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HomeMy WebLinkAbout2001- December le Copy • Jefferson County Board of Health Agenda • Minutes December 20, 2001 • • JEFFERSON COUNTY BOARD OF HEALTH Thursday, December 20, 2001 2:30—4:30 PM Main Conference Room Jefferson Health and Human Services AGENDA I. Approval of Agenda II. Approval of Minutes of Meetings of October 18, 2001 III. Public Comments IV. Old Business and Informational Items 1. "Comparing Sewage Systems" article from Linda Atkins, David • Christensen 2. Local Board of Health workshop, October 25-26, 2001: Report from Jill Buhler and Roberta Frissell 3. Hearing examiners decision in Port Ludlow sewers - Larry V. New Business 1. Bio-terrorism Preparedness Update: Jefferson County Plan, State Board of Health Report and Resolution, and Discussion/Action on Local Resolution - Jean, Tom 2. 2002 Data Steering Committee Fact Sheet - Geoff, Roberta 3. Update of 2002 Strategic Plan with Budget Shortfall Impacts - Jean, Larry VI. Agenda Planning V. Adjourn Next Meeting: January 17, 2001 • Main Conference Room Jefferson Health and Human Services JEFFERSON COUNTY BOARD OF HEALTH • MINUTES DR AFT Thursday, October 17, 2001 ORA Board Members: Starr Member:: Dan Titternesr,Member- County Commissioner District,T 1 Jean Baldwin, Nursing Services Director Glen Huntingford,Member- County- Commissioner District#2 Larry Fay,_Environmental Health Director .Richard Wojt,Member- County Commissioner District m3 Thomas Lathe,MD,l-leaith Officer Geo11'ry Masci,Member-Port Townsend City Council Jill Buhler, Chairman -Hospital Commissioner District#2 Sheila Westerman, Vice Chairman- Citizen at Large (City) Roberta Frirsell- Citizen at Large(County) Chairman Buhler called the meeting to order at 2:30 p.m. All Board and Staff members were present with the exception of Vice Chair Westerman. Member Masci moved to approve the agenda. Commissioner Huntingford seconded the motion, which carried by a unanimous vote. • APPROVAL OF MINUTES Member Masci moved to approve the minutes of September 20, 2001 with one correction noted by Member Frissell on Page 2, paragraph 5: In the last sentence, the words "of not" should be replaced with "under." Commissioner Huntingford seconded the motion, which carried by a unanimous vote. PUBLIC COMMENT Dale Wurtsmith read his letter to the Board restating his recommendation that all properties with on-site sewage systems be required to have an Evaluation of an Existing System (EES) inspection, including those systems currently monitored by PUD as well as homes sold under the PUD contract. He feels the septic tank must be inspected to determine if the system is functioning satisfactorily. Looking only at a pump chamber for an indication of failure is reactive rather than preventive. He stressed that homeowners should be allowed to choose to have their system monitored by someone other than the PUD. He also pointed out that he cannot compete with the County inspection at a cost of$100. In response to questions from the Board, Larry Fay explained the difference between an EES, an Advanced EES, and a real estate inspection. He noted a provision in the on-site sewage code which says that an EES is not required if monitoring is being provided by the PUD. • Member Masci expressed support for requiring an EES at the time of sale. He suggested a privatization model for on-site inspections in which the fees could be included in the property closing costs. HEALTH BOARD MINUTES - October 17, 2001 Page: 2 • Chairman Buhler expressed concern about liability and potential delays to the closing. Larry Fay said price is an issue for many who would prefer to wait for the cheaper public inspection rather than use a private service. He noted that at a cost of S100 per inspection, the County is not covering its costs. Before considering ordinance or policy changes, he asked to clarify whether the main objective is to promote private sector inspections or accomplish a particular level of inspection. He then talked about the arrangement with the PUD for on-site sewage inspection, tracking and notification. He believes we should begin thinking of this relationship in terms of a utility, with the County providing permitting and regulatory (compliance) functions. He mentioned that Staff has talked about scheduling a Board of Health workshop to assess the relationship with the PUD and discuss these issues. It was the Board's feeling that all inspectors should use the same forms for reporting and tracking and that the same reporting requirements apply to the PUD and the private sector. Commissioner Huntingford expressed concern about the inspector taking on an enforcement role, checking the site and drawing on the plot plan any new buildings or additions whether or not they relate to the function of the septic system. Mr. Fay responded that the inspection form notes the number of bedrooms under which the system was originally permitted. He asked if the inspector should ignore an obvious addition to a structure if the system is currently working. He believes it may be good to clarify in a policy what factors an inspector • considers. It was agreed that this could be a future agenda topic. Grace Chawes thanked the Department for the article in The Leader on how to check your mail. She asked how prepared the Health Department, hospital, and County are for a smallpox outbreak (training of doctors, nurses and staff; methods of educating/informing the public; and preparations by mental health professional to address public fears). She would like to see these topics covered in the newspapers so that the public knows what discussions and preparations are occurring. She recommended that retired health professionals be trained and utilized to assist in an emergency. Chairman Buhler talked about some of the collaborative efforts by the hospital and the County. Jean Baldwin reviewed the two main sources of information for the public: the County's new emergency management website and staff at the County Health Depaitinent. Other measures include distributing information from the CDC to healthcare and medical service providers, labs, pharmacies, law enforcement, and the general public. She noted that aside from personal contacts, they have access to state and national databases of retired physicians and nurses. The emergency management system also provides access to additional resources. OLD BUSINESS • (Re)Adoption of Amendments to Ordinance No. 08-0921-00 Onsite Sewage Disposal Systems Rules and Regulations: Larry Fay explained that due to insufficient public notice of the code revisions, the revisions approved by the Board last month have been resubmitted for approval by the Board. HEALTH BOARD MINLT - October 17, 2001 Page: • Member Masci moved to adopt amendments to Ordinance No. 08-0921-00 Jefferson County On- site Sewage Code as presented and approved by the Board at the last meeting. Commissioner Wojt seconded the motion, which carried. Commissioner Huntingford abstained. NEW BUSINESS Report from the 2001 Washington State Joint Conference on Health: Referring to budget information provided in the agenda packet from Mary Selecky, Dr. Locke said the biggest challenge is to preserve effective Public Health programs while maintaining and building up capacities to respond to public health emergencies. Currently, the State budget is Si billion in the hole and departments are being asked to make further budget cuts. He noted that bio-terrorism was a major focus of the conference. Bio-terrorism Preparedness —National. State and Local Efforts: Dr. Locke talked about local responses, proactive and reactive strategies to address local concerns about the risk of anthrax. Targeted outreach efforts have initially focused on hospital staff and healthcare providers. The Center for Disease Control is setting the standard for public health guidelines. Of the potential risks. anthrax ranks below HIV, multi-drug resistant TB, and the West Nile virus. There is little argument on the need to gear up the infectious disease control system. While anthrax threats have averaged about 80 a year throughout the 90s, they were 100% pranks or hoaxes. He said the threat of anthrax is being monitored on a day-to-day basis. He believes the Jefferson-Peninsula Regional Emergency Planning Committee (JPREP) meeting tomorrow will be well attended. Dr. Locke then talked about the County's likely response to new agents and probable bio-terrorism scenarios. A big concern, and one that has been used in table-top exercises across the nation, is covert introduction of a contagious agent. There is a need to develop criteria for evaluating potential threats, although the biggest challenge in dealing with an actual bio-terrorist incident is building up a competent emergency workforce. It was noted that the County is equipped for passive surveillance only and will be challenged if there is a long-term bio-terrorist attack. There is no way to build up local capacity to contain an event, but it is believed that federal resources will become available to gear up surveillance systems. There was discussion regarding the Board of Health's role during this period. Dr. Locke suggested that the Board educate itself on these issues and concerns. Depending on how events play out, it may be up to local Boards of Health to enforce state mandatory infection control procedures as well as getting tougher with surveillance. The Board expressed interest in receiving the same information being circulated to doctors. Dr. Locke agreed to include the Board in distributions of emergency and general information, including forwarding links to potentially helpful websites. Member Masci suggested that all those with a state health license be included in the distribution of information. 11) Charles Saddler reported that at tomorrow's JPREP meeting, an action plan for a bio-terrorist type incident will be presented. He noted that the County has an all-hazard emergency operations plan with a critical incident command structure designed to be implemented for manmade or natural disasters or HEALTH BOARD MIND I - October 17, 2001 Page: 4 41, weapons of mass destruction. He indicated there has been much discussion about how best to communicate with the public when conventional wisdom would indicate that the risk for this area is low. The County has updated its website and it is considered the best tool for getting out timely and very accurate information. During discussion about how best to disseminate information, Member Frissell suggested showing data such as the comparative risk of death from influenza as opposed to anthrax. She also recommended the County begin talking with the public about steps they can take. such as getting flu shots, updating their earthquake kit, etc. There was support for adding to the website a statement such as "while there is no problem in Jefferson County, you may obtain information on bio-terrorism...."Noting that not everyone has a computer or reads the newspaper, Commissioner Huntingford suggested a newsletter be sent from the Board of County Commissioners to Jefferson County residents to let people know the issues being addressed and where to call for information. Charles Saddler said a tri-fold bulletin is being prepared. Member Masci suggested the insert be placed in the City utility bill. Jefferson County Strategic Plan and Public Health Standards —Prioritization Exercise: Jean Baldwin and Larry Fay reviewed materials included in the agenda packet to aid in the prioritization exercise, which included the County's strategic plan, the County resolution adopting the plan, and example of the Law & Justice Committee's plan, and two matrixes. Mr. Fay then explained the matrix linking public health standards on which the State Board has been working to the County's goals and • strategies. The Board then considered how best to prioritize the five most important things that need to be addressed in the area of Public Health for Jefferson County. The decision was to use as a basis for this exercise the matrix prepared of the County's goals and strategies and Washington State Depai tiiient of Health's key measurement standards. The Board then prioritized the five key areas as defined by the Washington State Health Department. Following individual Board rankings, the collective priority rankings were as follows: 1. Assuring safe and healthy environment for people, 2. Protecting people from disease, 3. Prevention is best: promoting healthy living, 4. Understanding health issues, and 5. Helping people get the services they need. Member Masci moved to accept the prioritized list as above, using the strategic plan from the State. Member Frissell seconded the motion which carried by a unanimous vote. Charles Saddler noted that since the Board has chosen to use the same goals and strategies as defined by the Washington State Department of Health, this ranking shows the financial and budgetary priorities. • • HEALTH BOARD MINU FES - October 17, 2001 Page: • AGENDA CALENDAR/ ADJOURN Due to a Commissioners' conflict with the date of the next regular meeting, the Board agreed to cancel its November meeting. If by November 15, it is determined that a meeting is necessary, a tentative date of November 29, 2001 at 1:30 p.m. in Commissioner's Chambers was set. 2001 AGENDA ITEMS 1. CONTINUED STABLE FUNDING TO REPLACE MVET 2. ACCESS HEALTH CARE 3. PROGRAM MEASURES (Genetic Research and Public Health Implications) 4. METHAMPHETAMINE SUMMIT 5. PERFORMANCE STANDARDS & COMMUNITY ASSESSMENT 6. TOBACCO PREVENTION AND COALITION 7. FLUORIDE 8. TRANSIT AND PUBLIC HOUSING 9. BIOTERRORISM READINESS & PLAN 10. AGING POPULATION 11. WATER • 12. MATERNAL CHILD PREVENTION GOALS (0-3) The meeting adjourned at 4:25 p.m. The next meeting will be held on Thursday, December 20, 2001 at 2:30 p.m. at the Jefferson County Health and Human Services Conference Room. JEFFERSON COUNTY BOARD OF HEALTH Jill Buhler, Chairman Geoffrey Masci, Member (Excused Absence) 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 "Comparing Sewage Systems" • Article December 20, 2001 • . ...L : .. .. -- -it-i,,,,F-rw,',&,,-,+f!-•„-',' ',- ; .. ' ' '. ' '. e - , , ,..,,,,,,-74;:,,,,,,:._--.,.., ,..._. _a___ -I. -_,f; '''''',. •ir,,;;.„'IL, .;v:::,,,:!:,,,v,t'-".4*-'-r'-:''..*:' vembr2001 N .',.:. '- ',' v ' -. • • .,. ...,_...,.......... . =..........! __..,„_...1 41 ,....1.A....,::Eii: 7,, ' ; '/- E ,---__ , , :- - .k1/4.41-4•-•:_r'' ''''. '. 'c- ,11..- II' 1::' ' ill';',16. , ');:ji .....4: -i ,''-, . -iiii.lii,t.li:fill:,:;ii':ii,i;-,:4',.i.',ii,,-,,iii.,..., , . [a.. Fr a, .. . II! ,,- —t- ' : , . .. , ,!. 111111 : , „L. ... . ..1 --..,,....„ . , • , . . 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This range The U.S. Environmental Protection Agency has set a occurs because of a "rain shadow"effect from the Olympic maximum (10 milligrams per liter) limit for nitrate nitro- Mountains that minimizes precipitation over the northeast- gen in drinking water. Many state and local governments, ern part of the county. Elevation ranges from sea level to including the Washington State Department of Ecology 495 feet(150 meters) in the study area, which is served by (WDOE), have developed regulations to protect ground public water and private wells. Selected study site systems: water from nitrate contamination. • met current sizing and treatment standards. Ground and surface water nitrate contamination has • were occupied full time, been associated with on-site sewage systems. This contami- • were in use at least one year. nation occurs when the systems are used at high densities • had waste strength within residential parameters, or when ground water flow patterns prevent disbursement • had waste flows measured by at least one reliable and dilution of sewage effluent into an aquifer. method, • In Jefferson County, Wash., public water supply wells • were not subject to catastrophic events such as in areas with excessively coarse soils are protected from flooding and excessive nitrogen loading through wellhead protection • had occupants who could be interviewed about regulations. These rules require reducing nitrogen from household and landscaping practices. waste streams on individual septic systems. If it can be determined that a shallow trench or drip line can enhance _ Screw on plant growth and reduce nitrogen loading to the aquifer, the —'spring clamps p scream requirement for pretreatment may be unnecessary. oil ed tocmis, i - rygon on cap pvc IS Tubing Testing available systems security ilopi,`Figid —2.5cm Cover Tubing A recent study evaluated technologies approved for solid I _1 ocm nitrogen reduction based on literature and assessed per- PVC +Bentonite PVC formance under local soil, climate and rainfall conditions. To assess nitrogen reduction in on-site sewage systems, I specialists at Jefferson County Health & Human Servicesclear in Port Townsend, Wash., evaluated four alternative sewage , ' Tubection ; Ceramic disposal systems.They are: a shallow pressurized trench yup Pea solid Ball ?Silica Grava: system, an intermittent sand filter followed by drip irriga- I Rour .r.r: ,rt tion, a pressurized sand-lined bed and a proprietary aerobic Sampling Tube Lysimeter Piezometer treatment unit followed by drip irrigation. These devices took samples of untreated effluent and shallow The researchers measured the decrease in total nitro- gen (TN)concentration in the waste stream provided by the groundwater. treatment unit and in the soils up and downgradient of the The study used daily or weekly precipitation and tern- drain field.They assessed plant uptake in the drain field perature minimum and maximum records.Above normal and dilution by ground water. rainfall occurred during the sampling period for the areas • None of the treatment units reached the goal of a 50 per- studied. Normal temperatures ranged from 32°F to 77°F cent reduction in TN. Downgradient soil water samples had (0°C to 25°C). Each wastewater treatment system was TN concentration 50 percent less than in the dosing chamber. tested before treatment at the dosing chamber and after Overall, the intermittent sand filter system operated the most treatment before discharge to a disposal field. The aerobic consistently and reduced TN concentration the most. treatment unit had no trash trap or other sampling port for November 2001 11 LV an in tluent sample used to be taken. so only Four Treatment Systems Compared plfrom unsatu to draw sam • post treatment sam- pies Total nitrogen summary statistics include mean,standard deviation(std), coefficient of rated soils. pies came from this variation(CV)and number of samples collected(n). system. The piezome Suction lysime- ters had trouble Sand Filter obtaining samples in ters and piezometers were installed in pairs pump Treatment Upgradient Pooled dryer soils. No dif- chamber unit lysimeter downgradient ference was found 5 to 8 feet(150 to Mean 4.96 92.64 61.73 12.75 in TN concentration 240 centimeters) std 4.49 5.51 7.18 5.42 between side-by- upgradient and down- cv G 91rs gradient of the dis- n 9 10 0.06 0.12 0.42 side piezometers posal system. One 10 28 and lysimeters- pair was upgradient Aerobic Treatment Unit with one exception. pairs down Differences between and two Upgradient Upgradient Treatment Downgradient Downgradient the upgradient i gradient to a depth 12 iysimeter piezometer unit lysimiter piezometer to 18 inches(30 to 45 Mean 22.52 6.31 24.30 lysimeter and 2.98 7.57 centimeters)below std 5.31 4.21 7.49 1.82 1.70 piezometer at the j the disposal system. CV 0.24 0.67 0.31 0.61 aerobic treatment 0.22 the site using " 10 10 10 10 10 unit site were attrib- Onshallow pressurized uted to hydrological Unlined Pressurized Sand Filter Beds and construction trenches, only suction Siphon Pooled differences. lysimeters were used. chamber downgradient Data collected No upgradient Mean 63.88 45.4 soil moisture moni- from the aerobic std 1s.24 18.7 treatment unit site • toring was attempted cv 0.28 • at the site with the n s o.a1 indicate that the sys- 1d tem may provide unlined pressurized sand filter beds, due Shallow Pressure Trenches nitrogen treatment. However, the instal- pgradient Pu to coarse soil condi- ump Downgradient Downgradient tions and no docu- lysimeter chamber lysimeter 2 lysimeter 3 lation did not allow mented shallow Mean 4.96 92.54 61.73 12.75 for testing raw waste water table. Ports std 4.49 5.51 718 water before treat- 5.42 were installed in the cv 0.91 0.06 0.12 0 42 ment.To assess sys- drain field beds dur- " 9 10 10 28 tem performance via ing construction to ongoing operation and maintenance. allow installation of suction lysimeters 12 inches(30 cen- wastewater must be sampled at multiple points in on-site timeters) below the sand lining. Three samples were col- sewage systems. lected within 7 to 10 days to characterize wastewater sewage systems. At one site, no differences were found between using quality during weekly cycles.A Washington certified labo- suction lysimeters and piezometers for sampling.At ratory used standard methods for sample analysis. another site, differences did occur. Because ground water Data analysis flow patterns are complex and temporal variability is high. future study requires more test replicates to assess the dif- Overall, no treatment system tested met the goal to ferences. reduce TN 50 percent before discharge into soil. The inter- Test data also indicate that nitrogen concentrations mittent sand filter system reduced the most nitrogen. The were reduced in the drain field component of each system. average reduction was 34 percent within this treatment unit, The reason for the reduction, whether due to dilution. treat- with additional nitrogen reduction measured in the drain ment or a combination of these two mechanisms, remains field. The unlined sand filter beds reduced TN an average undetermined.A multi-season study could help determine 26 percent. each mechanism's contribution. R Determining the effect of dilution versus plant uptake 411) will require more study. Nitrogen loading to the aquifer is Linda Atkins and David Christensen are Environmental Health reduced by plant uptake-not dilution.Attempts to meas- Specialists with the Jefferson County Environmental Health ure downgradient soil moisture offered mixed results. Division, 615 Sheridan, Port Townsend, WA 98368, USA;360-385- Researchers determined that a suction lysimeter could be 9444, fax 360-385-9401, latkins@co.jefferson.wa.us. 12 November 2001 • Board of Health Old Business Agenda Item # IV. , 3 Hearing examiners decision • in Port Ludlow sewers December 20, 2001 • SUB00-00005 JEFFERSON CO HEALTH DEPT Y • NOTICE OF JEFFERSON COUNTY HEARINGS EXAMINER TYPE B DECISION • Date: November 28, 2001 The Jefferson County Hearing Examiner has submitted his written Findings, Conclusions, and DECISION regarding the following application: SUB00-00005. Applicant: PORT LUDLOW ASSOC LLC 70 BREAKER LN PORT LUDLOW WA 98365 Project Description: Appeal of a condition for the Type A Administrative Decision for the Walker Way short plat, which is a re-division of Lot 1 of Port Ludlow No. 6 large lot tract development. The site is presently used as a well site and water storage reservoir • site serving the greater Port Ludlow development. The project proposes to plat the parcel into two residential lots and a third tract containing the wellhead and reservoir. The site is served by existing roads with utilities at the eastern edge of the existing tract. Parcel Identification Number: 821085001 Project Location: Parcel number 821 085 001, Section 8, Township 28 North, Range 1 East, WM at NW Corner of Osprey Ridge Rd. and Walker Way intersection, Port Ludlow, WA 98365. For the above project, the Hearing Examiner has: Based upon the testimony presented at the Open Record Appeal Hearing, a site visit by the Examiner, the documents and exhibits admitted into the record, and the Hearing Examiner Findings of Fact and Conclusions of Law, the decision of the Hearing Examiner is that the appeal of the derision of the Subdivision Ordinance Administrator to require a connection of Lot B to the community sewer as a condition of approval of the Walker Way Short Plat is DENIED, and the decision of the Administrator is AFFIRMED. • A copy of the Examiner's report and decision is attached for information. Appeals of this decision must be made in writing as outlined in the attached instruction sheet. • INSTRUCTIONS FOR FILING APPEALS OF HEARING EXAMINER TYPE B DECISIONS: REFERENCE FILE NO. SUB00-00005 Final decisions of the examiner may be appealed to the Appellate Examiner by an aggrieved party of record or agency who participated in the open record hearing. Appeals of this decision must be made by 4:30 p.m. December 11 , 2001 in the following manner: Form and Content of the Appeal: 1) An appeal shall be filed with the Clerk of the Board of County Commissioners within fourteen (14) calendar days after the date of the decision. 2) All appeals shall be filed in writing with the Clerk of the Board of County Commissioners, shall identify the decision appealed and the date of the decision, and shall contain a summary of the grounds for the appeal. 3) The appropriate fee as set by the Board of County Commissioners in Ordinance No. 12-1209-96 as amended shall be paid upon filing of the notice of appeal. No appeal • will be processed without receipt of the appropriate fee before expiration of the period for filing the appeal. A file copy should accompany fees payable at the Jefferson County Department of Community Development. 4) Following receipt of a notice of appeal and payment of the appropriate fee, the Appellate Examiner shall conduct a closed record appeal. 5) The issues considered in the closed record appeal shall be limited to those specified in the written appeal. Instructions and requirements for processing an appeal of a Hearing Examiner Type B decision are explained in the Land Use Procedures Ordinance (Ordinance No. 04-0828-98). A copy is available at the Jefferson County Department of Community Development, 621 Sheridan Street, Port Townsend, WA, 98368. (360) 379-4450, Project Planner: J SMITH • • 1 BEFORE THE HEARING EXAMINER FOR JEFFERSON COUNTY 2 Iry Berteig, Hearing Examiner 3 RE: Port Ludlow Associates appeal ) File No. SUB00-00005 4 of a condition of approval ) requiring a connection to the ) 5 community sewer system. ) 6 ) FINDINGS, CONCLUSIONS, Walker Way Short Plat ) 7 ) AND DECISION 8 ) 9 BACKGROUND INFORMATION 10 Port Ludlow Associates LLC [PLA] proposed a short plat -as a re- 11 division of Lot 1 of Port Ludlow No. 6 . The proposal is to create tw. 12 residential lots with a third tract for the wellhead and reservoir. 13 The short plat was approved with a Condition that both residential . 14 lots, "A" and "B" , connect to the community sewer system. The appeal 15 by PLA is to the condition as it applies to Lot "B" . 16 PROCEDURAL INFORMATION 17 Notices: Mailed: October 16, 2001 18 Posted: October 16, 2001 19 Publication: October 17, 2001 (Port Townsend- 20 Jefferson County Leader) . 21 Site Visit: November 6, 2001 . 22 Open Record Appeal Hearing Date:November 6, 2001 . 23 The hearing was opened at 2 :15 p.m. in the Courthouse First Floor 24 Conference Room. After the procedures were explained, testimony was 25 accepted. A verbatim recording of the public hearing was made. The 26 tape is maintained in the Jefferson Permit Center file. 27 Participants : 28 Jerry Smith, Associate Planner, Jefferson County 29 Larry Fay, Environmental Health, Jefferson County v‘v c1Ke' Nov Short Peat Appeal Page 1 Findings,Conclusions SUB00-00005 Port Ludlow Associates LLC and Decision • 1 Marc Dorsey, Project Engineer for the Appellant 2 Ryan Tillman, PE, short plat engineer for the Appellant 3 William Funke, community participant 4 Ruth Altis, adjoining neighbor outside the MPR. 5 Other parties present but not testifying: 6 Robert P. Balck, 192 Montgomery Ct, Port Ludlow, WA 98365 7 Greg McCarry, 70 Breaker Lane, Port Ludlow, WA 98365 8 Everett G. Johnson, 64 Ames Lane, Port Ludlow, WA 98365 9 Lenetta Johnson, 64 Ames Lane, Port Ludlow, WA 98365 10 Brad Newell, 141 Jackson Lane, Port Ludlow, WA 98365 11 Judy Newell, 141 Jackson Lane, Port Ludlow, WA 98365 12 Jim Ryan, 901 Walker Way, Port Ludlow, WA 98365 13 Pat Ryan, 901 Walker Way, Port Ludlow, WA 98365 • 14 Conrad Yunker, 230 Pioneer Drive, Port Ludlow, WA 98365 15 Jim Laker, 612 Ranier Lane, Port Ludlow, WA 98365 16 Ruth Altis, 300 Coursey Lane, Port Ludlow, WA 98365 17 Janet Jacobson, 121 Coursey Lane, Port Ludlow, WA 98365 18 Philip Durnell, 186 Cr 5996 Cabool, MO 19 Katherine Funke, 75 Scott Ct, Port Ludlow, WA 98365 20 Shirley Kadish, 41 Foster Lane, Port Ludlow, WA 98365 21 Merland Moseson, 211 Montgomery Lane, Port Ludlow, WA 98365 22 Serene E. Moseson, 211 Montgomery Land, Port Ludlow, WA 98365 23 Larry Smith, PLA, 70 Breaker Lane, Port Ludlow, WA 98365 24 Shari Hagely, PLA, 70 Breaker Lane, Port Ludlow, WA 98365 25 Sally Smith, PO Box 65435, Port Ludlow, WA 98365 26 Theodore Wright, Jr. , PO Box 65245 Port Ludlow, WA 98365, 27 Sally & Gary Robin, 41 Libby Ct, Port Ludlow, WA 98365 28 Ryan Tillman, PE, PO Box 1375, Port Hadlock, WA 98339 0 29 Carl J. Jespers, 73 Pathfinder Ln, Port Ludlow, WA 98365 walker way Short Plat Appeal Page 2 Findings,Conclusions SUB00-00005 Port Ludlow Associates LLC and Decision • 1 Susan H. Null , 60 Dunsmuir Rd, Port Ludlow, WA 98365 2 Eve McDougall, 30 Foster Lane, Port Ludlow, WA 98365 3 Stanley Kadish, 41 Foster Lane, Port Ludlow, WA 98365 4 The Hearing Examiner closed the public hearing at 3 :30 p.m. , and held 5 the record open to receive specified documents. 6 TABLE OF EXHIBITS : 7 EXHBITS DOCUMENT DATE 1 Administrative Report together with a copy of the 10/30/2001 8 file containing 119 Log Items 9 2 Walker Way Short Plat Appeal Statement and letter 9/6/2001 with arguments attached. (Also marked Ex A] 10 3 Tillman Engineering Map showing features and 6/2000 dimensions. Scale: 1"=200' (Also marked Ex B] 11 4 Letter from F. Michael Krautkramer, Principal 8/9/2001 12 Hydrogeologist re implications of septic system (Also marked Ex C] 13 5 Property line map of Port Ludlow, annotated (Also No date marked Ex D] • 14 6 Letter from Mark Dorsey, PE, Project Manager to 11/6/2001 Hearing Examiner presenting additional arguments 15 7 Memorandum of Understanding between Olympic Water & 10/4/1999 16 Sewer, Inc. , and Jefferson County BOCC 8 NPDES Waste Discharge Permit No. WA0021202 5/18/2001 17 Effective: 7/1/2001 - Expiration: 6/30/2006 18 9 Resolution 42-00 to enter into a development 5/8/2000 agreement with land owned by Pope Resources 19 10 Sewer Extension Agreement between OWSI and Owner No date 11 Reduced copy of Basic Site Plan of Walker Way Short No date 20 Plat annotated in red by Ruth Altis 21 12 Memorandum from North Bay Lot Owners Association 11/6/2001 13 Letter from Ludlow Maintenance Commission 6/26/2001 22 14 Public hearing sign up sheet 11/6/2001 23 24 FINDINGS OF FACT 25 1 . The Walker Way Short Plat was approved by Subdivision Ordinance 26 Administrator ("Administrator") with the following condition: 27 SEWAGE DISPOSAL: The two (2) residential lots (A&B) within the Walker Way Short Plat shall connect to the community sewer system 28 owned and operated by Olympic Water and Sewer, Inc (OWSI) . 401 29 This condition is the subject of the appeal as it applies to Lot B. Walker way Short Plat Appeal Page 3 Findings,Conclusions SUB00-00005 Port Ludlow Associates LLC and Decision • 1 2 . The Administrator' s Findings of Fact 1 and 32 are excerpted hers 2 for convenience : ' 3 Fact 1) Under [he provisions cf the Port Ludlow Master Planned Resort Code, the subject property is within the Single 4 Family Tracts — 1 dwelling unit per 2.5 acres designation. The proposed lot size is 4. 5 acres and 2. 5 acres. The proposed short 5 pia: property is within the water and sewer service boundary of :he Olympic Water and Sewer Company. The Washington State Health 6 Department approved Sewer Plan anticipates connection to all lots created within the utilities service boundary. Subject to 7 condition, the proposal will be in compliance with this 8 Fact 32) Sewage disposal for the 2 new residential lots is 9 available from Olympic Water and Sewer, Inc. according to the October 4, 1999 Memorandum of Understanding regarding provision 10 of sewer service within the boundaries of the Port Ludlow Master Planned Resort. In support of connecting both lots to the existing sewer system, the MOU provides ". . . that the sewer system within the Port Ludlow MPR has capacity to serve the population 12 allocated and the level of development authorized in the Jefferson County Comprehensive Plan. " Olympic Water and Sewer, 13 Inc. provided a letter dated August 6, 2001 with an attached supplemental letter from Robinson and Noble, ground water and 14 environmental geologists. The Robinson & Noble letter provided San evaluation of implications of a septic system on Lot B of the 15 Walker Way Short Plat to the water resource and well at the applicant's Well 4N site. The Department of Environmental Health 16 provided the following response to the above correspondence: I have reviewed the letter from Larry Smith dated 8/6/01 and the 17 Robinson and Noble letter of 8/9/01. Environmental Health has recommended that these proposed new lots are within the 13 boundaries of the Port Ludlow Master Planned Resort and the Ludlow sewer service area and should be required to connect to 19 sewer even though the lots as configured may meet the minimum requirements for septic systems. Article 8.15. 010 of the 20 Jefferson County Code, which was in effect at the time of the subdivision application, requires connection to an approved G1 septic when sewer is not available. In other words, connection to sewer is the regulatory preference when sewer is available. 22 I: is my understanding that, through the Master Planned Resort designation and :he development agreement with the county, Ludlow L3 Utilities has indicated that sewer service is available to all properties within the MPR, therefore septic would not appear an 24 option. " 25 3 . The Appellant states that the condition would lower the propert 26 value of Lot B because it is approximately 1, 200 feet from the nearest 27 sanitary sewer line. The Appellant assigns error to the 28 • 29 1 Log Item 104, Walker Way Short Plat Decision, II. Findings of Fact. walker Wav Short Plot Aopeal Page 4 Findings.Conclusions SUBCO-00CC5 Port Ludlow Associates LLC and Decision • 1 Administrator' s Findings of Fact 1 and Fact 32, and makes the 2 following arguments :2 3 a. Regarding Fact 1 - OWSI Comprehensive Sewer Plan: The 4 Appellant argues that the OWSI Sewer Plan is not "a policy document 5 that would mandate all properties to connect to the sewer system," - . 6 that "the statement that 'the proposal will be in compliance with thi- 7 criterion' is incorrect. " 8 b. Regarding Fact 32 - Sewer Availability: The Appellant 9 disagrees that sewers are available, based on an argument that 10 "available" must be considered with some criteria. Appellant cites 11 other jurisdictions that qualify availability with some distance 12 criteria—in all cases shorter distances than the existing situation. 13 c. Regarding Fact 32 - Financial Feasibility: The Appellant • 14 argues that "available" must include "timely and reasonable" as 15 criteria, and suggest that reasonable includes financially feasible. 16 The Appellant used another area within the MPR as an example of 17 distances and cost to extend a sewer main 2, 800-LF to Lot 8 of Port 18 Ludlow Division 1 at a cost of $200, 000 to illustrate the effect of 19 applying the contested condition to such an example.3 20 d. Regarding Fact 32 - MOU: The Appellant argues that the 21 Memorandum of Understanding intended that " . . . all property owners 22 within the Master Planned Resort (MPR) would have an opportunity to 23 obtain sewer service on a first-come, first-serve basis. The MOU did 24 not state a requirement that all properties be connected to sewer." 25 e. Regarding On-site Septic System: Appellant states that 26 size and soil conditions of the property meet all applicable criteria 27 28 2 See Exhibit 2 and Log Item 107 for complete text of arguments. 29 3 Testimony by Mark Dorsey, PE, and Exhibit 6 for complete text of arguments. walker Way Short Plot Appeal Page 5 Findings,Conclusions SUB00-00005 Port Ludlow Associates LLC and Decision • i for an on-site system. Appellant also notes that in accordance with 2 WAC 246-272-07001 the local health board may require connection to 3 sewer to protect public health, but point out that there are no publi 4 health issues that would require the connection. 5 4 . The Staff Administrative Report contains background information, 6 a chronology, and detailed responses to the Appellant' s appeal 7 arguments, are adopted as Findings.' 8 5 . Larry Fay, Jefferson County Environmental Health, testified tha 9 he had reviewed the Robinson & Noble letter [Exhibit 4] and did not 10 disagree with their conclusions. 11 6 . William Funke testified that he was part of the group that 12 mediated the differences between parties regarding the MPR and the 13 OWSI Sewer Extension Agreement.5 14 7 . Ruth Altis, adjoining property owner to the north, submitted an • 15 annotated copy of the proposed short plat to show her well location 16 and other features.6 17 8 . The Examiner requested that three documents referenced in the MP' 18 and other documents submitted by the Appellant be made part of the 19 record. Those documents were collected and sent to the Examiner 20 (received November 10, 2001, whereupon the Record was closed) . 21 22 REVIEW CRITERIA 23 Appeals of administrative decisions that are questions of law ar:. 24 reviewed de novo, and are evaluated under the error or law standard 25 with weight given to the Department. Issues of fact are reviewed for 26 substantial evidence. The burden of proof rests with the Appellant. 27 28 4 Exhibit 1 and Log Item 118 29 5 Exhibit 10 6 Exhibit 11 Walker Way Short Plat Appeal Page 6 Findings,Conclusions SUB00-00005 Port Ludlow Associates LLC and Decision • 1 CONCLUSIONS OF LAW 2 1 . The matter before the Examiner is narrow to the appeal of the 3 Administrator' s short plat condition requiring that Lot B of the 4 proposed Walker Way Short Plat be connected to the community sanitary 5 sewer system. 6 2 . While the Port Ludlow Master Planned Resort Ordinance is at the 7 heart of this appeal, it must be viewed in the larger context of the 8 Growth Management Act—in particular the provisions for master planne• 9 resorts . The Legislature placed emphasis on avoiding unplanned and 10 uncoordinated growth, recognizing land is scarce and land use 11 decisions are largely permanent.? The Legislature states that [a] 12 master planned resort means a self-contained and fully integrated 13 planned unit development. [emphasis added] The Growth Management • 14 Hearings Board views this use of the term "planned unit development" 15 as a type of zoning treatment,8 and as "a generic term for a regulato 16 technique which allows a developer to be excused from otherwise 17 applicable zoning regulations in exchange for submitting to detailed, 18 tailored regulations. The technique is characterized by flexibility."' 19 Utilities, such as sewers, must be limited to meeting the needs of the 20 MPR. Moreover, an MPR and a service provider (OWSI in this instance) 21 are authorized to enter into agreements.10 Under this context of the 22 Growth Management Act provision, the Port Ludlow MPR consists of trade 23 offs to allow flexibility in exchange for assured sewer service and 24 elements of a self-contained, fully integrated development. 25 26 7 RCW 36.70A.010 Legislative Findings 27 8 HEAL v. Growth Management Hearings Bd. , 96 Wn. App. 522, 979 P.2d 864 1999) . 9 Id. citing Schneider Homes, Inc. v. City of Kent, 87 Wn. App. 774, 775-76, 28 942 P.2d 1096 (1997) and Barrie v. Kitsap Cy. , 84 Wn.2d 579, 585, 527 P.2d • 29 1377 (1975) . io RCW 36.70A.360 (2) "b iker Way Snort Plat Aopeal Page 7 Findings,Conclusions S :BOO-OOCO_` Port Ludlow Associates LLC and Decision • 1 Conclusions Regarding Appellant's Arguments: 2 3 . Fact I - OWSI Comprehensive Sewer Plan: The legislative basis 3 for the regulation of sewer systems is Chapter 90 .48 RCW. The 4 Department of Ecology [DOE] has the primary pollution control 5 responsibility, " and has the responsibility to review and approve 6 plans for sewerage systems .0 DOE considers RCW 90 .48 .110 to include 7 "general sewer plans" as within its scope of review responsibility.0 8 DOE defines the "general sewer plan" as a comprehensive plan for a 9 system of sewers, including subjects addressing cost distribution and 10 financial feasibility of plan implementation." Therefore, the OWSI 11 Comprehensive Sewer Plan is a policy document. Moreover, it must have 12 considered the defined elements, including financial feasibility, to 13 have been approved by DOE. While not containing an explicit policy t• • 14 require sewer connections, the OMSI Sewer Plan envisions sewer servic. 15 to all of the Port Ludlow MPR. The Appellant' s argument is not 16 persuasive. 17 4 . Fact 32 - Sewer Availability: While the Appellant agrees that 18 connection to sewer is the regulatory preference; the arguments 19 regarding "availability" are misdirected. The ordinances cited are 20 not parallel to the Walker Way Short Plat case. For instance: 21 • Port Angeles. The provision applies only to a building permit on a 22 single lot existing on January 1, 1995; and moreover, is an exception 23 that must meet all of series of conditions.'5 24 25 11 RCW 90.48.030 Jurisdiction of department. The department shall have the jurisdiction to control and prevent the pollution of streams, lakes, rivers, 26 ponds, inland waters, salt waters, water courses, and other surface and underground waters of the state of Washington. 27 1s RCW 90.48.110 28 13 WAC 173-240-010 Purpose 29 u WAC 173-240-020(f) m PAMC 13.61.090 Private Wastewater Disposal System Allowed - When. NC3lR . A Oy Short?°ct Appeal Page 8 Findings,Conclusions SU800-00005 Port Ludlow Associates LLC and Decision • 1 • Port Townsend. All new development must connect to sewers when located 2 within 260 feet of a line; however, subdivisions, short subdivisions 3 and planned unit developments must connect to sewers regardless of its 4 location.'6 5 • Kitsap County. An existing building or one under construction must 6 connect to a public sewer if it is within two hundred feet.17 Other 7 developments proposing septic tanks within urban and semi-urban 8 designations on the county's comprehensive land use plan will be 9 subject to review for determination of sewer feasibility by the Kitsap 10 County department of public works.18 11 Other jurisdictions around the State have similar regulations. Short 12 subdivisions are simply treated differently than single lots. The 13 Appellant's examples do not support his argument. • 14 5 . Fact 32 - Financial Feasibility: The Appellant' s argument 15 regarding cost is misleading. The cost to extend a sewer main 2, 800 16 feet may be $200, 000 when it includes the cost of installing the sewe. 17 pipe, manholes, engineered construction plans, record drawings and 18 connection fees, pavement removal, pavement restoration, and traffic 19 control . The cost to serve one lot at the end of a fully developed 20 sewer main is not relevant . 21 6 . Fact 32 - MOU: Related regulations, ordinances and other 22 instruments must be read together to ascertain their meaning and 23 applicability. The recitals of the MOU between OWSI and Jefferson 24 County clearly interrelate the sewer system, Port Ludlow MPR, the 25 Jefferson County Comprehensive Plan, and the sewer system capacity to 26 serve the customers within the MPR boundary and at a high standard. 27 28 16 PTMC 13.22.010 A & B(1) • 17 29 KCC 13 .12.020 18 KCC 13.12.025 Wcike'Way ShortPlat Appeal Page 9 Findings.Conclusions SUBCC-00005 Port Ludlow Associates LLC and Decision • 1 The six statements are clearly binding between the parties . The MOU, 2 read together with the purpose and operations of the approved general 3 sewer plan, indicates that service to all lots was intended. While 4 there is no explicit mandate that all parties be connected to sewer 5 (as argued by the Appellant) , there is also no policy or provision fo 6 on-site septic system as an exception. The Appellant' s argument 7 fails . 8 7 . Regarding On-site Septic System: The Appellant is correct that 9 an on-site septic system, as designed by Ryan Tillman considering the 10 existing soils, and with the separation from the well head, would meet 11 minimum requirements . The responsible Jefferson County Health 12 official acknowledges as such, but still recommends that Lot B be 13 connected to sewer. 14 Summary Conclusions: • is 8 . The function of comprehensive plans and the purpose of master 16 planned resort legislation form a thread of reasoning throughout the 17 above conclusions. The trade-offs allowed through the Port Ludlow MP' 18 are significant—even considering only the low density imposed outsid- 19 the MPR boundary. 20 9 . As noted in Conclusion 5 above, the Appellant's arguments 21 regarding financial feasibility are invalid. However, the arguments 22 point out the probability that approval of the appeal would set a 23 precedent and the extent of such a precedent would pose throughout the 24 MPR. 25 10 . The Appellant' s arguments are not persuasive, and the appeal mus 26 be denied. 27 28 • 29 walker Nay Short Plat Appeal Page 10 Findings.Conclusions SUB00-x0005 Port Ludlow Associates LLC and Decision • 1 DECISION 2 Based upon the testimony presented at the Open Record Appeal Hearing, 3 a site visit by the Examiner, the documents and exhibits admitted int. 4 the record, and the above Findings of Fact and Conclusions of Law, it 5 is hereby the decision of the Hearing Examiner that the appeal of the 6 decision of the Subdivision Ordinance Administrator to require a 7 connection of Lot B to the community sewer as a condition of approval 8 of the Walker Way Short Plat is hereby DENIED, and the decision of th= 9 Administrator is AFFIRMED. 10 DATED this 27th day of November 2001. 11 12 13 • 14 Iry Berteig Jefferson County Hearing Examiner 15 16 `b 17 Transmitted by the Jefferson Count Permit Center to the following: 18 19 DATE TRANSMITTED: 20 Marc Dorsey, PE, 70 Breaker Lane, Port Ludlow, WA 98365 21 Ryan Tillman, PE, PO Box 1375, Port Hadlock, WA 98339 22 William Funke, 75 Scott Ct, Port Ludlow, WA 98365 23 Ruth Altis, 300 Coursey Lane, Port Ludlow, WA 98365 24 Robert P. Balck, 192 Montgomery Ct, Port Ludlow, WA 98365 25 Greg McCarry, 70 Breaker Lane, Port Ludlow, WA 98365 26 Everett G. Johnson, 64 Ames Lane, Port Ludlow, WA 98365 27 Lenetta Johnson, 64 Ames Lane, Port Ludlow, WA 98365 28 Brad Newell, 141 Jackson Lane, Port Ludlow, WA 98365 • 29 Judy Newell, 141 Jackson Lane, Port Ludlow, WA 98365 Walker Way Short Plat Appeal Page 11 Findings,Conclusions SUB00-00005 Port Ludlow Associates LLC and Decision ` s • 1 Jim Ryan, 901 Walker Way, Port Ludlow, WA 98365 2 Pat Ryan, 901 Walker Way, Port Ludlow, WA 98365 3 Conrad Yunker, 230 Pioneer Drive, Port Ludlow, WA 98365 4 Jim Laker, 612 Ranier Lane, Port Ludlow, WA 98365 5 Janet Jacobson, 121 Coursey Lane, Port Ludlow, WA 98365 6 Philip Durnell, 186 Cr 5996 Cabool, MO 7 Katherine Funke, 75 Scott Ct, Port Ludlow, WA 98365 8 Shirley Kadish, 41 Foster Lane, Port Ludlow, WA 98365 9 Merland Moseson, 211 Montgomery Lane, Port Ludlow, WA 98365 10 Serene E. Moseson, 211 Montgomery Land, Port Ludlow, WA 98365 11 Larry Smith, PLA, 70 Breaker Lane, Port Ludlow, WA 98365 12 Shari Hagely, PLA, 70 Breaker Lane, Port Ludlow, WA 98365 13 Sally Smith, PO Box 65435, Port Ludlow, WA 98365 14 Theodore Wright, Jr. , PO Box 65245 Port Ludlow, WA 98365, 15 Sally & Gary Robin, 41 Libby Ct, Port Ludlow, WA 98365 16 Carl J. Jespers, 73 Pathfinder Ln, Port Ludlow, WA 98365 17 Susan H. Null, 60 Dunsmuir Rd, Port Ludlow, WA 98365 18 Eve McDougall, 30 Foster Lane, Port Ludlow, WA 98365 19 Stanley Kadish, 41 Foster Lane, Port Ludlow, WA 98365 20 21 22 23 24 25 26 27 28 0 29 Nalker way Short Plat Appeal Page 12 Findings,Conclusions SU800-00005 Port Ludlow Associates LLC and Decision • Board of Health New Business Agenda Item # V., 1 • Bio-terrorism Preparedness - Update: December 20, 2001 • STATE OF WASHINGTON WASHINGTON STATE BOARD OF HEALTH 1102 SE Quince Street • PO Box 47990 Olympia, Washington 98504-7990 Washington State Board of Health Resolution No. 01-001 WHEREAS, the State Board of Health's mission includes suggesting policies likely to better promote, protect,maintain and improve the health of Washingtonians; WHEREAS, Washington State faces potential health threats that include terrorist attacks involving the use of explosive and conventional weapons,the use of biological agents and other weapons of mass destruction, epidemics of new and re-emerging diseases, and the proliferation of disease organisms that are resistant to antimicrobial agents; WHEREAS, state and local public health and health care systems will be among the first responders in the event of any major disaster or disease outbreak; WHEREAS, state and local public health and health care professionals will be critical to the successful resolution of a major health event such as a bioterrorism attack; • WHEREAS,a long-term erosion in funding of the public health systems in this countryhas resulted in a progressive loss of public health system capacity to provide essential services; WHEREAS,efforts to contain health-care costs by limiting excess capacity in the health care system, combined with workforce shortages,have reduced the nation's and the state's surge capacity; WHEREAS,the federal government may make a significant investment in building capacity to respond to bioterrorist attacks and related events;however, federal funds for bioterrorism response have not, in the past, reached the state and local jurisdictions at a level commensurate with their role; and WHEREAS,recent state and local budget cuts have resulted in cuts in state and local public health programs and pending cuts threaten to further reduce state and local support for the public health infrastructure BE IT RESOLVED that the Washington State Board of Health, in order to protect the health of the residents of Washington, supports efforts by all levels of government to place a clear priority on maintaining, and enhancing when necessary,funding levels that provide for adequate state and local public health and health care capacity to respond to a health emergency such as a major disease outbreak or terrorist attack. APPROVED this 14th Day of November, 2001 Linda Lake, Chair State Board of Health • 0 • • • 1n rr. ;.�fl; y ..` STATE OF WASHINGTON WASHINGTON STATE BOARD OF HEALTH 1102 SE Quince Street • PO Box 47990 Olympia, Washington 98504-7990 Final Report Response Capacity During A Health Emergency • A Review of Selected Issues Board Sponsor: Thomas Locke, MD, MPH Lead Staff: Craig McLaughlin November 2001 For more information contact Board staff at: Telephone: (360) 236-4110 Fax: (360) 236-4088 E-mail: wsboh cr doh.wa.gov Web site: www.doh.wa.gov/sbohi zc Gk c (70 5 ed l Adopted by the Washington State Board of Health on November 14, 2001. • a U;,,cfw Washington State Board of Health • Response Capacity During A Health Emergency—A Review of Selected Issues "Health security is as basic a right of Americans as police and fire protection. And in times of crisis such as this, it is clear to all that health security is synonymous with national security." —Donna Shalala, President,University of Miami and former Secretary,Health and Human Services • Page 2 November 2001 Washington State Board of Health • Response Capacity During A Health Emergency—A Review of Selected Issues Executive Summary On December 15, 2000, Virginia Governor James S. Gilmore, III released the second annual report of the "Gilmore Commission"on terrorism response capabilities. His cover letter seemed prescient. "We are impelled by the stark realization that a terrorist attack on some level inside our borders is inevitable,"he wrote, "and the United States must be ready." The threat of a terrorist attack resulting in mass casualties is no longer theoretical. Neither is the use of biological weapons against civilian populations. Unfortunately, terrorism is not our only worry. This country and this state also face possible threats from the unintentional spread of disease—new diseases, re-emerging diseases we thought we had controlled, and familiar diseases such as malaria and tuberculosis that are developing resistance to antimicrobial treatments. When introducing the Frist-Kennedy Public Health Threats and Emergency Act of 2000, Senator Edward Kennedy called new and re-emerging diseases, antibiotic-resistant microbes, and bioterrorism the"Three Horsemen of the Modern Apocalypse." He added: "Today we face a world where deadly contagious diseases that erupt in one part of the world can be transported across the globe with the • speed of a jet aircraft. The recent outbreak of West Nile Fever in the New York area is an ominous warning of future dangers. Diseases such as cholera, typhoid and pneumonia that we have fought for generations still claim millions of lives across the world and will pose increasing danger to this country in years to come. New plagues, like Ebola virus,Lassa Fever and others now unknown to science may one day invade our shores." Whether the disaster is a naturally occurring disease outbreak, a mass trauma event along the lines of the September 11 tragedy, a natural disaster, or the use of weapons of mass destruction by terrorists or conventional militaries, the first response to a health emergency will come from the local and state level. Many experts and organizations have called for a more "robust"public health system in response to emerging bioterrorism threats. They note that the public health programs and activities needed to respond to a bioterrorism attack—disease surveillance, laboratory testing,risk communication, vaccine distribution,public education, environmental monitoring, and more—are the very programs public health uses quietly every day to create a safer and healthier nation. How prepared is the public health and health care infrastructure to respond to a bioterrorism attack, a mass casualty event, or a significant disease outbreak? From a global perspective, the answer, according to at least one longtime, well-regarded • observer, is unavoidable and unequivocal: As a global community, we are not prepared. Page 3 November 2001 Washington State Board of Health • Response Capacity During A Health Emergency—A Review of Selected Issues From a national perspective, the view of public health preparedness is less gloomy but still not encouraging. Last year, the Centers for Disease Control and Prevention asked itself, in response to a congressional inquiry, "is public health's infrastructure up to the task,prepared for the global health threats of the 21st century?" It concluded, "Unfortunately, the answer is no."A host of studies, expert pronouncements, assessments, field exercises, and real-world events support the CDC's conclusion. The state of Washington is regarded among public health professionals as having a high- performing network of state, academic, and local public health agencies. When it comes to preparing for bioterrorism and other major disease outbreaks, Washington is ahead of most other states. The state, however, is part of the national infrastructure and shares both its strengths and its weaknesses. In 2000, the Washington State Department of Health, as part of a joint Department of Justice and CDC nationwide effort, conducted a Public Health Emergency Preparedness Assessment. It asked the 39 counties to answer a series of questions based on the Draft Public Health Emergency Standards. "In general,"DOH concluded, "Washington's local public health systems are not adequately prepared for a major biological emergency." A survey of emergency departments at all hospitals in federal Region X—which includes Washington along Oregon, Idaho, and Alaska—attempted to assess whether hospitals are • prepared to respond to chemical or biological attacks. Less than 20 percent had response plans in place and only 6 percent had enough physical resources to respond to a theoretical attack using the nerve gas Sarin. Slightly less than half had an isolated decontamination unit, while only 12 percent had supplied air-line respirators or self- contained breathing apparatuses. The researchers concluded that emergency departments are generally not prepared to respond to an attack using biological or chemical weapons. One area of particular concern in Washington State is the surge capacity of the health care system. Historically, Washington has had a highly efficient health care delivery system with little excess capacity during times of normal utilization. In recent years, cost containment efforts have squeezed excess capacity out of the system. Washington hospitals, like hospitals nationwide, strive to eliminate excess capacity for financial reasons. Washington's comparatively low federal Medicare and Medicaid reimbursement rates, a by-product of the state's historically efficient health care delivery system, have made health care facilities and medical practices increasingly less profitable, as have overhead costs associated with meeting administrative requirements. Practitioners appear to be leaving the state and professional schools are not able to recruit and train enough new professionals to keep up with demand. Severe staffing shortages exist across the state for many health careers. Part of the reason that state and local public health and health care systems, including emergency medical systems, are underprepared for a major health event is a lack of adequate, stable funding. The United States spends nearly 15 percent of its gross national product on health care, but only a tiny fraction, an estimated 1 percent of total health care • expenditures, goes to the public health system. Many public health experts would Page 4 November 2001 Washington State Board of Health • Response Capacity During A Health Emergency—A Review of Selected Issues consider it a significant victory if 3 percent of health care expenditures consistently went to community-based, preventive public health activities. Of the money that does go to personal health services, an ever-increasing share is devoted to expensive, high-tech procedures and pharmaceuticals. Disproportionately few dollars go to primary and emergency care—the professionals and facilities that would be among the first responders in a bioterrorist attack or major infectious disease outbreak. In the wake of recent attacks, the federal government has shown heightened interest in funding public health and health systems, even at the risk of returning to deficit spending during an economic downturn. The administration has requested an emergency appropriation of$1.5 billion for bioterrorism preparedness. Yet less than 10 percent of that would go for state and local health preparedness. Patrick Libbey, president of National Association of County and City Health Officials and director of the Thurston County Public Health and Social Services Department,has described the kind of essential local programs not funded by the administration proposal. "We must be able to conduct active syndromic surveillance for disease,to do immediate, on-the-scene epidemiological investigations, to develop and test local bioterrorism plans, to coordinate community • responses, and to maintain the round-the-clock vigilance and readiness that all our nation's communities expect." NACCHO estimates that the public health system needs an initial investment of$835 million at the state and local level for disaster preparedness as well as ongoing funding sufficient to sustain this effort. In Washington State, the financial picture at the state and local level is not encouraging. Funding for state and local services has been and continues to be jeopardized by a host of factors, including Initiative 601 spending limits, the repeal of the motor vehicle excise tax, an economic downtown, inflation in the cost of government services, growth in the populations eligible for these services, and now, Initiative 747 restrictions on local property tax increases. On October 9 and 10, 2001, the Washington State Board of Health heard briefings from national experts, state and local public health officials, and hospital personnel about state and local capacity for responding to a health emergency such as a bioterrorism attack. The Board also reviewed briefing materials assembled by staff and heard informally from dozens of attendees at the October 8-10 Washington State Joint Conference on Health. This report represents an additional phase of the Board's response to the current crisis. The Board has identified, during its meetings and research, several specific programmatic areas where the capacity of the public health systems can and should be improved. In this rapidly evolving national context,the Board offers these specific recommendations for Washington State's emergency preparedness planners. Page 5 November 2001 Washington State Board of Health • Response Capacity During A Health Emergency—A Review of Selected Issues The primary purpose of this report, however, is to examine, in broad terms, the role and readiness of the public health and health care systems. Based on its hearings and research, the Board makes the following recommendations. 1. State policymakers and planners should embrace an"all hazards,"public health- oriented approach and fully integrate the state's public health, EMS, and health systems (including representatives of Tribal health programs) into planning and exercises. 2. The governor and state agencies should continue to work aggressively with the state's congressional delegates to make sure bioterrorism preparedness funds reach the state and local levels where they can be used to build critical public health, EMS, and health care infrastructure sufficient to provide initial response to biologic threats and emergencies. 3. State budget writers should use federal funding for disaster preparedness to expand response capacity at the state and local level—not to offset cuts in state contributions to existing programs. 4. State budget writers should protect funding for state and local public health (including local capacity funds and the I-695 backfill). These funds sustain most of the existing public health capacity that would be mobilized to respond to bioterrorist attacks or other disasters. Diverting funds from existing public health programs to supplement emergency response capabilities will not result in needed . improvements and may further erode the ability of local health jurisdictions to effectively respond to an emergency. 5. State budget writers should consider ways to make Department of Health funding more flexible (less categorical funding and fewer provisos) so the department can move funds between programs to respond to emergencies. 6. Efforts to reduce state spending on health insurance and health care purchasing should be tempered by the recognition that we need to increase surge capacity and provide additional resources that might be called on during a health emergency. (This is in addition to the need to ensure ongoing access to health care for all Washington citizens.) 7. State policy makers must address the deficiencies identified in the current emergency response system for bioterrorist threats and identify clear priorities for system enhancement. If priority enhancements cannot be funded through federal programs, the state must consider any and all options to make adequate funds available. 8. Federal and state governments must recognize that their fundamental duty to protect public health includes assurance of adequate supplies of essential vaccines. If private pharmaceutical companies entrusted with this essential task fail, as they have repeatedly, to produce adequate vaccine stocks, governments must look to federalization of vaccine manufacture as a last recourse to assure that current shortages are addressed and future breakdowns in the production are averted. Page 6 November 2001 Washington State Board of Health • Response Capacity During A Health Emergency—A Review of Selected Issues 9. The Board should initiate a review, in partnership with DOH, local health jurisdictions, and other affected parties, of the adequacy of current board rules concerning reporting of notifiable conditions, isolation and quarantine, and the emergency powers of local health officers. The Board should also determine the role it sees for itself in development of state legislation defining emergency health powers. Adequate preparedness for biologic emergencies cannot be accomplished in weeks or months. It will require sustained efforts over years or decades. Strategies will have to be continuously modified to deal with changing threats. As of the date of this report, Washington State has not sustained a direct bioterrorist attack. We do not know how much time is available to us to prepare for such an event. Responsible public health policy development requires that we heed the warning issued by the Gilmore Commission regarding the inevitability of such attacks. Should Washington State be so fortunate as to avoid a devastating attack, the investment in restored public health capacity will repay itself many times over in improved control of other deadly communicable diseases. If Washington State should become the next target of a bioterrorist attack, the costs of failing to make this investment will be measured in casualties, catastrophic economic disruption, and the potential for unprecedented panic • and social unrest. The State Board of Health urges all elected officials and state agencies to recognize the seriousness of this threat, the urgency of building adequate response capability, and the need for bipartisan cooperation and multi-agency collaboration to rise to this challenge. The citizens of Washington State have put their trust in their institutions of government to provide essential public health and safety services. To fail to meet the challenge of bioterrorism preparedness would truly be a betrayal of trust. S Page 7 November 2001 . r , Jefferson County g Health & Human Services Emergency Management Team Bioterrorism an For Infectious Disease % r� ?1 �,� sem/Ari i. �yam , IPN ^ I- ly 4 44.-or 74,, w rS fir i - 1112()01 • INDEX ■ Joint Incident Action Plan — Special Circumstances ■ First Responders —,ea2Law Enforcement ....m? 'Y `�'4.'; .., ..�'.'b.!* a.7' rf:;. ■ Jefferson County Health & Human Services Response Communicable Disease Fact Sheet Anthrax ■ Bioterrorism Incident Command ■ Bioterrorism Response Plan ■ Resource Numbers • • III Join IncidentA i t Action Plan SPECIAL CIRCUMSTANCES .... „..„,....__ _ _ , ...e.r.,;:i,„,,..,...„,„„:„.22 ..... ,' -''' '. qmALLpo - „:,-„,,,,,, ----*---,::::ic!..,,I,i'. 0 . :,'004,-,4 By Order of KEEp ouir OF ill's HousE „...,;,,,, ,„,.„,......„e, ...,,,,,,,,,,, HEALTH OFFICE ' Any person removing this card without authority is liable to prosecution. C 4' • iv" ' p' z, ` .''', -' S t avr k:rlwaba^ 7"l'''''''''! c''rs ahs • Special Circumstances Joint Incident Action Plan S Incident Nation-wide Terrorism Alert Date Prepared October 26, 2001 Operational Period Immediate to December 31, 2001 (or as conditions warrant) Strategy Increase readiness for coordinated response to terrorist incidents (actual, hoax, or copy-cat); lessen public anxiety with a consistent response strategy Control Objectives 1. Maximize inter-agency communication, coordination, and resources 2. Stick with the plan 3. Every incident will be treated as a CREDIBLE THREAT until otherwise determined Organization 1. Law Enforcement is Lead Agency (criminal investigation) 2. Unified Command is Law Enforcement, Fire/EMS and Health 3. Lead may change to Health in recovery phase (public health issues) Resources N / A lilExecution Level 1 Site Specific (suspicious object — single indeterminate threat) 1. Dispatch Law Enforcement (criminal investigation — use Biological Agent Threat Investigation guidance to determine credible threat) 2. Emergency Management can coordinate external resources and provide logistics support as needed 3. Incident Command is on-scene (law enforcement is lead) 4. Release of information coordinated by P.I.O. (all levels—Joint Information protocols if needed) Level 2 General threat, multiple sites, or unusual community anxiety 1. Law Enforcement, Fire/EMS and Public Health deployed as needed 2. EOC activated at Level 2 3. Incident Command is at EOC Level 3 Major credible threat or actual major occurrence 1. EOC activated at Level 3 staffing 2. Unified Command is at EOC 3. Law Enforcement, Fire/EMS, Task Force(s) deployed by Operations Safety Message • Use EXTREME CAUTION to prevent additional casualties or exposure • Beware of secondary devices — explosive or bio-chemical • Do not exceed training-experience levels • . , , . • First Responders LAW ENFORCEMENT ::„...,,,,,,,..,,,,,,,,,,,,,,or ..,7,:i.:''.7-!,,E ..II . } �s ,was . ;, : "�, •,^ ,,;=,-,,,;i.,,,,.*s � y'' ,qri%f , ' At; 0 Et,i,,ii‘-,.''.,':',r,--,',7,,,„-''.';','. r # o: / a _ y a� 4001''' v 7 =. .• .:,‘..',. „:„.r.,,,,,,,,,,,,,,„,„,,,,,, • ,,,,.,,,:. l,,,„. • , a ', Pyr4�j,,a 4 p ... • Joint Incident Action Plan Biological Agent Threats Investigation • DISPATCH CENTER DISPATCH mayoffer SUSPICIOUS MAIL � _0. pre-arrival OR PACKAGE instructions to the calling party • 7 ADVISE HEALTH DEPT. and DISPATCH USE POWERPHONE Training EMERGENCY MANAGEMENT LAW ENFORCEMENT Bulletin BIOLOGICAL AGENT (Information only at this time) THREATS • Leave the item undisturbed ASSUME COMMAND T' • Do not handle (Criminal Investigation) FIRST RESPONDER • Do not open, smell or taste ♦ Do not shake or empty contents Treat all threats as a CREDIBLE • Cover with anything (trash can, etc.) • threat until determined otherwise Evacuate the room ■ Close the door or section off the area • . • Anyone who has come in contact Process as a CRIME SCENE should wash hands thoroughly with DETERMINE THE soap and warm water CREDIBILITY OF THE THREAT IIT PRECAUTIONS THREAT INDICATORS AND INVESTIGATION • Do not move the object Basic Threat Indicators Other • Isolate, if possible • o Close the door Circumstances o Section off the area • Section off the area • Leaking powdery substance Is the sender unknown to the • Evacuate the immediate space • No return address addressee? • Prevent additional exposures • Mailed from foreign country • Secure the perimeter • Foreign or excessive postage Has the addressee received ■ Anyone that has contact with the • Badly typed or written threats/suspicious packages package should wash thoroughly • Misspelled words previously? with soap and warm water • Restrictive markings • No specific addressee Is there a reason the addressee • Protruding wires would be a possible target of • Shrink-wrap threats/retaliation? • Excessive tape or string 7 • Oily stains, discoloration Is there a stated or implied threat INJURIES • Crystallization (on the envelope or enclosed?) • Strange Odor • Signs of tampering Is the addressee a high threat • Odd shape potential (e.g. public official, law V • Excessive weight enforcement agency, etc.)? REQUEST EMS RESPONSE I I NO YES 1 • V Was the sender able to provide a plausible explanation for the condition of EMS WILL USE HAZMAT the package or the contents (personal visit from law enforcement)? PROCEDURE .., 111•1111. + J I YES/ NO LESS THAN CREDIBLE • • THREAT CR ,� r g EAT Refer Exposure Worries Or Other Health Related Item May Be Packaged and Questions To Health Maintained As Evidence Until GO TO CREDIBLE THREAT Department Threat Of Infection Has Passed PROCEDURES ON PAGE 2 Joint Incident Action Plan • Biological Agent Threats Investigation ® A From Page 1 �a4 , :: , "Iir REQUEST EMERGENCY MANAGENT "CREDIBLE THREAT" NOTIFICATIONS --O.. SUPERVISOR (Level 1 support) LAs Needed 1 l T ♦ ♦ NOFTIFY F.B.I. COUNTY HEALTH INCIDENT COMMAND FOR INCIDENT TRACKING DEPARTMENT Identify persons who may have been exposed, identify witnesses, obtain statements, V document NEEDED ON-SCENE ? Maintain site security V • Health Department can provide HEALTH DEPARTMENTMust obtain permission to ship guidance for exposures suspect items to state lab V Refer public health related Emergency Management can inquiries to the Health provide logistics and support Department Information Officer can assist Request WSP HASMAT unit to on-scene if requested respond to package item and transport PUBLIC INFORMATION V * OFFICER WILL THE ITEM BE SHIPPED (Media coordination) TO STATE LAB? I I L As Needed NO YES WERE LAB TESTS Package item and maintain as DOES RECIPIENT STILL POSITIVE? evidence until threat of I--YES HAVE CONCERNS? infection has passed I YES NOl V V Refer recipient to Health Notify F.B.I. Advise the recipient(s) • Department for guidance Continue criminal investigation document the incident. ,, Debrief the responders i 0 Jefferson County Health & Human Services RESPONSE ..„„,...........„ ,4 t THE PUBLIC ,.....HEALTH , I NURSE .17'1' .... . 1 -..„,, , i,.,...,,,,_, j.,,,v1: 0 i-.., A_____/., kt:-: ‘ '4/ * "4, • 144.1 - ie. . 11111 ,,„ , i, , ,A ....., - , /, , .....t,,._„-...,_ „.,.., - - ,, P' , fi -::„..t, c-- .,. . ,,',„ I it —1. .0., ,,,,i';?';#:,e,,,..v? i.,,i • 44 41.4, a,t, 4.44:, ,k '1 .- ;•i'''‘...' ,r4:1„71 tIN 4 1 i WI 1.4 il It / 4 I. '' r'rr—;'4?-; •,,,!'" ' 1 1V." (4, .0, '41 She Arswers Humanity's Call YoiiRedCt )ss Membership makes her work Possible , : • CALL TO HEALTH DEPARTMENT FROM •FIRST RESPONSES / EMERGENCY MANAGEMENT OR LAW ENFORCEMENT ❖ Is it a credible threat? o If yes, call State Lab, 360-361-2914. Tell them when, and by whom, it will be delivered. Give fact sheets to staff of office on Anthrax. (See attachment from Lisa) o If no, give fact sheets to staff of office on Anthrax and be available for questions. ❖ Lab to call results to: Lisa McKenzie 9:00a.m. — 4:30 p.m. (360) 385-9400 or after hours: o Jean Baldwin • • (cell) 360-531-1736 • (home) 360-379-9403 o Tom Locke • (cell) 360-808-3333 • (home) 360-683-9152 • (pager) 360-582-8353 ❖ Negative Results: o Jean or Tom to call Dispatch to tell: • Law Enforcement or Charles Saddler (360)-379-9453 • Employer • Emergency Management Team ':' Positive Results: Same as above, but initiate Communicable Disease • ❖Code Staff and Management time to BARS 790 • Information for People Involved in Evaluation of a Threatening Mail Item 11/6/2001 1 . A piece of mail found in the facility in which you work or visited is being investigated for biologic threat agents such as anthrax. The item will be sent to the State Public Health Laboratory. Test results will be available under most circumstances within 24 hours. Your supervisor will be notified of the test results as soon as they are available. 2. All strains of anthrax that have been detected in the United States are treatable by a wide range of antibiotics. Individuals who have a confirmed exposure to anthrax will be provided with antibiotics to prevent infection. 3. Any individual who has had direct contact with the suspicious material should wash their hands with liberal amounts of soap and water. Avoid use of irritating disinfectants or vigorous scrubbing that might injure your skin. If there is visible contamination of your clothing, change your clothes and place the contaminated clothes in a sealed plastic bag until laboratory results • are available. People who have been heavily exposed to a suspicious material may also wish to take a shower with soap and warm water to remove all potential contamination. No additional decontamination is necessary unless the laboratory identifies a biologic agent. 4. Feeling anxious and upset is a normal reaction when a person confronts an uncertain health risk. We encourage people to talk to others about their feelings. Laboratory information will be available within 24 hours and anthrax is a highly treatable infection if treatment is started early. Anthrax is not spread by person-to-person contact; you do not have to avoid contact with family or friends. 5. The risk of exposure to anthrax in Washington State is currently very low. At this time none of the suspicious mail items tested in Washington State have contained anthrax or any other biologic agent. If you have questions about this information, please call Jefferson County Health & Human Services at 360-385-9400. • Communicable Disease Fact Sheet 0 ANTHRAX , ..., _ ., -iArostitfoir,r Yom? @@d, rt 10 o pet, t' 9x • � . { ( it.' • ��. i nt '- __ 1-st Jefferson County Health 6'Human Services l jl� CASTLE HILL CENTER • 615 SHERIDAN • PORT TOWNSEND,WA 98368 • Communicable Disease Fact Sheet Anthrax What is anthrax? Anthrax is a serious infectious disease caused by a bacteria called Bacillus anthracis. It is a disease most commonly seen in animals, especially hoofed animals such as cows, sheep, goats and horses. Humans occasionally become infected with anthrax when they eat meat or handle the wool, hair or bones of an animal infected with anthrax. There are 2000-5000 cases of anthrax worldwide, and about 5 cases a year in the United States. Experts believe that anthrax is among the diseases which could be used as a biological weapon. How would someone get anthrax and what are the symptoms? The illness a person gets when they are infected with Bacillus anthracis depends on how the bacteria got into the person's body. There are three different types of anthrax disease: • Inhalational anthrax is the most serious form of anthrax and is caused by inhaling Anthrax bacteria into the lungs. Initial symptoms usually begin 1-6 days after infection, but can occur as late as 60 days after exposure. Symptoms include fever, headache, cough, difficulty breathing, chills, weakness, and chest discomfort. Without treatment, severe breathing problems and death usually result. Inhalation anthrax is NOT contagious (spread person-to-person). • Cutaneous anthrax is caused when the anthrax bacteria come into direct contact with skin that has a cut or break in it. Cutaneous anthrax begins within 1 to 7 days after exposure and first causes a raised, itchy bump that resembles an insect bite. Within 1-2 days after the appearance of the bump, a small blister develops. This blister then becomes a painless sore with a black center. Lymph glands in the area of the infection may swell. • Intestinal anthrax is caused by eating meat from an animal that has died of anthrax or by drinking other foods or liquids contaminated with anthrax bacteria. It causes nausea, vomiting, fever, pain in the abdomen, and diarrhea. Intestinal anthrax symptoms appear within 1 to 7 days after exposure. •If untreated, each of these forms of anthrax can spread to the blood, brain, or spine and cause severe illness or death. •Testing and Diagnosis of Anthrax • Law enforcement and Public Health authorities determine if an anthrax threat or suspicious substance represents a credible threat and is potentially dangerous. If so, the letter or parcel involved can tested for anthrax. Treatment of persons exposed in such circumstances is usually postponed until laboratory results are available. • There is no laboratory test to test for anthrax before symptoms begin. Nasal swabs are sometimes obtained during investigations of confirmed or likely anthrax exposures, but are not useful or available outside of these circumstances. Persons with a documented or likely anthrax exposure ALWAYS receive preventive antibiotics. Treatment for Anthrax • The preventive treatment for anthrax consists of antibiotic treatment alone or in combination with anthrax vaccine. • The duration of antibiotic treatment is 30-60 days, depending on whether anthrax vaccine is used. • When available, the anthrax vaccination series consists of 3 or more doses of anthrax vaccine. QUESTION: How will I know if I have been exposed to anthrax? • • Persons are considered exposed to anthrax if they have inhaled or come into direct contact with anthrax bacteria. • There are tests to detect anthrax in the environment or substances and these tests will be done as rapidly as possible by Public Health to determine if anthrax is present. • Environmental testing to detect anthrax can provide preliminary results within several hours and final results in about 2 days. QUESTION: What should I do until environmental anthrax test results are available? In most instances the likelihood of true exposure to anthrax is extremely small and no treatment is needed. • If evidence suggests that a true anthrax exposure has occurred, Public Health will make recommendations for antibiotic treatment of persons exposed to anthrax until results of laboratory tests are available. • Antibiotic treatment should be stopped if environmental tests show no exposure to anthrax has occurred. • If a true anthrax exposure is confirmed, antibiotic treatment must continue for the duration specified in Public Health recommendations, usually 30 days or longer. • • • QUESTION: When an exposure to anthrax is not thought to have occurred, treatment is not Orecommended. However, while the situation is being investigated any person who may have been exposed to anthrax and becomes ill with the symptoms described above should seek medical attention immediately and notify Public Health at the phone number listed at the end of this form. Antibiotics can be given to treat illnesses consistent with anthrax symptoms until the results of laboratory testing to detect anthrax are available. QUESTION: What can I do to protect others when I have been exposed to anthrax? • Take off the clothes you were wearing when you were exposed, place them in a sealed plastic bag. These clothes can either be thrown away, or they can be washed in hot water and soap. People who handle the contaminated clothes before laundering should be sure to wear gloves and protective clothing. Avoid shaking the clothes when placing them in the plastic bag or in the washing machine. • Take a shower and clean your skin and hair thoroughly with warm water and soap to remove anthrax bacteria. o Once you take these steps, you will pose no risk to others. o If you subsequently develop a sore on your skin, cover the sore with clothing or a bandage and see your health care provider immediately. • o If you are recommended for preventive treatment, please be sure to follow the treatment advice exactly. QUESTION: What can be done to decontaminate surfaces contaminated with anthrax? • The job of cleaning an area contaminated with anthrax will be left to public safety experts. QUESTION: What should I do if I become ill? • If you develop any of the illness symptoms described above, get medical attention immediately and notify Public Health. • Bring this sheet or mention you have been exposed to anthrax when you seek medical care. Report all cases to: Jefferson County Health Department 615 Sheridan Street Port Townsend, Washington 98368 O (360) 385-9400 Adapted from Public Health —Seattle and King County • BIOTERRORISM INCIDENT COMMAND 9 Pal A* alkotw • 4. ` 'c )01° c�r • • Jefferson County Health & Human Services BIOTERRORISM INCIDENT COMMAND Tom Locke Initiated by call to Tom from Emergency Management or Police or Dispatch • May Delegate to: Jean, Larry or Lisa Call emergency Management if not already involved • Bioterrorism Response Plan Y k t tc } • • Jefferson County Health & Human Services Infectious Disease Response Plan And Laboratory Results Community Coordination Press contact— Tom in Information to Public, with MD's, Pharmacies, ER JPREP and JCHHS Staff his absence, Jean, Lisa, Tom Julia Lisa or Larry • Immunizations Contact Tracing • Jane Denis, Wendy • • • • RESO U RC E N UMBERS . . . . ... . . „,. ...._... .. . ...,...•. . . . . ....,:... . ... .,.. ,.......;:: :.,:... . .... . . . . .. ...,......... . ...... ,.. . . . . .... „ . .... .. . ,. . . _ . . .. . . ... ...... : . 4.. a «« a •�' ' 0 ' : .' • , „.......,„ .. „ „, -..- ' 4-. ' . • • „. . . •, ` ,:•:.. , „ , ,,,,, . .. • „, ,,,:,' "• . .,., _ '-',' ,.' ... 0 °~''..•• . ...: 141:::'......,.. ,- ...,iit.': ...,' fi. --'., .. . , .... . - -till r... . 41G ---- - --- ill 03. . .. . ., , . ,... .. .. i...:... .,. ,.. 4 s 457e, ,.. 1, ' , 7 s ' .-c • Resource Numbers • Emergency Management o 360-395-3831, option 1 • Emergency Operations Center o 360-385-3831, option 7 • Department of Health EPI Line for Questions o 206-361-2914 o 877-539-4344 • Bob Hamlin o 360-385-3831 ext. 528 o (cell) 360-460-0500 o (home office) 360-457-1496 o (residence) 360-452-1552 o (pager) 360-681-5997 — 24 hours • Bob Minty o 360-385-3831 ext. 529 • o (home office) 360-797-7809 o (residence) 360-797-8742 • Port Townsend Fire Department, Ed Edwards Fire Chief o 1310 Lawrence Street, Port Townsend o 360-385-2626 • Chimacum Fire District #1, Chuck Boggs Fire Chief o P.O. Box 537, Chimacum o 360- • Quilcene Fire District #2 o P.O. Box 433, Quilcene o 360- • Port Ludlow Fire District #3 o 101 Southpoint Road, Port Ludlow o 360- • Brinnon Fire District #4 o P.O. Box 42, Brinnon o 360- • Gardiner Fire District #5 o 2000 Old Gardiner Road o 360- • Port Townsend Fire District #6 • o 3850 Cape George Road o 360- • Sheriff o 360-385-3831 II Board of Health New Business Agenda Item # V. , 2 • 2002 Data Steering Committee Fact Sheet December 20, 2001 • Jefferson County Board of Health Assessment Highlights Fact Sheet December 2001 • Birth/Maternal Child Health Indicators (vital statistics database) Jefferson WA State • Births to Unmarried Mothers, 2000 42% 28% • Medicaid paid delivery, 2000 62.3% 33.5% • Medicaid paid delivery, 1999 54.5% 32.5% • AFDC/TANF Participants, 2000 1.4% 3.2% • Low Birthweight rate (1996-2000) 5.1% 5.8% • Non-Smoking Mothers, 2000 73.2% 86.5% • First Trimester Prenatal care, 2000 77.3% 82.6% • First Trimester Prenatal care, 1998 87.1% 83.0% Comments: • In 2000, 87 births to unmarried mothers accounted for 42% of all births. In 2000, 62.3% (127) of all Jefferson County births were funded through Medicaid. This is a 7.8% increase from the 1999 total of 54.5%. • Jefferson County Medicaid-paid deliveries has been greater than 45% during all years 1992-2000. • Jefferson County participation in AFDC/TANF programs has continued to drop from the 1992 14.2% (33) to the 2000 total of 1.4% (3). • Mothers who smoked during pregnancy gave birth to low birthweight babies at a rate greater than twice that of non-smoking mothers; 8.6% and 3.6% respectively for 1996-2000. • In 2000, 73.2% (153) of mothers reported not smoking during pregnancy. • In 2000, 77.3% (160) of mothers reported beginning prenatal care in the first trimester; in 1998, 87.1% (171) of mothers reported beginning prenatal care in the first trimester. Socio-Economic Indicators Jefferson WA State • Estimated Median Household Income, 2000 (not from census) $34,662 $50,182 • Estimated Median Household Income, 1999 (not from census) $33,446 $48,289 • Median House Sales Prices, 2000 $174,700 $176,900 • Housing Affordability 78.1 108.4 Comments: • $34,662 was the 1998-2000 Jefferson County median household income as compared to $50,152 in Washington State. Jefferson County households earn an estimated 30% less than Washington State households. • 174,700 is the median house sale price in Jefferson County, nearly equal to the Washington State average $176,900. • The Jefferson County housing affordability index is 78.1 compared to 108 for Washington State. Given this climate of economic disparity, first time homebuyers, most often young families, are probably unable to afford to purchase homes in the county. Population Indicators (all from US 2000 census) Jefferson WA State • Growth Rate, 1999-2001 1.7% 2.5% • Population Age 65+ 2000 21.1% 11.2% • Population Age 85+ 2000 2.1% 1.4% • Median Age, 2000 47.3. 35.6 Comments: • The county's growth rate seems to have slowed to a rate below that of the state. • Jefferson County population of 65+ is nearly twice that of the state. • • Jefferson County population of 85+ is one and one-half times that of the state. • Board of Health New Business Agenda Item # V. , 3 • Update of 2002 Strategic Plan with Budget Shortfall Impacts • December 20, 2001 Vii ,4 , I c .'• • Jefferson County Health 6 Human Services 'J"Jim •l ; No, CASTLE HILL CENTER • 615SHERIDAN • PORT TOWNSEND,WA 98368 RESOLUTION NO. 01-01-HB Whereas RCW 70.05.060 assigns to the Jefferson County Board of Health "supervision over all matters pertaining to the preservation of the life and health of the people within its jurisdiction" and requires the Board to "(p)rovide for the control and prevention of any dangerous, contagious or infectious disease within the jurisdiction of the local health department"; Whereas the Jefferson County Board of Health has reviewed the "Response Capability during a Health Emergency—A Review of Selected Issues" adopted by the Washington State Board of Health on November 14, 2001; Therefore Be It Resolved, that the Jefferson County Board of Health concurs with the findings of the State Board on the need for enhanced preparedness for biological emergencies and supports the State Board's recommendations for improving state and local preparedness. • Adopted this 20th Day of December, 2001 JEFFERSON COUNTY BOARD OF HEALTH i.•i, tef,aji-- Ji uhler, Chair OriMP '5 4:12,c, (ijiti-746(Attf---,--. ,ge- - OM'AIIIMIO Sheila Westerman, Vice Chair Dan Titterness, Member (Excused) �"� GleiMember Geoffrey Masci, Member l ` `, ` 4,,,i7. A► /Cfet //, a Ric . d Wojt, . .er 1 Roberta Frissell, Member ATTEST: (>�Gt 4 , i , • Lorna Delaney, Clerk of the Boa 1 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 N2 2 .. . 2 C.) .� 0 � � ~ ^ � 2 � q o U I 0 I .y % - Q \ o U / § . / O ^' o c c- = S � � o 0 ' � -o ° \ Q § CA \ C \ / 2 \ C 22 • v) § ^ o g S ƒ o o q cd ./ ) 2 O , .5 ® � « / . VQ / § / § • a \ _\ `\ E L) Q Q / \ O / Q 2 3 CO O 222 § 7 . \ 0 § tdD / U m , U C— = Ct V q 2 ' • j CC cn / ?0 q m \ Cf � : w = e ' / a W 7 '§ 0 2 2 3 O o .- _ U % C / [ ° ± °. U L k 2 ILL j g / a _ v, . 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N Q G> ° [� • U ^O x � xQ x ¢ u) �° xa coa. xxa. a. xx (-7 SipZ • Board of Health Media Report • December 20, 2001 • Jefferson County Health and Human Services OCTOBER — DECEMBER 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. "Bioterrorism scare in PT", 2 pages, Peninsula Daily News, October 14, 2001 2. "Bioterrorism scare reaches U.S. Capitol", Peninsula Daily News, October 16, 2001 3. "Flu shot clinics announce schedules", P.T. LEADER, October 17, 2001 4. "Those at risk can receive flu vaccine", Peninsula Daily News, October 18, 2001 5. "Line up for flu shot clinic", P.T. LEADER, October 31, 2001 6. "Jefferson budget cuts `shocking", Peninsula Daily News, October 28, 2001 7. "Flu shots already given to 1,000 county residents", P.T. LEADER, November 7, 2001 8. Ad: "The Great American Smoke Out", P.T. LEADER, November 7, 2001 9. "Tests show no anthrax on PA letter", Peninsula Daily News, November 14, 2001 10. "County budget may cut jobs", P.T. LEADER, November 14, 2001 11. "Peninsula joins `Smokeout"', Peninsula Daily News, November 15, 2001 12. "CDC head speaks at health policy meeting", Peninsula Daily News, November 18. 2001 13. "Clallam mulls bioterror safety", Peninsula Daily News, November 21, 2001 14. "Mail scare fizzles at Courthouse", Peninsula Daily News, November 23, 2001 15. "The business of recycling", P.T. LEADER, December 5, 2001 16. "Reading study may aid toddlers and parents", Peninsula Daily News, December 6. ID 2001 .. ., . , ., ,, .,, ._..::::'..',:lit„' ..iu.,?...'..;z.x'..c.: . ...,... .,..:.,:,...., . ,-.. a:` ii 9.4 • • O • 4 j .:t tv,I, (77.1 i r ail . ' • `fir r.,., a E 0 0 oi • }tom .t k o 0 ---. ,•-'"Y (co' ..•• -....•••,....•• ,-1 1••C • O t','�1 - ° - .1 '' i s m R 0 I• J o •• ' '"'1, .` g is :t ... 1, HN • f 1 --1;c11;!::1t4 m CIII) ' ,c a "�' .. 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N • ' Scare: Letters from PA CONTINUED FROM Al was the result of something with the postal service's falling on the envelope,:'Owen Northwest division — who During the operation, the crew wore self-contained said. "It was a yellow powdery declined to give his name — breathin a residue." g apparatuses arrived from his home.. in The letters appeared to be Marysville. Postal inspectors Browne described the pow- der appeared to be a "caustic sent from a Port Angeles bank, serve as federal law enforce- acidic" substance. '` Owen said. . merit agents for the U.S. The discovery came in the Owen said the female clerk Postal Service. wake of anthrax scares was not wearing gloves when After learning the details she handled the two letters, on what had been found, the throughout the state and and that no policy requiring inspector conferred with the United States in recent days. employees to wear gloves or Port Townsend Fire Depart- R.J. Preston, a postal inspector at the U.S. Postal any sort of respiratory' device went,and a decision,was made Service's northwest division was in place at the post office. to call in the Washington State The bank from which the Patrol Statewide Incident headquarters in Seattle, char- letters were sent and to whom Response Team to handle the acterized the hazardous-mate- rial teams being called to Port they were addressed was not envelopes. Townsend as a precautionary disclosed. gesture. After the powder was dis- High alert all week He added that his office had covered, Owen, who was on received "hundreds" of calls duty at the,time,put on plastic The Port Townsend post - III from concerned citizens and gloves and put the mail in a office had been on high alert postal workers on Saturday separate container with a H. throughout the week, Espen- alone. She moved the container to an son said. empty office and called local Espenson said he has Reports in Seattle area authorities. received several e-mails from the Seattle area, ham_ Within 15 minutes,the Port higher-ups in the postal ser- InTownsend Fire Department vice over the past several days ardous-materials teams have had evacuated the buildin .ang, a eingshow o tos mantes and responded to a half-dozen includingfive reports of strange substances postal clerks re rand es and several mail carriers, one Employees at the Port — both liquid in the mailpowder and customer and a worker from Townsend office had been turning usp Thursday. Hanson Electric, which has an briefed twice in the past sev- elsewhereNone of the materials has office on the second floor of eral days on how to handle tested positive for anthrax, the building. such mail. though some tests were still Stationed "They handled it exactly under way. throughout day the way they were told handle The Port Townsend inci- Two Port Townsend police it," Espenson said. Owen said all mail on the ,,, dentoccurred just after the officers were stationed Olympic Peninsula is first sent post office opened at 10 a.m. throughout the day on either to Tacoma, where it is sorted Saturday, 'when a clerk came side of the Washington Street ' electronically, before it goes to upon two letters covered in building, which was cordoned the individual.post offices. residue, said Tammy Owen, off with cones and yellow plas- customer service supervisor. tic ribbon. Fire Department Owen said that it appeared personnel were also present theellow Y powder was not throughout the day. from inside the letters, but "We're in containment had possibly come from mode right now," said officer another package or elsewhere. Ed Green. "The powder seemed like it Around 3 p.m., an inspector • Bioterrorism scare 0 reaches U .S. Capitol THE ASSOCIATED PRESS • WASHINGTON — A letter sent =AffleflCa, to Senate Majority Leader Tom Daschle tested positive for anthrax RETALIATES on Monday as the bioterrorism scare rattling the nation reached the halls ■Airstrikes continue pounding of Congress. targets around Kabul/C1 The discovery of anthrax inA. Washington followed earlier inspected for anthrax contamination. instances in Florida, New York and Nevada in which at least 12 people The piece of mail in Daschle's were exposed to sporeof the poten— tially deadly bacteria. substance,was dispatched to an Army medical research facility at Fort Det- Monday night,another case of the rick, Md., for further examination, disease was announced in New York, The 7-month-old child of an ABC said Capitol Police Lt. Dan Nichols. News employee has tested positive for The Fort Detrick findings could anthrax, ABC News President David be available as early as today, offi- Westin said. The child is expected to cials said. Nichols and others recover. New York police commis- warned that the initial tests were sioner Bernard Kerik said news agen- not necessarily accurate. cies throughout the city were being TURN To TE oRJ • Scare: Study response CONTINUED FROM Al powder in the 76-story Bank of Jefferson County Commu- For information regarding America building, the city's nity Health Director Jean the threat of anthrax and tallest. Baldwin said she will discuss what to do with suspicious Initial tests were negative anthrax and other concerns at p and the streets were reopened Friday's meeting of the Jeffer- materials, visit the Jefferson about 90 minutes later, said son-Peninsula Response- County Emergency Seattle Fire Department spokeswoman Helen Fitz- Emergency Preparedness Management Web page at patrick. group, known as J-Prep. http:/jcdem.co jefferson.wa "We're having•a meeting Bathroom find with J-Prep to review bioter- .US. rorism concerns and our emer- The Bremerton ferry termi- gency response," she said. nal was shut down for more "The CDC (Centers for Dis- Church said. than five hours on Sunday ease Control in Atlanta) talks "It won't be something that after a passenger noticed a about being but alsokquietly comes out. If anything handful of white powder on aof certain calm ds of pack- tests positive, we'll hold a the floor of the women's bath- ages." press conference, but for room. everything else, the local agen- • But the powder tested neg- No anthrax recorded cies will handle." ative for any hazardous mate- Baldwin said the deadly rials, said Washington State Tim Church, communica- form of anthrax found back Patrol Lt. Helmut Steele. tions director for the state ' East last week has to be pro- Ferry'service was not affected. Health Department, said test pelled into a victim's respira- Initial tests also came back results are typically relayed tory system. �- negative on a white powder p . back to the original source, "It is most dangerous if it's found on a seat on the ferry and no substance found in in air. It has to be propelled," Wenatchee at Colman Dock in Washington state has tested Baldwin said. Seattle on Saturday night. The for anthrax. "That's very difficult to do, material was sent to the state 10 "We give the results to the thank heavens." Department of Health lab for local law enforcement agency, In Seattle on Monday, some further analysis. but if we did have a positive downtown streets were closed Q anthrax test in Washington, early Monday after a security The Associated Press con- we will let people know," guard found a container of tributed to this report. (: --' Wednesday,October 1 7, 2001 • B 7 •Flu shot clinics announce schedules Everyone wants to he first in The week of Oct. 14-20 is Townsend: For established pa- pay cash for the vaccination. line for a flu shot so they don't National Adult Immunization tients only.Dates and times to be Additional dates will be an- feel lousy or miss work or school. Week. This is a time when the announced later. nounced as more vaccine he- However, there is a good reason health department emphasizes • Olympic Primary Care, comes available. to let high-risk people go to the the need for adults to get up to 1010 Sheridan, Port Townsend: • Jefferson County Health front of the line, according to date on all their immunizations. For established patients only. Department:Friday,Nov.2,9:30 public health officials. High-risk With the delay in shipments of Call for an appointment. a.m.-12:30 p.m. people are much more likely to the vaccine this year,it is impor- •Port Townsend Family Phy- •Brinnon Booster Club:Mon- suffer complications,be hospital- tant to focus on getting your flu sicians, 934 Sheridan, Port day, Nov. 5, 10:30 a.m.-12:30 ized or even die from the disease. shot at the right time and check- Townsend: For established pa- p.m. & 1:30-3 p.m. Those at high risk include ing to se2•if you need a pneumo- tients only, 9-11:30 a.m. on two • Lutheran Church of the anyone 65 or older;children and coccal vaccine, advises Hayes. Saturdays,Oct.20 and Nov. 3. Redeemer (Tri-Area clinic): adults with chronic pulmonary or Check with your health care pro- Wednesday,Nov. 7. 9:30 a.m.- cardiovascular conditions, in- vider about what immunizations Health department clinics 1 p.m. eluding asthma, as well as those you may need. Jefferson County Health and • Gardiner Community Cen- with diabetes, renal dysfunction "Keeping a permanent life- Human Services sponsors flu ter:Tuesday,Nov. 20, 10 a.m.- or immunosuppression;residents time immunization record card is vaccine clinics throughout the noon. of long-term care facilities;chil- the best way to ensure you know county beginning in November. dren receiving long-term aspirin what immunizations you have Both influenza and pneumonia Other clinics therapy; women in their second had," says Hayes. vaccines will be available.Check • Safeway, 442 Sims Way, or third trimester of pregnancy The bottom line is this: your records for dates of previ- Port Townsend: Saturdays and during the flu season; and medi- • High-risk people: Get vac- ous pneumonia immunizations. Sundays, Nov. 3-4 and Nov. 10- cal providers who provide direct cinated as soon as flu vaccine Because many groups and ac- 11, 11 a.m.-5 p.m. Influenza 0 are to any of the above persons. is available, and check to see tivities utilize the Tri-Area Corn- costs$15; pneumonia costs$25. Due to delays in vaccine ship- if you also need a pneumococ- munity Center, health Medicare will be billed. ments,if you do not fit into these cal vaccine. department flu clinics for the Tri- QFC and the Bay Clinic are categories,you are encouraged to • Healthy people: Wait until Area take place in the Lutheran collaborating to offer influenza wait, states Dr. Maxine Hayes, at least mid-November to get Church of the Redeemer. It is vaccine clinics this year at the Washington state health officer. your flu shot. located off Chimacum Road,be- locations listed below. Influenza "We know everyone wants to tween Hadlock and Chimacum, costs $15: Medicare will be avoid the inconvenience and dis- Private clinics south of the Little League fields. billed. comfort of getting the flu,but we Many local physicians have Health department clinics • Bay Clinic, 121 Oak Bay must all take the necessary steps influenza vaccine available in charge$10 for influenza vaccine Road,Port Hadlock:Friday-Sat- to let our most vulnerable resi- their clinics during October. and$14 for pneumonia vaccine. urday,Oct. 19-20,and Saturday, dents get the shot first,"she says. Please check with your provider. Medicare and Medicaid clients Oct. 27, 10 a.m.-4 p.m. Protection develops about two The following providers have are asked to bring their Medicare • Port Ludlow Bay Club, 120 weeks after getting immunized, announced influenza vaccine cards or Medicaid coupons to the Spinnaker Place, Port Ludlow: and flu activity in Washington clinics: clinics for accurate billing infor- Friday, Oct. 26. 10 a.m.-4 p.m. usually does not peak until Janu- • Jefferson General Medical mation.Community Health Plan • Quilcene Community Cen- ary or February. Group, 834 Sheridan, Port of Washington clients.must go to ter, Quilcene: Tuesday. Oct. 23. their primary care physician or 11 a.m.-5 p.m. '-rL CZ_ • lo—/1-0 • A4 THURSDAY, OCTOBER 18, 2001 Those at can receive .1 Vaccination locations flu vacua PENINSULA DAILY NEWS Oct.26, Vaccinations are being II Quilcene Community Officials want offered in Jefferson County Center,—QuilcenQ, 11 a.m. eople with chronic at the following locations: healthy people "IJefferson County People in Clallam County medical conditions Health Department—615. can attend flu clinics at: to wait for shots residents and visitors Sheridan St., Port Townsend; w Safeway Food and Drug 9:30 a.m.to 12:30 —680 W Washington St., older than age 65, long p.m., Nov; 2. Sequim, n9Rn to 7 p.rt1„,,tkey, BY BRENDA term care residents, II Brinnon Booster Club— 2, Nov. 16, and 11 ash'.to ;5 ' PF:NINRlILA DAILN healthcare workers and Corey Lane, Brinnon, 10:30 P.m., Nov.3 and Nov. 17. pregnant women in the a.m.to 12:30 p.m.and 1:30 IN Safeway Food and Drug Vaccines for people at high- m.to 3 p.m., Nov:5. 170 Port Angeles Plaza, risk of contracting influenza— second or third trimester I Lutheran Church of the Port Mgeles, noon to 7 p.m. p. , • commonly called the flu — are are . . , encouraged to get a Redeemer—45 Redeemer Oct. 19., and 11 a.m.to 5 now available at various corn- m. Oct.20. munity agencies and stores in flu shot as soon as possible. Wax Port Hadlock, 9:30 a.m. p Clallam and Jefferson counties. to 1'p.m., Nov.7. � , � ■Safeway Food and Drug Delays in delivery and con- before flu season," Gleason Ce•erardi626 L Road 110 E Third p O �- cerns of vaccine shortages have said. y les, noon to 7 officials from the state De art PeopleGardiner, 10 a.m,to noon, 11 a.m.to 5 p.m., Oct,27; P with chronic medicalNov.20. noon to 7 p.m.Nov.9;:and 11 ment of Health strongly conditions, residents and visi ■ Safeway Food and Drug a:m.to 5 p.m."Nov.10. encouraging healthy people to tors older than age 65, long- —442 Sims Way, Port ■Jim's Pharmacy—424 wait until later in the year to term care residents, healthcare get a flu shot. workers and re Townsend, 11 a.m.to 5 p.m., East Second'St., Port Ange ?vlost clinics have received in the second or third trimester Nov. 11. III Forks Community Hos- P grant women Nov.3 Nov, .4, Nov. 10 and les, 3 p.m:'to°5 p.m , Oct. 19. only partial donations of the are classified as high risk and ■ Bay Clinic 121 Oak pita)—530 Bogachiel Way, vaccine," Department of are encouraged to get a flu shot y , Port Hadlock, 10' Forks, 2 p.m.to 6 p.m., Mon Health Health Educator Cind possible. Ba Road Gleason said. y as soon as a.m.to 4 p.m., Oct. 19, Oct. day through Friday. "We expect to have enough P Pharmacistspreported most 20 and Oct.27. Officials at other health g eo •le are adhering to the ■ Port Ludlow Bay Club, care clinics, stores and phar flu vaccine to meet state pro- request by health officials,with Spinnaker Place, Port macies will announce clinics gram needs." — 120 S inn the majority of those getting Ludlow, 10 a.m.to 4p,m., as they receive vaccines. Flu season the vaccine being older than 65. The high-point of the flu The average price for the flu season for the state doesn't vaccine is$15,officials said.An begin until January, allowing additional pneumonia shot healthy people to wait for the costs $25. Both shots are cov- second or third batch of vac- ered by Medicare. cine to be delivered, officials Delivery of vaccine depends said. on which manufacturer an "There will be plenty of time agency orders from, Gleason for others to get their flu shots said. 1111 • Port Townsend&Jefferson County Leader • ine u or u s o c inl Flu shot clinics in Jefferson their clinics. Please check with • Other clinics also have flu pay cash for the vaccination. County are being scheduled,with your provider. The following vaccine available for their pa- Additional dates will be an- health officials urging that high- providers have announced influ- tients. Call your provider. nounced as more vaccine be- risk people be first in line for the enza vaccine clinics: comes available. Call 385-9429 service. • Jefferson General Medical Health department clinics for information. Those at high risk include Group, 834 Sheridan, Port Jefferson County Health and • Jefferson County Health anyone 65 or older;children and Townsend: For established pa- Human Services sponsors flu Department:Friday,Nov.2,9:30 adults with chronic pulmonary or tients only. Dates and times will vaccine clinics throughout the a.m.-12:30 p.m. cardiovascular conditions, in- be announced later. county beginning in November. •Brinnon Booster Club:Mon- cluding asthma,as well as those • Jefferson Medical Associ- Both influenza and pneumonia day, Nov. 5, 10:30 a.m.-12:30 with diabetes,renal dysfunction ates, 617 Sheridan, Port vaccines will be available.Check p.m.& 1:30-3 p.m. •or immunosuppression;residents Townsend: Every day for estab- your records for dates of previ- • Lutheran Church of the Re- f long-term care facilities;chil- lished patients age 65 and over. ous pneumonia immunizations. deemer(Tri-Area clinic):Wednes- dren receiving long-term aspirin Call for an appointment. Because many groups and day,Nov.7,9:30 a.m.-1 p.m. therapy; women in their second • Olympic Primary Care, activities utilize the Tri-Area • Gardiner Community Cen- or third trimester of pregnancy 1010 Sheridan, Port Townsend: Community Center, health de- ter: Tuesday, Nov. 20, 10 a.m.- .during the flu season;and medi- For established patients only. partment flu clinics for the Tri- noon. cal providers who provide direct Call for an appointment. Area take place in the Lutheran care to any of the above persons. •Port Townsend Family Phy- Church of the Redeemer. It is Pharmacy-sponsored sicians, 934 Sheridan, Port located off Chimacum Road, clinics Private clinics Townsend: For established pa- south of the Little League fields. • Safeway, 442 Sims Way, Many local physicians have tients only, 9-11:30 a.m. Satur- Health department clinics Port Townsend: Saturdays and influenza vaccine available in day,Nov. 3. charge$10 for influenza vaccine Sundays,Nov. 3-4 and Nov. 10- and$14 for pneumonia vaccine. 11, 11 a.m.-5 p.m. Influenza Medicare and Medicaid clients costs$15;pneumonia costs$25. are asked to bring their Medicare Medicare will be billed. cards or Medicaid coupons to the •'QFC, 1890 Irondale Road, clinics for accurate billing infor- Port Hadlock:Thursday,Nov. 1, mation.Community Health Plan 11 a.m.-5 p.m. Influenza costs of Washington clients must go to $15;pneumonia costs$30.Medi- their primary care physician or care will be billed. • 10- 3(- o / 0C) �' s. s..' rn O •C C a) 0 cuN ° ° C '�� a) .O , � w , O L. 0) c.. c.. • O 0LD E 0) E E•-4 . .b . , C U cro a -oa _ cal w -Et". 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En Cl) o en ..,m 4...,- a) n -0.5 III Fl u shots alr to 1,000 county residents Flu shots have been adminis- Approximately 79.6 million QFC cooperated with the The following health depart- tered to more than 1,000 doses of flu vaccine will be pro- health department to offer its own ment flu clinics are scheduled: Jefferson County residents fitting duced this year,more than in pre- flu shot clinics in Port Ludlow, • Tri-Area clinic at Lutheran the definition of"high-risk"pa- vious years,but some will not be Port Hadlock and Quilcene. Church of the Redeemer,Wednes- tients,and the second wave of flu delivered until December. From Oct. 10 through Nov. 1, day,Nov.7,9:30 a.m.-1 p.m. shot clinics is just beginning. Those at high risk include QFC administered 726 flu shots • Jefferson County Health & Getting a flu shot is an impor- anyone 65 or older;children and to people fitting the "high risk" Human Services,Port Townsend, tant way to fight the flu,but some adults with chronic pulmonary or definition. people may find they have to wait cardiovascular conditions, in- Michael Son, pharmacy 2:30 P my' Nov. 14, 9:30 a.m. their turn;high-risk patients have cluding asthma,as well as those manager for the QFC store in • Gardiner Community Cen- priority. with diabetes,renal dysfunction Bellevue, helped the Port ter, Tuesday, Nov. 20, 10 a.m.- The Washington State Depart- or immunosuppression;residents Hadlock QFC pharmacy staff noon. likement of Health urges healthy of long-term care facilities;chil- the Jefferson County clinics. • Quilcene Community Cen- ople under the age of 65 to wait dren receiving long-term aspirin "The response is really phe- ter, Thursday, Nov. 29, 10:30 ntil mid-November or later to therapy; women in their second nomenal," Son said. "Your a.m.-12:30 p.m.and 1:30-3 p.m. be vaccinated.Shipping and pro- or third trimester of pregnancy health department is awe- Health department-sponsored duction schedules mean that during the flu season; and medi- some," he noted, in providing clinics are$10 for influenza vac- stocks of flu vaccine will arrive cal providers who provide direct help and referral information. cine,and$14 for pneumonia vac- in partial shipments through No- care to,any of the above persons. Port Townsen,d,'k,,$,afew,ay cine. Medicare and Medicaid vember and'December. Jefferson County Health & y store offered flu shots on Nov.3= clients are asked to bring-their Jane Kurata, a public health Human Services will continue to ' 4 and will repeatthe service this Medichre Cards or Medicaid cou- nurse with Jefferson County hold flu vaccine clinics through- coming weekend,Nov. 10-11, 11 pons to the clinics for accurate Health & Human Services, said out the county in November and a.m.-5 p.m. Dave O'Connor at billing information. Community providers have been asked to pri- December. Both influenza and the store pharmacy didn't have Health Plan of Washington cli- oritize initial shipments for high- pneumonia vaccines will be specific numbers, "but it was a ents must go to their primary care risk patients,including the elderly. available.The health department steady stream all weekend.They physician, or pay cash for the "Washington's flu season usu- advises checking records for ran out of vaccine,"he said. vaccination. ally starts in January or Febris- dates of previous pneumonia The health department's first Call 385-9429 for the latest ary,so there is plenty of time for immunizations.As more vaccine flu shot clinics Friday,Nov.2 and flu clinic schedule, or check the healthy people under age 65 to arrives,more clinic dates will be Monday,Nov.5 provided nearly Jeffferson County webs ite, be vaccinated," Kurata said. announced. 400 inoculations. www.co.jefferson.wa.us. ll- 7- o i WEDNESDAY, NOVEMBER 14, 2001 A3 • Tests show no anthrax on PA letter Suspect office, 424 E. First St., after a woman —on the bacteria advice of her doctor - requested that a letter with a New Jersey post- not found mark be tested. Officials did not release . BY BRENDA HANRAHAN the identity of the woman. PENINSULA DAILY NEWS PORT ANGELES — Woman became ill Prelimi- nary � • -': The woman had anthrax ., received the envelope from tests on a a known source two weeks letter earlier and became ill after received by �` , �= a local rest sti ` opening the letter, officials dent who became ill ft Health and postal offi- after open- tit, cials declined to comment ing it haveon the woman's current come back ' . ` % '`, medical condition. negative. -- Clallam Locke Initial testing at the County post office by the Fire health officials said Tues- Department determined day that testing included a the letter was not radioac- microscopic examination of tive. the letter at the Was ton State Public Heath hing Health regulations require the radioactivity Laboratory in Shoreline. test before items are taken to the Shoreline laboratory. Illness not from letter Locke said there have been no illnesses re "I can conclusively say from letters coming fromd that her illness is not from New Jersey. the letter," Clallam County Locke said the 22 con Health Officer Dr. Tom Locke said. firmed or suspicious cases of anthrax in other states But the lab is continu- ing to monitor the culture all involved people who to see if anything grows on worked in environments it, Locke said. where anthrax was Additional results could detected. be released today. All postal items tested "With anthrax,you in Washington state have would expect to see growth tested negative for anthrax, and Locke said it after 12 hours," Loc{e said. "The culture has would be highly unlikely • been monitored for four that routine mail items are days and it would be contaminated. highly unlikely for prelimi- "We are still urging peo- nary results to change." ple to follow suspicious On Nov. 7, police and mail criteria set by the FBI fire officials were called to and U.S. Postal Service," the Port Angeles post he said. • County may jobs By Shelly Testerman Leader Staff Writer Those unfilled positions that Saddler said. "The bear in the are essential — such as a build- Commissioner Dan Titterness ing inspector — may be subject interrupted Saddler's discussion When it comes to naming living room is to tradeoffs, with their funding the largest expense category in of expendable programs with i Jefferson County government, salares and contingent on not funding other this comment: County Administrator Charles proposedupositions,Huntingford "I think you've done an ex �� suggested. cellentjob of dancing around the Saddler doesn't hesitate: "Our benefits biggest cost is people,"he said. Staff positions are not the bear in the living room," the So paring 2002 budget ex- Dan Titterness only target of the budget-cutting commissioner said, "and the scythe. penses is going to involve ask- county commissioner bear in the living room is sala- ing all county departments to `The bottom line is we're go- ing to have to be looking the ries and benefits." at make a 1 percent reduction inAlthough the county has tip- 2002 personnel costs and a 2.5 Slimming the county's per- anddsding of ervices thatous program we provide," toed around the large and un- percent reduction in all other sonnel ranks could be part of a Saddler said Friday, friendly beast every budget costs.Some"discretionary"pro- long-term strategy to decrease Although county govern- cycle, Titterness said a "reor- grams may be cut as well. expenditures. ments are mandated to provide ganization" of county govern If allowed to continue, the When the Board of County many programs, many are pro- ment may now be necessary in trend of 5 percent growth in Commissioners met Friday vided at the commissioners'dis- order to prepare the county for salary/benefit expenses and 4 with Saddler and Deputy cretion. the next few fiscally challeng • percent growth in overall costs County Administrator Gary "Discretionary" expendi- mg years. means the county could face a Rowe, Saddler said the board tures include the county's con- proposal "I'd like to see some ro al $1.5 million shortfall in 2006. had the prerogative to target tributions to the Washington for reducing staffirtgsomewhere. The 2002 base budget, for- specific staff positions for State University Learning Cen- It looks to me like we're going mulated with numbers submit- elimination, but he recom- ter in Port Hadlock,the animal to have to face that,"Titterness ted by county departments, mended leaving that responsi- shelter and neighborhood said. "If we don't face it this lists nearly$12.1 million in ex- bility to the department heads. parks. year, next year it's going to be penditures but only $11.6 mil- The board readily agreed. "It pains me to say it, but worse." lion in revenues. However, Commissioner parks and recreation is the big- Saddler is scheduled to And while the budget could Glen Huntingford scrutinized a gest discretionary expense we present his proposal for a bal- be easily balanced this year, list of unfilled positions—rang- have in county government," anced budget by Nov. 21. county officials are concerned ing from sheriff's deputies to an with forecasted declines in state enforcement officer for the De- funding and constraints placed partment of Community Devel- on local property tax revenues opment — saying, "We need to with the passage of Initiative take a look at these and cut 'em 747. out." Lei,pEe_ ii_ itiL_ 6 ( • joins eninsuIa Drive urges young, old puffers "$mOkin g is really an son stops smoking, the oxygen level in their blood increases to drop tobacco like a bad habit addiction and should be and the carbon monoxide level treated like one. It is in blood drops. After 24 hours. the chance of a heart attack BY BRENDA HANRAHAN "Smoking is really an addic- amazing how fast results begins to decrease. PENINSULA DAILY NEws tion and should be treated like from quitting smoking can Stopping smoking can In observance of today's one," she said. "It is amazing decrease the Iikelih�,tni „f Great American ofStodaut, how fast results from quitting be seen.' heart disease and lung, mouth. officials in Clallam County smoking can be seen." RENE MARTINEZ larynx, esophagus, bladder. Clallam County health offs Clallam County health official have organized a no-smoking kidney and pancreatic cancer. campaign dubbed "Commit to cials estimated 12,500 adults she said. and 1,200 youths smoke. In smoking by pregnant women. There are several help lines Quit: Do it For Yourself, Do it Jefferson County, approxi- That can cause low birth available to people who cannot For Your Family." mately 5,200 adults and 540 The Tobacco-Free Clallam weight and greater suscepti- make it to today's meeting, County Community Coalition youths smoke. bility to asthma and upper res- Martinez said. will host an informational and In addition, 1,500 adults piratory infections, Martinez The state Department of celebratory meeting in the and 500 children and teen- said. Health can be reached toll-free basement conference room of agers use smokeless-tobacco by calling 877-270-STOP the Clallam County Court- products in Clallam County. Health effects Spanish-speaking residents house, 223 E. Fourth St., from In Jefferson County, 640 should call 877-2N0-FUME. adults and 230 youths use Studies show that some Locally, Clallam County 4 p.m. to ll p.m. positive effects kick in about stop-smoking"WW e will hand out various smokeless tobacco. sto Smokin officials can be informational pamphlets Each year, 150 Clallam 20 minutes after a person contacted at 360-565-2608. about smoking and invite peo- County. residents will die. of stops smoking. Theft .puttee In addition to Clallam who have successfully quit tobacco-related illnesses. Fifty and blood pressure rates health services, there are sev- share their stories," said people are expected 'to die return to normal and the tern- eral support groups including Rene Martinez, Clallam from related complications in perature of their hands and The Sequim Support Group I County Department of Health Jefferson County. feet increases as circulation For Quitting, Stop Smoking and Human Services tobacco One of the greatest prob- improves. Now, West End Quit Tobacco prevention specialist. lems in Clallam County is About 8 hours after a per- Class, and Makah Groups. SYN i(_ ( ,---o j . • • • 1111 CDC head speaks at healthmeeting THE ASSOCIATED PRESS public health agencies must ut the public be prepared for emergencies SEATTLE—During a crisis, local and state public health system has such as an anthrax outbreak health agencies need to take long been —a criminal action that the lead, and the federal gov- can't be predicted and may ernment will follow in sup underfunded although be repeated until the person port, the head of the Centers things could change in sending the tainted letters for Disease Control and Pre- light of the events that has caused four deaths vention said Saturday. is caught. But the public health sys- following Sept. 11. The CDC also has scram- bled to be prepared to back tern has long been under Seattle. up those agencies. funded, although things� "We'll be next to them, could change in light of the The federal health care events following Sept. 11, Dr. agency "is only as strong as them,witthem, ina said. of Koplan said. Jeffrey Koplan said via a the local and state health State health departments teleconference link at the departments," Koplan said should be funded in the National Conference of.State from CDC headquarters in same manner as the fire Legislatures' 5th annual con- Atlanta. department or police depart- ference on health policy in He said local and state ment, Koplan said. PZid / 1— ( 2' —01 • • • Clallam mulls bsafety ty Health, emergency officials discuss for anthrax and other diseases. Coast (to facilities that have The local response to that received anthrax), that really anthrax risk, response capabilities threat was what "we had envi- their risk of anthrax is virtu- sioned doing," Locke said. ally zero." BY EMELINE COKELET bioterrorism is all about," The county developed its County health officials have PENINSULA DAILY NEWS Locke said. first bioterrorism emergency sent Centers for Disease Con- On Tuesday, Locke met protocol Oct. 16, just seven trol information to doctors and PORT ANGELES — Clal with county emergency man days after the nation's first healthcare providers about the lam County health officials ager Joe Ciarlo, Port Angeles anthrax-laced letter was differences between anthrax and emergency responders are Fire Department Chief Dean mailed, Locke said. and the common cold. working to finalize county pro- McKeen and two county envi- "We're trying to help physi- tocol on bioterrorism threats. ronmental health officials to Modifications With anthrax still a threat, cians be prepared for those finalize emergency bioterror- The county has continued questions," Locke said. the newly adopted state Board ism protocol for county "first to modify its response since of Health policy for dealing responders"—members of law then, he said. with bioterrorism, county enforcement, fire districts and "We've been modifying it as Health Officer Dr. Tom Locke county personnel that respond things develop." to potential bioterrorist Tuesday's revised protocol told the county Board of Health on Tuesda . threats. will be y presented to county "We've been modifying that Recent anthrax scares ` first responders next week, protocol to fit with our local Locke said. circumstances," Locke said. The county's protocol is With flu season starting, Washington has a disaster based on experience in han- Locke told the Board of Health preparedness system, which is dling recent anthrax threats, that some people exhibiting • mostly for natural disasters, including a package a woman, flu-like symptoms might mis • chemical spills and mass casu- brought to the Port Angeles take them as signs of anthrax. alty events, Locke said. post office that she thought Anthrax symptoms are Last week, the state health came from a New jersey post almost indistinguishable from board adopted a bioterrorism office where inhalation upper respiratory infections response protocol to be added anthrax was present earlier and flu-like illnesses, though to its plan. this month, Locke said. people with anthrax usually "What we're trying to do is "This was the first time don't get runny noses or sore bring that system up to speed that particular situation had throats, he said. with the unique category of come up in the state," Locke "We're telling people that deliberate infectious disease said. unless they've had some kind . outbreaks, which is what The package tested negative of exposure out on the East Pt'Ai //—OR_/— o 1 • • Fl- if r,.. .: . • • � }, ,. .fir - + • :. • -Y h ,�. , • .. 4. r _} 1 ,..7..-. -.,..,. . ..,-, ti 1 1 ';..:;•,-:mit...- . • -1(k . li 4 t _ ft• '�v a 7 y .✓ /1 — PHILIP L WATYEsslPENINiu LA DAILY VEws Jefferson County Sheriff's deputies Don Johnson, left,and Alex Mintz discuss a plastic bag containing a suspicious letter discovered Monday in the Treasurer's Office. %J Mail scare ,,. • fizzles at Courthouse Mystery dust Port Angeles return address. That scare prompted local author- found to have ities to cordon off the building and to call in a Washington State Patrol hazardous materials response team. mundane origins No toxic threat BY PHILIP L.WATNESS That letter was sent to the state PENINSULA DAILY NEWS Health Department lab for analysis. PORT TOWNSEND — Powder- The study found no toxic threat,and covered tape and discolored stains on the post office reopened around noon a green envelope prompted a scare at Monday. the Jefferson County Treasurer's Treasurer Judi Morris said the Office in the county Courthouse. staffalse knewklarm what to doess withproa d suspi- The - envelope, which arrived in staff vto a Monday morning's mail, had all the cious" envelope. any- unusual markings of a suspicious let- We're relieved that it wasn't thing, but it was smart to take pre- ter. caution,"she said. A worker put it into a plastic bag "We know what works and doesn't and contacted county Safety Officer work,and we will know exactly what Mark Bowes. to do the next time." County officials contacted the U.S. Morris said the envelope was one Postal Service in Seattle,which sent of hundreds of green payment an investigator to the return address envelopes,provided for the return of listed on the letter. property tax payments. P D • An elderly man explained that he She said the office will receive A.) had spilled gin on the envelope, anywhere from 300 envelopes to 500 which contained his property tax envelopes daily for about the next (b 2.3- 0 payment. two weeks. Then he sealed it with double- The payment deadline is Oct.31. sided tape. To reduce the stickiness ---Deputy County Administrator he put talcum powder on the tape. Gary Rowe said the precautions No one was evacuated, and the taken by the Jefferson County Trea- emergency response wasn't near the surer's Office were appropriate. level a week ago when a worker at "We hope it won't happen again, the Post Office discovered a yellow but we will be better prepared if it powder outside an envelope with a does,"he said. Jefferson County Tobacco News provided by: PRESORTED Tobacco Prevention & Control Program STANDARD Jefferson County Health & Human Services U.S. POSTAGE PAID 615 Sheridan PORT TOWNSEND, WA Port Townsend, WA 98368 PERMIT NO. 45 • 360-385-9446 File Copy BOH 615 Sheridan Port Townsend WA 98368 X rResources Resources Resources Resources Resources Resources Resources Resources Resources Resources Resources A Consumer's Guide to Nicotine Replacement Therapy(brochure), posters, literature, & goodies-360-385-9446 Freedom From Smoking Cessation Clinics at Jefferson General Hospital-360-385-2200 The Low—Tar Lie tar and reducing risk is "deceptive" Americans to use these 1 and smokers' choice of these products thinking they were On November 27, 2001, the products as an alternative to quitting safer. It is critical that a National Cancer Institute (NCI) makes this deception an "urgent major public education I released a comprehensive new public health issue." campaign be initiated to report detailing the 50 year history counter these , of light and low-tar cigarettes and Smokers of light products misconceptions. their impact on the public's health. block ventilation holes; inhale The terms "light", "low tar" and "ultra The report is the most more deeply; take larger, more light" are deceptive and should be comprehensive and conclusive rapid, or more frequent puffs; eliminated. It is time to end the ever showing that there is no or increase the number of special exemption tobacco receives health benefit to smoking light and cigarettes smoked per day. from oversight by the U.S. Food and low tar cigarettes. In other words, smoking "light" cigarettes carries Drug Administration (FDA). the same risk of lung cancer, There are two clear messages to be Congress should grant the FDA heart attacks and other tobacco- taken from this groundbreaking new authority to regulate tobacco caused disease as regular report: products, including the ability to ban the terms "light", "ultra-light" and cigarettes. The report also concludes that the marketing of If smokers are concerned about their "low-tar." Until Congress acts, we these products as delivering less health, there is only one solution - to call on the tobacco industry to do so quit smoking. There is no significant on their own. If you are concerned about health difference between any of the • your health, quitting is your cigarettes currently on the market. View the entire report at the only choice. Low-tar and light Misunderstanding of the health National Cancer Institute at cigarettes are not safer than implications of the terms "light" and http://cancercontrol.cancer.gov/tcrb/ other cigarettes on the market. "low-tar" have led millions of nci_monographs/MONO13/ Healthcare Provider Education c H Whether you are a physician, The "5 R's," Relevance, Risks, Rewards cupuncturist, massage therapist or Rewards, Roadblocks, and The clinician should ask the patient to her type of healthcare provider, Repetition, are designed to motivate identify potential benefits of stopping `Ihe following models recommended smokers who are unwilling to quit at tobacco use. The clinician may by the U.S. Surgeon General's this time.After asking about tobacco suggest and highlight those that seem office, can provide additional use, advising the smoker to quit, and most relevant to the patient. Examples motivation for quitting tobacco assessing the willingness of the include: smoker to quit, it is important to • Improved health The "5 A's," Ask, Advise, Assess, provide the "5 R's" motivational • Food will taste better Assist, and Arrange, are designed intervention. • Improved sense of smell to be used with the smoker who is willing to quit. Relevance • Save money Encourage the patient to indicate why • Feel better about yourself 1)Ask—Systematically identify all quitting is personally relevant, being as • Home, car, clothing, breath will smell tobacco users at every visit. specific as possible. Motivational better Implement an office wide system that information has the greatest impact if it • Can stop worrying about quitting ensures that, for every patient at every is relevant to a patient's disease status • Set a good example for children clinic visit, tobacco-use status is or risk, family or social situation (e.g., • Have healthier babies and children queried and documented. Expand the having children in the home), health • Not exposing others to smoke vital signs to include tobacco use or concerns, age, gender, and other • Feel better physically use an alternative universal important patient characteristics identification system. (e.g., prior quitting experience, Roadblocks 2) Advise—Strongly urge all tobacco personal barriers to cessation). The clinician should ask the patient to users to quit. In a clear, strong, and identify barriers or impediments to personalized manner, urge every Risks quitting and note elements of treatment tobacco user to quit. The clinician should ask the patient to (problem solving, 3)Assess—Determine willingness to identify potential negative g consequences of tobacco use. The pharmacotherapy) that couldill make a quit attempt. Ask every address barriers. li clinician may suggest and highlight acco user if he or she is willing to those that seem most relevant to the Typical barriers might include: ake a quit attempt at this time (e.g., patient. The clinician should • Withdrawal symptoms within the next 30 days). emphasize that smoking low-tar/low • Fear of failure 4) Assist—Aid the patient in quitting nicotine cigarettes or use of other • Weight gain Help the patient with a quit plan. forms of tobacco (e.g., smokeless • Lack of support Assisting patients in quitting smoking tobacco, cigars, and pipes) will not • Depression can be done as part of a brief eliminate these risks. • Enjoyment of tobacco treatment or as part of an intensive treatment program. Even an Examples of risks are: shortness of Repetition intervention lasting fewer than breath•asthma•infertility•harm to The motivational intervention should be 3 minutes is effective. pregnancy•impotence•heart repeated every time an unmotivated 5)Arrange—Schedule follow-up attacks•strokes•lung and other 9 P patient visits the clinic setting. Tobacco contact, either in person or via cancers (larynx, oral cavity, pharynx, users who have failed in previous quit telephone. Congratulate success. esophagus, pancreas, bladder, cervix) attempts should be told that most chronic obstructive pulmonary people make repeated quit attempts diseases (chronic bronchitis and before they are successful. emphysema)•long-term disability.low Washington's Tobacco birth weight SIDS, asthma and Adapted from Clinical Practice Toll Free Quit Lines respiratory infections in children of Guideline Treating Tobacco Use and smokers. 1 -877-270-STOP Relapse Prevention Acknowledge Challenges Espanol (Llamada Gratuita) Did you know that most relapses • Holiday Stress/Depression - T 2 U M E occur within the first three months • Weight Gain after quitting? • Cravings Remember the benefits • Others using tobacco in home • TTY/TDD • Save Money Plan for challenging situations Users: • Cleaner lungs l • Drink Water 877777 1- - • Stronger Heart 11 f • Decrease Alcohol/Coffee -6534 • Purer Blood "� • Deep Breathe • Do Something Else Volume 1,Issue 3 Page 3 Jefferson County Tobacco News • December, 2001 Volume 1 , Issue 3 SmokingBarriers to Quitting and health care provider and try Women and _ . Women join smoking cessation to quit again. groups more often than men for • The first six months after quitting social support, but they are smoking are the most difficult. Why It's Important for Women to somewhat less successful than • The only short-term consequence Quit Smoking men in quitting smoking. of quitting smoking is a modest • Coronary heart disease is the#1 • Pregnant women may have weight gain of 5 to 10 pounds. killer of women in ample motivation to quit smoking, • Within 24 hours of quitting, the the U.S., and k but few have access to smoking risk of having a heart attack cigarette smoking At cessation programs tailored to decreases. doubles the risk. their maternal condition. • Within 1 year of quitting, the risk • Women smokers How to Quit of having heart disease is half show an increased • Have realistic expectations. that of a smoker. '-!N rate of heart attacks, cancer, oral Remember that many women • Within 10 years �- diseases, and lung conditions. need to try to quit up to three of quitting, the --?0:u� • Smoking may impair fertility. times before they finally succeed. risk of dying t • Smoking during pregnancy • Don't get discouraged if you from lung cancer is / �'' increases the risk of miscarriage, temporarily go back to smoking. about half that of a continuing stillbirth, preterm delivery, and Pick another quit date, get smoker. low birth weight. support from your family, friends, Adapted from http://www.4woman.gov/ • Retailer Education Compliance Checks annual compliance checks, also A local retailer asks: What Public Health's tobacco compliance known as `stings'. All of the should a clerk do if they suspect checks assess whether retailers sell tobacco retailers checked passed that a customer is buying tobacco to minors. "Compliance" with flying colors. Congratulations tobacco for minors? means the retailers obey the law to: Wbacington State Tobacco and refuse to sell tobacco to youth. Beaver Valley General Store Prevention and Control Program To conduct compliance checks, Brinnon General Store staff advise that clerks do the teams of young people go out with Cove RV Park following: Public Health staff and attempt to Discovery Bay Grocery • Ask the person for identification purchase cigarettes from randomly Nordland General Store • Write the name, address selected retailers in a community. If Peninsula Foods and ID down of the customer a retailer refuses to make the sale, a PennySaver • andCalthe of t Washington StaterLiquor congratulatory certificate and an Port Hadlock Jackpot Control hotline at 1-888-838-3956 educational packet with new signs is Port Hadlock QFC presented to the retailer. If an illegal Port Ludlow Marina & Grocery to phone in tobacco or alcohol sale is made, the Public Health Port Ludlow Village Store related complaints. employee gives the retailer an Port Townsend Jackpot This hotline provides the educational packet with a Port Ludlow Marina & Grocery Washington State Liquor Control notification that they can expect a Quilcene Grocery 1, Board with more tools to assist in visit from the State Liquor Control Safeway identifying places selling liquor and Board for further follow up due to the Sea Breeze akiga to minors, sellingviolation of the law. Grocery Wntaxed contraband cigarettes, or Smoker FriendlyAlli• over serving liquor. June/July, 2001—The Jefferson Templeton's LBC agents will follow up. County Tobacco Prevention and Village General When in doubt, refuse to sell. Control Program conducted its Store E.rap w Yo-tala Ito /make fleafflaj Choices Teachers, Coaches, and Mentors: Take advantage of teachable Tobacco History you may feel alarmed at the number of moments! Help young people understand the kids smoking or chewing tobacco in our Teachable moments can occur in the history of tobacco. Explore how • community. You might even hear classroom, at family meals, watching indigenous people used yourself saying things like "Where do TV, in the car, on the sports field, at tobacco in sacred they get the stuff—don't they know how practice, after ceremonies. Discuss damaging tobacco is—don't they know competitions. Teachable moments the introduction of _X----* IS stupid they look?" create an opportunity for open dialogue tobacco in Europe by r:'" . i about issues faced by kids and families. Jean Nicot, French Maybe you have struggled with your Where TV or videos Ambassador. own or a family member's tobacco characters smoke or /\56:%,0 addiction. The powerful cycle of chew, try some Encourage students to consider the addiction is felt by those near the sentence starters— impact of the invention of the center. The roller-coaster ride of • How long do you _ — cigarette-manufacturing machine by nicotine withdrawal includes feelings think that person has James Bonsack in 1884. Also think ranging from irritability, anger, and been smoking? about pioneer packaging introduced hostility to teary, sad, and depressed— • What happens to kids/people who by Washington Duke who included the relapse is common. Tobacco users smoke? first baseball cards in cigarette packs. average quitting 5 to 7 times before • How much does a person spend on they stay quit for good. tobacco? (FYI: A pack-a-day smoker Tobacco and Science spends over$1800/year on Bring real organs into the classroom to Perhaps you have lost a loved one to make unforgettable health and cigarettes) lung cancer, emphysema, heart • What can that much money buy? science presentations. For ideas, disease, breast and cervical cancer or contact Weird Science at 385-2285 or other lifestyle illnesses through life-long • Why is tobacco sold if it is so bad for thaddeus@scn.org. tobacco use. You may remember how peoples' health? that very active person became less Share your classroom projects with active the longer they smoked or Building Blocks of Health others via Jefferson County Tobacco Cardiovascular and respiratory fitness III chewed. p ry News—forward to happen when people are involved in kragan@co.jefferson.wa.us Nicotine is a highly addictive regular physical activity 3-4 times a substance—decades of research week. As a parent, coach, or PE validate this. Kids who start using instructor, you can: tobacco in their teens often find • Teach kids about the benefits of • More than 4,000 individual themselves still smoking as adults in aerobic activity—heart beats faster compounds have been identified in their 30's...and not because they and works more efficiently. tobacco and tobacco planned to keep using tobacco. • Help kids learn to take their pulse— smoke. You wonder"How can I teach kids resting and training • Among these are about It about the dangers of tobacco use?" • Make your activities kid-fun and kid- 60 compounds that are ev You want kids to stay healthy—you are friendly carcinogens,tumor a caring adult and you are not alone. initiators and tumor promoters So how can you include tobacco Tobacco Economics education in your interactions with kids? Explore how tobacco crops affect state, national and global economy. ■ • CHECK O UT TRE WEB Surgeon General Biolnteractive • • ■ American Legacy Foundation www.surgongeneral.gov www.biointeractive.org/ • www.americanlegacy.org The Truth Microbe Gallery ■ • American Cancer Society www.wholetruth.com www.microbeworld.org • • ■ www.cancer.org Tobacco-Free Kids • American Heart Association www.tobaccofreekids.org Cessation Resources ■ • www.americanheart.org WA Department of Health I Quit Online— ■ • • American Lung Association www.doh.wa.gov/tobacco www.wholetruth.com • ■ www.lungusa.org BrainPop Quitnet— ■ ■ Centers for Disease Control www.brainpop.com www.quitnet.org ■ www.cdc.gov/tobacco Eisenhower National Clearinghouse ThriveOnline— ■ Environmental Protection Agency www.enc.org www.thriveonline.com■ • www.epa.gov/iaq/ets/ Virtual cell- Youth cessation— Outrage Avenue personal.tmlp.com/Jimr57/tour/cell/cell. www.stop-tabac.ch/en/ •• w www.outrageavenue.com htm Committed Quitters— • www.committedquitters.com ■ NACCHO - News and Updates Page 1 of 2 • home news about naccho calendar jobs site map search n a cc-ho - s umembers corner NATIONAL ASSOCIATION or c.OL4TY AND CITY HEALTH OFFICIALS MEMBERSHIP I BOOKSTORE I NACCHO TOOLS IPROORAMSU PUBLIC HEALTH ADVOCACY NEWS AND UPDATES 11' PRESS RELEASES Congress Earmarks $865 million for State and Local Public Health Capacity 12/20/01 The House of Representatives today ratified supplemental spending to address bioterrorism. Senate passage is expected by the end of the day. These funds are in addition to the regular FY2002 appropriations for HHS, on which Congress also agreed this week. The supplemental spending is part of the $40 billion that Congress voted to spend shortly after September 11. The total to be spent on public health and bioterrorism activities is $2.5 billion, of which $865 million is earmarked for state and local capacity. The conference report language that specifies how these funds are to be spent appears below. The references to Sections 319B, 319C and 319F refer to last year's Public Health Threats and Emergencies Act, which provides for grants to states and localities to assess core public health capacity(319B), grants to • improve core public health capacity (319C) and grants for bioterrorism preparedness (319F). Congress authorizes the Secretary (of the Department of Health and Human Services)to waive the competitive aspect of these grants and requires that a plan for expending the funds be provided 15 days following enactment. This legislation represents a significant accomplishment for NACCHO and meets our legislative objective of providing funding for core local public health capacities alongside bioterrorism preparedness, as well as gaining flexibility for HHS to get funds out rapidly. THANK YOU to all of you who were so responsive and active in advocating for this funding. Your dedication during such a hectic and trying time has been the key to our collective effectiveness as voices for local public health. Language from Congressional conference report on bioterrorism spending: "The agreement includes $865 million for upgrading state and local capacity, instead of$423,000,000 as proposed by the House and $1,000,000,000 as proposed by the Senate. The conferees concur with language in the House report recommending that a portion of this funding be provided under the authority of Sections 319B, 319C and 319F of the Public Health Service Act, as amended. • The conferees believe that a portion of this funding should be available immediately to meet the needs of state and local health departments as a result of the September 11, 2001 attacks and other subsequent events related to terrorism. The conferees also believe that a portion of this funding should be granted under the authority of the Public Health 12/20/01 NACCHO -News and Updates Page 2 of 2 Threats and Emergencies Act, which calls for assessments of public health needs, provides grants to State and local public health agencies • to address core public health capacity needs, and provides assistance to State and local health agencies to enable them to respond effectively to bioterrorist attacks. The Secretary is requested to provide a plan to distribute this funding within 15 days of enactment of this Act. The conferees concur with language contained in the House report directing the Secretary to provide a report on the State of the Nation's public health and medical preparedness for bioterrorism. The conferees further believe that the peer review of competitive grants required under 319C, while desirable under normal circumstances, should be waived, at the discretion of the Secretary, to expedite funding to address gaps in public health preparedness." BA.&KBACK.TO TOP l ti • 12/20/01 • JEFFERSON COUNTY BOARD OF HEALTH Thursday, December 20, 2001 2:30—4:30 PM Main Conference Room Jefferson Health and Human Services To: Board of Health Members From: Cathy Avery, Assistant to Dr. Thomas Locke Re: Addendum to Board of Health packet • • 4 0 V i it: .' 1Jefferson County Health &Human Services l ll,✓ t itik CASTLE HILL CENTER • 615 SHERIDAN • PORT TOWNSEND,WA 98368 October 24, 2001 ' 1� ' The Honorable Patty Murray y)) United States Senate <7 The Honorable naria Cantwell, The Honorable Norm Dicks Washington, DC 20510 Dear Senator Murray: 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 depai tments 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 to bioterrorism acts will also be valuable in our daily efforts to monitor and respond to the outbreak of disease in our communities. Even Port Townsend has had to close the Post Office and the County Treasurer's Office while law enforcement and public health determined the potential threat. Jefferson County public health nurses and physician have done in-services to local law enforcement, physicians, hospital and fire departments in one week. Bioterrorism is not an acute outbreak, but has become a chronic threat that will require intensive staffing changes. As a small health department we cannot now respond to chronic outbreaks, the ongoing investigations and active surveillance work. 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, t--`` Olean Baldwin, MSN, PHND Community Health Director Jefferson County Health & Human Services HEALTH ENVIRONMENTAL DEVELOPMENTAL ALCOHOUDRUG DEPARTMENT HEALTH DISABILITIES ABUSE CENTER FAX 360/385-9400 360/385-9444 360/385-9400 360/385-9435 360/385-9401 • T YIn o m Z ,D: ° v > dcoF. _E a m E °_ ,2 Y rn - Y �c VI E -0 m 0 0 ,a m ° m p � c, • m V o m m c c v c °L v «- 0, mu.- a) m ` `., ` J°a = m= m 3E ovE_3mo 1� t"ti\t • a 1 — - °Y Ym Y- a - 7 '` 21>. Ol m ,2 4,HO� OE - -o Eo ti- > N o C m = � cmoS C% v i' m �um N > Q °SmVp N.r ` ° ; y,°Y m o 'ma>' 'N ommm E mT y a = ZV22do vCS..5 a>,:- 30 • ou-o N 4Y m . lc..-5 E : oa c -mm ommc. o ti c .V c ,o m N > y T8.y ac 0 ›,• .0 r; •a m m. >,V 0 0- m Nm-OQ Y a , -0Q LEy, m0 % mc 1:5 0Vz Ywc.,- a cY '. m w ,m m m c0 yLm o m mo 0a) ` o • TAS, v _Jm :' >.000 o md . N . '470 QN O_N N 9 J 1 LL P. ENm F-DLL V y O] O W Z N r�f S O J C - V1,� T, C = 10-,cc I Q Q 3\i bQ N° % tiu t d C aN 3 0 - ° H c3 c c3 ° on > in r. 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