Cirque Meadows by Adam Johnson



The Larimer County Board of Health (BOH) convened its regular meeting at 7:00 PM at the Larimer County Department of Health and Environment (LCDHE), 1525 Blue Spruce Drive, Fort Collins, CO


         Members Present:                     C.J. McKinney, Ph.D.

                                                N. Mark Richards, M.D., M.P.H. (via telephone)

Steve Yurash

Jennifer Lee, Ph.D.

                                                Janna West Kowalski, M.S.


Executive Secretary:               Adrienne LeBailly, M.D., M.P.H.

Commissioner:                         Steve Johnson

Staff:                                         Marie Macpherson, Averil Strand, Jerry Blehm,

Bruce Peters, Paula Lady, Lynda Aranda



1.   Call to order – CJ McKinney, Board president - The Board of Health meeting was called to order at 7:00 PM.   Lynda Aranda was introduced to the BOH.  She will record minutes in the event of Ms. Lady’s absence.  

2.   Approval of minutes of August 22, 2013 meeting – Minutes of the August 22, 2013 meeting were unanimously approved.

3.   Board of Health support request for expanding non-smoking ordinance in City of Fort Collins  

Dr. LeBailly reported to the BOH that on November 5th the Fort Collins City Council will consider expanding the city’s current non-smoking ordinance to include: outdoor dining areas and bar patios in Fort Collins and 20 feet from those same areas, outdoor areas of public transit facilities except for designated smoking areas that are 20 feet away from buildings, building entrances and bus shelters and benches, and 20 feet from the bus stop shelters, benches and platforms.  The City of Fort Collins is looking for feedback from the Health District and the Health Department’s BOH.  There was discussion regarding the exposure of secondhand smoke in outdoor dining areas and how this ordinance may affect business.   


Ms. Lee made a motion that the BOH appoint someone from the BOH or Health Department staff to attend the City Council meeting, if requested, to respond to questions regarding health issues and smoking in open air situations.  Ms. Kowalski seconded the motion. The motion passed unanimously.


4.   September Flood Update – Dr. LeBailly asked Dr. Richards to share his experience of how the recent flood has affected the Estes Park area.  He described some of the issues and concerns that the Estes Park area is facing.  He said that it was very impressive how all the government agencies have responded to the flood. 


Dr. LeBailly reported that the Health Department office in Estes Park is approximately 300 yards from Fish Creek Road, where both the road and the sewer system were severely damaged.  There are 300-400 houses in that area that are in a “no flush zone,” including the Health Department’s offices. 

It is hoped by the first week of November Upper Thompson Sanitation District will have a temporary sewer line that will restore services to 75% of those affected in the “no flush zone” area.  A team of four Environmental Health Specialists went to Estes Park on Monday after the flood to get restaurants approved so that they could be re-opened.  As of today, 95% of the food service establishments in Estes that were affected by the flood are back in business.


Homes and roadways along the Big Thompson and Little Thompson Rivers, and their tributaries, especially in the canyons, were significantly impacted. The largest group of stranded residents was in the area of Pinewood Springs, about 1,200 people. A volunteer firefighter there was able to transmit a list of prescription drugs needed by residents in the area.  The requested drugs were provided by Poudre Valley Hospital, and the drugs were transported to Christman Airfield, but the helicopters were grounded by weather on Sunday.  Resident evacuations were accomplished over the next several days.


Due to a washout of 5 lowl earthen dams, Big Elk Meadows subdivision (near Lyons) has lost their drinking water source, which comes from a series of small reservoirs strung out along the west branch of the Little Thompson.  The Big Elk Meadows Water Association, managed by their HOA, operates a drinking water treatment plant taking water from these reservoirs.  The Health Department and County are advocating with FEMA to make sure that the HOA, as a non-profit association providing a utility (drinking water) to residents, is found eligible for FEMA Public Assistance funds, which will pay up to 75% of the repair costs to their drinking water system. 


All of Highway 34 as well as the Glen Haven road (CR 43) have been significantly damaged.  The two deaths in Larimer County were in the Cedar Cove area, just west of the Narrows.


We have working on the safe removal of  hazardous waste, rather than solid waste debris.  FEMA will cover approximately 75% of the costs of debris removal.  The County and state will split the remaining 25% costs, so the County share will be 12.5%. We are working with the EPA and their contractors to do locate and safely dispose of identified hazardous waste in the flood-affected areas. 


The City of Loveland lost drinking water service in a few areas along the Big Thompson, but they have since been restored.


The septic tanks and/or leach fields of numerous homes have been washed away.  Interim and final re-designation of the floodplains and floodways may affect whether their lots can be permitted for re-occupancy or re-building. 


We have given 435 tetanus boosters to residents that have been in flood waters and/or helping with flood clean-up.


An increase in Legionnaires disease has been seen Colorado recently, but so far not in Larimer County.  This disease sometimes increases after hot weather, heavy rainfall, and flooding. We will be sending a health alert for physicians to keep this in mind when seeing cases of severe pneumonia so they may be thinking about Legionnaire’s.


A lot of effort has been made to maintain our Community Health Services in Estes Park. We have made arrangements to delay a family planning patient’s well woman exam until a nurse practitioner can be sent to the Estes Park office, or we can Skype the visit (still delaying the exam portion). There are about 100 WIC recipients in Estes Park.  Staff have been able to print WIC checks from our Loveland office to the printer in Estes Park.  If the federal government shutdown does not end soon, 4,000 WIC recipients in Larimer County will be deprived of whole grains, milk, eggs and nutritious proteins after November 1st.  



We staffed the Disaster Recovery Center in Loveland during its operation and provided handouts, video links on cleanup, and other information to flood-affected residents.  We have distributed a lot of public information, tweets and press releases. 


Ms. Macpherson reported that from September 12th to October 2nd we had 41 staff and 5 volunteers assisting in the flood disaster efforts in some way. The first week we spent 808 hours between Community Health, Environmental Health and Administration to the flood response. This equates to approximately $41,000. The next two weeks was over 1,000 hours and $50,000 in resources.  Because most Health Department professional staff are not eligible for overtime, the additional time our staff put in will not be reimbursable through FEMA. 


Dr. Richards said he is concerned with the safety of volunteer efforts and who is responsible for training volunteers.  He is also concerned about the mental well being of residents and volunteers affected by the flood.


Ms. Macpherson said that the State Vital Statistics Records Department has relaxed some of the stringent regulations of what documentation is required to obtain a birth certificate and waived the fees for those affected by the flood.  At this time, there has only been one fee waived.  We anticipate more in the future. 


Dr. LeBailly said another issue that may come up would be requests for waiving of septic system permit fees for flood victims. We did not do so in the High Park Fire disaster, since the fees are needed to support the staff that provide these services. In that disaster, the Building Department did waive some fees that the Commissioners agreed to backfill from county reserves.  At this time we don’t have the numbers that may be affected.  Dr. LeBailly will look at options and report back to the Board.


5.   Report on Budget Hearing with County Manager and Budget Director – CJ McKinney reported that the budget hearing with the County Manager and Budget Director went smoothly.   Ms. Macpherson said that the focus was on our budget letter and we shared some information on how the flood was affecting us.  Dr. LeBailly said that the there are some unknowns in the 2014 County budget if the cost of rebuilding roads and other infrastructure significantly affect the rest of the county’s 2014 budget.


6.   Changes to staffing and Health Dept. budget since August budget meeting (Federal shutdown, grant changes, etc.)


o  Ms.  Macpherson reported that the Nurturing Program, which has been funded by the county’s Human Services Department, would need to be eliminated due to budget cuts.  This program employs a half-time Public Health Nurse.  We were notified on September 23rd that the entire program will be eliminated at the end of October.  The Public Health Nurse will be moved to the Prenatal Plus Program where they need additional RN staffing .


o  Grand County had been offered $15,000 to inspect their own restaurants, but turned down the money and chose to have the State continue to inspect their food establishments. The $15,000 they turned down has been reallocated to those counties most affected by the flood.  This means we will receive an additional $3,750 in our per capita allocation from the state.


o  Our immunization program will not be affected by the federal shutdown at this time, and we will receive additional grant money (exact amount not yet known) from the state for our Core Immunization Services to be used by the end of December. 


o  We will be getting $6,500 from the Health District for the “Connect for Colorado” collaboration we have with them.  Our Healthy Communities program makes some referrals to Connect for Colorado when clients are found to be ineligible for Medicaid.


o  We applied for a grant through the Kaiser Foundation to support implementation of our Public Health Improvement Plan in 2014


o  Several Health Department programs receive federal funding but have not yet been affected by the federal shut-down: Emergency Preparedness, Family Planning, Immunizations, and the Maternal Child Health block grant. 

o  Our WIC program and 15 of our WIC employees will be directly affected by the federal shutdown.  We were notified by the State WIC office that the state has funds available for operations through the end of October. We currently are working with Human Resources with the development of a letter of potential furlough of the WIC employees.  A glitch we have is the way our County payroll is posted.  We are paid bi-weekly and the paychecks for the last two weeks in October hit the system in November, which the state may not pay.  Ms. Macpherson is seeking approval to use $32,000 of reserves, if necessary, to pay the WIC staff for the last two weeks of October.  . 


Mr. Yurash made a motion for the Board to approve the use of $32,000 of reserve funds to pay the WIC Program employees through the end of October.  Ms. Kowalski seconded the motion.  The motion passed unanimously.


Ms. Macpherson will provide updates via email to the BOH regarding the WIC program as necessary. 


7.   West Nile Virus Update – Dr. LeBailly will attend the Fort Collins City Council work session on October 28th.   She is hoping the data from this summer will support more timely decisions for the city  to spray, based of real time data about mosquito infections, rather than requiring human case reports, which lag behind infections by 3-4 weeks.  West Nile virus this summer has been the worst  since 2003.  We are currently at 97 West Nile cases of which 17 were neuroinvasive (meningitis and encephalitis) as well as 3 of blood donors who did not become ill.


 Dr. LeBailly believes we need a mosquito control district, if support from city and county elected officials could be obtained.  Health Department work on West Nile-related activities has become very time-consuming and generally peaks during budget preparation time.  The same staff who work on West Nile also are responsible for rabies, and this has been a very busy year as well, even worse than in  2012, our first year dealing with terrestrial rabies. 


8.   Director’s report – Dr. LeBailly reported there is currently a salmonella outbreak related to chickens, mostly in California, coming from a specific  poultry producer.  Only 4 human cases so far are from Colorado.  There are seven different strains of salmonella with a very high hospitalization rate, about twice the rate usually seen. 


A weight loss and body building supplement called Oxy Elite Pro has been associated with a cluster of  people in Hawaii with acute liver failure who did not have any underlying illnesses.  The CDC is looking nationwide to see if there are any more cases.  There will be a Health Alert to area doctors regarding this potential risk.


9.   Next meeting: November 14, 2013


10.   Adjourn – The meeting was adjourned at 9:15 pm.

_____________________________    _____________________________________________

Paula Lady, Recording Secretary         Adrienne LeBailly, MD, MPH, Executive Secretary

Background Image: Cirque Meadows by Adam Johnson. All rights reserved.