HomeMy WebLinkAboutBoard of Health December 2 20031 WHATCOM COUNTY COUNCIL
2 Board of Health
3
4 December 2, 2003
5
6 The meeting was called to order at 10:35 a.m. by Council Chair Dan
7 McShane in the Council Chambers, 311 Grand Avenue, Bellingham, Washington.
8
9
10 Present: Absent:
11 Barbara Brenner None
12 Laurie Caskey-Schreiber
13 Sam Crawford
14 Seth Fleetwood
15 Sharon Roy
16 L. Ward Nelson
17
18 1. PUBLIC SESSION
19
20 No one spoke.
21
22 2. WHATCOM ALLIANCE FOR HEALTH CARE ACCESS
23
24 Regina Delahunt, Health and Human Services Director, introduced the
25 presenters.
26
27 Chuck Beard, St. Luke's Foundation, submitted his presentation (on file).
28 They have been working on the issue of health care access in Whatcom County. He
29 read from his presentation. Two years ago, St. Luke's Foundation was asked to
30 provide grant funding to pay for physician tuition expenses, to entice a physician to
31 Bellingham. They felt they couldn't do it. Instead, the request prompted the
32 foundation to look at the issue of access in Whatcom County. The current steering
33 committee is diverse, including health care professionals, elected officials, and
34 consumers. Currently, the hospital, Madrona Medical, and individual offices are
35 doing recruiting. They are trying to get everyone on the same page to draw
36 providers into the community. Senator Murray has attended meetings. They will
37 meet soon with state and local officials.
38
39 Brenner asked if the percentages of poor and elderly in Whatcom County is
40 based on the average or the other areas in the state.
41
42 Sue Sharpe, Health Care Consultant, stated it is the average.
43
44 Roy asked if they have a way to measure their success on the goals. Sharpe
45 stated she would get to that.
46
47 Roy asked the impact of the new federal legislation. Sharpe stated they
48 don't know yet.
Board of Health, 12/2/2003, Page 1
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2 Brenner asked if they would discuss why Seattle can provide care when
3 Whatcom County can't. Sharpe stated she would.
4
5 Brenner asked why Washington and Whatcom County receive some of the
6 lowest Medicare reimbursement rates in the country. Sharpe stated that when
7 Medicare rates were set a long time ago, they were based on regional differences in
8 cost of living and other factors. That benchmark has not been changed. The Pacific
9 Northwest has a highly efficient health care system. Over time, physicians here do
10 not receive the same reimbursement rates as someone in the state of Florida. It's
11 a huge issue with physicians. The methodology was applied in the late 1960's. A
12 challenge for Washington State is the reluctance to put more money into the
13 Medicare system and to redistribute disbursements to put more money toward less
14 politically powerful states.
15
16 Sharpe continued to read the presentation (on file). Some of their greatest
17 opportunities to take care of issues can be done locally. The health care provider
18 supply survey produces the data that determines the support the providers get at
19 the state or federal level. Those surveys have been done under the radar screen in
20 the past. They asked them to come back and do the survey again with more detail.
21 That information is important when dealing with elected officials, and also provides
22 insight into the finer issues of access in the community. One area of concern is
23 access to health care for small businesses. The new small business roundtable is
24 beginning to talk about health care access for small businesses.
25
26 Now, every physician who needs specialty care for Medicaid patients is on the
27 phone begging specialists for service. They will try to develop a more coordinated
28 system. There might be opportunities for local funding for better health care
29 access. The St. Luke's Foundation has supported this effort generously. At some
30 point, the foundation will want to see how much the community wants to support
31 over time.
32
33 Brenner asked how Seattle is able to provide service. Sharpe stated most of
34 Medicaid is contracted to private managed care companies who are responsible for
35 creating a network of providers. Most of those managed care companies don't have
36 contracts with specialists in Whatcom County. The specialists will say the rates
37 offered by the managed care companies don't cover their cost because it comes
38 with a lot of administrative bureaucracy. They want to focus on a way to create a
39 specialist referral system and to work with the state to not contract with third party
40 payers who don't have a network of local providers.
41
42 McShane stated it sounds like the amount of paperwork is a problem because
43 it drives up costs. Sharpe stated it is.
44
45 Nelson stated that for the first time, they have a Whatcom County senator
46 who is serving on health care committees at the State level. He's positive that the
47 work going on will produce results. The DOH access study is a very important
48 needed tool. A problem in Whatcom County over other communities is that rural
Board of Health, 12/2/2003, Page 2
I communities have a different look than Whatcom County. They use different tools.
2 They have access to federal dollars that Whatcom County doesn't. They also look
3 at different criteria for low-income residents.
4
5 Roy asked what a new Medicare patient does for service. They have to plan
6 for a population explosion. A lot of those people will be older. Sharpe stated right
7 now they can go to a couple of different clinics or a hospital senior health center,
8 but they have a limited capacity.
9
10 Roy asked if there are private physicians who take the patient, and don't
11 charge. Sharpe stated there are, but there are issues with fraud and abuse.
12
13 Roy asked if they are looking at ways that local government can help attract
14 physicians to the area. Sharpe stated they are.
15
16 Caskey-Schreiber asked if any state or county has been successful in getting
17 its reimbursement rates increased. Sharpe stated not specifically. There are good
18 models of communities that have been successful in reorganizing the way they
19 provide care in the community, through a combination of how they work together
20 and receiving additional resources to support that community plan. The actual
21 reimbursement rate is the most difficult thing to do.
22
23
24 Roy asked if legislators at the national level are aware of the issues.
25
26 Nelson stated they are.
27
28 Brenner stated fair is fair. It sounds like this will end up in court for
29 discrimination. If they can't get a political solution, get a legal solution from the
30 attorney general. Sharpe stated that's been discussed. In the meantime, they still
31 have to figure out how to help patients.
32
33 Nelson thanked everyone who has worked on this issue. This is a positive
34 approach for solving health care issues.
35
36 3. PUBLIC HEALTH ADVISORY BOARD MEMBERSHIP
37
38 Regina Delahunt, Health and Human Services Director, stated that in January
39 2004, there will be four expiring terms on Public Health Advisory Board. The tribal
40 position is also vacant. They have had difficulty recruiting for the tribal position
41 because there aren't very many tribal folks who can come to these meetings. They
42 have also had difficulty recruiting for the natural science for higher education
43 position on the board. The staff's recommendation for amendments would require
44 an ordinance change.
45
46 Nelson stated many people are concerned with child healthcare and early
47 intervention for dental health care and access. People in the education system
48 provide a lot of insight into those issues. They could tap into those sources.
Board of Health, 12/2/2003, Page 3
2 Brenner stated she would like there to be members that could include
3 consumers, senior service providers, children services providers, in -home health
4 care providers, and senior services providers.
5
6 McShane moved to ask staff to prepare an ordinance to amend Whatcom
7 County Code (WCC) 24.01.050.
8
9 Brenner stated she wants to make sure they have an active board that is
10 populated with people who are interested. Someone with a natural sciences
11 background isn't any more important than people she suggested.
12
13 (Clerk's Note: End of tape one, side A.)
14
15 Brenner stated people who have been through the health care system and
16 have had problems may be interested in bringing issues forward.
17
18 Nelson stated he agreed with the problems. A problem with including
19 consumers is that they are very good at identifying problems, but they don't have
20 the background to know the specifics needed to solve the problem. Senior service
21 representatives already work with the Northwest Regional Council.
22
23 Delahunt stated the Public Health Advisory Board gathers a group of
24 community stakeholders for various issues, including consumers and others, for
25 discussion of a particular topic. Broadening this board might not be the best
26 approach, given all the stakeholder groups they already have.
27
28 Roy stated the board is supposed to represent the demographic character of
29 the community. Consumers are included in the paragraph describing the board.
30 Advisory boards need someone to identify the problems, even if they don't have the
31 skills to solve the problem. An advisory board needs to know where the problems
32 are. She asked for a definition of "minority," and if women are included in that
33 definition. Delahunt stated they would use a federal definition of ethnic minority.
34
35 Nelson stated he cautioned against including consumers. There are many
36 consumer concerns regarding Health Department issues, covering a broad range of
37 topics. It's better to bring in stakeholders and interested people when dealing with
38 specific issues. Including a position only defined as a consumer may attract a
39 person with only one interest or issue, and who would lose interest on other issues.
40
41 Fleetwood stated item seven could include a consumer representative.
42
43 Brenner moved to amend 24.01.050(2), "one fflembeF F.. the nat;,l
44 seienees-citizen at large member, with preference being given to an individual with
45 a background in natural sciences."
46
47 Nelson stated they need someone with a natural sciences background.
48
Board of Health, 12/2/2003, Page 4
1 Brenner stated that if there isn't someone to fill a vacant position with a
2 natural sciences background, they should get someone to fill it. If people have an
3 interest and put in the time, it should be fine. Activists in the community who have
4 committed to caring about these issues have something to add.
5
6 Roy stated she would rather save that position and add a section (8). Keep
7 the natural science position, and actively recruit someone.
8
9 Brenner withdrew her amendment.
10
it Brenner moved to amend WCC 24.01.050 "(8) Citizen at large."
12
13 Caskey-Schreiber suggested a friendly amendment to also amend WCC
14 24.01.050(7), "ThFee Two members from...."
15
16 Brenner accepted the friendly amendment in addition to her amendment.
17
18 Nelson stated that would be fine.
19
20 Delahunt stated that would help with recruiting. She likes the motion.
21
22 Motion carried 6-1 with McShane opposed.
23
24 Motion to request staff to prepare an ordinance as recommended and
25 amended carried unanimously.
26
27 4. SOLID WASTE REGULATIONS REVISION
28
29 Don Vesper, Environmental Health Manager, stated this year, the State
30 Department of Ecology (DOE) made new rules for handling solid waste in
31 Washington State. Those new rules became effective February 2003. They are
32 required to adopt those rules locally. The new rules will replace the old rules, which
33 are almost 20 years old. The new rules identify performance requirements and
34 permitting for composting facilities. Additionally, the guidelines for moderate risk
35 waste facilities are now codified and part of the rulemaking. There are also
36 compost quality regulations in the new rules, which were previously in the
37 guidelines. These rules also speak specifically to mushroom substrate production.
38 Not included in the State's solid waste rules was regulations regarding medical
39 waste. The Health Department is not asking to change any of those rules in
40 Whatcom County. There are current rules in Whatcom County for medical waste.
41 Transport and storage of waste tires is also included.
42
43 Staff is asking the Council to allow staff to put the changes into ordinance
44 form. Also, the Health Department proposes a repeal of the demolition and inert
45 waste landfill regulations in WCC 24.08. This is now covered under the State rule,
46 and is more stringent than Whatcom County rules. They don't need the local code
47 any longer. Additional work will be necessary to reconcile WCC 24.09 with the
Board of Health, 12/2/2003, Page 5
1 regulations in WAC 173-350. They will need to bring stakeholders in to determine
2 what is and is not more stringent.
3
4 Brenner stated the new beneficial use section will not lessen existing solid
5 waste composting rules. She asked for an explanation of section (iii) on packet
6 page 27.
7
8 McShane stated there have been wastes that are otherwise hazardous that
9 have been incorporated into a product. Fertilizer is a good example.
10
11 Brenner asked if this will get rid of the ability to put hazardous waste in
12 fertilizers.
13
14 McShane stated that's what they're after.
15
16 Kyle Dodd, Environmental Health Specialist, stated the intent is to not add a
17 product to lower the part per million factor.
18
19 Brenner asked if a person will no longer be able to dump hazardous waste in
20 a fertilizer and call it a beneficial use. Dodd stated that is correct, it isn't regulated
21 under solid waste rules. These beneficial uses are determined by DOE. A person is
22 required to show that the person is not disposing of a waste. There has to be a
23 beneficial use.
24
25 Brenner referenced packet page 29, section (c) regarding additional
26 requirements. She asked if the County or the State will make the determinations.
27 Dodd stated the State will issue determination. The County will have an
28 opportunity to add additional requirements.
29
30 Brenner referenced packet page 30, section (ii) and throughout, about the
31 process. There's no language that offers other interested parties an opportunity or
32 timeline for comment.
33
34 Nelson asked the requirements for the public review process. Vesper stated
35 it's not an issue they anticipated would come up often. The County Health
36 Department could engage the public for comments.
37
38 Brenner asked if they can add an opportunity for anyone other than
39 jurisdictional health departments to comment. Delahunt stated she would find out
40 if there is a public process. It may be an administrative determination.
41
42 Brenner referenced packet page 32, section (ii) at the top of the page. She
43 asked what, besides land applications, would be beneficial uses for solid waste.
44 Dodd stated there may be a solid waste that could be used in a manufacturing
45 process or for an engineering purpose. It's not limited to land application of a solid
46 waste.
47
Board of Health, 12/2/2003, Page 6
1 Nelson referenced packet page 31, section (f). He asked if the County will be
2 responsible for complaints about permits under DOE's approval if there are
3 complaints filed. DOE's putting rules together, but the County is responsible for
4 enforcement. Delahunt stated that's correct. The County gets enforcement dollars
5 from the State, plus local fees for permitted facilities.
6
7 Nelson asked if the DOE or Health Department makes decisions on appeals.
8 Delahunt stated it depends on what the complaint is about. There is a local process
9 for an administrative decision. A permit decision is heard locally, then goes to the
10 State Pollution Control Hearings Board. It depends on the issue.
11
12 Delahunt stated the public process for beneficial use is on packet page 30 at
13 the bottom of page in section (iii).
14
15 McShane stated a public process could also be found in section (j) on packet
16 page 30. This section implies a State Environmental Protection Act (SEPA)
17 determination, which can be appealed and is subject to a public hearing.
18
19 Fleetwood referenced packet page 24, the solid waste definition. He asked
20 what would be considered non-putrescible material. Vesper stated putrescible
21 material is garbage. Non-putrescible material is non -rotting material that is trash.
22
23 Caskey-Schreiber asked how the green onions could be a pathogen for
24 hepatitis. Vesper stated they don't know. It's possible that was from the fertilizer
25 on the fields.
26
27 Delahunt stated the green onions were from Mexico, where they don't treat
28 sewage sludge like they do in the United States.
29
30 Nelson referenced the top of packet page 60, section (i). He asked if that's
31 what they currently do. Dodd stated there are no piles under permit currently.
32 Under the old rules, there was a timeframe. He's not sure about the timeframe
33 without having the old rules at hand. The timeframes of the new rules and old
34 rules are close.
35
36 McShane moved to ask staff to prepare a draft ordinance as recommended
37 to amend WCC 24.06 and to repeal WCC 24.08.
38
39 Motion carried unanimously.
40
41 McShane moved to ask staff to propose language and definitions that would
42 reconcile WCC 24.09 with WAC 173-350.
43
44 Motion carried unanimously.
45
46
47 ADJOURN
48
Board of Health, 12/2/2003, Page 7
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The meeting adjourned at 11:57 a.m.
Jill Nixon, Minutes Transcription
These minutes were approved by Council on January 13 , 2004.
ATTEST:
u
Dana Brown -Davis, Counci lerk
WHATCOM COUNTY COUNCIL
WHATCOM COUNTY, WASHINGTON
Dan McShane, Council Chair
Board of Health, 12/2/2003, Page 8