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WHATCOM COUNTY COUNCIL
Health Committee
January 20, 2009
Committee Member L. Ward Nelson called the meeting to order at 9:00 a.m. in the
Council Chambers, 311 Grand Avenue, Bellingham, Washington.
Present:
Carl Weimer
Also Present:
None
OTHER BUSINESS
Absent:
Barbara Brenner
Weimer moved to appoint Councilmember Nelson as Committee Chair.
The Committee concurred.
1. PRESENTATION AND DISCUSSION REGARDING MOBILE FOOD UNITS
(AB2009 -022A)
Tom Kunesh, Health Department, submitted a handout on the guidelines for
pushcarts and the Washington State Retail Food Code (on file). He described the process
for getting a pushcart permit. Pushcarts are not equipped as permanent kitchens.
Therefore, the code requires the pushcart owner to have access to a commissary kitchen to
work from. The State Board of Health uses the 2001 Food and Drug Administration (FDA)
food code plus a series of amendments as the State code. He described the code, and
specific sections for plan submission, approval and alternative food facilities, and pushcart
menu limitations. To include an item on the menu not allowed in the code, the applicant
would have to go through a variance process. Many of the coffee stands that don't move
are plumbed with water and waste, and therefore are not governed under the mobile vendor
portion of the code.
Mr. Call has a permanent building with a pushcart inside. The County Health
Department offered that option to be consistent with the code, as long as the cart remained
mobile and his menu remain limited. The property on which the pushcart is located does
not have an approved source of water or septic system for waste disposal. Water must
come from a group A or group B public water system. Waste must go to an approved
sanitary sewer or septic system. The mobile unit regulations allow waste water storage
temporarily in a holding tank. One cannot have a permanent water supply and a holding
tank for waste water. In the case of the Rocket Coffee stand, there is no permanent
connection to water and /or septic on site. The only option for this individual to obtain a
Health Committee, 1/20/2009, Page 1
1 permit was to operate as a mobile pushcart, to obtain water at an approved source off site,
2 and dispose of waste water at an approved site that is off site.
3
4 Nelson stated that owner requested a change. Kunesh stated the additional approval
5 for the Rocket Coffee site included a limited menu of coffee drinks and prepackaged,
6 approved foods. With that menu limitation and commissary agreement, Mr. Call's business
7 was approved. Subsequently, Mr. Call went beyond the approved menu and started serving
8 shakes and smoothies, which are things that require additional water use and additional
9 utensil cleaning on site. Mr. Call didn't have the capacity to do that with the water supply
10 and waste storage capacity that he had on site. In addition, it was in violation of the code
11 restrictions on pushcart menus. Once the Health Department learned of the additional
12 menu items, they required him to return to the menu and method of preparation for which
13 he was originally approved. Mr. Call expressed to the Health Department that he can make
14 accommodations for providing additional water capacity and waste storage capacity on site,
15 with an additional mobile three - compartment sink. There are additional infrastructure
16 requirements.
17
18 Nelson asked if there are other operators in the state with the extra infrastructure
19 system. Kunesh stated he checked with Skagit, King, Pierce, and Snohomish Counties.
20 Snohomish County did not respond to his query. The other counties indicated they may not
21 allow a pushcart, even with a limited menu, operate more than 250 to 300 feet from their
22 commissary. Pierce County and King County would not allow shakes and smoothies or a
23 portable three - compartment sink on the pushcart. The proposal for the added pushcart unit
24 was discussed, but not formally proposed in an application.
25
26 Weimer asked how many pushcarts operate in Whatcom County. Kunesh stated
27 most coffee stands in Whatcom County are permanent establishments. There may be a half
28 dozen pushcarts. He can provide a list. Most of the mobile units work at fairs and festivals.
29
30 Regina Delahunt, Health Department Director, stated the main message is that it's
31 okay to have a limited menu from a pushcart. To serve additional food, a pushcart would
32 need much more water and waste water storage capacity. Even if the pushcart were
33 expanded, the tendency is going to not really use the water as they should. It calls into
34 question whether equipment is properly sanitized. That's why pushcarts have a very limited
35 menu.
36
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38 2. DISCUSSION REGARDING BIOMEDICAL WASTE PROPOSAL (AB2009 -022A)
39
40 Jeff Hegedus, Health Department, stated the idea is to extend to pharmacies the
41 residential generator exemption in Whatcom County. Code (WCC) 24.06 for sharps disposal,
42 specifically retractable syringes used for influenza vaccinations. He submitted and read
43 from his handout (on file).
44
45 Nelson stated there were no retractable needles in 1990, when a study was done on
46 needle stick injuries to solid waste workers. Statistics show that they have to be careful of
47 intravenous (IV) drug user needles. He hasn't found any information that indicates
48 subcutaneous needle use transfers bloodborne pathogens. Hospitals and doctor offices use
49 the IV needles. The different needles are being used for different things.
50
51 They are trying to keep down the costs of regulatory practices to encourage
52 immunizations. Increased costs, even incrementally, will decrease immunizations. They
Health Committee, 1/20/2009, Page 2
1 would have to justify to the public a reason for protecting all needles. The two solid waste
2 facilities in the county don't have any problem with the retractable needles. Hegedus
3 stated if someone gets a needle stick injury, that person won't know what type of needle it
4 was or where the needle came from. They don't track needle stick injuries in solid waste
5 workers. The 1990 study indicates there is a risk. He hasn't been able to find a more
6 recent study.
7
8 Nelson stated they can check claims to Labor and Industries (L &I). The cost to
9 pharmacies for disposing needles is more costly than indicated. That increased cost will be
10 reflected in increased immunization costs. If they are going to work toward the public
11 health goal of increasing immunizations, find ways to reduce costs. Maybe the County can
12 collect the needles. Hegedus stated he talked specifically to the company that would collect
13 and dispose of the needles for pharmacies, who quoted him these specific prices. The
14 pharmacies would have to purchase the biomedical disposal containers even if the sharps
15 were disposed of in the solid waste stream. The extra cost of the container is nominal. The
16 cost of collection and disposal is minimal.
17
18 Weimer asked how easily the retractable syringes can be crushed. Hegedus stated
19 they are just plastic syringes with retractable needles. It's more protected than a non -
20 retractable needle.
21
22 Nelson stated he would like to know the problem on the tipping floor today, if that's
23 the concern. Wolpers stated that if they didn't have a cost - effective, private sector
24 infrastructure for autoclaving and transportation, or if that infrastructure were onerous for
25 some reason, there would be a reason to consider an exemption. However, a 15- gallon
26 container of sharps costs $32 plus $10 per month to dispose. This is a successful story of
27 developing waste management services that work.
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29 Weimer asked how many syringes could go into a 15- gallon container.
30
31 Nelson stated that would contain a five -year supply.
32
33 Weimer stated the cost per injection would be less than a penny. It seems like a
34 cost - effective system. He asked why an increased cost of a penny per injection is a
35 problem.
36
37 Nelson stated he can't even get recyclable containers from suppliers. Most put them
38 into the waste stream, as homeowners do. He wants to know why they are adding more
39 regulation and costs onto healthcare. It will take effort for all the pharmacies to collect their
40 materials. Hegedus stated Stericycle allows much smaller containers and provides shipping
41 boxes.
42
43 Nelson stated he would like information on the risk at local sites to see if that issue is
44 even relevant.
45
46 John Wolpers, Health Department, stated they should be able to gather that
47 information from L &I.
48
49 Nelson stated they are incremental things to do to protect safety, but they don't
50 show if it really is necessary. Recognize the changes in technology and see if there is a
51 need for these same restrictions. Wolpers stated they will pull that information and
Health Committee, 1/20/2009, Page 3
1 schedule another discussion. They can also develop language that would allow this
2 exemption for pharmacies.
3
4 Weimer asked if there is a risk other than from a needle stick to citizens and solid
5 waste workers at a facility. He asked if a bloodborne pathogen is on other garbage if it's
6 released at the solid waste site when the needle is run over. Wolpers stated he doesn't
7 think there is volatilization of blood.
8
9 Nelson stated the original, primary concern with needle sticks and reason for the
10 County needle exchange program was to manage IV needles that go right into the vein.
11 These needles go into the muscle, not the blood.
12
13 Regina Delahunt, Health Department Director, stated that if stuck, the risk is low.
14 The problem is the testing and everything else the person has to go through, including the
15 person's stress level.
16
17 Nelson stated that they must consider the cost to business. They must collaborate
18 with both sides to make a better community.
19
20 Weimer stated this isn't a new cost. It is an existing cost.
21
22 Nelson stated it is a new cost because pharmacies didn't do immunizations in
23 pharmacies.
24
25 Weimer stated the additional cost to. a consumer is one cent or five cents for an
26 immunization that costs $10 to $20.
27
28 Nelson stated the cheapest immunization now is $25. That impedes people from
29 getting immunization. He's not willing to raise the cost of immunization just because people
30 will pay it. He's asking if that extra cost is necessary or an extra burden.
31
32 Hegedus stated the cost to all waste streams is increasing. They take that very
33 seriously. If this is onerous in any way due to lack of infrastructure, there would be a better
34 cost - benefit reason to consider an exemption for pharmacies.
35
36 (Clerk's Note: End of tape one, side A.)
37
38 Nelson stated most pharmacies won't generate even one gallon. Hospitals and
39 clinics already have their own infrastructure and won't ask for their own exemption. This is
40 for small pharmacies. He would like to see the actual L &I claims to find out the potential
41 risk to employees.
42
43 Weimer asked how many counties do allow these into the waste stream. Hegedus
44 stated not all counties have biomedical waste regulations. According to Stericycle, everyone
45 uses their service. Clinics and pharmacies know that biomedical waste doesn't go into the
46 garbage, regulated or not. That's why Stericycle offers a cost - effective price. They have
47 great economy of scale.
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49 Wolpers stated they would bring forward more information.
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Health Committee, 1/20/2009, Page 4
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ADJOURN
The meeting adjourned at 9:54 a.m.
Jill Nixon, Minutes Transcription
ATTEST����
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Darien Br' Davis, rft✓il Clerk
•
WHATCOM COUNTY COUNCIL
WHATCOM COUNTY, WASHINGTON
Ward Nelso , C&nmittee Chair
Health Committee, 1/20/2009, Page 5