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JEFFERSON COUNTY BOARD OF HEALTH
MINUTES
Thursday, January 20, 2005
Board Members:
Pbil Johnson - County Commissioner District #1
David Sullivan, Vice Chairman - County Commissioner District #2
Patrick M. Rodgers. County Commissioner District #3
GerJifrey Masci, Chairman - Port Townsend City Council
Jill Buhler - Hospital Commissioner District #2
Shezla Westerman - Citizen at Large (City)
Roberta Frissell - Citizen at Large (County)
StafMembers:
Jean Baldwin, Health & Human Services Director
Julia Danskin, Nursing Services Director
Thomas Locke, MD, Health Officer
Vice Chairman Frissell called the meeting to order at 2:40 p.m. in the Health Department
Conference Room. All Board and Staff members were present. There was a quorum.
APPROVAL OF AGENDA
Member Masci moved to approve the Agenda as written. Commissioner Rodgers seconded
the motion, which carried by a unanimous vote.
ELECTION OF 2005 CHAIRMAN AND VICE CHAIRMAN
Vice Chairman Frissell called for nominations for the position of Chairman. Member Buhler
nominated Member Masci. There being no further nominations, Member Buhler moved to
elect Member Masci as Chairman. Member Westerman seconded the motion, which
carried by a unanimous vote. In response to the call for nominations for Vice Chairman,
Member Masci nominated Commissioner Sullivan. There being no further nominations,
Chairman Masci moved to elect Commissioner Sullivan as Vice Chairman. Member
Westerman seconded the motion, which carried by a unanimous vote.
Member Frissell welcomed incoming Commissioners Johnson and Sullivan.
APPROVAL OF MINUTES
Chairman Masci moved to approve the minutes of December 16, 2004, as written.
Commissioner Rodgers seconded the motion, which carried by a unanimous vote.
HEALTH BOARD MINUTES - January 20,2005
Page: 2
PUBLIC COMMENT - None
OLD BUSINESS AND INFORMATIONAL ITEMS - None
NEW BUSINESS
2005 Legislative Session Preview - Key Public Health Issues: Dr. Tom Locke noted that
the legislature is currently in its lOS-day session, the budget writing session. For the third
biennium, they are beginning with a major deficit, a $1.8 billion shortfall, driven mostly by
increased caseloads. The highest public health priority this year remains a stable, predictable
source of funding. He was appointed public health spokesman for a campaign called "Walk
the Talk for Public Health." All legislators are being given pedometers and there would be a
competition between the two parties in the House and Senate for how many steps they can
get in each day. Beyond individual health, the program is about the health of all communities
and that the legislators should not walk out of Olympia without a plan for solving public
health funding. It has been estimated that bringing the state's public health system up to the
standards set in the public health improvement plan would cost $400 million. He reviewed
items included in the agenda packet: a priority of public health issues from the Washington
Association of Counties, a preview of 2005 Legislative Session written by the Executive
Director for the State Board of Health, and highlights of Governor Locke's Budget.
Dr. Locke reported that aside from the shoreline-related fund, it is uncertain whether any
other funding lines would have any significant impact to the County. Jean Baldwin
mentioned that a bill introduced last year by Senator Rosa Franklin of Tacoma is listed on
the Legislative Overview under Physical Activity and Nutrition. It would require physical
activity issues be considered when doing land use planning, including community
development and transportation planning.
Chairman Masci noted that last year's proposed special fund incentive for methamphetamine
site clean up was not specifically mentioned in the Governor's budget proposal this year. He
believes the Sheriffs Department is seeing increased methamphetamine use and production
in the County. Dr. Locke noted that the degree of State funding available is largely
determined by the site's level of contamination. Jean Baldwin noted that the Department did
not seek another contract with Ecology because of the burdensome contract requirements.
While the Governor had proposed keeping the current Public Health Backfill funding level
of $49 million, it would be channeled through Health Services' rather than CTED
(Community Trade and Economic Development). To help balance the Health Services
account, the Governor is proposing a one percent tax on physician services. With
Washington having the most regressive tax structure in the country, areas that can be taxed
HEALTH BOARD MINUTES - January 20,2005
are already heavily taxed. He further noted that Basic Health has roughly 100,000
clients/enrolled, but is authorized to go up to 130,000.
Page: 3
2005 Board of Health Work Plan - Prollram Review. Priority Setting. Rule
Development and Emergin~ Issues: Jean Baldwin urged the Board to review the Health
Department's mission and the Board's vision, as well as the expectations of its meetings.
The Department is scheduled to have an external review and audit of its standards over two
days in May. While the last audit was positive, during the last two years there has been a
decrease in services, staffing, etc.
Chairman Masci suggested that the Board schedule a retreat in February or March to
prioritize programs and services before this audit occurs. This might also provide an
opportunity to educate itself. Ms. Baldwin suggested holding such a retreat after the
completion of the 2004 performance measures in February or March. She also reminded that
the Board would need to review and adopt the Environmental Health On-Site rules and the
Jefferson County Food Code. Dr. Locke commented that the County's current Food Code is
very similar to the new State standards. The recently adopted On-Site Code while meeting
current technical standards, will need some modification, mostly to allow for consideration
of whether to use new tools/authorities from the State Code.
Regarding program updates, Jean Baldwin noted that there would likely be an in-depth
review of Family Planning next month, to be followed by Maternal Child Health (MCH).
The Board might benefit from seeing a comparison of prevention standards and programs.
At the last Board of Health meeting, there was also discussion of a workgroup to address
immunizations and work with the schools and Rotary Clubs. A three-day emergency
management tabletop exercise is scheduled for March. She solicited additional agenda topics
or program updates the Board might find of interest.
There was Board interest in scheduling an April Board retreat and Chairman Masci agreed to
work with Jean Baldwin on preparing an agenda for the Board's consideration.
Influenza Update - Vaccine Redistribution. Influenza Activity. Policy Implications:
Dr. Locke reviewed that the shortage and delayed distribution of the vaccine has made for an
unusual year, but the February and March influenza peaks in the northern hemisphere have
been fairly typical. There was a small cluster outbreak of Influenza A in Grant County in
Eastern Washington. Once the virus reaches the schools, there would be a shift from
sporadic to widespread activity. In mild flu years, on average, the nation sees 20,000 excess
deaths and hundreds of thousands of excess hospitalizations; in a bad year, this figure could
reach 40-50,000. In a pandemic year, with a new strain in circulation, this number could
cause 200,000 to one million excess deaths. Thanks to Jefferson Healthcare's good luck of
securing 10,000 doses, Jefferson County has had good vaccine coverage and been able to
share its surplus to help cover regional shortages in Clallam and Kitsap Counties. Having
filled providers' orders and vaccinated the high-risk populations, jurisdictions have been
HEALTH BOARD MINUTES - January 20,2005
Page: 4
loosening or lifting their restrictions on vaccine use; anyone in Washington State who can
find a vaccine can now be vaccinated. Acceptance of the live virus vaccine flu mist by the
public continues to be slow; not only does the vaccine cost more, its use is restricted to those
healthy and under 50.
Dr. Locke said there have been no reported flu cases in Jefferson County. Confirming
whether a respiratory infection is influenza is costly and time-consuming. An outbreak is
usually characterized by absenteeism in schools of greater than ten percent, an increase in
the rates of chest x-rays, and reports of influenza-like illness by physicians. A small
percentage of cases actually get cultures to determine influenza and identify the type. The
severity of respiratory illness is not a good indicator of influenza because there are a number
of other viral and bacterial infections that can be life threatening. The distinction with
influenza is that it is highly contagious and it mutates from year to year. It is hoped that the
publicity on hand-washing and respiratory etiquette would have some positive influence.
ACTIVITY UPDATE/OTHER ANNOUNCEMENTS
Isolation and Ouarantine Conference - February 3. 2005. Fort Worden: Jean Baldwin
urged the Board to attend this three-county event. She reviewed the list of invitees - those
who would have a role in the event of an illness requiring isolation and quarantine.
Reproductive Health Continuing Education Conference - January 20. 2005. Jefferson
Healthcare Auditorium: This afternoon there is a presentation by Dr. Vivian Webb
Hanson on cervical cancer screening and management guidelines and human papilloma virus
(HPV) vaccine. Noting that there is reason to believe that this virus causes 90 percent of
cervical cancer, Dr. Locke said an HPV vaccine is in the final stages of development.
Environmental Health Director Opening: Jean Baldwin reported that the opening of this
position would likely be extended beyond tomorrow's deadline in order to increase the pool
of applicants. In the meantime, she has been meeting twice monthly with the Environmental
Health team to address coverage and cross training. Staff is also working to develop a skills
test for applicants.
Substance Abuse Prevention: Jean Baldwin reported that the Department was represented
in recent panel discussions of substance abuse and adolescent development. She then
explained the Department's outreach and education efforts and leverage of funding. The
Department received a six-year, broad-scope federal juvenile justice grant of roughly
$IOOKlyear in support of the following: methamphetamine home visits, re-implementing
the Big Brother Big Sister programs, providing a mental health professional in the schools,
coordination of the Healthy Youth Coalition in partnership with Community Network, and
the Healthy Youth school survey. This federal money is matched by the City and County for
the Department's substance abuse education (youth health cards on suicide prevention,
HEALTH BOARD MINUTES - January 20,2005
Page: 5
alcohol poisoning education, etc.).
Some discussion ensued about the misperception that the Health Department is competing
with mental health services for the funding. Jean Baldwin indicated that the Department is
involved in crisis intervention and mental health screening/referrals, but is not a mental
health agency. It was thought to be important that the County Commissioners review the
RCWs of the different boards, and specifically the relationship between Mental Health and
the Health Department. Chairman Masci noted the City had offered $5,000 for drug and
alcohol prevention training with the caveat that it be disbursed through the Police
Department and the City Manager. He urged the Board of Health be involved to ensure that
these funds are not incorporated into the County's General Fund.
Jean Baldwin agreed to give the Board a written explanation of the family violence and
substance abuse prevention funding, which is matched by a substance abuse prevention grant
that the Department administers for the community. She would recommend the City's
funding go to Community Network rather than the Board of Health in order to complete a
program development requirement for a program evaluation and competitive bid.
AGENDA PLANNING/ADJOURN
Future agenda topics: Review future funding needs for Best Beginnings and Behavioral Risk
Factor Surveillance Survey (BRFSS).
The meeting was adjourned at 3:52 p.m. The next meeting will be on February 17, 2005 at2:30
p.m. in the Conference Room of the Jefferson County Health Department.
JEFFERSON COUNTY BOARD OF HEALTH
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