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HomeMy WebLinkAbout2006- July File Copy • Jefferson County Board of 3-CeaCth Agenda . 4 inutes • July 20, 2006 • JEFFERSON COUNTY BOARD OF HEALTH Thursday,July 20, 2006 Main Conference Room Jefferson County Public Health 2:30—4:30 PM AGENDA I. Approval of Agenda II. Approval of Minutes of June 15, 2006 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. West Nile Virus Newsletter, Summer 2006 2. Board Correspondence 3. Cyanobacteria Update 4. Solid Waste Enforcement Update • V. New Business 1. EnviroStars award for Dentistry Northwest 2. Waste Reduction and Recycled Product Procurement Policy 3. 2006-07 Tobacco Workplan Highlights 4. Proposed Board of Health Bylaws Changes 5. 2007 Budget Process Update 6. New Vaccines—Costs, Benefits, Controversies VI. Activity Update VII. Agei la Planning 1. On-Site Sewage Code Revision.Process VIII. Next Scheduled Meeting: August 17, 20 2:30PM-4:330 P Main Conference Room Jefferson County*blic Health • JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, June 15, 2006 Board Members: Staff Members: David Sullivan, Chairman— Couny Commissioner District#2 Jean Baldwin, Public Health Services Director Patrick M Rodgers, Vice Chairman—County Commissioner Julia Danskin,Nursing Services Director District#3 Thomas Locke,MD, Health Officer Phil Johnson— County Commissioner District#1 Mike McNickle, Environmental Health&Natural Jill Buhler—Hospital Commissioner District#2 Resources Director Geoff Masci—Port Townsend Ciy Council Sheila Westerman—Citiven at Large(City) Roberta Frissell—Citic<en at Large(County) Meeting was called to order at 2:30 pm on June 15, 2006 by Chair David Sullivan in the conference room of the Jefferson County Public Health Department. All Board members and staff were present. APPROVAL OF AGENDA • Board Member Masci moved to approve the agenda. Board Member Westerman seconded the motion,which was carried by a unanimous vote. APPROVAL OF MINUTES Board Member Masci moved to approve the minutes. Board Member Johnson seconded the motion, which was carried by a unanimous vote. PUBLIC COMMENTS Chair Sullivan called on the public for comments. A member of the community was concerned that t elianguage of the Solid Waste Ordinance is not clear. He stated that the regulations do not specify the number of junk cars allowed on one's property. Another concern was that the-Jefferson Count Public Health website is not being updated with Board of Health,minutes and ag as in a timely manner. - OL]) BUSINESS Drinking Water Week Nominations • The PUD was nominated by the Washington State Department of Health's Office of Drinking Water and staff for the category of Going Above and Beyond award. • NEW BUSINESS Areas of Threatened Shellfish Closures—Jefferson County and Cyanobacteria Bloom in Anderson Lake—Human and Animal Health Mike McNickle reported that the Lake Leland fishing derby was postponed because of a potentially toxic blue green algae bloom. The rising levels of algae were at the threshold of concern. The decision was made to postpone the event because the most recent water test results would not be back prior to the event and public health and safety could not be assured. Mike presented a power point presentation on Surface Water Management. He explained the roles of Environmental Health and Natural Resources and how the two programs work together on this issue. This collaboration includes shellfish harvest closures, blue- green algae blooms, monitoring, complaint investigations, and funding issues. Neil Harrington explained the influence of the commercial shellfish industry and the impact of recreational harvesting. Areas of concern are sections of Hood Canal and Mystery Bay. Mike advised that Environmental Health is working with the Parks Department to monitor all the county lakes that have public access during the summer months. Dr. Locke explained the science behind cyanobacteria blooms and discussion followed • regarding factors that stimulate cyanobacterial growth. Update—Joint Select Committee on Public Health Financing Dr. Locke gave an update on the work of the Legislative Committee tasked with making recommendations on long-term public health funding. He explained that this committee's job is to investigate public health system needs,propose solutions to identified problems, and send recommendations to the legislature for a stable, long term, and predictable source of funding for public health services. State and local public health agencies have done a great deal of work to support this effort, including a detailed report showing what would be done with additional funding. It was estimated that it would e at least two hundred million dollars per =- .to-wide to bring the Public Health system e up to a uniform standard performance acros - ate. Dr. Locke advised that the report is available for those who wo e to view it. Activi U s d e A.enda Pla in Jean Baldw. has evaluate. e Board of Health By-Laws,the Hearing Code and the Ordina "egulation . d will discuss the discrepancies and areas that need revising at t - u y BOH mee : g. There was a •:scussion regarding the funding sources for Anderson Lake monitoring, shellfish coo cerns, and the Surface Water Management Plan. SThere was a discussion on the language discrepancies, between the Unified Development Code (UDC) and the Junk Vehicle Ordinance regarding the definition of junk vehicles and how many are allowed on a property. Board Member Masci made a motion that recommendations be developed to assure consistency between the language of the UDC and the Solid Waste Ordinance and that these recommendations be brought back to the Board for review. Board Member Westerman seconded the motion. There was additional discussion regarding the policy to allow flexibility for those who restore cars. Mike McNickle stated that the Environmental Health Department has been following the policy of"three or more junk vehicles" and the violation of this policy has been enforced. Chair Sullivan called for the vote,which carried by a majority vote with two opposing. Chair Sullivan adjourned the meeting at 3:35 p.m. Next Board of Health meeting is July 20, 2006. JEFERSSON COUNTY BOARD OF HEALTH David Sullivan, Chair Jill Buhler, Member Patrick M. Rodgers, Vice Chair Sheila Westerman, Member • Roberta Frissell, Member Phil Johnson, Member Geoff Masci, Member • • Board of Health 0Cd-Bus iness Agenda Items # 11V., 1 • West Nile 'Virus Newsletter, Summer 2006 July 20, 2006 -\_„ • • WashingtonState Department PiHealth News Release For immediate release: June 21, 2006 Contacts: Tim Church, Communications Office 360-236-4077 Donn Moyer, Communications Office 360-236-4076 Environmental monitoring for West Nile virus underway around the state West Nile virus infection was found in birds, horses and humans in neighboring states last year OLYMPIA—West Nile virus was detected in a horse, a dead bird and two mosquito samples in Washington last summer, yet there still has not been a reported case of human illness acquired in our state. With the warmer months of spring and summer bringing a new mosquito season, the search resumes for West Nile virus exposure in Washington. The state Department of Health is working with local health agencies and other key partners to monitor dead birds and mosquito populations—important ways of tracking the presence of the virus. • `Environmental monitoring detected West Nile in mosquito samples and a dead bird in our state last summer, and we'll be looking intensively for the virus again this season," said Maryanne Guichard, director of the Department of Health's Office of Environmental Health and Safety. "We are testing certain species of dead birds and mosquitoes because they are usually affected by the disease before human cases are detected." In 2005, 660 dead birds, 54 horses and 915 mosquito samples were tested in Washington. The tests detected West Nile virus in one dead magpie, one horse that had not traveled out of state and two mosquito samples. No human cases have been acquired in our state. 1 West Nile virus is primarily a bird disease. Mosquitoes become infected by feeding on infected { birds, and then pass the virus to uninfected birds, humans,horses or other hosts. Crows, ravens, magpies and jays are especially susceptible to dying from the virus. Local health agencies coordinate the dead bird monitoring efforts in their areas, working closely with the state Department of Health. Anyone who finds a dead bird that isn't decomposed should • notify their local health officials, who may want to have some dead birds submitted for laboratory testing. People should avoid handling dead birds with bare hands. Gloves or shovels —More— West Nile virus June 21, 2006 Page 2 •should be used to place the carcass inside two plastic bags. Keep the carcass in a cool place while the local health officials are notified. In addition to monitoring dead birds, local and state health officials are collecting mosquitoes around the state to identify and test for the virus. At least one mosquito species that can be infected with West Nile virus has been found in every county in the state. "The best defense is to avoid mosquito bites," Guichard added. "There are simple steps we can all take to reduce the risk." Turning over old buckets or cans, emptying water from old tires, and frequently changing water in birdbaths,pet dishes and water troughs helps eliminate the small puddles of water in which many mosquito species breed. People can avoid mosquito bites by staying indoors around dawn and dusk when mosquitoes are most active; making sure that door and window screens are in good working condition; and using a mosquito repellent when outdoors in areas where mosquitoes are active. Always follow label instructions when using mosquito repellents. • Even after being bitten by a West Nile virus-infected mosquito, most people won't show any signs of illness. Some people may develop mild flu-like symptoms that go away without treatment. In a small number of cases the virus can cause serious illness including fever and inflammation of the brain. People over age 50 have the highest risk for serious illness. The Department of Health West Nile virus information line 1-866-78-VIRUS (1-866-788-4787) and the agency's West Nile virus Web site (www.doh.wa.gov/WNV) are excellent resources for anyone who wants to learn more. The Department of Health is working with local health partners as well as other state agencies, including the Departments of Agriculture, Ecology, and Fish and Wildlife on West Nile virus monitoring,planning, control and prevention. ### rVisit the Washington Department of Health Web site at http://www.doh.wa.gov for a healthy dose of information. r P BSA T i 4 �� ' 9 _ / J ,.M 4 fis ijr*" 43: :eft- tovst er-- - ,-, '--, : --°,!' -1- ''' : ;- _,,.. �° romp c wire gtar ,-� ash n tori t rt ep�rt n 014qea j June 15, 2006 Volume 4, Issue 4�4 Pur ° e West Nile virus activity in the United States To tcee c ur o,arttters Surveillance findings reported to CDC,May 30, 2006and ether'nterested -'entities informed about West Nile virua NAV) 1♦Indicates human disease tase(s). CDC Avian,animal or mosquito infections. i, MT ND x ill V OR ILt MN 1. SD " ,: ,. I ', i ",. NE i4 P1i IL iN KS tea VA f . N7 &8 8 3. SGA CO P NM ltrt, SC Mb ' AL GA - > 19 ® mm e ¢ ' AK 2 LA t• Wit a4..± e=w a - ? a Rim s • a National maps and data available at http://www.cdc.gov/ncidod/dvbid/westnile/sure&control.htm. .ter , � ! 1 On the lookout for West Nile virus in Washington i ice,e. 1 _ Last summer West Nile virus made its way into new parts of Oregon, Idaho, and r .'ie: , was detected for the first time in Yakima County, Washington. Now that the E mosquito season is under way, the search for the disease has begun. Monitoring , dead birds and mosquito populations are important ways of identifying the ,°8 presence of the virus. The Washington State Department of Health is working . - L,, with local health jurisdictions, mosquito control districts, the military, and other " ' ` ° E4 key agencies as this seasonal monitoring resumes around the state. Dead birds, especially corvids (crows,jays,magpies, and ravens) are often the first indication of WNV in an area. Anyone that finds a dead bird(particularly a corvid 0= . ` or raptor) that isn't decomposed or showing obvious signs of trauma is encouraged to contact their local health jurisdiction. Local health officials may want to submit the bird for testing to the Washington Animal Disease Diagnostic Laboratory in 10. . _._a - ki;o:: = Pullman. s. Mosquito surveillance is also underway. Monitoring mosquitoes`is—, : ical to identify potential amplifying and vector species, their distribution, and to I-tter Starget control efforts. Collected mosquitoes of certain species will be pooled a a ` ,eistested at Fort Lewis by the US Army Center for Health Promotion and 'd ,, Preventative Medicine-West. I .4 veet.tmg ,„eW � E Insects, beware of clothingthat bites back r or� By Deborah Franklin,New York Times,May 23,2006 • �: s A dozen years ago, the National Academy of Sciences convened a panel to weigh the health pros and cons of issuing soldiers combat uniforms that had been ® C .Ak pretreated with the insecticide permethrin. In the end, the panel deemed the i -' e l f 6 � clothing a safe and effective way to help the military prevent malaria, ® - leishmaniasis and other beleaguering, insect-borne illnesses that can pose a threat ¢¢ to fighting forces as great as bullets or bombs. outdoors. Th second I€taho ott This fall, Dr. Gene McConnell, the toxicologist who led that academy committee, report West Nue ctiu1 E in 2066'with Gem ▪ will reach for a consumer's version of the same clothing, now offered by a variety =County issuing a varnin of retailers, when he fights mosquitoes while fly-fishing in Alaska. earner this week'. are"seeing West "I have a couple of these shirts and I love them, not because 4 ctiuity'much early they look good, but because they work," said Dr. McConnell, 1 r than last,W 1 Th V� a former director of the division of toxicology, research and A: Vt,iitivoli". w M� -rake ▪ testing at the National Institute of Environmental Health 11,2,44.14:i*:;,.044t.'1";;.;-. Sciences, who now is a private consultant in Raleigh,N.C. g Dr. McConnell, who does not have financial ties to pesticide ii companies or clothing makers, said he still put a little of the insect repellent DEET = '" oh on the back of his exposed neck on the buggiest days in Alaska, and sprayed some iflitg iuito abatement along the brim of his cap. But he credits the permethrin-treated shirt for warding al�re off swarms of mosquitoes that would otherwise bite through the thin cloth on his V $ rteback as he wades into creeks. %friatit,M,,,,,44114*:sti • ` With the bacteria that cause Lyme disease and Rocky Mountain spotted fever now f " �" 4} ;'� endemic among ticks in several areas of the United States, and cases of mosquito- borne West Nile virus turning up in nearly every state, the threat is no longer just a soldier's bane or a vacationer's nuisance. And clothing retailers have taken notice. 7 --'"',-;V:',.'''' — ;1' Tommy Hilfiger now markets a line of twill golf shorts and cotton polo shirts 1 treated with permethrin. Ex Officio sells treated gardening aprons, canvas gloves "-. and socks. And L. L. Bean offers insecticide-drenched hats, shirts and zip-off convertible hiking pants in tropical colors. V `` Richard Lane,president of Buzz Off Insect Shield, a five-year-old textile treatment ' ''r'1"'-i"' 4' - company in Greensboro, N.C., is behind the patent-pending process that binds the ' ; -;441,";4.614-444,,,,,c4-E 0:4-,,,,:,t, permethrin to the outside of those clothes in a way that regulators confirm will stand up to at least 25 washings. Mr. Lane says he hopes to expand use of the !; technology. "Will we see a Buzz Off tux very soon?" he asked. "Probably not. But I did take one of our jackets to an outdoor wedding recently." Is all this garb really ;, necessary?More to the point, is it safe, and does it work? �` L , For safety, the answer is encouraging, though the data are not all in. Permethrin is ' �4 a synthetic, longer-lasting cousin to a natural insecticide found in .A- 'c' chrysanthemums. Since 1977, it has been incorporated in various products approved by the Environmental Protection Agency for killing or controlling insects. It is the active ingredient in many household foggers, crop sprays, flea dips • ir for pets and lice shampoos for people, as well as in sprays and soaks meant for clothing,mosquito nets and tents. / Unlike DEET or other repellents thought to confuse biting insects by masking Web I e`s�urce carbon dioxide in breath and other body odors,permethrin is thought to stun or kill Washington stake ,milill the bugs by disrupting their nervous systems when they bite something coated with Dparttr►ent of tleslth the chemical—or,perhaps,just get close to it. Permethrin is thought to work even u�u�vv doh iva�ouhrnv better than DEET against ticks. Centers for Disease r Control and Preverition `416vcd6qdv/ Over the years, some rat studies have indicated that very high oral doses of rrC("dtit�dvb idLwestnle`" s permethrin—much higher than those humans would be exposed to in normal use —might also cause tremors and seizures in animals. But occasional skin irritation, Geotoiea!Sunzey� : and hay fever or similar symptoms among people allergic to chrysanthemums, are CC?�Arbz3NET wraps ' liftp Mestnilemar�s users„_ the sort of adverse effects that consumers have reported. goufinder�:iitnat Ur ve lashington Mate Still, one environmental publication, the Green Guide, has objected to sale of the rsityOoaFper ►ve 1 clothing, saying its health and environmental effects are still in question. Extension viuw uonv 4vsv a Marion Ehrich, a former president of the Society for Washmgto State Toxicology and a co-director of the Laboratory for ', >JePartment of Neurotoxicity Studies at Virginia Tech, said that studies7i ' 7 E ��gncuCfure, - . �, � 40 preadily by Q �m �n�w agrwa z�ou�oedAn had shown that permethrin was not absorbed iria ll, n�melt ealthI sea the skin. "It's just not stable on skin,” she said. "It breaks _ , _ sesMtesit411 r rst tefaul ; down quickly." „ n t"htrri That instability, not health concern, is the main reason that the insecticide is suggested for use on fabrics. Repellents containing DEET, picaridin or oil of Northwesttinks E lemon eucalyptus are treatments recommended by the Centers for Disease Control • F Idaho C�epartment o and Prevention for use on skin. Any absorbed permethrin, Dr. Ehrich said,tends to Health 1Netfare be rapidly broken down into harmless metabolites and excreted, unlike some other ;VJvuw westn��e tdaFt�qct _ p Y chemicals that can accumulate in body tissues. {3regon i�tspart er of Human Seices There are no published studies exploring the effectiveness of the permethrin- http flegou Oregon go- Hs r3hfacdldrseasesfuvnit;. treated consumer clothing. But most of the data related to military uniforms have e�surueyghtml shown a protective effect that can be enhanced with judicious use of repellent on �brtssh Cotur b a,Center exposed skin. In one particularly vivid field trial against mosquitoes in Alaska, f :r Disease t trot published in 1988, volunteers in permethrin-treated uniforms who also used a bb 'wwwent repellent containing 35 percent DEET on their exposed skin were bitten an average of once per hour over eight hours; volunteers in untreated uniforms who did not use DEET averaged 1,188 bites per hour. Still, Dr. McConnell urges consumers to resist the notion that"a little is good, so a lot must be better" when using pesticides or repellents. "You have to use your head," he said. "Don't expose yourself to any pesticide unless there's a benefit. If I lived in a tick-prone area,I wouldn't hesitate to have it on all the kids'play clothes. But in the city, maybe not. And I wouldn't put it on clothes worn in the winter when insects aren't a problem. I wouldn't wear it to the office." f � � Vicki Kramer, chief of the vector-borne diseases section of the California Department of Health Services, said some travelers on brief trips to regions infested with biting insects might find it cheaper to buy a permethrin spray and treat their own clothing, though such sprays do not stay effective through as many • �.; : all washings. "Follow the label directions," Dr. Kramer said. "As long as you're doing a that, cost, convenience and personal preference should be the consumer's guide when trying to figure out which of these products to use." Y -DOHv�ru West Nile virus epidemics in North • America are driven Contacts by shifts in mosquito feeding behavior A.Marm Kilpatrick,et al.,Public Library of Science Biology Journal, Vol. 4,Issue 4,April 2006 Tell Free;Info;.Line x-$66 7�1l1R1S Abstract excerpt: Understanding the factors that determine the intensity of the spillover of this zoonotic pathogen from birds to humans (via mosquitoes) is a Publication Requests rere uisite for redictin and prey human e idemics. We inte ated yndi free p q p g p g p gr 36O-2$63384mosquito feeding behavior with data on the population dynamics and WNV 1yna`r` e oh"°q°" epidemiology of mosquitoes, birds, and humans. We show that Culex pipiens, the 1Vlosqutto and B�'rd dominant enzootic (bird-to-bird) and bridge (bird-to-human) vector of WNV in Surveillance urbanized areas in the northeast and north-central United States, shifted its feeding Jo Marie Branner preferences from birds to humans by 7-fold during late summer and early fall, 6f1 236>3064 atltane�araunertc dah:va°° :E, coinciding with the dispersal of its preferred host (American robins, Turdus Horse Surueittarice migratorius) and the rise in human WNV infections. We also show that feeding Hsu Woh ie shifts in Cx. tarsalis amplify human WNV epidemics in Colorado and California ,A0_236-3.469 and occur during periods of robin dispersal and migration. Our results provide a `°"w°�,r�ea°rowan°� direct explanation for the timing and intensity of human WNV epidemics. Aquatic Mosgt o Control NPDES Permit This research featured in a radio piece in the March issue of the WNV Newsletter, Beo l arriiiton is now available online at htt //biolo los ournals.or / erlsery/?re nest= et- 36©236364 P �'p j gP q g fi attamin ha taa6tan dat wa a° document&dot=10.1371/journal.pbio.0040082. WNV in Humes Local Health,l risdretton e©�1 o m ni a r-7-JV-4--:---x Washington environmental surveillance summary bisease idemtotogy Reported to DOH as of June 15, 2006 206- ,,,-1,5&Q or : • 8�7-539-4 44 Horses' aft die' sentiesAl Ftodts asgetto POO* ' ,.- County Tested Poaaiv^e Teated P°4 0• Tested Poaatave Testsd Pasative RAS 46 a : a a 0 0 ai a o �a '" :. 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Board of 3-feaCth Old Business .agenda Item # 117., 2 Board Correspondence • July 20, 2006 • Pac1fk ,_ • SHILFES1 611OWERS ASSOCIATION Partners with Mother Nature sustainably farmed oysters, clams, mussels, scallops July 8,2003 Craig Schrader/Tami Pokorny 615 Sheridan Street Port Townsend, WA, 98368 Dear Mr. Schrader and/or Ms.Pokorny, You have recently received notification from the Washington Department of Health Shellfish Program that Discovery Bay has been placed on the"Threatened" list due to downgrades in water quality. The Department's water quality monitoring indicates elevated fecal coliform at levels that could lead to a downgrade in growing area status if the source of this contamination is not found and remedied. I am writing this letter to request your attention to this serious issue. The shellfish industry is a • clean industry that accrues significant benefit to Jefferson County,both as a source of"new" monies and living wage jobs,and environmental benefits provided through the biofiltering function of the shellfish themselves. We take the threat of water quality degradation seriously. Since 1985,25%of Washington's growing areas have been downgraded or lost due to non-point pollution. The early warning system that places growing areas on the"threatened"list has resulted in some growing areas being upgraded back to"non-threatened"status and unfortunately, in some counties,the growing areas have been ultimately downgraded. When downgrades occur,the corresponding county health department is required by law to form a"Shellfish Protection District,"(RCW 90.72.030)which is time consuming,costly and involved and,unfortunately,not always successful in restoring growing areas. The difference in outcome is the level of commitment and action on the part of local health jurisdictions and growers. I mention this to highlight the importance and cost-effectiveness of quick action on your part now. I look forward to learning what action Jefferson County plans to take to protect your local shellfish resources. Thank you for your consideration of these issues. Sincerely,re 6 Robin Downey Executive Director • \ Olympia: 120 State Ave., NE PMB#142, Olympia,WA 98501 phone: 360-754-2744 fax:360-754-2743 Port Townsend: 2023 E. Sims Way#235, Port Townsend, WA 98368 phone: 360-379-9041 cell: 360-870-9611 www.pcsga.org �O�?O?ORT TOS CityPort of Townsend Office of the City Managerl 250 Madison Street, Suite 2, Port Townsend, WA 98368 'was/ (360) 379-5047 FAX(360) 385-4290 July 6, 2006 9t Mr. Mike McNickleJUL 0 200S Environmental Health Director Jefferson County Public Health Y "s r 615 Sheridan Street Port Townsend, WA 98368 Dear Mr. McNickle: Thank you for your letter expressing concerns with our water bodies. I will have my staff arrange a time and place to meet to discuss your concerns and share with you the steps we already have in place. As you know, Lords and City Lakes are part of the City drinking water supply and are heavily monitored as mandated by our permits issued by the State Department of Health. I am not sure • what more can be added to the monitoring that we already conduct, but we can discuss your concerns when we meet. The Kai Tai Lagoon is not monitored unless it appears a bloom is occurring. Generally public access is not provided or allowed. The City would not object if the County wishes to add this to your monitoring program. Again we can discuss this when we meet. erely, David G. `l'immons Port Townsend City Manager cc: Port Townsend City Council Ken Clow, City of Port Townsend Public Works Bob LaCroix, City of Port Townsend Public Works John Fischbach, Jefferson County Administrator Torn Locke,Health Officer,Jefferson County Public Health Jean Baldwin,Administrator,Jeffe a on County Public Health f, - .,v. .+gripp. 4 L c a e 4 + r . wry .F f., tY' t r `e t d ' 2 rte: '# $ fi '" exrmilw !sE 4Sua wn � �.. 4 `" ..,..„ '4tYfro ',''", � ;o .: r` ^ e-, fix..^..« 4T .r "k ,.5 - i. r., -?7,t ;"• - • A NATIONAL MAIN STREET COMMUNITY WASHINGTON'S HISTORIC VICTORIAN SEAPORT t h CO .f '4 JEFFERSON COUNTY PUBLIC HEALTH Aixo 615 Sheridan Street • Port Townsend •Washington • 98368 II www.jeffersoncountypublichealth.org June 23, 2006 City of Port Townsend Mr. David Timmons, City Manager 250 Madison Street, Suite #2 Port Townsend, WA 98368 RE: SURFACE WATER MONITORING PROPOSAL FOR BLUE-GREEN ALGAE Dear Mr. Timmons: As you may know, Anderson Lake experienced a toxic algae bloom that has killed two dogs and injured another. While algae blooms are very common in Western Washington lakes, toxic algae blooms are a fairly rare occurrence. The toxic algae bloom in Anderson Lake was the first documented toxic algae bloom in Jefferson County. While we were responding to the crisis of having a toxic algae bloom in • Anderson Lake, it became apparent that there was a lack of background and trend data on all of the lakes and other surface waters in Jefferson County, and some level of monitoring should be occurring. That leads me to the purpose of this letter. Jefferson County Public Health has noted that the City of Port Townsend has at least three surface water bodies of concern: City Lake, Kah Tai Pond, and Lords Lake. We recommend the following actions be taken by your staff: 1) Observe these surface waters for signs of an algae bloom during the summer months, generally the beginning of May through the end of September. 2) If an algae bloom is observed, samples of the algae should be collected and analyzed by an accredited lab for species identification and cell count. 3) If a toxic species of algae is identified and the cell count is over 100,000 cells per milliliter, then the samples should be analyzed for toxicity and the recommendations of the WHO should be followed to protect human health. 4) If toxins are present at 1 microgram or above, then steps should be taken to protect public health and safety. Jefferson County Public Health is able to offer our services to monitor these surface water bodies on a weekly basis throughout the summer months since we are sampling other lakes throughout the county when algae blooms are most likely to occur. We • COMMUNITY HEALTH PUBLIC HEALTHENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES ALWAYS WORKING FOR A SAFER AND NATURAL RESOURCES MAIN:360-385-9400 MAIN:360-385-9444 FAX: 360-385-9401 HEALTHIER COMMUNITY FAX: 360-385-9401 would work closely with your staff to assure that observations and monitoring results are shared on a timely basis. Jefferson County Public Health staff has the expertise to assure that this proposed water quality monitoring program is efficient and effective in protecting public health and welfare. I propose that a meeting be schedule for us to discuss a monitoring program, and a budget, that will help protect public safety and welfare in regards to the aforementioned surface waters of concern to the City of Port Townsend. Please call me at 360-385-9436 to schedule a meeting date and time or to discuss this letter in further detail. Respectfully, /rd./ Mike McNickle, MPA, RS Environmental Health Director Jefferson County Public Health Cc: Mark Welch, Mayor, City of Port Townsend Michele Sandoval, Deputy Mayor, City of Port Townsend Geoff Masci, Councilman, City of Port Townsend John Fischbach, Jefferson County Administrator • David Sullivan, Chair, Jefferson County Board of Health Tom Locke, Health Officer, Jefferson County Public Health Jean Baldwin, Administrator, Jefferson County Public Health • i • • Board of 3 Ce altli 0 C Business .agenda Item # . V., 3 • Cyanobacteria Zlydate July 20, 2006 • r 1'1-1 :: Working for a safer and healthier Jefferson I Lake Water Quality I Lake Water Quality Page 1 of 3 :4:11-.. :,, ,i:.,,,,,,,,,,,,„ 0 ‘.1-5-: '4. puBLIC HEALTH fri t .. '. A _ilk if,' fro H [ r� ,7,.„ #-IOME_ HEALTH 1 ENVIRONMENT INFORMATION NEWS I ABOUT 3CPH '_ Home > Environment > Lake Water Quality ,� Lake Water Quality Environmental Health works to monitor water quality at the various lakes in Jefferson County. a These readings are periodically updated as new tests are conducted the the results of the tests become available. Anderson Lake Lake Leland Beausite Lake Lower Putaansuu Creek Burge Pond Rodrigues Pond Burge Stream Sandy Shore Chinese Gardens Silent Lake Crocker Lake Tarboo Lake Gibbs Lake Teal Lake Kah Tai Pond Upper Putaansuu Creek III Anderson Lake Sample Date Cell Count Algage ID Toxicity Result Recommendaton 6/5/2006 1,500,000 Anabaena 20 ppb 6/19/2006 Closed 6/26/2006 Closed 7/3/2006 27,000,000 75% Microcystis 5-10 ppb Closed until further notice. Beausite Lake Sample Date Cell Count Algage ID Toxicity Result Recommendaton 6/19/2006 10,100 Not Tested 6/26/2006 _ Burge Pond Sample Date Cell Count Algage ID Toxicity Result Recommendaton 6/12/2006 12,800 Microcystis Y Burge Stream Sample Date Cell Count Algage ID Toxicity Result Recommendaton 6/12/2006 700 Microcystis • Chinese Gardens Sample Date Cell Count Algage ID Toxicity Result Recommendaton 6/19/2006 3,600 Microcystis Not Tested ttp://www.jeffersoncountypublichealth.org/index.php?id=171,0,0,1,0,0 7/13/2006 :1,'PH :: Working for a safer and healthier Jefferson I Lake Water Quality I Lake Water Quality Page 2 of 3 Crocker Lake Ill Sample Date Cell Count Algage ID Toxicity Result Recommendaton 6/19/2006 270,600 Gleotrichia No Toxins 6/26/2006* *Observation only Gibbs Lake Sample Date Cell Count Algage ID Toxicity Result Recommendaton 6/6/2006 21,400 Gleotrichia 6/12/2006 46,300 Aphanizomenon 6/19/2006 >100,000 Not Tested Open 6/26/2006 Open 7/3/2006 46,000 57% fannie, OK for recreational contact 34% mike + others Rah Tai Pond Sample Date Cell Count Algage ID Toxicity Result Recommendaton 6/19/2006 3,600 Aphanizomenon Not Tested 6/26/2006* Observation only Lake Leland Sample Date Cell Count Algage ID Toxicity Result Recommendaton 6/6/2006 96,100 Aphanizomenon 6/12/2006 97,700 Aphanizomenon No ToxinIII 6/19/2006 220,000 Microcystis No Toxin Use Bottled Water for Drinking if using Lake Leland as potable water supply 6/26/06 Use Bottled Water for Drinking if using Lake Leland as potable water supply 7/3/2006 31,900 nearly all Ok for recreational contact M icrocystis Lower Putaansuu Creek Sample Date Cell Count Algage ID Toxicity Result Recommendaton 6/12/2006 900 Microcystis Rodrigues Pond Sample Date Cell Count Algage ID Toxicity Result Recommendaton 6/12/2006 900 Microcystis Sandy Shore Sample Date Cell Count Algage ID Toxicity Result Recommendaton 6/19/2006 44,500 Anabaena Not Tested - Silent Lake Ill Sample Date I Cell Count I Algage ID I Toxicity Result I Recommendaton ttp://www.jeffersoncountypublichealth.org/index.php?id=171,0,0,1,0,0 7/13/2006 "PH :: Working for a safer and healthier Jefferson I Lake Water Quality I Lake Water Quality Page 3 of 3 • 6/19/2006 120,500 6/26/2006* IMicrosystis Not Tested *Observation i ton onl Y Tarboo Lake Sample Date Cell Count Algage ID Toxicity Result I Recommendaton 6/19/2006 23,700 Anabaena Not Tested Teal Lake Sample Date Cell Count Algage ID Toxicity Result Recommendaton 6/19/2006 900 Microcystis Non Tested (100/0) 6/26/2006* *Observation only Upper Putaansuu Creek Sample Date I Cell Count Algage ID Result Recommendaton 6/8/2006 30,100 Anabaena No To iinToxicity Ixs Back Jefferson County Public Health 615 Sheridan Street-Port Townsend, WA 98368 360.385.9400 l info)ieffersoncountyoublichealth.org • erson County Home Page Web Site by Lineangle Internet Solultions II ttp://www.jeffersoncountypublichealth.org/index.php?id=171,0,0,1,0,0 7/13/2006 . Blue-Green Algae: An Emerging Public Health Issue Cyanobacteria, also known as blue-green algae, are an emerging public health issue for water systems that use surface water. These cyanobacteria excrete toxins that affect the liver, skin, and nervous system. Microcystins,Anabaena, and Cylindrospermopsin are three of the most common cyanobacteria that can produce toxins. When they are present in large numbers, they can form visible blooms on the water surface that are green,blue-green, or reddish brown in color. Blooms usually occur during warm, calm weather with bright sunlight. The World Health Organization(WHO)has established a health based drinking water guideline of 1.0 part per billion (ppb) for the algal toxin,Microcystin-LR. The Australian standard is 1.3 ppb for total microcystins, while Health Canada has proposed a similar standard of 1.5 ppb for total microcystins. Algal toxins are on the EPA Contaminant Candidate List for future regulation. There are number of labs in Washington State and throughout the United States that can identify and count algae. Sample analysis usually costs $60-$125 depending upon the type of analysis and turnaround time requested. There are a more limited number of labs that can analyze for algal toxins, some of which can only analyze for microcystin. Sample analysis usually costs around$300-$500. • One of the best barriers to prevent algal toxins from enteringthe water system is a well run water treatment plant. Several studies have shown that water treatment plants can remove cyanobacteria and algal toxins so that the finished water meets WHO guidelines. In most cases, removing the algae will remove most of the toxins since up to 95 percent of the toxins are contained within the algae cells. DO NOT ADD ALGAECIDE IF A VISIBLE BLOOM IS PRESENT. Adding an algaecide can cause the algae cells to rupture, which can release toxins into the water. These toxins are more difficult to remove when they are outside the cell than when they are within the cell. The effectiveness of the water treatment process will vary depending upon the type of treatment and algae. There are several measures that can be taken to improve the removal of algae and their toxins. • Minimize preoxidation—Preoxidation with chlorine and ozone can cause algae cells to rupture releasing toxins. • Adjust coagulation, sedimentation, and filtration—By carefully monitoring and adjusting the coagulation and filtration processes, it may be possible to improve algae removal. Intact cells that are removed by these processes will significantly reduce the possibility that toxins will be present in the finished water. • Don't recycle backwash water—Backwash water can contain high concentrations 411 of algae that can rupture and release their toxins. 1/2 C:\DATA\WORD\BEACH\toxic algae\WaterTap Article-2005.docPrinted: 7/12/2006 • Adjust post-filtration disinfection—Once the algae cells are removed from the water, algal toxins can be destroyed by chlorine and ozone, which are strong oxidants. The effectiveness of ozonation and chlorination varies depending upon the dose and algal toxin. In the long term, algae problems can be minimized by reducing the conditions that favor the growth of blue-green. These actions include minimizing nutrients, especially nitrogen and phosphorus, from entering the lake. Treatment processes can also be added that will improve removal of algae and algal toxins. If you have additional questions about cyanobacteria, you can contact your regional drinking water office, one the following people, or refer to the materials listed below: Sam Perry—Water Treatment (253)395-6755 Sam.perry@doh.wa.gov Dr. Joan Hardy—Health Effects (360) 236-3173 Joan.hardy@doh.wa.gov Gary Frasier—Recreational Water Contact (360) 236-3073 Gary.fraser@doh.wa.gov • Additional Reading Chorus, I. and J. Batram. 1999. Toxic Cyanobacteria in Water. World Health Organization. E&FN Spon, London. Embrey, M. 2002. "Chapter 9: Cyanobacteria in Drinking Water". Handbook of CCL Microbes in Drinking Water. American Water Works Association. pp. 203-233. Newcombe, G. and M. Burch. 2003. "Toxic Blue-Green Algae: Coming to a Neighborhood Near You?" Opflow, American Water Works Association. Vol. 29(5). Westrick,J. 2003. "Everything a Manager Should Know About Algal Toxins But Was Afraid to Ask".Journal American Water Works Association. Vol. 95(9). ff 2/2 C:\DATA\WORD\BEACH\toxic algae\WaterTap Article-2005.docPrinted: 7/12/2006 • • Board of 3-featth New Business .agenda Item # �V., 1 EnviroStars Ativard • Dentistry Northwest July 20, 2006 • w���s°" °G- JEFFERSON COUNTY PUBLIC HEALTH _ { 615 Sheridan Street • Port Townsend • Washington • 98368 ID N o.�0 360-385-9400 Fax 360-385-9401 www.jeffersoncountypublichealth.org DATE: June 28, 2006 Jefferson County Board of Health: Port Townsend, WA 98368 Dear Board of Health Members: Attached for your signature is an EnviroStars award for Dentistry Northwest. Dentistry Northwest has been awarded the 5 Star rating, the highest EnviroStar rating. They have eliminated or are recycling all of their hazardous wastes. Dentistry Northwest has received high praise from the Department of Ecology as one of the most environmentally friendly dentists in the state. They are a leader in Environmental Business practices in Jefferson County. • After signing the award,please return it in the cardboard file holder to: Jasmine Fry Jefferson County Public Health Solid Waste Management Program 615 Sheridan Street Port Townsend, WA 98368 Thank you for your continued support of the EnviroStars Program! Sincerely, Jasmine Fry Environmental Health Specialist COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES ALWAYS WORKING FOR A SAFER AND NATURAL RESOURCES 360-385-9400 HEALTHIER COMMUNITY 360-385-9444 r-A * > j ›-N r11 CD Cf) r\> cp a 53 0 g 3 cn A111111111 CD -I 0 •-•• cr: c:3 W16 •-c co °) e-- 5- 0. C/13 OIN2 9 "5--> elm "11113 (37,2- it% AL 0.04 pail• Yti 4 c — 461 - „ . 2, .4„ .11 104 , (Ito fa =11 N 1141414 \ „ " • - • 1-1-1 •.• .1•A- P-11 cfr110) 0 , Z--Nis 4,4„, ;RV , tih!„, Cf3 N Cf,:•••oz fl* ft- Aso: rear (It (-Dp t-1:1 cf3 so› ,...• 2,› • • K • • DRAFT • Jefferson County Public Health Waste Reduction and Recycled Product Procurement Policy I. PURPOSE The purpose of this policy is to support the purchase of products that will minimize any negative environmental impacts of our work and to reduce the amount of waste produced in the daily work of the Jefferson County Public Health (JCPH). JCPH recognizes that the purchasing and product use decisions of our employees can make a difference in favor of environmental quality. We prefer the reuse of products where appropriate and to purchase environmentally preferable products whenever they perform satisfactorily and are available at a reasonable price. This policy shall be known as the "Jefferson County Public Health Environmentally Preferable Procurement Policy." Its purpose is to reduce waste production in this department and to support markets for recycled and other environmentally preferable products by encouraging JCPH divisions and contractors to buy such products whenever practicable. JCPH's resolution affirms the policy decision to help expand markets for the use of recovered materials by establishing greater Government preferences for products made with such materials, consistent with the demands of efficiency and cost- effectiveness. • The JCPH desires that all County agencies, boards, commissions, departments and offices take a leadership role in reducing waste generated by County business and work practices; reusing discarded materials; recycling its waste products when feasible and cost-effective, and also purchasing recycled products for use in the delivery of services, whenever feasible and cost-effective. II. DEFINITIONS A. "Environmentally Preferable Products" means products that have a lesser or reduced effect on human health and the environment when compared with competing products. This comparison may consider raw materials acquisition, production, manufacturing, packaging, distribution, reuse, operation, maintenance, or disposal of the product. B. "Minimum content standards" means standards maintained by the JCPH specifying the minimum level of recovered material and/or post-consumer material necessary for designated products to qualify as recycled products. C. "Post-consumer materials" means a material or finished product that has served its intended end-use and been discarded by a final consumer. "Post-consumer material" is a part of the broader category of"recovered materials". For the purposes of this policy document, office paper must contain 20% post-consumer materials, to qualify • as "recycled". D. "Post-consumer recycled materials" means only those products generated by a business or consumer which have served their intended end uses, and which have been separated or diverted from the solid waste stream for the purposes of collection, recycling and disposition. E. "Price-preference" means a percentage of a price that JCPH will pay to obtain a designated product. F. "Recovered materials" means waste material and by-products which have been recovered or diverted from solid waste, but does not include those materials and by- products generated from, and commonly reused within, an original manufacturing process. G. "Recycled paper" means paper meeting the JCPH minimum post-consumer recycled content standards of 20% post-consumer material. H. "Recycled Products" means a product manufactured using recovered or diverted material and meeting JCPH Minimum Content Standards. III. POLICIES JCPH staff shall use, and require their contractors and consultants to use, products manufactured with the maximum practicable amount of recovered material, especially post-consumer material and environmentally preferable products whenever • practicable. Ensure that contracts issued by the agency for recycled products require the maximum practicable amount of recycled material and that contractors provide certification of this content and report amounts used. A. JCPH shall establish a price-preference of up to ten percent (10%) for post- consumer recycled paper products. B. All imprinted letterhead paper, envelopes and business cards used by JCPH staff and their contractors shall bear an imprint identifying the post-consumer recycled content of the paper, whenever practicable. C. All JCPH staff shall recommend that they and their contractors use both sides of paper sheets whenever practicable, and reuse single-sided sheets for drafts or note paper. D. All JCPH staff shall recommend that they and their contractors reuse office supplies when practical (e.g. manila envelopes and file folders). E. The JCPH will cooperate with other county departments to develop comprehensive, consistent, and effective countywide regional procurement efforts intended to stimulate the market for recycled products, reusable products, and products designed to be recycled. F. JCPH will become a Wastewise partner/endorser through the implementation of this Procurement Policy and the Green Business Program. G. The Department Heads shall show leadership in waste reduction and procurement practices. The heads of each division of the JCPH shall fully understand waste reduction practices and find ways to apply them within the organization. Department Heads shall encourage staff to bring forward ideas to improve internal business functions and implement those ideas having the greatest potential for achieving efficiencies. IV. SELECTED ENVIRONMENTAL PRODUCTS The JCPH shall evaluate the following environmentally preferable products and purchase them whenever the evaluation is favorable. • Post-consumer recycled paper and paper products; • Recycled paper products other than office paper(ex. post-consumer toilet paper and paper towels); • Remanufactured laser printer toner cartridges; • Non-toxic cleaning products. • Programming and computer equipment that reduces paper use (e.g. send fax direct from computer, printer/copiers with default to double-sided printing, 11111 printers that do not discharge unused sheets of paper) • Water Saving Products (e.g. 1.6 gallon per flush toilets, waterless urinals); • Energy saving products (ex. compact fluorescent light bulbs); and • Other products appropriate for departmental needs/use V. RESPONSIBILITIES OF ALL EMPLOYEES The JCPH Director shall assign staff to: A. Ensure that contracting procedures do not discriminate against recycled products without justification; B. Assign appropriate staff to evaluate each designated product to determine the extent to which it may practicably be used by the agency and its contractors. C. Revise contracting procedures to maximize the specifications of designated products whenever practicable and facilitate compilation of data on the purchase of designated products by the JCPH and its contractors; S D. Transmit evaluation results and procurement data to the JCPH Director by the end of each year. The Fiscal Division will inform the Director, on an annual basis, regarding the results of this Procurement Policy, including recommendations for improvements to the policy, as appropriate. E. JCPH will confer with buyers of various divisions on an ongoing basis, to ensure that these buyers are aware of, and follow this Procurement Policy in the development of purchasing specifications and procurement decisions. F. Turn off electronics & lights when not in use (program computers to power save). G. Keep mailing lists up to date to delete repeat mailings both incoming and outgoing. r • • Board of Health New Business .Agenda Item #'V., 3 • 2006-07 'Tobacco 1WVorkpCan 3-lightights July 20, 2006 • JEFFERSON COUNTY " �� � �� PUBLIC HEALTH r .0 615 Sheridan Street • Port Townsend •Washington • 98368 • - www.jeffersoncountypublichealth.org Tobacco 2006-2007 Workplan Highlights Capacity Development Increase Capacity for Tobacco Prevention and Control (Required Activity) Convene a Tobacco Advisory Committee a minimum of 4 times to review Jefferson County Strategic Plan. Support Local Data Collection Provide technical assistance regarding administration of Healthy Youth Survey 2006; provide data analysis and intrepretation as time, talent and resources allow. Prevent Initiation Compliance Checks (Required Activity) Conduct 50 compliance checks among retailers throughout East Jefferson County Retailer Education (Required Activity) Provide Retailer Education packets to Jefferson County Tobacco Retailers Conduct Peer Education Programs Provide funding to support one best practice that promotes positive youth development (Big Brothers Big Sisters) Promote Cessation Promote Quitline Services Distribute Tobacco Resource Packet to East Jefferson County Healthcare and Social Service Providers Employer Cessation Support Provide technical assistance to 5 employers regarding employees cessation benefits Youth Cessation Conduct youth cessation classes for high school age youth in partnership with youth- serving organizations Eliminate Exposure to Secondhand Smoke Secondhand Smoke Enforcement and Compliance Monitor Clean Indoor Air Act (I 901) compliance Secondhand Smoke Task Force Convene Secondhand Smoke Task force that includes representation of citizens, business, healthcare and service organizations • COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES MAIN: 360-385-9400 ALWAYS;^vO 'ING FORA SAFER AND NATURAL RESOURCES FAX: 360-385-9401 HEALTHIER COMMUNITY MAIN:360-385-94 FAX:360-385-940101 „, $ r,fi7 �` ) JEFFERSON COUNTY PUBLIC HEALTH 444.1t01 615 Sheridan Street • Port Townsend •Washington • 98368 IIIwww.jeffersoncountypublichealth.org Jefferson County Tobacco Quitline Caller Data Performance Indicator: Number of phone calls to WA State Tobacco Quit line from Jefferson Co. Number of Callers to Washington State Tobacco Quitline reporting Jefferson County Residence, 2003-2005. 100% — 100 f: ,„I Fbrcent of Statewide Calls a Jefferson County Residents N E O r v 75% 71 .” c CD v 75 ° m 63 10, 50% Si c Cl) 6 y O (C O c w c o 25% ° a a .0 7% 5% 4% c -3 Z 0% i I I 1 I . 1 0 2003 2004 2005 • Percent of Jefferson County callers to Washington State Tobacco Quitline by Age Group, 2003-2005. 100% IN 2003 a c 2 c 75% 0 2004 C) a> a E50% i 2005 a, -ai U w 5 25% — _ d 0% 1 <18 18-24 25-34 35-44 >45 <18 18-24 25-34 35-44 >45 Jefferson County Washington State Source:Washington State Department of Health Tobacco Prevention and Control Program . COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIESIf�, Y I � NATURAL RESOURCES MAIN:360-385-9400 MAIN:360-385-9444 FAX:360-385-9401 HEALTHIER COMMUNITY FAX:360-385-9401 Jefferson County Public Health (071206 DRAFT) • Clean Indoor Air Regulation Variance* Application (*RCW 70.160.6/Jefferson County Ordinance 04 0216 06) Applicant/Owner Name: Establishment Name: Physical Address: Phone Number: (Street) (City) Mailing Address: (Street) (City) Zip) The afore named establishment requests a variance regarding prohibition of smoking within 25 feet of entrances, exits, windows that open, and ventilation intakes. Rebuttal application must include the following: 1) Application fee based on current fee schedule. 2) Written description of the proposed reduction in the separation distance requirement 3) Detailed floor plan showing the specific area to be considered for a reduced separation (must include location of all entrances, exits, windows that open, and ventilation intakes within 25 feet of the proposed smoking area. 4) Written explanation of why the presumptively reasonable distance of 25 feet cannot be met and why consideration for a reduced separation distance is necessary. • 5) Written justification from the application describing clear and convincing evidence that demonstrates that given the unique circumstance presented by the location of entrances, exits, windows that open, ventilation intakes or other factors, smoke will not infiltrate into the facility. 6) Written explanation describing how the applicant will monitor the effectiveness of the reduced distance in keeping smoke from infiltrating into the facility, and what action they will take if smoke is determined to be entering the facility at a future time. NOTE: The application for reduction of the 25-foot requirement applies only to the area addressed in the application and not to the entire structure or any other area near or around the facility. By signing this application form,the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge.Any material falsehood or any omission of material fact by the applicant/owner with respect to this application may result in this permit being null and void. I further agree to safe,indemnify, and hold harmless Jefferson County against all liabilities,judgments,court costs, reasonable attorneys fees and expenses which may result in a y way accrue against Jefferson County as a result of or in consequence of granting this permit. I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the purpose of application review and any required later inspections. Appeal-Any person aggrieved of a decision of the Director may appeal.Appeals must be submitted to the Tobacco Prevention Program within fifteen days after receiving written notice of the decision. Applicant/Owner Signature Date Return completed application packet including application fee to: • Tobacco Prevention Program-Jefferson County Public Health 615 Sheridan Port Townsend WA 98368 Direct inquires to Jefferson County Tobacco Prevention Program 360-385-9446 2006.06.27: New Surgeon General's Report Focuses on the Effects of Secondhand Smoke Page 1 of 2 Skip Navigation. • i¢ i s t t s artm n o ( Heallirian Services �< ,., >. _z a . v - .114111111110411 News Release FOR IMMEDIATE RELEASE Contact: HHS Press Office Tuesday, June 27, 2006 (202) 690-6343 New Surgeon General's Report Focuses on the Effects of Secondhand Smoke U.S. Surgeon General Richard H. Carmona today issued a comprehensive scientific report which concludes that there is no risk-free level of exposure to secondhand smoke. Nonsmokers exposed to secondhand smoke at home or work increase their risk of developing heart disease by 25 to 30 percent and lung cancer by 20 to 30 percent. The finding is of major public health concern due to the fact that nearly half of all nonsmoking Americans are still regularly exposed to secondhand smoke. The report, The Health Consequences of Involuntary Exposure to Tobacco Smoke, finds that even brief secondhand smoke exposure can cause immediate harm. The report says the only way to protect • nonsmokers from the dangerous chemicals in secondhand smoke is to eliminate smoking indoors. "The report is a crucial warning sign to nonsmokers and smokers alike," HHS Secretary Michael Leavitt said. "Smoking can sicken and kill, and even people who do not smoke can be harmed by smoke from those who do." Secondhand smoke exposure can cause heart disease and lung cancer in nonsmoking adults and is a known cause of sudden infant death syndrome (SIDS), respiratory problems, ear infections, and asthma attacks in infants and children, the report finds. "The health effects of secondhand smoke exposure are more pervasive than we previously thought,"said Surgeon General Carmona, vice admiral of the U.S. Public Health Service. "The scientific evidence is now indisputable: secondhand smoke is not a mere annoyance. It is a serious health hazard that can lead to disease and premature death in children and nonsmoking adults." Secondhand smoke contains more than 50 cancer-causing chemicals, and is itself a known human carcinogen. Nonsmokers who are exposed to secondhand smoke inhale many of the same toxins as smokers. Even brief exposure to secondhand smoke has immediate adverse effects on the cardiovascular system and increases risk for heart disease and lung cancer, the report says. In addition, the report notes that because the bodies of infants and children are still developing, they are especially vulnerable to the poisons in secondhand smoke. "The good news is that, unlike some public health hazards, secondhand smoke exposure is easily prevented," Surgeon General Carmona said. "Smoke-free indoor environments are proven, simple approaches that prevent exposure and harm."The report finds that even the most sophisticated ventilation systems cannot completely eliminate secondhand smoke exposure and that only smoke-free environments afford full protection. • Surgeon General Carmona noted that levels of cotinine -- a biological marker for secondhand smoke exposure -- measured in nonsmokers have fallen by 70 percent since the late 1980s, and the proportion of nonsmokers with detectable cotinine levels has been halved from 88 percent in 1988-91 to 43 percent in 2001-02. http://www.hhs.gov/news/press/2006pres/20060627.html 6/30/2006 2006.06.27: New Surgeon General's Report Focuses on the Effects of Secondhand Smoke Page 2 of 2 "Our progress over the past 20 years in clearing the air of tobacco smoke is a major public health success story," Surgeon General Carmona said. "We have averted many thousands of cases of disease and early death and saved millions of dollars in health care costs." He emphasized, however, that sustained efforts are required to protect the more than 126 million Americans who continue to be regularly exposed to • secondhand smoke in the home, at work, and in enclosed public spaces. To help communicate the report findings as widely as possible, the Surgeon General unveiled an easy-to- read guide with practical information on the dangers of secondhand smoke and steps people can take to protect themselves. Copies of The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General and related materials are available on the Surgeon General's Web site at www.surgeongeneral.gov/library/secondhandsmokei. ### Note: All HHS press releases, fact sheets and other press materials are available at http://www.hhs.gov/news. Last revised: June 27, 2006 HHS Home I Questions? I Contact HHS I Site Map I Accessibility I Privacy Policy I Freedom of_InformationAct I Disclaimers • The White House I FirstGov U.S. Department of Health & Human Services • 200 Independence Avenue, S.W. • Washington, D.C. 20201 --- • http://www.hhs.gov/news/press/2006pres/20060627.html 6/30/2006 JCPH :: Working for a safer and healthier Jefferson I News I Tobacco Retailers Earn Awards Page 1 of 2 0y 7s - per al ',;_i,, 'it 4::,A1.(‘, ,,,,,,,.:::4•TA%I,;:ir:'1 :/:i2:‘i;::0;i':,:;:k-: '„..,L,:; :,22,:. ,i.,,:.., ,,,,,,, s 1 HOME 11 HEALTH I I ENVIRONMENT 11 INFORMATION 11 NEWS /I I ABOUT JCPH 'sem Hom e > Tobacco Retailers Earn Awards ,,:, _;,,,,', , 0,-:, `, Port Townsend, WA - Jefferson County Public Health conducts tobacco compliance checks or regular basis to insure that retailers are following Youth Access laws. Youth Access laws prohibit the sale of tobacco products (cigarettes, cigars, bidis, and smokeless tobacco) to people under the age of 18 years old. Jefferson County Public Health is pleased to recognize following retailers for their compliance with Youth Access laws: Brinnon General Store, Chimacum Chevron, Cove RV Park, Discovery Bay Store, Don's • Pharmacy, Four Corners Store, Lehani's, Lighthouse Café, Nordland General Store, Peninsula Foods, Penny Saver Mart, Pleasant Harbor Marina, Port Hadlock QFC, Port Ludlow Village St( Port Townsend QFC, Port Townsend Safeway, PT Food Mart, Safeway Fast Shop, Seabreeze Grocery, Smoker Friendly, The Money Shop, Tobacco Depot and Village General Store. The following retailers need additional support and encouragement to follow the law: Beaver Valley General Store and Port Hadlock Jackpot. If you think that a retailer is selling tobacco to under age youth, you can make a report to ti Liquor Control Board at 1-888-838-3956 or you can make a report on line at http://www.Iiq.wa.gov/services/violator.asp. You will need to provide the following informat name and address of the business; your name, address and phone number; nature of complaint-a description of the alleged violation, including the date and time of day and a description of persons involved. Liquor Control agents follow up within 30 days of a complair • According to Jefferson County school survey data, about 9 in 10 Jefferson County youth thin that smoking cigarettes present some type of health risk. One in 4 County 10th graders thin adults view cigarette use among kids their age as wrong. However, among county youth wh http://www.jeffersoncountypublichealth.org/index.php?id=5,236,0,0,1,0 6/30/2006 JCPH :: Working for a safer and healthier Jefferson I News I Tobacco Retailers Earn Awards Page 2 of 2 report tobacco use, the average age of first use is 11 years old—the age of 6th graders. Abl half of Jefferson County 8th graders think it would be easy to get cigarettes if they wanted • them. As most people know, tobacco use one of the leading causes of preventable death in ( country. That's why it is important for all to prevent youth from accessing tobacco products. We can give strong, clear messages to youth that we care about their health and tobacco us just doesn't fit the bill. Jefferson County Public Health is committed to protect you and your family every day. One that Public Health achieves this by working together with community organizations such as tobacco retailers. Our goal is a community that is a healthy place to live, work and play. For more information about tobacco prevention, please contact Jefferson County Public Heal Tobacco Program Coordinator Kellie Ragan at 360-385-9446. Jefferson County Public Health • 615 Sheridan Street- Port Townsend, WA 98368 360.385.9400 i info@jeffersoncountypublichealth,org Jefferson County Home Page Web Site by Lineangle Internet Solul 111 http://www.jeffersoncountypublichealth.org/index.php?id=5,236,0,0,1,0 6/30/2006 • Board of Health Netiv Business .agenda Item # 17., 4 Proposed Board of Health • By Caws Changes July 20, 2006 1 BYLAWS OF THE JEFFERSON COUNTY BOARD OF HEALTH ARTICLE 1. NAME The name of this organization shall be the Jefferson County Board of Health. ARTICLE II. PURPOSE The purpose of the Jefferson County Board of Health is to supervise all matters pertaining to the preservation of the life and health of the people of Jefferson County and to comply fully with the requirements of all applicable chapters of Title 70, Revised Code of Washington. The Board of Health shall: • Collect, analyze and disseminate to the community, through the Jefferson County Health&Human Services department, information about community health conditions,risks and resources, and the availability of resources to address identified problems. • Enact such rules, regulations and policies as are necessary to preserve, promote and improve the health status of Jefferson County residents, and guide the allocation of appropriate and necessary public health resources. • Assure that necessary, high quality, effective public health services are available for the protection of the people of Jefferson County, including the control and prevention of any dangerous, contagious or infectious disease within the county. • Provide for the prevention, control and abatement of nuisances detrimental to public health. • Enforce, through the Health Officer, the public health statutes of the state and county. • Establish fee schedules for issuing and renewing licenses and permits, or for such other services as are authorized by the law and rules of the State Board of Health. Jefferson County Board of Health Page 2 Bylaws ARTICLE III. REPRESENTATION • Membership: The Board of Health shall consist of 7 members, selected as follows: • Each member of the Jefferson County Board of County Commissioners shall serve as a member of the Board of Health for the duration of their elected term of office. • Four members of the Board of Health shall be appointed by the County Commissioners. Appointed members shall include one Port Townsend City Council Member and one Jefferson County Public Hospital District #2 Commissioner nominated by their respective organizations, plus two at-large community representatives. Two of the four appointed members shall be residents of the City of Port Townsend and two shall be residents of unincorporated Jefferson County. Terms: Appointed members shall serve for three year terms. Board of Health members may serve more than one term, including consecutive terms. Vacancies: In the event that a vacancy occurs for an appointed representative, the Chairperson of the Board of County Commissioners shall with the approval of the majority of the Board of County Commissioners appoint another representative within thirty(30) days of the date of vacancy. In the event that a vacancy occurs • from the Port Townsend City Council or Jefferson County Hospital District#2, the City or District shall nominate another representative from their membership within thirty(30) days. Absences: Board members shall notify the Chairperson in advance if unable to attend any regular meeting of the Board of Health. Appointed Board members may be removed from Board membership by action of the County Commissioners for lack of attendance. Three or more unexcused absences from regular Board of Health meetings in one calendar year will be considered cause for removal. ARTICLE IV. OFFICERS Chairperson: The presiding officer of the Board of Health shall be the Chairperson, who shall serve for a term of one (1) year. The Chairperson shall be selected by a majority vote of the Board members present at the first regular meeting of each year. Vice-Chairperson: At the same meeting, a Vice-Chairperson shall also be selected for a term of one(1) year, who shall preside over all proceedings of the Board in the absence of the Chairperson. Vacancies: In the event of a vacancy in the office of Chairperson, the Vice- Chairperson shall immediately assume the duties of the Chairperson for the remainder of the year. Another representative shall be selected to serve as Vice-Chairperson at • the next regular or special meeting of the Board. Jefferson County Board of Health Bylaws Page 3 Consecutive Terms: Board members shall not serve consecutive terms as Chairperson or Vice Chairperson. ARTICLE V. RULES OF BUSINESS Business shall be conducted in accordance with the most current edition of Robert's Rules of Order so long as they are consistent with these Bylaws or amendments thereto. ARTICLE VI. COMMITTEES The Chairperson shall appoint subcommittees from the Board of Health or members of the community from time to time as the Chairperson shall deem necessary. The Chairperson shall be an ex-officio member of all committees. ARTICLE VII. ADMINISTRATIVE OFFICER The Board of Health shall appoint an Administrative Officer who shall fulfill the responsibilities specified by RCW 70.05.045, including administering the operations of the Health Department. The Administrative Officer shall serve at the will and approval of the Board. s ARTICLE VIII. HEALTH OFFICER The Board of Health shall appoint a County Health Officer, who shall be a qualified physician trained and experienced in public health, who shall exercise the powers, and perform the duties prescribed in RCW 70.05.070. The Health Officer shall serve at the will and approval of the Board. ARTICLE IX. OPERATING RULES Section 1. Meetings Regular Meetine• Regular meetings of the Board of Health shall be held on the third Thursday of each month. If the third Thursday is a legal holiday, an alternate day may be selected by the Chair. Any regular meeting of the Board of Health may be cancelled with the concurrence of a majority of the Board. The location of the meetings shall be within Jefferson County. Special Meeting The Chair or two-thirds of the members of the Board may call a special meeting of the Board consistent with RCW 42.30.080. Executive Session: The Board may hold executive sessions from which the public may be excluded for the purposes set forth in RCW 42.30.110. • uorum: A majority of all Board members, including at least two Jefferson County Commissioners, shall constitute a quorum for Board meetings. Jefferson County Board of Health Page 4 Bylaws Tape Recordings: The proceedings of all Board meetings shall be recorded 411 electronically. Any person may have a copy of tape a recording of any meeting of the Board by furnishing an appropriate recording tape to the Health Department Director's office and paying the costs of reproduction. Minutes: Written minutes of each Board meeting shall be prepared and approved by the Board at the subsequent regular meeting. Minutes shall be signed by the Chair and attending Members at the time of their approval by the Board. Meetings Open to Public: All regular and special meetings of the Board and Board committees shall be open to the public, in accordance with RCW 42.30. Materials to Board Members: Except in cases of emergency, the agenda and materials related to action items shall be sent to Board members in advance of the meeting at which the items will be considered. Section 2. Voting Actions Requiring a Vote: Each member of the Board shall be entitled to one vote on all actions of the Board that require a vote. An affirmative vote of a majority of Board members shall be required to pass an action of the Board,provided that a quorum of the Board is present. Tie Vote: In the event of a tie vote, the action does not pass. Voting By Proxy: There will be no voting by proxy on any question before the Board. 411 Section 3. Ethics Conflict of Interest: Members of the Board of Health having personal or professional interest on an action item that may be deemed conflicting or infringe upon the appearance of fairness shall declare the conflict and refrain from discussing or voting on such matters. Section 4. Public Testimony General Public Comments: At each meeting, according to the usual order of business, the Chair shall call for general comments. Persons wishing to comment shall give their name. The Chair may establish time limits for individuals who wish to speak. Comments on Action Items: Prior to voting on any item requiring action by the Board, the Chair shall call for comments by persons interested in or affected by the matter under consideration before the Board. Persons wishing to comment on action items shall give their name, and the Chair may establish time limits for individuals who wish to speak. • Jefferson County Board of Health Bylaws Page 5 • Section 5. Public Hearin s Public Hearin.s: The Board shall conduct 'ublic hearin s s 'rior to ado tion of fees ordinances rules or other exercises of its 'uasi-le'islative i owers. All members of the 'ublic in attendence at a 'ublic hearin. will be allowed to s teak if the so desire. Persons wishin. to 'rovide testimon shall .ive their name. Time limits ma be I laced on individual comments at the discretion of the Board Chair and the 'ublic should be advised that comments must relate to the matter at hand. Order and decorum should be maintained at all times. Rules for the conduct of the hearin! should be stated b the Board Chair at the be'innin. of the hearin'. Followin' 'ublic testimon the Board Chair shall close the 'ublic hearin. and the Board ma deliberate and take action on the matter at hand. Call for Public Hearin.: A 'ublic hearin• ma be called for b an affirmative vote b a ma'ori of the Board. Public notice will be i iven at least 10 da s 'rior to a •ublic hearin! of the Jefferson Coun Board of Health. Section 6 Appeals Hearing A g s eals Hearin.s: Board of Health hearin's shall be o 8 en to the 'ublic and resided over b the chair of the Board of Health. Such hearin's shall be • recorded. Board of Health hearin.5 shall be o.ened with a recordin. of the time date and 'lace of the hearin.• and a statement of the cause for the hearin The hearin' shall be limited to ar.ument of the 'arties and no additional evidence shall be taken unless in the 'ud'ment of the chair such evidence could not have reasonabl been obtained throu'h the exercise of due dili'ence in time for the hearin! before the Health Officer. Ar'ument shall be limited to the record enerated before the Health Officer unless the chair admits additional evidence hereunder. ARTICLE X. MISCELLANEOUS Reimbursement of Expenses: Board of Health members may receive reimbursement for approved expenses related to completion of their responsibilities. ARTICLE X. AMENDMENTS TO BYLAWS These Bylaws can be amended at any regular meeting of the Board by two-thirds (2/3) vote,provided the amendment has been submitted in writing to the Board of Health at least ten (10) days prior to said meeting. • Jefferson County Board of Health Page 6 Bylaws • ADOPTED the day of , 1997 [2006] Chairperson,Jefferson County Board of Health • 41111 f R.ter. • STATE OF WASHINGTON JEFFERSON COUNTY • In the matter of an Ordinance Defining the Responsibilities and ) Expanding the Membership ) ORDINANCE NO. 03-0505-97 of the Jefferson County ) County Board of Health ) WHEREAS: Pursuant to RCW 70.05.030, the Board of County Commissioners has constituted the Jefferson County Board of Health. WHEREAS: Section 6 of RCW 70.05.030 and 1993 c 492 s 235 were each amended in 1995 to include the following: The board of county commissioners may, at its discretion adopt an ordinance expanding the size and composition of the board of health to include elected officials from cities and towns and persons other than elected officials as members so long as persons other than elected officials do not constitute a majority. An ordinance adopted under this section shall include provisions for appointment, term, and compensation, or reimbursement of expenses. WHEREAS: The health and safety of the citizens of Jefferson County, and the condition of their living environment, are of paramount importance to the County's well being. WHEREAS: The Board of County Commissioners, sitting as the Board of Health,determined at its February 25, 1997 meeting that the addition of persons with knowledge, interest,and expertise regarding the health, safety, and • well-being of Jefferson County citizens and their living environment would benefit the operation of the Board of Health and the citizens of Jefferson County. NOW, THEREFORE, BE IT ORDAINED That the Board of County Commissioners after due deliberation and in the best interest of the public,does hereby expand the size and composition of the Jefferson County Board of Health. BE IT FURTHER ORDAINED That Title 8. Health and Safety, of the Jefferson County Code be amended to include a new Chapter 8.00, Board of Health, defining the responsibilities and membership of the Jefferson County Board of Health, as follows: 8.00.010 Duties and Responsibilities: The Board of Health shall have responsibilities over all matters pertaining to the preservation of the life and health of the people of Jefferson County and shall: (1) Collect, analyze and disseminate to the community, through the Jefferson County Health & Human Services department, information about community health conditions, risks and resources, and the availability of resources to address identified problems: (2) Enact such rules, regulations and policies as are necessary to preserve,promote and improve the health status of Jefferson County residents. and guide the allocation of appropriate and necessary public health resources: (3) Assure that necessary, high quality, effective public health services are available for the protection of the people of Jefferson County. including the control and prevention of any dangerous, contagious or infectious disease within the county; (4) Provide for the prevention,control and abatement of nuisances detrimental to public health: (5) Enforce, through the Health Officer, the public health statutes of the state and county: and • (6) Establish fee schedules for issuing and renewing licenses and permits,or for such other services as are authorized by the law and rules of the State Board of Health. Ordinance No.03-0505`17 Board of Health 8.00.020 Members: The Board of Health shall be composed of seven members. The three elected members of the Board of County Commissioners shall be members of the Board of Health. Four members of the Board of Health shall be appointed by the County Commissioners. Appointed members of the Board of Health shall • include one elected official from the City of Port Townsend City Council and three non-elected community representatives. Community representatives shall include one resident of the City of Port Townsend and two residents of unincorporated Jefferson County. One community representative shall be a Jefferson County Public Hospital District #2 commissioner;two community representatives shall be at-large members. 8.00.030 Terms: Appointed members shall serve for three year terms. Of the members initially appointed, an equal number shall be appointed for two years and for three years. The term of office for all appointees shall commence on the first day of June in the year in which the term is to commence. 8.00.040 Appointment: The chairperson of the Board of County Commissioners shall appoint the initial members to the Board of Health with the approval of the majority of the Board of County Commissioners. The Board shall request that the City of Port Townsend and Jefferson County Public Hospital District#2 each nominate one candidate for appointment to the Board of Health. The County Commissioners shall seek applications from citizens of Jefferson County to fill the at-large membership positions on the Board of • Health. 8.00.050 Vacancies: Vacancies on the Board of Health shall be filled by appointment by the chairperson of the Board of County Commissioners in the same manner as initial appointments are made. Appointments shall be for the unexpired portion of the term of the position filled. 8.00.060 Organization: The Board of Health shall elect a chairperson and vice-chairperson from among its members. 8.00.070 Meetings: The Board of Health shall hold no fewer than one regular meeting in each month of each year: provided that if no issues over which the Board has jurisdiction are pending upon its calendar. a meeting may be canceled. All meetings of the Board of Health meetings shall be open and public, pursuant to the Open Public Meetings Act. codified at RCW 42.30 et seq. Meetings shall be held at such times and at such locations as to be convenient for attendance by Board of Health members and the public,as determined by a Resolution passed by a majority of Board of Health members. 8.00.080 Rules and Record of Proceedings: The Board of Health shall adopt Bylaws for the transaction of its business. No actions shall be taken by the Board of Health unless a majority of members are present. including at least two Jefferson County Commissioners. The Board of Health shall keep a public record of its transactions, findings and decisions. 8.00.090 Compensation or Reimbursement: Appointed members of the Board of Health shall not receive compensation for their services. Appointed members may receive reimbursement for approved expenses related to the completion of their responsibilities. BE IT FURTHER ORDAINED That such amendment shall be effective immediately upon execution of this document by the Board of County Commissioners. APPROVED and ADOPTED this i day of / = . 1997. • JEFFERSON CO T /' SEAL: (�, • • . 11.4F CO i . CONI ••RS o • •� d Wojt,Chairman . .) t •, el -I V � . • ' ` Glen..Jluntingford. ��.-'`►`.er ATTEST: y " _.- I • �'.i .+1. l� Lorna Delaney.CMC Dan Harpole, Memb Clerk of the Board 2 • Board of Health .New Business Agenda Item # 17., 6 New Vaccines - O Costs, Benefits, Controversies f July 20, 2006 • 'DC - Media Relations -Press Release - June 29, 2006 Page 1 of 2 I l , D CDC Home Search Health Topics A r Office of Enterprise Comninnication , , MEDIA rsi.Tte,«, «P& " Phone (404)6394286 RELATIONS Media Home I Contact Us Press Release For Immediate Release Contact: Site Contents June 29, 2006 CDC Media Relations • Contact Us Phone: (404)639-3286 • Press Releases • Transcripts CDC's Advisory Committee Recommends Human • MMWR Summaries Papillomavirus Virus Vaccination • Press Kits • News Photos CDC's Advisory Committee Recommends Human Papillomavirus Virus Vaccination Vaccine considered highly effective in preventing infections Related Links that are the cause of most cervical cancers. • Centers at CDC • Data and Statistics The Advisory Committee on Immunization Practices (ACIP)voted • Health Topics A-Z Thursday to recommend that a newly licensed vaccine designed to protect • Image Library against human papillomavirus virus (HPV)be routinely given to girls when they are 11-12 years old. The ACIP recommendation also allows for • Publications,Software vaccination of girls beginning at nine years old as well as vaccination of and Other Products girls and women 13-26 years old. HPV is the leading cause of cervical • nors/Hoaxes cancer in women. • obal Health Odyssey =ind your state or local According to the ACIP's recommendation, three doses of the new vaccine iealth department should be routinely given to girls when they are 11 or 12 years old. The advisory committee, however, noted that the vaccination series can be -IHS News started as early as nine years old at the discretion of the physician or National Health health care provider. The recommendation also includes girls and women Dbservances 13-26 years old because they will benefit from getting the vaccine. The vaccine should be administered before onset of sexual activity(i.e., before women are exposed to the viruses), but females who are sexually active ItRiST • should still be vaccinated. Yessitat haat OttoriWatot Div.of Media Relations "This vaccine represents an important medical breakthrough,"said Dr. 1600 Clifton Road Anne Schuchat, director of CDC's National Center for Immunization and VIS D-25 Atlanta,GA 30333 Respiratory Diseases. "As a result, these vaccine recommendations :404)639-3286 address a major health problem for women and represent a significant =ax(404)639-7394 advance in women's health. It has been tested in thousands of women around the world and has been found to be safe and effective in providing protection against the two types of HPV that cause most cervical cancers." Gardasil®, manufactured by Merck, is the first vaccine developed to prevent cervical cancer, precancerous genital lesions and genital warts due to HPV-- 'HPV causes genital warts in men and women. The vaccine is highly effective against four types of the HPV virus, including two that cause about 70 percent of cervical cancer. Those who have not acquired HPV would get the full benefits of the vaccine. On average, there are 9,710 • new cases and 3,700 deaths from cervical cancer in the United States each year. HPV is the most common sexually transmitted infection in the United ttp://www.cdc.gov/OD/OC/MEDIA/pressrel/r060629.htm 7/13/2006 DC - Media Relations -Press Release - June 29, 2006 Page 2 of 2 States, More than 20 million men and women in the United States are currently infected with HPV and there are 6.2 million new infections each year. HPV is most common in young women and men who are in their late teens and early 20s. By age 50, at least 80 percent of women will have • acquired HPV infection. "Although an effective vaccine is a major advance in the prevention of genital HPV and cervical cancer, it will not replace other prevention strategies, such as cervical cancer screening for women or protective sexual behaviors," said Dr. Schuchat"Women should continue to get pap tests as a safeguard against cervical cancer." The ACIP, consisting of 15 members appointed by the Secretary of the Department of Health and Human Services (HHS), advises the director of CDC and Secretary of HHS on control of vaccine-preventable disease and vaccine usage. Recommendations of the ACIP become CDC policy when they are accepted by the director of CDC and are published in CDC's Morbidity and Mortality Weekly Report(MMWR). There are no federal laws requiring the immunization of children.All school and daycare entry laws are state laws and vary from state to state. For more information, visit www.cdc.gov. Media Home Page I Accessibility I Privacy Policy I Contact Us CDC Home I Search I Health Topics A-Z This page last updated July 3,2006 • URL:http://www.cdc.gov/od/oc/media/pressrel/r060629.htm United States Department of Health and Human Services Centers for Disease Control and Prevention Office of Communication Division of Media Relations • ttp://www.cdc.gov/OD/OC/MEDIA/pressrel/r060629.htm 7/13/2006 . NATION Wednesday,Jun.21, 2006 Defusing the War Over the "Promiscuity" Vaccine Viewpoint: The controversy over a vaccine to prevent cervical cancer is a sign of the deep suspicion on both sides of the cultural divide. It needn't be that way By NANCY GIBBS When my 11-year-old got her tetanus shot during her checkup last week, her pediatrician did not tell her that it was now safe to go dance barefoot on rusty nails. Which got me wondering about a recent battle in the culture wars, in which conservative groups were reported to be opposing a great medical breakthrough—the new cervical cancer vaccine—on the grounds that it might encourage kids to think that casual sex just got a little bit safer. This has been portrayed as Round 15 in the fights over religion and science. It's the kind of thing that can make a parent crazy: you mean my child might be denied a potentially life-saving vaccine because it could sabotage an "abstinence only" message—which, as the National Organization for Woman suggested, "presumably relies on a fear of cancer death to promote • abstinence." But for once in these polemical times, there may much more to agree on than to argue over. It a measure of the depth of suspicion on both sides that something almost universally hailed as a medical triumph still became a subject of controversy. First, some history. The new vaccine, known as Gardasil, was approved earlier this month by the Food and Drug Administration, as the first ever designed to prevent cancer; it works by guarding against the human papillomavirus (HPV), which is thought to cause about three of every four cases of cervical cancer, the second most common cancer among women, and the third most deadly around the world. It kills close to 4000 women each year in the U.S. alone. Public health experts say that vaccines generally work best when everyone gets them: the laws of"herd immunity" dictate that the more people are protected against a particular virus, the more likely it is to eventually disappear altogether. HPV is the most common sexually transmitted infection; the Centers for Disease Control estimates that 20 million Americans carry it. By vaccinating children before they are sexually active, there is a hope of dramatically reducing the prevalence of at least some • strains for the next generation. That means the next question is whether it belongs alongside measles and mumps and polio in the schedule of shots that children get before they're allowed to attend school. And this is where the fight breaks out. Back in the fall when the vaccine was submitted for FDA approval, some conservatives began asking whether physical protection could come at a moral cost: the technical term is "disinhibition, which the CDC defines as "an increase in • unsafe behaviors in response to perceptions of safety caused by introduction of a preventive or therapeutic intervention." (Once upon a time the concern was raised about introducing anesthesia during childbirth, or using penicillin to treat syphilis, as spurring more sexual activity; more recently, the argument is made about needle exchange and condom distribution.) The New Scientist in Britain quoted the Family Research Council's Bridget Maher warning that "giving the HPV vaccine to young women could be potentially harmful,because they may see it as a licence to engage in premarital sex." Others warned of promoting false confidence, since the vaccine does not protect against all strains of HPV or the many other sexually transmitted diseases. Reginald Finger, a former medical advisor to Focus on the Family who sits on the CDC advisory committee, told The Hill that "if people begin to market the vaccine or tout the vaccine that this makes adolescent sex safer, then that would undermine the abstinence-only message." "Cervical Cancer Vaccine Gets Injected With a Social Issue," was the headline in the Washington Post. "Some Fear a Shot For Teens Could Encourage Sex." Such concerns in turn inspired more than 100 lawmakers to write to the • CDC to warn about playing politics with what should be purely scientific judgments. "Certain activists and organizations are mounting a campaign to prevent this vaccine from becoming widely available," the letter stated. "They cite the possibility that,by preventing a horrible disease, and more than 3,700 deaths a year, this vaccine could remove an obstacle to teenage sex.... In contrast to the strong scientific evidence supporting the effectiveness of the cervical cancer vaccine,there is no scientific evidence to support the fear that its use will promote sexual activity." Women's groups also mobilized in support, worried that the fate of the vaccine could mirror that of Plan B,the emergency contraceptive that has been subject to political battles. "I lost my grandmother to cervical cancer, and have two daughters who might be spared that fate with this vaccine," wrote National Organization for Women President Kim Gandy. "Opposing an effective vaccine that would save hundreds of thousands of women's lives with the vacuous assertion that it would lead to promiscuity is inexcusable." At a time when government data shows 70% of girls having had intercourse by the time they're 18,the need for a vaccine seemed self- evident. "It was our belief that (conservatives)were trying to make their opposition clear to the FDA, which has been politically responsive during the Bush Administration to these conservative groups," says Gandy, "and that gave us tremendous concern that their influence would translate into non-approval of this vaccine." It all seemed to have the makings of a classic political showdown, except that conservatives now say they were not actually"opposing an effective vaccine." "This is an awesome vaccine," Linda Klepacki, analyst for sexual health at Focus on the Family, told me when asked her about her group's position. It could prevent millions of deaths around the world. We support this vaccine. We see it as an extremely important medical breakthrough. To read those headlines saying we're against this is really disconcerting." What they are against, she explained, is making vaccination mandatory rather than leaving it up to parents to decide. Some groups hadn't even formulated a position until reporters started to call. "I haven't had another issue where our position has been so distorted and exaggerated," says Peter Sprigg, vice president for policy of the Family Research Council. The vaccine was never a high-priority issue, he insists; what concerns were raised were a little more nuanced. "The issue that has been discussed quite a bit, and where our position has been exaggerated, is whether it would have an impact on sexual behavior. It's not illogical to think that if you reduce the risk of one behavior people might be more likely to engage in it. That's not something we ever asserted was going to be case with this vaccine—only that it was a question that at least needs to be raised." So conservative groups met with representatives from Merck, the vaccine manufacturer, which among other things presented evidence at the CDC hearings that there was no data linking access to the vaccine with increases in sexual behavior. "We did what we ordinarily do when we are prepared to • launch a vaccine," says Merck spokesperson Kelley Dougherty. "We met with physicians, consumer groups and in this case faith-based organizations, to talk about what the disease looks like, what the vaccine does; it was part of a broad communications strategy." Merck also launched an ad campaign, "Tell Someone," that aims to teach viewers about the prevalence of HPV and its link to cervical cancer. Sprigg, who was in the meetings, came away impressed with Merck's handling of their questions. Its representatives, he said, "expressed sympathy with our concern that this not be distributed with an accompanying message that this makes it safe to have sex. They acknowledged the limits of the vaccine, that it does not target all strains of HPV, or any other sexually transmitted diseases." During public hearings on the vaccine held by the CDC's Advisory Committee on Immunization Practices (ACIP) in February, the Family Research Council representative applauded the vaccine, hoped that health care professionals would enforce the message that the only sure protection from sexually transmitted diseases is abstinence, but also called the vaccine a benefit because transmission can come during an assault or from an infected spouse. The major point of contention surrounds whether to make the vaccine mandatory. The ACIP will weigh in during the last week of June; their • recommendation will guide the federal government and insurance companies about whether to pay for the vaccine, which costs more than $300, and states about whether to require it for girls—or boys—attending school. Doctors follow their lead about what to consider the recommended standard of care, and so whether or not Gardasil becomes widely available largely hinges on the ACIP recommendation. To conservatives, this comes down to a question of parental rights. Unlike diseases for which there are required immunizations, explains Klepacki, . "this is a disease you don't catch by sneezing or coughing. It's linked to a behavior. You don't contract HPV by sitting in a classroom. So this is a different issue." Parents need to make an informed decision; her group's website includes the pros and cons of vaccination and has links to the CDC and the American Cancer Society. "You may want to vaccinate a child just in case," she says. "We see the extremely positive effects of this vaccine. But we want it to be out of the government's hands and in the parents' hands,because this is a sexually transmitted infection." That position, responds Dr. Karen Loeb Lifford, a Boston Ob-Gyn who serves as medical director for Planned Parenthood in Massachusetts, "sounds incredibly reasonable. Who can disagree with parents making health decisions for their children? But take a closer look at that argument: it's denying the vaccine to many people who won't have access to it unless it's mandatory." Many parents might not know to ask for it, or be able to afford it. "If it's available in theory but it costs $375, its not available to everybody. If it's only effective before women have been exposed to HPV, we've missed our opportunity." Besides, she says, every state already has a law allowing parents to decline vaccination on religious grounds without their kids being banned from school. But "by making it mandatory, you make it accessible." Sprigg denies that this is all a clever campaign to praise progress in public S while derailing it behind closed doors. "We have no objection to it being part of the recommended standard of care," he says. Nor does his group object to Gardasil being covered by the federal Vaccines for Children program,which pays for immunizing uninsured and underinsured families. "So that should be sufficient to assure widespread distribution of the vaccine." He even suggests that if handled in a certain way, vaccination could be a teaching opportunity. "If health care providers use this as an opportunity to talk to young people about sexual health, with the parents'permission, and explain the full range of risks posed by having non-monogamous relationships, it could have positive impact on adolescent behavior." So how did his group and others come to be seen as trying to block a lifesaving treatment? One explanation is that they sensed a backlash from parents and moderated their position. "Originally some of the groups came out 100% against the vaccine," claims NOW's Gandy. "Some of those have backed off and are just saying they don't want it to be mandatory." But another possibility is that both sides reflexively clenched their fists for a brawl, even when there wasn't much of a fundamental disagreement. Sprigg contends that there's "a theme running through liberal criticism of the Bush Administration and conservatives in general that they are anti- science. This a theme they'll point to on things as disparate as global warming, intelligent design,RU-486. I think people with that mindset just latched onto this, thinking it looked like a good example of that theme." There may well be parents who are reluctant to give their nine-year-old in . pigtails a vaccine against a sexually transmitted disease, that the very idea makes them incomfortable. But you have to wonder. It's not just that most nine-year-old girls don't know what a cervix is. Or that most doctors won't declare, as they administer the vaccine, "There! Now when you go out and have promiscuous, unprotected intercourse with strangers, at least there is one less sexually transmitted disease to worry about." I think they're much more likely to say, "This will only hurt for a second." Even if, as they got older, girls did understand somehow what the vaccine was protecting them against, surely the messages parents send to them every day and over the years—about respect, responsibility,judgment and the boundaries of appropriate sexual behavior—count for more than the implicit suggestion of a single vaccine. MSNBC did an online poll asking: If you have a daughter under age 15, would you have her get the cervical cancer vaccine? Of more than 8000 responses, 80% said yes, while 5.4% said, "No. She's too young to worry about sexually transmitted diseases." But if conservatives are right that the vaccine sends a mixed message, then all the more reason to make it mandatory. That would allow concerned parents who favor abstinence to trust... but verify. And to explain that they're doing this for the larger good of the whole herd. • Copyright©2006 Time Inc.All rights reserved. Reproduction in whole or in part without permission is prohibited. • Board of 3-feaCth Media Report • July 20, 2006 • Jefferson County Health and Human Services JUNE — JULY 2006 NEWS ARTICLES 1. "Lake's toxicity 20 times above mark",Peninsula Daily News,June 11,2006 2. "Lake water still bad",P.T. Leader,June 14,2006 3. "Highway gas spill doesn't hurt bay",P.T. Leader,June 14, 2006 4. "New urgent care clinic opens in PT",P.T. Leader,June 14, 2006 5. "Everyone needs a 'Plan B' for contraception",by Beth Wilmart,Opinion Forum, P.T. Leader,June 14,2006 6. "Toxins threat to valuable shellfishing",Peninsula Daily News,June 16,2006 7. "Toxic algae found in 2°d lake"(2 pages), PDN, June 16,2006 • 8. "Inside poisonous lake/Best advice: Just don't drink the lake water",(2 pages) Peninsula Daily News,June 21,2006 9. "New Warning: Don't drink Lake Leland water"Peninsula Daily News, June 23, 2006 10. "Tobacco Retailers Earn Awards"(2 pages)Press Release,June 27,2006 11. "Elevated levels of algae detected in Lake Leland,Peninsula Daily News,June 30, 2006 12. "Lake Leland cleared; Anderson still closed",Peninsula Daily News,July 9,2006 13. "County targets smoking violations",P.T.Leader, July 12, 2006 14. "County health staff plus funding can counter meth epidemic"by James Rotchford,MD MPH, Opinion Forum Perspective,P.T. Leader,July 12, 2006 • j }. Huh 04. Oli8 F, w O 0. 01- . F �' t�t ;�a" NS` o a Cip ��� . r. 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Lake He said specialists have checked other area lakes for Weather dependent blue-green algae and found McNickle said his staff a bloom at Lake Leland that, would approach Washington . while not nearly as large State Parks officials about water as the bloom in Anderson reopening Anderson Lake Lake, merits a closer look. State Park only after the neu- McNickle said he has request- rotoxin dropped to safe lev- ed a toxicity test on a water els. S t•1 1 bad sample taken at Lake Leland McNickle could not say and expects results back by exactly when that would Thursday. be, but he did say it would By Steven Barry noted that four depend on the weather. The Leader Staff Writerpeople have called and said - algae need direct sunlight to they suffered gastrointesti- sustain a bloom, so cloudy Test results from a Tacoma lab nal illness after eating fish weather could help them die released June 9 confirm that dying caught at Anderson Lake,but off. Once the biomass disap- blue-green algae have filled- Anderson none of those cases has been pears, the toxins should dis- confirmed. Anderson Lake appear within 14 days, he Lake with a surprisingly high concen- State Park is closed until said. Even after that, he'll tration of a dangerous neurotoxin called further notice and the public wait for test results before "anatoxin A." is reminded to discard fish recommending the lake be Now,public health officials are seek- caught there recently, opened. ing funding to set up a regular monitor- "I'd rather have real num- ing program to help detect toxic algae 'Annie'in force bets,"he said. blooms earlier and close lakes before McNickle said it is unlike_ neurotoxins reach such levels. McNickle said he was The World Health Organization rec- somewhat taken aback by the lY that an adult would ever =mends closinga lake if algaelevel of anatoxin A found in enough algae-filled toxins are detected at a level of one part per Anderson Lake. Preliminary water for the neurotoxin to be See LAKE,Page 15 tests last week showed it lethal.The two dogs died due present at just seven parts per to their light weight,he said billion,rather than 20. McNickle said his office • "To be honest, I was sur- has been a flurry of activity prised at the level,"McNickje since news of the toxic algae Port Townsend&Jefferson County Leader said, bloom went public last week. "It's been crazy. It's been McNickle said anatoxin A is produced by the spe- cies very busy.We've had a lot of cies of blue-green algae, or folks call in very concerned Laice cyanobacteria, known as not only about Anderson Lake Anabaena. It is one of the but about their own ponds Continued from Page 1 three most common variet- and streams,"he said. billion. The test results from ies of blue-green algae that (Contact Steven J. Barry Water Management Labs are collectively referred to as at sbarry@ptleadercom) show a concentration of ana- "Annie,Fannie and Mike." toxin A in Anderson Lake of This is Annie, McNickje 20 parts per billion. said,_, The lake was closed June All.three have the poten- 4 after two dogs that drank tial to be toxic. For the algae the water died and a third fell to bloom is quite normal, into a temporary coma, but toxic blooms are rare "Based on the sam- and totally unpredictable, piing we've collected thus McNickle said. C7`� 1.60-6&IV far, it appears that yeah, The • regular monitor- [moniWring] is impor- ing program would consist t� tant," said Jefferson County of tasking an environmental ( - Environmental Health health specialist with driv- Director Mike McNickle. ing to area lakes and looking • McNickle said he would for algae blooms. McNickle approach the Jefferson termed this a"windshield stir- County Board of Health on vey."If the specialist found a Thursday to discuss a plan for large bloom, laboratory test- keeping tabs on toxic algae ing would ensue,he said. blooms. • • Wednesday,lune 14,2006.A 11 Highway 'gas spill doesn 't hurt Officials at Washington However,Hanson said only State Department of Ecology 10 gallons made.it to a tribu- and Fish and Wildlife reported tary of Snow Creek adjacent • Thursday that gasoline spilled to the highway, thanks to the on Tuesday from an over- quick and efficient response turned boat at the entrance of Fire District 5 (Discovery to State Route 104 from U.S. Bay/Gardiner) and District 2 Highway 101 poses no risk to (Quilcene/Dabob)responders. health. Jefferson County Public John Hanson, an Ecology Health staff were prepared responder at the scene June 6, to close shellfish beaches at noted that 35 to 50 gallons of the head of Discovery Bay as gasoline spilled onto the high- a precaution, but they deter- way when a fishing boat being mined that closure would not towed by a truck overturned. be necessary. (^tte--e4 • • uauv2:2 N)'2 o= _ ° o N'a.0 ' uo 'v a � °o3o0b c o. o '�itt, x � OU . _ • 1p o0 ° c, uauu -o 0 ° 0 3 H � ' ov . *a .0 i; ' i , N.U u U ` u s 14 o .. « U , b v "d « UW 3 H .,-o -, o w ,C aub ° doa d Q c:14 u . aoq pu a o - v ° - cQtoo y u t).c .. tav , -.da o^ AOoCa.:14) gUatOt).° Cw ~ x " a) °. ~ I, N �4 C ` •v ou 1..1":" y ) claw o 3 -.o o -a ° t0 •" illipa(ro == a ° �C�y q 8 + a " �a 5 td a c 0 u o co w ) °v u u N " 0 ° ''Uooxx * OQwquoO u N.' 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O A u ed « u '.�',.,. 0 0Z N .« t. a, - - • ..., it th .t e.o The Port Townsend Leader OnLine I Letter: Everyone needs a 'Plan B' for contraception Page 1 of 1 PRINT 4, I ma II .0.90,..,,.. , :.„, ,,..,,..,,,v 4 V=,.,....:e, ,' I,g,,,v, A,r,..;-,„1.,r,A'>•ft, 44 C,!v,,, ,, -r ,a a .r .PFB...ir. 9.eri." w a^rmsw's.*% ,asa'r r 61 Wednesday,June 14,2006 Letter: Everyone needs a 'Plan B' for contraception Wednesday,June 14,2006 Editor, Leader: It happens more often than we would like to admit. Despite plans to the contrary, people have unprotected intercourse. Condoms break, pills are forgotten, alcohol clouds someone's judgment. Women are forced to have sex when they do not want to. It happens. But there is a safe, inexpensive back-up method of birth control that can help prevent an unwanted pregnancy. Perhaps you are thinking "this doesn't affect me." But did you know that according to the State Department of Health, Jefferson County has the highest rate of births from unintended pregnancies in the entire state?And did you know that over 60 percent of all births in Jefferson County are paid for by Medicaid? filPlan B is an FDA-approved emergency contraceptive that can reduce the risk of pregnancy by 89 percent if taken within three days(72 hours)of unprotected sex. The sooner a woman takes it, the more effective it will be, especially within the first 24 hours. Plan B is not RU-486 (the abortion pill); it will not work if a woman is already pregnant. Emergency contraception prevents pregnancy in much the same way that regular birth control pills do. In fact, women have been using higher doses of their regular pills as de facto emergency contraception for decades. Plan B is available without a prescription from any pharmacy in Jefferson County. QFC/Hadlock, Don's and Safeway all have pharmacists that are trained and authorized to dispense emergency contraceptives. Jefferson County Public Health provides Plan B at its Port Townsend Clinic from 9 a.m. to 4 p.m. Monday though Friday and at its Quilcene Clinic from 12:30 to 4:30 p.m. Wednesdays. It can also be prescribed by any licensed physician. The Jefferson County Friends of Family Planning, a citizens advisory group to Public Health, has been tracking the availability of Plan B along with other family planning issues in Jefferson County. To get involved, please contact Hilary Metzger at 385-9417 or hmetzger@co.jefferson.wa.us. BETH WILMART member Jefferson County Friends of Family Planning Related Links .Content©2006 Port Townsend Publishing Company,Inc. Software©1998-2006 1up!Software,All Rights Reserved http://www.ptleader.com/print.asp?ArticleID=15246&SectionID=5&SubSectionID=5 6/22/2006 Toxins threa o valua • shelifishing Official urges . program of Jefferson , closes monitoring . BY JEFF CHEW PENINSULA DAILY NEWS PENINSULA DAILY NEWS . PORT TOWNSEND—Fail- MATS.MATS BAY- Disapvery Bayatea ing septic systems, manure Marine biotoxins that . runoff from farms, marine cause paralytic shellfish The southwest corner of bacteria or viruses which can - mammal waste and other poisoning have been Discovery Bray is considered also exist in fecal material. chemical toxins are threaten- detected at con centra- `threatened, said McNickle. The presence of fecal conta- ing to close many of Jefferson tions above the closure • The bay was once filled with urination is an indicator that a native Olympia oysters, and health risk exists for County's precious recreational level in shellfish sam- ' the Jefferson Count Marine potential and commercial shellfish pies collected from Mats Resources.Committee is work- individuals exposed to the beaches. Mats Bay. ing to reseed the silver-dollar water,health officials contend. That's why • As a result, the state size oyster's populations. county Envi- Department of Health "Areas of concern," 25 companies r o n m e n t a I has closed all beaches in McNickle cited, are Hood Aside from recreal Health Direc- • the Port Ludlow and Canal near the Duckabush shellfish areas of concern, Neil tor Mike Mats Mats Bay areas to delta and Marrowstone Harrington, McNickle pro- w - the recreational harvest Harrin on, countyenviron- Island's Mystery Bay. mental specialist told the posed ae county of shellfish.• The issue is fecal coliform, p Surface Water Jefferson County Total coliform bacteria are a health board that research has Management '"' Environmental`Health'= ',.;` •collection of relatively harm- found 25 companies that are Program dur- either based in Jefferson officials recently took less microorganisms that live ing Thursday McNickle water samples from ' in large numbers in the County or harvest shellfish. afternoon's Coast Seafood in Quilcene. county Board beaches in the area intestines of man and warm- Bay is the world's largest oys- The closure area . • and cold-blooded animals.They of Health meeting. ter seed nursery, and requires boundaries are from the'' aid in the digestion of food. the establishment e t of monitorsal would - north entrance to Mats =4. °. A specific subgroup of this quality water as part of its seed Mats Bay south to a collection is the fecal coliform production for companies ing the health threats to point 4',000 feet south-' ''' bacteria, the most common around the United States and county waterways. the world. It is proposed to prevent the east of Tale.Point ,: member being Escherichia coli. closure of the county's shellfish Commercially hart The presence of fecal col- Taylor Shellfish Co. has a beds,said McNickle. vested shellfish are. ° • iform bacteria in aquatic envi hatchery on Dabob Bay and a "It would provide staffing to sampled separately<and .. ronments indicates that the shellfish farm at Dosewallips. measure areas of high fecal col- products on the market', water has been contaminated McNickle said the county iform," he said. should'be safe to eat. with the fecal material of man needed the funding to identify Already-closed to shellfish , or other animals. and correct "hotspots" of fecal beds are those near the Port ;Warnngs posted At the time this occurred, coliform pollution. Townsend city sewer outfall . the source water may have Trend data is already avail- line, Port Hadlock Marina, Warning signs have been contaminated by able through the state Depart- Pleasant Harbor south of Brin- been posted at high-use .-; pathogens or disease producing ment of Health, he said. non and Bridgehaven near beaches,wariung people Shine on Hood Canal, said not to collect shellfish` McNickle. ,from.these areas. Also closed is the north end The closure includes of Indian Island, a hazardous clams, oysters, mussels,•, 10 waste cleanup site, he said. scallops and other "Restricted" is the south species of molluscan 7) (0- /67-6G Dosewallips River area near shellfish -, , Brinnon at Hood Canal. •T TO WARIONO810, , # '5:9,,,,r,:,,,,,,,,„: i F S4E ,r; . k t,< M:t* r' i Fk 4, . kk2e ♦k ri •ier2 • '; 0 ;M n r 4 atl `� J� s ( '�45 ' �< dF ti, '. , Y idi..v S.{(F ttt i f,y,,1 I i 1 ,,,.„ `....'. ash z •O 0 a .� z f r r 3T g ff :.,6„..i:.,4.,'":- �� �. i 0 L t s + { C ' 0 X • lir + ' " r,f. t .i4++ g1 11 `i Air,t, ,�;�- -?�-�, :+04 y ' ; 0 Al � p+y 6 i �r . . R "i'..'- : r .' ,+ . ' a 0 4) ii‘k : ' ! r tbt$,14 :::2'1:111.:!.:.... r�) j Vtf�I." x � -9 O r. • t`k. .' tt 5 ti tir? e '� k lYyy�2xa +y,3 -.,^ E :r 19CC Kr,t 1Vlillb e yy e r #- yt t.t. 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Fischbach, County Administrator David Sullivan, Commissioner District#2 D5 ‘�� DATE: July 18, 2006 RE: Mental Health/Substance Abuse Oversight Committee - Applications Solicited • On July 3, 2006, the Board of County Commissioners approved the plan for"Expanded Mental Health& Substance Abuse Treatment & Therapeutic Courts Funds." A copy is attached for your information. This report calls for the Board to "appoint a Mental Health/Substance Abuse Advisory Committee (MH/SA Advisory Committee)to review the community need, program recommendations and evaluation information and make recommendations to the Board of County Commissioners." The report goes on to provide that the"members will be from existing boards and have no fiduciary interests in the contracts: two (2)members of the Law & Justice Council; two (2) members from the Substance Abuse Services Advisory Board; two (2) members from the Board of Health; and a Commissioner who will represent the Board of County Commissioners and the Mental Health Regional Support Network and serve as Chairman. On Monday, July 17, 2006,the County Commissioners appointed Commissioner David Sullivan as the Chairman of this new Oversight Committee. Commissioner Sullivan and I will work together to implement this new program. • Phone (360)385-9100 Fax (360)385-9382 jfischbach@co.jefferson.wa.us July 18, 2006 Memo re: MH/SA Oversight Committee-Applications Solicited Page: 2 • Commissioner Sullivan and I would like to solicit interest from the members of the Board of Health, the Substance Abuse Services Advisory Board, and the Law & Justice Council to serve on this Oversight Committee. Once we know how many people are interested in serving, we will be able to let you know what the appointment process will consist of and when the decisions will be made. If you are interested in serving, please send a brief bio and statement of interest to: John F. Fischbach County Administrator P.O. Box 1220 Port Townsend, WA 98369 or email to: i fischbach(a&co.j efferson.wa.us The Statements of Interest are due by Friday, August 4, 2006. • i noc, • �,t %,„/bN JEFFERSON COUNTY Vf7 BOARD OF COUNTY COMMISSIONERS ORDINANCE, NO. 08-1003-05 Tax Increase 1/10 of 1 % Expanded Mental Health & Substance Abuse Treatment & Therapeutic Courts Funds • 07/01/06 • Table of Contents • Jefferson County Ordinance No. 08-1003-05 Purpose Statement of Needs Program Creation and Authority Program Design &Evaluation Program Elements Administration &Authority Program Funding Evaluation Termination • Attachments A. Jefferson County Ordinance No. 08-1003-05 B. Jefferson County Substance Abuse Advisory Board Letter Dated September 5, 2005 C. CODIT (Co-Occurring Disorder Integrated Treatment Program)Budget Narrative D. Definitions • 2 • Expanded Mental Health & Substance Abuse Treatment And Therapeutic Courts Funds ORDINANCE Jefferson County Ordinance No. 08-1003-05. (See Attachment A) PURPOSE of Expanded Mental Health & Substance Abuse Treatment & Therapeutic Courts Funds (MH/SA Fund) The purpose of this ordinance is to use the County Legislative Authority to authorize, fix and impose a sales and use tax in addition to other taxes authorized by law with a rate not to exceed 1/10 of 1%to provide monies to be used for the purpose of providing new or expanded substance abuse or mental health treatment services and for the operation of a new or expanded therapeutic court. In the 2005 legislative session Senator Hargrove introduced the Omnibus Mental Health and Substance Abuse Refoiln Act SB 5763 which focused on the expansion of substance abuse and mental health treatment (co-occurring disorders). The bill passed with strong bi-partisan support. • The goals of the legislation were to: 1. Reduce negative impacts of mental health and substance abuse on children and families 2. Avoid building more jails and prisons and prevent crime victims 3. Reduce public assistance expenditures and unemployment 4. Reduce homelessness 5. Reduce physical-health care and emergency room costs 6. Improve recovery and quality of life for those with substance abuse and mental health disorders To meet these goals the legislation provides a funding mechanism to expand or provide new mental health and substance abuse treatment by authorizing counties to impose a sales and use tax in the amount of 1/10 of one percent (10 cents per$100). STATEMENT OF NEEDS The impact of substance abuse and mental health disorders on Jefferson County is significant and it is clearly recognized as the most costly issue facing Jefferson County Government today because it affects all systems. The impact is across the board from emergency services,police, • 3 courts,jails,public health, mental health,business, child abuse,domestic violence,public11111 assistance, schools, environment, housing,crime, substance abuse services, shelters,non-profits, insurance rates, landlords,property values and more. It is all pervasive. The available state funds are inadequate to meet these needs. In the county there is a daily lack of access to treatment. These disorders contribute to continued problems within the schools, a majority of calls to law enforcement for the city and county, and for many of the Jefferson County Prosecutor's cases. The impact is substantial in the courts,Juvenile Justice,the jail system,the schools,Public Health, employers and agencies. The community impact is recognized in the health community and economic impact of citizens and families suffering through substance abuse and mental illness cycles. The true community impacts of the untreated diseases are difficult to measure and are indicated by accidents on the roadway;health care ER utilization rates; teen substance abuse arrests;unemployment rates and other impacts. Some impacts are silent and devastating like: the impact on schools shown by data that Olympic Educational Service District, Take Time Resources specialists found when serving 76 children that self referred from 4-5th grade. Other data is public and familiar like the treatment rate of publicly funding treatment with methamphetamines. These silent and visible behaviors impact our community negatively and pervasively. Mental Health services are very limited and most individuals receiving these services must be in crisis or have Medicaid eligibility. If the individual does not meet the proper criteria they most • likely will not receive the service. The impact of the rationed nature of these services is that underserved populations end up in hospital emergency rooms,jail or being involved with law enforcement or other emergency services. PROGRAM CREATION AND AUTHORITY By adopting this 1/10th cent sales tax Jefferson County has increased taxing authority to create and enhance mental health and substance abuse treatment services to decrease the fiscal and emotional impact of these diseases on the community and the legal system. The vendor contractors of these programs must implement comprehensive county-wide services available to all citizens without discrimination due to lack of income, if they can serve clients with any other available funding stream this"Mental Health/Substance Abuse Fund"becomes the payment of last resort. The County Administrator may ask for proof of billing denials in year end reviews. The fund and contracting will be administered by the Board of County Commissioners/County Administrator,who shall have the authority, along with the approval of Jefferson County Commissioners,to exercise all lawful powers necessary and appropriate for the contracting, statements of work and maintenance, operations. Community impact data and community needs will be identified by a group working with • Jefferson County Public Health Data Steering Committee. This data will help identify needs and • measurements on an ongoing basis. This is a moving target and we need a system that is flexible, innovative and responsive to community needs.. The director of each subcontracting agency shall submit a yearly operating plan, budget and an annual report to the County Commissioners for review and approval. This plan and budget format will be approved by the County. Program evaluation is also the responsibility of the contracting agency and will be requested by the Board of County Commissioners yearly and reviewed by the advisory group. The Board of County Commissioners will appoint a Mental Health/Substance Abuse Advisory Committee to review the community need,program recommendations and evaluation information and make recommendations to the Board of County Commissioners. Members will be from existing boards and have no fiduciary interests in the contracts: two members of Law and Justice, two from the Substance Abuse Committee; two from the Board of Health and a Commissioner who will represent the Board of County Commissioners and the Mental Health Regional Support Network and serve as Chairman. PROGRAM DESIGN & EVALUATION The County believes that the programs or services that are to be implemented are infoiuied by "evidence based", "research based", "emergency best practice", or "promising practice" as defined in the legislation and the group encourages innovative approaches to local problems • where there are no applicable models. A collaborative plan to supplement services for citizens is the best way to build a service network for Jefferson County. Services will be contracted through Interlocal agreements or contract between the County and private not-for-profit agencies or other government entities in Jefferson County. The County believes in the development of a"Drug Addiction Co-Occurring Mental Health Disorders (COD)model targeted on supporting Jefferson County crisis services and therapeutic jurisprudence needs. The model will include multiple levels of mental health and substance abuse services for adults and adolescents. PROGRAM ELEMENTS Contracts shall establish/or provide access to programs for the following services,based on the priorities of the Law and Justice subcommittee and other standing committees. • Treatment for individuals with co-occurring disorders • Therapeutic court and case management staff to coordinate Drug &Mental Health court referrals and dependency needs of families in courts • Expanded Mental Health/Substance Abuse treatment for populations not served • by other public funds • Substance abuse assessment and Mental Health assessment, counseling, and • medication management in the jail Additional funds could be available to contract with other vendors providing family, child counseling or substance abuse treatment. Services could be provided by additional vendors to provide care to family members coping with mental illness or substance abuse in a spouse, parent or child: • Family support in some schools providing mental health services to students • Substance abuse interventions in the schools • Ongoing Home Visits to families by Infant Mental Health & Public Health Nurses for young families or Nurse Family Partnership visitation • Other licensed treatment providers and addiction specialists who are successful with county population and may need to bill for services The program services and areas included in the model above could include the following components: • Family Dependency Court • • Juvenile Drug Court • Crisis Services including; Evaluation and Treatment Unit, Sub-acute and Acute Detoxification, and Residential Treatment (Inpatient) • Expanded Outpatient Treatment providing services to Adults and Adolescents who have Addition an Psychiatric Disorders (COD) • Case Expediters/Facilitators; these positions would be designed to assist patients with access to services, eligibility, and placement. • Systems Collaboration with all identified stakeholders including: mental health, crisis services, law enforcement, courts,jail, DCFS, CSO, Shelters, VA, alcohol and drug services,hospitals, emergency services, corrections,public health, and other to be determined. • Program and Project Evaluation—This component of the model would provide ongoing evaluation of programs and services. It would include accountability, outcomes, planning, efficiency, effectiveness and cost offsets. • Substance Abuse &Mental Health assessments within three working days for referrals from the Juvenile Justice; Public Health; and Jefferson General Hospital Emergency room. ADMINISTRATION & AUTHORITY The County Administrator shall submit an operating plan,budget and an annual report to the • Board of County Commissioners for review and approval. • PROGRAM FUNDING Money received from tax imposed under this ordinance shall be used solely for the purpose of providing new or expanded drug, alcohol abuse &mental health treatment service and for the operation of new and expanded therapeutic court programs. Moneys collected cannot be used to supplant existing funds for these purposes. This local funding provides a unique opportunity to enhance services to community members in need of mental health and substance abuse services that are presently not able to receive those services. Because it is funding locally collected and locally distributed it would also provide an opportunity to solve local problems innovatively, in other words, free from the constraints of other levels of state and federal government. A percentage will be set aside annually for reserve and match funding. Mental Health/Substance Abuse enhancement programs and any participating municipality, agency, department or special districts may solicit additional funds through grants, to supplement program funding or bill any available insurance or Medicaid resources that become available. The purpose of this partnership is to expand existing funds to serve more people. Receipts anticipated for this tax can best be estimated by taking the actual collections the County • is experiencing on a similar tax that was imposed last year for the E911 dispatch services. We have 12 months of actual collections from this tax which is imposed on the same taxable items. In the first 12 months this tax has produced$389,668.77, or an average of$32,472.40 per month. Receipts have ranged from $41,719.44 in November 2005 to $25,257.33 in March 2006. These receipts are noted below: Month of Receipt Amount Received June $26,860.47 July $30,266.38 August $36,995.77 September $34,513.70 October $35,607.00 November $41,719.44 December $30,807.59 January $29,244.01 February $37,087.04 March $25,257.53 April $25,862.79 May $35,447.05 • Priority Funding Identified for First Two (2) Years: • The"Expanded Mental Health & Substance Abuse Treatment &Therapeutic Courts Funds" are estimated to receive $360,000 during the first year the tax is imposed. The tax has been imposed, according to the State, effective April 1st. This means,based on past experience with the State Department of Revenue, receipts should be received by the County in June. This was confirmed by the Department of Revenue on June 7th. The following programs/activities are recommended to be implemented early on in the program within the anticipated funds to be received during the first year. Co-Occurring Disorder Integrated Treatment Program(CODIT): is envisioned as a combined project of Jefferson Mental Health Services and Safe Harbor/Beacon of Hope. The program is explained in detail as Attachment 'B' and a budget is incorporated as Attachment 'C' and is envisioned as a treatment based program for individuals with co- occurring disorders and those unable to find treatment through existing mental health or substance abuse programs. $167,608 Substance Abuse Assessment and Mental Health Assessment Counseling and Medication Management: for clients unable to find treatment and for those in jail. This service will be provided under the auspices of the Sheriff's office. $33,196 • Therapeutic Court and Case Management Staff to Coordinate Drug & Mental Health Court Referrals and Dependency Needs of Families in Courts: to assist in determining this service, a separate Ad Hoc Committee will be formed including representatives from all offices who will be involved (i.e. Juvenile Services, Courts, Health Department, Drug Court, etc.)The group should examine similar Courts in Washington State and the nation to find the model that is best suited for Jefferson County. $33,196 20% Reserve and Cash Fund Reserve: will ensure that 20% of receipts will be set aside and held in reserve to address any revenue shortfalls or provide grant matching opportunities. $72,000 10% for Baseline Studies, Community Assessments and Community Evaluation: this service will be handled by the Department of Health. To provide ongoing systematic collection of data and analysis of local needs through the use of Behavioral Risk Factor Surveillance Surveys (BRFSS), youth data analysis and other community evaluations and existing local data. This information will supply the Board of County Commissioners • and their designees with identification of the needs to prioritize and deteimine how mental health/chemical dependency funds should be focused. $36,000 5% Billing, Program Evaluation and Administration: this service will be provided by the County Administrator's office or a department designated by the County Administrator. $18,000 Additionally, the State passed a bill this year(Engrossed Second Substitute Senate Bill 6239) that will provide grants of up to $100,000 to those counties who pass/adopt this sales tax. The grant applications will be available in 2007 and if funded by the State will be available for three years, 2008, 2009 and 2010. It is recommended that the sales tax imposed by the Board of County Commissioners be utilized in this fashion to expand and implement new mental health and substance abuse services as well as the Therapeutic Family Court. The impacts of untreated mental health and substance abuse are great—to our economy and the quality of life in our community. Research by DASA has shown that treatment works for behavioral health diseases at the same level as treatment for other chronic diseases, such as diabetes. • The County believes that the programs or services that are to be implemented are informed by "evidence based", "researched based", "emerging best practice", or "promising practice"as defined in the legislation and innovative approaches to local problems where there are no applicable models, are encouraged. EVALUATION Needs: Residents of Jefferson County asked to pay additional taxes, deserve documentation of the needs and benefits of the use of those tax dollars. First, it is critical that an assessment of the current status of the community needs be measured to establish a baseline set of data so change can be measured. The Mental Health/Substance Abuse Services Advisory Board will be asked to establish treatment evaluation criteria. Evaluation of Impact: There is no data system that provides integration of substance abuse and mental health data for those receiving services that are not publicly funded. The lack of adequate baseline data will require that during the first year, specific data sets be established including population unable to access services; sources of information are identified; data collection be initiated; and analysis and establishment of baseline measures are created. It is expected that these measures will include data regarding the impacts of behavioral health needs within law enforcement, education, and health care. The collection of baseline data will enable the Board of County Commissioners to utilize the information in establishing outcome measures in order to • measure the impacts of the program design. The program will contract with the Public Health • Department to execute these functions. CONTRACT TERMINATION RULES The following rules will be incorporated into all contracts/interlocal agreements: Any party may terminate contract agreements for any reason upon 30 days prior written notification to the other party. If these agreements are so terminated, the parties shall be liable only for performance rendered or costs incurred in accordance with the terms of this Agreement prior to the effective date of termination. If for any cause, any contracting party does not fulfill in a timely and proper manner its obligations under these contract agreements, or if either party violates any of these terms and conditions, the aggrieved party will give the other party written notice of such failure or violation. The responsible party will be given the opportunity to correct the violation or failure within 15 working days. If the violation or failure is not corrected this Agreement maybe terminated immediately by written notice of the aggrieved party to the other. • • l f i?t,5 /S �me Q _ tr. . STATE OF WASHINGTON County of Jefferson the Matter of Imposing a Sales Po b and Use Tax; } Providing for the Administration and Collection Thereof } For Providing New or Expanded Chemical Dependency } ORDINANCE NO. 08-1003-05 or Mental Health Treatment Services and } for the Operation of New or Expanded Therapeutic } Court Programs as Provided in Ch. 82.14.460 RCW. } WHEREAS,substance use disorders are a serious and treatable health problem known to I impact directly or indirectly as many as 60%of Americans and mental illness is a serious and treatable health problem known to directly occur in more than 19 million Americans,the most serious and chronic conditions occurring in 3 to 5%of the population; and WHEREAS,approximately 50% of individuals with severe mental disorders are also substance abuse disordered, and approximately 37% of alcohol abusers and 53% of drug abusers are also affected by serious mental illness; and WHEREAS, individuals with co-occurring disorders(dually diagnosed mental illness and substance abuse disorders) are at high risk for negative outcomes, including hospitalization, overdose, violence, legal problems, homelessness, victimization, HIV infection, and hepatitis; and WHEREAS, community children and youth are impacted by mental disorders, substance 41,disorders and co-occurring disorders both as the children of, and as individuals with,mental ess and/or substance abuse disorders, often with resulting negative impact on their health, ability to learn,home life and safety, social behavior, and emotional development; with concomitant impacts on education,juvenile justice, child and family, health, and mental health service systems; and WHEREAS, services for individuals with co-occurring disorders cost nearly twice as much as for clients with single disorders; and non-integrated parallel methods of treatment have proven to be ineffective; and WHEREAS,treatment for individuals with co-occurring substance use and mental illness requires specialized care to meet the unique and often opposing needs of both disorders; and WHEREAS, the Jefferson County Substance Abuse Advisory Board, upon review of local,state and national data and information, identified the health, social, community,and economic impact of alcohol and other drugs on Jefferson County and its citizens, and the impact of mental disorders,substance use disorders and co-occurring disorders, as a major public health and public safety problem in their October 2004 White Paper to the Jefferson County Board of County Commissioners and to the citizens of Jefferson County,and • Ordinance No.08-1003-05;Imposing a Sales&Use Tax for Providing a New or Expanded Chemical Dependency or Mental Health Treatment Services and for the Operation of New or Expanded Therapeutic Court Programs as provided in Ch.82.14.460 RCW WHEREAS, the impact of substance use disorders on the Jefferson County law and justice system is significant, accounting for more than 2/3 of law enforcement calls in the City and • County and half of the Jefferson County Prosecutor's cases;and WHEREAS,Law and Justice system response to individuals with mental disorders, substance use disorders and co-occurring disorders represents a significant and costly problem throughout Washington State, so much so that the 2005 Washington State Legislature passed E2SSB 5763, an act relating to the creation of the omnibus treatment of mental and substance abuse disorders,in the belief that identification and integrated evidence-based treatment of mental disorders, substance use disorders and co-occurring disorders is critical to successful outcomes and recovery; and WHEREAS, Jefferson County citizens,through their property taxes, are paying for the cost of mental disorders, substance use disorders and co-occurring disorders through funding of courts,jails, emergency medical technicians, schools,hospitals and law enforcement personnel; and WHEREAS, sales and use taxes are funding sources that affect citizens who do not own property in Jefferson County, and apply as well to visitors to Jefferson County, and,thus,would expand the potential revenue stream to address mental disorders, substance use disorders and co- occurring disorder treatment; and WHEREAS, therapeutic courts and integrated mental disorders, substance use disorders and co-occurring treatment programs utilizing evidence based best practices have been shown to • have positive outcomes, thus decreasing negative social, health and fiscal impacts on individuals and communities; and WHEREAS,recognizing the health, social, community and economic impact of mental disorders, substance use disorders and co-occurring disorders on Jefferson County citizens as significant and negative, and desiring to achieve the goal of successful outcomes and recovery for individuals with mental disorders, substance use disorders and co-occurring disorders; and WHEREAS, Jefferson County has an aging population and older people consistently underutilize both mental health and substance abuse services, and therefore suffer a disproportionate degree of harm from these conditions, and need special services and efforts to utilize services effectively; and WHEREAS,the Board of County Commissioners recognize that successful outcomes and recovery for some citizens will be a prerequisite for becoming employable and entering the workforce, and make it possible for employers to retain valuable experienced employees; and Page 2 of 4 • Ordinance No.08-1003-05;Imposing a Sales&Use Tax for Providing a New or Expanded Chemical Dependency or Mental Health Treatment Services and for the Operation of New or Expanded Therapeutic Court Programs as provided in Ch.82.14.460 .RCW WHEREAS, RCW 82.14.460(2)authorizes the County Legislative Authority to •uthorize, fix and impose a sales and use tax in addition to other taxes authorized by law with a rate not to exceed one-tenth of one percent; and RCW 8244.460(3)provides that monies collected shall be used solely for the purpose of providing new or expanded chemical dependency or mental health treatment services and for the operation of new or expanded therapeutic court programs. WHEREAS,RCW 8244.460(3)provides that if Jefferson County authorizes the tax as provided,the County may include a new and expanded therapeutic court for dependency or mental health treatment proceedings as a component of its existing Drug Court program, effective July 1, 2005. NOW, THEREFORE, BE IT ORDAINED, by the Board of County Commissioners of Jefferson County, Washington, that: Section 1: Tax Imposed. .. There is hereby imposed by this ordinance a one tenth of one percent sales and use tax, as the case may be, upon every taxable event, as defined in Chapter 82.08 and 82.12 RCW, occurring within Jefferson County. The tax shall be imposed upon and collected from those persons from whom the state sales or use tax is collected pursuant to Chapters 82.08 and 82.12 RCW. This tax shall be in addition to any other sales and use tax imposed by the State of Washington and/or Jefferson _ County_ • Section 2: Applicability of Tax. The rate of tax imposed by this ordinance shall be applied to the selling price in the case of a sales tax or the value of the article used in the case of a use tax. Section 4. Administration and Collection. The tax imposed by this ordinance shall be administered and collected in accordance with Chapter 82.14.050. The Chairman of the Board of County Commissioners is hereby authorized to and directed to execute and contracts with the Washington State Department of Revenue that may be necessary to provide for. the administration or collection of the tax. Section 5: Establishment of Chemical Dependency/Mental Health Program Fund. There is hereby created the Chemical Dependency/Mental Health Program Fund. Monies collected pursuant to this ordinance shall be deposited in this fund by the - Jefferson County Treasurer: The fund balance may be invested by the Treasurer and any interest earned shall be deposited in this fund as well. Page 3 of 4 • Ordinance No.08-1003-05;Imposing a Sales&Use Tax for Providing a New or Expanded Chemical Dependency or Mental Health Treatment Services and for the Operation of New or Expanded Therapeutic Court Programs as provided in Ch_82.14.460 RCW , Section 6.. Use of funds. Monies deposited in such fund shall only be used solely for purposes as authorized • by the laws of the State of Washington, including,providing new or expanded chemical dependency or mental health treatment services and for the operation of new or expanded therapeutic court programs. Monies collected under this section shall not be used to supplant existing funding for these programs. Section 7. Administration of Fund. The Fund shall be administered by the Board of County Commissioners through the County Administrator. The County Administrator,with the help of the Jefferson County Law and Justice Council, the Substance Abuse Services Advisory • Board, and Jefferson County Public Health, is hereby directed to prepare a six-year spending plan and an annual budget. Section 8. Effective Date. This ordinance shall take effect July 1, 2005,however,the creation of a therapeutic court as provided under Ch. 26.12 RCW, as a component of the County's existing Drug Court program will not become effective until July 1,2006. Section 9. Severability. If any provision of this ordinance or its application to any person or circumstance is held invalid, the remainder of this ordinance or the application of the provisions to other persons or circumstances in not affected. IIP,ROVED AND ADOPTED this . -_:, day of �C, 'i , 2005. • '''1-.' -14,r---. -."--NI: :6.y-: - j JEFFERSON COUNTY BOARD OF COMMISSIONERS * T. . ...-r.,.......4"/ . s, • ...,:tti. " Phil Jo n, Chair ATTEST: rt, �,�'•' C'%rt� favi ul v. ,Mem.-r - pl Julie Matthes, CMC ,�i'�7/� ..„,„, - Deputy Clerk of the Board •atrick M. 'odgers, Member Approved as to Form: Prosecuting Attorney Page 4 of 4 •