HomeMy WebLinkAbout1997/01/02 - Board of HealthMASON COUNTY BOARD OF HEALTH
January 2, 1997
The Board of Health was called to order at 10:00 a.m. by Board Member Mary Jo Cady with
Board Members Bolender and Olsen in attendance.
ATTENDANCE:
Mary Jo Cady, Board Member
John Bolender, Board Member
Cindy Olsen, Board Member
Brad Banner, Director of Health Services
Steve Kutz, Personal Health Director
Dr. Mark E. Trucksess, Health Officer
Mark Tompkins, Environmental Health Program Manager
Brent Long, Board of Health Clerk
Sean Hanlon, Shelton -Mason County Journal
ELECTION OF CHAIRPERSON'- 1997
Board Members Olsen/Bolender moved/seconded that Board Member Cady be elected as
the Board of Health Chair for 1997. Motion carried unanimously.
APPROVAL OF MINUTES
Board Members Olsen/Bolender moved/seconded that minutes from the November 19th,
1996 appeal hearing and the December 5th, 1996 regular meeting be submitted to former
Board Members Faughender and Hunter for their review and acceptance. Motion carried
unanimously.
HEALTH OFFICER CONTRACT - 1997
Health Services Director, Brad Banner, reported that Dr. Mark E. Trucksess provides the services
of the Mason County Health Officer pursuant to a yearly contractual employment agreement.
He presented the 1997 agreement which is identical to the 1996 agreement except that it reflects
a 3% budgeted salary increase. The agreement has been submitted to the Prosecutor's Office for
signature, but has not been returned. Board Member Bolender asked if the 3% salary increase
was consistent with other personnel agreements. Mr. Banner replied that all the non -union salary
increases were 3%. Board Members Bolender/Olsen moved/seconded that the Board of
Health approve the 1997 contract with the Health Officer subject to approval of the
contract by the Prosecuting Attorney. Motion carried unanimously. (Exhibit A)
HEALTH OFFICER'S REPORT
Dr. Mark E. Trucksess, Health Officer, reported that at the turn of the century, public health
services became to be. It evolved to address major issues of the time such as clean water and
sewage disposal, solid waste disposal, and communicable disease control. As a result of great
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January 2, 1997 - Page 2 of 10
success, over the next several decades, management of major communicable disease problems
were controlled and/or eradicated. Diseases such as small pox, polio, rabies, cholera, diphtheria,
tuberculosis, pertussis, syphilis, and. measles essentially disappeared by the early 1980s. Health
Departments had started to shift their focus to being a provider of last resort for people without
health insurance. Physicals, pap smears, treatment of acute illnesses, ear washes, foot care, and
well -child care began to dominate the business of public health. Prevention had become
secondary, and a resurgence began to be seen in things like tuberculosis, measles and pertussis,
and AIDS appeared. New frightening diseases have evolved such as the Hanta and Ebola
Viruses. Hepatitis B and C were becoming much more prevalent. Nationally, there was a
growing sense of public health, as a profession, losing its identity. It was not clearly defined or
understood. The basic tenants of public health had been forgotten.
In the mid 1980s the Institute of Medicine undertook a nation-wide survey of all health officers
and educators in public health trying to determine what public health was and what it should be.
The results of this survey were published in a book entitled The Future of Public Health in 1988.
By acclamation it was decreed that the primary thrust of public health was to fulfill society's
interest in assuring that the conditions in which people can be healthy exist, and the primary
emphasis of public health ought to be prevention, and not treatment. Three core functions of
public health were identified: 1) assessment; 2) policy development and 3) assurance.
Assessment is the analysis to gain understanding of the nature and extent of the community's
health needs. Policy development is making comprehensive and correct rules and regulations
with an appreciation of the democratic process. Assurance is to assure that the needed health
services to achieve agreed -upon goals are provided, not just by the Health Department but in
collaboration with other entities, both governmental and private by requiring action through
regulation.
The Washington State Legislature responded to this mandate of the future of public health by
enacting the Public Health Improvement Plan (PHIP) which the Health Departments have had to
live by and also by enacting the Basic Health Plan so that all people will be insured so the
Health Departments do not have to be the provider of last resort. The blueprint of PHIP is
primarily to improve the health status of the residents of Washington by improving the capacity
of the Health Departments to provide services for prevention and protection. The PHIP has
addressed 88 capacity standards that are to be met at both the state and local levels. For the
Mason County Health Department, or the Mason County Department of Health Services, this
legislation has required a transformation from the position of many direct services.to a position
of providing prevention through assessment, policy development and assurance and reducing the
threats of susceptibility and exposure and in enhancing educational services, protection of the
environment, and other health hazards.
Because of these mandated changes in public health, Mason County's department has been
involved in the process of strategic planning over the past couple of years. The Mission
Statement and Guiding Principals have been revised. He presented copies of each for the Board.
(Exhibit B). The Department's attentions are to be directed towards education, regulation,
preventative services, protection from environmental hazards, outbreak investigations, infectious
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January 2, 1997 - Page 3 of 10
disease surveillance, clean water, sewage treatment, control of toxic waste, inspection of
restaurants and food services, and many other similar activities. The future of our public health
department involves a current and continuing assessment project which the Board will be briefed
on later. It involves striving to comply with the PHIP, developing long-range and short-range
goals and objectives, and developing collaborative arrangements with other community providers
to address the true causes of disease, tobacco use, alcohol and illicit drug use, diet, lack of
physical exercise, microbial agents, toxic agents, un-safe sexual practices, motor vehicle crashes,
violence and abuse.
The Health Officer receives legal definitions in RCW 70, the Public Health and Safety Statute.
Title 70.05.050 through .053 provides that the Local health officer should be an experienced
physician, and if he/she does not have a Masters in Public Health, which Dr. Trucksess does not,
then he should take courses to orient himself to public health which Dr. Trucksess has. The
Health Officer is initially considered a provisional health officer, but after three years on the job,
he is considered to be fully qualified. Dr. Trucksess noted that he completed three years as of
July, 1996. There are a number of powers which the Health Officer has. He needs to enforce
state and local laws and regulations, take action to maintain the health and sanitation of the
community, and control the spread of communicable disease. He is to inform the public as to
the cause and nature and prevention of disease and disability. He needs to prevent, control, and
abate nuisances which are determined to be detrimental to public health, and he is charged with
the responsibility to maintain competence and attend conferences in continuing education. In the
larger health departments and districts, where the Health Officer is a full-time employee of county
government, he serves as the administrator of the health department and as the secretary to the
Board of Health. In small districts, such as Mason County's, the Health Officer is usually part-
time, acts as a consultant to the administration and as advisor to the Board of Health. Title
70.24.24 delineates the powers of the Health Officer in regards to detainment of individuals
whose illnesses or behaviors pose a threat to others. He can order persons to be brought in for
treatment, testing, and for detention. Primarily, these powers exist in regards to AIDs and STDs
and tuberculosis. Presently, in addition to the aforementioned duties, Dr. Trucksess reviews
variances and appeals for on -site sewage systems and for wells and water systems. He also acts
as the first -level hearing officer for solid waste appeals and for other appeals such as wells and
septic systems. He has directed the development of a system of notifying all private providers
of health alerts and the communicable newsletter, which he presented to the Board. He noted
that the Board of Health should be receiving copies of all such communications. He has also
been granted a spot on the agenda of the monthly medical staff meetings at the hospital.
Steve Kutz, Director of Personal Health, reported that due to the ongoing Hepatitis A outbreak
in Mason County for most of the past year, there were about 500% more cases of the disease
than normal. Dr. Trucksess made recommendations a month ago recommending that children in
child-care and in kindergarten, and food service workers, consider getting the Hepatitis A vaccine.
Since Mason County is in an outbreak situation, the State Department of Health was consulted
to see if the department could use the free state -supplied vaccine to vaccinate kids. The
department has been notified that the Department of Health approved the request, and the
department is in the process of establishing the ground rules. It appears there will be a window
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January 2, 1997 - Page 4 of 10
of opportunity to get some of the kids vaccinated free.
Chairperson Cady asked for an update on the flu epidemic. Dr. Trucksess replied that there is
a lot of absenteeism in the schools. Many people are sick with the influenza, and perhaps
another virus.
A fifteen minute public health video was shown.
Board Member Olsen asked if the Mason County Department of Health coordinates with any of
the local fire districts and their EMS personnel regarding vaccinations they can receive through
the Health Department. Mr. Kutz replied that the department did coordinate the Hepatitis B
Vaccinations with the fire districts.
DEPARTMENTAL MISSION
Mr. Banner informed that the department's mission statement development began in 1994 when
Dr. Trucksess, Mark Tompkins, Steve Kutz, and he met intermittently during that year with Bob
Apple as the facilitator. Initially, they were far apart on what the wording should be, but by the
time it was done, the group was in agreement with almost every word in the document. When
they reached that point, in early 1996, staff meetings were held and amendments made according
to suggestions by staff members. At that point, the document was presented to the Board of
Health on April 4, 1996, at which time it was approved. Defining the department's mission and
guiding principals is actually the first phase of the project. Now, they want to use the document
for the basis of developing goals and objectives.
STRATEGIC HEALTH PLANNING
Mr. Banner stated that, in the past, in order to improve coordination and communication, the
Health Planning Council was created to work on future planning for policy proposals. In the
recent past, Dr. Trucksess and Mr. Kutz have reactivated the council with the help of a facilitator.
This will be an inter -agency, inter -departmental group with representation from private physicians
and hospital staff. They are considering bringing environmental health representatives into this
group, which has been proven to be successful in other places. Chairperson Cady asked that
proposals be submitted to the Board two weeks prior to the item being placed on the agenda in
order to give the Board sufficient time for review.
COMMUNITY ASSESSMENT PROCESS
Mr. Kutz commented that assessment is one of the four corner stones of the PHIP, and a
community assessment document is required to be published or ready for publishing by the end
of June, 1997. One of the things, completed in early 1996, was to access state dollars to help
fund the community assessment project. At that time, Mason County joined a five -county
partnership with Grays Harbor, Pacific, Lewis, and Wahkiakum Counties. The consortium
received $109,000. Lewis County is the fiscal agent for the assessment, and Mr. Kutz is the
chair of the partnership. Monthly meetings are held in Centralia. A facilitator has been hired,
and the partnership is in the process of selecting technical writers.
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January 2, 1997 - Page 5 of 10
Another partnership has been formed with 22 other health departments in counties throughout the
state. This is a VISTA partnership. VISTA is a community assessment software package that
allows community assessment to be done locally by utilizing the state data base on this subject.
It includes demographic, communicable disease, and birth and death data. The software is
currently on one Mason County laptop computer, but the department is requesting that it be
placed on the network. The Mason County Health Planning Council has agreed to look at the
assessment, when it is completed, in an attempt to prioritize issues. This will be one of the
council's primary duties in 1997.
Dr. Trucksess noted that several successful community assessments have been completed in other
health districts. Copies of those will be presented to the Board. Chairperson Cady asked if other
grant funding would be available once the community assessment document is published. She
wondered what the long-term benefit of this document would be. Mr. Kutz answered that the
benefit will be to provide information to the public and various community providers to help
focus energy on priority health issues that have been identified. It is very advantageous to have
documentation and data supporting grant requests available. This would help, not only the Health
Department, but also community -wide projects. Chairperson Cady wondered if all the counties
in the consortium were at the same level of completion. Mr. Kutz answered that Pacific County
already had their data collected, and just need assistance in putting it together. The group wants
to create a regional 5-county partnership report to identify issues at the forefront of rural counties
in our region, and to also compile a county -specific report in each of the five counties. Thurston
County completed their plan a year ago and it took 3 or 4 staff full-time between 4 and 5 months
to complete the document internally. One of the difficulties is that the same amount of items
need to be addressed regardless of the size of county.
ON -SITE OPERATION & MAINTENANCE PROGRAM IMPLEMENTATION
Environmental Health Program Manager, Mark Tompkins, stated he would be addressing the
single most important program that needs to be developed in Environmental Health in 1997 --
the On -Site Sewage Operation and Maintenance Program as adopted by Mason County Board of
Health on June 6, 1996. Copies of the 0 & M Program were presented as Exhibit C. A few
years ago it was learned that it was vitally important to maintain the sewage systems being
installed. And, most particularly, the complex systems that involve pumps, control panels, and
timers. Installers were experiencing call backs from their customers due to such things as alarms
going off or because panels were blinking.
The On -Site Sewage Advisory Committee formed a subcommittee which has met monthly or bi-
monthly to develop a program that not only benefits the on -site sewage system but which was
also user-friendly to the public. It essentially provided phasing in of the program over time so
the department did not get swamped. This is the first year of the phasing. On December 5,
1996, the On -Site Sewage Regulation was revised and adopted which put the legal framework
to certify people to perform the maintenance, enforcement, and follow-up which was necessary
to the 0 & M Program. Copies of this regulation were presented (Exhibit D). Chairperson Cady
noted that the 0 & M Program implementation was a condition of the consent order which had
been signed with the Department of Ecology.
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Mr. Tompkins reported that part of what has been learned during the survey program in Totten,
Little Skookum and Hood Canal was that systems fail for a variety of reasons. Even the newer
systems that are installed have problems. As mentioned, pumps can burn out, systems can
become inundated with ground water that was not seen during installation, or if a control panel
is set wrong it can overdose a system. All of these things we learned during the surveys, the
installers have seen for many years. With the adoption of the two regulations, and the work done
by professionals, and with the consent order, Mason County is in the process of implementing
the program. Right now, one half-time person is funded to oversee the implementation of this
program. The department is in the last stages of completing a data base which is linked with the
Assessor's data base which will provide updated addressing and site addressing so property
owners can be notified. A memo dated December 31, 1996, from Wayne Clifford to Computech,
Inc., was presented as Exhibit E. Computech is the company who is putting the linked program
together. This will enable the department to maintain a current data base, generate reports to see
how effective the program is, and perform general monitoring of the program. The first step in
implementing the program involves all new permits which utilize aerobic treatment devices or
a system which was under a Table 6 Repair, food service establishments and permits previously
approved where 0 & M was required as a condition for approval, and systems located within
critical aquifer recharge areas and marine shorelines of Oakland Bay, Skokomish, and West Hood
Canal Watersheds. A lot of these systems are older. These residents will be sent postcards
asking them to answer certain questions pertaining to the distance of their system from the
shoreline. If the system is not within 200 feet of the shoreline, then they will not be part of the
program; the 0 & M will be voluntary, not mandatory. They will also be asked what kind of
system they have.
Residents will then be sent notification informing them of the program, what the purpose is, and
what the inspection schedule will be. Chairperson Cady asked if the 0 & M would be mandatory
if a property owner's system was out of the 200 feet distance from the shoreline but was a sand
filter system. Mr. Tompkins replied that if it was an existing permit, they would not be part of
the first phase. Next year, the first phase will be evaluated to see how well it was working,
before going on to the second phase. Board Member Bolender asked if part of the process was
to identify the type of system being utilized. He wondered why they would not have this
information from the permit when the system was installed. Mr. Tompkins answered that
records are available on some of the systems, but it would be a very intensive program to try to
pull all those records. It would be a great time savings if the property owners would respond and
save the department research time. Board Member Olsen wondered if a lot of this research had
already been done by the Clean Water District testing. Mr. Tompkins responded that it has been
done on certain watersheds, but Oakland Bay has never been surveyed. Chairperson Cady noted
that the watersheds which have gone through the Clean Water District process will be last on the
list because they have recently been tested. She noted also that individual files are kept on each
system. However, they have never been computerized.
CHALLENGES FOR 1997- DATA MANAGEMENT
Mr. Banner remarked that data management will be a challenge in 1997. The INPHO system
which is an optical link with the State Department of Health and the VISTA Program which
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January 2, 1997 - Page 7 of 10
provides health statistics from birth and death certificates will be available for the first time.
There is a statistical program for analyzing the data called SPSS, however, it is not very user-
friendly. Seattle King -County Health Department received funding to write the VISTA Program.
VISTA is the shell for using SPSS. VISTA will put information at their finger tips which was
unheard of a year ago. VISTA will be easy to pull information from and print on a spreadsheet.
Mr. Kutz informed that people have their children immunized at multiple locations because health
plans or providers are changed. Records are not centrally located, so it is difficult for a new
provider to know exactly what the child's immunization status is when the parents are unsure.
Child Profile is a project that was started approximately four years ago which enacted a
centralized data base that keys off birth certificates. Right now, 33% of King and Snohomish
County are using Child Profile. Island and Kittitas Counties were brought into the program in
early 1996.
One community partnering aspect being done in Mason County is with the Thurston/Mason
Immunization Coalition in working to get Child Profile available in Thurston and Mason
Counties. Child Profile is becoming a public/private partnership. The private sector will provide
capital to expand the program state-wide. Fees and costs will be involved. Meetings with
managed health plans, who are the major players in this region, have taken place to see where
they fall in the funding process. As a health plan, they are responsible to see that the members
of their health plan are immunized. It is proposed that Thurston and Mason Counties will spend
upwards of $35,000 from grant monies to go into each provider's office and enter the
immunization files into Child Profile so that within 3 to 4 months, the data base will be
populated for Thurston and Mason Counties. If this is successful, they will be farther ahead than
anyone else in the state. Negotiations are being held on who will pay for the maintenance of the
data base. Right now, it is hoped that the 10 managed care plans will pay for the first year's
maintenance. The providers will give free use of the data base for one year because they will
benefit from that. Within a year, the private company will go to a transaction based model.
Each of the doctor's offices and health departments will be hooked to Child Profile via a modem.
A provider will be paid, probably a few cents, to enter data when immunizations are given and
when information is retrieved a cost will be attached. If a parent needs their child's immunization
history, the provider can enter Child Profile and retrieve the record, and the parent will pay for
the service.
Board Member Bolender asked if there was any indication as to the cost of retrieving the history
information. Mr. Kutz replied that transaction costs were still being negotiated. Right now, if
a health plan were to pay the total fee per child, it would be about $3.50 per child per year to
be on Child Profile. As kids get older and there is less transactions, the fee could drop. This
fee also includes the maintenance cost. Perhaps 10 or 15 cents per transaction would be charged,
because there will be many transactions.
Chairperson Cady asked how confidentiality of medical records relates to having this information
put into a data base. It sounds like this would not be optional. Mr. Kutz replied that the only
information being entered would be immunization records. However, some of these issues have
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January 2, 1997 - Page 8 of 10
been addressed by the legislature. A privacy agreement would be signed by each agency stating
that information on their clients only would be retrieved. Queries can be tracked to see which
files are being pulled by each agency. Chairperson Cady wondered if this has been a issue, and
asked why government was involved in this project which is seen as a parental responsibility.
Parents are aware that children are required to receive immunizations before they enter school.
Dr. Trucksess responded that one driving force behind Child Profile is managed care. Because
of managed care, all of the providers have to adhere to the National Quality Assurance. They
are being evaluated based on how up-to-date their patient's immunizations are. Providers,
likewise, are being evaluated by the plans based on how well the immunizations have been kept
up-to-date, along with many other things. It is disconcerting, but adhering to the standards is
mandatory. One driving force is that it means that communities will be healthier if all the kids
are immunized. Another is the year 2000 goal of • getting 90% of the children appropriately
immunized by the age of 2. This will provide assessment availability. Chairperson Cady noted
that people move from state to state. Dr. Trucksess responded that it was planned to be state-
wide and hoped to be a nationalized program eventually. Mr. Kutz stated that it was being
changed from a public -driven, paid -for system to a private system that plans to go nationwide.
Most everyone receives notices when dentist appointments are needed or when animal checkups
are due from the veterinary, however most practices do not computerize their patient's
immunization records. There just has not been the capability to generate reminder notices for
their practices. This will allow this process, and it will allow the state to access what the
immunization levels are in counties. Chairperson Cady asked what other information was on the
database. Mr. Kutz responded that names, addresses, and date of birth would be entered. He was
not sure if Social Security numbers would be listed. He noted that if immunization levels are
at only 50%, it is impacting our community in vaccine -preventable diseases because the immunity
is not there.
Mr. Kutz advised the Board that the Information Network for Public Health Officials (INPHO)
will hopefully be available soon. Mason County is one of the test sites for a WIC Program
utilizing INPHO. It will enable the health department to communicate with the State WIC
Offices via computer. The State Department of Health utilizes the network to publicize health
alerts. Birth certificates are being done via modem, but when INPHO comes on line, they hope
to send this information over INPHO. E-mail access will be available between each health
department in the state and with the Department of Health. Information from the Center of
Disease Control will also be available once the network is put on line. Physical capability to be
connected with INPHO will be available within a month or two. Chairperson Cady noted that
the internet would not be available to county departments until internet policies were adopted.
The policies are presently in the development stage.
COMMUNITY PARTNERING
Mr. Kutz reported that community partnering has been successful with WIC issues, the hospital,
and the Community Action Council. Two new WIC sites are now present in the county which
significantly expanded the WIC caseload. The caseload went from 700 to 1,400 or 1,500
between the three sites.
MASON COUNTY BOARD OF HEALTH
January 2, 1997 - Page 9 of 10
One of the biggest issues this year is the proposed legislation regarding the child review and
prevention teams which review deaths of children who are connected with CPS in some way.
Mr. Kutz sits on the state committee that is looking at bringing a Prevention and Review Team
to every county. It would be a joint responsibility of the state and the Local health departments
to make this occur. It will take community partnering to get these teams up and running. The
legislative packet will be considered this session. Dr. Trucksess and the Mason County Coroner
have been interested in this program, and both would be part of the team. The team will look
at a death and try to determine why it occurred and what could have been preventable.
Hopefully, it will give them the ability to address preventable causes of deaths.
Mr. Banner informed that Environmental Health has utilized community partnering in its advisory
committees. The Food Advisory Committee has been successful in establishing appropriate fee
schedules for food establishment inspections. When the duty of inspecting well constructions was
taken over from the Department of Ecology, another committee was formed -- the Drinking
Water Advisory Committee, which has been successful in developing revised design and
construction standards for public water systems which are reviewed by the county. The revisions
were reviewed at the last Board of Health meeting and will be considered again. The On -Site
Sewage Advisory Committee was formed in 1991 and has been meeting monthly ever since.
This advisory committee includes people from the public at -large, designers, installers, and
pumpers, and they have been very successful in their recommendations for the sewage program.
The 0 & M Subcommittee is still meeting. There are two groups, one working with technical
issues and the other on education and information for the certification program. Kitsap County
has submitted information on their certification testing which has been helpful. The Mason
County Homebuilders Association is another important component of community partnering.
Chairperson Cady stated that she has been in contact with PUD 1 and PUD 3 about the
possibility of including a quarterly newsletter from Mason County with their billings. This would
be a way to get information out to most all of the Mason County residents on issues being
considered by Public and Environmental Health. Hopefully, this will be enacted in the near
future. The newsletter would be a combined effort with information from various departments,
and would be another way to make government user-friendly, which is a goal of Chairperson
Cady's.
STAFF DEVELOPMENT
Additional requirements to provide more services has put a burden on staffing levels stated Mr.
Banner. Different ideas have been discussed with the Board to address this issue. Environmental
Health now has a new on -site sewage program which will be closely evaluated, as other services
are. Mr. Banner presented the Environmental Health Staff Meeting Agenda dated January 2,
1997, which was marked as Exhibit F. He explained which geographic areas each staff person
was responsible for.
Mr. Kutz commented that personal health staff development includes a health educator which will
be hired in the near future. A dental health educator program coordinator position has not been
filled due to the lack of interest. It is a part-time position (360 hours a year) for a dental
MASON COUNTY BOARD OF HEALTH
January 2, 1997 - Page 10 of 10
hygienist to provide education and assessment in the schools during the school year. This
position will probably be re -advertised. Dr. Trucksess suggested that a retired dental hygienist
be considered for the available position. Mr. Kutz replied that would be fine; the position was
open to any qualified dental hygienist. Board Member Bolender commented that perhaps a direct
appeal could be made to elicit more interest in the position. Mr. Kutz commented that personal
health staff development will also include cross training. Chairperson Cady asked if personal
health staff were involved in the Dental Care Program. Mr. Kutz replied that he attends the
Dental Work Group meetings which are a subcommittee of the Mason County Health Planning
Council.
A booklet entitled Welcome to Public Health! (Exhibit G) was distributed to the Board.
Chairperson Cady thanked all the presenters for their thorough presentations.
PUBLIC COMMENT
Chairperson Cady called for public comment; none heard.
MEETING ADJOURNED
• Board Members Bolender/Olsen moved/seconded that the Board of Health meeting be
adjourned at 11:50 a.m. Motion carried unanimously.
MASON COUNTY BOARD OF HEALTH
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Mary Jo dyhairperso
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John Bolender, Board Member
Cindy 1 sen, Board Member
Respectfully submitted,
Lorraine Coots