[0:08] i am Board of Health Vice Chair

[0:11] Cannon Daniels, and today I

[0:13] have the pleasure of serving as

[0:15] the chair for board. Chair

[0:16] Mosqueda. I

[0:18] m calling this

[0:20] meeting to order on JUNE 18th,

[0:23] 2026. Chair Mosqueda

[0:25] unfortunately could not attend

[0:27] today and I will surely MISS

[0:29] The charisma and the precision

[0:31] that comes with her leadership.

[0:33] Are you warning this meeting

[0:34] today MAY be a little rough

[0:36] around the edges, as this is

[0:38] only my second tier, second

[0:40] time chairing our monthly

[0:41] meetings. So I ask for your

[0:42] grace, and we

[0:43] ll work hard to

[0:44] ensure that our time together

[0:47] today is spent as effectively

[0:49] and efficiently as possible

[0:51] with especially with so many

[0:52] things vying for our attention

[0:54] on a per second basis. I really

[0:55] want to thank everyone for

[0:57] setting aside these next couple

[1:00] of hours to learn about and

[1:01] discuss various public health

[1:03] items that are set on our

[1:04] agenda today. It

[1:05] s good to see

[1:07] you all at our meeting today.

[1:08] The board will hear a chair

[1:09] s

[1:11] report from me and a director

[1:12] s

[1:14] report from Doctor Sandra

[1:17] Valenciano, health officer and

[1:18] acting director of Public

[1:20] Health Seattle in King County.

[1:22] You can also find a written

[1:24] report from doctor v in the

[1:25] meeting Materials packet,

[1:29] beginning on page nine. Today

[1:29] we

[1:31] ll hear three briefings.

[1:31] First, we

[1:33] ll hear from board

[1:37] administrator Joy Carpenter,

[1:40] Joy Carpine-Cazzanti Canty.

[1:43] Thank you. To about board

[1:45] membership and this summer

[1:45] s

[1:48] recruitment efforts for 2027.

[1:48] Second, we

[1:50] ll hear from board

[1:51] member Tripoli and Public

[1:53] Health about innovations and

[1:55] sexual health. This briefing

[1:57] was deferred at the MAY

[1:59] meeting. So I want to ensure

[2:01] adequate time is given. And

[2:01] lastly, we

[2:03] ll hear from me and

[2:04] the Washington State Department

[2:05] of Health about findings and

[2:07] recommendations from the

[2:07] Washington

[2:08] s Maternal Mortality

[2:11] Review Panel. At the end of the

[2:13] meeting. Board members will

[2:14] have the opportunity to share

[2:17] any updates. Additionally, our

[2:19] our JULY meeting will be held

[2:21] on the usual third Thursday,

[2:24] JULY 16th, 2026, beginning at 1

[2:25] P.M.. Clerk hey, would you

[2:27] please call the roll?

[2:28] Thank you. Chair. Daniels.

[2:31] Board member Dunn. Board

[2:32] member.

[2:33] Lewis.

[2:36] Here. Board member. Mosqueda.

[2:38] Board member. Von Reichbauer.

[2:42] Here. Board member. Foster.

[2:45] Board member. Juarez. Board

[2:48] member. Rinke. Board member.

[2:51] Soca. Board member. Falcone.

[2:51] I

[2:52] m here.

[2:54] Board member. Garcia.

[2:55] Present.

[3:00] Board member. Schroth. Board

[3:02] member. Blas.

[3:03] Present.

[3:05] Board member. Core.

[3:05] Here.

[3:10] Board member. Paquette. Here.

[3:14] Board member. De Castro. Board

[3:16] member two. Board member.

[3:19] Gadgil. Present. Board member.

[3:23] Hartfield. Board member.

[3:24] Mohammad.

[3:25] Here.

[3:27] Board member. Green. Board

[3:29] member. Polly.

[3:30] Present.

[3:33] Board member. Lu.

[3:34] Yes.

[3:38] Board member. Milligan. Board

[3:43] member. Elkins. Board member.

[3:47] Thomas. Board member. Williams.

[3:50] Board member. De Los Angeles.

[3:54] Board member. Bowen. Board

[3:59] member. Lucero. Here. Thank

[4:04] you. Board member. Gilli and

[4:06] chair. Daniels.

[4:08] Thank you. Clerk.

[4:11] You have a quorum.

[4:13] We always welcome alternates to

[4:16] join board meetings. Are there

[4:17] any alternates who are serving

[4:19] in place of regular members

[4:22] today?

[4:25] Board member Green is present.

[4:30] Thank you. Partner.

[4:33] Board member. Foster.

[4:35] Just identifying. I missed roll

[4:35] call, but I

[4:36] m present. Thank

[4:37] you so much, chair Daniels.

[4:41] Thank you.

[4:42] Okay. I think that

[4:43] s all I see.

[4:45] Okay. All right. Thank you

[4:47] everyone. We will now move to

[4:51] the approval of our MAY 21st,

[4:53] 2026 minutes. Board member

[4:55] Falcon, can you move to approve

[4:58] the MAY 21st, 2026 minutes?

[4:59] Yes. Thank you. Vice chair

[5:00] Daniels, I move that we approve

[5:02] the MAY 2026 meeting minutes.

[5:04] Thank you. All those in favor,

[5:06] please signify by saying I.

[5:06] I, I.

[5:08] I.

[5:12] All opposed name any

[5:14] abstentions? The ayes have it.

[5:16] The MAY minutes are approved.

[5:19] Thank you. Okay, now we will

[5:22] move on to public comments.

[5:23] Clerk. Do we have anyone in

[5:25] chambers or on the line wishing

[5:27] to provide public comment?

[5:30] We have one.

[5:33] Okay. Um, the Board of Health,

[5:35] we welcome public comment as an

[5:37] important part of the public

[5:39] process. And we truly want to

[5:41] hear your thoughts regarding

[5:43] public health matters in King

[5:45] County. With that being said,

[5:47] each commenter will have two

[5:49] minutes and I will be a bit

[5:50] stingy with that time as we do

[5:52] have a full agenda. Um, in

[5:54] addition, please keep in mind

[5:56] that all comments must be

[5:58] germane to the agenda items or

[5:59] items within the board

[6:00] s

[6:02] purview. Speakers should not

[6:03] make introductory statements,

[6:06] derogatory remarks, profanity,

[6:08] or personal attacks not germane

[6:10] to an agenda item, nor

[6:11] statements related to a

[6:13] political campaign or

[6:14] statements for or against a

[6:20] candidate or ballot measure.

[6:22] Clerk. We have.

[6:24] One in chamber.

[6:24] We do.

[6:27] Have one in chambers signed up.

[6:30] And that is Alex Zimmerman.

[6:44] Okay. Alex, you have the four.

[6:45] We

[6:50] ll take this down. Yeah.

[6:50] I

[6:52] m candidate for election 15

[6:53] times, and I

[6:54] m talking about

[6:55] agenda number eight for my

[6:57] understanding about sexual

[6:58] problem. That is, we have it

[6:59] s

[7:00] a little bit confused me

[7:02] because we have a syphilis

[7:05] epidemic. Who are you guys?

[7:08] 21st century. You can count on

[7:09] PRESIDENT. Be very

[7:10] intellectual. How many

[7:12] percentage people educate? With

[7:17] college degree? 77% plus minus.

[7:18] If you have a syphilis

[7:20] epidemic. Doctor months ago

[7:22] told me it was the biggest

[7:24] blood test I took. Everybody

[7:26] needs this epidemic. I know

[7:29] last time syphilis epidemic

[7:32] came in 15th century in Europe.

[7:34] Who are you? You. I told you

[7:35] so. King country number one for

[7:37] city in America. County in

[7:40] America. Right now you Wilt

[7:41] County. You know what I mean?

[7:46] Syphilis in 21st century for

[7:48] 2.5 million people. Because you

[7:51] are Baggett a killer. All

[7:52] money. What is you give, you

[7:53] give to people what is not

[7:55] deserve this like not legal

[7:58] immigrants who bring a thousand

[8:00] syphilis inside America. In

[8:02] King County you are a bandit.

[8:03] You are a killer. And I talk

[8:06] about this many times, but very

[8:08] interesting because professor,

[8:10] from you, you double present

[8:12] this of 20 year ago. And I know

[8:14] the PRESIDENT Of you double

[8:17] make a $1 million salary. I

[8:19] think why he make $1 million in

[8:21] salary in Alex Zimmerman have

[8:24] only $2,000 Social Security,

[8:26] whereas a problem when you stop

[8:28] an Arctic like a veiled stupid

[8:31] idiot. Viva Trump, viva new

[8:33] American revolutions, up slap

[8:35] and happy cow. You need stop

[8:38] and steal us money driving

[8:39] these millions and millions of

[8:42] dollars to stranger. What is

[8:46] being.

[8:48] That was the last person on the

[8:49] list. Chair Daniels.

[8:51] Thank you Claire. That

[8:52] concludes public comment. We

[8:54] will move on to the chair

[8:54] s

[8:57] report. Uh, first chair

[8:59] Mosqueda wanted to express her

[9:02] appreciation to all the board

[9:03] members for considering and

[9:06] signing the sign on letter to

[9:07] the state Department of Health

[9:08] regarding improving access to

[9:10] massage licensure, reducing

[9:12] barriers that are preventing

[9:13] many prospective and current

[9:16] massage workers, particularly

[9:17] immigrant, low income and

[9:18] non-English speaking Asian

[9:20] women, from from accessing

[9:21] Washington

[9:22] s Massage Licensure

[9:24] system. Chair. And in

[9:25] partnership with the board

[9:28] members assigned on stand ready

[9:29] to work with the Department of

[9:31] Health team to collectively

[9:33] address and reduce hurdles to

[9:35] licensure. Thanks to board

[9:38] members Foster, Lewis, Mercedes

[9:42] rink, Scruff, Muhammad, Green,

[9:45] Melanie Lucero, Lou Hartville,

[9:48] myself and chair Mosqueda for

[9:49] signing on to The letter. We

[9:52] sent a letter on JUNE 12th,

[9:54] 2026 and we

[9:55] ll let the board

[9:58] know what the response is. I

[9:59] also want to say

[10:01] congratulations to Doctor

[10:03] Sandra Valenciano. Her

[10:05] appointment as Director of

[10:06] Public Health was confirmed

[10:09] this month by both the Seattle

[10:10] City Council and the

[10:12] Metropolitan King County

[10:14] Council, and her title is

[10:16] officially official. So,

[10:18] doctor, v, just unpacked those

[10:20] last few boxes, settle in

[10:22] because we want to keep you in

[10:23] your step with us now.

[10:24] Congratulations.

[10:27] Doctor v.

[10:29] All right. This brings us to

[10:31] item number seven, the

[10:31] director

[10:33] s report. A written

[10:33] director

[10:35] s report is in the

[10:37] meeting material shared by the

[10:39] clerk last week, beginning on

[10:41] page nine. And it does include

[10:43] an update on the Community

[10:44] Health Improvement Plan or

[10:46] Chip. Board members Lew

[10:48] Muhammad and I serve on the

[10:50] Chip steering committee. So

[10:51] please take a look at that

[10:53] written report. Okay. Doctor,

[10:56] ve, you have the floor.

[10:59] Thank you. Chair Daniels. And

[11:02] thank you for the kind words.

[11:04] Um, that was actually the first

[11:07] item on my list of updates. Uh,

[11:10] yes. After four confirmation

[11:12] hearings or, uh, because I had

[11:13] to do two with the King County

[11:15] Council and two with City of

[11:18] Seattle. Um, happy to inform

[11:20] everyone that I was officially

[11:22] confirmed last week, Tuesday by

[11:25] both councils. And on Friday,

[11:28] um, was happy to participate in

[11:30] a swearing in ceremony at the

[11:31] city of Seattle, along with

[11:34] other directors. Um, we can

[11:36] share the link to that,

[11:37] actually, because I took oath

[11:39] of office and I had to make

[11:41] remarks. So happy to share that

[11:44] with the board. Um, and happy

[11:46] to be here in, in this dual

[11:48] role now officially as director

[11:50] and health officer. Um, thank

[11:52] you all for your support.

[11:54] Really appreciate it. Uh, the

[11:56] other item I wanted to just

[11:57] quickly highlight is, you know,

[11:59] fifa World Cup has officially

[12:01] kicked off in the city of

[12:04] Seattle. Um, and we had our

[12:06] first game here on Monday. We

[12:10] have a game tomorrow. Um, and,

[12:13] uh, happy to report that so far

[12:16] it has been knock on wood. Uh,

[12:19] blue skies in Seattle. Uh, of

[12:21] course, you all probably saw

[12:24] and felt the heat. Um, that

[12:26] happened over the weekend and

[12:28] earlier part of this week. We

[12:30] did see a slight increase in

[12:33] heat related calls for ems and

[12:35] a slight uptick in heat related

[12:38] illness. Um, an emergency

[12:40] department visits. However,

[12:40] that

[12:42] s not surprising, right?

[12:44] Given the changes in the

[12:46] weather and did not have a

[12:48] major impact on our health care

[12:51] system. Uh, aside from that, no

[12:53] other broader trends requiring

[12:55] any additional public health

[12:56] action have been identified at

[12:59] this time. Um, our team is

[13:00] activated. We have our Mac

[13:02] Health Medical Area Command

[13:04] activated since last week.

[13:06] Actually. And our team is

[13:08] continuing to do surveillance

[13:09] throughout throughout all of

[13:13] the matches in Seattle. Um, and

[13:15] I will also add that, you know,

[13:16] various members of our team are

[13:18] on a number of different calls

[13:19] related to fifa. We have, of

[13:22] course, our internal Mac calls.

[13:24] We have our emergency

[13:25] preparedness team that are

[13:27] sitting in on the King County

[13:28] emergency operations, as well

[13:29] as the City of Seattle

[13:32] emergency operations. Um, I am

[13:34] on calls with cdc, with local

[13:36] health officials from all of

[13:38] the host cities. Uh, so that

[13:38] s

[13:40] actually really great because

[13:40] it

[13:42] s an opportunity for us to

[13:44] learn about anything that could

[13:45] happen. You know, from a public

[13:46] health standpoint and any of

[13:49] the other host cities, um, as

[13:50] well as calls with the

[13:51] Department of Health and the

[13:53] Big Cities Health Coalition.

[13:55] So, needless to say, a whole

[13:57] number of coordination calls

[13:59] with a variety of different

[14:00] partners that are all

[14:02] monitoring everything related

[14:03] to fifa World Cup and public

[14:06] health. Um, at our last board

[14:08] meeting, I provided an update

[14:12] about, uh, the hantavirus, uh,

[14:14] outbreak associated with the

[14:17] cruise ship. And, um, informed

[14:18] the board about, you know, our

[14:20] King County residents that we

[14:23] had identified as being high

[14:25] risk exposures. And we did have

[14:27] an additional low risk

[14:29] exposure. Just wanted to share

[14:32] and report that, um, our

[14:34] residents followed public

[14:35] health guidance throughout

[14:37] their entire monitoring period.

[14:39] And, uh, some have completed

[14:41] their monitoring period without

[14:44] any symptoms. Um, and a couple

[14:45] will be completing theirs, uh,

[14:47] shortly. The there is one

[14:49] resident who chose to remain at

[14:51] the Nebraska facility during

[14:53] the entire monitoring period.

[14:55] Um, but happy to report that

[14:57] also without any symptoms. Um,

[14:59] and then, of course, right

[15:01] after hantavirus, I

[15:02] m sure you

[15:05] all have seen about the ongoing

[15:08] outbreak of Ebola. Um, wanted

[15:10] to share a little bit about

[15:13] that. So on MAY 5th, uh, the

[15:14] World Health Organization

[15:17] alerted, uh, about an outbreak

[15:19] of Ebola virus occurring in the

[15:21] eastern providences of the

[15:24] Democratic Republic of Congo.

[15:26] And there are different kinds

[15:28] of Ebola viruses. And the the

[15:31] one that has been identified is

[15:36] Buju Ebola virus. Um, so far as

[15:41] of JUNE 16th. And these are

[15:42] numbers from the cdc

[15:44] s, um,

[15:46] situational update report.

[15:49] There have been a total of 875

[15:53] confirmed cases in drc and 202

[15:57] deaths in Uganda as of JUNE

[15:58] 18th. There have been a total

[16:01] of 19 confirmed cases and two

[16:04] deaths. Um, there, as you can

[16:06] imagine, this is a situation

[16:08] of, uh, global importance,

[16:10] especially as we

[16:11] ve undertaken.

[16:13] Right? This, um, World Cup and

[16:15] lots of travel, summertime,

[16:18] etcetera. Um, the cdc is

[16:20] actively monitoring their

[16:22] emergency operations center is

[16:25] has been stood up and the they

[16:27] have implemented strict

[16:29] protocols, including routing

[16:32] individuals who are returning

[16:34] from any travel to drc, Uganda

[16:36] and South Sudan in the last 21

[16:40] days to specific airports where

[16:42] upon arrival they are screened

[16:44] and then state and local health

[16:46] departments are receiving

[16:48] information about any travelers

[16:49] that will then be returning to

[16:51] their states. Like other Ebola

[16:53] outbreaks in the past. Public

[16:54] health is working closely with

[16:56] the state Department of Health

[16:58] and the cdc, and will be

[16:59] conducting symptom monitoring

[17:01] on any travelers returning from

[17:03] these affected countries. Uh,

[17:05] currently, travelers that have

[17:06] returned have all been

[17:08] identified to be very low or

[17:11] low risk. Uh, the risk to the

[17:13] United States and here in King

[17:16] County remains low. We do not

[17:17] expect a bullet to be a local

[17:19] health threat during the World

[17:21] Cup. And we are, of course,

[17:22] continuing to monitor the

[17:25] situation as it continues to

[17:26] evolve. Um, and then just to

[17:28] note also on those numbers, of

[17:29] course, that, you know, numbers

[17:32] are actively changing rapidly.

[17:35] Um, and, uh, another important

[17:37] piece of information is that no

[17:39] cases of Ebola have been

[17:40] identified in the United

[17:43] States. Uh, and then lastly,

[17:47] wanted to share about, uh,

[17:49] measles. Um, so I think

[17:50] everyone has seen and I

[17:51] ve

[17:53] reported in previous board

[17:56] meetings about measles

[17:59] outbreaks and where we stand in

[18:00] the United States. So as of

[18:03] JUNE 5th, we have had a 45

[18:05] cases of measles. Measles in

[18:07] Washington state, uh, with

[18:09] three cases here in King

[18:12] County. Uh, cases in Washington

[18:15] have occurred typically in, uh,

[18:17] people who have been

[18:19] unvaccinated or not fully

[18:21] vaccinated and have either

[18:23] traveled domestically where

[18:25] active outbreaks of measles

[18:27] have been occurring, or

[18:28] internationally and have been

[18:30] exposed. Um, we

[18:31] ve also had

[18:34] introduction from travelers who

[18:36] traveled into Washington or

[18:37] traveled through Washington

[18:39] with measles and then, um,

[18:41] have, you know, exposed other

[18:43] individuals. Our team is

[18:46] actively working on measles

[18:48] surveillance at all times, uh,

[18:50] working with the state

[18:52] Department of Health and cdc.

[18:54] And I think really important,

[18:56] since, of course, we are now in

[18:58] summer travel period to make

[19:00] sure that, uh, community

[19:03] members know that it is really

[19:04] important to make sure that

[19:07] they are immune and have had

[19:10] two doses of measles vaccine.

[19:14] Um, before traveling outside of

[19:15] the United States or even

[19:17] traveling domestically in the

[19:18] United States, where there

[19:20] might be an active outbreak of

[19:22] measles. Um, and typically,

[19:24] children receive their first

[19:27] dose of the measles vaccine

[19:30] between 12 to 15 months of age.

[19:32] Uh, but I want to make sure

[19:35] that parents know that children

[19:38] that are 6 to 11 months old and

[19:40] who MAY be traveling

[19:42] internationally or to an area

[19:43] with an active outbreak, can

[19:46] get a dose prior to their

[19:48] travels, even though their

[19:49] child is not a year old yet. I

[19:50] think that

[19:52] s really important.

[19:56] Um, and so happy to conclude my

[20:00] updates at this time.

[20:03] Thank you. Doctor v board

[20:05] members, are there any

[20:06] questions or comments.

[20:08] For Doctor e.

[20:09] Or members of.

[20:13] The Sarah who have the floor?

[20:16] Hey doctor v. Congratulations.

[20:17] Uh, really happy to have you in

[20:20] this role. Um. My question.

[20:20] It

[20:21] s more of a recommendation.

[20:22] Actually, I

[20:24] m wondering if King

[20:25] County has considered putting

[20:28] forward all of the sites that

[20:30] actually provide vaccinations

[20:32] as, like a form of, you know,

[20:33] outreach to community with

[20:35] these reminders. Um, and I

[20:36] m

[20:37] particularly thinking because

[20:37] we, you know, it

[20:37] s very

[20:39] important that we contradict

[20:40] kind of the administration

[20:40] s

[20:42] position, the federal

[20:42] administration

[20:43] s position on

[20:45] vaccines. Um, and, you know,

[20:47] speaking as a leader of one of

[20:48] the federally qualified health

[20:51] centers, and I know this is a

[20:53] massive effort on our part. And

[20:54] so we could use some assistance

[20:55] from King County in getting

[20:58] that information out and having

[20:59] a broader reach. So that would

[21:02] be my request.

[21:06] Yes, absolutely. Um, our team,

[21:09] uh, we do have about 22

[21:11] community navigators who are

[21:13] actively working in community

[21:15] and with community and are

[21:18] sharing information regarding

[21:20] measles. Um, of course, at our

[21:22] public health clinics and

[21:23] through our community access

[21:25] and outreach teams as well. Um,

[21:28] and but always happy to

[21:30] collaborate in any way, shape

[21:32] or form to provide accurate

[21:34] information to the community.

[21:36] Um, actually, just yesterday I

[21:38] did a measles interview in

[21:41] Spanish, uh, as well. Uh, that

[21:42] was live Facebook live for

[21:45] community, kind of answering

[21:47] questions from community about

[21:50] misinformation related to

[21:52] measles vaccination. Um, you

[21:53] know, misinformation about

[21:56] measles and autism and just

[21:58] concerns that people have. Uh,

[22:00] so we did do that. And I have a

[22:01] one coming up in a couple of

[22:02] weeks as well that I

[22:03] ll be

[22:05] doing in Spanish for another

[22:07] outlet. Um, but our team is

[22:08] actively doing these two with

[22:11] other smaller community media.

[22:14] Um, any, you know, uh,

[22:16] recommendations or suggestions?

[22:18] Our team is happy to, to work

[22:19] on this.

[22:20] Thank you, Doctor Bee.

[22:23] Uh, board member Lucero, is is

[22:24] your hand up for additional

[22:25] follow up?

[22:25] It

[22:26] s just a follow up. Yes.

[22:26] Go ahead.

[22:28] Please. You know, I was

[22:29] speaking, um, as the co-chair

[22:31] who, um, led the Breaking the

[22:33] Cycle initiative from, um,

[22:36] executive Zahilay. And one of

[22:38] the commitments within that,

[22:40] um, committee is to make sure

[22:41] that we have meaningful

[22:44] community. Um, partnerships.

[22:45] And so I

[22:46] d like to see much

[22:48] more than just, you know,

[22:51] information. But really, um,

[22:54] advertising and marketing and

[22:57] communicating the community

[22:58] based organizations that are

[23:00] ready to assist with this and

[23:03] have capacity to be able to

[23:04] support the need. Um, so that

[23:04] s

[23:06] I want to be very clear about

[23:08] my ask. Thank you.

[23:10] And I will follow up with we

[23:12] have a within Public health,

[23:14] our Office of Equity and

[23:16] Community Partnerships because

[23:18] we work with a number of

[23:20] community based partners. Um,

[23:21] through a number of efforts,

[23:23] like Chair Daniels mentioned,

[23:23] our community health

[23:25] improvement plan work that

[23:26] includes a number of community

[23:28] partners who are constantly

[23:31] working with um, as well as our

[23:33] here tag group, which is our

[23:35] health equity and Anti-Racism

[23:36] community advisory group. Um,

[23:39] so we do constantly communicate

[23:41] with and coordinate and

[23:42] collaborate with all of those

[23:44] partners. But I will follow up

[23:45] with them just to make sure

[23:48] that, you know, there is that

[23:49] communication as you

[23:49] re

[23:51] mentioning and that, you know,

[23:53] collaboration. And if there

[23:53] s

[23:53] anything that

[23:54] s missing that

[23:54] we

[23:59] re addressing that.

[23:59] Thank you.

[24:01] Board member Lucero.

[24:05] Um, doctor v, any additional

[24:07] questions or comments from the

[24:10] board? Okay. Hearing none.

[24:12] Seeing none. Um, and thank you

[24:14] so much, board member. Lucero.

[24:15] It, um, it sounds like you

[24:15] re

[24:17] saying, hey, we don

[24:18] t want just

[24:20] information dispense. We want

[24:24] to have in-depth conversations

[24:27] and connections regarding this,

[24:29] not just information. So, um,

[24:31] so it looks like a work is

[24:34] already been, um, a been, uh,

[24:36] been done to ensure that that

[24:39] is possible. And, um, we will

[24:41] we will continue to make sure

[24:43] that our community is served.

[24:46] All right. Okay. All right.

[24:49] Thank you. Doctor v, next. This

[24:52] brings us to our. It brings us

[24:54] to item eight on the agenda

[24:55] with an update on board

[24:58] membership and recruitment for

[25:00] 2027. Uh, welcome, board

[25:03] administrator Joy Joy

[25:04] Carpine-Cazzanti. I think I got

[25:06] there, Rick, to join us.

[25:07] Yes. Thank you. Um, yes, you

[25:08] got it right. I

[25:09] m Joy

[25:11] Carpine-Cazzanti your board of

[25:12] health administrator from

[25:14] public health. Uh, and today,

[25:14] I

[25:15] ll give you an update on

[25:16] recruitment for board

[25:20] membership in 2027. The board

[25:22] has three members and one

[25:24] alternate whose terms will

[25:25] conclude at the end of this

[25:28] year. Board member Butch de

[25:29] Castro, who represents public

[25:31] health facilities and

[25:33] providers. Board member Lisa

[25:35] Chu, who also represents public

[25:36] health facilities and

[25:39] providers. Board member

[25:40] Christopher Archiopoli, who

[25:41] represents community

[25:44] stakeholders. And lastly,

[25:46] alternate Francoise Milinganyo,

[25:49] who also represents community

[25:51] stakeholders. Board Member Chu

[25:53] accepted the invitation to be

[25:55] reappointed and would begin her

[25:57] third term in JANUARY. Board

[25:59] member Archie Poli, an

[26:01] alternate Telangana, have

[26:03] accepted the invitation to be

[26:04] reappointed and would also

[26:06] begin their second terms in

[26:10] JANUARY. Board member Butch de

[26:11] Castro um, who

[26:12] s not with us

[26:13] today, but he has served on the

[26:15] board for many years and he has

[26:17] indicated that he will finish

[26:19] his current term but not

[26:22] continue next year. Uh,

[26:25] alternate Karen Hartfield, who

[26:27] is his alternate um, has

[26:29] accepted the invitation to be

[26:31] appointed to fill. Board member

[26:32] de Castro

[26:34] s position. So

[26:37] therefore, we need to fill her

[26:38] position. So that

[26:38] s what we

[26:41] will be advertising for this

[26:43] summer, for the recruitment and

[26:45] appointment process, the state

[26:47] Board of Health Code outlines

[26:49] requirements including posting

[26:51] vacancy announcements in public

[26:52] places, including the newspaper

[26:55] of record making, available

[26:56] vacancy announcements in any

[26:59] language upon request. Um,

[27:01] posting vacancy announcements

[27:03] in all geographic regions

[27:04] represented by the King County

[27:07] Board of Health. Working with

[27:09] local community organizations

[27:11] to distribute vacancy notices

[27:13] and complying with applicable

[27:14] provisions of the Americans

[27:16] with Disabilities Act. State

[27:18] requirements place

[27:19] responsibility for recruitment,

[27:21] selection, and recommendation

[27:23] with the Board of Health and

[27:24] the official appointment with

[27:27] the King County Council. So we

[27:29] hope to have board

[27:31] recommendations in the form of

[27:33] resolutions approved by the

[27:35] board this OCTOBER to allow

[27:37] time for final action by the

[27:39] King County Council before the

[27:41] end of the year. So the

[27:43] recruitment announcement is

[27:45] available now on the Board of

[27:45] Health

[27:47] s web page. Um, if you

[27:48] look for the Join the Board of

[27:49] Health link, and I

[27:50] ll send this

[27:52] out after the the meeting as

[27:55] well. And over the next month,

[27:56] we will announce the

[27:57] opportunity on Public Health

[27:57] s

[27:59] blog and social media channels

[28:02] and in paid ads in newspapers

[28:03] across the county. We

[28:04] ll also

[28:06] share it with public health in

[28:06] Public Health

[28:08] s newsletters,

[28:10] with community partners, and we

[28:12] will ask them and you to spread

[28:15] the word. So today, I would

[28:16] kindly request that our current

[28:18] board members and alternates

[28:20] share the announcements with

[28:22] your networks as well. And um,

[28:23] as I mentioned, I

[28:24] ll send an

[28:26] email in the next week with

[28:29] that information to share. Once

[28:32] we receive applications, I will

[28:33] share them with all the board

[28:35] members for your review. And

[28:36] while we don

[28:38] t expect a super

[28:40] intensive process this year,

[28:41] given that we are recruiting

[28:44] for only one seat, we will need

[28:45] 1 to 3 board members or

[28:47] alternates to volunteer to

[28:49] review applications and serve

[28:50] on the interview panel. This

[28:53] summer. Um, I will thank in

[28:55] advance. Uh, board members are

[28:57] Chipotle and alternate

[28:58] Hartfield, who have volunteered

[29:02] to serve on that committee. Um,

[29:05] and the commitment for serving

[29:07] in the committee would require

[29:09] time for 2 to 3 meetings

[29:11] outside of the board meetings,

[29:13] first to review applications,

[29:15] probably in late JULY, and then

[29:17] to interview candidates in

[29:19] AUGUST or SEPTEMBER and discuss

[29:20] the results in order to make a

[29:21] recommendation to the full

[29:24] board at the SEPTEMBER meeting.

[29:26] So if one or more members or

[29:27] alternates are willing to

[29:29] participate on the interview

[29:31] panel, um, if you

[29:31] d like to

[29:33] raise your hands now or let me

[29:36] know via email, I will sign you

[29:40] up. Thank you. That

[29:41] s it for

[29:43] me. Unless you have questions.

[29:45] And I see board member

[29:46] Muhammad.

[29:49] Board member Muhammad, are you

[29:52] volunteering to for the

[29:55] recruitment committee?

[29:58] Uh, yeah, if I have time. Yes,

[29:59] maybe. Yeah.

[30:02] Okay. Thank you. Yeah. I will

[30:04] follow up with you.

[30:07] Any any additional board

[30:09] members? Board member

[30:11] alternates who would like to

[30:16] serve? Well, we know that every

[30:19] that that board members, you

[30:20] have 20 million things on your

[30:23] schedule. So, um, take a look

[30:25] at that and see what your

[30:28] availability is for the summer

[30:30] and reach out to Joi if you

[30:32] have availability. That will be

[30:33] awesome.

[30:35] Thank you. And if you are an

[30:37] elected member, you could also

[30:38] send a staff member in your

[30:41] stead. Thank you.

[30:45] Thank you Joey. Okay. All

[30:47] right. This brings us to item

[30:50] number nine on the agenda, an

[30:51] update on innovations in sexual

[30:53] health in King County,

[30:55] including progress and

[30:57] innovation in hiv and sti

[31:00] control. This item was deferred

[31:02] at our main meeting. So thank

[31:04] you so much, presenters, for

[31:06] returning today. We thank

[31:08] Doctor Cannon for his

[31:09] flexibility. We

[31:09] ll hear from

[31:11] board member Archie Epperly and

[31:13] Doctor Chase cannon from Public

[31:15] Health. Just a quick reminder.

[31:17] We have about 30 minutes for

[31:19] this agenda item, including

[31:21] discussion. And welcome Doctor

[31:23] Cannon and board member Archer

[31:25] Poli. Please kick us off.

[31:27] Thank you, Vice Chair Daniels.

[31:28] And thank you, fellow board

[31:29] members. Uh, I

[31:30] m Christopher

[31:31] Archiopoli I

[31:31] m a community

[31:32] stakeholder on the Board of

[31:34] Health. I also identify as a

[31:36] person in long term recovery

[31:37] from substance use disorder.

[31:39] And a person living with hiv

[31:41] since 2008, and a member of the

[31:43] queer community. I

[31:43] ll make sure

[31:44] that Doctor Cannon has the

[31:45] majority of our time to talk

[31:47] about what public health is

[31:49] doing. My portion has less to

[31:51] do with innovations. Before

[31:52] handing things over, I

[31:52] ll

[31:53] address what is happening with

[31:55] community based initiatives, as

[31:56] well as how sexual health

[31:58] marketing reaches those most

[32:03] impacted. Next slide. So a lot

[32:05] has changed since the height of

[32:07] the Aids crisis and post-Covid,

[32:07] but there

[32:08] s still a robust

[32:10] community of people looking to

[32:11] engage with each other and with

[32:14] research. I facilitate a weekly

[32:16] support group, a support group

[32:18] for people living with iv on

[32:20] Mondays from 6 to 7 P.M. At

[32:21] Pier Seattle. I

[32:22] m co-chair of

[32:24] the University of Washington

[32:25] Positive Research Community

[32:27] Advisory Board, focused on

[32:28] connecting, communicating to

[32:29] people most impacted about

[32:31] research efforts being made

[32:32] towards ending the hiv

[32:35] epidemic. As vice chair of the

[32:36] King County Health Care for the

[32:38] Homeless Governance Council,

[32:38] I

[32:39] m always focused on

[32:40] highlighting the disparities

[32:41] marginalized communities

[32:43] experience regarding public

[32:44] health issues. I also sit on

[32:47] the communication subcommittee

[32:49] community for Advancing

[32:50] Clinical Therapeutics globally,

[32:52] an international organization

[32:53] focused on hiv and sti

[32:56] research. One of my favorite

[32:58] local organizations is Bailey

[32:59] Bush House in Seattle

[33:00] s Madison

[33:01] Valley neighborhood. They

[33:01] ve

[33:04] operated since 1992, providing

[33:06] hospice care as well as shelter

[33:07] services to people living with

[33:09] hiv who are unhoused or on

[33:11] stably housed. They provide

[33:12] meals, make connection to

[33:14] housing services, as well as

[33:16] ensuring individuals have

[33:17] access to lifesaving, saving

[33:19] medications and basic medical

[33:21] care. I provide haircuts to the

[33:23] residents once a month and have

[33:23] been doing qualitative

[33:25] interviews for a research study

[33:27] aimed at determining how to how

[33:29] to best communicate with this

[33:30] population. In my

[33:31] conversations, I

[33:32] ve heard

[33:33] growing concerns about the

[33:34] stability of this vital

[33:36] community resource. As weekend

[33:38] nursing services have been cut

[33:39] and quality of care has

[33:41] decreased since Common Spirit

[33:42] took over management of the

[33:44] facility, many shelters will

[33:45] not serve people living with

[33:47] hiv. And Bailey Boucher House

[33:49] is a unique resource that saved

[33:52] countless lives over 34 years.

[33:54] This is not an exhaustive,

[33:55] exhaustive list of what

[33:55] s

[33:56] happening in the community, but

[33:57] there aren

[33:57] t as many

[33:59] opportunities to be as engaged

[33:59] as there were at the height of

[34:02] the crisis. As hiv research and

[34:04] treatment have advanced, many

[34:05] have taken for granted that we

[34:08] have not solved this challenge.

[34:11] Next slide. So shifting to a

[34:13] kind of what what marketing

[34:15] looks like. I wanted to state

[34:17] first, I stand in awe of the

[34:18] talents of physicians and

[34:19] scientists who devoted their

[34:21] careers to improving the health

[34:23] and saving the lives of people

[34:24] in my community, including

[34:26] myself. I would not be alive

[34:28] without the advances in

[34:28] research that we

[34:29] ve seen over

[34:32] the last 30, 40 years. As

[34:33] someone with a background in

[34:34] marketing, I often view

[34:36] challenges through that lens.

[34:38] These images are examples of

[34:39] the kind of marketing targeted

[34:41] at our community. It is often

[34:43] so generic and sanitized that

[34:45] it can seem patronizing. I know

[34:47] from conversations within my

[34:48] social and professional circles

[34:49] that this type of marketing

[34:50] does not give people the

[34:52] information they need to make

[34:54] healthcare decisions. Next

[34:56] slide. So where are people

[34:58] getting their information? A

[34:59] quarter of Americans are

[35:00] getting their information from

[35:02] influencers. The majority of

[35:04] influencers are not healthcare

[35:06] professionals. Leo Herrera and

[35:08] Bobby Box are two influencers

[35:11] creating quality content, but

[35:12] there are many more spreading

[35:15] myths or disinformation. This

[35:16] challenge is a broader problem

[35:17] than just the topic at hand in

[35:19] this briefing. I think a lot

[35:21] about the American Revolution,

[35:22] when the British famously

[35:23] objected to the guerrilla

[35:25] tactics of the colonial rebels.

[35:26] Rather than adjust their

[35:28] tactics, they dug their heels

[35:29] in, expecting conformity to

[35:31] establish norms. We all know

[35:34] how that battle ended.

[35:35] Sanitizing our message leads to

[35:37] death by community committee.

[35:39] What offends? What offends? No

[35:41] one reaches no one. If we

[35:41] aren

[35:42] t willing to communicate

[35:43] with people the way that they

[35:45] receive messages, public trust

[35:46] will continue to migrate to

[35:48] online influencers rather than

[35:50] healthcare professionals. The

[35:51] information is out there. It

[35:52] s

[35:53] our choice if we want to be the

[35:55] source of that information. So

[35:56] with that, I want to hand

[35:58] everything over to Chase

[35:59] cannon. He

[36:00] s an assistant

[36:01] professor in the Department of

[36:03] Medicine at the University of

[36:05] Washington, medical director of

[36:06] the Public Health Seattle and

[36:07] King County Sexual Health

[36:09] Clinic, and medical officer on

[36:10] the Public Health Seattle and

[36:14] King County Prevention Division.

[36:16] Thank you very much. Board

[36:18] member Archer Pulley I will

[36:22] pull out my slides here.

[36:25] Hopefully everyone can see

[36:29] that. Okay. Um, so good

[36:32] afternoon everyone. Um, thank

[36:34] you for the opportunity to

[36:36] present, uh, about this

[36:38] important topic. Uh, so in the

[36:38] next few minutes, I

[36:39] m just

[36:40] going to review some of the

[36:42] highlights of the innovation

[36:43] and the progress that we

[36:43] ve

[36:46] made in the control for hiv and

[36:48] STIs. Uh, here in King County.

[36:50] So this is a brief overview of

[36:50] what I

[36:52] ll discuss. The state of

[36:53] hiv in Seattle, King County.

[36:55] Uh, the progress on what

[36:56] s

[36:57] called e or ending the hiv

[36:59] epidemic. And the four pillars

[37:01] that comprise that. And then

[37:02] we

[37:03] ll end with some trends on

[37:05] STIs, including for syphilis

[37:06] and something called Doxy Pep,

[37:09] which I will discuss. So I

[37:10] wanted to first start by

[37:12] discussing the status of hiv in

[37:13] King County. We

[37:14] ve made really

[37:15] extraordinary progress, I

[37:15] d

[37:17] say, over the past 20 years. So

[37:20] in the population overall, new

[37:23] hiv diagnoses have fallen by

[37:26] 65% among men who have sex with

[37:28] men who historically are a

[37:29] priority population that is

[37:30] disproportionately impacted by

[37:32] hiv. New diagnoses have

[37:35] dramatically decreased by 75%

[37:37] since 2010. And the reason that

[37:39] this is important is because,

[37:39] you know, we

[37:40] ve only had about

[37:42] 100 new diagnoses of hiv in

[37:45] this group in 2025, and that

[37:47] represents the lowest number

[37:49] that we have seen since the hiv

[37:50] epidemic began in King County

[37:53] in the 1980s. So extraordinary

[37:55] progress in much of that in

[37:56] recent years has occurred due

[37:58] to the success of something

[38:00] called e, or ending the hiv

[38:01] epidemic. Um, this is an

[38:03] initiative that was announced

[38:05] in 2019 that aims to

[38:07] substantially reduce hiv

[38:08] infections in the United States

[38:11] by focusing resources in 57

[38:12] jurisdictions that have the

[38:14] greatest need. So King County

[38:15] was selected as one of those

[38:18] jurisdictions, and in 2025, we

[38:20] received our sixth year of

[38:21] funding. And there are four

[38:22] pillars of e that you can see

[38:24] listed here. Diagnose, treat,

[38:26] prevent and respond. In the

[38:28] next few slides, I will just

[38:30] give a high level summary of

[38:30] public health

[38:32] s activities and

[38:33] successes within each of these

[38:35] pillars. But for those of you

[38:36] who are interested in more

[38:38] detail, I welcome you to access

[38:40] the county and State hiv

[38:42] epidemiology report that is

[38:46] linked here on the slide. So

[38:47] for the first pillar,

[38:50] diagnosing hiv, um, overall,

[38:52] 23% of all the new diagnoses in

[38:54] 2025 that we saw in King County

[38:56] were made as a direct result of

[38:57] public health. Seattle King

[38:59] County funding. And that

[39:00] includes activities ranging

[39:02] from our staff, you know,

[39:03] conducting testing at school or

[39:05] the South County Correctional

[39:06] Facility to promotion of

[39:08] testing and low barrier

[39:10] clinics. We closely followed

[39:12] diagnosis rates for several key

[39:13] populations that are

[39:15] disproportionately impacted by

[39:17] hiv, or who have been involved

[39:19] in historic outbreaks. So for

[39:21] women, we saw slight increase

[39:25] in diagnoses in 2024. Although

[39:26] this seems to have declined

[39:28] more recently. Women still made

[39:31] up 21% of all new diagnoses in

[39:33] 2025. We continue to see

[39:35] disproportionately high rates

[39:36] of hiv being diagnosed among

[39:38] black residents, and they

[39:40] comprised 36% of all new

[39:42] diagnoses, despite only making

[39:44] up 11% of the population in the

[39:46] county. And we see similar

[39:48] trends in men who have sex with

[39:51] men or msm, where both black

[39:51] and Latino men are

[39:52] disproportionately impacted

[39:54] compared to their makeup in the

[39:56] population. For people

[39:58] experiencing unstable housing

[40:00] or houseless, uh, we have

[40:03] observed decrease in new

[40:06] diagnoses since the 2018

[40:07] outbreak that people MAY

[40:09] remember, um, but still over

[40:11] 20% of heterosexual people who

[40:13] are diagnosed with hiv are

[40:15] unstable, housed. And then on

[40:16] the right side, you can see a

[40:18] figure here that outlines the

[40:20] fact that new diagnoses are not

[40:21] equally distributed

[40:22] geographically. So most of the

[40:24] new diagnoses that we see,

[40:25] actually over a third of them

[40:27] were in people residing in

[40:30] South King County. The second

[40:32] pillar is treatment. So since

[40:33] 2020, we

[40:35] ve had a real focus on

[40:37] building up differentiated care

[40:38] models. And so that is the

[40:40] strategy of tailoring our

[40:43] system of services to what we

[40:44] offer for people with hiv to

[40:46] really meet their needs. So

[40:47] increasing access to low

[40:48] barrier care has been a

[40:51] priority. And over the past

[40:53] year, 10% of all people living

[40:55] with hiv in the county received

[40:57] hiv primary care and low

[41:00] barrier clinics. In addition to

[41:02] expanding those brick and

[41:04] mortar low barrier services.

[41:05] Beyond the clinics that you see

[41:06] listed there in the table at

[41:08] the bottom left, um each

[41:11] supported a new, uh, hiv mobile

[41:12] Outreach team, or Mott uh,

[41:14] which aims to reach people with

[41:16] hiv who are virally suppressed

[41:18] and who are not engaged in care

[41:20] and face complex barriers to

[41:21] care, such as behavioral health

[41:23] disorders, housing instability,

[41:26] and justice system involvement.

[41:27] And out of those who were

[41:29] referred to the Mott who were

[41:31] still in county and agreed to

[41:34] engage with the team, 69% of

[41:38] people connected to care, 63%

[41:39] started or restarted hiv

[41:41] treatment, and then 46% reached

[41:43] viral suppression. So part of

[41:45] the success of reaching these

[41:46] levels of viral suppression,

[41:47] which is our end goal for

[41:49] people with hiv, especially

[41:50] those with the highest needs,

[41:52] um, is a direct result of the

[41:54] efforts to expand access to

[41:57] newer injectable hiv

[41:58] medications, both in low

[41:59] barrier clinics and also

[42:02] through the mobile team. So

[42:04] moving to pillar number three,

[42:05] which is prevention. We

[42:06] ve

[42:07] worked to increase access to

[42:10] Prep or hiv pre-exposure

[42:12] prophylaxis through new low

[42:13] barrier sites at community

[42:14] health centers, community based

[42:16] organizations and public

[42:17] health. Seattle King County

[42:18] s

[42:19] sexual and reproductive health

[42:20] clinics that are serving

[42:22] communities in South County.

[42:22] Um, we

[42:24] ve also made headway

[42:26] with promoting Prep through our

[42:28] e health care collaborative

[42:29] that brings together leaders

[42:31] and stakeholders within several

[42:33] major health systems in the

[42:34] community that provide care to

[42:36] over half of all adults in the

[42:38] county. And then our community

[42:40] education team has condom cubes

[42:41] that are set up around the

[42:43] county, including in some

[42:45] access spots for the World Cup.

[42:47] And they distributed nearly 1.3

[42:49] million external condoms in

[42:51] 2025. But then I

[42:52] d say the

[42:53] major innovation in prevention

[42:54] is the recent advent of

[42:56] injectable Prep. I mean, you

[42:57] saw a couple of advertisements

[42:59] for those that Boardmember

[43:01] showed, um, including an option

[43:03] that can be given every two or

[43:05] even every six months. And, you

[43:06] know, these are exciting. And

[43:08] there does seem to be a lot of

[43:10] demand for the community for

[43:11] these agents, but they are very

[43:13] expensive medications. And

[43:13] currently we

[43:14] re navigating

[43:15] financial challenges that are

[43:17] associated with the Washington

[43:18] State Department of Health

[43:18] s

[43:20] Prep assistance program. And so

[43:22] we, as public health, have

[43:23] issued guidance specifically on

[43:25] how to prioritize this

[43:27] resource. Um, and currently at

[43:28] the sexual health clinic, uh,

[43:30] we are limiting access to

[43:31] populations who have the

[43:32] greatest need, but the lowest

[43:34] uptake of Prep. So those

[43:36] include black and Latino men

[43:37] who have sex with men,

[43:39] transgender two, spirit and

[43:41] other gender diverse people,

[43:42] people who use drugs, and then

[43:43] others who have not found

[43:45] success using standard oral

[43:48] prep medications. And then the

[43:49] fourth and final pillar is

[43:51] respond. This has focused

[43:53] primarily on boosting our

[43:55] capacity to respond to hiv

[43:57] outbreaks. So one of our public

[43:58] health epidemiologists

[44:00] conducted focus groups with

[44:02] community members to learn what

[44:03] people know about cluster

[44:05] detection and response, and to

[44:06] explain how it can benefit the

[44:06] public

[44:09] s health. Staff capacity

[44:10] has expanded to conduct

[44:11] outreach to people within

[44:13] clusters and get them tested

[44:15] for hiv in either link to care

[44:18] or to prep for prevention. And

[44:20] over the last several years,

[44:21] you can see that a significant

[44:23] proportion of new diagnoses

[44:25] with available genetic

[44:27] information were found to be

[44:29] linked to clusters like this.

[44:31] So when public health can

[44:33] identify, um, these clusters

[44:35] and using systems that we have

[44:37] at hand, we can also sort of

[44:39] put in place activities and

[44:40] work to intervene to prevent

[44:45] new hiv transmission events. So

[44:46] transitioning away from hiv.

[44:47] Next, I wanted to talk a bit

[44:50] about syphilis. Um, so this is

[44:52] a type of bacterial sexually

[44:53] transmitted infection that I

[44:55] think people feel is antiquated

[44:56] and maybe isn

[44:57] t around anymore,

[44:58] but it very much is still

[44:59] present and circulating in the

[45:01] United States. Um, for many

[45:02] years, we were seeing

[45:03] consistent increases in

[45:05] syphilis cases. But the

[45:06] epidemic in King County has

[45:09] recently evolved in two main

[45:12] ways. So first, since 2023,

[45:12] we

[45:14] ve seen a decline in

[45:15] syphilis cases among all

[45:17] populations except for

[45:19] congenital syphilis. So

[45:20] congenital syphilis is when

[45:21] syphilis occurs during

[45:22] pregnancy, which can have

[45:24] really devastating effects on

[45:25] babies, including to their

[45:27] bones, internal organs, and can

[45:30] even cause stillbirth. So

[45:31] congenital syphilis is a major

[45:33] health public health issue that

[45:35] is completely preventable. So

[45:35] we

[45:36] ve put a lot of effort

[45:38] toward awareness testing and

[45:39] treatment. And thankfully, we

[45:41] MAY be seeing a little bit of a

[45:43] light at the end of the tunnel.

[45:44] Um, congenital syphilis cases

[45:46] seem to have kind of peaked in

[45:48] 2024. Um, and maybe coming

[45:48] down, but we

[45:49] re waiting for

[45:52] finalization of those 2025

[45:53] numbers. Uh, the second way

[45:53] that we

[45:54] ve seen the epidemic

[45:56] evolve is that we

[45:56] re seeing

[45:57] increasing proportions of

[45:59] people who are diagnosed with

[46:00] syphilis, who are living

[46:02] homeless and and or using

[46:04] substances. And like the trends

[46:04] that we

[46:05] re seeing with hiv, I

[46:07] think almost 70% of new cases

[46:09] among people and that our

[46:10] public health staff interview

[46:11] with syphilis are residents of

[46:14] South County. And then the most

[46:16] important recent innovation

[46:17] within the field of sexual

[46:18] health is Doxy Pep, which

[46:19] stands for doxycycline

[46:22] post-exposure prophylaxis. This

[46:25] is the strategy of taking 200mg

[46:26] of a common antibiotic,

[46:28] doxycycline, after sex, to

[46:30] prevent STIs. So multiple

[46:31] studies, including a major one

[46:32] that was conducted here in

[46:34] Seattle, were done in msm and

[46:35] transgender women and showed

[46:37] that doxy Pep can reduce the

[46:38] risk of getting committee on

[46:41] syphilis by more than 80%. So

[46:43] Doxy Pep is something that an

[46:44] individual can do for

[46:45] themselves that allows them to

[46:46] take control of their own

[46:48] sexual health, and based on the

[46:50] strong evidence from these

[46:51] clinical studies, cdc released

[46:52] guidelines that you see they

[46:53] re

[46:57] endorsing doxy Pep use in 2024.

[46:59] And here in Seattle, because we

[47:00] were involved in some of the

[47:01] initial studies, we were early

[47:03] adopters of Doxy Pep, uh, back

[47:06] in 2023, even before cdc

[47:07] released their guidelines to

[47:09] endorse it, we released our own

[47:10] for public health, Seattle,

[47:12] King County, and we started to

[47:13] see increasing numbers of

[47:16] people who used it after that.

[47:17] Um, given that we sort of know

[47:18] that it works very well for

[47:20] syphilis, we wanted to study

[47:21] what impact, if any, it had on

[47:23] syphilis locally. And so these

[47:24] are the data that you

[47:24] re seeing

[47:26] here in the graphs. We used,

[47:27] uh, county surveillance

[47:29] information. And we found that

[47:31] since the rollout began in

[47:34] 2023, Doxy Pep has really had a

[47:36] dramatic impact on syphilis

[47:38] diagnoses overall. Um, so

[47:39] specifically on the left side,

[47:41] you see that, uh, diagnoses

[47:43] went down over 50% in cisgender

[47:46] men and almost 50% in cisgender

[47:48] women. Um, but because numbers

[47:50] were so small, we did not see

[47:51] this type of change in

[47:52] transgender and nonbinary folks

[47:54] and other gender diverse

[47:55] people. But I think overall,

[47:57] this is an exciting, uh,

[47:58] finding. And it

[47:59] s it

[47:59] s nice to

[48:00] see that we finally basically

[48:02] have a low cost and easy to

[48:03] implement intervention that

[48:04] seems to to really be changing

[48:06] the tides for syphilis in King

[48:09] County. So to summarize, we

[48:09] ve

[48:10] seen tremendous progress in

[48:12] reducing hiv diagnoses in King

[48:14] County, but we still see groups

[48:15] who are disproportionately

[48:17] impacted, um, including all of

[48:18] the people that you see listed

[48:20] there. We have many ongoing

[48:22] activities to address the hiv

[48:24] epidemic. Overall, syphilis

[48:26] rates are decreasing, but cases

[48:27] remain high in pregnancy and in

[48:30] babies. And Doxy prep, sort of.

[48:31] Our newest intervention

[48:32] prevents chlamydia and syphilis

[48:33] and has contributed to

[48:35] declining syphilis cases at the

[48:38] population level in King County.

[48:41] So in there and again, thanks

[48:42] for the time. And we

[48:42] ll take

[48:55] questions. Let me stop sharing.

[48:57] Thank you. Board member Archer,

[49:00] Polly and Doctor Cannon. Looks

[49:01] like we do have some hands up.

[49:02] I think. I

[49:04] m not sure who had

[49:05] their hand up first, but board

[49:09] member foster.

[49:11] Thank you so much. Vice Chair

[49:13] Daniels. Um, and thank you so

[49:15] much to our presenters for that

[49:17] fantastic information. Doctor

[49:18] Cannon and board member Archie.

[49:20] Polly, I really appreciate it

[49:21] and I apologize, I did not

[49:22] write down the slide number for

[49:24] my question, but, um, it was

[49:26] during your presentation of the

[49:29] decline in hiv rates, and you

[49:31] highlighted the ongoing

[49:33] disproportionate outcomes for

[49:35] black folks. And I was curious

[49:36] if, um, we

[49:39] re seeing that

[49:41] disproportionate, um, number

[49:42] change or if that

[49:43] s been

[49:46] consistent in the decline. So,

[49:47] um, can you speak to that a

[49:48] little bit?

[49:51] Uh, yes. Sure. So, uh, the

[49:53] proportion of new diagnoses

[49:54] that we

[49:54] re seeing in King

[49:56] County for black people has

[49:58] sort of increased over time.

[49:58] Um, but it doesn

[50:00] t exactly sort

[50:00] of, uh, it

[50:02] s not the way that

[50:03] it looks, I will say. So it

[50:06] ranged from around 30 to 35%

[50:08] for the past couple of years,

[50:09] after it had been stable for

[50:11] about two decades, around 10 to

[50:13] 20%. But I think the main

[50:13] reason that we

[50:14] re seeing what

[50:16] looks to be like an increase is

[50:18] that, uh, the hiv diagnosis

[50:20] rate has risen over time,

[50:21] primarily in people who are

[50:22] black, who are born outside of

[50:24] the United States. So that

[50:24] s

[50:25] partly why public health,

[50:26] Seattle, King County, we sort

[50:29] of look at new hiv diagnoses,

[50:31] uh, by country of birth. So

[50:33] when we separate those out, um,

[50:34] we see that actually the

[50:36] numbers have remained fairly

[50:37] stable among people who were

[50:38] born in the United States who

[50:39] are black. But it is increasing

[50:41] among people who were born

[50:43] outside the United States. And

[50:44] I think, you know, there

[50:44] s a

[50:45] lot of reasons for that. But I

[50:46] think people who immigrate to

[50:48] the us MAY not be aware of

[50:50] their status. And so a new

[50:52] diagnoses when they move here

[50:52] doesn

[50:53] t necessarily mean that

[50:55] they got hiv here. And it MAY

[50:56] not represent local

[50:57] transmission that

[50:57] s happening

[51:00] in our area.

[51:01] Thank you so much for that. And

[51:02] then, um, just to make sure

[51:03] I

[51:04] ve got this right. So it

[51:06] would be uh, based on that, it

[51:07] would be, would it be accurate

[51:10] to say that the

[51:13] disproportionality for us born

[51:15] black residents has remained

[51:17] fairly consistent over time?

[51:18] And then we

[51:18] re seeing an

[51:20] increase in that overall number

[51:22] because it does not represent a

[51:24] disaggregation of the data

[51:26] based on, um, nationality or

[51:27] country of birth.

[51:27] That

[51:28] s correct.

[51:29] Okay. Thank you so much. I

[51:32] appreciate that.

[51:34] Thank you. Vice Chair foster.

[51:36] Uh, I think board member

[51:38] Google, did you have your hand

[51:40] up next?

[51:41] Um, I.

[51:42] Was willing to go last. If

[51:44] board member Hartfield wants to

[51:45] go and ask her question first.

[51:47] Okay. Thank you. Baughman,

[51:48] board member. Hartfield. You

[51:50] have the floor? Sure. Um,

[51:52] thanks for that. Really

[51:56] informative presentation. Um, I

[51:58] have questions about about

[52:00] funding. Um, doctor v mentioned

[52:02] the Medicaid changes that are

[52:03] going to be coming into place.

[52:05] And then in your slides, you

[52:08] mentioned the, um, doe, um,

[52:12] prep dep issue. And I wonder

[52:14] what kinds of, um, contingency

[52:18] plans are, how these two, um,

[52:20] difficult things that are going

[52:22] to happen are going to impact

[52:24] the patients that we have who

[52:26] are on Prep and whether or not

[52:27] there

[52:28] s something that you all

[52:29] are hoping that the Board of

[52:33] Health can, can do, so that the

[52:35] funding is prioritized toward,

[52:37] um, the the highest impact

[52:38] interventions, which sounds

[52:40] like Prep and oxy prep at the

[52:43] Oxy prep at this point.

[52:43] Yeah. Thank you. That

[52:44] s a big

[52:47] concern for our program. Um,

[52:48] and it

[52:49] s something that we just

[52:50] discussed actually this week in

[52:51] our policy planning meeting.

[52:53] Um, so I think I

[52:53] d say we

[52:53] re

[52:54] actively monitoring the

[52:56] situation, but it is, uh,

[52:57] there

[52:57] s a lot that

[52:57] s uncertain.

[52:58] And it

[52:58] s it

[52:59] s tough to know

[53:02] this early, uh, yet how, uh,

[53:03] this will impact everything.

[53:05] What the potential scale of it

[53:06] all will be. Um, so, yes, it is

[53:07] possible that we come back to

[53:09] the Board of health, the county,

[53:10] and sort of petition for

[53:11] additional financial support.

[53:14] But I would say in anticipation

[53:15] of all of the cuts, we

[53:15] ve done

[53:17] a few things. So, um,

[53:18] implementing some strategies to

[53:20] kind of economize the care and

[53:21] sort of making things more

[53:22] efficient, uh, what we

[53:23] re

[53:25] doing. So we want to sustain

[53:26] specifically capacity for

[53:28] priority services like

[53:29] screening and treatment of hiv

[53:31] and syphilis, um, uh,

[53:32] especially for people who are

[53:33] uninsured and really rely on

[53:36] our clinics for health care. So

[53:36] a few things that we

[53:37] ve done,

[53:39] decreasing the frequency of

[53:42] visits for Prep monitoring so

[53:43] we can expand capacity for the

[53:44] number of people we can see.

[53:46] And then also removing the

[53:47] recommendation for frequent

[53:48] Gonorrhea and chlamydia testing

[53:50] specifically for msm, because

[53:52] that is actually the major

[53:54] proportion of all the total

[53:55] expenditures that the state is

[53:56] spending on this Prep drug

[53:57] assistance program. So we

[53:58] re

[54:00] trying to decrease those costs.

[54:01] Um, and then, you know, like

[54:02] you said, we also anticipate

[54:03] people might lose coverage for

[54:05] their insurance. And so we

[54:05] re

[54:06] training more staff to be

[54:08] certified to be health

[54:10] insurance navigators. Um, and

[54:12] working with our Ryan White

[54:13] program, also to make sure that

[54:14] we have adequate case

[54:16] management for people with hiv

[54:17] and seeing if we can kind of

[54:18] shift funds around to

[54:19] contribute to people

[54:20] s premiums

[54:20] if they can

[54:21] t afford them. So a

[54:22] few things that we

[54:22] re kind of

[54:24] considering. But yeah, it

[54:24] s

[54:25] it

[54:27] s going to be an issue and

[54:27] we

[54:28] ll see.

[54:29] Yeah.

[54:30] And one other one other thing

[54:33] to add to that is, um, I was

[54:34] really excited to see the

[54:36] continued success of the mobile

[54:38] outreach team. That really

[54:40] looks amazing. Actually, the

[54:43] 28% viral suppression in that

[54:46] population. Um, that funding is

[54:49] federal, which is also shaky,

[54:49] which hasn

[54:50] t really been

[54:52] mentioned. Is there a chance

[54:53] that that could be funded

[54:55] through, say, another source

[54:58] like Ryan White or another, uh,

[55:00] because that that it looks it

[55:01] looks like what you want to do

[55:02] is prioritize the funding for

[55:04] the highest impact

[55:06] interventions.

[55:06] Yeah. That

[55:07] s correct. I mean, I

[55:09] think at this moment, uh, it

[55:11] looks like, you know, funding

[55:12] is either sort of level or

[55:13] hopefully will stay that way

[55:15] for e. Um, and so you

[55:16] re right,

[55:16] I think we

[55:17] re trying to

[55:19] prioritize the things that we

[55:20] think have the highest impact.

[55:21] And so we hope to be able to

[55:23] preserve that. Um, and Max

[55:24] clinic, I think those are sort

[55:26] of two of our big, uh, programs

[55:27] that we think are having the

[55:29] greatest impact. So, yeah, we

[55:34] will see.

[55:36] Thank you. Board member

[55:38] Hartville. Um, and thank you.

[55:41] Cannon on, uh, doctor cannon on

[55:42] that, uh, candid discussion

[55:44] regarding H.R. One and its

[55:48] impact. Um, on, um, Medicaid

[55:51] population. So, um, it is

[55:53] something that, um, uh, that is

[55:55] of public health concern, um,

[55:58] in King County. So thank you so

[56:00] much. Okay. So next we will

[56:02] have doctor. We will have board

[56:04] member, board member.

[56:06] Hartfield, your hand is still

[56:07] up. Where you working? Okay.

[56:09] Board member. Gojo, thank you

[56:10] for your patience. Please. You

[56:12] have the floor.

[56:15] Hi. Thank you. Board member and

[56:17] chair Daniels and board member.

[56:20] Archer and doctor Cannon. Um,

[56:23] I, uh, I work in South King

[56:26] County. Uh, and my primary

[56:29] populations, um, that my

[56:31] programs serve are our youth

[56:33] and people who are unhoused.

[56:34] And I

[56:36] d like to know what, um,

[56:38] what those efforts are that are

[56:40] being directed to decrease the

[56:42] number of people who are

[56:44] pregnant with syphilis and

[56:45] people who are, on, uh, excuse

[56:47] me. And congenital syphilis

[56:50] cases.

[56:51] Uh, yeah. Thank you for that

[56:53] question. Is absolutely an

[56:56] important, um, public health

[56:57] crisis that we

[56:57] re in. Uh,

[56:59] because this is completely

[57:00] preventable. So I think public

[57:02] health is doing several things,

[57:03] uh, trying to, of course,

[57:04] increase awareness about

[57:05] syphilis. There

[57:05] s still a lot

[57:05] of people who don

[57:06] t know what

[57:07] it is, um, you know, young

[57:10] people and others, uh, doing

[57:12] testing in multiple locations.

[57:13] You know, we

[57:13] ve done testing

[57:15] and sort of libraries and data

[57:17] centers in South County. Um,

[57:20] and, and, uh, score, which is

[57:22] one of the, the jails, um, and

[57:23] have had good success with

[57:25] that, actually. And we can

[57:27] initiate people treating in

[57:28] jail before they

[57:29] re released

[57:29] that way when they

[57:30] re out,

[57:30] they

[57:31] re already sort of treated

[57:33] and not having to worry about

[57:35] transmission. Um, and then

[57:36] specifically for people with

[57:37] pregnancy, I think that

[57:37] s a

[57:39] sort of challenging population,

[57:40] because increasingly we

[57:40] re

[57:42] seeing more that they are

[57:43] unhoused and or, uh, you know,

[57:45] having substance use, uh, sort

[57:48] of mixed into the picture. So,

[57:50] um, you know, we have a team

[57:52] that focuses specifically on

[57:54] this, this population. Um, and

[57:54] we

[57:55] re able to kind of support

[57:57] them to get treated, uh, you

[57:58] know, using a number of

[58:00] different strategies, uh, you

[58:01] know, incentives and sort of

[58:02] finding them a place to stay

[58:02] while they

[58:03] re being treated so

[58:05] that we can locate them. Um, so

[58:05] it

[58:07] s the sort of multi-pronged

[58:08] approach, and I

[58:09] m happy to give

[58:10] you additional information if

[58:11] you would like, uh, can maybe

[58:12] send it to you after the

[58:13] meeting.

[58:14] I

[58:15] d appreciate that. That would

[58:19] be great. Um, and, um, part of

[58:20] the thing that I

[58:20] m thinking

[58:23] about is that some of the

[58:25] testing and data centers and

[58:30] libraries, um, has been, has

[58:33] been diminishing, um, because

[58:35] the, the organizations that

[58:37] actually engaged people at

[58:39] those locations have pulled

[58:41] back from them. Um, and I

[58:42] m

[58:44] also I was really hoping to see

[58:47] data from the clinics in South

[58:49] County at the Federal Data

[58:50] Center and the Kent Engagement

[58:53] Center, and those numbers were

[58:55] not included in your report.

[58:59] And also, just to add to the

[59:01] concern, as far as the health

[59:03] of the population goes, though,

[59:07] that funding was, um,

[59:10] eliminated from the University

[59:12] of Washington at least, and,

[59:16] um, so could you just speak to

[59:19] that whole that whole, um,

[59:22] issue of providing low barrier

[59:26] access to hiv diagnosis and

[59:29] treatment in South King County?

[59:31] Yes. Yeah. That is, uh, I

[59:32] totally agree with you. And I

[59:33] think this is a priority for

[59:36] our program to support services

[59:37] in South County. So we

[59:37] re

[59:39] working with a few community

[59:40] health centers and

[59:42] organizations to try to, uh,

[59:45] boost their capacity for doing

[59:47] more sort of low barrier care.

[59:50] Um, as you alluded to, in the

[59:51] wake of sort of loss of a

[59:52] couple of centers that we had

[59:55] there, um, specifically about

[59:56] the engaged clinics. I can

[59:58] follow up with you again after

[59:59] the meeting to give you some of

[1:00:01] the sort of details about that.

[1:00:03] Um, but yeah, I think we are

[1:00:05] actively focusing on boosting

[1:00:07] our capacity there. Um, I think

[1:00:07] that

[1:00:08] s sort of the next big

[1:00:11] priority for our program. Uh,

[1:00:11] we I do agree it

[1:00:12] s a it

[1:00:12] s a

[1:00:15] major issue that we are facing.

[1:00:17] And just one one final

[1:00:19] question. Why why is it not

[1:00:22] currently a priority of the

[1:00:23] program?

[1:00:25] Uh, which.

[1:00:29] The, um, uh, additional access

[1:00:31] to testing and treatment in

[1:00:32] South King County?

[1:00:35] Oh, it is it is a priority. Uh,

[1:00:35] maybe. I don

[1:00:36] t know if I

[1:00:37] misspoke, but, uh, yes, that is

[1:00:39] a major priority for us to to

[1:00:40] increase capacity for that in

[1:00:44] South County. Yeah.

[1:00:46] I look forward to connecting

[1:00:47] with you after the meeting. And

[1:00:49] thank you again for your

[1:00:52] presentation.

[1:00:55] Thank you so much. Board member

[1:01:00] Archer Lee, doctor Cannon and I

[1:01:00] don

[1:01:02] t see any other I don

[1:01:02] t see

[1:01:04] any additional questions or

[1:01:06] comments. Okay. All right. This

[1:01:09] brings us to item number ten on

[1:01:12] the agenda. And update on

[1:01:14] findings and recommendations

[1:01:15] from the from Washington

[1:01:15] s

[1:01:17] Maternal Mortality Review Panel

[1:01:20] report. And this was an item

[1:01:21] that I suggested on the agenda.

[1:01:24] And while chair mosquito who

[1:01:26] can be here today. Um, uh, she

[1:01:28] did express support for

[1:01:31] continuing this conversation

[1:01:33] and the slides for this agenda

[1:01:35] item will begin on page 31, I

[1:01:36] believe, for the meeting

[1:01:39] packet, our presenters will be

[1:01:41] using a slightly shorter, um,

[1:01:43] deck to keep us on schedule.

[1:01:45] Today we are joined by Deborah

[1:01:47] Gardner and Anne McCue.

[1:01:49] Maternal Mortality Review

[1:01:50] coordinators for the Washington

[1:01:52] State Department of Health. Um,

[1:01:55] I will kick us off and then I

[1:01:57] will turn it over to Deborah

[1:02:02] and Anne and, um, so before we

[1:02:04] begin, I really want to ask

[1:02:07] this board to, to to do

[1:02:08] something with me. I really

[1:02:11] want us to to pause for a

[1:02:12] second. Um, what we

[1:02:13] re about to

[1:02:14] hear isn

[1:02:16] t easy. Um, and we

[1:02:16] re

[1:02:17] going to, we

[1:02:18] re going to talk

[1:02:20] about rates and numbers and

[1:02:21] recommendations, but I

[1:02:22] ve spent

[1:02:24] more than two decades as a

[1:02:24] nurse in women

[1:02:25] s health. And I

[1:02:27] can tell you behind every

[1:02:29] number in this report is a

[1:02:32] person, a birthing person,

[1:02:34] someone who cared. Hope,

[1:02:35] someone who wanted to build a

[1:02:38] life, raise a child and

[1:02:39] contribute to this community.

[1:02:43] We all serve the they were not

[1:02:45] strangers. Each one was

[1:02:45] someone

[1:02:47] s child, someone

[1:02:47] s

[1:02:48] partner, someone

[1:02:50] s best friend.

[1:02:52] Each one was our neighbor. Each

[1:02:54] one was a Washingtonian, and

[1:02:58] each one was ours. So before we

[1:02:59] move on into the data, I

[1:03:00] m

[1:03:02] asking us to hold that truth in

[1:03:04] this room. Please let it

[1:03:06] matter, because the way we

[1:03:09] honor their lives is simple. We

[1:03:10] listen closely, and then we

[1:03:12] act. Always say helping others

[1:03:13] heals us. Let

[1:03:15] s let that guide

[1:03:19] us in how we listen. Today, Deb

[1:03:21] and you have the floor. Please

[1:03:23] take it away.

[1:03:24] Thank you so much, Chair

[1:03:26] Daniels. I really appreciate,

[1:03:28] uh, taking that moment in our

[1:03:30] review of maternal deaths. We

[1:03:32] always have an acknowledgement

[1:03:32] that

[1:03:34] s similar at the beginning

[1:03:36] of our review meetings. So I

[1:03:36] m

[1:03:38] going to talk today and my

[1:03:39] colleague, my epidemiologist

[1:03:41] colleague Annie McCue, is also

[1:03:42] available especially for

[1:03:43] answering any questions. I

[1:03:43] m

[1:03:45] going to go through our slides.

[1:03:45] I

[1:03:46] m going to give you some

[1:03:47] background about the Maternal

[1:03:49] Mortality Review panel, and

[1:03:50] then talk about findings and

[1:03:52] then recommendations from the

[1:03:53] new Maternal Mortality Review

[1:03:57] Panel report. So some overview

[1:03:59] and background, uh, Washington

[1:04:00] state has a maternal mortality

[1:04:02] review panel that was

[1:04:03] established by the legislature

[1:04:06] in 2016. And then in 2019, the

[1:04:08] law was amended to make the

[1:04:09] panel permanent and add some

[1:04:11] details to it. It directs the

[1:04:13] mmp to conduct comprehensive

[1:04:15] reviews of every death of a

[1:04:16] Washington resident that

[1:04:18] happened in pregnancy through

[1:04:19] one year after the end of

[1:04:21] pregnancy, and then to present

[1:04:22] a legislative report of every

[1:04:24] three years. It also enables

[1:04:25] Doe to do things like access

[1:04:27] the kind of records they need

[1:04:28] to set the panel up to review

[1:04:31] these cases. Uh, as I said, the

[1:04:33] mmp is housed at the Department

[1:04:34] of Health in our state, the

[1:04:35] Washington State Department of

[1:04:36] Health. We are by far the

[1:04:38] largest committee or panel of

[1:04:40] this kind in the country. We

[1:04:41] had 80 members or so in the

[1:04:43] last term and just about 100

[1:04:45] right now, about 35 to 50 at

[1:04:47] each review meeting. And an

[1:04:49] incredible breadth of clinical

[1:04:51] and non-clinical expertise and

[1:04:52] backgrounds, including a strong

[1:04:53] priority focus on American

[1:04:55] Indian and Alaska Native

[1:04:56] communities. And I mentioned

[1:04:58] that breadth. This is a word

[1:04:59] cloud that is just a glimpse

[1:05:01] into some of the expertise

[1:05:02] areas, everything from

[1:05:04] indigenous lactation counseling

[1:05:05] to maternal fetal medicine to

[1:05:06] substance use disorder, to

[1:05:08] lived experience and more.

[1:05:08] We

[1:05:11] re very lucky in Washington,

[1:05:13] so our process at the state

[1:05:15] level, Doe identifies and

[1:05:17] confirms deaths. Doe requests,

[1:05:19] medical and other records, and

[1:05:21] then writes a de-identified

[1:05:23] summary for the panel to use.

[1:05:24] The panel meets to review

[1:05:25] deaths in a process that I

[1:05:25] ll

[1:05:27] talk about in a moment and make

[1:05:29] recommendations for prevention.

[1:05:30] And then every three years, as

[1:05:32] we prepare for these reports,

[1:05:34] and the mmr and Doe work to

[1:05:35] consolidate, narrow down,

[1:05:36] prioritize those

[1:05:38] recommendations for the report,

[1:05:40] compile them with data and have

[1:05:42] what we are presenting today. I

[1:05:44] want to go over just a couple

[1:05:46] of definitions that will give

[1:05:47] context to the data. I

[1:05:47] m going

[1:05:49] to talk about. We talk about

[1:05:51] pregnancy associated deaths.

[1:05:51] And that

[1:05:52] s just literally a

[1:05:54] term about timing. That is any

[1:05:55] death from any cause

[1:05:57] whatsoever, pregnancy related

[1:05:58] or not, that happened to take

[1:06:00] place during pregnancy through

[1:06:02] one year. After some of those

[1:06:03] pregnancy associated deaths are

[1:06:05] pregnancy related, they were

[1:06:06] caused or worsened by

[1:06:07] pregnancy. And this is, you

[1:06:08] know, the kind of things that

[1:06:09] could immediately come to mind,

[1:06:11] like a pregnancy complication

[1:06:13] or chain of events that

[1:06:15] pregnancy initiated. But it can

[1:06:17] even be an unrelated condition

[1:06:18] that was aggravated by some

[1:06:20] aspect of pregnancy, birth,

[1:06:22] postpartum. And some of the

[1:06:23] docs are not pregnancy related.

[1:06:24] Cause a no connection to

[1:06:26] pregnancy, and occasionally

[1:06:26] there

[1:06:28] s a death that the panel

[1:06:28] determines they don

[1:06:29] t have

[1:06:30] enough information to determine

[1:06:33] whether it was related. So they

[1:06:35] conduct very respectful reviews

[1:06:37] of each potentially pregnancy

[1:06:39] related death. Using that case

[1:06:41] narrative, I described, they

[1:06:42] determine whether the death was

[1:06:43] pregnancy related using the

[1:06:45] definition we just reviewed,

[1:06:47] and they look at the deaths

[1:06:48] from preventable to was it

[1:06:50] preventable, not just from a

[1:06:52] clinical perspective, but also

[1:06:53] from an equity or social

[1:06:55] determinants of health

[1:06:56] perspective? Ask questions like

[1:06:58] whether racism, discrimination,

[1:07:00] and bias played a role and what

[1:07:02] factors contributed to those

[1:07:04] preventable deaths. And then

[1:07:06] they make recommendations, both

[1:07:08] interventions at the time of or

[1:07:10] systems changes upstream that

[1:07:12] could prevent deaths like that.

[1:07:13] And those become the basis for

[1:07:14] the recommendations in the

[1:07:16] report. So I mentioned the

[1:07:17] report. I think my colleague

[1:07:19] Annie can put the link to the

[1:07:21] report in the chat. You all MAY

[1:07:23] have it available as well.

[1:07:23] There

[1:07:25] s a qr code for it here.

[1:07:27] We submitted this report in

[1:07:29] DECEMBER 2025. It was the

[1:07:30] fourth of these reports in

[1:07:32] Washington. It includes our

[1:07:33] newest data, which are from

[1:07:37] 2021 and 2022, and then some

[1:07:39] cumulative findings for like

[1:07:40] some demographics and things

[1:07:42] like that going back through

[1:07:44] 2014 to 2022. There

[1:07:44] s

[1:07:45] recommendations for the

[1:07:47] legislature and for other

[1:07:48] audiences, and there

[1:07:48] s also

[1:07:50] some new components like

[1:07:51] storytelling, people

[1:07:51] s

[1:07:52] experience in Washington of

[1:07:53] pregnancy, birth and

[1:07:55] postpartum, and success stories

[1:07:56] from a from the previous

[1:07:56] report

[1:07:58] s recommendations. This

[1:07:59] is also the second of our

[1:08:00] reports with an addendum from

[1:08:01] the American Indian Health

[1:08:03] Commission with findings and

[1:08:05] recommendations from American

[1:08:06] Indian and Alaska Native

[1:08:10] communities and health leaders.

[1:08:11] So I mentioned storytelling in

[1:08:12] the report. I

[1:08:12] m not going to

[1:08:14] read these to you, but I just

[1:08:15] wanted to highlight them on the

[1:08:17] screen to show the weight of

[1:08:21] this, um, to, uh, to show the

[1:08:21] weight of this and to

[1:08:23] understand, to help the reader

[1:08:26] understand how these issues

[1:08:27] really do affect people

[1:08:27] s

[1:08:29] lives. Even people who maybe

[1:08:30] had a challenging time but

[1:08:30] didn

[1:08:31] t pass away. Um, I also

[1:08:33] think there MAY not be a chat,

[1:08:34] but I think you have the link

[1:08:36] to the report in another

[1:08:37] format. So let

[1:08:38] s talk about the

[1:08:40] data and findings briefly here.

[1:08:41] So a couple of things to

[1:08:42] consider when we

[1:08:43] re talking

[1:08:44] about this. So maternal

[1:08:46] mortality is thankfully a rare

[1:08:48] event though every death is one

[1:08:50] to many. But the fact that it

[1:08:50] s

[1:08:51] a rare event means that it

[1:08:52] s

[1:08:53] difficult with those small

[1:08:55] numbers to discern things like

[1:08:56] true change or really compare

[1:08:58] demographic differences on a

[1:08:59] year to year basis. We do it

[1:09:00] anyway. It

[1:09:00] s just there

[1:09:00] s

[1:09:03] challenges around it and we can

[1:09:04] still make meaningful

[1:09:04] recommendations and

[1:09:06] interventions from what we do

[1:09:08] know. Um, we also often get

[1:09:09] asked about Washington compared

[1:09:10] to the us, we can

[1:09:12] t actually do

[1:09:13] a really good comparison

[1:09:15] because the us rates leave out

[1:09:17] some things like accidental

[1:09:19] deaths, including overdose,

[1:09:20] which is one of our major

[1:09:22] causes or major cause of death

[1:09:23] or injury. Deaths like homicide

[1:09:25] and suicide. We also don

[1:09:26] t have

[1:09:27] county level data because of

[1:09:29] extremely small or nonexistent

[1:09:31] numbers for each county. The

[1:09:33] state law has very strict

[1:09:34] requirements around

[1:09:36] confidentiality, which limits

[1:09:38] us, but counties can still find

[1:09:40] relevant information and

[1:09:41] recommendation based on their

[1:09:42] needs, their demographics, what

[1:09:43] they know is going on, and

[1:09:45] extrapolate from the report to

[1:09:48] apply in their regions. So the

[1:09:49] pregnancy related maternal

[1:09:51] mortality rate actually

[1:09:52] increased in these two years,

[1:09:55] 2021 through 2022. And this is

[1:09:57] the first increase to date in

[1:10:00] these Washington mmr reports.

[1:10:02] Um, that rate was 30.5 per

[1:10:04] 100,000 live births. And it

[1:10:04] s

[1:10:06] statistically significantly

[1:10:07] higher than the state

[1:10:08] s rate in

[1:10:09] the period of the last report,

[1:10:11] 2017 through 2020, which was 19

[1:10:15] per 100,000. Causes of these

[1:10:17] pregnancy related deaths,

[1:10:18] behavioral health related

[1:10:20] deaths accounted for nearly

[1:10:22] half, 45% of all of the

[1:10:23] pregnancy related deaths in

[1:10:25] these two years. Most of these

[1:10:26] were accidental overdose

[1:10:27] deaths, and most of those

[1:10:28] involved fentanyl. Other

[1:10:30] leading causes of death

[1:10:31] included Covid 19, primarily in

[1:10:34] 2021 and cardiovascular

[1:10:37] conditions. 82% of these

[1:10:39] pregnancy related deaths were

[1:10:40] found to be preventable. There

[1:10:42] was at least some chance of the

[1:10:43] death being averted if a factor

[1:10:45] that contributed to it had been

[1:10:47] different. This is very similar

[1:10:48] to in the previous report that

[1:10:51] found 80%, and this is a

[1:10:52] striking number. This is very

[1:10:53] high. It

[1:10:55] s also a motivation to

[1:10:56] act because it means we

[1:10:57] understand what

[1:10:58] s going on. Um,

[1:10:59] we know what

[1:11:00] s going on. We can

[1:11:02] take action. It also reflects

[1:11:02] the panel

[1:11:03] s continuing

[1:11:05] understanding of preventive

[1:11:07] ability, which has grown over

[1:11:09] the years of its work.

[1:11:11] Disparities by race and

[1:11:12] ethnicity are really important

[1:11:13] to pay attention to in this

[1:11:15] report. One that stands out is

[1:11:17] that non-Hispanic American

[1:11:18] Indian and Alaska Native people

[1:11:20] experienced much higher

[1:11:21] maternal mortality rates than

[1:11:22] any other racial or ethnic

[1:11:24] group. For example, their rate

[1:11:26] was 7.3 times higher than

[1:11:28] non-Hispanic white people,

[1:11:30] which is not the baseline. The

[1:11:31] baseline is no preventable

[1:11:33] pregnancy related deaths. Um,

[1:11:34] and again, that

[1:11:34] s a reason why

[1:11:35] we

[1:11:35] ve got that addendum from

[1:11:36] the American Indian Health

[1:11:39] Commission in the report. And

[1:11:40] also black communities,

[1:11:42] multiracial communities, and

[1:11:43] Native Hawaiian or Pacific

[1:11:44] Islander communities also

[1:11:46] experience disproportionately

[1:11:49] high rates looking by, um,

[1:11:52] urban rural residency insurance

[1:11:54] status and age are also really

[1:11:56] critical. So even though there

[1:11:58] are more pregnancy related

[1:11:59] deaths among people living in

[1:12:00] urban areas, the maternal

[1:12:02] mortality rate was highest

[1:12:04] among people in rural areas,

[1:12:05] which really underscores the

[1:12:07] importance of having access to

[1:12:08] quality rural maternity health

[1:12:10] services, including emergency,

[1:12:12] prenatal emergency support.

[1:12:13] People who are covered by

[1:12:15] Medicaid as primary insurance,

[1:12:16] which of course is a stand in

[1:12:18] for a lot of socioeconomic and

[1:12:20] related factors, had the

[1:12:21] highest frequency and the

[1:12:23] highest rate of pregnancy

[1:12:25] related deaths. Um, which

[1:12:26] underscores the importance of

[1:12:27] access to care and support for

[1:12:29] people with Medicaid and

[1:12:31] pregnancy and postpartum. And

[1:12:32] then the maternal, the

[1:12:34] pregnancy related mortality

[1:12:35] rate was most, uh, excuse me,

[1:12:37] pregnancy related mortality was

[1:12:39] most common among people ages

[1:12:41] 30 to 34, but the highest rate

[1:12:43] was among people age 40 and

[1:12:44] older. Which reminds us that

[1:12:45] risk increases with age,

[1:12:48] especially for those over 40.

[1:12:50] The panel did identify

[1:12:51] discrimination bias,

[1:12:53] interpersonal racism, or

[1:12:55] structural racism in 76% of

[1:12:57] preventable pregnancy related

[1:12:58] deaths in these two years. That

[1:13:00] includes bias about substance

[1:13:02] use disorder, reminding us that

[1:13:04] communities most burdened by

[1:13:05] these and perinatal health

[1:13:07] inequities have the expertise,

[1:13:09] cultural knowledge to lead

[1:13:10] solutions to reduce maternal

[1:13:12] mortality and must be centered

[1:13:14] as leaders in implementation of

[1:13:14] many of the report

[1:13:17] recommendations, the timing of

[1:13:18] pregnancy related deaths. Now,

[1:13:19] a lot of people, when they hear

[1:13:21] maternal mortality, they think

[1:13:23] death and childbirth, or they

[1:13:24] hear pregnancy related death,

[1:13:26] death during pregnancy. But

[1:13:27] actually most of the deaths are

[1:13:29] postpartum in this period. Um,

[1:13:31] if you look, most of them even

[1:13:34] incurred later postpartum 43

[1:13:36] days to one year, nearly half

[1:13:38] of those deaths, deaths

[1:13:40] occurred, followed by those

[1:13:42] between pregnancy. Excuse me,

[1:13:44] two days after, uh, pregnancy

[1:13:47] in 42 days. Um, one day after

[1:13:49] pregnancy. Anyway, that period.

[1:13:52] Excuse me? After pregnancy. Um,

[1:13:55] but that does that number

[1:13:57] skewed towards later postpartum

[1:13:58] is even more pronounced when

[1:13:59] you look at the unintentional

[1:14:02] overdose deaths, 82% of those

[1:14:04] occurred in later postpartum.

[1:14:06] Really? Again, underscoring the

[1:14:07] importance of care support and

[1:14:08] health insurance coverage

[1:14:10] through one year postpartum. So

[1:14:10] let

[1:14:11] s talk about

[1:14:13] recommendations in the report.

[1:14:13] They

[1:14:14] re all organized under

[1:14:16] three priority recommendations.

[1:14:16] And I

[1:14:17] ll go through those in a

[1:14:19] moment. And the legislative

[1:14:20] ones come first. They

[1:14:21] re in

[1:14:22] their own section. And then

[1:14:22] there

[1:14:23] s a separate section for

[1:14:24] recommendations for all the

[1:14:26] other audiences. We did want

[1:14:27] the legislative ones to stand

[1:14:27] out, but don

[1:14:28] t MISS, you know,

[1:14:30] one section or the other. These

[1:14:32] are the three recommendation

[1:14:33] areas, basically focusing on

[1:14:35] improving health care quality

[1:14:36] and access, strengthening

[1:14:38] community support services, and

[1:14:40] providing equitable, culturally

[1:14:42] responsive care. So the first

[1:14:44] one in detail, to ensure

[1:14:45] Washingtonians have access to

[1:14:47] high quality health care,

[1:14:48] including mental health care,

[1:14:49] substance use disorder

[1:14:51] treatment, and preventive care

[1:14:52] throughout pregnancy, birth,

[1:14:54] and postpartum. By

[1:14:56] strengthening and funding care

[1:14:57] coordination, improving

[1:14:59] communication and protocols,

[1:15:00] and ensuring providers actually

[1:15:01] have the skills and training

[1:15:03] and professional support they

[1:15:04] need to provide high quality

[1:15:05] care. I

[1:15:05] m going to show you a

[1:15:07] couple example recommendations

[1:15:09] under each, but again that by

[1:15:10] no means are they all the

[1:15:11] recommendations in the report.

[1:15:11] There

[1:15:12] s like over 90

[1:15:13] recommendations when you add

[1:15:14] them all up. But here are a

[1:15:15] couple examples in this

[1:15:17] category. So one for the

[1:15:18] legislature to protect and

[1:15:20] increase funding for family

[1:15:21] friendly, judgment free

[1:15:22] substance use disorder and

[1:15:24] opioid use disorder, and

[1:15:26] treatment and support for

[1:15:27] pregnant and postpartum

[1:15:29] patients, including in rural

[1:15:30] areas with limited access to

[1:15:32] community services. There

[1:15:32] s a

[1:15:34] recommendation for state and

[1:15:35] local agencies, health care

[1:15:37] systems, facilities providers,

[1:15:40] and community organizations to

[1:15:41] follow best practices in a

[1:15:43] health communication to counter

[1:15:45] health misinformation and

[1:15:47] disinformation about vaccines

[1:15:48] or other topics relevant to

[1:15:49] health and pregnancy and

[1:15:51] postpartum. Another ones for

[1:15:52] similar audiences to raise

[1:15:54] awareness about urgent maternal

[1:15:56] warning signs, perinatal mood

[1:15:57] and anxiety disorders, and

[1:15:59] substance use disorder. Opioid

[1:16:00] use disorder in pregnancy

[1:16:02] through public health messaging

[1:16:03] strategies and patient

[1:16:05] education. Um, there

[1:16:06] s also I

[1:16:07] wanted to highlight this

[1:16:08] recommendation because it calls

[1:16:11] out a King County program. So

[1:16:12] this is a recommendation for

[1:16:13] all different levels of

[1:16:15] agencies and organizations to

[1:16:17] follow strategies for medical

[1:16:18] outreach and workforce

[1:16:19] development to increase access

[1:16:21] to prenatal, postpartum, and

[1:16:22] primary care for unhoused

[1:16:24] people. And then one of the

[1:16:25] examples we actually

[1:16:26] highlighted public health.

[1:16:28] Seattle, King County Street

[1:16:31] Medicine Program. So the second

[1:16:33] of these three priority areas

[1:16:34] about strengthening community

[1:16:36] support services, this is

[1:16:38] investing in developing and

[1:16:39] expanding comprehensive

[1:16:41] community support services that

[1:16:42] are that address essential

[1:16:43] needs in pregnancy and

[1:16:45] postpartum. So things like home

[1:16:46] visiting, social work, doula

[1:16:48] support and wraparound support

[1:16:50] for mental health and substance

[1:16:52] use disorder. A couple examples

[1:16:53] from this. So there are a few

[1:16:54] for the legislator that I

[1:16:56] wanted to highlight about

[1:16:57] universal access to those

[1:16:59] wraparound services through at

[1:17:00] least a year postpartum,

[1:17:02] including home visiting, doulas

[1:17:04] and peer support. Also

[1:17:06] protecting both existing and

[1:17:07] funding new programs that meet

[1:17:08] people

[1:17:09] s needs in pregnancy and

[1:17:10] postpartum. Things like

[1:17:12] transit, housing, income and

[1:17:14] child care to be universally

[1:17:15] available. There

[1:17:15] s one for

[1:17:17] funders and state and local

[1:17:18] agencies to increase funding

[1:17:20] and capacity for community

[1:17:21] based organizations to support

[1:17:23] people in pregnancy and

[1:17:24] postpartum. And then there

[1:17:25] s

[1:17:27] one for Doe and local health

[1:17:28] departments to invest in

[1:17:30] building healthy and safe

[1:17:31] communities. There

[1:17:31] s a lot of

[1:17:32] examples of what that looks

[1:17:35] like. So the third priority

[1:17:37] recommendation is making sure

[1:17:38] all of that care and support is

[1:17:40] equitable and culturally

[1:17:42] responsive throughout pregnancy

[1:17:44] and postpartum, and also trauma

[1:17:46] informed, grounded and trauma

[1:17:47] informed practices and actively

[1:17:50] addressing racial injustice. So

[1:17:51] a couple examples under this

[1:17:53] one health care system, state

[1:17:55] agencies and academic

[1:17:56] institutions to work together

[1:17:58] to build and sustain a diverse

[1:17:59] maternal health workforce that

[1:18:01] reflects the communities it

[1:18:02] serves, when for state and

[1:18:04] local agencies, along with

[1:18:05] organizations to deliver

[1:18:07] ongoing, culturally relevant

[1:18:09] messaging about how to safely

[1:18:11] access perinatal care,

[1:18:12] including for immigrant and

[1:18:14] refugee communities. Language

[1:18:16] specific messages about health

[1:18:17] insurance access, privacy

[1:18:19] protections, and opportunities

[1:18:20] to receive perinatal care and

[1:18:22] support regardless of insurance

[1:18:23] or immigration status. There

[1:18:24] s

[1:18:25] one for both state and local

[1:18:26] agencies and jurisdictions to

[1:18:28] work together with and fund

[1:18:29] tribal and indigenous led

[1:18:31] provider training programs that

[1:18:33] emphasize culturally relevant

[1:18:35] health care and communication,

[1:18:37] and another one for Doe and

[1:18:38] health care systems to fund

[1:18:40] tribal led, indigenous led, and

[1:18:42] community led efforts to access

[1:18:43] to expand access to prenatal

[1:18:45] and birthing care in American

[1:18:46] Indian and Alaska Native

[1:18:48] communities, including in rural

[1:18:50] areas. I want to acknowledge

[1:18:52] that there is a lot of context

[1:18:55] at every level, um, local,

[1:18:58] state, national, global that

[1:19:00] currently and potentially in

[1:19:02] emerging contexts can make

[1:19:03] these recommendations both more

[1:19:05] challenging to implement and

[1:19:06] arguably even more important.

[1:19:08] So looking at Medicaid access

[1:19:10] changes I mentioned, Medicaid

[1:19:12] covers 45% of births in

[1:19:14] Washington. I think when you

[1:19:15] look at rural areas, we

[1:19:15] re

[1:19:17] talking 70%. So see some

[1:19:18] intersectionality there in our

[1:19:21] disparities and inequities. And

[1:19:22] there are rural maternity care

[1:19:23] shortages tying into all of

[1:19:24] that. There

[1:19:25] s challenges and

[1:19:27] access fears around perinatal

[1:19:30] and reproductive care, access,

[1:19:31] challenges to mental health

[1:19:32] care access. There

[1:19:33] s a lot of

[1:19:34] budget limitations at every

[1:19:36] level and challenges in the

[1:19:38] current funding landscape.

[1:19:38] There

[1:19:39] s misinformation and

[1:19:41] disinformation out there.

[1:19:41] There

[1:19:42] s threats to immigrant,

[1:19:44] Bipoc and lgbtq plus

[1:19:46] communities, including people

[1:19:48] who are perceived as parts of

[1:19:49] those communities. And there

[1:19:49] s

[1:19:51] just a lot of uncertainty about

[1:19:52] all sorts of aspects of health,

[1:19:54] environment and society in the

[1:19:56] future. And this is one reason

[1:19:56] the report includes

[1:19:58] recommendations about both

[1:19:59] protecting what already exists

[1:20:02] and taking new steps, and why

[1:20:03] some recommendations require

[1:20:05] funding or legislative support,

[1:20:05] and some don

[1:20:07] t. So implementing

[1:20:08] recommendations and

[1:20:10] highlighting success stories to

[1:20:11] know that we can do something

[1:20:14] about this, um, recommendation

[1:20:16] implementation happens on a lot

[1:20:17] of different levels. I like to

[1:20:19] think of it as centralized and

[1:20:21] decentralized. So centralized.

[1:20:21] We

[1:20:22] re talking about anything

[1:20:22] that

[1:20:23] s statewide. So

[1:20:25] legislative change or other

[1:20:26] statewide efforts. Um,

[1:20:27] Washington State Department of

[1:20:29] Health led work, the work of

[1:20:30] the Washington State Perinatal

[1:20:32] Collaborative. And if you

[1:20:32] re

[1:20:33] not familiar with the

[1:20:34] Washington State Perinatal

[1:20:35] Collaborative, I highly

[1:20:36] recommend looking it up, maybe

[1:20:38] getting involved in that. Um,

[1:20:39] they do a lot of amazing work,

[1:20:40] and they

[1:20:41] re kind of a hub of

[1:20:42] implementation, but that

[1:20:43] s just

[1:20:45] one piece of it. Anything that

[1:20:46] any person or entity or group

[1:20:47] does towards these

[1:20:48] recommendations is part of

[1:20:49] implementation. And that

[1:20:49] s

[1:20:50] where I see it as

[1:20:52] decentralized. So any local or

[1:20:54] regional efforts led by any

[1:20:56] organization, institution,

[1:20:58] coalition, board, individual

[1:21:00] health department and so forth,

[1:21:02] from the practice level to the

[1:21:03] regional level. Um, this could

[1:21:05] include regional perinatal

[1:21:07] collaboratives, regional county

[1:21:08] boards of health, or many other

[1:21:10] examples. Literally, we

[1:21:10] ve had

[1:21:12] like a doula practice change

[1:21:13] something based on a

[1:21:15] recommendation. So I want you

[1:21:17] to think next about how can

[1:21:20] this report connect to your

[1:21:21] priorities? Which

[1:21:23] recommendations are most

[1:21:25] relevant in King County? How do

[1:21:25] the report

[1:21:26] s findings and

[1:21:27] recommendations align with your

[1:21:30] work and priorities? How can

[1:21:31] they be useful in your work?

[1:21:33] What kind of collaboration

[1:21:34] might go on from, you know,

[1:21:36] efforts that already exist or

[1:21:37] new efforts that somebody would

[1:21:39] like to create and just what

[1:21:41] your next steps might be? I

[1:21:41] m

[1:21:43] putting my contact information

[1:21:45] here as long as as well as my

[1:21:47] epidemiologist, epidemiologist,

[1:21:48] colleague Andy McCue. And thank

[1:21:50] you so much for your time.

[1:21:51] Happy to take questions. If

[1:21:52] there

[1:21:54] s time.

[1:21:56] Thank you so much, Deb. And

[1:21:59] Annie. Um, amazing report.

[1:22:02] Looks like we have one hand,

[1:22:05] um, board member Gadgil, you

[1:22:06] have the floor.

[1:22:09] Thank you again, chair Daniels.

[1:22:11] And thank you for this really

[1:22:14] informative presentation. And

[1:22:14] it

[1:22:17] s, um, it

[1:22:18] s. Yeah, it

[1:22:19] s very

[1:22:21] sad to hear. And at the same

[1:22:24] time, um, I hate to ask this

[1:22:26] question, but I, I think we

[1:22:29] need to have it for all all

[1:22:33] data these days. Um, actual

[1:22:36] numbers are, are are missing

[1:22:38] more and more. It feels like

[1:22:41] from from presentations about,

[1:22:44] um, anything uh, and so it

[1:22:44] s,

[1:22:44] it

[1:22:48] s hard to especially

[1:22:52] advocate for resources when we

[1:22:52] don

[1:22:54] t know what the numbers are

[1:22:56] of things. And so this this

[1:22:57] applies across the board. I

[1:22:58] m

[1:22:59] not singling you out for that.

[1:23:01] And in fact, my purpose for

[1:23:04] raising my hand was, um, I

[1:23:07] checked in with nurses that are

[1:23:09] on my team this morning about,

[1:23:12] um, how can we get people into

[1:23:14] prenatal care? Because I know

[1:23:17] that that is a huge issue. And

[1:23:22] then I think it also relates to

[1:23:25] the high number of deaths due

[1:23:29] to opioid overdose. After, um,

[1:23:32] the postpartum period. And so

[1:23:35] what they told me is, among

[1:23:39] other things, people who are,

[1:23:42] um, using substances, for

[1:23:45] example, and our pregnancy are

[1:23:49] very worried about, um, the

[1:23:53] impact of being reported to cps.

[1:23:55] And they know that health care

[1:23:57] providers are mandatory

[1:24:00] reporters. So my suggestion is,

[1:24:02] how could King County Board of

[1:24:07] Health work to address policy

[1:24:11] that could, um, that could

[1:24:14] mitigate that barrier to people

[1:24:17] choosing to access care of fear

[1:24:22] of very negative consequences

[1:24:23] to themselves? Thank you.

[1:24:24] Thank you. Um, if I can speak

[1:24:26] briefly to both of those and

[1:24:28] thank you for that feedback.

[1:24:29] Um, the report has a lot more

[1:24:31] specific numbers than I went

[1:24:32] through. This is a very short

[1:24:33] version of our presentation

[1:24:35] that typically can go up to 45

[1:24:37] minutes or more. So we did cut

[1:24:39] the data section down to the

[1:24:41] short slides version. But

[1:24:41] that

[1:24:42] s helpful feedback to

[1:24:43] know. And please do look at the

[1:24:45] report for actual numbers. I

[1:24:46] also just wanted to mention

[1:24:47] that I know there

[1:24:47] s at least

[1:24:48] one I believe, maybe even

[1:24:50] multiple recommendations in the

[1:24:52] report that align with what

[1:24:52] you

[1:24:54] re talking about. Uh, 1.22

[1:24:55] if you look for that is about

[1:24:56] strengthening support for

[1:24:58] programs for pregnant and

[1:25:00] postpartum people experiencing

[1:25:01] substance use disorder who MAY

[1:25:02] not otherwise take care if they

[1:25:05] fear intervention by cps. So

[1:25:05] I

[1:25:05] m so glad that

[1:25:06] s coming up.

[1:25:07] And thank you for saying all

[1:25:10] that. See, um.

[1:25:11] Thank you, thank you.

[1:25:13] Boardmember board member

[1:25:15] Hartfield, you have before.

[1:25:17] Uh, yeah. Thank you for that.

[1:25:19] Um, thorough and really

[1:25:22] sobering presentation. Um, one

[1:25:23] of my questions was the same

[1:25:25] one that board member Gadgil

[1:25:27] raised about, um, knowing what

[1:25:30] the actual end is behind these

[1:25:33] numbers. Um, my second question

[1:25:35] was, are you also collecting

[1:25:38] data on, um, housing status?

[1:25:41] Um, whether do you know the

[1:25:44] percentage that are unhoused?

[1:25:46] And can you speak to that? I

[1:25:46] know we

[1:25:47] ve got one at least one

[1:25:49] piece of data in the report

[1:25:50] related to that.

[1:25:53] Yeah. No problem. Um, as far as

[1:25:55] like the first part with the

[1:25:58] whether this is the true end,

[1:26:01] we do a linkage with, um, the

[1:26:03] death certificate. Birth

[1:26:05] certificate. And we use things

[1:26:07] like the pregnancy checkbox.

[1:26:10] But, um, if someone is being if

[1:26:12] someone has a traditional death

[1:26:14] certificate, um, that comes

[1:26:16] through the vital statistics

[1:26:17] team, then we are getting

[1:26:20] catching that person. Um, and

[1:26:22] then as far as housing, um,

[1:26:24] that can come through in kind

[1:26:28] of abstracted records. Uh, but

[1:26:30] we are working to develop a

[1:26:33] flag that would identify if

[1:26:35] someone is actually like

[1:26:36] putting down a church address

[1:26:38] or does not have an actual

[1:26:38] address. So that

[1:26:39] s something

[1:26:41] that will be, um, adding into

[1:26:42] the next report.

[1:26:45] If I recall correctly, wasn

[1:26:45] t

[1:26:47] it nearly a third of the

[1:26:48] pregnancy related deaths were

[1:26:49] among people who faced housing

[1:26:53] instability or were unhoused?

[1:26:54] Um, I don

[1:26:54] t know what off the

[1:26:56] top of my head, but we do

[1:26:58] identify a fair amount.

[1:26:59] Okay.

[1:27:01] And my final question was just

[1:27:03] about, um, King County and sort

[1:27:05] of our role on the Board of

[1:27:06] Health that while it

[1:27:06] s, you

[1:27:08] know, obviously, really, really

[1:27:09] important for confidentiality

[1:27:12] reasons to, you know, limit the

[1:27:15] local information. Um, does

[1:27:17] King County, though, have

[1:27:20] access to information to, to

[1:27:21] these data? I guess for our

[1:27:22] county, because it

[1:27:22] s really

[1:27:23] hard to think about

[1:27:26] implementing recommendations

[1:27:28] without knowing how your local

[1:27:31] area is actually impacted.

[1:27:32] Um, and do you want to speak to

[1:27:34] that or do you want me to?

[1:27:36] Sure I can, I can speak to it

[1:27:38] and then you can add, um,

[1:27:40] because this is such a small

[1:27:42] number, like for one year, we

[1:27:44] have about 20 around give or

[1:27:46] take 20 pregnancy related

[1:27:49] deaths. Um, just as the count,

[1:27:49] we don

[1:27:51] t even provide the

[1:27:53] county to the panel members as

[1:27:53] they

[1:27:54] re reviewing the case

[1:27:56] because it it can be that

[1:27:59] identifiable. I will say that

[1:28:01] you can see from our data that

[1:28:03] a lot of deaths are happening

[1:28:04] in urban areas. And I think

[1:28:05] that a lot of the

[1:28:07] recommendations would apply to

[1:28:09] King County. Um, and you can

[1:28:10] kind of like Deb

[1:28:11] s mentioned in

[1:28:13] the in the presentation based

[1:28:14] on what you

[1:28:16] re seeing from, uh,

[1:28:18] general populations, you can

[1:28:21] kind of make that, uh, pathway

[1:28:22] to our report and pull out

[1:28:24] what, what is really going to

[1:28:25] apply to King County. But I

[1:28:27] would say that a lot of them, a

[1:28:28] lot of the recommendations

[1:28:30] probably do apply.

[1:28:31] I agree with all that. I mean,

[1:28:33] King County has such diversity

[1:28:35] on so many levels, including

[1:28:37] urban and rural areas. Um, I

[1:28:38] would say it

[1:28:39] s all relevant.

[1:28:40] Thank you.

[1:28:41] Thank you.

[1:28:43] Thank you. Boardman. Heartfelt

[1:28:45] board member Lucero, you have a

[1:28:48] floor.

[1:28:50] Um, I just want to say thank

[1:28:52] you for this report. I think

[1:28:54] that, um, in contrast to the

[1:28:56] federal system, you are

[1:28:58] highlighting the reason for,

[1:29:01] um, work around Dei. Um,

[1:29:03] because being able to identify

[1:29:06] these key populations and, you

[1:29:09] know, specific interventions to

[1:29:11] be able to address, um, you

[1:29:13] know, the high impact is really

[1:29:16] key. Um, I also want to point

[1:29:17] out that, you know, when it

[1:29:18] comes to substance use

[1:29:20] disorder, we need to look at

[1:29:22] the full continuum of care. So

[1:29:23] from prevention, early

[1:29:24] intervention all the way

[1:29:26] through treatment, aftercare is

[1:29:28] really lacking, particularly

[1:29:29] for pregnant and parenting

[1:29:31] people. Um, so, you know, just

[1:29:32] to highlight here that the

[1:29:33] number of treatment centers

[1:29:36] opening on JULY 11th, um, with

[1:29:38] the 15 beds dedicated to

[1:29:39] serving pregnant and parenting

[1:29:42] people opening in JANUARY. And

[1:29:42] I

[1:29:43] ll have to tell you, that

[1:29:43] s

[1:29:45] just not even going to scratch

[1:29:46] the surface. And so I think

[1:29:46] that that

[1:29:48] s really key. Um,

[1:29:50] also wanted to point out the,

[1:29:51] you know, impact of work

[1:29:53] requirements for Medicaid, um,

[1:29:55] eligibility, uh, and how we

[1:29:56] might be able to work as a

[1:29:58] community to be to get through

[1:30:00] that paperwork. Because really,

[1:30:00] that

[1:30:00] s what it is. It

[1:30:00] s

[1:30:02] paperwork burden. Um, and then

[1:30:04] finally to highlight, um,

[1:30:06] stigma and bias within hospital

[1:30:09] systems, uh, because I know one

[1:30:10] of the reasons that we have

[1:30:11] such prominent information

[1:30:12] related to American Indians,

[1:30:14] Alaska Natives is because of a

[1:30:16] particular incident that

[1:30:19] really, uh, you know, showcased

[1:30:21] the the bias within health care

[1:30:23] delivery systems or just health

[1:30:25] care systems, period. So again,

[1:30:26] I just want to thank you for

[1:30:28] this report. Um, and I look

[1:30:30] forward to working with all of

[1:30:32] you in interventions that are,

[1:30:35] um, going to have impact.

[1:30:36] Thank you. And likewise, and

[1:30:38] yes, everything you say very

[1:30:38] much is aligned with

[1:30:40] recommendations in the report.

[1:30:41] And yeah, I

[1:30:42] m glad we

[1:30:42] re all

[1:30:43] thinking about the same

[1:30:46] challenging things.

[1:30:47] Thank you. Board member.

[1:30:49] Lucero. Board member. Garcia.

[1:30:51] Thank you for the presentation.

[1:30:52] Uh, as sobering as it is, it

[1:30:53] s

[1:30:54] better that we are aware of

[1:30:56] these issues. Um, and so thank

[1:30:58] you very much for bringing this

[1:31:01] up. Um, and, um, presenting,

[1:31:03] uh, one of the things I, you

[1:31:04] know, was looking into as you

[1:31:06] were going through here is some

[1:31:08] of the recommendations on

[1:31:12] postpartum, um, and what kind

[1:31:15] of resources has our public

[1:31:17] health, uh, and King County

[1:31:21] Public Health pointed towards

[1:31:23] that aspect of things that

[1:31:23] we

[1:31:24] re very fortunate in the

[1:31:27] city of Baron that we have, uh,

[1:31:30] one doula who is a black woman

[1:31:31] led doula service BlackBerry.

[1:31:31] I

[1:31:32] ve learned a lot about this

[1:31:34] particular challenge through

[1:31:37] their advocacy, but in a lot of

[1:31:37] us, I

[1:31:38] m also a board member

[1:31:40] represented via our sca Small

[1:31:43] Cities Association, and a lot

[1:31:45] of the small cities in South

[1:31:46] King County and around the

[1:31:49] county. Just budget wise, are

[1:31:52] strapped and wanting to, uh,

[1:31:54] invest into this. So I just

[1:31:56] wanted to have a reality check

[1:31:57] on to what kind of funding has

[1:31:59] the county allocated towards

[1:32:01] this specifically, like doula

[1:32:03] postpartum? Since a lot of this

[1:32:06] happens after birth? And, um,

[1:32:08] how will the current budget

[1:32:10] crunch impact that? As I

[1:32:10] m

[1:32:12] preparing for my own budget in

[1:32:14] the city of Bern?

[1:32:16] Thank you for highlighting all

[1:32:16] of that. And I

[1:32:17] m hoping that

[1:32:19] the report, especially the

[1:32:21] findings about how critical

[1:32:23] this is in later postpartum,

[1:32:25] can help add some momentum to

[1:32:27] any support seeking to address

[1:32:31] postpartum issues. So thank you.

[1:32:33] I just.

[1:32:36] Want to respond to board Member

[1:32:37] Garcia about a couple of

[1:32:40] things. Um, so in terms of

[1:32:42] services that Public Health

[1:32:43] Seattle and King County

[1:32:45] provides, we provide a number

[1:32:47] of maternal and child health

[1:32:49] related services to ensure

[1:32:51] healthy pregnancies and early

[1:32:53] childhood development. Um, so

[1:32:54] just not running through

[1:32:56] everything, but just a couple

[1:32:57] of the programs we have, the

[1:32:58] women, infants and Children

[1:33:01] program, um, which supports

[1:33:02] pregnant postpartum

[1:33:04] breastfeeding individuals as

[1:33:05] well as children up to age

[1:33:07] five. We have a nurse family

[1:33:09] partnership that pairs low

[1:33:10] income, first time mothers with

[1:33:12] a registered nurse for home

[1:33:15] visits from early pregnancy

[1:33:16] until, I believe, until the

[1:33:18] child is two. Uh, there

[1:33:18] s also

[1:33:21] a family waste program, which

[1:33:22] provides pregnancy and

[1:33:25] parenting support, peer support

[1:33:28] for families that identify as

[1:33:30] black, African American, Native

[1:33:32] American, Alaska Native and

[1:33:33] Pacific Islander, Native

[1:33:35] Hawaiian communities. Um, and

[1:33:38] then we also have a first steps

[1:33:40] maternity support services and

[1:33:42] infant case management program.

[1:33:46] Um, and this is for individuals

[1:33:48] that are on Apple Health. And,

[1:33:50] um, it helps to support healthy

[1:33:51] pregnancies through care

[1:33:53] coordination and family

[1:33:54] support. Um, in terms of the

[1:33:55] funding, we

[1:33:56] d have to get back

[1:33:57] to you with specifics. You

[1:33:58] know, some of these programs

[1:34:00] are federally funded, some of

[1:34:02] them receive, um, state

[1:34:03] funding. Some of them are

[1:34:05] funded through fs dollars. Some

[1:34:06] of them are like completely

[1:34:07] braided funding, you know, so

[1:34:08] it

[1:34:11] s a mix. Um, but just to, to

[1:34:13] get a, you know, some a

[1:34:15] sampling of the wide variety of

[1:34:17] services that we provide to

[1:34:19] support healthy pregnancies and

[1:34:21] to help prevent, um, maternal

[1:34:23] mortality in our county.

[1:34:25] Thank you very much, director.

[1:34:25] That

[1:34:26] s really appreciated. I

[1:34:27] m

[1:34:29] hoping to circle back on how

[1:34:30] the funding for it works. It

[1:34:31] sounds like there

[1:34:31] s a lot of

[1:34:32] services there. I

[1:34:33] m not sure

[1:34:36] how geographically they are

[1:34:38] impacting. Uh, speaking of

[1:34:40] southern ca city, just making

[1:34:41] sure that that we are doing our

[1:34:44] part to promote and support

[1:34:47] referrals and those programs,

[1:34:49] uh, especially, you know, for

[1:34:51] us cities that have, uh, South

[1:34:52] King County as a regions, I

[1:34:52] m

[1:34:54] kind of connecting the dots and

[1:34:57] previous presentation on sti,

[1:34:59] hiv to current presentation.

[1:35:01] And how in that particular

[1:35:03] geographic impact, South King

[1:35:04] County was just bearing the

[1:35:06] brunt. And historically, we do

[1:35:06] that here. I

[1:35:08] m enduring and

[1:35:09] just wanted to make sure that

[1:35:11] we do as much as possible to

[1:35:12] lift up the current programs

[1:35:14] that are out there, keep

[1:35:16] funding as much as we can, and

[1:35:18] also look at to how to improve,

[1:35:21] maybe more culturally specific,

[1:35:22] like doulas. I heard a lot

[1:35:24] about, you know, in-home

[1:35:26] nursing. Um, but just, uh,

[1:35:28] learning. And I have a lot to

[1:35:29] learn, and I

[1:35:29] m always open to

[1:35:32] that. How to keep this in the

[1:35:33] forefront because there

[1:35:33] s so

[1:35:34] many things. But this is really

[1:35:39] sobering. So thank you.

[1:35:42] Thank you. Board member Garcia,

[1:35:44] any board member Garcia, was

[1:35:46] there anything else? Okay,

[1:35:49] okay, okay. Um, any additional

[1:35:51] questions or comments from the

[1:35:53] board members? Uh, I will say

[1:35:54] this. Now that we

[1:35:54] ve heard

[1:35:57] this, um, I really want to name

[1:35:59] where I believe it must lead

[1:36:01] us. Um, we have just been

[1:36:04] handed a data. The stories, the

[1:36:06] recommendations. Um, what? We

[1:36:09] do not yet have is a vehicle to

[1:36:11] carry them forward. So, I

[1:36:11] m

[1:36:14] asking for one, and we would

[1:36:17] not be the first right here in

[1:36:18] Washington County. Board of

[1:36:20] health have already heard this

[1:36:21] call and answered, actually,

[1:36:24] last fall, um, Clark County

[1:36:25] Board of Health passed a

[1:36:27] resolution committing to

[1:36:29] closing the gaps in pregnancy

[1:36:30] related care for their

[1:36:31] residents. They turned a

[1:36:33] presentation into a promise.

[1:36:35] And I believe King County can

[1:36:37] do the same, and that we can

[1:36:39] tailor it to the families we

[1:36:41] serve. So I

[1:36:41] m calling on this

[1:36:44] board to form a sort of

[1:36:46] maternal and perinatal

[1:36:47] workgroup. A group of board

[1:36:49] member volunteers willing to

[1:36:51] take what we heard today and

[1:36:53] shape it into a perinatal

[1:36:54] resolution for the board

[1:36:54] s

[1:36:56] full, um, for the full board

[1:36:56] s

[1:36:59] consideration. Um, I am not

[1:37:00] asking us to decide its

[1:37:02] contents right now. The

[1:37:04] language and the commitments

[1:37:05] belong to the workgroup built

[1:37:07] together and with care. When

[1:37:07] I

[1:37:09] m asking for right now is

[1:37:11] simpler. Who is willing to do

[1:37:14] this? Work with me? I will also

[1:37:15] share that I

[1:37:15] ve spoken with

[1:37:17] Chair Mosqueda about this, and

[1:37:19] I bring it forward with her

[1:37:22] support and her permission. So

[1:37:24] I will open the floor. If this

[1:37:27] is moved you the way that it

[1:37:29] moves me daily, I will be

[1:37:30] honored to have you at the

[1:37:32] table. If you are willing to

[1:37:33] serve, please raise your hand

[1:37:35] now so we can capture your

[1:37:37] name. And if you want to think

[1:37:39] about it, um. And would you

[1:37:41] reach out to Joey? Um,

[1:37:43] Carpenter, Garzanti, our board

[1:37:44] administrator, after today

[1:37:45] s

[1:37:47] meeting? Either way, the table

[1:37:53] is open. Okay. And so it looks

[1:37:56] like. Okay, I see from my

[1:38:01] screen, I see Vice Chair Foster.

[1:38:02] Yes, i

[1:38:03] d love to. Thank you.

[1:38:04] Okay. Thank you, thank you.

[1:38:06] Vice chair c, board member.

[1:38:07] Heartfelt.

[1:38:08] Yeah.

[1:38:10] Thank you. Board member. Awful

[1:38:11] I c board member.

[1:38:11] Gojo. I

[1:38:13] m in.

[1:38:14] Thank you. Board member. Gojo I

[1:38:17] see board member. Garcia.

[1:38:18] Minute to win it.

[1:38:20] Thank you. Board member.

[1:38:22] Garcia. Did I MISS Anyone

[1:38:23] else

[1:38:30] s hand? Okay. Okay. And,

[1:38:32] um. And like I said, if you

[1:38:33] want to think on it, reach out

[1:38:35] to Joi. Um, after, um, after

[1:38:36] today

[1:38:38] s meeting. Thank you so

[1:38:41] much. Uh, Debs and any, um, for

[1:38:44] your report. Um, it has

[1:38:46] definitely been eye opening.

[1:38:51] Uh, so next, we will move on to

[1:38:53] updates. Do any board members

[1:38:57] have updates to share? Board

[1:38:58] member. Heartfelt. Board

[1:39:00] member. Garcia, I. I see your

[1:39:01] hands up. Or is it up there?

[1:39:06] Okay. Okay. Any updates to

[1:39:09] share? Going once, going twice.

[1:39:11] Okay. Not seeing anyone. Okay.

[1:39:15] All right. Okay. Oh. Board

[1:39:18] member. Mustafa, I see you.

[1:39:20] Uh, yeah. Thank you. Uh, just

[1:39:23] the program of the, uh, health

[1:39:25] program. Department of health.

[1:39:26] Because of the Trump

[1:39:28] administration, it was been

[1:39:29] yesterday. It was the last

[1:39:32] meeting, and we graduated from

[1:39:33] that. The Community Advisory

[1:39:35] Council and health equity zone.

[1:39:36] So we don

[1:39:37] t we don

[1:39:37] t have

[1:39:38] funding. That

[1:39:39] s the program we

[1:39:41] started four years ago. We

[1:39:42] stopped that. So now I just

[1:39:44] want to update you guys for

[1:39:45] that.

[1:39:46] Thank you. Board member

[1:39:51] Mohammed, board member Gojo.

[1:39:51] Okay. I

[1:39:53] m speaking as a private

[1:39:55] citizen right now and not as a

[1:39:56] representative of Health Point,

[1:40:00] but I do want to, um, I do want

[1:40:04] to, uh, uh, appreciate my

[1:40:08] organization for stepping into

[1:40:11] the East King County area. Um,

[1:40:13] a very large, important, uh,

[1:40:18] primary care. Uh, delivery

[1:40:22] location. Um, is closing, and,

[1:40:25] uh, that would leave a huge gap

[1:40:28] in an already spread thin

[1:40:31] primary care system. Um, in

[1:40:32] South King County. And we are

[1:40:35] going to be opening a clinic in

[1:40:38] that same space to preserve the

[1:40:40] primary care there. And, um,

[1:40:42] prenatal care, perinatal care

[1:40:44] has been identified as a

[1:40:47] priority. Um, service at that

[1:40:50] location.

[1:40:54] Thank you. Board member Gojo.

[1:40:59] Okay. Any additional updates?

[1:41:02] All right. Um, next. Is there

[1:41:04] any other business to come for?

[1:41:10] To come before the board? Okay.

[1:41:12] Hearing none. Seeing none.

[1:41:16] Okay. Quick reminder, our next

[1:41:17] Board of Health meeting is

Board of Health on 2026-06-18 1:00 PM

Agenda

Transcript