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JEFFERSON COUNTY BOARD OF HEALTH
MINUTES
Thursday, February 17, 2005
Board Members:
Phil Johnson - County Commissioner District #1
David Sullivan, Vice Chairman - County Commissioner District #2
Patrick M. Rodgers - County Commissioner District #3
Geoffrey Masci, Chairman - Port Townsend City Council
Jill Buhler - Hospital Commissioner District #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 Conrmissioner Rodgers,
Member Buhler, and Member Westerman. There was a quorum.
APPROVAL OF AGENDA
Commissioner Johnson moved to approve the Agenda as written. Vice Chairman Sullivan seconded
the motion, which carried by a unanimous vote.
APPROVAL OF MINUTES
Member Frissell moved to approve the minutes of January 20,2005, as written. Vice Chairman
Sullivan seconded the motion, which carried by a unanimous vote.
PUBLIC COMMENT - None
OLD BUSINESS AND INFORMATIONAL ITEMS
Influenza Update Vaccine Redistribution. Influenza Activity. Policv Implications: Dr. Tom
Locke announced that Influenza A activity is now widespread in Washington State, with school
absenteeism near 30% on the peninsula. The CDC has also put out a new health alert on the Avian
flu, which is widespread in Asian poultry and periodically jumps to humans, with a fatality rate as
high as 80%. An anti-influenza drug does have effect on this virus when administered early. Asia is
working on an experimental vaccine. The pandemic scenario would involve the coupling of this
virus with the human version and acquires human-to-human transmission. Respiratory surficial
virus is also circulating and can also cause pneumonia. There is not a lot of benefit to doing specific
diagnosis except in response to outbreaks in institutions, such as in a nursing home. Noting that
HEALTH BOARD MINUTES - February 17,2005
Page: 2
drugs taken after the onset only reduce the duration by about a day, it is only cost-effective to
administer the drug before contact.
Washimrton State Board of Health 2004 Annnal Renort: A copy ofthe report was distributed.
Dr. Locke explained the report's purpose was to review work done on the four to six main priorities
the State Board had set for itself. In May, the State would be visiting to review with Staff its
measurement against Public Health Performance Standards and at next month's Board retreat, Staff
would plan to present the updated Standards for Public Health in Washington State. The Board
received advance copies of the updated booklet.
Governor Grel!oire Reannoints Secretarv of Health: Dr. Locke noted the packet included an
announcement of Gregoire's reappointment of Mary Selecky. There was interest in having her visit
Jefferson County again.
NEW BUSINESS
Isolation and Qnarantine Conference Follow-up - Role of Local Board of Health: Dr. Locke
discussed an article that found that past isolation and quarantine exercises have not been effectively
contained. Because isolation and quarantine can only work if99% of the diseased population is
contained, he stressed the importance of the Board of Health's role in public communication. He
showed a book, Crisis and Emergency Risk Communication by Leaders for Leaders, and suggested
the Board discuss it at a future meeting. Jean Baldwin noted that in-house risk communication
training is a requirement of all Staff. Dr. Locke said Staff would request copies for each member of
the Board. Ms. Baldwin noted the whole issue of incident management involves a good deal of
cross-county communication.
Vice Chairman Sullivan thought the exercise was helpful. Jean Baldwin offered to share job
description packets for everyone she is preparing for the three-day training March 29-31. It would
also help to look at the County and Health Department emergency plans.
Chairman Masci, in describing the critical communication challenges presented by emergency
situations such as 911, said a higher, military-like degree of discipline and organization is needed.
Jean Baldwin agreed that we are facing great tests and said the exercises are designed to give staff
the confidence that comes from knowing their role within the entire response picture, adding that
every agency in the chain must do this. When asked by Chairman Masci if funding is the reason the
tabletop exercises could not be expanded to accomplish this with all agencies simultaneously, Jean
Baldwin agreed that the County is limited by its bioterrorism planning budget of $25K.
2005 Lel!islative Session Kev Public Health Issues: Dr. Locke noted the packet contained a
number of pertinent documents. HB 1415 is a cruise-ship bill that seeks to expand the State's
jurisdiction over inland waterways but concluded that to fully realize the bill's intent, the federal
government would have to transfer those rights as they did with the corresponding Alaskan
waterways. HB 1516 is a health-care access bill, focusing on the "Kids Get Care" program to
prioritize children in service delivery. The goal ofSB 5597 is to make fresh, farmers' market
produce more accessible to those with WIC vouchers or Food Stamps. A tracking sheet shows that
HEALTH BOARD MINUTES - February 17,2005
Page: 3
hundreds of bills in committee, have health-related implications. While most will soon perish, some
elements may find life as part of some other legislation.
He called attention to three bills that address public health funding - seeking a stable funding source
in a State budget where there is estimated to be a $2.2 billion shortfall.
SB 5700 -
Establishes a $20M Statewide Emergency Communicable Disease Response
Fund.
Proposes to add .20 cents per $1,000 of assessed value to the (property)
taxing authority of public health hospital districts and divides it three ways -
hospitals get the same amount and the remainder is split for public health
funding and funding for uncompensated care. Approximately $93 million is
involved.
Getting public health system up to the level where it should be would take an
additional $400 million a year. This bill establishes a joint public health
financing committee or study group of stakeholders to take this issue on and
pick the best alternatives for further consideration.
HB 1818 -
HB 1737-
Member Frissell moved that the Board of Health draft a letter to the 24th District legislative
delegation supporting HB1818, SB5700, and HB1737, with a copy to other legislators. Vice
Chairman Sullivan seconded the motion, which carried by a unanimous vote.
Dr. Locke agreed to draft such a letter and suggested the effective use of e-mail to transmit the
letter. Jean Baldwin reminded that the Department had committed to speak as one with Washington
State Association of Counties on issues affecting the group.
Chairman Masci asked about Bill 1458, which addresses on-site sewage in marine areas. He said
Council members had been getting information about this bill from the Association of Washington
Cities that might be different from the Board's. He also expressed concern that local testimony
might be called on before Staff has been adequately briefed on the bill. Jean Baldwin noted that the
Washington State Association of Local Public Health Officials is opposed to the bill as currently
written because it increases regulation without addressing maintenance and education. Linda Atkins
and Dave Christensen submitted comment in opposition when the bill was being drafted.
Dr. Locke explained that the bill had been drawn up by the Puget Sound Action Council to force a
solution - an operating permit mandate - on an issue they had been waiting for local health
departments to solve for ten years. He added that board members could take a stand on pros and
cons as citizens as long as it is in public session. Boards discuss principles and priorities, but then
they give their Chairman the authority to testify. Discussion revealed that the City and County are in
agreement in their lack of support for this bill.
Dr. Locke predicted that the legislature would pass the mental health parity bill, which would
provide the same coverage as medical and surgical.
There was discussion about mental health bills by Jim Hargrove and Eileen Cody and a suggestion
to supply a letter to support Hargrove. Vice Chairman Sullivan moved to send a letter in support
HEALTH BOARD MINUTES - February 17, 2005
Page: 4
of Senator Hargrove's omnibus bill. Member Frissell seconded the motion, which carried by a
unanimous vote.
Vice Chairman Sullivan moved to send a letter of support on HB1154 and SB5450 mental
health parity bill. Commissioner Johnson seconded the motion, which carried by unanimous
vote.
Chairman Masci asked the Commissioners to make the Board of Health aware of bills on which
they plan to testify during this session. Jean Baldwin also agreed to send the Board drafts on bills.
Jefferson County Food Code: Dr. Locke noted that Dana Fickeisen previously reviewed with the
Board the changes to the State code that take effect May 2, which does not conflict with the
County's practices. If it was decided to synchronize the two, Staff could present a draft code to the
Board next month, with a soft deadline for passage in April. Dr. Locke said Staffs proposal is to
streamline the local code by adopting the very comprehensive state code by reference - with the
exception of the appeals process (i.e., suspensions/revocation of their license, closures of their
restaurants, fees). The current County code provides for a one-stage appeal process, which is the
Board of Health. He would suggest instead replicating the Methamphetamine Open Record/Closed
Record approach, which would begin with an open record, administrative hearing, or conference,
before the Health Officer (or Hearing Examiner in the case of a revocation).
Chairman Masci expressed favor for the more manageable, single-stage, closed-record hearing. Dr.
Locke noted that hearings are rare, because most issues are resolved in administrative conferences. It
is unlikely the administrative or Board of Health appeal would be used in the reahn of food service
licenses. There being no Board objection, he noted that next month the Board would consider a
document with a lot of strike outs of most of the current language and adopting the state code by
reference and focusing on the appeals process.
Member Frissell asked about the possibility of invoking a public - A,B,C - grading systemlpostings
in establishments as in Califomia. Dr. Locke did offer support for making publicly available
PassIFail scores for restaurants, which Jean Baldwin noted is available on the Countywebsite.
Washin~ton State Vaccine Prol!ram - Local Policv Issues: Jean Baldwin offered this
information to help the Board understand the level of commitment to this contract, even though it
had not come before the County Commissioners. Referring to a two-page document, she explained
how the immunization program is run, how we store and handle the vaccine internally but also the
monitoring of storage temperatures and logs in physicians offices throughout the county. Chairman
Masci congratulated the Department on its efficient use of resources to carry out this complicated
and costly federal mandate.
Prevention Monev: Jean Baldwin reminded the Board of their discussion last month of substance
abuse prevention. She offered the Board a written explanation of the family violence and substance
abuse prevention-programs the Department administers. All are best practices, all three based on
prevention, all use local dollars to match out-of county money, and each targets a different
population (matemal child health, school-aged youth, and Big BrotherlBig Sister). Veronica Morris-
Nakano's graphing and narrative of each of the programs and their funding contributions were
discussed.
HEALTH BOARD MINUTES - February 17, 2005
Page: 5
Chairman Masci noted that the 14.24% as shown on the Nurse Family Partnership graph is assumed
to be disappearing. Jean Baldwin noted that a set percent of the liquor excise tax, 2% of the total
City and County contribution, must go to substance abuse and was forwarded to Beacon of Hope
Safe Harbor Treatment Facility. Staff noted that they would get this handout to Commissioner
Rodgers, since he sits on the Substance Abuse Advisory Board. Veronica Morris-Nakano agreed to
do a brief workshop on the same with Chairman Masci and City Council Member Frank Benskin,
who would now be attending Substance Abuse Advisory Board meetings.
Access! Ability! Toward a Livable Community: Jean Baldwin noted the packet contained an
announcement of this March 23 event/presentation by nationally-known speaker Dan Burden.
Chairman Masci has committed to attend, representing the Board.
ACTIVITY UPDATE/OTHER ANNOUNCEMENTS
Environmental Health Director: The position has been closed. Based on phone interviews,
candidates would be invited to come and submit an example of their technical writing skills. Vice
Chairman Sullivan, Chairman Masci, Dr. Locke and Jean Baldwin were identified as the
interviewing team. There was some discussion of possible interview dates, roughly in the second
week of March. Ms. Baldwin agreed to send them resumes and a copy of the questions asked.
AGENDAPL~NG/ADJOURN
Future al!enda topics: Food Code (March), two-year Family Planning report, Board Retreat (April
21 "- retreat in morning, meeting in the aftemoon). It was also agreed that a review of the future
funding/partnership needs for Best Beginnings and Behavioral Risk Factor Surveillance Survey
(BRFSS) should occur before June.
The meeting was adjourned at 4:10 p.m. The next meeting will be on March 17,2005 at 2:30 p.m. in
the Conference Room of the Jefferson County Health Department.
(Excused Absence)
Jill BuWer, Member
(Excused Absence)
Sheila Westerman, Member
Ckf-kt.-4.<;t.uf!Z
Roberta Frissell, Member
(Excused Absence)
Patrick M. Rodgers, Member