HomeMy WebLinkAboutBoard of Health April 15 20141
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Whatcom County Council
Board of Health
April 15, 2014
CALL TO ORDER
Council Vice -Chair Ken Mann called the meeting to order at 10:30 a.m. in the County
Council Chambers, 311 Grand Avenue, Bellingham, Washington.
ROLL CALL
Present: Barbara Brenner, Sam Crawford, Rud Browne, Barry Buchanan, Ken
Mann and Pete Kremen
Absent: Carl Weimer
4. SEXUALLY TRANSMITTED INFECTIONS (STIs) IN WHATCOM COUNTY
Crawford stated he asked for this presentation after reading an article on work being
done in Spokane about rising gonorrhea rates. It's been several years since the Board of
Health has had a presentation on sexually transmitted diseases.
German Gonzalez, Health Department, read from the presentation in the Board
packet (on file).
(10:46:41 AM)
Crawford asked if partner therapy is counseling of the patient's partner. Gonzalez
stated it is, and it ensures the partner gets adequate treatment.
Crawford asked why Whatcom County's percentage of partner therapy is going up,
while provider percentages are going down. Gonzalez stated the patient's partner is not the
patient, so more providers are calling the Health Department for that service.
Crawford asked how many people are working on partner therapy and what
resources the County has. Gonzalez stated the County has one nurse. This service is
almost a full -time job.
Crawford asked if the County is able to follow up with patient partners. Gonzalez
stated they make extreme efforts to get in contact with the partners.
Crawford asked the actual number of cases in Whatcom County per year of STIs.
Gonzalez stated he will provide that information.
Crawford asked if there is some partnering that needs to go on with Western
Washington University. Gonzalez stated they identify key players in the next phase of the
program. They also partner with schools to have knowledge in the population before they
reach the age where there are problems.
Crawford asked about the effort needed at the university for response. He asked if
university students have available clinic services.
Board of Health, 4/15/2014, Page 1
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Greg Stern, Health Officer, stated he works part -time at the Western Washington
University student health center and described the services provided by the health center.
The numbers provided in the statistics of this presentation are of reported cases. Students
will be charged for medications, but the cost is not as much as going to a private doctor.
Regina Delahunt, Health Department Director, stated they now have enrolled over
11,000 people in Whatcom County for Medicaid due to the Affordable Healthcare Act, so
that should help with access for some of these cases.
Brenner asked about STI resistance. Gonzalez stated STIs can be treated. A
bacteria becomes more resistant when the wrong antibiotic is used. So far, they haven't
had anything like that happen here. Antibiotics are working.
Stern stated treatment guidelines for gonorrhea have changed to require two
antibiotics to reduce resistant strains and avoid emerging resistance.
Kremen asked the ages of the 11,000 local residents enrolled in the Affordable Care
Act. There was hope that a lot of young people would become enrolled. It's very
important, especially with STIs. Delahunt stated she would provide that information. Most
of the 11,000 enrolled are not in this age group.
Brenner stated those 11,000 enrolled in Medicaid don't pay much into the system.
Delahunt stated some of the 11,000 could now get treatment.
Brenner asked if more people are getting STIs than the flu. Gonzalez stated they
can combine the flu and common cold. Proportionally, there are more STIs than the flu.
Brenner stated syphilis facilitates the spread of all, not many, STIs. Gonzalez stated
the lesions from syphilis and gonorrhea increases the chances for infection by the HIV virus.
For certain STIs, there's no evidence that supports that statement.
Brenner asked why more females get chlamydia. Gonzalez stated that in his
experience, females go to the doctor more and are diagnosed. Males don't necessarily go to
the doctor and aren't diagnosed as much.
Crawford asked if prevention is from condom use. Gonzalez stated primary
prevention is not having multiple partners. Barrier protection is the condom.
Crawford asked if the condom is the prevention for people who are sexually active,
and whether someone can get an STI while using a condom. Gonzalez stated the condom is
the primary prevention method for people who are active. Technically, people can't get an
STI with a condom unless it breaks.
Brenner asked why they don't hear much about STIs as much now as in the past.
Gonzalez stated it has become more normal. HIV was the talking point because it used to
be a death sentence. Now there is treatment and people can survive. They suffer from
selective memory. People are more acquainted with STIs and treatment has gotten better.
Prevention and health education have evolved. They are still working on preventing the
diseases, but they're still happening. They are still working in the community to address
specific issues.
Board of Health, 4/15/2014, Page 2
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Stern stated there have been a lot of changes, including a change in diagnosis.
These statistics show reported cases, which are just a few of actual cases. The cases
reported change over time due to more sensitive testing and more routine health checks
during which they will pick up more diagnoses.
Browne asked what they're doing to increase awareness for the critical population
who aren't in university, and what are the particular challenges for those kids to get
treatment. Gonzalez stated the school districts don't have a standard approach for
education. One goal is to have a complete approach in their educational campaign.
Evidence shows educational campaigns help reduce STIs.
Stern stated sex education is not standardized and can be controversial. Focus on
what keeps kids healthy, and have those discussions with respect for people's beliefs, so
they may move ahead. They may need a forum to have the discussion. Determine the
barriers to treatment and come up with proposals to address them. It's a communicable
disease that is transmitted throughout the population. They keep viewing it as an
individual's disease, and the patient is responsible for treating it. The community pays for
the consequence of not treating it. How they spend public resources to deal with the
problem is a policy question.
Browne stated he wants to understand the cost components for identification and
treatment to see if they can drive the costs down and be more effective.
Mann stated the problems are also with high school -aged children. He encourages
policy that supports the scientific evidence for education and prevention in the schools. He
supports any effort to deal with the controversy and bring all parties to the table. Stern
stated evidence is necessary, but not sufficient to bring the community together.
Brenner stated the walk -in clinic should not charge $150 for STI screening when
other places charge as little as $20. Walk -in clinics are supposed to be less expensive for
people. Do something about walk -in clinics. Stern stated they're private businesses. Their
purpose is to increase access to healthcare, not on reducing costs. Often, it can be more
expensive to go to a walk -in clinic.
Buchanan asked the cumulative estimate for the chart on STD age distribution.
Gonzalez stated it cumulative for STIs. The data is taken over one year.
Gonzalez referenced and gave an update on the recent measles outbreak. Locally
there are six cases. Staff responded quickly. He hopes they will finish observation of the
existing cases soon and there will not be any other outbreaks.
I. PUBLIC SESSION
No one spoke.
2. PUBLIC HEALTH ADVISORY BOARD UDPATE (11:14 :12 AM)
Doug Benjamin, Public Health Advisory Board (PHAB), updated the Board on recent
advisory board comprehensive planning activities. The PHAB held a workshop and staff
have researched national trends to compare with local data. They identified a list of
priorities to identify best practices for Whatcom County. The work plan was given to the
Planning Commission in March.
Board of Health, 4/15/2014, Page 3
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Also, Councilmember Weimer asked the PHAB to contribute to the water action plan
development. The PHAB looked at some of the material, and they will address it at the
meeting on May 1. Staff are putting together information and questions for the advisory
board. He hopes the advisory board will have recommendations for the plan soon. Shellfish
contamination and onsite septic systems (OSS) are the primary public health issues. He
asked if there are other special water related issues the Board wants the PHAB to consider.
list.
Mann stated look at nitrates in groundwater in the north county.
Brenner stated look at Lake Whatcom water quality.
Browne stated he would like to know what the PHAB can think of to include on the
Kremen stated that if the PHAB considers everything, it should prioritize those items.
Benjamin stated they will consider priority and also which items can be worked on
that would have an impact.
Mann stated consider other areas where there is direct drinking water withdrawal,
such as from Lake Samish and possibly the Nooksack River.
Browne stated consider the water quality of wells and water district compliance with
water quality testing and treatment. Fecal coliform issues come from dairy farms, hobby
farms, wildlife, and industrial plants.
Mann stated consider Lummi Island arsenic issues.
Brenner stated she would like to know what chemicals end up in the bay.
Benjamin stated they are recruiting for an open position on the PHAB, which is the
natural sciences position.
Mann asked about integration of mental health and chemical dependency at the
behavioral health organization. Delahunt stated there will be a discussion at the Finance
Committee on April 22, and it will go to advisory board after that.
3. DECONTAMINATION OF ILLEGAL DRUG MANUFACTURING OR STORAGE
SITES (11:25:01 AM)
Jeff Hegedus, Health Department, gave a staff report on property contamination
from places where methamphetamine (meth) is either cooked or used. There is a health
risk from residual methamphetamine on surfaces where meth was produced or used. They
will begin to see more and more of the nonproduction sites that are contaminated. He
described the cleanup process with the property owner and the health effects from low level
meth exposure. Recent funding received for cleaning up illicit use sites has ended. They
will begin to see more and more of these nonproduction sites that need to be cleaned. He
described the safety standard and process for testing for contamination. Amend the code to
require cleanup of illicit use sites in addition to the production sites.
(11:37:32 AM)
Board of Health, 4/15/2014, Page 4
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Mann asked about long -term symptoms of someone who lives in a house that used
to be an illicit use site. Hegedus stated the 1.5 microgram level is for infants, the most
susceptible population.
Mann asked if the County is paying the cost of an investigation and cleanup.
Hegedus stated the County pays for staff time, lab time, and indirect costs. The landowner
pays for cleanup. The County is not recouping the $1,100 cost since the Department of
Ecology stopped providing funding.
Buchanan asked the difference in level of contamination between a user site and a
processing site. Hegedus stated there isn't a direct correlation. It depends on how much
was used over a short or long period of time.
Brenner stated that if the County finds contamination, the County's costs should be
reimbursed by the property owner. Hegedus stated the purpose today is to discuss by what
mechanism would make sense for Whatcom County.
Brenner stated she has a pamphlet on landlord tips that the Housing Authority and
other property owners can use to screen its applicants. Hegedus stated the County staff
train the Housing Authority staff and professional property managers.
Mann asked about the protocol for testing for contamination in all areas of a
property. Hegedus described the testing process.
Browne asked if the landlords can claim for the cost of cleanup on their insurance,
including the County's cost and whether a user site is reported on the title. He's concerned
about the long -term impact on property value. Hegedus stated the landlord can be insured,
but it's rare that private landlords are insured for this. Housing Authorities are typically
insured for cleanup. As awareness increases in the community, more landlords will get
insurance. The report on title simply indicates a report that the property exceeds cleanup
standards. It can be a stigma.
Mann stated it's a good incentive for property owners to not let it happen on their
property.
Browne asked if there are different standards of cleanup according to whether the
surface is accessible to infants, such as a carpet compared to a ceiling. Hegedus stated
there is no difference.
Kremen stated he would like Health Department staff to write a draft ordinance to
amend Whatcom County Code (WCC) 24.13 with their recommendations to adequately
address the issue. The Board can fine -tune the language. Also, consider the value of the
home. These structures are lower priced structures that don't have much value. A cleanup
cost of $30,000 could be one -third of the value of the structure. Make sure the inhabitants
of these contaminated structures aren't at risk.
(I1: 56:52 AM)
Mann stated the three requests from staff are whether they want to look at the
cleanup standard, try to recoup County costs, and consider technical assistance versus
regulatory compliance.
Board of Health, 4/15/2014, Page 5
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Delahunt stated they will ask the advisory board to work on those questions and
bring it back to the Board with some recommendations.
Brenner stated include the real estate industry. Make sure they hand out literature
to tenants and landlords. Hegedus stated he gets several calls a week about tenants and
prospective property buyers about potential for meth contamination.
Browne stated have an approach that encourages compliance as opposed to
imposing regulations and penalties.
Mann asked if the Board wants to hand this issue to the Public Health Advisory
Board.
Kremen stated the staff should first come up with a document to work from, and
then help the advisory board on the priorities so the advisory board can provide a
recommendation to the Board of Health.
Mann stated they can get the advisory board to make a recommendation on
technical assistance more than the policy issues.
Delahunt stated the advisory board can give a community perspective on the
potential public policy issues. Staff will share the technical information with the advisory
board.
Browne stated have a definition for a controlled substance and determine the penalty
if an owner gives false statements in the process.
Brenner asked if contamination would eventually go away if a house is left alone.
Hegedus stated it will if the environment is hot, ventilated, and over a long period of time.
It depends on how much contamination exists.
Kremen asked if there is a decrease in meth use recreationally, because heroin has
become less expensive. The Sheriff indicated there has been a reduction in meth activity in
Whatcom County. Delahunt stated meth use is decreasing, and heroin use is increasing.
Kremen asked if there is less likelihood of injurious health contamination from heroin
production and use than from meth. Hegedus stated no one is regulating residual
contamination from heroin. It may be a new problem no one is looking at yet.
Stern stated the County Code defines contamination as methamphetamine, mercury,
lead, and volatile organic compounds. Regulations address contaminated sites. Residual
marijuana and heroin aren't addressed in the code. In terms of environmental risk, he
hasn't heard that walls and carpets in areas where marijuana and heroin have been used is
an issue. The contamination standards for production sites can indicate contamination from
other things that aren't measured. The distinction between a production site and a use site
is important.
Also, methamphetamine is a pharmaceutical and can be prescribed for medical
purposes. The issue is actual health risk from low level, long -term exposure versus toxic
acute exposure. California's revised standards are looking at actual health risk. If they
balance health risk versus property cost, consider whether they can change standards
without excess cost.
Board of Health, 4/15/2014, Page 6
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Browne asked if asbestos is covered by different rules. Stern stated it is.
Browne asked if the County code doesn't include a standard for any material they
should be measuring. Hegedus stated lead, mercury, and other materials are from
production facilities. The State regulates production facilities. The County is adding
methamphetamine from illicit use sites. Focus on illicit use sites rather than production
facilities. The State has jurisdiction over production facilities. The County adopted the
State requirements by reference and then add the requirement for cleanup, regardless of
why there is contamination.
Browne described the history of how methamphetamine was developed.
ADJOURN
The meeting adjourned at 12:11 p.m.
The Council approved these minutes on May 6, 2014
ATTEST:
, Council Clerk
-, Minutes Transcription
WHATCOM COUNTY COUNCIL
WHATCOM COUNTY, WASHINGTON
Ken Mann, Council Vice -Chair
Board of Health, 4/15/2014, Page 7