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HomeMy WebLinkAbout031705 JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, March 17, 2005 Board Members: Phil Johnson - County Commissioner District # 1 David Sullivan, Vice Chairman - County Commissioner Distn'ct #2 Patn'ck M. Rodgers - County Commisjioner District #3 Geoffrey Masci, Chairman - Port Townsend City Council Jill Buhkr - Hospital Commissioner Distnd #2 Sheila Westerman - Citizen at Large (City) Roberta Frissell - Citizen at Large (County) Staff Members: Jean Baldwin, Health & Human Services Director Julia Danskin, Nursing Services Director Thomas Locke, MD, Health Officer Chairman Masci called the meeting to order at 2:35 p.m. in the Health Department Conference Room. All Board and Staff members were present with the exception of Julia Danskin. There was a quorum. APPROVAL OF AGENDA Commissioner Rodgers moved to approve the Agenda as written. Commissioner Sullivan seconded the motion, which carried by a unanimous vote. APPROVAL OF MINUTES Member Frissell moved to approve the minutes of February 17, 2005, as written. Commissioner Sullivan seconded the motion, which carried, with abstentions by Commissioner Rodgers and Member Buhler who were absent for the February meeting. PUBLIC COMMENT - None OLD BUSINESS AND INFORMATIONAL ITEMS Rel!ion 2 Public Health Newsletter and Communicable Disease Report: Jean Baldwin distributed to the Board copies of a new, bi-monthly newsletter concerning communicable disease issues, which had been produced through the three-county partnership. Seven Staff have now been trained on the communicable disease electronic tracking system, which permits sharing data with the State. Federal FIT 2006 Budl!et: Dr. Tom Locke reviewed a summary of "Discretionary" Health and Human Services funding produced by the Washington State Association of Local Public Health Officials (WSALPHO). He highlighted proposed cuts at a State and Federal level, including hundreds of millions cut from the CDC, which funds many local prevention programs. Most expect HEALTH BOARD MINUTES - March 17,2005 Page: 2 these major cutbacks to be approved by the majority in Congress. Some of these funds cut from counties are being redirected to Homeland Security tasks in several highly vulnerable cities, including Seattle. NEW BUSINESS Pre-AdoDtion Briefin!! - Jefferson County Food Code: Dr. Locke reviewed that this local code is being redrafted to be in alignment with the new State code, which takes effect in a little over a month. Staff proposed approving a local code that adopts the State code by reference. Dana Fickeisen then reviewed that the Board received a version with the strike outs, which are no longer covered in detail in the County code. The new State and proposed County codes vary only on the issue of hearing procedures. Dr. Locke noted that, procedurally, the Board would call for a public hearing and there would be a public notification with this draft code language. The Board then considered the timing of this series of events, understanding that the notification-hearing process takes about a month. Member Westerman moved that the Board call a public hearing on the adoption of the Jefferson County Food Code in May. Member Buhler seconded the motion. Member Buhler characterized as a weak link the lack of specificity in the timing of the Health Officer's setting/continuing a hearing. Dr. Locke noted this same language exists in the current methamphetamine code but added that the intent was for it to be open-ended to accommodate the circumstances of a particular case. There was concern that it should state "timely" or "an extension available if appropriate" rather than having no timeframe. Commissioner Rogers expressed reservations about setting a timeframe without considering the advice of those experienced in such procedures. Staff agreed to investigate a conventional continuance timeline. The motion carried by a unanimous vote. Familv Planninll Services - 1997-2004 ReDort: Kellie Ragan, Program Coordinator, presented highlights from their written program review of Family Planning Services. Referring to the 2004 Office of Financial Management population estimates, Kellie Ragan reported that the Department is serving almost one third of the 15-17 year olds and about three quarters of those 18 to 24. The total number of clients has doubled from 1997 to 2004. They have seen a 60% increase in services to new clients under the age of20 and a 15% decrease in new clients age 20-24. There were increases of 13% in zip code 98368 versus an increase of 14% in other areas of the county. In 1997, 35% were sliding scale and now 51 % are paid for through the Take Charge program. Staffing levels have increased, but include staff in the field and community education, which is a grant requirement. The average number of continuing clients per month has increased by 140%. The teen pregnancy rate has not changed significantly from 1985-1987 to 1998-2001. HEALTH BOARD MINUTES - March 17, 2005 Page: 3 Wendy White, Nurse Practitioner, then distributed a report with an overview of clinic services, a listing of the advantages of Health Department as the umbrella agency, scope of care, challenges for staff and positive aspects as well as barriers to access to care. She clarified that while Staff cannot restrict access to contraceptive services, STDs are reportable and Staff is bound to report sexual abuse. One of the advantages of the Health Department as an umbrella agency is to promote risk reduction and disease prevention, so they can offer STD services along with family planning services. Due to the increase in client volume in general, they adjusted their 2005 Staff schedule so that each practitioner is actually seeing twice as many patients in an eight-hour day than previously. They also address many secondary problems such as poverty, homelessness, domestic violence, mental health, medical/dental needs, and adolescent issues. She distributed copies of forms that are a requirement of Title X funding. In talking about possible improvements to access to care, she listed a new central triage/referral agent employed by Jefferson Healthcare and a one-stop application process that includes: a DSHS assessment, access to interpreters, forms written in Spanish (and other languages), and training for financial staff to be more sensitive to the disenfranchised. In answer to questions about striking contrasts between variances and curves in the State's numbers and those of the County, Staff explained that the relatively few incidents in our smaller population can cause more significant swings in the plotted data than they would in the larger statewide numbers. 2004 Public Health Imorovement Plan - Financin~ Public Health: Dr. Locke noted that the Board had received the public health improvement plan at last month's meeting. As a result of a process that began in 1994, Washington is now the only State with such a mandated plan. To make review ofthe plan manageable, he suggested Staff plan to address one ofthe seven main focus areas ofthis report at each successive meeting of the Board - what it knows about this problem area and what are we doing in terms of programs and interventions, beginning with funding of public health. Both Jean Baldwin and Dr. Locke have served on the various committees that prepared the plan. Dr. Locke noted that the agenda packet's white paper, "Public Health Financing for the 21" Century" attempts to make a more detailed case for a larger investment in public health and describe the consequences of not doing so. The continuing effort to address this legislatively are represented by two bills in Olympia. It was unsure whether the House study-bill got out of committee yesterday but ifit did not, it would essentially be dead. SB5700 is still alive, the intent of which is to repeal the current 75~ millage on property within the hospital's district and replace it with 20~ millage on all property in the State. That substantially larger dollar amount would then be divided three ways to a) reimburse the same funds each hospital gained under the old millage, b) provide hospitals $21M + $17M for uninsured and uncompensated care, respectively, and c) the remainder - estimated to be as much as $93M per biennium - would go to public health departments. Dr. Locke cautioned that something so radical might take two or three attempts to be passed by the Legislature. Dr. Locke noted that to achieve the improvement plan's standard for public health would cost an additional $400 million per year statewide. The new scheme would create "more room" for other, junior taxing districts by removing the hospital district's tax millage from the capped amount. HEALTH BOARD MINUTES - March 17, 2005 Page: 4 Expressing her dismay about continuing to look to property taxes for support, Member Westerman said she could not support this bill. She would like to see a longer-term, equitable taxing structure. Chairman Masci said failing the institution of a State income tax, there would still be a short-term funding crisis. In the short-term, this is the alternative proposed by the legislature. Jean Baldwin responded that despite its shortcomings, this bill does at least talk about public health as part of the healthcare system. Dr. Locke added that the bill acknowledges and spreads the responsibility over the entire State, not just among the residents ofthe hospital districts. Commissioner Rodgers liked the idea of a more equitable taxing system, but in the meantime better funding in public health prevention services could ease the hospital districts' inordinate burden. Vice Chairman Sullivan said he would support this bill, even though it is imperfect. Lel!islative Uodate Live Bills. Dead Bills. Budl!et Forecasts: Dr. Locke reported that many things have changed since the legislative update was published. Although many bills certainly died with yesterday's cut-off, one bill that remains alive is HB2105, the on-site sewage for marine counties, which is being driven by South Hood Canal. It has passed the House and is now going on to the Senate. The Building Association appears to be opposed to the bill, especially to giving Boards of Health authority to regulate nitrogen loading in the environment. Although only about 10% of the nitrogen in the Canal is attributed to human activities, most ofthat is believed to come from on-site sewage disposal, one factor over which we have some control. Linda Atkins provided an overview of the pending bills, on which she and Dave Christensen joined associates from Mason and Kitsap counties in presenting information before the select committee. Friends ofPuget Sound and the Puget Sound Action Team have been instrumental in working on the language in this bill and carrying the bill forward. She reviewed summaries of very similar bills, SB5431 and HB1458; although the Senate bill is effectively dead, HBl458 has moved to the Policy and Ways and Means Committees. The bill has a grant and loan program for the repair of identified systems and provides State funding assistance for updating the on-site sewage plan. The County is significantly ahead of others in compliance with this plan and will focus on beefing up its electronic data systems. Commissioner Rodgers urged that funds be put where they can have the biggest impact, which he believes is in south Hood Canal where small sewer systems are needed. Ms. Atkins agreed and said that this came up during the legislative committee, but there is still the issue of rural versus urban services that needs to be addressed. Josh Peters of the County's Long Range Planning Department provided a copy ofHB2086, which he said would change some of the growth management policies to allow sewer systems in rural areas, a remedy that currently requires local health officials to declare an emergency. Member Westerman cautioned that legislated changes to the Growth Management Act to allow on- site sewage treatment opens the door to denser development and its needs for transportation and water. You can't simply change legislation because it would impact areas not totally built out. HEALTH BOARD MINUTES - March 17,2005 Page: 5 Commissioner Rodgers noted that just as Health was instrumental for securing water for Qui1cene Health can advance this issue as well. He felt that to address the problem any other way would never yield the desired results. Jean Baldwin noted not all County governments agreed to the solution of extending sewer services in order to contribute to reduction and removal of nitrogen. Noting that our portion of the Canal does not have the density to warrant small sewage systems, Linda Atkins recognized there is still the ability to address the issue through systems that deal with nitrogen. The opportunity for grants and deferred payment loans provides an incentive for communities like Beckett Point, which is trying to put in a community drain field as is Paradise Bay. ACTIVITY UPDATE/OTHER ANNOUNCEMENTS Chairman Masci, Member Frissell and Vice Chairman Sullivan volunteered to work with Jean Baldwin on planning the four-hour retreat. She also sent a note to the Board inviting Members and the Commissioners on an on-site tour led by Linda Atkins. Dr. Locke reminded that March 29-30 there would be a region-wide communicable disease outbreak simulation. AGENDAPLANNING/ADJOURN The meeting was adjourned at 4:00 p.m. The next meeting will be on April 21, 2005 at 2:30 p.m. in the Conference Room of the Jefferson County Health Department. JEFFERSON COUNTY BOARD OF HEALTH 1~;lj:!f Ge M~S~jrman (; qt~t::L-,tI!.....",,--" D<l;~~~lli an, ice Chairman tiCl i/ il Johnson ember ~~k~mber i J I .. I', -' ._ . ." ~ " I i'L-l Lf.'-'" ,,\.. '~i ':10'_ Sheila Westerman, Member I _ <"'" (" /1 i,t<'L-'{'f Roberta Frissell, Member