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2004-April
�4�45°N,,o� PUBLIC HEALTH File Copy 4. ,�i 1.-AAlways Working for a Safer and VklNa o HEALTHIER JEFFERSON 615 Sheridan Street,Port Townsend, Washington 98368 SharingResponsibility for Public Health • Jefferson County Board of Health welcomes Port Townsend City Council April 15, 2004 JEFFERSON COUNTY BOARD OF HEALTH Thursday,April 15,2004 • 7:00-9:00 PM Auditorium Jefferson General Hospital AGENDA I. Approval of Agenda and Introduction of Guests II. Approval of Minutes of Meetings of March 18,2004 III. Public Comments IV. Old Business and Informational Items 1. Letter from Carl Osaki,Washington State Board of Health V. New Business Special Meeting with the Port Townsend City Council "Sharing Responsibility for Public Health" 1. Welcome/Introduction Jill,Paula (10 minutes) 2. The Crisis in Public Health Funding Tom,Jean (10 minutes) • • A brief history of public health funding in Washington state • The current crisis:rising demands and diminishing resources • Current trends: Jefferson County 2004 David,Jean (20 minutes) Budget and Public Health Impacts 3. Long-term Solutions: Statewide efforts to solve a statewide crisis Tom,Jean (10 minutes) • Tri-association Proposal to the 2003 Legislative Session • Planned Actions for 2005 Legislative Session 4. Additional Board of Health Comments 5. Finding a Short-term Solution (60 minutes) • Follow-up to February 9,2004 Port Townsend City Council Worksession - Response to City Council Questions and Proposed Funding Formulas • Additional Questions/Unresolved Issues • Next Steps Geoff,Kees VI. Activity Update VII. Agenda Planning VIII. Next Meeting: May 20th, 2004 • 2:30 - 4:40 PM Jefferson County HHS Conference Room 1 " -, PUBLIC HEALTH 14 ( J+ Always Working for a Safer and • k #' HEALTHIER JEFFERSON Sharing Responsibility for Public Health April 15, 2004 Joint Meeting of the Jefferson County Board of Health and Port Townsend City Council Contents Board of Health Meeting Agenda The Crisis in Public Health Funding • Statewide Efforts To Solve a Statewide Crisis Meeting Materials for the February 9, 2004 City of Port Townsend Worksession Proposed Funding Formulas Appendix • Jefferson County Health and Human Services Organizational Chart 2004 • Community Health Programs Coordinated and Staffed by Public Health Nurses • Managing for Results: Business Plan for Public Health - Jefferson County • Welcome to Public Health in Washington State • Historical Information • • JEFFERSON COUNTY PORT TOWNSEND BOARD OF HEALTH CITY COUNCIL Dan Tittemess, Chair Catharine Robinson, Mayor Jefferson County Commissioner Michelle Sandoval, Deputy Mayor Glen Huntingford Jefferson County Commissioner Kees Kolff Pat Rodgers Geoff Masci Jefferson County Commissioner Freida Fenn • Geoff Masci Port Townsend City Council Frank Benskin Jill Buhler Laurie Medlicott Hospital Commissioner Sheila Westerman Citizen at Large, Port Townsend Roberta Frissell Citizen at Large, Jefferson County • 4"6��66, PUBLIC HEALTH t��k sG4. Always Working for a Safer and HEALTHIER JEFFERSON _ Board of Health MeetingAgenda & Minutes • • JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, March 18, 2004 Board Members: Staff Members: Dan Titterness, Chairman - County Commissioner District#1 Jean Baldwin, Health &Human Services Director Glen Huntingford Couny Commissioner District#2 Larry Fay, Environmental Health Director Patrick M. Rodgers- County Commissioner District#3 Julia Danskin,Nursing Services Director Geoffrey Masci-Port Townsend City Council Thomas Locke,MD, Health Officer Jill Buhler-Hoijiital Commissioner District#2 Sheila Westerman - Citien at Large (City) Ex-officio Roberta Frissell, Vice Chairman - Citizen at Large (Couny) David Sullivan, PUD #1 Chair Titterness called the meeting to order at 2:30 p.m. All Board and Staff members were present with the exception of Commissioner Huntingford and Member Westerman. • APPROVAL OF AGENDA Member Masci moved to approve the Agenda as amended to add Discussion of Teen Suicide under New Business. Vice Chair Frissell seconded the motion, which carried by a unanimous vote. APPROVAL OF MINUTES Vice Chair Frissell moved to approve the minutes of February 19, 2004. Commissioner Rodgers seconded the motion,which carried by a unanimous vote. PUBLIC COMMENT—None OLD BUSINESS AND INFORMATIONAL ITEMS Recreational Shellfish Beaches: Larry Fay described recreational shellfish beach classifications for the first quarter of 2004 as issued by the State Department of Health Office of Food Safety and Shellfish Programs. Because of insufficient data, Jefferson County is listed as "unclassified." In the past, Old Fort Townsend and Fort Flagler beaches were classified as approved,but Department of Health staff are now uncertain whether there was enough data to support that status. With the tribes having asked that those dibeaches be classified as approved for commercial harvest, the Department of Health will begin a multi- year effort to collect data and monitor water quality. In the meantime, there is no plan to close these areas to recreational harvest. HEALTH BOARD MINUTES - March 18, 2004 Page: 2 • Notice of Public Hearing—Health and Human Services Fees: Jean Baldwin announced that the hearing on the proposed ordinance amending Health and Human Services fees is scheduled for Monday, March 22 at 10:05 a.m. In explaining the change in fees under Public Health Clinic, Environmental Health and Animal Services, she noted that while the RCW puts fees under the jurisdiction of the Board of Health, they have historically been approved by the Board of County Commissioners. The Commissioners had been briefed on the proposed fee changes prior to posting public notice. In response to questions from the Board about the new filing fee for Evaluations of existing on-site septic systems, Larry Fay provided the following information. He explained how a service water management district in Kitsap County uses a portion of their tax revenue to fund public health operation and maintenance activities. The destination of County septage depends on the pumper. Quantities primarily go to either the City's composting facility or to a private land application site in Mason County,but some also goes to Kitsap County Public Works wastewater treatment plant and some to Port Angeles. The $.02/gallon septage disposal fee is not targeted directly at the cost of handling the septage,but is intended to generate revenue to support Operation and Maintenance (O&M)program activities. In the past, most were funded through State Department of Ecology grants, but under the 2004 budget, these funds come out of the current expense fund. Instead of adding to the fees for septic permits, this new fee would be tied to the ongoing ownership and use of on-site septic systems. Linda Atkins then explained the education workshop program and ongoing education involving individuals getting building permits, those who need information about ongoing care of their systems, those with questions about evaluations of existing systems, as well as interactions with septic tank pumpers on their activities. There are also workshops with licensed O&M professionals (installers, designers and septic tank pumpers). Member Masci noted that the City recently reduced the composting facility fee by the same .02 cents per gallon as an incentive to pumpers to bring their septage to that site. Mr. Fay explained that the plan being discussed with pumpers for administering these fees is that the pumpers' invoices to customers would reflect the $20 Environmental Health filing fee for a 1,000-gallon septic tank. At the end of the month or quarter, when the pumper submits their report of gallons pumped to the County, they would then transmit the $0.02/gallon disposal fee collected from their customers based on the total gallons pumped. Member Buhler expressed concern that this fee might be perceived as punitive by those who need to pump their septic systems. Linda Atkins recognized this concern and noted that staff has done outreach to some real estate agencies and septic tank pumpers. In reviewing the evaluations of existing systems, only 42%were identified as needing to be pumped. NEW BUSINESS Cruise Ship Waste Discharge Report: Larry Fay reported on the cruise ship waste topic discussed at the relatively brief(30 min.) State Board of Health hearing. He raised points from the Board of Health and noted there had also been brief presentations by the Coast Guard and State Department of Ecology to get the State Board acquainted on the issue. The State Board of Health seemed reasonably satisfied with the memorandum of understanding (MOU), which was based on similar standards in Alaska's regulations, the most stringent in the country. There was success in raising the State Board's interest in •continuing to track this topic. He noted that other states have created regulations despite the MOUs. Dr. Locke reviewed the complex jurisdictional issues involved. The State Board of Health has no direct jurisdiction and it is even questionable how much authority the State has. There will be a brief period for review and comment on the MOU. HEALTH BOARD MINUTES - March 18, 2004 Page: 3 • Despite the State's effort on the MOU, Member Masci expressed his concern that there still are not stringent enough standards. Commissioner Titterness suggested that the Board of Health consider creating a local ordinance to prohibit all discharges in Jefferson County waters and send a letter to the State suggesting they incorporate this language into the MOU. Commissioner Rogers expressed concern about the County's inability to enforce such an ordinance. Member Masci moved that staff draft an ordinance to prohibit cruise ship waste discharges in Jefferson County waters and then send a letter to the State of Washington suggesting they incorporate this language into the MOU. Member Buhler seconded the motion, which carried with one abstention by Commissioner Rodgers. The draft ordinance will be reviewed by the County attorney. Jefferson Syringe Exchange Program: Dr. Locke reported that since beginning this program, there has been progress on the two most important goals: 1) communicable disease transmission prevention; and 2) reduction of the public safety hazards associated with random disposal of needles by intravenous drug users (IDU). Staff believes there is an opportunity to improve on the third goal to provide prevention education, referral information and treatment incentives to IDUs through an immunization incentive •program. This program would be offered to those who come in for needle exchanges, vaccinations for Hepatitis A and B, Tetanus/diphtheria, and tests for HIV and Hepatitis C. Jean Baldwin noted that most of these vaccines require two doses, which provides twice the direct contact and therefore, more opportunities for referral. Staff noted that to pay for the vaccines there was a transfer from other HIV outreach program services to this high-risk outreach. West Nile Virus: National Lessons Learned and Planning Efforts for 2004 Season: Dr. Locke reported the agenda packet contains a map showing the spread of West Nile infection among people in the U.S. last year and reflects no cases yet in Washington or Oregon. Not only would the County go into active dead bird surveillance once again, but it expects this year to bring the first human cases in the state. While it is known that 1 in 150 suffer the worst complications, it is a more serious disease than originally thought,with fatality rates up to about 10%. There are also more reports of central nervous system disease overlapping with the West Nile Fever and more serious complications. While the virus is lethal for horses, there is a vaccine. When the arrival of the virus is verified (two dead birds testing positive), the search for human cases will begin. Personal protection against mosquito bites is the most effective way to reduce risk of acquiring the virus. Other protection methods include ensuring homes are screened, use of DEET, habitat changes around the house, getting rid of standing water, and using larvicidal agents in ponds. The use of mosquito control districts is another mechanism used in some areas. It was noted that larvicidal agents kill more than mosquitoes and the long-term effect on fish and other insect populations is unknown. •When asked what public outreach and education would be, Jean Baldwin said that in addition to local education and website links to information from the Center for Disease Control, it would be important to know have knowledge of the State's public service announcement and preparation plan. Larry Fay added that West Nile Virus will be discussed again at the April Department of Health Zoonautic disease HEALTH BOARD MINUTES - March 18, 2004 Page: 4 conference. Most of his efforts have been focused on Port Ludlow, due to the elderly population in that area. He noted that the area also has a lot of stormwater systems and ponds as well as infrastructure in place to manage mosquito populations. He concurred that the primary message is personal protection. 2004 Legislative Session Wrap Up: Dr. Locke reported that while only a few bills were passed by the legislature this session, those that passed were significant and included: insurance coverage for injuries sustained as a result of alcohol or drug use; creation and local adoption of models on nutritious food; joint committee set up on health disparities (a top public health priority); expanded civil immunity from liability insurance for healthcare workers volunteering in clinic settings (SBHB2787); and an expanded liability insurance program for retired volunteer physicians. What did not pass and consumed a lot of time was tort liability reform focusing on medical malpractice and another bill that would have expanded prohibitions of smoking in indoor settings driven by occupational health concerns. In the supplemental budget there was an appropriation of about $10 Million that would go to physicians providing obstetrics (OB) care in rural areas to help defray the rising and prohibitively expensive malpractice insurance. Washington is facing a pending crisis in OB access as family practitioners discontinue providing obstetrical care (estimated to be 50%). There was an unsuccessful effort to use unexpected revenue increases in the supplemental budget to rollback premiums charged by insurance to low-income families. Chair Titterness asked whether the Board would like to take action to support and thank those representatives who supported legislation on tort reform or point out a position to those that didn't. Washington's representatives voted along party lines on medical malpractice tort reform. The Republican-controlled Senate were supportive of a Micra liability reform package and Democrats in the •House were very much in the trial lawyers camp and blocked the Senate bill from being heard. There was no Board support for taking any action on this. Proposed Meeting—Jefferson County Board of Health and Port Townsend City Council: Jean Baldwin reported on her presentation to the City Council about the County Health Department's budget shortfall and her request for funding assistance. Informed that the Board of Health determines this policy, Mayor Robinson suggested Council have a policy discussion with the Board of Health and possibly also the Hospital Board. Ms. Baldwin said she and Dr. Locke recommended beginning with a policy discussion of the community vision of public health and how funding should be shared by the Board of Health and the City Council. The best date for a discussion appeared to be the date of the regular Board of Health meeting on April 15 from 7:00-9:00 p.m. She also asked for assistance in planning the agenda. Members Masci, Buhler, Vice Chair Frissell and Kees Kolff agreed to assist. RCW 70.05.060 (Powers and Duties of Local Board of Health) was suggested as the first topic. Jean Baldwin provided the Board with a handout that included a draft funding formula. The desire is to look at the proportionate use by City residents and to find a defensible way to credit the City for the money their citizens already pay for these services through property tax. Member Masci moved to hold the Board of Health meeting on Thursday, April 15 from 7:00-9:00 p.m. Member Buhler seconded the motion,which carried with one abstention by Member Frissell. HEALTH BOARD MINUTES - March 18, 2004 Page: 5 • ADDITIONAL BUSINESS Teen Suicide: David Sullivan noted there was a lengthy newspaper article about a 13-year old boy in Joyce who had committed suicide in front of his classmates. He talked about the challenge of getting prevention activities occurring early enough to have a positive effect. While federally funded prevention/intervention specialists have been doing good work in the schools, local providers were going to pick up this work. When looking at funding youth activities, suicide prevention efforts are often overlooked. Jean Baldwin said suicide prevention does not have regular funding. Community Mental Health is charged with taking care of chronically mentally ill individuals and mental health in general is an underfunded mandate. She suggested that this would be an interesting discussion topic for the Washington State Association of Counties (WSAC)meeting to be held in June. While there are subtle indicators showing"at risk"population in the County, there are no solid indicators. During discussion, there was recognition of the need to look at the known risk and protective factors and to develop a suicide prevention program. Jean Baldwin did note that all clients in the prenatal programs receive elective depression screening. ACTIVITY UPDATE/OTHER ANNOUNCEMENTS The SmileMobile saw a total of 65 children, including all who were diagnosed with cavity or other restorative needs. Dr. Chuljian volunteered a few hours, as did a doctor from Sequim. Many of the children were preschoolers. More outreach will be done in the schools next year. • Jean Baldwin agreed to email the County's website address to the Board members. AGENDA PLANNING/ADJOURN The meeting adjourned at 4:22 p.m. The next meeting will be held on Thursday,April 15,2004 at 7:00 p.m. at the Jefferson General Hospital Auditorium. The Board will review the Solid Waste Ordinance and hold a hearing on the Clandestine Drug Lab Ordinance during the meeting in May. JEFFERSON COUNTY BOARD OF HEALTH Dan Titterness, Chairman Jill Buhler, Member (Excused Absence) Roberta Frissell, Vice Chairman Sheila Westerman, Member (Excused Absence) Geoffrey Masci, Member Glen Huntingford, Member Patrick M. Rodgers, Member g FK' , PUBLIC HEALTH � d (~ j . Always Working for a Safer and �`� W HEALTHIER JEFFERSON Letter from Carl Osaki, Washington State Board of Health • Old Business and Informational Items i ��STATg O� o a � x • STATE OF WASHINGTON WASHINGTON STATE BOARD OF HEALTH 1102 SE Quince Street ® PO Box 47990 Olympia, Washington 98504-7990 March 23, 2004 Mr. Stephen Tharinger, Chair Clallam County Board of Health 223 East 4th, Suite 14 Port Angeles, WA 98362 Geoffrey Masci, Chair Jefferson County Board of Health 615 Sheridan Street Port Townsend, WA 98368 Dear Chair Tharinger and Chair Masci: Thank you for your July 2003 letter regarding sewage releases from vessels and for your request that the State Board of Health(SBOH)hold a public forum on whether existing • practices and the current regulatory framework provide adequate public health protections. In response to Jefferson County and Clallam County boards of health concerns about sewage releases from vessels,the SBOH was briefed by Larry Fay, Ann Kenney from the Department of Ecology, and John Veentjer of the US Coast Guard at its March 10, 2004 meeting in Tacoma. Mr. Veentjer and Ms. Kenney described their agencies' roles in cruise ship wastewater management practices. Ms. Kenney also presented on the draft memorandum of understanding (MOU)between the state of Washington,the Port of Seattle, and the Northwest Cruiseship Association. At the March SBOH meeting I offered to monitor the MOU's impact on cruise ship wastewater management practices and periodically bring the issue forward to the State Board. I have tentatively scheduled a follow up briefing for the December 8, 2004 State Board meeting in SeaTac. At that point we may be able to get an update from Ecology and the US Coast Guard about the MOU's success in improving cruise ship wastewater management practices. The Department of Ecology is now inviting public comment on the draft MOU,which is available for review on the Internet at http://www.ecy.wa.gov/programs/wq(see under What's New). SBOH staff forwarded this request for public comment to Dr. Tom Locke, Larry Fay, and Andy Brastad. • Working for the Health of Washington and its People 0 18 t4F) s° PUBLIC HEALTH r� C¢� (~ Always Working for a Safer and 10,\".•'fr HEALTHIER JEFFERSON The Crisis in Public Health Funding a S 4. °� Jefferson County Health and Human Services • '�_ `i 615 Sheridan Street a Port Townsend, WA 98368 rxsa Tel 360-385-9400, Fax 360-385-9401 The Crisis in Public Health Funding: Protection of public health, along with public safety and welfare, has long been recognized as a core responsibility of government. National, state, and local systems have been developed to protect public health by- providing a wide range of essential public health services. Scientific advances—our expanding knowledge of the causes and prevention of human disease—could make the 21st Century the golden age of public health in the United States. Instead the survival of the most basic public health programs are threatened as never before by a collision course between rising demands and declining resources. Rising Demands: The battle against communicable diseases is an ancient one. Many of serious infectious diseases that public health deals with have been threats for thousands of years. In the past 35 years over 30 new infectious disease threats have emerged worldwide. 11W, West Nile Virus, SARS, and Pandemic Influenza are current or potential threats to Jefferson County residents. And that is just the short list. Added to public health's traditional mission of communicable disease control is the enormous task of preparing for a bioterrorism attack or similar public health emergency. • The science of prevention has advanced considerably over the course of the 20th century. We now have a detailed understanding of the impacts of delayed prenatal care, impaired maternal and infant nutrition, and the life long effects of child abuse. We also know a great deal about the impacts of unintended pregnancies, sexually transmitted diseases, and vaccine preventable illnesses. With each passing year we are more able to prevent the diseases and disabilities that are bankrupting our health care system. We have the technical knowledge to respond effectively to the many challenges facing the public health system. What is lacking is adequate, stable funding to fully implement science- based prevention strategies. Declining Resources: The"perfect storm"of the Dot Com bust, 9/11 impacts on the aerospace industry, and a nationwide recession triggered multi-billion dollar cutbacks in legislative funding for a wide range of health-related programs in Washington state. Even before September 11, 2001, serious strains were being felt in Washington's public health funding system. Replacing municipal funding for local public health with a state allocated share of the motor vehicle excise tax (MVET)not only removed many cities from public health governance roles but also precipitated a ongoing public health funding crisis when the MVET was repealed by the State Legislature. While the legislature has partially replaced these lost funds on a year-to-year basis, it is unlikely this "backfill" funding will persist beyond the current state biennium. In Jefferson County,public health programs have been sustained by a complex mix of • diversified funding sources. For every $1 of local funding for public health programs, there have been almost $6 of federal, state, contract, or fee-based funding that has matched it. This very successful "leveraging" of local funding has resulted in an exceptionl range of important public health services to the community. But it also creates a significant vulnerability. Each dollar of local funding that is lost is magnified by the loss of external funding sources. Program cutbacks are insufficient to deal with this magnitude of revenue shortfall. Staff layoffs and program discontinuations are inevitable unless stable local funding sources can be found. Public Health Funding as a Governmental Partnership: Public health, by its nature, involves the carefully coordinated efforts of local, state, national, and, at times, international governments. In the United States, instability of funding for public health at any level of government impairs the functioning of the public health system and increases the risk of serious consequences. Public health advocates are working hard in Washington, D.C. and Olympia to make the case for adequate, stable public health funding. Local governments must also see themselves as an essential member of this governmental partnership. Washington states public health system is highly decentralized relative to many other states. Most of the capacity to provide essential public health services and to respond to a public health emergency resides at the local health level. Loss of this "front line"response capability is a very serious concern in preparing for the terrorizing threat of biological warfare and the virtual inevitability of naturally occurring global disease outbreaks. Loss of public health's prevention-oriented . programs also has a very serious consequence for local governments (and the taxpayers that support them). Problems that could have been prevented but were not—unintended pregnancies, life threatening infections,juvenile criminality—have expensive social consequences and put ever greater strain on already overburdened medical care and criminal justice systems. There is a solution for the crisis facing public heath. It lies in the shared responsibility for public health funding at all levels of government and the leadership necessary to convince the public that public health funding is a wise and essential investment in a healthy future. Thomas Locke, MD, MPH J: . Baldwin,RN,ARNP Jefferson County Health Officer Health and Human Services Director • /4:6T4:?-, PUBLIC EAL Always Working for a Safer and • i ? ' HEALTHIER JEFFERSON Statewide Efforts to Solve a Statewide Crisis zioverning: Health services/June 2003 Page 1 of 3 ', ,k ' V47I f The Resourceof States .Li,—P;Mities , ,In Punt.Online.tri P-..,.7Nli . a , z HOME PAGE SCI ABORTUS $U .i'i I nt E•tdr;IL LIS t,.L CV.:.,:i I IN a c``saEifuEL `SV S From Governing's June 2003 issue COVER STORY/HEALTH CARE Deadly Strains SARS, West Nile virus and bioterrorism are the big scares. But the greater threat is the gradual erosion of public health services. By CHRISTOPHER CONTE When Seattle received$2 million in federal money last year to prepare for a possible biological,chemical or radiological attack,public health director Alonzo Plough was relieved.Along with his counterparts around the country,Plough had watched new health threats multiply while public health budgets stagnated.Finally,he thought,the city would have funds to work out emergency procedures with area police departments,fire officials and other"first responders."He'd be able to hire new staff to help combat naturally emerging diseases as well. Things haven't worked out as he planned.No sooner had he launched a terrorism-planning effort than he 4 E'."`'4- -RK' gg "*-1-1'-. '..'e tr at• had to drop it because the federal government au�«§® ordered its sweeping smallpox-vaccination program. r.,,,A,„,,,,,,,, ,. .„._,.,„,...„„,.,,,,,A....,„.t..7 ,1.,,,,i1 That task tied up so much of Plough's staff that they =43g 0 were slow to detect a new outbreak of tuberculosis among Seattle's homeless population.As officials ?4*''.T Jst#raP3 c: [aeaar scrambled to catch up with that problem,SARS,or severe acute respiratory syndrome,emerged in China.Almost immediately,the mysterious disease started showing up in travelers returning from Asia. Plough had to divert staff from the unfinished smallpox and tuberculosis efforts and put them to c s Dealliv work to keep the new disease from spreading in Seattle. Plough's job has become a continuous exercise in SIJ'RIflS triage.The reason: His department has too much to do and too few resources."In my 20 years in public 'I':7 health,I have never seen such a layering of challenges,all with fairly equal urgency and all ,,�_ drawing on diminishing core funding,"he says."We aren't providing anything near the web of protection that's needed." The problem isn't unique to Seattle.All over the country,local public health departments are struggling to keep on top of a growing list of health threats. Terrorism may turn out to be the least of their concerns.Changing patterns of land use are bringing people into contact with dangerous new microbes such as the West Nile virus and the coronavirus, which is believed to be the cause of SARS.Globalization is spreading these diseases more rapidly than human immune systems or modern science can build defenses.And many see a scenario in which the familiar influenza virus abruptly morphs into a deadly pandemic that the U.S.Centers for Disease Control and Prevention estimates could kill as many as 300,000 people.On top of that,old maladies such as tuberculosis have started appearing in drug-resistant strains;sexually transmitted diseases such as HIV and syphilis are on the rise because many people have become complacent about them; and chronic diseases such as asthma and diabetes are becoming more prevalent due to environmental and behavioral factors. Local public health leaders widely agree with Plough that their tools and budgets haven't kept pace with these challenges.Despite the growing threat from communicable diseases,for instance,state health agencies employ fewer epidemiologists today(1,400)than they did in 1992(1,700).When a • professional association this fall and winter asked state health laboratory directors to rate their preparedness to handle a terrorist chemical attack,half scored their own facilities"1"or"2"on a scale of 1 to 10,with 1 being the poorest mark.And a Little Hoover Commission in Califomia declared in April that the state's"public health infrastructure is in poor repair,providing less protection than it should against everyday hazards and unprepared to adequately protect us against the remote but substantial threats we now face."The commission noted,among other things,that only 20 percent of reportable diseases and conditions were actually reported to public health officials,and that at one key health laboratory,only 60 of 100 positions were filled. http://www.governing.com/articles/6health.htm 3/25/2004 Governing: Health services/June 2003 Page 2 of 3 As California goes,so goes the nation.Updating a 1988 report that concluded the country's entire public health system was in"disarray,"the National Institute of Medicine said last fall that the system is plagued by"outdated and vulnerable technologies,lack of real-time surveillance and epidemiological systems,ineffective and fragmented communications networks, (and)incomplete domestic preparedness and emergency response capabilities." STARVING THE SYSTEM • Policy makers are aware of the holes in the public health system.Last year,the U.S.Congress provided $940 million to help local health departments cope with emerging threats.Local health officials hoped to use the funds not only to prepare for terrorist attacks but also to improve their ability to conduct general surveillance and cope with natural outbreaks such as SARS. The federal smallpox-vaccination program has absorbed nearly all of the funds so far,however,making "dual use"largely a chimera.Indeed,many local officials say the federal government hasn't even provided enough money for them to prepare adequately for possible terrorist attacks,let alone cope with naturally occurring diseases that already are killing people.In particular,the preoccupation with smallpox has set back efforts to plan defenses against a host of other potential biological weapons, including plague,tularemia,botulism toxin,and viral hemorrhagic fever;chemical agents such as ricin and sarin gas; and a possible"dirty bomb"laden with radioactive materials. Many public health officials such as Plough also say they lack secure communications networks linking them with other first responders.On top of that,public health officials have received no money to start educating the public about what people should do if there is a biological or chemical attack."We are writing plans,but plans by themselves don't automatically translate into increased capacity,"says Jeffrey Duchin,chief of the Seattle health department's Communicable Disease Control,Epidemiology and Immunization section."We aren't committing the resources needed to turn them into living documents." Federal officials counter by saying that state and local agencies would have trouble absorbing many more funds than Congress Public health departments has provided. But the increased federal funding has had an have had to rely unintended side effect: Fiscally strapped states and localities increasingly on revenues have seized on it to cut their own public health spending.In that come with many Colorado's Larimer County,for instance,a$700,000 slash in strings attached. state funds for public health more than erased a gain of $100,000 in federal money.Even with new federal funds,the Boston Public Health Commission has been forced to cut scores of positions. "Overall,we are losing money in the public health budgets in the 50 states,despite funds for terrorism preparedness,"says Dr.George Benjamin,executive director of the American Public Health Association. Benjamin formerly was health director for Maryland,which has received federal funds to increase its epidemiological staff but has been forced to cut its state-financed food safety program. Perhaps more troubling,public health departments have had to rely increasingly on revenues that come with many strings attached.For years,they have sought wherever possible to support programs with grants or with user fees,such as charges for restaurant inspections.But you can't charge a mosquito when you test it for West Nile virus,and while you can persuade public and private grant-makers to provide funds for programs aimed at recognized ills such as breast cancer,nobody seems to want to pay for ongoing operations or general preparedness."There is a much greater investment in public health and public health programs now than there was a decade ago,"notes Mary Selecky,Washington State's secretary of health and president of the Association of State and Territorial Health Officers."But there is far less flexibility in how the dollars are spent.We are driven by categorical funding." Seattle's health department,considered by many to be dynamic and forward-looking,illustrates the problem.Its overall budget has grown impressively,reaching$187.9 million this year from$77.5 million in 1993.But almost all the increases have been in programs supported by user fees and grants. County government gives it$28 million to run its emergency medical services; a federal program provides$5 million to support AIDS victims(but not to help prevent spread of the HIV virus that causes AIDS);and the Robert Wood Johnson Foundation donated money for the development of a program to deal with asthma. None of these funds pay for basic public health operations,including surveillance to detect new disease outbreaks,investigators to track the spread of diseases and a host of prevention-oriented activities. This year,funding for"core"activities totaled$30.9 million,barely up from$30.1 million 10 years ago. The current West Nile virus and TB outbreak alone would more than eat up that increase this year.And that doesn't take inflation or Seattle's substantial population growth into account.Per capita,core funding has dropped from$21.34 in 1997 to$16.67 today. WAITING TIME Behind those numbers lies a slow deterioration in the department's ability to address long-term problems or react quickly to changing conditions.When SARS hit this spring,for instance,the department couldn't follow up on a number of hepatitis B cases.The rate of childhood immunizations has fallen since 1998,while cases of measles and pertussis(whooping cough)have increased,and new TB cases are at a 30-year high. When a team belatedly began combating the TB outbreak,it moved ahead in fits and starts.The key to • stamping out such an outbreak is painstaking detective work: Investigators interview known victims, identify places they frequent and other people with whom they have come in contact,and then follow up those leads with additional screening and information-gathering.Eventually,such searches enable them to track a disease's movements,isolate it and stamp it out.By this spring,investigators had collected more than 50 pieces of information on each of some 528 actual or potential carriers.But the http://www.governing.com/articles/6health.htm 3/25/2004 Governing: Health services/June 2003 Page 3 of 3 information lay unanalyzed for precious weeks because the outbreak team couldn't find an epidemiologist to work on it. "Somewhere in there is the answer to where and how this got kicked off,and where it's going next," says Linda Lake,a consultant who leads the outbreak team and also chairs the Washington State Board • of Health."But the department is too busy dealing with SARS or other things.When you find somebody to help,it's always part-time,it's always for a short period of time,and it always takes them away from something else." Outbreaks don't occur on a neat schedule,and there inevitably will be times that are busier than others.Even the most ardent Even the most ardent public public health advocates don't expect voters to pay to have health advocates don't public health workers waiting around for the next outbreak the expect voters to pay to have way firefighters are paid to be available at all times.But there's public health workers a backlog of tasks that could keep the public health workforce waiting around for the next busy when there are no emergencies. outbreak the way firefighters are paid to be Currently,the Seattle department can afford just 10 public available at all times. health nurses for an intensive counseling program called"Best Beginnings,"which has been proven to reduce a wide range of health problems affecting children of first-time teenage mothers.That's enough to reach only about one fourth of the mothers who need the service.Meanwhile,a strategy for working with schools to encourage teenagers to drink less soda and get more exercise—keys to reining in a near epidemic of juvenile diabetes—remains on the drawing boards for lack of funds,as does a major initiative to help Seattle's health providers incorporate ideas about safer behavior,better diets and exercise into their daily interactions with patients. Although public health departments could make good use of additional funds,public skepticism about government and taxes usually trumps proposals to increase their resources.In Washington State,public health advocates were optimistic early this year after the Republican and Democratic leaders of the Senate co-sponsored a bill that would ask citizens to vote on whether to raise property taxes by$151 million to support local public health agencies.But health advocates lost heart after a poll commissioned by the Washington State Association of Counties and others showed the idea was far from assured of winning voter approval. The lack of support demonstrates,in part,how reliance on categorical funding has become a political trap for public health agencies.Victims of specific illness often lobby tirelessly and effectively for funds to address their afflictions,but it's hard to find citizens who feel the same degree of passion for quiet government activities that keep people healthy.Public health workers have the passion,but it doesn't get them very far."People think they're just asking for a handout."says Pat Libbey,executive director of the National Association of County and City Health Officials. • REALITY CHECK Clearly,voters expect more than they are willing to pay for.The Association of Counties poll showed,for instance,that 96 percent of Washington voters believe the services public health agencies provide are "very important."Yet the state Department of Health estimates that total public health spending in the state—about$507 million annually—amounts to only one third of what public health agencies need to do the job they currently are expected to do.The department says only one half of local public health agencies are doing reasonably well in meeting 202 performance measures developed for them. For Carolyn Edmonds,a member of the county council for Seattle's King County and a former state legislator,the disparity between expectations and reality represents a political quandary.On one hand, she wonders whether advocates should present the budget situation in starker terms—by warning voters,for instance,that the current stringency is forcing public health officials to put fighting infectious diseases ahead of making sure children are immunized."Public health has shied away from doing that," she says,"but maybe we're going to have to be more blatant"about what the trade-offs are. On the other hand,Edmonds fears that voters won't believe leaders who say current budget and tax policy require such decisions:"People go to restaurants expecting that the food will be cooked properly. They go to a drinking fountain expecting that they won't get sick from the water.There is a built-in assumption that they will be taken care of." Eventually,she says,the assumption will be disproved—maybe not in dramatic ways but slowly and less noticeably."Response times will be slower.There will be fewer prevention measures,"she says. "More people will get sick.People will die." The end result,in Edmonds'view,may not be as shocking as,say,terrorists detonating a dirty bomb in a baseball stadium.Nevertheless,it will be very real and might have been avoided. Copyright 2003,CongreSs onst.Quattechr,Ioc.Reproduction in any form without the written permission of the publisher is prohibited. Governing,City&State and Goveming.com are registered trademarks of Congressional Quarterly,Inc. HOME PAGE SEARCH ABOUT US SUBtthit'lIONS 7E-MAIL US ADVERTISINGMAaSIFIIDA. http://www.governing.com/articles/6health.htm 3/25/2004 NACCHO - RECENT HISTORY OF FUNDING FOR LOCAL PUBLIC HEALTH Page 1 of 2 home news(about naccho calendar jobs site map search flaCCh bZ • NATIONAL ASSOCIATION OF COUNTY AND CITY HEALTH OFFICIALS to 1► R ti PUBLICATIONS" NAoCWo tIsttLSIPROBRAMs PUBLIC HEALTH AQVOCAcv PUBLIC HEALTH ADVOCACY ItilSoLUTIoNs RECENT HISTORY OF FUNDING FOR LOCAL PUBLIC HEALTH )AD3t15cACY AT NAccHo L1 21SLi 7YI1 Pre-'93: Counties and cities funded local public health per RCW Ac?iolt ziNtLR 70.05. 1993: Responsibility for funding public health shifted to counties and state. Passed by law in '93 and effective in '96, cities were relieved of responsibility to provide public health funding and a portion of the Motor Vehicle Excise Tax(MVET) proceeds shifted from cities to counties. The Legislature created a local capacity appropriation from the Health Services Account to start to build the capacity needed to meet the goals of the newly mandated Public Health Improvement Plan. The Legislature required the development of quantifiable measures. 2000: Legislature's repeal of the MVET eliminated significant funding capacity • When the MVET was repealed, counties lost Public Health Funding, Criminal Justice Funding and General Equalization Funding for low tax base counties. The Legislature replaced about 90% of Public Health Funding and about half of Criminal Justice Funding and General Equalization Funding. 2001: Terrorism,economic downturn and initiatives darken the picture. Terrorist attacks sparked new federal mandates, hoaxes and increased demands by the public, businesses and government for public health services. Federal categorical funding was slow, inadequate and limited to one-time costs for training, equipment and planning. The 1% limit on property tax levy growth, imposed by Initiative 747, had a disproportionate impact on county governments because they rely heavily on the property tax.At the same time, some counties' sales tax revenues declined. 2002: The state faced its own budget crisis and securitized Tobacco Settlement Revenue, one of the major fund sources for the Health Services Account. The state also eliminated most Criminal Justice and Equalization funding, further squeezing county budgets. 410 2003: Emerging health threats,shrinking resources—Health Officials and the Tri-Association propose a solution, Washington State Association of Counties, the Association of Washington Cities, and the Washington Association of County Officials teamed up with the Washington Association of Local http://www.naccho.org/advocacydoc722.cfm 3/25/2004 NACCHO - RECENT HISTORY OF FUNDING FOR LOCAL PUBLIC HEALTH Page 2 of 2 Public Health Officials to propose legislation that will create stable funding for local public health. The proposed statewide levy would generate$151 million per . year—replacing the MVET backfill and local government financing of public health. This means local cities and counties can allocate their scarce resources to other urgent community needs. S http://www.naccho.org/advocacydoc722.cfm 3/25/2004 Association of Washington Cities • L. I Z1ll'1 . 111111-111111111111111111,- I 51 2002-2003 Annual Report Washington cities of those jurisdictions lost in excess of a and towns are fourth of their total revenues with the legislative enactmentofInitiative 695, facing the great - eliminating the motorvehicle excise tax, est financialdifficulties and have to face the reality that the they've encountered in the Legislature will not continue to fund past 35 years. Many cities have "safetynet"appropriations. overcome these challenges by Few of those cities have any significantalternative revenue sources. exercising restraint, innovative• They are characterized by little if any thinking, and finding econo- commercialor business activityand the mies in the delivery of ser- yield of utilitytaxincreasesis minimal. vices. Reductions in employ- Thesearethecommunitiesthatare ees, cutbacks in services, and seriously considering whether they can continue to operate absent state deferral of critical mainte- assistance. nance projects have character- Washington's state and local ized city budgets for the past governments are facing the most serious The AWC Bylaws directs the financialthreats they've encountered Executive Director to submit a several years. report at each annual meeting on Times are dif9cultand the future since the early 1980's.However,from the progress of the Association, does not seem to be much brighter.The adversity often springs solutions.Local together with recommendations situation is so desperate thatin some officials have demonstrated a resiliency for its improvement.City officials and ability to innovate budget strate- are encouraged to contact communitiesthereis serious discussion members of the AWC Board of as to whether the city or town can gies to cope with shrinking revenues. Directors,the officers of the continuein existence. They've developed budget responses Association,or Executive Director designed to bridge the fiscal gap and Stan Finkelstein with questions, Cities Bridging the Gap,the theme comments, or suggestions. of this year's annual conference, have establishing longterm strategies focuses on the uncertainties that to address economic uncertainties. characterize our state's economyand They've become sensitive to the AWC the need for creative budgeting need for restraint in expanding services strategies tosustainseruices. during good times and the need for The Plight of Smaller Communi- reserves to"bridge the gap"during al AffaftA/1014 Of ties:The difficulties of the state's If continued Vilditlsmaller communities is worsening.Many Introduction • (continued) periods of economic retrenchment.Most The most significant outgrowth of seeking assistance.Itis anticipated that importantly,they've recognized that the the Tri-Association process this pastyear theTri-Association process willcontinue state and federal governments have was the development of a joint city/ on into the future and take on increas- regrettably abandoned Washington's county fiscal package.That package, ingly complex and controversialissues. local governments. adopted by AWC,WSAC,and WACO, included a series of revenue enhance- Annexation Intergovernmental ments,statutory efficiencies,and statutory revenue changes to best meet Cities and towns were dealt a severe Partnerships— the needs of cities and counties. blow lastyear when the State Supreme The Tri-Association TheTri-Association also strongly Court invalidated the petition method of Cities do not exist in isolation.At recommended thatthe Legislature annexation.Petition annexations have the local level cities and counties are the provide an ongoing source of public been the predominant form of annex- sole providers of general government ation for more then 50 years,and were services.They both provide law enforce- far easiertofacilitatethan election ment,roadways,and land-use controls. annexations.The court's decision left They are both financially strapped,and more unanswered questions than those do compete for fiscal capacity.While Most importantly, resolved.It was uncertain as to whether cities and counties should be allies,in they've recognized uninhabited land could be annexed,as some areas of the state,the relationship well as the status of those petition that the state and has withered. annexations comletedsubse uentto P subsequentto recent years,the AWC Board and federal governments the initialfiling ofthe action challeng •- those of the Washington State Associa- ing the specific annexations in Moses have regrettably Lake and Yakima. tion of Counties(WSAC)and the Washington Association of County abandoned Many municipallawspecialists were Officials(WACO)recognized the need for surprised by the decision and a request Washington's local for rehearingwas subsequently ran closer cooperation to address mutual q y g ted. legislative and service needs. governments. A decision on that rehearing is pending. During the pastyear,the Executive Resolution of the annexation issue Committees ofthe three organizations was a top legislative priority for the AWC initiated an ongoing dialogue to help health financial support and acknowl- in 2003.Recognizing the controversy resolve issues of conflict.They formal- edge the state's responsibility to assure surrounding annexations and the ized a Tri-Association,to give the AWC, every city,town,and county of suffi- likelihood of opposition,the AWC Board WSAC,and WACO leadership a way to cient resources to provide basic services. initiated a two-part strategy to improve address legislative and other issues of While the Legislature shied away the probability of success. conflict.The Tri-Association process has from most of the suggested legislation, The Board established an advisory also led the organizations'staffs to work the joint support of city and county committee,chaired byAWC President together on joint training and pubtica- Lobbyists sent a strong message to Chuck Mosher,and comprised of elected tion projects. legislators that local governments are in trouble and that they are in concert in • PAGE 2 2002-2003 AWC ANNUAL REPORT -a, PUBLIC HEALTH Always Working for a Safer and HEALTHIER JEFFERSON _ --- Meeting materials for February 9, 2004: • City of Port Townsend Work Session • iso PUBLIC , LT Always Working for a Safer and HEALTHIERJEFFERSON ss��No:�o 6I5 Sheridan Street,Port Townsend,Washington 98368 January 13, 2004 Port Townsend City Council 181 Quincy St. Suite 201 Port Townsend, WA 98368 Dear Council members: Public health departments in Washington State are facing a funding problem that has been building for decades and has now reached crisis proportions. Jefferson County is no exception to this trend and core public health programs are threatened with significant cutbacks. Under funding of public health programs has been longstanding. What has pushed things to a crisis point in a combination of factors: rising demands in "traditional" public health services (maternal and child health, communicable disease control), new demands for emergency response preparedness to a range of potential epidemics, bio-terrorist attacks, or natural disasters, and steady funding cutbacks at all levels of government—federal, state, and local. For most of Washington State's history, public health programs were largely funded by a dedicated property tax millage coupled with county and municipal general fund contributions. In • the mid-1960's federal funding began to grow significantly, while state funding remained minimal. In 1977 the property tax millage dedication was removed and counties were free to spend the money on other county services. By the late 1980's public health programs were in serious decline, an impending disaster detailed in the 1988 Institute of Medicine report"The Future of Public Health"and underscored by the HIV/AIDS epidemic and the reemergence of tuberculosis as a serious urban problem. Washington State responded to the growing national alarm, creating a state Department of Health in 1989 and beginning an ambitious process of public health and health system reform in 1993. This produced the Nation's first comprehensive public health system reform program— 1995's Public Health Improvement Plan—and a change in public health funding. Starting in 1993, state funding for public health (known as "Local Capacity Development Funding") increased in what was characterized by the Legislature as a "down payment on public health improvement". Another well intentioned change enacted in 1993 (to be effective in 1996) redirected Motor Vehicle Excise Tax (MVET) money from cities to local health departments and excused cities from their historical obligation to fund public health services for city residents. Three years later, Initiative 695 was passed by large margins, repealing the MVET. Although I- 695 was found to be unconstitutional, the Governor and Legislature quickly moved to repeal the MVET in 2000, leaving a $28 million gap in local health funding. Since 2000, the legislature has filled 85% of this hole with one time only funding. Legally, cities remain excused from any financial responsibility for public health services, a fact that has caused erosion in city-county public health partnerships in many areas of the state. • COMMUNITY ENVIRONMENTAL DEVELOPMENTAL SUBSTANCE ABUSE HEALTH HEALTH DISABILITIES & PREVENTION (360) 385-9400 (360) 385-9444 (360) 385-9400 (360) 385-9400 • During the 2003 legislative session the Tri-Association, made up of the Washington Associations of Counties, Cities, and County Officials (WASC, WAC, and WACO) recognized that the crisis in public health funding could not be fixed with year-to-year legislative patches and proposed that a dedicated, stable, long-term funding source be found. This proposal has yet to receive serious legislative attention. In the meantime, core public health services are threatened throughout the state—restaurant inspectors, communicable disease response_ teams, public health nurses, and various prevention-oriented community programs. This crisis is further compounded by the simultaneous meltdown of the health care financing system, leaving growing numbers of people uninsured or underinsured. The impact of loss of both public health and personal health services is felt most acutely at the community level. As state and federal agencies cutback on their services, people have nowhere to turn but to the community in which they live. Jefferson County has shown statewide leadership in this area and has been seen as a model for community-based public health and medical care access programs. Coupled with a lack of State funding, the County is facing its own fiscal problems with the passage of 1-747, the 1% cap in property tax. Over 54% of the County's revenues come from the property tax. The 1% cap has created a scenario where the County is unable to sustain existing programs and service levels. While public health is a priority, the County, as an arm of State government must fulfill mandated service requirements. This has eliminated the County's ability to further subsidize public health from the property tax. • In order to sustain essential public health programs in Jefferson County, we are appealing to our community partners—the City of Port Townsend, the Hospital District, and others to join us as we set priorities, look for greater program efficiencies, and strive to maintain the complex mix of public health and human services that are being provided to county residents, urban and non- urban. Thank you in advance for considering our request for assistance in maintaining high priority population-based services. We look forward to our ongoing partnership to making our community a healthier and safer place to live. Sincerely, J an Baldwin, ARNP Thomas Locke, MD, MPH Health Director Health Officer March 3, 2004 Jefferson County Health and Human Services (JCHHS) Demographics of clients receiving services at JCHHS in 2003 City of Port Townsend vs. Jefferson County Targeted Clinical Services programs 2003 split - 800 Port Townsend clients 1,292 total clients 61% Port Townsend residence, 39% County residence Family Planning Clinic unduplicated clients in 2003 from Ahlers data Location Number of Clients Port Townsend 800 Port Hadlock 196 Chimacum 79 Nordland 21 Port Ludlow 39 Quilcene 50 Brinnon 38 Out of county 69 Total 1,292 Clients Family Support Programs Average City County split of two programs listed below 44.5% Port Townsend Clients, 55.5% County Clients Maternity Support Services, Infant Case Management and Maternal Child Health Services 2003 unduplicated clients from KIPHS 2003 split 194 Port Townsend clients, 407 total clients 47% Port Townsend Clients, 53% County Clients Location Number of Clients Port Townsend 194 Port Hadlock 97 Chimacum 51 Nordland 13 Port Ludlow 20 Quilcene 14 Brinnon 14 Out of County 4 Total 407 Clients 1111 1 .r WIC Program unduplicated clients fro 2003 from WIC CIMS Split 426 Port Townsend Client, 1002 total clients 41) 42% Port Townsend clients , 58% County Clients Location Number of clients Port Townsend 426 Port Hadlock 242 Chimacum 86 Nordland 24 Port Ludlow 84 Quilcene 75 Brinnon 34 Out of County 31 Total 1002 Communicable Disease (CD) Programs Average of 62% Port Townsend clients, 38% County Clients See three tables below of CD Services and client counts Immunization Clinic 2003 unduplicated clients from KIPHS 2003 split—422 Port Townsend clients/ 696 total clients 60% Port Townsend Clients, 40% County clients Location Number of Clients Port Townsend 422 Port Hadlock 90 Chimacum 56 Nordland 17 Port Ludlow 30 Quilcene 29 Brinnon 15 Out of county 37 Total 696 Clients TB - unduplicated Client Counts Calendar Year 2003 from KIPHS 2003 split 124 Port Townsend clients/222 total clients 55% Port Townsend Clients, 45 % Jefferson County Clients Location Number of Clients Port Townsend 124 Port Hadlock 46 Chimacum 16 Nordland 3 Port Ludlow 9 Quilcene 10 Brinnon 7 Out of County 7 Total 222 Clients 2 Traveler's Immunizations — unduplicated Clients Year 2003 from KIPHS 2003 split 113 Port Townsend clients/ 153 Total clients 73% Port Townsend clients, 27% County clients Location Number of Clients Port Townsend 113 Port Hadlock 8 Chimacum 3 Nordland 5 Port Ludlow 16 Quilcene 5 Brinnon 1 Out of county 2 Total 153 Clients • 3 ~ o 0 0 0 0 o e a N CO O N len 00 W ,-- O d' N- O CO T 0 in N 1- 0 0 0 0 0 0 e O 0 O O O O 0 (n • sn o --- 06 O O O O W e 0 e o 0 0 0 0 o e W ce O V O O Ln O VD O Ln O O O O 0 CLO r CO V 0 J w N Q f W = 0 0 0 0 0 0 0 e o Z O O O) 0, r- Ln 0 _ > z in N co o o o 0 `° W T a) a' 0 c a) z a) 0 L OO O O O O O e w N I O o0 ti O O CO O w O Ch W O O O O 0 N 4 W 0 0 0 0 0 0 e ° U z O co co ch o LU O Z re 2 o co c.i m 0 W D v r) T o U =O Q o W W r` N rn NZ o N Z W 0 co LU CO N N 2 w coD Ce CD 0 2 06 0 L o CO o 0 co M M = O a N W • < / W Z ' N O ' O to 4 = 0 W a' v' co o N CTG H m 0 z o v N G. T Z W in O COO N O 0 O Z J = ' 'tCb O ' l!7 co V W m w .N- N in CO OZ Ce a C F„ o z co o v co o co 0.1— NLU CI co CO Ns o T LL W Q (O O co- N. LL G W d 0r- O O O CO W 0 0 CO ti in M CO a coo CO i 0 M N O) O C CO CO N 4- O) I- ,_ Cl a in 0 ui m z w > in cc z in wo _N v> ix N > < 0 p • O 0 w °� LL o z o o z < 0 w co J o J }F D W I- Q LI- V Z Q o ag = f- U) 0 1- I- 0 0 z a 0 0 o✓>s. .��.y.'▪ '.b t ya! „,,s i O2ppn Ng ,M (p : � ' 09 CD rNO Nw 3Ovcow xo :4,411iii:m......71. '' 7(\1:1C) co ON 01 Ln RI Mil iim mi 0) 64 AtA, 09 co amiss ME cs1 CN re Lu E4 -:..Mmong!,,ipm.,,Aiim. N M VNCO OONM OM '. QN (y O Mo',r2kyp� ;.:3'':'-1::,-,,:t' � 3 . 07 Vi .O s 'o00 N M Q 8n ON`' O N � y isM OL � (7)0, Lo,... c s r ;- C°„� {? <▪ fm �fi�o 4 2 ,Z C o vQ d i *N N N g CO� Q * � aZQO hx � °Is3` s TN (L) l sy &L g3 ‘A °' hW H p d s ” r O Q 4 rOO CD• OV ±p :..., :UM co to %li cn 4. cV orr !, lInt• , HEN z e5 0. cs) al ce o. o. ti O rnfn O OW v dxz . O co 0.0 rnO OO OO O WW p O OOOON ,nO O M = oO V v T '(.j O J rnOW o arQ rnN Li) V pZ ov orn y • • z (f) F'— z W z Q W I LI] Q Cl- (9 L 0 OI- C :,Y ® ❑ ❑ a) a) W N CO 0 O cxs otS N a) • .C� a) � t M CO cts a • CITY OF PORT TOWNSEND CITY COUNCIL MINUTES OF THE WORKSHOP SESSION OF FEBRUARY 9, 2004 CALL TO ORDER AND PLEDGE OF ALLEGIANCE The City Council of the City of Port Townsend met in regular session this ninth day of February,2004, at 6:30 p.m. in the Port Townsend Council Chambers of City Hall, Mayor Catharine Robinson presiding. ROLL CALL Council members present at roll call were Frank Benskin, Kees Kolff, Geoff Masci, Laurie Medlicott, and Catharine Robinson. Frieda Fenn and Michelle Sandoval were excused. Staff members present were Finance Director Michael Legarsky and City Clerk Pam Kolacy. Jefferson County Health Department representatives present were Jean Baldwin and Dr. Tom Locke. • FUNDING FOR JEFFERSON COUNTY HEALTH DEPARTMENT PROGRAMS The Health Department staff explained the Healthy Jefferson program and discussed other Health Department programs which may have to be cut or reduced this year because of diminished funding from the County. Programs which will be affected include the ongoing Healthy Jefferson Program, Family Planning Services, and Maternal Child Health Home Visiting Program. Ms. Baldwin noted that she had included an anticipated$24,000 in her budget as a city contribution to the Healthy Jefferson program. She stated that the County is not committing funding other than$15,000 for a web page. She would like additional funding to equal about$100,000 per year. Mr. Legarsky noted that the City had not made any commitment for funding the Health Department from the General Fund beyond the two-year funding for the BRFSS study in 2002 and 2003. Ms. Baldwin was asked to prioritize the programs for which she is seeking over$100,000 in annual funding from the City. She stated that the order of priority would be: 1) Maternal Child Health Home Visiting Program; 2) Ongoing Healthy Jefferson; 3)Family Planning Services. • City Council Workshop Page 1 February 9, 2004 Councilors requested information as follows: • More information on city vs. county taxes and how taxes paid by city residents are allocated by the county. What have other counties done and what city/county arrangements are possible (in terms of opportunities to promote partnership rather than just writing a check). Look into the Seattle/King County model. Where would the City cut funding for City services in order to fund County Health services. Why did this issue not come before the Council in last year's budget cycle. What information can the City get from the Board of Health. Is a joint retreat with the BOCC possible to discuss the issue, some time in mid- March. A special business meeting was tentatively scheduled for March 29 to deal with the short term funding issue. ADJOURN •There being no further business,the meeting was adjourned at 8:40 p.m. Attest: Pamela Kolacy, CMC City Clerk • City Council Workshop Page 2 February 9, 2004 Councilors requested information as follows: More information on city vs. county taxes and how taxes paid by city residents • are allocated by the county. What have other counties done and what city/county arrangements are possible (in terms of opportunities to promote partnership rather than just writing a check). Look into the Seattle/King County model. Where would the City cut funding for City services in order to fund County Health services. Why did this issue not come before the Council in last year's budget cycle. What information can the City get from the Board of Health. Is a joint retreat with the BOCC possible to discuss the issue, some time in mid- March. A special business meeting was tentatively scheduled for March 29 to deal with the short term funding issue. ADJOURN •There being no further business,the meeting was adjourned at 8:40 p.m. Attest: Pamela Kolacy, CMC City Clerk • City Council Workshop Page 2 February 9, 2004 PUBLIC H EALTH c$.4 Always Working for a Safer and ‘\.71.:5.7,161 : HEALTHIER JEFFERSON Proposed Funding Formulas • JEFFERSON COUNTY HEALTH & HUMAN SERVICES III 2004 COMMUNITY HEALTH BUDGET& PROPOSAL 2004 REVENUE Population Clinical Family Communicable TOTAL REV & Prevention Health Support Disease BUDGET TAXES: - GRANTS: 239,507 141,993 331,293 134,336 847,128 CHARGES FOR SVCS: - 293,750 85,220 59,850 438,820 INTERFUND CHARGES: - - - - MISCELLANEOUS: - 10,000 - - 10,000 COUNTY GENERAL FUND: - 66,488 39,021 114,991 220,500 I TOTAL REVENUE: 239,507 512,231 455,534 309,177 1,516,448 2004 EXPENSE Population Clinical Family Communicable TOTAL EXP & Prevention Health Support Disease BUDGET FTE'S 2.61 7.18 7.22 3.56 20.58 SALARIES&BENEFITS: 139,182 379,558 400,099 191,854 1,110,694 SUPPLIES: 2,909 65,215 6,212 79,397 153,733 EQUIPMENT: - 300 - - 300 PROFESSIONAL SERVCES: 80,500 27,177 6,660 22,391 136,728 COMMUNICATIONS: 4,079 3,364 2,710 1,352 11,505 TRAVEL: 2,459 5,522 8,351 1,210 17,542 jilskELLANEOUS: 14,709 30,517 27,905 16,590 89,721 _IirRFUND RENTS/LEASES: 18,617 51,222 51,528 25,419 146,786 INTERFUND PAYMENTS: - - - - TOTAL EXPENSES: 262,455 562,876 503,465 338,213 1,667,009 I TOTAL VARIANCE: I (22,949)1 (50,645)1 (47,932)1 (29,036)1 (150,561) POPULATION-BASED FORMULA- *calculated on the total city and county population Program Subsidy (County Contribution &Variance): 22,949 117,133 86,953 144,027 % of PT Users: 32% 61% 46% 61% PT Users Share of Subsidy: 7,344 71,451 39,998 87,856 Less City Share of County Contribribution (32%):* - 21,276 12,487 36,797 City Share Unfunded: 7,344 50,175 27,512 51,059 136,090 ASSESSED PROPERTY VALUE FORMULA-*calculated on the total city and county assessed property Program Subsidy (County Contribution &Variance): 22,949 117,133 86,953 144,027 % of PT Users: 32% 61% 46% 61% PT Users Share of Subsidy: 7,344 71,451 39,998 87,856 Less City Share of County Contribribution (26%):* - 17,287 10,145 29,898 City Share Unfunded: 7,344 54,164 29,853 57,959 149,320 III 04/09/04 PROPOSAL FORMULAS • Both proposals begin with identifying the local subsidy needed for each program. The subsidy for each program is calculated by adding the amount received from the county's General Fund to the variance of total revenue and expense. Multiplying this figure by the percent of city users identifies the city's proposed share of the subsidy. Since city residents contribute to the county general fund through their property tax payments,the proposed funding formulas need to adjust for this current contribution to public health funding. The"Population-based Formula" uses the ratio of city and county population (32%)to"credit"the city for this percentage of current county funding. The"Assessed Property Value Formula"uses the ratio of city assessed property value to total county assessed property value(26%)to make this same adjustment. Population (Census 2000) City of Port Townsend 8,325 Jefferson County 25,953 Ratio(city population/county population) 32.08% 411/ City Fair Market Real Property 740,476,665 City Personal Property Assessed 26,328,430 GRAND TOTAL CITY FAIR MARKET/ASSESSED: 766,805,095 JC Total Fair Market Real Property 2,918,397,975 JC Total Personal Property Assessed 89,752,605 GRAND TOTAL JC FAIR MARKET/ASSESSED: 3,008,150,580 Ratio(city property value/county property value) 25.49% • 8 PUBLIC HEAHEALTH I.^ Always Working for a Safer and it-kk74'P�� HEALTHIER JEFFERSON Appendix S 111 • The Mission of Jefferson County Health & Human Services is to protect the health of Jefferson County residents by promoting healthy communities and environments. D Q. 3 5' 0 0 <Z ED v, m v — 0 v Vo) m CDD 0 C 0. fa') I 5 v Cl)CD Vi n — D I v E a rn 0 o. . 0 � z � o — 7 � • o CO u o m}� 0) V) -a — . — . — "r1 Q I Cl) fit I 0 L.._.3. INI c c 13 0 N. o Q � � rtcrt = Z o O pD o = — . — Wcn • c CD H. - I pa q _ • N C .M11•1111•1111111•1111011111•11/ O O lb D o 0. 30 300 moa o a) o•, o Co) a CD m ~'q Dh o v ° to N . I a m 0) = -' 0 cn vg p � moo nm ,_„ 3 n v m CD CD = 3 a 0 2 v N O LA., Jefferson County Health and Human Services - May, 2003 Community Health Programs Coordinated and Staffed by Public Health Nurses 1. Best Beginnings—An intensive home visiting program serving first time mothers on Medicaid who are identified as having greater needs. Starting in early to mid pregnancy and until the baby turns two, home visits,parenting support and education based on a relationship model are provided. 2. Bio-terrorism Program-- Provides community coordination, education, and planning for response to bio-terrorism. 3. Breast and Cervical Health Program (BCHP) —Free Women's Health Exams with mammogram and Pap test are available for women over 40 with limited incomes that are underinsured. 4. Breastfeeding Consultation -Assessment, education and support are provided to pregnant and breastfeeding women through office, home and hospital visits. 5. Child Birth Education Classes—Comprehensive classes are offered six times per year. The fee is covered for women on Medicaid. 6. Child Death Review Program -Coordinates the Child Death Review community team. Reviews all unexpected child deaths ages 0 through 18 in Jefferson County, according to Washington State law, with the long term goal of child injury prevention. 7. Child Care Health Consultation-Provides health education and resources to licensed • child care providers by site visits and phone consultation. 8. Child Injury.Prevention —Provides community education on the importance of bicycle helmets, proper car seat use for children and playground equipment safety. Infant car seats, child booster seats and helmets are provided free when available. 9. Child Protective Services Public Health Nursing Contracts —On referral from DCFS for children at risk, provides family needs assessment; child health screening and referrals, and parenting education. 10. Children with Special Health Care Needs—Provides service coordination for children ages birth to 17 with chronic health conditions and their families. 11. Communicable Disease/TB Program-Consultation, investigation and reporting of communicable diseases within Jefferson County; TB screening, diagnosis and treatment. 12. Family Planning Clinic— Provides community and client education, gynecology exams, birth control information and supplies, pregnancy testing and counseling, emergency contraception, STD screening and treatment. 13. Foot Care Program -Provided to seniors at homes, senior centers and other facilities throughout the county. 14. Foster Care Passport Program — A comprehensive medical history and treatment • plan is updated bi-annually and follows a child throughout their placement in foster care to improve their health outcomes. 15. Health Care Access Program — Provides outreach for Medicaid and the Basic Health Plan. Applications, assistance and information are available at the H.D, outreach clinics, schools, medical provider offices, food banks, and community centers. • 16. HIV/AIDS Counseling, Testing and Case Management—Services include HIV testing and counseling for those at high risk, prevention education, and case management for HIV positive individuals. 17. Immunization Program —Coordinates community medical provider access to State supplied vaccines. Provides routine childhood and adult immunizations and vaccine education, with clinics on Tuesdays and Thursdays from 1:00-4:30. 18. International Travelers Clinic-Immunizations and travel health recommendations provided by appointment. 19. Maternity Support Services (MSS) and Maternity Case Management(MCM)— Through office and home visits, provides maternity support for income qualifying pregnant women their children up to age one. Additional case management is provided for at-risk individuals. Nurses provide monitoring of health status, education, support and referrals for needed services. All women on First Steps qualify. 20. Oral Health Program -New in 2002, provides community coordination of access to dental care. 21. Peer-In Program —School based prevention education program with high school youth. 22. Peninsula Syringe Exchange Program—Anonymous walk-in syringe exchange • clinics at the Health Department on Mondays from 10 to 12 and Thursdays from 3 to 5. Services include exchange of new syringes for used, secondary exchange, education and supplies for safer injecting, healthcare referrals, HIV counseling and testing, hepatitis screening and referral. 23. School Health Consultation Program— Provides public health nurses for school districts on a limited basis. Services include assessment and care planning for children with chronic health conditions; vision, hearing, and scoliosis screening; immunization review; medication administration training; health education and consultation. 24. STD Program — Provides confidential services including: diagnosis and treatment; prevention education; partner notification and medical referrals. 25. Sudden Infant Death (SIDS) Program—Provides community prevention education and follow-up counseling as needed for affected families. 26. Tea Party for Pregnant Women and Breast Feeding Mothers —A drop-in tea on Wednesdays from 1:30 to 3 at the Health Department for pregnant or breastfeeding mothers and their nursing infants. Support, mentoring, and education provided. 27. Vasectomy Referral Program —Coordinates a State grant for income eligible men who must be at least 21 years old, without insurance that covers vasectomy. Initial intake, consultation, and referrals are provided. 28. Women, Infant, Children (WIC)-A nutrition education and supplemental food program . for eligible low income and nutritionally at risk pregnant and breast feeding women, infants, and children under 5. Services provided at the Health Department and satellite clinics in Chimacum, Quilcene and Brinnon. PUBLIC H EALTH ) Always Working for a Safer and HEALTHIER JEFFERSON 615 Sheridan Street,Port Townsend, Washington 98368 STANDARDS EXECUTIVE SUMMARY TO BOARD OF HEALTH DRAFT 4-2-04 Jean Baldwin, Director -Jefferson County Health & Human Services MANAGING FOR RESULTS: BUSINESS PLAN FOR PUBLIC HEALTH -JEFFERSON COUNTY Jefferson Public Health Department successfully met the statewide Public Health Standards review. The Standards were approved as the Strategic Plan for 2002-2004 by the Jefferson County Board of Health and budget performance measures provide measurements of practice, programs and outcomes. The budget performance measures are organized around the Department's customers, programs and services. Together the documents will help Public Health managers, employees, community partners, and customers understand Public Health and participate in shaping its future. A review of Public Health's mission, vision, and lines of business indicates some • common themes. We are a Department whose employees are enthusiastically committed to improving the health of individuals and our community as a whole. The two are very related. We are concerned about people and the environment in which we live. Some of our programs focus on the total population in order to improve health status. Others focus on improving the health of the entire community by improving the health of target populations who are experiencing health disparities. Budget performance measures are based on these five Public Health Standards: • Understanding health issues: standards for public health assessment • Protecting people from disease: standards for communicable disease and other health risks • Assuring a safe, healthy environment for people: standards for assuring a safe, healthy environment • Prevention is best/promoting healthy living: standards for prevention and community health promotion • Helping people get the services they need: standards for access to critical health services What gets measured gets done. Jefferson County Public Health professionals are accountable to the community,policy makers, and their profession. It is difficult to move toward improvements without measuring performance and providing evidence based programs. Many programs have challenges in meeting current and projected demand for services; this will become obvious in reporting performance measures. Some recurring themes • are: • Recognition that, to improve the health of the community, we must maintain critical public health services by stabilizing resources. ■ Data collection and reporting are standardized and institutionalized, identifying community needs and strengths for policymakers. • Performance Measures goals and outcomes based on community needs using available resources to provide measurable services. • Complex community problems require community-based partnerships committed to long-term efforts. 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MI • • i ' N N s 3 I • • • t '4) .S1) WASHINGTON STATE 1g Board of Health ALWAYS WORKING FOR A SAFER AND HEALTHIER WASHINGTON S -60\ ^ PUBLIC HEALTH „6, • I Always Working for a Safer and HEALTHIER JEFFERSON 1111 IN Media Report • Impact of Vaccines in the 20th Century 20th Century 2001 Provisional Disease Annual Morbidity Total %Decrease Smallpox 48,164 0 100 Diphtheria 175,885 2 100 Pertussis 147,271 5,396 96.3 • Tetanus 1,314 27 97.9 Polio(paralytic) 16,316 0 100 Measles 503,282 108 100 Mumps 152,209 231 99.8 • Rubella 47,745 19 100 Congenital rubella 823 2 99.8 Haemophilus 20,000(est) 183 99.1 influenzae(< 5 yrs) Sources: - 1. CDC. Impact of vaccines universally recommended for children- United States,1900-1998. MMWR 1999;48(12):243-8. 2. CDC. Provisional cases of selected notifiable diseases preventable by vaccination,United States,weeks ending December 29,2001,and December 30,2000(52w week). MMWR 2002;50(52):1174-5. From: Epidemiology & Prevention of 'Vaccine Preventable Diseases, 2002- In addition, diseases such as Typhoid, Cholera and Malaria are no loger a problem in the U.S. because of enviornmental health solutions. • . " . .. IP Anti-Sn allpox - ' - _ ,. ._._ Progr m to Be y. Held in County - . 3/2, CHILDREN 'WIL BE VACCINAT- - �; '. . ED AT:COST OF ONLY = '•. ,,;� _ • FIVE'CENTS EACH . • Q tNTt3 4t4 QNB 7 . Under supervision of the county . •,,;,,�:r. — health officer and Miss Louise' ' Flanagan, county nurse, a._-county Health-'- 41 cer smallpox vaccination is now being _ • planned for the month of October. Urge.5.?_§niallpox • Miss Flanagan'said -today that � many people of Washington do not Vc�.�i�t�izons , know this state. has the 'largest .. . number of smallpox cases -per Because'=n!• the :possibility:that year of any state. in the union. It' the outbreak.of smallpox which has is one of the few diseases, she oc 'ed'. B.esttl@ :may- spread said, which can be :prevented by aro thetcstatre, it �Slnrlel! Ben the simple use of vaccine. ham► Jt� oo j j hath elfieer, to-' The cost of receiving vaccination l ` ees 'r g]1 P ksODs sins have 'treatment in this ro i 'beeA P lam will be ce °te$ abbit this but five cents per child f�p`a for =ease. tae pact five years to be the cost of vaccine. Miss Flanagan1Mptmiz+ t•oace.'�s solicits the help of every parent - "Sina4gi:s•.en =ofs.the most who, she says,.can help rid_Wash contagious.itis sion,._known-.to the ington of this disease. • medical. .and,the• state' departm rof:health has asked all- III health•-o were=to;tae on the alert for:any':ie'w 'outbt aks,' Di. Ben-�I hail. said t 4:Anyoai'can have com-1 plate'preftetion •t smallpox 1 i by being•-vaceinat before he is ex-1 posed to It.t!, . ,, „. Dr. Benhaan pointed out that ten Jitkyears ago the state��everaged about 1400 ssniallpox cask a -year, but' widespread- vaccination brought, 1936 this.down to less than a dozen cas-' es last'year. 1• • Vaccination may be obtained from any►private pl)rsician or from the Olympic Health4,District, locat- I ed at the court home, Port Town; - i send, each Tuesdaarom 1 to 5 p.I :- , m, _ • Vaccination Program. Now About"Completed, Miss Louise. Flanagan, Jefton! County nurse, announced Monday- that the county health office's• • county-wide anti-smallpox program' Is now aliot completed,.Only child- . ren of two schools, Brinnon and ` Nordland, had not been vaccinated Monday, but she hoped to complete them Tuesday and today, - • - . . . • .„---xe;• !:•17-, .. .. . i.,'.•.,. ,: .". • • • _....- _ :......,•.. . .....•-t' -.. ,, • - tx..4. . •-,:-..,,,..vsr.--,. .-,,.v ,t low=AI ,.,..-_ • •.•• — PblicIfeIth Norse Is Amo4misfest--- Of Olympic Health District Personae!. . . , . . The following is the last in a quires a unique insight into the ries of articles describing vani- problems of the family group and ous operations of the Olympic is thereby able to advise them Health District and the work of with tact and intelligence in times its personnel.This week's article of stress. In a sense, the public deals with the Public Health health nurse is:the ambassador of Nurse. - the health officer,-effecting his de- _cisions in. the' field, eneoiraging Ordinarily, people think of a sound 'health 'Vractices, and re. nurse as a.figure in a starched turning with data.'required for for- white uniform, quietly and effi- renlating broad'policy'in the field - ciently making her appointed of health. _ rounds of hospital corridors and An Important aspect of the 'work sickrooms. The public health nurse of the public health nurse Is that departs from this traditional con- of leading the patient to his treat- cept in many ways, but retains the xnent. From her knowledge of din- essential aspects of humane serv- ease and her knowledge of treat- 't . 2 3: / f.T4 Ice common to all nurses. me - at .she is able to ad- The public health nurse is a ,'vise the family as to where ip- trim, navy blue clad figure who is propriate treatment is available for seen making,her unobtrusive way the sick or disabled, be it a school • • about the community, in sch.00ls .child with a fever or an.adult and in homes, in city and in coun- with tuberculosis. She is acquaint ..,try. Her mission is to maintain ed with the doctors of..the com- z.the all important personal contact munity as well as with the ape- - between ithe health department cialised agencies, such, as those *and the family, in order that the which care for patients with hear- goal of prevention of sickness may lug defects Or cerebral palsy. be served. She requires the tact of From her knowledge many of the 4 a diplomat, the stamina of an ath- sick who would otherwise never 4-lete, the sharp sense of a detec- receive treatment, because of lack 7 tive, and the courage given_ of of knowledge of existing feat her conviction that what she is ties, are able to have the care 1,doing is useful, human service, in they need. • • order to accomplish her duties. Finally, the public. health nurse • groups }bons. kes ., to. con-, :1Often, working alone in the field, is a leader in the community. She ,she must exerCise independent is often called upon to speak t oj- cut, requiring a high degree owledge and experience duct tlastes In•Ikykle -- Bliiii is af ,.._ . hove all, she is a dedicated value. re--eirtamunIty 14e. .._,--_,.-..e] • 'slaw,U,,.1.,". "or T- person--dedicated to the premise ,that years of conscientious serv- , •,,,,,,,,„::kA --v ,'*=t-et,,,•„.-, .N. ice in applying the techniques of 4.-- ---t ---------:. • .a. ,..„44.\:.,4,„,.,,,,,,,--.-_-_.-----_,_ -N-tz, -i---- --.L. „---.?•,-- .--, s.,A- „,... -vm..., -•.7>:-."._7- ,".,.. preventive medicine will award the s-_-7,4t. 4'- ,--?-!_:-,--, * '',.-.1*-c.."40.,:,...m,•,- - .•1----- . . -- '-‘ _community with healthier, happier - - i•-t.-V.- --. 11.44'zt'. ,...,'''‘W• ' i HOME VISIT. — •-•:-_, ‘ ""', • W*.- -'‘ .., z,.-:1` ;citizens. -ak-•\ --' ----- '..,0,-Nv,.:-4.74:-..r..- -- The minimum educational back- i Among the btlad- ,,x,,,..,-,„-,°': ";\,,,, w-*=-t-- „-,....,-5•- 'Vt,...t.',.-zt-N, ground of a public health nurse in- / est personnel of ".t.t... '” --Efz-..'41W,, ,,a.=- ''' sNs.,Nk'o= - eludes a high school diploma, three ,k• «Vv.,I ....,,.1 \ the -Olympic , -..a„. ..,-,', '"•'..;''' . --- years of approved hospital training -, ---,s...-- . .,..: ''••- ..,441 ,r :-. , • ' \ H e a I t h District -1 n ,ki., „..„...„,.,„Rase-,v,..u., u.--. leading to a diploma in nursing, 1 s t h e p u b I I c .1 t/ ..r.i.'Zi-Ittst ' ‘, --.....?'„ and one year of post graduate sti, st,-,„:,a .. .s.: kw ,-=‘, dy in the field of public health to h e a I t h n u r s e. 7' ,-,p,. .. .,,,..,.- 4":...k,N.-: -..-,-, ,a-?• --- - - earn a certificate of public her.lth ' --- . •• - ' ,4 '.• 'ki, .,... . _ \ Nurse Mrs. Carol .i „. -i",:„.., *,." , w..,,ik,,,,I, _.:,., ,, nursing. Many public health nurs- Guthrie is pictur- '--,,t ...•• • .v... ,-, N."‘, ,W -s • .- • -- es are holders of the Bachelor of t•Wz..\tit- '.-• --ii"Nt\''''' " •., 7-.72. Science in Nursing degree, which ed here calling t3/4* Ti..-* . „•-• - . t.•. ,,,m-•\,--% - - - • , :. --.„ -,,,-• 4-z*.r. „ t-, . ,: t• •-',.':,- requires additional years of study , on a Gullcene ----- -1-'4'4,,.',Vati.“. A- '-. .4* '.4‘V 'T'''-. tVA4.--.0 ,**, ',..;i•v. -..,.---• , in a university. Thus, public housewife to in- „ts,, ,- .,, -- t--;•‘. * --N-4g.t,4-,AvAIVq --- -- --- , -- Vs..,k‘kNOZ N 4'..._ .7.-.• health nurses devote years of Stu- / quire about her •,•,-, -:' w„.••,,, •,.,,,•,,r ..,••• ,w--..-...''.s.p:•• •ts- '•..: dy and training to fit herself for daughter's illness. 2.."'' „.4-t.!:"k`-•—1r,._k,-`-t`5.*,--.\..;,•4,;., k :i. 3- ; -: a career of service. In the community the public W h e n children =....... . °' health -.- nurse works unceasingly to are absent from 1A.,".,s,\,k.,' N",'%'N",,NAX, -•tN,4.- $ :c ::,.. :.,, u„,,..0,-.....„--A,tt,- ..... K•airs --4:-A. ,.., *Ths ferret out those cases of sickness `, school three days -,.. 4.4t>$'-'7'. ?-',.4...'''‘ ' 'V''.,;..-" s, '4:04.' 4 ' ' 1 .•'-' and disability which contitute a: tZW- Z,-F., •ON4V*4==,'.....`,4 , • ftisA., or more,the nurs- ,4:-;z41, •.,• <-, .......,„..N..N...,, hazard to the community health. These range from communicable , I es call to ch cc lc '.1 Nz.,_,„„„,„.,,,--„,-, -., k,r,..,.* ,kla-,• -••,.‘ ..... ,.:„ 6„,.. diseases, such as whooping cough, ' on their recovery z`-` *ts. --'''.4-7 - .*.‘.,.,:t."'z'-4,4k1g&' 1 '''''$•:=', e' • \*.At 1'' '14-k...' measles, diphtheria, etc. to defects , 'The public health k,•<-,' ,,Z 14'14.4 N1,-t.,:,.,,k of hearing, vision, and teeth. Since .. „, Ist-4--..--. .:V --laki..\\ ••41 ',- 1•1,••\•, ..g.,..L.. •• ,, nurse spends a ,N, •••:' i" sx'.-V,‘ "tc.......,:-..\. .---1 A.....-W•'' it is among children that many Of -.4-----Ivh.4-,•,, ..`.....•-z-z4m.....\ ,..t ,of s''`'-' ... • these conditions occur, the nur major portion of •-'t 11.. ,...* ..*,,,„ , spends the major portion of kikr her time in the •w:;i ,..:,,,..., .1.-u,,..-*!,,,-. . t' -ind effort in the schools, act- schools, exam in- 'f•- VIt,,,,• \'...k,- 7. - - a ig cEildren, advising tea,cli- - 40 : ,...z..74.„1.0..,.., ....!t.1.. -R-, ,,,;,--kk,\ li • ••.... ,,,x,,,,•4; ing children, ad- <-',--,ms-:••••,-• ,,..„„,.,. er , and acting* as a link in the - „. ;* ,k'c'VN chain of health between the sch..'l ' vising teachers, • • ''.,:,••,- ' •••Ak •4'., 02,:k ' ' and the home. She seeks to -.1.,- and acting as a ,,, -,„,-;• .-..•••• ‘4,-..\\,.:%.‘ ,k,- • cate' .the pupil, the teacher 'Slid , link in. the,chain Zst.: \'.. ,:-, ,,,•'.7tn.,,;:,,,;41,i. ,''q the 'parent in matters of health \ of health between ....N\:' -'; .w.,..,,,;„"s ,,,\,*%,,ti,.-Nt-'4i4,111f;t};;V tion, the techniques for he main-! and to advise, within her jurisdic- •, •,‘,. ,•,• ---N, the "school- and % -.. -44.1-„tt.,,.I.ai.‘..\,,,,, tenance of good health and pre- the hewn.... - • Jefferson County Health and Human Services MARCH — APRIL 2004 NEWS ARTICLES 1. "County staff cuts might be less than 1995-04 growth",PT Leader March 24,2004 2. "Step up for Earth Day activities", PT Leader March 31,2004 3. "Thirsty island in the Sound: Saltwater has intruded into remote residents' lives", The Seattle Times, March 31,2004 (4 pages) 4. "PT dog issue may change law", Peninsula Daily News April 6, 2004 5. "Big Brothers Big Sisters celebrates l't anniversary", PT Leader • April 7,2004 (2 pages) 6. "County wants more city help to pay for public health services", PT Leader April 7,2004 7. "Dogs, rats, garbage: Neighbors want county action", PT Leader April 7,2004 • • � ,% '� -: EOOZ HU 0 N w w •.. a{-' 'o O N ,y, C d R j c'Oa 7 - > o w N o ,. O }> a, > a•, o o ° E w w .o ° 3 000 ® TAt'- ZOOZ 2e .2. > v' v wo o ° oo t40 I m �a uaN � o ooF" e4c,•, O 9LZ _ 0 5 ..° -o IU oc 30.. � •oc *-1'.. t...... O y b o —'ry O 1` U ,rya C 64 `=71- Ln ch � a s m d 3 ° � v° 6Ms o 3 8 � 0. c .0 Ea IOOZ ac = , o o ' a aox o C: ON �"' = o in cm � a AaN OOOZ = = 5 " � -- ti o � rx u °" L9Z - o•-• v)8 Y: ° 0o .E « egEoao) 0 .0 CU c � He° s3. 34„ UEo �° a °p � '° 5 ° a 99Z= 0 7 'Og .8 o Loi, ..- 0•yy° ,°', ;; . .� 8661 t1° a ` � N ° mac ° A1. � �� .. 0 c/a 200R _0 0 ° 0E. 0 s0 W UF a • a.3 ,c w E9Z ETXIXFOZIPA2STM.',7 2 . - oc > o o 2� °� „c o o n e° o as 9661. "E V E9 15 ' c7 0oa 3y00NI h +61°I) ° ° = Z .a ° o ° .so � O u 'ci 9661. 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VI 0 E y O ,d 0 w0 '''S U n Cips) P .2E .8-7410 .0 a E u � •ti 1,1 1 a 4¢ a4o Al`" mo ° � aNa aao ° 0 ' oZ ° ° v '° '3 .o t o° o° ° o.•av as< h ,°a g Wednesday,March 31,2004•B 3 Step up Earth activities In honor of Earth Day, April 22, Port elude information booths, workshops and Park, clean up near the Tidal Clock and Townsend and Jefferson County community displays,hands-on activities and entertain- other garden areas. groups will be sprucing up our communities ment. The Wooden Boat Foundation will help on the weekend of April 17-18. "Port Townsend has a long history of tackle Earth Day by sea with the able as- Earth Day celebrates its 34th anniversary strong community involvement in Earth sistance of the Puget Sound Explorers, this year,and communities across the coun- Day, and this year there are many new made up of Chimacum PI and Port try will undertake recycling, planting and ways to participate,"says Mari F.Mullen, Townsend ICE students and sponsored by clean-up projects all week long. Local citi- Port Townsend Main Street executive di- the foundation. zens and community groups are encouraged rector. To join in an Earth Day project,call the to join in beautification,cleanup,educational Earth Day will be one of the first ac- Port Townsend Main Street Program at and recycling_events. tivities of the newly formed Junior Main 385-7911. See a complete list of activi- Earth Day activities will include every- Street Program,a group of high school stu- ties and find out how to participate at http:/ thing from restoration projects to uptown/ dents who have joined as volunteers and /www.olympus.net/earthday. downtown cleanups and planting projects. plan to assist with a variety of downtown/ The Jefferson County commissioners There is a major "Earth Day Party" uptown projects. Merchants are asked to and Jefferson County Solid Waste have planned for Port Townsend, with activi- spiff up their storefronts, attack sidewalk been instrumental in making Earth Day a ties and entertainment at Pope Marine Park litter and adopt a tree well in front of their success, and Main Street expresses its Building on April 17 and expanded events store.Volunteers will paint the railings of thanks for their support of Earth Day ac- at Memorial Field on April 18, which in- Tyler Street's stairs, plant Adams Street tivities. • rt.) �l 3 • • • The Seattle Times: Thirsty island in the Sound: Saltwater has intruded into remote residen... Cbnvright 2004, Seattle Tines Company. Used with permission, abe leles seallietignesxom Wednesday,March 31,2004,08:18 A.M.Pacific Permission to reprint or copy this article/photo must be obtained from The Seattle Times. Call 206-464-3113 or e-mail resale(o�seattletimes.com with your request. Thirsty island in the Sound: Saltwater has intruded into remote residents' lives By Stuart Eskenazi Seattle Times staff reporter MARROWSTONE ISLAND, Jefferson County—Dueling yard signs line the dozen or so paved roads on this remote little island southeast of Port Townsend, a less-than-subtle hint at a division within that is upsetting life in paradise. "Conserve Water First" one sign says in blue letters. "Want Water to Conserve," says the red-lettered retort. • Saltwater from Puget Sound has infiltrated the aquifer below Marrowstone Island, contaminating an undetermined number of wells and prompting the Jefferson County PUD No. 1 to propose building a $4.4 million water system that would serve the island's 850 residents. The proposal is testing the civility and sanctity of a community where everyone knows your name but not necessarily your business, and lifestyles range from taking outdoor showers to commune with nature to having an indoor swimming pool for exercise. Residents who used to attend community potlucks together at the garden club now find themselves torn between helping neighbors who desperately need water and defending the community against new development. The debate has fractured friendships to the point where one resident didn't attend the funeral of another because they had different opinions on the proposed public water system. "There needs to be reconciliation on the island," says Wayne Marrowstone water Chimenti, a tall-ship captain who chooses to live simply in a cabin with his wife, Nicole, and 14-year-old daughter. An opponent of the The proposal: proposed system,he vows to mend those divisions once the issue is Jefferson County PUD 1 has proposed building a$4.4 llion water resolved, saying "community is the foundation for stability." to serve Marrowstone Island's 850m residents, who now rely on well "Ifwater, some of it tainted by saltwater we can't make community work on a little, isolated island like from Puget Sound.The public water this one, then that's really sad." would be piped from a new tank at Fort Flagler on the island's northern tip, which already receives public 11110 Property owners have until Tuesday to object to the PUD. If close to water via a pipeline from the half oppose the new system—an unlikely scenario, say PUD mainland. officials—the proposal likely will die. If they vote to build, The timeline: http://seattletimes.nwsource.com/cgi-bin/PrintStory.pl?document id=2001892030&zsectio... 3/31/2004 The Seattle Times: Thirsty island in the Sound: Saltwater has intruded into remote residen... construction would begin soon and the first faucet could be tapped by summer 2005. Property owners have until Tuesday • to voice objections to the proposal. If close to half oppose it, it won't be The bane of Puget Sound island living, saltwater intrusion has also built. Otherwise, construction would begin soon and be completed by bedeviled Whidbey, Camano and the San Juan islands,with wells summer of 2005. closest to the beach tending to be worse off. Residents there have suffered many of the ills Marrowstone is enduring today. The cost: Residents who connect would pay a Ralph Rush, 82, a semi-retired shellfish farmer who heads the group oon e-tim payable over 2f years. favoring the new water system on Marrowstone, abandoned his own Those who don't connect would pay tainted well about eight years ago. about$1,500 over time,the PUD reasoning that they would benefit from improved fire protection. Rush draws water from the well of his neighbor,who happens to be his son. To supplement his supply during the summer, he hauls water in a 55-gallon rain barrel he fills in the nearby town of Port Hadlock, which gets public water. "We have learned to take very short showers every other day or every third day," Rush says. "We take our clothes into Port Townsend or Port Hadlock to wash them. We don't flush our toilets every time we use them. "It's almost like living in a Third World country." Development held up The water problem has served as an inhibitor to growth. An estimated 350 buildable vacant lots on the island cannot be developed without first undergoing expensive and extensive testing of groundwater. Several property owners sit on their land,waiting for public water to come in and the development restrictions to come off. Opponents say public water will lead to the development of those lots, while supporters say they doubt the system would fuel growth much beyond the rate of 10 to 15 new houses a year,which has been constant since 1970. Six-mile-long Marrowstone has one town, Nordland, which has one business, the Nordland General Store. Fort Flagler, a former military outpost and now a state park, occupies the northern tip, with the rest of the island a mix of forest,pasture and beach. While many residents are retired, some heading for warmer climes each winter, others are younger and live on the island year round. An islander's closest neighbor, though, is just as likely to be a family of blue herons. On Marrowstone, settled in the 1870s by fishermen and land speculators, the primary mode of transport on and off the island once was a seven-car ferry. A two-lane bridge,built some 50 years ago, connects Marrowstone i and neighboring Indian Island, site of a naval ammunition depot, to the mainland. http://seattletimes.nwsource.com/cgi-bin/PrintStorv.pl?document id=2001892030&zsectie_.. 3/31/2004 The Seattle Times: Thirsty island in the Sound: Saltwater has intruded into remote residen... att 4 A rustic wood-plank sign welcomes Marrowstone visitors with the t,• �' 8eu� message: "Help us conserve our limited water." It's also a reminder r • to residents, who have been dealing with seawater intrusion for .`' several decades. '� 9 d 5 ' The water shortage has inspired many to engineer rain-catchment , '�.: t-7 systems into the de si s of their homes—ex eriments in utters t ' ' and downspouts, filters and chlorinators, pipes and cisterns. The ,� ����, �a �''"..'.1. '� water is then pumped through homes for showers,baths, toilets and r ' i _' laundry. '�. , so ak- Some catchment systems are elaborate and expensive,with tanks x .L.-.4,141 , 3 ` ; Sor tri r x secretedbeneath porches,patios or, in one house, a built-in bench in ;,;, . }.amu w the master bedroom. Others are cheaper and less sophisticated, using t i uil.:,:t.7%.,,,,,,,,act pillowcases to filter leaves that collect in downspouts. "`L"" But even rainwater is precious here. The island lies on the leeward , Ifilt:> , ' w . ', side of the Olympics, creating a rain shadow with only 18 inches of "' annual precipitation. Some catchment cisterns and tanks went drys � � �� last summer,when rainfall was less than 13 inches. �� 6a t THE SEATTLE TLMES Public-water opponents say rainwater catchment is an effective and o enlarge environmentally sound alternative to well water. But others say the systems are difficult to maintain and impractical. • "I didn't retire to have to bother with all that," says Paul Heinzinger, _. 7r who lives on the tract his parents bought for practically nothing in 's�' r 1936. "And I don't think a lot of people here did." IN ` 7nu. , Hookup optional �" as r If public water gets the go-ahead next week, each lot owner would i ' � i ' have an option to hook up to the system,which would be fed by a f {�� new tank at Fort Flagler. The park currently is serviced by PUD ' f i,,,: t water through a pipeline connected to the mainland via Indiani � 111111111°1! j , Island •-,', ..4*—„,-47...nos*.'.""91%- . Residents who connect would pay a one-time assessment of about ,; $6,850,payable over 20 years. Those who don't connect would pay kii,t; about $1,500, also over time, as the PUD reasons they would benefit - ,. � through improved fire protection. , - f Bob Van Etten, 80, a retiree, opposes a public water system but Qeniarge HaR�Ev SO /THELTES Es LE TIMESES would hook up to it. Nicole Chimenti gives water to her family's chickens and ducks using rainwater from one of several water After his well fell victim to seawater intrusion 21 years ago,0 he built tanks. The family grows most of its on the deck below his house a 5,300-gallon aluminum cisternthat own food in m their rooftop catchment a garden and orchard watered fro looks likebig backyard swimming pool. system. Van Etten has made do on the cistern alone, using water that he chlorinates for drinking and the rest http://seattletimes.nwsource.com/cgi-bin/PrintStorv.nl?document td=2OO1 R97 01 fR»certin 2/-11 r)(1(1.4 The Seattle Times: Thirsty island in the Sound: Saltwater has intruded into remote residen... for non-potable purposes. He uses well water for gardening, even though his plants react poorly to it. "The water for my garden is very salty," he says. "And as we get older, these catchment systems • become harder to handle." Moe Rogers, an 83-year-old retired Los Angeles fireman who invested about$13,000 in a rain- catchment system for his waterfront homestead,built his house with a fire-sprinkler system fed by two reserve tanks behind his barn. Rogers says that while his ingenuity serves him well;it doesn't solve the problems of his neighbors. The island is covered in salal, a dense native shrub that last summer got so dry Rogers thought it might combust. As part of the proposed water system, six to eight fire hydrants would be scattered about the island. Currently,tanker trucks from Port Hadlock have to return there to refill if they run out of water while fighting a blaze. While there has not been a big fire on the island in recent memory, 1-• Rogers fears one small blaze combined with a Santa Ana-like wind get stronggusts—could devastate the r —and Marrowstone can island. I e "The opponents seem to be saying, 'I've made it on the island, so w ' ' now nobody else can come.'To me, that's not the American way," he says. $enlarge HARLEY SOLTES/THE SEATTLE TIMES Once the water system is hooked up, users would be billed based on tto bRalph Rush ring headspublic the water citizensto group • consumption. A private golf course on the island,owned by Marrowstone Island. His well is shut Seattleite Wally Barclay,would be the largest consumer, using 3 down because of saltwater intrusion. million to 4 million gallons a year. Public-water opponents don't like Barclay's idea to turn his property into a public course once he connects to public water—although he would need to get his property rezoned first, which in itself would be a huge fight. Barclay says a public golf course would be a nice recreational asset.. But he doubts the nine-hole course would draw a lot of golfers and disrupt the serenity of the island. The debate over public water not only has pitted neighbor against neighbor but also, in a few casts, spouse against spouse. Bob and Sandy Barrett,who five years ago moved into a house they built on a waterfront bluff, equipped their home with one of the island's most sophisticated rain-catchment systems. Sandy Barrett opposes a public-water system because she thinks it will change the character of the island. Her husband has similar concerns but worries about those islanders with bad wells who need water. A retired Navy captain,he meets some of those neighbors in his volunteer job as driver of the island's sole medical-aid car. "I'm torn between thwarting those needs and seeing their needs as legitimate," he says. Stuart • Eskenazi: 206-464-2293 or seskenazi@aseattletimes.com Copyright ©2004 The Seattle Times Company • RIF dog issue ma change I aw y BY JIM MANDERS Commissioner Pat Rodgers, placing the animals in other Hynson,again claimed that the PENINSULA DAILY NEWS R-Brinnon, agreed that the or- homes and cleaning up the county is attempting to take his PORT TOWNSEND—Con- dinance could be studied during property. client's property. the update of the Uniform De- There have been no corn- "He sits on a very valuable tinued complaints about dogs velopment Code. plaints about the animals since being kept on property just off piece of property,"Hynson said. Rook completed an enclosure Hynson wouldn't specify the state Highway 20 south of the Issue needs resolved for them, Fay told the commis- exact date, but said Rook is city limit could lead to revision "All the heat maybe bring- of working on a plan to house all of the county's animal services' g_ sinners. ing to light an issue that really J.D. Rook has been respon- of the dogs. law.We need well-defined stan- needs to be resolved," Rodgers sive,"Fay said. Rook, according to Hynson, said. Fay told the commissioners is making a good-faith effort to dards that are enforceable," The heat emanated from that he believes problems with clean the property said Larry Fay,Jefferson county the 9100 block of Highway 20, rats in the neighborhood will Environmental Health Depart- where neighbors in late Janu- continue to decline as Rook ment director,during an update my complained to the county finds homes for the dogs, but to county commissioners Mon- that about a dozen dogs were pointed out that other unsani- day. roaming on J.D. Rook's prop- Lary conditions need to be ad- Fay said a draft of a revised erty and not being cared for. dressed before the concern ordinance was created several Fay on Monday credited ends. years ago but was never passed. Rook with making progress in Rook's attorney, John R. Rbj 9- r -® i 4111 The Port Townsend Leader OnLine I Big Brothers Big Sisters celebrates 1st anniversary Page 1 of 2 PUT 40 alfit .,,,,,,, _ 24,,,,,,, ,, ,,,„, s+ 1e,�,, g'4 a `� W i„ 1 is it :,..„:5 ..„,,:,,.111 0--- ,,,, y ,'' fiat- `,:. .'-:',. )r- , home *die Wednesday,April 07,2004 Big Brothers Big Sisters celebrates 1st anniversary By Janet Huck Leader Staff Writer Wednesday,April 07,2004 Steve Wilmart was apologetic. Even though Wilmart, a big brother with Big Brothers Big Sisters of Jefferson County, had played scores of Ping-Pong games, lost countless games of Mastermind and put together a computer from scratch with his little brother, h confessed he didn't think bowling was fun. However, when his little brother, Huxley Murphy, 11,was asked what he liked best, he said "bowling."So now the duo has entered bowling contest, "based entirely on Huxley's skill,"said the good-natured Wilmart. Big Brothers Big Sisters of Jefferson County(BBBS)was celebrating its first anniversary with cake and candles. Murphy gotirs piece. Funded by a federal grant, the organization has made a total of 26 matches with an additional 20 "littles,"or young pe , a 30 "bigs,"or adult and high school mentors, already screened for matches. The"littles" range in age from 5 to 18. The"bigs"can be any age as long as they have a willingness to spend time with someone who needs a friend. "The mentors give the kids someone else to talk to, someone else to listen to them, someone else to bring experience to their lives and someone else to celebrate with,"said Peggy Stanford, executive director of Big Brothers Big Sisters of Island County, which ha adopted Jefferson County as a satellite location. Higher grades The Jefferson County chapter has been able to get up and running in a year through the mentorship of the Island County organizat that didn't make its first match for three years. Mentorship programs around the United States have delivered results big-time. An independent study of the Philadelphia-based Bi Brothers Big Sisters found students involved in the program missed less school than students on the waiting list, had lower levels o substance abuse, showed less physical aggression, had better relationships with parents and peers, and achieved higher grades. Forbes magazine selected Big Brothers Big Sisters in 2004 as one of it top 10 charities in its annual survey of 200 large charities. BBBS serves more than two million children in 5,000 communities across all 50 states. Most of the Jefferson County matches have been based at school. Of the 26 Jefferson County matches, 22 involve Chimacum and Port Townsend high school "bigs" and elementary school "littles."The school-based matches are easier to arrange because the hig school and elementary school students,who don't leave the school premises, are always supervised "Kids are really excited about it,"said Maya Johnson, president of the Port Townsend High School BBBS club who helped throw a Valentine's party for the school "bigs"and "littles.""It's fun. We are really into it." Students and seniors • One 4.0 grade point student at PTHS has worked every day for two weeks with her little brother to help him catch up in school. He had trouble completing his homework before. "He's learning how to get it done now," said Johnson. http://www.ptleader.com/print.asp?ArticleID=126&SectionlD=10&SubSectionlD=10 4/7/04 The Port Townsend Leader OnLine I Big Brothers Big Sisters celebrates 1st anniversary Page 2 of 2 Another high school boy cheered his"little"at a Little League game. "The big brother showed up before the mother could get there, the kid was really thankful," said Johnson. Johnson added, "High school students know the difficulties in a town where there is not much for kids to do. We can help them get thoh it." Senior citizens are also stepping up to the plate. Perry Spring, coordinator of the local BBBS, said most of the seven "bigs"who ha qualified for a match are young retirees,45 and older, and seniors in their late 60s. "Perry is a good midwife for these matches,"said Laura Ferguson, Murphy's mother, who is delighted with the match. Originally, Ferguson thought BBBS was really for special needs' kids. She was lucky enough to be the mother of a gifted and focus kid without any problems, but she was concerned, as a single mother, that she couldn't be both mother and father to Murphy. "I'm a girl,"she shrugged. Better than a friend Consequently, she convinced Murphy to try out the mentorship. The first question Wilmart asked Murphy was, "Do you like sports? Ferguson said she was going to answer"no"for him when he piped up with "yes." "Huxley loves Steve because he's smart,"said Ferguson. "He's better than a friend. " Related Links Content©2004 Port Townsend Publishing Company,Inc. Software©1998-2004 1 up!Software,All Rights Reserved i • hap://www.ptleader.com/print.asp?ArticleID=126&SectionlD=10&SubSectionTD=10 4/7/04 it • • Port Townsend&Jefferson County Leader Countymore wants helptopay forpublic health The Jefferson County Board of Health has For years Jefferson County public health sioner),Pat Rodgers(county commissioner), set up a meeting with the Port Townsend City has successfully diversified funding and Geoff Masci (city councilor), Jill Buhler Council in an effort to negotiate joint ac- maintained programs and services,Baldwin (hospital commissioner) and Sheila countability for public health services. continued. For every $1 of local money in Westerman(citizen). Public officials meet 7-9 p.m.Thursday, public health programs,there are almost$6 A report titled "Health of Jefferson April 15 at the Jefferson General Hospital of federal, state money, fees or contracts. County"was jointly funded by the city and auditorium.At stake is whether city govern- That means for every $1 lost it is $7 out of county,and the prioritization of problems has ment can or will further help the county deal the community in the form of services,jobs been jointly determined. with health care funding issues. and quality of life. "When the health department has cata- The agenda calls for discussion of fund- The Washington State Legislature strophic cuts,the whole community suffers, ing of critical public health community and changed local funding of public health in not just city or county government,"Baldwin clinical programs,family planning services, 1993 to motor vehicle excise tax (MVET) said. maternal child health services including new- and removed cities from their historical fi- Jefferson County Administrator David born follow-up and breastfeeding support, nancial obligation to fund public health ser- Goldsmith notes public health funding as a immunizations and communicable disease vices for city residents. Since the repeal of key issue during a slideshow presentation on programs,according to Jean Baldwin,direc- Initiative 1-693 and MVET, public health the county budget situation he's been mak for of the Jefferson County Health Depart- funding has been backfilled one year-at a ing to local service and business clubs. ment. • time, Baldwin said. Goldsmith describes structural budget "Jefferson County public health care pro- Jefferson County BOH invites the city to funding issues as an impending "train grams and services are facing a crisis in assist in the continuation of these successful wreck."One of the unresolved funding con- county funding," said Baldwin. The Board programs. cerns he mentions is whether traditional of Health will be looking to the City of Port Jefferson County Board of Health mem- county services,such as health care and parks Townsend to assist in insuring that these ser- bers are Chairman Dan Titterness (county and recreation,may need to be cut—or new vices continue to be available in the com- commissioner), Co-Chair Roberta Frissell revenue located—to help balance the county munity,she said. (citizen),Glen Huntingford(county commis- budget. , •,. , Dogs, rats, garbage Neighbors want county action By Barney Burke ., ' i7 R, .v.r+.�» .;......,! Leader Staff Writer '.. a •-•‘;','J ra • r ^�c. i'„r r At least two people in Jefferson '' ry f County think that J.D.Rooks is respond • ;t , • s ing satisfactorily to concerns about dogs 1'; :<t $ . i. rats and garbage on a property he's tryreal r "" r .- • ° ing to buy just outside the Port Townsend :',1.:,7.',., } M-•4.k2�';"`"` city limits. tt S *• One is Larry Fay,Jefferson County a i ... kf$A. _ environmental health director.The other t t'4.7..;...,.......- ,--4.,,,,,,..,,•:, is John Hynson,Rooks'attorney. s- t Rooks is"responsive;'Fay told the at h d i Jefferson County Board of Commission- ..1." t %10+3,, , """° `— "�ers on April 7.He is"whittling away on s , .t the pile"of garbage,Fay reported,but .. ` C °1Y/ #� �."`�.:; there is"still a lot of work to do." 4,,,,c,-,e,&:- ;..r.< Describing his client as a"mentally 9t �artlit ,,r,IJ" w '�a disabled Korean War veteran,"Hynson ? -'"' { .t. �':r.:, said: "He's got a lot of faults, but so '^"t'`,°" 'Y"' r -°"rf�x"'� t "` i - what.Does.that give us the right to take �5 � � - , what little he's got?"He complimented i5V 't .; r m ,( the county for working with Rooks. 9 "Progress has been made every single N � * f„r �vy -'day,"Hynson said. But when Rooks , a, . ,- -. ' , brought a dumpster to the property, Jefferson County officials say that J.D. neighbors filled it up with their trash, Rooks Is making progress In the cleanup he said.Someone shot one of the dogs of a property where he keeps a number in the head,Hynson added. of dogs near the outskirts of Port See DOGS,Page A 10 Townsend. Photo by Barney Burke Dogs: Home video shows rats - Continued from Page A 1 "Mr.Campbell needs to get a • Rooks does not live on the property but comes by on the y i' ' new hobby,"Hynson said of the to feed and water his dogs.Thetr, ,.x video."Mr.Campbell has created property has several apparently 1 _ .t1d a ,-.�`, problems,"he said. " �, "Rats are a long-standing inoperative vehicles,a truck with // 8' 8 a camper, an RV, and a large ¢J ' /j;� zk . problem in the area," said f ' f r . " " . Hynson. "It's not just him amount of what most people "`[ ' �,, �' [Rooks]." would think of as trash or Junks, Neither Rooks nor Cam Access is from an unmarked ,sr a 'n' ',7"}}rt ,`, Campbell unlit dirt road located between J. ' attended Monday Monday's meeting. Discovery Road,State Route 20 gam' r , +. evening, a Leader and Fredericks Street. lia 3 +,, x reporter observed the property k�, , for about 30 minutes,but no rats were visible.However,a neigh- Too many dogs '' `. �''.' `' bor advised that the rats do not Neighbors and a county em- . ployee first brought concerns come out until very close to dusk, about the dogs to the county's . and the biggest rats come out at attention on Jan.26. E night. • "As far as I know,we've had The other reason that the rats no complaints"about the dogs .., weren't readily visible on Mon- since then, Fay said. But on day was that Rooks had not come March 22, neighbor Bill by to feed the dogs that day,said 8 Jefferson County Environmental Health Director Larry Fay(left)and the neighbor, who declined to Campbell expressed frustration John Hynson,attorney for J.D.Rooks,confer Monday. give his name.One day,he said, that not enough had been done Photo by Barney Burke he counted 22 rats at one time. by the county,contributing to an infestation of rats in the neigh- that.None of the dogs is licensed, in the"very near future."Gold- rThat man has shot a few of ane borhood,among other problems. which is a requirement for all smith pressed for a range of otherats from neighbortimhasto time,andohis "Nothing has changed,"he corn- dogs over six months of age,Fay dates,and Hynson said"no" try n traps the ihn- plained two weeks ago. said. Followingthat exchange and property to try to contain in- B fes hlsaid. While With the county's help, six "We could write an infraction a previous acknowledgment that Whlee most of the neighbor- older puppies have been placed today,"Fay acknowledged, but there is a need to update the rel- in homes or in"no-kill"shelters, he remains hopeful that compli- event county ordinances,Com- formalor properties lack lawns ora other but another five puppies that are ante can be achieved voluntarily missioner Pat Rodgers suggested the mostlandscaping,part freee of they i fe for now about six months old need and thus he has not set a"drop that the board move ahead on the accumulations.part significant to be placed in order to coniply dead"date.-The dogs are not be- morning's agenda,and the board trash single-widemobileMost and with county zoning and health ing treated cruelly,said Fay. concurred. homes and 0 codes,Fay said.The maximum After Hynson told the coin- an accessory structure or two. number of dogs on one property missioners that Rooks had given Rats on video Along the block or two of road is five unless the county issues a him a date by which the property Campbell has provided the is a collection of vehicles with conditional use permit, he ex- will be cleaned up,County Ad- county with a video of Rooks' greenish-broedwn license plates andg plained. ministrator David Goldsmith property that was shot over a 15- greenutsi efor tinge g.frbeing P y left outside for so long. Two adult dogs are chained asked Hynson if he would die- minute period on a recent up,and an estimated five puppies close the date."No,and I don't evening.Watching the video,it Almost every propertyssis P epmarked with a"no trespassing" are in a pen that Rooks recently intend to," Hynson responded. seems that not more than 30 sec- built. Fay said that the county Goldsmith asked if it might be odds transpires without at least sign. would like to see the dogs steril- in the next 30 to 60 days, and one rat scurrying across the "I think we will have ongo- would in¢problems."Fav predicted in