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HomeMy WebLinkAboutBoard of Health November 17 19982 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 WHATCOM COUNTY COUNCIL Special Council Meeting BOARD OF HEALTH November 17, 1998 The meeting was called to order at 12:30 p.m. by Council Member L. Ward Nelson in the Council Chambers, 311 Grand Avenue, Bellingham, Washington. Also Present: Kathy Sutter L. Ward Nelson Connie Hoag Tom Brown Barbara Brenner Absent: Marlene Dawson Robert Imhof Chuck Benjamin, Health and Human Services Director, introduced the members of the Public Health Advisory Board the Health and Human Services Department staff. REGULAR MEETING 1. PUBLIC HEALTH POLICY PROCESS Benjamin stated that he prepared a report on policy development, which deals with the Board of Health composition, and whether or not they should continue utilizing a citizen's advisory board in Whatcom County. He reviewed the boards duties and responsibilities, local boards of health composition throughout the State of Washington, the history of the Whatcom County Board of Health and Advisory Board. From that review, he presented three different options that Whatcom County can consider in processing public health policy. He presented the report to the Public Health Advisory Board on November 3`a. They adopted option #3 of that report. On pages 17 -19 of the packet is the summary of local boards of health in Washington State. There are 34 Boards of Health in the State. There are two types of local health jurisdictions in Washington State, independent health districts and county health departments. Of the 34, 27 boards of health are limited to county and city elected officials. That is 79 %. 15 are limited to county elected officials. That is 44 %. Six also utilize citizen's advisory boards or committees. That is 18% of all local health jurisdictions. Since Whatcom County has a county health department, page 19 outlines only county health departments and boards of health. There are 21. 15 of those are limited to county and city elected officials. That is 71 %. 15 are also county elected officials. 100% of all of those are utilizing county elected officials. Five of them utilize a citizen's advisory board or committee. Klickitat County use several smaller program advisory committees instead of one general advisory board, as indicated by the "Y" in the Advisory Board column. Board of Health, 11/17/98, Page l I Nelson clarified that a board of health must have a majority of county or city 2 officials. He questioned the process if there was to be a substantial change in the make - 3 up of the Whatcom County Board of Health, since it is outlined in the Home Rule 4 Charter. 6 Benjamin distributed information approved by the Public Health Advisory Board 7 on November 3rd. (Handout on file.) He took their recommendation and included a 8 transition/interim action plan. He suggested Board of Health members, Advisory Board 9 Members, and staff form a restructuring committee to determine whether the Board of 10 Health membership should remain the same or change and whether to continue utilizing 11 the Public Health Advisory Board. 12 13 Brenner questioned whether it would be better to form the subcommittee first. 14 Another option would be to put a proposal on the ballot to determine what the public 15 would like. 16 17 Hoag questioned what action is being requested of the Board of Health regarding 18 this issue. She had some problems with some of the language on option #3. Benjamin 19 stated that he hoped it would be used for discussion. The action that he would like to see 20 is on page #2 of the handout. 21 22 Nelson volunteered to be a part of the restructuring committee. 23 24 (Clerk's Note: Robert Imhof joined the meeting. Nelson continued to chair the 25 meeting) 26 27 Brenner stated that she would volunteer if no one else wanted to. There should be 28 the focus on membership being more public health, rather than everything as listed on the 29 proposed amendment on page #1 of the handout. Public health issues require a certain 30 expertise about public health. These representatives do not necessarily have the 31 expertise. There should be more physicians and environmental people. 32 33 Imhof stated that these are options that the restructuring committee would review. 34 35 Sutter stated that people in higher education have an interest in public health, 36 because they are dealing with children. Business /Industry has to deal with worker's 37 compensation. She agreed with the remaining representative groups. 38 39 Hoag stated that she wanted the first statement in the proposed amendment to 40 reflect that the community is represented. She proposed, "The Public Health Advisory 41 Board shall broadly represent the community and the programs of the department and 42 eland must be comprised..." She questioned the representation of the current 43 advisory board. 44 45 Benjamin stated that information is on page 36 of the packet. 46 Board of Health, 11/17/98, Page 2 I Hoag stated that the proposed representation does not include a registered nurse. 2 Benjamin stated that could be included. 3 4 Imhof stated that people who will be interested in the positions are those that have 5 an interest in health care. 6 7 Brown stated that he supported option #3, which included two citizens at- large. 8 On the handout, that was reduced to one citizen at- large. That second position should be 9 re- established. 10 11 Benjamin stated that the representative for "consumer" is really a citizen. They 12 could just make that another citizen at- large. 13 14 Brown stated that option #3 also lists a consumer. 15 16 Hoag questioned whether a definition of "consumer" would be someone who is 17 using the free clinic or mental health clinic. Benjamin stated that a "citizen" would be 18 better. 19 20 Brenner stated that she would like to see more emphasis on environmental health. 21 22 Sutter stated that page #2 of the handout should reflect, between steps five and 23 six, that the changes to the Home Rule Charter need to go to a vote of the people. 24 25 Hoag stated that the current system, and advisory board to the board of health, is a 26 good system. 27 28 Imhof moved to establish the Board of Health and Advisory Board restructuring 29 committee and to appoint two County Council members to that committee and let the 30 Advisory Board also appoint two members to that committee. 31 32 Motion carried unanimously. 33 34 Nelson stated that he and Imhof volunteered to be the Council representatives on 35 the restructuring committee. 36 37 Sutter stated that the committee needed to find out how soon they need to prepare 38 a ballot measure. 39 40 2. ON -SITE SEPTIC ENFORCEMENT 41 42 Benjamin stated that, at the last Board of Health meeting, there was an issue 43 regarding a timely response regarding a failing septic system. They looked at that and he 44 reported during that meeting that an abatement hearing was scheduled. Within 14 days 45 from that hearing, the house was connected to public sewer and has been abated. At the 46 same time, the Board of Health took action to say that the policy would not include the Board of Health, 11/17/98, Page 3 I County doing repairs, and would only seek vacation of the property. Staff reviewed the 2 policy and brought it forward to the Public Health Advisory Board. They were also 3 asked if the current policy was effective. A flowchart on page 53 of the packet outlines 4 the outcome of complaints that have been received. 59% of the priority two complaints 5 were repaired within 30 days of the notification. Overall, it is working well. The 6 Advisory Board reviewed the Board of Health policy decision to only seek vacations, not 7 repairs. The Advisory Board requested that the Board of Health reconsider that decision 8 for special cases. 10 Sutter questioned what would make up a special case. Benjamin responded that a 11 special case would be for an imminent health threat. The Health Officer has the ability to 12 order abatement. If the property owner does not do the abatement, then the department 13 has the authority to go in and abate that imminent health threat. With the current Board 14 of Health policy decision, they would not be able to do that. 15 16 Sutter questioned whether the property discussed at the last Board of Health 17 meeting had septic. Benjamin stated that it had its own on -site sewage system. Public 18 sewer was available, but they weren't connected to it. 19 20 Sutter questioned whether the County on -site sewage system enforcement policy 21 pertains only to septic. Benjamin stated that it does. 22 23 Sutter questioned page 41, paragraph 1, line 4, which begins, "The Abatement 24 Hearing was only to be held..." She questioned whether that means an abatement 25 hearing would be held only if the department plans a repair. Benjamin stated that there 26 were two options. They could go in and correct the situation and then put a lien on the 27 property. Or, they could order the court proceedings to vacate the property. 28 29 Sutter stated that the language indicates that the only time an abatement hearing is 30 held is if the Health Officer is going to repair the failure. If any other action is to occur, 31 then an abatement hearing would not be held. Benjamin stated that the sentence was not 32 correct. The intent is that the reason for the abatement hearing was because there were 33 two options, repair or vacation. Without that option, there was no sense in having an 34 abatement hearing. 35 36 Hoag stated that at the last Board of Health meeting, they did not change broad 37 policy. They addressed the one system that was brought forward. She read from the 38 minutes of the meeting. 39 40 Benjamin stated that he understood it to be a change in policy. He believed that 41 the purpose of the motion was because taxpayer's money should not be used to correct a 42 property owner's failure. 43 44 Hoag stated that they made the motion for the one property only. 45 46 Imhof stated that they still have both options. Board of Health, 11/17/98, Page 4 2 Brenner stated that she understood that she made a comment during the last Board 3 of Health meeting that she, in general, did not like to see taxpayer money spent. She 4 stated that she could understand how Benjamin got the idea, however they did not make 5 any policy change. 7 Brown concurred. 9 Nelson questioned whether it would go through an administrative process at the 10 Health Department. Benjamin stated that if it is an imminent health threat, then the 11 Health Officer has the ability to make the decision and take the action. 12 13 Hoag stated that at the last meeting, Benjamin stated that if they did follow 14 abatement, then they would put a lien on the property, so the County would get its money 15 back if the property was sold. 16 17 Brenner questioned whether the County has any recourse to collect money from a 18 lien, by forcing a sale if the property is not sold. 19 20 Hoag stated that she agreed with item #2 on page 41 of the packet. She 21 questioned how often a property owner fixes a problem within the 20 -day timeframe. 22 23 Regina Delahunt, Health and Human Services Environmental Services Manager, 24 stated that, in general, they know whether or not the system has been repaired. The extra 25 30 -day inspection just gives the property owner a little more time. 26 27 Hoag questioned whether the language was clear that this would stop the eviction 28 process, then there would be another inspection. Delahunt stated that they checked with 29 the Prosecutor and that is correct. 30 31 Hoag questioned whether, at the point the property owners says it has been fixed, 32 the department re- inspects the property. Delahunt stated that was correct. 33 34 Benjamin stated that the policy would change, as illustrated on page 54 of the 35 packet, to eliminate the "Inspection 30 days" step and to not eliminate the "Abatement 36 Hearing County Repair boxes." The other thing they discussed with the prosecuting 37 attorney through the process was, following the administrative hearing, send the notice of 38 violation along with the letter from the prosecuting attorney. The letter from the 39 prosecuting attorney, which goes out with the notice of violation, informs the property 40 owner that the County could seek eviction if the repairs aren't made in accordance with 41 the Notice of Violation. It doesn't start the eviction process. 42 43 Chris Chesson, Health and Human Services Environmental Health Specialist 44 Supervisor, explained that the "No repair Hearing 7 days" box is the administrative 45 hearing. At the administrative hearing, they issue a Notice of Violation, which 46 establishes a 30 -day timeframe for repair. The letter from the prosecuting attorney would Board of Health, 11/17/98, Page 5 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 go as a cover letter to that Notice of Violation. They would re- inspect at the end of the 30 days. If there is no repair, civil penalties would accrue and they may proceed with an abatement hearing or an eviction process. Nelson clarified that the only procedure being eliminated from the flow chart is the "Inspection 30 days" box. Hoag requested further explanation of the flow chart. She didn't want to be overly harsh in the first letter. Chesson explained that, at the beginning of the flow chart, the "Failure Identified" and the "Verbal /field Notice" happen concurrently. They give the owner 30 days to fix the problem. At that time, they are sent a first letter, which establishes the 30 -day time frame for repair of the failure. That letter does not contain threats. Benjamin clarified that the letter outlines what potential action could happen if the failure was not repaired, but it is not from the prosecuting attorney. They have to follow due process. Chesson stated that, after the 30 -day time frame, they do a re- inspection. Either the problem is repaired or not repaired. Benjamin stated that if there was no repair, then they have to schedule an administrative hearing. Nelson clarified that the language in one of the boxes should be changed, "Inspection mss" because it indicates a second 30 -day time frame. Nelson clarified that, after the administrative hearing, Notice of Violation, and letter from the prosecutor, the property owner then has a second 30 -day time frame to comply. Benjamin stated that the box "Prosecutor" should be moved up with the "NOV 30 -days repair." (Clerk's Note: End of tape one, side A.) Brenner stated that the "Court Vacate" should be under the "Abatement Hearing County Repair" instead of beside it. Brown questioned whether the intent was to keep the "County Repair" option with the "Abatement Hearing," even with the lower priority cases. Nelson questioned who would make the decision to repair or not. Benjamin stated that he hoped the Board of Health would allow the Health Officer to make that recommendation and report back to the Board of Health. Board of Health, 11/17/98, Page 6 I Nelson questioned whether an appeal would be to the Board of Health. Benjamin 2 stated that it would. 4 Nelson questioned whether that is included in the policy. That is not included in 5 the policy and should be. Benjamin stated that currently, the appeal goes to the Hearing 6 Examiner. It is already in there. 8 Hoag suggested the three options coming out of the Abatement Hearing should be 9 County repair, owner repair, or Court vacation. Benjamin stated that, in his experience, 10 some people are tight on resources and put it off until the last moment. That is when they 11 usually make the repairs. He hoped that they would always offer that as an option. It is 12 still cheaper for the County. If they don't, then they go to court. 13 14 Brenner questioned whether there has to be an abatement hearing before the 15 County could do repairs. Benjamin stated that if it is not a priority one, then there has to 16 be an abatement hearing. 17 18 Brown stated that some of the on -site septic systems are getting very expensive. 19 He questioned the process if the repair is not completed within the timeframe when the 20 property owner acknowledges a problem and takes steps to get funding in the early stages 21 of the process. Benjamin stated that they are still under the guise of the enforcement 22 polity timeline. They recognize the efforts of the property owner to try and obtain 23 financing. They are still under the timeline. 24 25 Chesson stated that what they have done in administrative hearings is extend the 26 timeframe to allow people to obtain financing. In situations where the site is sensitive, 27 then the County will make the repairs and work with the property owners. 28 29 Sutter stated that there is an option for interim measures to be taken with the 30 priority one. She questioned whether that is also used for priority two. Benjamin stated 31 that it is. The interim measure is that the outlet pipe of the septic tank has to be capped 32 off, the septic tank has to be pumped, and then pumped again as necessary. The property 33 owner has to identify the contractor that would do the pumping. 34 35 Sutter questioned what would happen if the tank itself is the problem. Chesson 36 stated that they would require a permit for a temporary holding tank. 37 38 Nelson stated that the Board of Health has made changes to the flow chart and 39 made clear their intent. 40 41 3. HEALTH & HUMAN SERVICES THREE -YEAR PLAN 42 43 Benjamin stated that this was presented at the Board of Health meeting in June. 44 They haven't received any written questions. The Board of Health was sent a revised 45 three -year plan in accordance with some of the suggestions made at that meeting. 46 Board of Health, 11/17/98, Page 7 I Nelson requested that some of the changes be highlighted. Benjamin responded 2 that there were some language questions and questions on some of the statistical areas. 4 Brenner questioned whether any of the Full Time Equivalent (FTE) employees 5 were increased. Benjamin stated that there may be an increase in a program, but it would 6 be balanced by a reduction from another program. There is no overall increase in FTEs. 8 Nelson clarified that any increase would have to be approved by the County 9 Council. 10 11 Sutter asked what EPSDT means. She suggested that they do not use acronyms. 12 13 Kay Guirl, Health and Human Services Community Health and Wellness 14 Manager, stated that it stands for Early Periodic Screening Diagnosis and Treatment 15 program through Medicaid. 16 17 Sutter questioned where the numbers originate regarding projected dosages. Guirl 18 responded that the Passport program has performance measures that are included in the 19 contract with the State Division of Children and Family Services. Other figures come 20 from come out of yearly reports. It is based on past need. 21 22 Sutter questioned whether any of the goals, objectives, and activities would be 23 tied in with the Domestic Violence Commission. Benjamin stated that it depends on 24 where they are housed. They would also put in a linkage to it. 25 26 Sutter stated that there were items regarding data collection for water resources. 27 She hoped that they would be actively and proactively shared with all the other water 28 resources planning. Benjamin stated that a public meeting would be scheduled. 29 30 Brenner questioned whether the staff listed on pages 56 — 58 is only for part of 31 Health and Human Services, or all of it. Benjamin stated that those pages are the 32 administrative portions of Health and Human Services. However, vital records, 33 assessment, and a health educator are not administrative. Some of the other program 34 costs under Assessment are for contracted services. The personnel costs are all County 35 FTEs. 36 37 Brown stated that personnel costs are not necessarily for administrators, but also 38 for general workers. Other program costs would include materials and such used in the 39 program. Benjamin clarified that was correct. 40 41 Hoag stated that she was concerned with wording on Goal 1, packet page 59. The 42 term "by choice" is pushing a particular political agenda in an area that is clearly 43 controversial. She moved to drop that term to read, "Pregnancy /Conception shall occur 44 by ,.heiee and under circumstances of lowest risk." 45 Board of Health, 11/17/98, Page 8 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 Nelson stated that he believed the phrase meant they are encouraging individuals to have a choice whether or not they become pregnant. If choice was removed, then it means pregnancy and conception shall occur, but not by choice. Hoag stated that was incorrect. The intent is that they want them to be under circumstances of lowest risk, which is a legitimate concern of a health department. Nelson questioned whether she was saying that it was up to them whether they become pregnant. Hoag stated that the choice should not be an issue that the Board of Health addresses. It is another political agenda. They should be saying that they should occur under circumstances of lowest risk. Brenner stated that she did not have a problem eliminating those words. If they eliminate them, it doesn't mean they are forcing people to get pregnant. Sutter stated that the phrase doesn't have anything to do with abortion. It has to do with conception, getting pregnant. It means that one should not get pregnant unless one wants to. It has nothing to with abortion. If that is the issue, then she suggested eliminating the word "Pregnancy." Hoag stated that they want the pregnancies to be under the circumstances of lowest risk. The problem is the phrase, "by choice." She would agree if all the phrase said was conception, but it also includes "pregnancy... by choice," which means one has a choice to terminate the pregnancy. Sutter stated that the language "shall occur" means conception. Brown stated that he came to the same conclusion that they are not talking about abortion, only conception. It is more of an education issue to ensure people are planning pregnancies. Brenner questioned the use of the word "shall" and what would happen if someone gets pregnant not by choice. Sutter stated that it is a goal, not a mandate. Nelson stated that the intent is that pregnancy is something that is wanted. In a healthy environment, that is an important issue. Sutter stated that Objective 1 discusses unintended pregnancies. Brown stated that Activity 2 concerns him. Hoag stated that Activity 2 is in there is because of the language in Goal 1. Board of Health, 11/17/98, Page 9 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 Guirl commented that the language comes out of the consolidated contract. Hoag stated that they don't have to adopt the State's language. Brown questioned whether Activity 2 means abortions. Guirl stated that if someone asks them about abortions, if they indicate that is an option that they want to pursue, then they have referrals. It is a legal right. Sutter stated that it also includes adoption. Benjamin stated that they would not have a problem amending the wording in accordance with Hoag's motion. Motion carried 4 -1 with Sutter opposed (Clerks Note: Imhof previously left the meeting) Hoag questioned which risks were being addressed and how. The items that she reviewed don't address risk. Guirl stated that it refers to Activity 1. Risk factors that they are specifically addressing are substance abuse, smoking, diet, and nutrition. Hoag stated that isn't included in the goal. It only includes unintended pregnancies. Guirl responded that the goal covers objectives 1, 2, and 3. Sutter questioned whether they should also delete objective one, since they deleted the wording in the goal. Hoag stated that unintended pregnancies mean teen pregnancies. Sutter stated that is not an issue of risk. That objective was pointed at the issue of conception by choice. Guirl stated that unintendedness is a risk factor. Sutter questioned whether pregnancy options have anything to do with risk. Guirl responded that it does not, but the activities relate to the objective. The objective is decreasing unintended pregnancies. They try to increase public awareness about unintended pregnancy and what those impacts are on the families and individuals. The second part of that is assuring that families have access to information related to all of their options related to their pregnancies. Hoag questioned whether they also make referrals to adoption agencies. Guirl stated that they do. Board of Health, 11/17/98, Page 10 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 Nelson questioned how Objective #3 on packet page 81 would be measured. Guirl stated that it would be included in the information survey asked of all the clients. Brenner questioned whether they could include an emphasis on abstention. It also belongs in the section regarding sexually transmitted diseases. She would like it to be an objective instead of an activity. It should have just as much emphases as condom use. Brenner moved to make abstention education an objective rather than an activity. Nelson questioned what activities would be listed under that objective. Brenner responded that it didn't have to have any activities. Sutter stated that there must be a way to measure the objective. Brenner suggested surveys through the schools. Benjamin stated that they have difficulty in entering into agreements with the school districts to do surveys. Brenner clarified her motion, `By the year 2000, 50% of individuals will ..." Hoag suggested a goal date of 1999, not 2000. This should begin immediately. "By the year 1999, abstinence education shall be included in all prevention activities." Brown stated that was a short time to get information together and get the program going. Hoag revised her suggestion to implement the education by the year 2000. Brenner accepted the friendly amendment. Sutter stated that they are discussing prevention activities conducted by the Health Department, not teaching abstinence in the public schools. Brenner stated that would be included. Sutter stated that they can't tell the schools what to put in their curriculum. Hoag stated that it is for all prevention activities. Motion carried unanimously. Brown referenced Objective 3, Activity 2, on page 81. He questioned whether that referenced the use of condoms. Sutter stated that it did, but there are other types of barriers. Board of Health, 11/17/98, Page 11 2 Sutter referenced Activity 4 on packet page 88. She stated that she believed all 3 public water systems had to have a wellhead protection program. She questioned the 4 threshold for public water system. 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 Delahunt stated that not all of the public water systems are required to have a wellhead protection program. Sutter questioned if that was true even if they are on a well. Delahunt stated that she didn't think so. There may be a limit on the size. She would have to find out what the limit is. Sutter stated that she would like to see 100 %, not 10 %. Brenner questioned the qualifications for someone to be able to do wellhead protection delineation. Hoag stated that a water system is considered public if it serves more than two families. She approved of the language regarding 100 people. Sutter suggested that 10% is not very many. Delahunt stated that currently only 3.5% of the supplies serving more than 100 people have wellhead protection. Also, they talked about trying to get generic wellhead protection plans for the smaller systems. Brown questioned whether there is a requirement that a house can't be within 100 feet if its well. Nelson stated that there is. Delahunt stated that new wells should have a 100 -foot radius around the well for a protection area. (Clerks Note: End of tape one, side B) Nelson moved approval of the three -year plan as amended. Motion carried unanimously. OTHER BUSINESS 1. COMMUNITY MEDICAL WASTE TASK FORCE UPDATE Benjamin stated that they have identified a task force membership of eleven. That includes Council Member Barbara Brenner, Health Officer Dr. Stern, Dr. Franklin of the Medical Society, either Joann Linville or Bill Palmer from the Public Health Advisory Board, Dr. Barnes who is an infectious disease physician, the City of Ferndale representative. Other representatives will be included from Western Washington Board of Health, 11/17/98, Page 12 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 University's Huxley College, the Solid Waste Advisory Committee, industry, and two citizens. Technical staff support would be Regina Delahunt. A meeting may be scheduled sometime in November. Sutter questioned which industry would be represented. Benjamin stated that it would be someone from the biomedical waste industry. The biomedical waste industry includes the solid waste industry. PUBLIC SESSION No one spoke. AD-11nURN The meeting was adjourned at 2:00 p.m. Jill Nixon, Recording Secretary These minutes were approved by Council on Februa . 2r 3 1 1999. ATTEST: Dana Brown - Davis, Council Clerk WHATCOM COUNTY COUNCIL WHATCOM COUNTY, WASHINGTON L. Ward Nelson, Council Member (Acting Chair) Board of Health, 11/17/98, Page 13