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HomeMy WebLinkAbout1994/03/03 - Board of Health s - MASON COUNTY BOARD OF HEALTH MARCH 3, 1994 The Board of Health was called to order at 10:05 a.m. by Chairperson William O. Hunter. ATTENDANCE: - William O. Hunter, Chairperson Henry Minch,On-Site Sewage Advisory Board Mary L. Faughender, Board Member Bill Taylor, On-Site Sewage Advisory Board Laura E. Porter, Board Member Mr. and Mrs. Arnold Tahja Brad Banner, Health Services Director Barry Jenkins, KMAS Radio Carol Oliver, Director of Nursing Jerry Wilson Mark Tompkins, Environmental Health Specialist Conley Watson David Hutsell, Environmental Health Specialist Bill Neal, Arcadia Drilling, Inc. Barbara Johnson, Head Start Dick Szymarek, DOE PERSONAL HEALTH SERVICES - PROPOSED PROGRAM EMPHASIS SHIFT Carol Oliver, Director of Nursing, handed out copies of and verbally presented the proposed programming changes in personal health services for the year 1994. She noted that her department looked at the services presently being provided and the needs of the community. She found that a number of needs were not being met and struggled with how to meet these needs with the existing staff. A prioritization process occurred which resulted in the following basic recommendations: 1) That services available by the private sector should no longer be provided by the Health Department. These include ear washes, pap smears, foot care, well-child exams and sports physicals and 2) That the Health Department focus available resources on population- based efforts to protect community health and prevent disease. Ms. Oliver proposed that her department give priority to developing effective communicable disease control programs, including STD, TB, HIV/AIDS, and immunizations. Along with that, funds available from the State Health Services Act to local health departments could be used to augment and expand these programs. She is looking at being able to improve their capacity for community assessment, mobilization, planning, and the distribution of information collected. She proposed allocating time to teen pregnancy and to begin looking at other issues such as community-level education and prevention efforts addressing tobacco use, alcohol and drug abuse, mental health issues,youth violence, and prevention of unintentional injury. The Health Department has a total of 8 FTE's, including Ms. Oliver. She noted that this was a very full plate for 8 people. The department cannot begin concentrating on these issues while providing the other services; it's essential to focus on other needs. If the proposed service elimination is done, a shift of resources would be made into those new areas. With the additional funding, 1 more FTE could be placed into the communicable disease program. She explained that she has checked on the availability of the services in the private sector that they are proposing to drop. A survey was completed which showed that private physicians and the Health Care Center were willing to take referrals, including five local providers. Ms. Oliver requested that the proposed policy change be approved and that the Health MASON COUNTY BOARD OF HEALTH March 3, 1994 - Page B of 10 Department be allowed to implement the objectives outlined beginning as soon as possible. Chairperson Hunter questioned whether the services could be phased out immediately. Ms. Oliver responded that certain services should be rendered, and that existing appointments would be honored. Referrals would then be made to the physicians in the private sector. Board Member Porter asked what the facilitator role would be within the Health Department to ensure people did not "fall into cracks," when being referred. Ms. Oliver replied that she felt responsibility in doing that and would work with other social services and providers. She noted that she has looked into the private sector's acceptance of these referrals. However, if it is found that a significant portion of people do not have access, the Health Department would review again. Board Member Faughender suggested that a date be established when those services would be stopped. He wondered if the month of May or June would be reasonable to stop taking appointments. Ms. Oliver felt that this would be reasonable, except that the additional staffing should be started so that the funding is not lost. Chairperson Hunter opened the meeting to public testimony. Barbara Johnson,Head Start Family Advocate, stated she was present representing Head Start. She stated she was aware there was managed care in the community now, which began last month. She asked that the Board wait 6 months to see if the managed plan does support the needs of the entire community. She wondered if it will work out as expected. Barbara Johnson stated that now families are given good coverage not dependant upon income. Her concern was with low income families serviced through medical coupons because physicians loose money when providing service to them. In this instance, the Health Department has plugged in with things like well-child exams. Board Member Porter asked Ms. Johnson if her primary concern was the well-child exams, and she replied that they were, as well as the elimination of ear washing if it impacted children who have had ear infections, or other services which are provided for children. Discussion followed on what services were available for families using medical coupons. Brad Banner, Health Services Director, noted that extensive planning has taken place with the Health Officer and himself, with quite a period of time spent on the issue. However, it was the consensus of staff, with the support of local physicians, that these changes more closely meet the public health mandate and more closely coincide with the future of health care. He stated that the proposal had been widely advertised and felt they had a good safety net. In looking at budgetary issues, this proposal would not be an added drain on county government. He felt that waiting would be detrimental to the department. In regards to the health of the poor and needy, this shift would emphasize and do more to protect them because the department is reviewing matters that affect everyone. Chairperson Hunter asked for any additional comments. Ms. Johnson asked if the department was cutting the style of service, but adding employees. Ms. Oliver explained they were adding MASON COUNTY BOARD OF HEALTH March 3, 1994 - Page 3 of 10 one additional employee to work in communical disease. She stated that in order to address concerns, she would quantify them in numbers; last year 68 well-child exams were done. Five percent of one FTE is dedicated to this service. Her feeling is that it may be a better approach trying to see that services are available rather than provide them themselves. She stated there were a number of options, and she would be happy to talk to Ms. Johnson about them. Ms. Oliver stated that in working within the community and addressing the needs, and by organizing a group to work on these issues, they may come up with a better solution than what the Health Department has provided. She stated the Department would continue its role of facilitating service and community problem solving to ensure important care services were available. The Board felt it was important for the Department to help people transition into the new system rather than just state the Department no longer provided the service. It was moved and seconded by Board Members Porter/Faughender that the Board adopt the new Personal Health Program Plan as recommended with the following change in 44: continue Department's role in facilitating community service and problem solving with the addition of preventive care and elimination of the following services: ear washes, pap smears, foot care, well-child exams and sports physicals effective May 1st, 1994. Motion carried unanimously. The board discussed whether or not May was a reasonable date. Ms. Oliver replied that it was, noting that they would continue to honor their appointments and work on eliminating the services by May. The Chairperson noted that the time frame could be amended at a future meeting if necessary. Board Member Faughender noted that the Health Officer was a local MD and would go out of his way to ensure that services would be provided. Board Member Porter stated that based on testimony received, there was a real gap being felt in Mason County. That gap being who does the work of identifying problems and calling meetings to discuss gaps in the network. She would like to see the Department move in that direction. PUBLIC HEARING - ON-SITE SEWAGE REGULATION Board Member Faughender read aloud the public hearing notice. Mr. Banner gave a staff report. He reported that revisions to the on-site sewage regulations were necessary because: 1) Need to allow the Board of Health to designate areas of special concern in order to require more stringent design and maintenance standards within those areas and 2) because the regulation was done in 1986, and references regulations which no longer exist. Procedure followed: Mason County On- Site Advisory Committee established a sub-committee which developed the draft, and then took it back to the advisory committee. A public workshop was held in which comments were received from the Department of Ecology, Department of Health and other agencies. The advisory committee then took these comments, addressed the concerns expressed, and revised the draft. It then unanimously recommended approval to the Board of Health. Mr. Banner stated that the draft was a simple document which adopted by reference and could be amended without taking away from the validity of the entire document. It laid out procedures and legal requirements for areas of special concern, established a new certification program for maintenance personnel, and updated the enforcement section. He noted that it incorporated the mandates from the state regulations, and selected options. One possible issue was if installers MASON COUNTY BOARD OF HEALTH March 3, 1994 - Page 4 of 10 and designers should have experience. When widely distributed and considered, it became apparent that the 2 year experience requirement should be retained. The community was divided at first, but after discussing it, it became unanimous. Mr. Banner had prepared an amendment to the draft to incorporate this. Board Member Faughender questioned Section 11. He asked if this was a way to give responsibility back to the private sector and if it is envisioned that the private sector would take over the part of monitoring. He wondered if the language was strong enough. Mr. Banner replied that they were excited about the prospect of this happening and believed that the private sector had a great capacity to do insurance part. The Department would use less resources in this area and would be able to focus skills on data base and running the program. He saw a shift towards ongoing watching of the system to see if it continues to work. Maintenance personnel can be given expertise in identifying problems. Henry Minch, on-site sewage committee advisory board member, stated that if the county checked every septic tank every 3 years it would be a never-ending task which would take monumental staff. However, if it was done by the private sector and the county had insurance program that they have to check the installers, it would make it easier. If anybody was not doing it correctly, would see failed systems. County services and resources of the Health Department could be better utilized in another manner. This will ensure better service, and it's paid for by the private septic system owner. Bill Taylor, Taylor United Inc., on-site sewage committee advisory board member, stated they worked for some time on these regulations and that the group supports them. He believed they were reasonable and will provide adequate public health safety. He noted they,will also help to improve water quality in protecting shell fish. Inspections will relieve some problems. Although there was a cost in checking these systems, people are concerned about on-site sewage and feel inspections should exist. This will be a cost effective way to carry this out. He believed the public will accept because it's better directed to public safety than water quality and it's better than paying a tax for a water district. Henry Minch recommended that the regulations be adopted as submitted. He stated people are concerned about clean water and clean drinking water, and the way to make sure drinking water is good is to have a good, up-to-date, working septic system. He stated that this proposal was a major step forward. Arnold Tahja, certified designer, presented written questions he had about the draft. He noted that his general questions could be answered by Mr. Banner. However, his major concern was that the regulations be checked by their legal advisor. He mentioned a case in another county which ran into trouble regarding the enforcement of their regulations. He stated he had no real objections to the standards of construction except for the reading in the paper that the Department had information available. He stated it took him 2 or 3 trips to the Department to pick them up and when he did get them, the standards of construction were not included so he had to make r T MASON COUNTY BOARD OF HEALTH March 3, 1994 - Page 5 of 10 another trip. Mr. Tahja stated he thought the hearing should be readvertised. Mr. Tahja stated he strongly believed no person should have a license revoked without a hearing, and there should be a process of revocation, after a hearing. He felt the license or certificate should stay in active status until a hearing. The Board thanked him for presenting his concerns in writing. Barry Jenkins, KMAS Radio, asked a few questions of Mr. Banner. Mr. Banner replied that the requirements he was asking about pertained to areas of special concern. Jerry Wilson asked about the requirement to have pressure distribution. Mr. Banner remarked that this was required for areas of special concern. He stated that the state is revising their regulations; this is the table out of proposed state regulations. The county cannot be less restrictive than the state, and he wants the county regulations to mesh even though the state has not adopted them yet. Mr. Banner noted that public hearings have been held with input from DOE, DOH, and the public to define these areas of special concern. Areas of concern have to be designated by the BOH. Mr. Tahja asked about the 2 year limit in Section 6.03, and if there was going to be flexibility in regards to it. Board Member Porter advised him that this section was discussed at length; and has grace periods. Mr. Banner agreed that they do have a policy adopted by the Board on extensions; and under limited circumstances will give extensions. Board Member Porter stated that the policy was in writing, and Mr. Tahja can get a copy. Mr. Banner stated that another issue was the grandfathering of systems. He stated there were two extremes, some people want everything updated while others want systems grandfathered. He stated that the meeting in Tahuya for policy on time frames, along with a hearing with the BOH which was well attended resulted in having a written policy available. Adoption of the design and construction standards was a legal precedent; the advantage being that you don't need new regulations every time a policy is changed. The danger is not going through process. The county process is to give it to the advisory committee, which is made up of installers and designers, who work on it and make recommendations. If it is a major issue, they have work shops, make time lines, and then take their recommendation to the BOH, where it is adopted. He stated that the certificate suspension mirrors the food regulation, in which the director can suspend, but in order to revoke it goes to the competency board; appeal process. Suspension is limited, the maximum suspension being 60 days. Board Member Porter asked the reason for that length of time. She stated it seemed like a long time before it went to the Board for revocation. Mr. Banner responded that it was an arbitrary figure which could be changed. Chairperson Hunter stated he felt there would be no resolution at this time. Possible changes may be made, and that the continuation of this hearing was in order. It was moved and seconded by Board Members Faughender/Porter that the public hearing to consider new on-site sewage regulations be continued until next month's meeting,April 7th, 1994.Motion carried unanimously. Board Member Faughender suggested that everyone look at the proposals closely and come back with comments. He noted that the Board will review them also. Board Member Porter stated she had concerns how the draft fit with other regulations and strategies to MASON COUNTY BOARD OF HEALTH March 3, 1994 - Page 6 of 10 address clean water issues. She planned to meet with Mr. Banner individually and as a board member during their discussions/briefings with the Health Department. She wondered how any new proposed changes in language could be given to the public to review before the next hearing. Chairperson Hunter stated that Mr. Banner could. make the proposed changes and present them at the next hearing. PUBLIC HEARING - DRINKING WATER REGULATION Board Member Porter read aloud the public hearing notice to consider adoption of Mason County Group B Drinking Water Regulations. Mr. Banner gave a background on the proposal. He stated that at the end of 1993 they had hired David Hutsell and that this proposal was the culmination of having focused on the main environmental health issue of the state, which was drinking water. He noted that since this was consuming more time, they need a more coherent policy to respond to needs. The Department has worked on this for months, holding several meetings with well drillers who are in general support. It also conducted a workshop in which several well drillers attended, as well as.Board Members. He explained that the state required a frequency schedule in which these systems have to be reviewed. This proposal would allow a schedule so this can get done, along with enforcement provisions which are an integral part of the water program. He then distributed copies of the Group B Water System Regulations. Mrs. Tahja asked for an explanation when water rights were necessary. Rich Hoey, State Department of Health, as well as Mr. Szymarek from the State Department of Ecology and Mr. Banner addressed her questions. She was informed that it depended upon how many hook-ups are planned and/or the number of gallons used per day. She asked if the designer bond satisfied the water drilling bond. Mr. Banner responded that the bond would have to have that particular intent stated .on it. She asked if this proposal would allow certification procedure. The Board responded that it would be part of the process. Conley Watson wondered if the system he was connected to would fall under this regulation. He commented that currently there was no one guiding the person in charge of his system. Conley Watson also asked about monitoring. Mr. Banner responded that monitoring was required. Rich Hoey, State Health Department commented that if Mr. Watson's system was an existing one, monitoring was required. One bacteria sample is required each year, and every 3 years a nitrate sample. He noted that more tests have to be done when getting a system approved. Board Member Porter asked about Section 7.02.02. She wondered if there was protection if the Department failed to approve in a timely manner, and if there was an automatic extension if the Department failed to give the certificate. Mr. Banner responded that they paid the fee and then received a new certification. She then asked about Section 7.03, regarding the suspension of a designer's certificate by the Director. She felt that a 30 day suspension, unless a longer time was needed would be adequate for a simple suspension without a competency board hearing. In some instances the competency board would need to get involved to review the action of a designer because the reasons for suspension are fairly serious. Mr. Banner agreed. However, MASON COUNTY BOARD OF HEALTH March 3, 1994 - Page 7 of 10 it would go before the Board of Health rather than a competency board. Board Member Porter thought that the technical and medical advisors would be better at making a decision than the BOH. She didn't see a need for a separate competency board, but was uncomfortable with these matters going before the BOH. Board Member Porter thought the final decision should be made by the Health Officer and the appeal to the BOH. She would rather spend time educating than suspending; and didn't want to staff a competency board that would never be used. Bill Neal, Arcadia Drilling, Inc., stated he had worked closely with Mr. Banner in preparing the draft. He did, however, have a concern about the effective date of the regulation. He asked that the regulation be effective 60 days following the public notification of adoption. He explained that businesses have plans in process and they need time enough to get plans in order to make a smooth transition. He felt the notification could be done through a mailing or through the local paper; but in any case, the Health Department should make every effort to notify everyone. Board Members Porter/Faughender moved and seconded that the Board adopt the Group B Water System Regulations with the following changes: On page 3 of 6, Section 7.03, the designer's certificate may be suspended by the Director for a period not to exceed 30 days for competency, negligence, misrepresentation, or for failure by the holder to comply with any other requirement of this regulation, unless the Health Officer feels a decision on revocation is needed. On page 5 of 6, under appeals, that any reference to the Board would be changed to Health Officer and that the hearing date sentence on the third line should read: A hearing date shall be scheduled with the Health Officer within 30 days. And on page 6 of 6, the effective date of this regulation shall be effective 60 days following public notification of the adoption. Motion carried unanimously. She asked Mr. Banner if he felt 60 days was too long. He responded that it would be fine. Chairperson Hunter asked for discussion. Board Member Porter asked about page 4 of 6, Section 7.05; revocation of designer certificate. She stated that the valid due process issue is important. She felt that if the Director suspended a certificate, then the Health Officer needed to hear from the Director and the person holding the certificate. Mr. Banner replied that if the appeal goes to the Health Officer, it needs to be independent from the Health Officer until it is appealed. The Board agreed. Chairperson Hunter asked for any further discussion. None heard. PUBLIC HEARING - CONSIDERATION OF WELL DRILLING FEE ADOPTION Chairperson Hunter read aloud the public hearing notice to consider adoption of a $60 well drilling fee to cover costs associated with tagging, inspecting, and decommissioning wells. Mr. Banner gave a staff report on this proposal. He noted that the Department has been working with the Department of Ecology to look at delegation of well tagging duties. This proposal is closely tied to whether or not the department receives the contract with DOE. Therefore, they need to consider adopting the fee proposal with a revision that it go into effect when and only if the contract is approved. He explained that the well driller would come into the office, fill out an application and pay a $60 fee. Chairperson Hunter asked for public comment. Bill Neal, Arcadia Well Drilling, Inc., stated he MASON COUNTY BOARD OF HEALTH March 3, 1994 - Page 8 of 10 worked hard on this proposal at the state level so that the county could take over delegation. Since 1971 it has been law that wells have to be sealed. DOE did not have anyone in the field until the late 1980s. Some are not being built to state standards. Therefore, tagging wells, if contaminated, was important. He stated that the merit of what is being asked to be done warrants an extra fee. The money being sent back to the county by the state will not be enough. It was important and warrants fee. He strongly encouraged the Health Department and Board Members to work with DOE for the contract. He commented that the implementation date of March 1st was not attainable, and that he would like to see it be implemented 60 days after public notification. Dick Szymarek, DOE, stated he was not planning to comment on the initiation of the fee, but was present to comment on questions regarding the contract. It was moved/seconded by Board Members Faughender/Porter that the Board approve the well inspection fee of$60 contingent upon signature and approval of the contract between DOE & Mason County; effective 60 days after public notification. Motion carried unanimously. Board Member Porter asked if the fee would be concurrent with the program implementation. The Board concurred that the program and fee would be implemented at the same time. Chairperson Hunter asked for comment regarding the contract proposal. Mr. Banner stated that it had been negotiated through meetings, an understanding reached, and then drafted. Mike Clift, Prosecuting Attorney's Office, reviewed the document as to form. His only comments on the contract were involving the Special Terms and Conditions Section. He pointed out that the contract will expire June 30, 1995, however a 2 year contract had been discussed. Regarding the funding; there would be a $10,000 one-time payment; and then 50% of fees collected. He stated they had talked about a minimum amount if fees did not reach $20,000. Mr. Banner stated he felt he had a solution to this. He suggested a revision to the section to address what they had talked about. Mr. Szymarek, DOE, stated that the draft had been completed with great haste. Addressing Mr. Banner's first concern.regarding the period of performance, he stated that the attorney for DOE said they could not encumber funds past the next fiscal year. He noted that it was DOE's intention to continue on, but for legal purposes had to show a June 30, 1995 expiration date. He had then added a statement that the contract may be extended. In regards to the funding, he apologized for any misunderstanding. He recalled talking about an average number of about 400 wells a year and 50% being $20,000. He stated they were conversing in magnitude, and 50% is what they had talked about. Mr. Szymarek stated that the state cannot be encumbered for more than 100% of fees collected in the county. His concern is that they won't reach 400 wells in Mason County. A minimum amount cannot be set as law will not allow. He stated he was open for suggestions, but encumbering the state to $20,000 cannot be done. Board Member Porter asked if it was a matter of language. Mr. Szymarek replied that yes, the language suggested by Mr. Banner tends toward the $20,000 figure rather than the total amount collected. He stated t - MASON COUNTY BOARD OF HEALTH March 3, 1994 - Page 9 of 10 he would like to look at it more carefully so it is easier to understand and more direct. His initial feeling was to stick with 50% of funds collected and the $10,000 one-time grant. Board Member Faughender asked if Mr. Szymarek was asking for time to look it over. Mr. Szymarek replied that yes, he would like to work with Mr. Banner, that this was the first time he heard of the revision. He stated he would hate to make a decision based on 3 minutes of conversation. He stated that if he had guessed they had felt they were describing a$20,000 minimum, he would have advised at that time. Board Member Faughender asked if the sentence regarding the period of performance could be tailored to be more friendly, since it is the intent of DOE to continue beyond the one year. Mr. Szymarek replied that he would be happy to do so. He noted that the regulation has a 1996 sunset legislation clause in it. It was DOE's intent at that time to testify, once again, in favor of continuing the delegation. The sunset clause had been included to see how it was working out. Board Member Faughender stated that in the worst case, the county would go back to inspecting. Mr. Szymarek replied that he would hate to see that as this was a good opportunity. He commented that the new draft would include a clause noting that it was printed on recycled paper and that he would allow for a report section, so they can evaluate how everyone is doing based on a written report. Board Member Porter asked how much time would be needed. He replied that it could be ready by the second week of March, easily by the third week. He noted that DOE was required to give notification state-wide to all well drillers and receive comment. This notification was mailed out the day before, so DOE could not sign until 60 days had passed. However, that will be a working period, and their attorney will review it before then. Mr. Banner stated that the BOH doesn't sign the contract, the Commissioners do. He stated the revisions could be reviewed through briefings with the Commissioners. It was moved/seconded by Board Members Porter/Faughender that the BOH endorse the contract from the health standpoint, subject to the Commissioners dealing with financial issues. In other words, the BOH endorsed the adoption of the program reflected in the Memorandum of Agreement once the other issues were resolved. Motion carried unanimously. PUBLIC HEALTH WEEK PROCLAMATION Chairperson Hunter announced that the Governor of the State of Washington had declared Public Health Week, and desired the BOH to declare a proclamation in conjunction. It was moved/seconded by Board Members Porter/Faughender that the Board adopt the proclamation establishing Public Health Week as recommended by Governor Lowery. Motion carried unanimously. MEETING CONTINUED It was moved and seconded by Board Members Porter/Faughender that this BOH meeting be continued until March 18, 1994 at 9:00 a.m., in their usual meeting location, Building 3 Conference Room. Motion carried unanimously. MASON COUNTY BOARD OF HEALTH March 3, 1994 - Page 10 of 10 MASON COUNTY BOARD OF HEALTH o n William O. Hunter, Chairperson Laura E. Porter, Board Member Mary L. Faughender, and Member Respectfully submitted, 6AW�L Lorraine Coots