approximately
$55,293 comes from Washington State and Federal funds, and an estimated $35,269 from
Jefferson County Funds. In Jefferson County, the Health Department serves over 500 clients
each month and provides nutrition education and food vouchers to clients. The Quileute Tribe
serves about 20 clients at the Hoh, the Quinault Indian Nation serves about 50 clients in Queets.
She also reviewed figures comparing Jefferson County to Grays Harbor and Clallam Counties.
In response to a question about lactose intolerance issues, Ms. Danskin reported that WIC would
also pay for Lactaid or lactose-reduced rnilk.
State Board of Health Request: Dr. Torn Locke noted that the State Board of Health continues
to send individual mernbers to visit local health jurisdictions in an effort to improve the working
relationship and to gather issues and priorities for the State Health Report. They have asked to
address the Board at a future meeting.
Member Westerman moved to instruct Staff to invite the State Board of Health
representatives to address this Board. Member Frissell seconded the motion, which carried
by a unanimous vote.
NEW BUSINESS
West Nile Virus Response - A Comprehensive Public Health ADDroach: Dr. Locke noted
that the Board received a handout entitled "West Nile Virus and the Ten Essential Services,"
which provides a framework for understanding and communicating public health services on this
Issue.
Larry Fay noted that the County's website shows the general information developed by the State
Department of Health which guides Jefferson County's information/education campaign. Staff
briefed the County Commissioners two months ago and he and Lisa McKenzie recently did a
PTTV program to talk about the West Nile Virus and Severe Acute Respiratory Syndrorne
(SARS). Tomorrow, they will hold a training on mosquito surveillance and control, the purpose
of which is to identify the species in the community and determine what percentage of that
population is capable of carrying West Nile. Staff should then be able to advise and assist
citizens in determining whether mosquito control is warranted. Neither the State nor the County
HEALTH BOARD MINUTES - April 17, 2003
Page: 3
has been funded to do mosquito abaternent.
In response to a question about landscape ponds, Lany Fay noted that there are relatively safe
larvicides that could be used. The Department of Agriculture is modifying the label restrictions
on BTI (Bacillan Thuringieniois Israelensis) to allow homeowner use in confined landscape
ponds. On the other hand, if a natural depression or wet area has developed into a pond it may be
subject to State licensing and permitting requirernents.
Commissioner Titterness reported having received the new Low Impact Development
Stormwater Manual from the Puget Sound Water Quality Action Team. He asked County
Commissioner's Staff to ensure that copies were given to each Cornrnissioner, the Building and
Cornrnunity Development Department, and Public Works and recormnended other Board
rnembers receive copies.
Chairman Masci asked if the Board of Health could issue a press release, including part of the
Board's discussion and suggesting mosquito control techniques.
Member Frissell moved to direct Staff to prepare a press release on this issue to include
mosquito controls. Commissioner Huntingford seconded the motion, which carried by a
unanimous vote.
Julia Danskin reported that the Department would be restarting bird surveillance and that a State
press release would ask citizens to notify the local Health Department if they find any dead
Corvid birds (crows, ravens, magpie, and jays).
Severe Acute Respiratory Syndrome (SARS); Dr. Locke provided background on the
spreading of this virus, a determinant of which is a new form of corona virus. He noted that the
level of concern about this virus changes from week to week. The majority of people with the
worst infections had the corona virus. As of today, there have been approximately 3,400 cases
and 165 fatalities or a case fatality rate of about 4%. There are 126 cases in Canada, 10% of
which have died. In the U.S., there have been 208 cases - 20 in Washington State - but no
fatalities. He noted the U.S. has the broadest case designation, which makes you a suspect SARS
case if you carne frorn any endemic area. Within the next week, it should be known how many of
the 208 cases have the corona virus. Most worrisorne are the people who are not being tested.
Preparing hospitals and healthcare workers is a rnajor undertaking, with healthcare practitioners
who are exposed also becorning a potential case. It is uncertain whether the current system for
surveillance and containment will be effective. He said that the widely variable cormnunicability
is mysterious - "superspreaders" somehow spread it efficiently and others less so. It appears a
co-factor (infection) occurs at the sarne tirne and produces this rapidly progressive, aggressive
and untreatable pneumonia. This virus is occurring before there has been much build up of
additional response capability in terms ofbio-terrorisrn funding.
HEALTH BOARD MINUTES - April 17, 2003
Page: 4
Julia Danskin noted that SARS has increased the Department's workload, with two conference
calls a week and other various communications. Communicable Disease Coordinator Lisa
McKenzie is getting bulletins and updates to providers. E-rnail provides an opportunity to get
information out quickly.
Smallpox: Chairman Masci circulated smallpox information he received as a provider. Julia
Danskin noted that all licensed medical providers in the State received the sarne information at
their home and were offered additional information. As part of the bio-terrorism plan, the
County would look to licensed rnedical providers to assist in an event, such as a rnass
immunization clinic. Jean Baldwin rnentioned that the Washington Ernergency Operations
Center (EOe) and Jefferson-Peninsula Regional Planning Committee (JPREP) have the ability to
mobilize volunteers, so the County would not need to keep a volunteer list.
Chairman Masci asked if the Board has the authority to produce a letter to providers soliciting
volunteers. Dr. Locke indicated that he does not believe there would be a barrier to making a
request. In the event of a declared emergency, the powers of the Board are very broad. Julia
Danskin noted that the State houses the data for doing this.
Board Sponsors for Environmental Health Regulation Develooment: Larry Fay reviewed
that at the retreat there was interest in individual mernbers serving as "sponsors" to help set the
general direction for specific rulemaking initiatives. Referring to his write-up, he recomrnended
the Board try this in the following areas: I) Methamphetarnine Lab Rules, 2) New State Solid
Waste Regulations, and 3) Water Policy or Cornprehensive Drinking Water Ordinance.
Member Westerman said that even though the Board contributed significantly to the on-site
sewage code, we were unaware of specific legal limits on irnplementation and enforcement.
Commissioner Tittemess commented that the County Prosecutor could ask for an Attorney
General (AG) opinion on accessibility. Dr. Locke said the State Board of Health is asking the
AG about the access to property question. Larry Fay added that he shared this with the Rural
Development Committee of the State Department of Health, which is seeking an AG opinion as
well.
David Sullivan noted that current legislation on catchment systems could impact Jefferson
County (HB1376).
The Board agreed to focus on the following topics:
1. Methamphetarnine Lab Rules - Chairman Masci and Member Frissell
2. State Solid Waste Regulations - Commissioner Huntingford and Mernber
Westerman
3. Water Policy or Cornprehensive Drinking Water Ordinance - Member Buhler,
Commissioner Wrinkle and David Sullivan
Although Member Buhler clarified that some of these issues could have a direct bearing on her
business as a realtor, the Board was not concerned about her involvernent in these matters.
HEALTH BOARD MINUTES - April 17 , 2003
Page: 5
ACTIVITY UPDATE/OTHER ANNOUNCEMENTS
Chairman Masci welcorned PUD Representative David Sullivan as an Ex-officio member of the
Board.
Jean Baldwin distributed postcard invitations to the May 13, 2003 Workshop "Translating the
Data: Moving from Numbers to People." She urged the Board to assist with the event.
Chairman Masci recommended members attend the April 29 Substance Abuse Advisory Board
"Clear and Present Danger" Conference.
Jean Baldwin distributed the 2002 Public Health Irnprovernent Plan produced by Washington
State Association of Local Public Health Officials (WSALPHO), which is a summary report for
legislators. Dr. Locke urged the Board read this report.
Jean Baldwin reported that the House, Senate, and Governor's budgets are not in agreernent on
public health funding. The Senate and the Governor placed the public health backfill money
(Motor Vehicle Excise Tax) back into their budgets, while the House put it in temporarily,
having clear and intended language to rernove it. She distributed legislative contact information
and reminded that West Nile and SARS are funded out of local or through the Motor Vehicle
Excise Tax.
The Washington Health Foundation Community Roundtable will be held on April 25 frorn 1-3
p.m. at the Port Townsend Cornmunity Center. It is an opportunity to give feedback on health
care and health care access in the comrnunity. Member Buhler reported that the Hospital has
talked with The Leader about publishing a series of articles on the health access issue.
AGENDA PLANNING/ADJOURN
The meeting adjourned at 4:02 p.rn. The next meeting will be held on Thursday, May 15 at 2:30
p.rn. at the Jefferson County Health and Human Services Conference Room.
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West Nile Virus and tbe Ten Essential Services
A Framework for Understanding and Communicating A Core Public Health Service
April - 2003
In 1988 the Institute of Medicine (10M) produced a report, The Future of Public Health.
Among other findings, the 10M noted that pubic health was fractionated and the public
lacked a clear understanding of the basic or core functions of public health. In 1994, The
Ten Essential Services of Public Health was developed as an alternative means of
organizing and presenting public health services and activities.
The Ten Essential Services provide a means to look at an issue in a comprehensive and
structured manner, addressing all aspects of the issue, not just the interesting or
problematic ones. As applied to West Nile Virus (WNV), one can frame the issue and
the approach of the Washington State Department of Health (DOH) into the 10 essential
services as follows:
I. Monitor status to identifY issues of public health importance related to WNV -
. Noted the arrival ofWNV in the United States in 1999.
. Noted its arrival in Washington state in late summer, 2002, in birds and
horses.
. Noted the magnitude of the epidemic and epizootic in the U.S. during 2002.
· The full extent of how WNV will manifest in Washington will not be known
until the fall of2003.
. Monitoring data from the Centers for Disease Control (CDC) and other states
is our primary source of information used to anticipate impacts. These
impacts can range from significant to minor.
2. Diagnose and investigate WNV related health hazards in the community -
· Initiated mosquito trapping to identifY potential carriers ofWNV, and
confirmed that such carriers exist throughout the state.
· Continue seasonal surveillance to detect WNV infections in dead birds
beginning in April 2003 through the end of the mosquito season.
. Coordinating with the Washington State Department of Agriculture
(WSDA) to receive reports ofWNV infection in horses.
. Developed capability and capacity for the DOH Public Health
Laboratories to provide diagnostic testing for suspected cases ofWNV
infection in humans.
· Developed case report forms and protocols to facilitate the identification,
diagnosis and reporting of human WNV illness and death.
3. Inform, educate and empower people about WNV related health issues in their
community -
. Developed a communication plan for the DOH that will be shared with
local health jurisdictions.
· Developed a brochure and distributed it to all local health jurisdictions and
other state agencies for their use.
· Set up a toll- free telephone number with basic information on WNV
issnes.
· Set up a web page with more detailed information on WNV, with links to
various other resources sites, both in state and federal.
· Developed resource packets for use with media and other interested
groups or parties.
· Initiated several media releases and will continue to do so throughout the
summer.
4. Mobilize partnerships to identify and solve WNV related health problems -
· Active working relationships with Washington State Department of
Ecology (DOE) and WSDA to facilitate information and access to
pesticide applications.
· Worked with local health jurisdictions to clarify roles and responsibilities
as now contained in statute for mosquito control efforts.
· Partnered with the U.S. Anny at Fort Lewis to prefect mosquito
surveillance techniques.
· Worked with local governments and mosquito control districts on control
efforts, including mosquito surveillance techniques.
. Worked with local health jurisdictions to clarify roles and responsibilities
in communicable disease surveillance and reporting.
· Presented information regarding mosquito control and employee safety
measures to other state agencies - such as Department of Natural
Resources, Washington State Parks and Recreation, Department of
Transportation, and Department of Fish and Wildlife - that may own
mosquito-breeding areas.
. Coordinated with Washington State Uuiversity for expanded laboratory
capacity to exam dead birds.
· Negotiated with CDC for funding to assist with surveillance activities
within the state.
· Contacted the Washington State Medical Association and the Washington
Veterinary Medical Association to provide current clinical and diagnostic
information to professionals concerning WNV.
. Contacted the Plan Medical Directors and Phannacy Benefits Managers
for orientation of understanding of potential WNV impacts on their
industry.
,-
5. Link human resources to needed WNV related health services and resources-
. Used CDC funding and General Fund State to enhance the agency's vector
control efforts to 2+ full time equivalents (FTEs) since 200 I.
· Dedicated a portion of an FTE to serve as WNV coordinator for this
upcoming summer season.
. Hired project employees to survey county readiness, develop web sites for
rapid reporting, and assist with mosquito trapping and identification.
· Created and filled a management level position in the agency for a State
Public Health Veterinarian with responsibility and knowledge ofWNV
issues.
6. Develop policies and plans that support individual and community WNV related
health needs -
· Developed a statewide response plan and distributed it to local agencies
(Brown Book).
· Articulated individual protection measures in WNV plans and
communication efforts.
· Provided education to local government and community groups on
creation of mosquito control districts and the functions of such districts.
· Informed critical policy bodies in the state of the issue and the plan:
Washington State Legislature, Washington State Board of Health,
leadership of local health and local government, and other state agency
executive managers.
7. Comply with laws, regulations and policies that protect WNV related health and
ensure safety -
· Thoroughly reviewed the existing laws and regulations that apply to
mosquito control, and control of vector borne diseases.
· Coordinated with DOE and WSDA on procedures and limitations
associated with application of pesticides within the state of Washington,
and secured a blanket National Pollution Discharge Elimination System
(NPDES) permit that will be available statewide for any entity wishing to
apply larvicide's under our general provisions and control.
· Reviewed the notifiable conditions WAC 246- I 0 I that requires cases of
viral encephalitis and rare diseases of public health importance to be
reported by health care providers to their local health authorities.
· Familiarized ourselves with the laws regarding Integrated Pest
Management (IPM) requirements in 17.15 RCW related to broadcast
spraying of pesticides.
· Established a dialogue and will continue to work with WDFW for ways to
condition applications to reduce impacts of any pesticide use to non-target
species, or the introduction of non-native fish species to control
mosquitoes (RCW 70.22).
8. Assure competent DOH and local workforce-
. Provided enhanced training to agency workforce on mosquito
surveillance, environmental surveillance, and health affects of pesticide
use.
· Provided training to agency laboratory staff and epidemiologists.
. Provided training to local health personnel and others on mosquito
trapping and identification, dead bird surveillance techniques, and
mosquito control methods.
9. Evaluate the effectiveness, accessibility, and quality ofWNV related health
servICes -
· DOH is prepared to evaluate and modify the effectiveness of our
surveillance and response plan as the summer progresses.
· Formed and maintain an internal steering group that will monitor the
emergence of the disease in Washington and modify our response as
necessary.
. Evaluate our response more formally after this year's mosquito season has
passed, and will share that evaluation with interested parties.
10. Conduct research for new insights and innovative solutions to WNV related
heath problems and issues -
. Consider innovative solutions and approaches to WNV surveillance and
response, both in forms of education and control.
. Continue to monitor the research and experience of states that have a
longer and more involved history with WNV, as well as results of CDC
studies currently underway.
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