Final Minutes of the State Board of Health

August 9, 2017
Cherberg Building, Senate Hearing Room 3
304 15th Ave S.E.
Olympia, WA 98501

State Board of Health members present:

Keith Grellner, RS, Chair Thomas Pendergrass, MD, MSPH, Vice Chair
The Honorable Jim Jeffords Fran Bessermin
Diana T. Yu, MD, MSPH Angel Reyna (by phone)
Stephen Kutz, BSN, MP
Kristin Peterson, Assistant Secretary of Health
Systems Quality Assurance, Secretary’s Designee

State Board of Health members absent:

James Sledge, DDS, FACD, FICD

State Board of Health staff present:

Michelle Davis, Executive Director Sierra Rotakhina, Health Policy Advisor
Melanie Hisaw, Executive Assistant Alexandra Montaño, Health Policy Analyst
Kelie Kahler, Communications Manager Lilia Lopez, Assistant Attorney General
Stuart Glasoe, Health Policy Advisor Kelse Kwaiser, Health Policy Intern

Guests and other participants:

Deanne Calvert, Sanofi Genzyme
Kate Shin, Community Member
Susie Bautista, Community Member
Lisa Snidermanking, Community Member
Sihoun Hahn, UW/Seattle Children’s
Kanwaldeep Mallhi, Fred Hutchinson/Seattle Children’s
Samantha Louderback, Washington Hospitality Association
Jesse McCoy, Community Member
Megan McCrillis, Department of Health
Ryan Day, March of Dimes
Joe Kunzler, Community Member
Michelle Austin, Department of Health
Titus Fordham, Community Member
Scott Sigman, Bluebird Bio
John Thompson, Department of Health
David Hudson, Department of Health
Theresa Phillips, Department of Health
Holly Davies, Department of Health
Kelly Cooper, Department of Health
Jessica Baggett, Department of Health
Laura Johnson, Department of Health
Max Bronstein, Audentes Therapeutics
Nancy Zakes, Zakes Foundation
Garret Fordham, Community Member
Spencer Fordham, Community Member
Rachel Fordham, Community Member

Keith Grellner, Board Chair, called the public meeting to order at 9:00a.m. , and read from a prepared statement
(on file).

1. APPROVAL OF AGENDA
Motion: Approve August 9, 2017 agenda
Motion/Second: Pendergrass/Bessermin. Approved unanimously

2. ADOPTION OF JUNE 14, 2017 MEETING MINUTES

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Motion: Approve the June 14, 2017 minutes

Motion/Second: Pendergrass/Jeffords. Approved unanimously

3. BOARD ANNOUNCEMENTS AND OTHER BUSINESS

Michelle Davis, Board Executive Director welcomed the Board to Olympia. She shared that the
meeting is on TVW and is streaming live online. She directed Board members to materials under
Tab 3. She announced Kathryn Steele is serving an internship with the board (biography on file),
and updated the Board on a recruitment for a half time position that will assist with health impact
reviews and other policy work.

Ms. Davis indicated that the Governor had appointed Dr. Chris Frank to represent local health
officials. She expects the Governor to appoint the city officials representative soon. She
congratulated Member Reyna on his reappointment to the Board. New members will join the Board
at its October meeting.

Ms. Davis directed the Board to the rule documents (on file) and announced the filings for extension
of the school rule, and adoptions of the Rabies and immunizations rules. The Board took action on
these rules in June. She alerted the Board about a rulemaking petition, scheduled for discussion later
in the day. She also identified correspondence to and from Representatives Ormsby and Chandler
and Senators Braun and Ranker regarding a proviso focused on donated foods prepared in private
residences. Ms. Davis said she received public comment from Ms. Gallion late last night and
indicated she would distribute it to Board members when staff return to the office.

4. DEPARTMENT OF HEALTH UPDATE

Kristin Peterson, Assistant Secretary of Health Systems Quality Assurance, Secretary’s Designee,
said the Secretary of Health is unable to attend as he is out of state on business. Member Peterson
talked about new staffing updates at the Department, primarily in a number of leadership roles.
Member Peterson said the Department was pleased that the legislature passed and allocated $12
million in funding for one of their top priorities; Foundational Public Health Services. This is
important in order to invest and modernize the public health system. Legislative funding also
included $3 million for work on lead. The Department received the authority to increase the fee for
newborn screening (NBS), which will allow for the addition of Adrenoleukodystrophy to the
screening panel. Other funding included; $6 million to invest in targeted case management for high-
risk populations with health disparities and HIV early intervention program; $700,000 from general
fund state to increase capacity for suicide prevention assistance; and funding to invest in breast,
cervical and colon health programs. Behavioral health care continues to be an issue the Department
is watching. Member Peterson invited Kelly Cooper to discuss the Department’s current work on
lead issues. Ms. Cooper said that the Department asked for about $10 million for lead funding in
response to last year’s Governor’s Lead Directive. The Department received $1.5 million for this
year and $1.5 million for next year, for a total of $3 million for lead purposes this biennium. The
legislature asked the Department to work with the Educational Service Districts to prioritize the
schools. At this point, there is enough funding to test about 250 schools.
Member Peterson shared further work by the Department to address health disparities in rural
communities, and discussed what is on the horizon for the next legislative session. Member Peterson
said noted that the legislature did not take action on the capital budget, which affects projects such
as the NBS lab boiler repair and expansion of the NBS wing. This also affects the state revolving

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drinking water loan fund. The Department has had to place about 74 projects on hold across the
state.

The Department is working on HB 1427 to address the opioid crisis and update the opioid
prescribing rules. This effort includes working with health professional boards and commissions.
The Department has planned seven stakeholder meeting across the state. Next year will be a short
legislative session and the Department is still drafting decision packages.

5. UPDATE — 2017 HEALTH IMPACT REVIEWS

Alexandra Montaño, Board Staff, provided an overview of health impact reviews (HIRs), outlined
the growth in the HIR work over the past eleven years, the reviews conducted during the 2017
legislative session, and the HIRs that Board staff are working on during the current interim. Ms.
Montaño noted that there has been a significant increase in the number of HIR requests and the
number of first time requestors (presentation on file). She highlighted upcoming projects related to
HIRs including working towards a publication for the strength-of-evidence criteria, a blog post
about HIRs, and a poster presentation at the Washington State Public Health Association
conference in October.

Chair Grellner thanked Ms. Montaño and Sierra Rotakhina, Board Staff on the quick turn-around,
writing, and useful summary content provided in the HIRs. Chair Grellner said he shares the HIRs
around his office and thanked staff for the work. Tom Pendergrass, Vice-Chair said the HIR is
important to bringing scientific evidence into policy-making.

Chair Grellner asked if Ms. Montaño has noticed changes of positions on bills or changes in the
language of bills based on findings from HIRs. Ms. Montaño did not recall observing language
changes in bills due to HIRs. Ms. Montaño said staff are working to follow-up with legislators who
requested a HIR this year to get feedback on the impact and influence that HIRs may have had on
their decision-making.

Ms. Davis noted HIRs are unique and is work staff does upon lawmaker requests. Ms. Davis
expressed her appreciation to the Legislature, the Governor, and the Department of Health for their
support in seeing that the Board received some additional capacity for the biennium.

Vice Chair Pendergrass said the University of Washington library system is crucial to the HIR work
and said the Board should ensure that access to the system is not dependent on a retired faculty
member. Vice Chair Pendergrass suggested that Ms. Montaño present information about HIRs to
the National Conference of State Legislatures.

Ms. Rotakhina added that anecdotally staff heard from legislators that they are using HIRs to inform
their decision-making. Ms. Rotakhina said that there was an external evaluation of HIRs, which is in
draft manuscript and waiting publication. The report highlighted new feedback including
information about how legislators use HIRs in closed-door budget conversations; highlighting the
level of impact this work is reaching.

Note: meeting was ahead of schedule, so #15 Legislative Update, switched here at 9:50am

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6. BRIEFING — DRINKING WATER LABORATORY CERTIFICATION AND DATA REPORTING

RULES

Stuart Glasoe, Board Staff, introduced Derrick Dennis, Department of Health from the
Department’s drinking water program. He noted that Mr. Dennis’ presentation would provide
background on the Department’s primacy agreement with the U.S. Environmental Protection
Agency implementing the Safe Drinking Water Act, the Department’s memorandum of
understanding with the Department of Ecology on lab certification, history and highlights of the
draft rules, and next steps in the rule-making project.

Mr. Dennis described the Department’s mission of protecting drinking water and key parts of its
drinking water program. He then provided a background on the laboratory certification program;
objectives and reasons for revising the rules; key issues addressed in the rule making; and process
steps taken to revise the rules, engage stakeholders, and respond to public comment on the draft
rules (presentation on file). Based public comment, the Department made changes to the draft,
adding language allowing both paper and electronic reporting; delaying implementation six months
to allow use of pre-printed stock of paper reporting forms; and clarifying technical terms and
definitions for added accuracy. He anticipates filing the CR-102 (proposed rule) in October, holding
the Board public hearing in November, and filing the CR-103 (adopted rule) in January 2018. The
rule would go into effect sometime in February 2018.

Stephen Kutz, Board Member asked if there are any critical guideline standards requiring labs to
notify the department by phone if the lab finds something unexpected. Mr. Dennis answered yes
and explained that there are specific actions required in the rules related to both bacteriological and
chemical contaminants at certain levels. Response under such circumstances typically require same
or next day reporting. Chair Grellner asked about the four tables with state detection reporting limits
(SDRL) and whether the Department has looked at the tables to ensure the tables correlate with the
MCLs in chapters 246-290 and 246-291 WAC. Mr. Dennis responded yes and clarified that the
tables are detection limits advising the labs on how low they should go and whether they should
report a non-detection or an actual number. So it relates to the very low limit of what a laboratory
can detect whereas an MCL is usually higher than those levels.

7. PUBLIC COMMENT
Note: Testimony related to the rules hearing took place in the afternoon.

Chair Grellner opened the meeting for public comment and read from a prepared statement (on
file).

Ms. Deanne Calvert, Director, State Government Affairs at Sanofi US/Genzyme stated her support
for the addition of both conditions to the newborn screening panel. She read from an article she
distributed to Board members. Ms. Calvert stated that Sanofi Genzyme believes that newborn
screening for Pompe disease and MPS I provides the greatest chance for babies born with these
conditions to have the best opportunity for early-treatment and to reach their highest potential. Ms.
Calvert suggests that in the future, the cost-benefit analysis take into greater account the benefit of
treatment, such as productivity gains, quality of life benefits, and the impact on caregivers.

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Ms. Kate Shin, Community Member, shared her personal experience learning that their youngest of
five children, Ruby, was born with infantile onset Pompe disease. Ms. Shin shared the effects of the
condition on her family. Ms. Shin said that after Ruby started Enzyme Replacement Therapy (ERT),
her motor skills greatly improved. Due to financial challenges in 2015, Ms. Shin and her family
struggled to balance the costs of Ruby’s treatment. Ms. Shin highlighted the emotional impact
Pompe disease has had on Ruby and her family. She said that early detection could have improved
all their lives, prevented much pain and suffering, and offered Ruby a higher quality of life. Ms. Shin
urged the Board to support newborn screening for Pompe disease to help minimize the pain,
suffering and medical expenses and to prevent family financial crises and to save lives.

Dr. Sihoun Hahn, Director, Biochemical Genetics at Seattle Children’s Hospital, provided a briefing
of his medical experience diagnosing and managing care for patients with Pompe disease. Dr. Hanh
discussed different health outcomes associated with early detection of Pompe disease and early
initialization of Enzyme Replacement Therapy (ERT). He expressed his support for implementing
newborn screening for Pompe disease and MPS I. Dr. Hahn added that failure to support screening
for Pompe disease would lead to tragic and sad consequences for patients and families.

Dr. Kanwaldeep Mallhi, Clinical Research Division, Fred Hutch and the University of Washington,
spoke about the benefits of newborn screening for both patients with Pompe disease MPS I. Dr.
Mallhi spoke on the efficacy of treatment associated with early detection and reiterated her support
for implementation of early screening for both Pompe disease and MPS I.

Ryan Day, March of Dimes testified in support of including MPS I, and Pompe disease in the
newborn screening panel. He emphasized the importance of early treatment. He said he believes that
the cost-benefit analysis did not capture the financial costs of delayed treatment for a family as they
seek an accurate diagnosis. He shared his personal story of the financial and emotional challenges
associated with caring for a child with a rare disease. He said March of Dimes fully supports
implementation of newborn screening tests for both Pompe disease and MPS I.

Joe Kunzler, Community Member, testified on the Island County jet-noise issues and referenced
written comments he also provided to the Board. He said that he believed a health impact
assessment would take away resources from basic public health for Island County Board of Health.
Mr. Kunzler said the Board should consider removing the state health apparatus and allow the
federal environmental impact statement (EIS) process to play out. He discussed his personal and
family connection to military service, his interest in protecting Outlying Field Coupeville, and letting
the federal court process play out. Mr. Kunzler thanked the Board for their public service.

The Board took a break at 11:10 a.m. and reconvened at 11:25 a.m.

8. UPDATE — ISLAND COUNTY JET NOISE

Mr. Glasoe provided background to help reset the Board’s work on this issue. He said that in
October 2016 the Board heard about health concerns from jet noise associated with Naval Air
Station Whidbey Island (NASWI) and received a complaint against two Island County health
officials filed by Citizens of Ebey’s Reserve and Concerned Island Citizens claiming the health
officials failed to carry out their duties to protect public health from the noise. At the Board’s
meeting in November 2016, the Board directed staff to work with the Department of Health to
conduct a preliminary investigation to determine the merits of the complaint and to report to the
Board. In March 2017, the Board received a briefing from the Department of Health on a literature

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6 Washington State Board of Health
Draft Minutes – August 9, 2017

review of the health effects of jet noise. In the briefing the Department listed recommendations it
made to the Navy on its draft environmental impact statement for expanded airfield operations at
NASWI, including a recommendation to conduct a health impact assessment (HIA). The Board
passed a motion endorsing the Department’s recommendations. The Board also received a briefing
from Board staff on the investigation of the complaint and passed a motion dismissing the
complaint. While considering a third motion at the March meeting the Board lost its quorum and
was unable to complete its work. At today’s meeting the Board resumed consideration of the motion
previously under consideration and an alternate version. On a related matter, Mr. Glasoe also
mentioned submittal of a letter to the Department of Ecology for its federal consistency review of
the expanded airfield operations under the Coastal Zone Management (CZM) Program restating the
Board’s recommendation that the Navy conduct a health impact assessment.

Chair Grellner said that the Board could consider the original motion presented at the Board’s
March meeting or the revised motion, or take no action. Vice Chair Pendergrass spoke in favor of
the revised motion. He said he was distressed to learn in this process that aviation issues are federal
issues and are beyond the Board’s and the Department of Health’s authority. He said federal
representatives and senators should be advised that this is an issue. He spoke of his support for the
military and the need for training. He said the motion places the responsibility with the Navy and
recognizes the monitoring function of the Island County Board of Health and health officials.
Member Peterson agreed given the jurisdictional issues and supported ongoing monitoring of the
issues. Fran Bessermin, Board Member said the Board’s Environmental Health committee met, had
discussions and believes this is the right avenue to take. Member Kutz said the Island County
Commissioners and Island County Board of Health have authority to address some of these issues if
they choose to do that. Their decisions to allow building to occur around aircraft have contributed
to this and he does not want to let them off the hook. If they continue to let building occur, they are
the ones who will need to figure it out. Chair Grellner said this was a challenging topic for the Board
and it learned a lot through the process. He agreed the armed forces need the training to carry out
their missions safely. However, the Department literature review demonstrated health impacts from
aircraft noise and the Navy is expanding the number of flights. He said it seems logical for the Navy
to conduct a health impact assessment to protect their own people as well as those neighboring the
airfield. This motion does not ask the Navy to stop but to consider the health effects on those
surrounding the airfield. He felt comfortable with the motion. Diana Yu, Board Member asked
about plan B because the Navy can choose not to do anything. The issue depends on the
Department of Defense to study—it is a balancing act with shades of gray. Island County leaders
can look at what they can do with zoning but it may be too late for those who have built in the area.
She empathized but did not know other solutions for the area. She said we need the pilots to train
and we need the citizens of Coupeville to have quality of life. The question is how to achieve that
and it is not in the Board’s jurisdiction. Vice Chair Pendergrass said he thinks there is a plan B and
C. They are not health regulations but rather growth management and engaging the Representatives
and Senators who represent Island County to engage with the Department of Defense and move
this up as a priority. There is noise and it is disruptive, but from a policy and regulatory point of
view, this motion acknowledges the limits of what we can do and what the Island County Board of
Health and their officers can do. It falls to the Island County Commissioners and others to see how
they can deal with this. We know King County has dealt with these issues. They bought a bunch of
houses on the approaches to SeaTac. They moved people out. It was difficult, but it can be done.
This is much more than a health issue.

Recommended Board Action:

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Washington State Board of Health 7
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Motion: If and when the Navy conducts a Health Impact Assessment on military jet noise exposure, the Board
recommends the Island County Board of Health and Island County health officials monitor the project and coordinate
with the Navy as resources allow. The Board directs staff to follow up with the Island County Board of Health on the
State Board of Health’s actions on this matter and to continue monitoring the issues.

Motion/Second: Jim Jeffords/Steve Kutz. Approved unanimously

9. BRIEFING — NEWBORN SCREENING TECHNICAL ADVISORY COMMITTEE (TAC)

RECOMMENDATIONS (POMPE DISEASE AND MPS I)
Member Yu reminded members the Board and Department of Health collaborated to convene a
Technical Advisory Committee (TAC) to determine if Pompe disease and MPS I meet the Board's
five criteria for determining if a new condition should be added to the newborn screening panel. The
TAC met on April 26, 2017 and June 28, 2017. She said this decision was one of the most difficult
she had to make during her tenure with the Board. Ms. Rotakhina thanked the Department for their
partnership in convening the TAC. She said there were 14 voting members at the first meeting and
12 voting members at second meeting (to consider cost-benefit). She advised the Board to consider
the conditions separately. She also referred Board members to written public comments.

Megan McCrillis, Department of Health, presented information on MPS I and as well as the votes
and comments from the TAC (presentation on file). She said there is a similar advisory board at the
federal level and the panel added both conditions.

MPS I
Following the presentation, Board members discussed and asked questions about the impacts for
infants with the severe form of MPS I, the less severe forms, and those who get a false positive
newborn screen. They discussed that for babies with the severe form, they will be identified and
provided treatment in a timely manner, for those with a later onset form (up to age 5) they may have
to receive an annual exam, and for false positives it may take a few weeks to confirm that it is a false
positive.

The Board next discussed treatment. Vice Chair Pendergrass pointed out that at this point we are
seeing that treatment has positive impacts, but we do not know that the therapies are completely
effective or completely benign. He noted that we are trying to minimize long-term effects and
maximize well-being. MPS I is a disease where we can make a difference. He reminded the Board
that it takes time to actually make the rule change and begin screening. John Thompson,
Department of Health, noted that he anticipates that the Department could begin testing in the fall
of 2018.

Motion: The Board directs staff to file a CR-101 to initiate rule making for chapter 246-650 WAC to consider
adding Mucopolysaccharidosis type I (MPS I) to the newborn screening panel.

Motion/Second: Tom Pendergrass/Fran Bessermin. Approved unanimously

Ms. McCrillis then presented information on Pompe disease and as well as the votes and comments
from the TAC (presentation on file). Dr. Thompson noted that the cost-benefit analysis requires a
dollar value, and that it is important to remember that these are real lives and the outcomes of the
analysis changes depending on what dollar figure you put on the value of a life. Chair Grellner asked
if treatment costs are shifted to the state. Vice Chair Pendergrass confirmed that many patients do

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8 Washington State Board of Health
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end up having their treatment costs covered by the state because most families cannot absorb the
cost of high treatment after their insurance coverage maxes out.

He went on to note that they do not know yet how long treatment will work because we do not yet
have decades of experience with long-term treatment. Member Yu noted that current treatment can
improve the lives of these individuals and technology continues to improve. She noted that once
those children lose function due to the delay in diagnosis they cannot get it back. Member Bessermin
pointed out that early detection and treatment improves the lives of the entire family. Member Yu
agreed that other societal costs are difficult to capture in the cost-benefit analysis.

Vice Chair Pendergrass noted that Pompe disease is affecting families and children, that it is
something that we can do something about, and if we delay detection, we have lost the benefit of
early treatment. Member Kutz asked if the follow-up literature for Pompe disease is less robust or
comparable to MPS I. Ms. McCrillis noted that Pompe disease is much more ambiguous than MPS I
because there are adult onset forms. Other states that are screening for Pompe disease are doing
annual follow-up with the individuals they have identified. Ms. Rotakhina referred Board members
to TAC members’ comments that were included in their ballots. Chair Grellner noted that he
recognizes the findings of the cost-benefit analysis but also the low incidence of the condition.
Member Yu said it will take time and will of the Legislature to fund the increase in the newborn
screening fee that would be required to add Pompe disease to the newborn screening panel. Vice
Chair Pendergrass highlighted that this was a difficult decision but that he does not believe that
delaying screening another two to five years is in the best interest of the children of Washington.

Motion: The Board directs staff to file a CR-101 to initiate rule making for chapter 246-650 WAC to consider
adding Pompe disease to the newborn screening panel.

Motion/Second: Tom Pendergrass/Fran Bessermin. Approved unanimously

10. PETITION FOR RULEMAKING ON FOOD SERVICE RULE—WAC 246-215-09150

Mr. Glasoe explained the petition process of the Administrative Procedures Act (RCW 34.05.330),
which allows any person to petition a state agency requesting adoption, amendment, or repeal of any
rule. Upon receipt of a petition, the agency has 60 days to either (1) deny the petition in writing
stating the reasons, or, as appropriate, offer other means for addressing the concerns raised by the
petitioner, or (2) accept the petition and initiate rule making.

On July 10, 2017, the Board received a rule-making petition from the Washington State Food Truck
Association. The petition requested a change to WAC 246-215-09150 increasing the minimum
distance to employee restrooms for mobile food units from 200 feet to 500 feet. The petitioner cited
a 2015 City of Seattle study identifying access to restrooms as the most difficult requirement to meet
when applying for mobile food unit permits. The petitioner claimed a change in the restroom
standard would create more vending locations for food truck operators. The Department of Health
reviewed the petition and recommended that the Board accept it and file a CR-101, Preproposal
Statement of Inquiry. Board staff agreed with the Department’s recommendation.

Rick Porso, Department of Health, explained the Department’s review and recommendation to
accept the petition. He clarified that this does not necessarily mean agreement with the requested
change, but rather willingness to open the rule, work with stakeholders, and discuss the potential to

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update the current standards for restroom distance. The 200-foot standard has been in place since at
least 1992. He added that the Department can also work with local health jurisdictions to consider
variance requests for those who cannot meet the current 200-foot standard. He explained that
distance is one item to consider but the real issue is convenient access to restrooms as well as
handwashing facilities—and developing guidance to locals that can be helpful in this case.
Independent of the petition he said there are many food issues emerging from many angles. To
assist with this, this fall the Department is establishing an ongoing food advisory committee to help
address issues in a more proactive way. He added that he Department has established a special
home-food advisory committee (HFAC) to advise on such issues as donated food and potential
commercial sale of home-prepared foods. Chair Grellner and Mr. Glasoe will represent the Board
on this committee. The goal is to assess pathways for safe and legal food preparation from the home
and to develop consensus-based recommendations for decision-makers.

Member Kutz asked if county jurisdictions were consulted on the 200-foot standard and whether it
is a real problem. Mr. Porso said they have done some informal work with about half the
jurisdictions and they are not aware of variances at this point. He added that the study itself focused
on downtown Seattle. Mr. Glasoe added that the study seems quite credible identifying the issue as a
barrier to permitting but they are looking at it from the perspective of flexibility siting their trucks.
We need to look at it from the perspective of food safety. In making the motion, Member
Bessermin again clarified that the action is to evaluate the matter and see if a rule change is possible.

Motion: The Board accepts the petition for rule-making to amend WAC 246-215-09150 and directs staff to file a
CR-101, Preproposal Statement of Inquiry, to further evaluate the request and possible rule change.

Motion/Second: Fran Bessermin/Tom Pendergrass. Approved unanimously.

The Board recessed for lunch at 12:30 p.m. and reconvened at 1:30 p.m.

11. PUBLIC HEARING — CHAPTER 246-650 WAC NEWBORN SCREENING

(ADRENOLEUKODYSTROPHY)
Member Yu re-introduced Ms. Rotakhina and Dr. Thompson. Ms. Rotakhina noted that the Board
received one written public comment on the proposed rule (on file) encouraging the Board to add
adrenoleukodystrophy (ALD) to the newborn screening panel. She share staff recommendation to
make one minor change to the rule. At the Board’s June meeting, the Board rescinded its delegation
of WAC 246-650-101, Newborn Screening Definitions, to the Department to update the text so that
it appropriately refers to individuals with disabilities. Board staff recommend updating the text in the
definition section of the rule to reflect terminology consistent with Chapter 94, Laws of 2010 while
the rule is already open.

Public Testimony:

Chair Grellner opened the meeting for public comment and read from a prepared statement (on
file).

Nancy Zakes, Ethan Zakes Foundation, is the mother of a child who passed away from ALD. Ms.
Zakes shared her family’s story and described how newborn screening would have changed the

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10 Washington State Board of Health
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outcome for her son. She thanked the Board and the Legislature for their work in adding ALD to
the newborn screening panel.

Garret Fordham, Community Member, shared a story with the Board about how his brother came
to find out about his diagnosis with ALD. Mr. Fordham urged the Board to add ALD to the
screening panel so that all children have the opportunity to grow up like his brother.

Motion: The Board adopts the proposed amendments to WAC 246-650-010 and WAC 246-650-020 (newborn
screening) to add X-linked adrenoleukodystrophy to the newborn screening panel, as published in WSR 17-14-102,
with the additional revisions agreed upon at today’s meeting; and directs staff to file a CR-103, order of adoption, and
establish an effective date.

Motion/Second: Bessermin/Yu. Approved unanimously

Note: meeting was ahead of schedule, so switched #12 with #13)

12. BRIEFING — HEALTHIEST NEXT GENERATION
Member Peterson introduced Daisye Orr, Department of Health, to present on the Department’s
Healthiest Next Generation (HNG) Initiative. Ms. Orr provided background on the program as well
as the points of influence that drive the recommendations and infrastructure changes. She discussed
the importance of collaboration of the teams and committees that work together to coordinate
agency change.

Vice Chair Pendergrass shared a number of issues that he would like to see the HNG initiative
address including sidewalks, safe routes to school, and bringing youth communities together in
person. Ms. Orr thanked him for his comments and shared successes related to his points. Member
Bessermin said because classroom teachers who have to take on extra duties there is a need for
people to supervise, teach, and instruct children on playgrounds.

Kelse Kwaiser, Board Staff, provided a short introduction on the youth civic engagement project
that she is doing for her MPH Practicum project in collaboration with the Board and Department.

13. RESCIND VISION SCREENING INTERPRETIVE STATEMENT

Vice Chair Pendergrass said the Board has an interpretive statement file that clarifies that RCW
28A.210.020 does not prohibit schools from offering “voluntary screening for vision problems other
than distance vision acuity.” When the Board adopted amendments to the vision- screening rule in
January of 2017, it made this clarification in the rule language itself. He noted that the Board no
longer needs this interpretive statement as a result. Ms. Rotakhina added that the Administrative
Procedures Act recommends that agencies incorporate long-standing interpretive statements into
rule to assure clarity.

Motion: The Board rescinds SBOH 11-01, Permissibility of screening school children for vision acuity using
procedures in addition to the Snellen eye chart test for distance acuity (filed as WSR 11-18-002); and directs staff to
file a memo with the Office of the Code Reviser to rescind the vision screening interpretive statement.

Motion/Second: Pendergrass/Kutz. Approved unanimously

14. SMILE SURVEY AND WASHINGTON’S ORAL HEALTH

PO Box 47990 • Olympia, Washington • 98504-7990

Phone: 360/236-4110 • Fax: 360/236-4088 • Email: WSBOH@doh.wa.gov • Web: http://sboh.wa.gov/
Washington State Board of Health 11
Draft Minutes – August 9, 2017

Vice Chair Pendergrass introduced David Hudson and Shelley Guinn, Department of Health to
present the 2015-2016 Smile Survey findings. Ms. Guinn presented data that demonstrates
disproportionate rates of tooth decay across racial/ethnic groups. Although the data demonstrates
that Washington State as a whole is meeting the Healthy People 2020 goal for tooth decay, we
continue to have work to do to achieve health equity within that goal.

Vice Chair Pendergrass noted that sealant use is similar among American Indian/Alaska Native
children, however; the sealant does not seem to work as well for this population as it does for other
racial/ethnic groups, and asked why that may be. Ms. Guinn said that this data does not necessarily
indicate that sealants are failing for some populations. Carries may be developing on teeth surfaces
that are not protected by sealants (e.g. between the back teeth). Member Kutz commented on the
potential for engaging with the Governor’s Health Disparities Council to collaborate on broader
disparities discussions. Member Kutz asked if the dental hygienists that go into the school to provide
dental care provide care for all students or only those with Medicaid. Ms. Guinn said they go into
schools with high percentage of Medicaid-eligible students and are mandated to provide sealants to
all students in a school. Member Kutz discussed access to care in the Medicaid system and the
importance of access to oral health care for the entire family. Ms. Guinn said that getting pregnant
women oral health care would help make a dent in reducing carries. Vice Chair Pendergrass said
many things are going in the right direction but there is a need to look deeper into why some these
health disparities still exist.

15. LEGISLATIVE UPDATE (moved to 9:50am)

Ms. Davis gave a legislative update (on file) and shared the number of bills Board staff tracked and
monitored during the 2017 legislative session and subsequent special sessions. She highlighted key
bills that fell within the Boards 2017 key legislative priorities and other bills of note. Ms. Davis
reminded the Board that all bills that died in the 2017 session will carry over into the 2018 legislative
session, and the Legislature may reconsider or act on these bills. Staff continue to follow bills that
died this year. Ms. Davis discussed foundational public health services and the bill’s intention to
assist the advancement of the foundational public health services effort. Ms. Davis reminded the
Board of its Public Health Is Essential resolution, and said the bill failed to pass the Senate Budget
Committee. Although the bill failed to pass, the operating budget included $12 million dollars for
foundational public health services. Ms. Davis says that of the amount received, $2 million dollars
will go to the Department of Health (including $125,000 for the Board for the purposes of hiring a
Health Impact Review Analyst at half time), and $10 million dollars will go to Local Public Health
Jurisdictions.

Member Kutz said he sits on a Tribal Foundation Public Health Sub-Committee with Torney Smith
from Spokane. He said the group has discussed Foundational Public Health Services using a tribal
point of view, and had discussed how to integrate a tribal point of view into the whole process. Ms.
Davis said the Tobacco 21 legislation requested by the Department and by the Attorney General
failed but will carryover into the 2018 legislative session. Board staff conducted an HIR on this bill.
Member Kutz asked if the bill also prohibited the sale and the transfer of those products to people
under 21. Ms. Davis responded that she would check and report to the Board.

Ms. Davis discussed bills that aligned with the Governors directive on lead on drinking water, as well
as legislation related to opioids. Vice Chair Pendergrass said opioids present a challenging issue due
to the rapid increase of people presenting to emergency services with narcotic overload and the
unique properties of prescribing and managing patient care. Member Yu commented on the

PO Box 47990 • Olympia, Washington • 98504-7990

Phone: 360/236-4110 • Fax: 360/236-4088 • Email: WSBOH@doh.wa.gov • Web: http://sboh.wa.gov/
12 Washington State Board of Health
Draft Minutes – August 9, 2017

different approaches for responding to the opioid epidemic. Member Kutz observed the lack of
collaborative efforts between the specialty physicians and the primary care physicians in tracking
prescription history and using the tracking tools. Ms. Davis reminded the Board that one of the
important pieces of the bill is that there will be greater access to information in the prescription drug
monitoring program healthcare providers within the system and there is a piece that will allow
certain groups to have access to the monitoring program for improvement efforts and prescribing
practices. Member Yu indicated that this is an appropriate role for public health to take in
consideration of the resources required for prescription tracking.

Ms. Davis discussed the Board’s past interest in safe medicine return and noted that larger local
health jurisdictions that have taken on this issue due to failed legislative attempts. A statewide
approach could achieve greater consistency across all communities.

She also reported on several other pieces of legislation including the donation of home-prepared
foods to charitable food organizations, exemptions for inflatable water slides, on-site sewage
legislation, and transient accommodations contaminated by methamphetamine. Ms. Davis also
spoke on was the paid family and medical leave, a bill that passed and clarified the benefits the bill
provides to a worker, parent, family member or military exigencies.

Chair Grellner asked about HB 1757 inquiring whether it is local health’s responsibility to
investigate. Ms. Cooper replied to Chair Grellner that she believes that the Department’s role with
contaminated drug labs is certifying the contractors who do the work and it is her guess is that the
investigation would be local but will need to confirm this. Ms. Davis returned to Member Kutz’s
question asked earlier about the transfer of Tobacco products to people under 21 years old and
clarified that selling or giving tobacco to anyone under 21 years old was included in the bill, and is a
misdemeanor.

16. BOARD MEMBER COMMENTS

Chair Grellner asked Board Members to share any comments or updates. Member Kutz said he
returned from canoe journey in Canada. He witnessed the rampant tooth decay among American
Indian/Alaska Native (AI/AN) youth. He discussed the issue of fear in families and reluctance to go
to the dentist unless they need to. The ABCD program made huge progress and we need to figure
out the next big step we need to take. Many AI/AN individuals do not live on reservations and can
only access dental care through Medicaid.

ADJOURNMENT

Keith Grellner, Board Chair, adjourned the meeting at 3:07 p.m.

WASHINGTON STATE BOARD OF HEALTH

PO Box 47990 • Olympia, Washington • 98504-7990

Phone: 360/236-4110 • Fax: 360/236-4088 • Email: WSBOH@doh.wa.gov • Web: http://sboh.wa.gov/
Washington State Board of Health 13
Draft Minutes – August 9, 2017

Keith Grellner, Chair

PO Box 47990 • Olympia, Washington • 98504-7990

Phone: 360/236-4110 • Fax: 360/236-4088 • Email: WSBOH@doh.wa.gov • Web: http://sboh.wa.gov/