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HomeMy WebLinkAbout2005-November File Copy • Jefferson Count Board of Health .agenda • .911inutes November 17, 2005 • JEFFERSON COUNTY BOARD OF HEALTH Thursday,November 17,2005 2:30—4:30 PM Main Conference Room Jefferson Health and Human Services AGENDA I. Approval of Agenda II. Approval of Minutes of Meetings of October 20, 2005 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. Letter to Port Townsend City Council 2. BOH and Hospital Joint Board Follow-up Meeting, October 27,2005 3. Initiative 901 Impacts for Local Public Health • 4. Hood Canal Coordinating Council Meeting Follow-up V. New Business • 1. Jefferson County 2005 Public Health Standards Report 2. Environmental Health Draft Fee Schedule—Possible Call for Public Hearing for December 15,2005 3. Report on school services by Olympic Education Service District (OESD) for Drug Free Community Grant 4. Subcommittee to appoint Substance Abuse Board members 5. Breast and Cervical Cancer Program Report 6. Public Health Heroes Awards to be given VI. Activity Update VII. Agenda Planning in December- Presentation of Healthy Youth School Data VIII. Next Scheduled Meeting: December 15, 2005 2:30 PM—4:30 PM Main Conference Room Jefferson County Public Health • • 4 JEFFERSON COUNTY BOARD OF HEALTH • MINUTES Thursday, October 20, 2005 Board Members: Staff Members: Geoffrey Masci, Chairman—Port Townsend Ciy Council Jean Baldwin, Health&Human Services Director David Sullivan, Vice Chairman—Couny Commissioner Julia Danskin,Nursing Services Director District#2 Thomas Locke,MD,Health Officer Phil Johnson— County Commissioner District#1 Mike McNickle, Environmental Health Director Patrick M. Rodgers-County Commissioner District#3 Jill Buhler—Hospital Commissioner District#2 Sheila Westerman—Citiven at Large (City) Roberta Frissell—Citiven at Large (Couny) Member Masci called the meeting to order at 2:34 p.m. in the First Floor Conference Room, Jefferson County Court House. All Board and Staff members were present with the exception of Jean Baldwin. There was a quorum. Approval of Minutes Motion made to approve the Minutes as written by Board Member Westerman, Board • Member Johnson seconded the motion. A vote was taken and passed unanimously. Public Comment No comments at this time. Old Business and Informational Items West Nile Virus Update There has been minimal West Nile virus activity in Washington State this year. Two mosquito samples, one bird, and one horse tested positive, all from Eastern Washington. Since we are at the end of the West Nile virus transmission season it would be very unusual to see human cases at this time. As was the case last year, Washington State is the only state in the continental U.S. to not have a human case of West Nile virus infection. Pertussis Update There has been an increase in Pertussis, (also known as Whooping Cough) activity in Kitsap and Clallam counties. Pertussis is not rare. It occurs chronically in the adolescent and adult population due to the loss of immunity from childhood vaccination. Pertussis can be life threatening to the elderly and is a serious health risk in infants. There has been only one recently documented case in Jefferson County in a school age • child and all the parents received notification of their childrens' possible exposure. Parents were encouraged to take the child in for testing if symptoms occur. Vaccination is strongly encouraged A Pertussis alert has been put out to all health care providers • stressing the need to get cultures for testing prior to initiating antibiotic treatment. Influenza and Pneumococcal Update An informational packet went out to health care providers kicking off the influenza vaccination season. This year we are making a special push to get health care workers vaccinated, to prevent the transmission of influenza to those at high risk of influenza complications. New Business Public Hearing — Jefferson County Solid/Hazardous Waste Regulation Ordinance (090-0175-04) Chair Masci opened the public hearing at 2:45 p.m. He directed the hearing schedule to be as follows: staff report; questions by Board of Health; public comments; questions by BOH to staff and public; deliberations; vote; close. Staff Reports: Dr. Locke, County Health Officer, reviewed the draft ordinance as discussed at the September BOH meeting with additional changes suggested by David Alvarez, Jefferson County Prosecuting Attorney. The public review draft incorporated the changes suggested by Mr Alvarez. In addition, Mr. Alvarez recommended that a written • document clearly indicate whom the enforcement officers will be, so that their authority cannot be challenged when writing a ticket. . Dr. Locke recommended that the process of appointing enforcement officers be done by the Health Officer to allow timely delegation of authority to employees. A draft appointment document was included in the Board's packet. Mike McNickle gave a brief summary of the ordinance to the Board and public. Public Hearing Comments: Many residents from the Lazy C development located in Brinnon Washington were in attendance for the public hearing. Their questions and comments included: o Who will the enforcement officers be and how will they respond? o How will the complaint process work? o Will Jefferson County be able to use the reserve fund to clean up the property? If so, how long would it be before the county would be able to replace those funds used? o Concerns in regard to the funding. Will the Health Department ensure sufficient funds in the budget to have the complaints addressed? o Unable to find the language that refers to the funding in the draft. o Would like to make sure there are budgets for the clean up and a way to have the monies recovered. o Concerns about the junk vehicles that are placed by the Dosewallips River. Hazardous materials can be leaking from these junk cars into the river and affecting our fish. • o Have been fighting problem for many years and the problem has never been able to be solved. o What is the County's time frame to have this issue resolved, or to start seeing some improvements? • o Are there any laws stating that you can't have vehicles that are not registered on your property? If there isn't, can anything be done about passing a law? o The neighbor's property is an eyesore, and the neighbor brings junk cars home on a flatbed truck to sit on their property o Burned down buildings, no one ever cleans them up, wants to know if this would be addressed as well. o Concerned about the fields that are extremely over grown with sticker bushes and trees, they are a fire hazard when dry. o Concerned about the Ordinance Chapter 8.1 that was passed in 2002 then again the same ordinance was passed again in 2004 under Solid Waste 8.10. Same ordinance passed twice. Will there be an amendment made under the new solid waste ordinance to address these same things? Chair Masci closed the public comments portion of the hearing. Questions from the Board for Staff and Public Board Member Buhler asked if the man bringing cars home was working on them. A member of the public responded no, he was not. Board Member Westerman presented a list of the public's questions and concerns and suggested that these be reviewed and discussed one-by-one. The group agreed and proceeded to discuss each question separately with staff • 1. Q: Do we have any way to deal with burned out buildings? Is that addressed under this code? A: Burned out buildings meet the definitions of solid or bulky waste and are covered by the code. 2. Q: Can people be required to mow or control overgrown grass that is potentially a fire hazard? Where is this activity regulated? A: This is not covered in the Solid Waste Code; it may be covered under the fire district regulations. 3. Q: We fine someone and they pay the fine but don't clean up the problem, how do we keep this from going on for years? Will there be a time frame put on it? A: Fines are available for each day of violation. This gets very expensive over time and is an incentive to correct the violation. 4. Q: At what point is the County going to act on solid waste code violations? A: If a person gets a notice of infraction they will need to act on it. They will have to pay the fine or attend court. 5. Q: Will we have a different time frame for those problems in the areas that are in environmentally sensitive areas? A: Yes, these will be given a higher priority. 6. Q: How many unregistered vehicles can one person have? A: It will depend on what category the vehicles are in. For vehicles that are not running, not being taken care of or not being restored, the number can be • as low as the Board determines, including zero. 7. Q: What will the County policy be regarding individuals who don't pay their fines and have a lien put on their property? • A: It can take up to several years before a lien can be collected. The lien takes effect when the property is sold. Other lien holders may have claims that supersede a solid waste violation. If money is left over after other lien holders are paid, the fine may then be paid. 8. Q: How are we budgeted for this? A: We have two Sanitarians supported, in part, by State funding. 9. Q: Where will we get the money to do the clean up ourselves? A: There is no money budgeted to fund solid waste clean-ups. Use of jail inmate work crews is one possibility. 10. Q: What is the procedure to log a complaint? A: This is done by calling the Environmental Health Department to have it logged and investigated. Deliberations Board Member Rodgers moved that the Jefferson County Solid/Hazardous Waste Regulations Ordinance be adopted. The motion was seconded by Vice-Chair Sullivan. Discussion followed and Chair Masci moved that the motion be amended to specify the number of junk vehicles. There was additional discussion and it was agreed that a maximum of 2 junk vehicles should be allowed. This amendment was voted on and passed by unanimous vote • Board Member Johnson moved that the motion be amended to adopt a zero tolerance in environmentally sensitive areas and buffers regarding both junk cars and other items. There was additional discussion and the amendment was voted on and passed by unanimous vote A vote was taken on the main motion: that the Jefferson County Solid/Hazardous Waste Regulations Ordinance be adopted as amended. The motion passed by unanimous vote. Board Member Westerman discussed the inclusion of the Superior Court process in the ordinance and the desirability of having a public document that shows which enforcement steps will be taken. It was proposed that a flow chart be produced that shows what happens once a ticket has been issued. Environmental Health Fees Environmental Health Director, Mike McNickle explained a handout that listed 2005 fees, proposed 2006 fees with a 3.7% Consumer Price Index adjustment and charges for new services, and a proposed 2006 fee schedule that funds the addition of an Environmental Health technician position. He answered questions and there was discussion about methods of setting fees. Currently fees cover the full cost of some services while other services are only partially fee supported and involve some general county fund support. There was discussion and a Board consensus that environmental • health services should be fully supported by fees and should not be subsidized by general county funds. Board Member Frissell made a motion: To direct staff to revise the draft 2006 • Environmental Health Fee Schedule to reflect 100% of costs and the addition of a technician position. Board Member Westerman seconded the motion. There was discussion and ideas offered. Chair Masci suggested that staff review the City's procedures on fees. He also suggested that there be a flat fee for travel. The motion was voted on and passed by unanimous vote. Pandemic Influenza Planning—Risk Communication Public Health Nursing Services Director, Julia Danskin reported that information has been sent to health care providers with recommendations from Jefferson County Public Health discouraging personal stockpiling of antiviral medications in anticipation of an avian flu pandemic. Dr. Locke discussed an article on risk communication and pandemic influenza in the BOH packet. He reminded the Board that they would play a crucial role in public health risk communication efforts should an influenza pandemic occur. Activities currently underway to promote "respiratory etiquette", influenza vaccination, and good hand hygiene are important elements of influenza pandemic preparedness. Preventive Services Funding and the Port Townsend Liquor Excise Tax • Chair Masci expressed his disagreement with the recent decision made by his fellow City Council members to support City Manager David Timmons' recommendation that the 2006 City Liquor Excise tax funds be redirected to the City Police budget. Historically, these funds have gone to Jefferson County Public Health to provide matching funds for grants that fund prevention programs in the community. Board Member Sullivan moved that a letter be drafted to Port Townsend City Council in response to Mr. Timmons' proposal. Board Member Johnson seconded the motion. A vote was taken and the motion passed by unanimous vote. A letter will be written that strongly encourages the City Council to continue to allocate City Liquor Excise Tax revenues to fund Drug and Alcohol Prevention programs. The draft letter will be provided to BOH members for approval and signatures will be gathered for a speedy turnaround. Chair Masci suggested that a Resolution be prepared in advance of the November BOH meeting that could be published if the letter is ignored. Hood Canal Coordinating Council Survey Dave Christensen, Water Quality Program Manager for the Hood Canal Coordinating Council (HCCC) discussed the upcoming November 16, 2005 HCCC meeting in Silverdale. The second half of the meeting will be devoted to Board of Health • discussions on implementation of the new State On-Site Sewage Codes. Board of Health members from Jefferson, Kitsap, and Mason counties are invited to attend. Mr. Christensen also directed the Board's attention to the Interim Report on Homeowner • Attitudes Regarding Hood Canal Water Quality and Sewage Treatment included in the Board's packet. The report contains valuable information on public perceptions of marine water quality problems in Hood Canal and the acceptability of various remediation proposals. Authorization for Health Officer to Delegate Solid Waste Code Enforcement Officers At the recommendation of legal counsel, the Board was encouraged to formally authorize the Health Officer, Dr. Locke, to sign the "Appointment of Enforcement Officers for 7.80 RCW and Jefferson County Solid Waste Ordinance No. 09-0175-04" document included in the Board packet. Board Member Westerman moved: To authorize Dr. Tom Locke to sign the referenced document and appoint current and future enforcement officers. Board Member Rodgers seconded the motion. A vote was taken and passed by unanimous vote. Chair Masci adjourned the meeting at 4:30 p.m. Next Jefferson County Board of Health meeting is Thursday, November 17, 2005 from 2:30 PM—4:30 PM in the Main Conference Room of Jefferson County Public Health. JEFFERSON COUNTY BOARD OF HEALTH Geoff Masci, Chairman Jill Buhler, Member Commissioner Sullivan, Vice Chair Sheila Westerman, Member Roberta Frissell, Member Phil Johnson, Member Patrick M. Rodgers, Member Board of 3-feaCth OCdBusiness Agenda Item # 1"V., 1 • Letter to Port rownsenc( C1ty Council November 17, 2005 • �~ JEFFERSON COUNTY PUBLIC HEALTH ,40` ..--- 615 Sheridan StreERort TownsertWPVashington98368 0 www.jeffersoncountypublichealth.org October 26, 2005 David Timmons City Manager, Port Townsend • 181 Quincy Street • Port Townsend WA 98368 SUBJECT: Port Townsend Liquor Excise Tax (PTLET) Dear David, The Jefferson County Board of Health (BOH) was gravely disappointed to hear your budget recommendation to allocate the 2006 PTLET in the Port Townsend Police budget. As you know, the PTLET has been awarded to Jefferson County Public Health (JCPH) for over 10 years. Jefferson County Public Health works diligently to keep our community safe and healthy. The BOH strongly urges you to reconsider this recommendation. We recommend that the City of Port Townsend continue to contract directly with JCPH to provide substance abuse prevention programs. The PTLET annual contribution is the only money the City of Port Townsend contributes to local public health which includes substance abuse prevention. JCPH has the infrastructure in place to assess community needs, develop and maintain capacity, plan • effective interventions, implement services, and evaluate prevention programs. All programs within JCPH have extensive reporting requirements. As Jean stated to you in her October 12, 2005 letter, PTLET funds two specific programs, Project Alert and Big Brothers Big Sisters. Both services have been rigorously researched, are nationally recognized best practices, and fill a documented need derived from local community health assessment data. In 2005, Project Alert served 211 Blue Heron students during 72 classroom sessions through the 13 core and booster lessons. From November 2004 through September 2005 over 40 Jefferson County youth have benefited from over 320 mentoring contacts and 1,382 mentoring hours through Big Brothers Big Sisters. Additionally, both above mentioned services are woven as part of the required 100% in-kind match in our federal Drug-Free Communities grant. Loss of the PTLET will seriously jeopardize JCPH's ability to fulfill the terms of the grant and thereby eliminate these services to youth and families. The core mission of Public Health is prevention. Prevention, simply stated, keeps bad things from happening. We look forward to ongoing collaboration with the City of Port Townsend. Partnership opportunities include developing a long range prevention plan, on-going community assessment, and program evaluation. III COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES ,.," p, PK�;,,_ ��✓ ., NATURAL RESOURCES MAIN: 360-385-9400 LIi,,,f5 a41i .1.�•_, JR ti AND MAIN:360-385-9444 FAX: 360-385-9401 HEALTHIER COMMUNITY FAX: 360-385-9401 Timmons Letter October 26, 2005 • Page 2 of 2 Thank you for your consideration of the above. If you need further information for your deliberation on this issue, please contact Jean Baldwin, Director or Julia Danskin, Nursing Director at 385-9400. Sincerely, Jefferson County Board of Health 11111% 44111111*IPP Ge.. asci, D i u ' n, ice C air I Buhler, ember Port Townsend City Council BOCC-District 2 Jefferson Healthcare Roberta Frissell, Member ""it John—in, atrick M. Rodgers, Jefferson County BOCC-District 1 BOCC-District 3 Sheila Westerman, Member • City of Port Townsend CC: Catharine Robinson, Mayor, Port Townsend City Council Michelle Sandoval, Deputy Mayor, Port Townsend City Council Kees Kolff, Port Townsend City Council Freida Fenn, Port Townsend City Council Frank Benskin, Port Townsend City Council Laurie Medlicott, Port Townsend City Council Michael Legarsky, Finance Director, City of Port Townsend Conner Daily, Chief, Port Townsend Police John Fischbach, Jefferson County Administrator • M Board of 3CeaCth Mew Business .Agenda Item # T., 1 M Jefferson County 2005 Public Health Standards Report November 17, 2005 • 4111 OD • 41. STATE OF WASHINGTON • DEPARTMENT OF HEALTH PO Box 47890. Olympia, Washington 98504-7890 Tel: (360) 236-4501 .FAX (360) 586-7424. TDD Relay Service: 1-800-833-6388 September 29, 2005 Dear Local Health Official: Thank you for using the Public Health Standards to help measure the performance of your agency and participating in the site visits. Your work in this process is an important contribution to improving the public health system in our state. Your individual site review report,prepared by MCPP Health Care Consultants, Inc., a question and answer sheet, and a fact sheet are enclosed. You will receive the full system report and a complete media kit in November. If you have questions about this packet, please contact Joan Brewster at 360-236-4062 or Rita Schmidt at 360-236-3714. • This round of site visits is the second measurement of performance using the Public Health Standards in Washington. As you and your staff review the report,please consider how you might use the results within in your agency and share it with your policy makers and community partners. As you talk with other public health leaders,you will have the opportunity to provide input about areas that could benefit from system-wide improvements or measures that need improvement. Please think about your suggestions and how you can be involved in the Public Health Improvement Partnership process. Thank you again for your hard work in this effort. The Public Health Standards process has already made a difference with our state legislators, and we know it will make an important difference in the future. Sincerely, ucs4414 /4ejei Janet Davis, President Mary C. Selecky, Secretary Washington State Association Washington State Department • of Local Public Health Officials of Health PUBLIC HEALTH ALWAYS WORKING FOR A SAFER AND HEALTHIER WASHINGTON FACT SHEET Washington State Standards for Public Health Why were the standards developed? The Public Health Standards for Washington were developed to measure the performance of the work we do in public health. They were developed by a partnership of state and local public health workers,the State Board of Health and the University of Washington. They were "field tested" in 1999 and published in 2000. The standards identify a higher level of performance than what exists and it is expected that the public health agencies in this state will work towards meeting the standards in the future. What do the standards measure? The standards measure the major areas of public health: communicable disease investigation, assessment of health issues, health promotion and prevention, environmental health and access to health care using a list of critical health services. Within each major area, the standards identify measures that meet the goal of"what every citizen has a right to expect" from their public health system. How does the process work? 411. In 2005 the Public Health System was assessed to determine how well state and local public health systems performed to meet the standards. This measurement was conducted April through July, with results available in September. MCPP Healthcare Consulting Inc.,who which conducted the performance measurement,visited 25 areas of the Department of Health(DOH), the State Board of Health and all local health jurisdictions (LHJ's). The measurement identified areas of exemplary practices and areas where services or programs did not meet standards. The results identified achievements of the entire public health system and areas that may need improvement. A new feature this year was a field test of the new Administrative Standards and a more detailed review of selected program areas. Before the site visit, each agency was asked to complete a self-assessment tool that lists the standards and their measures and to organize documentation supporting each measure. During the site visit the contractors looked at documentation for each standard to rate whether the standard was being met. Each agency that was visited receives received a report of their results. The consultants also collected"best practice"documents that will be posted to the DOH Web site as examples. S Washington State Public Health Partners Northwest Center for Public Health Practice,University of Washingtcn Washington State Association of Local Public Health Officials Washington State Board of Health Washington State Department.of Health PUBLIC HEALTH ALWAYS WORKING FOR A SAFER AND HEALTHIER WASHINGTON QUESTIONS AND ANSWERS Washington State Standards for Public Health What are the Public Health Standards and why are they important? Public health is a broad, diverse field that relies on expertise from many different organizations to protect the public. It's vital to our communities and quality of life, yet it's very hard to summarize and measure. The standards are divided into five major areas: 1) Understanding health issues: standards for public health assessment. 2)Protecting people from disease: standards for communicable disease and other health risks. 3)Assuring a safe, healthy environment for people: standards for assuring a safe, healthy environment. 4)Prevention is best/promoting healthy living: standards for prevention and community health promotion. 5)Helping people get the services they need: standards for access to critical health services. Standards for each topic area describe the work that should be performed across the state. They are a description of public health that can be used with communities,policy makers and within the public health field. How will the Standards for Public Health be used? These standards are a management tool used every three years to assess the overall performance of the public health system. They can be used by anyone in the governmental public health system and they articulate the role of each partner within the system. Over time, the standards will help identify ways to strengthen the system. Site specific reports have been distributed to each visited site. A more comprehensive report will be distributed later in the year. It will describe the overall functioning of the system and show comparisons and summary results. How will the standards help individual agencies? The reports show how public health organizations performed in 2005. They will help public health organizations in our state identify achievements and analyze why some organizations do . not have the resources needed to meet the public health standards. Some standards can be met by changing priorities, others may require more resources. This analysis will help focus our efforts on areas that need improvement. • Washington State Public Health Partners Northwest Center for Public Health Practice,University of Washingtcn Washington State Association of Local Public Health Officials Washington State Board of Health Washington State Department of Health A `f Standards for Public Health in Washington State: 2005 Performance Assessment Report Local Health Jurisdictions Report for: Jefferson County Health and Human Services The Standards and the 2005 Performance Assessment Thank you for participating in the performance assessment of the Standards for Public Health in Washington State. The intent of the Standards is to provide an overarching measurement framework for the many services, programs, legislation, and state and local administrative codes that affect public health. The Washington State Standards for Public Health Performance address all 10 Public Health Essential Services and crosswalk directly to the Centers for Disease Control and Prevention(CDC) Standards for Performance. The Washington standards and measures exemplify the national goals for public health performance measurement and development of standards—quality improvement, accountability, and science. Points to remember when looking at the reports include: • The Standards articulate a higher level of performance, often described as stretch standards, not a description of the system as it is performing currently. • The Standards reflect an improvement cycle; results of the performance assessment should be used to target areas for improvement. • This Report The site reviews again demonstrated the incredible commitment, creativity and hard work of the people in the public health system. This report is specific to your local health jurisdiction and is intended to give you feedback about the materials you provided as a demonstration of how you met each measure. However, before describing the details that are in the report, we want to summarize overall observations regarding your organization's strengths and opportunities for improvement as observed during the site review. Strengths • The 2003 Health of Jefferson County Report and the Report on Family Planning are just two examples of the comprehensive and easily understandable information for the BOH and other community groups.These provide good assessment data for the Healthy Jefferson Steering Committee and BOH priority setting process. • The 2005 Performance Measure and the 2004 Reports demonstrate good use of monitoring for performance on an annual basis. Encourage the continuing efforts in using the performance measures to help meet goals and objectives. • The FAQs about public health in Jefferson County on thewebsite are helpful to the public, as are the comprehensive data and information on environmental health and assessment of • community health issues. 2005 Standards Assessment Report 1 standard, specific measures are described for local health jurisdictions. For LHJs, all measures were applicable; however, some (for example those that required certain actions related to an outbreak) were not applicable if an event had not occurred. Program Review Results: For the measures that were assessed through program review, the scores for all programs reviewed for the individual measure were aggregated to calculate an "agency-wide" score for the measure. For these measures the LHJ detail shows only the aggregate score for the measure as the detailed comments for these measures are included in the program reports. Attached to this summary report are four program specific reports with the detailed scoring for each measure evaluated for each program, with related comments. Administrative Standards Results: For the Administrative Standards, this evaluation cycle was to evaluate the Proposed Administrative Standards and Measures themselves and not to report site specific performance. The results of our evaluation of these standards and measures are at the system level only, therefore, this report does not contain any results for the Proposed Administrative standards. Comparability to the 2002 Baseline results: Due to the major revisions in the environmental health topic area of standards, and to the program review method of evaluation used for numerous measures, only some of the 2005 results can be compared to the results of the 2002 Baseline. The measures that are considered comparable between the two cycles are: • All Assessment (AS) measures, except AS 3.2 and AS 3.3, which were evaluated through program review • All Communicable Disease(CD)measures • Prevention and Promotion(PP) measures in standards PP1, PP2, and PP3 • All Access (AC)measures This report provides you with the following information: • For all measures: a table listing all the measures with the performance designation to serve as a quick reference tool in identifying the measures that demonstrated performance, those scored as a partial, and those that did not demonstrate performance against the measure. • For each measure (we have not repeated these in the report in order to reduce the number of pages, but have grouped them under their overarching standard): the score assigned by the reviewer: o 2 =demonstrates the measure, o 1 =partially demonstrates the measure, o 0=does not demonstrate the measure, o 8 =not applicable, o 9=not able to rate [did not participate at a topic area level] Comments provide clarification regarding the intent of the measure or the score assigned. Documents lists, in abbreviated form, the documents that were the basis for the score. When • multiple documents were provided and some did not demonstrate the measure or there were many more examples than needed, they are not all listed. 2005 Standards Assessment Report 3 • ar ExemP 1practices: The Exemplary Practices Compendium provides you with III Y exemplary from many of the LHJs in Washington State. Potential exem lary practice documents were gathered from each of the sites and the very best examples for each measure will be organized into a electronic tool kit. This material will be available by year-end 2005 at www.doh.wa.gov/phip/StandardsBestPractices/StandardsExemplaryPractices.htm . • Statewide initiatives projects such as the implementation of the Public Health Issue Management System (PHIMS) for communicable disease and the Assessment in Action project to build assessment capacity at the local level also support improvement of practice and documentation. Based on the recommendations in the system-wide report, the PHIP process will adopt additional statewide initiatives related to the measures. Finally, begin preparing now for the next performance assessment. The assessment process itself has been conducted using quality improvement r 2000, thmethods, e baseline int 002 , and the Plan- Do-Check-Act cycle. As shown below, the standads field test in this 2005 performance assessment are all part of the cycle of continuous quality improvement. The next cycle is planned for 2006-08,with site visits probably occurring in the spring of 2008. Plan PlanPlan Draft Revised Standards I Standards 1.--- , I Plan Improvements F Do Act Do Act I Do p`� Understand Recommend Implement i 0 ICommittee ( Evaluate I Recommend I Improvements Improvement Standards/Self Illmprovement action Assessment 2 Check Check 42 Check � Sfte visit&Report Report/R ecommend Site visit&Report 12 Baseline Evaluation of Improvement Cycle Standards Development Standards 2003-2004 and Evaluation I I 2000-2001 2002 Strategies for building on your current performance: • Save the documentation you have used in this assessment as a good starting point for continuing to identify documentation for demonstrating performance. • Establish an electronic document library for collecting documentation and facilitating the use of an electronic format for the next assessment. This cycle there were three LHJs that used an electronic format for all their documentatio� an Sees stated it the lc eion was much easier and helpful to the process than paper copies of the documentation. • Adopt or adapt as many exemplary practices as possible to improve your performance against the measures. There is no reason to "re-invent the wheel", when another LHJ may have an excellent process or documentation method that you can start using ith less time and effort. • Participate in regional or state-wide improvement efforts that are identified through PHIP • work, or other multi-disciplinary efforts, such as the recent Assessment in Action effort to build capacity for assessment at the local level. 5 2005 Standards Assessment Report 11/ Understanding Health Issues (AS) Standards for Public Health Assessment Standard ASI Public health assessment skills and tools are in place in all public health jurisdictions and their level is continuously maintained and enhanced. Local measures: 2002 2005 Comments AS1.1L Current information on health 2 2 issues affecting the community is readily accessible, including qualitative and standardized quantitative data. AS1.2L There is a written procedure 1 0 describing how and where to obtain technical assistance on assessment issues. AS1.3L Goals and objectives are 2 1 established for assessment activities as a part of LHJ planning, and staff or outside assistance is identified to perform the work. AS1.4L Information on health issues 2 1 • affecting the community is updated regularly and includes information on communicable disease, environmental health and community health status. Data being tracked have standard definitions, and standardized measures are used. AS1.5L Staff who perform assessment 2 2 activities have documented training and experience in epidemiology, research, and data analysis. Attendance at trainings and peer exchange opportunities to expand available assessment expertise is documented. Standard AS2 Information about environmental threats and community health status is collected, analyzed and disseminated at intervals appropriate for the community. Local measures: 2002 2005 Comments AS2.1L Assessment data is provided to 2 2 community groups and representatives of the broader community for review and identification of emerging issues that may require investigation. • AS2.2L The BOH receives a report 2 2 annually on a local core set of indicators that includes data about community health status, communicable disease, and environmental health. AS2.3L There is a planned, systematic 0 0 process that describes how documented or emerging health issues are identified, assessment data gathered and analyzed, and recommendations are made regarding policy development and action. AS2.4L Assessment investigations of 2 1 changing or emerging health issues are part of the LHJ's annual goals and objectives. AS2.5L A local core set of indicators that 2 2 includes data about community health status, communicable disease, and environmental health is used as the basis for continuous monitoring of the health status of the community. This set of core indicators tracks data over time to signal changes in priority health issues. • Standard AS3 Public health program results are evaluated to document effectiveness. Local measures: 2002 2005 Comments AS3.1L Progress towards program goals is 2 2 reported annually to the Board of Health via a single compiled report or a planned calendar of reports. AS3.2L There is a planned, systematic 2 1 process that describes how appropriate data is used to evaluate program effectiveness. Programs, whether provided directly or contracted, have written goals, objectives, and performance measures, and are based on relevant research. AS3.3L Program performance measures 2 1 are monitored, the data is analyzed, and regular reports document the progress towards goals. AS3.4L LHJ program staff have training 2 2 in methods to evaluate perfoiniance against goals and assess program effectiveness. . AS3.5L There is documentation that 2 1 performance monitoring data is analyzed and used to change and improve program offerings. Standard AS4 Health policy decisions are guided by health assessment information, with involvement of representative community members. Local measures: 2002 2005 Comments AS4.1L There is documentation of 2 2 community involvement in the process of reviewing health data and recommending action such as further investigation, new program effort or policy direction. AS4.2L The annual report to the BOH 2 2 summarizes assessment data, including environmental health, and recommends actions for health policy decisions. AS4.3L There is a planned systematic 0 1 process that describes how health • assessment data is used t9 guide health policy decisions. AS4.4L Key indicator data being tracked 2 1 and related recommendations are used in evaluating goals and objectives. Standard AS5 Health data is handled so that confidentiality is protected and health information systems are secure. Local measures: 2002 2005 Comments AS5.1L Written policies, including data 2 2 sharing agreements, govern the use, sharing and transfer of data within the LHJ and with partner agencies. AS5.2L All program data are submitted to 1 2 local, state, regional and federal agencies in a confidential and secure manner. Protecting People le from Disease (CD) • Standards for Communicable Diseases and Other Health Risks Standard CD1 A surveillance and reporting system is maintained to identify emerging health threats. Local measures: 2002 2005 Comments CD1.1L Information is provided to the 1 2 public on how to contact the LHJ to report a public health concern 24 hours per day. Law enforcement has current local and state 24-hour emergency contact lists. Information is provided on how to contact the LHJ to report a public health concern 24 hours per day. Law enforcement has • current local and state 24-hour emergency contact lists. CD1.2L Health care providers and labs 1 1 know which diseases require reporting, have timeframes, and have 24-hour local contact information. There is a process for identifying new providers in the community and engaging them in the reporting process. CD1.3L There are annual reports to the 2 2 BOH that include communicable disease surveillance activity and related data from the local core set of indicators. CD1.4L Written protocols are maintained 2 2 for receiving and managing information on notifiable conditions. The protocols include role-specific steps to take when receiving information as well as guidance on providing information to the public. CD1.5L The local core indicators relating 2 1 to communicable disease are analyzed annually, and implications for changes in • investigation, intervention, or education efforts are identified. . CD1.6L A communicable disease tracking 1 2 system is used which documents the initial report, investigation, findings and subsequent reporting to state and federal agencies. CD1.7L There is documentation that staff 2 2 members receive training on reporting of communicable disease. Standard CD2 Response plans delineate roles and responsibilities in the event of communicable disease outbreaks and other health risks that threaten the health of people. Local measures: 2002 2005 Comments CD2.1L Phone numbers for weekday and 1 1 after-hours emergency contacts are available to DOH and appropriate local agencies, such as schools and hospitals. CD2.2L A primary contact person or 2 2 designated phone line for the LHJ is clearly identified in communications to health providers and appropriate public safety officials for reporting purposes. CD2.3L Written policies or procedures 2 0 delineate specific roles and responsibilities within agency divisions for local response and case investigations of disease outbreaks and other health risks. Standard CD3 Communicable disease investigation and control procedures are in place and actions documented. Local measures: 2002 2005 Comments CD3.1L Lists of private and public 2 2 sources for referral to treatment are accessible to LHJ staff. CD3.2L Infoumation is given to local 2 2 providers through public health alerts and newsletters about managing reportable conditions. CD3.3L Disease-specific protocols 1 1 • identify infoiniation about the disease, case investigation steps (including timeframes for initiating the investigation), reporting requirements, contact and clinical • management (including referral to care), use of emergency biologics, and the process for exercising legal authority for disease control (including non-voluntary isolation). Documentation demonstrates staff member actions are in compliance with •rotocols and state statutes. 0 0 CD3.4L An annual self-audit,using a sample of communicable diseaseIII investigations, is done to monitor timeliness and compliance with disease- s•ecific •rotocols. 2 CD3.5L LHJs identify key performance 1 MN. measures for communicable disease investi:ation and enforcement actions. 2 CD3.6L Staff members conducting IIIIIIIIIIIIIIII disease investigations have appropriate skills and training as evidenced in job descri•tions and resumes. Standard CD4 Urgent public health'messages are communicated quickly and clearly and • actions are documented. Local measures: 2002 2005 Comments CD4.1L Information is provided through 2 2 1.11111111111 public health alerts to key stakeholders and .ress releases to the media. CD4.2L A current contact list of media and providers is maintained and updated at least annually. This list is in the communicable disease manual,and at other a..ro•riate de.artmental locations. 0 CD4.3L Roles are identified for working with the news media. Policies identify the timeframes for communications and the expectations for all staff regarding information sharing and response to questions, as well as the steps for creating and distributing clear and accurate public health alerts and media releases: 2 CD4.4L All staff that have lead roles inNillIll • communicating urgent messages have been trained in risk communications. Standard CD5 Communicable disease and other health risk responses are routinely evaluated for opportunities for improving public health system response. Local measures: 2002 2005 Comments CD51.L An evaluation for each significant 0 N/A outbreak response documents what worked well and what process improvements are recommended for the future. Feedback is solicited from appropriate entities, such as hospitals and providers. Meetings are convened to assess how the outbreak was handled, identify issues and recommend changes in response procedures. CD5.2L Recommendations based on 0 N/A outbreak response evaluation and recommendations for effective response efforts are reported to the BOH. CD5.3L Local protocols are revised based 1 N/A on outbreak response evaluation findings or model materials disseminated by DOH. • CD5.4L Issues identified in outbreak 0 N/A evaluations are addressed in future goals and objectives for communicable disease programs. CD5.5L Staff training in communicable 2 2 disease and other health risk issues is documented. CD5.6L There is documentation that 0 N/A outbreak responses are evaluated and that evaluation findings are used for process improvement, and take into consideration surveillance processes, staff roles, investigation procedures, and communication efforts. Assuring a Safe, Healthy Environment for People (EH) Standards for Environmental Health Standard EH1 • Environmental health education is a planned component of public health programs. Local measures: 2002 2005 Comments EH1.1L Information is available about 2 2 environmental health, including compliance requirements, through brochures, flyers, newsletters, websites, or other mechanisms. EH1.2L The community and stakeholders 2 2 are involved in appropriate ways in addressing environmental health issues, including through presentations or individual technical assistance. EH1.3L Environmental health education 2 1 information in all forms (including technical assistance) is reviewed at least annually and updated, expanded or contracted as needed based on revised regulations, changes in community needs, etc. EH1.4L The critical components of all EH 1 1 activities are identified and used as the basis for education that is provided. Workshops and other in-person trainings 411 (including technical assistance) are evaluated to determine effectiveness. Standard EH2 Services are available throughout the state to respond to environmental_ events or natural disasters that threaten the public's health. Local measures: 2002 2005 Comments EH2.1L Information is provided to the 1 2 public on how to contact local jurisdictions to report environmental health threats or public health emergencies 24 hours a day. EH2.2L Environmental health threats and 2 1 public health emergencies are included in the local emergency response plan. After a public health emergency response, involving environmental health occurs, environmental health staff are included in the local jurisdiction after-action debrief. • Any changes to the response plan affecting environmental health response are documented. • EH2.3L Environmental health services 1 1 that are critical to access in different types of emergencies are identified. Public education and outreach includes information on how to access these critical services. After-action debrief includes a review of the accessibility of those services, and any changes necessary are made and documented. EH2.4L There is a plan that details the 0 1 roles and responsibilities for LHJ staff in a natural disaster or other public health emergency that both stands alone and is part of the local emergency response plan. All LHJ staff receive annual training on their respective duties. Standard EH3 Both environmental health risks and environmental health illnesses are tracked, recorded and reported. • Local measures: 2002 2005 Comments EH3.1L Environmental health data is 2 2 available for community groups and other local agencies to review. EH3.2L Key indicators of environmental 2 2 health risks and illnesses are identified. A system is in place for reporting suspected environmental health illnesses based on those indicators, and reporting is tracked to monitor trends. A system is in place to assure the data is shared with appropriate local, state and regional agencies. EH3.3L Public requests, BOH testimony, 2 2 compliance rates, and other data and information are used to determine what internal or external quality improvements may be needed. If needed, a plan is developed to institute needed changes over time. Standard EH4 Compliance with public health regulations is sought through enforcement actions. Local measures: 2002 2005 Comments • EH4.1L Written policies, local 2 2 ordinances, administrative code, and enabling laws are accessible to the public. EH4.2L There are written procedures to 0 2 follow for enforcement actions. The procedures specify the type of documentation needed to take an enforcement action,which conforms with local policies, ordinances and state laws. EH4.3L A selected number of 2 0 enforcement actions are evaluated each year to determine compliance with and effectiveness of enforcement procedures. If needed,procedures are revised. EH4.4L Enforcement actions are logged 2 2 (tracked) from the initial report, through the investigation, findings, and enforcement action, and are reported to other agencies as required. EH4.5L Appropriate environmental health 2 1 staff are trained on enforcement procedures. Prevention is Best: Promoting Healthy Living (PP) Standards for Prevention and Community Health Promotion Standard PPI Policies are adopted that-support prevention priorities and that reflect consideration of scientifically-based public health literature. Local measures: 2002 2005 Comments PP1.1L Prevention and health promotion 2 2 priorities are selected with involvement from community groups and other organizations interested in the public's health. PP1.2L Prevention and health promotion 2 2 priorities are adopted by the BOH, based on assessment information, local issues, funding availability, program evaluation 11111 and experience in service delivery, including information on best practices or • scientific findings. PP1.3L Prevention and health promotion 1 2 priorities are reflected in the goals, objectives and performance measures of the LHJ's annual plan. Data from program evaluation and key indictors is used to develop strategies. Standard PP2 Active involvement of community members is sought in addressing prevention priorities. Local measures: 2002 2005 Comments PP2.1L The LHJ involves a broad range 2 2 of community partners in considering assessment information to set prevention priorities. PP2.2L Staff members have training in 2 1 community mobilization methods as evidenced by training documentation. • Standard PP3 Access to high quality prevention services for individuals, families, and communities is encouraged and enhanced by disseminating information about available services and by engaging in and supporting collaborative partnerships. Prevention services may be focused on reaching individuals,families and communities. Examples of prevention services include chronic disease prevention, home visiting by public health nurses, immunization programs, efforts to reduce unintentional injuries and violence, including sexual assault. Local measures: 2002 2005 Comments PP3.1L Summary information is available 2 2 to the public describing preventive services available in the community. This may be produced by a partner organization or the LHJ, and it may be produced in a paper or web-based format. PP3.2L Local prevention services are 2 2 evaluated and a gap analysis that compares existing community prevention services to . projected need for services is perfoinied periodically and integrated into the priority setting process. • PP3.3L Results of prevention program 2 2 evaluation and analysis of service gaps are reported to local stakeholders and to peers in other communities. PP3.4L A quality improvement plan 0 2 incorporates program evaluation findings, evaluation of community mobilization efforts,use of emerging literature and best practices and delivery of prevention and health promotion services. Standard PP4 Prevention, early intervention and outreach services are provided directly or through contracts. Health promotion activities may be focused on the entire state or community or on groups within the community. Examples of health promotion activities include educational efforts aimed at increasing physical activity, reduction in tobacco use, improved dietary choices. Local measures: 2002 2005 Comments PP4.1L Prevention priorities adopted by 2 2 1111 the BOH are the basis for establishing and delivering prevention, early intervention and outreach services. PP4.2L Early intervention, outreach and 1 1 health education materials address the diverse local populations and,languages of the intended audience. Information about how to select appropriate materials is available and used by staff. PP4.3L Prevention programs,collect and 2 1 use information from outreach, screening, referrals, case management and follow-up for program improvement. Prevention programs, provided directly or by contract, are evaluated against performance measures and incorporate assessment information. The type and number of prevention services are included in program performance measures. PP4.4L Staff providing prevention, early 2 2 intervention or outreach services have appropriate skills and training as evidenced • by job descriptions, resumes or training documentation. • Standard PP5 Health promotion activities are provided directly or through contracts. Local measures: 2002 2005 Comments PP5.1L Health promotion activities 2 2 intended to reach the entire population or at-risk populations in the community are provided directly by LHJ's or by contractors. PP5.2L Procedures describe an overall 0 1 system to organize, develop, distribute, evaluate and update health promotion materials. Technical assistance is provided to community organizations, including "train the trainer" methods. PP5.3L Health promotion efforts have 1 1 goals, objectives and performance measures. The number and type of health promotion activities are tracked and reported, including information on content, • target audience, number of attendees. There is an evaluation process for health promotion efforts that is used to improve programs or revise curricula. PP5.4L Staff members have training in 0 0 health promotion methods as evidenced by training documentation. Helping People Get the Services They Need (AC) Standards for Access to Critical Health Services Standard ACI Information is collected and made available at both the state and local level to describe the local health system, including existing resources for public health protection, health care providers, facilities and support services. Local measures: 2002 2005 Comments AC1.1L Up-to-date info�uiation for 2 2 analysis of local critical health services is • available for use in building partnerships with community groups and stakeholders. • AC1.2L LHJ staff and contractors have a 2 2 resource list of local providers of critical health services for use in making client referrals. AC1.3L The list of critical health services 2 2 is used along with assessment information to determine where detailed documentation of local capacity is needed. Standard AC2 Available information is used to analyze trends which, over time, affect access to critical health services. Local measures: 2002 2005 Comments AC2.1L Data tracking and reporting 2 2 systems include key measures of access. Periodic surveys are conducted regarding the availability of critical health services and barriers to access. • AC2.2L Gaps in access.to critical health 1 2 services are identified through analysis of the results of periodic surveys and other assessment information. AC2.3L The BOH receives summary 2 1 information regarding access to critical health services at least annually. Standard AC3 Plans to reduce specific gaps in access to critical health services are developed and implemented through collaborative efforts. Local measures: 2002 2005 Comments AC3.1L Community groups and 2 2 stakeholders, including health care providers, are convened to address access to critical health services, set goals and take action,based on information about local resources and trends. This process may be led by the LHJ or it may be part of a • separate community process sponsored by multiple partners, including the LHJ. • • AC3.2L Coordination of critical health 2 2 service delivery among health providers is reflected in the local planning processes and in the implementation of access initiatives. AC3.3L Where specific initiatives are N/A 1 selected to improve access, there is analysis of local data and established goals, objectives and performance measures Standard AC4 Quality measures that address the capacity, process for delivery and outcomes of critical health care services are established, monitored and reported. Local measures: 2002 2005 Comments AC4.1L Clinical services provided 1 0 directly by the LHJ or by contract have a written quality improvement plan including specific quality-based performance or • outcome measures. Performance measures are tracked and reported. 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N co (13 3 > a ^ 4 _ O C h co ., e c. co E.0 (C d � oh C1) o 2 C p c • p d yU o ar Oo N Q y o o ) c y U) .0 C c N y d El - a) o co 2 i A z h ti -J -J h J J r) v tl co v 0 m a a a: MI to tri �� CO 'LI • Z C ti Board-of.9-fealth Netiv Business .Agenda Item # 'V., 2 • EnvironmentaCHealth Draft Fee Schedule November 17, 2005 • • Fee Increase Request Narrative Objective: The objective of this narrative is two-fold. First, this narrative explains JCPH's rationale to request an increase in EH fees. Second,this request fulfills the BOH's motion to cover 100% of all direct services with fees. Rationale: The BOH has requested that EH services cover 100% of all direct services with fees. Additionally, the fees in Liquid Waste/Operation&Maintenance will support one additional FTE required to meet the current and future workload. Request: EH Administration---no increase in fees. Drinking Water--- Increase of 3.7%per CPI as of August 2005. Solid/Hazardous Waste --- Increase of 3.7%per CPI as of August 2005. Liquid Waste/Operation&Maintenance ---Increase of 3.7%per CPI as of August 2005 and 16.3% in order to cover 100% of direct services with increase of 1.0 FTE • recommended by The Latimore Group. Food Safety ---Increase of 3.7%per CPI as of August 2005. Living Environment--- Increase of 3.7%per CPI as of August 2005. • ' JEFFERSON COUNTY PUBLIC HEATLH ' Environmental Health Division - Possible Fee Changes ,,,,,,?4'1 :.::2005 Fees -4, ,,, 0 :P oto all -,,-- • �,,,,4v,,� + .„;._,.;),.,,,,,,,,,,,T.4„,..;,,, e e E ra § h�• ,91,-.51. 17,11; <6:3774; . �.. 1 ONSITE SEWAGE DISPOSAL ' Sewage Disposal Permits New Conventional 361.00 433.00 New Alternative 436.00 523.00 New septic tank and/or pump chamber fee 159.00 191.00 New Community or>1000 G.P.D. (base fee) 361.00 433.00 New Commercial >1000 G.P.D. Conventional 436.00 523.00 Alternative 467.00 561.00_ Repair/upgrade/modification 85.00 102.00_ Expansion 287.00 344.00_ Redesign 85.00 102.00_ Reinspection 106.00 127.00_ Renewal 96.00 115.00 Evaluation of Existing System Septic system only 212.00 255.00 Septic system plus water sample 221.00 265.00 Retest/Reinspection 74.00 89.00 Filing Fee 30.00 31.00 Licenses Installer, Pumper, Operator(maintenance person) 287.00 344.00 Retest 117.00 Renewal 140.00 202.00 242.00 • Renewal after January 31 287.00 344.00 On Site Sewage On Site SPAAD 212.00 255.00 Septic Permit with SPAAD (conventional) 159.00 191.00 Septic Permit with SPAAD (alternative) 239.00 287.00 Boundary line adjustment review fee 130.00 Pre application meeting fee 130.00 Planned rural residential development review fee 130.00_ Density exemption review fee 65.00 Density exemption review fee requiring field work 130.00 Other WaiverNariance Application 127.00 153.00 WaiverNariance Hearing 212.00 255.00 Technical assistance-- Minimum 62.00 65.00 Technical assistance--Per Hour 62.00 65.00 Wet season evaluation 287.00 344.00 Revised building application review fee 130.00 New building application review fee: Residential 65.00 Commercial 130.00 General environmental health review fee 65.00 Food Service Immediate Consumption Limited 117.00 121.00 Non-Complex 149.00 154.00 Complex: 0-50 seats 266.00 275.00 51-100 seats 319.00 330.00 0 101-150 seats 361.00 375.00 Alcohol served in multiple areas 117.00 121.00 Not for Immediate Consumption Limited 117.00 121.00 Non-Complex 149.00 154.00 1 of 2 JEFFERSON COUNTY PUBLIC HEATLH t Environmental Health Division - Possible Fee Changes 2005 Fees 2006 Fees - CPI of 3.7%to all d . III �. „ ,-,,,i. „;,,,,,,,,,,, programs: & anadditional 16.3% ,, � t `' to Liquid Waste services Complex v, ..,.._ . a ., , 4 361.00 375.00 Annual Permit Issued after September 1 50% of fee 50% of fee Late Fee (Paid after January 31) 25% of fee 25% of fee Late Fee(Paid after February 28) 50%of fee 50% of fee Temporary Permit Non-Complex 96.00 99.00 Limited 53.00 55.00 Other Food Fees Waiver Plan Review 33.00 Minimum 62.00 65.00 Per Hour 62.00 65.00 Reinspection First Inspection 74.00 77.00 Second Inspection 127.00 132.00 Administrative Hearing 181.00 187.00 Food Handler Card 10.00 10.00 Reissue Unexpired Food Handler Card 4.00 4.00 Manager's Course 181.00 187.00 SOLID WASTE Landfills requiring environmental monitoring 436.00 452.00 Inert Landfills 276.00 286.00 Biosolid Utilization 382.00 397.00 Other Solid Waste Facility Permits 276.00 286.00 • Drop Boxes 127.00 132.00 New Facility Application 351.00 364.00 Plan Review 62.00 65.00 WATER ,".1', Drinking Water(notice of intent) 127.00 132.00 Notification of Availability 53.00 55.00 Well Site Inspection 255.00 264.00 Water Sample Bottles Cost+3.00 Cost+ 3.00 'LIVING ENVIRONMENTS Pool 234.00 242.00 Spa 234.00 242.00 Pool/Spa Combined 319.00 330.00 Subdivision Review Base Fee 319.00 330.00 Plan Review 62.00 65.00 • 2 of 2 Board of.9{ealth Mew Business Agenda Item # T., 3 • Report on SchoolServices by Olympic Education Service Dist. November 17, 2005 • PROJECT TAKE TIME EVALUATION SUMMARY (2004-05) PROGRAM DESCRIPTION MITake Time places a Family Resource Specialist (FRS) in targeted elementary schools to work with children and families who are identified as affected by family substance abuse and violence. • Olympic Education Service District (OESD) is responsible for delivering services PROGRAM SUSTAINABIITY • Funding for Project TakeTime is set to expire June 2007 • Current funding provided through Drug Free Communities Support Program (SAMHSA) PROGRAM SERVICES • 76 children referred for FRS participation in 2004-05. • Referrals of children were spread throughout the year, with the most referrals during the first two months of the school year and rising again in mid-year as the first cohort of children completed intensive services and the FRS had room on her caseload • The Take Time program formally served a total of 42 children in the 2004-05 school year PARTICIPANT CHARACTERISTICS • Most Take Time participants came from the fourth or fifth grades (38% and 50%), with five children (12%) in third grade • The children entered the program with a range of functional difficulties in school and in their interpersonal behaviors • Nearly all the children (88%) had moderate or severe problems with feelings of rejection at program entry • Three-quarters (74%) experienced similar problems with social withdrawal and isolation • 60% had comparable levels of difficulties with being the victims of bullying or intimidation • Nearly all the children (93%) were identified as having moderate or severe problems with uncontrolled or inappropriate anger or rage • 74% were verbally aggressive or themselves bullies • 71% had issues with physical aggression. Consistent with these indicators, most (86%) had moderate or severe problems with classroom behavior or disruption and academic performance FAMILY CHARACTERISTICS • Sixty percent of the families (82% of those for whom there was information) had been impacted by domestic violence • 93% of the families (all of those for whom there was information) had some degree of family function difficulty due to alcohol abuse • Severe effects of family violence or substance abuse on family function were noted for 20% to 42% of those for whom there was information 2004-05 OUTCOMES EVALUATION • Forty of the 42 children (95%) completed or participated fully in the recommended program services • Nearly all the students were judged to have somewhat or satisfactorily met program expectations. • 79% improved their sense of self and self-esteem • 88% had meaningful improvements in self-control and personal responsibility • 61% (25) of the participants were considered somewhat improved from pre to post program • school function • 32% (13) were felt to be significantly improved from pre to post program school function • Three (7%) were judged as unchanged in pre and post program school function • Board of HeaCth New Business .agenda Item # T., 5 • Breast andCervical Cancer Program Report November 17, 2005 • $,,,(*-.e0 JEFFERSON COUNTY PUBLIC HEALTH �r 'I Always Working for a Safer and Healthier Jefferson • 96 1 6C November 10, 2005 To: Jefferson County Board of Health From: Julia Danskin, Public Health Nursing Director Re: October 2005 Breast Cancer Awareness Month community outreach and collaboration report *Girl's Night Out event: Oct 6th sponsored by the downtown Mainstreet Association Three newspaper articles and numerous ads in the weekly and daily papers Article in chamber of Commerce paper distributed in every local newspaper *36 local businesses participated!!! (In a town of 7000 people) Businesses decorated their store windows with breast cancer ribbons, bras, etc...some had live mannequins, many had pink and white balloons outside the shops. The whole downtown looked very festive. There were a lot of tourists and locals wandering in and out of stores curious about what the all the excitement was all about. Distributed 50011111 breast cancer-specific goodie bags for a donation. Local stores, Komen, the local hospital, etc donated goodies. Each had a Breast and Cervical Health Program (BCHP) brochure in it, so that's 500 brochures distributed to people interested in Breast Cancer issues. Mainstreet Association raised $2,600 dollars int their "Girl's Night Out" event. 100% of the funds were given to Jefferson County Public Health, BCHP for Screening Exams. In 2005 BCHP state and federal funds about 85 exams a year. October report Jefferson County Public Health, BCHP outreach and Screening October 26 new clients 10 returning 20 additional callers screened 16 clients had 2005 from Outreach clients by staff who were determined mammograms at the not to be eligible mobile clinic Oct. 29th 2004 total clients receiving screening exams 148 (received $1,500 from Mainstreet fund raiser in Oct. 2004) 2003 total clients receiving screening exams 122 2002 total clients receiving screening exams 93 *Breast Cancer Symposium/ mobile mammogram screening: Sat Oct 29th at the local community center/next to the last farmer's market of the season. Organized by Soroptimists, co-sponsored by the Public Health, Breast and Cervical Health program Swedish Mobile Mammogram Unit came to town, screened 17 women that day Used both events to educate community that BCHP program is available all year at Public Health Department Full day of presentations and workshops including local MD's, local cancer survivors, Carrie Nass from CIS and Cherie Skager from Komen did presentations on Cancer rates in WA and how to do self breast exams, etc. "We got a lot of mileage from having all of these events during Breast Cancer Awareness Month. It was also a real plus having several events throughout the month as it built momentum. It provided a unifying theme yet allowed each organization to organize whatever they wanted." Margie Boyd, Public Health Nurse, Breast and.Cervical Health Program Outreach Coordinator IIICOMMUNITY ENVIRONMENTAL DEVELOPMENTAL NATURAL HEALTH HEALTH DISABILITIES RESOURCES (360) 385-9400 (360) 385-9444 (360) 385-9400 (360) 385-9444 615 Sheridan Street, Port Townsend, Washington 98368 fax: (360)385-9401 web: www.jeffersoncountypublichealth.org Board of Health .Media Report • November 17, 2005 • s • • Jefferson County Health and Human Services OCTOBER — NOVEMBER 2005 NEWS ARTICLES 1. "Flu shots begin for Jefferson's most at-risk",Peninsula Daily News, October 20, 2005 2. "Doctors' departures rattle healthcare"(6 pages), PT Leader, October 19,2005 3. "Bird flu could all economy", Peninsula Daily News, October 24, 2005 4. "Jefferson gets tough on eyesores"(2 pgs.),Peninsula Daily News, October 23, 2005 5. "Illegal dumping now$513 fine",PT Leader, October 26, 2005 6. "Mammogram exams offered",PT Leader, October 26, 2005 7. "Whooping cough cases are confirmed in PT",PT Leader, October 26, 2005 • 8. "Providers' prognosis: (4 pages),PT Leader, October 26, 2005 9. "Bush outlines flu strategy",Peninsula Daily News,November 2, 2005 10. "Nurse: Children need flu shots too",Peninsula Daily News,November 2, 2005 11. "Funding prevention",PT Leader,November 2, 2005 12. "State water rule misused,Kessler says",Peninsula Daily News,November 2,2005 13. "Navy vessel spills diesel in bay",PT Leader,November 2,2005 14. "PT Bay oil spill doesn't require cleanup work",Peninsula Daily News,Nov. 2, 2005 15. "B.C.birds test positive for Avian flu exposure", Peninsula Daily News,Nov. 2, 2005 16. "It Could Be Us....Are We Prepared?",PT Leader,November 2, 2005 17. "Proposed water use limits on tap", PT Leader,November 2, 2005 18. "Prosecutors swamped by meth cases",PT Leader,November 2, 2005 19. "PT council backs bike helmet law",Peninsula Daily News,November 9, 2005 `° r:. t, diii d PENINSULA DAu NEWS N: p C.C N o Shots: Availability c• ti CONTINUED FROM Al coupon or card. All others $28 M Q "c d a ° o ; Olympic .Primary;.Care, for flu shots,$35 for pneumonia E cg °,; 1010 , Sheridan. St.;;; Port shots. .:p C •� '° ° ' Townsend.9"a.m.'to noon Sat- The state Department of r= „ go-r-4.-.:14, urday and Nov.• 5. Medicare Health provides flu vaccine for o w g as �' patients should bring Medicare children younger than 19 who ”' °~ d cards.All others$20.Insurance are high-risk or are household ;j �- N cn-2 a. U °a contacts of a i cannot be billed. high-risk person. M; c~ ■ Port Townsend Family Local clinics that immunize 6 - 2 a 4.q . Physicians, 934 Sheridan St., c d'en also have children's flu • °. Port Townsend. 9 a.m. to noon vaccines. 3 O ° '� a Saturday, Oct. 29. Medicare Until Monday,state supplied ,o 2.0 patients should bringMedicare pediatric flu vaccine is priori- rd o ti ° q ° a cards.All others$20.Insurance tized fCh ', o a, o `i c3•0 • cannot be billed: II Children from 6 to 23 �� ti w b ti ■ South'County Medical months old. Children younger c q q f Clinic,, 294843 US. Highway than 9 receiving flu vaccine for k. g °.2 +' ° o >, the first time need two doses 04. „• 9 Ro &) .a' 101,Quilcene.5 to 6 p.m.Mein- 0 y a,0 o o �,.0 day through Thursdayfor given one month apart. 3; G o q 0 °p 3 w. south county residents only,: ■ Children with chronic 4�; °':a� Medicare'patients should bringhealth 1 conditions such • as ' A ol.,x r4 '' a rA a` Medicare tarda.All others$2asthma, .diabetes or heart clis- • O ■ ■;d a t v a IN v6 N Insurance cannot be billed. ease,Children receiving chronic 5 8 o $ 360-765-3111 for an appoint- aspirin therapy. fGf ,c111) /� ment. �/1 o $y ,c:, I Dr. Richard Lynn, 1136 ■ Children receiving ct .� y : . ,:. : Water St., Port Townsend. 8 II Pregnant teensn therapy is E ■Pregnant under 19 ° ° U. c o y a.m. noon Friday and Oct. ■Children younger than 19 d [ a ,and Nov 4, 11 and 18, who are household contacts or si ° nn y 0 .a ° Medicare 'patients should O' 'n �a . ,. a) 5 bring Medicare cards.All others months of of infants 0 to 23 CJ'' •.".,ti ° ly $20.Insurance cannot be billed. age, or'of children (� ti �, c° ..: with high-risk conditions Established clients only. After Monday,state supplied OCI) o w . ■ Monroe Street Medical Off; ,r, a� v °'' : Clinic, 242 Monroe St., Port same flu groups, piue is childrenfor-the . i/l�; t° g a •S Townsend. Limited su 1 for i ° S. PP Y under 9 wo are lcare 'ves or a .� ° w S high-risk only; $25 per shot.' household contacts of any high- �rr, _ ° x o o 'Call 360-385-5658 for an w a.x ,'U N p risk person. Off' a • • a >'a ao •■ bbilled.appointment.No insurance will, Jefferson County Public 1 • ° c " ■QFC Pharmacy, Hearth will have flu vaccine for 10/ O ury'1890Ipriority group children only 01 dale Road, Port Hadlock. Noon during walk-in immunization 0� 'P N a g m to 6 p.m. Thursday, clinics from 1 p.m. to 4 till > Oct. 27. Medicare and -.Tuesdays and Tursdays at 5 Vii,; . 'alp _ g, Medicaid patients should.bring Sheridan St.,Port Townsend. 0) � V ° tia) tiOo a� °D° � vra '' p� d 2' o ,'" Ela a/ m w 0 cd N a,c.°. w -o `2 ro. S �iz o. q Q'' ' E-1 C. O.° a) " °�� U . 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Opyy 1. ro [ 3_ �a 3� Wr , o - ter° n ” • •ix, / / /4 k3XA ` , , aa 97i / ,-, �, / fi r . /` n i„,,7.:(4f,„;, --'-'1/4--01,-,/,;;,;,;„,„,-,,, 41 ''',:';'r,it.';''''''''''4''''.5*'''''Vp::.`'' $:.:' • i s key pry` rs+ +' .;s . z '^3.aA , ° x r ;,� f - I til 4",,s yyI , xf' T;.-14,4,.;10k;',04',,, /f %�''/y y / 4. r ,:04,444:42.tie.- ,.;;<' , k '4x b 4/y4y/' 4,014:;bi4-'' '.' �gygr , C v 4s .1 i3 b Dr.Melanie McCrory operates her own independent practice With her Own computerized record system.She sees advantages and disadvantages to it.But 0 she's worried that the system-wide change at Jefferson Healthcare is causing some senior doctors to leave or cut back their practices. Photo byScottWilson "made all the decisions:' H E L P iNA N T E D Nowak, the hospital's D o�TD R S Information Systems manager,. seconded that. At the request of certain doctors,..THC began • looking at EMR systems three years ago, he said. Two years , t ``, ago a committee began studying specific platforms, and a year ago the nod was given to A4, one of the largest providers in the nation. A twopart-series ecr, "The physicians have been Next week: ter e_ very active and involved,” Burnout affects Nowak said. "We have worked small town docs hard to tryto have this project bee a success.We're not all the way there yet,but we're getting there." Nowak said JHC implemented A4's scheduling and billing com- ponent in August 2004 and its clinical component in November. "We are in the first wave of the smaller practices" shifting to _ EMS, said Dr. Forbes. Bigger'hospitalnetworks, such as Group Health and Kaiser Permanente, have been at it fora while. "There are not a lot of smaller practices doing it yet,"he said."It's expensive and it does take a lot of time." JHC mhof the , might catch up. Nowak believes ightbe theafedeaderal governmentcurvebut might mcurveandateigthat all clin- ics and hospital use EMR in the next five years.the "It's just something 0 that will happen,"he said. But he added that it will happen slowly and carefully. LO "It's anevolution,nota revolution@ptl,"he said. (Contact Scott Wilson at scotteader.com.) The problem is I'm losing face time because I don't have my face in "The process of choosing and implementing an Electronic Health front of the patient" Record appears to be more complex and varied than we expected," Dr.McGrory,who uses her own EMR system,agreed reported four experts in the journal Health Affairs in May 2005. : "Patients hate the computer,"she said."You are sitting there tap- Another journal pointed to the loss of narrative records as a key ping away instead of talking to them.I do a little bit of entry[in front concern by surveyed physicians. of the patient],but.l do the rest of it after they go.They want me to However the research also indicates that most experts see elec- t talk to them." tonic medical records as the future of healthcare. ID A computerized approach makes sense for specialists who focus A recent national study indicated that 18.9 percent of medium- in on specific conditions,Dr.McGrory said.But it's less useful for sized medical clinics such as Jefferson Healthcare have made the primary care doctors,most of whom are seeing patients with chronic transition.The same study suggested that within two years, 73 per- conditions. cent of clinics are expected to join.Federal health and health insur- "People come in complaining about a sore throat,but what's real- ance agencies are pushing EMR based on the ease of collecting stan- :ly going on is they haven't slept for two weeks,"said Dr.McGrory. dardized data Some observers,including Asbell,believe the federal :The kind of face-to-face conversations that bring out such a problem, government will mandate EMR systems within the next decade. and the narrative medical record that allows a doctor to capture it,are In that timeline,Jefferson Healthcare's move to EMR came early both weakened by an EMR records system,she said. 'in its evolution. Jennifer Lewis, marketing and communications "It [EMR] is excellent for template-driven medicine," said Dr. manager for A4,estimated that a year ago when JHC signed up for McGrory. "But primary care doesn't lend itself to the template uni, EMR it was probably among the first 15 percent of medium-sized verse."When Dr.McGrory reviews records prepared through EMR, clinics to do so. she said she finds"lots of pages of stuff that is not all that useful.It is "We don't have to invent the wheel in Pott Townsend,Washington," not reflecting the thought process of the interaction[between doctor said hospital nurse Harper."Maybe we should wait and see if a good and patient],It is all there,but It sayy.pothing h " ,,,•,,,, ,_Y program comes to us."-If the hospital would sit tight and worlC•with its time-tested paper iecorilk she said,the ui dus`try creating m'3ica1. Computer li'te'racy a factor software could perfect its programs."I just don't know why we need to be on the cutting edge out there, she said. A narrative record included observations and nuances that are Dr. Bringgold agreed. "Although computer applications have a hard to capture in the template-driven database records at the heartlot to offer medicine, a dominant electronic medical record has not of the EMR system,said Dr.Forbes: yet emerged,"he said When it does;he said he doubts it will be the "It's the narrative that takes the time,"said Dr.Forbes."The stuff A4 product,an earlier version of which he studied while in Alaska that doesn't fit into the template's takes the time.Unfortunately,that a decade ago. • is often the most important" Dr. Forbes added that he appreciates the beneficial qualities of JHr EMR,including the speed and accuracy.But he misses the narrative �+i Doctors d rove the of the old system."The quality of my documentation—there's less • • meat to it,"Dr.Forbes said."It gets it[the information]across,but hospital'p Ita I S I g I to upgrade it's not the same.It's not prose." Corey Asbell agreed that some physicians note a change in how JHC officials respond that they moved only at the request of phy- 410 ' themselves. They interact with a patient using EMR But just how far that change " goes depends on the physician,he said. This was Physician driven," "Each one has to balance that liimaelf,"he said."For me,I spend said Dowdle. "They came to us and jiist as much time on the laptop as I used to spend on paper records." said, We want.you g buy this.' There are several other doctors who are very comfortable in the cp a team from m tme EMR environment and believe they can capture a complete picture that incluluded a doctoreach of the patient office, and nurses and practice Asbell said there are fields in the EMR system that allow physi-. managers' They did extensive Pians to write in narration,and added that some physicians are using panicseserch and selected two coin- their laptops to experiment with a voice recognition software that worthy of a site visit might recapture some of the advantages of dictation.The jury on that The physician-ledseid, experiment is yet out Implementation Team,.she said, _ Physician complaints.over 1~MR are not new or unique to Jefferson County. Several stud- ies have tracked the issue nation- wide and come to the same conclusion. The transition from paper to EMR records involves a steep learning curve, affects the narrative nature of the doctor- patient relationship, and some clinics back away from the prac • - tice,the studies say. • .. - CONTINUED FROM Al 2005, , If'the supply. of poultry ......October. 2;. dwindles, 'American poultry ' farmers might find new oppor • - • '.; • tunitiea in filling the void. • But.if thebird flu becomes • r passable between humans or a ■ pandemic"that isglobal; then it's a different story..• ' The price of poultry every- O ' where might go upas chickens y C 'around .;the :world. ' are • destroyed.. r: : Dr.•::Ann .Marie• Kimball, • director of the emerging infec-,, ,tions network, fpx,the Asian'.. e:C0 O Pacific Econonu Cooperation, said countries are likely to . ' embargo or restrict products Washington S''trade froth mp ntces'where 'disease is "China will.know; its'mar kete,the United Kingdom will;• Industry vulnerable the United States will," Kim: ball to Asian epidemic "The importing countries will say, 'We don't want your' productunless you can ensure . - •PENINSULA DAILY NEWS SOURCES it's'free of avian'flu.or SARS '. The bird flu that health officers fear could whatever"! T -_ create a deadly epidemic.in the United States, , On a local level:the domes,-... :: Canada and Europe also has•the potential to tic economy could take a hit as ': make international:trade-- a Washington people avoid public places such lifeblood—sick,too. : • . : "' '` as restaurants,. bars, movie • Avian flu has killed about 60:people around theaters Or shopping malls to the world and millions'of chicken's a pother protect themselves from the' .birds in Asia.A turkey in Greece and parrot in flu. England were found,to have the flu last week .. , .That s what happened in • • (see item.'on Page,Ci). , : . .: China•during its BARS out- ',`Bruce Plotkin; a Seattle attorney:focused 'break a few years ago..,- ' on international health ana trade law, said •• . Minimizingomy* • negative - with the exception of the lost poultry,experts economic effects::avi11;depend have yet to•quantify the:cost of the avian flu on•how'clearly acid accurately'• to Asian and other economies: :• • the. government _:commune But they know it will have an effect and cafes information about he' how damaging it will.be depends on how well • di eas - governments, businesses..and public,health f• • g,,hctvr_w,ell thaJiu • agencies work together. , and health' '•sectors.. •wo=k ' •Plotkin, who splits his time:between 'together and whetherthe gov- Geneva and Seattle; has'advised:`tlie World ernment overreacts, Plotkin Health Organization on trade`:aiii 'health'. and Kimball said. issues: ;:�,;i i;;;; Teamwork "between these y groups will help do a lot of • Hindrance:to trade these things like get objective, - :'' accurate information out and • Disease long has been a factor yin interna-'• _. ' ":.tibfi'g'tiade, information about what mea :'` Ja an has hada ban on U:S.'beef and beef aures are really necessary and. •: .products'since 2003;after.health . officials des- what may not be necessary," •• covered a case of mad cow,disease in the Cen- Plotkin said. • tral Washington town.of Mabton '• Several.countries refused exports from Peru after a cholera outbreak there in the 'early 1990s. . • And consumers in Toronto avoided buying -' products from China in 2003 after a woman returned from Hong Kong with severe acute respiratory syndrome. • - As far as the avian.flu goes, the most visi- ble effect so far has been on the poultry mar- ket. '. �• "There are winners,and there are losers," III Plotkin told the Tacoma News Tribune.: ' Some countries already have enacted regu- lations on incoming Asian poultry,which will certainly hurt chicken farmers in Asian coun- tries. TURN TO FLU/46 • • , "•ei ..."..'",4 , :, :-.7•• - ...-.. 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CONTINUED FROM Al I In response :'to Health ' Citation would come(first Board`member Jill..Buhler Under. the 'new. law, raising concerns,,about',cars McNickle said that" , being restored;MCNickle'said citation would be written, giv vehicles clearly under restore-a- hg a property owner time to tion.would not be targeted• clean up the problem. Marshy .C resident wac reKaede If the owner refuses,then a said she was concerned civil infraction would be about the could not a a ten, carrying a.hefty fine of writ- law it could not afford i- 631 per violation'per day enforce, either through Envi- while the matter is resolved. the coutal Health staffers or through the system. ' the courtsystem.not see Chief Civil Deputy Prosecu- "I would not like to this` ' for David Alvarez told the Marshbe h •unfunded mandate;" Health.Board that the court said. t ' .. McNickle;however,said the ',system resort."should be"a weapon of last county is budgeted to enforce.'- He said onceacompSuch court cases often take the les c ` is . more than 18. months to ' : laint• � resolve,he said. • filed with Environmental • . The board debated the Health, a department:official issue of bow many junk v h will respond:to the site within cies.constituted a need for 24 hours. enforcement.` • Apaloosa Drive resident While County Commis Dennis rued-:.was velli ed • ' sinner Phil Johnson,..D-Port that' burned-out.'dwellings . Townsend,•'urged •that. one -would fall under provisions of Tovewne be the. eimit, Health what n county employees would. . Board member_Sheila Wester- cleaTh t • _•" ,man'said she believed the '"That would be considered threshold for enforcement solid waste,possibly haz- i ardous waste,"said McNickle. should be two Junkers. ass in:•empty They.settled on the two-car :' I Tall, dry gr lots,however,would fall under threshold.Johnson, however, insisted a fire district's responsibility, that Johnson, h County not ted posesfire ha said,because it • erate vehicles abandoned in poses a fire hazard: critical areas such as streams or wetlands. "I' think we should have • zero tolerance in environmen- tally sensitive areas,"he said. McNickle said.that now that the ordinance is passed and in effect, he intends to waste no time in enforcing it. "Wewant to get;out there. We just want this ordinance to be passed," said McNickle. "We know where the prob- lem areas are." • • e al dumpin • now fine e BY Kasha Pierzga by Jefferson County commissioners • Leader Staff Writer and the Board of Health on Oct.20, county enforcement staff can now Got a couple of junked cars rust- prod people into cleaning up their ing away in your yard?How about property by imposing fines when an old refrigerator or a pile of house- they fail to clean up trash or junk hold trash? deemed a public nuisance. Jefferson County has just the tick- Under the ordinance,people who et for you a solid waste violation are cited for illegal dumping cath be ticket thaat will cost you.$513 fined$513 per violation.per day:fulfil Under a new ordinance approved See'YVASTE,PageA73.: Waste: County fine . . Continued from Page A 1 the mess isf cleaned u : s , keeping it under a covered area, pe 4 that's fine. But not if it's in the ' Those fines can add up.That's . y • because each derelict vehicle or 0 growingmiddle through gh it.' of yard with weeds �rnsightly pile of trash can be ;�5�� "� _ . t ' Fy' i Enforcement:of the ordi- ;considered a separate violation, " nance is triggered bycomplaint, depending on the:circumstances, P �,. . said Mike�McNickle, Jefferson 4.<41W1 � ,.,: McNickle said.In other words,if nobody complains about junked County environmental health ,'� :director. cars or other solid waste piled - • ' up on a neighbor's property,the The ink had barely dried on could be addressed through the county isn't going to investigate the new ordinance when county county court system. i , _, or;write a citation... realth officials sent out a viola- Under the ordinance, county Complaints about cases of 'tion notice to a Brinson resident residents can keep no more than illegal dumping will trigger an whose collection of abandoned one inoperable car on their prop-' investigation of the problem • ars has been the subject of erty. within 24 hours,McNickle said. • trumerous neighbor complaints. However,the ordinance is not McNickle and two other - • • "It's like he's building a junk- designed to punish people who environmental health employees Yard right there in Brinnon,"said are actively restoring old cars or will be responsible for enforc- pne:d local man who showed up using them for parts, McNickle ing the ordinance. The cost of k 'speak at last week's public said. • enforcement is covered by, a hearing. "We ask the person directly grant from the state Department Violators will first receive a what they use the car for," he of Ecology. warning from enforcement offi- said. "If they demonstrate that. (Contact Kasia Pierzga at ters before any fine would be they're taking care sof it, like kpierzga@ptleader.com) imposed, McNickle said. Then they're allowed a reasonable period of time to clean up. "We ask how much time they • need," he said. "If they say 25 years,well,I don't think so.But 30 days,I can live with that." As a last resort, the problem Wednesday,Octol 26,2005 B 3 ammo ram exams o ere • Women ages 40 to 64 who are low and brought to Port Townsend as part By bringing the van here, Soroptimists income and have limited or no insurance of a daylong workshop on cancer and hope to let the community know that these might be eligible for a free women's wellness organized by Soroptimists services are available throughout the year. health exam and mammogram. International of Port Townsend/East This is the third year the group has On Saturday, Oct. 29, the mobile Jefferson County. Services provided to helped bring the mobile-van to Jefferson mammogram van from Swedish Hospital women that day are covered by the County. comes to the Port Townsend Community Washington Breast and Cervical Health Appointments are available year- Center. Twenty appointments are avail- Program (BCHP). BCHP is adminis- round. Those who have insurance with a able that day and must be scheduled in tered locally by Jefferson County Public high deductible might be eligible. Those advance by calling Kate at Jefferson Health and provides free and low-cost who don't fall within the age group but County Public Health, 385-9431. women's health exams and mammo- who have no insurance are encouraged to The mobile van is funded by a grant grams to women year-round who meet call anyway.Public Health offers services from theSusan G. Komen Foundation the above criteria. on a sliding scale. Flut all o vaccine. is Flu vaccines are now avail- 9 a.m.-noon. Medicare patients others$28 for flu shots,$35 for children ages 6 to 23 months, able for everyone who wishes bring your Medicare cards.All pneumonia shots. and high-risk children under to decrease their chance of others $20. Insurance cannot age 19 only. Walk-in immuni- catching influenza this season. be billed. Children's vaccine zation clinics are Tuesdays and Earlier supplies were targeted • South County Medical The Washington State Thursdays, 1-4 p.m.Bring your for clients who are at greater Clinic, 294843 Highway 101, Department of Health provides Medicaid coupon or insurance risk for complications from the Quilcene. flu vaccine for children less card. flu, but now anyone can get a Mondays throughThursdays, than 19 years of age who are • Jefferson Medical Group, • shot. 5-6 p.m. for South County resi- high risk or are household con- Olympic Medical Care,and Port Flu vaccine shots are avail- dents only. Medicare patients tacts of a high-risk person. Townsend Family Physicians, able at the following clinics: bring.your Medicare cards.All • Jefferson County Public local clinics that immunize • Jefferson Medical others $20. Health, 615 Sheridan St., Port children, also have children's Group, 834 Sheridan St., Port Insurance cannot be billed. Townsend, has flu vaccine for flu vaccines available. Townsend. Saturday, Oct. 29, Call 765-3111 for an appoint- 9 a.m.-noon. Medicare patients ment. `f' bring your Medicare cards.All • Dr. Richard Lynn, 1136 others $20. Insurance cannot Water St., Port Townsend. be billed. - Fridays, Oct. 28, &Nov. 4, 11 • Olympic Primary Care, and 18, 8 a.m.-noon. Medicare 1010 Sheridan St., Port patients bring your Medicare Townsend. Saturday, Nov. 5, cards.All others$20.Insurance 9 a.m.-noon. Medicare patients cannot be billed. bring your Medicare cards. All Established clients only. others $20. Insurance cannot • QFC Pharmacy, 1890 be billed. Irondale Road, Port Hadlock. • Port Townsend Family Thursday Oct. 27, noon-6 p.m. Physicians, 93.4 Sheridan, Port Medicare and Medicaid patients Townsend. Saturday, Oct. 29, bring your coupon or card.All. • • • • CI y 48 H Q.. ri 14'1 '4 I � ^moi ip #1, ya 1, 111 DA W 1--' . 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A 12•Wednesday,October 26,2005 Providers ' • million each year to pay for what Long hours, ha b i I i ty otherwise would be unfunded services."Our physicians are all insulated from that for now," rates press providers said Dirksen.About 15 primary care physicians work for JHC Continued from Page A 1 ating officer, said it's a result today. not on call I'm in the phone of the high level of commit- Dr.Forbes said that since his book." ment local doctors have for their employment by JHC,"I haven't Dr. Jay Lawrence, an active patients. had to worry about the insur- surgeon here for 12 years, said "The group of physicians we ance situation of my patients. in a small town a doctor is never have here are very responsible, Jefferson Healthcare has to really off-duty.In a grocery store caring individuals who don't worry about that." or at a football game, any doc- want to do assembly-line medi- Dr. Marc Mauney, the part- tor is likely to be engaged by a cine by seeing 40 patients in a time medical director of JHC, patient with a medical question. day and clicking them off a list," described the network as "I grew up in a small town," said Dowdle."They want to care "extremely physician-friendly." said Dr.Lawrence."I don't mind for their neighbors and care for • seeing patients in the store."But them in a holistic way. That's Hospitalist may help it means the doctor is never why they burn out." A key issue for the clini- really off work. Dr. Lawrence In response,Dirksen said the cal medical staff is the extra said that for some of the younger JHC administration is taking hours that go into caring for doctors, the ability to have a many steps. It is having doc- their patients who end up as in- private life that allows them to tors work fewer days, giving patients in the hospital. Those enjoy the natural wonders of this them the freedom to organize visits usually come out of what area — hiking, fishing, boating their clinical practices, and sub- otherwise would be personal —is considered compensation for sidizing their practices in other time — evenings, weekends or pay that is lower than that pos- ways. days off—because they cannot sible in an urban setting. The loss of family care phy- be scheduled in advance and • sicians in this area would have often result from being on call • Burnout,liability factors been much greater if the pub- for an emergency. Doctors need a break from lic hospital district now known Local providers have made their practice for many reasons. as Jefferson Healthcare had not their hospital rounds to ensure "I'm not sure there's a started employing doctors, phy- that their patients know they single pattern," said Jefferson sician's assistant, nurse practi- are being monitored closely by Healthcare (JHC) Chief tioners, nurses and clinic office those who know them best, the Executive Officer Vic Dirksen, staff in 1999,said Dirksen.That providers said. Still, it takes a but many issues. Family issues, decision created a financial safe- major bite out of a personal life. burnout and "issues related to ty net for the doctors because The issue is not new to how people want to live their the hospital assumed the cost Jefferson County.Many hospitals lives"all affect doctors and their for patients who could not pay have created a new position for a decisions about staying in Port or,to a degree, of federal reim- physician or physicians whose Townsend,he said. bursement programs that made job it is to watch over hospital "We're seeing burnout in a only=partial payments. Dirksen in-patients. Called a hospitalist, Medical Group, already try to number of ways," said Dirksen, estimated that JHC subsidizes its this in-patient specialist would perform that service for each Paula Dowdle, JH chief oper- clinics and specialists about $3 relieve primary care doctors in other.One of the five physicians those areas from an on-call role. does the in-patient visits for all "Here that's hard to do," Dr. the doctors one night a week, Mauney said."A larger area can he said, giving the others some absorb the expense,but here it's needed free time off. much more difficult." "It helps our quality of life • Dr.Bill Coyne has moved to and the patients'quality of care," Arlington, Wash., to take just he said. such a full-time hospitalist posi- According to Dirksen,JHC is tion. studying a model in which doc- • The hospital in Port Townsend tors rotate through the position might not have enough in- so the rest of the corps has actual patients to support a full-time time off. hospitalist,said Dr.Mauney. In most communities, there Pay,liability concerns is'ahiin-patient team, notedf•Dr. Even as hours grow•long, Forbes."They are trying to make compensation grows smaller. that possible." Physicians and administrators of Dr.Forbes noted that the doc- Jefferson Healthcare put the sal- tors of his own clinic, Jefferson ary range for doctors at SS0,000 Port Townsend&Jefferson County Leader • Burnout h doctors t � 8 '-,;° ''' r -7.3;1;1;• income down by capping reim- a `•�i, Ps . f bursement levels for certain pro- i cedures. " ' ` Adding to financial pressures �� is the cost of medical liability ' insurance, which has skyrocket a ed in recent years. Dr. Lawrence estimates that the cost of liability insurance for his practice has 41;;/,°' gone from $18,000 a year in 2000 to almost $60,000 today. ' l' For obstetrician-gynecologists °� 1 and neurologists, it's twice that, ` r, ft� he said. �'e 1., Liability has put many doc- .,, , a s tors on edge,said Dr.Lawrence. i y ''t One primary care doctor is going ��"' ' without•liability insurance,'he said. Others have caps, which / ' ' keeps personal property such as ,y a home at risk in the event of r • a major punitive damages, h said.It also forces doctors into a h. defensive posture in treatment of - patients,he said.They will order 1 = '- extra tests,scans and procedures • that might not be necessary but R" provide extra protection in the event of a lawsuit. "It's very _ t ;� �,, expensive" to the system, he 5. r, • said. fah 1' :y mak.. Still, lawsuits against doc x g tors are on the rise. "People talk ' #t _ about `three strikes and you're " -° out,"'noted Dr.Mauney. "Here, • it's two lawsuits and you're out. �� ;F People still expect physicians to i god-likeinfallible. They i, , r . be and :•' s are not." Rural healthcare providers face an in creased risk of burnout.They often Concern over liability has Dr. work long hours,and their personal lives are subject to constant interrup- Lawrence and almost all other tions while on-call or walking through a grocery store. Photo illustration doctors supporting statewide voter Initiative 330 in this elec- to $150,000. That looks good tion year,which would cap puni- compared to most wages in five damages against doctors in Jefferson County. But providers the$250,000 to$350,000 range. can usually make more money Likewise,the doctors oppose the in an urban setting,which leaves competing Initiative 336, pro- rural organizations such as JHC posed by trial lawyers,to sustain looking for providers willing to punitive damages. make some financial sacrifice in exchange for living in this beau- Safety net • tiful place. Hand in hand with the growth Comparisons must also take of insurance issues are other into account the fact that doc- forces that providers say make ii tors emerge from medical school harder for them to do medicine. • with 12 years of college edu- A physician working a 9= cation, said Dr. Mauney. Most to-5 shift seeing patients can of a medical school education count on doing paperwork until is funded through student loans 7 orr8 p.m.,said Dr.Gary Forbes that 'have-physil'i'n's 'stattil o''')eWWer'sd lh laical Grob. • their careers tens of thousands Often doctors are catchingg up of dollars in debt. on records during evening hours At the same time, insurance- or weekend hours, and often ai driven compensation pushes home. Need appointment? Consider the options . By Scott Wilson work. Dr. Douwe Rienstra's • Leader Staff Writer Monroe Medical Clinic, Dr. Bruce Stowe's Madrona Hardest hit with the doctor Family Medicine,along with • shortage are patients looking independent physicians such for a primary care;physician, as Dr. Melanie McCrory, who are either new to the Dr.]arises'Rotchford and Dr. community or left behind by Jack Hutton are examples. adeparture, ' Most independent clinics are Most Jefferson Healthcare advertising for new patients, (JHC)-connected physicians especially Dr. McGrory and are already extremely busy. Dr. Rienstra. But to sustain At PT Family Physicians, their independence,they have • for 'example, Dr. Claus opted outof the reimburse- Janssen and Bob Bammert ment codes and restrictions PA-C (physician's .assis- mandated by health insurance tant-certified) are struggling companies and instead charge to keep up with the patient patients directly on a per-visit load deposited by Dr. Doug basis.Patients are then free to Kurata and Dr.Taylor Dunn's pursue reimbursement from departures, and Dr. Brad their insurance companies. ' Bringgold's shift towards the Several of these indepen- emergency room. dent physicians are on the out- "It's difficult to see patients side of the EMR controversy who need to be seen," said affecting the JHC-connected Dr. Bringgold. "It's hard to doctors but have heard an ear- see patients within the prac- ful about the frustration. tice, not to mention new Dr.Rienstra relies on die-" patients." tation and paper records for JHC's Paula Dowdle,chief his practice. Dr. McGrory operating officer,agreed that launched her small practice the changes "hit that one with an off-the-shelf EMR office in particular," refer- system called Soapware and ring to PT Family Physicians, said she is gaining speed over • home to most of the county's time. most experienced primary "At first it took me three • care doctors. days to get two patients • A physician in another done"by entering and updat- JHC-connected clinic, Dr. ing their records electroni- Gary Forbes of Jefferson cally,she said.Now,she said, Medical Group,said it's been . she likes the system and finds tight for a while. it useful. "My practice has been The IHC clinics that are closed [to new patients] for all on the A4 system employ three or four years now,"said most of the doctors in this Dr. Forbes. During that time county—about 75 percent. the only new patients he's The hospital started hir- taken in are kids or family ing physicians and their din- _ members of existing patients. is staffs in 1999 and 2000. As an alternative, JHC's Because of low federal and Urgent Care clinic is seeing private reimbursement levels, more people.It's open week- most private clinics faced nights, 5:30-8:30 p.m. at the financial headaches.In 1999 hospital, and charges clinic the hospital district stepped rates.Various physicians do a in to offer employment to shift in Urgent Care. doctors and clinic office Dr. Bringgold said he staff. Hospital employment appreciates the clinic but said meant the hospital would it cannot replace a primary subsidize the low-pay or no- care doctor. pay patients, a commitment "It does not meet the needs that last year cost about $3 of some patients," he said. million, according to JHC Because they are older,many Chief Executive Officer Vic • Jefferson County patients Dirksen. have chronicillnesses that . In addition to PT Family don't go away,he said."They Physicians,Jefferson Medical don't get cured," he said. Group and Olympic Primary • "They get treated. They can Care, the one-man practice do well with treatment but of Dr. Richard Lynn and - require ongoing care." the South County Medical Other alternatives include Clinic,led by Merrily Mount the practices that remain MSN, ARNP, are owned by independent of the JHC net- Jefferson Healthcare. . , ..,. . I i 'iIndependent o,tors ace Ipq f ueeze from. lilsurance firms There was a time in the prac- lic hospital district now called patient is going to pay for that ` tice of medicine when a new doc- Jefferson Healthcare(IHC)hired extra time. But some patients, s q' - tor could come into a town,hang many doctors and staff of that especially older ones who might u6., out a shingle,open the doors for clinic, but McGrory took some not feel their physician is hearingt : business and more than get by. time off. She opened her new everything they have to say, are , ,� ';.. Because of sweeping changes in office in May 2003 in the warren . willing to do so,she said. k �` the practice of healthcare, how- of medical offices at 1136 Water . In terms of medical records, � ever,those days are waning. St.,where she works a part-time Dr.McGrory said she started her , %': The costs of running a small schedule.Drop in the office,and new practices with an electronic , , r4' ; clinic are high.The costs of habil- the smile from behind the coun- medical records(EMR)platform Y ' '' ,' 'i y;,,,. ity insurance are on the°rise. The ter.you are likely to see is hers, called Soapware. While it took` s ;�, g • ' level of mandated paperwork is With about 15 local physi- awhile to master, she said, shej, t, rising. The gap between services dansnow employed by JHC, now finds it useful and efficient. / `'R !offered and the reimbursement Dr. McGrory is now among Patients might enjoy the time y >y f levels from federal and private the minorityof local ', y i f provid- they spend with Dr McCrory, „,,A0,7011•,,,,, ,,-,4$ insurance is growing. Insurance ers who have remained inde- but.the.independent physician ' 1.., coverage increasingly pushes pendent of the hospital district's, notes that reimbursement trends :f 7 i` providers into specified options, employment. h - P p yment. Others include Dr. are lining up against her. Dr. Dr.Melanie McGrory 1 limiting the discretion of provid- Douwe Rienstra's Monroe Street.•` McGrory, .likesome other.rode ers in the field. As described in Medical Clinic,Dr.Bruce Stowe, pendents, has declined the more Kreidler to seek a correction. t. last week's article, the switch to and Sandra Vanvig MN-FNP of restrictive appointment and bill- . "We ;feel that this is• an electronic medical records is also Madrona Family Medicine, anding templates of the.insurance infringement of your rights as . changing the practice of medi Dr.James Rotchford '; companies that get a provider a consumer, and amounts to ali Like Dr: Rienstra, Dr on a "preferred provider” or. restriction of free trade for health. this environment,what Dr.` McGrory's office relies upon.a "in-network" list, As 'a result, care providers," she recently Melanie McGrory is trying to do unique financial structure. After increasingly the big insurance wrote a patient. "Unfortunately F in a small clinic in Port Townsend years;of battling with insurance `companies are reimbursing the as a small solo practice we have looks like a step back in time. companies over What the pro patients of such "out-of-net- no pull with the insurance corn f4 She is running her own clinic viders consider inadequate. and work"providers at a lower rate.. panics or the insurance commis= :on a part-time basis.with part- restrictive reimbursement prac In-network providers areaid u sioner. P P Hopefully as their paying time transcriptionist and medical tices, these offices do not bill to 90 percent of the cost of the customer and a voter in this state records help. insurance companies at all." They, visit; out-of-networkroviders P you may have more clout." Dr. McGrory came to Port directly bill the patient for the ,, get between-60'to,70 percent, She encourages patients to Townsend in 1996 and for several time spent with the provider. she said. And some companies, contact Kreidler at 800-562-6900 years worked as one of the doc- They provide the forms neces- including Regence Blue Shield or cad@oic.wa.gov. tors of Olympic Primary Care, a sary for the patient to then pursue and Premera,have stopped rem- 1 j private clinic. In 2001 the pub- direct reimbursement from the :bursing 'for out-of-network pro- 1 insurance company. viders altogether,she said. • ) HELP WANTED. "The patient determines "They are no longer going to Correction DOCTORSthe time" he spends, said Dr: allow you to apply the charge to The name of Merrily M. , McGrory, and thus the amount your deductible," she said. That Mount,MSN,ARNP, was • of his bill. 'decision is making it very hard omitted from the organza- _ � -'-!,',44,X;,-,,,,,, An advantage of this system on the smallproviders to survive ' � tional chart as director of" 1 ,' ti,, is that a patient doesn't need to . she said. "I don't want them set- the South County Medical , .- 4.,4-1,,,i,7\,-„,„ rush through his time with the ting my rates,"she said. McGrory Clinic in the Oct.19 Leader. F3„ doctor, said. She will Many independent physicians Mount is a strong propo 1 schedule up to 90 minutes with face the same issue. 1. a patient, if desired Providers'':: Dr.McGrory tryingto fight rent ofs electronic saying ; is � records (EMR), saying ; *Second ! at larger clinics usually schedule' back by getting Washington State they have linked the South their 'time in 10-minute to 20-' Insurance Commissioner Mike' ':t County clinic seamlessly -; two-part minute visits, and stick to that=` Kreidler involved.She encourag- with the rest of Jefferson ' . schedule with rare exceptions. es her patients who have trouble Healthcare. j seri Of course, Dr. McGrory's" getting reimbursement to contact I i A Bushoutlines flu strategy c.,_ ol .oEm o 9 ry En a o �,• .c�eo" coL , a. �' xo ° y' c)-8 .MZ 6 = 0 •13 .,..fif ir /1,;l',.---lwr...- - :-.7-- „Nri CO i'' 1tV; : oh c. nn 3 a) =E2 69:2c:33 4i,k ''''4:V.' y {4 fi E o car, o m O �� °� y 0 a. a - .:...w." " r a) (.0a) c C U 0 U 0 cn . 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Up O '� o g N O ca ,., 0 cd cd a.� a) cd -'b N CD cd.'4O•' 8 b )., .., cd^. ca n F. ,1 `.,r 3 �F 'G 5 O H ' bb"E F a o Ou) `:F,�'O-a)o P,W ?, � O~ aha c`ia1 (+-a \v V,f T I. 7 E..00 ccd N O p ' c) 0 cad ° a^'F. .9 ).°•3 o y 3 m .fin •9...W 4 cd a a) m G i--�-.1 C/•) ^a E- 0., m C ., O �, o ..,- .., i-. o m c.) q 3 P� a,c) d., 0 d 1 urse: Children n04111u- shts t,:_: .!,, ..,. :,� 0 _, 41444 ' * -i," . Z :-:,:,4",;-.2 -,„ i. ..a .... 3n�`'✓"or g�"� z.w�srf.�r 'std Jefferson Public Health authority south countydiCwater � s a . Cluuc 29484 Highway 101,,. a.m1 to;ao a ,"" b�, `.,_,,,,,,,,,i-,,-. urges vaccinations for youngsters . Quilcene5 m to 6 P•m 11 and ls ' i�3kz i l -z—Q S ,,,7Ylond"-\'''''---trc$i hw 'hursdays ' todle at- ' ' ", 'y,f ,� t t !w r.vc* � 1�+4'bF are-�'Patl. nts�i� PENINSULA DAILY NEWS - In �O' t a ,Vounty'�,lresldents -13‘. g their ediCare -d l years of age who are in certain ,� t r asere . ds.A1ii''''- high-risk oU s. aisrr �.t L 2Q An� n a PORT TOWNSEND—The p Centers for Disease Control Influenza vaccine made for f ,e. 1pat2ents,W-, ou'lc v"bel blIlecl r st,,► e ee1�xi �briri tl�air�Vledreare caxcl All .omY„, :1� ,-�� .P s , . children under age 3 is reser y' 1 r Thr , % ,, sas % recommended schedule of vac- g p o t'ersl i x Insurance ca,,,,:t s M vor mdre az ftlrmatioti.vpo , s cines for children includes an vative-free. rw Children s flu shots are „ b pw.Ja 1`366 785 caro urate at 86E385r.940Q, o`T' annual flu shot as a routine g ortan"apo tment 4�f,,`4, �tsendf",e=mall44' tr' `�kiu6a' eaor immunization for all babies available from area physi , 4� r is a, a, k and toddlers 6 to 23 months cians clinics who provide rou ,��� ` ' l-- �'- ,u� °oVeffer$o�tr'a r�,s "'-22'}, .,�vr,,� ,, �, 1+�,:. .,, ,;:fes old, according to Jefferson tine childhood immunizations" `'" County Public Health nurse- Jefferson Medical Group; Jane Kurata. Olympic Medical Care'and.: According to the Centers Port Townsend Family Physi-. for Disease Control; .childrem. ,cians,,. and from. Jefferson in this age group are.at eub County Public ii',ealth. stantially increased risk for Walk-in imiiiui ization clin-'1';' influenza-related hospitalize- ics are held from 1 p.m. to 4'' tions.". p.m. Tuesdays and Thursdays. A child younger than age 1 at Jefferson County Publico who catches the flu is as likely Health, 615 Sheridan St., Port; o -need hospitalization as Townsend. eone over age 65. Jefferson clinics providing Infants from birth to six flu shots for the general public months have an extremely include: high rate of complications ■ Safeway Pharmacy, 442;.; from the flu, but these chil- Sims Way, Port Townsend, 9-' dren are too young to get flu a.m. to noon and 1 p.m. to 5` vaccine. p.m. today. To protect these infants, ■ Olympic Primary Care, anyone living with or caring 1010 Sheridan. St., Port"4 for babiesyounger than 6 Townsend, 9 a.m. to noon Sate. months old should be receive a urday. flu shot. Medicare patients should,;' The 'state Department of bring their Medicare cards.A1i Health provides flu vaccine for others $20. Insurance cannotA; children younger than 19 be billed. " 1 • • y x „ • ni y f, Funding prevention JJ Susan Windle(second from left)and Sue Arthur(far right)present "4) a check for$2,665 raised through the Main Street Program's"Girls j,j Night Out"to Julia Danskin,the public health nursing director for X11 Jefferson County.The money will help fund breast and cervical examinations for low-income,women.Marjorie Boyd(far left)coor- dinates the Breast and Cervical Health Program.Boyd said all the money will be used locally. Photo by Steven J.Barry t y 740 ' -4, 0.2 r.: •"i10 • Q� • p- 8-5o O 6 3 mUU!- ' � E G:. €9 .43. . 3 NZ-� w0 2OU . 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CYC, Don3 � v, C •i v 7:1 'y p �crj' N N m o J -, as a. t C al cnw • y o 3 a .7).fl y 0 c CJ. cia > E° co ate' o0n, o 0 � V � Q - .� . °0. v) . -A 10•Wednesday,November 2,2005 • :SpillNavyis investigating • Continued from Page Al 28,members of the ship's crew the opportunity for a spill that's Base Kitsap,who contacted the began transferring diesel fuel hard to identify,"Holcomb told vessel,the guided missile frig- from a tank to a generator. The Leader Tuesday. "It was a "It was a ate Rodney M Davis. Crew members didn't realize significant spill." ZZI. ��SP "Our concern was that if they had spilled about 200 gal- Naval public affairs provided significant they were unknowingly pump- Ions. an e-mail contact for the public ing fuel into the bay they need- According to Ron Holcomb, "information officer aboard the Ron Holcomb ed to be alerted,"Polizzi said. a member of the Washington Rodney M.Davis,who said they spill response team "[The smell] was really, really Department of Ecology spill are conducting an investigation state Department of Ecology strong, and then it would get response team, the crew didn't but cannot offer details until it stronger as it was moving into follow Navy or Rodney M Davis has concluded the beach." standard procedures for a fuel The environmental impact sonnel started arriving about The Rodney M. Davis frig- transfer. The Navy's standards can be deadly, but there were 3 a.m. ate was anchored in the bay for call for fuel transfers in day- few immediate problems from At first light, the assembled a vessel change of command light so the crew on watch could this spill.When diesel first hits 'team of spill experts once again ceremony before it cruised detect a spill. the water, it is quite toxic for didn't smell or see anything.The to its homeport of Everett on "They were way outside the several hours until it begins to Coast Guard flew over the area Saturday. About 8 p.m. Oct. normal standards,so it allowed thin, explained Holcomb. Any and couldn't identify a sheen. sea birds that ingested the fuel Navy personnel searched the could die,he added.There was beaches for signs of a'serious already a ban on collecting shell- impact and didn't find any, so fish due to red tide. However, they decided to let the wind and the spill could have killed the tidal action mitigate it naturally, eggs of spawning forage fish if said Murray. they had been laid recently on Murray stressed that the spill the beach. ' didn't come from Indian Island Sally Davis,walking her dog operations and that the vessel on Saturday morning, said: "It• crew was conducting an inves- definitely smelled.It wasn't nau- ligation. seating,but it was unpleasant.I On Monday, Thompson and was worried some sea life might another member,of the state be suffocated under the sand pol- response team patrolled the luted by the fuel." . affected city beaches and found a After being notified by sheen in the seaweed washed up the,police, the Navy crew by the tide from the Washington and command immediately State Ferries terminal to the boat began investigating, but they haven. They thought the wind couldn't smell anything, said and tides would disperse the oil Naval Magazine Indian Island in two or three days and plan to Public Information Officer check it again today,Wednesday, Sheila Murray.The ship's crew Nov.2. couldn't begin any cleanup at "It was still visible on night because Navy manuals Monday,"reported Thompson. prohibit mop-up operations Department of Ecology in the dark as being too dan- officials have asked the Navy gerous, so they notified the_ to do a thorough assessment U.S.Coast Guard,Washington Nov.2 so Ecology can decide Dephrtment of Ecology, and a this week if a cleanup is nec- Navy response team.Navy per_- essary. If diesel sheen hasn't dis- appeared by ,Wednesday, Thompson said they might have to,remove the dead eelgrass and other tainted vegetation near the tidemarks. They don't want to do`this unless necessary, how- ever,because shellfish and other beach critters need the nutrients ,d the habitat from the vegeta- .. e survive • ' 6'esday morning shore grass'upended by the strong -: I`wind Friday and Sunday.nights • • F'appeared tobe saturated with. • oil,but anorthwest wind seemed to be carrying that material into the bay.. (Contact Janet Huck, at jhuck@ptleadercom) • A8 WEDNESDAY,NOVEMBER 2, 2005—(,n IllPT Bmi a oil spill y _ drequire; cleanup work 4 No significant in Olympia. { He was in Port Townsend on' damage found, M. day agseda sling any marine;, say "The good news is it doesn't officials stay inthe environment very, long.It tends to dissipate." BY JEFF CHEW . Two other Ecology oil spill;{ PENINSULA DAILY NEWS responder staffers visited Port; - PORT . TOWNSEND _ Townsend on Saturday,he said:;: • Even with some sheening No dead animals found sighted along the shoreline last ', • weekend between the ferry ter_ No dead marine animals.• ?. minal and Port Townsend Boat were found near the shoreline,;! ... ._ . . Haven, a 200-gallon marine he said. diesel spill was not significant "What we found was some • enough to require cleanup, a of the dead eelgrass deposited _ of state Department"- .Ecology at high tide still had some:' official said Tuesday. • residual diesel in.it,"he said. An initial investigation into Eelgrass is feeding habitat." • - the spill shows that it occurred for fingerling salmon. aboard the guided missile Holcomb said he planned to,. frigate USS Rodney M. Davis, return to Port Townsend today; caused by a crew member Map-' to examine the shoreline for: prop/lately transferring fuel at any additional signs of damage. night, which is against U.S. Residents walking near the Navy procedures. , shoreline reported a diesel odor The frigate, not connected' to police and firefighters over with Naval Magazine Indian the weekend. Island, was headed to Bremer- Holcomb said it appears ton,officials said. ' that diesel was spilled aboard State Department of 'Ecol- the Navy vessel "and some ogy oil spill responders came to escaped the vessel" before it Port Townsend on Saturday was noticed. and Monday, responding to the At first, he said, Navy offs- spill that occurred about 7:45 cials thought the spill was con- p.m.Friday about 1,000 feet off tained to the deck. the Port Townsend shoreline. "We're still awaiting a "The bad news is it's highly report from the Navy," said toxic initially when it hits the Holcomb. water to aquatic organisms," "It should not have occurred said Ron Holcomb, hazardous and if they followed their own materials specialist for Ecol- procedures, that wouldn't have ouy's Southwest regional office_ happened." • • • PQN , :•C: birds test positive for Avian fluexp ur° ' ... Tan P i year,KOMO-TV reported hes The British -Columbia sent to a lab in Winnipeg Min VANCOUVER x dymit.Y. Bntis� in'ovincial health officer, PerwatoFia, were'captured on the; .:. .1.`Columbia ' Health officers lai,? The H5N1 strain is the.killer`,Venda j said.,"We are all:ve01. British Columbia mr,nland, ;- British Columbia eine reporting b 'flu:from Asia which' half'''.'concerned -about H5N1: We- The.' British Columbia` that 24 percent of healthy,wild. alarmed health officials who, 'have no reason to believe this is announcement came as Presi ' birds sampled m August show; say if that,strain mutates H5N1. , .dent Bush announced he was .. exposure to Avian fl u}� :" '3 �y; and becomes ; transmissible "In:. fact,,,. itis entirel asking� But they : !' ngress for a$7 billion . say gone:had thg :human-to-human:-- it could unlikely thatit will be. But We effort toand H5N1 strain that resulted ni create a deadly flu'pandemic ' to be dome with a pa • F .do have that testing guar against or de�.1 the killing of thousands "et' Fourteen of the tested birds ,yet" pandemic. ckens in tlie provincelast` had an H5 strain,however nt o effective • ?�IQr is develop- All ofthe b�rds�wYick will be. ment.of an vaccine • iii. ,, ...,.. rt,;, --,_;tiI 1 t7,_;t Ciip Place *TheLEAI11tJt� 2hiS November 2,2005 page Jefferson County WEEK Inside*Obituaries B 4-5*Sports B 7-9 • It Could Be Us • • • . .• ,. . r., . . . Are You Prepared ? il• SCENARIO:A massive earthquake ravages the Puget Sound region,leaving downtown Port Townsend in ruins.Countless homes in Jefferson County SHELTER/TOILETS are severely damaged,and there is no electricity or running water. FOOD A major earthquake,volcanic erup— tion or tsunami could leave your The Hood Canal Bridge is out,and Highway 101 is blocked in Jefferson County.In the event of home completely destroyed or amine a major catastrophe,the food sup- , habitable.Inside your home is some- .. landslides.Authorities are scrambling to quell the plies at all area grocery stores and thing itwoditake you - ^'• chaos and confusion in major population centers. :; , ; markets would likely long to start missing: 1 P P the�"oomWithout • Jefferson County is at the end of the road. b< utes,a out ingwitto proper planning 1 t - minutes,according to the county Department human waste coma It will likely be days before immediate .- a Emergency stag to accumulate �i a gement thethroughout• town ` help arrives,and months or even : It is essential to have and become a health r your own food ready hazard. - years before anything dose to _L •Pack a tent large n rr. e - t` food will leave good enough for your fame - normalcy Lreturns: 4 cr -. - q' ;_r r witter h the pared to deal coo- lly, or materials to 4... f, �r�" with the auranofin con- build a temporary _ #-�. It S shelter - something �4.,._ y;r, ditions of a disaster. that willyouo could strike' r s a - Pack enough keep + t'.'�e rl-'4-?.1"'- •• ' canned food and dry of the wind and mut l` readyor4-,,,,,...4-,14,4d ' r r f, a 0 ' •Store a bucket and ' a:. � '' -. g� rtfeed evour plastic bags to use - c tai.. 4"•-•-••!'.;,..•-‘ .;,.d'i�^fie I t n member of even a makeshift toilet as t• ^ e • 'l �<y - t; household for seven portable shovel would ryII" 7'''''": days. no doubt be useful. s ,.........t.,:: = y �' ,M�j., ." •Packaged dry atilk •Pack enough toilette ser 2,...,,,-,..,,,,...........,..,,,i t {- Pb^rae i0.j,,,,4,!.„, ,'i"tt�'�.1T"��,:• that end just need wares • Paper for seven days ti .'.*.,,e'''.•'r - F 3 - ,� arc seal bre be sure -;.�t� a ,r iif • Coordinate with .-9-414„..*,* £�" a ,; �+ r sx+ aF, F neighbors to construct ��i,`- r • "•. ';-b .' -' •r� R` +?�.. --'...1. .7...,-.. - to seal them tightly better toilets and tem t:� .k • •,rii" • ,i • and check expiration dates. porary showers,or at a - '- •Be sure it is food minimum to designate i - \ , �. you like to eat Include central waste disposal , - t • _ 7 S some comfort foods Io•caPa k some duce • - � �ey—_,--,14.-.;:--, --.:.-----.„,,....--,..._,„-- is,��.►- _ a411 - -rte o� (cookies, candy) for da�L.J'' s.�-r' ?,-�.f "�'- children. tape and plastic sheet f Asn ��� ' r 'tr4+►t• inR to create a wPo i -�' ;r .••e+ r Pack enough snetrer. sometivng eoufd stake, f t �(t;,f3'4 '.> h 4,t canned food and dry that will keep you out s ,.} re7if(or -• r s .- i ass k r , goods to feed every of the wind and rain v t .14:,:''."!';',;V'...;'''':..:. : i •�,��.., Ik � g r .a member of your •Store a bucket and _ iL r r rcr j Plastic hags ba to use as `°`d°" � 7`�' L � ,�figg i F? a 7`{,p�v��,Y -dry household for seven P Bs .' i .: a +' 7',51'.1--'-',‘4,'.' t� '-', t5A ,. ,9 r-'^? • days. a makeshift toilet.A '[' '` Tt � + ,l.�d' r i •Packaged dry milk portable shovel would - • y Y w,- v',.r and similar items - rio doubt be useful. t ::...5,:: li �a r ,y 4w • �� a "'�f2•p��t s`r that just need water •Pack enough toilet _-t • t� i. r .�° ;,.;,,p,.,....,,,4,.......-. ...i _ wry s r � 9 - t� are OK,but be sine paper for oors seven dwnh 3j �x. k..!,;:„.71-05.. '•� 1- t .:,,,,,,t; t• • 'N.,:.-2,-h„.,,,,-:, a t e ' t ,b v "�' �` to seal them tightly neighbors to consouct 1•,-' ' - �"� #,:- '':- andes.heck expiration F. better toilets and tan •Be sure it is food minimum to de ignor te V1; i 7 - syou like comfo Includeporary s min'unim m designate central waste wasted some comfort foods isPosal [E I locations. g: - ��i ..aTfi Y '�- .rt .53..ort"t 'r" � .' "r"�'i+ children. • Pack some duct ',liti.;�ry�Y e / rte' �'"" - --...k ``r ..tlis�4 �`;ar•w^ •Pack a can opener, rope and photic sheet- i.i „- A't • • �• _J•``V �9 '��- k aasr� " 1 ,� •a '4A �_ plastic dinnerware ing to create a safe .:� a- a . - �A ,•, - — room"in the event of.F'' _ _ 11 � i _>.� j-- Y',. � (utensils,cups,bowls � MF r_�_-- ., r�e6" ""'.� ,y x � w� ,,t"w' plates)and napkins a biological or charm- tT N \ - - ,y„r+ "' :,.,,,,,.....• M.•0a„„^+^'v.�-"" • p Remember to cat attack '''f'-‘: '—.:±•....'"- \ .],,w "r - + ,...4---2,-,,;::::- 4,7 "`� >. • a keeps bit of extra pet •While some areas :: ..Y M�'.rj —;'•'�' 7s - -'" may be designated q �"'l� >>. t � �,, '� .,,�` -`� ." _ f�Pack a small bar- shelters"after a dssus 1 ' -e • • . aa+6 1 -... -- i, basila or camp stove ve tor,do not rely solely 2 ~•"y : .4. t>tt,: t , ,� `*"`' _T--. �tsir '''''''511:\ to cook with,but do on government sup- 'i' / �'W - .s and Panty, friends EMERGENCY CONTACTS p` not 'se'hOSe I`ems and neighborhoods (2JIan Aire Cede 3601. insldq as carbon B _ _ mono�de polsoniag need to help each County Deprmmeel of Emsitenq Dry'etPortTa,nsend:llt-2626 BUSQUEuna en mol Isdeadl ' other. LOOK fora full copy coplaY• of the 38-page Disaster Na a 3a3t,en sa6 rue o mors t.73:u33 del Manual de Preparation •If you lose electric power,use lAhrson tansy Fes Dbakt 2:76t-3333 para Cason de Desastre 2005 perishable foods first and quickly Preparedness Handbook Th„fyq :3a5 Salt nn District 3:431.2236 dispose of any food that has spoiled. 2005 in PDF format atwww. vontom,aena PorDisakt0964450 en www.doh.wa.gov/phepr/ u�aoubt throw It out • doh.wa.gov/phepr/Fact- Polka naps aanC 315-2321 nn pt ire:m rospanish.htm.El manual de 40 sheets.htm. .Fir. p5ginasestbenfonnatoPDF. I • : • • .o „F0 ,r4 ,.I., -o 83 3° 3 ° 30 o . 0 &70 y 0• 1..) 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CD yaw ,.. 3 . o x �x . . . . ° �, cL. � . 4 Port Townsend&JetfersonCounryleader • ieir,:ilsecutors � Meth: Growing • "F iz = Townseswam e can their only _y haw related to drugs or alcohol, way out. I" either because the suspects bad To avoid iierp+�1' N. committed a crime to support their b e i n g -� habit or because they had behaved charged dui `1, cases viohmeth omust agree to receive an evalu- 5— Meth mess ation and comply with treatment ���' By Steven J.Barry handling 12 cases directlyIt is meth that dnves some of recommendations,which usually Leader Staff Writer ' the worst behavior,Dalzell said involve intense outpatient brat- • • d to She said she has been shocked by ment, said Ford Kessler, Safe Methamphetamine-relatedinc easeddramatically crimes eitherssionhe pos-othe depravity of some long-term Harbor director. have• thatincreased so uPProsecuting session of or addicts.In one case she handled, Kessler said about 30 people AttoyJefferson County s the c u my sale etf mine. . , a woman was caught selling her currently participate in Drug Attorney Justis Dalzell thinks the county amphetamine. !R 4-year-old son to a known pedo- Court. The program has a 68 needs to hire another deputy prosecutor. According to r' pie in exchange for drugs.She percent retention rate, he said, • Every one of the staff's five aims, the Superior also said it's common for addicts and five people have graduated. net's is consistently working overtime, Court clerk's to drop off unsuspecting young While Kessler said he knows and Dalzell is concerned about burnout office, convictions for drug-related • women at dealers'houses so they of severalpeoplewhohaverecov- • 'and turnover among her deputies. crimes this year have already surpassed can be raped in trade for meth ered from meth addiction and ' "It's getting to the point where I last year's total.In 2004 there were 18 "T1iat's how bad this drug is have turned their lives around, don't get out of here until 6 p.m—ever," drug-related convictions in Jefferson , __.t takes your the relapse rate Dalzell said."We're not able to cover County.By the end of September this soul," Dalzell in Jefferson the workload with a 40-hour week at all, year,there load already been 22. I said Drug crime convictions where we used to be able to do that" But Dalzell said that what the statistics Dalzell also s o m e w h e r e • The prosecutor's office is currentlysee METH,PageA'lo in Jefferson County between 6 said that in•, ---- _ most cases of 2004: 18 and 80 per- 111. identity theft 2005: 22 cent =in" Jefferson "Nobody - (`January through September) •County, 'the.- who's addicted r. is everfree of `.underlying issueis meth. that.challenge ▪',• Sine 2003,she'said,not only of; .abstinence:'Anyone can`be has activity surrounding the drug sucked back into that if they're r.:increased,but the age of the aver— not taking care of themselves," :z agesuspect has dropped.Dalzell Kessler said. •said some juvenile offenders as :Since it was implemented in young as 15 are testing positive . 2003,no graduate has re-offend- • for meth while on probation ed,Dalzell said. something she hadn't previously "We try to get as many peo- seen in Jefferson County. pie as possible into Drug Court, "We never used to have• because it's so effective,"Dalzell minors using meth.We do now," said. she said. •- But she said some meth users The drug, which sometimes. aren't interested_' includes ingredients such as bat- "There are people who would tery acid,drain cleaner, lantern rather sit out the jail time than fuel and anti-freeze, according get clean and sober.They're not to the U.S. Drug Enforcement ready to give it up,"she said. Administration, is intensely Unless they have a lengthy addictive.Many people become criminal history, Dalzell said, hooked after using it just once. those convicted of possession of Still,Dalzell said addicts can methamphetamine will generally be saved from that horrific down- serve fewer than six mouths and ward spiral if they are caught are likely to re-offend,meaning during moments of clarity.: her caseload will continue to "Nobody's beyond'hope. I grow.Becaus4 her office;doesn't really believe that, I9;llzell.said ' 'v 'lne sa t meth takes "Some of them ge tA'the point s s a. th. where they know they just problem which she described • know—it's either fix it now or "a powder keg the . "You have to be on a mission I think,to stay,"she said. Drug Court ' (Contact Steven J. Barry at For those people, Drug sbarry@ptleader.com.) Court,run through Safe Harbor Recovery_Center._ in Port. tot stuck in one of those fire hydrant costumes t r ` • WEDNESDAY,NOVEMBER 9,2005 A9 III - Fr cou nc� backs bike • 1 • lh • I met law I • nd reading tion on cycling safety educa- tion efforts. • City Attorney John Watts of ordinance said he and Daily agree'that a police officer's first concern in December "is not to whip out a citation." Watts, said that police BY JEFF CHEW would first seek voluntary PENINSULA DAILY NEWS tom , . Othersesaid .state. laws I PORT.TOWNSEND—The already apply to Port City ,Council unanimously Townsend and the city really approved the first reading of. did not need a bicycle ordi- an ordinssnce that would make nance. bicycle helmets mandatory. Council member . Geoff The vote occurred follow= Masci,a Port Townsend chiro- ing a Monday night public practor, said as a health-care hearing on a proposed city provider he must insist on bicycle ordinance. requiring the use of helmets 1 With council members hav- in the ordinance. It was the ing different positions on var- professionally ethical thing to ious parts of the proposed do,he said. ordinance,it is expected to go "Everyone must wear a before the council for a second helmet in my world," Masci- reading in December. said. 'The proposed law,as it now III a p p Council member. Kees stands,does not require bicy- Kolff, a retired physician, • de licensing or registration. agreed. Much of the public concern expressed Monday at the Must be discussed' • council's meeting in the Waterman & Katz building Kolff, however, said he downtown surrounded the wanted issues to be talked helmet proposal. • through before anything was As proposed, helmets_ made mandatory would not just apply to Council . member Frank cyclists,but to skaters,scoot- Benskin said it was up to par- era and equestrians. ents to teach their'children Jane Whicher, ..Port bicycle safety and he was not Townsend Bicycle Association seeing family safety training. president,said after the coun- Council member Laurie cil's actions Monday that her Medlicott said as a former concern was about bicycle hel- nurse she believed"the brain met compliance.,, "Laws requiring helmets is a very precious thing" and have low compliance rates," should be protected by a hel- Whicher said after the coun- met. cil's actions. Council member Michelle • Sandoval, acting Monday as Urges caution mayor in Catharine Robin- David McCulloch,an advo- son's absence, said as a mother, `I m really conflicted cate for the association,urged about this." the council to "think care- She urged a delay in ado t- fully" about writing bicycle p legislation. ing the ordinance with the McCulloch also urged the helmet requirement until fur- city to.fund educationthat , ther discussion. would encourage safe cycling: ' Sandoval .said she would --O_C in the community. like to see the city's newsier- j 1 n/ ! /� J�_7 Whicher and McCulloch ter used for bicycle education. said they were happy with the As proposed, educational programs would be created education component of the' ordinance. through the city's nonmotor- McCulloch said the law ized transportation committee • should serve all economic lev- and any fees or fines would go els, including those who toward such programs. depend on cycles for their pri- The council also added mary mode of transportation. penalty and enforcement, Port Townsend Police Chief cycle impoundment and city Conner Daily said he would liability sections to the pro- work with the bicycle associa- posed law. r NON-PROFIT "IlkAg\44%ket, U.S.POSTAL chreerk7+ r>z nd PAID �� BRINNON,WA PERMIT#9 OlyCAP COMMUNITY CENTERS News &Views Brinnon Community Center P,O.Box 129 Brinnon,WA 98320-0129 Quilcene Community Center P.O.Box 281 Quikene,WA 98376 Tri Area Comunity Center P.O.Box 207 Chimacum,WA 98325 OlyCAP's Community Centers are here to help senior citizens and other ___ persons in the community have a place:to gather,to have fun,to learn UNrrEp 0000 NEIGHBORS new things, to do new activities,and to meet new people in a fun UGN environment.We invite you to join your friends and participate in the activities taking place at any of our Centers! Spotlight of the Month: OCTOBER: Myrtle Corey Myrtle was born to Vern and Ida Bailey and raised on a home- stead in Brinnon where she still lives. (It's a beautiful place, by the , way!) She and her husband Terry have a daughter in Port Angeles �. and another daughter and three grandchildren in Chimacum. She has been working for the Jefferson County Health Department 1, since 1984, this is her 21st year! She has foot care clinics in the Tri Area, Brinnon, Quilcene, and Pt. Townsend Community Centers. 2 WNL ref&Myrtle was not too anxious to talk about herself but one of her cli- -71'4 ents highly recommended her work and one of the volunteers also said she loves to work with Myrtle. She always wears a great smile. ' ' Myrtle is a member of the Brinnon Community Church and thepru Brinnon CemeteryBoard. She loves to garden and work outdoors, r ;.' �� as you can see at her lovely home. Her husband works in logging, ,.- r•.0 s • construction and lot clearing. Myrtle's parents, Vern and Ida, wrote a very popular book about the histo Myrtle is a hard working and very popular nurse with the Health of Brinnon and the surrounding ar Department. She is loved by all her clients in all the Centers! and presented a program for our 1st Thank you Myrtle, for all you do in our Communities. "3rd Thursday" program. It was great!