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2003- March
• Jefferson County Board of Health NEXT MEETING Agenda Item VIII • Board of Health Retreat March 20, 2003 • ,* Jefferson County Health and Human Services JANUARY — FEBRUARY 2003 NEWS ARTICLES 1. "Public health on shaky ground",Peninsula Daily News, January 10,2003 2. "County may restrict Marrowstone water",P.T.LEADER, January 15,2003 3. "Health chief: Smallpox plan drags others",Peninsula Daily News, January 17,2003 4. "Open-space preservation grant applications sought",Peninsula Daily News,January 21,2003 5. "Smallpox shots stalled",Peninsula Daily News,January 22,2003 6. "Official: West Nile Virus poses Peninsula threat",Peninsula Daily News,January 22,2003 7. "West Nile virus heads west,county cautioned",P.T.LEADER,January 29,2003 8. "Dental care gets boost with grant of$50,762",Peninsula Daily News,January 26,2003 9. "Developmental Disabilities Board updates website",P.T.LEADER,January 29,2003 10. "Skookum could lose county's recycling contract",P.T.LEADER,January 29,2003 • 11. "Toxic trash left at meth lab site",P.T.LEADER,January 29,2003 12. "County hears agricultural exemption issue tonight",P.T.LEADER,February 5,2003 13. "Vaccinations for smallpox being offered to hospital staff',P.T.LEADER,February 5,2003 14. "Health aides to get shots for smallpox",Peninsula Daily News,February 6,2003 15. "Jefferson hearing to focus on recycling contract",Peninsula Daily News,February 11,2003 16. "County to sell bonds", Peninsula Daily News,February 11,2003 17. "Jefferson,PT see fiscal crises",Peninsula Daily News, February 12,2003 18. "Community Network awards$18,000 to seven local programs",P.T.LEADER,February 12„03 19. "County approves bond issue",P.T. LEADER,February 12,2003 20. "County honors top food servers",P.T. LEADER, February 12,2003 21. "Impressed with health pros",Letter to the Editor, P.T.LEADER,February 12,2003 22. "Doctor: Alcohol overdose remains a grim possibility",P.T. LEADER,February 12,2003 I • . Public health on shakyround Clallam,Jefferson budgets include Locke said there was adequate health system is inevitable. capacity in the private sector "As health system resources possibility of state fundin cuts to cover the need. that provide basic strength are g The majority of funding for removed by cost cutting, the public health is provided by responsibilities for providing BY JIM MANDERS gency, Locke said. the federal and state govern- services are simply moved to PENINSULA DAILY NEWS There were also cuts in sup- ment,Locke said. the top of an increasingly Potential cuts in state and port staff in the Environmen- unstable structure," Vigdor tal Insurance affected federal funding will jeopardize Health Department in Clal- said. lam County. Cuts in the state bud He said public health is public health, according to get, Thomas Locke, director of Commissioners also moved according to Locke, will also "often unnoticed, repeatedly public health in Clallam and the environmental health unit. affect the amount of money underfunded and frequently Jefferson counties. from the Department of Corn- health departments receive misunderstood, despite its Public health munity Development to the from insurance programs, great success." across Puthe stecould lose agencies Health & Human Services such as Medicaid and Basic The Washington Health million in funding if the Legis- "Commissioners Health, for family planning Foundation, a nonprofit orga- million approves Gov. Gary `Commissioners made a and pregnancy care. nization, is one of many lature plan tov erase a $2 ary conscious decision not to cut "Those programs are really groups lobbying against cut- lion deficit. our budget because of the on the chopping block at the ting health care funding. potential for loss of funding at state level," Locke said. Those groups, including Locke, in a telephone inter- , mid-year,"ams will be Locke said. Public health programs representatives from Olympic ubl Thursday, said •manyP p Locke thinks the size of impact more than the poor or Peninsula health care organi- seriouslyeeffectedf the budget Clallam County's Public those with jobs that don't pay zations,will meet with legisla- cut is that deep. Health Department played a family wages. tors Jan. 16 in Olympia. role in staving off cuts. "Public health, It's a house of cards, andby its very "The health department in nature, is designed to protect they're tugging on the bottom cards,"Locke said. Clallam County is very small, everyone," Locke said. "So The list of programs facingso there's not that much to everyone is threatened." P gr cut,"he said. Greg Vigdor, cuts s isclonldg,Lockocfecte said,nrnoting ing Jefferson County was the Washington Health Foun- water monitoring; food safety forced to end flu clinics, but dation, says collapse of the programs, disease outbreak i response, communicable dis- eases, HIV prevention, immu- nizations and family planning services. "The list of challenges grows ever longer,"Locke said. "But, the resources are in jeopardy." Status quo budget Thij r_ /0 _ 03 Mindful of the potential cuts at the state level, which will be implemented at mid- year, Locke said commission- ers in Clallam and Jefferson counties didn't make major cuts to health programs in the 2003 budget. In Jefferson County, one iti) sition was lost in mid-2002 o take care of a budget emer- Port Townsend&Jefferson County Leader • County mayrestrict Marrowstone water By Barney Burke seawater intrusion,particularly Leader Staff Writer on Marrowstone Island. The hearings board gave the Marrowstone Island resi- county 90 days to clarify sec- dents, the three Public Utility tions of its seawater intrusion District 1 (PUD) commission- policy, finalize its adaptive ers and others filled the board management practices, set a of commissioners' chambers time frame for updating maps, Jan. 13 for a discussion on how and provide more public review the county might comply with of the policy. a state order concerning Although the county has the groundwater protection. • authority to implement those al- The ruling last month by the tematives, it does not have the Western Washington Growth authority to prohibit new wells, Management Hearings Board Christensen emphasized. could result in restrictions on In a memo to the county water use from new wells, an commissioners, Christensen island-wide restriction on wa- suggested that more stringent ter use, or a moratorium on standards could have impacts more water use until a public on county staffing and budgets. water system can be developed On the other hand,he points out • ✓ on Marrowstone, said Dave that continued reliance on wells Christensen,the county's natu- and other alternative sources ral resources division manager creates a disincentive for devel- The county commissioners oping a "permanent, safe and set another meeting for 10:05 reliable source of water for a.m. Tuesday, Jan. 21, and Marrowstone Island" asked staff to draft a policy sup- In 2002, the PUD began an porting the development of a engineering study to estimate public water system as the long- the cost of developing a public term solution for Marrowstone water system on Marrowstone Island.It's unclear whether the Island fed from a well in the commissioners will favor either Tri-Area . In addition to cost more restrictions or a morato- and engineering considerations, rium as a near-term solution, the PUD must secure water Christensen said. rights to drill a new well in or- The state hearings board ac- der to proceed with the idea. tion is the result of an appeal Also, if more than 50 percent filed by Shine Community Ac- of island residents vote against tion Council and Olympic En- it, the project would be termi- vironmental Council. In nated,according to PUD staff. upholding the appeal,the hear- The hearings board is sched- ings board determined that uled to have a hearing on the Jefferson County has not done county's response to its Decem- enough to protect aquifers from ber 2002 ruling on April 9. • /-15 -03 3 eachief: . „ Health : • Srnaiipox plan Liability drags other worries s CONTINUED FROM Al Federal edict „,.„-_, Americans from ter- By the middle of February,as r rorist attacks. many as 10 health department Y said to hinder In December, employees and 50 officials at Bush announced Jefferson General Hospital local programs plans to vaccinate could receive their vaccina- Q a Americans against a tions, he said. bF' possible bioterror- The health department will BY KEVEN DREWS VN't=t ism attack using then have to prepare to vaccinate 4} �a� t smallpox. more health care, law enforce- PENINSULA DAILY NEWS t ....4- p Smallpox is a ment officers and first respon- PORT TOWNSEND — The fed- Locke highly contagious ders,he added.The general pub- eral smallpox vaccination program is disease character lic will be vaccinated last. threatening to undermine several ized by prolonged fever,vomiting and Many of those locals who Pustular eruptions that leave scars. will receive the vaccination first public-health initiatives in Jefferson County. The disease was declared eradi- are`asking some good ques- cated in 1980, but experts fear it tions,Locke said. Jefferson County Health Officer could be used in a terrorist attack. They want to know who is Dr. Thomas Locke said Thursday his staffjust can't put as much time into As many as 30 percent of patients financially liable if somebody 411) public education programs, which contracting smallpox die. gets sick, dies or passes on the deal with issues like food-borne ill- However, vaccination is risky. disease following a vaccination, nesses and sexually transmitted dis- said Locke. Liability questioned "This is something we eases, because of the vaccination program. Two or three out of every million believe the federal government "This one issue has taken over who receive the vaccination can die, should assume the liability for,” public health and it really is displac- and about 15 out of every million he said. ing the other issues,"he said. "We're will face a life-threatening side Some residents will be exempt not ignoring these issues, but as effect. from inoculation,he said. health officer I have concerns. Locke said people are beginning Exempt residents include Officials in other counties have to ask who will be liable if they are those who are pregnant,have a told him smallpox plans are displac- adversely affected by vaccination. suppressed immune system or a ing public health issues in their According to Locke, three of fourhistory jurisdictions, too, he said. of some skin conditions, "Probably the main things its dis people, who deal with public health Locke said. placing is all other aspects of bioter- issues at the Jefferson County Besides dealing with bio-ter- rorism planning," he said. Health Department, have already rorism threats, Locke said the In November, President Bush worked on the smallpox vaccination county still has to find time to Program. signed the Homeland Security Act, plan for natural disasters. creating a department to protect TURN TO HEALTH/A2 i , • Open-space p reservation, grant applications sought PENINSULA DAILY NEWS erty taxes is available by law to Jefferson County residents will acquire land. get a chance to preserve forest lands, The Conservation Futures Citi- greenbelts or agricultural lands as zen Oversight Committee will spon sofficially designated open spaces,say individuals can submit a proposal or County officials are accepting learn more about the program. applications from the public to per- Feb. 1 workshop manently protect lands through con- servation easements, development The workshop will be held at the rights or purchase. Tri-Area Community Center, 10 W. David Christensen, manager.of Valley Road, Chimacum, between 1 the county's Natural Resource Divi- p.m. and 3 p.m. sion,'said any undeveloped piece of Residents can obtain more infor- land could be set aside as an open mation by calling the Natural - - space. Resource Division at 360-385-9444. • The county has $300,000 avail Once applications are in, the com able this year to fund projects. mittee will make recommendations Through .;the. . Conservations to the Jefferson County.commission- Futures ta., levy; a portion of prop- ers,who will make the final decision. f�l 03 6- • smallpox shots stalled BY JEFF CHEW as planned, despite concerns PENINSULA DAILY NEWS raised by an expert advisory group and calls for delay by Smallpox vaccinations of front-line health-care and national labor unions repre emergency service woxkers.in, senting health-care workers Jefferson and Clallam counties m'orried'tltat-thelederal'governt 'has been delayed, Dr. Tom ment will not compensate workers dor medical expenses Locke said Tuesday. or lost wages if they are harmed Locke, health officer for the two counties, said liability by the vaccine. issues and compensation for We intend to make this pro those who miss work or are happen on time,"said Dr. injured by the vaccinations are Julie Gerberding, director of the U.S. Centers for Disease among the major "hang ups." The vaccinations, all volun- Control and Prevention. to y, are part of the national . We live in a dangerous plan to protect against a possi- world these days where a ter- ble bioterrorism attack. rorist attack with smallpox is The vaccine has side-effects possible.We must be prepared." ranging from flu-like symptoms But ea report issued by the to death for five of every 1 mil- Institute of Medicine suggested that the vaccination program lion persons vaccinated. "The date for smallpox vac- t rushed and lacking impor- cinations keeps getting pushed Cant safeguards, back," Locke told Clallam The program, announced by President Bush on Dec. 13,calls County commissioners, acting for as many as 500,000 health as the county Board of Health. 1111 , care workers to be vaccinated. `A lot of concerns' Those inoculations can begin e "(Hospital) staffers have a Homela d wheSecuritysAct ion of ill lot of questions, a lot of con- take effect, protecting the gov- cerns," said Locke. "There are ernment, vaccine makers and some unanswered questions." those who administer the vac- Still, Locke said, a plan is cine from liability,except in the still in place to vaccinate emer- case of negligence. gency room workers and those A second phase of inocula- most likely to come into contact tions is to include 10 million with smallpox victims in the more people: health care work- event of a terrorist attack. ers, firefighters, police and "We need 50 people from emergency personnel. each hospital," Locke said, The Institute of Medicine adding that seven to eight Clal- urged the CDC to help clarify lam County law enforcement questions about compensation emergency and health staffers and consent forms in each would also be among the first to state. be vaccinated, with fewer Gerberding made clear,how- needed in Jefferson County. ever, that "we are certainly not Last week, federal health going to delay this program officials said the smallpox vacci-. because of concerns about coro- nation program would proceed pensation." i- c2a —63 411 Ic' • PENINSULA DAILY NEWS I Official : West Nile virus rus poses Peninsula threat' Mosquitoes could is a human case," Locke spread disease in Said. Clallam, Jefferson '` The stateui _ has mosquito abatement BY JEFF CHEW ;a, ', ordinances on PENINSULA DAILY NEWS '• £: the books, but there is no With several known breed- (\ '/,fr, funding source ing grounds for mosquitoes,the Locke available West Nile virus could become a should a big threat in Jefferson and Clal- Peninsula outbreak occur. lam counties this year. Under state law, forming a "We know Clallam County mosquito abatement district has least six vectors with mos- requires a petition and popular quitoes that could carry the vote. To pay for abatement, the virus," said Dr. Tom Locke public must set up and fund dis- Clallam and Jefferson counties' tricts through a tax levy elec- health officer. tion. "Some Jefferson County "I am not recommending 'mosquitoes are also present in that you rush out and form a Clallam County, and some in mosquito control district," Clallam County are found in Locke said, adding that he was Jefferson County and Grays merely trying to inform the Harbor. The variety is what we county commissioners of the are most concerned about." potential threat. In mid-November,West Nile West Nile is spread by the was discovered in a horse in bite of an infected mosquito, Coupeville on Whidbey Island, and can infect people, horses, across Admiralty Inlet from birds and some other animals. Port Townsend. Most people who become It was the first positive case infected with West Nile virus of the virus on the West Coast. will have either no symptoms or only mild flu-like tendencies. Two mosquito varieties On rare occasions, infection can in a and Locke on Tuesday said two times result fatal illnesseknownmas virus-carrying mosquito vari- West Nile encephalitis, an eties are of most concern. inflammation of the brain. One lays eggs that survive The risk of severe disease is several years,which float to the higher for people 50 and older. surface during flooding and Mosquitoes spread the dis- hatch.The other is the"north- ease from bird to bird, and ern house mosquito," which other animals — including favors the indoors. humans — are dead-end hosts "When the first horse case to the disease. This means shows with the virus, that's humans do not participate in when we need mosquito abate- the transmission cycle, but IDment,and certainly when there become ill when infected. /— 2°. -o3 • WestNile virus e as west county cautioned By Barney Burke The first two cases in Wash- horses and other animals, Fay Leader Staff Writer ington state occurred in 2002, said.There is a vaccine for horses said Fay. One was a visitor but not for humans,he noted. The West Nile Virus is mov- from Louisiana, and one was a‘ The best prevention measures ing westward across the United Washingtonian who visited are screens on windows, insect States at'a 'pace faster than Michigan, he explained. ' repellent,'long-sleeve shirts and originally estimated, Jefferson More human cases are ex- -,the elimination of standing wa- County Environmental Health pected in Washington state this ter,Fay said. Director Larry Fay said Jan.27. summer, Fay said. The disease Goldfish are effective for The disease has killed an es- should hit its nationwide peak in eliminating mosquito larvae in timated 259 Americans and in- two or three years. landscape ponds, according to fected 4,000 others since West Nile disease is carried by Fay. Larvacides can be used in arriving here in 1999, Fay mosquitoes and is known to kill water by licensed professionals, added. birds such as crows, as well as he added. Fay pointed out that influ- enza kills an estimated 34,000 Americans a year, many more than the West Nile virus.None- theless, the disease can cause encephalitis and leave people with disabilities, he said. Fay's observation is that Marrowstone Island probably has more mosquito breeding ar- eas than other parts of Jefferson County. But any area of stand- ing water can be a problem. The county's role in the West Nile virus issue will be surveillance, while the state will focus on public informa- tion. The local health depart- ment does not have the resources and expertise to abate mosquitoes on a large scale, said Fay. The best tool for that,he suggested,would be to form a single-purpose mos- quito abatement district.Form- ing and funding an abatement district requires voter approval, he noted. Looking ahead, Fay pre- dicted, "There's going to be a much higher level of concern with mosquitoes." • 8 PENINSULA DAILY NEWS 411 Dental - ca re gets boost with r ant of $50, 762 PENINSULA DAILY NEWS \ dental emergencies in the Port "The additional $50,762 Olympic Community Action Angeles and Sequim areas." Programs has received a will allow unto fully equip $50,762 grant from the Wash- and staff two clinics, in Local and visiting dentists ington Dental Service Founda- different IOCatiIn addition, the program tion to expand dental care for onS, vis- low-income families on the simultaneous) or t0 can make use of local and North Olympic Peninsula. y' iting dentists to assist with "We are extremely proud of operate at double capacity waiting lists and to help peo our Oral Health Care Access in the same locale." pie with dental emergencies, program and all of the good MAXINE HOFFMAN Hoffman said. to work performed by staff and director,Oral Health Care Access improve r primary mission is the oral health of vul- volunteers," agency Deputy Director Tim Hockett said. peoplenerable people so that they received dental care don't have dental emergen- "Even though the program from the mobile clinics during cies, which are much more has served more people each 2002. expensive to treat and can year, the demand for care The program also refers cause other serious health always exceeds our ability to dozens of dental emergencies problems," she said. serve." to local dentists and to the Dr. Todd Irwin, whose pri- The grant will enable the emergency rooms of local hos- mart'dental practice is in Port • non-profit, social service agency to serve hundreds pitals. Angeles,is a participating den- each year,he said. Olympic Medical Center .tist and strong advocate of the more people program makes use dof currently sees more than 80 program. portable dental equipmentf dental emergency cases per "It would be hard to overes- can be set up t month, according to a recent timate the need for good den- thatnity centers, schools,in churches study by the center's staff. tal care among our struggling or just about anywhere, he Washington Dental Service neighbors," Irwin said. added. Foundation funds will pur- chase portable dental equip- ment and cover the cost of Mobile dental care extra staffing. A combination of paid and "The additional $50,762 volunteer ntal saff carry will allow us to fully equip and out day-long clinics providing staff two clinics, in different out dean ng ad dental locations, simultaneously, or work for low-income individu- tooperate at doube Gofman ino als who either have no dental the same locale,"" Hoffman insurance coverage or cannot said. find a dentist who will accept We will also bring in visit- Medicaid. ing dentists to help address Maxine Hoffman, director of the Oral Health Care Access program, said more than 800 S hz, _ o 3 • Developmental Disabilities Board updates website The Jefferson County Devel- that citizens with developmental opmental Disabilities Advisory disabilities in Jefferson County Board announces that it recently have the choice,opportunity and updated its website to better support to achieve full,active and serve the community. productive participation in com- "The goal of this update is to munity{ife" provide the latest information If you have questions or regarding a variety of issues per- concerns to send to the board, taining to our citizens with de- click on the "Developmental velopmental disabilities," said Disabilities Coordinator" and Anna McEnery, developmental send an e-mail, or e-mail disabilities program coordinator. McEnery directly at Specific information available amcenery@co.jefferson.wa.us. through the county website in- She can be reached by phone cludes employment options,self- at the Jefferson County Depart- advocacy,govel-nment legislative ment of Health and Human information and government Services, 385-9400. contact information. All of this information::can lieifound in the "Resource Eiiiide,"whicl i.s'in an Adobe Acrobat Reader format. To access the information, go to the Jefferson County homepage at www.co.jefferson.wa.us, click on the "Departments" tab, then on "Health and Human Ser- vices,"and finally,click on"De- velopmental Disabilities" in the list to the left under "Programs and Services." On that screen, select from the categories in the left-hand column. The board hopes the up- dated website will 1) contrib- ute to expanding awareness of such issues as available support programs, 2) chart the latest trends related to people with • ( .— -0 3 developmental disabilities,and ! 3) enhance the quality of life (Pr LEA--)a for all county residents. The update supports the board's mission statement,which states: "The mission of the De- velopmental Disabilities Advi- sory board and staff is to assure S /0 • • Skookum. could lose • countY'sr recycling� contract Although the board of corn- fer station off Jacob Miller materials would be trucked to missioners hasn't made a deci- Road, is the county's current Tacoma and sorted there. Weak sion on it yet, the Jefferson recycling contractor. The market demand for recycled ma- County Public Works Depart- county sent out requests for terials is making it harder to jus- ment is recommending that ' proposals last year when that tify recycling from a business D&M Disposal, not Skookum contract expired. perspective, Goldsmith said. Environmental Services, be The D&M proposal would Over the first four years, the awarded the contract for county cost less but would not include D&M proposal would save the recycling. the employment of the disabled county a total of$87,000,accord- Skookum, which employs to sort recyclables, County Ad- ing to Goldsmith. five developmentally disabled ministrator David Goldsmith No date has been set for people at the solid waste trans- said Jan. 27. Instead,recyclable awarding the contract. /1 Wednesday,January 29,2003 •A 9 • • • Toxic trash left at meth lab site By Barney Burke briefly exposed to fumes from Leader Staff Writer the toxic materials used in manufacturing meth, and he An inquiry from an absen- reported light-headedness and tee property owner led to the a headache.He was checked at discovery of a methamphet- Jefferson General Hospital and amine lab near Quilcene on released, according to the Jan. 25. sheriff's office. Jefferson County Undersh- After a search warrant was eriff Ken Sukert said Monday executed, the Washington that the owner of the Donald State Patrol Incident Re- Road property became aware sponse Team assisted the that someone had been staying sheriff's department in inves- there without his permission. tigating the scene.Among the Upon investigation, Deputy evidence recovered were con- Tony Hernandez discovered a tainers of lye, pseudoephe- meth lab on the premises. drine, toluene and acetone, There have been no arrests ingredients typically used for in the case, but investigators . making meth. were able to obtain finger- The Jefferson County prints from much of the evi- Health Department is assisting dence, Sukert said. The the sheriff's office in arranging investigation is still under a cleanup of toxic materials, way, he emphasized. Environmental Health Director Deputy Hernandez was Larry Fay said Monday. • . l Countyhears agricultural • exemption issue By Barney Burke:,.. . ment,,,the county..agreed to ,develop criteria to.make that de- Leader Staff Writer change;tie UDC so that agricul- termination: tural lands would no longer re- Once the county makes the The Jefferson County Plan- ceive a blanket exemption to final decision on what lands are Hing Commission is taking up the requirements for buffers to pro- not of long-term significance, challenge of protecting both ag- tect environmentally sensitive the county will attempt to deal riculture and fish habitat at its areas such as creeks. with salmon habitat issues on public hearing at 7 p.m. tonight, As a result, says Dave a watershed-by-watershed ba- Feb.5 at the WSU campus in Port Christensen,the county's natu- sis, Christensen explained. Hadlock. ral resource manager,some ag- Currently,the staff is beginning In March 2002, the county ricultural lands are going to be work on the Chimacum Creek settled an appeal of its Unified subject to the same kinds of watershed. Development Code(UDC)filed building setbacks that would Christensen acknowledges that by the environmental group apply to residential and corn- some property owners who use Washington Environmental mercial properties. their land for agriculture and are Council (WEC). In that settle- What the county has not de- not in the production zone are termined is which properties will miffed at the county because of the continue to get the blanket ex- negotiated settlement with WEC. emption and which properties But he notes that a number of other will either follow the standard counties were challenged at the UDC rules or be able to negoti- Western Washington Growth ate other conditions. Management Hearings Board on Christensen said that agricul- the same issue by WEC,and they • tural lands determined to be"of all lost. long-term significance"are to get After the planning commission the blanket exemption. Land al- makes its recommendation, the ready zoned "agricultural pro- Board of County Commissioners duction" in the county's would make the final decision. comprehensive plan would be Also on tonight's planning considered to be of long-term commission agenda is a discus- significance,he said.But at least sion of the seawater intrusion is- some land not in that zone could sue. A public hearing on a also be classified as being of proposed airport noise overlay long-term significance,he noted, zone has been canceled and not and the commission is trying to yet rescheduled. • • is. . . • • Vaccinations or smaiu,. ox • beingoffered to hospital staff By Janet Huck in one person out of 20,000 vacci- vaccination program if there were scratch the lesion and handle a Leader Staff Writer nated.Death occurs in one to three an outbreak.As many as 500,000 patient who is immune-compro- per million.In some series of vac- healthcare workers as well as mili- mised," said Dr. Marc Maundy, Jefferson County Hospital Dis- cinations,30 percent were too sick tary personnel nationwide could JGH pathologist. trict 2 commissioners voted last to work, according to the Jeffer- be vaccinated during Stage 1. Therefore, the commissioners week to offer smallpox vaccina- son County Health and Human According to the federal plan, voted to give all care workers who tions to front-line healthcare work- Services Department's website. Stage 2 would involve a larger were vaccinated a paid furlough, ers who could care for infected "I'm not a daredevil,"said Dr. number of healthcare workers and if necessary, during their coma- persons. ' Brad Bringgold,who volunteered law enforcement personnel. In gious period. "We would never not care for to be vaccinated. "But it makes Stage 3,all Americans could vol- "It's our responsibility to pro- patients with smallpox,"said Vic sense to be one of the people who untarily be vaccinated.In the event tect both our front-line workers Dirksen, administer of Jefferson should be immunized." of an actual smallpox outbreak, and our patients,"said Dirksen. ;General Hospital (JGH) in Port When the hospital commis- Stage 4 would use regional or na- The hospital's agreement to Townsend. sioners agreed to vaccinate work- tional smallpox vaccinations as participate in Stage 1 is condi- The front-line staff, however, ers, the district agreed to part of the response plan,accord- tional, pending additional infor- •would need to volunteer for small- participate in Stage I of the Na- ing to the health department. mation on liability and possible pox vaccination and pass a corn- tional Smallpox Vaccination Plan Since the vaccination can shed compensation for healthcare prehensive health screening. For announced by the federal govern- the infectious virus for up to three workers who might have adverse 0 Instance,people with a history of ment on Dec. 13, 2002. Stage 1 weeks after inoculation, several reactions to the vaccination. eczema should not be vaccinated. vaccinations, to begin in early hospital workers expressed reser- "What JGH did is similar to the So far, despite the risks, 14 local 2003,involve public health work- vations about inadvertently expos- response of other hospitals across healthcare workers and physicians ers and hospital-based workers ing ill patients to the smallpox the state," said Dr. Tom Locke, have volunteered. who might be called upon to re- virus. If the vaccination lesion is Jefferson County's public health Though the vaccination is spond to a local smallpox out- properly covered, there is a low doctor. "There are still a lot of highly effective in immunizing break. The county's health risk of transmission. However, unanswered questions." people against•smallpox;'it can department healthcare workers accidents could happen: -- produce life-threatening reactions would form a team to jump-start a "It only takes one person to • L THURSDAY,FEBRUARY 6,2003 A3 aides. /!.� Health I l • . to get shots for smallpox Jefferson, , Washington. im a;th „, departments Clallam set z� 3, , will also oper- `.` d ate nine clinics throughout the vaccinations . g �� state. BY JEFF CHEW i Screening candidates for PENINSULA DAILY NEws il>, .':,i.1 the first round Public health and hospital Locke of vaccinations workers on the North Olympic requires that they be Peninsula who have volun- volun- Peninsula a ihealth-care teered to receive smallpox vac- worker onvestigator for cinations are expected to get either county. their doses at secured pilot clin- ics in about six weeks,a health Doctors and nurses official said. "People from Clallam and At the Peninsula's three hos- Jefferson will be vaccinated at a pitals in Forks, Port Angeles Dr. Tom and Port Townsend, health- clinic in March," said DLocke, health officer for Clal- care teams including doctors and nurses have been trained lam and Jefferson counties. Locke believes the vaccines and formed. will be administered in Kitsap Once volunteers are County part of a new three- selected,they must be screened county health district. to make sure there is no health • In what Locke called a sig- risk to them,Locke said. sig- nificant development, state At least 30 percent of the Department of Health officials population is at risk of nega- ttvely reacting to the vaccine announced Tuesday that it has ordered 4,000 doses of smallpox for medical reasons,he said. vaccine from the federal gov- Side effects from smallpox vaccinations range from mild to ernment to immunize public health and hospital workers. deadly. The order was placed with Some people may have sore the federal Centers for Disease arms and fever or feel sick Control and Prevention. enough to miss work. "The significance about the As many as 40 out of every announcement was that Wash- million vaccinated for the first time will face life-threatening ington was thinking about whether to do it or not,"Locke reactions, and one or two will said. "Enough questions were die. answered that the state of The vaccine is not recom- Washington is now moving for- mended for people with skin ward." problems, such as eczema, or those with weak immune sys- Vaccination training tems, such as HIV, transplant or cancer patients. Washington is participating P g The government says even in a national plan to vaccinate people with close family mem- front-line health workers who bers in those categories should would be the first to treat be screened out. smallpox infections in case of a bioterrorism attack. Vaccine delivery Locke said he has a prelimi- nary list of volunteers who will Once the state's vaccine receive the..vaccine, but a set order is filled,Locke said�itwill number has not been decided. be delivered to secure locations Those health care profes- such as military bases. sionals who qualify for a small- Select military personnel pox vaccination will be attend- received vaccinations in recent ing a clinic the latter part of weeks,including those at bases this month at an undisclosed, in Western Washington. secured location in Western Smallpox was declared erad- Washington, Locke said icated from the world in 1980, 0 Wednesday but experts fear it could be used They will receive training on by hostile nations or terrorist administering the vaccine to groups in an attack. others. The government's main Currently,there are no plans strategy is to vaccinate those to vaccinate the general public. who would have to care for vic- There will be two state-run tims—and vaccinate everyone pilot clinics for health care else if a deliberate release of workers, another in Eastern smallpox were to happen. 15 O 6) cd 6> o+--0 . .1 o, E30wo $ Ep• -2 oc. m T 0 2g8aaL � � �E' 666: � g.' .0 E,22'5, .E-S o-SSv° .5,b wE O `7'O g o ° E › oo oy a C 47 0, s, ,Q a> a. cd 0 C ° °'x O m o 0 O II® 6NC�"ly rgL oA co _ (a pp— ® -o 3 Q. "2+P)- E•E Ey. I. ta > 0 te, 0. o Y 0^ C.8 O CL^Z d - zU. 0 h "T O li":000 y 01 3_3 3 o U) a. 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Commissioners Dan Tit- • terness, R-Port Townsend, Glen Huntingford, R-Chi- Goldsmith macum, and Wendi Wrinkle, D-Shine, unanimously passed a resolution Monday authorizing the issuance of limited tax general obligation bonds. That means Martin Nelson & Co. of Seat- tle can now sell the 16-year bonds, which come in denominations of$5,000. "People like to buy bonds because of the safety of the principal," Martin Nelson's senior municipal underwriter Jim Nelson said, noting the bonds will likely sell out by today. Of the $4.58 million, $1 million would cover the costs of Jefferson County Court- house renovations. The rest would cover the annex, renova- Bonds: tions at the Jefferson County Sheriffs Office T and work at county-owned properties at Cas- tle Hill Mall. County Administrator David Goldsmith CONTINUED FROM Al buy bonds. said the county will build a new 7,800-square- He said the county must "We don't have to increase foot annex next to the Sheriff's Office in Port install a new elevator so it can taxes to do that,"he said. Hadlock. comply with the Americans Nelson said many Jefferson with Disabilities Act. County residents have already Remodeling project The ' county must also called him and expressed an re lace the courthouse's util- interest in buying the bonds, The county will also remodel 4,300 square ity lines, front doors, water which received a Triple A rat- feet of current space in the Sheriff's Office. lines in the front yard,and ing from Standard & Poor's Goldsmith said the county is ready to begin windows, he said. The court- Corp. the bid process and hopes to begin construe- house's back parking lot must He said the average aggre- • tion by April or May. also be repaved. gate yield rate for the bonds is The county alsowantsto renovate existing Huntingford said the bond 3.91 percent — ranging from office space,put onn a neww roof and install new sale means taxpayers won't 1.25percent in the first heating and ventilation systems at its Castleyear Hill properties, he added, have to foot the bill for the to 4.4 percent in the 16th year. The county bought its Castle Hill Mall ; work. The county, he added, will offices two years ago. He said the county will use make an average annual pay- In addition, Goldsmith said the county has l proceeds from its real estate ment on the bonds' principal I excise tax to pay off those who and interest of$386,000. a "laundry list" of courthouse projects. r 1 / . . fefferson , PT I. e see fiscal cri SIS Officials seek support for legislative crime-victim costs and coroner codes, reducing interest rates costs. on court awards and eliminat- bid to protect area revenue bases ing red tape on purchasing State would have to help and bid requirements. BY KEVEN DREWS and the Washington State Under the Local Govern- When it comes to law and PENINSULA DAILY NEWS Association of Counties are ment Joint Legislative Pro- Justice,. the proposal said behind the Local Government posal, however, the state •municipalities should be PORT TOWNSEND —Jef- Joint Legislative Proposal. would have to assist local gov- allowed to consolidate or Person County and city offi- "We're being asked to do a ernments that lose significant downsize courts and decrimi cials say they want residents lot of things we're not being funds from general revenues nalize suspended driver's- to help them battle a fiscal cri- funded for," said County Com- and continue to fund local license charges. sis that's hitting municipali- missioner Dan Titterness, R- public health. ties across the state. Will some cities fold? Port Townsend. The proposal would allow County commissioners and "One of the things we're counties to implement addi- Donna Eldridge, Jefferson city officials asked the Port going to be asking is for you to tional sales and property taxes County auditor, said the fund- Townsend Chamber of Corn- support the package to our after voter approval and util- ing crisis is so bad that some merce to back a legislative pro- Legislature in Olympia." ity taxes subject to action by a cities may have to disincorpo- posal that would protect and Jefferson County was local legislative authority. rate. expand their revenue bases. forced to pay an extra Local governments also One county, she added, They want to ensure that $451,158 between January want the state to change laws recently lost 59 percent of its cities and counties can meet and June 2002 for public ser- to allow counties to cut opera- general fund revenue. criminal justice needs, protect vices because the state either tional, capital project and law "Counties are really hurt- public health care and provide cut or reduced funding. and justice costs. ing," she said. other critical services. Included in the bill were jail For example, the proposal Mayor Kees Kolff said Port eAssociation of Wash- and law enforcement services, said the state can do that by Townsend has been affected i Cities, the Washington court-related services, land allowing private firms to con- less than other cities in the As ciation of County Officials use, water and infrastructure, duct audits, updating building state. PD 11 S is Community Network • awards S 18 ,000 to seen l eel .:p ro. _ams � Jefferson County Community County Juvenile and Family Network has awarded a total of Court Services. $8,000 in grants to seven local • Peer-In youth group spon- organizations for projects ben- sored by Jefferson County Health efiting Jefferson County children and Human Services. and families.The grants range in •Jefferson County 4-H Ropes size from $500 to $2,000 and Challenge Course manual by must be spent by June 30. WSU Extension. "In this time of tight budgets • Learn to Build and Play an we are pleased to be able to fund Instrument with Andy Mackie. so many worthy projects," said Community Networks were Network Chair Rick Tollefson. established by the state Legisla- "Jefferson County will see some ture in all Washington state coun- new and innovative programs for ties and tribes in 1994 and families in the coming months." operate under the authority of the The projects funded by the Washington State Family Policy Network include: Council. Networks function at • Best Beginnings home visi- the local level to improve the cation program for new mothers lives of children and families by administered by Jefferson County identifying social problems that Health and Human Services. are of particular magnitude or • • Guiding Hands childcare importance in the community. provider education program pro- The Jefferson County Corn- vided by Parent Line. munity Network has two coali- • Making Peace With Your tions which meet monthly to Teen parent education program share information and coordinate provided by Roots & Wings events. The Healthy Youth Coa- Counseling/The Growing Edge. lition focuses on youth substance • Aggression Replacement abuse prevention,and the Birth- Training at Chimacum High to-Five Coalition has child abuse School sponsored by Jefferson prevention as its focus. LEADE - t2. -63 S fq i • Countyapproves bondIssue By Barney Burke Although the architectural and building and community percent. Nelson commented Leader Staff Writer drawings for the sheriff annex development department. that the county received a fa- and jail remodeling project in According to bond under- vorable bond rating because of The Jefferson County Board Port Hadlock are nearly corn- writer Jim Nelson of Martin its low amount of debt, its re- of Commissioners gave final plete, the courthouse project Nelson company, the annual payment history, and stable approval Feb. 10 for the issu- has not been fully defined. bond payments will total economy. ance of$4,580,000 in bonds. Also, the money allocated in $386,000. Over the 16-year re- People interested in buying The funds are allocated to the bond issue for the court- payment schedule, Nelson bonds from the county bond is- $2.9 for the new sheriff annex house, opened in 1892, are not said, the average interest rate sue can contact Martin Nelson building and jail building re- enough to undertake a complete paid by the county will be 3.91 at 800-543-3332. modeling, $1 million in court- retrofit of the 100-foot clock house renovations, and a tower, which is subject to portion of the renovations stresses from high wind, let planned for the county-owned alone the complete list of other offices at the Castle Hill shop- repairs needed in the 19th-cen- ping center, tury landmark. Issuing the bonds does not The board of commissioners raise property taxes because the recently reviewed plans for the county is dedicating its real es- Castle Hill project and directed 0e excise tax revenues (a tax staff to try to reduce the cost of d on real estate sales trans- that project to about$700,000, actions) to the bond repay- some of which is to come from ments, according to county the bond issue. That building officials. houses the health department t Z— 12 03 9-0 • a cz 0.? o 4..,- ., ,,: x >,0? cab ao a �C N >•-• C C al N N r, N C� N cN cYCC C mac•' L L. y C U 2 N :..., y a.,, CG [� c N cC (13 C v� "-' M W N .`a ae E n q; y p ,a-3, `° C • 0. a Q: c4 c y j ca -4.inve Fs 4 � etp - cU oH— 2,-; 0..) 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' C ° c O C o v2 EYy o 'c • 3 yH a. c • i •0Eaa. a) c b E al , •� • CI CI) > b N to UTZ ? o y oo.a _ ' c ° ao a U 3ZbZ � i , ooa" c .78 o CO `qt., • . `'3 • c , C Wa. a • >, • Z• • fa O co '« U cC o y ( r P 1 o • Impressed with health pros Editor,Leader: • On Feb. 1,I brought a class of 45 stu- dents on a field trip to Port Townsend. All of our students have an interest in rural healthcare, and we hope the field trip will encourage them to pursue ca- reers in a rural setting.The students in the class are studying rural healthcare and they come from the schools of medi- cine,nursing,public health,social work, pharmacy and other clinical disciplines. We toured the hospital, took a driv- ing tour of the town and Fort Worden, had lunch at Point Hudson, and then walked over to City Hall for a final dis- cussion. All along the way, we heard presentations from folks who live and work in Port Townsend. I am writing this letter to publicly thank the folks in the Port Townsend and Jefferson County health system who took time out of their weekends to meet and greet our students. Katherine Baril (WSU.Extension),Teri.Camp(hospital),; Vic Dirksen:(administrator.at Jefferson' General Hospital) and Kees Kolff (mayor) planned and coordinated the • day's events.We also heard from Corey Asbell (physician assistant), David Chuljian(dentist),Julia Danskin(health department),Keri Johns(home health), Sara Katz (physician assistant intern) Fernando Lamas (physician), Wendy Nordquist (physical therapist) and Brenda Plouse(pharmacist).In addition, we met other folks in the hospital whom we came upon during our tour. Our hosts told us about their work in Port Townsend.The students were very impressed with the enthusiasm of the staff and scope of services that are avail- able in the county. Our students, like most Americans,tend to greatly under- estimate rural health systems, and it is always instructive for them to see the broad array of services that you have in Port Townsend. I hope all the citizens of the area ap- preciate,as I do,how fortunate you are to have such well-trained and dedicated health professionals serving you. We learned a lot in your town, and we appreciate all the arrangements that were made for us.The great weather and • the wooden boat regatta were particu- larly nice touches. PE 1`ER J. HOUSE clinical associate professor University of Washington a - 1 1 _d 3 4,,Port Townsend&Jefferson County Leader Doctor: Alcohol overdose •remains apossibility By Janet Huck The public health doctor said Deputy Prosecutor Jill Landes, Leader Staff Writer "Even if you fall it was difficult to calculate how the coroner called to the scene of much liquor it would take to raise Luther's death. "Alcohol is not There are dozens of ways you asleep' you're the blood alcohol level to 0.5 water with something added to can die of acute alcohol toxicity. because people absorb and me- it. It's a drug. It is a central ner- "Alcohol affects every part of still absorbing tabolize it differently. vous system depressant and it the body, so every function can alcohol into "People have died from drink- will kill you." be impaired," said Dr. Tomyouring a fifth of vodka, but others Many people think it's best to Locke, Jefferson County's pub- blood so your do it regularly,"said Locke."But , allow someone who is acutely lic health doctor. ' the bigger you are,the more body intoxicated to just sleep it off."It People with a blood alcohol blood-alcohol and muscle mass you have, the can be a fatal assumption.There level of 0.5 can die from a heartfaster you bum alcohol." is such a thing as an alcohol over- attack or from pulmonary edema, content will "I don't think teenagers rec- dose,"said Locke. in which the lungs fill up with » ognize the dangers of alcohol "If someone passes out and *liquid.A person is legally drunk increase. poisoning,"said Linda Pfafman, you can't rouse them, that's an- at 0.08. A blood level of 0.5 is Jefferson County Sheriff's De- other indication you need to find six times the level of the legal Conner Daily partment traffic safety officer. medical attention,"said Pfafman. limit.The primary life-threaten- deputy chief "They don't understand how Deputy Chief Conner Daily of ingeffect of acute alcohol toxic- Port Townsend Police quickly alcohol poisoning can the Port Townsend Police De- ity is a suppression of the central Department occur.People who aren't experi- partment said teens believe they nervous system. Alcohol, like enced drinkers don't have the can simply stop drinking and the other depressants,suppresses or ability to process large quantities effects will also immediately reduces brain activity.One of the breathing."If he stopped breath- of alcohol." stop. most critical activities directed ing, it wouldn't leave any clues On Feb.5,Pfafman's program "The danger is,kids don't un- by the brain is breathing. in the body,so they would need hosted a"Handing Over the Keys" derstand that your body continues "If the brain suppression gets a toxicology test"to establish the program at Port Townsend High to process the alcohol even after past a certain level,you cad stop blood alcohol level,he explained. School,where students and adults you've quite drinking,"Daily said. breathing,"said Locke. There is another significance learned how substance abuse im- "Even if you fall asleep, you're Since the post-mortem exami- of the toxicology screen, which pairs their ability to operate a mo- still absorbing alcohol into your nation of Shane Luther,who died has not yet been completed. If tor vehicle.A similar program is blood,so your blood-alcohol con- after attending a Feb.7 drinking Luther had taken a high dose of scheduled at 6:30 p.m.Thursday, tent will increase." party, didn't pinpoint the cause alcohol in interaction with other March 27 at the Chimacum High (Leader staff writers Philip L. of death,Locke suggested the 16- drugs, the combination could School commons. Watness and Patrick J. Sullivan year-old boy probably stopped also be fatal,said Locke. "Get a clue, kids," noted contributed to this story.) D S File Copy • Jefferson County Board of Health Agenda 0 & Minutes March 20, 2003 • • JEFFERSON COUNTY BOARD OF HEALTH Thursday,March 20, 2003 BOH Retreat 9:00 AM—3:00 PM Chapel—Fort Worden State Park AGENDA I. Approval of Agenda IL Approval of Minutes of Meetings of February 20,2003 III. Public Comments IV. Standards for Public Health: Accountability Standards for Local and State Health Jurisdictions • 2002 Baseline Assessment Report: Jefferson County and Washington State • Standard-specific Work Plans • 2003-2004 JHHS Strategic Plan • Next Steps Standard 1: Understanding Health Issues(Public Health Assessment) Standard 2: Protecting People from Disease(Communicable Disease Control) Standard 3: Assuring a Safe,Health Environment for People(Environmental Health) Standard 4: Prevention is Best:Promoting Healthy Living(Prevention) Standard 5: Helping People Get the Services They Need(Access to Critical Health Services) V. Lunch Presentation: Video of Gov. John Kitzhaber's presentation to the Rainier Institute Forum on 3/19/2002 on Health Care Access Challenges for Elected Officials and Health Policy Makers VI. Standard 5 -Access to Critical Health Care Services and Civic Engagement Grant: A Jefferson Health and Human Services and Jefferson General Hospital Partnership • Review of Grant Components and Timeline • Roles of Jefferson County Board of Health and Jefferson General Hospital Board of Commissioners (Joint Board Process) • Relationship of Grant to Other JHHS Activities • • VII. BOH Operational Issues and Meeting Structure 1. Board Operations, Quorum Rules,Public Comment, Quarterly Reports, Standard Updates, Field Trips, and Committee Structure 2. Legislative Update: Public Health Funding and Bills Still Active in Olympia VIII. Agenda Planning IX. Adjourn Next Meeting: April 17, 2003 2:30 PM—4:30 PM Main Conference Room Jefferson Health and Human Services • • • Board of Health Agenda Item # IV. • Standards for Public Health (you will be given a notebook at the Retreat for the Standards information) March 20, 2003 • f y • • • JEFFERSON COUNTY BOARD OF HEALTH 1 Glen Huntingford,Jefferson County Commissioner Dan Titterness,Jefferson County Commissioner Wendi Wrinkle,Jefferson County Commissioner Jill Buhler,Jefferson General Hospital Commissioner Roberta Frissell, Citizen at Large(County) Geoffrey Masci,Port Townsend City Council Sheila Westerman, Citizen at Large(City) Vice Chairman Wrinkle called the meeting to order at 2:38 PM. All Board and Staff members were present, with the exception of Chairman Geoff Masci. Commissioner Huntingford joined the meeting at 2:40 PM. APPROVAL OF AGENDA Commissioner Titterness moved to approve the Agenda as presented. Member Buhler seconded the motion, which carried by a unanimous vote. APPROVAL OF MINUTES Member Buhler moved to approve the minutes of January 16, 2003. Member Frissell seconded the motion, which carried by a unanimous vote. • PUBLIC COMMENT--None OLD BUSINESS AND INFORMATIONAL ITEMS Commissioner Wrinkle noted that the Healthy Youth Coalition is meeting this afternoon at the Tri-Area Community Center to provide the opportunity for Chimacum students to discuss the issue of the recent teen death. Member Westerman noted that there has been much publicity in the newspaper about the awarding of the recycling contract. The newspapers have not reported on the letter from the Developmental Disabilities Board to the Commissioners in support of awarding the recycling contract to Skookum. NEW BUSINESS Community Health Assessment Update (corrected handouts of agenda packet report): Dr. Chris Hale provided background of data previously reported to the Board: in 1990, the 1990 US Census and school survey data; in January 2001, 20 years of birth-related health indicators and mortality rates and preliminary short-form US Census data; and in March 2002, the Behavioral Risk Factor Survey data. She then prefaced her presentation of the 2000 long-form Census, by noting that a somewhat longer report looking at socio-demographic data would be offered at a community meeting tentatively planned for May 13th. The survey primarily focused on six areas: Port Townsend, Port Hadlock/Irondale,Port Ludlow, Marrowstone Island, Brinnon and Quilcene. She noted that only fragmentary information is available for the West End. This assessment was guided by Healthy People 2010, an ongoing international effort to improve health of communities, targeted at improving the number of years people live and the quality of those years and at reducing disparities. It is unlikely that life expectancy in Jefferson County can • go much higher,having nearly reached the biological limits. Quality of life conclusions can be drawn from Behavioral Risk Factor Data and other data. She believes the reduction of disparities is where the community would be focusing its efforts. The report focuses on two classes of disparity: differences in age composition(which will drive differences in the demand for health care) and differences in poverty. In reviewing the data in each of the report's, she offered the following comments: 1. Jefferson County's Population is significantly older than Washington State. Jefferson County's percentage of people 65 and over is nearly twice that of the State (21.5% compared with 11.2%). The implications of this are enormous because half of all health care expenditures are consumed by this group. As a result, any constraint at the national level in Medicare or other programs that benefit older people will hit this community twice as hard as it hits Washington State. The 85+ segment which is nearly twice what it is in the State, has been growing dramatically since about 1990 and is the most expensive to care for due to healthcare costs and the assistance they need if they stay in their own homes. Other analyses indicate that this is almost solely in-migration. 2. Age composition of places within the County are different. The major factors in changes over the last 20 years are: 1) in-migration of 40-50 year olds and 85+, 2) normal aging of existing residents, and 3) low birth rate. She noted that Port Townsend, Port Hadlock and Quilcene look similar to the County overall,whereas Marrowstone, Brinnon and Port Ludlow look similar to each other,but different from the County. The vastly different age • composition within each of the six communities would argue for different kinds of programs. She then reviewed the map in the back of the report,which overlays the Census Bureau delineation of these community populations with the postal zip code boundaries. These differences are important when considering socio-economic information. Dr. Hale talked further about census tracts and noted that Cape George, Kala Point and Shine were not represented. In summary, she noted that Jefferson County, with a median age of about 43, is old, even compared to the State figures. There are big differences in age composition among the communities, with the highest percentage of kids living in Port Townsend, Port Hadlock/Irondale and Quilcene. 3 Poverty rates in Jefferson County in 1999 were generally higher than in the state,but rates varied from place to place within the County. She pointed out that while Jefferson County's Median Household Income (MHI)in 1999 was $37,869, the data from Port Ludlow,representing 10% of the total households and whose MHI is nearly$57K, distorts upward the County's figure. For the past two decades, Jefferson County's MHI has remained at about 80% of the state average. Looking at those below 100% of the Federal Poverty Level, the County rate is 11.3%, which is higher than the State rate. However, when excluding Port Ludlow (1.2%), Marrowstone(4%), and Brinnon(13.8%), other communities reflect a higher poverty rate than the State. It was noted that of the 593 people shown as below poverty in the West End, over 300 are on the Hoh Reservation and some might also be in Queets. • 4. The universe of people in poverty consists of three segments: children younger than 18 and couple their parentshouseholds. The or guardians,people age 18-64, and people age 65+. Nearly one quarter of the 2900 people in the county who qualify as having incomes below poverty are children and female heads of household, with no spouse present. Nearly one in five are kids in married • next largest group is people 18-64 living in non-family households with no children under 18. Together, these groups account for 3/4 of all the people in poverty in Jefferson County. The other groups that account for the remainder are family households— 18-64 with no children under 18, and two groups of people 65+. 5. Poverty rates among children are higher in Jefferson County than in Washington State, and rates differ sharply by place. One in six children younger than 18 in Jefferson County lives below poverty. This compares with the national rate of one in four. Dr. Hale said that two confounders in looking at this data are housing costs and the rates of disability in those 65 and older, which may be a better indicator of program need than their income. The concept of poverty in rural communities is different. Even though incomes in a certain area may be lower,program utilization is also lower. People do not necessarily think of themselves as poor. Commissioner Huntingford noted that at one point there was school information that showed the number of children in the Brinnon School that are actually living with grandparents. 6. Jefferson County mothers are significantly more likely to be unmarried and to have their pregnancies and deliveries paid for by Medicaid than in the State. Medicaid pays for 55% of the births in Jefferson County as opposed to 36% statewide. Dr. Hale said she is concerned about the dependence in this County on Medicaid as a payment source for deliveries. 7. Adults in Jefferson County households that included children younger than 18 reported • higher rates of health risk behaviors than did adults in households that did not include children. 8. Poverty rates are higher among people age 18-34 and may be associated with the lack of advanced education. Jefferson County's poverty rate in this age group is about 18%, compared with 14% in the State. There again is a lot of variability by place, with 0% on Marrowstone and 6.5% in Port Ludlow, whereas in the rest of the county it is about one in four or five, except in the West End, where it is over half. To look more closely at the poverty rates, they split the population into two groups: 18-24 and 25-34. Of the 18-24, about 1/3 have not completed high school or have a GED (compared to the State's 1/4), another 1/3 have completed high school or GED, and another 1/3 have some post secondary education. She believes there is a huge potential to improve the educational attainment, such as with mentoring programs (youth 14+with an adult to help in transition to adulthood). 9. People age 18-34 have lower rates of healthcare access and higher rates of risk behaviors than the adult population as a whole. Dr. Hale noted the rates of access to healthcare are lower in the County than they are in the State for this group. 10. Poverty rates in Jefferson County among people 65-74 are lower than they are in the State (2.3%vs. 6.5%). However, the poverty rate among people 75+in the County is higher than in the State (10.6% vs. 8.6%). She noted that on Marrowstone, out of 152 people, 10.5% are below the poverty level—the highest rate in the County. She believes we are seeing • people with relatively low incomes but who may be sitting on valuable property, and may qualify for the property tax exemption program. 11. Healthcare access indicators are better among people age 65+ than the County average, but this group has significant health risk behaviors. This does not answer other access-related questions such as how far they have to travel,what is excluded, etc. This group is more likely to be overweight and less likely to be physically active, but is less likely to smoke. It is most surprising that there is no difference in the alcohol consumption rates among people 65+ and other adults in this county. The State alcohol consumption rate is a little over 60% for all adults and 46% for those 65+. Member Frissell asked whether the Census asks question about prescription coverage,which Dr. Hale said it does not. 12. Poverty rates in Jefferson County probably underestimate need because they are based on an assumption that 1/3 of income is for housing, 1/3 for food, and 1/3 is for everything else.Dr. Hale, in considering the median house price relative to median income, pointed out the"affordability gap," (the difference between the price of a house people could afford based on median income and the actual price of the average or median house in the county.) The Census data on annual income spent on housing revealed that one in five spend more than 35% of their income on housing,which is about the same as the State. However, in Port Hadlock/Irondale, one in four spend more than 35% on housing. Statewide, about 1/3 of all renters are spending more than 35+% of their income on housing,but in the County this is roughly 40%, although no one in Port Ludlow or Marrowstone falls into this category. Not represented are those who spend more than 50% of their income on housing. Housing prices are the most likely to affect the younger segment of the population. Poverty rates are really not a measure of program need. 13. Disability rates for County residents (male and female) age 65-74 and men 75+ are lower than they are in the State. In women age 75+, the disability rates are higher. However, • if you look at the population of people 65+, one third have some significant disability. The combination of disability and poverty rates points to a need for increased publicly funded services among people age 65 and older. Dr. Hale noted the Health Department will be issuing a detailed report on disabilities. There is relatively little difference in disability rates place by place. Jean Baldwin noted that the Data Steering Committee,with its various representatives from the hospital, City Council,Health Department, O3A, OlyCap, WSU, law enforcement, and citizens, has been working for two and a half years. This group has discussed making the data available to the public, community and policy makers by creating a book and a compact disc. They also plan to hold a summit on May 13 to present the data and indicators to senior managers and community leaders and to confirm whether we want to track them for the next 15-20 years. They are uncertain what policymakers need to know in order to support program providers and change or improve services. She also solicited recommendations on who else needs to attend the summit. Member Westerman spoke of the specific need for policymakers to attend the summit. She would like to find a way for summit attendees to focus on the big picture and not just advocate their specific interests. Member Frissell said she believes managers need to receive the information. Dr. Hale noted that Jefferson is the first County to have completed this type of detailed analysis. Clallam and Kitsap are doing identical analysis,in part because of their sense that their demands 411 look similar and because of their desire for a more regional approach. Dr. Locke also spoke of the need for a coordinated process to address these `multi jurisdictional problems."These are not city and county-based problems, but are national problems and are not solvable by local government alone. • Member Buhler said we might not realize the value of this information until specific needs arise, adding that the data will have to be indexed and accessible so that the desired information can be found. Bringing different interests together at a summit provides an opportunity for collaboration. There was Board support for holding a May summit. Legal Opinion Regarding O&M Inspections on Private Property: Larry Fay reported that after the last Board meeting, he and Dr. Locke drafted a memorandum to Deputy Prosecuting Attorney David Alvarez with the five key questions from Mr. Belinski. Deputy Prosecutor Alvarez said that his written opinion addressed the current regulatory scheme, Mr. Belinski's objections, the general rules that apply to search and seizure, and Washington State's protection of privacy as compared to federal courts. He believes the WAC sections related to Operation and Maintenance supports conditioning an on-site sewage permit on third party monitoring and allows requiring someone who obtains an on-site sewage permit to sign an operation and maintenance contract. Mr. Alvarez believes Mr. Belinksi is correct about the Fourth Amendment issues raised. There is either consent to access the property or a warrant is issued. He noted that there is a state statute (70.118.130) but it only applies in very limited situations. Particularized evidence would be • needed to get on the property. The Board is also faced with what he called a substantial quandary because while there is an obligation to monitor, a person with private property can refuse entry to the person doing the inspecting. That is where Bill 5108 comes into play, which he hopes would create an exception to the trespassing statute for people enforcing a permit. He said the Board might want to support this bill, which recognizes there are certain times when criminal trespassing should not pertain to the obligation to go on the property and fulfill a public duty. He then reviewed what changes Thurston County has made regarding the enforcement regulations for residential on-site sewage systems. He noted that there are points of view, statutes and aspects of constitutional law that conflict with the WACs as well as public policy that conflicts with the Fourth Amendment. He said he hoped to highlight the issue, answer the Board's questions and confirm that Mr. Belinski has been heard. Mr. Fay reviewed this issue with the adoption of the On-Site Sewage Ordinance in 2002. The Board has followed a set of State directives and regulations, but the County is not in a position to compel someone to let us onto his/her private property. Commissioner Titterness stated that Jefferson County's ordinance, adopted per the WAC, is probably not consistent with the Constitution of either the U.S. or the State of Washington. He then inquired whether to ask for a court decision on this matter? Member Westerman noted that the memorandum states that you can also surrender part of your Fourth Amendment rights in exchange for a privilege. She argued that the privilege of receiving a permit for an on-site septic system, which comes with the requirement that it be monitored, is similar to the privilege of obtaining a driver's license and consenting to undergo a breath or blood alcohol content test if requested while under arrest. Mr. Alvarez said he does not believe anyone has ever used this analogy to argue his or her point in a Washington court. Mr. Fay said the ordinance states if you have an on-site sewage permit, you are subject to being • on an inspection schedule. Mr. Belinski said there has to be probable cause to entangle someone and invade his or her privacy. While the County may be mandated to enforce public safety, the WACs as written begin to infringe on people's rights. There is nothing in the WAC that says you have to access someone's property. He said WACs are rules and the RCW is the law and neither one can step on your constitutional rights. Mr. Alvarez noted that a WAC also goes through a rule-making process and does have the effect of law, albeit a lesser level than the state statute or federal constitution. Commissioner Huntingford said he is interested in what Thurston County is doing. He asked Dr. Locke about a similar bill that failed before the legislature two to three years ago? Mr. Fay noted that in the early 90s Thurston County adopted an ordinance requiring both installation and operational permits for on-site sewage systems,permits that are renewable on some frequency depending on the complexity of the system. Before it could be renewed, they provide proof of passing an inspection by a qualified person. Rather than mandating an inspection frequency, they attached it to a permit. In practice, they have found something less than 40% compliance on renewals and they are largely not enforcing it. Mr. Alvarez said he understands Thurston County has changed their structure for regulating and would suggest Mr. Fay talk with his counterpart in Thurston County about their regulations. Mr. Fay,being on the State Board of Health's Rule Development Committee, is currently involved in • updating the on-site sewage code. Among the members of this committee, there is strong interest in prescriptive state standards on operation and maintenance. He will be sharing with them Mr. Alvarez's opinion,because it has significant influence on the policy direction for the State. Dr. Locke noted that while there was an administrative search bill that failed four to five years ago,he believes three to four years ago another one passed(RCW 70.118.030),which is very specific and says you have to prove that freshwater or marine water contamination is at risk. Commissioner Huntingford said it appears that without permission to access property, you have to prove just cause. Instead of trying to monitor every system in the County, encourage people to talk to the County when they have a problem and provide access to the Revolving Loan fund for help. Member Westerman, referring to the Gaikowski situation, said that while most people do not want to pollute the environment,there needs to be a mechanism for addressing these situations. Commissioner Huntingford stated that a mandatory inspection on a regular basis is different than a visible health problem,which the County should have the authority to fix. Mr. Belinski cited a case where the City of Seattle police were pulling drivers over and checking them for intoxication. This practice eventually went to court and was ruled unconstitutional. Neighbors can fabricate conditions on which the government would base its just cause. If a septic system fails, it is known 300 feet away. He believes there should be some proof of a hazard before you can invade his privacy. Mr. Alvarez said the Board should discuss whether there could be off-site monitoring. Mr. Belinski pointed out that the smell test helps and he also noted that a person who has a huge monetary investment in their system is unlikely to let it collapse. Mr. Fay recommended reviewing the Operation and Maintenance program with the basic operating principle remaining, which is that the homeowner is responsible for the system. We could also retain the program around authorizing certified people to work on systems at the homeowner's request. He noted there is interest across the state and county in operation and maintenance systems. He said onsite sewage systems have become increasingly complex because we are relying on technology rather than the site to provide treatment, with the tradeoff being that more systems can now be placed on marginal sites that would not have been permitted 10-20 years ago. We have recognized that with these systems, operation and maintenance is necessary to keep them functioning properly over the long run. If they fail, there would be environmental degradation, public health threat and impacts to shellfish, etc. With the objective of operation and maintenance being the prevention of failures, maybe the focus of the ordinance should be on failed systems and having tools in place to correct failures, with the policy goal of working with individuals to the extent possible to get problems corrected. It may be that the only way to get proper operation and maintenance in Washington State is to increase outreach and education around the consequences of failures. Not wait until there is a public health threat or shellfish problem in order to deal with failed septic systems. He noted that over the years, the strong prevention program has resulted in several shellfish upgrades. Member Frissell said if the County was to back down from monitoring, she would less likely vote in favor of exemptions. To protect public health, she might vote against making exceptions if no one is going to look at the system after installation. IPMember Buhler said a remodel, building permit, or sale of the property could trigger an inspection of the system. In response to a question whether the County can ignore the Washington Administrative Code for monitoring, Mr. Alvarez said the County could allocate resources as they see fit. Dr. Locke said the requirement to have an operation and maintenance agreement is sound, but what is not allowed is an involuntary search of the property. Since the County is not in the business of coercive searches, the requirement to do operation and maintenance agreements stands, but the homeowner has the ability to refuse access. The consequence may be that their system would fail and they would have to bear the expense. The Board recessed into Executive Session at 4:35 PM and came back into open session at 5:07 PM. Given the discussion with Mr. Alvarez and considering the issues raised by Mr. Belinski, Mr. Fay recommended the Board take three administrative steps to resolve the problem: 1) Modify a condition of the permit dealing with the contracts to include some language that recognizes people's constitutional right; 2) Incorporate similar language in the PUD's contract recognizing peoples' right to deny access, and 3) Create a written consent form for these inspections. Member Westerman moved to approve Staff's recommendation. Commissioner Huntingford seconded the motion,which carried by a unanimous vote. ACTIVITY UPDATE—None AGENDA PLANNING 40 It was noted that the Board of 2ealth Retreat Fort Worden from 9:00--3100. Drt Lockeld in leu of he Board's reported that Meeting on Thursday, March 20, 003 at accountability standards for local dPpUDllseatonthe Board. Other retreat topics were Intents would presentedat the along wwith bylaws information and a possible solicited. NEXT MEETING The meeting adjourned at 5:09 p.m. The next Regular Meeting will be held on Thursday, April 17 at 2:30 p.m. at the Jefferson County Health and Human Services Conference Room. Geoffrey Masci, Chairman Jill Buhler, Member Wendi H. Wrinkle, Vice-Chairman Sheila Westerman,Member Glen Huntingford, Member Roberta Frissell,Member • Dan Titterness, Member aç STATF,0 _2,,..,;.:.:. ?/:':11889 H") 0 STATE OF WASHINGTON ?14-1--1.---1 . DEPARTMENT OF HEALTH RECEIVED Olympia, Washington 98504 Oc^ G li 2 2002 November 27, 2002 Jefferson county Health&Human mces Dear Local Health Official: Thank you for participating in the first ever Baseline Assessment of the Standards for Public Health in Washington. Your work in preparing and participating in this process is an important contribution to the improvement of the Public Health System for our State. Your site review report and the overall aggregate report prepared by the consultants (MCPP) are attached. Also included is a communication toolkit that can be used to talk about this work. The toolkit includes a letter you can share with Board of Health members and Commissioners if you choose. It will not be mailed to them directly. If you have questions about this packet,please call,Joan Brewster at(360) 236- 4062. Please remind everyone that this is a baseline study. It is not a test to pass or fail. It is a framework that we can use to shape the future and demonstrate improvements over time. The Standards Committee recommends that we plan on re-measuring in about three years. • We suggest that you take time with your staff to read and digest the report. We encourage you to prepare a work plan to address the areas where your agency could make improvements, or to identify where you might benefit from teaming up with others. Looking at the key management practices described in the report may also provide a helpful cross-agency perspective. The Standards Committee will be requesting input in the Spring about issues that could benefit from system-wide improvements. At that time we will be looking for overarching issues where our partnership could bring the whole system to an improved level of performance. Thank you again for your hard work in this effort. We know it will make an important difference in the future. Yours truly, C\ Jean Baldwin, President Washington State Association of Local Public Health Officials 1141( Ae /14/ 0 Mary Selecky, Secretary Washington State Department of Health STAT titte:4;t1 '� :Beva • STATE OF WASHINGTON DEPARTMENT OF HEALTH Olympia, Washington 98504 November 27, 2002 Dear Commissioner or Board of Health member: Washington State is a national leader in public health. One reason for this is the close and continuing partnership between the state Department of Health and our state's 34 local public health jurisdictions. Our work to establish performance standards for public health is one example of how we have combined efforts to improve our ability to protect the health of the people of Washington State. You may have seen this work, summarized in a booklet, Standards for Public Health in Washington State. If not, your local health director will have a copy and can tell you more about this work. In July 2002, we received a national award for this work from the National Association of City and County Health Officials and the Association of State and Territorial Health Officials. The 1993 Health Services Act called for us to set standards for public health; this was reinforced in 1995 legislation and, in both cases, was linked to additional funding for public health. Our approach has been to develop standards in a state-local partnership, because that is how the public health system in our state operates every day. We recently finished a major step in the process of adopting and using performance measurement. A baseline study was conducted, measuring our ability to meet the standards we had jointly developed. This step was taken following a multi-year process of development, revision, and field-testing. The baseline study was carried out by independent consultants and included every local health jurisdiction, plus 38 program offices within the Washington State Department of Health. We are currently distributing the findings of the baseline study to local health jurisdictions and state programs. As expected, we found areas of strength and areas where we can make improvements. Many of the Standards are considered "stretch" standards—describing performance at a level that is desirable, but would require time and resources to achieve. Some of the Standards can be met more easily, with focused effort or increased partnerships. We view these results as a "baseline"—a picture of where we are today. This is not a test to pass or fail, but a framework for shaping our future. Over the months ahead, we will be using the baseline study findings to look at how we can improve our performance as a state-local government system. • ,e 0 Public Health Standards Baseline Evaluation Report • November 27, 2002 Page 2 This is a critical time for the public health system. We are working hard to improve preparedness so that every community has strong public health protection. We encourage you to support your local health department or district in efforts they make to use the Standards for Public Health in Washington. Sincerely, Ajt)/C Mary Selecky, Secretary Washington State Department of Health Jean Baldwin, President Washington State Association of Local Public Health Officials • • PUBLIC HEALTH • ALWAYS WORKING FOR A SAFER AND HEALTHIER WASHINGTON FACT SHEET The public health network in Washington State Public health agencies in Washington provide critical programs and services for all people in the state—from drinking water protection to disease prevention. The public health network coordinates at the local, statewide and national level to keep our communities healthy and safe. The work of public health includes: • Essential programs for improving health: Programs such as immunizations, communicable disease prevention, and chronic disease and injury prevention help individuals and communities stay healthy. • Information that works: Resources such as educational and training programs, community health reports and statewide health and safety information provide individuals . and communities information they can use to make good decisions. • • Protecting you and your family every day: Services such as drinking water and air quality monitoring, septic system inspections, restaurant inspections, disease prevention and planned community crisis response ensure individual and community health and safety. Washington State Public Health Partners Northwest Center for Public Health Practice, University of Washington Washington State Association of Local Public Health Officials Washington State Board of Health Washington State Department of Health • PUBLIC HEALTH ALWAYS WORKING FOR A SAFER AND HEALTHIER WASHINGTON FACT SHEET Washington State Standards for Public Health Doing a good job How do we know we are doing a good job in public health? The Public Health Standards for Washington were developed to answer this question. They were developed by a collaboration of state and local public health workers, the State Board of Health and the University of Washington over five years, field tested in 1999, and published in 2000. The standards cover the major areas of public health: communicable disease prevention, assessment of health issues, health promotion and prevention, environmental health, and access to health care using a list of critical health care issues. Within each topic area, the standards identify the work that meets the goal of"what every citizen has a right to expect" from their public health system. Measurable goals A goal for 2002 was to measure the ability of the public health system at the state and local levels to meet the standards. This baseline measurement study was conducted June through September, with results available in December. Thirty-eight areas of the Department of Health (DOH) and every local health jurisdiction (LHJ) were visited by MCPP Healthcare Consulting Inc., the firm that the Standards Committee recommended to conduct the study. Training sessions were held in May and June for DOH and LHJ staff to prepare for the study. The study identified areas of exemplary practices and areas where services or programs do not meet standards. The results help identify areas that need improvement and articulate achievements of the entire public health system. Self-assessment Before the site visit, each agency was asked to complete a self-assessment that lists standards and their measures, and to organize documentation supporting each measure. During the site visit the contractors looked at documentation for each standard to rate whether the documents demonstrated the standard was being met. Each agency that was visited will receive a report of their results. In addition the consultants have collected "best practice"documents that will be posted to the DOH Web site for agencies to use to help them meet the standards in the future. The standards were written to identify a higher level of performance than what currently exists and it is expected that the public health agencies in this state will work towards meeting the standards in the years to come. KEY FINDINGS AND RECOMMENDATIONS • Washington State Standards for Public Health Evaluation process • All 34 local health jurisdictions were reviewed • All local health jurisdictions were reviewed for 98 measures • Local health jurisdictions were grouped in peer rankings for reporting analysis o Small town/rural — 11 o Mixed rural —5 o Large town — 7 o Urban — l I Baseline evaluation findings • Strengths: o Public information o Community involvement o Public health assessment o Managing communicable disease issues • Needs: o Environmental health education planning • o Risk communication o Emergency response o Access to critical health services What was learned? • There is a need to increase consistency across the system. • There is a positive connection between size of budget and/or number of employees and performance on about 25 percent of the measures. • In many cases, additional resources would be needed for a program or health department to meet the standards. • The dilemma for most sites is that "doing" the work takes precedence over documenting the work. Standards and measures focus not only on doing the work but also on quality improvement steps: planning, implementation, and evaluation. Washington State Public Health Partners Northwest Center for Public Health Practice, University of Washington Washington State Association of Local Public Health Officials Washington State Board of Health Washington State Department of Health • PUBLIC HEALTH ALWAYS WORKING FOR A SAFER AND • HEALTHIER WASHINGTON Questions and Answers Washington State Standards for Public Health How will the Standards for Public Health be used? These standards are a public health management tool. They are for anyone in the governmental public health system to use. They articulate the role of each partner in the public health system. These standards will be used to assess the overall public health system. Over time, the standards will help identify needs to strengthen the public health system. The first public health standards survey was conducted in mid-2002. What will happen next? Reports will be generated in late 2002 and distributed to sites that participated in the baseline survey. These will include reports for individual sites and for the entire public health system. Each agency is responsible for distributing its report to use for organizational planning. How will the standards help individual agencies? The baseline measurement shows where public health is in 2002. It will help public health organizations in our state prioritize and plan for the future. Many programs do not currently have the resources needed to meet the public health standards. Where agencies cannot meet the standards,analysis will be initiated • to explore the reasons why. Sometimes standards can be met by changing priorities. Other times, it would take more resources to meet a standard. This analysis will help focus efforts. The initial survey provides a baseline. Areas of improvement can be targeted based on what's learned from the first study. Who did the baseline survey? An independent firm, MCPP Healthcare Consulting Inc., conducted the baseline survey. The Standards Committee advised the consultants and reviewed the study tool and format for the reports. MCPP also conducted training sessions for local and state public health staff to prepare for the site visits. Why are these standards important? Public health is a broad, diverse field that relies on expertise from many different disciplines to protect the public. It's vital to our communities and quality of life, yet it's very hard to summarize and measure. Five topic areas describe the purpose of public health: I) Understanding health issues: standards for public health assessment, 2)Protecting people from disease: standards for communicable disease and other health risks, 3)Assuring a safe, healthy environment for people: standards for assuring a safe, healthy environment, 4) Prevention is best/promoting healthy living: standards for prevention and community health promotion,5) Helping people get the services they need: standards for access to critical health services. What gets measured gets done. The measures particularly focus on quality improvement and management practices. The periodic surveys will track improvements in public health and help public health professionals to be accountable to communities, policy makers, and their profession. Public health work is too important to ignore. It is difficult to fix problems without measuring performance of . standards. How do these compare with program standards? The Standards for Public Health focus on the overall system, which includes local and state health departments, along with universities and the State Board of Health. In some cases, it includes other partners that deliver services locally, or state agencies that deliver or pay for services. Program standards remain very important. Both program standards and system standards are needed. The public health system is a network of professionals with expertise, a combination of specific programs, a range of laws and ordinances, and a set of values that protect and improve the health of people. It is bigger than any one program, and a systematic look at public health can help point out where future efforts are needed. Are these final? Yes and no. These are the standards used for the baseline measurement. Certainly what was learned through this survey will be applied to make changes to the standards. Some standards will be added, deleted, or changed accordingly. S Washington State Public Health Partners Northwest Center for Public Health Practice, University of Washington Washington State Association of Local Public Health Officials Washington State Board of Health Washington State Department of Health i PUBLIC HEALTH ALWAYS WORKING FOR A SAFER AND • HEALTHIER WASHINGTON TALKING POINTS Washington State Standards for Public Health • The public health system in our state helps protect you and your family every day. These standards are helping us find the gaps and address them so we can get better at what we do. • Our public health system is made up of local, state and federal agencies. Together, this network provides essential services for improving health in Washington state. • These standards help us take a critical look at public health performance to identify where we are now and what we need to do to improve. • The standards are designed to measure current practices, discover gaps, and help us find a way to improve public health in our state. • The standards survey has resulted in a library of "exemplary practices." This information - • successes around public health standards work — will be shared online, allowing health agencies in our state to learn from the good work of others. This resource will allow us to save time and effort, while improving the system. • The standards baseline measurement was taken over the past six months. We know some improvements are already being made. During the survey process, some agencies and programs found gaps they were able to address right away and make their systems stronger. • The standards survey has given public health agencies in Washington away to step back from everyday work, and look at the bigger picture. We are using what we learn to identify areas that need work, set priorities and improve the quality of public health in our state. • These analyses of the initial results are just beginning. This is a snapshot of public health at the time the survey was taken. We plan to measure public health on a regular basis to make sure we are moving in the right direction and making progress. Washington State Public Health Partners • Northwest Center for Public Health Practice, University of Washington Washington State Association of Local Public Health Officials Washington State Board of Health Washington State Department of Health Standards for Public Health in Washington State Page 1 of 20 A Waingten i SG r Drat of . 0 Health . , , , . i .V t . - - You are here: DOH Home » Standards for Public Health Search I Employees Site Directory: • Newsroom Some files on this page require free readers. Download a reader. • About DOH • Programs a* Services Standards for Public Health in Washington • DOH Web 1A-Z) State • Alternative File Format A Collaborative Effort by State and Local Health Officials Information June, 2001 • 2000 PHIP Contents • 2000 PHIP - Summary Background - _ Stashitl Irp 46, Understanding health issues • Protecting people from disease Assuring a safe, healthy environment for people Prevention is best: promoting healthy living Helping people get the services they need Background: Standards for Public Health in Washington State People depend on the governmental public health system to respond to public health threats and to prevent costly health problems that cause illness or death. Every resident and visitor, throughout the state, should be assured that the public health system is working to protect their health at all times. Standards for Public Health in Washington State provides a common, consistent and accountable approach to assuring that basic health protection is in place. Standards for Public Health in Washington State was developed in a collaborative process involving more than 100 public health professionals who work at state and local health departments. They shared their scientific knowledge and practical experience to define standards for the governmental public health system. The importance of standards 0 Common standards provide a clear and accountable measure of performance for public health agencies—a level of protection citizens can count on. Setting standards for public health will help us identify what we need to do to strengthen public health protection and will also let us measure improvements in the effectiveness of the public health system. State laws require that we set basic standards for public health as a part of the biennial Standards for Public Health in Washington State Page 2 of 20 Public Health Improvement Plan, a process designed to strengthen the public health system in order to improve the health of people. (See: RCW 43.70.520 and RCW 43.70.580) • Complementary roles for state and local government In Washington State, responsibility for public health protection is shared among the Washington State Department of Health, the State Board of Health, and 34 local government public health jurisdictions with local boards of health. Local and state agencies perform different tasks. They have unique, but complementary, roles and they rely on one another to make the public health system work. The standards recognize that state and local responsibilities are different.A single standard is proposed for the public health system, with separate state and local measures that demonstrate whether a standard is met. All residents depend on this strong partnership between state and local government. This set of standards was purposely limited to the responsibilities of state and local government. The contributions of non-government health providers and community- based organizations are essential, but they are separate from the specific accountability expected of government agencies. A common sense framework addressing five key areas The standards cover five key aspects of public health, selected because they represent basic protection that should be in place everywhere: o Understanding health issues • o Protecting people from disease o Assuring a safe and healthy environment for people o Promoting healthy living o Helping people get the services they need. In developing standards, the guiding principles were: define what is basic, use clear language, describe what every jurisdiction should be able to do regardless of size or location, incorporate the ideas of nationally described core functions and essential services of public health, and support the standards with a few carefully selected measures that demonstrate whether the standards have been met. The standards focus on the capacity of our public health agencies to perform certain functions, and not on specific health issues. A public health system that is well organized, meeting a common set of basic standards and adopting best practices, is better prepared to help bring about improvements in health. In a separate effort, we are developing a list of leading health indicators that will help answer the questions: How healthy are we?What are our significant health problems?Who is most affected? Indicators were separated from standards because of the belief that it is important to focus on both health trends and the level of performance in the public health system. The standards are not intended to substitute for the complex body of public health law, multiple regulations and individual county ordinances that have developed over time. The laws and regulations are vitally important to public health protection, but each is intended to address very specific issues. Standards for Public Health in Washington State provides a framework to assess how well our governmental public health system is working, overall; existing laws and regulations fit very well within that framework. Field test results The standards were field-tested in summer 2000 with on-site visits to every local health jurisdiction and many state health department programs. The purpose of the field test was to determine how well the standards and measures worked for evaluation. The standards and measures held up very well in testing and some additional measures Standards for Public Health in Washington State: • Baseline Evaluation Report Local Health Jurisdictions Report for: Jefferson County Health & Human Services Department The Standards and the Baseline Evaluation Thank you for participating in the baseline evaluation of the Standards for Public Health in Washington State. The Standards were developed through a collaborative effort between state and local health officials. The intent of the Standards is to provide an overarching framework for the many and very specific services, programs, legislation and state and local administrative codes that affect public health. The Standards exemplify the national goals for public health performance measurement and development of standards—quality improvement, accountability, and science. Points to remember when looking at the reports include: • The Standards articulate a higher level of performance, often described as stretch standards, not a description of the system as it is performing currently. • The Standards reflect an improvement cycle; results of the baseline evaluation should be used to target areas for improvement. • The Baseline Evaluation Approach The baseline evaluation included all 34 local health jurisdictions (LHJs) in the state and 38 Department of Health (DOH) program sites selected by the DOH for evaluation. Each site was asked to complete a self-assessment tool and to prepare for an on-site visit by organizing the documentation supporting the self-assessment on each measure. In this baseline evaluation, each LHJ identified the program materials that would best demonstrate a measure. During the site review, an independent consultant reviewed the documentation and scored each measure. In addition, potential exemplary practice documentation was requested from each site. The on-site reviews concluded with an exit interview in which qualitative information regarding supports necessary to fully demonstrate the Standards and feedback on the Standards was obtained. All of this information has been compiled into a system-wide report, with recommendations regarding the next steps for the system. This Report The site reviews again demonstrated the incredible commitment, creativity and hard work of the people in the public health system. This report is specific to your local health jurisdiction and is intended to give you feedback about the materials you provided as a demonstration of how you met each measure. However, before describing the details that are in the report, we want to summarize overall observations regarding your organization's strengths and opportunities for improvement as observed during the site review. Standards Baseline Evaluation Report 1 • Strengths • The enhanced ability of the department to be systematic and strategic in their relationship with the BOH and in their communication to the community through the knowledge of issues and activities addressed by the BOH and shared with the community provided by the Summary Index of BOH meeting topics/attachments and the Summary Index of Health Alerts • The extensive scope of assessment activities, including Data Steering Committee, BRFSS studies, and contract with consultant and internal assessment staff to conduct assessment activities • The involvement of itr ..cranunity reflected in most of the programs managed :>i feted through the organization. • The linkages between programs and performance measures described in the 2003 Goals and Objectives, Performance Measures, and Summary of Key Findings document to enhance the department's ability to monitor program performance • The clarity of the activities and related goals for services described in the 5 year Perspective for Family Planning Services • The information about environmental health provided through the Database Permit plan reports and GIS reports for EH • The assessment data linked to specific programs and to evaluation described in the Strategic Planning and Standards Matrix- • The program to increase access to services, including work with the community, and • assessment of access activities Areas for Improvement • Implement and communicate 24 hour contact number to providers to facilitate the process for the public to communicate with the department • Implement CD protocols and written EH compliance procedures to support staff's ability to conduct consistent and high quality CD investigations and EH enforcement actions • Develop and implement audit processes for CD and EH case write-ups of investigations and enforcement actions • Close the loop of the PDCA cycle in program evaluation—data is collected, activities documented, but there often is not a clear step of stopping to review the data, evaluate what it means regarding the success of the program, and revise the program based on this assessment. This requires an organization-wide program culture in which everyone is thinking about the importance of the evaluation process as well as staff capacity focused on program evaluation • Implement and document links between audit and evaluation results and new program plans or revisions made to educational curricula • Implement process for systematically documenting training • Identify and communicate roles and responsibilities of staff for emergencies and environmental threats Standards Baseline Evaluation Report 2 • Results of the Site Review The attached report is organized to follow the Standards format. The Standards have five topic areas (please note that these are not necessarily synonymous with program areas, there are organization-wide measures to be found in each of them). Within each of these five topic areas, four to five standards are identified for the entire governmental public health system. For each standard, specific measures are described for local health jurisdictions. For LHJs, all measures were applicable; however, some (for example those that required certain actions related to an outbreak) were not applicable if an event had not occurred. This report provides you with the following information: • For each measure (we have not repeated these in the report in order to reduce the number of pages, but have grouped them under their overarching standard): the score assigned by the reviewer: o 2=demonstrates the measure, o 1—partially demonstrates the measure, o 0=does not demonstrate the measure, o 8=-not applicable, o 9=not able to rate [did not participate at a topic area level] Comments provide clarification regarding the intent of the measure or the score assigned. Documents list, in abbreviated form, the documents that were the basis for the score. When multiple documents were provided, and some did not demonstrate the measure or there were • many more examples than needed, they are not all listed. Exemplary documents lists documents requested for review as potential examples in the exemplary practices tool kit. • For each topic area: at the end of each topic area, there is a roll-up of the scores on all applicable, rated measures in the topic area (the percent of measures scored as demonstrates, the percent scored as partially demonstrates, the percent scored as does not demonstrate). Next to your roll-up for the topic area is a roll-up for peer counties, and then a statewide roll- up. Your peer counties are identified below, based on the DOH analysis of Dominant Rural Urban Commuting Area Codes (for detail on this methodology, see Attachment C of the overall Baseline Evaluation Report). If you are not comfortable with the peer group assigned by the methodology, Attachment C provides you with the roll up data for all peer groups. There is no intent, in an improvement-focused effort, to compare specific organizations to one another. However, this roll-up data does provide each site reviewed with performance benchmarks. • For all topic areas: the final segment of this part of the report provides you with a roll-up of all topic areas, with the same benchmark data from the peer group and statewide roll-ups. • By key management practices: the last part of the report shows your percent distributions by 411/ the eight key management practices. This enables you to spot trends across all the topic areas. Standards Baseline Evaluation Report 3 • Next Steps . First, celebrate what you have accomplished. In the two-year period between the site reviews that tested the Standards and this baseline evaluation, it was clear to the site reviewers that improvements had been developed and implemented. Again, thank you for all of your hard work every day, and especially in preparing for the site reviews. All of the information provided in this report is intended to support improvement of your organization's work on behalf of the citizens in your community and Washington State. You will be able to look at your overall strengths and areas for improvement, at specific measures or topic areas, or at key management practices. From these varying views, you can select the areas that you want to focus on improving over the next two years and develop a plan for moving forward. You will be assisted in this effort by several initiatives: • Exemplary practices: the examples of exemplary practices gathered from each of the sites will be reviewed, and the very best examples for each measure selected. These will be organized into a tool kit that you can access electronically, selecting the examples that seem to be a good fit for your organization. This material will be available in early 2003. • Model policies and procedures: the nursing directors are sponsoring an effort to build model policies and procedures from the exemplary practices. This material will be available in early 2003. • Statewide initiatives: many of you have noted that bioterrorism planning offers an opportunity to improve some areas of your work. Other projects such as PHIMS and Envision also support improvement of practice and documentation. Based on the • recommendations in the system-wide report, the PHIP process may adopt additional statewide initiatives related to the measures. After you have had a chance to digest this report and share it with staff and your Board of Health, you should review the data again to determine which areas of your work might benefit from a focused improvement process. Develop a brief,but specific and doable work plan—don't try to improve everything at once! Peer Groupings Small Mixed Rural Large Town Urban Town/Rural Adams Clallam Asotin Benton/Franklin Columbia Grays Harbor Chelan/Douglas _ Cowlitz Garfield Island Grant King Jefferson Mason Kittitas Kitsap Klickitat Skagit Lewis Pierce Lincoln Walla Walla Snohomish NE Tri-County Whitman Spokane Okanogan S W WHD Pacific Thurston San Juan Whatcom W ahkiakum Yakima *at the time of the site review, included Skamania,which is classified as mixed rural Standards Baseline Evaluation Report 4 A p 1 , t 4=, O i d O �4 ` c c6 U •p '� U9 y j' -6 co, it U C9 C 2_ ) O gj C `1 m N (6 O 00 7 E (.-?. O U)Y N 'O •L p XN C a) tD O� t9 t` 1i Q) Q) O O E 'C E N a ca N O) 8 -o O N u! 2 as O` t' C O a) p O UTCS C d z �� o) �S � 7EW � NU ctiel E U S p-U M•t E aa) N en E Y a) m U a N O O U)'CI,... 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Coa2 uE0_ a � > L U x 0 0 a) (0 O O C cn 0 0 :C O Q (0 cc) C C ” O c m m m a) LJ a_ 2 U) CL cC 10_ '> > LL ..q > U U $ U) > c6 C6 0 U) co (1) a) eL > 0. u) V4111° >, O E •E O c0 (D N u U) 2002 Performance Measure Population and Preventions Programs • For Report March 2003 New for 2002 — Raising a Healthy Community Project Abstract The Raising A Healthy Community project (Healthy Communities) responds to the community concern about the high number of families and children younger than 18 who experience multiple risks including academic failure, early initiation of drug use, early and persistent anti-social behavior, family management problems, and community norms that favor alcohol and drug use. Project TakeTime and Big Brothers/Big Sisters (BBBS) programs work with youth in grades 3-5 to enhance protective factors including pro-social involvement, attachment to school, academic success, and family cohesiveness utilizing a variety of approaches including teacher consultation, group work, and one-to-one individualized contact. Additionally, parents are supported by TakeTime staff for family management and • personal support including treatment referrals and aftercare. BBBS supports one-to- one mentoring for youth ages six through fourteen. The Healthy Youth Coalition (HYC) promotes opportunities for healthy development by promoting the use of science-based prevention in youth serving programs throughout East Jefferson County. • 2 0 0 2 Report BUDGET/PROGRAM: Population & Prevention Programs •Tobacco, School Health, Childcare health and Safety, Child Death Review, Peer-In, MISSION: The purpose of the Population Health Services & Prevention is to provide assessment, health education and public health interventions to county residents in order to prevent disease and unintentional injury, improve the quality of life and reduce disparities in health. GOALS FOR FY 2002: 1. Improve identified social and health indicators for school-age youth(S/H) 2. Improve indoor air quality for Jefferson County residents (TP/C) 3. Education services offered to all Jefferson County parents of 2-year olds 4. Enhance the quality of child care provided in Jefferson County 5. Enhance the overall health & safety of Jefferson County children(CDR) 6. Enhance the overall health of adolescents in Jefferson County (S/PIn) OBJECTIVES FOR FY 2002: 1. Increase delivery of school in-service/trainings, student health screenings, student health consults, student health care referrals (S/H) 2. Increase number of restaurants participating in smokefree campaign; number of mothers who do not smoke during pregnancy (TP/C) 3. Increase pre-school readiness by increasing reading skills in parents 4. Increase child care provider satisfaction with consultation provided to them re: health, immunizations, safety and child development 5. Active participation between child death review team and Peninsula Safe Kids Coalition 6. Peer educators will provide school health classes to middle &high school students and health educationclasses will be provided to elementary, middle &high school students RFORMANCE INDICATORS: 2001 2001 2002 2002 Plan Actual Plan Actual Number of student health screenings 2400 2562 2490 2022 Number of restaurants offering 100% Indoor Smoke Free Dining (TP/C) 60 60 60 61 Number of 2—3 year olds &their families receiving reading instruction ** ** 150 98 Number of on-site visits to Child Care Providers, consult, mentoring ** ** 80 102 and technical assistance services provided % of child death reviews conducted within 6 months after death(CDR) 100% _ 100% 100% 100% Number of Peer-In educational presentations 50 67 50 60 Number of school health classes 200 256 220 260 Percent of mothers who report not smoking during pregnancy(TP/C). 70% 86.5% 70% **New for 2002 *Vital Statistics data not available as of 3/03 SUMMARY OF KEY FUNDING/SERVICE ISSUES Prevention services are difficult to complete outcome evaluations and have the highest expectations. State prevention health services monies come with extensive evaluation components. Tobacco and Peer-In funding have community specific goals and measures that must be met to maintain funding. These programs are all universal prevention programs available to all in the community. All public health services in the five program areas contain prevention services but are not solely funded or focused on prevention and education. Update: Received Federal Grant during 2002, Raising a Health Community Project. See attached abstract. •10 March 2003 2 0 0 2 Report • BUDGET/PROGRAM: Targeted Clinical Health Services Family Planning, Breast and Cervical Health Program, and Foot Care MISSION: The purpose of the Targeted Clinical Health Services is to provide outreach, access,health education, support treatment to specific populations in Jefferson County in order to improve the health of the community. Specific program purposes are: • Family Planning: to provide reproductive health, clinics, outreach and education for Jefferson County residents in order to promote health and well-being and reduce unintended pregnancies. • Breast and Cervical Health Program: provide public education and health screening services to women age 40-64 with low incomes and no or limited health insurance in order to assure early detection and treatment of breast and cervical cancer. • Foot Care: provide foot care and health outreach to Jefferson County seniors to prevent health complications. GOALS FOR FY 2002: 1. Insure access to breast and cervical health exams to women age 40 to 65 years old. 2. Decrease unintended pregnancy rates in Jefferson County(measure)/Assure Family Planning Services are provided in every community 3. Support seniors' independence by maintaining their mobility • OBJECTIVES FOR FY 2002: 1. Track Family Planning usage patterns and produce annual report 2. Increase breast and cervical health program outreach in Jefferson County 3. Emergency contraception to be provided under standing orders, 5 days per week, and expand community education and clinical services 4. Maintain the current level of community foot care and continue expanding into home care PERFORMANCE INDICATORS: 2001 2001 2002 2002 Plan Actual Planned Actual Number of unduplicated clients served in Family Planning 1085 _ 1032 1100 1198 Number of adolescents under 19 served in Family 318 300 320 320 Planning Number of Breast & Cervical screening exams 60 56 65 93 Number of foot care contacts 2080 2872 2500 2679 SUMMARY OF KEY FUNDING/SERVICE ISSUES: JCHHS Family Planning clinical services are funded by 12 funding sources; the federal 10% and state 16%have remained flat for years. Some funding relief became available in 2001 when the Washington State and federal negotiations over Medicaid waiver was approved called"Take Charge." 10 March 2003 2002 Report BUDGET/PROGRAM: Family Support Services Program Maternal Child Health(MCH), Maternity Support Services (MSS), Best Beginnings/Nurse-Family Partnership (NFP), Maternity Case Management (MCM), Children with Special Health Care Needs, Women Infants and Children (WIC), and Women Infants and Children Breast Feeding Promotion, and the Child Protective Services Contract Programs: Alternative Response System (ARS), Early Intervention Program (EIP), and Passport. MISSION: The purpose of the Family Support Service program is to provide community assessment, education, skill building, and support to pregnant women and families with children. Services also include voluntary home visits to prenatal, post partum families, and families at risk of Child Protective Services involvement. These services are provided so county babies are born with the best opportunity to grow and thrive, the impact of health problems are minimized, and children receive the care and nurturing they need to become functional adults. GOALS FOR FY2002: 1. To assess the percentage of pregnant and parenting women receiving JCHHS services, in which depression is an issue. 2. All newborns and their families will receive screening to identify needs for Family Support Services including: intensive home-visiting, case management, lactation support, special health and child development support,nutrition education and parenting education. • 3. Increase the availability of the Family Nurse Partnership Program (Best Beginnings) for Jefferson County residents. 4. Monitor Nurse Family Partnership Program replication by tracking data on program fidelity, from data input. 5. Increase ongoing breastfeeding education and support so that all county mothers can provide their children with the physical and emotional benefits of breastfeeding. 6. Prevent nutritional related problems for pregnant women and children under five in Jefferson County. 7. Identify Children with Special Health Care Needs in Jefferson County and assist families with health and development interventions as needed. 8. Provide services and information in Jefferson County aimed at preventing Child Abuse and Neglect. OBJECTIVES FOR FY2002: 1. To offer a depression screen to all pregnant and parenting women who are participating in JCHHS programs. To provide appropriate referrals for those who have a positive screen. 2. Increase newborn screening to universal screening by to all Jefferson County families of new babies, in order to identify early intervention needs and offer services and referrals. 3. Hire a full time PHN for the JCHHS Maternal Child Health Team to provide increased intensive home-visiting, as well as WIC, immunizations, and Maternity Support Services and Case Management. 4. Send client data monthly to Nurse-Family Partnership program head office for assessment and evaluation. 1111 5. Through universal screening of newborns and their families identify those who may need referral to breastfeeding tea party or lactation consultation home-visits. 6. Provide WIC nutrition education and support to all county women and children eligible. 7. Through universal newborn screening and community outreach in the schools and other JCHHS programs children with special health and development needs will get referred for evaluation and intervention services 8. Through screening of pregnant women, families of newborns and referrals from DSHS Childrens Services identify families at risk for child abuse and neglect and offer Family Support Services. PERFORMANCE INDICATORS: 2001 2001 2002 2002 Planned Actual Planned Actual 1. Number of depression screenings completed * * 50 57 - 2. Number of newborn screened 100 120 120 136 _ 2. a) % of those screened receiving continuing 50% 50% 50% 52% Family Support Services 3. Number of Home and Office visits provided for 1700 1298 1600 1356 BB,MSS,MCM,MCH and Breastfeeding consultation 4. Yearly report from Family-Nurse Partnership ' ' * *** *** *** - 5. #of attendees of Breast Feeding Tea * * 120 180 6. % of infants in Jefferson County served by WIC * 40% 40% 59%**** 7. Number of children with special health care * 60 60 38** needs receiving Public Health Nurse intervention through JCHHS. 8. Number of families served through CPS/DSHS * 15 15 15 contract. • *new for 2001 • **based on CSHCN Child Health intake forms filled out. Actual number of children needing receiving CSHCN services higher with School Nursing contracts • *** See attached report • • **** Based on 2002 Infant Enrollment in WIC Monthly average 129, and the est. average Number of infants in Jefferson any one month based from 2000 vital statistics 217 SUMMARY OF KEY FUNDING/SERVICE ISSUES: Maternity Support Services that have been provided over the last 10 years have demonstrated the positive outcomes and cost savings from home and office visits supporting and educating pregnant women. However Maternal Child Health funds from county, the state and federal government and Maternity support service fees have been flat for many years. The child abuse referrals in Jefferson County have continued to increase over the last ten years. These rates and juvenile justice involvement are shown to decrease in communities with comprehensive prevention programs and so in 1999 we chose to begin an intensive research tested home visiting program (David Olds Nurse-Family Partnership Program—Best Beginnings) for first-time parents within Jefferson County. Depression is another problem for Jefferson County families as identified by JCHHS health indicators work and is demonstrated by the current brain research to have a huge impact on the healthy development of a child. Update 2002: JCHHS received a federal Grant to increase Nurse Family Partnership intensive home visiting program. In October 2002 JCHHS sent 2 more Public Health Nurses to be trained in the David Olds Nurse Home Visiting program. JCHHS is now providing more Home visits and less office visits • to replicate the David Olds model of Home visiting interventions. Also, the Federal Grant increased services for Newborn Follow-up to all families of newborns in Jefferson County. Standards for Public Health in Washington State Page 3 of 20 were added. The visits also yielded a collection of best practice materials that are being shared statewide so that agencies can more easily meet a standard, adapting existing work to fit their needs. • Meeting the standards will take time The next step in the process of developing standards is to conduct a baseline test. That will give us our first real documentation of how far we are from meeting the standards today. From the field test, it was learned that some standards are met now, and some will take time or resources to achieve. It is expected that some standards will be beyond our reach for some time to come. Yet, even these unmet standards will provide an important guidepost for our future and a way to measure progress as we work toward meeting them. The standards are expected to become part of the contract between the state and local agencies in the future, but we expect they will be phased in, using the results of the baseline study. The Public Health Improvement Plan Act of 1995 required that the state develop "performance-based contracts"with each local agency, based on "the core functions of public health."Our approach has been to develop the standards collaboratively with both state and local officials, and to set forth a specific timeline for meeting the standards only after we have had time to assess our capacity to meet them. Public health is everyone's concern People care about issues that affect their health. On any given day, a glance at the newspaper articles reminds us that people place high value of public health protection. Setting standards for performance of our public health system will assure that basic • protection is available to all people in Washington State. On the following pages... Standard applies to the whole governmental public health system Local Measures lists measures to show that a local health jurisdiction meets the standard State Measures lists measures to show that the State Department of Health meets the standard While many different measures could be used, these were selected as the best and most practical measures to indicate how well the public health system is meeting each standard. DOH Washington State Department of Health LHJ Local Health Jurisdiction BOH Local Board of Health Table of Contents Understanding Health Issues Standards for Public Health Assessment Standard 1 Public health assessment skills and tools are in place in all public health jurisdictions and their level is continuously maintained and enhanced. Local measures: Standards for Public Health in Washington State Page 4 of 20 1. Current information on health issues affecting the community is readily accessible, including standardized quantitative and qualitative data. 410 2. There is a written procedure describing how and where to obtain technical assistance on assessment issues. 3. Goals and objectives are established for assessment activities as a part of LHJ planning, and staff or outside assistance is identified to perform the work. 4. Information on health issues affecting the community is updated regularly and includes information on communicable disease, environmental health and health status. Data being tracked have standard definitions, and standardized qualitative or quantitative measures are used. Computer hardware and software is available to support word processing, spreadsheets with basic analysis capabilities, databases and Internet access. 5. Staff who perform assessment activities have documented training and experience in epidemiology, research, and data analysis. Attendance at trainings and peer exchange opportunities to expand available assessment expertise is documented. State measures: 1. Consultation and technical assistance are provided to LHJs and state programs on health data collection and analysis, as documented by logs or reports. Coordination is provided in the development and use of data standards, including definitions and descriptions. 2. Written procedures are maintained and disseminated for how to obtain consultation and technical assistance for LHJs or state programs regarding health data collection and analysis, and program evaluation. 3. Goals and objectives are established for assessment activities as a part of DOH planning, and resources are identified to perform the work. 4. Information on health issues affecting the state is updated regularly and includes • information on communicable disease, environmental health and data about health status. Data being tracked have standard definitions, and standardized qualitative or quantitative measures are used. Computer hardware and software is available to support word processing, spreadsheets, complex analysis capabilities, databases and Internet access. 5. Staff members who perform assessment activities have documented training and experience in epidemiology, research, and data analysis. Statewide training and peer exchange opportunities are coordinated and documented. Table of Contents Standard 2 Information about environmental threats and community health status is collected, analyzed and disseminated at intervals appropriate for the community. Local measures: 1. Assessment data is provided to community groups and representatives of the broader community for review and identification of emerging issues that may require investigation. 2. The Board of Health receives information on local health indicators at least annually. 3. Assessment procedures describe how population level investigations are carried out for documented or emerging health issues and problems. 4. Assessment investigations of changing or emerging health issues are part of the LHJ's annual goals and objectives. 5. A core set of health status indicators, which may include selected local indicators, is used as the basis for continuous monitoring of the health status of the community. A surveillance system using monitoring data is maintained to signal changes in priority health issues. Standards for Public Health in Washington State Page 5 of 20 State measures: • 1. Reports are provided to LHJs and other groups. The reports provide health information analysis and include key health indicators tracked over time. 2. A core set of health status indicators is used as the basis for continuous monitoring of the health status of the state, and results are published at scheduled intervals. A surveillance system using monitoring data is maintained to signal changes in priority health issues. 3. Written procedures describe how population level investigations are carried out in cooperation with LHJs in response to known or emerging health issues. The procedures include expected time frames for response. 4. Investigations of changing or emerging health issues are part of the annual goals and objectives established by DOH. Table of Contents Standard 3 Public health program results are evaluated to document effectiveness. Local measures: 1. The annual report to the BOH includes progress towards program goals. 2. There is a written procedure for using appropriate data to evaluate program effectiveness. Programs, whether provided directly or contracted, have written goals, objectives and performance measures, and are based on relevant research. 3. Program performance measures are monitored, the data is analyzed, and regular reports document the progress towards goals. 4. All LHJ program staff have training in methods to evaluate performance against goals and assess program effectiveness. 5. Changes in activities that are based on analysis of key indicator data or performance measurement data are summarized as a part of quality improvement activities. State measures: 1. Consultation and technical assistance are provided to LHJs and state programs on program evaluation, as documented by case write-ups or logs. 2. Programs administered by the DOH have written goals, objectives and performance measures, and are based on relevant research. There is a written protocol for using appropriate data to evaluate program effectiveness. 3. Program performance measures are monitored, the data is analyzed, and regular reports document the progress towards goals. 4. State and LHJ staff members have been trained on program evaluation as evidenced by documentation of staff training. 5. Changes in activities that are based on analysis of key indicator data or performance measurement data are summarized as a part of quality improvement activities. Table of Contents Standard 4 Health policy decisions are guided by health assessment information, with involvement of representative community members. Standards for Public Health in Washington State Page 6 of 20 Local measures: • 1. There is documentation of community involvement in the process of reviewing health data and recommending action such as further investigation, new program effort or policy direction. 2. The annual report to the BOH summarizes assessment data, including environmental health, and the recommended actions for health policy decisions as evidenced through program, budget, and grant applications. 3. There is a written protocol for developing recommendations for action using health assessment information to guide health policy decisions. 4. Key indicator data being tracked and related recommendations are used in evaluating goals and objectives. State measures: 1. There is documentation of stakeholder involvement in DOH health assessment and policy development. 2. There is a written protocol for using health assessment information to guide health policy decisions. 3. State health assessment data is linked to health policy decisions, as evidenced through legislative requests, budget decisions, programs or grants. Table of Contents Standard 5 Health data is handled so that confidentiality is protected and health • information systems are secure. Local measures: 1. Community members and stakeholders that receive data have demonstrated agreement to comply with confidentiality policies and practices, as appropriate. 2. There are written policies regarding confidentiality. Written policies, including data sharing agreements, govern the use, sharing and transfer of data within the LHJ and with partner agencies. Written protocols are followed for assuring protection of data (passwords, firewalls, backup systems)and data systems. 3. All program data are submitted to local, state, regional and federal agencies in a confidential and secure manner. 4, Employees are trained regarding confidentiality, including those who handle patient information and clinical records, as well as those handling data. 5. All employees and BOH members, as appropriate, have signed confidentiality statements. State measures: 1. Stakeholders that receive data have demonstrated agreement to comply with confidentiality policies and practices, as appropriate. 2. There are written policies, including data sharing agreements, regarding confidentiality that govern the use, sharing and transfer of data within the DOH and among the DOH, LHJs and partner agencies. Written protocols are followed for assuring protection of data (passwords, firewalls, backup systems)and data systems. 3. All program data are submitted to local, state, regional and federal agencies in a confidential and secure manner. 4. Employees are trained regarding confidentiality, including those who handle patient information and clinical records, as well as those handling data. 5. All employees have signed confidentiality agreements. Table of Contents 2002 Report • BUDGET/PROGRAM: Community Health Communicable Disease ases Immunization,Travelers Immunization, Sexually Transmitted Disease, TB, Communicable Di Program. am• HIV, Syringe Exchange MISSION:ION: Communicable Disease program is to protect Jefferson County residents The purpose of the Communicable Disease Health investigati from serious communicable diseases by providing disease surveillance,Theprofit on and reporting, along with education, screening,treatment and immunization services. rs medical providers,the Washington State Department of Health and other community embe agencies while working toward this purpose. GOALS FOR 2002 1. Maintain the low rates of active TB in dt ons Jefferson County (TB) D) 2. investigation aces to State conditions vaccines for all childrenuse byall immunization 3• Support universal access to State supplied 4. Establish immunization registry in Jefferson County,promoting providers (Imm) ) 5. PT eve nt increased morbidity and mortality in Jefferson County Chlamydia transmission in due to influenza mm 6. The Family Planning and STD clinics will asses incontrolling Jefferson County (STD) ersons at risk for HIV infection 7. HIV testing and counseling clinic resources are focused on p 1111 (HIV) ent services will be easily accessed by new HIV clients who seek these services 8. Case management (HIV) 9. Prevent the spread of blood borne communicable diseases among injecting drug users and their partners (SEP) e outbreak 10.Develop 24/7 capacity for CD team runization Programs, STD se in case of 11. Annual report to BOH for CD,TB, OBJECTIVES INTERVENTIONS FOR 2002infection appropriate screening&treatment for reportB conditions B) 1. Encourage protocols for investigation 2. Develop &update p oState supplied vaccine and vaccine recommendation (CD) 3. Maintain to priefvate system for supplying to private Health Care Providers up-dates private Health Care Providers in Jefferson County (I�) p on the Child Profile Immunization Registry 4. Provide training and assist with data entry (I ) influenza vaccine clinics and coordinate vaccine distribution and availability 5. Hold countywide dia a e with private providers. seen in Family Planning and STD clinics who are at higher risk for Chlamy g 6. Clients criteria)will be screened for (STD)Chlamydia ill be high risk(HIV) 7. 75% of clients who receive HIV testing 8. 90% of new HIV clients who seek case management services will have an assessment within 1 week of the date requested (HIV)• pro ram services (SEP) 9. Promote utilization of syringe exchange p g PERFORMANCE INDICATORS: 2001 2001 2002 2002 A(TB) Number of clients started on preventive therapy for latent 12an 10 ttual Plan Actual �TB infection 10 2 (CD) Number of communicable disease reports confirmed, 56 51 56 58 interventions applied and processed for reporting to the state (Imm)Number of doses of publicly funded vaccine, 3,500 3,885 3,500 3,811 administered by private health care providers and Public Health clinics, supplied and monitored through Public Heath's immunization program (Imm) Number of local immunizations providers (clinics) a 1 a 7 a 1 a provided information and training on the Child Profile immunization registry (Imm) Number of providers participating in the Child Profile 1 0 4 immunization registry 1 (Imm) Percent of Jefferson County children< age 6 with 1 or 38% 56% 70% 72% more immunizations in the Child Profile registry (Imm) Doses of influenza vaccine administered 1330 1303 1320 80 b (STD) Percent of at risk FP and STD clinic clients at risk for 100% 100% 100% 100% Chlamydia screened (age criteria) (STD) Chlamydia rate per 100,000 for female Jefferson County 1,686 1,163 1,686 1,600 residents age 15-24 (2000) (HIV) Number of persons counseled and tested for HIV infection 90 85 90 79 (HIV) Percent of persons counseled and tested for HIV infection New for 65% 75% 71% that were in high-risk category 2002 *HIV) Percent of new HIV clients requesting case management New for NA 90% 100% services who have an assessment within 1 week 2002 (SEP) Number of clinics 100 96 103 (SEP) Number of visits to SEP 100 15 15 15 37 7 (SEP) Number of syringes exchanged 1000 1976 1 (SEP)Number of prevention/educational materials provided 9155 41649 (SEP)Number of referrals to other services 09 5 5 5 0 a. Due to major reorganization in the Child Profile Immunization Registry at the state level JCHHS was not able to start using the system 2001. In 2002 the State Child Profile staff trained the JCHHS staff to use Child Profile. Compatibility issues had to be worked out between our internal data/billing system, KHIPPS, and the Child Profile system. JCHHS began using Child Profile in the fall of 2002. Private providers will be trained and encouraged to use the system in 2003. b. As a result of Jefferson County budget cuts at the beginning of 2002 JCHHS eliminated the public influenza clinics that would have been held in the fall of 2002. JCHHS did continue to give influenza vaccine to identified high-risk groups. JCHHS continued to coordinate the information in the media about influenza vaccine recommendations and private provider, grocery store and pharmacy clinic schedules. JCHHS also sent out the new vaccine recommendations to private providers and worked with them to increase vaccine availability. As a result, the private providers ordered more vaccine, increased clinic numbers and expanded vaccine availability to the public (not only established 411 patients). An assessment of influenza doses given in the county in 2001 and 2002 has shown that vaccine utilization did not decrease. • SUMMARY OF KEY FUNDING/SERVICE ISSUES: Communicable disease prevention is a locally funded program since the county milage was returned from the state to counties for TB control. Immunization funds from the state have been primarily in the form of vaccine. In 2002 we are received some state funds to increase our immunization quality assurance site visits to physicians' offices. County funded Services are important in the Strategic Plan to promote healthy communities by having the infrastructure to maintain a professional staff preventing, identifying and responding to disease outbreaks. Substantial staff time is spent on responding to public requests for information about communicable diseases and screening for reportable illnesses in the process. HIV services are funded from the state and federal government to provide basic communicable disease prevention, HIV positive client case management, testing and counseling to high-risk community members, and focused high-risk interventions. Funds are highly programmatic and based on federal case numbers, which may not represent Jefferson County's incidence profile. Volatile program funding is based on formulas re-negotiated with Region VI AIDSNET every year. Developing the capacity for bioterrorism response is a new project which began mid year 2002. This response capacity will be in coordination with our bioterrorism regional partners, Kitsap and Clallam Counties, our local emergency response agencies, Jefferson General Hospital and other health care providers. Our work on developing an overall bioterrorism response plan was sidetracked in the fall by the mandate to concentrate on planning for smallpox prevention and response. New deliverables, on very short timelines, were coming from the federal level through the State Department of Health every couple of weeks. The amount if information and recommendations being sent out about smallpox was sizeable, and ever changing. Keeping abreast of this and sharing important information with team • members was in itself time consuming. JCHHS received $25,000 to cover bioterrorism planning over an 18 month period, $12,500 for 2002 and$12,500 for the first half of 2003. No additional funds came with the new smallpox mandates. JCHHS spent $12,854 in 2002 on bioterrorism planning activities, even though this work did not start until the last half of the year and was primarily concentrated in the last quarter of the year. The intensity of the work continues into 2003. 10 March 2003 • • Communicable Disease Investigation Guidelines Jefferson County Health and Human Services Communicable disease resources: • Control of Communicable Disease in Man (Chin), Lisa and Denis have copies. • Red Book (esp. for pediatric questions), Lisa's desk. • Infectious Disease Control Guide for School Staff, Lisa and Denis have copies. • Child Care Infection Control Guide, Seattle-King County (good for clear concise information in the form of"Dear Parent" letters), Lisa's desk. • Rash Illness Investigation Guidelines, DOH, use if suspect measles or rubella, top drawer of file cabinet across from back hall printer. • Guidelines for the Control of Pertussis Outbreaks, CDC, top drawer of file cabinet across from back hall printer. • Disease specific information files, second and third drawer of file cabinet across from back hall printer. • WA State DOH fact sheets, www.doh.wa.gov/topics/topics.htm • CDC fact sheets, www.cdc.gov/health/diseases.htm • King County fact sheets, www.metrokc.qov/health/prevcont Phone numbers: Tom Locke, M.D., check posted schedule. Clallam Co. Health Dept. (360) 417-2437 • Port Gamble S'Klallam Clinic (360) 297-2840 Home (360) 683-9152 Cell (360) 808-3333 Washington State DOH: Epidemiology Section (206) 361-2914 (24 hr) Immunization Section (360) 236-3595 (call if suspect vaccine preventable disease, especially measles or rubella). TB Program (360) 236-3436 State Lab Bacteriology (206) 361-2878 Enteric Bacteriology 361-2870 HIV results 361-2876 Parasitology 361-2871 TB 361-2872 Virology (including rabies) 361-2874 Donna Green (questions regarding kits and testing) 361-2878 Main Lab number 361-2840 King County Lab (206) 296-4740 Quest Lab 1-800-877-0051 Jefferson General Hospital Lab 385-2200 x 4444 See page 2 for investigation steps. H:LMworddocs/CDfomis7-02 1 • Communicable Disease Investigation Guidelines • Jefferson County Health and Human Services Steps for responding to a communicable disease report or question: 1.Identify disease. Is it reportable? 2. Basic information (transmission, incubation period etc.) can be found in Chin. Consult other resources as needed, see page 1. 3. Get appropriate DOH reporting form. Forms are in the top drawer of file cabinet across from back hall printer. If there is no disease specific form use the Acute and Communicable Diseases Case Report form. 4. Use Communicable Disease Investigation Notes form along with DOH reporting form to collect important information, including: • name, birthdate, address, phone, sex, occupation, place of employment • symptoms, date of onset of symptoms, diagnosing MD, treatment • other family/household members/friends with similar symptoms or recent disease • known exposure? • Depending on disease, other information may be important. Example: water source, travel outside of country, contact with pets. • Collect information first from MD, and Lab. We sometimes get the lab report before the MD has notified the person affected. The person affected can then be called for more information. 5. Conduct follow-up and /or contact investigation as needed. Give basic information to persons infected to decrease risk of transmission to others. Food handlers should not be working if they have any diarrhea or vomiting illness. 6. Lisa will log the report and send it to the State. 110 H:LMworddocs/CDforms7-02 2 Communicable Disease Investigation Notes To be used with Case Report Form Case Name Provider Disease Date Report Received From Date Investigation Initiated (Within 1 working day) Date Report Sent To DOH Date of Onset Date of Lab Specimen Symptoms Treatment Received and Date Suspect Exposure Source • Contacts Identified, (need for contact notification)? Referral for Follow-up? Investigation Notes • H;LMworddocs/CDforms7-02 Standards for Public Health in Washington State Page 7 of 20 Protecting People from Disease • Standards for Communicable Diseases and Other Health Risks Standard 1 A surveillance and reporting system is maintained to identify emerging health threats. Local measures: 1. Information is provided on how to contact the LHJ to report a public health concern 24 hours per day. Law enforcement has current local and state 24-hour emergency contact lists. 2. Health care providers and labs know which diseases require reporting, have timeframes, and have 24-hour local contact information. There is a process for identifying new providers in the community and engaging them in the reporting process. 3. The local BOH receives an annual report, one element of which summarizes communicable disease surveillance activity. 4. Written protocols are maintained for receiving and managing information on notifiable conditions. The protocols include role-specific steps to take when receiving information as well as guidance on providing information to the public. 5. Communicable disease key indicators and implications for investigation, intervention or education efforts are evaluated annually. 6. A communicable disease tracking system is used which documents the initial report, investigation, findings and subsequent reporting to state and federal • agencies. 7. Staff members receive training on communicable disease reporting, as evidenced by local protocols. State measures: 1. Information is provided to the public on how to contact the DOH to report a public health concern 24 hours per day. Law enforcement has current state 24-hour emergency contact lists. 2. Consultation and technical assistance are provided to LHJs on surveillance and reporting, as documented by case summaries or reports. Laboratories and health care providers, including new licensees, are provided with information on disease reporting requirements, timeframes, and a 24-hour DOH point of contact. 3. Written procedures are maintained and disseminated for how to obtain state or federal consultation and technical assistance for LHJs. Assistance includes surveillance, reporting, disease intervention management during outbreaks or public health emergencies and accuracy and clarity of public health messages. 4. Annual goals and objectives for communicable disease are a part of the DOH planning process. Key indicators and implications for investigation, intervention or education efforts are documented. 5. A statewide database for reportable conditions is maintained; surveillance data are summarized and disseminated to LHJs at least annually. Uniform data standards and case definitions are updated and published at least annually. 6. Staff members receive training on communicable disease reporting, as evidenced by protocols. Table of Contents Standard 2 Response plans delineate roles and responsibilities in the event of communicable disease outbreaks and other health risks that Standards for Public Health in Washington State Page 8 of 20 threaten the health of people. Local measures: • 1. Phone numbers for weekday and after-hours emergency contacts are available to DOH and appropriate local agencies, such as schools and public safety. 2. A primary contact person or designated phone line for the LHJ is clearly identified in communications to health providers and appropriate public safety officials for reporting purposes. 3. Written policies or procedures delineate specific roles and responsibilities within agency divisions for local response and case investigations of disease outbreaks and other health risks. State measures: 1. Phone numbers for after-hours contacts for all local and state public health jurisdictions are updated and disseminated statewide at least annually. 2. Written policies or procedures delineate specific roles and responsibilities for state response to disease outbreaks or public health emergencies. There is a formal description of the roles and relationship between communicable disease, environmental health and program administration. Variations from overall process are identified in disease-specific protocols. 3. Written procedures describe how expanded lab capacity is made readily available when needed for outbreak response, and there is a current list of labs having the capacity to analyze specimens. 4. DOH staff members receive training on the policies and procedures regarding roles and responsibilities for response to public health threats, as evidenced by protocols. • Table of Contents Standard 3 Communicable disease investigation and control procedures are in place and actions documented. Local measures: 1. Lists of private and public sources for referral to treatment are accessible to LHJ staff. 2. Information is given to local providers through public health alerts and newsletters about managing reportable conditions. 3. Communicable disease protocols require that investigations begin within 1 working day, unless a disease-specific protocol defines an alternate time frame. Disease-specific protocols identify information about the disease, case investigation steps, reporting requirements, contact and clinical management (including referral to care), use of emergency biologics and the process for exercising legal authority for disease control (including non-voluntary isolation). Documentation demonstrates staff member actions are in compliance with protocols and state statutes. 4. An annual evaluation of a sample of communicable disease investigations is done to monitor timeliness and compliance with disease specific protocols. 5. LHJs identify key performance measures for communicable disease investigation and enforcement actions. 6. Staff members conducting disease investigations have appropriate skills and • training as evidenced in job descriptions and resumes. State measures: 1. Consultation and staff time are provided to LHJs for local support of disease intervention management during outbreaks or public health emergencies, as documented by case write-ups. Recent research findings relating to the most Standards for Public Health in Washington State Page 9 of 20 effective population-based methods of disease prevention and control are provided to LHJs. Labs are provided written protocols for the handling, storage, and transportation of specimens. 2. DOH leads statewide development and use of a standardized set of written protocols for communicable disease investigation and control, including templates for documentation. Disease-specific protocols identify information about the disease, case investigation steps, reporting requirements, contact and clinical management (including referral to care), use of emergency biologics and the process for exercising legal authority for disease control (including non-voluntary isolation). Documentation demonstrates staff member actions are in compliance with protocols and state statutes. 3. An annual evaluation of a sample of state communicable disease investigations and consultations is done to monitor timeliness and compliance with disease specific protocols. 4. DOH identifies key performance measures for communicable disease investigations and consultation. 5. Staff members conducting disease investigations have appropriate skills and training as evidenced in job descriptions and resumes. Table of Contents Standard 4 Urgent public health messages are communicated quickly and clearly and actions are documented. Local measures: 1. Information is provided through public health alerts to key stakeholders and press • releases to the media. 2. A current contact list of media and providers is maintained and updated at least annually. This list is in the communicable disease manual and at other appropriate departmental locations. 3. Roles are identified for working with the news media. Policies identify the timeframes for communications and the expectations for all staff regarding information sharing and response to questions, as well as the steps for creating and distributing clear and accurate public health alerts and media releases. 4. Staff who have lead roles in communicating urgent messages have been trained in risk communication. State measures: 1. A communication system is maintained for rapid dissemination of urgent public health messages to the media and other state and national contacts. 2. A communication system is maintained for rapid dissemination of urgent public health messages to LHJs, other agencies and health providers. Consultation is provided to LHJs to assure the accuracy and clarity of public health information associated with an outbreak or public health emergency, as documented by case write-ups. State-issued announcements are shared with LHJs in a timely manner. 3. Roles are identified for working with the news media. Written policies identify the timeframes for communications and the expectations for all staff regarding information sharing and response to questions, as well as the steps for creating and distributing clear and accurate public health alerts and media releases. 4. Communication issues identified in outbreak response evaluations are addressed in writing with future goals and objectives in the communicable disease quality 1111 improvement plan. 5. Staff members with lead roles in communicating urgent messages have been trained in risk communication. Table of Contents Standard 5 Environmental Health Program 2003 Budget Assumptions • BUDGET/PROGRAM:Drinking Water Programs Programs Request Compared to Historical Revenues and Expenses MISSION: The mission of the Drinking Water Program is to assure that the residents and visitors to Jefferson County have access to the best quality drinking water that is reasonably available in order to minimize the threat of waterborne disease. GOALS FOR FY 2003: 1. Assure that all new wells are constructed in accordance with requirements established by the Washington Department of Ecology. 2. Provide technical assistance when requested so that individual water supplies are safe. 3. Limit public exposure to water systems with known deficiencies. OBJECTIVES FOR FY 2003: 1. Inspect at least 50%of all new wells constructed and 100%of all wells being decommissioned. 2. Increase compliance with state well drilling regulations. 3. Review all building permits and project applications to assure that potable water supplies meet basic public health standards as well comply with state statutory and regulatory requirements. 4. Provide technical guidance to any residents requesting assistance with their individual or small water systems to deliver safe drinking water. 5. Assure that food service establishments that operate their own water systems are in compliance with federal and state drinking water requirements. 6. Establish appropriate policies for alternative water supply systems. 7. Continue contractingwithDOH for public water supply projects as long as adequate funding is provided. s�bilr Ota A Y r i+'H r-d-; 8 htYprovee� � �` GF;�f It �� �w� -�, *t rested slake oldkts • PERFORMANCE INDICATORS: 2000 2001 2002 2003 Projected Planned 1.Percent new wells inspected 2.Percent of inspected wells with construction deficiencies. 3.Number and time spent providing technical assistance. 4 Percent of building permits issued with conditions identifying water supply deficiencies. 5.Percent of building permit applications denied based on water supply deficiencies. 6.Percent of food service establishments with water system deficiencies. SUMMARY OF KEY FUNDING/SERVICE ISSUES: Increased tracking will be done within existing databases such as permit plan and the food service database.Databases will be updated as necessary to add new fields to track performance indicators. Environmental Health Program 2003 Budget Assumptions • Solid Waste Programs MISSION: The purpose of the Solid Waste Enforcement and Education Program is to assure solid waste in Jefferson County is managed in a way that is consistent with state regulatory requirements,avoids harm to the environment,is protective of the public health and promotes goals and objectives for solid waste reduction and recycling consistent with the Jefferson County Comprehensive Solid Waste Management Plan. GOALS FOR FY 2003: 1.Reduce the occurrence of promiscuous dumping. 2. Increase the awareness of small quantity generator and household hazardous waste disposal requirements through education and outreach efforts. 3.Promote construction waste recycling in order to reduce illegal dumping. 4.Increase compliance with residential sharps disposal requirements. OBJECTIVES FOR FY 2003: 1.Finish updating solid waste regulations. 2. Conduct,workshops,and technical consultations with SQGs. 3.Establish baseline estimates of the distribution and disposition of residential sharps. 4. Complete long-term inter agency agreement with Public Works for solid waste education outlining agreed upon priorities and funding. PERFORMANCE INDICATORS: 2001 2001 2002 2003 Projected Planned 1. Percent of illegal dumps closed and cleaned up. 100% 2. Pounds of litter and illegally dumped waste collected per capita. 1.2 lbs./cap 3.Percent of verified nuisances cleaned up SUMMARY OF KEY FUNDING/SERVICE ISSUES: Generally there have been very few compliance problems associated with permitted solid waste facilities in Jefferson County. However,illegal dumping and neighborhood nuisance conditions continue to be a problem.Use of general fund and tipping fee funding to match DOE Solid Waste Enforcement and Solid Waste Education Grants will enable the division to maintain staffing at current levels. This level of staffing will enable the department to complete the solid waste regulation revisions,increase capacity for compliance activities and conduct regular community outreach programs. Environmental Health Program 2003 Budget Assumptions IIIOn Site Sewage Program MISSION: The purpose of the Onsite Sewage Program is to minimize the threat of surface and ground water contamination from failing or improperly designed,installed or maintained onsite sewage systems. GOALS FOR FY 2003 1. Educate homeowners,builders,real estate personnel,banks,installers,designers and onsite system maintenance personnel in the proper operation and maintenance of onsite sewage systems. 2. Assure a high quality-monitoring program. 3. Implement and enforce state and local rules and regulations governing the installation and use of onsite sewage systems. 4. Investigate Action Requests and complaints in a timely manner to reduce the threat of human contact with untreated wastewater. 5. Assure high quality customer service. 6. Reduce permit turn around time. OBJECTIVES FOR FY 2003: 1. Develop written informational materials for public distribution and conduct workshops for targeted community groups addressing onsite sewage system operation and Maintenance. 2. Provide training to targeted community groups to increase awareness on regulatory requirements for onsite sewage systems. 3. Review monitoring and inspection reports and provide timely follow up. 4. Utilize existing data systems to track action requests and complaints. 5. Develop and implement a system for routinely surveying customer service. 6. Assure that site inspections in response to permit applications are conducted within 14 days of receipt of application. 7. Expand use of laserfiche system to create electronic images of relevant onsite permit data. • PERFORMANCE INDICATORS: 2000 2001 2002 2003 Actual Planned #of systems repaired not associated with a violation 7 21 or building application=25(2 w/bld,2 w/compl) Percent of systems inspected(EES by HD&Priv,not 1.8% 30% PUD)that required maintenance(not major) Percent of existing systems receiving regular 3rd party 13% 14% monitoring Failure rate of systems less than 5 years in use 0 .14% 1998-2002 finaled systems=701 1 failure of a 1998 system; 1 in 1993 and 1 in 1994 #of new system applications 55% 252 (incl 54 tank only permits) Percent approved without major redesign 70% %of complaints requiring follow up enforcement unknown Unknown action. #of septic permits received 42??? 302 #of days to initial inspection 10.23 %of permits issued with no clock stops 55% Average days to process w no clock stops 20 Average days to process all permits 21.3 %of permits applications pending 40% S Average#of days to process w clock stoppers 23 EES total by HD 55 84 By Private—reviewed by HD 120+ Environmental Health Program 2003 Budget Assumptions %of systems inspected that required major 1% 2.9% • maintenance/failed All EES's=204 Assessed all failures/repair permits and six(6)were linked directly to EES's O&M #workshops 18 #participants 431 PUD on County datebase;O&M data being entered SUMMARY OF KEY FUNDING/SERVICE ISSUES: Increased tracking will be done with existing data systems to evaluate effectiveness of monitoring programs. With the completion of the DOE non-point source pollution grant ongoing O&M activities will need to be funded through permit and inspections fees. Implementation will focus on coordination with the PUD to set up systems for scheduling and tracking inspection activities and conducting community outreach to increase awareness of the new requirements. Staff allocation to onsite programs will be decreased by 1/2/FTE. i 1 4\.4114411114441\ • 1 • i i Environmental Health Program 2003 Budget Assumptions 1111 Food Programs MISSION: The purpose of the Food Program is to minimize the risk the spread of disease from improperly prepared, stored or served foods handled in commercial settings. GOALS FOR FY 2003: 1. Provide classroom food safety instruction for all food service workers. 2. Assure minimum sanitary standards are observed in all food service establishments. 3. Provide basic food safety information to the general public. OBJECTIVES FOR FY 2003: 1. Offer food safety training at a frequency and in locations convenient to food service workers. 2. Review all new food service establishments for compliance with state and county requirements. 3. Inspect all food service establishments at a frequency adequate to assure compliance with state and local regulatory requirements. 4. Offer educational materials and technical assistance to non-regulated community groups and organizations where requested. PERFORMANCE INDICATORS: 2001 2001 2002 2003 Actual Planned #of food workers trained and the%trained from out 1360 trained 1090 trained of county %0 of required inspections completed 92% %of inspected establishments that required repeat 10% inspections due to critical violations %of establishments receiving Outstanding 17% Achievement Awards #of complaints received and the%that resulted in 45 corrective actions or FBI verified complaints; 29% resulted in corrective actions SUMMARY OF KEY FUNDING/SERVICE ISSUES: Food Program activities are largely funded through permit fees. Standards for Public Health in Washington State Page 10 of 20 Communicable disease and other health risk responses are routinely evaluated for opportunities for improving public health • system response. Local measures: 1. An evaluation for each significant outbreak response documents what worked well and what process improvements are recommended for the future. Feedback is solicited from appropriate entities, such as hospitals and providers. Meetings are convened to assess how the outbreak was handled, identify issues and recommend changes in response procedures. 2. Findings and policy recommendations for effective response efforts are included in reports to the BOH. 3. Local protocols are revised based on local review findings and model materials disseminated by DOH. 4. Issues identified in outbreak evaluations are addressed in future goals and objectives for communicable disease programs. 5. Staff training in communicable disease and other health risk issues is documented. 6. A debriefing process for review of response to public health threats or disease outbreaks is included in the quality improvement plan and includes consideration of surveillance, staff roles, investigation procedures and communication. State measures: 1. Timely information about best practices in disease control is gathered and disseminated. Coordination is provided for a state and local debriefing to evaluate • extraordinary disease events that required a multi-agency response; a written summary of evaluation findings and recommendations is disseminated statewide. 2. Model plans, protocols and evaluation templates for response to disease outbreaks or public health emergencies are developed and disseminated to LHJs. 3. Model materials are revised based on evaluation findings, including review of outbreaks. 4. Response issues identified in outbreak evaluations are addressed in future goals and objectives for communicable disease programs. 5. Staff members are trained in surveillance, outbreak response and communicable disease control and are provided with standardized tools. 6. A debriefing process for review of response to public health threats or disease outbreaks is included in the quality improvement plan and includes consideration of surveillance, staff roles, investigation procedures and communication. Table of Contents. Assuring a Safe, Healthy Environment for People Standards for Environmental Health Standard 1 Environmental health education is a planned component of public • health programs. Local measures: 1. Information is available about environmental health educational programs through brochures, flyers, newsletters, websites or other mechanisms. 2. There are documented processes for involving community members and Standards for Public Health in Washington State Page 11 of 20 stakeholders in addressing environmental health issues, including education and the provision of technical assistance. 3. A plan for environmental health education exists and includes goals, objectives and learning outcomes. 4. The environmental health education plan identifies performance measures for education programs. There is an evaluation process for health education offerings that is used to revise curricula. 5. Staff members conducting environmental health education have appropriate skills and training. State measures: 1. Information is provided to the public about the availability of state level environmental health educational programs through contact information on brochures, flyers, newsletters,websites and other mechanisms. 2. There are documented processes for involving stakeholders in addressing environmental health issues including education and the provision of technical assistance. 3. A plan for environmental health education exists, with goals, objectives and learning outcomes. There is an evaluation process for health education offerings that is used to revise curricula. 4. Environmental health education services are provided in conformance with the statewide plan. 5. The environmental health education plan identifies performance measures for education programs that are monitored and analyzed on a routine basis. 6. Staff members conducting environmental health education have appropriate health education skills and training as evidenced by job descriptions, resumes or training documentation. Table of Contents • Standard 2 Services are available throughout the state to respond to environmental events or natural disasters that threaten the public's health. Local measures: 1. Information is provided to the public on how to report environmental health threats or public health emergencies, 24 hours a day; this includes a phone number. 2. Appropriate stakeholders are engaged in developing emergency response plans. Following an emergency response to environmental health problem or natural disaster, stakeholders are convened to review how the situation was handled, and this debriefing is documented with a written summary of findings and recommendations. 3. Procedures are in place to monitor access to services and to evaluate the effectiveness of emergency response plans. Findings and recommendations for emergency response policies are included in reports to the BOH. 4. There is a plan that describes LHJ roles and responsibilities for environmental events or natural disasters that threaten the health of the people. There is a clear link between this plan and other local emergency response plans. 5. Key staff members are trained in risk communication and in use of the LHJ emergency response plan. • State measures: 1. Information is provided to the public on how to report environmental health threats or public health emergencies, 24 hours a day; this includes a phone number. 2. Consultation and technical assistance are provided to LHJs on emergency preparedness, as documented by case write-ups or logs. Following an emergency response to environmental health problem or natural disaster, LHJs and other Standards for Public Health in Washington State Page 12 of 20 agencies are convened to review how the situation was handled. This debriefing is documented with a written summary of findings and recommendations. 3. Written procedures are maintained and disseminated for how to obtain consultation and technical assistance regarding emergency preparedness. • Procedures are in place to monitor access to services and to evaluate the effectiveness of emergency response plans. Policies are revised based on event debriefing findings and recommendations. 4. There is a plan that describes DOH internal roles and responsibilities for environmental events or natural disasters that threaten the health of the people. There is a clear link between this plan and other state and local emergency response plans. 5. All DOH program staff are trained in risk communication and the DOH emergency response plan, as evidenced by training documentation. Table of Contents Standard 3 Both environmental health risks and environmental health illnesses are tracked, recorded and reported. Local measures: 1. Environmental health data is available for community groups and other local agencies to review. 2. A surveillance system is in place to record and report key indicators of environmental health risks and related illnesses. Information is tracked over time to monitor trends. A system is in place to assure that data is shared routinely with local, state and regional agencies. S 3. A quality improvement plan includes consideration of environmental health information and trends,findings from public input, evaluation of health education offerings and information from compliance activity. State measures: 1. Coordination is provided in development of data standards for environmental health indicators. Information based on the surveillance system is developed and provided to LHJs and other state stakeholders. 2. A statewide surveillance system is in place to receive, record and report key indicators for environmental health risks and related illnesses. Results are tracked and trended over time and reported regularly. A system is in place to assure that data is transferred routinely to local, state and regional agencies. 3. A quality improvement plan includes consideration of analysis of environmental health information and trends, findings from debriefings, evaluation of health education offerings and information from compliance activity. Table of Contents Standard 4 Compliance with public health regulations is sought through enforcement actions. Local measures: • 1. Written policies, local ordinances, laws and administrative codes are accessible to the public. 2. Compliance procedures are written for all areas of environmental health activity. The procedures specify the documentation requirements associated with enforcement action. Documentation demonstrates that environmental health work conforms with policies, local ordinances and state statutes. Standards for Public Health in Washington State Page 13 of 20 3. There is a documented process for periodic review of enforcement actions. 4. An environmental health tracking system enables documentation of the initial report, investigation, findings, enforcement and subsequent reporting to other agencies as required. . 5. Environmental health staff members are trained on compliance procedures, as evidenced by training documentation. State measures: 1. Written policies, local ordinances, laws and administrative codes are accessible to the public. 2. Information about best practices in environmental health compliance activity is gathered and disseminated, including form templates, time frames, interagency coordination steps, hearing procedures, citation issuance and documentation requirements. 3. Compliance procedures are written for all areas of environmental health activity carried out by DOH. Documentation demonstrates that environmental health work conforms with policies, local ordinances and state statutes. 4. There is a documented process for periodic review of enforcement actions. 5. An environmental health tracking system enables documentation of the initial report, investigation, findings, enforcement and subsequent reporting to other agencies as required. 6. Environmental health staff members are trained on compliance procedures, as evidenced by training documentation. Table of Contents Prevention is Best: Promoting Healthy Living Standards for Prevention and Community Health Promotion Standard 1 Policies are adopted that support prevention priorities and that reflect consideration of scientifically-based public health literature. Local measures: 1. Prevention and health promotion priorities are selected with involvement from the BOH, community groups and other organizations interested in the public's health. 2. Prevention and health promotion priorities are adopted by the BOH, based on assessment information, local issues, funding availability, program evaluation and experience in service delivery, including information on best practices or scientific findings. 3. Prevention and health promotion priorities are reflected in the goals, objectives and performance measures of the LHJ's annual plan. Data from program evaluation and key indictors is used to develop strategies. State measures: 1. Reports about new or emerging issues that contribute to health policy choices are routinely developed and disseminated. Reports include information about best practices in prevention and health promotion programs. 2. Consultation and technical assistance is available to assist LHJs in proposing and developing prevention and health promotion policies and initiatives. Written procedures are maintained and shared, describing how to obtain consultation and assistance regarding development, delivery or evaluation of prevention and health promotion initiatives. 3. Priorities are set for prevention and health promotion services, and a statewide implementation plan is developed with goals, objectives and performance measures. Standards for Public Health in Washington State Page 14 of 20 4. The statewide plan is evaluated and revised regularly, incorporating information from health assessment data and program evaluation. Table of Contents • Standard 2 Active involvement of community members is sought in addressing prevention priorities. Local measures: 1. The LHJ provides leadership in involving community members in considering assessment information to set prevention priorities. 2. A broad range of community partners takes part in planning and implementing prevention and health promotion efforts to address selected priorities for prevention and health promotion. 3. Staff members have training in community mobilization methods as evidenced by training documentation. State measures: 1. The DOH provides leadership in involving stakeholders in considering assessment information to set prevention and health promotion priorities. 2. A broad range of partners takes part in planning and implementing prevention and health promotion efforts to address selected priorities for prevention and health promotion. 3. Information about community mobilization efforts for prevention priorities is collected and shared with LHJs and other stakeholders. 4. The statewide plan for prevention and health promotion identifies efforts to link public and private partnerships into a network of prevention services. 5. DOH staff members have training in community mobilization methods as evidenced by training documentation. Table of Contents Standard 3 Access to high quality prevention services for individuals, families, and communities is encouraged and enhanced by disseminating information about available services and by engaging in and supporting collaborative partnerships. Prevention services maybe focused on reaching individuals, families and communities. Examples of prevention services include chronic disease prevention, home visiting by public health nurses, immunization programs, efforts to reduce unintentional injuries and violence, including sexual assault. Local measures: 1. Summary information is available to the public describing preventive services available in the community. This may be produced by a partner organization or • the LHJ, and it may be produced in a paper or web-based format. 2. Local prevention services are evaluated and a gap analysis that compares existing community prevention services to projected need for services is performed periodically and integrated into the priority setting process. 3. Results of prevention program evaluation and analysis of service gaps are reported to local stakeholders and to peers in other communities. 4. Staff have training in program evaluation methods as evidenced by training Standards for Public Health in Washington State Page 15 of 20 documentation. 5. A quality improvement plan incorporates program evaluation findings, evaluation of community mobilization efforts, use of emerging literature and best practices and delivery of prevention and health promotion services. • State measures: 1. The DOH supports best use of available resources for prevention services through leadership, collaboration and communication with partners. Information about prevention and health promotion evaluation results is collected and shared statewide. 2. Prevention programs, provided directly or by contract, are evaluated against performance measures and incorporate assessment information. In addition, a gap analysis that compares existing prevention services to projected need for services is performed periodically and integrated into the priority setting process. 3. DOH staff members have training in program evaluation methods as evidenced by training documentation. 4. A quality improvement plan incorporates program evaluation findings, evaluation of community mobilization efforts, use of emerging literature and best practices and delivery of prevention and health promotion services. Table of Contents Standard 4 Prevention, early intervention and outreach services are provided directly or through contracts. Health promotion activities may be focused on the entire state or • community or on groups within the community. Examples of health promotion activities include educational efforts aimed at increasing physical activity, reduction in tobacco use, improved dietary choices. Local measures: 1. Prevention priorities adopted by the BOH are the basis for establishing and delivering prevention, early intervention and outreach services. 2. Early intervention, outreach and health education materials address the diverse local populations and languages of the intended audience. Information about how to select appropriate materials is available and used by staff. 3. Prevention programs collect and use information from outreach, screening, referrals, case management and follow-up for program improvement. Prevention programs, provided directly or by contract, are evaluated against performance measures and incorporate assessment information. The type and number of prevention services are included in program performance measures. 4. Staff providing prevention, early intervention or outreach services have appropriate skills and training as evidenced by job descriptions, resumes or training documentation. State measures: 1. Consultation and technical assistance on program implementation and evaluation of prevention services is provided for LHJs. There is a system to inform LHJs and other stakeholders about prevention funding opportunities. 2. Outreach and other prevention interventions are reviewed for compliance with • science, professional standards, and state and federal requirements. Consideration of professional requirements and competencies for effective prevention staff is included. 3. Prevention services have performance measures that are tracked and analyzed, and recommendations are made for program improvements. 4. Statewide templates for documentation and data collection are provided for LHJs and other contractors to support performance measurement. Standards for Public Health in Washington State Page 16 of 20 5. DOH staff members have training in prevention, early intervention or outreach services as evidenced by training documentation. • Table of Contents Standard 5 Health promotion activities are provided directly or through contracts. Local measures: 1. Health promotion activities are provided directly by LHJs or by contractors and are intended to reach the entire population or at-risk populations in the community. 2. Procedures describe an overall system to organize, develop, distribute, evaluate and update health promotion materials. Technical assistance is provided to community organizations, including "train the trainer"methods. 3. Health promotion efforts have goals, objectives and performance measures. The number and type of health promotion activities are tracked and reported, including information on content, target audience, number of attendees. There is an evaluation process for health promotion efforts that is used to improve programs or revise curricula. 4. Staff members have training in health promotion methods as evidenced by training documentation. State measures: 1. Health promotion activities are provided directly by DOH or by contractors and are IPintended to reach the entire population or at-risk populations in the community. 2. Literature reviews of health promotion effectiveness are conducted and disseminated. Consultation and technical assistance on health promotion implementation and evaluation is provided for LHJs. There is a system to inform LHJs and other stakeholders about health promotion funding opportunities. 3. Health promotion activities are reviewed for compliance with science, professional standards, and state and federal requirements. Health promotion materials that are appropriate for statewide use and for key cultural or linguistic groups are made available to LHJs and other stakeholders through a system that organizes, develops, distributes, evaluates and updates the materials. 4. Health promotion activities have goals, objectives and performance measures that are tracked and analyzed, and recommendations are made for program improvements. The number and type of health promotion activities are tracked and reported, including information on content, target audience, number of attendees. There is an evaluation process for health promotion efforts that is used to improve programs or revise curricula. 5. DOH staff members have training in health promotion methods as evidenced by training documentation. Table of Contents Helping People Get the Services They Need Standards for Access to Critical Health Services Standard 1 • Information is collected and made available at both the state and local level to describe the local health system, including existing resources for public health protection, health care providers, facilities and support services. Standards for Public Health in Washington State Page 17 of 20 Local measures: • 1. Up-to-date information on local critical health services is available for use in building partnerships with community groups and stakeholders. 2. LHJ staff and contractors have a resource list of local providers of critical health services for use in making client referrals. 3. The list of critical health services is used along with assessment information to determine where detailed documentation of local capacity is needed. State measures: 1. A list of critical health services is established and a core set of statewide access measures established. Information is collected on the core set of access measures, analyzed and reported to the LHJs and other agencies. 2. Information is provided to LHJs and other agencies about availability of licensed health care providers, facilities and support services. Table of Contents Standard 2 Available information is used to analyze trends which, over time, affect access to critical health services. Local measures: 1. Data tracking and reporting systems include key measures of access. Periodic • surveys are conducted regarding the availability of critical health services and barriers to access. 2. Gaps in access to critical health services are identified using periodic survey data and other assessment information. 3. The BOH receives summary information regarding access to critical health services at least annually. State measures: 1. Consultation is provided to communities to help gather and analyze information about barriers to accessing critical health services. 2. Written procedures are maintained and disseminated for how to obtain consultation and technical assistance for LHJs and other agencies in gathering and analyzing information regarding barriers to access. 3. Gaps in access to critical health services are identified using periodic survey data and other assessment information. 4. Periodic studies regarding workforce needs and the effect on critical health services are conducted, incorporated into the gap analysis and disseminated to LHJs and other agencies. Table of Contents Standard 3 Plans to reduce specific gaps in access to critical health services • are developed and implemented through collaborative efforts. Local measures: 1. Community groups and stakeholders, including health care providers, are convened to address access to critical health services, set goals and take action, Standards for Public Health in Washington State Page 18 of 20 based on information about local resources and trends. This process may be led by the LHJ or it may be part of a separate community process sponsored by multiple partners, including the LHJ. • 2. Coordination of critical health service delivery among health providers is reflected in the local planning processes and in the implementation of access initiatives. 3. Where specific initiatives are selected to improve access, there is analysis of local data and established goals, objectives and performance measures. State measures: 1. Information about access barriers affecting groups within the state is shared with other state agencies that pay for or support critical health services. 2. State-initiated contracts and program evaluations include performance measures that demonstrate coordination of critical health services delivery among health providers. 3. Protocols are developed for implementation by state agencies, LHJs and other local providers to maximize enrollment and participation in available insurance coverage. 4. Where specific initiatives are selected to improve access, there is analysis of local data and established goals, objectives and performance measures. Table of Contents Standard 4 Quality measures that address the capacity, process for delivery and outcomes of critical health care services are established, monitored and reported. • Local measures: 1. Clinical services provided directly by the LHJ or by contract have a written quality improvement plan including specific quality-based performance or outcome measures. Performance measures are tracked and reported. 2. Staff members are trained in quality improvement methods as evidenced by training documentation. State measures: 1. Information about best practices in delivery of critical health services is gathered and disseminated. Summary information regarding delivery system changes is provided to LHJs and other agencies. 2. Training on quality improvement methods is available and is incorporated into grant and program requirements. 3. Regulatory programs and clinical services administered by DOH have a written quality improvement plan including specific quality-based performance 4. or outcome measures. Table of Contents Menu of Critical Health Services This menu identifies health services and health conditions or risks for which appropriate • services—screening, education and counseling, or interventions—are needed. General access to health services Ongoing primary care Emergency medical services and care Consultative specialty care Standards for Public Health in Washington State Page 19 of 20 Home care services Long-term care Health risk behaviors • Tobacco use Dietary behaviors Physical activity and fitness Injury and violence prevention (bike safety, motor vehicle safety, firearm safety, poison prevention, abuse prevention) Responsible sexual behavior Communicable and infectious diseases Immunizations for vaccine-preventable diseases HIV/AIDS Tuberculosis Other communicable diseases Pregnancy and maternal, infant, and child health and development Family planning Prenatal care Women, Infants and Children (WIC)services Well child care Behavioral health and mental health services Substance abuse prevention and treatment • Depression Suicide/crisis intervention Other serious mental illness Cancer services Cancer-specific screening (i.e., breast, cervical, colorectal)and surveillance Specific cancer treatment Chronic conditions and disease management Diabetes Asthma Hypertension Cardiovascular disease Respiratory diseases (other than asthma) Arthritis, osteoporosis, chronic back conditions Renal disease Oral health Dental care services Water fluoridation • Table of Contents Documents posted in .pdf version on the Department of Health Web site will be made available in an alternative format on request to users who are unable to download or view .pdf files on the Web. To request an_alternative format, contact: Webmaster. Standards for Public Health in Washington State Page 20 of 20 DOH Home I Access Washington I Privacy Notice I Disclaimer/CopyrightInformation Washington State Department of Health 1112 SE Quince Street, P.O. Box 47890, Olympia, Washington, 98504-7890 Last Update : 06/21/01 09:52 AM Send inquires about DOH and its programs to the Health Consumer Assistance Office Comments or questions regarding this web site? Send mail to the Webmaster. 1110 • • Board of Health Agenda Item # VI. • Standard 5 Access to Critical Health Care Services & Civic Engagement Grant March 20, 2003 • Critical Access Hospital Grant Application January 2003 —August 2003 Please send to: Robin Walker Office of Community and Rural Health PO Box 47834 Olympia, Washington 98504-7834 FAX: 360-664-9273 e-mail: robin.walker@doh.wa.gov 1. Project Title: Jefferson Civic Engagement Project 2. Project Summary: The Jefferson Civic Engagement Project combines the work of several groups and organizations and will establish a local community infrastructure to assure access to essential public health and personal health services. This will be accomplished by more effectively engaging the community in discussions and decision-making about local health priorities. The project will be overseen by the "Joint Board" of Jefferson General Hospital and Jefferson Board of Health. For the past two years, the Joint Boards have had a successful community partnership to improve the health of east Jefferson County residents. 3. Name of Sponsoring Entity: CAH Hospital(s); Local Health Jurisdiction(s): This is a joint project for Jefferson General Hospital and Jefferson County Health Department. Jefferson General Hospital is the lead agency. OVlailing Address: Jefferson General Hospital 834 Sheridan Port Townsend, WA 98368 5. Contact Person Name: Phone Number: Email Fax# Vic Dirksen (360) 385-2200 vdirksen(c�j h ory ��. (360) 379-2242 6. Universal Business Identifier: 600 154 888 Federal Employer Identification Number i l of l 7. Program Goals: Community Planning/Health Assessment • The e Jefferson Civic Engagement Project will use the MAPP planning model by: 1. Collating the extensive existing information about local health services and needs; 2. Supplementing this information by conducting a gap analysis on local critical service capacity; 3. Formulating goals and strategies that have strong community support; 4. Planning for implementation. The steps to accomplish this work will include: • Establish a Steering Committee to advise the Joint Board on project activities and act as a forum for the development of local health policy options. • Summarize existing east Jefferson County information pertaining to health status and the availability of health services. • Review and revise the menu of Critical Health Services developed by the State Board of Health to produce a customized local list of relevant community health services. • Prioritize services based on specific selected criteria. • Assess the availability of each critical health service and identify gaps between projected needs and current services. • Determine local priorities and strategies for filling key gaps identified. • Solicit community opinion on health priorities through community meetings and polling. • Work with State Board of Health (Dr. Thomas Locke the Jefferson County Health Officer is a SBOH Member) and Washington Health Foundation (Victor Dirksen, CEO of Jefferson General Hospital is a WHF Board Member) and others to tie Jefferson work into state-wide initiatives. • 8. Brief Work-plan including products or outcomes, activities, costs, and timelines Activity Title: Critical Access Community Report 2003 Activity Description: This community report will identify key information about the health of Jefferson County by combining information from several important sources. Sources will include: 2002 BRFSS data, State Board of Health Critical Health Services, Washington Health Foundation, Jefferson Access Project and others. The report will identify demographic and health status information as well as services available in Jefferson County and include a gap analysis for critical services. The purpose of the report is to bring together important information from various studies and activities and use as a background document that is accessible to the community at large. This activity will be conducted by consultants in collaboration with hospital and health department staff Deliverable: Report and executive summary. Timeline January 1 - April 30, 2003 Budget $5,000 - Budget will cover consulting contract to research and summarize existing data, conduct gap analysis, coordinate work with key hospital and health department staff and prepare information as written report and presentations to Joint Board and Steering Committee. Activity Title: Civic Engagement Steering Committee Svity Description: This work will establish an influential and knowledgeable group of residents will provide guidance to this project and continue Jefferson General Hospital and Jefferson Board of Health. Membership ir work as vof the isory tJo nt Board inc do the Joint dos es 2 of 2 elected hospital commissioners, county commissioners, Port Townsend City Council, at-large citizens. The Civic Engagement Steering Committee will include representatives from the Chamber of Commerce, paper mill, pastoral association, area agency on aging, community action council, Joint oard, health providers. eliverable: Well informed and influential group of residents with the ability to advise local elected officials about health priorities on an on-going basis. Timeline January 1 through August 31, 2003 Budget $2,000 -Budget will cover meeting expenses, materials,mailings and staff time to identify, recruit and brief steering committee members. Activity Title: Community Discussions Activity Description: Community Discussions will include a series of facilitated meetings to engage existing community groups in a dialogue about the need for setting community health priorities. This work will be coordinated with the Washington Health Foundation and Human Links Health Choices projects and will be the first step in producing a local list of critical and essential community health services. Deliverable: Written summary of community discussions and community views. Timeline May through June, 2003 Budget $3,000 - Budget will cover health department and hospital staff time to prepare, organize, conduct and summarize 5-10 community meetings. Activity Title: Community Poll on Health Priorities • ctivity Description: Conduct a random survey of east Jefferson residents to assess views on local filth priorities, support for specific health initiatives and key determinates of adequate access for specific local services. Deliverable: Report for local policy makers and health care providers identifying levels of public support for specific initiatives and priorities. Timeline July 1 through August 1, 2003 Budget $8,000 -Budget will cover health depaitment and hospital staff time as well as consulting time to prepare survey questions, conduct telephone poll, analyze findings and prepare deliverable written report. Activity Title: Civic Engagement Project Coordination and Support Activity Description: Provide staff and contract support for both Jefferson General Hospital and Jefferson County Health Department to conduct project. Deliverable: Coordination of work, meeting scheduling, support staff, production of written materials, grant compliance. Timeline January 1 through August 31, 2003 Budget $6,000 - Budget will cover indirect administrative costs, grant monitoring and compliance, consultant contracting, communications and coordination of activities. iiiotal Grant Request: $24,000 3 of 3 Washington State Board of Health Access to Critical Health Services Final Report July 2001 Commitee on Access. ss•. Tom Locke, M.D. , M.PH M.P.H. ? } Ed Gray, M.D. 51_arE r _ �t oma, €18 N9 This report describes the Washington State Board of Health's work on access to critical health services during the 1999-2001 biennium. It contains Recommended Critical Health Services for Washington State Residents, which the Board adopted on September 13, 2000, and Critical Health Services Explained: A Guide to the Menu of Critical Health Services, which the Board reviewed on July 11, 2001. For additional copies or more information, contact the Board staff at: 1102 SE Quince Street PO Box 47990 Olympia, WA 98504-7990 Telephone: (360) 2364110 Fax: (360) 2364088 E-mail: wsboh@doh.wa.gov Web site: www.doh.wa.gov/sboh/ CZ/ Printed on recycled paper containing 30 percent post-consumer waste. • Table of Contents \ � Executive Summary 4 < . . < . / Critical Health Services Explained 6 Recommended Critical Health Services for Washington Residents 10 \ \/ Adopted Menu of Critical Health Service Items 11 Threshold Requirements and Criteria 14 About the Washingon State Board of Health 15 S a« y= �«: » y, /t.4te 11. Executive Summary People's health suffers when they do not ing in the elimination of third-party have access to the individual health coverage for services that have impor- services they need. Communities suffer tant public health benefits. when these services are not available to significant numbers of their residents. In To respond to the needs of the public Washington, state and local health health system, and to concerns about jurisdictions monitor access to critical adverse public health impacts from cost- health services and work with the health containment strategies, the Board cre �o ? care system—including insurers, medi- ated a Committee on Access that com- '' cal facilities, and health practitioners— prises two Board members, Tom Locke, to identify gaps in access and find ways M.D., M.P.H. and Ed Gray, M.D. During to reduce them. the 1999-2001 biennium, the committee identified a menu of core services. In k ..r This role, integral to public health's doing so, it set out to answer the key mission of preventing illness andro p question: Which health services are -• moting health, is explicitly included in truly essential for maintaining indi- - the Public Health Standards for Wash- vidual and community health? The • ington State developed by the Public result is Recommended Critical Health Ilealth Improvement Partnership.' Services for Washington State Residents, Vis_. Those standards stipulate that informa- a menu of services adopted by the Board tion should be available at the state and on September 13, 2000. local level about "a core set of critical -' health services that are necessary to MCPP Consulting compiled the protect the public health." They also call menu under contract to the Board, with on public health jurisdictions to provide funding provided by the Board and the referrals for clients who need these Public Health Improvement Partner- - • services, and to mobilize their communi- ship. This list was assembled by a team :" ties to reduce gaps in the availability of of independent medical professionals �� � services. and health care consultants using na = tional research regarding the impact of The Washington State Board of health services on individual and com- Health has been serving as the lead munity health without regard to funding agency at the state level in the develop- or payment. ment of public health standards relating to health care access. The two primary source documents were: ` The Board feels it is important to focus attention on a core set of critical 1. U.S. Department of Health and health services because of growing finan- Human Services, Healthy People • cial pressures in the health insurance 2010, January 2000 market and the health care delivery • system. A consistent theme in public ii 2. United States Preventive Services �" testimony to the Board in recent years Task Force, Guide to Clinical has been that cost pressures are result- Preventive Services, 2"d edition, 1996 No service appears on the menu as described in the PHIP standards, ,4141-41 III unless the provision and availability of should be available in each community. the service is thought to have a predict- These essential services include control able and demonstrated benefit to the ling the spread of communicable dis health status of the community-at- eases, educating the public about large—or the absence of this service is healthy lifestyles, and ensuring the thought to adversely affect the health safety of the air we breathe, the food we status of the community-at-large. eat, and the water we drink. • '� Any health service that met this The Board intends that the menu be threshold condition was then measured reviewed and updated periodically as against four criteria: new evidence and information becomes available. The Board approached this • This service addresses a health work from a population-based perspec- issue whose impact or potential tive. The need for specific services by impact on the population is known individuals should be determined on a to be great—either in terms of case-by -case basis, with consideration relative prevalence/incidence or in given to age, gender, risk factors, specific , terms of degree of risk for the diagnoses, medical necessity, and poten- ~ � community-at-large for events or tial risks and benefits. conditions that occur less fre- � quently. The Board recognizes that a single, standardized list of health services • Key national research, standard- would not serve the needs of every local • setting and policy-making bodies jurisdiction. Significant local consider this service important differences p exist in community attitudes, and a relatively high priority. population, geography, health service • There is strong evidence, through capacity, provider availability, and more. For this reason, the Board offers a true national or state research and/or . "menu" of services that can inform local '- evaluation, that the service is efforts to develop lists that are safe, effective, and/or cost-effec- responsive to local needs. tive. During 2001-2003, the Board will • Policymakers, providers, and the , collaborate with local health juris- public would agree (more likely dictions to develop than not) that the service is im and use localized lists, explore ways to incorporate the portant and necessary. menu into the creation of an insurance product, and develop a list of per- -",§ Services included on the menu were judged to have met these criteria. The formance measures for assessing access. R -: PHIP Steering Committee and the ' Board reviewed the menu before adop- ' The Public Health Improvement Partnership tion. is a collaboration of local health jurisdictions, -- the Board, the Department of Health and the Northwest Center for Public Health Practice at The list specifically addresses per- the University of Washington. The partnership sonal health care services. The Board was formed to develop and implement the bien- • assumes, for the purposes of this menu, nial Public Health Improvement Plan passed into r �- law in 1995 that the full set of public health services, nom; Critical Health Services Explained On Sept. 13, 2000, the State Board of The Board also created the menu to Health adopted Recommended Critical support the efforts of more than 100 Health Services for Washington State health professionals at the state and Residents.' The following questions and local level who have collaboratively answers explain the reasons for creating developed the Standards for Public the menu, its content, and how it might be Health in Washington State.3 The used. standards outline what our health officials believe must be in place -.,- 4 What is the menu of critical everywhere in Washington to provide health services? adequate public health protection. The standards detail the specific steps our These are health care services the Board state and local public health agencies has identified as essential to the health should take to monitor and report on our of the community at large. The Board entire population's health, to respond • �- _ quickly and effectively to disease believes that when health purchasers outbreaks, to protect us all from unsafe and policy makers decide which medical and unhealthy environmental conditions and public health services they will in our food, air and water, and to make available, they should consider the strengthen communitywide health services on this menu as high priorities promotion and disease prevention r 'tow for all Washington communities. efforts. Why a menu? Why now? A final section of the standards out- lines public health's role in assuring access The Board has a longstanding interest in to "critical health care services." Again the ensuring that all Washington residents question arises: Access to what? The • have access to health care services that standards call on the state and each cora- '!" F are necessary from a public health munity to determine a specific set of perspective. It is difficult to talk about critical health services. Once a commu- promoting access without first being pity-based set of services has been defined, able to answer the question: Access to the standards call on local health what? One reason the Board developed jurisdictions to maintain and disseminate this menu was to encourage a dialogue— information about the availability of these both within the public health community critical health care services, to provide ` and among the regulators and referrals for clients who need these purchasers of health care. It is theservices, and to mobilize their Board's hope that participants in that communities to reduce gaps in the discussion will be able to articulate availability of services. which of the many available health care e" services are truly critical to every community's health. �cx w ae�ss • How does this relate to What determined whether statewide public health a service would be on the improvement efforts? menu? Since the Legislature established the No service is on the menu unless public health improvement process in providing that service would be 1995, the Board has been a member of expected to have a demonstrable the partnership that produces the Public benefit to the community at large— Health Improvement Plan (PHIP).4 The or its absence would be expected to goal of the partnership is to create a harm the health of the community. public health system that will increase Each service also had to have its the level of protection from effectiveness documented by environmental and communicable scientific research and be broadly disease health threats and improve the supported by health experts and health of Washington state residents professional organizations. through effective use of health promotion, community assessment data, The following criteria were used to and personal health care services. One assemble the list: element of the PHIP work plan for 1999- 2001 was to develop a "menu of critical 1 The degree of impact or services." The Board took on that project potential impact on the as its contribution to the PHIP. The community's health. • Board's menu serves as a starting point for the state and local health 2. The level of agreement among jurisdictions to begin work on national research, standard community-specific sets of critical health setting, and policy-making services. Those sets will then provide a bodies that providing the framework for efforts to assess the service is an important and availability of services and mobilize relatively high priority. communities to improve access. 3. The strength of the evidence that the service is safe, Who created the menu? effective, and cost-effective. A team of independent medical 4. The likelihood that there professionals and health care research would be agreement among consultants produced the menu under policy-makers, health providers, the direction of the State Board of and the public about the Health. The consultants relied on importance of the service. current research findings and the authoritative thinking of national experts who have analyzed public health priorities. The PHIP Steering Committee and the Board reviewed the menu before adoption. • 1 What types of services are 7. Dealing with chronic conditions included? and improving disease management (for example, ' treating diabetes, asthma, and The services fall into eight general chronic heart disease). categories: 8. Improving people's oral health 1. Making sure that people have (for example, screening children general access to health services for oral disease and encouraging (for example, they are able to see use of fluoride to prevent tooth a primary care physician and can decay). get home health care if needed). 2. Preventing risky behaviors and So is this simply a list of •: encouraging healthy behaviors critical health issues? (for example, educating people about the dangers of smoking and The menu goes beyond that. encouraging healthy diets). First, it identifies target populations 3. Treating and preventing the for each menu item. For example, it spread of communicable and includes screening for serious mental infectious diseases (i.e., screening illnesses only for people at high risk; for tuberculosis and providing screening the general population is not immunizations for vaccine- on the menu. And while the menu preventable illnesses). includes efforts to decrease tobacco use among the general population, it ;, 4. Protecting the health of mothers, specifically includes prevention infants and children (for example, programs aimed at teens. �;, making sure pregnant mothers get good nutrition and providing Second, the menu specifies the type well-child checkups for young of service that is needed—screening, , iix children). education and counseling, or medical intervention. For example, it does not .t 5. Improving behavioral health and recommend screening or medical caring for people with mental intervention for unhealthydietary illnesses and disorders (i.e., d behaviors, but it does recommend _ r • preventing alcohol abuse and counseling and education. „ g providing intervention services for people who are suicidal). The menu also considers whether there is a need for infrastructure 6. Detecting cancer early and improvement or policy change. treating it effectively (for Infrastructure focuses on the availability - example, providing screenings to and distribution of providers, facilities, detect breast cancer early and and services throughoutthe state—are specialty care for treatment of needed services available from qualified with various people types of providers within a reasonable distance? cancers).) Policy on critical health services deals with decisions made by elected officials, mow. 1 • public agencies, health care providers, No, though the four criteria listed above and insurance purchasers that affect may be used in the future to rank-order the availability and quality of needed the menu. services. For example, a law making it more difficult for minors to purchase How might the menu be tobacco products would decrease teen used? tobacco use. Similarly, requiring insurers to cover mental health visits would increase access to behavioral • By measuring access to these and mental health services. specific services, researchers can determine the degree to which Why are some services state residents have access to critical health services—and that seem important not whether initiatives such as PHIP on the menu? result in better access and better health. Not everything that may be good for people's health is on this menu. For • Policymakers can use this menu some conditions, the degree of risk for to guide a community discussion the entire community is relatively to reach agreement about which small. Or there may be some services, if any, should be uncertainty about the safety or uniformly available. effectiveness of particular services. • Local health jurisdictions can use • Just because a service is not listed on this menu as a model from which the menu does not mean it is lacking to build local menus of critical in benefit for some people, only that health services. Those commu- it did not meet the rigorous selection nity-specific menus could then criteria used to determine the menu inform efforts to mobilize the of critical health services. community to improve access. For example, the menu does not • Policymakers may want to use include complementary and this menu to help set priorities alternative medical care (such as and guide policy choices. naturopathic and chiropractic services). Remember that the menu • Public and private employers may is a starting point for setting want to use this menu to shape community-specific priorities. the insurance coverage they Community leaders are free to add or purchase for their employees. subtract from this menu. Is the menu prioritized? 2 http://www.doh.wa.gov/sboh/Priorities/Access/ CriticalHealthList.pdf http://www.doh.wa.gov/standards/default.htm ' http://www.doh.wa.gov/Publicat/2000_phip/ 2000_PHIP.htm 410 -:* Recommended Critical Health Services for Washington State Residents Topic, Target Population, & Service Type Context Key Source Documents The Proposed Standards for Public Two sources provided the primary Health in Washington State' include a guidance for inclusion of items in this section focused on Access to Critical menu: Health Services. The intention of this section of the standards is to ensure that 1. Healthy People 2010, U.S. information is collected about a set of Department of Health and critical health services for purposes of Human Services, January 2000 monitoring, assessment of performance, identification of opportunities for 2. United States Preventive Services improvement, and community Task Force, Guide to Clinical mobilization efforts to ensure access to Preventive Services, 2nd edition, services and to address needs. In order 1996 to carry out the standards, it is first Contents necessary to define a set of critical health services, which will become the � Adopted Menu of Critical Health platform for assessment and action. The Service Items: Services are following menu of critical health services named by clinical or health topic has been adopted by the Washington in the left column. Other columns State Board of Health and will serve as indicate whether the service is this set. targeted for the general This menu is meant to be periodi population and/or a sub- tally reviewed and updated as new population with specific risk service— evidence and information becomes avail factors, and the type of able. The perspective of this work is whether screening/testing/ assessment; counseling,/education/ population-based. However, need for and education/ access to any of the proposed services is support; or intervention. determined by the individual patient/ ♦ Threshold Requirements and consumer circumstance—considering Criteria: This is a summary of age, gender, risk factors, specific diag- considerations and criteria that noses, clinical appropriateness, and have been applied in the selecting medical necessity. services to be included in the menu. The Standards for Public Health in. Washington ` 3 State were finalized subsequent to the adoption of this document. 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' ,477,74.1 iVi n .d .,,-. 1'; - °. ire 1 "ii'l t� vv . 'r. • . '. . .t �. �.2 a Vim.*, om, Degree of Impact This service addresses a health issue whose impact or potential impact on the population is known to be great- either in terms of relative prevalence/incidence or in terms of degree of risk for the community-at-large for events or conditions that occur less frequently. k s National Agreement Key national research, standard-setting and policy-making on Priority bodies consider this service important and relatively high � priority. � � Strength of Evidence There is strong evidence through national or state research ` and/or evaluation of the service's safety, effectiveness, and/or cost-effectiveness.' ' Likelihood of This service would be (more likely than not) agreed-upon ��:- Agreement by policy makers, providers, and the public as important and (vs.Divisiveness) necessary. , yg ,' S e �i , a x"'S P.:--7'''''t. :,'",.",'",::':''''''7`.:(,. ' 1"- ' ur, b `} e€ 1 ,-c:." s Y. 1,0“,:-;,'. 'u3 i3O. t Q =J, 4 tal`, + `3 's k 7`4te : IS About the State Board of Healthti The State Board of Health serves the citizens of Washington by working to under- stand and prevent disease across the entire population. Established in 1889 by the State Constitution, the Board provides leadership by suggesting public health policies and actions, by regulating certain activities, and by providing a public forum. The governor appoints ten members who fill three-year terms. 4likA Board Members Ed Gray, M.D., is health officer for the • � ` Northeast Tri-County Health District .fir" Consumers . and chair of the Basic Health Plan Advi- , Linda Lake, M.B.A, Chair, has 25 years sory Committee. of experience in the field of health and Carl S. Osaki, R.S., M.S.P.H., former • x social services. She has directed several '` director of environmental health for community health and social service Public Health—Seattle & King County, ,, organizations, including the Pike is on the faculty at the University of • . a Market Medical Clinic. Washington. *' Joe Finkbonner, R.Ph., M.H.A., is an Vicki Tbarra R.N. M.P.H. is director independent consultant on Native of planning and development for the f;R44-i American health issues. He has served Yakima Valley Farm Workers Clinic. �" as chair of the American Indian Health Much °1 x 14N, of her work is dedicated to Commission and director of the Lummi supporting children and families. LIFE Center. 4110 Local Health Officers Elected County Officials Thomas H. Locke, M.D., M.P.H., is The Honorable Neva J. Corkrum, Vice health officer for Clallam and Jefferson Chair, is a Franklin County commission- counties and medical director of the Port er and member of the Benton-Franklin Gamble S'Klallam tribal health program. Health District Board of Health. Board Staff Elected City Officials Don Sloma, M.P.H., Executive Director The Honorable Margaret Pageler, J.D., is president of the Seattle City Council Craig McLaughlin, M.J., Senior Health and a member of the Board of Public Policy Manager Health in Seattle and King County. Doreen Garcia, M.P.P., Senior Health Department of Health Policy Advisor MarySeleckyMarianne Seifert, M.A., Health Policy is secretary of the Advisor Washington Department of Health and former administrator of Northeast Tri- Desiree Day Robinson, Executive County Health District. Assistant to the Board Health and Sanitation Jennifer Dodd, Assistant to the Board Charles R. Chu, D.P.M., a practicing podiatrist, is president of the 4111 Washington State Podiatry Independent Physician Association. ' 4 •0 SfiAr`E r ;ren w4.� ,,, , , ,,,, .,$ �� x889 e Washington State Board of Health 1102 SE Quince St. PO Box 47790 Olympia, WA 98504-7990 Telephone: (360) 236-4110 Fax: (360)236-4088 E-mail: wsboh@doh.wa.gov Web: www.doh.wa.gov/sboh/ • • Board of Health Agenda Item # VII. • BOH Operational Issues and Meeting Structure March 20, 2003 • z M • BYLAWS OF THE JEFFERSON COUNTY BOARD OF HEALTH ARTICLE 1. NAME The name of this organization shall be the Jefferson County Board of Health. ARTICLE H. PURPOSE The purpose of the Jefferson County Board of Health is to supervise all matters pertaining to the preservation of the life and health of the people of Jefferson County and to comply fully with the requirements of all applicable chapters of Title 70, Revised Code of Washington. The Board of Health shall: • Collect, analyze and disseminate to the community, through the Jefferson County Health& Human Services department, information about community health conditions, risks and resources, and the availability of 110 resources to address identified problems. • Enact such rules, regulations and policies as are necessary to preserve, promote and improve the health status of Jefferson County residents, and guide the allocation of appropriate and necessary public health resources. • Assure that necessary, high quality, effective public health services are available for the protection of the people of Jefferson County, including the control and prevention of any dangerous, contagious or infectious disease within the county. • Provide for the prevention, control and abatement of nuisances detrimental to public health. • Enforce, through the Health Officer, the public health statutes of the state and county. • Establish fee schedules for issuing and renewing licenses and permits, or for such other services as are authorized by the law and rules of the State Board of Health. S Jefferson County Board of Health Page 2 Bylaws • ARTICLE III. REPRESENTATION Membership: The Board of Health shall consist of 7 members, selected as follows: • Each member of the Jefferson County Board of County Commissioners shall serve as a member of the Board of Health for the duration of their elected term of office. • Four members of the Board of Health shall be appointed by the County Commissioners. Appointed members shall include one Port Townsend City Council Member and one Jefferson County Public Hospital District #2 Commissioner nominated by their respective organizations, plus two at-large community representatives. Terms: Appointed members shall serve for three year terms. Board of Health members may serve more than one term, including consecutive terms. Vacancies: In the event that a vacancy occurs for an appointed representative,the Board of County Commissioners shall appoint another representative within thirty (30) days of the date of vacancy. In the event that a vacancy occurs from the Port Townsend City Council or Jefferson County Hospital District #2,the City or District shall nominate another representative from their membership within thirty(30) days. Absences: Board members shall notify the Chairperson in advance if unable to attend any regular meeting of the Board of Health. Appointed Board members may • be removed from Board membership by action of the County Commissioners for lack of attendance. Three or more unexcused absences from regular Board of Health meetings in one calendar year will be considered cause for removal. ARTICLE IV. OFFICERS Chairperson: The presiding officer of the Board of Health shall be the Chairperson, who shall serve for a term of one (1)year. The Chairperson shall be selected by a majority vote of the Board members present at the first regular meeting of each year. Vice-Chairperson: At the same meeting, a Vice-Chairperson shall also be selected for a term of one (1) year, who shall preside over all proceedings of the Board in the absence of the Chairperson. Vacancies: In the event of a vacancy in the office of Chairperson, the Vice- Chairperson shall immediately assume the duties of the Chairperson for the remainder of the year. Another representative shall be selected to serve as Vice-Chairperson at the next regular or special meeting of the Board. Consecutive Terms: Board members shall not serve consecutive terms as Chairperson or Vice Chairperson. • Jefferson County Board of Health Page 3 Bylaws ARTICLE V. RULES OF BUSINESS • Business shall be conducted in accordance with the most current edition of Robert's Rules of Order, so long as they are consistent with these Bylaws or amendments thereto. ARTICLE VI. COMMITTEES The Chairperson shall appoint subcommittees from the Board of Health and/or members of the community from time to time as the Chairperson shall deem necessary. The Chairperson shall be an ex-officio member of all committees. ARTICLE VII. ADMINISTRATIVE OFFICER The Board of Health shall appoint an Administrative Officer who shall fulfill the responsibilities specified by RCW 70.05.045, including administering the operations of the Health Department. The Administrative Officer shall serve at the will and approval of the Board. ARTICLE VIII. HEALTH OFFICER The Board of Health shall appoint a County Health Officer, who shall be a qualified physician trained and experienced in public health, who shall exercise the • powers, and perform the duties prescribed in RCW 70.05.070. The Health Officer shall serve at the will and approval of the Board. ARTICLE IX. OPERATING RULES Section 1. Meetings Regular Meeting: Regular meetings of the Board of Health shall be held on the third Thursday of each month. If the third Thursday is a legal holiday, an alternate day may be selected by the Chair. Any regular meeting of the Board of Health may be cancelled with the concurrence of a majority of the Board. The location of the meetings shall be within Jefferson County. Special Meeting: The Chair or two-thirds of the members of the Board may call a special meeting of the Board consistent with RCW 42.30.080. Executive Session: The Board may hold executive sessions from which the public may be excluded for the purposes set forth in RCW 42.30.110. Quorum: A majority of all Board members, including at least two Jefferson County Commissioners, shall constitute a quorum for Board meetings. Tape Recordings: The proceedings of all Board meetings shall be recorded electronically. Any person may have a copy of tape a recording of any meeting of the Board by furnishing an appropriate recording tape to the Health Department • Director's office and paying the costs of reproduction. Jefferson County Board of Health Bylaws Page 4 Minutes: Written minutes of each Board meeting shall be prepared and approved • by the Board at the subsequent regular meeting. Minutes shall be signed by the Chair at the time of their approval by the Board. Meetings Open to Public: All regular and special meetings of the Board and Board committees shall be open to the public, in accordance with RCW 42.30_ Materials to Board Members: Except in cases of emergency, the agenda and materials related to action items shall be sent to Board members in advance of the meeting at which the items will be considered. Section 2. Voting Actions Requiring a Vote: Each member of the Board shall be entitled to one vote on all actions of the Board that require a vote. An affirmative vote of a majority of Board members shall be required to pass an action of the Board, provided that a quorum of the Board is present. Tie Vote: In the event of a tie vote,the action does not pass. Voting By Proxy: There will be no voting by proxy on any question before the Board. Section 3. Ethics Conflict of Interest: Members of the Board of Health having personal or professional interest on an action item that may be deemed conflicting or infringe upon the appearance of fairness shall declare the conflict and refrain from discussing or voting on such matters. Section 4. Public Testimony General Public Comments: At each meeting, according to the usual order of business, the Chair shall call for general comments. Persons wishing to comment shall give their name. The Chair may establish time limits for individuals who wish to speak. Comments on Action Items: Prior to voting on any item requiring action by the Board, the Chair shall call for comments by persons interested in or affected by the matter under consideration before the Board. Persons wishing to comment on action items shall give their name, and the Chair may establish time limits for individuals who wish to speak. ARTICLE X. MISCELLANEOUS Reimbursement of Expenses: Board of Health members may receive reimbursement for approved expenses related to completion of their responsibilities. i r Jefferson County Board of Health Bylaws Page 5 ARTICLE XI. AMENDMENTS TO BYLAWS 11111 These Bylaws can be amended at any regular meeting of the Board by two-thirds (2/3) vote, provided the amendment has been submitted in writing to the Board of Health at least ten (10) days prior to said meeting. ADOPTED the 20th day of November, 1997 Chairperson, Jefferson County Board of Health • L L ' L' " .Lt.. • STATE OF WASHINGTON JEFFERSON COUNTY ;(!iHE ALTH & In the matter of an Ordinance ) Defining the Responsibilities and ) Expanding the Membership ) ORDINANCE NO. 03-0505-97 of the Jefferson County ) County Board of Health ) WHEREAS: Pursuant to RCW 70.05.030,the Board of County Commissioners has constituted the Jefferson County Board of Health. WHEREAS: Section 6 of RCW 70.05.030 and 1993 c 492 s 235 were each amended in 1995 to include the following: The board of county commissioners may, at its discretion adopt an ordinance expanding the size and composition of the board of health to include elected officials from cities and towns and persons other than elected officials as members so long as persons other than elected officials do not constitute a majority. An ordinance adopted under this section shall include provisions for appointment, term, and compensation, or reimbursement of expenses. WHEREAS: The health and safety of the citizens of Jefferson County,and the condition of their living environment,are of paramount importance to the County's well being. WHEREAS: The Board of County Commissioners,sitting as the Board of Health,determined at its February 25, 1997 meeting that the addition of persons with knowledge, interest, and expertise regarding the health,safety,and well-being of Jefferson County citizens and their living environment would benefit the operation of the Board of Health and the citizens of Jefferson County. NOW,THEREFORE, BE IT ORDAINED That the Board of County Commissioners after due deliberation and in the best interest of the public,does hereby expand the size and composition of the Jefferson County Board of Health. BE IT FURTHER ORDAINED That Title 8,Health and Safety,of the Jefferson County Code be amended to include a new Chapter 8.00,Board of Health,defining the responsibilities and membership of the Jefferson County Board of Health,as follows: 8.00.010 Duties and Responsibilities: The Board of Health shall have responsibilities over all matters pertaining to the preservation of the life and health of the people of Jefferson County and shall: (1) Collect,analyze and disseminate to the community,through the Jefferson County Health&Human Services department, information about community health conditions, risks and resources,and the availability of resources to address identified problems; (2) Enact such rules,regulations and policies as are necessary to preserve,promote and improve the health status of Jefferson County residents,and guide the allocation of appropriate and necessary public health resources; (3) Assure that necessary,high quality, effective public health services are available for the protection of the people of Jefferson County, including the control and prevention of any dangerous,contagious or infectious disease within the county; (4) Provide for the prevention,control and abatement of nuisances detrimental to public health; (5) Enforce,through the Health Officer,the public health statutes of the state and county; and (6) Establish fee schedules for issuing and renewing licenses and permits, or for such other services as are authorized by the law and rules of the State Board of Health. ,' Ordinance No.03-3505-17re: Board of Health 8.00.020 Members: The Board of Health shall be composed of seven members. The three elected members of the Board of County Commissioners shall be members of the Board of Health. Four members of the Board of Health shall be appointed by the County Commissioners. Appointed members of the Board of Health shall • include one elected official from the City of Port Townsend City Council and three non-elected community representatives. Community representatives shall include one resident of the City of Port Townsend and two residents of unincorporated Jefferson County. One community representative shall be a Jefferson County Public Hospital District#2 commissioner;two community representatives shall be at-large members. 8.00.030 Terms: Appointed members shall serve for three year terms. Of the members initially appointed, an equal number shall be appointed for two years and for three years. The term of office for all appointees shall commence on the first day of June in the year in which the term is to commence. 8.00.040 Appointment: The chairperson of the Board of County Commissioners shall appoint the initial members to the Board of Health with the approval of the majority of the Board of County Commissioners. The Board shall request that the City of Port Townsend and Jefferson County Public Hospital District#2 each nominate one candidate for appointment to the Board of Health. The County Commissioners shall seek applications from citizens of Jefferson County to fill the at-large membership positions on the Board of Health. 8.00.050 Vacancies: Vacancies on the Board of Health shall be filled by appointment by the chairperson of the Board of County Commissioners in the same manner as initial appointments are made. Appointments shall be for the unexpired portion of the term of the position filled. 8.00.060 Organization: The Board of Health shall elect a chairperson and vice-chairperson from among its members. 8.00.070 Meetings: The Board of Health shall hold no fewer than one regular meeting in each month of each year;provided that if no issues over which the Board has jurisdiction are pending upon its calendar,a meeting may be canceled. All meetings of the Board of Health meetings shall be open and public,pursuant to the Open Public Meetings Act,codified at RCW 42.30 et seq. Meetings shall be held at such times and at such locations as to be convenient for attendance by Board of Health members and the public,as determined • by a Resolution passed by a majority of Board of Health members. 8.00.080 Rules and Record of Proceedings: The Board of Health shall adopt Bylaws for the transaction of its business. No actions shall be taken by the Board of Health unless a majority of members are present, including at least two Jefferson County Commissioners. The Board of Health shall keep a public record of its transactions,findings and decisions. 8.00.090 Compensation or Reimbursement: Appointed members of the Board of Health shall not receive compensation for their services. Appointed members may receive reimbursement for approved expenses related to the completion of their responsibilities. BE IT FURTHER ORDAINED That such amendment shall be effective immediately upon execution of this document by the Board of County Commissioners. # -) APPROVED and ADOPTED this . ) day of /'k-aq , 1997. SEAL: 4 l ' , ' JEFFERSON CO T'' CO 1 Jr ;A -7d Wojt, Chairman 1 4. .). J•<1 Irl 4‘ ATTEST:,,,-, \-1' --f --- Glen�iuntingford, �..�!�er / .6-IA-W- 0 Lorna Delaney,CMC ,i----- Dan Harpole,Me II- Clerk of the Board ,,J •Legislative Tracking Page 1 of 9 , O� Washington State Association �' 't' e of . 0 Eg--.77a N7,70A ��. Local Public Health Officials aS WSALPHO 2003 LEGISLATIVE TRACKING BILL# COMPANION DESCRIPTION COMMITTEE( HEARING/ MONITOF DATE 1002 5124 Reduction of Mercury in House 2nd Reading Jim Environment Creating the research & 1003 Technology transfer commission House Appropriations Maggie - Would take 10% of annual tobacco settlement payments. 1007 Establishing a permitting bill State Government Jim of rights. Limiting the liability of 1051 5820 volunteer providers of Judiciary Sandy emergency or medical services Requiring insurance plans to 411 cover neurodevelopmental 1067 therapies for individuals age Health Care Kathy 18 and under. Requiring a vote on any local 1068 ordinance providing for Local Government Federico fluoridation. Changing the age of consent for minors receiving chemical Juvenile Justice & 1070 dependency and mental health Family Law Maggie treatment from 13 to 16 years of age. 1077 Regulating carrying animals or Transportation Rick persons in pickup beds. 1115 Establishes an arthritis pilot House Health Care DOH project. Exempts certain chicken House Agriculture & 1125 processors from regulation Natural Resources Jim 1127 Retail Sales of Sturgeon & House Rules R Jim Tuna Managing confidential records 1153 5275 as transferred to State House 2nd Reading DOH Archives. Requiring Medically Accurate 1178 5314 information in sex education House 2nd Reading Kim 411 courses. Eliminating Boards & Senate Gov. Ops. & 1213 Commissions Elections Vicki Making 2001-03 Supplemental 1235 5403 Operating Appropriations - By House Appropriations Vicki & request of Gov. Locke Rick i I I n II Legislative Tracking Page 2 of 9 12551 'Modifying beer excise tax 11House Finance pick 1265 Providing local government financial assistance. House Appropriations Vicki 12971 5335 Defining "motorcycle helmet" . House Transportation Rick Providing for evidence-based 1299 health services purchasing by state purchased health House Rules R DOH programs. Substitute Bill Ensuring that agency rules do 1309 not exceed their statutory House State Government DOH authorization. Providing businesses with 1310 notice of administrative House Appropriations DOH rules. Limiting the rule-making authority of certain entities 1312 to those instances where there House State Government DOH is a specific grant of legislative authority. Delaying the effect of significant legislative rules. 1314 5052 It basically delays rule implementation until House State Government DOH Legislature has a change to review. Prohibiting agencies from adopting rules that exceed federal standards without 1315 5053 legislative authority. Agency must provide written House State Government DOH documentation as to why federal standards should be exceeded Allowing the State Board of Health to reference the United 1318 States Food and Drug House 2nd Reading S Administration's food code for Cal. Randy purpose of adopting food service rules. Proposed operating budget for 1366 5404 2003-05 by request of Governor House Appropriations Vicki & Locke. Rick Protecting children from 1408 5243 material that is harmful to House Judiciary Maggie minors. Creating the children's 1412 5060 environmental health and House Fisheries, Ecology & Parks SBOH protection advisory council. 110 Consolidating state functions that are necessary to 1446 implement the 2003-05 omnibus House Appropriations Vicki & operating appropriations bill. Rick By requst of OFM I I I II I I •Legislative Tracking Page 3 of 9 Making human services-related 411111 statutory changes necessary to 1447 implement the 2003-2005 House Appropriations Kathy omnibus operating appropriations bill. By request of OFM. Clarifying the scope of 1493 5327 practice of a dental House Health Care Sandy hygienist. Restricting Utility 1524 Assessments and charges for House Local Government Kim certain mobile home parks. Requiring the Governor's 1531 signature on significant House State Government DOH legislative rules. Prohibiting smoking in publicly owned residence halls 1532 at public institutions of House Rules R Federico higher education. Providing for consolidation of 1545 early learning and child care House Appropriations Sandy programs. Using fees to develop and 1578 5545 maintain a web-based vital House Rules R DOH records system. Prohibiting tobacco product 1598 5110 sampling House Rules R Federico Increasing the number of health care facilities that 1604 are prohibited from requiring House Commerce& Labor Rick employees to perform overtime work. House Fisheries, 1618 Wood Smoke Pollution Ecology & Parks Ward 1638 Concerning Hepatitis C House Health Care Kim Modifying medical information 1642 exchange and disclosure House Judiciary Rick provisions. Requiring approval before 1646 adding fluoride to public House Local Government Federico water systems. 1705 Funding for Tire Recycling House Fisheries, Ecology, and Jim Parks Revising environmental review provisions to improve the 1707 development approval process House Local Government Art and enhance economic development. 1718 Revising provisions relating House Juvenile Justice & Kathy to treatment of minors. Family Law 1749 Relating to withdrawals of House Agriculture & Natural Art public ground waters. Resources I I I _ Legislative Tracking Page 4 of 9 Concerning the slaughter, House Agriculture & Natural 1754 preparation, and sale of Jim certain poultry. Resources 1756 5659 Authorizing additional funding for local governments. House Finance WSAC/V� 1758 Concerning the slaughter, House Agriculture & preparation, and sale of Jim certain poultry. Natural Resources Authorizing an additional 1762 motor vehicle registration fee to fund environmental House Transportation Lou protection or cleanup. Improving coordination of 1784 services for children's mental House Children & Family Kathy health. Services 1791 5317 Safe Storage of Firearms House Judiciary Kim Relating to alteration of 1817 health care information in House Health Care Sandy medical records. Relating to provision of meningococcal immunization 1827 5828 information to first-time studens by degree-granting House Health Care Ward postsecondary educational institutions III Providing flexibility for fire Maggie 1837 protection districts - Pt. House Health Care work Roberts Only closely with DOH Relating to the funding of House Children & Family Kathy 1841 prevention and early y intervention services. Services 1866 Relating to nutrition in public schools. House Health Care Kathy 1868 5791 Prohibiting smoking in public places House Health Care Federico Relating to required use of 1874 helmets with nonmotorized House Transportation Rick vehicles. Enacting procedural 1930 5852 enhancements to the master House Finance Federico settlement agreement. Removing restaurants from the 1956 provisions of the clean indoor House Health Care DOH air act. 1964 Residential use of ground House Agriculture & III water Natural Resources Art Changing age of consent for 1965 minors receiving outpatient House Juvenile Justice & Kathy mental health treatment. Family Law Authorizing local governments 1Q70to rcetrint nr r‘rnhil,it unrcr. T.nnml nr,rornmoni- V0,70,,.;,,,, •Legislative Tracking Page 5 of 9 ' 1 'smoking in public places. Establishing the joint task House Children & Family 1981 force on child death Services - Hearing 3/3 at 1:30 Ward • investigations in HHR D -TVW - Nuisance abatement powers of House Local Government 2006 county governments. Hearing 3/4 at 6:00 pm in HHR WSAC E Protecting an unborn quick child from harm by the use of House Criminal Justice 2008 any illicit drugs such as Ward cocaine, methamphetamines, and & Corrections her ion Relating to access to health 2015 insurance for small employers House Health Care Vicki and their employees 4403 Creating Health Care Access House Health Care DOH Options Workgroup 5039 Concerning Hepatitis C. Health & Long Term Kim Care Delaying the effective of Senate Government 5052 1314 significant legislative rules. Operations & Elections DOH Prohibiting agencies from 1111 adopting rules that exceed federal standards without legislative authority. Agency Government Operations 5053 1315 must provide written & Elections DOH documentation as to why federal standards should be exceeded Providing businesses with 5054 notice of administrative Government Operations DOH rules. & Elections Creating the children's Health & Long Term 5060 environmental health and Care SBOH protection advisory council. Requiring informed consent to Health & Long Term 5066 dental materials containing Care Sandy mercury. Repealing regulation of water Senate Health & Long- 5085 recreation facilities. Term Care Randy Removing statutory authority 5108 for access to private property Land Use & Planning Art for government purposes. Prohibiting tobacco product Senate Health & Long- 5110 1598 sampling Term Care Federico Changing provisions relating Government Operations 5151 to open public meetings. & Elections WSAC Relating to Open Public State Government 5185 Meetings Operations & Elections WSAC Concerning Actions for injury or damage against a health Senate Health & Long- 5209 care provider based upon Term Care Ward Legislative Tracking Page 6 of II (professional negligence. II II I 5230 Regarding motorcycle helmets Senate Highways & Transportation Rick I 5234 (Requiring helmets in public • skate parks. Senate Rules 2 SSB Rick Protecting children from 5243 1408 material that is harmful to Senate JudiciaryMa ggie minors. Relating to rule-making 5255 authority of various governmental entities (state House State Government DOH agencies) . Concerning accountability by 5260 2102 private owners of public water Senate Natural Resources, Art systems to provide required Energy& Water water service. Requiring local governments to 5307 issue project permits in a Senate Land Use & Planning Jim timely manner. 5313 (Enacting the Washington health Senate Health & Long-Term care recovery act. Care DOH Requiring Medically Accurate 5314 1178 information in sex education Senate Education courses. Kim 5317 1791 Encouraging safe storage of firearms. Senate Judiciary Kim 4i Clarifying the scope of 5327 1493 practice of a dental House Health Care Sandy hygienist. - Substitute Bill 5335 1297 Defining "motorcycle helmet" . Senate Highways & Transportation Rick Regulating utility services & 5384 connection charges for certain Senate Rules 2G mobile home parks. Kim Making 2001-03 Supplemental 5403 1235 Operating Appropriations - By Vicki & request of Gov. Locke - House Passed 3rd Substitute Bill Rick Proposed operating budget for 5404 1366 2003-05 by request of Governor Senate Ways & Means Vicki & Locke. Rick 5426 (Concerning the direct retail ll sale of sturgeon and tuna. Senate Parks, Fish &Wildlife Jim Controlling state 5427 expenditures. - Substitute Senate Rules 2 Vicki bill 5436 Regarding foods and beverages • sold at public schools. Senate Education II Sandy 5445 Requiring coverage for Senate Health & Long- neurodevelopmental therapies. term Care 11 Kathy Restricting use of wireless 5487 communications devices in Senate Highways & moving motor vehicles. Transportation Kim "Legislative Tracking Page 7 of 9 Authorizing a proposal for an Senate Natural 5493 environmental quality Resources, Energy & Jim benchmarks program. Water I! Establishing an environmental health tracking system. Used Senate Health & Long Term Kim 5495 to track and monitor chronic Care diseases. Offering health insurance to Senate Health & Long- Vicki 5521 small employers. Term Care Using Fees to develop and 5545 1578 maintain a web-based vital Senate Ways & Means DOH records system (DOH request) Granting authority to DOE to 5586 address concerns with lead- Senate Rules 2 DOH based paint activities. Senate Natural 5594 1743 Addressing problems of Resources, Energy, and Randy hazardous waste facilities. Water Prohibiting tobacco product Senate Rules 2 Federico 5597 sampling Requiring parental Senate Children, 5615 notification for abortions Family Services, & Kim provided to minors Corrections 5649 1318 Referencing the USDA food Senate Agriculture Randy code. 5659 1756 Authorizing additional funding Senate Government WSAC/Vic} for local governments. Operations & Elections Relating to citizen 5698 enforcement of health and Senate Judiciary Jim environmental laws. 5728 Omnibus Tort Reform Senate Judiciary Ward Relating to fluoridation of Senate Government Federico 57641 public water systems Operations & Elections I Review of permit decisions by Senate Land Use & Planning Jim 5776 state agencies Improving permit processing Senate Government 5777 performance by state agencies Jim and local governments. Operations & Elections Senate Health & Long-Term 1868 Prohibiting smoking in public Care Hearing 3/5 at 1:30 pm Federico 5791 places in SHR 4-TVW Disclosing information about Senate Financial Services, 5798 mold in residential dwelling DOH Insurance & Housing units. 58151 Reviewing responsibility for Senate Health & Long Term Rick mosquito abatement Care Limiting the liability of 5820 1051 volunteer providers of Senate Judiciary Sandy emergency or medical services Relating to provision of meningococcal immunization information to first-time Senate Health & Long-Term 5828 1827 Ward q, u"Pnc by riPnrF,P_rtrant-inn r'-�r�+ Legislative Tracking Page 8 of 9 L_______J postsecondary educational y institutions L_________ Enacting procedural 5852 1930 enhancements to the master settlement agreement. Senate Commerce & Trade Federi. 111111111 Authorizing local governments to restrict or prohibit Senate Health & Long- smoking in public places. Term Care Federico Evaluating and addressing the Senate Natural 5884 health risks associated with Resources, Energy, and Art toxic air pollutants Water NEW BILLS Week of February 24-28 2038 Refunds from escrow for certain tobacco manufacturers House Finance Federico Relating to withdrawals of 2067 public ground waters for House Agriculture & domestic use Natural Resources Art • 2070 5920 Relating to local public health funding House Health Care Vi Rickcki & 2085 Relating to return or recharge House Agriculture & of ground water Natural Resources Art Concerning accountability by • 2102 5260 private owners of public water House Agriculture & Art systems to provide required Natural Resources water service. Relating to preschool and 5917 elementary school students _ assisting in school kitchens. House Education Sandy I59201 2070 Relating to local public health funding Senate Ways & Means Vicki. & I ___________________________ Rick 59281 Rebating to retail sales and use taxation of candy Rick I 59301 Relating to lead-based paint activities Senate Health & Long- Term Care DOH Relating to the funding of House Children & Family 2114 family preservation and Services Hearing 3/3 at 1:30 Kathy intervention services. in HHR D - TVW Relating to minors ' access to 2125 shipments and sales of tobacco House Health Care Federico BASIC HEALTH PLAN BILLS III Eliminating Basic Health Plan 1375 eligibility of persons holding House Health Care Kathy . Subsidizing health benefit Legislative Tracking Page 9 of 9 premiums. Declares an intent to establish a method of determining subsidy amounts House Appropriations Kathy 1424 based on actual costs that provides predictability for budget purposes and fairness and certainty for families. 1451 Revising basic health care House Appropriations Kathy plan enrollment provisions 2019 Relating to nonsubsidized House Health Care Kathy basic health plan coverage Senate Health & Long 5807 Revising the Basic Health Plan Kathy Term Care Senate Health & Long- Kath 5944 Relating to Basic Health Plan Term Care y PRESCRIPTION DRUG BILLS Creating the prescription drug 1091 quality improvement and Health Care DOH purchasing board. Making prescription drugs more Senate Health & Long- DOH 1214 5406 available. Gov. Locke request Term Care bill. 2nd Substitute Bill State agency contracts with AIL2011 pharmaceutical benefit House Health Care DOH lir management companies 2068 Relating to prescription drugs House Health Care DOH Making prescription drugs more Senate Health & Long 5406 1214 available. Gov. Locke request DOH term Care bill. Creating the aggregate Senate Health & Long- 5489 purchasing prescription drug DOH term Care discount program. 5721 Creating a pharmacy access Senate Health & Long- DOH program. Term Care Establishing the prescription Senate Health & Long 5722 drug access board and state DOH Term Care purchasing consortium. Relating to prescription drug 5904 assistance programs for Senate Ways & Means DOH seniors [Home] [Calendar] [About WSALPHO] [Officers&Forums] [Related Sites] [Policies&_Positions] [WSALPHO Bylaws] [Directory_] III S-1604 . 1 • SENATE BILL 5920 State of Washington 58th Legislature 2003 Regular Session By Senators West, Brown, Deccio, Franklin, Winsley, Sheahan, Doumit, Hewitt, Morton, Poulsen, Regala, Reardon, Parlette, Carlson, Brandland, Fairley, Hale, Schmidt, Shin and Thibaudeau Read first time 02/20/2003 . Referred to Committee on Ways & Means . 1 AN ACT Relating to the local public health trust fund; amending RCW 2 84 . 52 . 065 and 84 . 55 . 010; adding a new section to chapter 84 . 52 RCW; 03 adding a new section to chapter 84 . 55 RCW; adding a new section to 1 chapter 70 . 05 RCW; creating new sections; providing a contingent 5 effective date; and providing for submission of this act to a vote of 6 the people. 7 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON: 8 NEW SECTION. Sec. 1. The people of the state of Washington 9 recognize that public health plays a vital role in the safety of their 10 families, communities, and workplaces . Historically, the people of 11 Washington have been leaders in their support for public health. The 12 nation's first public health district was established in Washington 13 state. The people of Washington further recognize that public health 14 is a cost-effective way of preventing disease and reducing health care 15 costs . The people find that the existing system of funding public 16 health is inadequate to assure the provision of traditional services 17 such as immunization, food and water supply safety, environmental 18 health, and communicable disease control and at the same time meet the 19 new challenges posed by issues such as bioterrorism, West Nile virus, i p. 1 SB 5920 1 and drug resistant tuberculosis . By this act, the people intend to 2 establish a stable and continuing funding source for local public • 3 health services and state services which support local public health 4 services . 5 NEW SECTION. Sec. 2 . A new section is added to chapter 84 . 52 RCW 6 to read as follows : 7 (1) In addition to the levy provided for in RCW 84 . 52 . 065, in each 8 year the state shall levy for collection in the following year a state 9 tax of twenty-five cents per thousand dollars of assessed value upon 10 the assessed valuation of all taxable property within the state 11 adjusted to the state equalized value in accordance with the indicated 12 ratio fixed by the state department of revenue. 13 (2) The taxes levied by the state under this section shall be 14 deposited into the local public health trust fund hereby created in the 15 state treasury. Money in the local public health trust fund may be 16 spent only for distribution to counties and health districts and to the 17 health services account solely for the purpose of maintaining and 18 improving local public health services . 19 NEW SECTION. Sec. 3 . A new section is added to chapter 84 . 55 RCW 111 20 to read as follows: 21 (1) The levy by the state under section 2 of this act shall : 22 (a) Not be subject to RCW 84 .55 . 010; and 23 (b) Be set in any year so that the taxes payable in the following 24 year shall not exceed a dollar amount calculated by multiplying one 25 hundred percent plus the fiscal growth factor by the amount of taxes 26 lawfully levied in the previous year, plus an additional dollar amount 27 calculated by multiplying the increase in assessed value in the state 28 resulting from new construction, improvements to property, and any 29 increase in the assessed value of state-assessed property by the levy 30 rate for the preceding year. In no case shall the levy exceed twenty- 31 five cents per thousand dollars of assessed value upon the assessed 32 valuation of all taxable property within the state adjusted to the 33 state equalized value in accordance with the indicated ratio fixed by 34 the state department of revenue. 35 (2) The limitation provided in subsection (1) (b) of this section • SB 5920 p. 2 1 does not apply to the first levy by the state under section 2 of this 2 act. (3) For purposes of this section, "fiscal growth factor" has the 4 same meaning as in RCW 43 .135 .025 . 5 NEW SECTION. Sec. 4. (1) Beginning in calendar year 2004, the 6 state treasurer shall make the following annual distributions, based on 7 calculations by the office of financial management, from the local 8 public health trust fund to the counties and health districts and the 9 health services account as follows: 10 (a) Forty-three percent of the revenue shall be distributed based 11 on each department ' s or district ' s proportional share of total 1999 12 local support from counties and their component cities to their 13 respective health department or district; 14 (b) Seventeen and nine-tenths percent of the revenue shall be 15 distributed solely for public health services in order to maintain 16 support previously provided from the health services account . Each 17 health department or district shall receive a distribution based on 18 their proportional share of funds appropriated in the 2003-2005 19 biennial operating budget; • (c) Three and two-tenths percent shall be distributed to counties 21 or districts to bring per capita funding for county health departments 22 or health districts up to seventy percent of the statewide average per 23 capita funding under (a) and (b) of this subsection; 24 (d) Twenty-one and one-tenth percent of the revenue shall be 25 distributed on a per capita basis to each department or district based 26 on their share of the total state population solely to improve public 27 health services and emergency response and prevention capacity for acts 28 of terrorism committed with biological agents, West Nile virus, and 29 communicable diseases; 30 (e) One and four-tenths percent will be distributed to counties or 31 districts to bring total funding under (a) through (d) of this 32 subsection up to an amount equal to eighty-five percent of the taxes 33 raised for distributions under those sections; and 34 (f) Thirteen and four-tenths percent shall be distributed to the 35 health services account for activities and support of local public 36 health. • p. 3 SB 5920 1 (2) In each year following calendar year 2004 : In calculating the 2 amounts to be distributed to each county under subsection (1) (a) and • 3 (b) of this section the office of financial management shall treat 4 funding increases attributable to the population change component of 5 the fiscal growth factor in the following manner: Only those counties 6 with population growth shall have a change in funding for population. 7 Funding increases generated by the population component of the fiscal 8 growth factor shall be distributed to those counties based on the 9 county' s pro rata share of the population increase component of the 10 fiscal growth factor as provided in RCW 43 .135 . 025 (9) . 11 (3) The state treasurer shall make the distributions under this 12 section to the counties and districts and to the health services 13 account as follows: 14 (a) One-half of the total amount that each county or district and 15 the health services account is entitled to receive for a calendar year 16 shall be distributed to the counties on July 1stof that calendar year; 17 and 18 (b) The remainder of the funds that the counties or districts and 19 the health services account are entitled to receive shall be 20 distributed to the counties on January 1st of the following calendar • 21 year. 22 NEW SECTION. Sec. 5. A new section is added to chapter 70 . 05 RCW 23 to read as follows: 24 (1) Each local board of health shall establish performance measures 25 for the health department that it governs and shall report annually to 26 the citizens of the health district or county about its performance 27 against those measures . In selecting measures, each board shall take 28 into account local public health priorities identified in a community 29 assessment conducted by the local health jurisdiction and the 30 performance standards adopted in the state public health improvement 31 plan. In the case of those departments and districts where cities have 32 provided funding for enhanced levels of service since 1999, the city 33 shall establish, in consultation with the local board of health, 34 performance objectives for that portion of the distribution under 35 section 4 (1) (a) of this act attributable to city contributions for 36 enhanced service levels . A special annual report shall be made by the SB 5920 p. 4 1 local board of health to the city and to the citizens of such cities Aik2 about performance against those objectives . 111, (2) Additionally, the secretary of health, in consultation with 4 local public health jurisdictions, shall annually select performance 5 standards from among those adopted in the state public health 6 improvement plan on which each local health department or district 7 shall be required to report . These performance measures shall be 8 designed to demonstrate progress toward meeting the standards and 9 progress made by the public health system toward improving the status 10 of the public' s health as required in RCW 43 .70 . 580 (5) . The secretary 11 of health shall report to the legislature, the governor, and the people 12 of the state regarding local health department and district 13 performance, comparing performance among jurisdictions and highlighting 14 local priorities . 15 (3) Within available resources, it shall be the responsibility of 16 the local board of health to implement the state public health 17 improvement plan within its jurisdiction. 18 NEW SECTION. Sec. 6. The secretary of state shall submit this act 9 to the people for their adoption and ratification, or rejection, atthe next general election to be held in this state, in accordance with 21 Article II, section 1 of the state Constitution and the laws adopted to 22 facilitate its operation. If approved by a majority of those voting at 23 the November 2003 general election, sections 2 through 4 of this act 24 apply to taxes levied in 2003 for collection in 2004 and every year 25 thereafter, and sections 1 and 5 of this act take effect on January 1, 26 2004 . If this act is not approved by a majority of the voters voting 27 at the next general election it is null and void in its entirety. 28 Sec. 7. RCW 84 .52 . 065 and 1991 sp.s. c 31 s 16 are each amended to 29 read as follows: 30 Subject to the limitations in RCW 84 .55 . 010, in each year the state 31 shall levy for collection in the following year for the support of 32 common schools of the state a tax of three dollars and ( (sixty) ) 33 thirty-five cents per thousand dollars of assessed value upon the 34 assessed valuation of all taxable property within the state adjusted to 35 the state equalized value in accordance with the indicated ratio fixed 6 by the state department of revenue. p. 5 SB 5920 1 As used in this section, "the support of common schools" includes 2 the payment of the principal and interest on bonds issued for capital 3 construction projects for the common schools. • 4 Sec. 8. RCW 84 . 55 . 010 and 1997 c 3 s 202 are each amended to read 5 as follows : 6 (1) Except as provided in this chapter, the levy for a taxing 7 district in any year shall be set so that the regular property taxes 8 payable in the following year shall not exceed the limit factor 9 multiplied by the amount of regular property taxes lawfully levied for 10 such district in the highest of the three most recent years in which 11 such taxes were levied for such district plus an additional dollar 12 amount calculated by multiplying the increase in assessed value in that 13 district resulting from new construction, improvements to property, and 14 any increase in the assessed value of state-assessed property by the 15 regular property tax levy rate of that district for the preceding year. 16 (2) The tax levy authorized under section 2 of this act is not 17 subject to the requirements of this section. --- END --- SB 5920 p. 6 5920 Sponsor (s) : Senators West, Brown, Deccio, Franklin, Winsley, Sheahan, Doumit, Hewitt, Morton, Poulsen, Regala, Reardon, Parlette, Carlson and Brandland Brief Description: Funding local public health services . SB 5920 - DIGEST Provides that, in addition to the levy provided for in RCW 84 .52 . 065, in each year the state shall levy for collection in the following year a state tax of twenty-five cents per thousand dollars of assessed value upon the assessed valuation of all taxable property within the state adjusted to the state equalized value in accordance with the indicated ratio fixed by the state department of revenue . Directs the secretary of state to submit this act to the people for their adoption and ratification, or rejection, at the next general election to be held in this state, in accordance with Article II, section 1 of the state Constitution and the laws adopted to facilitate its operation. Provides that, if this act is not approved by a majority of the voters voting at the next general election it is null and void in its entirety. • SENATE BILL REPORT SB 5920 • As of February 28, 2003 Title: An act relating to the local public health trust fund. Brief Description: Funding local public health services. Sponsors: Senators West, Brown, Deccio, Franklin, Winsley, Sheahan, Doumit, Hewitt, Morton, Poulsen, Regala, Reardon, Parlette, Carlson, Brandland, Fairley, Hale, Schmidt, Shin and Thibaudeau. Brief History: Committee Activity: Ways & Means: 2/27/03. SENATE COMMITTEE ON WAYS & MEANS Staff: Terry Wilson (786-7433) Background: All real and personal property in this state is subject to the property tax each year based on its value unless a specific exemption is provided by law. The Constitution limits the amount of property taxes that may be imposed on an individual parcel of property without voter approval to 1 percent of its true and fair value, or $10 per $1,000 of assessed value. Taxes imposed under the 1 percent limit are termed "regular" levies. The state levy • is limited to $3.60 per $1,000 of assessed value, equalized to market value, for the support of the common schools. Each year, the regular property tax levies of taxing districts are limited to a percentage of the districts' highest levy of the three preceding years. The percentage is the limit factor. The limit factor is equal to the lesser of 101 percent or 100 percent plus the percentage change in the implicit price deflator. However, a different limit factor applies in two instances. For a taxing district with a population of less than 10,000, the limit factor is 101 percent. A taxing district, other than the state, may provide for the use of a limit factor of up to 101 percent for the year by a super-majority vote of its legislative body. Added to this is an amount equal to the amount of revenue that new construction, improvements to property, and changes in state-assessed property would have generated at the preceding year's tax rate. Under Initiative 601, the annual growth in general fund expenditures is limited to the fiscal growth factor which is defined as the average rate of inflation and population increase of the prior three fiscal years. Summary of Bill: A new state property tax is authorized at a maximum rate of$0.25 per $1,000 of assessed value beginning with taxes due in calendar year 2004. The maximum tax rate for the state levy for the support of the common schools is reduced to $3.35. The new levy is not subject to the existing revenue limit. Aggregate levies under the new state levy cannot increase each year by more than the fiscal growth factor, plus an amount • Senate Bill Report - 1 - SB 5920 equal to the amount of revenue that new construction, improvements to property, and changes in state-assessed property would have generated at the preceding year's tax rate. • Revenues are deposited into the local public health trust fund which is created in the state treasury and for distribution to county health departments and health districts and to the health services account solely to maintain and improve local public health services. Moneys are distributed annually as follows: (a) 43 percent based on each department's or district's proportional share of total 1999 local support from counties and their component cities to their respective health department or district; (b) 17.9 percent for public health services in order to maintain support previously provided from the health services account based on their proportional share of funds appropriated in the 2003-2005 biennial operating budget; (c) 3.2 percent to departments or districts to bring per capita funding for county health departments or health districts up to 70 percent of the statewide average per capita funding under (a) and (b); (d) 21.1 percent on a per capita basis to each department or district based on their share of the total state population solely to improve public health services and emergency response and prevention capacity for acts of terrorism committed with biological agents, West Nile virus, and communicable diseases; (e) 1.4 percent to departments or districts to bring total funding under (a) through (d) to an amount equal to 85 percent of the taxes raised for distributions under (a) through (d); and (f) 13.4 percent to the health services account for activities and support of local public • health. Each board of health must establish performance measures that include elements from the state public health improvement plan and local public health priorities. Each board of health must report annually to its citizens on its performance against these measures. The Secretary of Health must select some measure which will be uniform statewide each year. The Secretary of Health must report to the Legislature, the Governor, and the people regarding local health department and district performance, comparing performance among jurisdictions and highlighting local priorities. Appropriation: None. Fiscal Note: Available. Effective Date: Thirty days after the election at which it is approved. Testimony For: Public health promotion and prevention is an essential public service. Public health funding has been eroding and is in crisis. Budgets are down as much as 75 percent. Funding requirements are up from anthrax hoaxes, the West Nile virus, and bioterrorism. Public health is vulnerable because of inadequate resources. Public health needs a stable, sufficient, dedicated, and equitable funding source. This bill restores funding to 1999 levels. • Senate Bill Report - 2 - SB 5920 Testimony Against: The state's $3.60 levy is dedicated to the common schools. Another source of funding needs to be found. Testified: PRO: Senator West, prime sponsor; Carolyn Edmunds,WA State Assn of Counties, King County Council; Stu Menefee, Grays Harbor Prosecutor; Wand Hinds, WA State Assn of Local Public Health Officials; Maureen Morris, WA State Assn. of Counties; Stan Finkelstein, AWC; Roger Valdez, WA State Public Health Assn; Concerns: Terry Bergeson, SPI. • Senate Bill Report - 3 - SB 5920 0 F• H-1792 .1 • HOUSE BILL 2070 State of Washington 58th Legislature 2003 Regular Session By Representatives Romero, Campbell, Jarrett, Kagi, Grant, Hankins, Lantz, Darneille, Fromhold, Moeller, Skinner, Cooper, Shabro, McIntire, Schual-Berke, Hatfield, Hunt, Cody, Delvin, Edwards, Morrell and Clibborn Read first time 02/21/2003 . Referred to Committee on Health Care . 1 AN ACT Relating to the local public health trust fund; amending RCW 2 84 . 52 . 065 and 84 . 55 . 010 ; adding a new section to chapter 84 . 52 RCW; Anik3 adding a new section to chapter 84 . 55 RCW; adding a new section to 1.4 chapter 70 . 05 RCW; creating new sections; providing a contingent 5 effective date; and providing for submission of this act to a vote of 6 the people. 7 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON: 8 NEW SECTION. Sec. 1. The people of the state of Washington 9 recognize that public health plays a vital role in the safety of their 10 families, communities, and workplaces . Historically, the people of 11 Washington have been leaders in their support for public health. The 12 nation' s first public health district was established in Washington 13 state. The people of Washington further recognize that public health 14 is a cost-effective way of preventing disease and reducing health care 15 costs . The people find that the existing system of funding public 16 health is inadequate to assure the provision of traditional services 17 such as immunization, food and water supply safety, environmental 18 health, and communicable disease control and at the same time meet the 19 new challenges posed by issues such as bioterrorism, West Nile virus, p. 1 HB 2070 1 and drug resistant tuberculosis . By this act, the people intend to 2 establish a stable and continuing funding source for local public 3 health services and state services which support local public health • 4 services . 5 NEW SECTION. Sec. 2 . A new section is added to chapter 84 . 52 RCW 6 to read as follows: 7 (1) In addition to the levy provided for in RCW 84 . 52 . 065, in each 8 year the state shall levy for collection in the following year a state 9 tax of twenty-five cents per thousand dollars of assessed value upon 10 the assessed valuation of all taxable property within the state 11 adjusted to the state equalized value in accordance with the indicated 12 ratio fixed by the state department of revenue. 13 (2) The taxes levied by the state under this section shall be 14 deposited into the local public health trust fund hereby created in the 15 state treasury. Money in the local public health trust fund may be 16 spent only for distribution to counties and health districts and to the 17 health services account solely for the purpose of maintaining and 18 improving local public health services . 19 NEW SECTION. Sec. 3 . A new section is added to chapter 84 .55 RCW • 20 to read as follows: 21 (1) The levy by the state under section 2 of this act shall : 22 (a) Not be subject to RCW 84 .55. 010; and 23 (b) Be set in any year so that the taxes payable in the following 24 year shall not exceed a dollar amount calculated by multiplying one 25 hundred percent plus the fiscal growth factor by the amount of taxes 26 lawfully levied in the previous year, plus an additional dollar amount 27 calculated by multiplying the increase in assessed value in the state 28 resulting from new construction, improvements to property, and any 29 increase in the assessed value of state-assessed property by the levy 30 rate for the preceding year. In no case shall the levy exceed twenty- 31 five cents per thousand dollars of assessed value upon the assessed 32 valuation of all taxable property within the state adjusted to the 33 state equalized value in accordance with the indicated ratio fixed by 34 the state department of revenue. 35 (2) The limitation provided in subsection (1) (b) of this section HB 2070 p. 2 1 does not apply to the first levy by the state under section 2 of this 2 act . •3 (3) For purposes of this section, "fiscal growth factor" has the 4 same meaning as in RCW 43 . 135 . 025 . 5 NEW SECTION. Sec. 4. (1) Beginning in calendar year 2004, the 6 state treasurer shall make the following annual distributions, based on 7 calculations by the office of financial management, from the local 8 public health trust fund to the counties and health districts and the 9 health services account as follows: 10 (a) Forty-three percent of the revenue shall be distributed based 11 on each department ' s or district ' s proportional share of total 1999 12 local support from counties and their component cities to their 13 respective health department or district; 14 (b) Seventeen and nine-tenths percent of the revenue shall be 15 distributed solely for public health services in order to maintain 16 support previously provided from the health services account . Each 17 health department or district shall receive a distribution based on 18 their proportional share of funds appropriated in the 2003-2005 19 biennial operating budget; (c) Three and two-tenths percent shall be distributed to counties 21 or districts to bring per capita funding for county health departments 22 or health districts up to seventy percent of the statewide average per 23 capita funding under (a) and (b) of this subsection; 24 (d) Twenty-one and one-tenth percent of the revenue shall be 25 distributed on a per capita basis to each department or district based 26 on their share of the total state population solely to improve public 27 health services and emergency response and prevention capacity for acts 28 of terrorism committed with biological agents, West Nile virus, and 29 communicable diseases; 30 (e) One and four-tenths percent will be distributed to counties or 31 districts to bring total funding under (a) through (d) of this 32 subsection up to an amount equal to eighty-five percent of the taxes 33 raised for distributions under those sections; and 34 (f) Thirteen and four-tenths percent shall be distributed to the 35 health services account for activities and support of local public 36 health. 111 p. 3 HB 2070 1 (2) In each year following calendar year 2004 : In calculating the 2 amounts to be distributed to each county under subsection (1) (a) and 3 (b) of this section the office of financial management shall treat • 4 funding increases attributable to the population change component of 5 the fiscal growth factor in the following manner: Only those counties 6 with population growth shall have a change in funding for population. 7 Funding increases generated by the population component of the fiscal 8 growth factor shall be distributed to those counties based on the 9 county' s pro rata share of the population increase component of the 10 fiscal growth factor as provided in RCW 43 .135 . 025 (9) . 11 (3) The state treasurer shall make the distributions under this 12 section to the counties and districts and to the health services 13 account as follows: 14 (a) One-half of the total amount that each county or district and 15 the health services account is entitled to receive for a calendar year 16 shall be distributed to the counties on July 1st of that calendar year; 17 and 18 (b) The remainder of the funds that the counties or districts and 19 the health services account are entitled to receive shall be 20 distributed to the counties on January 1st of the following calendar. 21 year. • 22 NEW SECTION. Sec. 5. A new section is added to chapter 70. 05 RCW 23 to read as follows: 24 (1) Each local board of health shall establish performance measures 25 for the health department that it governs and shall report annually to 26 the citizens of the health district or county about its performance 27 against those measures . In selecting measures, each board shall take 28 into account local public health priorities identified in a community 29 assessment conducted by the local health jurisdiction and the 30 performance standards adopted in the state public health improvement 31 plan. In the case of those departments and districts where cities have 32 provided funding for enhanced levels of service since 1999, the city 33 shall establish, in consultation with the local board of health, 34 performance objectives for that portion of the distribution under 35 section 4 (1) (a) of this act attributable to city contributions for 36 enhanced service levels. A special annual report shall be made by the HB 2070 p. 4 1 local board of health to the city and to the citizens of such cities 2 about performance against those objectives . 4113 (2) Additionally, the secretary of health, in consultation with 4 local public health jurisdictions, shall annually select performance 5 standards from among those adopted in the state public health 6 improvement plan on which each local health department or district 7 shall be required to report . These performance measures shall be 8 designed to demonstrate progress toward meeting the standards and 9 progress made by the public health system toward improving the status 10 of the public ' s health as required in RCW 43 .70 . 580 (5) . The secretary 11 of health shall report to the legislature, the governor, and the people 12 of the state regarding local health department and district 13 performance, comparing performance among jurisdictions and highlighting 14 local priorities . 15 (3) Within available resources, it shall be the responsibility of 16 the local board of health to implement the state public health 17 improvement plan within its jurisdiction. 18 NEW SECTION. Sec. 6. The secretary of state shall submit this act 19 to the people for their adoption and ratification, or rejection, at the 4100 next general election to be held in this state, in accordance with 21 Article II, section 1 of the state Constitution and the laws adopted to 22 facilitate its operation. If approved by a majority of those voting at 23 the November 2003 general election, sections 2 through 4 of this act 24 apply to taxes levied in 2003 for collection in 2004 and every year 25 thereafter, and sections 1 and 5 of this act take effect on January 1, 26 2004 . If this act is not approved by a majority of the voters voting 27 at the next general election it is null and void in its entirety. 28 Sec. 7. RCW 84 .52 . 065 and 1991 sp.s. c 31 s 16 are each amended to 29 read as follows : 30 Subject to the limitations in RCW 84 .55. 010, in each year the state 31 shall levy for collection in the following year for the support of 32 common schools of the state a tax of three dollars and ( (Jixty) ) 33 thirty-five cents per thousand dollars of assessed value upon the 34 assessed valuation of all taxable property within the state adjusted to 35 the state equalized value in accordance with the indicated ratio fixed 36 by the state department of revenue. p. 5 HB 2070 1 As used in this section, "the support of common schools" includes 2 the payment of the principal and interest on bonds issued for capital 411 3 construction projects for the common schools. 4 Sec. 8. RCW 84 .55 . 010 and 1997 c 3 s 202 are each amended to read 5 as follows: 6 (1) Except as provided in this chapter, the levy for a taxing 7 district in any year shall be set so that the regular property taxes 8 payable in the following year shall not exceed the limit factor 9 multiplied by the amount of regular property taxes lawfully levied for 10 such district in the highest of the three most recent years in which 11 such taxes were levied for such district plus an additional dollar 12 amount calculated by multiplying the increase in assessed value in that 13 district resulting from new construction, improvements to property, and 14 any increase in the assessed value of state-assessed property by the 15 regular property tax levy rate of that district for the preceding year. 16 (2) The tax levy authorized under section 2 of this act is not 17 subject to the requirements of this section. --- END --- III III HB 2070 p. 6 2070 Sponsor(s) : Representatives Romero, Campbell, Jarrett, Kagi, Grant, Hankins, Lantz, Darneille, Fromhold, Moeller, Skinner, Cooper, Shabro, McIntire, Schual-Berke, Hatfield, Hunt, Cody and Delvin Brief Description: Funding local public health services . HB 2070 - DIGEST Provides that, in addition to the levy provided for in RCW 84 . 52 . 065, in each year the state shall levy for collection in the following year a state tax of twenty-five cents per thousand dollars of assessed value upon the assessed valuation of all taxable property within the state adjusted to the state equalized value in accordance with the indicated ratio fixed by the state department of revenue. Directs the secretary of state to submit this act to the people for their adoption and ratification, or rejection, at the next general election to be held in this state, in accordance with Article II, section 1 of the state Constitution and the laws adopted to facilitate its operation. Provides that, if this act is not approved by a majority of the voters voting at the next general election it is null and void in its entirety. • 411 • Board of Health Media Report • March 20, 2003 • Jefferson County Health and Human Services FEBRUARY — MARCH 2003 NEWS ARTICLES 1. "Service& Support Groups", WHO'S WHO,P.T.LEADER,February 12,2003 2. "Basic Health Plan changes on table",Peninsula Daily News,February 18,2003 3. "One child in six at poverty, report says: Health board to review new data for county",Peninsula Daily News,February 18,2003,2 pages 4. "Jefferson officials back Marrowstone water plan",Peninsula Daily News,February 19,2003 5. "No island water curbs—for now",Peninsula Daily News,February 21,2003 6. "48 food safety winners named in Jefferson",Peninsula Daily News,February 23,2003 7. "Marrowstone growth ban considered",Peninsula Daily News,February 25,2003 8. "Teens: No place to turn for help",P.T.LEADER,February 26,2003 9. "State cuts childcare funding",P.T.LEADER,February 26,2003 • 10. "SatchWorks Auto earns EnviroStars award",P.T.LEADER,February 26,2003,2 pages 11. "Restrictions for Marrowstone",P.T.LEADER,March 5,2003 12. "Big Brothers/Big Sisters: Community program to be launched March 13",P.T.LEADER, March 5,2003 13. "Food sense teaches nutrition",P.T. LEADER,March 5,2003 14. "Teen smoking down in state",Peninsula Daily News,March 7,2003 15. "Lawmakers decide if sex info must be right",Peninsula Daily News,March 9,2003 • ' 2-1/ zit:3 •' i o v. iv 40 1°7.C e 7'..., I Rhody Paade and have a booth at the service and support groups County Fair. For meeting times and -1 general information call:Pat,360-385- rid 1, > AL-ANON FAMILY GROUPS for crisis line,advocacy-based counseling, parents sending child with another 094 t' n • families and friends of alcoholics. children's advocacy, information/ adult IntemationalTravelersClinic wU �NGEEXCHAI!GE:Anonymousand U District 27 scheduled meetings—all referral, legal advocacy, emergency for appointment one month before confidential walk-in syringe exchange meetings are open to all and are shelter,public education and lending departureInformation 360-385-9400. services available at the Jefferson nonsmoking. Port Hadlock:Thursday, library. Support groups are available ,t` ),rz County Health Department Services 7:00 pm,Steps and Traditions,Study for women who have experienced JEFFERSON COUNTY ANIMAL SERVICES 'AUXILIARY provides include exchange of new syringes for and Discussion. Community United domestic violence or sexual assault,. used, secondary exchange, safer nn rt Methodist Church, 130 Church Lane and for non-offending parents of financial assistance to qualified injecting supplies,healthcare referrals (off Chimacum Road).Port Townsend: children affected by sexual assault Call applicants for spay/neuter of pet HIV counseling and testing.Location.:` Monday, 7:00 am, Topic Discussion, 360-385-5291 for 24-hour crisis cats and dogs and feral cats (trap, 615 Sheridan St., Port Townsend. Atano Club, 1102-B Water St.(across intervention,to make an appointment. neuter & return). Information: 360 •Mondays 10:00-12:00 pm,Thursdays .+ from Swain's), above Pizza Factory; or to join a group. Website: 437-9085,JCASA P.O. Box 1466, Port 3:00 4:30 pm,-12:00oarrange other Monday, 7:30 pm, Steps and www.dvsajeffco.orq - Hadtock,WA98339wwwo(ympus.net/ `times-ask for Kehe-3603859446 Baptist Church, lower levet, 1202 FAMILY Traditions,Study and Discussion,First community %. PLANNING CLINIC at the i' i , -' " 7EA PARTY FOR PREGNANT WOMEN_' �J Lawrence St. (near library); efferson County Health Department LITERACY COUNCIL OF JEFFERSON AND BREASTFEEDING MOTHERS �v1 Wednesday,7:00 am,Topic Study and `n Port Townsend provides birth- COUNTY offers free,confidential,one- meets Wednesdays, 1.30-3:00 pm, ' Discussion,Alano Club,1102-B Water control information,pregnancy testing on-one tutoring to those wishing to Jefferson County Health Department. • St.; Thursday, 12:00 noon, Slogan, and counseling,exams and supplies, improve their reading or math skills. in for tea,meet other mothers, : Steps, Traditions, Topics Study and and STD exams. Sliding-scale fees; GED preparation and English for non- Droperid have questions answered.Nursing Discussion,Alano Club,1102-B Water medical coupons accepted. Open English readers also available. St.;Thursday, 3:15pm,Slogans and Monday through Friday,9:00 am-4:00 Information:Barbara,360-385-2715. infants and children welcome Y 9 •, Ihfo tion:360-385-9400. Steps, Study and Discussion, Alan° pm; by appointment Monday and ' " :5• _: r,,,,,,,,,,:i*, Club,1102-B Water St.;Saturday,9:00 Friday;walk-in from 1:00-3:00 pm. MATERNITY SUPPORTSERVICES offers THE JEFFERSON COUNTY TOBACCO am,Speakers,Steps,Traditions,Study Emergency contraception available Pregnancy testing and counseling, PREVENTION AND CONTROL . Mondaythrow h Friday,9:00 am-4:30 support and`education for pregnan and Discussion, Alano Club, 1102-B 9 Y PROGRAM provides information and Water St. pm.Family Planning Clinic in Quilcene nd infant care;referrals for medical, education to increase public awareness is open Wednesdays,12:30-4:30 m, nancial and otherservices;childbirth PP of:harmful effects of cigarette rTAND CERVICAL HEALTH on Ro er Street next to the South education classes. Jefferson County9 moking, mokeless tobcco and AM (BCHP) provides free County Clinic.Manyclients can qualify 'Hlth pepartment.360-385 9400 IFecond-hand smoke.The program also 's health exams, with for"Take Charge,"which pays for al MULTIPLE SCLEROSIS SUPPORT Promotes FREE Washington State gram and Pap test,for women family-planning services for both meq GROUP meets first Tuesday each Tobacco Quitline Services,1-877-270 with limited incomes who are and women.Call 360-385-9400., ,. month 10:00-11:30 am, craft room STOP and QUITLINE.COM. Contact ' •nder-insured. For appointment:Julia Kellie Ragan,M.A.,360-38S-9446. at PT Community Center.New members 9 anskin, PHN, outreach coordinator, FOOD WORKER CLASSES are provided ty 60-385-9400. to anyone interested in learning about are welcome. Information: JoAnna, TOPS(TAKE OFF POUNDS SENSIBLY) k`. food safetyor to individuals who need 360-76574443. - ,of Port Townsend meets 6:30-7:30 pm CENTERING PRAYER GROUP meets food-worker cards as a`requirement of NAM'(NATIONAL ALLIANCE FOR THE Mondays(weigh-in 6:00-6:20)Church ' each Wednesday, 8:30-9:00 am for a their occupation. Class is free; card MENTALLY ILL)Jefferson County meets of Christ, Cherry and A streets. New reading, 20 minutes of silence and a costs$10.Translators can be arranged on the second and fourth Sunday of each members, old friends welcome. brief sharing. This ecumenical ahead of time,as can reading help or Information: 360-379-6710 or 360- experience is a simple,ancient practice group classes (10 person minimum). month,4:00-5:30 pm, 2333 San Juan rooted in the tradition of silent Contact Jefferson County Avenue in Port Townsend. N9'4J is an 385-3719 contemplation. Open to all at First Environmental Health,360-385-9444, information, advocacy and support VASECTOMYREFERRALPROGRAM:State Presb rian Church,1111 Franklin St en healthico 'efferson.wa.us or network for people and families Y grant provided for eligible menwhomust affected by brain disorders (mental Information:360-385-6190. www.cojefferson.wa.tL1 beatLeast 21years old,without insurance illness). Information: 360-379-8276 CHILDCARE HFALTH CONSULTATION EALTH CARE ACCESS PROGRAM www.olympus.net/community/nami that covers vasectomy,and within income a guidelines. After initial consultation providesheattheducationandresources provides outreach to Medicaid and OVEREATERS,ANONYMOUS HOW there is a 30-day waiting period from the '�' to licensed childcare providers through Basic Health Plan eligible population. concept,12-step group,meets in Port time the consents are signed to the !�� site visits and phone consultation.Call pplications, assistance, and procedure. Call 360-385-9400 for Townsend at 5:00 pm Monday and 360-385-9400 and ask for childcare information available at Jefferson a „i - consultant nurse. County Health Department;call Julia Friday at Jefferson General Hospital P Conference Room. All compulsive Danskin PHN,360-385-9400. VITAL STATISTICS provides certified %//,4:,' rPMENTAL SCREENING:Do you ;,, overeaters welcome,no dues or fees: copies of birth and death certificates f ,f; eons about ur chis rowthHIV AIcounselor ,testin and case 360-385-0875.Yo 9 / 9 9 for fee. Applications available atopment?Port Townsend School management offered by JeffersonJefferson Coun Health De artment,PFLAG/PORT TOWNSEND/NORTH ty p"Birth to 3 Program" offers County Health Department. Services 360-3859400.OLYMPIC PENINSULA (Parents,tion and free screening for provided by health professionals; i Families,Friends of Lesbians and Gays) toddlers;ca1360-379-4539.For parents confidentiality maintained. Call 360- WOMEN, INFANT, CHILD (WIC) ft)� ' in other Jefferson County school 385-9400 for an appointment welcomes all sexual minority people: supplemental food program sponsored pZ3 districts, call MartyJohnson or AnnFncounty gay, lesbian, bisexual, transgender, 2 transsexual, and questioningand all:by Jefferson County Health Department x t McEnery at 360-385-9400. IZATION CLINICS,sponsored by for income eligible pregnant and Health Departmentare the people who care about them.We breastfeeding women, and childrenDOMESTIC VIOLENCE SEXUA and Thursda, 1:00-4:30 m. offersupportand referrals.We educate/ Y P under 5,offers nutrition education and ASSAULT PROGRAM of Jeffersong onlyravailable on Tuesday and advocate though PFLAG Presents food vouchers. Satellite clinics inmy provides services to victims oon clinic. Sliding-scale fees; on PTN and through www.pflagptorg, food vum,Quilcene and Bclivi.Call ual and domestic violence and their services for children not denied due to our Update Newsletter, and public a ro We march annually ' families. Services include 24-hour inability to pay.Consents required for programs. y in the 360-385-9400. • , PORT TOWNSEND&JEFFERSON COUNTY LEADERWHOS WHO 2003 .. ._ .._.. +.- t..a..-• ...• ... . ..->>-;-F --. - .T Oji'L..*t'TRo-'^,-.-•4^_4t-a<z•c:n-a:-.-.—..._. ;n ro c3 C C ro C-C - U v y `— :.0-, L- _ — -— - r y _ ro cM W y O E O �,O U— i = tt s c u u -c t� ro= o v J c •a - c =i ^ - _ - E 4 L u E.- c J C ca Z vl G v G; d✓) .y0., C C C :i— ^r i. U)7t1 -6 c6 N O— .yi C -� ro'O.+. u y 3 L - U y C �?= L i. i. G _ - _ C ^ Cl) >) a- GJ m y s EY- cy -62E yon, ° a_ £ Q a J3 roo3c ° o�.C > -` ro 3 c-E 4 > E !� t c � c� a 3 o X co o'c 0- L c = n • , ro 3 mo 33c yro � vp• O_ o" °' ym u_ -- Cyr G °y a) CD a U C C O G'- y y. G co ro c `C >�y �' E _o•8 .Ji y.0 to' ,a Lx E U m O.O ro C COy mL u._ . Cil c C, C .v ro y y G" y-c y ° ty.CL N Oro E n 6 y�—L m y E L=•'O— V m e CD�1•> m 7—. J co -- 0 0 o m. y Cl.) 0 `�' p �- a ro � y > m m o'- `n3' E y y ro :oro y v 3 -�'v `.� a'y 0.. 30 .. .-]-EsQW4Ct. vl— 36ul mrov,; alEcaE�x cy) c p >,�-> omm, ai` m'.u) onod `° o=`oalc — ua) yo— �---, o` 0— ) � n '-, a Ey Q m._� ro as > O _ c q�'� x.>o-c p;r V ° CO n'm ° pp O G �' E '-' O O" 7 0 °J ? C O ro ^C r. J C u y J O 'b U..V > ° a) m J° U O J m O o E L L a) g. O ro ° y 7..C_ro-d " a) O.d p O C ro C m .yi C C y CO E G o c000.) •••) .59., C0 y a7 a v L O• ❑. .O i O C..O E N — cU y y-O ui %�.� E ro 4 7+� 7 CD 4 y 0-> s 4 CL) c.. 3' t'2 y L O 69 C r"' 4 7:1 C U V]�3 ° G m-6 f/) E— ro q y y > N �•-c...� G m L E�... d 7 ••° C y y N �v ro o 0, 5 ygg j-0 _- ° y y ro E-'O O y U y x ° i G. U�yi m y.tea x`'' m ro `�' G y o`-- cC U N L— y a) y o' ui S>y vyi d • U roe'_^ ro y O..a L ° ' x E c .r U)U) �, m > _(o otz= E c ro y My— c m y r m ro y y-0 L a)=dU J In... y N t0 a) d 4 4.D V y-°W 4 ro -�y,c L'i7 3 ° 0•Ul C E x y ° u � >L ° y 4 cEn t C m E._ > � .•�.., y OU' pV y ' • ,•N F'• L u a) n. ._�' U ••▪ c▪ c•i g v c � y (D2 c)750 ro a� � oocs, ` m om —•G- u 0.2 LEHZ y dal X.. I. 0 >,O y V C 0 7 N yn.0 N a j d 'N up ,cJa > >-0 o1i o L C P:1 Ea 3 y 5 Ey croi>Cy o m 3 a w c Ew aax c-3�[zo, 8 clam 0. ° yo 3.73 o >r m4-o N U °O N C 'C J•-+ by° .yi .°CU 0(1' aLo°34>i�."�J?NpLy'—Ja>o>m),6+oOC9-'.J.ycG.. myyLs. x.o�aa—=°_o-� Oro>,E E o-yG G y�,•_ E m C G -p N yL oco °y sLL 4 z • C •2aN cdJ0 0 'LCD3 ry"•ac>rol,"VG�-cc7°Ul t-�LC�myV;, ,`aciLpEco ° y J^ CQ .y4= ily Newspaper February 18, 2003 3 , . , One child in • s�x a ove /4 report says Health board Senior citizens to review new better off data for county The state's poverty average for senior citizens is below BY KEVEN DREWS that for seniors in Jefferson PENINSULA DAILY NEWS County,according to the Com- munity Health Assessment One in six Jeffer- Update. son County children ,, Across Washington,the younger than 18 f report states that 6.5 percent lives in poverty, of seniors between ages 65 according to a report '� "' ''` " and 74 lived in poverty, that will go before t/ , 15 the county's Board � ti „: according to the 2000 Census. ry �the county's Board 10 ;,;; But in Jefferson County of Health on Thurs- - that rate only was 2.3 per- day. cent. In fact, the Corn- 44:—.."' Senior poverty rates were munity Health Locke the highest on Marrowstone Assessment Update Island, followed in order by • states that county poverty rates Brinnon,Port Hadlock-Iron- among children and adults ages 18-34 dale and Port Townsend. are higher than state averages, and In Port Ludlow and • that Medicaid pays for more than 50 Quilcene,the report said, no percent of all births in the county. person between ages 65 and The report is based on informa- 74 lived below the poverty tion gathered during the 2000 Cen- level. sus and singles out Port Townsend, About 21 percent of Jeffer- Port Hadlock and Irondale, Port son County residents were 65 Ludlow, Marrowstone, Brinnon and years or older, the report says. Quilcene. The county's largest age Of the 25,953 people who live in group,states the report, was Jefferson County, 16,084 live in between ages 35 and 64.That those six areas. group accounted for 46.8 per- The report looks at the West End cent of the county's popula- as a single county division. tion. Pockets of poverty' Peninsula Daily News "What we see in the report is sig- nificant pockets of poverty," said Dr. Thomas Locke, Jefferson County's and made less than $8,259. medical officer. It also said a household of two "What we really encourage is the which earned less than $11,239, a community to look at the problem household of three which earned less using accurate and up-to-date health than $13,738 and a household of information, and use that informa- four or more which made less than tion to set priorities on what things $17,603 was considered poor. to do." Of 4,938 Jefferson County chil- Dr. Chris Hale will deliver the dren, 818 lived in households with report to the Jefferson County incomes below the poverty level, Board of Health, which meets Census said. The report states that Thursday at 2:30 p.m. at 615 Sheri 19 percent of children in Port dan St., Port Townsend. Townsend,20.5 percent in Port Had- Locke said he expects board mem- lock and Irondale, 20 percent in bers will use most of the meeting to discuss the report's findings. Quilcene, 23.3 percent in Brinnon • In 2002,the Census Bureau said a and 59 percent of children in the single person was poor if he or she West End lived below the poverty was younger than 65 and made less level. than $8,959 or was older than 65 TURN TO Pooa/A2 Poor: Report to begiven Thursday' ' CONTINUED FROM Al Poverty rates may have been Three out of every 10 chil- so high for those ages 18-34,the �t dren were born to unmarried report says, because many lack Inter i est,n facts • mothers in Port Townsend and an advanced education. Quilcene. About one-third of those from assessment But that figure jumped to between 18 and 24 years had three out of five in Port Had- not completed high school. lock and Irondale. One-third completed high Jefferson County adults between ages 18 and 34 Rates for Marrowstone, school or earned a GED between ages 18 and 34 drank and 28 percent Brinnon and the West End diploma, and one-third had were more likely than any smoked in the 30 days were too small to report. some post-secondary education, other adult age group to before the county took a The report states that Med- the report says. drink,smoke and still boast behavioral risk factor study icaid paid for more than 50 per- Of those in ages 25-34, the of excellent health,accord- in 2001. cent of all births in Jefferson report states that two-fifths ing to the Community That's compared with 68 County. had completed high school or Health Assessment Update and 16 percent for all other Broken down, that means less,one-fifth had four or more to be publicly discussed adults. Medicaid covered 61.5 percent Yeas of college, and one-quar- Thursday. Meanwhile,while the of all Port Hadlock and Iron- ter had some post-secondary In fact,more than 90 report states 91 percent of dale births, 61.4 percent of all education. percent rated their health all other adults had health- Quilcene births,54.6 percent of as excellent,according to care insurance,only 74 per- all Port Townsend births and Renters the assessment,which was ' cent of adults between ages 41.3 percent of all Port Ludlow put together from 2000 cen- 18 and 34 could say the births. The report also notes that sus many Jefferson County resi figures. • same thing. Figures for Brinnon, Mar- dents were spending more than The same report states Only 16 percent of adults rowstone and the West End that adults in the 18-34 age between 18 and 34 were 35 percent of their incomes on were too small to count. group were less likely to overweight,the report rent. have health-care insurance, states,compared with 29 About 50 percent of all Port Below the poverty line According to the report, percent of all other adults. Hadlock and Irondale renters 73 percent of adults Peninsula Daily News Meanwhile,about one in five and 40.8 percent of Port of the 3,224 people between the Townsend renters were spend- ages of 18 and 34 in Jefferson ing more than 35 percent of County lived below the poverty their incomes on rent. level, the Census report said. Brinnon and Quilcene • Referring to that age group, renters spent about 31 and 29.7 the report states that 19 per- percent of their incomes on cent of Port Townsend resi- lodging. dents,'23.7 percent of Port Had- No Port Ludlow or Marrow- lock and Irondale residents, stone renters spent more than 23.2 percent of Quilcene resi- 34.9 percent of their incomes on dents 28.3 of Brinnon resi- rent. dents, 6.5 percent of Port Lud- "It's a very worrisome corn- low residents and 54.8 percent bination of low-income and of West End residents lived unaffordable housing," Locke below the poverty level. said. • 11 • �A orthwest PENINSULA DAILY NEWS Jefferson officials back Marrowstone water plan Commissioners Under the resolution, the about the proposed project, county will work with the util- which could cost a little more say they'll work ity to develop the public water than$3 million. system. While the commissioners with new PUDThe resolution further unanimously approved the res- acknowledes that the county. olution, Wrinkle raised con- could be in conflict with the cerns about its language. BY KEVEN DREws growth management board and Wrinkle said she feared PENINSULA DAILY NEWS face further review if Marrow- some people may feel they are — stone Island doesn't receive in conflict with the board if NOCounty commissioners saytrson heytimefralic water in a "reasonable they addingn't some support language system,inthe will support creating a public • resolution was not necessary. water system for Marrowstone Recent history She also said a public water Island. system may not be a solution Commissioners Dan Titter- Last August, Marrowstone for all areas of the county. ' ness, R-Port Townsend, Glen residents petitioned the utility But when Titterness asked Huntingford, R-Chimacum, district to establish a public her if she believed anything was • and Wendi Wrinkle, D-Shine, water-supply system. factually incorrect about the agreed to support the water Last December, the growth resolution,Wrinkle said no. system during a meeting Tues- management board ruled that Meanwhile, Mike Regan, day. the county unified development who represented the Irondale Under the resolution code and its coastal seawater Community Action Group, told approved, the water system intrusion policy didn't protect commissioners during the pub- would be developed in the next aquifers from saltwater intru- lic comment period that they 18 to 24 months. sion. should use water from outside "Clearly,this is the direction The board gave the county the Tri Area to supply Marrow- the board intends to go," Tit- 90 days to develop more strin- stone Island. terness said. gent protection standards or He said local wells may not Commissioners hope the implement a development have enough water to supply action will help the county com- moratorium. both areas. ply with a,Western Washington The board decided to develop David Sullivan, a utility Growth Management Hearings more stringent protection stan- commissioner in attendance at Board ruling requiring the dards. the county meeting, told the county to designate saltwater David Christensen, manager board utility district staff will intrusion areas and adopt stan- of the county's Natural test the redrilled Kively Well to dards to address the problem. Resources Division, said a sub- ensure it has a large enough The resolution means that committee is currently working water supply. all new developments on Mar- on plans to address saltwater And utility Commissioner rowstone Island that need intrusion during the next 18 to Dana Roberts told county offi- potable water will be required 24 months. cials the utility district is corn- to use the public water-supply The utility district has also mitted to serving existing cus- system. scheduled a 7 p.m. March 18 tomers. The system will likely be meeting at the Nordland Gar- He also said the Tri-Area built and managed by Jefferson den Club on the matter. water system was initially set County Public Utility District It has agreed to send out a up, in part, to serve Indian No. 1. letter informing residents Island. • .2, - tC l- ii3 , . 5 a) a) aacu co a) co cuO O . 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O p z O +' of ,� ,, U G Pill _ -0 o a E ° U 0, . -x o >,'c 0i O Q o -o a E .cF. 2)a. 0 a .aE z ,) Ex U) cOd E a E E 3 3 3 :G t ° c> cba' y • ° ° a 0 p0 ° c ° 0 ., 0 bw N c -, l n °q a -°Uow � �a) E x �,� ° °a cct 'n 0 .C a) ..0.u: „ ., U) a3 +> aci a m .3 y m q °�, �W CD 0cz t2 c� , O y t L� i,��+ct°, -0 p..p N cd b " }al O I-0 of o ,°_, F Q.> 3 o E , oA.as > .0 „ u) >, a) �. ¢ -- Q. QLJ t°.. 0 L3 O y Q. °�.� ” ,.O ,iI--." '.. a) ori ° .-[-, O +a CCCv o = EE -0 ac o() cd al .�,aa)i aa>i ° ca g) °ri . 3 a. �r 0 Cit: cu a)X oo- 0., c: on o o N a a. x E �°'s m :° o -'E 0 v i so ° � a ° 3 ° ca E 0 ° a p�' E a� `cl E" '_ al a) asami t'^ + i 0 C ° s O ° b O O C a) `� o c " oo , a E0 � �� E 0 ,..., V 'L' 0 3 a, n. � c ,_ ct oro _ ca E 0• ,a aS e°o ° bao ° C ° o ° as 4IMIa " o ° 1711:3 Q. a. 7:5 �a hoo G o ro `-' >cl) a> $.., [� a E7,37.;F+ 3 atoalQ. U vcoE u).� Uat'ti3 v.' xo Ea •� U w E G m ac"i > " o a) 0 ori^ 3 al 4'� E O '(13 4—) `•i N 2 1--.',.•a 0 O > .,., ° 0 E w— ori E >) P T1 IMMO 0 $ m p-° cn +I ., c • of -d z? E in O o � 3 O as � E ° °) E E o� u 9., 0 0 0 L, 3 o f E. p ° ' mow o > 13 o o as N a� o m U • 1.12 c � W Z o OF. 5O a) CD NO .>,�. E +' r- -p^Cf C O 0. y C R: a U a o cd E C ui m " O [ OSim A ¢ •tea •gr° Eq ° °: Cop • 48 food safety winners • named in Jefferson Achievements Also: Ajax Cafe, Thomas Weiner, four years; Heron awarded based Beach Inn, Joseph Mollerus, four years; Maxwell's Brewery on inspections & Pub, Chis Sudlow; Niblick's, • Joseph Mollerus; Pizza Factory, Francis and Valorie Danielek, PENINSULA DAILY NEWS four years; and Uptown Pub PORT TOWNSEND _ and Grill, Laura Millet and Forty-eight food service estab Katy Snell; Queets Clearwater lishments won Outstanding School, Mary Mason, three Achievement Awards for hav- years; Plaza Soda Fountain, ing the highest standards for Donna Hogland, three years; safe food handling during 2002. Manresa Castle, Walter Santschi, three years; Ferino's Dana Fickeisen, Jefferson County Environmental Health Pizzeria,Scott Browning, three years; Fountain Cafe, Kristen Department health specialist for the food safety program, Nelson, three years; Harbor- said the awards are based on master Restaurant, Joseph inspections. Mollerus, three years; Head Start, Mechelle Peterson, three To qualify for the award, establishments must prepare years; Chimacum High School and sell complex foods for Cafeteria, Mark Sperrazza, • immediate consumption, been three years;Blue Heron Middle in business for a year or more, School Cafeteria, Mark Sper- be responsive to correcting vio- razza,three years;and Brinnon lations, have no food worker School Cafeteria, Lynne Fay, card violations and be in com- three years. pliance with permit conditions. Also: Port Townsend High The following establish- School Cafeteria, Mark Sper- ments and proprietors received razza, two years; Quilcene the award: Port Townsend School Cafeteria, Veda Wilson, Senior Ngtrition, Denise Mor- two years; Bagel Haven Bakery ris, eight years in a row; Valley & Cafe, Greg and Robin Corn- Tavern, Chuck and Karen Rus- forto, two years; Belmont, Rick ' sell, eight years in a row; Java Unrue, two years; Burrito Port Cafe, Linda Kennedy, Depot,Tessie and Gary Hicken- 'seven years; Jefferson County bottom, two years; El Serape Jail,Eleanor Such,seven years; Mexican Restaurant, Sue Per- Lonny's Restaurant, . Lonny ley; Half-Way House Restau- Ritter, seven years; Whistling rant,Ruben and Dorothy Land, , Oyster, Sandra Van Wagenen, two years; Waterfront Pizza William Bailey, six years; Fat Upstairs, Diana Kuchera, two Smitty's, Carl Schmidt, six years; Wild Coho, Jay Payne, years; Seabeck Pizza of Pleas- two years; Chimacum Primary ant Harbor;Jerry Anderson,six School Cafeteria, Mark Sper- years; Silverwater Cafe,Allison razza, one year; Fin's Coastal and David Hero, six years; Cuisine, Doug Seaver, Joanne Bloomer's Landing, Pamela Saul, Pamela Felke, one year; Morgan, five years; Brinnon La Isla Mexican Restaurant, Senior Nutrition, Lynne Fay, Ignacio and Gabriel Rangel, five years; Hard Rain Cafe, one year; Subway of Port Michael Rasmussen, five years; Townsend, Mickey Davis, one. • Lanza's,Steve and Lori Kraght, year; The Upstage, Mark D. five years; Portside Deli, Lynda Cole; one year; BPOE Elks and Brian Douglas, five years; Lodge No. 317, Randall Unbe- and Tri-Area Senior Nutrition, dacht; and Shanghai Restau- Tom Daly. rant, Chuong Ly. -A3 -03 ly Newspaper February 25, 2003 arrw • o n 0 e growth -ban - considered Panel also mulls that the county's Unified Develop- ment Code and its coastal Seawater Intrusion Pocy water restrictions, aquifers from salt intrusion protect cites state code It gave the county 90 days to develop more stringent protection BY KEVEN DREws standards or impose a development PENINSULA DMLY NEWS moratorium. The county has until March 5 to Jefferson County will prohibit new adopt its amended Unified Develop- subdivisions on Marrowstone Island ment Code. and limit families to pumping 1,000 The commissioners decided to gallons of water from wells each day develop more stringent protection-- - - •_--- The county commissioners for- standards, and a Planning Commis- warded• thoseorderstotheirt • staff sion committee took over that task. Monday in an effort to comply with a On Monday, commissioners also Western Washington Growth Man- accepted about 10 other recommen- agement Hearing Board ruling that dations submitted bythePlaning officials to address the prob- lem of seawater intrusion in water Commission. wells. Among the steps: The staff will now incorporate ■ The county staff will develop an those recommendations into the Uni- accurate map of island wells and fled Development Code, which could institute a monitoring program at 25 come before the board next Monday. high-risk wells, 25 at-risk wells, and 25 wells in the coastal zone. State ultimatum The wells will be monitored every If a public water system is not six months for two years. operating at Marrowstone by Dec. 31 • Owners should install flow 2004, according to the recommenda- meters, have variable-speed pumps, tions,then the county will declare the and have 1,000 gallon minimum stor- island a seawater intrusion protec- age tanks. tion zone and could`prohibit people - The report also recommends that from drilling new wells. owners of new wells should install "There's a possibility if we didn't timers. proceed in a forthright manner, we I Jefferson County Public Utility could be found non-compliant with District No. 1 will take samples. the Growth Management Act," said Commissioner Dan Titterness, R- The county will encourage more Port Townsend. people to participate in the monitor- "We're trying to get something in ing program, and will ask for a six place so we can satisfy the hearing month extension on the Growth board," added Commissioner Wendi Management Board ruling. Wrinkle, D-Shine. ■ The commission also wants the Last December, the state Growth county to create a water conservation • Management Hearing Board ruled and education program immediately. . . . S en .0• 2 E uC oq: .0 „ -o o u• mo Q o obm 5 uU v c .) u ,. u o = c � nao uag ' Q E •SL U ./ 1 •cs0 ai � . ° y g5 •Eo c7eE552v ° oa � ioiai3tl '� ` I Ac:IE.3 �� Fu m ° I > , v vr = ,, 0 i > u : v,z 0 u . .54o u * g .� v c .o = . or c o o1 54v 9a ,udUto3 ' 3 ..'f'• 7, v uLA c , E E 3 v ° :' ot .3 r. v v , .g 2 3 U 4 e,F 1,j i2 `"3 3 K.• ¢ v .-g E 1 D Q xi .E 5 = V � � .E 3H° tx ^ 3 ° ii..:) i t TA g t, I) .1),,,)"“ 4L � . • u24Au -� E °t -wo • Q _ 5 = 3 g R 7 _. . . • nuE97o ; ., 'o o .F .7' '5 on a � y , ` 3 - vs Teens : Noplace ''yuo >., c = c .. • S > " -,nnOrU, $ D0 U -, ^ _ ; 7g L C't N O t-7 .r, 448 ,- y1166 au = u 'C doI � — d� �• vouto turn for helpvynao . o w vu 'Soa2a " 8a] ^-02Roc � 2 .h _ . C _ " 'G U v 0 4 ._ ., U • c o ' x uoo o E O >By Janet Huck ° = h °A > c A > ? hLeader Staff Writer rWe have to do O b85ai = cL = � _ : E= v A •v . g :45' So3 ° 5 8 The Chimacum High School senior something or we ll ° H t 2 ` '8 • U v g .`",,i) c ._ s = took a deep breath and said what no ' ° o = 5 o ' E o Y °° a CA Q v ., v " a •$ oxr = other student had said publicly."I was see someone else in ,�� o r .__ 3 F ° V o 3 b.. 0 up there,"he confessed,referring to the » .2,-. E-- a o .2,..;,°2 ° ¢ E _ 0 0 ob.7 drinkingpartywhere CHS junior a box. .x V L g 5 o ' 3 „to U ) > > . 1,)0. � -8 -'3 ° E°U ane Luther consumed the liquor that (1) apparently contributed to his death. Tyler Holtman ru: g o „a ° 3 ` t t c L c R g >R ,E "People were going to take care of sophomore 0$ o u a t U, 4 . .o o r > E " a o c- 17, a- s him,but they got scared,"said the sal- Chimacum High School C= .E L ;; .5 � a o cot o > .E ° .P dent. "They thought there was a cop b a''L o %°;.4 " o a 4 .8 E 0.'o .0 b E waiting for them. We had no place to T� v 3 . ° 4 o v E v °' 5 v c U T turn for help." They listened as the five Chimacum and v1 5= 0 -8 o o E 0 -5 V o; " ° `_Hra , None of the two-dozen people at the Port Townsend high school students o :i E 2 0 - o c r -' o = t „ • 8 ° ti ° ._ ay " u v --- .. 3 3 E „ E seminar said anything for what seemed railed against the communitytheyv >. ` i.13s = E `° '' T r,-,52 •v = Y�� g 8 ,..t' u•- ou. ,c . v R c‘,1 1 v o0 .0 .. " 8 ''S C O E like a long time.There were no recrimi- thought had abandoned them,the police m E o v$ 0 ¢ E � r E^ _ 00 E a c s nations,no questions.The members of they thought harassed them, and the .E. °? 5 C c 4 iq . 6. g o 5 x 3 E .E the Healthy Youth Coalition,which pro- media they thought blamed them. motes opportunities for healthy devel- Even when the Jefferson County U ° `o :X v o ;. d " h E A " .-•v € o0 opment in adolescents, the four sheriff was asked for his reaction, v S 2!; t o v-o > >o. € o. ,S 'E .° members of the Jefferson County Mike Brasfield quietly said, "I just C Thf, c o` -u, i' ," o ' „ U 0 E .c ° a Sheriff's Office and the Chief of Police want to listen." o o y c 3 r „ H o v ° Q c 0. V ; 3 of Port Townsend were willing to listen "It's important for adults to listen," °>'.r°c' o o y o L .o °q ; L - z •v G O Q o,..)'O O •0 " V ci •.. `.▪ , op ,, to the youths explain their points of view. See LUTHER,Page A 13 u o u " o°.^ t. g 4 V Z .o Q 2 "▪ , ;, ,D iv v b � ,,F c ',,,,1 y -`a' aca) .,,, t .) ‘1,h) A > - v _ o `� .° L vE Q Fes- " c U^ 0. 3 v x U Em Q " .u, 0 U <a , 3 A J L u ° u ° c' o 0 ° .., o CIu o _a 2 c .' 5u U e - u .8 - o a C "p V c y U U 00 C U 0fa. aa t g. >, 8 8 uu -8 2 c0 o .- u vu 2. c -0& = ,o .2r. $.S ° v a u 3 L.7.. S.v ai V. ..5 a n EO 'U N J0N ° ^ " U 00 t ,— )_/p —0 3 M ixU u , > s No DE .S o oS vy "u '' N 8 C -8 " U U .• 9C V, L , " LU O '� c .c ,3E A o= c o 3 >, g.5 -0 o aa " 0 c 12 104 cro � Euy " p � 8o " � � 3 �. u = Ca ° �' q U v ,= = t m u 2 .,uav y n o VI •• n o 3 Childcare. Workingoor hitp State cuts those ContInued dbyrom age A 1 !` r Langlois: "Many providers those headed by a single parent, rt, � r would not be in business today which represent the majority of r.,•:'; ...4 without the technical asst ce the recipients."These parents are i - '�" 41 and training they have r struggling already, said daycare j rJ °tt ' childcare !; and continue to receive.A w provider Tina Bainbridge. She { 1[1 " they[providers]will have fewer has been offering daycare for 0%-el.; !; ••:.•:-4.1%,,.41, . a- ..., resources to support their work a more than seven years,the past - i' ` Ai ftiriiIiri4g , rwith babies and children with three as a licensed family •� � ,�,,,. x ...- childcare childcare business out of her Ott;. • , g ''1,Vi.'' , ti:: special needs" home in Port Hadlock. i (4 ° Some assistance remains "A big percentage of the By Beth Cahape ,4„,N,..(...„„,, As of March I, basic assis- county's families are getting help • ' ? Leader Contributing Writer s tante for childcare through the [childcare subsidies] from ' I" Working Connections will DSHS,"the state Department of � .� continue, but the state will rc- The working poor of Jefferson Social and Health Services, ~`�'' County just received another blow as `y quire parents to pay a larger co- Bainbridge added, "and a big payment amount.According to a a result of the state's budget crisis. percentage will have to leave II Low-income families who receive • 1. recent University of Washington their small children at home, '* ' C , study Jefferson County families childcare subsidies have been noti- maybe with a big brother or srs i - w > fled by Gov.Gary Locke's office that ter; or worse, the parents will t «•,•:;• rank fourth among the state's the portion they must pay in state- have to quit their jobs and go t !,:„7,':'4i•14>;�. counties where parents pay a dis• subsidized childcare will be in- back on welfare. It breaks my r - •.i�.�. proportionately high amount Be.of creased,effective March 1. heart to see this,because it's the L 4ux,•`; fr �t their eamings for childcare. e- What might be even worse,most kids that are going to suffer more "y'' •` cause of typically low-wage jobs of the other state-funded programs here, the average single parent P Br than anybody else." spends 26.8 percent of her take- that pay the 26 licensed family Even those who helped Gov. ' b. da careproviders and three childcare home earnings on childcare.Ac- daycare Locke make the budget cuts are cording to experts in the field, centers in'Jefferson County face • chagrined by the changes that childcare that costs more than 10 elimination or serious reduction.This • have been made.Rachel Langen, is a situation that affects 250 local director of Washington's Child- Tina Bainbridge Is pictured with, two 4-year-olds who attend her conside ed unaffordable is children and may,according to some • hood and Early Learning Divi- daycare:Emery and Jarred.Bainbridge Is worried about what budget Gov.Locke has not cut subsi- childcare providers,ultimately close • sion, said: "None of these cuts In state programs that help the"working poor"pay for childcare dies for non-licensed childcare. some of those businesses,while oth- • programs were cut because they might mean to local parents,children and businesses. however, which allows a much ers will have to stop providing care didn't work.We have been fund- Photo by Beth Cahape smaller stipend for parents to pay for children of the working poor. ing very successful programs." family or friends, such as a This does not bode well for the Announced Feb. 3, the pro- "I want to emphasize that they grandparent.But these chi re low-income families — especially gram cuts are effective March 1 [programs] support people who "I want to situations are almost enti See CHILDCARE,Page A 16 to July 31.What funding changes are simply low income and not regulated and have no r are made during the ongoing necessarily on welfare,"Langlois emphasize that ments for safety of the home. Legislative session remains to be said."They are the working poor." Neither do these childcare situa- seen(see related story,this page). Along with a heavier they [programs] tions fund educational activities childcare burden for these par- or training for providers. How many are affected? ents,childcare providers are see- support people Licensed providers in the Most childcare programs now ing many services androvider P county earn about$20 per day per being reduced or eliminated were assistance eliminated.Gone will who are simply child. Unlicensed providers earn -22° 2 /_--0 3 created after the 1998 federal be additional compensation for low income and just under$2.09 per hour for the (/t� welfare reform bill.In Washing- childcare workers who work dur- first child and less than$I per hour ton state, the huge"Welfare to ing non-standard hours,namely not necessarily on for each additional sibling.That Work" program offered these evenings and weekends. They is in contrast to average childcare families,among other incentives, also have lost most of the grants, welfare. They are fees of$25-30 per day.Unlicensed childcare assistance through technical assistance and training the working providers are not allowed to care "Working Connections."This is the state has subsidized until for more than one family's chil- a co-pay subsidy arrangement now. Some of theserams11 ro P g poor, dren,although there is little over- based upon the parents'wages. were tailored for special needs sight and many providers are in Since its creation,this program children or for children coming Susan Langlois apparent violation of this rule. has additionally assisted all low- from homes where substance coordinator "Our governor has sacrificed income families. abuse is a problem. Parent Line quality for quantity in our state Susan Langlois,coordinator of What is most disturbing to li- childcare system."said Elizabeth the state-funded information and censed providers in Jefferson Bonbright Thompson,executive referral Parent Line for Jefferson County is how these cuts will Julie Schachter has run a 1i- director of the statewide Child Cotiriry residents,est thhateg there affect the most vulnerable chil- censed farhi]y childcare facility in Care and Resource and Referral are about 400 children in the dren:infants and toddlers.While Port Townsend's uptown district Network,a nonprofit agency that county whose parents get subsi- licensed providers serve families for three and a half years."1 have helps administer these programs dies for their childcare.About 150 with children of all ages, more only two subsidized children—1 and funds."These cuts are under- of those 400 children receive care people in the county turn to the couldn't survive financially if I mining the entire quality and fab- et home from family and friends, 26 family home childcare provid- only did [subsidized) children. ric of childcare in this state. .4 who also must be licensed provid- ers than they do Jefferson's three Both are very young,and one is a year ago,we were the best state ers.That leaves about 250 directly childcare centers or private unli- child with special needs.At least in the nation for childcare cover- subject to the budget cuts. censed care. in her case,it would be the worst age,and now we're toast.These tragedy to see these rates raised. cuts are so extreme that th s Her mom is single and could never not going to be anything pay even the minimum. "We're going to see a lo "Some of these childcare pro- kids become latchkey kids,"pre- vidersare salnts,"adds Schachter, dicted Jefferson County's "I know one woman who special- Langlois. "And we're going to izes in care for children during see a lot more unlicensed daycare unusual hours.The state has been — with people whom we don't paying special bonuses for that. know much about because they Others only care for DSHS[sub- probably won't have criminal I0 m 9 • t1 • 8 � � o° o � „ TyyS : ° o � uG �N C3 ° xc ° N a' 35 3 ° o . 3: • u r—o.h E E u h u r h e � . 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Svtc f Jefferson Transit buses nowpromote the county's EnviroStars program.Busi- nesses displaying an EnviroStars banner are a proven success in the respon- sible handling of their solid and hazardous waste. Submitted photo SatchWorks: Clean • Continued from Page C 1 mobile unit visit onsite to crush used "My long-term goal is that when oil filters, which must otherwise go I sell this property, I want core to the landfill. samples to show there is no contami- Yarbrough is a General Motors nation in the ground," Yarbrough master mechanic and an Auto Service said."That's just a good management Excellent-certified mechanic. He practice." stresses continuing education for Oil drained from vehicles is kept himself and his crew. The business free of other contaminants — clean- has recently become an AC-Delco ing products,solvents,propellants— authorized parts franchise and repair so it too can be recycled either into facility. AC-Delco is the chief sup- asphalt product or for reuse as oil. plier to General Motors vehicles. The business painstakingly sepa- "I don't try and tell anyone what rates its own garbage, with an em- they should or shouldn't do in terms phasic on recycling metal,cardboard, of recycling,"Yarbrough said. "Our paper,etc. SatchWorks has only one intent as a business is to always step 55-gallon trash barrel per week for forward in terms of our education as the landfill,while many repair shops mechanics and in how we deal with have an entire dumpster. environmental issues regarding our He is working toward having a line of work." • Port Townsend St Jefferson County Leader Restrictions for Marrowstone It buildingmoratorium, i : •sland u , but parched icould be declared 'high risk' seawater intrusion area by December 2004 By Barney Burke of the designation. But it would also allow Because the new ordinance was adopted Leader Staff Writer the use of alternative catchment systems that without a hearing,the county has to conduct meet certain state standards. a public hearing within 60 days.That hear- With just two days left to respond to an Under existing county policy, anyone de- ing has been set for April 28. order from the Western Washington Growth veloping land must connect to a public water Many of the recommendations in the ordi- Management Hearings Board,the Jefferson system if one is available.The new ordinance nance were developed by a subcommittee of County Board of Commissioners adopted does not change that policy. the county's planning commission,headed by stricter rules March 3 for Marrowstone Is- No rush to drill wells before the 2004 date Marrowstone resident Phil Flynn."It's almost land in an effort to address the seawater in- is anticipated,according to Dave Christensen, self-policing,"he said of the new law and resi- trusion problem. the county's natural resource manager. Ex- dents'interest in protecting their water supply. The ordinance prevents further subdivision isting wells aren't grandfathered under the But Janet Welch, who owns property on of land on Marrowstone—but does not pro- new rule. Accordingly, a hydrogeologist Marrowstone Island but does not live there,ex- hibit the construction of new homes — until would have to determine that such wells pressed concern that the new ordinance doesn't and unless there is a public water system. won't cause further intrusion if a high-risk include adaptive management strategies. She '; The ordinance also requires that wells in- zone is declared and a building permit is ap- argued that the ordinance should require the stalled from this point forward be subject to plied for subsequently. county to take further steps if monitoring shows quarterly monitoring for seawater intrusion. Commissioner Wendi Wrinkle cast the that intrusion is getting worse. They must also use flow meters and a new dissenting vote.She explained that if Marrow- Commissioner Glen Huntingford re- technology that varies the speed of the with- stone were declared a"high risk"area today, sponded, "Is there something we can do drawals in order to minimize the impact on it would take the pressure off existing water there?" Christensen answered that staff is the aquifer. users and allow the use of alternative systems. working with DOE on that issue.The county if no public water system is in place Wrinkle also noted that seawater intrusion hasuntil June 5 to address that aspect of the b. 31,2004,the ordinance calls for de- is a problem in all coastal areas of the county, . hearings board order,he noted. daring all of Marrowstone Island a"high risk but only Marrowstone is being considered for Christensen estimated that the cost of the seawater intrusion protection zone." If the a public system at the moment. Public Util- new rules will be about$10,000 this year and county commissioners were to take that ac- ity District 1 is currently exploring the idea $5,000 to$10,000 per year after that.Part of tion at that time,it would make it extremely and has scheduled a public meeting for March that cost is related to finding enough prop- unlikely that the Washington Department of 18 to talk with property owners. erty owners willing to make data on their Ecology(DOE)would allow any more wells Wrinkle has been an active member of the wells available to get a more comprehensive to he drilled there, associate planner Josh Shine Community Action Council,one of the analysis of seawater intrusion. Peters said.It is also unlikely that new homes two groups that successfully challenged the Commissioner Dan Titterness was in could be built at that point by relying upon a county's seawater intrusion rules before the Washington, D.C., but participated in the pre-existing well, Peters explained, because hearings board. meeting by telephone. `3- -a3 . • , ./20 Port Townsend&Jefferson County Leader B .i Brothers i S . Community program to be launched March 13 The community is invited to the kick-off provide supervision and training for the Community members are being called presentation of the Big Brothers/Big Sisters Jefferson County Big Brothers/Big Sisters upon to join the Jefferson Mentoring Advi= of Jefferson County at the next Healthy Youth match coordinator—the staff member respon- sory and Resource Committee. "This coni- Coalition meeting, 4-5:30 p.m. Thursday, sible for screening and training adult volun- mittee will provide the vision, inspiration, March 13 at the Jefferson County Library. teers (Bigs), recruiting youths (Littles), and and resources to make Big Brothers/Big Sis- The primary goal of a Big Brothers/Big insuring that the Big Brothers/Big Sisters stan- ters of Jefferson County a shining star in our Sisters group is to develop one-to-one mu- dards of service are met for each match. community,"say organizers. tually satisfying relationships between Jefferson County Health and Human Ser- The Healthy Youth Coalition, in partner- youths ages 6-14 and their mentors, ex- vices will provide funding for a part-time ship with Jefferson County Health and Hu- plained Jean Baldwin, director of Jefferson match coordinator and convene the Jefferson man Services and the Community Network, County Health and Human Services. Mentoring Advisory and Resource Commit- is sponsoring this presentation.The Jefferson. Featured speakers will be John Dyer,board tee through its Raising a Healthy Commu- County Library is located at 620 Cedar Ave.,. president, and Peggy Stanford, executive di- nity federal Drug Free Communities Support Port Hadlock. rector, of Big Brothers/Big Sisters of Island Program grant. Chimacum School has al- For more information contact Kellie County. This organization recently voted to ready offered office space for the local match Ragan, healthy community grant coordina- adopt Jefferson County.This means that it will coordinator. tor,at 385-9446 or kragan@co.jefferson.wa. • • . . • 13 FoodSense Washington State University's nutrition edu,. "'arranged to make this'information available to cation program, Food $ense, has been reaching '`-'''moreseniors, she noted. out to children, families and seniors in Jefferson Scheduled for spring in the county's quali- County since October 2002. The free, part-time, fying school districts are classroom programs grant-funded program teaches limited-income combining nutrition education and hands-on ac- ' residents how to get the most nutrition for their tivities to help students discover how and why food dollars. to choose healthy foods and be active. Addi- Presently,monthly classes are conducted at the tionally, a collaboration with county and tribal 'Port Townsend WIC (Women, Infants and Chil- public health nurses, titled "On the Road to dren) Clinic. "Participants are enthusiastic and Living Well with Diabetes," is planned. "Dia- appreciative of the practical, quality information betic participants will receive a free medical being made available to them on such topics as screening and information to help them know `Grains on the Go' and 'The Power of Protein,"' how they are doing with their diabetes and how •said Karen Faverty, nutrition education assistant to monitor their diabetes to prevent complica- ' at WSU, tions," said Faverty. A group of seniors from one of the subsi- All of this practical educational programming dized housing sites in Port Townsend recently is available to qualifying limited-income audiences •completed four sessions of "Eating Well throughout the county at no charge.To learn more ' Bingo," a series of bingo games with special about the program, or to learn how your agency cards designed to address health issues that could partner with WSU to bring the program to seniors are typically concerned about,reported your clients,call Faverty at 360-582-9267 or WSU Faverty. More sessions at other sites are being at 379-5610. • PT. L&\DEi ,- 63 • 14 FRIDAY, MARCH 7, 2003 All Teen: Smokiré• down In state ivy' a 3c ❑ F4,. .2.2'.2o co.x^ - O l ^ 1° ° tiU.b c w c7 w, °O ° w v 7 . y o °7c, N m W CONTINUED FROM Al And 18.7 percent of 10th b g -, " a c I" °c N'~ About 85,000 do smoke, Faders reported binge drink- in , down from 23.2 percent. w o v N ° a y o o °oa a ti o though, with 55 pupils picking g ''N N b o, o�,i o m .q ,,-0 ,;,,,,,c, z up the habit every day. Some 27.3 percent of high [ a The sample found: school seniors said they S S „ o 2 ° „�,..,.. .VD-0 I 2.2 percent of sixth- engaged in binge drinking in FF, ,> ''d s ' ,,,..::.w i'E °3 •[ graders smoke, down from 4:7 the previous two weeks, down co.12C 13 >1 Rc:. 7 g 0. 'i o8 ro percent in 1998, a drop of 53 from 31.8 percent in 2000. O3 4 ° >;3 ,_ -o o. ro o- ° N o percent. As for methamphetamine, wilmi the sample found use among c " a $ " „ ; ti I 9.2 percent of eighth- eighth-graders increased from °°- e'-',4 >,<"p. �w. o graders smoke, down fromNo ;-Qr ,OE in ; Lawmakerslc decide if • rightsex info must be Bill requires all publicly funded courses use medically correct data Inc�rrecfi :examples THE ASSOCIATED Puss said Lindsay Scola, a sopho- Examples of>incor, OLYMPIA - Washington more at the University of Wash- rect sex education infor- sex education instructors would ington. "The sex education I major"taught to Wash- be required by state law to give received in my high school was ington students,cam= out only medically accurate unforgivable." piled from interv'xows information if a bill passed by NotAnSI te$t ony,l efore the House becomes law. always appropriate eaY teQse•f ;11 : House Bill 1178 requires all Some Republicans, however, CaI Wome ` publicly funded sex-education argued that medicallyaccuraterapedWomen get are preg- courses provide "medically education is not always appro- i 'can't accurate" information sup- priate for students. X Birth control pills ported by scientific research Rep. Jim Clements said he lead to infertility. and experts in the sexual health once substitute taught a ninth I Women who field. grade health class in which he undergo abortions will "Our children deserve better accidentally showed students a likely,become sterile or than to be misled or misin- video depicting the insertion of die. formed," said Rep. Shay an intrauterine device. ■ Condoms never Schual-Berke, the bill's spon- "I was like a cat on the work. sor. linoleum floor when you start a ■Tampons can`get vacuum cleaner," said lost in a=woman's Leaves specifics to school Clements, R-Selah. uterus. IIIThe bill Washington schools are not The "rhythm passed on Friday required by the state to provide mett hod" is the only The a vote of 52 to 44, with any sex education, viable method of birth opponents arguing it was a Federal law bars federal control back-door attempt to ban absti- funds from being used for sex •Phildre ents condomsgive nence-only sex education, education unless it's "age don't children Supporters said the bill sim- appropriate" and teaches the It or trust them; ply requires that any informa- health benefits of abstinence. p It a responsibility tion given out in sex-education The state has received over al activity to stop courses be accurate, while leav- $700,000 a year in federal funds "too tabefore it ing the specifics up to local for abstinence-based education goes far" becausetl school districts. Further, they since 1997. boys cannot control said, the bill explicitly states themselves. that abstinence is the' best Sex education victory The Associated Press methtransmitted of avoiding diseases sexually Supporters of comprehen- unwanted pregnancy. nd sive sex education called Fri- "This bill is not about pro- day's vote a victory. trolled Senate, which Schual- hibiting abstinence education, This is a major step forward Berke acknowledges will be an and this bill not about a or- in the protection of young peo- "uphill fight." But she remains tion," said Schual-Berke, D ple against unplanned Ores- hopeful following conversations Normandy Park. nancy and sexually transmitted •with a few Republican senators Rep. Mark Schoesler he diseases," said Gwen Chaplin, who might favor the bill. hasn't heard c any r saidrhe president of Planned Parent- "I think the door is open — hasnt heard sex-educationconerns hood Affiliates of Washington. people are concerned that chil- programs. The legislation now faces a dren are protected," Schual- "It's an answer in search of a vote in the Republican-con- Berke said. problem," said Schoesler, R- Ritzville. At a committee hearing on • the bill, students testified they'd been taught that abor- tions were likely to lead to 9 death or sterility and that con- doms — l are rarely effective. "I was lied to in high school,"