HomeMy WebLinkAboutBoard of Health December 4 20011
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WHATCOM COUNTY COUNCIL
Board of Health
December 4, 2001
The meeting was called to order at 10:30 a.m. by Council Chair L. Ward
Nelson in the Council Committee Room, 311 Grand Avenue, Bellingham,
Washington.
Also Present: Absent:
Sam Crawford Robert Imhof
Barbara Brenner
Marlene Dawson
Dan McShane
Connie Hoag
1. PUBLIC SESSION
Kerry Chappell, 1121 Roland Street, stated an epidemic in Bellingham and
Whatcom County is promiscuous sex. She has three concerns for the Board of
Health to consider. One issue is cervical cancer, specifically caused by the human
papilloma virus (HPV), and the new health law. A second issue is intervention and
prevention, along with 30 years of treatment for sexually transmitted diseases
(STD). The amount of people infected with disease is outrageous. A third issue is
to include other nonprofit organizations that offer the services of life- affirming
alternatives, so they can broaden the base of information to the community. The
County brochures include Planned Parenthood, Sea Mar Community Health Center,
and Interfaith Family Health Center. Other organizations are out there for
treatment of STD's. In Bellingham and Whatcom County, two to three women die
due to HPV, a cause of cervical cancer. It is 100 percent preventable. People are
dying from promiscuous sex. There is no intervention from the Health Department.
Women are being ravaged by STD's. The three main STD's are chlamydia, HPV,
and genital herpes. Chlamydia is linked with cervical cancer. Prostate cancer in
men is linked to multiple partners in one's lifetime. Sex is extremely dangerous.
The information is not getting out to intercede and prevent sex. Put out a public
service announcement to the young people in the county to warn them against
HPV. Condoms don't prevent it. It is transferred by skin -to -skin contact. A
condom fails 15 percent of the time to prevent HIV, even if it is used 100 percent
accurately. She is stressed that the more broad -based information is not being
offered. The other agencies include Lynden Human Life, Great Expectations, and
the Whatcom County Pregnancy Center. Also, promote the adoption agencies in
the area when the Health Department does referrals. They may not agree with
being sexually active outside of marriage, but they do agree that the choice of
being sexually active ought to be an informed choice. People are destroyed from
lack of knowledge. Another request is to incorporate an abstinence education
Board of Health, 12/4/2001, Page 1
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program through the Health Department. Every year, 5,000 women die in this
country from cervical cancer.
Carol Thomas, Whatcom County Pregnancy Center Executive Director, stated
the pregnancy center has been in downtown Bellingham for 12 years. They are
nonprofit and interdenominational. They offer several services to the County. They
are not a political corporation, according to their bylaws. They are not advocates
for one side or another. They want to provide a safe haven for people with an
unplanned pregnancy and to educate teens. Their services are free. They also
have a mobile unit to take into the County at Everson, Kendall, Lynden, Ferndale,
and Blaine. The majority of the young women they deal with are 14 to 24 years
old. In this past year, they also included ultrasound services. Part of the reason
they've chosen to do that is because they are dealing with young women. Most of
the time, when the young women think they are pregnant, there is a degree of
panic. When making the decision, the young women need complete information so
they can see what is happening to them. This is very important because another
one of their services is post- abortion recovery groups for women who have regrets.
Of the young women who have an abortion, two out of three have regrets. These
regrets may come about later in life when the woman chooses to have a child, or if
the woman's faith deepens to see how God has created life. Their other program is
abstinence education for teens in public schools and in youth groups. There are
two school programs. They go into the schools as an invited guest. Their
abstinence education gives kids skills, shows them how to set boundaries, and
teaches them how to communicate those boundaries. They are one of the seven
agencies in Washington State that was awarded Title 5 funding for abstinence
education. The people who go into the schools and youth groups are college -aged
kids who are role models.
Tom Boenig, resident, stated the teen help card is supplied by the Health and
Human Service Department as a resource for teenagers. At the time of its first
printing, it seemed to meet the goal to provide phone numbers for a variety of
issues. Upon further assessment, there is a bias toward certain organizations and a
distortion of the term "pregnancy prevention." Under the category of pregnancy
prevention are listed groups that suggest this category is a euphemism of
pregnancy prevention by abortion. If a teen help card wishes to list organizations
that perform abortions, then change the heading to abortion /pregnancy
termination. Some other groups might not choose to be listed under this heading.
He asked why Mt. Baker Family Medicine and Planned Parenthood are singled out
when other family medicine and gynecology offices in the community also perform
abortions, counsel, and provide family medicine services.
In addition, one cannot prevent a pregnancy by performing an abortion. One
can only prevent the delivery of an existing pregnancy by terminating it. One can
only prevent a pregnancy through sexual abstinence and, less effectively, through
contraception. Since all medical offices are competent to discuss pregnancy
prevention, he questioned whether there is a bias toward Mt. Baker Family Medicine
and Planned Parenthood solely, while excluding other for - profit medicine and
OB /GYN offices. It is curious that, under the categories of Pregnant Support and
STD Testing, Mt. Baker Family Medicine, Sea Mar, and Planned Parenthood are
Board of Health, 12/4/2001, Page 2
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listed. Most OB /GYN offices in the county offer these services for all ages and social
economic groups. It is free advertisement. These offices were listed most likely
due to their apparent accessibility and slightly scaled fees for these age groups. He
questioned why these three organizations appear to receive preferential
consideration on this card. These agencies will seek the highest obtainable fee for
their services or will strive to qualify the individual for coverage from the State
Department of Social and Health Services (DSHS) no less avidly than other non -
listed medical offices in Whatcom County. The intent of this discussion is twofold.
Evaluate whether certain organizations need to be reclassified under its heading to
accurately reflect its distinctive function. Any bias in the card should be excluded.
The effect of these actions is more effective resources for the teenagers. Planned
Parenthood is also listed under the category of Education /Life Skills. He questioned
whether Planned Parenthood has any specific education programs that are unique
to Planned Parenthood and that are included in this category. He recommended
that the distribution of the teen cards cease immediately, that changes are
reviewed by interested parties, with recommendations made to the Council at the
next Board of Health meeting. If changes are made by the Council, new teen help
cards should be printed immediately upon approval, while discarding the current
cards.
Marlae Nieuwsma, 8600 Bender Road, Lynden, stated she represents Lynden
Human Life and Great Expectations. They have had a pregnancy home for six
years. They offer a safe place for young girls and women who are pregnant. Their
mission is to treat women with respect and dignity, and to comfort them. They also
provide pregnancy tests to those who are not sure whether or not they are
pregnant.
They get their monies from churches, private organizations, and individuals.
They don't have the money to advertise like Planned Parenthood does. They
depend on the County's good faith, so that they can have the same availability as
Planned Parenthood. They are political organizations, and felt that this is a natural
part of Lynden Human Life to bring comfort to those women who are in a panic
situation.
Brenner asked if they are not listed on the teen card. Nieuwsma said they
have tried to be on the teen card. They are on the second printing. They were
ignored for the first printing. Great Expectations is the name of the pregnancy
home.
Grant Bowles, Community Baptist Church Pastor, stated this past Sunday, a
young lady in his congregation told her youth leader that she was pregnant and had
an appointment set up for an abortion. The youth leader talked with the lady, who
had gone to Mt. Baker Family Medicine. The only alternative that she was offered
was an abortion. There was no discussion about keeping the baby or adoption.
She didn't know that there were other options until she talked to the people at the
church. It is disturbing that the local health department relies on Mt. Baker Family
Medicine and Planned Parenthood, which are pro- abortion, so much. He asked that
the Health Department look at how much they use an organization that promotes
abortion.
Board of Health, 12/4/2001, Page 3
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Mary Rogers, Old Samish Road, stated she is a retired caseworker. She used
to be an adoption worker for the State of Colorado during the time of Roe v. Wade.
When the case came up, she had been the last one hired to do adoption work, so
she was reassigned to something else because of the lack of children available for
adoption, due to the abortion program. Her job became doing studies for the court
for divorces and child custody disputes. Even though she was in the church, she
has never heard of abortion being talked about. When Roe v. Wade came about,
the state told her not to worry about it. That is what she believed. She didn't think
anything about it when people decided to abort.
The next year, they moved to Oregon. Her 14 -year old daughter became
pregnant. She urged her daughter to have an abortion, which she did. That was in
1974. There have been 25 years worth of something between them that wasn't
healed until 1999. Abortion destroys the child and also the mother and mother's
family.
Be open minded, and let the children in high school know that there is no
such thing as safe sex. She hoped the Board would do something about it. Kids
are being killed because people have been deliberately lying to them.
Crawford stated he disagreed that the teen card is something they should
discontinue immediately. It is a good thing. The County's role is to provide
direction to teens and connect teens with sources of help. As a County leader, he
needs to put his biases aside and look at what the County should do. Perhaps in
the next printing, they can have one category that says something about Pregnancy
Education, Support, and Termination or Pregnancy Services. Do not sort out who is
doing prevention. The words "prevention" and "support" might characterize a
particular kind of service that leads a vulnerable teen in a certain direction. The
County needs to be cautious to let the teen decide which direction she would like to
go.
If the County is in the business of referring and looking out for the youth of
the county, he hoped that in return for having more clientele come to their doors,
the agencies would have a set of standards. Have a checklist of options regarding
pregnancies be required of any service providers that the County recommends.
Each client has to be signed off and noted that the myriad of options was given. He
didn't know if this is an issue for Board of Health policy.
Nelson stated the Public Health Advisory Board has been working on
brochures in light of new Center for Disease Control (CDC) requirements,
particularly in light of HPV. He didn't know how far along they are with that.
Recent issues have taken staff time away from this issue. He thought they would
have revised brochures in January.
Regina Delahunt, Interim Health and Human Services Director, stated she is
putting staff back in their regular programs in January.
Board of Health, 12/4/2001, Page 4
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Brenner stated she supported sending those suggestions to the Public Health
Advisory Board. They make a lot of sense. She would like to have a presentation
by Planned Parenthood. She never heard that they are promoting abortion and not
giving people alternatives.
Crawford stated it was Mt. Baker Family Practice that was mentioned.
Brenner asked for a presentation about that and from Great Expectations.
She'd like the presentations to be done in a way that is not confrontational. Have
an informational discussion instead of debate. She wants to know what they do.
Hoag stated some of the councilmembers' suggestions are close to but not
the same as what the Board is being asked to do. She asked that the request from
the community go with the recommendation to the Advisory Board. The point is
that Mt. Baker Family Medicine should not be under the category of Pregnancy
Support unless the category includes everyone who offers prenatal care. She would
like to see the comments go forward. If there is a presentation from Planned
Parenthood, it would be appropriate that the citizens who brought forward concerns
be able to discuss it with the committee.
The comments from the pastor match what she experienced in her own
home, when she provided a safe shelter to someone in a difficult pregnancy.
Planned Parenthood told the woman to have an abortion because it would solve all
of her problems. The patient should sign the checklist suggested by
Councilmember Crawford.
Dr. Greg Stern, Health Officer and Whatcom County Medical Society
President, stated the society has a grievance committee for medical ethics and legal
requirements that are not being met. If there is a complaint about a medical
practitioner, the person has the option to go to the medical society grievance
committee. It applies specifically to practitioners who are members of the society.
Nelson stated the grievance procedure is against specific practitioners, not
organizations. Stern stated yes, but there are practitioners in those organizations.
Mt. Baker Family Practice is a family practice with physicians and nurse
practitioners.
Nelson asked if the funding for abortion pays just for the operation, or is it
for profit. Stern stated he didn't know. They would have to ask Planned
Parenthood or Mt. Baker Family Practice.
Brenner asked what is required of any of these organizations, and how they
are required to deal with teenagers. Stern stated it would be unusual if someone
came in and the full spectrum of options would not be provided. In terms of
medical ethics and legal precedent, they are required to give informed consent.
(Clerk's Note: End of tape one, side A.)
Board of Health, 12/4/2001, Page 5
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Brenner stated she assumed these organizations would try to provide full
spectrum of alternatives. Stern stated they would have to ask the practitioners'
policies. Informed consent is about being given information to make that decision.
Nelson suggested scheduling this at the next Board of Health meeting. There
are two significant issues. One is pregnancy counseling, and the other is a concern
about STD.
Hoag asked if the new brochures would be available in January. Delahunt
stated no, the process starts in January. They weren't planning to change the teen
card again. There was a lot of controversy surrounding the first printing, so they
modified it to include the categories. It is a difficult balance.
Hoag stated she would like the Health Department to print new cards based
on concerns that were brought forward. Don't wait until they are out of the new
cards. Delahunt stated they can't have the card issue done by January. The
Advisory Board should get involved.
Hoag moved that the teen card and concerns be directed to the Advisory
Board for recommendations for changes. Any recommended changes would be
implemented immediately upon approval of the Board of Health.
McShane stated this isn't based on any policy. They are getting into an
administrative matter in determining how cards are produced. If they want to have
a policy discussion, then fine. This isn't about policy. He agreed that the cards
could be tweaked a bit, but there could be many different opinions about them.
Nelson stated he agreed with both Councilmembers McShane and Hoag. The
Advisory Board is going to look at the card and say it is fine because it hasn't heard
the concerns. The discussion should be on what the policy is that they want to
portray on their brochures and cards. Then, staff can design the card according to
the policy. Policy discussions could include types of facilities included on the card
and information provided about the care and treatment of the pregnancies.
Brenner stated she agreed with Councilmember Nelson. Also, she agreed
with Councilmember Crawford's suggested policy.
Nelson restated the motion. He is talking about the Advisory Board looking
at the policies that go into the making of the card. The Advisory Board would
identify the different policies to be discussed, and recommend it to the Board of
Health. Then, allow the Health Department to design the card according to the
policies.
Dawson stated a County policy would be that they want these agencies to
make their services clear. The County wants clear policy on the agencies' policies.
Delahunt stated the staff had a list of criteria that the organization should meet
when they first put the card together. They could resurrect the criteria for the
Board of Health to take a look at it.
Board of Health, 12/4/2001, Page 6
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Dawson stated it is important for people to know, up front, that when they
go into a particular agency, they will hear an emphasis on one perspective.
Hoag stated she is suggesting policy, not administration. Have the card
revised to make equal access to pro -life organizations. That is what they need to
do, and that is policy. That is the basis of her motion. She amended her motion,
and moved to direct the Advisory Board to look at equal access for pro -life
organizations.
Nelson stated there are several policies that they need to address, including
how the agencies identify what they do and agency accountability. He suggested
that the motion be to send the policies to the Advisory Board for discussion, and
bring the policies forward to the Board of Health for adoption.
Hoag stated her motion was to ask the Public Health Advisory Board to
recommend revisions to the teen card to reflect the concerns that have been
brought forward, including providing equal access to pro -life organizations and
defining which services are offered by each organization. Delahunt stated staff
tried their best to provide equal access. It could be read in different ways.
Motion failed 2 -3, with Hoag and Dawson in favor, and Brenner abstaining.
Nelson moved to have the Public Health Advisory Board to:
• examine policies currently in use to see if the teen card is complying to
policies.
• evaluate policies regarding testimony received today.
• make recommendation to the Board of Health about how to apply those
policies or additional policies.
Crawford suggested a friendly amendment for the Advisory Board to also
look at the categorization of pregnancy prevention and pregnancy support, and
provide advice to the Board of Health.
Nelson stated that would be included in the policies. He wants to look at the
entire package.
Hoag stated she would not support the motion because policies will come to
the new Council. The public asked the Board of Health to review the card.
Dawson stated she doesn't know what policies are. Include abstinence and
adoption options in policies.
Brenner asked if the motion could be to have the Advisory Board recommend
revisions to the card that will clarify the issues that they are talking about.
Nelson restated the motion. They need to have policies for the
administration to take action on. They can't do it individually. Do it as a Council or
not at all. The motion is to ask the Public Health Advisory Board to:
• Review policies for pregnant teens,
Board of Health, 12/4/2001, Page 7
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• See if the policies are addressing these concerns.
• Bring recommendations to the Board of Health.
McShane stated he has no idea what the policies are on sex education and
pregnancy. None of them do. This card was presumably based on that policy, but
that is an administrative decision, not a decision made by the Council. They should
not get into how the card should look. He is interested in what the policy is. The
simple thing would be a presentation on the current policy on sex education and
pregnancy. There are plenty of people who would love to tell the Council what to
do.
Nelson withdrew his motion.
Dawson moved to make sure all options are available to teens and reflected
in the card. Options include abstinence, adoption, and termination.
Hoag stated the Board of Health has determined policy one issue at a time.
In the past, the Board of Health has removed language from the County Health Plan
that was pro- choice, and added language that encouraged abstinence education in
the schools. The Council has never said it will take on the policies for the entire
topic. They have taken on policy issue by issue, as things have been brought
forward. She would support Councilmember Dawson's motion because it is clear
and based on these requests. She can't support overhauling policy on the basis of
what the Advisory Board might suggest, because policy is supposed to be made by
the Council.
Motion failed 3 -2 with McShane and Crawford opposed, and Nelson
abstaining.
Crawford requested a presentation on the County policies.
Nelson agreed.
Brenner asked for a presentation from Planned Parenthood and Great
Expectations.
Delahunt stated she would invite them to make a presentation.
Hoag stated citizens brought forward concerns about this card, and the Board
of Health response is not to make changes, and to instead have a presentation by
Planned Parenthood.
Chappell asked for a public hearing on this issue.
Nelson stated the public is saying that there is a significant number of issues,
including STD's, pregnancies, and promiscuity in the community.
Hoag moved to hold a public hearing on this topic.
Board of Health, 12/4/2001, Page 8
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Brenner stated she wanted to hear what the policy is first. If they are going
to have a hearing, they have to have a presentation of what the policies are.
Hoag accepted a friendly amendment to begin with a staff report on the
current polices and how they are being carried out.
McShane asked to make clear the polices they are talking about.
Hoag stated her motion is clear.
Brenner stated she wants to have a discussion with staff and ask questions
before having the public hearing.
Stern asked for more clarity on the scope of the public hearing. He
understood that the staff report should address what the department's actions are.
There is a potential for a debate of pro- choice vs. pro -life, abstinence vs.
abstinence plus, and for a global discussion that needs to have a context. The
question is what information the Health Department provides like with the STD
brochures and the services related to STD's and reduction, who they refer to, what
they tell people when they put out information, and the criteria for making
referrals. Clinics such as Planned Parenthood and Mt. Baker Family Medicine
provide medical services that include procedures and counseling. Staff needs
direction on what the Council wants them to do. They need scope and policy
recommendations to know what to come back with.
Hoag stated the scope is about sex education and teen pregnancy, and what
the County does to inform, support, and refer on those issues. She restated the
motion to have a public hearing on the subject of teen pregnancy and sex education
and what the County is doing about it, and to first have a staff presentation on the
current policy and what the County is doing for the policy. She accepted the
friendly amendment to have the staff report first, and a public hearing at the next
meeting.
Motion carried 4 -2 with McShane and Crawford opposed.
2. BIOTERRORISM RESPONSE EFFORTS
Delahunt stated that, in the interest of time, she wouldn't say much. Dr.
Stern will discuss then ten essential services and how the Health Department is
doing, in terms of emergency response and public health response. Janet Davis will
discuss the emergency events that have been happening regarding communicable
disease.
Stern stated that when they think of bioterrorism events, there are two main
forks in the road. One is when there is a suspected or confirmed agent, such as a
positive test result for anthrax in the mail. The other is when people are becoming
ill. With their primary role in dealing with the illness, there is a role of surveillance
and response. This is an extension of the usual communicable disease functions.
They depend on physicians, emergency departments, clinics, and laboratories to
Board of Health, 12/4/2001, Page 9
1 notify the Health Department if they suspect or have confirmed a notifiable
2 condition, which includes suspected bioterrorism exposure. The Health Department
3 then responds accordingly. They are also involved in developing that surveillance
4 system by educating medical providers and the public in the signs and symptoms of
5 conditions that may represent an incident of bioterrorism. They analyze reports
6 from health care providers. They do contact investigation and make
7 recommendations on preventive treatment and containment of infection.
8 Bioterrorism is different from their usual activities because it is an intentional
9 exposure. It becomes a criminal investigation. It has also heightened the
10 immediacy need for coordination with emergency management, law enforcement,
11 hazardous materials (hazmat) teams, and federal and State agencies.
12
13 The State hired a bioterrorism response coordinator and did an assessment
14 of the local public health system, which is different from the local public health
15 agency. A public health system includes emergency management, the hospital,
16 laboratories, pharmacies, and fire departments. When a response is necessary,
17 they coordinate with other agencies. The system was evaluated using nationally
18 recognized criteria of the ten essential services for public health.
19
20 Crawford stated the strategy is well organized. The nature of what they are
21 talking about lends itself to metropolitan areas larger than Whatcom County. The
22 border is the largest cause of susceptibility. He questioned whether there is a
23 strategy for a communication system if someone releases an agent at a border
24 crossing. Develop a system to incorporate the border proximity for the strategy of
25 how they deal with a threat. Stern suggested that Councilmember Crawford talk
26 with Neil Clement about coordination of emergency management. In the case of
27 someone at the border, the Health and Human Services Department would respond
28 to a suspected biological agent or contamination. The Health Department would
29 coordinate efforts with the State Departments of Health and Ecology. There is not
30 a cookbook procedure for all possible scenarios. Instead, have a network of
31 agencies with communication links, and that can be flexible in responding to all
32 emergencies, including bioterrorism.
33
34 Crawford asked who would be in charge. Stern stated the Emergency
35 Management Division is the hub with an incident command structure. Those
36 protocols are developed there. If there is an emergency, he is on the phone with
37 Mr. Clement as soon as possible.
38
39 Dewey Desler, Deputy Administrator, stated one issue in terms of disaster
40 response is how to communicate between organizations. In every major incident
41 they've had, communication systems have been shut down. The administration is
42 working actively at trying to develop a new communication system to allow
43 communication between all appropriate safety organizations. The administration
44 will come forward with options.
45
46 Brenner stated she would like to emphasize Essential Service number five,
47 challenge two and Essential Service number eight, challenge one.
48
49 (Clerk's Note: End of tape one, side 8.)
Board of Health, 12/4/2001, Page 10
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2 Brenner continued to state that she didn't understand the challenge in
3 Essential Service number ten regarding research efforts. She assumed the federal
4 government is doing that. She is not interested in doing a bunch of research.
5 Billions of dollars are being provided at the federal level for that. Stern stated they
6 test new solutions. They do have the capacity to work on new communications
7 systems, for example. Whatcom County was a pilot county for an assessment
8 program. There is also local participation in clinical studies, such as St. Joseph
9 Hospital participating in a study done by the University of Washington. There is a
10 tabletop bioterrorism exercise. Whatcom County declined to be a pilot county
11 because the staff is stretched. That would be a situation where they would have
12 liked to participate in those developments.
13
14 Brenner asked to use different language, "...participate in FeseaFch testing
15 and assessment efforts." Stern stated they are using the language from their
16 report. This was advised from a more extensive report.
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18 Brenner stated the costs outlined in the November 26, 2001 memo from
19 Janet Davis seem reasonable. She asked if they will be included in the budget.
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21 Janet Davis, Community Health and Wellness Services Manager, stated it is a
22 related issue. The Communicable Disease Division will respond to bioterrorism.
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24 Stern stated that what the Health Department does in its day to day function
25 is to detect the unannounced bioterrorism. That is a major function of public health
26 regarding bioterrorism. Most of their efforts are going to strengthen that action,
27 and also strengthen their ability to respond to new emergent diseases. These are
28 all related.
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30 Hoag stated that the 911 system was overwhelmed during the Whatcom
31 Creek incident. It had been overwhelmed before. One recommendation she made
32 was that 911 be allowed to overflow into other fire departments. The people who
33 were looking at the system at the time supported her idea, but she never heard
34 more about it. Emergency personnel have said it would be helpful because 911 has
35 a limited amount of calls that it can take. They can't staff for an unknown flood of
36 calls. Many fire departments have people there all the time.
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38 She liked the presentation of the ten essential services. A downside of
39 anthrax is that, by the time they find out that someone has it, it is too late. She is
40 glad to see the response to the powder found in the courthouse. It is also
41 important to understand the influence of the border in a response incident.
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43 Nelson referenced Essential Service seven, challenge two. He questioned
44 whether they have identified pharmaceuticals if there is an outbreak. He also
45 questioned whether they have established access and contract availability. Stern
46 stated this is part of the assessment done a year ago, prior to September 11.
47 There is local capacity to contact the national pharmaceutical stockpile through the
48 National Guard. Other challenges include who distributes the pills and the record -
49 keeping that would need to occur.
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Nelson stated it takes time to get the process going and access the vaccine.
The concern is about the need to have the capability and be prepared for accessing
materials. Davis stated they learned a lot in 1989. They have benefited by those
lessons. Access depends on the product and what they need. Availability of
vaccines is always an issue.
McShane asked the biggest concern locally and nationally. Stern stated the
system could be saturated at a certain level. The challenge is to expand their
ability to respond to bigger and bigger concerns.
Delahunt agreed with Dr. Stern. The surge capacity in the public health
system is minimal. Things that happened during the last couple of months
eliminated any buffer they had.
Davis stated the hepatitis B outbreak is ongoing. Usually, they get three to
five cases per year. They are now at their 30th case. There was tuberculosis (TB)
exposure in the jail. One active case of TB has exposed 500 people. That is whom
they are trying to track down and test. On top of that, there have been issues of
bioterrorism. They are incapacitated in terms of staff time. She has had to bring
people in from other departments. The Health Department is the fire department
for health. Normally they put out little fires here and there, and can respond. Now,
there are many huge fires going on.
Nelson stated the information provided to the Board of Health was from the
assessment study. He asked if there would be specific concerns that will be
brought forward to the Board of Health. Delahunt stated they could do that.
Davis stated they alluded to the concerns in the list of challenges.
Brenner stated she supports an increase in front line people. She can't
imagine that it would take more than an hour if something happened at the border,
before the federal government would arrive. The world will never be safe. They've
never been safe. A magic solution will not happen. She would rather incrementally
work their way up to be as good as they can be, rather than assume they would
create the surge coverage. Davis stated there will be at least 24 hours before the
federal government could come in and mobilize. There is a lag time, and the Health
Department needs to have things in place to do initial planning.
Hoag asked if the TB outbreak has been advertised to inform people. Davis
stated they sent out numerous letters and have done home visits. They have not
done any public notice until they confirm that the disease transmission has
occurred. They have only finished testing about 20 percent of the people. To date,
no one has tested positive.
Stern stated that when a person is exposed to someone who is infected with
TB, he or she will develop a latent infection that is not contagious until it becomes
active. There are people they've tested early on that may have been exposed to
establish a baseline. It takes three months to develop the positive skin test after
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exposure that would indicate an infection. Those are the people they want to
identify. In general, those who would have been infected are not likely to be
contagious immediately. They test in concentric circles, starting with who had the
most exposure and going out from there. They don't need to test someone who
visited the jail for one day, for example, if the people with more intensive exposure
didn't get infected. They don't want to test people who have a low risk.
3. RESIDENTIAL SHARPS COLLECTION PROGRAM PROPOSAL
Delahunt stated there is a provision in the biomedical waste regulations for
development of a residential sharps collection in the county. The proposal is to
establish sharps collection stations in pharmacies throughout the county.
Pharmacies have expressed some interest, but issues need to be resolved. One
major issue is the fact that the way the regulations read currently, generators of
small quantities would be allowed to take those sharps to the sharps collection
stations. That would be problematic in a pharmacy because there would be
administrative things that need to be determined, such as whether or not someone
is truly a small quantity generator and if there is a fee. Pharmacies are not willing
to get involved in administrative things. In addition, it would increase the number
of sharps that would be collected. The staff proposal is to eliminate the provision to
allow a small quantity generator to take sharps to the sharps collections stations.
Brenner stated she is squeamish about bringing used sharps to drug stores in
grocery stores, and people coming in and out with that kind of stuff. She asked if
there is some kind of home container that can be put into the trash. She didn't like
the idea of traveling the sharps to a drug store. Delahunt stated that once there is
a sharps collection system in the county, then they can no longer be disposed of in
the solid waste stream.
Brenner stated they should have a sharps collection program through the
garbage pickup service. She asked where it goes from the pharmacy. Delahunt
stated Stericycle picks it up.
Brenner asked why Stericycle can't pick it up at Recomp or Recycling and
Disposal Services (RDS) or wherever they take it to. Delahunt stated it might be
problematic for the waste haulers to handle the material.
Brenner questioned why it would be problematic if they are being exposed
now. Delahunt stated that is a different focus from what they had considered.
Chris Chesson, Environmental Health Supervisor, stated they propose to not
allow residential generators to plaster encapsulate because of the establishment of
the sharps collection stations. There would be problems with having a large
quantity of residential generators in the community setting out a container for the
garbage haulers.
Brenner suggested that they talk to the haulers.
Board of Health, 12/4/2001, Page 13
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Crawford stated that sharps on the curbside would be something that kids
can get into.
Brenner stated they would be in a lockable container. She didn't like the idea
of bringing it into a grocery store or places where there are food products.
Chesson stated they could allow the option for residential generators to
plaster encapsulate the sharps in the solid waste stream.
Hoag questioned the meaning of the language. Chesson stated that if a
resident doesn't properly contain the sharps, then the pharmacy would not accept
it.
Hoag asked about Council packet page 19, Whatcom County Code section
24.06.04(4)(a)(i). She questioned whether these would be the people who would
be approved for plaster encapsulation, or if these people would just drop off the
map. Chesson stated they would allow the small commercial generators the option
of plaster encapsulation. The Health Department would still have to approve their
plan.
Delahunt stated They would have to contract with Stericycle to accept sharps
or treat onsite and do plaster encapsulation and dispose of in the regular waste
stream.
Hoag asked if any amount of sharps can be plaster encapsulated. Chesson
stated section .04(2)(8) is for small quantity generators, with less than 50 pounds
of biomedical waste. All of the conditions have to be met.
Dawson asked if the idea is the fact that the pharmacies sell the needles and
can educate the users. Delahunt stated it is.
Chesson stated they have convenient hours.
McShane asked if the Health Department has any significant concerns with
residential users encapsulating themselves. Delahunt stated encapsulation is only
done after treatment. If treated on site, they still have to send them to Stericycle.
McShane asked if there is a concern if residential users treated and put the
sharps in the regular waste stream. Delahunt stated there is a concern. It is a
concern to the solid waste workers. The haulers are willing to fund half of this
program. That is how much of a concern it is to them.
McShane stated he is impressed with Chris Chesson's work on many issues.
Brenner stated she is talking about treatment and plaster encapsulation at
home. She asked if the staff has talked to haulers. Many people will not take it to
the collection center. She is talking about residential treatment and encapsulation.
Delahunt stated she didn't know how residential users can treat at home.
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Brenner stated some people soak them in chlorine.
Dawson asked how to regulate something like that.
Brenner stated she is not comfortable having it in a grocery. The only
solution is to make it easy enough at home, so that it can go with the garbage.
She is also concerned about exposure. If it is not packaged properly, then there is
contaminated stuff going into the pharmacy that is not properly done, then coming
out, then coming back in again. They are opening themselves up to a lot of liability
by doing it that way.
Crawford stated the program is well put together and a great idea. He is
anxious to see what the Solid Waste Advisory Committee (SWAC) has to say about
it.
Hoag stated she also wants to know the SWAC's response to Councilmember
Brenner's concerns.
Nelson stated a concern as a pharmacist is spill management. He asked who
would provide the spill materials. Delahunt stated that section refers to treatment
facilities, not the pharmacies.
Nelson asks what happens if there is a spill at the pharmacy. Chesson stated
they haven't addressed that. That is one of the concerns of the pharmacies.
Nelson stated there would be exposure to untrained personnel. It won't be
stored in the pharmacy, but in a storage room. He questioned who does the record
keeping for spill response. He will write down all of his comments.
McShane stated he would take Councilmember Nelson's comments to the
Solid Waste Advisory Committee.
Nelson stated the language in sections .04(5)(a) and (b) says that no one
may transport biomedical waste that is not contained, handled, or treated in
accordance to the chapter. He questioned whether that means that an individual
user can't transport sharps if they are not encapsulated. Stern stated those
persons are exempt.
Brenner asked for an example of a tuberculocide. Delahunt stated there are
products that are sold that are labeled as a tuberculocide.
Brenner stated people have products such as bleach or peroxide at home
that can be used as a tuberculocide. Have them use it, and then take it to a drop
offsite at the dump or put it in with the garbage. Stern stated they are not talking
about TB. They are talking about bloodborne infections. With the issue of
disinfection, there is a trade off. If small volume generators have to develop a
treatment plan that the Health Department approves, then the Health Department
can look to make sure the generators are treating and encapsulating effectively. If
there is a general rule for the public to treat these at home and encapsulate them,
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the Health Department doesn't have a way to know if they are doing it effectively.
It may cause improper encapsulation, which may result in loose sharps ending up
on the tipping floor. They are trying to avoid that. The encapsulation was a
specific way to allow small generators to be closely monitored. The residential
generation plan is to say how they would segregate sharps from the solid waste
stream to keep them from being compacted. If someone is taking a bottle of
sharps that are properly packaged to a pharmacy or to some other drop off point,
without treatment, there is not a high risk of someone getting stuck if they are in a
puncture- resistant container that is closed. This plan avoids the resident from
having to do more than put sharps in a container and take it to the pharmacy.
Brenner stated she is concerned that not everyone will do it right. That kind
of exposure in a grocery store worries her. Stern stated his concern about liquid
treatment at home is that a risk from a puncture in a container is from the
materials in a syringe and in the needle. If one is not able to get the bleach
through the syringes, he or she will still have sharps that are potentially infectious,
even though they are sitting in bleach. Autoclaving is not an effective way of home
treatment either.
Brenner asked about putting them in a puncture -proof container for haulers.
Stern stated haulers would have to have separate facilities on their compact trucks.
Right now, everything goes into the compactor. It would require different
equipment. Also, kids may get into it.
(Clerk's Note: End of tape two, side A.)
Nelson suggested independent drop off locations. Stern stated the County
said it would set up a collection program. The least expensive and disruptive, if the
pharmacies agree, would be to accept the materials at the pharmacy. The County
would work with the pharmacy on getting it treated. It is a private - public
partnership.
Nelson questioned whether there could be drop -off boxes at a pharmacy
where the pharmacists could see the drop off, but would be in an area that is not
intrusive to the rest of the business. Stern stated that is up to the pharmacy.
Nelson asked why they would transport biomedical waste through a grocery
store where people buy their food. Chesson stated they've also contacted ten
single -site pharmacies in the county that are interested.
(Clerk's Note: Councilmember Nelson left the meeting at 12 :55 p.m.)
Hoag asked to incorporate the correct plaster encapsulation procedure into
the regulations.
Brenner asked if this would be monitored and if the Board of Health will
receive a report on how it is working. Delahunt stated they would collect the data
and number of sharps taken in, and any issues that come up.
Board of Health, 12/4/2001, Page 16
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Brenner asked how they would know the number taken in. Chesson stated
the County would pay for the number of tubs collected per month. It is a 40- gallon
tub. The tubs could be picked up on demand.
Stern stated that another issue is not just the amounts that are treated.
There will also be complaints. If the haulers find sharps at a residence in the trash,
it would be a violation. The goal is to get the sharps out of stream.
trash.
Delahunt stated the haulers will report a resident that puts the sharps in the
Dawson moved to forward the sharps collection proposal to the SWAC.
Brenner asked that her concerns be conveyed to the SWAC.
Motion carried unanimously.
4. RECOMP NEIGHBOR COMPLAINTS
Delahunt stated she wrote a memo about regulatory authority. At the
previous Board of Health meeting, the issue of the odor was brought up. The City
of Ferndale approached the County and asked to collaborate to resolve the issue.
One issue that comes up is the Health and Human Services Department's
regulatory authority over the mushroom compost facility. That facility is the major
odor offender. The County doesn't have regulatory authority over the mushroom
operation because it is conducted in a totally enclosed facility. When staff
inspected the facility, the doors to the mixing operation and composting operation
were left open, and are left open on a regular basis. Staff told the company that
they would not consider it a closed facility if the doors are regularly left open. The
facility agreed to keep the doors closed except when they need to move equipment
in or out of the buildings. If they do that, the County will not have regulatory
authority under the solid waste rules. Staff met with Recomp and the City of
Ferndale. Staff explained to them that keeping the doors closed is not going to
solve the problem. Recomp agreed to put together an odor mitigation plan and
submit it to the County by January 4. Staff will also work with the City and the
Northwest Air Pollution Authority (NWAPA) to get their approval on the plan.
Brenner stated Recomp should be required to not operate until the plan is up
and running. The Board of Health is allowed to deal with many issues, including
nuisance issues. If they can't do it through the Health Department, then do it
through the City of Ferndale through the State nuisance law, which addresses the
issue. She is frustrated that they are going to put together a plan. She moved to
work with the City of Ferndale to put together a solution by January 4, or they will
file an injunction. She asked how long it would take them to put this plan into
affect. They should not wait for them to put together a report before shutting them
down. Delahunt stated she didn't know how much confidence she has that the plan
would materialize and work. Attorneys have talked about the public nuisance path.
The County has made it clear to Recomp that it is a path they are willing to take.
Board of Health, 12/4/2001, Page 17
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The City of Ferndale and the County Health Department could partner on that path.
It is more difficult for the Health Department to take the public nuisance route,
because they have to prove the odor is injurious to people's health.
Stern stated the issue is that, for the health officer to issue a health order,
there has to be proof of adverse affects on health. The burden of proof is lower if it
is a nuisance odor rather than health issue. By issuing an order that says Recomp
has to shut down because it smells bad, the County will be in court. They don't
have the evidence to back up the claim that it is adversely affecting health. Many
people are saying it makes them sick, but there are no Labor & Industries (L &I)
reports or physician reports. The easiest way to do it is on the nuisance level. The
City of Ferndale has jurisdiction over nuisance odors. It is an issue of enforcing
this.
Delahunt stated they County agreed to support the City of Ferndale in a
nuisance odor route by collecting evidence and responding onsite. However, they
have to have significant evidence in order to get an injunction and shut the facility
down.
Brenner stated there is evidence, between NWAPA and the other stuff.
Delahunt stated the City's attorney had concerns about the amount of evidence that
it would take.
Brenner stated she spoke to the County's prosecuting attorney. There is a
dual jurisdiction. Many of the complaints are from outside of the city limits. It
should be a joint effort. It is not fair to dump it all on the City of Ferndale. They
don't have a lot of resources. It is a bigger issue than just in the city.
Hoag stated the State's nuisance law says that if a facility producing odors
prevents someone from reasonably enjoying use of his or her property, then it is
against the law. Her question is who enforces that law. She agreed with
Councilmember Brenner. This is a documented problem. Agencies have agreed
with the public that it is a problem. However, it continues. It is directly in violation
with nuisance laws. If in violation, find out who enforces it, and enforce it. Stern
stated that is a legal question.
Desler stated he assumed the prosecuting attorney would enforce the law, at
the direction of the County Council.
Brenner asked if filing an injunction is administrative or legislative or both.
Desler stated the prosecuting attorney looks at both the Executive and the Council
as his client. The prosecuting attorney may also be able to do it himself, given his
responsibility to enforce the law.
Hoag moved to recommend that the prosecuting attorney file an injunction
against Recomp until the odor situation is resolved.
Dawson stated she wouldn't support that because they have a deadline by
which they are supposed to come up with a solution.
Board of Health, 12/4/2001, Page 18
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Brenner disagreed. The date is to just have a plan, not solve the problem.
The plan will not likely stop the odor.
Hoag stated an illegal operation anywhere is shut down until it complies.
They don't allow the illegal operation to keep doing it until it comes up with a plan
to not be illegal anymore. The people who live out there are getting sick in their
own homes. She didn't understand why the County has to allow it to continue.
Crawford stated the County doesn't usually just shut people down. They
usually give someone an opportunity to correct the problem. Shutting them down
is the last resort.
McShane stated the Council should meet with its attorney on this issue in
executive session. Ask him to provide an interpretation on the law and what needs
to be done before an injunction can be filed. He needs legal advice on this. He
would lean toward being aggressive to see what they can do to push things along.
The Health Department is starting to respond well already. It is laying the
groundwork.
Hoag withdrew her motion.
McShane moved to have a discussion of Recomp and the nuisance ordinance
with the prosecuting attorney.
Desler stated the issue is noise in addition to the odor.
Crawford stated the Council is searching for legal help to inform the Council
on what the County can do.
Brenner stated this has been going on for years. For years, Recomp has said
it will take care of the problem. The City of Ferndale hired someone to do testing,
and who came up with measures that would help. Recomp didn't even do those
measures. They can't keep allowing Recomp to do something when they've been
causing this hardship on neighbors. This is the last resort.
Hoag stated the meeting needs to happen as soon as possible.
McShane stated he is also interested in hearing about the NWAPA complaints
from the prosecuting attorney.
Hoag stated NWAPA issued four notices of violation on the mushroom
composting operation.
Brenner stated the City of Ferndale just recently passed their nuisance
ordinance. That is why nothing has happened.
McShane stated the motion is to meet as soon as a quorum can be obtained.
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Motion carried unanimously.
OTHER BUSINESS
(Clerk's Note: Councilmember McShane left the meeting at 1:20 p.m.)
Dawson stated there is going to be a roundtable discussion with the State
Department of Ecology (DOE). Water District 10 is bringing it forward regarding
the listing of the lake. They are asking for a representative of the County Council.
The two possible discussion dates are December 14, 2001 or January 4, 2002.
Crawford stated they will discuss this at the Council meeting on December
11, when everyone is present.
ADJOURN
The meeting adjourned at 1:22 p.m.
Jill Nixon, Minutes Transcription
These minutes were approved by Council on January 15—, 2002.
ATTEST:
Dana Brown - Davis, Council Clerk
WHATCOM COUNTY COUNCIL
WHATCOM COUNTY, WASHINGTON
L. Ward Nelson, Council Chair
Board of Health, 12/4/2001, Page 20