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HomeMy WebLinkAbout05 May County Health & Human Services HEALTH BOARD MINUTES May 24, 1994 BOARD MEMBERS: STAFF MEMBERS Robert Hinton, Chairman Richard Wojt, Member Glen Huntingford, Member David Specter, Health Department Director Jean Baldwin, Director of Nursing Services Larry Fay, Director of Environmental Health J. Peter Geerlofs, M.D., Health Officer Chester Prudhomme, Director of Substance Abuse CITY OF PORT TOWNSEND REPRESENTATIVE: Bob Sokol The meeting was called to order by Chairman Robert Hinton. The following Board and staff members were present: Commissioner Glen Huntingford, Larry Fay, David Specter, Chester Prudhomme and Peter Geerlofs. Commissioner Wojt, Jean Baldwin and Bob Sokol were not present. APPROVAL OF MINUTES: Commissioner Huntingford moved to approve the minutes of April 26, 1994 as presented. Chairman Hinton seconded the motion. The motion carried. NURSING DIRECTOR'S REPORT COMMUNITY CLINIC UPDATE/PASTOR HOWARD FOSSER: David Specter reported that this is a follow up to the meeting held with the Board in January. He introduced the group in support of this clinic and stated they are here to respond to the issues and concerns raised at the previous meeting. A summary of those issues was presented for the Board's review. Pastor Howard Fosser of the Grace Lutheran Church explained that the group is proposing to establish a low income health clinic in the community and is requesting the use of the Health Department facilities. He then addressed the issues and concerns this proposal has raised. The group is somewhat perplexed as to how to assess the need for a low income health clinic. He has seen from experience where different groups have done community assessment needs that require statistics and are very involved. This group is not in a position to do that and feels that the best assessment of this need will be seen when the clinic is opened. The clinic will 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 - MAY 24, 1994 Page 2 be staffed by volunteers, including the doctors. They are working on a UGN grant to help fund the clinic. If no need is shown and the clinic is not utilized then it will be closed. The group does not have an elaborate community assessment but they have talked with medical providers and community members who say there are people that are falling between the cracks. The group is not seeking to set up a separate or competing program but instead are seeking to deal with immediate medical needs and help those people that are falling between the cracks get into the current medical system so their needs can be met on an ongoing basis. Chairman Hinton asked if the proposal is approved how soon could the clinic be operational? Pastor Fosser stated assuming the UGN grant is received, they would like to have the clinic open on July 1, 1994. Jefferson County will not be liable for this clinic. Community Action Council's (CAe) medical access program has accepted the clinic as an extension of that program. Their non-profit status Incorporation and liability will cover the clinic. The medical practitioners will all have malpractice insurance either through their own practice or through a State program where retired volunteers are covered. Pastor Fosser has spoken with CAC's insurance carrier, Homer Smith, and his only concern is that it be certain that the malpractice insurance names this clinic. Another issue is how the program will operate clinically. There will be a receptionist to welcome patients when they come in. There will be childcare for patients that come in with children. Staff will be trained by the health access workers to interview patients in order to establish their need for the service and their financial situation. Therefore, if they are eligible for Basic Health or DSHS programs the staff can serve as liaison in helping them sign up for those programs. There will be RN's, nurse practitioners, and MD's volunteering their time for this program. Commissioner Huntingford asked if there is a process in place or a flow-chart for directing patients that need additional medical attention to other facilities? Pastor Fosser stated that the medical access workers with CAC are going to help the group lay that out. If it is a medical emergency the patients will be sent to the emergency room at the hospital. Jean Baldwin of the Health Department has provided the group with the information on signing people up for Basic Health. The clinic manager is the only person that will be paid. Part of the UGN grant will be used to pay the clinic manager. Chairman Hinton asked if the clinic is dependant on receiving the UGN grant? Pastor Fosser stated that various churches have supplied the initial funding needed to get the program started. The group together with CAC applied for the UGN grant. The group did not do it by themselves. A letter was sent to all the physicians in town asking for their comments and suggestions. Contact has been made with many of the physicians to address their concerns and ask if they would be willing to volunteer. The group felt that some of the physicians are not entirely enthusiastic but are willing to listen. The clinic would not perpetuate access problems to existing providers. The clinic will act as triage by signing people up for managed health care which will facilitate their ongoing care. There were some concerns about no continuation of care. Dr. Rotchford has not been well received in the medical community in terms of hospital practice. So any kind of use of the hospital would have to be under the direction of someone else. In such a case, the emergency room would be used. HEALTH BOARD MINUTES - MAY 24,1994 Page 3 The summary states that the primary care clinic is not consistent with the direction of public health under health reform. Pastor Fosser is not sure that anyone knows what direction health reform is going. He feels the very people that are the most under served are the least aware of how to get the service they need. Health Officer Dr. Peter Geerlofs explained that the intent of that summary statement was less to focus on health care reform and more to focus on the issue that nation-wide public health is getting away from direct care. Public health is moving back towards its roots rather than providing clinics. Even Well-Child clinics are almost non-existent in Health departments. Pastor Fosser stated they are not asking that this become a Health Department program. They are asking to use the facilities of the Health Department. He added that they do not need the Health Department facilities to start this program. They could easily do this in the church sunday-school room and the tables could be used as exam tables. This does not however, give the patient a great deal of dignity where a proper exam room does. Pastor Fosser does not know if any alternative solutions have been considered. There may be several solutions and many people who can provide other solutions, but this is what they have chosen to do. Pastor Fosser commented on the concern about fragmentation of care. They will work to get people into managed care and the Basic Health Program. There will be no charges and no one will be paid. One of the group members commenting on the assessment need stated that she personally knows of many people who have fallen through the cracks. Ernie Green of CAC stated that he saw four clients this morning. Two had medical coupons and did not get to see a doctor and two did not even know about Basic Health. He feels one of the primary functions of the clinic will be to educate people about resources available in and outside the community and help them get to those resources. Pastor Fosser stated that they would like the Board to make a decision today to allow the use of the Health Department facilities and direct David Specter to work with them on developing a contract in order to be operational July 1, 1994. Commissioner Huntingford asked if the group could utilize any of the Health Department's programs already in place to meet the needs that have been discussed? Pastor Fosser stated that the Health Department chooses not to be in direct care. Dr. Geerlofs expressed his concerns with this program. After further discussion Commissioner Huntingford suggested that David Specter meet with the County's Risk Pool Manager Gary Rowe. Even though the clinic will be covered through CAC, there should be something in writing for the County's protection. David Specter stated the Health Department's relationship with the existing doctors is extremely important. There has to be a good working relationship with them. He is concerned that this program will be perceived by the doctors as something the Health Department has sponsored, endorsed, provided or is closely connected to. He wants to make sure that the Health Department is not jeopardizing or compromising those relationships. Another concern of David Specter's is that the Heath Department is not physically set up to allow access to just that portion of the facility so it would require some modification to the lock and key system since Health Department staff will not be working on Saturdays. Commissioner Huntingford stated there seems to be more details that need to be worked out. He is not against HEALTH BOARD MINUTES - MAY 24,1994 Page 4 the idea but would like to see an operating plan in place. Commissioner Huntingford suggested David Specter work with the group on working out these details and developing an operating plan. Until that is done he does not feel the Board should approve the request. Pastor Fosser asked if that meant that the group would have to wait a whole month until the Board meets again? Commissioner Huntingford stated if they get something developed sooner than that, then a Special meeting can be scheduled for the Board to review it. Pastor Fosser stated that they just received the list of issues today. If they had the list prior to today they could have responded more clearly. He added that this is the first he has heard about any physical issues with the facility. He was under the assumption that they would use the same facilities that Family Planning uses in the evenings. He presumes there is no Health Department staff working in the evenings. He was not aware that there were these kinds of issues that needed to worked out. Dr. Geerlofs stated he feels communication is an important part of this and the best way to proceed is for the group to address the issues discussed and come back for further discussion. Pastor Fosser stated he met with Jean Baldwin last week and he has not been out of communication with the Health Department. He added that he has only been dealing with the people he has been asked to deal with. The group thought they did everything asked of them at the last meeting and they are willing to do whatever else is necessary. Dr. Geerlofs stated that he has not been in the loop and he feels what would work better is for the group to work with the right people in the Health Department. He still has many concerns that have not yet been addressed. Commissioner Huntingford asked if Dr. Geerlofs would have time to meet with the group and David Specter and Jean Baldwin to work out the details and finalize a proposal to present to the Board? Dr. Geerlofs replied he would. Commissioner Hinton stated once the details have been worked out a special meeting can be scheduled to review the final proposal. ENVIRONMENTAL HEALTH DIRECTOR'S REPORT FOOD BORNE OUTBREAKS: Environmental Health Specialist Gwen Howard reported on two food borne outbreaks in Jefferson County. They have been unable to locate the sources because the food service management thought they could investigate and take care of it. However, the food service management does not always look at everything. Gwen Howard feels it is important to have a disinterested party conduct the investigation and do it as soon as possible. She reported that both were special events, not restaurants. Larry Fay added that emergency food borne outbreaks such as these can have a severe impact on staff time. The matter regarding publishing the food inspection scores of local restaurants in the Bremerton Sun Newspaper was discussed with the Food Service Advisory Committee. The committee prefers that the scores not be published in the paper, although some felt it would be good advertising. Larry Fay stated he met with a reporter from the Bremerton Sun and a member of the Food Service Advisory Committee and they decided to provide the scores if someone from the Bremerton Sun would come to learn about how the program works and what the scores mean. This way when the scores are published it doesn't appear to be Kitsap County versus Jefferson County. Gwen Howard stated that there was a problem this weekend in Brinnon during the shellfish festival. Last year she received complaints from the community that there were people selling oysters without a permit. This year she received an anonymous phone call giving her a name. She called the person's mother and sent them all the information they needed to get a permit. HEALTH BOARD MINUTES - MAY 24,1994 Page 5 When she got to the festival she found them not only selling oysters without a permit but they did not have any shellfish tags showing where the oysters came from. They were selling them out of a Uhaul type trailer. She closed them down. There was also a hot dog stand operated by some individuals she had been working with for two months on how to get a permit. Since they did not get a permit she closed down the hot-dog stand as well. REVIEW OF FINAL DRAFT ON SITE SEWAGE SYSTEM DESIGNER. INSTALLER. PUMPER, MAINTENANCE ORDINANCE: Larry Fay reported on draft #2 of the Onsite System Designer, Installer, Pumper, Maintenance Ordinance. The only change was made to part 15, Appeals Procedure, sections '.a" & "c". Section "a" states that "n. The appeal shall be reviewed first by the Jefferson County Board of Health". Section "c" states "Further appeal may be requested by the Licensee .n", "... Said appeal shall be heard by the Board of Commissioners". Since the Board of County Commissioners also act as the Board of Health it does not make sense for them to review an appeal of a suspended license as Health Board and then hold a hearing on the same appeal as County Commissioners. Therefore, the administrative review will be done by the Health Officer and his decision may be appealed to the Board of Health. These changes will be made and reviewed by the Prosecuting Attorney. A final draft will be prepared for adoption at the meeting in June. POLICY DISCUSSION/FINAL INSPECTIONS: Most of the onsite sewage systems that are inspected have no problems. The purpose of this policy is to allow more flexibility in doing final inspections. Random inspections will be conducted and if there are problems with a system the designer or installer will be put in an inspection program where their next five (5) systems will be inspected. If all five (5) inspections come out ok they will again be inspected randomly. The policy outlines some specific inspections that must be done for alternative systems and which will be the responsibility of the designer. Commissioner Huntingford asked if any of the installers have reviewed these policies? Larry Fay reported it has been reviewed by the septic advisory group and they plan to send it out to all the designers and installers for review and comment. WAIVER APPLICATION TO REDUCE SETBACK FROM DRAINFIELD TO STREAM FROM 100 feet to 50 feet; Zak Farid: Larry Fay stated Zak Farid is requesting a waiver for a reduced setback from 100 feet to 50 feet between his drainfield and a stream that runs across his property. The minimum required horizontal separation between a drainfield and a stream is 100 feet. However, the regulation does allow a reduction to 75 feet. Any reduction less than 75 feet needs to go through the process used locally and then be approved by the State Board of Health. Even though the nearest distance from the drainfield to the stream is 50 feet the main slope is going a different direction and there is little chance of effluent getting into the stream. If the Board approves this waiver today it will still have to be approved by the State Board of Health. Larry Fay was directed to contact Mr. Farid and advise him that the Board would like to see a higher level of treatment with a sand filter system before making a decision. If the applicant objects then he can resubmit the application in its current form. HEALTH BOARD MINUTES - MAY 24,1994 Page 6 DEPARTMENT OF ECOLOGY (DOE) WELL INSPECTION DELEGATION: Larry Fay will be meeting with some people from the Department of Ecology (DOE), Water Resources section, tomorrow (Wednesday, May 25, 1994). The Water Resources' budget was cut way back this year and many people were laid off. At the meeting tomorrow they will be discussing what the Health Department can expect from water rights processing and ground water items. They will probably also want to discuss delegation of the well-drilling, inspection, reporting, and licensing activities that DOE had traditionally done. There are some funds available to pay Counties for taking over these duties. ALCOHOL/DRUG ABUSE SERVICES DIRECTOR'S REPORT SAP COUNSELOR CONTRACT WITH PORT TOWNSEND SCHOOL DISTRICT: Chester Prudhomme reported that they have been talking with the Port Townsend School District about a Student Assistance Program Counselor contract. The School District has verbally committed to provide $5,000 for the remainder of 1994 and $10,000-$12,000 next year. Therefore the Health Department's contribution will be approximately $2,500.00 for next year. David Specter stated that the School District will fund it as long as the person is employed by the Health Department. One advantage to this is that the person would be full-time and with the school year only being 190 days the person would be available to the Health Department to help out with other programs for the remainder of the year. The Board concurred that the Health Department should proceed with drafting a contract with the Port Townsend School District. lOP SPACE PROBLEM: Chester Prudhomme stated he received a phone call last week from the Facilities Manager Warren Steurer regarding the utilization of space at the multi- services annex building. Planning and Public Works are looking to find under-utilized space for Growth Management Staffing. The space they are interested in using is currently being used at night (approximately 42 hours a month) for out-patient treatment. This space is grandfathered and if they had to move they would have to go through a recertification process with the State. The space is also used for one daytime program and they had planned to use it more this summer for daytime programs with high school kids. He feels the space could be shared. Growth Management staff could use it during the day and at night it could be used for the Health Department programs. The Facilities Department feels that would result in a security problem. The Board of Commissioners' recently received a letter from the people using the space for Health Department programs expressing their concerns. The location of the facility is important for the anonymity of the program. Commissioner Huntingford stated that he was informed that the Growth Management staff were going to be placed with the other Planning staff upstairs at the Courthouse. NURSING DIRECTOR'S REPORT FAMILY PLANNING UPDATE: In the absence of Jean Baldwin, Lisa McKenzie reported that the Health Department took over the operation of Family Planning at the beginning of May. They are seeing about 12 to 15 patients a week. They are hoping to target teenagers and people in their early twenties. HIV CASE MANAGEMENT: The two primary nurses doing the case management program had heard that there are approximately five (5) HIV positive people that have recently moved to this area. Possibly from hearing that this community has a referral and support system HEALTH BOARD MINUTES - MAY 24,1994 Page 7 in place. Most of those people were diagnosed somewhere else but have families in this area and have moved back for their families support. They had speculated that this was a result of how positive and supportive the community was to Mary Tudor. DIRECTOR'S REPORT PUBLIC HEALTH AND SAFETY NETWORK/VIOLENCE PROGRAM: David Specter reported that he has been to three meetings in two weeks on this program. Public Health has an important role in this program and the Health Department may be asked to take a leadership part. FINANCIAL REPORT: The Board was sent copies of the revenue and expense reports. Any questions can be directed to David Specter. The next meeting will be held on Tuesday, June 28, 1994 at 1:30 p.m. MEETING ADJOURNED SON COUNTY F HEALTH ~ EXCUSED ABSENCE Richard E. Wojt, Memb . " REQUEST FORM FOR WAIVER FROM WAC 246-272 (FoJllll!rly 248-96) Items (1) through (8) ~ust be completed to process waiver requests from WAC 246-272. The local health department must'approve the request and complete items (9) and (10) before the waiver is forwarcfed to tlieDeparanent ofHealth. fortlieir deciSIon. 'prease read and follow instructionS rioted on the reverse side. The instructions correlate to the numbers in parentheses. INDMDUAL REQUESTING WAIVER: (1) LOCAL HEALnI DEPARTMENT: (2) Name: LAir:' p;;!JR.11J Name: ...k.me.JdJ Address: f..:J !'fJfc, A)tc/,Ju lid ~ . Address: w.u S'UPPy';).I1", .'ftiIJ!1ICJiIDJ ~ 'Po12r-tVuJ.J SF~o Phone: (&fY/i /nc,,;J-3~~ Phone: ( ) 31?6-94'1'1 Propertyid....nfi....tion: (3) hA.efN--.j9"/( /iIJ/)AJ U)T s# ,t}i?/j/ tJ7/-4jn~3S~ ************************************************************************************ Please provide the following detail: WAC Number (4) I Reauirement in WAC (5) I .;J4/i-9q,-lcJcJ I /O()/~l7VtcJc -m >ueIltce wfi~ I TECHNICAL JUSTIFICATION: (1) -t1ft:; rt.ow FR/)).( -rJtti PRAIIIJPet..A )U!-€,q tVlU- ~tJ~(. J's--/OO'" n:er &;;i0-eE eiJcoUJJ7YVJJfj 7JIC 5~;<1 ~eCAl.<Se or me he-o~etV77ilZou (Jf" TJf6 S2-7C. 7')'!!eS",u.all-et:) );S'tZf!SUflO-J p,e~Jl)/Qe A/\J~ t..eVi!Z ct' -r~I"tCNI Waiver SOU2:ht (6) ! REt;tK-'?io.J 7V 50 -I-rEGr ! , I APPUCANTS ~ SIGNATIJRE:( ~_. ~ i,)//d" R'.s: TITI.E: JlR"/M.JF-R. ElATE: 1?f!YL/ ****************************************************************************** ***** LOCAL HEALTII DEPARTMENT COMPLETES Local Health Department Action: (9) Dare Received: ( ) APPROVED. Submir with justification ro DOH office nored on reverse side. ( ) DISAPPROVED. Return ro applicant. COMMENTS (especially concerning reasons for action): SIGNATIJRE: (10) TInE DATE: ~********************************************************************~*************~ DEPARTMENT OF HEALTI-l COMPLETES :::'eparrment of Health Action: (11) Dare Received: ( ) CONCUR. Return to Local health Department for granting of waiver request. ( ) DO NOT CONCUR. Return to Local Health Department for denial of waiver requesr. COMMENTS (especially concerning reasons for action): " SIGNA11JRE: (12) TInE ::.-'.TE: 73/~CN (01..1..1<-/ uw I 9 1994 .J .. ..... 83' -? 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