HomeMy WebLinkAboutSpecial Board of Health January 17 20021
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WHATCOM COUNTY COUNCIL
Special Board of Health
January 17, 2002
The meeting was called to order at 2:00 p.m. by Council Vice -Chair Barbara
Brenner in the Council Committee Room, 311 Grand Avenue, Bellingham,
Washington.
Present:
Barbara Brenner
Laurie Caskey- Schreiber
Sam Crawford
Seth Fleetwood
Dan McShane
Sharon Roy
Absent:
L. Ward Nelson
1. EMERGENCY ORDINANCE AMENDING WHATCOM COUNTY CODE
24.06.040, SOLID WASTE DISPOSAL STANDARDS (AB2002 -064A)
Brenner stated she was confused about who called the meeting.
McShane stated he called the meeting. He contacted all the councilmembers
to see if they could attend, and determined the time in consultation with staff. He
moved to rescind the motion passed on January 15, 2002 meeting which adopted
the emergency ordinance amended Whatcom County Code (WCC)
24.06.040, solid waste disposal standards (AB2002- 064A).
Crawford questioned whether a councilmember who voted against the
ordinance could move to rescind the ordinance. He would make the motion if
Councilmember McShane could not.
Brenner stated they don't need a motion to hear testimony. She preferred to
hear comments first.
Dave Grant, Senior Civil Deputy Prosecutor, stated Councilmember Crawford
should make the motion, just in case, because he voted for the ordinance.
McShane withdrew his motion
Crawford moved to rescind the motion passed on January 15, 2002 meeting
which adopted the emergency ordinance amended Whatcom County Code (WCC)
24.06.040, solid waste disposal standards (AB2002- 064A).
Board of Health, 1/17/2002, Page 1
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Dr. Gregory Stern, Health Officer, stated there are a couple of issues. One
issue is about process. The other issue is the status of whether or not there is an
emergency. The ordinance was passed because the Board of Health declared a
public health emergency. As the County Health Officer, his responsibility and duty
is to respond to health emergencies. He questioned why the Health Board did not
discuss this with him before declaring an emergency. If there are health
emergencies, he is available by pager 24 hours per day, seven days per week. If
there are health emergencies, it is the responsibility of the Health and Human
Services Department to respond. Neither the County Health and Human Services
Department nor the State Department of Health have identified a public health
emergency regarding invasive streptococcus.
The other issue is control of invasive group A streptococcus. There is a press
release from the British Columbia Center for Disease Control and the information on
group A streptococcus from the Center for Disease Control and Prevention. The
process of controlling group A streptococcus outbreaks is to identify whether or not
an epidemic exists, if the invasive disease is in the community, and to identify close
contacts. Those would be people who would be treated with antibiotics. They don't
have an identified epidemic in Whatcom County. British Columbia is dealing with
their outbreak in the usual manner.
The news release describes the numbers of cases and also points out that
that group A streptococcus is common in the community. There are 80 different
types of group A streptococcus. Their circulation varies. This group causes ear
infections, pneumonia, toxic shock syndrome, necrotizing fasciitis, and other
conditions. When there are outbreaks of invasive diseases, there is the direct
response. The reservoir for this bug is in people. It is passed on by direct contact,
such as kissing, direct touching of the infected wounds, or sharing eating utensils.
Large respiratory droplets can also pass it on if someone coughs and sneezes.
These aren't going to be a widespread, aerosolized infection. Occasionally there will
be streptococcus pharyngitis outbreaks from food poisoning. If someone has
streptococcus that is handling food with open sores, it can cause outbreaks of sore
throat. That is the background of the disease they are dealing with.
There are several factors in disease outbreaks, including microorganism, host
conditions, and a mode of transmission. He did not and does not see a public
health emergency of group A streptococcus in Whatcom County. They've had two
cases in invasive group A streptococcus in Whatcom County. One was on a patient
who was referred to St. Joseph's Hospital from out of the county in 2001.
Lab workers are dealing with these organisms all the time, and are not
seeing an increased number of cases in people who are handling clinical specimens
that contain infectious organisms.
Another issue is the implication of the ordinance. The ordinance requires
treatment of all lab stocks and cultures. The current regulations require on -site
treatment of materials out of bio- safety level three and four labs. They also added
any of the viruses or bacteria that are passed on by aerosolization. Aerosols are
Board of Health, 1/17/2002, Page 2
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suspended, very fine particles that act like gases. They would be suspended in the
air for hours. They are things like measles, chicken pox, and tuberculosis. Cultures
containing those or from level three or four labs have to be treated on site. All else
can be shipped offsite for treatment. The protection is through proper packaging,
containment, and transport as regulated by the Occupational Safety and Health
Administration (OSHA), State Department of Transportation (DOT), and the
Whatcom County Code. It can then go to a permitted and regulated site in the
county. The Health and Human Services Department would regulate it. That is the
current situation.
This revision requires generators of medical laboratory waste, the hospital
lab and any doctor's offices doing cultures, to treat onsite. They cannot transport
offsite for treatment. To treat onsite, they have to present a plan of operation, buy
equipment and get approval before they can treat medical waste onsite. If the
Council implements this ordinance immediately, these labs would need to transport
or treat their waste legally. They would need to stockpile the medical waste until
they get approval or stop operations. The ordinance also prevents importation of
medical waste that does not include stocks and cultures into the county for
treatment. That would require the Stericycle facility to stop operations until they
could assure that that they don't have stocks and cultures in their medical waste
stream.
If the ordinance is rescinded, public health will be protected. The current
regulations, prior to this emergency ordinance, provide for control of containment
of waste, transport of waste, and treatment of waste. They require personal
protective equipment such as splashguards and gloves on waste workers to prevent
direct contact. They prohibit the importation of tuberculosis, varicella, and other
aerosolized bugs. If that stuff got into the treatment plant, they have backup
protection, which is to prohibit grinding and shredding of medical waste, which
produces aerosols. There is a lot of redundancy in the system. There are
engineering controls when the waste comes into the facility. It is packaged in
plastic bags that are in cardboard boxes or tubs. They are tipped into the bins
where they are treated, so there is a minimized amount of direct handling of the
materials. There is a wide range of control in place on the spread of infection in
medical waste.
Crawford asked if British Columbia currently has an epidemic, and how does
Whatcom County best insulate itself from that epidemic. Stern stated British
Columbia has an epidemic in that they have a higher than expected numbers of
invasive group A streptococcus. There is not a need to insulate Whatcom County
from that epidemic, because the infections are passed directly from person to
person. If one is concerned about it, he or she can avoid visiting British Columbia if
there is an epidemic. If there are cases of influenza in Seattle, one could stay out
of Seattle. It is the same measure one takes when he or she hears that there are
higher than expected numbers of infections.
Crawford asked if streptococcus could be transmitted through medical waste.
Stern stated the infectious agents are in medical waste. If the question is whether
Board of Health, 1/17/2002, Page 3
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or not people have gotten infected with streptococcus through medical waste, they
don't have any documentation of that. They have control measures in place to
prevent people from getting infected from streptococcus and other infections.
Brenner stated the question was whether streptococcus could be transmitted
through medical waste. Stern stated he stood by his answer.
Crawford stated he was under the impression when he voted for this that
doctors' offices would not be affected. He asked if it is common to have a lab in a
doctor's office that is affected by this ordinance in Whatcom County. Stern stated
they don't know since there are no level three or four labs in the county. They
don't have an inventory of how many private offices do cultures. They do know
that the hospital and Madrona Medical Group do cultures. Others may be involved.
Fleetwood asked about the plan of approval for level one and two onsite
treatment. Stern stated it would entail a facility submitting a plan to the Health
and Human Services Department about how they will treat biomedical waste.
Health and Human Services Department staff would review the plan and issue
approval. Th complexity of the process depends on the volume and what they've
been treating. There have been two medical offices that have gotten a permit to
treat their sharps containers onsite. That was a process of having the equipment,
providing written description of how they would do it, and getting approval from
Health and Human Services Department staff.
Brenner read a letter from a local medical doctor, Jonathan Franklin, who
was the medical representative on Medical Waste Task Force (on file). The letter
stated that Dr. Franklin proposed and supported the idea that all stocks and
cultures be treated onsite prior to transport. In addition, she received an email
from Wayne Turnberg. Mr. Turnberg is recognized as the top expert nationally and
internationally. Mr. Turnberg sent her information about the requirement of stocks
and cultures being treated onsite. The information included correspondence from a
person from the Center for Disease Control (CDC), portions of which she read into
the record (on file). The CDC official said that the source of the tuberculosis
outbreak in Washington State is considered a bio- safety level (BSL) 2, that it is
better to prevent generating the aerosol from the waste in the first place, and that
BSL 2 organisms have been used as bioterrorism weapons. In addition, the official
said that the possibility exists that releasing untreated cultures and stocks from
hospitals could allow source microorganisms to fall into the wrong hands.
Brenner read from more information sent to her by Mr. Turnberg from a
colleague (on file). The letter stated that amplified microbial populations are
removed from those responsible for their production and transported by a second or
third party, and that this material is the most potentially hazardous component of
the entire medical waste stream.
Stern stated there are two issues. If the Council wants to reopen the
discussion of the treatment of stocks and cultures, it is a legitimate question to
Board of Health, 1/17/2002, Page 4
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bring up. The Medical Waste Task Force, the Public Health Advisory Board, and the
Board of Health discussed this.
Brenner stated that according to the CDC, of the 3.5 people per 100,000
people are infected with general invasive streptococcus, only six percent of that is
generally necrotizing. The death rate is 25 percent. This disease is deadly and
rare. This outbreak is in Victoria. It is off the chart compared to a normal rate.
The reason she proposed an emergency ordinance was because of what she heard
this weekend about what is going on in British Columbia.
Stern stated the discussion of whether all stocks and cultures should be
treated happened, and can be reopened. The question is whether or not it requires
an emergency ordinance to do that. He also talked to Wayne Turnberg specifically
about the issue of treating all stocks and cultures. Mr. Turnberg said his concern
was aerosolization by shredding and grinding, and that by prohibiting shredding and
grinding, Mr. Turnberg didn't think there was a need to prohibit treatment offsite.
His discussion with Mr. Turnberg was at the time they discussed the initial
ordinance.
Brenner stated Mr. Turnberg told her that he preferred that all stocks and
cultures be treated on -site. Stern stated that is totally contradictory to what Mr.
Turnberg told him.
McShane moved to end the debate and called for the vote. He would prefer
to stay because he wants to get a lot of input, but three councilmembers are not
going to be able to stay.
McShane stated this was introduced at the previous Council meeting and will
come forward to the full Council.
Fleetwood stated he would like to discuss the issue until 2:50 p.m.
Roy stated new councilmembers were asked a month and a half ago to be a
panel for a large group of people in Lynden today. She feels an obligation to keep
that prior commitment to the community members. This isn't a frivolous thing.
She appreciated their responsibility to work this through, but she is torn.
McShane withdrew his motion. He will make the motion at 2:45 p.m.
John Hoyt, Northwest Regional Laboratory at St. Joseph's Hospital Medical
Director, stated he was shocked to hear about this and to read the wording. The
ordinance would put them out of compliance immediately. He cannot be in
compliance instantly. This was done without any consultation from him or the
County Medical Health Officer, which is unbelievable. He is disturbed about the
streptococcus infections and their potential to hurt, maim, and kill people. Such
infections have occurred at the hospital. They have implemented a process to
handle culture waste some years ago. The process is above and beyond safe.
When cultures are done, they go into a very tough bag, which is placed into a
Board of Health, 1/17/2002, Page 5
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puncture resistant box specifically for transportation, which is approved by the
Department of Transportation. It is picked up by Stericycle, put into a leak proof
truck, transported, and autoclaved offsite in a process approved by the County
Health Officer. His organization has responsibility for the waste because they are
the generators. It is part of their regulatory responsibility to make sure it is dealt
appropriate, legally, and in a way to minimize risk. This ordinance is an alternative
approach, which is inactivation of all cultures by some means onsite. They
currently don't have an autoclave set up. That would cost $100,000 to design and
construct. They would then be faced with increased work requirements to
accomplish that in a setting that currently is perfectly safe and reliable.
He agreed with Dr. Stern about the mode of infection for this particular
organism. It requires close personal contact. He would have to theorize some odd
circumstances to imagine how these would become a community threat in the
transportation from the hospital to the facility for their inactivation. If they are to
be in compliance with an ordinance, it would require them to open all culture
dishes. Some of them do contain organisms that are dangerous when aerosolized.
It is a risk of exposure to his laboratory personnel that he is unwilling to accept.
They do over 60,000 of these per year. That is a true exposure that he is not
willing to agree to. Based on the emergency nature of this amendment, he is
placed in the immediate position of being out of compliance with no natural
recourse to be in compliance other than over several months with much expense.
He is open to analyzing their process. If there is any reasonable scientific evidence
and grounds for changing their process, he is open to reviewing that evidence,
particularly in regard to this current probable outbreak north of the border. These
are organisms that are not transferred by fine - droplet aerosolization. He is
convinced that the method of disposal is perfectly safe and within the guidelines
they are working under. If it is desired, he would participate in reopening the task
force that considered this issue a year and a half ago and to seek out additional
medical expertise. The impact on St. Joseph's Hospital is an immediate lack of
compliance. The problems are best addressed by an offsite location and place of
inactivation.
Brenner stated she is sensitive to the problem to do this immediately.
Someone from the hospital spoke to the Medical Waste Task Force and said that the
hospital would be willing to look at it. This was two years ago. She put two
manufacturers in touch with St. Joseph's Hospital. One manufacturer gave the
hospital some information, but apparently nothing came from that. A report from a
manufacturer showed that the cost is $26,000 to $36,000, not $100,000. They are
only talking about stocks and cultures. She also asked the manufacturers how long
it would take to put up a temporary piece of equipment on site. The manufacturer
said it can be done in a few days to a week if it is urgent.
She would compromise on only the second part of the emergency ordinance.
The first part is the about the labs themselves. Each lab produces probably little
compared to the overall amounts they are dealing with. Aggregating large amounts
of stocks and cultures is dangerous. That's why she set the limit to begin with.
The Journal of American Medical Association (JAMA) printed information on the
Board of Health, 1/17/2002, Page 6
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tuberculosis outbreak in its October 4, 2000 issue, which she read a portion of for
the record (on file). The article said that stocks and cultures should be
decontaminated prior to disposal, and preferably within the laboratory where they
are generated. The Council can enact the second part of the ordinance and not
allow acceptance of contaminated laboratory waste, and give time for the individual
labs to be able to do what they need to do to become equipped.
Someone from St. Joseph Hospital spoke with the Council and said they were
interested in exploring the idea and working with the Task Force on it. She has
information that the overall cost of doing it onsite is cheaper than sending it offsite.
She is willing to consider staying the first portion of the ordinance, but not allowing
the aggregation of higher amounts. They are at a higher risk because of the
proximity of Victoria. Not allowing the aggregation of the amounts would reduce
their risks, and give the medical facilities and laboratories the ability to take the
time they need.
McShane moved to close the debate so they can vote to rescind immediately.
The other items they can discuss later.
Motion to close the debate carried 5 -1 with Brenner opposed.
Crawford moved to rescind the emergency ordinance.
Roy stated some of this information could still continue to come to the
Council, because there is a lot of information that Councilmember Brenner and the
audience has. She would like to hear that information.
Crawford asked if the ordinance is going to be discussed in committee.
Brenner stated it is scheduled for a hearing.
Motion to rescind carried 5 -1 with Brenner opposed.
Caskey- Schreiber stated she supported rescinding the ordinance right now
because the community's health is affected by the hospital not being in compliance.
She applauded Councilmember Brenner's efforts. They need to work on revising
the ordinance to do this on a timeline that everyone can operate on legally.
(Clerk's Note: End of tape one, side A.)
Brenner moved to adopt an emergency ordinance to prohibit medical waste
treatment facilities from accepting contaminated laboratory waste. Laboratories
and hospitals have alternatives. She understood that none of the labs are sending
their waste to the facility in Whatcom County now anyway. This would not affect
that facility at all. This would prevent an aggregation of large amounts of stocks
and cultures in Whatcom County.
Board of Health, 1/17/2002, Page 7
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Grant stated it is ill- advised to vote on this motion because they've not had
an opportunity to review the ramifications of the proposal. It would be appropriate
to think about this first.
Brenner stated she is proposing an emergency ordinance. As an emergency
ordinance, it is a public health ordinance. She believes there is an emergency now.
This would not affect the labs at present, but it would be a wake -up call to start
moving in that direction. She restated her motion to adopt an emergency
ordinance so that medical waste treatment facilities in Whatcom County shall not
accept contaminated stocks and cultures from laboratories.
Roy stated she would not support the motion because she is feeling very
rushed on the entire process and needs Councilmember Brenner's information in
print to read. She needs more time to absorb the information. That is why she
doesn't support the motion. It is not that she doesn't' support the concept. She
doesn't understand the concept, the ramifications, and the unintended
consequences well enough right now to vote "yes."
Caskey- Schreiber agreed with Councilmember Roy. She was frustrated a bit
with how the ordinance went through. She wants to make educated decisions. She
wants to hear from County experts and have an extensive dialog all the way around
before they move into the emergency response phase, when an emergency has not
been declared yet.
Brenner stated that when there is an epidemic, which there is, they don't
always have time to get into detail.
Motion failed 1 -5 with Brenner in favor.
ADJOURN
The meeting adjourned at 2:53 p.m.
Jill Nixon, Minutes Transcription
These minutes were approved by Council on February 12, 2002.
ATTEST:
Dana Brown - Davis, Council Clerk
WHATCOM COUNTY COUNCIL
WHATCOM COUNTY, WASHINGTON
Barbara Brenner, Council Vice -Chair
Board of Health, 1/17/2002, Page 8