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HomeMy WebLinkAbout2001- October File Copy • Jefferson County Board of Health Agenda • & Minutes October 18 , 2001 1 • JEFFERSON COUNTY BOARD OF HEALTH Thursday, October 18, 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 September 20, 2001 III. Public Comments IV. Old Business and Informational Items 1. (Re)Adoption of Amendments to Ordinance No. 08-0921-00 On-Site Sewage Disposal Systems Rules and Regulations • —Action Item Larry (10 min) V. New Business 1. Report from the 2001 Washington State Joint Conference on Health Tom (10 min) 2. Bioterrorism Preparedness—National, State, and Local Efforts Tom/Lisa (30 min) 3. Jefferson County Strategic Plan and Public Health Standards—Prioritization Exercise Jean/Larry/Charles (60 min) 4. November Meeting Scheduling Tom (5 min) VI. Agenda Planning 1. Future Agenda Topics V. Adjourn Next Meeting: Date and Time to be Determined Main Conference Room Jefferson Health and Human Services • A Oct- 10-01 10 : 07A P _ 01 • JEFFERSON COUNTY BOARD OF HEALTH ORgMINUTES Thursday, September 20, 2001 %Pr Board Members: Staf Members: Dan Titterness,Member-County Commissioner District#1 Jean Baldwin, Nursing Services Director Glen Huntingford,Member- County Commissioner District#2 Lorry Fay, Environmental Health Director Richard Wojt,Member- County Commissioner District#3 Thomas Locke.MD, Health Ofl cer Geoffrey Masci,Member-Port Townsend Ctry Council Jill Buhler, Chairman -Hospital Commissioner District#2 Sheila Westerman, Vice Chairman - Citizen at Large(City) Roberta Frissell- Citizen at Lame (County) Chairman Buhler called the meeting to order at 2:30 p.m. All Board and Staff members were present. The agenda was amended to include Old Business item "PUD Saltwater Intrusion Monitoring Program" and New Business item "Access to Baby and Child Dentistry (ARCD)." Member Masci moved to approve the agenda as amended. Commissioner Wojt seconded the motion, which carried by a unanimous vote. • APPROVAL OF MINUTES Member Masci moved to approve the minutes of August 16, 2001. Commissioner Wojt seconded the motion, which carried by a unanimous vote. PUBLIC COMMENT Dale Wurtsmith expressed his concern that operations and monitoring inspections by the PUD exclude examination of the septic tank. He asked that a resolution be created requiring that all on-site septic systems have EES inspections prior to any sale of the property. He also believes people should have the right to choose who they want to monitor their alternative system. He agrees with the amendments to the On-Site Sewage Code as proposed. Chairman Buhler welcomed health services consultant Sherry Harry, RN to the meeting. Member Masci said Ms. Harry brings a lot of experience to the community through her work with First Choice Health Systems. • Oct- 10-01 1O : 08A P . 02 • HEALTH BOARD MINUTES - September 20, 2001 Page: 2 OLD BUSINESS 4th Annual Local Board of Health Leadership Workshop: Chairman Buhler encouraged Board members to consider attending the October 25-26 conference at SeaTac. When asked whether the topic of biological weapons will be on the agenda given the recent terrorist attacks in New York City, Dr. Tom Locke said he believes bio-terrorism will be discussed. Jean Baldwin agreed to forward information and registration materials to the Board. Letter to Senator Maria Cantwell: Chairman Buhler said the letter to Senator Cantwell reviews the issues raised during her July visit with community leaders. Public Utility District No. 1 Saltwater Intrusion Monitoring Program: County Administrator Charles Saddler distributed a copy of the PUD's response to the Joint Resolution between the PUD, Board of Health, and Board of County Commissioners. The resolution, discussed by the Health Board last month, would establish a program to conduct systematic groundwater monitoring to assess whether seawater intrusion may be affecting water quality. While it appears the PUD is interested in monitoring, they are concerned that addressing this issue now may delay the WR1A 17 watershed planning process. In their opinion, the severity of seawater intrusion has not yet been demonstrated. Mr. County • Administrator Saddler argued that under State statute, the WRIA planning process provides the only real mechanism for addressing the issue. County Administrator Saddler will address this topic with the Board of County Commissioners, but it is not expected that the they will adopt this resolution or propose a substitute soon. Commissioner Wojt questioned whether the Water Utility Coordinating Committee might be able to put forward a recommendation on the issue? Communicable Disease Update—Pertussis, Chronic Hepatitis Reporting, 2000 Jefferson County STD Profile: Public Health Nurse Lisa McKenzie said the report included in the agenda packet was sent to local health care providers to update them on the summer pertussis outbreak and other communicable diseases. She noted that 12 of the 14 reported measles cases in Washington State were in King County where the outbreak cost $60,000 —most of which was for 125 rash illness investigations to rule out measles. It was noted that half of the pertussis occurred in a susceptible population. Dr. Locke added that there appears to be widespread of not reporting on STDs and that it is difficult to improve the rates of reporting communicable disease. NEW BUSINESS Public Health Law 101 —Rules, Policies, Waivers, and Appeals: Dr. Locke referred to his memo in the agenda packet, which was meant to remind the Board of its many options under rules that have been passed. Rule changes and appeals are intended to be considered only after policies and waivers have 110 been employed. • Oct-10-01 10: 08A P . 03 • HEALTH BOARD MINUTES - September 20, 2001 Page: Onsite Sewage Code Rule Revision —Action Item: Dr. Locke reviewed the Board's action at the last meeting directing staff to prepare amendments to the Onsite Sewage Code to address O&M specialist qualifications and scope of practice. He noted that in addition to the language provided. Staff proposed the addition of two clauses for consideration, one of which would enable the department to respond to additional, unanticipated technical issues with policy changes rather than through continued amendment to the rule. The other would allow "other experience" to be considered on a case-by-case basis through an expedited waiver process. Staff is still trying to define appropriate qualifications for performing the latter, but he noted that the rule will be implemented primarily by monitoring the performance of O&M specialists. There were requests for clarification of the difference between approval by the "health officer"and approval by the "health division." Dr. Locke said the health officer has the power to waive regulations under the State codes where divisions or departments do not. Also, since the health officer is appointed, they may delegate the responsibility to whomever they choose. Regarding 8.15.150(6)(b), Member Masci asked why, in the absence of a local engineer,would the list of those who may perform an initial inspection not include a certified monitoring specialist or certified installer? He also asked why individuals with advanced degrees are required and why the owner of a conventional system would even need such a technical initial inspection? • Commissioner Tittemess mentioned Eric Page as a licensed professional engineer who provides the service in the County. Vice Chairman Westerman asked to understand the difference between an initial inspection and an O&M monitoring inspection? Linda Atkins explained that the reason for having a highly trained person perform initial inspections is to achieve a greater level of detail. Because many installers install only certain systems they may have a limited understanding of all components of various systems. She also discussed the different skills and qualifications brought by someone with an advanced degree. In explaining the level of training and licensing, she added that PUD staff can do initial inspections if they are Iicensed. Dr. Locke then reviewed the Board's options which were to leave the ordinance as adopted and previously amended; adopt the amendments as presented, including the Health Officer Ianguage; or adopt the ordinance as originally amended, striking staff's recommended additional language. It is Staff's recommendation that the Board adopt the amendments with the Health Officer language. Commissioner Titterness suggested the Board may choose to adopt the modifications as submitted, but also propose additional changes. Commissioner Titterness moved to adopt the amendments to the On-site Sewage Code as presented editing 6(c) to read "Owners of all onsite sewage systems (conventional, alternative and • proprietary systems) may obtain operations and monitoring inspections from a Certified Monitoring Specialist (after meeting manufacturers training requirements) in lieu of the Health Division, Licensed Designer or Licensed Professional Engineer for the following inspection." Oct- 10-01 10 :09A P . 04 • HEALTH BOARD MINU IES - September 20. 2001 Page: 4 Member Masci seconded the motion, which carried by unanimous vote. Commissioner Huntingford wondered about the eventual need for compliance officers to oversee training compliance. He expressed frustration with what appear to be increasingly complex and possibly unnecessary aspects of the septic code. Linda Atkins explained the registry system which ensures training compliance and how the public can obtain referrals to trained individuals. County Administrator Saddler referred to the WAC 246.272, adopted in 1995, which is the basis for this code. Commissioner Huntingford said his difficulty is not with the intent to protect public health, but with a process so complex and confusing that some people either cannot afford to comply or simply refuse to comply. He questioned whether septic inspections tied to a building permit on an unrelated project was something the public really wanted. He suggested that the code be reviewed annually to see if it can be simplified. Several Board members spoke about the Board's extensive work in drafting the ordinance. While there was some concern that it has been difficult for the Board to track the issues surrounding the code, most felt it is a work in process and that the Board will continue to address issues as they come to their attention. • Regarding the concerns expressed by Dale Wurtsmith, Vice Chairman Westerman asked whether it would be necessary for the Board to take action? Linda Atkins explained that staff is currently modifying this process with the PUD. Until September 2000, it was clear on the form that the owner was responsible for having the septic tank inspected. She noted, however, that even on systems where there has been continuous monitoring, there would be no requirement for an inspection at the time of sale. Vice Chairman Westerman expressed interest in receiving more information on what is involved in an initial inspection. Member Masci and Vice Chairman Westerman agreed to meet with Linda Atkins and report back to the Board. There was also Board interest in having Staff present background on the organization of the O&M program at the October meeting. Joint Board Access Project: Dr. Locke reviewed a list that he and Vic Dirksen generated following the Joint Board meetings of possible activities to improve access. Some of these activities were: better coordination of services among providers, ensuring that people in need of services are accurately evaluated for eligibility, looking for ways to increase insurance coverage for uninsured populations, and adding insurance products. They believe a steering group other than the Health Access Summit work group could attend a single meeting to scope out short and medium-range projects that the Washington Health Foundation could fund. He envisions including representatives from the different boards as well as several individuals who would be involved in those projects that are determined to be feasible. • Depending on the project, they might be service providers, health department staff or hospital staff. Oct-10-01 1O : 09A P . 05 • HEALTH BOARD MINI I"ES - September 20. 2001 Page: Dr. Locke then referred to the Menu of Critical Health Services adopted by the State, noting that this list reflects minimum standards. He suggested that in order to compare assessment data with this minimal set of critical health services and determine where gaps exist, the Board needs to first outline a process for determining how to arrive at a locally-adopted list. Discussion ensued about coordinating a follow-up summit. Several members understood from a previous meeting that the Access Group would be presenting to the Board some solid ideas for discussion at the next summit. It was suggested that the minimum standards would easily fold into the work of the Access Group. Dr. Locke supported reconstituting the Access Work Group if a follow-up summit were to be held. While the original goal of the summit was to discuss innovative ideas for healthcare financing, he doubted the achievability of such a solution and suggested that other potential options might not warrant another summit. He does not believe the Joint Board came to a resolution to pursue a local health authority model. The Health Board may have been interested in a system-wide approach, but the Hospital preferred several discrete projects to improve access. He asked if the Board wants to reach consensus with the Joint Board? Following several members of the Board expressing interest in holding a follow-up summit, Member Masci proposed convening several meetings of the Access Committee to discuss in what form and how • such a presentation might be structured? He believes three to five choices could be presented to at least the leadership group assembled at the last Health Access Summit. Chairman Buhler and Vice Chairman Westerman felt there was agreement among the Joint Board that the Access Committee should meet to discuss next steps and make a recommendation to the Joint Board. Jean Baldwin mentioned that all Health Board and Hospital Commission members were interested in being notified of the Access meeting in the event they want to attend. Jefferson County Strategic Plan: Commissioner Titterness distributed a copy of the adopted vision, mission statement and goals. He suggested the Health Board, as a gesture of support, could choose to support specific goals or the Jefferson County Strategic plan in its entirety. County Administrator Saddler explained the process by which the County Law and Justice Council created their own strategic plans, goals and objectives. He asked whether the Board of Health may want to take a similar course to develop its own goals and objectives? Commissioner Titterness suggested the Board might look at the strategies already developed by Law and Justice and use the parallel goals as the basis for the Board of Health exercise. Jean Baldwin suggested the Board of Health strategic goals integrate with the Department's goals and objectives. ioVice Chairman Westerman said she is supportive of the goals and objectives process, but wants the Board to stay focused on the Health Access Summit issues and long-range goals. Oct-10-01 10: 1OA P- 06 • HEALTH BOARD MINUTES - September 20, 2001 Page: 6 Member Masci moved that County Administrator Saddler and David Goldsmith facilitate a strategic planning exercise with the Board of Health. Member Frissell seconded the motion which carried by a unanimous vote. There was interest in starting the next meeting at 1:30 for this purpose. Access to Baby and Child Dentistry Programs (ABCD): In response to a request from Member Masci, Jean Baldwin explained that dental services for Jefferson County residents are offered infrequently via a long distance phone call to Clallam County. She agreed to forward her suggestions for improvements to the OIyCAP Board. It was noted that OIyCAP is trying to arrange a permanent base for dental services at a Brinnon facility and that oral health access are important to include in health access discussions. AGENDA CALENDAR/ADJOURN 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 41, 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 4:32 p.m. The next meeting will be held on Thursday, October 18, 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 Glen Huntingford, Member Roberta Frissell, Member Dan Titterness, Member • Board of Health Old Business Agenda Item # IV. , 1 • (Re)Adoption of Amendments to Ordinance No. 08-0921-00 On-Site Sewage Disposal Systems Action Item October 18, 2001 • Publish one (1) time: October 3, 2001 Bill to Jefferson County Health & Human Services 615 Sheridan Avenue Port Townsend, WA 98368 NOTICE OF PUBLIC HEARING NOTICE IS HEREBY GIVEN that a public hearing is scheduled by the Jefferson County Board of Health for Thursday, October 18, 2001 at 2:30 p.m. in the Health Department Conference Room, 615 Sheridan Avenue, Port Townsend, WA 98368. This public hearing has been scheduled for the Board of Health members to take comments for and against an ordinance amending Jefferson County Health and Human Services Department Rules and Regulations for On-site Sewage Disposal Systems Ordinance No. 08-0921-00 as provided below. JEFFERSON COUNTY BOARD OF HEALTH 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 • • 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 Depaituuent 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)may obtain operations and monitoring inspections from a Certified Monitoring Specialist(after meeting manufacturers training requirements)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 Cr7LiOtoQ✓Z t, 1 a470 I JEFFERSON COUNTY BOARD OF HEALTH t A. ./ Buhler, airman 6011W1.11"'s"'"' eila esterman, Vice Chairman Dan T. ess,Member Glen AkHu i•ird,R\ -r Ge asci,Member tri I ikkg.e.' kiA har. ojt,Member oberta Frissell,Member SEAL ATTEST: Lorna Delaney, Clerk of the Board • Affidavit of Public; NOTICE OF PUBLIC HEARING STATE OF WASHINGTON) NOTICE IS HEREBY GIVEN SS that a public hearing is scheduled ( y by the Jefferson County Board of COUNTY OF JEFFERSON) r/ • Health for Thursday, October 18, 2001 at 2:30 p.m. in the Health SCOTT WILSON, being sworn, Department Conference Room, Townsend Jefferson County Le. . I jv ATLLa f A6Z- 615 Sheridan Avenue, Port been established, published in the English language and circulated Town- continuously as a weekly newspaper in the town of Port Townsend in send, WA 98368. This public said County and State,and for general circulation in said county for hearing has been scheduled for more than six(6)months prior to the date of the first publication of the the Board of Health members to Notice hereto attached and that the said Port Townsend Jefferson take comments for and against County Leader was on the 27th day of June 1941 approved as a legal an ordinance amending Jefferson newspaper by the Superior Court of said Jefferson County and that County Health and Human Serv- annexed is a true copy of the ices Department Rules and Regu- lations for On-site Sewage Dis- Notice of Public Hearing: posal Systems Ordinance No.08- RE: Jefferson County Health and 0921-00 as provided below. Human Services Department Rules JEFFERSON COUNTY BOARD OF HEALTH and Regulations for On-site Ordinance No. Sewage Disposal Systems AMENDING ORDINANCE NO. Ordinance No. 08-0921-00 08-0921-00 -1)1/1 ^ JEFFERSON COUNTY HEALTH 4T` AND HUMAN SERVICES DE- PARTMENT rb' lt,n 4_ RULES AND REGULATIONS ON-SITE SEWAGE DISPOSAL SYSTEMS JLP 61..,GC_ (a L,;LL h Jefferson County Ordinance No. 08-0921-00, relating to the as it appe jualp id paper itself not it County Health and Human Serv- a su)plen tooeaxatizre weep ices Department and sewage dis- posal systems, is hereby amend- beginning on the 3 day of October ,2001 ed as follows: Amend: 8.15.140(3)(c) to read: Written &ending on the 3 day of October ,2001 proof showing a minimum of one and that said newspaper was regularly distributed to its subscriber: year experience tinder the direct • supervision of a Certified Instal- during all of this period.That the full amount of-$ 1 05.75 Instal- ler, Designer, Operation and Monitoring Specialist, Pumper or has been paid in full,at the rate of$9.50($9.00 for legal notices re other experience as approved by ceived elects nically, .,. . column inch for each inser the Health Officer. Completion of classroom training specific to on- tion. 011111%site sewage system operation and maintenance as approved by the Health Division may be sub- Publishe stituted for up to six months work experience. Subscribed and sworn to before me this_3 day of October Add: 8.15.140(4)(b)(v) Excavate for purposes of affixing sweeping /] /' 45 degree angle lateral ends and 20 � /J 4 �11a aYi removable end caps on manifolds C n and lateral lines, for purposes of Notary Public in and for the State of Washi gtoi maintenance, such as flushing, residing at Port Hadlocl jetting and brushing. Add: 8.15.140(b)(vi) Or other as ap- proved by the health• officer. Amend: 8.15.140(4)(c)(iv) to read:Alter or replace any portion of the subsurface disposal com- ponent or pretreatment compo- nents, 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 on site sewage systems (con- ventional, alternative and propri- etary systems after meeting man- ufacturers training requirements) • may obtain operations and moni- toring inspections from a Certified Monitoring Specialists in lieu of the Health Division, Licensed De- signer or licensed professional engineer for the following inspec- • Board of Health New Business Agenda Item # V., 1 • Report from the 2001 Washington State Joint Conference on Health October 18 , 2001 • • Overview of 2001-03 Budget and Revenue Conditions — 10/02/01 The size of the potential shortfalls, imbedded problems in the 2001-03 budget, and expected longer-term fiscal constraints in the 2003-05 and 2005-07 biennia all combine to create a complex and fragile fiscal climate. Uncertainty in the budget and revenue picture demands a disciplined approach including "holding" approval of capital budget allotments, potentially "holding" second year operating allotments, re-examining cut options, and limiting agency requests for additional resources and legislation. The September 2001 revenue forecast: • Released on Sept. 18. Lowered expected general fund revenue by $101 million compared with the June forecast. • Does not reflect economic and revenue impact of 9/11 attacks or 9/18 Boeing employment reduction announcements. The November 2001 revenue forecast is due on Nov. 16: • Once completed, it is expected to reflect the impact of the more recent economic and employment news on expected revenue. • • A wide range of revenue impacts is possible depending on whether the Boeing employment change is taken in isolation (down $200m), or is accompanied by some variant of a general economic slowdown (down $800m). • Economists have recently shifted from arguing over whether or not there would be a recession to debating how deep one will be and how long it will last. Many currently are saying they believe a recession would be short with a recovery starting in late 2002. After the September revenue forecast: • The 2001-03 operating budget now contains $761 million more in state general fund spending than the revenue forecast for the 2001-03 period. • Additional federal revenue for health and long-term care programs, along with general fund reserves and a variety of other fund transfers, has to fill the $761 million gap. This leaves only $66 million in the unrestricted balance, and another $390 million in the emergency reserve. • For a variety of reasons, there is an additional shortfall of nearly $300 million for 2001-03. Another $35 million in state revenue will be lost if Initiative 747 passes and $24 million will be lost to Initiative 773. • • Board of Health New Business Agenda Item # V. , 2 • Bioterrorism Preparedness - National , State and Local Efforts October 18 , 2001 • ti • Z • - Jefferson � County Health &Human Services '!^ JI l CASTLE HILL CENTER • 615SHERIDAN • PORT TOWNSEND.WA 98368 October 8, I.' To: Jefferson County Health Care Providers From: Tom Locke, MD, MPH, Jefferson County Health Officer RE: Bioterrorism The Problem: The September 11`h terrorist attacks on New York and Washington, D.C. have heightened public awareness on the threat of biologic agents as potential weapons of war. Although the United States formally abandoned development of offensive biological warfare agents in 1969 (and destroyed existing stocks in the early 1970's), there is compelling evidence that large stockpiles of"weaponized"biologic agents were produced by Soviet Union until the • early 1990's. Countries that support state-sponsored terrorism have likewise developed the capability of manufacturing some of these agents. U.S. concerns about preparedness for a bioterrorist attack began to intensify following the Gulf War when it was learned that Iraq had developed weaponized forms of anthrax and botulinum toxin. In 1998 the Public Health Threats and Emergencies Act (commonly known as the "Frist- Kennedy Bill") was introduced in Congress. It was passed in December of 2000 but awaits implementing appropriations. The purpose of the Act is to bolster the long-neglected public health infrastructure necessary to detect and effectively respond to major biologic public health threats, either deliberate (in the case of a bioterrorist attack) or natural (as with an influenza pandemic or antibiotic-resistant bacteria outbreak). Efforts to fully implement this Act will likely accelerate as part of America's new war on terrorism. Prompt recognition that a biologic attack has occurred is key to limitation of human casualties. For many agents, it is possible that early signs of widespread infection would be confused with other, more common, causes of illness. Surveillance for disease outbreaks can take two forms: passive and active. The best example of a passive surveillance system is our current "notifiable conditions" system of reportable disease. Over 50 different diseases and conditions (e.g. HIV, TB, Measles) are reportable to public health authorities when diagnosed. Under such a system, public health jurisdictions are in a "passive" mode, awaiting information to react to. Active surveillance involves special efforts to identify cases meeting certain clinical criteria (e.g. rash illnesses during a Measles outbreak). Both methods of surveillance have a role to play in • monitoring for infectious disease emergencies. Biological threats for civilian populations fall into 3 categories: bacterial agents, viruses, and biological toxins. 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 • Bacterial Agents: The microbial pathogens responsible for Anthrax, Brucellosis, Cholera, Glanders, Plague, Tularemia, and Q Fever are all candidates for use in biological warfare. Anthrax, Plague and Tularemia are considered the most likely agents to be used by bioterrorists given their potential for airborne transmissions and high case fatality rates if untreated. All are responsive to antibiotic therapy and vaccines have been developed for all agents except for Brucellosis and Glanders. None of the vaccines that have been developed are available for general public use. Ominously, scientists in the former Soviet Union have been reported to have carried out extensive research on antibiotic and vaccine resistant strains of anthrax, plague and tularemia. Viruses: Smallpox, Venezuelan Equine Encephalitis, and the causative agents of the various Viral Hemorrhagic Fevers are the leading candidates for weaponized viral agents. Smallpox is of greatest concern as a potential agent of mass infection. Naturally occurring smallpox was eradicated worldwide in the late 1970's. Routine U.S. vaccination ceased in 1972 and worldwide efforts stopped in the early 1980's. The military ceased routine vaccination of personnel in 1989. Average duration of immunity after vaccination is ten years. Most of the world's population is now considered susceptible to smallpox infection. Case fatality rates for smallpox average 30%. The CDC maintains a stockpile of approximately 7 million doses of smallpox vaccine. The vaccine has been in storage for over 2 decades and there is concern about its stability. In 2000, the CDC contracted for production of an additional 40 million doses of smallpox vaccine with first production batches expected in 2002. • Venezuelan Equine Encephalitis is endemic to South and Central America where it is spread by several mosquito vectors. It was weaponized by the U.S. Biological Warfare Program in the 50's and 60's and other countries are thought to have done likewise. An investigational vaccine is available. Viral Hemorrhagic Fevers are a large family of viral pathogens ranging from Ebola virus to Yellow Fever. Only Yellow Fever has an effective vaccine available. Intravenous ribavirin is thought to be beneficial for several types of hemorrhagic fever. Biological Toxins: Botulinum, Staphylococcal Enterotoxin B, Ricin, and T-2 Mycotoxins are candidates for biologically derived toxic weapons. Botulinum toxin is, gram for gram, the most neurotoxic agent known to man. It is relatively easy to produce and hs a high lethality. For those who survive initial exposure,prolonged disability is the rule. A heptavalent antitoxin is available. Staph Enterotoxin B is a common cause of food poisoning. In its concentrated form, it can be lethal. Ricin is a toxic protein derived from castor beans. It is highly toxic if inhaled. T-2 Mycotoxins are produced in a variety of fungi and are absorbed through the skin, digestive and respiratory epithelium. Health Care Provider CME and Reference Sources: An excellent resource for health care providers has been developed by Johns Hopkins University School of Medicine and Public Health's Center for Civilian Biodefense Studies. Their website can be reached at http://www.hopkins-biodefense.org/index.html. Concise "agent fact sheets" are available for the 5 most likely bioterrorist agents: Anthrax, Botulinum Toxin, Plague, Smallpox and Tularemia. JAMA Consensus Statements for each of these agents have also been developed and are accessible on the Hopkins website. 2 • A more comprehensive reference is the U.S. Army Medical Research Institute of Infectious Disease's "Medical Management of Biological Casualties". The third edition of this manual was published in July of 1998. At the annual meeting of the Washington State Medical Association on September 23, 2001, a resolution was passed by the House of Delegates calling for physician participation in biologic, toxic and radiologic disaster preparedness activities and promoting the development and distribution of appropriate CME materials. Summary: The events of September 11, 2001 have shocked the nation into an awareness of an organized international terrorist network whose apparent goal is to maximize human casualties. The potential use of biologic agents for this purpose has long been recognized. As the United States prepares for a long and uncertain war against world terrorism, the possibility of additional domestic attacks is very real. Just as police and fire fighters were the first line of defense against the bombing of the world Trade Center and Pentagon, health care providers will likely be on the front lines of a biologic attack, should it occur. Bioterrorism experts note that marine ports are a very attractive target for the importation of biologic agents. Clallam and Jefferson Counties have several commercial ports and smaller marinas. Professional education and ongoing disease surveillance should be the two highest priorities for health care providers. Unusual disease occurrences or increased numbers of illnesses should be • promptly reported to local and/or state health officials. The Centers for Disease Control maintains a 24-hou emergency number of(770) 488-7100 and an e-mail contact address of healthalert(a,,cdc.gov. The emergency number for the Washington Department of Health's Communicable Disease EPI/Public Health Lab is (toll free) (877) 539-4244. I can be reached after-hours by cell phone at (360) 808-3333. 4111 3 NACCHO NATIONAL ACOUSSOCIATITY&CITYONOF NEWS FROM WASHINGTON N HEALTH OFFICIALS A NACCHO Membership Monthly Supplement October 2001 PUBLIC HEALTH GAINS ATTENTION AS WASHINGTON MOBILIZES Every one of us in the public health community wishes that there were some other reason, some other harmless cause for the sudden spate of attention to the needs of public health systems. A headline in the September 22, 2001 Washington Post(page A4) says it all: `Biological Attack Concerns Spur Warnings: Restoration of Broken Public Health System is Best Preparation, Experts Say." Congress is listening. Among its first, well-publicized reactions to the September 11 catastrophe was to write a virtual blank check in the amount of$40 billion for recovery from the September • 11 terrorist attacks and to improve national security. Congress divided that sum into four parts. Ten billion is available immediately to the Administration for mitigating and responding to the attacks, for counterterrorism activities, increased transportation security, repairing public facilities and transportation systems damaged September 11, and supporting national security. An additional ten billion will be available 15 days after the Administration submits a proposed plan and allocation for those funds to Congress. The second $20 billion is available to be used in conventional appropriation processes for the same purposes. Of the total $40 billion, at least half must be used for disaster recovery activities and other assistance in response to the terrorist acts in New York, Pennsylvania and Virginia. The funds are not tied to any specific fiscal year budget and are therefore available until expended. A $15 billion package of assistance to the airline industry is a separate, additional item of emergency spending. There is no question that expenditures on bioterrorism preparedness will begin to increase markedly as a result and that improving the capacity of local and state public health agencies will be a cornerstone of these expenditures. Interest and support of Senators and Members of Congress of both parties for improving public health infrastructure has reached the highest levels we have ever seen. In one catastrophic day, the terms of debate changed. Public health advocates are finding an audience more receptive to the reasons for rebuilding public health and are beginning to collaborate in fleshing out rational spending plans for which many more legislators now understand the need. The magnitude of new resources that will become available is difficult to predict. Demands on the $40 billion from defense, law enforcement, and other agencies with a role in counterterrorism have been escalating steadily. The challenge for public health, and particularly for those who work at the local level, is to play an assertive and intelligent role in articulating precisely what is required to prepare for public health threats. The climate is hospitable. Senator Edward M. Kennedy(D-MA), co-author of the Public Health Threats and Emergencies • Act (known popularly as the Frist-Kennedy bill) that NACCHO and its members and partners worked hard and successfully to support last year, is working with his full committee, the Senate Health, Education, Labor and Pensions Committee, to propose an expenditure of$500 million on the public health capacity-building authorized by that legislation—fivefold the $100 million that the Act authorized for the first year and that NACCHO has thusfar been advocating for FY2002. This sum would be part of a$1.1 billion bioterrorism preparedness package that would include many other activities, including pharmaceutical stockpile improvements, additional funds for CDC for response teams, emergency preparedness planning, metropolitan medical response teams,and hospital and health care system preparedness. The Administration has proposed a far more modest initial increase in bioterrorism preparedness at the Centers for Disease Control —about $110 million. However, this amount is expected to be merely a"first wave" of new spending, for which planning and proposals will continue into 2002. FORMERLY HOT HEALTH ISSUES MOVE TO BACK BURNER The process by which Congress determines federal spending for FY2002, once expected to become a bitter and unpredictable partisan battle, suddenly became much easier. The $40 billion in emergency counterterrorism spending busted the budget definitively, with nary an outcry, thus • easing the way for compromise on routine spending bills. Congress was preparing to begin action on spending for the Department of Health and Human Services at this writing. It is not known exactly how the once intractable problem of increasing education and biomedical research spending within strict budget constraints will be solved, but it will surely be solved. New increases (beyond those proposed by the Administration) for the public health and health care programs at CDC and HRSA are unlikely, but so are new cuts. The House and Senate leaderships have not yet determined the legislative agenda for the rest of the year. Most Hill-watchers doubt that formerly hot, contentious issues, including patients' rights legislation and Medicare drug benefits, will see any action. The imperatives of responding to terrorism engendered bipartisanship, but just how far that will go remains unclear. The still- unresolved education bill is receiving continuing attention from legislators, as is a limited bipartisan Medicare reform bill that addresses contracting with claims processors. For more information, contact Donna Brown, Government Affairs Counsel, by phone at(202) 783-5550 or by e-mail at dbrown@naccho.org. NACCHO NATIONAL ; ASSOCIATION OF 111:411_--"-t COUNTY&CITY HEALTH OFFICIALS • ivcwsuay.Lulu. U.J. iii-rrepaieu cor iiloterrorism rage i 01 - , 4, _liVit.laweigiti:ran vomit 4 ttp_//www.newsday.com/news/nationworld/nation/nv-usbio222379246sep22.story AMERICA'S ORDEAL U.S. Ill-Prepared For Bioterrorism Critics say measures to deal with an attack are 'woefully inadequate' By Laurie Garrett STAFF WRITER September 22, 2001 A day after President George W. Bush told Congress he'll create a cabinet-level position to protect the nation against terrorism, experts in biological weapons said they're concerned that the classic law enforcement structure this position will oversee will not be effective in battling a bioterrorist attack. The critics, many of whom are top-level biologists, say neither the Republican administration nor its predecessor properly understood the unique nature of biological weapons. Therefore, they said, measures now in place to deal with such an attack are woefully inadequate. ''No one is in charge. They don't have anybody expert in biosciences and public health, as far as the eye can see in this administration," said Dr. Tara O'Toole, deputy director of the Center for Civilian Biodefense Studies at the Johns Hopkins Schools of Medicine of Public Health in Baltimore. Meanwhile, former Sen. Sam Nunn, speaking on CBS Tuesday night, said he believes the U.S. capacity to pre-empt or respond to a bioterrorist attack is in a shambles, all but nonexistent. Nunn, who heads the Nuclear Threat Initiative in Washington, D.C., is widely considered the best- briefed political leader in the United States on matters of intelligence and terrorism. He warned during that appearance that "the likelihood of a biological incident happening in the next few years far outweighs that of a missile" attack. Jerome Hauer, who created New York City's emergency preparedness and response system, is an adviser on bioterrorism to Health and Human Services Secretary Tommy Thompson. Friday, Hauer told Newsday that in the wake of the events of Sept. 11, there is a new sense of urgency in Washington on the bioterrorism issue. He said there is intelligence information that terrorist Osama "bin Laden wants to acquire these agents, and we know he has links to Saddam. And Saddam Hussein has them," Hauer said. Friday, in testimony before the Senate Committee on Governmental Affairs, David Walker, who heads • e General Accounting Office, echoed Hauer's remarks, noting, "the spread of infectious disease is a growing concern." Newsday.com: U.S. Ill-Prepared For Bioterrorism Page,2 of 2 "Whether a disease outbreak is intentional or naturally occurring, the public health response to determine its causes and contain its spread is the same," Walker said. "Because a bioterrorist event could IP look like a natural outbreak, bioterrorism preparedness rests in large part on public health preparedness." Citing New York City's battles with the West Nile Virus, Walker said even the best municipal health department in the nation had been unable to control the outbreak of a mosquito-borne disease, and outlined several public health shortfalls, at all levels of government, he said render America acutely vulnerable to a biological attack: Surveillance systems for monitoring disease trends and outbreaks are antiquated, even nonexistent in some regions, Walker said, and none is keyed to watching for the sorts of trends most likely to be related to a terrorist event. In many jurisdictions, health departments don't even have modern computers for use in tracking diseases. Few public health laboratories in America can correctly and rapidly diagnose such things as anthrax, smallpox, tularemia or Ebola. Despite outbreak drills conducted in many cities, most physicians cannot recognize the sorts of symptoms typical of bioweapons, and hospitals are ill-equipped to handle the expected burden of patients, hysteria and necessary quarantine. Concerns about biological weapons were heightened for some last week when the Atlanta-based Centers for Disease Control and Prevention, home to such deadly viruses as smallpox and Ebola, was evacuated within hours of the attacks on the Pentagon and World Trade Center last week, according to government sources. CDC director Dr. Jeffrey Koplan and his senior staff were hastily removed from their offices and taken to a private Atlanta airfield, where they were placed in a military transport. While Koplan and his staff waited, the rest of the complex was evacuated. However, Hauer said Friday that "CDC security has been reviewed on an ongoing basis." Hauer, who works three days a week for Kroll Associates in New York, said he'll be scrutinizing that security, as well as security of the Plum Island animal disease facility near Long Island in coming days. In the new command structure, dozens of federal agencies will answer to Pennsylvania Gov. Tom Ridge. The bulk of the $20 billion allocated for terrorism threat reduction and response will then go to law enforcement. Of$500 million requested for development of local public health infrastructures, $124 million was approved. Copyright ©2001, Newsday, Inc. • iNewsuay.com: muting btoterror rage i ui '+ 1 twss'!►t n 1`t 1111 • ttp://www.newsday.com/news/nationworld/nation/nv-usbio012393546oct0l.story Battling Bioterror Government's readiness is challenged as fear escalates By Laurie Garrett STAFF WRITER October 1, 2001 With public anxiety about bioterrorism on the rise, gas mask sales soaring and talk shows rife with alarming claims, the head of the federal department of Health and Human Services, Tommy Thompson, yesterday said America is prepared to deal with any kind of biological attack. But public health experts throughout the nation say yesterday's comments, made on the CBS show "60 Minutes," don't reflect a 2-week-long gag order that's kept them from getting specific information about preparedness from such agencies as the Centers for Disease Control and Prevention in Atlanta, leading to confusion and concern. "I've had people calling me. They can't get through to the CDC, because the CDC isn't allowed to talk to • nybody. They can't get through to HHS. And they're just terrified," said Dr. James Curran, dean of the _,ollins School of Public Health at Emory University in Atlanta. "I think it's stupid," he said. "I think the CDC ought to be responding." Dr. Steven Wolinsky, chief of infectious diseases for Northwestern University Medical School in Chicago, agrees. He said that as soon as he saw the videotape of the jets slamming into the World Trade Center, he decided to set up a meeting with leading infectious-disease doctors in the Chicago area to make sure they were ready. "But we are meeting the same difficulties [as other health professionals] because we don't know who to deal with" on the federal level, Wolinsky said. No government authority has explicitly said that members of the suspected terrorist network believed to be responsible for the Sept. 11 attacks have plans for a biological assault inside the United States. But the issue moved strongly into the public consciousness last week following announcements by Attorney General John Ashcroft. Last Monday, Ashcroft said there were indications suspected terrorists had looked into renting crop dusters. One day later, he said suspected terrorists had obtained licenses for trucks that can carry large tankloads of dangerous materials. By Wednesday, doctors and pharmacists from Montauk to Honolulu were reporting runs on the •'ttibiotic ciprofloxicin, the preferred prophylaxis for anthrax infection. Gas mask sales were vigorous Ltionwide, and by the end of the week most Internet distributors reported they were sold out. Newsday.com: Battling Bioterror Page 2 of 4 Finally, on Saturday, Newsweek added an exclamation mark to the activity with the release of a poll saying that almost half of Americans are "not too confident" that government in this country is prepared • to handle an attack with biochemical weapons. And just over eight in 10 in the poll, which surveyed 1,000 adults, thought the use of such weapons is at least "somewhat likely." Despite these concerns, attempts by the media - and even most health professionals - to get specific information from the CDC have been fended off since the Sept. 11 attacks. Sources have told Newsday that Thompson has given orders that his office is the only place that can release information. But calls to Thompson's office during this time have not been returned. Yesterday, on "60 Minutes," Thompson said: "We've got to make sure that people understand that they're safe. And that we're prepared to take care of any contingency, any consequence that develops from any kind of bioterrorism attack." He said eight staging areas around America are each stocked with 50 tons of medical supplies - including vaccines, antibiotics, gas masks and ventilators - that can be moved within hours to the site of a bioterrorist event. The secretary also said that 7,000 medical personnel are ready to respond. Yet public health experts point out that those steps -placing drugs in stockpiles and putting physicians on alert - are merely standard operating procedure under guidelines for emergency response drawn up during the Clinton years. Missing, they say, is detailed, logistical information that can guide their efforts locally. "It's really bad," said Margaret Hamburg, now head of the Nuclear Threat Initiative in Washington, • D.C., and a former assistant secretary of HHS and New York City health commissioner. "This is when they need to provide leadership, a visual presence ... the voice of the surgeon general comforting people." One issue that may be affecting that presence, sources in government say, is the amount of time now being taken by top health officials to cement a role within the anti-terrorism hierarchy. Dr. Scott Lillibridge, a bioterrorism expert for the CDC, was named as Thompson's special assistant for bioterrorism preparedness in July. He was supposed to begin Oct. 1, but the Sept. 11 attack moved up that timetable. He says he's just now beginning to assess the role HHS should play in the newly created Office of Homeland Defense, headed by Pennsylvania Gov. Tom Ridge. President George W. Bush announced the creation of the Office of Homeland Defense just 12 days ago. Since then, Congress has allocated $40 billion to rescue and recovery efforts for the three sites affected by the terrorist actions, as well as the new preparedness effort. Barely had the president finished his address when a power scramble began within the federal government, sources say, with several agencies competing for power and funds. Thompson, Lillibridge and other HHS officials have been preoccupied with their role in that debate. "It's unlike anything I've seen in any major departmental activity," Lillibridge told Newsday. • Before Sept. 11, the relative roles of both HHS and combating bioterrorism in Washington 1N VJuay.LU111. L)aU1111g D1U1e!iu! ["age 3 v1 `4 counterterrorism pecking order were substantially lower than that of the Departments of Justice and Defense with bioterrorism considered "an interesting, worrisome theory," according to Sen. Richard • Durbin (D-Ill.). Now, though, "nothing can be dismissed," Durbin told Newsday. "There's a great deal of concern from Washington, on down to the grassroots." The fact that the terrorists were on suicide missions, coupled with their deliberate targeting of civilians "was obviously very sobering," Hamburg said. "It removed hopes that terrorists might have a threshold beyond which they wouldn't go in terms of causing damage and disease." So the argument within government now, experts say, is who should hold the primary responsibility for heading off such an event and dealing with it once it occurs. Should it be law enforcement or the military, who have long experience with other terrorist weapons? Or should it be public health officials? "I sure hope that we understand we're not going to deal with bioterrorism with the military," answers Dr. D. A. Henderson, who heads up the Center for Civilian Biodefense at the Johns Hopkins School of Public Health. He argues that any bioterrorism event should first be dealt with as an epidemic, and that health officials should have the final word on any decisions taken early on. Dr. Christopher Davis, chief scientist for the Arlington, Va.-based Veridian Systems, Inc., agrees. When a large number of people get influenza, "by and large the police aren't involved. The military aren't involved. So the answer is we build a system we can actually use on a day-to-day basis to protect ourselves from emerging diseases," both naturally arising, and deliberately released. .After all, Davis insists, the ultimate police and military goals of finding the culprit are unlikely ever to e achieved in a bioterrorist assault. America must "raise the bar" to battle bioterrorism, he says, oolstering the public health infrastructure so significantly that terrorists see little chance that certain diseases would kill tens of thousands of people. This won't be easy, other experts note. For more than three decades, public health at all levels has suffered budget cuts, lost valuable personnel, and seen its legal and political clout diminished. Why? "As Americans we haven't had an epidemic to point to and say, 'See that?That's what we're facing," Wolinsky explained. One key to the public debate will be an honest assessment of just how real the threat of bioterrorism is, experts suggest. Are international terrorists capable of using diseases as weapons?Is it part of their schemes? What sorts of microbes might they use, and how would they use them? Those questions now form the basis of vigorous argument among the roughly two hundred bona fide bioterrorism experts in the world today. Henderson, who led the successful fight to eradicate naturally arising smallpox, argues, "We know Iraq has a terribly sophisticated operation -there's no question about that. We've got the Russians out there. After Sept. 11, I've had some very serious additional concerns. I think what changes the equation is you've got educated people, long-term planning, timing, coordination- all of these things suggest that you've got potential at a level not seen before." •ut Jessica Stern, a terrorism expert at Harvard, says Sept. 11 demonstrates more than anything else, ..he lethal capacity of low-tech weapons. If I were in government I would be thinking of low-tech Newsday.com: Battling Bioterror Page 4 of 4 ' bioweapons and low-tech chemicals." Ronald Atlas, president-elect of the American Society of Microbiology, concurs. "All you have to do is • infect some of your people with smallpox, send them out and you've got an epidemic," he argues "If you've got 40 or 50 people who are out there, committing suicide, you've got an epidemic," Atlas told Newsday. "I don't have to get anthrax from a laboratory, I can just go to [Africa], to an elephant outbreak and get it from the carcasses. "We can increase security," he said, "but all sorts of things are out there in nature." As for more exotic agents, germs that have been genetically modified into superbugs, Davis says terrorists need not know anything, even the difference between a bacteria and a virus. They just need enough cash to buy killer microbes from unscrupulous scientists who until recently worked for the massive Soviet biological weapons program. In January 1991, Davis was part of a small British-American inspection team that was the first group of Western scientists allowed inside the Biopreparat laboratories. What he saw - about 52 death laboratories and test sites employing about 60,000 scientists and technicians - left Britain's Davis a changed man. "The world is full of hazards," he says. The Associated Press contributed to this story. Copyright ©2001, Newsday, Inc. • • 1Ncwsuay.com: UNU: U.J. iNot tceaay rage 1 oI 1V wt mitis.*irrD 111 Ittp://www.newsday.com/news/nationworld/nation/nv-usbio022395239oct02.stoly AMERICA'S ORDEAL GAO: U.S. Not Ready Says response to bioterrorism fragmented, underfunded By Laurie Garrett STAFF WRITER October 2, 2001 The federal capacity to prepare for and respond to a bioterrorism attack "is fragmented," lacks accountability and suffers from duplication and inconsistencies, the General Accounting Office told Congress yesterday. The report is the third critical assessment released by the GAO on this subject since Sept. 11. It describes a government that lacks a clear line of authority over the planning process. GAO found that at least seven executive branch departments have bioterrorism programs. But so one xtensive is the fragmentation among these programs, the report said, that no two departments even .,hare a common list of the pathogens most likely to be used as biological weapons. "Fragmentation has also hindered unity of effort," the GAO wrote, leading to competition between agencies on issues concerning funding and control. The GAO report said it was difficult to determine how much is now spent on anti-bioterrorism activities because few agencies have line items within their budget specifically earmarked for such activities. But it estimated slightly more than $156 million was spent in 2001. The lion's share of that money, or$110 million, was spent by the Department of Health and Human Services, nearly half of which went to the Centers for Disease Control and Prevention, the report said. Among the smallest budget allocations were those aimed at protecting America's food and livestock from biological contamination. The U.S. Department of Agricultural spent just $200,000 on such efforts, the FDA spent $2.1 million. This comes at a time when some bioterrorism experts argue that non- human pathogens-including foot- and-mouth disease-could be used by terrorists to devastate the U.S. economy without posing a health risk to the terrorists themselves. Purdue University's Agricultural Extension Program, for instance, recently noted that a release of the foot- and-mouth disease virus into the U.S. livestock industry would cost the economy $24 billion a ear, every year until it is eradicated. Newsday.com: GAO: U.S. Not Ready Page 2 of 2 The GAO also suggested that federal problems with coordination may be sifting down to the states. The report said different U.S. agencies conduct local training programs that provide cities and states • with different advice and protocols. The result is that even cities that have had several training exercises "are still not adequately prepared to respond to a bioterrorist attack." The New York region's response to the emergence of the West Nile Virus in 1999 is offered in the GAO report as evidence of problems faced by local communities in diagnosing and asses- sing epidemics. "Because of the limited capacity at the New York laboratories, the CDC laboratory handled the bulk of the testing" for West Nile, according to the report. But that meant "the CDC laboratory would have been unable to respond to another outbreak, had one occurred at the same time." In addition, the GAO noted that most American hospitals have been reducing costs in the past decade by decreasing staff size and the number of patient beds they maintain. As a result, the report said, many regions found they had insufficient surge capacity to handle the 1999 flu season. A serious epidemic could well outstrip hospital capacities in most of the country, the GAO said. Finally, the GAO report described a tangled web of congressional and presidential laws and directives relevant to bioterrorism passed since 1989. While some of the laws and directives give authority during an outbreak to the FBI and to the Federal Emergency Management Administration, the report argues that any response should be guided by public- health authorities. • Copyright ©2001, Newsday, Inc. • • • Training for Public Health Emergencies A bioterrorism preparedness exercise demonstrates the need for interagency collaboration. Carl S. Osaki People have been enjoying a quiet, uneventful Practical Training Needed summer in a county of about 150,000 people. But during the first week of August, unusual This scenario was used in a bioterrorism tabletop exercise developed by the Northwest events begin to happen. Health care providers in Center for Public Health Practice. It is both fact the county begin to see increasing numbers of people with gastrointestinal symptoms. On and fiction. Many of the elements actually Friday evening health care providers become occurred in previously reported communicable alarmed when 30 patients, all exhibiting similar disease outbreaks.The Center combined them symptoms, flock to area hospitals or medical to make up a fictional story of a bioterrorist clinics. Hospital authorities, realizing something threat in a local community. Fact or fiction, the unusual is happening, contact the local health story raises interesting policy questions: Who is responsible for managing this problem? What department. Health authorities suspect a possible food borne disease outbreak.The are the communication channels? How and outbreak continues to grow over the weekend, when is information disseminated?Who Ecommon source of contamination.Then,cration and and local public health authorities search for a responds to the news media? Should the economic conference be canceled?A local ng remain the community responding to public health terrorists call the mayor of the largest city in the primary means for county and claim responsibility for the outbreak. emergencies needs to have the answers to these develo in a res on- The terrorists threaten to continue making and many other policy questions. pg p An agency's ability to respond to new and people sick until a major economic conference sive and competent scheduled in two weeks is canceled. emerging issues, such as bioterrorism, depends adjoining from ad people weekend, 'oon the level of knowledge, skills, and abilities of workforce. However, Over thep p 1 g counties also appear to be affected by the disease its workers. Education and training remain the new training outbreak. By Sunday, the source of the outbreak primary means for developing a responsive and competent workforce. However, because the strategies. . . must be remains unknown, but appears to be associatedpublic health workforce needs information that with a number of restaurants and specialty developed. grocery stores in two counties.The news media is useful, practical, and can be easily assimilated into practice, new training strategies, including are notified. Restaurant and grocery store business plummets in the affected counties. distance learning, case study exercises, mentoring, networking, and on-site practicums Health Department and county phone lines are must be developed to augment traditional jammed on Monday morning.The news media classroom teaching.This tabletop exercise is an request further information, particularly about example of a practical training approach that what the public should do and how law enforcement and public health officials will can be used to prepare local communities for a respond. large-scale communicable disease or By Monday afternoon,at the peak of the bioterrorism event. outbreak, more than 400 cases have been The Bioterrorism Tabletop reported. An elderly woman who ate a meal at one of the restaurants dies,and family members Exercise threaten to bring legal action against the agency In the summer of 2000, the Washington • responsible for her death.Two weeks later, the State Department of Health asked the North- west seems to have abated, except for a west Center for Public Health Practice, a number of secondary cases. No more is heard program of the University of Washington from the terrorists. School of Public Health and Community 18 Northwest Public Health • Spring/Summer 2001 Medicine, to develop a training module for local exercise.They indicated that the exercise had public health personnel and their emergency successfully: • counterparts to develop skills and knowledge • Identified measures that can be performed at needed to prepare for and respond to a large- the local level scale communicable disease or bioterrorism • Promoted interagency collaboration and event.The Health Alert Network and the coordination Bioterrorism Preparedness and Response • Recognized the roles of a variety of local public Program at the Centers for Disease Control and officials Prevention funded the project. • Illustrated the need for intense teamwork and The Northwest Center designed a four-hour communication tabletop exercise simulating the policy problems • Identified the gaps in local preparedness inplicit in responding to a large-scale • Identified additional resource or capacity needs bioterrorism event.The exercise was aimed at • Identified additional training needs helping participants identify policy questions Each pilot community also held follow-up that need to be considered in preparation for meetings to discuss the policy gaps identified such an emergency.The lack of established and through the exercise. (See box on page 20 for published policies and training for these kinds of some conclusions from the follow-up meetings.) events is a recognized problem.A survey conducted by the National Association of County and City Health Officials in March ='"e I i i < i* a 4 x 1999, found that only 23% of local health = `` ...: "� . .� a _„, '” r. ,. ,,,: departments had an emergency response plan _ `�� ., :n,..<.""_. ' _t that included bioterrorism. y'- `l \ • ,a , " '"1'.:. • '" : Three pilot tests of this training exercise have : been conducted in rural as well as urban '•' p.T�"�i r • V ,-x.6. 44r°'t j Sri% -.g'j communities, and participants have included a .�.''� - ; ,(0•,i,' v• _ lIpt • � 7e"V; -- ir'�., - ‘,-.-- - mix R..s • mix of staff from the local community health L "I'. $ 1 departments, emergency management, law Y% 6� ! fi � '� ,� enforcement agencies, emergency medical xd"` L atvde Rf` services, hospitals, and boards of health. s ZThe exercise contained a scenario with a ' ti tr' "°`- " `. progression of 22 separate incidents similar to the scenario above. After each incident was Public health rat catchers described, the participants discussed how they attaching collection identification would respond and what policies, if any,were Next Steps tags to their morning catch, already in place to support their responses. In the pilot exercises, the presenters received San Francisco, c. 1907. These discussions led participants to decide positive feedback about the value and need for whether local policies were present, docu- such training.Also through the pilot exercises, mented, understood, communicated, and the Northwest Center identified a number of followed. Participants also identified new future training needs, including basic epidemiol- policies their agencies should develop in order to ogy,dealing with the news media,effective respond effectively to the incident. communication across and among agencies, and An instructor from the Northwest Center for writing clear policies.The pilot exercise also Public Health Practice facilitated the exercise identified local strengths, particularly the ability using a PowerPoint presentation and three to work in teams and make rapid decisions and "storyboards" that provided the context or the desire to assist colleagues and other agencies setting for the incidents as the exercise unfolded. with resource or capacity needs related to The storyboards enabled the participants to emergency preparedness. progress without having to make their own The ability of local health officials to quickly • assumptions about events, such as time or place recognize a possible bioterrorism or communi- within the scenario. cable disease event depends, in large part, on the _ Prepared to Prepare diagnostic capabilities of healthcare providers il and clinical laboratories and their ability to At the end of the exercise participants communicate this information rapidly to public assessed the practicality and usefulness of the health officials. By the end of the exercise, • Northwest Public Health • Sprint Sumrner 2001 19 • participants recognized how important it is to work with the medical community to ensure the • presence of good reporting, recognition, and surveillance of unusual disease events in the community. Public health agencies need to address rapidly changing public health issues and require practical, value-added training modules Author for developing a competent and responsive Carl S. Osaki, R.S., M.S.I?H., is former chief of workforce.The positive response to this tabletop Environmental Health, Public Health—Seattle and exercise demonstrates that this type of creative, King County. He is also a member of the Washington interesting, hands-on learning activity should be State Board of Health and clinical associate professor considered an important addition to workforce in the Department of Environmental Health, training methods.The Northwest Center and UWSPHCM. the Washington State Department of Health For more information about rhe bioterrorism will continue to use this exercise and its tabletop exercise, call Julie Wicklund, Washington outcomes to enhance our region's preparation Department of Health, at 206-361-2881, or e-mail for public health emergencies. Qs, her at julie.wicklund@doh.wa.gov. Some Conclusions from the Bioterrorism Exercise • • Local policy makers (boards of health, county commissioners) may have an active interest in understanding and helping to define the public health emergency response policies. • Local county emergency responders are very interested and willing to learn about their role in a large-scale communicable disease or bioterrorism events. • Local health departments are good at responding to public health emergencies, but they lack written or documented policies. • Each county had its own unique politics,personalities,and command structure.A policy for one county may not necessarily be appropriate or relevant for others. • Local agencies,other than public health agencies,generally have written policies regarding emergency response, but these policies may not address or include public health emergencies. • Existing communication policies are typically related to internal agency or county operations,and policies for communicating formally across county lines or with state or federal officials are generally limited. Informal communication often leads to confu- sion, misunderstandings of decisions and authority,and misinformation about where to go for technical assistance or advice. • Emergency response policies are not always well communicated among all the agencies involved. •Those outside of the health department typically do not have a basic understanding of public health roles and responsibilities. •Communication is strained when public health officials assume that emergency responders understand basic public health terminology, particularly terms associated with diseases or symptoms. •A self-reported assessment of a localhealth department's ability to respond to a • • bioterrorism event may not be consistent with its actual or observed performance. 20 Northwest Public Health • Springy/Summer 2001 Viewpoint: The Public Health Threats and Emergencies Act �- �3S.i'1`F�SiL••�F".._::--.=..1 a_"_:'.;",,,Mis1-,s,,avPR tZARECP59:=1.51AMIIMOIVE:-IUM.'litna-"iu! S ddressing Public Health Preparedness Mary Selecky One of the most important issues facing me as resources needed to protect our health at all Secretary of Health for Washington State is assessing times the level of"preparedness"of our public health As a first step, the Public Health Threats and system.Are we ready,in the event of an emergency? Emergencies Act authorized funds for four specific Are we organized, prepared,and equipped to areas: public health capacity ($99 million), respond to an event that threatens the health of our antimicrobial resistance ($40 million), residents? bioterrorism ($215 million), and CDC facilities/ A terrorist was apprehended at our.border in . laboratories($180 million).These funds were not 1999, carrying bomb-making materials.Would we appropriated in the budget,but could be provided have been ready if he had instead slipped through the in the federal budget in future years. border with a biological weapon? I am especially excited by the potential of the Our responsibility to be prepared,every minute public health capacity provisions of the act. For the Our res OnSZUZIl of every day,was brought home dramatically on first time,our nation could undertake a systematic ✓' February 28,at 10:45 A.M.,when the Nisqually analysis of where we have gaps in our ability to to be prepared, earthquake hit.Throughout the aftermath,my ever- respond to public health threats and then,armed present thought was:This could have been so much with that knowledge,begin to fill those gaps.This every minute of worse in terms of injuries,deaths,and damage to key is an effective and sensible process that is tailored to every day, was systems,such as our drinking water supplies.I unique state and local needs. thought of all our health departments,hospitals,first •The assessment section authorizes$45 million for brought home responders,and laboratories.Would we have been grants to state and local agencies to assess and dramatically on ready? inventory specific needs in public health 41) guar at One tool to address that concern is a piece of infrastructure.This work would also help us y 28, landmark legislation that recognizes that many identify the performance standards we need to 10:45 A.M., when communities are not prepared to respond effectively measure our level of preparedness. the Nisqually to threats to the public's health,including new and •The improvement section authorizes$50 million resurgent infectious disease,the emergence of to address demonstrated needs in areas such as earthquake hit. pathogens resistant to antibiotics,the potential for developing electronic information networks, terrorist attack with biological weapons,and natural training public health personnel,enhancing local disasters. and state laboratory capacity,and developing The Public Health Threats and Emergencies Act detailed,coordinated emergency response plans was signed into law by President Bill Clinton, for such events as bioterrorism,natural disasters, November 13,2000.Commonly referred to as and significant outbreaks of communicable "Frist-Kennedy,"in recognition of its key sponsors disease. Senator William Frist and Senator Edward Kennedy, I look forward to working to support the intent the act passed with strong bipartisan support. of this act with our partners in ASTHO, As Senator Frist explained,"Our nation faces NACCHO,CDC,and HRSA to improve our alarming risks from a number of potential public ability to respond,across a system with 3,000 local health threats.... It is vital that we take steps to health departments, 50 states,and many federal address current inadequacies and ensure that our agencies.I like the way this was described in CDC's public health infrastructure is prepared to meet the report to Congress:"Every health departmentfully challenge of any public health crisis." prepared•every community better protected" To protect our health into the 21"century,the Public health protection is a high priority issue country must build a reliable,strong infrastructure among the general public.I know that my col- for public health,including: leagues throughout federal,state,and local •A public health workforce that is well trained and government,and among health care providers and ready to respond to biological and environmental health facility administrators,all share my concern • threats about our responsibility for public health prepared- •Information systems and technology to guarantee ness.tug rapid detection and transmission of critical data • Health departments,laboratories,and health Author facilities that are fully prepared and have the Mary C.Selecky is secretary of health for the Washington State Department of Health. 12 Northwest Public Health d Spring/Summer 2001 • Health Advisory to Health Care Providers - Precautionary Increase in Level of Suspicion for a Biological Attack, October 2, 2001 Please take this opportunity to review your protocols and preparedness for recognition, clinical management and infection control procedures for agents likely to be used in a bioterrorism attack. The biological agents most likely to be used in such an attack are dispersed by air and are described below. At this time we have no indication that our region is at increased risk for such an event. This advisory is strictly precautionary. Jefferson County Health and Human Services is requesting that Health Care Providers maintain a high index of suspicion for clinical syndromes compatible with a potential biological weapons attack. Please contact Jefferson County Health and Human Services immediately if you suspect a case of the diseases listed(prior to laboratory confirmation), or an increase in compatible syndromes. Monday—Friday, 9:00—4:30 call 385-9400 or fax 385-9401. After hours contact numbers: Tom Locke, M.D., Health Officer(360) 808-3333, or Jean Baldwin, ARNP, Nursing Director, 531-1736. Thank you very much for your support. Potential Bioterrorism Agents Agent Disease Syndromes and Clinical Findings Bacillus anthracia Inhalation Fever, malaise, cough and mild chest discomfort Anthrax progresses to severe respiratory distress with dyspnea, diaphoresis, stridor, cyanosis and shock. X-ray shows mediastinal widening. Yersinia pestis Pneumonic High fever, chills, headache, followed by cough Plague (often with hemoptysis) progressing rapidly to dyspnea, stridor, cyanosis and death. GI symptoms are also often present. Coxiella burnetii Q Fever Fever,; cough and pleuritic chest pain. Francisella tularensis Tularemia Fever,; headache, malaise, substernal discomfort, prostration, weight loss and non-productive cough. Variola Virus Smallpox Begins acutely with malaise, fever, rigors, vomiting, headache and backache. Two to three days later macular lesions appear which quickly progress to papular and then pustular lesions. The lesions develop synchronously and are more abundant on the extremities which helps differentiate it from rash due to varicella. Various Hemorrhagic I Fever, flushing of the face and chest, petechiae, Fevers bleeding, edema, hypotension and shock and may include malaise, myalgias, headache, vomiting and diarrhea. Clostridium botulinum Inhalation Begins with cranial nerve palsies including ptosis, toxin Botulism blurred vision, diplopia, dry mouth and throat, • dysphonia, dysphagia and is followed by symmetrical descending flaccid paralysis. < Clues that May Signal a Biologic or Chemical Attack 1. Large numbers of ill persons with a similar disease or syndrome. 2. An increase in unexplained diseases or deaths. 3. Unusual illness in a population (i.e., renal disease in a large population may suggest exposure to a toxic agent such as mercury). 4. Higher morbidity and mortality in association with a common disease or syndrome or failure of such patients to respond to usual therapy. 5. Single case of disease caused by an uncommon agent (i.e., Burkholderia mallei, smallpox, viral hemorrhagic fever, pulmonary anthrax). 6. Several unusual or unexplained diseases coexisting in the same patient without • any other explanation. 7. Disease with an unusual geographic or seasonal distribution (i.e., tularemia in a nonendemic area, influenza in the summer). 8. Illness that is unusual (or atypical) for a given population or age group (i.e.. outbreak of chicken pox-like rash in adults). 9. Unusual disease presentation (i.e., pulmonary instead of cutaneous anthrax). 10.Unusual, atypical, genetically engineered, or antiquated strain of an agent or antibiotic resistance pattern. 11.Stable endemic disease with an unexplained increase in incidence (i.e., tularemia, relapsing fever). 12. Atypical disease transmission through aerosols, food, or water, which suggests deliberate sabotage. 13. Many ill persons who seek treatment at about the same time. • 171144 11141 -441111 CENTERS FOR DISEASE Update: Public Health Message Regarding Florida Anthrax Case CONTROL \NO PREVENTION October 7, 2001 $ The ongoing investigation of anthrax in Florida has detected evidence that the bacterium that causes anthrax, (Bacillis anthracis) may be present in the building where the patient who died of anthrax worked. • $ B. anthracis was identified in one nasal sample from another worker in the building, which suggests exposure. No other workers are known to have illness consistent with anthrax. $ One of many samples collected from the workplace environment contains B. anthracis. Final results on the other environmental samples will not be available for several days. In the meantime, public health officials, in cooperation with the company, have secured the building. $ The current risk of anthrax among employees and visitors to the building is extremely • low. However, as a preventive measure, public health officials have begun to contact personnel who worked in the building since August 1, 2001, to provide antibiotics. Antibiotic treatment before symptoms occur will prevent anthrax. The incubation period from exposure to onset of illness with anthrax is usually 1-7 days, but may be as long as 60 days. $ Symptoms of inhalational anthrax include fever, muscle aches, and fatigue that rapidly progress to severe systemic illness. Workers who develop such symptoms will be advised to seek immediate medical attention for further evaluation. $ Anthrax is NOT contagious from one person to another. Family members and contacts of persons who work in or visited the building are not at risk and antibiotic therapy is not recommended for them. Other members of the community are not at risk. Public health officials, together with the FBI, are continuing the investigation. $ For more information regarding this public health action in Florida, atter 7 a.m , Monday, October 8. call: 1 800 342-3557 $ Media: Florida contact: 561 712-6400; CDC, pager 404 318-2380. • A • • • • Board of Health New Business Agenda Item # V. , 3 Jefferson County Strategic Plan & Public Health Standards, Enclosed find the county strategic plan, the county resolution adopting the plan, and example of the Law & Justice committees • plan, and two matrixes. Please review the matrix to see the county strategic plan elements and the statewide public health key areas. The adoption of these key standards will be required of JCHHS in 2002 and become the measure of public health agencies. BOH will review the standards and then Charles Saddler will conduct an exercise to design a BOH strategic plan. October 18 , 2001 • State of Washington • County - Jefferson In the Matter of Adopting a set of }}}.State Core Values, Vision Statement, } Mission Statement, and Goals for } RESOLUTION NO. 71-01 Jefferson County } WHEREAS, the elected leadership of Jefferson County have determined that they will address the issues facing this community through the use of strategic planning; and. WHEREAS,through the adoption of Resolution 38-01 reasons and methodology for the development of a strategic plan were established for Jefferson County; and, WHEREAS, the leadership of this County has collectively developed a set of Core Values that reflect those of the organization and it's leadership; and, WHEREAS, the leadership of this County has collectively crafted Vision and Mission statements that will guide the organization, and WHEREAS, the leadership of this County, with assistance from numerous • members of various Citizen Advisory Boards and with comments from hundreds of local citizens has crafted a set of 8 goals which will constitute the foundation of our strategic plan, and WHEREAS, the leadership of this County, has recommended the adoption of the attached Exhibit "A" that contains the Core Values, Vision Statement, Mission Statement, and Goals. NOW, THEREFORE, BE IT RESOLVED, that the Board of Jefferson County Commissioners that the attached Exhibit A is hereby adopted and ask that all County Departments acknowledge and are guided by the concepts and principles embodied herein. APP�ZOVF.IJ,4ND OPTED this 7 day of.„&p____t____2001. if , . 1 ) ` ' ' . C) JEFFERSON COUNTY 4 • BOARD OF COMMIS l\ RS SEAL: ct f • ' f ' ATTEST: `' t ." /ii Huntin_•f•r•/%'�ir -3/0441.4-Al() ., -- Clerk Dan Titterness, Membe ,, Lorna Delaney, CMC 1 �. Clerk of the Board C1-44-7--- • -roha Wojt, Me u-r Strategic Management Objective#1: Seek new sources of revenue and create internal revenues by improving the effectiveness and efficiency of agencies within the law and justice block. 1 Fully utilize all local option taxing authority for law and justice related needs. specifically adopt the .01 of 1�c sales tax for Juvenile and Adult Corrections. 1.2 Continue to seek full funding from the Washington State Legislature through formal professional associations and meeting between local legislators and the law and justice council. 1.3 Prioritize activities to assure available resources are channeled to critical service areas. Review each program area to assure the resources expended are effective in addressing a critical need. Establish performance measurement system that monitors program cost-effectiveness for each program area. 1.4 Review program areas across departmental lines to eliminate duplication or to shift responsibilities among agencies to eliminate or reduce duplication and to take advantage of economies of scale. 1.5 Develop a system for the exchange of data between agencies to keep all parties informed and to reduce waste or duplication of efforts. Strategic Management Objective#2: Develop short term facilities plan to address growing demand for adequate facilities while long range solution is being developed. 2.1 Assess and report to the Board of Commissioners on the existing utilization of courtroom, courthouse, detention, law enforcement and incarceration facilities to determine if low-cost alternatives exist. 2.2 Explore with Jefferson General Hospital and/or Jefferson Mental Health the provision of a Detox/Mental Health holding facility. 2.3 Explore with the Washington State Department of Social and Health Services, Division of Alcohol and Substance Abuse (DASA) additional funding for involuntary and inpatient treatment. •rategic Management Objective#3: Review current and emerging needs of the community to determine adequacy of programs provided. 3.1 Establish a Substance Abuse Task Force to review existing programs, assess impact on criminal justice system and identify.program needs and/or opportunities.and report back to Law and Justice Committee by end of 2001. 3.2 Establish formal process to review alternatives to incarceration. 3.3 Utilize the Behavior Risk Factor Surveillance System (BRFSS) to develop a profile of emerging law and justice issues, and then match this assessment against existing program areas and identify where programs need adjusting or where no program currently exists. Strategic Management Objective#4: Inform the community on Law and Justice Issues. 4.1 Continue the community outreach committee. Utilize specific issues or incidents to raise the public's awareness on Law and Justice issues. 4.2 Include question(s) about Law and Justice/Public Safety issues as part of the upcoming community feedback questionnaire. Strategic Management Objective#5: Reduce the County's exposure to liability. 5.1 Review each program area for exposure to liability. Where operating policy exists insure steps are taken within agencies to train employee on policies. Where no policies exist or policies are inadequate or out • dated, have department review, develop, and update as necessary. • w sON_ �,o VISION STATEMENT. 4 G We envision Jefferson County as a balanced, sustainable ~' 1 •!, community with economic opportunities for income potential that allows personal independence. Where post 7NGsecondary educational opportunities exist and are tied to the local economy. Where the community recognizes that a Core Values certain level of planned growth and development is healthy and necessary to maintain our quality of life. Where the • Integrity enjoyment of a rural lifestyle is protected without the • Professionalism expectation of urban services. Where the community is • Accountability engaged with its elected leadership to accept responsibility • Resourcefulness for contributing to the solution of community problems. • Innovation • Responsiveness • Empowerment MISSION STATEMENT: • Service • Citizen Jefferson County Government is committed to effective Involvement public policy, superior public service, courteous public • Value people, contact,judicious exercise of authority, and stewardship of heritage & natural• resources public resources, to meet the needs and concerns of our citizens. GOALS • Create a sustainable and balanced economic base focused on family wage jobs and geographically distributed. • Promote educational opportunities to support post secondary schooling, lifelong learning, and workforce training. Jefferson fount) Commission Jefferson County Courthouse Improve the balance between the cost of housing and 1820 Jefferson Street earned income. P. c' ""x 1'2(1 • Sustainable utilization of natural resources that Port "I ow-nsend. WA 9g368 preserve our county's physical beauty and delicate Ph. ± 4)-:85-QI0o ecosystems. xcl-831-z678 • A healthyand safe citizenry. Pa.. (10-000-,);x, .ieflvt,cc:,,co.ieffes,n.t a.tis • Adequate public facilities for work and play. • Affordable government. • • Actively engage citizens as community assets. Z N d O b ,-,'"c) 5' CixY a C r C3. . ,..�1.—"C+ 2 .0 Fij O co 0`C -, 9 ,rte'* C `C b C - o `C u) — p � ( - J > w (D 0 > 5- ° g › N a • �t• > 2 N D b y CD . - . co" t 'C3-- O `G J .ti cn 7. et X. CD ,'--1'`) CIq C7 �'C � y l 0 c y cD 0 y �, . ..t ° '� .,,AD C . W pD N a - �' CD (D Q4 (IQ ° cn CC1 C/1 O CD" c 0 0 n › x x › yC n n � ° 7 c0 rom 0 ?-. 00 ° 2) CO C4 2n c CD CA N Ed 0 n rnn � n w ° 5 _ ° w n "'• P w di r 2w cn p d ° A J nP r+ N Cfq 0 FL O Q n (D 1 (7 J ^I 9 X - f�?1 n w CDn H- a • Board of Health Media Report • October 18 , 2001 • • t 1. . To: Baldwin From: NACCHO 10/16/01 05: 40 PM 01/02 6 D ----)-A)ta6— • : Ace HO IIW 171-11 S HU:11T NW,_VO FLVIIK r WASI)INGT 1N,Dr?Dale, SPECIAL ACTION ALERT- , :31111,4= INS�i�fl P _ - 2oz)77A.-iss;c\x 4URGENT October 17. N.1'FIONAI. 201 i 1 ASSOCIATION Of • C'flt NTY R CITY _ ,. 11E11;III Oil ICI,\I.0 CONGRESS DEBATES BIOTERRORISM FUNDING ASK FOR$835 MILLION FOR STATE I E ANI)LOCAL PUBLIC HEALTH CAPACITIES! Many around the nation and in Congress now view hioterrorism preparedness as an important, immediate national priority. There is no doubt that.Congress will soon devote large amounts of funding to this issue. However,how much money and how the funding will be allocated remains to be determined. With so much money at stake,many Members of Congress are proposing new legislation to address the issue, and many new players are have entered the.debate. Amidst all of this activity, many in Congress are fighting for significant investments in state and local public health capacities. Leading the charge arc co-authors of the Public Health Threats and Fmcrgencies Act 012000 Senators Edward Kennedy(D-MA)and Bill Frist.(R-TN). NACCHO continues to work with them and others at.the national level to support their efforts. We need your help. 'Together,we need make sure that your Senators and Representatives understand the critical • need for investment in local public health capacities to prepare the nation for bioterrorism. There are three important ways listed below that you can help make the voice of local public health he heard. 1. FAX A LETTER TO SENATORS AND REPRESENTATIVES. I Irge them to support 5835 million in funding for local and state public health capacities. Use/revise the attached sample letter. Visit NAC X7l I()'s 1,egislative Action Center at www.naccho.org/puhlichealth.cfn to fax a letter directly from our Web site. (Yes,you can fax letters to your Representatives directly through this site!) /'/J:`IS/s'I FAX YOUR 1,/:7../i!RS! IN TIGHT OFRF.CF.NT EITATTS, "i7AT'JTT,",AlAIT,ITIGTIT NOT BE RF..1T)TMMEDTATET,Y. 2. KEEP US INFORMED. I lelp us keep track of efforts nationwide by sending a 131.IN1)COPY of your efforts to'ferry Randall at NAC:C[IO via e-mail to trandall(a),naccho.org or via facsimile to(202)7113-1583. 3. WITCII FOR I i'l)A'I'ES FROM NACCI10. As this issue evolves, we will again call on you for help. As always, your immediate and thoughtful response will he key to our success. Where can you find out more about this issue? NACCHO is posting up-lo-date information about this issue on our Web site,www.naccho.org. Click on the large link that reads"NACCI IO RESPONDS TO 1310TERRORISM"on the lower left corner of the page. There you will find copies of testimony to Congress,a link to our Legislative Action 10 Center,and links to other materials that we have compiled including articles and fact sheets. THANK YOU H'Dlt YOU!?WORK FM?PUBLIC BEA/J'/I! TAT,4 RE STRONGER WHEN WE WORK TOGETHER! • SAMPLE LETTER Feel free to use the sample letter below. Or,visit NACCHO's online Legislative Action Center at www.naccho.oreipublichealth.cfm. From our interactive Web site,you can edit the letter below and fax it directly to your Senators' and Representative's Washington offices. The Honorable OR: The Honorable U.S.House of Representatives United State Senate Washington,DC 20515 Washington, DC 20510 Dear Representative Dear Senator I am a local public health official,and I work every day on the front lines to avert public health crises. I am writing to urge you to ask the Appropriations Committee to provide$835 million in funding to improve the state and local public health capacity to respond to an act of bioterrorism. We need this funding at the local level to respond quickly and effectively to an event of bioterrorism. In light of recent events,the nation is asking the question, "Are we prepared for an act of bioterrorism?" The answer is,"Not nearly enough." Local public health departments have long experience in responding to infectious disease outbreaks and other local emergencies with public health implications. We have made progress and learned important lessons about the challenges of bioterrorism preparedness in the last few years. But we have a very long way to go to achieve the capacities we need to detect and respond to an act of bioterrorism as quickly as possible,to prevent the spread of disease and save as many lives as possible. • Investment in our state and local public health capacity is the critical next step to prepare our community for a potential act of bioterrorism. So far, our nation's bioterrorism preparedness activities have been limited,but worthwhile. We are not starting from scratch. We have found that the systems needed to build and prepare us to respond bioterrorism acts will also be valuable in our daily efforts to monitor and respond to the outbreak of disease in our communities. -ADD YOUR VIEWS ABOUT AND EXAMPLES OF WHAT IS NEEDED IN YOUR JURISDICTION HERE- We also have a legislative framework in place for expanding our general public health preparedness. The Public Health Threats and Emergencies Act of 2000,which has not yet been funded,establishes a process for systematically defining what our federal, state and local public health systems need to do,for assessing what they already can do,and for filling in the gaps. I urge you to ask the Appropriations Committee to provide $835 million in funding to allow this process to move forward swiftly. We wish that it hadn't taken a catastrophe to call public attention to the fact that,just as we must keep our military defenses strong, so must we also keep our public health defenses strong. Sincerely, Your Name REMEMBER TO SEND A BLIND COPY OF YOUR LETTER TO TERRY RANDALL AT NACCHO VIA E-MAIL AT TRANDALLNa,NACCHO.ORG AND VIA FAX AT(202)783-1583. • • f T ! Jefferson County Health and Human Services SEPTEMBER — OCTOBER 2001 NEWS ARTICLES These issues and more are brought to you every month as a collection of news stories regarding Jefferson County Health and Human Services and its program for the public: 1. "PT woman honored for advocacy"— P.T. LEADER, September 19, 2001 2. "Not everyone must get shots" - Opinion Forum, P.T. LEADER, September 26, 2001 See Editor's Note. 3. "Welcoming us" - Opinion Forum. P.T. LEADER. October 3, 2001 4. "Bioterrorism experts meet on Peninsula"—Peninsula Daily News, October 10. 2001 • • • a • PT woman honored for advocacy Tami Lydic of Port Townsend disabled adult she has become a and is currently on the Jefferson was honored Sept.8 at a luncheon voice in the community for those County Developmental Disabil- at Sea-Tac Marriott for her corn- who are unable to speak for ity Board. mitment and active participation themselves,according to Harvey Lydic's primary reason for her in People First,an advocacy group Putterman, community access extensive involvement is to give for the developmentally disabled. worker for Creating Connec- back to the community what it Lydic is a lifelong resident of tions. She has been a self-advo- has graciously given her, Port Townsend.As a learning and cate for approximately six years Putterman said. P- L CA" —9;Z-- • q- 11 _0 S t • Not everyone must get shots Editor,Leader: I need to take issue with your brief article regarding vaccinations in the Sept. 5 issue of the Leader. The article stated that vaccinations are "required" before a child may enter school. This is simply not true. In Washing- ton state parents have the right to choose whether or not their child gets vacci- nated. For any number of good reasons —such as an adverse reaction to a vac- cine in a family member—a parent may choose to forego vaccination, to selec- tively choose which vaccines to get, or to wait until a child is older and has a more mature immune system. If this is your choice, you fill out an exemption with the school agreeing to keep your child home in the event of an outbreak.This is the law. Here is the problem with printing • propaganda as fact: Many people are bullied into doing what they don't want to do because they believe they have no choice in the matter. SANDRA TALLARICO Port Townsend (Editor's Note: The press release from the Jefferson County Health De- partment published Sept.5 included the following statements: "Several immuni- zations are required before children are allowed to attend school.Immunization exemptions are allowed for medical, personal or religious reasons.") • • S . . , 1111 , : • Welcoming us Universalist Fellowship and the local medical community. Editor,Leader: We would also like to thank the fol- We would like to thank the corn- lowing for their acts of kindness and munity for their response following support after reading the article about the article of Sept. 19 in the Leader our family: Skookum, Dal's Trea- about our family. sures, the many people involved with When we first moved up here from Head Start,and the many anonymous Portland, Ore., we were concerned donors of cash and services. about how we would be accepted—an We are proud to call Port Townsend AIDS-affected family in a small rural home! li community. But, Port Townsend,has A final note: We are not alone in been outstanding in its support and the struggle against AIDS in this t; friendship. . - county. Other families and individut, - We would like to give special als are affected by AIDS and need thanks to the following people, who acts of kindness and support as especially welcomed us to the corn- well. If you wish to help,please send munity: Denis Langlois and the donations to:_Jefferson AIDS Ser- ' vices,P.O.Box 1686,Port Townsend, Jefferson County Health Department, Mark Gordon, Al Hernandez, Peter WA 98368. • Freyer, Janet Huck, Jefferson AIDS We thank you one and all! Services, the Rev. Craig Moro, the THE MONTEITH FAMILY members of the Quimper Unitarian , . " 4 Port Townsend Pi. L,CAD�ir __. /0- 3 o • • t • 3w 0 -: � >i a) L C C a C0 C0 ./ ' 2 LZ a C O y x 3'� �` L.- :4 a m F. U L` r , f Y eO W 7 0 :� c 3 a c C. O a G O - a 1..,.• v ~ Hfl yY o � x • - -2 ' 3 t " N O •' ldA 5 n C - 0r .nd LB % Y -4 ... *.11 M 4. 041= Q C--"▪ J U J .. . J L I A a C a J '.. il L C C o^. P . r. K a „x a .£,�L. 41 ar's`e`-. ,AL'S ,k,, C C '- .� ▪ L▪_: C t:W b• .a J ^d C �y -4. u s. :ss a� xro i e�q �k F � O 1 N y ,,roj n a C) a C L^C'j. = ., na ` . 3 f"' �. ' ' �3 ..4?.*. .b4 0 'O' U a) cU. 3 •E.° ° G a C 3 r • a a s ..r ID OE— y y E a-a)^ 3 `a) 2 3_"ux 4 ;y �r r.,, ?A+ 4$. . Ba. 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J L C Z bz 0 a)� WO cn.0 a >, O ., C .. CO .a O U z E i.r 1 >. LE' Uj a yG b bp aO = O C a z " C 0 y ., ' O - O FL) . Cf • X `-5 vi, \ 0O0 Q .C .1 UGyC; o_ oLCCCCdta5 '' `, > a a $...i. ...),.) ,V./ Q ° U 5 .. .. 0 tap ax ° EEoO >, L' E 4 °o� "o 5 „L,_. ao. ,..-- a°) �-a •- aO 2C) E0asaLxO.ro .., a y a ° a) U U O o 6) G a) 7 O toU ro +, �m CO O L.a ro > E G3 roL ° U. >, a U � -C . 3 C `' G .ro .b 'LCR., °' fl. z .. 0 O a^ -.,..0 GLC c 0 -.ECa� -0oa LFro LGGLL '” q Wm W-C✓ Qat I °<C. C .0 ac) cs bW J amCj Ua,0' 2 v .,nat a 5 O U] ro C File Copy • t. • ytt_-- . Jefferson County Health 6'Human Services J I lNijk CASTLE HILL CENTER • 615 SHERIDAN • PORT TOWNSEND,WA 98368 • November 9, 2001 To: Board of Health Members RE: Cancellation of Board Meeting Dear Members, • The Jefferson County Board of Health meeting scheduled for November 15, 2001 has been canceled due to conflicting schedules. You will be notified if a Board of Health meeting is rescheduled for a different time this month. Otherwise, the next scheduled meeting will be December 20, 2001. With kind regards, Cathy A ry Assistant to Dr. Tom Locke • 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