Clark County Board of Health

0:00 [Music] >> This webinar is being recorded and summarized. >> Good morning and welcome. Calling to order Clark County Board of Health Wednesday April 22, 2026 and we'll start with if you'll join me in standing for the Pledge of Allegiance. >> Okay, then if we could go to the roll call. >> Councillor Young. >> Here. >> Councillor Belkaas. >> Present. >> Councillor Fuentes. >> Here. >> Chair Marshall.

1:00 >> Here. Are there any amendments to the agenda? >> None today. >> Okay. Thank you. And then comments from the public. Is there anyone in the room that would like to speak? No one signed up. Anyone online? No one online. Okay. We must have worn them out last night. Okay. Then the consent agenda and it's simply the minutes of March 25, 2026. Are there any corrections or changes? Hearing none, I'll entertain a motion. >> So moved. >> Thank you for the motion. >> Second. >> And the second. All those in favor say aye. >> Aye. >> Motion carries. Okay. Public health in action and Dr. Melnick I'll turn it over to you. >> Good morning, Councillors. I'm delighted to present our environmental public health director Jerry Preston who will introduce the rest of his team

1:57 and provide the presentation. >> Thanks Dr. Melnick. Good morning Chair Marshall and members of the board. As Alan said I'm -- as Alan mentioned I'm Jerry Preston the director of environmental public health division. As I shared with the board in January -- if this is working. Suddenly not. Do you want to go to the PowerPoint or the PDF? There it goes. We can go to the PDF if you want. It seems to be stuck.

2:41 Sorry. Okay. As I shared with the board in January and February the first month of this year our public health and action series is focusing on the body of work that gets done in the environmental public health division. Next slide please. Our 50 person team protects public health through eight environmental programs. In January we covered the onsite septic system and drinking water programs. In February we talked with you about the food safety program and for this month today we're going to cover school health and recreational water safety

3:40 programs and next month we will wrap up with hazard assessment, pollution prevention and solid waste enforcement. Next slide please. Okay. So we're going to get into schools and recreational water programs now and like I stated in previous meetings with you each manager and their team members will be sharing real examples, stories and images to paint a picture of what is involved in our daily work. Next slide please. Who we regulate and our partners we work with, how we go about our work, why the work is so important, the metrics we use to measure success and the major challenges facing each program and we'll get into how our work is paid for. Covering our fees during these presentations should be good presentation or good preparation for the upcoming 2027 budget discussions. So with that I will turn it over to Miles Lawson and his team. Miles manages several programs in our division including

4:39 schools and recreational water programs. >> Thank you Jerry. Good morning board. Like Jerry said I am Miles Lawson program manager for our recreational water safety program and school health and safety program among others. I am joined today by Maggie from our rec water program and Jamie who will do a switcheroo here with Jerry who will talk a little bit about our schools. Next slide please. So we'll start off the morning with a deep dive into our recreational water program. Our recreational water program is essentially two parts. First we'll talk about pools and spas in the county as well as our swim beach monitoring program. Next slide please. Our recreational water safety program is made up of two staff members. We hold the licenses for approximately 400 pools in the county. We review plans for new recreational water facilities. We monitor swim beaches in the area for both E. coli and toxic algae and we respond to complaints at both of these facilities.

5:38 And with that Maggie will tell us a little bit more about the recreational water program. >> Good morning council. I'm Maggie Palomaki one of the environmental health specialists in the rec water program. Today I'm going to share briefly about our swim beach program and then do that deeper dive into the pools program. So for the swim beach monitoring program we do two types of monitoring in the warm months of the year. The first is E. coli at designated swim beaches. Starting around May that sampling is done on a biweekly basis. If we exceed an advisory threshold we increase sampling to every week. The other is toxins from harmful algae blooms. Sample collection starts when a bloom is present usually early in the summer and sampling is conducted weekly until that bloom dissipates. When sampling of either kind exceeds a predefined threshold advisories are issued to limit recreation at that lake. Unlike pools beaches are not formally permitted by public health but are addressed jointly with the different parks departments.

6:38 Next slide please. Jumping into pools there are four main components to the pools program. The first two are permitting inspections and plan review. Pools, spas, splash pads and float tanks that are public facing are regulated by our office. Public facing facilities include apartments, hotels, gyms, community centers and commercial businesses such as swim schools. This does not include backyard pools at private residences. Most permits are receiving two unannounced routine inspections per year. Plan review is required for all types of projects including new construction facilities, remodels, change of ownerships and variances. We have a state pool code that sets standards for design, plumbing, acceptable equipment such as NSF 50 certification and safety features. For new construction this includes a mid construction piping inspection as shown in the lower photo here to verify plumbing was built as approved

7:37 and a preopening inspection once construction is completed. Next slide please. The other two components of the pools program are complaint response and education and outreach. We receive different kinds of complaints such as illness reports which can be as simple as a rash all the way up to a waterborne outbreak that requires collaboration with the communicable disease team. We also complete serious injury and drowning investigations. When an incident of this nature occurs we do an onsite investigation to gather information about what happened. We also evaluate the facility to look for safety improvements to prevent it from happening in the future. The photo on the top here is a drawing I did to document a non-fatal drowning incident that I included with the report which was sent to the Department of Health for records. There are also sanitation complaints such as poorly maintained locker rooms or dirty pool surfaces. Education and outreach is typically combined with the swim beach program.

8:37 We attend several community events a year to teach the public and especially children about safe swimming. The bottom photo here is last year at the Camas farmer's market where we had kids take a safe swimming pledge. We also create educational resources such as handouts that show all the facilities in Clark County that offer swimming lessons. Next slide please. Getting into the why we do it and how, injury and drowning prevention is a top priority. Drowning is the leading cause of death ages 1 to 4 and second leading cause of accidental death ages 5 to 18 behind car accidents. During inspections we are evaluating safety features such as gates and fencing to ensure they are secure and locking as required. This prevents unauthorized access. We are looking at safety equipment like emergency phones, life rings and handrails and we're also reviewing equipment such as drain covers which are required to be VGB 17 certified to prevent injury or drowning

9:36 caused by suction entrapment. Next slide please. Illness prevention, the other big priority is managed primarily through water chemistry balance. Water quality is tested during every inspection and maintenance and water quality records are reviewed with our pool operators. Pool operators are required to check water quality at least once a day including chlorine levels, pH, water clarity, flow rates and water temperature. On the top left you'll see a chemistry test with extremely high levels of chlorine that should be a nice bright pink and on the right is an operator's water quality log sheet with missing records highlighted in yellow except not in the PDF version. All the blanks that you see should be filled in. We also verified that only chemicals approved for pool use are being used at the facility and review the filtration and sanitization equipment for proper function and circulation.

10:35 Next slide please. At higher level we are also looking at general safety and sanitation because we want going to the pool to be a safe and also positive experience. This includes items like cleanliness, pools that are regularly vacuumed, there's no slippery algae growing on the deck, and there's well maintained and stocked restrooms. So on the top right photo here that small black thing is a drain fly larva that is living in a deck drain that hasn't been properly cleaned. These are not harmful but they are an indication of sanitation needs. We're also looking for rough and cutting edges since most people around pools are barefoot. So the top left photo is a broken ladder step that has a sharp edge that needs repair. We're also looking at general function of the facility and equipment. The lower left photo is an equipment room that had a leaky water pipe that is causing flooding and this is creating water damage and mold around the equipment room door.

11:35 The lower right photo is a similar issue where there's poor functioning HVAC and high humidity is causing damage and mold in the ceiling. Next slide, please. Looking at some numbers. As Miles said, we have a little less than 400 permits. About 60% of those are pools. Another 35% are spas and then the rest are split between splash pads, float tank facilities and closed pools. Closed pools are ones that have been permanently closed but the physical pool still exists so they have their own permit and are inspected annually to verify that they are secured behind a barrier. We don't want somebody accessing that and falling into a large open hole in the ground. Next slide, please. Looking at some program metrics, on the left axis of this graph is inspection numbers. The dark teal bars show the number of inspections completed each year. This includes routine inspections, plan review related inspections, complaint

12:34 investigations, all inspection types. The smaller light green bar shows temporary closures. So this is an inspection that was completed and resulted in a temporary closure for the facility to correct violations. Usually this closure is just a day or two but we have had extended closures last over a year. If you look at the photo, the red arrow is pointing to a small white object. If you are having a hard time seeing it, that is the point. We have high standards for water clarity and this water is so cloudy that you can barely see the white drain cover in the bottom of the pool. This is the kind of condition that may trigger a temporary closure. The axis on the right is a count of plan reviews which is represented by the orange line. Plan reviews fluctuate with the economy since there tends to be less construction during times of economic uncertainty. 2025 was an unusually low year for us where we had only five plan reviews. For comparison, in 2026 so far we have already had six plan

13:34 reviews and several more that we are aware of that should be coming in. So we are expecting to return to more normal levels this year. The last thing I will add is that 2024 is the best representation of what we can do for inspections at full capacity. This was the only year where we did not have any staff turnover in the Rec Water Program. Next slide, please. Reviewing algae blooms, it can be really challenging to identify trends in harmful algae blooms since it's very situational and lake dependent. Samples are only collected when a bloom is present, so the number of samples collected varies drastically as shown on the left. For advisories on the right side you can see that a bad year for one lake does not necessarily mean there's been a bad year for all lakes. What these charts don't show is the toxin levels themselves. We test for two toxins and while 2025 did not have the most samples or advisories, we did have some of the highest toxin levels we have ever detected in

14:34 this program. One toxin test was 35 times above the advisory threshold, the other was over 250 times above the advisory threshold. At that point, the lab actually stopped diluting the sample to preserve supplies, so we're not 100% sure how high that toxin level was. Both of those tests came from Vancouver Lake. Next slide, please. Moving on to E. coli, we've been fortunate that in the last couple of years we've had very low E. coli activity, with one glaring exception at Vancouver Lake. If you remember, in 2022, early June, there was a major flooding event that contributed to an E. coli advisory at Vancouver Lake that lasted six consecutive weeks and had record high measurements of E. coli. This was likely due to a surge in nutrients and contaminants from runoff that allowed E. coli to flourish in the lake. Unlike harmful algae, E. coli has no visual indicators, so samples are collected on a regular schedule regardless of visible

15:33 conditions, so the number of samples collected is a little more steady year to year. Next slide, please. Like any program, we do have some major challenges. The first is that our work is highly seasonal. Half of our pool permits are only open Memorial Day to Labor Day, so half of our inspections need to be done in just a three-month period. Swim beach monitoring season starts around May and runs typically through mid-October, so the pool season is overlapped entirely by the swim beach program, creating competing priorities in the summer months. We also have an outdated state pool code. The last full revision was done in 2004, so it does not address emerging designs such as float tanks, cold plunges, or underwater shelves as pictured here. When the code has gaps, we reference the 2024 CDC model aquatic health code for current best practices. Fortunately, our code is currently under revision with plans to release in 2027.

16:33 For swim beach, laboratory turnaround times are a major challenge. Results can take up to 96 hours, which can delay advisories and slow our public communications. Furthermore, there are very few labs with the capability to test harmful algae toxins, so alternate options are extremely limited. That's a little about the recreational water safety program. I will hand it back to Miles. >> Thank you, Maggie. Now we're going to switch gears a little bit and talk about our school health and safety program. >> Sure. Can I ask a question? >> Yes, go ahead. >> And thank you for this information. As someone who swims laps at one of these pools and open water swims at one of these lakes to train for races, I really appreciate what you're doing. It seems very thorough. You had mentioned that the revised code won't be done until 2027. Is there a reason why it takes that long or can we do it any earlier? >> Well, so the Department of Health initiated Coder Vision in 2016. There was some delays, and then they were supposed to start in

17:33 earnest in 2020. I think we can all guess how that went. So they're finally getting back to a place where they have the capacity and ability to work on that Coder Vision. So it started kind of in earnest in 2024, I believe. I'm not part of the technical advisory group, so I'm not super familiar with what that schedule is. But we do have a draft version available now, and there's a final comment period, I think, that opens in June. And then they're hoping to have it wrapped up by the end of 2026, get the finalized version so that we can start preparation, training, making sure we know the code and can communicate the changes to our operators for full launch in 2027. >> Great, thank you. How many facilities are we missing right now with the code? Like you said, plunge pools and stuff like that. >> Oh, yeah. So emerging sciences. It's not necessarily that they are missing, it's just they have specific features that we don't have anything in our code about. So like cold plunge pools or

18:33 like this underwater shelves, there is nothing in our code that tells us how we should regulate them, what should the design be, are there additional safety things that are required when you have a feature like this. Our code just does not address it. Fortunately, the model aquatic health code is usually revised on a two-year cycle, so they have tons of information about how to regulate this specific item. So the pool is still permitted. We just didn't have great information about that specific feature, so we referenced the model code. >> Okay, thank you very much. >> Well, we've paused on the pools and beaches. I have a couple questions. On the swim beaches, is it just the designated ones, it's just Vancouver Lake, Battleground Lake, and Kleinline, is that correct? >> For E. coli, yes. For E. coli, we only do designated swim beaches, which would be Vancouver Lake, Swim Beach, Kleinline Pond, Battleground Lake. For harmful algae, we will test pretty much any lake. We have some that we do on a more regular basis, so Vancouver Lake, Lachmus Lake, Round Lake, those are checked on a regular

19:33 basis since those ones are prone to blooms. Kleinline and Battleground Lake, we don't typically see blooms, so those are not evaluated for that. >> Right. People swim in other areas besides the lakes, and is there some criteria for designating, or how does an area become designated? >> The designated swim beach, that is a term created by the Department of Health, and typically they have specific safety features that generally make it more safe for users, so they don't have a strong current. That's why you'll notice none of those are rivers. It means they usually have gentle sloping banks, so there's no sudden drop-offs, things like that. >> Okay. Thank you. Other questions while we're still on pools and beaches? >> One quick one, kind of administrative question. When you mentioned, you know, the pool season, you know, you see businesses that, you know, during the summer they sell pool stuff, during the winter they sell wood pellet stoves and stuff. How do you deal with that, like in terms of staff, where there's

20:33 such a high-intensity use, and then it just disappears and needs completely gone? How do you shift, I mean, are there other things, other tasks that people are doing during the off-season? >> Yes. So our off-season, which is our slow season, we still have the other half of our permits. Like I said, half of them are open just in the summer, the other half are open year-round. So that's a lot of our indoor pools or, like, a lot of our community centers. So we're still doing that work year-round. And I should say, while most of our pools are only open Memorial Day to Labor Day, their permits are valid starting May 1st all the way through October 31st. So there is a little bit of activity happening on the shoulder seasons with those. Winter is also the busy time for plan review work. So they want to be doing construction in the summer, which means they have to get approved before then. So we do a lot of our plan review work in the off-season. That's also when we're doing a lot of our project work, planning, preparation. We meet with all of our Swim

21:33 Beach partners, so we actually just did this last week. We met with the parks partners, kind of game planning for this coming season, see if there's anything that we need to adjust. We did a couple -- we made a couple minor adjustments from last year to kind of improve the program, so it's a lot of planning. Do you have anything to add? No, I'd say that about covers it, but yeah, there's new science laboratories are updating their processes, et cetera. So we typically -- like we just last week had a meeting with some folks at the state to give us an update on what the lab in King County who does all of our algae testing is going to be doing this year and what their capacity is. So a lot of planning and preparation goes into that -- happens in that off-season and in prep for the busy summer season. Thank you. I thought of another question related to the algae blooms. And I was wondering as far as the timing when it is a suspected bloom that might be a problem to the testing to the posting of a notice. What's the timeline for that?

22:32 Yeah, some of that depends on when we get the notification because we do have very specific timelines for the labs. So we get a notification if it is at like the end of the week, Thursday, Friday, sometimes we'll do a site visit, but we cannot submit samples to the lab over the weekend. So we'll have to wait until Monday to actually collect a sample for an algae bloom. So the typical process, we collect our samples on Monday, Monday or Tuesday. It goes to the lab that same day for harmful algae. It goes to Seattle King County Environmental Lab so it gets shipped overnight, shows up at the lab Tuesday morning. They are processing it Tuesday, Wednesday. Results typically come to us on Thursday. So Thursday afternoon, we get those notices, and then as soon as we get that, we start whatever advisory process is necessary. So if we are issuing an advisory, we immediately contact the parks partner. We're notifying Marissa Armstrong, our PIO, because she'll put together media releases. So all of that happens in a very short period of time on

23:32 Thursday. And then the ask of our parks partners is that by Friday they get all of the signage posted at the beach. So usually it's all happening within a one-week period. Sometimes it'll be a little bit shorter if the labs are not busy. Sometimes that can kind of extend really late into Friday if the labs are slammed. So if it's the middle of summer, we can extend by about a day. >> Okay, so there could be a week there where there's a hazard. There could be a hazard, but it hasn't been verified or posted. >> Yes. >> So that would be just good for the public to be -- if they see any suspicious algae bloom to, you know -- >> Stay away from it always. Yes. >> Or let you all know. >> Yes. Either notify us. Our messaging is always when in doubt, stay out. So if you see something, it looks unusual. Regardless of what the advisory status is, just don't go in the water. And then we also have signage that's posted year-round at our lakes where we do have issues. So Vancouver Lake, we have

24:31 signage year-round warning people, hey, blooms are common here. Here's what they look like. You should not stay out of the water if you see something. All our contact information is on there so people can notify us. So, yeah, we do keep it up year-round. >> Great. And you have to have that testing, that data before you can post. Is that correct? >> Yes. Yeah, that's the protocol. Once we get the results, we issue the advisories. >> Okay. Thank you. >> Chair. >> Yeah, go ahead. >> Sorry for all these questions. Just to add to that, is there any kind of instant test? And if a tester is seeing a big pile of green goop that they've known is a toxic algae bloom in the past, they have no ability to put some kind of like temporary warning sign or something like that? >> So the first question as far as an instant test, there are test strips that can be used. Their accuracy is variable. And they're typically more of a presence absence. So even if it's present at a

25:31 very low amount that we would not consider dangerous, you might get hit for it. But yeah, they're typically presence absence. We've not done a direct comparison like with our lab testing to like really look at the accuracy of that. And then to your second question, can you repeat it? >> If it was pretty obvious to the tester that there's a toxic algae bloom but the testing hasn't been completed, is there a way to put a warning up or a temporary -- >> So we used to have a three-step protocol. So we had a caution, a warning, and a danger. So right now we just have warning and danger. The caution previously was used any time a bloom was present. And what ended up happening is it was just always kind of posted because there was always an issue. So that's why we switched to the year-round educational signage that we posted at all the beaches. So we're hoping that people will always be mindful of that. I'm not 100% clear on the full

26:30 reasoning behind that why the three-step was changed. That was a little bit before my time. But we could dig into it. >> Can I make a point about instant testing? So you can have an algae bloom and have no toxins present. And so if you were to do instant testing -- now I'm saying it's a bad thing to do -- you could get a negative result, but that doesn't mean people should be having contact with that bloom because it can become -- they can release toxins at any time. For example, if you get a dye off of the algae, their cells break up and they release toxins into the water. So a negative test when you have an algae bloom, you still shouldn't be having any contact with it. >> Yeah, thanks. If there is a way to look at it and see if there's a better way to do it, I'd be interested in asking you to look at that because we hear these stories of dogs dying. My dog will drink any water, no

27:30 matter how nasty it looks. And when I'm swimming out in Round Lake, I'm getting water in my mouth. And so I would love to know if there was some indicator of something that maybe would be some pre-warring. Just love to learn more. >> Okay, I think we're ready to go on. >> Thank you, everybody, for your great questions. So we will switch gears here a little bit and talk about our school health and safety program. Next slide, please. So like Breckwater, currently the school health and safety program is made up of two staff, two environmental health specialists who work with about 150 schools in the county. There's a breakdown there of sort of rough relative percentages of public, private, and state schools that we work with. The program reviews plans for new facilities, remodels, those kinds of things. We respond to complaints at schools. We inspect the food service, so lunchtime cafeteria and the school health and safety program as well as provide what are

28:30 called environmental health assessments, which Jamie will talk about in a minute here. So pass it off to Jamie. >> Good morning, councils. I'm Jamie Circe, and I'm environmental health specialist in the school health and safety program. And today I'll talk a little bit about the what, why, and how of the program. One task within the school health and safety program is school construction projects. The first step with a new construction would be a site review. A site review is a pre-development review to evaluate the surrounding area of a proposed new school location for safety and hazards to determine any potential environmental contaminants based on the previous land use and to assess associated -- assess the risks associated with neighboring businesses and to observe for future land development. Then we'll perform a plan review. Plan review is to review the building designs for the intended use of the building and for the classrooms.

29:29 A plan review could be for a new construction school, for an additional building to an existing school, the remodel of the interior of an existing school, converting an existing school -- an existing building into a school, or adding and modifying playground equipment. The last step is an occupancy inspection, which then we are reviewing the end compliance with the previously approved plan reviews at the final construction phase. During the occupancy inspection, we will inspect the lighting, heating, ventilation, sanitation, and any additional technical areas such as art rooms or career technical education classrooms, otherwise known as CTE classrooms. And then lastly, we also perform periodic environmental health assessments for the public, private, and parochial schools within Clark County, and those assessments are performed every three years.

30:29 Next slide, please. Lastly, we also respond to complaint situations, which could involve pests, air quality, water, plumbing, or any general safety concerns. Next slide, please. Okay, so a little bit about the why and how of the program. So, according to Washington State Board of Health, a student will spend 180 days within a school facility per year, and a student spends approximately 13,300 hours in a school during their K-12 journey. So, in the Health and Safety Program, we perform the environmental health assessments every three years, as previously stated. With those assessments, we collaborate with the school and we assist with providing information and resources to support preventative efforts. So, one means of support, one means of support is discussing

31:28 integrated pest management to control pests by reducing their sources of food, water, and shelter, and this, by means, could be seen by storing food that is in classrooms and storing those food products in hard containers, making it difficult for pests to infiltrate those packages. Another one would be sealing areas around plumbing fixtures that are underneath the sinks and removing any upholstery furniture that is in classrooms. Next slide, please. Another aspect is the air quality within the schools and ensuring that fragrances, such as candles, plug-ins, diffusers, and essential oils are removed from classrooms. These fragrances could affect the health and safety of students and it can aggravate asthma within students as well. Another part of air quality is animals in classrooms can contribute to poor air quality as well, and we discuss the importance of ensuring that

32:28 animals are properly cared for during school breaks such as winter, spring, and summer break. Next slide, please. We also observe for proper ventilation and specialized curriculum courses, such as 3D printers in classrooms, the use of volatile chemicals, for example, spray paints and adhesives, the HVAC systems for woodshop classes, and the overall cleanliness of the building's air vents. Next slide, please. In addition, we'll examine the science chemical storage rooms to ensure chemicals are properly stored and that containers are labeled. And then in general classrooms, any residential or cleaning products are stored out of reach of children. Next slide, please. Another area of the school that we examine is the accessibility to emergency eye wash and shower stations for emergency preparedness. This is ensuring that there are

33:28 clear pathways and access to emergency fixtures and that the emergency showers and sinks are not blocked by objects. We activate the eye wash and shower stations to verify its functioning ability and review the maintenance tracking records. Next slide, please. And then lastly, we observe for any possible injuries and safety prevention. This could be by a tripping hazard from electrical cords or a rug that is curling at the corners to ensuring that bookshelves are securely attached to the wall and any overhead storage is secured to prevent the possibility of items falling onto someone. So with that, that concludes the what, why, and how. And I will pass it back to Miles to discuss the major challenges. >> Thank you, Jamie. So similar to the recreational water program, you might be sensing a theme here. The school health and safety uses a WAC that is seriously outdated. I think the last time this was updated was in the '70s.

34:27 And it doesn't currently address air quality, extreme temperatures, playground designs, and specialized rooms like Jamie mentioned, the CTE classrooms. Thankfully, that is under revision, and they're doing a phased approach. So phase one, best case scenario would take effect late 2027, not early 2028. And then, of course, everybody is, I'm sure, acutely aware school budgets are always a challenge. When levies don't pass, when budgets are suffering, it makes it difficult for schools to work with us or to keep enough staff in the custodial programs, et cetera, to make sure that they can meet some of these health and safety standards. Next slide, please. This is just a really quick rundown of some of the folks that we work with, both in the recreational water program and in the school health and safety program. So obviously, all the local school districts, local cities for both their parks department with the swim beaches, some of

35:25 them run pools. We work very closely with Department of Health in both programs, in some cases, Department of Ecology, and then, of course, other folks here at the county. And so now that we've talked a little bit about these programs, a little bit about who we work with, we're going to talk a little bit about how we pay for it. >> Can I ask questions about schools? >> Yes. >> Because I'm always worried about my kids. I always think about the HVAC systems, and I was just curious what the WAC standards are for HVAC pre-filters, what is filtered, if there is any requirements, if there isn't, do we have the ability to create standards above and beyond the WAC, that kind of question. And then on the emergency exits and stuff, do we have any -- is there any standard safety protocols for lockdowns and stuff like that, or is that not

36:22 part of this discussion? >> I'm sorry. >> For how they lock the doors and stuff when there's an emergency? >> For emergency purposes, that would be a district decision on what their protocol is. That wouldn't be something that we would address. As far as the -- I'm sorry, the first question again. >> HVAC filter system, do you test for mold in the air, other types of air quality, and do we require filters for the HVAC, and could we? >> So as of right now, since the WAC code is so old at this point, and they are in the middle of trying to update that language, we are using the OSPI guide that has recently been updated. I believe it was in '24 is when it was last updated. So we are using that. I would have to double check and see and get back to you about the HVAC system. As far as the code that we have

37:22 right now from the '60s, there is nothing in there as far as the specific requirements for HVAC systems. >> Like in the rec water program there is gaps in the old code. There is another document, OSPI, which is the office of the superintendent of public instruction has a health and safety guide for K-12 schools in Washington that is much more comprehensive than the WAC. >> So if there is a gap on HVAC systems and no filtering requirements or testing requirements, is that something that we at the county can create or are we completely dependent on what the WAC says? Can we go above and beyond that? >> I think the county has the ability to write an ordinance that would be stricter than the state standards. I will say that the WAC revision that is going to get started here this summer, they are doing a phased approach so they can focus phase one on low or no cost changes that are going to impact the school. So I think any rule making

38:21 activity has a cost impact analysis at the state. So they are trying to focus on changes that can be made that aren't going to burden the schools with additional unfunded mandates. So I think that would certainly be something to consider but I think generally we have the ability to write a local ordinance. >> Okay. I don't know about other counselors but I would be interested in looking into that at least. >> I would say I'm always willing to look at anything. I just would want a thorough presentation and making sure that there is a need to justify it. >> I would be interested. I know during the COVID period when students were returning to classrooms HVAC systems became a real issue and I think online there were guidance on how to rig up your own filtration system, so I think it would be

39:21 good to take a look at that. Go ahead. >> A number of years ago my memory is fading but here we had some -- I believe some shooting range activities in the school. I don't know if it was junior ROTC. I can't remember sure but there was some led in the HVAC system that we had to address and I could dredge that up. It was a number of years ago. Brian, were you here at the time? >> Yes. I can't -- right now -- so there are issues we had to address. I'm not aware of any of those activities going on now but we have been involved in dealing with residue in HVAC systems. >> I would be curious how that came to your attention because if there is ability to respond as things come to our attention there may be a lot of things out there that we are not aware about. >> Well, if there is a hazard, as a health officer we have the

40:21 authority to address potential hazards like that if the population is at risk and we can get you some more information. >> Okay. We will stick a pin in that. >> Chair? >> Yes, go ahead. >> Really quick question. I'm curious. So what happens -- and I didn't see any presentation or maybe I missed it -- but what happens if you're making these -- you have these inspections and there is a recurring issue at some of these schools. They're not meeting the health and safety standards that are required. What happens? How do you hold these schools accountable? >> Yeah, it's a challenge because again the code is sparse. It doesn't have a lot of enforcement language. I don't know that that's necessarily the best track for dealing with those kinds of issues. We see the school health and safety program very much as a collaborative effort. So working with schools to find

41:19 resources, strategies to deal with these issues, understanding that they're usually limited on staff and funding. But yeah, it's an issue. I think a testament to the program is the relationships we've built I think bridges some of those gaps when they do come up. >> Do you generally come across recurring issues in terms of health and safety? >> I can let Jamie add a little bit to that. But I wouldn't -- there are certain issues I think that we might see across schools. But I think generally schools are responsive. They want to work with us. They're invested in protecting the kids. So if there's something -- especially if it's limited cost, they're generally making those corrections. >> And to Miles' point too, with schools there is turnover. There's new staff that comes on. There's education. The principals change different school districts or different schools within the district. So it's a lot of education,

42:19 collaboration, and being a resource for the school districts and just information and education. >> Yeah, and I asked this question. The root cause of this question is because as schools continue to struggle financially, right, they're cutting resources, and if these standards aren't being met, then how do we ensure that our kids are attending schools where they're safe and they're healthy? And if these are not being enforced, then I guess I'm not sure what the next step is. >> I think that's just part of the program. It's a challenge because we just -- we don't want to be an enforcement. We want to be a collaboration. We want to be a partnership with the schools. This is why we want to be a resource for them to come to us when they do have situations so that we can, you know, collaborate with them. >> Thank you. >> Go ahead. >> Yeah. Chair Marshall, you had a

43:16 question earlier regarding if we hear about issues that come up, and I just wanted to give an example pretty recently, and I think it came up through, you know, a child going home saying to their parents they smelled sewer, and as it turned out when we heard about it, whoever installed the brand new -- this is a pretty new area. There was a cap missing, so just one example of where we'll get involved, and the accountability is there for the school because they hire, you know, a plumber real quick and took care of that. That's one example, and then another thing I would like to respond to is Councilor Young, you mentioned a really good point about, you know, efficiency when we're having, you know, a compressed time for pools, but then after that, you know, what's our staff do? I just wanted to mention that's one of the reasons we recently did a little mini reorganization in public health and now we have

44:15 pools and schools together because it can be a little bit slower in the summer for schools and busier for pools, so we have that ability now. >> Great. I think maybe it would be important if you do see some systemic issue or some need that you let us know if there's additional resources or if there's code or whatever may need to be done to address anything that isn't -- that becomes more of a problem. I just invite you to bring that forward. >> Okay. >> Chair. >> Yes, go ahead. >> My question is water. You know, water in the schools, you know, I mean, our expectations have significantly increased. I remember when I went to school at Park Rose in Portland in high school, every winter we would be walking through the halls and we would be walking around garbage cans that were collecting the leaks from the roof.

45:15 It was really sad. But water in the schools, I remember drinking from those water fountains. I know that in schools now, I mean, my kids are asked to bring reusable water bottles. That can be a health issue in and of itself, especially when kids use them and don't ever wash them. But the actual water sources in the schools, I don't even know anymore if they have water fountains available. But do we sample that water and make sure that it's safe for the kids to be drinking? >> Yeah, the Department of Health does regular lead sampling as a part of that. Most schools in the county are connected to some kind of municipal public water which, of course, has all of its own water. There's a couple of schools sort of in the farther flung parts of the county that are served by their own wells. But those are managed as large public water systems which are also subject to all the same state standards. >> Okay.

46:15 What about like PFAS? >> I'm not aware of testing in schools for PFAS at the moment. >> I'm not either. >> Sure. Just to follow up on those good questions, do we still have lead testing? I know there's a huge federal grant to replace lead pipes throughout the nation, especially in the Midwest. Just wondering if -- what the status of that is for our districts. >> Yeah, I mean, like I said, the state does regular lead testing. And some, you know, there are instances where exceedances are found. Usually that triggers a conversation with the school for some kind of mitigation plan. Being what it is, that sometimes means that fixture is just shut off as opposed to, you know, redoing all of the plumbing. >> Okay. So there are lead pipes still in

47:10 our schools or you don't know? >> I believe Brian -- there are, aren't there? >> Okay. >> Okay, can you hear me? Hi. So all of the schools statewide have been mandated by the Department of Health to test, either in partnership with Department of Health or via their own independent contractor to test all of their water fixtures by 2026. And based on the result or potential concentration of lead per fixture, the school is expected to formulate an action plan on how they're going to maintain or diminish that potential lead level based on

48:10 each independent fixture. So the fixture itself can have components, brass. The plumbing code has been updated, 1986 was one significant year where they started to regulate the concentration of lead in various drinking water fixtures, whether that's solder, brass fittings, et cetera. 2016 was a more recent update of that. So any schools that were built or in existence prior to 2016 are required to do this testing. We're still in this initial, excuse me, round of testing all the fixtures in schools for lead in drinking water. And as far as PFAS goes, those are generally, that is dependent not on the fixtures, but the source water itself. And 99.9% of our schools, I believe in Clark County, are servicing public drinking water

49:10 through their fixtures, so whether it's coming from the river, et cetera. >> Thank you. Would we be the entity to facilitate the federal grants if there is lead pipe replacement needs? >> We are working in collaboration with the Department of Health and the schools to make sure the schools have what they need to make whatever corrective action that is expected of them. >> Okay. Thank you. >> I think when that, whatever the results of the testing that is occurring this year are available, that would be great to bring back to the Board of Health to review that and understand what action plans are going to be implemented. And I would just note, you know, it would be great if every school got an equal amount of funding, but there are equity issues for sure within the schools, and some may have more struggles to meet some of the

50:09 needs that they have, and maybe there are the older schools as well. So it would be good to have a report back. >> Yeah. And you can see Department of Health on their website currently today since they are the ones who are issuing the mandate to the schools. So they have the two options. The schools can work directly and partner with Department of Health, and Department of Health will come down and do the sampling themselves of the schools. And all of that information is currently maintained on the Department of Health website. Vancouver School District, for instance, they've gone independent and they have their own contractor to do their own sampling. If you go to their school district web page, they have their current results per their school also. So we're currently, since we're still in that first round phase, we're working in collaboration with all the schools, the school districts, the Department of Health to make sure that all our schools are getting tested,

51:09 meeting that mandate, and then we're gathering up all the results. So we're still in that initial phase or round of sampling the schools. >> And are there still drinking water fountains that are used in the schools or it varies from school to school? >> It varies school to school. And there are grant programs out there for schools that have issues with high lead in their fixtures to get those replaced or removed. >> Okay, thanks. Other questions? >> Just one last follow-up on when you said 2016, they passed the higher regulations. Do we do any testing there? Like, you know, stuff gets slipped by sometimes. Every once in a while, products contaminated with lead, whatnot. I mean, I had a situation, and I still don't understand the physics behind it, but we had a water heater in our house, I think it was around a year old, and the dip tube that goes all the way from the bottom to the

52:08 top completely disintegrated. I mean, it was mush in the entire water heater. So I know that we were being exposed to that. So when products fail, I mean, is there anything that we do? Or are we just saying it was built after the law was changed and we're going to trust that it's okay? >> Amber, you have your finger on the button there. Did you want to add? >> Yes. Good morning, Amber Smith, chief civil deputy prosecuting attorney, just to help facilitate part of this conversation. And I think what's good to know is that with respect to the regulation of water quality that we're talking about in schools, in particular with PFAS, this is an emerging issue, and that the Washington code has just recently been updated. So this is an ongoing issue where they're looking at the federal guidelines and guidance that occur. And then there's the WAC 246-293-15, which goes into the state action levels and state maximum

53:07 containment levels with respect to certain contaminants in public drinking water, specifically schools is addressed in that as well. And then there's also additional guidance that has been disseminated to schools to assist them in checking their water quality as well. That's through the Department of Health that they have with respect to group A systems and just water systems for schools generally. So while there isn't concrete laws or things that are fully in place, it's still very emerging. So the WAC that I just stated, it actually went into full effect on January 15th of this year as it went through the rulemaking process. So I think with respect to a lot of the questions with quality and things and what this team is doing, they're moving with the speed that we can with the law, which is unfortunately sometimes slow. So there's this emerging regulatory data and guidance that are coming out almost in real time currently. But just to give context with respect to that. >> Thank you.

54:07 >> Sure. >> Go ahead. >> Just to follow up on that, thank you. I was going to do this during Board of Health updates, but this is more pertinent right now. Yesterday -- I live in Kamas, and so I received my email yesterday that said that Well 13 is going to be open on May 6th. Well 13 tested 10 times higher than the state standards on PFAs. It will not be starting to be remediated until 2027. So basically the PFAS will be going into drinking water sources in Kamas starting May 6th. That of course is a concern for all of us. What I'm doing in my home is putting a filter on that's specifically -- on our fridge that's specifically for PFAS. That's different than normal Brita filters. You have to actually buy one that's specifically for PFAS. Not only do we do that, but the water comes out of that fridge we put into a separate second PFAS pitcher so that it gets

55:07 filtered twice. I think families should consider it. I just want to put that out there for any families that are from Kamas who might be listening. >> I was just hoping I never got an answer to my question as to whether these schools are just completely not inspecting or the ones built after 2016. >> I'm sorry, could you repeat the question specific to the drinking water? >> Yeah. So you said after 2016 the rules changed and so we're under the assumption -- >> That was a plumbing code update is what it was. >> Do we do a periodic inspection once every five years to make sure that something is not leaking from the system? Or do we just blindly assume that the products that they use were proper and that there's no risk of contamination? >> Yeah. So the update was just in the plumbing code so it's any type of plumbing supply that you would buy at the store for your

56:07 home or a building, whatever. So that regulation in 2016 was just that the concentration of lead that's allowable in a type of plumbing component, the manufacturer has to make sure it's below a certain level. Okay, so that was the update in 2016. So what the Department of Health initiated in this first round that's about to end here in June of 2026 is this first cycling of testing the schools to see what schools, how many schools are facing lead issues in their fixtures that they're currently using. And then helping working with the schools to create action plans to address any issues that come up in that testing. >> Okay, and that includes the schools built after 2016? >> I believe that that mandated testing is for schools built before 2016. >> Yeah, see that? >> For lead specifically. >> Right, that's where my

57:05 question lies is if things can slip through and are we checking, I mean at least like once in, you know, five years or decade or something like that just to go in and double check that those systems were properly installed and that there weren't contaminating factors that are now leaking into the water that we're unaware of. >> Yeah, we're not the entity that's I guess given the jurisdiction to oversee the types of plumbing components that schools are using specifically. Department of Health is tasked with that. >> I'm not asking to go in and look at the equipment and do we test the water that's coming out of it is my question. >> So from the fixtures themselves, so you're asking specifically for the schools that are newer than built since 2016. There is currently no mandate or requirement that I am aware of where we go in or anybody is

58:04 required to go in and test fixtures. >> So the answer is no, we're not going in and testing. >> We are not, no. >> I think we should. >> Okay, Dr. Melnick you've had your finger on the button and so has Jerry. So Dr. Melnick we will start with you. >> Well, I was just going to respond to Councilor Little's question about PFAS. We have all information on our website about PFAS and water filters. There is even a video. There is some information in multiple languages so our website has that information on it. >> Okay, Jerry. >> I was just going to say Councilor Young we're hearing you loud and clear. It's been ten years now since 2016 and so we can look into how that and what possible plans Department of Health has with that as well and what we can do. >> Thank you. Okay. Is there more presentation to go? Fees. >> We've got a couple more slides. We're almost there.

59:03 Okay, so jumping right back in to where we were, the last thing is just to talk a little bit about how we pay for all the work that we do here. So I think you've seen some version of this schematic a few times now. This is just a very generalized overview of sort of what goes into making the fees and what those fees cover. So fees mostly cover staff time. They also help support our Environmental Health Support Team which is our front office where everything comes through as well as training and travel and that kind of stuff. And then building the fees is based on anticipated fee volume so sort of what we think is going to happen in the following year as far as permits that come into our office, estimated operating expenses, and then some accounting for what we call the greater good work. So that's that unfunded work like complaints that we'll talk about in a second. Next slide. So can you advance one? I just want to see if the highlight took effect. Can you advance just one?

1:00:01 Yeah. Okay, sorry. Can you go back? I just wanted to see if the highlighting made it to the PDF but it did not. So this is just a screenshot of our fee table for our recreational water safety program. In the PowerPoint, I had highlighted that top fee, the pool and spa plan review. So that would be a plan review for a brand new pool facility. That covers, like Maggie said, our time for looking over the engineered plans and then doing those couple of inspections that we do both during construction and at the end. And then, well, there we go. And then on the facility permits down there, that 5119 recirculating water feature. So that's a splash pad. Those have become increasingly popular in recent years. And so that fee covers their operating permit and allows us to go out and do our routine inspections. Next slide, please. Switching over to school health and safety. So that top fee there is the highlight for the construction

1:01:01 of a new middle or high school. So again, that's that plan review phase over looking over engineered plans and then the inspections that happen as a part of that work. And then at the bottom, I just wanted to highlight the OSPI summer lunch program. This is not actually a fee that we charge. This is the estimated cost that we submit to OSPI for reimbursement. And this is just to make sure that the summer lunch program that provides lunches for needy students during the summer when school is not in session have access to safe food. Next slide. And then lastly, there's the environmental health assessment fee for a high school. Again, these are done every three years. And this covers staff time to go in and do that inspection, work with the school, and then write up a report.

1:01:59 And next slide. And that about covers it. >> When were the fees last updated? >> Annually. Okay. Great. Okay. Any questions? I think we asked plenty of questions already. Thank you very much. It's very informative. Okay. Then I think we're moving on to director's update. >> I'll be brief here. So we're still -- I'm just going to give you an update on respiratory illness activities. We're still in the flu season. Flu season is defined by two or more consecutive weeks where the test results for flu are greater

1:02:59 than 10%, test respiratory samples are greater than 10% positive for influenza. We're right now at about 13% of influenza tests came back positive in the most recent week. And so we're still above 10%. But it's lower. It was 35% in late January. So we're moving in the right direction. The percentage of emergency department visits due to influenza is now at 0.8%. It was close to 6% in January. And now we're at 0.3% of hospitalizations down from a little bit over 4% in early February. Respiratory and social virus activity increased in February and March. We're kind of having a late season. It was extended into April. But it's been decreasing. And now it's accounting for

1:03:58 about 0.4% of emergency department visits and hospitalizations in the most recent week. And COVID-19 activity remains low. I think I want to spend a little more time on vaccination rates because there's not been much change in vaccination rates. Only about a quarter of Clark County residents and everybody aged six months and older is eligible for flu vaccine. About a quarter, 26% of Clark County residents received flu vaccine this season. It's been slowly decreasing over the last several years. I think it was 30%, which is still pretty low in the 2022 to 2023 season. But less than one out of four folks getting flu vaccine is returning. Only 14%, one-four percent of Clark County residents, again, six months in age and older are eligible, received an updated

1:04:58 COVID-19 vaccine. And those rates have also been decreasing over the years. About one-third of infants born this respiratory season, one third received the monoclonal antibodies, that immunization of the respiratory virus, one third of infants received it. And then in terms of the respiratory virus vaccine for older adults is a one-time vaccine that's indicated for people who are 75 and older, as well as people 50 to 74 with underlying conditions that put them at risk. Less than half of adults 75 and older have received an RSV vaccine since it became available three years ago. So less than half of people 75 and older receive that. Considering how deadly it can be in adults and how safe the vaccine is, that's concerning.

1:05:58 So I just wanted to add that. >> Yeah, thank you. Related to the flu vaccine, what was it when we were like at our peak of vaccinations? >> Yeah, it hasn't been great over the years. Just trying to remember looking at this over the years, it ranges around, you know, nationwide around 40 to 50%. If I remember correctly, this is just off the top of my head, but it's not great, but 25, 26%. >> Thank you. Any questions? I have a question, but it's related to measles. Any new measles outbreaks? >> We don't have any new cases. I think across the river they're having some measles cases. I would also point out that our vaccination rates for measles are dropping. I particularly look at the kindergartners because they're the new cohort moving through as they get older. The rates will -- if their rates are lower as they get older, as

1:06:56 they move into the 1 through 12 population, those averages will drop as well. So we're below herd immunity, at least with the kindergartners. I believe the last I looked it was around 90% or maybe a little bit below. >> Thank you. Are we ready to move on to the 2025 strategic -- >> Yeah, the only thing I'm going to mention about that is we've got the update, the year end report on our website. I'm not going to go through it, but we've got an update about where we are 2025. So folks can take a look at that. And then there's one other thing that I wanted to mention, so one other issue I wanted to mention if that's okay. We have been successful in hiring our racial equity director, Chanel Brown. Her start date is on May 4th, and I plan -- she will be reporting to me.

1:07:56 She'll be a member of our leadership team, and I will be introducing her to you at the next Board of Health meeting and bring her here and then we can talk more about that. >> Thanks. We will look forward to that. Okay. Anything else from the director or questions for the director? Okay. Comments from the board? Doesn't look like there's any comments from the board. Okay. Well, that concludes our Board of Health agenda and without objection this meeting is adjourned. Thank you.