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HomeMy WebLinkAbout1997/02/06 - Board of HealthMASON COUNTY BOARD OF HEALTH February 6, 1997 The Board of Health was called to order at 10:00 a.m. by Chairperson Mary Jo Cady with Board Member Olsen in attendance. ATTENDANCE: Mary Jo Cady, Chairperson Cindy Olsen, Board Member Brad Banner, Director of Health Services Steve Kutz, Personal Health Director Dr. Mark E. Trucksess, Health Officer Pam Denton, Environmental Health Specialist Carolyn Jensen, Environmental Health Specialist Brent Long, Board of Health Clerk Henry Minch, On -Site Sewage' Advisory Committee Ralph Wingert, On -Site Sewage Advisory Committee Donna Van Kirk, Communities in Schools Eva Rooks, Children's Dental Coalition Pixie Needham, Washington Dental Association Joan Martin, South Puget Sound Community College Pamela Johnson, Mason/Thurston Head Start/ECEAP CORRESPONDENCE Memo received from Adolfson Associates, Inc., dated January 30, 1997, regarding an assessment study of alternative on -site sewage systems. The survey was distributed to the Health Services Director. (Exhibit 1) Letter dated January 23, 1997, received from the Centers for Disease Control and Prevention pertaining to upcoming events to inform retailers and the public health community about the new FDA regulation to protect children and youth from tobacco. (Exhibit 2) APPROVAL OF MINUTES Board Member Olsen/Chairperson Cady moved/seconded that the Board concur with the former Board Members' approval of the November 19,1996, appeal minutes, the December 5,1996 board meeting, and to approve the minutes of the January 2, 1997 meeting. Motion carried. Vote: C:yes; O:yes; B:absent. HEALTH OFFICER'S REPORT Dr. Mark E. Trucksess, Health Officer, presented the morbidity report for 1996. There were 56 cases of Hepatitis A last year. It appears that the epidemic is waning, because there have been no new cases since mid -December. There were 10 reported cases of Hepatitis B, and 24 cases of Hepatitis C. Hepatitis B and C are primarily associated with transfusions or with IV drug use. In this community, at this time, it is primarily drug use where they are seeing the cases. However, a lot of people are turning up with Hepatitis C who did their IV drugs back in the MASON COUNTY BOARD OF HEALTH February 6, 1997 - Page 2 of 13 1970s, and have been clean and sober since but unfortunately the consequences of that activity shows up 10, 15, or even 20 years later with chronic Hepatitis. Board Member Olsen asked if there was a treatment for Hepatitis C. Dr. Trucksess replied there are treatments. One is a liver transplant. Patients who qualify for a transplant have to be clean from abusing drugs and alcohol. There is also treatment with interferon which is very expensive and is not instituted until liver enzyme levels are reaching a level of three to four times the normal. At that time, they can be considered for interferon therapy, but it does have many side effects. There were 6 cases of Pertussis reported in our county last year. The concern with seeing vaccine -related illnesses is an indicator of what is happening in our community. Whenever vaccine -related illnesses crop up, they know an adequate job of vaccinating the youth is not occurring. Camplyobactor, which is a food -transmitted disease, had 6 reported cases. Two cases of Meningitis were found in children who acquired the disease outside the county. Eight cases of Giardia were reported. This year so far, there has been an influenza epidemic. Ninety percent of the cases were from types which they were vaccinating people for, but for some reason this year, many people were seen with influenza who were vaccinated for it. So far, this year, there have been 3 cases of Hepatitis B and 3 cases of Hepatitis C, and 1 case of Salmonella. The State of Washington has published a Hanta Virus summary reporting that there have been 11 confirmed cases of the virus in our state since 1994. Two of the cases were found on the west side of the state. Upon investigation, in 9 out of the 11 cases, rodent infestation evidence was found in the homes. In three of those cases, there was also evidence of rodent infestation in the work place. It is believed that the virus is transmitted by inhalation of the excrement of rodents, especially the Deer Mouse. It can be from the feces, urine, or through the dust that has been contaminated. In cleaning up rodent infestation in homes, it is advised that people wear masks, gloves, and to saturate rodent droppings thoroughly with a solution of half water and half bleach before cleaning it up. Rodents have been trapped and tested for Hanta Virus in the past year. Of the 451 Deer Mice tested, 58 were positive for Hanta Virus, which is 12.9% which compares to a 11% prevalence reported in other western states. Not all counties were tested. Mason County was left out of the testing. The closest counties were Thurston which had no mice tested positive with the virus, Pierce with 13.9% tested positive, and Lewis County with 12% positive. The average of positive testing in the counties located west of the Cascades was 10% and in the eastern counties it was 20%. Eight other rodents were tested, the only other one which tested positive was a chipmunk. There is no evidence that rodents other than Deer Mice are a reservoir for this disease, at least not in Washington. There is no treatment for Hanta Virus except for supportive care and that is why prevention is being emphasized. Chairperson Cady asked if cats have problems with the Hanta Virus since they kill mice. Dr. Trucksess replied that he has no data on that, but so far they believe the only way you can get the infection is from inhaling or ingesting the excrement of the dead or live mice. There has been no person -to -person transmission documented and no transmission from any other animal documented. The Department of Health has updated the treatment of active Tuberculosis. A four -drug regimen is still recommended, unless drug resistance is documented. There have been no active cases of Tuberculosis in Mason County in the last year. MASON COUNTY BOARD OF HEALTH February 6, 1997 - Page 3 of 13 There is a new vaccine for Chicken Pox and if children reach their teenaged years without contracting the virus, it is recommended that they receive the vaccine. It is also being offered as part of the routine vaccinations of childhood. Shingles is caused by the same virus. You do not get Shingles without having Chicken Pox. The Chicken Pox virus remains in your body throughout your life. You have high immunity levels after infection, but when you reach middle age those immunity levels begin to fall. When immunity falls low enough, the rash of Shingles can appear. Shingles is a very painful and uncomfortable rash which can often cause blindness if it occurs in the ophthalmic nerves. It can cause morbidity in older persons. The University of Colorado, in the last year, has been vaccinating middle-aged people with the Chicken Pox Vaccine in the hopes of preventing Shingles. The 1995 Communicable Disease Report has been received for the State of Washington which does give data on our county. One positive HIV test occurred in 1996. The total number of HIV cases in the county is approximately 30, which has been remaining stable. One positive case of Diphtheria was diagnosed in a Washington Corrections Center resident by an Olympian physician. It did cause concern, and the individual was isolated. However, it was found later that it was actually in the carrier stage and was not contagious. The individual has been adequately treated. Henry Minch asked if Mason County residents receiving medical attention outside the county were included in the reports. Dr. Trucksess answered that it is the responsibility of the neighboring health departments to notify other counties if one of its residents has a reportable disease. He believed this reporting system was very effective. Joan Martin asked if the Chicken Pox Vaccination being given to older citizens was being administered to those who had already had Chicken Pox. Dr. Trucksess replied that was true, in an effort to prevent Shingles. ON -SITE SEWAGE STANDARDS Director of Health Services, Brad Banner, presented draft revisions dated January 15, 1997 to the On -Site Sewage Standards (Exhibit 3). The Design and Construction Standards for On -Site Sewage Systems were adopted in the beginning of 1992, and many changes have taken place in the technology since then. In 1992, the systems were predominantly gravity systems. Now the norm is to see pressure systems or some other type of alternative system. Also in 1992, the On -Site Sewage Advisory Committee was established which began working with staff on revising the standards. They have been revised several times since then. The revisions before the Board propose major changes in the standards. The Advisory Committee has been working on the draft for quite a period of time. One major change is the fact that the document will emphasize systems other than gravity, and it will incorporate new technology for alternative systems. It also clarifies the alternative system guidelines of the State, and how they are. applied in Mason County. It will incorporate the technical detail of the Operation and Maintenance Program that was adopted in June, 1996. The draft presented is what the Advisory Committee was recommending for adoption and what has been reviewed during staff briefings. MASON COUNTY BOARD OF HEALTH February 6, 1997 - Page 4 of 13 Mr. Banner introduced On -Site Sewage Advisory Committee Members Ralph Wingert and Henry Minch. Both have been involved actively on the committee since 1992. Mr. Minch commented that he was a retired professional engineering geologist who started working in 1955 and had a long association with metropolitan engineers from 1961 to 1965 on the major wastewater treatment plants in the Seattle area. After 1973 he was a partner in an engineering geology soils firm in California. He noted that people need to understand that their on -'site sewage systems are wastewater treatment plants. It is no different than the municipal plants. They handle sewage effluent from the house or from an industry. There are many chemicals in the waste which come out of a residence or an industry which need to be treated and either applied into the ground or applied onto the ground in the case of a top surface disposal system or discharged into water. The upgrading of on -site sewage systems is of extreme importance to Mason County as it is for any county or city. The proper maintenance, application of the use of the system, and the discharge of the waste is of paramount importance to keep the health of the residents of the community, the animals on land and the fish and animals in the marine waters. It is extremely important that there is high quality construction, maintenance, and operation on the systems: These systems should be called on -site wastewater treatment plants because that is what they are. He strongly urged the Board to adopt the recommendations. Mr. Wingert stated he was the President of the On -Site Sewage Advisory Committee this past year. The committee has had expert input from designers and installers on how systems should work and from State people shedding light on what was regulation and what was guideline. With the guidelines, they had some latitude, but with regulations they did not. They looked at what would provide an efficient system at an affordable cost. He was representing the real estate business on this committee, and wanted to see homes stay affordable. He believed they accomplished both. Chairperson Cady thanked both advisory board members for their volunteer time and for speaking. Chairperson Cady asked if Mr. Banner believed the State would allow alternative systems. Mr. Banner stated his department has been submitting information about the use of alternative systems and the barriers. The reason this is being studied is because there are a number of systems being disapproved even though the systems were initially approved by the state technical review committee. Mason County has always fully -accepted alternative systems. Mason and Kitsap Counties, probably more than any other counties, have been open to this new technology and continue to be. Board Member Olsen/Chairperson Cady moved/seconded that the Board of Health approve the On -Site Sewage Standards as presented. Motion carried. Vote: C:yes; O:yes; B:absent. Mr. Minch suggested that the Board consider changing the wording of on -site sewage systems to on -site wastewater treatment systems. Chairperson Cady replied that his suggestion would be considered. POLICY REVISIONS Mr. Banner requested that two policy revisions be considered for amendment. He presented a revised Low Interest Loan Program Policy depicting wording changes. Chairperson Cady noted that the policy was updated last year and the proposed changes will also be beneficial. MASON COUNTY BOARD OF HEALTH February 6, 1997 - Page 5 of 13 Board Member Olsen/Chairperson Cady moved/seconded that the Board of Health approve the policy revisions to the Low Interest Loan Program. Motion carried. Vote: C:yes; O:yes; B:absent. (Exhibit 4) Revisions to the policy which addresses permit extensions and renewals for septic applications were presented and reviewed. Board Member Olsen/Chairperson Cady moved/seconded that the Board of Health approve the septic permit extension policies as presented. Motion carried. Vote: C:yes; O:yes; B:absent. (Exhibit 5) GROUP B DESIGN AND CONSTRUCTION STANDARDS Carolyn Jensen, Environmental Health Specialist, distributed copies of the Mason County Department of Health Services Design and Construction Standards for Group B Water Systems with revisions dated January 28, 1997. Ms. Jensen stated that the document now follows the format of other departmental documents. The Drinking Water Advisory Committee has been working the last two years to refine the standards. A new section for the capacity test for multiple wells has been added, and new state regulations have been added to the satellite management section. Chairperson Cady questioned if additional testing would be performed in the county's lab. Ms. Jensen replied that nitrate testing certification was expected soon. Chairperson Cady asked if VOC (Volatile Organic Compound) testing was planned. Ms. Jensen answered that would only be required in cases where a problem was suspected. Overall, water quality is good in Mason County so they have not had to require this testing. Chairperson Cady asked if the lab would have the capability of performing this test. Ms. Jensen replied the lab would not. Chairperson Cady asked why the Water Rights Section referred to a DOE Water Right Permit. Ms. Jensen answered that water rights are independent from the Group B Water Systems but they do overlap to a certain extent. A Group B Water System is any water system from 2 to 14 connections. Water rights are governed by how many gallons per day are withdrawn from a well. The guidelines for designing water systems and Mason County's Water Adequacy Ordinance state that each residential connection must have 800 gallons per day. A seventh connection would exceed the 5,000 gallon connection minimum set by water right law. Chairperson Cady noted that was the reason why the systems were connected by every six residents. Chairperson Cady asked if on Page 9, the word residential was going to be inserted. Ms. Jensen replied that the word residential was added after the Section Three heading. She noted that committee members wanted to be present today but were unable to attend. Board Member Olsen/Chairperson Cady moved/seconded that the Board of Health approve the Design and Construction Standards for Group B Water Systems as presented on the January 28, 1997 revision. Motion carried. Vote: C:yes; O:yes; B:absent. (Exhibit 6) MASON COUNTY HEALTH PLANNING COMMITTEE Steve Kutz, Director of Personal Health, stated he was proud to introduce members of the Mason County Health Planning Council (Council) and the Children's Dental Coalition (Coalition), which is a subcommittee of the Council. Donna Van Kirk, Communities in Schools, will present an overview of the Council's activities. MASON COUNTY BOARD OF HEALTH February 6, 1997 - Page 6 of 13 Ms. Van Kirk, Healthy Kids Program Coordinator for Communities in Schools in Mason County, stated as an active member of the Council she was asked by the Council's leadership to make a brief presentation and give an overview of the Council. Bob Appel, Mason General Hospital Administrator and Steve Kutz serve as Co -Chairs. The Council appreciates the opportunity to speak with the Board. The main goal of this presentation is to raise the Board of Health's awareness of the Council's past and present, including its mission, goals, current organizational structure, and its three active work groups. The Council wants to be considered the primary voice in the county for health issues. Specifically, when the Board of Health deliberates on health issues, projects and programs affecting Mason County residents, the Council wants to be actively involved in the discussion and decision processes. The Council understands that in order for the Board of Health to work cooperatively with the Council, they need more information. Following this presentation, each Board Member will be provided with a copy of the Council's mission statement, the participant and work group rosters and a written copy of this presentation (Exhibit 7). Ms. Van Kirk explained that the Council brings together individuals .from all sectors of the county to enhance the health of the people in Mason County. They cooperate to assure accessibility, availability and acceptability of health services for all residents of and visitors to this county. Using the best available information for all, they advocate and plan for positive change in health care systems. In order to accomplish this mission, the Council meets monthly, attended by a broad variety of constituents representing such entities as social and health services, physicians, dentists, people from Communities in Schools, public schools and tribes. In the early 90's and to this day, dramatic changes have been occurring in the health care arena. Throughout this decade, and even before, the Council has conducted surveys to assess needs of the people who live in our county and to look at the relationships among and between different health providers. As managed care has grown, many citizens and many more each day, are coming under a health maintenance organization coverage. The Council is trying to play an active role in educating and understanding what these changes are in the health care system and to make recommendations for improving it. During late 1992 into early 1993, the Council was somewhat dormant. To get the Council back on track, in January, 1994, the Council leadership surveyed its members, asking them to comment on the. Council's mission, structure, purpose and goals. The main goal, at that time, which was identified and to this day being worked on, was to improve medical access for children in Mason County, and especially for those who are Medicaid -eligible, and to increase the number of children getting well -child exams, known as EPSDT or early, periodic, screening, diagnosis treatment. Another top goal was to work with the community to implement Communities in Schools. The survey also confirmed that members want to continue meeting on a regular basis, so the Council would maintain some momentum. In 1995, some of the people who had been involved in the earlier history of the Council were very instrumental in promoting the idea of Communities in Schools (CIS). During 1996, two CIS staff were hired to promote access to health and dental care. This has become a reality in the county. MASON COUNTY BOARD OF HEALTH February 6, 1997 - Page 7 of 13 During most of 1996, the Council focused its energy on improving dental access. In addition, the Council worked cooperatively with the Mason County Health Department to lend support to the department's community assessment process which will be completed this spring. Once the data is analyzed from the community assessment, the Council will review its priorities based on this new data. They are looking forward to the opportunity of having fresh data. Toward the end of 1996, the Council held a retreat to come up with new directions. They now have three active work groups which 19 people out of 35 signed up for. The work groups consist of: Legislative Advocacy/Community Education, Medical Access/EPSDT, and Dental Access. Since the retreat, each of these work groups have met at least twice. Each group is making absolute steps forward and concrete projects and programs are in the process of being developed. They are moving from more of a networking, information sharing body, and trying to move more into an action -oriented group. Since November, they are moving in this direction, which is very positive. They want to work with the Board of Health, and hope that the Board thinks of the Council when they are deliberating on health issues, projects and programs. They look forward to a positive, collaborative relationship. Chairperson Cady asked if the funding for the Council came from VISTA. Ms. Van Kirk answered that it was primarily funded by a Readiness to Learn Grant that comes from the State Superintendent of Public Instruction Office. Her position is fundedthrough this grant, which makes perfect sense because if they can get kids to be healthier, they attend school more often and they are more ready to learn. The Dental Program has the same outcome. If kids' teeth are in good shape and their mouths are in good shape, then they are more apt to stay in school and thrive. Simpson Timber donated $15,000 and KPS donated $5,000. Chairperson Cady wondered if the Readiness to Learn Grant would continue. Ms. Van Kirk replied that it was running out June 30th, but they believe it will be renewed for another two years. Chairperson Cady asked if SPIPA was part of the group. Mr. Kutz replied that there are representatives from the tribes, but not directly from SPIPA. Eva Rooks, Mason County Children's Dental Coalition (Coalition), read aloud a letter from Dr. Jim Penney in support of the Coalition and the work it is trying to do on behalf of Mason County children. A letter from Jerri Hawthorne, Pioneer and Belfair Head Start/ECEAP, was also read aloud. Her letter asked, on behalf of all the low income families in the Head Start Program and throughout Mason County, that the Board of Health address the availability of dental care for children. Chairperson Cady stated that the State was making a big mistake by giving people medical coupons and telling them that they will get dental care without providing the funding to cover it. She believed the legislative work group should be working on addressing this. The State is promising something that is not available especially with the requirements faced by the dental offices. It is a funding issue which needs to be corrected legislatively. Ms. Rooks reported that the Coalition began convening in August, 1996. It is a subcommittee of the Mason County Health Planning Council which was formerly the Rural Health Planning Committee. The purpose of the Coalition is to address the issues affecting the dental care of our Mason County children, with emphasis on children enrolled in Medicaid. The reasoning for this focus was substantiated in a telephone survey of Mason County dental providers which showed MASON COUNTY BOARD OF HEALTH February 6, 1997 - Page 8 of 13 that while nine dentists then practicing in Mason County were accepting new patients, only three of those nine dentists would accept new Medicaid patients. Of these three, only one dentist was practicing full-time in Mason County, and this full-time dentist limited his Medicaid patients to students in the Hood Canal School District. The Coalition targets two issues for the 1997 year. Increasing dental access for Mason County children and promoting dental education for both Mason County children and their families. While access has been a stronger focus, the Coalition determined that without dental education for children and their families, increasing access alone would not greatly improve the dental health of the county's children. Because dental disease is an infectious disease that is totally preventable through early education and ongoing access to dental treatment, the Coalition's two - pronged approach makes sense. However, dental access in Mason County is now at a crisis level and there is no dental education provided in our public schools by the Mason County Department of Health. The Coalition asks that the Board of Health address the following issues. Consider reestablishing or subcontracting dental education to Mason County school children through the Department of Health, establishing a low-income children's clinic, and applying to the Department of Health for sealant equipment. With the 1995 loss of the Department of Health dental hygienist, there has been no dental education provided to children by the Health Department. The position has not been filled, nor is there an alternative plan for teaching oral health practices to children. The Coalition requests that the Board of Health address the issue of this vital public education. If the Board of Health and Department of Health Services are unable to provide school -based education, work should be done to find another agency or entity to fulfill this responsibility. Members of the Coalition accessed the feasibility of a Mason County low-income children's dental clinic. Last year only 1,592 of the 4,435 Medicaid -enrolled children in Mason County saw a dentist. The large number of children on Medicaid who go without dental service indicates the access problem in our county. Of the 1,592 children who did see a dentist, only 329 of these children were seen in Mason County. This means that 1,263 children had to leave Mason County to obtain dental services. That is $164,190 in Medicaid dental services which were performed outside of our county last year because of lack of local providers. This $164,190 assumes there was only•one dental visit by each child in the course of a year. If children went twice in one year, that would mean about $328,380 worth of services, at a bare minimum, leaving the county each year. There is a short window of opportunity to fund a pilot project children's dental clinic in Mason County under expanded funds to a current grant with CIS through DSHS Medical Assistance Administration. The grant currently funds one FTE position as Dental Access Coordinator at Communities in Schools. This pilot project would finance leasing a local dentist's office and the office staff two days a week and hiring a dentist for those two days to treat Medicaid children. The project would run from March through June, 1997. The project would allow the Coalition and the organizations it represents (Communities in Schools, Shelton School District, DSHS, Mason General Hospital, South Puget Sound Community College and others) to obtain valuable MASON COUNTY BOARD OF HEALTH February 6, 1997 - Page 9 of 13 insight and experience into the material and personnel requirements involved in operating a low- income children's dental clinic in Shelton. By reviewing billing, caseload and personnel requirements, they can assess the feasibility of either continuing the present leasing situation, moving to other facilities or discontinuing the program at the end of the pilot period. The Coalition asks the Board of Health to formally collaborate with the Coalition and the above agencies by participating in this pilot project and the decision making process that will follow. The Coalition requests the Board of Health to direct the Mason County Health Department to apply for a dental sealant grant now available from the Washington State Department of Health to cover mobile equipment and initial staff costs. Dental sealants offer proven protection against decay and are cost-effective for the county and the taxpayers. The current reimbursement rate by MAA for dental sealants is $22 per tooth. A child will receive up to 8 or even 10 sealants. Cost savings are obvious by comparison to the cost for one surface filling. The reimbursement for one surface filling is $50 and must be done by a dentist. Two teeth can be sealed against decay for less than the cost of one surface filling. Sealants can be applied by a dental hygienist after a quick exam by a dentist. Sealants are painless, can offer protection against decay for up to ten years and are a proactive prevention piece for improving the oral health of Mason County's children. Dental sealants could also be profitable enough that the cost for a hygienist to apply the sealants to not only be covered by the reimbursement schedule, but it would exceed it. A hygienist can seal two kids in an hour and can apply eight sealants on each child. That is 16 sealants at the price of $22 per sealant which equals $352 of billable services in an hour. The cost of a hygienist is anywhere from $25 to $35 per hour, so there is a considerable amount of revenue generated through the process. When Smile Savers came to Matlock for a two-day clinic, they sealed 270 teeth on 56 children for a billable amount of $14,040. The Coalition strongly urges the Board of Health to improve our children's dental health by directing the Health Department to apply for the Department of Health's sealant equipment grant. The Coalition urges the Board of Health to allow the Coalition to collaborate and work with both the Board of Health and the Mason County Health Department on the issues affecting the dental health of Mason County's children. The Coalition strongly urges the Board of Health to address the issues presented. Ms. Rooks presented written documentation (Exhibit 8). Ms. Rooks introduced Pamela Johnson, Mason/Thurston Head Start/ECEAP; Joan Martin, South Puget Sound Community College Dental Program; and Pixie Needham, President of the Washington Dental Hygienist Association who is running the Thurston County Dental Sealant Program. Chairperson Cady asked Mr. Kutz if he was aware of the grants mentioned by Ms. Rooks. Mr. Kutz stated that he knew the sealant grant was available. Chairperson Cady stated that they should apply for these funds right away. She wondered how accessible the funding was if the grant was applied for. Ms. Rooks responded that the Coalition had originally applied for a grant to put in a portable at Shelton High School to work collaboratively with South Puget Sound Community College doing, not only dental treatment, but also training students in dental assisting MASON COUNTY BOARD OF HEALTH February 6, 1997 - Page 10 of 13 and in sterilization technology with high school students coming over. However, because they did not have the infrastructure in place to guarantee that it would be successful, and because they did not have a fiscal agency, even though they had the grant, they could not implement it. The group decided that the next best thing would be a pilot project to find out how much it would cost to treat these kids, to keep the dentists, and to find out if it was feasible. Chairperson Cady stated the county acts as the lead agency in many projects. If there is an administrative portion of the grant that would cover whatever the county staff would be doing, they would certainly look at helping in this way. Mr. Kutz commented that the fiscal lead agent is one of the steps. If the Board wants them to do this, they could pursue that. Chairperson Cady replied that they would like to see what it would involve as far as staff time. She suggested that the Coalition work with Mr. Kutz, who in. -turn would bring the proposals to the Board of Health, not necessarily waiting for a Board of Health meeting, but bringing it to be considered at a Commission meeting, in an effort to expedite the matter. Ms. Rooks noted that they would like to be up and running by March lst. They have negotiated with a dentist who seems agreeable to letting them lease her practice for two days a week, including her staff. They do have a dentist who they can hire for those two days. Chairperson Cady noted that she was very interested in participating in this project. Ms. Rooks stated the Board was welcome to attend their meetings on the first Tuesday of each month. Pixie Needham, President of the Washington State Hygienist Association, stated she has been involved in the dental sealant program and is a member of the Thurston County Dental Health Coalition, and also served as a member of the legislative joint select committee on access of oral health care last year. There was $47 million allocated to children's Medicaid funding in the 1995 biennium. That funding is currently up for renewal. There is a bill, in the process, to keep that funding in place. They do not know if it will happen at this point. There are more issues. She wished it was just as simple as funding. Some of the fee increases were increased over 150%. The problem, also, is that there are a lot of practitioners who do not feel comfortable working on children. That is not the fault of the practitioner, it is a fact, and it is also something they will have to deal with. They are addressing this issue in their Access Committee. The Thurston County Dental Health Coalition has been very active this past year as has Mason County's. They have a children's sealant program in conjunction with the Health Department and Providence St. Peter's Hospital Community Care Clinic. It has been a great team effort. The health department actually applied and received the grant for the equipment. It costs about $10,000 for one dental unit. .They have completed three schools this year. There are another two they are starting to screen for tomorrow. It has been very successful but it takes the efforts of the community, the schools, and the dental community in the area. Everyone has to be on the same page before it is started. It really is a cost-effective way to prevent tooth decay. Community water fluoridation and dental sealants are both very effective. Sealants can be 100% effective if applied properly. They are seeing about a 85% retention rate over a 5 year period. They are getting the kids through that span of time when they are not brushing and flossing. They are targeting the second graders and applying sealants to all their permanent first six -year molars. The kids are first screened by a dentist. If the teeth are not decayed, and if the parent requests, the child gets sealants as a preventative measure. Because it is preventative, it is topical, and it does not hurt the tooth, the sealants are applied. There is either decay, or if the parents want it, the child gets the sealants. It happens this way in general practices also. In third grade, the retention rate is MASON COUNTY BOAR.b OF HEALTH February 6, 1997 - Page 11 of 13 checked and sealants reapplied if any have chipped off or failed. The kids who were missed earlier are added. In fifth grade, kids who have 12 year molars will be targeted. Chairperson Cady asked if there was a maximum number of sealants which could be done. There is only so much money allowed for the program. If sealants are automatically applied to all the six year molars, they might reach their maximum and not be able to apply sealants to those molars which really need it. Not all six year molars need sealants. Ms. Needham responded that she would have to argue that point. Chairperson Cady commented that she knows it is a current philosophy, but questioned it because there is only so many dollars available. Ms. Needham responded that so far there has been money left over. She would rather see the tooth sealed than wait and see the decay at a later time. The new criteria is that everybody potentially needs sealants. They want to see it done in those who are eligible. The program basis is prevention. If they seal these teeth, they won't have the kids who need the fillings. At some point, it will be similar to an immunization. The sealant will be like an immunization for the tooth, at a lower cost. Ms. Martin commented that the dental community feels that all the kids need the sealants. Ms. Needham stated that the school nurses in Washington State were polled and it was found that the number one health issue for children that come to visit their offices was dental pain. This is a crisis situation and it does need to be addressed. Pamela Johnson, Health Coordinator for Mason/Thurston Head Start/ECEAP, stated she was the Co -Chair of the Children's Dental Coalition in Thurston County, as well as a member of the Community Care Advisory Board of Providence St. Peters Hospital which is the group that advises the Community Care Dental Clinic. There are a number of Mason County children who utilize the dental services in Thurston County. She has worked collaboratively with Mason County for quite some time because they serve a number of children from Shelton to Belfair. The Smile Mobile was placed here, and when they were trying to get it placed in Kitsap County there was a waiting list of 267 children in the Bremerton area alone. Needless to say, they did not get to all the North Mason children which is one reason why they have Smile Savers there because there is a problem. Next week, there will be children receiving outpatient oral surgery and that is a big deal. Dr. Keoning did apply and did receive privileges from St. Peters and he does pre -op exams in Shelton. Her vision for the far future would be that Mason County General would be able to do dental surgery. And beyond that, it would be nice if they did not have the problem, but she does not see that in the near future. In their program they have seen over 600 children, and close to 50 had to be done in the hospital. This was due to rampant baby bottle tooth decay. There is a need for collaboration. She is pleased to hear the Board strongly supporting applying for the grant for sealants. She was disappointed when it did not happen last year, and she is very glad that it is supported this year. Chairperson Cady commented that she did not remember this matter coming before them last year. Ms. Johnson stated it may not have. She encouraged the Board to work with the Health Department. Education is the piece that will be the primary reduction in dental disease. It is a preventable disease and if they do not begin a very strong educational program, they willforever be playing catch-up. In Thurston County she works closely with the Health Department and the Community Care Dental Clinic and they have collaborated on two grants. The sealant grant and a legislative grant for $112,000 which funded MASON COUNTY BOARD OF HEALTH February 6, 1997 - Page 12 of 13 a position like Ms. Rooks'. The grant has allowed the clinic to see an additional 700 children over an 18 month period. Within the Health Department, they are also looking at a peer education model in the WIC program because they realize that dental decay is one of the ways that children can qualify for WIC. They will be working collaboratively with the Head Start Program to train moms to be peer educators in WIC. She encouraged Mason County to also look at some other ways, particularly since the dental education piece in the Health Department has not been in existence for a while. There are a number of organizations who work in the community who want to see quality services for children and families. She is available at any time for additional information or collaboration since they also serve Mason County children. Chairperson Cady commented that the Board does support these proposals. She asked that Mr. Kutz work with the Coalition in getting the programs started. ADVISORY BOARD APPOINTMENTS Mr. Banner requested that several individuals be appointed to advisory committees, that expiration of terms of appointment be revised to all be June 30th, and to consider a recommendation from the Food Sanitation Advisory Committee to increase the membership to include a representative from the large, complex markets. (Written documentation was submitted as Exhibit 9). Chairperson Cady requested that the advisory board applications be presented as correspondence through the Clerk. She asked if all the appointments being requested were for expired terms. Mr. Banner replied they were. Board Member Olsen/Chairperson Cady moved/seconded that the Board of Health appoint Billie Ann Simmons, Bruce Rosenstein and David Westerman to the Food Sanitation Advisory Committee; Bill Neal, Jr., Donald Walker, G. John Brush, James Hungerford, Reg Hearn, Mike Mitchell, Jerry Marshall, and David Wilson to the Drinking Water Advisory Committee; Greg Hasbrouck, Dana Wolliscroft, Ron Gold, Rob Goodwin, and Carolyn Jensen to the Certified Contractor Competency Board. Motion carried. Vote: C:yes; O:yes; B:absent. Board Member Olsen/Chairperson Cady moved/seconded that the Board of Health adopt the new term expiration dates as presented by Mr. Banner for the Food Sanitation Advisory Committee, Drinking Water Advisory Committee, On -Site Sewage Advisory Committee and the Certified Contractors Review Board. Motion carried. Vote: C:yes; O:yes; B:absent. Board Member Olsen/Chairperson Cady moved/seconded that the Board of Health amend the Food Sanitation Advisory Committee by-laws dealing with committee membership to include representation from large, complex markets. Motion carried. Vote: C:yes; O:yes; B:absent. DEPT OF HEALTH SERVICES - VISION STATEMENT A revised Vision Statement for the Health Services Department was presented for the Board's review (Exhibit 10). Board Member Olsen/Chairperson Cady moved/seconded that the Board of Health accept the proposed revisions to the Vision Statement as presented. Motion carried. Vote: C:yes; O:yes; B:absent. MASON COUNTY BOARD OF HEALTH February 6, 1997 - Page 13 of 13 MASON COUNTY EPI-NEWS Mr. Kutz presented the January 14, 1997, edition of the Mason County EPI-News (Exhibit 11). He asked if the Board has been receiving their copies of the publication. Chairperson Cady asked that individual copies be made for each Board Member to insure that they receive it. PUBLIC COMMENT Chairperson Cady called for public comment; none heard. MEETING ADJOURNED Board Member Olsen/Chairperson Cady moved/seconded that the Board of Health meeting be adjourned at 11:55 a.m. Motion carried. Vote: C:yes; O:yes; B:absent. MASON COUNTY BOARD OF HEALTH (Absent) . John Bolender, Board Member Cindy 0 en, Board Member Respectfully submitted, dAtfkkftL-1 r-A7 Lorraine Coots