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JEFFERSON COUNTY BOARD OF HEALTH
MINUTES
Thursday, June 16,2005
Board lVfembers:
Geoffrey Masci, Chairman - Port Townsend City Council
David Sullivan, Vice Chairman - County Commissioner District #2
Phil Johnson-- County Commissioner DtJtrict # 1
Patrick AI. Rodgers - County Commissioner District #3
]il! Buhler- Hospital Commissioner District #2
Sheila Westerman - Citizen at Lar;ge (City)
Roberta Frisse!~ Citizen at Lar;ge (County)
StqffMembers:
] can Baldwin, Health & Human S eroices Director
Julia DanskinJ l'olursing Services Director
Thomas Locke, MD, Health Officer
}..Jjke McNickle, Environmental Health Director
Chair Masci called the meeting to order at 2:31 p.m. in the Health Department Conference Room.
All Board and Staff members were present with the exception of Member Frissell. John Fischbach
was also in attendance. There was a quorum.
APPROVAL OF AGENDA
Jean Baldwin requested two additions to the agenda under Old Business and Informational Items.
She would like to add item IV.6. Health Department moving update and, item IV.7 DSHS Contract.
Member Rodgers moved to approve the Agenda as amended. Member Buhler seconded the
motion, which carried by a unanimous vote.
APPROVAL OF MINUTES
Member Buhler requested corrections on wording from the May 19,2005 minutes under Activity
Update/Other AnnouncementslHospital District. The corrected wording of the 2nd sentence should
read She provided background about the hospital's shift to critical access designation, reviewed
opportunities it has for growth and described methods being used to reduce expenses, which will
result in a net financial gain.
Member Westerman moved to approve the Minutes from May 19, 2005 as amended.
Commissioner Johnson seconded the motion, which carried by a unauimous vote.
PUBLIC COMMENT - None
OLD BUSINESS AND INFORMATIONAL ITEMS
West Nile Virus Provider Alert: Dr. Tom Locke reviewed a letter (included in BOH packet) sent
out by W A State Department of Health to all health care providers that served as an educational
piece providing information on West Nile virus (WNV). The letter asked for assistance in
monitoring and reporting known cases of WNV. In 2003, WNV infection became a provisionally
notifiable condition in Washington, and in 2004 the State Board of Health revised the WA
Administrative Code to include Arboviral Diseases. Reporting of suspected and confirmed cases are
to be done through the local health department or district. Dr. Locke noted that Jefferson County
doesn't have any known cases at this time but it is anticipated that the State will have a few cases in
summer. There followed additional discussion about any threat that might come from sites in the
HEALTH BOARD MINUTES - June 16, 2005
Page: 2
county. Environmental Health Director Mike McNickle noted that DOHIJCPH are training local
volunteers monitor and research mosquitos. This training will be sponsored by State DOH will
provide training & materials and will not incur any internal costs.
Avian Flu: Dr. Tom Locke reported on an article (included in BOH packet) about the World
Health Organization's alarm concerning an imminent threat posed by the outbreak of H5NI
influenza in South Asia. He noted that this comes as close to Pandemic since the 1960s and that
there is an international debate going on about whether it would be best for countries to stockpile
the anti retroviral drugs for their own citizens, or if it would be more effective to send the drugs to
Asia to try to stop the outbreak. It would take the entire world supply to stop it, and there is question
whether that would even be possible.
Letter Re: OnSite Sewae:e Rule: Dr. Tom Locke gave background on the letter prepared per the
request of the JCBOH dated 4-13-05 (included in packet). This letter is in regard to the Onsite Rule
that is going through the Public Hearing process with the W A State BOH and is on track to be
adopted July 13th. It states that the Jefferson County BOH is in support of the update of the W A
State Department of Health's proposed Draft Onsite Sewage System Rule. Both Dr. Locke and
Mike McNickle, Environmental Health Director, commented that they are pleased that the Draft
Rule is written with a minimum of mandates, leaving a lot of discretion to the local BOH. Mike
made further comments on funding; the Sewage Management Plan; and a template that will be
provided in 2006 by the W A State Department of Health to make a management plan.
E2SSB 5763 - Omnibus Treatment of Mental and Substance Abuse Disorders Act of 2005:
Health Department Director, Jean Baldwin referred to the portion included in the packet that lists
the key components. As a discussion item she referenced point #25 that indicates that a county
legislative authority may impose a 1/IOth of one percent sales tax. In Jefferson County this would be
approximately $273,000. There is a need for clarification on how substance abuse and mental health
would work together towards determining priorities. Extensive group discussion followed. Jean
advised the Board that there is a County legislative piece if the Commissioners want to raise the tax,
but there's no County legislative piece for evaluation. Chair Masci recommended that they develop
a timeline to discuss further. Member Westerman noted that it would be a difficult decision for the
Commissioners to make unless they know what the money is going to be used for.
Member Westerman moved that staff develop a plan for what would be done with the money
that would come from a decision by the BOCC to raise the tax. The motion was seconded by
Member Buhler and carried by a unanimous vote.
A 60 day timeline was set for completion of the proposal. Further discussion led to a decision to
pursue the formation of some kind of a joint task force with Law & Justice. Geoff Masci and David
Sullivan will attend the next meeting of Law & Justice on July 23rd.
ServSafe Manae:er Certification Course: Mike McNickle explained the State requirement that all
persons in charge of food service establishments must demonstrate knowledge of food safety during
m: inspection: One. way to meet this re~uirement is to be certified with ServSafe. Mike McNickle
WIll be teachmg thIS course on June 28 to a full class of 10 students. He noted that the course is
quite comprehensive and will require reading the text book to pass. There are 90 questions on the
exam and students must have 70% or better to pass. Dana Fickeisen will be teaching future classes.
Dr. Locke noted that because of a very high turnover in the restaurant industry, the training of
HEALTH BOARD MINUTES - June 16, 2005
Page: 3
management is a point of assurance for food safety and he is very glad and supportive of this new
training.
Health Department Movine: Update: Jean Baldwin reported that JCPH will be closed on Friday,
July 8th for the second leg of the departmental move. Fiscal and Natural Resources have already
moved into their temporary quarters in the old DSHS building. The remaining staff will make their
move into the DSHS building on the 8th. Clinic will move to their temporary location immediately
next door on the 8th where space is limited, but adequate. Volume will be down during this time.
Clinic will resume seeing clients again on Monday, July II tho The general contractor will begin his
work on July 11th and completion must meet schedule requirements to allow DCD to vacate their
premises for the final stage of the remodel. JCPH will issue a press release and post notices on the
doors. Jean also noted that meeting room space in the DSHS building is quite small and the Board
will need to meet at a different location during this transition.
DSHS Contract: Jean Baldwin reported that the Prosecuting Attorneys of several counties have
met with DSHS over a period of a year regarding the general terms and conditions of the DSHS
contract. This particular contract has been onerous and irritating for many years. She noted that
DSHS has the counties responsible for the liability for many things. Negotiations have broken down
and several counties are trying to negotiate changes. There will be a discussion with the
Commissioners about what Jefferson County should do. She explained that this is a "FYI" - that the
contract is not ideal. David Alverez has been very helpful articulating the County's issues. This is
worrisome because it is such a large contract for local services. Julia Danskin added that the
renewal dates for most of these contracts is July 1st and that we have functioned in the past under
these contracts without them all being signed, but it is a little nerve-wracking to provide services
without a signed contract. David Alverez is scheduled to meet with the Commissioners on July 27tl1.
NEW BUSINESS
Solid Waste Proe:ram - Board of Health as Jurisdictional Health Authority for RCW 70.95:
State law established the BOH as the jurisdictional health authority for solid waste rules. This is
somewhat unusual since it is a Department of Ecology code, but is assigned to the Health
Departments and the Board of Health. He explained that what this means is that if one of these solid
waste permitting decisions is appealed, it will be appealed to the BOH with potentially very high
stakes.
Mike McNickle briefed members further on where Environment Health is going in the county with
solid waste. He reported that the department has hired Mark Nelson as an Environmental Health
(EH) Specialist to deal with solid waste issues and enforcement. It is our mandate under State law
and as a Health Department we need to address this issue. He indicated that EH will be coming to
the BOH and the BOCC regarding the need for a nuisance ordinance so that enforcement can be
done properly. Two solid waste employees will be hired to strengthen the solid waste program. First
priorities are permitted facilities verifying that code and State requirements are being met. BOH will
be reviewing the local solid waste ordinance.
Jean Baldwin pointed out that due to maternity leave and vacancies this work has not been staffed.
Dr. Locke and Member Rodgers elaborated on other benefits of a strong, detailed and focused local
code. There followed extensive group discussion about solid waste issues.
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HEALTH BOARD MINUTES - June 16,2005
Page: 4
Mike invited the BOH members to join him for a tour of Kitsap County's Moderate Risk Waste
(MR W) and recycling facility as well as their transfer station operation. He feels this might give an
idea of what we will need to do in the future and that it would be very worthwhile. He would
arrange to tour our own facility as well, on the same day. Members expressed interest in doing this
and David Sullivan requested to wait until about two months after his brace comes off so he can
also participate.
Public Health Identity Communication Proiect: Dr. Locke stated the communication project is
an initiative the Public Health Improvement Plan and is about the survival of Public Health in the
State. Demands are increasing every year and funding is going down (it's dropped at least 10% in
the last decade). Fundamentally this communication campaign promotes Public Health as an
essential investment
Julia Danskin attended a State training on the "Public Health Identity Campaign". The history of
this campaign to communicate a unified message of what we do and how we work together. Julia
passed around a copy of a booklet published by the State, "Public Health Always Working for a
Safer and Healthier W A" that she had received at the training. This introduces the common logo
that is being used by many Health Districts and Departments. JCPH will be adding this logo on all
of our letterhead and literature and it will read "JEFFERSON COUNTY PUBLIC HEALTH - ALWAYS
WORKING FOR A SAFER AND HEALTHIER COMMUNITY". She gave details on some things that other
counties have been doing to implement the campaign and specific things that we will be doing
locally. The State has tried to make it as easy and affordable as possible by providing various tools
that can be downloaded off the Web.
Jean Baldwin elaborated on the idea of "branding" and it's importance to Public Health. We need to
keep putting the message out. We will have a booth at the County Fair where this motto will be
displayed.
Powers and Duties of Local Boards of Health - Routine and Emerl!:encv: Dr. Locke pointed out
that member packets contain a copy of the laws that govern local health jurisdictions and confers
specific powers and duties to a local BOH and to the Health Officer that serves under the direction
of the Board. He explained that his understanding of the design of this is that the BOH is not really
the emergency responder, but rather it is a policy and oversight Board. Emergency action really
occur with the Health Officer and all the people within the local Health Department that serve as
Health Officers (anyone who is invoking the legal authorities is, in effect, the Health Officer for the
purposes of the law). In recent context of emergency response, the role of the local BOH has to do
with risk communication and public communication and community leadership, not engaged in the
"nuts and bolts" of response. The powers and duties of the BOH are broadly written in the State. He
noted that he personally goes back and reads this section of the statute several times a year as a
starting point in answering the questions "Is this something we really need to be involved in? Is this
part of the organizational mission? Does it fall under this statutory mandate?". If it doesn't pass this
test, maybe it's not something we should be involved in.
Member Westerman expressed her interest in having us consider changing our Bylaws so we don't
have to have two County Commissioners here to hold a BOH meeting (she noted that we have
asked staff to check with David Alverez on this). She referenced RCW Section 70.05.030 and made
the point that we actually have 5 elected officials on the Board and only 2 non-elected, so as far as
this Statute goes, we can do pretty much what we want.
Member Rodgers addressed the need to begin thinking about how to best provide direction to the
Substance Abuse Board and how to execute that direction.
. ,-
HEALTH BOARD MINUTES - June 16, 2005
Page: 5
Joint Board Meetinl!: - Potential Al!:enda Items: Dr. Locke noted that he has been meeting with
Vic Dirksen (Administrator, Jefferson Healthcare) on a regular basis and they have been collecting
issues, have some things to brief the joint Boards on and may have some action items. July or
August would be a good time to have a joint meeting with the Hospital Board. He asked the BOH if
such a meeting should be scheduled and if so, are there any particular issues they would like to see
on that agenda. Member Buehler, Hospital Commissioner, commented that the Hospital Board is
anxious to have another joint meeting and felt strongly that it is very worthwhile to meet on a
quarterly basis or twice a year.
Dr. Locke noted that it would be helpful to allow the BOH to have a half-hour business meeting
immediately prior to the joint meeting, as this would be taking the place of the normally scheduled
BOH meeting. The proposed date is July 21 st. There was discussion about the starting time. Member
Buehler will check to see what time frame would work best for the Hospital BOald. Jean Baldwin
asked about items for the agenda. Responses include I) the Hospital's new urgent care issue, 2)
Access, 3) Assessment, 4) Summer indigency issues and impacts, and 5) Challenges that the
Hospital is facing (recruiting, fmances, medical community). Jean Baldwin will check about
availability of the Hospital's conference room for the joint meeting
ACTIVITY UPDA TE/OTHER ANNOUNCEMENTS
Jean Baldwin informed that the Hood Canal Coordinating Council wants to meet jointly with the
Boards of Health from Kitsap, Jefferson and Mason Counties to talk about contract issues and
priorities. She proposed that the meeting be held at Kitsap Health Department in September or
October.
Jean Baldwin also announced that J CPH is sending out a survey on substance abuse under a separate
grant. She had intended to (but did not) include a copy of the survey in the packets. She will send it out
by emaiL The University of Minnesota has actually done all the work and we bought the service from
them. We will receive and compile the data and the University will compile.
AGENDA PLANNING/ADJOURN
The meeting was adjourned at 4:24 p.m. The next meeting will be on July 21, 2005. Exact time and
location to be announced.
Excused
Roberta Frissell, Member
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.~, \J;.- \i J 'l<. ,. \
st Member
Clinicians' Biosecurity
Network
CBN Weekly Bulletin for
May 23, 2005
Center for Biosecurity
of UPMC
Clinical information for healthcare providers interested in
biosecurity
Unsubscribe
The CBN Bulletin presents the editors' analysis of important
current events in clinica1 biosecurity.
Ebola Oubreak in Congo
On May 18, the WHO reported that an outbreak of Ebala
hemorrhagic fever was confirmed in the Republic of the Congo.
The outbreak was apparently initiated by a family of hunters
who contracted the disease after finding the body of a dead
chimpanzee that they took home to eat. As of May 23, a total of
11 cases had been reported, including 9 deaths, and
approximately 80 contacts were placed under surveillance for
the development of symptoms. The outbreak was reported to be
under control after the implementation of swift infection control
measures by local public health authorities. However, in 2003,
approximately 150 people died from Ebola in the same area.
Ebala virus was first identified in 1976 after outbreaks of acute
hemorrhagic fever occurred in Sudan and Zaire (now Republic
of the Congo). Ebola virus belongs to the Filoviridae family
(which also includes the Marburg virus). There are four distinct
subtypes of Ebola virus: Zaire, Sudan, Cote d'Ivoire, and Reston.
The latter is not known to cause human illness. Case-fatality
rates range from 50-90% in clinically ill persons, depending on
the subtype.
This is significant because along with a number of other
"hemorrhagic fever viruses," Ebola is considered a Category A
agent. However, there has never been a case of Ebola disease
imported into the United States during outbreaks in Africa. This
may be in part due to the fact that transmission of disease does
not appear to occur prior to the development of symptoms.
Additional information:
WHO's Ebola hemorrhagic fever fact sheet number 103:
CDC's fact sheet on Ebala hemorrhagic fever:
Hemorrhagic fever viruses as biological weapons:
by Luciana Borio,M.D.
WHO: Pandemic Influenza Risk Increases
This week, the WHO underscored the imminent threat posed by
the current H5NI outbreak in Southeast Asia. Speaking at the
WHA, both Dr. Lee Jong-wook. Director-General of the WHO
and U.S. Secretary ofHHS, Mike Leavitt expressed dire concern
about avian influenza, describing it as "the most serious health
threat facing the world today" and an "urgent health challenge."
On May 6-7, an urgent exoert consultation meeting was held in
Manila in response to new infonnation indicating that "the
epidemiology ofH5NI could be changing. . . and the risk for
pandemic influenza could have risen." The expert panel noted
specifically that in northern Viet Nam in the last 5 months:
. There has been an increase in the number of clusters of
cases in the north (8) as compared to the south (2).
. The interval between the first and last cases in clusters
in the north have prolonged, which is inconsistent with a
discreet common source exposure.
. The case fatality rate in the north has decreased.
. Sub-clinical infections have been observed.
. The age range of victims has expanded.
Although careful to say that this has not been proven, the expert
group concluded that this pattem is consistent with human-to-
human transmission and that the recently emerging H5N I
viruses are more infectious for humans. The implication is that
the virus may be adapting to a human host, causing less
mortality, infecting a greater range of people, and being spread
person to person.
In addition partial neuraminidase inhibitor resistance has been
detected in one viral specimen. Neuraminidase inhibitors are the
only antiviral drugs to which the current strain ofH5Nl is
sensitive.
Finally, the group of experts commented on the lack of relevant
surveillance infonnation, the lack of antigenic and genetic
infonnation sharing, and the urgent need for countries and
individual researchers to release infonnation that has already
been collected on the H5NI viruses. As we have pointed out in
previous articles, inadequate surveillance of the current outbreak
undermines all other attempts at preparedness.
Toner, M.D.
by Eric
JEFFERSON COUNTY
BOARD OF HEALTH
April 13, 2005
To Whom It May Concern:
Jefferson County Board of Health supports recommendations in the draft rule Chapter
246-272A. We specifically support the following three Health District WAC
recommendations:
. Support the proposed Onsite Sewage System Draft Rule as currently written.
. Support the development and implementation of the Local Plan for enhanced
management of onsite sewage systems in marine counties (2SHB1458) only if
funding is provided through the Legislature.
. Continue to support the Health Department in its effort to ensure that onsite
sewage systems are designed, installed, and maintained properly through the
approval of good sound regulations, which provide the highest level of protection
for both the environment and public health.
Jefferson County Board of Health supports the update of the Washington State
Department of Health's proposed Draft Onsite Sewage System Rule, which is currently
going through the Public Hearing process with the Washington State Board of Health.
Thank you.
1iJ~-
David Sullivan
Jefferson County Board of Health Co-Chair
Jefferson County Commissioner
615 Sheridan. Castle Hill Center. Port Townsend. W A
(360) 385-9400