HomeMy WebLinkAbout2003-October File Copy
Jefferson County
Board of Health
Agenda
•
Minutes
October 16, 2003
•
•
JEFFERSON COUNTY BOARD OF HEALTH
Thursday, October 16,2003
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 August 21,2003
III. Public Comments
IV. Old Business and Informational Items
1. Cruise Ship Sewage Releases—Follow-up Letter from Dept. of Ecology
2. BCHP Report—Quilcene
V. New Business
• 1. Regional Communicable Disease/Bioterrorism Response Duty Officer
Protocol
2. Port Townsend Water Supply Status
3. Evaluation of Existing On-site Sewage Systems: When and How?
4. Community Health Assessment Update—Preparation for October 29,
2003 Healthy Jefferson Meeting
VI. Activity Update
VII. Agenda Planning
VIII. Next Meeting: November 20,2003, 2:30-4:30 PM
Main Conference Room
Jefferson Health and Human Services
•
F 2 i
JEFFERSON COUNTY BOARD OF HEALTH
MINUTES
Thursday, August 21, 2003
Board Members: Staff Members:
Dan Titterness,Member-County Commissioner District#1 Jean Baldwin, Health &Human Services
Glen Huntingford, Vice Chair- County Commissioner District#2 Director
Judi Mackey- County Commissioner District#3 Larry Fay,Environmental Health Director
Geoffrey Masci, Chairman-Port Townsend City Council Julia Danskin,Nursing Services Director
Jill Buhler,Member-Hospital Commissioner District#2 Thomas Locke,MD,Health Officer
Sheila Westerman,Member- Citizen at Large(City)
Roberta Frissell,Member- Citizen at Large(County) Ex-officio
David Sullivan, PUD#1
Chairman Masci called the meeting to order at 2:30 p.m. All Board and Staff members were present.
There was a quorum.
APPROVAL OF AGENDA
• Member Frissell moved to approve the agenda with the addition of Informational Item—Dissolved
Oxygen Report, and New Business Item 5—OSS Licensure. Commissioner Huntingford seconded
the motion,which carried by a unanimous vote.
APPROVAL OF MINUTES
Commissioner Titterness moved to approve the minutes of July 17,2003. Member Buhler
seconded the motion,which carried by a unanimous vote.
PUBLIC COMMENT
Dale Wurtsmith referred to his August 12,2003 letter to Chairman Masci (also copied for the rest of the
Board), in which he requested that his company, EnviroCheck,be issued a Permanent Operations and
Maintenance license based on their working knowledge,training and experience in the business of
evaluating existing on-site septic systems. He reminded the Board that they had issued him a Provisional
License two years ago while he waited for the Washington On-Site Sewage Association(WOSSA) and
other agencies to develop a standardized statewide test for operation and maintenance—a test that has
yet to be created. Citing the difficulty in attracting business partners with just a provisional license,he
asked to be grandfathered and issued a permanent license. He went on to recommend that anyone with
two years experience with operation and maintenance also be grandfathered.
Member Westerman asked about Mr. Wurtsmith's willingness, as ongoing education, to take a test when
it becomes available as a part of issuing a permanent license? When Mr. Wurtsmith asked why a
•
HEALTH BOARD MINUTES - August 21,2003 Page: 2
permanent license would be dependent on a test, she said she sees this as different than issuing a
•
provisional license.
Commissioner Huntingford asked if relicensing every two years would be required once a test is in
place? Larry Fay clarified that WOSSA is working on association-based testing and voluntary
certification program that the County has said it would recognize as meeting the requirements of
licensure. He does not think the discussions amount to any momentum for a statewide licensing program
for Operation and Maintenance. In response to questions, Mr. Wurtsmith reviewed the types of ongoing
education he has taken—basics of monitoring and maintenance, and troubleshooting as well as those of
particular interest to him (design, soil sampling, and soil analysis classes),but added that the classes do
not conclude with an exam. He did stress that continuing education is critical if you have employees,
because of liability issues.
Asked by Member Frissell if operating under a provisional license is hampering his business in any way,
Mr. Wurtsmith said that it is hindering his search for investors to help expand the business
OLD BUSINESS AND INFORMATIONAL ITEMS
Findings of Fact/Conclusions of Law for July 17,2003 Appeal Hearing: Member Buhler expressed
confusion regarding the language under Item B, Conclusions of Law,which lists punitive options but •
does not seem to include the option chosen by the County, which was to do nothing. She suggested
adding language similar to what was in the Staff memo from the previous meeting describing actions
taken.
Larry Fay explained that the action taken was specified in 8.15.150(1)—Issuing a Notice of Violation,
which advised Peterson/Roberts that they would not receive any subsequent permits until they resolved
the violations. Despite the appellant wanting the County to take more aggressive action, the County
decided against doing so.
Without objection from Member Buhler, Chairman Masci suggested clarifying Page One by changing
Items C and D to subsets of Item B.
It did not seem to Member Westerman that the action taken presented much of a disincentive for people
to do similar things. Larry Fay responded that there is a variety of violations, each with a variety of
potential consequences—Staff tries to tailor the response to the severity of the problem and
recommended not wasting prosecutor/court time over such issues.
Commissioner Huntingford moved that the Chair sign Findings, Conclusions and Decisions as
amended above. Member Frissell seconded the motion,which carried by a unanimous vote.
Quasi-Judicial Appeal Procedures: Chairman Masci asked if there was Board support for adopting 4
the protocols for hearings as modified for use during last month's hearing. Member Frissell pointed out
corrections needed on page 4 under the Appearance of Fairness Doctrine. In paragraph(b),references to
1 . 1
HEALTH BOARD MINUTES -August 21, 2003 Page: 3
• the City Council should instead be Board of Health and the last sentence relating to Street Vacations
could be deleted.
Member Buhler moved that the Quasi-Judicial Appeal Procedures as amended above be adopted
as part of the Jefferson County Health and Human Services Procedural manual. Member Frissell
seconded the motion, which carried by a unanimous vote.
Cruise Ship: Larry Fay said that the agenda packet,pursuant to direction by the Board as last month's
meeting, included a draft letter to the State Board of Health documenting the Board's concerns about
infectious waste discharges. Regarding the State Board of Health's role in safeguarding the Health of the
State, the Board is asking them to investigate the regulatory structure for cruise ship operations and
consider whether the acceptable practices are genuinely going to be protective of the health of people of
Puget Sound. As a result of recent conversations between Commissioner Huntingford,Dr. Locke and the
Clallam County Board of Health, the final version of the letter will also include a signature line for the
Chair of that body. Mr. Fay noted that another letter to Washington State Department of Ecology has
been drafted and would be reviewed by Chairman Masci and Dr. Locke. Commissioner Huntingford
mentioned that when he raised this issue at a recent State Board of Natural Resources Retreat, five
people expressed interest in supporting these efforts.
Commissioner Huntingford moved to approve the draft letter to the State Board of Health
regarding sewage releases from cruise vessels, to be signed jointly with the Clallam Board of
41) Health,with minor modifications as recorded by Staff. Member Westerman seconded the motion,
which carried by a unanimous vote.
Letters to and from State Board of Health Delegation: Dr. Tom Locke noted that the Board had
received a letter from the State Board of Health following their visit last month. As directed by the
Board,the packet also contained a draft letter of thanks from the Health Board for their visit.
Commissioner Huntingford moved that the Chairman sign the letter of thanks to the State Board
of Health,with minor modifications as recorded by Staff. Commissioner Titterness seconded the
motion,which carried by a unanimous vote.
Letter from Jefferson County Prosecutor Re: Child Death Review: Jean Baldwin referred to
Juelanne Dalzell's letter in the Board's packet communicating her concern about the disbanding of the
Child Death Review Team. Given the good participation and low cost to resume, Staff would like to
keep the team going.
Dissolved Oxygen Report: Commissioner Titterness reported on his attendance at a meeting today
organized by the Hood Canal Salmon Coalition to inform attendees about the potential causes of oxygen
• depletion in Hood Canal. A sizeable portion of the discussion centered on failing septic systems and the
flow of effluent into streams and the canal. He heard the opinion expressed that while we test for
bacteria,we do not design to prevent nitrates from being released into the aquifer. There was also some
discussion at that meeting about asking the legislature to implement some kind of nitrate treatment.
HEALTH BOARD MINUTES -August 21, 2003 Page: 4
Larry Fay said that since 1995, the County has had special treatment requirements in critical aquifer •
recharge areas that address nitrate reduction from on-site sewage systems. It is also a topic of general
statewide concern, although standards are not yet forthcoming through the state regulatory process.
There was mention of other potential contributors to the dissolved oxygen problem, such as lawn
fertilization along the shoreline or other natural or forestry-related actions as well as a discussion of
nitrate treatment alternatives for on-site sewage systems.
NEW BUSINESS
Performance Measures and 2004 Budget Narrative: Jean Baldwin noted the inclusion in the packet of
performance measures for Community Health, Environmental Health and Administration. There was
also an overview of the Department and its financial structure. She pointed out that in terms of
administrative and fiscal responsibilities,Health and Human Services provides the infrastructure for
many departments. She noted that while these performance measurements are used in their budget
request, it has not yet been finalized. Similar reports would be given to the Board of County
Commissioners and the Board of Health every six months.
Member Westerman pointed out that on the page for Administration performance indicators under
"Number of birth and deaths in Jefferson County as handled through requests in the Jefferson County
Health and Human Services,"it says"baseline"instead of listing figures,which Staff said might need to •
be rephrased. Regarding the organizational chart,Member Westerman asked to understand how the
"Policy" line differs from the"Advisory?"Jean indicated that it is based on the RCWs and the WAC,
but recognized that the chart needs to be revised to reflect a policy line from the Developmental
Disabilities and Substance Abuse Boards to the County Commissioners. The Board of Health should
also indicate a direct policy line to the Health Officer and Director. Dr. Tom Locke recommended
eliminating the"Advisory" line from the Board of Health to the County Commissioners,reminding that
there are two jurisdictions—County government that has to do with County Departments, and the Board
of Health that has to do with all the legal authorities involved in public health code creation and
enforcement. Staff agreed to modify the chart.
Member Frissell pointed out that the chart on Page 2 of the Environmental Health On-Site Sewage
Programs reflects a decreasing number of educational workshops and participants,which is bothersome.
Larry Fay explained that with a two-year grant from Ecology, County was able to initiate and implement
the Operations and Maintenance(O&M)Program and conduct the very popular workshops. While some
of the funding is carrying over to this year, essentially, the workshops would not be able to continue
because staffing in the on-site sewage program was cut back. However,the Department will have
revenues to allocate about one-quarter of Linda Atkins' time to ongoing O&M.
Staff pointed out that figures(and,therefore, Staffing) in the Food Program is similar to that of Mason
County—which is three times larger—because of our tourist industry and special events.
Chairman Masci asked if the lack of change in performance indicators from 2003 to 2004 is reflective of •
a flat budget? Staff confirmed there is the same expectation of funding and services. Asked if there is
any provision in any one of those indicators for a crisis, Staff said there is a minimal buffer.
•
5 • s
HEALTH BOARD MINUTES -August 21, 2003 Page: 5
• David Sullivan asked about the basis for the reduction in the number of projected complaints in the On-
site Sewage Program? Larry Fay agreed to check with Staff, but it might be that they felt that
enforcement/compliance position that we created this year has been successful in resolving past
complaints with the result that fewer will be coming. A question under the Drinking Water Program was
whether the 2004 objective to inspect at least 50% of new wells could be higher. Larry Fay responded
that the agreement with the State Department of Ecology is to inspect 50%,but in the past, and quite
possibly this year, it would be more.
Under On-Site Sewage,Member Westerman asked if the County would also be working with private
individuals to get into O&M inspections. Larry Fay said that with respect to alternative systems,
individuals would receive a notification stating that three years has passed since their installation and
that their system is due for inspection and would also list the individuals who could conduct those
inspections. Once the inspection is done, a report would be submitted. Currently, the PUD is tracking
that information. Since the ordinance was only adopted in 2000, the County is just entering the initial
cycle of notices. The County should begin receiving some figures next year.
Member Buhler asked whether a permit or just an application is required to construct a well. Larry Fay
responded that anyone wanting to construct a well is required to file a notice to both the County and
Department of Ecology. Department of Ecology acknowledges receipt of the notice and the County
ensures they are not proposing to drill inside a water service area,but does not issue a permit. She asked
if a permit process would lead to being able to enforce or inspect. Mr. Fay explained that due to
• Department of Ecology's lack of inspectors, the County has agreed to conduct field inspections and
report any deficiencies. Department of Ecology, as the agency who licenses the drillers, would take
enforcement action.
Jean Baldwin explained that the requested budget is flat based on the 2002 County contribution.
However, 2003 saw a reduction in facilities and Health and Human Services is now paying its full share
of rent and asking for County General funds to go back to the 1994 pre-belt tightening level.
West Nile Virus on the Move—National Activity and First Reported Washington State Case: Jean
Baldwin provided two handouts from the Centers for Disease Control. Dr. Locke said West Nile is on
the move and is progressing across the country faster than last year. This is the time of year that the most
surveillance was anticipated. In Washington, there have not yet been any animal cases—it is monitoring
horses,but has yet to have a positive bird specimen. He noted that a Yakima resident developed a mild
case of encephalitis and while his spinal fluid initially tested positive for West Nile antibodies, those
tests are not confirmatory because West Nile is closely related to three other viruses. He noted that they
are testing for the immune response in humans. Explaining the "Guidelines for a Phased Response"
included in the agenda packet,Dr. Locke noted we are currently at Alert Level 1. The County's current
focus is on public information and personal protective approaches to preventing mosquito bites.
Jefferson County Health and Human Services Emergency Response Plan—Tabletop Training
• Exercise Report: Jean Baldwin,Julie Danskin and Dr. Locke reviewed today's County tabletop
exercise of the Public Health Plan,which is part of the Emergency Management Plan.
response team,hospital, g Participants were
the EMS
p ,public health, state representatives and several from the Regional
Emergency Management Team, as well as the Local Emergency Response Coordinator, Lisa McKenzie
HEALTH BOARD MINUTES - August 21, 2003 Page: 6
(who had also attended Kitsap's and Clallam's exercises). The exercise scenario is now a public •
document. Staff felt the simulations and conducting the three County exercises at the same time with all
the participants were extremely helpful in identifying systemic flaws in the plan. The exercises have very
much to do with communicable disease response in general rather than bio-terrorism specific and
provide increased clarity each time they are held.
Multi-County Communicable Disease Cross Coverage: Risk Pools,Health Officer and Draft
Protocols: Dr. Locke reported on the effort to create regional communicable disease capacity in Kitsap,
Clallam and Jefferson,which is associated with the bioterrorism planning. They are establishing a"duty
officer,"who would be the single point of contact for any medical provider, or anyone who has a
communicable disease report or concern and who would activate the system. The best hope of getting
additional emergency capacity is the ability to tap into other health departments. This system would be
the first in the state—a system of standardized investigations and disease-specific protocols. The Board
of Health would have to appoint the Deputy Health Officer and Staff has just begun looking at the
liability and legal issues of these cross appointments. Because there are two large risk pools, a joint
agreement has been drafted for cross coverage,based on mutual aid agreements for law enforcement and
firefighters use. The draft agreement was included in the agenda packet. It was noted that nursing staff,
which would be going between counties, are also in separate risk pools so the insurance aspect is more
complex than the financing. Staff would be coming back to the Board with recommendations.
Chairman Masci asked whether the Board would be required to issue a Request for Qualifications prior i
to appointing someone? Dr. Locke said the choices would be limited to currently appointed Health
Officers in Washington State(20 people). In theory,the Board could appoint someone who met the legal
criteria yet lacked an understanding of how the system works.
Commissioner Huntingford asked if the County would be required to pay the appointed Health Officer if
the designated Health Officer was on a two-month leave of absence? Dr. Locke said that since this is a
voluntary,reciprocal agreement, the County would instead pay the Deputy Health Officer,not both.
OSS Licensure: Larry Fay,responding to the request by Dale Wurtsmith, said he is unaware of any
problems with Wurtsmith's work. Because a state exam is not on the immediate horizon,the County
could let an individual sit through a King County exam, for instance, (administered by WOSSA) and
proceed with licensure. Over the last several years,he has been working with the Board of Registration
for Professional Engineers on their On-site Designer Licensing Advisory Committee and working with
the State Department of Licensing. The exam is a competency-screening tool. The idea of licensure is
that it is your performance after the exam that determines your ability to continue to practice. If we were
to provide a license—conditioned on passing an exam—to someone whose four-year history in the field
met or exceeded the minimum standard but who then failed the examination,we might be challenged if
we threatened to revoke that provisional license. He suggested that our regulations might contain a
potential remedy,which could prevent a blanket waive of the requirement. Mr. Wurtsmith could apply
for a waiver from the requirement to be examined,his rationale for which is contained in the body of •
work that he has provided.
•
HEALTH BOARD MINUTES -August 21, 2003 Page: 7
• Chairman Masci pointed out that grandfathering of existing practitioners has been allowed in other
licensed activities. He sees no problem with grandfathering to permanent status until a certain date such
as January 1, 2005 as long as the County constructs the mechanism and standards for its own test.
Member Westerman suggested creating a process that would serve not only this individual,but also
other individuals in similar circumstances.
Chairman Masci said most Boards,whether disciplinary, educational or other, have continuing education
requirements,which we could use as models and accelerate or expand the requirements as needed.
Member Westerman asked whether another County might already have something that could be
adapted?Larry Fay said that at the same time we were considering creating our own standards and
examination process there was state movement to create an industry-driven certification program. We
presented the latter to the Board, but it has not been realized. If the County were to create its own
examination, it would need to consider how to handle it administratively. Several Counties have
examinations in place and WOSSA is talking with Pierce and King Counties about contracting to
administer their exam. We could find their exam meets our needs and the individual could go to
WOSSA and take the King County exam and that certification would meet our requirement. Mr.
Wurtsmith's concern is that, despite building a creditable history of experience in the field over two
years,he could somehow fail the exam and be told he could no longer do this work. Assuming WOSSA
had an acceptable testing procedure in place by, say,January 1, 2004, we would probably have to tell
• those to whom we had issued a provisional license that while we might want them to take the exam,
their license is not in jeopardy(unless some sort of disciplinary hearing had cast doubt on the
competency of their performance).
Chairman Masci said we could make the license contingent upon the completion of x number of hours of
continuing education. Mr. Fay pointed out that we already have this in our licensing requirement and
said the County runs classes periodically to create opportunities for folks in the field to get their CEs.
David Sullivan suggested considering the administrative responsibility for and cost of licensing. Staff
responded that spelled out in our code are the pieces from initial qualifications, work experience and
education, examination, continuing education, complaint procedure, disciplinary process,hearings, fees,
etc. The critical thing has been the structural exam, the entry exam.
Member Westerman summarized that first we said that anyone in the County could have provisional
licenses with the understanding that they would take an exam the minute it became available from
WOSSA. But now you are saying that if we go out and find an exam that we think can substitute for the
WOSSA, we can't ask those provisional licensees to take that exam. Mr. Fay said we would need legal
counsel's input on this,but added that we would find ourselves on shaky ground legally if we took away
a license of someone who had been practicing and meeting industry standards solely on their inability to
pass the exam. Member Westerman said then we should not have made that a condition. Mr. Fay said it
seemed reasonable at the time because we thought the exam was going to appear during what was, in
effect, a probationary period. Had the exam shown up in three or six months, it would not have been the
• same strategy as the person who can demonstrate the work experience. She asked if anyone with two
years experience would be vested?Larry Fay said we do need to decide whether WOSSA is moving with
its process rapidly enough for us to continue to work with them or are we going to go develop our own
exam?If we decide to develop our own,we would try to borrow it from another County,but then we
HEALTH BOARD MINUTES -August 21, 2003 Page: 8
would need to get into its administration. Once our exam is in place, any new applicant would have to •
complete and pass that exam? The policy question is whether anybody we had licensed previously who
might still be in a probationary period could reasonably be required to pass the exam. If they are past the
probationary period when the test is offered,we would say that,having performed up to our standards
thus far,we are going to waive the exam requirement and grandfather your license.
Chairman Masci suggested that the process might be facilitated if Staff were to develop a flowchart of
the options on which the Board might then make policy statements at each of the steps.
Commissioner Huntingford reminded the Board that this is not a real big issue for us to try and decide,it
sounds like we have some controls over this process as we go forward. Mr. Fay is responsible for review
to ensure these individuals are doing their job—providing education and checks and balances. If Staff
wants to develop the chart and make some calls to other counties and if we are not having a problem,
how we want to deal with it is probably more of a housekeeping issue.
Mr. Fay said that if someone came in tomorrow and applied and met the qualifications,we would issue
the same kind of provisional license. Although there are fewer and fewer,the County is still doing
inspections. There is some concern that a private sector person who also is licensed to do maintenance
has an incentive to find something wrong, so they choose to call the County.
Member Westerman reiterated her request that we provide a solution for everyone,not just this
individual.
•
Chairman Masci proposed that Staff get back to the Board with its recommendation and then we could
notice the affected individual. Mr. Fay said he would target getting the issue resolved before it comes
time to talk about license renewals next year.
ACTIVITY UPDATE/OTHER ANNOUNCEMENTS
Survey: Commissioner Titterness reviewed the results contained in the packet,which indicate good
participation. The purpose was just to get a general sense of how the public felt and to see where we
could make some improvements. Because of how services were prioritized,it appears citizens feel the
County is spending money where it should. Commissioner Huntingford said there were internal
suggestions as to how to do it differently in the future. For example, determining their recent use of these
services. They found it surprising that no one considered Park and Recreation neutral. It was noted that
since citizens often confuse City/County services,there might be a need to specify that this would be for
County-provided services.
AGENDA PLANNING/ADJOURN
Joint Board Meeting—September/October: The Board discussed the possibility of rescheduling its
September meeting because Staff and some of the Board have conflicts. It was thought to be important to
hold the Joint Board Meeting where the Civic Engagement Committee would present separate from
either of the Board's regular meetings. Dr. Locke noted that this would not only be a presentation,but a
priority-setting exercise by the Joint Boards. Tentative dates were as follows: September 25th for the
HEALTH BOARD MINUTES -August 21, 2003 Page: 9
. regular Board meeting(2:30—4:30) and the Joint Board meeting in October replacing the regular Board
of Health meeting. Upcoming agenda items were noted as follows: Maternal Child Health, Budget
Issues in September.
Roberta Frissell asked that the Board schedule a meeting with legislators before they return to Olympia
in January. Commissioner Huntingford suggested the County Commissioners take responsibility for
scheduling this and other meetings as part of a day-long visit to discuss various issues.
At 5:30 p.m. today, there would be an open house of the Child and Family Resource Center.
The meeting adjourned at 4:34 p.m. The date and time of the next meeting is to be determined.
JEFFERSON COUNTY BOARD OF HEALTH
Geoffrey Masci, Chairman Jill Buhler,Member
Glen Huntingford, Vice Chairman Sheila Westerman,Member
• Dan Titterness,Member Roberta Frissell, Member
Judi Mackey,Member
O
•
•
0
I
•
Board of Health
Old Business
Agenda Item # IV., 1
•
Cruise Ship Sewage Releases
Follow-up letter
From Dept. of Ecology
October 16 , 2003
1
��e STATE O�
O
W�
Y�
1889 O
STATE OF WASHINGTON
DEPARTMENT OF ECOLOGY
P.O. Box 47600 • Olympia, Washington 98504-7600
(360) 407-6000 • TDD Only (Hearing Impaired) (360) 407-6006
September 8,2003
RECEIVED
Mr. Geoffrey Masci,Chair SEP 12 2003
Jefferson County Board of Health
Castle Hill Center Jefferson County
1ealth&Human S ic -
615 Sheridan Street
Port Townsend,WA 98368-2476
Dear Chairman Masci:
In response to your letter concerning the Norwegian Sun sewage release, the Department of
Ecology appreciates and concurs with your expressed concerns for water quality and how the
cruise ship industry might adversely impact the state's waters and your community.
The Norwegian Sun accidentally discharged sludge into the Strait of Juan de Fuca on May 11,
2003. The Department of Ecology considers the sewage release to be a serious matter and is
• taking steps to prevent reoccurrence of similar incidents by the cruise industry in the future.
The cruise industry is a growing concern here in Washington as it has been in Hawaii,Alaska,
California,and Canada. The cruise industry's track record for sewage releases in Washington
consists of only one known self-reported discharge for the sewage release on May 3,2003.
However, throughout the country, the cruise industry has had a less than stellar track record
for gray water releases,oil discharges,hazardous waste,and garbage releases.
While the cruise ship industry is not part of a Washington community,they do have a stake in
gaining the trust of customers in Washington. The cruise industry has assured us that they
strive to be responsible stewards of the marine environment that they transit over and rely
upon for their business.Though there is this expressed ethic on the part of the industry,state
and local authorities-including the Department of Ecology-are limited under the Clean Water
Act in regulating the operation and discharge from marine sanitation devices (MSDs). The U.S.
Coast Guard has primary authority for the regulation of MSDs on board ships. Given this
awkward regulatory scheme with respect to wastewater discharges from vessels,how do we go
about structuring a system that will provide ourselves,local authorities,and most importantly
the public that level of assurance the cruise ship operations in Washington State are not
violating our state's water quality standards or jeopardizing public health?
The Department of Ecology,Port of Seattle,U.S. Coast Guard,and Puget Sound Clean Air
Agency are presently working with the Northwest Cruise Ship Association on a memorandum
of understanding(MOU) that will have operating conditions in it for the industry. This MOU
Board of Health
Old Business
Agenda Item # IV., 2
• BCHP Report
Quilcene
October 16, 2003
•
Windermere
Real Estate
11111 Port Townsend
October 8, 2003
Julia Danskin
Jefferson County Health Department
615 Sheridan
Port Townsend,WA 98368
Dear Julia,
This letter is to communicate and marvel at the skills and dedication of Margie Boyd. She has single-
handedly whipped women into action to help other women of Jefferson County. Please allow me to explain
a bit.
I met Margie in 1998 when she was looking for property to move to Jefferson County. Later,I saw her at
the Tri-Area Center being so kind to an elderly woman who needed medical attention. I had no idea she was
with the Health Department. We would see each other and talk periodically. In 2000 I was diagnosed with
Breast Cancer. Being a'life changing and affirming' disease, I decided I needed to do something to help
other women when diagnosed with cancer.
As a member of the Jefferson County local Soroptimist International (SI)Women's Organization,we
• organized a workshop for women entitled"Do Your Dream". Margie saw me the day after the very
successful event and asked what my dream was. I explained my dream. Margie walked into my office the
following Monday and said, "I'm here to help you do your dream!" She proceeds to inundate me with
wonderful brochures, self-exam cards and details on the Breast and Cervical Health Program. Her initiative
got the ball rolling!
About 6 months later, SI of the Pacific Northwest challenged each local club to define a project that helps
women with early detection of women's cancers. Of course,we call Margie! The combination of Margie,
Jennifer and the JC Health Department and her contacts at Susan G. Komen and NCI along with the local
women of SI and a group of concerned women in South County made a powerful group to coordinate the
activities of events to focus on early detection of women's cancers. Our first event was at the Quilcene Fair
in September 2003.
Margie made a presentation to SI,then brought in Susan G. Komen and NCI for another presentation to SI.
She then made the arrangements for a number of tasks and plans for the events at the Fair and specifically
all the exam/medical services. Since SI and South County Women were `womaning' a booth with
information, Margie even arranged for`Cancer 101' Training from NCI to prepare us for questions from the
women. This is only our first step in educating the women of Jefferson County!
•
Windermere Real Estate/Port Townsend 1220 Water Street Port Townsend,WA 98368
Telephone(360) 385-9344 (800) 776-9344 E mail `ptnancy@olypen.com'
Mr. Geoffrey Masci
Page 2
September 8,2003
will hopefully provide assurances that the industry is meeting state water and air quality
•
standards. The target date for completion of this MOU is March 1,2004. The Department of
Ecology has confidence that the memorandum of understanding will be a step in the right
direction. Kevin Fitzpatrick,section manager of our Water Quality Program in the northwest
regional office,is heading up this effort on behalf of Ecology and you are welcome to contact
him at 425/649-7033 to get further details on the MOU.
If you have any questions on this letter or other water quality matters,please feel free to call me
at 360/407-6405.
Sincerely,
Richard K. Wallace,Manager
Water Quality Program
•
•
Julia Danskin
October 8, 2003
Page 2
SI is thrilled to have partnered with the Susan G.Komen Foundation and Health Department and
III
specifically Margie. You may not know this,but SI Northwest has used the Jefferson County Early
Detection Project as an example to our sister clubs all over the Pacific Northwest. Because of Margie,
Susan G. Komen is partnering with Soroptimists and will be making a presentation to our Regional Meeting
to partner with them and with their local Health Departments. None of this would have been possible for us
without Margie's drive and determination.
We look forward to more projects with you in the future.
Sincerely,
- .0.4
ff
IF WO, liyArinrillir
N .cy
cy Stelow
•
Windermere Real Estate/Port Townsend 1220 Water Street Port Townsend,WA 98368 •
Telephone(360) 385-9344 (800) 776-9344 E mail `ptnancy@olypen.com'
PUBLIC HEALTH
Always Working for a Safer and
• HEALTHIER JEFFERSON
October 9, 2003
Margie Boyd
Jefferson County Health & Human Services
615 Sheridan Street
Port Townsend, Washington 98368
Dear Margie,
At this Jefferson County Board of Health meeting we would like to take a moment to honor
you and your work with the outreach design implemented in South County to reach women in
need of breast and cervical cancer screening.
You put together a team within JCHHS and with community volunteers. With the help The
• Doseducks and the Soroptimists you provided the women of Quilcene and Brinnon with
excellent care in a highly advertised clinic. You were able to encourage new folks to come in
for care. This was a major success.
Your idea to apply for the Komen Grant for the mobile mammogram, and then planning a
Saturday clinic was a novel and wonderfully successful approach. You also started a chain of
peer-to-peer outreach making it easier for women in South County to encourage each other to
get yearly exams and mammograms.
The outreach you have started will continue to help the women of South County for years to
come.
With heartfelt appreciation,
Geoff Masci, Chair Jean Baldwin, Director
Board of Health Health & Human Services
• COMMUNITY ENVIRONMENTAL NATURAL DEVELOPMENTAL SUBSTANCE ABUSE
HEALTH HEALTH RESOURCES DISABILITIES & PREVENTION
615 Sheridan Street, Port Townsend,Washington 98368
(360) 385-9400 Fax: (360) 385-9401
PUBLIC HEALTH
Always Working for a Safer and
• HEALTHIER JEFFERSON
October 9, 2003
Jennifer Doyle
Jefferson County Health & Human Services
615 Sheridan Street
Port Townsend, Washington 98368
Dear Jennifer,
At this Jefferson County Board of Health meeting we would like to thank and honor you. Your
dedication to clients and commitment to a successful project is clearly seen in our BCHP
Review Report and the highly successful Quilcene clinic.
The leadership you have shown is recognized by our contractors in Seattle and by the clients.
You have received rave reviews from grateful clients and staff as you work above and beyond
the call of duty to help the women of this Jefferson County.
Your job requires you to do timely, efficient billing and program management, but you invest so
much more with your compassionate client follow-up. You have been instrumental in BCHP
screening. No detail, referral or question is beyond your complete attention.
Your work is truly appreciated,
Geoff Masci, Chair Jean Baldwin, Director
Board of Health Health & Human Services
• COMMUNITY ENVIRONMENTAL NATURAL DEVELOPMENTAL SUBSTANCE ABUSE
HEALTH HEALTH RESOURCES DISABILITIES & PREVENTION
615 Sheridan Street, Port Townsend,Washington 98368
(360) 385-9400 Fax: (360) 385-9401
•
Board of Health
New Business
Agenda Item # V., 1
•
Regional Communicable
bisease/Bioterrorism
Response Duty Officer
October 16, 2003
•
•
Duty Officer Protocol
Overview
A duty officer is a public health professional that is available 24 hours a day, seven days
a week for public health consultation. The main responsibilities of this individual will be
to provide accurate information to callers and triage requests for public health services in
Clallam, Jefferson and Kitsap counties. Clallam, Jefferson and Kitsap counties
(Bioterrorism Planning Region 2) will use a common duty officer as the point of contact
for the public health system in each county. It will be the responsibility of the duty
officer to initially assess a service request and contact the appropriate local staff with the
problem-specific expertise to resolve the public health issue. The region is currently
developing a duty officer handbook with disease or situation specific contact and
response information(see example below). While the duty officer is encouraged to
contact the health officer available to each county whenever necessary, the duty officer
can directly answer many simple questions. Memorandum of Agreements will be drafted
between each county to satisfy each county jurisdiction and insurance providers concerns
about authority and liability. Dr. Tom Locke and Dr. Scott Lindquist will continue to be
available 24 hours a day as the health officers.
Technical Contact Information
• The duty officer will carry a pager(360-412-2556) accessible in each county. The region
has 10 assigned pagers, each with the same number. This allows the person"on-call"to
turn on their pager for their shift. The other nine pagers will remain off. This makes it
easier for the rotation of duty officers so that no pager needs to be handed off. Shifts will
consist of 7-day periods (Monday 4pm through the following Monday morning start of
business). The number for the duty officer will be given to all community agencies and
health professionals that currently contact public health after hours. Examples include
emergency rooms, police, fire, medical providers, and the state public health system. In
Kitsap County the 911 operators will now have a single contact number for the Kitsap
County Health District,which is the duty officer pager number.
•
110 Flow Chart
Duty Officer Protocol
Telephone Call Routine Inquiry:
Public Health Received:
Determine if routine Record contact information
Emergency: And public health question on
public health inquiry
or emergencyduty officer log sheet.
Contact County —
Health Officer
Consult Duty
Contact identified Officer
local public health Handbook
worker
1 1
Provide protocol
• response
Identified
information
Public Health
Personnel
contacted?
Yes \,\To 11,
Continue to attempt
Record action taken contact with back-up
personnel
If no backup available:
Contact County Health Officer
And record action taken
Notify Local Health Jurisdiction on
Monday morning of all actions taken
•
Sample Duty Officer Protocol
ANIMAL BITE
CATEGORY: Other
DESCRIPTION: An animal bite can result in a variety of infectious diseases, including
tetanus or rabies. An animal bite also poses three immediate health concerns: the need
to provide first aid/wound care,the risk of rabies,and the potential for continued risk to
the public posed by the animal. The initial animal bite investigation should also
ascertain the species of the animal involved, the circumstances of the bite, and the
condition of the animal.
NOTIFICATION REQUIREMENTS:
• Kitsap County: Kitsap Animal Control (Kitsap Humane Society) at (360) 698-
9654 or 911
• Jefferson County: Jefferson County Animal Services (360)385-3292
• Clallam County: No current Animal Control Service
CONTROL MEASURES:
• PRECAUTIONS: None.
DISINFECTION: Clean and debride the wound.
ISOLATION & QUARANTINE: None for the patient. Request Animal Control
quarantine the animal for a minimum of 10 days,if domestic.
IMMUNIZATION:
• Ensure patient has had tetanus vaccine within the past five years; if not,
vaccinate with age-appropriate tetanus-diphtheria vaccine (DtaP,DT,Td).
• Ascertain rabies vaccination status of the animal,if domestic.
• Contact Health Officer with any questions.
TREATMENT: None.
INVESTIGATWE MEASURES:
COMMUNICABLE DISEASE: If possible risk of rabies, ensure animal specimen is
collected (animal is humanely killed without damaging the brain). Refrigerate, but
do not freeze,the head,and forward to the DoH Public Health Laboratory.
FOOD: None.
WATER: None.
ZOONOTIC: Contact Animal Control if the animal is domestic and needs to be
• controlled.
EPIDEMIC MEASURES: None.
Schedule
The schedule is based on percentage of regional population. The total population for
Kitsap County is 237,000 and this is 72%of the total regional population(Jefferson-
26,700 or 8%, Clallam 65,300 or 20%). Kitsap County will cover 72%of the 61
upcoming call weeks, or 44 weeks. Clallam will cover 12 weeks and Jefferson will cover
5 weeks.
The proposed schedule for 2003/2004 is as follows:
November
3rd Kitsap
10th Clallam
17th Jefferson
24th Kitsap
December
. 1St Kitsap
8th Kitsap
15th Clallam
22nd Kitsap
29th Kitsap
January
5th Kitsap
12th Jefferson
19th Clallam
26th Kitsap
February
2"a Kitsap
9th Kitsap
16th Clallam
23rd Kitsap
March
1st Kitsap
8th Kitsap
15th Clallam
• 22"a Kitsap
29`h Jefferson
• April
5` Kitsap
12th Kitsap
19th Clallam
26`h Kitsap
May
3rd Kitsap
10`h Kitsap
17`h Clallam
24th Kitsap
31st Kitsap
June
7th Kitsap
14`h Clallam
21st Kitsap
28th Kitsap
July
5th Kitsap
12th Kitsap
• 19`h Clallam
26`h Kitsap
August
2nd Kitsap
9th Kitsap
16`h Jefferson
23rd Kitsap
30`h Kitsap
September
6th Kitsap
13th Clallam
20th Kitsap
27th Kitsap
October
4th Kitsap
11th Clallam
18th Kitsap
25`h Kitsap
November
• 1st Kitsap
8th Kitsap
15th Jefferson
22nd Kitsap
29`h Kitsap
December
6th Kitsap
13th Kitsap
20th Clallam
27th Kitsap
Summary
A public health duty officer responsible for Clallam, Jefferson, and Kitsap Counties will
begin to enhance the ability to contact the public health system regionally. The proposed
starting date to implement the system is November 1, 2003. A document with contact
information will be drafted for the medical community. A memorandum of agreement
between counties will be in place, and we will notify the state Department of Health of
our first day of the call system. The Public Health community in our region looks
forward to this successful partnership, which will ultimately improve our public health
• system.
•
•
Board of Health
New Business
Agenda Item # V., 3
•
Evaluation of Existing
On-Site Sewage Systems
October 16, 2003
•
M E M 0 R A N D U M
•
DATE: October 8, 2003
TO: Jefferson County Board of Health
FROM: Larry Fay
RE: Evaluation of Existing Systems
With the 2000 rewriting of the Jefferson County Onsite Sewage System Code we
began moving more completely into the realm of operations and maintenance
assurance for all onsite sewage systems than we had in the past. The ordinance
was written to bring the county into compliance with the 1995 state board of
health regulations. The state regulations require the counties to establish
systems to assure periodic monitoring of all onsite systems.
Our regulation implements the state standards by requiring owners of existing
systems to have an operational inspection performed by an authorized individual
• (health department staff, licensed O&M provider, licensed designer or engineer)
at one of several triggering events. These include when a property is sold or
transferred or when an application for a building permit is submitted. I think that
the underlying policy intended by the required inspections is the assurance that
anyone applying for a building permit or at the sale of a property has a
functioning septic system regardless of whether the particular application directly
impacts the onsite system. A secondary policy objective is to get the property into
a routine inspection program in the future. Both of these tie to our longer term
goal to get all systems into a regular inspection schedule
When we adopted the rules, the board recognized that a phased approach to
implementation would be desirable both from a workload stand-point and to gain
experience working with the inspector licensing program. To date we have only
required inspections when a property is being sold or ownership is otherwise
transferred. We are now proposing to move into a second stage of
implementation by requiring inspections upon application of a building permit. It
should be noted that we have always required an evaluation of the onsite
sewage system when the building permit is for an expansion and there is no or
very limited documentation concerning the septic system
One of the issues that arise when we move into this phase is the apparent link or
lack of link between the building permit application and the septic system. It is
111 fairly easy for the public to understand why it is desirable to have their system
Statement of Agreed Priority page 2
inspected if the building permit application includes plumbing, bedrooms or a
• major remodel. It is less obvious when the application is for a shop, garage or
changes to the house that do not result in an expansion. It may seem
unreasonable when the application is for a propane tank, woodstove or deck. Our
efforts to move towards a comprehensive system of regular onsite sewage
system inspection may be undermined if there is popular consensus that we
have adopted unreasonable standards.
In general, we think that our code as adopted is consistent wit the intent of the
state regulations. We believe that the tactics that we adopted are the result of a
long deliberative process and when applied intelligently make sense. We also
think that we have been implementing the rule in a graduated fashion and in
accordance with the direction of the Board. Never-the-less, the devil is in the
details and the Board may want to re-consider its policy directive as the details
are reviewed.
To this end, we would like to present to the Board a model the describes the
following:
• When an evaluation of existing system (EES) is required,
T.
What information is necessaryto complete
e the EESui,
• How that information will be gathered and,
• The decisions that arise from the EES.
• The Board may consider the utility of thmodel and
that there is a clear understanding of what is intended. dance in the details so
We think this kind of model will make the overall process clearer for the public
and permitting staff, provide greater consistency and improve an applicants
ability to anticipate what is needed in order to move the application forward in a
timely and efficient manner. The model will be presented during the board
meeting.
•
Board of Health
New Business
Agenda Item # V., 4
1
Community Health Assessment
Update
October 16, 2003
1
Community munity Health
Assessment In Action Report
Executive Summary
Background
In 2002, the U.S. Centers for Disease Control and Prevention (CDC) awarded funding to the
Washington State Department of Health (DOH) to improve the quality and effectiveness of
community health assessment practice among Local Health Jurisdictions (LHJs) across the
state. To implement the CDC grant, the LHJs and DOH formed the Assessment in Action
(AIA) partnership. A Steering Committee comprising LHJ and DOH staff representatives
provides leadership for implementation of the partnership. An Advisory Committee made
up of a broad-based group of individuals from the Washington Health Foundation,Turning
Point, United Way,the University of Washington,health and human services staff from
Oregon,the LHJs,and DOH provide input on Steering Committee processes and products.
As a first step toward developing strategies to improve assessment practice, the AIA Steering
• Committee contracted with Clegg&Associates to conduct this intensive,participatory
review of community health assessment practice among the state's LHJs. The purpose of
the review was to create a body of knowledge from which the partnership could develop a
set of practice improvement strategies to pursue during the remaining four years of the CDC
grant. The project builds on the recently completed Standards for Public Health in IVashington
State:Baseline Evaluation Report(which documents the extent to which LHJs and DOH are
meeting assessment standards) by identifying successful approaches to community health
assessment,analyzing the factors that contribute to this success,and developing strategies to
enable other LHJs and DOH to learn from these approaches to improve their own results.
Defining Community Health Assessment
To ensure a clear focus for this practice improvement initiative, the AIA Steering Committee
created the following working definition for community health assessment practice:
"Collecting,analyzing,and using data to educate and mobilize communities,develop
priorities,generate resources, and plan actions to improve public health." Such practice
entails:
• Carrying out the assessment activities necessary to meet the Standards for Public Health
related to understanding health issues
• Building a local constituency invested in examining and addressing community public
health issues
•
Community Health Assessment Report
Clegg&Associates
• • Developing and distributing accurate, timely,and user-friendly information regardingthe
health status of the local population
• Facilitating strategic decision-making regarding the response to assessment findings
To better identify the role assessment plays in achieving changes in local health status, the
Steering Committee and Clegg&Associates developed a logic model. This logic model
articulates the program theory underlying community health assessment:
ACTIVITY SHORT-TERM LONGER-TERM GOAL
OUTCOMES OUTCOMES
Conducting Changes in Changes in
Improved
community attitudes,
health programs, community
awareness
policies, health status
assessment and and
activities knowledge/skills resources
regarding the
use of
assessment data
in decision-
making
• Research Methodology
In order to capture how LHJs are implementing community health assessment, Clegg&
Associates conducted one-hour telephone interviews with 34 of the 35 LHJs. Participants
were asked to describe their current assessment capacity,what changes had resulted from
assessment activities,what resources were essential,what obstacles they have encountered,
and how important they believe the assessment function is to the LHJ achieving its goals. In
addition,Clegg&Associates interviewed nine key informants identified by the ALA Steering
Committee as having important perspectives on community health assessment,including
several DOH staff. The AIA Steering Committee used the information learned in the
telephone interviews to select six LHJs for Clegg&Associates to visit. The purpose of the
site visits was to gather more in-depth information about practice methods that are working
in specific LHJs and to identify the factors that contribute to success.
The LHJs selected for site visits were Island County Health Department,Jefferson County
Health and Human Services,Kitsap County Health District,Kittitas County Health
Department,Spokane Regional Health District,and Thurston County Public Health and
Social Services Department. These six sites comprised one large LHJ,three medium-sized
LHJs,and two small LHJs. The sites included two health districts, two county health
departments,and two county health and human services departments. Four of the LHJs
visited were in Western Washington,one was in Central Washington,and one in Eastern
Washington.
At each site visit, Clegg&Associates met with the LHJ director and assessment staff and
held focus groups with internal and external stakeholders. External stakeholders included
Community Health Assessment Report ii
Clegg&Associates
• Board of Health members,individuals serving on LHJ community advisory/mobilization
groups, other community partners,hospital administrators,and others. Internal stakeholders
included health officers and LHJ program staff.
In order to enhance the transfer of knowledge between the AIA partnership and the LHJs,
Clegg&Associates conducted a search of current research pertaining to effective knowledge
dissemination and utilisation processes. Recommendations for improving the quality and
effectiveness of community health assessment practice across the system were then
developed in conjunction with the AIA Steering Committee and Advisory Committee.
Findings
KEY FINDINGS FROM THE TELEPHONE INTERVIEWS
• Every LHJ performs some assessment activities;not every LHJ (nor everyone at each
LHJ) thinks of these activities as community health assessment
• Most LHJs see the value of community health assessment even if they believe they lack
the capacity to sustain effective assessment practice. (Nearly 75 percent of all LHJs
consider assessment to be very important or"mission critical.")
• For LHJs that do not consider assessment very important, the main reason cited is a lack
of discretionary funding
• Nearly all LHJs have lost funding and assessment capacity since the mid-1990s
• Every LHJ said they need more money to conduct community health assessment. Other
frequently-cited important resources included staff capacity,DOH support, technology
and data,and community partners
• Obstacles to community health assessment include a lack of time and money,resistance
to change, competing priorities,and a lack of understanding of what assessment is and
what it can do, and a lack of a clear vision from DOH
• "Champions"are important in starting and growing assessment capacity
• LHJs reported a number of positive impacts as a result of assessment,including:
O Increased resources
O Increased effectiveness
O Better decision-making
O Increased ability to act proactively
O Increased visibility
O Improved services
O Increased collaboration and cooperation
O Improved community perception of LHJ
O Increased awareness of public health issues
O Decreased influence of politics on LHJ priorities
i
Community Health Assessment Report iii
Clegg&Associates
•
• Most LHJs use some of their Local Capacity Development Funds to support assessment.
Other funding sources include grants,contracts,county general funds,and local funds.
A few LHJs do not fund assessment.
• Community health assessment is most likely to be sustained when LHJs see assessment
as an investment that leads to increased resources or improves their ability to do more
with fewer resources and when communities come to view LHJs as vital partners
because of their assessment capacity
KEY FINDINGS FROM THE SIX LHJ SITE VISITS
There is no one right way to conduct community health assessment. Each of the LHJs that
participated in a site visit implements community health assessment in a way that is tailored
to its own community. This customization contributes greatly to the success these LHJs are
achieving in educating and mobilizing their communities to address a broad range of public
health issues.
At the same time,there are a number of key similarities that emerge from these individual
sites. The following characteristics common to the six LHJs appear to be critical in making
community health assessment practice an effective ingredient in achieving the LHJs'goals:
• Leadership and vision are essential
O LHJ directors have an expansive vision of public health and the role of the
• community in achieving it
O Directors view assessment as a core function
O The health officer is engaged in the assessment function
O The Board of Health makes an important contribution
• The community is a powerful partner in achieving health goals
O Five of the six LHJs visited have a community-based stakeholder group of
some kind. These groups are invested in public health issues and bring an
additional,and separate,voice to local public health issues. The size,
structure,and composition of these groups vary—the key is that the LHJ has
an active voice in addition to its own.
• Dedicated staffing(and staff) make a big difference
O Assessment is a dedicated staff function
O Assessment staff have direct access to the LHJ director
O Staff conducting assessment have passion for it
O Staff development and training are available
•
Community Health Assessment Report iv
Clegg&Associates
• • LHJs committed to assessment find a way to make it happen
O Paying for assessment takes creativity and commitment
O Directors who value assessment find a way to pay for it
O LHJs move beyond traditional funding streams to pay for assessment
O Assessment weathers budget reductions
• Access to key supports is critical
O Access to useful, timely data
O Ability to take advantage of peer learning opportunities
O Technological expertise,in such areas as statistical analysis and epidemiology,
as well as enhancements, such as GIS capability and web design/posting
KEY FINDINGS REGARDING KNOWLEDGE DISSEMINATION AND
UTILIZATION
• Organizations need to have the adaptive capacity(i.e.,internal and external factors in
place to support change) to incorporate new knowledge into existing practice
• Effective knowledge dissemination requires a link between the information being
disseminated; the needs, beliefs, experiences, and skills of the intended audience;and the
dissemination approach or strategy
411 • Research points to considerations or factors disseminators of information can take into
account to increase the effectiveness of knowledge dissemination efforts, e.g.,
demonstrating the benefits of the information/knowledge when translated to practice,
providing ongoing support and personal intervention, focusing on a problem-solving
approach
• "Messengers"are critical—they need to be trusted,knowledgeable opinion leaders
Recommendations
Clegg&Associates developed recommendations for the AIA Steering Committee that
include asset-building work at multiple levels. These recommendations provide the
foundation for the AIA partnership to assist the LHJs and DOH in creating a statewide
network of communities using assessment to plan actions for public health improvement.
The following recommendations describe what needs to take place to improve community
health assessment practice throughout the state. The subsequent stage in this process, the
development of a four-year work plan,will detail how the AIA partnership will translate these
recommendations into specific strategies to improve the capacity of LHJs and DOH to
successfully conduct community health assessment practice throughout the state. This work
plan will be completed prior to the beginning of the second year of the CDC grant in
October 2003.
Community Health Assessment Report v
Clegg&Associates
• RECOMMENDATION #1
Create a stronger system at the LHJ and DOH levels to support
implementation of community health assessment practice
The four-year implementation phase for the AIA grant offers an opportunity to make
significant gains in strengthening the assets required at the LHJ and DOH levels for
statewide community health assessment capacity. The following asset-building
recommendations are not easy to accomplish—they require vision,commitment, financial
resources, a willingness to change,and strong coordination between the LHJs and DOH.
• Develop critical assets at the LHJ level, e.g.,leadership, assessment capacity,Board of
Health support, community partners
• Build complementary assets at the DOH level, e.g.,articulation of community health
assessment purposes, demonstration of data-driven decision-making, organizational and
technical support for LHJs
• Forge a shared LHJ/DOH vision for the role of community health assessment in
achieving the public health standards and public health goals
• Improve DOH integration of the funding and reporting of assessment activities taking
place in categorical programs with broader DOH and LHJ community health assessment
efforts
i • Enhance the type and amount of assistance DOH provides to help LHJs build their
capacity to conduct community health assessment,e.g.,providing/analyzing data,
organizing trainings and workshops,providing mentoring opportunities
RECOMMENDATION #2
Help LHJs build the community health assessment capacity
necessary to achieve the Public Health Standards related to
"Understanding Health Issues"
The 35 LHJs are at different stages of development in their use of community health
assessment as a tool in achieving the public health standards and strengthening community
health. This recommendation offers a customized approach that each LHJ can employ to
begin improving its community health assessment practice,regardless of where it is on the
development continuum. As part of the implementation process, the AIA partnership could
create a self-evaluation tool to help each LHJ identify which group it fits best with and the
strategies from which it would most benefit.
• Group One
The LHJs in this group currently focus primarily on the implementation of
categorical public health programs,e.g.,Maternal and Child Health,HIV/AIDS,
drinking water quality,and are not performing many community health assessment
Community Health Assessment Report vi
Clegg&Associates
• activities. They may not have a capacity-building process underway that will lead to
achievement of the Understanding Health Issues standards.
The practice improvement focus for LHJs in Group One is on establishing the value
of community health assessment as a means to achieving the public health standards
and the LHJ's goals. A secondary focus is on the different methods for developing
organizational capacity to conduct a sustainable community health assessment effort.
Strategies include assisting LHJs in selecting a community health assessment project
to implement and providing technical assistance to complete it, assistance in
implementing and learning how to use Vista software,and organizing peer
mentoring among LHJ directors.
• Group Two
These LHJs have added broader issue areas, e.g.,domestic violence, to their public
health focus. They see the value of community health assessment to better
understand health issues but do not see a way to go beyond some limited efforts due
to a lack of financial resources. As a result, they may conduct discrete community
health assessment activities but do not have an ongoing mechanism for involving
stakeholders in setting priorities and planning public health improvements.
The practice improvement focus for Group Two is on developing the organizational
capacity,both in terms of finances and expertise,to develop and conduct a
sustainable community health assessment effort. Strategies include investigating
implementing regional health assessment capacity,providing skills training on
forming and facilitating collaborative processes, and providing peer mentoring
opportunities.
• Group Three
The LHJs in Group Three are engaged in a variety of community-based health-
improvement initiatives around issues like violence prevention. They view
community health assessment as a critical function in achieving the public health
standards and attaining their LHJ and community goals. They have dedicated some
amount of internal staff or consultant time to community health assessment and are
active in seeking out additional assessment projects. These LHJs may have a strong
community-based assessment focus and are interested in developing a stronger
internal use of data to inform program design, decisions, and policies.
Strategies for Group Three include providing a tool LHJS can use to determine the
appropriate next steps in improving their community health assessment practice,
convening statewide peer learning workshops,and offering skills training in teaching
community agencies and LHJ program staff how to collect and analyze data.
•
Community Health Assessment Report vii
Clegg&Associates
• RECOMMENDATION #3
Make community health assessment more useful to personal
health and environmental health programs
Community health assessment practice is not contributing adequately to the achievement of
personal health and environmental health program goals within LHJs. There are numerous
benefits assessment could bring to these program areas, but this contribution has not yet
been realized. LHJ leadership and staff involved in assessment have an opportunity to share
the benefits of data-driven program and policy decision-making with these program areas.
The willingness of assessment staff to reach out and encourage the participation of the staff
in these program areas is critical in making this happen. Specific strategies for implementing
this recommendation include:
• Develop a vision for the role of community health and environmental health assessment
in achieving the personal and environmental health-related standards and program goals.
One implementation strategy would be to convene a leadership-level work group from
DOH and LHJs to create a vision and identify individuals who can champion the
importance of community health assessment.
• Offer training opportunities, e.g., customized leadership development training,
community mobilization training
• • Support professional development opportunities by ensuring that training on community
health assessment is available at state-level personal health and environmental health
conferences
•
Community Health Assessment Report 8
Clegg&Associates
• Vista .v stem Evaluation
Assessment in Action Report
Executive Summary
Background
Starting in 1991,Public Health—Seattle and King County(PHSKC) began developing Vista
to provide their epidemiology and program staff with a user-friendly tool to access timely
assessment information on a wide range of public health issues. In its present-day form,
Vista is both a web-based,menu-driven user interface and a collection of public health data
sets.The program is a rapid,reliable,and interactive data analysis tool,designed to maximize
user flexibility. Through a partnership with the Washington State Department of Health
(DOH),Vista was disseminated to local health jurisdictions (LHJs) across Washington in
1996 and remains to date the primary software tool used by LHJ staff for community health
assessment.
In 2002,the U.S. Centers for Disease Control and Prevention (CDC) awarded funding to
410
DOH to improve community health assessment practice, enhance Vista,and share the Vista
tool and partnership model with Oregon State.The first grant year was devoted to evaluating
existing systems and developing a four-year work plan for achieving grant goals. The
evaluations and work plan development were implemented through a new partnership—
called Assessment in Action (AIA) —with Washington's LHJs and the Oregon Department
of Human Services,Health Services (DHS).A Steering Committee composed of LHJ and
DOH staff directs grant implementation,with guidance and advice provided by a broader
Advisory Committee.The Vista Advisory Group also provides input and oversight on the
Vista-related aspects of the AIA grant.
As a first step toward enhancing Vista and disseminating the tool to Oregon State,the AIA
Steering Committee conducted a comprehensive evaluation of the Vista system that
addressed four questions:
• How healthy is the Vista Partnership?
• How can Vista better meet users'needs?
• How well does the software function?
• What does it take to adopt Vista outside Washington State?
The methods, findings,and recommendations from these four components of the Vista
system evaluation are summarized below.
411
n n
Of 0 „..„,
. .,
i , ,, „ , •
. ., ,,..,„:„: ..„. ,,..
#. ..... .._,,: :; ,•, .
7,.,,, .„ „. , :,..., .,.:,...
.7 ,,,H, ..„.,,
• . „ .., , . ..1 „..;
. , . . :, :
Re. 5
> ...,- .. , . , 1
„
.. . . . .
. . . . . , .. . ,
, . ,.
. . .. ,
. ‘-'4, ;*';.. , ..
- ' •
.,,..-,..-0,14.4.:„‘.. . ., „i .,,,,.-.,, • ,• . .
• • . '• -••
0 z , , , ..
2. co ii ' ,,,:„ - .t: ; ' i'l'z;. ' ,',:..-::'''' ... •s.,:• ' e.;,,, ..;.- -— ••• ', ii„,..! 7,-; '' •
P P : .:.• „
, .-- i ,k
2 6- ,, ,
.; .
! , 1: ,' ..... ;
.. ,
. :
, , ,.
CD
: ..r .:: ..:-. ::
E - : „• . .;
L , • ?, .
CD , . . .
- -
:: It `,”, ,1 i,,„ . , . ' .' ' ' •.'.'
,
I
- .' iH'!.•
„::,..-„ ,
11I j I tat 1 i141
,
:i•.
a,-...-.,.,-:„ 1:.,„4',:,.iiW.1.'!•„v,.,-z..,-•x'L.:,0,,:,i_,.-0-.,,...,.,,,-
,
',•
.';..,
1.-. . ... ..1,2 L
. , ....
.: ..,
, ..„.,..,._, . .
' '
4 ,----„„.„,,,•:. :-.,. .: 1';: :: -: -,.; :-:,;.<4;-;-,,,:,---
-, 44,11zaw,trt;a4 'h''*otimy.;*„.**104,1,W,•, !,ti- , !4' 4.'•
:1."'a,:7S:14HP: Ilkitaltti44"1"rOgi`WW ;:'ql I
0
- - •
. .
., ,14!
;':':
1
•, rk ,,,---,op
*1111rzeileft4PIffec.111,1163‘ ii
,
f'.-
'.,,..: - •-,. . . ,
:,..,i;,, :
„,!t...._ ,...,, „?...,
:....,.
•.\
. .
. ..
• . „,
,.:..i i•,., ..,,,,, ...i.gm4Awir,.._-..-ft,siaronAR.,„,,
f.,:.',.:E§t iw.,......ligki tigrga,taa-RittalFtseZir, ;'.i,1.,'•! : .!., .,
,47.: 1::...:iV,t.4..x,w.,-4,42 +.1.-f;:ircitit., '
.,,..
--.v-:- -,2x13,-.. :..,-T,--,w:,..t -,,--'Y P:1,', Vi.;;I:g':'40, '-:.. .i4. 4.47A .,, ' . • . g
'C'.'''1.75i: "Mt-:S...:2,N4::.•Z4.4.I2441b.:EP.-0P.Z.
..'A' leir., 7:241hdc„:4:Eg.,':4:A,' 'Ef.11.:14..W.27-;;;;E
a-rd,s,..74---e.A-..It'z-vmai
-- ,
'• --- :'''' ,' ,
... ....
..7. : ,
•
\40
i <, •
..: v '
:. ''.:C •
': '.,'• :'.
. .
. ,.. . ....
•
'..,'„.,., ,.. „- •
• '.. 'T4'*4,tt'''''TfrtNit .-.. . , 1,- . ',
. i... ':',; !'• '''';,,;
. .
„,7, ,. .:•,,,
• , , ,
--1
0
•
Board of Health
Media Report
•
October 16, 2003
•
Jefferson County Health and Human Services
AUGUST — SEPTEMBER 2003
NEWS ARTICLES
1. "Healthy Youth Coalition meets at Point Hudson Sept.4"
P.T.LEADER,August 27,2003
2. "Community Preparedness Information Line expands"
P.T.LEADER,August 27,2003
3. "Free mammograms available Sept.20 at the Quilcene Fair"
P.T.LEADER,August 27,2003
4. "PT audience given insight in AIDS battle"(2 pages),
Peninsula Daily News, September 1,2003
5. "AIDS walk Saturday in PT",
P.T.LEADER, September 10,2003
6. "Brink noted for 20 years'service",
P.T.LEADER, September 10,2003
• 7. "AIDS Walk raises spirits and$5,200,
P.T.LEADER, September 17,2003
8. "Public harvesting of shellfish banned",
P.T.LEADER, September 17,2003
9. "Trio arrested for suspected meth lab",
P.T.LEADER, September 17,2003
10. "FDA official says wide tampering alert justified",
Peninsula Daily News,September 22,2003
11. "County has preliminary budget",
P.T.LEADER, September 24,2003
12. "Officials await shellfish toxin results",
Peninsula Daily News,October 1,2003
13. "Get your arms out for flu vaccinations",
P.T.LEADER,October 1,2003
14. "Immunization urged for pertussis",
P.T.LEADER,October 1,2003
15. "Health-uninsured ranks grow",
Peninsula Daily News, September 30,2003
• 16. "Measles Makes a Surprising Comeback"(2 pages),
The Washington Post National Weekly, September 29-October 5,2003
•
. .
•
• Healthy..Youth Coalition
• meets at Porn' tEudson, Sept 4
Jefferson County Community• -.disciplines of boatbuilding, Sail-
; slety/qrk'si.Ijealthy ou#1 canoe paddling and shipboard
• ;tion resumes its monthlkmeetings g with more traditional.therapy,
'ThursdawSerit.r.4,4,5:30 lint..at kind family counseling:Mari4d'a.
the.Port Hudson Marina R6om. •.Malcani Olu(gracious wind)pro.-
Guest spealcer is Matt Claybough, gram offers sailing and team-
president and CEO of Manned• building trips around the Hawaiian
Foundation.No RSVP is required Islands to local youth groups.
and all are welcome. The Healthy Youth Coalition
Marirned Foundation is a Ha- brings youth service providers,
wail-based public charity that uses government and agency officials,
activities on around the ocean and concerned community mem-
to help Hawaii's young men make bers together to help school-age
the often stormy passage through youths make healthy choices for
• adolescence.Marimed's Kailana themselves.Preventing youth sub-
(calm seas)program offers a resi- stance abuse is a primary focus of
dential service that combines the the group's collaborative efforts.
•
, t
s
•
ct)-T. Le-A-ere e.
•
• •
110
•
Community Preparedness
Information Line. expands •
' The Jefferson County Depart- 9161 and is available 24 hours
ment of Emergency Management a day.The new expanded menu
has expanded its Community allows a caller to connect di-
Preparedness Information Line, rectly from one menu option to
previously called the Homeland the Jefferson County Health
Security Information Line. The Department, or choose other
new features offer Jefferson options to hear various re-
County citizens some vital infor- •corded messages. It also lists
mation on issues beyond home- .the,federal website for terror-
land security. ism readiness,and instructions
"We see this phone line as a for contacting the county's
means to communicate with Department of Emergency
citizens about a broader range Management.
of issues,including community
disaster preparedness, mental
liealth concerns during a crisis,
and public health news such as
West Nile virus updates,"said
r Bob Hamlin, program man-
ager."We'll always be keeping
an eye on terrorist alert levels,
but folks need other informa-
tion as well."
"We lack radio and televi-
sion that has a real local focus,
so this helps," noted Daphne
Kilburn, public information
officer and volunteer for the
• department who maintains the
messages. "It's going to serve
as a convenient way for people
to get current information.You
dial one number and you can
get the latest on disaster pre-
paredness, West Nile virus
cases, terrorism alert levels,
counseling services, and the
emergency operations•center
status. And it has got a menu
choice for wildland fire up-
dates on the peninsula. That's
real important from now until
mid-October or so," she
stressed.
• That phone number is 385- -
•
LEA-DE-e_ r
$- 27- 3
Wednesday,August 27,2003•B 3
Free mammograms available
e at
•
cene alr
•
By Beth Cahape Soroptimists. International, cancer and explain how to do
Special to the Leader What Stelow convinced the local chap- breast self-exams.
V V h at to.
o do ter to sponsor this south county "We're learning not only how
Breast cancer is the most Schedule a free mam- effort to bring in a mobile mam- to walk these women through the
common kind of cancer to afflict mogram or pelvic exam on mogram unit.The Soroptimists, screening process,"said Stelow,
women. This year there will be Sept.20 by calling Health a service organization of business "but if there needs to be medical
more than 200,000 women diag- Department BCIIP screen--, and professional women dedi- follow-up for some individuals,
nosed with it—and 39,600 will ing coordinator Jennifer cated to women's and family we'll give them a variety of types
die from it. . Doyle at 385-9423. concerns,have been joined in this of support, both emotional and
That's the terrible news. But endeavor by other women as well physical,"she said."We see these
the good news is that if breast as women's groups. Care Buddies as people who can
cancer is detected early,chances . received a grant from the Susan . Stelow is fervent about getting respond intelligentlyto the fear
for survival are good. G. Komen Foundationto bring the early detection and treatment that someone has."
For women in South Jefferson in a state-of-the-art mobile mam- message out.. .After that training session,
County—especially those who are mogram unit from the Swedish "One of the things I keep tell- one of the attendees admitted:
uninsured or underinsured—there Medical Center Comprehensive ing people when I speak about "You know, I don't give up my
is more good news.There's a new Breast Center in Seattle. this to groups,"she said,"is that Saturdays for just anything.And
network of local volunteers and This is one of the best oppor- a breast lump or abnormality is I must admit that my expecte-
healthcare professionals working tunities to get these services in the not like a stomachache. It's not tions were very low, but it was
to bring free mammograms to the south county region,but in order to going to go away.You need to get terrific.It really,really helped fill
Quilcene area during the Quilcene receive the free services,organiz- it looked at, you need to get it in a lot of blank areas in my un-
Fair on Saturday,Sept.20.This is ers say you must call soon to get resolved.And with early detec- derstanding of breast cancer."
tof many efforts planned one of the day's limited slots.Only tion, if it's cancer, the cure rate Stelow is already looking be-
efferson County to help pro- 20 tests are possible,and five have is tremendous." yond the'Sept. 20 event. "We
mote free or low-cost services to already been taken. Now is the hope to take this and other efforts
detect and treat this and other time to take advantage of a proce- Other work planned to Hadlock,Chimacum and Port
women's cancers. dure that could save your life. . Group members as well as vol- Townsend in the coming months.
unteers from the Dosey Dux of Maybe we'll even make it over
South county Idea grew quickly Brinnon and other women's orga- to Forks and the people in the
These free mammograms will The effort is the brainchild of nizations in south county have West End of the county," she
be offered at the Quilcene Fair two local women—public health signed on to.staff this screening said."Wouldn't that be great?"
on Sept. 20. Additionally, the nurse Margie Boyd.and Nancy event and provide follow-up assis-
n e w group plans to offer Stelow,a local Realtor and survi- tance to women who receive ex- Signup information
women's health exams and bone vor of breast cancer.They wanted • ams at the Quilcene Fair.They will In addition to free
density tests. the group to both educate Jefferson also have booths there with health mammograms, organizers note
Mammograms are one of the County residents about this can- information, and South County that Health Department person-
best tools available for detecting cer and promote already-existing Medical Clinic administrator and nel will also offer women's
breast cancer,but the equipment federal,state and private programs nurse practitioner Marilee Mount health exams.The South County
to run these tests is large and ex- that pay for testing and treatment will give a presentation on breast Medical Clinic staff has arranged
pensive. This means that for . The Health Department has been cancer. for free bone density testing too.
Jefferson County women, providing access to free and low- Seventeen members recently To schedule a free mamma-
mammograms have only been cost mammograms and women's received cancer information gram or pelvic exam on Sept.20,
available in Port Townsend or at health exams for years through the training through Seattle's Fred call Health Department BCHP
locations outside the county. state-funded Breast and Cervical Hutchinson Cancer Information screening coordinator Jennifer
In order to offer mammo- HealthProgram(BCHP),butget- Service to become "Care Bud- Doyle at 385-9423. To learn
grams at the Quilcene Fair, the ting the word out has been chal- dies."Those who attended this more about this group's efforts
group — spearheaded by the lenging. training should be able to answer or to volunteer to help, call
county Health Department — An active member of people's questions about breast Stelow at 379-9236.
•
R Q a
�� 4 w m Z
y.� .gym
4 4)
1 1 o.E
t as
R as C.
or. a
0-' .. .
? � � a41
O
i' dH
` - =r ro
1. tt • a L+.
r � - V root
sra rE
b i . iO.
me-
--'1.---.4::::-.•,er � ` - €' .m1%.H
h d L
r
mr"c3
:��` � _t., -
4 Ctr m
y=.
Fla- --- a ". - ' i.W
0 S- --z.-------- .4::14.1.:1-i;n4,,,,,,I,v,--,s-,...-- -_. =,..- -- . . ., c 6
z r
' ut'. b" " $ Q3 co .- H0V � a) . -8w � 4P "
E4 p \
o �'� N $6-3 V ~
1" 0
0ima � 0 30 v v f .C.m
xy2.
Q a) .0 F NPliI
von L.,,,
F.- o x0 '" A sti \
Cli) mom o—.3
-cs0
(.1) Cr -., • • .4 o �yy�°O V p C/ a
4,) 1... , co 0•c ..0,..-,
Imo
O . I .0to ho . .4.
-�u .b . 3aoo Q"
einj
oW cWn� 0E a„��. -.8 0� ",1' NH
cz a c. -0_,.1 .,.....,- -1.r.b 0, ami-w
P---
0 CU .... V 'a F,,,,:3,-2 1 i -if ,) 1,,:-. .tii 5. 80.Q 2
'_ oa
y•'. o 4E' �'. •h
Oy mvOo > „ �G4z Leq
f. .q U A•os - d O A••-' a) d'tY b O vi
-4.r7 �o � a�wbi g o N eed' y � md q
U .2 s." g, 2"' 'f', 0 13-°'-4 'Z' ,TA 4-) g as "Sw-cycst3bJ • 4°-.1.4s• 71. •
d a) r ..ci „) .. ,0 Ergo .42 . "S o ro a) o
0.11i 04 0 01 0=.4 4 3 m g CO id a ' R 0 iJr °4.
°og8.�a'" • +°y 6' 2.3 'o.°q o � ac, N�. � � g "�
�� .qo a"i0a›, 00 " 1"'x. oQ+� agi'0. .cfo ad0 � cap 0gt°A �
oa' 02 0O0U]'0 os0Es 20 36Oa 7.. ...cc') a;3 PI'd0.'
"• a) dn
W .G 0 fr A0r� a1 y.0 0• 3 m 'vJ u '� �,t' ; + 'a::0 r.0 '4 " i 0 'd •
ac°;0 3 'd.8 0 0 p'2 0'49 A. '•. t.:. ,o Aa o 0 -:. .. •
tr
t , eo.0mca .0q a� a p.0 «� 3 to4g , .0
Pi
`I"� tto
_04) NJ a"iai4 CO °0ia3000 q `°md 9) a") q " is a) -Sq .0 P,U'- 0
;P3 • Hjn
q q d0 0.' , N HJid !
d = p 0-bp
7i >1 q m .,f3,. +� 3 > ag.., 3 0 :4 .a m w a 3 o 1 E-1 8 3 ::E- ..a
•
x • B
'. ..� ., •;. 0 .
ct a`w5i �'-?a qfi0q
Ot0 d
n 'ig r
1.
s^t: ' ' 5vO , .mem p v oayj • 111110
.x.,Tifkz,-1-W2,..?.• , Aw.,...14-,F.Filtrol: .-5 . a 0 gs 2 0 0 4.-i-0 0
F-,,,p,,,,,,,,,vr,,,zt ,,,m,..1:,,,,,:k...•,,,,,,:,4,• :wc-...,„7,,, ,) 0,.-ts -.0= .-ca.
a..k,, - '-4,-.0z to.4.N.,•410;.17. ',-t=" - • •`.1 ;-I 4 ,_(1)-,..,0)...0 0 ,c0 a,
'' .� u A Wy rd o O .'_
.. a � Uqi O : ? L
_eN O .... i ,
i ) ...:4„.,-„,,,, ,,...al.,,,,.."' Awa` �� w'd 42 q 2 O d '0 f.,.a)
. 'Up 4�. � O , :., q C 0
e 0 - Nc5 x -,.•,,,-,,,s s Hnt, s , . , 4 y
bpp
la) * 2 00"tdi g w q •
,tsiA..r\?.,040<t4in.:,':-,,,,:‘,,i4,,,I,,t,'-... ,r_>.1.1$••i.•a11,,-,:.21,.4.v,,42,
VD
',cAmay
� e t°'�s� �• q'b ' y °° q y a) 0 0•d ts
V„..':, • - O •a) y Wa) 4 .0 ,
iv , 1 , ' - >>oq .
c a, a�� C aa6y
7::,
g° „ " O•.. q q q, ,. a� ° .3 w4r . . C11 fa
O U
O ,� 3 f. p
41 10) al ..0.4 42 03.° I "P 0.5 0 0":11:i..01) ..cs°
4.GDW d•+� p`qo os bA...q ai4.1 pM 3dx d -QA II::
°' c
: i 0 '�]+o0
w C 0
_ ,0 ~ ' raotaP
aw
as
CI
U as c. o +4.�h ! iCH
01' Nq.' o0 •
124 d- Pu3o + ai- , s`d' d d rs taps q�� �C`5.0 01 0 o �
•> r , 4• d v� d " > t'.q�2 4 ) q C A".) 0 c, o 0 d 01 ca) 03 ° CO
ista 0 0 a c.0. v a) d a) d L O +0 A.`0^+ y H
q .-,•.c,.., a)"�+V y uJ .0 3 0 t 0 0 q a~ o p.q a)
O f1•d a).q 3 «'R q d tL'.., O V U 2,� 2 r� E-+ 3 . )4
A 2•Wednesday,September 10,2003
°AIDS
walk S •inPT
Need for local fundraising heightened by federal cutbacks
By Janet Huck Jefferson AIDS Services(JAS), JAS's chairwoman.Many AIDS bers talk to high school classes,
Leader Staff Writer the entity that helps meet the needs organizations have seen their churches and outreach groups.
of people still living with HIV and fundraising decrease.steadily At the same time, some JAS
Every two years, the AIDS AIDS by providing yearly sti- over the last couple of years. clients need more. help now.
drugs that keep Jim Monteith pends,wants to raise$6,000 at its As their deficits grow in the AIDS might have changed from
alive fail.He becomes sicker and annual AIDS Walk this Saturday, ongoing recession, federal and a life-threatening disease to a
weaker as the virus increases in Sept.13.Registration for the 1.33- state funding agencies have cut chronic illness, but the miracle
his body.Unusually fatigued re- mile walk starts at 10 a.m.and the housing and medical stipends for drugs that have helped saved the
ccently, he is concerned that his walk begins at 11,at Chetzemoka people living with AIDS. Last lives of people living with AIDS
present medication might be Park.Port Townsend Rotary Club year,people with AIDS were able are creating their own problems.
flagging.There's only one more serves lunch at 1 p.m. as a ma- to draw a$350 grant for housing The side effects of the medica- .
set of drugs awaiting him. rimba band provides entertain- and utilities from a federal agency. tions — including diabetes, os-
"If it fails, I have nothing," ment.Port Townsend Mayor Kees This year it is only$250 a year. 'teoporosis and blindness—require
said the father of three children. Kolff,who is honorary chairman "With the George Bush ad- even more medications.Monteith,
One person already has noth- of the walk, is scheduled to par- ministration focused on terrorism who takes 38 anti-AIDS pills a
ing — all available drugs have ticipate. and the war in Iraq, there is no day,also has to take two pills when
failed the Jefferson AIDSServices Last year, the walk raised focus on the epidemic on AIDS the painfromneuropathybecomes
client.A third client is struggling $6,000 that was dispersed almost in this country,"said Hernandez. too great and four shots of insulin -
on the last available drug. 100 percent to clients for hous- "For the first time in years,the daily for diabetes.
ir
them,it's a waiting game," ing, food, medication, supplies numbers of AIDS cases is in- "Fighting diabetes is harder
Al Hernandez,former chair- and utilities. Presently, the ser- creasing because people think it's than fighting AIDS because it is -
man of Jefferson AIDS Services vice has 13 clients; the number a manageable disease,"said Jean more immediate,"said Monteith.
that raises money for its clients. of clients has ranged from 11 to Baldwin, director of Jefferson His kindergarten daughter found
'Tune is ticking away,but time is 20 over the last two years. County Health and Human Ser- him passed out on his living room
what they don't have" "We need to make$6,000,as vices. floor one day last year and called
One client ran out of time.He other agencies cut back on their Faced with this increase,JAS her mother to say she couldn't
died in the last year. coverage," said Susan Price, is devoting more resources to wake him up.
prevention,education and inter- "People are walking closer
vention programs through a and closer toward the edge,"said
speakers'bureau. Several mem- Hernandez.
•
•
•
•
Wednesday,September 10;2003•B 9
:••••• k •
•
R T
R
•
•
.
• J
•
•
Ci
Brink noted for ,20 years' service • •
Helen Brink(right)accepts a certificate of appreciation for her
20 years of service as a member of the county's Developmen-
tal Disabilities(DD)Advisory Board,as DD coordinator Anna
McEnery listens.Brink announced her retirement from the board _
at the August meeting. Submitted photo
•
•
•
•
I
•
AIDS .Walk raises
spirits s ts
Teenagers, seniors in wheel- "It's becoming a choice be-
chairs and young men with canes tween food and good medical
walked in the 13th annual AIDS. care,"said Al Hernandez,former
Walk to raise money for people chairman of JAS. •
living with AIDS. The event Port Townsend Mayor Kees •
was staged Sept. 13 in Port Koiff was encouraging about
Townsend. finding solutions for these chal-
In a time of diminishing do- lenges.
nations for the now-controllable "If we walk together, if we
disease,Jefferson AIDS Services work together and if we talk to-
(JAS)managed to bring in about - -gether," he said, "we can make
$5,200 for its 13 clients. The our community a better place for
walk itself raised only $3,200. people with AIDS and people
The difference was largely made without health care." -
up by 21 corporate sponsors, -
which each donated$150,bring-
ing the total raised to within$800
of last year's total.
110 Still,federal and Washington
state cutbacks are creating new
costs for clients, such as higher
utilities,dental care and medical
co-pays.
•
•
•
•
g-tuu8 EEQ..n o § EV ° 1o
•'EO
V1 - V > u �c .2 ° °'e Ev • '255 Al2w °-0ou2. v0 9o us'v.88 ., 8,61. . g71.-108.-0 = o
• �$ . �Q >' u;y, u •5a wu - yEo_ 2 '
• 3uu S1^ � ° e ' c � t. r5. K. ) .
U y O `
k_ v
o $ �`uir
V c�y ASs' 0 « yg o▪ • oeoou
'"
uO v ° 0o uUcE ° oO 1° a 4) C-°� ,$ .a•$ "•o tory ,c O0 � uo.:2 �"'-. °a3 ° u . wCEK .b Q . u3.1 u.o g o,•3 o 7= v U o �a o 8 PI v3 N .CC y .0 L�r•O GN !12 .
0.. O• 3 6 E •, N y N •C
ti) •i; t0 g 2 r V C y H O 2 g.' _ O M C 2 V . C
• y O O., y O . O O V.0 y p, 0OuaC _ y9 •O pp g OUV -
• Q. EOUyN Equ0. ° VDO 1.4
— u v '7• 3 oV E > 2NE •coe ° N ° ta .. a40
>11
L $Ig
�J G' O 'OEVGO'OEy▪ yy • . V A0. . .,L . ..
Ci) >' Gt3 $ py 2.)V Q. O • L °
\. v . tQto c � 0. A y =' = 7
" v oc o v 4 r u eo co 3 o -0 = x c eo
'• a „ ` aaa' cE2 ,. ou > > V0c4 , n20ary u o , U
0 u w uuu_ V 0 3tit0 wLUyOC > V .3 ae 0
L
Cid
URU
HU :! flflI *E 0 C eC e-- c 2.76
a
0.12
Y•OCC• ppVI
O
° v • '• .9. = Eu s 00 g ` ., L _y Kca ° ° nu u ° `
•
• uoeE ° E.tayc°i u•• cn rizi ' - OQ•O u) 0.Q, 0 u Q. 7C OO•o bo_ 8 vC •O y 'Cy VA` °' con $ a� o ° ° ° uE2g ° Y Lee ° a aa < o y
° - ` u E
/ = ) . 0 ,g , -o ° •1V — .5 °20 ye *3 0 o •E Jil tipa.Y Q s "g•2 W .. , V y U> , 0:1 87 &..5 °4 y tea. w aoa _ x;cQ°$ u °; > u E E .E u °° u• E Vi • .2 774. ay v8 NCI cn v .. wd .0 W .g eb6u a :,ij > E � py- O� - us _
aEo > au •-• op eo- '”` E
0 yo � g ° a > ° cum0ou. 1� ua. w
oS � uu .. . a..5 V Om o " u u c t N u^ yavi Q. o
w v) co.2" pi°302w � si° � u "= HE00;,7coLcV
Em ` Qcu �'i °youcy $ U ' "
4::) 0. vo ° Q. •g •u
O , b °'oO o au.gou ai 3 � 604- 050 o uE.a•P. I 6,83 .c9• "a 3 y 3v E w.BU S y Cv
0
3 `veoQ 003 a •; MN
• � 3�.�a o o o o �• a s G� .c tie1 0 0 ,' .5 oA c
_ b U O y ° b °
a• .50 7.) u 3 $ `' a S c> pcn . u
c o G .E . o y Uw • a O Ob
X .Ep -44. 0 .1'0a / ; o
• � — a2C 0. C ` ^;U OHO . 0C U C U gU OU • C C c
E V0 .a a ' >' grw E 2aKJ 3 . oo " qu .rg .a :
0.E � c > d` uc X aa § 2Ko
hC/ oU oou �U fl ° 03So� mo 1tm � w
uu vk. h � a � �
.
_cw � o ° ... vaoo . ,3u >, i. a ° � " Ey ° u▪ •C .. C °
4 4-4 (0
Q. .
Q y ° E � A � �� / o � oO Z ` c oua } us la
$ o } wa
ti
•
. .
• .
•
• -
•
. .
• -
' • .
•
•
. . .
_ _ .• .. . . .. . ___
. •.
• • F. .' ; • . • ;.‘
.. • ...
- ::f.::. •.•••':...•.
.•• • mil.. ...-
1......•-.•ct1.•. ,,g•s .tn_, •Vt,"i•-•:.t.3.r;-:.2tgg...:I•I ..-: .. *1.g5 1a- §!
a
1.•.
•.:
• - -0..,__. - t; Is• .. ›,, d. t.
-. • • i • : . 1 4'110 I- : • ° °la' 8-- .-- t) 8 . s.s.= -. .0- .N .
- tiP)• .: . . 0 • 1-0-... ..„2.-• ....N ..-6. ..s. g
.. yi.4 .,,4,12,:o--d.i.0 s•••._a •cci.A.t.0.01...-,tyl .• a 8..
- •
. . . : 4..5 .-4,..• '-: 0 .4 • A.- I. or
• • -isitsse. 0.4 tr:4) 0-0.' =,r1 .ti. 0:. Q't I cd'-g v;-
• • • *• -, .. ' • CL) 8 ---.A.8„.,"4,,. .11 .g. ...4). a 0 46 g••>,..
- .0 - ° ILI 1..• te-1 64 0
-'...• . - . .
. . . . . . - a.0 0•I2 g CIA:.4 P. .1"' 0 gn as- :8 g 4:1
• • • ;,. ..
.-.7.> .." .0. a...0'0• .-ca, M.'0 .ft-g. . .1.,...,..,
S - ".-
.,,
..... a • .0 a g- ..0-•-‹
. ... .
. . . •
.
0:• .i:• .' r' . ., .,- . . ... . . . ...g 1,3.4.',;:‘ e . o.A 'g;':'• -_g.-=-.-g. •,- 2 4 0":1 .
OIS: -.•1 ::- . ..( ,7,," .024-°14) -. g..714: ar° -"ar•
•
• -; - .-.•‘•# . ' ... 5 >: • - ...P...8 g,s•8 1 -i3 0• .5-
£1-.0 •s"e cl g-4. •0-0 ›, .4:0.-
• - • • • . •/4,0 ,->4.,73 es:,,, -a o xv•_. E3.8,'-ri .0° 8 z,s
. .
. •••-• •
. • . . •;.--. -•: -.-74-4 r -4:`41"a 4 oel.gi ill :H als g 21
• , . ... .
• . .. •. . ..) a§ 0 .:2.0 c• N ... . .0.
.1:51:115k:i 4
• - • • • -.. - _0 >,i .c4..„.,d 0.-1,73"54:6.• 4 0.1'a 1-...3 :.
•.
a) .. _AI ._ 5 °'M .6 4:12 1:1 .ou 0 .. ' ,A*41 8 8..g- •
• • . • • '.. • " -• . amok' •T...•-0, 0.0 00•g 44.,.0 ..=
.. .: :- .•. •. :. .. . .. .. .- : -.. • • 49.. 8 .- •.8 -E.- 1"-§( ...z.v, ;) ,4 0 •
.0. 13.! .s ,
- 's°'m-° g 0 c).. '1),a :a-1;P -5 -0 u .
. . .
• . . .1
• :,,,,, 2 4 . ia•-, g . 0
-. - •• -0 0- r:c...2.21 71.U. 3 ..5-a.-.
• • • •• . .. , .• .0. .. .._•
• •
•_ . •
. ,...4 ..., 0 . . it. 0... ..•••..t..... .
.- Cl)
. - •..
- - ... ..,.:..... •:'. ..• : ..11 ..- • :-.•0•E at ccR g -g.,..1 ,s--.6.1.,.:... .
. . • • • - 4-'• ' El 0 9
• - . • • . • - - 8 E 4:1 92 wi.7.4:g.4-°3 1 cs 7.1*1-1:3
. . '-'1 - - 1-0:4teI a•lata g•a• g'
. -. .. . .
• :• i.' eN..-• ••• -' gg ig.‘" Pr tia:41 .‘° 14 .0 .0 g •' •
a .4
• • ' ; •- • - .,:: •.5410:• A.'0."CI'V, N 9'4•4.tet... §:s$.1 15,.A 4> .)-.
.• • . ••-r.- •• ... -•(41•44. .-:c'
.... ,....
- - 0 - -4 - - Cl• g' .0"o:°•.8 1::).' • '
.-•.• •
•
. .. . . • -• *: -.. -.-... - . :-.09'g:g- b-.. .•- a.414-41.T-g it-. 2-1'- 0-1' - .
_ ...0 0••, ..S.g.g.t g 0 0>-; ,..0 g.d fig:1-024
,• • 0 1 g .0t).0 c.P.,• - -.8-72-.2 °-'8
. - .
.. .%:-:
.. - :.-A Ni .-. i ci.`63-8._4.0. r.1 .r!).A >sit -;,-,rn '• ol-g- -
t5 - u k." (>4 . • •u." - o"
•_ .-•. •
- •.•t . ••••;• -Nur• .5,,o oi-a-b c)-4' :,--f,ir.,:g•---0 La t•Pi'to j:t .2 ) .
••••- ' - -4.64.' ..-LI- _-.,-cs'.0- - bo.. .0. g m..ir. ..-`41 :i .r& r4
wi
.01 . '.. .01) • - •
•• . ..:alci.' 0'. :'8- I.(.4.4"...:-,cf.411;:.08...5d. i A"`14 '
2 0.0. --- 0 ' 0 tig• 1 we
‘,-41
' • • ' " kt :8' g. I Cn . Agt cn r?
•• • 7E1 • %' '• ; • . g z 0.4:1 • t. 0 5 0.E4 >7;'7"S ft r. R. o
$ - . =. GO a.
• . ' 16 0- . IS
.
•
• •' ' - ......0
•-• .E .
• .
cd- a,
;,.§. - . t; § uA . ,se.0 g"614
6•4, =
ar '. 40 it)v,p, g PI .4 i Id 1-1 F. .s V)• I .._ - -
0 tor 0 cd bp 0 0 0- .
-E-1 .1 1 4.5 ..,02 ra 9....-4 r. gri-N c.,: V-0 8
o > � A S
o . N W �, 0 a ��' a
.A
d o m o
AN °� gd g g.45>.0.0 lPI
o a s y as
N El2 � ° .11
Ycn • U d ~ .4.. .4_, � n3 ° ai ai�a !J15
as an '0'
"3.` 'F. at 4.1 S�• c2 :,tV, tom'.iskp (3-1 : ,„ t1- 17,§ ii CI( 73: ° ' y'Id. : °�°'1 •y O•�' 8 Ofarf --9,..::—2 cj
;,;':•-;.-!lu-.!`. ut ,t.- 83 ° '' °.4 CI -
a
f . R. p �0o �° � a o8 .•
13
'r,,..•. ^ o d '" ` �,3.^1.8
d a C a� d of >,o c. -
k. ,0.. N C F A a , i S a cmi ( . I a7 o Y �4, ,�a a, a
7E125 �r�/ • a) C + E+ m w • m a7
1' 17.
' Z �� 'g��dtb aai � y •�,'C .� aN.oC'-�' '. = .b
A OZ
0as. .. a., W .4 cow .a3 . •..—i °' 7,3 a 2xx 18 Ca 'a)y 'L)
..x.x ai o cim
<; G CI p o o d, ° >
• Ndw0t,3 N A s a .
' (r,7•1:1 Ti .II7:2,>,o->, E .8 - ;; c '18
• m m rp m
�E
0 9'0 0. -@..v ,e. o 4, on x - 0
kv . -0o0. m ydo t ,. . ..._� ao� j' • _ ..§Ei �oNt � a80 ,..0 lO
g > ,.
A ,a 30 . e.S., :bm b
Ct
o A� 1 a �
\aN� F- k y .h 0 I::
(I) o asd 3V +Tai 4.--,-
'I? m o �X> a
(13
r '
CI. O �1 W N. 7�0 4 Ft:2ad'->,‘'a• L.
- '. r
L , . ° a ° v
hiIJI
L7 0.6.D
•
v
'� � gba3 °a *diq B Oo atl .
1. ' e. . 4' ...1'"' S
141
i.74 ''L. 0 1 -1,1 i 4 . g. .-940 cp, . .1.z ,
« < zg w.g.....5 a3 C7n � end aQ '°'IIIq -4;14- N p i' A g-.�ts Q a 8 ..
oIkh
C9 a ti
:_A 2•Wednesday,September 24,2003
• County has preliminary budget
Property tax revenue increase of. 1 % proposed
ByBarneyurk
Y e budget attempts to address the Liberties Union (ACLU) have expenditures for 2004 are
Leader Staff Writer top three priorities identified all but settled a lawsuit $11,329,636, down slightly
by residents in a survey earlier whereby the county has agreed from this year's $11,426,845.
Jefferson County Adminis- this year: law and justice, to provide a higherlevel of ser- It is estimated that the general
trator David Goldsmith likens roads,and public health:Even vice at the jail,including more fund will havea balance of
-.1the budget situation of county so,he is recommending against medical care.
governments in Washington to the addition of another patrol The completion of the $1,861,275 at the end of
.-A"slow-motion train wreck." deputy in the sheriff's office sheriff's annex in Port Hadlock The proposed expenses for
At a Sept.22 presentation to and is proposing less training is part of the justification for other county funds are esti-
: the board of commissioners,he resources than what was re- adding one more janitorial per- mated to total$28,712,730,ap-
: !noted that counties are man- quested by Sheriff Mike son, and legal assistants in the proximately $1.7 million
dated by the state to operate a Brasfield. prosecuting attorney's office higher than this year. Capital
'number of programs,but prop- Also chopped out of the will see their hours increase expenditures,which are part of
erty tax revenues, a county's budget is a code enforcement from 35 to 37.5 hours a week this amount, include
' core revenue source, arepro- position that the county has under Goldsmith's plan. $2,191,521 for road projects,
hibited from growing by more been talking about since late in Not yet accounted for,Gold- $2,162,290 for facilities (in-
than 1 percent annually. 2002. smith explained,is the negotia- cluding
Goldsmith's draft 2004 bud- "I couldn't find a revenue tion with the Teamsters Union county-owned offices at Castle
get is based on a 1 percent in- source to support that," Gold- fora new sheriff's-deputy con- Hill, $1.2 million for the
' crease in property tax revenues. smith said of the unfilled posi- tract slated for 2004 as well as sheriff's annex and $100,000
However, the change in indi- tion. Also, the position of proposals by other employee in
• vidual tax bills will not neces- building official,currently va- bargaining groups fomore and$422,000 in passsengercouousentsan),
d
sarily equal 1 percent because cant,has been deleted. healthcare fundin
g.
the tax base continues to grow The county and the City of Compounding the budget e construction vehicldg
and the county's tax levy is Port Townsend have been dis- challenge is a$172,087 reduc- onlineplayedcompletet is di at
,only one portion of the bill re- cussing ways to share those tion in payment-in-lieu-of- www.co.jefferson.wa.us/audi-
ceived by taxpayers.In Decem- two positions, and Goldsmith taxes (PILT) from the federal tor.
ber 2002,the county approved acknowledged that it is neces- government, the major prop- Public hearings on the bud-
a 1 percent tax revenue in- sary to have a properly trained erty owner in the county. In get are scheduled for 2 p.m.
crease for the 2003 budget. and certified building official. addition, the county's interest Monday, Oct. 6 and 9 a.m.
Goldsmith said that his draft One position that Goldsmith income is projected to decline Thursday, Oct. 9 at the court-
is proposing to add is another by $140,000 due to low inter- house.
jail correctional officer. The est rates. (Contact Barney
county and the American Civil The proposed general fund bburke@ptleader com.)Burke at
•
•
U11) • I
) t k • S �bA yo
4 . ... -, 1 0= 1f.' T •0 4.,^d o
I
� O U a� -C
r'
13„) , rtc r a 2 a+ y< m 3
M ,i d. �l ��. C Q IR N O b 0.
IIIIIM
C E m 0 0
C ) -
L
....... .tioi.,,,,,,A, .
X ,
b+ �� a z ° a c,
0
aal w -a •aw
�., ,. K :.. yyam ` W ° a .- .b
6 °NC '''' .1.1 - , 1 ° 0
a0 a) O H
s O a) 0 o O
Ull) ' , : ". -
■� ti. LA."- "Ti ° o E a
f I O 5 H o a
1111.1111 ' fill� H `ice
Ea w � �
— s g g If fdJjJ 0_m moo+ o
11110
al) tt,,,,,;?,t,,,,,,,,,,, , , \
, 7 ;„, , . .. o 7, 0
tx
EIC KV,•.,-..,2,. `ii.•,-.,•..'. , , \
(1) r. .'i,,;' : ,
1 t 0• o 0 al Z
F? o
% � 0 "'
Cm () o °
� o a b4110 � ▪ CZ ti aid 0�Z 'd
CCS ‘,„?;........•,.•• -. t
i-i °.� �y 3,- ow y oro c.y a ° w � a � ,�, %•..8 TIE �$,0
0Ct 0,o or- mm .° 0 _-', 3 4gi .'°..-o ciao o.a " '-'>;1
;1a
ti
�., O � 3 00 0 P. �,0 2 3 0 � � � ° ow d awg U0' o vX
i~ o ° ° m b.. a o 3 a.� O w s 0 0
�++ U 3'." O�' ,H, b y'� O. Q' fit
U°° y o w 0ad,. �. A °w .0 a)
^d a>,-,4: o E3 ' m.b rn .. d as ... d.�p 5305 v y O os o O to] .
(I) (I)
PHil!
3
xO oaS ° a ,sw . 9 ?mo ga a-o-oXab ° g5):4 vm4.e8 % § S Mi
HO �.b03agdaS.- y ? E. 000 0gP° m -o' .9 +' p 4a °
� '. .a a) 4 G .'og o c X , a) a0NZo0dEo i0C., Ea � _ m8coooo a)'vh .m � w i4m gmHti)+ 0- (1✓) ,pm o= a)>� <o° -a) 3 o 2 mv•a 'a i�U ci . . � � m7::, :,..,,,,.),..7
a) C
m d °° ai°° �>,ti) �• aC> ) o= 4v
ril
Ems
0 Cf)
•
Q^ �-� u d �' � w = oF) ° 1� b � v � bad � �'..-F„ ,,,,..,,?„> °3 0 O N ` ' �• O ca IV/ a) 0 0 O o O-° Oa7 U m Twdim H.;.,r o ° O x ° '0Zv a ° 4.a Ol y0 Ha ''' ElH " X ) a a) mm P U m o Zn,x 60^Cl) 1ak0a. 0 ° .SaF £ I § 0mm,� a +' m'mo > a) @, 0e0 0 0o0■� mmyac . maa0 o woB , da>,„,—E, 5cxoy, C! ZAHHNtmvC09 °A.oO C ma.• Ccs.73gb -0 ya 5, 'a
.� Q ' ,a&• ao �di" 7O1a Om2y ° . Wmo� mAgaO y•4b &Or—tNPac ..• -',z •A-s. v43,'� ?Glo > .. a .°y °w.bc 'oaP y
c/J ] Ad . G U yaGr, Ho .^ d ')-2-`•-e3)] 4-
d• -1 , t z Oros213` y -+' a3E4-. '.'C " aa);'y oOO - aZd v 7 ,� Qi� m,�WcO , 3a � .P1 ^ w _4.-0.0a: V db a' "r
, . _ , _
•
GetyOur'.arms out for flu vaccinations
u vaccine clinics will take caregivers of high-risk people. tors listed above should not get Townsend: Saturdays, Oct. 18
in a variety of locations
e 0 •Medical providers who pro- the new vaccine. It is notet &
y Nov. 1 and 15 from 9 to
in Jefferson County beginning vide direct care to any df the known if the new vaccine will be 11:30 am. Medicare patients _
in October. People with a high above persons. available at .any'clinics in bring your Medicare cards.All
risk for complications if they Flu shots are encouraged for Jefferson County. others pay $10. No insurance
catch the fluare encouraged to lower-risk groups including: Jefferson County Health & will be billed.
get immunized early.However, • Healthy children 6 months - Human Services will not be hold- • QFC Pharmacy, 1890
there is plenty of vaccine avail- through 2 years old.Young chil- ing flu clinics this year, but flu Irondale Road, Port Hadlock:
able this year, so there is no dren who catch the flu are just as- 'shots will be available at many Thursdays, October 2, 9, 16, 23
need for healthy people to wait likely to need hospitalization as area physicians'offices and gro- and 30 from 8 a.m. to noon and
for their vaccines as in previ- the elderly.Children under age 9 cery stores. from 5 to 7 p.m.
ous years. receiving flu vaccine for the fist s • •Quilcene and Brinnon dates
People with a high risk of time need two doses given one Flu vaccine-clinics will be announced later. Medi-
complications or serious disease month apart. •Jefferson General Medical care and Medicaid will be'billed.
from the flu include: • Family members and care- Group, 834 Sheridan St., Port Bring your coupons. All others
• Anyone 50 years of age or takers of children less than 2 Townsend: Saturdays, Oct. 25 pay$15 for flu shots and$25 for
older. years of age. and Nov.8 from 9 a.m.to noon. pneumonia shots.
• Children and adults with •Those who provide essential Medicare'patients bring your • Safeway Pharmacy, 442
chronic diseases such as heart community services. Medicare cards.All others pay Sims Way, Port Townsend: Sat-
disease, lung disease, asthma, •People who live in dormito- $10. No insurance will be urday and Sunday, Oct. 11 -12,
diabetes,kidney disease or ane- ries or in other crowded condi- billed, and Nov. 15-16 from 11 a.m. to
mia. tions. • • Jefferson Medical Associ- 5 p.m. Medicare will be billed.'
• People with weakened im- • All those who want to re- ates, 1136 Water St., Port Bring your Medicare card. All
mune systems due to HIV/AIDS, duce their chance of getting.in- Townsend:Tuesdays and Thurs- others pay$20.
long-term steroid treatment or fluenza. days from 1:30 to 5 p.m.begin- • South County Medical
cancer treatment. In addition to the traditional ping Oct. 2. By appointment . Clinic, 294843 Highway 101,
•Residents of long-term care flu shot,there is also a new type only. Call 379-5121. Medicare Quilcene: Mondays through
ies. of flu vaccine this year that is billed. Thursdays from 8:45 to 9:45 a.m.
Children receiving long- sprayed into the nostrils. It is • Olympic.Primary Care, and from 5 to 6 p.m. Medicare
•
term aspirin therapy. only to be given to healthy 1010 Sheridan St., Portpatients bring
• Women who will � more people`betweeri the`a es of y T your Medicare
r .A)e,;un $ 5 . , „ send: Saturdays, Oct..25 cards.All others pay$10.
than three m•onths pregnant dur- tffidi FT 44D11+ears'.Any 8 •fie'ltli and Nov. 8 from 9 a.m.to noon.
ing the flu season. a ine cal condition,pregiiaricy Medicare patients bring your
• Family members or or one of the other high-risk fac- Medicare cards. All others pay
$10.No insurance will be billed.
• Port Townsend Family
Physicians,934 Sheridan,Port
/b -0 3
rh-CC--A-DE • . .
•
•
•
•
•
•
• Wednesday,October 1,2003•B 3
ur ed for e •rtussis.
Immunizationg p
By Patrick J.Sullivan "This is a very communicable disease," waiver.Children who are not immunized are
Leader Staff Writer Locke said Sept.25."The more of it that is removed from school should an outbreak
around anywhere in the state,the more ofa occur.
Jefferson County health officials are . chance there is that aJefferson County resi- Locke and the local health department
-ging that young children have their per- . dent can contract it and bring it back to the urge that immunizations be kept up to date.
ssis (whooping cough) immunizations community and spread it to adults or adoles- "Our position is that we recommend that
schedule. cents or the group we're most concerned kids be fully immunized," Locke said. "In
On Sept. 24, the Seattle and King about,young children." terms of vaccines people tend to decline,
ounty Health Department reported that Adults and older children can also ac- pertussis,is generally on the top of the list.
)03 has brought the highest number of quire pertussis,but infants are at the great- Part of this is because in the past,there was
[fant pertussis cases in more than 25 est risk. a more primitive form of the vaccine that had
:ars.To date this year,189 pertussis cases higher side effects.Since the mid-'90s we've
we been reported,28 of them among in- Immunization urged had a much better pertussis vaccine. It's a
.nts less than 7 months old.By compari- Dr..Elinor Tatham noted that Jefferson highly purified vaccine, so the side effects
►n, last year at this time there were 10 County is one of the most under-immu- are much lower and comparable to other vac-
;rtussis cases among infants of this age ,nized counties in the state,and such a large cines."
•oup. None of the 28 infants have died, outbreak in King County definitely has re- 'Locke strongly advises parents to vacci-
rt 13 have been hospitalized, percussions elsewhere. Tatham said per- nate their children for pertussis, starting at el
The Jefferson County Health and Human' tussis symptoms might seem "like a bad . age 2 months.
.trvices Department is using that news as a cold,and it's very hard to tell this from a "This is one of the most likely infections
minder that this highly contagious prob- bad cold. But it's from a bacteria that re- a young child is apt to be exposed to,as evi-
m could occur here too. p leases a toxin that causes an inflammatory denced by what's going on in King County,"
Jefferson County had a cluster of 10 per- ' response." he-noted.
ssis cases here in 2001 but none since,ac- Pertussis is one of the vaccines'that state For Jefferson County immunization infor-
)rding to Dr. Tom Locke, the county's law requires of children entering public mation,contact Health and Human Services
:alth official. school—unless parents of that child sign a at 385-9400. • •
• y Y o O o
03 co aa
0 3 N .o :r8mV ® T r
400 .. i ® ®a� 0
C $ o c c`
L
sOOUR
ItoH.
jill u y ONE am
o0
C c R.-, 0 =
cle
ca
�S.E a 'c o T N
Ca ‘11■•O C, c co T
I . I ! i
imi Crn rn 1
.0 H N ® ic ori - o 9
0 a N 0 'C .D C 'B (fl C g
co O 3 Y NN N c
73 O U
V?am =7Ut0 ,NLb9 p gp C13 1.7-' y O O p j NN7 p W
Z O 222 V Z Z Z U Z =
6N9 (A69. J
O
• Ug0_ 4�o 'd m . .appsc2a)ggo .,„?) ,e) ., v] gao 'a U d= . 2.g 0 o,0 0 a
cb, 00 Soot ol
� o q3q'
0 fg,. 0. . o c bo an$-5 w
w 0,.,1 C
� g en
k 142.a .u > q � 2'b •�oo y >b• �q m8 `� agi
■� baso a �� U ° NF. ° b., a q ,-14)
2' ad >O sz O•E ab b11 m CD y r~
00' °.0•r�
Ii !5. . t3U g;-g CO
�dq.gq m nth ' �.51 lz.� y
mai .r4-i..r ° 'S TO Jr A.0 O &if)_�. °
C/1 a°
In
i= . I-C '74 4g t"cl-a 7-1 °I 4.)
pgil . gog ›, 0 .8 co
63
w �
E CCS 1 3L•0 . 8 ° do0� o > nTh
co .
(1) T±L-4 4 (u (i) ,- z.,.., tl 0 c.f., V 4 k...0 4.,
(t-
co
042-08� dH ~:w 3 o 2 . b � ,4
oW r-, •.-, F 81 :
.2 2, -ago 3Z
•
•
September 29-October 5,2003
+ THE WASHINGTON POST NATIONAL WEEKLY EDITION
SCIENCE LAB
• Measles Makes a Surprising Comeback
The number and size of outbreaks is climbing steadily in England
By David Brown virus is looking for,metaphorically speaking,
'Washington Post Staff Writer They will be a group of susceptible hosts(with
new ones being born all the time)large enough
case of measles was once a rite of for the bug to set up a self-sustaining chain of
passage for every child,and a person-to-person transmission.The "herd
route to the grave for about one in immunity'now protecting tens of thousands of
every 300. children will disappear.
_ Worldwide,there are still 30 The term was coined in 1923,and its defini-
lliomostto 40 ly
cases a year,and 745,000 tion has evolved-Tbday,'herd immunity"typi-
deaths, Ily in Africa.In the affluent world, cally refers to a situation in which so much of a
however, measles has population is immune to a
been as good as gone EPIDEMIOLOGY the few scattered"susceptibles'earas diseaseas
for a generation.But it immune to it.That is because an invading
is coming back in an microbe is unable to
place.unlikely case when it encounters one oa f the In the
In England,the number and size of measles titles,that person is so surrounded by protect-
outbreaks is steadily climbing.In 1996,the ed brethren that there is no one nearby to
country recorded 112 cases,Last year,there become infected.The chain of transmission
were 308.This follows a steady drop in the breaks,and the infection disappears.
proportion of children fully immunized against
the virus by their second birthday.In 1996,it
was 92 percent.By last year,it had fallen to 84 IF ENGLAND LOSES HERD IMMVMUNTTy TO
percent. measles,it will not be without precedent.
This trend is the product of fears that a Fear of rare but severe reactions to the per-
measles vaccine,especially in its current formu- tussis(whooping cough)vaccine in the 1970s
lation as one-third of the measles-mumps-rubel- led to a drop in vaccination and loss of herd
la (MMR)shot,increases a toddler's risk of immunity to the disease in both the United
developing autism a devastating neurological Kingdom and Japan.The introduction of a far
disease.In the late 1990s,a physician named safer vaccine later boosted coverage rates to
Andrew Wakefield,then at London's Royal Free more than 90 percent.Similarly,several parts of
Hospital,published research suggesting a con- the former Soviet Union lost herd immunity to
• nection.Although the great majority of experts diphtheria after that country and its public
believe the link he drew is spurious,the number health system collapsed.
of parents refusing to vaccinate their children Just two weeks ago,the U.S.Centers for
appears to be growing, Disease Control and Prevention(CDC)report-
The faltering public confidence in the ed that measles had broken but in the Republic
measles vaccination has British public health of the Marshall Islands for the first time since
officials very worried,because the population of 1988.There have been 647 cases and three peo-
England and Wales is approaching a tipping pre have died,including two adults,in a popula-
point.It is about to lose "herd immunity" tion of 25,000 people.Before health authorities '
against one of childhood's most dangerous launched a crash immunization campaign,less
infections. than 75 percent of children o
If vaccine coverage continues to fall,some- had gotten a dose younger than 13
time soon the unvaccinated children will no Te islanders lost their of d immunity.
longer be able to"hide'in the larger crowd of The idea that a population's immune status
vaccinated ones.Instead,there will be enough could affect an individual's risk was recognized
of them to become exactly what the measles as early as the 1840s by astute observers of the
Protecting the `Herd'
When a large fraction of a population is vaccinated,the few who are not
also tend to be protected.The easier it is to transmit an infection,the greater
the proportion of the population that must be vaccinated for"herd immunity"
to take hold.
le Properties of •"Basic reproductive number": Ns Herd Immunity 1111
popalatloe' the average mber of people threshold Proportion°t
co
beseuni:ed ow Infected penes wig infect' susceptibpopulation
l
e
'When news an not Immunised
•
Diphtheria 6-7 85% 11lI tlll8111111�
2.1S
Measles = 83%-94%lPHIII
Mumps 4-7 i i I 75%-86% `
!!ifilli(iilfllll�
Pertussis 12'17 !92%-94%
worm tam Ir t!!!I
Polio 54 8°%.
0% %
tliifi!!PI!!i!!!!• �
Rubella 6.7 83%-85%
illll0Uu!!!nlbq
Smallpox S.7 80%•85%
IIIIllt6!llRltil
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
SOURCE.Fine,P.E.M.,Epidemiologic Reviews,1993
THE WASHINGTON POST
', ` . ,
•
-
1
li '°� S
`
i
• •i
a > ,f
®'Vii. , T1
-cd W, ""kr " in
1
`j i si
I€F
ra (( ( y. g
:fan
C
, p,
f'
•r lY
6_
'
i
I
CENTERS FOR DISEASE CONTROE AND PREVENTION
A doctor gives a measles vaccination to a young boy in Atlanta in 1962.
effects of smallpox vaccination, according to a not hard and fast. It depends not only on a •
review of herd immunity published in 1993 by microbe's innate biology,but also on conditions
Paul E.M. Fine, an epidemiologist at the that can change. Social factors, such as how
London School of Hygiene and Tropical many people sleep in a room and whether chil-
Medicine. dren attend school,and seasonal and geographi-
That, in turn, helped lead to a crucial cal conditions also affect an infection's RO.
insight—namely that epidemics stop not Nevertheless, the number for each disease
because a pathogen ceases to be dangerous, as tends to fall into a consistent range.
many had thought,but because of a complicat- al
ed interplay among a microbe's biology, the ONCE A POPULATION HAS A LARGE NUM-
number of susceptible members of a population, ber of people who are immune, the key ques
and how much contact they have with each tion becomes:If the microbe finds a susceptible
other. person in this mixed population, how many
The fraction of a population that must be additional people is that victim likely to infect?
vaccinated for herd immunity to kick in is That number is called the "effective repro-
something public health authorities like to ductive number."When it is less than 1,an out-
know,for obvious reasons.The"herd immunity break will disappear spontaneously because the
threshold"differs from disease to disease.It can victims in each round of infection will not
be observed,but it can also be calculated. "replace" themselves with new victims.
Intuition suggests that the more contagious a However,if the number is more than 1,the out-
disease, the greater is the percentage of the break will sustain itself or grow.
population that must be immune to achieve In a paper published in August in the journal
herd immunity.This turns out to be the case. Science, Vincent A.A. Jansen of Royal
The reason is that herd immunity threshold Holloway, University of London, reported that
is mathematically related to another key con- in England's recent measles outbreaks, the .
cept in epidemiology called the"basic reproduc- "effective reproductive number" has been ris-
tive number."Expressed as RO,this is the aver- lag—a very ominous sign.
age number of people each newly infected per- In the outbreaks from 1995 to 1998,the num- -
son will infect in a population when everyone is ber was 0.47. For those from 1999 to 2002, it
susceptible. In practical terms, this means the was 0.82.
average number of new cases produced by each If it reaches 1, measles will be able to find
victim in the first few rounds of infection, enough new victims to keep the infection mov-
because in later rounds there will be significant ing through the population—at least until
numbers of people who have natural immunity something is done to raise the percentage of4110
and are no longer susceptible. people who are immune.Herd immunity will be
An infection's basic reproductive number is gone. •
CDCCo V 0corn o0 a' 0g4 CD co v4 v
(D y --3 .0
v cn 0 - � EO N cn � � 0 171
CD N 3 I I W I (D I o I 3 1 I o _a CD
x
n cD -C • C 0 ° U1 (—D �, Cll CD m Cn O ,--' .- N SD Q
0 cu(D (D �, x CD -� 0p _ � 00 CD- N�QX X O0 ° � 0'
o �' c� o � ° � w ° cD
v 73.) m O o cu -a o s• �, �.7 Cl.v o o FF5'-a m �' N
CSD Z = ED C_D — (0 6,....,---
D .Q C r,- i....,, M -0- O O CD - 0
• D pOO 3 P (DC (DD
cD
CDCD(Q (D (D (Q • <D 'vCoCC Dcn* o 0D pO * Q Q _
O co co v D 0 D o O y v v CD 00
Qo Cco80m0) ° CO � 0 c o us
o o C o' O Ccnco
' CO ID m v O ° O (j)) Fe
CDfl;0,) (D N ,
o 0 N C0D ccDD v 5' sz ~' Cn W O 0 O 0 E C a- ccnci) x. 2
3 a, — cD 0. cD .p Q 0 =- o (D -O (D
CO CO Op oh ' O a) 0) -t 5• -1 (�D (D
� < 'a
D
o -,, Mn - = (DD 05_. = D ` v
a6
o 0, 0 esQ ao 6 � ° °m S CD 0 a� o LI r o n
a =o_ co D � 0 coD3 • Q Q p (Q, _
OX CD. o = -p 70O : - Cy -p cn (Q 0.) -- (Q 0 D =h D
N � m. (D --4 = 0..) � = - (DcnNg � oon � cn oma
O CO cD cQ (D v CD — cD p X co Ft v,
nrn o 3 co3lj orn FDI- C -4- CD -1 � g o
O O0 0 O 0 Q v O 0 • (D v CD S g 3
< Cl. - 3' co 00 =-, Z — C Cu
X o CD o 0 CD �' � r CD a o o o 2. o !o
0 0 0 0 ° cn0 Oo ° CD o c• (T). = xj
t CD
5- 0- _, CDr-.). OCD (D0p 0_ < N
m � CD - o � � o - 0) -0 � a m CoEa). (1)
co o • �- Co 0 CD
n, m o ° Q CD Q W 2 v' O � Q ° 0 = ° -.1
0- (D
o m
• o � o � si' z � 0 �(Q Q ", 0°, � � D
v -0 a 3 coo• SCD cDOv QCD5 CD Off_ - Ci
C cD 0 0- n, (n CDN v o• v CD -fi co 0_ a O- i
n 5- (D N O (D CO 0 o C-D C7 (1)
Q.
n 5• v
0 0 2) 0- Q (D U Q 0 O1 CO =• (D (D co p•
(-D 0 (D
- —• -, X p (n 0 'Q -p p' ,..,. v O a ID
•Q5- con co c3. a)
Quo (C"n �' � pais 0 � � Q
Q Q- CD C, Q c0D iv a' (D 4 °co —. o (D 3' c v
a. v 0 0 w. c�D O_ CD 6-5. 1, = C CD N 3 0• (D O
Q (p • �' O p co(D • N (D (�D
o v v �-0 oaO0 �' ? _ O-� �O �. m v
o a CD 3 a
= COD 0 O g p o- ° 0 0) v 0 v co
I •_ v 4 a
—,, n (D 3 Q fb 0 c,• 0
D ° O O 5 ° v co 0 (n v v, O
v' O N ., v O a) Cv O' 0
p ° (D p OD Q p CD
3 tZ � � cQ 0 o � � ova' 0 = Q
57 ED N (n 0C) >< (D -D C p` o CD
CO O ID C 'C --� p n 0 ' nQ 0 D -o u,
Co CD (D 4 D � (n v0 -
a co -p
-0 Q 0 C CD ° N p Q p O v
O• •
c0D co p ccoo �' Q Lo ^3 O� 0
0 0 ° > O (n CD O' 0-0 ° m' 5' 0 o • ,
O N (D (D 4 �' C (D O (D CD 0.
3 cD 0. v
5 °� 0 vk',' Z3 co v 3 0 � m -o `� (D
F6' CL
CL
Cn° 0. cQ � CD CO CD � pv� o a) -.%
40 -.
Z -a- )>
o• ma �Cn � CD
v' 0 V
<
v 0 � 5 pcQ v CD CO Q
W CD �� v CL CD : --,1 C o 5 O
a a CD
m
a F13 a)
O N nc = a (D � cDNXD0 cCsa O � a cn O
(D
cn .-ri 0
N (D p �� . (D D T n _
co(Q O C O 0 O
(D 0 • 0) CD = C C • (I) v lirN-
CI
C C
0 O n- Q- (D -' 0 7 o CD (n N fA (D 0 n O 7 -0 W Li
0 =i cn CD x 6 G O� (D (D O G , -� n (D C
Q a 3 EQ, c .0 s< cn = �• n 3 v < � m° 0 5. H
_ 0 s.
m p ° . (D �' n v O — . .- O,, X X D 00 (D o c0 O
O N
� N C n D O 3 0 O. 3 � ai k Q
O (--1), (D `ED -IG to O cD O O (D 'y'
v (I)
- MC
(n _ Q v X k(D v D _ (D CD, D 0 3 c (D O co
1-0
-h
1-3
3
O ' CD c (Z3 `- m "O �• = -o 0 A CAa) y C n D cD v O C cav O Ofn -+, N v p DQ (D( ) < vn X CO 7. n(D O< D = () O OC Q 0 1 - 03 TI o C NO p p (D =Q3= C Q 0--O5. 0- -O (p ,t O p
CD
a -,, -
C * O o 6 c� mv cn (D o. N a r- m �• 4
Cr ,D cl cn n �' o N ai
0) . o
o •- St (D cn ° (D0 Q (D (�p O o O .a p N
< 0- 3 -, o N a cn 0 3 g X X X 0 c o
wip0)
B 0 0O O -, U) N v p O O3 _ 0 p -"8 - p o 0 •OD3 D I1
p0. N
-,z• 0_ v CDl ( 3 F) 0 vN= --0cn 0 (n.-0 p O = (D C W-' C
pFa)
.<--' O SCCn y ' Q .. 0Q 0 CDD n --
6 QX X n
v0 ( 01 0
CM v Q fn D Q' 0
tCN ( � ( 7 0 U
3 (D cn `< m- a)
CD CQ ' Q CT 0 p
D (L] O
cn
? coo< D ID v n (D (D -I II a3D (D O (nD N D .g' RSD v N '0 QO 0 Qo(Dn (0 0_ al D 3 O N coW Cv (n Q r' cD Vp) o N N ( p v 3 Q Qv . 5' NN V' D 3 . U (D CD n Z a n Q o o_ ' N X X X lN N O V) !y N v N' C J
co a) 0 cn o
- v ( D ( 0.
O pC . ( D -
0 Q = Oo IIQ. N < E;Q( CD D ( ( ' 'O O 5• co( D �
al
•
•
3 8
us
,� v 0 0 cD cn a 3. CT. o 0 rn 0 •<
v O - (D (o -, -c-n- O X T a O o 0
(D (n o n
CL RI
cn v (D v N' `< (7/3 (p 0 O m
O O `< (D O a S 3 `< C 0
cr 7 5' --h
3 D-
N o 3 o O (D O < < , '� 0 0 0 (D
3
(n a C n (D (D cn O a) r
cn * (nvo 3 E -
ifs 3 < O co -p C (p -�,
o C = O
CI 0
P = CD — C
. R cn Cv (n
(D v 'O < ' D
0 0 C O — C n D
0D _
o. p o ,.
(D v I� V) o _Itoil
I? C U) >z 0 o X m 3
(D -7' (D cn (D m
D 0
N
• W
CO
N
z
ii
Z J
W m ..�
(5J--
I- a. w
u.0 :a
CL
m c
w v
� z
a
Ar)
w (;�
z
u-.
\K.), . .-
„,\
0
w r___ r
CZ
5\:, >
f Em
S
3 :-\ .t)
C °g v
v
m
cn
C_ w
k D
X
-0o
0
a' O
w a to 2
•
I _ >
tNi m 4 -I
,.r nQ r rt M
c. Z
t O
TS
C p
Cr o
0O
v
. O
O
=.4
(1p Z
C
m
0
-,
Windermere
Real Estate
• Port Townsend
October 8, 2003
Julia Danskin
Jefferson County Health Department
615 Sheridan
Port Townsend,WA 98368
Dear Julia,
This letter is to communicate and marvel at the skills and dedication of Margie Boyd. She has single-
handedly whipped women into action to help other women of Jefferson County. Please allow me to explain
a bit.
I met Margie in 1998 when she was looking for property to move to Jefferson County. Later, I saw her at
the Tri-Area Center being so kind to an elderly woman who needed medical attention. I had no idea she was
with the Health Department. We would see each other and talk periodically. In 2000 I was diagnosed with
Breast Cancer. Being a 'life changing and affirming' disease, I decided I needed to do something to help
other women when diagnosed with cancer.
As a member of the Jefferson County local Soroptimist International (SI)Women's Organization, we
• organized a workshop for women entitled"Do Your Dream". Margie saw me the day after the very
successful event and asked what my dream was. I explained my dream. Margie walked into my office the
following Monday and said, "I'm here to help you do your dream!" She proceeds to inundate me with
wonderful brochures, self-exam cards and details on the Breast and Cervical Health Program. Her initiative
got the ball rolling!
About 6 months later, SI of the Pacific Northwest challenged each local club to define a project that helps
women with early detection of women's cancers. Of course, we call Margie! The combination of Margie,
Jennifer and the JC Health Department and her contacts at Susan G. Komen and NCI along with the local
women of SI and a group of concerned women in South County made a powerful group to coordinate the
activities of events to focus on early detection of women's cancers. Our first event was at the Quilcene Fair
in September 2003.
Margie made a presentation to SI,then brought in Susan G. Komen and NCI for another presentation to SI.
She then made the arrangements for a number of tasks and plans for the events at the Fair and specifically
all the exam/medical services. Since SI and South County Women were `womaning' a booth with
information, Margie even arranged for `Cancer 101' Training from NCI to prepare us for questions from the
women. This is only our first step in educating the women of Jefferson County!
•
Windermere Real Estate/Port Townsend 1220 Water Street Port Townsend, WA 98368
Telephone (360) 385-9344 (800) 776-9344 E mail 'ptnancy@olypen.com'
Julia Danskin
' October 8, 2003
Page 2
• SI is thrilled to have partnered with the Susan G. Komen Foundation and Health Department and
specifically Margie. You may not know this,but SI Northwest has used the Jefferson County Early
Detection Project as an example to our sister clubs all over the Pacific Northwest. Because of Margie,
Susan G. Komen is partnering with Soroptimists and will be making a presentation to our Regional Meeting
to partner with them and with their local Health Departments. None of this would have been possible for us
without Margie's drive and determination.
We look forward to more projects with you in the future.
Sincerely,
a.
_ ,„„ ws.--vorprig,
N cy
cy Stelow
III
• Windermere Real Estate/Port Townsend 1220 Water Street Port Townsend,WA 98368
Telephone(360) 385-9344 (800) 776-9344 E mail `ptnancy@olypen.com'
PUBLIC HEALTH
Always Working for a Safer and
HEALTHIER JEFFERSON
October 9, 2003
Margie Boyd
Jefferson County Health & Human Services
615 Sheridan Street
Port Townsend, Washington 98368
Dear Margie,
At this Jefferson County Board of Health meeting we would like to take a moment to honor
you and your work with the outreach design implemented in South County to reach women in
need of breast and cervical cancer screening.
• You put together a team within JCHHS and with community volunteers. With the help The
Doseducks and the Soroptimists you provided the women of Quilcene and Brinnon with
excellent care in a highly advertised clinic. You were able to encourage new folks to come in
for care. This was a major success.
Your idea to apply for the Komen Grant for the mobile mammogram, and then planning a
Saturday clinic was a novel and wonderfully successful approach. You also started a chain of
peer-to-peer outreach making it easier for women in South County to encourage each other to
get yearly exams and mammograms.
The outreach you have started will continue to help the women of South County for years to
come.
With heartfelt appreciation,
Geoff Masci, Chair Jean Baldwin, Director
Board of Health Health & Human Services
• COMMUNITY ENVIRONMENTAL NATURAL DEVELOPMENTAL SUBSTANCE ABUSE
HEALTH HEALTH RESOURCES DISABILITIES & PREVENTION
615 Sheridan Street, Port Townsend, Washington 98368
(360) 385-9400 Fax: (360) 385-9401
PUBLIC HEALTH
Always Working for a Safer and
HEALTHIER JEFFERSON
October 9, 2003
Jennifer Doyle
Jefferson County Health & Human Services
615 Sheridan Street
Port Townsend, Washington 98368
Dear Jennifer,
At this Jefferson County Board of Health meeting we would like to thank and honor you. Your
dedication to clients and commitment to a successful project is clearly seen in our BCHP
Review Report and the highly successful Quilcene clinic.
• The leadership you have shown is recognized by our contractors in Seattle and by the clients.
You have received rave reviews from grateful clients and staff as you work above and beyond
the call of duty to help the women of this Jefferson County.
Your job requires you to do timely, efficient billing and program management, but you invest so
much more with your compassionate client follow-up. You have been instrumental in BCHP
screening. No detail, referral or question is beyond your complete attention.
Your work is truly appreciated,
Geoff Masci, Chair Jean Baldwin, Director
Board of Health Health & Human Services
COMMUNITY ENVIRONMENTAL NATURAL DEVELOPMENTAL SUBSTANCE ABUSE
HEALTH HEALTH RESOURCES DISABILITIES & PREVENTION
615 Sheridan Street, Port Townsend, Washington 98368
(360) 385-9400 Fax: (360) 385-9401