HomeMy WebLinkAboutBoard of Health March 27 20011
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WHATCOM COUNTY COUNCIL
Board of Health
March 27, 2001
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.
Also Present: Absent:
Dan McShane Robert Imhof
Marlene Dawson
Connie Hoag
Sam Crawford
Barbara Brenner
1. INTRODUCTIONS
Regina Delahunt, Interim Health and Human Services Director, stated that
the Community Health Partnership (CHP) members are present. John Worlund,
Public Health Advisory Board (PHAB) chair, is also present.
2. PUBLIC SESSION
No one spoke.
3. COMMUNITY HEALTH PARTNERSHIP PRESENTATION
Delahunt introduced Susan Trimingham of the Community Health
Partnership.
Susan Trimingham, Community Health Partnership, introduced the other
partnership members. In 1996, the partnership was brought together as an
outgrowth of the Public Health Improvement Plan developed by the state. The
Public Health Improvement Plan gave communities the opportunity to develop what
they viewed as healthy communities. A steering committee helped define the
vision and the mission of a community health partnership for Whatcom County.
There were two community -wide retreats to create a community vision for a
healthy Whatcom County.
From the retreats, they defined health in a broad sense. Their vision is to
involve people in the community. The mission is to bring people together to
facilitate the process of change in the county. The CHP is in the process of
becoming a 501(c)(3) organization. Their guiding principles include using the asset
model to look at what good is happening, bringing people together, and
collaborating with people and groups. People working together are the keys to
change.
Board of Health, 3/27/2001, Page 1
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Nancy Bitting, St. Joseph Hospital and Community Health Partnership, stated
that they want the community to make the decisions on what is a healthy
community. There are 25 members on the CHP, including the hospital, educators,
human service providers, and businesses. The group discusses how to mobilize the
local resources. A large aspect of the CHP is its involvement with the community.
In addition to having the Leadership Council participate in what they do, they have
staff to help work through the issues. The sponsors include the Whatcom
Community Foundation, the United Way, the Health Department, and St. Joseph
Hospital. The sponsors have given financial and technical support.
The hospital is committed to supporting CHP in the future. CHP has been
involved in mammogram testing. Early prevention is the best cure. The CHP began
a project to make a difference in testing. The stakeholders in the process included
physicians, survivors, radiologists, and insurance providers. The involvement of the
breast cancer survivors was important to the system that was developed, which will
make a difference to how women can have more access to testing. The program
would improve statistics on breast cancer prevention by improving availability of
mammograms.
Crawford asked about prostrate exams. Bitting stated that hasn't happened
at this time.
Don Drake, Whatcom Community Foundation and Community Health
Partnership, stated the foundation became a partner because they wanted to be
involved in the community. CHP was perfect because of the asset -based approach,
practical community building, and countywide service.
There are many activities that CHP is involved in, such as domestic violence.
A transportation summit is scheduled for May 18 to discuss how transportation
affects a healthy community. CHP is involved in initiatives. A group is working on
health indicators to provide economic, environmental, and social condition data.
An ongoing project is early childhood education and parental support.
Professionals work with parents so the parents understand why the children are
acting in the way they are. It also involves the Mother Read /Father Read program.
Whatcom County uses more of these projects than any other place in the state.
Another initiative is the Personal Attitude Toward Health (PATH) study, in
which they contracted with Washington State University to do a random telephone
survey of over 400 people, asking them where they get their health information and
how they make their health decisions. They have also been doing a follow up to the
PATH study. They have done eight focus groups around the county asking about
the two areas that came out highest from the PATH study. People want to discuss
the issues of importance.
The last activity is called Health Works. CHP wants to be a catalyst for
change, and not necessarily a doer. The idea is borrowed from Spokane. It is a
Board of Health, 3/27/2001, Page 2
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database and also an invitation for action. This is a way to gather information
about people to help those people be more successful.
People want to be involved because they have their own ideas about things,
and want to do something meaningful. CHP provides that chance for people. The
work groups are growing in size.
Hoag stated people identified environmental health as the item of most
concern in the PATH study. She asked if this group is reactive to the proliferation of
power plants in Whatcom County. Trimingham stated the CHP has not been
involved, but has been aware of the issue. CHP is the catalyst for bringing people
together, and does not take a position.
McShane stated the results of the study are interesting, given the events that
have happened since the study.
Nelson asked how they reach out to the business community that provides
living wage jobs. Trimingham stated it is a constant challenge to have that
representation. The Leadership Council needs people with a business perspective.
Nelson suggested reaching out to organizations that have business people as
members. Trimingham stated they brought in that diversity through the work
groups and focus groups.
Dawson asked why there is a discrepancy that drug and alcohol use is not a
problem in the personal response, but the community response said it was a major
problem.
Pamela Jons, Community Health Partnership, stated there are two ways to
look at the result, the cynical view or the altruistic view. A person taking the study
could think that their alcohol use is not a problem, but that alcohol abuse is a
problem for the community. That is the cynical view. Or, a person taking the study
could in reality not have a drinking problem, but think that alcoholism is a problem
in the community. That is the altruistic view. It is a scientifically valid survey that
was not skewed. Regarding the business community, they look to United Way
because it has a strong connection with the business community. They are in the
process of recruiting other folks. They used the focus groups to ask about
environmental and economic issues, since they were a priority in the PATH study.
Nelson asked the approach taken to look at how to provide health care in the
future. A critical issue is Medicare reimbursement of rates, and how to get services
to people if Medicare starts losing capacity to deliver health care.
Bitting stated the hospital is working with other providers to deal with it.
That issue didn't show up because the community is bringing other issues to the
CHP table at this time.
4. ON -SITE SEWAGE SYSTEM SHORELINE MANAGEMENT ZONE
Board of Health, 3/27/2001, Page 3
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Regina Delahunt, Acting Health and Human Services Director, stated that
over the past few years, they have had discussions about areas of special concern.
There is a proposal resulting from all the discussions.
Chris Chesson, Environmental Health Supervisor, stated they need to do
something else with onsite septic systems in the Lake Whatcom watershed and
Shellfish growing areas. The Lake Whatcom watershed has more stringent
requirement than other areas. Regulations were developed in the 1970's.
Additional protection was provided by more soil, vertical separation, and setback
requirements. Zones in the watershed were established with specific regulations
based on proximity to the lake. They also increased setback regulations. In the
shellfish areas, there are no additional onsite requirements.
The Health Department staff recommends establishment of a 200 -foot onsite
septic (OSS) shoreline management zone and to establish consistent uniform
standards in the areas. They also propose treatment standards based on ordinary
high water mark, and an additional vertical separation requirement. This 200 -foot
zone is consistent with the County Shoreline Management Program. It incorporates
all identified surface water bodies in the Shoreline Management Program. Some
owners will incur an additional expense in design, permitting, construction, and
maintenance of OSS systems. In the Lake Whatcom watershed, there will be a
much more balanced approach to provide for equity. With the additional operations
and maintenance (O &M) compliance, they may need additional staff resources in
the Health and Human Services Department.
Hoag stated the Portage Bay Shellfish Protection District is huge. She asked
if this would only apply to areas within 200 feet of any stream or tributary.
Chesson stated that is correct, only areas identified in the existing Shoreline
Management Program.
Hoag stated that any new or repaired OSS would require treatment standard
two. She asked for an explanation. Chesson stated that from a distance of zero to
100 feet, if someone proposes new construction and an OSS system, the Health
Department would require an alternative device capable of meeting treatment
standard two. There is a list of such devices.
Hoag asked if everyone has to put in new devices. Delahunt stated only new
systems or repaired systems.
Hoag asked if the regulation is that residents are going to have to meet
treatment standard two, or use one of the different devices. Chesson stated a
device would be required that meets treatment standard two.
Dawson stated 94 percent of the applicants were granted variances in the
Lake Whatcom watershed.
(Clerk's Note: Brenner arrived at 11 :10 a. m.)
Board of Health, 3/27/2001, Page 4
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Dawson questioned why the County doesn't just require owners to do the
mound system instead. It is costly for the applicant to go through the variance
procedure. Delahunt agreed. What is happening now is the applicant comes in,
HHS denies the permit, the applicant has to submit a variance application with a
fee, go to the Sewage Appeal Board, and the variance is granted. It is one extra
step that doesn't make sense. It is not equitable for homeowners in the watershed.
By requiring these devices, they will have better resource protection than they
currently have.
Dawson asked if they are looking at allowing any properties where people
can use their land. Chesson stated a landowner could still construct the home, but
the system has to be 100 feet from the ordinary high water mark.
McShane asked if the backup system must also be the alternative system, or
if they require a backup. Chesson stated they require a backup in the design
phase.
Dawson stated her concern about extending the 100 foot surface
requirement. She asked what happens to people who are currently trying to get
permits. Delahunt stated the County would have to go through a rule change
process.
Chesson stated the water availability permit and sewer permit are two
separate processes. One could still go through the OSS system permitting process
and do the water availability process separately. The processes are not tied
together until they go through the building permit process.
Delahunt stated some property owners would be affected if their lot is
shallow.
Chesson stated an option is to create an easement on a neighboring parcel.
Brenner asked what would happen if a neighbor doesn't grant an easement.
Chesson stated there would always be a small percentage of people who will be
negatively affected. The department will work with people to get something done.
Brenner asked if the County can grant an exemption if the owner can make it
work. Chesson stated there is a Sewage Appeals Board.
Brenner asked if the appeals board has an authority to overturn a Health
Department decision. Chesson stated it does.
Delahunt stated the board has done that before. The board can grant
approval of the system with a variance. They usually require additional mitigation.
Crawford suggested rearranging language to make the concept clearer.
Board of Health, 3/27/2001, Page 5
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(Clerk's Note: End of tape one, side A.)
Delahunt stated staff would bring forward a formal draft ordinance if they
received direction from the Board of Health to do so.
Nelson asked if there are already shoreline construction restrictions.
Delahunt stated there are for shorelines. She was not familiar enough with them to
know what they are.
McShane stated that people could build within 100 feet with a variance.
Hoag stated she liked the concept because it puts the protection where it is
needed. She asked if there would be inspections in the 200 -foot zone for failing
septics. Also, she asked how they determine a failing septic system. She was
concerned about solving a problem that doesn't exist. Chesson stated this does not
include a sweeping survey of all systems in the area. They are trying to identify
smaller areas with high fecal counts from the DOE sampling. There is a definition
of a failure in the state regulations. It does not say that a failure in the flow check
is a failure by definition. The County has revised its inspection protocol to only
require a repair if the system is failing by both state and County definitions. He
would provide that definition.
This issue came up during the loan program. He included addenda to the
loan form that inform the potential buyer that there are items they've identified,
although the system works at this time.
Delahunt stated the issue comes up when they work on inspections for the
sale of property. The flow check might be fine for the people in the house, but it
might not be fine for purchasers who use more water, causing the system to fail. It
is a liability issue. That is where the flow check problems come in. What the
County is doing now will cover the County liability.
Nelson moved to approve the proposed OSS standards for the shorelines and
have staff develop the appropriate regulations.
Motion carried unanimously.
5. ARSENIC MAXIMUM CONTAMINENT LEVEL (MCL)
Delahunt stated this was brought up at the previous Board of Health
meeting. The Environmental Protection Agency (EPA) passed an arsenic rule to
come into affect on March 22. The new presidential administration put the rule on
hold. They will take a look at the new arsenic limits, and is to come up with new
recommendations in 60 days. Staff collected information about Whatcom County
and its levels and how the proposed standard would change how the County looks
at water quality.
Board of Health, 3/27/2001, Page 6
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Paul Chudek, Environmental Health Supervisor, stated the proposal is to
change the MCL from 50 parts per billion (ppb) to 10 ppb. He displayed a map
showing private wells in the county. The green dots are wells that have an arsenic
level of 10 ppb or less. The yellow dots are wells that have a level of 10 ppb to 50
ppb. The red dots indicate the five wells in the county that have over 50 ppb. Prior
to the proposed change to the arsenic rule, Whatcom County was the same as
other counties. The high level systems are being treated. The County knew that
there are high levels on Lummi Island.
He displayed another map showing the condition of the wells if the proposed
rule goes to 10 ppb. The yellow dots indicate wells with a detectable level of
arsenic, and the green dots are wells with a non - detectable level of arsenic. The
County has low levels with the exception of the Sumas Aquifer, which doesn't have
much arsenic at all.
They asked the state Department of Health (DOH) to provide information on
public water supplies. It appears that fewer than 15 public water supplies would be
impacted by new rule. Of those 15, one has several sources and only one of those
sources has ever tested above the MCL. In Whatcom County, they will see a
tremendous amount of small treatment systems that have to be installed.
Brenner asked if the County determined whether all high area clusters are
naturally occurring. Chudek stated they are not sure, but pretty certain. Where
the arsenic hits are, they are generally in deep wells greater than 60 feet and
confined.
Hoag asked who tested the wells. Chudek stated a state certified tester for
water availability applications for building permits. The chemical analysis is done
by a state certified tester. The detectable level in testing is only 10 ppb. Some of
the data may be suspicious because reporting levels are at or near detection levels.
They could see, as the MCL goes down, refinements in testing that provide more
accurate data.
Hoag asked how they treat the water. Chudek stated reverse osmosis is one
option. Ion exchange is another option. There are many options.
Hoag asked if treating nitrates would also treat arsenic. Chudek stated he
didn't know.
Dr. Greg Stern, Health Officer, stated he would discuss the health effects of
arsenic exposure. The EPA referred the effects to the National Research Council,
who issued its report in 1999. A panel reviewed existing studies on the effects of
arsenic, and looked at the quality of the data. Studies were based in areas in the
world where the arsenic level is over 100 ppb. They don't know whether there is a
linear affect to the amount of exposure. The National Research Council concluded
that they did not have evidence that a linear dose response to low levels did not
exist. It also didn't have conclusive evidence for a threshold effect. Therefore,
they have to take the worst case scenario as a linear effect and no threshold.
Board of Health, 3/27/2001, Page 7
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Unless there is conclusive evidence otherwise, they have to assume that the low
doses would have an effect. There is a lot they don't know. The federal
government funded studies looking at these questions. That leaves the EPA making
decisions without complete information. That is a dilemma. Different substances
have different elimination rates. Assumptions are made on low dose exposure are
based on a linear dose response and absence of a threshold.
He would discuss the known and suspected effects. There has been an
association with bladder cancer and lung cancer that has been semi - quantified.
There is also a concern about prostate and skin cancer. Arsenic damages blood
vessels and is associated with cardiovascular disease. There are skin changes,
pigment changes, and keratosis. There is a suspicion that it is related to diabetes
and reproductive effects.
Thirteen million people would be affected by the shift of standards. He
provided information on the reduced number of people effected per disease per
year if the new standards were implemented.
Nelson asked the EPA's proposed goal for carcinogens. Stern stated the
exposure standards are based on trying to reach zero adverse health effects.
Another assumption is that there is a linear response, based on the ability to detect
and treat arsenic. The health effect goal is for people to not get sick.
Nelson asked about the conclusion of the 1999 study. Stern stated the
conclusion was that a level of 50 ppb is too high and should be reduced.
Nelson stated he understood that the conclusion from the EPA was that the
current standard does not achieve the EPA's goal of protecting public health, and
should be lowered as soon as possible. Their goal is zero. If they have not met the
goal of zero, they need to lower the levels as soon as possible. The objective was
based upon a goal they can't define. They don't have measurement standards to
get to the goal.
McShane stated the EPA acceptable goal is 1 part in a billion, not zero. The
EPA needs to take into consideration the cost accounting. The National Academy of
Science actually recommended a lower number in their report. The EPA has to take
into consideration the cost in setting the MCL. The cleanup standard for arsenic in
groundwater is three times lower than the drinking water standards. The EPA has
to take into consideration the cost to society. That is why the EPA proposes 10
ppb. The National Academy of Science goal was to lower the level to that below the
detectable level.
Stern stated the issue of the cost to prevent one event in Whatcom County is
based on the cost of treatment and the numbers needed to treat per event. It is
also based on the cost of installing and maintaining a treatment system. The EPA
uses a cost of $360 per year for a system serving up to 25 people, up to $ .86 per
year per person for systems that serve millions of people.
Board of Health, 3/27/2001, Page 8
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Nelson stated he has information from the EPA website that the average
household cost will be $28 for Americans served by large systems, and $85 for
those served by small systems that serve fewer than 10,000 people. Stern stated
the EPA has a technical fact sheet that has the system size categorized by number
of people served. In the category of a system that serves 25 to 500 people, it
would cost $327 to $162 per year. For 10,000 people or more on a system, the
cost range is from $32 to $ .86.
Chudek stated a treatment home system will cost about $4,000. The cost is
less for a water system. There is quite a cost difference.
Hoag asked if the skin absorbs arsenic. Stern stated a urine test is the most
accurate measure of body load. He was not sure if arsenic is absorbed into the
body. It attaches to the skin and hair. He didn't know that the data on ingestion
has been addressed.
Hoag stated it is important to know that to estimate the cost.
Chudek stated that they asked potential treatment providers to estimate the
cost for treatment of the entire house. They all came up with a number similar to
$4,000.
Nelson stated he heard that the EPA is looking at implementing the standard.
McShane stated there is going to be a standard set one way or another.
There is a timeline of when it will be implemented. In the meantime, if they know
this is coming, the County should maybe be more proactive about informing people
of their arsenic levels. He proposed looking at the possibility of setting a level now
for approval of water systems so people don't have to do a fix on them six years
down the road at a substantial cost.
Brenner stated the cost would be either now or later.
McShane stated the County might not approve a system that would need
treatment six years down the road.
Stern stated the County might want to give people a heads up that standards
will be changing.
Nelson stated that is more appropriate. This would give people an
opportunity to prepare for that. The County should not establish its own levels
now, while not knowing what the standard will be.
McShane stated the County should set any level, and then change it when
the standards come down.
Chudek stated a public water supply is regulated by state Department of
Health (DOH).
Board of Health, 3/27/2001, Page 9
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(Clerk's Note: End of tape one, side 8.)
Chudek stated there is a statewide issue at the DOH regarding arsenic.
McShane stated he preferred being more aggressive and proactive. He
moved to set a standard of 10 ppb for approval of water, or cite the MCL level now.
Stern stated the County currently refers to the MCL level.
Chudek stated that if there is a new rule, the County would require people to
treat the water if the level is higher than 10 pp, prior to approving the water for
water availability.
Hoag stated the reporting requirements are something that might be a good
idea to implement. Currently, water systems are required to provide a nitrate
health sheet to those with levels that are too high. If wells exceed 10 ppb, then the
County could send out an information sheet. Whether or not the EPA has
formalized anything, the County should pass the information on to the consumer.
They don't need to worry about those with a level less than 10 ppb. She asked the
difference between an association with health affects and a concern of health
affects. Stern stated the difference is the presence of quantifiable information.
There is a lot of question about the validity of studies and how strong the
information is.
Hoag suggested a friendly amendment to include educational literature to
wells that have arsenic levels above 10 ppb.
Delahunt asked if they are referring to private wells.
Hoag stated private wells and public water systems. Delahunt stated that
the County doesn't have jurisdiction over public water supplies. Notification would
have to come from the state Department of Health. Private systems are a different
story. They are already providing a fact sheet if arsenic is detected.
Hoag asked about water treatment for a real estate sale. Chudek stated that
is a buyer and seller agreement. The Health Department only does the work if
contracted to do that, and only does the work that the buyer or seller requests.
Nelson questioned whether the County is sending out information to wells
with detectable levels of arsenic. Chudek stated the County is, for those requesting
new water availability.
McShane restated his motion to set the local MCL for water availability at 10
micrograms /liter until the EPA comes up with their new MCL.
Nelson questioned what the enforcement would be.
Board of Health, 3/27/2001, Page 10
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McShane stated they have to get approval of their water system from the
County Health Department.
Nelson asked how the County would justify it if the EPA hasn't set its MCL
level.
McShane stated it is an emergency because the County doesn't know what
the EPA is going to do. If the EPA keeps the level at 50 ppb, then the County could
change its level back to 50 ppb. In the meantime, people are putting in new homes
and may be drinking arsenic. They are coming in under the radar, and will be stuck
with arsenic at that home from now on.
Nelson stated the County doesn't know what the levels will be or what the
health effects are at any level.
McShane stated he was satisfied that the level of 10 ppb is adequate
protection.
Brenner stated her only concern was that they are only affecting the private
wells. She didn't like having two standards. She would rather do a different kind of
notification that there is a proposed change in the level from 50 ppb to 10 ppb.
McShane stated a similar experience was with ethyl dibromide. There is not
much the County can do once those wells are in.
Hoag asked for a legal opinion on whether the County could establish a
stricter standard.
Brenner stated she remembered the issue with the ethyl dibromide, and
asked whether the level set was above or below the level already established.
McShane stated that once the well is in, they are stuck with it. He would
amend his motion to also get a legal opinion.
Motion failed 1 -5 with McShane in favor.
Hoag stated she wanted to get a legal review.
Delahunt stated they would hopefully know what the EPA limit would be by
the next Board of Health meeting.
(Clerk's Note: Crawford left the meeting at 12:17 p.m.)
Hoag stated she would like to approve the motion if it can be done legally.
The purpose of the Board of Health is to protect public health, and they should not
focus on what the EPA would do. Bring the motion to the full Council.
Board of Health, 3/27/2001, Page 11
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28
29
30
31
32
33
6. DRAFT ORDINANCE: PROVIDING FOR TEMPORARY HEALTH OFFICER
COVERAGE
Delahunt stated this would come forward to County Council. When Dr. Stern
goes on vacation or is out of town, there is no one to officially cover his duties.
Other counties are in the same dilemma. The proposal is for the counties to enter
into an agreement to switch health officers when one is unavailable. They would
need to change the County Code, and an ordinance will come forward.
Brenner stated that the first "Whereas" statement should not name Dr.
Stern, but should just say "Health Officer." Otherwise, they will have to change the
code every time they change Health Officers.
ADJOURN
The meeting adjourned at 12:21 p.m.
Jill Nixon, Minutes Transcription
These minutes were approved by Council on April 17 , 2001.
ATTEST:
Dana Brown - Davis, Council Clerk
WHATCOM COUNTY COUNCIL
WHATCOM COUNTY, WASHINGTON
L. Ward Nelson, Council Chair
Board of Health, 3/27/2001, Page 12