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Jefferson County
Board of Health
Agenda
Minutes
January 15, 2004
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JEFFERSON COUNTY BOARD OF HEALTH
Thursday,January 15, 2004
2:30—4:30 PM
Main Conference Room
Jefferson Health and Human Services
AGENDA
I. Approval of Agenda
II. Election of Board Chair and Vice-Chair for 2004
II. Approval of Minutes of Meetings of December 18,2003
III. Public Comments
IV. Old Business and Informational Items
1. Gypsy Moths in Port Ludlow
2. Healthy Jefferson
• 3. Medical Assistance Administration Survey
V. New Business
1. Draft Ordinance regarding Methamphetamine Manufacturing Site
Evaluation and Clean-up
2. Bovine Spongiform Encephalopathy in WA State
3. On-Site Sewage Permitting Program Activity-- 2003
4. 2°d Draft of Policy Concerning Evaluation of Existing On-site Sewage
Systems and Building Permits
5. Influenza Update
VI. Activity Update
VII. Agenda Planning
VIII. Next Meeting: February 19, 2004, 2:30-4:30 PM
Main Conference Room
Jefferson Health and Human Services
i
JEFFERSON COUNTY BOARD OF HEALTH
MINUTES
• DR,ACI Thursday,December 18,2003 bRAP7*
Board Members: Sta fMembers:
Dan Titterness,Member- County Commissioner District#1 Jean Baldwin, Health &Human Services
Glen Huntingford, Vice Chair-County Commissioner District#2 Director
Patrick M. Rodgers-County Commissioner District#3 Larry Fay,Environmental Health Director
Geof ry 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 with
the exception of Member Buhler. There was a quorum.
APPROVAL OF AGENDA
Member Frissell moved to approve the agenda as submitted. Commissioner Titterness seconded
.he motion,which carried by a unanimous vote.
APPROVAL OF MINUTES
Vice Chairman Huntingford moved to approve the minutes of November 20,2003 as corrected.In
the first and second sentences in the second paragraph on Page 3 "immigration"should be
changed-to-"in-migration. -Member-Frissell seconded the motion,which arrie by a unanimous
vote.
PUBLIC COMMENT-None
OLD BUSINESS AND INFORMATIONAL ITEMS -
Appreciation Awards to Jefferson General Hospital: Jean Baldwin circulated for signatures awards
thanking Jefferson General Hospital, their Clinic Staff, and individual doctors who bought extra vaccine
and scheduled extra clinics during this flu season.
Washington State Nutrition and Physical Activity Plan: Dr. Tom Locke called attention to the kick-
IVbrochure included in the agenda packet,which recognizes the health impacts of inactivity. Currently
Jefferson County does not have any associated programs,but there will likely be opportunities within the
next year.
HEALTH BOARD MINUTES -December 18, 2003 Page: 2
Budget Update: Financial Manager Veronica Morris-Nakano and County Administrator David •
Goldsmith were present to brief the Board on the significant budget shortfall affecting the Health and
Human Services 2004 budget. Ms. Nakano reviewed that the Board's packet contained revenue and
expense budgets for 2004. The first of three factors contributing to this budget problem was that $61,705
in expenses was not seen until after the budget was completed. These expenses related to increases in
Information Services(computers,building rent,records management) and Benefits (health insurance).
The second factor was that the Department received$36,700 less than expected in revenue. The third
factor was how the County's change back to a modified accrual basis of accounting versus a cash basis
system created a 13th month in 2003 (13 months of expenses and 12 months of revenue), and accounts
for a$100,000 shortfall. Because expenses are increasing faster than revenue,the likelihood of catching
up on this shortfall is unlikely.
David Goldsmith then used the budget summary he had distributed to the Board to explain the role of the
County as agents of the state, its regional functions, and its municipal corporation responsibilities (parks
and recreation and other services,which are not generally mandated). In looking more closely at regional
functions,he reviewed the 2002 impacts to the Health and Human Services budget of the repeal of the
Motor Vehicle Excise Tax and the passage of initiative 701,which put a one percent limitation on
property tax. In 2002,the County cut 4%across the whole budget and because of their interfund
transfers, the Health and Human budget was reduced by just over$100,000 and that amount was held for
2003. Given the current budget conditions, it is unlikely this $100,000 would be restored. Although the
Board of County Commissioners has authorized the use of the ending fund balance to bridge the gap in
2004,unless there are program changes,the fund balance of$301,597 in 2003 would be further •
diminished to $42,314 at the end of 2004. He recognized that while priorities are often driven by outside
funding, even if the Department reduces programs and people, it would still be paying certain costs for
the building and infrastructure. In considering where the community prioritized these services in the
recent survey, he noted health was number two. The County cannot run any fund as a deficit and as
Agents of the State responsibilities increase, the pie that funds everything else is decreasing. The County
could cut a municipal function like Parks and Recreation,but parks keep people healthy so there is not
- ; . : :: - : : : •-. He noted the . . . i ' we i; - '-Area Teen Center and
the Brinnon, Tri-Area, and Port Townsend Senior Programs. He said the Board of County
Commissioners would be looking at both its broad responsibilities and also programmatically,within the
agency.
Referring to the 2004 Staffing Schedule,Chairman Masci commented that despite the decrease in
revenues, there has been an increase in staffing since 2001. David Goldsmith explained that the 7.75
budgeted new positions were comprised of 4.25 of fully grant supported position and .5 is a user fee and
contractual support for the City of Port Townsend which is for the building official. The remaining 2.5
positions were a corrections officer(required from an ACLU lawsuit), a code enforcement coordinator, a
half time property assessor, and a half time custodian for the new Sheriff's Department annex. Chairman
Masci said that he would expect to see levels of service decrease along with the revenues. When he
asked about transfers from other departments, the Commissioners said this was not possible because of
statutory limitations.
David Sullivan called attention to another pressure,which is whether the need is being met by current •
expenditures. He asked about the possibility of using banked capacity. Commissioner Titterness
HEALTH BOARD MINUTES -December 18, 2003 Page: 3
responded that in his mind this is off limits. In the survey, citizens had strongly voiced their objection to
• raising taxes.
Referring to David Goldsmith's letter in the agenda packet,Member Westerman asked for clarification
of the statement that Community Development and Health and Human Services Departments' budgets
have to be fully sustainable. Mr. Goldsmith explained that this meant transfers to the Health Department
should be sustainable such as a set percentage of property tax revenue, so that there is a known amount.
As it stands,Health and Human Services would likely stay at the current level of public support,plus
whatever they generate in fees. He recognized what$100,000 of local support accomplishes through our
Health Department saying it is possibly one the best-leveraged health departments in the State.
Member Westerman expressed concern that in order to balance the budget for one or two years,we
might cut programs that we have spent years building and then have to build them up again. Short-term
budget solutions can have long-term ramifications. Mr. Goldsmith agreed that as a community we would
have to make tough decisions. When the 2003 books are closed,he agreed to report back the actual FTE
count.
Vice Chairman Huntingford noted that even if the County were to allocate a percentage of property tax
for Health and Human Services, other factors would impact that amount—salaries and benefit increases,
or changes in programs or funding at the state or federal level. Across all departments,the County needs
to get a handle on its expense growth until revenues catch up. He asked to clarify whether the operating
reserves are secure,which Veronica Morris-Nakano confirmed.
•Jean Baldwin reminded that many costs—rent, information services,wages,benefits and insurance—are
ongoing and out of our control. The Department would need to consider cutbacks in its office space and
get rid of some computers as well as cutting programs and on-call staff,but there is an issue of matching
funds. The Developmental Disabilities and Substance Abuse Boards and their budgets would also need
to be reviewed separately.
David-Sullivan said_he- longer;alue_in_ta Iran OPT-+Pm zie
�$-� a� w=-He--thinks-there would be public support
for services of value. David Goldsmith agreed and said there needs to be a dialogue with the community.
Member Westerman commented that if the Board realizes that it is necessary to increase revenues
instead of cutting anymore services it would benefit from the broader political base of having the
Commissioners sitting on the Board.
The Commissioners stated that in January the County Commissioners should have an update on five-
year revenue projections and would be looking closely at all departments and programs for solutions.
Mr. Goldsmith added that there is not a lot of flexibility between funds and reminded that the County's
primary revenue source is capped.He suggested the Board look at setting program priorities without
dollars and then overlay their budgets.
Chairman Masci expressed his frustration that the Board's retreat preceded the budget discussion.
•
HEALTH BOARD MINUTES -December 18, 2003 Page: 4
Medical Assistance Administration Strategic Planning Questionnaire: Dr. Locke distributed a bar •
graph comparing State spending in general to State spending on healthcare costs,which reflected a 393%
increase over the last ten years. The agenda packet included a questionnaire from the Medical Assistance
Administration to solicit the Board of Health's input on how to prioritize spending,work with other
agencies and communities and improve health and the workforce.
Member Westerman moved to direct Dr.Locke to fill out the survey on the Board's behalf,which
could then be brought back to the Board for review/changes in January.Member Frissell
seconded the motion,which carried by a unanimous vote.
Group B Water Systems Project Report: Susan Porto, Environmental Health Specialist with the
Jefferson County Drinking Water Program, gave a presentation on local findings of a voluntary sanitary
survey of Group B water supply systems, of which there are about 110 in the Jefferson County. The
agenda packet contained the full report from the Washington State Department of Health summarizing
data from all participating Counties. The study's objectives were to obtain accurate information for
systems with greater than five connections, identify public health risks and needed corrections through
site visits, determine status and compliance with routine water quality monitoring requirements, and
inform water system operators of needed corrections and required water quality monitoring
requirements.There were 37 inspections of the 42 systems with greater than five connections. She
showed examples of the top five issues found: 1)potential biological/chemical contamination within 100
ft of well(57%); 2) improperly constructed vents and openings in well caps(46%); 3) open storage
reservoirs(46%); 4) inadequate water quality monitoring(33%); and 5)lack of source sample tap(26%). •
Benefits of the program were to provide information to owners about simple alterations that significantly
lower risk of contamination, local familiarity with County water systems, existing system conditions
were documented, outdated and inaccurate information was corrected, owners were informed of water
quality monitoring and provided with a local point of contact to facilitate technical assistance.
NEW BUSINESS - - --
Influenza Update: Dr. Locke distributed an updated influenza report from the Centers for Disease
Control. The agenda packet also contained information the Department sent to providers about influenza
activity and anti-viral drugs. Washington State was one of the first 11 states to have widespread activity.
As of this week, school absentee rates in the state have dropped slightly,but might go through multiple
peaks. The success of getting people to vaccinate early resulted in using up the national supply of 83
million vaccines. A limited supply of vaccine is still available for children and high-risk adults through
doctors. As of Yesterday,Jefferson County reported its first influenza-related death—an elderly woman
with chronic lung disease. This year's strain might have an unexpected higher virulence and mortality
with children. With the shortage in vaccine supply, efforts have shifted to infection control,with
respiratory etiquette programs developed for SARS preparation being implemented.
Member Frissell noted a concern among the public that this flu vaccine contains mercury. Dr. Locke
agreed that thimerosol is used in the adult vaccine as a preservative,but it has an extraordinary safety .
record. However,he did recognize the general problems of increasing levels of mercury in the
environment.
a • M
HEALTH BOARD MINUTES -December 18, 2003 Page: 5
•Draft Policy Concerning Evaluation of Existing On-Site Sewage Systems and Building Permits:
Linda Atkins reported that the second draft policy document in the agenda packet incorporated the
comments and agreements of the subcommittee. She asked whether the Board felt it reflected the
consensus and the desired direction of the Board to bring into the monitoring schedule more systems
pursuant to the 2002 code?
Member Frissell suggested that Specific Standards#2 -Building Permit Applications contain a notation
to clarify the exception that there would not be an inspection requirement for building permits on greater
than five acres and greater than 200 feet from shoreline,if the building does not increase plumbing. To
address this, there was support for a suggestion by Member Westerman to move the second paragraph
ahead of the exceptions.
Member Westerman also made the following additional suggestions: to note on the first page who the
"third party"is and to include better definitions of terms such as "non-building building"permits and
clarify the difference between"EES"and"basic operational checks."Mr. Fay recognized the need to
define the different levels of EES and suggested better characterizing"non-building building permits"
instead of using that term. Member Westerman suggested amending or replacing the reference to WAC
246-272,with a title or description of the WAC. Under inspection results, she asked why any correction
of deficiencies would not be done prior to a property sale and said the ordinance might need to be
changed to ensure that deficiencies are corrected beforehand?
410Chairman Masci asked if a property is sold and bought within a year,why there would need to be two
EESs?There should be a time frame in which an inspection certificate remains valid. Staff noted that
this is covered in the code,but agreed this could be clarified in the policy.
There was Board agreement to allow Staff an opportunity to review and consider incorporating
comments submitted by Member Westerman before bringing the policy back to the Board.
Healthy Jefferson Distribution: Jean Baldwin distributed a flyer regarding the three"Making a
Difference"groups that would be meeting in January 22 (Families with Children), January 27 (Drug and
Alcohol Issues), and January 29 (Job Skills and Family-Wage Jobs). The input collected by these groups
would first go to the Steering Committee before coming to the Board.
ACTIVITY UPDATE/OTHER ANNOUNCEMENTS-None
AGENDA PLANNING/ADJOURN
January or February: Briefing on the Draft Ordinance regarding Methamphetamine Manufacturing Site
Evaluation and Clean-up, Draft Policy Concerning Evaluation of Existing On-Site Sewage Systems and
Building Permits, and Joint Meeting of Board of Health and Hospital Board.
4110F'ebruary: End-of-the-Year Performance Measurement Reports.
HEALTH BOARD MINUTES -December 18,2003 Page: 6
The meeting adjourned at 4:30 p.m. The next meeting will be held on Thursday, January 15, 2004 at 2:30 •
p.m. at the Jefferson County Health and Human Services Conference Room.
JEFFERSON COUNTY BOARD OF HEALTH
(Excused Absence)
Geoffrey Masci, Chairman Jill Buhler,Member
Glen Huntingford,Vice Chairman Sheila Westerman,Member
Dan Titterness,Member Roberta Frissell,Member
Patrick M. Rodgers,Member
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Board of Health
Old Business
Agenda Item # IV., 1
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Gypsy Moths in Port Ludlow
January 15, 2004
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• STATE OF WASHINGTON
DEPARTMENT OF AGRICULTURE.:-,i r} r p. -1 P.O. -
Box 42560 • Olympia, Washington 98504-2560 • (360 9 c J 81 '' ' `- i if �7 T j f
December 15, 2003
DEC .1 8 2rrq
The Honorable Dan Titterness
Jefferson County Commissioner ' FES''''''-'
P.O. Box 1220ilt ' �'�sie .. % ;i:i y
CO CO PAIr.'�'j.,Ali p��,E',
Port Townsend,WA 98368 :s .:
Dear Commissioner Titterness:
Last summer the Washington State Department of Agriculture(WSDA)caught 14 European gypsy moths in Port
Ludlow. The majority of gypsy moths were caught north of Oak Bay Road in an area centered on Sparrow Court.
In addition, gypsy moth egg masses have been found in the area. WSDA entomologists have determined that a
reproducing population of European gypsy moths now exists in Port Ludlow.
To eradicate the infestation, we are proposing to treat an 18-acre site in Port Ludlow next spring with the biological
insecticide Bacillus thuringiensis var. kurstaki(Btk), utilizing ground-based equipment. Btk is registered for use in
the U.S. by the U.S. Environmental Protection Agency(EPA). It has been used successfully on numerous gypsy
moth eradication projects in the past and has a proven safety record.
The purpose of this letter is to inform you of our proposed eradication treatment and our plan to conduct a public
information campaign in the Port Ludlow area on the nature of the gypsy moth threat and our proposal.
111 ur public information campaign will include letters to residents and community leaders; articles in local
ewspapers and other media outlets; a community open house in early February 2004; information on our Web site
at www.agr.wa.gov(click on gypsy moth); and an invitation to call our toll-free hotline(1-800-443-6684)for answers
to questions.
In addition, we will prepare documents for public review and comment. Two of the documents to be prepared are
a completed State Environmental Policy Act(SEPA)checklist, and a National Environmental Policy Act(NEPA)
draft environmental assessment. Comments submitted by residents in response to these documents will be
reviewed before a decision to proceed with the treatment is made. All documents prepared for public review and
comment will be posted to our Web site.
Enclosed is a fact sheet on the gypsy moth in Washington state, a map of the proposed treatment site in Port
Ludlow, and a copy of a news release to be sent soon to the local media.
In addition to our proposed treatment at Port Ludlow, we are also proposing to treat infestations of gypsy moths
detected in Bellevue and in Lewis County near Mayfield.
If you have any questions on any aspect of our gypsy moth program, please call the toll-free hotline (1-800-443-
6684) and ask for me. Thank you for your support of our efforts to keep the gypsy moth out of Washington.
Sincerely,
PLANT PROTECTION DIVISION
A7./i�
*had Phillips
State Entomologist
Enclosures
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ypsy Moth
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WASHINGTON STATE
DEPARTMENT OF AGRICULTURE 1 ecem 1 er 200 6 =w x
P.O.Box 42560,Olympia,Washington 98504-2560
What is a gypsy moth and why is it a threat to Washington?
The gypsy moth is one of America's worst forest pest insects. It w�
feeds on the foliage of more than 500 different species of trees and i. c
shrubs and causes enormous damage to the environment and to the 5,- ,
economy. 4
Economic losses caused bythe ' a ,
gypsy moth have averaged$30 Thegips).moth
million a year for the last 20 years,according to U.S.Department has a wing span of
of Agriculture estimates.Most of the loss is due to quarantines about 1 '/2 inches.
imposed on timber and agricultural products. 1 The female is
Due to its voracious appetite and ability to rapidly reproduce,the white►with brown
� �� �� ���� markings.The
gypsy moth causes incredible damage to forests,nurseries,vegeta- '1�! ��
g :-' male is slightly .
tion along creeks and rivers, and trees and shrub in yards and ii F: "nailer and is tan
parks.It alters wildlife habitat and affects the quality of life in „ with brown
communities that experience repeated outbreaks. ; . markings. _____.
Major infestations are cyclical.When disease and other factors bring an outbreak to an end,the gypsy moth population
remains small for four to six years and then begins to build again.A ten state area in the Northeast,for example,expen-
d a tremendous increase in gypsy moth damage between 1997 and 2001. The number of defoliated acres in these
lets rose from 540,000 acres to 1.6 million acres during the period.
The gypsy moth has no native enemies in this country.If allowed to become established '
in Washington,this insect could cause devastating impacts to agricultural,timber and
residential areas. 4�
Are all gypsy moths the same?
No. The European variety was brought to the U.S. from Europe over 100 years ago. It � a(
got loose by accident and quickly established residency in Massachusetts.It has proved t r '
extremely resistant to eradication efforts.Although it has been the subject of more ;±i1,: ::4:44,r4.1'-tA tk,R. 1
eradication and control strategies than any forest insect in U.S.history,it has spread to When the leaves are all eaten,gypsy
19 states and the District of Columbia. moth caterpillars will search anywhere
for food-even the eaves of a house.
.\ The Asian variety was first found in this country in 1991 on a ship visiting the Port of
Tacoma. It is a much greater threat to Washington state than the European variety
because it eats evergreen as well as deciduous trees, and its female can fly. This
- '.•:..T, k
l means that Asian infestations can spread much more quickly and further,and they
are much more difficult topinpoint.To date,the Asian gypsymoth has not become
established in this country.
-' x What kind of damage does the gypsy moth doa
�✓y r s
��� � ���� It devours the leaves of more than 500 species of trees and shrubs. Its favorites
' include oak,birch,apple,poplar,alder,cottonwood,hawthorn and willow The Asian
�; �* ` ‘,.••-,,, -F PP ,PP'4 variety also favors evergreens.
4.w39',",.,0'`4 ' Trees repeatedly defoliated either die or become so weak that they are susceptible to
ip
1 disease and other pests.This results in a loss of wildlife habitat;and significant
degradation of water quality in streams as a result of increased temperature,siltation,
and large mounts of caterpillar droppings being deposited in the water.
Washington's successful gypsy moth program
The Washington State Department of Agriculture(WSDA)conducts an annual survey to locate new introductions of gypsy
moth and determine if a reproducing population of the pest exists.Every summer,approximately 20,000 cardboard gypsy
moth traps are placed throughout the state. Most traps are placed in Western Washington where commerce and people Ai•
moving or traveling to our state from the East Coast increase the risk of introduction.
Male moths are attracted to the traps by a female scent lure. Traps are checked every a
two weeks to three weeks during the summer. If moths are caught, more traps are
placed in the area to pinpoint the center of the infestation.Introductions have occurred
every year in Washington since 1977.The Department of Agriculture has eradicated all
infestations due to: ,
• An aggressive summer trapping program to find new introductions of gypsy moth; #
• Treatment programs to eliminate infestations in the spring before they spread;and
• Cooperation among local municipalities,the public,U.S.Department of Agriculture,
and other agencies regarding summer trapping and spring eradication programs.
What is the difference between eradication and suppression?
Eradication entirely eliminates an infestation.Suppression reduces a population.
Why has Washington typically selected eradication as a strategy?
Eradication better protects the environment and costs less.This strategy has kept
Washington free of gypsy moth since 1974,the first year it was detected. States in the
East and upper Midwest where the moth is permanently established must deal with the Since the'70s,Washington
cost of damage to trees and shrubs,the cost of conducting suppression and slow-the- state has successfully detected
spread programs,and the cost associated with quarantines and other regulatory actions and eradicated gypsy moth ..:.
Western states still have the option of conducting eradication programs. infestations and kept the pest
What control measures or tools might be used against the gypsy moth? from WSDA cooperatesecoming establishedwith here.
Control measures are needed when a reproducing population of the gypsy moth is found. neighboring states and Canadian
Potential tools include: provinces to make sure the •
• Gypchek:A virus that affects only gypsy moth caterpillars. Pacific NW doesn't end up like
• Bacillus thuringiensis var.kurstaki(Btk):A bacterium that affects only caterpillars, the Eastern states and several
including gypsy moth.The caterpillar must eat Btk for it to have an effect. provinces that are permanently
• Diflubenzuron:A chemical that disrupts the growth of caterpillars. infested with gypsy moth.
• Mass trapping,mating disruption,and the release of sterile male moths.
The U.S.Environmental Protection Agency registers all three pesticides for use in this Statewide trapping results
country. Diflubenzuron and Btk have been used successfully for gypsy moth here. 2003—59 total
How will a control measure he selectedp 31 King County
14 Jefferson County
If a decision is made to treat an area,a method or a combination of methods will be 8 Lewis County
selected based on potential effects to human health,environmental considerations,and 2 Kitsap County
3 Pierce County
the effectiveness of the product. 1 Skagit County
The U.S. DeparthfAgriculture prepared a fmal environmental impact statement on
2002—17 total
national gypsy mothipnagement in 1995.It presents a range of alternatives for control- 7 Kin
g County
ling the pest,�ft ses potential impacts of using control measures. 6 Whatcom County
�`, X44, ° 1 Clark County
The state Dep 4,u® -,0 + gnculture prepares documents required under state and 1 Kitsap County
national environ a h vl __ se,documents are made available for public 1 Lewis County
review and comme.iv,R411e cOttFfping the documents are reviewed before a 1 Pierce County
decision is made rm g � edvlth treatment. 2001—33 total
Where can I get e Werth `_on on the gypsy moth in Washingtona 14 K 0 Lewisg County
1County
Community outreach programs are conducted in areas where eradication treatments are 2 island County
anticipated to make residents aware of the gypsy moth threat and the options available 2 Snohomish County
to eradicate the moth. 1 KitsapCounty
1 Pierce County •
For information,call(800)443-6684,e-mail to gypsymoth@agr.wa.gov,or visit the i Skagit County
1 Thurston County
WSDA Web site at www.agr.wa.gov and click on"Gypsy Moth." 1 whatcom County
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\cm Washington State Department of Agriculture
�. Mina News e e
ase
For immediate release: Dec. XX,2003
(03'XX) WASHINGTON STATE DEPARTMENT OF AGRICULTURE
Contact: John Lundberg(360) 586-8459 P.O.Box 42560,Olympia,Washington 985042560
Dr. Jim Marra(360) 664-0905
Mike Louisell (360) 902-1813
DRAFT DRAFT DRAFT
State proposes action at three sites to keep European gypsy moth out of Washington
OLYMPIA—The Washington State Department of Agriculture(WSDA)is proposing action this spring to prevent
the European gypsy moth from becoming established in three Western Washington locations.Control measures are
called for when a reproducing population of gypsy moths is present.The locations are an 18-acre site at Port Ludlow
in Jefferson County,an 11-acre site in Bellevue,and a 15-acre site near Mayfield in Lewis County.
State entomologists believe reproducing populations of gypsy moth are present in all three communities and are
recommending that the sites be treated with a biological insecticide to eradicate the infestations.Each treatment
would be applied using ground-based equipment.
*The gypsy moth is one of the worst forest pest insects ever brought into the U.S.It attacks more than 500 species
of trees and shrubs,causing millions of dollars of environmental and economic damage in the U.S.annually.The
moth is permanently established in 19 states in the East and Upper Midwest.
Gypsy moth has been detected in Washington state every year since 1977,but permanent populations have not
been established because of consistent trapping and eradication programs.
"We've kept permanent populations of the moth out of the state for 29 years,"said Jim Marra,managing
entomologist with WSDA."We want that record to continue."
Residents whose properties are affected by the proposal to treat for gypsy moths will receive written information
from the state Department of Agriculture.In addition,open houses will be held in Port Ludlow,Bellevue,and
Mayfield in early February.
Before the action is approved,the state Department of Agriculture will comply with the State Environmental
Policy Act(SEPA)and National Environmental Policy Act(NEPA).
•
MORE
European gypsy moth action proposed at three sites—2 of 2
Dec. XX 2003
•WSDA will consult with other state agencies and federal agencies regarding the proposed treatments,plus
prepare documents for public review and comments that assess the impact of the proposal on the environment.
Two of the documents are a SEPA checklist and a NEPA draft environment assessment.
Gypsy moth catches and other evidence
Of the 59 gypsy moths caught in the state last summer,21 were found in the Bellevue, 14 in Port Ludlow,and
eight in Mayfield.
In addition,three egg masses,pupal cases,cast skins, and a dead female gypsy moth were detected in Port
Ludlow; six gypsy moth egg masses and pupal cases were detected in Bellevue;and three pupal cases and one
cast skin were detected in Mayfield.
The biological insecticide WSDA proposes to use is Bacillus thuringiensis var. kurstaki(Btk),the same
insecticide used in recent years to keep Washington state free of gypsy moths.The active ingredient in a
biological insecticide is found naturally in the environment.Btk is registered for use in the U.S.by the
Environmental Protection Agency(EPA)and has a proven safety record.
If the proposal to treat for the gypsy moth is approved,the first of three treatments,applied seven to 14 days •
apart,will occur in late April or early May.
For more information,citizens may call the department's toll-free hotline(1-800-443-6684)or visit its Web site
at www.agr.wa.gov and click on"Gypsy Moth."
###
•
•
Board of Health
Old Business
Agenda Item # IV., 2
• Healthy Jefferson
January 15, 2004
•
.ifi..t/ .3/ -I, .1.# .1/ ...!/ ...t., ./....:\
ry HEALTHY JEFFERSON
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� J1')? -..w You can make a difference!
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1Join colleagues, friends, and
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' 1 ,' ) 4--Y-,"-' Jefferson Open Houses.
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STRENGTHEN SUPPORT FOR FAMILIES WITH CHILDREN
IL)
Thursday,January 22, 2004 3:30-5:30 p.m. Pope Marine Bldg.
ft;ei
Hosted by Judi Morris, Catharine Robinson, Beth Wilmart
Roberta Frissell, Julia Danskin & Quen Zorrah c")
REDUCE ALCOHOL & DRUG ABUSE IN OUR COMMUNITY
%Tuesday, January 27, 2004 3:00-5:00 p.m. Pope Marine Bldg.
1
ILSI Hosted by Barbara Carr, Sherry Kimbrough, Geoff Masci, Bruce Marston
N.
Kees Kolff, David Sullivan & Mike Blair
k.
INCREASE JOB SKILLS & FAMILY-WAGE JOBS
Thursday,January 29, 2004 3:00-5:00 p.m. Pope Marine Bldg.
Hosted by Dan Titterness, Katherine Baril, Deborah Johnson k.
Michelle Sandoval, Quentin Goodrich & Larry Crockett
kl
Who Should Come?—Everyone ready & willing to make a difference.
What to B ri
ng—Your ideas and enthusiasm. Bring your co-workers, qiN.
Ir..) friends, family and neighbors.
.
irl
What We'll Accomplish—Find p ind a place where your action counts.
STRENGTHEN SAFETY NET FOR FAMILIES WITH CHILDREN
Organization
What We Do to Strengthen the Safety Net/How We Make a Difference
We Invite You to Join Us in Making a Difference
List a range of opportunities here. Some examples might be:
• Install new operating system software on our computer(or computer network) and test drive
the application software with the new OS.A one-time commitment for 3-5 hours.
The difference it would make--increase the efficiency and cost-effectiveness
of all the computer-based work, and free-up staff to serve our clients in an even more effective
• way.
• On-call drivers available to drive (people in drug-rehab, pregnant moms) to treatment or
doctors' appointments.
Time and frequency:You decide. Some trips would be about 4 hours round trip, some are
all-day trips to Seattle.You can specify what you want to do.
• Board member with specialty in finance. I 2-hour meeting/mo. +4-6 hours of non-meeting
work/month.
• Office organizer to provide 2 hrs./month of time/month to work with executive director on
office organization--paper files, computer files,tracking and follow-up system.
• Adults with hobbies needed to share their hobbies with young people in 4-H.
• Men who fish needed to take teen-age boys fishing—several hours on a weekend every month
during the season, or on a weekend-long fishing trip, once-a-year.
• Algebra tutors for high school students, and parents returning to school for GED or other.
• Cash donations to buy musical instrument kits for young people and families. (Andy Mackie)
• Cash donations to buy life vests for children available at area boat launches.
• OTHERS YOU CREATE
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January 7, 2004 \4•►�
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Meredith Wagner
Jefferson County Library
P 0 Box 990
Port Hadlock, WA 98339
Meredith,
For many months a group of citizens has reviewed Jefferson County Health
Statistic data. We know there are key areas where the social, physical, mental
and economic health is lacking. We also know that government alone can't fill
the voids. That's where I hope you can help.
• We have scheduled three open houses focused on critical areas of concern. I am
a co-chair of the first event and would especially like to have your involvement in
the effort to strengthen support for families with children.
Using an open house forum we hope to attract as many private citizens to see
what is being done and suggest ways each of us can make a difference in the
lives of our neighbors.
Please join me Thursday, January 22, 2004 anytime between 3:30 PM and 5:30
PM. Bring friends and neighbors. We want to be a community effort and we want
to see improvement in the lives of families in Jefferson County.
The attached flier lists all three open houses and may be distributed, as you feel
appropriate.
See you on the 22nd.
Judi Morris
•
Barbara Bowen
III
Subject: Update on Healthy Jefferson Open Houses--
\ .
10
►•
From: "Beth Wilmart" <bwilmart@co.jefferson.wa.us> `
Cc: "Barbara Bowen" <bbowen@co.jefferson.wa.us>
Sent: Monday, January 05, 2004 3 :34 PM
Subject: Update on Healthy Jefferson Meetings
..C..)k
Birth to Five Coalition & Healthy Youth Coalition:
On December 15th I sent you an email to save the date for upcoming Healthy
Jefferson Meetings. I now have more complete information, and hope that you
have set aside time to attend these important events.
Three "Open House" events for the community will be held at the Pope Marine
Building next to the Police Department in Port Townsend. At the first Open
House, any organization that interacts with families with children is
invited to publicize their program and solicit help in the form of
volunteers, etc. Tables will be placed around the perimeter of the room and
attendees will be able to meet and talk with you about your program or
service. Attendees will be asked to sign "I Want to Make A Difference" forms
that programs can use to follow up with interested parties.
Open House #1 - Strengthen Support for Families with Children Thursday Jan.
22, 2004 3 :30-5:30pm
Open House #2 - Reduce Alcohol and Drug Abuse in our Community Tuesday Jan.
27, 2004 3 :00-5:OOpm
oen House #3 - Increase Job Skills and Family-Wage Jobs Thursday Jan. 29,
04 3 :30-5:30pm
Note: my previous email indicated that child care would be available. Since
these will be "open house" events, you are welcome to bring your children,
but there will not be any special accomodations for them. Older children may
find this to be a valuable learning opportunity.
Action Requested:
*If you are involved in a group/agency/organization that works with
families, please let me know if your group will attend the Open House on
January 22 .
*Please talk these events up to your friends/neighbors/associates; it won t
work without citizen participation. There will be articles and ads in the
newspapers, but one-to-one invitations are most successful.
*Call Barbara Bowen at the Health Department (379-4498) to order flyers or
for more info.
What to bring if you will attend: groups should bring
information/photos/brochures about their program, and a stack of one-page
handouts that lists what your group does, and *explicity* what type of help
you need from the community. Use a different page for each program, so
people can really hone in on their area of interest. If you need help with
your handout, let me know.
And of course, you can always contact me with any questions!
Beth Wilmart
Jefferson County Community Network
firth to Five Coalition
althy Youth Coalition
00.379.4495 (Mon/Wed/Thur)
bwilmart@co.jefferson.wa.us
1
0
Board of Health
Old Business
Agenda Item # IV., 3
Medical Assistance
• Administration Survey
January 15, 2004
•
407;:os PUBLIC HEALTH
4,1
Always Working for a Safer and
HEALTHIER JEFFERSON
615 Sheridan Street,Port Townsend, Washington 98368
January 15, 2004
Doug Porter, Assistant Secretary
Department of Social and Health Services
Division of Policy and Analysis
PO Box 45533
Olympia, WA 98599-5533
Dear Mr. Porter:
Thank you for the opportunity to comment on your Strategic Planning for our Clients' Future
survey. On behalf of the Jefferson County Board of Health, I offer the following
recommendations:
1. How can MAA improve the health of Washington residents?
Epidemiologic studies since the 1970's have consistently found that the determinates of health
are roughly 50%behavioral, 20% environmental, 20% genetic, and 10%related to medical care.
• MAA programs have traditionally focused on the provision of acute and chronic medical care. A
greater focus on evidence-based medicine and quality of care could certainly improve the
effectiveness of that care,but the greatest health improvement benefit will come from greater
attention to the other 90%of health determinates. Support of clinical prevention services,home
visiting nurse programs,health promotion and health education programs are some examples of
areas that need much greater public sector support.
2. When dollars are limited, how do we prioritize our health care spending?
Highest priority should be given to those least able help themselves—the poor, children, and the
disabled. Services also need to be prioritized based on their cost and effectiveness. Low cost
services that are highly effective should be at the top of the priority list. High cost services that
are lacking in evidence of effectiveness should be at the bottom of the priority list. Mental health
and oral health services should be included in the same prioritization listing.
3. How do you think we can improve upon the MAA workforce of the future?
First and foremost the workforce should reflect the cultural and ethnic/racial diversity of the
populations that are served. The MAA workforce of the future should also be distributed
throughout the state and play an active role in the communities that are served. Greater use of
•
COMMUNITY ENVIRONMENTAL DEVELOPMENTAL SUBSTANCE ABUSE
HEALTH HEALTH DISABILITIES & PREVENTION
(360) 385-9400 (360) 385-9444 (360) 385-9400 (360) 385-
9400
information technology should allow this decentralized workforce and reduce the administrative
burdens that current DSHS programs impose on service providers.
4. How can MAA work with other state agencies and local communities to blend our services so •
we can improve access and quality health care services?
Work with other state agencies should focus on administrative simplification and efficiency. The
Basic Health Plus plan is an excellent example of this type of collaboration. At a community
level, MAA must be seen as an honest broker—willing to pay the true cost of the services being
provided. Payment that falls far below the cost of service delivery(which has become the rule,
rather than exception) erodes access and degrades quality. Equitable funding of critical health
services is a legislative responsibility. Chronic underfunding of MAA programs by the
legislature has caused a breech of trust with community providers. Improvements in access and
quality will be difficult if not impossible until this trust is restored.
5. How can MAA maintain and expand our partnerships with health care providers so there is
adequate coverage for all Washington State residents?
MAA is often perceived as a bureaucratic agency isolated in Olympia and locked in an
adversarial relationship with its providers and clients. We suggest you start with specific
initiatives—prescription drugs, administrative simplification, and clinical preventive services—
to build trust. Ultimately, there must be a commitment by the Governor and Legislature for
adequate health care coverage to be universally available to all state residents. Partnerships
cannot be built on unfunded mandates, unstable programs, and indifferent political leadership.
6. Of the suggestions you have given MAA,please list and prioritize the three most important. S
1. Invest in prevention(well child exams, visiting nurses, family planning, maternal
child services)
2. Reduce administrative burdens, eliminate unfunded mandates
3. Restore trust through cost-based reimbursement for basic health services
Sincerely,
Geoff Masci, Chair
Jefferson County Board of Health
Board of Health
New Business
Agenda Item # V., 1
•
Draft Ordinance
Methamphetamine
Manufacturing Site
Evaluation & Clean-up
January 15, 2004
•
I
e4 °N,,`c°G� PUBLIC HEALTH
(~ j,t,`1 Always Working for a Safer and
ii
p '"SINo °° HEALTHIER JEFFERSON
615 Sheridan Street Port Townsend,Washington 98368
Memorandum
TO: Jefferson County Board of Health
From: Larry Fay
Environmental Health Director
Date: January 5,2004
Re: Draft ordinance addressing clandestine drug labs
Attached for your consideration is a draft ordinance addressing clandestine drug labs.
RCW 60.44 and WAC 246-205 establish reporting,cleanup and administrative responsibilities around
clandestine drug labs,commonly called meth labs.The law requires that a police authority engaged in
a raid or bust of a suspected meth lab must contact the local health authority.The health authority then
has an obligation to initiate an investigation to determine whether the property containing the drug lab
has been contaminated.If the health authority determines that the property has been contaminated then
• the property must be posted and documents recorded with the property title advising that the property
is unfit to occupy.
It is the property owner's responsibility to arrange to have the lab cleaned up.Clean up is handled by
licensed contractors.The contractor is responsible for developing a clean up plan that is submitted to
the local health authority for review and approval. Once approved,the contractor may implement the
plan.A final step includes sampling and testing to verify that the lab has been cleaned up to
established standards.Upon final report and verification that the site has been cleaned up the property
can be declared fit for use.
The existing laws and regulations provide pretty good guidance overall,however,there are two major
gaps that cause problems.First,there are no penalties identified for individuals who ignore the posting
order and,second,there is not time frame established for completion of clean up.
The primary purpose of this local ordinance is to establish some enforcement provisions around
occupation of the property and for failure to clean up a property in timely manner.We are also
proposing to include specific procedures for appeal and hearings.This draft is ahe same ordinance that
was recently adopted by the Clallam County Board of Health.It was prepared with the assistance and
guidance of Board Members Frissell and Masci.
The Board is being asked to review and comment on this draft.Unless major issues are identified the
draft will be forwarded for legal review and we will to begin formal adoption hearings in February.
11111
COMMUNITY ENVIRONMENTAL DEVELOPMENTAL SUBSTANCE ABUSE
HEALTH HEALTH DISABILITIES & PREVENTION
(360) 385-9400 (360) 385-9444 (360) 385-9400 (360) 385-9400
JEFFERSON COUNTY HEALTH REGULATION No. , 2004
• Contaminated Properties from
Illegal Drug Manufacturing or Storage
BE IT ORDAINED BY THE JEFFERSON COUNTY BOARD OF HEALTH
SECTION I. AUTHORITY AND PURPOSE
A. Authority
This Regulation is adopted pursuant to Chapters 64.44 and 70.05 of the
Revised Code of Washington(RCW) and Chapter 246-205 of the Washington
Administrative Code (WAC). All references to these RCWs and this WAC
refer to the cited chapters and sections,as now or hereafter amended, and this
regulation is supplementary thereto.
B. Purpose
This chapter provides for the protection of the health,safety, and welfare of
the public by reducing the potential for public contact with hazardous
chemicals associated with the manufacture of illegal drugs. This chapter:
1) Provides procedures for enforcement of the Jefferson County Health
• Officer's determinations that property is unfit for use due to
contamination from illegal drug manufacturing or storage,
2) Establishes requirements for contamination reduction, abatement and
assessment of costs,and
3) Creates an appeals process for orders of the Health Officer issued to
carry out the duties specified in Chapters 64.44 and 70.05 of the
Revised Code of Washington(RCW) and Chapter 246-205 of the
Washington Administrative Code (WAC).
SECTION II. APPLICABILITY
This regulation shall apply to any site defined as an illegal drug manufacturing or
storage site as per WAC 246-205-010. This regulation shall also apply to any
property that is contaminated. This regulation shall not apply to industrial or
commercial sites licensed or regulated by state or federal agencies where
manufacturing processes use hazardous chemicals.
SECTION III. DEFINITIONS
When used in this regulation, the following terms have the meanings provided
below. Definitions for other terms used in this regulation that are not defined below
ID are provided in the WAC Chapter 246-205 and the RCW Chapter 64.44.
A. Approved: Approved in writing by the Health Officer.
1
B. Board of Health: Jefferson County Board of Health.
C. Environmental Health Division: The Jefferson County Environmental Health
Division.
D. Health Officer: The Jefferson County Health Officer appointed under RCW
70.05.050 or the Health Officer's authorized representative.
E. Nuisance: Any act or omission that may be detrimental to public health.
F. Property: Any site, lot, parcel of land, structure, or part of a structure
involved in the illegal manufacture of a drug or storage of hazardous
chemicals, including but not limited to:
1. Single-family residences;
2. Units or multiplexes;
3. Condominiums;
4. Apartment buildings;
5. Motels and hotels;
6. Boats;
7. Motor vehicles;
8. Trailers;
9. Manufactured housing;
10. Any ship, booth, or garden; or
• 11. Any-site, lot, parcel of land, structure, or part of a structure that may
be contaminated by previous use.
G. Property owner or owner: any occupant of property or person having an
interest in the property as shown in the records of the Jefferson County
Auditor or other such governmental licensing or recording body.
SECTION IV. CONTAMINATION REDUCTION
A. Applicability
The requirements in this regulation apply to contractors and property
owners. The requirements in this regulation apply to property that has been
found by the Health Officer to be contaminated and unfit for use pursuant to
RCW 64.44.020 and 64.44.030,and WAC 246-205-540,including properties
found contaminated and unfit for use by the Health Officer prior to the
effective date of this regulation.
B. Sampling
All sampling performed for an initial site assessment or following
• contamination reduction procedures shall be conducted by a contractor
certified by the Washington State Department of Health under WAC Chapter
246-205 or a Jefferson County Environmental Health Specialist using
standardized sampling protocols and methodology.
2
•
C. Decontamination or Disposal Required
• 1. The owner of a contaminated property shall decontaminate or dispose
of the property. The owner shall decontaminate the property in
accordance with RCW Chapter 64.44 and WAC 246-205-570, or dispose
of the property in accordance with state and local laws. The owner of
the contaminated property shall submit a decontamination plan within
forty-five (45) days and decontaminate or dispose of the property
within sixty(60) days of notification of contamination by the Health
Officer,unless alternate deadlines are approved by the Health Officer.
D. Decontamination Work Plans
1. All decontamination activities performed by property owners or
contractors must have a work plan approved by the Health Officer.
2. All certified contractors and other persons approved by the Health
Officer performing decontamination operations in Jefferson County
shall use the"Environmental Health Division's Contractor Work Plan
Template for the Cleanup of Illegal Drug Manufacturing Sites", as
amended, or the"Washington State Department of Health's Work plan
Template", as amended. These work plan templates may be obtained
from the Jefferson County Environmental Health Division or the
• Washington State Department of Health.
SECTION V. ABATEMENT AND ASSESSMENT OF COSTS
A. After all appeals have been exhausted or if no appeal is filed within the time
allowed for filing an appeal as required in Section VIII of this regulation,and
the property owner or other persons to whom the order was directed have
failed to decontaminate a contaminated property as ordered by the Health
Officer under this regulation, the Health Officer may direct or cause the
property to be decontaminated,closed,vacated, boarded up,removed,
disposed of or demolished, and all costs thereof, including any actual
administrative costs and actual attorney's fees and costs,shall be assessed
against the property,the persons to whom the order was directed,or the
owners of the property upon which the cost was incurred.
B. Notice of the costs incurred shall be sent by first class and certified mail to the
owners of the property upon which the costs are assessed or other persons
against whom the costs are charged. The Health Officer may modify the
amount,methods, or time of payment of such costs as he/she may deem just,
considering the condition of the property and the circumstances of the owner.
In determining any such modification,the costs may be reduced against an
. individual who has acted in good faith and would suffer extreme financial
hardship.
3
C. Any costs incurred by Jefferson County abating the condition of the property
may be collected by any appropriate legal remedy and shall constitute a lien
on the property and the lien may be foreclosed in the same manner as real
• property tax liens. Costs associated with the foreclosure of the lien,
including,but not limited to advertising, title report, and personnel costs,
shall be added to the lien upon filing of the foreclosure action. In addition to
the costs and disbursements provided by law, the court may allow the
prosecuting authority a reasonable attorney's fee.
D. Any amounts collected shall be distributed to any fund or source of funds for
the program area from which payment for the work was made.
SECTION VI. NOTICE AND ORDER TO CORRECT VIOLATION
A. Issuance
Whenever the Health Officer determines that property hasbeen
contaminated and issues an order prohibiting use,he/she may issue a written
"Notice and Order to Correct Violations" (NOCV) of this regulation to the
property owner, or to any person causing, allowing, or participating in the
violation.
B. Content
• The NOCV shall contain:
1. The name and address of the property owner or other persons to
whom the NOCV is directed;
2. The street address or description sufficient for identification of the
property upon or within which the violation has occurred or is
occurring;
3. A description of the violation and a reference to that provision of the
regulation which has been violated;
4. A statement of the action required to be taken to correct the violation,
and a date or time by which correction is to be completed;
5. A statement that each violation of this regulation shall"be a separate
and distinct offense and in the case of a continuing violation,each
day's continuance shall be a separate and distinct violation; and
6. A statement that the failure to obey this notice may result in the
issuance of a notice of civil infraction and/or imposition of criminal
penalties.
• C. Disposal Receipts
The NOCV may also include a statement requiring the person to whom the
NOCV is directed to produce receipts from a permitted solid or hazardous
4
waste disposal facility or transporter to demonstrate compliance with an
order issued by the Health Officer.
• D. Service of Order
The NOCV shall be served upon the person to whom it is directed, either
personally or by mailing a copy of the NOCV by first class and certified mail,
postage prepaid,return receipt requested,to such person at his/her last
known address.
E. Extension
Upon written request received prior to the correction date or time, the Health
Officer may extend,for good cause,the date set for corrections. The Health
Officer may consider substantial completion of the necessary correction or
unforeseeable circumstances that render completion impossible by the date
established, as a good cause.
F. Supplemental Order to Correct Violation
The Health Officer may at any time add to,rescind in part,or otherwise
modify a NOCV. The supplemental order shall be governed by the same
procedures applicable to all NOCV procedures contained in these
regulations.
• G. Enforcement of Order
If, after the Health Officer duly issues any order,the person to whom such
order is directed fails,neglects, or refuses to obey such an order, the Health
Officer may:
1. Cause such person to be prosecuted under these regulations; and/or
2. Institute any appropriate action to collect a penalty assessed under
these regulations; and/or
3. Abate the health violation using the procedures of these regulations;
and/or
4. Pursue any other appropriate remedy of law or equity-under these
regulations.
H. Written Assurance of Discontinuance
The Health Officer may accept a written"Assurance of Discontinuance" of
any act in violation of this regulation from any person who has engaged in
• such acts. Failure to comply with the "Assurance of Discontinuance" shall be
a further violation of this regulation.
5
SECTION VII.VIOLATIONS, CIVIL REMEDIES,AND CRIMINAL PENALTIES
A. Violations
1. Violations of this regulation may be addressed through a civil remedy,
or punished as a criminal act as provided in Sections VII, b. and c.
2. Each violation of this regulation shall be a separate and distinct offense
and in the case of a continuing violation, each day's continuance shall
be a separate and distinct violation.
3. Any property that is declared contaminated or unfit for use is a
public nuisance.
4. This regulation may be enforced by law enforcement officers, by the
Health Officer, or by the Health Officer's designee.
B. Civil Remedies
1. The violation of any provision of this regulation is designated as a
Class 1 civil infraction pursuant to RCW Chapter 7.80, as amended.
• The Health Officer may issue a NOCV pursuant to RCW Chapter 7.80
if the authorized representative has reasonable cause to believe that
the person has violated any provision of these regulations or has not
corrected the violation as required by a written NOCV. Civil
infractions shall be issued,heard,and determined according to RCW
Chapter 7.80, as amended, and any applicable court rules.
2. Civil infractions under this regulation include,but are not limited to,
the following:
a. Failure to Decontaminate: Any person who fails to
decontaminate any property as required pursuant to this
regulation,RCW Chapter 64.44, or WAC Chapter 246-205, has
committed a Class 1 civil infraction;
b. Occupying or Permitting Occupation of Property Declared Unfit
for Use: Any person who occupies,permits or authorizes the
occupation of any property ordered vacated pursuant to this
regulation, RCW Chapter 64.44,or WAC Chapter 246-205 has
committed a Class 1 civil infraction;
• c. Removing, Destroying, Defacing, or Obscuring a Notice: Any
person who removes, destroys, defaces, obscures, or otherwise
tampers with any notice posted pursuant to this regulation,
RCW Chapter 64.44, or WAC Chapter 246-205 has committed a
Class 1 civil infraction;
6
d. Failure to Comply with Order: Any person who fails to comply
• with any order issued pursuant to this regulation,RCW
Chapter 64.44, or WAC Chapter 246-205 has committed a Class
1 civil infraction;
e. Failure to Comply with a Written Assurance of Discontinuance:
Any person who fails to comply with a written"Assurance of
Discontinuance" issued pursuant to this regulation,RCW
Chapter 64.44, or WAC Chapter 246-205,has committed a Class
1 civil infraction.
f. Failure to Comply with Approved Work plan: Any person who
performs decontamination activities not in accordance with the
approved decontamination work plan has committed a Class 1
civil infraction.
g. Failure to Report Contamination: Any person who becomes
aware of contamination at a property is required, upon gaining
such knowledge,to report the contamination to the Health
Officer within one (1)working day.
C. Criminal Penalties
The following are crimes under this regulation:
1. Failure to Decontaminate: Any person who has previously been found
by a court to have committed a violation of section VII.B.2.a. of this
regulation, "Failure to Decontaminate," and fails to decontaminate the
same property as required pursuant to this regulation,RCW Chapter
64.44, or WAC Chapter 246-205,shall be,upon conviction, guilty of a
misdemeanor and shall be subject to a fine of not more than$1,000 or
to imprisonment in the county jail not to exceed ninety (90) days, or to
both fine and imprisonment. The court may also impose restitution.
2. Occupying or Permitting Occupation of Property Declared Unfit for
Use: Any person who has previously been found by a court to have
committed a violation of section VII.B.2.b. of this regulation,
"Occupying or Permitting Occupation of Property Declared Unfit for
Use," and occupies the property pursuant to this regulation,RCW
Chapter 64.44, or WAC Chapter 246-205,shall be,upon conviction,
guilty of a misdemeanor and shall be subject to a fine of not more than
$1,000 or to imprisonment in the county jail not to exceed ninety (90)
days, or to both fine and imprisonment. The court may also impose
restitution.
3. Any person who occupies, permits or authorizes the occupation of any
property ordered vacated pursuant to this regulation, RCW Chapter
7
64.44, or WAC Chapter 246-205 has committed a Class 1 civil
infraction;
• 4. Obstructing Employees or Agents of the Local Health Jurisdiction: Any
person who obstructs any enforcement officer,employee or agent of
the local health jurisdiction or other governmental unit in the
enforcement or carrying out of the duties prescribed in this regulation,
RCW Chapter 64.44, or WAC Chapter 246-205 shall be,upon
conviction, guilty of a misdemeanor and shall be subject to a fine of not
more that$1,000 or to imprisonment in the county jail not to exceed
ninety (90) days or to both fine and imprisonment. The court may also
impose restitution.
D. Other Legal or Equitable Relief
Notwithstanding the existence or use of any other remedy,the Health Officer
may seek legal or equitable relief to enjoin any acts or practices or abate any
conditions that constitute or will constitute a violation of these regulations, or
rules and regulations adopted under them.
E. Imminent and Substantial Dangers
Notwithstanding any provisions of this regulation, the Health Officer may
take immediate action to prevent an imminent and substantial danger to the
. public health.
SECTION VIII. APPEALS
A. Appeal of an Order Prohibiting Use
Any person required to be notified of an order prohibiting use under RCW
64.44.030 may appeal the order. The Health Officer will hear such appeals.
Any such appeal must be made within ten(10) days of service of the order,
and the appeal will conform to the requirements of RCW 64.44.030 and this
regulation. The Health Officer's decision regarding an order prohibiting use
may be appealed to the Board of Health. Any action to review the Health
Officer's decision must be filed within thirty (30) days of the date of the
decision. The order prohibiting use shall remain in effect during the appeal.
1. Health Officer Administrative Hearing: Any person aggrieved by an
order prohibiting use may request, in writing, a hearing before the
Health Officer or his or her designee. The appellant shall submit
specific statements,in writing, of the reason why error is assigned to
the Health Officer's decision. Such request shall be presented to the
Health Officer within ten(10) days of the action appealed. Upon
• receipt of such request, together with any applicable hearing fees, the
Health Officer shall notify the person in writing of the time, date, and
place of such hearing,which shall be set at a mutually convenient time
not less than twenty (20) days nor more than thirty (30) days from the
8
•
date the request was received. The Health Officer will issue a decision
affirming, reversing, or modifying the order prohibiting use. The
Health Officer may require additional actions as part of the decision.
• 2. Hearing Procedures: Hearings shall
g be open to the public and
presided over by the Health Officer. Such hearings shall be recorded.
Hearings shall be opened with a recording of the time,date and place
of the hearing,and a statement of the cause for the hearing. The Health
Officer shall then swear in all potential witnesses. The case shall be
presented in the order directed by the Health Officer. The appellant
may present rebuttal. The Health Officer may question either party.
The Health Officer may allow for a closing statement or summation.
General rights include:
(a) To be represented by an attorney;
(b) To present witnesses;
(c) To cross-examine witnesses;
(d) To object to evidence for specific grounds.
In the conduct of the proceeding, the Health Officer may consider any
evidence, including hearsay evidence that a reasonably prudent person
would rely upon in the conduct of his or her affairs. Evidence is not
admissible if it is excludable on constitutional or statutory grounds or
on the basis of evidentiary privilege recognized in the courts of this
state. The Health Officer shall decide rulings on the admissibility of
• evidence, and the Washington rules of evidence shall serve as
guidelines for those rulings.
Inasmuch as any appeal to the Board of Health from a Health Officer
decision is a review on the record, the Health Officer shall ensure that
the record generated contains testimonial and documentary evidence
supporting the Health Officer's issuance of the order prohibiting use.
The Health Officer may continue the hearing to another date to allow
for additional submission of information or to allow for additional
consideration. Prior to closing of the hearing, the Health Officer shall
issue its oral ruling unless the Health Officer determines that the
matter should be taken under advisement. Written findings of fact,
conclusions of law, and orders shall be served on the appellant within
fourteen days (14) of the oral ruling. If the matter is taken under
advisement,written findings,conclusions,and orders shall be mailed
to the appellant within twenty-one (21) days of the close of the hearing.
The appellant shall bear the burden of proof and may overcome the
order prohibiting use by a preponderance of the evidence.
5. Appeals: Any decision of the Health Officer shall be final and may be
• reviewable by an appeal filed with the Board of Health through the
Health Officer. Any action to review the Health Officer's decision
must be filed within thirty (30) days of the date of the decision.
9
B. Appeal of Notice and Order to Correct Violation
1. Stay of corrective action: The filing of a request for hearing pursuant
to this section shall operate as a stay from the requirement to perform
corrective action ordered by the Health Officer while the hearing is
pending,except there shall be no stay from the requirement for
immediate compliance with an emergency order issued by the Health
Officer or from the requirements of an unfit for use order prohibiting
use.
2. Health Officer Administrative Hearing: Any person aggrieved by a
NOCV may request, in writing, a hearing before the Health Officer or
his or her designee. The appellant shall submit specific statements in
writing of the reason why error is assigned to the decision of the
Health Officer. Such request shall be presented to the Health Officer
within ten(10) days of the action appealed. Upon receipt of such
request, together with any applicable hearing fees, the Health Officer
shall notify the person in writing of the time, date, and place of such
hearing,which shall be set at a mutually convenient time not less than
twenty (20) days nor more than thirty(30) days from the date the
request was received. The Health Officer will issue a decision
affirming,reversing, or modifying the NOCV. The Health Officer may
require additional actions as part of the decision.
1111 3. Hearing Procedures: Hearings shall be open to the
g p public and
presided over by the Health Officer. Such hearings shall be recorded.
Hearings shall be opened with a recording of the time, date and place
of the hearing, and a statement of the cause for the hearing. The Health
Officer shall then swear in all potential witnesses. The case shall be
presented in the order directed by the Health Officer. The appellant
may present rebuttal. The Health Officer may ask questions. The
Health Officer may allow the opportunity for a closing statement or
summation. General rights include:
(a) To be represented by an attorney;
(b) To present witnesses;
(c) To cross-examine witnesses;
(d) To object to evidence for specific grounds.
In the conduct of the proceeding,the Health Officer may consider any
evidence, including hearsay evidence that a reasonably prudent person
would rely upon in the conduct of his or her affairs. Evidence is not
admissible if it is excludable on constitutional or statutory grounds or
on the basis of evidentiary privilege recognized in the courts of this
state. The Health Officer shall decide rulings on the admissibility of
• evidence, and the Washington rules of evidence shall serve as
guidelines for those rulings.
10
Inasmuch as any appeal to the Board of Health from a Health Officer
decision is a review on the record, the Health Officer shall ensure that
the record generated contains testimonial and documentary evidence
supporting the Health Officer's issuance of the NOCV.
The Health Officer may continue the hearing to another date to allow
for additional submission of information or to allow for additional
consideration. Prior to closing of the hearing,the Health Officer shall
issue its oral ruling unless the Health Officer determines that the
matter should be taken under advisement. Written findings of fact,
conclusions of law and orders shall be served on the appellant within
fourteen days (14) of the oral ruling. If the matter is taken under
advisement,written findings,conclusions and orders shall be mailed
to the appellant within twenty-one (21) days of the close of the hearing.
The appellant shall bear the burden of proof and may overcome the
NOCV by a preponderance of the evidence.
4. Appeals. Any decision of the Health Officer shall be final and may be
reviewable by an appeal filed with the Board of Health through the
Health Officer. Any action to review the Health Officer's decision
must be filed within thirty (30) days of the date of the decision.
5. Appeal of Administrative Hearing
•
a. Any person aggrieved by the findings,conclusions or orders of
the Health Officer shall have the right to appeal the matter by
requesting a hearing before the Board of Health. Such notice of
appeal shall be in writing and presented to the Health Officer
within thirty (30) days of the Health Officer's decision. The
appellant shall submit specific statements in writing of the
reason why error is assigned to the decision of the Health
Officer.
b. The decisions of the Health Officer shall remain in effect during
the appeal. Any person affected by the NOCV may make a
written request for a stay of the decision to the Health Officer
within five (5)business days of the Health Officer's decision.
The Health Officer will grant or deny the request within five (5)
business days.
c. Upon receipt of a timely written notice of appeal, the Health
Officer shall set a time, date, and place for the requested hearing
before the Board of Health and shall give the appellant written
notice thereof. Such hearing shall be set at a mutually
convenient time not less than fifteen(15) days or more than
thirty (30) days from the date the appeal was received by the
Health Officer unless mutually agreed to by the appellant and
Health Officer.
11
d. Board of Health hearings shall be open to the public and
presided over by the chairman of the Board of Health. Such
hearings shall be recorded. Board of Health hearings shall be
opened with a recording of the time, date and place of the
hearing; and a statement of the cause for the hearing. The
hearing shall be limited to argument of the parties and no
additional evidence shall be taken unless, in the judgment of the
chair, such evidence could not have reasonably been obtained
through the exercise of due diligence in time for the hearing
before the Health Officer. Argument shall be limited to the
record generated before the Health Officer unless the chair
admits additional evidence hereunder.
e. Any decision of the Board of Health shall be final and may be
reviewable by an action filed in Superior Court. Any action to
review the Board's decision must be filed within thirty (30) days
of the date of the decision.
SECTION IX. SEVERABILITY
Should any part of this regulation be declared unconstitutional or invalid for any
reason, such declaration shall not affect the validity of the remainder.
SECTION X. EFFECTIVE DATE
• The effective date of this regulation gu tion shall be",13 2004.
APPROVED this Day of 2004.
JEFFERSON COUNTY BOARD OF HEALTH JEFFERSON COUNTY HEALTH OFFICER
Geoff Masci, Chair Thomas H. Locke,M.D.
•
12
Board of Health
New Business
Agenda Item # V. , 2
• Bovine Spongiform Encephalopahty
in Washington
January 15, 2004
•
•
TOUGH QUESTIONS AND ANSWERS: HUMAN HEALTH AND MAD COW DISEASE
• DRAFT #1, DECEMBER 31,2003
A note on the "Tough Q-and-A" document: At Department of Health, "Tough Questions and
Answers" are a form of message mapping intended for internal use in message development. It is
different than a"Frequently Asked Questions" document that may be posted to our Web site, for
example. The questions and answers listed here are intended for use in planning response to
questions from media, public, or stakeholders, and to help develop public message documents
such as "Frequently Asked Questions."
MAD COW DISEASE AND HUMAN HEALTH ISSUES
Question: What is"mad cow disease?"
Answer: Mad cow disease, or bovine spongiform encephalopathy(BSE), is a brain disease of
cattle that results from infection by a prion. Prions are small proteins that cause nerve diseases in
humans and animals. The prion that causes BSE can be spread to an animal when it eats feed
contaminated with the BSE prion.
Q: How many people have died from mad cow disease in Washington?
A: None. The human disease linked to mad cow disease or bovine spongiform encephalopathy
(BSE), is called variant Creutzfeldt-Jakob disease, and no cases of this disease have been
acquired in the state or the nation. There was one human death attributed to variant Creutzfeldt-
• Jakob disease in Florida in 2002,but it was in a person who had lived primarily in the United
Kingdom.
Q: I've read in the news that people in the U.S. have died from the illness associated with mad
cow disease, but CDC and state health says there's never been a case in this country. One news
report says a Tri Cities man died from mad cow disease. What is the truth?
A: There is often confusion over variant Creutzfeldt-Jakob Disease (vCJD) linked to mad cow
disease/BSE and another illness caused by a similar agent called"classic" Creutzfeldt-Jakob
Disease (CJD). "Classic" CJD occurs throughout the world,with about 100-200 cases a year in
the United States; between 0-8 cases of classic CJD are reported in Washington state annually.
Meanwhile, vCJD is even less common and has never been acquired in the U.S. The Centers for
Disease Control and Prevention(CDC)has an active surveillance system in place to monitor for
both of these diseases in humans.
Q: How do I know if I'm sick from mad cow disease (vCJD)?What are the symptoms?
A: The human illness is called variant Creutzfeldt-Jakob disease (vCJD) and has generally only
been seen in countries where cattle have been diagnosed with BSE, or those that receive meat
from areas where BSE occurs. In the United Kingdom,where most cases have occurred,vCJD
appears about 10-20 years after exposure to contaminated meat. The first symptoms are usually a
change in personality and may be easily missed. After several months of illness,problems with
memory, concentration, balance and coordination occur, followed by confusion and dementia.
• The illness is fatal.
DOH talking points
Original draft 12-26-03
Revised 12-31-03
Q: My son ate beef at a restaurant last night, and today he is sick. Is it mad cow? •
A: No. First, the human disease that is associated with mad cow disease is thought to take years
to present itself. Second, USDA has asserted that meat poses an extremely low risk of BSE to
humans because muscle meat is not believed to carry BSE.
FOOD RECALL ISSUES AND INDUSTRY CONCERNS
Q: What meat is being recalled?How do I know if I have that meat?
A: The current voluntary meat recall announced by USDA is approximately 10,000 lbs. of
deboned meat from animals slaughtered on December 9, 2003 at Vern's Moses Lake Meats in
Moses Lake Washington and then distributed by Midway Meats in Centralia, WA. As of Sunday,
December 28, this meat is thought to have been distributed to retail establishments in seven
states (including Washington) and the territory of Guam. For the latest information on the recall
you should check the USDA's Web site.
Q: Is it safe to sell raw hamburger? What about frozen hamburger?
A: Whether a store should continue to offer a product is a business decision at this time. USDA
has not suggested that hamburger no longer be offered to the public for consumption. According
to that agency, no infected meat products were introduced into the human food supply.
Q: Should we take beef off the menu? •
A: According to USDA, the meat poses virtually no risk of BSE to humans because muscle meat
is not believed to carry BSE. Whether a restaurant should include or remove any food item from
the menu is a business decision at this time.
Q: Should we stop selling beef until we know more about this?
A: According to the USDA, muscle meat is not known to carry BSE therefore, whether a store
should continue to offer a product is a business decision at this time.
Q: Should Mexican restaurants take cow brains (or other dishes that contain brain) off the menu?
A: Brains and other parts of the central nervous system of cattle are at the highest risk for
containing BSE in cattle over 30 months old. It is important to note that BSE cannot be cooked
or frozen out of meat products. USDA has announced that as of December 30, 2003 high risk
parts from cattle that are over 30 months old will be classified as unfit for human consumption
and therefore will be prohibited from use in the human food supply.
Q: Should restaurants/grocery stores put up placards that talk about BSE?
A: USDA has not recommended this action. This is a business decision and certainly some
grocery stores have done so. •
DOH talking points
Original draft 12-26-03
Revised 12-31-03
• Q: What should we do with the products (raw meats) that are being returned to our grocery store
but are not part of any recall?
A: Treat it as solid waste. Reminder: under the Washington state food code,product that has
been sold and returned may not be resold to the public.
Q: What should I do if I have already eaten the meat subject to the recall?
A: USDA has repeatedly said that the parts of the cow considered at high risk to contain BSE did
not enter the food chain. The recall was initiated out of an"abundance of caution,"not because
it posed any sort of health risk.
FOOD SAFETY AND FOOD PREPARATION
Q: Now that mad cow disease has been confirmed in this cow,would it be safest for me to just
throw out all of the hamburger in my freezer?
A: The brain and spinal cord material from cattle is banned as a component of hamburger,
according to the USDA. If you have any question about whether your meat is being recalled,
contact the store from which you purchased the meat. However, USDA officials continue to
reiterate that this recall is be made out of an"abundance of caution" and that meat poses virtually
no risk of BSE to humans because muscle meat is not believed to carry BSE.
• Q: Is sausage safe? How about other pizza toppings like pepperoni? What about headcheese?
A: According to the USDA, BSE only affects cattle, and even then, only parts of the meat.
Sausage, pepperoni and other pork-based products are not affected by BSE.
Q: What parts of the cattle are affected by BSE?
A: According to the USDA,the brains, spinal cord, eyes, tonsils, central nervous system nerve
bundles, and the far end of the small intestine(distal ileum) are considered high risk material for
carrying BSE.
Q: Does that mean I should not eat brains or cow heads?
A: USDA is taking steps to classify high risk cattle brains, eyes, skull, spinal cords and other
internal parts as not fit for human consumption if they are from cattle that are over 30 months
old. The lower intestines from cattle of any age will also be prohibited from use in the human
food supply.
Q: Does cooking the meat destroy the BSE?
A: BSE cannot be cooked out. Again, according to USDA,the meat poses virtually no risk of
BSE to humans because muscle meat is not believed to carry BSE.
DOH talking points
Original draft 12-26-03
Revised 12-31-03
Q: What about cross contamination in the kitchen? Is it the same as cross contamination with E.
coli or different? •
A: Cuts of beef that are muscle meat are not believed to pose a risk of BSE. Preventing cross
contamination of food products however, still plays an important role in the control of foodborne
illness from other pathogens.
INVESTIGATION, RESOURCES
Q: What is your office doing as compared to WSDA? or other state or federal agencies?
A: The Washington State Department of Health is providing support to USDA, FDA and
WSDA, the agencies that are leading the investigation. In Washington State, the USDA is in
charge of the meat inspection program and is the lead agency for this animal investigation.
Q: Do you have a fact sheet specifically for restaurants? Do you have a fact sheet for groceries?
Do you have a fact sheet for local health food programs? Do you have a fact sheet for local
health food programs to provide info for consumers?
A: Because information about BSE is being learned every day, for the most up-to-date
information, refer to the USDA and FDA Web sites or call the USDA Meat and Poultry Hotline
at 1-888-MPHotline.
Q: What are you doing to coordinate with the other states impacted by the recall?
110
A: As with any recall of a meat product that affects multiple states, we are working with the US
Department of Agriculture,which is the lead agency for this food product recall.
The USDA Web site(http://www.usda.gov/news/releases/2003/12/0449.htm) has more
information.
•
DOH talking points
Original draft 12-26-03
Revised 12-31-03
•
•
January 5, 2004
To Neurologists, Neuropathologists, Medical Examiners, and Health Officers:
To improve detection of human prion diseases (transmissible spongiform
encephalopathies, e.g., Creutzfeldt-Jakob disease [CJD] and variant Creutzfeldt-Jakob
disease [vCJD]), Washington State Department of Health, in collaboration with the
National Prion Disease Pathology Surveillance Center (NPDPSC), plans to enhance
surveillance for these diseases. Accurate confirmation of prion disease requires
examination of brain tissue obtained at biopsy or autopsy, and this is the only means to
distinguish CJD from vCJD. Human prion diseases are notifiable in Washington as rare
diseases of public health significance as described in Washington Administrative Codes
(WAC) 246-100 and 246-101. The discovery of a case of bovine spongiform
• encephalopathy(BSE or mad cow disease) makes this notification especially important.
We request that health care providers and others report suspected cases of CJD or vCJD
in Washington, so that suspected prion disease is reported in a timely manner and,
whenever possible, tissue from individual cases is examined to confirm or rule out the
diagnosis. It is critically important that suspected prion disease is accurately
diagnosed through examination of brain tissue obtained at biopsy or autopsy.
The NPDPSC performs histopathology, immunohistochemistry, Western blot, and prion
gene analysis in brain tissues obtained at autopsy and biopsy to confirm the diagnosis of
and the type of prion disease. Cerebrospinal fluid (CSF) is also examined for the
presence of the CJD protein marker 14-3-3. All tests are free of charge and results are
reported to the health care provider.
To increase detection of suspected prion disease in Washington, we ask you to assist in
the following ways:
1. Report all suspected prion disease to the Washington State Department of Health
(DOH) (206 361-2914 or 877-539-4344) as soon as the diagnosis is suspected.
Staff from DOH or NPDPSC may contact the healthcare provider to monitor the
4111 course of the disease.
2. Discuss the issue of autopsy with the patient's family when appropriate. NPDPSC
can help make arrangements for the autopsy by identifying institutions willing to •
perform it, and, when necessary, by covering the expenses.
3. Submit clinical information on all reported cases upon request to DOH, regardless
of whether or not a biopsy or autopsy was performed. Although it is essential that
tissue be examined in as many cases as possible, the case will be classified as
possible or probable prion disease based on clinical data if a biopsy or autopsy
cannot be performed.
4. Clearly indicate the diagnosis of CJD on the patient's death certificate when the
clinical diagnosis applies because CJD is also monitored from mortality data.
5. Advise patient's families about supporting organizations. The CJD Foundation
operates a national toll-free line to assist families and professionals (800-659-1991.)
To report a suspect CJD case or if you have questions, please contact the Washington
State Department of Health at 206-361-2914 or 877-539-4344 and ask for Drs. Marcia
Goldoft or Mira Leslie.
Thank you for your assistance with this important public health activity.
•
Jo Hofmann, MD
State Epidemiologist for Communicable Disease
•
Tests performed by NPDPSC and reports turn-around-times
Ost on biopsy tissue Turn-around-times
Western Blot (WB) of the prion protein (PrP). (Establishes 3 — 5 working days
presence and type of scrapie PrP; frozen tissue required)
Histology and PrP immunohistochemistry (IHC). (Establish 5 working days
presence and distribution of scrapie PrP on fixed tissue)
14-3-3 determination in CSF 3 — 5 working days
Tests on autopsy tissues
WB of PrP 3 weeks
Histology and IHC of PrP 3 weeks
PrP gene sequencing. (Identifies mutations and codon 129 3 —4 weeks (biopsies and
genotype needed for precise prion disease type diagnosis) autopsies)
Summary report with prion disease type diagnosis based on 4— 5 weeks (biopsies and
all above tests autopsies)
Cases referred and diagnosed on tissue at NPDPSC (1997-2003)
Year Referrals Prion D. Sporadic Familial Iatrogenic vCJD
Total
1997 104 60 54 6 0 0
• 1998 94 51 44 6 1 0
1999 114 74 65 9 0 0
2000 169 111 97 12 2 0
2001 247 154 138 16 0 0
2002 2651 151 127 22 1 12
20033 102 61 s N/A N/A N/A 0
Total 1095 662 (60%) 525 71 4 1
1 Includes 2 inconclusive; 2 Acquired in United Kingdom, living; 3 Through May 2003
Information about the NPDPSC, specimen collection, and shipping instructions can be
obtained at www.cjdsurveillance.com or calling 216-368-0587. All NPDPCS
correspondence and shipments should be addressed to:
Pierluigi Gambetti, M.D.
Division of Neuropathology, Room 419
Case Western Reserve University
2085 Adelbert Road
Cleveland, Ohio 44106-4907
Telephone: 216-368-0587
0 Email: cjdsury@po.cwru.edu
Board of Health
New Business
Agenda Item # V., 3
On-Site Sewage Permitting
Program Activity - 2003
January 15, 2004
e' _cPUBLIC HEALTH
r� `1 Always Working for a Safer and
SNjNoc '' HEALTHIER JEFFERSON
411
615 Sheridan Street Port Townsend,Washington 98368
Memorandum
To: Jefferson County BOCC
From: Larry Fay,Environmental Health Director7/11/6Z,.
Date: January 8, 2004
Re: Septic Permitting Report for 2003
The attached materials are being submitted for your review and consideration. Included
in the materials are:
• Environmental Health 2004 program budget
• Process diagram,
411 • Report on 2003 permit application process time. This has been broken down by
permit status, final, active and pending,
• An analysis of reasons for"clock stoppers",.
• Comparison data with several benchmark counties including staffing levels,
• Summary of designer meeting,
• List of designer issues,
• Recommendations,
These materials have been prepared to address concerns expressed by the BOCC about
permitting processing in general with specific reference to onsite sewage systems. As we
look at process changes it is important to understand where potential bottle necks exist so
that the changes we introduce are most likely to result in performance improvement.
i
COMMUNITY ENVIRONMENTAL DEVELOPMENTAL SUBSTANCE ABUSE
HEALTH HEALTH DISABILITIES & PREVENTION
(360) 385-9400 (360) 385-9444 (360) 385-9400 (360) 385-9400
• Jefferson County Health&Human Services
Budget/Program: Environmental Health Program Budgets
REVENUE: 2004 2004 2004 2004 2004 2004 2004 2004
EH Admin Water Solid Waste On Site Food Living Zoonotic Budget
Program Prevent/ Sewage Program Environments
Eduction
Restricted Fund Balance:
Beg.Fund Balance 19,465 17,001 - - - - 36,466
Taxes -
-
Federal Grants - 1,250 - 1,500 1,500 - 4,250
State Grants 2,300 12,750 78,986 - - - - 94,036
Intergovernmental 24,212 - - - 24,212
Fee for Service - 34,000 2,180 140,000 68,000 6,700 - 250,880
Misc.Revenue,Contributions
-
Interfund Chg.For Service 12,383 2,760 40,883 - - - 56,026
Feasibility Study-GF
-
General Fund 69,148 - - 20,034 - 5,019 94,201
Total Revenue 127,508 67,761 122,049 161,534 69,500 6,700 5,019 560,071
EXPENDITURES: 2004 2004 2004 2004 2004 2004 2004 2004
EH Admin Water Solid Waste On Site Food Living Zoonotic Budget
-40 Program Prevent/ Sewage Program Environments
Eduction
Wages&Benefits 76,207 51,734 96,064 128,465 47,839 4,734 4,193 409,235
Supplies 370 584 1,774 894 1,346 17 15 5,001
Tool&Equipment 200 - _ - - 200
Professional Services - 200 - 1,500 1,500
Communication _ - - 3,200
905 618 1,752 1,693 700 57 50 5,775
Travel 1,760 125 1,150 500 330 25 110 4,000
Training 200 100 400 500 100 - 200 1,500
Miscellaneous 13,586 203 2,339 1,325 209 13 11 17,687
Interfund Services 2,300 5,005 5,000 13,815 - 1,200 - _ 27,320
Interfund Leases 4,835 3,298 6,687 7,760 3,684 307 265 26,835
Interfund Rent 3,166 2,160 4,380 5,082 2,413 201 174 17,575-
Sub-Total Expenditures 103,529 64,026 119,547 161,534 58,120 6,555 5,018 518,328
Required Fund Balance - -
Total Expenditures 103,529 64,026 119,547 161,534 58,120 6,555 5,018 518,328
Balance Forward 23,979 3,735 2,502 0 11,380 145 1 41,743
STAFFING: 2004 2004 2004 2004 2004 2004 2004 2004
EH Admin Water Solid Waste On Site Food Living Zoonotic Budget
Program Prevent/ Sewage Program Environments
Eduction
1 Hours 2,917.00 1,990.00 4,035.00 4,682•00 ,222.60 185 160 16,191.60
iETE's 1.39 0.95 1.93 2.23 1.06 0.09 0.08 7.73
2 Jefferson County 2004 Budget Request
Health&Human Services Environmental Health
SEPTIC PERMIT
APPLICATION PROCESS
• . . . . . .
APp{itaxion Received:::
I ::i4 Pii..ati: 6' Compjete No Return t0 .
` Applicant
Yes lir
:Entered:into f?.P..File Made
Serif tti EF{
-0I Initial EH Review
Confer with L +
Yes
Planner , ESA
No
v Yes
Formal Review No Missing Information
Needed?
No Contact
Yes411 Designer/Owner Resolve
Stops Clock y
Site Visit —Stop Clock?
Send to DCD
for Review 4
Design Matches No Contact Designer
V Site Conditions Maior Fla, Clock Stop
Bill Applicant Yes i i
Yes
- Does Design Meet 4 Re-design Using
State Standards? Existing Information
•Contact No Approve In House,
Applicant/Designer 4 Conditions only A Problem No
•Site Visit No Problems V
•Contact Other
Professionals • Contact New Soils, New
Yes Designer Location Re-design
•Require Additional UDC Holds
Info V Clock Stop Pay Fee Start Over
Signed Off
•Stops DCD Clock Bills Paid
• No Resolve
Requires System to Yes No Start Clock
be Relocated
Yes ,. DCD Sign
Off Yes
Re-design
Pay Fee
iik Start Over
V
ISSUE PERMIT
II
S
Tech Review Environmental Health Department of Community Development
• Attachment C:
2003 Septic Processing Time by Permit Status:
1/1/03 #of Days to Corrected #of % Average %with
through Cases Initial Days to Clock Stopped #of Pre-
9/30/03 Inspection Issue Stoppers Days design
Stopped Inspection
Final 42 12 21 13 30% 12 7%
Active 146 12 22 63 43% 15 8%
Pending 18 11 - 18 - - 6%
10/1/03
Through
11/30/03
Final 0 - - - - - -
Active 23 10 17 5 21% 3 12%
Pending 7 9 - 7 - - 0%
Note 1: Days reported are calendar days
Note 2: Different staff has entered data differently when reporting inspections that
occurred before the application was submitted. This has resulted in the right hand column
41) under reporting the actual frequency. This problem has been corrected.
Causes of Clock Stoppers:
In order to understand why clock stoppers occur we reviewed 60 cases that have them.
We broke down the causes into 4 broad categories.
1. Missing information(most commonly such things like easements and restrictive
covenants)
2. Environmentally Sensitive Areas
3. Minor redesign(typically things like inconsistencies within the design submittal)
4. Major redesign(situations where the design submitted is inappropriate for the site
conditions)
Cause of stopper # Of the apps with %of total apps
clock stoppers received
1 23 38 % 17%
2 27 45 % 20%
3 15 25 % 11 %
4 12 20% 9%
Note: The total# exceeds 60 cases because several applications had multiple clock
0 stoppers
S
Additional interesting permits data:
Percent of System permitted but not installed by year of issuance
2000 (expired in 2003) 36%
2001 (expires in 2004) 43%
Submittals by Designer:
In 2003 designs were submitted by 20 designers or engineers
In 2003 6 designers submitted 85%of the total applications
In 2003 1 designer submitted 30%of the total applications
In 2003 11 designers submitted 3 or fewer applications
O
110
Attachment E: Comparison by Benchmark Counties
Request for information was sent to Island,Mason, Clallam,Kitsap,Grays Harbor and
Lewis Counties. We received no response form Mason, Lewis nor Kitsap Counties.
No county was able to report the number of applications remanded or redesigned. (Clock
stoppers)
All counties report that septic applications undergo some review for conformance with
zoning and critical areas ordinances
County Ave. Caseload Staffing Typical Applications %
Processing per FTE Conventional
Island 880 applications 6.7 FTE 30 days* 131 (app) 30%
• + 660 site eval. 229 (total)
Clallam 485 4.5 FTE 1-2 107 28%
weeks**
Grays Harbor 320 2.2 FTE About 2 145 51%
weeks**
Jefferson 278 2.23 FTE 21 days 125 52%
*Island County uses a two step process for permitting. They do a site registration or
approval process followed by a design submittal permit approval.A site approval
takes 13 days. Permit processing takes an additional 17 days. The total time is 30
days not counting time waiting for additional information or corrections.
** These reported times are estimates.
S
• Attachment F:
Designer/Engineer Meeting Notes
Meeting Date: 12/11/03 7-9 pm
Location: Jefferson County Health and Human Services
Attendees:
Paul Gruver,Designer
John Fleming,PE.
Ralph Wilson,Designer
Bernt Ericsen,Designer
Janet Welch,Designer
Linda Atkins, JCH&HS
Randy Marx , JCH&HS
Susan Porto, JCH&HS
Larry Fay, JCH&HS
• Purpose:
1. Review and Comment on process change that would mandate pre-design
inspections.
2. Identify and list issues and practices that make is difficult to successfully
complete and onsite sewage system design.
Pre-design Inspection comments and conclusions:
• An opportunity for an inspection or consultative visit onsite prior to design is very
useful on challenging sites or when dealing with borderline type situations.
• A mandatory pre-design inspection is probably not necessary or desirable.
• There should be some structure or policy around when and how pre-design
services are available, fees for these services,validity of results of pre-design
inspections and documentation of any agreements reached..
• There was disagreement on how formal the process should be. Opinions ranged
from a very casual, hand shake type process to one where the designer has already
reached preliminary conclusions based on soil and site conditions that are
submitted in a written report prior to the pre-design or consultative visit.
• There was recognition and appreciation expressed that staff have always been
willing to meet onsite to talk over issues or offer suggestions when a designer or
engineer requests it.
40
• The question was raised as to how a mandatory pre-design inspection relates to
ID the SPAAD process established in the UDC.
Issues Identified that Make It Difficult to Complete Designs:
There was lively discussion. The attached list compiles the things that the designers
experience that cause problems. We have attempted to prioritize and schedule for
completion or addressing the issues listed. The priority was set by two factors; degree of
difficulty and level of urgency. We have also identified where decisions need to be made,
eg. BOH, BOCC,DCD,DOH or H&HS.
Probably the consistent message in the discussion was the need for consistency,written
policy and procedure,timely communication of changes in process or policy as well as a
mechanism for regularly review and update.
There was agreement that regular informal meetings with designers and installers is very
valuable for exchanging information,identifying problems and offering solutions. We
agreed that, beginning February,we will host quarterly evening meetings. Initially we
will focus on design and permitting but anticipate that we will rapidly expand into
installation.
•
i
Notes from Designer Roundtable meeting December 11,2003
Potential Items to address thru
Process Change
IP Policy
PA=Policy Amendment required
P=new policy required
Al=written Administrative Interpretation
A/D/G=Advise/Discuss provide Guidance
Difficulty Priority Who Question/Problem When to Tool to
E=easy, L=low, EH,DCD, complete implement
M=medium M=rediu PW,BOCC, (month/
,H=hard m, State year)
H=high
H M DCD UDC difficult to use—need matrix of setbacks for
ESA's
H H DCD UDC—consistency of interpretation of code between
planners,between staff and manager.
H H EH Consistency of interpretation of health code between
staff.
E M EH UDC—training for designers on ESA's-technical
standards
Training on using available maps and computer tools
E H EH Getting the Fee Schedule out is a priority 12/03
E H EH Index of forms &policies ,Directives, interpretations. 01/30
On web and hard copy
E H EH What forms/applications do owners need to sign and 01/15- AI
when can a designer or rep_sign. What about faxed 30
signatures
M H BOH/ Water/ Sewer line crossing 03/30 P
EH ? Always-ok if meet standard of DOE
? Only ok it can't do it otherwise
? Waiver required when.
E H EH Quarterly roundtable meeting- Include any new p
changes. o
Tie adopt date of any policy to after date of E.
next meet
E H EH Reduced size drainfield—letter from client-* signed 01/30 AI
by client? form letter from Health?Design
justification by designer.
E H EH & Asbuilt corrections
STATE Can missing info on as builts be submitted by e-mail?
M M EH Stakeholder involvement in Policies that are adopted O
Communicate in some ongoing way o
as
•
Notes from designer roundtable,Dec. 11, 2003 Page 1 of 2
Difficulty Priority Who Question/Problem When to Tool to
E=easy, L=low, EH,DCD, complete implement
M=medium M=mediu PW,BOCC, (month/
,H=hard m, State year)
H=high
• M M EH Clarity RE Flood Prevention Elevation of 03/30
components. Which one&How much
E M EH 30 Ml. liner V.S. EPDM 01/15
E M Eh RV Dump's allowed?Any sizing changes? 03/30 A/D
M H EH If you don't meet guidelines do you apply for a 02/03 A/D
waiver?
M M EH Can we use round table as CEU's 06/30
M M EH/ 17"of soil—is this requiring a wet season eval? 06 PA
BOH
M L EH Elevated containment vessels Done
H M EH/ Plumbing in out buildings? Garage, satellite bedroom, 09/ P
BOH ADU
H L/M EH/ RV's—residences/recreational. "park models" P
DCD
H H ? Policies that are adopted by other agencies the in the p
county, communicating those to designers. o
vo
• M H EH Size &who can do reserve area 03 AI
M H EH Who is allowed to apply for a tank only permit? 03 AI
H L EH/ Is it allowable to do a holding tank?
STATE
H L EH/ D-Box Future
STATE
M L EH Knowing who is out(Staff) Future
E H EH Round table that includes p
Installers &Designers or Crossover/Both _ o
o
(IQ
For next roundtable concensus was for Evenings 5:30—7:30 pm,NOT Wednesday, designers only for the next
couple of meetings
•
Notes from designer roundtable, Dec. 11, 2003 Page 2 of 2
Process Recommendations
• Based on the preceding information we think that the best way to improve septic permitting performance
is to focus in two areas.These are to assure that the process is supportive of complete and accurate
applications(that already make up the majority of submittals)and to work towards increasing the
percentage of applications that are complete and accurate.We suggest that the following statements
capture what should be the principles that guide our process(I believe most of these statements are
reflective our approach now,but we have not adopted them in a written form)
Septic design and permitting guiding principles
1. Onsite sewage system designers and engineers are knowledgeable and practice competently in
balancing the needs and desires of their clients with the minimum standards contained in
regulations and within generally accepted industry standards of practice.
2. Error free submittals and work that requires no out of office review will take priority over rework
and field work.
3. The system is set up so that information needed by a designer or engineer is readily accessible.
This can include information concerning rules,policies and procedures as well as documented
information pertinent to the design(eg. Critical areas, shorelines,previous soils information,
previous permit history).
4. The system is predictable and repeatable.
5. EH staff is well trained and qualified.Rules are applied consistently and fairly.Rule
interpretations are documented and when appropriate rule interpretations are adopted as policy.
6. Staff facilitates the permit process.
7. Staff is available to consult with designers and engineers about specific projects either in the
• office or in the field in order to offer guidance towards the completion of a design.
8. Once a permit has been issued quality control (inspection)is mainly the responsibility of the
designer.EH will provide support through oversight of licensed installers taking appropriate
actions against installers when necessary and as provided in the regulations.
9. Data will be used to track performance.
Possible new goals not identified in the 2004 budget:
1. Improve the quality of application submittals in order to reduce rejections and rework.
(Associated objective: Conduct quarterly workshops/roundtables that include CEU's with
designers/engineers to identify and resolve system problems)
2. Provide ESA training to designers/engineers.Training would address technical requirements
contained in the UDC and the use of the county web based maps.
Possible system improvement measures(we already have identified several *):
1. %of systems failing prematurely(<5 years).*
2. %of initial inspections completed< 14 days.*
3. % of applications approved the first time through.*
4. Corrected days to process.*
Expected Outcomes:
1. Reduced processing time for complete and accurate applications.
2. Concurrently processing time for incomplete applications may increase.
3. Applications processed without clock stoppers exceeds the current level, 55%.
11110
,00N `°Ly PUBLIC HEALTH
�~ e`� Always Working for a Safer and
• "SX�Na�°� HEALTHIER JEFFERSON
615 Sheridan Street,Port Townsend,Washington 98368
Septic design and permitting guiding principles
1. Onsite sewage system designers and engineers are knowledgeable and practice
competently in balancing the needs and desires of their clients with the minimum
standards contained in regulations and within generally accepted industry standards of
practice.
2. Error free submittals and work that requires no out of office review will take priority over
rework and field work.
3. The system is set up so that information needed by a designer or engineer is readily
accessible. This can include information concerning rules,policies and procedures as
well as documented information pertinent to the design(eg. Critical areas, shorelines,
previous soils information,previous permit history).
4. The system is predictable and repeatable.
5. EH staff is well trained and qualified. Rules are applied consistently and fairly. Rule
interpretations are documented and when appropriate rule interpretations are adopted as
• policy.
6. Staff facilitates the permit process.
7. Staff is available to consult with designers and engineers about specific projects either in
the office or in the field in order to offer guidance towards the completion of a design.
8. Once a permit has been issued quality control (inspection)is mainly the responsibility of
the designer. EH will provide support through oversight of licensed installers taking
appropriate actions against installers when necessary and as provided in the regulations.
9. Data will be used to track performance.
Adopted January 12,2004
Lawrence D. Fay Jr.
Environmental Health Director
Jefferson County Health and Human Services
•
COMMUNITY ENVIRONMENTAL DEVELOPMENTAL SUBSTANCE ABUSE
HEALTH HEALTH DISABILITIES & PREVENTION
(360) 385-9400 (360) 385-9444 (360) 385-9400 (360) 385-9400
Board of Health
New Business
Agenda Item # V., 4
•
2"d Draft Policy
Concerning Evaluation
Existing On-Site Sewage
January 15, 2004
•
1/7/2004 2nd Draft
JEFFERSON COUNTY HEALTH AND HUMAN SERVICES
• ENVIRONMENTAL HEALTH DIVISION
POLICY STATEMENT
PROGRAM — On-site Sewage Disposal
SUBJECT— Evaluation of existing onsite sewage systems
Effective this date the following procedure shall be adopted concerning when
evaluations of existing onsite sewage systems (EES) will be required, by whom,
and how they will be conducted.
PURPOSE
Section 8.15.140 of the Jefferson County Onsite Sewage Code establishes that
owners of existing onsite sewage systems shall obtain an initial inspection (EES)
when the property that is served by the system is being sold and/or when an
application for a building permit is submitted. The purpose of this policy is to
provide more specific direction as to when an EES is required, how an EES must
be conducted, who can conduct inspections and what may result from an
inspection.
APPLICABILITY
This policy applies to individual residential and commercial onsite sewage
systems. This policy is not intended to address EES required under other
provisions of the onsite sewage code: community systems, areas of special
concern or systems that were permitted with waivers.
GENERAL POLICY STATEMENT
It is the policy of the Jefferson County Board of Health that all residences,
businesses or other buildings where people work, live or congregate in Jefferson
County not served by a public sewage treatment system must be connected to
an approved, properly functioning onsite sewage system. It is also the policy of
the Board that all systems must be maintained properly in order to reduce the
frequency of failure and that all systems will receive periodic inspection by an
approved third party (Health Department staff, Designer or Professional Engineer
Licensed to practice in Washington, Certified Operations and Monitoring
Specialist) or EES at the frequency established in the Onsite Sewage Code.
SPECIFIC STANDARDS
A. Types of Evaluation of Existing Systems (EES)
•
1/7/2004 2nd Draft
. 1. Operational check - intended to verify that there is an existing
functioning system on the property. The inspection must include a visual
inspection of the septic tank to confirm the construction material, structural
integrity, and liquid capacity, sludge and scum depth as well as general
condition with specific reference to inlet and outlet baffles. The general
location of the drainfield must be identified and evaluated to verify that
there are no direct discharges or surfacing effluent.
2. Full Assessment - Includes an operational check as described above.
In addition it requires establishing the location of the drainfield
components, both depth and size, to determine its treatment capacity and
level of compliance with standards. If insufficient information is available
after a review of the record the next step is to complete evaluation onsite.
This typically entails uncovering some system components.
B. Who Can Conduct an EES:
1. The operational check EES may be conducted by licensed onsite
sewage system Designers or Engineers Licensed to practice in
Washington, County Environmental Health staff and Certified O&M
Specialists.
• 2. The full assessment EES Inspections that are intended to establish the
treatment capacity of a system and/or designate a reserve area may be
conducted only by Licensed Designers, Engineers or Environmental
Health Division staff.
C. When EES is required
1. Time of Sale: An operational check EES shall be conducted at the
time of sale. It is intended to verify that there is an existing functioning
system on the property.
2. Building Permit Applications: An application for a building permit will
trigger the requirement to have an EES completed as specified in the
attached table, appendix 1.
a. Exceptions- An EES is not required for building permit applications
for building maintenance including but not limited to re-roofing, replacing
or adding windows, wood or propane stove installation, above ground
propane tank installation and interior remodels that do not include new
plumbing or additional bedrooms.
•
1/7/2004 2nd Draft
D. Inspection results:
1110
1. Anyinspection identifying p a failure as defined in WAC 246-272 - Onsite
Sewage System Rules and Regulations of the State Board of Health, must
be reported to Jefferson County Health and Human Services within 24
hours. Owners of failed onsite sewage systems will be required to initiate
steps to correct the failure upon notice from the health department.
2. Any inspection identifying maintenance deficiencies must be recorded
in writing in the inspection report. The report must be submitted to
Jefferson County Health and Human Services and to the property owner,
at the first reasonable opportunity.
3. If the EES is performed for the purposes of property sale, it will be the
responsibility of the seller and buyer to determine who will correct
identified deficiencies. Deficiencies not corrected by the time of the next
regular inspection will be considered a violation.
4. If the EES is performed for the purposes of a building permit
application, it will be the responsibility of the property owner to correct the
identified deficiencies. Deficiencies must be corrected prior to final
inspection and sign off on the building permit.
• EFFECTIVE DATE
This policy shall become effective on the date of adoption and remain in effect
until amended or repealed by action of the Jefferson County Board of Health.
Health Officer Date
Chairman of the Board of Health Date
•
Board of Health
New Business
Agenda Item # V., 5
• Influenza Update
January 15, 2004
•
-CDC - Influenza(Flu) I Current Weekly Report: Influenza Summary Update Page 1 of 4
E
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n to 4 t l? i t 4 �'J� E.r z t o € } Search-I
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)A out lu ° 7 '
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Professionals
Flu_Horne>About-theFlu>Flu Activity>
>News-&Highlights
Weekly Report: Influenza Summary Update
)Flu Activity Week ending December 27,2003-Week 52
)Influenza.VaccineBulletins The following information may be quoted:
>Ftu.Gallery Patient-Education
Materia_I.s
References&Resources Synopsis:
The number of states reporting widespread influenza activity decreased during week 52(December 21-27,2003).However,the percentage of outpatient
visits for influenza-like illness(ILI)continued to increase(9.4%),and pneumonia and influenza(P&I)mortality(9.0%)exceeded the epidemic threshold for
)?Mlat'sNew week 52(7.9%).Nine hundred eighty-eight(28.1%)of 3,510 specimens collected from throughout the United States and tested by U.S.World Health
Organization(WHO)and National Respiratory and Enteric Virus Surveillance System(NREVSS)collaborating laboratories were positive for influenza Forty-
)Contact Us two state health departments,New York City,and the District of Columbia reported widespread influenza activity and 8 states reported regional activity.
Availability of trivalent inactivated influenza vaccine is limited;additional doses of the vaccine previously purchased by CDC will be shipped to state and local
public health agencies in January.The live,attenuated influenza vaccine continues to be available in both the private and public sectors.
Laboratory Surveillance*:
During week 52,WHO and NREVSS laboratories reported 3,510 specimens tested for influenza viruses,and 988(28.1%)were positive.Of these,148 were
influenza A(H3N2)viruses,836 were influenza A viruses that were not subtyped,and 4 were influenza B viruses.
Since September 28,WHO and NREVSS laboratories have tested a total of 50,743 specimens for influenza viruses and 14,942(29.4%)were positive.
Among the 14,942 influenza viruses,14,847(99.4%)were influenza A viruses and 95(0.6%)were influenza B viruses.Three thousand five hundred seventy-
seven(24.1%)of the 14,847 influenza A viruses have been subtyped;3,576(99.9%)were influenza A(H3N2)viruses and 1(0.1%)was an A(H1)virus.All
• 50 states have reported laboratory-confirmed influenza this season.
UUHOJNREVSS Collaborating Laboratories
National Summary, 2003-04
3000 - ®A(H3N2) - 50
2800 - mioA(H1N1)and A(H1N2)
-45
2800 - imms A(Unsubtyped)
2400 - B • 40
2200 - -Percent Positive
2000 - •35 0
O 1800 - •'•a •30 8
SQ A; d
1800 -
1400 •25 rC
0i CD
1200 - -20 2
41
=1000 - . ci-
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K
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40 42 44 46 48 50 52 1 3 5 7 9 11 13 15 17 19
Week
•
View WHO-NREVSS Regional Bar Charts i View Chart Data
http://www.cdc.gov/flu/weekly/ 1/8/2004
CDC - Influenza(Flu) I Current Weekly Report: Influenza Summary Update Page 2 of a
Antigenic Characterization:
CDC has antigenically characterized 361 influenza viruses collected by U.S.laboratories since October 1:two influenza A(H1)viruses,357 influenza A
(H3N2)viruses,and two influenza B viruses.The hemagglutinin proteins of the influenza A(H1)viruses were similar antigenically to the hemagglutinin of the
vaccine strain A/New Caledonia/20/99.Of the 357 influenza A(H3N2)isolates that have been characterized,91(25.5%)were similar antigenically to the•
vaccine strain A/Panama/2007/99(H3N2),and 266(74.5%)were similar to the drift variant,A/Fujian/411/2002(H3N2).Both influenza B viruses
characterized were similar antigenically to B/Sichuan/379/99.
Pneumonia and Influenza(P&l)Mortality Surveillance:
During week 52,9.0%of all deaths reported by the vital statistics offices of 122 U.S.cities were due to pneumonia and influenza.This percentage is above
the epidemic threshold of 7.9%for week 52.
Pneumonia and Influenza Mortality
for 122 U.S. Cities
Week Ending 12/27103
12
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Weeks
•
View_Full._$creep
Influenza-like Illness Surveillance*:
During week 52,9.4%"of patient visits to U.S.sentinel providers were due to ILI.This percentage is above the national baseline of 2.5%.The percentage of
patient visits for ILI increased in 7 of the 9 surveillance regions.On a regional level"',the percentage of visits for ILI was highest in the East North Central
region(11.4%),followed by the South Atlantic region(10.4%),the Mid-Atlantic and Pacific regions(10.1%),West South Central region(8.5%),Mountain
region(7.6%),West North Central region(7.4%),New England region(6.7%),and East South Central region(5.8%).Due to wide variability in regional level
data,it is not appropriate to apply the national baseline to regional level data.Some elevations in ILI may be due to fewer routine visits scheduled during
holiday weeks.
•
http://www.cdc.gov/flu/weekly/ 1/8/2004
CDC - Influenza(Flu) I Current Weekly Report: Influenza Summary Update Page 3 of 4
Percentage of Visits for Influenza-like Illness
Reported by Sentinel Providers
• National Summary, 2003-04
12-
11 -
10-
9 f1
d 8 ..1
b
re 6
S
rF
3-
2
1 '►•v
0 •
10 42 44 45 48 517 52 1 3 5 7 9 11 13 15 17 19
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'Tie 1999,2030 se aso was se ket d for can pato r because tt tteis 1i a most rece 1 to Qf3N7 se aso 1 ale ode rate se ue Of.
View Chart Data I View_Full_Screen
Influenza Activity as Assessed by State and Territorial Epidemiologists**:
Influenza activity was reported as widespread in 42 states(Alabama,Alaska,Arizona,Arkansas,California,Colorado,Connecticut,Delaware,Florida,
Georgia,Idaho,Illinois,Indiana,Iowa,Maine,Maryland,Massachusetts,Michigan,Minnesota,Mississippi,Missouri,Montana,Nevada,New Hampshire,
New Jersey,New Mexico,New York,North Carolina,North Dakota,Ohio,Oregon,Pennsylvania,Rhode Island,South Carolina,South Dakota,Tennessee,
Texas,Utah,Vermont,Virginia,Wisconsin,and Wyoming),New York City,and the District of Columbia.Regional activity was reported by 8 states(Hawaii,
Kansas,Kentucky,Louisiana,Nebraska,Oklahoma,Washington,and West Virginia).
•
Weekly-Influenza Activity Estimates;.Reported:
by State,&Territorial Epidemiologists
• Week endllig.DecW
ember27,2003 eek 52
•
1aoDeport No At tlbr,'.;,',Spoaaid'.•.•.LncatA:Wiv. .'..Regbrtai.'. W.Itleapread'. .'. .'. .:
. . View Full Screen
Vaccine Availability:
• In the private sector,trivalent inadwated influenza vaccine is no longer available for sale by the manufacturers,although some vaccine may still be available
through private wholesale/distribution companies.The live,attenuated influenza vaccine continues to be available for purchase from Wyeth Pharmaceuticals
(Collegeville,Pennsylvania,telephone 800-358-7443).
In the public sector,the live,attenuated influenza vaccine is also available for immediate purchase through a CDC contract.Additional doses of trivalent
http://www.cdc.gov/flu/weekly/ 1/8/2004
CDC - Influenza(Flu) I Current Weekly Report: Influenza Summary Update Page 4 of 4'
inactivated influenza vaccine previously purchased through CDC contracts will be shipped to state and local public health agencies in early to mid-January.
•Reporting is incomplete for this week.Numbers may change as more reports are received. •
"The national and regional percentage of patient visits for ILI is weighted on the basis of state population.
""Surveillance Regions:New England(Connecticut,Maine,Massachusetts,New Hampshire,Vermont,Rhode Island);Mid-Atlantic(New Jersey,New
York City,Pennsylvania,Upstate New York);East North Central(Illinois,Indiana,Michigan,Ohio,Wisconsin);West North Central(Iowa,Kansas,
Minnesota,Missouri,Nebraska,North Dakota,South Dakota);South Atlantic(Delaware,Florida,Georgia,Maryland,North Carolina,South Carolina,
Virginia,Washington,D.C.,West Virginia);East South Central(Alabama,Kentucky,Mississippi,Tennessee);West South Central(Arkansas,Louisiana,
Oklahoma,Texas);Mountain(Arizona,Colorado,Idaho,Montana,Nevada,New Mexico,Utah,Wyoming);Pacific(Alaska,California,Hawaii,Oregon,
Washington)
Report prepared:January 2,2004
Home I Privacy Policy I Disclaimer I Accessibility I Q I Information Quality I Contact Us
11AAPtR•H gALT71[1itiR:PCOPLE
Centers for Disease Control and Preven5on,1800 Clifton Rd,Atlanta,GA 30333,11.5.ASTrOV/Wa ✓ x, 'Qartment of Health
Tel:404�39J311/Ph el., Inqui :800-232-2522•espa5ol 800-232-0233•TTY 800.243-7889 i' sand............................
Clinician Infonna5on Line:877554-4825
http://www.cdc.gov/flu/weekly/ 1/8/2004
•
Board of Health
Media Report
1
January 15, 2004
•
• Jefferson County Health and Human Services
DECEMBER 2003
NEWS ARTICLES
1. "Jefferson flu death reported",Peninsula Daily News
12/19/03
2. "Mad cow feared in U.S.",Peninsula Daily News
12/23/03
3. "Flu bug is quiet now; be wary of new surge",P.T. LEADER
12/24/03
4. "More flu vaccine on its way, health official says", Peninsula Daily News
12/26/03
5. "Mad cow born prior to ban",Peninsula Daily News
12/30/03
December 19-20, 2003
Jefferson
• •
u d
Bath
reported
Elderly woman also
had lung ailment
By LUKE BoGUEs
PENINSULA DAILY NEWS
Health officials believe the •..
death of an elderly Jefferson
County woman was caused by
the influenza epidemic sweep-
ing the nation.
No other influenza-related
deaths have been reported in
Jefferson and Clallam coun-
ties.
The woman had an under-
lying lung disease, but the flu Locke
is believed to be the cause of
her death this week,Clallam-Jefferson Health
Officer Dr. Tom Locke said Thursday.
• Locke refused to release the identity of the
woman.
"There's a privacy issue when we're deal-
ing with such small numbers of people," he
said.
Locke said the woman was the first person
in Jefferson and Clallam.counties to die due to
•
• influenza, adding the Health Department
won't be releasing much information on the
incident.
The state Department of Health doesn't
keep track of the number of flu deaths
statewide.
Elderly flu deaths'not a rare thing'
"Deaths among elderly individuals with
chronic medical conditions is not a rare
thing,"Locke noted.
"You hear about 36,000 flu deaths per year
—this is where that number comes from."
Locke said it's too early to tell if this year's
flu outbreak is more severe than other years.
Health officials agree it came earlier than
most years,but its affect is still being studied.
The flu has hit especially hard in some
places,like Colorado,Locke said.
"There isn't really any state or national
•
evidence that this influenza season is any
worse than previous years,"he said.
The state expects to receive reports of 700-
800 influenza-related deaths each year,mean •
-
ing some people in every county would likely
die after contracting the virus,Locke said.
The elderly,seriously ill and very young are
especially at risk to be hit hardest by
influenza.
Health officials recommend people over 65
or younger than 2 years receive flu vaccines.
..
Mädowfeared
in U .S .
•
0
Washington 1« �{'. ;' �h yr> eT ' e r + ` ?'�'" .:.
state dairy
quarantined *i qty
f ' ii
y
BY SHANNON DININNY , 7 t vu / - - 1;,. .---'10
rHE ASSOCIATED PRESS )'€s 7 .�
MABTbN—A _ 3
dairy farm near h
this south centralF s
Washington "N.
.+
was under quer- • ":44"�4-# '. �- , '''
antine Tuesday c.;=,> e
after federal offi- f
cials received pre- ;
liminary test 1 0
results indicating \ 1 �` ';�<
one animal had Veneman r
mad cow disease. fi ,,
"We are taking all necessary `
steps to assure the protection of
the health and safety of our citi-
zens and our states livestock f,
industry,"Gov.Gary Locke said. "'
USDA officials said the affected .
cow was a "downer," meaning it , -- Tila AssocuTED P,
couldn't walk. Agriculture Secre
tary Ann Veneman said the Gov.Gary Locke, center,state Deputy Director of Agriculture Bill Brookreson and state
slaughtered cow was screened ear- Health Officer Dr. Maxine Hayes address the media on Tuesday in Seattle.
tier this month and any diseased
parts were removed before they Federal authorities believe 1
ill
could enter the food supply and I,really dont think the American consumers will react that cow was deboned at Mida
infect humans. 'negatively.They'll listen to what's going on,and they'll make Meats,before its flesh was sent
SOUnd judgments." two other facilities: Willame
Farm not identified 1 $ Valley Meats in Portland, 0:
Theydid not disclose the name De.JAN Busve rty and Interstate Meat in Fede
or exact location of, the farm. professor,Washington State University Way.It was not immediately cl.
There are'doiens of dairy farms in where the animal was slau;
the area. " slaughterhouse into a drain. In a statement released Tues- tered.
If follow-up testa in Britain con-' A man who refused to give his day afternoon, the National Cat- Dr.Jan Busboom,a professor
firm the initial results,it would be ,name escorted an Associated tlemen's Beef Association urged meat science at Washington St
the first case of mad cow disease in Press reporter off the property,'. consumers not to panic. University predicted that the b
U.S.history Also known as bovine located at the south end of Cen- industry would not be hit
spongiform encephalopathy, the tralia. 'Safe to eat' hard.
disease eats holes in the brains of "I wish somebody had let me , ll scientific studies show that "I really don't think the Am.
cattle. Outbreaks decimated the know something about this,"Mid-
European beef industry and killed way Meats owner .William Sex the BSE infectious agent has can consumers will react that n
more than 100 people in the smith told The Chronicle of Cen- never been found in beef muscle atively,"he said."They'll listen
1980s. traria. meat or milk and U.S. beef what's going on,and they'll mi
About 160 miles west of. . Calls to Midway Meats and to remains safe to eat." sound judgments."
Mabton, the Midway Meats plant Sexsmith's home-by The Associ- '`While this one case is unfortu- Busboom noted that Canad
— where authorities believe the ated Press were nbt immediately nate, the association said, "sYs- consumption of beef hasn't fal
cow was deboned — appeared to returned.Tu Y terns have been built over the past since the discovery of a mad c
16years toprevent this disease
be operating at full blast late. Officials.with the state Depart- case in Alberta was announced
Tuesday afternoon, with workers' meet of Agriculture and the'Wash- from spreading and affecting May, though trade bans by :
loading meat into trucks, and ,ington State lieefcommission had either animal health or public United States and other nati(
Fresh blood running out of'the no immediate Dominent rliesday health." have hurt the industry.
•
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..
Mad orn p tcow rfor o
an
i
ans gather evidence "The recalled meat Alberta, Canada, in May. Th
411 veterinar
on animal's origin, movement representsessentially earlier case was found in a bei
animal, while the Washingto
zero risk to consumers." case was found in a dairy cow,
BY EMILY GERBEMA this single cow, the U.S. Holstein.
THE ASSOCIATED PRESS remains at very low risk," he DR. KENNETH PETERSEN The recalled meat is from
n WASHINGTON — A Hol- said,because of the ban on feed USDA veterinarian herd of 20 cows that include
`� stein infected with mad cow dis-
t
that includes animal parts. the infected Holstein slaug}
Theprion that causes mad tered Dec. 9 at Vern's LMOSE
ake
P ease was born four months had consumed recalled meat
np before the United States and cow disease is not found in and were worried. Lake Meat Co.,in Moses Lake
�, began banning from muscle tissue, the source of Baun said they were being DeHaven said there are n
use Canada cattle feed brain and roasts, steaks and other beef plans to expand the recall.
cuts. DeHaven said studies told the meat was safe since it
spinal cord tissue that is the was muscle meat and not Because it is not know
primary means by which the have shown the prion is found affected.
exactly what portions of th
ailme is transmitted,Agricu e only in the central nervous sys- "If it had been from the meat cut that day came fror
ture Department officials said tem tissue,the brain and spinal •spinal column it would have the diseased cow,health author
Monday. cord. been different,"he said. ities must assume that som
Dr. Ron DeHaven, the •He said decisions by 3Q coun- Petersen had said Sunday could have reached any locatio
department's chief veterinar- tries to refuse U.S. beef exports that the government's investi where any part of the 10,00C
ran, said records from. the in response to the case have gat revealed that meat from pound supply was distributed.
•Washington cordairyds• from.
m't}iat`•vuea`�a "gin Potions-of•-fie-.infected--dairy--cow-could Mad cow disease,known I'm
was the infected cow's last the disease and not on scientific have reached retail markets in mally as bovine spongiforr,
home, and in Canada, confirm fad' Alaska, Hawaii, Idaho and encephalopathy, or BSE, is
that the animal born in
Japan rejects liftingban Montana and the territory of concern because humans whn
Canada in April was before Guam, in addition to Washing- eat brain or spinal matter fron
U S. agriculture officials in ton, Oregon, California and ;P infected cow can develop .
the new restrictions on cattle
feed took effect. Tokyo tried to persuade Japan- Nevada. brain-wasting illness, varian
40DeHaven said that DNA ese officials Monday to lift that Creutzfeldt-Jakob disease.
studies now under way would country's ban. Distribution of Cow's meat During,a mad cow out
provide more evidence on the But Japan rejected the in the Britain. 143brew]
origin of the cow request, saying officials first Petersen said that most of people died o
infected. They also are that was- should establish the facts sur- the recalled meat was distr e- it in Britain,
ing records of the herd that rounding the infection, a uted in Washington and Ore- Petersen said the slaugh
included the infected cow. Japanese official said on cndi- gon' although some six other tered cow was deboned at Mid
tion of anon states also were involved.Some way Meats in Centralia, am
Calves at low risk ymity. Japan is the of the other states received the sent Dec. 12 to two othe
largest overseas market for U.S. meat in as few as one location, plants, Willamette Valley Mea'
The cow had three calves beef he said. and Interstate Meat, both nea
after she entered the United Dr. Kenneth Petersen, a "The recalled meat repre- Portland, Ore.
States, officials said. One died, USDA veterinarian, said the sents essentially zero risk to •
and another remains in a herd Par tment is continuing toWillamette also received bee
de consumers," said Petersen, of gs, which were sold tt
in Washington state. A third monitor all efforts to trace andtrimmin
recall all products associated USDA's food safety agency some three dozen small, mom
calf,a male,is being held in iso- DeHaven said the USDA is and-pop Asian and Mexicai
lation with other animals, ofli_ with the 10,000 pounds of meat testing at a rate that would
cials said, that have been recalled. About facilities in Washington, Ore
80 percent of the meat was dis- detect BSE, or bovine spongi- gon, California and Nevada
DeHaven said it would be form encephalopathy, or mad officials said.
tributed to Oregon and Wash- cow, at the rate of one in a mil- Several Western supermar
highly unlikely that the mad
cow disease could be transmit- ington, Petersen said. lion. He said there is no scien- ket chains —Albertson, Fre(
ted to calves from infected Matt Baun, a spokesman at tific evidence that BSE occurs Meyer, Safeway and WinC(
animal. He also said there was the U.S.Department of Agricul- spontaneously in cattle. Foods
no reason to question the safety ture in Washington, said Mon- — have voluntarily
of the U.S. meat supply day that about 100 callers He said it is premature to` removed ground beef product:
"Even with the findingof mostly from Oregon Wash- conclude that the infected ani- from the affected distributors
most y had called to and theymal found in Washington is Safeway has said it will look foi
Y linked to a case found in another supplier.
• 4$(3N =;ff\ PUBLIC HEALTH
) Always Working for a Safer and
• , �s� ° HEALTHIER JEFFERSON
615 Sheridan Street Port Townsend,Washington 98368
January 15, 2004
Doug Porter, Assistant Secretary
Department of Social and Health Services
Division of Policy and Analysis
PO Box 45533
Olympia, WA 98599-5533
Dear Mr. Porter:
Thank you for the opportunity to comment on your Strategic Planning for our Clients' Future
survey. On behalf of the Jefferson County Board of Health, I offer the following
recommendations:
1. How can Medical Assistance Administration(MAA) improve the health of Washington
residents?
Epidemiologic studies since the 1970's have consistently found that the determinates of health
are roughly 50%behavioral, 20% environmental, 20% genetic, and 10%related to medical care.
410 MAA programs have traditionally focused on the provision of acute and chronic medical care. A
greater focus on evidence-based medicine and quality of care could certainly improve the
effectiveness of that care,but the greatest health improvement benefit will come from greater
attention to the other 90% of health determinates. Support of clinical prevention services,home
visiting nurse programs, health promotion and health education programs are some examples of
areas that need much greater public sector support.
2. When dollars are limited, how do we prioritize our health care spending?
Highest priority should be given to those least able to help themselves—the poor, children, and
the disabled. Services also need to be prioritized based on their cost and effectiveness. Low cost
services that are highly effective should be at the top of the priority list. High cost services that
are lacking in evidence of effectiveness should be at the bottom of the priority list. Mental health
and oral health services should be included in the same prioritization listing.
3. How do you think we can improve upon the MAA workforce of the future?
First and foremost the workforce should reflect the cultural and ethnic/racial diversity of the
populations that are served. The MAA workforce of the future should also be distributed
throughout the state and play an active role in the communities that are served. Greater use of
information technology should allow this decentralized workforce and reduce the administrative
burdens that current DSHS programs impose on service providers.
•
COMMUNITY ENVIRONMENTAL DEVELOPMENTAL
HEALTH SUBSTANCE ABUSE
HEALTH DISABILITIES
(360) 385-9400 (360) 385-9444 (360) 385-9400 (360)
PREVENTION
(360) 385-9400
4. How can MAA work with other state agencies and local communities to blend our services so
II/ we can improve access and quality health care services?
Work with other state agencies should focus on administrative simplification and efficiency. The
Basic Health Plus plan is an excellent example of this type of collaboration. At a community
level, MAA must be seen as an honest broker—willing to pay the true cost of the services being
provided. Payment that falls far below the cost of service delivery(which has become the rule,
rather than exception) erodes access and degrades quality. Equitable funding of critical health
services is a legislative responsibility. Chronic underfunding of MAA programs by the
legislature has caused a breech of trust with community providers. Improvements in access and
quality will be difficult if not impossible until this trust is restored.
5. How can MAA maintain and expand our partnerships with health care providers so there is
adequate coverage for all Washington State residents?
MAA is often perceived as a bureaucratic agency isolated in Olympia and locked in an
adversarial relationship with its providers and clients. We suggest you start with specific
initiatives—prescription drugs, administrative simplification, and clinical preventive services—
to build trust. Ultimately, there must be a commitment by the Governor and Legislature for
adequate health care coverage to be universally available to all state residents. Partnerships
cannot be built on unfunded mandates, unstable programs, and indifferent political leadership.
6. Of the suggestions you have given MAA,please list and prioritize the three most important.
• 1. Invest in prevention (well child exams,
visiting nurses, family planning, maternal
child services)
2. Reduce administrative burdens, eliminate unfunded mandates
3. Restore trust through cost-based reimbursement for basic health services
Sincerely,
;i7
Dan Titterness, Chair
Jefferson County Board of Health
I