HomeMy WebLinkAboutBoard of Health September 22 20091
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WHATCOM COUNTY COUNCIL
Board of Health
September 22, 2009
Council Chair Seth Fleetwood called the meeting to order at 9:36 a.m. in the Council
Chambers, 311 Grand Avenue, Bellingham, Washington.
Present: Barbara Brenner, Laurie Caskey- Schreiber, Seth Fleetwood, Bob Kelly, Sam
Crawford and Carl Weimer.
Absent: L. Ward Nelson.
1. PUBLIC SESSION
No one spoke.
2 WHATCOM ALLIANCE FOR HEALTHCARE ACCESS
Steven Gockley, Whatcom Alliance for Healthcare Access (WAHA) Board President,
thanked the County for its support. He submitted and read from a presentation (on file).
The WAHA mission has three prongs, including connecting residents with services,
improving the system, and engaging in policy decisions.
Caskey- Schreiber asked about changes as a result of the Madrona and Peace Health
merger. Gockley stated no decisions have been made yet. He doesn't sense there will be
problems in specialty areas. A lot of effort is on emergency healthcare and diversions.
They will all be better off if they improve the flow of patients through the system.
Brenner asked if WAHA is supposed to consist of doctors who would provide services
for people who can't afford them otherwise. Gockley stated that is WAHA. They have
organized a way to work with specialty practices and emergency rooms to take on patients.
A lot of work is getting people on some kind if medical insurance plan.
Brenner stated she thought the main purpose of WAHA is to develop a coalition of
doctors for people who can't get services another way.
Caskey- Schreiber asked if they have been working with Peach Health to identify
common factors among people who use emergency room as frontline care. Gockley stated
they have.
Kerri Lenderman, Whatcom Alliance for Healthcare Access Executive Director,
continued to read from the presentation beginning with WAHA's on- the - ground services.
Brenner asked for data on the percentage of the people from different parts of
Whatcom County who use WAHA services. Lenderman stated she can provide that
information.
Board of Health, 9/22/2009, Page 1
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Gockley stated he would like to know if there are areas of the County they're not
reaching.
Caskey- Schreiber asked the point at which they can't provide the service because
there are too many people and the number of WAHA staff. Lenderman stated they continue
to refine the process and understand more about what people really need and how to
provide that information to them. They have developed a lot of self -help tools for
individuals. WAHA will provide information on resources, but people have to take personal
responsibility for securing their medical home. They are trying to empower people to take
responsibility for getting care in the right setting and setting up a medical home, so they
don't present in the emergency room. She and seven staff do this work. There is continued
demand for the services. Cutbacks make balancing services challenging.
Caskey- Schreiber asked who is coordinating all the participating providers.
Lenderman stated they contract with the Whatcom County Medical Society, which provides
a medical director for clinical guidance to their care coordinator. They also have
responsibility for recruiting specialists to ensure there are adequate resources to provide
that donated specialty care. They also work daily with the community health centers.
Gockley stated they are successful because of the collaboration among all
participants in the county.
Weimer asked how many county residents are uninsured. Lenderman stated 15
percent of the county residents, which is about 30,000 people, are uninsured.
Weimer asked about statistics on the use of emergency rooms for primary care.
Lenderman stated St. Joseph Hospital has seen a reduction in the use of emergency rooms
for non - emergencies.
Fleetwood asked if WAHA is the only organization that provides application
assistance. Lenderman stated she doesn't know of other organizations that provide medical
application assistance.
Gockley stated there are similar application programs that have low application
approval rates.
Brenner asked the percentage of doctors who are accepting Medicaid. Lenderman
stated they have talked about developing a program to identify that information.
Brenner stated she's hearing that many general practitioners are not taking new
Medicaid patients. That needs to be defined or the other parts won't work.
Gockley stated he is hearing the same issue about access to primary care.
Brenner stated she prefers they use the term "family physician" or "general
practitioner" instead of "medical home."
3. HiNi UPDATE
Greg Stern, Health Department, described the pandemic, including its history and
effects on the community. Schools are seeing increased absenteeism. People should stay
home when they're sick. Confirmation testing is only done on severe cases. The virus is
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circulating. They are not talking about containment, not slowing transmission. Few people
hospitalized with this flu end up dying, compared to regular flu. More people are susceptible
because fewer people have built up immunity. The H1N1 vaccine is not available for
commercial use. The Centers for Disease Control and Prevention (CDC) established a
priority list of people who are eligible until there is enough supply to cover everyone. About
half the population of Whatcom County will be eligible. About 12,000 people in the county
are in the highest priority group. It should be distributed late October. They don't anticipate
closing schools or public events. If they do go to closure, it will be all the schools in the
county, including events. That would be done regionally or statewide. He read the
statistics regarding the H1N1 virus (on file).
Fleetwood asked how someone gets the flu. Stern stated the virus is in respiratory
secretions. It may also be spread by contact and aerosol.
Brenner stated it seems like just another bug they have to get used to, yet they are
talking about pandemics and command posts. She asked if the concern is being hyped up.
Stern stated the risk is about the same as seasonal flu, but many more people are
susceptible. A concern is the impact on community systems, such as the healthcare
system.
Caskey- Schreiber asked where university students go for treatment.
Regina Delahunt, Health Department Director, stated they can go to the university
health center. The flu is more prevalent in the younger age group.
Stern stated treatment and testing isn't necessary for the flu.
Caskey- Schreiber asked if it's better with anti -viral treatment. Stern stated the anti-
viral treatment may take a day off a four -day illness.
Fleetwood asked about younger people getting this flu more often than older people.
Stern stated adolescents and adults under the age of 50 are getting the flu more often.
Usually infants and folks over 65 are hit the hardest.
Fleetwood asked about complications from the medication. Stern stated there have
been secondary complications from weakened immune systems. He described the side
effects of the vaccine.
Delahunt stated that since the spring, they have had an incident command structure
in place in Whatcom County. There are three incident commanders. The incident command
system has gone from a planning phase to an operational phase to distribute the vaccine.
The incident command focused on the system for vaccine and anti -viral distribution and an
alternative medical care system that can be activated if the current medical system
becomes overwhelmed.
Kelly asked what would trigger an alternative medical care system. Delahunt stated
there isn't a specific trigger. They'll know when medical offices become overwhelmed.
4. ONSITE SEWAGE OPERATIONS AND MAINTENANCE UPDATE
John Wolpers, Health Department, stated he would go through questions from
Councilmember Crawford. Initially, 5,585 notifications went out since they started the
Board of Health, 9/22/2009, Page 3
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program. Over 8,000 first and second letters have gone out. The number of inspections or
reports of system status (ROSS) that have been submitted is 4,092. The department has
received a total of 2,640 of those routine compliance ROSS. Of those, 1,052 were
satisfactory, 707 needed maintenance, and 81 were failures. The second type of ROSS is
the property transfer. The department received a total of 1,452 property transfer ROSS. Of
those, 844 were satisfactory, 533 needed maintenance, and 75 were failures. Therefore,
they are seeing a four percent failure rate, which is what they anticipated.
They began in the Drayton Harbor watershed shoreline management area. The
compliance rate was 85 percent. They looked at 350 targeted properties. The compliance
rate is those who received the notice, had the inspection performed, and submitted the
ROSS to the Health Department. The first notification allows 60 days, and the second
notification allows another 60 days.
They are also working on the Birch Bay, Chuckanut, Lummi Island, and Lake
Whatcom watersheds. In 2010, they will move to Point Roberts and Bellingham Bay. Last,
they will begin to move inland.
There are about 35 licensed operations and maintenance (O &M) specialists. The
Health Department is doing quality control checks on those specialists.
Homeowner training classes are ready to go for individuals who completed their
initial evaluation in the Drayton Harbor watershed. They have issued a press release on
those classes to the general public and specifically to those individuals. He described the
classes, which will be specifically tailored to the systems belonging to the class participants.
Regina Delahunt, Health Department Director,
Warren Loop, resident, stated he understands this is a difficult program for the
County, and it is highly emotional for residents. He explained his situation with his mother's
property. The failure letter sent to his mother is worded in such a way that causes distress
to residents. The Health Department told him that the options were to fix the problem or
move. He spoke to Executive Kremen, who reassured his mother that she wouldn't get
thrown off her property. He had to learn about this process in Skagit County. Skagit
County handled the situation much better than Whatcom County. Skagit County has
programs, low- interest loans, and grants in place. They educated the populace on the
purpose of the regulations. He went through their education program.
Whatcom County dumped this program on its residents. The bank has been
inundated with requests from people who need loans to fix their systems. The County has
put these residents through this problem in a bad economy. He is a safety coordinator at a
refinery. When he puts new regulations and rules on people, he educates them first. Most
citizens probably don't know about new regulations. Whatcom County doesn't have low -
interest loan or grant programs. This Council and the Health Department didn't understand
how emotional these regulations are to the constituents, who were treated terribly.
Whatcom County's planned training is scheduled during the day when most people
are at work. Skagit County schedules its training in the evening. He asked if the training
covers Glendon systems.
Wolpers stated they don't address Glendon systems because those systems are
proprietary.
Board of Health, 9/22/2009, Page 4
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Loop stated Whatcom County prefers the Glendon systems.
Wolpers stated that's not true.
Crawford stated many professional system designers in Whatcom County like the
Glendon systems. Therefore, the Health Department gets a lot of Glendon proposals.
Glendon did a lot of effective marketing to the local designers.
Loop stated the designers he talked to said they know they can get a Glendon
system approved by Whatcom County. The installer told him that Whatcom County doesn't
require that system, but that it prefers that system. Therefore, it was more cost to his
mother. That is wrong. From now on, his mother will have to spend about $300 per year
to have her system inspected. She spent her entire savings on this new system. The
Health Department staff need to realize they work for the people of Whatcom County. They
need to treat the resident with respect and work with the citizens.
Wolpers stated they hope to get going on a low- interest loan program. They have
applied for State and federal funds. They were awarded $1.25 million through a federal
program, but weren't able to apply the funding to an onsite sewage loan program. It was
tailored more for a public works program. They intend to have Shore Bank do this program
for the County.
He doesn't know who Mr. Loop talked to about his options. They've never evicted
anyone or vacated the property. For those individuals who have difficulties, they extend
timelines as long as the homeowners are making good faith efforts to do something. Health
Department staff are looking at those failures to make sure it really doesn't effect public
health to the point where it causes disease.
Brenner stated she has requested for years that the Health Department set up
programs like Skagit and Island County programs, but was told that those programs
wouldn't work. She's never been told why they won't work. Law - abiding citizens are
scared. Instead of waiting for State funding, use County funds right now. Delahunt stated
they had a low- interest loan program years ago. It didn't work because the County isn't set
up as a loan company. There were defaults on loans, so the County had to repay the loans
with general fund money. Now, they propose to use a bank to administer the program.
Brenner stated other counties have been using Shore Bank for years. Wolpers stated
three other counties use that bank. They received Puget Sound funding.
Delahunt stated Shore Bank only recently agreed to expand into other counties.
Wolpers stated Whatcom County is the next county in line to try and get this going.
Crawford asked what will happen to a homeowner who just can't afford a loan or any
more debt. Delahunt stated the process is to find a way to get systems fixed. The County
has been doing this for years. There has always been a way to get the system fixed. There
are only two options, which is that the system is fixed or the home is vacated, which
happens very rarely. When the house has been vacated, the homeowner decided to sell
and it was a rental house. Once or twice in 20 years have they gone to court to make a
determination.
Crawford asked if the County can work with people who need to wait a year or two,
until they get back on their feet economically. Wolpers stated that scenario is happening
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right now. Those situations aren't causing contamination, so those people are on an
extended timeline, and the Health Department is keeping an eye on it.
Crawford asked if someone has to have a first inspection and ROSS before taking the
class. Wolpers stated that is correct. They want to concentrate on individuals who need it.
Crawford asked when the classes will get to gravity systems. Wolpers stated there is
a three -year window before they need classes on gravity systems. Skagit County and other
counties have a general class. Whatcom County classes are geared specifically for the
systems owned by the class participants.
Fleetwood asked about the daytime class concern. Wolpers stated they scheduled
the classes when the venue was available. The classes are full, and they have a waiting list.
If necessary, they can schedule classes after hours. The class participants will complete a
survey to help refine future classes.
Brenner asked if there has been a ROSS approved by the inspector and then was
rejected by the Health Department. Wolpers stated it is usually a status of maintenance
needed, not failing. No satisfactory report has been reversed completely.
Loop stated they need education to help people understand the reason for the
regulations. No one has been educated.
Wolpers stated people have been educated appropriately. Some individuals may not
like it. It's a new regulation. They have been doing this since 2007.
Al Melton, 1420 Mt. Baker Highway, Bellingham, stated he wants to know why the
federal funds were incompatible with the Whatcom County program.
Wolpers stated there was no way to jump through the required federal hoops to
secure funding. The funds didn't allow contracting with an actual homeowner or licensed
provider. Representatives from the State Department of Ecology (Ecology), County
Finance, and County Treasurer went through this. The money was passed through the
State Department of Ecology from the federal Environmental Protection Agency (EPA),
which wouldn't budge on its requirements. Other counties also couldn't take the money
because it didn't fit with a loan program.
Melton stated the federal government started this issue by telling them to clean up
Puget Sound. He asked when they might get funds from the Department of Ecology.
Wolpers stated he'll find out next week. When the County applies for funds, it will be
ranked and have to meet criteria. Then Ecology will offer funds. They are also looking for
grant dollars in addition to loan dollars. Grant dollars need to be used to provide forgivable
principal.
Melton stated that anyone can check the systems with the right materials and
information. He doesn't understand why someone can't go ahead with the classes before
getting to the systems that are only every three years.
Tom Graham, 5570 Starry Road, Bellingham, asked if gravity flow systems work
better than above ground systems, since they only require inspections on gravity flow
systems every three years. He asked why they are insisting on above - ground systems as a
replacement when they can fix a gravity flow system for less money. Above ground
Board of Health, 9/22/2009, Page 6
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systems are ugly. He doesn't understand why they are requiring above - ground system
when there is room for a gravity system.
Crawford stated the Board has spent several years on that question.
ADJOURN
The meeting adjourned at 11:38 a.m.
Jill Nixon, Minutes Transcription
The Council approved these minutes on , 2009.
ATTEST: WHATCOM COUNTY COUNCIL
Please contact the Council Office to obtain an
official, signed copy:
360- 676 -6690 or council(§-.o.w hatcom .w a.us
Board of Health, 9/22/2009, Page 7