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HomeMy WebLinkAbout061903 JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, June 19, 2003 Board Members: Dan Tit/erness, Member - County Commlssioner District #1 Glen Huntingford, lli[ember - County Commissioner District #2 Vacant - County Commissioner District #3 Geoffrey Masci, Chairman - Port Townsend City Council Jill Buhler, Member - Hospital Commissioner District #2 Sheila Westerman, Member - Citizen at La",e (City) Roberta Frisse!!, Member - Citizen at La",e (County) Staff Members: Jean Baldwin, Health & Human S erv/ces Director Larry Fay, Environmental Health Director Julia Danskin, ]\.Tursing Services Director Thomas Locke, MD, Health Officer Ex-o(ficio David Sullivan, PUD #1 Chairman Masci called the meeting to order at 2:35 p.m. All Board and Staff members were present with the exception of Commissioner Huntingford. There was not a quorum until the arrival of Commissioner Huntingford at 2:45 p.m. PUBLIC COMMENT Catherine Robinson was present for the discussion of the Cruise Ship Waste Discharge agenda item. She provided information to Larry Fay about an EPA grant program, the deadline of which is June 30. The grant is for program development and implementation for microbiological testing and monitoring of coastal recreation waters, beaches, etc. Forest Shomer also spoke about the health aspects of the cruise ship discharge issue. With the possibility for 200 cruise ship transits through the Strait over the next four to five months, there is a potential for other grey-water ~ if not black-water ~ releases in the lane between Whidbey Island, the San Juan Islands and Port Townsend. He understands that the Department of Ecology is working on an agreement with the cruise ship industry, which would permit them to discharge grey water in this area. He has also spoken with the County Commissioners and other agencies about this topic. If the Health Board agrees that this is a significant issue, he would urge them to submit a letter to Department of Ecology and other relevant agencies. OLD BUSINESS AND INFORMATIONAL ITEMS Cruise Ship Waste Discharl!e: Larry Fay noted that information on this topic was in the agenda packet. He offered to do additional research, including looking for opportunities for comment, but he believes the matter is under the jurisdiction of the Coast Guard and Department of Ecology. Chairman Masci asked whether the Board might be interested in submitting a "placeholder" letter of interest for the grant? Member Buhler suggested partnering with Clallam and other counties. Member Westerman, referring to her understanding that no fine was levied for the accidental black water discharge, expressed support for writing a letter of concern about the discharge and the potential for such incidents due to increased cruise ship traffic in the Strait. She wonders why they cannot dump in the open ocean? HEALTH BOARD MINUTES - June 19,2003 Page: 2 Chairman Masci reviewed what he understood to be options for the Board: 1) a letter to Department of Ecology, inquiring why no fine was levied and why the ships could not discharge in the ocean (and copying Clallam), 2) letter to other counties (Island, San Juan, Clallam, possibly Mason) regarding how this affects all of us and stressing the need to impress upon Department of Ecology the need for a ban on future discharges (with copies to the City of Victoria). Dr. Locke noted that the Board's jurisdiction in this matter relates to the human impact and exposure. Recognizing the difficulty in identifying direct human impacts in marine waters, he said most would be indirect, through contamination of fish or shellfish or to divers, swimmers and kayakers. Referring to a study of the Sequim Bay outfall, he said that having data would strengthen the case. There was further discussion comparing the volume of treated discharge from the Cities of Sequim and Port Townsend to that dumped by the cruise ship. It was noted that the City of Port Townsend wastewater discharge is roughly SOOK pounds a day. Recognizing this as a serious issue, Commissioner Titterness said he trusts Department of Ecology is addressing this and cautioned the Health Board against spending staff time and energy on a matter that is beyond the Board's jurisdiction. Based on his experience, Chairman Masci was not confident that the matter is being adequately addressed by Department of Ecology. Since the matter directly affects Jefferson County, he believes there is merit in sending letters. Commissioner Huntingford noted that in response to Forest Shomer's presentation on Monday to the County Commissioners, the County is drafting a letter to the State expressing their concerns. Member Westerman said her concern with Department of Ecology establishing an agreement with the cruise ships to dump grey water is that it invites potentially similar situations/accidents. Her suggested approach in a letter would be to express concern on behalf of the health of the Board's constituents. Member Frissell spoke about Alaska's negative experiences with cruise ship discharges. She does not want to see that happen here. Member Buhler spoke about the fragility of the Puget Sound ecology, which this dumping does not help. Member Westerman moved to write letters to the Department of Ecology (with copies to Clallam, Island and San Juan Counties) expressing the Health Board's concerns about grey water discharges in the Strait of Juan de Fuca. Commissioner Huntingford seconded the motiou which carried by a unanimous vote. Commissioner Huntingford suggested Health Department Staff might contact the Commissioner's staff to coordinate the drafting of similar language. Forest Shomer provided a copy of Department of Ecology's Immediate Action Order sent to the cruise line. He recommended the Board copy its letter to the legislative committee in Olympia. APPROVAL OF AGENDA Member Frissell moved to approve the Agenda as presented. Commissioner Huntingford seconded the motion, which carried by a unanimous vote. HEALTH BOARD MINUTES - June 19, 2003 Page: 3 APPROVAL OF MINUTES Commissioner Huntingford moved to approve the minutes of May 15, 2003. Member Westerman seconded the motion, which carried by a unanimous vote. OLD BUSINESS AND INFORMATIONAL ITEMS (Continued) "Deadlv Strains" on Pnblic Health Svstem: Dr. Locke noted that in the packet was an article from a national magazine about the dilemma facing health departments, who are gearing up their surveillance for infectious diseases. Summarv of Mav 13 Data to Action Summit: Jean Baldwin noted that the agenda packet contained a summary of the summit evaluations, which were very positive. Although the intent was for groups to reconvene within two months, Staff has not been available to coordinate these meetings. Chairman Masci, speaking for the Board, recognized the significant effort needed to put the summit together and the Board's understanding of the need for more time. In response to a suggestion by Member Frissell, Staff agreed to contact participants with an update. NEW BUSINESS Public Health Fundin!! and Le!!islative WraD UD: Dr. Locke noted that the packet included a summary of the budget highlights. Under close observation was the $49M continuation of core local public health funding, 98% of which ($48M) ended up in the final budget. This is thought to be a big achievement, and indicates that state and local public health programs scored high in the Governor's budget priorities. Basic Health was reduced from 135,000 slots to 130,000 and would essentially not be taking any new enrollments. The Medically Indigent Program was eliminated and no longer benefits trauma hospitals and county jail programs. Counties would now have to bear this expense. The fees for copies of death certificates would be raised to cover the costs of developing a web-based death certificate system. There would be additional funding for conducting hearing screening on all newborns. Jean Baldwin said it is not yet known how a reorganization of the maternity support program by Department of Social and Health Services would impact the Health Department's program, which is currently about a $250K project. Communicable Disease ReDortin!! and Control- Provider Initiatives: Jean Baldwin reported that the recent in-service to Jefferson General Hospital by Dr. Locke was so well received that they asked him to return every three to four months. Dr. Locke thanked Jean Baldwin, Dennis Langois, and Lisa McKenzie for helping with the presentation. He then reviewed materials the Board received in the agenda packet: I) Centers for Disease Control Updated Interim Case Definition for Severe Acute Respiratory Syndrome (SARS) and Information for Clinicians on West Nile Virus Infection; 2) Updated Procedures for Communicable Disease Reporting and a recent version of "Notifiable Conditions and The Health Care Provider," from the State Department of Health; 3) Chlamydia Update; and 4) Emergency Contraception Fact Sheet and Information. In response to questions from Chairman Masci, Dr. Locke spoke further about the recent spike in Chlamydia cases, which has nearly tripled inexplicably in the first four months of2003. He said the screening efforts have focused on people in their first decade of sexual activity, which is often characterized by higher risk behaviors, such as multiple partners. In this County, roughly 28 of the 32 Chlamydia cases are in these identified risk groups (age or multiple sexual partners). Chairman Masci expressed concern about cases that go undiscovered in the middle-aged population, which is more vulnerable in terms of disability and economic loss. He asked whether the Board should suggest that physicians also screen for Chlamydia when screening for RA. Dr. Locke recognized the potentially life- HEALTH BOARD MINUTES - June 19, 2003 Page: 4 threatening complications from undiagnosed or untreated cases of Chlamydia. To reduce rates, they are trying to encourage much greater use of new diagnostic testing and screenings based on risk factors, universal screening of certain populations, and automatic rescreening of every positive Chlamydia case three months later. The critical issue is that every case has a contact, so it is important to do contact tracing and follow up. Member Buhler asked if the Health Information Protection Act (HIP A) laws effect being able to do the anonymous partner notification. Staff responded that public health has broad exemptions from HIP A, especially in terms of things necessary for the control of communicable diseases. Member Westerman asked to hear more about the discussion among the providers regarding emergency contraception. Jean Baldwin reported that they discussed who stocks it, how it is prescribed, the lack of side effects of "Plan B" contraceptive pills and where it is available without a prescription (QFC in Hadlock and the Health Department). There was interest among the providers in further investigating why other pharmacies did not carry it. Jean Baldwin agreed to follow up with the medical staff that seemed to be willing to send a letter to pharmacies that do not stock it. Dr. Locke said he assumes that the issues surrounding not carrying it relates to a perceived lack of demand. On-site Sewal!e Operation: Larry Fay noted that the purpose of this presentation was to provide a status report since the Board's adoption of the Onsite Sewage Regulation in 2000, the major change of which was the ramped- up operation and maintenance program. Jodi Holdcroft, an Environmental Health Specialist in Kitsap County, reported on her master thesis project, which involved entering and analyzing the Jefferson County PUD inspection reports from 1987 to 2001. In May, she presented this information at a conference of her peers. Project goals were to figure out causes of system failures and to utilize this information to educate the public about operating and maintaining their septic systems more effectively. She reported that of 2,00 I inspections, 1,600 had installation dates. Being able to determine the age of a system is important since a major factor in system failure is age. She reviewed problems that can be discovered from inspection forms and noted that systems that had problems tended to be the ones where it was the same owner, instead of a new owner. Out of 855 inspection sites, there were only six failures, compared to an average failure rate according to EPA of about 10%. She noted that access was an issue. The first, most likely, problems to occur would be electrical. Larry Fay noted that even electrical problems, if they are identified and corrected, do not necessarily lead to a failure. Ms. Holdcroft noted that the message she tried to deliver to her colleagues was that this is one of the few places that she knows of in Washington State that collects this information. This sort of early warning system for septic systems can prevent massive failures and is needed on a wider basis. She pointed out several aspects ofthis project that were important: accurate data entry, quality control, careful interpretation and collaboration. She noted that Terry Hull ofthe Puget Sound Water Quality Action Team spoke with her about the Action Team's desire to find funding for local jurisdictions to collectively gather O&M information. Chairman Masci referred to several of the problems occurring in the period between 3-5 years, which could be viewed as human errors rather than system problems. Ms. Holdcroft agreed to the usefulness of a brochure explaining the risk factors and the need for a system "physical," which would check the status of the system and provide an interpretation of what was found during the inspection, including identifying risks. Linda Atkins reported on the implementation of the regulations, which began in January 2001, and on what Staff has leamed over the last two years of data collection. One of the goals of adopting the ordinance was to increase homeowner education and improve contact with homeowners. The 14 workshops held last year involved 400 participants. She also gave presentations on the O&M program, and on-site septic systems in general, to all real estate offices and is following up with a brief survey regarding the usefulness of these presentations. The feedback so far has been positive and will guide future work. HEALTH BOARD MINUTES - June 19,2003 Page: 5 The requirement for an inspection at the time of sale applied to any system not already being inspected on a regular basis. In large part, systems being monitoring by the PUD were not included in this set. This list targeted conventional systems not yet inspected by or systems part of the PUD monitoring schedule but which were no longer under the monitoring contract requirements. The general method by which systems would be brought into the inspection program is through an application for building permit. Staff is utilizing its database for this scheduling and the PUD would send out inspection reminder notices. Inspections since implementation of the O&M program showed that 42% of the systems needed to have their tank pumped and reported problems in 150 (26%) of the 574 systems. Approximately 55% required actual tank repair, 16% had evidence of a system malfunction. There were several systems with sogginess or standing water in the drain field area and they have written less than a dozen notices of violation. Only 1 % were in substantial noncompliance. Inconsistencies with the permit record were present in 27% of the systems. These systems might still be functioning fme, but the buyer must be aware that if a permit is presented to replace a non-compliant 3- bedroom mobile with another 3-bedroom mobile, they would need to upgrade that system to meet the needs of the newer structure. Ms. Atkins noted that, at the request of the realtors, the County sends out a monitoring certification, which tells them that the inspector's report has been received and acknowledged. Records did not exist for 54 of the systems inspected - they were either installed prior to 1970 when permits were first required or simply installed without permits. This group also had a higher number of reported problems, age of the system being a factor. Electrical components were present in 54 of the systems and 24% of these reported problems. Breaking up the data by planning area showed that areas of higher population have more problems. Data collected by the PUD over the past year reflected results similar to the County's. Of the 638 inspected systems, about 155 indicated a problem, 22% of those were electrical. Assessor's records of improved properties indicate that there were about 9,000 County residents using on-site sewage disposal. Having inspected about 10% of systems in use to-date, they estimate it will take about two years to finish the rest. Staff is pleased with the results and feels it gives them an opportunity to interact with and educate system owners. Commissioner Huntingford noted that more problems might exist further south in the County because of the increase in the amount of rainfall. Ms. Atkins noted that many of the system problems were issues of general maintenance. Interaction with owners might also have contributed to the level of reporting. Jean Baldwin expressed interest in how many ofthese are primary, versus secondary, residences? Linda Atkins said this element could easily be added to the application, but it would only show the information at the time of application. Larry Fay reminded the Board that the next phase of implementation would bring systems into the inspection program through building permit applications. Commissioners Huntingford and Tittemess asked that there be further discussion of what permits require an inspection, the potential increase in workload on County Departments, the time needed for permit approval, as well as the expected increase in fees. Mr. Fay said the Board previously discussed a policy that would address what type of permit applications trigger an inspection. The fee is set and if Staff conducts the inspections, they would receive the money to offset costs. There is also a second private individual as well as three designers who can perform inspections. He agreed to bring this policy forward in August for discussion. The Board commended Staff for their significant efforts in providing helpful information to citizens. There was Board support for issuing a press release with an executive summary of this presentation reflecting the success of the onsite sewage inspections. HEALTH BOARD MINUTES - June 19,2003 Page: 6 ACTIVITY UPDATE/OTHER ANNOUNCEMENTS Civic Engagement and Critical Health Services Proiect Timeline: Dr. Locke reminded that this ongoing project would be reported to the Board in August. AGENDA PLANNING/ADJOURN August Meeting Topics: Civic Engagement and Critical Health Services Project Timeline and Discussion of Policy Related to Building Permits and Inspections of On-site Sewage Systems. The meeting adjourned at 4:34 p.m. The next meeting will be held on Thursday, July 17 at 2:30 p.m. at the Jefferson County Health and Human Services Conference Room. JEFFERSON COUNTY BOARD OF HEALTH () t 1/ 6..i.-1~ irli Buhler, Member 16 Dan Titterness, Member ) (F i L ~-lAd( 'l Sheila Westerman, Member /' d . {~4(UUf4/:;jA Gtle-f f Roberta Frissell, Member (Vacant) Commissioner District #3 Larry Fay From: Sent: To: Subject: Lorna Delaney Wednesday, May 21, 2003 12:46 PM Dave Christensen; Larry Fay FW: cruise liner waste dump Lorna Delaney, Clerk of the Board Jefferson County Commissioners <mailto:ldelaney@co.jefferson.wa.us> > -----Original Message----- > From: Forest Shomer [mailto:ziraat@olympus.net] > Sent: Wednesday, May 21, 2003 6:57 AM > To: Lorna Delaney > Subject: cruise liner waste dump > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Dear Commissioners, I'm dump from writing to express great concern over the massive, 40-ton sewage by the cruise ship Norwegian Sky, in our inland waters not far Port Townsend, earlier this month. Although the incident was described as Iraccidental" and while there may be fines levied at some point, there was also some dissembling the part of the Port of Seattle and the ship owners to the effect that the three-mile statutory offshore requirement for sewage releases might not apply to a portion of the waters between Whidbey Island and Dungeness Spit (and the San Juans) because the central part of those waters lie over three miles from our shore! on Therein lies the potential for that area to become a de-facto sewage dump for cruise ships! With as many as 100 cruise ships expected this year (passing both going and coming), even a casual "look the other way" attitude on the part of maritime officials could result in the degradation of intracoastal water quality and shorelines. For example, not two days after the dumping incident, I observed several people harvesting seaweed (for human consumption) on beaches fronting that part of the strait. Local fishing boats bring their catch from those waters to be sold in our markets and consumed in our restaurants. We have long derided the City of Victoria for its release of untreated sewage into the Strait. Compound that with releases from cruise ships (which are 'floating cities' of 3,000 or more people), and we have the makings of a serious threat to human and ecological health. These waters have a limited ability to cleanse themselves: not the open ocean! I contacted the Port of Seattle nearly two weeks ago, that contact this week, and have not yet received any Commissioner Lawrence Molloy. and repeated response from I ask that you be among our more responsible officials insure that: in working to --cruise ships be tightly policed on sewage dumping while in Washington State waters 1 > --that the idea that dumping in this area by thoroughly nixed by all > agencies of government > --that the three-mile limit be specifically applied to only the outer > coast, not the inland waters > > > > > > > > > > > > > > > > > > > > > > > > > > > > We all know that the cruise ship industry has a mediocre record on dumping at sea, in Alaska inland waters, in the Caribbean, and elsewhere; and that shipboard illness is becoming very commonplace (including an incident here this week). These folks can't be counted on to self-regulate! Please help assure that all sewage discharges take place under sanitary conditions at onshore locations or on the high seas. Once our marine ecology becomes compromised, or our shorelines become degraded by excessive human waste, it will be difficult for dependent food systems, and regional tourism, to recover. Thank you, sincerely, Forest Shamer P.O.Box 639 Port Townsend WA 98368 PS--Your written response will be appreciated. Inside Passage Seeds and Native Plant Services Forest Sharner, owner Port Townsend, WA, USA ziraat@olympus.net www.insidepassageseeds.com 2 uovemmg: l1eann sel'VlCes/June ",UUJ l'age I 01'6 From Governing's June 2003 issue COVER STORYIHEALTH CARE Deadly Strains SARS, West Nile virus and bioterrorism are the big scares. But the greater threat is the gradual erosion of public health services. By CHRISTOPHER CONTE W hen Seattle received $2 million in federal money last year to prepare for a possible biological, chemical or radiological attack, public health director Alonzo Plough was relieved. Along with his counterparts around the country, Plough had watched new health threats multiply while public health budgets stagnated. Finally, he thought, the city would have funds to work out emergency procedures with area police departments, fire officials and other "first responders. H He'd be able to hire new staff to help combat naturally emerging diseases as well. Things haven't worked out as he planned. No sooner had he launched a terrorism-planning effort than he had to drop it because the federal government ordered its sweeping smallpox-vaccination program. That task tied up so much of Plough's staff that they were slow to detect a new outbreak of tuberculosis among Seattle's homeless population. As officials scrambled to catch up with that problem, SARS, or severe acute respiratory syndrome, emerged in China. Almost immediately, the mysterious disease started showing up in travelers returning from Asia. Plough had to divert staff from the unfinished smallpox and tuberculosis efforts and put them to work to keep the new disease from spreading in Seattle. Plough's job has become a continuous exercise in triage. The reason: His department has too much to do and too few resources. "In my 20 years In public health, I have never seen such a layering of http://governing.comlarticles/6health.htrn 6/4/03 \Juvt:mmg: nt:aun st:rVICt:SlJUIlt: .WVO> challenges, all with fairly equal urgency and all drawing on diminishing core funding: he says. "We aren't providing anything near the web of protection that's needed." The problem isn't unique to Seattle. All over the country, local public health departments are struggling to keep on top of a growing list of health threats. Terrorism may turn out to be the least of their concerns. Changing patterns of land use are bringing people into contact with dangerous new microbes such as the West Nile virus and the coronavirus, which is believed to be the cause of SARS. Globalization is spreading these diseases more rapidly than human Immune systems or modem science can build defenses. And many see a scenario in which the familiar Influenza virus abruptly morphs into a deadly pandemic that the U.S. Centers for Disease Control and Prevention estimates could kill as many as 300,000 people. On top of that, old maladies such as tuberculosis have started appearing in drug-resistant strains; sexually transmitted diseases such as HIV and syphilis are on the rise because many people have become complacent about them; and chronic diseases such as asthma and diabetes are becoming more prevalent due to environmental and behavioral factors. Local public health leaders widely agree with Plough that their tools and budgets haven't kept pace with these challenges. Despite the growing threat from communicable diseases, for Instance, state health agencies employ fewer epidemiologists today (1,400) than they did In 1992 (1,700). When a profeSSional association this fall and winter asked state health laboratory directors to rate their preparedness to handle a terrorist chemical attack, half scored their own facilities "1" or "2" on a scale of 1 to 10, with 1 being the poorest mark. And a Uttle Hoover Commission in California declared In April that the state's "public health Infrastructure is in poor repair, providing less protection than it should against everyday hazards and unprepared to adequately protect us against the remote but substantial threats we now face.. The commission noted, among other things, that only 20 percent of reportable diseases and conditions were actually reported to public health officials, and that at one key health laboratory, only 60 of 100 positions were filled. As California goes, so goes the nation. Updating a 1988 report that concluded the country's entire public health system was in "disarray," the National Institute of Medicine said last fall that the system is plagued by "outdated and vulnerable technologies, lack of real-time surveillance and epidemiological systems, Ineffective and fragmented communications networks, (and) incomplete domestic preparedness and emergency response capabilities. " STARVING THE SYSTEM Policy makers are aware of the holes In the public health system. Last year, the U.S. Congress provided $940 million to help local health departments cope with emerging threats. Local health officials hoped to use the funds not only to prepare for terrorist attacks but also to improve their ability to conduct general surveillance and cope with natural outbreaks such as SARS. The federal smallpox-vaccination program has absorbed neariy all of the funds so far, however, making "dual use" largely a chimera. http://goveming.com/articlesl6health.htrn rage ,t, OJ 0 , 6/4/03 Governing: Health services/June 2003 , Indeed, many local officials say the federal government hasn't even provided enough money for them to prepare adequately for possible terrorist attacks, let alone cope with naturally occurring diseases that already are killing people. In particular, the preoccupation with smallpox has set back efforts to plan defenses against a host of other potential biological weapons, induding plague, tularemia, botulism toxin, and viral hemorrhagic fever; chemical agents such as ricin and sarin gas; and a pOSSible "dirty bomb" laden with radioactive materials. Many public health offidals such as Plough also say they lack secure communications networks linking them with other first responders. On top of that, public health officials have received no money to start educating the public about what people should do if there is a biological or chemical attack. "We are writing plans, but plans by themselves don't automatically translate Into Increased capacity," says Jeffrey Duchin, chief of the Seattle health department's Communicable Disease Control, Epidemiology and Immunization section. "We aren't committing the resources needed to turn them into living documents." Federal officials counter by saying that state and local agencies would have trouble absorbing many more funds than Congress has provided. But the Increased federal funding has had an unintended side effect: Fiscally strapped states and localities have seized on it to cut their own public health spending. In Colorado's larimer County, for instance, a $700,000 slash in state funds for public health more than erased a gain of $100,000 in federal money. Even with new federal funds, the Boston Public Health Commission has been forced to cut scores of positions. Public health departments have had to rely increasingly on revenues that come with many strings attached. "Overall, we are losing money in the public health budgets in the 50 states, despite funds for terrorism preparedness," says Dr. George Benjamin, executive director of the American Public Health Association. Benjamin formerly was health director for Maryland, which has received federal funds to increase its epidemiological staff but has been forced to cut its state-financed food safety program. Perhaps more troubling, public health departments have had to rely Increasingly on revenues that come with many strings attached. For years, they have sought wherever possible to support programs with grants or with user fees, such as charges for restaurant inspections. But you can't charge a mosquito when you test it for West Nile virus, and while you can persuade publiC and private grant-makers to provide funds for programs aimed at recognized ills such as breast cancer, nobody seems to want to pay for ongoing operations or general preparedness. "There is a much greater investment In publiC health and public health programs now than there was a decade ago, " notes Mary Selecky, Washington State's secretary of health and president of the Association of State and Territorial Health Officers. "But there Is far less flexibility In how the dollars are spent. We are driven by categorical funding. n Seattle's health department, considered by many to be dynamic and http://goveming.comlarticles/6heahh.htm Page 3 of6 6/4/03 \.Jovernmg: tleaJID servlCeS/June .lUUj page 4 016 . forward-looking, Illustrates the problem. Its overall budget has grown impressively, reaching $187.9 million this year from $77.5 million In 1993. But almost all the Increases have been in programs supported by user fees and grants. County government gives it $28 million to run its emergency medical services; a federal program provides $5 million to support AIDS victims (but not to help prevent spread of the HIV virus that causes AIDS); and the Robert Wood Johnson Foundation donated money for the development of a program to deal with asthma. None of these funds pay for basic public health operations, including surveillance to detect new disease outbreaks, Investigators to track the spread of diseases and a host of prevention-oriented activities. This year, funding for~core. activities totaled $30.9 million, barely up from $30.1 million 10 years ago. The current West Nile virus and TB outbreak alone would more than eat up that increase this year. And that doesn't take Inflation or Seattle's substantial population growth Into account. Per capita, core funding has dropped from $21.34 in 1997 to $16.67 today. WAITING TIME Behind those numbers lies a slow deterioration in the department's ability to address long-term problems or react quickly to changing conditions. When SARS hit this spring, for instance, the department couldn't follow up on a number of hepatitis B cases. The rate of childhood immunizations has fallen since 1998, while cases of measles and pertussis (whooping cough) have increased, and new TB cases are at a 30-year high. When a team belatedly began combating the TB outbreak, it moved ahead in flts and starts. The key to stamping out such an outbreak is painstaking detective work: Investigators interview known victims, identify places they frequent and other ~ople with whom they have come In contact, and then follow up those leads with additional screening and information-gathering. Eventually, such searches enable them to track a disease's movements, Isolate it and stamp it out. By this spring, investigators had collected more than 50 pieces of information on each of some 528 actual or potential carriers. But the information lay unanalyzed for precious weeks because the outbreak team couldn't find an epidemiologist to work on it. "Somewhere in there Is the answer to where and how this got kicked off, and where It's going next," says Unda Lake, a consultant who leads the outbreak team and also chairs the Washington State Board of Health. ~But the department Is too busy dealing with SARS or other things. When you find somebody to help, it's always part-time, It's always for a short period of time, and it always takes them away from something else." Outbreaks don't occur on a neat schedule, and there inevitably will be times that are busier than others. Even the most ardent public health advocates don't expect voters to pay to have public health workers waiting around for the next outbreak the way firefighters are paid to be available at all times. But there's a Even the most ardent public health advocates don't expect voters to pay to have public health http://governing.comlarticles/6health.htrn 6/4/03 uovemmg: Health servICes! June 2Um backlog of tasks that could keep the public health workforce busy when there are no emergencies. worKers waiting around for the next outbreak the way firefighters are paid to be available at all times. Currently, the Seattle department can afford just 10 public health nurses for an intensive counseling program called "Best Beginnings, n which has been proven to reduce a wide range of health problems affecting children of first-time teenage mothers. That's enough to reach only about one fourth of the mothers who need the service. Meanwhile, a strategy for working with schools to encourage teenagers to drink less soda and get more exercise - keys to reining in a near epidemic of juvenile diabetes - remains on the drawing boards for lack of funds, as does a major initiative to help Seattle's health proViders incorporate ideas about safer behavior, better diets and exercise into their daily interactions with patients. Although public health departments could make good use of additional funds, public skepticism about government and taxes usually trumps proposalS to increase their resources. In Washington State, public health advocates were optimistic early this year after the Republican and Democratic leaders of the Senate co-sponsored a bill that would ask citizens to vote on whether to raise property taxes by $151 million to support local public health agencies. But health advocates lost heart after a poll commissioned by the Washington State Association of Counties and others showed the Idea was far from assured of winning voter approval. The lack of support demonstrates, In part, how reliance on categorical funding has become a political trap for public health agencies. Victims of spedfic illness often lobby tirelessly and effectively for funds to address their afflictions, but it's hard to find citizens who feel the same degree of passion for quiet government activities that keep people healthy. Public health workers have the passion, but it doesn't get them very far. "People think they're just aSking for a handout. n says Pat Libbey, executive director of the National Association of County and City Health Officials. REAUTY CHECK Clearly, voters expect more than they are willing to pay for. The Association of Counties poll showed, for Instance, that 96 percent of Washington voters believe the services public health agencies provide are "very important. n Yet the state Department of Health estimates that total public health spending In the state - about $507 million annually - amounts to only one third of what public health agencies need to do the job they currently are expected to do. The department says only one half of local public health agencies are doing reasonably well In meeting 202 performance measures developed for them. For Carolyn Edmonds, a member of the county council for Seattle's King County and a former state legislator, the disparity between expectations and reality represents a polltlcal quandary. On one hand, she wonders whether advocates should present the bUdget situation In starker terms - by warning voters, for Instance, that the current stringency is fOrcing public health officials to put fighting infectious diseases ahead of making sure children are Immunized. "Public health http://governing.comlarticlesl6hea1th.htrn Page 5 of6 6/4/03 VV",""J.J.J.U:ao. ..L..L......uJ.U..1 >)\.<.1 ".""'i:)IoIU1..Po.r 4VV-' rllgt: 0 01 0 has shied away from doing that," she says, "but maybe we're going to have to be more biatant" about what the trade-offs are. On the other hand, Edmonds fears that voters won't believe leaders who say current budget and tax poliCY require such decisions: "Peopie go to restaurants expecting that the food wlil be cooked properly. They go to a drinking fountain expecting that they won't get sick from the water. There is a built-in assumption that they wlli be taken care of." Eventuaily, she says, the assumption wlil be disproved - maybe not In dramatic ways but slowly and less noticeably. "Response times will be slower. There will be fewer prevention measures," she says. "More people will get sick. People wlli die." The end result, in Edmonds' view, may not be as shocking as, say, terrorists detonating a dIrty bomb In a baseball stadIum. Nevertheiess, It wlli be very real and might have been avoided. Copyright @ 2003,CpnaressfonglQ!Jart@.rlY.-1nc. Reproduction in any form without the written permission of the publisher is prohibited. Governing, City & State and Governing.com are registered trademarks of Congressional Quarterly, Inc. ~ ~ -1['\1; "A:::-" j. Sbl\RCt-i AH(hJ~._'S S:l}Bst~jJONS~ Ii.M"h...~jS A..!hERT1S'NGc:C;LASS1HEG~' ~ L~' ,.~ http://goveming.comlarticles/6health.htrn 6/4/03 Evaluation Results Translating the Data: Moving from Numbers to People Tuesday, May 13, 2003 9:00 to 3:00 Port Townsend Elks Club Highlights . Nearly all of the participants who completed evaluations gave good, very good, or excellent scores on the various segments of the day. . Nearly all of the participants who completed evaluations reported that Goals 1 and 2 were met, (93.6% and 69.3% respectively). . Less than half of the participants who completed evaluations reported that Goals 3 and 4 were met (46.8% and 43.5% respectively). Poor, Fair Good, Very Good, Excellent Data Overview and Highlights-Chris Hale 1.6% (1) 98.4% (61) Lunch Speaker-Judi Morris, "So What?" 3.2%(2) 96.8% (60) Strategic Issues Session #1-lmplications for Action 6.4% (4) 93.6% (58) Strategic Issues Session #2-Key Priorities 4.8% (3) 95.2% (59) Taking the Next Steps 8.1%(5) 91.9% (57) Katie Carlson-Event Facilitator 17.7% (11) 82.3% (51) Small Group Facilitators 3.2% (2) 98.6% (60) Were the goals for the day achieved? Goal Not Goal Exceed Met . Barely . ed Met Goal Goal 1 : Data overview and major highlights 0% 0% 1.6% 45.2% 48.4% (0) (0) (1) (28) (30) Goal 2: Implications of data related to policies and 0% 1.6% 12.9% 53.2% 16.1% services (0) (1 ) (8) (33) (10) Goal 3: Identify Key Priorities for Action 0% 1.6% 29.0% 37.1% 9.7% (0) (1 ) (18) (23) (6) Goal 4: Provide a framework for Next Steps 3.2% 6.5% 24.2% 38.7% 4.8% (2) (4) (15) (3) (3) Translating the Data PROGRAM EVALUATION Comments . What about holding a "Whole Systems Event? Where a group similar to this one today would focus on the two age groups at most risk: < 18 year olds and the 75+ year olds? A WSE in a community-wide brain-storming da where a broad spectrum of people generate lots of ideas. Marvin Weisbard has a book that describes this kinds of event. . Wasn't here for entire session . Kellie's outfit - excellent . I felt that some of the assumptions Dr. Hale made based on the data were not supported by the data . Numbers along with percentages would have helped in the presentation by Hale. As she noted, percentages are often misleading. . Very good . Thank you - good job. I had to date some lower to highlight others, not that they are less important. . A survey of all the people here and others could have been sent out prior to the stats being put together - could have included other items in book such as young children problems, stats. . My comments are general. Won't try to rate individual problem. I found the meeting extremely interesting. This information will be very useful in redoing the UGN allocation process. A committee has already been set up. . Facilitator was way too shrill. Not enough time for lunch. . Forum was excellent and very informative . It is clear that there seems to be a disconnect between needs/challenges and the resources that are available. Great program. . Very inspiring. Thank you! . Great job!! . Do kids in Seattle say "there's nothing to do here'''? . Needed drug & alcohol survey data from schools . No direction in small group discussion. Discussed everything but accomplished nothing (might have been my group only). Data presentation great! Informative and useful! Conference Budget Highlights for Counties Issue Conference Proposal 16 counties are provided a total of $5 mil. for State Fiscal Year 2004. No appropriation is County and City Backfill provided for 2005. A list of 134 cities share a total of $3 mil. in 2004 and $2 mil. in 2005. $48 million is provided through the Department of Community, Trade and Economic Public Health Funding Development. $24 million in each fiscal year of the biennium. Individual departmenlldistrict allocations in budget. Becca and Truancy Becca and truancy petitions fully funded. Funds now flow hrough Office of the Administrator for the Courts No caseload reductions. Funds reduced are: ($2.898 m) Inpatient pool, ($5.840 m) admin cap to 10%, ($4.262 m) increased eligibility verification, and ($4.170 m) children's medical premiums for total of ($17.258 m). Funds added are $18.640 m for enhanced local match options and 5% Mental Health requirement eliminated. MIO pilot funded - $902,000 and advance directives, Marr Settlement, and JLARC children's mental health recommendations. Ongoing provisos for increased direct services, Clark County project, MPC costs, DVR, and formula. Medicaid Integration Partnership fund shift authorized. Reductions to staffing for McNeil Island SCTF and funds provided for off- island facility. The budget provides sufficient funding for approximately 100,000 persons per month to receive state-subsidized health insurance coverageduring January 2004-June 2005. Beginning in 2004, the BHP is to be restructured, to reduce the state cost of covered services by approximately 80 Basic Health Plan percent. The revised benefit package is expected to include the following increases in enrollees' out-of-pocket costs: a $250 annual deductible; a $5 increase in office visit co-pays; a $3-7 increase in co-pays for prescription drugs; a $200 increase in the cost of a hospital stay; and a $60-70 annual increase, depending upon income, in the minimum premium charged to enrollees . whose incomes are below 125 percent of the poverty level. Drug Sentencing and $8.9 m for counties and $1.2 m net after savings included for DOC for early implementation of Treatment drug sentencing reform. CRAB, TIB, FMSIB No consolidation Consolidation. WSP Crime Lab Capital budget includes $800 k for Seattle toxocology Lab, $11.365 mil for Spokane Crime Lab, $10 mil for Vancouver Crime Lab Criminal Justice Training Includes Coroner and Prosecutor training. $250,000 is provided for Wash. Assoc. of Sheriffs and Commission Chiefs sex offender web site. Homicide Investigation SMART is eliminated. HITS state funding now from PSEA. Tracking System $11,152,000 for county assistance to ensure minimum statewide service. and to provide new Enhanced 911 wireless tech staff in state office Includes $2.2 m. for county equipment purchases. From federal fiscal '03 budget: $8.3 M to locals for prescribed equipment, exercises, planning, admin, terrorism consequence management, and competitive grants. From federal '03 Homeland Security supplemental: $20.7 M to locals for prescribed equipment, training, exercises and planning. $2 M for enhanced security at critical infrastructure facilities. No local matching funds required. Distribution formulas developed by Adjutant General and govemo~s domestic security advisory group. MI eliminated. Grant program for rural hospitals created - $6.2 m and other hospitals with large Medically Indigent and GA-U proportion of low-income - $52.160 m. GA-U restructured requiring client to prove disability ($6.637m) cash and ($7.069m) medical savings. No additional funds to ADATSA for treatment. No reduction to pre-vac. No capping of daily rate.$2.5 m for community residential. $2.2 m for Developmental Disabilities community protection. One-time SSP payment $10 m. Reductions are ($19.806 m) for ARC lawsuit, ($1.749 m) Medicaid Personal Care level of care, ($3.252 m) freeze on CAP waiver enrollments. Developmental Disabilities. Consolidation across all RHC's in order to downsize Fircrest. $3.160 m for community Institutions placements.$2.472 m for transition processes. Sentencing alternatives savings of ($3.328 m) and funds to counties for implementation of Juvenile Rehabilitation $1.183 m. Across the board reduction of county consolidated juvenile services funds - ($1.316 m). Becca funds shifted to Office of the Administrator for the Courts. WSACIWACO 06106103 Page 1 of3 Conference Budget Highlights for Counties Issue Conference Proposal Prenatal care covered. Dept. required to obtain approval of federal waiver authorizing premiums for children over the poverty level saving ($67.038 m). Increased eligibility verification savings ($ 51.184 m). Same as House for changes in durable medical equipment and dental. Co-pays for Medical Assistance vision and hearing services authorized. Medicaid Integration Project authorized for nursing home residents saving ($12.670 m). Proviso requiring medical care management project for General Assistance clients continued with enrollment start of 7/1/04. MAA included in Medicaid Integration Partnership authority to shift funds. CRCs, HOPE beds, Family Policy Council, Networks, and Street Youth all fully funded through Children and Family Services PSEA- $23.0 m.. Funding for $16 mil. of this support came from a $10 increase in infraction penaities. TASC reduced - ($4.64 m). Gravely disabled cut - ($2.0 m). No VRDE reduction. DASA included Alcohol and Substance Abuse in Medicaid Integration Partnership authority to shift funds. No cut to rural hospital detox. Raise level of care standard for medicaid personal care services saving ($3.664 m). Limil Aging COPES waiver enrollment growth saving ($10.390 m). Spousal resource limits reduced from $90,000 liquid assets to $40,000 saving ($9.868 m). No caseload adjustment for Area Agency on Aging case managers. Medicaid integration Partnership fund shift authorized. $14,782,000 savings due to elimination of community supervision for low- and moderate-risk offenders except those convicted of sex and violent crimes. $24,939,000 in savings due to early Post Release Supervision implementation of drug sentencing changes, and to increases in maximum amount of earned early release time. Shifts LFO billing to OAC and collection to county clerks. Provides $1.8 M in PSEA grants to clerks based on WACO formula. Indigent Defense for Maintains current pilot programs but does not provide for further expansion in '03-'05. Funding Dependency/Termination would support 800 cases in the juvenile courts of the two pilot projects. Cases Extraordinary Criminal Justice $766,000 for King County. Costs Shorelines Planning Provides one time funding of $2 million. GMA Planning/Growth Boards CTED GMA grants appear to be restored. Funding is restored for Growth Boards. Watershed Planning and $11.5 million in grant funding for watershed planning. Technical assistance staff appears cut. Management FCAAP grants cut by 50% to $2 million. Salmon Recovery Reduces salmon recovery planning grants to $3.25 m. No appropriation is provided for regional recovery boards in the operating budget. The capital budget is not yet available. State Conservation Agency not merged. Commission Economic Development Increases funding for tourism promotion (400K), foreign offices (400K) and other economic Programs at DClED development efforts by $2.6 million total. DOH Water Reclamation Eliminates water reclamation assistance. DNR Geology Public Same as Senate. Information. AIDSNEl Funding No reduction in AI DSNets funding. Tire Recycling No funding Is provided. Child Death Reviews Funding is eliminated. The fee for certified copies of birth, death, marriage, and divorce certificates is increased from Web-based Death Certificate $13 to $15. This is expected to generate approximately $600,000 per year of additional revenue System for local health departments, and $1.7 million of additional revenue per year for the state Center for Vital Statistics. The Center will develop a web-based death certificate system. Per SSB 5545, the fee for a certified copy of all birth, death, marriage, and divorce certificates is Vital Records Fee Increase to be increased by an additional $2 in order to reduce the need for general tax subsidy of the vital records system. Expand Food Safety Program Funding is provided for a 33 percent increase in statewide coordination and quality enhancement of local food safety inspection efforts. 1.5 FTE and $266,000. Mercury Reduction and Funding from the State Taxies Control Account is provided in DOH and DOE to develop a plan for educating schools, local governments, businesses, and public on proper disposal methods for Education mercury-added products and to implement the requirements of HB 1002. WSACIWACO 06106/03 Page 2 of 3 . Issue Conference Proposal Funding is provided to DOH for implementation of ESHB 1338 (Municipal Water Rights). DOH is required to draft rules, implement policy, and provide technical assistance regarding new, Municipal Water Systems enforceable water conservation requirements. It is also expected to result in 50 additional water systems seeking plan reviews each year in order to secure water rights. Most of the cost is to be financed by a 25 cent per residence fee on water connections. The State Board of Health has recommended that all newborns be screened by the state public heaith laboralor for five additional disorders whch can cause menal or motor retardation, Add Newbord Screening blindness, hearing loss, physical abnormalities, andlor death if undetected. Testing for the five Tests. conditions will increase public health laboratory expenditures by approximately $1.6 million per year beginning in CY 2004, requiring an estimated $20.50 (50%) increase in the fee charged for newborn screenings. The State Board of Health has recommended that all newborns be screened for eariy hearing Newborn Hearing Screening loss. Funding is provided for technical assistance to hospitals on implementation of this requirement, and to fund surveillance and tracking activities associated with early hearing ioss detection. diagnosis, and intervention. Funding is reduced $152.000 for technical assistance to local health districts for engineering review for new landfills and moderate risk waste facilities, landfill closure, and groundwater Solid Waste - Techinical monitoring. Local health districts can utilize existing Local T oxics grant funding for projects to Assistance Reduction offset this engineering and hydrology technical assistance reduction. In addition revenue generated from the Biosolids permit program will be utilized to provide additional technical assistance and permit processing for the Biosolids program. Funding is reduced $1.726 million for technical assistance related to hydrogeology, sediement, Site Cleanup Technical chemistry, and biological impact analysis for site clean-up. One-time $2.1 million fund balance Assistance Reduction from delays payments to the US EPA and other savings will be utilized for emergency site clean- ups. Hazardous Waste: Funding is reduced $406,000 for education and technical assistance for businesses that generate less than 220 pounds of dangerous waste a month, otherwise known as small quantity Reducation Technical generators. This equates to 3,000 less technical assistance visits for the biennium out of a total Assistance of approximately 18,000 inspections. PBT Reduction Funding is eliminated for a strategy to address persistent, bioaccumulative toxic chemicals. Conference Budget Highlights for Counties WSAClWACO 06/06103 Page 3 of 3