HomeMy WebLinkAboutBoard of Health October 4 20051
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DISCLAIMER: This document contains the Whatcom County Council or Committee
minutes, as approved. However, unless an attested signature page is attached, they
are not the final approved minutes.
WHATCOM COUNTY COUNCIL
Joint Meeting of the Board of Health and Public Health Advisory Board
October 4, 2005
Council Chair Laurie Caskey- Schreiber called the joint meeting to order at
5:30 p.m. in the Council Chambers, 311 Grand Avenue, Bellingham, Washington.
WHATCOM COUNTY COUNCIL MEMBERS
Present: Absent:
Barbara Brenner None
Dan McShane
Sam Crawford
Seth Fleetwood
Sharon Roy
L. Ward Nelson
PUBLIC HEALTH ADVISORY BOARD MEMBERS
Present:
Andy Byrne
Laurie Caskey- Schreiber
David Davidson
Lavern Lane - Oreiro
Chris Phillips
Mary Ellen Shields
John Worlund
1. PUBLIC SESSION
No one spoke.
2. 2006 HEALTH DEPARTMENT WORK PLAN
Absent:
Jenny Shuler
Regina Delahunt, Health Department Director, stated she would discuss
priorities for the Board of Health and Public Health Advisory Board for 2006.
The work plan is structured in the format of the public health standards for
Washington State. There are five key areas. She read the five key areas. In the
past, public health work plans and work have been divided into health programs.
Dividing the work into the five key areas makes the work more understandable.
It's easier to see the big picture of what public health is all about.
Recently, a State Department of Health audit was completed. It looked at a
baseline of how local health departments can fulfill all the standards developed for
Board of Health, 10/4/2005, Page 1
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DISCLAIMER: This document contains the Whatcom County Council or Committee
minutes, as approved. However, unless an attested signature page is attached, they
are not the final approved minutes.
Washington State. The State and the auditors were impressed with Whatcom
County's work plan for meeting all the public health standards. It was designated
as an exemplary practice in Washington State, and can be used as a model for
other jurisdictions.
The financial information in the Council's packet includes the department
budget, expenses, revenues, and the current expense fund contribution. There is
also information on non - personnel expenses and the percentages of the budget
spent on each of the public health standards.
The first standard is Understanding Health Issues. It is about doing
assessments. Local health departments must understand the health issues in the
community. The department must evaluate the issues by looking at data and
making sure the policy decisions are based on the assessment the department has
done. In the past, they've been lacking in this area, as most other public health
jurisdictions have lacked in this area. This year, they were able to hire a health
information specialist, which is the position to help do community assessment work.
Also, in 2005 they updated four sections of the Health Status Report, which
was last updated in 1996 or 1997. It should be updated at least every three years.
The Centers for Disease Control and Prevention (CDC) fellow who worked with them
enabled the department to do that work.
In conjunction with the Coalition for Healthy Communities, they assisted with
a project for tracking community health indicators. It's a large pilot project.
Whatcom County is one of four communities in the nation that was selected for this
project. She hopes to have it up and running next year. A lot of staff resources
helped with data collection for that project.
Last, they completed the 2002 behavioral risk factor survey. The last survey
was done in 1997 or 1998.
There are quite a few priority actions for 2006. In the past, they have not
been strong in evaluating the programs to make sure they make a difference in the
community. There are many good programs, but they don't have much evidence
showing the programs are effective or the best programs the department can have.
This year, with the new health information specialist, they will pick a few programs
to set up indicators and evaluation measures.
They also want to continue with the update of the Health Status Report,
including the communicable disease section.
Brenner asked who is included in the coalition. Delahunt stated there are
many members.
Board of Health, 10/4/2005, Page 2
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DISCLAIMER: This document contains the Whatcom County Council or Committee
minutes, as approved. However, unless an attested signature page is attached, they
are not the final approved minutes.
Phillips stated the primary sponsors include the hospital, Health Department,
United Way, and the Whatcom Community Foundation. They have provided the
financial support. Many other organizations are at the table.
Delahunt stated the coalition includes school districts, physicians, and others.
Caskey- Schreiber asked if there is a Council representative. Delahunt stated
they don't. They would welcome one.
Davidson stated physical activity program planning will be undertaken in
2006. In the same vein, they are looking to understand health issues. He asked if
an evaluation of the status in the community can be done at the beginning of the
program planning. Delahunt stated that is a good suggestion.
Brenner asked if the County is involving people in the on -site sewage (OSS)
operations and maintenance (O &M) business in the 2006 goal to plan and conduct
evaluations of programs for OSS O &M. Delahunt stated they are. The Public
Health Advisory Board has a subcommittee that meets and involves a variety of
stakeholders in the planning process.
Davidson stated the subcommittee has been challenging, especially with
staying focused on what they are really trying to do. They are making progress.
Staff will put together a suggested framework for an O &M program. The
subcommittee has some ideas.
Caskey- Schreiber stated Island County has a program that the subcommittee
might want to look at. Delahunt stated that putting a program together is an
enormous undertaking. There are many different interests at the table. Everyone
wants to do everything. It's difficult for the committee to prioritize.
Roy asked if there is representation on the subcommittee from the Shellfish
Districts. Delahunt stated there is.
Roy stated they should look at what they need to protect the resources they
have, particularly water resources, and see what they need to do. After that, see
how they will fund what they need. Don't adjust what they need to do based on
what they think they can pay for. Figure out first what they need to accomplish.
Don't let funding limit their thinking on what they need to do.
Brenner stated there should be a yearly fee for operations and maintenance
for anyone who has an on -site sewage. She asked if that fee could be attached to
their taxes. Delahunt stated those are ideas that the subcommittee is discussing.
They aren't limiting their perspective based on what they can pay for.
Nelson stated the subcommittee is trying to think inside of a box, yet it must
determine the proper response to septic systems. On -site septic systems don't
contribute to all the degradation.
Board of Health, 10/4/2005, Page 3
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DISCLAIMER: This document contains the Whatcom County Council or Committee
minutes, as approved. However, unless an attested signature page is attached, they
are not the final approved minutes.
McShane stated the idea is to get a good understanding of these issues.
Delahunt stated the purpose is to take a look at developing measures to see if
they're making a difference with the existing programs. Take a look at the outcome
measures to see if the programs are making an impact.
McShane asked if the program for children with special healthcare needs is
an individual program. Delahunt stated it is one program that looks at many
different needs the children have.
McShane stated they will figure out a way to measure that. He suggests
they have that information as a baseline before they embark on a new physical
activity program. Delahunt stated they will have baseline outcome measures to see
if the programs make a difference.
Brenner stated it seems they have the data that shows who has OSS
systems. They know the different types of soils and drainage in the county. People
are in the business of O &M. It doesn't seem like a big jump to set up a fee
schedule and an O &M schedule for everyone with an OSS system. Make it so that,
by law, people must do O &M. The County can keep a copy of the contract to know
that O &M is happening regularly. They need to make the determinations of what's
working, but there are people who do that.
Worland stated the issue is that they need a hammer. They really need a
voluntary compliance program unless they are going to have a huge bureaucracy to
check 30,000 tanks that have to be checked every year to three years. The issue is
how to structure a program to get people to cooperate voluntarily and what to do
with people who don't cooperate.
Delahunt stated a lot of discussion by the subcommittee is enforcement. It's
a huge prospect.
Caskey- Schreiber stated Island County has very steep fines for people who
do not keep up a septic tank system. People take it seriously.
Crawford stated the goals for this program are sweeping. If they are going
to emphasis things, include education, which is huge. People who have septic
systems have lifestyle issues ingrained, but others don't. Some people wait until
they have septic problems before doing any maintenance. There are a lot of
educational things that would help a lot. The issue is discerning the problem users
from those who do a good job of maintaining their systems. Delahunt stated the
evaluation would be in relation to the educational programs they have in place.
Caskey- Schreiber stated this is a high priority among councilmembers.
Board of Health, 10/4/2005, Page 4
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DISCLAIMER: This document contains the Whatcom County Council or Committee
minutes, as approved. However, unless an attested signature page is attached, they
are not the final approved minutes.
Roy stated this is a really important topic to her. She's pleased to see the
emphasis on it. Delahunt stated the subcommittee summary would get to the
Board of Health in November.
Delahunt stated the next standard is Protecting People from Disease. It
encompasses the communicable disease programs and emergency response
programs. They need to focus on disease surveillance. They do a good job at
disease response. Upfront surveillance has suffered in the past, just because they
don't have the capacity to focus on it. They would like to focus on it more. It's not
listed as a priority action in the coming year, but it is something they want to focus
on in the future. Now, they are focusing on emergency response plans. The major
accomplishments include controlling the pertussis outbreak in 2004.
Davidson stated there is a great opportunity now to look at the pertussis
response that occurred last year. That could be a priority now. Delahunt stated
that is another standard where they are not as strong as they should be. It's still a
capacity issue. The communicable disease nurses are busy constantly trying to do
control rather than surveillance.
Shields stated a pertussis immunization is coming soon for adolescents. It's
supposed to be available in this state sometime this year. Medicaid currently funds
it.
Dr. Greg Stern, Public Health Officer, stated there were multiple episodes of
pertussis last year. The idea is to prevent infants from getting sick. They've done
well at preventing that. The instances of pertussis is cyclical around the nation.
Previously, pertussis vaccinations were available for kids under the age of seven.
Now, there is a vaccination for adults and adolescents. Adolescents are the primary
reservoir. There are vaccines available for different age groups. It is in the process
of being approved by the federal government and Washington State. The State
pays for all vaccines for kids under the age of 19, so it's a budget issue. There is a
time delay between when the federal government approves the vaccine for use and
the State approves it for funding. People can order the vaccine now.
Roy asked if the upswing in pertussis has to do with the parents who do not
vaccinate their children. Stern stated it does not. Vaccinations protect the
individuals. It's only 80 to 85 percent effective and may reduce the severity of the
disease. There is a huge reservoir of adults and adolescents who haven't been
vaccinated. It won't impact its spread through society.
Roy asked if they are seeing effects of parents who choose not to vaccinate
their children. Stern stated it is an issue they're looking at. The State Board of
Health is looking at the exemption policies from schools.
Crawford asked if the nurse giving out fake flu shots was a Health
Department issue and if there was any discussion about how they can keep that
from happening. Delahunt stated it was not. It was a State Department of Health
Board of Health, 10/4/2005, Page 5
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DISCLAIMER: This document contains the Whatcom County Council or Committee
minutes, as approved. However, unless an attested signature page is attached, they
are not the final approved minutes.
licensing issue. Internally, they have discussed what the Health Department can
do, which is education to people who host flu shot clinics. They make sure the
providers have checked the people they invite to clinics.
Stern stated the department sent out information this week to clinic hosts.
Delahunt stated there are two things to do in 2006 for the second standard.
One is to test the plan for mass vaccination in case of an outbreak. Public health
nurses will try to vaccinate 1,000 per day.
Caskey- Schreiber asked if there is any word about the avian flu. Delahunt
stated this topic is the second thing to do for the second standard. This year, they
plan to finalize the plans for pandemic flu and SARS. There are draft plans for
responding to those outbreaks. They have been involved in many meetings about
the pandemic flu. Unfortunately, not a lot that can be done once the influenza hits.
A vaccine can't be developed until they know the strain of influenza circulating in
the community. It takes a vaccine six to nine months to be readily available.
There are preparations they can do. Should avian influenza strike, a challenge will
be maintaining community infrastructure. It's something the Department of
Emergency Management must plan for. Education will be important.
Nelson stated asked if there is enough money in budget for planning.
Delahunt stated there is, but only recently because of new federal funding.
Nelson asked where funds would come from if there was a pandemic
response. Many pharmacies are stocking up. The private sector has already
incurred an expense. He asked where the money from the public sector comes
from. Delahunt stated if a pandemic flu hit, a state of emergency would be
declared. Dollars would be accessible from the federal government CDC homeland
security resources.
(Clerk's Note: End of tape one, side A.)
Nelson stated the County has reserve funds, which was originally set up for
emergencies. He asked if they would be available.
Dewey Desler, Deputy Administrator, stated they would be available.
Nelson stated it's important to maintain a good reserve fund.
Desler stated the Council recently adopted certain procedures that allow the
administration to immediately respond financially, if needed.
Brenner stated she's frustrated. The Health Boards nationwide should
reprioritize so vaccines are developed more quickly. Make a strong statement to
the federal government about this. Delahunt stated the country relies on private
companies to supply vaccines. That is problematic. The companies are not going
Board of Health, 10/4/2005, Page 6
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DISCLAIMER: This document contains the Whatcom County Council or Committee
minutes, as approved. However, unless an attested signature page is attached, they
are not the final approved minutes.
to stockpile and make a vaccine if they have to throw it away at the end of the
year. If there is a national program, there could be a stockpile.
Shields stated vaccine shortages aren't isolated to flu. There are also
shortages of normal pediatric vaccines. That has never happened until the last few
years. It's a serious federal problem that doesn't happen in other countries. One
reason is only certain companies create certain vaccines. Sending a statement to
the federal government is a good idea, but may not help.
Nelson asked for more information on the mental health emergency
preparedness plan. Delahunt stated that during a crisis or emergency, mental
health is an issue for the survivors and first responders. They need to include that
as a part of the emergency response plan. Make sure there are providers for
mental health during an emergency.
Delahunt stated Assuring a Healthy Environment is a third standard. OSS is
a big part of it. Accomplishments includes a computer -based system for food
worker training, which results in improved training and efficiency in customer
service. Next year, the department can offer food worker training whenever
anyone wants to walk in and take the food handler test. That will be a big
improvement.
Another accomplishment is that the Council amended Title 24 to include
illegal drug manufacturing and storage regulations.
The Kendall Clean Project is a notable project. They have worked with
community partners, courts, and the Sheriff to curb illegal dumping. It is making a
difference.
Caskey- Schreiber stated she's noticed a difference in the Kendall community.
Delahunt stated they will pick the top dozen offenders and work hard to get them
taken care of. They will work through the court system now that they know how
that works. There's a lot of cooperation, and the community appreciates it.
In 2006, they will establish the OSS O &M system and coordinate with the
Planning and Development Services Department on one -stop permitting system.
Health Department staff is now stationed at the Planning Department offices a
couple of days per week. It works well to improve communication and customer
service.
Crawford asked if the public can still get that service in town. Delahunt
stated they can. The Planning Department and the Health Department are learning
each others' processes.
Davidson stated the environmentally related disease statistics on page six
talk about disease instances. Some diseases such as giardiasis run a higher rate
here. He asked if there is an action to change that trend. Delahunt stated there is.
Board of Health, 10/4/2005, Page 7
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DISCLAIMER: This document contains the Whatcom County Council or Committee
minutes, as approved. However, unless an attested signature page is attached, they
are not the final approved minutes.
For the past couple of years, they have participated in a study with the University
of Washington to get at the reason for the high rates of these enteric diseases.
They're just finishing up that study. One or two other counties in the state also
have these high rates. They're looking to see if there are common themes among
these counties.
McShane asked the status of the program for computer -based training for
food workers. Delahunt stated they have the system, but the program is not
implemented it yet due to space limitations.
McShane asked about funding for the Kendall Clean Project enforcement for
next year. Delahunt stated enforcement is funded with State dollars. They get
some dollars that are meant to allow local health jurisdictions to expand capacity to
do certain things.
Caskey- Schreiber stated the Council approved the program.
Delahunt stated another goal for this next year is to add an environmental
health component to their childcare facility program. There are a lot of
environmental health issues associated with childcare facilities. They will also do
another study with the University of Washington related to childcare, in -home care,
and how home nurses can intervene on some of those issues. More information will
come forward later.
Delahunt stated the next standard is Prevention and Health Promotion. They
need to prevent chronic disease and promote healthy living. Existing programs
include tobacco prevention and the Women, Infants, and Children (WIC) program.
Now there is a new physical activity component.
Brenner asked if there was supposed to be a mental health component in
teenagers in schools. Delahunt stated that program is listed under a different
standard of Helping People Get the Services They Need.
Brenner stated substance abuse is in this standard, but not mental health.
People can't have a substance abuse problem without a mental health issue.
Mental health should be included.
Delahunt stated accomplishments for this standard include the
methamphetamine (meth) awareness campaign, oral health program, and physical
activity program. Next year, priority actions include review of youth risk data
related to substance abuse and secondhand smoke education for a smoke -free
workplace. Initiative 901 is related to smoke -free workplaces. It adds to the
existing statute. The current legislation talks about who is responsible for enforcing
smoke -free workplaces. Initiative 901 will move responsibility from the fire
marshal to local health departments. That could be significant. They will have to
start thinking about implementing such an ordinance if the initiative passes. No
money is available for enforcement.
Board of Health, 10/4/2005, Page 8
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DISCLAIMER: This document contains the Whatcom County Council or Committee
minutes, as approved. However, unless an attested signature page is attached, they
are not the final approved minutes.
Brenner asked why the expenditures for this standard take a dip next year.
Delahunt stated one reason could be that some of the physical activity dollars were
available for only one year. They've applied for additional grant funding.
Crawford asked if the Health Department is not directly engaged in meth
prevention. Delahunt stated the Environmental Health Division is engaged in
cleanup.
Crawford asked if community presentations on the effect of meth continue in
2006. Delahunt stated it might, but not as much.
Crawford stated a power point presentation he saw is striking. Get it to high
school kids.
Caskey- Schreiber stated they should also get to middle school kids.
Roy stated scare tactics don't work with adolescents.
Delahunt stated the last standard is Helping People Get the Services They
Need. This is not to provide services to the community, but to make sure services
are available to people who need them. This past year, they worked with Whatcom
Alliance for Healthcare Access on several projects, including physician recruiting
and retention, helping people who qualify for Medicaid, primary care access survey,
and to get a new designation for a health professional service area, which brings
more care to the rural areas. They will continue that in this funding year.
Caskey- Schreiber asked if they have ever thought about doing methadone
treatment in Whatcom County. There is an age group in the community that uses
that drug. Get them treatment options. Getting treatment now is not viable.
Delahunt stated there is an upcoming conference on opiate substitution that will
happen in Whatcom County. That discussion is happening.
Caskey- Schreiber stated she supports treatment here, especially because it's
a university town. The use is very prevalent.
Davidson stated the Health Department has done very well with the access
issue. Keep at it. It makes a difference. He asked about coordinating a county
housing effort. He asked how that comes home to the Health Department as
opposed to other departments.
Desler stated the Planning Department is regulatory. In this case, they want
to integrate housing with low- income issues, organized through the Health
Department. It ties together those substance abuse and mental health issues with
housing.
Board of Health, 10/4/2005, Page 9
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DISCLAIMER: This document contains the Whatcom County Council or Committee
minutes, as approved. However, unless an attested signature page is attached, they
are not the final approved minutes.
Delahunt stated homelessness and affordable housing is a key issue for a lot
of the population served by the Health Department. The mental health, substance
abuse, and low- income mother populations have housing issues. It's about
affordable housing for the homeless. The program isn't about housing in terms of
building houses. It is about the homeless and affordable housing.
Desler stated Whatcom County doesn't currently have a community
development operation like some cities have. In the future, there might be a more
active effort by the administration on this issue.
McShane stated that link to health is critical. He sees the situation getting
more intense.
Delahunt stated community stakeholders are working on a homeless housing
plan.
McShane stated people in that area do have mental health problems and
physical problems. They must be served so others do not prey upon them. That is
a separate issue regarding policing.
Nelson stated this issue will be more prevalent because the State has
withdrawn its resources to the local communities. He asked if the County chose not
to engage in a lawsuit against the State for reducing its funding.
Byrne stated the Regional Support Network (RSN) pursued a lawsuit for the
loss of $10 million. Thurston County Superior Court ruled against the others.
Nelson stated this is the direction of the future, which is unfortunate.
Homelessness will become a critical issue in urban areas. The Health Department
will be impacted. He's pleased they're doing additional work with housing. It's
difficult to get some of these people into housing. The outreach program to get
people into services is critical. Get people to services that are available and get
people into treatment. Any type of program should be tied to treatment.
3. 2006 PUBLIC HEALTH ADVISORY BOARD WORK PLAN
Regina Delahunt, Health Department Director, stated there is a list of topics
that the Health Department would bring to the Public Health Advisory Board next
year. She would like to get feedback from the advisory board and Board of Health
about topics to look at next year.
Davidson asked for Ms. Delahunt's top four topics from the list. Delahunt
stated two would be on -site sewage operations and maintenance and an in -depth
analysis of sexually transmitted disease (STD) rates and program capacity in
Whatcom County.
Board of Health, 10/4/2005, Page 10
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DISCLAIMER: This document contains the Whatcom County Council or Committee
minutes, as approved. However, unless an attested signature page is attached, they
are not the final approved minutes.
Davidson stated the STD rate locally is lower than the State rate. He asked
why that is a priority. Delahunt stated the rate of incidences of some STD's have
been increasing.
Shields asked about the absence on the list of planning for pandemic. It
needs to be on the top of the list. Include regular influenza, not just avian flu. The
community is due for a pandemic. Include how they coordinate with other
jurisdictions and outlying areas.
Phillips stated there is a difference between having it as a priority for the
department versus having it before the advisory board for discussion. He asked if
the department has a work plan for it already. Delahunt stated the department is
putting together the pandemic plan. Advisory board input would be valuable in
terms of finding resources to implement the plan.
Roy asked if physical activity program planning is something they are
encouraged to do because there is a grant. Delahunt stated there is some grant
funding. However, obesity and lack of physical exercise is a huge public health
issue.
Roy stated it's been an issue for the community her entire life. She's not
hopeful that putting County resources toward it will change that reality. That is not
a high priority for her because they won't get much benefit for the money spent.
Dr. Greg Stern, Public Health Officer, stated physical activity and diet are
seen as individual choices. One thing that impacts activity and nutrition is how
they design society, such as there not being any safe places so kids can play and
walk to school or if people are selling things that aren't nutritious. It's not that the
Health Department will turn the problem around. The Health Department wants to
be at the table with the coalition that will be part of the solution.
Brenner stated she agrees with Councilmember Roy. The school buses get
money for every kid they pick up. None of the kids are walking, even in areas that
are safe.
Stern stated type II diabetes is starting to show up in kids. It's a health
impact that is a big problem.
McShane stated they got here because society was ignorant of what it was
doing to itself back in the 1950's and 1960's. He's frustrated that society is set up
this way. It's because no one was at the table to discuss it. Think about the fact
that the high schools in Bellingham have gigantic parking lots. Schools are set up
so kids are bused because of other issues besides distance to the school.
Development planning must include parks.
Caskey- Schreiber stated the point is how much time they can put into this
and come up with solutions they can implement. They definitely have to work on it.
Board of Health, 10/4/2005, Page 11
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DISCLAIMER: This document contains the Whatcom County Council or Committee
minutes, as approved. However, unless an attested signature page is attached, they
are not the final approved minutes.
Delahunt stated they want to be a partner to this huge issue, but they aren't going
to change Whatcom County overnight.
Shields asked if school food is part of the discussion. It's disgusting.
Delahunt stated it is not for the physical activity coalition, but it is an issue.
McShane stated they don't have the solutions. The advisory board can
identify the roles the Health Department can play to facilitate solutions. Delahunt
stated she agreed. That's the discussion the department needs from the advisory
board.
Phillips stated that when the issues come to the advisory board, staff has
prepared questions and issues to talk about. It sounds like this should be part of
that discussion.
(Clerk's Note: End of tape one, side B.)
Delahunt stated part of that discussion could be the Environmental Health
Division's role in the planning process for communities. The physical built
environment has a huge impact on public health. That would be a topic for
discussion.
Shields stated it is a financial issue. Schools depend on Coke machines to
fund the athletic departments, for instance. Be at the table to discuss things like
how athletic programs are funded. Look at community planning more globally.
ADJOURN
The meeting adjourned at 7:05 p.m.
Jill Nixon, Minutes Transcription
The Council approved these minutes on October 25 , 2005.
ATTEST:
Dana Brown - Davis, Council Clerk
WHATCOM COUNTY COUNCIL
WHATCOM COUNTY, WASHINGTON
Laurie Caskey- Schreiber, Council Chair
Board of Health, 10/4/2005, Page 12