HomeMy WebLinkAboutBoard of Health July 29 20141
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Whatcom County Council
Board of Health
July 29, 2014
CALL TO ORDER
Council Chair Carl Weimer called the meeting to order at 10:34 a.m. in the County
Council Chambers, 311 Grand Avenue, Bellingham, Washington.
ROLL CALL
Present: Barbara Brenner, Sam Crawford, Barry Buchanan, Ken Mann, Pete
Kremen, Rud Browne, and Carl Weimer
Absent: None
1. PUBLIC SESSION
No one spoke.
2. DIRECTOR'S REPORT
Regina Delahunt, Health Department Director, stated they are in the midst of a
public health accreditation process. They met 90 percent of the 97 standards in the review
process. Only three standards were not met. There is a gap in data and measurement.
The department will get the accreditation in September. They have not done a good job of
having measurable, demonstrable measures, but they are working on it. If they don't get
accreditation, they will have a year to make adjustments. The review board determined
that their greatest strengths are: nurturing community partnerships; assuring critical health
services are provided in the community; and positive communication between the
department and the governing body. Their greatest challenges are: specific, measurable,
time - framed strategies and objectives in the Community Health Improvement Plan (CHIP),
the strategic plan, and the operational plans; timely implementation of plans; and
systematic data analysis for trends and program effectiveness.
They are working with the Public Health Advisory Board (PHAB) on updating the
strategic plan. They will bring the update forward in October for feedback on strategic
priorities for the next four years.
They were awarded the local health department of the year award by the National
Association of County and City Health Officials (NACCHO). They won the award as a result
of the Board of Health's policy decisions.
Weimer stated the Developmental Disability Advisory Board spent a recent meeting
talking about measurable metrics. Delahunt stated it's an area they want to focus on.
Brenner asked if there will be an information technology upgrade that will help put
that measurable information together. Delahunt stated they have the technology. It's a
matter of focusing on it and making sure the measures are in place.
Board of Health, 7/29/2014, Page 1
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Kremen asked if the accreditation board is aware of the award. Delahunt stated they
are the same organization. The County will be accredited. It's just a matter of whether the
accrediting board wants the County to do a little more work before accreditation.
Weimer asked how many counties are accredited. Delahunt stated around 40 to 60
are accredited. It's not many. It's a new program. The State Department of Health and
Spokane County are accredited. Whatcom County is the third entity in Washington State to
have applied.
Browne asked if they will benchmark the County against State and national
information. Delahunt stated they will. They will align with national benchmarks and other
measures that are reported statewide.
Browne stated he would like to see a benchmark that places and keeps people on
eligible benefits as long as possible, rather than going in and out of the system.
Mann stated he congratulates Ms. Delahunt for the award. All in the department
deserve it. He's grateful for the Health Department.
3. PUBLIC HEALTH ADVISORY BOARD (PHAB) UPDATE
Doug Benjamin, Public Health Advisory Board Chair, stated the Board has a full
complement of members. Three issues they reviewed include the decontamination of illegal
meth sites, the water action plan, and the budget.
They have prepared a letter regarding their recommendations on the water action
plan. They also developed a matrix that categorized the long list of water issues in terms of
public health jurisdiction. They will provide the Board of Health with a copy of that matrix.
Weimer stated he thanks the Advisory Board for addressing the water action plan
and asked if the Advisory Board appreciates having suggestions from the Board of Health
about issues to discuss. Benjamin stated it does. That's the way the process should work.
The Advisory Board members have broad areas of expertise.
Weimer stated the Board of Health members often don't have that expertise to
address health concerns that the community brings forward, such as herbicide spraying
using Roundup. That may be a good issue for the Advisory Board to review. Benjamin
stated they will put that item on the Advisory Board agenda.
4. BUDGET /PROGRAM PRIORITIES
Regina Delahunt, Health Department Director, stated she would like to focus on their
priorities for the upcoming budget, including restructuring and making changes. She would
like feedback from the Board about restructuring. She referenced and read through the
budget background information in the Board packet (on file). Each program manager will
present the priorities in their areas.
Community Health
Astrid Newell, Health Department, stated they want to focus on building the
foundation of lifeline health in childhood, developing healthier neighborhoods and
communities, and helping families with special needs. Each area is connected to the
community health improvement plan developed with community partners. Continue the
Board of Health, 7/29/2014, Page 2
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current programs in those areas. In addition, invest time and resources in coordination for
the Community Health Improvement Plan (CHIP). Use State flexible grant dollars to do
that. Also, focus on the East County area, which lacks resources. The community is ready
to come together to address issues of community safety and the wellbeing of families and
children. They will dedicate a nursing position to that area.
Delahunt stated the Human Services program area is also focusing on the East
County. They will work in tandem. They will focus some resources to make sure the CHIP
happens, but the community and several agencies will also invest resources into making
sure the plan happens. A meeting is planned in August to figure out how all that will
happen. It will cost in total about $250,000. It is coming together nicely.
Mann asked about a past shift away from providing services to taking a bigger role in
policy. He asked how that shift is going. Delahunt stated that shift is away from individual
nurses who provide services to individuals and toward using nurses who bring people
together, find resources, and bring in other community partners.
Mann asked if they are happy with that philosophical shift and if it's working.
Delahunt stated they are happy with it. The department still has to provide some services,
but they will continue to shift where they can when others are capable of providing services.
Kremen stated he supports the East County initiative. This community is very
important and in need.
Browne stated it seems there is an improving level of community engagement and
pride in the East County. He asked how to clean up the derelict properties in that area, to
continue raising the sense of community pride. Delahunt stated that is a difficult issue.
There is a task force, but the jurisdictions have limited enforcement capacity.
Browne asked if the County can proactively buy some of those properties that come
up at tax auction, clean them up, and put them back on the market. Delahunt stated the
Health Department will take over the solid waste fund from the Public Works Department.
They will be able to spend more time thinking about the system as a whole and the
programmatic emphasis they can place on solid waste in the county. That suggestion is an
issue around which they can bring partners and community members. The solid waste
program needs enhancements.
Brenner stated the County shouldn't buy properties. Instead, put a lien on the
property so the County inherits the property, instead of buying it at auction. Delahunt
stated they can make it a community -based solution by working with the community
leaders and the various health department programs.
Brenner stated do a better job of community trash pickups and drop -offs. Delahunt
stated they can emphasize that program.
Browne stated contact the Northwest Clean Air Agency to provide burning
alternatives.
Environmental Health
John Wolpers, Health Department, stated they want to concentrate on the Health
Department's role in the water action plan through the Onsite Sewage (OSS) program. A
portion of the $19 fee can hire someone to help with operations and maintenance (O &M).
Board of Health, 7/29/2014, Page 3
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There is a growing issue with Portage Bay, which will be designated as a marine recovery
area (MRA). They try to improve water quality where they have jurisdiction. They plan to
partner with the pollution identification and control (PIC) program being developed with
other agencies and departments to figure out why there is so much degradation in the
waterways.
Delahunt stated they won't need additional funds for this position. They have been
able to generate more revenue than anticipated. The new position will be covered by fees.
It can better insure O &M is being done, particularly in Portage Bay.
Wolpers stated another area in which they want to concentrate is with the solid
waste fund and solid waste programs that are currently in the Public Works Department.
The solid waste program used to focus on infrastructure, but the system has become more
privatized. The Health Department has always been involved from a health standpoint, and
they know the people involved and how the funding sources work. They can do a lot of
work on solid waste planning. Many programs exist that aren't being used, which can help
clean up the areas in East County, for example. They can do education and outreach.
There are litter programs they can develop with community partners. They will bring
forward an additional service request (ASR) for a solid waste specialist. Convert the current
solid waste staff to an environmental health specialist.
Brenner stated the solid waste fund is healthy. Delahunt stated there are resources
in the fund balance.
Wolpers stated a third focus area is restructuring the food program. They try to
inspect establishments once per year. They do a lot of plan review, and more businesses
are opening. There are also special events that come up. They must redefine the
inspection frequencies and base them not on seating capacity, but on the complexity of the
menu.
Delahunt stated the fee structure assumes they will inspect each facility annually.
However, some facilities need inspection more often and others need inspection less often.
They will restructure the fees based on the risk the facility's menu poses. With that
restructure, they will adjust fees accordingly over the next four years. Their goal is to have
a minimum number of inspections designated for each facility while having the permit fee
cover the cost of the service provided, including the overhead. They won't achieve that in
one year, because the fees for some facilities will be raised too high too quickly. They are
also considering whether or not they want to submit an ASR right now for an extra position
for the food program. Now, they can do 900 to 1000 inspections per year. With the new
structure, they will have to complete 1,400 inspections per year. In the first year, they
won't generate enough revenue to cover the additional staff person, but they will be able to
generate enough revenue in the next three or four years. It is a policy decision on how high
the fees are raised and if they want to supplement that additional inspection cost the first
few years.
Brenner asked if they could have a flat fee and then charge an additional fee for the
more complex facilities. Don't lower the fees. People who violate should get charged. In
addition to menu complexity, consider the people who don't comply. Delahunt stated there
is an additional fee for those who don't comply.
Wolpers stated menu complexity and the risk to the individuals who dine at the
facility are reviewed.
Board of Health, 7/29/2014, Page 4
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Browne stated the community wants more restaurant options in the area. Don't
discourage people from opening restaurants. The approach of menu complexity may have
unintended consequences. He doesn't want to discourage complex menus. Also, monitor
restaurant review websites to see what the patrons are saying.
Wolpers stated they aren't talking about doing anything new with menu complexity.
Other counties have already used this model. There are different ways to structure fees. It
won't raise fees. They are reassigning different establishments within the proposed fee
structure.
Crawford stated also inspect various unknown wedding venues around the county.
The Planning Commission is taking on the issue of wedding venues. It may be something
the Health Department may want to look into.
Communicable Disease and Epidemiology
German Gonzalez, Health Department, stated they will continue their efforts in
communicable disease and control. They plan a couple of changes. The first is to the
tuberculosis (TB) program and managing latent TB infections. There are community
resources that can help address complex cases to make the staff's time more efficient.
They have been studying this change for the past year, and it is based on solid evidence.
The second change is to the immunization program. They must improve vaccine
coverage in the county. The staff have limited time to give vaccines to patients. They are
proactively referring patients to services instead. There is a proposal to suspend the
immunization clinic, which gives immunizations to children one afternoon per week. They
surveyed why people come to the Health Department, and they are addressing those
reasons and referring people to providers. They propose to stop the weekly clinic and will
allow the nurses to continue to help providers and to implement more visible programs that
can affect immunization rates. They want to mirror outcomes from the Healthy People
2020 initiative. They will retain the ability to give vaccines as needed to those who cannot
get a provider. The Department doesn't have the manpower to make an impact on the
community directly, so it's necessary to have strategic alliances with stakeholders in the
community. For example, there is a task force to deal with sexually transmitted infections
(STI). They will recruit more people to help fight the problems and be more effective.
They have also convened a task force on infection control and prevention for nursing
facilities and nursing homes. Prevent outbreaks by creating a task force that includes
emergency medical services (EMS) and hospital staff. Address long -term infections in those
care facilities.
Brenner asked what is latent TB and if there will be a TB vaccine. Gonzalez stated
the person with latent TB has been exposed to the infection, has a risk of developing an
active infection, and becomes a risk to others. Those with latent TB are not contagious. A
TB vaccine is available in other countries, but it's questionable whether it works. They don't
use it in the United States.
Brenner asked about infections at hospitals. Gonzalez stated it is a big issue. Make
sure they have a coordinated effort, and people know what is happening when someone
with an infection is discharged. There must be standard procedures.
Buchanan asked about potential upcoming communicable disease issues, such as
recent breaches in containment and the Centers for Disease Control and Prevention (CDC)
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and ebola. Gonzalez stated they don't anticipate upcoming problems. They have a good
communicable disease surveillance system and good communication and coordination with
healthcare providers. They are working on partnerships with schools, such as Western
Washington University.
Dr. Greg Stern, Health Department, stated the surveillance system depends on
relationships with the public and community clinics. People must report in a timely way.
They work with emergency preparedness staff to allow them to quickly identify and respond
to issues. They have the capacity to recognize, communicate, and respond to any potential
problems.
The policy shift doesn't eliminate direct services, but it has the appropriate balance
with policy system and development.
Human Services
Delahunt stated housing revenues are down by 40 percent. They don't see that
trend changing. Staff is blending funding streams to keep the services at the highest level
possible. Some services may drop off. Mental health court is happening. They are in the
hiring process for a mental health coordinator. Behavioral health integration is happening
to combine substance abuse and mental health funding streams at a regional level. They
must make sure the local needs are met. Behavioral health will also be integrated with
primary care in the next three to five years. The improvements to the triage program are
necessary to meet all their needs. They will remodel the current facility to make better use
of the existing beds. An additional service request (ASR) will come forward for short -term
improvements. In the long term, have a secure facility where EMS and law enforcement
can drop people off. That will take some policy change by the State in the next few years.
Staff will work with the Board to support that policy. They will need a complete facility
redesign for that. Dollars are set aside for a change to that facility.
Weimer asked if money for the triage program will be blended into the costs of the
new jail. Delahunt stated they discussed co- location of the two in the past, but they
decided it may not be in the best interest of the two.
Weimer stated triage may help reduce the number of beds they need at the jail. He
asked if the funding for that should somehow be a part of what the voters think about.
Delahunt stated $3 million is for the facility, and there are also significant ongoing
operational costs.
Crawford asked how they are going to invest in the facility on Division Street.
Delahunt stated they will put in about $60,000 to make the facility more functional. Now,
they aren't able to fill all the beds because of reduced functionality.
Crawford asked if a permanent triage facility will be in town. Delahunt stated they
don't know yet where it will be located.
Mann stated there are so many designated funding streams. He asked what it will all
look like in a few years given the recent changes to the Affordable Healthcare Act. They
have little control over so many things. Delahunt stated they have been struggling with the
uncertainty for a couple of years. They're predicting as best they can as they go along. All
they know is that things will change in the next two to four years. She doesn't know how
the system will settle.
Board of Health, 7/29/2014, Page 6
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Crawford asked the time table for moving out of the State Street facility. Delahunt
stated they will stay at State Street for the time being. There will be remodeling done at
the Civic Center building. The plan was for administration and the Human Services program
to move into the Civic Center. The staff at State Street would move into the Girard Street
building with Environmental Health. Those plans aren't decided, and it likely won't be this
year or next year.
Crawford stated the remodeling costs haven't come through the Council yet.
Delahunt stated the Executive plans to bring those forward this fall.
Browne stated he would like to have a presentation on the levels of response if there
is a major disease outbreak.
S. COUNCIL DISCUSSION AND RECOMMENDATIONS REGARDING HEALTH
PRIORITIES
(Clerk's Note: See item four for discussion and recommendations.)
Delahunt stated it sounds like the health department is heading in the right direction,
and the Board members aren't opposed to anything they plan.
The Board concurred.
ADJOURN
The meeting adjourned at 12:05 p.m.
The Council approved these minutes on September 30, 2014.
ATTEST:
Dana Brown - Davis, Council Clerk
Jill Nixon, Minutes Transcription
WHATCOM COUNTY COUNCIL
WHATCOM COUNTY, WASHINGTON
Carl Weimer, Council Chair
Board of Health, 7/29/2014, Page 7