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HomeMy WebLinkAbout01 January Health & Human Services HEALTH BOARD MINUTES JANUARY 25, 1994 BOARD MEMBERS: STAFF MEMBERS Robert Hinton, Chairman Richard Wojt, Member Glen Huntingford, Member Larry Fay, Director of Environmental Health David Specter, Administrator Jean Baldwin, Director of Nursing Services 1. Peter Geerlofs, M.D., Health Officer Chester Prudhomme, Director of Substance Abuse CITY OF PORT TOWNSEND REPRESENTA TlVE: Bob Sokol The meeting was called to order by Chairman Robert Hinton. The following Board and staff members were present: Commissioner Richard Wojt, Larry Fay, David Specter, Jean Baldwin, and 1. Peter Geerlofs. Commissioner Glen Huntingford arrived shortly after the meeting began. APPROVAL OF MINUTES: Commissioner Wojt moved to approve the minutes of November 23, 1993 as presented. Chairman Hinton seconded the motion. The motion carried. DIRECTOR'S REPORT FINANCIAL REPORT: David Specter reported that 95.7% of the budget was expended and 100.4% of budgeted revenues have been collected as of year end 1993. Nursing fee revenue was high while revenue from environmental health was a little under target. There were also some grant revenues that came in on time. PROGRAM/GRANT UPDATE: The Health Department was contacted by DSHS Child Protective Services regarding grant money ($20,000) that is available and can only be used for public health. David Specter stated this grant does not require the Health department to do anything different than they are already doing. Since there is no extra work, only extra money, the Health department drafted an agreement which will be placed on a future agenda for the Board of County Commissioners approval. PUBLIC HEALTH IMPROVEMENT PLAN/PROGRESS REPORT: David Specter reported that there is a meeting on Thursday, January 27, 1994 at which time discussion regarding the action plan for health problem priorities should be finalized. This process has taken longer than expected but a lot has been accomplished. HEALTH DEPARTMENT 206/385-9400 ENVIRONMENTAL HEALTH 206/385-9444 DEVELOPMENTAL DISABILITIES 206/385-9400 ALCOHOL/DRUG ABUSE CENTER 206/385-0650 FAX 206/385-9401 HEALTH BOARD MINUTES - JANUARY 24, 1994 Page 2 DIRECTOR OF NURSING SERVICES REPORT HEALTH CARE REFORM: Jean Baldwin reported she is trying to analyze what it means if the Health Department's well child clinic is completely absorbed by private physicians. Approximately 60% of the well child clinic clients are covered by medicaid. The loss of those clients will have an impact on the Health Department financially since that 60% paid for the other clients who are low income and on a sliding scale. PROPOSAL FROM GRACE LUTHERAN CHURCH: The Grace Lutheran Church is proposing to establish a low income health clinic in the community and has requested the use of the Health Department facilities to keep costs down. David Specter reported that during the meeting in November the Board directed the Health Department to look into the liability issues regarding this proposal. Meetings have been held with Grace Lutheran Church, other churches and the public to discuss the need of such a clinic and to recruit volunteers. A second physician, Alan Finley has also become involved. Dr. Rotchford is transitioning from Grays Harbor and has opened a practice in this area. David Specter feels more needs to be done to specifically define what the need is in the community and how they will operate both clinically and in terms of establishing relationships with other medical providers in the community. He is concerned with the continuity of care since they have not contacted any other medical providers to develop referral relationships. David Specter met with Pastor Fosser who stated it is his sense that the medical community is opposed to this proposal and is not cooperating. Pastor Fosser feels the need is one of access to the local physicians and talked about segregation, discrimination and dealing with a class of patients that do not have resources, and that local physicians do not want to see. David Specter expressed his concern that by setting up this separate clinic for this class of patients you are making it easier to perpetuate the problems they are trying to address. The Hospital Administrator Vic Dirksen has not had any communication with the group. He is not sure what the need is and proposed the emergency room as an alternative for this clinic. David Specter spoke to the Prosecuting Attorney Mark Huth regarding the liability issues and how this would be structured. There are two ways this can be done: 1) The Health Department can act as landlord, which may be fraught with problems; 2) they may enter into a professional services contract with them similar to the one between Family Planning and the Safe Clinic. If a contract is entered into it would be the Health Department's program and David Specter doesn't see public health reform going in that direction. Health Officer Dr. Peter Geerlofs stated he is open to the concept but agrees with David Specter that more research needs to be done to determine the need. If well defined needs are identified then the role of the Health Department would be to look at alternative ways to meet those needs. The group has jumped to a particular solution without looking into alternative solutions that work within the existing system. He is also concerned with fragmentation of care. The hospital deals with people with urgent needs. Anyone in this community with a truly urgent problems will get care whether they can afford to pay or not. The problem in this community is the difficulty of getting people into the system on an ongoing basis and this proposal does not solve that need because they have not communicated with other medical providers. David Specter added that the group does not intend to establish ongoing relationships with their patients. Fragmented care is the worst kind of care because you are dealing with physicians who don't know the patients. Certain problems are not urgent but require repeated care. At this point, Dr. Geerlofs does not feel it is appropriate for the Health Department to get involved. If more research is done he is more than willing to work with them on their proposal. HEALTH BOARD MINUTES - JANUARY 24, 1994 Page 3 At 1:30 p.m. the group in support of this proposal arrived. Chairman Hinton excused himself to attend another meeting and Commissioner Wojt volunteered to temporarily serve as chairman for the remainder of this meeting. A vote to elect a new chairman will take place at the next meeting in February. After all the introductions were made Elaine Beckman RN stated there is a need in this community for a low income medical clinic. She has looked into other clinics that are very successful and visited one that has been established in Tacoma. There are a lot people who seem to fall through the cracks of the system. They have low-income jobs, do not qualify for medicaid but do not make enough money to get private health insurance. This clinic would serve as a place to triage people who don't know how to get into the health care system. It would also prevent the hospital emergency room from getting overloaded with problems that don't need to be there. Dr. Geerlofs asked if the group has spoken with other medical providers? Ms. Beckman stated they are still in the preliminary stages and outlined what the group has done so far. Dr. Geerlofs stated this proposal may represent an alternative to the existing system or an integral integrated part of the existing system which may have potential he reiterated the concerns he expressed earlier to the Board and stated the only way he can see this proposal working is if it fits within the existing system. Ms. Beckman stated that is their goal. Dr. Alan Finley stated there is no question that this would have to fit into existing system. The group is still in the preliminary stages and have not yet had the opportunity to contact the other medical providers in the community. He feels the participation of the local physicians is crucial for this proposal to work in this small community. Another point to consider, stated Dr. Geerlofs, is that there is a new managed care approach to health care that is becoming much more prevalent in this community. Physicians are having to provide health care within a certain budget amount. If a low-income clinic opens up and a substantial number of people are using it, it could end up driving some of the local physicians out of business. He is not saying this is a reason not to open the clinic but the whole picture needs to be looked at and there needs to be communication with other medical providers so they can be involved. Jean Baldwin reported that on January 1, 1994 a statewide insurance program called Basic Health went into effect. This program is for uninsured people and allows them to buy a KPS policy similar to a KPS medicaid policy, at a very reasonable rate. She knows people are falling through the cracks and feels there is a larger need for volunteers to help people get into the system by signing up for Basic Health. Once a person is on Basic Health no physician can refuse them. They are assigned within the system to a primary care provider. After further discussion Dr. Geerlofs stated he feels it is too early to make a decision on this request to use the Health Department facilities. The group will do more research on the need and contact c.A.C., the hospital and the local physicians and meet again with the Health Department to review the proposal. ENVIRONMENTAL HEALTH DIRECTOR'S REPORT REQUEST FOR WAIVER OF 100 FOOT SETBACK REQUIREMENT BETWEEN WELL AND RESERVE DRAINFIELD: RICHARD FALCONE, APPLICANT: Larry Fay stated Mr. Falcone's property is located 5 miles south of Brinnon on Highway 101. The Board reviewed the application, the letter from his designer, and the plot plan of the system. This permit was originally issued in 1991. The system was installed last summer which consists of an intermittent sand filter and a pressurized drainfield. The original plan called for the well to be drilled in the north-west corner of the plot plan. In order to maintain the 100 foot setback HEALTH BOARD MINUTES - JANUARY 24, 1994 Page 4 after the septic system was installed, the well would have to be drilled right in the corner which would be difficult to access. Therefore they requested the setback be reduced in order to get a well-drilling rig in there. The setback would be from the reserve area not the primary area of the system. Larry Fay stated that the well has already been drilled on the assumption that the Board was going to approve the waiver request. The Health Department does not have any objection to this request. After further discussion Commissioner Huntingford moved to waive the 100 foot setback requirement for Richard Falcone as requested. Acting-Chairman Wojt seconded the motion. The motion carried. ONSITE SYSTEMS IN FLOOD ZONES; POLICY DIRECTION: Larry Fay stated that there are no clear guidelines for implementing the provisions of the Flood Plain Management Ordinance. The onsite sewage regulations do not prohibit the installation of systems in a flood plain, but they do require a flood plain certificate in a flood hazard area. The Flood Plain Ordinance requires a flood plain certificate to install utilities including on site sewage systems within flood hazard areas and it does establish general criteria for construction of facilities within flood plains. This ordinance states under section three that "all new and replacement sanitary sewage systems shall be designed to eliminate buoyancy and minimize or eliminate infiltration of flood waters into the systems and discharged from the systems into the flood waters." Essentially this is an impossible standard to meet. The Health Department needs to know how this is to be interpreted. If this is an ordinance that will not allow any new systems in a flood plain then the Health Department needs to advise all the designers and engineers of these regulations. Flooding is a risk and once there is sewage in the flood waters it is a threat to shellfish resources and drinking water not to mention the impact the flooding would have on the long term performance of those systems. The Board agreed that the installation of sewage systems will be prohibited in flood hazard areas that have gone through the provisions of the Flood Management Ordinance and are clearly found to be in a flood plain. This will be in conjunction with the issuance of flood plain certificates. Larry Fay stated if it is a mapped flood plain then the Health Department would send it to the Planning Department to determine whether or not the location is actually in a flood plain. Since the Board agrees with this interpretation, a proposal will not need to be drafted. Larry Fay will talk with the Prosecuting Attorney regarding this matter to see if he feels specific policies need to be adopted. Commissioner Huntingford stated he agrees with the interpretation for the installation of new systems, however, when dealing with repairs to systems, he feels there should be some clear guidelines. Larry Fay stated he will work with the onsite designers and engineers to establish a set of standards that are reasonable for repairs in flood hazard areas. PROPOSED ORDINANCE; ONSITE SEWAGE SYSTEM DESIGNERS. INSTALLERS AND PUMPERS PROGRAM: Larry Fay stated that he intends to expand this program to include licensing of septic system designers, installers and pumpers. He presented a draft on designers for the Board to review and comment on. REVISIONS TO STATE ONSITE SEWAGE REGULATIONS: In December the State Board of Health held a hearing on the draft Onsite Sewage Regulations. The regulations were not adopted, but were sent back to the State Health Department staff for clarification on five (5) different issues. One of the most controversial issues was the three foot (3') vertical separation requirement for conventional systems. This has always been the regulation, however the language was unclear. The language in the draft regulation is explicit regarding this issue. This was not one of the five issues the staff has to go back to. The issues that they do have to review again include: non-conforming repairs; reduction of horizontal setback between the drainfield and rain waters from 100 feet to 50 feet; ongoing operation and maintenance in areas of special concern; inserting language to include involvement HEALTH BOARD MINUTES - JANUARY 24, 1994 Page 5 by the State Board of Health during arbitration between local and State Health Departments; and effective date for the regulations. DISCUSSION WITH BREMERTON SUN REGARDING PUBLICATION OF FOOD SERVICE INSPECTION SCORES: Larry Fay presented a letter from the Bremerton Sun asking the Jefferson County Health Department to send them the restaurant inspection scores. Kitsap County sends their scores to the Bremerton Sun to be published weekly. The Bremerton Sun was told that the scores are public record and they are welcome to come and look at them, but it is not routine to mail them out. Publishing the restaurant scores was discussed at a meeting of the Food Service Advisory Committee earlier this year. Larry Fay feels that the information sent out needs to be meaningful. Kitsap County takes the raw inspection scores and converts them into a percentage. This is not a very accurate measure since there are variabilities between county programs and inspections. Comparing Jefferson County to Kitsap County would not have a lot of meaning. Larry Fay explained how Jefferson County restaurants are scored. Violations are scored differently depending on how critical they are. Percentage scores do not tell much about the nature of the violation. For instance, Jack in the Box may not have any problems except that they do not cook their hamburgers well enough. This would show as a score of 97% which is excellent. Larry Fay expressed his concerns to the Bremerton Sun. David Specter stated that the Seattle Times publishes a note about the nature of the violation along with the scores. If the Bremerton Sun would consider doing it that way also, Jefferson County would participate. Larry Fay stated this could be a positive thing by giving the consumers a chance to see the status of a restaurant and it would serve as an incentive for restaurants to take care of any problems they have. Commissioner Huntingford stated that this information is available to the public anyway and he doesn't have a problem with the scores being published as long as the information can also be provided that explains how the formulas work for figuring the percentages. Rather than asking the Board he feels that the Health Department should ask each of the businesses if they want the information published. Larry Fay will discuss this matter with the Food Service Advisory Committee. The next meeting will be held on Thursday, February 24, 1994 at 1:00 p.m. (This meeting was later cancelled and rescheduled for Tuesday, March 22, 1994 at 1:30 p.m.). MEETING ADJOURNED ~ REQUEST FORM FOR WAIVER FROM WAC 246-272 (Fonnerly 248;-96) 1 8,=_ Items (1) through (8) must be completed to process waiver requests from WAC 246-272. The local health depamnent must approve the request and complete items (9) and (10) before the waiver is forwarded to the Department ofHealili"for their decision. Please read and followiilsfrllctions noted . on the reverse side. The instructions correlate to the numbers in parentheses. . INDMDUAL REQUESTING WAIVER: (1) LOCAL HEALTIi DEPARTMENT: (2) Name: 'e.\,-I-\~b ~U91\JE Name: .Y~,,-) G:....v,,)~ ~ Address: \42./;>'1- n ,"1"11 1"L. ~ Address: 1n1S' 5l1\eR \~A\.l l(u'z..I<.LI'.l\\b,WA '~3g. "f'"<9/2.."T --r;.u.,^", ~",,1\l-t', ,W--.A 'B3~&' Phone: ~ ~'-\ -2~LD Phone: C2ab '0 ~S- -~'T4 Propeny identification: (3) L-o-r ~, :> <-\.~ ~ 'f1..A.T '"FA-&. M ~:-r <T ,}71-'2-00 -1'705 ************************************************************************************ Please provide the following detail: WAC Number (4) I Reauirement in WAC (5) 2'\~ }b-!SO I) Iloo~ lf072JaoifT~L- I scP MlA-7'UJ1V ~ 1A/EJ.,I- ~ '-16 - ~ '/~ - /l( 0 I TECHNICAL JUSTIFICATION: (7) I Waiver Sou\!ht (6) ! /Z€bl4'67nTIV 70 ~ &- ~ J7<rnJ",&-~ ~1J-1Vr-71<71V .5C3 e; IFTr-4-GlJE:b APPUCANTS SIGNATIJRE:(8) -c.td,P los~ TITLE:-(c^,,-,( flMcW. E.nPATE: 1/- /-.93 ***************************************~*********************** LOCAL HEALTIi DEPARTMENT COMPLETES Local Health Department Action: (9) "Date Received: e ) APPROVED. Submit with justification to DOH office noted on reverse side. e ) DISAPPROVED. Rerum to applicant. COMMENTS (especially concerning reasons for action): SIGNATURE: (10) TITLE DATE: -~***************************************************************~~~***~************* DEPARTMENT OF HEALTII COMPLETES uepartment of '-1ealth Action: (11) Date Received: e ) CONCUR. Return to Local health Department for granting of waiver request. e ) DO NOT CONCUR. Return to Local Health Department for denial of waiver r~auest. COMMENTS (especially concerning reasons for action): SIGNATURE: (12) TITLE .=.-\':"::: . LAND DEVELOPMENT CONSULTANTS ,'- - -;:.;: I I Q '" ~ ; 17410. 133rd AVE. NE WOOOINVILLE. WA 98072 UilDBJ 4158.1 DB3 , L_. Project Number 13990 November 1, 1993 Richard Falcone 14209 119th Place NE Kirkland;WA98G34'''' . RE: Lot 8 OfSURUY SIi!pe PIal Dear Mr. FaIc,me: This report presents the results of our research and investigation of the Private Well setbacks to the Septic Tank/Drainfield System installed at the above described site. The purpose of this study was to investigate the possibility of contamination of the private wells by the existing septic tank/drainfield system. There will be three wells in the general vicinity of the existing septic system. The existing well on the South adjpining Lot 7 is approximately twenty feet higher in elevation and greater than 100 feet away from the existing septic drainfield and reserve area on Lot 8. The existing private well located on the North adjoining Lot 9 is approximately twenty feet higher in elevation at greater than s.eventy,five feet in horizontal distance from the existing septic drainfield on Lot 8. A variance from Health Department Regulations has been approved for reducing this setback to no less than Seventy-five feet. Both of these wells meet current setback requirements between private wells and septic tanks. At this time an additional variance from the Health Department Regulations is being requested to allow the proposed well of Lot 8 to.be located no less than. eighty-five feet from the existing soil absorption trenches and reserve c!rainfield area. The reason for this request is to accommodate the installation of the well. Soils on the site consist of approximately 36-48" of topsoil underlain with a thick layer of cemented glacial tilL A weiI log of the well on Lot 11 indicates that the till layer is approximately sixty- two feet deep well water bearing gravel at 62-64 feet. The thick layer of the cemented glacial till should prevent any sewage effluent from filtering into the ground water aquifer. The only point of entrance into the well appears to be around the well casings. Since the soil absorption system 0 n lot . is twenty feet lower in elevation than the above described wells, it does not appear . . possible for effluent from the system to enter the aquifer at the well casing. Based on the above observations, it appears that the potential contamination of the private wells from sewage effluent discharge into the septic tankjDrainfield System on Lot 8 is negligible. If you need additional information or clarification, please call. ASin erelY,.. Q.,.- k arold Dean Blacketer Certified Sewage Disposal System Designer .cc: --, SUr"'lGW"T s.(),,~O .... !II SUN i Serving Kitsap, North Mason and Jefferson counties 545 Fifth St. . P.O. Box 259 . Bremerton, WA 9831 0 PHONE,12061377.3711 NEWSROOM FAX, 12061479-7681 January 14, 1994 Larry Fay Jefferson County Health Department 615 Sheridan St. Port Townsend, VVA 98368 ~~'~VEr ~ ~ t;- ~.'1;:l '" :~'r t; ~~ ~ r} JAN 18 1994 ",,,'. \...vuNI ( ---- 'L-\-l ~."PT ':A Il. !..i...1 . Dear Larry: Enclosed is a copy of the Kitsap County restaurant inspection scores that The Sun runs every other week in the arts-and-entertainment section called Bravo. I would like to include the Jefferson County scores too. Bravo is published on Thursday and the Kitsap County Health Department sends the scores to us electronically on the Friday before. Shipping the scores directly into our system works well -- and avoids errors -- but working with hard copy by mail is okay too. According to Gwen Howard, who suggested I talk to you, the KC Health Department is converting the raw scores into numerical percentages with 100% equaling perfect. The information at the bottom of the score explains what the numbers mean. But these are details that can be worked out. The most important thing is if you're willing and able to have us publish the scores. I think they're widely read -- all restaurant news is. And the health department considers them a public service. Let me know what you think. I can be reached Monday through Friday from about 8 a.m. to 5 p.m. at 792-9218. Or write care of: The Sun, P.O. Box 259, Bremerton, WA 98310. Sincerely, Deborah Woolston, coordinator of Bravo //- /'; ,I /; hi}'[;;/; f'.'):/11,', Mike Phillips, Editor Ron Muhleman, General Manager'