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HomeMy WebLinkAbout2001- September File Copy *lb Jefferson County Board of Health ' Agenda • Minutes September 20, 2001 S r • r • JEFFERSON COUNTY BOARD OF HEALTH Thursday, September 20, 2001 2:30—4:30 PM Main Conference Room Jefferson Health and Human Services AGENDA I. Approval of Agenda II. Approval of Minutes of Meetings of August 16, 2001 III. Public Comments IV. Old Business and Informational Items 1. 4th Annual Local Board of Health Leadership Workshop October 25-26, Radisson Hotel, SeaTac • 2. Letter to Senator Marie Cantwell V. New Business 1. Public Health Law 101 —Rules, Policies, Waivers, and Appeals Tom (10 min) 2. On-Site Sewage Code Rule Revision —Action Item Tom (15 min) 3. Communicable Disease Update— Pertussis, Chronic Hepatitis Reporting, 2000 Jefferson County STD Profile Lisa (15 min) 4. Joint Board Access Project—Update and Framework for Local Board of Health Involvement Tom (15 min) 5. Jefferson County Strategic Plan—Potential Role of Jefferson County Board of Health Dan (15 min) VI. Agenda Planning 1. Future Agenda Topics VII. Adjourn Next Meeting: October 18, 2001 —2:30—4:30 PM Main Conference Room Jefferson Health and Human Services i • EFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday,-h-- , 2001 Qom('. /6., Board Member: Staf Member:: Dan Titterness. Member- County Commissioner District#1 Jean Baldwin. Nursin Services Director Glen Huntingford, Member- County Commissioner District#: Lan Fa„Environmental Health Director Richard Wolt.Member- County Commissioner District#3 Thomas Locke._SID. Health Officer Geoffrey'Math,Member-Port Townsend City Council Jul Buhler. Chairman -Hospital Commissioner District#2 Sheila Westerman, Vice Chairman - Citizen at large (City) R Roberta Frissell- Citizen at Lampe (County) Chairman Buhler called the meeting to order at 2:35 p.m. All Board and Staff members were present with the exception of Commissioner Huntingford. Member Masci moved to approve the agenda. Commissioner Wojt seconded the motion, which carried by a unanimous vote. • APPROVAL OF MINUTES Member Masci moved to approve the minutes of July 19, 2001. Commissioner Wojt seconded the motion, which carried by a unanimous vote. PUBLIC COMMENT Dale Wurtsmith spoke about the On-Site Sewage Ordinance adopted by the Board on May 17, 2001. He requested that the provisional licenses for Operation and Maintenance (O&M) of conventional systems be expanded to include alternative systems. As a member of the Washington On-Site Sewage Association (WOSSA), he noted that most of his training relates to alternative systems. He has submitted an application to be licensed and understands that the permanent licensing test will likely be given at WOSSA and that it will be roughly six months to a year before a class is designed. He expressed concern that the PUD inspection does not include opening and inspecting the septic tank. He has heard that one third of alternative systems fail within the first five years and wonders if it is due to a lack of inspection. Testing for temperature, PH, and dissolved oxygen may be able to prevent a collapse or other expensive repairs. He also proposed that the language in the current ordinance be changed to allow for excavating. In his opinion people should have the option of choosing who they want to monitor their alternative system. If the PUD continues doing their light monitoring, he would suggest having another individual inspect the tank and give the citizens a credit for that portion of the field that was inspected. • Chuck Molisky of Goodman Sanitation said that at the March 2001 Health Board meeting there was discussion about revising the Evaluation of Existing System Ordinance to allow anyone demonstrating a HEALTH BOARD MINUTES - August 16, 2001 Page: 2 • certain level of competency to perform inspections. Those individuals would be required to become licensed once a test became available. Although, he has been providing monitoring services, he is no longer qualified to perform inspections under the ordinance because he is not a designer. installer, or a monitoring specialist and does not have a year of experience under a monitoring entity. He also questioned why he has to pay $200 to apply for a license when he is already in business in Jefferson County. Because the County has placed the PUD in a position of monitoring all alternative engineered systems, the consumer is under the impression that they do not have to do the operation and maintenance until periodically told to do so. He understood it was the Board's intent to open up the monitoring to qualified persons. An amendment to the ordinance's monitoring terminology would allow him to monitor conventional systems. To protect their investment, he believes his customers would like the opportunity to choose who provides their monitoring, maintenance and ongoing service. Vice Chair Westerman clarified that it was the Board's intent to create a way for other individuals to do the monitoring of both conventional and alternative systems. Board members concurred. Commissioner Wojt commented that whoever does the inspection, there has to be a clear understanding of the need for centralized record keeping. OLD BUSINESS Provisional Certification Onsite Sewage O&M Specialists: Discussion of Expedited Rule Changes • Adopted 5/17/01: Larry Fay reported that he and Dale Wurtsmith met and discussed the issues and concerns he raised today. The PUD has specific statutory authority to conduct maintenance and monitoring inspections of on-site sewage and community sewage systems. Because the PUD inspections are focused on the secondary treatment process involved with alternative systems, they have not included inspecting the septic tank. In those cases, the Health Department may need to go back and inspect the tanks. He believes it would be a disservice to discount the work the PUD has done over the last 15 years in monitoring alternative systems in Jefferson County. The inspections were not intended to be diagnostic, but to identify major system failures. If the PUD discovers a problem, homeowners would be notified and referred to an O&M specialist to perform a more detailed analysis. With respect to conventional systems, he noted that the Board worked on an ordinance for provisional licensing as a pathway to further testing and certification under development by WOSSA. While the full license would take the place of a provisional license and adopted Sections would no longer apply, the core O&M responsibilities would remain. Aside from minor changes made in May, no major changes were made from the original direction before Board adoption. Commissioner Tittemess said he believes it was the Board's intent that a person with expertise in the field be allowed to receive a provisional license. Larry Fay said he understood that the Board and staff were looking for a mix of work experience and formal training for licensed installers, licensed pumpers, and licensed O&M people. To be a licensed • O&M person, you have to have had some work experience either with a designer, installer, or an O&M person, plus training. While Chuck Molisky has been in the pumping business for years but has not worked with an installer or designer, the question for the Board is whether to amend the ordinance. • HEALTH BOARD MINUTES - August 16. 2001 Page: • Historically, in Jefferson County. those who have done O&M are designers. installers and pumpers. The Board could choose to state that Mr. Molisky's years of experience as a pumper in Jefferson County constitutes the needed work experience. Chuck Moliskv apologized for giving the impression that the PUD has not been doing their job. He believes that given their limited mandate they have been doing their job. His position is that others besides the PUD should be allowed to do the monitoring. The 15 years of data could be the basis for other monitoring entities if individual homeowners chose that path. He also believes the PUD standards should be updated to improve the database. Member Masci agreed that the Board's intent was to pass provisional licensing to conduct inspections for those people doing the work. However, before adoption the Board failed to realize that the new language in Section 8.15.150(6)c did not include all sewage systems. He believes the tapes of the previous meeting will show the Board was talking about all systems, both conventional and alternative. He was under the impression that Messrs. Molisky and Wurtsmith and possibly others in the County had extensive WOSSA training and had spent a lot of money on course training. He suggested that the Department review the PUD contract to ensure similar training of their inspectors. He proposed that newly adopted Sections 8.15.150(6)(c) and 8.15.140(4)(b) and (c) be modified with the suggested wording provided in the Health Board packet titled "Dear Honorable Geoff Masci." He believes these changes reflect the Board's original intent. He also suggested adding to the list of qualified inspectors, • "installers and service provision companies." He does not believe anyone, including staff did anything egregious. Dr. Tom Locke reviewed the Board of Health's process of adopting this ordinance. To modify the rule, the Board would need to present new language and publish it for comment before adoption. Member Masci moved that Staff present to the Board amendatory language to Sections 8.15.150(6)(c) and 8.15.140(4)(b) and (c) as exists in Items 1 and 2 of the correspondence titled "Dear Honorable Geoff Masci" and bring it forth at the next meeting for discussion. Member Frissell seconded the motion. Commissioner Wojt commented that the County has contracted with the PUD which as a public entity will stay in business whether or not they make a profit for these services. As a public entity, the PUD also has the longevity to keep the records. Any inspectors would need to have a legal obligation to track inspections. Vice Chairman Westerman said she was unaware that this legal obligation was included in the ordinance. Larry Fay said that the contract with the PUD is to perform O&M tracking and records management to verify the recipient of the report, to verify inspection has occurred, and notify Environmental Health of any system problems. Although record keeping is important, it is more of an administrative than • ordinance issue. Member Masci said the intent of the motion is to allow provisional monitoring certificates to be issued HEALTH BOARD MINUTES - August 16, 2001 Page: 4 so the work can be done. He expressed concern about additional delays. • Larry Fay said typically a draft is reviewed by the Board to be followed by the advertisement. however. he may be able to expedite the process by making the suggested amendments and immediately placing the advertisement. Member Masci asked to revise his motion. Member Masci moved that Staff expedite revisions to the On-Site Sewage Ordinance Sections 8.15.150(6)(c) and 8.15.140(4)(b) and (c) consistent with the changes as suggested in Items 1 and 2 of the correspondence titled 'Dear Honorable Geoff Masci.'" Member Frissell seconded the motion. Larry Fay asked if the work qualifications should be modified to include one year's work experience with a licensed pumper? The concern is that pumping septic tanks is different than doing O&M of alternative systems and requires an additional training component. Commissioner Wojt asked where in the ordinance it states the requirements for record keeping? Larry Fay responded that he believes it is in two sections. Vice Chair Westerman expressed interest in the Board having a future discussion about record keeping by the PUD. • The motion carried. Commissioner Wojt abstained. Member Masci moved that Staff present before the Board the qualifications of the Certified Monitoring Specialist to include "licensed pumper" to the possible O&M service providers currently listed as licensed designer, licensed installer, and licensed O&M specialist. Commissioner Titterness seconded the motion, which carried by a unanimous vote. Member Masci moved that the Board discuss at an upcoming meeting not to exceed 60 days from today, the topic of"PUD record keeping, retention and custodianship." Commissioner Wojt seconded the motion, which carried by a unanimous vote. Commissioner Titterness suggested the PUD be invited to attend this discussion. Staff agreed to follow- up. Larry Fay circulated the signature page for the Board's May 17, 2001 On-site Sewage Code amendment, which the Board is now proposing to amend. NEW BUSINESS Joint Resolution —Seawater Intrusion Monitoring: Larry Fay reviewed the Joint Resolution which 11would establish a program to conduct systematic groundwater monitoring to assess whether seawater intrusion may be occurring in Jefferson County and affecting water quality. He provided background on r • HEALTH BOARD MINUTES - August 16. 2001 Page: 5 the appeals to the Unified Development Code last fall regarding whether or not the County provided adequate protection of aquifers near marine shorelines or. on Marrowstone Island, from over appropriation. Two ordinances which the City. Public Environmental Council. and the Shine Community Action Council have appealed have been discussed. The City and County reached an agreement that Jefferson County be the data managers for water quality information. The PUD was interested in positioning themselves to implement a long-term monitoring program. This resolution would formalize the roles of the County, PUD and Board of Health in developing a rational monitoring program. in cooperation with the State Departments of Ecology and Health. which the PUD would then implement. The role of the Department of Health would be to assist in developing the methodology. The financial responsibility for implementation would reside with the PUD. Member Masci moved that the Board accept the Joint Resolution for Developing a Countywide Seawater Intrusion Monitoring Program between the Jefferson County Board of County Commissioners, the Jefferson County Board of Health, and the Jefferson County PUD No. 1. Member Frissell seconded the motion. During discussion of the motion, Vice Chair Westerman said that, given the importance of this issue, she does not believe this is an area where the County should try to save money. She suggested eliminating the words "already strapped"from the second paragraph of the resolution. Dr. Locke noted that because this is a joint resolution already adopted by the Jefferson County Board of Commissioners, it cannot be modified. Commissioner Wojt said in other counties saltwater intrusion is dealt with by public purveyors of water, as opposed to individual homeowners. The PUD, as the largest water purveyor in the County, has agreed to make its water system data available to others in the County. Member Masci explained that during UDC appeal settlement negotiations, the City became aware that the County's data collection was limited to public water systems. With the pending sale of the Tri-Area water system to the PUD, the PUD will become subject to more stringent State standards. Larry Fay said the PUD is contemplating not only monitoring the public water supply wells but, at least in some strategic areas, thinking about dedicated monitoring wells using proactive groundwater monitoring. Commissioner Titterness said that given that there has been nothing inaccurate noted in the resolution, he proposed that the Board proceed with it. The motion carried by a unanimous vote. • I 4 r HEALTH BOARD MINUTES - August 16. 200; Page: 6 • AGENDA CALENDAR ; ADJOURN The agenda item "Draft Policy Pertaining to Building Permit Repair'. will be presented at the next meeting. Commissioner Titterness suggested that the topic of"Treatment and Prevention'. be high on this year's Health Board agenda. Jean Baldwin agreed to provide a preliminary report in October. 2001 AGENDA ITEMS 1. CONTINUED STABLE FUNDING TO REPLACE MVET 2. ACCESS HEALTH CARE 3. PROGRAM MEASURES (Genetic Research and Public Health Implications) 4. METHAMPHETAMINE SUMMIT 5. PERFORMANCE STANDARDS & COMMUNITY ASSESSMENT 6. TOBACCO PREVENTION AND COALITION 7. FLUORIDE 8. TRANSIT AND PUBLIC HOUSING 9. BIOTERRORISM READINESS & PLAN 10. AGING POPULATION 11. WATER 12. MATERNAL CHILD PREVENTION GOALS (0-3) • The meeting adjourned at 3:35 p.m. The next meeting will be held on Thursday, September 20, 2001 at 2:30 p.m. at the Jefferson County Health and Human Services Conference Room. JEFFERSON COUNTY BOARD OF HEALTH Jill Buhler. Chairman Geoffrey Masci, Member Sheila Westerman, Vice-Chairman Richard Wojt, Member (Excused Absence) Glen Huntingford, Member Roberta Frissell, Member Dan Titterness. Member • • Board of Health Old Business Agenda Item # IV. , 1 • 4th Annual Local Board of Health Leadership Workshop September 20, 2001 • • LOCAL BOARD OF HEALTH LEADERSHIP WORKSHOP OCTOBER 25-26, 2001 RADISSON HOTEL SEATAC, WA. DRAFT AGENDA "EMERGING ISSUES IN PUBLIC HEALTH" Thursday, October 25th 9:00 Registration and Refreshment 10:00 Tom Milne, Executive Director, National Association of County & City Health Officials a. National Perspective on Public Health b. Public Health Funding c. National Perspective on 4 main topic areas: a. Emerging Diseases b. Water and Waste Water c. Early Intervention d. Illegal Drug Labs • Mary Selecky, Secretary, Washington Department of Health a. State Perspective on Public Health b. Public Health Funding c. State Perspective on 4 main topic areas: a. Emerging Diseases b. Water and Waste Water c. Early Intervention d. Illegal Drug Labs 12:00 LUNCH 1:00 Plenary Session: a. Water and Waste Water— Background information on Issue and introduction of Case Study b. Early Intervention — Background information on Issue and introduction of Case Study. 1:30 Roundtables on Water and Waste Water and Early Intervention a. What is the Board of Health Role? b. How would you know if you made a difference? c. Who else will you have to enlist to address the issue? d. What should be done next? In your County.....? Collectively/state- wide... ....? • e. What are the barriers to action? • 3:00 BREAK 3:30 Switch Roundtables (Same as above) 5:00 BREAK 6:00 No-host bar and Hosted Dinner a. Fireside Chat a. Wrap-up and Discussion of Day b. Exchange between Local Board members, Mary Selecky and Tom Milne Friday, October 26th 7:30 Continental Breakfast 8:00 Plenary Session: a. Emerging Diseases— Background information and introduction of Case Study b. Illegal Drug Labs — Background information and introduction of Case Study • 8:30 Roundtables on Emerging Diseases and Illegal Drug Labs a. What is the Board of Health Role? b. How will you know if you made a difference? c. Who else will you have to enlist to address the issue? d. What should be done next? In your county.....? Collectively/State- wide... ...? e. What are the barriers to action? 10:00 BREAK 10:30 Switch Roundtables (Same as above) NOON Lunch and Closing Plenary Wrap-Up and Action Plan for Next Steps 2:00 Adjourn • • Board of Health Old Business Agenda Item # IV. , 2 • Letter to Senator Marie Cantwell September 20, 2001 • ' . N. �t. • - - __ -- .� Jefferson Coun Health &Human Services -1 JI, •- II It CASTLE HILL CENTER • 615 SHERIDAN • PORT TOWNSEND,WA 98368 N August 16, 2001 The Honorable Maria Cantwell United States Senate Washington, DC 20510 Dear Senator Cantwell: On behalf of the Jefferson County Board of Health and the people of Jefferson County, I would like to thank you for your visit to Port Townsend on July 21, 2001. Your meeting with community leaders concerning the deteriorating state of rural health care access shows your concern for this important issue. The Board of Health, in partnership with the Jefferson General Hospital Board of Commissioners, has embarked on an ambitious project to develop both short and long-range solutions to regional health care access problems. We sincerely appreciate your support of these efforts. • Among the other issues discussed, assuring an adequate supply of essential public health vaccines and medications is a growing problem. Delays in influenza vaccine production and outright shortages of diphtheria-tetanus vaccine are only the most recent examples of this problem. Anti-tuberculosis medications and antibiotics used to treat sexually transmitted diseases are also being discontinued by their manufacturers due to low profit margins. A national strategy to assure adequate supplies of essential public health biologics and pharmaceuticals is urgently needed. The Nurse Family Partnership ("Best Beginnings") program, intensive home visiting to first time at-risk families, is another vital service. Based on the well researched Dr. Olds' preventive family health intervention model, this program has the potential to significantly decrease violence, substance abuse and unintended pregnancy as well as their associated social costs. Assuring adequate funding for these proven early interventions is essential to our efforts to improve community health and control escalating law and justice costs. And finally, we can not overstate the need for Congress to follow through on the full funding of the Frist-Kennedy Bill (The Public Health Threats and Emergencies Act of 2000). Efforts to increase federal and state disaster response capability are certainly important but the greatest vulnerability of our national public health system exists at the local level. There is strong consensus among bioterrorism and infectious disease experts that prompt, effective local response to a biologic disaster offers the best hope of • successful containment. This capacity is largely non-existent at the local level. The HEALTH ENVIRONMENTAL DEVELOPMENTAL ALCOHOL/DRUG DEPARTMENT HEALTH DISABILITIES ABUSE CENTER FAX .1 :--• 11 .1' 2 -Q••i 1 2 -•411 .1 : -• of • -•• 1 Frist-Kennedy Bill offers a strategy for addressing this problem but will require0 substantial resources to deal with the longstanding neglect of local public health capacity needs. Thank you again for your visit to Jefferson County. We are deeply appreciative of your concern for our community and leadership on the many crucial public health issues discussed. Sincerely, ---r(----;--2— J., --... -"fc.,---0--.,=----"`b Thomas Locke, MD, MPH Jefferson County Health Officer cc: Jefferson County Board of Health • • • Board of Health New Business Agenda Item # V. , 1 • Public Health Law 101 Rules , Policies, Waivers And Appeals September 20, 2001 • t I ( 4,4, . , • . ,J,. . - -- -----"101.:=- _ J,A„..._ __ ' -- 111,,,, ,z. � , .; .� / ' Jefferson County Health &Human Services . . '',r•fpr ., - 1 . � , ` CASTLE HILL CENTER • 615 SHERIDAN 4V PORTT0NSEND.WA 98368 . September 9, 2001 To: Jefferson County Board of Health From: Tom Locke, MD, MPH, Health Officer -'71, Re: Rules, Policies, Waivers, and Appeals Statutory boards (such as boards of health) have specific legal powers that are delegated to them by state legislatures. These powers are often categorized as quasi-executive, quasi-legislative, or quasi-judicial. Under this classification system, the rules adopted by a local board of health are an exercise of quasi-legislative power. This process is designed to be deliberative and to maximize opportunities for public review. Rules of a board of health have the "force of statute" and can carry civil and/or criminal penalties for violation. • Policies adopted by a board are an exercise of quasi-executive authority. Ideally, a policy should act to clarify and implement the legislative intent of a rule or statute. Policies, in themselves, should not break new ground legislatively. Instead they should facilitate the implementation of an existing rule by clearly explaining enforcement procedures and applying those procedures, when appropriate, to specific circumstances. Policies are designed to be much more flexible than rules and can be adopted without mandatory public notice, review, or waiting periods. They can be amended or repealed at the will of a majority of the board. Waivers are an administrative mechanism built into many rules to adjust the rule to individual circumstances that cannot readily be addressed in either rule or policy. A waiver process is of particular value in highly technical rules where regulatory guidelines at times clash with real world realities. Criteria for granting specific waivers are usually contained within the rule. In general, the key consideration in granting a waiver is whether the fundamental intent of the rule can be achieved even when certain technical criteria cannot be met. Public health protection is poorly served by rigid codes that restrict activities that have no adverse public health impact. Waivers allow the intent of the law to be given a higher priority than the letter of the law. Waivers also establish precedents for code enforcement. Once a waiver of a rule has been granted, anyone subject to that rule has a legitimate expectation of receiving the same waiver in similar circumstance. Judicious use of waivers promotes fairness and regulatory compliance. Careless granting of waivers can dilute the authority of the rule and render it less effective in fulfilling its intent. 0 HEALTH ENVIRONMENTAL DEVELOPMENTAL ALCOHOL/DRUG DEPARTMENT HEALTH DISABILITIES ABUSE CENTER FAX 360/385-9400 360/385-9444 360/385-9400 360/385-9435 360/385-9401 N ' • And finally, boards of health are called upon to exercise their quasi-judicial authority through an appeal process. Appeals of public health codes challenge the administrative interpretation and implementation of a particular code. Anyone aggrieved by a decision of a public health official can appeal that decision to a board of health. The board's power to affirm or reverse the decision of its administrative officers is a final check against the misuse of the board's authority and a means by which the board retains the "final say" on what the intent of the rule truly is. A highly functional board of health uses all of these available strategies to carry out its statutory responsibilities. Rulemaking and appeals are, hopefully, the least frequent strategies. Policies and waivers, the most frequent. If this balance is reversed, it suggests that problems exist in the rule, its enforcement, or both. • • • I Board of Health New Business Agenda Item # V. , 2 • On-Site Sewage Code Revision - Action Item September 20, 2001 • Jefferson County Board of Health Agenda Item Information / Description Regular Business "'For Month of: September, 2001 Description - Amendments to the Onsite Sewage Code addressing O&M Specialists qualifications and scope of practice of O&M specialists . Issue - During the August BOH meeting the board directed staff to prepare several amendments to the County Onsite Sewage Code. The Board provided specific language for the amendments . The board language has been incorporated into the draft ordinance amending the adopted code and the board is also provided with the text of the effected ordinance sections . Staff has incorporated the board language with some additions . The board amendments are shown in bold print, staff recommended changes in bold italicized print. Staff has made the recommendation to include the phrase "or as approved by the Health Officer" in order to enable the department to respond to additional unanticipated technical issues through policy rather than through continued amendment of the rule. "'Opportunity Analysis - This is an action item. The range of options available to the Board include: • Leave the ordinance as adopted and previously amended • Adopt the amendments as presented • Strike the staff recommended changes and adopt as originally directed Specific Departmental Recommendation - Adopt the amendments with the staff recommendations included This recommendation is made because, if implemented, it reflects the intent of the board recommended amendments but offers the flexibility to respond to changing demands or knowledge through the simpler process of policy rather than reworking the rules . • Ordinance No. AMENDING ORDINANCE NO. 08-0921-00 • JEFFERSON COUNTY HEALTH AND HUMAN SERVICES DEPARTMENT RULES AND REGULATIONS ON-SITE SEWAGE DISPOSAL SYSTEMS Jefferson County Ordinance No. 08-0921-00. relating to the County Health and Human Services Department and sewage disposal systems, is hereby amended as follows: Amend: 8.15.140(3)(c)to read: Written proof showing a minimum of one-year experience under the direct supervision of a Certified Installer, Designer, Operation and Monitoring Specialist, Pumper or other experience as approved by the Health Officer. Completion of classroom training specific to on-site sewage system operation and maintenance as approved by the Health Division may be substituted for up to six months work experience. Add: 8.15.140(4)(b)(v) Excavate for purposes of affixing sweeping 45 degree angle lateral ends and removable end caps on manifolds and lateral lines, for purposes of maintenance, such as flushing,jetting and brushing. Add: 8.15.140(b)(vi) Or other as approved by the health officer. Amend: 8.15.140(4)(c)(iv)to read: Alter or replace any portion of the subsurface disposal component or pretreatment components, EXCEPT as stated in 8.15.140(b)(v)and EXCEPT in the case where he/she also holds a valid Installer's Certificate and a permit has been obtained for such work; or Amend 8.15.150(6)(c)to read: Owners of all onsite sewage systems(conventional, alternative and proprietary systems after meeting manufacturers training requirements) may obtain operations and monitoring inspections from a Certified Monitoring Specialists in lieu of the Health Division, Licensed Designer or licensed professional engineer for the following inspection: • (i) Routine O&M (ii) The sale or transfer of a property (iii) The application for a building permit that is not classified as an expansion. APPROVED JEFFERSON COUNTY BOARD OF HEALTH Jill Buhler, Chairman Sheila Westerman,Vice Chairman Dan Titterness,Member Glen Huntingford, Member Geoffrey Masci, Member Richard Wojt, Member Roberta Frissell, Member SEAL ATTEST: Lorna Delaney,Clerk of the Board • • Bold=new text Bold Italics=new text added hr Health Department staff 8.15.140 OPERATION AND MONITORING SPECIALIST (3) Requirements for Monitoring Specialist Certificate shall include all of the following: (a) Application shall be made on forms provided by the Health Officer. (b) Certificate and/or application fees as set forth in the Fee Schedule shall be payable to the Health Division. (c) Written proof showing a minimum of one-year experience under the direct supervision of a Certified Installer, Designer, Operation and Monitoring Specialist, Pumper or other experience as approved by the Health Officer. Completion of classroom training specific to on-site sewage system operation and maintenance as approved by the Health Division may be substituted for up to six months work experience. (d) Written proof of completion of a minimum of sixteen (16) hours of training in on-site wastewater treatment, operation and maintenance at the Northwest On- site Wastewater Training Center or equivalent. (e) Take and pass a written examination to determine the applicant's knowledge of the operation and monitoring requirements for the on-site sewage systems approved by the Washington State Department of Health, excepting those proprietary devices requiring a special authorization from the system proprietor. (b) The Operations and Monitoring Specialist may complete the following if authorized by the homeowner: • (i) Clean pump screen or outlet baffle screen; (ii) Install and repair septic tank lids, risers and baffles; (iii) Replace pumps, float switches, and check valves intended to prevent the back flow of effluent into the pump chamber, within Washington State Labor and Industry requirements; or (iv) Make repairs to a septic tank or pump chamber to correct a condition of ground water intrusion or leakage. (v) Excavate for purposes of affixing sweeping 45 degree angle lateral ends and removable end caps on manifolds and lateral lines, for purposes of maintenance, such as flushing,jetting and brushing. (vi) Or other as approved by the health officer. (c) The Operations and Monitoring Specialist shall not: (i) Pump the septic tank and/or pump chamber, EXCEPT in the case where he/she also holds a valid Septic Tank Pumper's Certificate; (ii) Excavate an OSS's drainfield or any drainfield component, EXCEPT as stated in 8.15.140 (4)(b) above, OR in the case where he/she also holds a valid Installer's Certificate; (iii) Alter devices such as cycle counters or operating hour meters without the prior written approval of the Health Division; (iv) Alter or replace any portion of the subsurface disposal component or pretreatment components, EXCEPT as stated in 8.15.140(b) (v) and EXCEPT in the case where he/she also holds a valid Installer's Certificate and a permit has been obtained for such work; or (v) Replace or alter devices that monitor or regulate the distribution of the effluent. • 8.15.150 OPERATION, MAINTENANCE AND MONITORING (6) Operations and Monitoring Agreement and Contracts. (a) The owner of a conventional OSS shall be subject to a permit condition requiring compliance with the inspection schedule specified in Table 1 beginning with the earliest of the following events: (I) The installation of an OSS. (ii) The repair of an OSS. (iii) The alteration of an OSS. (b) Owners of existing conventional systems shall obtain an initial inspection by the Health Division, Licensed Designer or licensed professional engineer and comply with the inspection schedule specified in TABLE 1 beginning with the earliest of the following events: (i) The sale of the property. (ii) The application for a building permit on the site. (iii) The use of an OSS as a community OSS. (iv) Identification that an OSS is in an Area of Special Concern as designated by the JCBOH. (v) Identification that a system has received a Waiver/Variance from State or Local Code. (c) Owners of Owners of all onsite sewage systems (conventional, alternative and proprietary systems after meeting manufacturers training requirements) may obtain operations and monitoring inspections from a Certified Monitoring Specialists in lieu of the Health Division, Licensed Designer • or licensed professional engineer for the following inspection: (i) Routine O&M (ii) The sale or transfer of a property (iii) The application for a building permit that is not classified as an expansion. • Board of Health New Business Agenda Item # V. , 3 • Communicable Disease Update - 2000 Jefferson County STD Profile September 20, 2001 • \ �. • yam- -- Z . . • Jefferson County Health & Human Services r1 CASTLE HILL CENTER • 615 SHERIDAN • PORTTOWNSEND.WA 98368 d. August 29, 2001 To: Jefferson County Physicians and other Health Care Providers (Please circulate.) From: Lisa McKenzie PHN 14, JCHHS Communicable Disease and Immunization Program Re: Report on Pertussis Outbreak Summer 2001 , Chronic Hepatitis Reporting Form, STD Profile Jefferson County 2000 During June and July there were 11 cases of pertussis reported to JCHHS. These cases met the case criteria for reporting by being laboratory confirmed or by meeting the clinical case definition and being epidemiologically linked to a laboratory confirmed case. There were other possible cases that did not have a known exposure to a laboratory confirmed case so did not meet the confirmed case classification for reporting purposes. • Of 11 cases 3 were adults and 8 were children. The children ranged from 2-14 years old. The adults were 38 — 45 years old; two of these were parents of children who were cases. Four of 8 children had no previous pertussis immunization, 2 had 1 dose and 2 had unknown immunization histories. Onset of symptoms ranged from 5/4/01 — 7/11/01. Many local Health Care Providers screened and cultured possible cases and treated close contacts of cases. Thank you for your assistance in getting this outbreak under control. We feel fortunate that there was no infant who became ill. It is probable that some low level of pertussis activity remains in the community so we ask for a continued increased level of suspicion for pertussis. Enclosures: The new Chronic Hepatitis 8/ Chronic Hepatitis C case report. These reports will allow us to gain information on the magnitude of Hepatitis C and B infection in our county. Could you please send reports to me monthly on patients who you have seen each month, unless you have already sent a report for them. The labs do not consistently report on chronic hepatitis and are not required to in the new WAC. I can help with asking about risk factors if requested. Acute cases of Hepatitis B should still be reported within 3 days. Thank you for your much appreciated assistance with this. The STD Profile for Jefferson County 2000. JCHHS staff continues to be available to assist 110 with partner notification if needed. HEALTH ENVIRONMENTAL DEVELOPMENTAL ALCOHOL/DRUG DEPARTMENT HEALTH DISABILITIES ABUSE CENTER FAX ':).4 _OA • .t _ _�i� ZR�1/7•F_�a 1R / •F_Os7F 2.1 -• � � Sexually Transmitted Disease Profile JEFFERSON COUNTY - 2000 &NMI kt Jefferson -41 • rAirL kOrt �fsi �Health Summary • This report describes the sexually transmitted disease burden in Jefferson County. Primary emphasis is placed on chlamydia and gonorrhea since they are the most frequently reported STDs in Washington State. The 2000 incidence rates by age and sex for gonorrhea and chlamydia are presented. The report concludes with a presentation of which providers in your county reported STDs. Contents County STD Trends 7 Table 1: Washington State Reportable Sexually Transmitted Diseases, 2000 Chlamydia Figure 1: Chlamydia Incidence Rates, by Age and Gender, 2000 3 Figure 2: Chlamydia Cases by Age (13-19) and Gender, 2000 4 Table 2: Chlamydia Repeater Infections, 2000 5 Table 3: Chlamydia Asymptomatic Infections, 2000 5 Gonorrhea Figure 3: Gonorrhea Incidence Rates, by Age and Gender, 2000 6 Conclusion • Table 4: Reported Cases of Gonorrhea and Chlamydia by Provider Type, 2000 7 Appendix A: Data Sources, Analyses, and Limitations 8 • 1 • Jefferson County STD Disease Trends Table 1: Washington State Reportable Sexually Transmitted Diseases, Jefferson County, 2000 1999 2000 2000 2000 Jefferson Jefferson Jefferson Washington Disease County Cases County Cases County Rate State Rate (per 100,000) (per 100,000) Chlamydia 35 32 121 224 Gonorrhea 1 0 - 42 Early Syphilis 0 1 * 1.5 Congenital Syphilis 0 0 - 1.3(live births) Late/Late Latent Syphilis 0 0 - 1.5 PID (Acute)** 4 3 * 8(female) Herpes (initial infection) 3 0 - 35 NGU** 3 2 * 38(male) GI/LGV/Chancroid** 0 0 - 0.0 AIDS cases** 1 2 TOTAL 46 38 144 327 (excluding AIDS cases) • 'Denominator estimates for the calculation of incidence rates from the population estimates, 1990-2002 Population Estimates and Projections:Department of Social and Health Services, Washington State Adjusted Population Estimates.April 1999. 'Rates cannot be calculated for years with fewer than five cases "See Appendix A for explanation of disease acronyms. In 2000, Jefferson County experienced a decrease from 1999 in its combined STD morbidity rate. With 38 new cases of STDs (excluding AIDS cases 1) in 2000, the incidence rate for all STDs was 144 per 100,000 persons. This is 56% less than the 327 per 100,000 combined STD rate for Washington State. Jefferson County reported no cases of congenital syphilis or GI/LGV/ Chancroid in 2000. 2000 compared to 1999: • Chlamydia had a 9% decrease in reported cases (32 vs. 35). • Gonorrhea had 100% decrease in reported cases (0 vs. 1). • Early syphilis had a 100% increase in reported cases (i vs. 0). • Acute PID had 25% decrease in reported cases (3 vs. 4). • Initial infection herpes had a100% decrease in reported cases (0 vs. 3). • NGU had a 33% decrease in reported cases (2 vs. 3). • ' Complete information on the HIV/AIDS epidemic in Washington Washingtoncan be found in State HIViA1DS Epidemiologic Profile- 1999, Washington State Depaitment of Health, Office of IDRH, Assessment Unit. 7 Chlamydia • Figure 1: Chlamydia Incidence Rates by Age and Gender, Jefferson County, 2000' 2000 •Female Rate ®Male Rate 1750 — 0 0 1500 — — — 0 0 0 1250 -- - - - - - a Co 1000 — — — — cc a) 750 — c - - - a) c 500 — - - - — 250 - - - - - - - 0 0-9 10-14 15-19 20-24 25-29 30-34 35-39 40+ • Age (years) Female Rate 0 0 1,617 1,776 I 0 • Male Rate 0 0 ' • 0 • 0 ' Female Cases 0 0 12 10 3 1 I 0 1 Male Cases 0 0 2 1 0 1 0 1 Denominator estimates for the calculation of incidence rates from the population estimates. 1990-2002 Population Estimates and Projections:Department of Social and Health Services. Washington State Adjusted Population Estimates.April 1999. Incidence rates rounded to the nearest whole number. 'Rates cannot be calculated for ages with fewer than five cases In, 2000 the female chlamydia incidence rate peaked among the 20-24 year old age group at 1,776 cases per 100,000 after this peak , chlamydia incidence among females progressively declined with increasing age. Only women are routinely screened for chlamydia. Because active case-finding is preferentially limited to women, the incidence of chlamydia in men may be under-reported by comparison. Caution should be used in interpreting comparisons of chlamydia rates between genders. • 3 • T T O Oy 0 t , `L ; CO >, Y tl }{ r N , t T Cf) w h Du) ‘,.. ,.. . .. , . • .... ...4;,,,,:,. ,.,: . :.,.:-..fi,,x.'::.,.• -,•-::;;.:. ' : % .!-;,-.- i 1-- 0 (.....) ,-t1.-J.,t. .. t.',...,.,,,,w,.., CV nN-55:;,......-.,....,. cn �. r4co w(......) ....._ a� 110 2 sof t Q li 0 < a i�y YYS asy A '�- '*'3.4;',1 ,'''.*'' . ?, te, ' ° T"� -Clirill) 0 Cr) -',WAr''A•klk> ' • ,,....,....,..„_...1 a...- LIL CO T lam %ft...00Li] Z W M T o sese3 10 Jegwn 4 • Repeater Infection (Person having more than one infection in a 12-month period prior to being • treated.) Recurrent infection is common and associated with increased risk of PID and other serious outcomes. Data suggest that young age and incomplete therapy increases the risk for a persistent/recurrent infection. Studies also suggest that women's current male sex partners are not receiving treatment for chlamydia and that women are being re-infected by resuming sex with preexisting (and infected) sex partners. Careful interviewing and prompt, concurrent treatment of all partners is important. People should be coached to ask health care providers for re- screening if risk behavior occurs. Table 2: Chlamydia Repeater Infections, Jefferson County, 2000. MALE FEMALE TOTAL Reported Cases 5 27 32 Repeaters Identified 1 2 '3 Repeaters 20% 7% 9% Asymptomatic Infection • STD infections often lack signs and symptoms. Additionally, signs of severe complications may not appear until long after infection, reducing the likelihood that the patient will associate complications with the initial time of infection. Screening sexually active adolescents (19 years and younger) for chlamydia should be routine during annual examinations even if symptoms are not present. Screening women and men aged 20-24 is also suggested, particularly those who have new or multiple sex partners and who do not consistently use barrier contraceptives. Careful interviewing and treatment of all partners is important. Table 3: Reported Cases of Chlamydia by Diagnostic Category, Jefferson County, 2000. Private Public , TotalTotal Dia!nosis Male i Female Cases Asvm.tomatic 1 7 1111.11.1111EMIIIMM 14 Sgo.tomatic-Uncomplicated 1 5 MIIIEIIIMIMIII®IIIIIIIII 11 Pelvic Inflammato Disease 1 3 IIIIIIMIIIIIII j 6 6 Other -1111.11.- -111.11. Unknon 1 111.1 1 I 1 TOTAL n 2 15 ®IIIIMINIMEM 32 • 5 • Gonorrhea There were no cases of gonorrhea reported from Jefferson County in 2000. Because most gonorrhea cases are symptomatic and seek medical care, reported cases are considered to be an accurate reflection of true disease incidence in the overall population. Providers in Washington who reported gonorrhea cases in 2000 indicated that 75% of the men were symptomatic for gonorrhea; 50% of the women were symptomatic. Unlike chlamydia there is no widespread screening program for gonorrhea, however, most clinics provide gonorrhea screening at some level and 99% will perform gonorrhea testing if the client is symptomatic. National gonorrhea incidence rates have precipitously declined from 1974 to the present. Paralleling national trends, the Washington State gonorrhea incidence has declined 74% from 156.7 per 100,000 in 1988 to 41.5 per 100,000 in 2000. Age distribution in Washington State in 2000 showed age-specific rates peaked at 186 per 100,000 in the 20-24 females and peaked at 157 per 100,000 in the 20-24 year old males. Any targeted intervention for gonorrhea should consider the impact of this disease on different age groups within both genders and direct the prevention message accordingly. S • 6 Conclusion • Table 4: Reported Cases of Chlamydia and Gonorrhea by Provider Type, Jefferson County, 2000 Chlamydia Gonorrhea Provider Type No. of No. of Percent of No. of No. of Percent of Providers Cases Total Cases Providers Cases Total Cases AlcohoUSubstance Abuse Blood Bank'Plasma Center Community Health Center Emergency Care(excl. hosp.) Family Planning 2 2 6% Health Plan/HMOs HIV/AIDS Hospitals 2 4 13% Indian Health JaiUCorrection/Detention Job Corps Migrant Health Military Neighborhood Health OB/GYN 1 1 3% Other 5 8 25% Private Physicians 2 2 6% Reproductive Health 1 15 47% • STD Clinics Student Health TOTAL 13 32 100% 0 0 In Jefferson County, the Reproductive Health providers reported the highest number of chlamydia cases. These providers reported 47% of the total. Other providers reported the second highest number of chlamydia cases (25%). The Healthy People 2010 national objectives for chlamydia incidence are: Females aged 15-24 attending family planning clinics: 3%. There are 0 Region X Chlamydia Project* Family Planning clinics in Jefferson County. Females aged 15-24 attending STD clinics: 3%. Males aged 15-24 attending STD clinics: 3%. There is 1 Region X Chlamydia Project* STD/Reproductive Health clinic in Jefferson County. The 2000 positivity rate was: Male Female Site Tests Pos Pos Tests Pos Pos Jefferson Co FP 57 3 5.3 448 10 2.2 The year 2010 Health People national objective for gonorrhea incidence is 19 cases per 100.000. • Chlamydia Project Screening Criteria see page 9. 7 • Appendix A: Data Sources, Analyses and Limitations Cases: The number of cases identified and submitted by providers to local health jurisdictions and forwarded to the Washington State Department of Health, Office of Infectious Disease and Reproductive Health, STD/TB Services. Population: Denominator population estimates for incidence rates are from 1990-2002 Population Estimates and Projections: Department of Social and Health Services, Washington State Adjusted Population Estimates, April 1999. Incidence Rates: Incidence rates are calculated as the number of new episodes of a disease (not persons) in a given year divided by the total population (age and sex appropriate) for that year, expressed as a rate per 100,000. Incidence rates allow comparisons between two or more populations by standardizing the denominator and are the most appropriate statistic td use when investigating differences between groups. Rates should not be calculated for incident case totals fewer than five because the rates are unstable. Data Reporting: Gonorrhea, chlamydia, syphilis, Acute PID, NGU and herpes (initial infection) are reportable diseases to the local health jurisdictions and forwarded to the Department of Health. To be reported and included in surveillance data, disease definition must be met. • Disease Definitions: • Gonorrhea - isolation of Neisseria gonorrhea from a clinical specimen or observation of gram-negative intracellular diplococci in urethral smears or endocervical smears. • Chlamvdia- isolation of Chlamydia trachomatis from a clinical specimen by culture or non-culture methods that detect chlamydia antigen or genetic material. • Syphilis - a complex sexual transmitted disease with a highly variable clinical course. See CDC guidelines for surveillance definition. • Herpes Simplex (initial infection only) - diagnostic criteria for reporting can be made through clinical observation of typical lesions and/or laboratory confirmation. • Non-Gonococcal Urethritis (NGU) - presence of at least two of the following features: history of urethral discharge and/or dysuria; presence of purulent or mucopurulent urethral discharge; and/or urethral Gram-stain smear showing 4 or more polymorphonuclear leukocytes (PMNs) per oil immersion field. • Acute Pelvic Inflammatory Disease (PID) - an acute clinical syndrome unrelated to pregnancy or surgery. A combination of lower abdominal pain: adnexal tenderness; adnexal mass; pain on cervical motion; mucopurulent discharge: and temperature elevation. Patients with a positive test for chlamydia or gonorrhea are reported in those disease categories. • Chancroid - an S IT) characterized by painful genital ulceration and inflammatory inguinal adenopathy. • Granuloma Inguinale (GI) - a slowly progressive ulcerative disease of the skin and • lymphatics of the genital and perianal area. 8 • Lvmphoaranuloma Venereum (LGV) - characterized by genital lesions, suppurative • regional lymphadenopathy, or hemorrhagic proctitis. The diagnosing practitioner is responsible for providing the case information which includes patient demographics, source of diagnosis, limited clinical information including site of infection and treatment, and date of diagnosis. Data Strengths: Sexually transmitted disease data may provide more timely information on behavioral trends in the community than diseases with similar modes of transmission particularly HIV/AIDS. There is a high level of participation in the STD surveillance system by private providers of STD services. Data Limitations: Clinically diagnosed cases of STDs (without laboratory confirmation) may be missed through this surveillance system. Depending upon diagnosing practices, completeness of reporting may vary by source of health care. Data Biases: Biases could exist in the data due to under-reporting, inability of certain populations to access medical services, error in laboratory reporting, or differential reporting or screening by disease and source of care. However, it is assumed that the number of cases that would fall into these categories is small and normally distributed, thus not significantly impacting the calculated STD rates. Assumptions: It is assumed that the cases reported from year to year are independent of each • other. One violation of this assumption could be if a person who has an STD one year is more likely to have an STD the following year. Also, repeat episodes of the same S I'll by the same person are not excluded from the numerator count; it is felt that these numbers are not large enough to significantly impact the calculated incidence rates. Finally, we have assumed that all rates follow a chi-square distribution. Female Selective Screening Criteria in Family Planning and Expansion Sites: 1. Women 24 and under are to be tested when undergoing a pelvic examination or 2. Women of any age who meet one of the following criteria should be screened at any visit if a pelvic exam is performed: a. Cervicitis or signs and/or symptoms of other S I'll,* b. PID. c. Exposed to CT, GC or NGU in past 60 days, d. New sex partner during past 60 days. e. Two or more sex partners during the past 60 days, f. Pregnant/Currently planning a pregnancy, g. Seeking an IUD insertion. h. Prior + chlamydia or other STD* within the past 12 months. * STD is defined as Positive for Chlamydia, Gonorrhea , Trichomonas, Syphilis or a Primary case of Herpes or Warts (HPV). • 9 .,� , i h . .,,: '��- HelpingPeople Get the Services ., : * . , IIS. ,,, .�2 TheyNeed \C\ ►' Standards for ,•1', +Fin . • t. Access to Critical Health Services Standard I State measures: 4 Protocols are developed for implementation by state agencies, Information is collected and made available at 0 Consultation is provided to communities to help gather and LHJs and other local providers to maximize enrollment and analyze information about barriers to accessing critical health participation in available insurance coverage. both the state and local level to describe the services. 0 Where specific initiatives are selected to improve access, there is local health system,including existing resources @ Written procedures are maintained and disseminated for how to analysis of local data and established goals, objectives and for public health protection, health care obtain consultation and technical assistance for LHJs and other performance measures. providers,facilities and support services. agencies in gathering and analyzing information regarding Local measures: barriers to access. Standard 4 T Up-to-date information on local critical health services is @ Gaps in access to critical health services are identified using Quality measures that address the capacity, available for use in building partnerships with community groups periodic survey data and other assessment information. process for delivery and outcomes of critical and stakeholders. 0 Periodic studies regarding workforce needs and the effect on health services are established, monitored and C.2) LHJ staff and contractors have a resource list of local providers critical health services are conducted, incorporated into the gap reported. of critical health services for use in making client referrals. analysis and disseminated to LHJs and other agencies. Local measures: O The list of critical health services is used along with assessment Standard3 OO Clinical services provided directly by the LHJ or by contract information to determine where detailed documentation of local I have a written quality improvement plan including specific capacity is needed. Plans to reduce specific gaps in access to quality-based performance or outcome measures. Performance State measures: critical health services are developed and measures are tracked and reported. 0 A list of critical health services is established and a core set of implemented through collaborative e f forts. OO Staff members are trained in quality improvement methods as statewide access measures established. Information is collected on Local measures: evidenced by training documentation. the core set of access measures, analyzed and reported to the O Community groups and stakeholders, including health care State measures: LHJs and other agencies. providers, are convened to address access to critical health O Information about best practices in delivery of critical health 4 Information is provided to LHJs and other agencies about services, set goals and take action, based on information about services is gathered and disseminated. Summary information availability of licensed health care providers, facilities and local resources and trends. This process may be led by the LHJ regarding delivery system changes is provided to LHJs and other support services. or it may be part of a separate community process sponsored agencies. Standard 2 by multiple partners, including the LHJ. © Training on quality improvement methods is available and is OO Coordination of critical health service delivery among health incorporated into grant and program requirements. Available information is used to analyze trends y providers is reflected in the local planning processes and in the 4 Regulatory programs and clinical services ad nistered by DOH which, ove r time, affect feet access to critical health implementation of access Ines. have a written quality improvement plan ng specific services. • © Where specific initiatives art. cted to improve access, there is quality-based performance or outcome measures. Local measures: analysis of local data and established goals, objectives 'nd Data t r:jrtg 4fid ,eporting systems inciude key measures of i performance measures. access. Periodic surveys are conducted regarding the availability State measures: of critical. services and barriers to access. 0 Information about access b441)affecting groups within the • ' Gaps in access to critical health services are identified using state is shared with other state agencies that pay for or periodic survey data and other assessment information. support critical health services. OO The BON receives summary information regarding access to © State-initiated contracts and program evaluations include critical health services at least annually. performance measures that demonstrate coordination of critical health services delivery among health providers. Menu of Critical Health Services This menu identifies health services and health Communicable and infectious Cancer services condition or risks for which appropriate services diseases — screening, education and counseling, or Cancer specific screening (i.e.,breast,cervical, intervention — are needed. Immunizations for vaccine preventable diseases colorectal) and surveillance General access to health HIV/AIDS Specific cancer treatment services Tuberculosis Chronic conditions and disease Ongoing primary care Other communicable diseases management Emergency medical services and care Pregnancy and maternal, infant, Diabetes Consultative specialty care and child health and Asthma development Hypertension Home care services YP Long-term care Family planning Cardiovascular disease Prenatal care Respiratory diseases (other than asthma) Health risk behaviors Women, Infants and Children (WIC) services Arthritis,osteoporosis,chronic back conditions Tobacco use Well child care Renal disease Dietary behaviors Behavioral health and mental Oral health Physical activity and fitness health services Injury and violence prevention (bike safety, Dental care services Substance abuse prevention and treatment Water fluoridation motor vehicle safety,firearm safety,poison prevention,abuse prevention) Depression Responsible sexual behavior Suicide/crisis intervention U 0 6 2001 Other serious mental illness For additional information contact the Dept. of Health at (360) 236-4085 Standards for Public Health in Washington State • Board of Health Media Report • September 20, 2001 • Jefferson Coun,ty Health and Human Services AUGUST 2001 NEWS ARTICLES These issues and more are brought to you every month as a collection of news stories regarding Jefferson Count\ Health and Human Services and its prouram for the public: 1. "County's strategic plan nearing adoption" — P.T. LEADER. Auaist 8. 2001 2. "Objection to county booklet" by Kevin Bowen — Opinion Forum. P.T. LEADER. August 9. 2001 3. "Options, not beliefs are being promoted" by Patricia Perreault. and Editors-Note by Patrick Sullivan. "Celebrate diversity" by Ray Jackson— Opinion Forum. P.T. LEADER. August 15. 2001 4. "Churches offer help, answers" by Rev. Dan McMillan and "Practice what you • preach" by `"inky Fuller— Opinion Forum. P.T. LEADER. August 22. 2001 5. "Flu season to hit soon on Peninsula" — Peninsula Daily News. August 26. 2001 6. "Back-to-school season is vaccine checkup time" and "vaccine available for college students" — P.T. LENDER. September 2001 • _ _ L> J ` f7 l ^ll J 7J _ l S _ _ S J 7., ! _ - J / 7 :J r J / 1• S • J _ J -• • • - - . --0 ,, ,, - - _ 2 " •.... J ' 3 _ f , S.' 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I know my statements will cause some to label me a hater or homopho- bic.I am not. I am merely a person who, along with many other informed and non-hateful persons,disagrees with the advocates of homosexuality and is dis- turbed by the government-funded forc- bj ection to ing of a non-Christian worldview on our children. county booklet Instead of solely advocating the ho- v mosexual lifestyles, why didn't the Editor,Leader: county include a parallel section stating Recently we received, at taxpayer that, if youths are having such tempta- expense,a copy of the"Jefferson County tions, they might want to talk with a Youth Yellow Pages"in which I encoun- pastor or youth director? Why not list tered the following endorsement of ho- Christian websites? mosexuality by the county: The section about homosexuality is "Being gay, lesbian or bisexual is a not my only concern.There are also sev- normal and healthy way to be. It's one eral church groups listed under"Church more part of who you are — like being Activities for Youth,"but the list is not • tall or short,or black or white,or Asian inclusive. It does not list the Latter Day or Latino.It takes time to know who you Saints,the Unitarians or some New Age are.You might feel confused,or unsure fellowships. These are churches that I whether you're gay or straight. It's OK strongly disagree with,but my question to take your time finding out." is why does a county-funded publica- The large section included a web link tion discriminate among religions? and phone number to a pro-homosexual My issue is about fairness.I believe lifestyle organization. it is time that non-elected government Many intelligent and compassion- bureaucrats stop propagating their ate people believe that being gay, les- opinions at taxpayer expense and at bian or bisexual is not "normal." In the cost of performing more basic ser- fact, many of us believe that homo- vices. Furthermore, it is only reason- sexuality or other inappropriate het- able to ask that, when they feel erosexual behavior is a choice — and compelled to venture into controversy, not in the same category as being black they present both sides of an issue and or white or Asian or Latino. We also stop forcing their views on those of believe that correctly addressing such us of differing opinions. deviant behavior involves identifying it KEVIN BOWEN as something that is not good.As such Port Townsend i iT `C National Association of Social Workers. Mr.Bowen demonstrates courageous devotion to his beliefs. However, the 2001,2003 promotion of religious perspectives is Jefferson County the responsibility of the churches who Celebrate • Youth Yellow P es espouse[hem.It is not the task of a pub- licly financed health department. oswrc.,z� a�jS,`i�i PATRICIA . PERREAULT diversity' :;;',a .ft`.• ® ?.i, :;• Y-1 president ° ,, - PFLAG/Port Townsend-North Editor,Leader •i';!,•,..,.-• - Olympic Peninsula I am both shocked and appalled by pthe intolerance and bigotry displayed by rte . _.7� '• !Editors !Vote: The 2001/2003 Kevin Bowen in the Aug.8 Leader.You '. u • ,j:'' Jefferson County Youth Yellow Pages is should be ashamed of yourself.You have t labeled as a resource guide for preteens, the audacity to consider gays and other � X I r , teens,coun.g adults and families.!ts in- people who live alternative lifestyles as "`F"" troduction includes: "The contents have "net normal." . V " I T- 4 been reviewed for accuracy by proles- As the"Heavy Metal Warrior,"I have ��'` I I / e �CW '�"� sionals in the community and are not to say that such intolerance about gays, ,cw,v4 ;rr,_,j'•�• intended:o reflect arty particular point lesbians and those who are"non-Chris M�' 1 N6. of view Parents, guardians, teachers, tian"as far as their beliefs are concerned i -`'R� ' �ir�'' 6�1i I counselors and spiritual leaders are is not acceptable in this town,which by your first source of help when you need the way,celebrates diversity. A Roaourc•Guld•for Preteens,Tams, understanding, information and guid- RAY JACKSON Young Adults and Families once. If you still need help and aren't Port Townsend sure where to turn. the Youth Yellow Options, not . Pages offers ideas for where to find people who can listen and advise" beliefs are It continues "The resources listed are primarily local nonprofit organi:a- bbeinpromoted tions that offer support,direct services and community-based programs appro- Edi tor, '_elder priate for preteens,teens,young adults In his letter of Aug.3,Kevin Bowen and families. Some private providers objected:o the inclusion in the Jefferson and regional agencies have also been • County Youth Yellow Pages of informa- included when local nonprofit options non that provided resources for gay,les- are limited.Please note that a listing in bear. and bisexual youths, Mr. Bowen the Youth Yellow Pages does not imply states that his issue a about fairness in support of theorganizationorprogram.- eaard :he use et taxpayers' money Tire :able of contents lists these cat- lad:ne_resentauon of positions on the '2ories: alcohol, marijuana and other matter of homosexuality. drugs.birth control,childcare,clubs and The cooklet qtr. Bowen mentions is hangouts.conflict resolution,counseling ,.:114 mental health services, dating vio- 2ublishec ov our county health depart- mem as service :0 Jefferson County .e.nce.disabilities and special needs,do- .ouths. A sieruncant percentage of our mesuc violence, driving and auto heterosex al taxpayers, including many licensing,eating disorders,education and who cons:oer themselves Christian,sup- schools.emergency contraception,emer- • 'A port and applaud the department's efforts gency preparedness,employment,family in reachir a out to sexual minority youths. planning.financial, medical and other Our ax-funded public health system assistance.fire and safer',food and cloth- has the cbLgation to serve all its constitu- .'i3• gun safety at home, harassment, ems .and :o provide them with the best 'eal ft services, hepatitis. H(V/AIDS, available health tnformauon.The"repara- rousing,juvenile and family court ser- available or"conversion"therapy described cel.law enforcement.legal assistance, b> Mr. Bowen has been rejected as un- library services,mentoring,minor inpos- eipful and potentiali'. harmful by all session,parenting,peer pressure,preg- ma:or health and mental health profes- nancy,probation and parole,rape,sexual on;. Among them are the American assault and sexual abuse.recreation,lei- ..ions. of Pediatrics, the American sure ana sports programs, runaways, Counseiing Association, the American homeless and street youths.sexual brien- Ps�chiatr:c Association, the American ration,sexually transmitted diseases,sui- Ps cholceical Association and the cede prevention and intervention counseling.TV and media violence,talk- ing to your kids about anything,tattoos and body piercing,tobacco,transporta- tion, tutoring, volunteering and service • learning. ,� Copies of the booklet are available at ( C r� Jefferson County Health and Human Ser- 7 ( ' ' ' ii --(C-- 015 Sheridan St.,Port Townsend.) -- (" - C/ Churches offer • help, answers Practice what Editor,Leader thought it was quite amazing, al- re you preach though not surprising,that Ray Jackson ✓V l 1. it can state in the Aug. 15 Leader that this :s a town that celebrates diversity, and Editor,Leader: n the same sentence tell Mr.Bowen that In his letter to the editor in the Aug. his beliefs are not acceptable in this 15 Leader, Ray Jackson said he was • :own.Mr.Jackson,aren't you being in- shocked and appalled by the "intoler- tolerant of Mr.Bowen's intolerance? since and bigotry" displayed by Kevin A town claiming to be tolerant of di- Bowen in his letter of Aug. 8. versify must itself be willing to accept Well, I am shocked and appalled by all diverse viewpoints,and that includes he views of concerned Chnstians.l,and the intolerance and bigotry displayed by many others in this town,agree with Mr. Mr. Jackson in attacking Mr. Bowen's Bowens concerns regarding the infor- beliefs. The question raised as to mation provided in the Youth Yellow whether the county was promoting"al- Pages.Although I do appreciate the at- ternative lifestyles" was legitimate. It tempt at providing helpline numbers to teens m trouble.I was troubled about the might behoove Mr. Jackson to look up • • repeated reminders in bold letters and the word"normal." boxed borders that the purchase of Mr. Jackson, in his letter, came per- condoms, birth control methods and ilously close to telling Mr.Bowen to get pregnancy testing could be attained out of town if he couldn't conform to without parental consent and that a the thinking of those who"celebrate di- whole section was devoted to sexual on- versity."In effect,Mr.Jackson not only entation. where it was stated: "Being gay,lesbian or bisexual is a normal and trashed Mr. Bowen's beliefs,he denied healthy way to be"(page 39).Many have his right to express them. concerns about these types of messages I guess tolerance doesn't mean what it given to teens. used to mean anymore. (Well, I knew I have and hold to a different set of that.) • beliefs.Will you celebrate my diversity W'U KY FULLER as well? Pon Townsend When I received a copy of the yel- 'ou.pages,I was also disappointed that out at'50 pages,the editors chose to in- clude only a 2-inch listing of a few churches in the area.The directory did not include the valuable services that our local church youth groups and youth workers can provide in the support and counsel of local teens.1 called the health and human services office and asked if churches were contacted about being included in the directory,or considered important in their listing of nonprofit organizations. The friendly voice told me that she thought the church names were probably selected randomly out of the church directory section in the news- paper, and that due to separation of church and state, more information about churches and their work with teens could not be included. But she did encourage me to-keep art eye on- r s.�sita.which may soon Include i ,. 'uid encourage eser- teen io take d :uu::ec of the outstanding support that can he found in many of our local churches.We certainly don't have all the answers,but we can point you to the one who does: "Trust in the Lord with all your heart. Lean not on your own un- — — _- derstanding.In all your ways acknowl- edge Him and He shall direct your . paths"(Proverbs 3:5.6). The Rev. DAN McMILLAN San Juan Baptist Church Port Townsend ( PENINSULA DAILY NEWS • Flu season to hit soon on Peninsula But official urges aider getting shut Gleason said this year three some to delay strains of tlu will be .ncluded • in the vaccine. Two A-Strains, (Jetting vaccine New Caledonia and AMoscow ,17+ and Sichuan, a B-Strain type BY BRENDA RANRAHAN flu. PEN1NsL:.ADAO NEWS The symptoms of :he flu include fever, headache. mus- In an attempt to avoid a flu cie aches, weakness, sore epidemic among the hign-risk throat and cough. Gleason population the state is encour- iaid. ug-ing heuitny people to u•eiay hThose wno are a..ergic to g Lettina ft,: sot. :he protein found in the y•olk We expec: nave enougn eggs shca •id no: rhe vace:ne :c meet state Pro- vaccination. S --:•arn. needs.- said Cindy Glea- Gleason a:d. son, health educator for toe -tate Department of Health's Misconceptions • .mrnunization program. supb.:ers t t lei.vel• :he .:accine later than G_leason said :here are But expeco many misconceptions about Ce n past. tne tlu. including :he shot has er: i :he ;meeting toe person .-vith :he Viashinghch state rec- nmen0ing t. care • 'The vaccine is nut live, it providers :oat flu shuts De -Liven to hign-risk groups." cannot cause an infection," she said. "Tif someone gets sick Plenty of time after getting a flu soot. they probably caught a or flu Gleason said there will virus before they got the po:nCy Jt'time for others to get shot." their shots before flu sea- She said it takes scout two son. weeks before the vaccine Gleason said :he flu season begins to protect people :ur the state generally runs against the three strains of flu hetween Januar:: and March. included in this years vaccine. oeaLc---g, .n. 17ebruary. Gleason said anyone want- .rne said tne vaccine is ing w avo.-; the ::u .; encour- ,xpeeted to be delivered aged to get a flu 3i.lut. out that around the :Irv,- of October. the state is raging "We are encouraging :hose healthy oeople to ..+.2:t until the n.igh-r:sk categories a athe yea, oat tne snot as soon as the vac- •We wan: tncse are at arrives. G.eason said. nigh-risk to be first in line to Healthy people can wait prevent theflu " Gleason. said. until late November or • • " December to get the shot and That means those who are avoid the :lu healthy and can afford to wait s•till ." should allow others to protect People ineluded in the high- themselves." risk category include those etto diabetes, asthma or other Gleason said last year 15 to .ung conditions, heart disease, 30 percent of the United kidney disease, and those who are HIV-posit:ve. States population became infected with the tlu. Senior citizens over 65. More than 114.iOU flu- .ung-term care residents, preg- related hospitalizations and rant Nomeri n their second or more than 20,000 flu-related :hti•d trimester and health deaths occurred.-in tne United _are workers should also con- States, she said. • Wednesday, September 5,2001 •B 3 Back-to-school 411 season is vaccine checkup time Vaccinations against such childhood dis- "W'hat did you do on summer vacation?" eases as measles, mumps, rubella, diphthe- na,tetanus,hepatitis B,whooping cough and That's a ommon question when kids head polio are a safe and effective way to prevent back to school.Whether you went to Illinois serious complications associated with these to visit grandma, saw a Mariners game at illnesses,report health professionals.Parents, Safeco Field or took the trip of a lifetime to health care providers, daycare centers and China, you may have come back carrying schools can play an active role to ensure that more than just the memories and souvenirs, children in Washington are protected against reports the Washington State Department of possible complications from vaccine-pre- Health. ventable diseases. The health department As international travel becomes more encourages parents and providers to include common,so has the number of vaccine-pre- immunization checks at every office visit. ventable diseases that are being imported. For more information on immunizations, Many diseases that are rare in the United check the state health department website, States still cause devastating illness in other www.doh.wa.gov/cfh/immunize,talk to your parts of the world.And you don't have to go health care provider, or call the local health to those places to be exposed, warns the de department at 385-9400. partment. Some viruses stay in the air for quite a while, and all it takes to be exposed is to breathe the same air as someone who Vaccine available carried the disease back with them from a trip overseas. ! for college students So before those summer memories fade away, health officials recommend that par- i The Centers for Disease Control suggests ents start the school year off with the com- I that students entering college who plan[olive fort of knowing their children are fully in dormitories be aware of the availability of immunized. meningococcal vaccine.Living in close guar- "Kids deserve a healthy start when school ters with others makes college students par- opens," says Secretary of Health Mary ticularly susceptible to infectious meningitis. Seieckv. "That's why it's so important to It is recommended that students discuss make sure your children are up to date with meningococcal disease and the benefits of required immunizations before school starts." . vaccination with their health care provider. Immunization rates are relatively high in Currently there is a nationwide shortage i Washington state, yet about one-quarter of of this vaccine, reports Jane Kurata of ail 2-year-olds are not fully immunized, re- Jefferson County Health and Human Ser- ports the department.The percentage of teens vices. JCHHS can only get the vaccine in and adults who are not fully protected is even vials containing 10 doses that expire in 10 higher. As parents take their children shop- days. To make the most efficient use of the ping for school clothes and"back to school" available meningococcal vaccine and avoid ciassroom supplies,they should make it pan wasting doses, the health service is taking of the routine to see their health care pro- names, phone numbers and dates of depar- ider to check on what vaccinations the chil- Lure for students wishing to receive the vac- ' dren need to return to school, advises the cine. When the department has at least five department. clients wanting the vaccine, they will be Several immunizations are required before called to come in to receive the vaccination children are allowed to attend school. All within the time the vaccine is usable. children in kindergarten and first grade must To learn more about the vaccine,residents receive a second dose of the measles-con- should call their health are provider or tamQZ taming vaccine,usually given as the"MT .' JCHHS, 385-9400. Most kids get the first dose between 12 and 15 months.The Centers for Disease Control and Prevention recommends the second dose be administered to children between ages 4 and 6 rather than waiting until they reach the 4 , sixth grade. Students in sixth through 12th _ grade still need the second dose of MMR if they haven't received it.The required hepa- titis B vaccind has(-been extended to include kindergarten through fourth-grade students. Immunization exemptions are allowed for medical, personal or religious reasons. • A Monthly Bulletin on Epidemiology • &Public Health Practice in lk ., Washington State Vol. 6 No. 4 Mercury Levels in Some Fish Pose Health Concerns In This Issue: For Children and Women of Childbearing Age Call for Sentinel gi As a coastal state. Washington is a haven those that are long-lived. Last year, the Physicians for seafood lovers. Fish is an excellent, National Research Council reported on the 2 low-fat food and a great source of protein, toxicological effects of methylmercury.' y vitamins, and minerals. Eating a variety of In January. the Centers for Disease Control Monthly fish and shellfish contributes to a balanced. and Prevention (CDC) published data= indi- Surveillance Data healthy diet. However, some species of fish eating that most of the exposure in young _ contain mercury levels that present health children and women of childbearing age in - concerns for children and women of the United States results from eating fish Calendar childbearing age. contaminated with methvlmercurv. In April. the Washington State Depart- Other possible sources of mercury ment of Health (DOH) issued a statewide exposure include: WWW Access lips "Fish Consumption Advisory." It expands • airborne mercury vapors From spills, • ; on a federal advisory by the U.S. Food and incinerators, and industrial processes: Drug Administration that warns women of • workplace contamination through air childbearing age and children under age 6 vapors or skin contact: not to eat any shark, swordfish. tilefish. or • folk practices that include :he use of king mackerel. The DOH advisory extends mercury; that warning to both fresh-caught and • release of mercury from dental work frozen tuna steaks. It also recommends and medical •_reatments. :hat children, and women who are or who ':-,wiurred page may become pregnant, limit their eating of canned tuna, based on their bodvweight. Survey Gives Closer Look Guidelines are: • Women of childbearing age should at Prevalence of Asthma limit the amount of canned tuna they eat to about one can per week (6 oz). Increases in asthma prevalence, seen in A woman who weighs less than 135 national lata, have led to growing recogni- pounds should eat less than one can of _ion of the substantial public health burden tuna per week. of childhood asthma. The Department of • Children under age 6 should eat less Health began estimating the prevalence than one-half a can of tuna (3 oz) per rate i asthma in Washington State in 1997. week. Specific weekly limits for chil- A recent survey of adolescents allowed dren under 6 range from 1 ounce for a closer examination of prevalence data. child who weighs about 20 pounds, to We compared data on the prevalence 3 ounces for a child who weighs about rate of asthma in adolescents from two 60 pounds. sources: the Behavioral Risk Factor Surveil- lance System (BRFSS) and the Youth Risk . Mercury Exposure Behavior Survey (YRBS). Throughout the Mercury contamination is a worldwide year, BRFSS interviewers use a computer- problem. Methylmercury is commonly assisted survey to conduct telephone found in many kinds of fish, especially interviews of persons aged IS and over, large species that eat smaller fish and also Continued page Page 2 Asthma Survey (from page 1) Sentinel Physicians Needed who respond for the child. From prior for Influenza Surveillance • BRFSS data, we know that about 40% of households have children, and that about The Washington State Department of Health, 16"s, of those have a child with asthma. in conjunction with the Centers for Disease The '•RBS is a classroom paper-and-pencil Control and Prevention,seeks sentinel physicians for influenza surveillance during survey, relies upon self-report, and was the 2001-2002 season. Contact Phyllis administered in April 1999. Shoemaker,206-361-2830 by August 31. We examined the 1999 data from BRFSS "proxy respondents" for children aged 13-17 and YRBS self-report data from children in grades 9-12. Most children in these grades Several reasons may explain these For More Information: are in the age group 13-17 for most of the differences, including "instrument effects," school year, though some high school underreporting by proxies. and overreport- Contact the DOH Office of seniors are older. ing by adolescents. Instrument effects may Nun-Infectious Conditions The BRFSS asks: "Has a doctor ever said arise from differences in wording between Epidemiology: Steven that that one of your children had asthma?" similar questions in the two surveys. . Macdonald at 360-236-+'53• and "Does this child still have asthma?" The However, the magnitude of the effects is tcyen.macdonald@doh.Ra.;oy: YRBS asks: '`Have you ever been told by a likely to be small. or Lillian S. Bensley at 36e-236-4248 doctor or other health professional that you Underreporting may occur if proxies are liilian.bensleyadoh.wa.gov: had asthma?" and "During the past 12 unaware of the condition or are "in denial." months, have you had an asthma attack or The BRFSS proxy is usually the parent, taken asthma medication?" These 1999 although a grandparent or unrelated adult surveys included 3.608 BRFSS respondents may be the respondent. However, asthma and 4,022 YRBS respondents. is not a hidden disease, nor a disease with stigma, and it is hard to hide even if de- Self-Report Gives Higher Prevalence Rates sired. Although a parent or caregiver may • Responses from the two surveys show be in denial, the research literature gives that self-report results in a higher breva- little e‘idence o., such situations. lence estimate, both for current asthma and Overreporting by adolescents is another ever had asthma (Table 1). These differ- Possible explanation for the higher preva- ences are statistically significant and mean- fence estimates in YRBS. although the ingful. The prevalence rate of asthma in reason is unclear. One plausible explanation adolescents from self-report is about double is that children are likely to be less knowl- that seen with proxy;report: 1.7 times as edgeable about a precise medical diagnosis, high for ever had asthma, and 2.1 times as and some may inaccurately label their high for current asthma. condition as asthma. While it is true that a The children in the YRBS survey are parent or caregiver may be more knowl- slightly older, and thus have had more time edgeabie than a teenager. there no reason • to receive a diagnosis of asthma. However, for the effect to be differential: the less this factor would not explain the higher knowledgeable child would seem equally Prevalence rate Of current asthma. In the likely to underreport as -;•.) ,ver report, all YRBS data, we found no trend for increased other factors being equal. asthma prevalence (either current or ever But. all other factors may not be equal. had) with higher school grade. Asthma mai: have a Perceived beneficial For ror example, a teen may gain in sccial status if the child's peers view asthma TABLE 1: Comparison of proxy reports and self-reports of asthma as a sympathy-inducing disease. It is also in adolescents plausible that excused absences from school may be a desired benefit. These data confirm that asthma in Proxy-reported Self-Report CII % 195% % 195'/o CI► children is a substantial public health burden. It is unknown whether the true Ever had asthma 12.3 (9.9-14.61 20.9 (19.6-22.2) prevalence rate is closer to proxy report or Current asthma 7.1 (5.4-9.21 14.8 (13.7-15.9) self-report, but it probably lies somewhere between the two estimates. -c.T RENDS July 2001 Page 3 Monthly Surveillance Data by County 40. June 2001+ —Washington State Department of Health ���a`\`\' Oy aye • 0 O moo' 0\\ ..e> ate`` Q„ •�• ' <JgZ 0�6J 'D��� �,z, S �.G\ J County c `.-. 4.. .r�Q .t.,Fi ,e , qz �o,p G,o\ Goy \0 „e \'za Adams 1 0 : J : J 0 Sento l 2 - : 3 - — ,nelan � 0 _ _ : : 2;ailam 3 3 : 3 _ 3 3 : - aark _ - - 0 1'7 _ 0 - 0olumbia 2 3 2 : 2 : ' 3 _ : :13 :owlitz 3 3 3 : : 3 3 2 20 : 3 3 • 41 Oouglas 3l �7 J : : J .1 : : J _ _ #- Fern/ 0 0 3 0 3 3 3 3 0 ., 2,0 Franklin 0 0 0 : 0 0 0 0 3 : 2,* Garfieic 0 3 0 : : 0 0 0 2 7 : 2 : ::0 Grant 0 : 3 : : 3 12 0 5 _ 12 ;rays Harbor 0 1 : 3 3 : 3 : 3 3 island 3 : 7 3 : : Jefferson 0 0 0 : 0 0 3 2 : 0 0 King 3 6 _ 3 3 316 5 Kitsac 0 0 1 : 0 0 0 3 17 ': 2 :i* kittitas 0 0 3 ,3 3 3 3 3 : : _ , • . : 2 ' _ : •• _ : <:c�rta. 2 � 2 ^ 'Lewis 0 0 3 : 3 �0 0 2 '2 - - _. ..o. 2 2 0 : : 3 2 : 0 2 2 Mason 3 0 0 3 2 2 a : •: : . Okanogan 3 0 0 3 3 3 3 : 5 : _ 2 : r 33cific 2 2 D : 3 3 : 3 : : _ _ 'end Oreille 3 J Pierce _ _ _ 3 _ - -- : :- San Juan 2 3 2 2 0 0 : ., _ _ _ • Skagit 1 0 2 2 0 3 2 26 3 2 : # Skamania 3 3 : 2 0 0 2 : 1 : : _ Snohomisn 2 3 : 0 . . : - - - Scokane 3 3 : 0 2 2 52 _ : : Stevens I 2 2 3 : 3 : : . _ : _ : Wahkiakum 3 : 3 : 2 3 2 3 : 0 : 3 2 : _ Walla Walla 3 J 0 _ 0 0 0 3 "3 2 _ __ ' Whatcom J 2 1 2 3 0 3 0 : o , _ _ Whitman 3 3 J : 3 0 3 : 5 9 2 : , 'fakima 0 : 2 : 0 : : 45 5 : 3 n Unknown, -/0 :urrentMonth 9 =6 13 _ 3 5 22 24 986 27 33 38 31301 June 2000 26 32 19 2 21 3 6 57 112 962 153 34 57 33,319 j 2001 to date 26 208 83 52 59 16 43 67 29 6818 1453 270 97 76/2301 • 2000 to date 52 206 316 12 8 30 139 33 6391 1112 255 '69 62/2093 • ata are provisional cased cn reports•ece ved as of June mess otherwise-clad _^confirmed reports of illness associated with pesticide expca.ue. :amber of elevate:tests(data include unconfirmed reports :c:al tests performed not number of cnl',reo•ec:ed,,^_T.cer of lasts per county -dicates ounty of health:are provider,not county of residence for cm :ren tested;#means fewer than 5 tests cerrer^m.ed,numcer omr,•ed for confider.:si,ty reasons 2001 Page 4 Mercury in Fish r,'rori page 1) Health Effects About Mercury • ----�l/ Health problems caused by mercury are Mercury is a metal that occurs naturally in I N most severe for the developing fetus and rocks,soils,water,and air. It may be ror young children. Pregnant women who released into the environment as a result of eat fish contaminated with large amounts volcanic activity. Mercury also comes from ndustrial pollution,especially the burning of of methvlmercury run the risk that their coal and other fossil fuels and from burning babies will have central nervous system household or industrial wastes.Mercury WWWchanges that can affect their baby's abilitycompounds settle into sediments of lakes, Access Tips to learn and possibly damage to the heart -fivers.and oceans,where bacteria convert or blood vessels. In adults. methvlmercury the inorganic mercury compound to methyl- -Jr more information on can lead to problems of the central nervous mercury.Fish primarily absorb methylmercury mercury advisory, system and possible adverse effects on the from the prey they eat,and also from water peter to the Department cardiovascular system. passing over their gills. ;r Health web site on Based on human and animal data, the "Fish Facts For Healthy International Agency for Research on Nutrition"at: Cancer (IARC) and the Environmental www.doh.wa.govi fish Protection Agency (EPA) have classified releases into the atmosphere from burning methylmercury as a "possible" human mercury-containing fuel and waste and carcinogen. This means that mercury has from other industrial.processes. Contami- produced cancer in two animal species, but cants like mercury that are released into Mercury References: that evidence is not adequate to say that it the atmosphere today may end up on our causes cancer in humans. _inner table tomorrow. National Research I JL':a:.Tri.yiwtJgJia/ Reliable and accurate ways to measure c.;errsr,f.ilerini,rJrrcJtr,. mercury in Humans require tests of blood, • `S'ashington,DC:National urine, or hair samples. and must be per- Calendar .Academy Press, 2.700. formed in a doctor's office or in a health clinic. Most tests do not determine the form 8th Annual Joint Conference on Health -enter for Disease Control - of mercury exposure. Hair analysis is.'.Icon October 10, Yakima end Prevention. orbithi - r.i/ortrrliti'll'eekh'Report. sidered usetut for exposures to methvlmer- 31ood and hair mercury curs, and may yield results for exposures The conference theme is Health Disparities levels in young children within the past year. is :i 'Tr,rid 'XI:i.1011t Boraiet S: sponsored by -..3 women of chiidbear- Choosing to eat fish low in mercury is the \Washington State Public Health Associa- :ng age. .t/.tltt"R 2CC1; an important strategy to protect health. The :ion in cooperation with the Washington 5:':9i:14c-143. long-term strategy for recucing exposure to State Department of Health and the Yakima mercury is to lower concentrations of Health District. For information, visit the methylmercury in fish by limiting mercury web site at www.wspha.org iot0P3:q!Juar.:s SSPE-69,'3E yM ON3SN1101 ±dCc :,1 4OPloo r 2'=1eiN LS NtICI33HS ;79 02/p35u1i5ecew 1N3W1dtjd30 S33I0d3S NHWilH 1 H1l1:J3H 03 NOSd3.d33! .a" ;d33Ido H1,b3H .auwnle Wi elpue s £L $SSh 3)l3O1 S iWOH1 suoippuo3 snatoa/ut :86 llifq—_'xx0inoxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx .“.-4;s1Soicyumpteg ems -49oNiiii ,,,,1, ,I ,I,,l,IT!T rirI„I„l,ll HdiN lW'IyseAegoNutior .1j1 S Ug •,n sucycuo3 snotoalut-uo,y �n0 4 A/ ;cJ ts0otorwaprd3 ateJs LOn CS; ti G' %o,y,t, SLV'T.Id•tlAmua3 ueA ori !Z s ”` n Z L8L-170986 VM '"dWA10 1a?'NO utleaH stets 1 d G �� C �'/r Z LBLt! 2 •0 d Hdii OI 'saAeH awxeW • rjw uu o 'Idea xo eieis uolbuiyseM /1/.. J SGN=911de Aaetaacas ClItvd A�aalaS.o Aaeyy abelsod .s.n I(; J !?cJ l / I" j 1 illeaH 10 wawuedaa : atm uoi6wyseM ayl 01;_ yEdd Sq*pow paysygnd Si SON3alyda • Board of Health New Business Agenda Item # V. , 4 • ' Joint Board Access Project - Update and Framework for Local Board of Health Involvement September 20 , 2001 • Public Utility District #1 Of Jefferson County 10 Septembei2001 Board of Commissioners !n i II- (�.,, i ,111/? '__ —Richard M. Shipman, District 1 I^-r i (= J i II enneth McMillen, District 2 - IVa ne G. Kin , District 3 Board of Commissioners SEP 1 2 2001 — v g Attn: Lorna Delaney James G. Parker, Manager 1820 Jefferson Street JEFFERSON COUNTY P.O. Box 1220 BOARD OF COMMISSIONERS Port Townsend Washington 98368 Dear Lorna: The purpose of this letter is to reply to your August 20th letter which included a Joint Resolution for the Countywide Seawater Intrusion Monitoring Program. At the 5 September 2001 PUD BOC meeting the Board of Commissioners reviewed your proposed Resolution 66-01. After a examination of all the whereas's, therefore's and finally resolved, the PUD BOC felt that such a voluminous resolution was confusing and unnecessary. If a resolution is really need they recommended that most of the original be dropped. Inclosed is a • possible resolution that we, the PUD staff, is floating by our Commissioners for their review. We have also included an outline that was developed by Bill Graham. We are looking forward to taking a leading role in this step to better protect the future of our water resources. Until we hear from you, we will continue to plan towards implementation of the monitoring plan. Your assistance is vital to the success of this program. As the County Government you are the conduit to cooperation with both DOE and DOH. Both of these agencies are essential, if our studies are to be more than just studies. Also your staff is well versed in the use of GIS, the joint PUD-County well log data base, GPS, water quality procedures, and existing county ordinances. We a wait your reply or comments. CA 0! -s G. • :0k r � ager Enclosure 1. Sea Water Intrusion Monitoring Plan • 2. Possible resolution 230 Chimacum Road/P.O. Box 929, Port Hadlock,WA 98339 (360) 385-5800 FAX(360)385-5945 STATE OF WASHINGTON County of Jefferson In the Matter of Developing a } Jefferson County RESOLUTION NO. 66-01 Countywide Seawater Intrusion } Monitoring Program } Jefferson County Board of Health RESOLUTION NO. 01-01 Jefferson County PUD No. 1 RESOLUTION NO. - - weir - - • •• • :. .• • • : ; ... -•• • : • . - . . - . - • - and, WHEREAS, the Board of County Commi_.'-• . . '. • . _ •e .._ . . •_ •- • -L. .ting • •- • , - .. _ -b . . , . : .._ . . - d-13-as-no- pee axing a water re-sou-fGF-.. , . , . •. : . e • - • . • • •• • if. - . .. -_ •.-• • -.- . •• • /1•1 . - ..d WHEREAS, the Board of Health has a regulatory role in assessing that water supplies are safe for protection of public health, . - : • . -• : ; . •; - • - • . . - . - . ; : -. : - -resource management al} , WHEREAS, the Public Utility District has authority for--developing and managing-water- systems, and has limited taxing authority for undertaking water resource management and protection; • and , .. • ... - - - . .. •• _ • - - , • - - •, e Se ' a • _ . e - - .e• _._ .. •e •- •e • atter-sights, .if_• . _ _• . • • : _ - . .. '_ • - ; . WHEREAS;-the Jcffcr ;- .. ::.. a . . . •• e•- =e. . e - _- • •• • P Up. . • • • • •• - e-tha • ... . _ •—. :: . .' .. . •'s from . : - ! •.:• e - - •, - • : - - e - ... . '; ••• - :.blie-water systems; and, WHEREAS,the Jefferson County Beed ofCerxnissioners, Board of Health and the PUD e e -the—Wash'• • - . • `• .. ..- - ; Ecology, Washington State De-pale- He-of He-alth-an• e-• - • : :- :e ate • . : .. • e • . -•e e: - . :, e _ . . . • : -•.: _ •1.12 RCW, panic.:.. . . ..•- • • • - - -- 4- • '•.. '•• • • . .d 11I/LT D L-� 7, ,4/74 -S-. - • • _e •• •. • • _ ••• ••. ••- :• • s . -. • . .. PJJD . .b - • .. . . . . . _•, _ •e, . •e . •. • . e e - •e • - 9 No 1 of Jefferson-aunty do ad_will support inrlusinn of policies to air ss-se-a-I.:Later i 4r.0 ien-in--the-- • final WRT A 1 7 WatPlch d pin n;.and Jefferson Co. Res. 66 01 -olution No 01.-01 re:Developing a Countywide Seawater Intrusion Monitoring Program Page 2 of 3 - .• - - ir. , g • .. - . . • ..,,., . 'need-for . . . NOW, THEREFORE, BE IT RESOLVED, by the parties to this resolution that: 1. The PUD No. 1 of Jefferson County will be the lead agency for the development of a seawater intrusion monitoring program of : .. " _ - _ . _ _ : •• • e • _ e e...-. • - - - - • -- • • e - e. - e. - _ e e. he • _ _ 1 • .. 1- .. . .. - . . . .. . .. • . Sas .. . a .. .. . . _ . . . _ .. .. .. . M.: . il 2. The Jefferson County Board of Commissioners and Board of Health will assist the PUD by providing staff support to work cooperatively with the PUD for the development of a seawater intrusion monitoring program. - - .. • " -.1:'. - . _2•• ••....e• - - . . I also utilize the data collected for inclusion e pricy Fecommendatiens in the WRIA 16 and 17 Watershed Plans to implement RGW-90.$2. 3. Jefferson County Board of Commissioners and Board of Health will assist the PUD in working cooperatively with other local and State agencies, including Island County, • Island County PUD, San Juan County, and other interested parties to assess the best available technical information and legal issues. . 2 . •a . . a . . •_ tt:. _ • . : . • • • ..: • •• .: : •. : ..-. :. ..• . :• •- :: .n •. . • i - • -: ' .• . . • '•' :1 '. . �.-; 1`i c U v �, APPROVED AND ADOPTED this 13th day of August 2001. ` .,a" • I' • v.-. • —�`- 1 c} :- SEAL. . . ,`"� JEFFERSON COUNTY BOARD OF COMMISSIO ► lS (Excused Absence) /�j�f ��`�� ��'' 6:rigz::: 1 Glen Huntingford, Dan Titterne Ss� Richard Wojt, .,• /, , Chair Member Member oma'D .- 1-_ elaney, CMC , Clerk of the Board • Jefferson Co. Res. 66-01 BOH Resolution No. 01-01 re:Developing a Countywide Seawater Intrusion Monitoring Program Page 3 of 3 APPROVED AND ADOPTED this ) day of 94'tA ,3 ,2001 JEFFERSON COUNTY BOARD OF HEALTH Ji Buhler, Chair APPROVED AND ADOPTED this day of 2001. SEAL: JEFFERSON COUNTY PUD NO. 1 BOARD OF COMMISSIONERS AITE.ST: Ken McMillen, Wayne King, Richard Shipman Richard Shipman, Chair Member Member Secretary • • 110 September 5, 2001 The regular meeting of the Public Utility District No.1 of Jefferson County was called to order at 5:10 P. M. by the Vice President of the Board of Commissioners at the district office, 230 Chimacum Road, Port Hadlock, Washington. Commissioners and staff present were: Wayne G. King, Vice President Richard M. Shipman, Secretary ' 41P7 James G. Parker, Manager William A. Graham, Resource Manager Thomas C. Neal, District Auditor Ronajean M. McConnell, Recording Secretary Kenneth A. McMillen, President was absent AGENDA -The agenda was approved after adding `public facilities sales tax committee' to discussion items and moving the Kitsap PUD presentation before action items. MINUTES • MOTION: To approve the minutes of the regular meeting of August 15, 2001. The motion was made and seconded by Commissioners Shipman and King respectively. Motion carried unanimously. Commissioner McMillen was absent. VOUCHERS MOTION: To approve warrants numbered 4656 through 4711 in the amount of$33,904.21. The motion was made and seconded by Commissioners Shipman and King respectively. Motion carried unanimously. Commissioner McMillen was absent. ITEMS FROM THE FLOOR- NOT INCLUDED ON THE AGENDA Brad Kemp—Sprint Communications—asked if the Board felt they were under an artificial deadline to sign up with NoaNet for the K-20 network by October 20, 2001.The Board answered no, they felt that the schools would be served by other entities if need be. Jay Levine—stated he was disappointed with the Board for not taking immediate action to collect the money owed the PUD by the City for the Kah Tai property. The Board decided to wait several weeks for the City to respond. Guy Rudolph—asked if the PUD was getting test reports for the Tri-Area wells and will the PUD develop a water budget for the Tri-Area? The answers were yes and the PUD would hope to • develop a water budget in the future provided the correct studies had been done to do so. I Earl Gibson —asked when the PUD receives the money from the City for the Kah Tai property • what can it be used for? The answer was to be put into the general fund; there are no encumbrances against it. COMMISSIONERS REPORTS The Board attended a telecommunications workshop with NoaNet representatives on August 28, 2001 —No decisions were made. Commissioner King attended a growth management steering committee meeting. He asked if the PUD would like to be a member of this steering committee?The decision was made not to become a member but ask to be notified when water issues were to be presented so a PUD representative could attend. DISCUSSION ITEM /4 A. Kitsap PUD Presentation —Telecommunications �f�$ // David Jones discussed Kitsap PUD's telecommunications network progress, goals, funding, learning process, and costs. David explained some of the differences between Kitsap and • Jefferson County's economic bases and similarities of PUD operations including the possibility of developing LUD's for telecommunications. He invited the Board to attend a Kitsap EDC presentation on telecommunications October 20, 2001. ACTION ITEMS A. Ed Ulrich —Request to Waive Late Fees From J. C. Treasurer's Office—LUD#5 The Manager explained the history of Mr. Ulrich's segregation and assessment. Mr. Ulrich asked the Board to waive the.penalties on his assessment because he thought he was not to pay for the assessment until he began using the community drain field. MOTION: To waive the penalty for Mr. Ulrich's overdue assessment, after he pays the total now due the Treasurer. The motion was made and seconded by Commissioners Shipman and King respectively. Motion carried unanimously. Commissioner McMillen was absent. B. Resolution No. 01- 036 Developing a Countywide Seawater Intrusion Monitoring Program After considerable discussion, the Board felt this resolution was premature and needed significant revision. • • TABLED. Resolution No. 01-036 tabled at this time. The Board asked William Graham to draft a substitute resolution. DISCUSSION ITEMS -Continued B. Public Facilities Sales Tax Committee MOTION: To authorize the Manager to write a letter requesting PUD participation in the Public Facilities Sales Tax Committee. The motion was made and seconded by Commissioners King and Shipman respectively. Motion carried unanimously. Commissioner McMillen was absent. C. USGS Proposal to WRIA 17 William explained that the USGS proposal was different than the original scope-of-work, that it did not include the study of the deep aquifers. The Board asked that he continue to push for the proposal to include the study of the deep aquifers. D. Rate & Fee Changes (New Service Installation Requiring a Road Crossing) • The Manager explained revisions to the proposed rates for 2002- 1) increase charge for road crossings due to increased costs 2) including the proposed rate schedule for the Tri-Area Guy Rudolph —asked what the base fee charges would be for i.e. mobile home parks in the Tri- Area. The Manager explained that would have to be determined. OLD BUSINESS/MANAGER'S REPORT The Manager went over old business and upcoming events. STAFF REPORTS Auditor Report—None CORRESPONDENCE - None ADJOURNMENT-The time was 8:40p.m. • Sea Water Intrusion Monitoring Plan Outline Prepared by Bill Graham 9/5/2001 Stage of completion U-Yet to start S- Started C- Completed Pre-planning—Information Gathering and Coordination S Gather existing studies on Marrowstone Island, Jefferson County and other related areas from USGS, Ecology and other sources. S Look to existing seawater intrusion monitoring programs in adjacent counties as models, particularly Island and San Juan. S Coordinate with county staff, State Dept of Ecology and Health for technical assistance, shared data management duties, etc. Scoping S Determine geographic scope of study(ie distance from coastline to which study will extend). Proposed scope is for 1 mile from tidewater from Eagle Creek to Triton • Cove including all of Marrowstone Island. S Determine density of wells per square mile desired for study by comparing with pervious studies. le 400 wells recommended for Island County study, which has roughly equally linear feet of shoreline as Jefferson County. S Determine which water quality parameters would be best used to monitor seawater intrusion. 'i- - Y U Identify wells used in previous seawater intrusion monitoring studies within Jefferson County. Attempt to resurrect contacts with well owners. U Identify wells NOT included in previous studies within scope are requesting their participation in study. U Identify wells where digital logging devices can be emplaced for short intervals of time (ie to determine tide effects, transmissivity of aquifer). Database Development S Develop/refine database. May be able to use existing PGG/PUD well log database. Input existing seawater intrusion data from past studies, samples U Locate using GPS, map where a radius of influence of%2 mile outlines wells with • seawater intrusion history. Input into county GIS. S Determine(after parameters for assessing sea water intrusion have been chosen) what methods, equipment and protocols need to be used/followed. U Issue press release calling for help from local families to "volunteer" their wells for monitoring purposes. U Coordinate volunteers such as Watch Watchers to sound and sample wells. Wells to be sounded and sampled bi-annually. On-going ❑ Data management ❑ Annual Reporting (Press Release, Presentation to Commissions, Planning Unit) ❑ Expansion of well monitoring network ❑ Statistical and graphical analysis ❑ Develop scientific basis for policy recommendation for waterhed plan • •