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HomeMy WebLinkAboutBoard of Health June 7 1994WHATCOM COUNTY COUNCIL Special Meeting June 7, 1994 The meeting was called to order at 4 p.m. in the Council Chambers, 311 Grand Avenue, by Chair Robert Imhof. Also Present: Absent: Barbara Brenner None Marlene Dawson Larry Harris Alvin Starkenburg Ken Henderson Ward Nelson BOARD OF HEALTH REPORTS FROM DR. FRANK JAMES, HEALTH OFFICER, AND FOLLOW - UP TO REQUESTS MADE AT THE LAST HEALTH BOARD MEETING (AB94 -316) (Maximum time allowed for this meeting. SO minutes) (Clerk's Note: Please see attached g. � minutes � trans �healthbd. 607 for transcript.) Respectfully submitted, erstin M. Bail y, Transcri ionist These minutes were approved by the Council on July 12, 1994. ATTEST: WHATCOM COUNTY COUNCIL WHATCOM COUNTY, WASHINGTON �. --� '�► DRAFT TRANSCRIPT OF THE WHATCOM COUNTY COUNCIL SPECIAL MEETING BOARD OF HEALTH TUESDAY, JUNE 7, 1994 Robert Imhof - Council Chairman I call this meeting of the Whatcom County Health Board to order. It is June 7, and we have an agenda in front of us. We need a roll call. Would Mr. Clerk please call the role? (Bob Woods - Acting Clerk - Roll Call, all present) Robert Imhof - Council Chairman We are here. Okay, the first item on the agenda is attachment one, and Dr. James, I guess that's in your ball park. Would you take it away, and we'll see where we go. Dr. Frank James - Health Officer Thanks, Bob. There's actually one prior item, if you don't mind. I did receive a letter from Ramona Reeves, and I believe you all received copies of it, about staffing and organizing these meetings. She makes some very good points. I think it would be more appropriate for Health Department staff to record the meetings, as well as provide some of the other support services, so that Mr. Clerk wouldn't be burdened with that. It is called for in the statutes. At your pleasure, actually, but the interpretation that I've got at least, is that I'm your executive secretary for these meetings as well, so you can rely on me for typing and spelling and so on, that sort of thing. (Laughter) Dr. Frank James - Health Officer Seriously, though, I think it would be appropriate for Health Department staff to do the advertising, to staff the meetings, to produce the agendas, to produce the minutes, to run the tapes of the meetings, as well as to develop a filing system. I realize that some of the concerns that Ramona had are very valid ones. We already have all the Health Board minutes and tape recordings for years and years ago in the Health Department. We're responsible for keeping them in accordance with all the laws. So, with your leave, perhaps I would recommend that we accept Ramona's recommendations, generally, so that in fact, our staff does these things, which is more effective. I would, however, recommend that we have them here, in that this is a convenient location for you. Although I understand the sentiment of her comment, I think it would be appropriate to still have them here, since the recording materials and all that are here. Would that be acceptable to the Health Board? Whatcom County Board of Health Meeting, June 7, 1994, Page I Barbara Brenner - Council Member I understand that you want it done this way, but doesn't that take up staff time, and time is money? It seems to me, the most expedient, cheapest way we can do this is probably in the best interest. I didn't see your letter. I just saw Ramona's. I still don't understand why this worries you so much. Dr. Frank James - Health Officer No, in fact, my staff make up the agendas and do the preparatory material anyway, and then we transfer it over to Ramona. The concern was about some of the forms that are used, like the agenda bill form. It's really not a Health form. It's something that belongs to the County Council and isn't necessarily appropriate. Working with her, we tried to modify that form to make it appropriate for this use. It became quite confusing, because then you had two forms that were similar, but not the same. Since most of that work is already done by my staff, I just thought it would be appropriate to have us learn how to click the tape player and also do some of the record - keeping, which, traditionally, has always been done at the Health Department. All the records are there, too. Barbara Brenner - Council Member All I'd like to do is find out from Ramona, or do you know, Bob? Is that going to be inconvenient for our staff at all? Is what we're doing now legal? If it's legal and we aren't broke, I just don't see what the problem is. Bob Woods - Budget and Program Analyst I haven't been a privy to the conversations. I think if you need to talk to Ramona, you should. My understanding is that the County Council is the Council, and they sit as the Board of Health. That doesn't divorce you from being the Council at the same time. Barbara Brenner - Council Member Right. I'd rather check with Ramona. Kenneth Henderson - Council Member I would like to comment. In the other departments, in Combined Treatment, Substance Abuse, Developmental Disabilities, those meetings are staffed and taken care of by the staff for those departments. We all sit on various positions there, and the question is, is it advantageous to take advantage of the expertise of the Health Department in staffing these meetings. My inclination is to accept that offer. Barbara Brenner - Council Member But Ramona's letter also indicates that it needs to take place somewhere other than the Council Office. Kenneth Henderson - Council Member Why? Whatcom County Board of Health Meeting, June 7, 1994, Page 2 Barbara Brenner - Council Member I don't know. That's why I say, we really should check with her before we make a decision. Dr. Frank James - Health Officer That was the one thing I thought really wasn't a wise recommendation. The others, I think, are very prudent and appropriate. Barbara Brenner - Council Member And you would be willing to advertise and do all that? Dr. Frank James - Health Officer Sure. Barbara Brenner - Council Member Okay, well, let's just talk to Ramona about it before we do anything. I feel she should be part of the discussion. Robert Imhof - Council Chairman And I think that's one thing we don't have to do tonight. But it's a good thing to get into the hopper. Let's follow up on it with Ramona, and we can get back with Dr. James, and if there's problems we can kick those around, iron them out, and decide what we want to do then. Dr. Frank James - Health Officer Your pleasure. Whatever you like. Marlene Dawson - Council Member Although, there's probably a consensus to go forward with what he suggested, don't you think? Robert Imhof - Council Chairman Well, there's no great hurry. It's gone this way for a few years, so why don't we check and make sure we do it correctly the first time. Kenneth Henderson - Council Member So, the questions are whether we would have the meeting here... were there other questions raised? Barbara Brenner - Council Member Yes, did you get that letter? Kenneth Henderson - Council Member I didn't see that one. Whatcom County Board of Health Meeting, June 7, 1994, Page 3 Barbara Brenner - Council Member Other questions concern advertising, staffing, and the Health Department's responsibilities. Robert Imhof - Council Chairman I don't think the location of a meeting has a whole lot to do with it. I think this was built for meetings. There's not very many places to hold meetings. Kenneth Henderson - Council Member I guess that's my point. If there isn't any questions coming up, why don't we make a decision? Robert Imhof - Council Chairman Well, rather than just by letter, I would like to get Dr. James and Ramona together and just sit down at the table and say, "Okay, why is there a problem ?" Dr. Frank James - Health Officer I actually haven't talked to Ramona about it. I just got the letter just recently. Again, they are her suggestions, and I concur that that would be appropriate. Robert Imhof - Council Chairman Okay. Dr. Frank James - Health Officer One of the things is, we're just getting back into meeting as a Health Board. It's going to take some time to get on our feet. I'm more than happy to work with Ramona to resolve them to her satisfaction and our satisfaction. I'm just saying that we have traditionally always done that for the Health Board, and we're more than happy to do it. Robert Imhof - Council Chairman We could get rid of some of the work at our office! Dr. Frank James - Health Officer We also already do most of the preparatory work now, and it might make more sense for us to provide that continuity. Robert Imhof - Council Chairman Instead of duplicating the effort. Barbara Brenner - Council Member Bob, how about just having Dr. James and Ramona sit down and work it out? That sounds good to me. Whatcom County Board of Health Meeting, June 7, 1994, Page 4 Robert Imhof - Council Chairman Yes, and maybe myself. We can sit down and work out the details of it. Then we can bring it back to the Council. Okay, let's do that. Dr. Frank James - Health Officer The next thing on the agenda, as you review the laws of the Health Board, is you need a Chairman. I certainly would defer to you organizing that however you like, but one of the things that it does say is that you need to elect a Chairman. Not that Mr. Imhof, the Chairman now, wouldn't be a good Chairman. But you need to select him, and the period that he would sit for would be one year. It might be appropriate to have someone else as Chairman. Really, again, that's your pleasure. But one of the things we should do is select a Chairman for the Health Board, and that's something that the RCW says we are supposed to do. Robert Imhof - Council Chairman But isn't there also some conflict under the County Charter? Dr. Frank James - Health Officer No, the only difference is that in a Home Rule Charter, the Administrative Officer who becomes the Executive Secretary for the Board of Health, can be an Administrative Officer appointed by Shirley Van Zanten, who ends up being me. I'm both the Administrative Officer and the Health Officer of the County. So here, I'm afraid you don't have a lot of choice. You're kind of stuck with me, and the Home Rule Charter, by my interpretation, makes me both halves. I'm the person that has to do the support work and staff work for this Committee. And again, that seems appropriate to me. Robert Imhof - Council Chairman Okay. Yes? Barbara Brenner - Council Member Maybe it's best asked, who wants to be Chair? Kenneth Henderson - Council Member I would like to comment that. I don't think it should be a thing based on preference or assignment each year. It's my sense that it should either be the Chair of the Council or it should be the representative to the Health Advisory Board. Also, it should be set up as a policy, that when you accept it, that's the role that you have. Robert Imhof - Council Chairman It's just one of your duties. Barbara Brenner - Council Member Yes. Whatcom County Board of Health Meeting, June 7, 1994, Page 5 Kenneth Henderson - Council Member I have no preference as to which way it goes. Marlene Dawson - Council Member That sounds like a good idea. Robert Imhof - Council Chairman What is the preference of the Council? Marlene Dawson - Council Member To have the Health Advisory Representative. Robert Imhof - Council Chairman Okay, further comments? Larry Harris - Council Member (The Health Advisory Representative) Yeah! I think that... (Laughter) Ward Nelson - Council Member We know who it is now! Barbara Brenner - Council Member We almost sent that through fast, didn't we? Robert Imhof - Council Chairman Caught him napping! Larry Harris - Council Member Well, just to be on the other side of the argument, for whatever reason ... I don't know. Okay. (Laughter) Robert Imhof - Council Chairman Well, you know, the only thing you'd have to do is touch base with the scheduling.. . Larry Harris - Council Member Well, it'd just be a lot easier if you did it! I think that's the easiest thing. Robert Imhof - Council Chairman That's probably true. Whatcom County Board of Health Meeting, June 7, 1994, Page 6 Larry Harris - Council Member The most uncomplicated thing is to have the Council Chair. Dr. bank James - Health Officer As a point of information, on the other side, since Larry does come to the Health Department Advisory Board meetings and there is a certain amount of continuity between issues, it would also facilitate bringing those issues to that Board and back to this Board, if Councilman Harris were the Chairman. But, your pleasure. Robert Imhof - Council Chairman Well, it's six of one, half a dozen of the other. Barbara Brenner - Council Member Well, Bob, what do you think about it, because you have a lot of stuff on your plate as well? Robert Imhof - Council Chairman It matters not to me. It would be easier to schedule. Like tonight, I can just schedule it, but all it takes is a note from Larry. Barbara Brenner - Council Member It doesn't sound like Larry is really.. . Marlene Dawson - Council Member But he does a good job. I've seen him in action. Barbara Brenner - Council Member Okay, I'm going for him. Robert Imhof - Council Chairman So the motion is to... Ward Nelson - Council Member I haven't heard a motion. Robert Imhof - Council Chairman Wasn't that a motion? Kenneth Henderson - Council Member That is a motion, that the representative to the Health Advisory Board chair the meetings of the Board of Health. Robert Imhof - Council Chairman Okay. That is the motion. Whatcom County Board of Health Meeting, June 7, 1994, Page 7 Barbara Brenner - Council Member The reluctant Chair. Robert Imhof - Council Chairman All those in favor of the motion signify by saying, "Aye ". (Unanimously, "Aye ") Kenneth Henderson - Council Member I'm sure next year, in return, Larry will be undoubtedly nominating me for the Health Advisory Board . Ward Nelson - Council Member Campaigning for you as well! Robert Imhof - Council Chairman Okay, we've got that item settled. Dr. Frank James - Health Officer The next several agenda items are items returning to you from the prior meeting. The first is a public notification policy, which went forward to the Health Department Advisory Board, who had a meeting about it. They discussed it, actually, rather extensively and made some recommendations about it. In addition, the other thing that was done was that we contacted a number of other health departments to find out what policies they had. That forms the draft proposal which has been put forward in our standard policy format. I'll just point out that this may not have the sharp teeth that some of you may have intended. It turns out that it is really difficult to describe all the details in a way that you can prescribe ahead of time how these decisions should be made. I believe that's a fair way to say it. A considerable amount of discretion still remains. You can't simply specify everything in a crisp policy. If you've had an opportunity to read it, I'd certainly entertain questions. Chairman Harris was also there at these discussions. Larry Harris - Board Chairman I might say that we talked about this at some length at the Advisory Committee. Certain things that seemed obvious at the beginning of the discussion turned out not to be as obvious as we got into it. There are many aspects of it that aren't obvious at first glance, so we were quite comfortable with what was produced here in the end, although it does leave a lot of things to the discretion of the Health Department. Barbara Brenner - Council Member Bob? Whatcom County Board of Health Meeting, June 7, 1994, Page 8 Larry Harris - Board Chairman Yes? Barbara Brenner - Council Member Oh, that's right. Larry Harris - Board Chairman Hey, you put me here! (Laughter) Barbara Brenner - Council Member Now I'm going. to suffer for it! So basically, from what I've read, it's been policy that you were using before. There's nothing different. Larry Harris - Board Chairman Actually, no. There isn't, quite frankly. It's very similar; it's a written policy, rather than an implied policy. That's the difference. The problem is that there are many cases that look the same on the surface, but when you delve into them, they're different and could be decided differently. It is a balance between the public interests and the private interests, as there are in many cases. We need to protect to the absolute maximum extent private interest's policy, while preserving the public's interest as well, and that's just something that isn't easy to do. Sometimes it might be perfectly appropriate to announce the name of a restaurant that was involved, say in a food -borne exposure. In other cases, it would not be. It just isn't possible to specify all the details of when you'd go one way and when the other. Barbara Brenner - Council Member Okay, I can appreciate that. The problem I had, which is why I brought it up originally, is that I don't see that we're playing by the same rules at all by treating everybody kind of equally. To say that E coli originated at the Bellingham Daycare Center, which had a horrible, negative impact on that facility, rather than Measles.. . Dr. Frank James - Health Officer Can I just clarify the record for that, since this goes on the record? The Health Department did not ever state what you just stated. We have never said that E coli emanated from any daycare. Barbara Brenner - Council Member I was told by a member of the staff there that... Dr. Frank James - Health Officer I realize that there are people on the staff that believe that, but I stand by the record Whatcom County Board of Health Meeting June 7, 1994, Page 9 and would invite you to come and look at that record with me, and we tried to track that with them. Barbara Brenner - Council Member Okay. Dr. Frank James - Health Officer And I know they feel victimized; they feel a lot of things. And when children die as a result of infectious diseases, there's a lot of room for guilt. Everybody feels bad about it, and it's hard to take on responsibility. Barbara Brenner - Council Member So you acted the same way at that time about the facility as... Dr. Frank James - Health Officer We did not specifically identify that facility and would not. Barbara Brenner - Council Member Alright, I understand that. Larry Harris - Board Chairman Any other questions on this. Ken, I saw your hand a moment ago. Kenneth Henderson - Council Member Well, in having a business myself, which might come under this rule sometime, I still question whether the Health Department shouldn't be notifying people. I can see where the problem would arise, and in some cases, it may not have a relative value to be noticing the public. So, I suppose that we will just hope that that will work. But it does worry me a little bit. Was there a discussion of the concept of having a phone information, if it were not publicly announced. I guess, if you tell one person, it's out. Dr. Frank James - Health Officer Tell one person, and it's a public announcement. Kenneth Henderson - Council Member Yeah, I suppose. Robert Imhof - Council Chairman I think you have to also give some discretion to the Health Department to do what they think best. That's what their expertise is. Dr. Frank James - Health Officer I trust that you know that if we're ever really stuck and don't know what to do, I'll come and lay it on your lap. Guaranteed. Whatcom County Board of Health Meeting June 7, 1994, Page 10 (Laughter) Dr. Frank James - Health Officer Because some things are policy decisions. No, I mean your lap. The big lap. (Laughter) Larry Harris - Board Chairman We have broad laps. Yes, Barbara? Barbara Brenner - Council Member I appreciate all the work you do, and it's just a philosophical problem that I have. How are you going to measure the protection of these private businesses or people, with the public anxiety of the people who want to know, but aren't told. I feel that there is no excuse for not letting people know, if you know where something comes from. If you're not sure, I can see not making it public. But if you are sure where it originated, I really feel we are obligated to let the public know. I feel very strongly about it. Larry Harris - Board Chairman Alvin. Alvin Starkenburg - Council Member Based on the fact that this is much different than most cases we deal with, I think each one needs to be handled on its own merits. And I think that's what we have before us. Larry Harris - Board Chairman That's where the judgement comes in. Alvin Starkenburg - Council Member Based on that perspective, I think it's necessary to go with this type of a document in order to cover it, because each one has to be looked at separately. Dr. Frank James - Health Officer One thing I'll point out is that our practice is pretty effective. We have, in the past five years, been through some very, very difficult and trying times in this community. A small religious community potentially had polio in it. We've had the measles exposure; we had the Haggen's event. We've had a lot of different things, and we actually have not had serious complaints, generally, about that. I'm not going to tell you that we're going to do it perfect every time, because I know that we can't be perfect every time, but I think we have an extremely good track record in this area so far. I think our practice is sound. Larry Harris - Board Chairman I think that it's really important to remember that public health's policy and public Whatcom County Board of Health Meeting June 7, 1994, Page 11 health's action is not the same as we would expect from a political body. Public health policy is in a different arena. It involves important public opinions and anxieties and those kinds of things. Bob? Robert Imhof - Council Chairman I'll move acceptance of the policy for public announcements as presented. Larry Harris - Board Chairman It's been moved that the public policy announcements be accepted. Marlene Dawson - Council Member I'll second that. I guess we're not doing seconds. Larry Harris - Board Chairman Do we have discussion? Barbara? Barbara Brenner - Council Member I have one other comment. I really do think that public is the word, not private. When you start to keep people's names out of it for private reasons, it's not for public reasons. These are private places for which we end up keeping people's names private, and it's public anxiety we're sacrificing for it. So, I just.. . Robert Imhof - Council Chairman I don't understand what you're trying to say. Explain! Barbara Brenner - Council Member Okay, well, it happened with the measles outbreak. Robert Imhof - Council Chairman Okay. Barbara Brenner - Council Member I had a lot of phone calls from people who were very concerned about whether or not their children or someone else's children were at risk. One person I know, her daughter had just been given chemotherapy, quite extensively. She would have to be in a very restrictive environment if she was risking exposure. She didn't know. Her daughter has been kept inside so much anyway. It's terrible not to be able to know those things and to force her to keep her daughter in for that period of time without even knowing if it was necessary. And it turned out not to be necessary. And there are people, for one reason or another, religious reasons or whatever others, who do not have their kids immunized, but at least they should be notified. I feel like this is more like a punishment. It's like, "You either get your kid immunized or take your chances." I don't think it's our job to punish people when they have their own personal reasons for immunizing or not immunizing. I feel public anxiety is very high, and I can see very few Whatcom County Board of Health Meeting, June 7, 1994, Page 12 instances where I would feel that it's okay to keep the public in the dark about these things. Larry Harris - Board Chairman Okay, thank you. That's an important point of view on this. Kenneth Henderson - Council Member Question: as also the Medical Officer, in a case like that, would you feel that you had the discretion to advise that person? Was there a discussion of signing a confidentiality note in the cases of special circumstances, or something? Dr. Frank James - Health Officer I see. I don't know that it's the same person you're mentioning, but a person in a similar circumstance did approach the Health Department. We counseled them, worked with them, and gave them what I thought was adequate information to them to make wise choices about their child. Kenneth Henderson - Council Member Sure. Barbara Brenner - Council Member This person was not told where it came from. Dr. Frank James - Health Officer We did not make a public announcement about where it came from. That's true. And we certainly don't want to punish anybody for anything. Kenneth Henderson - Council Member But the question was, is it possible to establish some ... I recently participated in an activity where I had to sign a confidentiality statement before I participated. Maybe, in very specific cases, based on the discretion of the Health Officer? Dr. Frank James - Health Officer I think that there are cases where that is true. HIV testing, for example. When you test someone who's exposed HIV, in special cases, you can do mandated testing of the person that was involved with the exposure, the supposed case, and the person who was exposed can become aware of the results of that test, but they are bound by confidentiality not to disclose that information to anyone. So, there's a principle there, at least, that says that yes, indeed, we could do that, if the situation warranted it. So, to answer your question, yes, that would be possible. Larry Harris - Board Chairman We have quite a tight agenda here. I'd recommend that we voted on this now, and if you don't feel that you can vote on it and you'd like to revisit it, then vote no. And we'll Whatcom County Board of Health Meeting, June 7, 1994, Page 13 return it to the Health Department and re -tool it, but I'd like to have us move on to the next item. So, I'll ask all those in favor of the motion to accept say "Aye ". (Chorus of "Ayes ") Larry Harris - Board Chairman Opposed? Barbara Brenner - Council Member No. Larry Harris - Board Chairman It passes, six votes to one. The next item is the sewage lagoon, the sleepy lagoon. Dr. Frank James - Health Officer There is, actually, not just a letter, but a packet of materials that came before you with respect to this. I don't think that my concern, my anger came through in the letter as much as I feel it. Barbara Brenner - Council Member Oh, I thought it was excellent! Dr. Frank James - Health Officer I rewrote it several times. The Department of Ecology is the department legally responsible for licensing sewage lagoons, not the Health Department. We, I think, have gone to extreme lengths (we've been in court twice, we've won once, we lost once) in trying to get this problem resolved. The Department of Ecology, as the letter states, in 1979, acknowledged that it was a problem and acknowledged that it needed a timely resolution. I didn't mean to burden you with all the paper and didn't want to cut down any more trees, but I thought it was instructive to read the exchange of letters over the years. It's been some 15 years, now. And Ecology, really quite frankly, has not done what they should be doing to correct the situation. I don't think you've been there, but there are three open sewage lagoons, to my knowledge, built without permits, built without any appropriate design. The sheet flow into the creek, and we have video tapes of it. There are two violations. First, it isn't built in accordance with the regulations, nor is it permitted according to the regulations, and that's Ecology's issue. The second thing is that raw sewage is flowing into a public body of water, which is also illegal, blatantly illegal. There's also some nuisance issues about the odor of this, with the adjacent facilities. There are two mobile home parks on either side of this facility, both of whom we force to fix their septic systems at considerable expense. The people who own those are very, very angry, understandably, about the inability of the Health Department to get this problem fixed. The only problem is that I don't have the authority to fix it in any direct way. If I could prove that people were getting sick from it in an immediate sort of way, if we had more evidence, we could fix this, and perhaps we "atcom County Board of Health Meeting, June 7, 1994, Page 14 could take more legal action. However, it is clearly the responsibility of the Department of Ecology and clearly within their jurisdiction and authority to move forward on this, and they simply haven't. What I would ask you to do is simply write this letter, or one like it, to the Department of Ecology and simply bring it to the attention of people higher up in the rank, where it's more appropriate for you to be talking to them than me. They have not listened to me, and I have spoken loudly and clearly for years. Marlene Dawson - Council Member I think it's an excellent letter. I have another suggestion. It was Andy Anderson. He was interviewed for Al Swift. He says that the public has a lot of problems with our departments at the State level. They are not getting responses. This isn't the only department that has had no response in 15 years. There are other things out there. And I would suggest that along with this letter, we send a cover letter to Slade Gorton and Patty Murray, because they are in a position to allocate funds to the Department of Ecology. They are also in a position to have some leverage over them, more so than us. Larry Harris - Board Chairman Barbara? Barbara Brenner - Council Member I also think that it's a really good letter. Speaking of not getting responses, I don't get response from our own staff, so I sure understand the problem. But anyway, on the last page of it, I just wanted to make a couple of corrections. It's Rod Graber, from the Ferndale Mobile Home Village, not Ron, and the Ferndale City Manager is not Ron Peterson anymore. What is his name? Kenneth Henderson - Council Member Stan Strebel. Barbara Brenner - Council Member Stan Strebel. Right. Other than that, there's a couple of places where I thought "state" was supposed to be capitalized, but maybe not. Anyway, it's a very good letter, a long time in coming. Why did we lose in court the second time? And why, do you think, we're not getting any response from your requests? Dr. >}ank James - Health Officer The loss in court, on the second occasion, I'm not familiar with in detail. The information I got was that we didn't put forward the strongest arguments, but one of the pieces was that we don't have regulatory authority. Ecology does. Barbara Brenner - Council Member So that's probably why we lost? Whatcom County Board of Health Meeting, June 7, 1994, Page 15 Dr. Frank James - Health Officer That was an element. There were other elements as well. What happened was that the apartments were actually vacated. We succeeded in vacating the apartments and then, they were illegally reoccupied over a period of time. So then we went back to get them vacated again. It was at least partially because it is the Department of Ecology's responsibility to bring that action and not the Health Department's. And Ecology, more recently has been, again, doing some things. But they always do some things, but we never get it done. We just need to move this forward. Larry Harris - Board Chairman Is it the fact that the mobile home problem has been cleared up? Dr. Frank James - Health Officer Oh, absolutely. Larry Harris - Board Chairman So, it's simply the apartments and the lagoon, at this point? Dr. Frank James - Health Officer At considerable expense, these folks repaired these things. Tens of thousands of dollars. It was very expensive for them. But you see, we regulate septic systems. We can go make people do that. If this were a septic system, I'd have it fixed. But we don't have the authority to fix this. Barbara Brenner - Council Member And this particular one is not fixed? Larry Harris - Board Chairman Right. I've seen the videos of it, and it's quite... Dr. Frank James - Health Officer Of the sewage lagoon? Larry Harris - Board Chairman Right. Dr. Frank James - Health Officer Oh, yes. Right. Larry Harris - Board Chairman Ward? Whatcom County Board of Health Meeting, June 7, 1994, Page 16 Ward Nelson - Council Member Well, I was a little confused. It sounds like the sewage system for Ferndale goes right by the property. Dr. Frank James - Health Officer Historically, it did not, but at this point in time the sewer system goes immediately adjacent to the property, yes. Ward Nelson - Council Member And it sounds like the property owners are just waiting for a decision by the Department of Ecology, one way or another? Dr. Frank James - Health Officer I would invite you to come look at our records. We have a lot of letters saying that they are ready to do, but they have done.. . Ward Nelson - Council Member For that matter, we've had this one before! Dr. Frank James - Health Officer Yes, and I would be happy to show you. I think that there's an iron -clad case against this person, and if Ecology simply moves forward in an expeditious way with their administrative order, it will be fixed. So, I think we simply need the leverage to make it happen. But they need to make it a priority. It simply hasn't been a priority. Marlene Dawson - Council Member I will make a motion to approve this letter to be sent out by the Health Board, and then I also have some wording for a cover letter to go to Slade Gorton and Patty Murray that I'll bring up after this motion. Dr. Frank James - Health Officer I will redraft it and provide it to the Council, if that's your pleasure. Larry Harris - Board Chairman Alright, the motion is that we endorse this letter and send it from the County Health Board. Any other discussion? Barbara Brenner - Council Member Just that you correct the names on it. Dr. Frank James - Health Officer Yes, alright. Whatcom County Board of Health Meeting June 7, 1994, Page 17 Kenneth Henderson - Council Member I would think it appropriate, also, that the Health Officer and the Medical Officer for the County sign it. Barbara Brenner - Council Member Well, maybe we should all sign it. That would give it some impact. Dr. Frank James - Health Officer They get letters from me regularly. Barbara Brenner - Council Member Right. It sounds to me like they need some more. Kenneth Henderson - Council Member Alright. Whatever. Judgement of the Chair. Larry Harris - Board Chairman Any other discussion? All in favor of the motion? (Unanimous, "Aye ") Larry Harris - Board Chairman Opposed? Motion passes. Marlene Dawson - Council Member Okay, I have some wording for a cover letter to Slade Gorton and Patty Murray that I would like to enclose with this, unless Dr. James has some other wording. It would basically say that it is important that the service delivery of our agencies be evaluated on an ongoing basis. It is our feeling that Ecology has ignored their obligation to the enclosed case. Since the problem has not been addressed in 15 years, we hope you will follow up with Ecology on this issue. Larry Harris - Board Chairman Why don't you give Dr. James that wording, and he can smooth it and adapt it. Marlene Dawson - Council Member Smooth it and adapt it. Dr. Frank James - Health Officer I would be more than happy to. There are also a few typographical errors in the letter that we'll correct. Whatcom County Board of Health Meeting, June 7, 1994, Page 18 Larry Harris - Board Chairman Okay. Alright, moving on to the Immunization Policy Statement and Barrier Reduction Plan, 15 minutes. Dr. Frank James - Health Officer We're actually doing pretty well with time. Immunizations are a significant problem, if you look at health status in this Country and compare it to other countries. The difference between our health status in this Country and health status in a third world nation is built on hygiene, sanitation and immunizations. All the stuff you go to primary care doctors for and your coronary by -pass graphs don't make a measurable difference in health status. What separates us is immunization, sanitation and hygiene, the stuff people mostly do for themselves. And medical procedures, although I'm very fond of them, don't make a huge impact, except for immunizations. In the past, when most of us grew up, we lined up, and we all got immunized. Because of some changes in laws and because of some changes in policies, that has changed to where more responsibility is put back on the individual to seek out this care on a case by case basis. The other thing that changed is that now vaccines are remarkably effective. There hasn't been a case of polio, wild -type polio, in the United States for years, nor has their been a case of measles in months, and even then it's sporadic cases. I think our last case here was in 1987, and it was 11 cases. Vaccinations have been remarkably effective. The problem is that younger people raising families today don't know people who have had polio and they think measles is spots and a fever. They don't know that one in 100 people can die from it. There's become a very complacent attitude about vaccinations. Now, the hammer we have is on entry to school. People have to get vaccinated or have a darn good reason not to. About one percent of kids have religious objections; the families have religious objections to vaccine. About one percent have medical contra - indications. So, they are both considered very legitimate reasons not to be immunized. But that leaves 98% of kids that can and should be immunized. On entry to school, we get up around 95% in our community. We do very, very good once kids get to school. The problem is that most of these diseases are most prevalent before you get to school. And that's the group that vaccination rates have waned considerably on. We got some money from the State to do some retrospective, look -back studies over the past year, and what we found is that it varies from 30 -some percent up to 70 -some percent. But in most of the populations we've looked at, the aggregate number looks like about half of children in our County are fully immunized at age two. Now, that's a problem, and we need to develop, I think, some effort at solving this problem. At the Health Department, we've been doing this for a while. If you look back at the numbers, we increased vaccines delivered in the County by more than 25,000 doses in 1991. We've made huge strides in improving things. The main mechanism of that has been working with the State to insure that low -cost or no -cost vaccine is available, not only through the Health Department, but also through private providers in the community. We have about 60 kind of Deputy Health Officers out there delivering no -cost vaccine for $10 or less per dose and participating in a public program to vaccinate kids. We still haven't met the need, however. Not only the Health Department, but we have several partners in this Whatcom County Board of Health Meeting; June 7, 1994, Page 19 venture. The Kiwanis Clubs (not just one, but a number of them) and all the Rotary Clubs in our County, all have agreed to make this a priority during the year, and assist us in trying to come to terms with this problem. And I think it's a very, very important priority. The Rotary Club, in particular, is very proud of the fact that they've helped to eliminate polio in many parts of the world, and when they realize that, hey, we're vulnerable in our own back yard, they've taken that issue seriously and want to move forward with the project. The policy statement simply says basically what I've said, and that is, about one percent have contra - indications, about one percent have religious objections, but we need to get the other 90% offered vaccines in an effective way. We need to make sure that it's being offered and that there are no barriers to getting it. The second page of the attachment is looking at what we believe to be barriers. Some of these things we can do with no new staff and no new money.. We can just be smarter and more effective. We're going to try to educate people better. One of the significant barriers is that doctors don't understand contra - indications very well. Many of what some doctors think are contra - indicators are not. So, we're going to try to do outreach to the doctors, the nurses, other people, to make sure they know when and how to give vaccines appropriately. Another thing that we can do is that we can change some of the laws to make sure that an informed consent is as streamline as it can possibly be, to insure that the people can get to information they need, to insure that it's not a barrier. Right now, grandma brings the kid in, and we can't vaccinate him, because grandma legally can't give consent for him, only the parents can. That's item number three in the Barrier Reduction Plan. The one thing that probably will cost money and take staff is the barrier of not knowing what the kid's immunization status is. Now, well - organized, together. moms have got the card right in their pocket, and they pull it out, and they can tell you. Unfortunately, not everybody is like that. Some people have very difficult lives and can be pretty disorganized. When a child comes to one practitioners office, and they don't have a record, and the mom doesn't know what the immunization status is, that's a problem. What we'd like to do is to try to put in a system where we can track immunization status on a community -wide basis. There are other communities that have already done it.. Seattle, King County, and Snohomish are in the process of doing it, and that is one of the things that the service clubs in town are interested in helping us with. They can, I think, provide us both funding and additional public support for that effort. There's a whole list there of things, and there was a fairly extensive discussion of this at the Health Department Advisory Board, too. We have another board, the Immunization Practices Advisory Board, which also meets. There are a number of people in that group, 20 or so, I think, from around the community, and this is the result of those two groups of people's work. That's just a brief, well, maybe a wordy, introduction. Larry Harris - Board Chairman Any discussion? Ward? Whatcom County Board of Health Meeting June 7, 1994, Page 20 Ward Nelson - Council Member I have two statements. Are you just tracking the immunization that the Health Department does? Dr. Frank James - Health Officer Currently, the system in place is that we moved, in the past two years, from the old card file system. We have banks of three -by -five cards, where we had it back for 40 years. We've computerized all that in the past couple of years, so we now have a computerized tracking system for all those who receive a vaccine at the Health Department. Ward Nelson - Council Member So, your statistics are based just on Health Department records? Dr. Frank James - Health Officer No, no, no. The look -back studies that we did? No, what we've done is we've gone to, for example, a school, looked at everybody in the school or in the daycare, and gotten their record, the actual record itself, and looked back on that record to see if by two years of age they were up to date. They are called "Look -back Studies ". Ward Nelson - Council Member I just wanted to know where you went and got your information. The second statement is that I think that one of your key points that you wanted to get to was how do we get out and reach the public, the education and that. I would think that probably the easiest method, if you want to do it for Whatcom County, is getting with the retailers in Whatcom County and stickering all the Pampers, and we should have it covered. Larry Harris - Board Chairman So to speak. (Laughter) Dr. Frank James - Health Officer That, actually, is one of the ideas that was a very prominent one in our discussion, and I think, a very good one. When we had the recent shigella outbreak, where there were literally 100 and some people with shigella and a number of them hospitalized, the strategy was developed. The brainstorming was that we'd put it on radio, T.V., and the newspaper. It turns out that those aren't the right people. People don't necessarily go to those sources, so we ended up having little stickered things by the diapers in the grocery stores. And we also gave them out at the DSHS office where people pick up their checks and a couple of other places. But you're right. Those kinds of creative approaches are really important. Ward Nelson - Council Member Yes. Whatcom County Board of Health Meeting, June 7, 1994, Page 21 Dr. Frank James - Health Officer I think that is definitely something we would do. If you've been out to Bellis Fair Mall, you'll see the little Kiosk things on the table, little paper things that have information about vaccines. We're especially working with Kiwanis Clubs, because that's a priority they have this year, and the public education and media pieces are what they are really good at. We're in a public - private partnership with them to try to address that particular issue. Larry Harris - Board Chairman Is that a suggestion you might add to this draft? Dr. Frank James - Health Officer Sure. Larry Harris - Board Chairman Barbara? Hands for discussion? Ken? Kenneth Henderson - Council Member So, you're going to work more with local doctors to get them to do this more often? Is that you're saying? Dr. Frank James - Health Officer What we've done over the past few years is that we have recruited about 60 positions in this County, which is a very big number. In Thurston County there are two doctors, besides the Health Officer, to help deliver public vaccine. And the way we've done that is by saying that we could get free vaccine for you, at no cost to you, because we get it from the State. It's going to be free to the kid, and you can give it to him, but you have to agree to a couple of things. You have to agree one, to not charge any more than $10 for an administration fee. Some charge nothing, some charge $10, or something in- between. And you have to do some tracking. Kenneth Henderson - Council Member Who pays the administration fee? Dr. Frank James - Health Officer The patient. Kenneth Henderson - Council Member Okay. Dr. Frank James - Health Officer One of the other things they have to agree to is that there has to be the ability of any kid under seven years of age to get vaccine for free if, in fact, they don't have the resources to pay for it. And that's also a policy at the Health Department. If anybody Whatcom County Board of Health Meeting, June 7, 1994, Page 22 comes in there and they're under seven years of age and they need a vaccine, they can receive that at no cost. Not even a registration fee. All fees are waived. Kenneth Henderson - Council Member I was unaware that they have the option to walk in. Most people don't believe that they can walk into a doctor's office and get an immunization and walk out without paying. Dr. Frank James - Health Officer It's considerably more complicated than that. People can't go in and demand. They need an appointment. Many doctors only see patients that are already registered for an appointment with them. So, just because they are publicly spirited doesn't mean that they are a public facility. Kenneth Henderson - Council Member Correct. So, now, I'm not debating the program. The question is, are you going to trade something else off for this. Is there something that you're not going to do by focusing on this effort? Dr. Frank James - Health Officer Some of the money you've approved for our budget in the past is doing some of this work right now. Some of the supplemental budget dollars went into this. We are also not doing some fairly minor things. The one thing that we can't do would be the tracking system. We can't do that with existing staff, and that would require additional funding from somewhere in order to do that piece of the work. And there might be both capital costs and staffing costs in order to do that. Kenneth Henderson - Council Member It's my understanding that the Medical Bureau and possibly the hospital, is working on what is being used in other communities, a community medical record tracking system. With this system, when you go in and see a doctor, the doctor can, in fact, call up on a master computer link and get this information. Is that something you're working on? Dr. Frank James - Health Officer Yes, we've had discussions with providers of care, actually, the payers of providers of care, because they are the ones who are going to drive that particular system, and with the hospital. That system will be of some utility, but will not be universal, although it should be. Right now, everybody knows that with health care reform, there has to be a centralized information system that collects some sorts of information. The other thing you have to be aware of is that everybody has good reason to believe that you shouldn't just build a data system that many people have access to and that has medical details in it that are confidential. So, there's going to be a juggling that goes on there. The main problem with the thrust that you're taking is that not everybody is going to be in that data base. If we have one for immunizations, we've got to get every kid into it and make sure that we're up to date on it. Whatcom County Board of Health Meeting, June 7, 1994, Page 23 Kenneth Henderson - Council Member Why isn't everybody going to be in this? Dr. Frank James - Health Officer In the other one? Kenneth Henderson - Council Member If we go to a universal health care system in Washington State, which we're going to. Dr. Frank James - Health Officer Well. some day, in ten years, that may well be the case. I can't perceive that system coming to fruition as an effective system in less time than that. I think it may come to that. And I'm fairly experienced in this. I spent two years on a Navaho reservation putting in an entire computerized medical record system for clinics and hospitals for an entire population of 20,000 people. It had all the information in one system, but that was an organized system. Kenneth Henderson - Council Member Right. Dr. Frank James - Health Officer So, that may come to fruition and if it did, that would be wonderful. My estimation from the initial discussions is that that may happen in ten years, and the first priority is going to be, "How do you bill ?" Immunizations are going to be way down the priority list. Larry Harris - Board Chairman If we're going to get on with the rest of the items, we've got to move on. If you'd like to continue this, then we'll have to drop something off, probably. Barbara? Barbara Brenner - Council Member I like the idea of making it very accessible. I do not like the idea of tracking and forcing stuff. I think it should be a decision people make and having it very accessible is great. Also, I am not in favor of offering it free to everybody. I think it should be that if people can't afford it, they should get it free. If they can afford to pay, I don't feel that it should be given free to them. So, those are my two sticking points. I don't care about tracking. I care about having it readily accessible to the public, and I feel that it should be free to those who need it for free. Dr. Frank James - Health Officer Just as a point of information, we don't have any choice about the free /not free stuff and how that works. That's in Federal and State legislation. And if we want to get their vaccine, we have to play by that rule. Whatcom County Board of Health Meeting, June 7, 1994, Page 24 Barbara Brenner - Council Member Okay, but I also... Dr. Frank James - Health Officer I share your sentiments about some of those things, but we don't have the flexibility to change it. Larry Harris - Board Chairman Other comments? Robert Imhof - Council Chairman Just a quick one here. This is mostly policy things, and it's things that are going to be developed. They will be brought back before us, I'm sure, if there is any costs incurred or for a finalization of the policy. So, in that vein, I will move approval of the Immunization Policy Statement and the Barrier Reduction Plan. Larry Harris - Board Chairman Okay, it's been moved. The Draft Barrier Reduction Plan, as amended, is moved, and the Policy Statement on Childhood Immunization is moved in one motion, I presume? Robert Imhof - Council Chairman Yes. Larry Harris - Board Chairman Discussion? Barbara Brenner - Council Member Yes, quickly. It seems to me that if we support this, we're supporting the tracking and that means more staff. Robert Imhof - Council Chairman Well, they will have to come back to us with that. They're going to have to develop this policy. (End of Side #1, Tape #1) Larry Harris - Board Chairman Other comments? All in favor of the motion, say "Aye ". (Unanimous, "Aye ") Larry Harris - Board Chairman The motion passes unanimously. The next item is the Lummi Island Groundwater Study. "atcom County Board of Health Meeting, June 7, 1994, Page 25 Dr. Frank James - Health Officer In the interest of time, and by my watch, we're out of time. . Larry Harris - Board Chairman We've got to save ourselves ten minutes to get organized. Dr. Frank James - Health Officer What I will do is briefly describe the next items and bring those back to you at a future date. These two studies have recently been completed. The first one is the Lummi Island Groundwater Study. The reason this was started is that there is a problem with arsenic in the water on Lummi Island. There was also a concern identified among the residents there, that there was a potential problem with salt water intrusion, where the pumping of water out of the aquifer is leading to salt water entering into the aquifer from the ocean. There are two simple conclusions. One is that arsenic is present and that it is probably naturally occurring and not from some contamination that occurred on site. And the salt water intrusion, although it is a problem in a few wells, is not a major problem there. And I'd be happy to come back and talk with you about some of the details about that, because I think it does make a difference. It's information you may well want to -know more about. It's a rather lengthy report, and it took several years to compile. The second one is the LENS Groundwater Study, and there's considerable interest in this study, as I think there should be. It's straightforward conclusion is simply that nitrates are present in as many as 54% of studied wells at levels higher than background. That number came up both in the formal study done by the USGS, as well as our informal and inexpensive study which we conducted on a voluntary basis with citizens. About 24% of the wells have levels that exceed safe drinking water standards. Robert Imhof - Council Chairman How many of the wells? Dr. Frank James - Health Officer Twenty percent, one out of five. In the formal studies done by USGS, there were several pesticides which were identified, again, at levels which, interestingly, exceed the US drinking water standards, but not the Canadian. It's also believed that a considerable amount of this problem is very complex in that some of it is coming underneath the border from Canada. Ward Nelson - Council Member Is this a localized study in a certain geographic area? Dr. Frank James - Health Officer Yes, it's the northern part of the County. It's north of the River, up to the border, and actually crosses the border. And what it shows is that that water supply is vulnerable and is being affected. What we do in the future is going to make a difference. Both of these, I think, warrant a fuller discussion. I'd be happy to bring those back and talk Whatcom County Board of Health Meeting, June 7, 1994, Page 26 about them in more detail at a later time. The final item is just scheduling our next meeting and some wrap -up. You also may have seen some of these hand -outs. I'm going to try to send you a packet of information about current topics on a monthly basis: health care reform and access to care, E coli and drinking water, some immunization information, EPA drinking water standards and lead from submersible pumps. Those are just informational items, and I'll try to send a packet of that kind of information once a month, so that, as a health board, you'll be abreast of some of the cutting issues. When I do that, you can any questions about them during this final period of time. We can answer those questions. The one that you may get questions about is the issue about lead, that there is lead which leaches from submersible pumps. A brass pump has lead in it. Now, it's recommended that they all be removed or at least that water be checked to test lead levels. It's actually a fairly complex issue, and I hope the handout has enough information to answer your questions. Barbara Brenner - Council Member There was a news article on that, and they said that it was just the ones that were built in the last year. Are you saying that even if they're older, they're affected? Dr. Frank James - Health Officer It's actually a little more complex than that. Plastic and stainless steel ones aren't affected. It's just the brass and bronze pieces inside that leach lead. And if they are old enough, a coating builds up on the inside which prevents it from leaching out, okay? The same thing is true of your faucet at home. If it's old enough, there's a coating on the inside that keeps the lead from leaching. And if they're new enough, they're built with parts that won't leach. So, there actually is a time frame in which there is a vulnerability. Larry Harris - Board Chairman Thank you. As far as our next meeting goes, we haven't really discussed how often this Board should meet. What is your feeling? Monthly? Bimonthly? Quarterly? Barbara Brenner - Council Member I think monthly or as needed. Robert Imhof - Council Chairman Meet quarterly, but I think we ought to leave it up to Council Members to initiate an agenda with items, or from Dr. James, if he has things that need to be taken care of. Larry Harris - Board Chairman Ken? Kenneth Henderson - Council Member Having been on the Health Advisory Board, Larry, I think I would let you look at the nature of the issues and let us know what your recommendation is. Whatcom County Board of Health Meeting, June 7, 1994, Page 27 Larry Harris - Board Chairman I'd be glad to do that. And also, my function, I hope, is to be a conduit between the Health Department and this Council. So, if questions come up, I'd be glad to carry them to Health Department Advisory Board meetings. So, we'll leave it to Dr. James and myself to schedule future meetings. Barbara? Any other discussion? Meeting adjourned. iB g7\minutes \trans \hea1thbd.607 Whatcom County Board of Health Meeting, June 7, 1994, Page 28