HomeMy WebLinkAboutBoard of Health October 29 20131
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Whatcom County Council
Board of Health
October 29, 2013
CALL TO ORDER
Council Chair Kathy Kershner called the meeting to order at 10:30 a.m. in the
County Council Chambers, 311 Grand Avenue, Bellingham, Washington.
ROLL CALL
(10 :30:24 AM)
Present: Barbara Brenner, Ken Mann, Carl Weimer, Sam Crawford, Bill
Knutzen and Kathy Kershner.
Absent: Pete Kremen.
1. PUBLIC SESSION
No one spoke.
2. PUBLIC HEALTH ADVISORY BOARD UPDATE AND RESOLUTION
Regina Delahunt, Health Department Director, stated the Public Health Advisory
Board has been discussing this item.
Doug Benjamin, Public Health Advisory Board Chair, stated the impact of childhood
trauma on mental health, substance abuse, and long -term physical health is significant.
This isn't about a specific service. It's about how services are provided. It's about a
sensitivity of service providers of all kinds. The Advisory Board concluded this is about how
to have an overall paradigm shift of how they provide services. Consider the impact of early
trauma, how to address it, how to mitigate it, and how to inoculate against it. The more
they address it, the more they can prevent it from occurring in the future.
To shift the paradigm, they must put forward and approve an idea that this is a
concept they want to put on the table and get support for. The Advisory Board asks the
Board of Health to approve this idea through the resolution, and the Advisory Board will
begin to build the idea into all services, including contracts.
Through his professional experience, he has been struck by how early trauma can
impact long -term health. This is the key public health issue. When they deal with how to
pay for healthcare, the simplest thing is to be healthier. Don't have long -term, chronic
health conditions such as hypertension, diabetes, and obesity, which are very expensive and
have the biggest impact on population health. These illnesses are directly connected to the
kind of trauma they're talking about. Science can map why early trauma produces certain
chemical changes in the body that later on lead to these adverse health outcomes. The
long -term impact to overall health is significant. It has a greater impact than the kinds of
infectious diseases that public health works to eradicate.
Board of Health, 10/29/2013, Page 1
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Mann asked how compassionate approaches are built into contracts. Benjamin
stated one example is to specify certain kinds of training that staff and service providers
must have regarding sensitivity to these issues. There is a growing movement about how
to design and provide services. The pact regarding compassionate schools is a great model
for how these concepts can be woven into educational systems.
Delahunt stated many contracts have specific training or certification requirements of
staff. Contracts could include requirements that staff must have a certain number of hours
of training in compassionate approaches.
Mann stated they are describing a culture in the school that begins with the principal
or school district. It may be difficult to find a principal able to begin this culture shift.
Benjamin stated an Advisory Board member is a professor at Western Washington
University (WWU) and an expert in this field. The professor has a graduate student who is
also a school principal in Tacoma. Her research is to move her school toward this model,
including implementing and measuring the movement.
Mann asked if they are talking about giving momentum and credibility to the
movement by declaring they believe it and want to pursue it. Benjamin stated that's
correct. All the resolution asks for is the Board of Health to approve this cultural shift.
Ann Deacon, Health Department, stated 50 percent of the Nooksack Valley School
District population is transient. They have a difficult time building a school community
culture. They seek help from the Health Department to figure out how to build a more
compassionate community to engage this population. A Bellingham School District school
had a high incidence of gang membership. The Health Department put together a
curriculum that addressed the entire community of that school. About 500 people showed
up for a community event at the school to connect people to their community. There are
best practices to help get there. The school districts ask for help to get there also.
Brenner stated the idea is wonderful. Her first thought is to ask why this hasn't
already been done and why is it new. As someone who has experienced all those childhood
traumas, it made her a stronger person. She's nervous about where they draw the line
between compassion and pampering. Recent commercials about how horrible it is to bully
doesn't ring true to her. Something is missing. She would like to see people in charge of
this who have experienced this trauma. They would have the best connection with kids.
People who take classes can't substitute for people who have experienced trauma. Offering
classes on something that should be common sense isn't going to get people to change their
behaviors. The most benefit to someone who is hurting is one -on -one interaction with
someone who understands their pain. Everyone comes away from community meetings
feeling good about themselves because they attended. Those 500 meeting attendees
probably aren't the ones causing the problems. There needs to be one -on -one interaction
with the person at risk and the bully, or the person who makes people feel bad. It was
vague, but she likes the idea of people being more compassionate. She doesn't know how
much this kind of thing really works. There needs to be a component that says they won't
put up with that kind of stuff. There can't be one without the other. She asked if a
consequences or responsibility component will be included. There should be emphasis on
that.
Benjamin stated the Advisory Board had some of this discussion. It became clear it
wasn't their responsibility to dictate on the level of individual services. To get there, they
need a cultural shift, where they all understand how important this issue is. The Advisory
Board backed up and decided to approve an idea and incorporate this idea into all the
Board of Health, 10/29/2013, Page 2
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services. They aren't at the level of individual services. The Health Department staff want
buy -in on the idea so they can build the culture into services and contracts in any way
possible. The Advisory Board and Health Department staff will continue to remind the Board
of Health about this idea.
Delahunt stated this is a start at the policy level. From there, they will move into the
service level that Councilmember Brenner is talking about. A lot of groundwork needs to be
done. This connects with elements of the Community Health Improvement Plan (CHIP)
goals.
Knutzen stated to change the culture, they must involve other partners. Have the
State Department of Social and Health Services (DSHS) on the same page. A lot of faith -
based organizations in the community can provide insight. It's a great start. He asked if
they've talked with anyone at DSHS. DSHS doesn't seem to have any kind of mission
statement or driving force behind it. It would be nice if they could all be on the same page,
with some kind of end in mind. Look at other partners in the community besides the school.
Delahunt stated the whereas statement about promoting the concept is aimed at working
with others. They have talked with DSHS.
Brenner stated a number of people contacted her who have worked hard to turn their
lives around to get their children back. She doesn't necessarily take someone's word for it,
but these people really did it. She went into meetings with them and their DSHS
representative and was appalled at the way the people were treated. It got to the point
where the DSHS representative refused to work with the person if she was present. She
wasn't butting in. She was just there. A lot of stuff was going on in some of these
agencies. The bad ones make it difficult for the people trying to do a good job. She was
shocked. If they are going to do something like this, she wants the teeth to say people who
are found to not be doing this need to be fired when they're in a position of helping the
most vulnerable people. It was awful to sit through.
Kershner stated this is similar to the goal to end homelessness. She supports the
policy of this. She asked if they've thought about how much it might cost to agencies who
do work with the Health Department. Delahunt stated the Health Department won't take a
heavy- handed approach. It's a collaborative approach to see what an agency needs to
move in this direction, which may include some revenue in the contract to do this. This is
the direction they want public health to move. It's not fair to penalize the contractor and
not provide sufficient revenue if this is something they really want to see in the community.
Kershner asked if there is a funding source for this kind of thing. Delahunt stated it
depends on the contract. When possible, they will work with each contractor to see how to
structure it. When buying a service from a contractor, they might include something within
the contract to reference training or the manner in which services are delivered.
Benjamin stated this is about best practices and evolving information. All service
providers work to improve their services. Service providers look for signals about what they
should study in continuing education to continue improving their practice. This is one of
those signals. It is a way services can improve. That's how they build this into the culture.
Brenner stated one of the biggest impediments to compassion is burn -out. When her
kids were in school, she saw the difference between teachers who just got out of college
and were really excited and one particular teacher who had been teaching for many years.
That teacher would actually fall asleep in class. Burn -out is a big factor that will cost
money. She asked if this presentation has been given to the school districts. Delahunt
Board of Health, 10/29/2013, Page 3
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stated different school districts have been involved in this discussion. She agrees that the
burn -out factor is a big issue.
Brenner stated there is a cost to dealing with that.
Kershner stated there is also a cost if they don't do it. They continue to see the
results of not getting to the real problem. Benjamin stated that in terms of healthcare, it is
much less expensive to prevent, intervene early, and mitigate problems than to deal with
health outcomes.
Kershner stated they will want to see some empirical data in the future.
Mann stated call it 'trauma sensitive" or "compassionate approach" but not both.
Benjamin stated parents are sensitive to having their kids labeled as experiencing trauma.
They prefer the notion of a compassionate approach, which is more descriptive of what
they're trying to do. He doesn't know what will appeal to people or best communicate the
idea. The Advisory Board used the language interchangeably.
Delahunt stated the CHIP uses the compassionate community approach. It's more
widely embraced in the community and the term staff prefers.
Crawford stated he's skeptical that legislating compassion does anything, but he will
support the resolution and the Health Department's recommendation.
Knutzen moved to approve the resolution.
The motion carried by the following vote:
Ayes: Brenner, Mann, Crawford, Knutzen, Kershner and Weimer (6)
Nays: None (0)
Absent: Kremen (1)
3. GROUP B REGULATIONS
Kyle Dodd, Health Department, gave a staff report and stated the State code has
been revised and will become effective January 1, 2014.
Knutzen asked to see the map of all systems in the county. Dodd stated he can
distribute that information. Group B systems occur throughout the county. The occurrence
of Group B systems is wherever development is proposed, is required to have public water,
and where there are no existing public water systems in the area that are able to serve the
development.
He referenced and read through the staff report in the packet describing the new
system requirements.
Crawford asked if these rules are applied to new applications and are not retroactive
to existing systems. Dodd stated that is correct, unless they choose to expand. He
continued the staff report.
Brenner stated the State information has a waiver provision that the County could
issue if the water source doesn't need treatment, as long as they do monitoring and
maintenance. Dodd stated the State code has an option. They would have to explore that
in detail if they want to implement the option consistently. It's a potential option. He
Board of Health, 10/29/2013, Page 4
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concluded the staff report. Monitoring is currently required. Realistically, only 20 percent of
water systems are in compliance. They have an opportunity to catch people who don't do
monitoring at the time they ask for a new connection. The additional connections will have
to go through a water availability review process and current sampling will be required.
Brenner asked how a waiver would apply. Dodd stated a waiver may not be the
most appropriate thing to apply. A section of the code addresses situations where they can
require monitoring. If they believe a public health threat exists, if there is known
contamination in the area, if a well is subject to some sort of event, or if a known disease
outbreak occurs, they can require monitoring. It won't be a general requirement in the
code. It will still be recommended, but not required.
Brenner asked what happens if someone has problems and agrees in writing to do
monitoring and maintenance. Dodd stated they expect people to submit applications that
address how they will monitor. The rule says they have to provide a safe and adequate
drinking water source. The only way to ensure that is to monitor. This is not about
requiring a waiver. It's not a regulatory requirement to move forward.
Brenner stated the new rule says the source has to be clean.
Regina Delahunt, Health Department Director, stated Councilmember Brenner's
question is about the requirement that a contaminated source doesn't get approved.
Previously, an owner or operator of the system could provide treatment, and the County
would approve it. The question is whether there is a process for a waiver that includes
continuous monitoring if the source is contaminated and the owner decides to provide
treatment.
Dodd stated there is a pathway to get there.
Delahunt stated a waiver process would be for that situation, decided on a case -by-
case basis, depending on the contaminant, for example. That's the waiver section that
gives them that option.
Brenner stated it's not in the County code. Delahunt stated the County code is
written to adopt all changes to the Washington Administrative Code (WAC) when they
become effective. They are not here making major changes to the code. It will become
effective after the effective date by reference.
Brenner asked if the waiver is a change. Delahunt stated it is not.
Knutzen stated that if the County chooses option one, to turn this over to the
Department of Health (DOH), it will take nine months to a year to get a permit and require
a $1,000 fee. If the County continues its program, the permit process is 60 to 90 days and
a $650 fee. Option two is the simplest way to go.
Dodd stated the County has a choice to continue to take primary responsibility for
group B water systems, like it has in the past or turn the oversight over to the State DOH.
The County provides better customer service than the State. They've demonstrated the
County can provide the service more timely and cost - effectively, based on their review
times and fees. The County is responsible for recommending approval of water sources to
the Planning Department anyway. They are in a better position to remain engaged about
where these water system approvals are when requested.
Board of Health, 10/29/2013, Page 5
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Crawford moved to request the Health Department bring forward an ordinance
using option two, to continue with the current group B water system program using the
revised Washington Administrative Code (WAC) 246 -291 as it is currently written.
Delahunt stated staff will bring forward an ordinance to amend the code.
Mann asked if someone who is approved for six connections, but only has four
connections, and has arsenic contamination, for example, would have to get a waiver to use
the two unused connections. Dodd stated that's not correct. That system would be an
existing system, approved prior to the new code. That system would operate according to
rules in effect when that water system was approved. As long as they don't choose to
exceed beyond the number of connections for which they were approved, they would be
allowed to operate as -is. They still have to get water availability to go from four
connections to six connections. The Health Department would require water quality
monitoring to make that decision, but would not apply the new code to that scenario. The
Health Department would provide feedback in that scenario that recommends continued
monitoring and treatment. However, they wouldn't deny water availability because the
system was approved under the current rule.
Knutzen asked if only Chuckanut, Lummi Island, and H Street only have arsenic
contamination. Dodd stated those are the three main areas where wells are in rock
formations. Those are the highest concentrations.
Crawford stated there is an area north of Ferndale with issues. It's all over. Dodd
stated that's correct. Those three areas have the highest concentrations.
Brenner asked if the County can modify the rules so the County can do what it is
doing currently. It seems like they can do what they do now, except for arsenic, if someone
is willing to enter into a contract as part of a waiver system. She wants to make as few
changes as possible. The arsenic has to pass a level of ten parts per billion (ppb). Dodd
stated that's correct.
Brenner asked if the owner will be allowed to use a source that may not be perfectly
clean if they agree in writing through the waiver process to do monitoring. Dodd stated
they would have to have assurances that are outlined in the waiver process.
Delahunt stated that the State code includes a waiver section in the State code that
the County can use to address this issue.
Kershner asked if the arsenic level is in the State code. Delahunt stated it is.
Crawford stated the level is set by the Environmental Protection Agency (EPA).
Weimer stated he supports option two. He asked if the County has the option to
change its mind about which option it prefers in the future, and give the oversight back to
the State Board of Health. Dodd stated they can. The joint plan of responsibility is renewed
every four years.
Weimer asked if the County can decide in a few years to set well monitoring
requirements that are stricter than the State, if necessary. Dodd stated they can.
Weimer asked if someone moving into a house on one of these group B systems
would know their water is not being monitored. Dodd stated it's required to record a notice
Board of Health, 10/29/2013, Page 6
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to future property owners, which includes detailed information about the system, who is
responsible for maintenance and operation, that it is an unmonitored system, and there is a
recommendation that an owner monitors the system to ensure the water source is safe.
The buyer will get those papers at closing.
Brenner asked if a change to the code to require monitoring would apply to existing
systems. Dodd stated it depends on whether they decide to make it retroactive.
The motion carried by the following vote:
Ayes: Brenner, Mann, Crawford, Knutzen, Kershner and Weimer (6)
Nays: None (0)
Absent: Kremen (1)
OTHER BUSINESS
There was no other business.
ADJOURN
The meeting adjourned at 11:30 a.m.
The Council approved these minutes on November 26, 2013.
ATTEST:
, Council Clerk
-, Minutes Transcription
WHATCOM COUNTY COUNCIL
WHATCOM COUNTY, WASHINGTON
Kathy Kershner, Council Chair
Board of Health, 10/29/2013, Page 7