HomeMy WebLinkAbout2005-March File Copy
Jefferson County
Board of 3-fealth
.Agenda
•
.Minutes
.larch 17, 2005
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JEFFERSON COUNTY BOARD OF HEALTH
Thursday, March 17, 2005
2:30—4:30 PM
Main Conference Room
Jefferson Health and Human Services
AGENDA
I. Approval of Agenda G,. 44AQ.e,.1) k
II. Approval of Minutes of Meetings of February 17, 2005
III. Public Comments
IV. Old Business and Informational Items
1. Federal FFY 2006 Budget
2. Region 2 Public Health Newsletter and Communicable Disease Report
V. New Business
• 1. Pre-Adoption Briefing—Jefferson County Food Safety Code
2. Family Planning Services, 1997-2004 Report
3. 2004 Public Health Improvement Plan—Financing Public Health
4. Legislative Update—Live Bills,Dead Bills,Budget Forecasts
VI. Activity Update
VII. Agenda Planning
VIII. Next Scheduled Meeting: April 21, 2005
Jefferson County Board of Health Retreat
10:00 AM—2:00 PM
Point Hudson Marina Room
•
JEFFERSON COUNTY BOARD OF HEALTH
MINUTES
Thursday,February 17,2005
Board Members: Staff Members:
Phil Johnson-County Commissioner District#1 Jean Baldwin, Health &Human Services Director
David Sullivan, Vice Chairman- County Commissioner District#2 Julia Danskin,Nursing Services Director
Patrick M Rodgers-County Commissioner District#3 Thomas Locke,MD,Health Officer
Geoffrey Masci, Chairman-Port Townsend City Council
Jill Buhler-Hospital Commissioner District#2
Sheila Westerman-Citizen at Large(City)
Roberta Frissell-Citiren at Large(County)
Chairman Masci called the meeting to order at 2:35 p.m. in the Health Department Conference
Room. All Board and Staff members were present with the exception of Commissioner Rodgers,
Member Buhler,and Member Westerman. There was a quorum.
APPROVAL OF AGENDA
• Commissioner Johnson moved to approve the Agenda as written. Vice Chairman Sullivan seconded
the motion,which carried by a unanimous vote.
APPROVAL OF MINUTES
Member Frissell moved to approve the minutes of January 20,2005, as written. Vice Chairman
Sullivan seconded the motion,which carried by a unanimous vote.
PUBLIC COMMENT—None
OLD BUSINESS AND INFORMATIONAL ITEMS
Influenza Update—Vaccine Redistribution,Influenza Activity,Policy Implications: Dr. Tom
Locke announced that Influenza A activity is now widespread in Washington State,with school
absenteeism near 30%on the peninsula.The CDC has also put out a new health alert on the Avian
flu,which is widespread in Asian poultry and periodically jumps to humans,with a fatality rate as
high as 80%. An anti-influenza drug does have effect on this virus when administered early.Asia is
working on an experimental vaccine. The pandemic scenario would involve the coupling of this
virus with the human version and acquires human-to-human transmission. Respiratory surficial
virus is also circulating and can also cause pneumonia. There is not a lot of benefit to doing specific
• diagnosis except in response to outbreaks in institutions, such as in a nursing home.Noting that
HEALTH BOARD MINUTES -February 17,2005 Page: 2
drugs taken after the onset only reduce the duration by about a day, it is onlycost-effective to •
administer the drug before contact.
Washington State Board of Health—2004 Annual Report: A copy of the report was distributed.
Dr. Locke explained the report's purpose was to review work done on the four to six main priorities
the State Board had set for itself.In May,the State would be visiting to review with Staff its
measurement against Public Health Performance Standards and at next month's Board retreat, Staff
would plan to present the updated Standards for Public Health in Washington State. The Board
received advance copies of the updated booklet.
Governor Gregoire Reappoints Secretary of Health: Dr. Locke noted the packet included an
announcement of Gregoire's reappointment of Mary Selecky. There was interest in having her visit
Jefferson County again.
NEW BUSINESS
Isolation and Quarantine Conference Follow-up—Role of Local Board of Health: Dr. Locke
discussed an article that found that past isolation and quarantine exercises have not been effectively
contained. Because isolation and quarantine can only work if 99%of the diseased population is
contained,he stressed the importance of the Board of Health's role in public communication. He
showed a book, Crisis and Emergency Risk Communication by Leaders for Leaders, and suggested
the Board discuss it at a future meeting. Jean Baldwin noted that in-house risk communication •
training is a requirement of all Staff. Dr. Locke said Staff would request copies for each member of
the Board. Ms. Baldwin noted the whole issue of incident management involves a good deal of
cross-county communication.
Vice Chairman Sullivan thought the exercise was helpful. Jean Baldwin offered to share job
description packets for everyone she is preparing for the three-day training March 29-31. It would
also help to look at the County and Health Department emergency plans.
Chairman Masci, in describing the critical communication challenges presented by emergency
situations such as 911, said a higher,military-like degree of discipline and organization is needed.
Jean Baldwin agreed that we are facing great tests and said the exercises are designed to give staff
the confidence that comes from knowing their role within the entire response picture, adding that
every agency in the chain must do this. When asked by Chairman Masci if funding is the reason the
tabletop exercises could not be expanded to accomplish this with all agencies simultaneously,Jean
Baldwin agreed that the County is limited by its bioterrorism planning budget of$25K.
2005 Legislative Session—Key Public Health Issues: Dr. Locke noted the packet contained a
number of pertinent documents. HB 1415 is a cruise-ship bill that seeks to expand the State's
jurisdiction over inland waterways but concluded that to fully realize the bill's intent, the federal
government would have to transfer those rights as they did with the corresponding Alaskan
waterways. HB 1516 is a health-care access bill, focusing on the"Kids Get Care"program to
prioritize children in service delivery. The goal of SB 5597 is to make fresh, farmers' market
produce more accessible to those with WIC vouchers or Food Stamps. A tracking sheet shows that
•
• HEALTH BOARD MINUTES - February 17,2005 Page: 3
hundreds of bills in committee, have health-related implications.While most will soon perish, some
elements may find life as part of some other legislation.
He called attention to three bills that address public health funding—seeking a stable funding source
in a State budget where there is estimated to be a$2.2 billion shortfall.
HB 1818- Establishes a$20M Statewide Emergency Communicable Disease Response
Fund.
SB 5700 - Proposes to add.20 cents per$1,000 of assessed value to the (property)
taxing authority of public health hospital districts and divides it three ways—
hospitals get the same amount and the remainder is split for public health
funding and funding for uncompensated care. Approximately$93 million is
involved.
HB 1737- Getting public health system up to the level where it should be would take an
additional $400 million a year. This bill establishes a joint public health
financing committee or study group of stakeholders to take this issue on and
pick the best alternatives for further consideration.
Member Frissell moved that the Board of Health draft a letter to the 24`"District legislative
delegation supporting HB1818,SB5700, and HB1737,with a copy to other legislators.Vice
Chairman Sullivan seconded the motion,which carried by a unanimous vote.
• Dr. Locke agreed to draft such a letter and suggested the effective use of e-mail to transmit the
letter. Jean Baldwin reminded that the Department had committed to speak as one with Washington
State Association of Counties on issues affecting the group.
Chairman Masci asked about Bill 1458,which addresses on-site sewage in marine areas.He said
Council members had been getting information about this bill from the Association of Washington
Cities that might be different from the Board's. He also expressed concern that local testimony
might be called on before Staff has been adequately briefed on the bill. Jean Baldwin noted that the
Washington State Association of Local Public Health Officials is opposed to the bill as currently
written because it increases regulation without addressing maintenance and education. Linda Atkins
and Dave Christensen submitted comment in opposition when the bill was being drafted.
Dr. Locke explained that the bill had been drawn up by the Puget Sound Action Council to force a
solution—an operating permit mandate—on an issue they had been waiting for local health
departments to solve for ten years.He added that board members could take a stand on pros and
cons as citizens as long as it is in public session.Boards discuss principles and priorities,but then
they give their Chairman the authority to testify. Discussion revealed that the City and County are in
agreement in their lack of support for this bill.
Dr. Locke predicted that the legislature would pass the mental health parity bill,which would
provide the same coverage as medical and surgical.
There was discussion about mental health bills by Jim Hargrove and Eileen Cody and a suggestion
to supply a letter to support Hargrove. Vice Chairman Sullivan moved to send a letter in support
HEALTH BOARD MINUTES -February 17,2005 Page: 4
of Senator Hargrove's omnibus bill.Member Frissell seconded the motion, ya
which carried b •
unanimous vote.
Vice Chairman Sullivan moved to send a letter of support on HB1154 and SB5450 mental
health parity bill. Commissioner Johnson seconded the motion,which carried by unanimous
vote.
Chairman Masci asked the Commissioners to make the Board of Health aware of bills on which
they plan to testify during this session. Jean Baldwin also agreed to send the Board drafts on bills.
Jefferson County Food Code: Dr. Locke noted that Dana Fickeisen previously reviewed with the
Board the changes to the State code that take effect May 2,which does not conflict with the
County's practices. If it was decided to synchronize the two, Staff could present a draft code to the
Board next month,with a soft deadline for passage in April. Dr.Locke said Staff's proposal is to
streamline the local code by adopting the very comprehensive state code by reference—with the
exception of the appeals process (i.e., suspensions/revocation of their license,closures of their
restaurants, fees). The current County code provides for a one-stage appeal process,which is the
Board of Health. He would suggest instead replicating the Methamphetamine Open Record/Closed
Record approach,which would begin with an open record, administrative hearing, or conference,
before the Health Officer(or Hearing Examiner in the case of a revocation).
Chairman Masci expressed favor for the more manageable, single-stage, closed-record hearing. Dr.
Locke noted that hearings are rare,because most issues are resolved in administrative conferences.It •
is unlikely the administrative or Board of Health appeal would be used in the realm of food service
licenses. There being no Board objection,he noted that next month the Board would consider a
document with a lot of strike outs of most of the current language and adopting the state code by
reference and focusing on the appeals process.
Member Frissell asked about the possibility of invoking a public—A,B,C—grading system/postings
in establishments as in California. Dr. Locke did offer support for making publicly available
Pass/Fail scores for restaurants,which Jean Baldwin noted is available on the County website.
Washington State Vaccine Program—Local Policy Issues: Jean Baldwin offered this
information to help the Board understand the level of commitment to this contract, even though it
had not come before the County Commissioners. Referring to a two-page document,she explained
how the immunization program is run,how we store and handle the vaccine internally but also the
monitoring of storage temperatures and logs in physicians offices throughout the county. Chairman
Masci congratulated the Department on its efficient use of resources to carry out this complicated
and costly federal mandate.
Prevention Money: Jean Baldwin reminded the Board of their discussion last month of substance
abuse prevention. She offered the Board a written explanation of the family violence and substance
abuse prevention programs the Department administers.All are best practices, all three based on
prevention,all use local dollars to match out-of county money, and each targets a different
population(maternal child health, school-aged youth,and Big Brother/Big Sister). Veronica Morris-
Nakano's graphing and narrative of each of the programs and their funding contributions were
discussed.
• HEALTH BOARD MINUTES -February 17, 2005 Page: 5
Chairman Masci noted that the 14.24%as shown on the Nurse Family Partnership graph is assumed
to be disappearing. Jean Baldwin noted that a set percent of the liquor excise tax, 2%of the total
City and County contribution,must go to substance abuse and was forwarded to Beacon of Hope
Safe Harbor Treatment Facility. Staff noted that they would get this handout to Commissioner
Rodgers, since he sits on the Substance Abuse Advisory Board.Veronica Morris Nakano agreed to
do a brief workshop on the same with Chairman Masci and City Council Member Frank Benskin,
who would now be attending Substance Abuse Advisory Board meetings.
Access!Ability! Toward a Livable Community: Jean Baldwin noted the packet contained an
announcement of this March 23 event/presentation by nationally-known speaker Dan Burden.
Chairman Masci has committed to attend,representing the Board.
ACTIVITY UPDATE/OTHER ANNOUNCEMENTS
Environmental Health Director: The position has been closed. Based on phone interviews,
candidates would be invited to come and submit an example of their technical writing skills. Vice
Chairman Sullivan, Chairman Masci, Dr. Locke and Jean Baldwin were identified as the
interviewing team. There was some discussion of possible interview dates,roughly in the second
week of March. Ms. Baldwin agreed to send them resumes and a copy of the questions asked.
•
AGENDA PLANNING/ADJOURN
Future agenda topics: Food Code(March),two-year Family Planning report,Board Retreat(April
21"—retreat in morning,meeting in the afternoon). It was also agreed that a review of the future
funding/partnership needs for Best Beginnings and Behavioral Risk Factor Surveillance Survey
(BRFSS) should occur before June.
The meeting was adjourned at 4:10 p.m. The next meeting will be on March 17,2005 at 2:30 p.m. in
the Conference Room of the Jefferson County Health Department.
JEFFERSON COUNTY BOARD OF HEALTH
(Excused Absence)
Geoffrey Masci,Chairman Jill Buhler,Member
(Excused Absence)
David Sullivan,Vice Chairman Sheila Westerman,Member
Phil Johnson,Member Roberta Frissell,Member
• (Excused Absence)
Patrick M.Rodgers,Member
•
Board-of Health
OCdBusiness
.Agenda Item # 1'V., 1
•
JwecCeraCyJTy
2006 Budget
Nlarch 17, 2005
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•
President Bush's FFY 2006 budget— Talking Points—CT 3/7/2005 12:51 PM
Part 1: The Big Picture
Proposed: $2.5 trillion budget
Pluses
• Biggest winners: Defense and Homeland Security (show cartoon)
Minuses
• Cuts scores of domestic programs to show Prez. is serious about reining in deficits
that have ballooned under his watch. Bush's goal=halve the deficit by 2009.
• Bush budget calls for the first reductions in entitlement programs since 1997—
calling for a net total of$38.7 billion in savings from entitlement programs.
• Begins to slow the rapid growth of homeland security and defense spending.
• • • More than 150 federal programs are slated to be slashed or eliminated.
• Calls for reducing growth of overall discretionary spending to below 2.3 percent—
the projected rate of inflation—from 3.9 percent this year.
Reality Check
• Bush's budget will mask the true fiscal picture because it leaves out:
1) future costs of military operations in Iraq and Afghanistan
2)borrowing required under his plan to add private retirement accounts to Social
Security
•
President Bush's FFY 2006 budget— WSALPHO Talking Points—CT 1
i.
Part 2: The Devil is in the Details—A Snapshot
Summary of Discretionary Health &Human Services funding, compiled by the Senate
LHHS Appropriations Minority Staff, February 7, 2005
T Community Health Centers --Funding is increased substantially for the final year of
a Presidential initiative to increase the number of Community Health Centers. The
budget includes $2 billion for this effort, an increase of$304 million or 17%over last
year.
+ Rural Health programs overall--cut by$115 million or 80%for a total of$29
million. The $29 million includes: $2 million for Access to Emergency Devices (77%
cut from$9 million), $8 million for State Offices of Rural Health(level funded), $8.5
million for Rural Health Policy(level funded), $10.8 for Rural Health Outreach(73%cut
from$39.6 million).
+ Children's Hospitals Graduate Medical Education--$201 million total, a cut of
$100 million or 33%from the FY 2005 funding level of$301 million.
40 Health Professions Training--cut by$290 million or 64%. The proposed$161
million total includes:Nurse Reinvestment Act($150 million), Scholarships for •
Disadvantaged Students ($10 million—down from$47.5 million), Workforce
Information and Analysis ($1 million).
Ryan White CARE Act—Level funded with the exception of a$10 million increase
in the AIDS Drug Assistance(ADAP)program,which brings the Ryan White total
funding level to $2.083 billion with$798 million in ADAP.
Title X Family Planning—level funded at$286 million
Substance abuse treatment and prevention--would basically remain flat at$2.4
billion,rising by$10 million.
+ Mental health --cut by$64 million, or 7.1%, from$901 million to$837 million.
+ Abstinence Education --increased by$39 million, for a total of$193 million.
•
President Bush's FFY 2006 budget—WSALPHO Talking Points—CT 2
v
Part 3: The Devil is in the Details—Three Specific Programs of Interest
#1 Homeland SecurityBioterrorism
State and Local Capacity
The very existence of our regional health response network is threatened with reductions
to the Health Resources and Services Administrations(HRSA)and Centers for Disease
Control Prevention(CDC) grants.
HRSA: President Bush's FY 2006 budget cuts HRSA funding for hospitals
and related programs by$8 million—from$491 million in FY 2005 to $483
million in FY 2006.Previous funding helped to ensure that two thirds of
Washington's hospitals received preparedness training and personal protective
equipment and that our tribes and community health clinics completed needs
assessments. This reduction jeopardizes the ability to continue the preparedness
work we started in 2002. Without adequate funds,these new and essential
collaborations among hospitals,local health,tribes, community clinics,the poison
center,EMS, food safety,home health care,and the mental health system will
fail. Lack of resources will result in incomplete plan development, fewer
exercises and trainings,and insufficient protective equipment for responders. The
Washington State Department of Health(DOH) cannot continue to build an
effective public health response system while suffering from reduced funding at
. the same time. HRSA programs must be funded at the very least at 2005 levels so
we can continue to connect the health care community with public health.
Washington's current HRSA grant is for$10 million.
CDC: President Bush's FY 2006 budget cuts CDC funds for state and local
health by$130 million—from$927 million in FY°2005 to $797 million in FY
2006.Again,DOH faces increased mandates with decreased funds. DOH
continues to be asked by the Department of Homeland Security(DHS)and the
Department of Health and Human Services (DHHS)to address programs such as
Chempak(for pre-positioning pharmaceuticals in the community), Biowatch
(environmental monitoring for select terrorist agents)BDS (the biohazard
detection system to be used in post offices), Cities Readiness Initiative(dispense
oral antibiotics to 560,000 people in Seattle and surrounding counties within 48
hours)—all with no increase in sustainable funding. Throughout many decades
the public health infrastructure has been woefully neglected. While funds
continue to decrease,public health is expected to increase its level of readiness
and respond to everything. Once again,public health cannot build a response
system while simultaneously suffering from decreased funds. Please continue to
allow states sufficient flexibility to ascertain that state funding methods closely
align with a state's actual needs. In Washington State,our regional structure uses
state,regional and local levels to complete the work; this structure provides a
more efficient approach than 35 separate local public health jurisdictions working
alone, yet ensures local action can happen as needed. Washington's current CDC
1111 grant is for$16.9 million.
President Bush's FFY 2006 budget–WSALPHO Talking Points–CT 3
#2 Immunization
•
Funding for the Section 317 Immunization program is increased by$50 million in FY
2006,for total funding of$529 million. The increased funds will be used to increase
the availability of influenza vaccine.
Three key,Washington State impacts:
a) The prime impact of the President's FY06 budget is the proposed new legislation
for VFC Improvements. The majority of Washington state children receive vaccines in
their medical home—a private provider clinic. Public health clinic referrals for
underinsured children could potentially leave many children under-vaccinated. If
this proposal goes through, Washington's 317DA funds will be reduced,therefore
requiring more state funds to cover underinsured children in a private provider's clinic
that most likely will not be referred to a facility where VFC DA funds could be used.
b) The removal of price caps for VFC vaccines will negatively impact our state
spending plan. How negatively this will impact the program will depend upon the
amount of rise in vaccine prices.
c) Funding for the flu stockpile,IND flu vaccine,and the routine childhood stockpile
may not be as significant as recently thought.
#3 Preventive Health Block Grants •
The FY 2006 budget eliminates the Preventive Health and Health Services Block
Grant.
Every local health jurisdiction receives block grant funds to conduct community
health promotion activities for which little other funding is available. The loss of these
funds would eliminate services to thousands of Washingtonians who now receive STD
education and testing; child safety restraints and education clinics; TB testing,treatment
and monitoring; immunization services to children and adults; and testing,treatment and
monitoring of a variety of other infectious diseases.
In addition to basic grants to every local health jurisdiction, PHHS block grant funds
support core capacity in six counties to address the growing obesity epidemic. While
CDC provides limited funding to address obesity through obesity and STEPS funds,it
extends to only five counties in Washington State,leaving the balance of state without
support to address the second leading cause of preventable death.
The PHHS block grant provides core support for health education throughout the
state through the provision of
• online health promotion clearinghouse,
• workforce training, •
President Bush's FFY 2006 budget— WSALPHO Talking Points—CT 4
P
• core funding to address health disparities among populations with little or no English
• language proficiency.
In addition to the flexible dollars, a proviso in the PHHS Block Grant also sets aside
$144,000 each year for services to victims of sexual assault in Washington State.
Services include crisis intervention,medical and legal advocacy, general advocacy,
therapy and support groups. The lack of no or low-cost therapy is a significant barrier for
many sexual assault victims.
Part 4: The Devil is in the Details—Eliminated Programs
40 Eliminated programs
The President's budget proposes eliminating 28 health programs within the LHHS
jurisdiction totaling$1.369 billion.
Healthy Communities Access Program($83 million)
Emergency Medical Services for Children($20 million)
Traumatic Brain Injury($9 million)
Universal Newborn Hearing Screening($10 million)
Sickle Cell Anemia Demonstration($200,000)
Trauma Care($3.5 million)
State Planning Grants for Hospital Access($11 million)
Cord Blood Stem Cell Bank($10 million)
• Diversity Centers of Excellence($34 million)
Health Careers Opportunity Program($36 million)
Minority Faculty Loan Repayment($1.3 million)
Training in Primary Care and Dentistry($89.5 million)
Area Health Education Centers ($29.2 million)
Public Health Education and Training Centers ($3.9 million)
Allied Health and Other Disciplines($11.8 million)
Geriatric Programs($31.8 million)
Quentin Burdick Rural Training($6 million)
Public Health Workforce Development($10 million)
Rural Emergency Medical Services($500,000)
Rural Hospital Flexibility Grants ($39.5 million)
Youth Media Campaign/VERB ($59.3 million)
Preventive Health Block Grants (131.8 million)
Community Services Block Grant($641.9 million)
Economic Development Grants ($33 million)
Rural Community Facilities($7.3 million)
National Youth Sports($18 million)
Community Food and Nutrition($7.2 million)
Denali Commission($40 million)
President Bush's FFY2006 budget— WSALPHO Talking Points—CT 5
Winter 2005
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Good HeaCth. Public Health 24/7
arGnerS— Public Health is now available via pager to physicians and other health care
providers in Kitsap.Jefferson,and Clallam Counties 7 days a week,24 hours a day.
The Centers for Public Health professionals in the three counties rotate the Regional Duty Officer
Disease Control (CDC) (RDO)responsibility by taking turns carrying the pager.The RDO responding to the
now offers a variety of
colorful "respiratorypage will triage after-hours requests for public health services,taking appropriate
action as needed.
etiquette" posters to Check out the box on the back for more # � '
download from their
z
website. information. v 4k
Public Health Visits You
The basic messagesv
of the posters are: The Regional Duty Officer information and .�.� " -.
AR
•Cover your mouth much more Public Health information will be r ;.,.
when you cough or coming in person to your clinic(if it hasn't ,..
. 4111111114
sneeze and throw away already)when a Public Health staff member visits
the tissue. you soon. "'
•Wash your hands often She will be bringing you a Public Health ...,,
and alwa s after ou binder that contains information on emer enc CD NurseEllen Arthur shares a
y Y $ }' Public Health binder with Harrison
cough or sneeze. contacts,notifiable condition reporting,public health Hospital Urgent Care staff in
Port Orchard.
•Remind children to programs and more.
IDpractice healthy habits. And she will return regularly throughout the year with updates.
Posters, Fact Sheets How Did We Cope? Flu Vaccine Shortage in Region 2
& More
At the CDC website Kitsap: Sixty Kitsap County provider office sites answered the Health District flu
you can also find data, vaccine availability survey. As a result of the survey,Kitsap County Health District
such as has not been giving flu shots this season so that all vaccine could be diverted to
the chart Cleaning Hands Keeps providers to immunize their staff and high risk patients.The Health District
shown Students In School provided approximately 8,300 doses of flu vaccine to health care providers,
here, to Harrison,`s 3 Hospital,nursing homes and pharmacies throughout Kitsap County.
Share with Website: www.kitsapcountyhealth.com.
days
staff and ! 2 Mil'"' Clallam: Through a"blast fax" survey of providers,Clallam County
patients. I HI Department of Health&Human Services staff learned that only 4,000 doses of
For i flu vaccine would be available to meet the projected 22,000 dose need. The
posters • Health Department.was able to secure an additional 5,200 doses that were
I
I
and more i o redistributed to nursing homes and health care providers for administration to
info: a a1d«^^vry ' high risks patients. By mid-December all provider orders had been filled
www.cdc. tbie"/ft •u° •
"" "°'
wep proper studwingproper leaving the Health Department with 500 doses which were offered to the
hand hygiene bene Mg+ena
gov/ general public through regularly scheduled clinics.Website: www.clallam.net/
cleanhands and www. HealthServices
cdc.gov/flu/protect/ Jefferson: Jefferson Healthcare(formerly Jefferson General Hospital)received
covercough.htm or call their order of over 5,300 doses from Aventis before the shortage was announced.
Ruth at(360) 337-5752 if They then placed a second order and received 5,000 additional doses. Public clinics
you'd like posters were held as planned through Jefferson Healthcare provider clinics,following the
• delivered to your clinic. CDC guidelines.Jefferson Healthcare supplied vaccine to the local nursing home,an
assisted living center and worked with Public Health to redistribute 2,000 doses each
The Region 2 Public Health Emergency to Clallam and Kitsap Counties.Website: www.co.jefferson.wa.us/health
&Preparedness Program(PHEPR)
endeavors,through this newsletter,to keep you,our health care providers in Clallam,Jefferson,and Kitsap Counties,informed about Public Health issues that affect
you and the patients you serve.If you have questions,comments or need more information about items in this newsletter,please contact the editor,Ruth Westergaard,
by phone at(360)337-5752,email wester@health.co.kitsap.wa.us or at 345 Sixth Street,Suite 300,Bremerton,WA 98337.
Winter 2005—page 2
4 J Zoonotic Surveillance Regional Duty Officer
-..-a.00 Tracking unusual disease and death in animal populations enables
op public health to rapidly detect outbreaks,assess any human risks,and The RDO provides public health•
Y provide information to both veterinarians and public health. consultation to physicians and
Veterinarians— including those working in private practices,laboratories, other health care providers across
academic settings,zoos,wildlife centers,animal shelters,and government Region 2(Kitsap,Jefferson,and
agencies—have an important public health role in the identification and Clallam)on a 24/7 basis.
control of zoonotic and vector-borne diseases. The responsibilities of
veterinarians are outlined in the Washington State Administrative Code During regular business hours
(WAC 246-101-405)and include: call:
1.Notifying your local Public Health department of any Kitsap (360)337-5235
MRIP ILreportable animal disease case or outbreak such as rabies, Jefferson (360)385-9400
' "mad cow" (bovine spongiform encephalopathy)or bat bites. Clallam (360)417-2274
2.Working with Public Health in the investigation of suspected and After hours:
� J confirmed cases or outbreaks of zoonotic disease. Call the pager(360)415-2005 or 911
3.Coordinating with Public Health to implement zoonotic disease
infection control measures including isolation and quarantine when necessary.
Kitsap Cases Reported Jefferson Cases Reported Clallam Cases Reported
Reported Cases ofi Region
January - January - January TOtai
Selected Diseases in Region 2 December December December December December December
2004 2003 2004 2003 2004 2003 2004 2003 2004 2003 2004 2003 2004 2003
Campylobacteriosis 3 1 26 23 0 0 2 5 0 0 2 8 30 36
Cryptosporidiosis 0 0 1 0 0 0 0 0 0 0 0 0 1 0
Chlamydia 48 82 672 671 4 7 36 59 13 9 113 156 821 886
Cyclosporiasis 0 0 2 0 0 0 0 0 0 0 0 0 2 0
Enterohemorrhagic E.coil(non-0157) 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E.coil 0157:H7 1 0 4 4 0 0 0 1 0 0 0 0 4 5
Giardiasis 2 1 14 10 0 0 3 4 0 0 7 4 24
18
Gonorrhea 11 10 70 91 0 1 3 2 0 0 5 8 78
Hepatitis A 0 0 3 2 0 0 0 0 0 0 0 3 3
Hepatitis C 4 16 157 139 8 0 35 2 17 0 49 54 241 195
Herpes 10 4 54 64 0 1 10 7 2 6 17 32 81 103
HIV and AIDS(includes only AIDS cases not previously reported as HN) 3 1 18 17 0 0 0 0 0 0 0 2 18 19
Malaria 0 0 3 1 1 0 1 0 0 0 0 0 4 1
Meningococcal Disease 0 0 2 2 0 0 0 0 0 0 0 0 2 2
Mumps 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Pertussis 1 0 7 16 1 0 18 0 0 0 1 2 26 18
Rubella 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Salmonellosis 1 1 13 7 1 0 2 4 1 0 6 1 21 12
Shigellosis 0 2 4 4 0 0 1 1 0 0 0 0 5 5
Syphilis 4 1 11 6 0 0 0 0 0 0 1 0 12 6
Tuberculosis 1 1 6 2 0 0 0 0 0 0 0 1 6 3
Region 2 Public Health
Kitsap County Health District
345 Sixth Street,Suite 300 -
Bremerton,WA 98337
We've Moved! Please note the new
return address.The Kitsap County Health
District is now in the heart of downtown
Bremerton four blocks north of the ferry
� w...s w , , I terminal.
, Call(360)
`"N 337-5235 for
'' II w i hours, •
•M 0111%ll services,and -
M11 ti, public
health
". information.
1
r
... Twp__. f'
•
Board of.3-fealth
Netiv Business
.agenda Item # 1�, 1
Pre-Adoption Breifing
* Jefferson County
FoodSafety Code
.March 17, 2005
1
}
• PRE-ADOPTION BRIEFING TO BOH 3-17-05
PROPOSED REVISION TO:
JEFFERSON COUNTY CODE, Title 8, Chapter 8.05 Health& Safety FOOD SERVICE
SANITATION
WAC 246-215, Washington State Retail Food Code Revision takes effect May 2, 2005.
Tom and I are recommending that:
• Our current code for food service would be repealed since it is covered in the new
WAC 246-215,by design, to achieve more uniformity across the state.
• We adopt a new Jefferson County Code that addresses the adoption of the state
code by reference and other sections as noted in the table below.
Most counties are adopting the State Code without additions including two traditionally
more restrictive counties, Snohomish and Tacoma/Pierce. Kitsap is apparently proposing
to adopt by reference without additions.
411111 In order to address inspection frequency, we have a draft policy, which is a risk-based
plan for frequency.
New red-blue inspection forms are being provided by DOH, which will have check boxes
for compliance or out of compliance, and plan for correction will be entered.
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ha. a d SEES 11E .- Qo_ E
I. Health Department
4-
Chapter 8.05 ,410%.
FOOD SERVICE SANITATION
•
Sections:
8.05.010 Purpose
8.05.020 Regulations adopted
8.05.030 Hearings
8.05.040 Fees
8.05.050 Severability
8.05.060 Effective date
8.05.010 Purpose
The purpose of Chapter 8.05 of the Jefferson County Code is to establish local Board of
Health standards for food safety to supplement 246-215 WAC to promote and protect the
health, safety, and well being of the public and prevent the spread of disease through food.
8.05.020 Regulations adopted
The Rules and Regulations Washington State Board of Health for Food Service Sanitation,
• WAC 246-215,is hereby adopted by reference as the rules and regulations governing food
service sanitation in Jefferson County, and including subsequent revisions thereto.
8.05.030 Hearings
A. Request for a Hearing Following Notice of Suspension of a Food Establishment Permit
Any permit holder who has received a notice of suspension of a food establishment permit
may request a hearing by filing a written request for a hearing within ten days of receipt of
the notice of suspension. The Health Officer will hear such appeals. The Health Officer's
decision regarding an order prohibiting use may be appealed to the Board of Health. Any
action to review the Health Officer's decision must be filed within thirty(30)days of the date
of the decision.
1. Administrative Hearing: Any person aggrieved by an order suspending a food
establishment permit may request,in writing, a hearing before the Health Officer or
his or her designee. The appellant shall submit specific statements,in writing, of the
reason why error is assigned to the Health Officer's decision. Such request shall be
presented to the Health Officer within ten(10)days of the action appealed. Upon
receipt of such request, together with any applicable hearing fees,the Health Officer
shall notify the person in writing of the time, date, and place of such hearing,which
shall be set at a mutually convenient time not less than twenty(20)days nor more
than thirty(30)days from the date the request was received. The Health Officer
will issue a decision affirming,reversing,or modifying the order prohibiting use.
The Health Officer may require additional actions as part of the decision.
Jefferson County Code Chapter 8.05—Food service Sanitation— Revision DRAFT Page 1 of 4
t
2. Hearing Procedures: Hearings shall be open to the public and presided over by the , ;
Health Officer. Such hearings shall be recorded. Hearings shall be opened with a
recording of the time, date and place of the hearing, and a statement of the cause for
. the hearing. The Health Officer shall then swear in all potential witnesses. The case
shall be presented in the order directed by the Health Officer. The appellant may
present rebuttal. The Health Officer may question either party. The Health Officer
may allow for a closing statement or summation. General rights include:
(a) To be represented by an attorney;
(b) To present witnesses;
(c) To cross-examine witnesses;
(d) To object to evidence for specific grounds.
In the conduct of the proceeding, the Health Officer may consider any evidence,
including hearsay evidence that a reasonably prudent person would rely upon in the
conduct of his or her affairs. Evidence is not admissible if it is excludable on
constitutional or statutory grounds or on the basis of evidentiary privilege
recognized in the courts of this state. The Health Officer shall decide rulings on the
admissibility of evidence, and the Washington rules of evidence shall serve as
guidelines for those rulings.
Inasmuch as any appeal to the Board of Health from a Health Officer decision is a
review on the record, the Health Officer shall ensure that the record generated
contains testimonial and documentary evidence supporting the Health Officer's
issuance of the order prohibiting use.
The Health Officer may continue the hearing to another date to allow for additional
submission of information or to allow for additional consideration. Prior to closing
of the hearing, the Health Officer shall issue its oral ruling unless the Health Officer
determines that the matter should be taken under advisement. Written findings of
fact,conclusions of law, and orders shall be served on the appellant within fourteen
days(14)of the oral ruling. If the matter is taken under advisement, written
findings,conclusions, and orders shall be mailed to the appellant within twenty-one
• (21)days of the close of the hearing.
The appellant shall bear the burden of proof and may overcome the order
suspending the food establishment permit by a preponderance of the evidence.
3. Appeals: Any decision of the Health Officer shall be final and may be reviewable by
an appeal filed with the Board of Health through the Health Officer. Any action to
review the Health Officer's decision must be filed within thirty(30)days of the date
of the decision.
B. Request for Hearing Following Notice of Revocation of a Food Establishment Permit:
1. Administrative Hearing: Any permit holder in receipt of a notice of revocation of a
food establishment permit may request,in writing, a hearing before the Health
Officer or his or her designee. The appellant shall submit specific statements in
writing of the reason why error is assigned to the decision of the Health Officer.
Such request shall be presented to the Health Officer within ten(10)days of the
action appealed. Upon receipt of such request, together with any applicable hearing
fees, the Health Officer shall notify the person in writing of the time, date,and place
of such hearing,which shall be set at a mutually convenient time not less than
twenty(20)days nor more than thirty(30) days from the date the request was
received. The Health Officer will issue a decision affirming, reversing,or modifying
the revocation order. The Health Officer may require additional actions as part of
the decision.
•
Jefferson County Code Chapter 8.05—Food service Sanitation— Revision DRAFT Page 2 of 4
•
•
•
3. Hearing Procedures: Hearings shall be open to the public and presided over by the { �
Health Officer. Such hearings shall be recorded. Hearings shall be opened with a
recording of the time, date and place of the hearing, and a statement of the cause for
• the hearing. The Health Officer shall then swear in all potential witnesses.The case
shall be presented in the order directed by the Health Officer. The appellant may
present rebuttal. The Health Officer may ask questions. The Health Officer may
allow the opportunity for a closing statement or summation. General rights include:
(a)To be represented by an attorney;
(b)To present witnesses;
(c)To cross-examine witnesses;
(d)To object to evidence for specific grounds.
In the conduct of the proceeding, the Health Officer may consider any evidence,
including hearsay evidence that a reasonably prudent person would rely upon in the
conduct of his or her affairs. Evidence is not admissible if it is excludable on
constitutional or statutory grounds or on the basis of evidentiary privilege
recognized in the courts of this state. The Health Officer shall decide rulings on the
admissibility of evidence, and the Washington rules of evidence shall serve as
guidelines for those rulings.
Inasmuch as any appeal to the Board of Health from a Health Officer decision is a
review on the record, the Health Officer shall ensure that the record generated
contains testimonial and documentary evidence supporting the Health Officer's
order revoking the food establishment permit.
The Health Officer may continue the hearing to another date to allow for additional
submission of information or to allow for additional consideration. Prior to closing
of the hearing, the Health Officer shall issue its oral ruling unless the Health Officer
determines that the matter should be taken under advisement. Written findings of
fact, conclusions of law and orders shall be served on the appellant within fourteen
• days(14)of the oral ruling. If the matter is taken under advisement, written
findings,conclusions and orders shall be mailed to the appellant within twenty-one
(21) days of the close of the hearing.
The appellant shall bear the burden of proof and may overcome the permit
revocation order by a preponderance of the evidence.
4. Appeals. Any decision of the Health Officer shall be final and may be reviewable by
an appeal filed with the Board of Health through the Health Officer. Any action to
review the Health Officer's decision must be filed within thirty(30)days of the date
of the decision.
5. Appeal of Health Officer's Decision to Board of Health:
a. Any person aggrieved by the findings,conclusions or orders of and
administrative hearing conducted by the Health Officer shall have the right
to appeal the matter by requesting a hearing before the Board of Health.
Such notice of appeal shall be in writing and presented to the Health
Officer within thirty(30)days of the Health Officer's decision. The
appellant shall submit specific statements in writing of the reason why
error is assigned to the decision of the Health Officer.
b. The suspension or revocation of food establishment permits by the Health
Officer shall remain in effect during the appeal process. Any person
affected by the suspension may make a written request for a stay of the
decision to the Health Officer within five(5)business days of the Health
•
Jefferson County Code Chapter 8.05—Food service Sanitation— Revision DRAFT Page 3 of 4
iiapi
Officer's decision. The Health Officer will grant or deny the request within
five(5)business days.
• c. Upon receipt of a timely written notice of appeal,the Health Officer shall
set a time, date, and place for the requested hearing before the Board of
Health and shall give the appellant written notice thereof. Such hearing
shall be set at a mutually convenient time not less than fifteen(15) days or
more than thirty(30) days from the date the appeal was received by the
Health Officer unless mutually agreed to by the appellant and Health
Officer.
d. Board of Health hearings shall be open to the public and presided over by
the chair of the Board of Health. Such hearings shall be recorded.Board of
Health hearings shall be opened with a recording of the time, date and place
of the hearing; and a statement of the cause for the hearing. The hearing
shall be limited to argument of the parties and no additional evidence shall
be taken unless,in the judgment of the chair, such evidence could not have
reasonably been obtained through the exercise of due diligence in time for
the hearing before the Health Officer. Argument shall be limited to the
record generated before the Health Officer unless the chair admits
additional evidence hereunder.
e. Any decision of the Board of Health shall be final and may be reviewable by
an action filed in Superior Court. Any action to review the Board's
decision must be filed within thirty(30)days of the date of the decision.
8.05.040 Fees
The Board of Health shall establish fee schedules for issuing or renewing licenses or permits
• or for such other services as are authorized by the law and the rules of the state board of
health and necessary for the enforcement of this regulation: PROVIDED, That such fees for
services shall not exceed the actual cost of providing any such services(RCW 70.05.060(7)).
8.05.050 Severability
Should any part of this regulation be declared unconstitutional or invalid for any reason,
such declaration shall not affect the validity of the remainder.
8.05.060 Effective date
The effective date of this regulation shall be .
•
Jefferson County Code Chapter 8.05—Food service Sanitation— Revision DRAFT Page 4 of 4
Jefferson County Code
Chapter 8.05
• Food Service Sanitation
Sections:
8.05.010 Regulations adopted
8.05.020 Permit Required
8.05.030 Permit Application
8.05.010 Permit Issuance
8.05.050 Permit Display
8.05.060 Permit Suspension
8.05.070 Permit Suspension Appeal
8.05.080 Inspection records
8.05.090 Demerit values
8.05.100 Hazard point scores
8.05.110 Additional provisions
8.05.120 Toilet, handwashing facilities
8.05.130 Backflow prevention devices
8.05.110 Hand dishwashing
8.05.150 Worker permits
8.05.160 Access to establishments
8.05.170 Fees
8.05.180 Plan review
8.05.190 Enforcement
&05,-010-Regulations-Adopted
1. The State Board of Health Rules and Regulations, Food Service Sanitation, as adopted October 1, 1980, is
2. The 1976 Edition of the United States Public Health Service Food Service Sanitation Manual is hereby
adopted by reference as the official interpretation of this chapter, where applicable.
3. Where a conflict may occur between this chapter and the State Board of Health Regulations, or the PHS
Sanitation Manual third. (Ord. 2 85; Ord.2 77 Part 1 AU 1)
A valid permit issued by the Health Officer shall be required for any person to operate a food service establishment
' - •- '. ' . -- - - .. - !-.. •• . . a .- . .. ' . . . • . -
permit shall be made no later than 10 days prior to the first scheduled date of operation. Permits issued for
8,1)&030-Permit—Application
• - • . .- •• . . . .. . .. . . . . •- . -. . e - . -. • . .. . .. .
establishments shall include the inclusive dates of the proposed operation, location and proposed menu items. (Ord.
2 85; Ord. 2 77 Part 1 AU 2.2)
8.05.010 Permit Issuance
A permit shall be issued by the Health Officer after receipt of the application and an inspection of the premises
reveals compliance with minimum requirements and upon receipt of inspectien fees as-established by this chapter.
• (Ord.2 77 Part 1 AU 2.3)
Jefferson County Code Chapter 8.05–Food Service Sanitation Page 1 of 3
(Ord.2 77 Part 1 AU 2.4)
regulations. Notwithstanding this provision of these regulations, should the inspecting officer have reasonable
(Ord.2 77 Part 1 AU 2.5)
following a hearing, he may within five days file a written notice of appeal with the Jefferson.County Board of
Health. (Ord. 2 85; Ord. 2 77 Part 1 AU 2.6)
&Oe n8OI t n a
. . a . - e _ • A
Q n_c O90De.. •t V >
ues
• : •. : . -- 9. - • e:. e ; • A
&G5100u du tc
1. When the hazard point total is 74 or less all violations of blue items must be corrected by the next regular
±± ±
- . . .. • . . !-.. ••- .
safe food handling.• . :•. : -, ._ - .•.:.• .•--- •- - _ .-. - ^. . . . . -• . .
The establishment may be re inspected and the operator shall pay the Health
2. When the hazard point total exceeds 74 red items or exceeds 100 total items, the establishment's food
Environmental Health or the County Health Officer, if, in the opinion of the inspecting officer, an
An administrative hearing shall be scheduled after two re inspections -and failure to correct repeated
• may be charged to the operator. In the event the operator refuses or fails to abide by the compliance
Jefferson County Code Chapter 8.05—Food Service Sanitation Page 2 of 3
over a course of three inspections, these violations must be corrected within 30 days. At that time the
• (Ord.2 89; Ord.2 85; Ord. 2 77 Part 1 AU 3.2)
8.05.160 shall also be met. (Ord. 2 85; Ord. 2 77 Part 1 AU 4.1)
All food service establishments, other than temporary establishments, that are constructed or extensively
other backflow prevention devices. (Ord. 2 77 Part 1 AU 4.1.b) - - - - - - -
n 05 l lnuaftd Dis�.w ti
v :o�a-�u�nmg
8.05.150 ... ..a ci-crvra
•
(Ord. 2 77 Part 1 AU 4.1.d) ... - " . - -- •• - - - . '. - .
time for the purpose of inspecting the establishment and/or-equipment to determine compliance with these
- e -•
8.05.170 Fees
SASA-80-P1an-Review
regulations shall be guilty of a misdemeanor. In addition thereto, such person -can be en-jeined from
2. The prosecuting authority of the county or municipality in which any alleged violations may occur and/or
Board of Health Food Service Sanitation)may be waived by the Jefferson Comity Health Department if it
•
Jefferson County Code Chapter 8.05—Food Service Sanitation Page 3 of 3
h
IICurrent County Content Covered WAC 246-215 New County Code
Code Section (Working Document) Section
Deleted Reference
8.05.010 (Purpose)
8.05.010 Regulations adopted 8.05.020
(Regulations
Adopted)
8.05.020 Permit required 8-301.11
Permit retained if comply with 8-301.13(B)
code
Permits not transferable 8-304.20
Permit posted 8-304.11(A)
Time frame for application 30 days 8-302.11
prior
Temporary Food Estab. Time limit Definition 95
Temporary Food Estab. Applic. 14 9-201.11 (C, 1)
da. prior
8.05.030 Application Form 8-302.12
Contents of Application(incl. 8-302.14
Temporary)
8.05.040 Permit issuance 8-303.10
• 8.05.050 Permit Display 8-304.11
8.05.060 Permit Suspension 8-601.11
8.05.070 Permit Suspension-Appeal 8.05.030 (Hearings
8.05.080 Inspection Interval 8-401.10
Inspection report 8-403.10, 30
8.05.090 Inspection report form 8-403.10
8.05.100 Hazard Point Scores 8-403.20
8.05.110 Additional Provisions Not applicable
8.05.120 Toilet, handwashing facilities 5-203.12, 204.11
8.05.130 Backflow prevention 5-202.14, 203.14
8.05.140 Manual warewashing 4-301.12
8.05.150 Food Worker Cards 2-103.12
8.05.160 Access to Estab. 8-402.20
8.05.180 Fees 8.05.040 (Fees)
8.05.180 Plan Review 8-2
8.05.190(1) Enforcement Penalties 8-601.11(A)
8.05.190(2) Enforcement Definition 73
8.05.190(3) Waiver 8-103.10
8.05.050
(Severability)
8.05.060(Effective
Date)
Jefferson County Health and Human Services
Name: Date:
Birthdate: Age:
P SAB TOP LC Allergies
CONSISTENT USE SINCE LNMP? YES NO
OBJECTIVE CURRENT METHOD:
HIEF CONCERN:
PMH/FH/ROS: See Hx Form I (date) Tobacco: I Caffeine:
OBJECTIVE
HT: WT: B/P: LNMP: HGB : TEMP: PULSE:
EXAM NE NL ABN DESCRIPTION
HEENT / v TESTS POS NE(3
THYROID (' y Preg Test
HEART 4 Wet Mount
LUNGS Bact
BREASTS Li_ a WBC
LIVER Clue —
ABDOMEN /(ii) Whiff =
SKIN Yeast
VULVA Trich
H
BUS n —
VAGINAUrine Dip
CERVIX Glucose
- Ketone
UTERUS DANTE ❑MID METROgl DN EXA Protein
CTUM Nitrite
_111XTREMITES ., Leucocytes
OTHER �� Blood
pH
Bili —
lam•' Done Def _
Pap
ASSESSMENT CT _
GC
HANDOUT COUNSELING _
❑STD ❑Contraception ❑Preg/Options
❑Fe++ ❑STD Prev/Ed DPre-Concept
❑Ca++ DAbstinence ❑Infertility
❑Folacin ❑Relation Safety ❑Hep B Series
OVaginosis OSterilization ❑N.F.P.
-
❑Meds ❑SBE ❑Parent Involv
PLAN ❑SBE ❑Tobac/Risks ONutrition -
❑BCM ❑MMR ❑Sub Abuse
❑Hep B ❑ECP ODES -
❑Other 0 Anat/Physio ❑HIVAssm/Ed
DAbn Pap ❑Suicide
-
0 Other OCrisis
-
0
RTC/Fasting Labs: I 0 Comp Chem I ❑ CBC I 0 Lipids I 0 TSH I ❑ Other Lab
CLINICIAN SIGNATURE: RTC:
I
January 2002
Board-of-Health
New Business
.Agenda Item # 'V., 2
• family PCanning Services
1997 - 2004 Report
.larch 17, 2005
r
M
Family Planning Services, 1997-2004-Jefferson County Public Health
• Highlighted Findings
• In 2004, Family Planning served an estimated one third of the 15-17 year old females in the
county and about three quarters of the county females age 18-19 years old and 20-24 years
old.
• The total number of clients served has nearly doubled from 1997 to 2004.
• Take Charge pays for over half of the Family Planning visits.
Overview
This is an eight-year review of the Family Planning (FP) Program. Within the context of clinic
services, this review examines target populations (females 19 and younger and females 20-24),
client-specific areas (unduplicated clients, total visits, new clients and continuing clients),
payment sources, ZIP Code of residence, and staffing levels.
Family Planning services encompass annual exams, reproductive health and risk reduction
education, FDA approved prescriptive birth control methods, devices and supplies, non-
prescription over-the-counter products (male &female condoms, contraceptive cream, film,
foam, gel and suppositories), authorization and referrals for sterilization (vasectomy or tubal
ligation), abortion and other reproductive health issues. The goal of the Family Planning
Program is to reduce unintended pregnancies. Primary target populations are women 15-19
years old and women 20-24 years old.
The Health Department began providing comprehensive family planning services in 1994
• through the Family Planning Program (Family Planning). In July 2001, the Health Department
implemented the Take Charge Program (a federally funded Family Planning Waiver Program).
Family Planning Clinic Utilization
FP has experienced a steadily increased from 1997 to 2004 as evidenced by the following:
• The total number of clients served nearly doubled (730 clients served in 1997; 1,330 clients
served in 2004); this includes a 60% or greater increase in clinic utilization by the target
populations (Figure 1).
• The total number of client visits has doubled (1,342 visits in 1997; 2,687 visits in 2004; this
includes an 85% or greater increase in client visits by the target populations (Figure 2).
• The total number of new clients (male and female) has increased 2%; this includes a 59%
increase in new clients age 19 and younger and a 15% decrease in the number of new
clients age 20-24 years old (Figure 3).
• The total number of continuing clients has increased by 140%; this includes a 71% increase
in continuing clients age 19 and younger and a 127% increase in the number of continuing
clients age 20-24 years old (Figure 4).
Clinic Utilization by ZIP Code
• FP has seen a 13% increase in clinic utilization by residents in ZIP Code 98368, and a 14%
decrease in clinic utilization by residents in all other East Jefferson County ZIP codes
(Figure 5).
el • Clinic utilization by residents in all other WA/US ZIP codes have decreased by 23%.
03-09-05_Prepared by Kellie Ragan, M.A.
Payment Sources •
Family Planning relies on a variety of payment sources to maintain financial solvency (Figure 6).
• Medicaid reimbursement, private insurance, and full fee payment sources have seen
relatively little change from 1997 to 2004.
• Sliding scale and partial payment sources have experienced dramatic decreases from 1997
to 2004.
• Take Charge currently pays for over half of the FP visits and maintains consistent
enrollment.
Staffing Levels
• Staffing levels within Family Planning have increased from 2.16 FTE in 1997 to 4.91 FTE in
2005; this reflects a 127% increase in staffing since 1997 (Figure 7)
• FTEs include staff time providing Community Education. Community Education is a
requirement of Federal Title X* and Washington State Consolidated Contract**.
*Program Guidelines for Project Grants for Family Planning Services, United Stated
Department of Health and Human Services, Office of Population Affairs
**Washington State Consolidated Contract, Family Planning and Reproductive Health
Monthly Clinic Utilization, 1997-2004
• FP has experienced an 82% increase in the number of total clients served per month—from
an average of 61 per month in 1997 to average of 111 per month in 2004 (Figure 8. •
• The average number of client visits per month has doubled from 112 client visits per month
in 1997 to 223 client visits per month in 2004 (Figure 9.
• The average number of new clients per month has increased by 27% from an average of 31
new clients per month in 1997 an average of 41 new clients per month in 2004 (Figure 10.
• The average number of continuing clients per month has increased by 140%, from an
average of 30 continuing clients per month in 1997 an average of 72 continuing clients per
month in 2004 (Figure 11.
Target Populations
• In 2004, FP served 31% of county 15-17 year old females, 76% of county 18-19 year old
females and 75% of county 20-24 year old females (Figure 12.
• The county teen pregnancy rate has not changed significantly from 1985-1987 to 1998-2001
(Figure 13).
• The current county teen pregnancy rate is not significantly different from the state rate.
Technical Notes
Rate of Chance formula
(dew Year..... Oid Year)/Old Year too
03-09-05_Prepared by Kellie Ragan, M.A.
Figure 1. Total clients (male and female), by age, Family Planning,1997-2004
Jefferson County Health Department AHLERS data
•
Total Clients by Age Group
Year <202 20-24' 25-29 30-34 35+ Total'
1997 207 191 104 79 149 730
1998 239 213 139 84 172 847
1999 258 218 128 87 228 919
2000 276 221 114 91 244 946
2001 300 253 139 111 230 1033
2002 319 283 166 130 300 1198
2003 329 306 197 124 336 1292
2004 342 308 203 116 361 1330
% Change 2004/1997 65% 61% 95% 47% 142% 82%
Figure 1. Total clients (male and female), by age, Family
Planning-Jefferson County Health Department, 1997-2004
Source: Jefferson County Health Department AHLERS data
1400 1
1200 -
>1 E11997
=. ® 1998
411111 1000 -" ❑1999
El 2000
8001 = ®2001
-1:1 ` � E12002
'- 8 2003
.3 600 - • -K.Z. m 2004
o ...
400 - ?.4
z:=
200 -
r ii
Z
<202 20-24'J 25-29 30 4 35+ Total'
'Total Clients-Increased by 82%siince 1997.
'Total Clients<20—Increased by 65%siince 1997.
'Total Clients 20-24--Increased by 61%siince 1997.
3/9/05 DRAFT
Figure 2. Total client visits, by age, Family Planning,1997-2004 -
Jefferson County Health Department AHLERS data
Total Visits by Age Group
Year <202 20-24' 25-29 30-34 35+ Total' •
1997 447 345 172 150 227 1341
1998 473 416 245 142 267 1543 .
1999 578 415 241 149 400 1783
2000 557 435 237 161 390 1780
2001 699 499 263 213 366 2040
2002 866 610 323 250 459 2508
2003 774 616 388 234 556 2568 _
2004 834 687 366 233 567 2687
% Change 2004/1997 87% 99% 113% 55% 150% 100%
Figure 2. Total Client Visits, by age, Family Planning-
Jefferson County Health Department, 1997-2004
Source: Jefferson County Health Department AHLERS data
3000 -
2500 — 01997
1 ® 1998
1999
2000 - `:-- i
_ - I 012000
a :„..=
a ::. M 2001
" 1500 ' : 0 2002
5 `'
= B 2003
:z. j
1112004
1000 I _...
500 - = F. I :
- r
;.:,1:... _ ,:i:::i 7. i'/
... - .. ... -'.. 1 I4
<202 20-24' 25-29 30-34 35+ Total'
'Total Visits-Increased by 200%since 1997.
2Total Visits<20 Year Olds-Increased by 186%since 1997.
'Total Visits 20-24 Year Olds-Increased by 199%since 1997. •
3/9/05 DRAFT
Figure 3. New Clients(male and female), by age, Family Planning, 1997-2004
Jefferson County Health Department AHLERS data
New Clients by Age Group
. Year <202 20-24' 25-29 30-34 35+ Total'
1997 102 89 59 39 83 372
1998 150 84 81 47 98 460
1999 133 85 50 36 121 425
2000 126 70 42 41 115 394
2001 163 85 56 47 89 440
2002 137 86 56 50 136 465
2003 139 91 78 47 133 488
2004 162 76 64 34 135 471
% Change 2004/1997 59% -15% 8% -13% 63% 27%
Figure 3. New Clients (male and female), by age, Family
Planning-Jefferson County Health Department, 1997-2004
Source: Jefferson County Health Department AHLERS data
600 -
500
Ell
1997
1998
El 1999
400 - _
El 2000
1111 .
2001
ci 2002
ami B 2003
v 300 _= [ID
2004
aa)i
Z _
200 -
100 r- iiii
ii.: 'ai I ':: .11::
...... ./
; ......s. i
—
iiiIi
_
I
<20° 20-24' 25-29 30-34 35+ Total'
4 'New Client_All clients 102%increase from 1997 to 2004. I
'New Client_Younger than 20 years of age 108%increase from 1997 to 2004
'New Client 20-24years of age-90%increase from 1997 to 2004.
3/9/05 DRAFT
Figure 4. Continuing Clients (male and female), by age, Family Planning,1997-2004 _
Jefferson County Health Department AHLERS data
Age Group •
Year <202 20-24' 25-29 30-34 35+ Total'
1997 105 102 45 40 66 358
1998 89 129 58 37 74 387
1999 125 133 78 51 107 494
2000 150 151 72 50 129 552
2001 137 168 83 64 141 593
2002 182 197 110 80 164 733
2003 190 215 119 77 203 804
2004 180 232 139 82 226 859
Change 2004/1997 71% 127% 209% 105% 242% 140%
Figure 4. Continuing clients (male and female), by age,
Family Planning-Jefferson County Health Department, 1997-
2004
1000
Source: Jefferson County Health Department AHLERS data
900 Ei 1997
®1998
soo _ 1999 •
0 2000
700 2001
=
:4= D 2002
N 600 - _
>= 02003
U =
c 500 - _ m 2004
0 400 - =
U
300 -
200 —
--
100 -
iiFi
— r
iii1
..• 1;:iii. :: iiil! - _
.:. :::._
<202 20-24' 25-29 30-34 35+ Total'
I !
'Continuing Clients-AD Clients_240%increase from 1997 to 2004.
2Continuing Clients-Younger than 20 years of age 171%increase from 1997 to 2004
'Continuing Clients-20-24 years of age 227%increase from 1997 to 2004.
Ill
I
3/9/05 DRAFT
, • • ••,.
Figure 5. ZIP Code comparison, Family Planning Clinic, Jefferson County, 1997-2004
Jefferson County Health Department AHLERS data
Clients Served by ZIP Code
40All Other East All Other WA/US
ea r 98368 Jefferson County ZIP Codes ZIP Codes Total
1997 401 55% 280 39% 44 6% 725
1998 499 60% 285 34% 54 6% 838
1999 531 58% 310 34% 76 8% 917
2000 559 59% 331 35% 56 6% 946
2001 598 58% 378 37% 57 6% 1,033
2002 702 59% 426 36% 70 6% 1,198
2003 782 61% 435 34% 75 6% 1,292
2004 827 62% 440 33% 62 5% 1,329
% Change
2004/1997 13%
-14% -23%
Figure 5. ZIP Code Comparison, Family Planning Clinic, Jefferson
County Health Department, 1997-2004
Source: Jefferson County Health Department AHLERS data
•98368
1000 -
CI All Other East Jefferson County ZIP Codes
900 - ID All Other WA/US ZIP Codes
1
827
800 _
411p
700 -
598
Tr 600 -
o
>
L.
0
co
to 500 - 499 531 559 702 782
c
426 435 440
o
401
CS 400 - 378
310 331
300 _ 280 285
200 -
100 7..6 70 L5
44 54 56 57 62
o
1997 1998 1999 2000 2001 2002 2003 2004
111°
3/9/05 DRAFT
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Figure 7. Staffing Levels, Family Planning,1997-2004
Jefferson County Health Department Budget, 1997-2004
Year FTE Total'
. 1997 2.16
1998 2.31
1999 2.15
2000 2.25
2001 3.19
2002 4.12
2003 4.56
2004 4.70
2005 4.91
Vo Change 2004/1997 127%
Figure 7. Staffing Levels, Family Planning-Jefferson
County Health Department, 1997-2004
Source: Jefferson County AS 400 Data System 4.91
5
11111)
4.56 4.70 ::
4.12 IIIIIIIIIE
4 -
3. 9
1
I
3
2.31
2.25
2.16 5
1
2.
2
1
1997 1998 1999 2000 2001 2002 2003 2004 2005
'Staffing level-127%increase from 1997 to 2005.
FTEs include staff time providing Community Education.Community Education is a requirement of Federal Title X* and Washington State
nsolidated Contract**.*Program Guidelines for Project Grants for Family Planning Services,United Stated Department of Health and ll
an Services,Office of Population Affairs;**Washington State Consolidated Contract,Family Planning and Reproductive Health)
3/9/05 DRAFT
Figure 8. Total clients & mean (average) number clients per month,
Family Planning,1997-2004. Jefferson County Health Department AHLERS data
Total Number Average# clients •
Year Clients Per Year' per month2
1997 730 61
1998 847 71
1999 919 77
2000 946 79
2001 1,033 86
2002 1,198 100
2003 1,292 108
2004 1,330 111
% Change 2004/1997 82% 82%
Figure 8. Total clients & (mean) average number clients per month,
Family Planning-Jefferson County Health Department, 1997-2004
Source: Jefferson County Health Department AHLERS data
1400 - 1,292 1,330
11997
1,198 —
1200 - ❑1998
1,033 w 1999
946.:, ::::< � ®2000
1000 919 =>
847;:>€€'€> 's `>` <' ®2001
::>::»:y;::::::::::»:<:>;>:::_>:.< >,.._ 0 2002
800 730
El 2003
<' » :>:<:::::.:::::::>::: ; � 12004
600 - �'�;�—
400
200
100108111
61 71 77 79 86
Total Number Clients Per Average# clients per
Year1 month2
•
'Total Clients per year-182%increase from 1997 to 2004
2 Total Clients per month-182%increase from 1997 to 2004
3/9/05 DRAFT
t . '-
figure 9. Total client visits and mean (average) number visits per month,
Family Planning, 1997-2004. Jefferson County Health Department AHLERS data
Total Visits Per Total Visits
• Year Year' Per Month2
1997 1,341 112
1998 1,543 129
1999 1,783 149
2000 1,780 148
2001 2,040 170
2002 2,508 209
2003 2,568 214
2004 2,678 223
Change 2004/1997 100% 100%
Figure 9. Total client visits and mean (average) number client visits
per month, Family Planning-Jefferson County Health Department,
1997-2004
l Source: Jefferson County Health Department AHLERS data
3000 -iillo
2700 2,678
2,508 2,56 --
_ 1997
2400 =>� ®1998
> 0 1999
2100 2,04 := � 0 2000
'«: >:>:::::_— ®2001
1,781478 <> �
1800 0 2002
1,54 82003
1500134:€i ; :� 02004
:•::n:_:-:::i iii .:: ....4
1200 - =gr"—
900 :.:..= -
600 <=>>':>
300 -?EiMi '?`. x = 209214223
112129149148170
.......,........... . _. „,.... mizEiiii---1
Total Visits Per Yearl Total Visits Per Month2
4110 'Total Visits per year-200%increase from 1997 to 2004
2 Total Visits per month-200%increase from 1997 to 2004
1
3/9/05 DRAFT
Figure 10. New Clients (Family Planning), Jefferson County Health Department, 1997-2004.
Jefferson County Health Department AHLERS data
Total New Clients Average New Clients •
Year Per Year' Per Month2
1997 372 31
1998 460 38
1999 425 35
2000 394 33
2001 440 37
2002 465 39
2003 488 41
2004 471 39
% Change 2004/1997 27% 27%
Figure 10. New Clients, Family Planning-Jefferson County Health
Department, 1997-2004
Source: Jefferson County Health Department AHLERS data
1200 -
1100 - EJ 1997
1000 ❑1998 •
1999
900 - : 2000
E 2001
800 - El 2002
700 8 2003
112004
600 -
500 - 4600465488471
CI) 425
v
400 -372 39. •
a1 egg
Z .'^
300 ��,',: y::::::::_ >.33 New clients
``' ' Jan�lune 2002
200 :='>><g
100 =
31 38 35 33 37 39 41 39
,, IMMIME1117 1111
Total New Clients Per Year' Average New Clients Per
Month2
1 Total New Clients-27%increase from 1997 to 2004
z Total New Clients per month-27%increase from 1997 to 2004
3/9/05 DRAFT
r
Figure 11. Continuing Clients & mean (average) number continuing clients per month,
' Family Planning, 1997-2004*. Jefferson County Health Department AHLERS data
• Continuing Clients Average#Continuing
Year Per Year' Clients Per Month2
1997 358 30
1998 387 32
1999 494 41
2000 552 46
2001 593 49
2002 733 61
2003 804 67
2004 859 72
% Change 2004/1997 140% 140%
Figure 11. Continuing clients & Average number continuing clients
ii„
per month, Family Planning-Jefferson County Health Department,
1997-2004
Source: Jefferson County Health Department AHLERS data
859
1000 -
900
804
800 -
733= 1997
❑1998
700
s 1999
59 = ':i 2000
600 - 552::::::::::::
N .n
W N N O =
o ea Fe.
Percent of Females served through FP Clinic A o
cno 0.Ah
N A O CO O 'T1 n v G
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Figure 13. Pregnancy Rate per 1,000 females ages 15-17, Jefferson County &Washington State,
1985-1987 through 2001-2003.
Jefferson LB UB Washington LB UB
• Period County' LB variance UB variance State LB variance UB variance
1985-1987 27.10 18.17 8.93 38.93 11.83 53.76 52.92 0.84 54.60 0.84
1986-1988 23.36 15.14 8.22 34.49 11.13 54.93 54.09 0.84 55.79 0.86
1987-1989 27.88 18.70 9.18 40.05 12.17 56.83 55.95 0.88 57.71 0.88
1988-1990 37.62 26.65 10.97 51.66 14.04 57.48 56.58 0.90 58.38 0.90
1989-1991 44.50 32.49 12.01 59.58 15.08 57.64 56.74 0.90 58.55 0.91
1990-1992 48.65 36.25 12.40 63.91 15.26 57.17 56.28 0.89 58.06 0.89
1991-1993 47.79 35.82 11.97 62.46 14.67 56.26 55.40 0.86 57.14 0.88
1992-1994 42.04 31.13 10.91 55.62 13.58 54.54 53.71 0.83 55.38 0.84
1993-1995 37.31 27.34 9.97 49.80 12.49 51.76 50.97 0.79 52.56 0.80
1994-1996 30.57 21.86 8.71 41.65 11.08 48.56 47.82 0.74 49.32 0.76
1995-1997 33.22 24.34 8.88 44.34 11.12 46.03 45.32 0.71 46.74 0.71
1996-1998 35.39 26.37 9.02 46.50 11.11 43.38 42.70 0.68 44.06 0.68
1997-1999 38.64 29.29 9.35 50.03 11.39 40.86 40.21 0.65 41.51 0.65
1998-2000 39.60 30.17 9.43 51.05 11.45 38.28 37.65 0.63 38.91 0.63
1999-2001 39.4 35.7
2000-2002 34.6 33.3
2001-2003 32.0 30.8
Figure 13. Pregnancy rate per 1,000 females ages 15-17,
Jefferson County and Washington State,
• 1993-95 through 2001-2003.
Source:VistaPHw 2.3.4, Calculator Version 5.0;Center for Health Statistics,
Washington State Department of Health,02/2005.
t`
• 100.00 -
w 90.00 -
a)
• 80.00 -
N
is 70.00 -
d _ Washington State
u. 60.00 -
O - - _ _
0 50.00 -
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20.00 = - Jefferson County
co 10.00 -
a)
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00 00 00 CO CO C) CO C) 0) C) C) Q) C) CO C) 0 0
0) Cr) C) C) C) CO C) C) 0) CO 0) 0) C) C) C) 0 0
T T T T T T T T T T T T T T T N N
The county teen pregnancy rate has not changed significantly from 1985-1987 to 1998-2001;additionally the current county teen
pregnancy rate is not significantly different from the state.
3/9/05 DRAFT
Jefferson County Family Planning Clinic
I. Overview
A. The Family Planning Clinic offers unduplicated services to women in the
community between the ages of 13 - 65+ . (Services to menopausal women are
through the Breast and Cervical Health Program.)Features of the clinic include:
- Confidentiality - adolescents are able to access care without parent permission and
can sign up for Take Charge if they do not want parent's insurance to be billed.
- Comprehensive care—birth control,pregnancy tests,exams,pap smears, STD
services, counseling, education,referral
-Affordable—Take Charge can be applied for on site, sliding scale fee is offered, no
one is turned away due to the inability to pay.
- Satellite clinic in Quilcene every Wednesday
B. Advantages of the Health Department as the umbrella agency:
- Interface with other Health Department Programs(WIC,Maternity Support,
• NFP, STD/Communicable Disease for referral and care management co-ordination.
- STD services are incorporated into the family planning visit, including a
chlamydia/gonorrhea screen of every woman 24 years of age and younger as part
of the state Infertility Prevention Project.
- Promote risk reduction and disease prevention—a public health model of care
delivering current, accurate and consistent information to the target population.
C. Title X is a federal funding source which also provides guidelines for care standards.
It includes a hefty paper trail and regular audits. See attached forms
II. Scope of Care
A. Point of Entry to health care for many women in the community(75%of the
County's female population 20-24 years of age seeks women's health care services
from the Family Planning Clinic—federal law requires that women are allowed to
self select their health care.) Why are women seeking care at the FPC?
- un or underinsured—"clinic of last resort"
- confidential,comprehensive, non judgmental services
- same day appointments are available
- South County Clinic site is a convenience
•
B. Challenge for staff—Acuity of secondary problems
- Poverty
- Homelessness
- Domestic violence
- Mental health
- Drug/ETOH
- Crisis
- Other Medical/Dental needs
- Adolescent issues
Separation from family of origin, drugs/etoh, self
injury(cutting) ,abandonment, depression, suicide, date rape, domestic
violence, sexual abuse—step-parent or family member, involvement with
the legal system, school failure
III. Access to care—referrals
A. Positive aspects
- sliding scale fee available through Jefferson Healthcare
- Mash Clinic offers free medical care, good segway to mainstream care
• - Port Townsend Women's clinic is a great addition to referral options
B. Barriers
- the application process for sliding scale fee is complex and
cumbersome; feedback that financial workers have been insensitive
- lack of resources and interpreters for Hispanic clients (an ever growing
population cohort in our community)
- same day appointments are rarely available
- one practice insisted that client commit to establishing care with them
before they would accept them as a patient
- no system for identifying which practice has the soonest opening
- referrals can become hour+long advocacy sessions to get patients seen.
B. Possible 2 pronged approach
- a central triage/referral agent who is an employee of Jefferson Healthcare
- a one stop application process that includes: a DSHS assessment,access to
interpreters, forms written in Spanish(and other languages), training for
financial staff to be more sensitive to the disenfranchised.
r
Board of 3-feaCth
Netiv Business
agenda Item * 17., 3
•
200 Pu6Cic
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ment Playl
Nlarch 17, Zoos
•
SB 5700 Page 1 of 2
SENATE BILL REPORT
SB 5700
As of February 24, 2005
Title: An act relating to public health.
Brief Description: Modifying hospital district funding.
Sponsors: Senators Haugen, Parlette, Fairley, Hargrove, Delvin and Mulliken.
Brief History:
Committee Activity: Ways & Means: 2/23/05.
SENATE COMMITTEE ON WAYS & MEANS
Staff: Terry Wilson (786-7433)
Background: All real and personal property in this state is subject to the property tax each year based on its
value unless a specific exemption is provided by law. The Constitution limits the amount of property taxes
that may be imposed on an individual parcel of property without voter approval to 1 percent of its true and
fair value, or$10.00 per$1,000 of assessed value. Taxes imposed under the 1 percent limit are termed
"regular" levies.
The state levy is limited to $3.60 per$1,000 of assessed value, equalized to market value, for the support of
the common schools. The levies by the cities, counties,road districts, and junior taxing districts are limited
to $5.90 per$1,000 of assessed value. Under the $5.90 limit, public hospital districts are authorized to levy
up to $0.75 per$1,000 of assessed valuation in the district.
Total state and local levies are limited to $9.50. Several levies are authorized outside this $9.50 statutory
rate limit. If the combined rate of all levies that are imposed exceeds $10.00 per $1,000 of assessed value,
the levies over the $9.50 limit are reduced first. If the levies are still over$10.00, the levies subject to the
$5.90 limit are reduced according to statutorily set priorities.
Summary of Substitute Bill: A new state property tax is authorized at a maximum rate of$0.20 per$1,000
of assessed value beginning with taxes due in calendar year 2006 and the $0.75 regular property tax levy of
public hospital districts is eliminated beginning with taxes due in calendar year 2006.
Revenues from the new state tax levy are deposited into the public health subsidy account which is created
in the state treasury. The moneys are distributed first to public hospital districts based in their 2005 levy and
second to the Department of Health solely for the purpose of maintaining and improving local public health
services and for subsidizing emergency room care.
Substitute Bill Compared to Original Bill: The original bill was not considered.
.Appropriation: $49 million General Fund State
Fiscal Note: Available.
http://www.leg.wa.gov/pub/billinfo/2005-06/Htm/Bill%20Reports/Senate/5700.SBR.htm 3/10/2005
SB 5700 Page 2 of
Committee/Commission/Task Force Created: No.
Effective Date: Ninety days after adjournment of session in which bill is passed.
Testimony For: There is a health care crisis in this state. This is a statewide problem that needs a statewi
solution. People in hospital districts subsidize the use of their hospitals by nonresidents. This bill decrease
the tax on some and increases the tax on others. A side benefit is that the elimination of the local tax eases
proration pressures. Local resources for public health are declining because of the repeal of the motor
vehicle excise tax and increasing criminal justice costs as demand continues to rise. The recurrence of old
diseases is a sign of a deteriorating public health system. The public expects the government to protect
them. Health is a fundamental government purpose.
Testimony Against: None.
Who Testified: PRO: Senator Mary Margaret Haugen, prime sponsor; Rick Mockler, WA State Assoc. of
Local Public Health Officials; Vicki Kirkpatrick, WA State Assoc. of Counties; Jeff Mero, WA State Assoc.
of Public Hospital Districts, State Public Health Assoc.
•
•
http://www.leg.wa.gov/pub/billinfo/2005-06/Htm/Bill%20Reports/Senate/5700.SBR.htm 3/10/2005
•
•
Department of Revenue Fiscal Note
!II Number: 5700 SB Title: Public health Agency: 140-Department of
Revenue
Part I: Estimates
0 No Fiscal Impact
Estimated Cash Receipts to:
FUND FY 2006 FY 2007 2005-07 2007-09
NEW-State 67,080,000 134,288,000 201,368,000 293,244,000 329,684,000
01 -Taxes 50-Property Tax
Total$ 67,080,000 134,288,000 201,368,000 329,684,000
Estimated Expenditures from:
FY 2006 FY 2007 2005-07 2007-09 2009-11
FTE Staff Years 0.8 0.1
Fund 0,5 0.1 0.1
GF-STATE-State 001-1 68,100 7,300 75,400 14,600 14,600
Total$ 68,100 7,300 75,400 14,600 14,600
III
The cash receipts and expenditure estimates on this page represent the most likely fiscal impact. Factors impacting the precision of these estimates,
and alternate ranges(fappropriate),are explained in Part II.
Check applicable boxes and follow corresponding instructions:
JIf fiscal impact is greater than$50,000 per fiscal year in the current biennium or in subsequent biennia,complete entire fiscal note
form Parts I-V.
0 If fiscal impact is less than$50,000 per fiscal year in the current biennium or in subsequent biennia,complete this page only(Part I).
0 Capital budget impact,complete Part IV.
X� Requires new rule making,complete Part V.
Legislative Contact: Terry Wilson Phone:(360)786-7433 Date:
02/07/2005
Agency Preparation: Margaret Knudson Phone:360-570-6082 Date:
02/21/2005
Agency Approval: Kim Davis Phone:360-570-6087 Date:
02/21/2005
ii;OFM Review: Doug Jenkins Phone:360-902-0563 Date: 02/21/2005
Request# 5700-1-1
Form FN(Rev 1/00) 1 Bill# 5700 SB
T
Part II: Narrative Explanation
II.A-Brief Description Of What The Measure Does That Has Fiscal Impact •
Briefly describe,by section number,the significant provisions of the bill,and any related workload or policy assumptions,that have revenue or
expenditure impact on the responding agency.
Section 1 creates a new state levy of up to 20 cents for the newly created public health subsidy account in the state
treasury that will be distributed: (1)to public hospital districts;and(2)to the Department of Health solely to maintain and
improve public health services and to subsidize emergency room care. This levy is assessed on all taxable property within
the state adjusted to the state equalized value with the indicated ratio fixed by the Department of Revenue.
Section 2 requires the state treasurer to distribute,beginning in CY 2006, from the public health subsidy account to public
hospital districts with a regular levy in calendar year 2005,55 percent of taxes collected by the public hospital district on
June 1 and 45 percent of the taxes collected on December 1. For CY 2007 and thereafter,the distributions shall equal the
distributions from the previous year increased by the increase in the state property tax for the public health subsidy
account.
Section 3 states that the first state levy made for this account is not subject to the limit factor in RCW 84.55.010.
Section 4 amends RCW 70.44.060,which outlines all the powers of public hospital districts. The language authorizing the
two existing levies by such districts is deleted. To raise revenue,the public hospital district may levy an excess levy
exceeding the constitutional limit of 1 percent for a one year period to be used for operating or capital purposes with voter
approval pursuant to RCW 84.52.052 and Article VII,section 2(a),and for the retirement of voter-approved general
obligation bonds, issued for capital purposes only,by levying bond retirement property tax levies.
Section 5 amends RCW 84.52.010, which contains the constitutional 1 percent limit and the prorationing order for
reducing levies when this limit is exceeded,by deleting all references to levies made by public hospital districts.
Section 6 amends RCW 84.52.043 to include the new state levy of up to 20 cents for the public health subsidy account as a •
senior taxing district on par with the state school levy.
Section 7 amends RCW 84.52.068 by adding a reference to RCW 84.52.065 to specifically order the distribution of the
proceeds of the state school levy.
Section 8 orders the state treasurer to make two appropriations from the public health subsidy account for distribution to
public hospital districts: (1)$21 million(or as much thereof as may be necessary)for the fiscal year ending June 30,2006;
and(2)$17 million(or as much thereof as may be necessary)for the fiscal year ending June 30,2007.
Section 9. This act applies to taxes levied for collection in 2006 and thereafter.
II.B-Cash receipts Impact
Briefly describe and quantify the cash receipts impact of the legislation on the responding agency, identifying the cash receipts provisions by section
number and when appropriate the detail of the revenue sources. Briefly describe the factual basis of the assumptions and the method by which the
cash receipts impact is derived Explain how workload assumptions translate into estimates. Distinguish between one time and ongoing functions.
ASSUMPTIONS/DATA SOURCES
This bill has no impact on the general fund. It is a statewide levy and the revenues are to be deposited into the newly
created Public Health Subsidy Account(PHSA). The estimated levy amount is calculated by using the statewide market
value of all taxable property within the state as directed in the bill and applying a 20 cent levy per$1,000 of value.
Distributions to public hospital districts are to be made by the Office of the State Treasurer from the PHSA in amounts
directed by the Department. The 2006 distribution is based on the actual regular levy amounts for hospital districts for
taxes due in 2005. •
Request# 5700-1-1
Form FN(Rev 1/00) 2 Bill# 5700 SB
f
CURRENTLY REPORTING TAXPAYERS (Impact for taxpayers who are known or estimated to be currently paying the
tax in question)
ilkis proposal has no impact on the state property tax levy.
This legislation creates a new statewide levy of 20 cents per$1,000 of assessed value and creates a new fund. This bill
replaces local hospital district regular levies. It is outside the$5.90 limitation so no local taxing districts would be
harmed. In replacing the local hospital district levies with a statewide levy there is a partial shift from those property
owners in hospital districts to those property owners not in a hospital district. Hospital districts may levy up to 75 cents,
though the average rate for levies due in 2004 was$0.415 per$1,000 of assessed value. This bill asks for a 20 cent levy.
On a$150,000 home,the impact would be$30 per calendar year starting in 2006. The intent is to hold harmless current
hospital districts with distributions from the new PHSA fund. As this levy is outside the$5.90 limitation, it may open
levy room for other local districts that have been prorated under the$5.90 cap.
TOTAL REVENUE IMPACT:
State Government(cash basis,$000):New account:Public Health Subsidy Account
FY 2006- $ 67,080
FY 2007- $ 134,288
FY 2008- $ 142,262
FY 2009- $ 150,982
FY 2010- $ 160,041
FY 2011 - $ 169,643
Local Government, if applicable(cash basis,$000): See narrative above.
II.C-Expenditures
Onefly describe the agency expenditures necessary to implement this legislation(or savings resulting from this legislation),identifying by section
ber the provisions of the legislation that result in the expenditures(or savings). Briefly describe the factual basis of the assumptions and the
method by which the expenditure impact is derived. Explain how workload assumptions translate into cost estimates. Distinguish between one time
and ongoing functions.
The Department will incur implementation costs of$68,100 in FY 2006 and$7,300 in FY 2007,for a biennium total of
$75,400.
FY 2006 costs include:
1.0.2(rounded)FTE representing 400 hours at the Financial Analyst 5 level to create and provide training for the new
payments and distributions process,to test new tracking systems,to create new forms,and to reconcile property tax levy
data.
2.0.1 (rounded)FTE representing 98 hours at the Financial Analyst 3 level to record and process property tax payments and
to review and reconcile tax distributions.
3. 0.01 FTE representing 24 hours at the Financial Analyst 1 level to key and process payments and distributions
documents.
4.0.3 (rounded)FTE representing 600 hours at the Information Technology Applications Specialist 4 level to develop and
update existing programs to aid in the payment tracking and distribution process.
5.$22,900 for rule amendments using the expedited rulemaking process. These costs include FTE time,printing,and
mailing.
FY 2007 costs include:
1.0.1 (rounded)FTE representing 110 hours at the Financial Analyst 5 level to reconcile levy data and to coordinate and
update information between other agencies.
2.0.04 FTE representing 84 hours at the Financial Analyst 3 level to record and process payments and to review and
reconcile distributions.
0 0.01 FTE representing 24 hours at the Financial Analyst 1 level to key and process payments and distributions
Request# 5700-1-1
Form FN(Rev 1/00) 3 Bill# 5700 SB
1
documents.
The Department anticipates incurring ongoing costs of$14,600 in the 2007-09 Biennium and$14,600 in the 2009-11 •
Biennium. Ongoing costs are associated with FTE costs described in FY 2007, items 1-3.
Without an appropriation to cover the expenditure impact,the Department may not be fully able to implement the
legislation.
Part III: Expenditure Detail
III.A-Expenditures by Object Or Purpose
FY 2006 FY 2007 2005-07 2007-09 2009-11
FTE Staff Years 0.8 0.1 0.5 0.1 0.1
A- 41,000 5,200 46,200 10,400 10,400
B- 10,300 1,300 11,600 2,600 2,600
E- 11,500 800 12,300 1,600 1,600
J- 5,300 5,300
Total$ $68,100 $7,300 $75,400 $14,600 $14,600
III.B-Detail: List FTEs by classification and corresponding annual compensation. Totals need to agree with total FTEs in Part I
and Part IIIA
Job Classification Salary FY 2006 FY 2007 2005-07 2007-09 2009-11
FINANCIAL ANALYST 1 31.032 0.0 0.0 0.0 0.0 0.0
FINANCIAL ANALYST 3 42,58$ 0.1, 0.0 0.1 0.0 0.0
FINANCIAL ANALYST 5 49.380 0.2 0.1 0.1 0.1 0.1
HEARINGS SCHEDULER 31.032 0.0 0.0
INFO TECH APP SPEC 4 51.864 0.3 0,2
RULES MANAGER 69,500 0.0 0.0
RULES POLICY SPECIALIST 68.600 0.0 0.0
TAX POLICY SPECIALIST 3 58.656 0.1 0.1 III
Total FTE's 0.8 0.1 0.5 0.1 0.1
Part IV: Capital Budget Impact
NONE.
Part V: New Rule Making Required
Identif provisions of the measure that require the agency to adopt new administrative rules or repeal/revise existing rules.
Should this legislation become law,the Department would need to amend WAC 458-19-005-Property tax levies,rates,and
limits definitions; WAC 458-19-070-Property tax levies,rates,and limits procedure to adjust consolidated levy rate for
taxing districts when the statutory aggregate dollar rate limit is exceeded; WAC 458-19-075-Property tax levies,rates,and
limits constitutional one percent limit calculation;and WAC 458-19-550-Property tax levies,rates,and limits state levy--
apportionment between counties. Each of these rules would need to be amended using the expedited rulemaking process.
Persons affected by this legislation include all owners of Washington State property and any individuals required to pay
Washington State property taxes.
•
Request# 5700-1-1
Form FN(Rev 1/00) 4 Bill# 5700 SB
r
LOCAL GOVERNMENT FISCAL NOTE
Department of Community, Trade and Economic Development
ill Number: 5700 SB Title: Public health
Part I: Jurisdiction-Location,type or status of political subdivision defines range of fiscal impacts.
Legislation Impacts:
0 Cities:
0 Counties:
DSpecial Districts: Public hospital districts
0 Specific jurisdictions only:
0 Variance occurs due to:
Part II: Estimates
0 No fiscal impacts.
0 Expenditures represent one-time costs:
0 Legislation provides local option:
0 Key variables cannot be estimated with certainty at this time:
Estimated revenue impacts to:
IIndeterminate Impact I
timated expenditure impacts to:
Indeterminate Impact
Part III: Preparation and Approval
Fiscal Note Analyst: Linda Kercher Phone: 360-725-5038 Date:
02/07/2005
41;
Leg.Committee Contact: Terry Wilson Phone: (360)786-7433 Date: 02/07/2005
gency Approval: Louise Deng Davis Phone: (360)725-5034 Date:
02/23/2005
FM Review: Doug Jenkins Phone: 360-902-0563 Date: 02/23/2005
Page 1 of 3 Bill Number: 5700 SB
Part IV: Analysis
A. SUMMARY OF BILL
Provide a clear, succinct description of the bill with an emphasis on how it impacts local government. •
Sec. 1 creates a new state levy of up to 20 cents for the newly created public health subsidy account in the state treasury that will be
distributed to public hospital districts and to the Department of Health to maintain and improve local public health services and to subsidize
emergency room care.
Sec.2 requires the state treasurer to distribute,beginning in CY 2006,from the public health subsidy account to public hospital districts with
a regular levy in calendar year 2005,55 percent of taxes collected by the public hospital district on June 1 and 45 percent of the taxes
collected on December 1.For CY 2007 and thereafter,the distributions shall equal the distributions from the previous year increased by the
increase in the state property tax for the public health subsidy account.
Sec.3 states that the first state levy made for this account is not subject to the limit factor in RCW 84.55.010.
Sec.4 amends RCW 70.44.060,which outlines all the powers of public hospital districts.The language authorizing the two existing hospital
district levies is deleted.The section authorizes public hospital district to levy an excess levy exceeding the constitutional limit of 1 percent
for a one-year period to be used for operating or capital purposes with voter approval,and for the retirement of voter-approved general
obligation bonds,issued for capital purposes only,by levying bond retirement property tax levies.
Sec.5 removes references to public hospital districts from RCW 84.52.010,which contains the constitutional 1 percent limit and the
prorationing order for reducing levies when this limit is exceeded.
Sec.6 amends RCW 84.52.043 to include the new state levy of up to 20 cents for the public health subsidy account as a senior taxing district
on par with the state school levy.
Sec.7 amends RCW 84.52.068 by adding a reference to RCW 84.52.065 to specifically order the distribution of the proceeds of the state
school levy.
Sec.8 orders the state treasurer to make two appropriations from the public health subsidy account for distribution to public hospital
districts:(1)$21 million(or as much thereof as may be necessary)for the fiscal year ending June 30,2006;and(2)$17 million(or as much.
thereof as may be necessary)for the fiscal year ending June 30,2007.
Sec.9 provides that the act applies to taxes levied for collection in 2006 and thereafter.
B. SUMMARY OF EXPENDITURE IMPACTS
Briefly describe and quanta the expenditure impacts of the legislation on local governments, identifying the expenditure provisions by
section number, and when appropriate, the detail of expenditures. Delineate between city, county and special district impacts.
Counties could incur an expenditure impact for implementing the bill,but the cost is indeterminate at present(see below).
The potential expenditure impact to county assessors could result from computer reprogramming.This cost can be based on a flat fee(often
subject to a minimum amount),or an hourly rate for work required.The cost would vary according to the work performed in each
jurisdiction.
C. SUMMARY OF REVENUE IMPACTS
Briefly describe and quantify the revenue impacts of the legislation on local governments, identifying the revenue provisions by section
number, and when appropriate, the detail of revenue sources. Delineate between city, county and special district impacts.
The local revenue impact under this bill is indeterminate.However,local revenue gains are anticipated from(1)distributions from the public
health subsidy account,and(2)with the creation of more taxing potential for local government that occurs by removing the hospital levy
from the local regular levy.
Distributions from the Public Health Subsidy Account:
Revenue collected under the new state levy for public hospital districts is to be deposited into the public health subsidy account.The bill
directs this revenue to be distributed to public hospital districts,and secondarily,to the department of health for maintaining and improving
local public health services and subsidizing emergency room care.While reported as impact to state revenue on DOR's fiscal note,
distributions from the new account would ultimately impact local governments in the form of revenue gain for public hospital districts.
According to the Washington State Association of Counties(WSAC),public hospital districts are locally constituted and have a local board
of directors.Additionally,distributions through the Department of Health(DOH)made to improve local public health would impact local
government.According to WSAC,these funds distributed through DOH will go to either county health departments or public health districts
Page 2 of 3 Bill Number: 5700 SB
created by counties.
New state levy:
The bill creates a new state levy of 20 cents per$1,000 of assessed value to fund the public health subsidy account,which the bill also
*'reates in Sec. 1.This state levy replaces the local hospital district regular levies.As the new state levy is outside of the$5.90 limitation on
al regular levies under RCW 84.52.043,the bill may open levy room for other local districts whose levies have been prorated under the
5.90 cap,according to DOR. This is not expected to impact cities and counties,but is more likely to impact junior taxing districts that are
first subject to levy prorationing when aggregate levies for local junior and senior taxing districts exceed the$5.90 limit.Under current law,
hospital districts may levy up to 75 cents,and the average rate for levies due in 2004 was$0.415 per$1,000 of assessed value,according to
DOR.
NOTE:While the bill may open up room for junior taxing districts under the$5.90 limitation,prorationing may still occur under the I
percent constitutional limit.The bill removes reference to hospital districts from RCW 84.52.010,which contains the constitutional 1 percent
limit and the prorationing order for reducing levies when this limit is exceeded.This moves hospital districts to the last category of levies
(the state levy)subject to prorationing under the constitutional 1 percent limit.
SOURCES
Department of Revenue Fiscal Note for SB 5700
Washington State Association of Counties
Washington Association of County Officials
Association of Washington Cities
Department of Revenue Tax Reference Manual 2002
•
i
Page 3 of 3 Bill Number: 5700 SB
I
•
PUBLIC HEALTH FINANCING FOR THE 21ST CENTURY
Adopted by the Public Health Improvement Partnership
February 23, 2005
This White Paper informs state policy makers and funders of the important role of
governmental public health in Washington State and the urgent need to invest more of
our health care dollars in public health. It is prepared by members of the Committee on
Finance for the Public Health Improvement Plan.
People in Washington want a strong and vital public health system. They count on the
governmental public health system for protection from disease and environmental
threats. In a 2003 survey, 96%of residents rated public health as important.
• But the 2002 Public Health Improvement Plan identified fundamental problems in the
way we finance our public health system: 1)public health is persistently under funded; 2)
funding for core services is eroding; 3)public health protection is inconsistent across the
state; and 4) categorical restrictions on funds serve as barriers to responding to many
community needs. Now is the time, before we experience a large-scale health threat, to
take a leadership role in strengthening public health protection equally across all
communities. In this paper, we propose a system-wide approach to providing stable and
secure funding for public health.
Introduction
Our public health professionals have maintained and improved our public health system
for nearly 100 years, improvements made possible by the investments in public health
secured by state leadership. But over the past several years, these investments have
dwindled as the system has faced new challenges. We have experienced new and deadly
• infectious diseases such as AIDS and SARS, the re-emergence of traditional public health
1
threats such as tuberculosis and whooping cough, and the threat of bioterrorism. •
Washington's investment in its public health system has not kept up with these increasing
demands, and our citizens are vulnerable.
How the Public Health System Works
The public health system in the United States has, since 1900, achieved stunning gains in
preventing early mortality and extending life expectancy. These gains did not occur, for
the most part,because of miracle cures and advances in medicine but through public
health activities such as providing a clean water supply, ensuring the safety of foods, and
preventing communicable disease. Government public health agencies play a key role in
this broad effort, and in their work to keep our communities healthy and safe, they
collaborate with a range of partners that include hospitals, local providers, voluntary
health organizations (such as the heart and lung associations), community health centers,
professional and community-based organizations, and colleges and universities.
The governmental public health system and the private medical system depend upon each
other to be successful, and their respective responsibilities continually intersect. The
governmental public health system:
• Identifies diseases that are the leading causes of death and illness, and learns the
causes and methods of disease transmission,
• Finds methods to prevent or control diseases and injuries,
• Provides "population-based"prevention and disease control services, through
legislation,policy and education,
• Monitors and reports on health trends (statistics) and collects and disseminates health
data on vital statistics,health status, incidence of infectious diseases, incidence of
health problems and risks, health behaviors, environmental health concerns, and the
availability and quality of health care services,
• Conducts primary prevention,which reduces susceptibility or exposure to health
threats, and
• Provides health education and training.
i
2
In Washington State, the governmental public health system consists of the State
Department of Health, the State Board of Health, and 35 local health jurisdictions. The
State Department of Health works to preserve and improve the health of the public,
maintains standards for quality in health care delivery, and provides funding, support and
assistance in delivery of local services. The local health jurisdictions, which perform the
bulk of public health activities in Washington, ensure that public health prevention and
protection services are in place in all our communities. The State Board of Health is an
independent, 10-member citizen board appointed by the Governor that provides a citizen
forum for public health policy development and sets public health policy.
By contrast, the private medical system addresses most of its activities to individuals,
rather than communities. Its focus is on:
• Diagnosing illness and disease conditions,
• Providing treatment on an individual basis,
• Reporting any unusual cases or suspicious cluster of cases to public health,
• Implementing best-practice interventions
• Publishing cases of interest in professional medical journals,
• Issuing professional medical practice guidelines.
The private medical system relies on the public health system to analyze health
information and provide feedback on the types of diseases to look for and the best way to
prevent or treat them. One example of how this relationship works in practice can be
seen in the response of both systems to the emergency of HIV/AIDS in the early 1980s.
Public health experts first learned of the new"mysterious"disease when private
providers, searching for answers, contacted the U.S. Centers for Disease Control and
Prevention(CDC). The federal agency initiated an extensive epidemiological study to
determine who was becoming ill and what was causing the strange symptoms. Although
it took several years to fully answer the questions, within a very short time,public health
experts were able to identify the disease as an infectious breakdown of the immune
system and were able to describe its mode of transmission. Medical providers and public
S
3
health policy makers were quickly given the critical information they needed to help
•prevent the spread of the deadly disease.
On a smaller scale, Washington's governmental public health system conducts statewide
data collection and analysis and provides reports on statewide and local disease trends to
our medical providers, facilities, and labs on a regular basis. Washington public health
experts work closely with private medical providers and health plans to improve chronic
disease management and to reduce tobacco use among pregnant women. These
combined efforts have paid off in terms of healthier behavior—leading to improved
health outcomes for patients.
To make sure that the collaboration of our public health system and private medical
providers works effectively, we must invest resources rationally in both systems. Medical
care is important,but it is expensive. Public health disease prevention and health
promotion efforts can help mitigate the high costs of medical care by keeping people
healthier and safer to begin with. These population-based programs cost less than the
•
treatment services required when prevention opportunities are absent. When disease
outbreaks do occur,public health professionals are the investigative lead team,
interviewing ill individuals, reviewing health records, and working closely with the state
Public Health Laboratory and health care providers to identify the cause of the outbreak
quickly and stop it in its tracks.
Unfortunately, the way we spend on health in general does not reflect the inter-
connectedness of these two systems or the important contribution made by governmental
public health. A 2004 report by the United Health Foundation ranks Washington State
39th in the nation for per capita public health spending and 44th for the share of total
health dollars spent on public health. According to this study, only 2% of our total
health care expenditures are invested in our public health system, even though public
health services directly affect the health of our residents. According to the same study,
America's Health: State Health Rankings,United Health Foundation,American Public Health a
Association,2004.
4
Minnesota has the best overall health of any state in the nation. That state spends 17% of
1111 its health dollars on public health, compared to Washington State's 2%.
Local Pressures on Public Health Spending
Several trends are undermining funding for Washington's public health system,which
relies of funds from local, state, and federal sources. The most significant of these trends
is local. Across Washington,public health is funded in a piecemeal fashion,with every
local county setting its own spending levels. Historically, the counties and their city
partners have paid for core public health activities such as water protection, food safety,
and communicable disease control and prevention. State money,made up of both state
and federal funds, is added to provide special categories of services. When county
budgets come under pressure and local funds for public health decline, the impact is felt
in basic operational budgets—not the state -funded special programs. Adding to the
problem is that locally funded public health programs must compete for county dollars
• with programs with highly specific mandates. During the past 20 years, criminal justice
spending by counties has increased from 50%to 70%of county general fund spending,
leaving little or no money for public health. Over time, this trend creates lopsided
services and leaves counties without basic resources for disease control, environmental
health protection, and health education.
No one can see what is happening to these services system-wide because all of the
decisions are made in separate local budget processes. We have no policies in place to
assure an acceptable level of public health funding across the state. Nor do we have any
mechanism to strengthen our public health system when weaknesses are identified.
There is no minimum level of funding established for local public health protection,nor
is there a minimum amount per citizen from the state or local governments and no
commitment to systemic investments in protection.
Public policies have been unsuccessful, over the long-term, in addressing the chronic
under-funding for core public health services at the local level. Washington has had no
5
dedicated funding for public health protection since 1976, when state legislators repealed
II!the dedication of a portion of the property tax that had been set aside for general public
health and tuberculosis control. Recognizing the need for stable public health funding, the
Washington Legislature in 1993 allocated a portion of the Motor Vehicle Excise Tax
(MVET)to support public health,while at the same time releasing cities from funding
responsibility. (Ironically, the new source provided$7 million less in funding than the
cities would have contributed had they still been required to participate, and this was
provided through a series of special appropriations.) In 2000, the MVET revenue source
was repealed. Although the Legislature restored 90% of the lost funds to public health,
resources were still short by more than$2.5 million a year.
Threats and Consequences of Under-funding Public Health
We are already seeing evidence of weakness in our system. Because our rates of
immunization are not as high as they need to be to provide immunity to our growing and
increasingly diverse public, Washington has begun experiencing repeated breakthrough
cases of vaccine-preventable diseases such as whooping cough and measles. In 2003,
•
Seattle had the highest number of whooping cough(also known as pertussis)cases
among infants in 25 years, and more than 800 cases occurred statewide. During 2004,
two Seattle-area hospitals experienced outbreaks.
During 2003, Seattle public health experts scrambled to stop a large outbreak of resistant
TB among its homeless population. The outbreak of 44 cases required additional staff
and funds to carry out intensive screening and testing of high-risk individuals to control
the outbreak among the homeless population and minimize exposing others in the
community.
Infectious diseases have not disappeared. In fact, they are back with a vengeance. Public
health threats to our citizens are constantly changing, and our public health system is not
positioned to counter such threats throughout the state. In recent years,public health
experts have identified and developed prevention interventions for several new and
emerging deadly diseases, including AIDS,Hantavirus, SARS, and West Nile Virus. In
6
addition, there are now bacteria that are resistant to many, if not all, of the antibiotics in
• our arsenal. Some of the old diseases that we thought to be conquered—including TB,
syphilis, and malaria—have re-emerged stronger, more dangerous, and resistant to
multiple antibiotics And since 2001, we have recognized a new threat in bioterrorism.
Suddenly,public health agencies became the first line of defense against terrorist attacks,
using smallpox or anthrax as weapons.
An increasingly mobile world population helps diseases to travel further and faster than
ever before. A single outbreak of any one of the many emerging diseases, occurring
anywhere in the world, can have a severe impact on residents of Washington State. The
human toll, in terms of the suffering, loss of life, and the economic impact of illness on
families, is devastating when these outbreaks occur. These outbreaks also deliver a
sudden and crushing blow to the economies of communities. For example, a SARS
outbreak in China spread to Toronto within weeks. The inability of Toronto's public
health system to contain the outbreak led to widespread fear, which effectively shut down
• the city. When it was all over, 438 probable and suspect cases of SARS and 44 deaths
were reported. The economic impact was estimated to be $1 billion in lost revenue from
tourism, transportation, and retail trade.
The next major threat may be looming in the form of avian flu. Public health scientists
believe that a flu pandemic–a widespread epidemic with global consequences–could
spread quickly in today's mobile societies and that millions worldwide could die within
weeks. Experts have reported isolated cases of human to human transmission of the virus
and are closely watching it for mutations that will lead to a global pandemic. The virus
has already killed 12 people in Vietnam in 2005.
Our environment will not remain constant, and we cannot assume that our current level of
services will protect us from unforeseen events such as the ones experienced in Toronto
and Southeast Asia. These threats are real but difficult to predict. It is not a matter of if
we will be hit by a new disease it is a matter of when. Investments made now to prevent
7
and minimize the impact of these events will be less expensive and more effective if we •
make them now—before a crisis occurs.
The Public Supports and Expects Public Health Protection
A recent survey2 showed that Washingtonians place a high premium on public health and
its role in their lives. They believe that public health is a governmental responsibility and
are willing to pay for it. When asked how important local public health departments and
districts are to Washington State, 96%responded, "extremely important"or"somewhat
important." When asked if they believe local public health departments and districts are
adequately funded, and if they would support or oppose a ballot measure to increase
funding for public health, 53%percent said local public health is "not adequately
funded," and 52% said they would"strongly support" or"somewhat support" a ballot
measure to increase funding.
The need for dedicated Public Health Funding
What our public health system needs is dedicated funding. There are viable options for
•
statewide dedicated funding for public health protection, including:
• Setting aside a portion of an existing tax,
• Lifting exemptions from an existing tax, and
• Establishing a tax on insurance premiums
These dedicated funds would be used to fortify and maintain fundamental public health
protection activities. Following is a summary of ways we could invest dedicated
resources:
• Improving our disease—tracking and monitoring systems
One of public health's best weapons against all health threats is having a sensitive
disease tracking system in place. It is through ongoing surveillance that public health
professionals get the first inkling of trouble. To be effective,the system must be
operational throughout the state. To be successful, it must be operated by trained and
•
2 Washington State Public Health Association,April 18,2003,Evans/McDonough Company Inc.
8
• prepared public health staff. A good tracking and response system must also include
the secure technology for sharing information and maintaining strong lines of
communication among local, state, and federal public health agencies; between public
health and the health care system; and among public health agencies and other
governmental agencies. Because of the threat of bio-terrorism,partners must also
include the Department of Homeland Security and state and local law enforcement.
Protecting the public's health today depends on having a seamless state and local
system that provides consistent and relentless monitoring and rapid response to all
potential threats—bacterial, viral, and man-made. To achieve this constant level of
alertness and responsiveness requires a long-term investment at both the state and
local levels.
• Improving our immunization rates
Immunization is one of public health's most powerful defenses against
infectious disease; the CDC estimates that childhood immunizations prevent
about 10.5 million cases of disease and 35,000 deaths a year nationwide.
But Washington could be more effective in this area. Our state experienced
more than 800 cases of pertussis in 2003, and in 2004, experienced several
outbreaks of whooping cough and one outbreak of measles. According to the CDC,
pertussis cases in 2004, nationwide and in Washington, exceeded historical rates3. All of
these cases would have been prevented if people had been immunized.
• Strengthening our food and drinking water programs
Our food and water supplies, if not closely monitored, offer the greatest potential for
large-scale outbreaks such as a recent cryptosporidiosis outbreak in Milwaukee,
which affected 403,000 residents, and a hepatitis A outbreak in Pittsburgh. The cost
associated with the cryptosporidiosis outbreak alone was $96.2 million. All
Washington residents benefit when our food and drinking water are monitored on a
'Notifiable Diseases/Deaths in Selected Cities Weekly Information,MMWR November 19,2004153(45);
1073-1081.
• a Corso,Phaedra S.,et al, Cost ofIllness in the 1993 Waterborne Cryptosporidium Outbreak,Milwaukee,
Wisconsin.Emerging Infectious Diseases Vol 9,No.4,April 2003.
9
regular schedule. And they all benefit when restaurants are inspected regularly and •
their workers receive training in safe food handling.
• Training our public health workforce
All Washington residents rely on the specialized expertise of our public health
workforce when health threats occur. To be effective, they must be trained in the
latest emergency response protocols, including infectious disease and bio-terrorism
investigations. They must know how to coordinate with appropriate other state and
local partners in the event of a public health emergency. Training must change as
public health threats change and our staff must receive periodic training to maintain
their expertise and readiness to deploy. This type of training must be available in all
areas of the state.
• Providing equal public health protection across the state
Public health protection is not equal across all 39 counties within Washington State.
And in common with many systems, our public health system is as vulnerable as its
weakest point. Recognizing this, the Department of Health and its partners have
developed a set of public health standards that clearly define what every citizen has a
right to expect of Washington's public health system. The standards allow us to
evaluate how well each local public health jurisdiction is providing public health
protection. By conducting periodic assessments, and working with a commitment to
investing adequately to maintain our public health system, we can eliminate its
weaknesses.
The Time to Act
Today, Washington's public health system is equipped to evaluate, on a regular basis,
where public funds are needed,what they are buying, and how well they are being spent.
Our state and local public health experts have been working to build accountability into
our public health system. This work encompasses two important activities:
• setting standards to measure performance for all the public health agencies in the
state and to ensure a level of protection all citizens can count on; and •
10
• measuring the health of all Washingtonians on more than 50 health "indicators"to
411 improve health outcomes through population-based health promotion and disease
prevention activities.
Together, the standards and key health indicators work provides Washington health
policy makers with information on the operational "health"of the system as well as the
effectiveness of public health interventions.
Our citizens expect and deserve equal public health protection across all parts and regions
of Washington State, whether rural or urban, coastal or inland. It is not an unreasonable
expectation, but it is one that cannot be met under current funding. Money spent on
population-based activities has consistently yielded measurable improvements in the
health of Washingtonian residents. Our world has changed dramatically over the past
several years, and public health has an even greater responsibility for protecting the
public. Not only must we monitor public health threats within our state border,but we
must also monitor health threats occurring throughout the world—diseases that are only a
day's journey away. We must upgrade our technology. We must train our public health
workforce to handle the new threats. Washington's success or failure in managing future
public health crises hinges upon having reliable and sufficient funding. It is time for our
state's leadership to make a new investment in public health.
For more information, contact:
Tim McDonald, Co-Chair, PHIP Finance Committee
Director, Island County Public Health and Human Services, (360) 679-7350
Lois Speelman, Co-Chair, PHIP Finance Committee
Assistant Secretary, Office of Financial Services, Department of Health,
(360)236-4503
Donna Russell,PHIP Finance Committee Staff
Health Services Analyst,Public Health Systems Planning and Development,
Department of Health(360)280-8526
•
11
•
Board of HeaCth
Netiv Business
.agenda Item # 17., 4
• Legislative Zlpdate
March 17, 2005
•
4.
Status of Priority Bills of Interest to WSALPHO
After March 2, 2005 Policy Committee Cutoff
The Bad News
• Good Bills that Died (Priority 1 or 2):
HB 1052—Creating the Prevention Quality Council.
HB 1427—Ordering a public information campaign on postpartum depression
HB 1473 —Safe Storage of firearms
HB 1705—Regarding medical assistance and physician recruitment
HB 1714—Prohibiting smoking in public places
HB 1889—Requiring the disclosure of gifts made by pharmaceutical manufacturers
to persons who prescribe prescription drugs
HB 1892—Recycling of waste tires
HB 2067—Establishing a legislative/executive task force on health care access, delivery
and financing
SB 5306—Regarding Sexual health education
SB 5342—Encouraging safe storage of firearms
SB 5450—Mental Health Parity
SB 5592—Prohibiting smoking in public places
SB 5725 —Establishing the joint public health financing committee
SB 5731 —Requiring seat belts on school buses
Bad Bills Still Alive (Priority 1 or 2):
HB 1370—Allowing intermediate drivers to carry unrelated underage passengers
HV 1807—Restricting motorcycle helmet requirements only to persons under twenty-one
SB 5305 —Prohibiting vaccinating pregnant women and children with mercury-
containing vaccines.
SB 5783 —Restricting motorcycle helmet requirements only to persons under twenty-one
SB 5909—Revising regulation of indoor smoking for the purpose of protecting minors
and public health.
The Good News
Bad Bills that Died (Priority 1 or 2):
HB 1109—Modifying designated smoking area requirements.
HB 1253 —Modifying designated smoking area requirements.
HB 1433 —Establishing parental notification requirements for abortion
HB 1559—Modifying designated smoking area requirements.
HB 1562—Prohibiting partial birth abortions.
HB 1656—Defining abstinence education and comprehensive sex education for K-12
students.
HB 1670—Revising regulation of indoor smoking for the purpose of protecting
minors and public health
HB 1776—Prohibiting public funding of abortion
HB 2093 —Protecting an unborn quick child from harm by the use of alcohol or any
illicit drug
HB 2095 —Authorizing the use of pharmaceutical birth control or tubal ligation in cases
of children born alcohol or drug-affected
• HB 2139—Requiring parental consent for students to participate in sex education
4.
Status of Priority Bills of Interest to WSALPHO
After March 2, 2005 Policy Committee Cutoff
HB 2177—Requiring toxic mold testing in schools
HB 2201 —Prohibiting vaccinating pregnant women and children with mercury-
containing vaccines
HB 2231 —Protecting the unborn
SB 5478—Defining abstinence education and comprehensive sex education for
K-12 students
SB 5821 —Establishing parental notification requirements for abortion
SB 5836—Requiring a report of pregnancy termination be provided to birth mother
and biological father and kept by department of health
SB 5852—Prohibiting public funding of abortion
Good Bills Still Alive (Priority 1 or 2)
HB 1107—Providing for early intervention services for children with disabilities
HB 1152—Creating a Washington early learning council
HB 1154—Mental Health Parity
HB 1282—Regarding sexual health education
HB 1441 —Providing access to health insurance for children
HB 1475 —Modifying child passenger restraint provisions
HB 1482—Revising provisions on child abuse and neglect
HB 1494—Requiring a work group to assess school nursing services in class 1 school
districts
HB 1516—Increasing access to health services for children through the "kids get care"
service delivery model
HB 1534—Identifying health care providers covered by the retired health care provider
liability malpractice insurance program
HB 1536—Providing the secretary of health with authority to administer grants
HB 1593 —Funding farmers market nutrition programs
HB 1663 —Creating the prevention and intervention investment council
HB 1737—Establishing the joint public health financing committee
HB 1818—Providing funding for local public health obligations
HB 1850—Creating a retired volunteer medical worker license
HB 1939—Concerning well construction
HB 2038—Enacting a complete statewide smoking ban in public places
HB 2085 —Regarding the cleanup of waste tires
HB 2105 —Including Hood Canal in the on-site sewage grant program
HB 5048—Prohibiting tobacco product sampling
SB 5141 —Providing for early intervention services for children with disabilities
SB 5149—Requiring the disclosure of gifts made by pharmaceutical manufacturers
to persons who prescribe prescription drugs
SB 5186—Increasing the physical activity of the citizens of Washington State
SB 5420—Modifying restrictions on children riding motorcycles
SB 5494—Identifying health care providers covered by the retired health care provider
liability malpractice insurance program
SB 5495 —Providing the secretary of health with authority to administer grants
SB 5597—Funding farmers market nutrition programs
SB 5637—Creating the "Health Care Responsibility Act"to expand access to health i
Status of Priority Bills of Interest to WSALPHO
After March 2, 2005 Policy Committee Cutoff
insurance coverage
• SB 5700—Modifying hospital district funding
SB 5703—Regarding medical assistance and physician recruitment
SB 5831 —Concerning well construction
SB 5895 —Increasing coordination between the Puget Sound Action recovery
partnership and other governmental entities
SB 5898—Ordering a public information campaign on postpartum depression
SB 5973 —Imposing sales and use tax on candy
I
lb
Board-of Health
Media Report
1
.larch 17, 2005
•
Jefferson County Health and Human Services
MARCH 2005
NEWS ARTICLES
1. "PA council OKs fluoridation `gifting' pact",Peninsula Daily News, March 2,2005
2. "Help for parents of disabled kids",PT Leader, March 2, 2005
3. "Kids: Create art for tobacco education",PT Leader, March 2, 2005
4. "Schools prep for emergencies",PT Leader, March 2, 2005
5. "County teens honored for service, leadership",PT Leader, March 9, 2005
6. "Homeless numbers up",PT Leader, March 9, 2005
•
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•
Help for parents of disabled kids
Parent to Parent, a local orga- State Trust Accounts explains
nization for parents or caregivers about how to set up a trust fund
of children with disabilities, for your child with the state
brings two speakers to town. making a contribution.
On Tuesday, March 15 at The Parent to Parent program
6:30 p.m., Marsha Threheld of offers emotional support and infor-
the Washington Initiative for mation for children with disabili-
Supported Employment speaks ties or special healthcare needs.
on "Transition: from school to a Meetings take place at Jefferson
working adult." County Mental Health, 884 West
On Tuesday, April 19 at 6:30 Park Ave. in Port Townsend. Call
p.m., Patti Bell of Washington Penny James at 3/11 1173.
S
•
•
•
Wednesday,March 2,2005 •B 3
Kids : Create art for tobacco 'education
School-age youths who can Sheridan in Port Townsend. 10 smokers start smoking before 1/2 by 11 inches. Paper orienta-
express themselves through art Entry forms are available at the age of 18. For every eight tion must be horizontal.
are invited to submit their cre- schools, the Health Department, smokers tobacco smoke kills,one Selected entries will be fea-
ations to the Tobacco Prevention youth service organizations nonsmoker is also killed by tured as 4-foot-by-8-foot Little
Program at the local Health throughout the county, and at inhalation of secondhand smoke, League outfield signs or used in
Department.The harmful effects w w w.j e f f e rs on c o u n t y p u b- and smoke-filled rooms can have tobacco education efforts
of cigarettes or chew or second- lichealth.org. Completed entry up to six times the air pollution of throughout the county. Youths
hand smoke is the theme for this forms must include signatures of a busy highway. More tobacco whose art is selected will received
art extravaganza. the artist and parent or guardian. facts can be discovered on the web $25 in Town Dollars,redeemable
Submissions of youth art Grim but true short messages at unfilteredtv.com, cancer.org throughout Fast Jefferson County.
must be received by Wednesday, can be included in kids'poster cre- (American Cancer Society) and The Tobacco Free Youth Art •
March 16 at the Jefferson ations,such as:Nearly one in five alaw.org (American Lung Extravaganza is made possible
County Health and Human deaths in the United States are Association of Washington) through the efforts of the
Services Department, 615 related to smoking,and nine out of Artists are encouraged to Jefferson County Tobacco
think big and create a plain and Prevention Program and funding
. simple message or image. from the Washington State
Original art can have two colors Department of Health. Call
maximum on a white back- Kellie Ragan at the Heath
ground and be no larger than 8 Department,385-9446.
•
•
•
t
Schools prep for emergencies
On Friday, Feb. 25, the operations center in Port
Jefferson County Department of Hadlock.
Emergency Management con-
ducted training for administra-
tion, office and security person-
nel from Chimacum and •
Quilcene school districts. The
training session—"Orientation to
the Incident Command System
For School Officials" — was
taught by Bob Hamlin, program •
manager for Emergency
Management.
"The schools have been
focusing for a couple of years on
upgrading their emergency •
response plans, and a key corn •
-
ponent of that process involves
integration with the community r
response," said Hamlin. 7)-
"Emergency officials in the com — 2- —0
munity use the Incident c7
Command System, and the •
school personnel needed to learn
the language and the design of
the system so they approached
us,"he added."It's a part of what
our department does in prepar-
ing the community for a disaster.
We are pleased to equip school f'
officials with this information."
A dozen officials from the
two school districts attended the
half-day class at the emergency
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