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WC CWF Health District Board Minutes - 07/13/2018WICHITA FALLS-WICHITA COUNTY PUBLIC HEALTH BOARD MINUTES July 13., 2018 Wichita Falls -Wichita County Public Health District 1700 Third Street - Parker Conference Room Wichita Falls, Texas BOARD MEMBERS PRESENT: David Carlston, Ph.D., Chair Julie Gibson, D.V.M., Vice -Chair Melissa Plowman Keith Williamson, M.D. BOARD MEMBERS EXCUSED ABSENCE: Robin Moreno, MHA-HSAI, ACHE. Secretary Larry Rains, D.D.S. Kathleen Williamson, MSN, Ph.D., R.N. OTHERS PRESENT: Lou Kreidler, R.N., B.S.N. Amy K. Fagan, I.P.A. Amy Gardner Woodrow W. Gossom, Jr. Citizen At -Large -County Veterinarian -City Restaurant Association -City Physician -City Citizen At -Large -City Dentist-Cou my Registered Nurse -City Director of Health Assistant Director of Health Municipal Court Prosecutor Wichita County Judge I. CALL TO ORDER Dr. David Carlston called the Health Board meeting to order at 12-22 pm after a quorum of members was attained. 11. APPROVAL OF MINUTES AND ABSENCES Dr. David Carlston called for the review and approval of minutes from the meeting held on Friday May 11, 2018. Dr. Julie Gibson introduced a motion to approve the minutes as presented and Melissa Plowman seconded the motion. The motion passed unanimously. At this time, it was noted the excused absence of Robin Moreno, Dr. Larry Rains and Dr. Kathleen Williamson. Ill. ON -SITE SEWAGE FACILITIES (OSSF) ORDINANCE Environmental Health presented an overview of changes to the OSSF ordinance at the Health Board meeting on March 9, 2018. Susan Morris the Environmental Health Administrator advised since then a stake holders meeting was held with all the installers those in the business for septic tank installation and on -site sewage facilities their concerns were taken into consideration and changes made. She visited with State officials that gave her some suggestions she made changes then sent the ordinance to the State. The ordinance was sent back from the State with recommendations she made changes with justification then returned to the State and it was sent back approved. If the Board approves the ordinance it will be taken to the City Council, Burkburnett, Iowa Park, Electra, and County Commissioners for their approval so that an updated current ordinance order would be consistent across the County. The enforcement and regulation of the ordinance would be easier if it was the same across the County and there are only two changes not that huge. The first change was homeowners in the old ordinance could regulate their own aerobic septic system that had the effluent which sprinkled out onto the yard if treated with chlorine and had electronic monitoring. The electronic monitoring fell through the National Sanitation Foundation (NSF) stopped providing the electronic monitoring service so the ordinance was out dated. Susan Morris reviewed all ordinances in the State some stated that homeowners could do their own maintenance on the effluent aerobic septic system if the homeowners went through a maintenance providers class. In Texas to be a maintenance provider for the effluent aerobic septic system they must have experience, attend and pass a class to become a company to maintain systems. Before approval was by TCEQ whom suggested the change because there may be other courses come available the regulatory authority can approve. The homeowner must own the home and live in the home it cannot be a rental property. City of Wichita Falls Code of Ordinances Chapter 106. Utilities Article V. Sewage Disposal Systems Division 3. On -Site Sewage Disposal Sec 106-408. Additional Requirements 7. On -Site Sewage Facilities Maintenance and Management Practices.- Maintenance contract requirements for all OSSFs are identified in 30 TA 285.91 (12). Further, maintenance and management practices shall comply with 30 TAC 285.7 and 285.39. a. No homeownerlproperty owner shall be allowed to perform any maintenance on an on -site disposal system using aerobic treatment unless the homeownerlprop erty owner; 1) What was put in the ordinance was that a homeowner can do their own maintenance when documentation is provided of their completion and passing a basic OSSF maintenance course approved by the regulatory authority for aerobic treatment units and the property to be maintained is owned by the trained homeowner or 2) Holds a valid wastewater Class D license or higher wastewater treatment license or 3) An owner of an OSSF lawfully installed as of October 1, 2009 who has maintained said OSSF prior to that date may continue to do so. 4) All of the above mentioned must be able to demonstrate to a licensed designated representative of the Health District that he can perform the following procedures for maintaining the OSSF.- replacing air filters, cleaning aerobic diffusers'. spinners and agitators, cleaning pumps, testing for chlorine and fecal collform, monitoring rabidity, scum and sludge build-up, controlling odor, and ensuring the application area is distributing properly and according to the original system design. The owner must inspect the OSSF and submit an inspection report to the Health District every four months. An owner who fails to submit inspections as required shall not be permitted to self -maintain, and will be required to obtain a testing and reporting contract from a licensed OSSF maintenance provider. The other change was a fairly big change when Susan Morris conversed with installers and maintenance companies all supported the change. Wichita County has about 900 aerobic systems with several 1. 00 that do not have current maintenance contracts and several 100 that do not operate properly. The Health Department would be held accountable to ensure the systems are maintained. Maintenance Companies would be accountable to register with Environmental Health at no cost any failure to turn in the reports three times a year as required would warrant suspension that would cease the Company to obtain any more contracts until the suspension was rescinded. The Company would still be able to provide maintenance for those 'Individuals that had already paid $200 to $300 for the maintenance contract just no new contracts could be obtained. Homeowners would be provided the ordinance in order to also be held accountable. If a homeowner wants to take the course it now is offered in San Marcus for $325 but the homeowner could probably get two maintenance contracts for that course cost. Judge Gossom inquired if it was a one-time course or would be continuing education. Susan Morris replied the homeowner is not a maintenance company and would not provide the service to other people so there would be no continuing education for the homeowner. 7-b- Each maintenance provider having contracts in Wichita Falls shall register with Wichita Falls - Wichita County Public Health District (Health District) Environmental Health Division. Maintenance KA provider registration shall be effective ve from the date of registration to December 3 1 " of the same year. Renewal maintenance provider registration for the next year shall not be accepted before December Is' of the current year. New and renewal maintenance contracts will only be accepted from maintenance providers whose regl . stration is current and in good standing. Maintenance provider registration shall be free of charge. 1) Maintenance providers who fail to perform maintenance testing at the required intervals, mark an inspection tag, or submit a report on time two (2) or more times during any twelve (72) month period may have their registration suspended for no longer than one (1} year in addition to any other penalties that may apply. Na new or renewal maintenance contracts will be accepted from a maintenance provider during the time their registration is suspended. 2) A licensed OSSF maintenance provider will submit an inspection report for each OSSF to the Health District every four (4) months. Renewal contracts shall be for a term of no less than one (1} year and include at least three (3) inspections. Contract renewals with the same maintenance provider will not be accepted by the Health District unless a// of the maintenance reports from the previous contract period have been received. Susan Morris deems the changes as reasonable. The process to update the database has been a lot of paperwork with daily entries, reports ran, letters sent out to all the maintenance companies for notification of what is now expected and notices on expired contracts as an alert to get a new contract. The maintenance companies have hustled to work with the homeowners to get in the contracts. No charges have had to be filed because the homeowners have been responsive to convey they bought the house and did not know the requirement. The homeowners are required to file an affidavit at the Courthouse on the property that states a system is in the yard that it requires a maintenance contract that is filed on the deed. Some reason it never becomes known when the property sells so the buyer does not know to have a maintenance contract. Judge Gossom questioned if the Realtors are aware of that. Susan Morris answered yes a search is never done for it so it never gets revealed and the Title Companies should be aware. Wichita County Clerk Lori Bohannon has been asked for some reason it is hard to find it is a piece of paper filed in the County but the Title Companies never find it. Judge Gossom asked if it was a standard State form. Susan Morris said it was a standard affidavit filed in the Courthouse. Judge Gossom perceived it should be part of the closing. Susan Morris affirmed it should be it has always been in the ordinance as a requirement for an inspection at closing and an aerobic system Is not approved unless it has a current contract. Sometimes the homeowners are not dealt with only the Realtors unless the Realtor tells the homeowner of if or if it sells without a Realtor it can be an honest mistake so the approach has been to do it in a friendly manner. It will take a couple of years to get it all caught up and done. Eric West asked if any push back from the City Council or any others was to be expected, Susan Morris said usually from one City Councilor but the Councilor usually comes around. Lou Kreidler asserted it is a push back on everything. Dr. David Carlston asked for any other questions with no response he introduced a motion to recommend the changes to the Ordinance as presented. Dr. Keith Williamson introduced a motion to approve the Ordinance changes as presented and Melissa Plowman seconded the motion. The motion passed unanimously. Lou Kreidler advised the ordinance changes would go to Council the second week in August. There 3 are requirements that must be met prior to taking to Council. It has to be posted in the newspaper and be so many days before going to Council when it is on all the Council Agendas there will be a public hearing with a vote. IV. COUNTY HEALTH RANKINGS Amy Fagan the Assistant Director of Health every year visits with the Board about the County Health Rankings and Community Health Assessment. The Health District Vision is Healthy People, Healthy Community through the Mission of Prevention, Promotion, Protection the three components to accomplish the Vision. The Strategic Plan is specific to the Health District mission with three primary outputs from the strategic planning process'. strategic targets, goals, and strategies. Susan Morris does a lot with the Environmental Health regulations then there are Animal Services and the Laboratory all are different areas that appear dissimilar in many ways but the focus is on how to do these things together to move toward a common mission. The strategic plan focuses in on to build knowledge among the community about who the Public Health District is, what the Public Health District does and how to accomplish that. The focus today is on the Community Health Assessment that has been done since 2011 with a publication of 50 pages with charts and graphs that people did not read. A supplemental shorter condensed update was published with focus on factors in the Community of where a difference can be made and of interest to the public. The County Health rankings come out annually from the University of Wisconsin with the Robert Wood Johnson funding. Remember with the rankings of the ranked counties which is 242 that Archer County ends up being 911 or 1111 on the list every year because there is not any way to record health outcomes with no physician office or reporting methodologies those residents tend to come into Wichita County for care. All that data information ends up coming from Wichita County so it is not a fair apples -to -apples but does give some basic information on how the community ranks. Unfortunately, Wichita County ranked 193 out of 242 Texas counties, 168 in Health Outcomes and 144 in Health Factors. A huge factor in Health Outcomes is Premature Death in Wichita County at 9,200, Texas at 6700 and Top U.S. Performers the gold star at 5,300 an inspiration to achieve it is a challenge with the lag of data uncontrollable. The period 2012-2014 saw a small spike then back down now with a better year than last however not even close to where Texas is it identifies an incredible amount of work to be done. Premature death can be a result of many factors an evaluation of the lead causes of death under age 75 can indicate those causes directly related to premature death. The leading causes of death under age 75 in Wichita County are: Cancer, Disease of the Heart, Accidents, Chronic lower respiratory disease, Chronic liver disease and Cirrhosis, Not before the last two years have estimates of new cancer cases and death been offered to project what type of cancer people in the community tend to get and die from, in the past it had been historical data. A chart of the top five cancer and death rates associated with the cancer was reviewed. Lung and Bronchitis are in the lead but anticipated to change with the passage of the Smoke Free Ordinance in Wichita Falls and Burkburnett it made a big difference to second hand smoke exposure. Estimated New Cancer Cases and Expected Deaths Expected New Cases Expected Deaths Total Male Female Total Male Female -Type Lung and Bronchitis 109 55 54 69 39 30 Breast 76 1 75 16 0 16 excludes Rectum 36 20 34 16 0 18 10 9 -Colon Prostate 34 12 12 0 Melanoma of the Skin 32 19 14 4 3 1 One issue studied is how people perceive their health someone completely healthy can perceive their health as poor that would cause poor health outcomes because of the perception of health then the complete opposite occurs someone unhealthy perceives themselves as healthy. The Perception of Health as Fair or Poor by Income Levels meets expectations for those that make less than $25 ,00 4 annually have a higher percentage of poor or fair of their perception of their overall health. That confirms that economics as it has been known has close ties with the perception of health which has close ties with the health outcorres. Adult Obesity percentage of the adult population age 20 and older that reports a body mass index (BIVII greater than or equal to 30: Wichita County 33%, Texas 28%, Top U.S. Performers 26%. It does not capture overweight only obesity. Physical Inactivity percentage of adults age 20 and over reporting no leisure -time physical activity, Wichita County 29%, Texas 24%, Top U.S. Per -formers 20%. Challenging, scary and troubling this year is the Alcohol -Impaired Driving Deaths percentage of motor vehicle crash deaths with alcohol involvement- Wichita County 35%, Texas 28%.. Top U.S. Performers 13%. STI Infections only for Chlamydia incidence (number of new cases reported) per 100,000'. Wichita County 504, Texas 523, Top U.S. Performers 145. Incredibly high for STI's in the community as in Texas there are other challenges with Gonorrhea and Syphilis. Wichita County ranked 241 out of 242 in Health Behaviors. The community is unhealthy with all the work done on the Eat Well Wichita County and Live Well Wichita County campaigns how much gets absorbed to change behavior. The work needs reformed to not tell people what they should do but to provide the education, knowledge and power to make changes. Public Health is incredibly important because the Mission of Prevention, Promotion, Protection works to help make improvements. The Public Health District County Health Assessments and Community Health Assessments ask people how healthy do they think Wichita County is the replies are not very healthy then it is asked how healthy do they think they are the replies are pretty good. In comparison to the Driver philosophy everyone is out on the road, I can barely make it to work with all the bad drivers on the road, are you a bad driver, no I am great, no one would say that they are the bad driver in the scenario. People need the help to identify how to make personal health changes then the overall, health outcomes can change. Free Diabetes Prevention classes and Diabetes Education and Empowerment (DEEP) classes provide an hour of education and 30 minutes of physical activity for people whom have pre -diabetes or diabetes. Out of all the advertisement and 20 physician referrals only 3 people signed up for the Diabetes Prevention Classes. After consideration the classes have been rebranded now called Health Living classes. When it was posted on Facebook people responded wanting to come to a Healthy Living class which prompts the reevaluation of what resonates with people and make changes. Once a quarter a morning is dedicated to staff engagement and advocacy. The Board of Health is asked to be advocates for the Public Health District to help educate the public and provide awareness of the Vision and Mission. The focus is on quality improvement to look for ways to make the improvements and continue to engage with the Community partners that includes the Clinical systems, Health Coalition and the Healthy Eating Active Living sub group of the Coalition. It all is a big job with a lot of work to be done. Judge Gossom mentioned a Resilience Program through United Way coming to Wichita Falls in October the researchers went back looked at the health outcomes to detect where it started. A survey is taken that asks was there any violence in the home, sexual abuse, a list or stressful or traumatic events. In the study over about 20 years it shows that people who are overweight, with heart disease, mental health issues whom score 3 out of 10 are likely to be suffering as an adult. The adult that has children just carries on what had happened. It must become a community effort but how do communities come up with change. Call it Healthy Outcomes, Diabetes program, etc., when he was first diagnosed with diabetes he went a year without any treatment because he was still active in the Army he had that it is not me but it was and that is part of it when you call it Diabetes 5 no it is not me. Amy Fagan viewed that as something to seek input from Judge Gossom on as moving forward on projects since the County works in a different capacity. The Diabetes Prevention classes have been done for two years it was pondered why only 2 or 3 people showed for class. Sometimes the leaders in the individual groups are too close to see to figure it out but relieved that it was. There certainly will be more of the same work ahead. Dr. Gibson thinks to start with children is the starting point because kids can make their parents turn around sometimes too. Always gear toward the kids because they learn at an early age it comes more normal for them. Any Fagan stated the evidence is behind that approach. Dr. Gibson does think the majority of people do want to live and eat healthier it is just a matter to get the information out there on how to live and eat healthier. Everyone eats so fast, everything is fast paced and harder to do then back when being a kid and the mom cooked now everyone eats out. Amy Fagan asserts there is too much information blasted all the time which raises the question on how to get the programs information out there or how to help people sift through what is there. It can be too much for people and thought to be unmanageable. Anew class is to start called Chronic Disease Self -Management Education (CDSME) to teach people how to live better with their chronic disease no matter what the disease. One thing taught is to basically cease all the other stuff, Facebook ads, what the friends are doing and figure out what works for you in your house that is going to be a really Important message. The Public Health District has partnered with the United Regional Physicians Group to officially start the CDSME class the first week of August at their location with another class in the fall and one in the spring. Dr. Carlston articulated with all the Prevention material the focus is always on the bad things that can happen. Everything to be done to be healthier is punishing it takes away enjoyable things and adds things not enjoyable are you would already be doing them. In terms of branding there needs to be a way to make life style change appealing. Everybody groans with the mention of diet or change the way to eat it is not appealing it is much easier to keep doing what you are doing. Amy Fagan agreed. As well as nnarageable so that it is sustainable. V. NEXT MEETING DATE Friday September 14, 2018 was noted as the next meeting date. V1. ADJOURN Dr- David Carlston adjourned the meeting at 12-57 pm. cl r016 C-(5. Print Name David Cariston, PhD. Chair, Julie Gibson, DVM, Vice -Chair, Robin Moreno, MHA-HAS. ACHE, Secretaty Wichita Falls -Wichita County Public Health Board it _Count Board 0