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Wellfleet Board of Health
Minutes of Meeting of October 9, 2002
Senior Center, Long Pond Room
Present: David Breen, Chair; Betty Kimball, Lezli Rowell, Geoffrey Karlson,
Zel Levin; Emily Beebe, Health Agent; Helen Miranda Wilson, Water
Issues Advisory Committee
Chair Breen convened the meeting at 7:00 p.m.
Discussion regarding VNA Contract As It Addresses Flu Shot Clinic. Health Agent Beebe, stating that she would make copies of the VNA contract for the next meeting, explained her proposal for a different way to administer the free flu shot clinic heretofore run by the VNA. She stated that the Town contracts with the VNA for $6500 per year, looking to them to provide basic clinics (blood pressure, colorectal, etc.) as well as home visits throughout the year. Included in that service has been the free flu shot clinic; however, since Wellfleet this year received only 150 shots from the Department of Health (fewer than requested and fewer than last year), Ms. Beebe feared that the previous method of using the VNA to dispense shots at the Senior Center on a first-come, first-served basis would not be an
effective way to insure that those in the greatest risk areas were able to get their shots. She proposed combining with Outer Cape Health Services and putting the free doses for the town and the facility together, therefore better servicing the community. Further, this clinic would be located in a medical facility which would schedule appointments for the shots with the benefit of offering time slots over several different days, making it unnecessary for patients to wait in line to be served and insuring that those in the high risk group would receive them. She added the proposal that, after the free shots were used up, patients be asked to pay $3.00 per shot; since patients are regularly charged $20 per shot, a $3.00 donation should not seem unreasonable. She strongly urged the Board to recommend this plan.
Lezli Rowell asked if EMTs, etc. are categorized in the upper tier; Beebe replied that they have their own budgets and are covered.
Geoff Karlson asked who would keep the schedule and was told that volunteers and the staff of the Council on Aging would do so. He questioned whether, once the free shots ran out, there was an indefinite number of paid shots. Ms. Beebe stated that there was a limited number of shots in total and that every year the town asks for more than it receives. Karlson commented that there should be an established criteria to be fair to the people who needed shots the most.
Beebe noted that the town paid the VNA about $800 last year for administering the clinic and giving the shots; she feels that Outer Cape would be less costly and might be able to offer more than 150 free donations.
Rowell asked how other VNA clinics have worked out; Beebe replied that the blood pressure clinics are very successful. She added that although the Board was discussing only the flu shot clinic at this time, she could supply documentation for all the other VNA clinics. To RowellLezli Rowell moved and Betty Kimball seconded that the Board of Health approve a plan that the Town of Wellfleet combine with Outer Cape Health Services for the flu clinic of 2002; the motion was passed unanimously, 5-0.
Discussion Regarding Board of Health Policies. Elements of this discussion follow:
q Betty Kimball felt that the BOH was coming to the discussion without some needed information; she had called other towns requesting policies but nothing had been forthcoming.
q Health Agent Beebe read from a copy of the Board of Selectmenq Zel Levin emphasized that formulation of policy needs common sense and need not be heavily regulated, since restrictions are already on the books.
q Mrs. Kimball suggested use of material found in MHBA, the state periodical from the Mass Associated Boards of Health; she had found a good source in an article entitled q Geoff Karlson stressed that when policies have to do with technical matters: (1) consistency is important and (2) submitting engineers should know what is expected.
q Ms. Beebe agreed that the BOH needs to have some policies, e. g. licenses, written down and consistent.
q David Breen agreed with Levinq Lezli Rowell, stating that she had made some notes on regulations for the policies section, suggested that some recent BOH regulation decisions should be revisited in a public hearing, specifically the upland decision (608), bedroom definition (302), and requirements for triggering use of nitrogen reducing system (607B).
q In connection with the above, Helen Wilson (from the audience) emphasized the importance of posting agendas; she stated that she had tried to find out if there was grandfathering for health regulations in the state and there is not; therefore, it is a good idea to have a fully publicized hearing.
q Health Agent Beebe suggested another subject for BOH regulations: the need to address elevated ground water in a septic inspection. Since this is one of the elements which triggers an upgrade, it needs to be well-defined; she has an office policy of 5 feet adjusted which needs to be written into a regulation in accordance with the Boardq Beebe added that the BOSq Lezli Rowell suggested a series of standard conditions on non-conforming dwellings for variance requests, adding that she would also like lot coverage and lot size to be clear. Ms. Beebe added that there should be a standard for the scale of plans allowing nothing smaller than 1 to 30.
q David Breen turned to his concern about another policy matter: how to conduct the BOH image in public. He used the example of writing or speaking under the name of the BOH and the need to clear this with the BOH, mentioning Geoffrey Karlsonsituation should give notice to the BOH that he has been asked to speak.
q Geoff Karlson explained that he was unable to announce his intention at a BOH meeting, since the 9/11 meeting, at which he would have done so, was cancelled. He added that he sent BOH members an outline of his talk and commented that the Taxpayersthem.) Karlson, noting that Breen had also earlier mentioned an article Karlson had written for the Banner at the time of his Town Meeting role as BOH representative, stated that he had been authorized by the Board to present its opinion to Town Meeting by unanimous vote, had researched his material thoroughly, and used this material as the basis of the article.
q Chair Breen suggested that in the future when a BOH member speaks to a group or writes an article, he should not allow himself to be presented as a BOH member; Karlson agreed that one should state that he speaks for himself and not as a member of the BOH but not that he should hide his identity as a Board member. Ms. Beebe emphasized that in speaking to a group or writing for the paper, Board members must make it clear that they are not authorized to represent the opinion of the Board. Betty Kimball stated that it is a courtesy to the BOH to apprise it of such speech or writing. Karlson suggested that the Board should, on a critical issue, come to a
consensus of opinion and send this out under everyoneq Chair Breen added a further policy suggestion: an unwritten policy that the Board members should try not to defame anyone petitioning the Board
Discussion Regarding Water Supply. Chair Breen, citing a suggestion he had made at an earlier meeting, directed that the discussion move around that table so that each Board member might briefly state his opinions on water quality issues.
q Geoffrey Karlson stated that he felt that rather than give an opinion on the water situation, he would explore how people made decisions about water issues. He felt that people listen to all explanations, often become confused, and may ultimately choose the least expensive. If this is so, he continued, it is a dangerous situation and the Board needs to know what to do to counteract it. He suggested that the BOHwhether we know enough to make a determination, (3) come to a consensus. He wished the Board to consider his document (an earlier distribution of his presentation to the Taxpayersq Lezli Rowell stated that an easy answer to the question of water quality is that both ground water and surface waters are important resources, but that she liked the idea of taking Karlsonq Chair David Breen stated that since he has been on the Board of Health, he has listened to the many presentations concerning Wellfleetto vote for a $12 million school system to which a great majority would be denied admission, which is only open 3 days a month, and which teaches highly suspect material.
q Zel Levin stated that he agreed with the recommendation that the municipal buildings be served by a water system.
q Betty Kimball stated that she has listened to and read all the Wellfleet water proposals and was surprised that the Environmental Partners concentrated just on the Coleq Health Agent Beebe agreed that Mrs. Kimballq In a comment on the Seashore representatives at the Environmental Partners meeting (their land surrounds possible well sites), Beebe stated that she did not have the sense that they were in a negotiating mind-set, that removal of water is seen as mining in the Park, and they are always obliged to consider all the towns. Helen Wilson disagreed, feeling that the Park will respond after the town tells them where the site will be. Beebe felt that the Park might entertain one well but might not entertain two in their Zone 2 and that they were not oppositional to the town.
q Wilson discussed state regulations in which any lot in the State of Massachusetts that abuts a water main can hook up to that main; at that point the lot is served by a municipal system, and Title 5 septic regulations are relaxed. She suggested that it was possible that the Board of Health might consider a regulation that all of Wellfleet would have to comply with Title 5 standards. Ms. Beebe added that the BOH can designate Wellfleet as a nitrogen sensitive area. Lezli Rowell suggested that the BOH look at Regulation 508 (Coleq In connection with the water report, Ms. Wilson discussed the landfill capping, no leaching of water there, and the town's reaching build-out in that area. She stated that under no circumstances should a big well that would serve more hook-ups be put on the site next to the Herring River (Coleq Lezli Rowell, speaking of Ms. Wilson's claim of the
Discussion Regarding Wastewater. Since time was growing late, the Board, noting that the above discussion had contained some discussion of wastewater, decided to return to further consideration of this topic at another meeting.
Minutes of September 25, 2002 and Other Business. Lezli Rowell moved and Geoffrey Karlson seconded approval of the minutes of 9/25/02; the motion passed, 4-0-1 (Breen). The Board signed a warrant for collection of taxes for Harborside Condominiums.
Health Agent
The meeting was adjourned at 9:45 p.m.
Respectfully submitted,
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Frances J. Castillo, Assistant to the Committee Secretary
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