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2003- June
File Copy • Jefferson County Board of Health Agenda • Minutes June 19, 2003 • • JEFFERSON COUNTY BOARD OF HEALTH Thursday, June 19, 2003 2:30—4:30 PM Main Conference Room Jefferson Health and Human Services AGENDA I. Approval of Agenda II. Approval of Minutes of Meetings of May 15, 2003 III. Public Comments IV. Old Business and Informational Items • 1. Cruise Ship Waste Discharge 2. "Deadly Strains" on Public Health System 3. Summary of May 13th Data to Action Summit V. New Business 1. Public Health Funding and Legislative Wrap-Up 2. Communicable Disease Reporting and Control—Provider Initiatives 3. On-site Sewage Operations and Maintenance Report VI. Activity Update 1. Civic Engagement and Critical Health Services Project Timeline VII. Agenda Planning VII. Next Meeting: July 17,2003, 2:30-4:30 PM Main Conference Room, JHHS • JEFFERSON COUNTY BOARD OF HEALTH DRAFT MINUTES Thursday, May 15, 2003 -44Plv Board Members: Staff Members Dan Titterness,Member-County Commissioner District#1 Jean Baldwin, Health&Human Services Director Glen Huntingford,Member- County Commissioner District#2 Larry Fay,Environmental Health Director Wendi H. Wrinkle, Vice Chairman- County Commissioner District#3 Julia Danskin,Nursing Services Director Geoffrey Masci, Chairman-Port Townsend City Council Thomas Locke,MD, Health Officer Jill Buhler,Member-Hospital Commissioner District#2 Sheila Westerman,Member- Citizen at Large(City) Ex-officio Roberta Frissell,Member- Citizen at Large(County) David Sullivan,PUD#1 Chairman Masci called the meeting to order at 2:30 p.m. All Board and Staff members were present with the exception of Member Westerman. There was a quorum. APPROVAL OF AGENDA Member Buhler moved to approve the Agenda as presented. Commissioner Huntingford seconded the "lotion, which carried by a unanimous vote. APPROVAL OF MINUTES The following corrections were noted in the Minutes of April 17, 2003: Page 2, Informational Items: • Under the Jefferson County Washington State WIC Report, Sentence 2 should read: "Julia Danskin reported that this federally-funded Women, Infant and Children(WIC)program is subsidized 34%by Jefferson County."The following sentence should also be added: "The estimated cost to provide the WIC program at JCHHS is $90,562, of which approximately $55,293 comes from Washington State and Federal funds, and an estimated$35,269 from Jefferson County funds." Page 4, Board Sponsors for Environmental Health Regulation Development: • Paragraph 5, the sentence should be corrected to reflect (HB1376) rather than (SB1376). • Paragraph 6, the Water Policy or Comprehensive Drinking Water Ordinance workgroup should include Wendi Wrinkle in addition to Member Buhler and David Sullivan. Commissioner Huntingford moved to approve the minutes of April 17, 2003 as corrected. Member Frissell seconded the motion,which carried by a unanimous vote. 411 PUBLIC COMMENT—None • HEALTH BOARD MINUTES - May 15, 2003 Page: 3 larvicide products available for home ponds. It was suggested that in light of the recent letter to editor, The Leader might be more likely to print the Department's letter response and an article. Public Health Funding—Action Alert: Dr. Locke noted that the referendum that would have allowed a public vote on a dedicated source of public health funding died in the legislature. Since the$49M that had been a stable funding source never made it into the House budget the current focus is to have complete funding for the second year of the biennium. There was support for modifying the last paragraph of the draft letter in the agenda packet as follows: in the third sentence, replacing"its minimum share of funding"with"the state's share of funding" and in the fifth sentence, replacing "Without this funding"with "Without adequate funding." May 13, 2003 Health of Jefferson County Forum—Next Steps: The Board commended Staff and Chairman Masci for their excellent efforts in putting together the workshop, noting that the information was valuable and the groups well organized. Jean Baldwin recognized the valued participation of school boards, UGN, hospital commissioners, and the OlyCap Board. She then led a discussion of a strategy for moving into the next phase, noting there was interest in the following work groups continuing: health care access; vulnerable populations—young children, 18-34, and seniors; socio-economic issues and impact on health; substance abuse, and mental health. Each work group would include one staff person and two community facilitators (Chairman Masci, David Sullivan, and Members Frissell and Buhler). The facilitators would help the Department define what the workgroup would be measuring long term. A workshop summary and priorities would be provided to the Board in its next Board packet. �Jean Baldwin noted that on May 15, the State Department of Health and Clague and Associates would e coming to get feedback on how local health jurisdictions do assessment. They might want to contact Board members. There was discussion of other opportunities for groups to hear a presentation of this data: presentation to the physicians, the religious community, mental health and substance abuse boards, and the hospital board. It was suggested that a written summary of BRFSS/Other Data as well as what was done in the forum might be more useful than a lengthy presentation. Jean Baldwin recognized that CD-ROMS with the data would replace future printing of the books, which cost$8 each. There was Board agreement that the Data Steering Committee and new facilitators should meet before the groups start convening so that facilitators can present in a common format. It was suggested that the format used in the afternoon of the workshop be duplicated, but receiving discussion questions in advance and suggesting certain portions of the book with which the group should become familiar. Chairman Masci suggested that the work groups might be tasked to issue a press release after three to six months. Jean Baldwin agreed to send some information out soon to bring this all together. National Nurses Week—Focus on Public Health Nursing: Marty Johnson, School Health Nurse for Chimacum, Brinnon and Quilcene as well as Children with Special Healthcare Needs, talked about National Nurses Week, which is celebrated May 6-12t. She provided background on the life of the founder of Nursing, Florence Nightingale and provided a brief review of the history of Public Health. She then offered the results of her survey of the professional background of the County's public health nurses, which accrued to 429 years of collective nursing and nursing-related work experience. Referring to a 1946 discussion guide titled "Is Your Health The Nation's Business?," she described how public •ealth protection has become a basic government responsibility. She reviewed the core functions of Public Health and displayed a chart of the impact of vaccines in the 20`h Century. She showed newspaper clippings about smallpox collected by health nurses from 1936-46. The U.S. Department of Health and HEALTH BOARD MINUTES - May 15, 2003 Page: 4 Human Services predicts the critical shortage of full-time nurses to reach 150,000 by 2005 and 800,000 by 2020. She then compared contemporary public health nursing practice with some of the qualities • being sought in nurses in 1914. She reviewed the various County Health programs and discussed a sampling of client contact counts from 2002, representing home, office and school encounters in community-based programs coordinated and staffed by public health nurses. A pie chart was used to illustrate revenue sources for community health programs and the challenges of funding for Public Health for 2003. She provided background about and reviewed goals of public health nurse home visits. ACTIVITY UPDATE/OTHER ANNOUNCEMENTS - - None AGENDA PLANNING/ADJOURN The meeting adjourned at 3:42 p.m. The next meeting will be held on Thursday, June 19 at 2:30 p.m. at the Jefferson County Health and Human Services Conference Room. JEFFERSON COUNTY BOARD OF HEALTH Geoffrey Masci, Chairman Jill Buhler,Member (Excused Absence) 1111 Wendi H. Wrinkle, Vice-Chairman Sheila Westerman, Member Glen Huntingford, Member Roberta Frissell, Member Dan Titterness, Member • • Board of Health Old Business Agenda Item # IV., 1 • Cruise Ship Waste Discharge June 19, 2003 • Larry Fay iiirom: Lorna Delaney nt: Wednesday, May 21, 2003 12:46 PM Dave Christensen; Larry Fay Subject: FW: cruise liner waste dump Lorna Delaney, Clerk of the Board Jefferson County Commissioners <mailto:ldelaney@co.jefferson.wa.us> > Original Message > From: Forest Shomer [mailto:ziraat@olympus.net] > Sent: Wednesday, May 21, 2003 6:57 AM > To: Lorna Delaney > Subject: cruise liner waste dump > > > Dear Commissioners, > > I'm writing to express great concern over the massive, 40-ton sewage > dump by the cruise ship Norwegian Sky, in our inland waters not far > from Port Townsend, earlier this month. > > Although the incident was described as "accidental" and while there > may be fines levied at some point, there was also some dissembling on 0 the part of the Port of Seattle and the ship owners to the effect that the three-mile statutory offshore requirement for sewage releases might not apply to a portion of the waters between Whidbey > Island and Dungeness Spit (and the San Juans) because the central > part of those waters lie over three miles from our shore! > > Therein lies the potential for that area to become a de-facto sewage > dump for cruise ships! > > With as many as 100 cruise ships expected this year (passing both > going and coming) , even a casual "look the other way" attitude on the > part of maritime officials could result in the degradation of > intracoastal water quality and shorelines. For example, not two days > after the dumping incident, I observed several people harvesting > seaweed (for human consumption) on beaches fronting that part of the > strait. Local fishing boats bring their catch from those waters to be > sold in our markets and consumed in our restaurants. > > We have long derided the City of Victoria for its release of > untreated sewage into the Strait. Compound that with releases from > cruise ships (which are 'floating cities' of 3, 000 or more people) , > and we have the makings of a serious threat to human and ecological > health. These waters have a limited ability to cleanse themselves: > not the open ocean! > > I contacted the Port of Seattle nearly two weeks ago, and repeated > that contact this week, and have not yet received any response from > Commissioner Lawrence Molloy. > 0 I ask that you be among our more responsible officials in working to insure that: > --cruise ships be tightly policed on sewage dumping while in > Washington State waters 1 > --that the idea that dumping in this area by thoroughly nixed by all > agencies of government > --that the three-mile limit be specifically applied to only the outer > coast, not the inland waters > •> We all know that the cruise ship industry has a mediocre record on • > dumping at sea, in Alaska inland waters, in the Caribbean, and > elsewhere; and that shipboard illness is becoming very commonplace > (including an incident here this week) . These folks can't be counted > on to self-regulate! > Please help assure that all sewage discharges take place under > sanitary conditions at onshore locations or on the high seas. Once > our marine ecology becomes compromised, or our shorelines become > degraded by excessive human waste, it will be difficult for dependent > food systems, and regional tourism, to recover. > Thank you, sincerely, > Forest Shomer > P.O.Box 639 > Port Townsend WA 98368 > PS--Your written response will be appreciated. > -- > Inside Passage Seeds and Native Plant Services > Forest Shomer, owner > Port Townsend, WA, USA > ziraat@olympus.net > www.insidepassageseeds.com • • 2 Board of Health Old Business Agenda Item # IV. , 2 • " Deadly Strains" on Public Health System June 19, 2003 • uoverrung: Hearn services/June Luus Page 1 of 6 0 V I fir mists Er 'drlt v F•!4�efi C1 94T€rt EfEd3 From Governing's June 2003 issue COVER STORY/HEALTH CARE Deadly Strains SARS, West Nile virus and bioterrorism are the big scares. But the greater threat is the gradual erosion of public health services. By CHRISTOPHER CONTE hen Seattle received $2 million in federal money last year to prepare for a possible biological, chemical or radiological attack, public health director Alonzo Plough was relieved. Along with his counterparts around the country, Plough had watched new health • threats multiply while public health budgets stagnated. Finally, he thought, the city would have funds to work out emergency procedures with area police departments, fire officials and other"first responders." He'd be able to hire new staff to help combat naturally emerging diseases as well. Things haven't worked out as he *0Freww planned. No sooner had he launched a terrorism-planning effort than he Governin9 government ordered its sweeping smallpox-vaccination program. That task tied up so much of Plough's staff that they were slow to detect a new outbreak of tuberculosis among Seattle's homeless population. As ea officials scrambled to catch up with strains .•, that problem, SARS, or severe acute respiratory syndrome, emerged in China. Almost immediately, the mysterious disease started showing up in travelers returning from Asia. Plough had to divert staff from the unfinished smallpox and tuberculosis efforts and put them to work to keep the new disease from spreading in Seattle. Plough's job has become a continuous exercise in triage. The reason: His department has too much to do and too few resources. "In my 20 years in public health, I have never seen such a layering of http://governing.com/articles/6health.htm 6/4/03 uovermmng: meaun servicesi.oune zoo." rage z oI o challenges, all with fairly equal urgency and all drawing on diminishing core funding," he says. "We aren't providing anything near the web of protection that's needed." • The problem isn't unique to Seattle. All over the country, local public health departments are struggling to keep on top of a growing list of health threats. Terrorism may turn out to be the least of their concerns. Changing patterns of land use are bringing people into contact with dangerous new microbes such as the West Nile virus and the coronavirus, which is believed to be the cause of SARS. Globalization is spreading these diseases more rapidly than human immune systems or modern science can build defenses. And many see a scenario in which the familiar influenza virus abruptly morphs into a deadly pandemic that the U.S. Centers for Disease Control and Prevention estimates could kill as many as 300,000 people. On top of that, old maladies such as tuberculosis have started appearing in drug-resistant strains; sexually transmitted diseases such as HIV and syphilis are on the rise because many people have become complacent about them; and chronic diseases such as asthma and diabetes are becoming more prevalent due to environmental and behavioral factors. Local public health leaders widely agree with Plough that their tools and budgets haven't kept pace with these challenges. Despite the growing threat from communicable diseases, for instance, state health agencies employ fewer epidemiologists today (1,400) than they did in 1992 (1,700). When a professional association this fall and winter asked state health laboratory directors to rate their preparedness to handle a terrorist chemical attack, half scored their own facilities"1" or"2"on a scale of 1 to 10, with 1 being the poorest mark. And a Little Hoover Commission in California declared in April that the state's "public health infrastructure is in poor repair, providing less protection than it should against everyday hazards and unprepared to adequately protect us against the remote but substantial threats we now face."The commission noted, among other things, that only 20 percent of reportable diseases and conditions were actually reported to public health officials, and that at one key health laboratory, only 60 of 100 positions were filled. As California goes, so goes the nation. Updating a 1988 report that concluded the country's entire public health system was in "disarray," the National Institute of Medicine said last fall that the system is plagued by "outdated and vulnerable technologies, lack of real-time surveillance and epidemiological systems, ineffective and fragmented communications networks, (and) incomplete domestic preparedness and emergency response capabilities." STARVING THE SYSTEM Policy makers are aware of the holes in the public health system. Last year, the U.S. Congress provided $940 million to help local health departments cope with emerging threats. Local health officials hoped to use the funds not only to prepare for terrorist attacks but also to improve their ability to conduct general surveillance and cope with natural outbreaks such as SARS. The federal smallpox-vaccination program has absorbed nearly all of • the funds so far, however, making "dual use" largely a chimera. http://governing.com/articles/6health.htm 6/4/03 Governing: Health services/June 2003 Page 3 of 6 Indeed, many local officials say the federal government hasn't even provided enough money for them to prepare adequately for possible • terrorist attacks, let alone cope with naturally occurring diseases that already are killing people. In particular, the preoccupation with smallpox has set back efforts to plan defenses against a host of other potential biological weapons, including plague, tularemia, botulism toxin, and viral hemorrhagic fever; chemical agents such as ricin and sarin gas; and a possible "dirty bomb" laden with radioactive materials. Many public health officials such as Plough also say they lack secure communications networks linking them with other first responders. On top of that, public health officials have received no money to start educating the public about what people should do if there is a biological or chemical attack. "We are writing plans, but plans by themselves don't automatically translate into increased capacity," says Jeffrey Duchin, chief of the Seattle health department's Communicable Disease Control, Epidemiology and Immunization section. "We aren't committing the resources needed to turn them into living documents." Federal officials counter by saying that Public health state and local agencies would have trouble absorbing many more funds than departments have Congress has provided. But the increased had to rely federal funding has had an unintended side increasingly on effect: Fiscally strapped states and revenues that localities have seized on it to cut their ownco e with many public health spending. In Colorado's 1111 Larimer County, for instance, a $700,000tr attached. slash in state funds for public health more than erased a gain of $100,000 in federal money. Even with new federal funds, the Boston Public Health Commission has been forced to cut scores of positions. "Overall, we are losing money in the public health budgets in the 50 states, despite funds for terrorism preparedness,"says Dr. George Benjamin, executive director of the American Public Health Association. Benjamin formerly was health director for Maryland, which has received federal funds to increase its epidemiological staff but has been forced to cut its state-financed food safety program. Perhaps more troubling, public health departments have had to rely increasingly on revenues that come with many strings attached. For years, they have sought wherever possible to support programs with grants or with user fees, such as charges for restaurant inspections. But you can't charge a mosquito when you test it for West Nile virus, and while you can persuade public and private grant-makers to provide funds for programs aimed at recognized ills such as breast cancer, nobody seems to want to pay for ongoing operations or general preparedness. "There is a much greater investment in public health and public health programs now than there was a decade ago," notes Mary Selecky, Washington State's secretary of health and president of the Association of State and Territorial Health Officers. "But there is far less flexibility in how the dollars are spent. We are driven by categorical funding." Seattle's health department, considered by many to be dynamic and http://governing.com/articles/6health.htm 6/4/03 uovermng: rieaitn services/June.vus Page 4 of 6 forward-looking, illustrates the problem. Its overall budget has grown impressively, reaching $187.9 million this year from $77.5 million in 1993. But almost all the increases have been in programs supported by user fees and grants. County government gives it $28 million to run its emergency medical services; a federal program provides $5 million to support AIDS victims (but not to help prevent spread of the HIV virus that causes AIDS); and the Robert Wood Johnson Foundation donated money for the development of a program to deal with asthma. None of these funds pay for basic public health operations, including surveillance to detect new disease outbreaks, investigators to track the spread of diseases and a host of prevention-oriented activities. This year, funding for"core"activities totaled $30.9 million, barely up from $30.1 million 10 years ago. The current West Nile virus and TB outbreak alone would more than eat up that increase this year. And that doesn't take inflation or Seattle's substantial population growth into account. Per capita, core funding has dropped from $21.34 in 1997 to $16.67 today. WAITING TIME Behind those numbers lies a slow deterioration in the department's ability to address long-term problems or react quickly to changing conditions. When SARS hit this spring, for instance, the department couldn't follow up on a number of hepatitis B cases. The rate of childhood immunizations has fallen since 1998, while cases of measles and pertussis (whooping cough) have increased, and new TB cases are at a 30-year high. • When a team belatedly began combating the TB outbreak, it moved ahead in fits and starts. The key to stamping out such an outbreak is painstaking detective work: Investigators interview known victims, identify places they frequent and other people with whom they have come in contact, and then follow up those leads with additional screening and information-gathering. Eventually, such searches enable them to track a disease's movements, isolate it and stamp it out. By this spring, investigators had collected more than 50 pieces of information on each of some 528 actual or potential carriers. But the information tay unanalyzed for precious weeks because the outbreak team couldn't find an epidemiologist to work on it. "Somewhere in there is the answer to where and how this got kicked off, and where it's going next,"says Linda Lake, a consultant who leads the outbreak team and also chairs the Washington State Board of Health. "But the department is too busy dealing with SARS or other things. When you find somebody to help, it's always part-time, it's always for a short period of time, and it always takes them away from something else." Outbreaks don't occur on a neat schedule, Even the most and there inevitably will be times that are busier than others. Even the most ardent ardent public public health advocates don't expect health advocates voters to pay to have public health don't expect workers waiting around for the next voters to pay to outbreak the way firefighters are paid to have public health be available at all times. But there's a http://governing.com/articles/6health.htm 6/4/03 Uovermng: Health services/June 20U3 Page 5 of 6 backlog of tasks that could keep the public or rs Waiting health workforce busy when there are no around for the • emergencies. next outbreak the way firefighters Currently, the Seattle department can are paid to be afford just 10 public health nurses for an available at all intensive counseling program called "Best Beginnings,"which has been proven to times. reduce a wide range of health problems affecting children of first-time teenage mothers. That's enough to reach only about one fourth of the mothers who need the service. Meanwhile, a strategy for working with schools to encourage teenagers to drink less soda and get more exercise — keys to reining in a near epidemic of juvenile diabetes — remains on the drawing boards for lack of funds, as does a major initiative to help Seattle's health providers incorporate ideas about safer behavior, better diets and exercise into their daily interactions with patients. Although public health departments could make good use of additional funds, public skepticism about government and taxes usually trumps proposals to increase their resources. In Washington State, public health advocates were optimistic early this year after the Republican and Democratic leaders of the Senate co-sponsored a bill that would ask citizens to vote on whether to raise property taxes by $151 million to support local public health agencies. But health advocates lost heart after a poll commissioned by the Washington State Association of Counties and others showed the idea was far from assured of winning voter approval. • The lack of support demonstrates, in part, how reliance on categorical funding has become a political trap for public health agencies. Victims of specific illness often lobby tirelessly and effectively for funds to address their afflictions, but it's hard to find citizens who feel the same degree of passion for quiet government activities that keep people healthy. Public health workers have the passion, but it doesn't get them very far. "People think they're just asking for a handout." says Pat Libbey, executive director of the National Association of County and City Health Officials. REALITY CHECK Clearly, voters expect more than they are willing to pay for. The Association of Counties poll showed, for instance, that 96 percent of Washington voters believe the services public health agencies provide are "very important."Yet the state Department of Health estimates that total public health spending in the state — about $507 million annually — amounts to only one third of what public health agencies need to do the job they currently are expected to do. The department says only one half of local public health agencies are doing reasonably well in meeting 202 performance measures developed for them. For Carolyn Edmonds, a member of the county council for Seattle's King County and a former state legislator, the disparity between expectations and reality represents a political quandary. On one hand, she wonders whether advocates should present the budget situation • in starker terms — by warning voters, for instance, that the current stringency is forcing public health officials to put fighting infectious diseases ahead of making sure children are immunized. "Public health http://governing.com/articles/6health.htm 6/4/03 'LOW V%1111116. 11\+611611 JSil Y1ti6.J/.f u11� wrage p o o has shied away from doing that,"she says, "but maybe we're going to have to be more blatant"about what the trade-offs are. On the other hand, Edmonds fears that voters won't believe leaders • who say current budget and tax policy require such decisions: "People go to restaurants expecting that the food will be cooked properly. They go to a drinking fountain expecting that they won't get sick from the water. There is a built-in assumption that they will be taken care of." Eventually, she says, the assumption will be disproved — maybe not in dramatic ways but slowly and less noticeably. "Response times will be slower. There will be fewer prevention measures,"she says. "More people will get sick. People will die." The end result, in Edmonds'view, may not be as shocking as, say, terrorists detonating a dirty bomb in a baseball stadium. Nevertheless, it will be very real and might have been avoided. Copyright© 2003, Congressional Quarterii, Inc. Reproduction in any form without the written permission of the publisher is prohibited. Governing, City&State and Governing.com are registered trademarks of Congressional Quarterly, Inc. 4 klf?. E ' SEARCe AECAr St.rSCR4 E MAL A,3wE3I • http://governing.com/articles/6health.htm 6/4/03 • Board of Health Old Business Agenda Item # IV., 3 • Summary of May 13th Data to Action Summit June 19, 2003 • Evaluation Results Translating the Data: Moving from Numbers to People Tuesday, May 13, 2003 • 9:00 to 3:00 Port Townsend Elks Club Highlights • Nearly all of the participants who completed evaluations gave good, very good, or excellent scores on the various segments of the day. • Nearly all of the participants who completed evaluations reported that Goals 1 and 2 were met, (93.6% and 69.3% respectively). • Less than half of the participants who completed evaluations reported that Goals 3 and 4 were met (46.8% and 43.5% respectively). Total Responses = 62 (#of responses in parenthesis) Poor, Fair Good, Very Good, Excellent Data Overview and Highlights-Chris Hale 1.6% (1) 98.4% (61) Lunch Speaker-Judi Morris, "So What?" 3.2% (2) 96.8% (60) Strategic Issues Session #1-Implications for Action 6.4% (4) 93.6% (58) Strategic Issues Session #2-Key Priorities 4.8% (3) 95.2% (59) Taking the Next Steps 8.1% (5) 91.9% (57) Katie Carlson-Event Facilitator 17.7% (11) 82.3% (51) Small Group Facilitators 3.2% (2) 98.6% (60) Were the goals for the day achieved? Goal Not Goal Exceed Met Barely ► ed Met Goal Goal 1: Data overview and major highlights 0% 0% 1.6% 45.2% 48.4% (0) (0) (1) (28) (30) Goal 2: Implications of data related to policies and 0% 1.6% 12.9% 53.2% 16.1% services (0) (1) (8) (33) (10) Goal 3: Identify Key Priorities for Action 0% 1.6% 29.0% 37.1% 9.7% (0) (1) (18) (23) (6) Goal 4: Provide a framework for Next Steps 3.2% 6.5% 24.2% 38.7% 4.8% (2) (4) (15) (3) (3) • Translating the Data PROGRAM EVALUATION • Comments • What about holding a "Whole Systems Event? Where a group similar to this one today would focus on the two age groups at most risk: <18 year olds and the 75+ year olds? A WSE in a community-wide brain-storming da where a broad spectrum of people generate lots of ideas. Marvin Weisbard has a book that describes this kinds of event. • Wasn't here for entire session • Kellie's outfit— excellent • I felt that some of the assumptions Dr. Hale made based on the data were not supported by the data • Numbers along with percentages would have helped in the presentation by Hale. As she noted, percentages are often misleading. • Very good • Thank you —good job. I had to date some lower to highlight others, not that they are less important. • • A survey of all the people here and others could have been sent out prior to the stats being put together—could have included other items in book such as young children problems, stats. • My comments are general. Won't try to rate individual problem. I found the meeting extremely interesting. This information will be very useful in redoing the UGN allocation process. A committee has already been set up. • Facilitator was way too shrill. Not enough time for lunch. • Forum was excellent and very informative • It is clear that there seems to be a disconnect between needs/challenges and the resources that are available. Great program. • Very inspiring. Thank you! • Great job!! • Do kids in Seattle say "there's nothing to do here!"? • Needed drug & alcohol survey data from schools • • No direction in small group discussion. Discussed everything but accomplished nothing (might have been my group only). Data presentation great! Informative and useful! • Board of Health New Business Agenda Item # V. , 1 • Public Health Funding and Legislative Wrap-Up June 19, 2003 • 4 f Conference Budget Highlights for Counties Issue Conference Proposal 16 counties are provided a total of$5 mil.for State Fiscal Year 2004. No appropriation is County and City Backfill provided for 2005. A list of 134 cities share a total of$3 mil. in 2004 and$2 mil. in 2005. $48 million is provided through the Department of Community,Trade and Economic ublic Health Funding Development. $24 million in each fiscal year of the biennium. Individual department/district allocations in budget. Becca and truancy petitions fully funded. Funds now flow hrough Office of the Administrator for Becca and Truancy the Courts No caseload reductions. Funds reduced are: ($2.898 m)inpatient pool, ($5.840 m)admin cap to 10%, ($4.262 m)increased eligibility verification, and ($4.170 m)children's medical premiums for total of($17.258 m). Funds added are$18.640 m for enhanced local match options and 5% Mental Health requirement eliminated. MIO pilot funded-$902,000 and advance directives, Marr Settlement, and JLARC children's mental health recommendations. Ongoing provisos for increased direct services, Clark County project, MPC costs, DVR, and formula. Medicaid Integration Partnership fund shift authorized. Reductions to staffing for McNeil Island SCTF and funds provided for off- island facility. The budget provides sufficient funding for approximately 100,000 persons per month to receive state-subsidized health insurance coverageduring January 2004-June 2005. Beginning in 2004, the BHP is to be restructured,to reduce the state cost of covered services by approximately 80 Basic Health Plan percent.The revised benefit package is expected to include the following increases in enrollees' out-of-pocket costs:a$250 annual deductible;a$5 increase in office visit co-pays;a$3-7 increase in co-pays for prescription drugs;a$200 increase in the cost of a hospital stay;and a $60-70 annual increase,depending upon income, in the minimum premium charged to enrollees whose incomes are below 125 percent of the poverty level. Drug Sentencing and $8.9 m for counties and$1.2 m net after savings included for DOC for early implementation of Treatment drug sentencing reform. CRAB,TIB, FMSIB No consolidation Consolidation. Capital budget includes$800 k for Seattle toxocology Lab, $11.365 mil for Spokane Crime Lab, AP Crime Lab $10 mil for Vancouver Crime Lab urinal Justice Training Includes Coroner and Prosecutor training. $250,000 is provided for Wash.Assoc.of Sheriffs and Commission Chiefs sex offender web site. Homicide Investigation SMART is eliminated. HITS state funding now from PSEA. Tracking System $11,152,000 for county assistance to ensure minimum statewide service, and to provide new Enhanced 911 wireless tech staff in state office Includes$2.2 m.for county equipment purchases. From federal fiscal'03 budget:$8.3 M to locals for prescribed equipment,exercises, planning, admin,terrorism consequence management,and competitive grants. From federal'03 Homeland Security supplemental: $20.7 M to locals for prescribed equipment,training,exercises and planning. $2 M for enhanced security at critical infrastructure facilities. No local matching funds required. Distribution formulas developed by Adjutant General and governor's domestic security advisory group. MI eliminated. Grant program for rural hospitals created-$6.2 m and other hospitals with large Medically Indigent and GA-U proportion of low-income-$52.160 m.GA-U restructured requiring client to prove disability ($6.637m)cash and ($7.069m)medical savings. No additional funds to ADATSA for treatment. No reduction to pre-voc. No capping of daily rate.$2.5 m for community residential.$2.2 m for Developmental Disabilities community protection. One-time SSP payment$10 m. Reductions are($19.806 m)for ARC lawsuit, ($1.749 m)Medicaid Personal Care level of care, ($3.252 m)freeze on CAP waiver enrollments. Developmental Disabilities- Consolidation across all RHC's in order to downsize Fircrest.$3.160 m for community Institutions placements.$2.472 m for transition processes. Sentencing alternatives savings of($3.328 m)and funds to counties for implementation of Juvenile Rehabilitation $1.183 m.Across the board reduction of county consolidated juvenile services funds-($1.316 m). Becca funds shifted to Office of the Administrator for the Courts. • WSAC/WACO 06/06/03 Page 1 of 3 p I Conference Budget Highlights for Counties Issue Conference Proposal Prenatal care covered. Dept. required to obtain approval of federal waiver authorizing premiums for children over the poverty level saving ($67.038 m). Increased eligibility verification savings($ 51.184 m). Same as House for changes in durable medical equipment and dental. Co-pays for III1Pedical Assistance vision and hearing services authorized. Medicaid Integration Project authorized for nursing home residents saving ($12.670 m). Proviso requiring medical care management project for General Assistance clients continued with enrollment start of 7/1/04. MAA included in Medicaid Integration Partnership authority to shift funds. CRCs, HOPE beds, Family Policy Council, Networks, and Street Youth all fully funded through Children and Family Services PSEA-$23.0 m.. Funding for$16 mil.of this support came from a$10 increase in infraction penalties. TASC reduced-($4.64 m). Gravely disabled cut-($2.0 m). No VRDE reduction. DASA included Alcohol and Substance Abuse in Medicaid Integration Partnership authority to shift funds. No cut to rural hospital detox. Raise level of care standard for medicaid personal care services saving ($3.664 m). Limit COPES waiver enrollment growth saving ($10.390 m).Spousal resource limits reduced from Aging $90,000 liquid assets to$40,000 saving ($9.868 m). No caseload adjustment for Area Agency on Aging case managers. Medicaid Integration Partnership fund shift authorized. $14,782,000 savings due to elimination of community supervision for low-and moderate-risk offenders except those convicted of sex and violent crimes. $24,939,000 in savings due to early Post Release Supervision implementation of drug sentencing changes, and to increases in maximum amount of earned early release time. Shifts LEO billing to OAC and collection to county clerks. Provides$1.8 M in PSEA grants to clerks based on WACO formula. Indigent Defense for Maintains current pilot programs but does not provide for further expansion in'03-'05. Funding Dependency/Termination would support 800 cases in the juvenile courts of the two pilot projects. Cases Extraordinary Criminal Justice $766,000 for King County. Costs Shorelines Planning Provides one time funding of$2 million. 'PIA Planning/Growth Boards CTED GMA grants appear to be restored. Funding is restored for Growth Boards. Watershed Planning and $11.5 million in grant funding for watershed planning.Technical assistance staff appears cut. Management FCAAP grants cut by 50%to$2 million. Salmon Recovery Reduces salmon recovery planning grants to$3.25 m. No appropriation is provided for regional recovery boards in the operating budget.The capital budget is not yet available. State Conservation Agency not merged. Commission Economic Development Increases funding for tourism promotion (400K),foreign offices(400K)and other economic Programs at DCTED development efforts by$2.6 million total. DOH Water Reclamation Eliminates water reclamation assistance. DNR Geology Public Same as Senate. Information. AIDSNET Funding No reduction in AIDSNets funding. Tire Recycling No funding is provided. Child Death Reviews Funding is eliminated. The fee for certified copies of birth,death, marriage, and divorce certificates is increased from Web-based Death Certificate $13 to$15. This is expected to generate approximately$600,000 per year of additional revenue System for local health departments,and$1.7 million of additional revenue per year for the state Center for Vital Statistics. The Center will develop a web-based death certificate system. Per SSB 5545,the fee for a certified copy of all birth,death, marriage,and divorce certificates is Vital Records Fee Increase to be increased by an additional$2 in order to reduce the need for general tax subsidy of the vital records system. Funding is provided for a 33 percent increase in statewide coordination and quality enhancement Expand Food Safety Program of local food safety inspection efforts. 1.5 FTE and$266,000. ---- Funding from the State Toxics Control Account is provided in DOH and DOE to develop a plan rcury Reduction and for educating schools, local governments, businesses, and public on proper disposal methods for Education mercury-added products and to implement the requirements of HB 1002. WSAC/WACO 06/06/03 Page 2 of 3 Conference Budget Highlights for Counties Issue Conference Proposal Funding is provided to DOH for implementation of ESHB 1338 (Municipal Water Rights). DOH is required to draft rules, implement policy,and provide technical assistance regarding new, Ounicipal Water Systems enforceable water conservation requirements. It is also expected to result in 50 additional water systems seeking plan reviews each year in order to secure water rights. Most of the cost is to be financed by a 25 cent per residence fee on water connections. The State Board of Health has recommended that all newborns be screened by the state public health laborator for five additional disorders whch can cause menal or motor retardation, Add Newbord Screening blindness, hearing loss,physical abnormalities, and/or death if undetected. Testing for the five Tests. conditions will increase public health laboratory expenditures by approximately$1.6 million per year beginning in CY 2004, requiring an estimated$20.50(50%)increase in the fee charged for newborn screenings. The State Board of Health has recommended that all newborns be screened for early hearing loss. Funding is provided for technical assistance to hospitals on implementation of this Newborn Hearing Screening requirement,and to fund surveillance and tracking activities associated with early hearing loss detection,diagnosis, and intervention. Funding is reduced$152,000 for technical assistance to local health districts for engineering review for new landfills and moderate risk waste facilities, landfill closure,and groundwater Solid Waste-Techinical monitoring. Local health districts can utilize existing Local Toxics grant funding for projects to Assistance Reduction offset this engineering and hydrology technical assistance reduction. In addition revenue generated from the Biosolids permit program will be utilized to provide additional technical _ assistance and permit processing for the Biosolids program. Funding is reduced$1.726 million for technical assistance related to hydrogeology,sediement, Site Cleanup Technical chemistry,and biological impact analysis for site clean-up. One-time$2.1 million fund balance • Assistance Reduction from delays payments to the US EPA and other savings will be utilized for emergency site clean- ups. Hazardous Waste: Funding is reduced$406,000 for education and technical assistance for businesses that Reduc tion Technical generate less than 220 pounds of dangerous waste a month,otherwise known as small quantity Assistance generators. This equates to 3,000 less technical assistance visits for the biennium out of a total of approximately 18,000 inspections. Reduction Funding is eliminated for a strategy to address persistent, bioaccumulative toxic chemicals. • WSAC/WACO 06/06/03 Page 3 of 3 • June 19, 2003 To: Jefferson County Board of Health From: Julia Danskin Nursing Director Re: June 19th Board of Health Meeting, Maternal Child Health update Two of the larger programs in the JCHHS Nursing section are Maternity Support Services (MSS) and Maternity Case Management (MCM). Both of these programs were started in 1989 through a federal initiative to increase services to pregnant women and decrease infant morbidity and mortality in the United States. Washington State Department of Social and Health Services (DSHS) manages these state and federal funds. DSHS contracts with Health Departments and other agencies to provide these programs, which include home visits, office visits and Case Management to pregnant women and infants up to one year of age. JCHHS provides these services with 4 Public Health Nurses, a Nutritionist and a Mental Health specialist. We use these funds to do the Nurse Family Partnership intensive Home Visiting Program that has proven effective in decreasing Child Abuse and Neglect, decrease use of Drug and alcohol use, and decreased violent behavior later in life. •Due to Washington State Budget deficits MSS and MCH were almost totally cut last year. This year Washington State DSHS is making major changes in these two programs. The result for JCHHS is a potential lost of funds for these services. MSS and MCH will be changing to Integrated Maternity Support Services/Infant Case Management. The reapplication arrived June 8th and it is due July 1, 2003. The new program will start Oct. 1, 2003. At this moment we are analyzing the new billing fees verses the current billing fees. In 2003 budget we anticipated $130,000 in revenue in MSS and MCM. It is unclear how much of a cut we can anticipate since the new billing contract is very different from how we currently bill. My own crystal ball says about $20, 000 annual loss. Consequently, there are a lot of unknowns at this moment. We anticipate the Juvenile Justice Grant, "Preventing Delinquency Early", from last year will be renewed July 1, 2003. This grant help expand the Nurse Family Partnership Intensive Home visiting program and universal home visiting to all newborns this past year. Other funding changes are the loss of Child Death Review program as of July 1, 2003. This is a small program with a $3,000 annual budget with all the funds coming from Department of Health. S WASHINGTON STATE ASSOCIATION OF LOCAL PUBLIC HEALTH OFFICIALS May 6, 2003 The Honorable Gary Locke Governor State of Washington PO Box 40002 Olympia, WA 98504-0002 tS-1) Dear Governor Locke: The Washington State Association of Local Public Health Officials(WSALPHO)wants to thank you for your support for the local public health backfill funding included in your proposed 2003-05 biennial budget. Only the House of Representatives budget did not include two years of funding for local public health. WSALPHO appreciates the high priority placed on public health services through your Priorities of Government process. It is critically important that the full two years of funding be included in the final 2003-05 • biennial budget approved by the Legislature and signed into law by you. That funding represents, on average, 30%of the unrestricted funding for local public health jurisdictions.It is the unrestricted funding that is necessary to respond to communicable disease issues such as SARS, West Nile Virus, as well as Tuberculosis,Hepatitis, HIV/AIDS and other infectious diseases. These dollars are also used to respond to a food or water borne disease outbreak. Local public health agencies are straining to maintain basic disease surveillance and response plus build response capacity for SARS, West Nile Virus, and Bioterrorism preparedness. Additional funding is necessary to adequately meet the demands being placed upon the public health system. Any reduction to existing funding will have very real consequences in our communities and disease protection will be reduced. WSALPHO is asking that you insist that local public health receive two full years of backfill funding in any 2003-05 biennial budget approved by the Legislature. Again, WSALPHO appreciates your recognition of the critical importance of governmental public health services. Sincerely, Jean B dwin Chair • • Board of Health New Business Agenda Item # V., 2 • Communicable Disease Reporting And Control - Provider Initiatives June 19, 2003 • SEVERE ACUTE RESPIRATORY SYNDROME Updated Interim U.S. Case Definition for Severe Acute Respiratory Syndrome (SARS) The previous CDC SARS case definition (published May 23, 2003) has been updated as follows: • In the Epidemiologic Criteria, the last date of illness onset for inclusion as reported case for Singapore is now June 14, 2003. Clinical Criteria • Asymptomatic or mild respiratory illness • Moderate respiratory illness — Temperature of >100.4° F (>38° C)*, and — One or more clinical findings of respiratory illness (e.g., cough, shortness of breath, difficulty breathing, or hypoxia). • Severe respiratory illness — Temperature of >100.4° F (>38° C)*, and — One or more clinical findings of respiratory illness (e.g., cough, shortness of breath, difficulty breathing, or hypoxia), and — radiographic evidence of pneumonia, or — respiratory distress syndrome, or • — autopsy findings consistent with pneumonia or respiratory distress syndrome without an identifiable cause. Epidemiologic Criteria • Travel (including transit in an airport) within 10 days of onset of symptoms to an area with current or previously documented or suspected community transmission of SARS (see Table), or • Close contact§ within 10 days of onset of symptoms with a person known or suspected to have SARS Travel criteria for suspect or probable U.S. cases of SARS Area First date of illness onset Last date of illness onset for inclusion as reported for inclusion as reported case* caset China (mainland) November 1, 2002 Ongoing Hong Kong February 1, 2003 Ongoing Hanoi, Vietnam February 1, 2003 May 25, 2003 Singapore February 1, 2003 June 14, 2003 Toronto, Canada April 23, 2003 Ongoing Taiwan May 1, 2003 Ongoing May 23, 2003 Page 1 of 3 • DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION SAFER•HEALTHIER•PEOPLE'" Updated Interim U.S. Case Definition for Severe Acute Respiratory Syndrome (SARS) (continued from previous page) Laboratory Criteria¶ • Confirmed — Detection of antibody to SARS-CoV in specimens obtained during acute illness or >21 days after illness onset, or — Detection of SARS-CoV RNA by RT-PCR confirmed by a second PCR assay, by using a second aliquot of the specimen and a different set of PCR primers, or — Isolation of SARS-CoV. • Negative — Absence of antibody to SARS-CoV in convalescent serum obtained >21 days after symptom onset. • Undetermined — Laboratory testing either not performed or incomplete. Case Classification** • Probable case: meets the clinical criteria for severe respiratory illness of unknown etiology and epidemiologic criteria for exposure; laboratory criteria confirmed, negative, or undetermined. • Suspect case: meets the clinical criteria for moderate respiratory illness of unknown etiology, and epidemiologic criteria for exposure; laboratory criteria confirmed, negative, or undetermined. Exclusion Criteria A case may be excluded as a suspect or probable SARS case if: • An alternative diagnosis can fully explain the illness*** • The case was reported on the basis of contact with an index case that was subsequently excluded as a case of SARS (e.g., another etiology fully explains the illness) provided other possible • epidemiologic exposure criteria are not present *A measured documented temperature of>100.40 F(>380 C) is preferred. However, clinical judgment should be used when evaluating patients for whom a measured temperature of>100.4°F(>380 C) has not been documented. Factors that might be considered include patient self-report of fever, use of antipyretics, presence of immunocompromising conditions or therapies, lack of access to health care, or inability to obtain a measured temperature. Reporting authorities should consider these factors when classifying patients who do not strictly meet the clinical criteria for this case definition. §Close contact is defined as having cared for or lived with a person known to have SARS or having a high likelihood of direct contact with respiratory secretions and/or body fluids of a patient known to have SARS. Examples of close contact include kissing or embracing, sharing eating or drinking utensils, close conversation (<3 feet), physical examination, and any other direct physical contact between persons. Close contact does not include activities such as walking by a person or sitting across a waiting room or office for a brief period of time. $The WHO has specified that the surveillance period for China should begin on November 1; the first recognized cases in Hong Kong, Singapore and Hanoi(Vietnam) had onset in February 2003. The dates for Toronto and Taiwan are linked to CDC's issuance of travel recommendations. The last date for illness onset is 10 days(i.e., one incubation period) after removal of a CDC travel alert. The case patient's travel should have occurred on or before the last date the travel alert was in place. ¶Assays for the laboratory diagnosis of SARS-CoV infection include enzyme-linked immunosorbent assay, indirect fluorescent- antibody assay, and reverse transcription polymerase chain reaction (RT-PCR)assays of appropriately collected clinical specimens(Source: CDC. Guidelines for collection of specimens from potential cases of SARS. Available at http://www.cdc.00v/ncidod/sars/specimen collection sars2.htm).Absence of SARS-CoV antibody from serum obtained <21 days after illness onset,a negative PCR test, or a negative viral culture does not exclude coronavirus infection and is not considered a definitive laboratory result. In these instances, a convalescent serum specimen obtained >21 days after illness is needed to determine infection with SARS-CoV. All SARS diagnostic assays are under evaluation. **Asymptomatic SARS-CoV infection or clinical manifestations other than respiratory illness might be identified as more is learned about SARS-CoV infection. *** Factors that may be considered in assigning alternate diagnoses include the strength of the epidemiologic exposure criteria for SARS, the specificity of the diagnostic test, and the compatibility of the clinical presentation and course of illness for the alternative diagnosis. June 5, 2003 Page 2 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION SAFER•HEALTHIER• PEOPLE' • Updated Interim U.S. Case Definition for Severe Acute Respiratory Syndrome (SARS) (continued from previous page) • For more information, visit http://www.cdc.gov/ncidod/says or call the CDC public response hotline at (888) 246-2675 (English), (888) 246-2857 (Espanol), or (866) 874-2646 (TTY) • June 5, 2003 Page 3 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION SAFER•HEALTHIER• PEOPLE' CCenters for Disease Control and Prevention West Nile Virus(WNV)Infection Information for Clinicians R•HEALTHIER•PEOPLE" Clinical Features I Mild Infection Most WNV infections are mild and often clinically unapparent. o Approximately 20%of those infected develop a mild illness(West Nile fever). o The incubation period is thought to range from 3 to 14 days. o Symptoms generally last 3 to 6 days. Reports from earlier outbreaks describe the mild form of WNV infection as a febrile illness of sudden onset often accompanied by ► malaise headache ► anorexia ► myalgia ► nausea rash ► vomiting ► lymphadenopathy ► eye pain The full clinical spectrum of West Nile fever has not been determined in the United States. Severe Infection Approximately 1 in 150 infections will result in severe neurological disease. o The most significant risk factor for developing severe neurological disease is advanced age. o Encephalitis is more commonly reported than meningitis. In recent outbreaks,symptoms occurring among patients hospitalized with severe disease include ► fever ► gastrointestinal symptoms weakness change in mental status o A minority of patients with severe disease developed a maculopapular or morbilliform rash involving the neck,trunk,arms,or legs. So Several patients experienced severe muscle weakness and flaccid paralysis. o Neurological presentations included ► ataxia and extrapyramidal signs ► optic neuritis ► cranial nerve abnormalities polyradiculitis • myelitis seizures Although not observed in recent outbreaks,myocarditis,pancreatitis,and fulminant hepatitis have been described. Clinical Suspicion Diagnosis of WNV infection is based on a high index of clinical suspicion and obtaining specific laboratory tests. o WNV,or other arboviral diseases such as St. Louis encephalitis, should be strongly considered in adults>50 years who develop unexplained encephalitis or meningitis in summer or early fall. o The local presence of WNV enzootic activity or other human cases should further raise suspicion. o Obtaining a recent travel history is also important. Note: Severe neurological disease due to WNV infection has occurred in patients of all ages. Year-round transmission is possible in some areas. Therefore,WNV should be considered in all persons with unexplained encephalitis and meningitis. IDiagnosis and Reporting Procedures for submitting diagnostic samples and reporting persons with suspected WNV infection vary among states and jurisdictions. Links to state and local websites are available at http://www.cdc.gov/ncidod/dvbid/westnile/city states.htm CDC Diagnosis and Reporting—continued Diagnostic Testing WNV testing for patients with encephalitis or meningitis can be obtained through local or state health departments. o The most efficient diagnostic method is detection of IgM antibody to WNV in serum or cerebral spinal fluid (CSF)collected within 8 days of illness onset using the IgM antibody capture enzyme-linked immunosorbent assay(MAC-ELISA). o Since IgM antibody does not cross the blood-brain barrier,IgM antibody in CSF strongly suggests central nervous system infection. o Patients who have been recently vaccinated against or recently infected with related flaviviruses(e.g.,yellow • fever,Japanese encephalitis,dengue)may have positive WNV MAC-ELISA results. Reporting Suspected WNV Infection Refer to local and state health department reporting requirements:www.cdc.gov/ncidod/dvbid/westnile/cite states.htm o WNV encephalitis is on the list of designated nationally notifiable arboviral encephalitides. o Aseptic meningitis is reportable in some jurisdictions. The timely identification of persons with acute WNV or other arboviral infection may have significant public health implications and will likely augment the public health response to reduce the risk of additional human infections. ILaboratory Findings Among patients in recent outbreaks o Total leukocyte counts in peripheral blood were mostly normal or elevated,with lymphocytopenia and anemia also occurring. o Hyponatremia was sometimes present,particularly among patients with encephalitis. o Examination of the cerebrospinal fluid(CSF)showed pleocytosis,usually with a predominance of lymphocytes. o Protein was universally elevated. o Glucose was normal. o Computed tomographic scans of the brain mostly did not show evidence of acute disease,but in about one- third of patients,magnetic resonance imaging showed enhancement of the leptomeninges,the periventricular areas,or both. ITreatment Treatment is supportive, often involving hospitalization,intravenous fluids,respiratory support,and prevention of • secondary infections for patients with severe disease. o Ribavirin in high doses and interferon alpha-2b were found to have some activity against WNV in vitro,but no controlled studies have been completed on the use of these or other medications, including steroids, antiseizure drugs,or osmotic agents, in the management of WNV encephalitis. For additional clinical information,please refer to Petersen LR and Marlin AA, "West Nile Virus:A Primer for the Clinician[Review],"Annals of Internal Medicine(August 6)2002: 137:173-9. For clinical and laboratory case definitions, see `Epidemic/Epizootic West Nile Virus in the United States:Revised Guidelines for Surveillance, Prevention, and Control, 2001,"at www.ccic.gov/ncidod/dvbid/westnde/surv&control.htm August 20,2002 www.cdc.gov • /_)L ••v ,je er f� son County Health eT'Human Services l' 11_4, r l 615 SHERIDAN • PORT TOWNSEND,WA 98368 • FAX 360-385-9401 • May 6, 2003 To: Medical Providers From: Jefferson County Health and Human Services RE: Medical Providers Communicable Disease Reporting Attached is an updated Medical Providers Communicable Disease Reporting Instruction Sheet. We have added several new after hours and weekends contact numbers. Please replace all of your existing instructional sheets with our new and improved version. We will routinely update this information once a year or immediately if changes occur. Also enclosed is the most recent version of the"Notifiable Conditions & The Health Care Provider"poster from Washington State Department of Health If you have any questions, suggestions, or comments please do not hesitate to call Lisa McKenzie at(360) 385-9422. Jean Baldwin Director COMMUNITY ENVIRONMENTAL NATURAL DEVELOPMENTAL SUBSTANCE ABUSE HEALTH HEALTH RESOURCES DISABILITIES &PREVENTION 360/385-9400 360/385-9444 360/385-9444 360/385-9400 360/385-9400 - ___ 1 , . Jefferson County Health e.Human Services - 1• • > 615 SHERIDAN • PORT TOWNSEND,WA 98368 • FAX 360-385-9401 �. FOR LIMITED DISTRIBUTION MEDICAL PROVIDERS COMMUNICABLE DISEASE REPORTING Immediate Notification: • Diseases of Suspected Bioterrorism Origin • Diseases Designated As Immediately Notifiable(see attached poster"Notifiable Conditions&The Health Care Provider"poster from WA State Dept of Health) • Unexplained Critical Illness or Death • Rare Diseases of Public Health Significance Call: Monday-Friday 9:00-4:30—385-9400 for Communicable Disease Nurse on duty • Diseases of Suspected Foodborne or Waterborne Origin(clusters only) Call: Monday-Friday 9:00-4:30:—385-9444 for the Environmental Health Program Specialist,Food Program 1111 After hours and weekends call: 1. Tom Locke,MD,Health Officer Pager (360)582-8353 Cell (360)808-3333 Home (360)683-9152 If unable to reach#1 call: 2. Public Health Emergency Phone Cell (360)531-1736 Pager (360)379-6104 If unable to reach#1 or#2 call: 3. Jean Baldwin,Director(360)379-9403;(360)531-0220 Cell 4. Lisa McKenzie,Nurse(360)344-3183 or 5. Julia Danskin,Nursing Director(360)385-3320 6. Larry Fay,Environmental Health Director(360)379-0384 7. In the event of a health emergency where no Jefferson County Heath Official can be contacted the State Department of Health Duty Officer is available(by pager)at:(360)971-0601 For all other notifiable conditions a report may be made by telephone(360)385-9400 Monday thru Friday(9am thru 4:30pm)or by mail courier. 11) This is Version#1 dated 5/1/2003 Version#2 will be sent immediately if changes occur or in one year(May 2004)whichever is soonest. COMMUNITY ENVIRONMENTAL NATURAL DEVELOPMENTAL SUBSTANCE ABUSE HEALTH HEALTH RESOURCES DISABILITIES &PREVENTION 360/385-9400 360/385-9444 360/385-9444 360/385-9400 360/385-9400 • Notifiable Conditions & Washington State Department of • The Health Care Provider /Health The following diagnoses are notifiable to local health authorities in Washington in accordance with WAC 246-101. Timeframes for notification are indicated in footnotes. Immediately notifiable conditions are indicated in bold and should be reported when suspected or confirmed. Acquired Immunodeficiency Syndrome (AIDS)3 (including Legionellosis 3 AIDS in persons previously reported with HIV infection) Leptospirosis 3 Animal Bites s Listeriosis Botulisms (foodborne,wound,and infant) Lyme disease 3 Brucellosis s Lymphogranuloma venereum 3 Campylobacteriosis 3 Malaria 3 Chancroid 3 Measles(rubeola)s Chlamydia trachomatis 3 Meningococcal disease s Choleras Mumps 3 Cryptosporidiosis 3 Paralytic shellfish poisoning s Cyclosporiasis 3 Pertussis t Diphtherias Plague s Disease of Suspected Bioterrorism Origin(including)1 Poliomyelitis s Anthrax Psittacosis 3 Smallpox Q fever 3 Disease of Suspected Foodborne Origin s(clusters only) Rabies I Disease of Suspected Waterborne Origins(clusters only) Rabies post-exposure prophylaxis 3 Encephalitis, viral 3 Relapsing fever(borreliosis)1 Enterohemorrhagic E. co//including E.coli 0157:H7 infections Rubella,including congenital s Giardiasis 3 Salmonellosis s Gonorrhea 3 Shigellosis s Granuloma inguinale 3 Streptococcus Group A, invasive disease 3 • Haemophilus influenzae invasive disease 1Syphilis 3(including congenital)(under age five,excluding otitis media) Tetanus 3 Hantavirus Pulmonary Syndrome 3 Trichinosis 3 Hemolytic Uremic Syndromes Tuberculosis s Hepatitis A-acute s Tularemia 3 Hepatitis B-acute 3;chronic M(initial diagnosis only) Typhus' Hepatitis B-surface antigen+pregnant women 3 Vibriosis 3 Hepatitis C-acute and chronic M(initial diagnosis only) Yellow Fevers Hepatitis, unspecified(infectious)1 Yersiniosis 3 Herpes simplex, genital and neonatal 3(initial infection only) HIV infection 3 Unexplained Critical Illness or Death s Immunization reactions,severe,adverse 3 Rare Diseases of Public Health Significances The following diagnoses are notifiable to the Washington State Notification time frame: s Immediately, Department of Health in accordance with WAC 246-101. 3 Within 3 work days, M Within one month Timeframes for notification are indicated in footnotes. Immediately notifiable conditions are indicated in bold and should be reported when suspected or confirmed. Asthma,occupational(suspected or confirmed) M INSERT LOCAL REPORTING Call 1-888-66-SHARP Birth Defects—Autism M Call(360)236-3492 INFORMATION HERE Birth Defects—Cerebral Palsy^^ Call(360)236-3492 Birth Defects—Fetal Alcohol Syndrome/Fetal Alcohol Effects M If no one is available at the local health Call(360)236-3492jurisdiction and a condition is I Pesticide poisoning(hospitalized,fatal,or cluster) Immediately Notifiable, please call 1-800-732-6985 .Pesticide Poisoning (other)3 Call 1-800-732-6985 (877) 5394344 For more information please see WAC 246-101 or see www.doh.wa.gov/nc.htm • Jefferson County Health & Human Services CHLAMYDIA UPDATE ■ The number of Chlamydia cases in Jefferson County has nearly tripled in the first 4 months of 2003 compared to 2002, from 8 to 23. Thirteen of these were diagnosed through the Health Department Family Planning or STD clinics, and 10 through Private Providers. There is an increase of cases statewide. • The CDC and Washington State Department of Health recommend that all sexually active women aged 14—25 years should be screened for chlamydial infection at least annually, even if symptoms are not present. This age group is considered high risk for chlamydial infections. Screening is also recommended for older women with risk factors (e.g., those who have a new sex partner or multiple sex partners). • Of the 32 Chlamydia cases reported in Jefferson County in 2002, 28 were in this high risk age group. Eighteen patients were symptomatic at the time of the exam and 14 were asymptomatic. • A reminder that the CDC recommends that individuals with chlamydia be re-screened in 3 months. This corresponds to an increased risk of re-infection vs. the need for a • test of cure since treatment with Doxycycline or Azithromycin is very effective. • The recent increase in cases makes partner notification, evaluation and treatment even more important. Please ask all cases about sex partners in the 6o days preceding onset of symptoms. If patients desire assistance in notifying and referring their partners, the Health Department can do anonymous partner notification. • The new ligase chain reaction (LCR) tests are more sensitive than the Gen-probe, DFA, or culture. See the attached chart for comparisons of test sensitivity, specificity and cost. To order this test specify "Chlamydia, Neisseria Gonorrhoeae PCR test" on the JGH Lab requisition form and this will be sent out to Quest Lab. All tests are highly specific (99—99.9%), so the rate of false positives is very low. • An excellent on-line guide for clinical information about chlamydia and other STD's, the STD Handbook from the University of Washington's STD/HIV Prevention Center is available at www.STDhandbook.org. The CDC's Sexually Transmitted Disease Treatment Guidelines 2002 is at www.cdc.gov/std/treatment. • For assistance with information for clients and partner notification, please contact Denis Langlois, ARNP at 385-9421, or Lisa McKenzie at 385-9422. • June 6, 2003 Emergency Contraception Fact Sheet Page 1 of 2 • ' ` " Emergency Contraception Fact Sheet What is Emergency Contraception? The most common emergency contraception regimen uses progestin and estrogen - (levonorgestrel and ethinyl estradiol)the same hormones found in birth control pills. Emergency contraception, started as soon as possible within 72 hours, can prevent pregnancy after sex without birth control or sex with known or suspected birth control failure. Emergency contraception works the same way birth control pills do to prevent pregnancy; it can delay or prevent the release of an egg (ovulation). Emergency contraception is not an"abortion pill"and will not harm an existing pregnancy. The only definitive scientific evidence indicates that emergency contraceptive pills work by preventing or delaying ovulation. Theories about other modes of action of birth control pills include prevention of fertilization or implantation. Like all birth control pills, emergency contraceptive pills do not protect against infection with HIV, the virus that causes AIDS,and other sexually transmitted diseases. SAre Emergency Contraceptive Pills Safe? The FDA found combined oral contraceptives to be safe and effective for use as emergency contraception, based primarily on a meta-analysis of 10 studies with special doses of birth control pills that showed a favorable safety profile. The most commonly reported side effects are nausea and/or vomiting. Emergency contraception is not a replacement for the responsible use of regular contraception. It is an important"back-up"method,for use when contraception fails or was not used. Why is Emergency Contraception Necessary? Based on statistics from the 1995 National Survey of Family Growth published by the Centers for Disease Control and Prevention (CDC),there are over 2.7 million unintended pregnancies per year in the United States, nearly half are due to contraceptive failure. About 1.35 million unintended pregnancies end in abortion each year. More than 11 million women reported using contraceptive methods such as condoms, withdrawal, periodic abstinence and diaphragms.These methods were associated with failure rates of 14 percent, 24 percent, 21 percent and 12 percent, respectively. Experts at the American College of Obstetricians and Gynecologists estimate that emergency contraceptive pills could prevent 800,000 abortions each year. How Many Unintended Pregnancies in the U.S.? 2.7 million unintended pregnancies in 1995 (last year for which data is available) 47%of unintended pregnancies end in abortion,40% in birth and 13% in miscarriage http://www.amwa-doc.org/Quiz/fact.htm 6/6/03 Emergency Contraception Fact Sheet Page 2 of 2 47%of unintended pregnancies end in abortion,40% in birth and 13% in miscarriage 53%of women with unintended pregnancies were using contraception Among those women using contraception, 51%of unintended pregnancies ended in abortion; and 43%of unintended pregnancies ended in abortion among women who were not using contraception 48%of woman aged 15-44 have had an unintended pregnancy Take the Sex & Sensibility IQ Test Sign Our Guestbook HOME I HEALTH TOPICS I ABOUT AMWA I ADVOCACY I EDUCATION I MEETINGS I JOIN US STUDENTS I FOUNDATION I PUBLICATIONS I)AMWA I LINKS I MEMBERS ONLY American Medical Women's Association 801 N. Fairfax Street,Suite 400 Alexandria,VA 22314 tel: 703.838.0500 fax: 703.549.3864 info@ amwa-doc.org copyright© 1999 by the American Medical Women's Association,or AMWA has authorization from the copyright holder. • r http://www.amwa-doc.org/Quiz/fact.htm 6/6/03 Jefferson County Health & Human Services Castle Hill Center-615 Sheridan Port Townsend, WA 98368 • 360-384-9400 Plan B Emergency Contraception Information & Consent What ft is and How It Works The emergency contraceptive pills called Plan B can greatly reduce the likelihood of unintended pregnancy. There are known failure rates with each barrier method of birth control (condoms, diaphragm, cervical cap) and withdrawal. Women are also exposed to unprotected intercourse. Plan B may prevent unintended pregnancy. Plan B consists of two doses of a synthetic form of the hormone, progesterone. Treatment is initiated as soon as possible but no later than 72 hours after intercourse to prevent ovulation and/or implantation. Plan B disrupts the hormone patterns essential for pregnancy. This disruption is temporary, lasting only a few days. Talk to your clinician before using Plan B if you have ever had: >any serious medical disorder, such as diabetes, liver disease, breast cancer, stroke, high blood pressure, heart disease, kidney disease, blood clots in your legs or lungs. >any reason to think the medication may pose a health risk for you >or if you are on any prescription medication >or if you are breastfeeding • >or if you have just delivered a baby within the last three weeks Effectiveness When you have sex without using any birth control, your risk of pregnancy depends on where you are in your menstrual cycle. During your most fertile days, midway between menstrual periods, the risk could be as high as 30%. Plan B can reduce the chance of pregnancy by about 89%. For example, a 30% risk would be reduced to no more than 3%. This method is not perfect. Approximately 3% of women get pregnant in spite of this treatment. The best results are achieved if treatment starts within 24 hours of unprotected intercourse. The latest Plan B should be started is 72 hours. Who Should Consider Plan B >A woman who does not desire pregnancy >If you had unprotected sex less than 72 hours ago Who Should Not Consider Plan B • >If you think you might be pregnant from intercourse before the last 72 hours. Symptoms of early pregnancy can include: breast tenderness, last period not quite normal, nausea. >If you have any undiagnosed abnormal genital bleeding. • Side Effects . Temporary side effects include: >nausea (23%) >abdominal pain or fatigue or headache (17%) >heavier or lighter menstrual bleeding (13%) • >dizziness or breast tenderness (11%) >vomiting or diarrhea(6%) Most (87%) women resume their period within a week of when it was expected. If there is a delay of onset of menses beyond a week, the possibility of pregnancy should be considered. Plan B is not recommended for routine use as a contraceptive. Plan B is not effective in terminating an existing pregnancy. Precautions Pregnancy Many studies have found no effects on fetal development associated with long-term use of oral progestins. Ectopic Pregnancy There may be a higher rate of ectopic pregnancy with this treatment. Pregnancy or lower abdominal pain after taking Plan B should be reported to a health care provider. STD/HIV Plan B does not protect against sexually transmitted infections. Carbohydrate Metabolism Diabetic women should be monitored after using Plan B. • Drug Interactions You need to tell your provider if you are on any other medications. I understand that if I see a doctor for any reason before I get my period, I should inform him/her that I have used Plan B emergency contraception. No guarantee or assurance can be made as to the results which may be obtained by using birth control pills or any other birth control methods. Regular checkups are necessary while taking the pill, and I know where to return for follow-up care. Client Signature Date Witness Signature • EC: For Providers and Pharmacists Page 1 of 2 BACK UP• -', .- - BIRTH CONTROL „ .. . f1' FOR PROVIDERS/PHARMACISTS t -ou are I e en ica in •e een emergency con racep ion an. ---- V.,--;41,. II �- , he women who need it. e Back Up Your Birth Control campaign aims to educate women bout EC—and put it into their hands before a crisis occurs. Here are a few things you can do to help: octors and other health care providers... • • Talk to your patients about EC • Send letters to your local pharmacies to let them know that you are willing to prescribe emergency contraception • Buy a supply of EC and offer to sell it at cost to your female patients of reproductive age Pharmacists... • Make sure you have EC in stock. • • Talk to your colleagues about EC. • When women get prescriptions for birth control pills that can also be used as EC, be sure to include information on their back-up options. [Sample Prescription Insert] Click here for more ideas Print out materials from this site—and feel free to tailor them as you see fit. • Talking Points on Emergency Contraception (EC) [Printable HTML] • Talking Points on Back Up Your Birth Control Campaign [Printable HTML] • Patient Brochure on Emergency Contraception (EC) [JPG imag_e,800K] • Back Up Your Birth Control Poster [PDF file,750K] • Fact Sheet on Emergency Contraception.(EC) [Printable HTML] • More Info About EC • Campaign ToolKit • Campaign Co-sponsors Additional information—including training guides—is available from several medical and health organizations: 0 • American Medical Women's Association • American Pharmaceutical Association (large PDF download) • Association of Reproductive Health Professionals http://www.backupyourbirthcontrol.org/providers/index.htm 6/6/03 EC: For Providers and Pharmacists Page 2 of 2 • Association of Reproductive Health Professionals • PATH: Program for Appropriate Technology in Health • Physicians for Reproductive Choice and Health • You can also check out your own professional association's website for EC materials.And encourage them to become co-sponsors of the campaign, if they haven't already. For specific questions about the campaign,e-mail info@backupyourbirthcontrol.org. "ack Up Your Birth Control" unites more than 100 national and local medical organizations and womere health advocacy groups to promote awareness of emergency contraception. This campaign is being coordinated by the non-profit Reproductive Health Technologies Project. HomeWhat is EC?I How to Get EC I Campaign Toolkit I Get Involved For Health Care Providers/Pharmacists I For the Press I Meet Rosie • 4 http://www.backupyourbirthcontrol.org/providers/index.htm 6/6/03 • Board of Health New Business Agenda Item # V., 3 • On-site Sewage Operations and Maintenance Report June 19, 2003 • O & M UPDATE —JUNE 18, 2003 • Briefing by Jodi Holdcroft, Masters Thesis Project on the monitoring data collected by the PUD from 1987 to 2001. General findings and stats for systems inspected since monitoring required at time of sale. Jan 2001 - May 30, 2003. General info on # of property sales of improved properties same period. Report on repairs by planning area 1995 - 2003. • • • Board of Health Media Report • June 19, 2003 • • Jefferson County Health and Human Services MAY — JUNE 2003 NEWS ARTICLES 1. "County eighth-graders report alcohol and drug use,depression" P.T. LEADER,May 14, 2003 2. "Community leaders begin to turn data into action plans" P.T. LEADER, May 14, 2003 3. "County's life-expectancy above state's rate" Peninsula Daily News, May 15,2003 4. "Jefferson needs expert to analyze well results" Peninsula Daily News, May 20, 2003 5. "County prepares citizen survey" P.T. LEADER, May 21, 2003 6. "On alert for West Nile Virus" 1110 P.T. LEADER, May 21, 2003 7. "Listings sought for `youth' pages" P.T. LEADER, May 28, 2003 8. "County adopting `final' seawater intrusion rules" P.T. LEADER, June 4, 2003 9. `Birds,insects could pose health threat" Peninsula Daily News, June 12,2003 i I%) Port Townsend&Jefferson County Leader • oun el t - a ers re ort • lcooah l rug usedepression nJefferson County eighth-grad- Some drink heavily.Among eighth-graders, or 16 percent, One out of four county eighth- •:ers participated in the Healthy the eighth-graders, 17 percent reported marijuana use in the graders•met the clinical screen- :'Youth Survey last fall,revealing —or about one out of five—re- past 30 days. Again, the ing criteriafor depression.They :some eye-opening statistics ported heavy drinking in the Jefferson County percentage:.is reported feeling so sad and hope- :about drinking, drugs and de- two weeks before the survey. higher than the state percent- less that they did not do their :•pression. This percentage is nearly age of 10 percent. usual activities for two weeks or Eighth-graders drink alcohol. • double the state percentage of Nearly ohe out of 10 eighth- more. About 17 percent of the ',Twenty-eight percent of the 10 percent.The heavy drinking graders,or 13 percent,also said youths reported they seriously :county's eighth-graders con- rates among the youths mirror they used illicit drugs such as considered suicide in the past 12 ,'sumed at least one drink of alco- the heavy drinking rates of methamphetamine,psychedelics months, and 9 percent said they :hot in the 30 days before the Nov. adults who were surveyed by and,cocaine at least one time in attempted suicide in the past 12 '30, 2002, survey. This figure is Jefferson County Health and the last 30 days. Only 8 percent months. :significantly higher than the state Human Services. of the state's eighth-graders re- Significantly fewer county •rate of 18 percent. 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AFF •rube > aa 411111 2o' -5 �," Cai r a 0 0 b�A Q, z 0 � ; ft. . jerso:-n , ne,eds . exp : to analyze 'well , results . . _,.. .......... warrowstoneChairman Tom McNerneybsaid "I think people will `.... ... . ..'the first test could be the ase- , ..,, . . , data collected questionour authority to , line, but Titterness said he thinks averaging the fourfirst.: limit usage. over two years year tests would be,,a.better DAVID GOLDSMITH measure because r-,..i tun eA gs By j131 MANDERs ' .' :.• . , 'county administrator . could vary from seaiOn4a:Sea- PENINSULA DAILY NEWS' . • .'" •-''. ' ' • . - : • ..'.-:son.., • of groundwater on the island-..- A public hearing orillie rec- PORT TOWNSEND—Jef- can't'be made from what hap- - onunendations is scheduled for ferson County will hire an pens*:any group of wells. . 2 p.m. May 27 and COunty expert to analyze test results "We can't look beyondlndi- Administrator David Gold from monitored ' domestic, vidual wells, because most'of. -smith said'recommendations water wells on Marrowstone Marrowstone Island doesn't limiting water use and moth- Island. , 'have 3.a 1."like, aquifer," Chris-- tonn• g wells may be one of the Jefferson County officials te.hse.,, ..n, said. •. ' 'biggest issues are Monitoring the wells. i4, ,''''.4..•.S..... ' . tq think peoptd-ttwill-= conjunction with a. wester!-:.:,yorify„,,proposal our authority tjo ihniv.um. go.',, order to prevent saltwater'..'::.-I-iurillg,a discu§sian,,pa%nine 1Sal th . ,,. Thei,1:11..:pliniiin - g%:‘9.0Commission Golds intrusion. Planning-Cominiasion. r pos- :, ' .The countY,-Tl-As,,te 14*- .45 to stg.1)*twater-iiiAt4:19n-,10 ,:r.PC°0PIX01c1#4,a--49974.1011211. mine what. to do, with,the .county C91,11..fill4iP110P44-Titfg4W-4#71g;41:464;:Att,f,00,17 I. results from eight tests terness, .R-Port- ;:TeWaVd:`'.' each houseno- rataWing:t.fr-,6111' required over a two-year asked that the testing proposal wells in the county . period. be clarified so the public.isn't :. County cenamissionere;:put the limit at 1,000 gallons-per David Christensen, county - confused. ',.1 - ' - ...::. . . . Department of Natural Titterness said the Planning day in pa.ssmg an interim-ordi Resources manager,told Jeffer- Commission's proposals aren't -mance in Jaimary,:::.• . .. ipon County commissioners clear about,testing or- how' -Both lints are significantly i onday that a hydrogeologist results' will be put into context. less than the 5,000 gallons a will be needed to examine the Christensen said the hydro-,s,day.-. allowed ,by the . state test results and determine if' geologist:would be needed to Department of EcologY . . groundwater is being degraded determine„ what.-the results-...-.:. The county-has .a J1440,5 . , , . . • by seaivater. MOLD.' 2 :-' -'' •,.- "!..1• - ' .deadline to complete its salfiVa7., . , Christensen said test results '• A question also arose about ter intrusion plan,:but :.an • from individual wells will have how a baseline would be deter-. extension may be soUght:JOIE- . to be scrutinized and that mined. . , - ---*.!•-..:4.'.i.'':,-.:';'',',': ,-.10W44 next :Teek'S:ii.lubliCheiti:', assumptions for the condition Planning -' Coiiiiiiiafien-A;:•14)?: 4;: -:; ','':'.....s'r'.% .0-.•.,'";::',:. . ''''..' . ','; : -,3,--. ...v....,._ , .- :...,;;:,4'.,-. ',--'..".,. -.:.:t.:,i:._-.2,i.-;1-'•-,IL . • , .. 2-- re . , -Die .', —eu' vi iti_le,L, Da_i ty jOe iA.)5 .,,,:;;q1 f in • A 10•Wednesday,May 21,2003 Countyprepares. • • . ... , .. . citizen survey By Barney Burkenaire. "Several citizens have Leader Staff Writer .; asked me about using bonds :, the courthouse," he said. "I Jefferson County, residents think it might be a legitimate can expect to receive a`"state ' question to add to the survey."` , of the county"newsletter from ' Earlier this year,the county. county government by June 1 ->issued$4.6 million in bonds to The mailing to 9,000 house- be repaid by the real estate ex-` holds,` which was approved °:cise tax,which is collected when May 20 by the Board of County properties are sold.Most of that Commissioners,gives residents money is earmarked for the new a synopsis of how-the county sheriff's building in Port uses tax revenues,and provides Hadlock,jail remodeling, and' ; highlights on other issues, ":renovation of county offices at County Administrator David the Castle Hill shopping center . Goldsmith said. _ in Port Townsend.About$1 mil Also included is a question- hon from the bond revenues is naire seeking.feedback from ;:designated'for'the'courthouse, .' residents on their level of satis-. but the county is still looking for. faction with a number of differ ' several million dollars from ent county services. , grant funds and:other.sources to` At yesterday's"meeting, undertake all ofthgworkneeded *;; Chairman DanTitterness asked `;to stabilize and restore;the 1892 that a question on possible bond"i‘'landmark.The board has been , funding for the renovation of discussing the formation of a the Jefferson County Court- blue-ribbon committee to chain- _ house be added to the question- pion the courthouse renovation. • Wednesday,May 21,2003•A 7 - \\fly^ • • On alert for West Nile virus By Lisa McKenzie,RN,MPH Communicable Disease Coordinator Jefferson County Health&Hyman Services I write in response to the letter published in the May 14 Leader that raised concerns about the West Nile virus. Jefferson County Health and Human Services(JCHHS)shares your con- cern about West Nile virus and hopes we can clear up the misunderstanding about the testing of dead birds. West Nile virus can cause mild illness in many people and can cause a serious,even fatal,illness in some.It can affect people,horses,certain types of birds and other animals.In 1999,West Nile virus first appeared in the United States in New York City.Since that time,it has spread rapidly through- out the country.In 2002,the virus was found for the first time in birds and horses in Washington. West Nile virus is almost always spread to people by the bite of an in- fected mosquito.Mosquitoes become infected after feeding on birds that carry the virus.There is no evidence that West Nile virus can be spread by direct contact with infected people,birds or animals. West Nile virus infects certain wild birds.Of those infected,particular' birds—crows,jays,ravens and magpies—tend to become sick and die.In- creasing numbers of dead birds may be an indication of West Nile virus in the community.JCHHS is participating in the statewide surveillance for West Nile virus to identify when the virus becomes present in an area of the state. 4110 What birds tested? JCHHS is tracking reports of dead crows and other birds.When a report is received a decision is made whether to test the bird.Most dead birds will not be collected or tested.The state testing capacity is lim- ited,and so a few birds will be sent from each area throughout the spring, summer and fall. The birds must not be dead longer than 48 hours and intact,with no sign of trauma or being scavenged.If the carcass has an odor,is soft and mushy,has skin discoloration,feathers or skin that easily rub off,has sunken eyes or has maggots,it can't be tested.Birds may be frozen for storage and shipping. While there is no evidence that you can get West Nile virus from handling dead birds,always avoid bare-handed contact with any dead animal or bird. Use gloves or double plastic bags to place the carcass in a garbage can. JCHHS recommends taking measures to protect yourself from West Nile virus.There is no human vaccine for West Nile virus.The best way to pro- tect yourself and your family is to avoid mosquito bites and reduce the places mosquitoes live and breed around your home. Guard against mosquitoes • Make sure windows and doors are"bug tight."Repair or replace screens. Stay indoors at dawn and dusk,if possible,when mosquitoes are the most active. Wear a bong-sleeved shut;long pants and a hat when going it?tp mos._ quito-infested areas,such as wetlands or woods. Use mosquito repellent when necessary. Empty anything that holds standing water—old tires,buckets,plastic covers and toys. Change water in your birdbaths,fountains, wading pools and animal troughs at least twice a week. Recycle unused containers that may collect water—bottles,cans and buckets. Make sure roof gutters drain properly,and clean clogged gutters in the spring and fall. Fix leaky outdoor faucets and sprinklers. • Effective mosquito repellents are those that contain DEET.DEET prod- ucts come in lotions,creams,gels,sprays and towelettes.Check the label for the chemical name for DEET—N,N-diethyl-m-toluamide.Products contain- ing DEET must be used properly. For more information,refer to the following websites: •www.doh.wa.gov/ehp/ts/Zoo/WNV/WNV.html •www.cdc.gov/ncidod/dvbid/westnile.htm Information on communicable diseases will be updated regularly on the Health Department's website—www.co.jefferson.wa.us—and will continue Listings sought'for youthpages By Philip L.Watness printed every other year at a responded to the criticisms,but Leader Staff Writer printing cost of $6,235 for she said she would not corn- 10,000 pamphlets and as many ment. The next edition of the East wallet-sized phone number Baldwin said the listings so Jefferson County Youth Yellow cards. Jefferson County pays far have been garnered from Pages goes to press Friday, for the guide with money from previous editions and from the June 6, so anyone wishing to several state agencies, includ- Healthy Youth Coalition, a get information into the guide ing the Division of Alcohol and group made up of representa- needs to contact the Jefferson Substance Abuse of the Depart- tives from government, social County Health and Human Ser- ment of Social and Health Ser- service organizations and corn- vices Department. vices and the Department of munity groups. The guide has drawn some Health. Baldwin said the guide is in- criticism in the past for includ- The only county money that tended to give teens the ing seemingly complete infor- goes into its publication is means to seek help or get ques- mation about homosexuality spent in the form of wages for tions answered on diverse is- and birth control —while hay- the staff who prepare the ma- sues. ing less than complete listings terials, about$1,000, Baldwin The upcoming edition of the for religious organizations and said. Youth Yellow Pages will have groups that advocate against "The main criticism we've an expanded focus to be a re- some of those practices. heard is that we encouraged in- source guide for youths,young Community Health Director appropriate behavior,"Baldwin adults and families. Jean Baldwin said the guide is said. To view the Youth Yellow intended to readily provide in- The 2001-03 edition in- Pages,look under new items on • formation for teenagers on a cluded a new section on the health department website whole range of issues, includ- "Sexual Orientation" and re- at www.co.jefferson.wa.us/ ing sexual orientation.She said ferred kids to the Parents, health/defaui't.htm. If' a re- other information, however, is Families and Friends of Lesbi- source is not listed, e-mail welcome. ans and Gays (PFLAG). editor Kellie Ragan at The resource guide is Baldwin said that organization kragan@co.jefferson.wa.us. =28-a3 LEri te-K I . . . •Countyadôptihg final • intrusion seawater r By Barney Burke protection rules prior to her deal with the shortage of water ' Leader Staff Writer election in November 2002, on Marrowstone•and other resigned from the board effec- coastal areas of the county. Trying to- determine if tive June 15 and did not attend It's unknown whether the Jefferson County has satisfied this week's meeting. hearings board will find the re- an order from the We.stern ' vised ordinance io be satisfac- Washington Growth Manage- County authority ment Hearings Board is about questioned stsoafg, the commissionprsff and liance ' as challenging as discerning if Although the county's plan- hearing is eyet to be scheduledd the seawater intrusion problem ning commission had recom- on the matter. on Marrowstone Island is get- mended lowering the amount ting measurably worse. of water that can be withdrawn Subdivisions on hold . The Jefferson County Board from new and existing wells Earlier on Monday, the of Commissioners adopted a from 1,000 gallons per day in board was reminded of another "final"ordinance on June 2 ie- the interim ordinance. to 400 provision ofthe ordinance that garding aquifer protection.The gallons per day,Tittemess and ' has caused concern for prop- board is expected to adopt a Huntingford were clearly un- erty owners. As adopted, the "cleaned-up" version of the comfortable with the idea of ordinance prevents land subdi- ordinance and a resolution limiting water consumption. visions on Marrowstone Island' adopting some related policies "Why have a regulation if for an undetermined period of at its June 9 meeting, Chief you don't have a way to en- time. Civil Deputy Prosecuting At- force it?" Huntingford asked, "Due to documented seawa- • torney David Alvarez said. noting that it would be difficult ter intrusion on Marrowstone These actions will miss by to enforce and might not be Island and the existence of un- four days the hearings board's within the county's authority developed lots of record, June 5 deadline for implement- . under state law.Titterness rea- Jefferson County has imposed ing its order to the county, soned that either the county a moratorium on additional Alvarez noted. However, he will end up challenging the land divisions on the island plans to send a letter to the hearings board in court or a until such time as public water ' hearings board informing them property.owner will challenge is available or it is demon- •, of the timing and didn't expect a county law limiting water strated through the well that to be a substantive issue, consumption. he said. monitoring program that Alvarez and other staff groundwater quality is not de- The bigger and more nebu- members have maintained grading due to seawater intru- lous questions are (1) whether throughout the hearings board sion,"the ordinance reads. the hearings board will find the process:that only the Washing- Anne McLaughlin and Carol county's actions sufficient and ton Department of Ecology Wise,real estate agents at Cold- (2) whether the county has the (DOE), not the county, can well Banker Forrest Aldrich, legal authority to do what it has regulate groundwater con- spoke at the board's.Monday been ordered to do by the hear- sumption. c comment ses- ings board. That was the Ultimately, Titterness and sion.1They ng ugave examples of consensus of Commissioners Huntingford agreed to delete property sales that won't occur •' Dan Titterness and Glen the consumption limitations because of the moratorium. In Huntingford and county staff at from the ordinance and add one case, McLaughlin said, an ' Monday afternoon's meeting. them to a lengthy list of water owner of a 10-acre parcel with Wendt Wrinkle, who was a conservation recommendations two working wells can't subdi- leader of the Shine Community developed by the planning vide it into two five-acre parcels, Action Council,one of the two commission.That information as allowed by the zoning ordi- community groups that chal- would be provided to property nance, because of the seawater • lenged the county's aquifer owners as suggested ways to .intrusion ordinance. 6—Y10 Birds, insects could pose health threat • Officials testing traps to take samples for for presence of ' av "�$testing. �� •„%, virus Meanwhile, Locke told the West Nile virus air ,i board that the z "fresh" dead BY JEFF CHEW crow found in PENINSULA DAILY NEWS ,1 the Sequim- .-44.: "`lief area has been Howard Sprouse says the Locke turned over to mosquito population in his the WSU ani- Salt Creek-area neighborhood mal diagnostic lab to test for is the worst he has experi- West Nile virus. A finding is enced in 10 years. expected in about a week, he "The area down there is said. plagued with the most impres- Crows are among the birds sive volume I've seen,even in found to be most likely con- the many years I've lived in tract West Nile. Alaska,"Sprouse told the Clal- "Our goal is to sample lam County commissioners, around the county, so every acting as the county Board of time we get a report we can Health,on Tuesday. evaluate it,"Locke said. Sprouse and three other Clallam County health offi- neighbors urged health offi- cials from both Environmental cials to help them form a mos- Health and Health and quito abatement district near Human Services are working the mouth of Salt Creek and together on West Nile virus its estuary. • surveillance and prevention. The request came during As part of this joint effort, an update from county health public health officials are official Dr. Tom Locke on the monitoring bird deaths and status of West Nile virus in the identifying the kind of mosqui- county. toes in the county that carry The virus is almost always the disease. • spread to people through the bite of a mosquito that has Hot line,Web site set up become infected after feeding The department this week on birds that carry the virus. announced a new Public • Dead crow tested Health Information Line this week to contact health officials Locke told the panel that at 360-417-2431 to report dead Washington State University bird sightings, receive infor- is testing for West Nile virus in mation about mosquito con- a dead crow found in the trol or other West Nile virus Sequim area, the first bird questions. tested for the virus in Clallam The county health depart- County. ment's Web site with informa- Wild birds are the most tion about how to reduce the common hosts for West Nile risk of West Nile virus can be virus, though not all birds found at www.clallam.nett need to be tested to effectively westnile. monitor the disease, health "West Nile virus is likely to officials said. arrive in Clallam County, or The mosquito-infested wet- counties nearby, in 2003," a land and creek is on the south- news release from the county west edge of the county's pop- Health Department says. ular Salt Creek Park, which Locke said no cases of West attracts thousands,of visitors Nile virus hiffe been reported and Campers in the Joyce area in the state this year. each year. County health officials ask Locke has said that a mos- that before calling to report quito abatement district can dead crows,jays or other rap- be formed through a resolu- tors,callers should consider: tion approved by the county ■Is the bird a crow,raven, commissioners. Neighbors jay,eagle,hawk,falcon or owl? would have to vote on the des- These species are more sus- ._ ignated area,because it would ceptible to the virus,and test- involve forming a taxing dis- ing them is more likely to trict to pay for abatement. detect the virus than testing Sprouse said in an inter- other species. • view on Wednesday that his ■ Has the bird been dead neighborhood around the for less than 48 hours? estuary consists of about 29 The carcass may be too residents and weekenders who decomposed for testing. live there part-time. When you call,you will be Locke and Andy Brasted, asked when and where you county environmental health found the bird,how long it has -1 a (3 and natural resources director, been dead,and whether or not said they would work with the bird is damaged, the neighbors to set up mosquito county says. • May 6, 2003 The Honorable Gary Locke Governor State of Washington PO Box 400026I") Olympia, WA 98504-0002 Dear Governor Locke: The Washington State Association of Local Public Health Officials(WSALPHO) wants to thank you for your support for the local public health backfill funding included in your proposed 2003-05 biennial budget. Only the House of Representatives budget did not include two years of funding for local public health. WSALPHO appreciates the high priority placed on public health services through your Priorities of Government process. It is critically important that the full two years of funding be included in the final 2003-05 • biennial budget approved by the Legislature and signed into law by you. That funding represents, on average, 30%of the unrestricted funding for local public health jurisdictions.It is the unrestricted funding that is necessary to respond to communicable disease issues such as SARS, West Nile Virus, as well as Tuberculosis,Hepatitis, HIV/AIDS and other infectious diseases. These dollars are also used to respond to a food or water borne disease outbreak. Local public health agencies are straining to maintain basic disease surveillance and response plus build response capacity for SARS, West Nile Virus, and Bioterrorism preparedness. Additional funding is necessary to adequately meet the demands being placed upon the public health system. Any reduction to existing funding will have very real consequences in our communities and disease protection will be reduced. WSALPHO is asking that you insist that local public health receive two full years of backfill funding in any 2003-05 biennial budget approved by the Legislature. Again, WSALPHO appreciates your recognition of the critical importance of governmental public health services. Sincerely, 1""Tb' Jean Ba dwin Chair • • Jefferson County On-site Sewage System Inspection Program Analysis Jodie Holdcroft May 2003 Jefferson County Inspection Program X1987-2001 • SPUD Inspectors Alternative OSS Regulations Project Goals ?OSS failure factors/causes aEducation information 1 • Available Data x2,001 inspections a Approximately 1600 inspections with installation date 4-855 locations 4,697 locations with installation date Problem Fields sWater Infiltration Timer Absent • ?Timer Panel Access Maintenance Access EDF Maintained QEF/Screen Access Problem Fields, con't aObservation Ports Access wElectrical -no power Alarm Functional sFailure • 2 • Installation Factors kSoil Type System Type aDaily Flow Categories *Depth Installed Property Size 4 Age aChange of Owner Results 4-6 failures analyzed-need larger dataset • "Access,access,access aElectrical problems appear first What can others learn? 4,What do you want to know? 4-Collect data for answers Data entry can take lots of time ? Quality control!!!! Watch interpretation Collaboration is needed • 3 • Jodie Holdcroft (360) 337-5629 holdcj@health.co.kitsap.wa.us • 4 itoblems Proportion Table Problem Problems Percentage Problem Percentage Category Category / Occurring in Category / Occurring in Problem Problem All Inspections All Inspections Inspections Inspections Change of owner 30/346 8.7% 30/1589 1.9% DF 99/346 28.6% 99/1589 6.2% maintained/vegetated Water infiltration 12/1346 3.5% 12/1589 0.7% Component access 113/346 32.7% 113/1589 7.1% Effluent filter access 154/346 44.5% 154/1589 9.7% Observation port 132/346 38.2% 132/1589 8.3% access dimer panel access 52/346 15% 52/1589 3.3% Timer absent 31/346 9% 31/1589 1.9% Electrical Problems 49/346 14.2% 49/1589 3.1% Alarm functional 86/346 24.9% 86/1589 5.4% Failure 6/346 1.7% 6/1589 0.4% • • vi i ca + n + ONO ,t oc N M d' N .--. . r cA i-. 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