HomeMy WebLinkAboutBoard of Health October 1 20021
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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
Board of Health
October 1, 2002
The meeting was called to order at 10:30 a.m. by Council Chair L. Ward
Nelson in the Council Chambers, 311 Grand Avenue, Bellingham, Washington.
Present:
Barbara Brenner
Laurie Caskey- Schreiber
Sam Crawford
Seth Fleetwood
Sharon Roy
Dan McShane
1. PUBLIC SESSION
No one spoke.
2. 2003 WORK PLAN
Absent:
None
Regina Delahunt, Health and Human Services Department Director, stated
the Health Department brings the work plan forward to the Board of Health each
year for discussion and approval. This year, they've changed the format a little bit
from previous years.
Nelson stated the work plan has gone before the Public Health Advisory
Board, which did extensive work and had a great deal of discussion.
Dr. Greg Stern, County Health Officer, stated he would discuss disease rates
and tracking in Whatcom County. The Health Department does surveillance for
infectious and noninfectious diseases. The Health Department is part of a system
that includes the private health care providers, hospital, State Department of
Health, and Center for Disease Control (CDC). There is a list of infectious
conditions that health care providers are required to report to the Health
Department. The Health Department also gets reports from laboratories. The
Health Department's first priority is preventing the spread of disease, investigating
cases, and providing preventive treatment. At the same time, they are collecting
data that goes to the State Department of Health in standardized case report
forms. The State Department of Health takes that data and passes it on to the CDC
for a national disease report. County residents may be diagnosed with conditions
outside of Whatcom County. When looking at disease rates, the State's data will be
Board of Health, 10/1/2002, 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.
most accurate because it will be sorted by county of residence, not just by county
of diagnosis. There are several other sources for data.
Page 55 is a summary of the county disease rate and five year averages for
several infections, cancers, and birth defects in Whatcom County.
Enteric disease rates run higher in Whatcom County than in the entire state.
Also, the number of reported cases of prostate cancer is higher in Whatcom County
than in the entire state, but the mortality rate is lower. The higher rate for prostate
cancer diagnosis is due to more aggressive testing for cancer.
Nelson stated there is a possibility that enteric disease increases could be
due to the type of environment that they have in Whatcom County, compared to
other counties. There is a larger agricultural community in Whatcom County. Stern
stated the purpose of the study is to see if that is a factor. It appears that e -coli
cases that are not involved with food -borne outbreaks are from contact with
livestock. This study will determine whether or not that is true.
Brenner asked if the data could be pinned down a little bit better. That's kind
of a blanket statement. The rates are still higher even though Whatcom County
has become less of a rural county. Stern stated that's why that study is being
done.
Delahunt said there is a higher incidence in counties that have agriculture,
but there has not been a proven correlation. That's what people are thinking, but
the study will get them closer to an answer.
Brenner stated she never heard of autism being called a birth defect. She
thought birth defects happen as part of the pregnancy.
Roy stated many genetic things are considered birth defects.
Stern stated that is a good point. He would have to look at the State's
documents on the reporting system. The bottom line is that autism is reportable.
It's more of an organizational issue of whether it goes to the birth defects section at
the Department of Health.
Nelson stated there may be funding tied with it.
Brenner asked if autism is usually found at birth. Stern stated it is not. It is
found later.
Delahunt stated that in preparing for the budget this year, the department
went through a prioritization process. They set up criteria to evaluate various
programs and determine what is a high priority in the department. She used
templates for evaluating and prioritizing public health programs. She and her staff
looked at each program, funding streams, and the possibility of dividing programs
Board of Health, 10/1/2002, 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.
into smaller programs. They also looked at the mission, the number of people who
would be affected, the severity of the health impact if they no longer have this
program, the interventions for the programs and whether or not the interventions
are effective, legal aspects, whether or not the service is mandated, the level of
community concern and political support, and budgetary criteria. They also looked
at whether or not the County Health Department must implement the program.
Staff scored the criteria and came up with an overall health mission score
and an overall score for the program. Some programs ranked high, and others
ranked relatively low compared to other programs. Staff looked critically at the low
ranking programs to determine whether the County should continue these
programs as they are, or should the department move the resources into other high
ranking areas.
Communicable disease and tuberculosis immunization programs ranked very
high. The food program and environmental health program also ranked high. The
tobacco program ranked very high. The teen clinic, health education program, and
onsite sewage system (OSS) loan programs ranked low.
This year, they decided to look at eliminating the teen clinic and the health
educator position for next year, and adjusting the resources to add to the
communicable disease program, emergency response, and communicable disease
surveillance activities.
Council packet page 57 is a staffing change summary. They can see what
cost savings are achieved by the program eliminations. They can also see the costs
associated with the modifications that they are planning to make to the
communicable disease and emergency response activities. The Health Educator
position will be eliminated. Although this position is valuable, it is really a resource
to the other programs in the department. Much of the Health Department staff is
comprised of health educators. That is a big part of what they do. However, they
do have a position that assists program staff with developing health education
materials. Staff would lose this resource, but staff would still continue with the
health education needs.
The teen clinic is a service the Health Department provides for sexually
transmitted disease (STD) testing and information. During the last couple of years,
the number of teens using the service has decreased dramatically because there
are other programs available in the community. The teens are going to the other
programs because they provide a broader range of services for the teens. They've
only been seeing two to four teens per week in the clinic recently. It's a big
expense, and there are other resources for those kids.
The department will propose to decrease a full -time equivalent (FTE) account
clerk to a .5 FTE. Software has reduced their need for account clerks.
Board of Health, 10/1/2002, 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.
The County will receive federal bio- terrorism funding in the amount of about
$100,000 to increase the disease surveillance and response activities.
Brenner asked to whom they should talk about the funding for bio- terrorism
being too low because the county is so close to the border. One instance could use
up all of this funding. Delahunt stated it is a lot of money compared to how much
they've gotten for this before. It will help the Health Department's communicable
disease program significantly.
Nelson stated that if there is a bio- terrorism event, this money would only be
for the starting point. At that point, there will be a flood of federal and state dollars
coming in.
Brenner stated she recalled Ms. Delahunt saying in the past that the county
would be on its own for a while if an event occurred, and they can't count on the
feds coming in right away. Delahunt stated the Health Department is definitely the
first line of defense and response. The Health Department needs to be able to
determine quickly, with sufficient staff, if something is happening in the community.
That's why the County would be on its own. It is the front line.
Related to the federal bio- terrorism funding, it is being given out by region.
Whatcom County is in bio- terrorism region one. Snohomish County is the lead
county for region one. There will be a regional epidemiologist and regional
response coordinator. They will all work together. It is an additional resource
beyond the local resources. Whatcom County is responsible for putting together a
response plan for Whatcom County. She is working with the Emergency
Management Division in putting that plan together. That plan will be folded into the
regional response plan.
Fleetwood asked what the $100,000 would buy. Delahunt stated the funding
would pay for an existing Public Health Nurse position. This position will be working
on communicable diseases. They will also reclassify a registered nurse to a public
health nurse. They would like to add an environmental health specialist to work on
emergency response and communicable disease. The Environmental Health
Division staff works on the enteric communicable disease responses. They will also
need to make sure they are prepared with plans for protection of water supplies
and food supplies in the county in the event of bio- terrorism attacks. They want to
increase the clerical support for emergency preparedness activities.
The savings to the general fund is about $60,000 and a decrease of .30 FTE
over the 2002 budget.
Crawford asked about the alternatives for the teen clinic.
Janet Davis, Community Health Manager, stated the Take Charge program
began over a year ago. It is funded by the State. The Health Department is not a
Take Charge provider because it provides all of the reproductive health care
Board of Health, 10/1/2002, 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.
options, including family planning. There are a number of providers in the
community, including SeaMar, Interfaith, and Planned Parenthood that are Take
Charge providers. Over the last year, they've seen a decrease in the teen clinic,
which is reflective of the teens going to the other providers. The other providers
give the full spectrum of reproductive health care. Whatcom County does not. The
Health Department will triage kids who are symptomatic and telling kids where to
go.
Roy asked about the registered nurse being re- classed to a public health
nurse. That doesn't seem like very much money. Delahunt stated it is the salary
difference between an RN and a public health nurse.
Roy asked if the bio- terrorism response requires a lot of administration and
planning time. She asked if there is a significant impact and who is working on it.
Delahunt stated that she and Janet Davis are working on it now. One public health
nurse position has been doing a lot of the work. In the initial stages, it is taking a
lot of administrative time. Once the program is set up and the staff is in place, it
will take less administrative time.
Roy stated she is concerned that it might be taking away from some of the
other responsibilities. Delahunt explained that it does take a significant amount of
time right now, but it's not overwhelming. The timeline on getting these activities
done is short if they want to get funding from the state. The idea is to get the
system in place as quickly as possible, and then maintain the system after it's in
place.
Nelson asked if the direction of the administration is near this target.
Delahunt stated it is. She was required to reduce its budgetary levels by one
percent for 2003. That is included. The motor vehicle excise tax replacement
dollars will be eliminated as of June 2003. The County receives about $1 million
per year in funding. There will be $500,000 less in revenue for 2003. That's a
significant hit. The administration has not asked them to take that entire hit out of
public health. They are working hard to find a way to get that public health money
back into the State's budget.
Crawford moved approval of 2003 Health Department work plan as presented
to the Council.
McShane asked if the Health Department has reviewed its fees and increased
its fees for drinking water permits. Delahunt explained that they have increased
their fees for 2003. They are proposing to raise the fees so that they pay for the
cost of services that the Health Department provides. Not everything they do in
the drinking water program is directly related to fees. That's why they see that this
program doesn't cover costs 100 percent.
Brenner asked about the rate of complaints relative to public and private
supplies, and whether the inquiries are rated with the complaints. Delahunt stated
Board of Health, 10/1/2002, 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.
the information in the table on page four just includes the complaints. They
wouldn't have the data unless staff filled out a complaint form. There is no such
thing as an inquiry form. The department does get a lot of phone calls about
private supplies. It is a significant part of the program.
Brenner asked why is it so hard to track down the giardiasis illness. Stern
stated there are standard disease investigation protocols that include the
appropriate questions. The information is there. Occasionally people will not have
an identifiable source.
Delahunt stated that they will probably see a higher rate of giardia that have
similar water and recreational activities, but it is a theory. It has not been proven.
Brenner asked what the campylobacter cases are in the food program.
Delahunt stated it is an enteric bacterium that causes diarrhea. It's fairly common.
McShane asked about the accomplishments of the food program regarding
the paralytic shellfish toxin. He asked if the Health Department does specific
testing for that toxin. Delahunt stated they don't test, but they collect the samples
and send them to the State. The State does the testing for the toxin.
Brenner asked about the rabies post- exposure rate. Stern stated several
families shared a cabin and bats were found. The CDC changed the
recommendation that if someone is alone with a bat, it's prudent to get the series
of shots. A lot of the fatal cases have been from people with no known bite from a
bat, although it was a bat strain of rabies, so they know that the source of the
rabies was from a bat. If someone finds a bat in the bedroom or tent, that person
should report it. Rabies is a virus that is found in the saliva of infected animals. It
can be passed on primarily through bites, scratches, and getting into the skin. The
rabies shots is a series of rabies shots plus an immune globulin. It is the only thing
that will prevent death.
(Clerk's Note: End of tape one, side A.)
Delahunt stated there have been cases where there weren't any physical
marks on a person, but that person died. The CDC changed its recommendation a
few years back so if there is a possibility that anyone is alone and unconscious with
a bat, then it is prudent to get the vaccine.
Brenner asked if rabies could be airborne. Stern stated there is no scientific
evidence of rabies being airborne.
Fleetwood stated a bat has flown into his window. He asked if all bats carry
rabies. Stern stated about one wild bat in a hundred carry rabies. One in ten that
are sent for testing are positive.
Board of Health, 10/1/2002, 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.
Caskey- Schreiber asked if the Health Department would address the West
Nile virus in the education program. Delahunt stated they will. They've had many
calls. People are concerned about mosquito control and abatement. Over the
winter the Health Department will gear up for the West Nile virus. The Health
Department really needs to provide people with information on how to protect
themselves and how to eliminate habitat for the mosquitoes. It will be a challenge
in wetland areas. She would be surprised if the Council doesn't get proposals for
mosquito abatement districts in the future.
Nelson asked if there has been any evidence on exposure with DEET. A few
years ago, there was concern about overexposure of DEET. Stern stated that if
someone is using it according to instructions there isn't a problem.
Nelson stated the County might want to prepare information on that if it is
going to advocate using mosquito repellant. Stern stated they would do that. The
idea is to eliminate the breeding ground. Some of the urban mosquitoes that carry
the West Nile virus don't travel far from their breeding area. They tend to breed in
shallow standing water.
Brenner asked that the Health Department look into organic mosquito
repellents. Stern stated there was a review recently in the New England Journal of
Medicine on insect repellants. The study looked at the things that are sold as insect
repellents. The conclusion was that DEET was the most effective. The study looked
at how long the insect repellent kept the mosquitoes from biting. DEET was the
best by far.
Delahunt stated the State Department of Health has been working on West
Nile virus information, which the County can use.
Brenner stated the third paragraph about the solid waste program talks
about the ways people could become sick around solid waste. It doesn't talk about
person -to- person contact with people who have been exposed. Delahunt stated
that is secondary disease transmission.
Brenner stated she would like to see person -to- person contact information
provided.
McShane asked about the solid waste complaints and where those are
coming from. Delahunt stated they haven't mapped the locations of those
complaints. The staff that investigates the complaints would know, and she would
get back to Councilmember McShane.
Caskey- Schreiber asked if the solid waste complaints include complaints
about sewage sludge.
Don Vesper, Environmental Health Manager, stated they do. Last year, the
Health Department did an educational campaign to encourage complaints of
Board of Health, 10/1/2002, 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.
indiscriminate dumping. Some of these complaints are related to that educational
campaign.
Brenner stated there have been a lot of complaints about Recomp. She
assumed that a large portion of the complaints in the table is about Recomp.
Delahunt stated she's sure that a lot of the complaints are about Recomp.
Roy asked who identifies the pregnant woman at risk for the maternal and
child programs. Davis stated the Health Department primarily serves women with a
low income and use the medical coupon system through the State Department of
Social and Health Services (DSHS). They don't end up serving women who have
health insurance through work. They also accept referrals from physicians who
might refer someone who isn't necessarily on medical coupons.
Roy asked if the Health Department focuses services on those who can't
afford services, and makes some assumptions that people with insurance get their
services elsewhere. She asked if someone can take advantage of the Health
Department services if someone has insurance. Davis stated a number of providers
in the community do prenatal and postpartum visits to women. The Health
Department is one of those agencies. It is called the First Steps system. There are
other First Step providers. First Step providers focus on people who don't get
services elsewhere, and also accept referrals from physician offices and bill
insurance. The Health Department is not set up to do that at this time. The Mother
Baby Center is the biggest First Steps provider that will bill insurance companies. If
the Health Department gets a referral from a physician, the Health Department will
get Mother Baby Center involved to make sure the women gets the services that
she needs.
Nelson stated the Health Department does everything possible to take care
of those with needs for maternal education. Davis stated that is correct. The
Health Department focuses on people who aren't getting that care elsewhere.
Roy asked if the Health Department is meeting the needs of this population
overall. Davis stated the biggest need in this county is to get more obstetrician
(ob) providers. That's not something that the Health Department or County can
impact. It takes a month or longer to get in to see an ob doctor.
Brenner asked if there are not enough doctors, or if there are not enough
doctors who are signed up to participate. Davis stated there aren't enough ob
doctors.
Roy stated this is an important area for the Health Department that has
repercussions all the way down the line.
Brenner asked how the Health Department could serve 109 percent of the
Women Infant Children (WIC) caseload. Davis stated the Health Department
served more than the State pays the department to serve.
Board of Health, 10/1/2002, 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 that the actual number of those served be listed in the work
plan.
Brenner asked if part of the problem with access to baby and child dentistry
(ABCD) could be that there aren't enough dentists participating. The County should
publicly list those dentists who do and do not participate. Shame the dentists into
participating. It's an important program. Davis stated more and more dentists are
signing up to become a Medicaid provider. The dentists get an enhanced
reimbursement. There are issues about serving young kids. The first checkup is
recommended for kids at one year of age.
Nelson stated it goes beyond dental health access. If teeth are hurting, then
diet and nutrition begins to get neglected. One of the problems is that this is
Medicaid driven. There is a vast majority of the population who fall through the
cracks. They are the working poor. Dentistry is neglected firsthand.
Stern stated part of this program is changing the framework of providing
dental disease in kids. There are a lot of dentists who don't see a need to see kids
before the age of four or five. The paradigm has shifted. They want to get high -
risk kids examined within six months of their first teeth coming through, and
getting regular dental hygiene going. This collaboration has been interesting. One
of the issues is getting primary care doctors and pediatricians to look more at kids'
teeth and to know when to refer to a dentist. There is a pilot program to provide
fluoride varnish in medical offices. The flyer the Health Department developed
includes information for providers on how to screen for dental disease. Economics
are a key issue. They find more dental disease in poorer populations. SeaMar and
Interfaith have increased their dental services. More and more dentists are coming
on board with the ABCD program. Fluoridation of water reduces cavities by 40
percent.
Brenner stated she does not support mass fluoridation of water. She does
like the idea of the pediatrician offering it at a very young age. She wasn't aware
that they are trying to get kids to a dentist at one year of age. There is still a big
problem with kids who aren't babies. They don't have access either. She's glad
they are doing it with very young children, but there should be someone to take
care of kids' teeth by the time they enter kindergarten.
Nelson stated there is a need for education that helps people know they need
to get their kids to the dentist. Davis stated oral health in general will become a
focus of the Health Department in coming years.
Brenner stated the indicator chart regarding the tuberculosis (TB) program
leaves out information on the number of latent TB cases. She asked that that
number be included in the work plan. It reflects what is happening in the
community more than just the number of active cases. Davis stated she could do
that. They do a number of skin tests, and she can list the number of positives.
Board of Health, 10/1/2002, 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.
Brenner asked if meningitis doesn't have to be listed as a communicable
disease. Davis stated meningococcal meningitis is a condition that must be
reported. There are other kinds of meningitis.
Brenner stated some of the indicator chart for mental health is confusing.
The statistic for the monthly average number of clients in ongoing outpatient
service is confusing. She asked if they would be better off knowing how many
people are accessing that service rather than how many times people are coming in
for the service.
Andy Byrne, Human Services Manager, stated that figure compares the
number of people in Whatcom County who are eligible for Medicaid with the number
of people that the Health Department services.
Brenner stated she interprets that statistic to mean that there are a lot of
repeat visitors.
Nelson stated a person can come in multiple times for different reasons that
would require different evaluations.
Brenner stated they can't say that this average is ten percent of the total
eligible because it may not be ten percent. They don't know what the percentage
is. Byrne stated that in Whatcom County, on average in any given month, there
are 23,365 people who are Medicaid eligible. On the average for outpatient
treatment, the average number they are seeing is 2,355 people. If someone is in
service that month, he or she is only counted once. It is outpatient treatment. A
crisis event or hospitalization would be different.
Brenner asked about item two in the indicated data interpretation section.
She asked if a person with multiple crises is only counted once. Byrne stated it
could be one person multiple times. It is a count of the number of crises.
Nelson stated they have to do an assessment for each crisis. It is a workload
evaluation.
Crawford stated they are using the same standard they used years ago when
the population was smaller, so they are just saying the workload is going up
proportionately.
Nelson stated they are looking at the workload, not the number of
individuals. Byrne stated they are also looking at where the service money is
going. The money is increasingly going to the area if crises.
Brenner asked why the developmental disability program waiting list dropped
to zero. Byrne stated there was more funding to accommodate those people who
were waiting.
Board of Health, 10/1/2002, 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.
Brenner asked if fewer people know about the program, and if information is
getting out about the program the same as it used to. Byrne stated they are
getting the information out. The referrals come from the State Division of
Developmental Disabilities. The County doesn't serve everyone who is eligible for
developmental disabilities. It is only those who are 21 and older and who, with
their case manager and family member approval, want to come to work. Case
managers definitely get the word out. They are also creating an interesting media
campaign later in the year that is aimed at employers.
Brenner asked how substance abuse is different from chemical dependency.
Byrne stated that someone who is chemically dependent certainly abuses
substances. People can have a need for substance abuse treatment for a
psychological dependency, but not have a physiological dependence.
Brenner stated it is shocking that no data is available through State or local
databases regarding treatment effectiveness. They are doing all this stuff. She
asked what happens if it is not working. Byrne stated he agrees. There are
research studies that say people who stay in treatment and complete the treatment
tend to do better at stopping substance abuse better than people who abort
treatment halfway through. The lack of data is an industry concern.
Crawford referenced the program change for 2003 regarding the Methadone
Maintenance facility. The State legislature has decided that the State will
determine where these facilities go. The Substance Abuse Advisory Board, under
the leadership of Lieutenant Jamison, is coming up with a course of action and a
work plan so the County is prepared to deal with this the best it can if the State
determines that a facility will be in this region. The State will be more responsive if
there is no plan at all. It has been a very active topic at the Substance Abuse
Advisory Board. The bigger issue is if there is community acceptance of methadone
treatment. It is very controversial, but it is becoming more accepted. There is a
range of opinions and feelings about this program. Most of the members of the
advisory board have had some exposure to drug treatment issues. The advisory
board is working through those opinions. They've had some very informative
presentations. He would like the Council to see those presentations, upon the
recommendation of the Substance Abuse Advisory Board. It is an interesting topic.
Fleetwood asked if there is a relationship between crisis services and the
Crisis Center. Byrne stated the Whatcom Crisis Center is for victims of domestic
violence. Crisis services are for those who are inebriated, brought to the
emergency room, and put in a detoxification program.
Fleetwood asked if 911 dispatch will refer people to this service. Byrne
stated they could. St. Joseph hospital runs this program.
Roy stated Whatcom County has a much higher rate of clients in
detoxification programs and custody than the rest of the state. Byrne stated part
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of the reason is the county's location. Whatcom County is a high intensity drug
trafficking area. A lot of attention is put into surveillance and finding people who
are under the influence. There is also a lot of drug traffic around here.
Brenner stated a lot of people get turned back from entering Canada, so they
land here.
Byrne stated another factor is that Whatcom County has a statewide -
recognized program called the Alcohol Protective Custody program. It allows them,
through cooperation with the County Jail and the hospital to place people in an
eight -hour hold if they are too drunk and don't want to stay. It's an unusual
program. Whatcom County captures a lot more people. Through the program, he's
noticed that there are people who tend to come through a lot. They have difficulty
getting some people into inpatient treatment programs because there is a long wait
for publicly funded inpatient treatments. He is focusing on what they can do to get
someone through crisis and detox and into an inpatient treatment.
Caskey- Schreiber stated the juvenile alcohol and drug violation arrest rate is
also extremely high. She asked if the high rate is for the same reason as the rate
of people in the detoxification programs and custody. Byrne stated this county has
zero tolerance.
Fleetwood asked how the Health Department gathers the information on the
percentage of eight graders who are at risk for favorable attitudes toward drug use.
Byrne stated the Washington State survey of health behaviors is a self- report.
Brenner asked who has the right -of -way on the road when a bike cuts in
front of a car.
Nelson stated bikes have the right -of -way anywhere.
Brenner stated that bikes are supposed to follow automobile traffic laws, but
they run red lights if nothing is coming.
Crawford stated they are supposed to stop.
Delahunt stated they are supposed to obey traffic rules. They don't always
do that.
Brenner thanked the Health Department.
(Clerk's Note: End of tape one, side B.)
Brenner continued to state that the work plan was easy to read and
informative.
Motion to approve the work plan carried 6 -0 with McShane absent.
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3. HIV /STD EDUCATION MATERIALS
Janet Davis, Community Health Manager, explained the background of this
issue. These are the final recommendations of the Public Health Advisory Board.
There are two policy recommendations that include a general prevention education
policy and a policy specific to sexually transmitted diseases (STDs) and HIV. The
advisory board also recommended a message to be distributed with all condoms
provided by the Health Department. After the two policies and the condom
message are approved, the advisory board recommends that the Health
Department take specific steps to implement the policies regarding the messages
and educational materials.
Crawford moved to approve the four recommendations from the Public
Health Advisory Board as presented.
Thomas Boenig, 3907 Aaron Court, stated he is a retired OB /GYN doctor.
The condom message is well written and medically accurate. However, they left
out the words 'pelvic inflammatory disease." It was omitted as an oversight. He
suggested that the Board of Health insert the wording in the second sentence,
"Condoms can reduce but not eliminate... gonorrhea, pelvic inflammatory disease,
syphilis and unintended pregnancy." The language needs to be included because it
is part of the summary workshop conclusions.
Davis stated the committee focused on specific reportable diseases.
Although pelvic inflammatory is a condition, it can be caused by different
organisms. Pelvic inflammatory disease is reportable.
Brenner moved to amend the wording in the second sentence of the condom
message, "Condoms can reduce but not eliminate... gonorrhea, pelvic inflammatory
disease, syphilis and unintended pregnancy."
Motion carried with 6 -0 with McShane absent.
Boenig stated this process was motivated by a public law passed a couple of
years ago. It was designed to mandate that all relevant educational materials
address the effectiveness of condoms. That's what the Health Department has
done. It's done a good job of it. He suggested going beyond that to include other
things on this pamphlet. The condom insert is to be printed on a business card and
distributed with each condom. He suggested that the messages be expanded to
make it twice as large, similar to the teen health card. It could include the larger
definition of health, including the social, emotional, and psychological well being of
individuals. The proposed prevention policy says that the most reliable way to
avoid transmission of STDs and HIV is to abstain. One study shows that 93 percent
of teens should be given a strong message about abstinence. The Board of Health
should reinforce this policy and expand the condom message. He listed suggested
messages that include medically based messages and character based messages.
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He read his suggested messages. The message is designed for at risk kids, who
have dropped out of school or are involved in drugs. Those kids may not have
gotten the information in the health education program in school. This would be
particularly important. He understands it's very expensive to do this. It would cost
approximately twice as much to make the card twice as large. This condom
message is something that people will read, throw away, and forget. He suggested
that they use regular paper to reduce costs, and cut the paper to size so they can
include the medical and character messages. The cost of that would be minimal.
Having worked in a medical practice, he saw women daily who had STD's and the
negative consequences of not getting treatment. Unplanned pregnancies, chronic
pelvic pain, infertility, and emotional, physical, and sexual abuse issues are a result
of an incomplete condom message. To change peoples' behaviors, they need to
address both their heart and their mind by including the medically -based and
character -based messages.
Fleetwood asked if Mr. Boenig presented these ideas to the Public Health
Advisory Board. Boenig stated he did not present these specific ideas to the
advisory board.
Davis stated the committee considered the audience that this material is
designed for. They are not addressing teens at this point in time. They will not be
having a clinic that deals with teens. Their audience is men who have sex with men
and people coming to the needle exchange program. For the most part, those are
adults who are in a different frame of mind. The committee carefully considered
how they should phrase the messages and who the messages should be aimed at.
In a different setting and place, those messages would be appropriate. The
committee unanimously approved the recommended language as being the best to
address the people who they will provide services to.
Brenner stated the messages are incredible. They don't get in anyone's face
and they make the point. She asked to incorporate the messages if they could.
Davis stated that the Health Department incorporates those messages when the
staff does personal counseling.
Brenner stated she liked the language.
Roy stated that the committee has done a wonderful job in giving precise and
concise information. As an educator, there is lots of evidence that shows people's
behaviors are not changed by written comments. Adolescent drug behavior was
not changed by all the television advertisements. The written word is not going to
change their behaviors. Counseling and significant peers and adults are what
change their behavior.
Nelson stated the average rate of chlamydeous cases is 124.8 cases per
100,000 people. He asked if the average rate should be 251.8 cases per 100,000
people. Davis stated the average actual number of cases over a five -year period
would be 251.8 cases. However, the amount of cases per 100,000 people is the
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rate. She wasn't able to create a rate for all the STD cases. Some STDs have such
a small number of people that she can't create a rate.
Brenner stated that the recommendations are excellent. She really liked the
extra messages. She disagrees with Councilmember Roy. If an adult sees some of
this information, it might be cause for a pause to think about it. It's important to
give people information on the statistics and the permanence of some of these
things.
Nelson suggested that one of the counselors talk to the Board of Health
about what they counsel on. Counselors discuss much of these messages.
Fleetwood stated Mr. Boenig wants to request the Health Department to
deliver the strongest educational message possible to the at -risk youth, students,
and residents of Whatcom County. He asked if the advisory board does that. Davis
stated the committee got that charge from the Public Health Advisory Board. They
spent quite a bit of time crafting the language that would do exactly that. When
the committee recommended these comments to the Public Health Advisory Board,
Dr. Boenig made comments, which were incorporated. These are totally new
comments that he is suggesting. The committee worked, and unanimously agreed
on all this. The recommendations reflect a very strong message.
Motion for approval as amended carried 6 -0 with McShane absent.
ADJOURN
The meeting adjourned at 12:30 p.m.
Jill Nixon, Minutes Transcription
These minutes were approved by Council on October 22—, 2002.
ATTEST:
Dana Brown - Davis, Council Clerk
WHATCOM COUNTY COUNCIL
WHATCOM COUNTY, WASHINGTON
L. Ward Nelson, Council Chair
Board of Health, 10/1/2002, Page 15