HomeMy WebLinkAbout2002- August File Copy
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Jefferson County
Board of Health
Agenda
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Minutes
August 15, 2002
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JEFFERSON COUNTY BOARD OF HEALTH
Thursday, August 15, 2002
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 July 18, 2002
III. Public Comments
IV. Old Business and Informational Items
1. Civil Penalties Ordinance—Public Hearing and
Potential Adoption Larry
V. New Business
1. Jefferson County Seawater Intrusion Policy—Public
Health Implications and Responsibilities Larry
2. 2001 Jefferson County Sexually Transmitted Disease
Report Lisa, Tom
3. Jefferson County Family Planning Program Report Kellie
Jean, Torn
VI. Agenda Planning
VII. Next Meeting: September 19, 2002, 2:30-4:30 PM
Main Conference Room, JHHS
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JEF ERSON COUNTY BOARD OF HEALTH
MINUTES
• DR.4 Thursda
Thursday,July 18 2002
Board Members: Staff Members:
Dan Titterness,Member- County Commissioner District#1 Jean Baldwin, Nursing Services Director
Glen Huntingford,Member- County Commissioner District#2 Larry Fay,Environmental Health Director
Richard Woft,Member- County Commissioner District#3 Thomas Locke,MD, Health Ocer
Geoffrey Masci, Vice Chairman-Port Townsend City Council
Jill Buhler,Member-Hospital Commissioner District#2
Sheila Westerman, Chairman- Citizen at Large(City) DRAFT
Roberta Frissell,Member- Citizen at Large (County)
Chairman Westerman called the meeting to order at 2:35 p.m. All Board and Staff members were
present, with the exception of Member Masci. Commissioner Huntingford joined the meeting at 2:45
p.m.
APPROVAL OF AGENDA
tooommissioner Titterness moved to approve the Agenda as presented. Commissioner Wojt seconded the
don, which carried by a unanimous vote.
APPROVAL OF MINUTES
Dr. Tom Locke asked that a correction be made to minutes of Thursday, June 13, 2002 . On page 6
under State Board of Health —Arsenic a sentence reads, "This is expected to affect nearly 13 million
people, largely in Group B water systems."It should instead be "Group A." Member Frissell moved to
approve the minutes of Thursday, June 13, 2002 as amended. Commissioner Titterness seconded the
motion, which carried by a unanimous vote.
PUBLIC COMMENT - None
OLD BUSINESS AND INFORMATIONAL ITEMS
Civil Penalties Ordinance: Larry Fay reviewed the draft ordinance and Complaint Response Policy,
which he prepared after receiving direction from the Board at its last meeting. He requested the Board
provide input so that Staff could begin advertising a notice of legal adoption in August. Excluded from
e ordinance is procedural information (which is defined in other parts of the referenced RCW), court
s regarding the filing of a ticket, etc. He proposed that the Complaint Response Policy -- originally
HEALTH BOARD MINUTES - July 18, 2002 Page: 2
intended to be a County standard operating procedure for dealing with complaints, investigation and •
compliance -- be used as a companion document.
Member Buhler inquired about Page 2 of the ordinance, Section IV Designation of Civil Infractions
which reads "each 24-hour period when a violation is found to exist shall constitute a separate and
distinct violation." She asked if this would necessitate separate tickets, resulting in"first offense, second
offense, etc." for each 24 hour violation? Mr. Fay explained that he interprets this to mean that Staff
could write a ticket with a time frame. In practice,jurisdictions have not used the ordinance this way but
have instead cited a specific violation on the day they were there. The overall intent is to get the case and
person in front of a judge. If convicted, depending on whether it is the first, second and third offense it
would be classified as a Class 3, Class 2, or Class 1 civil infraction.
Member Buhler then asked to receive a better understanding of the statement on page 16 of the policy,
under Violation Compliance Deadline which states "In most cases, the deadline recommended for the
correction of any violation is seven to thirty (7-30) days following receipt of the written notice." Mr. Fay
explained that this refers to the notice of violation. The suggested procedure is investigation followed by
notice of violation and corrective action. If the problem is remedied, then there is no ticket.
To avoid confusion in the two areas mentioned by Member Buhler, Chairman Westerman recommended
defining "violation" and "offense" after the first instance of these terms or having a separate definition
section, to which Mr. Fay suggested might be added in a new Section III. •
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Referring to Section VI, Enforcement Officers, Commissioner Titterness said he spoke with the Sheriff
and more than one candidate for Sheriff about why the Sheriff's Department would not be the most
appropriate enforcement agency. He also spoke with Deputy Prosecutor Alvarez about whether or not
the Sheriff's Department could act as enforcement officers, but his response was that right now that is
not the way it is done.
Larry Fay explained a situation where a ticket was written by one of the Deputy Sheriffs regarding a
food violation in 1996-97. Sheriff personnel may know ticket writing but they are not trained in public
health. Similar issues exist in Animal Control; while a City Police Officer or Deputy Sheriff could each
write the same ticket, they generally rely on the Animal Control enforcement officer. In recent
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discussions, Deputy Tracer expressed interest in joining in some of the investigation and enforcement of
solid waste nuisance property violations. In talking with Pete Piccini about expanding the Animal
Control enforcement officer's commission to give them the authority to write tickets under Public
Health, Piccini was reluctant due to the enforcement officer being a Health Department employee and a
clerk versus a teamster member.
Dr. Tom Locke reported that under state law all police and law enforcement officers shall enforce any
lawful order by a Board of Health, Health Officer, or State Board of Health. Related to issues of bio-
terrorism, police organizations were unaware of this requirement to enforce a quarantine or an isolation
order. It is equivalent to all of the other laws they enforce and is their legal obligation.
Commissioner Titterness said he is reluctant to start appointing enforcement officers other than those •
under the jurisdiction of the Sheriff. He is looking for a way to cooperate with the Sheriff's Department
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HEALTH BOARD MINUTES - July 18, 2002 Page: 3
have them assist with enforcing this ordinance and proposed that the Board involve a member of the
'heriff's Department in this discussion.
Larry Fay agreed and said their input would be more appropriate in discussing the standard operating
procedure. The Board could proceed with the ordinance and have a separate discussion about
enforcement and whether there is a mechanism for involving officers if a situation gets to the ticket-
writing stage. Staff could also follow up with Deputy Tracer.
Chairman Westerman suggested that because this is a Board of Health issue, any initiation of
communications with the Sheriff come from the Board of Health and Dr. Locke as the Health Officer,
not from the County Commissioners.
Responding to Commissioner Huntingford's concern about how the Sheriff's activities in this area
would be funded, Dr. Locke explained that while the use of police powers have come up in the context
of bio-terrorism (such as in a disease outbreak) it also applies to other significant issues of public health.
He thinks law enforcement will become more comfortable with this role as the bio-terrorism training
continue.
In response to a question by Member Frissell about how many tickets Staff would anticipate writing
over the course of a year, Mr. Fay said he would expect one or two dozen in a variety of areas. But after
a couple of years, they would hope that number to decrease as people realize it is far easier to respond to
ape notice of violation.
Chairman Westerman then asked about the statement in the ordinance under"Purpose" on page 1, which
says "No provision of or term used in this ordinance is intended to impose any duty upon the Jefferson
County Health and Human Services Department nor any of its officers or employees for whom the
implementation or enforcement of this ordinance shall be discretionary and not mandatory." Larry Fay
explained that if Staff decided against writing a ticket, it would not be accountable or legally liable to
another citizen for a failure to do so. This language came directly out of other county ordinances.
Dr. Locke said he believes Staff should investigate revising that sentence to clarify "discretionary and
not mandatory."
There was further discussion about who to involve in the policy discussion. There was support for
inviting representation from both the Police and Sheriff's Departments.
Commissioner Huntingford spoke of the need to involve the Sheriff's Department before having a
hearing to adopt the ordinance. He believes they should have opportunity to see what they are being
asked to enforce.
Chairman Westerman responded by referring to page 3 of the ordinance which states that the Board of
Health, or its designated Health Officer, may authorize one or more person to serve as an "enforcement
Ipfficer," duly authorized to enforce this Ordinance. The ordinance establishes civil penalties for
olations of public health and the policies and procedures would outline the method of enforcing the
ordinance, but does not obligate the Sheriff. The Sheriff and Police Departments could be involved in
HEALTH BOARD MINUTES - July 18, 2002 Page: 4
the discussion and adoption of the ordinance or subsequently, during a discussion of the policy and •
procedures.
Larry Fay noted there is an opportunity to do investigator training and certification through either the
Washington Department of Licensing or with the Council on Licensor and Enforcement. If the Board
finds that the Sheriff or Police do not want to get involved, then training and certification might be
appropriate. He then reviewed areas to which Staff will give further consideration: (1) changing title
"civil enforcement"to "civil penalties", (2) clarifying (per Deputy Prosecutor Alvarez) Section 1 --
Purpose "discretionary and not mandatory," and (3) include definition of"offense" and "violation."
Commissioner Wojt moved to direct Staff to proceed with scheduling a Public Hearing on the
Environmental Health Civil Enforcement ordinance, including possible modifications as
discussed. Member Frissell seconded the motion, which then carried with one no vote by
Commissioner Huntingford.
Complaint Investigation Enforcement Manual: Chairman Westerman suggested that in future
discussions of these procedures, the Board discuss how to proceed with the involvement of both the
Sheriff and Police Departments.
Larry Fay said that if in discussions these departments indicate a willingness to become involved in
enforcing this ordinance, the policy would likely be completely redrafted. The procedures outlined were
prepared with the assumption that the Department would be handling the actions. •
Commissioner Titterness proposed that the Health Board Chair and Health Officer send a letter with
information about the legislation as well as a request to participate in a discussion about how we might
work together on ordinance enforcement. There was no objection from the Board to proceeding in this
manner. Larry Fay noted at least one officer in the Sheriff's Department expressed interest.
NEW BUSINESS
2002 Washington State Health Report: Dr. Locke explained that this report is a product of the State
Board of Health under a 12 year old legislative mandate to establish priorities for State agencies
budgeting for health issues. Although to date, this report has been more of a wish list than a strategic
planning document. This new report was developed with the Governor's subcabinet on health. The
report focuses on issues that this Board has dealt with in the past. He reviewed the Strategic Health
priorities as listed:
• Maintain and improve access to critical health services
• Improve patient safety and increase value in government-purchased health services
• Bolster the health system's capacity to respond to public health emergencies
• Reduce disproportionate disease burdens among racial and ethnic minority populations •
• Encourage responsible behavior to reduce tobacco use, improve nutrition, and increase physical
activity.
HEALTH BOARD MINUTES - July 18, 2002 Page: 5
ie stressed his commitment to reminding individuals in the executive agencies that they agreed to these
priorities and asking where they are reflected in their budgets?
Commissioner Titterness commented that he was impressed that 13.2% of the gross national product is
spent on healthcare, noting that 13.2% of Jefferson County's budget goes towards personal health
insurance for its employees. With the money the County and other government agencies are paying for
health insurance he wonders if we could help the entire County?
Chairman Westerman noted this was the main topic at the day-long health summit. Despite all the
representation in attendance there and the desire to improve the situation, she is uncertain how to move
forward on this issue but feels that if it were easy to do, it would already have been done.
Jean Baldwin said a major issue discussed with the hospital today, is the need to get their cost
reimbursement through Medicaid and Medicare, which would be at a much higher rate. Health
professionals will have political discussions with legislators on the issue of reimbursement rates, but she
stressed that as elected officials, the Commissioners' voices have more importance at the State and
Federal level.
Chairman Westerman spoke of the need to address the inequality of reimbursement rates between
Washington and Florida.
ommissioner Huntingford expressed some concern about the misperceptions, spread by the article in
he Leader, regarding the hospital going bankrupt. He also questioned the benefit of some of the options
(such as the HIPA program) that the State or Federal government keep sending to hospitals. The cost to
implement it would seem to far outweigh the benefit.
Member Buhler explained that help is needed on the federal level with regulatory reform. For every hour
of patient time in the emergency room there is one hour of paper work. The disparity between Medicare
payments arose when Medicare asked for efficiencies.
Member Frissell commented that some legislators erroneously assume that it costs more to treat patients
in a rural counties than in urban areas. Medical reimbursement rates are lower in rural counties than in
urban counties. State and Federal legislators appear to be hearing of these problems for the first time.
Member Buhler said that with the break down of the healthcare system, the hospital will be able to
continue only because of the Critical Access Hospital designation. She noted that the critical access
designation currently comes with a 15-bed limit, but another bill in Congress would increase that to 50
beds and provide not only cost-based reimbursement but cost-based enhanced reimbursement, which
would provide even more funding for capital expenditures for technology and equipment. She noted the
cost of malpractice insurance has doubled and there is no support for tort reform in the State.
Chairman Westerman was most impressed that this report narrowed the list to five priorities, which
pear to be the priorities that would have the most impact for the least investment.
HEALTH BOARD MINUTES - July 18, 2002 Page: 6
Jefferson County Tobacco Prevention and Control Report: Kellie Regan reported that tobacco use •
was one of the last Behavioral Risk Factor Surveillance System (BRFSS) modules to be analyzed.
Referring to the report included in the packet, she reviewed the following Jefferson County data:
• Fifty-five percent reported having smoked at least 100 cigarettes in their lifetime compared to
51% of the State. (Fig. 1)
• Sixteen percent of the adults are current smokers, compared to 21% of the State. (Fig. 2)
• Thirty-nine percent consider themselves former smokers (not smoked for 30 days or longer).
• Jefferson County is not statistically different by gender. (Fig. 3)
• Current smokers by age showed 28% of 18-34 year olds, 19% of 35-64 year olds, and 5% of 65+,
compared to the Washington State numbers of 24%, 22% and 10% respectively. (Fig. 4)
• Twenty-eight percent of those with a high school education or less are current smokers, 15%
with some post secondary education, and 8% of those with four or more years of college,
compared to the State's 30%, 21% and 11% respectively. (Fig. 5)
• In zip code 98368, 11% are current smokers while the rate in other County zip codes is 21%. She
noted that Washington State's health goals are to reach 12%. Dr. Chris Hale commented that as
you reach the lower percentages, intervention costs go up. (Fig 6)
• In rating their own overall health status, nonsmokers report being in better general health status
than current smokers -- 86% compared to 78%. (Fig. 7)
• Thirty-four percent of those who reported heavy drinking in the past 30 days are also current
smokers. (Fig. 8)
• Jefferson County is significantly better than the State in those trying to quit smoking -- 76%
compared to 49%. (Fig. 9) •
• The percentage of 18-34 year olds trying to quit (28%) was significantly lower (worse) than the
State's 55%. However, 72% of those 35 and older tried to quit, compared to 42% of the State.
(Fig. 10)
• Fifty-nine percent with a high school education or less quit for one day or longer, as compared
with 42% of Washington State. Of those with any college, 41% tried to quit compared to 50% of
Washington State. (Fig. 11)
• Of those living in zip code 98368, 24% said they tried to quit during the past 12 months, as
compared to 76% in the other County zip codes combined. (Fig. 12)
Ms. Regan mentioned that the statewide media campaign launched 18 months ago, involved bus
billboards and television commercials. She has asked herself whether the media spots could be having an
effect on the younger audience to whom it is targeted? Noting that BRFSS only surveys those 18 years
of age and older, she is uncertain whether the Healthy Youth survey planned for this fall will include a
question about those who have tried to quit. She then reviewed data about smoking in the home.
• Seventy-nine percent in the county said smoking is not allowed in the home, as compared to 8%
who said it is permitted in some places and 13% who said there were no rules. She was surprised
that there were this many people across all age groups who said it is not allowed. (Fig. 13)
• Respondents with more education are significantly more likely to prohibit smoking in the home -
- 71% with high school or less, 79% with post secondary, and 85% with 4+ years of college.
(Fig. 14) ,
HEALTH BOARD MINUTES - July 18, 2002 Page: 7
• Among current smokers only 43% do not allow smoking in the home as compared to 86% of the
nonsmokers (Fig. 15). It appears information about second-hand smoke is affecting smoking in
the home. Rules about smoking in vehicles are not known.
• Eighty-one percent of respondents who report excellent/very good/good health are significantly
more likely to prohibit smoking in the home. (Fig. 16)
• Current smoking among adult respondents with children under 18 years old is significantly
higher (worse) than households without children (13%). (Fig. 17)
• Households with children under 18 years old are significantly more likely to prohibit smoking in
the home (87%) as compared to households with no children (76%). (Fig. 18)
Ms. Regan then reviewed the data on the age of first use and age of regular use:
• The median age for reported first use was 13.5 years among 18-34 year olds, as compared to 16.7
for 35-64 year olds.
• Among the 18-35 year olds, the median age of reported regular use was 18 years, as compared to
20.3 years among those 35-64.
• Among those with a high school education or less, the median age of reported first use was 14.7
years as compared to 17.9 years among those with some post secondary education, and 16.4
years among those with 4+ years of college.
Overall, Jefferson County's smoking rates are good, comparable to Washington State. People are
otivated to quit and have clear messages about smoking in the home. The BRFSS analysis was
ompleted after she submitted the annual tobacco prevention control Statement of Work. The BRFSS
data has given her a clearer path to her target audience, which are the 18-34-year-olds. She speculated
that even though there is a higher prevalence of smoking outside of 98368, they most likely work in the
City of Port Townsend. One of the best practices known is periodic healthcare provider intervention;
however, because 18-34 year olds are the most healthy, they are not as likely to get this intervention.
Alternative ways to reach them are through intervention at the family planning clinics and through
employer outreach.
In response to concerns expressed by Chairman Westerman about employers getting involved in
discouraging employees from smoking, Ms. Regan said the desire is for employers to have resources
available, such as the Quit Line. It is known that smokers lose more work days, so there are economic
costs involved.
Commissioner Wojt said he would be interested in the results of how many have adopted a lifestyle that
avoids smoke, first-hand or second-hand.
Commissioner Huntingford mentioned that Kellie Regan provided him with a County brochure of
smoke-free restaurants. What caught his attention was the statement that said if you find any of these
restaurants that are not smoke free, contact Kellie and she will follow up. Ms. Regan confirmed that she
follows up with a letter. Responding to his question about how this enforcement is funded, she added
4iat funding for these activities come from tobacco settlement dollars.
HEALTH BOARD MINUTES - July 18, 2002 Page: 8
Commissioner Huntingford expressed interest in getting the same data about illicit drug use. Recent •
figures show increasing numbers of drug use and he is concerned about our ability to solve the drug
problems unless there is a way to quantify usage. Jean Baldwin responded that asking those sorts of
questions is illegal -- there are issues of privacy and confidentiality. Staff has done other extrapolations
on drug use and age profiling based on the number of people in treatment and those who go to
assessments. They also look at medical referrals and ER data. The same 18-34 age group is the concern.
The Substance Abuse Board, who reports to the County Commissioners, has requested another work
project from Chris Hale and Kellie Regan to look at substance abuse issues. She agreed to get the Board
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more information about these issues. Segments of the BRFSS data was presented at the Meth Summit,
the Domestic Violence Meeting, and the Law and Justice Meeting.
Kellie Regan mentioned that the school survey analysis showed that Jefferson County is higher than the
State in the particular areas of marijuana use and early use of marijuana. Dr. Locke noted that marijuana
is five times as dangerous as tobacco.
Kellie Regan said part of the required activities for the tobacco work plan for this year is to convene a
group of stakeholders to advise community planned development and implementation. Rather than
create another board, she asked whether the Board of Health has interest in being this stakeholder board?
The purpose is to receive periodic updates. Although it was recognized that the Substance Abuse Board
also addresses addictive substances, there was no objection to the reports coming to the Board of Health.
The Health of Jefferson County and Port Townsend—July 8, 2002 Report to Port Townsend City •
Council: Jean Baldwin reported that she and Dr. Hale conducted a workshop with the City Council.
Following a motion to provide more financial support, Michelle Sandoval, Kees Kolff and Geoff Masci
agreed to meet with Jean Baldwin to discuss the City's responsibility for health care, to look at the
BRFSS data, to prioritize their funding of programs, and to move toward some action on the
prioritization of community issues and community programs. Particular indicators of interest are teen
pregnancy rate, suicide rate, housing affordability, and living wages. The City is interested in continuing
on the Data Steering project. Member Frissell also agreed to help with community indicators.
Jefferson Critical Access Designation: Member Buhler reported that in 2001, the hospital lost $1.3
million from operations. Also during this time, Medicare and Medicaid paid about $1.6 million less than
what it cost to provide those services. Had they paid what it cost, the hospital would have had a profit of
about $300K. The hospital district finished the year with $4.7 million in operating reserves, which
indicates they are not close to bankruptcy, despite what was reported in The Leader. She noted there was
a good article in The Peninsula Daily News today. For next year, the hospital is considering the critical
access hospital designation, which is cost-based reimbursement. They do not have to cut services and it
does not limit them from implementing new programs and services. At worst, it may mean that once a
month they may have to turn someone away from the hospital,but it would not be emergency care.
To a question by Chairman Westerman about how the costs are determined and whether an upper level is
set, Dr. Locke said the hospital submits a cost report and they allow a certain cost that falls within their
expected parameters and in many instances they place a cap. .
HEALTH BOARD MINUTES - July 18, 2002 Page: 9
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AGENDA CALENDAR/ADJOURN
The meeting adjourned at 4:30 p.m. The next meeting will be held on Thursday, August 15, 2002 at 2:30
p.m. at the Jefferson County Health and Human Services Conference Room.
JEFFERSON COUNTY BOARD OF HEALTH
Sheila Westerman, Chairman Jill Buhler, Member
(Excused)
Geoffrey Masci, Vice-Chairman Richard Wojt, Member
Glen Huntingford, Member Roberta Frissell, Member
*an Titterness, Member
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Board of Health
Old Business
Agenda Item # IV. , 1
• Civil Penalties Ordinance
Public Hearing & Potential
Adoption
August 15, 2002
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Memorandum
To: Jefferson County Board of Health
From: Larry Fay, Environmental Health Director
Date: August 6, 2002
Re: Civil Penalties Ordinance
Attached for your review and consideration is the most recent draft of the civil penalties
ordinance. This draft incorporates changes recommended by the Board during the July
meeting. Changes are shown in italics.
The first change noted in Section I is intended to clarify the somewhat confusing
language contained in the first draft. This makes it clear the implementation of the
• ordinance is discretionary. David Alvarez suggested the specific language.
The second change is contained in Section IV where the term offense was changed in
favor of violation. By consistently using the term violation through the ordinance the
necessity for definitions is eliminated. Again, David Alvarez reviewed the change.
Legal notice of the hearing and proposed regulation was published in the Peninsula
Dailey News on Tuesday, August 06, 2002, 10 days prior to hearing.
Staff recommendation is to adopt the ordinance as written.
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STATE OF WASINGTON
• County of Jefferson
Authorizing Environmental 1 ORDINANCE NO.
Health Civil Enforcement I
WHEREAS, the Jefferson County Board of Health wishes to establish civil penalties for
violations of public health laws, regulations and/or ordinances adopted by the Washington State
Legislature, Washington State Board of Health, Washington Department of Health or the
Jefferson County Board of Health; and,
WHEREAS, all conditions which are determined by the Health Officer to be in violation
of any public health law, regulation and/or ordinance shall be subject to the provisions of this
ordinance because they are detrimental to the public's health, safety and welfare;
WHEREAS, all violations of public health laws, regulations and/or ordinances are
detrimental to the public health, safety and welfare and are hereby declared to be public
nuisances pursuant to Ch. 7.48 RCW;
WHEREAS, a civil infraction process, established pursuant to Ch. 7.80 RCW, can
protect the public from the harmful effects of violations,will aid in enforcement, and will help
reimburse the County for expenses of enforcement;
WHEREAS, enactment of this Ordinance promotes the health,welfare and safety of the
citizens of Jefferson County; and
WHEREAS, the Jefferson County Board of Health enact this Ordinance pursuant to the
authority granted them by various state statutes, including, but not limited to, those codified at
Ch. 7.48 RCW, Ch. 7.80 RCW and Ch. 70.95 RCW.
NOW, THEREFORE, BE IT ORDAINED by the Jefferson County Board of Health as
follows:
Section I Purpose:
It is the express purpose of this ordinance to provide for and promote the health of the general
public and not to create or otherwise establish or designate a particular class or group of people
who will or should be especially protected by the terms of this ordinance.
- _ It is the specific purpose of this ordinance to place the obligation of complying with its
requirements upon persons,businesses or companies required to meet provisions of the health
regulations. Enactment of this Ordinance and its terms and provisions does not impose any duty
upon the Jefferson County Health and Human Services Department or any of its officers or
employees unless a duty is imposed on such officers or employees by the express terms of this
Ordinance. Implementation or enforcement of this ordinance by County officers or employees
shall be discretionary and not mandatory.
Page 1 of 3
Section II Authority
• This ordinance is promulgated under the police power granted to the Jefferson County Board of
Health, including, but not limited to, authority granted to them by Ch. 7.48 RCW, Ch. 7.80 RCW
and Ch. 70.05 RCW to protect the public health, safety, and welfare of the people in Jefferson
County, including those County residents residing within the City of Port Townsend.
Section III Applicability
Provisions of this ordinance apply to violations of the following statutes,regulations and/or
ordinances as they now exist or as they may hereafter be amended:
Chapter 70-90 RCW Water Recreation Facilities
Chapter 70-95 RCW Solid Waste Management
Chapter 246-203 WAC General Sanitation
Chapter 246-215 WAC Food Service
Chapter 246-260 WAC Water Recreation Facilities
Chapter 246-261 WAC Recreational Water Contact Facilities
Chapter 246-272 WAC Onsite sewage systems
Chapter 246-290 WAC Public Water Supplies
Chapter 266-291 WAC Group B Public Water Systems
Chapter 173-304 WAC Minimum Functional Standards for Solid Waste
Chapter 173-308 WAC Biosolids Management
Chapter 8.05 JCC Food Service Sanitation
Chapter 8.10 JCC Solid Waste
4111 Ordinance# 08-0921-00 Onsite Sewage
Section IV. Designation of Civil Infractions
Any violation of the laws, regulations and ordinances specified above in section III (including
any future amendments to those statutes, regulations and ordinances) shall constitute a civil
infraction.
Each (twenty-four) 24-hour period when a violation is found to exist shall constitute a separate
and distinct violation.
The owner or Lessor of any real property shall be and is jointly and severally liable with any
tenant, occupier or user of real property for any violation alleged against that property or alleged
to have occurred on the owner's property. The legality or illegality of the use or occupancy of
the land by a person or entity shall not be a defense available to the owner of said property if it is
alleged a violation of this Ordinance occurred on that property.
- A first violation shall be a Class 3 civil infraction as established in Chapter 7.80 RCW.
A second violation shall be a class 2 civil infraction as established in Chapter 7.80 RCW.
A third violation shall be a class 1 civil infraction as established in Chapter 7.80 RCW.
i
Page 2 of 3
Section V. Processing and Adjudicating Civil Infractions:
• Such infractions shall be adjudicated and any related fines determined in accordance with the
procedures established in Chapter 7.80 RCW, the Jefferson County District Court rules for
Infractions and the Washington State Rules for Courts of Limited Jurisdiction, which shall be
paramount to the terms and obligations of this Ordinance if this Ordinance conflicts with state
statutes or court rules.
Upon a determination that the County has met its burden of proof regarding any contested
infraction alleged against a person or entity pursuant to this Ordinance, the County may seek to
obtain attorney's fees against the violating party or entity pursuant to RCW 7.80.140.
Utilization of the procedures and penalties laid out in this Ordinance and the underlying state
statutes shall not prohibit this County from utilizing any other lawful means or seeking any other
lawful remedies against the person or entity that has allegedly violated the terms of this
Ordinance.
Nothing in this Ordinance shall prevent the Judge hearing these civil infraction matters from
reducing or mitigating the monetary fines that would otherwise be imposed.
Section VI Enforcement Officers
The Board of Health, or its designated Health Officer, may authorize one or more persons to
serve as an"enforcement officer,"duly authorized to enforce this Ordinance.
• Section VII. Severability
Should any section, paragraph, phrase, sentence or clause of this ordinance be declared invalid or
unconstitutional for any reason, the remainder of this ordinance shall not be affected.
Section VIII. Effective Date
The effective date of this ordinance shall be the date of its adoption.
APPROVED AND ADOPTED this day of , 2002.
JEFFERSON COUNTY
BOARD OF HEALTH
Sheila Westerman, Chair
SEAL: , Member
ATTEST: , Member
• Lorna Delaney, CMC Clerk of the Board , Member
Page 3 of 3
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Board of Health
New Business
Agenda Item # V. , 1
• Jefferson County Seawater
Intrusion Policy
August 15, 2002
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Memorandum
To: Jefferson County Board of Health
From: Larry Fay, Environmental Health Director
Date: August 6, 2002
Re: Sea Water Intrusion
Attached for your review are copies of the newly adopted county policy and ordinances
addressing seawater intrusion. While these ordinances have been adopted under county
planning authority there are implications for the Board of Health and Health and Human
Services.
• Briefly, the ordinance establishes three categories of seawater intrusion protection zones.
Within these zones there are limitations on use of ground water that are largely voluntary
in"coastal" and "at risk"zones but become mandatory in "high risk"zones. Within all
zones anyone proposing to build will be required to connect to public water if public
water is available. Within low and at risk zones, individuals proposing to build will be
able to drill wells and use the wells if the water quality is OK. They may be subject to
ongoing monitoring by the PUD.
In high-risk zones, new wells will only be allowed if the Department of Ecology issues a
waiver allowing the applicant to drill within 100 feet of sources or potential sources of
contamination. (The county is maintaining that its designations of seawater intrusion
protection zones constitute "salt water intrusion areas" as identified in 173-160-171
WAC thus obligating the Department of Ecology to restrict well drilling in those areas).
If public water is not available and a person cannot obtain a waiver to drill no building
permit will be approved unless the person uses a so-called alternative water supply.
Under the UDC these include but are not limited to rain water collection systems, hauled
- . - -water and direct withdrawal from marine waters.
The challenge for HH&S and the Board of Health is identifying where minimum
standards for alternative water supplies are necessary and adopting them so that a basic
level of public health protection is maintained. At a minimum the alternative systems
should offer no greater risk of disease or illness than the source that is being restricted,
• salty groundwater.
•
}
• The Board adopted standards for rainwater catchment in 1997. These ought to be
reviewed. We have no standards for hauling water or for storing water. We have no
standards for desalination of marine waters.
An adequate supply of potable water is fundamental to the maintenance of personal
hygiene and the protection of public health. It is appropriate for the Board of Health to
establish minimum quality and quantity standards necessary for the promotion of a
healthy community. Staff is proposing that we begin a review of the strengths and
limitations of so called alternative water supplies and offer potential policy direction for
Board consideration. Because the ordinance becomes effective by the beginning of
October there is a relative urgency for some basic policy direction. I would expect that
we could have in place background information and policy framework by our October
meeting. Issues I would anticipate opening include the appropriate role of alternative
water supplies with new development, costs of implementing a program (including
staffing needs)to oversee compliance with the adopted standards, other potential water
sources, and examples of policies from other jurisdictions.
•
•
JEFFERSON COUNTY ADOPTED NEW REGULATIONS
TO COMPLY WITH
A GROWTH MANAGEMENT HEARINGS BOARD ORDER
TO PROTECT AQUIFERS FROM SEAWATER INTRUSION
WHAT IS HAPPENING AND WHY?
Jefferson County is designating all coastal areas within VI mile of the marine shorelines, and all
islands, as"Seawater Intrusion Protection Zones", or SIPZ. If ground water quality(measured
by chloride) is slightly degraded, indicating potential seawater intrusion, then it is designated as
an "At Risk" SIPZ. If ground water quality (measured by chloride) is degraded, indicating
likelihood of seawater intrusion, then it is designated as a"High Risk" SIPZ.
Jefferson County's development regulations(the Unified Development Code, or UDC)were
appealed by the Olympic Environmental Council and Shine Community Action Council. The
Western Washington Growth Management Hearings Board upheld the appeal and ordered
Jefferson County to adopt protections for ground water from seawater intrusion. These
regulations are the result of technical and public input to satisfy the requirements of the Hearings
Board Order.
• HOW WILL THESE NEW REGULATIONS IMPACT MY
DEVELOPMENT PLANS?
Most of the County is NOT experiencing problems with seawater intrusion, so most likely it will
not impact your development plans. But, if you are near the coast or on an island, seawater
intrusion may be impacting the aquifer that you intend to draw from. .
WILL THESE REGULATIONS STOP ME FROM USING MY
PROPERTY?
NO. These regulations do not stop you from developing and using your property. Connection to
an approved public water system provides proof of potable water for a building permit. Jefferson
County REQUIRES the use of an approved public water supply if a public water system can
provide water to your parcel. Therefore, even though the new regulations may limit the use of
individual water supplies in severely impacted areas in Jefferson County,property owners can
still connect to an approved public water system to provide proof of potable water for a building
permit. Asa condition of your building permit, Jefferson County may require extension of an
existing public water system, creation of new public water system, or use of an alternative water
- _ -- system in severely impacted areas. Areas without public water supplies can always utilize
Alternative Water Supplies which are ALLOWED under the new regulations. Therefore you
have several options to develop your property.
•
HOW DO THESE REGULATIONS AFFECT MY EXISTING HOME AND WELL?
• If you are NOT building a new home or structure requiring potable water, then the new
regulations DO NOT APPLY TO YOU.
WHAT HAPPENS IF I WANT TO DRILL A WELL ON MY LAND?
Already, under the current law, the owner or well driller is required by the Department of
Ecology(DOE) to submit a notice of intent to DOE. DOE currently uses the marine shoreline as
the definition of the "sea-salt water intrusion area". According to the Well Drilling Regulations
(WAC 173-160-171)wells must be 100 feet from a sea-salt water intrusion area. The new
designations under these regulations mean that if the well is in a"High Risk", then it will be
interpreted by the DOE to be a"sea-salt water intrusion area". Thus, DOE may not allow the
well to be drilled if the DOE determines the well would violate the state administrative code.
In sum, a property owner would have to get approval from the DOE before drilling the well (just
as they do now). The major change is that a"sea-salt water intrusion area"now includes the
"High risk" SIPZ.
CAN I OBTAIN AN ONSITE SEWAGE DISPOSAL (SEPTIC) PERMIT?
If you are not building a new home, then the new regulations DO NOT APPLY TO YOU. There
are no regulations that are triggered at the time a landowner applies for an onsite sewage disposal
permit.
I ALREADY HAVE A WELL. WHAT HAPPENS IF I WANT TO BUILD A HOUSE?
• At the time that you apply for your building permit, you are required to provide"proof of potable
water". If you are located near the coast or on an island, your property may be within an"At
Risk" or"High Risk" SIPZ, and then new regulations would apply to you.
In the"At Risk"zones, owners are required to enter into a well monitoring program approved by
the County. This is similar to the monitoring agreements that are required when the County
issues a permit with an alternative onsite sewage disposal system. There may be a charge to
cover the costs of the monitoring. Additionally, the applicant is required to install a flow meter
and is ENCOURAGED to use drought-tolerant landscaping and conserve water.
In the "High Risk"zones, owners will be required to conduct a hydrogeologic assessment to
indicate that their water use will not degrade water quality in the aquifer. If such an assessment
can prove that there would not be degradation, then the applicant can use the well with
conditions to install a flow meter and submit a water conservation plan to Jefferson County;
otherwise, the applicant will be required to use another water source for their building.
I HAVE AN EXISTING HOME AND WELL. WHAT HAPPENS IF I REMOU,EL?
If you are not building a new home, then the new regulations DO NOT APPLY TO YOU. There
are NO regulations required for home remodels.
I HAVE AN EXISTING HOME AND WELL. WHAT HAPPENS IF I WANT TO DRILL
A NEW WELL?
The regulations under Scenario #2 (above)would apply.
RECEIVED
AUG' 0 2 2002
• STATE OF WASHINGTON Ernnron nal fferson Ham,
County of Jefferson
IN THE MATTER OF ADOPTING A }
COUNTY POLICY WITH RESPECT TO }
SEAWATER INTRUSION } RESOLUTION NO. 44-02
WHEREAS, the Board of Jefferson County Commissioners ("the Board") has, as
required by the Growth Management Act, as codified at RCW 36.70A.010 et seq.,
adopted the Jefferson County Comprehensive Plan (the "Plan"), a Plan that was
originally adopted by Resolution No. 72-98 on August 28, 1998 and subsequently later
amended, and;
WHEREAS, in furtherance of the Plan, the County adopted its GMA-derived
development regulations, known locally as the Unified Development Code (or "UDC"),
in December 2000 to be effective as of January 16, 2001, and;
WHEREAS, the UDC, upon its adoption, was timely challenged through means of
not less than five Petition For Reviews ("PFRs") filed with the Western Washington
Growth Management Hearings Board (or "WWGMHB"), and
WHEREAS, another of the five PFRs was filed by two citizens' groups: the
Olympic Environmental Council and the Shine Community Action Council; and
- _- WHEREAS, the PFR filed by these citizens' group proceeded through to fi hearing
on the Merits before the WWGMHB in December 2001; and
WHEREAS, the WWGMHB ruled against the County on all but one issue (that
• one issue being the sufficiency of protections offered critical areas with respect to the
.
Resolution No. 44-02 re: County Policy with Respect to Seawater Intrusion
installation of asphalt batch plants) by publishing a Final Decision and Order (or "FDO") •
in January 2002 that mandated this County to undertake and implement six distinct steps;
and
WHEREAS, that FDO listed as mandate or directive #1 that this County enact as
part of the UDC the four housekeeping changes listed in the Response Brief of the
County and discussed at the Hearing on the Merits; and
WHEREAS, Ordinance #04-0422-02, adopted April 22, 2002, put the County in
compliance with mandate#1 of the FDO;
WHEREAS, a distinct Ordinance enacted on this date amends the UDC so that it
reflects and includes the changes the County was required to make in order to gain
compliance with directives #2 through #6 of the FDO;
•
WHEREAS, the elected County Commissioners and staff discussed possible
routes to compliance, including adopting UDC amendments, after the FDO was issued,
specifically in meetings open to the public during February and March of 2002;
WHEREAS, staff presented in writing possible routes to compliance in early
March 2002. But the County Commissioners wanted to open this discussion about
seawater intrusion to the entire populace of the County;
WHEREAS, in the spirit of the GMA, which requires "early and continuous"
participation by all who are interested and/or expressly or potentially affected by any
proposed GMA-derived regulations, the County Commissioners decided to empower a
stakeholder group to discuss the issues of seawater intrusion and return to them with a
report within 30-45 days; .
Page 2 of 4
Resolution No. 44-02 re: County Policy with Respect to Seawater Intrusion
• WHEREAS, the County Commissioners took the formal step of empowering the
stakeholder group on April 8, 2002. The stakeholder group was specifically informed
that the task before them was not whether or not this County should impose regulations to
protect impacted regions from seawater intrusion but instead was to determine the how
and the what of the regulations that would be put in place;
WHEREAS, the stakeholder group consisted of nine persons, including the
representative of the Petitioners. The stakeholders met four times and an outside
consultant was present at all the meetings to facilitate the process. A non-voting County
representative was present at the meetings not to offer opinions but to simply offer
information;
WHEREAS, the stakeholder group made its report to the elected Commissioners
in late May 2002;
•
WHEREAS, the recommendations of the stakeholder group, as memorialized in a
document entitled "Coastal Seawater Intrusion Policy" prepared by the County's Natural
Resources Director, were discussed and reviewed by County staff in another public
meeting of the elected Commissioners on June 10, 2002;
WHEREAS, the policy document prepared by the County's Natural Resources
Division Manager describes the "adaptive management practices" that will be
undertaken, enacted and implemented by the County Commissioners if data collected
indicates, via scientifically valid methods, a "statistically significant degradation of water
- quality in a particular region of the County due to seawater intrusion;"
WHEREAS, because the policies and plans outlined in the document attached to
this Resolution are not appropriate for inclusion in the County's UDC because they are
policies and plans rather than rules and regulations that are found in the typical GMA-
Page 3 of 4
Resolution No. 44-02 re: County Policy with Respect to Seawater Intrusion
derived development regulations to regulate specific land use applications and processes,
III
this distinct Resolution became necessary; and
WHEREAS, adoption of the policy document via a Resolution serves to place this
County in partial compliance with a portion of FDO Directive#4; and
WHEREAS, this Resolution is adopted as part of the County's Compliance with
the EDO issued in January 2002 in WWGMHB Cause No. #01-2-0015.
NOW, THEREFORE, BE IT RESOLVED as followed by the County ,
Commissioners in and for the County of Jefferson:
1. That the attached document entitled "Coastal Seawater Intrusion Policy" be and
hereby is adopted by the County Commission of Jefferson County as official county
policy pursuant to the Growth Management Act and this County's Comprehensive Plan.
0
Approved and adopted this 23rd day of July 2002.
- ' �_ r k.v JEFFERSON COUNTY
. A : ` 0 #0, - ',,G : SARDOF 6 ,41 ISSI• ' I ''0
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x •. ;1 , Richard Wojt, Chair
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. _ _ - Lorna Delaney, CMC
Clerk of the Board
Dan Titterness, Member
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•
Page 4 of 4
•
BOARD OF COUNTY COMMISSIONERS
• Coastal Seawater Intrusion Policy
July 23, 2002
Goal: Jefferson County intends to protect groundwater quality from further degradation due to
seawater intrusion, primarily through land use regulatory authority under Revised Code of
Washington (RCW) 36.70A. A corollary goal is the promotion of public health through
encouragement of public water system use throughout the county.
Elements: Designation of affected areas, voluntary and mandatory measures (implemented
through Unified Development Code—UDC- and Environmental Health regulations), other
policy elements,public outreach and education, monitoring and adaptive management.
Designation: Seawater Intrusion Protection Zones (SIPZ) include aquifers and land areas
overlying aquifers at some level of vulnerability to seawater intrusion, as defined either by
proximity to marine shoreline or by proximity to groundwater sources that have demonstrated
high chloride readings. All land area within 1/4 mile of marine shorelines and on all islands is
classified as a coastal SIPZ, a subcategory of a Critical Aquifer Recharge Area. Additionally,
areas within 1000 feet of a groundwater source with a history of chloride analyses above 100
milligrams per liter (mg/L) are categorized as either"at risk" (between 100 mg/L and 200 mg/L)
or"high risk"(over 200 mg/L). High risk SIPZ shall be considered "sea-salt water intrusion
areas,"which are among the "sources or potential sources of contamination"listed in
Washington Administrative Code (WAC) 173-160-171, implementing code for the Water Well
Construction Act.
In some cases, high chloride readings may be indicative of connate seawater (i.e., relic seawater
in aquifers as opposed to active seawater intrusion). When best available science or a
hydrogeologic assessment demonstrates that high chloride readings in a particular area are due to
connate seawater, the area in question shall not be considered an at risk or high risk SIPZ. (The
Chimacum valley is an example of this type of area.) When the status of an area is in question,
the UDC Administrator is responsible for making the determination based upon recommendation
from the Department of Health and Human Services.
Geographic Information Systems (GIS)maps of designated SIPZ will be periodically updated
using data from permit applications, well monitoring, and other available information.
Voluntary and Mandatory Measures: Activities to be conditioned and regulated include well
drilling, subdivision approval, and issuance of building permits. General information is
provided, followed by voluntary and mandatory measures specific to coastal, at risk, and high
risk SIPZ.
1. Well Drilling: The Washington State Department of Ecology (Ecology) is responsible for
regulation of well drilling under RCW 18.104. Per WAC 173-160-171, proposed wells
must be sited at least 100 feet from "known or potential sources of contamination,"which
include"Sea-salt water intrusion areas." Ecology provides a procedure for applicants to
obtain a variance from a regulation or regulations of Chapter 173 WAC "...[w]hen strict
• compliance with the requirements and standards of this chapter are impractical"(WAC
Coastal Seawater Intrusion Policy Page 1 7/23/02
•
BOARD OF COUNT)'COMMISSIONERS
173-160-106). Though certain types of wells, including the standard individual well for •
domestic purposes, are exempted from the need to obtain a permit from Ecology, all
wells are subject to State laws and administrative code. According to WAC 173-160-
106, Ecology response to a variance application is given within fourteen days.
2. Subdivisions: Applications for land division (UDC Section 7) in any SIPZ when the
average net density proposed is less than five acres per dwelling unit must include
specific and conclusive proof of adequate supplies of potable water through a qualifying
hydrogeologic assessment (relevant components of an Aquifer Recharge Area Report per
UDC 3.6.10.e) that demonstrates that the creation of new lots and corresponding use of
water will not impact the subject aquifer such that water quality is degraded by seawater
intrusion. All subdivisions in Jefferson County that create more than six new lots are
subject to the acquisition of water rights (per State Attorney General opinion).
3. Issuance of a building permit: RCW 19.27.097 states, •
"Each applicant for a building permit of a building necessitating potable
water shall provide evidence of an adequate water supply for the intended
use of the building. Evidence may be in the form of a water right permit
from the department of ecology, a letter from an approved water purveyor
stating the ability to provide water, or another form sufficient to verify the
existence of an adequate water supply. In addition to other authorities, the
county or city may impose conditions on building permits requiring
connection to an existing public water system where the existing system is
•
willing and able to provide safe and reliable potable water to the applicant
with reasonable economy and efficiency."
Evidence of potable water may be an individual well, connection to a public water system, or an
alternative system such as rainwater catchment. Whatever method is selected, the regulatory and
operational standards for that method must be met, including Jefferson County Health Code and
Washington Administrative Code. Public water systems shall be preferred from a public health
standpoint to other alternatives, such as the importation of water or an individual surface or
rainwater catchment system, though those alternatives are allowable subject to appropriate and
established design and operational criteria.
Public water systems are subject to Washington State Department of Health (DOH) saltwater
intrusion policy and all applicable safe drinking water standards. DOH and Ecology regulate
public water systems to protect against water quality degradation. The Jefferson County
seawater intrusion policy therefore concentrates on water supplies that are not regulated as public
water systems by DOH and Ecology. Jefferson County shall encourage DOH and Ecology to
- consider amending licenses and water rights for public systems in areas where there is evidence
of seawater intrusion in the public water source or as a result of groundwater withdrawal such
that no additional connections to or expansions of the affected systems are permitted.
All types of building permits that require proof of potable water use are subject to this policy,
specifically building permits for new single-family residences (SFRs) or other structures with
plumbing that are not associated with an existing SFR (i.e., shops or garages with a bathroom). S
Coastal Seawater Intrusion Policy Page 2 7/23/02
BOARD OF COUNTY COMMISSIONERS
• Proof of Potable Water on Existing Lots of Record
Voluntary and mandatory measures of the Jefferson County seawater intrusion policy apply to
well drilling proposals and building permit applications on existing lots of record within the
coastal, at risk, and high risk SIPZ in the following manner:
COASTAL SIPZ
(i.e., all islands and area within 1/4 mile of marine shoreline, but no history of chloride
concentration above 100 mg/L in groundwater sources within 1000 feet)
VOLUNTARY:
• Water conservation measures.
• Installation of a flow meter.
• On-going well monitoring for chloride concentration.
• Submittal of monitoring data to County.
MANDATORY:
• For proof of potable water on a building permit application, applicant must utilize DOH-
approved public water system if available.
• If public water is unavailable, a qualifying alternative system may be used as proof of
potable water or an individual well may be used as proof of potable water subject to the
• following requirements:
1. Chloride concentration of a laboratory-certified well water sample submitted with
building permit application.
AT RISK SIPZ
(i.e.,within 1000 feet of a groundwater source showing chloride between 100 and 200 mg/L)
VOLUNTARY:
• Water conservation measures.
MANDATORY:
• For proof of potable water on a building permit application, applicant must utilize DOH-
approved public water system if available.
• If public water is unavailable, a qualifying alternative system may be used as proof of
potable water or an individual well may be used as proof of potable water subject to the
following requirements:
1. Chloride concentration of a laboratory-certified well water sample submitted with
building permit application.
2. Installation of a flow meter.
3. On-going well monitoring for chloride concentration.
4. Submittal of flow and chloride data to the County per monitoring program.
•
Coastal Seawater Intrusion Policy Page 3 7/23/02
BOARD OF C'OUN'IY COMMISSIONERS
HIGH RISK SIPZ
(i.e., within 1000 feet of a groundwater source showing chloride concentrations above 200 mg/L)
MANDATORY:
• Water conservation measures (per list maintained by UDC Administrator).
• For proof of potable water on a building permit application, applicant must utilize DOH-
approved public water system if available and if public water is unavailable, a qualifying
alternative system may be used as proof of potable water; an individual well may only be
used as proof of potable water subject to the following requirements:
1. Variance from Chapter 173 WAC standards granted by Ecology per WAC 173-160-
106 for a new groundwater well within 100 feet of a sea-salt water intrusion area
per WAC 173-160-171 (i.e., within 1100 feet of a groundwater source showing
chloride concentrations above 200 mg/L); or for an existing groundwater well,
applicant must provide evidence through a qualifying hydrogeologic assessment
(relevant components of an Aquifer Recharge Area Report per UDC 3.6.10.e) that
subject aquifer will not be degraded by the proposed use of the well.
2. Chloride concentration of a laboratory-certified well water sample submitted with
building permit application.
3. If chloride concentration exceeds 250 mg/L in a water sample submitted for a
building permit, then the property owner shall be required to record a restrictive
covenant that indicates a chloride reading exceeded the U.S. Environmental
Protection Agency secondary standard (250 mg/L) under the National Secondary
Drinking Water Regulations. •
4. Installation of a flow meter.
5. On-going well monitoring for chloride concentration.
6. Submittal of flow and chloride data to the County per monitoring program.
Other Policy Elements:
• Continue County approval of qualifying rainwater catchment systems as an alternative to
individual wells (Environmental Health regulations).
• Develop policies to approve the importation and storage of water in certain problem areas
(Environmental Health regulations).
• Strengthen approval and monitoring requirements for public water systems to ensure that
chloride testing is an element of DOH monitoring for systems which have sources located
within a SIPZ(Coordinated Water System Plan—CWSP—and DOH).
• Strengthen protections of aquifer recharge areas through adoption and implementation of
Ecology 2001 Stormwater Management Manual for Western Washington, promoting on-
site infiltration of stormwater (UDC regulations; amendment anticipated 2002).
• Eliminate off-site disposal of surface or sub-surface water (stormwater tightlines and
curtain drains) unless exceptional circumstances justify off-site disposal and appropriate
mitigation is proposed and implemented; adjust current regulation so that affected area
extends from 500 feet to 1/4 mile from marine shorelines (UDC regulations).
• In order to limit well construction and protect public health, continue promotion of public
water systems as preferable to individual wells and other alternative water supplies;
continue requirement for connection to existing public water systems when proposed
•
development location is within approved public water service area boundaries.
Coastal Seawater Intrusion Policy Page 4 7/23/02
HOARD) Of C'OC1NTY COMMISSIONERS
• • Continue application of Uniform Plumbing Code (UPC) requirements with regard to low-
flow faucets and other mandatory water conservation measures.
Public Outreach and Education:
• Conduct education and outreach program through Washington State University (WSU)
Extension; establish Memorandum of Understanding (MOU) with WSU for program.
• Encourage water conservation measures countywide; mandate water conservation
measures in high risk SIPZ.
• Send letter to new Jefferson County residents/property owners regarding groundwater use
and protection; implement other means of public notice, as resources allow.
Monitoring:
• Enter into MOU with Public Utility District#1 (PUD) regarding the monitoring program.
• Standardize chloride sampling in a manner that assures quality control.
• Establish other well monitoring locations, as resources allow.
• Coordinate data interpretation and application through Water Resource Inventory Area
(WRIA)Planning Units operating in Jefferson County per the Watershed Planning Act.
• Seek grant funding for additional research and encourage State and Federal partners to
conduct research related to the issue of seawater intrusion in Jefferson County.
Adaptive Management:for aquifers with degrading water quality due to seawater intrusion.
Jefferson County will rely on technical input from the PUD, WRIA Planning Units, and others,
as appropriate, in annual review of well monitoring data, building permit data, and other relevant
• data on groundwater quality and quantity in order to determine whether water quality vis-a-vis
seawater intrusion is degrading. The Department of Health and Human Services and/or the
Department of Community Development will report to the BOCC annually on the status of
seawater intrusion in Jefferson County. Every five years a comprehensive analysis will be
conducted and report generated summarizing results.
If the Board of County Commissioners determines that actions under the Jefferson County
seawater intrusion policy prove insufficient to protect groundwater in at risk and high risk SIPZ
from seawater intrusion (i.e., analysis of the monitoring data for a defined area using appropriate
methodology' shows statistically significant degradation of water quality due to seawater
intrusion), Jefferson County will immediately:
1. Adopt a moratorium in the affected area on the issuance of building permits for which
individual groundwater wells are proposed as proof of potable water until such time as
area water quality improves or a plan is developed with the objective of improving area
water quality.
2. Adopt a moratorium on subdivisions in the affected area that propose individual
- . groundwater wells as proof of potable water until such time as area water quality
improves or a plan is developed with the objective of improving area water quality.
3. Establish an aquifer protection district via public vote (RCW 36.36) or, if necessary,
petition Ecology to form a groundwater management area (per WAC 173-100).
1 Appropriate combination of accepted scientific methodology for evaluating seawater intrusion impact, as described
in Pacific Groundwater Group study(1996),Washington Administrative Code, United States Geological Survey
protocol,and other contemporary examples and approaches.
Coastal Seawater Intrusion Policy Page 5 7/23/02
RECEIVED
STATE OF WASHINGTON AUG2 un y
Jefferson County
• County of Jefferson Environmental Heaffh
IN THE MA'rlER OF REVISIONS AND }
ADDITIONS TO THE COUNTY'S UNIFIED }
DEVELOPMENT CODE ASSOCIATED WITH} ORDINANCE NO. 07-0723-02
A HEARING BOARD FINAL DECISION AND }
ORDER ENTERED IN CAUSE NUMBER }
01-2-0015 AND RELATING TO SEAWATER }
INTRUSION ISSUES [MLA#02-00314] }
WHEREAS, the Board of Jefferson County Commissioners ("the Board") has, as
required by the Growth Management Act, as codified at RCW 36.70A.010 et seq.,
adopted the Jefferson County Comprehensive Plan (the "Plan"), a Plan that was
originally adopted by Resolution No. 72-98 on August 28, 1998 and subsequently later
amended, and;
WHEREAS, in furtherance of the Plan, the County adopted its GMA-derived
• development regulations, known locally as the Unified Development Code (or "UDC"),
in December 2000 to be effective as of January 16, 2001, and;
WHEREAS, the UDC, upon its adoption, was timely challenged through means
of not less than five Petition For Reviews ("PFRs") filed with the Western Washington
Growth Management Hearings Board (or "WWGMHB"), and
WHEREAS,another of the five PFRs was filed by two citizens' groups: the
Olympic Environmental Council and the Shine Community Action Council; and
WHEREAS, the PFR filed by these citizens' group proceeded through to a
Hearing on the Merits before the WWGMHB in December 2001; and
WHEREAS, the WWGMHB ruled against the County on all but one issue (that
-one issue being the sufficiency of protections offered critical areas with respect to the
installation of asphalt batch plants) by publishing a Final Decision and Order (or "FDO")
in January 2002 that mandated this County to undertake and implement six distinct steps;
and
•
ORDINANCE NO. 07-0723-02 re: Seawater Intrusion
WHEREAS, that FDO listed as mandate or directive #1 that this County enact as •
part of the UDC the four housekeeping changes listed in the Response Brief of the
County and discussed at the Hearing on the Merits; and
WHEREAS, Ordinance #04-0422-02, adopted April 22, 2002, put the County in
compliance with mandate #1 of the FDO; and
WHEREAS, this Ordinance amends the UDC so that it reflects and includes the
changes the County was required to make in order to gain compliance with directives #2
through #6 of the FDO.
NOW, THEREFORE, BE IT ORDAINED by the Board of County
Commissioners that they approve the following revisions and additions to the UDC and;
BE IT FURTHER ORDAINED by the Board that they make the following
general Findings of Facts applicable to these revisions and additions to the UDC:
Section 1 - General Findings of Fact for Revisions and Additions to the UDC:
Plan The County adopted its Comprehensive Pl n m August gu 1998 and its development •
regulations or UDC in December 2000.
2. The Growth Management Act, which mandates that Jefferson County generate and
adopt a Comprehensive Plan, also requires that there be in place a process to
amend the Comprehensive Plan.
3. These amendments to the County's UDC are being made in order to resolve
certain litigation before the WWGMHB, specifically the PFR timely fled by two
citizens' groups, the Olympic Environmental Council and the Shine Community
Action Council.
4. The elected County Commissioners and staff discussed possible routes to
compliance, including adopting UDC amendments, after the FDO was issued,
- _ _ specifically in meetings open to the public during February and March of 2002.
5. Staff presented in writing possible routes to compliance in early March 2002. But
the County Commissioners wanted to open this discussion about seawater
intrusion to the entire populace of the County.
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ORDINANCE NO. 07-0723-02 re: Seawater Intrusion
6. In the spirit of the GMA, which requires "early and continuous" participation by
• all who are interested and/or expressly or potentially affected by any proposed
GMA-derived regulations, the County Commissioners decided to empower a
stakeholder group to discuss the issues of seawater intrusion and return to them
with a report within 30-45 days. The County Commissioners took the formal step
of empowering the stakeholder group on April 8, 2002.
7. The stakeholder group was specifically informed that the task before them was not
whether or not this County should impose regulations to protect impacted regions
from seawater intrusion but instead was to determine the how and the what of the
regulations that would be put in place.
8. The stakeholder group consisted of nine persons, including the representative of
the Petitioners. The stakeholders met four times and an outside consultant was
present at all the meetings to facilitate the process. A non-voting County
representative was present at the meetings not to offer opinions but to simply offer
information.
9. The stakeholder group made its report to the elected Commissioners in late May
2002.
• 10. The recommendations of the stakeholder group, as memorialized in a document
entitled "Coastal Seawater Intrusion Policy"prepared by the County's Natural
Resources Director, were discussed and reviewed by County staff in another
public meeting of the elected Commissioners on June 10, 2002.
11. Proposed UDC amendments, reflecting the substance and content of the policy
paper prepared by the County's Natural Resources Division Manager , were
prepared by County planners and, with the approval of the elected County
Commissioners, sent to the County Planning Commission for review by that
advisory body.
12. A public hearing on the proposed UDC amendments occurred before the Planning
Commission on July 10, 2002.
13. The Planning Commission prepared a written recommendation and sent that
- - recommendation to the elected County Commissioners.
14. The policy document prepared by the County's Natural Resources Division
Manager describes the "adaptive management practices" that will be undertaken,
enacted and implemented by the County Commissioners if data collected
indicates, via scientifically valid methods, a "statistically significant degradation
•
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ORDINANCE NO. 07-0723-02 re: Seawater Intrusion
of water quality in a particular region of the County due to seawater intrusion." •
They are:
• Adopt a moratorium in the affected area on the issuance of building permits for
which individual groundwater wells are proposed as proof of potable water until
such time as area water quality improves or a plan is developed with the objective
of improving area water quality.
• Adopt a moratorium on subdivisions in the affected area that propose individual
groundwater wells as proof of potable water until such time as area water quality
improves or a plan is developed with the objective of improving area water
quality.
• Arrange for a public vote to form an aquifer protection district (RCW 36.36) or
petition Ecology to form a groundwater management area (per WAC 173-100).
15. The policy document is being adopted by this County Commission separately but
simultaneously as a Resolution of this elected body.
16. Adoption of the policy document via a Resolution serves to place this County in
partial compliance with a portion of FDO Directive #4.
17. All types of building permits that require proof of potable water use are subject to
this policy, specifically building permits for new single-family residences (SFRs)
or other structures with plumbing that are not associated with an existing SFR, •
e.g., shops or garages with a bathroom.
18. The attached UDC amendments serve to "classify and designate vulnerable
seawater intrusion areas," as is required by FDO Directive #2, by classifying three
types of"Seawater Intrusion Protection Zones," or "SIPZ's."
19. ._ The first type of SIPZ is known as a "Coastal" SIPZ. A Coastal SIPZ is found on
all islands within the County and any other area within 1/4 mile of a shoreline as
long as there is no history of any individual well having a chloride reading in
excess of 100 mg/L or parts per million ("ppm") within 1000 feet of any new well
or any well that is to be used as a source for potable water. The landowner must
undertake certain mandatory and voluntary measures if the land in question falls
within a Coastal SIPZ.
- 20. - The second kind of SIPZ is known as an "At Risk" SIPZ. An At Risk SIPZ is
found within 1000 feet of any groundwater source showing a chloride reading
between 100 and 200 ppm. Again, the landowner must undertake certain
mandatory and voluntary measures if the site of the well in question falls within or
creates an At-Risk SIPZ.
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21. The final type of SIPZ is known as a "High Risk" SIPZ. A High Risk SIPZ is
• found within 1000 feet of any groundwater source showing a chloride reading in
excess of 200 ppm. Much like with the "At Risk" SIPZ, certain protective
measures will be mandatory for new wells or wells newly needed for proof of
potable water if that well is located within or creates a High Risk SIPZ.
22. Note well that not until potable water has a chloride reading that exceeds 250 ppm
does that potable water exceed the United States Environmental Protection
Agency secondary standard promulgated pursuant to the National Secondary
Drinking Water Regulations. In Jefferson County any individual well with a
chloride reading in excess of 250 ppm will require a "Notice to Title" to be
recorded with the County Auditor's land records indicating that the well water
contains unacceptable (according to the US EPA) salinity.
23. All of the numbers listed in paragraphs #19 through #22, both in terms of a)
distances and b) categorizing risk levels by the chloride readings found in the
water of any particular well, are based upon the 'best available science' found and
described in various reports placed before the Jefferson County Commissioners
during the last seven years, including, but not limited to, the Washington State
Department of Ecology Bulletin #59 [relating to Marrowstone Island,) the Hong
West report and the 1996 report of the Pacific Groundwater Group.
• 24. However, in some cases, high chloride readings may be indicative of what is
called "connate" seawater (i.e., relic seawater in aquifers as opposed to active
seawater intrusion). When best available science or hydrogeologic assessment
demonstrates that high chloride readings in a particular area are the result of
connate seawater being present then the area in question shall NOT be considered
to be an "At Risk" or "High Risk" SIPZ. The Chimacum valley is an example of
this type of area. If the status of a region or area is in question, then the UDC
Administrator is responsible for making the determination based upon a
recommendation from the Department of Health and Human Services.
25. The stakeholder group was familiar with and used these same BAS reports when
deciding on distances and the categorization of risk according to the quantity of
chloride found in any particular well water sample.
- 26. These UDC amendments also reflect the County's "develop[ment] and adopt[ion]
[of] protection standards for CARA's, based on BAS, to prevent further
groundwater degradation from seawater intrusion," the mandate of item #3 listed
in the FDO handed down by the WWGMHB.
27. While all the protection standards will not be listed here since they are found in
the UDC amendments and the distinct "policy" document, the protection standards
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implemented by the County include mandating that no new well be built within •
any category of SIPZ if that residence or business can instead be hooked up to a
public water system.
28. Most, if not all of the protection standards are mandatory in any High Risk SIPZ.
The MANDATORY protection standards within a High Risk SIPZ include water
conservation measures, installation of a flow meter, ongoing well monitoring for
chloride concentrations, submittal of that monitoring data to the County and a
waiver (permission) from the State Department of Ecology for the installation of
any well that is within 1,100 feet (1,000 feet zone and 100 foot buffer) of another
well showing chloride concentrations in excess of 200 ppm.
29. In situations where there is a lesser risk of seawater intrusion into the groundwater,
i.e., well locations found inside either the "At Risk" or "Coastal" SIPZ's, certain
of the mandatory protection standards become voluntary.
30. But for any individual well in an "At Risk" or "High Risk" SIPZ, the ongoing
monitoring of the chloride levels found in that well's water is and shall remain
mandatory. Also mandatory is the reporting of that data to the appropriate
officials in order to monitor that well for potential degradation of the aquifer it is
attached to and/or the area within 1000 feet of that well.
31. The UDC, as a GMA-derived development regulation, is not well-suited to answer •
many of the procedural and substantive questions about the monitoring of chloride
levels that the County intends to perform in order to gather the data that will allow
it to take a scientific approach to "regularly evaluating] the effectiveness of
adopted performance standards, as is mandated by FDO Directive#4.
32. But certain other steps that the County has agreed to do put this County in
compliance with FDO Directive #4. These are some of the other action steps the
County has promised to undertake in order to protect any and all groundwater
sources, as reflected in the adoption of the "policy" Resolution simultaneously to
the adoption of this Ordinance:
• Enter into a contract with PUD No. 1 of Jefferson County with respect to a
monitoring program and data exchange;
_ - - • - Standardize chloride sampling in a manner that assures quality control; "`
• Establish other well monitoring locations, as resources allow;
• Coordinate data interpretation and application through the Water Resource
Inventory Area (WRIA) 17 Planning Unit; and
• Seek grant funding for additional research and encourage State and Federal
partners to conduct research related to the issue of seawater intrusion in Jefferson •
County.
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. 33. Jefferson County also intends to do outreach and education programs for the
citizens to increase awareness about the need to protect groundwater sources.
Listed below are items this County intends to pursue with respect to public
education programs:
• Conduct education and outreach programs through Washington State University
(WSU) Extension;
• Establish Memorandum of Understanding (MOU) with WSU for the
education/outreach program;
• Encourage water conservation measures countywide;
• Mandate water conservation measures in high risk SIPZ; and
• Contact new Jefferson County residents/property owners regarding groundwater
use and protection or implement another means of public notice, as resources
allow.
34. The County also intends to strengthen protections for aquifer recharge areas
through adoption and implementation of the rules and regulations laid out within
the document known as the 2001 Stormwater Management Manual for Western
Washington, a document promulgated by the Washington State Department of
Ecology.
• 35. Adoption of this amending language (which alters the UDC)promotes the health
and welfare of the citizens of Jefferson County.
36. Adoption of these UDC amendments was made necessary by the FDO issued by
the WWGMHB on January 10, 2002. These UDC amendments and the "policy"
document attached to the distinct but simultaneously-enacted Resolution place
Jefferson County in compliance with the FDO.
37. Although the substance of these amendments, if not the particular language
chosen, has been mandated by a quasi-judicial body, making these amendments
extraordinary and not necessarily suitable for the usual UDC-driven analysis, it
remains wise to make certain findings that would otherwise be made with respect
to any UDC amendments adopted without the mandate of a quasi-judicial body.
_38. Pursuant to Section 9 of this County's Unified Development Code, all proposed
amendments to the GMA-derived development regulations should be analyzed, in
part, through the "filter" of the seven growth management indicators (or "GMI")
listed at UDC §9.5.4(b), although those GMI represent only some of the criteria
that the County Commission must use when deciding whether to adopt or reject a
proposed UDC amendment.
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39. Because of the general nature of the GMI, each and every GMI will not be •
applicable or apropos for each and every amendment that this County Commission
has considered.
40. However, the County Commission, in order to comply with UDC Section 9, •
should and must make generalized findings of fact with respect to the seven GMI
listed there and do so now.
41. With respect to UDC §9.5.4(b)(1), the County Commission finds, as an example
of numerous findings they might make with respect to (b)(1), that in the short-term
the population of this County has not increased as quickly as the Comprehensive
Plan envisioned, but this short-term decline in the rate of population growth does
not necessarily mean that the County's current population is not, in certain regions
of the County, already causing stress on groundwater sources.
42. Regardless of the possible fluctuation in the rate of population growth that does
occur or might occur in this County the adoption of these UDC amendments
supports GMA goals to further protect groundwater resources.
43. With respect to UDC §9.5.4(b)(2), the County Commission finds that the capacity
of the County to provide adequate services has not changed, although expected
continued severe pressures on the County's budget may alter this picture in the •
coming years, thus suggesting that it is wise to protect groundwater resources now.
44. With respect to UDC §9.5.4(b)(3), the County Commission finds that while
sufficient `urban' land is designated and zoned within this County to meet
projected demand and need pursuant to the agreed-upon population allocation in
Joint City and County Resolution No. 17-96, that conclusion will, by definition, be
revisited and reconsidered as the County considers establishing an urban growth
area in the Port Hadlock and Irondale neighborhoods. If this County creates
additional UGA's, then the protection of groundwater will be of paramount
concern.
45. With respect to UDC §9.5.4(b)(4), the County Commission finds that while most
of the assumptions that supported the policies and goals of the 1998
Comprehensive Plan remain valid, there are at least two assumptions that need
_ _ revisiting..
46. The first assumption of the 1998 plan worthy of reconsideration comes about
because of the documented need for additional rural commercial and industrial
land as indicated by the Regional Economic Analysis and Forecast of January
1999 prepared by Richard Trottier, which suggests the County can expect to see a •
growth in jobs of some 7,000 to 9,000 in the next: decades and must accommodate
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them with additional commercially and industrially zoned land not currently in
• existence. This commercially and industrially zoned land must not be allowed to
impose any additional stresses on the groundwater sources, and thus these UDC
amendments do further one or more GMA goals.
47. Secondly, the County always intended to revisit its conservatively-drawn
boundaries around the rural commercial districts, known formally as "limited
areas of more intensive rural development" or "LAMIRD's" and has new
definitions of"built environment" provided to it by the Western Washington
Growth Management Hearings Board to work with as it does that redrawing.
Again, the presence of rural commercial land on the County's zoning map cannot
be allowed to additionally stress the groundwater sources of this County.
48. Each of these new assumptions makes protecting groundwater resources and, more
generally, critical areas, of that much greater importance.
49. With respect to UDC §9.5.4(b)(5), the County Commission finds that recent
election results indicate not necessarily a change in the attitudes of the County's
citizenry, but certainly a reprioritization of those basic values with an emphasis
now placed on economic opportunity and a healthy economy. This reprioritization
becomes particularly important in the face of increasing unemployment and our
• current national recession. While this shift in priorities does not necessarily require
wholesale changes to the goals of the plan, it does and will require some
modification of the plan in order to better achieve opportunity for improving the
economic base in a manner that is consistent with GMA and the County's Plan,
which do and will continue to mandate the protection of critical areas and
groundwater resources so that this continues to be an attractive place to live.
50. With respect to UDC §9.5.4(b)(6), the County Commission finds that the County
has undergone changed circumstances with respect to the worsening of the gap
between the median income of a citizen and the general unavailability of housing
that is affordable based on such a salary, the listing of salmon species as
"endangered" pursuant to federal statute, new development regulations adopted by
the County to implement the GMA and the County's Plan and additional Hearings
Board decisions which illuminate what the state laws permit or do not permit.
Such changed circumstances may make amendments to the Plan appropriate.
51. With respect to UDC §9.5.4(b)(7), the County Commission finds that any
inconsistencies between the County's Plan and the GMA exist because Jefferson
County was found to be out of compliance with respect to the protection of critical
areas and groundwater resources.
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52. With respect to UDC §9.8.1(b), another portion of the UDC which the County •
Commission should consider when adopting amendments or revisions to the UDC,
the County Commission finds at least two of the three criteria listed there
inapplicable in these circumstances, specifically circumstances where the UDC is
being revised to implement the written mandate of an FDO published by the
WWGMHB in January 2002 directing this County to undertake and complete six
distinct actions. .
53. With respect to the criterion listed at UDC §9.8.1(b)(3), the County Commission
finds that there has been much public testimony and concern on the issue of
seawater intrusion during the entire GMA era of this County and that therefore
there is interest in this issue among the general public.
54. Adoption of this amending and revision language to the UDC, this County's
GMA-derived development regulations, and simultaneous adoption of a
Resolution (with an attached "policy" document) places Jefferson County in
compliance with the January 2002 FDO published by the WWGMHB with respect
to the PFR filed by the Olympic Environmental Council and the Shine Community
Action Council.
55. On June 7, 2002, the Jefferson County Department of Community Development
generated and mailed an "Integrated GMA/SEPA Document & Notice of •
Hearing." This document simultaneously served three purposes: 1) it notified the
Washington State Office of Community Development of this County's intent to
amend its GMA-driven development regulations, 2) notified the world that
existing documents would be adopted in lieu of a distinct SEPA-driven
environmental review and 3) informed the world that elected County
Commissioners would hold a public hearing on this topic on July 22, 2002.
Section 2 - Language Revisions and Additions to the UDC:
The language of the attached Exhibit, consisting of 7 pages, is hereby adopted as the
detailed revisions and additions to the UDC.
Section 3 Section 3 - Severability:
If any section, subsection, sentence, clause, phrase, or figure of this ordinance or its
application to any person or circumstances is held invalid, the remainder of the ordinance
or the application to other persons or circumstances shall not be affected.
•
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•
Section 4 - Effective Date:
This ordinance shall become effective 60 days from adoption by the Board of County
Commissioners, also known herein as the County Commission.
y.' ' 'a O V D AND ADOPTED this 23rd day of July, 2002
/ s.
'. :y ' JEFFERSON COUNTY
;: , r BOARD OF COMMISSIONERS
I Dot 4,3n )
i
die„,/,0!4 Dt (51-1/At., eLS1--QC1-4"1 Richard WoJt, Chai
Lorna Delaney, CMC
Clerk of the Board !• --
•
Dan Tittemess, Member
APPROVED AS TO FORM:
-7 12407___
004 amio, ed,Glen Huntin_ ord, ► /m•er
Deputy Prosecuting Attorne
•
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BOARD OF COUNTY COMMISSIONERS
• UDC groundwater protection/seawater intrusion amendments
In conjunction with Coastal Seawater Intrusion Policy dated July 23, 2002
Section 2 Definitions
Alternative Water System
Any source of water for an individual single-family use that is not a legally constructed well that
produces more than 400 gallons per day or an approved public water system that can provide
adequate water for the intended use of a structure.
Critical Aquifer Recharge Areas (for reference;no amendment proposed)
Selected watersheds and critical aquifers where resources are potentially threatened by salt
water intrusion or primary contaminants or limited due to poor recharge. (p.2-6)
Seawater intrusion
(See "Salt Water Intrusion")
Salt Water intrusion (for reference;no amendment proposed)
The underground flow of salt water into wells and aquifers. (p.2-20)
•
Source of Contamination
A facility or disposat or storage site for material that impairs the quality of ground water to a
degree that creates a potential hazard to the environment, public health, or interferes with a
beneficial use. Or in reference to well drilling, a specific area or source as defined in WAC 173-
160-171. (p.2-22)
Section 3 Land Use Districts
3.6 Overlay Districts
3.6.5 Critical Aquifer Recharge Areas.
a. Classification. Critical Aquifer Recharge Areas are naturally susceptible due to the
existence of permeable soils or a seawater wedge in coastline aquifers. Certain overlying
land uses can lead to water quality and/or quantity degradation. The following
classifications define Critical Aquifer Recharge Areas.
(1) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic
conditions that promote rapid infiltration of recharge waters to groundwater aquifers.
For the purposes of this section, unless otherwise determined by preparation of an
Aquifer Recharge Area Report authorized under this section, the following geologic
units, as identified from available State of Washington Department of Natural
Resources geologic mapping, define Susceptible Aquifer Recharge Areas for east
• Jefferson County:
UDC seawater intrusion amendment 7/23/02
Exhibit B: MLA02-00314 Page 1
BOARD OF COUNTY COMMISSIONERS
i. Alluvial fans (Ha), •
ii. Artificial fill (Hx),
iii. Beach sand & gravel (Hb),
iv. Dune sand (Hd),
v. Flood plain alluvium (Hf),
vi. Vashon recessional outwash in deltas and alluvial fans (Vrd),
vii. Vashon recessional outwash in meltwater channels (Vro),
viii. Vashon Ice contact stratified drift (Vi),
ix. Vashon ablation till (Vat),
x. Vashon advance outwash (Vao),
xi. Whidbey formation (Pw), and
xi'. Pre-Vashon stratified drift (Py).
(2) Those areas meeting the requirements of Susceptible Aquifer Recharge Areas
(above) and which are overlain by the following land uses as identified in this Code
are subject to the provisions of the protection standards in this Section:
I. All Industrial Land Uses
ii. All Commercial Uses
iii. All Rural Residential Land Uses
A. requiring a Discretionary Use or Conditional Use Permit or
B. with nonconforming uses that would otherwise require a Discretionary Use
or Conditional Use Permit •
iv. Unsewered Planned Rural Residential Developments
v. Unsewered residential development with gross densities greater than one unit
per acre •
(3) Special Aquifer Recharge Protection Areas include:
i. Sole Source Aquifers designated by the U.S. Environmental Protection
Agency in accordance with the Safe Drinking Water Act of 1974 (Public Law
93-523).
ii. Special protection areas designated by the Washington Department of Eco-
logy under Chapter 173-200 WAC.
iii. Wellhead Protection Areas determined in accordance with delineation
methodologies specified by the Washington Department of Health under
authority of Chapter 246-290 WAC.
iv. Ground Water Management Areas designated by the Washington Department
of Ecology in cooperation with local government under Chapter 173-100 WAC.
(4) Seawater Intrusion Protection Zones (SIPZ) are aquifers and land overlying_
___ aquifers with some degree of vulnerability to seawater intrusion. SIPZ are defined
either by proximity to marine shoreline or by proximity to groundwater sources that
have demonstrated high chloride readings. All islands and land area within 'A mile
of marine shorelines and associated aquifers together compose the coastal SIPZ.
Additionally, areas within 1000 feet of a groundwater source with a history of
chloride analyses above 100 milligrams per liter(mg/L) are categorized as either at
risk (between 100 mg/L and 200 mq/L) or high risk (over 200 mg/L) SIPZ. High risk .
SIPZ shall be considered "sea-salt water intrusion areas,"which are among the
UDC seawater intrusion amendment 7/23/02
Exhibit B: MLA02-00314 Page 2
BOARD OF COUNTY COMMISSIONERS
"sources or potential sources of contamination"listed in Washington Administrative
• Code (WAC) 173-160-171, implementing code for the Water Well Construction Act.
In some cases, high chloride readings may be indicative of connate seawater (i.e.,
relic seawater in aquifers as opposed to active seawater intrusion). When best
available science or a hydrogeoloqic assessment demonstrate that hiqh chloride
readings in a particular area are due to connate seawater, the area in question shall
not be considered an at risk or high risk SIPZ. When the status of an area is in
question, the UDC Administrator is responsible for making the determination based
upon recommendation from County Department of Health and Human Services.
b. Designation. Jefferson County shall prepare and exhibit a-dated Critical Aquifer
Recharge Area maps which*Ail-demonstrate the approximate distribution of the
Susceptible Aquifer Recharge Areas..-.apd-Special Aquifer Recharge Protection Areas,
and Seawater Intrusion Protection Zones. The Critical Aquifer Recharge Area maps shall
be periodically revised, modified, and updated to reflect additional information.
c. Applicability.
(1) The following land use activities are considered high impact land uses due to the
probability and/or potential magnitude of their adverse effects on groundwater and
shall be prohibited in Susceptible Aquifer Recharge Areas and Special Aquifer
Recharge Protection Areas. In all other areas of the County outside of Susceptible
Aquifer Recharge Areas and Special Aquifer Recharge Protection Areas, these
activities shall require an Aquifer Recharge Area Report pursuant to this Section.
I. Chemical manufacturing and reprocessing;
ii. Creosote/asphalt manufacturing or treatment (except that asphalt batch plants
may be permitted in Susceptible Aquifer Recharge Areas ONLY if such areas
lie outside of Special Aquifer Recharge Protection Areas and ONLY if best
management practices are implemented pursuant to sections 4.24.8d ad 6.17
of this Code and an accepted Aquifer Recharge Area Report);
iii. Electroplating and metal coating activities;
iv. Hazardous waste treatment, storage and disposal facilities;
v. Petroleum product refinement and reprocessing;
vi. Underground storage tanks for petroleum products or other hazardous
materials;
vii. Recycling facilities as defined in this Code;
viii. Solid waste landfills;
ix. Waste piles as defined in Chapter 173-304 AC;
x. Wood and wood products preserving;
xi. Storage and primary electrical battery processing and reprocessing.
(2) All other land uses shall be subject to the protection standards contained in this
Section and mitigating conditions included with an Aquifer Recharge Area Report,
where applicable.
- - - (3) ---Seawater Intrusion Protection AraasZones. Marine shorelines and islands are
susceptible to a condition that is known as seawater intrusion. Seawater intrusion is
a condition in which the saltwater/freshwater interface in an aquifer moves inland so
that wells drilled on upland areas cannot obtain freshwater suitable for public
consumption without significant additional treatment and cost. Maintaining a stable
balance in the saltwater/freshwater interface is primarily a function of the rate of
aquifer recharge (primarily through rainfall) and the rate of groundwater withdrawals
(primarily through wells). The Washington Department of Ecology is the-eply-agency
UDC seawater intrusion amendment 7/23/02
Exhibit B: MLA02-00314 Page 3
BOARD OF COUNTY COMMISSIONERS
with statutory authority to regulate groundwater withdrawal for individual wells in •
Jefferson County. Therefor ew New development, redevelopment, and land use
activities on islands and in close proximity to marine shorelines in particular should
be developed in such a manner to maximize aquifer recharge and maintain the
saltwater/freshwater balance to the maximum extent possible by infiltrating
stormwater runoff so that it recharges the aquifer._
- - - • . - -" -- - - - - -
d. Protection Standards.
(1) General.The following protection standards shall apply to land use activities in
Susceptible Aquifer Recharge Areas and Special Aquifer Protection Areas, and
when specified in Seawater Intrusion Protection Zones, unless mitigating conditions
have been identified in a Critical Aquifer Recharge Report that has been prepared
pursuant to this section.
(2) -Stormwater Disposal.
. I. Stormwater runoff shall be controlled and treated in accordance with best
management practices and facility design standards as identified and defined -
in the Stormwater Management Manual for the Puget Sound Basin, as
amended and the stormwater provisions contained in Section 6 of this Code.
ii. To help prevent seawater from intruding landward into underground aquifers,
all new development activity on Marrowstone Island, Indian Island and within
1/4 mile of any marine shoreline shall be required to infiltrate all stormwater •
•
runoff onsite. The Administrator will consider requests for exceptions to this
policy on a case-by-case basis and may require a hydrogeologic assessment.
(3) On-Site Sewage Disposal. •
i. All land uses identified in Section 3.6.5.a and Special Aquifer Recharge
Protection Areas that are also classified as Susceptible Aquifer Recharge
Areas (as defined in this Section), shall be designated Areas of Special
Concern pursuant to Chapter 246-272-21501 WAC.
A. Such designation shall identify minimum land area and best management
practices for nitrogen removal as design parameters necessary for the
protection of public health and groundwater quality.
B. Best Management Practices (BMPs) shall be adopted by action of the
Board of Health.
ii. As new information becomes available that would classify an area as a
Special Aquifer Recharge Protection Area or an Area of Special Concern
under this Section, said area may be designated as such by the County.Any
additional Areas of Special Concern designated through this process shall
receive the same protections identified in Subsection (3)LA and B above.
(4) Golf Courses and Other Turf Cultivation. Golf courses shall be developed and
operated in a manner consistent with "Best Management Practices for Golf Course
- - _ _ . -- Development and Operation", King County Environmental Division (now: Depart-
ment of Development and Environmental Services),January 1993. Recreational
and institutional facilities (e.g. parks and schools) with extensive areas of cultivated
turf, shall be operated in a manner consistent with portions of the aforementioned
best management practices pertaining to fertilizer and pesticide use, storage, and
disposal.
(5) Commercial Agriculture. Commercial agricultural activities, including landscaping
operations must be operated in accordance with best management practices for •
UDC seawater intrusion amendment 7/23/02
Exhibit B: MLA02-00314 Page 4
BOARD OF COUNTY COMMISSIONERS
fertilizer, pesticide, and animal waste management as developed by the Jefferson
• County Conservation District.
(6) Above Ground Storage Tanks. Above ground tanks shall be fabricated,
constructed, installed, used and operated in a manner which prevents the release of
a hazardous substances or dangerous wastes to the ground or groundwater. Above
ground storage tanks intended to hold or store hazardous substances or dangerous
wastes are provided with an impervious containment area, equivalent to or greater
than 100 percent of the tank volume, enclosing and underlying the tank, or ensure
that other measures are undertaken as prescribed by the Uniform Fire Code which
provide an equivalent measure of protection,
(7) Mining and Quarrying. Mining and quarrying performance standards containing
ground water protection best management practices pertaining to operation,
closure, and the operation of gravel screening, gravel crushing, cement concrete
batch plants, and asphalt concrete batch plants, where allowed, are contained in
Sections 4 and 6 of this Code.
(8) Hazardous Materials. Land use activities that generate hazardous waste, which
are not prohibited outright under this code, and which are conditionally exempt from
regulation by the Washington Department of Ecology under WAC 173-303-100, or
which use, store, or handle hazardous substances, shall be required to prepare and
submit a hazardous materials management plan that demonstrates that the
development will not have an adverse impact on ground water quality, The
hazardous materials management plan must be updated annually by the facility
owner.
(9) Well Drilling, Land Division, and Building Permits in Seawater Intrusion
Protection Zones.
• i. Well Drilling: Proposed wells must be sited at least 100 feet from "known or
potential sources of contamination,"which include"Sea-salt water intrusion
areas" (WAC 178-160-171), unless a variance is obtained from the
Washington State Department of Ecology per WAC 173-160-106.
ii. Subdivisions: Applications for land division (UDC Section 7) when the
average net density proposed is less than five acres per dwelling unit must
include specific and conclusive proof of adequate supplies of potable water
through a qualifying hydroqeoloqic assessment (relevant components of an
Aquifer Recharge Area Report per UDC 3.6.10.e) that demonstrates that the
creation of new lots and corresponding use of water will not impact the
subject aquifer such that water quality is degraded by seawater intrusion.
iii. Building Permits:
A. Evidence of potable water may be an individual well, connection to a
public water system, or an alternative system. Whatever method is
selected, the regulatory and operational standards for that method must
be met, including Jefferson County Health Codes and Washington
Administrative Code.
B. All types of building permits that require proof of potable water use are
- . subject to this policy, specifically building permits for new single-family
residences (SFRs) or other structures with plumbing that are not
associated with an existing SFR (i.e., shops or garages with a bathroom).
iv. Voluntary and mandatory measures of the Jefferson County seawater
intrusion policy apply to development proposals within the coastal, at risk, and
high risk SIPZ in the following manner, in addition to all existing applicable
Health Codes:
• A. COASTAL SIPZ
UDC seawater intrusion amendment 7/23/02
Exhibit B: MLA02-00314 Page 5
BOARD OF COUNT!' COMMISSIONERS
VOLUNTARY ACTIONS: •
1. Water conservation measures,
2. Installation of a flow meter.
3. On-going well monitoring for chloride concentration.
4. Submittal of data to County.
MANDATORY ACTIONS:
1. For proof of potable water on a building permit application, applicant
must utilize DOH-approved public water system if available.
2. If public water is unavailable, an individual well may be used as proof
of potable water subject to the following requirements:
o Chloride concentration of a laboratory-certified well water sample
submitted with building permit application.
3. If public water is unavailable, a qualifying alternative system may be
used as proof of potable water.
B. AT RISK SIPZ •
VOLUNTARY ACTIONS:
1. Water conservation measures.
MANDATORY ACTIONS:
1. For proof of potable water on a building permit application, applicant
must utilize DOH-approved public water system if available.
2. If public water is unavailable, an individual well may be used as proof
of potable water subject to the following requirements: 4111
o Chloride concentration of a laboratory-certified well water sample
submitted with building permit application.
o Installation of a flow meter.
o On-going well monitoring for chloride concentration.
o Submittal of flow and chloride data to the County per monitoring
program.
3. If public water is unavailable, a qualifying alternative system may be
used as proof of potable water.
C. HIGH RISK SIPZ
MANDATORY ACTIONS:
1. Water conservation measures (per list maintained by UDC
Administrator).
2. For proof of potable water on a building permit application, applicant
must utilize DOH-approved public water system if available.
- - - - -- 3. If public water is unavailable, an individual well may only be usedas
proof of potable water subject to the following requirements:
o Variance from Chapter 173 WAC standards granted by Ecology per
WAC 173-160-106 for a new groundwater well within 100 feet of a
sea-salt water intrusion area per WAC 173-160-171 (i.e., within 1100
feet of a groundwater source showing chloride concentrations above
200 mq/L); or for an existing groundwater well, applicant must provide
evidence through a hydrogeologic assessment (relevant components •
UDC seawater intrusion amendment 7/23/02
Exhibit B: MLA02-00314 Page 6
BOARD OF COUNTY COMMISSIONERS
of an Aquifer Recharge Area Report per UDC 3.6.10.e) that subject
aquifer will not be degraded by the proposed use of the well.
o Chloride concentration of a laboratory-certified well water sample
submitted with building permit application,
o If chloride concentration exceeds 250 mg/L in a water sample
submitted for a building permit, then the property owner shall be
required to record a restrictive covenant that indicates a chloride
reading exceeded the U.S. Environmental Protection Agency
secondary standard (250 mq/L) under the National Secondary
Drinking Water Regulations.
o Installation of a flow meter.
o On-going well monitoring for chloride concentration.
o Submittal of flow and chloride data to the County per monitoring
program.
4. If public water is unavailable, a qualifying alternative system may be
used as proof of potable water.
49}00) Mitigating Conditions.The Administrator may require additional mitigating
conditions, as needed, to provide protection to all Critical Aquifer Recharge Areas to
ensure that the subject land or water use action will not pose a risk of significant
adverse groundwater quality impacts. The determination of significant adverse
groundwater quality impacts will be based on the Antidegradation policy included in
Chapter 173-200 WAC,
44-0}(11)Authortty for Denial. The Administrator may deny approval If the protection
standards contained herein or added mitigating conditions cannot prevent
. significant adverse groundwater quality impacts.
Section 4 4.24 Mineral Extraction, Mining, Quarrying and Reclamation.
4.24.8. The following performance standards are required for mining, quarrying and
asphalt/concrete batch operations located within a designated
Susceptible Aquifer Recharge Area or Special Aquifer Recharge Protection Area,..
Section 6 6.17 Mining, Quarrying and Asphalt/Concrete Batch Plant Best
Management Practices In Critical Aquifer Recharge Areas.
The following shall be considered minimum development standards necessary ONLY for mineral
extraction, quarrying and asphalt/concrete batch operations located in
Aro= Susceptible Aquifer Recharge Areas or Special Aquifer Recharge Protection Areas as
defined in Section 3.6.5 of the UDC...
Section 6 6.18 On-Site Sewage Disposal Best Management Practices in Critical
- - Aquifer Recharge Areas.
The following best management practices (BMPs) are required to meet minimum onsite sewage
standards within - ' '_- •. - -- - -- --- Susceptible Aquifer Recharge Areas or Special
Aquifer Recharge Protection Areas, as identified in Section 3.6.5 of this Code...
•
UDC seawater intrusion amendment 7/23/02
Exhibit B: MLA02-00314 Page 7
•
Board of Health
New Business
Agenda Item # V. , 2
• 2001 Jefferson County
Sexually Transmitted
Disease Report
August 15, 2002
•
Figure 1. Total clients, by age, Family Planning,1997-2002
Jefferson County Health Department AHLERS data
• Total Clients by Age Group
Year <202 20-24' 25-29 30-34 35+ Total'
1997 207 191 104 79 149 730
1998 239 213 139 84 172 847
1999 258 218 128 87 228 919
2000 276 221 114 91 244 946
2001 300 253 139 111 230 1033
2002* 230 166 103 73 166 738
2002/2001 %Change 77% 66% 71%
4 YR %Change 45% 32% 42%
* data available through 2nd quarter only
Figure 1. Total clients, by age, Family Planning-
Jefferson County Health Department, 1997-2002*
Source: Jefferson County Health Department AHLERS data
1200
01997
1000
0E 1998
1 ❑ 1999
800 0 2000
w
a 2001 ::
sa
Lo
600 0 2002*
U
m
0
I-
400
200 ill -
<202 20-24' 25-29 30-34 35+ Total'
'Total Clients-Served 71%of 2001 total in first 6 months of 2002;42 overall increase 1997-2001.
2Total Clients<20-Served 77%of 2001 total in first 6 months of 2002;45%overall increase 1997 to 2001.
•tal
Clients 20-24-Served 66%of 2001 total in first 6 months of 2002;32%overall increase 1997 to 2001.
8/8/02 FINAL
''
Figure 2. Total client visits, by age, Family Planning,1997-2002*.
Jefferson County Health Department AHLERS data
• Total Visits by Age Group
Year <202 20-24' 25-29 30-34 35+ Total'
1997 447 345 172 150 227 1341
1998 473 416 245 142 267 1543
1999 578 415 241 149 400 1783
2000 557 435 237 161 390 1780
2001 699 499 263 213 366 2040
2002* 469 268 165 120 217 1239
2002/2001%Change 67% 54% 61%
4 YR %Change 56% 45% 52%
* data available through 2nd quarter only
Figure 2. Total Client Visits, by age, Family Planning-
Jefferson County Health Department, 1997-2002*
Source: Jefferson County Health Department AHLERS data
2500 —
2000 - D 1997
7
® 1998
0 1999
rn 1500 0 2000
n 2001
N
N D 2002* :::;::Iii,:i.i !1:-'!.!
5
o 1000
500
•- -- ••• ---- ••• .i...: ii..;:. ..:::i 1 ••:::1• Iii: .:::::,
11." ill H:;:, I M 1 /1111 :,::... 17. '.:::::::::: :-...::..
II
<202 20-24' 25-29 30-34 35+ Total'
'Total Visits-Completed 61%of 2001 total in first 6 months of 2002;52%overall increase from 11997-2001.
2Total Visits<20-Completed 67%of 2001 total in first 6 months of 2002;56%overall increase 1997 to 2001.
•TOtl
Visits 20-24-Completed 54%of 2001 total in first 6 months of 2002;45%overall increase 1997 to 2001.
8/8/02 FINAL
Figure 3. New Clients, by age, Family Planning, 1997-2002*.
Jefferson County Health Department AHLERS data
II/ New Clients by Age Group
Year <202 20-24' 25-29 30-34 35+ Total'
1997 102 89 59 39 83 372
1998 150 84 81 47 98 460
1999 133 85 50 36 121 425
2000 126 70 42 41 115 394
2001 163 85 56 47 89 440
2002* 69 48 28 20 68 233
2002/2001%Served 42% 56% 53%
4 YR %Change 60% -4% 18%
* data available through 2nd quarter only
I Figure 3. New Clients, by age, Family Planning-
Jefferson County Health Department, 1997-2002*
Source: Jefferson County Health Department AHLERS data
500 — - - - --
450 -
0 1997
400 - ® 1998
• 01999
350
0 2000
y 300 - 2001
c
Q CI 2002*
U 250 -
3
d
Z 200 -
150
100
50 .:::
<202 20-24' 25-29 30-34 35+ Total'
New Client Total-Served 53%of 2001 total in first 6 months of 2002;18%overall increase 1997 to 2001.
ew Client<20-Served 42%of 2001 total in first 6 months of 2002;60%overall increase 1997 to 2001.
w Client 20-24-Served 54%of 2001 total in first 6 months of 2002;4%overall decrease 1997 to 2001.
I
8/8/02 FINAL
Figure 4. Continuing Clients, by age, Family Planning,1997-2002*.
Jefferson County Health Department AHLERS data
Age Group
•
Year <202 20-24' 25-29 30-34 35+ Total'
1997 105 102 45 40 66 358
1998 89 129 58 37 74 387
1999 125 133 78 51 107 494
2000 150 151 72 50 129 552
2001* 137 168 83 64 141 593
2002** 161 118 75 53 98 505
2002 /2001%Served 118% 70% 85%
4 YR %Change 30% 65% 66%
**data available through 2nd quarter only
Figure 4. Continuing clients, by age, Family Planning-
Jefferson County Health Department, 1997-2002*
Source: Jefferson County Health Department AHLERS data
700 - --- — -- --
01997
600 - ® 1998
• 01999
500 - 02000
®2001*
c D 2002**
400 - -- -
U
c iiitigl .'r:11
c
300
O
0
200
100
4 iiiiii i • ,,,,, , .: ,,,,, !:!i!i! it :': lig 1!!! :•••:••-- !!!!! g.,:.:! -,:.! o
<202 20-24' 25-29 30-34 35+ Total'
'Cont.Client Total-Served 85%of 2001 total in first 6 months of 2002;66%overall increase 1997 to 2001.
41ocont. Clients<20-served 118%of 2001 total in first 6 months of 2002;30%overall increase 1997 to 2001.
Cont.Clients 20-24-Served 70%of 2001 total in first 6 months of 2002;65%overall increase from 1997 to 2001.
8/8/02 FINAL
Figure 5. ZIP Code comparison, Family Planning Clinic, Jefferson County, 1997-2002
Jefferson County Health Department AHLERS data
Clients Served by ZIP Code
All Other East All Other WA/US
'ear 98368 Jefferson County ZIP Codes ZIP Codes Total
1997 401 55% 280 39% 44 6% 725
1998 499 60% 285 34% 54 6% 838
1999 531 58% 310 34% 76 8% 917
2000 559 59% 331 35% 56 6% 946
2001 598 58% 378 37% 57 6% 1,033
2002* 435 59% 278 38% 25 3% 738
* data available through 2nd quarter only
Figure 5. ZIP Code Comparison, Family Planning Clinic, Jefferson
County Health Department, 1997-2002*
Source: Jefferson County Health Department AHLERS data
1000 -
■98368
900 -
❑All Other East Jefferson County ZIP Codes
El All Other WA/US ZIP Codes
• 800 -
700 -
598
I, 600 -
559
%> 531
cn 499
500 -
c 435
1 d
401
V 400 - 78
31
10
r ,
300 - 80 8578
1
1
200 - I / _1 i
1
100 - 76
44 54 56 57
'�":'' 25
0
'....
1997 1998 1999 2000 2001 2002*
8/8/02 FINAL
•
Figure 6. Payment Source, Family Planning, 1997-2002*
Jefferson County Health Department AHLERS data
Allkyment Source 1997 1998 1999 2000 2001 2002*'
NW ding Scale2 897 67% 1038 68% 1147 64% 1104 62% 665 33% 40 3%
Title XIX (Medicaid) 245 18% 245 16% 284 16% 309 17% 405 20% 289 23%
Take Charge 579 28% 670 54%
Private Insurance 117 9% 181 12% 221 12% 198 11% 278 14% 182 15%
Full fee/Other 82 6% 70 5% 127 7% 172 10% 113 6% 58 5%
Totals 1341 100% 1534 100% 1779 100% 1783 100% 2040 100% 1239 100%—
* data available through 2nd quarter only
Figure 6. Payment Source, Family Planning-Jefferson County
Health Department, 1997-2002*
Source: Jefferson County Health Department AHLERS data
1400
1200
i
so
• 1000 Sliding Scale
•
so
5 \
�p 800
O •
Take Charge
600
•
400 w
•
r a,
Medicaid4
• t •
•
200 Private Insurance
Full Fee/Other
0 , -- —.
1997 1998 1999 2000 2001 2002*'
•2002-54%total visits qualified for Take Charge,23%qualified for Medicaid,3%qualied for sliding scale.
21997-2000--65%of total visits(based on annual average)qualified for sliding scale payment options
8/8/02 FINAL
Figure 7. Payment Source, Family Planning, 2001-2002*
Jefferson County Health Department AHLERS data
2000 2001 2002
SaYment Source QTR I QTR II QTR III QTR IV QTR I QTR II QTR III QTR IV QTR I QTR II
Sliding Scale 304 263 266 263 278 307 48 32 22 18
Title XIX (Medicaid) 87 78 66 78 81 83 117 130 158 131
Take Charge 0 0 0 0 0 0 257 322 359 311
Private Insurance 47 53 42 56 58 80 67 77 81 101
Full fee/Other 24 44 44 60 36 22 26 29 19 39
* data available through 2nd quarter only
Figure 7. Payment Source, Family Planning, Jefferson County
Health Department, 2001-2002*
Source: Jefferson County Health Department AHLERS data
I
I
400
Take Charge
350 .
411; SI ding Scat
300 ■
/ ■
S • / .
v)_ 1. .. . .i • ■
•
to 250 ■
5
■
(73
+'
O ■
200 ■
:
•
•
150 •
/
• ■ •
100 Medi.aid
` / ■ ..m..........--..
. �/
.111 .001100
Private Insuran e .-
■
50 •
Full Fee/Other
0 I
1
IP
2000 2001 2002
8/8/02 FINAL
•
•
Figure 8. Staffing Levels, Family Planning,1997-2002.
Jefferson County Health Department Budget, 1997-2002
• Year FTE Total'
1997 2.16
1998 2.31
1999 2.15
2000 2.25
2001* 3.19
2002** 3.65
2002/2001% Change 14%
4 YR % Change 48%
Average Annual % Change 12%
**-data available through 2nd quarter only
Figure 8. Staffing Levels, Family Planning-Jefferson
County Health Department, 1997-2002*
Source: Jefferson County AS 400 Data System
5 -
4110 01997
® 1998
4 3.65 ❑ 1999
2000
3.19 ®2001*
3 - 0 2002**
2.31
2.25
2.16
2.15
.
2
1
0
FTE Total'
IDtaffing level-48%overall increase 1997 to 2001; 14%increase from 2001 to 2002,12%average annual increase.
8/8/02 FINAL
•
Figure 9. Total clients & mean (average) number clients per month,
Family Planning,1997-2002. Jefferson County Health Department AHLERS data
Year Total Clients' Average # clients/month2
0 1997 730 61
1998 847 71
1999 919 77
2000 946 79
2001 1033 86
2002* 1150 96
2002 /2001 change 11% 11%
4 YR (97-01) change 42% 42%
4 YR mean (average) annual change 9% 9%
* Staff projection-data available through 2nd quarter only
Figure 9. Total clients & (mean) average number clients per month,
Family Planning-Jefferson County Health
Department, 1997-2002*
Source: Jefferson County Health Department AHLERS data
1200 - 1150
0 1100 103 >'
1000919 946 ? ' im
900 - 847 Iiieil i€ilii€€€€€i ME
Eig i ii is< i':i.iii:iii>iiiii 738 Total
800 730 `'`ilii Clients
Jan-June 2002
0
7 0
1997
soo
❑ 1
998
® 1999
500 --1" illaililiiiiiriliggiiiiiiiiiiiiligig
®2000
400
®2
001
:orf:•...:.:.:.::>.;.::.::i LI 2002
*
300 � ; :: :::::::::::< :::>: :
200
77
r'i -
61 71
79
86 96
100
..:::::::.:
:fi�
.:::.:.:.:..
........... ::::::::::
........... .......
...... -..........
Total Clients' Average # clients/month2
I
11110'Total Clients-111%of 2001 total;42%overall increase 1997 to 2001,9%annual average change.
2 Total Visits/month-111%f 2001 total;42%overall increase 1997 to 2001,9%annual average change.
8/8/02 FINAL
•
Figure 10. Total client visits and mean (average) number visits per month,
Family Planning, 1997-2002. Jefferson County Health Department AHLERS data
• Year Total Visits' Total visits/month2
1997 1341 112
1998 1543 129
1999 1783 149
2000 1780 148
2001 2040 170
2002* 2390 199
2002 /2001change 17% 17%
4 YR (97-01) change 52% 52%
4 YR mean (average) annual chang 11% 11%
* Staff projection-data available through 2nd quarter only
Figure 10. Total client visits and mean (average) number client
visits per month, Family Planning-Jefferson County Health
Department, 1997-2002*
Source: Jefferson County Health Department AHLERS data
2390
2400 -
io 2200
2040
2000 1997
®1998
17831780n??`a>`
1800
:.;;:;:.::::::g a 1,239 ❑1999
1600 1543 :::»:<::<:>: total visits
<<:>;::::::: ❑2000
Jan-June
::>::::::: 2002
1400
1341amx,i:K ' <<? ®2001
0 2002*
1200 <>
1000 ::...:
800
600
400
199
200 - >?>€ <> > ::: 112 129 149 148 170
MOM
Total Visits' Total visits/month2
'TotalVisits-117%of 2001 total;52%overall increase 1997 to 2001,11%annual average increase.
iikrotal Visits/month-117%of 2001 total;52%overall increase 1997 to 2001,11%annual average increase.
8/8/02 FINAL
Figure 11. New Clients (Family Planning), Jefferson County Health Department, 1997-2002*.
Jefferson County Health Department AHLERS data
• Year
1997 Total New Clients' Average new clients/month2
372 31
1998 460 38
1999 425 35
2000 394 33
2001 440 37
2002* 458 38
2002/2001change 4% 19%
4 YR (97-01) change 18% 6%
4 YR mean (average) annual change 5% 5%
* Projection-data available through 2nd quarter only
Figure 11. New Clients, Family Planning-Jefferson County Health
Department, 1997-2002*
Source: Jefferson County Health Department AHLERS data
1200 1
1100 -
• 1000 01997
❑1998
900 - ® 1999
800 ®2000
02001
700 - Ell 2002*
600 -
500 - 460 440 458
cu 425 233 New clients
394 : •: ::::::
U 400 - 372iiiiii%'••+ Jan-June 2002
a,
Z 300
ks
200
100
31 38 35 33 37 38
Total New Clients'Il
Average new
clients/month2 ,
'otal New Clients-104%of 2001 total; 18%increase from 1997 to 2001,4%average annual increase.
otal New Clients/month-103%of 2001 total; 18%overall increase 1997 to 2001,5%average annual increase.
L
8/8/02 FINAL
Figure 12. Continuing Clients & mean (average) number continuing clients per month,
Family Planning, 1997-2002*. Jefferson County Health Department AHLERS data
411 Year Continuing Clients' Average# continuing clients/month2
1997 358 30
1998 387 32
1999 494 41
2000 552 46
2001 593 49
2002* 800 67
2002 /2001change 35% 37%
4 YR (97-01) change 66% 66%
4 YR mean (average) annual change 14% 14%
* Projection-data available through 2nd quarter only
Figure 12. Continuing clients & Average number continuing clients
per month, Family Planning-Jefferson County Health Department,
1997-2002*
Source: Jefferson County Health Department AHLERS data
1000
900 -I
• 800
800
700
593 :::
600 552 ::: I.1997
505 continuing
494 liliiiiiiiii ' :i:: clients ❑1998
500 iE;:t�xiii3 Siiiir>::>: Jan-June 2002
® 1999
387 ` ]ill ` ,::::::::::
400 - 358 ®2000
0 2001
300 ->
> 2002*
200 , `„:.;::iiii ii:::::::::::
<:> � iii
100 > '>` :,::••.„•:::.:::::::::::::.::s:•:
:: 30 32 41 46 49
Continuing Clients' Average # continuing
clients/month2
Total Continuing Clients-135%of 2001 total;66%overall increase 1997 to 2001,14%average annual change.
4/0
Total New Clients/month-137%of 2001 total;66%overall increase 1997 to 2001,14%average annual change.
I
8/8/02 FINAL
Figure 13. Births per 1,000 females ages 15-17, Jefferson County &Washington State,
1980-82 through 1998-2000.
• Period Jefferson County' Rural Counties Washington State Healthy People 2010
1985-87 15.9
1986-88 13.1
1987-89 16.3
1988-90 21.6
1989-91 29.3
1990-92 35.8
1991-93 36.6
1992-94 32.2
1993-95 26.0 34.2 29.1 45.0
1994-96 19.1 32.4 27.6 45.0
1995-97 19.5 31.8 26.1 45.0
1996-98 18.1 30.4 24.5 45.0
1997-99 21.7 28.8 23.1 45.0
1998-2000 22.2 27.7 21.8 45.0
Figure 13. Births per 1,000 females ages 15-17,
Jefferson County, Rural Counties and Washington State,
1993-95 through 1998-2000.
Source: Washington State Department of Health Vital Statistics;Washington Health Foundation
• 50.0
State and National Target
r- 45.0 x x x x x x
e-
pi
• 40.0
Q 35.0 Rural Counties
1) 30.0
m 25.0 ashington State
u_ Jefferson County
O
0 20.0
e=
a)• 15.0
a
10.0
El 5.0
0.0 I - 4-- I I +- I I I I
N- 00 O 0 e- N M U) CJ N 03 C) 0
00 00 CO C) C) C) C) C) C) C) C) 0) C) 0
!f) CD t` 00 O 6 e- N M 4 6 CD t` O N
03 CO 00 03 03 Cr) CO Cr) O CO CO C) C)
C) C) D1 C) C) C) C) C) C) C) C) C) C) 00
t- c-- e- e- e- e- e- t- e- e- e- C)
C)
11990-92 through 1992-94-Births among 15-17 year olds greater than 30/1000;decrease seen in in 1993-95 rate(26/1000).
8/8/02 FINAL
Figure 14. Female Population comparison, Family Planning clients and Jefferson County Females,
2000 Population. Jefferson County Health Department AHLERS data
Sge Group Female Clients % Female Pop. Total County Females
15-19 245 34% 727
20-24 132 35% 378
25-29 96 22% 433
30-34 80 14% 590
Figure 14. Female Population Comparison-Family Planning
clients and county residents, by age,
Jefferson County Health Department, 2000
Source: Jefferson County Health Department AHLERS data;Census 2000
1000
■ Female Clients
900 -
❑Total County Females
800 -
727
700
04! 600 590
:a
a)
5
° 500
R 433
E
Li 400 - 378
300 -
245
200 -
132
100 - 9s 80
fiL110 , I
15-19 20-24 25-29 30-34
Age Group
8/8/02 FINAL
t t
Sexually Transmitted Diseases, Jefferson County
2001 Report
• Sexually Transmitted Diseases Reported to
Washington State Department of Health by Jefferson County
JCHHS Private Provider Total
diagnosed diagnosed
2001 2000 2001 2000 2001 2000
Chlamydia* 10 15 13 17 23 32
Gonorrhea 1 0 0 0 1 0
Herpes (initial infection) 4 0 5 0 9 0
Syphilis 0 1 0 0 0 1
*2001 reported chlamydia cases include 19 females and 4 males
Chlamydia Trends, Cases, Rate per 100,000 Population
Jefferson County Washington State
Cases Rate Cases Rate
1997 16 60.8 9,523 169.8
1998 15 56.6 10,998 193.4
1999 35 131.5 11,964 207.8
2000 32 121.1 13,066 224.5
2001 23 88.1 13,631 228.1
Jefferson County Chlamydia Rates for Females in High Risk Age Range:
Chlamydia Rate per 100,000 Population,
Females Age 15—24 Years, Jefferson County
1997 477 per 100,000
1998 546 per 100,000
1999 1,382 per 100,000
2000 1,686 per 100,000
2001 1,163 per 100,000
2001 Chlamydia Rates, Jefferson County and Washington State
Chlamydia rate per 100,000 population
Jefferson County Washington State Healthy People
2000 Target ffiv
Females age 15 -19 684.9 per 100,000 1,978.7 per 100,000
Females age 20 -24 2,061.9 per 100,000 1,823.6 per 100,000
Total Population 88.1 per 100,000 228.1 per 100,000 170 per 100,000
Healthy People 2000 and 2010 Objectives
Chlamydia Prevalence, Females Age 15-24 Years
Jefferson County 2001 Healthy People Healthy People
2000 Target 2010 Target
0 Age 15 -19 0.68% 5% 3%
Age 20 -24 2.06% 5% 3%
• S ex u ally Definition:Three of the over 25 diseases spread primarily through
sexual activity. Syphilis(ICD-9 codes 090-091),gonorrhea(I0D-9
code 098),and chlamydia(ICD-9 code 099.5)are all caused by
bacteria(Treponema pallidum,Neisseria gonorrhoeae,and
1 'ransmitted
Chlamydia trachomatis,respectively).For syphilis,symptoms are
divided into four stages: primary and secondary(highly infectious),
latent,and late(no longer contagious). Primary stage symptoms
IDiseases include one or more painless indurated lesions(chancres),and
secondary stage symptoms include rashes,swollen lymph nodes,
and flu-like symptoms. For gonorrhea,symptomatic women often
(Syphilis, Gonorrhea have abnormal vaginal discharge or painful urination;approximately
50%do not experience symptoms. Men usually have discharge
and Chlamydia) from the penis and urination that can be severely painful. For
chlamydia,approximately 70%of infected women have few or no
symptoms;symptoms are often mild or absent in men. If symptoms
occur,men and women can have abnormal genital dicharge or pain
during urination in the early stages. Women can also experience
Summary abdominal pain.
Syphilis Chlamydia
Syphilis is the oldest recognized sexually Chlamydia is the most commonly reported
transmitted disease, and its prevention has sexually transmitted disease (STD) in
been an historic focus of public health Washington. In 2000, 13,066 cases (9,582 females
activity. Cases of primary and secondary and 3,484 males)were reported; the incidence
syphilis (P & S), the infectious stages of rate was 221.7/100,000. Selective screening efforts
disease, decreased steadily in Washington focused primarily on women, including the
State during the first half of the 1990s to all- federally-funded Infertility Prevention Project,
• time lows. Syphilis has recently re-emerged contribute to the observed difference in cases
among certain populations.In Washington in reported among females and among males (2.8 to
2000, 66 cases of P & S syphilis were reported 1).Untreated chlamydia infection is a major
for an annual case rate of 1.1 per 100,000. cause of pelvic inflammatory disease (PID)
Untreated P & S syphilis infection can have among women. PID can lead to infertility and
serious health consequences including heart ectopic pregnancy. Women who become infected
abnormalities,mental disorders,blindness, with chlamydia while pregnant can transmit it to
neurological problems, and death. Among their infants resulting in neonatal eye infections
pregnant women,trans-placental and pneumonia. In 2000, 18 such neonatal
transmission of syphilis is a potential cause of infections were reported.
congenital abnormalities and fetal loss.
Gonorrhea Time Trends
In 2000, 2,419 cases of gonorrhea were Syphilis
reported among Washington residents; the Over the last two decades, epidemic infectious syphilis
rate was 41.0 cases per 100,000. Overall, has emerged in several distinct populations in
gonorrhea incidence in Washington Washington. In the early 1980s,P&S cases were
decreased dramatically over the past decade diagnosed primarily among men who have sex with men
from a high of 112 cases per 100,000 in 1990. (MSM). Behavioral changes in this community,largely in
However,the annual rate has increased from response to the HIV epidemic,led to a dramatic decrease
a low of 34.1 cases per 100,000 reported in in cases among MSM by the late 1980s.As P&S cases
1998. Untreated gonorrhea infection is a decreased among MSM, the epidemic shifted to affect
major cause of pelvic inflammatory disease heterosexuals,with cases in the late 1980s related to illicit
(PID) among women. drug use and prostitution. This epidemic phase peaked
in 1989, and P& S cases fell steadily to a low of 9 cases
• reported in 1996. Since that time,however, cases of P&
S have again risen precipitously among MSM,
The Health of Washington State 1 Sexually Transmitted Diseases
Washington State Department of Health updated:07/23/2002
concentrated primarily in Seattle and urban King at-risk populations,such as men who have sex with men
• County. It has been estimated that the annual rate of (MSM)and people with HIV infection.
infectious syphilis among MSM increased from zero
Recent increases observed in annual gonorrhea rates in
in 1996 to 200 per 100,000 in 19992.Based on Washington,while not large in comparison to the decline
review of clinical records,70%of all syphilis cases noted over the previous decade,highlight the continuing
in King County occur in MSM infected with HIV and
the annual infectious syphilis rate among HIV- need to reach populations at risk with intensified and
expanded prevention,treatment,and partner services.
infected MSM was estimated at 1,500 per 100,0002.
This epidemic continues: 50 cases of P& S syphilis
Chlamydia
were reported from King County in 2000, accounting y
for 76%of all cases statewide. Chlamydia became reportable in Washington in 1987 and
became reportable nationally in 1994. The lowest
Primary&Secondary Syphilis chlamydia case rate reported in Washington was 167.4
Reported Annual Incidence cases per 100,000 persons reported in 1996. Since then,
25 chlamydia rates have increased steadily. Several factors
0 might have contributed to this increase including more
N 20 A sensitive laboratory tests, an increase in routine screening,
cu
"Mkimproved surveillance,and a potential increase in sexual
0 15 risk-taking behaviors.
0
0 10 IIIIM
� Chlamydia
5 Reported Annual Incidence
au •
ec 0 300
co
0 250
a) a) m a) N N N 4.3
n 200
WA US 0
O \11\.../•
•
• HP 2000 Goal x HP 2010 Goal 0 150
4.5 100
a
Gonorrhea @ 50
i
National and state gonorrhea rates have fallen 0 , , , , , , , , , , , , , , , , , , , , , , , , ,
11
dramatically since the early 1980s. However,this 0rnco rn 0 o CD
decrease in rates reversed in 1999;both the national 0) 0) 0) '- N N N
and state annual incidence rates increased sli htly in
WA US • HP 2000 Goal
1999 and 2000. There is mounting evidence that rates
of gonorrhea infection are increasing among specific
Year 2000 and 2010 Goals
Gonorrhea
Reported Annual Incidence Syphilis
U) 350 Washington has met the Healthy People 2000 goal of 4.0
0 300 or fewer P&S cases per 100,000(1995 Midcourse
250 Revision). However,this apparent success disguises the
0 200 fact that rates continue to be considerably higher for
0 150 specific populations such as MSM.
a 100 . The goal established by Healthy People 2010 of 0.2 cases
cp 50 of P&S syphilis or less per 100,000 reflects the national
to
0 x intention to eliminate syphilis transmission entirely. In
0' ' , r LO ' '0r ' in
00. 0 0 2000,the most recent year for which reporting is
co co r T r N N N complete, 66 cases of P&S syphilis were reported
WA US statewide for a case rate of 1.1 cases per 100,000. A
• HP 2000 Goal HP 2010 Goal greater than five-fold reduction in cases will be necessary
. to achieve the Healthy People 2010 goal.
Sexually Transmitted Diseases 2 The Health of Washington State
updated:07/23/2002 Washington State Department of Health
Gonorrhea County,reflecting the epidemic among MSM.Cases
• Washington has achieved the national goal for reported from adjoining counties might be related,as
gonorrhea incidence(100 cases per 100,000)set in travel for sexual contact to urban centers is common.Case
Healthy People 2000(1995 Midcourse Revision)as rates are not statistically reliable in counties in which the
well as the state goal of fewer than 60 cases per population is small and the number of cases is low.
100,000 for 2000. In Healthy People 2010,CDC has Only four counties(King,Pierce,Yakima,and Kitsap)
set an aggressive national goal of 19 or fewer cases reported more than one case of P&S syphilis in 2000,
per 100,000. To reach this goal,Washington needs and 29 counties reported having no cases.
to expand prevention interventions to specific at-risk
groups,such as MSM,African Americans, and Gonorrhea
people with HIV infection.
Washington's three-year average rate(see Technical
Chlamydia Notes)for gonorrhea between 1998 and 2000 was 37.6
cases per 100,000. This is almost a quarter of the national
Incidence rates nationally have increased in each of rate, 133.2 per 100,000.Twenty-one counties in
the five years for which data are available and have Washington had a rate greater than eight cases per
exceeded the Healthy People 2000 goal of reducing 100,000. The highest average rates were in King and
incidence to 170 per 100,000 persons. Washington Pierce counties(62 and 75 cases per 100,000,
reached the Healthy People 2000 goal in 1996 and respectively). These two counties have experienced
1997,but since that time,chlamydia incidence has significant recent increases in morbidity,but both rates
risen.An overall population-based goal for the are considerably below the Healthy People 2000 goal of
reduction in chlamydia incidence was not included in 100 cases per 100,000.
Healthy People 2010. However,there is a goal to
reduce the overall chlamydia infection rate for people GONORRHEA
15—24 years old to 3%at STD and family planning 1998-2000
clinics in Washington. Expanded screening and
treatment among women and an increased effort to IdoiE*0 04.,
4 ,*.
improve partner treatment as well as screening of
. selected,high-risk groups of young men—such as
those in correctional settings—will be required to
meet this goal. �� 41 p,..4' c1:52i 4.,4,,,;,, , 14,
li -,,,— ,
Geographic Variation la
Syphilis �'7
yP , g 111
In 2000,76%of the cases of P&S syphilis were rf 1111111P
reported from clinics in Seattle and urban King
Average Annual Crude Incidence per 100,000
PRIMARY&SECONDARY SYPHILIS En 0.0 to 7.9 State Rate: 37.6
1998 2000 8.1 to 27.7 National Rate: 133.2(1999)
27.8 to 61.6
MYrk 61.7 to 74.7 P a D'RM_:s
Old' "` Chlamydia
' Statewide,the three-year average incidence rate(see
Technical Note)for 1998—2000 was 206.4 per 100,000.
Chlamydia infections were reported from all counties in
All Washington,which in part reflects the wide availability of
miill
ltiitira
screening through the Infertility Prevention Project.
✓'� Chlamydia infection is widely distributed among sexually
'maIIIPIP
active populations regardless of geography.The highesthest
case rates for 1998-2000 were in Franklin,Yakima,
Average Annual Crude Incidence per 100,000 Pierce,and King counties.
0.0
• 0.1 to 0.9 State Rate: 1.1
1.0 to 1.5 National Rate: 2.5(1999)
1.6 to 2.9 P ced by DiRMG3
The Health of Washington State 3 Sexually Transmitted Diseases
Washington State Department of Health updated:07/23/2002
CHALMYDIA urban areas,including higher concentrations of younger
• 1998-2000 people and particular at-risk groups in urban areas.
,,,,ts'
Gonorrhea
a Urban and Rural
Aliffa- s!"--11:%` ,144'?
G Reported Average Annual Incidence
WA State, 1998-2000
me j
, • Urban
43.4
PM. ,„,,,
Large Town/ 9.3
1 ga
Mixed RuralWhew ■
Small Town/ 6.3
Average Annual Incidence Rate per 100,000 Rural , I
33.6 to 139.2 State Rate: 208.6
MEI 142.8 to 201.2 National Rate: 377.1(1999) 0 10 20 30 40 50
209.3 to 236.2
282.0 to 370.2 Prod.�c-d s.; ,r.r•�=,_1s Rate per 100,000 persons
Urban and Rural Chlamydia
Chlamydia rates are higher in urban counties in
Syphilis Washington. Multiple factors contribute to the observed
Rates of P&S syphilis are higher in Washington differences in rates between rural and urban areas,
counties in closest travel-time proximity to large including higher concentrations of younger persons in
urban centers. The most prominent factor urban areas.Greater prevalence of disease in specific
contributing to the observed differences in recent P& urban populations contributes to increased exposure risks;
S syphilis rates between rural and urban areas is the the presence of sex workers and anonymous sex venues in
•
higher concentrations of MSM in population centers urban areas might magnify this effect.
in western Washington.
Greater prevalence of disease in specific urban Chlamydia
populations contributes to increased exposure risks; Urban and Rural
the presence of sex workers and anonymous sex Reported Average Annual Incidence
venues in urban areas magnifies this effect. WA State, 1998-2000
Urban 220
Primary&Secondary Syphilis
Urban and Rural
Reported Average Annual Incidence Large Town/ 162.3
WA State, 1998-2000 Mixed Rural
Urban 1.2 Small Town/ 112.1
Rural
0 50 100 150 200 250
Large Town/ 0.2
Mixed Rural Rate per 100,000 persons
Small Town/ 0.12
Rural ' Age and Gender
0 0.5 1 15 2 Syphilis
Rate per 100,000 persons Males accounted for 88%of all P&S syphilis cases
reported in 2000.The male-to-female ratio of P&S
Gonorrhea syphilis cases in 2000 was 7.3 to 1,clearly reflecting the
Gonorrhea rates are significantly higher in urban fact that the current epidemic is concentrated among
ii• counties in Washington. Multiple factors contribute MSM.Among men,the highest average annual incidence
to differences in gonorrhea rates between rural and
Sexually Transmitted Diseases 4 The Health of Washington State
updated:07/23/2002 Washington State Department of Health
•
rate of P&S syphilis between 1998 and 2000 was women. Factors that might contribute to this pattern
• among those 25 to 34 years of age, 6.0 cases per include selective screening of young women,higher
100,000. levels of sexual activity in this age group among both men
and women,increased susceptibility to infection due to
Primary&Secondary Syphilis cervical ectopy,and the absence of immunologic
Age and Gender experience with chlamydia which may result in partial
Reported Average Annual Incidence immunity. The overall rate of chlamydia among females
WA State, 1998-2000 in 2000 was 328.0 per 100,000 while the male rate was
65-74 almost a third of that, 120.2 per 100,000.
55-64 Males diagnosed with nongonococcal urethritis(NGU),a
45-54 principal indicator of chlamydial infection in men,are
often treated presumptively without laboratory
3544 �— confirmation of disease. Only laboratory-confirmed cases
25-34 of chlamydia infection are required to be reported to the
15-24 local health jurisdiction and the Depaitment of Health.
For this reason,chlamydia might be significantly under-
0 2 4 6 8 reported among males. In light of this practice,true
Rate per 100,000 persons chlamydia morbidity might be much closer to 1:1 for
LEg Female Male males and females.
Chlamydia
Gonorrhea Age and Gender
There are significant differences in gonorrhea rates Reported Average Annual Incidence
by gender and age. Males had a higher gonorrhea WA State, 1998-2000
rate(46.3 per 100,000)than females(36.9 per 85+
100,000)in 2000.The highest rates are in women age 75-84
15 to 24 years, 183.0 cases per 100,000. These cases 65-74
• accounted for 29%of total gonorrhea morbidity in 55 64
2000.Among males,the burden of disease is 45-54
distributed more evenly among those 25 and older. 35-44
25-34
15-24 miTir
Gonorrhea 5-14 -
Age and Gender 1-4
Reported Average Annual Incidence <1 1
WA State, 1998-2000
0 500 1000 1500 2000
85+
75-M -
Rate per 100,000 persons
65-74 } ®Female •Male
55-64 ti
45-54 110111
35-44 Race and Ethnicity
25-34 The 2000 US census allowed reporting of more than one
15-24 race per person,but until 2001,the STD surveillance
5-14
1-4 system only recorded one race. For this reason,current
<1 - STD incidence rates by race were not developed for this
report. However,other reports have been developed by
0 50 100 150 200 the Department of Health using census estimates(Annual
Rate per 100,000 persons Communicable Disease Report,2000; STD Disease
Morbidity Report,2000). Incidence rates for sexually
Female •Male transmitted diseases are higher for some racial and ethnic
minorities.
Chlamydia
Chlamydia infection is disproportionately reported Income and Education
among women and younger people.In 1998-2000,
4110
incidence was highest among 15—24 year old Case reports for these three STDs do not include
information about income and education.
The Health of Washington State 5 Sexually Transmitted Diseases
Washington State Department of Health updated:07/23/2002
•
Other Measures of Impact and conjunctivitis and chlamydia pneumonia. In 2000, 18
• Burden such neonatal infections were reported in Washington.
HIV Co-morbidity: Infection with bacterial sexually
transmitted infections facilitates sexual transmission Risk and Protective Factors
of HIV infections. A recent study of HIV/STD co- Sexually transmitted disease risk behavior cannot be
morbidity found that among people with P&S viewed as merely the result of conscious choices. Sexual
syphilis in Washington,23%were reported as HIV- health and the practice of responsible and sustainable
positive in 1999,and 29%were HIV-positive in sexual behaviors is a complex issue influenced by a wide
2000 . Among people with gonorrhea,the minimum array of biological,social, emotional, interpersonal, and
prevalence of HIV infection among reported GC spiritual issues. Specific behaviors can be identified
cases was slightly less than 3%;for all people which facilitate the transmission of STDs,but factors
reported with STDs,the minimum prevalence of HIV influencing these behaviors are not generally amenable to
infection was approximately one half of one percent simplistic explanation.
of all STDs reported. As HIV reporting becomes
Unprotected vaginal and anal intercourse is the primary
more complete, surveillance for co-morbidity will
more accurately reflect the extent of co-infection. method of transmission for STDs. Abstinence or delay in
the onset of sexual activity is an effective protective
Studies based on clinical records,rather than
surveillance data, suggest that the prevalence of HIV measure for preventing the transmission of all STDs.
infection among STD patients might be considerably Among people not practicing abstinence,mutually
higher. One such study recently found that 70%of monogamous relationships provide a protective measure
syphilis cases were also infected with HIVE. against STDs. Avoidance of multi-partnering and
Pelvic Inflammatory Disease(PID): About 20%of anonymous sex venues can also significantly reduce the
risk of infection with STDs. Correct and consistent use of
women with untreated gonorrhea infection will
develop PID,and approximately 10%of women with latex condoms during penetrative sexual activity
constitutes an equally important protective behavior to
untreated chlamydia will develop PID 7. PID causes
inflammation of the female genital tract,especially prevent transmission of bacterial STDs.
• the fallopian tubes. In 20%of cases,PID causes
intermittent fever,severe abdominal pain,vaginal High Risk Populations
discharge,and potential tissue damage resulting in Adolescents and young adults: Young people between
infertility. Ectopic pregnancy is strongly associated 15 and 19 years of age account for 40%of chlamydia
with PID.One hundred nineteen cases of gonococcal infections nationwide and account for 36%of all
PID and 325 cases of chlamydial PID were reported chlamydia morbidity in Washington. Among sexually
in Washington State in 2000. The actual incidence of active women prevalence can exceed 5%and might reach
PID is difficult to estimate because of the relative as high as 10%among teenage girls3. Females are over-
complexity of diagnosis and a more recent shift from represented in chlamydia reporting,and the incidence
inpatient to outpatient treatment,and incompleteness among males is more likely similar to that of females in
of reporting. Screening for chlamydial infection has this age group.
been shown to reduce the incidence of PID.
Late-stage Manifestations: Serious disability or Men who have sex with men(MSM): P&S syphilis
mortality rarely results during primary or secondary infections in MSM reported from Seattle-King County
syphilis infection. However,untreated syphilis can have increased precipitously since 1997. Multiple
partnering and sexual activities in anonymous sex venues
lead to serious complications including central
nervous system and cardiovascular involvement and represent significant risk factors for syphilis infection in
skin,bone,and viscera lesions. These complications the MSM population. Gonococcal infections in MSM
can shorten life, impair health,and lead to disability. reported from the Seattle-King County Harborview STD
clinic more than doubled from 1997 to 1998. It has been
Infant morbidity and mortality:Among pregnant estimated that the rate of gonococcal infection in MSM in
women with untreated syphilis infection,infection of King County increased from 180 per 100,000 in 1997 to
the fetus can occur in utero with subsequent risk of 363 per 100,000 in 2000(projected from data through
infant mortality,brain damage,blindness,and/or September 2000). In contrast,the rate among presumed
developmental abnormalities. Gonorrhea and heterosexuals in King County was projected to be 57 per
chlamydial infections have been identified as 100,000 in 2000.8
• possible causes of premature birth. Maternal Racial/ethnic minorities:Evidence suggests that African
gonococcal and chlamydial infections can be American MSM are disproportionately affected by P&S
transmitted to infants during birth causing
Sexually Transmitted Diseases 6 The Health of Washington State
updated:07/23/2002 Washington State Department of Health
• syphilis infection and gonorrhea, and racial and abstinence from sexual activity,consistent and correct use
ethnic minorities are disproportionately affected by
chlamydia infection. There is no scientifically valid of latex condoms,regular screening if sexually active,and
prompt treatment if infected. Prompt identification and
reason to expect STD rates in some groups to be treatment of infected people reduces duration,which
different from those of others. Race and ethnicity do, consequently reduces the infected person's sexual
however,correlate with socioeconomic and partners'risk of exposure.
geographic factors that contribute to recognized When people are screened and STD infection is detected,
disparities in access to health services. Race and public health approaches to STD control,such as prompt
ethnicity may be salient characteristics defining treatment with antibiotics,interviewing infected
sexual networks;more constrained sexual mixing individuals to identify people potentially exposed through
might,in part,help explain observed differences in
sexual activity,and contacting these exposed partners are
STD rates.9 STD case reporting may also be biased
an effective foundation for limiting the spread of disease.
toward more complete reporting from publicly-
funded STD clinics than from private medical Timely identification and prompt response to STD
providers. Surveillance data might under-represent outbreaks by the public health community can also
infection among people seeking care in privately interrupt the chain of transmission in sexual networks and
funded settings thus heightening the observed limit the extent of the outbreak.While often resource-
disparity in infection rates by race and/or ethnicity. intensive,these interventions can be highly effective.
Repeat infections: People with multiple episodes of In light of the mounting evidence that inflammatory and
gonorrhea infection in a given 12-month period ulcerative STDs can facilitate transmission of HIV
represented 6.7%of gonorrhea cases in 2000,and infection, STD control efforts also provide an additional
people with multiple episodes of chlamydia infection opportunity to prevent HIV transmission especially
in a given 12-month period represented 9.3%of among people at greatest risk for infection.
chlamydia cases in 2000. These figures are based on
surveillance data and may underestimate the impact
that a relatively small group of persons may have in See related chapters on Sexual Behavior,
facilitating HIV transmission. Recent studies in King Social Determinants of Health, and
• County and elsewhere have shown that 12%of HIV/AIDS.
women infected with chlamydia are infected when
retested 3-5 months after treatment. Repeat infection Data Sources
is also a risk factor for infertility among women.
Those with multiple episodes of STDs can also Sexually Transmitted Disease Morbidity 2000, Washington
interact regularly with 'core transmitters'of disease State,Washington State Department of Health, Infectious
in the community and so deserve additional Disease&Reproductive Health STD/TB Services Section&
preventive emphasis. IDRH Assessment Unit. This report contains surveillance data
on legally reportable STDs in Washington State.
Sexually Transmitted Disease Surveillance 1999,United States
Intervention Strategies
Department of Health&Human Services,Centers for Disease
Three key factors combine to determine ongoing Control and Prevention, 1999. This report contains surveillance
transmission of STDs: 1)the rate at which uninfected data and analysis for STDs reportable to CDC in 1999.
people have unprotected sexual contact with infected
people(exposure),2)the probability that an For More Information
uninfected person will become infected if exposed
(transmissibility), and 3)the length of time an Washington State Department of Health, Infectious Disease&
infected person is infectious and able to transmit the Reproductive Health, STD/TB Services Section,360-236-3460.
pathogen(duration).
Endnotes
Reducing the incidence of STDs requires creating
programs to engender behavior change both at the
individual and population levels to impact one or ' 1990 Annual STD Progress Report,STD/TB Services Section,
more of these factors.For non-vaccine preventable Infectious Disease&Reproductive Health,Washington State
STDs,only exposure and duration factors are Department of Health.
amenable to public health intervention. 2 Resurgent Bacterial Sexually Transmitted Disease Among Men Who
Limiting the rate of individual exposure can be Have Sex With Men—King County, Washington,1997-1999,MMWR
• accomplished by programs that encourage people at Weekly,48(35);773-777,Centers for Disease Control and Prevention,
risk to adopt preventative strategies such as
Atlanta,Georgia,September 1999.
The Health of Washington State 7 Sexually Transmitted Diseases
Washington State Department of Health updated:07/23/2002
p ►
3 CDC,Tracking the Hidden Epidemics:Trends in STDs in the
United States,2000.
a Courogen M,Stenger M,unpublished data from the Washington
State Department of Health OASIS Project,2000.
5 Fleming DT,Wasserheit JN,From Epidemiological Synergy
toPublic Health Policy and Practice:the Contribution of Other
Sexually Transmitted Diseases to Sexual Transmission of HIV
Infection,Sex Trans Dis 1999;1:3-17.
6 Golden,M. Unpublished data from Public Health—Seattle&
King County STD Program,January 2002.
Westrom L,Joesoef R,Reynolds G,et al.Pelvic Inflammatory
Disease and Fertility:a Cohort Study of 1,844 Women with
Laparoscopically Verified Disease and 657 Control Women with
Normal Laparoscopy.Sex Trans Dis 1992;9:185-92.
8 Whittington W.,Celum C.Sleepless in Seattle: Risk Behaviors
among HIV+and HIV-MSM;STD Prevalence;Implications for
Prevention,Unpublished Report,December 2000.
Laumann EO,Youm Y. Racial/Ethnic Group Differences in
Prevalence of Sexually Transmitted Diseases in the United
States: A Network Explanation. Sex Trans Dis 1999;26(5):250-
261.
•
•
Sexually Transmitted Diseases 8 The Health of Washington State
updated:07/23/2002 Washington State Department of Health
Board of Health
New Business
Agenda Item # V. , 3
• Jefferson County Family
Planning Program Report
August 15, 2002
•
BOH 8/02 Packet
FINAL 8/8/02
A Five Year Perspective, 1997-2002
• Family Planning Services—Jefferson County Health Department
Prepared by Kellie Ragan, M. A.
This is an evaluation of the Family Planning Program within the Jefferson County Health
Department. Within the context of clinic services, this comparative analysis examines target
populations (females 19 and younger and females 20-24), client-specific areas (unduplicated
clients, total visits, new clients and continuing clients), payment sources, ZIP Code of residence,
and staffing levels.
Family Planning services encompass annual exams, reproductive health and risk reduction
education, FDA approved prescriptive birth control methods, devices and supplies, non-
prescription over-the-counter products (male & female condoms, contraceptive cream, film,
foam, gel and suppositories), authorization and referrals for sterilization (vasectomy or tubal
ligation), abortion and other reproductive health issues. The goal of the Family Planning
Program is to reduce unintended pregnancies. Primary target populations are women 15-19
years old and women 20-24 years old.
The Health Department began providing comprehensive family planning services in 1994
through the Family Planning Program (Family Planning). In July 2001, the Health Department
implemented the Take Charge program (a federally funded Family Planning Waiver Program).
The Present: January 1 through June 30 2002
Family Planning has experienced rapid growth in demand for services due to the Take
• Charge program. Family Planning serves the target audiences outlined by the CDC—
specifically teens and 20-24 year old females. The Take Charge program is minimizing
the cost barrier for reproductive health. Based on Census 2000, approximately one-third
of the primary target populations are accessing family planning services. Unduplicated
client numbers have increased, total visits are up, new clients are requesting services,
and continuing clients are returning.
From January 1 through June 30, 2002, Family Planning:
• Served 738 total clients-71% of the 2001 total (Figure 1).
• Served 230 unduplicated teen clients (19 and younger)-77% of the 2001 total (Figure 1).
• Served 166 unduplicated clients age 20-24-66% of the 2001 total (Figure 1).
• Completed 1239 visits-61% of the 2001 total (Figure 2).
• Completed 469 visits with teens-67% of the 2001 total (Figure 2).
• Completed 268 visits with 20-24 year olds-54% of the 2001 total (Figure 2).
• Served 233 new clients-53% of the 2001 total (Figure 3).
• Served 69 new teen clients-42% of the 2001 total (Figure 3).
• Served 48 new clients age 20-24-56% of the 2001 total (Figure 3).
• Provided services to 505 continuing clients-85% of the 2001 total (Figure 4).
• Provided services to 161 continuing teen clients-118% of the 2001 total (Figure 4).
• • Provided services to 118 continuing clients age 20-24-70% of the 2001 total (Figure 4).
1
BOH 8/02 Packet
FINAL 8/8/02
• Provided services to 738 total clients-of those 59% resided in ZIP Code 98368, 38% resided
• in All Other East Jefferson County ZIP codes, and 3% resided in All Other WA/US ZIP codes
(Figure 5).
• Billed for 1239 client visits—of those 54% qualified for Take Charge, 23% qualified for
Medicaid and 3% qualified for sliding scale (Figures 6 & 7).
• Clinics were staffed with 3.65 FTE—this includes all clinical and support staff (Figure 8).
The Future: 2002
Preliminary calculations estimate that Take Charge program revenue is likely to pay for
expanded services to accommodate increased demand. The following 2002 clinic
projections (based on data from the past 12 months of Take Charge) are anticipated in
Family Planning:
• Serving 1150 total clients-111% of the 2001 total (Figure 9).
• Serving 96 clients each month-111% of the 2001 total (Figure 9).
• Completing 2390 total visits-117% of the 2001 total (Figure 10).
• Completing 199 visits per month-117% of the 2001 total (Figure 10).
• Serving 458 new clients-104% of the 2001 total (Figure 11).
• Serving 38 new clients per month-103% of the 2001 total (Figure 11).
• Providing services to 800 continuing clients-135% of the 2001 total (Figure 12)
• • Providing services to 67 continuing clients each month-137% of the 2001 total (Figure 12).
The Past: 1997-2001
The utilization of Family Planning services has steadily increased.
• In 1997, Family Planning served 730 unduplicated clients. In 2001, Family Planning served
1033 unduplicated clients; this is 42% increase over four years with an annual average
increase of 9% (Figure 9).
• In 1997, Family Planning saw an average of 61 clients per month. In 2001, Family Planning
saw an average of 86 clients per month; this is 42% increase over four years with an annual
average increase of 9% (Figure 9).
• In 1997, Family Planning completed 1341 visits. In 2001, Family Planning completed 2040
visits; this is a 52% increase over four years with an annual average increase of 11
(Figure 10).
• In 1997, Family Planning completed 112 visits per month. In 2001, Family Planning
completed 170 visits per month; this is a 52% increase over four years with an annual
average increase of 11% (Figure 10).
New Clients
New clients consume more clinic staff time than continuing clients due to program
requirements. These requirements include client assessment, risk reduction and method
• education, and frequently—crisis intervention.
2
BOH 8/02 Packet
FINAL 8/8/02
• In 1997, Family Planning served 372 new clients. In 2001, Family Planning served 440 new
. clients; this is an 18% increase over 4 years with an annual average increase of 5% (Figure
11).
• In 1997, Family Planning served an average of 31 new clients each month. In 2001, Family
Planning served an average of 37 new clients each month; this is a 19% increase over 4
years with an annual average increase of 5% (Figure 11).
Continuing Clients
Continuing clients may require visits ranging from one time/month to one-time/6 months,
depending on the birth control method, and other clinical, medical and personal factors.
• In 1997, Family Planning served 358 continuing clients. In 2001, Family Planning served
593 continuing clients; this is a 66% increase over 4 years with an annual average increase
of 14% (Figure 12).
• In 1997, Family Planning served an average of 30 continuing clients each month. In 2001,
Family Planning served 49 continuing clients each month; this is a 66% increase over 4
years with an annual average increase of 14% (Figure 12).
Target Populations
• In the early 90's, the teen birth rate peaked to above 30 per 1000 females age 15-17 (Figure
13).
• In 2000, Family Planning served an estimated 34% of the 15-19 year old females in
Jefferson County (Figure 14).
• In 2000, Family Planning served an estimated 35% of the 20-24 year old females in
Jefferson County (Figure 14).
Clients 19 and younger
Pregnancies among young women age 15-17 are associated with lifelong negative social
and economic consequences for the mothers and their children, and reducing these
pregnancies is a state and national public health goal.
• In 1997, Family Planning served 207 teens (19 and younger). In 2001, Family Planning
served 300 teens; this is a 45% increase over four years (Figure 1).
• In 1997, Family Planning completed 447 teen visits. In 2001, Family Planning completed
699 teen visits; this is a 56% increase over four years (Figure 2).
• In 1997, Family Planning served 102 new teen clients. In 2001, Family Planning served 163
new teen clients; this is a 60% increase over four years (Figure 3)
• In 1997, 105 continuing clients were teens; in 2001 Family Planning served 137 continuing
teen clients; this reflects a 30% increase among continuing teen clients over four years
(Figure 4).
•
3
BOH 8/02 Packet
FINAL 8/8/02
Clients age 20-24
Women age 20-24 have one of the highest rates of unintended pregnancy of any age
group.
• In 1997, Family Planning served 191 adults age 20-24. In 2001, Family Planning served 253
clients age 20-24; this is a 32% increase over four years (Figure 1).
• In 1997, Family Planning completed 345 visits with adults age 20-24. In 2001, Family
Planning completed 499 visits with clients age 20-24; this is a 45% increase over four years
(Figure 2).
• In 1997, 89 new clients were age 20-24. In 2001, Family Planning served 85 new clients age
20-24; this is a 4% decrease over four years (Figure 3).
• In 1997, 102 continuing clients were 20-24 year olds. In 2001, Family Planning 168
continuing clients were adults age 20-24; this is a 65% increase over four years (Figure 4).
ZIP Code of Residence
Clients within ZIP Code 98368 utilize Family Planning in greater numbers than All Other
East Jefferson County ZIP Codes.
• In 1997, 401 residents of ZIP Code 98368 (55%) utilized Family Planning as compared to
280 residents of all other East Jefferson County ZIP codes (39%) (Figure 5).
• In 2001, 598 residents of ZIP Code 98368 (59%) utilized Family Planning as compared to
378 residents of all other East Jefferson County ZIP codes (37%) (Figure 5).
• • For the years 1997-2001, approximately 6% of clients reported residences outside of East
Jefferson County (Figure 5).
Payment Sources
Since it's implementation, Family Planning has relied on a variety of payment sources to
maintain financial solidity. Medicaid reimbursement, private insurance, and full fee/other
payment sources have seen relatively little change from 1997-2001.
• Since 1997, sliding scale payment schedules have encouraged heavy program usage. From
1997 through 2000, over 60% of clients qualified for sliding scale fees (Figures 6 & 7).
• From 1997-2000, Medicaid reimbursement has been consistent (Figure 6). Medicaid
reimbursement has increased due to coordination of benefits with the Take Charge
program.
Staffing Levels
Staffing levels within Family Planning have increased from 2.16 FTE in 1997 to the
current 3.65 FTE.
• The 1997 clinic staffing level was 2.16 FTE (Figure 5). The 2001 clinic staffing level was
3.19 FTE; this represents a 42% increase over 4 years with an annual average increase of
12% (Figure 8).
•
4
• Adolescent Definition:In this section,"adolescents"or"teens"are 15-17
year-olds unless otherwise indicated.Analysis was restricted to
15-17 year-olds because they are school age. Pregnancy among
teens younger than 15 are a rare event and teens older than 17
Pregnancy and are at lower risk for poor birth outcomes.Adolescent pregnancies
are estimated by adding together reported births,induced
abortions,and fetal losses for females age 15-17.Spontaneous
C h i l d b e a r i n abortions(miscarriages)occurring prior to 20 weeks gestation are
g not included because there is no way of accurately estimating
their number.
Summary births. Where possible, in the following sections we
provide characteristics of all teen pregnancies. In some
instances,we have provided data only on live births due
Adolescent pregnancy is a complex issue
to the unavailability of data on all pregnancies.
influenced by many factors including
individual,family and community
characteristics.Its consequences negatively Time Trends
affect the health,social and economic well
being of the teen, child and society. Adolescent Pregnancies. The rate of pregnancy among
15— 17 year-olds in Washington decreased during the
In 1999 in Washington State,the adolescent early 1980s to a low of 53/1,000 in 1984 and then
pregnancy rate among 15— 17 year-olds was increased to 59/1,000 in 1989.The rate declined to
39 per 1,000,the lowest rate in 20 years. 39/1,000 in 1999,which is the lowest rate in the 20-year
Washington has achieved the Healthy People period of 1980— 1999.For every year between 1980 and
• 2000 goal for teen pregnancies of no more
than 50/1,000.While declining rates of 1996,the pregnancy rate among 15— 17 year-olds in
Washington was well below the national average.
adolescent pregnancy call for cautious Adolescent Births. Washington's birth rate for 15— 17
optimism,US rates remain higher than in year-olds began rising steadily after 1986 and peaked in
other developed countries. 1992 at 33/1,000.After 1992,the rate decreased to
22/1,000 in 1999,the lowest rate in the 20-year period
No single approach for preventing adolescent between 1980— 1999.National studies suggest adolescent
pregnancies is appropriate for all adolescents birth and pregnancy rates might be declining because
in all circumstances. Some approaches,such fewer teens are having sex and those who do engage in
as youth development programs,show sexual activity are more effective contraceptive users.'
promise in reducing pregnancy rates. Other
approaches, such as abstinence-only Adolescent(Age 15-17)Pregnancies
programs, require further evaluation.
Coordinated and sustained interventions 100
from all sectors of society will be needed to 80 _-
ensure the declining trend of adolescent o 1
pregnancy rates continues. 60
tis
•
ani 40
Background Note cc
20
The primary sources of data for adolescent pregnancy
are birth certificate data,abortion data,and fetal 0
death certificate data from the Center for Health o co o a) O 0, O
co a) a) W O N N
Statistics at the Washington State Depait,uent of
Health and data from the First Steps Database at the WA US
• Department of Social and Health Services.AlmostHP 2000 Goal • HP 2010 Goal
60%of teen pregnancies in Washington result in live
The Health of Washington State 1 Adolescent Pregnancy and Childbearing
Washington State Department of Health updated: 07/23/2002
Adolescent Abortion.Washington's abortion rate for
0 15— 17 year-olds steadily decreased from 30/1,000 in Births to Women 15-17
1989 to 17/1,000 in 1999. Urban and Rural
WA State, 1999
Year 2000 and 2010 Goals Small Town/ 28
Rural
Washington's year 2000 goal for pregnancies among
15— 17 year-olds was no more than 45/1,000.The Large
Healthy People 2000 and 2010 goal for adolescent Town.Mixed 29
pregnancies was no more than 50/1,000 and Rural
45/1,000,respectively.Washington has already
achieved both the state goal and the 2000 and 2010 Urban 22
national goals. The state rate for adolescent inimmia
pregnancies among 15— 17 year-olds from 1997 o io 20 30 40
through 1999 was 42.5 per 1,000. Rate per 1,000
Geographic Variation Race and Ethnicity
For the 1997— 1999 period,teen pregnancy rates at
the county level varied from a high of 78/1,000 in Race information on abortion reports in Washington is
Franklin County to a low of 12/1,000 in Whitman frequently missing.Additionally,the 2000 US Census
County. The counties with the highest average teen allowed people to choose more than one race,but multiple
pregnancy rates were Grays Harbor, Skagit,Yakima, race as collected by the birth certificate in Washington is
Okanogan,Grant,Adams and Franklin.The lowest of uncertain quality and completeness.Therefore,we
rates were in Whatcom, San Juan,Island,Kittitas, cannot currently calculate pregnancy rates by race for
Klickitat,Lincoln,Stevens, Spokane and Whitman adolescents in Washington.National data available from
. counties. 30 states indicate that pregnancy rates for 15— 19 year-
olds in the 1995— 1997 period were higher for blacks
than for whites.2
ADOLESCENT(Age 15-17)PREGNANCIES
1997-1999
rill& Age
In the 1997— 1999 period,adolescent birth rates for 15—
17 year-olds rapidly increased with maternal age.
Seventeen year-olds had the highest birth rate, at 38 births
per 1,000 adolescents.
Births by Mother's Age
a-
WA State, 1997-1999
ill
ufkowiP 17 38
Rates per 1,000 ' In Columbia,Garfield and Wahkiakum counties
I
12.3 to 35.6 the counts are too small to generate a rate. -
35.8 to 41.7 State Rate: 43.0 0 16
1111111111122 1
9
43.3 to 50.7 Q
52.8 to 77.7 Produced by DIRM GIS
Urban and Rural 15
. - a
Adolescent birth rates for 15— 17 year-olds in 1999 0 10 20 30 40 50
were lower in urban locations compared to rural Rate per 1,000 Adolescent Women
locations or large towns.
•
Adolescent Pregnancy and Childbearing 2 The Health of Washington State
updated: 07/23/2002 Washington State Department of Health
.f
Income and Education 19 year-olds have the highest rates for smoking during
•
pregnancy at 18%.8 Smoking during pregnancy is
Research suggests that early parenthood is a associated with intrauterine growth restriction,low birth
challenge to teens trying to complete their high weight, and infant mortality.
school education. In the United States,parenthood is
finish high school.3 Children of teen mothers are more likely to be born
a leading reason teen girls do not
prematurely and be low birth weight than children born to
Nationally,less than one-third of teens who gave
birth before age 18 ever completed high school.4 The women who delayed childbearing beyond their teen
years.4 Low birth-weight increases the likelihood of infant
high school completion rate for teen girls would
mortality,blindness,deafness,respiratory difficulties,
increase by 40%if psregnancy and births by teens
could be prevented. mental illness,retardation,and cerebral palsy.4 The
chances of being later diagnosed with dyslexia and
Teen childbearing leads to adverse economic hyperactivity are more than doubled among low birth
consequences. Studies have indicated that not weight infants.4
completing high school is more likely to result in
Children of teen parents are more likely to repeat a grade,
welfare dependence and low earnings.°Nationally
and less likely to complete high school than children born
about 80%of teen mothers eventually become
welfare recipients.'Teen mothers are more likely to to older mothers. Sons of teen parents are 13%more
likely to enter prison and daughters of teen mothers are
have repeat pregnancies and to spend more of their
adult years as a single parent than women who delay 22%more likely to become teen mothers themselves.4
childbearing.4 As a result,more children must be
supported on a limited income. Risk and Protective Factors
National research studies among 15— 19 year-olds are
Other Measures of Impact and
Burden used here to identify common risk factors and protective
mechanisms that impact adolescent pregnancy.These can
Adult Fathers of Children born to Adolescent be viewed from the individual,family and community
• Mothers. Fathers involved in teen births are level.
frequently not teens themselves.Nationally, about Individual Factors. The likelihood of an adolescent
29%of sexually active female teens age 15— 17 have becoming pregnant increases with early alcohol and drug
partners three to five years older,and 7%have use,early sexual activity,early challenging behaviors in
partners six or more years older.°These data suggest kindergarten through grade 3, and physical or sexual
the issue of teen-adult sexual activity has important abuse. Low expectations for the future also place
legal, economic,and public health implications that adolescents at risk for pregnancy.10
require further investigation.
Delaying sexual activity and limiting alcohol and drug use
Cost of Teen Births. According to data from the First as well as developing good communication skills have
Steps database,nearly 88%of births to 15— 17 year- been identified as effective strategies for reducing
olds in Washington from 1997— 1999 were paid for adolescent pregnancies.°
by Medicaid. In 1999,the mean cost for prenatal
Family Factors.An adolescent's family plays an
care and delivery was$5,6907per woman for all
Medicaid covered deliveries. This figure may differ important role in determining risk for adolescent
pregnancy.Frequent conflict in the family,illness or
when limited to teen deliveries.
addiction of a parent,and lack of parental supervision are
Outcomes for Teen Births. Teen childbearing can significant risk factors for adolescent pregnancy.°
result in several adverse outcomes for both mothers Adolescent child bearing has been statistically associated
and their children. It is unclear to what extent the age with low levels of education in the family,and previous
of the adolescent mother versus pre-pregnancy family experience of adolescent pregnancy by a parent or
behaviors and risk factors contribute to poor a sibling. Families with open and positive
childbearing outcomes among teens.4 Thirty-four communication have been identified as a vital protective
percent of 15— 17 year-olds who delivered in factor for adolescents. Providing youth with clear rules
Washington in 1997— 1999 did not receive first and boundaries and opportunities for involvement in
trimester prenatal care. family activities and duties are important protective
According to the Centers for Disease Control and mechanisms.
9
• Prevention(CDC)national data suggest that in 1999, Community Factors. Teens living in communities with
for all age groups of mothers 15 years and older, 15— high poverty,crime,unemployment,divorce, and
The Health of Washington State 3 Adolescent Pregnancy and Childbearing
Washington State Department of Health updated:07/23/2002
adolescent birth rates and low educational levels is required before using an abstinence-only approach
• appear to be at risk for adolescent pregnancy.10 A alone in adolescent pregnancy prevention programs.
feeling of connection to adults in the community,
Eighty-three percent of teen pregnancies are unplanned 13
availability of schools providing support and respect
to youth, and constructive after-school activities and A lack of individual commitment to specific pregnancy
organizations such as clubs and youth centers act as prevention methods(i.e. abstinence,contraceptive use),
ambivalence about child bearing,and confusion about
protective factors for adolescent pregnancy.9
prevention appears to result in the high rates of
unintended pregnancy rates among adolescents.
4
High Risk Populations Promoting correct and consistent use of contraceptives for
sexually active teens can lead to reduction in unplanned
Adolescents who give birth. Many adolescents who pregnancy rates.13
give birth have another pregnancy within two years.
In 1999,17%of all births to adolescents under 20 in Help young people develop their skills and abilities.
Interventions addressing skills and competencies of
Washington were repeat pregnancies.Adolescents at
high risk for a repeat pregnancy might not use adolescents can help increase their motivation to avoid
contraceptives consistently after the birth of their first pregnancy,child bearing,and other related problems.
child.11 A positive attitude about adolescent Examples of these interventions include youth
development programs,which assume that adolescents
pregnancy and ambivalence about postponing further
childbearing beyond adolescence are associated with must develop basic competencies and skills to become a
repeat pregnancies.t1 successful adult. These basic skills and competencies for
adolescents include a sense of belonging,self-awareness,
Adolescents experiencing difficult life situations. self-worth and a sense of mastery and competence.5
Research suggests that the likelihood of pregnancy Evaluation of youth development programs show varied
increases with adolescents facing difficult life results in reducing adolescent pregnancy rates.Youth
situations.In a recent review of at least 250 studies, development programs such as vocational education
the National Campaign to Prevent Teen Pregnancy programs do not appear to have any impact on pregnancy
(NCPTP)identified more than 100"antecedents"to or birth rates at follow up.t2 However,service-learning
• teen sexual activity,pregnancy,and child bearing.12 programs can reduce actual adolescent pregnancy rates
These antecedents fall under categories such as while youth participate in the program. While some
economically disadvantaged families and youth development programs appear to show promise in
communities,"risky"characteristics of teens,family, reducing adolescent pregnancy rates, further evaluation is
and peers,and partner attitudes and beliefs that required to determine the most effective approach.
support adolescent pregnancy.
See related chapters on Unintended
Intervention Strategies Pregnancy, Low Birth Weight, Prenatal Care,
Infant Mortality and the section Major Risk
Adolescent pregnancy is a complex problem and Protective Factors.
influenced by a multitude of factors.Because the
reasons leading to adolescent pregnancy vary,no
single approach can be expected to reduce adolescent Data Sources
pregnancy.Effective approaches are more likely to Washington State Adolescent Pregnancy Data: Pregnancy&
focus on several identified"antecedents"to Induced Abortions 1999. Center for Health Statistics,
adolescent pregnancy.12 Approaches to address Washington State Department of Health.
adolescent pregnancy prevention need to consider the Washington State Department of Health, Center for Health
following: Statistics,Washington State Births, 1980-1999 CD-ROM
Support abstinence as the safest choice for teens released February 2001.
and promote correct and consistent use of First Steps DataBase. Research and Data Analysis Division.
contraceptives for sexually active teens.The NCPTP Department of Social and Health Services.2001
study emphasized that the above approach neither
increases sexual activity nor decreases contraceptive "Intercensal and Postcensal Estimates of County population by
use.12 While the few rigorous evaluations of Age and Sex: 1980-2001".August 2001. Forecasting Division.
abstinence-only curricula completed to date do not Office of Financial Management.
show any overall effect on sexual behavior or
• contraceptive use,12 abstinence is the safest choice to
prevent pregnancy in adolescents. Further evaluation
•
Adolescent Pregnancy and Childbearing 4 The Health of Washington State
updated:07/23/2002 Washington State Department of Health
For More Information
• Washington State Department of Health, Division of
Community and Family Health, Office of Maternal and
Child Health, Child and Adolescent Health/Child PROFILE
Section at(360)236-3531.
Endnotes
1 The Annie E.Casey Foundation.When Teens Have Sex:Issues
and Trends.A Kids Count Special Report. 1999
2 Centers for Disease Control and Prevention.National and State
Specific Pregnancy Rates among States, 1995-1997.MMWR July
14,2000:49(27):605-611
3 Alexandria V A.Policy Update:The Role of Education in Teen
Pregnancy Prevention.Policy Information Clearinghouse.
National Association of State Boards of Education.1998
a The National Campaign to Prevent Teen Pregnancy.Whatever
Happened to Childhood?The Problem of Teen Pregnancy in the
United States. 1997
5 National Association of State Boards of Education.The Impact
of Adolescent Pregnancy and Parenthood on Educational
Achievement.A Blueprint for Education Policymakers'
involvement in Prevention Efforts.2000
6 Darroch JE,Landry DJ and Oslak S.Age Differences between
Sexual Partners in the United States.Family Planning
Perspectives. 1999;31(4):160-167
'Washington State Department of Social and Health Services.
.
Medical Assistance Administration.State of Washington
Pregnancy Related Expenditures,Fiscal Years 1988-2001.
Centers for Disease Control and Prevention.Smoking during
pregnancy in the 1990s.National Vital Statistics Report.August
28,2001.Vol 49,No 7
9 Kirby D.Looking for Reasons Why.The Antecedents of
Adolescent Sexual Risk-Taking,Pregnancy and Child Bearing.
The National Campaign to Prevent Teen Pregnancy. 1999.
10 Kirby D.No Easy Answers.The National Campaign to Prevent
Teen Pregnancy. 1997.
"Stevens-Simon,K L and Singer D."Preventing Repeat
Adolescent Pregnancies with Early Adoption of the Contraceptive
Implant"Family Planning Perspectives Vol 31,No:2.1999.
12 Kirby D.Emerging Answers.The National Campaign to
Prevent Teen Pregnancy.2001.
13 Henshaw S.K.Unintended Pregnancy in the United States.
Family Planning Perspectives.1998;30(1):24-29
•
The Health of Washington State 5 Adolescent Pregnancy and Childbearing
Washington State Department of Health updated:07/23/2002
• Unintended Definition:Pregnancies that are identified by the mother as either
unwanted or mistimed(occurring earlier than wanted)at the time
of conception.
Pregnancy
Summary women of reproductive age about their pregnancies,
whether they were intended,and the outcome of the
An estimated 53% of all pregnancies and pregnancy(live birth,miscarriage,abortion). Most of the
38% of all births in Washington State in 1999 Washington-specific data on unintended pregnancy in this
were unintended at the time of conception. chapter describe births from unintended pregnancy
Rates have remained relatively unchanged because these data come from the Pregnancy Risk
Assessment Monitoring Surveillance system(PRAMS),a
since 1994.While young women,poor survey sent to a sample of women who have given birth.
women, and some minorities have the highest (See Technical Note 1.) Overall rates of unintended
rates,unintended pregnancies occur in all pregnancy in Washington are only estimates,derived
segments of society. from a formula combining PRAMS data on births from
When pregnancies are begun without unintended pregnancy and vital statistics data on abortion.
(See Technical Note 2.)These estimates allow some
planning or intent,there is less opportunity to analysis of overall rate,trends,and age distribution but
• prepare for an optimal outcome.Unintended cannot be used to assess variability by race/ethnicity,
pregnancies are associated with adverse geographic units,income,education,or measures of
maternal behaviors such as delayed entry into impact and burden. Limitations of both the abortion data
prenatal care,poor maternal nutrition, and using a formula that combines population and survey
cigarette smoking, and use of alcohol and data restrict further analyses of these characteristics.
other drugs.Women whose pregnancies are
unintended are more likely to have infants Time Trends
who are low birth weight and are less likely to
breastfeed. Their infants are more likely to be Unintended pregnancy has been monitored in Washington
abused and die in their first year. Other since 1994 using PRAMS data and vital statistics data on
negative social outcomes such as reduced births and abortions.No significant reduction in the
education and career attainments of parents, percent of pregnancies that were unintended is evident in
increased welfare dependency,divorce, and this time period.In 1994, an estimated 55%of all
domestic violence are associated with pregnancies were unintended,and 39%of all births were
unintended pregnancy.About half of from unintended pregnancies. In 1999,an estimated 53%
of all pregnancies were unintended,and 38%of all births
unintended pregnancies end in abortion. were from unintended pregnancies.
Access to quality family planning information
and services is an important factor in Year 2000 and 2010 Goals
planning for healthy pregnancies and
preventing unintended pregnancies. At the national level,the Healthy People 2010 goal is to
increase to at least 70%the proportion of pregnancies that
Background Note are intended. According to the 1995 Institute of Medicine
report on unintended pregnancy, The Best Intentions,the
National data on intention status comes from the US goal has already been achieved by other industrialized
• National Survey of Family Growth(NSFG).That nations(p.253).1 If that goal had been reached in
survey asks questions of a random sample of all Washington in 1999, almost 6,400 fewer births would
The Health of Washington State 1 Unintended Pregnancy
Washington State Department of Health updated: 07/23/2002
have been unintended at the time of conception and
• nearly 2,100 fewer pregnancies would have resulted Race and Ethnicity
in abortion.The Department of Health and the According to PRAMS data, in Washington,rates of births
Department of Social and Health Services have a from unintended pregnancies were higher for women of
joint performance measure to reduce the rate of some racial minorities. Black women reported 59%(±
unintended pregnancy by 3%each year over the next 3%)of their pregnancies were unintended, as did 52%(±
two biennia. Achieving a 3%reduction in 2000 3%)of Native American women,39%(±3%)of
would have resulted in over 900 fewer births from Asian/Pacific Islander women,and 37%(±2%)of white
unintended pregnancies and 300 fewer abortions.
women. Thirty-nine percent(±3%)of births to Hispanic
women were from unintended pregnancies;this is not
Geographic Variation statistically different from non-Hispanic women,whose
rate was 38%(±2%).
Because of the small number of respondents for some
counties in PRAMS,county comparisons are not Births from Unintended Pregnancies
available. Race and Ethnicity
WA State PRAMS, 1997-1999
Urban and Rural Am Indian! '�J
Alaska Natve ;»g r 5�/°
PRAMS data for 1997— 1999 do not indicate a AsianIslanderic :1-e-Vi
statistically significant difference in births from
unintended pregnancies in urban core, suburban Black 59'1°
areas,towns,rural large towns,or rural small towns.
National data for pregnancy intention in urban/rural w h' FieRr37%
areas are not available. Hispanic I-1-1 39%° a
S
Age Non-Hispanic It 38 % w
0
Based on data from PRAMS and records of abortions, 0% 25% 50% 75% 100%
unintended pregnancies occur in all age groups.
Women aged 19 years and younger had the highest Income and Education
percentage of unintended pregnancies,81%(±6%).
Birth rates from unintended pregnancies are strongly
The percentage of unintended pregnancies for women
associated with income level. In the PRAMS survey,
aged 20—24 was estimated to be 64%(±4%),for
Medicaid status is one indicator of low income. Women
women 25—29,46%(±4%),and for women aged 30
—34,39%(±4%).(See Technical Note 2.)The actual who qualify for publicly funded medical services through
number of births from unintended pregnanciesMedicaid fall into two main groups: (1)those who receive
among both Medicaid and cash assistance(Grant Recipients),and
women ages 20—34 account for most of the state's
(2)those who receive only Medicaid Services(Medicaid
unintended births because more women in that age
group become pregnant. only). Grant recipients reported 66%(±5%)of their
pregnancies were unintended,and Medicaid only
Unintended Pregnancies recipients reported 50%(±4%)were unintended.Among
Age of Mother women without Medicaid coverage for their deliveries,
WA State PRAMS, 1997-1999 27%(±2%)of births were from unintended pregnancies.
35+ 61 h. 41% Washington PRAMS data indicate that unintended
30-34 " ° pregnancy rates decrease as mothers'education increases.
Among women with 6— 11 years of education,52%(±
ri)
•cce25-29 v 46%
, 4%)of pregnancies were unintended;among women with
12 years of education 42%(±4%)were unintended;and
20-24 , 6a% among women with 13 or more years of education,28%
<20 _ (±3%)of pregnancies were unintended.
81%
• 0% 20% 40% 60% 80% 100%
Unintended Pregnancy 2 The Health of Washington State
updated: 07/23/2002 Washington State Department of Health
• Births from Unintended Pregnancies Unintended pregnancy is associated with delayed entry
Income and Education
WA State PRAMS, 1997-1999 into prenatal care.PRAMS data indicate that 54%(±5%)
of Washington women with unintended pregnancies had
Grant Recipients late or no prenatal care. Relative to women whose
E pregnancies were intended,they were more likelyto have
Medicaid Only 4 o
used drugs or alcohol during their pregnancies,to have
Non-Medicaid 27% smoked in the three months prior to pregnancy,and were
- less likely to breastfeed.
0.llYears E i 52%
32 Years Maternal and Family Stress:PRAMS data show an
w association between pregnancy intention and indicators of
13+Years + 23%1 maternal and family stress.Washington women with
unintended pregnancies are more likely to be divorced or
0% 25% 50% 75% 100% homeless and to have lost a job themselves or to have
husbands who lost jobs in the twelve months preceding
their births than women whose pregnancies were
Other Measures of Impact and
Burden intended.
Abuse: Washington women who have been physically
Abortion:According to the The Best Intentions, abused more frequently report that their pregnancy was
about half of all unintended pregnancies end in unintended.PRAMS data indicate that women who were
abortion. Thus,abortion is one of the primary in a physical fight within 12 months of the current birth
consequences of unintended pregnancy,and reducing were almost twice as likely to report that their pregnancy
unintended pregnancy would decrease the incidence was unintended(71%±9%)compared to women who
of abortion(p. 51).1 In 1999,there were 25,965 were not in a fight(36%±2%). Women who have been
abortions reported for women living in Washington. abused by their husbands more frequently reported their
This is a decline of about 5%since 1994.According pregnancies were unintended(66%±9%)than women
to the Institute of Medicine(IOM),long-term who were not abused(37%±2%).
II medical or psychological consequences from abortion
are few.However,abortion poses difficult moral and Economic Costs:There are financial burdens for
unintended pregnancy as well. At an average cost of
ethical questions,and it continues to be a
$5,639 for prenatal care and delivery in Washington,the
controversial procedure. Complications from abortion
annual cost to federal and state government for births
increase with increasing pregnancy duration.Most
abortions(86%)are obtained before 12 weeks from unintended pregnancies aid for by Medicaid is
gestation when there is less risk of complications. estimated to be$97.6 million. Healthy People 2010
estimates that the pregnancy care cost for a woman who
Abortions obtained after 12 weeks gestation are
does not intend to be pregnant yet is sexually active and
accessed at disproportionately higher rates by
younger women:Among women who had an uses no contraception s s about$3,200 annually in a
abortion in 1999,almost 10%of those age 15— 19 managed care setting.
had the procedure after 12 weeks gestation compared
to 8%of women 20—24, 6%of women 25—29, 6%
of women 30—34,5%of women 35—44.The Risk and Protective Factors
percentage for women 45 and older is not calculated Contraceptive Use:One determinant of pregnancy and
due to small numbers. birth rates is use of contraceptives.A woman who is
sexually active throughout her reproductive years and
Morbidity and Mortality:Unintended pregnancy
limits the opportunity for the mother or couple to wants only two children will need contraceptive
protection for more than 20 years.4 National data indicate
participate in preconception risk assessment and
about half of unintended pregnancies occur among the 3.9
intervention that can mitigate many serious medical
million women who are neither using contraceptives nor
conditions. Strict metabolic control of maternal
seeking to become pregnant. The other half occurs among
diabetes and phenylketonuria reduces the risk of
congenital malformation of the fetus. Neural tube the estimated 21.2 million women using reversible
contraception.In Washington,PRAMS data indicate that
defects can be reduced through dietary folic acid
supplementation before and during the early months 28%(±3%)of women who said their pregnancies were
of pregnancy. unintended were not using contraception while 72%(±
• 4%)reported using contraception at the time of
conception.Pregnancies occur among some contraceptive
The Health of Washington State 3
Washington State Department of Health Unintended Pregnancy
updated: 07/23/2002
users because some methods are of limited would require a long term effort to educate the public on
effectiveness even when used correctly,and some•
the social,economic, and public health burdens of
methods fail because of difficult compliance unintended pregnancy and stimulate interventions to
regimens.Healthy People 2010 cites numerous reduce such pregnancies. The IOM recommends that
studies indicating a disturbing degree of efforts be structured around the following five goals:
misinformation about contraceptive methods and
recommends increased public education efforts and (1) Improve knowledge about contraception and
improved accuracy in the media.' reproductive health;
The Institute of Medicine(IOM)study cites the (2) Increase access to contraception;
reasons for the high rates of unintended pregnancy in (3) Address the roles attitudes and motivation play in
the US compared with other countries. These include: avoiding unintended pregnancy;
gaps in reproductive knowledge and information;
lack of high quality instruction on sexuality and (4) Develop and evaluate local initiatives,and
contraception;the wide range of personal feelings,
cultural values,and attitudes regarding sexuality; (5) Stimulate research on contraceptive methods,
organizing services,and the determinants and
expensive,often complicated access to birth control;
antecedents of unintended pregnancy(p.254).'
public policies and institutional practices such as
insurance coverage of abortion but not contraception; The National Association of City and County Health
Officials published a set of action steps for local health
administrative barriers causing delays in service;and
the sexual saturation of the media(p.2-3).' departments based on the goals of the IOM report.
Improving Access to Family Planning:The IOM report
Contraceptive Access:Although a variety of family
and Healthy People 2010 both call for more reproductive
planning services are available across the state,the
Alan Guttmacher Institute(AGI)estimates that fewer health education and access to clinical reproductive health
services. Federal and state dollars provide subsidized
than half of Washington women in need of publicl-in family planning services in 31 of the state's 39 counties.
funded services are served.They rank the state 16
the provision of contraceptive services to women in Medicaid provides family planning services for TANF
40
need.4 Health insurance provides limited coverage of clients and has expanded coverage to provide free family
planning services for men and women up to 200%of the
contraceptives in Washington. While a large
percentage of private insurance plans cover federal poverty level for five years through a federal
waiver of Medicaid eligibility.Data from a Medicaid
gynecologic,maternity,reproductive cancer
report on birth spacing in a population qualified for
screening,and STD and AIDS services,nearly half
do not cover any kind of contraceptive method. e family planning services for one year after delivery
Only 22%of eligible enrollees have coverage for the showed the two-year subsequent birth rate was two to
five FDA-approved reversible methods of three times higher for women who did not receive family
contraception.s A new rule promulgated by the planning services compared to those who did.8
Insurance Commissioner will require companies to One strategy advocated by the IOM is to increase the
provide coverage for most forms of birth control as of
range of health professionals and institutions which
January 2002.
promote and provide contraceptive services.Five state
agencies initiated a novel pilot project in Western
High Risk Populations Washington to enable pharmacists to prescribe emergency
contraceptive pills(ECPs)directly to women through
collaborative drug agreements with doctors. During the
Data in The Best Intentions indicate that although
project period,more than 1,000 pharmacists and 140
unintended pregnancies occur in all subgroups,
pharmacies provided about 12,000 prescriptions in 16
women at either end of the reproductive age
months of service,potentially preventing 700 or more
spectrum,poor women,uneducated women,
unintended pregnancies(assuming a 10%pregnancy risk
unmarried women,some minorities,and women who
do not use contraception are at higher risk of and 75%method effectiveness).9 A clinic in the Kaiser
Permanente system in San Diego made reducing
unintended pregnancies(p.47).'
unintended pregnancy a strategic goal and reduced the
number of abortions in their practice by 25%over a three-
Intervention Strategies year period. Strategies included educating providers and
staff about unintended pregnancy, finding opportunities to
• According to the Institute of Medicine report, educate patients,prescribing birth control and following
achieving a new social norm where all pregnancies up on use, increasing access to emergency contraception,
are consciously and clearly desired at conception
Unintended Pregnancy 4 The Health of Washington State
updated:07/23/2002 Washington State Department of Health
and reducing administrative barriers to family Endnotes
planning appointments.10
See related chapters on Adolescent 1 Institute of Medicine,The Best Intentions:Unintended Pregnancy and
the Well-Being of Children and Families,National Academy Press:
Pregnancy and Childbearing, Prenatal Washington,D.C. 1995
Care, and Sexual Behavior. z Cawthon,L,Salazar,E,and Lyons,D:County Profiles:Birth and
Unintended Pregnancy Statistics,DSHS,Research and Data Analysis,
Data Sources February,2001
3 U.S.Department of Health and Human Services. Healthy People
Washington State Department of Health, Center for Health 2010: Understanding and Improving Health. 2nd ed. Washington,DC:
Statistics, Washington State Deaths, Washington State U.S.Government Printing Office,November 2000.
births, 1980-1999 CD-ROM released November 2000 a Alan Guttmacher Institute(AGI):Facts in Brief,Contraception Counts:
Pregnancy Risk Assessment Monitoring System(PRAMS) Washington Information,Washington D.C. 1999.
e Kurth,A,Reproductive and Sexual Health Benefits in Private Health
1996-1998 Washington State data. (See Appendix B for
description.) Insurance Plans in Washington State,Family Planning Perspectives,
Washington State Abortion Data: Pregnancy&Induced e olume 33,No.4,July/August 2001.
Abortions 1999. Center for Health Statistics, Washington Office of the Washington State Insurance Commissioner,
State Department of Health. g Reproductive Health Benefits Survey,September 1998
National Association of City and County Health Officials,Unintended
Washington State Department of Social and Health Pregnancy:Prevention Strategies for Local Health Departments,Spring
Services, Research and Data Analysis. First Steps 1996.
Database, 2001. 8 Cawthon,L,First Steps Database:Post-Partum Family Planning
Services,Department of Social and Health Services,Research and
For More Information Data Analysis,June 2001
9 Program for Appropriate Technology in Health,Quarterly Update for
Washington State Department of Health Office of Maternal Collaborating Prescribers,Seattle, 1999.
and Child Health(360)236-3502;Maternal and Child 10 Kaiser Permanente Medical Group,Things a Department Can Do to
4111 Health Assessment(360)236-3558;Office of Infectious
Disease and Reproductive Health 360)236-3444;Family Reduce Unintended Pregnancy,San Diego,CA,December 1999.
Planning and Reproductive Health(360)236-3471
Technical Notes
Technical Note 1:The Pregnancy Risk Assessment
Monitoring System(PRAMS)is a population-based
surveillance system that uses birth certificates to survey
new mothers who are representative of all registered births
to Washington residents. PRAMS data in this chapter are
from surveys collected in 1997-1999. Confidence intervals
presented are 95%for all point estimates.
Technical Note 2: Percentages of births from pregnancies
that were unintended at the time of conception are derived
from PRAMS data.To estimate the total number of
pregnancies that are unintended, the percent of live births
identified by PRAMS respondents as unintended are
combined with the number of abortions from vital statistics
for that year. This definition excludes ectopic and molar
pregnancies as well as fetal deaths at less than 20 weeks
gestation,which are not reportable. This estimate also
assumes that all reported abortions are due to unintended
pregnancies though a small percentage might be medically
indicated.
S
The Health of Washington State 5
Washington State Department of Health Unintended Pregnancy
updated: 07/23/2002
•
Board of Health
Media Report
•
August 15, 2002
•* JEFFERSON COUNTY BOARD OF HEALTH
. • �
k.' ' Glen Huntingford,Jefferson County Commissioner
�����' �• Dan Titterness,Jefferson County Commissioner
Richard Wojt,Jefferson County Commissioner
Jill Buhler,Jefferson General Hospital Commissioner
Roberta Frissell, Citizen at Large
Geoffrey Masci, Vice Chair,Jefferson County Board of Health
Sheila Westerman, Chair,Jefferson County Board of Health
August 8, 2002
Kristen Anderson
Chief of Police
City of Port Townsend
607 Water Street
Port Townsend, WA 98368
Dear Police Chief Anderson:
The Jefferson County Board of Health is considering the adoption of an environmental health
• civil penalties enforcement ordinance. The purpose of this ordinance is to improve enforcement
of existing public health laws, including those that address nuisances detrimental to public
health. The Board is asking for the active participation of law enforcement officials in its rule
making process to assure that the final product of the Board's deliberations fully meets its goal of
improved public health protection.
The statutory basis for public health code enforcement is addressed in both the Port Townsend
Municipal Code and Washington State statute. Section 9.08.100 of the Municipal Code states:
The chief of police shall be the executive officer to execute and carry out the
orders and directions of the health officer, except when otherwise provided by
ordinance or the orders or directions of the health officer
RCW 43.20.050(4) states:
All local boards of health, health authorities and officials, officers of state
institutions,police officers, sheriffs, constables, and all other officers and
employees of the state, or any county, city, or township thereof shall enforce all
rules adopted by the state board of health. In the event of failure or refusal on
the part of any member of such boards or any other official or person mentioned
in this section to so act, he shall be subject to a fine of not less than fifty dollars,
upon first conviction, and not less than one hundred dollars upon second
conviction.
• . ' •�z
•
JEFFERSON COUNTY BOARD OF HEALTH
�' , ` . Glen Huntingford,Jefferson County Commissioner
,f,J? k . Dan Titterness,Jefferson County Commissioner
Richard Wojt,Jefferson County Commissioner
Jill Buhler,Jefferson General Hospital Commissioner
Roberta Frissell, Citizen at Large
Geoffrey Masci, Vice Chair,Jefferson County Board of Health
Sheila Westerman, Chair,Jefferson County Board of Health
August 8, 2002
Sheriff Pete Piccini
81 Elkins Road
Port Hadlock, WA 98339
Dear Sheriff Piccini:
The Jefferson County Board of Health is considering the adoption of an environmental health
civil penalties enforcement ordinance. The purpose of this ordinance is to improve enforcement
of existing public health laws, including those that address nuisances detrimental to public
• health. The Board is asking for the active participation of law enforcement officials in its rule
making process to assure that the final product of the Board's deliberations fully meets its goal of
improved public health protection.
The statutory basis for public health code enforcement is addressed in Washington State
statute. RCW 43.20.050(4) states:
All local boards of health, health authorities and officials, officers of state
institutions,police officers, sheriffs, constables, and all other officers and
employees of the state, or any county, city, or township thereof shall enforce all
rules adopted by the state board of health. In the event of failure or refusal on
the part of any member of such boards or any other official or person mentioned
in this section to so act, he shall be subject to a fine of not less than fifty dollars,
upon first conviction, and not less than one hundred dollars upon second
conviction.
Although this statute refers specifically to State Board of Health rules, it has been interpreted by
the courts to also cover supplemental rules adopted by local boards of health and enforcement
orders issued by the health officer. The civil penalties enforcement ordinance being considered
by the Jefferson County Board of Health would create an alternative to current criminal
enforcement procedures for violation of these rules. For the ordinance to be effective, we must
clearly define the roles and responsibilities of all public officials with enforcement
• responsibilities.
• Jefferson County Health and Human Services
JULY — AUGUST 2002
NEWS ARTICLES
1. "Goldsmith faces county budget woes",P.T. LEADER, July 17, 2002
2. "County salary rollbacks mean lower filing fees", P.T. LEADER, July 17, 2002
3. "Kicking the Smoking Habit", Peninsula Daily News, July 21, 2002
4. "County OKs law on salt in wells",Peninsula Daily News, July 24, 2002
5. "County OKs new well regulations", P.T. LEADER, July 24, 2002
6. "Community members talk sexual abuse issues", P.T. LEADER, July 24, 2002
7. "Area bioterror response plan in the works", Peninsula Daily News, July 26, 2002
8. "Clallam commissioners OK funds for human service agencies", Peninsula Daily
• News, July 31, 2002
9. "Celebrate World Breastfeeding Week August 1-7",P.T. LEADER, July 31, 2002
10. "County-by-county health study released", Peninsula Daily News, August 2, 2002
11. City of Port Townsend newsletter enclosed with August city billings (2 pages)
12. "Northwest Kiwanis Camp a unique experience",P.T. LEADER, August 7, 2002
13. "Suspected meth maker busted after son's call", P.T. LEADER, August 7, 2002
•
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CONTINUED FROM Al
SUNDAY '€�.�v .' ` s,« "' drug and alcohol abuse,"she
There are roughly 13,700 a ® ® ® said."They said smoking isn't `-�
smokers in Clallam County SHOWCASE v really good for you,either.
and 5,700 in Jefferson County. r.t r`y . ` i Wim a me." put a lot of pressure on
In the battle against smok- tion classes for teenagers, s �j,^S a ,� s t'° �` me."
ing, officials in Jeffer- young adults and pregnant A,to r r� ^a t h. v'A;' x° �.- Barbara decided to attempt
son and health officials
counties are mothers has also been low in $ ac , + `' to quit cold turkey Jan.1,
Clallam CountyAlt. ° 1ref t l"l'3t
icularly concerned about said Joanne '� .` rrif,'Yfez r "�42tV . 1988
ting high smoking rates Dille,director the Health and ; . t c }fig tld '
ong young adults,ages 18 Human Services Department. p7t"` �, .� �,t. a Going cold turkey
to 34,and pregnant woman. "We've been offering classes .' 1 _!r i� r +
On Thursday,Jefferson regularly but they're not well ,; . i a' etIlifiltrQdV„��� a sµ+ b d Meyer went from two packs
County health officials pre- attended,"she said. . e I ee"7aT� „,,, l� a a day to zero.
pre-
sented the results of a nine- About 40 percent of Amer- ;�'" 3' > .a E , She and a relative holed up
month survey containing ice's 50 million smokers will 't R ' '°r '' §Ills 4`a ® n a house playing solitaire for
detailed data on tobacco use. try kick the habit at least ® n ^,, 1 'V' R + „ three straight days.
A similar yearlongstudy
once this year. _ "t � x �a ....,,,,„,..1m.3, t� '` .f I had Meyertokeep I hands
known as the Behavioral Risk One in 10 will succeed. A "i y ry;- yy 1 busy," yesad. •"The fust
Factor Surveillance Survey Usually takes seven tries to ;"ii`st'sr-"`fr r-„4 k�� couple of days were hells-
One
be started in Clallam y quit permanently. i� , �" $� r ' " ' cioThe
t''''' ..'1:4
SwitYq of ll t-sart;.,,: i �"�` .
401011,
County in January But Ragan said she was �• t riy The initial detoxification
The good news is that the encouraged by Jefferson period was over after three
�"ir>nS' s z r` f i 9 irty,i�'�,',�°� �s da
overall percentage-of current
County statistics bEhic,b4hg34tK ,fir-i'c ° Y` .- � x*f�1,. .,.. x+-t�F ys•
adult smokers in J,ff,�ersdn 76 percent of curren�,aptoker ,, ��y� +_1' Duringthe next several
ee 'nom+'° �Fw f'd•'1t,r,t`ii�'rAl rtt a
County is low compared=with tried to quit smoking#or enn+`^+ r1ea, :' ° ' months,the blood vessels that i si'd�. er ,, ":44,..,,, were constricted due to smok-
the state—16 percent versus or more days during the past- - f .p �a,�
v-v ' '°#�'�3 s + a� 1 in rer ned,leotio
21 percent statewide.
year.
g Pe g to a flood
That's much higher a° rr� '°' @®'t`1 ' \-°' ° of repressed emotions.
In Clallam County,the per- ger than i. � r 3 a r i.„, „,V x �
the 49 percent rate for Was _ :.;F "pin you son yo,you
are
centage of smokers is 21.2 per- �I,f stY� ���3 ' r6: t �� n
in n state. clamping
cent,slightly about the rs ¢ a A g down on your an er,"
e. �r �e 3 she said. e.was really angry
But statewide28 percent of those ages Pregnant mothers <�"- "., aS�m..ffi?3 _ _` a; for a while."
18 to 34 in Jefferson County A 12-step smoking cessation
are current smokers,compared In Clallam County in recent Educational and geographic But Meyer said she was program was instrumental in
p years,much of the focus has factors were also examined in building up resolve to quit. helping her quit,she said.
with 24 percent statewide. been on mothers—particu- the report. Over the next two years, It was a similar story for
"That's the group we need larly pregnant mothers—who Twenty-eight percent of several things pushed her in her husband,Gene,who
to target,"said Kellie Ragan, smoke. those with a high school educe- smoked two packs a day from
tobacco prevention specialist According to 2000 statistics, g the right direction,she said.
for the Jefferson Countytion or less are current amok- A new job was in an office age 16 to age 49,when he had
24.9 percent of mothers era,compared with 15 percent a heart attack.
Department of Health."It's smoked during pregnancy in where there was a"no smok- His doctor attributed the
significantly worse than the Clallam County. of those with some post-high ing"policy.
state." In Jefferson school education and 8 percent She rented a house where heart ng o fk in part toa s d con-
The number of smokers in percent of mothers smoked with four or more years of col- she would payless if she didn't stricting of arteries caused by
Cl The County in that age duringre lege. smoking.
pregnancy. The percentage of smokers smoke. He eventually had four
group was slightly higher than It's really concerning to in Port Townsend was 11 And there were the children 1994.Threeewee ss in starting in
the statewide rate at 25 per- us,"Dille said. per- in the psychiatric hospital 1994. weeks in a hospi-
ent,based on four-year-old Other data culled from the figceure of 21 pelower rt nt county the Where she worked in Phoenix. tel prompted him to quit all at
ta. recent Jefferson report were "I worked with them with once.
Not getting the message more positive. Quitting takes work
Seventy-nine percent of
Ragan said she is concerned those polled in Jefferson Taking the steps toward a
County said they do not allow smoke-free life takes work.
that younger adults aren't get-
smoking inside their homes.
ting the message about the Meyer began smoking while
"That's phenomenal," in college,unconsciously as a
habit that may wind up kinin
them decades later. g Ragan said of the number. way to control weight,she said.
That's despite a multimil- The number was pre- The small habit would
dictably higher for non-smok- spread to most parts of her life
lion-dollar state campaign
ing households—43 percent —her definition of addiction.
against smoking that began 18
months ago and increased of currently smoking adults "For me,it was really hard
distributed to counties prohibit smoking in their home to drink coffee without a ciga-
moneyto helpfund local anti-smokingas compared with 86 percent of rette,"she said."They were
those who don't. like salt and
programs,the result of a 1998 pepper."
national tobacco lawsuit settle-
ment.
Smokers are also starting
younger,according to the Jef-
ferson County report.
The average age young
adults in Jefferson County
began smoking was 13,accord-
ing to the study.That's com-
pared with the starting age of
16 for those who are now
between 35 and 64.
Recent studies show that
many younger adults don't
make regular visits to a doctor
—because of lack of health-
care coverage and a general
absence of medical problems—
and therefore miss out on
"brief interventions"from doc-
tors,Ragan said.
Turnout for smoking cense-
a
7 q a
3a3
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•
Community members
•
talk sexual abuse issues
By Helen Hollister domestic violence while preg-
Leader Staff Writer According to the nant give birth to babies who
g have high levels of cortisone,
More than 38 people gathered survey [2001 which indicates stress. She tries
to engage in dialogue concern- to develop a trusting, therapeu-
ing domestic violence and sexual Behavioral Risk tic •relationship •with the family
abuse July 16 at the Pope Marine Factor to prevent such effects.
Park Building. Bill NeSmith, supervisor of
JES Schumacher, community Surveillance the Department of Child and
education coordinator with the Family Services and also a mem-
Domestic Violence/SexualAssault System] 25 her of Organized Response to
Program of Jefferson County,said ' Child Abuse (ORCA), spoke
she was pleased with the turnout percent of about ORCA's efforts in investi-
In her introduction she was quick Jefferson Countgating reports of child abuse.He
to point out the importance of y mentioned the substantial
fighting against domestic vio- residents reported amount of collaboration among
lence and sexual abuse on a lo- • the different offices in the area,
cal level, even though it is "not at least one abuse such as Domestic Violence, the
immediately apparent in our de- Port Townsend Police Depart-
lightful to n,i' 3 '.;"'experience i D ment and the Jefferson County -
Topics of'dicuss on such asChildhood Sheriff's Office.
prevention, the criminal justice Hilary Metzger, a nurse and
process,programs in schools, health educator with Jefferson
• victim advocacy and statistics County Health and Human Ser-
were touched on by the evening's ship between experiencing vices,spoke about the connection
five speakers, all of whom deal sexual abuse as a child and hav- between sexual abuse and teen
with sexual abuse issues profes- ing recurring poor physical and pregnancy. She has been work-
sionally. mental health into adulthood. ing in area schools in prevention
Lianne Perron-Kossow,a vic- Quen Zorrah,a public health programs with children in grades
tim witness advocate in the nurse with Jefferson County 5 and up. Metzger said she has
Jefferson County Prosecutor's Health and Human Services, noticed a positive change in the
Office,discussed the importance spoke on the Nurse-Family Part- level of awareness in the schools.
of providing support for victims nership and the Best Beginnings In terms of providing a solid base
and their families as they go program,which works with low- of sex education in schools,she
through the criminal justice pro- income,first-time mothers-to-be, said the Port Townsend commu-
cess for various sexual assault providing support and reinforc- nity has been supportive corn-
crimes. ing healthy behavior. pared to other communities.
Health Educator Kellie Ragan The program,which has only After the five presentations,
of the Jefferson County Health two nurses working with be- Schumacher encouraged every-
Department distributed selected tween 30 and 35 cases at a given one to split up into smaller
results from the 2001 Behavioral ` time,focuses on long-term pre- groups and discuss ideas,
Risk Factor Surveillapce System vention. projects, goals and concerns to
at the meeting.According to the "It's a parallel process," help further awareness about
survey,25 percent of county resi- Zorrah said."What I do with the sexual assault issues.One group
dents reported at least one abuse mother,I want her to do with her was involved in discussion until
experience in childhood, which baby." She described the after- almost 10 p.m.;its members now
is significantly worse than the shocks of sexual abuse as"corn- plan to meet monthly, with their
1997 state rate of 20 percent The municable diseases,"explaining next meeting scheduled for 7 p.m.
survey also pointed to a relation- that mothers who are victims of Aug. 13 at the DV/SA office.
•
9 ,
, .
Areabioterror
• response plan
.
in the
works
Official says spend it on.
Y Lindquist said the federal
federal funds government is likely to offer
more funding in the future and
aren't enough its commitment to bioterror-
ism preparedness is likely to
PENINSULA DAILY NEWS last at least five years.
First on the local agenda is
WANTED: three emergency an assessment of each county's
response coordinators for Jef- ability to respond to a bioter-
ferson, Clallam and Kitsap rorism event, identify weak-
counties, one epidemiologist, nesses and fix them.
one surveillance coordinator, Lindquist, a national
one administrative assistant. authority on bioterrorism
DUTIES: Make sure that when he took the health dis-
the three counties are ready as trict job last year, said he
they can be for a flu pandemic, already knows about one.
smallpox outbreak or any other "The biggest weakness in
kind of bioterror an unknown, any biological preparedness
unseen and immoral enemy system is the hospital system
might throw this way. and the lab system," he said.
The first of $20 million in
• federal bioterrorism funds are Hospital facilities
flowing into Washington;with
'"$500,000 designated for plan- Lindquist already has begun
i ping and coordination in the conversations with Harrison
three-county region under the Hospital in Bremerton to add
authority of Scott Lindquist, more showers and isolation
director of the Kitsap County rooms.
Health District. He plans similar talks with
Because of Sept. 11 and the Olympic Memorial Hospital in
anthrax scare, Lindquist also Port Angeles and Jefferson
now wears the title of regional General Hospital in Port
"bioterrorism health officer," Townsend.
one of 10 in the state. A major goal of the response _
One of the first things he program is to make sure each
must do is hire the emergency of the three counties will be
response coordinators and fill able to back up the others,
the three other slots. keeping service stable and
Not enough available, no matter who needs
it.
A half-million dollars is not "Remember,the only county
quite enough, Lindquist said in the country that's ever
last week when he met with caught a terrorist before the
representatives from about 20 event was Clallam County,"
agencies whose duties now said Lindquist, referring to the
include bioterrorism response. capture of would-be bomber
The Kitsap health district Ahmed Ressam by U.S. Cus-
will kick in an additional toms agents in Port Angeles.
$30,000 to meet standards and The state has set deadlines A
deadlines set by the state for each step needed to create a 'V
Department of Health, which workable response plan, with
• funnels federal money to the the final version required in 13 `�-.26'o J
regions and tells them what to months.
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Nownimmummumer
Celebrate
World Breastfeeding Week
August 1 -7
• X-
iopems.. }.,
441
l+� '
Laura Showers,IBCLC(Intarnationai Board Certiflad Lactation Consuhant)and Carol Hardy,IBCLC.
Breastfeeding: Healthy Mothers and Healthy Babies
Breastfeeding is a powerful process that has been shown to be of significant benefit
to both mother and child. While fostering maternal attachment,breastfeeding is
also the"ultimate prevention"of potential physical and emotional ailments. Current
studies show that women who breastfeed demonstrate decreased risk of breast
and ovarian cancer,anemia and osteoporosis. Breastfed children have fewer and
less serious childhood illnesses and
"Having the support of all of allergies. They also show a reduced risk
• Our community is important for Sudden Infant Death Syndrome,
in order to ensure the health some childhood cancers and diabetes.
of our community mothers In an effort to protect, promote, and
and babies. And World support the well-being of mothers and
Breast feeding Week is the to encourage breastfeeding for
perfect time for us all to healthier babies and children, the
demonstrate this support." Jefferson County Breastfeeding
Alliance has formed. Members include
Jefferson General Hospital, Jefferson County Health & Human Services, the La
Leche League,the local healthcare community and private citizens.
The goal of this alliance is to ensure that every mother in our community has the
opportunity to be successful with breastfeeding. Carol Hardy, head of Jefferson
County's Lactation Program, in collaboration with Laura Showers, head of JGH's
Lactation Program and T.J.Plastow,local La Leche League leader,has organized a:
Community Picnic in celebration of i,.STFEF,o
World Breastfeeding Week A, \\
at Chetzamoka Park on Wednesday, , `J
August 7 from Noon-3pm.
The community is ,7AUG'&�
encouraged to attend.
Jefferson General Hospital"Caring people, caring for you"
La;;_: - s :ate (360) 385-2200
ff
_'tf Ior (800) 244-8917
• 834 Sheridan Ave, Port Townsend
www.jgh.org
•
County-by-county health study released
BY STUARF EWoTr ferson County was 2.1 percent worse than the overall state That number was worse in
PENINSULA DAILY NEWS of all public school students in average,which stood at 21.8. Clallam County, with 26.3 per-
Jefferson County students the ninth through 12 grades. The teenage birth rate in cent of mothers smoking dur-
are less likely to drop out of That compares with 4.2 per- Clallam County was 21.5, bet- ing pregnancy.
school than their peers in Clal- cent statewide, and excludes ter than the rural and IIIHeart disease was less of a
lam County and statewide. those leaving school for statewide averages. problem in Jefferson County
And births to teenage moth- unknown reasons. Other findings included: than elsewhere in the state,
ers in both counties are much In Clallam County, the per- ■ Babies born weighing less accounting for 200 deaths per
lower than the rates of other centage of dropouts was slightly than 5.5 pounds decreased in 100,000 persons versus 214
higher than the state average,
rural counties in Washington Jefferson County, from 4.9 per- statewide from 1998 through
state. with 4.3 percent of all students cent of all births from 1997 to 2000.
Those are parts of findings of in those grades dropping out of 1999 to 3.3 percent of total Clallam County was closer to
school, births from 1998 through 2000. the state average,with a rate of
a county-by-county health study •
In Clallam County, babies 215 deaths per 100,000 persons
recently released by the Wash- Teen births born weighing less than 5.5 from 1998 to 2000.
ington Health Foundation. pounds decreased slightly to 4.9 The county health profiles
The annual report by the Teenage birth rates in both percent of all births, better were prepared by the nonprofit
Seattle-based health organiza- counties were considerably bet- than the statewide average of health organization to provide
tion looked at a variety of ter than other rural counties. 5.7 percent. insight into the health of Wash-
health factors, including educa- The teen birth rate in Jeffer- • The report said mothers ington state residents, said
tion, income, population and son County was 22.2 per 1,000 smoked during .pregnancy in Greg Vigdor, president of the
birth and death statistics. births, better than other rural 20.6 percent of all births in Jef- foundation.
The report found that the counties in the state,where the ferson County, compared with The report can be viewed
percentage of dropouts in Jef- average was 27.7, and slightly 14 percent statewide. online at www.whforg.
• -
•
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(360)379-5047(email: citycouncil@ci.port-townsend.wa.us) www.ci.port-townsend.wa.us August 2002
Council News: 4111*
By Kees Kolffand GeoffMasei
The Health of Our Citizens
w CITY PARTNERSHIPS
On July 8 your City Council received a detailed report To help understand the complex issues that face our
on the health of local residents from Dr. Christiane City, there is a need to partner with other governments,
Hale, an epidemiologist,and Jean Baldwin, Director of agencies,boards and committees. "No man is an
Health for Jefferson County. Information from the island"and therefore the City Manager, staff and
2000 Census and a recent Behavior Risk Factor Survey Council attend meetings outside of city business to
(BRFSS)gave us a mixed message. Some highlights bring up to date information to the decision making
include: process in order to make well-informed decisions.
1. Fully 25%of County adults reported sometype of Some of this partnering becomes quite intensive,
depending on the issue at hand. It ranges from
abuse in their childhood. This rate rose to 33% in interlocal agreements,to financial support,to sharing
households with children under 18. information and office space. The following are
2. Although 16%of adults reported currently examples of the agencies that maintain working
smoking, and this is the nation's goal for 2010, relationships with staff and council members:
24%of households with children under 18 smoked.
3. Though only 17%of adults were heavy drinkers(5 Jefferson.County
or more drinks at one time)and this is lower than Economic Development Council
the state average,this rate rose to 28%in JeffCo Animal Shelter
411?
households with children under 18. Fire District 6
Children under 18 and female headed families in JeffCo Technology Alliance
the County had poverty rates higher than the state Main Street
average. Port of Port Townsend
5. Two-thirds of the childbirths in this County are Law& Justice Committee
paid for by Medicaid. Arts Commission
Are our children at risk in this county and in our city? P'TTo Townsend SD 50
The State has cut public health funding for the Fort Worden Advisory Board
counties. To balance the budget without raising taxes,
the County is cutting some critical services. Solid Waste Advisory Board
planning WSU Small Business Development
Reductions in family P g programs, YMCA
immunization clinics and supplemental nutrition
programs for Women,Infants and Children(WIC) Northwest MaritimeCenter
Regional Transit Board
could be costly and affect future generations for years OLYCAP
to come.
JeffCo Historical Society
What is our vision for the health of people in this Marine Science Center
community?What benchmarks should we use?What is Wooden Boat Foundation
our role in the funding of critical public health Chamber of Commerce
programs?We hope to address some of these questions Centrum
in the fall. Volunteer Firefighters Association
North Olympic Resource Council&Development
(continued on back)
•
a1
LEOFF Board
55`t'
Association of Washington Cities Gise to Wilson,
JeffCo Board of Health 2he Hendricks to Sherman,
Conservation Futures Advisory Committee Sherman 29th to 30th,
0th
Etta Steering CommitteeBRFSS 3 e Sherman to Hendricks,
evelopmental Disabilities Board Hendricks 30th to 31St,
2
Distressed County Infrastructure CommitteeSherman,
Ferry Advisory Board Sherman� Hendricks t25th to Hastings,
5th
Higher Education Coordinating Committee Hancock ran
Gra to 27`h,
1St
Granto the end,
HUD Loan Committee U
Intergovernmental Elected Officials Spruce to Redwood,
Spruce Center to U.
JeffCo Alcohol & Substance Abuse
JeffCo Water Resources Advisory Council TO FACILITATE THIS ROAD WORK AND TO
JeffCo Healthy Youth Coalition EXTEND THE LIFE OF THE NEW ROADWAYS,
Jefferson Transit Board THE CITY REQUESTS THE FOLLOWING:
Joint Growth Management Steering Committee > DRIVE SLOWLY for the first few days after
Peninsula Development Committee
Boiler Room paving;
United Good Neighbors > REFRAIN from making excessively sharp
Domestic Violence Program turns or accelerating suddenly;
Farmers Market ➢ PARK AWAY from the streets being chip and
sealed;
➢
To these and all our other partners...THANK YOU! and REMEMBER, vehicles will be towed if
`' left on the street after being notified of the
`0`0' CHIP SEALING scheduled work.
The County and City will be chip sealing City streets THANK YOU FOR YOUR COOPERATION.
the first part of August(weather permitting). While If you have any questions regarding these projects,
dthey are busy repairing the streets, there will be traffic please call John Freitas at 379-4435 or John Merchant
ays. Also, residents along those streets will be at 379-4432.
requested to remove all vehicles off the shoulders of
the road. The City will be notifying residents at least
24 hours in advance of the work.
Chip sealing consists of putting down a layer of hot ANIMAL CONTROL
During the summer months, as citizens and visitors use
asphalt emulsion oil and then covering the oil with
crushed rock (l/2"—l/4"). The oil is water based and our public beaches and parks more frequently, we
sets up to hold the rock in it. The work is done in two receive phone calls asking for stricter enforcement of
dog control. Some children and adults have a natural
phases approximately one week apart. After the first
fear of dogs and feel threatened by their presence even
application sets,the roadway is swept and then the
finished product when they are being supervised. The Port Townsend
second application is applied. The
will end up looking like most of the other streets in the Municipal Code 8.04 Animal Control and 8.08 Dogs—
City. Objectionable Waste Removal address these issues
The roads scheduled for work are: concerning our pets.
Street from/to We can enjoy our public areas together by being
courteous and responsible dog owners. Please
Thomas Hastings to 25th,
31st Hancock to Thomas remember to clean up after your dog and keep him/her
under control when you are visiting a public area. We
McClellan 31S`to 32"d
55th to 57�', need to respect the different views people have about
Gise56Jackman to Wilson, dogs and especially to keep our parks and beaches
safe, clean and sanitary for everyone to enjoy.
Your efforts are greatly appreciated.
•
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Suspected meth maker
• busted after son 's call
By Philip L.Watness
Leader Staff Writer ` �+ ,yti L et
When the 13-year-old son of
Brian S. Hughes,36,of Quilcene T
discovered a glass pipe at his $ , f ,
father's home, he decided he had
....d .
to do something. % 4 '
The boy and Hughes'ex-wife a
contacted the Jefferson County .m ,i,,.1,.,.."1:_,,,' 7_ '.yaw
Sheriff's Office on July 30 and ``
provided enough information for 40.!Alit 4. ' a.
1t+-ay, '4 a
a search warrant for drugs and ._.a, � '
guns. -
/ t � ' ,
Sheriff's deputies and detec- paaa, � y,
tives raided Hughes'rental home ^ � to
at 1743 Dabob Road on the Coyle .. 1z �jr •< k� ::'- -1 M`
Peninsula the next day, July 31. A deputy In action during execution of the search warrant.
They found suspected drugs and
a 9 mm handgun,then discovered ers also found empty cold medi- set bail for Hughes at $50,000
chemical ingredients for the cine packages, starting fluid, a cash. He is scheduled to be ar-
man ufacture of methamphet- two-burner camp cookstove, and raigned on the three charges at
amine. That prompted Detective white powder which will be tested 8:30 a.m.Friday,at which time he
Dave Miller to get an expanded to determine whether it is meth- is expected to enter his plea.
search warrant, call in the Wash- amphetamine.0
Both Hughes'son and his ex
-
Miller State Patrol's Statewide Miller said Hughes probably wife are expected to testify against
Incident Response Team (SIRT), had been recently making meth- him should the matter go to trial,
and inform the county health de- amphetamine. so Walters prohibited Hughes
partment of the possibility of a "One thing that tells us it is re- from having any contact with
contaminated residence, cent is the dry ice we found," them.
Hughes faces charges of meth- Miller said."It's not very common The lab bast was the county's
amphetamine production with in- in manufacturing meth, but-it is second one in.2002.The sheriff's
tent to sell,felon in possession of used.There was still some dry ice office had previously discovered
a firearm,and endangerment of a in a bucket that had not evaporated a lab March 21 in Quilcene.That
child with a controlled substance. yet, so [Hughes was producing was the first meth lab discovery
Because he has a previous conic- meth) within days, anyway. We since Dec. 16,2001.
non for methamphetamine posses- also found numerous buckets with Undersheriff Ken Sukert said
cion, Hughes could serve a multi-layered liquids,and some of the suspected meth lab might have
maximum of 20 years and pay a the layers tested positive for an- caused environmental damage
$50,000 fine under the first count hydrous ammonia and others had outside of the house and shop
alone. The gun charge carries a muriatic acid.We also found lots where the chemicals were found.
maximum penalty of five years of rock salt." "The potential for significant
and/or $10,000 fine, while the The Jefferson County Health environmental impacts is there,"
third count,endangerment,carries Department on Aug. 1 placed a Sukert said. "We found five-gal-
a 10-year maximum sentence and/ "no occupancy"order on the rental Ion buckets that tested acidic, in-
or$20,000 fine. house as well as a storage build- dicating waste products from
While the officers didn't find ing behind it.The property own- previous cooks,and that stuff was
an operational meth lab, they did ers must have the buildings tested such that it appeared it had been
reportedly find enough evidence for toxic residues and have those there awhile and rain had filled the
to substantiate the meth produc- chemicals cleaned up before the buckets and they were overflow-
tion charge. Among the items health department lifts the order. ing."
found was a propane tank that had Environmental Health Director Miller said the evidence taken
a brass fitting that had turned blue, Larry Fay said the cost of prop- by the SIRT members will be ana-
a clear indication that anhydrous erty cleanup could be in the thou- lyzed at the Washington State Pa-
ammonia,a primary ingredient in sands of dollars. trol Crime Lab in Tacoma to
meth production,had been in the On Monday, Superior Court determine its chemical composi-
tank, according to Miller. Offic- Commissioner Marianne Walters tion. ��