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Home My WebLink About112003 JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, November 20, 2003 Board Members: Dan Tiftemess, Member - County Commissioner District # 1 Glen Hunting/Ord, Vice Chair - County Commissioner District #2 Patrick M. Rodgers - County Commissioner District #3 GelJjfrey Masci, Chairman - Port Townsend City Counczl Jill Buhler, Member - Hopital Commissioner District #2 Sheila Westerman, Member - Citizen at Large (City) Roberta Frissell, Member - Citizen at Large (County) StatfMembers: Jean Baldwin, Health & Human Services Director Larry Fay, Environmental Health Director Julia Danskin, Nursing Services Director Thomas Locke, MD, Health Officer Ex-officio David Sullivan, PUD #1 Chairman Masci called the meeting to order at 2:30 p.m. All Board and Staff members were present with the exception of Dr. Tom Locke. There was a quorum. APPROVAL OF AGENDA Commissioner Huntingford moved to approve the Agenda as amended, moving New Business Item Evaluation of Existing On-site Sewage Systems Subcommittee Update to the beginning of New Business. Member Westerman seconded the motion, which carried by a unanimous vote. APPROVAL OF MINUTES Member Frissell moved to approve the minutes of August 21, 2003 and October 16, 2003 as submitted. Member Buhler seconded the motion, which carried by a unanimous vote. PUBLIC COMMENT - None OLD BUSINESS AND INFORMATIONAL ITEMS Maternal Child Health (MCH) UDdate: Jean Baldwin reported that while this program recently lost some federal funding, other private sources are being sought. Public Health Nurse Quen Zorrah briefed the Board on the many programs under the MCH umbrella - Women Infant Children (WIC), Maternity Support Services, Case Management Programs, Nurse-Family Partnership program, Universal Newborn Screening and Follow-up, Breastfeeding Consultation/Tea, two contracts with Child Protective Services, and Daycare Consulting on Health and Behavior Issues. The current program goal is to offer services at the level of need for each family, regardless of program boundaries. Some of the supporting data used to meet their team goals was included in the agenda packet - community assessment data and the State Public Health Standards. Also available for the Board were copies of a physician's study, which has HEALTH BOARD MINUTES - November 20,2003 Page: 2 motivated Staff. The Relationship of Adverse Childhood Experiences to Adult Health, which showed that a healthy brain structure is determined by the quality of relationship developed in the family within the first year or two years of life. Those families with the most severe and long-standing issues benefit most from long-term and high-intensive services. She talked about the data being collected under the Nurse- Family Partnership and noted that since they have increased the programs' intensity, their biggest referral source has been word of mouth. As she spends about 25% of her time on South County services and she has noticed a dramatic increase in the acceptance of home visits over the years. Part of broadening their program involved expanding their skills to include services that clients might not seek elsewhere - such as depression screening. The study's theory of how infants and children develop correlates with the roots of mental health and behavior problems has helped them sharpen their skills at identifying and working with these challenges. She reiterated the importance of building a long-term relationship with clients and their families. Cruise Shin Sewal!e Releases Follow-un Letter from Denartment of Ecolo~: Larry Fay noted that the agenda packet included a November 14 update from Dr. Tom Locke. Various agencies are paying attention to this issue and the State Board of Health is interested in identifying public health issues and applying pressure to the respective agencies with jurisdictional authority. As directed last month, the packet also contained a letter from Dr. Locke to the Department of Ecology expressing the Board's concerns about infectious waste discharges in the coastal waters surrounding Jefferson County and offering his services (as a Health Officer in both counties) to sit on the committee negotiating a Memorandum of Understanding between involved agencies and the Northwest Cruise Ship Association. Dr. Locke has agreed to continue to keep the Board apprised on this issue. Member Westerman asked for clarification on the third item in Dr. Locke's memo, regarding the State's investigation of its authority to adopt administrative rules related to cruise ship discharges. Mr. Fay responded that while the State Board of Health might have the authority to adopt administrative rules, given the conflicting jurisdictional issues in the Strait, they are still investigating whether such rules would be applicable offshore. NEW BUSINESS Evaluation of Existinl! On-Site Sewal!e Svstems Subcommittee U ndate: Larry Fay reported that since the last meeting, Commissioner Titterness and David Sullivan participated in a subcommittee meeting to further consider the permit decision matrix. Linda Atkins reported on her evaluation of the 682 building permits issued in 2003. They determined that about 175 might be considered as needing an EES because they include additions, alterations, a plumbing increase or raising the roof (changing the square footage of the structure), change of use, decks and garages. Building permits not being considered as having the potential to need an EES were changing windows, re-roofing, the addition of propane and hot water tanks, and other mechanical improvements. These are therefore classified as "non-building building permits." They also considered the issue of land area to capture the highest risk. Only lots equal to or less than a quarter acre or within 200 feet of shoreline would have an EES for all of the above-referenced building permits (not including the non-building building permits). Parcels greater than a quarter acre but less than five and more than 200 feet to the shoreline would need an EES if they are adding 120 square feet or more (based on the fact HEALTH BOARD MINUTES - November 20,2003 Page: 3 that you currently do not have to have a building permit for less than 120 square feet for a shed or small addition. Lots greater than five acres would only require an EES if they were adding plumbing. These criteria would potentially result in about 175-200 additional inspections a year. She said they would be modifying the table accordingly and would bring it back to the Board for its consideration. Based on the total number of households from Assessor's roles, less the number served by sewer in Port Townsend and Port Ludlow and the 900 currently under contract, the County would have to capture between 6,500 and 8,200 systems for future monitoring. At the current rate of inspection, it would take approximately 15-20 years to bring all those systems into compliance. Staffs experience is that we are moving at a better rate than most jurisdictions, which have between one in five or six of their systems in a computer database tracking system compared to Jefferson County's 6,000 of9,000. Staff recognized the need to continue to educate to facilitate compliance. Some jurisdictions take a voluntary approach. A small community in Skagit County has requested designation as an area of special concern. Staff clarified that the State regulation required Counties to develop a system to ensure the establishment of peri odic evaluations of all on-site septic systems by the year 2000, but it did not specify a deadline to have all septic systems entered. Member Westerman expressed her hope that the work could be done faster in light of the County's current rate of in migration and the fact that inspections would benefit both the property owner and the environment. Mr. Fay said that with this program the County would prevent future pollution problems by tracking in migration through sales and new construction. Member Westerman said her concern is the cumulative impact of new systems on top of the existing uninspected systems. Linda Atkins noted that as part of the implementation ofthe State Department of Health's Early Warning System, there was an early warning of water quality issues for Lower Hadlock Bay. While the source of the problem(s) is still unknown, Staff has been working with the Planning Department on permit applications for new mooring buoys, signage, etc. in that area. Commissioner Huntingford said that with the increase in the number of liveaboards in that area, some type of pump out facility might be appropriate. EnviroStars Presentation: Melinda Bower was present to review the regional EnviroStars program (created in 1996), which certifies businesses for reducing, recycling and properly managing hazardous waste disposal and storage and gives consumers an objective way to identify environmentally sound businesses. After listing the qualification requirements, she talked about the measures taken by the five Jefferson County businesses - Circle and Square, Auto Works, SatchWorks, Jefferson Transit and Carr's Lube Express - to qualify for ratings oftwo to five stars in the auto repair/body shop industry categories. The other business receiving recognition was SOS Printing. She is also educating dentists regarding regulations under development by Ecology to require dentists to have amalgum separators to prevent mercury from getting into the storm water systems. David Sullivan mentioned that Circle and Square clean business practices are especially helpful because they are close to a well serving the Tri-Area. He asked whether the County considered giving breaks on sewer or storm water rates? Melinda said there are not yet financial incentives, but the new surface water management plan does mention recognition for those businesses that contribute financially to surface water management. HEALTH BOARD MINUTES - November 20,2003 Page: 4 Larry Fay noted that Circle and Square was also instrumental in getting the EnviroStars program started in Jefferson County. He added that through the Solid Waste Enforcement Grant, Melinda Bower is able to do program promotion, general outreach, and individual visits with businesses to acquaint them with the program and ongoing audits. Benefits for the businesses include recognition and free publicity. Melinda's position is funded through solid waste enforcement grant, solid waste education grant, and an operational transfer from the Solid Waste fund to Environmental Health. Member Frissell talked about how proud the business owners were of this recognition of having done "the right thing." Bioterrorism Draft Plan: Referring to the progress report included in the agenda packet listing the County deliverables for the federal graut for bioterrorism preparedness, Communicable Disease Nurse Lisa McKenzie explained that there are also multiple layers of state, regional, and local activities. Jefferson County's activities are tied significantly to their regional partners, Kitsap and Clallam Counties, as well as in-County partners who are developing emergency preparedness plans (Jefferson General Hospital, the Department of Emergency Management, and EMS groups). This planning effort has increased communication and coordination efforts, so that it is an all-hazards or all-emergency planning. Influenza-A Season / SARS Preparedness: Since the packet came out, Lisa McKenzie said, there has been a new update. On Monday, the head of CDC announced in a media briefing that there are indications of an early and possibly more severe flu season. One indicator is that one of the two lnfluenza- A strains toward the end of last year started changing a little, so there is not a perfect match now between the vaccine and the virus that is circulating now. The predominant H3N2 strain has drifted and tends to result in a more severe flu disease than other strains. The CDC has provided clinics and hospitals with the SARS Algorithms (included in the agenda packet) to increase preparedness in the event people come in with respiratory illness. Jeau Baldwin reported that the CDC had last week targeted Washington as one of the most likely places for a SARS outbreak and began putting Staff in place in the State. By fall, Washington State will also have an electronic surveillance data system in place in each of its regions. Healthv Jefferson: Jean Baldwin reviewed that the packet contained notes from the May 13 meetings as well as a sununarization into three main areas of focus generated during a successful prioritization session. Leaders ofthese three main work groups would meet December 2nd to decide on a framework for their individual groups, who would then meet in December aud January. In order to be as inclusive as possible, she has decided to try to make these meetings open to the public aud has solicited assistauce from County staff member Barbara Bowen. The first group - Strengthen and Support Safety Net for Families With Children - would meet December 15. The goal is to have a report to the Steering Committee by February. HEALTH BOARD MINUTES - November 20,2003 Page: 5 2003/2005 Youth Yellow Pal!es Proiect Summary: Jean Baldwin noted that a copy of the Yellow Pages was included in the packet for the Board's information. ACTIVITY UPDATE/OTHER ANNOUNCEMENTS Jean Baldwin said the Department is in the process of redoing the web page to update member rosters for each Board, etc. Member Frissell said, conceming meth lab regulations, that a committee has been meeting and considering alternatives. There might be a presentation to the Board sometime in the next couple of months. Larry Fay reported that there has been a series of meetings with the BOCC on septic permitting issues. Staff is investigating administrative and procedural changes. AGENDA PLANNING/ ADJOURN The meeting adjourned at 4: 13 p.m. The next meeting will be held on Thursday, December 18,2003 at 2:30 p.m. at the Jefferson County Health and Human Services Conference Room. i1:::0~ARD ~FHEALTH ()Jl6dd/ !!fi. Buhler, Member cS li\..v..- U)it,ctu~ Sheila Westerman, Member /) -(, M<.tdii. d~ Roberta Frissell, Member Patrick M. Rodgers, Member I~ Jefferson County Health and Human Services 1':$ )615 Sheridan Street '\., Port Townsend, WA 98368 "1 II!!""..O""J Tel 360-385-9400, Fax 360-385-9401 ~~ November 14. 2003 To: Jefferson County Board of Health From: Tom Locke. MD, MPH, Jefferson County Health Officer Re: Cruise Ship Waste Discharge Update My apologies for missing the Board's November meeting. I have been invited to speak at a CDC conference in Atlanta on 11/20 on the important but obscure topic of newborn screening for cystic fibrosis. There have been a number of deveiopments in the Cruise Ship infectious waste discharge issue. The State Board of Health is taking an active role in identifying the public health issues involved and applying pressure on the respective agencies with jurisdictional authority. A welcome addition to the process is Washington State's new acting Secretary for Department of Health's Environmentai Health division. Janice Adair. Janice comes from Alaska's Department of Health where she was instrumental in the very contentious negotiations that lead to strict state and federal standards for cruise ship discharges in Alaska's sensitive waters. I spoke at length with Janice on November 13, 2003 and she will be glad to assist us. In our conversation I learned that the federal legislation that resolved Alaska's problem is specific to Alaska and will not benefit us in Washington state. I also learned that Alaska's investigations found that both the blackwater (treated sewage) and graywater (all other waste water) from cruise ships were significant sources of bacterial contamination and that E. Coli counts in some graywater discharges actually exceeded those in blackwater. There are three potential avenues of increasing public health protection as relates to Cruise ship discharges that are being pursued: I) The memorandum of agreement being negotiated between the Department of Ecology, Port of Seattle, U.S. Coast Guard, Puget Sound Clean Air Agency, and the Northwest Cruise Ship Association. Their target date for completion is March of 2004. 2) Several legislators from the Puget Sound area have expressed concern about the issue and plan to hold hearings in the upcoming session of the Washington State Legislature. This could, conceivably, result in legislative action relating to this issue. 3) The State Board of Health is investigating use of existing authority to adopt administrative rules relating to Cruise ship discharges. The Board has broad authority to adopt rules related to control of communicable diseases. Marine water discharges involve a complex mix of overlapping local, state, and federal jurisdictions and may not have the desired force of law in many parts of Puget Sound and the Straits of Juan de Fuca. In summary. this issue is certainly on the radar screen of a number of agencies. I believe the cruise ship industry has strong incentive to be proactive in this area - the cost of compliance is relatively low and the potential for adverse publicity is high. I will keep the Board posted on developments. fj......~. ...t.......... Jefferson County Health and Human Services I . ... 615 Sheridan Street ,~: .~ \ . Port Townsend, WA 98368 \". . Tel 360-385-9400. Fax 360-38S-9401 '~n!_G November 14, 2003 Mr. Richard K. Wallace Manager, Water Quality Program State of Washington Dept. of Ecology P.O. Box 47600 Olympia, Washington 98504-7600 Dear Mr. Wallace: On behalf of the Jefferson County Board of Health, thank you for your letter of September 8, 2003 responding to the Board's concerns about cruise ship infectious waste discharges in the coastal waters surrounding Jefferson County. The Board appreciates your thoughtful response and explanation of the complex jurisdictional issues involved. The Jefferson County Board of Health has joined with the Clallam County Board of Health to express our concerns to the Washington State Board of Health and seek their assistance in pursuing a solution to this problem that is broadly protective of the health of coastal residents. We understand that, in addition to the multi-agency workgroup you have convened to pursue a memorandum of understanding, there is significant legislative interest in this issue. The Jefferson County Board of Health supports the Department of Ecology's efforts to negotiate a MOD among the involved agencies and the Northwest Cruise Ship Association. The Board also feels that input from local health jurisdictions (especially those with extensive coastlines and sensitive shellfish populations) is very important in this process. In this respect, the Board asks that you include a local health representative in your workgroup. As Health Officer for both Clallam and Jefferson counties, I would be glad to serve in this capacity. Again thank you for your attention to this issue. Although no imminent health threat resulted from the Norwegian Sun's accidental discharge last May, the potential for such threats is very real. We appreciate Department of Ecology's leadership in convening the responsible local, state, and federal agencies with authority to effectively address this Issue. 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YYP Community Distribution Blue Heron staff, Counseling Center Boiler Room* Brinnon Visitor Center* CHS staff, Counseling Center CMS staff, counseling Center Community Corrections Food Coop* DCFS* DSHS* DV/SA * JGH Emergency Dept.. Lab* Fresh Press Java & Juice Healthy Youth Coalition Hwy 104 Visitor Center I nsatiables Java Port Cafe* Jefferson County Library* Jefferson Mental Health* Jefferson Co. Sheriff Juvenile Services* Nordland Store 03A OlyCap-Linda* On common Ground* Peninsula College* Peninsula Midwives pennySaver Port Townsend Police* Prosecuting Attomey* Port Townsend Library* Port Townsend Visitors Center* PTHS * PTHS Martina H Quilcene Community Center Quimper Sound Rec Center S. Co. Medical Safe harbor Sheriff Sisiutl* SOS* Tyler Street Coffee *Complimentary acrylic displays September, 2003-Gaye Martin, CHS & Martina Haskins, PTHS integrate YYP into Health class curriculum. .' October, 2003-Help card w/Alcohol & Drug Overdose infonnation to printer November, 2003-Help Card distribution ---Q,5000 2003/2005 Youth Yellow Pages distributed to date o , } C'J-/ll1JtfCiJff/ IJ!c,J/ :;Joo/.- (iOO3 YOUTH YELLOW PAGES TREASURE HUNT NAMES WRITE THE PAGE THAT YOU WOULD FIND INFORMATION ON THE FOLLOWING TOPICS: 1. Alcohol poisoning W 6 sperd. p:u+ of Gl;!" ~" cl~d€k.'" :/p', .. j('Y'-=-~ -.,. .. " ";--,q,-",*- ~,~ .. ~;:'.' . .. .. 'J:SJl..l~_ .. .".. , ..,".:)-~;t:<~:__",;, q^..I,lM~.~4r,<i.. {'~,I4'"c..V11V~ n~t<JKA' "'Jt..rp~_~~ ':~>~'-tlW.,<____ c....:' ~~s~~~~'~+~ Real M~n't Rape Washington Coolition of Sexual Assault Programs www.wcsap,org 2. library services 3. religious organizations 4. tattoos and body piercirigs 5. eating disorders 6. rape, sexual assault and sexual ' 7. What company published this pamphlet? 8. There is an emergency number for Trevor Help line. What is it a crisis' line for? 9. What is the purpose of the Youth Yellow Pages? 10. 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