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HomeMy WebLinkAbout2008- May File Copy • Jefferson County Board of Health Agenda Minutes • _May 15, 2008 • JEFFERSON COUNTY BOARD OF HEALTH • Thursday,May 15, 2008 2:30 PM--4:30 PM First Floor Conference Room Jefferson County Courthouse Port Townsend,WA DRAFTAGENDA I. Approval of Agenda II. Approval of Minutes of April 17, 2008 Board of Health Meeting III. Public Comments This time is dedicated to listening to the public. All speakers shall confine their remarks to facts that are germane and relevant to Public Health. 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. Please state your name and address. (If the light is present and when it turns green the speaker may proceed to speak; the yellow light will go on when the speaker has 30 seconds remaining; the red light illuminated mean stop). The Board will typically not respond to comments. • IV. Old Business and Informational Items 1. Note from Jill Buhler 2. Rabies in a Puppy Imported from India to Jefferson County V. New Business 1. Jefferson County Public Health Heroes 2. Feasibility Study on Converting the Jefferson County Public Health Department to a Jefferson County Public Health District VI. Activity Update VII. Agenda Planning June: On-site Sewage Code Revisited VIII. Next Scheduled Meeting: Date, Time, and Location to be Determined • • JEFFERSON COUNTY BOARD OF HEALTH MINUTES %%*1 Thursday, April 17, 2008 2:30 PM— 4:30 PM 1:11' a C� 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 to order at 2:30 PM in the First Floor Conference Room of the Jefferson County Courthouse, Port Townsend. Members Present: John Austin, Roberta Frissell, Phil Johnson, Michelle Sandoval, Chuck Russell, David Sullivan, Sheila Westerman Staff Present: Jean Baldwin, Dr. Thomas Locke, M.D., Julia Danskin, Susan Porto, Sarah Murphy, 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 passed unanimously. APPROVAL OF MINUTES OF MARCH 20,2008 Roberta Frissell noted a correction on page 5, third paragraph: It should read: "The deputy prosecutor, Mr. Alvarez, has ...." Chuck Russell pointed out that the date of the Minutes is March 20, not April 17, 2008. Member Westerman moved for approval of the minutes of March 20, 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 and explained the rules regarding this portion of the meeting. Kristen Marshall, Environmental Manager at Port Townsend Paper Corporation, was recognized to speak. She said she had attended the last several BOH meetings, anticipating the Washington State DOH Public Health Consultation report, and intending to hear the BOH comments on that Page 1 of I I Jefferson County Board of Health,April 7,2008 r process. Ms. Marshall said that PT Paper is involved in three public processes at this time. The first is the Public Health Consultation draft, which came out on April 8; PT Paper is reviewing it • and plans to submit comments by May 8. The second is the Industrial Footprint Project through the Department of Ecology. She provided correction to certain comments from the previous BOH meeting: She said that the project is more than a carbon footprint; it is a sustainability footprint involving three categories: economic, social and environmental impacts. Health concerns and health benefits fall under the social tier of that process. If there are any health issues that are not addressed through the Health Consultation, the open format of the footprint project can allow those issues to come forward there. She said her company has begun to look at the Health Consultation, and noted that the statistics in the report do not show a statistical difference between Jefferson County and the rest of the state over the five year period studied for cancer rates, respiratory and cardiac issues. Ms. Marshall said that the report will be reviewed more thoroughly; some issues are being identified. She noted that this is a learning process for PT Paper, and the thoughts and comments of the BOH are appreciated. She requested that the Board contact her office if there are any questions. Mr. Michael Belinsky was recognized to speak. He commented on his concerns regarding adequate notice of the change of the Board of Health meeting site from 710 Harrison Street to the County Courthouse, fire code issues with the meeting room at the Health Department, and rules governing time limits for public testimony Chair Austin thanked the speakers and closed the Public Comment period. OLD BUSINESS • Tobacco Prevention Efforts Julia Danskin reported that Karen Obermeyer had been working with the Health Department as Prevention Specialist since September on the Tobacco Prevention Program. Ms. Obermeyer has been working with Jefferson Health Care on the Quit Line and the Tobacco Prevention programs that can be implemented by nursing staff She has commended the Hospital on their smoke-free campus program. She has also been working with success at Port Townsend High School on the TATU, Teens Against Tobacco Use program. Additionally, she has been promoting the Washington State Quit Line throughout the community. The Board was encouraged to refer any businesses or organizations with interest in an employee quit smoking program to contact Ms. Obermeyer or Ms. Danskin for assistance. She said the department wishes to support the community in efforts to cease smoking and not start smoking. The hospital is offering a free smoking cessation class that will run from April 16 to May 28. More information can be obtained from Jefferson Health Care or the Health Department. Jefferson County Restaurant Awards Sarah Murphy reported that the Outstanding Achievement Awards for restaurants had been announced in the newspaper the week prior. The awards are given according to criteria developed by the Food Service Advisory Committee: inspection scores; preparation and sale of • complex food; same owner for at least one year; responsiveness to correcting violations; cleanliness and attention to detail. Chair Austin asked if there were any restaurants that did not Page 2 of 11 Jefferson County Board of Health,April 7,2008 pass muster. Ms. Murphy said that about half of the eligible restaurants did not receive the Saward. She verified that no establishments had been closed for health violations recently. NEW BUSINESS Public Health Heroes Julia Danskin reported that in honor of National Public Health Week(April 6-12), awards were given for local Public Health Heroes. Nominations were requested from the community in March. Four awards were announced last week, and two winners were present at the BOH Meeting to receive them: Dennis Crawford and Jill Buehler. Julia Danskin read a citation for Dennis Crawford and his work in Emergency Management as Disaster Preparedness Education and Outreach Coordinator. Mr. Crawford has worked to create over ten separate emergency community groups that focus on different aspects of emergency preparedness. He also works with Local 20/20 Emergency Preparedness Action Committee and Disaster Animal Welfare Group (DAWG). He has greatly helped Bob Hamlin, Program Manager, with preparing the community for emergency conditions. Mr. Crawford has worked at the grass roots level and has started 144 neighborhood emergency preparedness groups in Jefferson County. He is credited with being a highly dedicated and effective leader. Julia presented the Public Health Hero to Mr. Crawford on behalf of the community. For more than 10 years, Jill Buehler was an outstanding, contributing member of the Jefferson • County Board of Health. She was a dedicated and involved Board member who could look at a problem from many angles and fully participated in problem solving. She has led a vision that our public health department and public hospital share: the need to coordinate services, know the needs of citizens and work together. She has a positive attitude and faces challenges with a can do attitude. Jill serves as a liaison between the Board of Health and Jefferson Health Care where she is an elected Hospital Commissioner. She helped clarify the mission and services of the respective public agencies to both Boards. She fostered a number of cooperative projects and recognizes strengths of both organizations. The health of the citizens of Jefferson County has been enhanced and served by her efforts for many years. Julia Danskin presented Ms. Buehler with the Public Health Hero award on behalf of the community. Since the other two award recipients were unable to be present at this meeting,they will be honored at a future meeting. Port Townsend Paper Mill Health Consultation Report Dr. Locke noted that the document had been in draft form for about three months. He said it had undergone several revisions and was improved with each draft. He said the statistics in the current report have gone through careful review and represent the best available information on the respective health measures. The format is fairly standardized. The Agency for Toxic Substances and Disease Registry is the principle federal agency for human health impacts of environmental contaminants. In most states they contract with the state Department of Health to perform specific evaluations. These evaluations review the known information about the specific area of concern: e.g. the health Page 3 of 11 Jefferson County Board of Health,April 7,2008 effects from air pollution in general or a specific source of industrial air pollution. The report that is before the Board compiles known facts about emissions in Port Townsend statistics and , available health statistics that might be connected to air pollution. Dr. Locke said that reports like this often raise more questions than they answer. He explained that determining specific health impacts is very expensive and sometimes impossible. For example, to relate cancer studies and air pollution there is a need for very precise information about duration and severity of exposure to specific contaminants. Modern populations tend to reside in many locations throughout their lives and are therefore exposed to many different environments. Lifetime exposure to carcinogens is extremely complex and it may not be possible to determine all relevant data. Environmentally-induced cancer can occur as long as 40 years after the exposure making it very difficult to research. These reports attempt to assemble available information and present it in a factual way. He pointed out that there are no precise measurements of what is being released. The law requires that the emitters of industrial air pollutants specify the maximum amount that would be emitted. As the report points out, industries tend to estimate high, because there is a penalty for emitting more than the threshold but no penalty for underestimating pollution. Measuring what leaves the stack on a daily basis is seldom done. The only public monitoring station as relates to air quality in Port Townsend is a monitoring station located at the Blue Heron School. Commissioner Johnson said that location was chosen because of the wood burning stove emissions that tend to hang in the valley. Dr. Locke said that the state Olympic Region Clean Air Agency (ORCAA) is responsible for monitoring and enforcing particulate matter guidelines. Dr. Locke said it is not his intention to walk through the document in any detail. He said it raises • a number of questions that would require considerably more information. He noted that Jefferson County Public Health staff made some specific recommendations and they were incorporated in the report. Regarding health effects, the starting point is good air quality data. One wants to know what is in the air and its relationship to what is legally permitted. If it is in excess of the permitted level, there is a clear legal remedy. If what is emitted does not exceed the limits, the process for reducing emissions is much more complicated and involves changes of state and federal law. Minimizing human health impacts can be done in a number of ways. He discussed the need to know age groups, distribution in the community, and factors that increase/decrease exposure. Computer models can take in prevailing wind currents and weather patterns and predict exposure levels. Hospitalization and death rates are not good measures for air quality. Dr. Locke mentioned an asthma study in Port Angeles where asthmatic children and their parents were asked to maintain diaries of their asthma activity which were then correlated with mill emissions and meteorological data. The study technique was developed at Harvard University. He noted that it is very difficult to establish a cause and effect relationship between air pollution and specific health effects. Dr. Locke said the data on death rates is similar to age adjusted rates for the state. He pointed out that hospitalization rates for ischemic heart disease and for lower respiratory tract disease (for one year) was statistically higher in Jefferson County compared to Washington States. • Page 4 of 11 Jefferson County Board of Health,April 7, 2008 He noted that some cancer rates that are not normally associated with air pollution are relatively • common in Jefferson County, such as prostate cancer. Even factoring in the age composition, prostate cancer rates are significantly higher in Jefferson County than elsewhere in the state, but the death rate is not any higher. It is possible that this is due to better access to health care and appropriate screening for prostate cancer. Early detection of prostate cancer increases cancer rates but also promotes better treatment outcomes. With regard to ischemic heart disease and lower respiratory disease, the data is insufficient to analyze more deeply. Dr. Locke cited several possible explanations/interpretations such as better access to hospital care, or that the threshold for admissions to rule out heart disease is lower, or actual higher rates. Member Westerman referred to page 27, Public Health Action Plan and read the section. She asked what the difference is between collecting air emissions data and air monitoring. She also asked for clarification of the phrase: "the best locations to establish air monitoring". Dr. Locke said that in his interpretation, the report recommends setting up one or more monitoring stations that can analyze periodic air quality samples. Picking appropriate sites begins with a preliminary analysis that can include vacuum bottle samples taken in locations where air quality concerns have been reported. Another method is to site monitoring stations based on meteorological predictions of air currents. Ms. Westerman summarized her understanding by saying that there are three types of activities that could be done over time: collecting, monitoring and modeling. She said that this was a very • good report, but it does not mention anything about funding mechanisms and this was a concern to her. Dr. Locke said that the regulatory responsibility typically lies with the Department of Ecology. They are responsible for data collection, analysis and ongoing monitoring. Health assessments are the role of the Department of Health and involve considerable interpretation of the data. The DOE work is paid for by industry taxes and permit fees. Ms. Westerman asked where our particular situation might fall in terms of Ecology's priorities. Jean Baldwin explained the process. After the Department of Health releases the draft report, they may or may not hold public hearings, depending on public comment/reaction. The Department of Ecology has already started the Footprint project; it is led by the same person who is responsible for permitting and emissions, and works with ORCAA around air monitoring. Ms. Baldwin said the priority will likely be based on the Carbon Footprint project and air monitoring outcomes. She said it would not be entirely based on this Health Consultation and will involve a larger community process which is not predictable at this time. Ms. Westerman asked how the report would be disseminated to the public. Ms. Baldwin said that the report has been sent to the libraries, to the Air Watchers group, to the newspapers via press releases; it will be placed on the Department of Health website. Dr. Locke said that although he does not know what priority Ecology will assign, that tends to be based on the level of concern expressed by the public. Board member Russell said that paper products will still be produced somewhere in the world, if • not here locally. The result would be more pollution, not less, and he believes it better to keep this mill operating, with appropriate controls. Page 5 of 11 Jefferson County Board of Health,April 7,2008 Dr. Locke noted that air quality involves not just industrial emissions, but also auto emissions, household and business chemicals, etc. The air is shared by all and contaminated by all. A a community program to improve air quality should address all the inputs. Member Johnson mentioned that he had learned about the reason for selection of the Blue Heron monitoring station in his work with ORCAA. There was further discussion about the great complexity of the issues and the extreme difficulty of effective modeling considering local/regional weather patterns, air currents and the myriad of factors involved. Meth Action Team White Paper Ann Winegar is Program Manager for the Jefferson County Community Group and consultant to Jefferson County Public Health working on methamphetamine prevention, education and outreach. In addition, she is the convener of the Jefferson County Meth Action Team. She presented the final draft version of the "Methamphetamine in Jefferson County" white paper. The paper has been developed by the members of the Meth Action Team (MAT), all listed within the document. Ms. Winegar explained the extent of the meth use problem for this community. She noted that this is every person's problem, if only by virtue of its cost to taxpayers and to major health, legal, school and law enforcement agencies. The purpose of the document is to increase community awareness, and provide information and guidance about methamphetamine use/abuse in • Jefferson County to the BOH, BOCC and City Council for future policy decisions. Ms. Winegar called attention to the graphs included in the packet, which highlight some of the statistical information about meth use currently in the county. Member Sullivan commended the Team on the report. He said the one thing he would add (under Treatment, page 6) would be the local funding provided by the County and recent state. This would help people understand the impact locally. Jean Baldwin noted that the MAT (Meth Action Team) had been getting ready to disband and resume Substance Abuse Committee work. At the same time, meth treatment money was coming from the State Office of Financial Management(OFM). MAT decided to write a summary of the work done and recommendations for the staff treatment money. The first year of OFM money ends June 30; there is will be one more year of funding; renewal for the next biennium is uncertain. The funds are to treat 12 individuals for 8 months. Ms. Winegar said the treatment has already started and the mental health component will begin within the next week. She said she had been meeting with Jefferson Mental Health and Safe Harbor about the implementation, and was very encouraged by the progress and process. Member Sullivan noted that the extra $100,000 for three years was an incentive for the County to adopt the 1/10th of 1% sales tax and thanked Ms. Winegar for her efforts. Member Sandoval referred to the summary statistics, inquiring whether they included all of • Jefferson County, including Port Townsend. The statistics do include the City and its schools, Page 6 of I I Jefferson County Board of Health,April 7,2008 although the Port Townsend School District is not participating on the MAT. The background of • the Team and funding was reviewed briefly. Member Westerman pointed out a textual repetition on page 6 under Impact on the Legal System. Referring to the list of addictive substances on page 7, she also expressed her hope that these education and treatment programs would not simply lump all drugs together. She noted the potential loss of credibility that can result. Member Johnson added that when he attended a National Association of Counties meeting in Washington, D.C. two years ago, they did distinguish among drugs and methamphetamine was the number one issue for virtually every county in the nation. Ms. Winegar said that it is also the number one fear, particularly for law enforcement agencies. Chair Austin called attention to the first bullet under the Legal System on page 6. He asked if the dollar amounts cited were correct and what costs it is referring to. Ms. Winegar said she would follow up on those questions. Draft DEC (Drug Endangered Children) Document Ms. Winegar next discussed this document, which is in early draft form and has not yet been permanently titled. She explained that both this and the Meth white paper are collaborative efforts of many view points. While still in process, there have been sign offs from Law Enforcement, Child Protective Services, Public Health and the Prosecutor's Office. • Medical Response Recommendation, page 4, is the final item to be developed. She said that currently there is a chain of custody protocol which is being reviewed for improvements with Jefferson Health Care and law enforcement representatives. Quen Zorrah provided her perspective. She noted that for many years, the problem of drug endangered children was not fully acknowledged. She noted that it has taken time for the community to understand and define what a drug endangered child is and the extent of the problem in this county. She said collaboration among many agencies and organizations has increased as a result of this project and in efforts to meet the increasing complexity and intensity of needs of families. She stated that despite the coordination and collaboration, the problem is not going away. More funding is needed to actually implement plans and take necessary actions. Ms. Zorrah noted the importance of the chain of custody protocol. Ms. Zorrah said that this work of the MAT had started when the focus was on meth labs. Since that time, the problem has shifted away from the safety and environmental issues of meth labs to children and families exposed to continuing drug use. The consequences of direct drug exposure and severe neglect are now better understood. She said that this community, despite its small size, has done amazing work, and more quickly than many other parts of the state. Member Sullivan added that denial plays a large role in this issue. He said that in doing interventions and getting people into treatment, he has often found that the child has been the • most powerful person once they were heard. He also noted the abuse cycles that start in childhood. Ms. Zorrah agreed that wanting their children to escape the addiction cycle is a powerful motivator for parents to seek or accept treatment. Page 7 of 11 Jefferson County Board of Health,April 7,2008 Our Kids: Our Business Ann Winegar reported on the local programs that are part of National Child Abuse Prevention and Sexual Assault Awareness month. Packet handouts include a description of the campaign, a list of sponsors and the range of associated activities for the month of April, as well as Call to Action leaflets and Business pledge sheets. Ms. Winegar mentioned that many organizations, such as The Leader and Jefferson County Parks and Recreation, are doing wonderful publicity and outreach efforts. She gave credit to Kelly Matlock for her vision in bringing this idea to the fore. The original group decided to start small and then grow the program annually. However, many other organizations would have wished to be included at the outset. She said that the 'principles before personalities' ethic has been clearly demonstrated. Additional ads and articles will appear in the Leader throughout April. Although the emphasis has been on prevention, the program will also honor survivors of child abuse and neglect with a candlelight vigil at Haller Fountain on April 27. Members Sandoval and Westerman, who had both attended the Compassion/Dalai Lama event in Seattle, shared related highlights. Chair Austin mentioned the excellent document that had been distributed at the Town Meeting, which gives guidance on what to say if/when you observe a parent who appears to be abusing or neglecting a child. Ms. Winegar said that information will be published in the Leader and appear on the Public Health web site. She said the information is also appearing on the Food Coop and Jefferson County Public Safety Network websites. The campaign costs have been extremely low—about $2500 for 20 weeks of ads and thousands of pinwheels, etc. —thanks to community contributions and discounts. • Protocol for Responding to Public Meeting Disruptions Chair Austin recalled that at a previous meeting there had been a request for a protocol for responding to public meeting disruptions. At that time, he had promised to consider what he could do as Chair. He had then drafted a statement to be read at each meeting. He said this is not a formal protocol, but is what he plans to do as Chair. He will read the introduction to the public as he did prior to the Public Comment portion of the meeting on this date. He said he did not think it necessary to remind the public each time that disruptions will lead to certain responses. However, if it appears to be necessary, in his judgment as Chair, he will read the statement that a disruption of this meeting constitutes disorderly conduct and is a misdemeanor, and persons causing a disruption will be asked to leave—based on RCW 84.030. Member Westerman asked whether the statement would be read after the disruption had occurred; he indicated that was the case. If the person(s) are asked to leave and do not, Courthouse Security will be called upon to assist. Member Westerman, who is Vice Chair, said she wished to use the same procedure and desired clarification on the following points. She questioned whether it is necessary to include "Please confine your comments to issues that pertain to public health". She pointed out that the BOH also deals with environmental health issues. She said she is willing to read this whole statement, but she would like to say that we ask that statements are civil, and not delineate what is not considered civil. Chair Austin said he could accept that. Member Frissell suggested that the Chair(or Vice Chair) also state that the • Board is not going to respond to public comments. Member Johnson said that the BOCC states Page 8 of 11 Jefferson County Board of Health,April 7, 2008 that they typically won't respond to public comments. Member Sullivan noted that it is also not • the time to ask questions, that there are other venues for that. Jean Baldwin said she wished to verify that the ordinance adopted for courthouse behavior only applies to the BOCC; Commissioners said that is the case. Chair Austin said the protocol under discussion for the BOH is from the RCW for public meetings. There was a brief discussion regarding the need to limit comments to the topic of public health. Member Westerman said she did not wish to monitor and enforce the appropriateness of every comment. Chair Austin agreed that she would not need to do so. Jean Baldwin asked whether the statement should be printed on the meeting agenda. Chair Austin said that would be helpful, and noted that he had added the word typically, as suggested. Member Frissell said she wished to address the apparent confusion about meeting venue changes. She said she had seen the announcement in the newspaper twice before receiving the meeting packet. She suggested that perhaps when the meeting is not being held at the Health Department, a notice should be posted there the day of the meeting indicating the location of the meeting. Jean Baldwin said that the notice of adjournment had been posted at the Courthouse and at the Health Department, but not at Pope Marine because of the notice in the paper. Member Westerman said it was especially important to post if the meeting location is changed. Ms. Baldwin confirmed that a notice was posted at the Fire Hall on April 17. She added that this venue (First Floor Conference Room, Courthouse) may be the permanent location. i ACTIVITY UPDATE Public Health Standards Review—The Department is undergoing a 3-year review by the State as to compliance with 12 public health standards. The review covers communicable disease, food safety, and maternal/child health. The Health Department will be rated along with every other health department in the State. Reviewers will be on site for one day. Julia Danskin is leading a team in preparation for the visit. She mentioned that as a small county, Jefferson has not had the infrastructure and funds to maintain every aspect up to the level that would be desired. She said that the funding for Emergency Preparedness has been of considerable help in related areas. She said they had done very well six years ago with Assessment, but ratings dropped three years ago due to the loss of various sources of funds. Jean Baldwin said that it is similar to performance standards, but it involves testing a whole state wide system. The State Department of Health does not fund for many of the things they are testing, i.e. it is not tied to their money. Funding is all from local dollars. Jean Baldwin noted the inherent challenge of ensuring state-wide standards when many local systems receive no state funding. This entire process is the attempt to establish a common infrastructure across the state. However, the measurement process can be onerous. Dr. Locke said that the department had gone through identical audits in 2002 and 2005, and the comparison over the three year period was informative. The current audit is structured . differently and focuses on a subset of an expanded set of standards, so that direct comparison with 2002 and 2005 assessments will not be possible. Infrastructure standards such as methods of contracting and business management will be measured across the state. For other areas, Page 9 of 11 Jefferson County Board of Health,April 7,2008 various counties will be measured for different combinations of standards. Dr. Locke said that the most useful comparison of this data is to measure the department's own performance, , strengths and weaknesses over time. Home Owner Inspection Data—Dr. Locke said that data from other counties is being collected. Clallam County is scheduled to attend the May BOH meeting to make a presentation. The Clallam Work Group has just completed new documents on site certification and home owner inspection. AGENDA PLANNING Member Westerman suggested that the Homeowner Inspection presentation be scheduled at a different meeting from the Royer Report to allow sufficient time for full discussion. After a brief discussion, it was agreed that the Clallam Work Group presentation would be postponed. Jean Baldwin said she would also like to schedule a School Based Clinic briefing soon. The hope is to begin the program for the 2008-2009 school term, so action would be needed in the near future. NEXT SCHEDULED MEETING The next BOH meeting will be held Thursday, May 15 from 2:30 to 4:30 PM in the Courthouse, First Floor Conference Room. • ADJOURNMENT Member Johnson moved to adjourn and Member Westerman seconded, with all in favor. The meeting was adjourned at 4:29 PM. Page 10 of 11 Jefferson County Board of Health,April 7, 2008 • JEFFERSON COUNTY BOARD OF HEALTH ot 6511;4, ti--ki3 61+AI"-------- Jo Austin,`Chair Sheila WI, terman, Vice Chair fii Roberta-Frissell, Member Chuck Russell, Member ' k ft so Phil Johnson, Member David Sullivan, Member / // / Michelle Sandoval, Member ID • Page 11 of 11 Jefferson County Board of Health,April 7,2008 0 Board of Health, Old Business .agenda Items # fV., 1 0 Note from jIlTBuhLer flay 15, 21908 • • -- _ . • ! 0 • Board of Health Old Business .Agenda Item # IV., 2 Rabies in a Puppy Imported • from India to Jefferson County Nlay 15, 2008 • �* Zoonoses and Public Health • ORIGINAL ARTICLE Rabies in a Puppy Imported from India to the USA, March 2007 L. Castrodalet, V. Walker2, J. Baldwin3, J. Hofmann4 and C. Hanlon5 Alaska Department of Health and Social Services,3601 C St,Suite 540,Anchorage,AK 99503,USA 2 Walker Veterinary Service,P.O.Box 34941,Juneau,AK 99803,USA 3 Jefferson County Public Health,615 Sheridan,Port Townsend,WA 98368,USA 4 Formerly of the Washington Department of Health, 1610 NE 150th St,Shoreline,WA 98155,USA 5 Rabies Laboratory,Kansas State Veterinary Diagnostic Laboratory, 1800 Denison Avenue,Mosier Hall,Manhattan, KS 66506,USA;formerly of the Poxvirus and Rabies Branch,US.Centers for Disease Control and Prevention, 1600 Clifton Rd,Atlanta,CA 30333,USA 44-4oluem*igsitiVielife A440: o€ a , d , . b IP al I €, 4 - a • a € q a " tk/ . • o1' o as 8 6: as €f Ii a i ,€ a' gfltI. € ® �w,YE,e Keywords: Summary Canine rabies;importation;Alaska; Washington;veterinarians;interstate transport In March 2007, a puppy that was recently imported from India into the United States was found to be positive for rabies by the Alaska Department of Health • Correspondence: and Social Services. This case report highlights several important public health Louisa Castrodale.Alaska Department of issues. First, recognizing that humans and animals are part of a global commu- Health and Social Services,3601 C St,Suite nity with frequent travel and translocation, the risks of disease introduction, 540,Anchorage,AK 99503, USA. Tel.: +907 269 8002;Fax:+907 562 7802; particularly with sub-clinical or incubating animals, are real and present. Ani- E-mail: louisa.castrodale@alaska.gov mal-importation regulations, policies and practices are intended to minimize these risks and should be routinely evaluated and updated as needed in response to occurrences such as detailed in this communication. Second,veter- inarians play key roles in safeguarding the public's health with regard to moni- Received for publication October 10,2007 toring the movement of animals and diagnosing zoonoses. Third, investigating rabies cases that involve multiple jurisdictions are labour-intensive and require doi: 10.1111!.1863-2378.2008.01107.x significant resources to ensure that all potentially exposed persons are identified and receive the appropriate rabies post-exposure prophylaxis. Case report and investigation puppy bit veterinarian A and another dog at the clinic, and a veterinary clinic staff member observed the puppy In March 2007, a Washington state veterinarian (veteri- gnawing on its kennel, resulting in bleeding gums and the narian A) who was volunteering at an animal shelter in loss of multiple deciduous teeth (see Fig. 1). New Delhi,India,assumed temporary ownership of a local Seven days after the puppy entered the United States, stray mixed breed puppy, aged approximately 11 weeks. another veterinarian (veterinarian B) adopted the puppy Within a week of finding the puppy, the veterinarian flew and transported it in cargo by aircraft from Seattle to by aircraft with the puppy in cargo back to Seattle, Wash- Juneau, Alaska. The day prior to travel, a third veteri- ington. Two days after arrival in the United States, the narian (veterinarian C) completed a Washington State puppy was observed to have non-specific clinical signs that Department of Agriculture health certificate required for were, in retrospect, compatible with rabies (i.e. at least the interstate shipment of live dogs. The certificate stated one episode of regurgitation). During the next 4 days, the that the animal was not known to have been exposed to • No claim to original US government works Journal compilation©2008 Blackwell Verlag•Zoonoses Public Health. 1 Canine Rabies Translocation L.Castrodale et al. March 14-23,2007 Puppy gets a Puppy dies health certificate early AM; for travel to AK rabies Puppy from India to WA confirmed at Puppy AKDHSS from WA Virology Lab Puppy bites to AK at 9:30 PM Puppy person& regurgitates another dog; Puppy ill, gnawing on cage seen by breaks AK vet deciduous teeth Fig.1. Timeline for travel and clinical progression of puppy • + from India to Alaska(AK)via 14 15 16 17 18 19 20 21 22 23 Washington(WA),March March 14-23,2007. rabies, did not originate in a rabies quarantined area and States have led to the elimination of canine rabies and was free of symptoms of communicable disease. control of the occurrence of wildlife rabies in dogs, from The day after arriving in Alaska, veterinarian B noted approximately 9000 rabid dogs identified in 1944 to 79 that the puppy was lethargic and irritable. A fourth veter- rabid dogs in 2006 (Blanton et al., 2007). Although US inarian (veterinarian D) evaluated the puppy and noted a rabies control measures have been successful, there is a severely depressed state of consciousness, dilated non- risk for re-introduction of canine rabies virus variants responsive pupils, absent palpebral reflex and paresis. through the importation of unvaccinated, or rarely, even Despite supportive therapy, the puppy's condition deteri- vaccinated dogs, from areas where canine rabies is enzo- orated rapidly and it died early the next morning. Veteri- otic, such as parts of Latin America and most of Asia and narians B and D suspected rabies and immediately Africa. The risk of such occurrences can be minimized notified the Alaska Department of Health and Social through appropriately formulated and adequately imple- Services (AKDHSS). Rabies was confirmed later that day mented animal importation policies and practices. • at the AKDHSS Virology Laboratory by direct fluorescent Dogs imported into the United States demonstrating antibody testing of brain samples from the animal. Phylo- overt signs of illness may be detained by port authorities. genetic analysis of the virus at the US Centers for Disease In addition, because of concerns about the possible Control and Prevention (CDC) indicated relatedness with importation of canine rabies, current federal regulations a canine rabies virus variant typically found in northern require that dogs imported from rabies-enzootic areas, India. More than 20 persons were interviewed for poten- such as India, have proof of current rabies vaccination tial rabies exposure from the puppy and eight (five in (CFR, 2003). Federal regulations state that dogs too Washington and three in Alaska) received rabies post- young (i.e. <3 months old) to be appropriately vaccinated exposure prophylaxis (PEP). The puppy was apparently by current recommendations must be confined by their only in contact with one other dog while in the Washington owners until 3 months of age, then vaccinated and con- clinic.That dog was subsequently under medical treatment fined for an additional 30 days (DGMQ, 2006). Unvacci- for an orthopedic condition. Because the clinical recovery nated dogs, and even previously vaccinated dogs, from process was complicated with rabies exposure concerns,the canine rabies-enzootic areas may be in the incubation dog was euthanized;rabies testing was negative. stage of infection and appear clinically normal during the importation process. If these animals are not properly Discussion managed after entry, they may develop rabies and pose an imminent public health threat. For example, a currently Rabies virus infection results in fatal encephalomyelitis in vaccinated animal might be incubating rabies, particularly humans and other mammals. The majority of human if the exposure occurred before an initial rabies vaccina- cases occur as a result of bites from infected animals. tion or if an animal suffers a severe exposure that is Globally, the most common sources of rabies in humans unrecognized and the recommended booster vaccination are geographically distinct rabies virus variants main- is not received (CDC, 1987;NASPHV, 2008). tained predominantly through dog-to-dog transmission In addition to the case described in this report, (i.e. canine rabies), with spillover into other species. two other cases highlight the risk associated with translo- Rabies vaccination and stray dog control in the United cating dogs, especially unvaccinated ones, from canine No dam to original US government works • 2 Journal compilation©2008 Blackwell Verlag•Zoonoses Public Health. L.Castrodale et al. Canine Rabies Translocation • rabies enzootic areas. In May 2004, a 12-week-old unvac- animal importation to determine the need for cinated puppy was flown from Puerto Rico to Massachu- further rulemaking. setts as part of a shelter rescue programme. The puppy In addition to federal regulations, interstate transport developed neurological signs the day after entry, and was of dogs may also be subject to state regulations intended subsequently euthanized and diagnosed with rabies (F to minimize the risk of disease translocation. Many states, Cantor, DVM, formerly Massachusetts Department of including Alaska and Washington, require a United States Public Health, personal communication, July 2007). Phy- Department of Agriculture health certificate form to be logenetic analysis of the virus indicated that the puppy completed by a licensed and accredited veterinarian prior was infected with a variant of rabies associated with mon- to interstate transport of a dog or cat. During the accredi- gooses in Puerto Rico. At least six persons required PEP tation process, veterinarians are instructed on the func- following exposure to this animal. During June 2004, a tion and importance of completing health certificates, stray 12-week-old unvaccinated puppy adopted by a US copies of which must be filed with state authorities. This resident in Bangkok, Thailand, was flown from Thailand event highlights the need for utmost vigilance in obtain- to Los Angeles, California, in the passenger cabin of an ing a travel history and performing a physical examina- airline. The puppy was ill during transit, and was diag- tion when an accredited veterinarian is completing a nosed with rabies 2 days after entering the US (B Sun, health certificate. Following national rabies prevention DVM, California Department of Public Health, personal guidelines, a puppy that bites a human should have been communication, June 2007). Phylogenetic analysis indi- placed under a 10-day period of clinical observation/con- cated a rabies virus variant associated with rabid dogs in finement in Washington in accordance with the Advisory Thailand. Twelve persons required PEP following expo- Committee on Immunization Practices (ACIP) and the sure to this animal. Prior to these cases, the most recent Compendium of Rabies Prevention and Control, to deter- reports of animal rabies imported into the United States mine the risk of exposure to rabies of the bitten human occurred in the late 1980s (CDC, 1987, 1988). (CDC, 1999; NASPHV, 2008). Furthermore, the ACIP With regard to importation of unvaccinated and and Compendium recommend that an ill or stray animal recently vaccinated (less than 30 days before importation) that bites a human should bypass observation and be dogs, confinement agreements are completed by staff immediately euthanized and tested for rabies. from the CDC's Division of Global Migration and Quar- Practicing veterinarians are the frontline of defense • antine (DGMQ) or their designees (commonly Customs against translocated, imported, and newly emerging ani- and Border Protection staff) at ports of entry into the mal diseases and zoonoses. As such, veterinarians play a United States (CDC, 2006). Owners or agents of the dog key role in public health when they are responsible for are instructed about the specific terms of their agreements assessing the health of animals prior to, during, and even based on the age and vaccination status of their animal. after transport. Interstate health certificates are primarily These agreements are legal documents; however, they rely intended to minimize the risk of diseases of agricultural primarily on the owner or agent of the dog to adhere to significance, but accredited veterinarians must also be the agreement's terms. A copy of the signed agreement is attentive to the risk of zoonoses. Strong clinical acumen intended to be forwarded to the state health officer or with consideration of a comprehensive list of differential designee in the destination state. State and local health diagnoses is critical to accurately and efficiently identify departments vary in their ability to track and follow-up notifiable zoonotic diseases. In this report, the suspected each form received. Additionally, there is variation in the clinical diagnosis was rapidly confirmed through labora- procedures for distributing these agreements by port of tory diagnostic testing that then triggered an extensive entry, i.e. some quarantine stations send copies via fax or public health investigation. mail and more recently, via electronic means. There was Finally, zoonotic disease translocation events such as no record of confinement agreements being issued for this one, often involve emergency responses from a num- either the 2007 Alaska/Washington or the 2004 California ber of responsible federal, state and local agencies. Fortu- puppies. nately in this case, the disease threat ended without On July 31, 2007, the US Department of Health and further transmission when this puppy died and humans Human Services posted an Advance Notice of Proposed and animals potentially exposed were identified and prop- Rulemaking (ANPRM) as part of the process to evaluate erly managed. In addition to the implications of intro- the need to revise CDC animal-importation regulations, duced disease, the economic impact of public health including those that apply to the importation of dogs and investigations should be taken into account when consid- other companion animals (DHHS, 2007). This ANPRM ering potential changes to current federal animal importa- was intended to solicit public comment and feedback tion policies and procedures. • No claim to original US government works Journal compilation©2008 Blackwell Verlag•Zoonoses Public Health. 3 Canine Rabies Translocation L.Castrodale et al. Acknowledgements New Hampshire,California.MMWR Morb.Mortal. Wkly •The authors wish to thank the following persons for Rep 37,559-560. CDC(Centers for Disease Control and Prevention),2006: contributions made to the investigation: M. Westcott, Form 75.37 Rev.08/2006 (Notice to Owners and Importers K. Martinek, RN, MPH, K. Slotnick, RN, J. Butler, MD, of Dogs).Available at http://www.cdc.gov/ncidodldq/pdf/ Alaska Department of Health and Social Services; R. Ger- animal/dog—quarantine—notice_08-04-06-cdc7537.pdf[last lach, VMD, Alaska Department of Environmental Conser- accessed on 29 January,2008]. vation; R. Baer, MPH, M. Lang, R. Wohrle, DVM, CDC,Human Rabies Prevention—United States, 1999:Rec- B. Wieman, Washington Department of Health; T. Locke, ommendations of the Advisory Committee on Immuniza- MD, MPH, L. McKenzie, RN, MPH, Jefferson County tion Practices.Erratum in:MMWR Morb.Mortal. Wkly Rep. Public Health; S. Lindquist, MD, Kitsap County Health 1999;48(1): 16.MMWR Morb.Mortal. Wkly. Rep. 2000; District; J. McQuiston, DVM, MPH, S. Roohi, RN, MPH, 49(32):737.PMID: 10077411. H. Hastings, MPH, P. Houck, MD, Division of Global CFR(Code of Federal Regulations),2003:Foreign Quarantine, Migration and Quarantine, National Center for Prepared- Importations,Dogs and Cats,42 C.F.R.Sect 71.51.Available ness, Detection, and Control of Infectious Diseases, CDC; at:http://frwebgate.access.gpo.gov/cgi-bin/get-cfr.cgi [last C. Rupprecht VMD, PhD, A. Velasco, PhD, I. Kuzmin, accessed on 29 January,2008]. MD, L. Orciari, MS, P. Yager, Division of Viral and DGMQ (Division of Global Migration and Quarantine),Cen- Rickettsial Diseases, National Center for Zoonotic, ters for Disease Control and Prevention,2006:Importation Vector-Borne, and Enteric Diseases, CDC; and R. Fagan, of Pets,Other Animals,and Animal Products into the MD, MPH, R. Gulati, MD, Office of Career and Work- United States.Available at http://www.cdc.gov/ncidod/dq/ force Development,EIS Field Assignments Branch, CDC. animal.htm [last accessed on 29 January,2008]. DHHS(Department of Health and Human Services),2007:42 CFR Part 71. Foreign quarantine regulations,proposed References revision of HHS/CDC animal-importation regulations.Fed. Blanton,J. D.,C.A.Hanlon,and C. E.Rupprecht,2007: Regist. 72,41676-41679.Available at http://www.cdc.gov/ Rabies surveillance in the United States during 2006.J.Am. ncidod/dq/anprm/indexhtm [last accessed on 29 January, Vet. Med.Assoc. 231,540-556. 2008]. CDC(Centers for Disease Control,Prevention), 1987:An NASPHV(National Association of State Public Health Veteri- narians),2008:Compendium of Animal Rabies Prevention imported case of rabies in an immunized dog.MMWR . Morb. Mortal. Wkly Rep. 36,94-96, 101. and Control, 2007.Available at http://www.nasphv.org/ Documents/RabiesCompendium.pdf[last accessed on CDC (Centers for Disease Control,Prevention), 1988: Epidem- 29 January,2008]. iologic notes and reports:imported dog and cat rabies— No claim to original US government works 410 4 Journal compilation©2008 Blackwell Verlag•Zoonoses Public Health. f/ Zoonoses and Public Health SHORT COMMUNICATION Importation of dogs into the United States: risks from rabies and other zoonotic diseases J. H. McQuiston', T. Wilson', S. Harris', R. M. Bacon', S. Shapiro', I Trevino2, J. Sinclair', G. Galland' and N. Marano' Division of Global Migration and Quarantine,Centers for Disease Control and Prevention(CDC), 1600 Clifton Rd,Atlanta,GA 30333, USA 2 Office of Career and Workforce Development, Epidemiology Program Office,enters for Disease Control and Prevention(CDC), 1600 Clifton Rd,Atlanta, GA 30333, USA Impacts • Based on import trends suggesting that theannual number of unvacci- nated puppies being imported into the United States increased substan- tially from 2001 to 2006, imported dogs pose a risk for introducing zoonotic pathogens such as rabies into the United States. • Commercial resale or adoption of unvaccinated puppies originating from rabies-enzootic countries poses a risk for spread and transmission of foreign canine variants of rabies; since 2004, at least two cases of foreign', variants of canine rabies virus have been documented in recently imported puppies. • On July 31, 2007, CDC posted an Advance Notice of Proposed Rulemaking on the:.topic,and invited public comment on issues regarding possible requirements for a unique identification and health certificates, and setting a minimum age for importation that would require valid rabies vaccination prior to entry into the United Stat 1111 Keywords: Summary Zoonosis;rabies; importation, dog,cat;ferret The importation of dogs into the United States poses a risk for the introduc- Correspondence: tion of rabies and other zoonotic diseases. Federal regulations (42 CFR 71.51) 1.H.McQuiston. Rickettsial Zoonoses Branch, currently require proof of valid rabies vaccination for imported dogs, but allow Division of Viral and Rickettsial Diseases,CDC, the importation of some unvaccinated dogs, including dogs less than 3 months 1600 Clifton Rd MS G-44,Atlanta, GA of age, provided certain requirements for confinement are met until the dog is 30333, USA.Tel.:404-639-0041; Fax:404-639-2778; vaccinated. Although there are no accurate surveillance data on the number of E-mail:jmcquiston@cdc.gov dogs imported each year, it is estimated based on extrapolated data that over 287 000 dogs were imported into the United States during 2006. Of these, Received for publication October 30,2007 approximately 25% were either too young to be vaccinated or lacked proof of valid rabies vaccination. Import trends suggest that an increasing number of doi: 10.1111/j.1863-2378.2008.o1117.x unvaccinated puppies are being imported into the United States, many through commercial resale or rescue operations. Since 2004, foreign canine rabies virus variants have been documented in at least two imported puppies. Federal regu- lations are currently being reviewed by the Centers for Disease Control and Prevention to determine if they can be updated to address current import trends and disease risks, such as requiring a health screen and valid rabies vaccinations for all dogs prior to entry. Introduction possible threat for the introduction of zoonotic pathogens into the United States. In many parts of the world, canine In the current era of global travel and trade, the transport rabies virus variants are enzootic in dogs (Canis lupus of companion animals across U.S. borders represents a familiaris), and bites from infected dogs cause over • ©2008 No claim to original US government works Journal compilation©2008 Blackwell Verlag•Zoonoses Public Health. 1 Importation of dogs into the United States J.H.McQuiston et al. 50 000 human deaths each year (WHO Expert Consulta- threat to U.S. agriculture through the introduction of • tions on Rabies, 2007). Although the United States has screwworms or certain Taenia species of tapeworms successfully eliminated canine rabies variants from which are not found in the United States (U.S. Depart- domestic circulation, introduction of foreign canine rabies ment of Agriculture Animal and Plant Health Inspection virus variants via imported dogs threatens this status. Service, 2007). Under the Public Health Services Act, the Rabies is of particular concern in imported dogs because Centers for Disease Control and Prevention (CDC) under of its long incubation period; on average, clinical disease the Department of Health and Human Services (HHS), develops 4-8 weeks after infection. Because of this, dogs has the authority to restrict the importation of dogs due may be admitted on the basis of apparent good health, to risks to human health. Under 42 CFR 71.51,CDC may but may be incubating the virus and could develop dis- require dogs that appear ill with a at the point of entry to ease after entry. Other zoonotic pathogens (for example, the United States to be confined and referred to a veteri- leishmaniasis) may also be imported with dogs, and could narian for examination (Fig. 1) (Title 42 Code of Federal potentially develop a sustained or enzootic presence in Regulations, 2007). this country (Rosypal et al., 2003). Imported dogs may 42 CFR 71.51 requires a valid rabies vaccination for also harbor exotic or other ticks that could carry human dogs 12 weeks of age and older imported to the United . or animal pathogens not currently present in the United States from countries where canine rabies is present. States, or may physically introduce insects or pathogens However, this regulation has provisions that allow the of agricultural significance, such as screwworm larvae entry of unvaccinated puppies and dogs if the owner or tapeworms (Barre et al., 1987; Mannelli et al., 2003; agrees to confine the dog at a place of the owner's choos- Nyangiwe et al., 2006; U.S. Department of Agriculture ing until vaccinated, and then for 30 additional days Animal and Plant Health Inspection Service, 2007). Dogs (Title 42 Code of Federal Regulations, 2007). The regula- may also serve as a source of human infection with intes- tion does not require a health screen for these dogs prior tinal parasites such as Toxocara and enteric pathogens to arrival in the United States, nor does it require such as Salmonella and Campylobacter (Enriquez et al., treatment for ticks or evaluation for specific zoonoses 2001; Robertson and Thompson, 2002). of concern. Under 42 CFR 71.51, importers are expected No single U.S. agency has the sole authority to regulate to appropriately confine and vaccinate imported dogs the importation of dogs. The Animal and Plant Health that lack valid rabies vaccination. Enforcement of this Inspection Service (APHIS) within the U.S. Department regulation is problematic because there is no federal 11111 of Agriculture (USDA) requires health certifications and requirement, mechanism, or capacity for documenting inspections at the port of entry for some dogs imported compliance. In addition, the current CDC regulations from some countries on the basis that they may pose a provide an exception to vaccination if the dog originates y! I ') ' '' y// �.�� ,. ft , __,...._......, ,,. ,,, S ill m.Rm.'.=.. . ,3,: bN. `, Fig.1. Imported puppies und- ; ergoing inspection at JFK Inter- '''''''''a `. * t w national Airport, New York (note evidence of diarrhea on the animals and in the cage). Photo courtesy of Sheryl .: f. Shapiro,CDC New York m „ _° Quarantine Station. ©2008 No claim to original US government works • 2 Journal compilation©2008 Blackwell Verlag•Zoonoses Public Health. J. H.McQuiston et al. Importation of dogs into the United States • Table 1. Estimates of dogs imported into the United States during 2006 Port of entry Type of surveillance system Surveillance data Extrapolations from surveillance data* Airport Dog importation data collected by 10 125 dogs(5156 unvaccinated) These airports account for 20%of CDC Quarantine Stations for were imported through ORD in international air passenger traffic Chicago O'Hare International 2006.An estimated 7350 dogs entering the United States.* Airport(ORD)and John F. (1327 unvaccinated)were Therefore,estimated 87 375 dogs Kennedy International Airport imported through JFK in 2006. were imported through U.S. (JFK)(CDC unpublished data). airports in 2006,of which 32 415 (37%)are estimated to have been unvaccinated. Northern land Confinement agreements issued for Reports were submitted for 73 These land border crossings border crossing unvaccinated dogs at Canadian unvaccinated dogs during 2006. accomodate 47%of passenger land border crossings within CDC's Unvaccinated dogs were vehicle crossings from Canada.* New York Quarantine Station's presumed to represent 18%of Therefore,an estimated 870 (at JFK airport)regional jurisdiction overall dog imports(the same as dogs entered from Canada in (CDC, unpublished data). dogs entering through JFK airport). 2006,of which 157(18%)are An estimated 404 dogs were estimated to have been therefore imported through these unvaccinated. stations in 2006. Southern land A multi-agency 2-week border 1991 dogs(381,or 19% These ports accomodate 26%of border crossing surveillance operation conducted unvaccinated)were imported passenger vehicle crossings from November 27 through December during the operation.Presuming Mexico.*Therefore,an estimated 10,2006,at San Ysidro and Otay that this 2-week period was 199 100 dogs entered from Mesa border crossing stations. similar to other times of the year, Mexico in 2006,of which 38 100 (Aaron Reyes, Southeast Area an estimated 51 766 dogs are estimated to have been Animal Control Authority,personal (9906 unvaccinated)entered the unvaccinated. communication 4/12/2007). U.S.through these ports during 2006. All United States Combined extrapolations from >287 000 dogs are estimated to airport, northern land border,and have been imported into the southern land border ports of entry United States during 2006, including an estimated 70 600 (25%)unvaccinated dogs. *Extrapolations presume that the available surveillance data is representative of dog importations occurring at other similar ports of entry. *Border crossing statistics available at Bureau of Transportation Statistics, http://www.transtats.bts.gov. from a `rabies-free' country. The presence of canine rabies The importation of unvaccinated dogs into the United is determined by CDC based on surveillance data States appears to be increasing. The number of reports reported to the World Health Organization by member that CDC received for dogs entering John F. Kennedy countries, and determining an updated and accurate list International Airport doubled from 2003 to 2006 (CDC, of rabies-free countries is difficult because countries with- unpublished data), and reports of unvaccinated dogs out robust surveillance systems may appear free of rabies. being imported into California increased by over 500% While there are no official surveillance statistics on the during the period 2001-2006 (Ben Sun, California numbers of dogs imported into the United States each Department of Public Health, personal communication year, it is estimated based on extrapolation of limited 3/22/2007). Some of these increases may be explained by importation data that over 287 000 dogs were imported the apparent recent expansion in a high-volume interna- into the United States in 2006 (Table 1) (Bureau of tional commercial puppy trade. Breeders overseas and Transportation Statistics, 2007). Of these, approximately across borders ship puppies to the United States for sale 70% entered through land border crossings, while the through commercial pet stores, flea markets, and internet remainder entered through airports. Because not all trading sites. Consumer demand for puppies under imported companion animals are inspected on entry, the 4 months of age results in some animals being sold before true volume of imports is likely much larger than these the end of the required vaccination confinement period estimates suggest. An estimated 25% of dogs imported (Fig. 2) (AP News Article, 2007; Discussion of the Pet into the United States during 2006 were either too young Animal Welfare Statute (PAWS), 2005). The number of or otherwise not current for rabies vaccinations, imported puppies sold commercially before the end of • ©2008 No claim to original US government works Journal compilation©2008 Blackwell Verlag•Zoonoses Public Health 3 Importation of dogs into the United States J. H. McQuiston et al. •4:, aia 6 ri t $Ilt iaact�. r at II.' i ._ 3£' '..,i ' i ilk A # r sx f,� `a °��ip�s� T4s � is I� $ ?'" �t.4 a '� fl, St" } f Sid t'dt w1C � �t p4 �. x � '� ��' flt as .i§a fi ;,curs 4 '� w s. 4,i ! ,„'.:t. •'..: ',..0C.if, ,,,/#,!:!k.'•.".! look i t �`- s ;# a 1 , �' + f '� _. t "I�a f i• Fig.2. Puppies imported to i"1 ' the United States from Mexico } I " ", via a land border crossing, ( +� °�• 2006. Purebred puppies such �� as these are most commonly i � NI ,l � �j � �`c ' '' ' - ' '"'��� ,��i � destined for quick commercial t sale within the United States, t I � many in violation of CDC con- . finement requirements_ Photo fr i gis courtesy of Gregory Elizondro, .a= "' -- USDA-APHIS,Pharr,TX Port of Entry. the required confinement period is unknown, but over animals during travel abroad and bring them back to 4000 confinement agreement violations are known to the United States. have occurred in 2006 (CDC, unpublished data). In addi- The importation of unvaccinated dogs from areas tion to imports for commercial sale, several animIII al rescue where canine rabies is enzootic poses a potential public operations import dogs from other countries for adoption health risk. Since 2004, CDC has received two reports in in the United States. For example, in 2006, a humane res- which young, unvaccinated puppies were imported from cue organization imported 295 dogs to the United States rabies enzootic countries and developed rabies after arriv- from the Middle East (Fig. 3) (Best Friends Middle East ing in the United States. In 2004, a puppy rescued as a animal rescue operation, 2007). In addition to organized stray in Thailand was diagnosed with a canine rabies virus efforts, U.S. citizens may less formally acquire stray variant the day after being imported to California. (Ben I1uiiIIIut `-� by - 5,,,.,,...*11 , ,;:44:111 :' 11-1*.q"-''',#41,',,-' ''.'.',1 ktil-,...:'-',s,:l",":- -.. ' iii ...a tsr 4 Jssk 6 E, •I;Y, i * xl Fig.3. Humane rescue opera- tion importing large numbers " li 1 ii of dogs from the Middle East, „77,-.:,'...L.- " q ' `' s ,:9 ' 2006. Photo courtesy of Sheryl �„A ,e r , 014011-,'",0«..4 _� Shapiro,CDC New York ''• ,,.0! : ii i'i it; ga Quarantine Station. ill® claim riginal 4 Journal compilation©20082008 No Blackwell to Verloag•Zoonoses US Publicgovernment Healthworks p . J.H.McQuiston et al. Importation of dogs into the United States 41111 Sun, California Department of Public Health, personal On July 31, 2007, CDC posted an Advance Notice of communication 8/1/2007). In 2007, a puppy rescued as a Proposed Rulemaking (ANPRM) soliciting public opin- stray in India was imported through Washington to ion on possible changes to current federal regulations Alaska, where it was diagnosed with a canine rabies virus (Centers for Disease Control and Prevention, 2007). variant commonly circulating in dogs in India. (Louisa Questions posed for public comment included whether Castrodale, Alaska Department of Health and Social Ser- dogs should have a minimum age for importation, and vices, personal communication 8/1/2007). As these cases whether a unique animal identifier and health certificate highlight, the importation of unvaccinated dogs poses not signed by a licensed veterinarian in the country of origin only a direct human health risk, but also a risk for trans- should be a requirement for importation. The ANPRM location and establishment of canine variants of rabies also asked whether cats and ferrets should be subjected virus not currently present within the United States. to the same importation requirements as dogs. The pub- Although the documented risk appears small (less than 2 lic comment period for the ANPRM closed on December per million imported dogs), it is likely underestimated 1, 2007. Following review of all comments and consider- because imported puppies with rabies may die without ation of specific disease risks, CDC will consider whether being appropriately tested or diagnosed, particularly if federal regulations regarding the importation of compan- they did not bite other animals or humans prior to death. ion animals should be strengthened to prevent the While rabies infection may not be highly prevalent in importation of foreign canine rabies virus variants and imported dogs, even the importation of one or two other zoonoses. infected animals per year represents an unacceptable and preventable risk. While import restrictions may not be Acknowledgements able to specifically address all possible zoonoses, a requirement for a health screening by a veterinarian in The authors thank Gregory Elizondo for providing one of the country of origin prior to shipment could help reduce the photos used in the manuscript; Ben Sun and Louisa the likelihood of zoonotic disease transmission from Castrodale for providing information used in this report; imported dogs. More stringent requirements for animal and Bob Mullan, Sena Blumensaadt, and Connie Austin identification, such as a tattoo or microchip, as well as for their expert advice. The findings and conclusions treatment for ticks and other ecto- or endoparasites prior in the manuscript are those of the authors and do not to import, are successfully employed in many other coun- necessarily represent the views of the Centers for Disease tries, including the United Kingdom and western Euro- Control and Prevention. pean countries (Europa European Commission, Animal Health and Welfare, 2007). In addition to dogs, compan- References ion animals such as cats and ferrets are highly susceptible to rabies, and some other countries have importation AP News Article,2007: Study: Number of Puppies Smuggled restrictions for these animals, including requirements for Down.Available at http://www.l0news.com/news/10656417/ rabies vaccinations (Europa European Commission, Ani- detail.html,accessed July 13. mal Health and Welfare, 2007). The zoonotic diseases Barre,N.,G. Uilenberg, P. C. Morel, and E. Camus, 1987: risks associated with these additional companion animal Danger of introducing heartwater onto the America main- species should be carefully reviewed if changes to the land:potential role of indigenous and exotic Amblyomma ticks. Onderstepoort J. Vet. Res. 54,405-417. current federal regulations are considered. Best Friends Middle East animal rescue operation, 2007:Avail- able at http://network.bestfriends.org/middleeast/news/ Discussion 7914.html,accessed July 11. Bureau of Transportation Statistics, 2007: Air Carriers Interna- CDC's regulations regarding the importation of dogs were promulgated in 1956 and updated in 1983 (Title 42 clonal Market (T-100) and U.S. Border Crossings. Available Code of Federal Regulations, 1956; Title 42 Code of Fed- at http://www.transtats.bts.gov. Accessed May 1. Centers for Disease Control and Prevention, 2007: Foreign eral Regulations, 2007). During this time, international Quarantine Regulations, Proposed Revision of HHS/CDC pet travel was not routine and typically involved the Animal-Importation Regulations. Federal Register, July 31, occasional family pet. In contrast, today's importation 72:41676-41679. practices include highvolume importation of unvacci- Discussion of the Pet Animal Welfare Statute (PAWS), 2005: nated puppies for commercial resale and humane rescue. Nutrition and Food Assistance,Sustainable and Organic Federal regulations are currently being reviewed to deter- Agriculture, and General Legislation Subcommittee. Tues- mine if they should be strengthened to prevent the pos- day,November 8. Available at http://agriculture.senate.gov/ sible importation of foreign canine rabies virus variants. • ©2008 No claim to original US government works Journal compilation©2008 Blackwell Verlag•Zoonoses Public Health. 5 A Importation of dogs into the United States 1.H.McQuiston et al. Hearings/hearings.cfm?hearingid=1649&witnessld=4758, Rosypal,A. C.,A. M.Zajac,and D. S. Lindsay, 2003: Canine • accessed October 3, 2007. visceral leishmaniasis and its emergence in the United States. Enriquez,C., N. Nwachuku,and C.P.Gerba, 2001: Direct Vet. Clin. Small Anim. 11,921-937. exposure to animal enteric pathogens. Rev. Environ. Health Title 42 Code of Federal Regulations, 1956: Chapter 1 Public 16, 117-131. Health Service. Department of Health and Human Services, Europa European Commission,2007:Animal Health and Part 71.154. Federal Register,December 12,9879. Welfare. http://ec.europa.eu/food/animal/liveanimals/pets/ Title 42 Code of Federal Regulations, 2007:Chapter 1 Public index_en.htm. Accessed August 28. Health Service. Department of Health and Human Services, Mannelli,A., M. L. Mandola, P. Pedri,M.Trioli,and P. Neb- Part 71.51.Available at http://a257.g.akamaitech.net/7/257/ bia,2003: Associations between dogs that are serologically 2422/05dec20031700/edocket.access.gpo.gov/cfr_2003/octgtr/ positive for R. conorii relative to the residences of two 42cfr71.51.htm,accessed July 11. human cases of Mediterranean spotted fever in Piemonte U.S. Department of Agriculture Animal and Plant Health (Italy). Prey. Vet. Med. 60, 13-26. Inspection Service. 2007: Importation of Pets and Other Nyangiwe,N.,I.G.Horak,and N.R.Bryson,2006:Ixodid ticks Animals into the United States, http://www.aphis.usda.gov/ on dogs in the eastern region of the Eastern Cape Province, vs/ncie/pet-info.html. Accessed October 3. South Africa.Onderstepoort J. Vet.Res.73,305-309. WHO Expert Consultations on Rabies, 2007: First Report. Robertson, I. D.,and R. C. Thompson,2002: Enteric parasitic Copyright 2004,World Health Organization: Geneva, zoonoses of domesticated dogs and cats.Microbes Infect. 4, Switzerland; 13, available at http://www.who.int/rabies/ 867-873. ExpertConsultationOnRabies.pdf,accessed July 11. i ©2008 No claim to original US government works 6 Journal compilation©2008 Blackwell Verlag•Zoonoses Public Health. Board of Health New Business .agenda Item # T., 2 jeasIbIaty Study on Converting The Jefferson County Public • Health Department to a Jefferson County 3fealth District stay 15, 2008 1 • Feasibility Study on Converting the Jefferson County Public Health Department to a Jefferson County Public Health District • Presented to the Jefferson County Board of Health and the Jefferson County Public Health Department May 2008 conducted and prepared by The Royer Group • Jefferson County Public Health Feasibility Study Report Outline I. Executive Summary II. Methodology Ill. Local Health Jurisdictions & Boards of Health in Washington State IV. Financial Feasibility Review V. Political Feasibility Review VI. Operational Feasibility • VII. Conclusions & Recommendation Jefferson County Public Health Feasibility Study— Page 2 Prepared by The Royer Group f • I. Executive Summary For several years, the Jefferson County Board of Health and the Jefferson County Health Department have discussed the possibility of converting the County Health Department into a stand-alone Public Health District. This Feasibility Study on Converting the Jefferson County Public Health Department into a Jefferson County Public Health District explores three distinct issues relevant to this discussion: i) the financial feasibility; ii) the political feasibility; and iii) the operational feasibility of converting from a health department to a health district. Based on the findings of this study, it is the conclusion of The Royer Group consultant team that it is both politically and operationally feasible to convert to a health district. However, the challenges associated with the financial feasibility of converting to a health district are significant. The most significant financial risk in converting to a health district is the recent trend of reduced funding support from Jefferson County for public health. Since 2006, the County's annual contribution to the Public Health Department has declined both in actual dollars and as a percentage of the department's total annual revenues. Additionally, the 2008 Beginning Fund Balance for the Public Health Fund is the lowest it has been in the past eight years. The biggest risk to converting Jefferson County Public Health from a County department to a stand-alone health district is the possibility, especially with competing demands for County General Fund revenues over time, that the County would see itself as having less of a financial responsibility to support public health. And, unlike many special purpose districts authorized under Washington State law, public health districts are not give the authority to levy taxes to carry out their responsibilities. Rather they must rely on local government support, fees, reimbursements and grants. Without another source of revenue, any further reductions in County financial support will likely result in reductions in public health services in Jefferson County. From a political perspective, there is expressed interest among several stakeholders in creating a health district. Other stakeholders have not yet taken a position, and only one (former) stakeholder expressed any opposition to doing so. Thus, converting to a health district appears to be politically feasible, provided that it is financially and operationally feasible. Additionally, there are some political advantages to Jefferson County Public Health (JCPH) operating as a health district. The most significant advantage is that as a public health district, JCPH would be seen as a more independent and apolitical agency responsible for addressing the public health needs within Jefferson County, and less as an arm of County government. Currently, JCPH is often viewed as a county agency • Jefferson County Public Health Feasibility Study— Page 3 Prepared by The Royer Group first, and a public health agency second. This has created challenges for JCPH, • especially in some interactions with the City of Port Townsend. Regarding the operational feasibility of converting to a health district, there was consistent acknowledgement and praise from stakeholders regarding the quality of services and work done by the professionals and leadership within the JCPH department. It is the opinion of the consultant team that JCPH could successfully transition to become a health district without a lessening in the quality of public health services in the County, assuming that adequate financial resources are provided. One of the operational advantages to becoming a health district is the "purity of purpose" that comes from operating as a stand-alone agency, rather than as part of a larger organization with its inherent and necessary bureaucracy. As a result, a health district would be more nimble and flexible and thus better able to pursue the demands of a changing public health environment. In summary and based on the feasibility study findings, the foremost being the financial uncertainty of local funding support for public health, it is the consultant team's recommendation that now is not a good time for Jefferson County Public Health to convert to a Health District. While JCPH could benefit both politically and operationally from converting to a health district, the current financial risk is too great and offsets the political and operational advantages. If, however, the long term issue of funding Public Health is resolved, The Royer Group's recommendation would be to pursue converting to a health district. • II. Methodology In October of 2007, the Jefferson County Public Health Department retained the services of The Royer Group (TRG) to study the political and financial feasibility of converting JCPH to a Health District. As part of this effort, TRG reviewed the JCPH budgets for the years 2003 — 2008 and the Jefferson County annual budget reports for the years 2003— 2008. Special attention was given to the administrative costs charged to JCPH and to fees charged by JCPH for Environmental Health regulatory services. TRG also conducted interviews with representatives from the Jefferson County Board of Health, the Jefferson County Commissioners, the Jefferson County Administrator (since resigned), the JCPH Director, the JCPH Health Officer, three sitting and one former Port Townsend City Council members, the Port Townsend City Administrator, and five representatives from Jefferson Healthcare, including the CEO, COO, Chief of Staff and two Hospital Commissioners. In addition, TRG interviewed the Administrators and/or Health Officers from eight Local Health Jurisdictions (LHJ) throughout Washington state, six of which . Jefferson County Public Health Feasibility Study— Page 4 Prepared by The Royer Group • operated as health districts and two as county health departments. The two county health departments had reverted from health districts within the last decade. Finally, TRG interviewed the Acting Director for Washington State Department of Health's (DOH) Office of Public Health System Planning& Development, who serves as the liaison between the DOH and LHJs throughout the state. Ill. Local Health Jurisdictions and Boards of Health in Washington State Under Washington State law, Title 70 RCW, local health jurisdictions may be constituted in one of four ways: a single county health department; a combined city-county health department; a single county health district; or a multi county health district. In Washington State there are currently 22 county health departments, two city-county health departments, seven single county health districts, and five multi-county health districts. The governing bodies for local health jurisdictions are the Boards of Health for each health department or health district. Pursuant to RCW 70, the Board of Health membership requirements for a health department or a health district are essentially the same. In both cases, the County Commissioners establish by • ordinance the members of the board which include the County Commissioners, and may be expanded to include elected officials from cities and towns in the county, and persons other than elected officials so long as elected officials constitute a majority on the board. The current make up of the Jefferson County Board of Health, which includes the three County Commissioners, elected representatives from the City of Port Townsend, an elected Jefferson Healthcare Hospital Commissioner, and a citizen member, meets the requirements for becoming a health district as currently constituted. IV. Financial Feasibility One of the key criteria in determining the feasibility of converting the Jefferson County Health Department into a free-standing health district is the financial feasibility of operating as a district. Several factors come into play here including the following: • The ongoing level of local tax support to the health district; • The administrative/overhead costs of operating a health district; • The extent to which the Environmental Health regulatory activities are • subsidized by local tax dollars; and Jefferson County Public Health Feasibility Study— Page 5 Prepared by The Royer Group • The fund balance in the Jefferson County Public Health Fund. • TRG reviewed the Jefferson County Health & Human Services annual operating budgets for the six years of 2003 — 2008. Between 2003 and 2008, the department's expenditure budget increased from $3,277,217 to $4,016,149, an increase of 22% over 6 years or on average, 3.7% per year. However, it is important to note that between the years 2003 and 2005, the budget decreased each year, and it wasn't until 2007 that the budget was increased back to the 2003 level. The budget increases for 2007 and 2008 were driven primarily by an increase in salaries and benefits consistent with the County's wage structure. Jefferson County Public Health Budget 2003 - 2008 Actuals 2003 2004 2005 2006 2007 2008* Expenditures $3,277,217 $2,993,882 $2,876,719 $3,190,127 $3,585,634 $4,016,149 Revenues $3,083,360 $3,044,273 $2,872,692 $3,316,716 $3,381,949 $3,723,721 * Because the Actual Expenditures & Revenues are not available for 2008,the 2008 Approved Budget numbers are used. Table note: In several years the Actual Revenues were less than the Actual Expenditures. In these years, the Fund Balance in the Public Health Fund was carried forward and used to cover this gap, resulting in a year-end balanced budget. Local Tax Support • During these same six years, the contribution to JCPH from County's General Fund steadily increased until 2008 when it significantly declined to below the 2005 level. Between 2003 and 2006 the General Fund contribution increased from $473,646 to $625,467, then leveled off in 2007 and was reduced to $543,937 in 2008. This reduction raises serious questions for Public Health's 2008 budget, given that their approved expenditures exceed approved revenues by $293,428 and represents a significant drawdown on the Public Health Fund's fund balance. In addition to the County General Fund contributions to public health, the City of Port Townsend has contributed liquor tax revenues to support JCPH's Substance Abuse Prevention Program. These revenues remained flat at $28,340 annually between 2003 and 2006, but increased to $34,921 in 2007 and 2008. For 2008, the City's contribution of liquor sales taxes represents less than 1°/0 of the total revenues for Jefferson County Public Health and is categorically restricted for use in the Substance Abuse Prevention Program. While it is clear in state statute that local funding support for public health rests primarily with the county government, the most finahcially successful local health jurisdictions receive funding support from the cities as well. It is also clear from • Jefferson County Public Health Feasibility Study— Page 6 Prepared by The Royer Group • TRG's interviews that, at this time, the City of Port Townsend feels little obligation to provide anything more than the liquor tax revenues to support public health. Jefferson County & Port Townsend Contributions to Public Health 2003 - 2008 Actuals 2003 2004 2005 2006 2007 2008* County $473,646 $498,986 $570,359 $625,467 $603,109 $543,937 General Fund City Liquor $ 28,340 $ 28,340 $ 28,340 $ 28,340 $ 34,921 $ 34,921 Tax *2008 Approved Budget Jefferson County Overhead Service Charges Jefferson County provides overhead/administrative support to JCPH for services such as rent, computer support, fleet, telephones, etc. Overall, the County Overhead Service Charges range from 5.8% to 8.3% of the department's budget in any given year. While there has been an increase in these charges, these percentages of the overall budget are reasonable. To get an idea of whether these services were significantly out-of-line with what they might cost on the open market, a comparison was done on building rent. For 2008, JCPH is paying $104,761 for 9,069 square feet of space, or $11.55/sq ft. Similar Class B • office space in Port Townsend ranges from $9.60/sq ft to $15.00/sq ft. There may be a possibility that JCPH could obtain some administrative/overhead services on the open market at a slightly reduced cost should they become a health district. Such services may also be more tailored to the unique needs of a health care agency. However, any such savings would be marginal, given their overall percentage of JCPH's annual budget. Jefferson County Charges to Public Health for Overhead Services 2003 — 2008 Actuals 2003 2004 2005 2006 2007 2008* County $ 190,604 $240,517 $237,679 $ 193,258 $243,232 $267,598 Charges *2008 Approved Budget It is worth noting that the increase of$70,291 in County General Fund contribution to JCPH between 2003 and 2008 has been offset by an increase of almost $80,000 in county charges to the department for overhead/administrative services. • Jefferson County Public Health Feasibility Study— Page 7 Prepared by The Royer Group Environmental Health Fees • Another factor examined as part of the financial feasibility analysis was the extent to which the Environmental Health regulatory responsibilities of JCPH are covered by user fees vs. being subsidized by local tax dollars. Based on the 2005 Environmental Health budget, user fees cover between 75%-85% of the total program and administrative costs for the Drinking Water, Liquid Waste, Septic Operations & Maintenance, and Food Inspection programs. In 2005 the total costs for these programs was $363,448, of which $69,000 was subsidized by non-fee revenues. The Solid Waste program, on the other hand collected only 12% of its costs from fees, with approximately $46,000 in costs being supported by non-fee revenues. Together, these subsidies represent over $100,000 annually in Environmental Health regulatory services that could legitimately be supported by fees, but are not. Rather, these services are subsidized using revenues that could be used for other public health programs. It is noted that the Jefferson County Board of Health is considering proposed changes to the onsite septic regulations and a commensurate fee structure. It is important for the long-term financial stability of JCPH that the new fees cover any additional program expenses and the associated administrative costs that will accrue to Environmental Health as a result of any new regulatory requirements. Fund Balance 41 Finally, the fund balance of the Public Health Fund was reviewed. The annual beginning fund balance has consistently declined from $715,251 in 2003 to $449,050 in 2008. This trend is further exacerbated by a revenue vs. expenditure gap of$292,428 in the adopted 2008 Public Health Budget. If no additional revenues are provided to JCPH in 2008, and/or if no budgeted expenditure reductions are taken, the Public Health Fund would end the year with an unhealthy fund balance of only $156,622, less than 4% of their annual budget. Beginning Fund Balance— Jefferson County Public Health Fund 2003 — 2008 2003 2004 2005 2006 2007 2008 Fund $715,251 $492,793 $543,403 $529,402 $494,729 $449,050 Balance — _ a Jefferson County Public Health Feasibility Study— Page 8 Prepared by The Royer Group • Stakeholder Comments on Financial Feasibility TRG also addressed the financial feasibility issue in our interviews with the key stakeholders. Everyone interviewed felt that the long term financing for public health in Jefferson County is critical, regardless of whether it remains a county department or converts to a health district. Several expressed concerns that if JCPH were to become a health district, the County would, over time, reduce its level of financial support to public health. At the same time, others felt that as a health district (and not administratively linked to the County), JCPH would have a greater likelihood of securing additional funding support and/or financial partnerships from the City of Port Townsend and Jefferson Healthcare. This was seen more as a longer term possibility than an immediate one. Financial Feasibility Conclusion TRG's conclusion from the financial analysis is that there are significant budget challenges facing JCPH that present a real risk to converting to a stand-alone health district at this time. The biggest of these is the recent reduction in 2008 County General Fund support to public health, which, when combined with the dwindling Fund Balance in the Public Health Fund makes the financial future for JCPH very uncertain. Regardless of whether JCPH remains part of the County or converts to a health district, the long term financial challenges facing JCPH need to be addressed. If not addressed, there is a significant likelihood that public health services provided to the citizens of Jefferson County will be • reduced. It is important to note that health districts in Washington State do not have the authority to levy taxes to support their mandates, unlike many other special purpose districts (e.g. fire districts, school districts, water districts, etc.) Therefore, regardless of whether Jefferson County converts to a health district, it will be dependant upon tax revenues generated by the State of Washington, Jefferson County, the City of Port Townsend, contributing partners, and the fees it charges for services. If the issue of local financial support for public health can be addressed, whether from the County, the City or local health institutions like Jefferson Healthcare, and if the Environmental Health fees are adjusted to include the administrative costs of the regulatory programs, then the financial feasibility of converting to a health district dramatically improves. However, without these assurances, the risks are significant. • Jefferson County Public Health Feasibility Study— Page 9 Prepared by The Royer Group V. Political Feasibility Review • Jefferson County Stakeholders Interviews As part of this Feasibility Study, TRG interviewed eighteen municipal leaders and local public health stakeholders to determine the level of interest and receptivity to establishing a health district for Jefferson County Public Health. Representatives from the Jefferson County Board of Health, Jefferson County Council, City of Port Townsend, Jefferson Healthcare, and Jefferson County Public Health were interviewed. While there was no clear consensus on whether to establish a health district, several interviewed felt that there were significant benefits to being a health district, and only one individual expressed opposition to doing so. The number one interest among all those interviewed was to maintain and improve the high quality of service currently provided by JCPH. Several of those interviewed felt strongly that converting to a health district was critical in order for JCPH to be viewed as a more independent and apolitical agency responsible for addressing the public health needs within Jefferson County. More specifically, it was expressed that as a department of the County, JCPH was challenged to engage the community in discussions regarding public health without the perception or political backdrop of having a County government bias. It was stated that JCPH is often seen as a County agency first, and a public health agency second. It is also worth noting from our interviews . that the current political tensions that exist between Jefferson County and the City of Port Townsend cloud the ability of JCPH to effectively develop expanded health initiatives and/or partnerships with the City. It was the opinion of many stakeholders that as an independent health district and Board of Health, JCPH would be better positioned politically to explore and create an expanded vision for public health as it deals with the changing demographics and long term public health needs throughout Jefferson County. It was also felt that as a district, JCPH would be better able to create expanded partnerships with other agencies involved in health related initiatives within the community, such as Jefferson Healthcare. There was also a consistent theme among those interviewed that as a health district, JCPH would be relieved of the administrative constraints of being a County department, thus allowing the leadership of JCPH to spend more time focusing on strictly public health issues. This is discussed further in the following section on Operational Feasibility. Finally, the possibility of creating a multi county health district with either Kitsap Health District and/or Clallam County Health Department was pursued in these interviews. There was almost no support for this idea, at least at this time. Most felt that there were too many differences among the three counties--ranging from • Jefferson County Public Health Feasibility Study— Page 10 Prepared by The Royer Group • demographics, to population size, to levels of local funding support, to governance--that would make such a multi-county health district a viable option. A few of those interviewed expressed that a multi county health district might be worth considering as a second step, should a decision be made to first create a Jefferson County Health District. Other Health Districts/Departments Interviews To obtain a statewide perspective on the characteristics and advantages/disadvantages of health districts and health departments, TRG interviewed six health districts and two health departments in Washington State. TRG also interview the Washington State Department of Health liaison to Local Health Jurisdictions. Among health district administrators, the most consistently expressed advantage to being a health district was their ability to operate with a "singularity of focus" or "purity of purpose." This was specifically in reference to being free from the general administrative responsibilities of a county department, thus allowing the health districts to undertake administrative duties and district initiatives that were clearly public health in nature, and not general county government duties/initiatives. • Another theme among district administrators was the increased ability of their Boards of Health to make decisions based on science, without the undue political pressures that come from being a county department. This was specifically in reference to decisions relating to septic systems, food establishment inspections, and other environmental health matters, especially those related to land use which in most every county is very political. There was also the feeling among some health district administrators that the elected officials, when convened as the Board of Health, were better able to focus on public health issues of the entire district, and with somewhat less pressure of the political interests of their home jurisdiction. They felt that the role of a Board of Health member for a health district (as opposed to a county health department), provides elected officials, and especially the county commissioners, a level of insulation from political pressures facing their respective jurisdictions, allowing them to reach their decisions at BOH meetings with a greater reliance on health science, and less on their jurisdictions' political issues (i.e. the county commissioners could more easily "take off their commissioner hat and put on their BOH hat"when serving a health district). Another advantage expressed by the health district administrators was having representation from the cities and general population on their districts' Boards of Health, thus providing a broader perspective on how best to address public health issues in their jurisdictions. However, this is less of an issue for the • Jefferson County Public Health Feasibility Study— Page 11 Prepared by The Royer Group Jefferson County Board of Health, given that the current composition of the 4111 Jefferson County Board of Health includes elected representatives from Port Townsend, Jefferson Healthcare and a non-elected citizen representative. Political Feasibility Conclusion TRG's conclusion is that there are political advantages for Jefferson County Public Health to convert to a health district. And there is enough interest in such a conversion that it is indeed politically feasible. The most significant political advantage is that it would better position JCPH to engage in a more apolitical series of discussions with their stakeholders throughout the county to determine and create the long term vision for public health in Jefferson County. The current distrust of the County's administration, especially from the City of Port Townsend, limits the ability of JCPH to pursue an expanded vision for public health without the issue of"being part of the County" coming into the conversation. As a health district, JCPH would more likely to be viewed as an independent public health agency with a singularity of purpose and mission, thus allowing the discussion of the future of public health in Jefferson County to be more broadly supported by the stakeholders throughout the county. • VI. Operational Feasibility Review While not explicitly part of the scope of work for the Feasibility Study, one additional factor that warrants discussion is the operational feasibility of converting to a health district. This came to light both in our interviews with the stakeholders within Jefferson County and our interviews with other local health jurisdictions around the state. It is important to note that throughout our interviews with the stakeholders in Jefferson County, there was consistent acknowledgement and praise for the quality of services and work done by the professionals and leadership with in the JCPH department. It is the opinion of TRG that this group could successfully transition to become a health district without a lessening in the quality of service provided. The overarching operational advantage to becoming a health district again speaks to the singularity of purpose, but in this case relates to the administration and staff of the health department being relieved of the non-public health tasks/assignments they are charged with as a result of being a county department. This was seen as a potential benefit not only by the staff in JCPH, but was one of the advantages often expressed by the administrators in health districts throughout the state. i Jefferson County Public Health Feasibility Study— Page 12 Prepared by The Royer Group S Additionally, as a district JCPH would be more nimble and flexible, thus better able to pursue the demands of a changing public health environment. A case in point here is the recent salary adjustments that were negotiated for JCPH nurses. This effort took two years to achieve through the county, primarily due to the need to conform to the County's collective bargaining procedures and policies for all county union employees. The responsibility of negotiating with the union was not given to JCPH, but rather was done by the county's labor negotiator, yet the costs of this settlement are in the 2008 expenditures for JCPH. One of the results of this delay was the loss of a very qualified long term nurse who went to work for Jefferson Healthcare. As a district, JCPH would have been able to directly negotiate with the unions and very likely not have reached a crises point. Operational Feasibility Conclusion TRG's conclusion is that there are clear administrative and operational advantages to converting to a health district. VII. Overall Conclusions & Recommendation It was clear from the outset of this feasibility study that the question of whether to convert to a health district was a complex one about which the Jefferson County Board of Health and the JCPH leadership were seeking additional information before engaging in a decision-making process on the matter. And, as TRG conducted its research, it became even clearer that there was no right or wrong answer to the question. There are pros and cons for both alternatives. What was also evident from the interviews with every stakeholder was that their number one interest was to maintain and improve the high quality of service currently provided by JCPH. As stated above, TRG's conclusion from the financial analysis is that there are significant financial risks to JCPH if they were to convert to a health district at this time, given the tenuous financial condition resulting from the 2008 budget decisions. This financial risk of converting to a health district directly translates to a risk to sustaining the level of service historically provided by JCPH. If this analysis were done in 2007 without the knowledge of the 2008 budget, the - financial feasibility conclusions would likely be different. However, the reduction in County General Fund support to JCPH in 2008, combined with an adopted budget that requires 65% of the $449,000 2008 Beginning Fund Balance to break even, significantly increases the financial risk of converting to a health district at this time. Regarding the political feasibility, TRG's conclusion is that there are indeed political advantages and it is politically feasible for Jefferson County Public Health to convert to a health district. The most significant advantage is that it • Jefferson County Public Health Feasibility Study— Page 13 Prepared by The Royer Group would better position JCPH to engage in apolitical discussions with stakeholders 40 throughout the county to determine and create the long term vision for public health in Jefferson County. Additionally, there does not appear to be any opposition to converting to a health district. Finally, it is TRG's conclusion is that there are real administrative and operational advantages to converting to a health district. Principal among these is the opportunity to operate an independent public health agency with a singularity of purpose and mission without the added administrative responsibilities of being a county department. Based on these conclusions, the foremost being the financial uncertainty of local funding support for Jefferson County Public Health it is TRG's recommendation that now is not a good time for the department to convert to a health district. While JCPH would benefit both politically and operationally from converting to a health district, the financial risk is too great and offsets the political and operational advantages. If, on the other hand, the long term issue of funding public health is resolved, TRG's recommendation would be to pursue converting to a health district. As a benchmark, it is recommended that the 2006 level of County and City finding, adjusted for inflation and increased medical care costs, be reasonably guaranteed for the next five years before any conversion to a health district is initiated. But if the 2008 level of local funding is a harbinger of future funding • reductions for public health, now is not a good time for Jefferson County Public Health to make the structural change to become a health district. i Jefferson County Public Health Feasibility Study— Page 14 Prepared by The Royer Group • REQUEST FOR PROPOSALS THE TRANSFORMATION OF JEFFERSON COUNTY PUBLIC HEALTH INTO THE JEFFERSON COUNTY PUBLIC HEALTH DISTRICT NOTICE IS HEREBY GIVEN that the Jefferson County Public Health is accepting proposals from firms specializing in organizational change/development, strategic planning, financial analysis, public health, and the ability to clearly communicate to decision makers. Jefferson County Public Health is the contracting authority. The resulting contract will be signed by the prime consultant and Jefferson County Public Health and the work will be directed by Jefferson County Public Health. Seven copies of proposals must be received no later than 4:30 p.m. on August 10, 2007. Late responses will not be accepted. Electronic mail, mailgrams, telex or facsimile proposals will not be accepted. The proposals should be sent or delivered to: Mr. Mike McNickle Deputy Director Jefferson County Public Health 615 Sheridan Street Port Townsend, WA 98368 Questions regarding the project scope and contents of the Request for Proposals • should be directed to Mike McNickle. CONTENTS OF THE REQUEST FOR PROPOSALS I. Introduction 2 A. Project Description 2 B. Desired Qualifications 2 II. Project Management 3 III. Budget 3 IV. Evaluation Criteria 3 V. Proposal Contents 4 VI. Selection Process and Schedule 5 A. Selection Process 5 B. Preliminary Schedule 5 • Request for Proposals 1 Jefferson County Public Health THE TRANSFORMATION OF JEFFERSON COUNTY PUBLIC HEALTH INTO • THE JEFFERSON COUNTY PUBLIC HEALTH DISTRICT I. Introduction A. Project Description Jefferson County Public Health seeks a qualified consultant and/or team to provide a feasibility study of whether Jefferson County Public Health (currently a department of Jefferson County) can become a stand-alone Health District. Jefferson County Public Health has received funding from Jefferson County for this project. Jefferson County Public Health already has an expanded Board of Health, which is a critical step in becoming a Health District. This end goal of this project is a report on whether Jefferson County Public Health, under current financial/contractual/political circumstances, can, or should, transform into a Health District. The report should also outline the steps needed to become a Health District. B. Desired Qualifications 1) Analyze whether Jefferson County Public Health should become a stand-alone Health District. ✓ Research existing Health Districts statewide and determine whether • institutional/political conditions exist in Jefferson County to permit the formation of a Health District. ✓ Conduct a financial analysis of Jefferson County Public Health and determine whether JCPH can afford to become a Health District, and if not currently, under what financial circumstances Jefferson County Public Health could become a Health District. ✓ Determine whether the current infrastructure (IT, building location, legal counsel, office space, etc.) would permit the formation of a Health District— and if not currently, under what circumstances Jefferson County Public Health could become a Health District ✓ Provide report showing research findings and make recommendations on how to proceed, or under what circumstances could Jefferson County Public Health proceed in the future, with instituting the transformation into a Health District by the end of October 2007. • Request for Proposals 2 Jefferson County Public Health • 2) Provide Education/Outreach Services to Community Decision Makers ✓ Post related information and report summaries on Jefferson County Public Health web-site for public information and access, related to project activities. ✓ Assist with special requests for information from the media related to project activities. II. Project Management A narrative description of your proposed management approach for this project must be provided. Include an organizational chart that lists the specific individuals assigned to each sub-task included in your proposed scope of work. A detailed resume for each person listed in the organization chartmust be included in the proposal. Please Note:It is mandatory that you identify the actual persons who will be performing the work. Jefferson County Public Health reserves the right to disqualify the consultant awarded this project if that consultant assigns staff to the contract that are not listed in the proposal without the prior consent of Jefferson County Public Health. Ill. Budget ID There is approximately $10,000.00 available for this project. The proposed budget for this project should include a detailed breakdown by each subtask included in your proposed scope of work that indicates: 1) the hours assigned to specific individuals and that person's hourly rate; and 2) the breakdown of hard costs associated with completion of the task. The budget should include the following assumptions: IV. Evaluation Criteria • Approach to Scope of Work (20%) The Selection Committee will be evaluating the proposed team's ability to accomplish the requirements of the scope of work plus any original ideas or approaches proposed that will enhance the project. • Qualifications of the Team (40%) The Selection Committee will rank teams' qualifications based on their past experience, credentials, and references. • Project Management (30%) The Selection Committee will rank teams based on the proposed project manager's experience and proposed approach to managing the project, as well as the overall organization and work distribution among the project team. • Request for Proposals 3 Jefferson County Public Health • Budget (10%) The Selection Committee will rank teams based on the ability to achieve the stated goals of the project. V. Proposal Contents All proposals shall be limited to 10 pages, not including the cover letter or resumes. The proposals shall, at minimum, include: ✓ A description of the proposed team, including a description of each firm and its qualifications to complete the assigned work. ✓ A proposed scope of work, including detailed sub-tasks and deliverables. ✓ A detailed budget and schedule that includes dollar amounts and deadlines for each sub-task listed in the proposed scope of work. ✓ Detailed project descriptions of past related work. Each project description should include: o Client name and phone number, o The names of the proposed team members who worked on the project and their role, o The budget amount allocated to the tasks assigned to the team members, • and o A specific description of the project and the product(s) delivered. ✓' Resumes for each person assigned work on the project, except for clerical or administrative support. Firms selected for interviews will be asked to supply work samples; please do not provide work samples with written proposals. VI. Selection Process and Schedule A. Selection Process The selection committee will consist of representatives of Jefferson County Public Health and Jefferson County. Mike McNickle, Deputy Director of Jefferson County Public Health, will manage the selection process, and he will be the primary contact between Jefferson County Public Health and the consulting teams submitting proposals for this project. The selection committee will evaluate all written proposals based on the evaluation criteria listed in section V. of this RFP. Each written proposal will be scored with a maximum of 100 points. The top 3-5 firms will be invited to participate in an oral interview in front of the selection committee. • Request for Proposals 4 Jefferson County Public Health • Interviews will be worth an additional 50 points. The evaluation criteria for the interviews and a request for selected work samples will be sent to finalists prior to the interview. B. Preliminary schedule (subject to change) ✓ July 27, 2007: RFP is advertised ✓ August 10, 2007: RFPs are due back to Jefferson County Public Health ✓ August 17, 2007: Short-listed firms are notified ✓ August 20-24, 2007: Interviews ✓ August 31, 2007: Consultant Selected ✓ September 3-7, 2007: Contract Negotiations ✓ September 10, 2007: Contract Signed/Project Kick-off • • Request for Proposals 5 Jefferson County Public Health a ., Wi II - eilit^{. k &___ _ ._ __ st f c ' -E. ' c„......, iy2:, ,,ft, 4 ,t...e_.),..r((a...:,,"I-72 VIi'di -— — - I.-`--- .__b.-�':�'' ' 1). _$ f� ) 6a:9,f� f h ( h D I - cpi),,Pi1 cAAr Q 3 MY COv1.0c'Ttat� 5 P - ,0r4\1G 7--1-3- iiej OAT, SQ.-�., A tP, o U ; ' (AJ I)CQQy tel„( 2- . 0 Si- , ut P /2-e (W f M UC.1.4 A CrP 6 S14 1k (1.k. 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"Public Health Heroes to be recognized,"Port Townsend Leader, April 16th, 2008. 3. "Kite Tip of the week: What to say when you observe a parent being harsh with a child in public," Port Townsend Leader, April 16th, 2008. 4. "Pinwheels recognize Soroptimists,"Port Townsend Leader, April 16th, 2008. 5. "Logic of love,"Port Townsend Leader, April 16th, 2008. 6. "Syringe exchange,"Peninsula Daily News, April 20th,2008. 7. "Smoke-free hospital is great," Port Townsend Leader,April 23`d, 2008. 8. "Abuse victim: Stop it by telling your story,"Port Townsend Leader, April 23`d, 2008. 9. "Candlelight vigil Sunday honors children in need,"Port Townsend Leader, April 23`d, 2008. 10. "Kite Tip of the week: YES,it is your business...,"Port Townsend Leader, April 23rd, 2008. 11. "Anderson Lake,tainted by toxic algae woes past two summers,set to open for fishing season,"Peninsula Daily News, April 24th, 2008. 12. "Focus on abuse,violence,"Peninsula Daily News, April 25th, 2008. • 13. "Smoking target of 2 Jefferson groups,"Peninsula Daily News, April 30th, 2008. 14. "Pledge to work to end child abuse,"Port Townsend Leader, April 30th, 2008. 15. "Help complete your family's `puzzle',"Port Townsend Leader, April 30th, 2008. 16. "'Our Kids: Our Business' a creative idea,"Port Townsend Leader, April 30th, 2008. 17. "Kite Tip of the week,"Port Townsend Leader, April 30th, 2008. 18. "Our kids: Our business—Pledge List,"Port Townsend Leader, May 7th, 2008. 19. "Kudos for'Our Kids' support,"Port Townsend Leader,May 7th, 2008. 20. "Coyle cleanup help appreciated,"Port Townsend Leader, May 7th, 2008. • �' a "J�1a�`''. � :� 3 � 'F_," '- 7'�k; $ Ft':N� r "t"� `� 't�,. rim yn$}d}F _`�,gy,d ,7a K'[' '.. . 'z.$ : y 4,r b *,� +*,S'r`i 't'•r4 ,�Sr +L x ..- r' • 1 x3 ,7 �L xi h , k„T RY F i C' 1 S ,,i_otitit... ,,,,,/ ..„:„. ... • '.c.°'.��'.r{'` ei � ` tw"'a°As ygs4f' 'S i�`Y'' "+° "c'' fY' b'^ ?w9�M �ro.µ 00...?b«�'"+ - 4,,.t. �.� . we, ;: rc^ 3 ..Pie • _ � � �„�,+�,�xt r', ti:.a ro-r"'�re 'p w yV...,..1.; at r'�` +y� 4..... 5. - �k' ' a it fl +.....-,,,,,,,,,,,,,,,t,-,....,,,,,,..., `',~b T,.., ,� �b �` � :-. ttfg.�3,,,y-F �,s ,ifz. c r ty''+, iR..r.. �.4 :� r. b' »'q` '"rev' s' xii, yy,,�'•; �' 3 • .-— ''';• -.V4.'•-;. :4.;!:<=4.iiliiti d • i.;.5itt.tit.1!:.1t!:'''/.!.!. .-i.''',Ac wa, '..'3§&*"- -. yy X9 1 u�2lit t .� 7. 4osio.y ,,, q. i � x 4a t s Oxy � 3 ax .?fit$7' rr ktt4 �1 .y : . � a e Ufa +)+�r 3 s s " ? r.` FOR THE CHILD•REN �? Soroptimists of Port Townsend/Jefferson County display birthda i s they children at Jefferson County Child Protective Services. Soroptimi gifts are vice president; Pam Street; referral coordinator and social w are donating to foster Protective from left, Ruth Gordon, Sandvig, board member of Guardian Friends; and Sherry Perry, coordinato of thelFoster Bies;Ella Project. rthday • • /P7 JV -V//''.57d67 Public Health Heroes oto be recognized • In observance of National Buhler for Community Health Public Health Week, April 7-13, Promotion,and Dennis Crawford, 'Jefferson County Public Health in the category of Community- honors ommp Special honors local public health heroes. based Organization. The annual Public Health Hero Recognition Award goes to Geoff award is bestowed on people who Masci. have made a significant difference The Public Health Hero in the quality of life in the corn- awards are presented at the munity through their exemplary Jefferson County Board ofHealth work and contributions that pro- meeting at 2:30 p.m. Thursday, mote good public health. April 17 at the Jefferson County Recognized as 2008 Public Courthouse, Conference Room HealthHeroes areShirley Williams 1.The public is invited to attend for Public Health Leadership,Jill the ceremony. • • Bete; ; /II.,,,„„,.. ?..... Healthy Kids, Healthy Families • . ....,„,.. i and a Healthy Community Kite Tip of the week: What to say when you observe a parent being harsh with a child in public: •'My son behaves like that sometimes,and I...." •'Isn't it amazing how children think they can get what they want by kicking and screaming?" •If the child is having a difficult time,divert his attention by engaging him in conversation. •If you are concerned about the physical safety of the child,offer assistance or alert the store manager. •If you know the parent,offer to watch the child while she/he takes a break,gets a refreshment,etc. •Find more tips at www.jeffersoncountypublichealth.org and click on the pinwheel. Adapted from Virginia Child Abuse Prevention Month Coalition For hWry,,Infornation, gottp:,www.Jeffer•soncountypublichealth.org Brought to you by: The Port Townsend&Jefferson County Leader,Jefferson County Public Health,Jefferson County Community Network,bepartment of Children 6 Family Services/Children's Administration,and the Jefferson County Meth Action Team. • ,;,,e R , ^k 07, ,iJ° 1I: .F ', io;,..,-'44 I l'F.V,f, -4,,,,,,,,,, x , �• . .* v,.;,gy� , ),4 B VK p/�+A JA911., ,4„ :0e yn ry •1Li tot vf , [4 r �t Pinwheels recognize Soroptimists Denise Irish of Child Protective Services recently made"pin wheel" displays recognizing the Soroptimists of Port Townsend and East Jefferson County for the group's Foster Birthday Project,which has provided more than 40 birthday gifts to foster kids since 2006.With the help of Irish and Nancy Schrader of CPS,Soroptimist members match up their monthly birthday gifts with each foster child's"wish" list.Pictured are(from left)Soroptimist Ruth Gordon,vice president; Pam Street, Ph.D.,M.S.W.and referral coordinator and CPS social • worker;Ella Sandvig,Guardian Friends board member and life mem- ber of Soroptimists;and Sherry Perry,Soroptimist coordinator of the Foster Birthday Project. Photo courtesy of Joy McFadden,SIA Logic of l Parents learn share ideas • By Blythe Lawrence ,_ , Leader Staff Writer Our Kids: (This is the third of a five part series :t �,Our Business relating to "Our Kids: Our Business," ,�"' Association,meets in the music a local effort to bring attention to child the Conversation. room at Grant Street on Friday abuse and sexual assault awareness.) „�,,,,,y,�,,,......y„wow�..,,,,,c,.�,,,a,,ti mornings.Classes are still open This is a storyabout a drills sergeant and free to all adults. Although all 12 Love and and a helicopter. index finger waving in the air, popular Logic sessions are important if a It can be tempting for well-meaning with many exasperated parents. parent can make it to even three parents to guide children too harshly, "So often in the old-fashioned way, or four, it's likely to be benefi- said Jeanie G a counselor at Grant it's like, `You do it,you do it now,'and cial,Braden said. Parents take time during ses- Street Elementary School,demonstrating if the kid doesn't do it,to respond with Bions to share their own experi- the"you-do-this"gesture,complete with See PARENTS,Page 4 ences using techniques discussed in class,and generate new ideas • e for dealing with problems. Parents: Developing strate g les being a drill sergeant,it's impos- Continued from Paget ,, ;. Bible for one to transform into a anger," d from ll said.It's a par- • s �� r� ' '` ,. `'` , '� consultant overnight. all ® • er- "Sometimes it's as easy as, erring style she refers to as"the • , ',m • drill sergeant.,, e hmm, can we try this again?, Equally tempting,she cortin- �tNy' s Braden said."We want kids who ued,is an opposite mode,where & a � she took it that she returned for are respectful,responsible and fun PPo 1giilr,.... f` Y atlo*se 3 n,, Dhow lei_• parents swoop in with cook- t gland LFA' , seconds,and now,thirds. to be around.To do that,you also les and comforts whenever the ° �' . na ' "w , ," "It's been an amazing tool for need to be respectful,responsibleheli slightest thinggoes a ` il ` f; being a more successful parent," and fun to be around." ill ' t i r asta Iage{A • is c 74 "There's this thought that I • she said."Each time I take it I The April 9 class focus e e�� air al sa s i t I learn so much more.It's a whole modeling and passing on values. can protect my child from all y 5 '. r kind of reworking about the way The biggest thing parents can the world's woes,"Glaspell said .n ; Meet the"helicopter parent." SD cho bong into . de foFtt'tj you think about parenting." do to pass on good values is to In the real world,both parent- 'Of. q s i k To see the Love and Logic demonstrate those values them- ing styles have problems:Beingi.gu' ' '�* 1 Y model in action,one needs only selves,Glaspell counseled. a"drill sergeant can lead chit- ° , �4 , ,-, �'-" to venture as far as the Grant "It raises the respect level in a dren to anunhealthy amount of ` " '' '• ' 4 3alon,l ,,, ,+ + Street office, where secretaries family,"Glaspell said. 41,1 submissiveness, while being a ,� • js'p�C ,otand counselors have mastered And when it comes to having "helicopter"gives kids an unreal A' list the art of talking to kids who a parent moment,it's OK to say sense of how life works. ,41 aren't feeling well or have been so,Greg Walsh contributed. "The problem with both of 4)4004,,,,,,,,:,1,30„,04.414114. 2,,,,,,,,,,„,„,eacting up in class,Glaspell said. "I just say,it's time for me to _ . . t14 those is kids don't do their own What happened? they ask. be dad,"he said. "It really sets learning," said Peter Braden, , Goodness,I'm sorry to hear that. boundaries." who teaches first grade at Grant ; What are you going to do about Parent Becky Nunn agreed. e a Ol it?How are you going to solve "I love that,"she said,trying Street. As much as one mightto . et _ these sessions,which follow the phrase, "OK, the mom not like to admit it,s"the road to +�Q� a k, this problem? out the wisdom is paved with mistakesr Love and Logic Institute's model speaks." and consequences,"he said. $e s Call of helping parents raise children. The process So did Glaspell. q Which goes for parents as welly p. t � The institute, founded by Jim The present Love and "You've taught me something i4 r Fay and psychiatrist Foster Cline, Logic series, funded bya ant today,"she said. as kids.So what's a parent to dol gi gr At Grant Street Elementary one ' st C- exual operates on the principle that from file Kitsap and Olympic (Next week Our Kids: Our morning per week, a group of • t- � `. e , children learn best when they peninsula Teachers Union and Business explores some success parents-occasionally with kids e f` are allowed to make their own the Washington Education stories in Jefferson County) in tow-meets to talk strategy. el Hca 3 t choices about smaller matters. There, they share experiences a "1 u r d Grant Street teachers got a t o- ne-day introduction to the prin- and things they've learned in the , �t„Mall c- iples of Love and Logic Bev- great adventure that is raising q t e' , , 4 „. seal years ago, Glaspell said. children. ' To... !�t-t' �, They found it so effective that The sense of making theirt , t 'e li n they began conducting Love and own decisions and dealing withr74.,411::'r 2 Logic classes at Grant Street for problems when things go wrong ��* _:., parents in the community. - coupled with empathy from • parents and adults-helps kids Jenny Allen,a Port Townsend take responsibility for their lives. mother of three,got so much d{tt A parent's role •in this is to act of Love and Lo Port the first time as a consultant, someone who is empathetic but unwilling to wave the proverbial magic wand 'ir e%;::t.c ,(-' and cure all problems. 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',-.' • r i , '' -., ' -, ' i ot • e', :Jefferson County Leader Weise ;Api 23,2008•t, Smoke-free hospital is great Editor,Leader. I applaud Jefferson Healthcare for voluntarily becoming a tobacco-free campus. Thank you to the hospital commis- sioners — Jill Buhler, Chuck Russell, Kathy Hill, Tony DeLeo and Mark Mauney—for supporting this policy. A tobacco-free environment makes a clear statement that good health and healthcare do not include the use of tobacco. Tobacco is the number one reason for avoidable illness and death. More than 440,000 people die each year from tobacco-related diseases.This is more than all alcohol,cocaine,crack, . heroin,homicide,suicide,car crash,fire and AIDS deaths together. Tobacco is a factor in heart disease, cancer,stroke and lung disease. Smoking costs the United States $96.7 billion each year in public and private healthcare expenditures. The United States loses $97.6 in 'productivity from smoking. Patients who smoke before surgery have twice the risk of infection of non- smokers. Smoking slows healing after.. surgery. A smoker's broken bones take almost , twice as long to heal. , By removing the presence of tobac- co at our healthcare facility, Jefferson. Healthcare shows commitment to sup- porting the health of all people of East Jefferson County and sets a good exam- ple. Freedom from Smoking tobacco ces- sation classes are offered free in April and May at Jefferson Healthcare. Call,, 385-2200, ext. 2300, to register. Call, 800-Quit-Now for more information olr quitting tobacco. III • KAREN OBERMEYER Tobacco Prevention&Control Prograt Jefferson County Public Hea ,t • Abuse victim : Stop it • • , by telling story By Allison Arthur Leader Staff Writerwit And Annie was that,too,a half-cen- y Our Kids: �ago. Annie was the youngest of nine (This is the fourth ofafive-part series ` r Business children.Her mother divorced her alco- relating to "Our Kids:Our Business,"a ' local effort to.bring attention to child it` a e Conversation. Takenae father before Annie was born. el- abuse and sexual assault aivmeness ' away from her uneducated Healthywl- Famines,Hea y April is both National Child Abusefare mother at a young age,Annie suf Prevention Month and. National Sexual "` fered emotional and physical abuse at Assault Awareness Month) the hands of a foster mother and sexual overcome the abuse, the odds and take abuse by a foster father. ADII1e remembers pancake Sundays control of their lives. —not in a fond way. When her real mother found her at "My definition of success is not the foster home, Annie was covered Sunday came around and her foster being a victim and reclaiming my life from head to toe with bruises. mother heaped more pancakes on her . and moving forward so my early child- "I had enough bruises on me that she plate than she could ever eat When hood doesn't play in my head,"she told was able to get me out of there,"Annie she stopped eating and started vomiting The Leader yesterday. recalls. It was the second.foster mother the pancakes, her foster mother would The truth is this: While there are who made pancake Sundays so horrible. force-feed her the vomit abuse survivors out there, not many of When she was reunited with her That's abuse.That's a memory. them want to share their stories or go family me Those days are over for Annie,now public because doing so is traumatic. life was "chaotie c,"with Annie's rmotherho a middle-aged woman in Port Townsend It's like living it all over again. working literally day and night to make • who considers herself more than a suc- The Leader isn't revealing Annie's ends meet in a two-bedroom home cess story. She considers .herself "a real name or her age in order to protect Annie shared with her eight siblings. miracle," and she's here to tell anyone her, just as it does victims of sexual "Oftentimes we didn't have enough who is a victim that like her they can abuse. See ABUSE,Page 11 • 9/aa3/oP . . Abu e s .,,,,,,„:„..„...„,„,,,,,,,„.. ® ® .... � � ,,,,,,,,,,,,„„, contloued from Paye 1 . So eat,"Annie recalls. But her 4 • mother had a friend with chit- o dren, and they would combine ®� �' r r i `P toA ifood to make ends meet. •0�. • 4 ;r Raped at 13 and molested "` a it most of her childhood, Annie P .y . e 4 : gpt married two weeks after she 'Awned 18. Although her first husband came froth a loving woman,"she said."I tell people 8amily,there was an incident that that they have to learn to forgive ended the marriage. themselves for feeding them- e Annie recalled she was just selves the negative information horsing around. "I dinged him long after those people are in With a spoon and he kicked me. their lives." I,was so shocked that I said, Annie also had to learn to .Nope, you're not going to do trust people. "I learned to trust that.'That was the beginning of other people. Children raised the end,"she said of that mar- in alcoholic homes learn to not riage.. trust and not tell,"she said. 5; So what's the key to success, A girlfriend of 40 years and to surviving, to Annie becom- her husband, who had 11 chil- ing a social worker and helping dren, were mentors and people others? she learned to rely on. She also "The first step is seeking says that she discovered while help.Tell somebody. Once you doing social work that she was tell one person,it's no longer a capable of doing more than what secret,"says Annie. she dreamed of doing. A moment-of-truth day came In her work now,Annie says when Annie was about 36 and she sees families who are in pain her sister told her mother that it and she also sees people who (bas Annie who had had taken have turned a blind eye to abu- te brunt of the abuse in the sive situations. ster home so she,the smaller, To all of those who are suffer- 'cMieter and older girl,wouldn't ing abuse now,Annie sends this be hurt.All three women started message eYou Can • blying,Annie recalls. "' There's nothing that you can't r4 Truth. Talking to her sister, overcome...Sometimes it takes to her mother,to a therapist and a long time to find your way out, Ltounselor,to mentors who'sup- but there is a way out." grrted her,to others in support Now on her own after two oups.Talking helps. marriages and three children . And when she went home — she left her second husband one time she saw a photograph as well because she didn't want f the family, all nine children, to live any more of her adult and she realized her mother had life in fear—Annie feels she has done pretty dais good. succeeded not just because other "All nine kids were success- people say so. ful," she said. "It was really "Coming from where I came a freeing moment.'I looked at from,I feel like I'm a miracle," her and what she survived. She she said,sounding like the con- really was my hero.I don't know fident woman others see her as if I could have done it with nine now. children,"Annie said. "It took me 25 years to be „ Today, there's more help able to eat pancakes. I can eat g'ailable than her mother had them now, but I stop when I 1(} the 1940s and 1950s, more don't want any more." figsources available to people in liie community.' Although Annie sees her pother as her hero, she also pgys her mother was emotionally neglectful and didn't realize that her comments had a big impact en her daughter — comments .bout how Annie was the reason s)le had the nervous breakdown and Annie was the reason she divorced her husband. III n, Those negative comments led Annie to have a negative self- Jnage. She says she used to took in the mirror and see a 300- pound unattractive woman. "It wasn't until I was 40 I discovered that I'm an attractive • Port Townsend&Jefferson County Leader • Candlelight viit g Sunday honors children in neeI d A candlelight .vigil on ISunday, April 27, marks the ,s Our Kids: end of the social awareness blur Business I--- and prevention campaign in Start the Conversation. Jefferson County called"Our Zi Kids:Our Business." He+''yKw..H hhyFaallk+.MetltyCommunity The vigil takes place from zb 7:30 to 8:30 p.m. downtown The local campaign at Haller Fountain and honors helped focus attention on the children, youths, women April as National Child y2 and families who are in need Abuse Prevention and Sexual in our communities. Assault Awareness Month. • • dF ,: . ,,,... FX1 ` Healthy Kids, _, Healthy Families and a Healthy Community � .s Kite Tip of the week: • YES, it is your business... Maybe he's your friend,your brother or brother-in-law,your cousin, co-worker:gym partner or fishing buddy. You've noticed that he interrupts her, criticizes her family,yells at her and the kids,or scares them.You hope that when they're alone,it isn't worse. The way he treats them makes you uncomfortable,but you don't want to make him mad or lose his friendship. You surely don't want to see him wreck his marriage,hurt his kids or have to call the police. What can you do? Say something.If you don't,your silence is the same as saying abuse is okay. He could hurt someone,or end up in jail. Because you care,you need to do something...before it is too ,late. bomestic Violence/Sexual Assault Program of Jefferson County 360-385-5291 Available 24 hours a day For more information, go to: www.jeffersoncountypubiichealth.org Brought to you by: The Port Townsend b Jefferson County Leader,Jefferson County Public Health,Jefferson County Community Network,Department of Children Q Family services/Children's Administration,and the Jefferson County Meth Action Team. • III Anderson Lake, tainted by toxic algae woes past two • summers, set to open for fishing season By Jeff Chew and Paul Gottlieb, Peninsula Daily News Article published April 24th, 2008 PORT HADLOCK—Anderson Lake—which has been threatened the past two years with unpredictable, recurring outbreaks of deadly blue-green algae—is scheduled to open for trout fishing season on Saturday. The good news for freshwater fishing on the 70-acre lake comes as some Jefferson and Clallam County ocean beaches on Thursday were closed early by paralytic shellfish poisoning, or red tide. Jefferson County water quality officials today awaited the lab results of water samples taken from Anderson Lake earlier this week. Anderson was closed after a short fishing season last year. It also had been closed in June 2006 after two dogs died from biotoxins when they drank the lake's water. The lake inside a state park will open to fishing at 5:30 a.m. Saturday, said Mike Zimmerman, Anderson Lake State Park manager. Jefferson County Environmental Health officials have posted a cautionary sign at the lake's entrance, warning those using it not to drink, swim in, water ski or allow their pets in the water. • "It does not appear bad enough to prevent fishing,"said Zimmerman, adding that fish caught in the lake should be cleaned as soon as possible and their internal organs discarded. Biotoxins in algae levels in two other Jefferson County lakes, Leland near Quilcene and Gibbs in Chimacum, have been determined to be low, but county water quality specialists advise residents to take precautions before coming into contact or drinking water from the lakes. No lakes in Clallam County have been tested for biotoxins. Clallam health officials conduct visual monitoring and said they would respond if a person or animal were sickened by collecting samples and submit them for testing with the state. Early red tide In Jefferson and Clallam County's ocean waters, meanwhile, an onslaught of paralytic shellfish poisoning has closed key beaches to recreational shellfish harvesting. Those beaches include Port Townsend, Kilisut Harbor between Marrowstone and Indian islands, and Mystery Bay at Marrostone. Closed to recreational butter clam harvesting in Jefferson County are Port Ludlow Bay, Discovery Bay and Mats Mats Bay. In Clallam County, only butter clams have been marked as dangerous to consume in Sequim Bay and along the Clallam County shoreline of Discovery Bay. • "The news is Mystery Bay and Port Townsend,"said Neil Harrington, Jefferson County Environmental Health water quality manager. "It's early. Last year they never closed. Usually it's late May to July when red tide closes it. • "It's really odd that we didn't have a (red tide) bloom last year, and here it is April, and it's been a cold April." The state Health Department has posted warnings on its Web site at www.doh.wa.gov. Paralytic shellfish poisoning, or red tide bloom, "Red tide has more to do with ocean currents, circulating into shoreline,"said Tom Locke, Jefferson and Clallam County health officer. "It may be connected with current patterns offshore. "Red tide may not be from human impact. Rather it's from mysterious processes in the ocean." Algae precautions Water samples will continue to be taken and tested each week at Anderson Lake, Harrington said. "It's been up and down this spring,"he said of the lake's water quality. "It was down last week, and then [Tuesday], when our folks were up there, it was fairly clear and a scum had formed. Then we came by later and it was gone. 'What we're advising people to do is just be cautious." Blue-green algae tends to grow in warm weather. • If biotoxin levels reach potentially dangerous levels, Harrington said, then county and state officials would have to discuss possible closure. "Fishermen have been calling us a lot now[about Anderson Lake],"Zimmerman said. Health officials have said they don't know why the algae grows in Jefferson County lakes, the source of the nutrients fueling algae growth or the reason that benign blue-green algae will begin producing toxins. Algae blooms, which occur naturally, are fed by an overload of nutrients such as nitrogen or phosphorous. Possible sources of such nutrients include fertilizer or human or animal waste. Jefferson County Public Health recommends closure of lakes when toxic levels reach more than one part per billion. Anderson Lake was the first lake in Jefferson County to be found to have lethal levels of toxic blue-green algae. Jefferson County Editor Jeff Chew can be reached at 360-385-2335 or jeff.chew@peninsuladailynews.com. Last modified: April 23. 2008 9:00PM il -t k i 1 9,. • > ^ } �yy 3R4 1,,,..' b • ..•,,,,c..-� y4-- 3 *s' w s"` tag ,p. "d �r1 R' «� tF ke 3 t �` 1 % 2 ax�a 1"•,-.7 `teti ".3. t " i . ' xi y � f; „ t S g k A R' � �rg' ,.�/ ,,yy3 y'g7,� C'$ „,,,:::%.4.-,,, 1 sr $�s ; {gam' y '� '' ¥I + ��' � .It q. ";'t .,;1';' �Y` �. „„ qq�� � .�i t�. i 1 3 �. Y'. ;"-:.t,- , sK .:'''::;;'47147'.77.7,7 .. ' .. 4 : '‘.:,::-..i,i4•:,,,,zi..,.,,-;. :,-.!„..-,-,2,-._:,-,2:.,---,,,,„:- :.„I 1 ,fiff,', ,', i,,,,i,_.?„.,4„,-„,:-,,,,,,, 111 t `2 'k f ” <` + t j fF,,, tea=/ a . y �, A 9 .Jst1 ..614:41,140;15:' .".0:,.,,,,,. . ' P.-,4,. ..--,*--.,..•.-: I , .ogam^ E-1' ,, , a T � / • t c =a , s S aeNi ' JENNIFER JACKSON/PE,\S,,J_',F^.L, Rachel Lee,standing center back In black,tries to persuade her mother,played by Chetah MacCalla,to give her a ride to school after missing the bus and falling to raise a response from her hung-over stepfather, played by Mickey McKinney,on couch,right,In the Poetic Justice Theater's Interactive skit,"A Day in the Life." Focus on abuse, violence Group helps "This is an opportunity to connect healthp rofessionals Lima of Jefferson Countv Juvenile Services led a session PTkids make with students." based on an anger-manage. JUIIE?Amnon ment class they teach to juve- better choices conference organizer nils offenders that has reduced recidivism. prevention specialist with the a medical explanation of how "We're trying to prevent BY JENNIFER JACKSON Jefferson County Health people become addicted to Poor choices that lead to crime PENINSULA DAILY NEWS Department, organized the drugs. and violence,"Munich said. PORT TOWNSEND — It conference. Beth Mosely,a retired Kit- "This whole campaign is happens every day in every It is part of the health sap County chemical depen- effective in raising awareness. community. On Thursday, it department's monthlong"Our dency specialist, showed dia- "It's also good that kids see happened here. Kids,Our Business"campaign grains of how brain cells trans- us in this setting,and see that Ricky, a high school stu- to raise awareness of the root mit messages and how alcohol we care about them and care dent, missed the bus for the causes of child abuse and sex- and drugs alter that process. about their future." third time this week. ual assault, said Kelly Mat- "I have a passion to do His mother, busy getting lock, prevention coordinator something about drug and Other events ready for work,told him to ask for Jefferson County Health. alcohol abuse and how it's The "Our Kids, Our Busi- help of his stepfather,who was "Chemical dependency is destroying our youth and soci- ness"campaign also included too hung-over to give him a one of many issues figuring ety,"Mosely said. an April 14 Town Hall meeting ' 'in contributing to domes- When Ricky arrived late for especially neglect," Matlock tic violence prevention." . on how adult drinking and class, the teacher lectured said drugs influence teenagers, him, then threw him and Alcohol is a legacy that Discussions Matlock said. another student out of class contributes to the continua- The Jefferson County His- for tion of violence in the home." Lisa Modelle Bottomley led art e l Society sponsored an talking. On Thursday,olencea discussion of violence in art exhibit bystudents on the Outside, the classmate juniors and offered Rickysomepot,saying seniors explored ways to deal movies, music and media. ;theme,and Dot Kelly ofJump- seniors will make r g withproblems created byd Renee Archement, a dependency '.Star Mouse ere o sed Main It Will Ricky's life continue to y membe s County chemical -"Street members on ways to functional family specialist, talked to students go wrong? through an interactive play,"A approach adults who are Dayin the Life." about teen depression and sui- exhibiting abusive behavior Luckily,Ricky is a character tide. Elizabeth Bloch, dis- in an interactive skit, "A Day It was presented by Marc cussing hope and hopeless- towards children. in the Life," a scenario that Weinblatt and the Poetic Jus- ness, told students that the Matlock said the"Our Kids, was started over again and tics Theater players, aug- choice depends on what you Our Business" campaign was rerun with different outcomes. mented by two Port Townsend tell yourself about past events modeled after a similar pro- ' Staged by the Poetic Justice High School students, Mitch and experiences. gram held last year in Theater at Port Townsend Lovett and Morrea Render- "No one can take away our Spokane,which did not have a High School, it was part of a son' value of ourselves unless we school component. two-day conference designed Together, the troupe came choose to believe that some- I think the schools are a to get students to take asst- up with the skit about Ricky's thing in the past is more real critical hub in the commu- and look at the choices life day, asking students to raise that right now,"Bloch said. Wily,"she said. throws them. their hands and say "Stop," In one classroom, students They have the responsibil- The conference will con- when they wanted to take over heard from two young adults ity of educating our children, tinue today. a role. pastand are a keyplayer about situations that led P Y r in nur- • `We're inviting you to work them to try methampheta- turing our children." How to help youth out what you're going to do mines:when you walk out that Drug use,alcoholism,child se ,both now "There's a lot of good heart, Weinblatt told the students. in Tae two treatment kers program, haviolence PP every dayc in every a lot of good talk about how to "It's a rehearsal for life." talked about the hallucina- community. help the youth in our commu- Freshmen and sophomore tions,twitching,paranoia and Port Townsend health offi- nity,"said Julie Marston,one students are seeing the the- weight loss that resulted from dials and teachers hope that of the organizers. atrical presentation today. meth use. today's lesson means it hap- ,P. 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Tc G a „ E n^ oa� F :,,,r.- 1 � 1° o,Q ° bCdGcV U NepN p'� ° p1r :c N Tyc oa dvI ' ` `' uv` '— BY N 6AC c~ g,,CCy> er .0o3 . N °' ebw9L :° EN '- Uk- aTa -s ° c . N > vaetJ// C o• s ' o ~wb N > ci0sW N u 8TON VE 2 c _ g vT+ 7tpL 1GV •� U ° � W P W.O aO P. p w Ov v cdmyWl dOu 3 tgW i oyoyga vo ° " Ei 1 = Ob ° v�" ocv ,r aagc ° �v— o _`` OiO3V v a° o 3Tgo Eow ^ E'.° 0 Xx a° g ua o 5 t w 6 c�� � ^ d Q rQ0m3 > nv ceaI ' re' 3 'b yz , —vid gvi0` C s -g g":' 114' a>i c1ldwv 'E > g !it oZ 113 •&c1 o 4a �N'53 iS •�F0 • 'Our Kids: Our Business' a creative idea. Editor,Leader: On a recent visit to a friend in Port Townsend, I was very impressed with the community's actions to sup- port children. First I noticed many of the employees in the grocery stores wearing a pin that said:"Our Kids: Our Business."When I asked about the pin, I was directed to a"Call to Action"that asked people to make a pledge to take some action to improve the community for-youths. How refreshing to have a pledge that asks for positive actions. rather than money. Then I read an article in the paper, because ofthe"Our Kids:Our Business" image next to the article,about a parent- ing class that was,being offered. When I made a comment to my host about this,she told me I needed to see the pin- • wheeldisplays in the courthouse.There I saw pinwheel displays that honored programs for youths,and I was told that these displays were all over the county. This effort on the part of your busi- nesses, community agencies and the paper to work together in a small town to make things better for kids is a cre- ative idea.It is one that I would love to see happen in my small town. VICTORIA CAMP Leadville,Colo. • s ; Healthy Kids, , . • z�. Healthy Families and a Health Communi 41 . „:.. ,, „,,, = y tY Kite Tip of the week: Our community has the power to influence choices gq° young people make and help them become caring, itt0 . responsible adults.We can do this for youth in many a' "' ways,some of which include: # 4i • Empowering youth by showing that we value them. 4. Y ' Ask their opinion. d " •Provide clear rules and consequences.Neighbors share responsibility for monitoring young people's behavior. •Parents and other adults model positive,responsible behavior. •Young people spend three or more hours per week in sports, clubs,or organizations at school and/or in community organizations. Learn more about how communities can help kids through developmental assets at www.search=institute.org. 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. • , 1111 /Praii.die., y/?,,,/d, We pledge to put into action • our commitment to healthy kids,healthy families,and a healthy community, n A• 6 e � B :9,..;,'.' J s tli ,'':0-° QrS4n r3 t . 4.7 . -' � " - n 3 Rc7 x 1:0.1, d t ,Tk.„ t¢ su H fn7 t ' t, , ',' p, M'_ 1 d i d p l ® I 9 'fie rdt€i 1061424A #lassea0 1, ,;,;: 1 ,,« >]efhrfgrttaulLtjr 7 v ist ,. :10efe6on4augH} - a s 5)0454 Couliti, I- , - �lIF 4:,,,;,-:-.:,,, �`�6Y�gtF �. I�£ 4-400* � a� Id s : r Y°� ,Xtri �47' ,z«> RA qfB v T'rt .:`., r x2't 1e4 3 i':11:4�x Abbie Little Dave Winegar Karen Cartmel Patricia Gora AldrythO'Hara David Alvarez Karen Manier Paul Smith Alex Little David Sullivan Karen Nelson Paula Hill Allison Spiceland David Timmons Karen Obermeyer Payton O'Meara Alyssum Purkey Debra Bouchard Kari Binns Peach Stebbins Amy Paselk Debra Roberts Kathleen Legarsky Peggy Albers Andrea Dandal Denis Langlois Kathy Luch Phil Burwell Angel Duerst Deyi Noltemeier Kathy Shipman Phil Johnson Ann Bambrick Diane Morency Kathy Stevenson Phyllis Synder Ann Knox Don Kaye Kelli King Quen Zorrah Anna Mclnery Dott Kelly Kelli Parcher Rafael Urquia Anne Steurer Doug Goodman Kelly Matlock Randy Marx Anne Winegar Dyrklansdon Kelly Von Volkli Rejane Mintz Barb Matter Ellen C.Peterson Ken Clark Robin Kitchen Barbara Carr Elsa bolts Kim Aldridge Ruth Gressley Barbara Waterbury Erin Brown Kris McCarthy Sabrina Hathaway Decca Lupton ford Kessler Kris Raikes Sandi Eldridge • Betty Johnson, Hank Walker eckSandra Flaherty Sandy Short Dill Rush Hilary MetzgerKristinDer Kurteckh Bill Tennent Holly Shepherd Leah Stollar Sara Murphy Bob Archibald J.Briar Kolp liannePerron-Kossow Sarah Smith Bonnie Eissinger J.Kimber Rotchford Lies'Slabaugh Sarah Young Brace Marston James Roberts Linda Middleton Shane R.Seaman Brwyn Griffin Jan Hopfenbeck Linda Pfafman Shannon Burns Carla Abrams Jane Kurata Lisa Madelle Sharron Sherfick Carol Brannan Janet Emery Lisa McKenzie Shena Kellewea Carol Hardy Janet Holbrook Loma Delaney Sorcha Ashling Catharine Robinson Janie Nelson-Clark Lyn Hersey StacySouza Chauncey Jean Baldwin Tudhope-Locklear Jean Pugh LynnyTa Taylor SteveRoe auer Cheryl McClanahan Jeanie Glasell e Steve Kraght P Maira Leon Steven Kraght Chris Kluck Jeni Little Marie Killian Susan Jacob Chris Ota lender Taylor Marjorie Boyd Susan O'Brien Connor Dailey Jennifer Huskey Marty Johnson Susan Parke CoryStollar Jenny Manta Mary Jo Mackenzie TamiPokomy Courtney Roberts Jessica Rice MaryMikelson Ted DeBry Cynde Marx Jim Doros MaryAnn Seward Terri Martin Cynthia Koan Jim Singleton Matthew L.Tyler Tod Wakefield D.Allis Joan Gitelman Melanie Bozak Tom Locke Dan Goldstein Joe Von Volkli Melissa Nixon Toni Walker John Austin Michael D.Brasfield Tracy Nichols John Dodger Michelle Farlan Trely Watford Josephine E.Holmstedt Michelle Moore Troy Surber Judy Surber Michelle Sandoval Veronica Shaw Julie Dalzell Mike Beers Violet Nelson Julia B.Cochrane Molly Pearson Wendy White DUr Julia Danskin Nan Toby Tyrrell Yuko Umeda Julie Archibald Nancy Speser Yvonne Cleveland kids: Julie Marston Norms Stevens Yvonne Starkey Our business Junne Seela Pat Scott K.Anderson Pat Teal "No one person can do everything,but everyone can do something,and together we can create change for the better:' • 127 e , c Kudos for 'Our Kids' support Editor,Leader: Kudos to The Leader,the businesses and agencies that are supporting the "Our Kids: Our Business" campaign. As a past chairwoman of Jefferson County Community Network and the Healthy Youth Coalition, I am thrilled to see all of these different parts of our community working together on the issues of child abuse prevention and sexual assault awareness. It takes a vil- lage! .l I • tt) .tLJ HOLLEX\»CAltlygiV Port Townsend • „7-125,/, f � JhA C -•-,' c ° 7q .2 '7 ,_>.,,c.?.. . 1:31) .g •s .n .8 .6 *,--' -7: .=. 2 .45, O ,-, a) 7 v a CC 7O ~ d GO 4aL CO `b d O O L ,O? u � 1 on v oT'O � 4, C"�j V c v-• r •- � � mo .4c a -0 -0 411.0 • •) oy ] aa' y — g &° •, ° O yA N y' pWq R • ; INS • •-•4 0 3- -,9, s 2,,, 5 74 Fl gig ., > (LP r a ? ? U t .• g ox cFx . •=,, x ° bCC `D L .0 ba° . 'b N , y Yco O Xi ox ¢ S a CD $7.14C7:$ .-g- 1 C Iv?! m>, t O C ii:• Cilc oS �... o c 3 F o tea _ «., gt . I:: 7-1, a • ' a) RflPi O iH11ij var .D U I. N ti ° C x 0 Oe, ° gy, 8 .+ N N G � .EpaS ° ..Ena) >Wv , . . . . bo_ O O C w ° r� g •x ) 2 � a .S • 3 b * 6, • " > u •v a, a> v 75 b x u a. 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N o g v .s3 - a, >, m iUo03yuoyo Fp c> " cEodv' ,00v 0v 'o = m 6 aiAo ° c'8. •av ¢1,)-E �rxo ❑ 0x 1.o1 >.. * 1 ca) vv, , a, NC4 ,gpv .g:41-K.411, v jo EaxEiouo i.0 0 FyosiUv 2.A8 $ 1`'iwvsu .acy.5aAv. Nos ° xwNU • • Coyle cleanup lected from Coyle Road on Earth Day. Assistance was also provided by Marjorie Boyd at Environmental help appreciated Health; Al Cairns, solid waste coor- dinator; and Michelle Ham at Public Editor,Leader: Works. With their help, our crew Our community along Coyle of volunteers removed hundreds of Road wishes to express apprecia- pounds of roadside debris from 16 tion to deputy Brian Peterson of miles of county road. the Jefferson County Sheriff's Office Thank you. for providing manpower and equip- S.RUSSELL ment to remove debris that we col- Coyle i S i 7/ dw • s`, r. c. u' al O z 13 CIM • D D ( E cit m Z a G) 73 So o 3 � 3 CD rrirt F. 6+ 0 N Cn 410 C L