[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