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Home My WebLink About2008-April File Copy • Jefferson County Board of 3-feaCt(1, gencCa 3vlinutes .Aprili7, 20 o8 • s JEFFERSON COUNTY BOARD OF HEALTH Thursday,April 17, 2008 2:30 PM--4:30 PM First Floor Conference Room Jefferson County Courthouse Port Townsend,WA 2:30-4:30 PM DRAFTAGENDA I. Approval of Agenda II. Approval of Minutes of March 20,2008 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. Tobacco Prevention Efforts in Jefferson County 2: Jefferson County Restaurant Awards • V. New Business 1. Jefferson County Public Health Heroes 2. Port Townsend Paper Mill Health Consultation Report 3. Meth Action Team White Paper 4. Our Kids Our Business 5. Protocol for Responding to Public Meeting Disruptions VI. Activity Update VII. Agenda Planning May: Royer Report On-Site Sewage System Homeowner Inspection VIII. Next Scheduled Meeting: May 15,2008 2:30 PM--4:30 PM First Floor Conference Room Jefferson County Courthouse Port Townsend,WA • • JEFFERSON COUNTY BOARD OF HEALTH MINUTE S Thursday, March 20, 2008 2:30 PM— 4:40 PM Board Members Staff Members Phil Johnson, County Commissioner District#1 Thomas Locke,MD, Health Officer David Sullivan, County Commissioner,District#2 Jean Baldwin,Public Health Services Director John Austin, Chair, County Commissioner,District#3 Julia Danskin,Nursing Services Director Chuck Russell,Hospital Commissioner District#2 Michelle Sandoval,Port Townsend City Council Sheila Westerman, Vice Chair, Citizen at large(City) Roberta Frissell, Citizen at large(County) Chair John Austin called the meeting of the Jefferson County Board of Health (BOH) to order at 2:33 PM in the Pope Marine Building, Port Townsend. Members Present: John Austin, Roberta Frissell, Phil Johnson, Michelle Sandoval, David Sullivan, Sheila Westerman Members Excused: Chuck Russel Staff Present: Jean Baldwin, Dr. Thomas Locke, Julia Danskin, Susan Porto, Neil Harrington, Gail Bernhard (Recorder) A quorum was present. APPROVAL OF AGENDA Chair Austin recognized a motion to approve the agenda and a second. The motion to approve the agenda, as written,was approved all in favor. APPROVAL OF MINUTES OF FEBRUARY 21, 2008 Sheila Westerman noted that at the top of page 2, the motion for approval of the minutes of January 17, 2008 should include "as amended". Also, on page 8 (line 2 and 3) the minutes should read "Member Westerman stated that the whole Board should ....", not the whole committee. Chair Austin, under Public Testimony, provided the surname for Denver Shoop. He also pointed out the typographical error in the spelling of"Sandoval"under Board Members, page 1. Member Westerman moved for approval of the minutes of February 21, as amended; the motion was seconded by Member Sullivan and approved, all in favor. PUBLIC COMMENTS • Chair Austin opened up the meeting to public comment. There were none. Page 1 of 13 DRAFT • Dr. Locke referred to the letter in the packet,which expressed BOH opposition to SB6620. He reported that the bill had not passed. He said that a bill by the same sponsor had almost passed, but was held up in committee. Member Westerman said that she was pleased at the outcome and felt that the local health departments were pivotal in stopping this measure. The bill would have required the installation of a costly specific system for septic systems in certain locations,which would have been very expensive for the home owner. There is inadequate scientific evidence that this process has been effective in reducing nitrate levels. The proposal had gotten through the House and into the Senate, and was expected to pass. However, it was defeated at the last minute, with the help of opposition letters, such as the one from the Jefferson County Board of Health. Region 2 Public Health Newsletter Dr. Locke reported that there had been considerable publicity about the rather poor match between flu vaccine formula and circulating influenza strains this year. He said there was still some influenza activity in Washington state; typically, it does not disappear until about April, but the peak seems to have passed. The CDC and WHO are planning to reformulate the vaccine for next year. He also called attention to the Communicable Disease Surveillance Data for 2007. He noted the local statistics for Chlamydia and Gonorrhea. According to a federal report, one out of every four female teenagers women has had an STD. Although the general trend is upward, the rate in Jefferson County has been reduced significantly. This is the beginning of the second year where the rate is significantly • lower than for neighboring counties. He said he hoped that that is related to aggressive STD screening and partner treatment strategy. He said that it may be well to have a more in depth presentation at a future meeting. Dr. Locke also noted that Jefferson County leads the region in the number of Giardia cases, which may be due to the amount of recreational activity and wilderness area. In addition, local physicians are quite familiar with the presentation of Giardia, so they tend to look for and identify it. It is a very treatable infection if correctly diagnosed. Chair Austin asked what the latency time is between exposure and onset of symptoms. Dr. Locke said that, particularly with intestinal infections, that varies with dose. A very large exposure may show up more rapidly, i.e. in a week or two. For Giardia, a one cyst exposure can take a month or more to present as illness. hi response to a question, he said that not all Giardia infections cause symptoms. A mild infection may naturally resolve, but can be spread to others. Chair Austin said he wondered about the rate of unreported infection, particularly for tourists whose symptoms may not manifest until weeks after they leave the county. Dr. Locke said that there is little known regarding the number of cases that spontaneously resolve. Often, physicians are alerted to Giardia when symptoms have persisted past two weeks, or when investigating causes for mal- absorption syndromes, with weight loss and chronic diarrhea. Chair Austin asked how statistics are reported, with regard to location. Dr. Locke said that the reporting is by county of residence, and if not given, by county where diagnosed rather than where treated. Jean Baldwin gave other examples such as highway deaths and HIV incidence where interpretation of data depends on understanding the location information. • Michelle Sandoval said that, with regard to the paper mill footprint project, citizens have been asking questions about cancer rates, for example. She asked how tracking is related to treatment location. Dr. Locke explained that the Tumor Registry tracks a great deal of information about each case of cancer. Page 3 of 13 DRAFT It is based on county of residence when diagnosed, and also linked to the facility where the cancer is • diagnosed and treated. He briefly explained the challenges of cluster analysis and attempting to associate cause and effect relationships. He said that with most environmental cancers there are latency periods of thirty to forty years, and estimates of the dose of exposure are nearly impossible. The best cancer data comes from occupational statistics, where the length of exposure and the levels of exposure can be determined. Member Westerman asked if levels of MRSA are likely to reach levels such that the incidence would be reported on this chart. Dr. Locke said that a Science Panel had been convened by the Governor in December 2007 and had recommended against mandatory MRSA reporting. The State is now tracking all the MRSA cultures out of hospitals and labs. Jean Baldwin said that she believes there should be two other reports to the BOH in the future. One is the Expedited Partner Therapy program and the other is on HPV vaccines. National Public Health Week Julia Danskin referred to the March 6 press release in the packet,noting the highlights. National Public Health Week begins April 7. This is a nationwide campaign with a national website. The theme this year is "Climate Change and the Nation's Health". In conjunction with this event, for the second year, Jefferson County will recognize and honor Public Health Heroes. These are people who live or work in Jefferson County and promote Public Health in their daily lives. She said nominations should be received by March 27. The nominations will be evaluated by the committee: Roberta Frissell and Julia Danskin. Public Health Heroes will be honored at the next BOH meeting on April 17. Jean Baldwin urged members of the BOH to nominate candidates for this honor. • NEW BUSINESS Proposed Revisions to Jefferson County Septic Code 8.15 Chair Austin referred the Board to the document containing line in/line out revisions to the Septic Code 8.15 based on the last meeting. Dr. Locke explained that, as directed by the Board, staff had continued to revise the language, reconcile definitions with other regulations, and to translate policy language into code language, per the recommendations from county attorney David Alvarez. This makes it easier for people to understand what the rules are and gives the policies greater legal standing. Dr. Locke described three options for the Board with regard to the code. The first would be to do nothing at this time, but to revisit it at a future time when the homeowner inspection concept and standard have been fully developed and there is community consensus. There would also be some homeowner inspection models from other communities available for review. The second option, which he did not recommend, would be to adopt the document as of this meeting. He said that the hearing requirements have been met and the Board has the authority to do that, although he did not believe Board members were inclined to take that option. He noted that having further public involvement would be desirable and hoped many good ideas would be brought forth. The third option is to pursue these proposed changes to the current on-site code and continue the public hearing process. He noted that David Alvarez has made a few additional minor changes in the draft ip code language. Further public hearings would entail finalizing the draft changes,publishing this draft on the web, and scheduling facilities with adequate space. This would mean moving ahead on the non- Page 4 of 13 DRAFT • controversial changes to the code, while continuing to work on development of a homeowner inspection program. He said that the one and three year inspection cycles are not at the discretion of the BOH; it is in the state code and is a state mandate. However, the implementation schedule is up to local discretion. It had never been the plan to implement everything at once. Dr. Locke said that the implementation priorities are laid out in the on-site sewage plan: to look for failing systems and to look at the most sensitive areas, like marine recovery areas. The strategy is to put resources where they will do the greatest good in the shortest time. Referring to the latest draft, Dr. Locke said staff has been wrestling with the issue of how to incorporate existing BOH policy into the code. Citing various options, he said Kitsap County has a section in their code where they adopt all the policies into the ordinance by reference. His feeling is that this practice tends to blur the distinction between policy and code. From an environmental heath law perspective, a BOH ordinance is a quasi-legislative act while a policy interprets authority that already exists and is a quasi-executive function. If the policy is actually creating new regulations, then it belongs in the ordinance. The advantage of keeping policy separate is flexibility. The Mr. Alavarez has categorized the process options as 1. most desirable—transform all policies into text in the onsite sewage plan; 2. middle ground—have an onsite sewage code section that discusses adopting policies, lays out the rules for who has authority to adopt the policies and list the current policies (the Kitsap Health District has code language along those lines.); 3. least desirable—make no reference to policies in either the paper copy of the Jefferson County code or the 81.5 version on the web. • Dr. Locke said that the approach taken is between option 1 and 2. Policies that seem to have regulatory aspects have been written into the code. An appendix has other policies so they are easy to find. Member Westerman asked whether a citizen requesting a copy of the ordinance would automatically receive the policies referenced in the appendices. Dr. Locke said yes, they would; and on the web site, a policy addressed in the code would be in the same document, eliminating the need to look for it elsewhere. Chair Austin pointed out a typographical error on page 55: Policy 94-01 should be Policy 04-01. Others noted that notification of the error had been previously e-mailed. Chair Austin asked for clarification on the opinion of Attorney Alvarez regarding policies referred to in the appendices of the code: would that be virtually the same as being part of the code? Dr. Locke said that was not addressed in his memo, but in conversations; he feels that legally the highest standard is if it is in code language. However, for some of the policies, it would be cumbersome to put the entire policy document in code since they are written in different styles. Code language is often technical and follows the format set by state administrative codes (WAC) and statutes (RCW). Policy documents are written to explain the interpretation and enforcement of state regulations,plus any additional requirements imposed by the local BOH. They are written to be understandable to as many people as possible. He said his recommendation was to keep both: to reference policies in the code when appropriate and • incorporate policy language in the code when possible. A case in point is the discussion we have had over reserve areas or what triggers a sanitary survey assessment. Those are things that naturally mesh in with the code language. Policies referenced should be placed in the appendices, which is a new Page 5 of 13 DRAFT thing not done previously. Reducing the number of policies and consolidating them whenever possible is a desirable goal as well. Jean Baldwin said that updating them as other state and county laws change • around us is also desirable. So, if they are in the code that means more frequent changes to the code, as opposed to simply a policy change. Dr. Locke also clarified that policies are adopted by the Board in a public process. They are not simply an administrative action; it is an action of the Board. Sheila Westerman said she would like to go over a few proposed revisions in the spirit of refining and improving the document, time permitting. She said certain items are substantive and may require more Board discussion. Page 2 of 55,bottom of page under the Design paragraph: she suggested that the acronym JCPH be written out the first time it appears in the document. Subsequently, it was agreed that the full designation should be written out, followed by the acronym,the first time the acronym is used. Page 5 under 0 &M Inspection: she suggested stating where"in these regulations"the criteria are listed. Page 5 under Ordinary High Watermark,B: she suggested defining the term"Mean High Water" in the definition section. [Chair Austin invited other Board members to make comment about any item along the way. Jean Baldwin also asked staff Susan Porto and Neil Harrington to provide additional background or other ip information about items in question. ] Page 9, number (3): Member Westerman asked if the "minimum land area requirement" is described anywhere in the document; she said a reference should specify where the definition appears, whether it is within a Policy, in the appendix, or other. Page 12, number(3) a: Member Westerman noted that the definition was cumbersome and unclear, and asked why the term"bedrooms"could not be used instead of a list of exclusions. A discussion ensued about the rationale, which is to determine how many people are residing in the house and using the septic system. Dr. Locke noted that the goal is to accommodate both current and probable future uses so that people do not inadvertently overload their systems. The significance of the presence of closets and ADUs was also discussed. One suggestion was to include the phrase"number of rooms used for sleeping" followed by explanatory information. Staff explained that they shared the concern about the language and would continue to attempt to simplify/clarify it. Page 21, (9), bottom of page: Member Westerman asked for the meaning of "....is in a marine recovery area or other area identified by the Jefferson County Board of Health." After a brief discussion about how to clarify it, Dr. Locke noted that David Alvarez, County Attorney, had suggested the language "identified by the BOH in a public meeting". Dr. Locke said staff would add language to clarify why such a designation would be needed to be made by the Board. Member Westerman requested that this be corrected wherever it occurs in the document. Page 23, top of page: misspelling of`floatation"; should be "flotation". • Page 6 of 13 DRAFT Page 24, 8.15.40 (3) d: Is the 16 hours state-mandated; if so,can the reason be explained? After a • brief discussion, Dr. Locke noted that the state gives the local boards discretion over the amount of training for an 0 &M Specialist. Jean Baldwin noted that the requirements are similar to what other counties require. Member Westerman asked if this could be considered a standard. Audience member Chuck Molisky was recognized to speak. He said that based on his experience in the septic business, 16 hours seemed like the very minimum to be expected. He questioned the verbiage about recertification, noting the lack of differentiation between certification and recertification. The term "education contract hours"was explained. Dr. Locke said that any out of state training would be reviewed on a case by case basis. Member Sullivan added that 'recertification" is explained on page 26 (11) and staff added that "continuing education is explained in(9). [An audience member questioned the need for so many hours for a simple home system. Staff clarified that this requirement is for a specialist and does not apply to homeowners.] Page 25 (4) b vii: Member Westerman questioned whether this means "... as approved by the Health Officer"or whether it means Jefferson County BOH? Jean Baldwin explained that Health Officer is correct, and this could be a designee. Dr. Locke said the intention is to provide flexibility to handle this maintenance in some other way. Page 26 (6): Member Westerman asked if Jefferson County has designated some other authorized agency. Susan Porto said that the intention is to leave this open to work with a web based data base/collection system, if possible. The suggestion that the language for that item could be made clearer was accepted. • Page 36 (b) vii: This is another instance of"other area as designated" discussed above (page 21 (9)). Page 37 (7) iv 8: This is another instance of"other area as designated"discussed above (page 21 (9)). Page 37 IV: Wording change suggested: "evidence" in place of"identification. Page 38 (10)b v: This is another instance of"other area as designated" discussed above (page 21 (9)). Page 40 (4) d: Is the timeline of 35 days too tight? Dr. Locke explained that this is in the current code. If there is an appeal, there would be need to be a special meeting or, if the appellants agree, there can be a continuance. Chair Austin referred to page 2, Critical Areas. He noted that Chapter 18.15 should now be Chapter 18.22. Staff noted that that change had also been noted by Attorney Alvarez. Member Sullivan mentioned that there are still a number of references to homeowners. And, if they are removed for the time being, he cautioned that these references should not be lost. Susan Porto noted the difference between Maintenance and Operations and Monitoring. She said there are still a number of items dealing with maintenance for the homeowner. She said all the homeowner 0 & M should have been stricken but possibly a few were missed. Dr. Locke noted that homeowner maintenance does not require BOH permission. • Member Sullivan referred to page 35 (5) a. iii, where he pointed out one such reference. He pointed out another reference on page 38 (10) a. Page 7 of 13 DRAFT Member Sandoval stated that she had spoken with staff about changes,but did not have her copy with • her. She said she would forward any comments/changes not already mentioned during the meeting. Member Westerman asked if there were steps in progress for developing a home owner inspection program. Staff noted that they were contacting other counties for program ideas . Dr. Locke said that if the Board wished to accept these proposed changes and proceed with a public hearing,he thought there would be good attendance and an opportunity to review what other counties are doing. The public would be able to hear what ideas and options are available in the state and which ideas have the most support. He said that could be done at any point. Representatives from the Clallam County work group process would be happy to speak at one of the Jefferson BOH meetings. There was a brief discussion about timing and process: should this be a workshop or a hearing? Several members were in favor of a workshop approach. Jean Baldwin said that this document could be corrected/updated and brought back quickly. Member Westerman said that she thought the entire document should be adopted at one time. Member Sandoval said she would like to explore the pros and cons of both approaches more fully. A member of the audience was recognized to speak. He suggested that a group of 8 to 12 should be formed with representation of: staff, industry professionals, and concerned citizens. This group would hold a series of workshops/meetings with efficient process, open to the public, similar to the way the BOH is run. He suggested that one or two months would be adequate time. Mr. Bergeron (audience) noted his agreement with that suggestion and recalled his own comments at the last meeting. He also said he did not believe that Clallam County is as far ahead in the process as might be imagined. He said he was quite familiar with their process and it was not a panacea. He said their next workshop would be held on Monday, March 25. Dr. Locke commented that a work group process was not likely to be completed over a short time period,noting that the Clallam group had been meeting for over two years, first on code revisions and now on homeowner issues. Experience says that this is not a fast, easy or cheap thing to do. A septic system expert, Chuck Molisky,recognized all that had already been done, and said he foresees it moving quickly only if it can be seen as legitimate in the eyes of the public and if all interests are included. A suggestion that staff use discretion in inviting knowledgeable citizens to assist in the process was considered. Member Sandoval spoke in favor of the BOH, rather than staff, taking the responsibility for assembling a group of experts, citizens and support staff, thereby accepting any negative fall out. She also said that the next steps should focus on workshops, not action meetings; public comment should be deferred until after the workshops, so that questions can be asked and answers from the experts can be heard and digested by all. Citing City Council experience, she advised such a two step process and that there should be a citizen involved committee. She cited the Sign Code process, which began with a citizen committee, which is followed by Planning Commission hearings and then City Council hearing. The process takes preparation and a longer duration,but results in more citizen good will, more information and ideas, and a well developed and better product in the long run. She said • that it is important for there to be a real directive in terms of who is involved, how many people, and the length of time allotted, even if the result is "no agreement". Page 8 of 13 DRAFT • Member Sullivan noted that the topic is the home owner option, and that there are implications for staff, budget, format, etc. He said he believed the workshop approach would work well. Member Sandoval asked what the pros and cons would be of passing the non-homeowner inspection parts of the document immediately. Sheila Westerman said that the ordinance is actually in effect. One important negative is the likelihood that it would be misconstrued, if it is passed, even if the BOH makes clear that the controversial parts have been removed in order to work on them. She said that she is worried about the perception that has persisted from the outset. Phil Johnson said that he also thought the BOH action of passing this draft of the document could be misconstrued. Member Westerman suggested that the Board should continue to make the draft better, including trying to figure out a better way to define a bedroom, as well as recognize that a citizen work group is needed. She said she agrees with Member Sandoval that the Board should name the work group, not staff, although staff should come to the meetings. She also said that since there are many repercussions, she was not proposing that all planning decisions should be made at this meeting. She said that the Board needs to decide a calendar, the location, the number of participants, and the process for determining the particular participants, etc. Dr. Locke said that as a recommendation to the Board, he would propose that staff bring back this issue to the next BOH meeting. At that time, they would review what other Counties are doing. He noted that if there is any shortcut, that would be where it would be found. He suggested that the experience of the Clallam work group would be worth hearing, including the amount of time and money involved. • Jean Baldwin noted that the idea of homeowner inspection came from the community but was then taken away by other individuals in the community. She asked if there is some way to bring back homeowner inspection in a simple way, e.g. gravity systems at first, following up with investigating the requirements for more complex systems. Member Sullivan said that the focus for much of the public comment was cost, and the other was due to misinformation. Once the information was clarified, everything came back to cost. He said he would certainly want feedback but does not know if it is necessary to have a committee formed to work on the process of putting together a fully defined program, with specific training time, cost and processes. Chair Austin stated that he would like to have a workshop, as had been previously discussed. Ms. Westerman asked for clarification on the next steps of the process. Dr. Locke said that staff would bring this subject back for presentation to the Board, which would include a review of what other counties, including Clallam County, have done and are doing. Jean Baldwin added that they would also explore a possible schedule, realizing that while this is not urgent, it should continue to move forward. • NEW BUSINESS Jefferson County Public Health Performance Measures Page 9 of 13 DRAFT Jean Baldwin referred to the packet item, 2007 End of Year Report. Julia Danskin explained that this report is done annually and is part of the budget process. All of 2007 the staff has worked under these • performance measures and is now reporting back to the BOH on them. The four areas cover all of community health; she noted that Public Health performs a wide variety of services. Three years of actual statistics are available. Family Planning unduplicated client numbers are down slightly. About six years ago, a huge increase was associated with extra dollars for a program called Take Charge. Since then the number of clients has leveled off. However, positive news is that the number of adolescents being seen is fairly constant. The Breast and Cervical Health program is fairly constant. She mentioned that Myrtle Corey had done almost 3000 foot care contacts in the community in the past year. There was a question about how the patients (in the report) related to the 3000 foot care contacts. Ms. Danskin said that the contact records collected while out in the community are not integrated with the computerized patient database, so that it is not possible to determine how many patients are seen by Myrtle Corey. Member Sullivan noted the importance of foot care. Jean Baldwin added that it is one of the services that is hardest to staff. School aged population is slowly decreasing. The screening statistics are low,partly due to the discontinuance of the scoliosis and other screenings formerly required by state law. John Austin noted that the recommendation to drop the scoliosis screening had not passed the legislature. Jean Baldwin said that the department had been slowing down on screenings that have not proven to be effective, so that resources could be better applied elsewhere in the schools. • She noted some changes in staffing in school health classes and in drug and alcohol prevention classes. The numbers have stabilized and are now coming back up. She anticipates the numbers to rise during this next year with changes in staff in the Alcohol and Tobacco staff and more information coming out about the Quit Line. Communicable Disease—Vaccine distribution numbers are rising; most of the shots are given in physician offices. Jean Baldwin commented about the figures for Family Support . She said that although most of the figures have remained within a predictable range over time, the number of families served through CPS/DSHS has risen from 15 to 30 from 2005 to 2007. She said this represents 2-3 hours per week per family, a significant demand on resources. The reason(s) are not well understood,but may include drug use, the recession, population shift or other. However, there is higher acuity and more referrals. 2007 Jefferson County Syringe Exchange Program Report Jean Baldwin pointed out the number of clinics and the number of syringes and the number of referrals. Julia Danskin said that they believe they are seeing a lot of secondary exchangers, i.e. persons coming in on behalf of other users in the community. This indicates a degree of safety and trust in the program. The increase in the syringes could mean people understand the importance of not sharing and/or it could mean the numbers of users are growing. Jean Baldwin noted the number of clients seen is not rising. • Page 10 of 13 DRAFT Member Westerman said she was glad that the Board has supported this program. Julia Danskin said • the staff very much appreciates the continuing support of the Board for this program. Dr. Locke noted that as of 2006 there were only about 150 needle exchange programs in the United States. Of them, 15 are in Washington State. He said that Washington state's rates of needle transmitted communicable diseases are among the lowest in the nation. Remarkably, this program is very inexpensive at less than$10,000 per year. Julia Danskin noted that a group of very well trained nurses allow the program to operate during office hours 5 days a week, rather than restricting the exchange period to a 2 hour period one day a week. Jean Baldwin said that a work group has been started which will look at how to reach actual users directly to do referrals for treatment, to administer Hepatitis A or B vaccine or other medical services. Policy Regarding Disruption of Public Meetings Chair Austin said that the BOCC had adopted a resolution regarding policy and protocol for dealing with disruptive persons during its meetings. He said that one of its primary intentions was to provide guidance to security personnel in the Courthouse as to how to respond. He said Jean Baldwin had requested that the BOH examine the issue and this policy to determine if a similar process should be available for its meetings. Jean Baldwin said that traditionally the BOH meetings have been held at the Health Department offices, and more recently at larger venues such as Pope Marine Building, the Fire Department, etc. Typically, meetings are not held in a place protected by sheriffs or police. There are no existing standard protocols for dealing with disruptive behavior, and it may be well to adopt such a policy and • procedure. Member Westerman noted that, other than the most recent history, the BOH has had no problems in nine years; she said it had been very civilized. She said she would rather not adopt anything unless it is determined to be a recurring problem. Member Sandoval said that she believes the ground rules should be set, at least amongst the Board, if not in a resolution form. At any public hearing or meeting, everyone should acknowledge and the Chair should supervise behavior; there should be no clapping, cheering, booing or demonstrations of any kind. This set of rules should be imposed by the Chair. Otherwise, she believes individuals can be urged on by the crowd. She said that it important that the public is made aware of this formally, even if not in resolution form. There should be an agreement as to appropriate behavior. She said if it is clear at the outset that the rules of order will be upheld, everyone attending can feel safe. She said that shortly after incidents at City Council and the BOH meeting in Chimacum, several citizens had approached her asking whether there were metal detectors or emergency buttons in Council Chambers. She suggested that it be very clear what the rules are amongst he BOH members so that everyone can back up the others and enforce the rules. A brief discussion ensued. Jean Baldwin said she believed that having rules about convening/reconvening, posting and scheduling, such as number 6 in the BOCC policy, would help those responsible for the meeting. It was also noted that knowing what the options are for dealing with disruption will help to alleviate anxiety. Member Sullivan noted that the Chair needs to know his/her • options and the plan that will be followed. Page 11 of 13 • DRAFT Member Westerman said that if a majority of Board members wish to pursue this matter, she would certainly be willing to have that happen. Member Frissell recalled the recent hearing at Chimacum. • She noted that perhaps a statement could have been read before the meeting to set expectations of the audience and make clear what steps would be taken in the event of disruption. There needs to be some way of communicating rules of order and expectations to attendees. Chair Austin said, if desired, the Commissioners could bring a statement to the BOH similar to the one the BOCC has pronounced at the beginning of each session. He said that the particulars of the resolution 14-08 were made to meet a request by the County Sheriff, who provides security at the Court House. It may not be necessary to have the exact same resolution for meetings that take place elsewhere in the City/County. He said this is covered by the procedure in the RCW, although the writing could be made clearer. He asked if the BOH would like to have a rephrased version read before each hearing, and there was agreement that a BOH version should be prepared. Jean Baldwin said that perhaps, since meetings are usually held in Port Townsend, she should also have a discussion with Police Chief Conner Daily to get his input on this issue; all agreed. Substance Abuse Advisory Committee Appointments John Barth reported that there had been two letters received regarding possible appointments to the Substance Abuse Advisory Board. Both individuals were well qualified. For one person, there may be a Conflict of Interest issue; that letter is on hold. Dr. James Rotchford sent a letter of resignation. One other member who is a student, now residing in Seattle, has resigned. Board members were urged to suggest other possible candidates for application. After a brief discussion, the motion was moved and Member Sullivan seconded that Robert Archibald be appointed to the Substance Abuse Advisory Committee. The motion was approved, all in favor. Correspondence There was no discussion. ACTIVITY UPDATE/AGENDA PLANNING Jean Baldwin said that Julia Danskin had verified that the Royer Report could be scheduled for the May BOH meeting. The Meth Action Team wishes to schedule the Meth White Paper for review by the BOH meeting in April. The Washington State Board of Health will visit Jefferson County in November, 2008. NEXT SCHEDULED MEETING The next scheduled Board of Health Meeting is April 17, 2008 at the Fire Hall. (The location was subsequently changed to the County Court House, First Floor Conference Room.) • ADJOURNMENT Page 12 of 13 1110 Chair Austin adjourned the BOH meeting at 4:35 PM. Next Board of Health meeting is April 17, 2008 JEFFERSON COUNTY BOARD OF HEALTH L •) (.3V 1 . r---)mA -kVyvv-,._...---- ms John still,Chair Sheila Westerman, Vice Chair 1 tey2 1"/ ff/. Et// ,,- ed ' Roberta Frissell, Member Chuck Russell, Member 4— titi---,,44.-4---- Phil Johnson, Member David Sullivan, Member i i IIMichelle Sandoval, Member 411 Page 13 of 13 • Jefferson County Board of 3-fealth OCcCBusiness & Informational ltems .agenda Item # 1 • 7"o6acco Prevention Efforts in Jefferson County A.prili7, 2008 • From: Karen Obermeyer Subject: News from Tobacco Prevention Recent news: Tobacco Prevention efforts in Jefferson County: • 45 nurses from Acute Care Unit at Jefferson Healthcare were trained in Brief Tobacco Intervention by Karen Obermeyer. The training emphasizes the importance of health care providers: Asking all patients if they smoke, Advising all smokers to quit and Referring all those who want to quit to the WA Quit Line. • 30 PT High School Student were trained as peer educators by the American Lung Association TATU (Teens Against Tobacco Use) program and will be providing peer tobacco prevention education to local 4th graders. • Congratulations to Jefferson Healthcare for becoming a Tobacco Free Campus 3/1/08! JC Tobacco Prevention participates in Tobacco Free Environment Committee. • Promote the WA tobacco Quit Line. It's a great FREE resource! o Free to all WA Tobacco Quit Line 1-800-QUIT-NOW/ 1-800-784-8669/ www.QUITLINE.COM • Private counseling &support by degreed professionals with additional training in tobacco cessation. • Personalized Quit Plan tailored especially for you. • Access to local resources • A tobacco Quit Kit mailed to you • Nicotine Replacement Therapy for those ready to quit. Need free tobacco prevention supplies? Let me know and I'll get them for you. Know of a business that could use some support for their employees to quit smoking? Let me know. Karen Obermeyer Prevention Specialist Jefferson County Public Health 615 Sheridan St. Port Townsend, WA 98368 • 360-385-9417 • ,Jefferson County Board-of HeaCth Old Business Agenda Item # 1V., 2 � Jefferson County Restaurant Awards AyriCl7, 20 o8 • For immediate release: March 20, 2008 . Contact: Susan Porto, Phone: 360-385-9444 Email: sporto@co.jefferson.wa.us Jefferson County Public Health Presents the 2007 Outstanding Achievement Awards Forty (40) Jefferson County Restaurants Demonstrate Commitment to Achieving the Highest Food Safety Standards in 2007 Port Townsend, WA — The 2007 Outstanding Achievement Awards have been presented to food service establishments (restaurants) and their proprietors who have demonstrated the highest standards for safe food handling during 2007. Awards were given to forty (40) restaurants and were presented by Jefferson County Public Health. The Outstanding Achievement Awards are based on the following criteria: • No more than 5 red points on any one inspection • Not more than 15 total (red and blue) points on any one inspection • No repeated red point violations • Establishment prepares and sells complex foods for immediate consumption • In business with same owner for one year or more • Responsiveness to correcting violations • No food worker card violations • Compliance with the establishment's permit conditions • Cleanliness and Attention to Detail "These forty restaurants and proprietors have demonstrated a strong commitment to food safety and handling and deserve to be recognized for that outstanding effort," said Sarah Murphy, Food Safety Specialist. "We're very excited to present the Outstanding Achievement Award to these establishments because of their hard work and dedication to achieving such a high level of food handling safety." The Outstanding Achievement Awards for 2007 were presented to the following Jefferson County Establishments (in alphabetical order): Restaurant Proprietor 1. 123 Thai Food Somsak Chong 2. Ajax Café Moxi Inc. 3. Blue Heron Middle School Cafeteria Port Townsend School District #50 4. BPO Elks Lodge #317 BPOE Elks Lodge #317 5. Brinnon School District #46 Olympic Community Action Programs 6. Brinnon Senior Nutrition Olympic Community Action Programs 7. Chimacum Schools Chimacum School District #49 Board of Directors 8. Discovery View Retirement Discovery View Associates 9. Dos Okies Larry Dennison & Ron McElroy 10. Fat Smitty's Carol & Miyo Schmidt 11. Food Co-op Deli Food Co-op 12. Galatea Café & Tapas Laura Wood 13. Harbormaster Restaurant Port Ludlow Associates 14. Jordini's Waterfront Sandwiches Laura Flanigan 15. Key City Fish Co. John Paul Davies 16. La Isla Mexican Restaurant Ignacio Rangel 17. Lawrence Street Deli Joann Saul 18. Lanza's Lori & Steve Kraght 19. Lehani's Lynn Hamlin-LeMaster &William LeMaster 20. Little Dinghy Deli KMC Investment Group, LLC 21. Logger's Landing Jack Helgens 22. Macadoo's BBQ Nick Harper 23. Niblick's Deli Port Ludlow Associates 24. Penny Saver Deli Roger Ramey 25. Pizza Factory Francis & Valorie Danielek 26. Port Townsend Senior Nutrition Olympic Community Action Programs 27. Portside Deli, Ltd. Lynda & Brian Douglas 28. The Public House Joann Saul 29. QFC #106 Deli — Port Townsend Fred Meyer Stores, Inc. 30. QFC #870 Deli — Port Hadlock Fred Meyer Stores, Inc. 31. Quilcene School Cafeteria Quilcene School District#48 32. Shanghai Restaurant Chuong Ly & Nu Ha Luong 33. The Spot Randy Unbedacht 34. Spruce Goose Cafe Chris Cray &Andrea Raymor 35. T's Nancy Tocatlian 36. Tri-Area Senior Nutrition Olympic Community Action Programs 37. Twana Roadhouse Melody Bacchus 38. Victorian Square Market & Deli Gina Landon 39. Waterfront Pizza Diann Kuchera • 40. Wild Coho Jay Payne Please call Sarah Murphy if you have any questions about this press release at 360-385- 9444. Also remember to visit us on the web: www.jeffersoncountvpublichealth.org if you would like to see the inspection reports for these and other restaurants in Jefferson County. Jefferson County Public Health is always working for a safer and healthier Jefferson County. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * S • Jefferson County Board-of 3-fealth Netiv Business .Agenda Item # 17., 1 • .Iefferson County Public 3-Cealth 3-feroes April 17, 2oo8 • Kh ✓ ' JEFFERSON COUNTY PUBLIC HEALTH Rv 0 615 Sheridan Street • Port Townsend •Washington • 98368 • www.jeffersoncountypublichealth.org For immediate release: April 11, 2008 Contact: Jean Baldwin (360) 385-9400 jbaldwin@co.jefferson.wa.us Jefferson County Public Health Celebrates 'National Public Health Week' Local heroes to receive honor at next Jefferson County Board of Health Meeting Port Townsend, WA - In observing National Public Health Week, Jefferson County Public Health will be honoring local Public Health Heroes. The annual Public Health Hero award honors people who have made a difference in Jefferson County through their exemplary work and contributions that promote good public health. These heroes have made a significant difference in the quality of life in our community by their years of contributions. The following 2008 Public Health Hero awards go to: Shirley Williams Public Health Leadership 4111 ' Jill Buhler Community Health Promotion Dennis Crawford Community Based Organization Geoff Masci Special Recognition Award The Public Health Hero awards will be presented at the Jefferson County Board of Health meeting on April 17, 2008 at 2:30 pm. The meeting will be held at the Jefferson County Courthouse, Conference Room 1. The public is cordially invited to come and celebrate with us. Jefferson County Public Health wishes to thank those in our community who submitted nominations for this award and to extend a very special thanks to the 2008 Public Health Heroes for their ongoing contributions. Please call Jean Baldwin, Director of Jefferson County Public Health, if you have any questions about this press release at (360) 385-9400. Remember to visit us on the web at www.jeffersoncountypublichealth.org. Jefferson County Public Health is always working for a safer and healthier Jefferson County. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * • COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES , ,r,r�� ne WATER QUALITY MAIN: 360385-9400 AL VAYSI J l l G#O �i SAFER AND MAIN: 360385-9444 FAX: 360-385-9401 HEALTHIER COMMUNITY FAX: 360379-4487 • Jefferson County Board of 3-fealth Wow Business .agenda Item # T., 2 • Port Townsend-Paper MCC Health Consultation Report Aprili7, 20o8 • Subject: Ecology News Release: Ecology responds to Port Townsend air quality health consultation • FOR IMMEDIATE RELEASE - April 8, 2008 08-085 Ecology responds to Port Townsend air quality health consultation OLYMPIA - In conjunction with the release of a draft state Health Department report, the Department of Ecology (Ecology) today announced it will look for more ways to help respond to citizen concerns about Port Townsend Paper Corp. ' s air emissions . These steps could include increasing the number of pollutants monitored, developing a better assessment of chemicals emitted and their possible impacts, and improving Ecology' s complaint response and tracking system. Ecology will review the health consultation findings to see if they justify changes to the mill' s five-year air operating permit . Ecology will also look for other options to address community concerns . 110 "As the agency responsible for regulating ting pulp and paper mills in Washington, we are always concerned when we hear of health issues that could be tied - even in a small way - to industrial operations, " said Carol Kraege, manager of Ecology' s Industrial Section. "I believe we can work with the community, health agencies and the mill to improve our understanding of what is being emitted in order to address some of these tough questions . " The draft health consultation was sought by the community in response to concerns that air emissions from the mill could be linked to short-term and long-term health issues reported by some living in the community. Some residents have complained about the mill' s odor and becoming sick after exposure. Department of Health research could not directly associate any of the observed conditions such as asthma and certain cancers in the community to chemicals most likely in mill emissions . And since the levels of air pollutants are not well established, Health could not determine whether air emissions from the mill pose harm. • Some local citizens have requested air pollution monitors be placed in the community. Ecology and Health agree that additional information about specific pollutants is needed. Ecology will work with Health and the local air authority to determine the most effective way to gather reliable information for addressing health concerns . This likely will involve developing site-specific information about chemicals that the mill emits and using the information in a sophisticated model to try to identify any areas where contaminants are likely to be the highest . Ecology plans to meet with mill representatives soon to discuss the health consultation findings. The mill has operated in Port Townsend since 1927 . Ecology has the responsibility for regulating the mill' s air emissions through an air operating permit, which specifies the types and amounts of hazardous chemicals that must be collected and treated before being released into the air. Federal regulations limit Ecology' s authority to include more conditions in the permit. However, additional requirements could come through an administrative order which would be available for review and appeal by the community or the mill . • The mill' s air operating permit has been the subject of review by the community and state Pollution Control Hearings Board. Ecology is reworking sections of the permit to address specific concerns by the Environmental Protection Agency. Once modified, the public will have another opportunity to review and comment . Ecology is also collaborating with Port Townsend Paper and the community on a voluntary project designed to reduce the mill' s environmental "footprint" on the community over time. As part of this project, Ecology is encouraging community members to bring forward any concerns about the mill' s performance, including those raised by the health consultation. ### Media Contact : Larry Altose 425-649-7009; pager 206-663-1785 Link to DOH Environmental Health Assessments report : www. doh.wa. gov/ehp/oehas/whatsnew.htm Ecology' s Web site: http: //www. ecy.wa. gov • • Port Townsend Mill Paper ATSDR Health Consultation Summary of Air Quality Issues and Identification of Information Needed to Address Community Health Concerns - Port Townsend Paper Corporation Jefferson County, Washington S April 2008 Prepared by, The Washington State Department of Health Under a Cooperative Agreement with the Agency for Toxic Substances and Disease Registry �ii VVashincton State Department of Health i Foreword • The Washington State Department of Health (DOH) has prepared this health consultation in cooperation with the Agency for Toxic Substances and Disease Registry (ATSDR). ATSDR is part of the U.S. Department of Health and Human Services and is the principal federal public health agency responsible for health issues related to hazardous waste. This health consultation was prepared in accordance with methodologies and guidelines developed by ATSDR. The purpose of this health consultation is to identify and prevent harmful human health effects resulting from exposure to hazardous substances in the environment. Health consultations focus on specific health issues so that DOH can respond to requests from concerned residents or agencies for health information on hazardous substances. DOH evaluates sampling data collected from a hazardous waste site, determines whether exposures have occurred or could occur, reports any potential harmful effects, and recommends actions to protect public health.The findings in this report are relevant to conditions at the site during the time of this health consultation, and should not necessarily be relied upon if site conditions or land use changes in the future. For additional information or questions regarding DOH or the contents of this health consultation, please call the health advisor who prepared this document: Elmer Diaz Washington State Department of Health Office of Environmental Health Assessments • P.O. Box 47846 Olympia, WA 98504-7846 (360) 236-3357 FAX (360) 236-3383 1-877-485-7316 Web site: www.doh.wa.gov/ehp/oehas/sas.htm For persons with disabilities this document is available on request in other formats. To submit a request, please call 1-800-525-0127 (voice) or 1-800-833-6388 (TTY/TDD). For more information about ATSDR, contact the ATSDR Information Center at 1-888-422-8737 or visit the agency's Web site: www.atsdr.cdc.gov/. 1 • Glossary An air emissions inventory is a listing of the amount of air pollution emitted by various sources. Every year,Ecology and the local air quality Air emissions inventory agencies inventory large businesses. Every three years,Ecology inventories many additional sources such as motor vehicles,woodstoves, outdoor burning,agricultural sources,and natural sources. Acute Occurring over a short time[compare with chronic]. Agency for Toxic The principal federal public health agency involved with hazardous waste Substances and Disease issues,responsible for preventing or reducing the harmful effects of Registry(ATSDR) exposure to hazardous substances on human health and quality of life. ATSDR is part of the U.S.Department of Health and Human Services. Carcinogen Any substance that causes cancer. Chronic Occurring over a long time(more than 1 year)[compare with acute]. Calculated concentration of a substance in air,water,food,or soil that is • Comparison value unlikely to cause harmful(adverse)health effects in exposed people.The CV is used as a screening level during the public health assessment process. Substances found in amounts greater than their CVs might be selected for further evaluation in the public health assessment process. Contaminant A substance that is either present in an environment where it does not belong or is present at levels that might cause harmful(adverse)health effects. The amount of a substance to which a person is exposed over some time period. Dose is a measurement of exposure. Dose is often expressed as Dose milligram(amount)per kilogram(a measure of body weight)per day(a measure of time)when people eat or drink contaminated water,food,or (for chemicals that are not soil. In general,the greater the dose,the greater the likelihood of an effect. radioactive) An"exposure dose"is how much of a substance is encountered in the environment. An"absorbed dose"is the amount of a substance that actually got into the body through the eyes,skin,stomach,intestines,or lungs. An emissions inventory provides a detailed description of the quantity of Emissions inventory pollutants along with their emissions characteristics(how and where contaminants are being emitted. Contact with a substance by swallowing,breathing,or touching the skin or Exposure eyes. Exposure may be short-term [acute exposure],of intermediate duration,or long-term[chronic exposure]. • 2 HAPs are those pollutants that are known or suspected to cause cancer or • other serious health effects,such as reproductive effects or birth defects,or Hazardous air pollutants adverse environmental effects. Examples of toxic air pollutants include (HAPs) benzene.which is found in gasoline;perchlorethlyene,which is emitted from some dry cleaning facilities;and methylene chloride,which is used as a solvent and paint stripper by a number of industries. Inhalation The act of breathing. A hazardous substance can enter the body this way [see route of exposure]. Media Soil,water,air,plants,animals,or any other part of the environment that can contain contaminants. Organic Compounds composed of carbon, including materials such as solvents,oils, and pesticides that are not easily dissolved in water. Air pollution describes a collection of airborne pollutants that contribute to Pollutants our air quality.The term"pollutants"recognizes that these substances are undesirable because of their impact on human health,the environment and the economy. Units commonly used to express low concentrations of contaminants. For • Parts per billion example, 1 ounce of trichloroethylene(TCE)in I million ounces of water (ppb)/Parts per million is 1 ppm. 1 ounce of TCE in 1 billion ounces of water is 1 ppb.If one drop (ppm) of TCE is mixed in a competition size swimming pool,the water will contain about 1 ppb of TCE. The way people come into contact with a hazardous substance. Three Route of exposure routes of exposure are breathing[inhalation],eating or drinking[ingestion], or contact with the skin [dermal contact]. Toxics Release Inventory(TRI)-TRI is the common name for Section 313 of the Emergency Planning and Community Right-to-Know Act(EPCRA). Each year,facilities that meet certain thresholds must report their releases Toxics Release Inventory and other waste management activities for listed toxic chemicals.That is, (TRI) facilities must report the quantities of toxic chemicals recycled,collected and combusted for energy recovery,treated for destruction,or disposed of. A separate report must be filed for each chemical that exceeds the reporting threshold.EPA compiles the reported information into a publicly available database known as the Toxics Release Inventory. • 3 • Purpose The Washington State Department of Health (DOH) prepared this health consultation at the request of citizens of Port Townsend and Jefferson County. Local residents expressed concern over the potential health impacts of both past and current air emissions from the Port Townsend Paper Corporation (PTP) mill. The purpose of this health consultation is to summarize health concerns regarding air pollution generated from the PTP mill and respond to the community's requests for an investigation of the following issues: • Epidemiological analysis of the incidence of cancer cases and detailed geographic tracking of cancer cases in Jefferson County. • Tracking of hospital visits for asthma, respiratory issues, and/or cardiac problems with comparison to wind direction and speed at the time of visit to the emergency room to see if there is a correlation to mill plume or other sources of air pollution. • Tracking of self-reported health impacts from the mill. DOH reviewed available information and attempted to find answers for these questions, unfortunately, they are complex and not easy to address. The cause-and-effect relationship between the administered exposure and the observed health effect needs to be established to estimate the public health impact at any given level of exposure to a specific chemical. DOH found no record of specific health evaluation studies done in the Port Townsend area by either • Jefferson County Public Health or the Washington State Department of Health Office of Epidemiology. Such a study would require a sufficiently large population exposed in sufficient concentrations to the contaminants being investigated. The health endpoints must also be distinguished from other causes. Correlations between mill emissions and symptoms of the odorous compounds such as headache, sleep disturbance, nausea, vomiting, and worsening of respiratory symptoms and asthma would need to be confirmed. Many other exposures and conditions can bring about these classes of symptoms. Studies would need distinctions between exposed and unexposed populations of sufficient size to be able to attribute effects to these gases. All the information necessary to conduct a health study, as described above, is not available to assess the possible health effects associated with air emissions from PTP mill. Instead, DOH focused on available information and studies on health effects of mill emissions released by kraft paper and pulp mills in general. DOH also reviewed available epidemiological data in order to assess whether Port Townsend residents experience a higher rate of certain health conditions than those reported for Washington State residents overall. In addition, this health consultation included a discussion of data gaps that need to be filled in order to assess the health impacts of mill related pollutants on the community. DOH prepares health consultations under a cooperative agreement with the Agency for Toxic Substances and Disease Registry(ATSDR). • 4 Background and Statement of Issues • Site Description and History The Port Townsend Paper(PTP) mill is an active facility located along the southeast shore of Port Townsend Bay on the northeastern corner of the Olympic Peninsula in Port Townsend, Jefferson County, Washington (Figure 1). The Port Townsend site began operation in 1927, employs approximately 325 full-time employees, and manufactures unbleached kraft pulp paper and lineboard for sale both domestically and internationally.'The process produces approximately 941 tons of pulp per day. This corresponds approximately to 2/3 of unbleached kraft pulp and 1/3`d of recycled pulp from corrugated cardboard. Kraft is the German word for"strength," which is an important characteristic for paper making. The kraft chemical pulping process includes a recycling process where most of the chemicals used to produce pulp and paper are captured, recovered, and reused again and again. At the same time, byproducts from the pulping process are used as a fuel source to generate steam and electricity.The site contains both a pulp mill and a paper mill.The product of the pulp milling process is pulp fiber and water slurry which, through the use of mechanical and chemical treatment at the paper mill, is turned into various paper products such as boxes, paper bags, paper towels, and paper sheets. Industry description and practices The main steps in pulp and paper manufacturing are raw material preparation, such as wood debarking and chip making; pulp manufacturing; pulp bleaching; paper manufacturing; and fiber recycling. PTP mill uses a chemical pulp process without bleaching to make printing papers for applications in which low brightness is acceptable. The pulp mill uses wood chips and sawdust as raw material and adds them separately to digesters. The digesters chemically break down the lignin holding the cellulose fibers together in the wood. The chip digesters use steam and a sodium hydroxide and sodium sulfide solution (liquor) to break down the wood fibers into a brown wood pulp. The pulp is washed, screened, and the liquor is removed and recycled. Air permit PTP mill is required to have a Title V Air Operating Permit because it emits or has the potential to emit, one hundred tons per year or more of one or more air pollutants (WAC 173-401- 300(1)).2 Sulfur dioxide and hydrogen sulfide are monitored periodically, but because the volumes are thought to be low, they are not monitored frequently. Toxics emissions are not monitored. According to Ecology and PTP mill, chlorine, chloroform, and chlorine dioxide are not currently being released at the mill.3'4 Consequently, chlorine, chloroform, and chlorine dioxide are not monitored. • 5 • Local air monitoring In Port Townsend, monitoring for air pollution occurs at Blue Heron Middle School, 3339 San Juan Avenue in Jefferson County. This monitor only collects information on particulate matter (PM2.5).5 Additionally, it may not be sited in a place that is relevant(i.e., does not consistently capture emissions from PTP mill). Indeed, this monitoring station was sited to represent air quality conditions representing the overall air shed. It was never intended to capture emissions directly from the mill. Potential air pollution sources at PTP mill There are many potential emission sources at the pulp mill including combustion units, chemical manufacturing operations, and effluent treatment processes. Toxic Release Inventory (TRI) data shows self-reported estimates of pollutants emitted from PTP in the past. Tables 1 and 2 show TRI emissions (tons per year) from 2002, 2005 and 2006. Some limitations of the data collected in the TRI inventory include the following:6 • TRI requires the reporting of chemical releases only when a facility manufactures, processes, or otherwise uses an amount greater than the TRI reporting threshold (e.g., more than 0.1 grams/year of dioxin and dioxin-like compounds, more than 100 pounds/year of polycyclic aromatic hydrocarbons (PAHs)). • Per TRI guidance, release reports may be based on estimates, not measurements. As a result, facilities may overstate releases because they can be penalized for under-reporting releases.6 • Certain chemicals (PAHs, dioxin and dioxin-like compounds, metal compounds)are reported as a class, not as individual chemical compounds. Because the individual compounds in the class have widely varying toxic effects, the potential toxicity of chemical releases can be inaccurately estimated. • 6 Table 1. Annual Air Emissions and Toxics 8Release Inventory for 2002-2006 from PTP , Cor'oration, Port Townsend, Washington.�'8 r ' ,;.' Description of Poll � k., ,, ': Units (Tons per year) 'xx "aim fuel or material ' y�� t 2002* 2005 2006 e, • �{ ! , rocgsse ae� Recovery Furnace Pulp-unbleached Formaldehyde 5 NA NA kraft PM 71 150 144 PM3o 53 113 107 PM2 5 48 101 97 SO2 298 196 195 NO2 185 193 185 CO 1124 1166 1122 VOC(reported as THC) , NA 36 35 Smelt Tank Pulp—unbleached Phenol 2.5 NA NA kraft PM 40 NA NA PM10 30 NA NA PM25 27 NA NA SO2 3 NA NA NO2 5 NA NA CO 0 NA NA Ammonia(NH3) 22.1 NA NA Lime Kiln Pulp—unbleached PM 38 NA NA kraft PM10 38 20 26 PM2_5 37 19 25 SO2 1 2 1 NO2 62 64 62 CO 10 11 10 VOC(reported as THC) NA 1 1 • NH3 NA 14 13 Hog Fuel Wood/Bark Lead 0.04 NA NA Manganese 0.7 NA NA Mercury 0.0005 NA NA Hydrogen Chloride 136.5 NA NA PM 116 NA NA PMio 113 NA NA PM2 5 113 NA NA SO2 167 NA NA NO2 250 NA NA CO 531 NA NA Boiler Oil(residual oil, CO 8 8 10 normal firing) PM 18 25 33 PK() 15 21 28 PM2,5 10 14 18 SO2 76 69 74 NO2 48 46 60 VOC(reported as VOC) NA 0 1 Boiler Industrial, CO NA 592 515 wood/bark PM NA 110 102 PMIo NA 107 99 PM2 5 NA 107 99 SO2 NA 140 14 NO2 NA 273 239 VOC(reported as VOC) NA 17 15 S 7 4110 Kraft pulping Paper machines— Methanol 56.5 pulp dryers VOC(reported as THC) NA 15 14 Pulp&paper,wood Pulp and paper,and PM NA 13 6 products,fugitive wood products PM10 NA 5 2 emissions PM2.5 NA 1 1 NA=not available,emissions were not measured at these locations during these years VOC=Volatile organic compounds THC=Total hydrocarbon * Emission year 2002 represents emissions and stack data:This data set gives emissions of criteria pollutants and some air toxics by emission point(emission unit)basis-and includes stack data;criteria pollutants are from Washington Department of Ecology(WDOE)data. Air toxic data are from the Toxic Release Inventory(TRI).The TRI pollutants are on a plant wide basis.The TRI pollutants were assigned to emission points based on engineering judgments. Table 2. Summary of PTP TRI and annual air emissions, TRI 2002/2005. Pollutant Annual emissions, Tons/year 2002 2005* Acetaldehyde 5 Ammonia 36 42.23 Formaldehyde 5 Hydrogen Chloride 137 Lead 0 Manganese 1 Mercury 0 • Methanol 57 Phenol 3 PM10 333 PM2.5 278 SO2 410 NO2 581 VOC 72 CO 1,788 Total reduced sulfur(TRS) 14.6 Polycyclic aromatic compounds 0.04 Propionaldehyde 12.75 Manganese compounds 49.55 Naphthalene 7 Cresol(mixed isomers) 8.5 Lead compounds 0.8 Catechol 0.02 Formaldehyde 7.5 Phenol 3.1 Acetaldehyde 46.8 Mercury compounds 0.00075 Hydrochloric acid 10.5 Methanol 57.9 Source:Olympic Regional Clean Air Agency(ORCAA)estimated emissions inventory,year 2005.7 * 2005,Annual Air Emissions,Port Townsend Paper Corporation. Based on annual air emissions reported in 2005 (Table 2), total chemical releases at PTP mill were about 3,681 tons per year. PTP mill's emissions consist of 51% carbon monoxide (CO), • 8 17%nitrogen dioxide (NO2), 12% sulfur dioxide (SO2), 10% particulate matter PM10, 8% PM2.5, • and 2%volatile organic carbons (VOCs). Use of Reprocessed Fuel Oil(RFO) The package boiler is run on reprocessed fuel oil (RFO). In 2006,the total pulp mill burned an estimated 14,000,000 gallons of RFO (the package boiler itself used 3.8 million gallons).9'10 RFO is essentially used oil blended with other fuels to achieve the desired specifications. Some effort is made to remove contaminants from RFO. RFO is less expensive than alternate fuels such as#2 fuel oil or diesel, and it has properties most similar to#4 fuel oil. It is used in all of the power boilers, recovery furnace, and lime kiln. Burning RFO emits less sulfur into the atmosphere than burning#6 fuel oil, but RFO creates significantly more ash. RFO combustion generates an ash content of 0.54%weight compared to 0.05 —0.10 for#6 fuel oil. Ash is a source of PTP particulate emissions that come from PTP.11 Notices of violation at PTP mill Notices of violation have occurred periodically since 1999 at PTP mill. Most of the violations were for opacity (measurement of PM emissions) exceedances, but included TRS and nitrogen oxides (NOx) exceedances. For instance, in 1999 most exceedances were related to opacity, while in 2000, most exceedances were related to opacity, TRS and NOx. In 2001 and 2002, most exceedances were attributed to opacity,NOx,TRS and PM. Violation of opacity limits have decreased since 2004 until 2007. No data exist to evaluate opacity violations before 2004 and 2008. Violations of NOx standards were more frequent in 2005 and decreased in 2006 and • 2007.12 Community health concerns DOH has received numerous health complaints since May 2007, from the Port Townsend AirWatchers and local citizens. DOH received community complaints by regular mail, electronic mail and summaries from the Port Townsend Paper Corporation. DOH received a list of 285 complaints recorded by the mill from 1/19/2004 to 7/10/2007, ten written letters and ten electronic mail messages. Overall, the community complaints include smells of rotten egg and/or "pungent acid" odors that irritate eyes, throat, and nose and causes headaches. Some residents have reported that these odors trigger asthma-like reactions and vomiting. The following summarizes community health complaints made by citizens of Port Townsend to the mill related to air emissions from March 2004 to July 2007:13 • Chronic throat and lung irritation • Persistent"respiratory and cardiac"problems in a previously healthy 43-year old female • Strong smells "pungent acid" • High noise level • Headaches and/or nausea and/or eye irritation and/or respiratory irritation • Development of"chronic respiratory problems" that disappear when people leave town • Development of"extreme chemical sensitivity" and severely heightened seasonal allergies • 9 • Some members of the community complain that smoke emissions from the mill are higher in the middle of the night, and on weekends. Residents perceive higher odor levels at night.' People living in close proximity to the pulp mill often complain of breathing discomfort, with some people expressing concern about possible adverse health effects following exposure. Residents reported experiencing headaches, coughing, nausea, allergies, mucous irritation in eyes and respiratory tract concurrent with odors. Odors are typically a rotten egg and pungent acid smell that may be associated with hydrogen sulfide (H2S) and sulfur dioxide (SO2) respectively (these chemicals are described in detail below). Over ten residents also reported that they have left their homes in order to avoid the ill effects associated with the odors. Air pollution and health effects Air pollution is associated with a variety of health effects including respiratory tract irritation, asthma, heart and lung diseases, decreased immunity, and increased risk of cancer. The very young and very old are particularly sensitive to air pollution. Most healthy people recover from the effects of air pollution when air quality improves. However, people with existing lung and heart diseases (such as asthma or chronic obstructive pulmonary disease) are at risk of dying from either short-term or long-term exposure to air pollution. The air we breathe contains a mixture of gases and particles, and breathing this mixture affects us 24 hours a day, indoors and outside. Humans are exposed to air pollution outdoors and indoors, including during transit in vehicles. Indoor air pollution comprises a mixture of contaminants penetrating from outdoors and those generated indoors. Because most of the health • effects attributable to air pollutants can also be attributable to a wide variety of other risk factors, the impact of air pollution on human health is further complicated by human exposure to a mixture of substances at various concentrations present in the air. The mixture is different inside and outside, and may affect people in different ways. There are many different factors that contribute to air pollution. Depending on the length of time you are exposed, your health status, your genetics, and the concentration of pollutants, air pollution can have a negative effect on your respiratory system (lungs and airways) and on your cardiovascular system (heart function and blood circulation) by: • Making it harder to breathe • Irritating the respiratory system a Ecology has determined that the mill does not release more reduced sulfur gases during the night. Reduced sulfur gas emissions remains steady,day and night.The natural behavior of air in relation to day and night warming and cooling of water can explain why more odorous gases are released from water bodies at night. Winds tend to be calmer at night,and there is little or no mixing of the air. As the surface of the water cools at night,mixing occurs as the cooler water sinks,and more dissolved gases are released. In the daytime there is good mixing of air as the land heats up,and this leads to ventilation that disperses and dilutes gases. Because of topography,odorous,heavier than air gases can also be trapped so that their concentrations increase under an inversion layer and the smell will be more intense.14 • 10 • Affecting Chronic Obstructive Pulmonary Diseases such as chronic bronchitis • emphysema and in some cases asthma • Causing heart attack, heart failure and other manifestations of heart disease because of narrowing (constriction) of blood vessels, altering heart rate and rhythm and affecting blood clotting Adverse health effects associated with air pollution increase as air pollution worsens. Studies have shown that even modest increases in air pollution can cause small but measurable increases in emergency room visits, hospitals admissions and death. Some health effects, such as an increase in asthma attacks, have been observed in conjunction with episodes of high pollution concentration lasting one or two days. Such effects are considered acute, because they are associated with short-term exposures to a pollutant. In fact, it has been shown that even small increases in air pollution levels for a short period of time can exacerbate illness among sensitive or at-risk people.15,16,17 There are many substances emitted from kraft mills that can have an effect on the respiratory tract, and little is known about the health effects of living in close proximity to pulp and paper mills and low-level exposure to malodorous sulfur compounds. A review of the scientific literature indicated there is a possible association between a paper mill's location and wheezing symptoms among adolescents. The results of a study conducted in North Carolina suggests that the community-based exposure to pulp and paper mill emissions may have a greater impact on smokers and individuals exposed to cigarette smoke in the home than on non-smokers without such household exposure.18 In 1995, DOH conducted a health study (Phase I) in Port Angeles to • determine the amount of respiratory disease among elementary school children in response to community health concerns regarding air pollution. This study reported levels of cough and bronchitis among school children in Port Angeles as high as those in other areas of the U.S. with relatively high levels of air pollution.The reported levels of other respiratory conditions (wheeze, asthma, etc.) in Port Angeles were not high compared to those in other areas of the U.S.19 A second phase (Phase II) of the study in Port Angeles was conducted in order to determine whether children who reported asthma, wheeze, or chronic cough in the Phase I study had more respiratory symptoms on days with relatively high levels of ambient air pollution compared to days with relatively low levels of air pollution. The results of this study showed that respiratory symptoms in children increased as levels of air pollution (i.e., SO2) increased. However, there were several limitations of this study which made the results uncertain including changes in symptom reporting over time and difficulties in accuratelycharacterizingindividual exposures using air pollution data collected from monitoring stations. An air pollution study conducted in 1996, assessed exposure to very low levels of ambient-air malodorous sulfur compounds and their effects on eye irritation, respiratory-tract symptoms, and central nervous system symptoms in adults. This study concluded that residents living in close proximity to a pulp mill had a higher risk of developing respiratory infections, headache and cough.21 No data currently exist for the Port Townsend area that specifically can be used to assess the direct relationship between health effects in the community and PTP mill air emissions. Even if • 11 • there were reports from the community about these types of health effects such as headache, nausea, or respiratory irritation, asthma, and cancer, it would be difficult to establish the extent the mill's emissions contribute to these effects. There may be other air contaminant exposures (e.g., motor vehicle exhaust including diesel emissions,b chemicals released by wood stoves, fireplaces, outdoor burning, and wildfires)d, and reasons why people experience these symptoms. Thus, the relationship of health effects to PTP emissions remains undetermined. Discussion Community members in Port Townsend and surrounding neighborhoods have raised health concerns regarding potential exposures to chemical compounds emitted into the air from the PTP mill. The residents have contacted state and local agencies. The discussion that follows will address sources of pollution, key pollutants, possible exposures, health data relevant to air pollution concerns, and data gaps. Sources of pollution at PTP mill TRI data indicate that emissions from the mill occur from these predominant sources (Tables 1 and 2). • Recovery furnace • Smelt Tank • Lime Kiln • • Hog Fuel and package boiler • Treatment system • Water treatment ponds The TRI data for the PTP mill includes plant-wide emissions to air, land and water. However, the list of chemicals in TRI is not comprehensive and does not report emissions of many air toxics below certain threshold quantities, nor does it attribute emissions to specific sources at the mill. Key pollutants at PTP mill Air pollution is not completely characterized. PTP Corporation only monitors emissions specified in their Air Operating Permit.2 Toxics emissions are not monitored. The TRI emissions inventory only includes a partial list of chemicals emitted from the mill. Key pollutants from the mill that could possibly cause odors or health effects are nitrogen dioxide, sulfur containing b Chemicals in vehicle emissions can irritate the eyes,nose and throat;cause wheezing,coughing and breathing difficulties;worsen existing heart and lung problems; increase the risk of heart attacks;and lead to premature death. Health effects of wood-smoke exposure include an increased risk of lower respiratory tract illness such as coughing,wheezing,shortness of breath,and chest tightness.For people with asthma,wood smoke is associated with an exacerbation(or flaring up)of asthma.Other health effects include a decrease in lung function or decreased breathing ability resulting in increased emergency room visits. d Wood stoves,fireplaces,on-road diesel,and on-road gasoline have been identified as sources of air pollution in • Port Townsend area.22 12 • • chemicals (i.e., sulfur dioxide, and total reduced sulfur compounds), and particulate matter. As • mentioned above, local residents typically report rotten egg and pungent acid smells that may be associated with H2S and SO2 respectively. Some people believe that the odors signal something harmful to their health, and that the odors reduce their quality of life and sense of well-being. Without knowing more about the specific emissions from PTP mill and the resulting ambient air concentrations, it is difficult to identify which chemical substances might contribute to adverse health effects. The presence of odors in the air does not necessarily suggest that adverse health effects will occur among exposed populations. To estimate, identify and quantify the public health impact at any given level of exposure of a specific pollutant is a challenging task and typically requires the use of large sample sizes and sophisticated statistical methods. The following discussion summarizes health related information for each of the primary air pollutant categories associated with Kraft paper mill production methods. Nitrogen Dioxide (NO2) NO2 is a gas produced as a by-product of nitrogen oxide incineration at sufficiently high temperatures.NO2 is a product of the combustion of fuels in boilers.NO2 contributes to two major pollution problems: smog and acid rain.NO2 combines with volatile organic compounds and sunlight in the lower atmosphere to form ozone, a key component of smog. In moist air, nitrogen oxides can also form nitric acid, which is precipitated as a component of acid rain. NO2 is harmful to the lungs, irritates bronchial and respiratory systems, and increases symptoms in asthmatic patients. • Sulfur containing chemicals Sulfur Dioxide (SO2) SO2 is a colorless gas or liquid that has a pungent odor. SO2 is emitted when sulfur containing fuel (i.e., burning of fossil fuels (coal, oil) is combusted for uses during kraft pulp production). SO2 increases symptoms in asthmatic patients and irritates the respiratory system. 41) 13 STotal reduced sulfur (TRS) Total reduced sulfur compounds cause the distinct odor typically associated with kraft pulp mills. These mills can release a range of odorous sulfur compounds that include hydrogen sulfide (H2S), methyl mercaptan (CH3SH), dimethyl sulfide(CH3SCH3), and dimethyl disulfide (CH3SSCH3). The sulfur in these malodorous substances can be measured or monitored in ambient air as a group. When measured in this manner they are referred as "total reduced sulfur" (TRS) compounds, also known as "non-condensable" gases. According to the Environmental Protection Agency (EPA) Sector Notebook for the pulp and paper industry, "humans can detect some TRS compounds in the air as a `rotten egg' odor at as little as one part per billion"23 Mercaptan has a skunky odor(it is about ten times less toxic than H2S) while H2S smells like rotten eggs at low concentrations. The combined odor of the TRS gases may not be distinctly the odor of rotten eggs or skunk, but a different complex odor. Residents from Port Townsend report that this odor irritates the eyes and the respiratory tract, can awaken people from sleep, and causes a sensation of"not being able to breathe." Generally H2S, methyl mercaptan, dimethyl sulfide and dimethyl disulfide account for 95%of TRS in air, with other sulfur compounds generally present in small amounts. Environmental exposures to malodorous emissions are usually to a mixture of sulfur-containing gases. The exact concentration of hydrogen sulfide in these types of mixtures cannot be determined. In estimating exposure, there is also uncertainty about the dose and duration of exposure. Based on limited • information presented in toxicological studies, rodents appear to be less sensitive to hydrogen sulfide than humans. Since the respiratory tract is the major target organ of hydrogen sulfide toxicity, humans with asthma, the elderly and young children with compromised respiratory function represent sensitive subpopulations.24' 5 Hydrogen sulfide Hydrogen sulfide can be found in sewage treatment facilities, fish aquaculture and in areas where livestock or manure is handled.26 Hydrogen sulfide is also present in emissions from industrial paper plants that use the kraft process (i.e., it is a by-product of kraft pulp and paper manufacturing). Of all reduced sulfur gases, hydrogen sulfide is the most toxic, followed by methyl mercaptan (about one-tenth as toxic) and the methyl sulfides (much less toxic). Effects resulting from short term, relatively high exposures are well documented and are of great concern for occupational safety and health. Hydrogen sulfide is a respiratory tract irritant and exposures greater than 20 ppm can cause irritation of the mucous membranes. Respiratory irritation may decrease the ability of people to fight off infection. Generally pulmonary function tests changes are not seen in healthy people exposed to 5-10 ppm. However, asthmatics have shown changes in pulmonary function following exposure to 2 ppm for 30 minutes.27 Eye irritation is another sensitive effect. A normal healthy adult male exposed to concentrations in the range of 30 ?pm and higher could exhibit olfactory sense paralysis—so he could no longer smell the gas.28' 5 At very high exposures—greater than 500 ppm during brief periods, or greater than 50 ppm during several hours—the exposed person could lose consciousness and stop 111 14 breathing. H2S in ambient air could, at times, pose a health risk to area residents, especially for • persons with pre-existing respiratory conditions. In some people, levels found in the air(i.e., at low levels, perhaps at less than 1,000 ppb) could lead to headaches, eye irritation, nausea, and can sometimes make asthma symptoms worse or more frequent. In general, symptoms are unlikely to occur if the odor is not present. (See Appendix A,Table 1 for a detailed description of effects of hydrogen sulfide at increasing concentrations). The emissions that most people are likely to notice(reduced sulfur gases) are not known to be causes of cancer, and other known emissions such as the aldehydes, are not known to be associated with the top five common cancers in Jefferson County (i.e., prostate, bladder, breast (female) lung, and melanoma of the skin).29 Asthma is not a condition that results from hydrogen sulfide exposure.30,25 Asthma can be a relatively non-specific indicator for exposure to irritant gases, of which TRS are one class. Acute exposures to such gases could be tracked if monitoring in the community were done over a period of time sufficient to encompass a fair number of odor episodes, and if tracking of asthma- related indicators (emergency room (ER) visits, hospitalizations, physician visits or medication use)was conducted over the same time period. However, the reported effects are not necessarily related to TRS gases, or may result from exposure to these or other as yet unidentified components of mill emissions. Particulate Matter(PM) Epidemiological studies indicate that small particles or particulate matter air pollution is • associated with increases in mortality, especially in people older than 65 years old who have existing cardiopulmonary diseases and in infants. It is also associated with health problems including aggravation of asthma, especially in children, and other chronic lung diseases, impacts on lung function, and increased susceptibility to infectious illnesses. Particulate matter air pollution includes several types of particles with different chemical compositions. Particulate matter with a diameter of less than 10 micrometers (µm), PK() has been the criteria pollutant of greatest current interest with respect to lung cancer because particles of size 10µm or less can be inhaled into the lung and generally originates from combustion processes and may carry carcinogenic substances, such as polycyclic aromatic hydrocarbons, on their surfaces. Smaller sized particulate matter with less than 2.5µm in diameter(PM25)has the potential to penetrate deeply into the lung's small airways and alveoli. PM25 comes from combustion sources, while larger particles between PM2.5 and PM10 in diameter include wind-blown dust as well as bacteria, pollen, and mold spores. Particles emitted from a combustion source generally consist of a central carbon core upon which other pollutants can be attached, such a polycyclic aromatic hydrocarbons (PAHs) or metals, depending on the source. 15 • Other potential contaminants released at pulp mills PTP Corporation has never been a bleaching mill, so it never used chlorine as a bleaching agent. There is no historical reason to associate dioxin with the mill's liquid effluent. Chlorinated organic compounds such as dioxin, however, may form as a by-product of combustion if chlorine is present in hogged fuel.14 In addition to pollutants identified in the TRI, PTP mill may also emit numerous other compounds in smaller quantities (e.g., dioxins, mixtures of dioxin-like compounds (DLCs), chlorinated forms of dibenzofurans and certain polychlorinated biphenyls (PCBs), VOCs (volatile organic compounds), and metals). Emissions from fuel oil combustion depend on the grade and composition of the fuel, the type and size of the boiler, the firing and loading practices used, and the level of equipment maintenance. Because the combustion characteristics of distillate and residual oils are different, their combustion can produce significantly different emissions.31 An emissions inventory is not available at this time to assess potential human health risks related to air emissions from the mill. The mill process releases these chemicals through: • Air emissions, i.e., from burning of lignin/black liquor to generate energy • Water emissions through effluent disposal • Sludge - incinerated or landfilled • Contaminants in products Dioxins and DLCs are released into the environment from several sources, including combustion, metal processing, and chemical manufacturing and processing. They are ubiquitous in the environment. The most toxic of these compounds is TCDD (2,3,7,8-tetrachlorodibenzo-p- dioxin), often simply called dioxin. PCBs, dioxins and furans have been found in fly ash from the burning of sludge from bleached kraft pulp mills 32 raising concerns that some quantities may be emitted to the atmosphere. Because of its exceptional potency TCDD is the most studied dioxin or furan, therefore, the IARC (International Agency for Research on Cancer) has classified TCDD as a known human carcinogen (Group 1) and NTP(National Toxicology Program) as a known human carcinogen.33'34 Other polychlorinated dibenzo-p-dioxins and dibenzofurans have not been studied sufficiently for IARC to determine their carcinogenicity. Information about environmental levels and health effects is available http://www.atsdr.cdc.gov/toxprofiles. The U.S. EPA provides updated exposure and health assessments online at http://www.epa.gov/ncea/pdfs/dioxin. • 16 Review of Jefferson County health data • DOH reviewed the literature and compiled available data. DOH used age-adjusted hospitalization, cancer incidence and death rates for Jefferson County and compared these to the Washington State total. The use of age-adjusted rates' is necessary due to differences in population demographics between Jefferson County and Washington State overall. Also, the population of Jefferson County is relatively small and so rates vary from year to year relative to Washington State rates. Differences in rates may be assessed by comparing 95%confidence intervals (CIs)f 35 Limited information exists on health data relevant to air pollution concerns for residents of Jefferson County. In general, air pollution can increase the risk of developing asthma attacks through several different mechanisms including: 1) a direct irritant effect on sensitive airways; 2) a toxic effect on the respiratory epithelium; 3) generating bronchial hyper reactivity, both allergen-specific and nonspecific; or 4) modifying the immune response by increasing susceptibility to an immunological trigger.36 Exposure to other allergens, airborne pollen, irritant gases, cold air,physical and emotional stress, and exercise have been shown also to initiate asthma attacks. 7,38,39 Based on published reports and the health concerns raised by residents, disease conditions that might be associated with mill air emissions in general are respiratory diseases (i.e., diseases of the lung such as, asthmas, and chronic obstructive pulmonary disease (COPD))h, ischemic heart diseases' and some forms of cancers. . e Age-adjustment is a method of developing rates that eliminate the impact of different age structures in two populations.Age-adjustment also allows us to compare rates in the same population over a period of time during which the population may have aged.Age-adjusted rates are computed by multiplying the rate for a specific age group in a given population by the proportion of people in the same age group in a standard population and then adding across age groups. r In statistics a confidence interval(CI)is an interval estimate of a population parameter. Instead of estimating the parameter by a single value,an interval of likely estimates is given.How likely the estimates are,is determined by the confidence coefficient.The more likely it is for the interval to contain the parameter,the wider the interval will be. g Asthma is a chronic inflammatory disorder of the airways characterized by variable airflow obstruction and airway hyper-responsiveness.Prominent clinical manifestations include wheezing and shortness of breath. h Chronic obstructive pulmonary disease(COPD)is a term referring to two lung diseases,chronic bronchitis and emphysema,that are characterized by obstruction to airflow that interferes with normal breathing.Both of these conditions frequently co-exist,hence physicians prefer the term COPD.It does not include other obstructive diseases such as asthma.COPD is most often caused by smoking,but also cause by exposure to second-hand smoke and in some instances by exposure to other toxic substances. ' Ischemic heart disease: A condition in which there is an inadequate blood supply to the heart due to blockage of the blood vessels to the area. 17 • Asthma One of the diseases that might be associated with air pollution is asthma. The telephone-based Behavioral Risk Factor Surveillance System (BRFSS)i reported that Jefferson County in 2003- 2005, the age-adjusted county level prevalence for current asthma was 8.8%, 95% confidence interval (CI) (6.5- 12%). The overall asthma prevalence rate in Washington for 2003 to 2005 was 9.1% (8.8-9.3%).40,41 The Jefferson County rate is similar to the Washington State rate. The rates of hospitalization for asthma have been declining in Washington and Jefferson County over the past decade.42 In the period 1997-1999, the state asthma age-adjusted hospitalization rate was 91.3 per 100,000.42 The Jefferson County rate was similar to the Washington State rate (Table 3),40 Table 3. Age-adjusted asthma hospitalization rates per 100,000 for all ages combined from 2003 to 2005 in Washington.4° PLACE'`` W' RATE LB OB State Total 80.6 79.3 81.9 Adams 109.3 83.5 141.3 Asotin 38.4 24.2 58.4 Benton 85.0 76.7 94.0 Chelan 78.3 66.8 91.3 Clallam 118.6 103.4 135.6 . Clark Cowlitz 46.3 42.3 50.5 109.7 98.0 122.5 Douglas 74.4 58.9 93.2 Ferry 61.8 29.6 117.2 Franklin 88.5 74.5 104.8 Grant 88.2 76.8 100.9 Grays Harbor 92.2 79.6 106.4 Island 31.8 24.8 40.2 Jefferson 85.2 63.3 113.4 King 83.7 81.2 86.3 Kitsap 79.9 73.3 86.9 Kittitas 41.9 29.6 58.0 Klickitat 90.7 67.5 120.1 Lewis 85.8 73.9 99.3 Lincoln 99.0 66.9 144.0 Mason 69.0 55.9 84.4 Okanogan 51.6 39.2 67.0 Pacific 76.0 54.7 104.4 'The purpose of the BRFSS is to provide indicators of health risk behavior,preventive practices,attitudes,health care use and access,and prevalence of selected diseases in Washington. BRFSS is the largest telephone survey of health in the world sponsored by the Centers for Disease Control and Prevention(CDC),BRFSS utilizes random- digit-dialing to survey adults ages 18 and over,and is used to track health risks among the American people. • 18 Pend Oreille 98.0 65.7 143.0 • Pierce 91.3 87.4 95.5 Skagit 54.2 46.6 62.7 Skamania 87.6 51.2 141.9 Snohomish 60.3 56.8 63.9 Spokane 104.9 99.4 110.7 Stevens 120.4 99.8 144.5 Thurston 80.7 73.8 88.1 Wahkiakum 166.7 91.7 287.3 Walla Walla 75.2 62.2 90.3 Whatcom 98.4 89.8 107.6 Whitman 51.5 38.0 68.5 Yakima 108.0 100.3 116.2 Counties with fewer than 10 hospitalizations not reported. Asthma Hospital Rates per 100,000, 2003-2005 combined, by age, by county 11-27-2007, VistaPHw 7.2.0.0, Calculator Version 6.0.2.1 Web. LB =lower bound, and UB=upper bound LB and UB correspond to 95%confidence intervals. From 2000 through 2005, while the age-adjusted asthma hospitalization rates in Jefferson County appear to be higher than for the state overall, in fact,the rates are not different than the Washington State rates(Table 4). Due to the small numbers of cases in Jefferson County, asthma rates vary between years and have wide confidence intervals. Asthma is a complex illness that varies in extent and severity among individuals. Some studies on short-term exposure to gaseous pollution on asthma hospitalization in children showed that carbon monoxide, sulfur dioxide, . coarse particulate matter(P1\410_25) and nitrogen dioxide were positively associated with asthma admissions in both sexes.43,44,45 Table 4. Age-adjusted hospitalization rates per 100,000 for asthma, Jefferson County vs. Washint on State, 2000-2005. Jefferson � � different Year Rate LB UB Rate LB UB 2000 91.7 89.3 94.3 126.0 82.6 187.8 No 2001 88.7 86.3 91.2 104.3 62.8 165.7 No 2002 93.4 91.0 95.9 92.0 53.7 150.1 No 2003 81.4 79.1 83.7 88.7 52.8 143.9 No 2004 75.9 73.7 78.1 92.8 56.3 148.4 No 2005 84.1 81.8 86.4 70.6 37.1 124.8 No 2000-2005 84.6 83.6 85.7 89.6 71.7 111.2 No Data Sources: Hospitalization Discharge Data: Washington State Department of Health, Office of Hospital and Patient Data Systems. 1990-2005 Population Estimates:Population Estimates for Public Health Assessment, Washington State Department of Health. Vista Partnership, and Krupski Consulting. November 2006. LB=lower bound, and UB=upper bound, LB and UB correspond to 95%confidence intervals. International classification of disease(ICD)ICD-9 codes:493 • 19 • *Jefferson County rates are not significantlyk different than Washington state rates. Table 5. Childhood (0-14 years old) hospitalization rates per 100,000 for asthma, Jefferson County vs. Washington State, 2000-2005. n Jefferson ` " different a State Total Jefferson County,` 1thnAWA* Year Rate LB UB Rate LB UB 2000-2005 157.0 154.2 159.9 152.6 105.8 213.3 No LB=lower bound, and UB =upper bound, LB and UB correspond to 95%confidence intervals. * The significance for individual years in Jefferson County can't be tested because the number of hospitalisations is too small to perform a statistical test. Table 6. Adult (15-99 years old) hospitalization rates per 100,000 for asthma, Jefferson County vs. Washington State, 2000-2005. �qa � 4"' Jefferson • S `` rc r w different ,. Stat Total ,' Av ± fferson'County s. than WAS Year Rate LB UB Rate LB UB 2000 64.5 62.2 66.9 91.4 55.1 142.5 No 2001 67.5 65.1 69.8 76.1 43.6 123.4 No 2002 70.2 67.8 72.6 75.7 43.4 122.8 No 2003 67.6 65.3 69.9 79.6 46.4 127.3 No • 2004 58.9 56.8 61.1 101.7 63.8 153.9 No 2005 64.3 62.1 66.6 58.4 31.1 99.5 No 2000-2005 65.4 64.5 66.4 80.3 65.6 97.4 No Data sources: Hospitali-ation Discharge Data: Washington State Department of Health, Office of Hospital and Patient Data Systems. 1990-2005 Population estimates: Population Estimates for Public Health Assessment, Washington State Department of Health. Vista Partnership and Krupski Consulting. November 2006. LB =lower bound, and UB =upper bound, LB and UB correspond to 95%confidence intervals. 1CD-9 codes: 493 * The statistical test did not show significant differences between Jefferson County and the state. The observed childhood (0-14 years old) asthma hospitalization rate is not significantly different for Jefferson County compared to Washington State (Table 5). A statistical test cannot be performed for individual years because the number of hospitalizations is too small. The observed adult(15- 99 years old) hospitalization rates for asthma were not significantly different for Jefferson County compared to Washington state rates (Table 6). k Significantly different means that the number of asthma cases in a place or time is greater than would be expected due to normal fluctuations alone.Researchers use statistics to help them decide if a disease rate is really unusual. For asthma concerns,researchers commonly agree that an excess of asthma cases is"statistically significant" when it is so different from average that you would expect it only 5 out of 100 times by chance alone. "Statistical significance" only means that the number of cases that has occurred is unusual. It does not explain why the number of cases is elevated. Furthermore, it does not rule out chance as a cause. • 20 Other health conditions that might be associated with air pollution in Port Townsend are • ischemic heart diseases and chronic lower respiratory diseases. Tables 7 and 8 present hospitalization rates for these conditions, comparing Jefferson County with the overall Washington State hospitalization rates. The observed hospitalization rate for Jefferson County compared to Washington State for ischemic heart disease was higher in 2000, 2001 and 2002, but not different than the Washington State rate in 2003, 2004, and 2005 (Table 7). The combined hospitalization rate (2000-2005) for ischemic heart disease was higher in Jefferson County compared to Washington State total. The observed hospitalization rates for chronic lower respiratory disease was higher only in 2003 in Jefferson County compared to Washington State total (Table 8). The combined hospitalization rates (2000-2005) were not significantly different in Jefferson County compared to Washington State total. Due to the small numbers of cases in Jefferson County, rates vary between years and have wide confidence intervals. The rates of ischemic heart diseases are expected to be higher in populations where there are larger numbers of residents in the older age group. The overall observed pattern of the two conditions does not indicate Jefferson County as having an unexpected occurrence of ischemic heart disease and respiratory disease over the years. Table 7. Age-adjusted hospitalization rates per 100,000 for ischemic heart disease, Jefferson County vs. Washington State, 2000-2005. Jefferson � 7 .-�� _ f s `,a" -0 ,� ^ dad different. �� `� � te��Tota)< 45,-F4��.� �,' ,,„�lrffersCc��uini�v�° ',; . than WA Year Rate LB UB Rate LB UB 2000 488.4 482.6 494.3 631.3 553.5 722.7 Yes,higher 2001 463.2 457.6 468.9 618.8 543.5 707.5 Yes,higher 2002 441.4 435.9 446.8 592.8 515.8 683.7 Yes,higher 2003 418.6 413.4 423.9 377.7 319.2 450.3 No 2004 407.7 402.6 412.9 446.8 383.3 524.1 No 2005 383.6 378.7 388.5 343.2 288.3 412.0 No 2000-2005 432.3 430.1 434.4 499.7 471.3 530.2 Yes,higher Age adjusted to 2000 US population. Data Sources for the Ischemic Heart Disease and Respiratory disease figures: Hospitalization Discharge Data: Washington State Department of Health, Office of Hospital and Patient Data Systems. 1990-2005 Population Estimates: Population Estimates for Public Health Assessment, Washington State Department of Health, Vista Partnership, and Krupski Consulting. November 2006. LB=lower bound, UP=upper bound, LB and UB correspond to 95%confidence intervals. ICD-9 codes: 410-414, 429.2 • 21 • Table 8. Age-adjusted hospitalization rates per 100,000 for chronic lower respiratory disease, Jefferson County vs. Washington State, 2000-2005. 7 ,State' o ah' 'x 0'';��• ' ,, , Tefffrson. u --: ��. ��. ��'' ntllall �,#�'� Year Rate LB UB Rate LB UB 2000 760.6 753.3 767.9 794.3 689.1 915.1 No 2001 756.0 748.8 763.2 729.5 628.8 845.7 No 2002 762.9 755.7 770.1 728.6 631.3 841.1 No 2003 754.8 747.7 761.9 904.8 795.3 1029.6 Yes,higher 2004 684.9 678.2 691.6 780.4 681.0 895.0 No 2005 798.9 791.8 806.1 769.6 668.5 886.2 No 2000-2005 752.9 750.0 755.8 783.7 741.1 828.7 No Age adjusted to 2000 US population. Data Sources for the Ischemic Heart Disease and Respiratory disease figures: Hospitalization Discharge Data: Washington State Department of Health, Office of Hospital and Patient Data Systems. 1990-2005 Population Estimates:Population Estimates for Public Health Assessment, Washington State Department of Health, Vista Partnership, and Krupski Consulting. November 2006. LB=lower bound, UP=upper bound, LB and UB correspond to 95%confidence intervals. ICD-9 codes: 460-519 Information on cancer mortality is available from the death certificate system.46 Death and hospitalization rates have similar trends. The age-adjusted annual death rates in Jefferson County • show that death rates for chronic lower respiratory disease and major cardiovascular diseases are not significantly different compared to Washington State rates (Tables 9 and 10). Table 9. Age-adjusted chronic lower respiratory disease death rate per 100,000 in Jefferson County vs. Washington State, 2000-2005. P �. a+ �'e-., o Pit s�- n r ,• ',i � tea- - `fid � cad 'h� 1p e ex°+1, tr ,. ��+Il_t fx 7 :, . d �to oia F.' , ,•FAO,- �Je'fer ,'n; NNP t ,E... iP YEAR RATE LB UB RATE LB UB 2000 49.3 47.4 51.2 43.5 25.7 77.5 No 2001 48.2 46.3 50.0 32.5 17.7 64.2 No 2002 48.6 46.7 50.4 33.6 18.3 65.8 No 2003 46.4 44.6 48.2 25.6 12.8 56.4 No 2004 43.6 41.9 45.4 51.1 31.2 87.3 No 2005 45.1 43.4 46.9 42.7 25.6 76.0 No 2000-2005 46.8 46.1 47.5 38.3 31.0 47.9 No Source: Center for Health Statistics Death Data.47 Rate per 100,000 age-adjusted to U.S. 2000 population. Does not include deaths where age is unknown. LB and UB correspond to 95%confidence intervals. ICD-10 codes:J40-J47;ICD-9 codes: 490-494, 496 Comparability ratio: 1.0411, standard error(SE): 0.00095 *There were no significant differences for Jefferson County compared to Washington State rates. For each individual year and for 2000-2005 combined years, the confidence interval for Jefferson County either completely contained the state confidence interval or at least contained the point estimate for the state. This implies • that there were no significant differences between Jefferson County and the state. 22 Table 10. Age-adjusted cardiovascular death rate per 100,000 in Jefferson County vs. • Washington State, 2000-2005. Jefferson different ,: State Total_ :„ .5r, JeffersonCounty than VA* Year Rate LB UB Rate LB UB 2000 299.1 294.5 303.8 245.1 198.5 305.4 No 2001 290.3 285.9 294.9 314.6 260.9 382.0 No 2002 281.6 277.3 286.0 253.0 206.3 313.3 No 2003 272.6 268.4 276.9 261.5 214.0 322.8 No 2004 251.3 247.2 255.3 201.4 160.7 256.0 No 2005 244.9 241.0 248.9 237.4 193.6 294.8 No 2000-2005 272.5 270.7 274.2 252.1 232.5 273.8 No Source: Center for Health Statistics Death Data.47 Rate per 100,000 age-adjusted to U.S. 2000 population. Does not include deaths where age is unknown. LB =lower bound, UP = upper bound, LB and UB correspond to 95%confidence intervals. ICD-10 codes: 100-178, ICD-9 codes: 390-434, 436-448 Comparability ratio: 0.9963, SE: 0.00021 For each individual year and for 2000-2005 combined years, the confidence interval for Jefferson County either completely contained the state confidence interval or at least contained the point estimate for the state. This implies that there were no significant differences between Jefferson County and the state. Cancer incidence data Heart and lung illnesses and diseases are common in Washington, and there are many factors that III can increase the chances of contracting them such as smoking and genetic predisposition. The role of air pollution as the underlying cause remains unclear but it is the subject of considerable research. However, it is clear that air pollution, infections and allergies can exacerbate these conditions. An early diagnosis can lead to appropriate treatment and ensure a normal or close to normal quality of life. In many cases however, there is no cure and those affected may die prematurely. The Washington State Cancer Registry (WSCR) has collected information on all Washington residents diagnosed with cancer since 1992.46 Information includes the type of cancer, age and ZIP code of the person's residence at diagnosis. Data sharing agreements with Oregon and Idaho assure that we obtain information on Washington residents who have cancer even if they are not diagnosed and treated in Washington. Lung and bronchus cancer' rates for Jefferson County and Washington State are presented below (Table 11).The age adjusted incident rates for lung and bronchial cancer are not significantly different in Jefferson County compared to the state overall. Rates vary considerably between Lung Cancer-is the most common cause of death due to cancer in women and men. Cigarette smoke contains various carcinogens and is responsible for most cases of this often fatal disease.The symptoms of lung cancer begin silently and then progress to chronic cough,wheezing and chest pain.Air pollution has been linked somewhat weakly to lung cancer. • 23 • years due to the small number of cases. The overall observed pattern of lung and bronchial cancer does not indicate Jefferson County has a significantly elevated occurrence of lung and bronchial cancer over the years compared to Washington. Table 11. Age-adjusted incident rates per 100,000 for lung and bronchial cancer, Jefferson County vs. Washington Sate, 2000-2005. ' � * , s 2' r - 4 M,2 x re , Jefersdn` M n 1 z„ t. n i m r : ,2,,,,,;,,,, ifferen , -..1,,3,-,-:,,,,k, tt ... than w„ State Total h . " m0ffer$on CQunty... ? WA* Year Rate LB UB Rate LB UB . 2000 71.3 69.1 73.6 55.7 34.6 92.7 No 2001 72.0 69.8 74.3 71.4 48.1 110.0 No 2002 68.9 66.8 71.1 70.9 46.9 110.6 No 2003 69.8 67.6 72.0 87.9 62.4 128.4 No 2004 67.3 65.3 69.5 54.6 34.9 90.4 No 2005 67.0 65.0 69.1 74.0 50.4 112.8 No 2000-2005 69.3 68.4 70.2 69.0 59.1 81.1 No RATE=Cancer cases per 100,000, age-adjusted to year 2000 US population. Data Sources for the cancer rates: Cancer Registry: Washington State Cancer Registry, Washington State Department of Health, November 2006. 1990-2005 Population Estimates:Population Estimates for Public Health Assessment, Washington State Department of Health, Vista Partnership, and Krupski Consulting. November 2006. LB=lower bound, UB = upper bound, LB and UB correspond to 95%confidence intervals. II 1CD-O: C34.0-34.9, excluding histologies 9140, 9590-9989, SiteCode Codes: 14 For each individual year and for 2000-2005 combined years, the Jefferson County confidence interval completely contains the state confidence interval, implying that the rates are not significantly different. Child health considerations ATSDR and DOH recognize infants and children are susceptible to environmental hazards from multiple sources and in a variety of settings that can occur at levels much lower than those causing other types of toxicity. Infants and children are also more vulnerable to exposures than adults. The following factors contribute to this vulnerability at this site: • Children can be at increased risk because they are more sensitive to air pollution • Not only do children have less developed respiratory systems, but because of their relative size, children also breathe more rapidly and inhale more air per kilogram of body weight compared to adults • Children also tend to be more exposed to ambient air pollution because they spend more time outdoors being physically active • Fetal and child exposure to many chemicals can cause permanent damage during critical growth stages • 24 These unique vulnerabilities of infants and children demand special attention in communities • with contamination of their water, food, soil or air. Conclusions Port Townsend residents have long reported odor and health illnesses from the mill's air emissions. The following is a summary of DOH findings. Keeping in mind that Jefferson County has a small population, rates vary by year and have wide confidence intervals, a review of available health statistics in Jefferson County revealed that: • Age-adjusted asthma hospitalization rates are not significantly different in Jefferson County compared to Washington State overall between 2000 and 2005. • Childhood (0-14 years old) asthma hospitalization rates are not significantly different in Jefferson County compared to Washington State overall between 2000 and 2005. Adult (15-99 years old) asthma hospitalization rates are not significantly different in Jefferson County compared to Washington State overall. • Age-adjusted hospitalization rates for ischemic heart disease are higher in 2000, 2001 and 2002 in Jefferson County compared to Washington State overall.The hospitalization rate was higher for the combined period 2000 to 2005 in Jefferson County compared to Washington State overall. The age-adjusted hospitalization rates for chronic lower • respiratory disease in Jefferson County were only significantly higher in 2003 compared to Washington State overall. • Age-adjusted death rates for chronic lower respiratory and major cardiovascular diseases for individual and combined years are not significantly different for Jefferson County compared to Washington State overall. • Age-adjusted incidence rates for lung and bronchial cancer are not significantly different in Jefferson County compared to Washington State overall. At this time, it is not possible to directly associate any of the observed disease conditions at Port Townsend to chemical substances that may be emitted to the air from the mill. Even in the presence of certain chemicals, not all individuals would be expected to develop a disease, and for those who did, pinpointing the sole cause to emissions from the mill would be very challenging. This is because several other factors can contribute to respiratory diseases, ischemic heart diseases, and cancer. In order to identify specific cause(s), information on all possible exposure factors, and a follow-up of healthy individuals for a long period of time would be required. Since levels of all air pollutants in the community of Port Townsend are unknown, exposure cannot be fully assessed. DOH cannot conclude whether air emissions from PTP mill could harm people's health because the information we need to make a firm conclusion is not available. DOH cannot currently evaluate the degree of past, current, or future exposure to PTP site-related contaminants. (Appendix B lists a more detailed description about general steps for evaluating • 25 • exposure pathways that can be applied at PTP mill). In communities where hazardous chemicals exist, DOH's goal is to ensure that the community has the best information possible to safeguard its health. In order to reach a conclusion, DOH needs air monitoring data for levels of chemicals emitted by the mill which could impact neighborhoods surrounding the plant. Data gaps DOH has identified the following data gaps: a) Emissions inventory data—e.g., information about all the possible chemicals being released from the mill to outdoor air b) Dispersion modeling (See Appendix B, for more detail) c) Meteorological data In order to help determine if the odors experienced by individuals are coming from PTP or if there are certain meteorological conditions under which odors seem to be more prevalent, DOH needs meteorological data. Data must be collected during these events. Useful information would include temperature, wind speed, wind direction, relative humidity, and barometric pressure etc. Recommendations I. In addition to the criteria pollutants and precursors' (e.g., carbon monoxide, particulate • matter, nitrogen oxides, sulfur dioxide, and lead) and the non-condensable gases coming from the pulping process (e.g., TRS compounds), DOH has identified the following chemicals of concern (COCs) as the most significant hazardous air pollutants (HAPs) emitted from the pulping process and combustion sources: • Metals (e.g., cadmium, beryllium, arsenic, chromium (total), manganese compounds and all forms of mercury) • Various organic compounds (e.g., methanol, propionaldehyde, acetaldehyde, and formaldehyde) • Hydrochloric acid (HCI) However, there may be other COCs released by the mill which can cause health impacts. In order to begin assessing exposure to air pollutants, DOH recommends Ecology, as the regulatory enforcement authority, require an expanded emissions inventory". "'A precursor of a criteria pollutant is a compound that reacts in the air to produce that pollutant(e.g.,the precursors of ozone are VOCs,and nitrogen oxides). "An emissions inventory provides a detailed description of the quantity of pollutants along with their emissions characteristics(how and where they are being emitted). • 26 The information obtained from the emissions inventory should be used with appropriate • emission factors (e.g., EPA's AP-42 emission factors°, and/or emission factors listed in the EPA's National Emission Inventories (NEI) clearinghouse for inventories and emission factors, web page(http://www.epa.gov/ttn/chief/) from the PTP mill to determine what, how and where they are being emitted. In conjunction with recommendations 2 - 4, this information will be used to estimate community exposures at various locations downwind of the PTP mill. 2. Obtain meteorological data near the source: • Useful information includes temperature, wind speed, wind direction, relative humidity, and barometric pressures etc. • These data in conjunction with emissions data will be useful to model air emissions 3. Ecology should ensure that air dispersion modeling or risk modeling is conducted in order to estimate levels of contaminants in ambient air at locations in the community. This will help us to determine the community's short- and long-term exposures to contaminants from the mill. 4. Continue to track odor complaints from community members specifically identifying the date, time, and nature of the complaint. Useful information would include: • Address where the odor was detected • Time when odor was first detected • Duration of odor 41110 • Description of the odor, perhaps taken from a list of possible descriptors • Intensity of the odor, rated on a 1-2-3 scale rather than a 0-to-5 scale, without fractions • Any additional information the citizen wishes to share 5. Communicate the results of this health consultation and health messages to the community through fact sheets and public health meetings. Public Health Action Plan DOH understands that the uncertainty surrounding air quality issues and their health is stressful to community members. DOH will work closely with PTP mill and Ecology to assure air emissions data is collected and conduct air modeling in the community in order to gather the °An EPA42 is an emission factor is a representative value that attempts to relate the quantity of a pollutant released to the atmosphere with an activity associated with the release of that pollutant.These factors are usually expressed as the weight of pollutant divided by a unit weight,volume,distance,or duration of the activity emitting the pollutant(e.g.,kilograms of particulate emitted per megagram of coal burned). Such factors facilitate estimation of emissions from various sources of air pollution.In most cases,these factors are simply averages of all available data of acceptable quality,and are generally assumed to be representative of long-term averages for all facilities in the source category(i.e.,a population average). • 27 • information needed to assess community exposures to emissions from PTP mill. Once this information is at hand, one could look at"hot spots' and determine the best locations to establish air monitoring, if possible. The adverse health effects caused by industrial air pollution have been the subject of international health research for many decades. The association between air pollution and human illness has been well established. People who are most sensitive to air pollution are those with heart and lung disease (including asthma), stroke, diabetes, infants and children, and older adults, (those 65 and older), or people with a current respiratory infection. While we are gathering the information we need, if you are among those sensitive to air pollution or are concerned about your health, limit outdoor activity during poor air quality days. If this is not possible, reduce the amount and intensity of activity or exercise and take frequent breaks. Establishing a cause and effect relationship between specific industrial pollution sources and patterns of illness in a community requires expensive, large scale studies that are oftentimes inconclusive. Human disease is the result of many risk factors—behavioral, genetic, and environmental—with effects cumulative over an individual's entire life span. If the goal is improvement of air quality, the highest priority should be given to accurately characterizing the type and range of contaminates in industrial emissions, determining whether they exceed legally permitted levels, and measuring the concentrations of pollutants that community members are being exposed to. This information can be used to guide individual health recommendations and, if indicated, prompt regulatory action or changes in industrial practice (i.e. reduced emissions during adverse weather conditions). • DOH will be available to comment on work plans that are generated in the future at this site. DOH will also explore the need to conduct further studies. Residents can get general information on air quality from the Olympic Regional Clean Air Agency at 2940 B Limited Lane NW Olympia, Washington 98502, 360-586-1044 or 1-800-422-5623. Email: info@orcaa.org or http://www.orcaa.org/ • 28 . •24 '+xe (lir ms`s s ` = 11: '. x �" r ': 1sWS,treef ,'''''.1-k,yt , '. „. �a FiCO3, f$\\*:'s N., . i., 1.'.•.,•;,i.- itklf; • s a � 0,i0 ' , s a � C/ m ';':',.:•12,?;.''''..'.-''','.--, ` T" _ . ' rtb4 br' [['�A•yy0n'. rtsceannd�{ Paper/4lAa lYp�9 $eb 1t ,.,1.,,,;,,,-i=, '.V y . 1 t ,+ a 0, 4 ,� � ,„,,,,,,,,,,,,,t. .i.,:.„..4.„. „.,!4 ....;,. ,„, .. ,‘04.4.1 ask a a „4 tl,,, ,ge„: ,r uv '4,44- 4.0 ',,,i,;:'‘.,:....9, ,y }} • i, y� ,,,..,\:3.,:t.... 3. • '' .. .. 'W R .• k SQA S � � le ` �w ��5 " 1 ••s., �2007 TurnNere.lne. '� -, F r "2007 a0 spcflas t.. -.7 1871 ft V V„. 200.7 European Sp&a Rgen�y + !mage 0,2008 0121talQloho. Pointer 4 06.38121 N ">122'47'54,34 ,,lee i1f£Streaapn8 fllllllll! 1005 Eye�!t $120t3'!t Figure 1. Port Townsend Paper Mill, Jefferson County, Washington s 29 • Preparer of Report Elmer Diaz, Health Assessor Site Assessments Section Office of Environmental Health Assessments Washington State Department of Health Designated Reviewer Dan Alexanian, Manager Site Assessment Section Office of Environmental Health Assessments Washington State Department of Health ATSDR Technical Project Officer Jeff Kellam, Commander U.S. Public Health Service National Centers for Environmental Health Agency for Toxic Substances and Disease Registry Division of Health Assessment and Consultation • • 30 Appendix A S Table 1. Effects of hydrogen sulfide at increasing concentrations H2S concentration Reported effects 0.02—0.05 ppb This is the concentration of H2S measured in undeveloped area48. 0.5 ppb The odor of 0.5 ppb H2S can be detected by 2%of the population.49,50 0.7 ppb This is the Chronic Reference Concentration(RfC) for H2S For the United States Environmental Protection Agency (USEPA). It is an estimate (with uncertainty Spanning perhaps and order of magnitude) of a daily inhalation exposure of the human population (including sensitive subgroups) that is likely to be without an appreciable risk of deleterious effects during a lifetime. H2S concentration Reported effects 2 ppb The odor of 2 ppb H2S can be detected by 14% of the population, and 2% of the population is annoyed by the odor,49,50 4 ppb The odor of 4 ppb H2S can be detected by 30% of the population and 5% of the population is annoyed by the . odor.49,50 5 ppb The World Health Organization (WHO) recommends that H2S concentrations not exceed 5 ppb (7 µg /m ) for 1/2- hour.21 ,5I 7 to 27 ppb annual average with Exposure to ambient air containing H25 at these levels peaks up to 500 ppb resulted in elevated self-reported health symptoms (especially those related to the central nervous system) for 9 of 12 symptom categories.52 8 ppb The odor of 8 ppb H2S can be detected by 50% of the population, and 11% of the population is annoyed by the odor49,50 10 ppb The odor of 10 ppb H2S can be detected by 56% of the population and 17% of population is annoyed by the odor. 49,50 10 ppb average (100 ppb peak) Exposure to air containing 10 ppb H2S on average resulted in neurophysiological abnormalities in reaction time, color discrimination, and mood in humans.53 10 ppb daily average At an average daily exposure to this level of H2S, there were increased reports of eye and nasal symptoms and cough for the previous year.51 S 31 • 30 ppb This is the intermediate inhalation minimum risk level (MRL) for ATSDR.26 30 ppb (CAAQS) The odor of 30 ppb H2S can be detected by 83% of the population, and 40% of the population is annoyed by the odor. In addition, 30 ppb or 42 µg /m3 H2S averaged over 1 hour and not to be equaled or exceeded is the California Ambient Air Quality Standard (CAAQS).5° H2S concentration Reported effects 40 ppb This concentration constitutes the mean annoyance threshold, i.e., odor annoyance for 50% of the population (annoyance occurs by 5 times the detection threshold; 5 times 8 ppb=40 ppb).5° 70 ppb This is the acute inhalation minimum risk level (MRL) for the Agency for Toxic Substances and Disease Registry (ATSDR). This MRL is an estimate of the daily exposure that is likely to be without appreciable risk of adverse non-cancer health effects for acute (1-14 days) exposure.48,25 0.32 ppm averaged over 1 hour Nausea, diarrhea, sleep disturbance, shortness of breath, • respiratory irritation and headache were linked to H2S emissions in Terre Haute, Indiana.54 2 ppm Headache and increased airway resistance were found in an asthmatic subset.27 2.5 to 5 ppm Coughing and throat irritation (after 15 minutes) were found for this level of H2S.50'55 • 32 Appendix B • General steps for evaluating exposures that can be applied at PTP mill To evaluate whether the public will be exposed to concentrations of chemicals that could cause adverse health effects, chemical concentrations in the emissions are compared to health comparison values (CVs). When exposure to contaminated media occurs, the exposure pathway is regarded as "complete." To determine whether completed pathways pose a potential health hazard, DOH compares contaminant concentrations to health-based comparison values. Comparison values are calculated from scientific literature available on exposure and health effects. These values, which are derived for each of the different media, reflect the estimated contaminant concentration for a given chemical that is not likely to cause adverse health effects, given a standard daily ingestion rate and standard body weight. If contaminant concentrations are greater than comparison values, DOH further analyzes exposure variables(for example, duration and frequency) and the toxicology of the contaminant. The following questions need to be answered in order to determine exposure pathways for residents of Port Townsend exposed to air pollutants and to conduct a prospective health risk assessment for air emissions from the facility: • What is in the emissions?And/or what chemicals and at what concentrations are they in the air when odor events are reported? • Where are people exposed? • • How much are people exposed? • How much is in the air and what is the personal exposure pattern? • What is the direction of the wind? What is in the emissions? An adequate emissions inventory, dispersion analysis and meteorological data can help identify "hot spots"and determine the best locations to establish air monitoring, if possible. 1) What chemicals, at what concentrations, are detected in the air during odor events?Are the concentrations above background, or control, levels? 2) Are chemicals detectable in the air during odor events? Is there a temporal (time)trend to the detection of these chemicals? 3) What airborne particulates, and at what concentrations, are in the air? 4) Is it plausible that the Port Townsend citizen's complaints of health effects are associated with detected chemicals and concentrations? 5) When an odor event occurs, do meteorological data indicate that the PTP mill is upwind of the odor detection? • 33 • Where are people exposed? Modeling is used to predict the average concentration of a pollutant at different distances and directions from the source in the air for a specific time. Air dispersion models are mathematical equations that predict(simulate or model) the movement of chemicals in the air; this movement is called dispersion since the chemicals disperse after they are released into the air. The mathematical equations are entered into a computer program for ease of use. Data needed for these air dispersion models include weather data, the amount of pollutants released to the air over time, site topography, and site geometry. Predicted concentrations are generally calculated for one hour or 24 hours and are called the predicted one hour average or the 24 hour average ground level concentrations. The modeled hourly results can be used to calculate 24-hour or annual averages or maximums. Dispersion modeling works by matching patterns of emissions from a specific source with the variability of winds (meteorology data)that occur over a year in the general area. Overall air models can.56 • Be used to estimate a substance's concentration over different time frames, such as a given day or an entire year. • Be used to estimate the level of multiple substances in the air as a result of emissions from a single source or multiple sources. • Estimate a substance's concentration at a wide range of locations. • Be used to estimate levels of air pollution in residential areas. • • Offer insights into where contaminants deposit in greatest quantities. • Identify areas where air sampling should take place. Models usually require inputs that describe the source of contamination and local weather conditions. Model outputs are estimates of air pollution levels and the amount of air contaminants that might land on the ground. Though many models are quite advanced, none are perfect. Therefore, outputs from models should be viewed as estimates of actual conditions. Certain meteorological patterns may exacerbate conditions that result in health complaints. Air current monitoring is extremely complex in coastal Washington, especially along the Straits of Juan de Fuca, where the interaction of sea, mountains, water currents, and atmospheric changes complicate most software modeling efforts. Therefore, certain meteorological conditions which odors seem to be more prevalent need to be considered. How much are people exposed? The extent people are exposed to background pollutants and mill emissions is determined by two major factors; how much is in the air and the behavior of the person. How much is in the air? Concentrations of pollutants in the air from point industrial sources are not constant; the concentration varies according to the direction and strength of the wind, time of day, how far away the location is from the emission source etc. Sometimes the pollutant concentration may be • 34 high for a short time but not present at other times and will be between these extremes for • varying periods. Most of the time the concentration will not be zero, but nonetheless will be very low. Personal exposure pattern Most people spent 90—95%of the time indoors. Whether or not a person is affected by a pollutant in air from an industrial source requires them to be present at the location at the same time the high concentration occurs. Although people may move around, they can still receive different levels of exposure while they are indoors or outdoors. Although the chances of being present during an episode may be low if the receptor is a residence, the chances are high if the modeled receptor is a workplace. • • 35 • Certification The Washington State Department of Health prepared this Evaluation of Air Exposure at Port Townsend in Washington, Washington Public Health consultation under a cooperative agreement with the federal Agency for Toxic Substances and Disease Registry (ATSDR). It was completed in accordance with approved methodologies and procedures existing at the time the health consultation were initiated. Editorial review was completed by the Cooperative Agreement partner. Technical Project Officer, CAT, SPAB, DHAC The Division of Health Assessment and Consultation (DHAC), ATSDR, has reviewed this health consultation and concurs with its findings. Team Lead, CAT, SPAB, DHAC, ATSDR • 36 Reference List • 1. Port Townsend Paper Mill. 2003. Port Townsend Paper Company. http://www.ptpc.com/community.shtml 2. WA State Department of Ecology. 1-17-2007. Air Operating Permit WA 000092-2. 1-12- 2007. http://www.ecv.wa.gov/programs/swfa/industrial/IND PERMITS/AirPerm its/PT AOP07. pdf 3. (McCall, M., Carruthers, R., and Diaz, E., Washington Department of Ecology and Washington Department of Health, personal communication, 2007) 4. 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Report on Carcinogens. http://ntp.niehs.nih.gov/ntp/roc/tocll.html 35. Washington State Department of Health. 2001. Guidelines for Using and Developing Rates for Public Health Assessment. http://www.doh.wa.gov/Data/Guidelines/WordDocs/Rateguide.doc 36. Wardlaw, A. J. 1993. The role of air pollution in asthma. Clin.Exp.Allergy. 23:81-96. 37. Brunekreef, B., Hoek, G., Fischer, P., and Spieksma, F. T. 4-29-2000. Relation between airborne pollen concentrations and daily cardiovascular and respiratory-disease mortality. 411 Lancet. 355:1517-1518. 38. Brunekreef, B. and Holgate, S.T. 10-19-2002. Air pollution and health. Lancet. 360:1233- 1242. 39. Tobias, A., Galan, I., Banegas, J. R., and Aranguez, E. 2003. Short term effects of airborne pollen concentrations on asthma epidemic. Thorax. 58:708-710. 40. Washington State Department of Health. 12-7-2007. Asthma. 1-23-2008. http://www.doh.wa.gov/HWS/doc/CD/CD AST2007.pdf 41. (Gunnels, L. and Diaz, E., Washington State Department of Health, personal communication, 7-23-2007) 42. Washington State Department of Health. 7-24-2002. Asthma. http://www.doh.wa.gov/HWS/doc/CD/CD AST.doc. 43. Lin, M., Chen, Y., Burnett, R. T., Villeneuve, P. J., and Krewski, D. 2003. Effect of short- term exposure to gaseous pollution on asthma hospitalisation in children: a bi-directional case-crossover analysis. J Epidemiol.Community Health. 57:50-55. • 39 • 44. Lin, M., Stieb, D. M., and Chen, Y. 2005. Coarse particulate matter and hospitalization for respiratory infections in children younger than 15 years in Toronto: a case-crossover analysis. Pediatrics. 116:e235-e240. 45. Lin, M., Chen, Y., Burnett, R. T., Villeneuve, P. J., and Krewski, D. 2002. The influence of ambient coarse particulate matter on asthma hospitalization in children: case-crossover and time-series analyses. Environ.Health Perspect. 110:575-581. 46. Washington State Department of Health. 2007. Washington State Cancer Registry. http://www3.doh.wa.gov/WSCR/ 47. Washington State Department of Health. 2007. Centers for Health Statistics Death Data. http://www.doh.wa.gov/ehsphl/chs/chs-data/death/dea VD.htm 48. Chou, S. 11-2-2000. Hydrogen sulfide issues. Presented at: Hydrogen Sulfide Health Research & Risk Assessment Symposium. 49. Amoore, J. E. 1985. The perception of hydrogen sulfide odor in relation to setting an ambient standard. 50. Collins J and Lewis, D. Hydrogen sulfide: Evaluation of current California air quality standards with respect to protection of children. Prepared for California Air Resources Board, California Office of Environmental Health Hazard Assessment. 9-1-2000. 11110 51. Jaakkola, J. J., Vilkka, V., Marttila, 0., Jappinen, P., and Haahtela, T. 1990. The South Karelia Air Pollution Study. The effects of malodorous sulfur compounds from pulp mills on respiratory and other symptoms. Am.Rev.Respir.Dis. 142:1344-1350. 52. Legator, M. S., Singleton, C. R., Morris, D. L., and Philips, D. L. 2001. Health effects from chronic low-level exposure to hydrogen sulfide. Arch.Environ.Health. 56:123-131. 53. Kilburn, K. H. and Warshaw, R. H. 1995. Hydrogen sulfide and reduced-sulfur gases adversely affect neurophysiological functions. Toxicol.Ind.Health. 11:185-197. 54. U.S.Department of Health, Education and Welfare Public Health Service. The air pollution situation in Terre Haute, Indiana with special reference to the hydrogen sulfide incident of May-June, 1964. 1964. 55. Bhambhani, Y. and Singh, M. Effects of hydrogen sulfide on selected metabolic and cardiorespiratory variables during rest and exercise. Report submitted to Alberta Worker's Health and Safety and Compensation. 1985. 56. Agency for Toxic Substances and Disease Registry(ATSDR). 2006. Air Sampling and Modeling, Measuring and Estimating Levels of Air Pollution. • 40 • ,Jefferson County Board of 3-realth New Business Agenda Item # T., 3 • Meth .Action beam White Taper Aprill7, Zoog • Methamphetamine "Meth" in Jefferson County Meth Lab Clean Up, ource Jefferson County and Washington State, 1997-2007 Source: Washington State Department of Ecology UM Jefferson County Washington State 4 In Jefferson County and Washington State, meth production lab clean- 20 1890 2,000 up has decreased due to legislation 18- 1693 making it more difficult to get the a 16— a 1454 --.1480 — 1,500 ingredients to produce meth and °w 14 12 1339 because of an influx of high grade 0 12— v 2 N meth produced in other places. m, 10- - 1,000 -, o 4 This shift in source, from local to o l 8- 789 806 o N imported, has not resulted in a .a-' 6- 5 5 5 5 ° 3 —500 decrease in the rates of meth use. § 4— 349' 1390 z Z 203 2 2 237 0 ® I , I I I III I I , I . I I ° 0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Reported Meth Use .Ni Around 7 - 8% of Jefferson County youth report having used meth in their lifetime compared with 2- 7% of Washington State youth. Only 2- 4% report having used meth in the past 30 days. J About 1% of lower income Jefferson County Youth Self-Reported Lifetime Methamphetamine Use, • adults report having used meth in the past year Jefferson County and Washington State while 9% report lifetime use. Source:Healthy Youth Survey 10% ° ° 2002 2004 a 2006 Adult Reported Methamphetamine Use, 8/0 8/° Jefferson County and Washington State,2003 8% " °� 7% 7% 7% Source:DSHS:Washington State Needs Assessment Household Survey 6% 6% (WANAHS) 6% - 5% � 5% , ( 14.0%- total' 4% ,,, ®above 200% FPL* 4% ��' 12.0% ■at or below 200% FPL* 2% „2, ' , . „ 10.0% ,I ` * * ,4 €” -r, 9.0% 0% _ "kr a m Jefferson County WA State Jefferson County WA State w 8.0% d 10th graders 12th graders o, . 5.5% w 6.0%- 4.40, Youth Self-Reported Past 30 Day Methamphetamine a 404,- Use,Jefferson County and Washington State Source:Healthy Youth Survey 2.0% 0 3% o s i 1.0% 10% - 2002 se 2004 in 2006 0.3% 0.1% data not available 0.2 0.0% tam 8% - Jefferson County Washington State Jefferson County Washington State past year lifetime 6% 4%4% Methamphetamine Use 4% - 2% 3%3%3% ° 3%3%3% *FPL=Federal Poverty Level.In 2003,a family of 4 at or below 200%FPL earned$36,800, 2/0 0,, a single person earned$17,960. 2% �'; 2,;w 0% ,w • �^ w'�� Jefferson County WA State Jefferson County WA State 4 14''<4.13' "- , , m 10th graders 12th graders :?�r ' PUBLIC HEALTH *data not reported,response rate below 40%. February 15,2008 Methamphetamine "Meth" in Jefferson County publicly Funded Treatment Admissions Number of Publicly Funded Meth Treatment Admissions, ~~ Jefferson County Publicly Funded Treatment Admission Adults Youth Rates, Jefferson County Rank Among 1998-2000 101 9 WA Counties (worst rate = #1) 2001-2003 88 8 Adult #8 2004-2006 216 16 Youth #4 Source:DASA,Abuse Trends in Washington State The meth treatment admission rates for low-income Jefferson County adults and youth were significantly higher than the Washington State rates for adults and youth in 2004-2006. Adult Publicly Funded MethamphetamineTreatment Youth Publicly Funded MethamphetamineTreatment Admissions*,Jefferson County and Washington State, 1998-00 through 2004-06 Admissions*,Jefferson County and Washington State, 1998-00 through 2004-06 Source:DASA:Abuse Trends in Washington State g 350.0 Source:DASA:Abuse Trends in Washington State d .41--Jefferson County Adult Rate 319.1 150.0 12 Washington State Adult Rate .-i—Jefferson County Youth Rate o n 1,5 300.0- Washington State Youth Rate co 0 a m 250.0' m 105.9 wa 100.0 v o 200.0- o A 0 163 6 0 111!0 0 c o 0 150.0- 136. 172.6 57,9 a 526 d a a 50.0 °' 100.0- - 130.1 CC 55.6 ce 0 93.4 w 41.4 N .N 50.0 E Q 25.6 -o Q 1998-00^ 2001-03 2004-06^ 1998-00 2001-03 2004-06^ 'Admission rate per'00,000 population.Excludes detox,transitional housing,group care enhancement,private 'Admission rate per 100,000 population age 0-17 Excludes detox,transitional housing,group care enhancement. pay and Department of Corrections Includes total admissions-counts may be duplicated for an individual based private pay and Department of Corrections.Includes total admissions-counts may be duplicated for an individual on multiple admissions or multiple modalities of carebased on multiple admissions or multiple modalities of care. ^Jefferson County rate significantly higher than Washington State. ^Jefferson County rate significantly higher than Washington State. Impacts of Meth: Jefferson County... N/ jail costs have reportedly risen from $30,000 to more than $210,000 per year over the past two years; most of the additional costs can be directly attributed to meth. -Ni drug court reports that the primary addiction diagnosis is methamphetamine for approximately 70%of their offender population. Approximately 85% have used meth. ' children placed in foster each year (X%) are reportedly coming from meth-affected homes. • PUBLIC HEALTH P ALWAYSWORDO43 FOR A SAFER AND HEALTHIER TE • February 15,2008 s Methamphetamine in Jefferson County • Understanding the Impact of Methamphetamine Abuse: Issue Paper & Recommendations FINAL DRAFT--April, 2008 OSS FM Jefferson County Meth Action Team • Page 12 Introduction: • "People often forget that meth hurts not just individuals,but families,neig communities. You might not be using meth or know anyone who is but it doesn't mean it's not affecting you." --The Partnership for a Drug-Free America Methamphetamine use has significant impact beyond the individual user. The manufacturing and distribution of meth has been shown to cause significant damage to innocent children,the environment, the economy and the infrastructure of communities and to be a drain on public resources. Meth use affects EVERYONE in our community. Meth users are prone to neglectful behavior, violence and paranoia. These tendencies can cause physical and psychological harm, not only to themselves, but to their children, their families and to the community, including law enforcement and first responders. This paper was written as an outcome of the Jefferson County Meth Action Team in its deliberation, prioritization, and actions as citizens and agencies responding to the problems of methamphetamine use and treatment needs in Jefferson County. After reviewing data from local, state and national resources,the Jefferson County Meth Action Team finds that methamphetamine use is a public health and public safety problem in our community. Methamphetamine use also causes significant problems at the state and national level. • The purpose of this document is to provide information and guidance about methamphetamine use in Jefferson County. The Meth Action Team hopes this report will increase awareness and be utilized as an educational tool for the residents of Jefferson County. The Meth Action Team also hopes this report will offer guidance and recommendations to the Board of County Commissioners and the Port Townsend City Council for future policy decisions. Problem: Methamphetamine use and addiction is a continuing problem throughout Jefferson County; affecting the jails financially, taxing police and sheriff,creating increased demand for mental health and substance abuse treatment, as well as costing untold amounts in child welfare, public health, legal justice system, and public education expenses. Directly or indirectly, methamphetamine and other addictive legal and illegal substances are impacting all individuals, families, children, the environment, schools, housing, neighborhoods, and businesses throughout the county. • FINAL DRAFT-APRIL,2008 Page 13 • Effects of Meth on Users': "The cr •stalline white dru � � � y g quickly seduces those w "o�$noi�#,s►do a or'�ntec �� • of confidence,hyperalertness and sexiness that lasts for hours on en.. And then it starts destroying lives..." --David J.Jefferson, "America's Most Dangerous Drug", Newsweek This is Your Broin on Meth Dopamine is a feel-good chemical produced by the brain. Upon first use, meth kicks dopamine production into high gear—this is what produces the initial euphoric rush. Meth changes brain chemistry, and after extended use, the brain can no longer respond to dopamine. The result is that users can no longer feel good, and increase consumption of the drug in an attempt to recapture the first high. This cycle often leads to addiction. Negative Effects o Meth becomes focus of life–users neglect families, home, work, personal hygiene and safety. o Prolonged use leads to bingeing,consuming the drug continuously for up to 3 to 5 days without sleep (some sleepless binges last up to 15 days) and ends with intolerable crashes. o Users are driven into severe depression, followed by worsening paranoia, belligerence, aggression– a period known as "tweaking". o Users eventually collapse from exhaustion and sleep for long periods of time often forcing • neglected children to try to fend for themselves. How Meth Can Affect a Community2: "People don't understand how tragic this drug can be. Meth is now one of Child Protective Services'biggest concerns. Using meth and raising kids don't mix!" . ; -Robert Judd, Child Protective Services Children at Risk Thousands of children are neglected every year after living with parents, family members or caregivers who are meth users or meth cooks. Children who reside in or near meth labs are at great risk of being harmed by toxic ingredients and noxious fumes. Cooking meth is extremely dangerous, and labs often catch on fire and explode. Children whose parents have been using or making meth are often placed in foster homes, straining social services in states hit hard by meth. These children need special care: they may be malnourished, suffering the effects of physical or sexual abuse, and often have behavioral problems as a result of neglect. Crime Meth labs, use of meth and sales of the drug, are often associated with other crimes, including burglary, identity theft, domestic violence and even murder. Teens and adults addicted to the drug will eventually steal valuables from their friends or family to pay for their habit. Meth- • FINAL DRAFT-APRIL,2008 Page 14 related crime requires extra attention from law enforcement, and meth users are often violent, • posing an added risk to local law enforcement. Environment& Harm A meth lab can operate unnoticed in any neighborhood, posing a health hazard to everyone around. For each pound of meth produced, five to six pounds of hazardous waste are generated. The chemicals used to make meth are toxic, and "meth cooks" routinely dump waste into streams, rivers, fields, backyards and sewage systems, which can contaminate water resources. Poisonous vapors produced during cooking permeate insulation and carpets,often making homes and buildings uninhabitable. Cleaning up these sites requires specialized training and can cost thousands of dollars per site. Health Care Meth use is a strain on a community's health care resources. Children removed from homes where a parent is making or using meth often require extensive medical attention. Meth use can damage teeth resulting in extensive dental care expenses. Meth use is associated with spreading hepatitis and HIV, as the drug lowers inhibition and increases libido,which can lead to unsafe sexual practices and needle-sharing. In addition to these strains on a community's health care system,communities assume responsibility for funding treatment to help meth users recover from addiction. National Statistics Regarding Meth: • 70. "...the federal government still budgets far more for stopping drug`flow and enforcing mug lair ($8.3 billion this year) than it does for treatment and prevention($4.6 billion):" --Claudia Kalb,"And Now, Back in the Real World", Newsweek • Approximately 1 1.7 million Americans ages 12 and older reported trying methamphetamine at least once during their lifetimes, representing 4.9% of the population ages 12 and older.3 • There were 73,400 Methamphetamine related Emergency Department visits in 2004 (DAWN). • There were 158,880 treatment admissions that listed methamphetamine as the primary substance of abuse in 2006 which was 8.6% of the overall treatment cases in 2005. 56.8% of these admissions were for people ages 21-35. 10.9% were ages 12-20.4 • According to the 2006 National Drug Threat Assessment of the Department of Justice, 39% of local and state agencies reported that methamphetamine is the greatest drug threat in their region. Methamphetamine received the highest vote among law enforcement agencies compared to all other drugs, with cocaine coming in second. • Children living in homes with meth users may witness domestic violence against one or both of their parents. One study found that over 85% of women and 69% of men in treatment for meth dependence reported experiencing violence. 80% of women reported violence from their partners.5 • FINAL DRAFT—APRIL,2008 Page 15 • Washington State Statistics Regarding Meth: "This is the biggest problem to ever hit the state,period. Meth wrecks families more frequently and more completely than any drug we've ever see'. Washington Attorney General Rob McKenna, May, 2006 • Young adults in Washington State are using meth at a rate nearly twice the national estimate. Data from 2002 through 2005 show that 3 percent of Washington residents between the ages of 18 and 25 reported past year meth abuse, compared with a national estimate of 1.6 percent.° • Meth prevalence rates in Washington across all ages exceed the national estimate. Data from 2002 through 2005 indicate that 1.03 percent of Washington residents 12 and older reported past year meth abuse,compared with 0.6 percent nationwide.? • Meth treatment admissions in the State of Washington have almost doubled since the late 1990s, increasing from 4,056 admissions in State fiscal year (SFY) 1998 to 8,052 in SFY2004.8 • Readmission to publicly funded treatment for methamphetamine addiction occurs in the year following primary treatment for about 1 in 5 clients.9 • The number of meth lab incidents in Washington reported to the Drug Enforcement Administration decreased from 1,441 in 2002 to 206 in 2006.10 • As of September 30, 2005, the total confinement population for the Washington State Department of Corrections was 17,788 and rough estimates of incarceration costs for methamphetamine-related drug crimes total nearly $31 million per year. 11 • • Based on June 2005 data, drug crimes that involve methamphetamine make up approximately 36 percent of all drug convictions (6.4% of all convictions).12 • According to the Washington State Department of Social and Health Services, the monthly costs for providing chemical dependency treatment are $167 per client for stimulant abusers. In SFY 2004 there were 6,512 adults and 1,540 youth admitted to DASA-funded treatment for methamphetamine; the costs for methamphetamine-related treatment are thus estimated at $1.3 million for each month of treatment.13 Meth in Jefferson County: Methamphetamine addiction erases what makes us human. The drug,®e'• es a cr tdpers ' only reason for living. Family, friends,husbands, wives, lovers, even children are di 41 point where they become commodities to be traded, used or at best ignored in the addict's wort.. The only value lived becomes the drug itself. --Jefferson County Prosecuting Attorney Juelie Dalzell Pre valence • Adult reported methamphetamine use in the past year is less than 1% or about 65 residents, similar to Washington State. 5.5% of Jefferson County adults have used methamphetamine during their lifetime.14 • 9% of Jefferson County residents at or below 200% of the Federal Poverty Line have reported use in their lifetime.15 • FINAL DRAFT-APRIL,2008 Page 16 • Reported meth use, in the past year, is higher, about 1%, among those at or below 200% . FPL in both Jefferson County and Washington State.16 • Youth (10th grade) reported lifetime methamphetamine use is about 8%,or about 25 10th grade students,slightly (but not significantly) higher than Washington State.17 • On the 2006 Healthy Youth Survey, 1-4% of Jefferson County 8th and 10th grade students said that they had used methamphetamines within the past 30 days.18 Treatment • The adult publicly funded treatment rate is significantly higher than Washington State (2004, 2005 and 2006); Jefferson County has the eighth highest rate in the State (2006).19 • The youth publicly funded treatment rate is significantly higher than Washington State (3 year period 2004-06); Jefferson County has the fourth highest rate in the State (2006).20 • In Jefferson County,for publicly funded treatment,there are approximately 72 adult treatment admissions and 5 youth treatment admissions annually where methamphetamine is designated the primary drug (3 year admissions average, 2004 through 2006). 21 • Publicly-funded alcohol/drug treatment services are provided on a rationed basis in our community. In 2005, in Jefferson County, 66.3% of adults in households who qualified for and were in need of DASA-funded chemical dependency treatment did not receive it. 169 people received treatment, 332 were unable to access publicly-funded treatment.22 • Publicly-funded 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 publicly-funded service. • impact on the Legal System • Jefferson County Jail costs over the past two years have reportedly risen from $30,000 to more than $210,000 a year; and most of the additional costs can be directly attributed to methamphetamine.23 Jefferson County drug court reports that the primary addiction diagnosis is methamphetamine for approximately 70% of their offender population. Approximately 85% have used methamphetamine. • Jefferson County drug court reports that the primary addiction diagnosis is methamphetamine for approximately 70% of their offender population. Approximately 85% have used methamphetamine. • Meth-related prosecutions are on the rise, severely taxing the legal system. Impact on Families • Children who reside in homes where parents are involved in methamphetamine and other substance use, as well as criminal behavior, are extremely vulnerable to abuse, neglect or endangerment. • Jefferson County's Division of Children and Family Services report that approximately 24% of their cases had methamphetamine involvement or meth-related allegations. • Inhalation, absorption, or ingestion of toxic chemicals, drugs, or contaminated foods or drink that may result in respiratory difficulties, nausea, chest pain, eye and tissue irritation, and chemical burns.24 • FINAL DRAFT-APRIL,2008 Page 17 • • Initial studies indicate pre-natal exposure to meth may lead to birth defects, fetal death, growth retardation, premature birth, and a range of other developmental disorders.25 With appropriate care, however, initial studies have shown that many children who have been exposed to meth in utero can go on to meet normal physical and developmental milestones.26 However, the long-term impact of meth on children's health is still unknown. Intervention & Treatment ,111"A problem with drugs or alcohol doesn't discriminate,it can_happen'to anyone..anywhere.'.', it cuts across race,gender and economic lines and occurs in every region of this country" • The Partnership for a Drua Free America Methamphetamine addiction is more similar than it is different from other forms of addiction. Understanding that drug addiction is a disease is key to successfully overcoming some of the barriers to seeking treatment. Drug addiction is a complex disease with the potential to have serious negative impacts on the individual,the family, and the community. It is characterized by compulsive, at times uncontrollable, drug craving, drug-seeking, and use/abuse that persists even in the face of extremely negative consequences. For many people, drug addiction becomes chronic, with relapses possible even after long periods of abstinence. The path to drug addiction is complex and begins well before the act of taking drugs. Genetics and the environment contribute to the risk of addiction. The Center for Disease Control's Adverse • Childhood Experiences Study has proven that difficulties experienced by children increase the risk of poor health including substance abuse and addiction. Substance use and addiction is often the consequence of a person's attempt to cope with unbearable emotional pain. Over time, a person's ability to choose not to take drugs can be compromised. Drug seeking becomes compulsive, in large part as a result of the effects of prolonged drug use on brain functioning and, thus, on behavior. The compulsion to use drugs can take over an individual's life. Addiction often involves not only compulsive drug taking, but also a wide range of dysfunctional behaviors that can interfere with normal functioning in the family, the workplace, and the broader community. Family members, especially children, are impacted by the chaos and neglect that accompanies addiction. Children are more likely to have health and developmental consequences including behavior problems, poor academic performance, and a higher risk of their own addiction and mental illness. Positive social and family relationships tend to break down and be replaced by substance using peers. Addiction also can place people at increased risk for a wide variety of other illnesses. These illnesses can be a consequence of poor living conditions, dangerous social contacts, malnutrition, and poor health habits that often accompany life as an addict, or because of the toxic effects of the drugs themselves. Methamphetamine addiction can result in temporary and long-term neurological damage, including paranoia, hallucinations,cognitive impairment, and mood disturbances. Some of these symptoms may persist long after withdrawal has ended. Addictive substances, such as methamphetamine, opiates, sedatives, inhalants, marijuana, phencyclidine, and alcohol can cause physiological damage. This includes potentially permanent damage to neurotransmitters leading • FINAL DRAFT-APRIL,2008 Page 18 to an increased incidence of mental illness. Though there is some research to point to specific • differences between methamphetamine and other drugs, the process of addiction and the client treatment needs are more similar than different. Addiction is a disease, regardless of the substance. Like other diseases, it can be treated! People Do Get Well from Meth Addiction27 METH MYTH: "Once a meth addict,die a meth addict." Research proves meth addicts have the same success rates for recovery as other addicts. It may take longer to regain brain function or to start feeling good about things w: than with some other drugs of choice. www.methtalk.com Recovering from meth addiction can be difficult, but is not impossible. Research shows that meth addiction is treatable and people do get well. C;nallenget, of Meta Treatment Because of the drug's destructive nature, treating meth addiction presents unique challenges. Upon entering treatment, a meth user may: • Require several nights of good sleep, since meth users have often been awake for days • Be more agitated during the first month and have a very short attention span • • Have delusions or extreme agitation • Have physical problems, such as wounds, seizures, other health issues and advanced tooth decay • Require longer treatment than they might from an addiction to another substance What Works? There are many forms of treatment, but effective treatment will raise awareness; addresses physical, psychological, emotional and social problems; and will involve family and friends. Treatment is usually more successful when the individual has the support of loved ones. State and National research indicate several key factors in treating methamphetamine addiction. Rapid access to treatment system through multiple entry points, intensive engagement of the client into services, longer stays in treatment, relapse prevention programs which require client monitoring and accountability, and support services for affected children and families of addicts. Tr acme t for :Meth is Getting Setter: and Better The National Institute on Drug Abuse (NIDA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) have invested tens of millions of dollars into researching the effects of meth and effective treatments. According to NIDA and other experts, one treatment method, the Matrix Model, has shown significant success in treating meth addiction. And : p n Mind • Treatment options vary. Sometimes a variety of approaches are needed to help someone achieve recovery. Recovering people may need to do inpatient treatment, FINAL DRAFT-APRIL,2008 • Page 19 Soutpatient treatment, 1 2-Step meetings and/or mental health counseling. Different combinations of treatment work for different people. • Treatment takes persistence but it pays off in the end. Recovery is not instantaneous. It is an ongoing, difficult process that requires work to maintain, but it can lead to a profound life transformation and enormous personal growth. • Treatment does work. People with drug or alcohol problems can get well; they can regain their physical health and well-being and improve their relationships with others. • Act Now! When it comes to addiction, you cannot wait. Addiction is a disease, a serious health problem, like heart disease,that can happen to anyone. If left untreated, it can progress and may even be fatal. Don't wait until something bad happens. GET HELP NOW! Recommendations from the Jefferson County Meth Action Team: "Properly addressing the meth issue is going to take some bold, innovative of that innovative thinking is realizing that the "cost"of doing nothing or justl'p'pysng'R" ®' e„ solutions is enormously,more expensive than the "price"you pay for using the proper solution." www.allpositiveoptions.com The Jefferson County Meth Action Team recommends that the citizens of Jefferson County focus on reducing the factors that lead to costly financial, social and health outcomes of methamphetamine use. The group believes that energy and resources should be directed, comprehensively, toward efforts in prevention, intervention, treatment and aftercare. • The Jefferson County Meth Action Team hopes that the following recommendations offer direction for leadership and positive action: • Addiction is a complex disease that affects the individual, family, and community. To successfully prevent and treat addiction there should be an ecological model of services designed to meet the needs of a diverse population with accountability for positive outcomes. An ecological model looks at prevention and treatment as intertwined and is accessible through any point in the health and social services arena. This model targets the identified addict for treatment as well as prevention and treatment for the children, family, and social support network of the addict. • Substance abuse and addiction is a community issue. Public education and outreach through a wide range of sources and media will help citizens learn how to recognize and respond to substance abuse. • Our community values every individual whether low income or with plentiful resources. Prevention and intervention activities should have consistent and adequate funding at the local, state and federal levels. • People who are ready to get help will find multiple avenues for assistance and referral into the treatment system. It is expected that the primary routes will be through the health care system, social services, children's services, schools, the legal justice system, substance abuse treatment and the mental health system. • FINAL DRAFT-APRIL,2008 Pnge 110 • • Intervention Services should be made available to the community. Concerned family and friends would have a resource to turn to learn more about the process of interventions and have trained facilitators available to assist them. • Families need a continuum of integrated treatment. Multiple approaches to treatment and recovery will more effectively honor the perspective and preference of the person seeking help. Programs and/or providers shall have proper accreditation and utilize evidence-based programs. Programs and/or providers will be responsible for providing evaluation measurements to funding sources as required. • People need rapid access to treatment when they are motivated to make change. Wait times for assessment and intake in both mental health and treatment agencies need to be minimal with accountability to the community as well as regulatory agencies. Access to inpatient treatment facilities should be expedited. • All Jefferson County students should have access to Prevention/Intervention Services. Schools are ideal sites for prevention programs and intervention services as well as ongoing mental health and substance abuse treatment services. • People who seek help with addiction and substance abuse often are self medicating or suffering from an untreated mental illness. All routes of access will acknowledge and consider the co-existing nature of mental health and substance abuse disorders. • Addiction has serious impacts on family members. A family includes children, parents, • partners, spouses, relatives, and close friends. Providing information, support, prevention, and intervention to those who request help is an integral component of the ecological model. Family member treatment choices should be funded and independent of the choices and treatment outcome of the identified addict. • Agencies and providers of services should be mandated collaborators. Agencies and providers need to work together,share information and look at treatment crossover as a means for their patients/clients' long-term recovery, safety and well-being. • In order for substance abuse and/or mental health treatment to be effective, and for a better chance of lasting recovery, support resources should be made available, including: o Affordable housing o Transitional housing o Therapeutic childcare o Education o Workforce development o Transportation assistance o Access to healthcare and dental care o Support to families headed by grandparents, extended family o Parenting education and support • FINAL DRAFT-APRIL,2008 Page 111 . For help and further research- Local Methamphetamine Resources: • Safe Harbor Recovery Center 360-385-3866 • Turning Point Recovery 360-385-4855 • Narcotics Anonymous/Alcoholics Anonymous 360-379-1016/360-385-0266 • Jefferson Mental Health Services 360-385-0321 • Jefferson County Meth Action Team/Meth 360 Presentations 360-379-4495 National Metham heiarrline Resources: • The Partnership for a Drug-Free America www.drugfree.ora/meth (Comprehensive information,resources,video stories and tips from experts and parents) • American Council for Drug Education www.acde.org • • Community Anti-Drug Coalition of America www.cadca.orq • The Drug Enforcement Administration—Methamphetamine Information www.dea.gov/concern/amphetamines.html • Just Think Twice www.iustthinktwice.com (A youth oriented site created by the Drug Enforcement Agency's Demand Reduction Program) • KCI:The Anti-Meth Site www.kci.org (Extensive resources and links about methamphetamine) • MethResources.gov www.methresources.gov (The federal government's directory of information and programs related to meth) • The National Alliance for Drug Endangered Children www.nationaldec.orq (Alliance for those concerned about children endangered by caregivers who manufacture,deal or use drugs) • Substance Abuse and Mental Health Services Administration(SAMHSA) www.samhsa.gov • SAMHSA's National Clearinghouse for Alcohol and Drug Information(NCADI) www.ncadi.samhsa.gov • FINAL DRAFT-APRIL,2008 Page 112 • References: This section adapted from the Meth 360 Information Kit,created by The Partnership for a Drug-Free America,2007. 2 Ibid. 3 Office of Applied Studies.(2005).Results from the 2004 National Survey on Drug Use and Health:National findings(DHHS Publication No.SMA 05-4062,NSDUH Series H-28).Rockville,MD:Substance Abuse and Mental Health Services Administration. 4 Office of Applied Studies,Substance Abuse and Mental Health Services Administration,Treatment Episode Data Set(TEDS). 5 Abandoned Infants Assistance Resource Center,Newsletter,Spring 2006,Volume 15,No. 1,What Do We Know About the Impact of Methampehtamine on Infants and Children? 6 National Survey on Drug Use and Health,SAMHSA,State Estimates of Past Year Methamphetamine Use,2002-2005.URL: htto://oas.samhsa.gov/2k6/stateMeth/stateMeth.htm 7 Ibid. 8 Washington State Department of Health and Social Services,Division of Alcohol and Substance Abuse,Northwest High Intensity Drug Trafficking Area Program,Methamphetamine and Related Crime:The Impacts of Methamphetamine Abuse,March 2006. URL:http://mfiles.ora/publications/Methandrelatedcrime.pdf 9 Luchansky,Bill Treatment for Methamphetamine Dependency is as Effective as Treatment for Any Other Drug.Looking Glass Analytics,Olympia,WA December 2003.) 10 DEA,SMARTS Federal-Wide Drug Seizure System.URL:http://www.usdoi.aov/dea/pubs/states/washinaton.html Washington State Department of Health and Social Services,Division of Alcohol and Substance Abuse,Northwest High Intensity Drug Trafficking Area Program,Methamphetamine and Related Crime:The Impacts of Methamphetamine Abuse,March 2006. URL:http://mfiles.ora/publications/Methandrelatedcrime.odf 12 Ibid. 13 Ibid. 14 Ibid. 15 Washington State Department of Social and Health Services,Washington State Needs Assessment Household Survey (WANAHS). URL:http://www.dshs.wa.gov/rda/research/4/52/data/40_meth.shtm 16 Washington State Department of Social and Health Services,Washington State Needs Assessment Household Survey (WANAHS). URL:http://www.dshs.wa.gov/rda/research/4/52/data/40_meth.shtm 17 Washington State Office of the Superintendent of Public Instruction,Departments of Health,Social and Health Services, Community,Trade and Economic Development,and Family Policy Council,Healthy Youth Survey-2006. t8 Washington State Department of Social and Health Services,Washington State Needs Assessment Household Survey (WANAHS). URL:http://www.dshs.wa.gov/rda/research/4/52/data/40_meth.shtm • 19 Washington State Department of Social and Health Services,Division of Alcohol and Substance Abuse,Tobacco,Alcohol,& Other Drug Abuse Trends in Washington State,2007 Report. 20 Ibid. 21 Ibid. 22 WA Division of Alcohol and Substance Abuse. (2006.) Abuse Trends 23 Washington State Department of Health and Social Services,Division of Alcohol and Substance Abuse,Northwest High Intensity Drug Trafficking Area Program,Methamphetamine and Related Crime:The Impacts of Methamphetamine Abuse,March 2006. URL:http://mfiles.ora/publications/Methandrelatedcrime.odf 24 http://www.whitehousedrugpolicy.gov/NEWS/press05/meth_children_factsheet.html 25 Nancy K.Young,Ph.D.,Director Children and Family Futures,Inc.,National Center on Substance Abuse and Child Welfare, The Social and Economic Effects of the Methamphetamine Epidemic on America's Child Welfare System,Testimony before the United States Senate Finance Committee,April 25,2006. 26 Abandoned Infants Assistance Resource Center,Newsletter,Spring 2006,Volume 15,No. 1,What Do We Know About the Impact of Methampehtamine on Infants and Children?An Interview of Dr.Rizwan Shah,Medical Director of the Child Abuse Program at Blank Children's Hospital in Des Moines,Iowa. 27This section adapted from the Meth 360 Information Kit,created by The Partnership for a Drug-Free America,2007. FINAL DRAFT-APRIL,2008 • Page 113 • Representatives from the following agencies and organizations are members of the Jefferson County Meth Action Team: Chimacum School District Division of Children & Family Services (CPS) Domestic Violence/Sexual Assault Program of Jefferson County Jefferson County Community Network Jefferson County Juvenile Services Jefferson County Meth Action Team Jefferson County Prosecutor's Office Jefferson County Public Health Jefferson County Sheriff's Office Jefferson Healthcare Port Townsend Police Department Special thanks to Siri Kushner, Epidemiologist, Kitsap County Health District For Further Information: Please contact Anne Winegar, Program Manager for the Jefferson County Community Network and Convener of the Meth Action Team, at 360-379-4495 or awinegar@co.lefferson.wa.us • • FINAL DRAFT-APRIL,2008 . **DRAFT** DEC Document Nsssible Titles. • Jefferson County Collaborative Community Response to Drug Endangered Children • Jefferson County Drug Endangered Children Guidelines Introduction and Purpose: Innocent children, under 18 years of age, are sometimes found in environments where methamphetamine and other legal and illegal substances are produced, sold or used. Nationally, Drug-Endangered Children (DEC) programs have been developed to coordinate the efforts of law enforcement, medical services, child welfare workers and other agencies, to ensure that children who live in or frequent these sites receive appropriate care and attention. The purpose of the (titiel project is to implement and evaluate a collaborative response ................ among law enforcement, prosecutorial, medical and social service professionals to the needs of children endangered by exposure to substance abuse and manufacturing, trafficking, and use of legal and illegal drugs throughout Jefferson County. In addition, text tev a0,Sspode1, t G � firtcenter etc) Thisp protocol has been prepared through a collaboration of allied agencies to address a multi-disciplinary approach that provides intervention and;assistance to DEC. The agencies and • organizations are listed in Section Vll Ar The purpose of this document is to outline guidelines for evaluating and providing services to children who are exposed to neglect or abuse by caretakers who are using, selling, manufacturing and/or trafficking of legal and illegal substances. Although our community continues to experience a decrease in the numbers of clandestine methamphetamine labs, there are still children that reside in homes where parents are involved in methamphetamine and other substance use, as well as criminal behavior, leaving them extremely vulnerable to abuse, neglect or endangerment. This protocol represents an agreement among participating agencies within Jefferson County concerning the manner in which drug-endangered children incidents are handled and investigated. These are recommendations for participating agencies and organizations. It is anticipated that each incident will involve unique circumstances and flexibility must be allowed for modifications. This protocol is not intended to increase the civil or criminal liability of member agencies or their employees. • C:\Documents and Settings\dmarvin\Local Settings\Temporary Internet Files\OLK5\DEC Document-Guidelines-DRAFT as of January 2008.doc Page 1 of 6 sf�enta _ t xk�k�1 � I. Law Enforcement Response Recommendation In the best interest of the child, sensitive and confidential information should be shared amongst interagency DEC team members. Law enforcement should notify Child Protective Services (CPS) when there is reason to believe that a child has been exposed to controlled substances or illegal drug manufacturing activities or has been abused or neglected as a result of such activity. The following guidelines are provided to assist Sheriff Deputies in drug endangered children investigations. Definition of Drug Endangered Children (DEC) 1. Children who there is reason to believe have been abused or neglected by the adult (a parent or another adult) responsible for their care due to that adults abuse of alcohol; or controlled substance; or 2. Children who are at rsckbe se they ore being directly exposed to alcohol, illicit drugs, or rl(e a drug manufacturing activities. • Law Enforcement Protocol If Deputies have a reason to believe a child is in immediate danger: • Assess circumstances related to endangerment. • Take child into temporary custody and hold for Child Protective Services • Transfer custody to Child Protective Services. • Complete investigation packet documenting reason for removal (environmental dangers, childcare conditions, etc. • Collect Physical Evidence (i.e. photos, statements, environmental dangers etc.) o However, state statutes do NOT allow or direct law enforcement to conduct invasive tests i.e. blood, urine, hair etc, for evidentiary purposes. • Forward investigation report to Child Protective Services and Prosecutors Office. II. Child Protective Service Response Recommendation When there is reason to believe that abuse or neglect of a child has occurred as a result of illegal drug manufacturing, legal or illegal drug use, it is essential for Child Protective Services or their designee to: • C:\Documents and Settings\dmarvin\Local Settings\Temporary Internet Files\OLK5\DEC Document-Guidelines-DRAFT as of January 2008.doc Page 2 of 6 • 1. Respond at the Scene. If the presence of children at a methamphetamine lab is known ahead of time, CPS will be called to provide relevant advance information and may respond with the initial investigative team whenever possible. During business hours, law enforcement will contact the local CPS office in Port Townsend at (360) 379-4330. The CPS supervisor or designee will collect known information and will dispatch a social worker to the scene. After business hours, weekends or holidays, law enforcement will call Central Intake at (1-800-562-5624) who will dispatch a social worker. 2. Decontamination of Child (if necessary). CPS will not be responsible for the primary decontamination of children involved in a gross decontamination. If on site decontamination is necessary, law enforcement, fire department and medical professionals at the scene will conduct the decontamination process following standard EMS and medical protocols. If the child appears acutely ill or intoxicated, the child should be transported immediately to the emergency room via EMS (91 1) for further evaluation. If gross decontamination is not necessary, CPS will provide clean clothing for the child. Items from the drug lab site will not be taken with the child. Transport vehicles will have disposable blankets to transport the children into care after decontamination. 3. Accept Transfer of Custody of Child. When a child is placed in protective custody, a CPS worker responds to the scene to pick up the child. CPS, in cooperation with law enforcement, will attempt to-locate and coordinate placement of children that are not on the premises. 4. Input a Referral. CPS will ensure a referral is entered in the CPS computer system and will update the information as necessary. All appropriate reports will be forwarded to law enforcement and the Prosecuting Attorney's office. 5. Coordinate Sample Collection and Medical Exam. A brief medical exam, including a respiration check, full physical exam, a urinalysis, and a blood draw will be arranged within 24 hours of placement, if possible. CPS may sign a medical consent for treatment and is authorized per RCW to receive copies of relevant medical information. CPS will assist by attempting to obtain old medical records and/or the child's medical passport. 6. Conduct Initial Placement Assessment with Child and Transport Child to Appropriate Facility. CPS will conduct the initial placement assessment to determine whether relative or licensed foster care is the most appropriate placement for the children. The Department will conduct a relative search as soon as possible to try and locate a family member who is able to pass a homestudy and is willing and able to be a placement resource for the child. 7. Consultation. The CPS worker will consult with the CPS supervisor and Attorney General's Office regarding the legal status of the case, specifically if a dependency or relative third-party custody should be initiated. In rare instances, • parents will engage in services on a voluntary and informal basis in order to reunify with the children without court intervention. C:\Documents and Settings\dmarvin\Local Settings\Temporary Internet Files\OLK5\DEC Document-Guidelines-DRAFT as of January 2008.doc Page 3 of 6 8. Court Makes Placement Determination. If a dependency is initiated, legal • determination will take place within 72 hours of assuming custody. 9. Continuum of Care. The foster home or relatives will arrange a medical exam through the child's primary medical provider within 24 hours (if illness is suspected) or 7-14 days (no illness suspected). The relatives or foster parents will follow through with the children's medical needs_ Ill. Medical Response Recommendation—This section Not approved by Jefferson Healthcare at this point--sample from "We Care"—DEC Document, ONLY! 7) Determine Emergency or Non-Emergency Response i. Emergency: 1. Treat Immediately ii. Non-Emergency: 7. Collect Urine Sample 2. Conduct Medical Exam 3. Conduct EPSDT Exam IV. Prosecutor Response Recommendation Prosecutors review evidence collected slur h tejnvestigation to determine if child endangerment and/or drug violation charges should be filed. 1) Prosecutors shall be available 24 hours/7 days per week to assist law enforcement in obtaining search warrants where needed 2) Review Evidence for Criminal Charges collected by: i. Law Enforcement ii. Medical Services iii. Child Protective Services 3) Reference appropriate laws 4) Determine appropriate actions to take that are in the best interest of the child: i. Criminal Charges ii. No Criminal Charges V. Additional Community Agencies/Organizations Response Recommendations Jefferson Healthcare 1) Jefferson Healthcare Family Birth Center i. Women and families with known and suspected drug abuse are cared for at Jefferson Healthcare. • C:\Documents and Settings\dmarvin\Local Settings\Temporary Internet Files\OLKS\DEC Document-Guidelines-DRAFT as of January 2008.doc Page 4 of 6 • ii. The hospital strives to create and maintain a positive, therapeutic and non-judgmental environment to assist families in accessing drug treatment. iii. All mothers and infants who have risk factors will be screened for substance abuse/exposure. iv. Methamphetamine or other drug positive results will be referred to child protective services and Jefferson County Public Health. ,.:7 - B 1:: :. - ALWAYS, 4 K .; , A i __ 2) Public Health Response Recommendation i. Jefferson County Public Health (JCPH) will receive referrals on families needing support services from CPS, law enforcement or other community agencies. ii. JCPH will be a collaborative partner in service planning and providing services to families. iii. JCPH will facilitate staffing of DEC cases and issues in routine monthly meetingof the DEC Tea • s 3) Public Schools ????4 VI. Applicable Laws in Washington State for DEC • RCW 9.94A.533 (6) Adjustments to Standard Sentences • RCW 9.94A.605 Methamphetamine—Manufacturing with Child on Premises—Special Allegation • RCW 9A.42.100 Endangerment with a Controlled Substance • RCW 13.34.060 (1) (b) Shelter Care- Placement • RCW 26.44.050 Abuse or Neglect of a Child • RCW 26.44.056 Protection, Detention or Custody of Abused Child • RCW 26.44.200 Methamphetamine Manufacture-Presence of Children II/ C:\Documents and Settings\dmarvin\Local Settings\Temporary Internet Files\OLK5\DEC Document-Guidelines-DRAFT as of January 2008.doc Page 5 of 6 VII. Participating Agencies and Organizations • Although each of the participants have different functions within the community, it is agreed that a coordinated, interagency response best advances the goal of child protection. Representatives from the following agencies, organizations and community volunteers participated in the development and/or implementation of the TITLE. Chimacum School District Division of Children & Family Services (CPS) DVSA of Jefferson County Jefferson County Community Network Jefferson County Juvenile Services Jefferson County Meth Action Team Jefferson County Prosecutor's Office Jefferson County Public Health Jefferson County Sheriff's Office Jefferson Healthcare Port Townsend Police Department QTHE it A1 C VIII. Community Resources In case of any emergency, please dial 9-1-1I ,Tri Prepared bythedtffersonCounty Meth Action Team. • 104 o • C:\Documents and Settings\dmarvin\Local Settings\Temporary Internet Files\OLK5\DEC Document-Guidelines-DRAFT as of January 2008.doc Page 6 of 6 • Jefferson County Board of Health Netiv Business .Agenda Item # 17•, 4 • Our .aids: Our Business .Aprill7, 2oo8 • r April is National Child Abuse Prevention and Sexual Assault Awareness Month. "Our Kids: Our Business" is a social awareness and prevention campaign. Many community partners are • collaborating on this campaign to highlight the things we can do as individuals, organizations, agencies and businesses to prevent child abuse and sexual assault. Our. No one person can do everything, kids. but everyone can do something, and Our business together we can create change for the better. Sponsors: Jefferson County Community Network, Jefferson County Domestic Violence and Sexual Assault, Jefferson County Historic Society, Jefferson County Juvenile and Family Services, Jefferson County METH Action Team, Jefferson County Parks & Recreation, Jefferson County Public Health, Jefferson Teen Center, Brinnon School District, Chimacum School District, Port Townsend School District, Quilcene School District, Department of Children and Family Services/Children's Administration, Jumping Mouse Children's Center, The Boiler Room, Safe Harbor Recovery Center, Substance Abuse Advisory Board and The Port Townsend & Jefferson County Leader. "Our Kids: Our Business" activities in April include: • A front page story related to child abuse every week in April in the Port Townsend & Jefferson County Leader. • A "Call to Action" for the residents of Jefferson County inviting citizens to pledge an action that will make Jefferson County a more nurturing and safe environment for • children. (The pledge is asking for action, not money.) • The City of Port Townsend and Jefferson County Commissioners have proclaimed April to be National Child Abuse Prevention Month. • A Student Art Show (A Must See) at the Historic Museum in downtown Port Townsend during April Gallery Walk was hosted by the Jefferson County Historic Society. The theme for the exhibit is: The devastating effects of child abuse /What a happy healthy home looks like/What a resilient child looks like. • Town Hall Meeting titled "How Does Adult Drinking and Drugging Influence Our Teens" was hosted by Jefferson County Public Health on Monday, April 14th from 6:00—8:00 pm at Blue Heron Middle School Commons. • At the Main Street April meeting Dott Kelly, the Director of Jumping Mouse Children's Center, presented "What to do when parents abuse their children in public,"April 15th at 8:00 am. Open to all. $5.00 cover includes a light breakfast and coffee. • Two half-day workshops at Port Townsend High School will address teen issues for teens, Thursday and Friday, April 24th and 25th. • PPTV will air a number of programs on child abuse and sexual assault. • Businesses, agencies, and organizations that provide services for children, youth and families are displaying pinwheels to represent the children and families served by their programs. • A series of 20 ads highlighting parenting tips, community resources, child abuse prevention tips have been appearing in the Leader weekly from Dec 2007 through April 2008. • Candlelight vigil at the Haller Fountain, Sunday, April 27th, from 7:30 to 8:30 pm to mark the end of the "Our Kids: Our Business" child abuse prevention and sexual • assault awareness campaign .,.,...........,„... ,..,,"...„-- ...........,.....;:„-,,...........-....„-............,...-.. :-.....-...:-..,-,.......,-„-....,.._-;,,,4.:....-,,....„:„„:„.,,:...,„„......,,...;.:„.,:z..„:„..„....:.,.....,...:„,.,..„.„,„....,...,........,:„....,,,,,....,...„.„....,.....1.,..,.,................„..,,.......,-„,...........,:............„,,....... .. ,,::..„:„...;:.. . .:„. ..„ :dit .:.....: '•• .--., s, - \-.•„, .- '•• .t...?..j , „ ...„. 4 ..: , ,.. . . ..., , . . , .. . .... ,, : ,, . , •. . -,..,.. . j • ,- . . ...... .. ... .... , . ,,. _. ... .1. • ,• , . ,.- , ,•••• -, ''''' " - • ' „,••••' • •., ,- . - , • ..• , • , ' • '- • , ... • , . f'.• ,4iC--... ,''' '41-'...;":',,”: '. - , . .. \ ' .-'• -, " , '. . . ., .. . - ,.. , . ... , . ..., . ....,„„.. . , ,,il,,,'''-;- i, ...., - - -' I „....''',i1;:•..7 i, ., .... _. 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[ , . ..,..,..., , -...'........,P....4,,,;;Zi4574'...','zaiit::,-..--,.- .. 4.'"-- . '• -- ' ' ' ' . ,i .' '''•;„.•;'-',",.`''''".'s.'''..1''..':''''.*•'1:',Z4V:t••.,,..-',.4'- .. .......,,....,,..,...,, , , , , . ...,--' . i , - / --,-- CI) Ci) U.I • . z > Cf) u) " ' .. 7i.-..,, ' :„. ."-- ' V-' k k .'1..'- • ..., ' '''':T.'1.,;'..' "--:?,' ",'&J 03 - - '.47; ..-"--""- , ' •-- i' ', ; --:„-_--• ' ....:::-...,;.- :",.... '4,4,-"I'' 'i . Cr >, , . . .. . .„ ,.,.. , - _.... ...,...,,,, . ....... . . . , . .. ._i „...v., , . cl) . . . .. ,, , ,., ..........., Y 0 .... .... ,. .... . - . ,, .. . • ,. , , ,,...„ ,. .......,,,....,..., ...„ . , i iii.li..',5 . - . . :.. 0 ' 1. ..."-..:.1. ,.,, , .... Our Kids: Our Business A Call to Action No oneerson can do everything, but p everyone can do something, and together we can create change for the better. As part of National Child Abuse Prevention and Sexual Assault Awareness Month, a coalition of child advocates, volunteers, business leaders, public officials and media professionals are joining together to call attention to child abuse, neglect and sexual assault issues in Jefferson County. Citizens are invited to make a positive difference in the lives of youth and families. Support the "Our Kids: Our Business" campaign and agree in the coming year to take specific action in support of the Five Promises. Five Promises to our Children 1. Caring Adult • 2. Safe Places and Constructive Activities 3. A Healthy Start and Future 4. Effective Education for Marketable Skills 5. Opportunities to Serve Please consider turning your concern into action by completing the pledge form below. For more information read the Port Townsend & Jefferson County Leader, look for the pinwheel logo, call 360-379-4476 or 360-379-4495 or email okob@co.jefferson.wa.us Sponsored by: Jefferson County Community Network, Jefferson County Domestic Violence and Sexual Assault, Jefferson County Historic Society, Jefferson County Juvenile and Family Services, Jefferson County METH Action Team, Jefferson County Parks & Recreation, Jefferson County Public Health, Jefferson Teen Center, Brinnon School District, Chimacum School District, Port Townsend School District, Quilcene School District, Department of Children and Family Services/Children's Administration, Jumping Mouse Children's Center, the Boiler Room, Safe Harbor Recovery Center, Substance Abuse Advisory Board and The Port Townsend & Jefferson County Leader. • Our (Kids: Our Business • My Call to Action { Our Kids: Our Business Pledge: My Call to Action: I believe our children are owed a safe community; a nurturing environment where all kids can become connected to the resources they need to live healthy and fulfilling lives as caring and competent citizens. In furtherance of my commitment to this mission, I support the"Our Kids: Our Business" campaign and agree in the coming year to take specific action in support of the Five Promises. Five Promises to our Children 1. Caring Adult 2. Safe Places and Constructive Activities 3. A Healthy Start and Future 4. Effective Education for Marketable Skills 5. Opportunities to Serve Actions can be big or small and can address any one of the above promises, such as: * Be a caring adult who asks a neighbor about their school activities. *Serve an organization that supports healthy youth and families. * Donate time or money to a cause that supports healthy youth and families. *Allow youth opportunities to serve in your organization. • For more information read the Port Townsend and Jefferson County Leader, look for theinwheel logo, call 360-379-4476 or 360-379-4495 or email okob@co.jefferson.wa.us The names of all those signing this Call to Action will be printed in The Port Townsend Leader in May, 2008. Name: City: Signature: OPTIONAL: If you wish to have your contact info forwarded to a local group or agency, please fill out the address section below. This information will not be printed in the newspaper. Your pledged activity: Your Name: Address: Phone Number: Agency/organization preference(s): . Mail or deliver this form to: Our Kids: Our Business Jefferson County Public Health 615 Sheridan Street Port Townsend, WA 98368 Or fax to (360) 385-9401 • • . 'Our Kids: Our Business"is the April campaign for a year round campaign that is called"Health Kids, Healthy Families, Health Community." These are two of the 20 ads that have been in The Leader since December, 2007 and will run through the end of April, 2008. • Ad in the 3-19-08 paper mak ' k Healthy Kids, Healthy Families and a Healthy Community � . e ' , Kite Tip of the week: I Challenge You! When we witness a destructive behavior inflicted on another,what do we do? We are often the silent witness who remains silent,giving a bully or abuser even more power to hurt others. We can take back the power by declaring what we've observed, tell the bully to stop, and report what has happened to those in authority. We are witnesses in our community as well. When we witness abusive, hurtful, mean, harassing, or bullying behaviors, challenge yourself to a higher level of responsibility. Speak up and become the child's advocate. -Marilyn Sterbick,Chimacum Middle School Counselor For more information, go to: www.jeffersoncountypublichealth.org Brought to you by: The Port Townsend&Jefferson County Leader,Jefferson County Public Health,Jefferson County Community Network,Department of Children&Family • Services/Children's Administration,and the Jefferson County Meth Action Team. Ad in the 3-26-08 paper _ wiz-V Healthy Kids, Healthy Families ti and a Healthy Community Kite Tip of the week: Parenting does not come with a manual. Raising children might be the most demanding task we undertake.Our own childhood leftovers make us very vulnerable to our children's challenging behaviors. When parents feel overwhelmed,it is vital to •Temporarily stop interacting with your child when you're angry,just for a few minutes. •Create some distance long enough to repair your own feelings before you discipline your child. • Put in place a buddy system for yourself,so that you have someone to call who understands the demands of parenting and of loving. When stress becomes chronic,please find professional support. The child you love is also the human being who will make the deepest demands of you. Your relationship with your child holds the single most important influence in your child's life. Dott Kelly,Jumping Mouse Children's Center • For more information, go to: www.jeffersoncountypublichealth.org Brought to you by: The Port Townsend&Jefferson County Leader,Jefferson County Public Health,Jefferson County Community Network,Department of Children&Family Services/Children's Administration,and the Jefferson County Meth Action Team. • Jefferson County Board-of Health Netiv Business .agenda Item # T., 5 • Protocol-for Responding to Public .Meeting Disruptions A_priC17, 2008 • • SON �,,... . O W ,_,140 Agenda,.< Ein- ,,S,IING�O Regular Meeting-- April 14, 2008 MONDAY 9:00 a.m. Meeting Called to Order by Chairman 9:01 a.m. PUBLIC COMMENT PERIOD This time is dedicated to listening to the public.All speakers shall confine their remarks to facts that are germane and relevant to County Government.Be civil.Focus on issues,not individuals. Personal attacks,derogatory language or threatening remarks will not be tolerated. To ensure equal opportunity for the public to comment,all comments shall be limited to three(3)minutes per person. To further ensure equal opportunity for the public to comment,each person may address the Board one(1)time during public comment period. When the green light is on it means proceed to speak;the yellow light will go on when the speaker has 30 seconds remaining;the red light illuminated means stop.In certain cases,such as decisions relating to land use applications, the County Commission does not make the final decision and will not express any opinions in that regard.Comments relating to an item where others make the final decision will not be sent to that • decision maker. You will have other forums that will allow your comment to reach the relevant decision maker.The commissioners will typically not respond.Please state name and address. 9:30-9:35 a.m. APPROVAL AND ADOPTION OF THE CONSENT AGENDA: (Items listed below have been distributed to the Commissioners in advance for study and will be enacted by one motion. If separate discussion is desired on an item,that item may be removed from the Consent Agenda and placed on the Regular Agenda,at a specific time,at the request of any of the Commissioners.) 1. AGREEMENT re: Medical Transcription;Jefferson County Public Health;Jackie Aase 2. AGREEMENT re: Facilitate Jefferson County Transition Network Meetings;Jefferson County Public Health;Kathy Goldenberger, Creative Employment Consultants 3. Advisory Board Resignations (2);Marine Resources Committee (MRC); 1) Hal Beattie, District#3;and 2) Jim Donaldson,District#3 Alternate THE COMMISSIONERS MAY ADD AND TAKE ACTION ON OTHER ITEMS NOT LISTED ON THIS AGENDA. • Americans with Disabilities Act(ADA)Accommodations Provided Upon Request PAGE 1 PUBLIC COMMENT PERIOD • This time is dedicated to listening to the public. All speakers shall confine their remarks to facts that are germane and relevant to County Government. Be civil. Focus on issues, not individuals. Personal attacks, derogatory language or threatening remarks will not be tolerated. To ensure equal opportunity for the public to comment, all comments shall be limited to three (3) minutes per person. To further ensure equal opportunity for the public to comment, each person may address the Board one (1) time during public comment period. When the green light is on it means proceed to speak ; the yellow light will go on when the speaker has 30 seconds remaining; the red light illuminated means stop. In certain cases, such as decisions relating to land use applications, the County Commission does not make the final decision and will not express any opinions in that regard. Comments relating to an item where others make the final decision will not be sent to that decision maker. You will have other forums • that will allow your comment to reach the relevant decision maker. The commissioners will typically not respond. Please state name and address. • • Jefferson County Board of 3CeaCth Correspondence • April 17, Zoog • JEFFERSON COUNTY PUBLIC HEALTH • `mow 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypublichealth.org Summary of Assessment work 2007 JEFFERSON COUNTY ASSESSMENT ACTIVITIES : ❑ Initiated process of updating The Health of Jefferson County report to identify demographic changes, update policy, and inform community action. o Part I: Jefferson County demographics including information on population growth, income, housing affordability, access to healthcare. Indicators presented in a community forum, June 14, 2007 attended by 65 community leaders and elected officials from the city, county, port, schools and colleges, large employers and community. o Part II: Jefferson County statistics around Mental Health, Alcohol and Drug Use. Initially presented to Jefferson County Board of Health, October 18, 2007. o Support to Meth-Action team doing data analysis for their issue paper, February 2008. • o Healthy Youth Survey 2006-07 data shared with schools, school boards and press. ❑ Data analysis for the Jefferson County Substance Abuse 6 year plan (available through Safe Harbor). o Work products available at: http://www.jeffersoncountypublichealth.org/index.php?health_of_county What is assessment? Assessment is a discipline of professionals dedicated to understanding and helping others to understand how community issues and conditions impact quality of life and health. Assessment practitioners utilize specialized skills and tools to collect, analyze, interpret, and share information as well as conduct evaluation activities to measure program effectiveness. Assessment informs the development of both community priorities and policies for policy makers and the public. COMMUNITY HEALTH HEALTH DEVELOPMENTAL DISABILITIES al PUBLICNYS r HEALTH ENV{RONWEANTERLQUALITY • MAIN 360-385-9400 MAIN: 36(}385-9444 FAX: 360-385-9401 HEALTHIER COMMUNITY FAX 360-379-4487 Who benefits? • Elected officials, Community grant writers, policy boards and the taxpayer through increased effectiveness and targeting of community resources. What tools does assessment utilize? Assessment practitioners are versed in the availability, accessibility and both the strengths and limitations of community-level data sources. Data sources available to local public health assessment include: o Death Certificate System: deaths by manner, primary, and contributing causes including demographics o Birth Certificate System: birth related information including mothers demographics o Comprehensive Hospital Abstract Reporting System: hospital inpatient discharge by diagnosis including patient demographics o Syndromic Surveillance Emergency Room Visit System: real-time hospital emergency room visits by chief complaint including patient demographics o Behavioral Risk Factor Surveillance System: prevalence of adult health conditions, risk related behaviors, and risk and protective behavior factors, including demographics, alcohol use, and family violence, health care and service access. o Healthy Youth Survey: Jefferson County schools have chosen to • survey all 6,8,10 and 12 graders. Data is analyzed and released by JCPH and schools looking at youth perceptions, behaviors, and influences including demographics o Public Health Information Management System: counts of reportable communicable diseases and sexually transmitted infections o Cancer Registry: cancer incidence by type including demographics Additional data used in assessment include; alcohol and substance abuse treatment program participation, school and academic information, population, employment, income, poverty, crime and arrests, real estate, injury and safety, Medicaid program participation. COMMUNITY HEALTH HEALTH DEVELOPMENTAL DISABILITIES PUBLIC r H EALTH E NATURALTAL URRCES MAIN:360-385-9400 n J s1+3 ,V�a h h` K �tb' MAIN:360-385-9444 FAX 360-385-9401 HEALTHIER COMMUNITY FAX 360-385-9401 • • Community Outreach Association Shelter Team 'interfaith response to local shelter needs' Kim Hammers, COAST Director 360-385-7774 • - - 4 - 0 / /1-e--4"--. 2C1--(L111--( S/u__L ity Lik-Frk_4„-x)k.Au /1dit )4-6 / _e.._ yiA__vRA/LuLys., ir � � • • BIG Grow • in Jefferson & Clallam Counties! Help us celebrate our expanded location to serve more matches. ,„ 4, , r` N Big Brothers Big Siste • Puget Sou • - Reception : =n1H,o e • „• Thanks to tremendous rrr ra a Isuppo ,Big Brothers Big Sisters of Pu e oun .-:i own even BiGger in-Jefferson and CIa .•. cou• '-s!You're invited to help us celebrate the opening of our new Port Townsend offices. New offices located at: 2021 E.Sims Way Port Townsend,WA 98368 (360)379-4984 (next to UPS in the Lighthouse Mall) -Appreciation Reception:3:00 pm to 4:00 pm Jean Baldwin •Hosted by BBBSPS President&CEOTina Podlodowski Director,Jefferson County Health and members of the Board of Directors Department -Open House:4:00 pm to 7:00 pm 615 Sheridan St. •See slide show of local matches Port Townsend, WA 98368 •Video by former PTHS student Nickolas Hoffmann •Paint-a-pot purple and plant a seed •Raffle—win BIG prizes •Door Prizes—everyone takes home something! Il,l�,i�.I„SII„Ifs.l I,.,I,1,h1Il,��I.II,,I,I,.hi1 hhd • • Jefferson County Board of 3Cealth nVledia Report • April 17, 2oo8 • , • Jefferson County Public Health March/April 2008 NEWS ARTICLES 1. "Hadlock site labeled Priority 1 for cleanup,"Peninsula Daily News,March 23`d,2008. 2. "A pointed success,"Peninsula Daily News,March 24th, 2008. 3. "Healthy Kids,Healthy Families and a Healthy Community,Kite Tip of the week,"Port Townsend Leader,March 26`h, 2008. 4. "Jeffco septic problem,"Peninsula Daily News,March 30th, 2008. 5. "Topic is child abuse,"Peninsula Daily News, April 1st, 2008. 6. "Born to Read,"Port Townsend Leader,April 2nd, 2008. 7. "Our Kids: Our business, all April,"Port Townsend Leader,April 2nd,2008. 8. "Anderson Lake turning into toxic soup,"Peninsula Daily News, April 4th,2008. 9. "Healthy Kids,Healthy Families and a Healthy Community—Kite Tip of the week,"Port Townsend Leader, April 2nd, 2008. 10. "Health Officials Take a Closer Look at Port Townsend Mill,"Kitsap Sun,April 8th, 2008. 11. "How does adult drinking& drugging influence our teens?",Port Townsend Leader,April 9`h,2008. 12. "Child neglect cases pile up in county,"Port Townsend Leader,April 9`h,2008. • 13. "State seeks more mill air monitoring,"Peninsula Daily News,April 9`h,2008. 14. "Ecology Responds to Port Townsend Air Quality Health Consultation,"Olympia News Release, April 8th, 2008. 15. "Neglect,Abuse Seen in 90,000 Infants,"New York Times,April 4th, 2008. III Hadlock site labeled Priority 1 for cleanup • BY JIM CASEY Carlsborg, 5. PENINSULA DAILY NEWS ®The former Alpine PORT HADLOCK—An auto Realty/Jiffy Cleaners site, now Three more are in Pierce yard on Old Hadlock Road has the Safeway Fuel Station on Lin- County, and one is in been named a No. 1 hazardous coin Street in Port Angeles, 5. Thurston County site by the state Department of Sites are ranked from 1 to 5 Under the toxics control Ecology. —most to least hazardous— act, sites' polluters must pay Ecology on Friday added two according to the risks Ecology for their cleanup. sites each in Jefferson and Clal says they pose to people and the The state pays only when lam counties to its list of haz- environment. a liable person cannot be ardous locations slated for The Old Hadlock Road site is found or when liable parties cleanup. where Anderson, who lives at can't afford to pay for the 270 W. Maude St., Port Hadlock, work. They include a No. 1 ranking operates Michael's Custom As for the other Jefferson for property owned by Michael Anderson on Old Hadlock Road Rebuild and Towing as well as County site, the Port Ludlow south of Port Hadlock. Michael's Hulk Hauling. Golf Course, 751 Highland The others are: It also is the target of the Jef- Drive, was cited for polluting • Port Ludlow Golf Course, ferson County Environmental groundwater from the former Port Ludlow with a ranking of 3. Health Division. location of an underground II301 Business Park Loop, TURN TO HAZARDOUS/Al2 storage tank at the Golf Pro Shop. Fuel and cleaning fluids Hazardàus: In Clallam County, the SafewayFuel Station site at Third and Lincoln Streets in Port Angeles was found to be • State assessment contaminated with heavy oil from a heating oil tank and solvents from a dry-cleaner CONTINUED FROM Al These estimates came that formerly occupied the from a Dec. 21, 2005 inspec- location. On the division's behalf, I tion of the property by The original fuel station David Alvarez, chief deputy county and state officials, was in business from 1936 to civil prosecuting attorney, and Marjorie Boyd, Jefferson 1976. has filed for a warrant of County Environmental Jiffy Cleaners operated abatement against Anderson. Health specialist, says condi- there from 1966 to 2001. If granted at a court hear- tions have not improved Althoughvoluntary ing set for April 18, it would since then. cleanups removed seven allow the county to enter underground storage tanks Anderson's property, remove Owner: Not a junkyard from the site before Safeway the junk cars and clean up During the inspection, built its new fuel station, the the site. voluntary cleanup was termi- According to Ecology's son repeatedly said his operacording to Ecology, Ander- - Site in July 2007. Site Hazard Assessment, it tion wasn't a junk yard or The Carlsborg site, now has. occupied by a warehouse, auto-wrecking yard but was a • More than 100 junk source of spare parts for his first was developed as a shin- vehicles,ranging from cars to mechanic's shop in Irondale. gle mill and the first all elec trailers, some within 40 feet Soil and water samples tric sawmill in the North- of salmon-bearing Chimacum taken that dayexceeded west. It operated until 1967. Creek. The warehouse was built Leaking car batteries. cleanup levels set by the Model Toxics Control Act. in 2004 after contaminated ■ Petroleum residue leak- Neither Anderson nor his soils had been removed to a ing from exposed engines and attorney, Roy Rainey of Sil- depth of 18 feet. transmissions. verdale, returned calls from Additional sidewall sam- ■Piles of between 800 and Peninsula Daily News. pies were recommended but 01,000 tires. The Anderson site is one not taken, and the site was •Pools of petroleum prod- of five that Ecology ranked removed from the voluntary ucts on soils and surface I number one in the list it cleanup list in September water. released Friday. 2007. ■ Open and exposed antifreeze bottles, oil cans Reporter Jim Casey can be reached and 55-gallon drums. V.07V at 360-417-3538 or at jim.casey@ peninsuladailynews.com, '/ak/1 $ rZ E - cvLaCO VD to z O m co O L' 1‹. to O C, N 1341 o F Cv. O t CO c .. NO 0 CO oS o O O O _ N c*)N OC C), m NLN . 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E a E o GC II) mons roe`oroG 6-uuyy u iui G ` �x x a, Q �(111) 3-. b) cp 75.50 ,,, bD (1) C `' C �... Gf§ -' " +� ^,�000 U ro.� y O l9 y G `O+ a7 C:... '4,•,',1v-.s /,:' .gip aN.0 't)y o m X m� G d > �� - , x__ s.-DA O m m a+ L u, �xi ".0 7 11:11; g >1) .40,13,- 1 >,og 2 U71,-5,, ,,, ,4 ,,,I;;':;,c2 � kms* R'.G O•l;�0 c0. @ `re .ti '. G ca °'P c u t'"opn>,-O s.`rv,,, . = ..1% al) O 8 O. N� C d'O m i; td.t m- G C U '� ' El' s* X co F ��od-rteaGix9'2a y vygo't. w_cio•m ° wx 6 °'„,..to OINNIP - .co cra N N ro i N td O ro 4 .O.G C'4 �.r.-:- } r Iy. i C C &)0 0 i--� O ro.b G O,�.L O.G y .m` , -� s, ..,-.0,1„.4., x 5 710 0 wGc' d a0a' '- : c ' '• "b*t vm I ME ^ }�/� y cd'� y y y C N i 1 a a, ,vm K''•Mx.s'nraci'e to i y YI co C� I - E ood dv gy m ,' 4 C, Oc(46 +'.5 OODFG.aL.l CO CO 00 , ., ,, V ) `_ '-.C)< y--i A Z 15 aroi C C > 00 a C'V.N o , •.- 4't-t,-•••=t-', j� ,,5 e a 5° 0. (1.) E -.1 z r., E 5.4 .E Iti CCS •^� Q a O ..,,, ei � a s u x.tw aw e o p H ,1, i. y C �.. y o v stic (uo , � �� o ma , d�� o G ro .�z�;� �, �� ' � Q� a C o �...E, c 0 0 _�v o '+C- ��jj- m- Z v) POW U0o y a� oxwa r i xy Healthy Kids, Healthy Families t. and a Healthy Community • Kite Tip of the week: Parenting does not come with a manual. Raising children might be the most demanding task we undertake.Our own childhood leftovers make us very vulnerable to our children's challenging behaviors. When parents feel overwhelmed,it is vital to •Temporarily stop interacting with your child when you're angry,just for a few minutes. •Create some distance long enough to repair your own feelings before you • discipline your child. •Put in place a buddy system for yourself,so that you have someone to call who understands the demands of parenting and of loving. When stress becomes chronic,please find professional support. The child you love is also the human being who will make the deepest demands of you. Your relationship with your child holds the single most important influence in.your child's life. Doti.Kelly,Jumping Mouse Children's Center For more information, go to: www.jeffersoncountypublichealth.org Brought to you by; The Port Townsend&Jefferson County Leader,Jefferson County Public Health,Jefferson County Community Network,Department of Children Si Family Services/Children's Administration,and the Jefferson County Meth Action Team. • • Jeffco septic problem CONTINUED FROM A10 failed septic systems. The Jefferson County sep- WAC 46-272A-0270 gives Septic systems appear to be tic management plan is being counties a lot of flexibility as to a minor problem. • rewritten. whether a permit is required The two biggest sources of The state requires that and what the qualifications of pollution in Puget Sound are counties have a septic manage-• a septic system inspector are. chemicals and nutrients going ment plan in effect by 2012. ' Everyone I know believes through sewage treatment Gravity systems must be t,,hat all of the septic systems plants and runoff from streets, checked every three years, should be kept in good working highways and lawns. and mechanical systems every order all of the time. James Fritz, r Port Townsend year. The question is how to be the most effective at the least TURN TO PENINSULA VOICES/A11 cost and inconvenience to homeowners. One of the options put forth in the original septic manage- ment plan Called for a$200 certification fee and a$46 fee to the health department to keep the records. That seemed excessive. I would suggest that Wash- ington State University Exten- sion teach a program on septic system inspection and mainte- nance. Food should be composted, • or go out with the garbage, and not put down the garbage dis- posal. Biodegradable products Should be used in the house. Excessive bleach and chemi- cals should be avoided. WSU Extension would be in a position to teach all aspects of owning a septic system. One study I saw on Hood Canal concluded that only 3 percent of the nitrogen going into Hood Canal came from k$ 3_'. r`-.l.€ s- ,T* <' yam,r d}*-Tt�'3S �<0ar,'"4 a�.kP yy�,,�� F' rw ..b'�.7g 410 nen .h , ni �s r .� w ' :a . 3�' "} .fig0f'si `:f .;,..,::•.47..471,,,,;tYe3 } ' 'moi,„�: t '�'�° .. >£` 7� wY d, ....4*- ar,, � _ ,tea- n -� �, b t a r 8 :.;-..,,,,,:4,:,,,,,,A,„,,,,,,,,, x x 5 h -.- i' >t;< i 4,r f � ,„-'*5.1/4.01,0- . a� ',,;%.;:k77, � �. r� 1°ya �� • a fr..,..,4,,,'.:‘ �'� 1,,,, , .....,.. ... _....„.„ , t. . : or .,:.tr.;, , n 3 e r x Soh�”}y�, „$t 4 4 3 ...s 5° F '-'.,;;?-1-`• X44 + �} �{ ,�, . t .,..„.14.i„,,,,.,.1,.„,„.„,..,, :�� ..s '��.�.� �-EE r`��:F D is ��r 'adv. s, .v: s# - 'S j",, ', . `! •:i S lei}i .,..�` .w .1-�* '� -,tea. ;::rt 7-`::::',---37, -,-.-...''''''''-'''-'-f-:-;-,--.- j Lam- y. .., 3 t,,,' s`,, r 4,ag$y�u . aY,. �4 �' a'k .1 -1 .V s spa „rM, �tl- 4�' ,"� .' <fi, -. r+;k ct t ._. t. - ra. x 3. d0 .5.1;:-Sili.':§:: ;.''''' -...--1,;:.:,-,,,,ii.q1:1,2-7'.7f-::a:';''''''' fi';:'-'," -,:'-'' ' . • Est •...� ', t€, E �" y.:.,..ss 4 ,tir S fir'i ,+a > a ,_,,w . ..' .. `. JEFFERSON COUNTY HISTORICAL SOCIETY TOPIC IS CHILD ABUSE Bridget Spegal; a student at Port Townsend High School, displays her artwork portraying the effects of child abuse. The Jefferson County Historical Society, Jefferson County Health Department, Chimacum High School and Port Townsend High School-will display a collection of student artwork showing happy, healthy homes and the effects of child abuse, during a gallery walk on Saturday. The program will include a show by the Blue Heron Middle School Quartet titled "What!" The gallery walk begins at 5 p.m. Saturday at the Jefferson County Museum, 540 Water St. • 1/412 . , i s Iii 's t 40I. ., t_„:„..1 „, ,,,..„ „:„.„,,,.._ ,7,,,...„:„. .,,,la , , fit _ , . ,,.- ''''''• ?,''.! 4 ::4 'Nit; -1•1';'*!c•—.T,:': 111 ) L:::' -111:4 -kilr-,,,, „:,, :,. .,;-,,,,,-3 ...11 4,14-1L4 : ,v-,,,,,,,:t1:11.7,F „goox, LI . . ,,,,,,,, ik.,,,,,,,..4!_.:.:Iii,-,a...f- 4„.5.,z,„„„.„,„.„...:,tf,p- tl 1 1.;1-I 1 tilLtt, „,:::-,-,,,....4., ..„....1:::,,,...., . --- 3if -h `" 2iL 3 a � at#s ,xr & ,�3g F t 9 Pili' +rtepfSY M `g g : . b'..F /+.e, 4 a T k bVitilQ� " _.mss3 :.. �" q W �`lc ; y, .��t ,,--4- .;.:', '\ 2,,,.'7.111,N, ,I,' y meq, ...�;. ciiik y ‘1() 44 /j' t ,2' is z A 4.,,,..1--;t a z i 4,sr .0 haw Laura Parsons and her son,Torin Brostriim,5 months old,check out books at the Port Townsend Llbrary.The library's Born to Read program gives every family of ai newborn a bag with reading-related goodies. Photo by Barney Burke Born to Read Library wants babies to grow into reading By Barney Burke The program started in January,and a bumper crop of Leader Staff writer 16 babies were welcomed withbook bags in February,said JeanTarascio,children's librarian. Having a baby?You can look forward to getting baby's "The point is to get parents thinking about these first binky,baby's first shoes and,of course, baby's first things,"said Tarascio. library card. The"Read to Your Baby"guide that comes with the ) Thanks to the generosity of bingo players at the Hilltop book bag has aneasy-reference list of everything from �(J Tavern and Friends of the Port Townsend Library,there's a songs to stories to"knee bouncers"that are enjoyed by bag full of baby book items for every child born here. moms and babies at the librarytwice each week. ti "It's so important to read," said LibraryDirector The library's Baby Lap Sit program takes place at , Theresa Percy."Literacy starts the day a baby is born." 10:15 a.m.Tuesdays and 2 p.m.Thursdays.No advance ' I � The library works with Jefferson Healthcare Hospital registration is required,and the moms and babies sing and il. j, and the Jefferson CountyHealth Department to hand engage in other language-building activities,Percy said. out the bags,which include a board hook,a pamphlet of Some of the library's best books for tiny readers, nursery rhymes and finger plays,tips and ideas for sharing Tarascio said,include Time for Bed by Mem Fox,Guess books with babies,and libraryinformation for parents.The How Much I Love You by Sam McBratney,and Peek-A- Hilltop Tavem raised more than$800 for the program. 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Citizens are invited to make a positive difference in the lives of youth and families. Support the "Our Kids: Our Business" campaign and agree to take specific action in support of the Five Promises. Five Promises to our Children 1.Caring Adult t 2.Safe Places&Constructive Activities 0 3.A Healthy Start do Future , 4.Effective Education for Marketable Skills 5.Opportunities to Serve Please Join Us!For more information,read The Port,To ""send and Jefferson County Leader and look for the pinwheel:logo around the community. To receive a pledge form,or for any questions,please call 360-379- 4495 or e-mail okob@co.jefferson.wa.us. For more information, go to: www.jeffersoncountypublichealth.org • Brought to you by; The Port Townsend&Jefferson County Leader,Jefferson County Public Health,Jefferson County Community Network,Department of Children&Family Services/Children's Administration,and the Jefferson County Meth Action Team. • yla/oar • Health Officials Take a Closer Look at Port Townsend Mill By Christopher Dunagan(Contact) Tuesday,April 8,2008 STORY TOOLS • E-mail story • Comments • iPod friendly • Printer friendly • News alerts .J MORE TOP STORIES • Top Navy Admiral to Lead Parade • Outdoor Education Comes Closer • Kingston Ferry Running Behind Schedule SHARE THIS STORY What's this? • PORT TOWNSEND Washington Department of Health is calling for increased air measurements in the Port Townsend area to get a better idea whether pollution from the local paper mill may be causing health problems. A new health report by the agency found no evidence that chronic illnesses are triggered by pollution from the plant, which is owned by Port Townsend Paper Company. But more information is needed to better understand the risks, according to agency officials. Some residents of the Port Townsend area have complained of shifting odors from the mill and occasional health concerns, including headaches and vomiting. Some people have worried that the mill may be causing asthma, cancer or other serious conditions. "State health officials recommend more research on air emissions from the mill to learn where the 'hot spots' might be found and, if possible, to try to find the best locations for ongoing air monitoring," according to a statement issued Tuesday by the health department. "This additional information would help identify chemicals of concern and consider whether or not they pose a public health hazard to residents of Port Townsend." SMeanwhile, officials with the Washington Department of Ecology said they will try to find ways to better respond to concerns from area residents. "As the agency responsible for regulating pulp and paper mills in Washington, we are always • concerned when we hear of health issues that could be tied—even in a small way—to industrial operations," said Carol Kraege, manager of Ecology's Industrial Section. In January 2007, Ecology issued a new air-emissions permit for the mill with requirements that certain chemicals be captured and treated. Saying conditions were not strict enough, citizens appealed the permit to the state Pollution Control Hearings Board. The federal Environmental Protection Agency weighed in with concerns of its own, mostly technical in nature. The permit is being revised by Ecology and should be available for public review in a few weeks, according to Merley McCall, acting supervisor of Ecology's Industrial Section. McCall said he may seek to have Port Townsend Paper Co. look into meteorological conditions that could affect where the plumes of pollution go as it leaves the smokestack. Sophisticated computer modeling may be employed to determine which areas could have the highest concentrations of certain chemicals. Also, procedures for responding to citizens complaints may be spelled out in the permit or in a side agreement, he said. The Port Townsend mill, in operation since 1927, is one of six industrial operations in Washington that • has agreed to participate in the state's"Industrial Footprint Project."The effort is designed to measure the overall environmental, economic and social consequences that each facility has on its community. The companies have pledged to work with their communities to improve conditions. Environmental benchmarks include measurements of trash, recycling, emissions, water consumption and purchase of raw materials, according to Laurie Davies, manager of Ecology's Solid Waste and Financial Assurance Program. Included in the effort is a"carbon challenge"to see whether the facilities can voluntarily reduce their fuel and electricity consumption. Economic indicators include total jobs provided by the industries, while social factors include the company's community involvement, health and safety records, and good-neighbor efforts. Comments 5 Comment(s).Click here to view/post comments. S • I ' i • I • ,- HOW DOES 'LT DRINI(I G & DRUGGIIG • -,r I ' FLUENCE OUR TEENS? -,::::4- -;-:', �� si . ,, : ;;t r ;q4 t. ` . :1 tilitr: . .. .,:'::"...:::...., f ....•:-.5,:....i. " ',:, *,i'i,Z,A,j; : • '• TOWN HALL MEETING:Monica Olsson,one of 3 film c makers for"Second Hand Hangover"will present the film. a The film portrays 3 young girls'experiences growing up in x addictive family environments.Question&answer period - and community discussion to follow. WHEN: Monday,April 14th,6 8 PM , •• W-1-7::::::.-4,v- WHERE: Blue Heron Middle School,Commons FOOD: Appetizers . QUESTIONS: Call Kelly Matlock,379-4476trt �'t FUNDED BY: SAMHSA :*,� • For more information,go to:www jcffersoncountypublichealth.org t Brought to you by:The Port Townsend&Jefferson County`Lcader, 1z} Jefferson County Public Health,Jefferson County Community Network, ' Department of Children&Family Services/Children's Administration, and the Jefferson County Meth Action Team. • to • I 1 ' • • x/94)9 :1. ....„ -',-.-.'' :;..-.Z',- --;-- ..„--,-, . .• : . - ,. . ' .- ... 0 ,---. - 0 i-.. 0 b1) 0 [-. ' -,..12•2,1r-1.:::1, g .; -16, el ii—g csa:3' e : .., . , .0 g ,..; vi. A-. 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PENINSULA DAILY NEWS EVELEEN MUEHLETHALER PORT TOWNSEND —The state vice president,environmental affairs • Department of Health recommended Port Townsend Paper Corp. more monitoring- of air emissions from the Port Townsend Paper Corp. mill because it needs more data, in a try to find the best locations for report released on Tuesday. "While the agency's health con ongoing air monitoring," statement sultation concludes it does not said. appear that emissions from the "This additional information would help identify chemicals of con- plant are linked to any chronic dis- eases among area residents, 'more cern and consider whether or not data is needed to better understand they pose a public health hazard to the risks," said a'written statement residents of Port Townsend." from the department. Eveleen Muehlethaler, vice presi- The report did not directly associ- dent of environmental affairs for ate any observed conditions such as Port Townsend Paper, said the com- asthma or certain cancers in the pany is paying attention to the community to chemicals most likely report. in mill emissions. "We take the report's recommen- Also, the department could not dations seriously," Muehlethaler determine if the air emissions from said. the mill pose any harm to the public. "We take just as seriously the The report recommended more DOH conclusion that health statis- research into specific chemicals. tics are not significantly different in "State health officials recommend Jefferson County, compared. with more research on air emissions from Washington state overall." the mill to learn where 'hot spots' might be found and, if possible, to TURN TO MILL/A6 • Mill: Emissions CONTINUED FROM Al representative monitoring for every air quality regulation. Gretchen Brewer of PT Air- Buxton said she was forced III Watchers,a Port Townsend air to move from Port Townsend to quality advocacy group, was Haines, Alaska, because the not available for comment on mill's air emissions made her Tuesday. sick. In response to the report, As a result of her challenges, Ecologyofficials said they will and interest by the federal look for more ways to help Environmental Protection respond to citizen concerns Agency, the state Pollution about air emissions. Control Hearings Board ruled "As the agency responsible Jan. 18 that the permit should for regulating pulp and paper be reopened for further review mills in Washington, we are of how the mill manages its air always concerned when we emissions. hear of health issues that could In the meantime, the mill be tied-even in a small way can continue its operations — to industrial operations," under the existing permit. said Carol Kraege, manager of Ecology is reworking sec- Ecology's industrial section. tions of the permit to address secific concerns by Address tough questions ron ental Protectionthe Ag Agency "I believe we can work with Once modified, the public will the community,health agencies to review and comhave another the opportunity and the mill to improve our • understanding of what is being 'Footprint'project emitted in order to address some of these tough ques- In a separate project, Ecol- tions." ogy is working with Port Ecology officials said they Townsend Paper and the corn- plan to meet with mill repre- munity on a voluntary project sentatives soon to discuss the designed to reduce the mill's • report. environmental "footprint" on They will review the health the community over time. consultation findings to see if it Ecology is encouraging com- justifies changes to the mill's munity members to bring for- air operating permit. ward any concerns about the Ecology is responsible for mill's performance, including regulating the mill's air emis- those raised by the health con- sions through an air operating sultation. permit, which specifies the In a meeting March 4, peo- types and amounts of haz- pie living in the area affected ardous chemicals that must be by,the mill showed up at Jeffer- collected and treated before son County Fairgrounds to being released into the ait express their thoughts and con- Federal regulations limit cerns about Port Townsend Ecology's authority to include Paper mill's environmental, more conditions in the permit. social and economic effects on Additional requirements the community could`come through an admin Muehlethaler said the mill is istrativeorder which would be dedicated to improving lives in available for review and appeal the region as well as meeting or Iy the community or the mill, exceeding environmental Stan- dards. Operating permit She said the health and well-being of the mill's neigh- The mill's air operating per- bors is important to the opera- mit has been the subject of tion, and that it will continue community and state Pollution to operate within the EPA Control Hearings Board guidelines set for them. review. "Port Townsend Paper will Former Port Townsend resi- prioritize its resources and • dent,Cindy Buxton,challenged focus on the best science for the the mill's five-year operating greatest benefit of the commu- permit issued by Ecology in nity overall," Muehlethaler 2007. said. Supported by PT AirWatch- ers, Buxton argued that the mill doesn't meet state law Reporter Erik Hide can be reached at requirements for reliable and ordd� ryt erik.hidle@peninsula From: Hughes, Sandra (ECY)[mailto:shug461@ECY.WA.GOV] Sent: Tuesday,April 08,2008 1:29 PM To: ECOLOGY-NEWS@LISTSERV.WA.GOV Subject: Ecology News Release: Ecology responds to Port Townsend air quality health consultation • FOR IMMEDIATE RELEASE—April 8,2008 08-085 Ecology responds to Port Townsend air quality health consultation OLYMPIA—In conjunction with the release of a draft state Health Department report,the Department of Ecology (Ecology)today announced it will look for more ways to help respond to citizen concerns about Port Townsend Paper Corp.'s air emissions. These steps could include increasing the number of pollutants monitored,developing a better assessment of chemicals emitted and their possible impacts, and improving Ecology's complaint response and tracking system. Ecology will review the health consultation findings to see if they justify changes to the mill's five-year air operating permit. Ecology will also look for other options to address community concerns. "As the agency responsible for regulating pulp and paper mills in Washington,we are always concerned when we hear of health issues that could be tied—even in a small way—to industrial operations,"said Carol Kraege, manager of Ecology's Industrial Section."I believe we can work with the community,health agencies and the mill to improve our understanding of what is being emitted in order to address some of these tough questions." The draft health consultation was sought by the community in response to concerns that air emissions from the mill could be linked to short-term and long-term health issues reported by some living in the community. Some residents have complained about the mill's odor and becoming sick after exposure. Department of Health research could not directly associate any of the observed conditions such as asthma and certain • cancers in the community to chemicals most likely in mill emissions.And since the levels of air pollutants are not well established, Health could not determine whether air emissions from the mill pose harm. Some local citizens have requested air pollution monitors be placed in the community. Ecology and Health agree that additional information about specific pollutants is needed. Ecology will work with Health and the local air authority to determine the most effective way to gather reliable information for addressing health concerns.This likely will involve developing site-specific information about chemicals that the mill emits and using the information in a sophisticated model to try to identify any areas where contaminants are likely to be the highest. Ecology plans to meet with mill representatives soon to discuss the health consultation findings. The mill has operated in Port Townsend since 1927. Ecology has the responsibility for regulating the mill's air emissions through an air operating permit,which specifies the types and amounts of hazardous chemicals that must be collected and treated before being released into the air. Federal regulations limit Ecology's authority to include more conditions in the permit. However,additional requirements could come through an administrative order which would be available for review and appeal by the community or the mill. The mill's air operating permit has been the subject of review by the community and state Pollution Control Hearings Board. Ecology is reworking sections of the permit to address specific concerns by the Environmental Protection Agency. Once modified,the public will have another opportunity to review and comment. Ecology is also collaborating with Port Townsend Paper and the community on a voluntary project designed to reduce the mill's environmental"footprint"on the community over time. As part of this project, Ecology is encouraging community members to bring forward any concerns about the mill's performance, including those raised by the health consultation. • Media Contact: Larry Altose 425-649-7009; pager 206-663-1785 Link to DOH Environmental Health Assessments report: www.doh.wa.gov/ehp/oehas/whatsnew.htm Ecology's Web site: http://www.ecy.wa.gov • Neglect, Abuse Seen in 90, 000 Infants -New York Times Page 1 of 3 i 1j Nate ijoik it o PaaNirk.rRIENC r Far.AR: votti 110 April 4, 2008 Neglect, Abuse Seen in 9o, 000 Infants By THE ASSOCIATED PRESS Filed at 6:23 p.m. ET ATLANTA(AP) --About 1 in 50 infants in the U.S. have been neglected or abused, according to the first national study of the problem in that age group. Nearly a third of the victims were one week old or younger when the maltreatment was reported, government researchers said Thursday. The study focused on children younger than 1. Most of these cases involved neglect, not physical abuse. In the case of the newborns, experts said the data suggests drug abuse by the mother may have been the cause for reports of neglect, but they couldn't be certain. 110 Maternal drug abuse is often discovered through blood tests while newborns are still in the hospital, CDC researchers and others said. "That is the story here," said Dr. Howard Dubowitz, a professor of pediatrics at the University of Maryland School of Medicine. The researchers counted more than 91,000 infant victims of abuse and neglect during the study period Oct. 1, 2005 to Sept. 30, 2006. About 30,000 of those cases were newborns aged one week or younger. The information came from a national database of cases verified by protective services agencies in 45 states, the District of Columbia and Puerto Rico. Other studies have looked at national child abuse and neglect cases, but this is believed to be the first to focus on infants, said study co-author Rebecca Leeb, of the Centers for Disease Control and Prevention. The results mirror what a study in Canada found, said Leeb, a CDC epidemiologist. • "We certainlywere distressed"bythe study's results, said Ileana Arias, director of the CDC's YCs http://www.nytimes.com/aponline/us/AP-Infant-Neglect.html?ei=5070&en=8074x781 dccec... 4/7/2008 Neglect, Abuse Seen in 90, 000 Infants - New York Times Page 2 of 3 National Center for Injury Prevention and Control. "It's a picture you don't want to imagine --that this number of infants is being mistreated," Arias added. Only about 13 percent of the newborn cases were counted as physical abuse, meaning the large majority involved neglect. Federal officials define neglect as a failure to meet a child's basic needs, including housing, clothing, feeding and access to medical care. The counted cases did not include new parents stumbling their way through breast-feeding or making other rookie mistakes. "Things like abandonment and newborn drug addiction would qualify as neglect, not things like parents learning how to be parents," Leeb said. Medical professionals identified about 65 percent of the maltreated newborns to protective services staff. The others came from law enforcement, relatives, friends, neighbors and from protective services staff. The neglect cases include situations in which medical professionals conclude that a child got • sick or didn't correctly develop because parents didn't get recommended medical care. Those cases were not necessarily life-threatening, noted David Finkelhor, who directs the Crimes against Children Research Center at the University of New Hampshire. Finkelhor said the cases might in part reflect families who don't have adequate health insurance. The study's authors said they don't have information to verify that theory. Both Finkelhor and Dubowitz have worked with the same database the researchers used. But Dubowitz pointed to data showing that most of the neglect cases in newborns were reported in the first two days of life. That is a time when results from blood tests of mother and child come back and are often shared with protective services. Such tests would indicate whether the mother was abusing drugs. However, Dubowitz said data on potential explanations behind neglect cases is skimpy, so it is difficult to draw conclusions. But more prenatal care and drug treatment services would seem like a wise way to address the • problem, he added. http://www.nytimes.com/aponline/us/AP-Infant-Neglect.html?ei=5070&en=8074a781 dccec... 4/7/2008 Neglect, Abuse Seen in 90, 000 Infants - New York Times Page 3 of 3 The study didn't include data on fatal abuse and neglect. But federal officials said about 500 infants under age 1 died of abuse or neglect during the study period. The CDC collaborated on the study with the federal Administration for Children and Families. The research was published in the CDC's Morbidity and Mortality Weekly Report. On the Net: The CDC publication: http://www.cdc.gov/mmwr Copyright2008 The Associated Press Priv__acy Policy I Search I Corrections I FESS I First L_ook Help I Contact Us I Work for Us I Site Map • • http://www.nytimes.com/aponline/us/AP-Infant-Neglect.html?ei=5070&en=8074a78I dccec... 4/7/2008 v • -..- -, S v` Z1-4,,tZ M t\ .s.).. P 7-Nsk,t_ , R ri 11 171 J _ ; N w(--.4. -1 ...,,,,-. - ° ,= ° C) m a' O D xi -0v C- O � .7, (0• 1 I `, ^m • f _ m -0 --1 (0 _ D 7 g t. I— (4. m m C v 3 0 o c 3 3 5 CD r+ o 'N) o -C m Z i-I `. .t) Cn C i W rn • 0_, 410 **DRAFT** DEC Document Possible Titles; • Jefferson County Collaborative Community Response to Drug Endangered Children • Jefferson County Drug Endangered Children Guidelines Introduction and Purpose: Innocent children, under 18 years of age, are sometimes found in environments where methamphetamine and other legal and illegal substances are produced, sold or used. Nationally, Drug-Endangered Children (DEC) programs have been developed to coordinate the efforts of law enforcement, medical services, child welfare workers and other agencies, to ensure that children who live in or frequent these sites receive appropriate care and attention. The purpose of the (title)! project is to implement and evaluate a collaborative response among law enforcement, prosecutorial, medical and social service professionals to the needs of children endangered by exposure to substance abuse and manufacturing, trafficking, and use of legal and illegal drugs throughout Jefferson County. In addition, nextile3ciiWiliftirpTWaeieAigk*-*iajfksch*Kf*Vjiti-ikkali•,I,cta This protocol has been prepared through a collaboration of allied agencies to address a multi-disciplinary approach that provides intervention ani assistance to DEC. The agencies and 110 organizations are listed in Section VIII The purpose of this document is to outline guidelines for evaluating and providing services to children who are exposed to neglect or abuse by caretakers who are using, selling, manufacturing and/or trafficking of legal and illegal substances. Although our community continues to experience a decrease in the numbers of clandestine methamphetamine labs, there are still children that reside in homes where parents are involved in methamphetamine and other substance use, as well as criminal behavior, leaving them extremely vulnerable to abuse, neglect or endangerment. This protocol represents an agreement among participating agencies within Jefferson County concerning the manner in which drug-endangered children incidents are handled and investigated. These are recommendations for participating agencies and organizations. It is anticipated that each incident will involve unique circumstances and flexibility must be allowed for modifications. This protocol is not intended to increase the civil or criminal liability of member agencies or their employees. • C:\Documents and Settings\dmarvin\Local Settings\Temporary Internet Files\OLK5\DEC Document-Guidelines-DRAFT as of January 2008.doc Page 1 of 6 a, SNEPIFF 1 l r fERf �1 k„� _ f-N0,4' 40114 °int** I. Law Enforcement Response Recommendation In the best interest of the child, sensitive and confidential information should be shared amongst interagency DEC team members. Law enforcement should notify Child Protective Services (CPS) when there is reason to believe that a child has been exposed to controlled substances or illegal drug manufacturing activities or has been abused or neglected as a result of such activity. The following guidelines are provided to assist Sheriff Deputies in drug endangered children investigations. Definition of Drug Endangered Children (DEC) 1. Children who there is reason to believe have been abused or neglected by the adult (a parent or another adult) responsible for their care due to that adults abuse of alcohol; or controlled substance; or 2. Children who are at=rtsk becauses-they`are being directly exposed to alcohol, illicit drugs, or" illegal drug manufacturing activities. Law Enforcement Protocol If Deputies have a reason to believe a child is in immediate danger: • Assess circumstances related to endangerment. • Take child into temporary custody and hold for Child Protective Services • Transfer custody to Child Protective Services. • Complete investigation packet documenting reason for removal (environmental dangers, childcare conditions, etc. • Collect Physical Evidence (i.e. photos, statements, environmental dangers etc.) o However, state statutes do NOT allow or direct law enforcement to conduct invasive tests i.e. blood, urine, hair etc, for evidentiary purposes. • Forward investigation report to Child Protective Services and Prosecutors Office. II. Child Protective Service Response Recommendation When there is reason to believe that abuse or neglect of a child has occurred as a result of illegal drug manufacturing, legal or illegal drug use, it is essential for Child Protective Services or their designee to: C:\Documents and Settings\dmarvin\Local Settings\Temporary Internet Files\OLK5\DEC Document-Guidelines-DRAFT as of January 2008.doc Page 2 of 6 1. Respond at the Scene. If the presence of children at a methamphetamine lab is known ahead of time, CPS will be called to provide relevant advance information and may respond with the initial investigative team whenever possible. During business hours, law enforcement will contact the local CPS office in Port Townsend at (360) 379-4330. The CPS supervisor or designee will collect known information and will dispatch a social worker to the scene. After business hours, weekends or holidays, law enforcement will call Central Intake at (1-800-562-5624) who will dispatch a social worker. 2. Decontamination of Child (if necessary). CPS will not be responsible for the primary decontamination of children involved in a gross decontamination. If on site decontamination is necessary, law enforcement, fire department and medical professionals at the scene will conduct the decontamination process following standard EMS and medical protocols. If the child appears acutely ill or intoxicated, the child should be transported immediately to the emergency room via EMS (91 1) for further evaluation. If gross decontamination is not necessary, CPS will provide clean clothing for the child. Items from the drug lab site will not be taken with the child. Transport vehicles will have disposable blankets to transport the children into care after decontamination. 3. Accept Transfer of Custody of Child. When a child is placed in protective custody, a CPS worker responds to the scene to pick up the child. CPS, in cooperation with law enforcement, will attempt to locate and'coorrinate placement of children that 4111 are not on the premises z 4. Input a Referral. CPS will ensure a referral is entered in the CPS computer system and will update the information as necessary. All appropriate reports will be forwarded to law enforcement and the Prosecuting Attorney's office. 5. Coordinate Sample Collection and Medical Exam. A brief medical exam, including a respiration check, full physical exam, a urinalysis, and a blood draw will be arranged within 24 hours of placement, if possible. CPS may sign a medical consent for treatment and is authorized per RCW to receive copies of relevant medical information. CPS will assist by attempting to obtain old medical records and/or the child's medical passport. 6. Conduct Initial Placement Assessment with Child and Transport Child to Appropriate Facility. CPS will conduct the initial placement assessment to determine whether relative or licensed foster care is the most appropriate placement for the children. The Department will conduct a relative search as soon as possible to try and locate a family member who is able to pass a homestudy and is willing and able to be a placement resource for the child. 7. Consultation. The CPS worker will consult with the CPS supervisor and Attorney General's Office regarding the legal status of the case, specifically if a dependency or relative third-party custody should be initiated. In rare instances, • parents will engage in services on a voluntary and informal basis in order to reunify with the children without court intervention. C:\Documents and Settings\dmarvin\Local Settings\Temporary Internet Files\OLK5\DEC Document-Guidelines-DRAFT as of January 2008.doc Page 3 of 6 111 8. Court Makes Placement Determination. If a dependency is initiated, legal determination will take place within 72 hours of assuming custody. 9. Continuum of Care. The foster home or relatives will arrange a medical exam through the child's primary medical provider within 24 hours (if illness is suspected) or 7-14 days (no illness suspected). The relatives or foster parents will follow through with the children's medical needs_ !!l. Medical Response Recommendation—This section Not approved by Jefferson Healthcare at this point—sample from "We Care"—DEC Document, ONLY! 1) Determine Emergency or Non-Emergency Response i. Emergency: 1. Treat Immediately ii. Non-Emergency: 1. Collect Urine Sample 2. Conduct Medical Exam 3. Conduct EPSDT Exam IV. Prosecutor Response Recommendation Prosecutors review evidence collected sluing thenvestigation to determine if child endangerment and/or drug violation'charges should be filed. 110 1) Prosecutors shall be available 24 hours/7 days per week to assist law enforcement in obtaining search warrants where needed 2) Review Evidence for Criminal Charges collected by: i. Law Enforcement ii. Medical Services iii. Child Protective Services 3) Reference appropriate laws 4) Determine appropriate actions to take that are in the best interest of the child: i. Criminal Charges ii. No Criminal Charges V. Additional Community Agencies/Organizations Response Recommendations Jefferson Healthcare 1) Jefferson Healthcare Family Birth Center i. Women and families with known and suspected drug abuse are cared for at Jefferson Healthcare. • C:\Documents and Settings\lmarvin\Local Settings\Temporary Internet Files\OLK5\DEC Document-Guidelines-DRAFT as of January 2008.doc Page 4 of 6 04 ill ii. The hospital strives to create and maintain a positive, therapeutic and non-judgmental environment to assist families in accessing drug treatment. iii. All mothers and infants who have risk factors will be screened for substance abuse/exposure. iv. Methamphetamine or other drug positive results will be referred to child protective services and Jefferson County Public Health. s,'-'-'''',,,.7.,--,..0\ PUBLIC HEALTH ,:.' i:, _ ,„, - , Anwo- *NO * * A 3 AND ,Xp f.C��, 2) Public Health Response Recommendation i. Jefferson County Public Health (JCPH) will receive referrals on families needing support services from CPS, law enforcement or other community agencies. ii. JCPH will be a collaborative partner in service planning and providing services to families. iii. JCPH will facilitate staffing of DEC cases and issues in routine monthly meetings of the DEC Team. 1111 ;,,, 3) Public Schools—????? VI. Applicable Laws in Washington State for DEC • RCW 9.94A.533 (6) Adjustments to Standard Sentences • RCW 9.94A.605 Methamphetamine—Manufacturing with Child on Premises—Special Allegation • RCW 9A.42.100 Endangerment with a Controlled Substance • RCW 13.34.060 (1) (b) Shelter Care- Placement • RCW 26.44.050 Abuse or Neglect of a Child • RCW 26.44.056 Protection, Detention or Custody of Abused Child • RCW 26.44.200 Methamphetamine Manufacture-Presence of Children III C:\Documents and Settings\dmarvin\Local Settings\Temporary Internet Files\OLK5\DEC Document-Guidelines-DRAFT as of January 2008.doc Page 5 of 6 VII. Participating Agencies and Organizations 111. Although each of the participants have different functions within the community, it is agreed that a coordinated, interagency response best advances the goal of child protection. Representatives from the following agencies, organizations and community volunteers participated in the development and/or implementation of the TITLE. Chimacum School District Division of Children & Family Services (CPS) DVSA of Jefferson County Jefferson County Community Network Jefferson County Juvenile Services Jefferson County Meth Action Team Jefferson County Prosecutor's Office Jefferson County Public Health Jefferson County Sheriff's Office Jefferson Healthcare Port Townsend Police Department OTHERS TO AICD VIII. Community Resources In case of any emergency, please diaL9-1-1I Prepared by theJfferson County Meth Action Team. 11111 C:\Documents and Settings\imarvin\Local Settings\Temporary Internet Files\OLKS\DEC Document-Guidelines-DRAFT as of January 2008.doc Page 6 of 6