HomeMy WebLinkAbout2003-August File Copy
Jefferson County
Board of Health
Agenda
Minutes
August 21, 2003
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JEFFERSON COUNTY BOARD OF HEALTH
Thursday,August 21,2003
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 July 17,2003
III. Public Comments
IV. Old Business and Informational Items
1. Findings of Fact/Conclusions of Law for July 17, 2003 Appeal Hearing
2. Quasi-Judicial Appeal Procedures
3. Cruise Ship Waste Discharge—Draft Letter(w/Clallam County Board of
. Health)
4. Letters to and from State Board of Health Delegation
5. Letter from Jefferson County Prosecutor re: Child Death Review
V. New Business
1. Performance Measures and 2004 Budget Narrative
2. West Nile Virus on the Move–National Activity and First Reported
Washington State Case
3. Jefferson County Health and Human Services Emergency Response Plan
–Tabletop Training Exercise Report
4. Multi-county Communicable Disease Cross Coverage: Risk Pools,Health
Officers, and Draft Protocols
VI. Activity Update
VII. Agenda Planning
1. Joint Board Meeting–September/October 2003
2.
• VII. Next Meeting: September Board of Health Meeting–Schedule Conflict
JEFFERSON COUNTY BOARD OF HEALTH
MINUTES
• DR A5 Thursday,July 17, 2003 DRAFT
Board Members: Stag-Members:
Dan Titterness,Member- County Commissioner District#1 Jean Baldwin,Health&Human Services Director
Glen Huntingford,Member-County Commissioner District#2 Lany Fay,Environmental Health Director
Vacant- 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 2:44 p.m. All Board and Staff members were present with
the exception of Member Westerman. There was a quorum.
APPROVAL OF AGENDA
Member Frissell moved to approve the Agenda as presented. Member Buhler seconded the
motion, which carried by a unanimous vote.
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APPROVAL OF MINUTES
Commissioner Huntingford moved to approve the minutes of June 19, 2003. Commissioner
Titterness seconded the motion, which carried by a unanimous vote.
PUBLIC COMMENT--None
OLD BUSINESS AND INFORMATIONAL ITEMS
Cruise Ship Waste Discharge: Larry Fay noted that the agenda packet contained a Staff memo
following up on the public comment and Board discussion of the last meeting. Also included was a copy
of the State Department of Ecology Action Order sent to the President and CEO of Norwegian Cruise
Line. Chairman Masci proposed an addition to the draft of the Board's letter to the State Department of
Ecology regarding the sewage release in the Strait: A third paragraph could state "We(the Board of
Health of Jefferson County)recommend that the Department of Ecology reconsider its four-mile
discharge limits given that the four-mile point happens to be at the head of Discovery Bay. Because this
bay does not flush well, the recommendation is to instead extend that limit to past Cape Flattery, in
unprotected waters, so as not to damage the Olympic Coast Sanctuary".
HEALTH BOARD MINUTES -July 17, 2003 Page: 2
Commissioner Huntingford moved to direct Staff to amend the letter as recommended by
Chairman Masci.The letter would be reviewed and signed by Chairman Masci. Member Buhler 411
seconded the motion,which carried by a unanimous vote.
Threatened Shellfish Area—Jefferson County: Larry Fay noted that the Board received a Staff memo
accompanying a press release from the State Department of Health reporting that their Early Warning
System lists a threatened shellfish area off the boat landing in Lower Hadlock. He explained that he now
has more information about the classification and data collection and analysis. Because of a rolling five-
year method of grading, a series of bad water quality results in 1998-99 are causing the County to now
be classified as threatened. However, if the current trends in water quality continue, in the absence of any
intervention the County might be off the list next year. Nevertheless, Staff would meet with
representatives from the State Department of Health's Shellfish Program to further investigate potential
sources in Lower Hadlock and see if additional action is needed. He noted that virtually all septic
systems along the shoreline have had system upgrades over the last five years.
Member Frissell asked whether liveaboards in that area could be contributing to the problem?Mr. Fay
said this would be part of Staff's analysis. He added that a party interested in placing more mooring
buoys in that area has had a pre-application meeting with the Department of Community Development.
Staff has recommended that if an application were made, it should be denied until more information is
known about the source of the water quality problem. He said he would be providing the Board with a
letter from the Pacific Shellfish Growers Association that expresses their concern and their desire for the
County to act diligently. A Staff response has been sent. •
State Budget Summaries: As a follow-up to last month's legislative budget update, Dr. Tom Locke
noted that the Board has received a summary of the major health and medical care portions of the 2003-
05 biennial operating budget as prepared by Don Sloma, Executive Director of the Washington State
Board of Health.
NEW BUSINESS
Washington State Board of Health and Local Boards of Health Partnership Initiative: Chairman
Masci welcomed Don Sloma and Carl Osaki of the Washington State Board of Health. Executive
Director Sloma passed out copies of the 2002 Annual Report from the State Board of Health as well as a
2002 Washington State Health Report. He reported on the Board's desire to get out and visit local
Boards of Health to hear about the local health concerns. Board Member Osaki expressed the desire to
better understand health threats and issues in Jefferson County so they could be considered during policy
making. Mr. Osaki explained his background experience as a former Director of Environmental Health
and also spoke of the history of the State Board of Health,which is the longest existing Board in
Washington State. With 10 members, it is comprised of two elected officials (City and County),
Secretary of Health, a local health officer(Dr. Locke), and four members representing health and
sanitation, and two members representing consumers. The Board's primary functions are to: 1) adopt 410
rules and regulations; 2) serve as a public forum; 3) gain input on and establish health policy. As part of
gaining input, they solicited issues of concern of the Board.
HEALTH BOARD MINUTES -July 17, 2003 Page: 3
Member Frissell asked what support the State Board of Health might provide in tightening regulations to
•prevent future sewage discharges in inland waters? Since the cruise line indicated it was an accidental
discharge of black water, David Sullivan said it was an issue of ensuring training in policy and
procedure. Commissioner Huntingford added that all discharges should take place outside of the Straits
because of the issues of the surrounding counties. Chairman Masci suggested action to urge the federal
government to negotiate with the provincial government to require secondary or tertiary black water
sewage discharge from Victoria(and said there is a relationship between the cruise ship discharge and
Victoria's). Mr. Osaki said he believes this is an issue on which they might be able to present a letter of
support and he asked for more clarification. Mr. Sloma said he would like to know the justification for
differential standards for cruise ships and local individuals or municipalities. Larry Fay called attention
to the jurisdictional issues of responsibility,which prevent more directly addressing grey water
discharges. Chairman Masci noted that another range of concern related to the discharge of medicinal
hormones into the water, which could affect fish health. He believes the State Board of Health has a
broad base of data on which to rest. Mr. Osaki recommended two options: 1) The Board could write a
letter to the State Board of Health about its concerns and specifically state its policy and make specific
requests, or 2) this topic could be an agenda item on which the Board could receive a briefing so they
can have a broader sense of the issue. Member Buhler noted that the federal government has been
concerned enough about the fragility of the Straits to have given funding to the counties' Marine
Resource Committees to investigate marine impacts. Commissioner Titterness moved that the Board
send a letter about its concerns and request that Chairman Masci be given the opportunity to
present to the State Board of Health on this issue. The motion was seconded and carried by a
unanimous vote. Mr. Osaki noted that if the Board feels this is an issue that it wants to address,they
Wmight invite representatives from the Cruise Ship Industry and others to explain some of the actions they
have taken—or not taken—to protect the health of the people in the State.
Chairman Masci said he feels that local law enforcement does not consider the public health violations,
such as on-site sewage regulations, seriously enough. He would like the State Board of Health to
consider a policy statement that could lead to legislation giving Boards of Health more direct
enforcement powers. He added that this cannot be an unfunded mandate. Commissioner Huntingford
suggested that since there is a new policy in place and the County has begun to deal with civil
infractions, there should be more Board discussion on this issue before asking the State Board of Health
to spend much time on it. Dr. Locke said the issue of private property rights has come before the State
Board of Health not only with regard to whether a local Board could compel an individual to go through
an annual inspection,but also with mosquito abatement. The State Board of Health is trying to bundle
these issues together for an opinion from the Attorney General's office.
Jean Baldwin said health disparity is a big issue for this County even though the statewide assessment
data,relates the problem to racial minorities or those in urban environments. Rural health indicators are
not well documented on a state level and most of our state is rural.Rural hospitals,public health
departments, and doctors are in trouble. The issues of mental health and drug and alcohol use are
separated on the urban model and are a bigger issue in the rural areas' overall health status. Mr. Osaki
noted that they also welcome comments at their meetings from local Health Departments and Boards of
Health.
°Appeal Hearing Procedure: The Board reviewed and consideredos
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p p ed protocols for this and
future public hearings of the Board of Health presented by Chairman Masci. The procedures, aimed at
HEALTH BOARD MINUTES -July 17, 2003 Page: 4
providing for greater consistency, are based on closed-record appeal procedures for public hearings of
the City, even though he recognized that this is not a closed record appeal. He also provided language •
from an Appearance of Fairness and Conflict of Interest doctrine. If the Board adopted the protocols as
interim procedures, the Board could then request County legal review prior to formal adoption so that
the terminology will be more appropriate for the Board for future hearings.
Member Buhler moved to adopt the Public Hearing Procedures as interim procedures for Board
of Health hearings. Member Frissell seconded the motion,which carried by a unanimous vote.
Appeal Hearing—Peterson/Roberts Violation SEP85-00045 (Filed by Dr. David Green): At 3:36
p.m., Chairman Masci informed the group of the standard rules for the public hearing and opened the
hearing. He read the Rules of Order and asked if any Board members had any interests, financial or
property, to disclose in connection with the matter. Chairman Masci disclosed that he and Dr. Green
have had a fiduciary contract/subcontract relationship in the past and have been discussing the possibility
of reestablishing that relationship in the near future. He also received a phone message from Dr. Green
yesterday and responded likewise, declining to speak with him directly in order to avoid any form of ex
parte communication. He has not at any time approached Dr. Green relative to the matters involving this
appeal, nor did he have any knowledge of the appeal during prior conversations with Dr. Green. Due to
his significant, ongoing involvement with Dr. Green,he is concerned about the appearance of fairness.
Commissioner Huntingford then led a brief discussion, without Chairman Masci present, of whether
Chairman Masci's recusal would be appropriate. The Board concurred that Chairman Masci should •
recuse himself from discussion or votes on this matter,but could continue to Chair the meeting. There
was no audience objection to Chairman Masci's or any other Board member's participation in the
proceedings.
Staff Presentation:
Larry Fay reminded the Board that Dr. Green's appeal is of the action taken by Staff in response to the
violation on the Peterson/Roberts property. He reviewed the facts regarding the Peterson/Roberts
construction of a deck on their property at 574 Beckett Point Road, which was built over the existing
drain field without notification or approval of the Health Department. That action constitutes a violation
of the On-Site Sewage Code 8.15.150(1)f. Staff responded to an initial complaint by Dr. David Green
and confirmed that the deck had been constructed consistent with their as-built plans in the permit filed
and confirmed that the deck was there. Staff, in an opinion based largely on the construction of that
system, determined that the impact of the deck's placement over the drain field, is,while not desirable,
probably minimal in terms of infiltration into the soil and the field's general reliability. Staff issued a
Notice of Violation to Peterson/Roberts on September 25, outlining the specific violation, advising of
the action needed to resolve the violation, and identifying the consequences of the failure to do so. Given
that Staff classified this as a low-priority violation,the consequences for failure to correct being a
possible restriction on future building permits. Staff feels their actions were correct and appropriate.
Public testimony and comment:
Appellant Dr. David Green circulated photographs taken from his property. He then cited reasons why
the system would be prone to fail due to the construction of a new deck over the septic system — 1) •
prevention of the aeration needed for aerobic bacteria; 2)unequal profusion of the soil; 3)the pressure
on the drain field from the weight of the deck, the pylon supports holding the deck, and the people on the
HEALTH BOARD MINUTES -July 17, 2003 Page: 5
deck, which can alter and clog the drain pipes; 4)the depth of drain field at a level where there is no
longer aerobic activity; and 5)the slope of the land from the house down toward the road to his property,
where drain field effluent could tend to accumulate. Since there would be no room for an alternative
drain field, we should best protect what we have now. He noted that while a proposed sewer system in
the Beckett Point Fisherman's Club is awaiting approval of appropriate funding, the completion of any
sewer system there is 2-3 years away. As he believes that a failure of the existing system would prevent
him from occupying his premises, he would prefer a preventative solution.
Opponent Almeta Peterson then circulated photographs for the Board's viewing. She noted that this
issue comes as a complete surprise to her, having learned of this situation only six days ago. Her last
meeting with Dr. Green was during his complaint about his perceived lack of privacy. While she has a
consultant, he could not possibly be available on short notice. She said her only mistake was not asking
enough questions. She based her actions on the fact that in her initial call to the Department, she was
told that an on-the-ground deck did not require a permit. They are snowbirds, so are only up here about
six months of the year. She said that they had received the notice calling for no further development until
possible adjustments were made. They then left for the south. She does not believe their septic system is
a threat to public health. They had the septic tank cleaned and examined by Goodman Sanitation,who
reported it to be in tiptop condition. The Tillman Engineering review of the system plan submitted by
Mr. Green mentioned no sign of surface effluent, and goes on to say that leach lines are keeping the area
wetted. The records show that the system on their property includes a pit system at the depth of eight
feet,which rapidly moves the effluent in a downward manner discharging through a fast-rating substrata
and is therefore not a surface system. She does, however, use a circular ground sprinkler to water her
Wplants. While her septic design might not be approved any longer, it is still used in houses like hers. Mr.
fillman's documents use a lot of"can,""may,"and"if'instead of facts. The letter touches on other
things of which she has no knowledge. Finally, having worked for eighteen years for a County
Department of Transportation, she respects government authority and regrets the time that has been
required on this issue. She would appreciate an opportunity to correct any health hazards that might exist
and would like to mitigate this situation, although she does not believe her system is a threat to health.
Appellant rebuttal:
Dr. Green asked the Board what it intends to do about this situation?
Mr. Fay recognized Dr. Green's grasp of the technical function of on-site sewage systems. He is correct
that the current standards would not allow an eight-foot deep seepage trench,however, those were the
permitting standards in 1985 and it has not been a practice of the Department of Health to ask people to
upgrade older systems. The information Staff has on the on-site inspection of the system is that the
system is functioning. As far as the consequence of the failure, if the system were to fail the County
would be dealing with a Notice of Violation and working with property owners to come into compliance.
In a worst-case scenario, if there was nothing that could be done to repair the system, there would be two
options: put the people on a holding tank or declare the house uninhabitable. Owners of systems would
be responsible for the operation and maintenance of their system and bear the consequences if it were to
fail. There are community consequences if the failure goes uncorrected. While Staff would agree that
placing a deck over a drain field is not good practice, it is not explicitly prohibited in our regulations and
not entirely unprecedented in the County. Given the situation, he believes Staffs low-level enforcement
•ction was appropriate.
HEALTH BOARD MINUTES - July 17, 2003 Page: 6
Questions by the Board: •
Commissioner Titterness asked Staff to clarify that this deck being in this location, in their opinion,
poses no health threat. Mr. Fay responded that there is not an immediate or imminent health threat
represented by the deck. The placement of the deck could result in a premature failure of that system,but
given the construction of that system the risk is not as high as it would be in other situations.
Member Buhler asked if the system is on a monitoring schedule,which Staff confirmed is on a three-
year cycle.
Chairman Masci closed the hearing at 4:08 p.m.
Member Frissell moved to uphold Staff's decision on this matter. Member Buhler seconded the
motion. During discussion, Member Buhler commented that Staff followed policy and assured the
Board there was no health threat. Since the system is on a monitoring system, if a problem becomes
apparent in the future there are remedies that could be employed. She added that she has questions about
the policy, which Chairman Masci indicated could be brought forward at a later date.
Staff indicated that a variety of remedies are available under the code,ranging from criminal violations,
civil infractions,notices of order to correct and low level enforcement, which Staff felt was most
appropriate.
Dr. Tom Locke noted that these are the types of judgment calls and decisions anyone involved in
enforcement, including law enforcement, has to make. One of the important reasons to set priorities and •
intensity of effort is to allow ourselves the capacity to work intensively on those issues that are imminent
threats. He thinks the issue before the Board is an example of how Staff must assign low enforcement
priority in order to effectively delegate resources.
Member Frissell, Commissioner Huntingford,Member Buhler and Commissioner Titterness
responded in the affirmative. There were no negative votes and Chairman Masci recused himself.
Staff was directed to prepare findings and the decision in this matter.
At 4:12 p.m., the discussion on this matter concluded.
Child Death Review: 2003 Committee Recommendations,DOH Budget Decision, and Future
Planning: Julia Danskin reported that the packet included an announcement from the Office of
Maternal and Child Health regarding the end of state funding of Consolidated Contracts for Child Death
Review Activities. She reviewed the make up of the Jefferson County Child Death Review Team. Since
car accidents rank as one of the main contributors to child death, the CDR team has made
recommendations related to traffic safety, in addition to local prevention measures related to substance
use and abuse. In 2003,they had only one child death to report to the State. On July 15`, $3,000 in
funding was cut and Staff is recommending that these review meetings be continued, with County
general funds if needed.
Commissioner Huntingford expressed concern about unfunded mandates and continuing to support this •
program through the general fund. Dr. Locke provided a brief history of this program and noted that the
County is not mandated to do this but if it accepted the funding, it must perform the reviews.
,M
HEALTH BOARD MINUTES - July 17, 2003 Page: 7
•Jean Baldwin talked about the benefits of building better relationships with the Coroner and the Sheriff's
Department through this program. This is a good community debriefing and planning opportunity.
Ms. Danskin added that there might be an opportunity to use some of the State MCH block grant funding
to support the program. However, in this fiscal year,this money has already been earmarked for other
staff time. She proposed tracking Staff time and costs over six months in order to reassess whether the
County can justify the estimated$500 per meeting.
Dr. Locke noted that this type of data is pulled from all over the State to determine opportunities for
prevention, which is how Sudden Infant Death Syndrome was discovered. The hope in continuing this
program is that the legislature would recognize that they have responsibility for funding.
Commissioner Huntingford expressed concern that the legislators, after seeing that our dedicated public
health Staff are willing to pick up more responsibilities in order to carry these important programs
forward, will not see the need to come through with the funding.
Commissioner Titterness said he would like to put this on next month's agenda and get a Board of
Health recommendation on whether and how it would be funded.
Board Membership/Terms: Chairman Masci reported that terms for Members Frissell and Buhler
expire in August. He urged them to submit a written request for reappointment to the Board of County
commissioners if they desire to continue. Noting that there is not currently a Vice Chair, Commissioner
untingford volunteered to accept this position. Member Buhler moved to elect Commissioner
Huntingford as Vice Chairman. The motion was seconded by Commissioner Titterness and
carried by a unanimous vote.
ACTIVITY UPDATE/OTHER ANNOUNCEMENTS
Civic Engagement/Critical Health Services Project Update: Dr. Locke solicited the Board's interest
in having a joint Board of Health and Hospital Board meeting in September, the purpose of which would
be to consider having a community meeting. Much has been done by the work group and a series of
recommendation would be presented to the Joint Board about actions to be taken related to various
critical health service priorities. There was interest in Staff bringing some information to the Board in
August, which could then be reviewed at the joint Board meeting in September.
Opening of the Child and Family Resource Center: Julia Danskin distributed a brochure announcing
the August 21st grand opening of the Family Resource Center in a building next to Jefferson Mental
Health Services. The Center is funded to provide outreach and service to high need families with
identified mental health problems,but would also try to serve all families and are working cooperatively
with school districts. They are also establishing a foundation to receive donations from private
•nonprofits. It was noted that the grand opening ceremony would coincide with the August Board of
tealth meeting.
d w.
HEALTH BOARD MINUTES - July 17, 2003 Page: 8
AGENDA PLANNING/ADJOURN
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Member Frissell suggested that Staff write letters of thanks for the visit by Don Sloma and Carl Osaki of
the Washington State Board of Health. Commissioner Huntingford moved to direct Staff to write a
letter of thanks to Don Sloma and Carl Osaki of the Washington State Board of Health. Member
Buhler seconded the motion,which carried by a unanimous note.
The meeting adjourned at 4:34 p.m. The next meeting will be held on Thursday, August 21 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)
Glen Huntingford,Vice Chairman Sheila Westerman,Member
Dan Titterness, Member Roberta Frissell,Member
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Vacant
Commissioner District#3
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Board of Health
Old Business
Agenda Item # IV., 1
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Findings of Fact/Conclusion
Of Law for July 17, 2003
Appeal Hearing
August 21, 2003
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. BEFORE THE JEFFERSON COUNTY BOARD OF HEALTH
In RE: Appeal of enforcement action against Almeta Peterson and Eugene Roberts, 574
Beckett Point Road
File # SEP-85-00045
Findings, Conclusions and Decisions
Findings of Fact
A. Section 8.15.150(1)f of the Jefferson County On-Site Sewage System Code
specifies that owners shall not build any structure in the OSS area or reserve
area without express prior consent of the Health Officer.
B. Almeta Peterson and Eugene Roberts did build a deck in the area of the on-site
sewage system without prior consent of the Health Officer.
C. Environmental Health staff evaluated the effect of the construction and
determined that placement of the deck was not likely to immediately threaten
the function of the OSS.
D. Environmental Health issued a Notice of Violation and Order to Correct.
E. Section 8.15.150(2) of the Jefferson County On-Site Sewage System Code
specifies that "An owner or occupier's failure to fulfill any of the responsibilities
in 8.15.150(1) shall be the basis for a Notice of Violation and for the Health
Officer to decline to issue approval for further development on the parcel."
F. Dr. Green as a person aggrieved of a decision of the Health Officer may appeal
the decision.
G. Dr. Green filed an appeal.
H. Dr. Green's appeal was heard by the Jefferson County Board of Health on July
17, 2003.
II. Conclusions of Law
A. Almeta Peterson's and Eugene Roberts' action to construct a deck over their
OSS without prior consent of the Health Officer is a violation of the Jefferson
County On-Site Sewage System Code.
B. The Jefferson County On-Site Sewage System Code provides for a variety of
remedies or actions in response to a violation. These include Notices of
Violation, Civil Penalties and Criminal Penalties. However, the code provides
specific guidance that violations of 8.15.150(1) are cause for the Health Officer
to issue a Notice of Violation and to withhold approval of any future
development.
C. Due to the nature of the on-site system serving the Peterson/Roberts property,
the placement of the deck over the drainfield is unlikely to cause an imminent
failure.
D. The Peterson/Roberts property will be subject to regular inspection in the future
so any failures will be identified and corrected when or shortly after they occur.
DECISION
The Jefferson County Board of Health upholds the actions taken by the
Environmental Health staff and denies appeal filed by Dr. Green.
Dated this I3`h day of August, 2003.
Geoff Masci
Chair,Jefferson County Board of Health
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Board of Health
Old Business
Agenda Item # IV., 2
� Quasi-Judicial Appeal Procedures
August 21, 2003
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Quasi-Judicial Appeal Procedures — Script
Jefferson County Health and Human Services
Opening [All statements by Presiding Officer.]
1. The requested appeal for the (state name of application) is now open.
2. This is an open record hearing. Anyone wishing to be heard must have signed
in at the sign-in table in front. If you have not done so, please do so now.
Rules of Order
3. The public hearing will proceed in an orderly fashion and I would like to ask
your cooperation in the following procedures: This is an appeal of actions taken
by department staff in regards to (state the case in question). Comments from
speakers must be based on and limited to facts relevant to the appeal being
heard.
4. All comments shall be made from the appropriate seat, and any individual
making comments shall first give his or her name and address. Please speak
411 slowly and clearly. This is required because an official recorded transcript of the
hearing is being made. If there is an additional appeal, the court must make its
decision on the basis of what was said here and the record.
5. If anyone requires special accommodation in order to speak, please let me
know and we will make arrangements.
6. In fairness to all in attendance, each person will be given an opportunity to
address the Board for an initial period not to exceed 3 minutes. The appellants
shall be given 5 minutes to make their initial presentation. If more time is
needed, it will be made available after everyone has had a chance to speak. I
am requesting Board to hold their questions of the public until everyone is done.
7. It is not necessary to be a proponent or opponent in order to speak.
8. There should be no demonstrations (clapping or cheering) during or at the
conclusion of anyone's presentation.
Appearance of Fairness and Conflict of Interest Issues
9. This hearing is quasi-judicial in nature, and therefore the appearance of
fairness and conflict of interest rules apply. Quasi-judicial actions are defined as
• actions of the Board, which determines legal rights, duties, or privileges of
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specific parties in a hearing. The public hearing must be fair in three respects: .
form, substance and appearance.
10. [Option A —A Long Form] All Board members and the Chair should now give
consideration as to whether they have (1) a demonstrated bias or prejudice for or
against any party to the proceedings; (2) a direct or indirect monetary interest in
the outcome of the proceedings; (3) a prejudgment of the issue prior to hearing
the facts on the record, or (4) ex parte contact with any individual, excluding
administrative staff, with regard to an issue prior to the hearing. Does any Board
member have an Appearance of Fairness or Conflict of Interest issue or
disclosure to make? See none, (to next item, or if there is a questions to
disclosure, refer to City Attorney.)
[Option B— Short Form] Do any Board members, and this includes the Chair,
have an interest in this property or issue, or stand to gain or lose any financial
benefit as a result of the outcome of this hearing, or have any disclosures to
make? See none,
11. Is there anyone in the audience who objects to my participation or any other
Board member's participation in these proceedings?
Purpose of Hearing and Order of Speaking
12. The purpose of this hearing is for the Board to hear the appeal and to take •
action relating to the (name of proposal— from the agenda).
13. The order of speaking will be:
a. Staff presentation
b. Then argument from the appellant— 5 min.
c. Then arguments from proponents of the appeal-3 min.
d. Then argument from opponents to the appeal, or those who are
neutral — 3 min.
e. Then any argument from the applicant in response
f. Then response from staff
g. Then questions from Board members
Staff Presentation
14. Before hearing arguments, I am going to introduce (name in
memo in agenda packet) who will make the staff presentation.
Public Testimony and Comment
15. (To Clerk) Are there any additional written materials that have been
submitted, or that anyone wishes to submit without speaking? (Any documents
are given to Chair, who will read or summarize the document.) 411
• 16. I will call upon the appellant to speak.
17. Is there anyone else who favors the item, or is neutral, who wishes to speak?
18. At this time, I will call upon opponents to speak.
19. Are there any other opponents, or anyone else who has not spoken, who
wishes to speak.
20. I will now call upon the applicant to speak in rebuttal.
21. Does staff wish to respond to any subjects raised by any speaker, or make
any additional statement?
Questions and Answers
22. At this time, any Board member may ask any questions of any speaker or
staff. (Any person recalled will speak from the rostrum.)
23. Does any speaker have any comments soley to clarify any item raised by a
Board member's questions? Please, no new issues can be presented, and
please do not repeat your or any other person' previous testimony. Your
• comments should be limited to clarifying any item raised by any Board member
or staff.
Board Discussion
24. There being no further comment, I will close this portion of the hearing. It is
now in order for the Board to discuss this matter and for a Board member to
make a motion to take action or postpone. (Chair calls on Board members
wishing to be recognized.)
25. Is there any further discussion by Board members?
26. Is there any further recommendation or comments from staff?
27. (Chair states the motion and call for a vote. Following a vote by the Board.)
Staff is directed to prepare findings and decision.
28. This concludes the public hearing for this matter.
•
PUBLIC HEARING PROCEDURES •
Appearance of Fairness Doctrine. Appearance of Fairness Doctrine and it
Application:
(a) Appearance of Fairness Doctrine Defined. "In short, when the
law which calls for public hearings gives the public not only the
right to attend, but the right to be heard as well, the hearings
must not only be fair but must appear to be so. It is a situation
where appearances are quite as important as substance."
Smith vs. Skagit County 75 Wn.2d 715 (1969). "The test of
whether the appearance of fairness doctrine has been violated
is...as follows: Would a disinterested person, having been
apprised of the totality of a board member's personal interest in
a matter being acted upon, be reasonably justified in thinking
that partiality may exist? If answered in the affirmative, such
deliberations, and any course of conduct reached thereon,
should be voided." Swift vs. Island County, 87 Wn.2d 348
(1976).
(b) Types of Hearings to Which Doctrine Applies. The Appearance
of Fairness Doctrine shall apply only to those actions of the •
Council, which are quasi-judicial in nature. Quasi-judicial
actions are defined as actions of the City Council, which
determines the legal rights, duties, or privileges of specific
parties in a hearing or other contested proceeding. Quasi-
judicial actions to not include the legislative actions adopting,
amending, or revising comprehensive, community, or
neighborhood plans or other land use planning documents or
the adoption of area-wide zoning ordinances or the adoption of
a zoning amendment that is of area-wide (versus site-specific)
significance (RCW 42.36.010). Street vacations are typically
legislative actions, unless clearly tied to, and integrated into, a
site-specific development proposal, which is quasi-judicial in
nature.
•
•
Board of Health
Old Business
Agenda Item # IV., 3
Cruise Ship Waste Discharge -
• Draft Letter
w/Clallam Co. Board of Health
August 21, 2003
•
tic
JAL__ __
- 4 '',
JEFFERSON COUNTY BOARD OF HEALTH
G•
len Huntingford, Jefferson County Commissioner
'.r jI Dan Titterness, Jefferson County Commissioner
Jill Buhler, Jefferson General Hospital Commissioner
Roberta Frissell, Citizen at Large
Geoffrey Masci, Chair Jefferson County Board of Health
Sheila Westerman, Vice Chair, Jefferson County Board of Health
July 31,2003
State Board of Health
1102 SE Quince St.
P.O.Box 47990
Olympia,WA 98504-7990
RE: Sewage Releases from Vessels
Dear Members of the Board:
In the last several months Jefferson County residents and the Jefferson County and Clallam County Boards of Health
have become increasingly concerned about possible impacts from sewage releases from vessels passing through
Admiralty Inlet and the Strait of Juan de Fuca.These concerns stem from the growing presence of cruise ships
hailing from the Port of Seattle and were highlighted by the sewage release that occurred off our shores last May.
Each of these vessels is,in effect, a floating city but unlike a city the regulatory authority over discharges is
• somewhat clouded.As the Port of Seattle actively recruits more cruise ship business there is greater potential for
more of these kinds of releases and the possibility of marine water contamination of public health significance
increases.
Both of our counties have expended tremendous resources to protect and enhance marine water quality within our
jurisdictions.Our cities have spent huge sums to upgrade wastewater facilities.We have embarked on
implementation of new stringent stormwater standards.We do these things because they are the right thing to do yet
are afraid that our efforts could be jeopardized by a haphazard regulation of sewage discharges from vessels.
Questions that come immediately to our minds following the May release include;Why do vessels routinely release
sewage within the straits?Why not only in the open ocean?Why was necessary for this vessel to begin discharging
so soon after leaving Port?Weren't there shore facilities that would have enabled them to pump out before leaving
port?Is the level of training and oversight of onboard wastewater technicians up to the standard required of our
municipal operators?
We bring this matter to the attention of the State Board of Health because we believe that the Board is in a unique
position to investigate and evaluate whether the existing practices and regulatory framework are adequate to provide
public health protections and to preserve our valuable shellfish resources.RCW 43.20.050(1)authorizes the Board
to conduct hearings and explore ways to improve the health status of the citizens of the state.We respectfully
request that the Board exercise this authority with respect to sewage discharge standards and practice from vessels
plying our waters.
We would welcome the opportunity to address the State Board at a future meeting.
Thanks you for your attention to this matter.
Geoff Masci
Chair,Jefferson County Board of Health
•
Board of Health
Old Business
Agenda Item # IV., 4
•
Letters to and from
State Board of Health Delegation
August 21, 2003
•
• '",
•
j ! . .� JEFFERSON COUNTY BOARD OF HEALTH
Glen Huntingford, Jefferson County Commissioner
r j _ Y.1 Dan Titterness, Jefferson County Commissioner
Jill Buhler, Jefferson General Hospital Commissioner
Roberta Frissell, Citizen at Large
Geoffrey Masc, Chair Jefferson County Board of Health
Sheila Westerman, Vice ChairJefferson County Board of Health
August 14, 2003
Don Sloma, Executive Director
Carl Osaki, Member
Washington State Board of Health
1102 SE Quince Street
PO Box 47990
Olympia, WA 98504-7990
• Dear Mr. Sloma and Mr. Osaki:
I am writing on behalf of the Jefferson County Board of Health to express our appreciation for
you presentation to the Board on July 17, 2003. We enjoyed your thoughtful review of the issues
the State Board is currently engaged in and appreciate the high priority the State Board has
placed on forging partnerships with local boards of health.
The issue of cruise ship infectious waste discharges is an important one for the Jefferson County
Board of Health. Recently, the Clallam County Board of Health has also expressed concern over
this practice, its potential public health consequences, and the poorly defined authority to
regulate such discharges in the marine waters of Washington State. You will be receiving a
letter regarding this issue cosigned by chairs of both the Clallam and Jefferson County Boards of
Health in the near future. Thank you for your prompt attention to this matter.
Again, it was our pleasure to host your visit and we look forward to future opportunities to fulfill
our mutual responsibilities to protect and improve the health of Washington state residents.
Sincerely,
Geoff Masci, Chair
Jefferson County Board of Health
STATE
' r 4.
'3• Oy
��1889
STATE OF WASHINGTON
WASHINGTON STATE BOARD OF HEALTH
1102 SE Quince Street • PO Box 47990
Olympia, Washington 98504-7990
August 1, 2003
Jefferson County Board of Health
615 Sheridan Street
Port Townsend, WA 98368
Dear Chair Masci,
Thank you and the other members of your board of health for allowing Don Sloma and me to
come before you recently to learn more about your priority areas of concern.
We heard three primary areas of concern during our visit: the dumping of gray and black water
from cruise ships into Puget Sound waters within Jefferson County; enforcement authority and
resources for on-site sewage rules and for other environmental health programs; and medical
service access disparities.
We found the discussion about cruise ship dumping to be most animated and enlightening as you
and your fellow board members and staff shared the results of your investigations. All of the
issues you raised, including the adequacy of training, the adequacy of existing federal policy and
procedures for cruise ships and the consistency of local, state and federal programs for the
regulation of sewage on land, on small pleasure craft and on commercial vessels bear further
discussion. We look forward to further communication from you on these subjects. I can assure
you,this is an item I will raise for the state board's consideration. I hope to have some specific
answers for you in the coming months about some of the questions you raised, as well as a
determination by the state board of their willingness to pursue this subject in further detail.
We heard your board's concern about increasing demands and declining resources for public
health infrastructure in your community to perform even routine monitoring and enforcement of
long stand public health programs such as on-site sewage regulation. This is a recurrent theme in
our meetings with local boards of health this year, together with the lack of capacity across our
state's public health system to pursue emerging threats to public health from the environment. It
is part of the larger issue often raised about the absence in our state of an adequate, stable
financing base for public health. Our discussion with your board leads me to wonder about the
need for a higher priority in state public health financing discussions on environmental health
infrastructure. Thank you for sharing your insights.
Finally, I want to acknowledge the excellent points made at the end of our discussion by your
Administrator, Jean Baldwin, regarding the growing medical care access disparities in rural
areas. Her comments about unmet needs for alcohol and mental health treatment, as well as the
concerns she expressed about the continued financial viability of primary medical care and even
some hospital care in rural areas are well taken. The board views with alarm the state's apparent
Working for the Health of Washington and Its People
Jefferson County Board of Health
August 1,2003
Page 2 of 2
determination this year that subsidies for access to needed medical care for the poor and other
minorities was not of sufficient priority for government to continue them at historic levels in our
current economic climate. Her comments served to strengthen our resolve to continue speaking
out on this important public health issue.
Our meeting with your board was very helpful to our ongoing efforts to learn more about
community perspectives on public health issues. As I mentioned during our discussion, we
intend to use the information we receive from you and other Boards of Health in our 2004 State
Health Report. By law, the state Board must produce this report biennially, together with
recommendations for state health priorities for the ensuing biennium. Although we distributed
copies of the 2002 State Health Report at our meeting, you may also view that report on our web
page at http://www.doh.wa.gov/sboh/Pubs/2002SHR.pdf
If you would like to provide additional information, other community perspectives or other
suggestions for statewide health priorities,please feel free to call or write. We will be accepting
additional input from local boards of health for the state health report until September 30, 2003.
We are open to hearing from you about emerging issues at any time.
If you have any further questions or requests, please call the Board office at(360)236-4110 and
one of our staff would be happy to assist you in anyway possible.
Again, thank you for allowing us some time with you in your busy schedules.
•
cerely /�
Carl Osaki, Member
Washington State Board of Health
Cc: Jefferson County Board of Health Members
Jean Baldwin, Jefferson County Health and Social Services Department
Washington State Board of Health Members
Don Sloma, Executive Director, State Board of Health
a
•
Board of Health
Old Business
Agenda Item # IV., 5
•
Letter from Jefferson
County Prosecutor re:
Child Death Review
August 21, 2003
•
Juelanne Dalzell _
c'-`e, 1.:3 -,.• JEFFERSON COUNTY PROSECUTING ATTORNEY
• , -- Courthouse—P.O.Box 1220
F - - t
.. 'r, Port Townsend,Washington 98368
. ' Telephone(360)385-9180 FAX
.if;
I\ ,: P (360)385-0073
pw�. Till Landes,Deputy Prosecutor
�!_ +�
5-• _ • . .,. __ Michael Haas,Deputy Prosecutor
JEFFERSON COUNTY MS-PORT,O„,,,, ,,,,,, David W.Alvarez,Deputy Prosecutor
Tracey Lassus,Deputy Prosecutor
Lianne Perron-Kossow,Victim Services
MEMORANDUM
TO: Board of County Commissioners
FROM: Juelanne Dalzell /
Prosecuting Atto - r
DATE: July 29, 2003
RE: Child Death Review
•
In its infinite wisdom, the state has cut off funding to Jefferson County for all
child death review team assessments.
In spite of lack of funding, I would like to continue holding these team
assessments as the need arises.
Fortunately, we do not have many children die in our county, so the team rarely
meets. When we do meet, though, the information gathered may prove useful to
the county.
To my knowledge, no team member bills the county for their presence nor for
their expertise. The information gathered may prevent future child deaths.
Occasionally, we are able to identify areas that can be enhanced so future loss
may be minimized. I can give you specific examples if you wish to contact me for
more information.
Thank you. RECEIVED
0 JUL 31 2003
JD\acb Jefferson County
Health&Human Services
Doi iDansk1\.
•
Board of Health
New Business
Agenda Item # V., 1
Performance Measures and
• 2004 Budget Narrative
August 21, 2003
•
Jefferson County Health and Human Services
• 2004 Performance Measures
COMMUNITY HEALTH
Family Support Programs
BUDGET/PROGRAM: Community Health: Family Support Programs
Maternal Child Health(MCH) including newborn follow-up, Child Birth education and Breast
Feeding Support, Integrated Maternity Support Services (MSS)/Infant Case Management, Best
Beginnings/Nurse-Family Partnership (NFP), Children with Special Health Care Needs
(CSHCN), Women Infants and Children (WIC), and the Child Protective Services (CPS)
Contract Programs: Alternative Response System (ARS), Early Intervention Program(EIP), and
Passport.
MISSION:
The purpose of the Family Support Programs is to provide health and parenting education, skill
building, support, and referrals to community resources to pregnant women and families with
children. Services also include voluntary home visits to prenatal,post partum families, and
families at risk of Child Protective Services involvement. These services are provided so county
babies are born with the best opportunity to grow and thrive, the impact of health problems are
minimized, and children receive the care and nurturing they need to become functional adults.
GOALS FOR FY2004:
1. All newborns and their families will receive Newborn Health Screening to identify needs
. for Family Support Services including: intensive home-visiting, case management,
lactation support, special health and child development support, nutrition education and
parenting education.
2. Maintain the current number of clients served through the Family Nurse Partnership
Program (Best Beginnings) for Jefferson County residents.
3. Monitor Nurse Family Partnership Program replication by tracking data on program
fidelity.
4. To assess the percentage of pregnant and parenting women receiving JCHHS services, in
which depression is an issue.
5. Continue to provide breastfeeding education and support so that all county mothers can
provide their children with the physical and emotional benefits of breastfeeding.
6. Prevent nutritional related problems for pregnant women and children under five in
Jefferson County.
7. Identify children with special health care needs in Jefferson County and assist families
with health and development interventions and referrals as needed.
8. Provide services and information in Jefferson County aimed at preventing Child Abuse
and Neglect.
9. Increase awareness and support of the Family Support Program mission and services
among local health care and other service providers.
•
1
OBJECTIVES FOR FY 2004:
1. PHN's will provide Universal Newborn Screening to all Jefferson County families of
new babies through telephone calls and office or home visits in order to identify early
intervention needs and offer services and referrals.
2. Support the Nurse-Family Partnership PHN's maintaining caseload intensity by
providing opportunities for ongoing support and education both within JCHHS and
through other offerings such as the Washington State Consortium for Nurse-Family
Partnership.
3. Send client data monthly to Nurse-Family Partnership program head office for
assessment and evaluation. As part of the Office of Juvenile Justice Department Grant-
Preventing Delinquency Early we are conducting an analysis of the MSS/MCM,
Universal Newborn Screening, and Nurse-Family Partnership programs by collecting a
variety of client specific data over the next year. Dr. Rebecca Kang, a professor at the U.
of Washington, has been contracted to help design the assessment and analyze the data.
4. Depression screening and education will be offered to all pregnant and parenting women
who are participating in JCHHS programs and appropriate referrals will be made for
those who have a positive screen.
5. Through universal screening of newborns and their families identify those who may need
referral to breastfeeding tea party or lactation consultation telephone, office or home-
visits. Ongoing collaboration with JGH staff for lactation support will help ensure all
families receive the services they need.
6. Provide WIC nutrition education and support to all eligible county women and children.
7. Through universal newborn screening,other JCHHS programs and community outreach to
• providers and the schools children with special health and development needs will get referred for
evaluation and intervention services
8. Awareness and assessment of risk for child abuse and neglect is an integral component of all
Family Support Service Programs. Referrals to CPS/DCFS will be made as appropriate and
services will be provided to families at risk or involved in CA/N through the ARS and El?
contracts.
9. Staff will meet with local health care and other service providers to share information about
program goals, services,referral process, and to offer collaboration in care and services to
Jefferson County families.
PERFORMANCE INDICATORS: 2003 2003 2004
Planned Projected Planned
1. Number of depression screenings completed 60 70 70
2. Number of newborn screened 120 120 120
3. Number of those screened receiving continuing Family 60 70 70
Support Services (2002 no MCH add)
4. Number of Home and Office visits provided for BB,MSS, 1500 1500 1500
MCM,MCH and Breastfeeding consultation
5. Yearly report from Family-Nurse Partnership ** ** **
6. Total number of women infants and children served by 900 900 900
WIC in Jefferson County(from CIMS report)
7. Number of children with special health care needs 60 60 60
receiving Public Health Nurse intervention through JCHHS.
• 8. Number of families served through CPS/DSHS contract. 15 15 15
**report yearly
2
SUMMARY OF KEY FUNDING/SERVICE ISSUES:
2003 Jefferson County Health report published in May 2003 confirmed what the staff in the
Family Support Programs have observed in their work in the community: `families with young
children are very vulnerable'. Multiple factors contribute to this status: poverty, mental illness,
substance abuse, and family abuse/violence. For many families these challenges have been
transmitted across generations and now the newborns are vulnerable to these risk factors. Over
the years of providing services through programs such as MSS/MCM, WIC, and for the last 4
years,Nurse-Family Partnership, staff have worked to increase knowledge and skills in a
committed effort to prevent and reduce the effects of these conditions. We are now able to
effectively serve clients and families who previously were resistant, or too entrenched in
complex psychosocial problems to accept services. Working effectively with these families
requires a high degree of skill and support. These families,with multi-generational challenges,
respond best to consistent, intensive services delivered over a long period of time. The program
assessment project will increase our knowledge of this specific population and demonstrate that
the positive outcomes shown in the national program are also being achieved in Jefferson
County. Washington State Department of Health and DSHS are redesigning the First Steps
programs MSS and MCM into Integrated Maternity Support Services and Infant Case
Management expanding the eligibility criteria and documentation requirements but reducing
reimbursement.
3
Jefferson County Health and Human Services
• 2004 Performance Measures
COMMUNITY HEALTH
Targeted Community Health Services
BUDGET/PROGRAM: Targeted Community Health Services
Family Planning, Breast and Cervical Health Program, and Foot Care
MISSION:
The purpose of the Targeted Community Health Services is to provide outreach, access,health
education, support treatment to specific populations in Jefferson County in order to improve the
health of the community.
Specific program purposes are:
• Family Planning: to provide reproductive health, clinics, outreach and education for
Jefferson County residents in order to promote health and well-being and reduce unintended
pregnancies.
• Breast and Cervical Health Program: provide public education and health screening
services to women age 40-64 with low incomes and no or limited health insurance in order
to assure early detection and treatment of breast and cervical cancer.
• Foot Care: provide foot care and health outreach to Jefferson County seniors to prevent
health complications.
GOALS FOR FY 2004:
• 1. Insure access to breast and cervical health exams to women age 40 to 65 years old.
2. Decrease unintended pregnancy rates in Jefferson County(measure)/Assure Family
Planning Services are provided in every community
3. Support seniors' independence by maintaining their mobility
OBJECTIVES FOR FY 2004:
1. Track Family Planning usage patterns and produce annual report
2. Maintain breast and cervical health program in Jefferson County
3. Emergency contraception to be provided under standing orders, 5 days per week, and
expand community education and clinical services
4. Maintain the current level of community foot care and continue expanding into home
care
PERFORMANCE INDICATORS: 2003 2003 2004
Planned Projection Planned _
Number of unduplicated clients served in Family 1,500 1,500 1,600
Planning
Number of adolescents under 19 served in Family 330 330 330
Planning
Number of Breast&Cervical screening exams 65 80 70
Number of foot care contacts 2,500 2,500 2,500
•
1
SUMMARY OF KEY FUNDING/SERVICE ISSUES:
• Preventing unintended pregnancies is a local, state, and national Public Health Goal. JCHHS
provides the only Family Planning program in east Jefferson County. Family Planning is
considered a Critical Health Service by the State Board of Health. In July 2001 Washington
State started a 5-year federal waiver program called Take Charge which increase funding and
clients for Family Planning Services in Jefferson County. The number of clients served increase
dramatically the first year of Take Charge. JCHHS anticipates maintaining the increased
numbers of clients with only minimal increases now. The Breast and Cervical Health programs
addresses the need for Cancer screening and early treatment to decrease deaths from Breast and
cervical Cancer in Jefferson County. JCHHS increased outreach efforts in 2003 with an increase
of clients coming in for services. Demographics in Jefferson County are showing an increase in
the over 85-year-old population. JCHHS foot care program help this population maintain
independence and mobility in a rural community.
•
•
2
Jefferson County Health and Human Services
• 2004 Performance Measures
COMMUNITY HEALTH
Population and Prevention Programs
BUDGET/PROGRAM: Population & Prevention Programs
Raising Healthy Community Grant(HC), Tobacco (TP/C), School Health (S/H), Childcare
health and Safety(CC), Peer-hi (PI) and Oral Health(OH)
MISSION:
The purpose of the Population&Prevention Programs is to provide health education and public
health interventions to county residents in order to prevent disease and unintentional injury,
improve the quality of life and reduce disparities in health.
GOALS FOR FY 2004:
1. Improve identified social and health indicators for school-age youth(S/H)
2. Improve indoor air quality for Jefferson County residents (TP/C)
3. Enhance the quality of child care provided in Jefferson County(CC)
4. Enhance the overall health&safety of Jefferson County children (PI) and(OH)
5. Improve Healthy Youth Coalition functioning(HC)
OBJECTIVES FOR FY 2004:
1. Maintain delivery of school in-service/trainings, student health screenings, student health
• consults, student health care referrals (S/H)
2. Increase number of restaurants participating in smokefree campaign, develop baseline of
smoke-free overnight accommodations; number of mothers who do not smoke during
pregnancy(TP/C)
3. Maintain child care provider consultation re: health, immunizations, safety and child
development(CC)
4. Peer educators will provide school health classes to middle&high school students and
health education classes will be provided to elementary, middle&high school students
(PI) and increase awareness Oral Health prevention interventions.
5. Maintain number of Healthy Youth Coalition meetings annually
PERFORMANCE INDICATORS: 2003 2003 2004
Planned Projected Planned
Number of student health screenings 2,400 2,400 2,300
Number of restaurants offering 100%Indoor Smoke Free 62 62 62
Dining(TP/C)
Number of overnight accommodations offering 100% Smoke NA NA 15
Free lodging(TP/C)
Number of Peer-In educational presentations 10 10 50
Number of school health classes 50 50 175
Number of phone calls to WA State Tobacco Quit line from 80 80 80
Jefferson County
Number of Healthy Youth Coalition Meetings 8 _ 8 8
•
1
SUMMARY OF KEY FUNDING/SERVICE ISSUES:
• A specific Juvenile Justice grant funds Healthy Communities with in-kind services from the
community agencies involved. Healthy Communities grant provides intervention and prevention
programs to identified children in vulnerable families. Besides the Healthy Communities grant,
the above programs provide universal prevention programs available to all in the community.
State prevention health services monies come with extensive evaluation components. Tobacco,
Peer-In and Healthy Communities funding have community specific goals and measures that
must be met to maintain funding. School funding is based on State School Nurse corp funds and
contracts with school districts. School enrollment is decreasing slightly anticipating less health
screening.
•
•
2
Jefferson County Health and Human Services
Community Health 2004 Performance Measures: Communicable Disease
• BUDGET/PROGRAM: Community Health Communicable Disease
TB, Communicable Diseases, Immunization, Travelers Immunization, Sexually Transmitted Disease,
HIV, Syringe Exchange Program.
MISSION: Communicable Disease
The purpose of the Communicable Disease Health program is to protect Jefferson County residents
from serious communicable diseases by providing disease surveillance, investigation and reporting,
along with education, screening, treatment and immunization services. The program interacts with
community members, medical providers, the Washington State Department of Health and other
agencies while working toward this purpose.
GOALS FOR 2004
1. Maintain the low rates of active TB in Jefferson County(TB)
2. Timely investigation of reportable conditions (CD)
3. Support universal access to State supplied vaccines for all children (Imm)
4. Continue to support immunization registry in Jefferson County,promoting use by all
immunization providers (Imm)
5. The Family Planning and STD clinics will assist in controlling Chlamydia transmission in
Jefferson County(STD)
6. Providers will be informed about current communicable disease trends and new communicable
disease control recommendations
7. HIV testing and counseling clinic resources are focused on persons at risk for HIV infection
• (HIV)
8. Case management services will be easily accessed by new HIV clients who seek these services
(HIV)
9. Prevent the spread of blood borne communicable diseases among injecting drug users and their
partners (SEP)
10. Annual report to BOH for CD, TB, Immunization Programs, STD
11. Develop bioterrorism response capacity
OBJECTIVES (INTERVENTIONS) FOR 2004
1. Encourage appropriate screening &treatment for latent TB infection (TB)
2. Develop &update protocols for investigation of reportable conditions (CD)
3. Maintain an efficient system for supplying State supplied vaccine and vaccine recommendation
up-dates to private Health Care Providers in Jefferson County(Imm)
4. Continue to provide training on the Child Profile Immunization Registry to private Health Care
Providers
5. Clients seen in Family Planning and STD clinics who are at higher risk for Chlamydia(age
criteria) will be screened for Chlamydia(STD)
6. Provide updates, outreach and training to providers about local, state and national
communicable disease outbreaks and disease control recommendations
7. 75%of clients who receive HIV testing will be high risk(HIV)
8. 95% of new HIV clients who seek case management services will have an assessment within 1
• week of the date requested(HIV)
9. Promote utilization of syringe exchange program services (SEP)
1
10. Develop regional bioterrorism plan, coordinating with regional bioterrorism partners, local
emergency response agencies and Jefferson General Hospital
• PERFORMANCE INDICATORS: 2003 2003 2004
Planned Projection Planned
(TB) Number of clients started on preventive therapy for latent 8 3 3
TB infection
(CD)Number of communicable disease reports confirmed, 62 75 62
interventions applied and processed for reporting to the state
(Imm)Number of doses of publicly funded vaccine, 3500 3500 3500
administered by private health care providers and Public Health
clinics, supplied and monitored through Public Heath's
immunization program
(Imm)Number of local immunizations providers (clinics) 3-6 2 2
provided information and training on the Child Profile
immunization registry
(Imm)Number of providers participating in the Child Profile 4 3 5
immunization registry
(Imm)Number of Jefferson County children<6 in Child Profile 80% 80% 85%
system
(STD)Percent of at risk FP and STD clinic clients at risk for 100% 100% 100%
Chlamydia screened (age criteria 14 - 24)
(HIV)Number of persons counseled and tested for HIV infection 60 60 60
(HIV)Percent of persons counseled and tested for HN infection 75% 75% 75%
arwere in high-risk category
V)Percent of new HIV clients seeking case management 90% 95% 95%
services who have an assessment within 1 week of the date
requested
(SEP)Number of clinics 100 100 100
(SEP)Number of visits to SEP 15 25 25
(SEP)Number of syringes exchanged 1000 2000 2000
(SEP)Number of prevention/educational materials provided 15 15 15
(SEP)Number of referrals to other services 5 5 5
(BT) Develop bioterrorism response plan 1 1 1
SUMMARY OF KEY FUNDING/SERVICE ISSUES:
These programs address locally identified and defined local public health problems. Communicable
disease prevention is a locally funded program since the county milage was returned from the state to
counties for TB control. Immunization funds from the state have been primarily in the form of vaccine.
County funded Services are important in the Strategic Plan to promote healthy communities by having
the infrastructure to maintain a professional staff preventing, identifying and responding to disease
outbreaks. Substantial staff time is spent on responding to public requests for information about
communicable diseases and screening for reportable illnesses in the process.
HN services are funded from the state and federal government to provide basic communicable disease
prevention,HN positive client case management, testing and counseling to high-risk community
• members, and focused high-risk interventions. Funds are highly programmatic and based on federal
case numbers,which may not represent Jefferson County epidemic profile. Volatile program funding is
based on formulas re-negotiated with Region VI AIDSNET every year
2
In 2002 federal funding was received for developing the capacity for bioterrorism response. This
response capacity is being developed in coordination with our bioterrorism regional partners, Kitsap
and Clallam Counties, our local emergency response agencies, Jefferson General Hospital and other
health care providers. This project involves completing a Local Health Department Emergency
Response Plan in 2003 and giving it a trial through a tabletop exercise. A Regional Emergency
Response Plan and a regional tabletop are due in 2004.
Increased funding will support the development of a Regional Emergency Response Plan and
exercising it through a regional tabletop. Increased funding will also allow for increased
Communicable Disease surveillance, outreach and resource development with the Health Care
Providers in the community.
Decreased funding would result in scaling back on services. The Board of Health would be involved in
deciding which services would be impacted.
•
•
3
1
III Jefferson County Health and Human Services
2004 Performance Measures
ENVIRONMENTAL HEALTH
Drinking Water Programs
MISSION: The mission of the Drinking Water Program is to assure that the residents and
visitors to Jefferson County have access to the best quality drinking water that is reasonably
available in order to minimize the threat of waterborne disease.
GOALS FOR FY 2004:
1. Assure that all new wells are constructed in accordance with requirements established by
the Washington Department of Ecology.
2. Provide technical assistance when requested so that individual water supplies are safe.
3. Limit public exposure to water systems with known deficiencies.
4. Integrate water adequacy review information with Natural Resource water quality
database
OBJECTIVES FOR FY 2004:
1. Inspect at least 50% of all new wells constructed and 100% of all wells being de-
commissioned.
2. Increase compliance with state well drilling regulations.
3. Review all building permits and project applications to assure that potable water supplies
• meet basic public health standards as well comply with state statutory and regulatory
requirements.
4. Provide technical guidance to any residents requesting assistance with their individual or
small water systems to deliver safe drinking water.
5. Establish appropriate policies for alternative water supply systems.
6. Continue contracting with DOH for public water supply projects as long as adequate
funding is provided.
PERFORMANCE INDICATORS: 2000 2001 2002 2003 2004
Actual & Planned
Number of well applications received&reviewed, includes 88 75 119 Estimated
carry forward from previous years (USR's) 157 165
Number of new wells start notification(drilled) N/A 43 101
Number of wells abandoned 84 88
7 2 7 31 33
Number of applications with no well drilled(carry forward) N/A 30 11
Number of new wells inspected(start notification received) N/A 36 45 42 44
63 66
Percent of new wells (starts)inspected
N/A 84% 46% 75% 75%
Number of abandoned wells inspected N/A 2 N/A
Percent abandoned well inspected 31 33
N/A 100% N/A 100% 100%
•
1
J
SUMMARY OF KEY FUNDING/SERVICE ISSUES:
Increased tracking will be done within existing databases such as permit plan and the food
service database. Databases, including the water quality database,will be updated as necessary
to add new fields to track performance indicators.
LINKS TO COUNTY STRATEGIC OBJECTIVES:
• Protecting and enhancing natural resources
• Addressing local public health problems
•
•
2
J
Jefferson County Health and Human Services
• 2004 Performance Measures
ENVIRONMENTAL HEALTH
Food Program
MISSION: The mission of the Food Program is to minimize the risk of the spread of
disease from improperly prepared, stored or served foods handled in commercial settings.
GOALS FOR FY 2004:
1. Provide classroom food safety instruction for all food service workers.
2. Assure minimum sanitary standards are observed in all food service
establishments.
3. Provide basic food safety information to the general public.
OBJECTIVES FOR FY 2004:
1. Offer food safety training at a frequency and in locations convenient to food
service workers.
2. Review all new food service establishments for compliance with state and county
requirements.
3. Inspect all food service establishments at a frequency adequate to assure
compliance with state and local regulatory requirements.
4. Offer educational materials and technical assistance to non-regulated community
groups and organizations where requested.
•
PERFORMANCE INDICATORS: 2000 2001 2002 2003 2004
Actual & Planned
Estimated
Number of food workers trained 1,044 1,008 1,090 1,306 1,500
Number of food worker classes at Health N/A 51 60 62 60
Dept tnient
Number of food worker classes at other N/A 13 18 29 30
locations
Number of food establishment permits N/A N/A 251 248 260
Number of required inspections completed 352 247 293 300 300
Number of inspected establishments that 33 22 21 20 20
required repeat inspections due to critical
violations.
Number of establishments receiving 41 55 48 48
Outstanding Achievement Awards
Number of temporary food service permits N/A 72 65 75 78
Number of complaints received and N/A 26 46 22 *
resolved
* Not able to project, will report at year-end.
•
1
i
SUMMARY OF KEY FUNDING/SERVICE ISSUES:
• Food Program activities are largely funded through permit fees.
LINKS TO COUNTY STRATEGIC OBJECTIVES:
• Addressing local public health problems
• Sustaining economic development
•
•
2
Jefferson County Health and Human Services
• 2004 Performance Measures
ENVIRONMENTAL HEALTH
ON SITE SEWAGE PROGRAMS (OSS)
MISSION: The mission of the Onsite Sewage Program is to minimize the threat of surface and
ground water contamination from failing or improperly designed, installed or maintained onsite
sewage systems.
GOALS FOR FY 2004:
1. Educate homeowners, builders, real estate personnel,banks, installers, designers and
onsite system maintenance personnel in the proper operation and maintenance of onsite
sewage systems.
2. Assure a high quality-monitoring program.
3. Implement and enforce state and local rules and regulations governing the installation and
use of onsite sewage systems.
4. Investigate action requests and complaints in a timely manner to reduce the threat of
human contact with untreated wastewater.
5. Assure high quality customer service.
OBJECTIVES FOR FY 2004:
1. Develop written informational materials for public distribution and conduct workshops
for community groups addressing onsite sewage system operation and maintenance.
• 2. Provide training to community groups to increase awareness of regulatory requirements
for onsite sewage systems.
3. Review monitoring and inspection reports and provide timely follow up.
4. Utilize existing data systems to track action requests and complaints.
5. Develop and implement a system for routinely surveying customer service.
6. Assure that site inspections in response to permit applications are conducted within 14
days of receipt of application.
PERFORMANCE INDICATORS: 2001 2002 2003 2004
Actual & Planned
Estimated
Number of systems repaired/upgraded not associated 7 21 22 25
with a violation or building application.
Percent of existing systems receiving regular 3rd party 13% 14% 16% 20%
monitoring.
Percent of system failures less than 5 years in use 55% 14% 16% 15%
Number of complaints received 83 60 24 30
Percent of complaints requiring enforcement action. 17 21 18 20
Number of septic applications 248* 318* 329* 345*
Number of permits<14 days to initial inspection 132 147 180 190
• Number of permits>14 days to initial inspection 44 48 35 30
1
Percent of permits issued with clock stoppers that 48% 52% ** 30%
• delay processing time
Average days to process permits 23 14 ** 14
Percent of permits applications pending 68 65 ** *
Number of evaluations of existing system(EES) 277 210 230 200
Percent of EES resulting in required significant 1.8% 30% 26% **
maintenance or repair.
Percent of failures/major maintenance 1% 2.9% 1.7% **
Number of educational workshops 15 18 5 5
Number of workshop participants 624 431 100 100
* Number of applications does not equal approved permits
**Not able to calculate until year-end.
SUMMARY OF KEY FUNDING/SERVICE ISSUES:
Tracking will be done with existing data systems to evaluate effectiveness of monitoring
programs. With the completion of the DOE non-point source pollution grant, ongoing O&M
activities will need to be funded through permit and inspections fees. Implementation will focus
on coordination with the PUD to set up systems for scheduling and tracking inspection activities
and conducting community outreach to increase awareness of the new requirements.
LINKS TO COUNTY STRATEGIC OBJECTIVES:
• Addressing local public health problems
• Protecting and enhancing natural resources
2
Jefferson County Health and Human Services
2004 Performance Measures
• ENVIRONMENTAL HEALTH
Solid Waste Programs
MISSION: The mission of the Solid Waste Enforcement and Education Program is to assure
that solid waste in Jefferson County is managed in a way that is consistent with state regulatory
requirements, avoids harm to the environment, is protective of the public health and promotes
goals and objectives for solid waste reduction and recycling consistent with the Jefferson County
Comprehensive Solid Waste Management Plan.
GOALS FOR FY 2004:
1. Reduce the occurrence of promiscuous dumping.
2. Increase the awareness of small quantity generator and household hazardous waste
disposal requirements through education and outreach efforts.
3. Promote construction and demolition waste recycling in order to reduce illegal dumping
and to see a decrease in the annual tonnage of solid waste.
OBJECTIVES FOR FY 2004:
1. Finish updating local solid waste regulations.
2. Conduct workshops and technical consultations with SQG's
3. Begin green business program as envisioned in the Jefferson County Solid Waste
Management Plan and within available funding.
•
PERFORMANCE INDICATORS: 2001 2002 2003
2004
Actual & Planned
Percent of illegal dumps closed and cleaned up 100% N/A Estimated
*
Pounds of litter and illegally dumped waste 1.2 N/A
collected per capita _ pounds/cap
Number of complaints/reports received about 37 78 37 *
illegal garbage and waste dumping and storage
Number of complaints that were resolved without 17 45 34 *
issuance of a Notice of Violation
Number of illegal dumping complaints resolved 9 27 16
after a Notice of Violation was issued
Number of illegal dumping complaints unresolved N/A N/A 10
(pendin )
Number of illegal dumping complaints unresolved N/A N/A 3 *
waiting for legal action
Number of EnviroStars Businesses—Note: there N/A N/A 6
are 100 EnviroStars eligible businesses in 10
Jefferson County
Pounds of Recycled Material at Electronics N/A N/A 11,328 lbs
Recycling Event(began in 2003)
*Not able to calculate until year-end
1
SUMMARY OF KEY FUNDING/SERVICE ISSUES:
• Generally there has been very few compliance problems associated with permitted solid waste
facilities in Jefferson County. However, illegal dumping and neighborhood nuisance conditions
continue to be a problem. Use of general funds and tipping fee funding to match DOE Solid
Waste Enforcement and Solid Waste Education Grants will enable the division to maintain
staffing at current levels. This level of staffing will enable the department to complete the solid
waste regulation revisions, increase capacity for compliance activities and conduct regular
community outreach programs.
LINKS TO COUNTY STRATEGIC OBJECTIVES:
• Protecting and Enhancing Natural Resources
• Addressing local public health problems
• Sustaining economic development
•
•
2
• Jefferson County Health and Human Services
2004 Performance Measures
ADMINISTRATION
GOALS FOR FY 2004: ADMINISTRATION
1. Assure accurate and timely fiscal reports
2. Assure technical support in assessing the basic health needs of Jefferson County
communities
3. Assure administrative, technical and financial support for all Health & Human Services
contractual agreements.
4. Provide administrative, technical and financial support to Inter-local agencies that
contract for fiscal services with JCHHS.
5. Assure accurate and timely technical and clerical support to each department within
JCHHS in serving the residents of Jefferson County.
6. Provide certified birth and death certificates to the Community with accurate and timely
information of births and deaths
OBJECTIVES FOR FY 2004
1. Provide quarterly fiscal reports to each Health and Human Services department.
2. Provide technical support and leadership assessing the basic health needs of Jefferson
County communities through analysis of vital records and data and working with
community leaders to make prioritizations and program goals and objectives.
3. Provide administrative and financial support to meet required reporting, invoicing, and
• tracking of contractual agreements with Federal & State agencies, inter-
local/departmental agreements and MOU's held by Health& Human services.
4. As fiscal agent provide administrative and financial support to meet quarterly reports and
contractual agreements as required by Federal & State agencies for all contractual
agreements held by agencies who contract with JCHHS.
5. Provide supervision, training, assistance and evaluation of the systems that provide the
business service support to the various Public Health services provided to the residents of
Jefferson County.
6. 90%of requests for birth and death certificates will be processed with 5 working days
PERFORMANCE INDICATORS: 2003 2003 2004
Projected Actual Projected
100%compliance of all fiscal contractual 100% 100% 100%
agreements
Data study groups have a statement of work * Quarterly and
identifying indicators for Health and Human annual report to the
Services of Jefferson County BOH
98— 100%compliance on State/Federal Audits 100% 100% 98-100%
Number of birth and deaths in Jefferson Co. as Baseline Baseline Baseline
handled though requests in JCHHS
Number of days to process birth and death Baseline 5 days 5 days
• certificates
1
• SUMMARY OF KEY FUNDING/SERVICE ISSUES: Funding for public health services
continues to plague the stability of technical support for basic health needs in Jefferson County.
The majority of the technical support that JCHHS provides to the community includes internal
support to the departments and is dependent on external funding. The department recognizes
the inter-relationships between the county and city and the importance of continued support from
each. Categorical funding limits the ability of HHS admin to provide support for the whole
department and to objectively meet community needs.
•
2
JCHHS 2004 Budget Summary
In keeping with the Jefferson County Resolution establishing the 2004 Budget Goals,Jefferson County Health&
• Human Services has identified how each program meets county strategic objectives on the enclosed performance
measures. The department mission adopted by the County Board of Health is"to protect the health of Jefferson
County residents by promoting healthy communities and environments." Protecting and enhancing natural
resources promotes a healthy community,prevention programs serve a viable law and justice system,and local
public health problems must continue to be identified and addressed.
• This budget submittal represents essentially no change in overall Health and Human Services staffing
levels;some minor program reassignments do not impact the budget.
• Expense increases are a reflection of salary,benefits and rent increases.
• The general fund contribution to JCHHS was reduced in 2003 in conjunction with the reduction of
expenses to Facilities. The additional space,Health Department Annex and Natural Resources Department,
acquired in 2003 has caused and increase of expenses to Facilities. This budget reflects restoring the
general fund contribution back to the original 2003 amount in order to cover new increase.
Planned and expected changes in 2004 funding for Nursing Services
• Elimination of Child Death Review from Washington State($3,000 loss)to assessment process.
• Decrease in Breast and Cervical Health Program funds. Anticipated 19%cut in Federal dollars. Unsure on
how much the grant will be decreased within the local contract.
• Washington State Medical Assistance fees being limited and/or decreased. JCHHS is unsure how much
funding will be lost.
• Maternity Support Services and Maternity Case Management being redesigned by DSHS to be finalized by
Oct.2003. Some fees will be eliminated,other fees being increased. Anticipated loss in Local Funds,
JCHHS unsure how much and what services will be changed.In 2004-2005 the OJJDP grant will stabilize
funding for maternity services.
EH 2004 Budget Summary
• • The only significant change is that a program code for zoonotic diseases has been added.While we have
always done some zoonotic disease response,the emergence of West Nile Virus and more recently the
monkey pox episode have highlighted the need to track our time to that program.However,we have not put
new money into zoonotic disease.Rather we have shifted county general fund within EH.
• A workload analysis of Environmental Health staff will be completed in 2003. It may impact EH
budgeting.
Animal Services 2004 Budget Summary
• This budget submittal reflects no changes in Animal Services duties.The main change is an increase in
building rent and Facilities no longer providing grounds maintenance. The Shelter Staff are currently
maintaining the grounds around the shelter.This will require an increase of$4,029 from the County general
fund.
• In October of 2003 the regional services contract for 2004 will be negotiated and at that time the
city/county formula will be reviewed.
Drug and Alcohol Services 2004
• The addition of the Criminal Justices Treatment Account(CJTA)increases the funding for alcohol and drug
treatment services for clients in the Justice system.This is an overall increase in treatment money available
for Jefferson County citizens. As a new program there will be some start up difficulties.
Administration Budget 2004
• Contracts management,community prioritization and community Boards policy/development work is
expensive tasks and not covered in individual contracts and grants.
• The cost of the County Health Officer was moved from Administration to the programs that he is legally
responsible for.
Developmental Disabilities Budget 2004
• • There are no significant changes in the Developmental Disabilities 2004 budget.
NATURAL RESOURCES 2004 Budget Summary
•
Natural Resources Budget 2004
• The Natural Resources budget is FTE neutral from the 2003 budget-that is no FTE's were added,nor were
reduced. However,there were programmatic shifts that accommodated different projects and grants to fund
those projects. Changes include:
• Completion of Fish and Wildlife Habitat,Refugia,Site Hazard Assessment,Channel Migration Zone Study,
and services for WRIA 17 Planning
• Continuation of stream gauging
• Beginning stream flow measurements and habitat protection projects
• Depending on service demands and the availability of grant funding to help meet those demands,Natural
Resources may need to add FTE's on a project by project basis in 2004.
•
•
• Health & Human Services 2004 FTE by Revenue
GRANTS - 18.02 FTE
6.34
5.10 - - 18.02 ■FEES -8.52 FTE
❑OTHER-5.10 FTE
8.52 inOPERATING TRANSFER-
6.34 FTE
This chart identifies how revenue resources support our FTE's. Our FTE's continue to be
primarily supported by grant, fees, and other revenue. "Other"is compiled revenue such
as taxes,interfund charges, carry-forward, and miscellaneous revenue. Approximately
17%of operating transfer, 13%other revenue, 22%of fees, and 47% from grant revenue
cover our 2004 FTE's.
•
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Board of Health
New Business
Agenda Item # V., 2
• West Nile Virus on
the Move
August 21, 2003
•
• Washington State Department of
Health Ne
Release
For Immediate Release: August 14, 2003 (03-139)
Contacts: Donn Moyer, Communications Office 360-236-4076
Tim Church, Communications Office 360-236-4077
Laboratory tests indicate Yakima area man is probable first human case of
West Nile virus acquired in Washington state
Enhanced laboratory capacity produces more definitive test results
Yakima—Results of preliminary state Department of Health laboratory tests show a Yakima
County man in his 30s is very likely the state's first human case of West Nile virus (WNV)
infection. The case will be listed as "probable"until confirmatory testing can be performed at the
Centers for Disease Control and Prevention (CDC). The man was hospitalized when he first
became ill in early August and is now recovering.
The state health agency is working closely with the Yakima Health District to investigate the
• situation. The Department of Health's Public Health Laboratories recently expanded testing
capabilities and now has a test that can distinguish between recent WNV infection and one
caused by the St. Louis encephalitis virus. The Department of Health has also sent additional
samples to the CDC laboratories in Fort Collins, Colorado for confirmation.
"Most people with West Nile virus infection don't get sick, but in a small percent of people, it
can be very serious, even deadly," said Secretary of Health Mary Selecky. "Now that it appears
we have a human case, people need to be serious about preventing mosquito bites and reducing
the places where mosquitoes live around their homes."
According to Dr. Jo Hofmann, State Epidemiologist for Communicable Disease, "West Nile
virus has been moving west, and we certainly expected to see it here this summer. We've been
working with other agencies, veterinarians, and health care providers to identify human and horse
cases of WNV infection, and testing dead birds for infection. While it's important to remember
that West Nile virus is not spread from person-to-to-person, this case is a reminder of the
• importance of avoiding mosquito bites."
--More--
WNV-Washington's first suspected human case
August 14, 2003
Page 2
West Nile virus infection causes mild symptoms in about 20 percent of those infected,but most
people have no symptoms at all. Less than one percent of those infected will get seriously ill,
with encephalitis (brain inflammation), or meningitis (inflammation of the spinal cord and lining
of the brain). People over 50 are the most likely to have a serious infection. In May, preliminary
tests indicating a Franklin County resident had WNV infection,but that was ruled out and
additional testing is underway.
The Department of Health West Nile virus Web site(www.doh.wa.gov/WNV) and toll-free
phone line, 1-866-78VIRUS,provide information on avoiding the disease, including mosquito
bite prevention and mosquito breeding habitat reduction strategies. Information for health care
providers on recognition and reporting suspected human WNV infections is also available.
The state Department of Health and local health departments are working together on monitoring
and testing dead birds to detect West Nile virus and track the disease. The disease has been
growing rapidly in other states this year, though it still has not been detected in horses or dead
birds tested so far in Washington in 2003. The disease appeared in our state last year in two dead
birds and two horses. State and local health agencies also provide education on mosquito bite
prevention and reducing preferred mosquito-breeding sites around homes.
Mosquitoes carrying WNV can transmit the disease to people,horses and birds. The statewide
WNV project monitors all three groups. The Department of Health and local health partners are
sending select dead birds to the Washington Animal Disease Diagnostic Laboratory(WADDL)
for testing. Testing of sick horses suspected to have WNV infection is also being done at
WADDL this year.
Additional information about West Nile virus surveillance in the Yakima Health District is
available by calling 509-249-6541.
###
Visit the Washington Depaitment of Health Web site at http://www.doh.wa.gov for a healthy dose of information.
•
Washington State Department of Tough Questions and
t` Answers:
West Nile virus
What is West Nile virus?
West Nile virus (WNV) is a mosquito-borne disease that can cause illness in birds, horses and
humans. WNV is spread by the bite of an infected mosquito. The virus is not spread from
animal-to-person or person-to-person.
Who's at risk for West Nile virus?
Most mosquitoes are not infected with West Nile virus. The risk of getting sick from WNV is
very low—only one in 150 people bitten by an infected mosquito will become seriously ill. Age
is the biggest risk factor; while anyone can be affected, the vast majority of serious illnesses have
been in people over 50 years of age. You can minimize the risk to your family, horses, and pets
by preventing mosquito bites and reducing mosquito-breeding habitats around your home.
What is the risk to children?
Older adults are the most likely to have serious illness from West Nile virus. No children have
died from West Nile virus in the United States, however some young children have contracted
the illness. So,people of all ages should take precautions to prevent mosquito bites. If you use
repellant for your family, make sure it is suitable for children and follow the label instructions.
111 How can I protect my family from mosquito bites?
The best way to protect your family is to prevent mosquito bites and reduce mosquito-breeding
habitat around your home:
• Make sure window and door screens are "bug tight."Repair or replace if needed.
• Limit outdoor activity at dawn and dusk when mosquitoes are the most active.
• Wear a long sleeve shirt, long pants, and a hat when going into mosquito-infested
areas, such as wetlands or woods.
• Use a mosquito repellant containing DEET when necessary; always follow directions
on the label very carefully.
• Empty anything that holds standing water around your home—old tires, buckets,
plastic covers, cans,bottles and toys; dispose of those you do not need.
• Change water in birdbaths, fountains, wading pools and animal troughs twice a week.
• Make sure roof gutters drain properly; clean all clogged gutters in the spring and fall.
• Fix leaky outdoor faucets and sprinklers.
• Ornamental, self-contained ponds may be treated with larvicide to reduce mosquitoes.
Follow label instructions and make sure it is for home use.
• Contact the state Department of Ecology about working with local officials to address
other water bodies and before applying any pesticides.
1 don't like to use chemicals like DEET; can I use other repellents?
Some non-DEET repellents that are applied directly to skin may provide some short-term
• protection from mosquito bites. However, the Centers for Disease Control and Prevention (CDC)
does not recommend non-DEET repellents because studies have found that they do not offer the
same protection as repellents containing DEET. People should choose a repellent that they will
Page 1 of 1 Revised August 4,2003
use regularly and will provide enough protection for the amount of time that they will be
outdoors. Choose a repellent that clearly indicates on the label the length of time that a-single
application will give protection against mosquitoes. Be sure to use the repellent as directed. If
you are concerned about using DEET, ask your health care provider for advice.
What are the symptoms of West Nile virus infection?
Most people who are bitten by mosquitoes infected with West Nile virus do not have any
symptoms at all. Others experience very mild symptoms such as fever,headache,nausea and
fatigue that usually appear within 2-15 days after a bite by an infected mosquito. In a very small
number of cases (less than one percent)WNV infection can cause a severe illness known as West
Nile encephalitis—inflammation of the brain. The risk of severe infection is higher among
people age 50 and older. Symptoms of WNV encephalitis include high fever, severe headache,
and confusion, often accompanied by muscle weakness and nausea.
How is West Nile illness treated?
There is no specific treatment for West Nile virus illness. Patients with serious WNV illness may
be hospitalized and receive supportive care such as intravenous fluids, respiratory support, and
prevention of secondary infection. If you have West Nile virus symptoms you should consider
contacting your health care provider.
A mosquito has bitten me: Can I get tested for West Nile virus?
Most mosquitoes are not infected with West Nile virus. If you are bitten by a mosquito and have
no symptoms of illness, you do not need to be tested. If you feel ill or have health concerns,your
health care provider can help determine if a WNV test is needed. If you or a family member
develops severe symptoms such as high fever, confusion,muscle weakness and severe
headaches, you should see your health care provider immediately. •
Can I have the mosquito tested?
No. We are not testing individual mosquitoes for West Nile virus.
Is there a human vaccine for West Nile virus?
There is no human vaccine against West Nile virus. You do not need to be tested for WNV after
being bitten by mosquitoes unless you develop symptoms of WNV illness.
Can West Nile virus be spread by blood transfusion or organ donation?
Yes–although rare, WNV can be spread from blood,tissue or organs donated from a recently
infected person. The person does not need to be sick to spread the virus,but everyone with fever
and headache during the week before they donate blood,tissue, or an organ should wait to donate
until a later date.
What can be done to reduce the spread of West Nile virus by blood
transfusion?
In 2003, all blood banks will screen blood for WNV, and will not take donations from people
who had fever and headache in the week before donation. These screening tests are already in
place at most of Washington's blood banks. State and/or local public health agencies will notify
blood banks of any patient with WNV infection who received blood right before they got sick, or
about WNV infection in anyone who donated blood in the two weeks before they got sick. If S
someone becomes ill after a transfusion,blood banks will destroy the blood taken from the ill
donor. Prompt reporting of WNV infections will help identify and remove any potentially
Page 2 of 2 Revised August 4,2003
infected blood. Local, state and federal agencies will investigate WNV infections in people who
receive blood, tissue or organ donations to make sure these new screening methods are working.
More information is available on the Food and Drug Administration(FDA) WNV blood
. screening guidelines Web site(http://www.fda.gov/cber/gdlns/wnvguid.htm).
Should I stop donating blood?
No. You can't get WNV infection by giving blood. Blood saves lives and donating blood is safe.
Donors are always needed, especially during the summer months. We encourage all donors to
truthfully answer questions asked by the blood bank staff to make sure you are able to donate.
Should I avoid getting blood transfusions or organ transplants?
More than 4 million people receive blood products annually. The benefits of receiving needed
transfusions or transplants outweigh the small risk for WNV infection, but health care providers
and their patients who need transfusions or transplants should be aware of the small risk for
WNV infection.
If I recently had a transfusion or transplant, should I be worried about getting
West Nile virus?
You should be aware of the small risk for WNV infection and the need to monitor your health. If
you have symptoms of WNV or other health concerns you should contact your health care
provider. Many people had WNV infections from mosquito bites in the US in 2002, and some of
them also received transfusions and/or transplants. If a patient who recently received a blood
transfusion or an organ transplant develops WNV infection, it may not necessarily mean that the
blood or organ was the source of infection.
• Can West Nile virus be spread by breast-feeding?
WNV can be spread through breast milk. In 2002, a new mother got WNV infection from a
blood transfusion shortly after giving birth. She breastfed her infant, and three weeks later her
baby's blood tested positive for WNV. The child is healthy, and never had symptoms of WNV
infection.
Should I continue breast-feeding if I think I have West Nile virus infection?
Yes. The benefits of breast-feeding are well known and the risk for West Nile virus infection
through breast-feeding is unknown, so you should not stop if you are breast-feeding. The
American Academies of Pediatrics and Family Physicians recommend that infants be breastfed
for a year. Women who are breast-feeding and become ill or who are having difficulty breast-
feeding for any reason should consult their health care providers.
If I am breast-feeding, should I be tested for West Nile virus?
No. There is no need to be tested just because you are breast-feeding.
If I am breast-feeding, should I use insect repellent containing DEET?
Yes. Insect repellents help people reduce their exposure to mosquito bites that may carry
potentially serious viruses such as West Nile virus, and allow them to continue to play and work
outdoors. There are no reported side effects following use of repellents containing DEET in
pregnant or breast-feeding women.
110
Page 3 of 3 Revised August 4,2003
How do I find out if West Nile virus is in my community? What information
about positive West Nile virus tests will be publicly available?
The Department of Health West Nile virus Web site (http://www.doh.wa.gov/WNV) and the toll-
free information line (1-866-78VIRUS)will have the latest information on bird, horse, and •
human cases in the state.
Birds: Local health departments are gathering information about dead birds in their
communities. Some dead birds, such as crows and ravens, may be collected for
testing. The Department of Health West Nile virus surveillance program will track the
number and general location of dead birds that test positive for WNV.
Horses: The Washington State Department of Agriculture manages and monitors horse cases
through its reporting system. The state Department of Health will track the number
and county of horse cases.
Humans: If there are human cases of West Nile virus acquired in Washington, the state
Department of Health will track the patients. Limited information on the county of
residence, age-range, gender, and outcome will be reported.
What is the connection between dead birds and West Nile virus?
Dead birds are often the first sign that West Nile virus is in your area. Many species of birds in
the United States have been infected with West Nile virus and certain species—crows,jays,
ravens, magpies, hawks, and owls—appear to be the most likely to be infected. Testing dead
birds for West Nile virus infection can show if the virus is present in a community and can
provide an early warning for control and prevention efforts. If you find a dead bird, contact your
local health department for information on dead bird testing available in Washington. •
Will you be testing every dead bird found?
Testing will be performed on species most likely to have a West Nile virus infection (crows,
jays, ravens, magpies, hawks, and owls). Testing is most accurate in birds that have recently
died. State and local resources for bird testing are limited, so only a certain number of birds will
be tested in each area. If birds are already being tested in your community, the bird you find may
not be needed for testing. The dead bird can be safely thrown away in the trash, using gloves or a
plastic bag to cover your hands. Always wash your hands after touching live or dead animals.
Are my pet birds at risk?
There have been very few cases of indoor and outdoor pet birds being infected. Information on
the dangers of West Nile virus to pet birds is still very limited. However, bird owners can take
the following precautions:
• When possible,keep pet birds indoors behind good screens.
• Take steps to prevent exposure to mosquitoes.
• All pet bird owners should consult a veterinarian that deals frequently with avian
medicine for advice on West Nile virus.
Can West Nile virus cause illness in dogs, cats or other animals?
Birds and horses are the most likely animals to become ill with West Nile virus infection. Other
animals are at much lower risk of contracting WNV illness. Dogs and cats generally do not have •
any symptoms after being bitten by mosquitoes infected with WNV. There is a West Nile virus
Page 4 of 4 Revised August 4,2003
vaccine that is licensed for use in horses; there is no specific treatment or vaccination for WNV
infection in other animals.
• What is going happen to this year with West Nile virus in Washington?
This is difficult to project. Based on the experience of other states, once WNV has been detected
in a state it is likely to expand its range and have a broader impact in that state the following
year. In 2002, there were four cases of positive WNV tests in animals in Washington—two in
horses and two in dead birds. It seems likely that there will be additional horse and dead bird
cases this year, and perhaps some human cases.
Is there a public health plan to address West Nile virus?
The state Department of Health has developed a comprehensive mosquito-borne disease
response plan(www.doh.wa.gov/ehp/ts/Zoo/WNV/WAArboviralRespPlan.pdf) that addresses
West Nile virus. This plan takes a three-pronged approach to mosquito-borne illnesses:
prevention, surveillance and control. The Department of Health is working closely with other
state agencies, local health departments, and other local authorities to plan for and respond to this
year's mosquito season. Two important parts of the response plan are tracking the spread of
WNV in the state and providing the latest information to our partners and the public. Local plans
have been adjusted to meet local needs, resources and capabilities.
What is being done in Washington to prepare for West Nile virus?
The Department of Health is coordinating activities with other state agencies, federal agencies,
local partners, tribes, the University of Washington, and Washington State University to provide
early detection of West Nile virus. Testing dead birds for WNV is a useful surveillance tool.
Identifying mosquito species helps focus prevention and control programs. Local health
• departments are gathering information about dead birds, and some species of dead birds such as
crows and ravens may be collected for WNV testing. Some communities may choose mosquito
control to reduce mosquito populations. Educational materials are being distributed to
Washington health care providers, and are available to the public on the Department of Health
West Nile virus Web site (http://www.doh.wa.gov/WNV). The agency's Public Health
Laboratories will be accepting specimens for suspected human cases of WNV infection.
What happens once West Nile virus is found in Washington state?
The Department of Health has been working on education and prevention strategies, including a
streamlined permit process for certain mosquito control activities. The agency will track West
Nile virus in the state and will offer to assist local health departments with case investigations,
laboratory testing, and mosquito control and prevention strategies for their communities. The
state Department of Health West Nile virus Web site (http://www.doh.wa.gov/WNV)will be
updated regularly with the number of West Nile virus cases in humans, horses and dead birds.
The agency also provides a WNV toll-free information line(1-866-78VIRUS).
I've eliminated mosquito-breeding habitat around my house, but my neighbor
is doing nothing. What can .I do?
You can educate your neighbors and coordinate efforts to address mosquito-breeding habitat in
your area. You may also contact your local health, public works or code enforcement offices to
help address the issue of standing water. Information on how to create a mosquito control district
• in your area is available from the Department of Ecology. Meanwhile, you can still reduce your
chance of exposure to West Nile virus by following mosquito bite prevention precautions.
Page 5 of 5 Revised August 4,2003
Why doesn't the state just use pesticides to wipe out mosquito populations?
It is not possible to eliminate mosquitoes,but local measures to reduce mosquito populations
may be taken as needed in some communities. Local authorities and other landowners may use
the Department of Health's streamlined permit process to use aquatic larvicide in certain •
mosquito habitats. Larvicides are the preferred and most effective method of biological and
chemical control for mosquitoes because they destroy the mosquito larvae in water before they
mature and begin flying. The Departments of Agriculture and Ecology regulate the use of
pesticides on and around water bodies.
Will I be informed about the use of pesticides in my neighborhood?
The use of pesticides will be decided upon at a local level. Contact local officials to see if
pesticides will be used in your neighborhood.
What is the state doing about West Nile virus on state-owned lands?
The Department of Health is working with other state agencies to coordinate mosquito control
strategies. Contact the state agency that owns the property regarding mosquito control plans.
Why doesn't the government just declare a West Nile virus emergency?
The state Departments of Health, Agriculture, Ecology and Fish and Wildlife are working with
other agencies to identify the circumstances under which an emergency may be declared should
that become necessary. Local health officials may declare emergencies and request help from the
state or neighboring counties if their health systems become overloaded.
Why hasn't government done more to prevent West Nile virus from coming?
West Nile virus is a naturally occurring disease that does not stop at state boundaries and cannot •
be completely eradicated. There are multiple environmental factors contributing to the spread of
WNV throughout the United States. The state has taken several measures to prepare for WNV:
• Developed a mosquito-borne illness plan, including statewide dead bird surveillance.
• Coordinated habitat reduction and mosquito control strategies, including a streamlined
permit process for aquatic larvicide application.
• Promoted horse vaccination.
• Produced educational materials, including brochures, Web page and a toll-free info line.
• Coordinated the efforts of multiple federal, state and local agencies.
• Implemented in-state horse and dead bird testing procedures.
At what point will the state get involved with local mosquito control efforts?
The state Department of Health is working closely with state and local agencies on mosquito
control strategies, and has provided a streamlined permit process to address mosquito larva
within their jurisdiction. The state Department of Health is not planning to apply any pesticides.
Where can I get the most up-to-date information on the number of West Nile
virus infections in Washington state?
The state Department of Health West Nile virus Web site (http://www.doh.wa.gov/WNV)will be
updated regularly with information on the number of human,horse, and dead bird cases in our
state. You may also call our WNV toll-free information line(1-866-78VIRUS).
•
Page 6 of 6 Revised August 4,2003
• de
1Nashrngtnn State DeParhnent of
Health
Volume 1. Issue 10 August 14, 2003
This is an electronic publication designed to keep you informed on issues of interest related to
West Nile virus (WNV) in Washington, and provide current information to assist you in
developing a response plan to WNV in your jurisdiction.
Latest News _.
Yakima—Results of preliminary state Department of Health laboratory tests show a 36 year-
old Yakima County man is very likely the state's first human case of WNV infection. The case
will be listed as "probable"until confirmatory testing can be performed at the Centers for
Disease Control and Prevention (CDC). The man was hospitalized when he first became ill in
early August, and is now recovering.
• Surveillance News
Surveillance Activity in Washington
In Washington, local health jurisdictions and volunteers have submitted 606 birds for WNV
testing this year. All have been negative for the virus. In addition, 34 horses from 18 counties
have been tested with no positive findings. The Department of Health(DOH) is also preparing
to initiate some limited testing of mosquito pools in September focusing on Culex tarsalis and
Culex pipiens.
As of August 11, local health jurisdictions and DOH Communicable Disease Epidemiology have
investigated at least 32 suspected cases of human WNV. Twenty-eight cases have been ruled out
as WNV infections by testing at the DOH Public Health Laboratories, and four cases have tests
results that are pending
National Surveillance Activity
The following information summarizes WNV surveillance data reported to CDC through the
national reporting system (ArboNET)as of August 13, 2003.
During the week of July 31-August 6, 109 human cases of WNV infection were reported from 13
states (Colorado, Iowa, Kansas, Kentucky, Louisiana, Minnesota, Mississippi, Nebraska,New
Mexico,North Dakota, Ohio, South Dakota, and Texas), including four fatal cases from three
states (Alabama, Colorado, and Texas). During the same period, WNV infections were reported
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in 622 dead birds, 191 horses, one dog, four unidentified animal species, and 359 mosquito
pools. • _
During 2003, a total of 393 human cases of WNV infection have been reported from Colorado
(195), South Dakota(51),Texas (39),Louisiana(21), Mississippi (14),Pennsylvania(12),
Alabama(10), Ohio (7), Minnesota(7),Nebraska(6),North Dakota(6), Florida(4), Iowa(4),
Kentucky(3),New Mexico (3), Wyoming(3), Kansas (1), Oklahoma(2), Arkansas (1), Georgia
(1), Missouri (1), South Carolina(1) and Wisconsin(1). Of the 393 cases, nine fatal cases were
reported from Alabama(2), Colorado(5), and Texas (2). Among 150 cases for which
demographic data were available, 81 (54%) occurred among men;the median age 45 years
(range: 17 months--87 years). Additional information about nationwide WNV activity is
available from CDC at http://www.cdc.gov/ncidod/dvbid/westnile/index.htm and
http://www.nwhc.usgs.gov/research/west nile/west nile.html.
Local Health Focus — Thurston County Public Health
Submitted by L. Darrell Cochran, Thurston County Public Health
The Thurston County Health Department has developed a WNV response plan that is modeled
after the Washington State Mosquito-Borne Disease Response Plan. However,the phased
response section has changed to fit the county's own coordinated response. The plan has three
key components: 1)public information, 2) surveillance, and 3) control. These strategies are
designed to promote public cooperation and personal responsibility in reducing man-made
mosquito habitat and using personal protection. The plan encourages the cooperation and
assistance of the public, other local, state, and federal government agencies,veterinarians, and
physicians in WNV surveillance to implement control measures using an integrated pest •
management approach. Under the plan, control is used only when the highest risk category is
confirmed.
The public education campaign started in the spring with local television shows explaining the
disease transmission and control measures for WNV and providing information resources for
both the public and governmental agencies that wish to pursue aquatic mosquito control. WNV
brochures were obtained from DOH and provided to local city and county agencies for
distribution to their employees and the general public.The Thurston County Web site,
www.co.thurston.wa.us/health/welcome.html, also provides information of WNV and provides
links to other important resources.
The Thurston County response plan places a weighted effort on dead bird surveillance as a
disease identification strategy. To enhance the effort, a WNV dead bird response line was set-up
for the public to report bird deaths. A digital mapping system was also developed to track and
analyze the dead bird data reported to the county. A local agreement between Animal Services
and the county was established to assist in the pickup, delivery, and storage of dead birds prior to
shipment to Washington State University for testing. To date,we have received 184 dead bird
reports and have shipped 43 for testing.
In June, county staff participated in mosquito surveillance training provided by federal mosquito
experts at Ft. Lewis,to help enhance the county's ability to identify problem areas. The county
is assessing some of the county owned storm water facilities for mosquito identification in
preparation for aquatic mosquito control if it becomes necessary.
• WNV surveillance linkages were also established with the medical community and local
veterinarians through the health officer, Dr. Diana Yu. The contacts in both fields are designed
to provide critical information that will help guide the application of the Thurston County
response plan.
If you want additional information about the program please contact L. Darrell Cochran at(360)
754-3355 x 7524 or e-mail at cochrad@co.thurston.wa.us.
Communicable Disease Epidemiology Update
West Nile Virus and Blood Banks—Reporting in Washington
During 2002, WNV infection was detected among people who had recently received blood
transfusions. Investigations found that infected blood donors with no symptoms had spread the
virus. To protect the blood supply, new tests(nucleic acid amplification tests [NAATs])have
been developed for blood banks to screen donated blood for WNV. These tests are not yet
licensed and are being used on an investigational basis, so how well they detect WNV infection
is not yet known. However, a number of sites across the US have already seen test results that
were falsely positive, so the results of NAATs are considered preliminary. Confirmation of
WNV infection requires testing of the donor's serum for WNV antibody, and donors who are
reactive by NAAT will be asked by blood banks to return for serologic testing.
FDA and CDC recommend that blood banks: 1) screen potential donors for symptoms of illness;
2)provide information to donors encouraging them to report unexplained illness with fever,
• headache, or other symptoms of WNV infection that occur within one week of their donation;
and 3) quarantine potentially infectious blood when appropriate.
CDC also drafted recommendations to assure that blood banks and public health departments
notify each other of potential infection in donors or recipients that would warrant follow-up. In
response, Office of Communicable Disease Epidemiology(CD Epi)has contacted the four
largest blood banks in Washington (Puget Sound Blood Center, Cascade Regional Blood Center,
Inland Northwest Blood Center, and Pacific Northwest Region American Red Cross). They have
agreed to report the following information (at a minimum)to CD Epi when they identify a donor
with WNV infection by NAAT: 1) donor's age or date of birth, gender, and zip code; 2)date of
donation; 3) test results to date; 4)travel history in the two weeks before reactive test result.
In turn, CD Epi will notify local health jurisdictions if any of their residents identified by blood
banks as having WNV infection. CD Epi will notify blood banks of any Washington donor
reported as having confirmed WNV infection who gave blood within 28 days before the onset of
their illness. If you are contacted by a blood bank regarding a donor with WNV infection, please
report the result to CD Epi so we can coordinate our interpretation of the results and the planned
response.
More information about blood safety and WNV is available at:
http://www.fda.gov/oc/opacom/hottopics/westnile.html
http://www.cdc.gov/ncidod/dvbid/westnile/index.htm
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Mosquito Focus — Aedes cinereus
species that can be found in a wide range •
Aedes cinereus is an opportunistic of larval habitats but
prefers woodland and open meadow pools. It can be found in transient water situations,
including floodwater areas and cattail swamps. Larvae are present in early spring at lower
elevations through late June at higher elevations. Larvae are quite small compared to other
species and tend to aggregate within dense stands of aquatic vegetation. Dipping close to
emergent vegetation enhances the chances of collecting this species.
The greatest number of adults usually occurs in spring at higher elevations,however,they can re-
appear in late summer depending on weather and water availability. In some mountain areas it is
the dominant species and a serious pest. The species has a short flight range and adults rest near
the ground in grass or underbrush near their breeding location. Aedes cinereus is an aggressive
biter that will bite anytime during the day. It is known as an ankle biter as it usually focuses
feeding activity toward the lower extremities. The species is common in Washington and one of
the species from which WNV has been isolated in other states.
Colorado Cases Increasing
WNV is hitting Colorado harder than other states so far this year. For this year the state health
department is reporting 154 cases and four deaths as of August 7. Viral activity is heaviest
around areas of irrigated farmland and river valleys. Culex tarsalis,the mosquito identified with
the highest number of virus-positive pools in Colorado, is wide spread in Washington. For more
information about WNV in Colorado go to •
www.cdphe.state.co.us/dc/zoonosis/wnv/wnvhom.html. The June 5, 2003 issue of the WNV
Newsletter www.doh.wa.gov/ehp/ts/Zoo/WNV/Newsletters/June503.pdf has information on
Culex tarsalis.
CDC Emphasizes Prevention and Control
The following is excerpted from an August 8,2003 New York Times article entitled "WEST
NILE MOVING FASTER AND WIDER"by Andrew C. Revkin:
The outbreak of West Nile virus infection this summer is more broadly dispersed and
accelerating earlier than it did last year, making it vital that more communities work to prevent
mosquitoes from biting and breeding, federal health officials said yesterday.
The officials focused their message on states that are experiencing big outbreaks for the first time
like Colorado and states like New York that had past outbreaks but have seen no illness so far in
2003.
"The time for people to really be conscientious about taking the steps necessary to protect
themselves from mosquito bites is right now, Dr. Julie L. Gerberding, Director of the Centers
for Disease Control and Prevention, said at a news conference in Atlanta.
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The big pulse of infections is yet to occur, she said, urging communities and individuals to use
insect repellants containing DEET, remove standing water, repair screens, and try to stop all
41 other contact between people and mosquitoes.
Communities should generally understand that methods to prevent the infection, particularly in
the most vulnerable population, the elderly, "are straightforward stuff," said the New York City
health commissioner, Dr. Thomas R. Frieden.
Municipalities would do well to use larvicides that prevent new generations of mosquitoes, he
added, saying extensive spreading of a natural product, a bacterium that kills just mosquito
larvae, had greatly reduced mosquito numbers around New York.
West Nile Research
Scientists and health experts at the National Institute of Allergy and Infectious Diseases
(NIAID), along with public health officials, have enhanced research on WNV. The effort is part
of NIAID's comprehensive emerging infectious disease program, which supports research on
bacterial, viral and other types of disease-causing microbes. Research is underway to develop a
vaccine, antiviral medicines, and new diagnostic tests for WNV. Additionally, basic research is
providing new clues about the virus itself,the disease in humans and animals, and how the virus
is maintained in the environment. This knowledge is essential to developing prevention,
treatment and control strategies. For a more detailed description of research projects go to:
www.niaid.nih.gov/factsheets/westnile.htm.
• Multilan ua a West Nile Information
g 9
CDC's West Nile website www.cdc.gov/ncidod/dvbid/westnile/index.htm has links to public
information about WNV in Spanish, French, Chinese and Vietnamese.
Article Submission
We are interested in receiving articles for future publications of the WNV newsletter. Please
submit articles to Jack Lilja,jack.lilja@doh.wa.gov.
Community Comments
Let us hear your comments on this newsletter, your needs, or things you would like to see, by
sending them to Maryanne Guichard, (360) 236-3391 or maryanne.guichard@doh.wa.gov.
WNV Web Resources
Washington State Department of Health www.doh.wa.gov/wnv
Center for Disease Control http://www.cdc.gov/ncidod/dvbid/westnile/
Washington State University Cooperative Extention http://wnv.wsu.edu/
Cornell University, Center for Environment http://www.cfe.cornell.edu/erap/WNV
DOH Contact List for West Nile Virus
General Public Toll-Free Hotline 1-866-78VIRUS
Publications: Brochures/Response Plan/Fact Sheets
Laura Harper, (360)236-3380, or laura.harper@doh.wa.gov.
Surveillance: Mosquito
Jo Marie Brauner, (360) 236-3064, or jomarie.brauner@doh.wa.gov.
Surveillance: Dead bird surveillance and general WNV response
Tom Gibbs, (360) 236-3060, or tom.gibbs@doh.wa.gov.
Surveillance: Horses,case reporting,laboratory assistance
Dr. John Grendon, (360)236-3362, or john.grendon(a�doh.wa.gov.
NPDES: Training,technical assistance
Ben Hamilton, (360)236-3364, or benjamin.hamilton@doh.wa.gov.
WNV in Humans: Clinical information,case reporting,and laboratory testing
Call your local health jurisdiction or DOH Communicable Disease Epidemiology,
(206) 361-2914 or(877) 539-4344.
Assistance with news releases and media response
Donn Moyer, (360) 236-4076, or donn.moyer@doh.wa.gov. •
Tim Church, (360) 236-4077, or tim.church@doh.wa.gov.
WNV Program Management
Maryanne Guichard, (360) 236-3391, or maiyanne.guichardAdoh.wa.gov.
WNV Coordinator
Jack Lilja, (360) 236-3366, or jack.lilja@doh.wa.gov.
To subscribe to this newsletter
Jill Christensen, (360) 236-3000, or jill.christensen@doh.wa.gov.
Guidelines for a Phased Response
The following response categories have been developed for use during the active
mosquito season, generally April through October in Washington. The categories are
intended to be applied at the county level rather than statewide. If applicable, areas
within counties can be in different categories based on surveillance activity, geography,
known mosquito habitat, population centers, etc. It is important to remember that new
mosquito habitat is created regularly through development, farming practices, flooding,
etc. Periodic county-wide assessments should be undertaken to identify new mosquito
habitat and implement surveillance if necessary.
During the time of year when adult mosquitoes are generally not active, usually from
November through March, activities can be undertaken to prepare for the next mosquito
season. This may include development of state and local plans, training of staff involved
in surveillance and response, inventory and mapping of known mosquito habitat, and
development of community outreach and education programs. Mosquito habitat
reduction around homes should also be encouraged year around to reduce the number
of overwintering mosquitoes.
Alert Level 1
Definition: Areas with no positive surveillance findings or cases in humans or horses
indicating epizootic arbovirus activity in the current calendar year.
Recommended Response: Inventory and map new mosquito habitat; conduct
mosquito and dead bird surveillance; monitor and map surveillance findings; conduct
passive human case surveillance and horse case surveillance; provide information to
health care providers regarding recognition, diagnosis, laboratory testing, and reporting
of arbovirus infection, public education emphasizing source reduction; encourage
reporting of mosquito activity; consider use of larvicides at specific sources identified as
having potential vector species and where larval counts meet or exceed an established
level.*
Alert Level 2
Definition: Areas with confirmation of arbovirus activity in wild birds or in sentinel flocks
and/or mosquito pools if used as surveillance tools.
Recommended Response: Conduct surveillance in areas of positive findings to
identify possible sources and mosquito species; expand surveillance in adjacent areas;
expand larval control, including adjacent areas; provide information to health care
providers regarding local arbovirus activity and suggest increased vigilance for human
cases; increase public education emphasizing personal protection, particularly for
persons over 50 years of age. •
Alert Level 3
Definition: Initial confirmation of horse or human cases and/or multiple positive birds,
and/or multiple positive sentinel flocks and/or mosquito pools if used as surveillance
tools.
Recommended Response: Investigate cases; expand surveillance as necessary;
provide regular updates to health care providers regarding arbovirus activity and human
cases; encourage vigilance for cases in persons who may have received or donated
blood products or organs (CDC guidelines); expand public information to include TV,
radio and newspapers emphasizing personal protection, particularly for persons over 50
years of age, use of repellents, source reduction and risk communication about adult
mosquito control.
Alert Level 4
Definition: Surveillance indicates an escalating epizootic in horses and birds and
multiple human cases likely to have been acquired locally due to a high level of
arbovirus activity; abundant adult vectors; conditions favoring continued transmission to r
humans.
Recommended Response: Continue public information focused on personal protection
and persons over 50 years of age; provide regular updates to health care providers
regarding arbovirus activity and human cases; consider active surveillance for
encephalitis and /or aseptic meningitis; continue larval control and consider adult
mosquito control targeted at areas of potential human risk if surveillance indicates the
risk is likely to increase and vector species are abundant.** If feasible, monitor
effectiveness of spraying on target mosquito populations if adulticides are used.
* Larval counts used to trigger control range from 0.3 larvae per dip to 5 per dip. Each jurisdiction should
establish their own trigger level based on experience or consultation with mosquito control personnel.
**In general, the finding of a positive bird or mosquito pool does not by itself constitute evidence of an
imminent threat to human health and warrant mosquito adulticiding. Adulticiding should be considered
only after careful evaluation of the risk to human health by taking into account multiple factors including:
• documentation of the presence of arboviruses in the area
• the abundance and species of the mosquito populations
• the density and proximity of human populations
•
• the time of year and weather conditions
• accessibility to the area where the vector is located
• rapidity of the response required as determined by the seriousness of the public health threat •
• the potential impact on people and the environment.
•
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•
Board of Health
New Business
Agenda Item # V., 4
•
Multi-county Communicable
Disease Cross Coverage
August 21, 2003
•
• RESOLUTION OF THE BOARD OF HEALTH
RESOLUTION NUMBER
RESOLUTION SUBJECT: PROVIDING FOR TEMPORARY LOCAL
HEALTH OFFICER COVERAGE
WHEREAS,Dr. is currently appointed by the (County/District) Board
of Health as the duly appointed local health officer for(County/District)pursuant to
RCW 70.05.050, and
WHEREAS, the Board of Health judges that it is in the best interest of(County/District)
to ensure continuous health officer coverage in the temporary absence of the local health
officer; and
WHEREAS, the Board of Health desires to allow for temporary local health officer
coverage for(County/District)when needed, and
WHEREAS, (County/District) is authorized under RCW 39.34 (Interlocal Cooperation
Act) to enter into an Interlocal Agreement with other local government jurisdictions, and
WHEREAS, the duly appointed local health officers in(Counties/Districts involved)
meet the statutory qualifications of RCW 70.04,
1110
NOW, THEREFORE, be it resolved by the Board of Health ofCount /District
( Y ) as
follows:
The (County/District Official) is authorized to enter into an Interlocal Agreement with
(Counties/Districts) to provide temporary health officer coverage as needed for periods
caused by a work-connected out-of-state travel, vacation, prolonged illness, or other
excused absence of the (County/District) health officer. This appointment can occur
without the need for further Board of Health confirmation. Provided, that if the
temporary coverage is to last (number) consecutive weeks or more then Board of Health
confirmation of the appointment shall be required.
ADOPTED this day of ,
•
Board of Health
Activity Update
Agenda Item # VI., 1
•
Survey
August 21, 2003
•
Board of Health
Media Report
•
August 21, 2003
f
• Jefferson County Health and Human Services
JULY— AUGUST 2003
NEWS ARTICLES
1. "Head off pollution,official urges",Peninsula Daily News,July 15, 2003
2. "County benefits making budget 'a train wreck',PT LEADER,July 16,2003
3. "New program targets cancer prevention for county women",PT LEADER,
July 23, 2003
4. "County pursues water quality issue",PT LEADER,July 23, 2003
5. "Quil Teen Center warmly reopens",PT LEADER,July 23,2003
6. "Certificate fees rise to $17 each",Peninsula Daily News,July 27, 2003
7. "Troubling trends: Eighth-graders have higher use of drugs,alcohol...."
(2 pages), PT LEADER, July 30,2003
• 8. "High toxin levels found in Discovery Bay shellfish",PT LEADER,July 30,2003
9. "Breastfeeding week events planned",Peninsula Daily News, July 30, 2003
10. "World Breastfeeding Week" announcement,PT LEADER,July 30, 2003
11. "Mother Nature: breastfeeding's importance",Point of View,Peninsula Daily News
August 5, 2003
12. "Health official receives honor from state",Peninsula Daily News,August 5,2003
13. "Immunization refusal limited",PT LEADER,August 6,2003
14. "Volunteers sought for county Big Brothers Big Sisters",PT LEADER,August 6, 2003
15. "Poll shows Jefferson views on. . .",Peninsula Daily News,August 10,2003
16. "Advisers sought for disabilities grant",PT LEADER,August 13,2003
17. "New family resource center ready to open on Aug.21",PT LEADER,August 13, 2003
•
•
Head o ollution official urges
Jefferson commissioner But he wants county officials to area to commercial shellfishing.
move quickly to make sure a sus- • "We don't want a closure," Hunt-
Wants action on possible pected problem doesn't becozlie ingford•told county officials during a
shellfish contamination wors •
e. Monday commissioners meeting.
Last week, state Department- of A closure, according to Hunting-
BY JIM MANDERS Health officials included a small por- ford, could lead to forced designation
PENINSULA DAILY NEWS tion of the bay, just off lower:Port of a shellfish protection district and
Hadlock, on a list of 20 areas where assessment of additional taxes to help
County Commissioner Glen Hunt- shellfishing is threatened. . pay the cost of eliminating the pollu-
ingford, R-Chimacum, isn't positive Increased pollution, measured by tion.
shellfish in south Port Townsend Bay the amount of bacteria In the water,
are threatened by pollution. could cause state officials to close the r • TURN'ro WAl h xIA2
•
Water: Higher bacteria counts in summer •
CONTINUED FROM Al could come from a higher num- reading when you dipped miles of Center Road in the the Upper Hoh River were
ber of boats being moored in (water) with your right hand southern part of the county. opened.
The pollution problem in the area where the tests were and another with your left," Lakeside Industries of Port Adelman Logging of Port
Port Townsend Bay appears to conducted. Huntingford said." Angeles bid $446,005 on the Angeles had the low bid of
be limited to one testing sta- Huntingford questioned the Pollution isn't a threat at project. The bid is about $494,750, about $10,000 more
tion, according to David Chris- numbers indicating pollution any other commercial shellfish $93,000 higher than estimated than the engineering bid.
tensen, manager of the Jeffer- used in the test, saying they areas in Jefferson County, and by engineers. D&H Enterprises of Forks
son County Department of Nat- were far different from the Huntingford said there had ■ Asked Public Works to was second at $536,766 while
ural Resources. range he'd previously heard been `few closures::;.;in the make a recommendation after Rogland's Inc.of Aberdeen bid
being used to determine pollu- county's history three bids to build log jams on $733,100.
Summer bacteria counts tion in salt water. In other business Monday,
Christensen and County He also questioned the accu- the commissioners:
Environmental Health Director racy of the test, based on the ■ Approved listing eight
Fa said the are encour- fact that the amount of P0llu- changes to the Comprehensivey y y tion was at the lower end of the plan suggested by the planning
aged that the higher bacteria threshold.
counts were found during sum- Commission and planning staff
he
mer months, which means the Inexact science All eight will be ss aub)ect of
a Planning Commission public
one source rather than many. Huntingford,who previously hearing before coming back to
High bacteria counts during worked with the Jefferson Con- the county commissioners for a
winter months would indicate servation District; said water- final decision late in the year.
widespread sources,they said. quality testing is often an inex- ■ Ordered Public Works
Fay said the monitoring sta- act science. staff to study the lone bid on a
tion, which is located near the "I remember getting one project to add aaoverlay to 2,5'
shore in the area where the " 1`"`4 '
•
Wooden Boat Foundation has
moorage, showed a bacteria
reading at the threshold for
inclusion on the state's list of
threatened sites. •
County and state officials ._
plan a check of the area later
this month to see if they can •
locate the cause of the pollu-
tion,according to Fay. 111
"I don't know if there's an
old septic or a stormwater out- /— r 5
fall in the area,"Fay said. l
The increased pollution ;� 1)l.,
County benef•
•
its
•
. making budget
` a train wreck'
By Barney Burke 2004. Goldsmith said he plans
Leader Staff Writer to renegotiate that contract at
that time,and if not,the county
Like many other county gov- .would be unable to offer the
emments in Washington state, current level of health insur-
Jefferson County is facing a ance coverage.
downward trend in revenues and The recent increase works out
• increasing cost for its number to 77 cents per hour per em-
• one budget item: labor. ployee. According to the con-
"Salaries are growing faster tract, the increase in healthcare
than revenues," Commissioner costs is to trigger a new split in
Dan Titterness observed July 7 employer/employee shares of
as County Administrator David healthcare benefits,dropping the
Goldsmith summarized his ef- employer contribution from 90
forts to hold down healthcare percent to 85 percent.
costs for county employees. But county employees, who •
County government is one of took a 4 percent pay cut last year,
the largest local employers, so showed up at the board of corn-
staffing and financial changes missioners meeting July 7 to ex-
can be significant for the local press'concern over how the cost
economy. is affecting their families.
• The county had budgeted "We're going backwards,"
$229,000 for an increase in medi- said employee Patsy Caldwell.
. cal insurance premiums and a She asked whether management
cost of living allowance for 2003, was being affected in the same
Goldsmith said. However, the way. Goldsmith answered that
• jump,in healthcare costs alone is managers' share of healthcare
now estimated to be$286,000. benefits would increase by the
"Suucturallv. we're going to same proportion.
run Into a tram 'wrec 'nem' I oon't see tits getting a lot
Goldsmith continued,noting that better soon,"Commissioner Glen .
next year's situation should be Huntingford predicted. "We
even more difficult. He said that don't want good employees to.
- he has tried to-get other bids for leave,"he said,but the county is
• the employee group, but so far having to choose between keep-
has found no takers. ing.everyone working or cutting
The cost of healthcare is about the workforce.
$10,000 per employee per year, Tittemess noted tl;,at the com-
e Goldsmith said. Nonetheless, missioners'salaries were also cut
"We don't recommend dropping in 2002, but everyone's pay cut •
family coverage." was fully restored in January.He
The county's major bargain- noted that while other nearby
ing unit, represented by the re- counties lost an estimated 30 to .
tail clerks union, has a contract 100 employees,Jefferson County
that is set to expire in summer didn't lay off anyone last year. •
• •
y_
3
•
- Wednesday,July 23,20030
New program targets
cancer
preventionfor .county
women
Reserve now for free exam Sept. 20 in Quilcene
By Beth Cahape county women's organizations, risk for breast.cancer, Stelow well as volunteers from the Dosey
Special to the Leader "This all started with the Do said.
Dux and other women's organize.
Your Dream Day last October," Boyd sees this as an opportu- tions,have signed on to promote;
Women's cancers that are said Stelow, who is a Port nity to increase services available staff,and do follow-up assistance
found early are cancers that can Townsend Realtor.At that one-day .to the women of South Jefferson for those women who receive ex,
be successfully treated. That's event,Jefferson Soroptimists of- County.
the message that a new ams.In fact,they have organized
g group of fered county women the opportu-. `Typically, many health ser- cancer training for volunteers
women and healthcare providers nity to define and help realize their vices are clustered in larger towns, through Seattle's Fred Hutchinson
are promoting in South Jefferson dream of,for example,going back and Jefferson County is no excep- . Cancer Information Service.
County. to school or starting a business. tion,"said Boyd."The health de- "We'll learn not only how td
To help get that message out, "I stood up there on that day partment would like to help walk these women through the
they have organized the first of and told people that my dream 'women in underserved areas—and screening process, but if there
many events that will offer free was to do breast cancer educa- for Jefferson County that means needs to be medical follow-u
mammograms,pelvic exams and tion for the women in Jefferson outside of Port Townsend—gain some individuals, we'll0
bone density tests. The first of County,"she said."And the next access to these services."She and them a variety of types of sups
these events will be at the Monday,Margie came into my the health department will use port, both emotional and physis
Quilcene Fair on Sept. 20. office and said 'Hi! I'm here to funds from the BCHP as well as a cal," said Stelow. "We plan to
Women are strongly encouraged help you do your dream.'Then grant from the Susan G. Komen train these helpers so that they
to call the health department and she proceeds to lay on me all this Breast Cancer Foundation to bring can respond intelligently to the
reserve a slot now. information about the Breast and in a mobile mammogram unit fear that someone has." .
This project is the brainchild of Cervical Health Program from Swedish Medieal Center's To schedule a free mammo-
two local women—public health (BCHP), which is a state pro- Comprehensive Breast Center. gram or pelvic exam on Sept.20;
nurse Margie.Boyd and Nancy gram offering mammograms and Health department personnel also please call health department
Stelow, a Soroptimist and survi-, women's health exams to,low- will offer pelvic exams, and the BCHP screening coordinator
vor of breast cancer. The project income,underinsured or non-in- South County Medical Clinic staff Jennifer Doyle at 385-9423. Td
includes not only the Jefferson sured women between the ages has arranged for free bone density learn more about the soutlj
County Health Department and of 40 and 64." testing.
the East Jefferson Count This is a county women's group,or to vol4
County population of women Stelow and the Soroptimists,as unteer,call Stelow at 379-9236;
Soroptirnists,but the South County that tend to be underserved and,
Medical Clinic and many south because of their age,are most at
•
bounty pursues water quality issu
By Erica Dirksen Division. But he is concerned which is averaged over the last Christensen, Larry Fay, the
Leader Staff Writer with the cause of the high level five years. - county's Environmental Health
of fecal coliform found in the There could be many causes director, and county Board of
The fecal coliform"warning" water there, usually in the sum- for the peaks in the samples Health personnel are planning a
for a section of Port Townsend mer months. taken,Christensen said. It could walking tour of Lower Hadlock
Bay off Lower Hadlock is just The samples,taken about six be the result of a recent hot next week.They are looking for
that — a warning, the Jefferson times a year, reflect the water sample;for example,a ship could any obvious problems and for
County commissioners were told quality of the particular day,not have just dumped sewage or a potential sources of fecal
again Monday. necessarily the water quality in family of whales could have coliform.
The threatened listing off general. passed through. But it could be The Washington Department
Lower Hadlock does not pose an Generally the water quality is the result of something more per- of Health has regular ambient
immediate threat of closure for good,but almost every year there manent,such as a septic tank or monitoring. In Lower Hadlock,
commercial shellfishing, said are a few peaks in fecal coliform stormwater runoff, Christensen the state takes samples about six
David Christensen, manager of found in the water off Lower explained. • times a year and has done so for
the county's Natural Resource Hadlock. In 1999 and 2000,the Although the warning for more than 10 years.The samples
summer month peaks were larger closure to commercial shell- show the concentration level of
than other years; 2001 showed fishing could be the outcome, fecal coliform, which results
small peaks.The effect of these Christensen is concerned with from boat wastewater, upland
above-average samples is still what caused the peaks in poor septic systems, stormwater run-
reflected in the current data, water quality. off and seawater mammals.
•
lT LE/3d)CR---
7- z —o3
•
•
Quit Teen Center
warmly reopens
•
By Caryl Delaney "At any point he[Sandy]could have
Special to the Leader said he had had enough, but he kept
hanging in there,"Anderson added.
After a six-month period of obstaclesThe kick-off event included the board
and permit problems,the Quilcene Teen of directors,musician and teen advocate
Center had its official grand reopening Andy Mackie,Jefferson County Supe-
Saturday, July 19 in its new location nor Court Judge Tom Majhan,Commu-
across from the high school along U.S. nity Network members, and several
Highway 101. students. Alysha Middleton is one of
The reopening attracted more than 50 three Quilcene High School students on
people,many congratulating,thanking the board of directors.
and praising one another for their corn- "They wanted teenagers on the
bined efforts to reopen the anti-drug. board,"said Alysha."Becky approached
anti-alcohol,anti-violence facility. me and I said yes."
"We got help from so many people," "We need to make an impact," she
said teen center board secretary Becky added,explaining that the new facility
Anderson,"but without the perseverance will serve as analternative to partying
of building owner Sandy Oen, we in the woods.
wouldn't be here today." Reta Miller,president of the volunt-
The teen center now shares the Leer board,mentioned she would like to
former Sandy's Chevron station with see more young people as directors. -
Tri-County Transmission. See TEENS,Page A 10
Port Townsend&Jefferson County Leader
:J7‘,,-hrf..,,,,, ill
j,.2 '_,.sem €`4',v,, acu F 4 i *.^exwx.,:.
Teens
,. „,,,,,,,,,>,.....,,,,,, ,,,,„:„-,,,,, ..,,, .,,,,,:,,,,,,,,,,,,,,,, .,:,:,,
_ ,,,,,„
'ti.T,.6.44,.„.6.&.;‘:.4'',-:‘‘,;A:‘—;;;;‘,74::71'7.4
4:;TIttli: I..,„:,
Continued from Page A 1 F '''''''174'1.''''*''' Y P Nr .i. *41,1v4,-,0!
Currently there are three �� , y ,, 4 J ; ` 0:
Middleton, Jamie Glaze and x qtr ., tet:' , "�'+
Ahmed Saleh, who is vice T„, ' 'r a .4 ¢ %t " g Ax*
„,,,,,,,,.„,,,,,
president. � � „:7,,,.,„1!,,,,,;f. ,.1„,.. � x ,�
x, •fir e y. : ra a w• a �s t:, ;r
"We would like to see the ra- tee `' c 14F ; °N ,
do shiftaway from six adults �, `4' * Jud �),� � � z
with three kids to just the oppo- 1'` * tF "�'� ' `t� � _ - � '
f: - i
site,”added Miller. z �+ .,: � r Sr T �, ��
QHS sophomore Jesse r; A:r1. 1
Maher cut the ribbon amidst -Y
kt
applause shortly after 1 p.m. He ,
4` kg
'K 4]F ":,,4.i. if
im
said:"I am all for it.The more �.� �� � t� - •• ,�
teen centers,the better!" .r � .�z
The new location is larger, The Quilcene Teen Center's grand reopening ceremony July 19,attracted more than 50 people.
more visible and more acces- Celebrants included(from left,back row)teacher Terry Heineman,CommunityNetwork Block Grant
sible to the high school.It also liaison Jude Anderson,board member Reta Miller,Quilcene High School sophomore and cadet
offers better parking, more ac- Jesse Maher, board member Alysha Middleton,activities director Carrie Thompson,community
tivities, more programs and development consultant Beth Wilmart,the Rev.Becky Anderson and(front row)students Sammy
computers. Fields and Souhil Alazani. Photo by Caryl Delaney
"We would eventually like to
see kids running this place," huge difference," she added. Quilcene Lions Club, Terreo came in on Saturday with anex-
commented Carrie Thompson, "When we closed, it hurt us; Trust, Hadlock Building Sup- tra generous donation.The Port
activities director."It could also but we do have a following and ply, QFC, Mountain Propane, Ludlow philanthropist simply
turn into an excellent senior they are back." Pat Chadwick, Hughes said:"This is needed.When we
project,"currently a graduation Other contributors and sup- Sawmilling,and many commu- were young,the war saved us in
requirement at QHS. porters include Ann Norton nity and high school volunteers. that we didn't have time to think ill
"If we start now reaching the Wildflowers, Henery's Hard- Many thanks also go to anof what to do.Now kids need a
younger kids, we will make a ware,Olympic Springs Water, anonymous benefactor who place like this."
1-a3 -03
SUNDAY JULY 27,2003 A7
Certificate
•
fees rise
to $17 each
PENINSULA DAILY NEWS
The fee for certified copies of
birth, death, marriage and
divorce certificates has
increased to$17.
The increased fees, which
went into effect Saturday,were
established to help maintain
and improve the state's current
vital records system and to cre-
ate a Web-based electronic
death registration system,
state officials said.
Electronic birth registration
was initiated statewide 10 •
years ago, and in January,
Washington became the first
state in the country to register
births with a Web-site-based
system.
Creating a similar death •
registration system will speed
documentation, allowing fami-
lies to proceed more quickly
with insurance claims and
other needs after a family
member dies, said state regis-
trar Teresa Jennings.
• Birth and death certificates
may be ordered from the Cen-
ter for Health Statistics, 1112
SE Quince St.,P.O. Box 47890,
Olympia WA 98504; or from a
local health department.
In Port Townsend, the Jef-
ferson County Health Depart-
ment, located at 615 Sheridan
St., is open Monday through
Friday from 9 a.m.to 4:30 p.m.
The Clallam County Health
Department office is open Mon-
day, Wednesday and Friday
from 9 a.m.to noon and 1 p.m.
to 4 p.m.The office is located in
Room 53, downstairs at the
courthouse, 223 E. Fourth St.,
Port Angeles.
The Clallam County office
also has a self-serve center,
which is available Monday
through Friday, 8:30 a.m. to
4:30 p.m.; and a Web site,
clallam.net/healthseruices,
where application forms are
available.
Marriage and divorce certifi-
. cates must be ordered from the
state office in Olympia,or they
may be obtained online at
www.doh.wa.gou, for an addi-
tional fee of $11. Orders are
processed and mailed within 24
hours. •
• The
last time certificate fees
were increased was in 1997.
July 30, 2003
Vol. 114 No.31
•
Troubling
County eighth-graders have
higher use of drugs, alcohol
than counterparts statewide
By Janet Huck "This is pretty grim," said Rick
Leader Staff Writer Tollefson, Healthy Youth Coalition
(HYC)chairman.
The analyst told the Healthy Youth "Wait — let me finish," said Kellie
Coalition the bleak statistics.One in five Ragan, assessment coordinator for
Jefferson County eighth-graders re- Jefferson County Health and Human
ported drinking heavily—as heavily as Services. She was analyzing the statis-
adults. tics of the Healthy Youth Survey.
The 13- and 14-year-olds also said Then Ragan continued with equally
they started drinking when they were sobering numbers about local drug use.
just 11. See DRINKING, Page A 8
' •
Jefferson County
Washington State
W�y/�At
Ya�.n s.sa,.'r e. i s - �..
cigarettes alcohol mariju• a/hashish illicit drugs
Among Jefferson County eighth-graders,the rates for using tobacco,alcohol and
drugs in the last 30 days are consistently higher than the state averages.Illicit drugs
•
include methamphetamines, psychedelics, ecstasy, cocaine, Inhalants and other
drugs. Source:Kellie Ragan,Jefferson County Health& Human Seri ces
Port Townsend&Jefferson County Leader
Drinking: Troub
ln
g
• Continued from Page Al in their lives, compared to 44
Last November, Jefferson percent across the state. 1. 1.y�
County students in grades 6, 8, • The average age of"first Parental guidelines
10 and 12 took part in the use"was 12 or younger among
•
Healthy Youth Survey.It assessed the county's eighth-graders who Although some experi- some guidelines for what
health risk behaviors—such as reported any alcohol,tobacco or mentation is normal behav- parents can do:
violence and use of alcohol,to- other drug use, for for teenagers testing • Know
bacco and other drugs —which •The average age of the first g yourdson's or
g g their boundaries, parents daughter's friends.
could impede child development. use of alcohol(more than just a can help reduce the use, •Establish a network with
In order for the results to sip)was 11.1 years. misuse and abuse of alcohol, the friends'parents.
achieve a representative group,70 •The average age of regular drugs and other risky behav- •Involve your teens in ex-
percent or more of each grades' use of alcohol(one to two times iors. Kellie Ragan, assess- tracurricular projects.
population had to complete the monthly)was 12 years. ment coordinator for •Know where they are.
survey.Only the county's eighth- •The average age of the first Jefferson County Health and • Listen to them without
graders (Brinnon, Chimacum, use of marijuana was 11.5 years. 'Human Services, suggests needing all the answers.
Port Townsend,Quilcene)met that •The average age of the first
requirement. use of tobacco was 11A years.
Unsettling numbers Dangerous trend r :' Jefferson County
Consequently, the only "There's some troubling t `
8th Graders
Jefferson County results avail- trends here," said outgoing
able are for 13-and 14-year-olds. Chimacum School Superinten- Washington State
However,the eighth-gradestatis- dent Dr.Mary Lynne Derrington. auN 8th Graders
tics for alcohol, tobacco and "We used to see the onset of ex-
other drug use were unsettling perimentation in the 11th and
because the numbers aren't de- 12th grades,but now it's younger.
0. iii
creasing—even as state numbers That's alarming." 41
are dwindling. Heavy or binge drinking by °Z'1. - ,'r'1-
From 2000 to 2003,Jefferson youths can
pose serious risks,in- y -'
County eighth-grade rates re- eluding alcohol poisoning,over- 2 Bio, a
• main unchanged for the"last 30 dose and death. Last February, 0;401).,,, , ' ` a .
days"use of alcohol,marijuana, outdoor party participant Shane f> .; `:" •-
cigarettes and/or binge drinking. Luther, a junior at Chimacum , ®o .�„
However the state eighth- High,apparently died in his sleep ,.` lA ,1`�, ' "
graders were significantly lower from alcohol overdose.
any use
from 2000 to 2002 in binge Despite these daunting indi- tobacco of any alcohol
any sans ttny use of
drinking and the use of alcohol cators,there hasn't been much of
marijuana illicit drugs
in the last 30 days. an outcry over the survey results. Jefferson County eighth-grade rates for projected lifetime use of to-
Jefferson County Juvenile "People are overwhelmed," bacco,alcohol,marijuana and illicit drugs are decidedly higher than
Services Administrator Barbara said one community leader. the state rates.
Carr said while juvenile filings "Many people have tried to do Source:Kellie Ragan,Jefferson County Health&Human Services
on all crimes have stabilized, something, but conditions
charges for minors in possession aren't getting better. They're would blame the schools. department,the police,the parents
of alcohol or other illegal sub- discouraged." "We aren't going to turn it and the schools to work together
stances aren't shrinking or even Carr thinks community lead- around in the schools because we to put together a multi-faceted pre-
plateauing. ers don't know what to do now can't control what happens in the vention program."
Other pertinent statistics show that they have tried different ap- community and the family,"said As a result of the HealthyYouth
more Jefferson County youths proaches without much success. Port Townsend Superintendent Survey and the health depart-
than statewide eighth-graders re- Carol Andreasen."We seem to have ment's 2001 Behavioral Risk Fac-
porting these risky behaviors: Town norm a norm in this town that drinking torSurveillanceSystem,community
• Twenty-eight percent said Chimacum and Port Town- • and taking drugs is acceptable." groups are meeting this summer
they drank alcohol in the 30 days send school officials held on to "No one agency has the key to to come up with action plans on
before the survey,compared to 18 the survey results for several the solution," agreed Jean alcohol and drugs,mental health
percent of students across the state, months while preparing their Baldwin, county health depart- and vulnerable families.
•One in five Jefferson County own analysis. School leaders ment director."We need the men- "We can't let the issue die,"
students said they drank five or were concerned the community tal health agency, the health said Baldwin.
more drinks in one setting in the
two weeks before the survey.Only .
one in 10 in the state said the same.
•Sixteen percent of Jefferson
County-students said•they-smoked.•
4) marijuana or hashish: Only 10
percent of the students across the
state said they smoked marijuana
in the 30 days before the survey.
• Fifty-nine percent of the
county eighth-graders said they
had consumed alcohol sometime
E
•
Wednesday,July 30,2003•B 3
High toxin levels found •
in Discovery 'shellfish
The Washington State Depart- ill.within minutes of eating.The many recreational beaches.How-
ment of Health has closed Dis- symptoms usually begin with tin- ever,there are miles of shoreline
covery Bay to the harvest of all gling of the mouth and tongue. that have not been posted. Har-
shellfish because of-very high Severe poisoning can result in vesters should not rely on warn-
PSP concentrations, which have dizziness,numbness and tingling ing signs to decide if beaches are
risen extremely rapidly over the in the arms and legs,paralysis of safe for shellfish harvesting.
past week. the arms and legs,and paralysis Jefferson County Health and
The rapid rise and high levels of the muscles used for breath- Human Services Department can
of PSP have resulted in enhanced ing,which can cause death. be reached at 385-9444 and can
monitoring by the state, reports Recreational harvesters provide additional information or
the Jefferson County Health De- 'should check for biotoxin do- answer questions.
partment. sures by calling the State Depart- Commercially harvested
PSP is nerve toxin that is not ment of Health's biotoxin hotline shellfish currently on the mar-
destroyed by cooking or freezing. at 800-562-5632 or by checking ket have been tested to make •
It is a natural marine toxin,com- the department's website at sure they are safe to eat. If
monly called "red tide," that is www.doh.wa.gov/ehp/sf/ samples tested indicate high
produced by a species of plank- biotoxin.htm.Harvesters should PSP concentrations, commer-
• ton.A person who eats shellfish also look for,and obey,warning cial harvesters are not able to
with high PSP levels can become signs that have been posted on sell the shellfish.
cl)--T- LEH) -E-e_
•
••
Breastfeeding week events
planned
PENINSULA DAILY NEWS Network.
PORT TOWNSEND — "Breastfeedingfeeding in a Globalized World
best efforts one of the —for Peace and Justice."
World BreastfeedingWeek is parents can make The 12th annual observance,
celebrated Aug. 1-7, and Port toward the well-being of their sponsored by the World
Townsend families and;,breast- infant and child," said regis- Alliance for Breastfeeding
feeding supporters will'gather tered nurse Laura Showers. Action,marks the Aug. 1, 1990,
Wednesday, Aug. 6, at Chet- "Women need support from proclamation by 32
govern-
zemoka Park. family, friends and the commu- ments and 10 United Nations
The noon to 3 p.m. potluck nity to keep breastfeeding when agencies that officially recd -
-bring your own picnic, orga- it .is difficult :or when they 'nizes the importance
nizers say — is sponsored by return to work. We must feedingn and of maternal Jefferson County Health change our focus to view breast- health as well as the social,eco-
DepartmeLa nt, Jefferson Jefferson General feeding as our cultural norm." nomic and ecological benefits it
JeHospital, Cour he League,and The theme of this year's provides to the family and soci-
ty Community world celebration is "Breast- ety.
• �-'D
1-3
•
r
— '«. ., aim c�*. ._ .rat.. � �.. -.: a,v,.ni rut' iuw,u6cuu tcsl- HC works anu the pc
partment. /'�/1
Under the guidanc /
police, the new pro
Celebrate ready to go.Because,
time is limited and n
World Breastfeeding Week unteerstare enew being ctr
August 1-7 . Thursd •
.,
The Port Townsend
4'" ,',4 ,::. Commission convenes
Thursday, July 31 in
7 ' , 1k r.3 chambers in City Hall f
�" lic hearing on a prop(
f ; , conservation ordinance
�, ‘ '.4
' � • The ordinance wool
'fir!'Z'1,,e,„'#;',"•:',:i �' ;, '? retention of some trees
r .'�-v A � 4 , ,, cleared for developmer
d
z • �h " cel ti land could not b
` .,,,'";1:-1,.c::. � �°t` � >� in anticipation of future
a 414 � � �� ' ��-� a g - mens without the owner
r ,- : _ �,• , twining a pre-devel
2 ° • logging and thinning
g• g
Projects that have obtain
�' ,�c �. "; ing permits would be
x
� �.. ,,,t,,,:, ,, ,,, ,r, , �� Secretar
S
€ '.i.,. ! . Sam Reed,secretary
x and chairman of the Wa
s � , -c" ate. �S ria," ?
Laura Showers,IBCLC(International Board Certified Lactation Consultant)and Carol Hardy,IBCLC. Territorial Sesquicei
Commission, will be
Breastfeeding: Healthy Mothers and Health Babies Townsend on Thursday,
yto give a sesquicentennia
Breastfeeding is a powerful process that has been shown to be of significant benefit to . ` ration.The presentatioi
both mother and child. While fostering maternal attachment,breastfeeding is also the
"ultimate prevention" of potential.physical and emotional ailments. Current studies
show that women who breastfeed demonstrate decreased risk of breast and ovarian ' I •
• cancer, anemia and osteoporosis. . ',
"Having the support of all of our Breastfed children have fewer and
community is important lessse�iouschildhoodillnessesand t-,,, , eL
in order to ensure the health O f allergies. They also show a reduced
risk for Sudden Infant Death t �,`
our community mothers and ��,.
Syndrome,some childhood cancers '
1 babies. And World Breastfeeding and diabetes. ��
Week is the perfect time for us all
In an effort to protect,promote,and
to demonstrate this support." � �
support the well-being of mothers 0. i '
`� and to encourage breastfeeding for •
healthier babies and children,the Jefferson County Breastfeeding Alliance has formed.
,�
Members include Jefferson General Hospital, Jefferson County Health & Human
Services,the La Leche League,the local healthcare community and private citizens.
J
Come join us for a community picnic in
celebration of 1$TFE46
Schedule an appo
World Breastfeeding Week at 4 � ,�
Chetzemoka Park, �, �
p �� Experience a 1-ho
Wednesday,August 6 from Noon to 3 pm. y ,k, relaxation massage
minute maintenani
Bring your lunch. j 7Au GA3C. only$8(
U.
((, Haircuts
$28
Ti
Jefferson General Hospital or less 8
,, 111/"Caringpeople, caringfor you"
p P Cornrows
(360) 385-2200
starting ,/
H `�4 'I or (800) 244-8917 Get r
834 Sheridan Ave, Port Townsend 34
www.jgh.org Flagship Landing
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1 -2 .
•
Health official
receives honor
from state
PORT TOWNSEND—Dr.
Thomas Locke, chief public
health officer
for both "''
Jefferson and •
Clallam coup a`
ties, recently
received the s "'�,_.
Washington a< 4``
Association of
Health Offi- :x
cials' annual
Award of ,> r
Excellence. Locke
Jean Bald-
win, director of Health and
Human Services in Jefferson
County, said Locke's award is
especially significant because
it was made by his peers.
Locke, according to Bald-
win, has served three terms •
on the state health board
totaling eight years. -
She said Locke's represen-
tation on the board makes a
difference in public health on
the North Olympic Peninsula.
"Working at the local level
is the most satisfying for me,"
Locke said after the award
was acknowledged Monday by
Jefferson County commission-
ers.
"Jefferson County is—and
always has been—a leader in
public health," Locke said.
PbJ g-s--o
•
13
g'-(-03
Port Townsend&Jefferson County Leader
Immunization.
refusal hmite
d r
D�apents have the right to refuse im-
ifOntiniiackinfor their children
Therete certain immunizations that are
mandatory:in all"-states if you enroll your
children in•daycare or any school system:
x In most•cases,parents can refuse minium-
,;
ntnum,,' zations for their children only on religious
or.:philosophical grounds.`Check with the
schools for forms that must be signed by par:
ents if you choose not to have your child
immunized.
Dear Dana ' If a child,is not immunized and an out-
break of a disease such as measles occurs,
BY • the child will be'excluded from school.
Dana MkhelsenWhen traveling with children remember that,
P depending'On your destination, there are
• immunization requirements as well: . •
There are quite a few websites that offer information and ad-
vice on vaccines and immunization.Make sure you go'to a repu
table site,as there are some that make statements based on bias'
and misinformation,Don't just accept as truth the first one that
agrees with your present point of view.'
You can check with your own physician for immunization in-
formation.Many clinics now stock vaccines and provide the same
.service as the health department. Jefferson County Health De-'
artment nurses spend time taking your family history and your
Id's personal health history7 noting any contraindication for
immunization as well as options for vaccines.
(Dana Michelsen has been part,of the Jefferson County medi=`.'•
cal community for 20 years.She is past director of-clinical ser-AS-
vices for Jefferson General.Hospital, where she is currently
Working on a special project.Her column appears the first issue
of each month.)
.t. kA( Y
Wednesday,August 6,2003•B 3
o un r
ee s ._.sou - - or,coup
r
•
e •ri �,:: t ,r ;$, tri .r + x
Big Brothers Big.Sisters of tions,interviews,and education Spring intends to start high proved relations with peers,
Jefferson County seeks adult about the match process. school BBBS clubs this fall. teachers and parents, and im-
volunteers (aka Bigs) and Bigs and Littles expand each "High-school grads report being proved academic performance,
youths ages 6 to 14 (aka other's horizons by sharing eV- a Big as one of their best com said Spring '-:
Littles)to take part in the new eryday activities such as playing triunity service experiences,he . ': The local program is a satel-
program.Perry Spring has been sports,taking walks,working on said. E lite agency of BBBS of Island
hired as program coordinator .projects together,visiting a mu- Other adults interested in County,which received national
and has set up office in Room seum, going to the park or tak- . helping to build the local pro-. recognition in 2002 for the qual
904 at Chimacum Elementary ing in a movie. BBB S staff gram can be a behind-the-scenes ity of services delivered and the
School. provides ongoing support for volunteer or become involved in number of friendship matches it
"Developing and supporting friendship matches and organizes the BBBS of Jefferson County serves. The Jefferson County
one-to-one friendships between group outings > Mentoring Advisory and Re- program has come about as part
a caring adult volunteer and a Spring noted that there will be source Committee (JMARC). of the five-year Healthy Comm
child in need of a consistent role at least three types of BBBS JMARC will provide the vision, ' nines Grant awarded to Jeffers
model is the primary task"of the matches offered in Jefferson resources and inspiration to make County Health and Human Ser-
Big Brothers Big Sisters(BBBS) County. Community matches BBBS a shining star in the com- vices in.October 2002.
program,said Spring. typically get together three to munity.Kellie Ragan-at Jefferson Those interested in becoming
Bigs can be high school-age four times a month for a few County Health and Human Ser- a Big or having their child be a
youths, working-age or older hours in a location of their choos-: vices is heading this effort. Little should contact Spring at
adults. Enrollment involves a ing.School-based matches meet BBBS has been serving 732-4090, ext. 368, or
detailed interview, reference for one hour per week during or America's youths for nearly a perry=spring@csd49.org.Those
and background checks,train- after school at the campus the century, and one-to-one interested in the mentoring advi-
ing, and a one-year minimum Little attends. Activity-based mentoring has been proven to be sory resource committee or help-
commitment. club matches bring together Bigs an effective prevention and inter- ing out in some.other way can
Youths interested in becoming and Littles with a common inter- .vention strategy in reducing contact Ragan at 385-9446 or
Littles need written parent or est in a supervised setting. youth substance abuse and other kragan@co.jefferson.wa.us.
guardian permission to partici- Greywolf Fishing Club recently negative behaviors.Research has More information about the pro-
pate in the program.Enrollment took the bait to launch a BBBS shown that youths involved with gram can found at http://
includes parent-youth applica- Fishing Pals Club. BBBS consistently show im- www.bbbsislandcounty.org.
y
•
•
Newspaper August 10. 2003 15
ill Poll shows
Jefferson
-
views
on . . .
Survey may rl
,,,.
x ,
•
r,,„„ .Fes,
guide policy
1 � yyi
in keyareas
BY LUKE BocuEs ` ,
PENINSULA DAILY NEWS Titterness Huntingford
PORT TOWNSEND — Jefferson
County residents are evenly split on large number of
whether they'd support increased respondents 85 percent
taxes to raise money for clocktower '
repairs and other renovations at the indicated they were happy
courthouse. with the parks and recreation
The feelings about the courthouse
IIII repairs are part of a survey sent to all program. Fewer 27 percent,
county postal customers in June. Of were satisfied with permit and
about 15,000 mailed,more than 1,500 building development services
were returned,county Commissioner
Dan Titterness, R-Port Townsend, and youth programs, 24 percent.
said.
Forty-two percent of the people with our efforts of stabilizingand
that responded indicated they were in
favor of a repair bond,the same num- streamlining development regula-
ber were against it and 16 percent tions and project review," Commis-
�aid they weret�nsure. sioner Glen Huntingford, R-Chi-
Residents returning the surveys macumthe said'
were less than happy with many ser- Other services on which fewer
vices provided by the county. than 50 percent of respondents indi-
cated they were satisfied:Animal ser-
Survey in newsletter vices,45 percent satisfied;courts/judi-
cial,43 percent;public health,40 per-
The survey was sent out as part of cent;general government,34 percent;
a county newsletter to help commis- senior programs,31 percent.
sioners get a feeling on the direction
citizens want them to take the county. Services rated
As a whole, people said they were
happy with the quality of life and level Survey participants rated county
services by importance.
of personal safety and security the '
county provides.But there is room for Topping the list was law enforce-
improvement,Titterness said. ment, followed by roads/transporta-
tion, public health, parks and recre
A large number of respondents,85
percent, indicated they were happy ation, youth programs, general gov-
with the parks and recreation pro- ernment, courts/judicial,
gram. Fewer, 27 percent, were satis- permit/development services, senior
feed with permit and building devel- programs, animal services and
opment services and youth programs, garbage/recycling.
24 percent. Of the people responding to the
Titterness said he was surprised at survey, 65 percent live in unincorpo-
the results about county building per- rated Jefferson County. Thirty per-
mit services. cent live in Port Townsend and 5 per-
Staff reports indicate the services cent did not say where they live.
are now completed faster and more Full results from the survey are
accurately than before,he said. available on the Internet at
"However,it is clear that a portion www.co jefferson.wa.us/commission-
of the community doesn't perceive it ers/2003Survey/Results.htm or in the
that way." County Administrator's office at the
"It appears we need to continue courthouse, 1820 Jefferson St.
R.°
Advisers sought
a
:for disabilities grant
. Jefferson County has the op- will talk about how best to
portunity to apply for a Real meet the goals of increasing
Choices grant designed to sup- choice and self-determination;
port communities in educating then we will draft our applica-
people about the value of tion."
choice and self-determination The expected amount of the
as well as about resources and state grant is $10,000.Those
special topics of interest to the who are interested in contrib-
disabilities community. uting to this process are invited
"The first step in our appli- to attend the group's first meet-
,cation process is to gather a ing,2-4 p.m.Tuesday,Aug. 19
group of interested citizens to in the health department con-
;form an advisory council,"says ference room at 615 Sheridan,
Anna McEnery,developmental Port Townsend.
disabilities coordinator with For further information call
Jefferson County Health and the health department at 385-
;Human Services."Together we 9410.
-�3ro3
. -
PFkW4o6((
1
/7
IIIPort Townsend&Jefferson County Leader
•
New fam resource c
rea
to
oenon •
u .
The community is invited to a grand open- help is still needed. $548,739 of family-support funding.
ing of the Child and Family Resource Cen- "Anyone who cares about children and "We know from our census figures that
ter on Thursday,Aug.21. . families is welcome"said Beth Wilmart of county families are at risk from the stresses of
- Festivities are 5:30-8 p.m.at 884 Park St. Jefferson County Community Network. poverty," said Jean Baldwin, director of
in the Port Townsend Business Park. (Turn The Blossoming Project of the family re- Jefferson County Health and Human Services.
off Sims Way at Jackpot Food Mart; follow source center,a new program dedicated to sup- "The Blossoming Project is the Child and
the signs.)The facility is adjacent to Jefferson porting Jefferson County families so that they Family Resource Center's initiative to pro-
Mental Health Services. • can raise healthy children,has received fund- vide specific support to families,"said Laurie
Planned are a magic show, live music, ing from the Washington Council for Preven- Strong of Jefferson Mental Services. "The
food,face painting and more. - tion of Child Abuse and Neglect(WCPCAN). . WCPCAN award will fund parent education
Bring the family,'say organizers.Learn The center is one of 17 child abuse prevention classes and a weeklyfamily recreation and
what is planned for the center and what programs across the state that will share in parent support activity."
•
'--(3-03
•
•
r
Are We Ready?
POST OFFICES HAVE been cleaned, and many mail-
rooms are better protected. But how much has the U.S.
medical establishment really learned from the anthrax
attacks of October 2001?If anthrax—or smallpox, or a
newly engineered disease—were to break out tomorrow,
1111 would hospitals and public health departments be pre-
pared?
Part of the answer is deeply unsatisfying: At least at
some level it is impossible to say, because no federal
agency has published the results of a full investigation into
what went right and what went wrong.The Department of
Health and Human Services says it has conducted its own
investigations but will not publish the results,for security
reasons.That leaves everyone else to rely on the work of
private scientists.
Their conclusions, some recently published, indicate
that the medical response to the anthrax attacks was
flawed.After extensive discussions with those involved,
three scientists from Johns Hopkins University and the
ANSER Institute for Homeland Security found,for exam-
ple,that the work of doctors dealing with anthrax patients
was significantly hampered by the poor distribution of
information.
Hospitals in Florida,New York and the Washington area
were compiling evidence about anthrax cases but weren't
receiving timely medical advice in return. Whereas the
Pentagon held daily news briefings after Sept. 11, 2001,
health professionals got their information about the spread
of anthrax from CNN. An electronic system designed to
link public health departments with the Centers for
EDITORIALS Disease Control and Prevention(CDC) in Atlanta worked
poorly, and a public CDC Web site crashed twice. In any
case,neither was dispensing pertinent medical information
directly to hospitals and doctors who needed it.
HHS says much has improved.The department, along
u with many communities across the country,has begun con-
_
�ij n Ijost�31111y
_"1 L� tis ductingmock disaster
drills, furthering the inte-
gration of public health
The nation's
officials with hospitals.
• hospitals are Money has been spent on
computers and cell phones,
already as well as safety shoes and
J surgical masks. Scientists
are trying to develop a new
overstretched
anthrax vaccine. HHS says
and they have it can get antibiotics to any
part of the country within
verylittle hours—though it isn't
dear,at the local level,how
"surge capacity." they
t �ld be distributed
afIs it enough?Some think
not—and they usually point to personnel problems.
Another report, issued this month by the Partnership for
Public Service,points out that federal biodefense agencies
may actually lose qualified staff in the next few months.
Despite claims by Tom Ridge, the secretary of Homeland
Security, that "a new human resource management sys-
tem"is one of his top priorities,and although HHS says it
has hired "hundreds" of public health officials, starting
salaries for public health workers are still far lower than
those in the private sector,and academia still offers scien-
tists more stable careers. Others,both inside and outside
government, point to a shortage of medical personnel as
well:The nation's hospitals are already overstretched,and
they have very little"surge capacity."
After creating a computer model of the effects of a major
anthrax attack in New York City—and concluding that
120,000 people might die Stanford University business
professor Lawrence M. Wein concluded that the nation
needs a medical SWAT team,specialists who could fly to
an emergency from cities across the country,set up tents
and start caring for patients.
Both the administration and its critics agree that corn-
ing to clear conclusions is difficult,if not impossible.They
generally agree that the nation is better prepared than it
was,but also that if an attack took place tomorrow,many
people still might die. Worse, substantial resistance
remains at many levels to the very idea of preparing for a
bioterrorist attack. s