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HomeMy WebLinkAbout031804 JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, March 18, 2004 Board Members: Dan Titterness, Chairman - County Commissioner District # 1 Glen Huntingford - County Commissioner District #2 Patrick M. Rodgers - County Commissioner District #3 Geuffrey Masci - Port Townsend City Council Jill Buhler - Hospital Commissioner D,strict #2 Sheila Westerman - Citizen at Large (City) Roberta Frisseli, Vice Chairman - Citizen at Large (County) StqIJ Members: Jean Baldwin, Health & Human Seroices Director Larry Fay, Environmental Health Director Julia Danskin, Nursing Seroices Director Thomas LAcke, MD, Health Officer Ex-~tJicio David Sullivan, PUD #1 Chair Titterness called the meeting to order at 2:30 p.m. All Board and Staff members were present with the exception of Commissioner Huntingford and Member Westerman. There was a quorum. APPROVAL OF AGENDA Member Masci moved to approve the Agenda as amended to add Discussion of Teen Suicide under New Business. Vice Chair Frissell seconded the motion, which carried by a unanimous vote. APPROVAL OF MINUTES Vice Chair Frissell moved to approve the minutes of February 19, 2004. Commissioner Rodgers seconded the motion, which carried by a unanimous vote. PUBLIC COMMENT - None OLD BUSINESS AND INFORMATIONAL ITEMS Recreational Shellfish Beaches: Larry Fay described recreational shellfish beach classifications for the first quarter of 2004 as issued by the State Department of Health Office of Food Safety and Shellfish Programs. Because of insufficient data, Jefferson County is listed as "unclassified." In the past, Old Fort Townsend and Fort Flagler beaches were classified as approved, but Department of Health Staff are now uncertain whether there was enough data to support that status. With the tribes having asked that those beaches be classified as approved for commercial harvest, the Department of Health would begin a multi-year effort to collect data and monitor water quality. In the meantime, there is no plan to close these areas to recreational harvest. Notice of Public Hearinl! - Health and Human Services Fees: Jean Baldwin announced that the hearing on the proposed ordinance setting fees is scheduled for Monday, March 22 at 10:05 a.m. In explaining the change in fees under Public Health Clinic, Environmental Health and Animal Services, she noted that while the RCW puts fees under the jurisdiction of the Board of Health, they have HEALTH BOARD MINUTES - March 18, 2004 Page: 2 historically been approved by the BOCC. Commissioners had been briefed on the proposed fee change before the public notice posting. In response to questions from the Board about the new filing fee for Evaluation of existing on-site septic systems, Larry Fay provided the following information. He explained how a service water management district in Kitsap County uses a portion oftheir tax revenue to fund public health operation and maintenance activities. The destination of County septage depends on the pumper. Quantities primarily go to either the City's compo sting facility or to a private land application site in Mason County, but some also goes to Kitsap County Public Works wastewater treatment plant and some to Port Angeles. The $.02/gallon septage disposal fee is not targeted directly at the cost of handling the septage, but is intended to generate revenue to support Operation and Maintenance (O&M) program activities. In the past, most were funded through Ecology grants, but under the 2004 budget, these funds come out of current expenses. Instead of adding to the fees for septic permits, this new fee would be tied to the ongoing ownership and use of on-site septic systems. Linda Atkins then explained the education workshop program and ongoing education involving individuals getting building permits, those who need information about ongoing care oftheir systems, those with questions about evaluations of existing systems, as well as interactions with septic tank pumpers on their activities. There are also workshops with licensed O&M professionals (installers, designers and septic tank pumpers). Member Masci noted that the City had just reduced the composting facility fee by the same .02 cents per gallon as an incentive to pumpers to bring their septage to that site. Mr. Fay explained that the plan being discussed with pumpers for administering these fees is that the pumpers' invoices to customers would reflect the $20 Environmental Health filing fee for a 1,000-gallon septic tank. At the end of the month or quarter, when the pumper submits their report of gallons pumped to the County, they would then transmit the $0.02/gallon disposal fee collected from their customers based on the total gallons pumped. Member Buhler expressed concern that this fee might be perceived as punitive by those who need to pump their septic systems. Linda Atkins recognized this concern and noted that Staff has done outreach to some real estate agencies and septic tank pumpers. In reviewing the evaluations of existing systems, only 26% were identified as needing to be pumped. NEW BUSINESS Cruise Shiv Waste Discharl!e - Renort: Larry Fay reported on the Cruise Ship waste topic discussed at the relatively brief (30 min.) State Board of Health hearing. He raised points from the Board of Health and noted there had also been brief presentations by the Coast Guard and Ecology to get the State Board acquainted on the issue. The State Board of Health seemed reasonably satisfied with the memorandum of understanding (MOD), which was based on similar standards in Alaska's regulations, the most stringent in the country. There was success in raising that Board's interest in continuing to track this topic. He noted that other states eventually created regulations despite the MODs. Dr. Locke reviewed the complex jurisdictional issues involved. The State Board of Health has no direct jurisdiction and it is even questionable how much authority the State has. There would be a brief period for review and comment of the MOU. Despite good effort on the State MOU, Member Masci expressed his concern that there still are not stringent enough standards. HEALTH BOARD MINUTES - March 18, 2004 Page: 3 Commissioner Titterness suggested that the Board of Health consider creating a local ordinance to prohibit all discharges in Jefferson County waters and send a letter to the State suggesting they incorporate this language into the MOU. Commissioner Rogers expressed concern about the County's inability to enforce such an ordinance. Member Masci moved that Staff draft an ordinance to prohibit cruise ship discharges in Jefferson County waters and then send a letter to the State of Washington suggesting they incorporate this language into the MOU. Member Buhler seconded the motion, which carried with one abstention by Commissioner Rodgers. Staff agreed to run the draft ordinance past the County attorney. Jefferson Svrinl!e Exchanl!e Prol!ram: Dr. Locke reported that since beginning this program, there has been progress on the most important program goals from a public health perspective - communicable disease transmission prevention and reduction ofthe public safety hazards associated with random disposal of needles by intravenous drug users (IDU). Staff believes there is an opportunity to improve on the third goal- to provide prevention education, referral information and treatment incentives to IDU - through an immunization incentive program, which would offer to those who come in for a needle exchange, vaccinations for Hepatitis A and B, Tetanusidiphtheria, and tests for HIV and Hepatitis C. Jean Baldwin noted that most of these vaccines require two doses, which provides twice the direct contact and therefore, more opportunities for referral. Staff noted that to pay for the vaccines, there was a transfer from other HIV outreach program services to this high-risk outreach. West Nile Virus: National Lessons Learned and Planninl! Efforts for 2004 Season: Dr. Locke reported the agenda packet contained a map showing the spread of West Nile infection among humans in the U.S. last year and reflects no cases yet in Washington or Oregon. Not only would the County go into active dead bird surveillance once again, but it expects this year to bring the first human cases in the state. While it was known that 1 in 150 suffer the worst complications, it is a more serious disease than originally thought, with fatality rates up to about 10%. There are also more reports of central nervous system disease overlapping with the West Nile Fever and more serious complications. While the virus is lethal for horses, there is a vaccine. When the arrival of the virus is verified (two dead birds testing positive), the search for human cases will begin. Personal protection against mosquito bites is the most effective way to reduce risk of acquiring the virus. Ensuring homes are screened, use ofDEET, habitat changes around the house, getting rid of standing water, and using larvicidal agents in ponds. The use of mosquito control districts is another mechanism used in some areas. It was noted that larvicidal agents kill more than mosquitoes and the long-term effect on fish and other insect populations is unknown. When asked what public outreach and education would be, Jean Baldwin said that in addition to local education and website links to CDC information, it would be important to know what the State's public service announcement and preparation plan is. Larry Fay added that West Nile Virus would be discussed again at the April Department of Health Zoonautic disease conference. He has focused most of his efforts on Port Ludlow, because of their elderly population, they have a lot of stormwater systems and ponds as well as the infrastructure in place to manage mosquito populations. He concurred that the primary message is personal protection. HEALTH BOARD MINUTES - March 18, 2004 Page: 4 2004 Lel!islative Session WraD Up: Dr. Locke reported that not a lot got through on this session but a few small but significant bills did: insurance coverage for injuries sustained as a result of alcohol or drug use, creation and local adoption of models on nutritious food, joint committee set up on health disparities (a top public health priority), expanded civil immunity from liability insurance for healthcare workers volunteering in clinic settings (SBHB2787), and an expanded liability insurance program for retired volunteer physicians. What did not pass and consumed a lot of time: tort liability reform focusing on medical malpractice and another bill that would have expanded prohibitions of smoking in indoor settings driven by occupational health concerns. In the supplemental budget, there was an appropriation of about $IOM that would go to physicians providing obstetrics (OB) care in rural areas to help defray the rising and prohibitively expensive malpractice insurance. Washington is facing a pending crisis in OB access. As faruilypractitioners that do OB pull out of obstetrical care (estimated to be 50%), they are unlikely to return. There was an unsuccessful effort to use unexpected revenue increases in the supplemental budget to rollback premiums charged by insurance to low-income families. Chair Titterness asked whether the Board would like to take action to support and thank to those representatives who supported legislation on tort reform or point out a position to those that didn't. Washington's representatives voted along party lines on medical malpractice tort reform. The Republican-controlled Senate were supportive of a Micra liability reform package and Democrats in the House were very much in the trial lawyers camp and blocked the Senate bill from being heard. There was no Board support for taking any action on this. ProDosed Meetinl! Jefferson County Board of Health and Port Townsend City Council: Jean Baldwin reported on her presentation to City Council about the County Health Department's budget shortfall and her request for funding assistance. Informed by Jean Baldwin that the Board of Health determines this policy, Mayor Robinson suggested Council have a policy discussion with the Board of Health and possibly also the Hospital Board. Ms. Baldwin said she and Dr. Locke recommended starting first with a policy discussion ofthe community vision of public health and how funding should be shared by the Board of Health and the City Council. The best date for a discussion appeared to be the date of the regular Board of Health meeting on April 15 from 7-9:00 p.m. She also asked for assistance in planning the agenda. Members Masci, Buhler, Vice Chair Frissell and Kees Kolff agreed to assist. RCW 70.05.060 (Powers and Duties of Local Board of Health) was suggested as the first topic. Jean Baldwin provided the Board with a handout that included a draft formula. The desire is to look at the proportionate use by City residents and to find a defensible way to credit the City for the money their citizens already pay for these services through property tax. Member Masci moved to hold the Board of Health meeting on Thursday, April 15 from 7-9:00. Member Buhler seconded the motion, which carried with one absention by Member Frissell. Teen Suicide: David Sullivan noted there was a lengthy newspaper article about a 13-year old boy in Joyce who had committed suicide in front of his classmates. He talked about the challenge of getting prevention activities occurring early enough to have a positive effect. While there were federally funded prevention/intervention specialists doing good work in the schools, local providers then were to pick up this work. When looking at funding youth activities suicide prevention efforts are often overlooked. Jean Baldwin said suicide prevention does not have regular funding. Community Mental Health is charged with taking care of chronically mentally ill individuals and mental health in general is an underfunded mandate. She suggested that this would be an interesting discussion topic for the June Washington State Association of Counties (WSAC) meeting. While there are subtle indicators showing at risk population HEALTH BOARD MINUTES - March 18, 2004 Page: 5 in the County, there are no solid indicators. During discussion, there was recognition of the need to look at the known risk and protective factors and to develop a suicide prevention program. Jean Baldwin did note that all clients in the prenatal programs receive elective depression screening. ACTIVITY UPDATEIOTHER ANNOUNCEMENTS - None The SmileMobile saw total of 65 children, including all who were diagnosed with cavity or other restorative needs. Dr. Chuljian volunteered a few hours, as did a doctor from Sequim. Many ofthe children were preschoolers. More outreach would be done in the schools next year. Jean Baldwin agreed to email to the Board the County's web address, so the Board could review and make suggestions for changes. AGENDA PLANNINGI ADJOURN The meeting adjourned at 4:22 p.m. The next meeting will be held on Thursday, April 15, 2004 at 7:00 p.m. at the Jefferson General Hospital Auditorium. The Solid Waste Ordinance would be reviewed in May along with the hearing on the Clandestine Drug Lab Ordinance. JEFFERSON COUNTY BOARD OF HEALTH ~---~ .' ~------_/ an-Titterness, Chairman ~~~ I c~/'-4~.::I;,u~t Roberta Frissell, Vice Chairman , NOTICE OF PUBLIC HEARING NOTICE IS HEREBY GIVEN that a public hearing is scheduled by the Jefferson County Board of Commissioners to take comments on a proposed ordinance setting the fees for the Health and Human Services Department. The hearing is scheduled for Monday, March 22, 2004 at 10:05 a.m. in the County Commissioners Chambers, Lower Level, Jefferson County Courthouse, 1820 Jefferson Street, Port Townsend, W A 98368. JEFFERSON COUNTY BOARD OF COMMISSIONERS Glen Huntingford, Chair STATE of WASHINGTON COUNTY of JEFFERSON In the Matter of an Ordinance Amending Certain Fees Contained in Section 2 of Ordinance No. 11-1115-99 for the Health and Human Services Department } } } } ORDINANCE NO. SECTION 1 - PURPOSE AND SCOPE: The purpose of this ordinance is to amend specific fees for the Jefferson County Health and Human Services Department. SECTION 2 - FEE SCHEDULES: The portion of the fee schedules are as follows: PUBLIC HEALTH CLINIC SERVICES All of the fees listed in Ordinance No. 11-1115-99 under Public Health Clinic Services are hereby being replaced with the following: The Health Department Community Health Nursing Fee Schedule will be set at the same amount, to the nearest higher dollar, as the current rate schedule - Reimbursable by the Washington State Department of Social and Health Services for Medicaid clients. Community Health offers fees based on the sliding scale schedule to clients who are not on Medicaid. Clients are not turned away due to the inability to pay. A copy of the current Federal Poverty Guidelines, which establishes the sliding scale fees, is available at the Health Department. All fees for immunizations not subsidized by the Washington State Department of Health will be the cost of vaccine, shipping and visit fee. This visit fee is set by Medicaid standards. There is no sliding fee scale for privately purchased vaccines. Laboratory Services are based on the actual fees of laboratory contractors. Price lists are available. Cost is not subject to sliding scale. In cases of communicable disease prevention, the lab costs may be waived. Fees for medications, family planning methods, and antibiotics are based on cost of acquisition and are updated quarterly. Vital Records services are not subject to a sliding scale and fees are set by the RCW 70.58.107. The cost sheet is available by request. ENVIRONMENTAL HEALTH SERVICES Specific fees listed in Ordinance No. 11-1115-99 under Environmental Health Services are hereby being amended to add the following: Add to the end of the list under Evaluation of Existing System: A $20.00 filing fee for Evaluation of Existing System (EES) reports submitted by third party inspectors. A $ .02/gallon septage disposal fee. Add to the end of the list under Food Service Establishment Permits (Annual Permit): Food Services late fee is defined as fees paid past the expiration (January 31) of permit. Late fee paid less than or equal to 30 days is 25% of base fee and late fee paid after 30 days is 50% of base fee. ANIMAL SERVICES Specific fees listed in Ordinance No. 11-1115-99 under Animal Services are hereby being amended with the following: ' Add to the end of the list under Adoption Fees: Adoption Fee - Dogs and Cats - Includes spay or neuter, vaccination, and veterinary exam. DOES NOT include cost oflicense. SECTION 7 - REPEALER This Ordinance repeals and replaces only those portions of Section 2 of Ordinance No. 11-1115-99 that deal with the specific Health and Human Services fees identified in this ordinance. SECTION 8 - SEVERABILITY If any section, subsection, or sentence, clause, phrase, or figure of this Ordinance or its application to any person or circumstance is held invalid, the remainder of the ordinance or the application to other persons or circumstances shall not be affected. SECTION 9 - EFFECTIVE DATE This Ordinance shall become effective upon adoption.