HomeMy WebLinkAboutBoard of Health May 5 20151 WHATCOM COUNTY COUNCIL
2 Board of Health
3
4 May 5, 2015
5
6 CALL TO ORDER
7
8 Council Chair Carl Weimer called the meeting to order at 10:32 a.m. in the Council
9 Chambers, 311 Grand Avenue, Bellingham, Washington.
10
11
12 ROLL CALL
13
14 Present: Barbara Brenner, Ken Mann, Satpal Sidhu, Carl Weimer, Pete Kremen,
15 Rud Browne, and Barry Buchanan
16 Absent: None
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18
19 1. PUBLIC SESSION
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21 No one spoke.
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23 3. PUBLIC HEALTH ADVISORY BOARD (PHAB) UPDATE
24
25 Ben Schultz, Public Health Advisory Board (PHAB) chair, submitted a handout (on
26 file) and gave an update on their last two meetings. The main topic was the cleanup of
27 homeless camps. Renee La Croix, City of Bellingham Public Works, gave a presentation to
28 the PHAB about homeless camp cleanup. The presentation would be interesting for
29 business owners in particular. The advisory board is working with the Health Department
30 on a policy agenda and looking at national samples as examples. They adopted one from
31 Dr. Hutchings that breaks down policy- making into problem statements, programs, and
32 politics, and focusing on the political component. This has led to the project of stakeholder
33 mapping of the PHAB members using a survey. One result that stood out is that downtown
34 business owners are a high - influence or high - leverage group.
35
36 Weimer asked if the PHAB has met with the City of Bellingham about homeless
37 solutions. The City plans to spend $7 million on homeless housing. Schultz stated they
38 could discuss it at a future PHAB meeting.
39
40 Brenner stated she would like to see the stakeholder mapping transcript and Renee
41 LaCroix's slide presentation to the PHAB.
42
43 Sidhu asked what was the criteria for coming up with the stakeholder survey
44 information. Schultz stated it was a brainstorming activity by the PHAB members. It's not
45 intended to be a sociological survey.
46
47 2. DIRECTOR /HEALTH OFFICER REPORT
48
49 Dr. Greg Stern, Health Department, updated the Board on a recent E.coli outbreak
50 that originated at a Lynden milk event and affected several children. The Health Department
51 has been trying to find out the exact strain and source of the bacteria. Of the 22 lab -
52 confirmed cases, seven have been hospitalized. If the source can be identified, it can help
Board of Health, 5/5/2015, Page 1
1 the Health Department to keep this strain from making others sick again. They have been
2 working with the State Department of Health.
3
4 Brenner asked what the treatment is. Stern described some of the damage to the
5 body caused by the bacteria and stated that keeping the patient hydrated is the most
6 important treatment. Prevention is a goal at this point.
7
8 Weimer asked if all the patients that were hospitalized were children. Stern stated
9 some were children, and some were older.
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11 Kremen asked how likely it is to find the source of the bacteria. Stern stated it is
12 hard to say. They are not currently working with the Center for Disease Control (CDC), but
13 they are working with the State Department of Health to find the source.
14
15 Kremen asked how many had primary exposure and how many had secondary
16 exposure. Stern stated he did not know.
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18 Kremen asked if any other cases were reported outside of Whatcom County. Stern
19 stated he is not aware of any.
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21 Browne asked if there is any video that can be watched, in terms of trying to identify
22 behavior that might have contributed to this. Stern stated there is not, that he is aware of.
23 They'd have to know there is a particular behavior.
24
25 Browne stated his question is trying to identify if there were patterns of behavior
26 that were likely to have contributed to it that people didn't notice because it didn't seem out
27 of the ordinary but, in hindsight, shouldn't have been going on. Stern stated he's not
28 aware. They've been reviewing the event setup and where people were eating.
29 Environmental sampling has been done to see if there were areas that could have had
30 surface contamination. They have identified when kids were washing their hands and using
31 sanitizers and when they were eating their lunches.
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33 Regina Delahunt, Health Department Director, stated the staff stepped up, and she
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36 Kremen asked if this is the largest outbreak of E.coli in Whatcom County. Stern
37 stated it may be.
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39 Weimer stated social media has blown out of context how people can be exposed. He
40 asked if there is accurate information available for people. Stern stated the transmission
41 routes are contaminated water, food, and unwashed hands. Raw dairy products are of
42 concern. They've had issues with produce that has been contaminated by animal waste and
43 undercooked ground meat. He's not aware of concerns with manure spraying. It's a
44 theoretical source, but he's not aware of any outbreaks. If that was an issue, they would
45 see problems. When they have these sporadic cases, they find there has been contact with
46 livestock.
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48 Brenner asked whether E.coli can be on "pre- washed" produce. Stern stated the
49 contaminants can get into the leaf when the produce is cut, but water remains the best way
50 to clean vegetables.
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Board of Health, 5/5/2015, Page 2
1 4. CRIMINAL JUSTICE DIVERSION
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3 Ann Deacon, Health Department, referred to the article in the board packet about the
4 Sequential Intercepts model and submitted a handout (on Me) that shows programs and
5 their budgets. The information shows the different points at which the County deals with
6 people with mental health and how the County might intervene at each step. Intervening
7 as early as possible is best. She summarized the programs that are currently in place. The
8 Health Department has de- escalation and crisis hostage training programs for law
9 enforcement and first responders. There are various services for youthful offenders,
10 including behavioral health services. The triage facility offers a pre- arrest diversion, and
11 includes crisis stabilization, treatment, and follow -up.
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13 For people who the Health Department does not meet until they are in jail, they can
14 treat medical issues, but re -entry services are the target intervention. There is a dedicated
15 position to connect people from jail to services and follow -up care. This includes counseling,
16 medication, health benefits, housing, and transportation. An outpatient mental health
17 treatment program has been established via providers all over the county. The next level of
18 the intercept addresses how the courts intervene in the process. The Health Department
19 has a drug court and a mental health court that involves the judicial system in the intercept
20 process. There are probation officers in District Court that only work with those with mental
21 illness. Once people with mental health issues are in the community, there are intensive
22 case management programs and staff - supportive housing programs to follow up with them
23 and to help them remain stable. These programs have helped people finish school, get jobs,
24 and learn how to be good tenants.
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26 The County's Behavioral Health Fund provides $3.7 million per year, and the Health
27 Department makes use of several grants. They built a budget that spends about $4.2
28 million, and this should bring them back to being even.
29
30 Regarding the current triage facility. The short term goal is to utilize it completely.
31 For the long term they would like to establish an urgent care facility that would include the
32 purposes of mental health crisis stabilization and detox. The triage facility needs a back
33 door for these services. There are frequent waits to receive services. The Health
34 Department is networking with services in the community, but they still need more mental
35 health beds and a better "back door" patient system. Currently the pre- booking diversion
36 options are minimal, and that is where they need to do some work.
37
38 They are trying to work with Medicaid to change the Institutions for Medical Diseases
39 (IMD) rule that limits inpatient services to medical facilities that aren't institutions, which
40 aren't anything over 16 beds. There is a cost savings with a bigger facility. If they can't
41 change the rule, they will have to get creative in designing urgent care facilities, which
42 might include separate units: one for detox and one for mental health. They are working
43 with other community partners on that. Pre - booking diversion options are minimal. That's
44 where they need to do a lot of work.
45
46 Brenner asked about the possibility of building pods with 16 beds each. Deacon
47 stated they could not get Medicaid funding for that. That hasn't worked for other
48 communities who have tried it. There must be a distinct entrance and a distinct governance
49 structure. Washington state and other states are pushing back on the IMD rules and are
50 trying to work within the state to get more clarity.
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52 Brenner asked if there are enough doctors in the community who take Medicaid.
53 Deacon stated the demand for Medicaid services outweighs the supply.
Board of Health, 5/5/2015, Page 3
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2 Brenner asked if the County should do part of the program adequately instead of
3 doing all of it inadequately. Deacon stated they looked at what programs they could
4 implement adequately when they developed their budget. They had to fund the continuum,
5 so they decided to target the most vulnerable and ill and chose which programs they could
6 fund adequately for this population and with this particular program.
7
8 Weimer asked if the Health Department is tracking who in emergency medical
9 services (EMS) and law enforcement are being trained. Deacon stated the jurisdictions are
10 eager to have their officers trained, so they haven't needed to track it.
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12 Buchanan asked where Whatcom County is in terms of best practices and how they
13 measure their effectiveness. Deacon stated they use the substance abuse mental health
14 services administration registry of evidence -based practices whenever possible. Sometimes
15 there aren't evidence -based practices, but there are models and programs showing good
16 results. All contracts with the County have performance measures, but there is not a robust
17 program evaluation component.
18
19 Weimer stated each councilmember needs to give a statement on how ready they
20 are to decide on a resolution. It's important to focus on diversion. The money and follow -
21 through are not concrete enough to know that these things will be implemented. He can live
22 with the size of the jail. It's a little big, but he's ready to move forward and get people out
23 of the existing jail. Regarding the Task Force agreement, he is not yet satisfied with how to
24 deal with system issues such as bail and failure to appear.
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26 Buchanan stated the parallel track is good, but there are still unanswered questions.
27 Move forward with the new jail as soon as possible, but get answers to those questions that
28 have been asked.
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30 Mann stated he will not be ready to vote affirmatively on May 12. There is time to
31 get all the questions answered. The administration has been responsive, but pre- booking
32 diversion options are minimal right now. A lot of the money needs to be spent on pre -
33 booking options and on systemic review of the entire criminal justice system. It is too
34 expensive in ine iony ierrn io jusi L)uiid d My jdii.
35
36 Brenner referenced an email about a Canadian prison that is being built. The layout
37 was very similar to the one proposed in Whatcom county. The cost of the Canadian prison is
38 much higher than the County's proposal. She is pleased to know that if Whatcom County
39 doesn't use all the beds for jail purposes, the extra beds can be used for other social
40 services purposes, including stabilization. Make sure the robust diversion program will be up
41 and running at the same time the jail is up and running. Also, the Task Force needs the
42 perspective of those who are mentally ill and stabilized.
43
44 Kremen stated he doesn't think the Council is ready to make a decision on May 12,
45 but he is encouraged that the Council has been firm about bringing focus and attention on
46 diversion. He supports what has been presented from the administration, though it can still
47 be worked on and honed. Specifically, there still needs to be concrete options for criminal
48 justice diversion.
49
50 Sidhu stated the county needs a jail. Taking time is a good thing. The Council must
51 be more informed. The Council and cities approving the jail is just the beginning of the
52 process. Cutting off the discussion on May 12 would not be good for anyone. They need to
53 be clear to the public why the County has decided on a new jail project.
Board of Health, 5/5/2015, Page 4
1
2 The word "diversion" means many things to many people. They have to decide the
3 funding source for each diversion program, who will be responsible, and what is the
4 definition of a diversion program. Don't put the Sheriff on the spot in terms of who has
5 access to diversion programs. The Sheriff has a job to do, and pre- arrest and post -
6 incarceration have nothing to do with the Sheriff. Be specific on the programs and funds to
7 be used. Everyone supports a new jail. The number of beds is a minor issue, but how the
8 County spends taxpayer money is more important.
9
10 Browne stated this is a complex question. The single largest area of the budget is
11 law and justice. Therefore, by definition, it deserves a lot of time and thought as they go
12 through these discussions. He is torn through the whole spectrum of this. When he ran a
13 business of more than 300 people, one gets to go through a lot of experiences. One
14 touches many people's lives and is touched by many people's lives. One becomes a victim
15 of crime, by the nature of running a business that size. One watches employees become
16 victims of crime or make mistakes. One watches the children of employees make mistakes.
17 There is inequity in the entire process and at both ends of the spectrum. At times, he's
18 either felt that the punishment has been inadequate for the consequence or that the
19 punishment has been grossly excessive for the issue. He's lived in the same house, in the
20 same community, for over 20 years. He's watched the friends of his children grow from
21 infants to adults. Some of those kids have come from circumstances that have given them
22 less opportunity, single - parent families, and he's watched those kids make mistakes.
23 Sometimes those mistakes have a ripple effect, because there isn't diversion in the process.
24 When he was a kid, if someone threw a rock at a house, the owner talked to the kid and the
25 parents. Maybe local law enforcement would become involved, and there would be a stern
26 talking -to. That was it. Now when a kid throws a rock at a house, it becomes a criminal
27 case. A 12 -year old kid becomes a misdemeanant. Over a period of time, the record is
28 expunged, but the point is that it escalates to a degree that didn't exist when he was
29 growing up.
30
31 He likes the initiative in terms of the criminal justice diversion task force. A couple
32 of things needed to be added. First, funding is crucial. Look for grant funding for
33 alternative programs. There are a lot of initiatives that are getting a lot of traction from a
34 most unlikely group of people. Get both sides of the political spectrum in a room to come up
35 with different programs. He wants Whatcom County to aggressively go after that money.
36 He wants the County to be at the forefront of good science in terms of diversion, pre - trial,
37 and pre- arrest. This Task Force is being designed to have a limited life. He would like to
38 see it be permanent. He would like to see a permanent process in the community that has
39 high value, engages quality people with deep knowledge that is a permanent program that
40 tries to do better every year.
41
42 He would then like to see benchmarks against best practices. The National
43 Association of Counties is spending a tremendous amount of its focus on jail diversion and
44 criminal diversion programs. They should be aware of every one of those programs and
45 benchmarking themselves against best practices. It will be a struggle for him on May 12.
46 He absolutely supports the new jail.
47
48 Weimer stated put the resolutions in committee on May 12. Talk more about funding
49 and the scope of the Task Force in committee. Talk about the budget for ongoing diversion
50 operations. They must talk about the Task Force membership. The Task Force needs to be
51 permanent and use metrics and benchmarks.
52
Board of Health, 5/5/2015, Page 5
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Jack Louws, County Executive, stated it would be great if the four documents would
be ready to put before the Council, including: the resolution on the jail use agreement, the
actual jail use agreement, the resolution establishing the Task Force, and the resolution for
the ballot measure. The administration intends for the Task Force to be ongoing.
Give the Council the opportunity to provide specific language changes to get an
agreement. They must also engage the public to get the public's support. The cities of
Ferndale and Bellingham want to hear the County Council's direction before they give their
approval.
Mann asked about what the resolutions bind the Council to in terms of the jail's
design. Louws stated the jail use agreement is specific to the number of beds, which is 521.
The whole facility can handle a mixture of people who may or may not have mental illness.
There can be segregation within the jail structure for different purposes.
Brenner stated the resolution should indicate that the County and citizens will clean
up the criminal code to keep misdemeanants out of jail in some situations. Louws stated
city representatives will be on the Task Force and have that discussion. It will be a policy
decision of the individual cities.
Sidhu asked if there is flexibility in the process and jail use agreement. The jail is a
subset of everything they are trying to achieve with this money. Louws stated there would
be some flexibility within the Task Force. There is little flexibility in the jail use agreement
because they would otherwise have to get every elected official in the county in one room to
negotiate.
Sidhu stated he is concerned about the jail operating costs. That is where flexibility
ended.
Browne asked if the County gets stuck if the use of the beds gets reduced because
they are successful with the jail diversion programs, demand on the jail is reduced, and the
per diem rate doesn't change. Make sure the County doesn't find itself in a position of not
having operating funds because it doesn't have per diem revenue. Louws stated
aNNruxiiiia%eiy 2u NercenL ui Lhe jdii 15 useu Uy 11115U21nedndnL5. Ii Lice diversion programs
are 50 percent successful, then 10 percent of the jail is used by misdemeanants. The
County would absorb ten percent more of the operating cost moving forward. In 2019, they
anticipate that the cities will pay about $2.45 million for their charges. Success of the
programs mean they will postpone the need to expand the facility, which will be much more
expensive than the increased operating costs due to successful diversion programs. If the
County only keeps felons in the jail, the County could lose money.
Weimer stated the Council maybe needs a Committee of the Whole meeting to
continue discussions. In the meantime send questions to the administration.
David McEachran, Whatcom County Prosecuting Attorney,
file) and stated there is a Law and Justice Council already set
includes the cities, treatment officials, and law enforcement. It
then lost funding. This committee addressed diversion programs.
force. Revive the one that exists. It is supposed to be permanent.
Board of Health, 5/5/2015, Page 6
submitted a handout (on
up by State statute that
was vibrant for years and
Don't create another task
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ADJOURN
The meeting adjourned at 12:15 p.m.
The Council approved these minutes on October 27, 2015.
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Kristi Felbinger, Minutes Tralhscription
WHATCOM COUNTY COUNCIL
WHATCOM COUNTY, WASHINGTON
Carl Weimer, Council Chair
Board of Health, 5/5/2015, Page 7