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11/16/23 02 PM: BOH Agenda Approved; Health Updates; Septage Issues; Disaster Prep

BOH Agenda Approved; Health Updates; Septage Issues; Disaster Prep

Board approved agenda with onboarding addition and minutes. Updates on staffing, Jefferson Healthcare expansion, state priorities, infectious diseases, septage capacity challenges, disaster behavioral health, and reconstituted onboarding subcommittee. Joint BOCC meeting set for fees.

Approval of Agenda with Addition

Metadata

  • Time Range: 00:02:38–00:04:13 (PART 1)
  • Categories: operations

Summary

The chair proposed adding a new business item on re-initiating efforts for Board of Health orientation and onboarding new members as item 3. Commissioner Brotherton made a motion to approve the agenda with this addition, which was seconded and passed unanimously.

Key Discussion Points

  • Chair recommended brief 2-minute discussion to decide on continuing the effort and set context (Chair).
  • Shad Gray requested addition due to prior group efforts to improve and streamline onboarding processes (Shad Gray, referenced by Chair).

Public Comments

No public comment on this topic.

Supporting Materials Referenced

No supporting materials referenced.

Financials

No financial information discussed.

Alternatives & Amendments

No alternatives discussed.

Outcome, Vote, and Next Steps

  • Decision: Agenda approved as amended with new business item 3 on Board of Health orientation for new members.
  • Vote: Unanimous (all in favor by aye).
  • Next Steps: No next steps specified.

Approval of Minutes

Metadata

  • Time Range: 00:05:20–00:05:43 (PART 1)
  • Categories: operations

Summary

The board approved the minutes from the October 19 meeting without discussion.

Key Discussion Points

  • Motion to approve minutes as submitted, seconded (Unattributed motion and second).

Public Comments

No public comment on this topic.

Supporting Materials Referenced

No supporting materials referenced.

Financials

No financial information discussed.

Alternatives & Amendments

No alternatives discussed.

Outcome, Vote, and Next Steps

  • Decision: Minutes approved.
  • Vote: Unanimous (all in favor by aye or thumb).
  • Next Steps: No next steps specified.

Public Health Director's Information Report

Metadata

  • Time Range: 00:05:58–00:14:19 (PART 1)
  • Categories: personnel, planning, other

Summary

Director Apple acknowledged the local landscape, honored departing staff Chris Goy, noted seasonal themes of abundance and grief, highlighted positive staffing levels with ongoing recruitments, praised new hires' skills, and reported cross-departmental progress on climate change and emergency preparedness funded by Foundational Public Health Services. Environmental health teams are preparing fee changes for a joint BOCC-BOH special meeting.

Key Discussion Points

  • Positive staffing outlook; still recruiting talented people (Apple).
  • Shoutouts to Ocean, Lara Gaslin Titro, Laura Siddini, and managers for climate/emergency work (Apple).
  • Fee increase of 6.01% (3.56% CPI + 2.54% for wage increases; wages up 19% since 2020, fees only CPI-adjusted since then); special meeting November 27 at 10:30 AM (Apple, Pinky).

Public Comments

No public comment on this topic.

Supporting Materials Referenced

No supporting materials referenced. Fee proposal planned for December but combined with BOCC ordinance repeal/replace on clerk's advice.

Financials

  • Fee increase: 6.01% overall.
  • Wage increases: 19% since 2020.

Alternatives & Amendments

No alternatives discussed.

Outcome, Vote, and Next Steps

  • Decision: Informational; special meeting scheduled November 27, 2023, at 10:30 AM joint with BOCC.
  • Vote: None.
  • Next Steps:
  • Attend joint hearing November 27 (All Board members).

Jefferson Healthcare Update

Metadata

  • Time Range: 00:14:19–00:26:34 (PART 1)
  • Categories: infrastructure, services, budgeting, personnel

Summary

Jefferson Healthcare reported ongoing staffing shortages (40 short, 675 FTEs/~850 people, high traveler nurse costs), progress on demolition/construction of 56,000 sq ft facility (abatement of 65 building complete early December, opening early summer 2025), new bonds approved ($66M public sale + $46M bank loans for $89.2M construction + loan payoffs), and planned services including expanded OBGYN, neurology, radiation oncology. Discussion noted low local tax support relative to other hospitals and need for community education.

Key Discussion Points

  • Bonds: $66M public (sale November 16), $46M bank; total project $89,207,191 incl. $7M taxes ($2M local) (Speaker, likely hospital rep).
  • Radiation oncology: Separate building, 7-ft concrete walls; ~100 patients/year currently travel out-of-county (Hospital rep).
  • Levy: ~$0.5M/year (<1 day operations); other hospitals get 5-10x more per capita (Hospital rep).
  • Workforce: Reducing travelers to cut costs (Hospital rep).

Public Comments

No public comment on this topic.

Supporting Materials Referenced

No supporting materials referenced. Jefferson Healthcare website and Foundation videos mentioned for patient stories.

Financials

  • Construction cost: $89,207,191.
  • Bonds: $66M public + $46M bank.
  • Taxes in project: $7M ($2M Jefferson County/city).
  • Levy revenue: ~$500,000 annually.
  • Workforce: 675 FTEs.

Alternatives & Amendments

No alternatives discussed.

Outcome, Vote, and Next Steps

  • Decision: Informational update.
  • Vote: None.
  • Next Steps: Monitor bond sale results (November 16); continue recruitment.

State Board of Health Update

Metadata

  • Time Range: 00:26:34–00:34:41 (PART 1)
  • Categories: planning, other

Summary

Kate Dean reported State BOH legislative priorities including adding accepted capacity, school environmental health rules (2009 rules unimplemented, potential study/funding via proviso), climate resilience for Group A water systems (overlaps county water plan), rule-writing authorized to DOH, and incorporating traditional ecological knowledge (TEK/IKE). HEAL Act changes consultation with tribes.

Key Discussion Points

  • School rules: From 1970s enforced; update needed post-pandemic (air quality) (Kate Dean).
  • Climate/water: New GMA element; county coordinated water plan lagging (Kate Dean).
  • TEK: Storytelling panel; challenges integrating with best available science (Kate Dean).
  • Consultation: HEAL Act, treaty rights via management conferences (Kate Dean).

Public Comments

No public comment on this topic.

Supporting Materials Referenced

No supporting materials referenced.

Financials

No financial information discussed.

Alternatives & Amendments

No alternatives discussed.

Outcome, Vote, and Next Steps

  • Decision: Informational.
  • Vote: None.
  • Next Steps: No next steps specified.

Infectious Disease Update and Public Health Statement

Metadata

  • Time Range: 00:34:41–00:39:26 (PART 1)
  • Categories: public safety, services

Summary

Dr. Barry reported declining COVID hospitalizations (1-2/week), emerging RSV/flu in EDs, urged vaccines (flu/COVID for most, RSV for elderly/pregnant/infants) and masking indoors. Acknowledged Israel-Gaza crisis: >4,000 child deaths, impending infectious disease surge from shortages; public health duty to speak for vulnerable.

Key Discussion Points

  • Masking protects young/elderly/immunosuppressed (Dr. Barry).
  • Gaza: Civilian deaths exceed combatants; post-violence disease risk (Dr. Barry).

Public Comments

No public comment on this topic.

Supporting Materials Referenced

No supporting materials referenced.

Financials

No financial information discussed.

Alternatives & Amendments

No alternatives discussed.

Outcome, Vote, and Next Steps

  • Decision: Informational.
  • Vote: None.
  • Next Steps: No next steps specified.

Septage Disposal Capacity Challenges

Metadata

  • Time Range: 00:39:26–01:02:02 (PART 1)
  • Categories: infrastructure, planning, operations

Summary

Pinky presented ongoing septage disposal issues since 2021: limited local capacity (PT compost facility 4,000 gal/day; no FOG acceptance), out-of-county restrictions, Port Hadlock sewer incoming (dewatered to compost), 54 food establishments with combined systems. City PT analysis complete (Sep 2023, $30K funded 2022); options: $20M forced main to WWTP, $6M to collection, $3.8M existing improvements. Regional issue (7/12 jurisdictions affected); present to BOCC Dec 18. Nitrogen rules, ecology pressures noted.

Key Discussion Points

  • History: Black Lagoon closed 1990s; PT SBR partnership (Pinky).
  • FOG: No local acceptance; private Mason Co. only regional option (Amanda Grace).
  • Regional: WWTPs at capacity 5-10 yrs; no obligation to accept septage (Apple, Amanda Grace).
  • Expansion: City best packaged solution; county/private alternatives have pros/cons (Pinky).
  • Legislative: Elevate to Ecology/DOH; nitrogen conflicts (Pinky).

Public Comments

No public comment on this topic.

Supporting Materials Referenced

No supporting materials provided. City PT capacity analysis (Sep 2023) referenced.

Financials

  • Capacity study: $30,000 (2022).
  • Expansion options: $20M, $6M, $3.8M.

Alternatives & Amendments

  • County-owned or private facility considered (management/funding/cost risks) (Pinky).
  • Dewatering: Possible but Ecology approval/costly; historical aversion (Pinky, Amanda Grace).

Outcome, Vote, and Next Steps

  • Decision: Informational; agenda request for BOCC presentation Dec 18 by Dan Mayham (H2 Engineering).
  • Vote: None.
  • Next Steps:
  • Present options to BOCC December 18 (Pinky, Commissioner Eisenhower).

Disaster Behavioral Health and Climate Vulnerability

Metadata

  • Time Range: 01:02:13–01:50:22 (PART 1)
  • Categories: planning, public safety, services, other

Summary

Dr. Kira Marcel presented on integrating behavioral health into disaster/climate planning: rising disasters (5x in 50 yrs), population impacts (4-10% mental health rise), phases (impact/rescue/honeymoon/disillusionment/reconstruction 18-24 mos), cascades prolong recovery, risk tiers (systemic/primary/secondary), IDEAL model (Identify strengths/Develop insight/Resilience/Active coping/Listen). Emphasized psychological first aid, resilience (purpose/adaptability/hope/connection), scalable interventions. Q&A on COVID grief acknowledgment (none large-scale), disparities, integration into prep.

Key Discussion Points

  • Disasters rising; survivors up, cumulative trauma risk (Dr. Marcel).
  • Interventions: PFA early, education honeymoon, resilience building (Dr. Marcel).
  • COVID: No national memorial; local/school examples (Dr. Marcel).
  • Prep: Include in EM training, multilingual resources (Dr. Marcel, board discussion).

Public Comments

No public comment on this topic.

Supporting Materials Referenced

No supporting materials referenced. Slides offered for sharing.

Financials

No financial information discussed.

Alternatives & Amendments

No alternatives discussed.

Outcome, Vote, and Next Steps

  • Decision: Informational presentation.
  • Vote: None.
  • Next Steps:
  • Share with Emergency Management (Willie Benz), 2-020 (Apple).
  • Integrate into neighborhood prep, trainings (Board discussion).

Board Member Onboarding Subcommittee

Metadata

  • Time Range: 01:50:51–01:57:07 (PART 1)
  • Categories: personnel, operations

Summary

Shad Gray requested reconstituting onboarding subcommittee (previously formed) to improve/streamline processes using digital tools (minimal meetings). Volunteers: Shad Gray (lead), Commissioner Brotherton, Kate, Glenn. Discuss tribal recruitment progress (ongoing outreach).

Key Discussion Points

  • Use digital collaboration (e.g., Google Docs alternatives) for sections (Shad Gray).
  • Board page already centralized resources (Commissioner Brotherton).
  • Tribal: Outreach via personal interaction, AIHC (Glenn).

Public Comments

No public comment on this topic.

Supporting Materials Referenced

No supporting materials referenced.

Financials

No financial information discussed.

Alternatives & Amendments

No alternatives discussed.

Outcome, Vote, and Next Steps

  • Decision: Reconstitute ad hoc subcommittee.
  • Vote: None (informal agreement).
  • Next Steps:
  • Glenn initiate Zoom with Shad Gray, Brotherton, Kate to plan resources/approach (Glenn).

Background Materials

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