HomeMy WebLinkAboutBoard of Health March 28 20001
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
WHATCOM COUNTY COUNCIL
Board of Health
March 28, 2000
The meeting was called to order at 12:30 p.m. by Council Chair Marlene
Dawson in the Council Committee Room, 311 Grand Avenue, Bellingham,
Washington.
Also Present: Absent:
Sam Crawford None
Barbara Brenner
L. Ward Nelson
Robert Imhof
Dan McShane
Connie Hoag
Also Present:
Fielding Formway, Public Health Advisory Board Member
Mary Ellen Shields, M.D., Public Health Advisory Board Member
Ernie Diaz, Public Health Advisory Board Member
David Davidson, Public Health Advisory Board Member
1. INTRODUCTION
Chuck Benjamin, Health and Human Services Director, thanked everyone
for attending. Several staff members would be available for questions.
2. JOINT MEETING WITH THE PUBLIC HEALTH ADVISORY BOARD
FOR THE PURPOSE OF DEVELOPING THE YEAR 2000 WORK PLAN
The calendar is on page two of the packet. The shaded areas indicate the
tasks that have been completed. The unshaded areas are tasks that have not
been completed. They also put in a proposed calendar for the Public Health
Advisory Board (PHAB) for the year 2000. They took the lead on suggesting
some topics to be discussed. Another item in the packet is a list of topics to be
discussed.
Brenner stated the work plan asked about the reason for the numbers
listed next to each topic. Benjamin stated the numbers are an estimate of how
Board of Health, 3/28/2000, Page 1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
many times the topic will have to be presented before the PHAB or the Board of
Health (BOH) to complete the process. Some topics are more complicated and
will take more meetings.
Hoag stated one side of the calendar has the quarterly meetings. The
other side is monthly meetings. Benjamin stated the monthly meetings are for
the PHAB. Today, they wanted to decide when to address the new issues. They
did not include on the list any issue that has not been brought up.
Hoag asked about the final 1999 work plan and the Hepatitis C screening.
She didn't see it anywhere. Benjamin stated that would be done under the
bloodborne prevention policy.
Hoag asked why it was not done last year. Benjamin stated they needed
more time to gather a proposal. Last year they discussed universal vs. targeted
testing. They also worked on education.
Kay Guirl, Personal Health Services Manager, stated the BOH agreed at
the November board meeting to not do universal testing, but to have an overall
plan for bloodborne infections. The staff was also asked to collect information on
the number of referrals.
Benjamin asked how the BOH would rate the issues. He listed the issues
that are listed on packet pages six and seven. The PHAB knows that they are
looking at the travel clinic and the sexually transmitted disease clinic. They will
go to the PHAB for review and recommendation to the BOH.
Brenner asked if HIV would be connected to the sexually transmitted
disease clinic. Benjamin stated they would deal with that separately.
Brenner stated the on -site sewage system (OSS) should be high on the
list.
Hoag asked for more information on the OSS. The County has been doing
upgrades and she wanted to know where the County is. Benjamin stated that
item would be about proposing Areas of Special Concern.
Regina Delahunt, Environmental Services Manager, stated the Shellfish
Protection Districts are looking at special requirements that might be put in place
for Areas of Special Concern and creating Areas of Special Concern. They are
looking at the districts and Lake Whatcom to see if there should be additional
requirements in those areas. They will hopefully be able to treat all the areas
the same way.
Hoag asked about the tobacco prevention activities. When she talked to
Mr. Benjamin earlier, he mentioned that there was a possibility of taking the
ordinance up. Benjamin stated the court voted against reconsidering. It failed.
This issue is about looking into what to do next.
Board of Health, 3/28/2000, Page 2
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
Crawford stated that OSS is a big issue. He asked if a component of that
could be an inventory of permitted and existing systems in certain areas,
specifically the Paradise area. Benjamin stated the department attends those
monthly meetings and checks out the addresses that the residents report.
Delahunt stated it would be staff - intensive to do a full survey. Paradise
would not be her first choice of an area.
Crawford stated the neighbors are convinced a tool shed is really being
used as an outhouse. No one has the means to go find out. He questioned
whether a survey would solve that problem. Benjamin stated the results
wouldn't any better than what the department is doing now. What the
department is doing now is more complaint- driven.
Dawson stated all of the issues look important. She asked for the
department's recommendations.
Brenner stated she didn't agree. OSS is number one. She was interested
in putting the public health standards together, but it is not as important.
Hoag stated she wanted tobacco addressed first. This is a real health
problem and is a more imminent problem than the sewage. The bloodborne
issue is also important.
Benjamin stated he would ask Regina Delahunt and Kay Guirl how long it
would take before each issue can be addressed.
Imhof suggested that the Health Department come up with a plan.
Benjamin stated the idea was to get the PHAB and BOH together and discuss the
priorities.
Guirl stated the bloodborne issue could go to PHAB in June. The HIV issue
could be done anytime.
Delahunt stated the OSS issue will go to PHAB in October.
Guirl stated the home visiting issue could go to PHAB in May. The
transitioning work plan needs to be done quickly. Program measures and
outcomes could be done in July.
Brenner wanted drinking water policies and onsite sewage to be at the
front of the list.
Hoag asked about child abuse and neglect. Benjamin stated some of the
issues were raised by the PHAB at their retreat. Formway stated the PHAB
needs to find the gaps between what currently is being done on the child abuse
Board of Health, 3/28/2000, Page 3
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
and neglect issue. It isn't a policy issue yet, just a review of what is happening.
It is a topic the PHAB wants information on.
McShane suggested an issue about residential development on former
agricultural land where row crops had been grown. There could be ethylene
dibromide (EDB) and pesticides in soil. They are known carcinogens. Before
development is approved in those areas, the Health Department could provide
information on soil contaminants.
Brenner asked that it be broadened to all areas, not just those where row
crops were grown. Benjamin stated there are no resources this year, but they
would develop a plan to find the resources for 2001. They would work with the
Planning Department and Cooperative Extension.
McShane stated some protections already exist for hazardous waste sites.
There is a problem that the Environmental Protection Agency (EPA) and
Department of Ecology (DOE) don't have a good policy on what to do with area -
wide soil contamination from agriculture uses. If one is switching land use from
agriculture to residential, it becomes a problem.
Delahunt stated they have to look at the issue, determine if testing has
been done, and then tie it into the planning process.
McShane stated it is not a drinking water issue.
Delahunt stated the issue is soil contact.
Hoag stated it is an issue around Lynden and the potato fields.
Benjamin stated it is a good time to discuss how the BOH wants to raise
issues to the Health Department and the PHAB. He questioned whether
individual councilmembers or the BOH as a whole would decide to make
something an issue.
Imhof stated it should come from the BOH as a whole.
There was consensus on looking at this issue about soil contamination.
Hoag stated she didn't want to wait for a BOH quarterly meeting to bring
forward an issue. They could get consensus from the BOH members and send it
to Mr. Benjamin.
Dawson questioned whether they need the Domestic Violence Task Force.
She suggested putting it in Finance Committee to evaluate the program.
Benjamin stated there is a joint ordinance between the County and the City of
Bellingham. The ordinance gives a charge to the commission. One charge is to
come up with a plan. That plan needs to come to the County Council, who has
to decide how it would deal with the issues.
Board of Health, 3/28/2000, Page 4
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
Dawson stated a plan should be presented in committee.
Hoag asked how long they've been in operation. Benjamin stated they
started in August of 1999.
Nelson stated it could go into The Public Works Committee.
Brenner agreed.
McShane asked if the BOH is interested in looking at changing the makeup
of the BOH. Benjamin stated they discussed that once. He can bring it back for
review.
Brenner stated she wanted to discuss working more with schools on
mental health issues. The Mental Health Advisory Board (MHAB) did a pilot
program at Vista Middle School for kids at risk. Benjamin stated that is an issue
for The Mental Health Advisory Board.
Hoag suggested they address the impact of air pollution on public health,
particularly industrial emissions.
Dawson stated that would go to the Northwest Air Pollution Authority
( NWAPA).
Nelson asked if the County has the resources for a legitimate
investigation. There are concerns in the Health arena about the effects of air
pollution. The County hired an epidemiologist several years ago. Benjamin
stated the regional epidemiologist partnership folded. Currently, the County's
community health assessment coordinator position is vacant. To address this
issue, they would have to contract out the study.
Nelson asked if the PHAB could look at the issue globally. Benjamin
stated that until there is a certain rate of whatever they are looking at and when
they can identify it, they can't do an epidemiological study.
Hoag stated people believe that NWAPA can prevent them from being hurt
by pollution, but NWAPA has said they can't do that. All they do is see if
industries are meeting the standards. The standards come down from higher
up. In terms of public health, there are a lot of epidemiology studies available.
Nelson stated studies are based on data that may not mean anything to
the individual community. Benjamin stated can look at pulmonary diseases.
Shields stated she recently attended a conference in which Dr. Elkayam
discussed asthma incidents.
Board of Health, 3/28/2000, Page 5
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
Nelson stated data collection is difficult because it is difficult to identify
specific causes.
Shields stated data defines incidents in urban areas, for instance.
Benjamin stated they could bring a speaker.
Brenner stated she wanted to have Dr. Elkayam as a presenter. It should
be on the agenda as soon as possible.
with.
Benjamin stated they could tie the speaker to data the County is working
Brenner stated Dr. Elkayam would be relevant to the county.
There was consensus to look into a pulmonary disease and air pollution
data review.
Brenner stated it could be a joint meeting with the PHAB. Benjamin
stated the PHAB will discuss the issue, then the presentation from Dr. Elkayam
will go before the BOH when the issue comes forward from the PHAB.
Formway stated it is up to the Health Department to prioritize issues
according to available resources.
Imhof stated Benjamin should lay out the timeline.
Hoag stated the prioritization should come from the BOH.
Brenner stated they've said all the issues are important.
Imhof asked if the schedule can work with the department. Benjamin
stated he would have to talk to the division managers. He will discuss the plan
with the staff.
(Clerk's Note: End of tape 1, side A.)
Brenner suggested having more BOH meetings.
Hoag asked to move some of the issues forward on the PHAB agenda so
that not all the issues will be brought to the BOH in October.
Formway asked what outcome the BOH expects on the tobacco prevention
issue.
Imhof stated the only thing Benjamin can do is look at what other
jurisdictions have done. The Supreme Court decision limits their options.
Benjamin stated other efforts do things such as working with the youth. The
Board of Health, 3/28/2000, Page 6
I current house bill puts aside $15 million for a program that is inadequate. There
2 will not be a statewide campaign to divert youth from smoking. The County will
3 have to see what the State Department of Health (DOH) will do to target efforts.
4 The County may have to do it all locally.
5
6 Formway stated the only place it would be effective would be in the
7 schools.
8
9 Benjamin stated they are already doing some things in the schools. This
10 report will let the BOH know what the County is doing and who they are
11 partnering with in the community.
12
13 Shields stated there is much going on with the American Lung Association.
14 Communities can be effective lobbyists. The advisory board could also write a
15 letter to the congressmen about it.
16
17 Benjamin stated there is another court decision that the Food and Drug
18 Administration (FDA) can't regulate tobacco.
19
20 Hoag stated she wanted a legal review of why the ordinance was
21 overturned. If there are portions that are not deemed illegal, she wanted to
22 retain those portions. There may be things that the County can do in an
23 ordinance that will pass constitutional muster. They also should put pressure on
24 the legislators to change the laws. She asked the PHAB to determine where the
25 appropriate pressure should go. Regarding schools, they could use newspaper
26 advertising and other methods to get into the schools. Benjamin stated that
27 information is what the BOH would hear when the issue is addressed.
28
29 Formway stated that is a legal matter. Benjamin stated he would refer
30 the legal question to the Prosecuting Attorney.
31
32 Formway stated the Council's question would go to Randy Watts instead
33 of the advisory board.
34
35 Shields stated Mr. Watts just recently addressed the legality of the
36 ordinance.
37
38 Imhof stated their recommendation was to drop it.
39
40 Hoag stated they should not throw the baby out with the bath water. The
41 PHAB should have the legal information also.
42
43 Dawson stated any one of the BOH members could call Mr. Watts.
44
45 Brenner stated she liked it when James Marx headed up project COMMIT,
46 where they would send people to different stores to check and see if the stores
47 were asking for ID. Benjamin stated they do that.
48
Board of Health, 3/28/2000, Page 7
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
Brenner stated she never hears about it. She wants to know if it is
working.
Benjamin stated they would discus what the department is doing when
the issue came up.
Brenner stated they talked about state money. She asked how much the
County got in the tobacco settlement and why the state is only spending $15
million. Benjamin stated they are only authorizing expenditure authority for $15
million. They are transferring $25 million to support the public health impacts
from Initiative 695. The state wants the remaining amount to grow interest.
Brenner stated that settlement came about because of tobacco. They
should lobby the state officials to say it is not right for the state to hold the
money. They need at least one solid statewide program. Benjamin stated the
public health officials are educating the politicians in Olympia about the
importance of the plan.
Brenner asked how much money the plan asked for. Benjamin stated the
plan asked for $26.2 million.
Brenner stated the Council needs to write a letter saying its hands are
being tied by the state. Benjamin stated the best people to contact are the
senators.
Shields stated it is a hot issue. The issue is whether the money should be
earmarked for tobacco prevention. That isn't necessarily happening.
Benjamin stated originally not all the money went to health issues.
Shields stated the question is if it will go to health issues at all.
(Clerk's Note: Imhof left the meeting at 1:27 p.m.)
Brenner stated the County BOH should write a letter. Benjamin stated
they already passed a resolution.
Hoag stated the resolution was specific to childhood tobacco prevention.
Brenner stated they need to do it again.
Benjamin stated a lot depends on the individual school districts and the
school superintendents. They will try.
Brenner asked how closely they are working with schools. Benjamin
stated they are working a lot with schools.
Board of Health, 3/28/2000, Page 8
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
Nelson asked if students could leave the campus. Shields stated it
depends on the campus.
Nelson stated they could require that students stay on campuses.
Benjamin stated they can't regulate the school districts.
Hoag suggested a letter that says closing the campus will help them deal
with it better.
Dawson stated that would cause kids to drop out of school.
Shields stated it would cause discrimination against those kids who had to
leave for the Running Start and other reasons.
Brenner stated she didn't want to go there.
Hoag asked the PHAB to review what is going on in other communities to
make smoking un -cool.
Shields stated Chris Covert - Bowlds has that information already.
Brenner stated the kids who smoke and come from parents who smoke is
a higher percentage. There is not as much peer pressure for kids to smoke.
More of the influence comes from home. They should also educate parents
about when and where to smoke to reduce risk and exposure to the kids.
Shields stated that has been studied. Doctors try to educate parents
about smoking around kids.
Hoag stated the statistics show that adult smokers are decreasing but the
youth smokers are increasing.
Brenner stated there are many reasons for a kid to smoke.
Formway stated one wouldn't start to smoke if he or she didn't see it
somewhere.
Davidson suggested discussing health - related impacts from power lines.
Dawson stated Planning and Development Committee would discuss it.
Brenner stated it doesn't belong there. It should be addressed in the
realm of health.
Benjamin stated they would review the issue from the state. There are
many studies available. He has not looked at the issue for more than 12 years.
Board of Health, 3/28/2000, Page 9
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
Brenner stated there were several comments about the National Institute
of Health (NIH) study. She wouldn't want any exposure even if there is a weak
link.
Nelson stated data can't always substantiate a disease link.
Brenner stated it downplayed the significance of childhood leukemia.
Every time she reads something, it says it is inconclusive.
Benjamin stated that if they don't know what they are looking for and the
numbers, a study will be inconclusive.
Formway asked what they could do with it if they determine that EMF is
very bad.
Hoag stated that locally they could address the zoning to make sure no
houses are near high -power lines.
Formway stated it is a deep subject and wasn't sure the advisory board
could do it.
Benjamin stated they could only look at the most recent studies. They
don't have the resources to do a full -scale study. They can pull together what is
out there.
3. SUGGESTED MODIFICATIONS TO RECOMMENDATION #12
REGARDING TREATMENT OF STOCKS AND CULTURES
Benjamin stated they received the materials from Brenner. They
reviewed the materials and have considered revised Center for Disease Control
(CDC) bio- safety levels. They are going to have a revised recommendation in the
solid waste regulations, which will come forward on April 25. He suggested
addressing this in conjunction with the entire regulation.
Brenner stated Dr. Stern made a disturbing statement when he said that
there is no problem if they are not grinding the waste. She toured the facility
with Crawford. The person who took them on the tour said there are spills
coming off the truck. The person even showed her and Sam how they hose it
down. Tuberculosis (TB) can be spread airborne. It doesn't have to be ground
to be spread. There are spills at any regional facility. There are always spills. It
is not right to say that it is okay to simply not grind the material.
Nelson presented a letter from a microbiologist working in a lab. It might
address some of the concerns, but it doesn't address the issues if it is imported.
He read from the letter (on file). TB is a bio- safety level three. The local labs
are bio- safety level two labs. They do not culture for or isolate TB or any other
level three agent. The difference is whether they isolate and culture for the
organism. It is common to identify TB. That is level two. There are no level
Board of Health, 3/28/2000, Page 10
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
three labs in Whatcom County. Level two labs can do a TB smear, but that
smear renders any potential TB organism non - infectious and dead.
Brenner stated stuff comes in from all over. More people become sick
from level two organisms.
Nelson stated that is because they are more common.
Brenner stated the CDC say that the most hazardous part of the medical
waste stream is stocks and cultures. If they don't treat level two organisms,
they cannot prevent another episode like Steri- cycle. Although salmonella is
found everywhere, it is all about concentrations. There are heavier
concentrations in stocks and cultures. She questioned why they would not do it
if it will make it safer to treat on the waste on the site.
Nelson stated the point is there are cost differentials. He asked what
benefit would be achieved by raising the concern.
Brenner stated people are on both sides of the issues. Because there is so
much controversy, they should just do it and be safer. If the labs already have
to do level three treatment, it is more risky to make a person determine which
has to be treated and which doesn't. This stuff is coming in from all over. They
have to make rules that apply to the facilities in the county.
Nelson stated they can't make rules apply to facilities outside of the
county.
Brenner stated they can make rules for people who treat the materials in
the county. It is up to the treatment facilities to contract with people and
stipulate that the untreated stocks and cultures of level two and above will not
enter the county.
Hoag questioned whether this change was reviewed by the PHAB, who
made additional changes. Benjamin stated that was correct.
Hoag stated that she spoke with an endocrinologist who has had a run on
low thyroid problems. The doctor called the County health officer about it. Dr.
Stern said thyroid is not a reportable disease. She questioned the doctor about
what could cause this. The doctor told her he didn't know. She thought that is
unusual. The Board of Health should be aware of it.
Dawson asked if there is a virus that promotes heart attacks.
Brenner stated there is a heart virus. Benjamin stated there is also a
heart bacteria.
Brenner stated three workers at Recomp stated they all contracted a rare
heart virus. All that stuff is not reportable. Being the dumping ground for
Board of Health, 3/28/2000, Page 11
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
infectious waste makes it hard to determine what caused what. When experts in
the country who work for the CDC say it would be prudent to treat levels two
and above stocks and cultures, the County should be looking at it.
Hoag asked if it would address the stuff coming in from other areas.
Benjamin stated the recommendation would regulate the local generators and
the local regional treatment facilities on what they can accept.
Hoag questioned whether regulating the treatment center means stocks
and cultures won't be brought into the county. Benjamin stated they also have
to look at the providers it would impact.
Hoag again questioned whether regulating the treatment center means
stocks and cultures won't be brought into the county. Benjamin stated it would
have to be monitored. It would be illegal to bring them into the county.
Brenner stated it would be up to laboratories to treat locally. When it was
discussed at the Medical Waste Task Force, it was a matter of the simple use of
a level two disinfectant. They will not convince her that there is a great burden
on the local labs. That is not a reason to not take the extra precaution.
Nelson stated all cultures and waste must be decontaminated according to
the CDC. All cultures, stocks, and other regulated wastes are decontaminated
before disposal by any approved contamination method, such as autoclaving.
Anything to be decontaminated outside of the immediate laboratory are to be
placed in durable, leak -proof containers.
Hoag stated that is just prior to going into the landfill.
Nelson stated it applies to the same material one generates in a home.
Brenner stated the concentrations are more intense on stocks and
cultures.
OTHER BUSINESS
Benjamin stated the public health week is coming up. They will recognize
public health heroes on April 5 at noon at the courthouse rotunda. Also, a
statewide BOH leadership workshop at Sea -Tac is open to the PHAB and the BOH
members.
4. PUBLIC COMMENT
No one spoke.
ADJOURN
Board of Health, 3/28/2000, Page 12
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
The meeting adjourned at 2:00 p.m.
Jill Nixon, Minutes Transcription
These minutes were approved by Council on April 18 , 2000.
ATTEST:
Dana Brown - Davis, Council Clerk
WHATCOM COUNTY COUNCIL
WHATCOM COUNTY, WASHINGTON
Marlene Dawson, Council Chair
Board of Health, 3/28/2000, Page 13