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HomeMy WebLinkAbout101603 JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, October 16, 2003 Board Members: Dan Tittemess, Member - Coun!y Commissioner District #1 Glen Huntingford, Member - Coun!y Commissioner District #2 Vacant - Coun!y Commissioner District #3 Geoffrey Masci, Cbairman - Port Townsend Ci!y Council Jill Buhler, Member - Hospital Commissioner District #2 Sheila Westerman, Member - Citizen at urge (Ci!y) Roberta J:nssell, Member - Citizen at urge (County) Sta(fMembers: Jean Baldwin, Health & Human S eroiees Director Larry Fqy, Environmental Health Director Julia Danskin, Nursing Seroices Director Thomas Locke, MD, Health Officer Ex-o(ficio David Sullivan, PUD #1 Vice Chairman Commissioner Huntingford called the meeting to order at 2:30 p.m. All Board and Staff members were present, with the exception of Chairman Masci and Member Buhler. There was a quorum. APPROVAL OF AGENDA Member Frissell moved to approve the Agenda as submitted. Member Westerman seconded the motion, which carried by a unanimous vote. APPROVAL OF MINUTES Given that the copies of the minutes in the agenda packets were incomplete, approval of the August 21, 2003 minutes was tabled until the November meeting. It was noted that the Board did not hold its regular meeting in September. PUBLIC COMMENT Dale Wurtsmith was present to find out if there had been any resolution to the issue of permanent Operations and Maintenance licensure, which he brought before the Board at its August meeting. (See later in minutes: Operations and Maintenance Licensure) OLD BUSINESS AND INFORMATIONAL ITEMS Cruise Shio Sewal!e Releases Follow-uo Letter from Deoartment of Ecolol!v: Mr. Fay noted that the agenda packet included Ecology's response to the Board's letter expressing concems about the potential negative impact to water quality by the cruise ship industry. The State Board of Health also received a response. Member Westerman asked to clarify whether there was one or two discharges, since Ecology's letter refers to two May dates: May 3 and 11. Mr. Fay said there was one discharge, but he is uncertain of the exact date. She expressed concern about the time it would take for Ecology to write a Memorandum of Understanding (MOD) with the Northwest Cruise Ship Association and suggested the Board write a letter acknowledging receipt and recommending the issue be resolved sooner than March 2004. Health Board Minutes - October 16, 2003 Pa2e 2 Member Frissell referred to the response she received to her personal correspondence with Carnival Cruise Lines (the parent company of Holland America), in which they referred to their discharge guidelines. Alternate Member Kolff asked whether the Board might suggest having the opportunity to give input or provide recommendations into that MOU, which might change the letter being suggested by Member Westerman. Instead of pushing them to move more quickly, the letter could thank them for moving forward and state the Board's interest in providing input into the draft MOU or being represented at the MOU's creation to ensure local concerns are addressed. Mr. Fay noted that Ecology, the Port of Seattle, U.S. Coast Guard and the Puget Sound Clean Air Agency are working with the Northwest Cruise Ship Association and that Jefferson County participates in a different air quality body than the Puget Sound Clean Air Agency. If there are issues, the Olympic Regional Air Control Authority (ORCA) might need to be engaged. He agrees it is appropriate to ask to be involved since the County is directly affected. Dr. Tom Locke commented that the State Board of Health is pursuing this issue and he agreed to request an update. The potential health impact is the main concern. Commissioner Titterness moved that the Board direct Dr. Tom Locke to request an update from the State Board of Health, then confer with Larry Fay on sending a letter to the Department of Ecology on the Board's behalf. The Board requested that it receive a copy of the letter. The motion was seconded by Alternate Member Kolff and carried by a unanimous vote. Breast and Cervical Health PrOl!ram (BCHP) ReDort Ouilcene: Julia Danskin reported that the Breast and Cervical Health Program at the Health Department serves women aged 40-65. This program, funded by the Center for Disease Control, provides mammograms and annual exams to low-income women in this age group. With outreach and education funding associated with this grant, staff (Margie Boyd and Jeunifer Doyle) in coordination with the Soroptimist International arranged a Women's Health Fair in Quilcene to conduct breast and cervical cancer screenings. Jean Baldwin recognized both Margie and Jennifer at the meeting by reading letters of appreciation she and the Board of Health had written regarding this extra project that resulted in providing 16 mammograms and 4 women's health exams. The project also involved the assistance of many trained volunteers. NEW BUSINESS Rel!:ional Communicable Disease/Bioterrorism ResDonse Duty Officer Protocol: Dr. Tom Locke reviewed that this topic of establishing a "duty officer" position was discussed last month and arose out of regional bioterrorism planning and health officer coverage involving Kitsap, Clallam and Jefferson Counties. The proposal for this shared responsibility was included in the packet. Beyond health emergency response, this system would provide increased regional communicable disease control capacity. While there is not a high enough volume of emergencies in anyone jurisdiction to justifY having call schedules on a county-by-county basis, there is a need for a public health professional presence 24 hours a day, seven days a week. This system would provide a single point of contact for emergency rooms, medical providers, first responders and the public in the three-county area. Another advantage is that it would require these counties to meet a long-time goal of creating standardized response protocols. The local Health Officer would continue to be available as a back-up (either Dr. Locke or Dr. Scott Lindquist can be reached 2417). Asked whether this position is a requirement for Health Board Minutes - October 16,2003 Pa2e 3 receiving bioterrorism funding, Dr. Locke said while it is not required, it is generally expected that each county would have a 24/7 response capability and a system for contact. This region is the first in the state to propose sharing this position. Julia Danskin noted that all Health Departments having someone available 24/7 for emergencies is a Washington public health standard, and Jean Baldwin has been fulfilling this role for Jefferson County for several years. Dr. Locke gave examples of the importance oftimely public health contact. David Sullivan spoke favorably about having a single contact number. Jean Baldwin noted that a University of Washington physician who also consults with the nation of Japan on communicable disease issues, would hold a series of regional Staff trainings supported by bio- terrorism funding. Funding would also be used to get information to the medical community about reportable conditions, the emergency contact number, and available public health resources. The intent is to use funding for activities that could be continued beyond the bio-terrorism funding. There would also be more work on active versus passive surveillance, which will involve liaison with the hospitals and clinics. Commissioner Huntingford expressed some concern about far-reaching impacts of this commitment, which goes beyond "beeper time." Dr. Locke responded that this is essentially the formalization of a system that is already functioning informally. The lack of fees/charges and the fact that this is a volunteer activity from County to County simplifies liability and risk pool issues. Economic impacts include paying the people who are on call, which would be modest for Jefferson County since its population is roughly 10% of the region. Kitsap County, on the other hand, would be impacted more heavily because on-call time is directly proportional to their population size. Mr. Fay said this provides an opportunity to share and work together on the creation ofthe protocols that the County needs to have anyway. Looking at the flow chart printed in the agenda packet, Member Westerman asked who would be in contact with the local public health worker. Dr. Locke agreed that the chart should reflect the expected flow that the Duty Officer would contact the local public health worker. Dr. Locke noted that a formal agreement between Jefferson and Clallam Counties and the Kitsap Health District would likely be a matter for the County Commissioners and their legal advisors. Port Townsend Water SUDDlv Status: Larry Fay reviewed that during last year's dry fall and low reservoir level, the City and Mill developed a clear plan around low water conditions with trigger points, thresholds and specific actions. In September 2003, Staff from City Public Works, the Mill and Environmental Health met to review the plan. The City and Mill had come up with additional water conservation efforts not previously identified, including the renting of cooling towers, which might save up to two million gallons a day by cooling and reusing water in various aspects of Mill operations. This year, the City had to shut down the diversion from the Big Quilcene River about a week earlier than last year due to low flows at which point the Mill also implemented plan measures significantly reducing water consumption. He then sketched out the results of implementing new water conservation measures. Even though severe drought conditions forced the City to begin drawing from the Lords Lake reservoir much earlier, the reservoir was left higher than the year prior. He believes that watershed and forest management work done in that basin has gone a long way toward protecting water quality. Health Board Minutes - October 16, 2003 Pa2e 4 Alternate Member Kolff added that the Mill's additional internal water conservation measures were a significant contribution, as was their shutting down the Mill for maintenance. He also noted that there is excellent watershed planning occurring in the County. Water Resources Inventory Area 17 now has a draft Watershed Plan for water quantity, quality, habitat, and which would eventually include instream flow. Evaluation of Existinl! On-Site Sewal!e Svstems: Mr. Fay reviewed that under the On-Site Sewage Code, the transfer or sale of property or application for a building permit would trigger an inspection of a septic system (also documented in a Staff memo included in the agenda packet). An additional level of inspection is needed when a building permit is for an expansion that includes the construction of bedrooms, or when the permit is for an expansion and there is little or no documentation about the septic system on file with the County. He noted that applicants often question the reasoning behind the need for a septic inspection, for example, when applying for a permit to add a garage or re-roof a house. By putting an inspection requirement on an application for a project that has no apparent connection to the septic system, the County might be encouraging the public to not apply for a permit. Board input was then solicited on a draft matrix to explain to the public when an inspection would occur and what would be involved. Linda Atkins then explained the risk thresholds for the range of inspections. Member Westerman asked to claritY what is meant by an operational check versus a full assessment as well as a first and second level review. Mr. Fay noted that an operational check is a functional inspection of the system (whether or not it is working), whereas a full assessment looks at the capacity of the system and how that capacity relates to the building proposal being submitted. The latter involves two steps: Level One (file review for system documentation) and Level Two (field work to veritY the system). Staff noted the need to define what a basic operational check involves. Even though the intent is to get all systems documented, Member Westerman felt that there are certain places that are a priority to document. If it is a shoreline property or near an environmentally sensitive area (ESA), she would want a full assessment. Linda Atkins asked to clarify that the suggestion is that Staff should look more at whether or not it meets vertical separation, etc. which Member Westerman confirmed and added that people have to be educated that these are trigger points toward reaching the long-term goal of having all systems on an Operations and Maintenance (O&M) schedule. Commissioner Titterness pointed out that only a position that is perceived as rational in the greater community would be enforceable. Commissioner Huntingford agreed and used the example of how someone with a 40-acre parcel who would be required to establish a reserve area in order to install a propane stove might simply choose to do the installation without a permit. Linda Atkins clarified that the County has not required anyone to establish a reserve area for putting in a propane stove. She said it would be difficult to make generalizations based on the size of the parcel, recalling a 20-acre plat that was divided into four five- acre sites. Each lot probably had less than an acre of use able ground. Staff continued to show examples of scenarios. As to how to show in the matrix ESAs and shorelines, Mr. Fay said there might be a way to come up with guidelines to allow Staff to treat the critical areas information not as a regulatory standard, but as a flag to look at the particular situation more closely. He noted that Staff does this regularly on septic permits - for instance, if there is a wetland on the property. He agrees with the statement that in the end, if what we are doing appears so weird and is so unreasonable to the public, we will not have accomplished anything. Health Board Minutes - October 16, 2003 Pa2e 5 In response to a question about the status of the access to property issues that he was going to take to the State, Mr. Fay said he informally encouraged those involved in rule development, as well as Staff ofthe Puget Sound Water Quality Authority, to ask the same questions of the Attorney General. He believes Dr. Locke has also talked with the State Board of Health, but he is uncertain anyone has made a formal request. Commissioner Huntingford wondered if we are getting into the same property issue with requiring an operational check as a condition of getting a permit. Ifthe goal is to get more people on O&M, wouldn't it be simpler in some cases to grant the building permit, but require an evaluation within three years? Linda Atkins noted that there have been times when Staff has allowed an applicant to postpone the required evaluation of their system until the final approval ofthe building permit, which allows owners to get started. However, most often they reach the time for final approval and the evaluation hasn't occurred and they are in crisis. If the issue is whether we can make it a condition of the building permit, then we might as well address that question up front. Larry Fay added that if, in a relatively early inspection, Staff finds a failing septic system or a direct discharge - which they do with some frequency - the individual could incorporate into their building plans and financing a repair and upgrade of the system. David Sullivan said he can understand getting everybody on the system, but that is costly - ongoing inspection can cost a couple of hundred dollars. The PUD charges a lot less, but is subsidizing some of it. Some citizens will object because they do not see what they get for their dollar. They won't say"well I got to build that addition five years ago," but would say "you came out and just looked at the system and you are charging me how much?" The more people added to the O&M program, the more the PUD would be subsidizing. They might eventually have to raise their rates, which would cause more problems. Member Frissell asked ifthere are other ways of putting people on the inspection schedule instead of tying it to permits. Mr. Fay said another is to first identify sensitive areas and focus the O&M inspections in those geographic areas. Member Frissell said she thinks separating the inspection initiation system from the individual building permits should be seriously considered. People would be hard pressed to complain about the rationale (shown in the matrix), which explains what needs to be done to get your permit. There would likely be much less objection to getting individuals on an O&M schedule if everyone is being asked to comply at the same time. Commissioner Mackey said the question is whether it would be equitable and fair. Some of the worst offenders are likely not going to be the same people with the disposable income to build a new shop or re-rooftheir house. Mr. Fay said the thinking was that over time, through building permits and sales, they would pick up a significant percentage of the systems and then at some point, the Department would have a manageable number to go in and pick up the rest. Member Westerman suggested first starting in sensitive areas. She commented that there would be cases that do not fit even the best matrix. Commissioner Tittemess pointed out that we have been going down this path for two years based on input from the community, this Board and the Planning Commission. Ifwe now decide to change horses, we might lose credibility. Member Westerman questioned what would be wrong with admitting that it is not working - people comprehend the intention and fairness. Health Board Minutes - October 16, 2003 Pa2e 6 Commissioner Tittemess and David Sullivan volunteered to work with Staff in giving this topic more thought, including fine-tuning the chart. Staff could then do additional work and bring it back to the subcommittee. Community Health Assessment Uodate - Preoaration for October 29. 2003 Healthv Jefferson Meetin!!: As a follow-up to the Healthy Jefferson forum, Jean Baldwin proposed a meeting ofa smaller steering committee comprised of Commissioner Tittemess, Judy Morris, Kees Kolff, GeoffMasci and Roberta Frissell. Then on October 29, to ensure more community buy-in, a number of those previously on the Data Steering Committee, including some others such as the Port and School Board could help prioritize the four biggest issues for this community - recognizing the limited resources of governments, private nonprofits and individuals. Subcommittees of this larger group would then consider how to accomplish and evaluate the work and within two months report to the first steering committee group. In February, the smaller steering committee group would then report to the Board of Health since there is City, County and Hospital representation. Ooerations and Maintenance Licensure: Larry Fay said that during the August meeting he had agreed to undertake tasks late this year or the beginning of next year. He communicated to Dale Wurtsmith that the Board would be coming back and addressing this matter in a few months. Gaikowski Comolaint: Member Westerman asked for an update on this situation. Larry Fay said although this situation was brought to some closure, it has resurfaced again. He agreed to ask enforcement officer Molly Pearson to prepare a report on all compliance activities. ACTIVITY UPDATE/OTHER ANNOUNCEMENTS - None AGENDA PLANNING/ ADJOURN The meeting adjourned at 4:35 p.m. The next meeting will be held on Thursday, November 20, 2003 at 2:30 p.m. at the Jefferson County Health and Human Services Department conference room. JEFFERSON COUNTY BOARD OF HEALTH (Excused Absence) Geoffrey Masci, Chairman / (Excused Absence) Jill Buhler, Member ~~\e-i~ Sheila Westerman, Member . fit0c/,t/ d/J/-('j-d/! Roberta Frissell, Member Judi Mackey, Member II,,' 'TAr, o~ ~ <: ~ - = E ~./: 1~8t\\1~ STATE OF WASHINGTON DEPARTMENT OF ECOLOGY P.O. Box 47600 . Olympia, Washington 98504-7600 (360) 407-6000 . TDD Only (Hearing Impaired) (360) 407-6006 September 8, 2003 Mr. Geoffrey Masci, Chair Jefferson County Board of Health Castle Hill Center 615 Sheridan Street Port Townsend, W A 98368-2476 RECEIVED SEP 1 2 2003 J.\/l<Irson County \.Iealth & Human Sei',iCQ.< Dear Chairman Masci: In response to your letter concerning the Norwegian Sun sewage release, the Department of Ecology appreciates and concurs with your expressed concerns for water quality and how the cruise ship industry might adversely impact the state's waters and your community. The Norwegian Sun accidentally discharged sludge into the Strait of Juan de Fuca on May 11, 2003. The Department of Ecology considers the sewage release to be a serious matter and is taking steps to prevent reoccurrence of similar incidents by the cruise industry in the future. The cruise industry is a growing concern here in Washington as it has been in Hawaii, Alaska, California, and Canada. The cruise industry's track record for sewage releases in Washington consists of only one known self-reported discharge for the sewage release on May 3, 2003. However, throughout the country, the cruise industry has had a less than stellar track record for gray water releases, oil discharges, hazardous waste, and garbage releases. While the cruise ship industry is not part of a Washington community, they do have a stake in gaining the trust of customers in Washington. The cruise industry has assured us that they strive to be responsible stewards of the marine environment that they transit over and rely' upon for their business. Though there is this expressed ethic on the part of the industry, state and local authorities - including the Department of Ecology - are limited under the Oean Water Act in regulating the operation and discharge from marine sanitation devices (MSDs). The U.S. Coast Guard has primary authority for the regulation of MSDs on board ships. Given this awkward regulatory scheme with respect to wastewater discharges from vessels, how do we go about structuring a system that will provide ourselves, local authorities, and most importantly the public that level of assurance the cruise ship operations in Washington State are not violating our state's water quality standards or jeopardizing public health? The Department of Ecology, Port of Seattle, U.S. Coast Guard, and Puget Sound Clean Air Agency are presently working with the Northwest Cruise Ship Association on a memorandum of understanding (MOU) that will have operating conditions in it for the industry. This MOU ~ o Mr. Geoffrey Masci Page 2 September 8, 2003 will hopefully provide assurances that the ind1:lStry is meeting state water and air quality standards. The target date for completion of this MOD is March 1, 2004. The Department of Ecology has confidence that the memorandum of understanding will be a step in the right direction. Kevin Fitzpatrick, section manager of our Water Quality Program in the northwest regional office, is heading up this effort on behaU of Ecology and you are welcome to contact him at 425/649-7033 to get further details on the MOD. If you have any questions on this letter or other water quality matters, please feel free to call me at 360/407-6405. Sincerely, Hf{?'/~ Richard K. Wallace, Manager Water Quality Program w~ Real Estate Port Townsend October 8, 2003 Julia Danskin Jefferson County Health Department 615 Sheridan Port Townseod, WA 98368 Dear Julia, This letter is to communicate and marvel at the skills and dedication of Margie Boyd. She has single- handed1y whipped women into action to help other women of Jefferson County. Please allow me to explain a bit. I met Margie in 1998 when she was looking for property to move to Jefferson County. Later, I saw her at the Tri-Area Center being so kind to an elderly woman who needed medical attention. I had no idea she was with the Health Department. We would see each other and talk periodically. In 2000 I was diagnosed with Breast Cancer. Being a 'life dl~ngjng and affirming' disease, I decided I needed to do something to help other women when diagnosed with cancer. As a member of the Jefferson County local Soroptimist International (SI) Women's Org:>ni:rntion, we organized a worlcshop for women entitled "Do Your Dream". Margie saw me the day after the very successful event and asked what my dream was. I explained my dream. Margie walked into my office the following Monday and said, ''I'm here to help you do your dream!" She proceeds to inundate me with wonderful brochures, self-exam cards and details on the Breast and Cervical Health Program. Her initiative got the ball rolling! About 6 months later, SI of the Pacific Northwest challenged each local club to define a project that helps women with early detection of women's cancers. Of course, we call Margie! The combination of Margie, Jennifer and the JC Health Department and her contacts at Susan G. Komen and NCI along with the local women of SI and a group of concerned women in South County made a powerful group to coordinate the activities of events to focus on early detection of women's cancers. Our first event was at the Quilcene Fair in September 2003. Margie made a presentation to SI, then brought in Susan G. Komen and NCI for another presentation to SI. She then made the arrangements for a number of tasks and plans for the events at the Fair and specifically all the exam/medical services. Since SI and South County Women were 'womaning' a booth with information, Margie even arranged for 'Cancer 101' Training from NCI to prepare us for questions from the women. This is ouly our first step in educating the women of Jefferson County! Windermere Real Estate/Port Townsend 1220 Water Street Port Townsend, W A 98368 Telephone (360) 385-9344 (800) 776-9344 E mail 'ptnancy@olypen.com' Julia Danskin October 8, 2003 Page 2 SI is thrilled to have partnered with the Susan G. Kamen Foundation and Health Department and specifically Margie. Yau may not know this, but SI Northwest bas used the Jefferson County Early Detection Project as an example to our sister clubs all over the Pacific Northwest. ~"n~ of Margie, Susan G. Komen is partnering with Soroptimists and will be making a p~1JIl to our Regional Meeting to partner with them and with their local Health Deparbneots. None of this would have been possible fur us without Margie's drive and determination. We look forward to more projects with you in the future. Sincerely, Windermere Real EstateIPort Townsend 1220 Water Street Port Townsend, WA 98368 Telephone (360) 385-9344 (800) 776-9344 E mail 'ptnancy@olypen.com' PUBLIC HEALTH Always Working for a Safer and HEALTHIER JEFFERSON October 9, 2003 Margie Boyd Jefferson County Health & Human Services 615 Sheridan Street Port Townsend, Washington 98368 Dear Margie, At this Jefferson County Board of Health meeting we would like to take a moment to honor you and your work with the outreach design implemented in South County to reach women in need of breast and cervical cancer screen ing. You put together a team within JCHHS and with community volunteers. With the help The Doseducks and the Soroptimists you provided the women of Quilcene and Brinnon with excellent care in a highly advertised clinic. You were able to encourage new folks to come in for care. This was a major success. Your idea to apply for the Komen Grant for the mobile mammogram, and then planning a Saturday clinic was a novel and wonderfully successful approach. You also started a chain of peer-to-peer outreach making it easier for women in South County to encourage each other to get yearly exams and mammograms. The outreach you have started will continue to help the women of South County for years to come. With heartfelt appreciation, Geoff Masci, Chair Board of Health Jean Baldwin, Director Health & Human Services COMMUNITY HEALTH ENVIRONMENTAL HEALTH NATURAL RESOURCES DEVELOPMENTAL DISABILITIES SUBSTANCE ABUSE & PREVENTION 615 Sheridan Street, Port Townsend, Washington 98368 (360) 385-9400 Fax: (360) 385-9401 PUBLIC HEALTH Always Working for a Safer and HEAL THIER JEFFERSON October 9, 2003 Jennifer Doyle Jefferson County Health & Human Services 615 Sheridan Street Port Townsend, Washington 98368 Dear Jennifer, At this Jefferson County Board of Health meeting we would like to thank and honor you. Your dedication to clients and commitment to a successful project is clearly seen in our BCHP Review Report and the highly successful Quilcene clinic. The leadership you have shown is recognized by our contractors in Seattle and by the clients. You have received rave reviews from grateful clients and staff as you work above and beyond the call of duty to help the women of this Jefferson County. Your job requires you to do timely, efficient billing and program management, but you invest so much more with your compassionate client follow-up. You have been instrumental in BCHP screening. No detail, referral or question is beyond your complete attention. Your work is truly appreciated, Geoff Masci, Chair Board of Health Jean Baldwin, Director Health & Human Services COMMUNITY HEALTH ENVIRONMENTAL HEALTH NATURAL RESOURCES DEVELOPMENTAL DISABIUTIES SUBSTANCE ABUSE & PREVENTION 615 Sheridan Street, Port Townsend, Washington 98368 (360) 385-9400 Fax: (360) 385-940 I