Loading...
HomeMy WebLinkAbout2008- October File Copy • Jefferson County Board of 3 feaCthi Agenda .BVI inutes • October 16, 2008 • • • 0 • JEFFERSON COUNTY BOARD OF HEALTH Thursday October 16,2008 2:30 PM--4:30 PM Pope Marine Building 100 Madison Street Port Townsend, WA 2:30 —4:30 PM DRAFT AGENDA I. Approval of Agenda II. Approval of Minutes of September 18, 2008 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. Public Health Funding News 2. Letter re: Mental Health and Substance Abuse Treatment Funding 3. Public Health's "A-Ha" Moment • V. New Business 1. 2008 Standards for Public Health Practice: Jefferson County Public Health Site Report 2. Immunization Program Update: Immunization Program Review, 5930 Funding Activities, and Adult Vaccination Program 3. Substance Abuse Advisory Board Presentation 4. Public Health Fee Discussion 5. Expedited Partner Therapy Program VI. Activity Update VII. Agenda Planning VIII. Next Scheduled Meeting: November 20, 2008 2:30—4:30 PM Pope Marine Building 100 Madison St. Port Townsend, WA 4. • CA*11 JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, Sept 18, 2008 2:30 PM—4:30 PM Court House, First Floor Conference Room, Port Townsend 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 Andrew Shogren,Environmental Health Director Chuck Russell, Hospital Commissioner,District#2 Julia Danskin,Nursing Services Director 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 Court House, Port Townsend, WA. Members Present: John Austin, Roberta Frissell, Phil Johnson, Chuck Russell, David Sullivan, Sheila Westerman Members Absent: Michelle Sandoval • Guests Present: Frances Joswick, Substance Abuse Advisory Board Staff Present: Jean Baldwin, Dr. Thomas Locke, Andrew Shogren, A quorum was present. APPROVAL OF AGENDA Roberta Frissell moved to approve the agenda and Chuck Russell seconded. The agenda was unanimously approved, as written. APPROVAL OF MINUTES Dr. Locke said that approval of the June 12 minutes had been deferred until information could be obtained from Mr. Andy Brastad. He read the updated information aloud: "Mr. Brastad stated that Clallam County spent approximately $50,000 the first year on facilitation and stakeholder group in development of the 0 & M Plan. The $50,000 was part of an approximately $100,000 grant from the Department of Ecology." Sheila Westerman moved to approve the June 12, 2008 minutes, as amended. The motion was seconded by Roberta Frissell, and approved by unanimous vote. • Page 1 of 8 September 18, 2008 Sheila Westerman moved to approve the minutes of August 21, 2008, as submitted. The motion was seconded by Phil Johnson, and approved by unanimous vote. • PUBLIC COMMENTS There were no public comments. OLD BUSINESS Quilcene Bay Oyster Harvest Closed Due to Vibriosis Risk Dr. Locke stated that Vibriosis risk is becoming an annual occurrence in Hood Canal and other areas of Puget Sound. The Vibrio organism tends to proliferate in warm weather, particularly in shallow tidal areas. Ingestion of infected oysters can cause serious human illness including diarrhea, intestinal cramps, vomiting, and fever. Skin rashes and skin infection can also occur from wading or swimming in water where Vibrio is present. Dr. Locke said that the State of Washington has enhanced its monitoring, testing and shellfish closure procedures in recent years. Dr. Locke said he knew of at least one case of intestinal infection and one skin infection have occurred in Jefferson County this season. DOE water samples/cultures are showing increased Vibrio levels, as well. Case counts are compiled at the end of the season. West Nile Virus Activity in Washington State Dr. Locke reported that there have been almost 50 positive mosquito pools, 14 horses, and • numerous birds carrying the virus found in Eastern Washington. One human case was discovered in a blood donor. Jean Baldwin said that earlier in the day there was also one reported case from Seattle and one from Yakima. The Seattle individual had traveled extensively in Eastern Washington. Dr. Locke said there appears to be increasing activity in Eastern Washington, and the season typically lasts through the end of October, i.e. until the first hard freeze. He noted that there are many variables, but thus far Washington State has had some of the lowest West Nile activity in the continental US. Chair Austin asked if blood centers typically test for West Nile virus. Dr. Locke said that they do. About 80% of carriers do not know they have the virus; potential blood donors can pass it on without knowing they have it. He said there had been at least a dozen cases of West Nile inadvertently passed on to others through blood transfusions before screening was employed. Implementation of E-Onsite in Jefferson County and Homeowner Inspections in Clallam County—Follow Up Report Andrew Shogren, Environmental Health Director, introduced Angela Pieratt, Environmental Health Specialist. He said that this presentation would include a follow up to the presentation by Andrew Brastad's June report on Clallam County Homeowner Inspections. Ms. Pieratt stepped through a slide presentation on Clallam County's code revisions, their homeowner pilot project, 0 & M implementation and training. • Page 2 of 8 September 18, 2008 Clallam adopted the revised code on August 19, 2008. She pointed out highlights of their code: • new Homeowner Program; new Professional 0 & M program; Inspection at time of sale; and new Inspection for Land Use/Building Permit. Homeowner Pilot Project—Before the code was adopted, homeowner trainings and classes were held. The 8.5 hour one day class was free to participants; 120 spaces were available. Funding was provided by a grant from the Washington State Department of Health. The total cost, which included administration, staffing and provider fees, is estimated at about$200 per participant. Training was for conventional, permitted, gravity systems only. The provider is WOSSA, Washington Onsite Sewer Association. WOSSA supplied the original estimate for Jefferson County homeowner classes. Staff members who attended the class in Clallam County said the class was very well done, which was also reflected in high ratings based on evaluation forms. Ms. Pieratt noted, however, that thus far relatively few inspection reports have been received from participants. Member Westerman questioned whether there was information indicating that such as class could be done at a lesser cost. Staff indicated that it may be possible to shorten the class to 5 hours. Much of the time was devoted to safety and very basic information about septic systems. Clallam future plans for the class are uncertain at this point. O & M Implementation—Clallam County does not plan to implement enforcement until the entire program is up and running. Although the Homeowner program is limited to systems under a certain size, the number of inspections per person is not limited. Electronic submittal of inspection reports (E-Onsite) is available. A fee structure has yet to be determined. • Future Homeowner Trainings—Education cation and training will be required. Training and testing must be approved by the Health Officer, and will be offered if grant funding is available. There was mention of a special program that will be offered in December for septic systems of special concern that is separately grant funded. They are presently focusing on conventional and pressure system types, and will issue an RFP for training and materials. In the case of systems in Marine Recovery Areas or unpermitted systems, initial inspection must be done by a professional. Building/land use activities require inspection by a licensed designer. Member Westerman asked for clarification on the process and expectations regarding submission of the reports by the participants in the pilot. Dr. Locke said that participants had signed an agreement to submit reports electronically, and that input was essential to the evaluation of the training and program. There was a brief discussion about State deadlines. Jean Baldwin stated that the effective date for the new state 0 & M mandates was July ofd 2.007, Ms. Pieratt then described the work that had been done on the Jefferson County database and website application enhancements via recent grant funding. Permits dating back to 1974 - 2004 have been scanned and made accessible in a database. More recent permits, as well as those from 1970 - 1974 will also be entered. Tidemark is the permit database that is used by the Health Department and Public Works. eOnsite.net is an internet driven database system that has • been designed and developed to support local health jurisdictions. She walked through a series of screens and functions that are used by staff for reference, for permit processing, as well as for Page 3 of 8 September 18, 2008 professionals (and possibly homeowners) to submit inspection reports online. The public can access parcel and permit information, etc. Eventually, there will be convenient linkage among the three websites employed: www.co.jefferson.wa.us ; www.jeffersoncountypublichealth.org; • and eonsite.net. The number of cases in the database is about 8,000 out of about 11,000 known septic systems in the County. Breast and Cervical Health Program "Girls Night Out" Fundraiser Julia Danskin described this fundraiser scheduled for October 2 that is sponsored by Jefferson Healthcare Home Health and Hospice, the Port Townsend Wedding Guild and Wedding Show and other Main Street Project participating merchants. Proceeds go to the Jefferson County Health Breast and Cervical Health program. In 2007, over $3,300 was raised. The program offers health exams, pap smears and mammograms to low income women ages 40 to 64 with limited or no health insurance. Approximately 100 - 110 women are served by this program per year. Ms. Danskin said that funding is also received from King County and the State. This additional funding is used to ensure that there is no waiting list. For those who may not be eligible for free services, referrals to other providers are given. The coverage includes those with incomes up to 150% of the federal poverty level. Anyone diagnosed with either cervical or breast cancer through this program can get on full medical assistance through Washington State. This year the mobile mammogram from Swedish Hospital will be brought to Quilcene. Several BOH members affirmed that this is a great program and enjoyable community event. • NEW BUSINESS National Alcohol Abuse And Recovery Month Kelly Matlock, Health Educator, said that the Substance Abuse Advisory Board, Jefferson Community Networks, and Jefferson County Public Health had partnered this year to promote September as National Alcohol Abuse and Recovery Month. A series of awareness articles were written and published by the Leader. The Substance Abuse Advisory Board (SAAB) has also placed a referral information ad in the Leader. Ms. Matlock also presented written information on methamphetamine treatment services, including copies of a brochure and special cards listing resources and telephone numbers, which are being distributed throughout the County. The intention of the cards is to urge people to call for support, for themselves or someone else. In addition, the methamphetamine white paper has been published, and is now available on the web site. Hard copies are also available. Jean Baldwin noted that the two year methamphetamine treatment funds are from the Office of Financial Management, provided to counties who adopted the one tenth of one percent provision. Frances Joswick added that the SAAB has approved implementation of a relapse prevention program for the County Jail. It is expected to begin on October 1. The recidivism rate for Page 4 of 8 September 18, 2008 Jefferson County is about 70%, one of the highest in the State. The SAAB has decided to initiate • different types of intervention, and this program was considered to be the easiest, as well as doable without special grant funding. The jail has hired Patricia Wiggins, a nurse with considerable relevant experience, for 20 hours per week. Many inmates, having experienced relapses several times, had requested such a program. There will be two educational gender specific classes per week, provided by Safe Harbor at no cost. A third session will be a 12-step meeting to help participants get involved with the 12 step community, which is well established and has many experienced members. Lack of a structured program is considered to be a major factor for those who relapse. The goal is to reduce the recidivism rate, possibly to 60-62% by October 2009. There was a brief discussion about the need to track the budget process to ensure that monies for programs do not fall away. Commissioner Sullivan requested that the BOCC should be kept apprised of funding status so that they can provide support as needed. Ms. Joswick noted that it is important to spread community awareness of the startling statistics about drug and alcohol abuse locally. To that end, Ann Winegar is developing a PowerPoint presentation. The SAAB welcomes help in reaching various community groups about this serious problem. Members Sullivan and Johnson moved and seconded that staff should send a letter to legislators regarding the need for continued funding. The motion was unanimously approved. • Shell Fish and Discovery Bay Water Quality Update Andrew Shogren said that a letter from the State Department of Health had proposed the upgrade of Discovery Bay from Restricted to Approved. Neil Harrington, Water Quality Manager, walked through a slide presentation explaining the background, reasons for the upgrade and discussed related issues, including shellfish economics and safety. The portion of Discovery Bay that was downgraded early in 2007 has recently been proposed for upgrade to Approved; that order should become final on October 14. Mr. Harrington pointed out the 50 acre area on the map and explained the two conditions for upgrading. The area needs to meet water quality standards for growing commercial shellfish, and pollution sources need to be sought out and, if found, corrected. He showed where Snow Creek and Salmon Creek flow near the station. He explained the two pan standard and sampling requirements. The area(Station 48) had failed the standard estimated at the 90th percentile in late 2006. For the last 18 months, however, the FC (Fecal Coliform) level has been sufficiently low to again meet the standard. Mr. Harrington retraced the history including the convening of a closure response group (DOH, Conservation District and JCPH as lead agency) and the development of a Closure Response Plan. Actions taken included: water quality monitoring of the Salmon and Snow Creek watersheds; implementation of agricultural best management practices; shoreline surveys; and door to door sanitary surveys to talk to residents about their septic systems. Page 5 of 8 September 18, 2008 He said they found no major sources in terms of re-samples from shorelines and small streams. • There were several corrections and repairs for septic systems where problems, potential problems or failure to meet code were identified. Certain stations on Salmon and Snow Creeks still do not meet the freshwater standards. Continuing work is to show where best management practices could make a difference. Also continuing are shoreline surveys to sample small drainages to catch any seepages that may occur. Other areas of concern—Mr. Harrington said that a Centennial Grant was recently received to address threatened Mats Mats Bay water quality, where either septics, boats or possibly wildlife are suspected. Mr. Harrington also noted high readings in the area of Hood Canal #3 in the Duckabush delta, which is a shellfish growing area. Mystery Bay is also on the threatened list due to boat moorage. The standards do not allow shellfish to be grown in a marina. In this case, there is a question as to whether or not this should be classified as a marina; the number of actual "live aboards" is not known. However, samples continue to be clean. He pointed out that the water quality sampling method is intended to detect chronic pollution problems, not episodic events. Paralytic Shellfish Poisoning—Mr. Harrington said that the Health Department, with the help of seven volunteers, submits shellfish samples to the DOH every two weeks during the growing season. Results are known in 24 hours, and signs posted immediately if appropriate. He said the process has been very effective and there has only been one case of illness in the last few years, which was caused by eating butter clams from a beach in Kitsap. • Regarding closures, there was a very fast bloom in Kilisut Harbor, which led to recall of commercial shellfish product. There have also been blooms in Mystery Bay, Port Ludlow, Discovery Bay, and Port Townsend Bay, and these areas have been closed. There have also been closures for Vibriosis in Quilcene Bay due to several confirmed cases in commercial product. He noted the need for education and tight procedures, i.e. cold temperatures, all the way from harvest site to consumption. Economic Impact— Statistics for Jefferson County (2006) were reviewed: • 15 million pounds of shellfish harvested each year; • Estimated $22 million in gross sales/year (including hatcheries); • 17-20% of production for Washington State; • Third most productive county in Washington; • Two largest shellfish hatcheries in North America; • Impact of V. tubiasi; affects larvae development; • Possible implications of low dissolved oxygen and increased acidity; • Tribal harvest is estimated at about 283,000 pound of clams and geoducks and 2.9 million oysters; • 77 jobs generated in the County. Recreational harvest is estimated at 74,000 pounds of clams, 111,000 pounds of oysters; 30, 324 harvester-days. • Page 6 of 8 September 18, 2008 Mr. Harrington displayed a map showing the numerous locations throughout the county that are • approved for shellfish harvesting in Jefferson County, and which must be monitored to control health threats. Public Health Funding Resolutions—Washington State Medical Association and Draft Jefferson County Board of Health Dr. Locke reviewed the background to the funding resolutions, which address the issue of providing adequate, stable and dedicated long term funding for local public health statewide. He said that at the urging of Public Health leaders statewide the legislature had created the Joint Select Committee on Public Health Funding and had made recommendations last year, which were not acted upon. During recent years, a number of large health departments have been spending down reserves in anticipation of enhanced statewide funding. Since the easy budget reductions had already been made, important core public health programs are now being eliminated. An attempt is now being made to return to the legislature, with support from existing partners such as the State Medical Association and local Boards of Health. Dr. Locke said that the outcome is not at all certain. In some counties, lay offs may occur before the legislature is in session to consider the requests. Jean Baldwin added that in some cases, such as King County, the notion of taxing districts is also now on the table for discussion. She mentioned the types of cut backs that are occurring in several large counties. 1111 Member Westerman said she was discouraged by the lack of new ideas for addressing this problem statewide. She mentioned past experience with the motor vehicle excise tax, and suggested that something similar, targeted only for public health, is needed again. Dr. Locke said that there has been much discussion about specific taxes and junior taxing districts, which all have problems. He said that the favorite proposal seems to be a "sin tax" on alcohol and tobacco, but the legislature had not placed sufficient priority on this whole issue. There was a brief discussion about strategies and possible eventual outcomes. Jean Baldwin noted the lack of a statewide solution, and the chances of survival and transition to taxing districts by the larger counties. Sheila Westerman moved that the BOH sign and send the draft BOH Resolution. The motion was seconded by Roberta Frissell, and approved unanimously. ACTIVITY UPDATE Jean Baldwin reported that staff is working on the idea from the previous meeting regarding acquisition of birth certificate copies for low income families. This item will be on a future agenda. A Substance Abuse Advisory Board presentation will be scheduled for the October meeting. 1111 Homeowner septic systems discussion will p y be scheduled for November. Page 7 of 8 September 18, 2008 Jean Baldwin is continuing to seek information on the Pierce County Preventative Therapeutic . Court model. ADJOURNMENT Phil Johnson moved to adjourn and Chuck Russell seconded. Chair Austin adjourned the meeting at 4:40 PM. JEFFERSON COUNTY BOARD OF HEALTH John Austin, Chair Sheila Westerman, Vice Chair Roberta Frissell, Member Chuck Russell, Member Phil Johnson, Member David Sullivan, Member • Absent Michelle Sandoval, Member • Page 8 of 8 September 18, 2008 Board of CeaCth OCd Business Agenda Items # IV., 1 • Public .7CeaCth Funding Netivs October 16, 2008 • • WSALPHO WASHINGTON +CT1. E Washington Stabs Association of Local Public Health lifflcials ASSOCIATION OF COUNTIES September 9,2008 Mary Selecky Secretary,Department of Health PO BOX 47890 Olympia, Washington 98504-7890 Subject: WSAC/WSALPHO Local Public Health Funding Request for 2009 Dear Mary: As you develop the Department of.Health 2009-2010 biennium budget,the Washington State Association of !Counties (WSAC) and Washington State Association of Public Health Officials (WSALPHO) respectfully ask that you consider our funding request for local public health for 2009. Because counties are the agents of the state on the local level and provide public health services on behalf of the state, we ask your support and inclusion of our 2009 budget priorities in your 2009-2010 Department of Health biennial budget. As you are fully aware, local public health funding services are currently not sustainable for the following reasons: • Federal grants for public health programs and emergency preparedness are decreasing and federal funds for Medicaid reimbursement are not keeping up with inflation and population growth; • State flexible funding has remained flat for the last decade(i.e., are not being adjusted for inflation nor population growth); • Counties are strapped for funds due to the.1%property tax limitation of I-747, and local public health must compete with criminal justice and transportation for limited funds. Because local public health services are currently not sustainable,many are now saying: "Local public health is dying on the vine out here." • 206 Tenth Ave. SE Olympia,Washington 98501 Telephone: 360-753-1886 FAX 360-753-2842 www.wacounties.org/wsac To address the above fiscal crisis that has been building over the years in local public health,WSAC and • WSALPHO currently seek the following: • Maintenance of all state flexible public health funding,including the$20 million biennial funding from the 2007 legislative session for the additional performance requirements required by the legislature (associated with E2SSB 5930 and the budget proviso) • Increased state general fund appropriation for public health in the following prioritized order for 2009 : o $40 million to sustain existing public health services anticipated to be lost in 2009 without this additional funding; ..; o $23 million to support evidence-based home visiting services that give children a healthy start, support early learning, and save future criminal justice dollars; o $32 million to address chronic diseases(obesity, asthma,heart disease,stroke);" o $5 million to respond to any new public health mandates required to support implementation of the new school environmental health and safety(See WACs 246-366 and 246-366A). • Increase flexibility of revenue spending through adoption and implementation of WSAC's recommendation to remove the non-supplant clause from the 2007 funding and future public health appropriations at the county;level. We also seek your support in finding a sustainable,ongoing funding source to support the public health system into the future. Such a funding source must include factors for increasing costs(inflation)and population growth in order to continue to protect the public's health. • WSALPHO and WSAC want to work closely with you to secure the above-requested funding for our public health system.. We thank you for considering our requests. If you need additional information,please feel free to contact Jeff Killip,WSALPHO-Managing Director at 586.4219 x106. Sincerely, Eric Johnson,WSAC-Executive Director Richard Mockler,WSALPHO-Chair cc: Victor Moore Christina Hulet • 206 Tenth Ave.SE Olympia,Washington 98501 Telephone: 360-753-1886 FAX 360-753-2842 www.wacounties.org/wsac Local News ; Budget woes put public he z41 agencies on critical list l Seattle Times Nil' Page l of 3 Tije$eattit Titues • *v. Tuesday,October 7,2008-Page updated at 09:42 AM Permission to reprint or copy this article or photo, other than personal use, must be obtained from The Seattle Times. Call 206-464-3113 or e-mail resale@seattletimes.com with your request. 4 Budget woes put public- health agencies on critical list PS By Kyung M.Song Seattle Times health reporterw' When voters revoked against the state's motor- vehicle otor vehicle excise tax in 1999, chances are that few .w, ' people made the link between their ballots and _ . =;..n immunizations, dental care or birth control. CI{( !S JOSLPF I 'f AYLOR/ 1 HE SLAT 1 LE I IMLS Laurice Slaughter,20, right, and Ericka Boyd, a registered Yet the taxpayer rebellion that ushered in the flat$30 nurse with the Nurse-Family Partnership program,talk together about parenting techniques as Slaughter's car-tab fee also eliminated dedicated funding for daughter, Quashia, plays. public-health agencies, which oversee virtually every aspect of a community's well-being, ranging from Explaining the cap on property taxes restaurant inspections to preparing for a bird-flu Q: Public-health officials blame their unreliable funding in • pandemic. part on a state law that limits annual increases in county property-tax collections to just 1 percent without a vote of the people. So why do many homeowners get property-tax Since then, Public Health—Seattle & King County bills that exceed the cap? has managed to avoid deepcuts in services thanks A:The 1 percent cap is not on individual properties but on 9the" total amount of property taxes collected by the county. only to backfill money from state and county coffers. So your tax bill could go up more than your neighbor's if your property value appreciated faster.What's more,taxes can go up if new tax districts,such as for ferries, are created, or But now, as governments at every level in if voters authorize higher taxes for libraries, parks and other Washington are anticipating budget deficits in 2009, purposes. those financial crutches themselves are about to snap, imperiling what already was a shaky funding system for public health. In King County, which is grappling with an expected $90.6 million shortfall in its general fund next year, Executive Ron Sims has proposed slashing its discretionary support for public health by $12.6 million—a 44 percent drop. That likely would force the closure of some public-health clinics and curtail a host of services, including vaccinations, interpreter services and communicable-disease control. One program that could be at risk is the Nurse-Family Partnership, which puts vulnerable young pregnant women under the tutelage of public-health nurses until their child's second birthday. When Laurice Slaughter was first teamed up with a nurse, she was hardly a model of maternal promise: an unemployed teen who more often slept on other people's couches than in her own bed. But for two years, • public-health nurse Erika Boyd has visited her every two weeks without fail, guiding her through an emergency C-section, postpartum depression, single parenthood and homelessness—not to mention a http://seattletimes.nwsource.com/cgi-bin/PrintStory.pl?document_id=2008234401&zsectio... 10/7/2008 Local News !,Budge-< ,voes put public-health agencies on criticaf i.4 ! Seattle Times News... Page 2 of 3 IIP neophyte mother's general inexperience. Today mother and daughter live in a subsidized apartment in Pioneer Square, and Slaughter, at 20, is hoping to enroll in community college next year. She wouldn't be the mother she is without the help she's received, • she said. "I wouldn't be here right now."The funding crisis has added urgency to calls by community advocates and public-health officials for a stable revenue source to replace the lost car-tax money once and for all. The King County Board of Health is weighing possible solutions, including asking Olympia to grant it authority to levy local taxes. Without a permanent funding fix, warns Dr. David Fleming, public-health director for King County, vital health services will face"death by thousand cuts." Cuts, layoffs loom The money for county health agencies is evaporating even as their responsibilities and demand for their services are growing In 2007, 143,000 people relied on King County's public-health centers for primary care and other services. Almost a third had no insurance, more than half needed interpreter help, and 60 percent were people of color. But unless the county finds a way to shore up the threatened funding, significant cuts and layoffs loom for public health, according to Fleming. The nurse-partnership program is vulnerable despite having been proved nationally to reduce child abuse, prevent subsequent unwanted pregnancies, help mothers get jobs and prepare their children for school. But • it's also costly and labor-intensive, and yielding benefits that may not be apparent for years. For Slaughter, it was nothing short of a lifeline. The fruits of her time spent with Boyd show in daughter Quashia, a healthy and inquisitive toddler with soft corkscrew curls, already able to recite numbers and alphabets. When the child turns 2 later this month, Slaughter will graduate from the program, and mother and nurse must part. Slaughter said it distresses her to imagine leaving vulnerable first-time mothers—and their babies—to fend by themselves. Boyd "kept telling me how far I'd made it and how far I could go," Slaughter said. "She just got me in the right mindset." Closing health centers Though the beleaguered county general fund provided King County's public-health agency with only 15 percent of its $193 million budget this year, the money is pivotal—parlayed by officials into getting matching • grants from the federal government and other sources. The state also has kicked in $9.5 million each year to King County public health ever since the car-tab tax went away. But that largesse is voluntary— hardly reassuring at a time when Olympia is expecting a $3.2 billion shortfall of its own during the next two years. • On top of service reductions, King County is considering closing some of its 10 public-health centers. http://seattletimes.nwsource.com/cgi-bin/PrintStory.pl?document_id=2008234401&zsectio... 10/7/2008 Local News ;,1 Budget woes put public-health agenciesX61.1: 11itical list j Seattle Times News: : Page'3,03,3 V Two—one in Northgate and one in Bothell —were threatened with closure two years ago before getting a reprieve. Like some of the other clinics, those two operated in the red last year, exceeding their allotted budget by a combined $4.9 million. • Fleming lays part of the blame on state voters. Not only did they do away with the motor-vehicle tax, they passed strict limits on property-tax increases, barring counties from raising total existing property-tax levies by more than 1 percent annually without explicit voter approval. While Fleming said the best solution may be for state lawmakers to authorize health departments to collect their own taxes, Snohomish County is looking for money elsewhere. Snohomish County Executive Aaron Reardon has proposed returning to having cities chip in directly to pay for public health. But with most of Snohomish County's 20 cities braced for red ink next year, Reardon's plan so far has been a nonstarter. Dr. Gary Goldbaum, head of Snohomish Health District, argued that leaving public health without fixed funding is no longer tenable. "We can't look to the cities. We can't look to the state. And we know the federal government isn't going to kick in anything," he said. "Only the county can give us money, [and only] by shifting away from someplace else. It's a zero-sum game." Kyung Song: 206-464-2423 or ksong@seattletimes.com Copyright©2008 The Seattle Times Company • • http://seattletimes.nwsource.com/cgi-bin/PrintStory.pl?document_id=2008234401&zsectio... 10/7/2008 Public Health:;The best remedy s Page 1 of 1' Cathy Avery . From: Jean Baldwin Sent: Wednesday, September 17, 2008 9:38 AM To: Cathy Avery Subject: Emailing: Public Health The best remedy/boh oct packet *ante 1USt3fltdtigtUttT http://seattlepi.nwsource.com/opinion/379088_healthed.html Public Health: The best remedy Last updated September 14, 2008 3:33 p.m. PT For lengthening lives, nothing works like public health. Control of infectious diseases, sanitary food and good medical care for infants have all made large contributions to increasing U.S. life spans. With a budget crunch in King County, policymakers need to pay attention to protecting public health. County Executive Ron Sims sounded an appropriate alarm on how public health may be treated in decisions next year. If the 2009 Legislature and the governor don't give all counties more tax and revenue options, the ability • to maintain vital public health services will be threatened everywhere. One early warning signal: In Snohomish County, the health district could send out layoff notices as early as October. Counties' woes will worsen in coming years if the state doesn't help. In a blog posting, Sims seemed to suggest that it could be hard for the King County Council to treat public health fairly in comparison with criminal justice if decisions become too politicized. The council will have to sort through tough choices, no matter the pressures. And we don't know what balance would be best. It would be particularly sad for the county to trim its commitment to public health just as we learn how much social inequity is involved with the lack of access to good nutrition, safe exercise opportunities and basic care. Research shows significant gaps in life spans -- ranging to a shameful 10 years across the country -- between those in affluent areas and poorer places.A local report found that a Southeast Seattle resident has four times the risk of diabetes as a Mercer Island resident. Native American babies have a fourfold chance of dying before their first birthdays. Poor neighborhoods often have the greatest need for law enforcement. But health and safety must not be played off against each other. It's critical for county leaders to deliver that message in unified fashion to Olympia, so the strains of the coming budget year don't breed tragedies from both violence and unnecessary health problems. © 1998-2008 Seattle Post-Intelligencer 9/17/2008 Board of Health OCd Business .Agenda Item # 2 Letter re: • 314ental.7CeaCth and Substance .A6use Treatment Tuncling October i6, 2008 • JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypublichealth.org • October 7, 2008 The Honorable Lynn Kessler PO Box 40600 Olympia, WA 98504-0600 Dear Representative Kessler: The Jefferson County Board of Health would like to thank the County Commissioners for adopting the county ordinance to raise sales taxes per SB5763. This tax increase has allowed for an increase in treatment services for families suffering from mental illness and substance abuse addiction. It has also created a strong review board helping the county to prioritize spending needs. Jefferson County adopted this tax on October 3, 2005. In this short time we have created an active partnership with the Methamphetamine Action Team, the Substance Abuse Advisory Board, the mental health community and the Jefferson County Board of Health. As a result of being one of the first counties in Washington to implement the "Expanded Mental Health and Substance Abuse Treatment and Therapeutic Court Funds" tax, Jefferson County received an award of$100,000 per year, for three years, to implement • additional methamphetamine treatment services and serve the citizens of Jefferson County. It is our understanding that the award was put in the State biennial budget for two years, but will need to be added into the OFM budget for funding in the third year. Jefferson County was the second county to adopt this tax partially because of the interest in increasing the funding for methamphetamine treatment. We ask for you continued support of this award for the third year, as referenced by SB5763. By receiving this award, community organizations were motivated to collaborate and build capacity to address the community's methamphetamine treatment needs. After a thoughtful review process, culminating in the "Methamphetamine in Jefferson County: Understanding the Impact of Methamphetamine Abuse" document (enclosed), Safe Harbor Recovery Center/Beacon of Hope, Jefferson Mental Health Services and Jefferson County Public Health launched expanded methamphetamine treatment services available through Jefferson County Methamphetamine Treatment Services (JCMTS). The organizations joined together to bring the JCMTS program to Jefferson County to address the need for expanded treatment services and reduce some of the barriers that prevent people from entering treatment. By funding the JCMTS, the organizations expected increased access to assessment, evaluation and treatment services, reduced wait-times, and increased collaboration and coordination of patient treatment plans. We are in the early stages of offering these services, but we are already accomplishing . these goals. COMMUNHEALTH DEVETY HEALTH LOPMENTAL D SABILITIES PUBLIC HEALTH ENVIRONMENTAL WATER QUALITY MAIN: (360) 385-9400 ALWAYS WORKING FOR A SAFER AND MAIN: (360) 385-9444 FAX: (360) 385-9401 HEALTHIER COMMUNITY FAX: (360) 379-4487 The concern we have is, this good work with three providers and the many families • obtaining Methamphetamine treatment will end in July, 2009. Methamphetamine use and addiction is a continuing problem throughout Jefferson County; affecting the jails financially, taxing police and sheriff, creating increased demand for mental health and substance abuse treatment, as well as costing untold amounts in child welfare, public health, legal justice system and public education expenses. We feel we are at the beginning of being able to better serve the citizens of Jefferson County. Thank you very much for your continual support of chemical dependency and mental health treatment and your consideration of an extension of the methamphetamine treatment award. Sincerely, The Jefferson County Board of Health John Austin, Chair Sheila Westerman, Vice Chair Roberta Frissell, Member David Sullivan, Member • Phil Johnson, Member Michelle Sandoval, Member Chuck Russell, Member COMMUNHEALTH DEEVELOPITY HEMEN LLTHDSABILITIES PUBLIC HEALTH ENVIRONMENTAL QUALTY MAIN: 360385-9400 `'�� ` ' MAIN: 364385-9444 FAX: 360385-9401 HEALTHIER COMMUNITY FAX: 3603794487 • Board of l feaCth O11 Business Agenda Item # IV., 3 Public 3-leaCtCi's "Ah-3-Ca" .Moment • October 16, 2008 • Page 2 of 3 yG2it- f,..A1:7 ,� ,T` T✓5cty' 7" Tk 7,74."*.'''''' ,ti , ren.•'T" ;G'`i',"€t�v R°i yy,--4 P110,''r `c,id F ` t;+;w k '"_i, -ii#,.' f>l'" ii t*t t Tw ": ` ''''''','*:7!," ,. Y'' '1-, rya: ` ti r . 4 j n i ixr 7 • t'i b;�¢ ',4 j b'� � �. Ali r• 't i f 1 ab'^i'ekt.�n 4 •'y, t p•"t( ,-....4,-F44,.i ,o- € c �` 'Y 'h: s ', r n stk t•£ r _h i - ', SP A WAR;y8Tltdf 4,.:'" '-';„,7-jet-'1":7, 74-'''':,?..''„, t.'.'-27,,Ti'','‘--1 ' ' " " 7' ' ' ' ' '"''..:.-Li $'.db w -i'*. ;;"1 c' 8',.... �tr`e 1 C 1 y Y pr tC .. .£,. let %# 'C Jf"ar �+ ' Y 4 .SQL .'I' 11- ,"6/11':,t,1** } .', �r{y ' f �tr s ,cs H, K .,efmlFst(aa Wei ---...,____...„..s-' � hr a"t:` `� h x a v "'' t > > ft n 'a.< Y ., `! FYadsr SVaaint t -q HPS° Ii rs ri iatle►" t tie/Maj ir�su:rat' wara-- tt7j�¢ r 11 ` 1 Au diidoetiplasatdna gad enr luittod• k co.p er<ain g t.h.emend re fit,'&`Rak,A'I tet .! B4„,.put br _. itx r' i{ ThL do M IwmdFdd Y A e' I A� a 4 w'I kf M� x F �. � 10skaliat i milia,,M LOAM lief.- r'p i .at�iF'R i oq'tis_ a' 1 j l'ir'as 1Y�e PtesaIp#ion r<.''''' c. p �a 13 Hpanih`w.r Y i �t�ftiv:A[€ c t a -ktfa : iaa>tv.(ki i, coH - ` tui th agk'"Tat 8tdmooteett�difeHl't W70-114•"7‘- a tIEM I gaaa`- «We reialragaaei and disorders of Wooten. was.aid et Red Men's tY R ;Oc"t+ ro 11 u4'dl.add est the digitate mod imPororat - meeting Me In i.e prasrate of n taiga .Ldm.On t.-",07-2e.,.,...7?-7,....� �etko 3ffnr by,..of rhes b 'p,,,..,-.r. tt m{ina aaneerneA io motherhood,maAiad dorm tor-. f.� vmboenht ': pAonuMint Altd'todc'biitl to oi1An"l ,.60otry-for yegts and I.a rel. • beWhyr-meowte yidorork resits and eosdr. 1 i f, , 14'4 jM re'.t M , . 1 a'Fdeedie Preacrletiom"haeialws aha jedie.`mi kr"'o!the It Ii Ment rave of Palms''.lel i.f.0 ,, a `"t" aatlpttaM. It if aro end of t period of espeotawy cod makes bony advent cosy,mid .. The installing officer woo Past Cum it*,out,,,,„,„>58 gin<Trbn he'apd.apes ttlp&o known,oomkuad tHtt:. edam,point°,.. 1t quicken. and ringing.tine;Mandaeroomier Rn rry A.R.Krog°,,tic.Clumps•If Ski f minutes MJr4ra t loft ony toed patifkis, acting directly V ardor.,mad wore.a heaith7 mad robot baby,.Thooanda of wem0a firm presidjag officer end thosk xha LrJft.0,CTe�fomiqu;.mtaarg ' '.. mteen.o0 de000w I The jieefert antra.to ite marvelous merit.. N - ff Makes Weak Waaeo SUVA:, it Melees Sfafr 11"f6...'tYdf, rid rs-d iota office were: '}'A "wort Repo for your trouble is mien of the'two ingraliedla Hanoi drum/into do not Mine oeobonteoea .d ergo them r0pme roue*'Iestr- F4 F.rme thtinn-fool"ovarbt t4 sucb woudei ni Mouitt 1 ,f , no good,•• Aaeept no Naomi rtonrum b pis.of.Mks habit-forming fel C. nomads•Ju na+e J.Clark: 0 ,.hog o, , t - I watsbre nota drop of alcohol and oat a grakn of.b s forming or m`'ore Fi 4t ice(,...rich,, Nathan W. Digsrti'e orgenh&cameos weak t�IWO.is Ing O(tarrah,.Send tar taxi ,g', ^mugs. la a pure mrFrio minim of 000 04. stir. - - I hick of Generic she; r food tt'"u F s Raynor. i y7 4u.,- F.J.S)flENak'd; `trumd v,ry I' m+o 1 Petee V,/1 hail digested rind you..mime affepted :I. props.,Taft TEE MORNING r'TORI 1PEw IIEALTFI OFFICER - c-Rh Ion,of appatile,(1-rescues,ant full Sold by Dcugglatal Prints 730 TEE MORNING L DER r- yof fo,. nares atCed .shag, '1ou4ttg, Hann°,;, gybe Moira Pomlly Pill*re. IS GS VIN[:SATISF f,Ktkee of Day..lama°Y.McGuire.a IIEPVBIICAN NBW.SP i':34 —` Dltio°r for I:ao i,Remy 1loRxlAw haoettmra, /spin/ fa'Gnwnlo, totoko patine. sandalled ivnr Monolog Except Mon '.erste. a Campugo al --mans sr ho:pt el eleekeh hod „;nee Ito 7 g P �4diuWdt,by That.Will Be-PreseMted will O. Mouth,constipation, poin in�^Wails '. 'A Comtn9.party,. dar Qaartermaater, Chance Y"'"R ain.H A.3t.xrager. 0l. 7r '00,' tlh u of gap, muleNeseIo1gefaTHE LFAD R COMPANYTho wisdom...Mood wd by Moyer Rutnrh , with,sick kuddeota;norvaan0uu,'Afnl• hot.eget Vetecans,will gree m in the filling of the appotntire dike. Tr,.oetee.Charas A.,lagmm,.. nems or man other similar tome. ' uarg "' Okuaradat the gait Of tfd at Port Tawe• y� eyml? seal and Dntm'Jan It,18I0 .send,Wmeh.,M o o t..Netter. In the maok'itolity it being deify nt• All of the foremantinned are new of. If your appetite,to fickle,and;not&• ;Mag.'haf at the ewpteat of the tested,.no faire,...Ionic of the norm firms, with the exception of&ergaant jag tempte you,or"yon.belch gee nr It 1 trtem,,.. • Tams of Suhamiptiwl bring°hewn than in the gage of the rice' Yovvg,.who as a reward ter good mel•' pen fool bleated after agllAf t Pr yemr Ieoelant dance music will ho eno yeser,In advance 98.09 houitk Whitt. Or.J.Ct Bova,On Prom .lee in the lw0itien .30 uoantnwuot7 lood lot Hke 0 lump of lead to your ed and 0100 m orviyoe 8p..14,t 'Ro months,in edvenee MAO Mont focal praetitioner was name.; neaten tel se,,rod himself on eamp quer- otomooh,you eon make ap your mind pr'.-A goodflag to promise Per month.doltoerrd by weeks ' 730 for the position and the Next day toe- le-rmnstrr that at the bottom of all-thea there is the.prnolvua dove...Admiast • AU aommualentions, tkeoho, drafts towing the,conch meeting stert0d on John I.+ud (.amp her been organised.Imo'woomuse-Ternwaoatten of uudk- pee waple,inaudiog tapper. 0 eru0ndn of°kaoline.»which.he do /sated toad- uotrolt utAYCtOp1R money orders,etc,chem.(be addressed only8 iturrtlts. vet Its roster and it. $ lf in five mI, foo glares boa only jurt begun but which n;o�.a.aLh°haw growth. B.P.O.ELltN-Port Tow001 On THE oLEADER CO.,Port Tvwtwad will.when I„oily cemplcted,rotuio in i.-1.....474%°.:°42.....°°":to as/Mehl a0 0070.11.S.. No.317 01001,..in regales, e°av ; Washimstan .„....,,_...._,....._... .... fort,Townsend being one of the°''''..• ,A4 aJr.rtiae•d eleexhera in toles lorries that thcr.. is M,L6uig really wrong, ThurWty eeemng at 7x90 a' Copy for advertisements .00,10 he rat end 01,000 heelthhol Macao in the the vetcin0,here n grind ball robed- Stop this fermentation and begin'eat. its arra gsateo'.corner of Ti met,to the office not kter than Q p. nsire Maio, led f the loth mot.,and It to nn- lug what y wont without fear of Wrohiugfoo 0i...to. Al vial: e.of the day preAnne to lasnrl:l,eu. I Outhouses and nuisances of that da nonrated that the neat metal ontettnin- lkevrmfort ar'misery. Mae Elia are medially tooled F riledoo ereeeele&;/ feet t attend° t ,ftvmptoot will be banquet,-1 Atnmt(natant relief In'waiting for o,Ki.00CE&Kxelted • .: ----g--o' i d t oda n morons mal.., nor cited b . l veteran.of'ai'd4 will ho the7-a. It to merely a matter of how S 7.O.Nowo0ld9 Seoeetot T'be caagt aekooucr 01 I pawned ofathe� 7 lightship ma not seem to make any chore mote,pinnlhwg and nafer0 Mweml Atm..of honor. ac::n you take s little Djopepain,. bribe sleteesa of it thee the Atkntia l"annuoas m e eoeppknttng the emelt' KNIOIITPI OP PYTffbAE one did which ren fall tilt lila o 1sl ht- toms which prevailed pre.vioosly. An' W NTED---ikiri for general how- COAST A70TITAERhSTS ARK Lodge No.SI meets every ThaiAanee other critter that bac already receive,/ roil.. Gad.wagon to the right port, IXJAIL FOR MUTINY cuing in Ito own hall on Watt Die attnntioo of the now health officer Apply to,Ilei.H.A.Y,#R-YEl.T.7.06 .......... Visftiag Knights cordially trees It ts possible that Wo change the with beneficial results, to the kitchen Mei.1:101 Imt.p4,odeet 1981 ,jet*.gaiters Company Rama..to Go Got on ' , I.E011 It(SACK Japanese Embasaador'Tanta 3a ft,. oauipntent net store and euthoueea _ a Long Hike. J.W.B.SCOTT,'K.of N.A Beat-Tokmbiro agreement about labore0sn00ted with tonal rentooreeto. In. Mena of the ams commissioned gift- '' - imndgrotion to n preol.o adetiting the many of these the conditions found M.TLANATIONAL STEAMSHIP R0. eery gent.mea of the One Hundred-an,! FRES AND ACOSP'rlD.M Attie brown ikld band.to Howell and ware not omdnatiee.to kelt'',out or TIC$STRAITS STAAMSHIP CO. tPlttrlysehrst rampany, united,8hitete Past Iree'.sead L°dgu No.'0.5. Des Philippines and deboretog tion dere wee.Steam tea promptly oompliel — Coast Artillery,it.b .rated,are con.;mists.fa"mgnly'aonmuele.t from molaktrd selmSttanen, with which wit.Eminate smelt objte- TIME OARD, Pmol m.tine guerdhoonte s6 Fort N.O. Mod Wedawdwy of mei. mor Ilona in future. The resideger needled -•— Weight near Flatter Island,N.Yv at'a F m is'Maooula Temple-8 '� .will nest receive attention tram the Owning and operating Mall Simmers riwlt of a mutley'In ton eoeopoay-The tient►ars ore'An-ltrd, NOTICE OP OFFER OF REWARD new MTfiekl,and many pmporty-owoer.i IeuMag,.I7njon Whorl, Poet-Towaamd, .00j noeod sou./c0..,Mot for°mar+:& -. itli W�� The City of Port Townsend win pay N.Il:mat,Sawvtsry:� One$undid Dolan (97tHIA0) to asp ore emg.riy aortkipntdng Cha apatemat:t<. foe Ra>au potMa,aA fallawat of�iditeee ,lea ami a8 bob nine taco person,or persons furnbhhtg Informs. Irapeation which I will be made and Sesame,00FAK for mottle daily at Of.the eompsny refused duty. ' : ,J/QYAI..*RWL MASONS--P. ,s.N/.... tion or mid cmo;kat tin lead to the wbkh ,Otte welt let the deveaping of 7:13 n.m.end 3 p.ne. ,i,...., „..x_?said ,'.his,IL A A,.9 arrest end conviction of the person or mom sanitary can litIone under pain of On Monday only the I p.M.trip i# .j ;044 tltsiLatdob Bossed.( 1� 'mum ifrArgxi gvA au__ .., Tom I,'` poraons who committed certain depre• arrest ant the kande of the...king a 01tal. RTA'NOtQ/PONt'iowaisc Dt WAS$ jou ngmoCleo �to 1 tattoos by breaking, destroying and officiate- Both Mayor Rats and Dt, Steamer DOVE for smut.via to J°11raI°9 yes° ,y 4,1 raining Certain artifice of.ornament tad House em to ha oosogeotnlatoel in tic, poet.,doily oomph 8aoday,it 9 a m,. 'F.,s ORier of the(Metonym,my Do•. Altr`HFll;31,WA ST,. general utility placed in,mad telonglOg penman,*for there won ninny places in` 34eomcr ROSALIR,fm'$mettles'feet., asmknr 91,1968, 8eskd Props ., . N.A gII.In gwtelnp, to Gbetoemoko Park,on or°boot the the cit ,ehld.wane eortool in„red 14.y.Thar leo.rrc0{sal at thla .....t-.--7,-;oot4 two , Sb'Y CITY LOGOS NA 04. 7 7 °day sod and bion'at E 7,m. Ji 3Mh.dap of October,1908. ' deock,Ir.let-,mr.•t3a 19t1 dal.1,11f."-M.-Koala, -waiF amend, ';esti Mf a vigorous'looking-up at the hands For)kIV doom tad Island P010ts nnw Ay order of the aiey,-Coanali of Om para,.1010,.sed tea.npeidltdr for ta- 'nsaa+s7`sag at 7,30°"rites of the antfroAt{w. Monday,tVedaeeday and Friday at feOOoars Nati' All.isle Lily of part Townsend,Wesbingto0. - pain to wharf at thls'slnttlon,it an--')d tog Wee !Seal) MAT GEI49ON a m' 0°1‘1"'" with apeatI' tied,°apices df- ` ..- Attaae - Mayor St... W..atv.m for Sakti*dant - )S.0.pETEasakf.. oroaoE ANDERSON. 'For Sale exoept Thursday at 6 p.m, 'thigh may bo obtalnad upon'appyka• J.'M.IACKBed Y Mt. (City Clerk. 4 ' : 945440 For Port Angeles 401$'except Thant. tign, FRATERNAL+OR8ER'OS'R "" Date of Pablia naamher a,1909 J.IL CtAttidCY. - tion. A big lot a0 by 100,A 88 foot slay to deg at 0 a,m: Clmtadian %rt 15vansaad Aar[°Na.lags WANPRD-Girt to do Toorral hoe.' the rear,in veep desirable location,km For Port WWittom, Doogeaae and - tsgular ewoiaa for bwinaoa er wink.Apply to M3tS.GEORt,P'MAT- pored Witt mono on of 3 rooms,two Port Cremeant,outvoted bowed Sunday -' 00 .day evening, et 7130° .100 KISS,C0000r ill 1.x00000 mad 01Moo 011000 I ro 19 by 12 end a kitchen, The Wednesday and Fridoy d.NY,NOY anxious.to earn n090ey ou: I- - at 6tiks''hail, tamer.K w atneta. '18•'•house is furnished with good Move, Steamer BEl4,tNOHAA1 for Snmttie olds of atdtwln hour:can sfmizg:k poet- and Quincy Meseta Alf''kith _ tion with ms: Ta.my bast boys I am ,..onedioR, chair 4 tables,centring uteaaila,ete-mt Kondey,WWnaday and Friday at IQ y(melted to.attend . CMl/0 roars Cry bane and contents will 6o mold at above a.m. "going:to't vile'SA@ITRG9I3M2IKS and -jo$x Rgtg$.e Auu w. FUR FLETCHER'S Mins H applied few rams,.Apply as Far Port William,nalrgemenr,port Fah prime. �Ybe wpmR'b Bail no.1doe.'BARRY A MART,W.Bee Boder oTHes. anti.,Nash Itt7 nod way porta Tuan ° (rte; re wot'h aobsat drama, ....... '-W DMEw OF TKA WOR C A S T 0 R I A oIb i1r3i1c, 34 Wester.Bf, ,.. ... - dist TAsmdny mend 8attlyday ukt peg,a. Toxneend'Camp Na l'w W,8teamem and achcduk eubJaat t .,:".>•—•s -�• aueet►.0vw,p Ptfy' aef014 ebmoves wlthaaL dtolion. it vox IYiANT1sD,-f'hssa s Fatlawir iaR. Vfd tg stem . IS.I.TIBBALS,Jr.Agent. a petmammt pwFLtoa,for htfgkd,emir- 0ordjaM Welted. •, geek se4<aat boy. The tight boy esu J I/hog Bath Rbomu,Ida.931, y L mike time 30o to*t0 or more a weak J,)l+LO('KIt4RT Bot, •:r.i"w�,♦lt UCCZ'$,Claim pun ty; TWENTY ons WAl to worn fat Witheat lntm'fsting with his'school.td• ny-r-c-- ..00.0.0.... _. but we can ba.+CK a Shct1.n1 tin: ItSioOLD 334 Water CIxY T31gABIt7tDAS ND I.•:q ,' IoW,mat ant&manes.L'ib e , " Wartaat Call 34 lea.. .. , eml Po" to bright (toles Weld.*tae .. ... ';70fpI(D..15-HSRIHrY OtV http://content.lib.washington.edu/cdm4/item_viewer.php?CISOROOT=/ptleader&CISOP... 10/10/2008 Public Health's "A-Ha!" Moment and What it Means for the American People ...4 • Presented by Risa Lavizzo-Mourey,RWJF President and CEO September 10,2008 Robert Wood Johnson Foundation 2008 ASTHO-NACCHO Conference Sacramento,Ca. No one bears a heavier load,faces greater challenges,or is more important to the protection and , promotion of health in America than you. My mother always told me that we are known by the 1. „' company we keep—so today I am looking really good. Where I work at the Robert Wood Johnson Foundation(RWJF),we think you are all-American • .; heroes.We see how you put everything you have into the good health,safety and well-being of all Americans.We know that you do it against great odds,with limited resources and few champions, Risa Lavizzo-Mourey, propped up by an infrastructure that is too fragile, in a field that is too fragmented and usually so far out M.D.,M.B.A. of the public spotlight that no one pays attention until disaster strikes.We also know that while celebrities get on the news,it is the men and women like you who are making real history. We are proud to be your partner in making public health history and in shaping public health's future. RWJF is absolutely committed to seeing that you get what you need to do your jobs: • the political support you deserve; • the policies you need; •funding that is realistic and responsible; III •technologies and infrastructure that are cutting-edge;and •the backing of an informed public that knows you and trusts you. It is an ambitious list. It has to be if you are going to achieve your ultimate goal—a healthier America through a new public health,a new public health that is: •accredited and accountable to the communities you serve •performing to evidence-based standards of quality • engaged in the political process and • reliant on hard evidence to determine how best to improve performance. It is a tough road you have chosen.You are not going alone.At RWJF,we are in this with you for as long as it takes,whatever it takes. Nothing we do is more important.Trust me. Nothing. It is fitting that we are having this discussion at this time and in this place. Right here in Sacramento the storm tracks of seemingly unrelated crises have intersected in ways that expose the vulnerabilities of public health—and the health of the public. For all you public health veterans,this is the story of your times.Remember this summer's TV images of California burning?More than 2,000 fires,a million acres destroyed at a cost of more than $1 billion. So much smoke hung over the capital that it fouled the air. Some of you in nearby counties declared public health emergencies.You cautioned everyone to limit their outdoor activities. People with heart and lung problems were told to stay indoors. And did you hear about Gov. Schwarzenegger? He couldn't even duck outside for a cigar in that famous smoking tent of his. Instead,he had to stay inside the capital,where a different kind of firestorm III t ©2008 The Robert Wood Johnson Foundation I www.rwjf.org Public Health's "A-Ha!" Moment and What it Means for the American People Presented by Risa Lavizzo-Mourey,RWJF President and CEO • September 10,2008 Robert Wood Johnson Foundation was raging. California has run out of money.The state has been without a budget since July 1.The budget gap is$15.2 billion.And so far,there is no agreement how to close it. It is the state's worst budget crisis in a generation.Thousands of state employees have been laid off; 200,000 had their pay cut. Medicaid is in trouble. Money for health and social services has disappeared. Community health clinics are losing$1,000 a minute in uncompensated expenses.The safety net is torn and tattered. Governing has turned into a fight for survival.And oh,yeah,there is not even money left to fight any new forest fires. California is not alone. More than half the states,along with the District of Columbia, are struggling with their own budget shortfalls.The estimated total for 2009 is a staggering$47 billion. Options are limited. Many states are doing what California is doing—cutting Medicaid and public health. Don't expect help from the federal government,either. The administration is shackled by its own deficit of$482 billion.That is nearly half a trillion dollars; 10 times more than all the state deficits combined.Tack on the costs of war and an economy that is shaky at best—and the outlook is bleak. You might ask what all this has to do with you. It has everything to do with you. Here is what I mean. Five years ago today,at your meeting in Phoenix,Bill Foege spoke like a prophet when he told you that public health's worst dilemma was"resource allocation." I would add that it is a 3-D dilemma. It has three dimensions: •One:As Dr.Foege says,every public health decision and every resource decision is really a political decision. •Two: Public health historically fails to close the resource sale with policy-makers and politicians. • •Three: Public health officials tend to be scientists at heart. Many of you have an innate aversion to politics. Yet,you are the only ones who can make public health's case in the political arena.That is why, according to Foege,you cannot stay out of politics.We are not talking partisan,get-out-the-vote politics. No,we are telling you to leverage your stature as leaders to get the political system working for public health—and not against it. It means changing how you do things. Change is hard. Most people instinctively resist it. But,let me ask you this:How is the old way of doing business working out for you?From where I sit,it looks like whenever public health knocks on the resource door,more often than not the possessors of power shut you out.Why is that?What's really going on?Some of the answer is in a story I have been saving for you today. Back east—right when the California fires were at their worst—a group of health policy experts and Washington insiders sat around a conference table not far from the White House. They talked about the election and what it means for big issues like coverage,cost, Medicare and children's health insurance. Public health did not come up until late in the day,almost as an afterthought.What they said may be hard to take,but you need to hear it. They spoke of public health as hardened in separate silos—federal,state,local—each distinct, disconnected and dysfunctional.They did not see you as you,as champions of the common good. Rather,as supplicants,hands out,complaining and bearing bad news, long on pleading and short on results. Those who know you actually winced when one D.C. insider said: "What a bunch of whiners.All they want is more money,but they never explain what they really do with it.Just fund CDC and 2 O 2008 The Robert Wood Johnson Foundation I www.rwjf.org Public Health's "A-Ha!" Moment and What it Means for the American People ''''4 • Presented by Risa Lavizzo-Mourey,RWJF President and CEO September 10,2008 Robert Wood Johnson Foundation community clinics." The person talking is a real behind-the-scenes power broker, someone who wields tremendous influence at both ends of Pennsylvania Avenue over health policy,funding and legislation. The message I want you to hear is that too many still don't get it.They don't know what they don't know.The danger is that what they don't know can hurt all of us. The public, however,does know that something is terribly wrong.They are insecure,anxious, fearful. One of our national grantees,Trust for America's Health(TFAH),tracks public opinion on a range of public health issues,including preparedness.The most recent TFAH poll,conducted before Gustav or Hanna hit,found that: •More than half the public-54 percent—feel that the United States is not as safe as before September 11,2001. •Among African Americans,the number jumps to 73 percent—something we need to pay close attention to. •Large majorities fear that neither community nor country is prepared for emergencies like Katrina, pandemic flu or bioterrorism. In a separate survey,the Harvard School of Public Health talked to people in high-risk coastal hurricane zones along the Gulf Coast, New Orleans, Florida and the Carolinas. The results,released in July,are provocative.A large segment of the population does not think you are going to be there when III they need you. Roughly 40 percent do not trust the government to protect them if they evacuate in an emergency. Obviously, these are matters of emergency preparedness that public health should resolve—if you had the resources. But you do not.And the public feels it. I have to believe that this is one important reason 2 million people were so quick to evacuate this time as a hurricane approached Louisiana. Here is the point.The people are telling us what they need—and what they expect—from public health.The larger message is that this is finally your time, the time,to change the discussion, to rebalance the equation,to establish a new public health. We see two tightly connected pathways that will take you where you need to go. First, improve how you do what you do. Second,influence decisions affecting you by demonstrating the value of what you do. Improving quality and performance is a very big deal at RWJF—and has been for nearly 30 years. For a long time, health care delivery systems were the target of our research and our testing of hypotheses.We have spent hundreds of millions of dollars gathering evidence about what works,testing and measuring solutions,building test pilots,and spreading successful models across the country.Along the way,we learned important lessons that directly apply to public health: •We learned that quality means delivering the right programs and services to the right people the right way with the right outcomes. •We learned that"systems"can be their own worst enemy—keeping capable professionals from doing what they are educated and trained to do. •We learned that research is indispensable and that action without evidence is a waste of time, money and political capital. S 3 ©2008 The Robert Wood Johnson Foundation I www.rwjf.org Public Health's "A-Ha!" Moment and What it Means for the American People '***4 Presented by Risa Lavizzo-Mourey,RWJF President and CEO . September 10,2008 Robert Wood Johnson Foundation •We learned that simply trying harder does not work—but that changing systems,practices and policies does work. Let's get real specific about what this means to you.Think how you would answer questions like these: •How does the public know it is getting the best value for how you spend their money? •Does it matter if Nevada spends only$4 per capita on public health—and Hawaii spends $152? •What is the right course of action if the evidence says Nevada's outcomes are just as good as Hawaii's? •When neighboring states or localities share the same public health problems,how can one choose to attack them,but the other doesn't have to? •If a city,a county, a state and a territory all do the same thing—but each does it differently—how are we to measure what is effective and what is not? • Should the public know how you measure up? • Do you want the public to know how you measure up? Now that is the hard one—letting the public see behind the curtain.Your impulse may be to keep the curtain closed.You may worry that the playing field is already tilted against you;that standards will not • be fairly applied;that better-funded,better-staffed agencies in better-off communities will rate higher; that hard-pressed agencies with low-income,high-risk populations will be judged unfairly and punished accordingly;and that public scrutiny and accountability will hurt you more than any promised gain. These are legitimate concerns.They raise important questions. Take heart. You are already coming up with your own answers. We see them in your actions and your outcomes. Case in point—California's tobacco-control program.Though it began slowly 20 years ago, it is an impressive success. Smoking has declined 25 percent statewide,saving an estimated 50,000 lives by 2010. The state is saving billions of dollars,too;good news in bad budget times. Two weeks ago, Stan Glantz and his colleagues at the University of California, San Francisco Medical School reported that by 2004 California's tobacco-control program had saved the state some $86 billion in personal health care costs. That is a 50-to-1 return on a total program investment of only$1.8 billion. This is a great story of how public health can transform the health trajectory of an entire population with a sound strategy and a willingness to stay the course. In Genesee County,Mich.,and the city of Flint,they have long struggled with a three-to-one disparity between the deaths of African-American and white infants. Right, Bobby? Bobby Pestronk and his colleagues are smart and have been around a long time.They know that inequities in race, economics and resource distribution were harming the health of the community at least as much as the genes and lifestyle choices.They also knew that if they were going to take on socioeconomic contributors to infant mortality,that they would need help and funding. With state and federal grants,they teamed up with local hospitals and community-based organizations to enhance baby care,educate the community and providers,and lower the level of racism as much as possible. The results are dramatic. Black and white babies and their families both benefit. Between 2002 and • 4 ©2008 The Robert Wood Johnson Foundation www.rwjf.org Public Health's "A-Ha!" Moment and What it Means for the American People '''''4 • Presented by Risa Lavizzo-Mourey,RWJF President and CEO September 10,2008 Robert Wood Johnson Foundation 2005,the African-American infant mortality rate dropped from 22 per 1,000 live births to 15. For white infants, it also dropped,from 9.9 to 6.3.The black—white disparity ratio also dropped from 3.6 to 2.4. Taking on the social determinants of community health—a hallmark of the new public health. Here is another case in point: In Colorado,trail-blazing legislation just signed into law is designed to improve the quality of public health services.The new law mandates that local,county and state officials work together to improve quality,even if it means sharing resources and responsibilities across jurisdictions. Collaboration,performance standards and resource allocation are key.Important elements include a public health information infrastructure,performance standards tied to outcomes,and resource allocation that realistically matches need. Legislative advances like this are why Bill Foege says you cannot stay out of politics. How else do you think public health in Colorado pulled this off? The old public health—working and worrying in anonymous obscurity—could never achieve a success like this. The new public health operates out front,in the full light of day,connecting the dots,building partnerships,and creating collaborative relationships that reach far into every corner of the community. The new public health thrives on partnerships.The new public health does not for a minute presume that government can do it all on its own.The new public health taps into the very best leadership the larger community has to offer.The new public health includes leaders from government,business, community and faith-based organizations,health care,academia, even the news media.The new public health breaks out of its old silos;works with others;collaborates on preparedness,prevention,chronic • disease,social inequities and economic disparities. There is tremendous power in these cross-sector collaborations, in getting strange bedfellows to work together, accountable to one another and to their own constituencies.There is a side effect to all this collaboration. Each time you bring together leaders from other sectors,you widen your own base and you acquire new champions.Lord knows,we are going to need them. Last year,I joined many of you at the NACCHO meeting in Columbus,Ohio.We talked about how hard it is to bust through the budget barriers without both a loyal constituency to help make your case, and good research to prove your point.Advocates and evidence go hand-in-hand. The lack of convincing,compelling evidence has been public health's major stumbling block for many years. Until now,that is. Now you are able to build the evidence base you have been missing. Now you have the one thing that is certain to get the attention of the decision-makers. Now you can show them the money,show them the ROI—the return on their investment. For example,the next time you sit down with your decision-makers,you can show them a direct cause and effect between what a community spends on public health and significant declines in infant mortality and preventable deaths as a result of new research conducted by Glen Mays and Sharla Smith at the University of Arkansas. They used NACCHO data,collected from 2,900 local public health agencies. It is the most comprehensive look yet at the effect of local public health spending on population health.We funded the project and we have seen an early draft of their report. Mays and Smith matched—in exquisite detail— what communities spend on public health with rates of mortality among infants and deaths due to cardiovascular disease,diabetes and cancer. Then they asked: "Does More Money Matter?"The evidence conclusively said yes. For each 10 percent increase in public health spending,mortality rates fell from between 1.1 percent to a whopping 6.9 percent. They also found that funding public health is a faster and cheaper way to lower mortality rates than beefing up local medical resources. For instance: Increasing public health spending in an average • 5 ®2008 The Robert Wood Johnson Foundation j www.rwjf.org Public Health's "A-Ha!" Moment and What it Means for the American People Presented by Risa Lavizzo-Mourey,RWJF President and CEO September 10,2008 Robert Wood Johnson Foundation • community by 10 percent,roughly$300,000,can achieve a 3.2 percent reduction in cardiovascular mortality.To get the same outcome without relying on public health would take 14 new primary care physicians for every 10,000 in population.If you figure that the typical underpaid family doctor makes about$176,000 a year,that's $2.5 million in new spending.You do the math—$2.5 million versus $300,000. It's a no-brainer. TFAH,Trust for America's Health,came out with another public health ROI study in July.This is truly groundbreaking.The study shows that even a small investment in community prevention can produce substantial savings in overall health care costs.The report shows that an annual investment of $10 per person in community programs like increasing physical activity, improving nutrition and preventing smoking could save the country more than $16 billion within five years. This is a return of$5.60 for every$1 invested. Projected savings include $5 billion for Medicare;$1.9 billion for Medicaid;and$9 billion for private payers. I want to thank our partners TFAH;the New York Academy of Medicine;the California Endowment; and Prevention institute for these stunning results. Here's what is important to remember:The ongoing national debate over health and health care usually focuses on just two factors—cost and coverage.The truth,however,is that there is much more to it—like prevention,preparedness,racial and ethnic disparities in resource allocation,and the social determinants of individual and community health. With research—and the evidence it yields—you are better equipped to make a convincing argument for the new public health and for the fiscal and political commitment you need to do your jobs the way the American people expect and deserve. • I think you get the point. It is research that talks before the money walks.We are helping build a brand new field of"public health systems and services research"to provide you with a constant flow of reliable information.We stand shoulder-to-shoulder with ASTHO,NAACHO and NALBOH in this important work. We are housing a data clearinghouse and analysis center at the University of Kentucky,with help from the National Library of Medicine.This will be the go-to source for the very best and latest data on what public health agencies are doing and learning.The goal is to supply you with all the proof you need to justify more resources—even now,when public dollars are so scarce. What we are doing together is nothing less than creating a new field of public health study,practice and innovation. It is literally a new public health,firmly set on a fresh foundation of accreditation, quality improvement,performance standards,advocacy, and a relentless reliance on research and evidence. You are setting a course that will take the new public health—and the health of America—to new heights this century.You are heroes.You are,indeed,making history.Just think how,down the road,in grad school, the professors will be talking about what you did. Listening will be all those young hot shots who would like nothing better than to do the job you are doing now.They will ask how was it that you had the insight to see exactly what was needed,when it was needed,and the courage to act decisively and without hesitation.What a tough question.Insight is so hard to explain. Let me try this way.We started out talking of wildfires.There is a story that forest firefighters tell that defines insight far better than any dictionary that I know of. It goes like this: More than half a century ago—Friday,August 5, 1949—Big Sky country of Montana was hot and dry,a tinder-box being stoked by 100-degree heat, high winds and 4 percent humidity. First-responders called it a red flag day. About noon,a fire-spotter reported smoke rising from a remote canyon called Mann Gulch—that is right where the Rocky Mountains shoot up from the Great Plains. Parachute was the only way in.A • 6 ©2008 The Robert Wood Johnson Foundation I www.rwjf.org Public Health's "A-Ha!" Moment and What it Means for the American People Presented by Risa Lavizzo-Mourey,RWJF President and CEO September 10,2008 Robert Wood Johnson Foundation rugged firefighter named Wag Dodge(I love that name)and 14 other smoke-jumpers were on the ground by 3:30 p.m. It was like diving into an erupting volcano.Within minutes,a wall of flame 50 feet high and 100 yards wide was racing toward them at 700 feet a minute. There was no way they could outrun it,though most tried.Wag Dodge,however,suddenly stopped in his tracks. He put a match to the tall grass around him,let the new fire burn and then threw himself face-down on the smoldering circle of ashes.The forest fire roared over like a freight train.A thin layer of air clung to the ground and gave him just enough oxygen. Dodge and one other lived;the rest died. Later,he could not explain where his idea came from. But he did say that he knew instantly and intuitively that it would work. Today, almost 60 years later,neuroscientists call this the insight experience. It is what happens when we know exactly what to do—and we do it.These sudden make-it or break-it moments share a common dynamic. First,there is the big problem that seems unsolvable. Nothing works. It is all impasse,gridlock. Next,there's a breakthrough,the big"A-Ha!"---a clarity when knowledge,experience and instinct click together like tumblers opening a lock. It is so palpable you feel it in every fiber of your body.With the "A-Ha!"comes the unshakeable confidence that this will work—that there is only one way forward and you know exactly what to do. Bill Foege tells us the philosophy of public health is to find the truth. Ladies and gentlemen,this is your moment of truth.This is the"A-Ha!"moment for the new public health. Seize this moment. Face the flames. Strike the match.And turn to your future with the absolute certainty that this will work. • Review Risa Lavizzo-Mourey s presentations,commentaries,interviews and media briefings at the President's Corner of the R WJF Web site at www.rrz!/f.org. 4111 7 ©2008 The Robert Wood Johnson Foundation I www.rwji.org • Board of Health Netiv Business .agenda Item #17., 1 2008 Standards for Public Health • Practice: Jefferson County Health Site Report October 16, 24908 PUBLIC HEALTH IMPROVEMENT PARTNERSHIP 41) ' -:::;RMANCE. MANAGEMENT The Standards for Public Health in Washington State provide the framework for performance management of the public health system. 4,5 Standards — What Every Person has a Right to Expect The first standards were jointly written by local and state public health representatives in 1998. Since that time, the standards have been updated four times. There are currently 12 standards and approximately 70-100 measures. Lo- cal and state standards are the same except for the measures that define the specific job that each agency should carry out. The topics covered by the standards include: data collection and assessment, education of the pub- lic, emergency preparation, disease control and investigation, collaboration with communities, and highlight the administrative functions that each agency should have. Measuring Performance — Continuous Quality Improvement Every three years, all local health jurisdictions in the state are reviewed to measure their performance on the standards. This includes if the standard was met, partially met or did not meet specific measures. It also contains strengths and opportunities for improvement. Each agency can • then use this report to identify and plan how to improve over the next three years or to focus improvement efforts. Statewide results, which are a compilation of results from all local health jurisdictions, are used to produce an "Overall Statewide Review Report" of the public health system. This report summarizes statewide performance by measure, progress from the last standards review, by size of agency, and differences between state and local programs. This report is used by public health leadership and policy makers to focus statewide improvement efforts. The most recent round of local and state standards review was in the spring of 2008. Every local health department participated, as well as each division of the State Department of Health and the State Board of Health. The results of these visits will be used to improve performance over the next three years. Integration with Other Efforts The measurement of the "Standards for Public Health in Washington" is one element of performance measurement. There are several other elements that must also be in place. The standards require that local and state agencies have processes in place to collect data, make decisions about pro- grams using data, and then monitor their progress in implementing programs. All this requires an active data system, use of the Local Public Health Indicators, staff that can interpret data and on- going processes to evaluate their work. • PUBLIC HEALTH ALWAYS WORKING FORA SAS ER AND HEALTHIER WASHINGTON JEFFERSON COUNTY w��or `Or PUBLIC HEALTH PUBLIC HEALTH s 411 NO.Co • ALWAYS WORKING FOR A SAFER AND HEALTHIER WASHINGTON Standards Review Process Standards are just one measure of local performance; other measures include performance measures and local public health indicators. Each Standard has a "Measure"which shows local and state public health how well the Standard is being met. It is important to note that comparability to the 2005 review results is limited because there were major revisions in the 2008 Standards and Measures. All LHJs, the Department of Health and the State Board of Health went through a Standards review in the spring, 2008. Results for 2008: ]efferson County Peer Group'Totals Combined LHJ Totals totals 0/0 Demonstrates 73% 50% 55% % Partially 19% 34% 34% Demonstrates 0/0 Does Not 8% 16% 12% Demonstrate • Strengths and Areas for Improvement Strengths • The involvement of BOH in health district activities and decisions, including the review of community health data • The extent of involvement with community organizations and partners, especially for the Maternal and Child Health activities • The use of PHIMS system for tracking CD reports and activities • The JCPH website with CD, EH and other program information • The Region 2 activities that are shared with Kitsap and Clallam counties for assessment activities, the twice yearly visits to providers for updating then on notifiable conditions and the Emergency Response Plan • The Performance Measures Report for most agency programs and activities with trended data • The First Steps UGN application, the Nurse Family Partnership reports and Logic Models • The Family Planning and MCH chart review process for timeliness and compliance with protocols Areas for Improvement • Link data review and conclusions to actions taken, especially link program evaluation results to program improvements, in other words, close the Plan-Do-Study-Act loop • Adopt a process to review all policies and educational materials and date all documents with review or revision dates to assure they are still accurate and relevant • Assure that staff are oriented and trained to the Emergency Preparedness and Response Plan • Implement internal audits of CD and EH investigations and reports to assure timeliness and compliance with protocols • Expand content of the data and information on the JCPH website to share health data and program data • I Standards review summary results compare the LHJ result with their"peer group",as well as combined LHJ total, regardless of LHJ size. JEFFERSON COUNTY �45dN `oL PUBLIC HEALTH • ,1 PUBLIC HEALTH "rHt*cs° ALWAYS WORKING FOR A'SAFER AND HEALTHIER WASHINGTON • Develop a Strategic Plan with Quality Improvement Plan for the agency Next Steps First, celebrate what we have accomplished. In the two and a half year period between the 2005 Evaluation and this performance cycle, it was clear to the site reviewers that improvements had been developed and implemented. Next, select the areas where we want to improve our performance. All of the information provided in this report is intended to support improvement of our organization's work on behalf of the citizens in Jefferson County and Washington State. After we have had a chance to digest this report and share it with staff and Board of Health, we should review the data again to determine which areas of your work might benefit from a focused improvement process. Develop a brief, but specific and doable work plan— don't try to improve everything at once! In selecting areas of improvement we will be able to look at our overall strengths and opportunities for improvement (summarized above), or at the scores of specific Standards or measures. We will be assisted in this effort by several initiatives: • Exemplary practices: The Exemplary Practices Compendium provides us with documentation from many of the LHJs in Washington State. Potential exemplary practice documents were gathered from each of the sites and the very best examples for each measure will be organized into a electronic tool kit. This material will be available by year-end 2008 at www.doh.wa.gov/phip/Standards/BestPractices/StandardsExemplaryPractices.htm . • Statewide initiatives such as the Multistate Learning Collaborative and other efforts like the 5930 Initiative provide opportunities for formal efforts to improve performance. Based on the recommendations in the system-wide report, the PHIP process will adopt additional statewide initiatives related to the measures. Additional Resources Public Health Improvement Plan: www.doh.wa.gov/phip Standards for Public Health: http://www.doh.wa.qov/PHIP/PerfMgmt/product.html Performance Measures: http://www.doh.wa.dov/PHIP/5930PM/overview.htm Peer Groupings Small Mixed Rural Large Town Urban Town/Rural Adams Clallam Asotin Benton/Franklin Columbia Grays Harbor Chelan/Douglas Clark Garfield Island Grant Cowlitz Jefferson Mason Kittitas King Klickitat Skagit Lewis Kitsap Lincoln Skamania Walla Walla Pierce NE Tri-County Whitman Snohomish Okanogan Spokane Pacific Thurston San Juan Whatcom Wahkiakum Yakima d#' PUBLIC HEALTH u LTIIvRuwrow Standards for Public Health * Created in 1998 by local and state public health •' e • Provide framework for performance in public health ALWAYS WORKING FOR A SAFER AND • Goal is to create"What every person has thef. + , t "r. tN right to expect" • Voluntary review every 3 years -2002(baseline) -2005 Standards for Public Health in Washington -2008(revised) * This year's review included each LW, DOH and Standards Review 2008 SBOH PUBLIC HEALTH PUBLIC HEALTH .--_-_ll€N1Ntd_tIM. triza MFAtT i Yf�ra. rLT3H 12 Standards Standards Review • Public Health agencies should be able to: * Standards are one measure of local performance -Community health assessment -"process measures" -Communicate to public,stakeholders • Other measures include -Involve community members -Local Public Health Indicators • -Monitor and report health threats -Performance Measures on specific topics such as immunizations, -Respond to emergencies communicable and chronic disease -Provide prevention and health education • Standardhas Each specific"Measures" -Address gaps in critical services -Plan and evaluate programs -Maintain management,finance -Maintain workforce/Human resources -Maintain information systems -Provide leadership,governance PUBLIC HEALTH PUBLIC HEALTH __-xEA{TNItR wAfxNr6mN„ HU1LIHPt WSSWI6TOx. Standards and Measures Standards at the Local and State Level • STANDARDS-describe 12 functions public health • The 12 Standards are the same; but there are agencies should be able to perform different Measures for local and state agencies • MEASURES- used to assess whether public health agencies meet a standard VALUC QFST_ANDARDS WHAT STAnpARDS CANNQT 40 A Single Standard -Define expectations -Compensate for under-funded for the Public Health System -Set a standard of practice programs -Can be measured and compared -provide information on as,separate -Show common weak spots&strengths services -Allow Comparisons among health 'Change health status or outcomes departments directly I ocat, State -Highlight excellent practices Measures. Measures -Data for setting system improvement goals • 1 PUBLIC HEALTH PUBLIC HEALTH rizm R WAfM111Gi9N IILWNIIR w11fNHI TUN Understanding the Results Results for[placeholder for LHJ!DOH prgm] • Results are for each Standard and Measure [this is a placeholder example and should be • • Summary results compare: deleted when creating slide. NOTE: this table can - The LI-13 result with the"peer group" be found in your Standards Review Report on - Combined LW total,regardless of LH]size page 8] • Comparability to the 2005 Standards Review results is not possible for each Standard and °p"°C LM1 Totals '°' '"" `°""`°`a LOU Totals Measure due to the 2008 revisions Cats P.nem..« .% ,�, �• PUBLIC HEALTH PUBLIC HEALTH ---y�It—"lu vasxawrox_ —IIMMumlirdw011 KNN11 Strengths and Areas for Improvement Local Opportunities [This is a placeholder example to be deleted when • [this is a placeholder to describe opportunities creating slides. NOTE: this information can be based on the initial analysis of strengths and found on page 1 and 2 of your Standards Review areas for improvement. NOTE: this is not in your Report] Standards Review Report,so this will have to be created locally.] • sTREtiGH75 AREAS FOR IMPl2OVEMENT -(this Is a placeholder for strengths] -lthls Is a daceholder for areas of improvement] PUBUC HEALTH PUBLIC HEALTH NEII no wasxltiail.. ..xlwxrca wux1)piIGN.. Next Steps OVERALL STATEWIDE RESULTS • [this is a placeholder to describe your local next Statewide results will be released in 2008 • steps based on your Standards Review Report. Incorporate exemplary practices into local health NOTE: Strategies for"next steps"can be found Continue to work with PHIP Committees on page 3 and 4 of your Standards Review Report. You may also want to tailor your own next steps based on your local results.] . • 2 • PUBLIC HEALTH MWINI R WWXNGTON Additional Information • Public Health Improvement Plan www.doh.wa.gov/phip a�.3ec—` v • Standards for Public Health ��s, ■ ,., httw.doh.wa.govJPHIP(PerfMgmt/product.htm! :HEAL • Performance Measures ALWAYS WORKING FORA SAFER AHD http://www.doh.wa.gov PHZP/5936PM/overview.htm • Exemplary Practices www.doh.wagov(phip/documents/PerfMgmt/oSEP/EPreport.pdf S • 3 FACT SHEET • Washington State Standards for Public Health Why were the standards developed? The Public Health Standards for Washington were developed to measure the performance of the work we do in public health. They were developed by a partnership of state and local public health workers, the State Board of Health and the University of Washington. They were "field tested" in 1999 and have been revised to meet our changing environment. The standards identify a higher level of performance than what exists and it is expected that the public health agencies in this state will work toward meeting the standards in the future. What do the standards measure? The standards measure the major areas of public health. Within each major area, the standards identify measures that meet the goal of"what every citizen has a right to expect" from their public health system. How does the process work? In 2008 the Public Health System was site visited to determine how well state and local public health systems performed to meet the standards. This measurement was conducted March through June, with results available in August. MCPP Healthcare • Consulting Inc. and'a team of state and local reviewers conducted the performance measurement, visited 25 areas of the Department of Health (DOH), the State Board of Health and all local health jurisdictions (LHJ's). The measurement identified areas of exemplary practices and areas where services or programs did not meet standards. The results identified achievements of the entire public health system and areas that may need improvement. Before the site visit, each agency was asked to complete a self-assessment/guidance tool that lists the standards and their measures and to organize documentation supporting each measure. During the site visit the contractors looked at documentation for each standard to rate whether the standard was being met. Each agency that was visited received a report of the results. The consultants also collected "best practice" documents that will be posted to the DOH Web site as examples. PUBLIC HEALTH ALWAYS WORKING FOR A SAFER AND HEALTHIER WASHINGTON i Washington State Public Health Partners Northwest Center for Public Health Practice,University of Washington Washington State Association of Local Public Health Officials Washington State Board of Health Washington State Department of Heath QUESTIONS AND ANSWERS Washington State Standards for Public Health What are the Public Health Standards and why are they important? Public health is a broad, diverse field that relies on expertise from many different organizations to protect the public. It's vital to our communities and quality of life, yet it's very hard to summarize and measure. There are twelve standards. Standards describe the work that should be performed across the state. They are a description of public health that can be used with communities, policy makers and within the public health field. How will the Standards for Public Health be used? These standards are a management tool used every three years to assess the overall performance of the public health system. They can be used by anyone in the governmental public health system and they articulate the role of each partner within the system. Over time, the standards will help identify ways to strengthen the system. Site specific reports have been distributed to each visited site. A more comprehensive report will be distributed later in the year. It will describe the overall functioning of the system and show comparisons and summary results. How will the standards help individual agencies? The reports show how public health organizations performed in 2008. They will help public • health organizations in our state identify achievements and analyze why some organizations do not have the resources needed to meet the public health standards. Some standards can be met by changing priorities, others may require more resources. This analysis will help focus our efforts on areas that need improvement. Who conducted the survey? An independent firm, MCPP Healthcare Consulting Inc. (MCPP) along with state and local reviewers, conducted this year's performance review. The Performance Management Committee directed the consultants and reviewed the measurement tools and format for the reports. MCPP also conducted training sessions for local and state public health staff to prepare for the site visits. How do the Standards for Public Health compare with program standards? The Standards for Public Health focus on the overall functioning of government system of public health, which includes local and state health departments, and the State Board of Health. Program standards focus on specific services or areas of work. Both program standards and system standards are needed to measure performance and identify strengths and weaknesses. The public health system is a network of professionals with expertise, a combination of specific programs, a range of laws and ordinances and a set of values that protect and improve the health of people. It is bigger than any one program and a systematic look at public health can help point out where future efforts are needed. • Washington State Public Health Partners Northwest Center for Public Health Practice,University of Washington Washington State Association of Local Public Health Officials Washington State Board of Health Washington£t-<re Department of Health Will the standards change? The Performance Management Committee has used recommendations from the consultants and input from all sites to change the Standards and Measures between each cycle of review. • These changes were made for the 2008 review and there will be more suggestions after all the results are distributed. It is important that the Standards are relevant to the work we do and that we work to improve them with each cycle. As they are used it becomes clear what the standards mean and what they should include. • PUBLIC HEALTH ALWAYS WORKING FOR A SAFER AND HEALTHIER WASHINGTON Washington State Public Health Partners • Northwest Center for Public Health Practice,University of Washington Washington State Association of Local Public Health Officials Washington State Board of Health Wasrington State Department of Health • Board of i fealth New Business .Agenda Item #17., 2 Immunization Program ',lpdate • October 16, 2008 • WashmgtonStallDepartmentof Washington State Department of Health 1 • rHealth Immunization Program CHILD Profile nli Site Visit Summary Report IMUNIZE It All Ages LHJ: JEFFERSON COUNTY PUBLIC HEALTH Review Date: September 26, 2008 Site: JEFFERSON COUNTY PUBLIC HEALTH -Port Townsend, WA DOH Reviewer: Chris Halsell LHJ Staff Participating: Jane Kurata and Lisa McKenzie Procedures/Systems Reviewed: 1) Standards For Pediatric Immunization Practices 2) Consolidated Contract Requirements 3) Vaccine for Children Requirements Program Components: Program Administration Provider Quality Assurance • Registry/Record Systems Consumer Information Service Delivery Vaccine Management Summary: Program Administration • JCPH health clinic has written policies, procedures and protocols that are outlined in a detailed and comprehensive immunization program manual. The policies were last updated on September 8, 2008. Written policies outline proper vaccine storage and handling, vaccine relocation in the event of a power failure/mechanical difficulty, vaccine ordering procedures, and vaccine inventory control. • Standing orders are current and dated September 4, 2008 and are reviewed on an annual basis by Thomas Locke, MD, County Health Officer. • The agency charges a vaccine administration fee of$6 and a sliding scale office visit fee with a maximum of$27. Provider Quality Assurance • There are six (6) VFC-enrolled provider sites in Jefferson County, including the health jurisdiction clinic. One provider(a hospital) only administers the birth dose of Hepatitis B vaccine. • • JCPH has conducted their one (1) required provider quality assurance visit for 2008. • Staff from JCPH reviews provider's temperature logs at a minimum of a monthly basis. Providers are called or visited if any variances are noted. All current providers are located in 1 close proximity to the health department, so the JCPH staff routinely visit the provider offices for a variety of reasons. While not formal VFC/AFIX site visits, these visits provide ongoing • educational opportunities. • All VIS forms at health jurisdiction clinic were current. Registry/Record Systems • JCPH utilizes the KIPHS billing system to capture immunization records. This data is downloaded to the CHILD Profile Immunization register on a weekly basis. • JCPH staff will explore if the KIPHS system has the ability to or can be modified to capture VFC status. Consumer Information • The health jurisdiction clinic staff provide VIS forms to each patient/parent/guardian for each vaccine administered. • The health jurisdiction clinic has an ample supply of immunization handouts and brochures. • Foreign VIS forms are available, and health center staff is knowledgeable on how to download foreign VIS forms from the various available websites. • Immunization services are provided to all, regardless of the ability to pay for services. Vaccine Management • Vaccine is distributed via a third party system • CPIR is used for vaccine ordering • The health jurisdiction has a manual that contains written procedures for vaccine management, retrieval, and storage. • Emergency procedures for power outages/mechanical failure are known by all clinic staff. • • Vaccines are ordered on a monthly basis and physical inventory of stored VFC vaccine is conducted on a regular basis. • Physical review of the refrigerator/freezer showed that the temperatures were in acceptable range, and that all vaccines were stored in the body of the unit. • "DO NOT DISCONNECT" stickers were placed on each outlet with a vaccine storage refrigerator and freezer and on the circuit breaker panel. Summary: Jefferson County Health District Immunization Program is in full compliance with the State Immunization Program requirements. The LHJ immunization staff is experienced, knowledgeable, and conscientious in every program component and are dedicated to providing the best in customer service. This program has the highest standards of practice for immunization service delivery and program administration. Their method of separating public and private purchase vaccine in their refrigerator and freezer is an outstanding example of vaccine storage best practice. No further follow-up is required for JEFFERSON COUNTY PUBLIC HEALTH during 2008. • 2 JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypublichealth.org • Jefferson County Public Health is pleased to announce three new free programs for low income, uninsured or underinsured people who may not otherwise be able to access these services due to cost. The first two programs listed below are provided by the Department of Health. Available now: Free adult Hepatitis A & B combination vaccine (Twinrix) for high risk adults age 19 and older. 18 year olds are covered by the Vaccines for Children (VFC) program. Risks include persons living with chronic hepatitis C, more than one sex partner in the last six months, history of injected or snorted street drugs, history of a sexually transmitted disease or unprotected sex, history of unprotected sexual contact with someone infected with viral hepatitis, or men who have sex with men. This vaccine is offered in our walk-in immunization clinics on Tuesdays and Thursdays 1-4pm. Free adult Hepatitis C testing for high risk adults age 19 and older. Risks include: exposure to someone else's blood; injected or snorted street • drugs, steroids, silicone or hormones; sex with someone who has Hepatitis C; a history of high risk sexual practices; tattoos or piercings from a non-professional; transfusion, blood products or transplant before 1992; long-term kidney dialysis or persistent abnormal liver tests. Tests are offered on Wednesdays by appointment, 385-9400. Available later this year: Free HPV vaccine (Gardasil) for low income, uninsured women ages 19- 26. Girls age 9-18 are covered by the VFC program. This is a six month pilot program through Merck pharmaceutical's Patient Assistance Program. All women who sign up at any time during the six month program will be provided with the full three dose series. This vaccine will be offered in our walk-in immunization clinics. Providers or patients can call now to sign up for this program and will be notified when we have a start date. 10/08 COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH • DEVELOPMENTAL DISABILITIES a �,U +ii{ � HEALTH^ �n WATER QUALITY MAIN: 360385-9400 �� � ��� iav ' �� MAIN: 360385-9444 FAX: 360.3$59401 HEALTHIER COMMUNITY FAX 360379-4487 JEFFERSON COUNTY PUBLIC HEALTH `' 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypublichealth.org • Immunization Program BOH Update Human Papillomavirus Vaccine 10-9-08 In June 2006, the Centers for Disease Control and Prevention recommended a new vaccine to prevent human papillomavirus (HPV). The HPV vaccine is recommended for all girls age 11 — 18 years and the three dose series protects against the types of HPV that cause 70% of cervical cancers. HPV vaccine became available through the State-Supplied vaccine program in May 2007. Parents and teen-agers seemed quite receptive to this new vaccine. All parents and adolescent girls are educated about the vaccine during immunization visits whether they choose to receive the vaccine that day or defer it to a later time. Jefferson County Public Health immunization clinics administered between 5 and 13 doses of HPV vaccine per month through the remainder of 2007. In order for this vaccine to be most effective, the goal is to immunize young women before they become sexually active and at risk for exposure to the various strains of the virus. Teen- agers don't routinely come into JCPH immunization clinics unless they need school required vaccines. JCPH Immunization Program staff wanted to find a way to reach more adolescent girls with this vaccine. Although vaccines were not given through our Family Planning program, those clinics seemed like a logical place to introduce the HPV vaccine to our young female clients. Many young female clients in our clinics were familiar with the vaccine through mass media advertisements. In March 2008, JCPH Family Planning Nurse Practitioners were oriented to immunization procedures and began offering HPV vaccine in Family Planning clinics. The vaccine continued to be offered in Immunization clinics. With the addition of HPV vaccine administration in Family Planning clinic the number of doses administered per month doubled and has remained at 23 to 30 doses each month since. Clients started on the vaccine in Family Planning appointments are reliably returning to Immunization clinic for their 2nd and 3rd doses to complete the vaccine series. COMMUNITY HEALTH PUBLIC HEALTH NVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIE` WATER QUALITY MAIN FAX 3603385-940100 HEALTHIER COMMUNITY MAIN: 360385-9444 FAX 364379-44$7 JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypublichealth.org • Immunization Program BOH Update South County Immunization Clinic 10-9-08 Many children in the Quilcene & Brinnon areas are under-immunized. A Jefferson Healthcare nurse who lives near Quilcene became aware of this problem and was interested in providing immunization clinics at the South County Medical Clinic. This nurse is already familiar with the recommended childhood immunization schedule, and experienced in vaccine administration and vaccine inventory management. In days, Jane Kurata, PHN, JCPH Vaccines for Children Program Coordinator, completed the required contract for South County Medical Clinic to receive State-Supplied vaccines, and submitted both the contract and an initial vaccine order to the Washington State Department of Health. IDThe Jefferson Healthcare nurse contacted the schools to advertise the new immunization service. One week later, she held the first clinic and vaccinated 4 under- immunized children. She is scheduled to be there one day per week. The school districts of Brinnon and Quilcene and Jefferson County Public Health's WIC and Family Planning clinic in Quilcene will be a referral source for teens and young families needing immunization services. JCPH facilitated Child Profile immunization data entry training for her in another Jefferson Healthcare clinic, so she will be able to document vaccines administered in the state registry, like other Jefferson County vaccine provider clinics. As this immunization clinic becomes well-known, the hope is to expand immunization services to 2 days per week. COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH • DEVELOPMENTAL DISABILITIE 00 ALWAYS WORKING FOR A SAFER AND WATER QUALITY FAX: 360385-9401 HEALTHIER COMMUNITY MAIX: 360379-4487 FAX 364379-44x7 JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypublichealth.org • Immunization Program BOH Update Child Profile 10-09-08 The Washington State Department of Health has encouraged vaccine providers to enter clients' immunization data in the secure, web-based, Child Profile Immunization Registry since 2003. In 2004, all local clinics providing State-Supplied vaccines for children were trained and began using the registry. By 2005 all but one Jefferson Healthcare clinic had stopped using Child Profile due to the double entry required with their transition to the new electronic medical records (EMR) system. Jefferson County Public Health (JCPH) is able to electronically download immunization data directly from our electronic billing and immunization record system into Child Profile. Jefferson Healthcare's EMR is not compatible for data downloads with Child Profile. • Since 2005, JCPH's Vaccines for Children Program Coordinator repeatedly contacted Jefferson Healthcare's EMR Coordinator regarding the importance of capturing Jefferson Healthcare clinics' immunization data into Child Profile. To date, none of the EMR upgrades have been able to interface with the Child Profile program. Whenever the VFC Coordinator visited the clinics, the advantages of using the Immunization Registry were discussed, such as the ability to access a client's vaccination history when they transfer to a new clinic or have lost previous immunization records. The clinic with the largest pediatric population contacted Child Profile in March 2008, and with the help of Child Profile's technical assistance began entering immunization data, even though this still requires double entry. The staff at the remaining Jefferson Healthcare clinic was new and unfamiliar with the Child Profile program. JCPH's VFC Coordinator worked with Child Profile staff to set up a basic training for that clinic on August 1, 2008. A more in-depth training was also provided for all 3 clinics involving report options, reminder/recall lists, generating school Certificate of Immunization Status forms, and inventory control. All three Jefferson Healthcare clinics providing children's vaccines now enter their vaccine data in to Child Profile. The immunization nurse at the new vaccine clinic at South County Medical Clinic will be trained in Child Profile Program on 10-17-08. • COMMUNITY HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES PUBLIC HEALTH WATER QUALITY MAIN: (360) 385-9400 ALWAYS WORKING FOR SAFER AND MAIN: (360) 385-9444 FAX: (360)385-9401 HEALTHIER COMMUNITY FAX: (360) 379-4487 Human Papillomavirus: ('?&A What you should know ;VA Volume 1 Fail 2006 ' - gy !i *, In June 2006, a federal advisory committee to the Centers for Disease Control and Prevention (CDC) recommended a new vaccine to prevent human papillomavirus (HPV). The HPV vaccine is recommended for all girls between 11 and 12 years of age and is designed to prevent most cases of cervical cancer. Q. What is human papillomavirus? Q. How do you get HPV?How can you avoid it? A. Human papillomavirus (HPV) is a virus that infects the genital A. HPV in the genital area is passed from one person to another area and lining of the cervix.There are many different types of through genital contact, most often during sex. The best way to papillomavirus. Some types of HPV infect the genital areas of avoid HPV infection is to abstain from any sexual activity.You men and women, causing warts. Genital warts may be unsightly, can also lower your chance of getting HPV by having sex with but they are generally not harmful. Other types of HPV cause only one person who isn't infected with HPV. But most people ical cancer. who have HPV don't know they have it,so it can be hard to avoid. Although condoms are recommended as a way of decreasing sexually Q. How common is HPV? transmitted infections, they don't offer complete protection A. HPV is the most common sexually against HPV. transmitted infection in the United States and around the world. More than Q. Can't I avoid cervical cancer by getting routine half of sexually active people will bet, Pap tests? infected with HPV at some time in their t lives.Twenty million Americans are currently infected with HPV and another A. Not always. Once, cervical cancer was the most common cause of U.S. cancer deaths.The Pap test changed that. HPV N4,,44 V 6 million become infected every year. infection causes changes in the cervix that can result in cancer. / ; Half of those newly infected with HPV The Pap test is performed by scraping cells from the cervix and are between 15 and 24 years of age. examining them to see whether they show changes consistent with the early development of cancer (called precancerous changes). If Q. Is HPV dangerous? these changes are detected, the doctor can perform surgery on the affected areas before cancer develops.Typically, the length of time A.Yes. Most of the time, HPV goes away on its own and doesn't from infection with HPV to development of cervical cancer is cause any health problems. But sometimes HPV can linger and decades. So, although most HPV infections occur in teenagers lead to cervical cancer. Every year in the U.S., approximately and young adults, cervical cancer is more common in women 10,000 women develop cervical cancer and 4,000 die from during their 40s and 50s. the disease. Cervical cancer is one of the most common cancers The Pap test is one of the most effective cancer screening tests in women, killing about 300,000 every year worldwide. and has dramatically reduced the incidence of cervical cancer in the U.S. But the test isn't entirely predictive of cancer, and not all women get tested as often as they should. ID more For the latest information on all vaccines,visit our Web site at vaccine . c h oP . e d u Human Papillomavirus: What you should know Q. Is there a vaccine to prevent HPV? Q. Is the HPV vaccine safe? A.Yes. In June 2006, a vaccine to A.Yes. Because the HPV vaccine is made using only a single prevent HPV was licensed by the Food protein from each type of the virus, it can't cause HPV and, and Drug Administration (FDA) and therefore, can't cause cervical cancer.The most common side recommended by a federal advisory effect of the vaccine is redness and tenderness at the injection committee to the Centers for Disease site.The vaccine may also cause a slight fever. Control and Prevention (CDC). Studies in about 21,000 girls and young women found the vaccine was Q Do young women who get the HPV vaccine 100 percent effective in preventing still need to get Pap tests? persistent infections caused by four severe types of HPV. The vaccine is given as a series of three shots.The second shot A.Yes. Because the HPV vaccine will protect only against is given two months after the first, and third shot is given six HPV types that cause 70 percent of cervical cancers,women months after the first. should continue to be screened with routine Pap tests. Q. Who should get the HPV vaccine? Q. Do women who have received the HPV vaccine still need to worry about sexually transmitted A. The HPV vaccine is recommended for all girls between infections? 11 and 12 years of age.The vaccine can be given to girls as young as 9 years of age. It is also recommended for all teenage A.Yes.The HPV vaccine does not prevent other sexually and adult women between 13 and 26 years of age if they did transmitted infections such as syphilis, gonorrhea, chlamydia not get the vaccine when they were younger. or herpes.Also,the vaccine doesn't protect against all HPV types. Q. How is the HPV vaccine made? Q. Will the HPV vaccine ever be recommended for boys? A. The HPV vaccine is made using a protein from the surface of the virus.The vaccine protects against four types of HPV: A.Probably.Even though boys don't get cervical cancer,the types 6, 11, 16 and 18.Types 16 and 18 are responsible for disease is transmitted through sexual contact.So it is likely that about 70 percent of cervical cancers.Types 6 and 11 are the CDC will eventually recommend it for boys,too.Since the responsible for about 90 percent of cases of anal and genital warts. initial studies of the HPV vaccine were performed in teenage girls and young women,there isn't much evidence that the vaccine works in boys. However,studies in boys are underway. Y This information is provided by the Vaccine Education Center at The Children's a1 • ae,. Hospital of Philadelphia.The Center is an educational resource for parents and �` �7'*' s "'' ' healthcare professionals and is composed of scientists,physicians,mothers and fathers who are devoted to the study and prevention of infectious diseases.The Vaccine Education Center is funded by endowed chairs from The Children s Hospital of Philadelphia and Kohl's Department Stores.The Center does not vaccine.chop.edu receive support from pharmaceutical companies The Children's Hospital of Philadelphia This project was completed in collaboration with the American College of Hope lives here. Obstetricians and Gynecologists. The Children's Hospital of Philadelphia,the nation's first pediatric hospital, „ is a world leader in patient care,pioneering research,education and advocacy. 2 o ©2006 by The Children's Hospital of Philadelphia,All Rights Reserved. o Board of Health Netiv Business .agenda Item IV, 4 Pu6Cic 3-fealth Fee Discussion • October 16, 2008 • `"s�>� JEFFERSON COUNTY PUBLIC HEALTH 9sf� �a�o 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypublichealth.org • October 10, 2008 To: Jefferson County Board of Health From: Julia Danskin, RN, Community Health Program Manager To open the discussion of the 2009 Community Health Fee setting policies please review attached documents: Excel Fee Schedule Comparison by county Current Jefferson County Public Health (JCPH) Community Health Fee Ordinance, JCPH Income Conversion Table based on 2008 Federal Income Guidelines The Excel Fee Schedule Comparison by County has 7 columns: 1. JCPH Community Health 2008 fee 2. Cost Analysis projections for JCPH Family Planning 2009 fees 3. Kitsap Health District fees approved Sept. 15, 2008 4. Grays Harbor County Public Health fees (note, Kitsap and Grays Harbor are the only other counties listed that do Family Planning) 5. Mason County Department of Health Services 6. Clallam County Health Department • 7. Island County Health Department Historically JCPH fees for Family Planning services have been based on what Medical Assistance would reimburse. Most of the clients served in Family Planning qualify for State Medical Assistance program or their income is low enough to qualify for our federally required Sliding Fee Scale. During our 2008 State Family Planning site visit and Audit we were required to do a Cost Analysis within a year. According to our Federal Title X Family Planning contract"Charges must be based on a cost analysis of all services provided by the project." (From Program Guidelines for Project Grants for Family Planning Services, US Dept. of Health and Human Services, Section 6.3, Financial Management) The 2009 projected Fees for Family Planning services are based on the Family Planning Cost Analysis done by our Fiscal Manager in May of 2008. We recognize these 2009 projected fee increases are likely to be too large yet we could possibly increase the amount of our reimbursement for services provided to clients with Health Insurance. At the moment we anticipate the 2009 Medical Assistance reimburses to stay the same. The 2008 fees listed are based on what we are currently getting from Medical Assistance per county Ordinance. From our 2007 data of Family Planning services Visits per payment source Actual No Charge 79 4% Medical Assistance including Take Charge 1,329 66% Private Insurance 269 13% Full Fee 28 1% Partial Fee 139 7% Other 168 8% Total Visits 2,012 • COMMUNITY HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES PUBLIC HEALTH WATER QUALITY MAIN: (360)385-9400 ALWAYS WORKING FOR A SAFER AND MAIN: (360) 385-9444 FAX: (360)385-9401 HEALTHIER COMMUNITY FAX: (360)379-4487 rR 3 m 4 0 ) . . m m . C) C) C) C Oo _ W _ cn cn (n (n tr . . . . . . . . . . . . . . . . . . . . . 0 W W N N 0 O O) V 6) V V - O) -+ -+ -� O C j O) O O O O O O A ( (O O (O CO O (D (D O O (O (O fD O (O (O O O J N O O (T O O J 01 A W A (O (O (O W W (n O W W W W W W N N N N W W W W W W N N N N N 0 W O N A N Cn (D W O O O O A -+ W M W O O J O (T (D (O (O (O (O (.O -, -, -+ W W M W W O O O O O -+ O -> W W (T A N W -� W -+ O 0 W N -, -, 0 0 -, 0 O O Ut to A A A W N -� O O (T 0 A A A W N -. -., 0 Z 0 -1 m Ai 2m'mmnomcc ' cior r < m735x5o * go mmmmmmom u zzzzzzzzzzzo DcCr mW m m o - ) mwmFcop -oDDc» D pmmm m mxxm mmmmmmmXm - mmmmmmmmmmmm > 75 0 7Kim -JOKxn-,.., _ 0003 HOC ZOI/ WaT < ccC --1p « H < nmmmmmmmmmnZWDmmmmmm (7pmWk- m 13 3 OZ- CzzzZAz < p0 -pDRym mc Nnmvcp - - 0 « « « Dm r cn p / mm � > ", t/) im p < O AO ) NN mmmmmmm mmz ,- D mZ mrco -< mc - mci7Jz m0 - L m izzzzzzpm "{ z D OWwc° DOmmw (amcyZmnzmr- A0 c r = mmcnn O G) zAA - - - CA An H Onoz m zzo o co W N N co coOz < m Z WMI Dp Z DZK A a K 0 ,TT T. T. A (DOVV O - NO Z pm m D m m m Z COm p r m m D H D D D G) H o ZZ m m m Z 3 Wcn m Ni m j, sj C)EA o m to 69 to to Eo N 69 69 EA N A 69 to to 69 69 to to 69 to 69 EA EA to 69 EA 69 EA 69 to 69 V, EA!A Eo to No L Cn Ni N N N 1 to N -+ N N N A A -, -, W W J 0 AAO) O) O) (O O Ou U1 W N W U1 N (O -• V O J (O C N W A N m a O W O A J (O O O O o 0 0 0 O O W J O N N (T O U1 W O O W V O - - 0 0 (T J J O 01 CQ O N W D) O -n _ O O O o o O 0 O 0 0 c 0 c O o O O o O O O O O O O J O (O o O c c O N o O O J O O O O O O m m O O O O O O O O O O O O o 0 0 0 0 0 0 0 0 0 0 O O W O A O O O o o O O N O W O O o 0 0 0 m m p tv m > 08 ;7 Q m to to v, .0401-0 EA to 60-EA-06s - 0 Cr m• z 0 EA IIIIJIIE 69 Eo to Efl EA EA Eo EA to Eo Ni Ni Ni Eo to '� (� Ni 69 N A A COMM -, (0 O J M -4 -A -44 Ni O (O J W N O A N D7 K O O O -� (11 J O Co 0 (n O W O W W O (O O N (n - -+ N o y .N+ (yp G D O O O O O 00000 O O O O O O O b O O o O o 0 O 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 m cn z co N X -< 69 to Eo 69 69 69 69 69 to EA Eo EA 69 to to EA Ej to to to - EA to 69 69-,-_69 EA C m D o o w N O A A n A W A O (n A J J O W O W U1 V N W J A (O -sV (O J (O O A O W m D C 00 O O Ni O O O cn O U1 Ou (O O N J (D N U1 (n O (T O J (O U1 J 0 0 0 0 'U Z O O Ci) O O O O O O O O o O V N (O (n O o O O N W Co W - N 0 0 0 o H O O Ho O O O O O o o O N W (O A o o O o O (T -. N W W (O O O O o -< G`) Ni m 0) c 0 g m = oo M > tj 6�9 to j, -en tj 69 69 X -6,3-6,1 EA 69 C) to to to EA 69 EA to -+ to 69 N 69 to 69 Ni N O (O J O O (O O (O W W O N O W Ou - W -� O W (O U CO co - - (DM (n N J A A O N J W (O O -• O N A O A A O N Q O (n (n 00 O O O O o 0 0 0 0 0 0 0 0 0 0 O o 0 0 0 O o o O O O O O O o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 g p N m fn 0o m 69 to Eo Eo - AA A N Z CD A (n (n co' (O (O U1 N O O O O O 6o O O O O O O o O O O o 0 Ni r n D to a It m r o °) m I- O O D o C Il _r, 7) m 00 V m z ` 0 4 , 1 0 W CO0 Q n 0 J LL N CO 2 00 Q LL N J U , ^( : s-o _464 00 00 0 00 00 0 o . ,... 0 v z mm (A A to Ow u.,0 co Qu- N 2 0 0 0 O O O O O O O O O W O O O 0 O O O 0 000 0 O (n CO O N W (n (0 a 1---. (0 — O m to 4V) fA ca fA N CO ce 69 (A (A Ff3 W- fA 2 aLu co = LL# 0 co N >- <Q c O o OOHHHHHHHHHHHHHH H H CO O u7 (n CO (n CO CO CO CO CO CO (n CO CO CO CO CO ZH aco - 00000000000000 0 (A c‘47- 00000 (...) 000 (..) 0000 0 O (q ujj # 0 U F- LL N m Y z O ` 0 000000 0 0 0 0 o 0 0 0 0 0 0 0 0 0 o 0 0 0 0 0 0 0 0 O o 000000 0 0 00 p o Q Q Q Q Q Q Q < 0 0 0 0 o O O 0 0 Q - d w N (v• (n V r o 0 0 (n o N W O O N u') V o 0 0 (f) .- o IZ 0) N N •y CO O M N N CO V to.- CO ,- (n (V O ([) o N V O EA EH(A fA V3(A(A to to tato (A m fA(A N (A d' (A(A M- � W m U 0 ZO xt .00 oQ Ci. N w W 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 o U U U U 0 0 0 0 0 0 0 0 W L.' - O0000000000000000000000 Z Z Z o (n 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 LL o u1 N dn C M NO o( ( M O) M U> V 4O1` V (n L() o (( Z o ,- of r r N 1� r 1` n r W I-: V o uiu") u) M o M O UJco N v- N N M V N N N N V' N .- .- M (A(A (A N .- (R(A 1- .- N N EA(0 CO NC V (A(A N Cr) r„ CO EA(A(A(A(A(A(A(A(A(A(A(A(A(A 69 69 fA (A CO CO 69E9 (A fA(A(A CO(A(A(A(A (A M (A V (A (n 69 (A (A W W # 0 0 §74D: Via,. '. ,V,f,--4,,,.. - W 0 2 z FCL F H H 0m Z Z(n j �0 (n 5 Q CCU Q O — > > m X cn O a O � O00 < Z0 O Q Z Q Ce >- mm0H J �, W = 0 W w 0 a 00< 0 � zzzH Z 0 , H W J W0 0 w } H z03 WZ 1- 19_ § H < d ( NJ >' W z LL m W H H W W W O o >- Z w U) J < - 0' w W J W w U U N O W H CLQ , 00080 W 0 D U < Hz OF c, w W Q , FH-- F0 , w Q � � a- 0 a' 2 JH W LILICai - maZ 0 d � - W XQ F 0C� , > W WOOQ Q' > OOUO W O w W � Z a 0 a 0 » > < Z O Z H w W v - z 0 F r }- O 0 < - �OU C CC H H w ri Z WQ v m U W W W (nLL W (` } U (n (n (n ' < o - W 2UZ0 (n < O0 U ;„-) Luc JJO DP., ( - Q CLD U` W - Z= O W WCC '- z >> on. ddddw > 2 d - 2 W 2x � > ,5 H YdZ W tladddaad. > HQ 0 °- W 5Uwa, O X TM ° (1. ‹ owwww W w W W m O Q imwcCwO � ol- < Q00000000003 WQQ - W rd U a f- F2 _JU222222222 (n2 d HO24. 2 > 22U m HOU W mmmmmmmmz00 0 00 (n W O 0 N V 0 0 V (O N 0 W M V 0 ,- 0 '7 N O O M W N M N 0 CO O N 0 M M M CO M M M M M ,t 0 O (O N (O O C 00000 C) O) 0 0 0 'C 0 0 0 0 N (O V O N- 0 O) 0 0 0 N M (O O) O) O) O) O) C) C) O) W 0 0 (n 0 0 0 (O O (O O V V N 0 C) (O (O N N N M N W W (O N O N N 0 (0 N N W 0 V N Q) Q) O) O) O) O) O) O) M M O M N M N O) N F- 0 0 0 W W 0 0 0 00 W W W W WW W W 0 W W Co 00 0 W 0 W 0 0 H (0n Q CO C) C) C) 0 0 0 0 0 -) -> -) < O < H Q a O 1 W I m m r Cn j co 0 0 0 co co co 0 co co (fl 0 0 co co O co co co 0 0 co 0 0 H . m -, O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 --4 AO cn N VVVVVMVVVMVVVWMMMMNN N 0 VO W - Ni W --I. --. 0 co -+ -+ -• V O W W 0 W A W cT A -' O O O N O O -, 0) cn V 0) O O cT N W O J W A O 0) 0) N O, co -� z m H m z z$ W - CO 0 --i > D m D ? O M M O Z K m mRm m m r- v = m X X 3 0 0 M " r rT m O O D D m M M 3 X 0 MXW HZ mDwmrXm5O -1 -IrmxzZvvvc < > D3 T -< pOm000c< -< mmm O _ cncn _ m � immrOrDD - cA DCDDD � « c OXv -iX � � { j « - 10 OC = zzn W > °' mv' mOm --I -� cc0 � 0Om � � -i Dmmmi vnoxlizo Rrripon oz ni ( OC Hn ' C wrr- W -< Cno) O OH -I _I _I r :7 :!iii ��t..vtt ZC-i00DAomoo7 < < OOzZ -1 0 � OS � my mmDr2OO p O � Plncncn 75, rX � NorDD �7 �7 � 000 C -rionmK - � rrii zmm H HHoO OW WD a, mmn �r � '�oj -�Ii �ioon � NCCfl m m < < O0 m � m mm >n > r0 m HHr0 G) oaN < # oR. R � � a, 00 W < < mD 2 O 55 Z � - DD o : D ' Ja, 00C) G) Ocncn -< HiD DD p7 i o = O D O 1 Oz OZ D o Dm O M 007 m -{ --I 3 Z z z I Oz m O D C -n0 z O D _ F- T N m EA to fA Efl .. . Efl EA EA W fA tf,E!,Ef3 EA ti9 Efl EA —fA EA EA fA to t-A Efl V, 0 0It m L C/l W N W Ef, N Efl Cn O au cD Ut A A N W W Cn co Co W Cn W W N N N W Q) 00 -,069690 .A4,969 00 m C7 411 000 VM 0) J A N U O -+ N O] N 0 A 0 0 0) W V -+ -, co a cn O z z z z W W W W W M V W V V m = 000 O O O o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 O 0 0 0 0 0 0 0 0 0 0 000 00 0 000000000000ooao o aooa o nC) C) C) 000co oocaa m 11 m 0 m c D O o Y 0 m ai fO Z 0 yj �' y O Cal „n„ N w w N "' A O. D 0 o G X Cn 0 z co N X -, �' ' 0 W m N Otot»t» tototoen tot» � Otovatot» to W Ni W to V1 O -, oa, AN AOWWnWWN (0 cn U, cn CA 0) O O cn O cn cn cn cn cn O O CD to O O O 000 0 0 000000 00o OC/C0000 0 H 000 0 0 0 0 0 0 0 0 000 0 -I000 0 0 O -< M 0 p m 2 03 MD P3 CO 0 X '.4.3 0 n N g M > Na to tf 0 N m to m en t,,totov+tots,entoto tot-t»tA to t,, to co m0 CO A W W o A A N N W cn O O A W N N M 694A - -,69 Z CA W J O - U o - W o A N W 40 ,1 (003 00 MW A W 0) O 00000000000 OOOO O O O O O O O O 00000000000 OOOO O 00 O O O T .Z1 n M r- 0 m ss 69 It m 0 N Ni CA 0 0 0 0 T r O O 0 o 0 0 Efl to toW W to to,A to tii-- to to to to Ni m r- 1.3 to 0 - 0 a1 cn (r 0 cn V W W cn A W N 0 CA U cn O A O cn cn O cn Cn 0 0 000 0 0 V rn D li 0 0 0 0 0 0 0 0 0 0 0 0 0 000 0 — ao m y 0 0 000000000270 0oO o 0 4 i. Z W :g, J LL O 41; 4' 1, ''' 0 00 Q LL N J U Z co0 LU to LL 0 2 N CC0 CO C 00 2wa O 0 fn LL N ›- < re CD 1 0000 z a. C) O 0 0 O (� uJ M O 4,96969(i) c.) f— u. -.* 0 m Y z 0 — cY U) G . � N e a u o •y 0 N U O ZO It .o c o Q LU CI- D W WN 0 W W 0000 D O 00 00 W U V' 0000 (0 M N 00 00 O W O O O co o Loco O <tO ' V <f N (n -) ,_ 0°3 N (A fA EN 69 b4 a a EA Efl W k O W N LL LU C z c WQ - = 2 H LoW 0 W W 0 2 d < E z W a Wr- 2 0 LUG - cn d U)50W0 p � Q Z.N � WW F Cf m U Q Z ¢ ¢ z 0 0 0 0 >d V) U – < 000 LO_ o W LLLUD CL O W z W a w y:U) U) cr)co O D z0 < 0 V) coskII a a W W UJ N L OOa3 � < 0Q ...fU) U) QQQ 000 oO LL z EzJ ¢ HU _iF Oca HHH O DO F- Q2m zi < - zoo 000 Ow D2 < 0 zW O � .e O a a 000 0 0a zLL F 01- 0 = 00 U /) w LL LL W Hz O Nr- MLO CO O W V if) ct W Y.)0 O O O O CO Q) 0) Q) F- 0) H H U) 0 0 0 a> a) a. 0 0 W w LL STATE OF WASHINGTON S JEFFERSON COUNTY BOARD OF HEALTH AN ORDINANCE ESTABLISHING A Ordinance No. 11-1215-05 FEE SCHEDULE FOR JEFFERSON COUNTY PUBLIC HEALTH Section 1—Purpose Section 2—Hearing Section 3—Effective Date Section 4—Fees Section 5- Severability Section 6- Prior fee schedules repealed Section 1 -Purpose The purpose of this ordinance is to set fee schedules for Jefferson County Public Health Community Health • Environmental Health Section 2—Hearing December 15,2005 Section 3—Effective Date January 1,2006 Section 4—Fees Schedules Public Health Clinic Services All of the fees listed under Public Health Clinic Services and Environmental Health Division are hereby being set by the Jefferson County Board of Health as follows: Public Health Community Health Fee Schedule will be set at the same amount,to the nearest higher dollar as the current rate schedule—reimbursable by the Washington State Department of Social and Health Services, with the exception of non-mandated services. Community Health offers fees based on a sliding fee scale to clients. Clients will not be ip- turned away due to the inability to pay. A copy of the current Federal Poverty Guidelines,which establishes the sliding fee scale, is available at Jefferson County Public Health. • All fees for immunizations not subsidized by the Washington State Department of Health will be the cost of vaccine plus handling, shipping and nursing time. There is no sliding fee scale for privately purchased vaccines or the visits. Laboratory Services are based on the actual fees of laboratory contractors,price lists are available. Cost of such services is not subject to sliding scale. In the cases of Communicable disease prevention,the lab costs may be waived. Fees for medications, birth control methods and antibiotics are based on cost of acquisition. Fees for antibiotics for the Communicable Disease program may be waived. Vital Records are set by the RCW 70.58.107. The cost sheet is available by request. The Environmental Health fees are described in the following chart. Section 5: Severability: A determination that any fee or fees adopted as part of this Ordinance is unlawful or illegal shall not cause any other fee or fees adopted as part of this Ordinance not affected by that determination to be repealed,revised or reduced. • Section 6: Prior fee schedules repealed: Any prior fee schedule previously adopted by this Board that contains or reflects fee amounts that are less than those adopted herein is hereby repealed and replaced by this Ordinance. • �- .-- t-- . . . . . > O) O a) C) C7) C3) O _O o Q. 0 0 0 0 0 O O O o C. � CA CO d; CO CA COO d' N 0 N C'') Tr up CD r` cocco N 0 -:, N (Ni M CD ID A 0 A 0 O O 0 0 0 0 0 0 F_Cb CA OD CA CO CO CA OD 0 0 0 0 0 0 0 0 CD 1-- CO - CD - CD `- 0 CD 0 0 0 0 0 0 r- A O V '— O CD o >+ iri NM &J". _ OO C0 Nctri Oo N co >o V o 0 1 o r N- i-- 17 t- 17 r . o ,,..N I's N r- N N N N- Z t0 CO 0 0 0 0 0 0 0 0 CO CO Cf) N O N- 0 N O N Z N c1 Cl) CD N- (A O O N CO C� CD CO 0) CD CO O CD Z > N CO co d• co CD N N N N CO- CO- d CD O Ce a. 0 0 0 0 0 0 0 0 0 C' N- CD — 0 v- CD — CD V' OC) CO OC) OCA CD O r0 CD Cn N O r` co N O d C7) co co CA CD M O CD J F- N o M O C!7 M N O N \ r- N CO CO O O 65 ul >. N M M cY tf) CD co N >, Q >+N , >`N ? QU N o i i i f i i i o n 1 1 1 1 1 1 1 �E _" r r r �- r r r r E up up �" , 0 � 0 0 0 C) 0 0 0 O C0 M M COomM CCOO M M CO Z 11 N ,; 00 O CV 't CD OD O N LL O <,I� M O Cn c- I- COO Z o O CO- 0 N O CD ,- >'N T- N N co d O N N M tt U) CD ti - 0 o m > M > 0 0 0 0 0 o O o J d O O O O O O O O J C) C) C) C) MT:- M C) M J o CC O N d CD CO O N r� M (A LU r N- M O V o O CO- co N CA CO CD ,- o >. T- N N M �t Cn Cn Z W ,oo .` N N M d ct Cf) O O oo CO >.. Na.... IIIIIIII > N O- - I I I I I I I 1 CO 0 o r r r �--• 7.7 O . o co co co co co co co co LU o p 0. N N = 0 0 0 0 0 0 0 d CD ti .- V (D (A r- V O O N r N l!7 co c- o M R n N E lf) O 0 O CD — CD •-- 00 V O r- M O CO N i_ r .- N N co M d- 't Lo- 5 cW �- r- N co co d- d• Cf) co CV W2 = y CV 0 V 0 0 0 0 0 0 O O u- ' N r•-• N ti N N- N (I) (� 0 0 0 0 0 0 O O w %',- cC CD O c- CD CA J Ow o N U) OD r- O CO O o Cn O 0 O CD - CD r-- Z �, o 00 V O f� M o r- N N M M Nt N L Q — Q O t19 >+ .- N M C tt CC7 (D O >+ 0 V V r Q. I 1 i i i i i V N. Q ., f:2 �, r I I � � i i � P Z Z W y o r r r r r r O d • o N N N N N N N N E - Ali > •a �- M -, c) 0) 000. 000 E CL �- M -O C!) O co O co O in CI) J LL5 T co O CO N CD O -D Cf) . :, co I,- N CO c- CC) O E V C N N COM �t CMf) co s `- c- N CV CO CO '`,Zr V (z = U U CO o c W C) o ‹ a J Eir- Lu LL 00000000 E r- `- `- `o 0 W CD00 nO0CD1.0 0 rn w m W C) CD o CO N CD O C o M N- N CD r C1� O O M J U < E o >. CA c- CD c- N N CO M U o 1- r N N Cr) Cr) V CC co J t0 co N N CO CO >. tu, Ca ' U N- I- J Z ,„c ,. ...„. , „. i i i i i N r Q M Z o• - c- ,- c- .-- c- c- O o Cq O l!7 O coin O lA O CO O Z N N com #, O U) 0 0 0 LU O l0C) O Z N N O NY CA N LU C) coMN _O d CL Q M N O Lo O 0 T" c .- N N N M C) OD > '_=�- N N CO M M co O Z W = CA >. E!? O p Z >I- O O O coO O O coE •x 000 0 Cr) O 000 0 COO "p W 0 0 0 0 0 0 0 0 �� LL co to ;, OVCANCnCAMN- ctf N 2 o C) N- N CD .- Cn O 4. co 1Lr c- .- N N N M M V) 0 y to 17 N N CO CO �Y N to i!9 >,f CD 0 CD 03 Z0 ° W O N Q moll i i i 1 1 �C O r O i Z Z CD o r r r ,_ r �- r E o W' O O 0 0 0 0 0 0 O Q •• o �� Cp CD CD CD CD CO CD co (U O Q O ;' O O N 00 �Y O E et ' O r O M O O) E r U ,...7;,- . O t7 ,...(0, N N N M Loco_ `- •- N N N N Op CA c- r r W Ce Z CO CO o LL y Zili OOOOOOOO CI) r� N- ti r� N- titi N C,� d LU co o ) dr O CD ON co d- O CO O o C6 co0O M CD CD O 0 - O N. N N CO CO M L O Q 17"' .- N N N N L V o v o 3 N y a) 4.13 y w GO) N 7 y 0.) 7 C7) Q o , _ N M C) CO co Ed C� v- '.0 - 0E LL O Q. rN co ct 0 CO r- CO E LL C> ON LL w NNO N� � ) p aa IL Il Cl. it o r= JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street • Port Townsend •Washington • 98368 fY;ht� www.jeffersoncountypublichealth.org S Memorandum To: Jefferson County Board of Health From: Andrew Shogren, MPH Environmental Health Director Date: October 10, 2008 Re: Environmental Health Fee Discussion Every year Environmental Health sets fees that seek to cover 100% of all direct services. Traditionally, Environmental Health (EH) has charged fees based on the actual costs to do services, adjusted yearly by Consumer Price Index (CPI). This year we will be bringing to the board proposed changes based on the CPI and an updated cost analysis. Historically, Environmental Health Division has been directed the BOH that fees cover • direct services. To begin the discussion, please find attached regional comparisons for EH fees from Kitsap County and Clallam County. In November, the process will continue by bringing to the BOH a detailed cost analysis of EH services and fees. COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH • DEVELOPMENTAL DISABILITIES ��, � WORKING WATER QUALITY MAiN: 36438 x9400 MAIN: 360385-9444 FAX: 360.3859401 HEALTHIER COMMUNITY FAX: 360.379-4487 JEFFERSON COUNTY PUBLIC HEALTH ENVIRONMENTAL HEALTH DIVISION Additional Jefferson • Jefferson Fees and with 2009 ENVIRONMENTAL HEALTH 2008 Fees Other CPI increase Kitsap 2008 Fees Clallam 2008 Fees Information (to be provided) ONSITE SEWAGE DISPOSAL Sewage Disposal Permits New Conventional 465.00 Valid for 3 years 923.00-1102.00 590.00-700.00 New Alternative 561.00 Valid for 3 years 923.00-1102.00 590.00-700.00 Issued in New septic tank and/or pump chamber only 205.00 conjunction with 150.00 Plus$78 per connection-valid New Community or>1000 G.P.D.(base fee) 465.00 for 3 yrs 923.00-1102.00 590.00-700.00 New Commercial>1000 G.P.D. $700 for first 350 gallons plus$200 for each Conventional 561.00 Valid for 3 years 923.00-1102.00 additional 350 gallons $700 for first 350 gallons plus$200 for each Alternative 602.00 Valid for 3 years 923.00-1102.00 additional 350 gallons 109.00 Applies to existing installed sewage disposal system Repair/Upgrade/Modification/Designate Reserve Area 229.00 150.00 Expansion 369.00 923.00-1102.00 260 Applies to pending or Redesign 109.00 active but not 923.00-1102.00 100.00 Reinspection 137.00 145.00 75.00 Evaluation of Existing System/Monitoring Inspection Septic system only 274.00 202.00 private • Septic system plus water sample 285.00 510.00 Retest/Reinspection 96.00 145.00 Filing Fee 39.00 50.00-200.00 42.00 On Site Sewage On Site SPAAD 274.00 565.00-744.00 300.00 Septic Permit with SPAAD(conventional) 205.00 923.00-1102.00 590.00-700.00 Septic Permit with SPAAD(alternative) 308.00 923.00-1102.00 590.00-700.00 Plus$70.00 Per Subdivision Review Base Fee 354.00 Lot 440.00-514.00 300.00/lot Boundary line adjustment review fee 140.00 Pre application meeting fee 140.00 Planned rural residential development review fee 140.00 Density exemption review fee 70.00 Density exemption review fee requiring field work 140.00 Other WaiverNariance Application 164.00 101.00 95-140 WaiverNariance Hearing 274.00 101-202 150-250 Technical assistance--Minimum 65.00 101.00 70.00 Technical assistance--Per Hour 65.00 Per Hour 101.00 70.00 Wet season evaluation 369.00 202.00 200.00 Revised building application review fee 140.00 New building application review fee: Residential 70.00 223.00 Commercial 140.00 263.00-364.00 • 1 of 3 10/10/2008 3:11 PM Jefferson Additional with 2009 ENVIRONMENTAL HEALTH Jefferson Fees and CPI increase Kitsap 2008 Fees Clallam 2008 Fees 2008 Fees Other (to be Information provided) • General environmental health review fee 70.00 101.00 Licenses Installer,Pumper,Operator(maintenance person) 369.00 504.00 390.00 Retest 150.00 168.00 150,00 Annual Renewal 260.00 168.00 240.00 Delinquent Renewal after January 31 369.00 223.00 FOOD SERVICE ESTABLISHMENT FEES PERMIT FEES (Annual Permit) Immediate Consumption Limited 130.00 400.00-734.00 210.00-420.00 Non-Complex 166.00 400.00-734.00 210.00-420.00 Complex: 0-50 seats 296.00 400.00-734.00 210.00-420.00, 51-100 seats 355.00 400.00-734.00 210.00-420.00 101-150 seats 402.00 400.00-734.00 210.00-420.00 Alcohol served in multiple areas 130.00 100.00 Not for Immediate Consumption Limited 130.00 129.00-335.00 140.00-280.00 Non-Complex 166.00 129.00-335.00 140.00-280.00 Complex 402.00 129.00-335.00 140.00-280.00 50%of Annual Annual Permit Issued after September 1 50%of fee Permit Fee Additional to Late Fee(Paid after January 31) +25%of fee Permit Fee _ Additional to Late Fee(Paid after February 28) +50%of fee Permit Fee Temporary Permit Non-Complex 106.00 12.00-142.00 25.00-120.00 Limited 59.00 12.00-142.00 25.00-120.00 Additional(Paid when application is submitted less than 7 days prior to the event) Late Fee +50%of fee 25.00 Other Food Fees Waiver 35.00 Plan Review Minimum 65.00 152.00-202.00 70.00-210.00 Per Hour 65.00 70.00 Reinspection First Inspection 83.00 101.00 75.00 Second Inspection 142.00 101.00 75.00 Administrative Hearing 201.00 101.00-202.00 95.00-250.00 Food Handler Card 10.00 10.00 10.00 Reissue Unexpired Food Handler Card 4.00 10.00 2.00 Manager's Course 201.00 168.00 100 SOLID WASTE Landfills requiring environmental monitoring 485.00 101.00-2000.00 700.00-6000.00 Inert Landfills 307.00 101.00 2100.00 Biosolid Utilization 426.00 Other Solid Waste Facility Permits 307.00 101.00-2000.00 700.00-6000.00 Drop Boxes 142.00 1062.00 350.00 New Facility Application 390.00 101.00-2000.00 700.00 $700+$70/hr if more than Plan Review 65.00 Per Hour 101.00 10 hours spent WATER Inspection of well construction, decommission& $101 +$101 after the Application Fee 142.00 reconstruction first hour. 210.00-290.00 Building Permit Determination of Adequate Water Supply 59.00 Process 101.00-308.00 60.00-70.00 Well Site Inspection-Proposed public water supply 284.00 380.00 210.00 2 of 3 10/10/2008 3:11 PM Additional Jefferson Jefferson Fees and with 2009 ENVIRONMENTAL HEALTH 2008 Fees Other CPI increase Kitsap 2008 Fees Clallam 2008 Fees • Information (to be provided) Water Sample Bottles LIVING ENVIRONMENTS(Annual Permit) Pool 260.00 449.00 240.00 Spa 260.00 449.00 240.00 Pool/Spa Combined 355.00 560.00 310.00 Plus$15.00 Per Subdivision Review Base Fee 355.00 Lot 440.00-514.00 Plan Review 65.00 Per Hour 101.00 $70/hour Compliance Enforcement 65.00 Per Hour 101.00 $70/hour Reinspection 70.00 101.00 $70/hour Rebuttal Application 140.00 • 3 of 3 10/10/2008 3:11 PM • Board of Health New Business Agenda Item #`V., 5 Expedited Partner therapy Program • October 16, 2008 • I-3 JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypublichealth.org • Expedited Partner Treatment (EPT) A new initiative from Jefferson County Public Health (JCPH) and the Washington State Department of Health (DOH) helps ensure the treatment of partners of people diagnosed with gonorrhea and chlamydia. The health department recommends that all heterosexual patients be offered medications to give to their sex partners if the diagnosing clinician cannot otherwise be certain that partners will be evaluated and treated. This treatment method is called Expedited Partner Treatment (EPT). The DOH guidance for use of EPT is supported by the Washington State Medical Association and has been reviewed by the Washington State Board of Medical Quality Assurance and the Washington State Pharmacy Board. This initiative includes the following elements: • 1) New partner treatment recommendations: Most persons with gonorrhea or Chlamydia should be offered medications at the time of their diagnosis to give to their sex partners 2) Free medication for partner treatment: The health department is providing all clinicians in Jefferson County with access to free medications to give to patients for their sex partners 3) Referral of hiqh risk patients: JCPH asks that providers refer selected, high-risk patients to receive assistance notifying partners 4) New case report forms: Providers are asked to indicate on new case report form how the patient's partners have been managed • COMMUNITY HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES PUBLIC HEALTH WATER QUALITY MAIN: (360) 385-9400 ALWAYS WORKING FOR A SAFER AND MAIN: (360)385-9444 FAX: (360) 385-9401 HEALTHIER COMMUNITY FAX: (360)379-4487 Board of Health .Tvledia Report • October 16, 2008 • Jefferson County Public Health O September/October 2008 NEWS ARTICLES 1. "County panel to hear water quality report," Peninsula Daily News, September 14th, 2008 2. "County official considering N.M.job offer," Peninsula Daily News, September 14th, 2008. 3. "Discovery Bay getting back to its old self—shellfish growing to be reopened soon," Peninsula Daily News, September 15th, 2008. 4. "Local school-based health centers considered; Sept. 17-18 public meetings explore concept," Port Townsend Leader, September 15th, 2008. 5. "State officials searching for E.coli source," Peninsula Daily News, September 16th, 2008. 6. "City, school district 'town meeting' is Thursday," Port Townsend Leader, September 15th, 2008. 7. "County is hiring a new No. 1, losing a No. 2," Port Townsend Leader, September 15th, 2008. 8. "Methamphetamine treatment services expand in county," Port Townsend Leader, September 17th, 2008. 9. "Discovery Bay is reapproved for commercial shellfish harvest," Port Townsend Leader, September 17th, 2008. 10. "School-based health centers is subject of Sept. 17-18 forums," Port • Townsend Leader, September 17th, 2008. 11. "Commissioners to meet over yard waste," Peninsula Daily News, September 21St, 2008. 12. "Rant to Jefferson," Peninsula Daily News, September 21st, 2008. 13. "Jefferson OKs hauling fees for yard waste," Peninsula Daily News, September 23rd, 2008. 14. "Commissioners officially hire county boss," Peninsula Daily News, September 23rd, 2008. 15. "Jefferson County smoking rate lower than state's," Port Townsend Leader, September 24th, 2008. 16. "Agencies expand meth treatment funding," Peninsula Daily News, October 1st 2008. 17. "Hood Canal—It's not always greener over the septic tank," Port Townsend Leader, October 1St, 2008. 18. "School consolidation favored in Port Townsend town hall meeting," Peninsula Daily News, October 6, 2008 19. "Cash-poor county may still aid pool," Peninsula Daily News, October 7, 2008 20. "New county boss sits in as an observer", Peninsula Daily News, October 7, 2008 21. "Prevention helps positive futures," Port Townsend Leader, October 8, 2008 22. "Agencies expand meth treatment funding," Peninsula Daily News, 23. "Morley's meet and greet," Port Townsend Leader, October 8, 2008 24. "Fall flu clinics under way;" Port Townsend Leader, October 8, 2008 • 25. "More money needed to keep pool open," Port Townsend Leader 26. "Shopping with heart at Girls' Night Out," Port Townsend Leader, October 8, 2008 27. "State high court ruling on smoking having little effect," Peninsula Daily News, October 9, 2008 28. "No rise in Medicare premiums for 2009,"The Associated Press 29. "Town Meeting about Parks and Recreation," 4 pages • • a 'Yr".. - ,N. a, County to hear • waterqualityreport PENINSULA DAILY NEWS x1-1e a f ` i ciMitialik w .I � 1$ dpi �� j,,, f on Wednesday. The three Jefferson r k '`'1r: f l + 1, ,1 The commissioners will t f x E `; meet at 6:30 m. in the Wash- County commissioners will r Jc f fe.JSOn� ` { p hear a water quality report on '� ;,_,,;>'q.z'.: W, 3 t<. „,f,x ing-ton State University Learn Discovery Bay on Monday. ing Center Spruce Room, County environmental ference room, City Hall, Shold Business Park, 201 W health officials are expected II Tuesday, 3 p.m. — HisPatison St., Port Hadlock. update the commissioners toric Preservation Commit- ers Tae planninghearPlanning commission- to at 10:15 a.m. in their cham- tee, third floor conference also will Planning Whit- bers on the ground floor of room, City Hall. Commissioner Mike Whit the countycourthouse, 1820 ■ Tuesday, 3 taker's presentation on mining y, p.m. — PEG Jefferson St. Access Coordinating Commit- buffers proposed in the countyUniform Development Code. The commissioners will tee, second floor conference Written public comments also meet at 1:30 p.m. Mon- room, City Hall. on the comprehensive plan day for a briefing with the ■ Tuesday, 7 p.m. — East amendments will be accepted interim county administrator. Jefferson Fire Rescue Joint by the Department of Com- munity commissioners will Oversight Board, Fire Station Development on open their meeting at 9 p.m. 1-5, 35 Critter Lane. behalf of the Planning Corn- with a public comment period, ■ Thursday, 3 p.m. — mission until 4:30 p.m. Oct. 3. followed by consideration of Alternative Electric Manage- The Integrated Staff the consent agenda at 9:30 a.m. ment Committee, Port of Port Report and State Environ- Townsend commissioner mental Policy Act Addendum Port Townsend council chambers, 375 Hudson is available to the public at the • The Port Townsend Cit Street, Point Hudson. community development office y ■ Thursday, 4 p.m. — City or on the county's Web site at Council will discuss the pur- Council Finance & Budget www.cojefferson.wa.us. chase of the Kosec Funeral Committee, first floor confer- Community development Home building for use as the ence room, City Hall. staff has recommended deny- new city police station on ing four of the eight site-spe- Monday. Port Townsend schools Council members will meet cific amendment proposals, at 6:30 p.m, in council chain- The Port Townsend City and approving three with bers at Old City Hall, 540 Council and the Port modifications. Water St. Townsend School District One proposal was recom- The council also will dis- Board of Directors plan a joint mended for approval without cuss changes to the city code, town meeting on Thursday. modifications. and possible approval of a The meeting will be at 6 The Iron Mountain Quarry float loan for the Hastings p.m. at Blue Heron Middle proposal remains on the Building. School, 3939 San Juan Ave. docket,and was recommended Other city meetings, held The topic will be planning for approval with modifica- school facilities. tions and mitigating measures in City Hall conference as conditions of approval. rooms, 250 Madison Street, County planning Hearing Examiner unless otherwise noted, are: Stephen Caussaeux Jr. has ■ Monday, 4 p.m. — The Jefferson County not rendered a decision on the Library Advisory Board, Pink Planning Commissioners code interpretation to require House, 1256 Lawrence St. plan a public hearing on the the quarry to have a condi- II Tuesday, 1 p.m. — Arts 2008 site specific comprehen- tional use permit near the Commission, first floor con- sive plan amendment proposals Shine Quarry. • • ...<,..81wrimmtrzle•MiltiloV.,„,,r-ra,,VV,?0,'?",;f:V,,".-;V',„ :, a� L ?4 z ax e sax. #fi4 6 ,:;4 a <: «, ,,. County official 25 years in county govern- • ment. considering N.M. job offer CHIMACUM—Allen Sartin, Jefferson County's central services director, has been chosen for the position of manager of Eddy County,. • N.M., but he had not accepted the post as of Satur- day. will be discussing this with my employer on Mon- and 'Ment I'will amake now," corn- 'Merit Sartin said from his Chi- macum home. The Eddy County commis- sioners unanimously voted Friday to choose Sartin to succeed Steve Massey, who is • retiring at the end of the year from overseeing the county in southeast New Mexico. Sartin was chosen from,a short list of four finalists that was selected from 14 appli • cants. Eddy County Commission - Chairman Guy Lutman said the choice was based on Sartin's experience and spe- cial interest in finance and technology. Sartin's resume lists four years in municipal govern- ment management work and S /fes Discovery Bay getting back to its old sell -- shellfish growing to be reopened soon Page 1 of 2 r= _. Nw ENINSULA AILY"N 'WS Port Arlpeles.�YA qy'^;` '' Currently I Hourly Into 116 Del, o Your Peninsula a Your Newspaper A14,';',.4,,,,,, ': ' r � Sunny "Welcomto ours 5 s 'k s :{.,. , rr r' 66QF Web site" T.1.1.7-.,;',.,-.17:77-. M'»s..-. -ti -:'.-'ir zr 4.>3'•* s.f i` ` ,,',,.: T,. _ ' c0:',/-'-." fi f ¢ ReatFeetu:66°F 0 14' " 's tl t' .� cTlraiaS.r x zx. w .. .a< �' .>1�`. _ .a�, .:.,s ,. ,, ,_ .. -,* ,. �.. winds:Eats mph CLICK IIIIMI " d w F a Ica l.Mans 7i � r a (raj[ �1r-'Ag} -..,s,,,.,— le E v .. 'y N o,•lR al Jj . f _ � '''.'i'7=7•7';I 107L. L Monday,September 15,2008 Search online stories:WO': (a4yanced search) Contact Us HOME E NATIOWORLD 1 SUBSCRIBE 1 THINGS TO CODO t CLASSIFIEDS OBITUARIES I BUY PHOTOS l Tot:A Sr10 140041 THE i>(i,t I Local News PENINSULA DAILY NE1\/S Path HOME a NEWS Discovery Bay getting back to its old self-shellfish growing ID-be reopened soon .,-prim This Emelt This By Jeff Chew,Peninsula Daily News 'a"«s. „a t. 'ate .d �cT°t e = t DISCOVERY BAY—State Department of Health officials have recommended upgrading the water � z quality status of the south end of DiscoveryBay,which means that a SO-acne site,which had been ,t '^P „ ' :,,, ' p closed to commercial shellfish ofDisgrowing tar about 20 months,can be reopened. w a 7T c.`. 5 z q The southern end of the shellfish nch bay had been classified as"restnded.”because of elevated �, a x 1 - T „..,x.‘,44,.:,:::::: _ kA fecal coiform tevehfound mwater-quality tests 7,x 3 q - 'Atter thorough efforts to clean u the waters s Dsaid to Bl conditions have rim ” s A`e-%,a fr 10 9 P ry Y. proved enough to a " c"' *-_, = 8 a reopen the area m ns to cl a shellfish harvest,"saitl Ned Hartington,Jefferson County Water .w &y' �� ", "P ' Quality program manager,on Friday. ,,,- f X "This is great news' a _ Bob Woolnch manager of the shellfish growing area section of the state Heath Departments water quality division,said the agency has sent an initial order to Jefferson CountyPubic Health notilymg the county o(me change in status �pg "The water quality there has improved,and now meets the Inationaq standard,"Woolrich said. Before the order becomes final in mid-October,a public comment period of five weeks is allowed. r The o h err of Deco ry pay,shown hen:beyond Ria e d et Salmon Greek he ding toward reopening to Creeks a concern tum real shesfish g wpg Rer. slate and Jelrerson County heaah oflxdal ro a a water qua1M to be impro d ',..4,-,4,,,, ill Photo DY Jag ChewrPenmwla Da News •., While months-long monitoring of the south bay section shows clean waters,fecal coliform .. contamination has been found upstream en Salmon and Snow creeks,which reed into the southernbead of DiscoveryBay.Hartington said. ----- - - From the PDN • m 'This is an ongoing process.This is good,but we're still looking at the current data tom the fresh water that's not good. `, frOf,. "We still need to carred those sources of pollution and find them. 10,995 "This upgrade isn'tthe end" The water quality upgrade is based on marine water sampling done bly the state heath department,and work done by Jefferson County Pubic Health.Jefferson ��aa l 1 County Conservation Distrd and area landowners to find and fix pollution problems. ea �I', PR E FORD "There is much work to be done to ensure that Discovery Bay remains approved for the harvest of commercial shellfish,"Harington said. Survey_, Cr a wit continue conducting onsite sewage education and improving agricultural practices to reduce the amount of fecal coiform contaminating Salmon and Snow `""" Creeks which flow into DiscoveryBay.' The conservation district will continue to work with local landowners to improve their agricultural practices Harrington said - )-INCoIN-MERCURY ' Stip 171.4)11 L d „ Click r7 PJPS }" M1 Flt'_ 4, (OJi,{ r l C) L i`k E rT ' BII L',rg}It(T 4 - Swam's Ahl.r. f" ' a� `Ynur Ndracr.0aeraced * � DENEf?L OVULE x state i' ,,' ., a %' f VReal r jai" �+ P'y ' . . t #Offices to Serve Youcrit the 4 C)igrnpic Peninsula Triggered district,plan ''a The January 2007 downgrade Mggere d a requirement in slate law coling on the county to work cath other agendas to estabish a district and a program to "C improve and maintain water quality in the shellfish growing area. / SECURITY The three Jefferson County commissioners created a closure response plan that includes monitoring surface water,improving agricultural practices,and correcting 0 SECURITY problems with anode septic systems. SERVICES The area of the downgrade is next to the Salmon and Snow Creek estuary,therefore the response area ieCludea these watershetls. TheShogren,state county DepartmentEnvironof meEcologyntalHealth providedand a$495,638waterquaily Centennialdirector.Clean Water Fund grant,which Jefferson County matched with$165,212 for monitoring and clean-up efforts,said Andrew 1.800-859-3463 Jefferson County Public Health worked closely with Jefferson County Conservation District to on comprehensive water quality monitoring in the Salmon and Snow Creek watersheds. Protecting creeks The distect worked with landowners to install 10,250 feet of fencing to keep livestock out the streams,wetlands,and ditches,Harrington said. http://peninsuladailynews.com/article/20080915/NEWS/809150306 9/15/2008 Di: cdveryBay getting back to its old self-- shellfish growing to be reopened soon Page 2 of 2 The district also installed off-stream watering troughs along Snow Creek to reduce livestock access to the creek,and two livestock culverts at key stream Welcome o crossings. YI Realty A 62-foot bridge will soon be installed to give added protection to Salmon Creek. Woolrich said the state Health's change in status came after several improved water quality samples were taken and tested from the four monitoring stations the . , ' r Here state has in the south Discovery Bay section. REJ<, LisE'1;tyr I • There are 20 water quality-monitoring stations throughout the bay. Woolnch said his division has looked at 30 water samples taken since the closure and'they've looked good for quite some time now.' Bray Broker Harrington said county Public Health inspected onsite septic systems on most of the shoreline properties in south Discovery Bay and properties along Salmon and Snow Creeks. Public Health also surveyed six miles of the south Discovery Bay shoreline to sample small drainages and seeps that may have been contributing fecal coliform � pollution to the bay,Harrington said. Repairs to two septic systems occurred in the project area that may have been contributing to the pollution problem,he said. a-; The area now meets the water quality standards of the National Shellfish Sanitation Program for commercial shellfish. County health department officials will present the news to the Jefferson County commissioners at 10:15 a.m.Monday during a meeting in their chambers on the •f.- + ground floor of the county courthouse,1820 Jefferson St. W1'- rth To provide comment on Dsicovery Bay,write Jefferson County Pubic Health,615 Sheridan St.,Port Townsend,WA 98368 or phone 360-385-9400. �# kj Port Townsend/Jefferson County Editor Jeff Chew can be reached at 360-385-2335 or/off chew@ neninsuladaifvneWs.cow. Last modified:September 14.2008 9:00PM ea1613 " PEN1 . SA, 1' Your 1 i . lila oiir _Newspape All materials Copyright 0 2008 Horvitz Newspapers.•Terms of Use•Privacy Policy•Associated Press Copvrighl Notice•Contact Us • • http://peninsuladailynews.com/article/20080915/NEWS/809150306 9/15/2008 Local sclrvol based health centers considered.,-Sept. ,l 18 public meetings explore concept ept - Page i of 2 ,0, ` '. aal �W 1kt3sfx - ,. f '^fi . et 410 The LEADER ,_::,, .> home" classifieds _top jobs. subscribe contact us photos contests ` ferry&tides it RSS`` Search ruff C I RC LE& � � • (,v„rk -PPro,�esi Auto Rea6 c er, l,r} Reco nized as AAArs Search , cJSQUARE s ,, g Tr ii Top Shop in WA State Advanced Search Domestic&import Auto Care w . r ok „'"ys '''iii r 185.2070—Port t da initsieS es r. ?el TownKend 69°F ._ .' _{^ aaw waanrar home daily news Rash daily news flash September 15,2008 9/152006 12:36:00 PM ,.. .,.,.A»...N..�,,.x..,.-,.,aN.m.,»:,�.....�,«,....,...�,-...,.,........«,.�.....•,..., o,,.,.�,.7.b..,.,..,•.�-..-....�.�,•. � ..,. � �� w Email thus article•Print this amok= - ,ot yEin u""'r' , Local school-based health centers considered;Sept.17-18 public meetings explore I bt ,I , _° ,,, .---V ` concept ,, , n�,l Shopflo4Cally�^��-, Jefferson County Public Health,Jefferson Healthcare,and Port Townsend and Chimacum school districts invite '.;.,i;,:'�€...'0"-t,..; _a,,., parents,students and interested community members to be part of the conversation on school-based health ""''" centers to serve students at Port Townsend and Chimacum high schools. a#,1' A,' local coupons o Two meetings are set:Wednesday,Sept.17,6-7 p.m.at the Port Townsend High School library,and Thursday, Sept.18,6:30-7:30 p.m.at the Chimacum High School library. O'UTSTAN D I, rieWs% 3'PortTownsend "School-based health centers are nationally recognized as one of the best ways to provide effective,efficient and building site Dally News Flash appropriate health services to adolescents who may otherwise not have access to needed care,"said Jean ,1 Baldwin,director of Public Health. k " Top Stories a Arts&Entertainment The meetings will introduce the concept of school-based health centers and the need to improve the health of our Gallery Walk youths.They will also outline the partnership among the local sponsoring entities and how they are working to 4 . *t �.r4, Opinion Forum establish the health centers. Ca� Our Place There are 17 school-based health centers in Washington state.Services typically include diagnosis and treatment x Columns of minor illnesses and injuries,management of chronic health conditions,sports physicals and mental health --''' ' '47t.,i'ti's Sports counseling. '' Marketplace For more information,call Public Health at 385-9400,or the high schools:PT,379-4520;CHS,732-4481. Law&Justice Hood Canal Update Lf.' 1az'" Citizen Journalist ., : e 0 News Release Forms C communrly Community Billboard 'shledlOPLIt Community Calendar i?liatiatthinit Online Calendar [iroakhaven Retreat Activities Guide A true retreat for Women Upload your Professional Staff-Call Government Meetings u: local music Links Directory 2008 Support Groups here! visitors Visitor Information Getaway Guide t multimedia` tP Photo Gallery t� Photo Slideshows Article Comment Submission Form YEtti Sul` Local Music 00....-':,f''', d5u%6et1vdan Local Video -114146140,v Please feel free to submit your comments. .,- liisoikummo special sections oistaii4hAily w., Publications site comments are not posted immediately to the Web site,Each submission must be approved by the Web site editor,who may edit content for appropriateness.There may be a delay of 24-48 hours for any submission ', Insider Map while the web site editor reviews and approves it. ( ,,,,,.„ J advertising Frshin Note:All information on this form is required.Your telephone number is for our use only,and will not be attached g,hunting Display Ad Rates to your comment. camping,outdoor Online Advertising Name: clothing,work Classifieds clothing&MORE! Legal Notices Telephone: r._--- about us '' E-mail: Newsstand Locations ,' Freedom of Information Passcode: This form will not send your comment unless you copy exactly the passcode seen below into the text field.This is an ant ij �t.t.mwa.1, NIE - spam device to help reduce the automated email spam coming through this form. m Archives Leader History 6441yPlease copy the passcode exactly it is case sensitive. 0 Interact with Staff http://www.ptleader.com/main.asp?SectionlD=4&Subs ectionlD=4&ArticlelD=21812&T... 9/15/2008 State. offlcials . . .. .. searchungfor • E. coh source • .. Cases reported ' "We usually see an increase in cases during the summer, Port Townsend, with the hemosstt prevalent in ,' Seattle Oregon "We have upwards of as g many as 200 E.coli cases a year in the state so it is not uncom- , PENINSULA DAILY NEWS mon what we see right now," OLYMPIA—State officials One other Jefferson case have confirmed they are work- ing on finding a link between Lisa McKenzie, state health common strands of identified representative••for:Jefferson E. coil bacteria cases in Wash- County, said'one.'other case of ington and Oregon. ` E. coli is being investigated at They are not calling it an this time in the county. outbreak. "There is another.possible . We are in the process of case they are looking at right conducting a cluster investiga- 'now [in Jefferson County]," tion," said Kathryn MacDon- McKenzie said, aid, food-borne illness special- "Right now we're not 100 ist for Washington State percent sure,tho " Department of Health.. Health officials have said We can't say how many :•:three or four sporadic cases casae are connected.right now,;.;appear in Jefferson County each but that's what were trying to y ear figure out. The case being investigated "We know we do have other will still need to be referred to cases that are connected, but. right now at this point we don't state labs before it can be deter- •think there is an outbreak." mined u it also matches the MacDonald said the E. coli cluster, of cases. McKenzie said while the • strand found in a case in Jef- E. coli can be ferson County recently 1ulde�ira�bleoanA painful it is matched other cases near Seat-' that,someone dies from it. tie and PortlandDa, a Ore reporter "In most healthy adults, it the Peninsula D Erik Hidle, ally News,was was for would be rare to kill someone," admitted to Jefferson Health- ' she said. care hospital with extreme `In yob children, it can abdominal pain•onSept.3. cause complications in kidneys It was later discovered that and it cart also cause problems he was ill with E.coli 0157:17, for older folks and�k)eople with a strand which causes severe medical conditions.,. illness.. McKenzie said E. coli is a rare disease and as of right now Interviews conducted there is not much cause for Both states are conducting„.. s'-.. , "Some of the basic guide- interviews with those who" lima are to always thoroughly were infected with the;,illness., cook meat such as ground beef,. in an attempt to find a common 'and when working with raw denominator.. ' ;4 meat-to,avoid any cross conte- "The DNA in some of the mination with other.food"she cases is the same,"MacDonald said, said. "If there is„ a common thread or not,we don't know. "Sometimes they lead to identifying a certain.product, sometimes they, don't, some you can't find a common • • thread and then it just goes away., MacDonald'said the l coli' strand being investigated `is fairly common and has,been,;• III seen in the.state before. . ' MacDonald, also said she, didn't believe the situation wasn ` out of the ordinary. !`/�(/ 9//o/op '' PTLeadei%com I Port Townsend & Jefferson.Ct anty h't.ader's daily news website,I City,'Sc::.: Fage I44c, 1 PST l CM • Lill)4 tlr The LEADER '-. A. Monday,September 15,2008 City, school district 'town meeting' is Thursday By Barney Burke Monday,September 15,2008 Thursday's"town meeting" is the fourth in a series of community outreach events in Port Townsend this year. The topic is"Planning school facilities for Port Townsend's future."The meeting is jointly sponsored by the City Council and Port Townsend School District 50 Board. The meeting is from 6 to 8:30 p.m. Thursday, Sept. 18 at Blue Heron Middle School. One of the core messages heard from the public at this year's previous town meetings is the importance of having good schools if the town is to attract and retain young families, said Mayor Michelle Sandoval. ii• She noted that some residents had questioned the city's timing of a property tax lid lift that voters approved in August and whether it contributed to the failure of the school district's construction bond in May. The city lid lift to help the public library was announced the week before the school bond ballots were due. "It would be hard to have a good school system without a library,"Sandoval said, noting that Port Townsend schools no longer have their own librarians. "I don't think retired people know that," she said. Sandoval said it's important for the city to work in partnership with other local entities such as the school district, the county and the port to collaborate on issues that affect everyone. This meeting will once again emphasize small group discussions, she said. "It's a conversation about our schools. For more information, contact Planning Director Rick Sepler at 379-5081 or rsepler@cityofpt.us. Related Links Content©2008 Port Townsend Publishing Company,Inc. Software©1998-2008 lup!Software,All Rights Reserved S http://www.ptleader.com/print.asp?ArticlelD=21813&SectionID=4&SubSectionID=4 9/25/2008 PTLeader cOni I Port'1`viitsend & Jefferson County Leader's daily`news`website 1 County... Pagej of 2 "`. s0.444= PRINT • � K3e The LEADER Monday,September 15,2008 County is hiring a new No. 1, losing a No. 2 By Allison Arthur Monday,September 15,2008 Philip Morley of Edmonds is the unanimous pick of Jefferson County commissioners to be the next county administrator. Commissioners voted Monday to start contract negotiations with "!.---114 !114 Morley,who currently works as the assistant city manager of the City of Maple Valley, Wash. ?.TpJust as Morley was tapped to succeed John Fischbach as a � � permanent county administrator, Allen Sartin, who was Fischbach's right-hand man as director of central services, • announced Monday he had accepted a job as county manager of Eddy County, N.M. Sartin's last day on the job is Sept. 30. " =, The changes in top management come as Jefferson County is w working to balance its preliminary 2009 budget, which Sartin said Monday still needs work before being presented Sept. 22 to 3 �,'commissioners. Morley could not be reached Tuesday for comment. County commissioners cited Morley's work with budgets and the state-mandated Growth Management Act, and his excellent z ; research skills as reasons for his selection. "I like the fact that he's savvy on budgets," said Commissioner Phil Johnson, D-Port Townsend, adding that Morley also understands Washington and the Growth Management Act"so it's not going to be a massive learning curve." Jefferson County Central Services Director Johnson also said he felt that Morley would be someone who Allen Sartin, the county's No. 2 employee, would stay in Jefferson County. "He's a person who may be resigned Monday as county commissioners around for a long time," Johnson said of Morley, who has hiked started negotiating with Phillip Morley to take in the area. over as Jefferson County Administrator. Sartin"I think he's got a lot of great experience and he really fits our often filled in as acting county administrator. - county,"said Commissioner David Sullivan, adding that Morley Photo by Allison Arthur understands sewers and the GMA and had done research on the county before being interviewed. III "He was remarkable prepared. He had studied the issues of the county, and he and his wife have been to the county, to Fort Worden. He knows the challenges unique to Jefferson County," agreed Commissioner John Austin, http://www.ptleader.com/print.asp?ArticleID=21815&SectionlD=4&SubSectionID=4 9/25/2008 I neader.conalPort Townsend& Jefferso. Co mty Leader's daily news website I County...-:Page 2 of 2 • D-Port Ludlow. Morley holds a master's degree in public administration from the University of Washington. He has a bachelor's degree in biology from Brown University in Providence, R.I. Morley also has county experience as an executive management analyst in Snohomish County and worked in the • solid waste division in Snohomish County, according to Interim County Administrator Dennis Richards. Morley also has been an assistant general manager of the Alderwood Water and Wastewater District. Contract negotiations were just starting this week, so Morley's potential salary and other details still were to be worked out. Commissioners directed Richards to start working on those details. Richards said the salary for the job ranges from $102,000 to$120,000 a year. Fischbach, who resigned effective Feb. 15 and then took a job in Goodyear,Ariz., was making $89,000 a year plus benefits. In Goodyear, Fischbach's salary is $168,000 a year. After Fischbach left, Prothman Co., an executive search firm, was hired to find both a temporary and a permanent replacement. To date, Prothman has been paid $86,724 for its services, which includes hiring Richards and his salary. The company also helped commissioners conduct interviews with five candidates last Tuesday. Because they were candidates and not considered finalists, their names were not released. Richards said some candidates did not want to jeopardize their current employment. Sartin leaving While Morley may be coming, Sartin said Monday he would work through Sept. 30 and then head to New Mexico. He said his wife, who likes the drier climate there, would be staying around to sell the house. Sartin, who also has served as deputy county administrator, resigned five years to the day he started-Sept. 15. Sartin declined to say what his salary will be in Eddy County. Newspaper reports of his hiring in Carlsbad did not • specify the salary, and a human resource spokesman in Eddy County did not return a call from The Leader on Tuesday. Sartin's annual salary in Jefferson County is$81,748 plus health care benefits. "It's an opportunity to be a county manager. It will allow me to retire as a county manager,"Sartin said. Sartin was one of three Jefferson County managers considered initially to fill the county administrator's position earlier this year when Fischbach resigned. Public Works Director Frank Gifford was tapped instead to serve as temporary interim administrator until the search firm Prothman found Richards to serve as interim administrator. Richards thanked Sartin on Monday for helping him during his tenure. Asked more about the job in New Mexico, Sartin said that Eddy County is doing well financially because of oil and gas exploration and in fact has a surplus of revenue, unlike Jefferson County, which likely will have to dip into reserves to make ends meet next year. (Contact Allison Arthur at aarthur@ptleader.com.) Related Links Content©2008 Port Townsend Publishing Company,Inc. Software©1998-2008 1 up!Software,All Rights Reserved • http://www.ptleader.com/print.asp?ArticlelD=21815&SectionID=4&SubSectionlD=4 9/25/2008 ANY Wednesday,September 17,2008•8 3 Methamphetamine t eat er m nt • services expand in county As part of National Alcohol demand for mental health and "The renewed hope that springs agencies to deliver expanded and Drug Recovery Month,Safe substance abuse treatment, and from long-term recovery truly can treatment services and directly Harbor Recovery Center/Beacon costing untold amounts in child make a difference in helping more benefit the residents of Jefferson of Hope,Jefferson Mental Health welfare,medical and dental care, families get healthy.The Jefferson County," said Janet Polley, Services and Jefferson County public health, the legal justice County Methamphetamine executive director of Jefferson Public Health announce expand- system and public education. Treatment Services is another Mental Health Services. ed methamphetamine treatment September is National Alcohol opportunity for our residents who JCMTS is funded by an award funding and services avail- and Drug Recovery Month,and it need help." from the Washington State Office able through Jefferson County offers the opportunity to support By funding the JCMTS, the of Financial Management. As a Methamphetamine Treatment and recognize those in long-term organizations expect increased result of being one of the first Services(JCMTS). recovery and encourage others to access to assessment,evaluation counties in Washington to imple- Methamphetamine use and seek treatment. and treatment services, reduced ment the "Expanded Mental addiction affects every person in "Treatment for substance-use wait times, and increased col- Health and Substance Abuse Jefferson County, according to disorders is effective and neves- laboration and coordination of Treatment and Therapeutic Court Anne Winegar,program manager sary to sustain a healthy and patient treatment plans. Funds" tax, Jefferson County of Jefferson County Community productive society," said Jean "Working with Safe Harbor received an award of $100,000 Network.Methamphetamine use Baldwin, director of Jefferson Recovery Center/Beacon of per year for two years to imple- has significant impact beyond County Public Health. Hope and Jefferson County ment additional methamphet- the individual user, affecting Ford Kessler, president and Public Health on this program amine treatment services. the jails financially, taxing law CEO of Safe Harbor Recovery shows a renewed spirit of part- To learn more about JCMTS, enforcement, creating increased Center/Beacon of Hope, noted: nership and collaboration among call Safe Harbor at 385-3866.To learn more about mental health treatment services,call Jefferson Mental Health Services at 385- 0321. • To schedule a presentation about meth prevention,visit www. j effers onco untyp ub 1 i che a lth.o rg or contact Winegar at 379-4495 or awinegar@co.jefferson.wa.us. • .1 Nati: 4. • 'x,.tF a Y` F;,. tti} ,r"Sa` r4 14 $ { .. • !sr i saStvp, .v e *kft m I.4?xk n . , , „ , g d �t ��t t r� 4it • � sac � � ';x#'�,z c f �- °� .'X �� a {� 46 I 6. = v f °, ~ t. r�3 q 0. a f L • '-a'"�•u 3yi �j C 4+ .e -. 4a'' A� � .0) 1,4' . * t �p�.T*47 2=. eNa b o a "'� 4 if , , „"e• •<:t',t As 3 : x:4 R t •1 t..t' ',rx _ n Iflh og a �Q• JS f � J.t 'yL w F �kr r F • S "4 n , lgil '7 �rr t9'� �. %1 ,• „4 a-•fix . 8 ,, '8 gEg C x 0 AO ::::-.i.41'4, �b; `f',Y s r r A _o .5 !.V. C' 11���� 1'920 p 1.'a'0 Ca w ,, j 'f �• - F :•� t �,.i7 aTc$, i ` g n .`� p 4� � �. O d! y �' j .{ t. ( r z4.$•< x-+t+)�k 1,I. Fy7 s'k y 8 1 4_ ;a1.41 rIS: }C��Yr OO�p QY� 3 q3q -10,1%.,14t- :y ys i.��''f i +, 3. ',:''''...;:;;;?4.1,;,'C'7, i j-:,:..s.,1--4'"3 '^ a �VD , It bg"' .h)1 , 7 'ry kd,; ,,,,,-;*•: Y .c..10s x. .mss, ,. / ) n p rJ' �+o- 7y} � ,';'''',:072,2.- :4,7..c.es '�y � y i • N a 4g a A •x ' ' s is.1 n t c'"{ yl'` M1• x = 1.1.11 id'8 V g 4 °3 C 7 O ill .*'- 1'.. .4.- .' .4< t. +E s f • &aar ,I 'l. sL' fi.R'�FC't,, ?N o z°' �y O �tl O G u — ,�{,. s €n yy5,,�� +r "t 35,.,1 .f s,.::r/ v' t �G a rn U'c, u u G o > 5. t [} irig ftt,„ iiuIilhiifli o G.:d �u„' cR 00 0'O �' F •f'4 P y;�. .+ ,5, 4, e , ``-, +:,.'„,„•,-.;g �° , a A b y i 10. 7 e '1.''''''' Y Z T"—� E l p.AU Ei.u i Arg g 3 u:aa i., * rt :a#p i.!, °#'yrs • .,. --.-:. .f..!;,','".: a,z f 5, /� "' p sa H U w 'd o y i '4y t .4 �," .wgi♦e '^- c i i M • u 1 u.G H pa J 51 u t` '. lief 5;+t'1,. ?..i . • x - L VI qq Q Fy o = +:'>+', j * EItJ: - o� 51 H E.5a moo$-5 5 f v o--7-- c - cc o Ori* Gg .grig�C 0 �_t€ n ry 0°u a� c C ^ 2 7 C 1 _ vt 3i o u ."1b--.6 p N T� a A- 5 ° 3 v C.E "Rt hI u N 4.?—= ,4s G • • flLh 0 `� ° - - `- :pnx � ! ! F! E! H Se p2 QQ FF IJ '= f? a�J O 2 P rJ' V ` .sJ' 0.Q 3 i r f w,� i5 Cl '3 ° yO± �\ a 5 `2�U u5 b.5Y c m" •''- _- r f Z+ • tgg �p) pCp S 3.—f, >-.1.' 0 .�j y y C O r, e {y y U 43 s D >, u g 41g213 '�••� =rn5 3 u V E o5 u School-based health centers is subject of Sept. 17-18 forums • Jefferson County Public conversation on school-based ship among the local sponsoring Health,Jefferson Healthcare,and health centers to serve students entities and how they are working Port Townsend and Chimacuni at Port Townsend and Chimacum to establish the health centers. school districts invite parents, high schools. There are 17 school-based students and interested commu- Two meetings are set: health centers in Washington nity members to be part of the Wednesday,Sept. 17,6-7 p.m.at state. Services typically, include the Port Townsend High School diagnosis and treatment of minor library,and Thursday, Sept. 18, illnesses and injuries, manage- 6:30-7:30 p.m.at the Chimacum ment of chronic health condi- High School library. tions, sports physicals and men- The meetings will introduce tal health counseling. the concept of school-based For more information, call health centers and the need to Public Health;at 385-9400, or improve the health of our youths. the high schools: PT,379-4520; They will also outline the partner- CHS,732-4481. 1111 • • 9/7/,y2 Commissioners to meet over yard waste PeNwsuu Dans Newsprnmty Parks and Recreation 111 Tuesday. 5 p.m.—Tear The three Jefferson County Eye On Jefferson Open Space Planning Commit- Down and Bulk and Scale Task commissioners will conduct a tee,on the Parks and Recce- Force, third floor conference public h on ato aeon Open Space Plan/Study room at City Hall,250 Madison 1111 Baring proposal the ground floor of the Jeffer- Circles. St. deb sat thete a fee for county waste waste son County Courthouse, 1820 At 11:30 am.,the commis- •Wednesday, 3:30 p.m.— transfer station when they Jefferson St.,Port Townsend. sioners will meet in executive Climate Action Committee, meet on Monday. At 10:30 a.m.,the commis- ton Washington State University The commissions will meet sioners will hear an update The commissioners will Extension Office,201 W.Pati- at 10 a.m.in their chambers on from Richard Hull, with the intmeet'erat 1:30county p.m. with theadministrator son St-,Port Hadlock im for a briefing session. Port of Port Townsend At 9:30 a.m.,they will con- sider a consent agenda that The Port of Port Townsend will set a hearing date on the commissioners will discuss the proposed county budget at 10 2009 budget and the strategic a.m.Oct.6. plan for the port on Wednes- The commissioners open day their meeting at 9 a.m. with The commissioners will public comments. meet at 1 p.m.in the Port Com Port Townsend council mission Chambers, 375 Hud- son Street. No Port Townsend City Also being discussed by Council meeting is set this commissioners are the condi- week. tions of the roofs in the port, Other city meetings are: industrial park. • • • • • RANT TO JEFFERSON County Health Department for raising fees for senior foot care from $15 to $20. A great health guard and service now may be too costly for many on a fixed income who are being nickeled and dimed from every angle. EDITOR'S NOTE:The fee has been increased, but a date for imposing it has not been set, Veronica Shaw, the agency's chief operations director, said Friday. People who are unable to•pay are asked make a donation, "whatever they can,"Shaw said. • 9/.2./o, • PPENINSULA DAILY9/2.3x News ' Jefferson OKs hauling fees foryard waste P 1 County scapers.We've got to figure out I i how we can charge equitably." County Commissioner John Will share Austin,D-Port Ludlow,said he felt the fees could no longer be new revenue delayed, moving to approve them. BY JEFF CHEW Two weeks ago,the commis- PENINSULA DAILY NEWS sioners were told that in 2006, 43 percent of all transactions PORT TOWNSEND — and 35 percent of total tonnage Despite concerns raised by recorded at the weight scale yard waste haulers,Jefferson were for yard waste. County commissioners for the The situation has created a first time approved yard waste financial burden for the county tipping fees on Monday. in terms of accounting and scale Approved was a flat fee of maintenance,and for the city in $5 for loads of 200 pounds or terms of the cost for upgrading less, and $48•a ton for loads and maintaining the compost- more than 200 pounds. ing facility,they were told. The Port Townsend City Al Cairns, county solid • Council has already adopted waste manager, said the an amendment to an interlocal county now subsidizes the fee agreement that allows the col- with $65,000 and the city lection of tipping fees. between $200,000 and The city and county share $300,000 through sewer fees. an interlocal agreement for• Port Townsend residents • biosolids composting at the Larry Boner, George Yount county's waste transfer sta- and Bill Miller said they sup- tion south of Port Townsend. -ported the new fees,although As proposed, the.county Bonar called for a minimum would receive a share of the charge of$3 for a minimum of fee based on a fixed cost per 100 pounds. transaction. County Commissioner David Dorothy Seraphin,who for Sullivan,'D-Cape George, said • 22 years has owned and oper- he had concerns about fees for ated Quality Landscapes in smaller loads resulting in illegal Port Hadlock with her nus- dumping or burning. band,Stephen,said she at first He said he hoped that coy- . was concerned about the fees, ered loads would cost less to but after hearing county offi- prevent materials, such as cials Monday; she was more noxious weed seeds to blow amenable to them. out on the roads. Cairns said his division was Many senior citizens prepared to educate residents "It's still going to be a night- about the new fees and.why mare to figure it out," said they were r ecessa an Seraphin, who was concerned approach supported by Sullivan. about having to pass the added No increasing In burning fee on to customers, many of whom are senior citizens on Cairns recently said his fixed incomes who can't handle research showed that the city yard waste themselves. of Port Angeles and others saw She said she would wait and no increase in illegal burning see what impact it might have or dumping when yard waste on her business. tipping fees went into effect. Louise Frombach, 83, said Cairns said the need for she has driven more than 400 grinding yard waste at resi- truckloads of,yard waste from dents','hpnies has.resulted in 'the'historic•Redrnrnds and two—new Jefferson' County Laurel Grove cemeteries in busines's'es that will provide Port Townsend as a volunteer that service on site. • landscaper with a 1-ton pickup. For 15 years, Cairns said, "I guess I can't make a yard waste has been offset by a mess anymore," Frombach tipping fee for solid waste,but said,half-jokingly. is not enough to meet expenses. County Commissioner Phil . Johnson, D-Port Townsend, Jefferson County Editor Jeff Chew said he "never•really consid- can be reached at 360.3135-2335 or ered this conundrum for land- jeN.chewepeninsuladailynews.com. a .5 0o w.x , > r y II 1g 0, .'asp m g Q., 7-.d.a d V o1 o �1 U o j U if--. tgA %tg (\AD 9t:. 8a10.. at'co� $` . .�,• 13ro: 13• w� I N M 9 a7 a a. .>) lC "a 8mQ ' sae (''� ao.5�a� 0 Q cox atJ▪ $2 I 'am.5 k.:2-,33 N-o ;P"'"(.... t t E O V C p ,moi, •Lop 5 > . I t•/J .5 .vWv :,.o c� O a 9i1i fir#'+' I 5 a °3 a :• ' 0 E . o.m tb "a'a • E [ �.o w� I oco po • Ra'S :a e 0 3bil,-- c "''np i moo ao8p pa •5gtgpii- G) 0oa L. . .4 • E -...X -1-:$ 2i 8A. I . IC ! Rl�p t , C s J Tj'p+46� OD6l3N � gyp" 2 E .1 ,-, id a r ax m J ii>p, d d A. N wt, 8.`L) g,, 'F E:,..-474 •r'�1 S :q E. ,b IEEE 7:1 a Al ospal a g v J .t p�, `s a 8• .-o a S p INEE 12.= a � i,; ► aaQ Nti ., dm00 o . OO y gea > pce aS �T '41a fl� b 4)2 INNIII , ., ::- ,,,-, oo4zcv.a., 0. 5 • -.51 73 at. IUU • V\ 5 V]O$ tJ OD a N .52 •0 s,11 nam 8om�. 04 ■• aa ad >• °_ 8T0 ; y ] Olt d S1 v: 410FVd W a °' oria A> 8I411.5 La' _ .�o.cggc m . o 4 m 0 L. . q ill ?- .5,9.1 A : ag Z 8 ru.00-,4:„ 0, 2 °98. 5- 5 .80, p a� . �� a- 8 p .50.".. o. xl ,5 0,,a a aF 8 o 21T8 $iw co -t ) I— qb ;x g h T E .ox A. 0 gay 1 1 38 IN 2 a m� qaT, •$ pc, l.r ,•a1pi , • E . ,, • tl ti '173 co ° . . z ... .4 0 .t-a ts a a .°: OvQVo� E E m $ a 'a �a . vl 73 M (5.81-.;',-°. . r Port Townsend&Jefferson County Leader Wednesday,September 24,2008•B 3 • VF . W n: • Jefferson Countysmoking rate lower than state s Medicaid now offers free help with smoking.cessation Anew state survey shows that afp/20070315/poc.htmL. and support they need to suc- 85 percent of Jefferson County When the state Department ceed." adults don't smoke. of Health began its compre- Medicaid clients can call But Jefferson County offi- hensive Tobacco Prevention the toll-free Washington State cials say that still means 4,290 and Control Program in 2000, Tobacco Quit Line at 800-QUIT- Jefferson County adults do. the Washington adult smok- NOW (877-2NO-FUME in "Non-smokers live longer and. ing rate was 22.4 percent. The Spanish). live better,"said Port Townsend most recent survey shows the The Tobacco Quit Line pro- physician Joe Mattem. "It's that. smoking rate in Washington has vides some level of quit support simple." decreased to a new low of 16.5 for all Washington residents, For that reason, Jefferson percent in 2007. including counseling, help with County's Tobacco Prevention At the same time, smokii2g �a personalized quit plan, and at • Program says it will continue to rates remain higher among peo- least a two-week supply of nico- work with healthcare providers ple with low income and low tine patches or gum. More than to help people quit smoking. education,officials say. 55 Jefferson county residents Health officials note that the Washington's 25 percent drop have already called the quit line rate of 15 percent for smokers in in adult smoking since 2000 for help in the past year. Jefferson County is lower than translates to 240,000 fewer peo- Jefferson Healthcare offers both the Washington state rate pk smoking and an estimated Freedom from Smoking classes. of 16.5 percent and the national savings of$2.1 billion in future Call 385-2200,ext.2300,for more average of 19.8 percent.- healthcare costs. information on this free class. Still,health officials say there New outreach efforts are For information on local is room for improvement. under way to promote the free tobacco cessation resources, call Efforts by health officials help available for people who Jefferson County Public Health include community education, want to quit tobacco — particu- at 385-9400 or visit www jef- increasing access to cessation larly those at higher risk. fersoncountypublichealth.org/ resources, decreasing youth "State quit-line services were index.php?cessation_resources. access to tobacco, and support- recently expanded .to specifi- ing healthcare changes. cally help low-income smok- "Research has shown that a ers," said Secretary of Health. 60-year-old female smoker is Mary Selecky. "Now everyone nearly twice as likely to die in on Medicaid has free access to the next 10 years as a non-smok- counseling, nicotine patches or er,"note health officials. gum, and prescription medics- Those interested inestimat- tions, if they need it. I know ing their mortality risk can check quitting smoking is tough.We're out the charts at www.aafp.org/ trying to provide people the help • ttantially and aze the major factorsions insubsthe inter-annual variation of 1 2 mg/L in minimum oxygen Concentra- - tions.Both the mainstem of Cd Lower Hood Canal areHood affectedanal by . . .. . . • these factors. However, we also find . CANAL that human factors can be of sufficient magnitude to reduce minimum oxygen concentrations on the order of I.0 mg/L in Lower Hood Canal over the course of the summer." Fish suffocate The layer of dense, cold water that has been lying on the bottom of Hood It's not always greener Canal willsoon rise towardthe surface. This water will be low in the oxygen that fish need but high in nitrogen. If e it rises all the way to the surface, fish over the septic tank will have no place to go,and they will suffocate. After the Hood Canal fish kill in t 2006,McClure reported:"Low-oxygen Septic leaks pose a small - but important - role in 'dead zones waterinthebottomofthecanalquickly surged up to overtake fish.... Scientists There are many contribut- were able to measure it because of ing factors to explain Hood �" a major new scientific investigation Canal's dead zone, and ` started after fish kills in 2002,2003 and k g x r 2004." not all of them stem from f fir , There's more than one way to suf- human activity. Septic tanks '."1.7:44. "' i r focate a fish. Toward the surface,that " nitrogen-rich water from the depths have often been singled out g meets additional nitrogen from the land, most of it from rotting alder leaves. as a main culprit, but it's not �~ (Originally, alders weren't much of a clear whether cleaning them 0. m ��` factor,but as people cut the native coni- ira.„ .A� ,, r. '. '.t t,i- rote r.a y up would clean up Puget �s + « 4 t " -� fern,alders sprang up in the clearings.) ,'�.r 2 o a Some additional nitrogen leaches from Sound. Still, buildingmore '+���� � +• �� �°." ��„q=� ����,��., septic drain fields,anLI esser amounts '" ''-'7-"..'"' come from fertilizer off and other ~s'ewers might help, and it —�;. � t"` " s ilo .yam 4.t � �..a a z artifacts of human population growl h certainly won't hurt. along the shores. �_z^ �6.y. a+, In water shallow enough for son- ByDanielJackChasan light to penetrate,nitrogen tend;algia Some of the richest shellfish beds in the world are found In South Jefferson County.Hood g Special to The Leader Canals' dead zones,often found in the southern reaches of the canal,are believed to be which proliferate and then die Bactena making their way northward. Photos by Patrick J.Sullivan eat them.Bacteria need oxygen too,and (Daniel Jack Chasan is an author, they take it from the water. This pro- attorney and writer of many artic/es Hood Canal's infamous dead zone water near the surface. In effect, the cess of"eutrophication" contaminated about Northwest environmental issues. has killed thousands of fish on four deck doesn't get shuffled, so the low- Lake Washington until Metro started This article first appeared in Crosscut, different occasions in the past decade. oxygen cards stay on the bottom. dumping treated sewage from lakeside a daily news website based in Seattle, ``Hood Canal Fish Suffocate" blared McClure's 2006 P-!story noted that communities into Puget Sound Take which can be found at www.crosscut. a P-I headline in fall 2006. Robert the sources that are"thought to be con- enough oxygen from the water,and a lot corn.It is reprinted with permission.) McClure reported: tributing the nitrogen that drives Hood of fish are history. "Scientists are scrambling to doe- Canal's algae blooms are fertilizers, In _recant.years, Hood Canal has ument what appears to be the most leaking septic tanks, ocean water and Ocean patterns become a poster child for the perils widespread fish kill to date in Hood alder trees that pop up on vast patches Ocean circulation patterns drive facing Puget Sound.A 2003 report by Canal, the deep and poorly flushed of clearcut forest." that dense,high-nitrogen water into the the Pew Oceans Commission listed it waterway that researchers say suffers That's all true,but notice the order of Strait of Juan de Fuca. Heavier than and Los Angeles harbor as the only two from oxygen levels at their lowest ebb causes.Fertilizer and septics come first, surface water, it creeps along the bot- dead zones on the Pacific Coast. in at least five decades....Reports from then ocean water and alder.This,like a torn.When enough of it builds up in the But that's not the whole story. area residents started early Tuesday of lot of other rhetoric about Hood Canal, main basin of Puget Sound,it slops over Just recently,scientists reported find- dead shrimp,Dungeness crab, lingcod, helps feed our well-earned guilt about a relatively shallow underwater sill near ing more than 400 other dead zones in flounder,sand lance and other fish.The what we have done to Puget Sound. Bangor and down into Hood Canal.The saltwater around the globe.The Seattle kill stretches about six miles along the However,it doesn't fit the facts. new flow of dense water coming into Post-Intellieencer reported on Aug. 15 `Great Bend'of the 60-mile-long,gla- Most of the nitrogen entering Hood the canal drives dense, oxygen-poor that"dead zones with too little oxygen cier-carved fjord." Canal has nothing at all to do with us. water from other years up toward the for life are expanding in the world's This spring, thousands of Hood And yet,arguably,in a political context, surface, Some flows back out toward oceans."The P-I referred to an article Canal's tiny,shrimp-like krill died. our own tiny contribution is the only the Pacific. Some uses toward the sur- in Science showing that the number of small piece of the large puzzle that face.This happens in late September or dead zones in the world had doubled Dead zones expanding really matters. As scientists conduct- October. what the United Nations had reported in Dead zones have been expanding ing the Hood Canal Dissolved Oxygen Clearly, around this time of year, 2006.According to the P-I,researchers near river mouths, where agricultural Program Integrated Assessment and there's not always enough oxygen to go maintained that"some of the increase is fertilizer feeds plankton.blooms.Other Modeling Study reported at the end of around. That's when people start find- because of the discovery of low-oxygen dead zones—such as one that lies deep June: ing dead fish. 0 areas that may have existed for years in the Black Sea—can be traced to a "Several natural factors,such as sun- But what really causes the oxygen and are just being found ... but others lack of mixing between oxygen-poor light, wind and extemal ocean condi- depletion? are actually newly developed." deep layers and the better-oxygenated tions,affect Hood Canal oxygen condi- /%/o d' ,4., 2g .t^a 3r : -.r -.,*a %, ..td ',, .12- :3 0 s erf : + `.."-Fr. "?' .•*c---a rt?""s"'.'' `rt °.w"`". .;i__ _ :,fi e« :. r.; -, r sL`-`,- °'` -'- ;y-r:e^C.r.�cm•:,.. '* .- :ir+.+.r < s ShrimpFest brings hundreds of boats,large and small,to Hood Canal waters.Dead zones affect marine life in the canal.The role of septic systems-in contrast to natural forces-affecting oxygen depletion is under study by scientists. "Can the human contribution of the sunlit surface layer(measured at 25 nitrogen be of sufficient magnitude to percent to 45 percent of the influx)and Hood Canal: Growth have an impact?" asks University of some...upwells to the surface layer in Washington oceanographer Jan Newton, northern Hood Canal. This [nitrogen] • Continued from Page 1 gentrification, or both. Sewers who leads the dissolved oxygen study. does not contribute to primary produc- be done? The obvious answer: provide the infrastructure for Newton explains that the answer"really tion in the surface layer of Lower Hood Build sewers. All else being growth. Indeed,if some distant depends on when and where." In the Canal." main part of Hood Canal, the answer Duxbury doesn't buy the idea that equal,how can it be a bad thing arm of government doesn't pick is no. deep ocean water has no effect on the to keep what we can decorously up the tab, the cost of sew- But, Newton says, "in lower Hood surface layers of lower Hood Canal. If term human waste out of Hood ers creates pressure for growth: Canal?It can't. • The more people live there,the Canal, in late summer, the answer is it doesn't,he says,"I wonder how salt But what good will it do? more widely you can spread yes." She explains that below Hood is making its way into the surface layer What will it cost? Where will that cost. Canal's Great Bend,where the water is of Lynch Cove." the money come from? And And we all know, or should shallower and flushes less, if weather Duxbury explains: what happens when you build know, that population growth conditions are just right(or just wrong) "This surface layer is continuously a sewer in a rural area? You poses the greatest threat to Puget in late summer,then yes,nitrogen from receiving fresh water from the river to promote population growth or Sound. septic tanks and other anthropogenic the south and from the small stream that sources"could tip the balance"toward enters at Belfair.Yet this shallow surface ,,: {"] oxygen concentrations at which fish layer which has all the plankton,does "'dam` ` ' ., • tth. i expire. Something else killed the krill, not continually get fresher and fresher. ! • j s9� she says, but septics although they The only thing that can prevent this is se r :, port � ., in contribute far less nitrogen than Mother the addition of saltwater from below + Sequlrn kh fl ,r.T.OWnsend ` 'J . >' Nature—may be among the reasons for up to the surface layer....This saltwater v:,.,+_ ',...':;4:i x at depth not only has the required salt ,; tt? '> fish kills. but also the nutrients,with a source infie •f i° Role of septic systems the oceans as well as nutrients liberated �' ° S Retired University of Washington from the organic matter sinking from 1+ i oceanographer Alyn Duxbury is skepti- the surface layer above." 20 a },. cal.Duxbury,coauthor with his wife of i 19 ,}e.t. Nitro en inflows Port„ Fundamentals ofOceanography,sa s: g ''� "The problem timis in late Newton says you can think of Hood `- "' Canal's nitrogen inflows rather like the Ludd w"~' September or October when the big g final surge of deep water from the cash outflows in a household budget. .�04 + .kr.. coastal area finishes filling the Main Most of your money may go to rent, Basin of the Sound and then spills over utilities and food,but a relatively small expenditure—for,say,shoes—may push °�•• the Hood Canal sill to displace the resi- p Quilcene deep water upward in the end of you into the red.The other expenditures • the Canal.... The problem becomes as may be far larger, but paying for rent is �'"` follows:Small inter-annual changes in a and utilities isn't really optional, so "you're stuck with those [smaller but very large natural nutrient flux system, �' in late summer and early fall,can actu- more discretionary]amounts." Brannon ally cause a change in the nutrient bud- In Hood Canal, the ocean contrib- get that is many times more significant utes way more nitrogen than septics ,. ever do or will, and so do alders. But than the nutrient flux emanating from at least in the short run,no one is going 1144.004,',?;'>' 3 the on-site septic systems.How can one to do anything about the alders,and no Canal f,. point to the small nutrient influx from '"'' • the septic systems and say it is the fac- one is ever going to do anything about Y e the ocean. Therefore, policy makers ....;•:-:-;•] r tor that pushes the problem over the top, ,'t when inter-annual changes in natural are stuck wondering what to do about 1 fluxes are magnitudes larger?" septics. At first,the dissolved oxygen study "I also believe that septics are the 'i- scientists thought septics had only a • only possible nutrient source that can be 4 negligible effect. They reported, how- managed,"says Duxbury."However,if ever: the nutrients from the septic source are, "Previous estimates of the marine say, one one-thousandth of the other input of[nitrogen]to Hood Canal were sources in Lynch Cove,their contribu- Hoodsport 16 based on the flux of nitrate over the sill. tion is way back in the noise level of We have found that this greatly overes- the problem.Little or no benefit will be timates the flux of[nitrogen] into the derived from eliminating them. 4." • surface layer of Lower Hood Canal.A Even if one assumes that septic tanks4 ! • do create seasonal problems,what's to - `r'-' w' large amount of this[nitrogen]does notf ":., See HOOD CANAL,Page 9 reach the surface layer in Lower Hood Hood Canal has suffered from periodic'dead zones'during autumn months that are Canal because some of this becomes caused by oxygen depletion.The zones kill thousands of fish and other sea life.The role of part of the seaward return flow beneath septic systems in oxygen depletion trends is under intense study. / �v School consolidation favored in Port Townsend town hail meeting 44* ttr M ' r^. Participants in Saturday's Port Townsend town hall-style meeting on the school district's future have electronic pulse pads in front of them for instantaneous survey results.--Photo by Erik Hidle/Peninsula Daily News By Erik Hidle, Peninsula Daily News PORT TOWNSEND—The community still has mixed feelings about what exactly to do with Port Townsend schools, though a Saturday town meeting indicated many residents like the idea of consolidating facilities. About 100 people showed up for the combined city-school district town meeting Saturday morning, and most arrived with an abundance of ideas. Although the meeting was designed for the community to look at the long-term needs of the town's aging schools, it stopped short of lobbying for a school bond measure on the November ballot to build a new Grant Street school. ivdiscussions dominated most of the afternoon. The most elaborate talks focused on school district facilities: what would work best, what needed to be modified and what needed to be removed from a series of existing plans. City Planner Rick Sepler said workshop results would a crucial ingredient in the final plan. "The next meeting will show what our plan in now [after listening to the responses]," Sepler said. "Then we will ask what you think of it." The next town meeting will be at 6 p.m. Oct. 21 at the Blue Heron Middle School auditorium, 3939 San Juan Ave., Port Townsend. Sepler said that will be the time for big-picture questions and large revisions. "It should be an exciting, dynamic meeting," he said. The Oct. 21 meeting will again address the district's facilities and continue to hammer out a plan designed by the community. Instant polling available at the meeting included a series of questions pertaining to work accomplished so far. When asked if the district should consider consolidating elementary schools, 95 percent of respondents said yes. Iver, there was some disagreement on which elementary school should bear the load of all the districts K-5 students. Fifty-five percent felt Grant Street was the better location, while 45 percent opted for Mountain View Elementary. When as'.f,ed if the district needed to construct a new budding or expand an existing facility, 81 percent said yes. All results from the meetings are being posted on the city's Web site (www.cityofpt.us). A few people in the crowd took issue with the queries,yelling during the polling that they were being asked leading questions. Sepler said there was no intention to lead anyone down a particular path. . "The intent was to go back and ask questions which came up in the groups at the meeting before," he said. "We are striving to the greatest intent possible to reach your goals. "And the proof will be in the pudding.You will see it when we present the plan [at the next meeting]" The meetings have stopped short of pushing for the school bond that's on the Nov. 4 general election ballot. The school district is asking voters to approve a $35.6 million bond that would primarily finance construction of a new school on the Grant Street campus. If voters approve the bond, all elementary school students would be housed there in 2010 after Mountain View Elementary School is closed. Also included in the measure is funding for maintenance upgrades at the district's other schools, bus storage and maintenance shop repairs and district communications upgrades totaling about$1.34 million. The bond would raise the property tax rate in the school district by 54 cents per $1,000 of assessed valuation. If voters approve the measure, the owner of a $362,000 house—the median price of a house in Jefferson County—would pay $195 more in property taxes. City Planner Rick Sepler said the meetings are not intended to move forward the bond's agenda. • "This is not about the bond," Sepler said at the Sept. 18 meeting. "What you hear tonight will likely help you make your decision, but it's not about the bond." Sepler also said the meetings are not about the pool, which is costing the school district and the city more money in operational costs than what's been budgeted. The pool was a topic that came up in every group discussion but will likely end up as a separate process. Still, the instant polling did ask if the community should construct a new pool. Eighty-six percent of respondents said yes. "The pool is a symptom of the problems we are addressing," Sepler said. "What we are asking is what direction to go in from here," he said. "There are no wrong answers. We want to find answers that resonate. No good idea will go unexplored." Reporter Erik Hidle can be reached at 360-385-2335 or erik.hidleepeninsuladailynews.com. Last modified: October 04. 2008 9:00PM • • n°^\L4 'i'} Cash-poor . ..r county may still aid pool BY JEFF CHEW PENINSULA DAILY NEWS PORT TOWNSEND - Facing a general fund budget deficit of nearly$1.5 million,Jef- ferson County commissioners on Monday gave . serious consideration to a request from Port Townsend for $5,000 to help keep the city- operated pool open through 2008. The commissioners opted to discuss the matter further with county parks and recre- ation officials to come up with options to redi- rect$5,000 to the pool. "We really have to think where this money comes from,".said Commissioner David Sulli- van,.D-Cape George,citing the possibility of pulling it from about$1.5 million in county reserves,or elsewhere in the county budget. ' Tuan TO COUNTY/A6 County: Hearing budget concerns CONTINUED FROM Al As part of an agreement their Monday morning budget documents online. between the city and the dis- hearing,listened to concerned Joe D'Amico, Security Ser- During a brief public hear- trict,the municipal swimming residents, including Jim vices Northwest president, ing Monday morning,the corn- pool on the Mountain View Hagen, former county plan- asked the commissioners "to missioners heard suggestions Elementary School campus, ping commissioner and promi- do whatever you can" to pro- and concerns about the budget 1919 Blaine St.,is operated by nent county Republican, who tect law enforcement's budget. process, which is expected to the city on property owned by complained about a lack of He also urged the commis- 4 include another public hearing the Port Townsend School Dis- public information available sioners to consider some form d continue through Novem- trict. on the state of the county bud- of security measures for the er. The city is responsible for get. county courthouse,even itis a The $5,000 city pool the funds to keep the pool run- "For something as impor- •"meet and greet" post at the request was brought to the ping,but any bills from utility tant as the budget,we should courthouse entrance. table by Commissioner Phil companies go directly to the have been givensome back- The general fund shortfall Johnson, D-Pott Townsend, school. ground about the general state combined with a declining who voiced support for the The current agreement has of the budget and a brief number of funding sources is funding along with Commis- the city paying for up to analysis of department by why county leaders are consid- sioner John Austin, D-Port $72,000 of the pool's operating department conditions and. ering service-cut options,such Ludlow costs each year. what they are requesting in as many of the county's 320 Austin raised the possibility Anything over that is paid increased funding, and why" employees voluntarily work- of taking money from a county by the school district. Hagen said after the hearing. ing four nine-hour shifts,or a park,such as H.J.Carroll Park "What will likely happen is 36-hour week. in Chimacum,and earmarking Cantwell praised we'll have another hearing— The general fund was off, it for the pool While the pool's future is after the election—and then about$700,000 this time last uncertain, the commissioners this will be approved nine days Year and has more than dou- Commissioner reluctant voted to write a letter of before Christmas, which is bled since then. Sullivan expressed some thanks to U.S. Sen. Maria sure to draw a crowd,right? The dilemma is blamed on a reluctance based on the fact Cantwell, D:Mountlake Ter- "I just thought today was loss of sales, excise and real that.he felt the city should race, who they cited as push- ari embarrassment: of` our `t estate tax nerevenues, n higher strue- fuel, have addressed the matter mg through legislation passed elected officials failing to.:act. g sooner in the budget rheas. last week that revived the in the best and open interests asphalt and transportation - p Secured Rural- Schools and of citizens who pay for our costs combined with the loss of The city is also seeking Community Self Determine- county government." federal grants. $5,000 from Jefferson Health- The county is already not ,tion Act funding thought to be Hagen complained that also care hospital and Make Waves, lost in this county budget the county commissioners filling vacant staff positions,is the nonprofit group seeking to cycle. were not undertaking "the limiting training and travel to build a new aquatic recreation To assist these financially aggressive pursuit of an eco- only that which is mandatory center in the county. strapped counties, Congress nomic development policy" Employees are being asked The city needs about passed act in 2000, resulting The county is taking public to restrict driving of county $35,000 to keep the pool open in Title HI timber grant fund- comment through Oct.10. vehicles whenever possible. through the end of the year ing from national forest her- As scheduled,a preliminary The soaring cost of utilities vests. Other comment balanced budget must be pre- to heat the pool is the Main Title II projects are termed sented to the Jefferson County reason for the city shortfall. special projects on federal While Jim Tracy, land-use commissioners by Dec.22,and The future of East Jeffer- lands, planning attorney for Fred they are required to adopt a son County's only public Congress authorized the Hill Materials, urged the final budget and present it to wimming pool is uncertain funding last Friday, which county to present an- the state auditor by year's cause the city of Port amounts to about$500,000 in understandable budget'end. wnsend and the Port Title II and HI funding and document, resident Tom ownsend School District about $1.3 million for county Thiersch thanked county Jefferson County Editor Jeff Chew can't find a way to pay the roads. Auditor Donna Eldridge for can be reached at 360-385-7315 or utility bills. The commissioners,during putting more electronic' jeffchewepeninsuladailynews.corn New county boss sits in as observer IP BY JEFF CHEW PENINSULA DAILY NEWS PORT TOWNSEND -- Voicing Voicing some apprehension about dropping into Jeffer- 4:4` son County government during a difficult time of year — budget season — newly hired county Admin- istrator Philip Morley sat in �k on his first county commis- sioners ommis sioners meeting Monday. : . "Pm here as a citizen," Morley he told the commissioners with a smile, adding he would accept any budget help the commission- ers could offer. C3 TURN TO NEW/A6 • Nevv•II Humby re u.es t assistance 'Y q CONTINUED Fxom Al viewed.by the commissioners, agreed to work as temporary: As assistant_city manager county department staff interim Jef'erson County of Maple Valley, a community "I'm`goingto be hitting this supervisors and elected administrator. of 20,000 southeast of Renton, stone cold," Morley said. "I department heads. Morley,.who has lived with' Morley said he was accus- would,humbly request some Morley succeeds John Fis- his wife and two children in, tomed to delivering services assistance." chbach,who resigned Feb. 15 Edmonds,said he has found a with limited resources. Morley, 54,who worked his and was later hired as city new home close to the Jeffer- In 1997, he earned a mas- last -day .as Maple Valley's manager of Goodyear,Ariz. son County Courthouse. ter's public administration assistant city mAnager on Fri- Morley will .be, paid from the University of Wash- day, takes the county adminis $110,000,plus health benefits County, utility experience trate-ea-.seat Oct. 16. and mileage , m He n earned; his bachelor's With-Allen-Sartin, formes Fischbach," when`he left, brings`-eicperience =in b �, makin county government, as well as,coundegree in biology in 1977 from ty udget expert:and ben- g $$9,000 plus s with cities and utility districts Brown University in Provi- tra1_services director, heading . $360 a aronth auto allowance dence R.I. toward a new:job as county Be .worked nine years in:, towardstrator.hi Eddy County, !ntertm chiefs the Snohomish County execu He holds national certifies- ! office,helping administer: tion by the American Institute N.M., the commissioners Before the county commis- county:departments, improve:: of Certified Planners. offered:'some interum budget goners hired interim Adminrs- customer service, manage;: help to Morley. " trator.Dennis Richards,who growth 'wisely, promote eco Jefferson County'Editor Jeff Chew Morley was one of five started 'in late. April, Public nomic development and sus-, can be reached at 360-385-2335 or unnamed candidates inter-. Works Director Frank Gifford tain local farming. je/J.chew@peninsuladairymews.com. • e cket-eir 1 *V • , » ... 7e-:eron County Public Prevention helps Health has offered this program to our community. We were among the first in the state to make the bold decision positive futures 'to invest in our families through NFA Editor,Leader: First-time parents commit to two years I appreciated Fred Obee's sharing of intensive, in-home parent education the message of prevention that Sen.Jim and coaching with their own specially Hargrove;presented in Port Townsend trained public health nurse. This pro- .recently. I strongly agree that we need gram demands great effort and commit- to focus on prevention both to be fis- ment of the families and the nurses but cally responsible and to decrease the delivers positive futures. burden that the entire community expe- If that sounds a little too sweet and nen:es when a crime is committed. mushy, consider that former Seattle We have evidence of what works. Police Chief Gil Kerlikowske stated to The Washington State Institute for the press and the Legislature that to pre- Public Policy (WSIPP) report to the vent crime he wants more public health Legislature on options for reducing nurses. Through the anti-crime group 'crime and prison construction found the Fight Crime: Invest In Kids,he-along top-ranking crime prevention program with many other law enforcement pro- is Nurse-Family Partnership(NFP). fessionals,prosecutors and crime victims NFP should be a familiar name. -has called for investing tax dollars in , • evidence-based programs proven to pre- vent crime by focusing on babies. A child who experiences abuse o; neglect has a greatly increased chance • ;-.e �tCA t iejek lell4, lui nai,, By preven, - Child Xaause and neglect( those babies can grow up to become safek healthy members of the community. NFP yields high returns for every dollar spent. In 2006, WSIPP released a report stating that taxpayers saved more than $5 for every dollar invested in NFP. Thanks to the commitment o#' support from our community, 120 fami lies in our county have been part of this program.'This is a significant achieve;, ment and a great investment. To read more about these programs and reports, visit wwwjeffersoncoun, typublichealth.org/index.php?family_ support. - QUEN ZORRAH NFP program supervisor Jefferson County Public Health Agencies expand meth treatment funding PENINSULA DAILY NEWS Recovery Month. joined together to bring the41, "Treatment for substance program to Jefferson County PORT TOWNSEND — use disorders is effective and to address the need for Safe Harbor Recovery Center/ necessary to sustain a healthy expanded treatment services Beacon of Mental Health Servicpe, es erson and and productive society," said and reduce some of the barri- Jefferson CountyPublic Jean Baldwin, director of Jef- ers that prevent people from entering treatment. Health have expanded meth- ferson County Public Health. The organizations expect amphetamine treatment "Substance use disorders increased access to assess funding and services avail- take an enormous toll on our ment, evaluation and treat- able through Jefferson County community,and it is time that ment services, reduced wait- Methamphetamine Treat- we support those who need times and increased collabo- ment Services, as part of our help." ration and coordination of National Alcohol and Drug The organizations have patient treatment plans. The treatment service is funded by an award from the state Office of Financial Man- agement. As a result of being one of the first counties in the state to implement the Expanded Mental Health and Substance Abuse Treatment and Thera- peutic Court Funds tax, Jef- ferson County received an award of $100,000 per year, for two years, to implement additional methamphetamine treatment services. For more information about • substance abuse and treat- ment options, phone 360-385- 3866. For information about mental health treatment ser- vices, phone 360-385-0321. To learn about the impact that methamphetamine has had on Jefferson County, phone 360-379-4495; e-mail awinegar@co.jefferson.wa.us; or click on www.jefferson countypu blichealth.org. • • PS.��'' • ,rid, *If '-1°-$'-� • x was •-.£" Y'r z A 43 114.0 Morley's meet and greet Newly hired Jefferson County Administrator Philip Morley (right), who will start his new job next week,introduced himself Monday to Mike Belenski after a public hearing on the proposed 2009 budget. Belenski introduced himself to Morley using a phony name,which Morley was advised of after the meeting.Only a few people com- 41111 mented on the preliminary 2009 budget,which Interim Administrator Dennis Richards recommended county commissioners not approve yet.Work on the budget will continue when Morley assumes the job. Morley,who sat and watched the meeting,accepted an offer of help with the budget,since Central Services Director Allen Sartin left Sept. 30 to take a job in New Mexico.Commissioners directed Richards to contract with Anne Sears temporarily because she had worked with Sartin and knew his computer programs. Photo byAli/son Arthur • Fall flu clinics under wV vaccine y' recommended for disease p revention The beginning of fall brings County Public Health expects the bring your Medicare cards. All Safeway Pharmacy•442 cool evenings, colorful leaves children's vaccines will arrive others$25 cash or check.Private Way,Port Townsend. Saturd and the start of influenza vaccine within a week. The following insurance will not be billed. Oct. 11 and Oct. 18, 9 a.m.- clinics. Some Jefferson County clinics will stock children's vac- Port Hadlock Medical Care 5 p.m. Walk-ins welcome for clinics have already taken place; cine for their young clients: • 121 Oak Bay Road, Port immunizations from 10 a.m.to 6 many more are scheduled. • Jefferson Medical & Hadlock. Saturdays, long lines. p.m.Monday through Friday.No Vaccine supplies are adequate Pediatric Group, 834 Sheridan Call 379-6737 for appointment appointment necessary.Medicare this year, with more vaccine St.,Port Townsend slots. Medicare and Medicaid and Medicaid accepted. Many being produced than ever before, •Olympic Primary Care,1010 billed; bring your cards. Flu insurances billed. Bring your according to Jefferson County Sheridan St.,Port Townsend shots$25.Public welcome. insurance card. Flu shots $30. Public Health officials. • Port Townsend Family Port Townsend Family Pneumonia shots $45. Clients The Centers for Disease Physicians, 934 Sheridan, Port Physicians • 934 Sheridan, Port must be at least 11 years old. Control recommends flu shots Townsend Townsend. Saturdays, Oct. for the same groups it has tar- Jefferson County Public 11 and Nov. 1, 9 a.m.-noon. geted in the past: all persons 50 Health also will have injectable Medicare patients bring your years of age and older, all chit- children's flu vaccines plus a Medicare cards. All others $25 dren from 6 months through 18 limited supply of the nasal spray cash or check.Private insurance years old; women who will be flu vaccine,FluMist. FluMist is will not be billed. pregnant during influenza s•,ason; approved only for those without children and adolescents on long- any medical risk factors listed term aspirin therapy;residents of above,including pregnancy. nursing homes or long-term care facilities; anyone with chronic Scheduled flu clinics health conditions,including heart, Many flu shot clinics are kidney, lung or metabolic condi- scheduled in the area over tions,diabetes,asthma or anemia; the coming weeks. Continue anyone with a weakened immune to check The Leader for any system due to medical treatment changes in this information. For • or HIV; anyone with a condition questions about influenza or the that can lead to breathing or swal- vaccine, call Jefferson County lowing problems,such as seizures Public Health,385-9400. or cerebral palsy;healthcare per- Jefferson Medical&Pediatric sonnel — vaccination is strongly Group • 834 Sheridan St, Port recommended to protect vulner- Townsend. Saturdays, Oct. able patients; healthy household 25 and Dec. 6, 9 a.m.-noon. contacts and caregivers of chil- Medicare patients bring your dren younger than 5 years of age Medicare cards; all others $25 or of adults older than age 50; cash or check. Private insurance healthy household contacts and will not be billed. caregivers of persons with medi- Madrona Hill Urgent Care • cal conditions that put them at 2500 Sims Way,Port Townsend. higher risk for complications of Flu vaccine available during influenza; all persons who wish clinic hours, Monday-Friday, 9 to reduce their risk of becoming a.m.-7 p.m.; Saturday, 9 a.m.-4 ill with influenza or of transmit- p.m.;and Sunday 10 a.m.-2 p.m. ting influenza to others. Vaccine available for adults and _ children age 4 years and older. Children & teens Flu shots $25. Medicare billed. New this year is CDC's rec- All others cash. ommendation that all children Monroe Street Medical Clinic and teens from 6 months of age •242 Monroe St.,Port Townsend. until their 19th birthday get a flu Limited supply preservative-free shot. In Washington, this quali- vaccine.Flu shots$32.Call 385- fies all children and teens for 5658 for an appointment. No the state-supplied flu vaccine, insurance will be billed. • whether they have risk factors for Olympic Primary Care 1010 complications of the flu or not. Shemdai -nsf:, Port Td"v ns 4., State-supplied flu vaccines Saturdays, Oct 18 and Nov. 8, have not yet arrived,but Jefferson 9 a.m.-noon. Medicare patients • � ' - D . ticC 5 +._ 0-. = 4, 0mt ,A � �: �, , 1 V1 ° N ou 0> . I O U N •a_, � , 4z yd �O T ' N yy.° ya ° - •� °> °� $ ° e " > 30 � ..� o° ou, a � t 3 E 0 =ma ..00 ., ,u0071.3 ...., ..., 0 , 00 _,. b -oB •01 -0z ` � g , nd• 42 r° IPLiihIfhiLll1!P1Pil , VWiPt) r ;Ld 0 .6.0 ..5. •t•-•,:, • .s bk,e,...5, 5 — gi b°*.S 0 I.) "•H.0-E 0 W .Cbp '�.,"b0. ° ° 0 '0 0 0• ° •� °z U 0 ce l_° dam.. °)A - "-is. .'�- -� 4-8 0�_u_°� W 5 `R U "0 %-..., • coli ° E $..) 002 SI0 w b 3 1 0 U N yt 0 O ° 00 3 cy ° ° ;;-,•° ° E •7U .00 b° • >•-,' ° 0 ° U b0 ° O ^. 0O -. 0U ca � e� p�pN W ODS ,0, ° �_ �C�2+ � 00-°i :q . .�J iCy aOiA a~i � y $:14 /® O"U O � 0 N 0 0 .° y O U b ° id 0 0 5 -cd 0) - E S H- £ ° ° ° ° � qO .d.t 0U 4oaur > ° ga "> nt 400rin ° 0 0y ° 54 oo aca � p > . ° " �' o a � �:oo w0so -a z.") ° uy m ° 0 C*014 .-• >,g'W ..., *6 0 a'11.) .0 VI—6 0 2 0 .0 °s y y 4"6 y '% @.U• o ° 0 . p y y ('4,2 - 0 .r a°i 3 °, °' -g, w 0 ° 0 ° p'ao oo °' _°? � � v' 4 °O ° ° 4, .5 y .ra3 U I) N ° • 0, 08 �n v a, 5� c,F 8 .5 .o °o o - a o...0 X 5 .5 0 ° V ° 3 co ,..ci • 0 t)40Z Z Z .A..)) • Q '"' 'Mtiv ^ CO C w b ° U U U O E 0 �.• ' O O N • O -o. d 0. N � &s. � pz ° ° .0 > zyY°• o - �N O cox, 0000 ^ ac � Fb y'7 t'•• N •g 0 yi m° y ° y b m :� al0 'c ' i . ° ° N 0' . 0U v � 00 Y pU Qe C o3 ..,y o 0 .H ° . A d ti ° '� Y " d . — '4 4.00y 4,bO _ 00N 0 tj s y.-, ° 1 11.0 Wbo °G7 H ° A N ,d liD o 4; w �. 3 ▪ 0 O y• ° .. y•�' 4, 0 . yo > v U ' 0 y Y0N ,54 ° .c, . oIla .52 LA 0 4 ts"Vv,i - ' cb cl-, 4' 'g a g ..0 "'Fil 2 '1 F?1 tt' '' 0 • .• s. c9 q.''' i..' 'To' = 0 ° o U o ' y t" §i1 v) .a ' 06 • a 0 0 •0 o OA'a ® 04� d ,: 4+ ° Y ° x .' .0 00.0 ^' 0 U ° y 160 5 ed 0 E 0y� ° � a, °°i•o � ° 0 0 ° ...1".5 o g ..x � O 0 0 Vi 3 5 a, 2vA �-' ° . V 2 a av o " vG oo 0 �; 0 U Uo'° asa ° N 06 �. . t t ,3 g °'-— 04- 0 0 0 0"7, - — G ^a' a•o °i g °,306......1.' . ,' ° t v • N . 3 A U_ao § 0 � 0) yNa t' aoag ,s0 "0 e boa', 8 to c 4n ca H °' y YO o ca ti .a N o U g Y ° A b Y-, O 0 0 4.-; c 3N N 1 • C D •I 1 I• -F, & ,5 r,.,0 .1 .s ..€1 I .0 •i. ,., .4 4 s J o'll� Y�_ 0y E. U W4. ° nt. 3 ,•' O V ° 'N y aOOo " 0 oo � � � A � udo " � � op' pw�0 � ° o0v. NA Us. vi = � c aE� c . UA i f 1 12&(A % -1--) 1 3 1 b f v Shopping vvlth heart at G • Zght Ou Hundreds of women tamed tr`, out fora day and night of shop - J t•i v ` .. ping fun at Main Street's Girls' ;; jf ; ,10116 Night out on Oct.2."Thirty Port 3 t Townsend businesses uptown and " Ao. t - 41, downtown participated, offering t`s � s,to • special events, in-store promo- iti �R P ' tions and refreshments from 11 "' F.J x a.m.to 8 p.m. r ffi The goal of the event was to . bring women out to shop and 1 z';, S,; A a ,,„7-,'*'-.1-(,(0, ,,,,,,,,-„,„-, ,--,,,,,,.-1..,,,,y,tielfer.40,44, enjoy each other's company on a -� ` weekday in October.There were fit; „y n _ live window models, hand and - s .. foot massages, fashion shows, s 'f.r�.` wine tastings and prize drawings. , . October is Breast Cancer ,7 .-'�', - �$ *# Awareness Month, and 26 mer- �f �' a $ * oaf chants donated generously to the * ,, „t �` event's"goody bags”to help raise - `at money for the Jefferson County ? s n Health Department's Breast and / � 2 , Cervical Health Program,which i , t w R helps pay for cancer screenings x i' � for local women in need. .'' �.- ;�� ` Three sizes of goody bags %� a-, � -- _ ,: , r' ._ were available, for a$5,$10 or Sue Walker of Wild Sage Tea Shop on Washington Street offered several teas for customers to sample during Girls' $25 (deluxe) donation, and the Night Out subunit?dpnoro • event raised$3,100 this year.The $5 bags and deluxe bags sold Accommodations, were filled .' A • out: there are still $10 goody with assorted luxury gifts. ' `,� ' bags available. Contact the Port The grand-prize winner was a r , Townsend Main Street Program guy:Rob Lovato ofPortTownsend at 385-7911 to purchase a bag. won the"Feathered Friends Night xt. i Since the Girls' Night Out on The Town"getaway package. a` � : . .a event began in 2004, the Port Cathy Abraham won the door ,/ir t t ,;,;tom ,,-,':;:,-4,. Townsend Main Street Program, prize basket, and Cathy Avery, p" �/,•'. , "1 with the helpof participating Susan Jacob and Rachael Collins, srnq f - i• , ," merchants, has raised $13,547 and Christy Van amp took home f1?gill fs� ,. :,,,,,k, „, .„ L z� for the local Breast and Cervical the runner-up baskets. .'rte” Health Program. The raffle brought in$1,300 H Raffle winners were to benefit the nonprofit Port a • announced at the wrap-up party at Townsend Main Street Program. F xe � ? " ; Water Street Brewing.Available Girls'Night Out was present- - ', were a door prize,three beautiful ed by the Port Townsend Main p i � �• runner-up baskets,and the grand Street Program and sponsored prize basket valued at more than by Jefferson Healthcare Home, ,t „ `„;,...P,,,,.,,:,1;;,;,,,;„(04,.,' � w,.i ”' r $700. The baskets, created by Health & Hospice, the Port , � �� Marilou Sullivan of All About Townsend Wedding Show and w 'fl7�� s c#� participating merchants. , Qt4, The event was planned by s J the Port Townsend Main Street -g J , P ,e„ , Promotion Committee,compris- s a ing Sue Arthur, Sue Ramage, ' 4 / i e h Marilou Sullivan,Donna Haynes � • it � , �t „ .t Ve and Kathy Decker. Many vol- ; unteers also contributed energy, F"•` -ti,-.:11 " ' ; noted Mari Mullen,Main Street ,Aa,•: ,�%�'` r k ' -. fit: . ..,. executive director. t.„:.;„:„.„.�� � � as• t° Mullen expressed herthanksto � e the many merchants who donatedor, t M t,-= y - generously to the goody bags, re, fi �f�. 3 vs `'r as well as the participating mer- touttri - ,` y x ,: chants and volunteers, generous • f � �; - • businesses, and all the women ,.., x ", who attended Girls' Night Out Patti Stucky(left),ChristineRich,KarenSpoelstra,JaneManzerandRoxanne and bought a goody bag or raffle Fryer,all from Sequin,check out what is in Rich's$25 goody bag during ticket. Photo,hi AlGsen Arthur Girls'Nioht Ont in Port Townsend.• ;t... ..- b f• ff S„ State high court ruling on smoking u g • having little effect BY Jun CASEY must they protect their work- PENINSULA DAILY NEWS ers—as the law also orders? PORT ANGELES—A state Five of the justices, led by . Mary Fairhurst, opted for the Supreme Court decision that second choice. private clubs must abide by "Unlike the former Clean the Clean Indoor Air Act prob- Indoor Air Act," they wrote, ably will not stop smoking in "the voters in Initiative 901 such places at least until recognized the importance of November,probably next year. protecting workers in their The Clallam County Board places of employment from of Health has postponed get- harmful exposure to second- ting tough with violators while hand smoke." the case—brought by Bremer- ton American Legion Post 149 No no-smoking ordinance —wound its way through the legal system. Dr. Tom Locke, health offi- It was decided Sept. 12 on a cer for Clallam and Jefferson 5-4 vote. counties, has resisted crack- Meanwhile, the county's ing down on scofflaw smokers, Health and Human Services noting that the nonsmoking Department has relied on customers of most venues can forms of friendlier persuasion enforce the restriction more such as letters to offenders. effectively than health inspec- Iva Burks,the department's tors can. . • director, said some of what Clubs that flout the law, she called "the critter clubs" however,are playing with fire: had continued to allow smok- fines of up to $205 per day or, ing in their buildings and on as the Jefferson County Board their premises within the of Health has decided,suspen- • statute's 25-foot limit. sion or revocation of their food The"critters"include frater service licenses. nal/social organizations such The Clallam County Board as Moose,Elks and Eagles. of Health has no legal stand- The Clean Indoor Air Act,a ing as an enforcement agency, citizen initiative that voters Locke said. approved overwhelmingly in Board members would have 2005,outlaws smoking in any to authorize him to draft an place of employment and ordinance, then schedule a within 25 feet of any window, public hearing on it, and door or ventilation intake. finally consider adopting it. Most bars, bowling alleys With state Secretary of and non-tribal businesses Health Mary Selecky the guest have complied with the law, at the board's Oct. 21 meeting which sought to protect both —which also will include rec- . customers and employees ognition of seven Public Health from the health risks of sec- Heroes — the issue is not ondhand smoke. likely to move far before Nov.. And therein lay the legal 18,Burks said Tuesday. argument: Could a private club's mem- Reporter Jim Casey can be reached bers permit smoking—as the at 360-417-3538 or at jim.casey® law appears to allow — or peninsuladailynews.com. S . - • • • No rise in Medicare Bailout: U.S. debt to rise -premiums for 2009 - Cornutm nom D1 quo will only TL!5 Federal budget Sen. CSchumerD- seniorsand m N.Y., called the plan "a good deserve." deeper in the res THE AssocuTeo PRESS from Medicare Part B to cover amount- beneficiaries pay foundation," but said it was Bush said he worried the WASHINGTON — The hospice benefits. before their insurance cover- miming"some kind of supervi- financial troubles "could rip- federal deficit readied Health care costs have been willsort authority,and some kind plc throughout" the economy S483 billion for the first 11 monthly premium for the age kick in. of protection for homeowners and affect average citizens_ months of 2008. majority of the elderly and vastsrising much more quickly than Officials said next year's and taxpayers." "bled participating in overall inflation over the freeze is just the fifth time "The risk of doing nothing Budget surplus or deficit, Medicare will hold steady at years. That trend indicates since 1976 that premiums did The proposal wouldit raise. far outweighs the time,e of the fiscal year this year's break for beneficia- not increase, the statutory limit on the package. ... Over we're SAGE $96.40n ynational debt from$10.6 tr a going to get a lot of the money CLINTON yc: ries is likely a blip. However,about 5 lion to$11.3 trillion to make back." It's the first time since 2000 percent of $200 crson . that the fm since 00 In the future,we're going the nearly 44 million people in room for the massive rescue. He added, "People are 5236 eragehis charget increasing. health to have to go back to raising Medicare are subject to a "The American people are beginning to doubt our sys- too Premiums usuallythe premiums to match the higher premium based on furious that we're in this situ- tem,people were losing confi- go up to increase in expenditures,"said their income. ., reflect higher costs and Richard Foster, chief actuaryanon, and so am I," the deuce and I understand it's 0 II demand for care projected forCongress approved higher House's top Republican,Ohio important to have confidenII ce `_ the coming year at the Centers for Medicare premiums for wealthier bene- Rep John A.Buchner,said in in our financial system? Such increases will most and Medicaid Services. ficiaries as part of a bill estab- a statement. The monthly premium for lishng a new drug benefit. A. Neither presidential Candi- zoo certainly occur in 2009, but Medicare Part B covers a por- The participants affected "We need to do everything date took a position r•n the they will be offset when calcis- tion of the costs for physician are those individuals possible to protect the ccs of- Proposal- -30o t lacing the premiums by an services, earning brokenrs from the consequences of a GOP.nominee John McCain Jou $255 adequate reserve in thehome health and the more than $85,000 and con- Was purchase of certain medical pies earning more than Washington."." and any changesha by specifics ss. ,, -4t3. Medicare Part B trust fund. equipment, such as wheel- $170,000. brutalintSignaling what could erupt and by Congress. .500 That reserve gained $9.3 chairs and oxygen machines. The amount of those remi- Democrats a overadd-fighon with ObamaDused ec rivalhpar party's ty ,93 .9'6 ,� '; billion earlier this year after The deductible for those urns will range from $134.90 lig, Boh er said "efforts nto d- weekly radio addressstocall or �d t� officials discovered money was services will also hold steady to $308.30, depending upon exploit this crisis for political help for Main Street as well as SOUxCES Co gressmai tiueget inadvertently being drawn next year at$135.That's the the participant's income. leverage or partisan quid pro Wall Street. Office:Treasury Department • I 0 TOWN MEETING ABOUT PARKS AND JEFFERSON COUNTY PARKS AND RECREATION CONTACT MATT TYLER: 360-385-9129, MTYLER@COUNTYREC.COM I -Nor 4 4101 1 ' lf%* -) ( ) • 1(*:Ago i • ., fiiiiii".F dik 17 7---- (,,,, Apii pi • I We need help planning for the future. Please come to our Town meeting for Brinnon, Quilcene and Coyle. We will: . Shape the short and Tong term future . Discuss funding options . Share your ideas and concerns Thank you for your support. NOVEMBER 5TH, 2008 6:00PM TO 8:30PM Quilcene Sc s TOWN MEETING ABOUT • PARKS AND JEFFERSON COUNTY PARKS AND RECREATION CONTACT MATT TYLER: 360-385-9129, MTYLER@COUNTYREC.COM -If- 11 4 del Alb tik • j pi �r } • • •• __. We need help planning for the future. • Please come to our Town meeting for Chimacum, Irondale, Port Hadlock and the ' 4 surrounding areas. • Shape the short and long term future . Discuss funding options • Share your ideas and concerns NOVEMBER 6TH, 2008 6:00PM TO 8:30PM \Chimacum School Main Campus. Multiple Purpose Gym. Directions-enter the Chimacum School main campus via West Valley Rd. Park in main lot and follow the - signs south towards the Cenex.Look forthe large sign that says"Multi Purpose". • Do not enter from SR-19. TOWN MEETING ABOUT PARKS AND RECREATION JEFFERSON COUNTY PARKS AND RECREATION CONTACT MATT TYLER: 360-385-9129, MTYLER@COUNTYREC.COM -1) 4 41i • 7— ,r far_ • We need help planning for the future. Please come to our Town meeting for Port Ludlow and the surrounding communities. • Shape the short and long term future . Discuss funding options • Share your ideas and concerns Thank you for your support. NOVEMBER 10TH, 2008 6:00PM TO 8:30PM Port Ludlow Beach Club Bayview Room Address: 121 Marina View Drive. Directions:take Oak Bay Rd.to Marina View Drive and turn towards the water • Park and follow the signs to the Beach Club, Bayview Room. TOWN MEETINGABOUT • PARKS ANS RECREATION JEFFERSON COUNTY PARKS AND RECREATION CONTACT MATT TYLER: 360-385-9129, MTYLER@COUNTYREC.COM rem -\\ r 4 411 411k144 Aft pi . N 1 We need help planning for the future. E • Please come to our Town meeting for Port { Townsend & North Eastern Jefferson County. . Shape the short and long term future . Discuss funding options . Share your ideas and concerns NOVEMBER 12TH, 2008 6:00PM TO 8:30PM Blue Heron Middle School Commons Area Address:3939 San Juan Ave. Directions:take S.R. 19 into Port Townsend and follow the signs towards the County°F.airgrounds. Blue Heron Middle School is on San Juan Avenue on the left. Follow the small sins to the i _.__ Commons Area C.) CL) •••• v-D C/) • 4.) Cl) Cl) co CD CI) c r\I < 1p 0 U cn .S.-2 ‘-n co 2 ca 4) _(..) ED oh) • P• 1 STATE OF WASHINGTON JEFFERSON COUNTY BOARD OF HEALTH S AN ORDINANCE ESTABLISHING A FEE Ordinance No. SCHEDULE FOR JEFFERSON COUNTY PUBLIC HEALTH Section 1 —Purpose Section 2 —Hearing Section 3 —Effective Date Section 4 — Fees Section 5 — Severability Section 6—Prior fee schedule repealed Section 1 —Purpose • The purpose of this ordinance is to set the fee schedules for Jefferson County Public Health. Section 2—Hearing December 18, 2008 Section 3 —Effective Date January 1, 2009 Section 4—Fees All of the services/fees listed for Jefferson County Public Health are hereby being set by the Jefferson County Board of Health as follows: A cost analysis will be completed annually to set reimbursement rates for Community Health including family planning services, birth control methods, and immunizations. * Fees for medications, antibiotics, and treatment methods will be based on cost of acquisition unless acquired by an outside vendor at no cost to Jefferson County Public Health. All fees for immunizations not subsidized by the Washington State Department of Health will be the cost of the vaccine plus handling, shipping, and nursing time.* • Jefferson County Board Of Health Ordinance No.7799997 Page 1 of 2 Laboratory Services are based on the actual fees of laboratory contractors, price lists are available upon requests. The Clinical Services Financial Guidelines policy is in place, reviewed and updated annually, using the Federal Poverty Guidelines to establish the sliding fee schedule. A copy of the sliding fee schedule will be available upon request. The sliding fee schedule will not be available or offered for privately purchased vaccines administered for international travel or laboratory services. Certain services, provided for communicable disease prevention cases, medication or vaccines to prevent outbreaks of communicable disease, where personal insurance denies reimbursement and individuals involved have no ability to pay, fees may be waived. Jefferson County Public Health will automatically implement future modifications to these service charges for vaccines, medications, and medical supplies based on the following: 1. The actual cost of the service provided by an outside vendor, the supply, medication, vaccine, and laboratory charges, and like costs plus shipping and handling fees. 2. Any new Federal Poverty Level Guidelines that are published annually. 3. The maximum allowable Medicaid reimbursement rate. *The sliding fee schedule may apply. Services will not be denied due to clients in ability to pay. Fees for Vital Records are set by the RCW 70.58.107. The cost sheet is available by request. Environmental Health fees, established by this ordinance, shall be adjusted annually on the first business day of January (Adjustment Date) by the amount of the increase in the Consumer Price Index as reported for the month of September preceding the Adjustment Date. A cost analysis for Environmental Health will be completed every 2 years. Section 5— Severability A determination that any fee or fees adopted as part of this Ordinance is unlawful or illegal shall not cause any other fee or fees adopted as part of this Ordinance not affected by that determination to be repealed, revised, or reduced. Section 6— Prior Fee Schedules Repealed Any prior fee schedule previously adopted by this Board that contains or reflects fee amounts that are less than those adopted herein is hereby repealed and replaced by this Ordinance. • Jefferson County Board Of Health Ordinance No.9999999 Page 2 of 2 . � ? \ / z eee0m3 = @ec = 2 m = zz z zz/ \ { f � CDa , { f2 \ gg > 0 mm m , ! , m . @ « C a -. _• , 0 0 — m © m a o ® m = R 3 : t » 0 f F o CD m IJ ® � yyyfo2a ® ` G 00 $ » 0 m mm ƒ2m2. m_ m_ � & : � ƒ \ a E2 -o f = � # } \ \ ° ® * } ® ® } \ \ 0 m O \ oo \� � / $ 2 k \ \ § m »« 0 \ ; m � ) 2 = -0 -o / Cl. 0V J 0 0 / \ CD \ CD CD C) " / g k/ \ \ 5. \ z C z m , D 0 5 0 7 7 » ® \ 0 { R _ / 3 0 < z J / \ _ o (Q co < , > \ f ƒ - 2 '..O § I 0 § t_ ' z q § U- m eee NJ NJ = - CO - = a A e e � � 7 q $ CD @ + $ / 52 CD S8 CD CD CD -' @ CD 20 \ G \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ / k m0 7 \2 ƒ 7 % » % \ $ } 0 } 0 7 \ \ > O ai J� \ / \J & & = ncD = -nD > E ink- /\ \ � � 5. \ \ \ CD_ CL \ \ / % % \ R \ 0 IZ ® n0- \ (:)..". a = m / rn 0 - \ / / a) CD in ° 0. ID � CO \ \ m = Ir rs.) a - fO0 E n » CD - m k w / Q « C7 D K2Q a / y \ 2 % CO « E 01 t NJ Gt R � D ( CO 2 \ Ae « = — o = Aa CO 01e -N -' CD a —' e cc ° moo I CD66 6666 66 0 66 6 6 CD 66 £ = o0 = D co co CD CD CD CD 0 CD CD CD CD CD CD 0 CD CD co ® X 3 / \ / Ea § E E 6 E / E 0 \ 2 Re R 9 9 @ aoP / 9 y= E 0 9e0 8 \ / / 0 / D / ° ` 0 q _ — _ -' —' \ E } 2 / \ \ \ \ \ \ \ \ / \ \ / \ / \w0 ?$ \ 66 6666 06 ao 6 6 6 66 , § ; % m .o0 0000 00 00 0 0 0 oomeC9 En M @ 0 0,_ @ & G E & \ 13 } -0 } a' / § / / � \ \ / 01 01 CU k\ .0 .6 \ \ PP.0 .6 \ \ G2G / / R / / @ / 03 \ \ \ \ -N / \ co Er \ G / \' lrlCD 600 6 < o0 2 \ 707 D0 SD 0 CD OD 0 6 • \ \ \ CD 0000 o E oc CD CD m , CilCDCD > M i I-• Et) D oCD oz , 3 D 00 r o 0 o e o o Q m ODS ( to ZX * —A —I * * "I 0073 "Do cn a CD 13 o O 7 _. O) Cn 0 [D < ,LD n n a) Di (D 7 p) o c CD --' cnO � r-t. m7 m y C� � �CD > > > c CL v 2 m o 0- o 0 o m o a °' m um m c<u B a CL x m (c) x o m 5. o °' m y Z Z m m CL m v u a 4 o cn 00 �o o n -o o n) m - c o w m x x c o' - o. CD C x ° NNN " N3 N - oON0 ( C cn ZQQ 8 cn m O OD CU 5' < N• • -p -Om pv co SGa —1 CD __ nmo m o o 3 a . '0.) 0m o = 7 may 0 00 0m o o v n MCL wo mmm m m •- co Om _ CD• CD m o m 3c. g m < 7 =• o o ,..)3o a3CD 0 m c.,, lIT1 13 mE, m M 0 + cn N O L U' o O O o O , 0 co 6 o -w A -, A CO N .� W N -- OD _. W N _. -. CO 0 O) W CO 0 CP CO O) CO O) 0) CT O) J A V A O) CO 0) J O) A J A A A O, T y N O) O O N CJ, O) O) 0 CO O O O O 0 O O CO CT U, A A O O O O O A CD CCD (D O O O O O O O O O 0 0 0 0 O O O 0 0 0 0 0 0 0 0 0 0 0 0 CD O 0 0 0 0 0 o O O O 0 0 D 0 0 0 O 0 0 0 0 0 0 0 o o D 0 O N O -a D -0 0.1 CD a CD 0 CD O F • N 3 _CL �_ o = 0) -e, 7'I „CL o o C9 C o r' .i 3 O CO -0 0 O. D) a) 0+ cN) ) Cr C .0 7 .74: L o N O O o _ CI v c SU O fMD () A -. A GO CO _ _ OD _ _ _ _ _ CO 03 co o N J W CO N J J CO 00 v Cr C) J A J A CO O) CX) CO J A V A A A V D > N (1) 0 A A V V A A Ni A J (O A CO CO A J A V (O U, A Co CO V A V J V () C O Doo 0000 00 0000 000 000000 000006 (4 CQ 0 C) 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 o O 0 0 0 0 0 0 0 O o 0 o O — tn 0) N) N N 0 0 0 0 0 CD - N CO CO CO O o 0 O O W O 0 O O O O O o 0 0 O 0 O 00 0 0 0 0 O O O O CO ,(A, 6., (a -IQ v V V J N --� -, 01 -, W N N - -+ o -, CP T co W co W W CO CO W N O) O) O O O) N o 0 O 0 CD U) CT CJ, A A A A A W CX) Co A -. A CO N -+ A O O O O O O O O O O O O O O OO O O O o 6 CD N O O O 0 0 0 O O O O O O O O O 0 0 0 NJ 0 O C) • 0) 0) _ _ _ 3 A A A _N j_ N N _N N O O O O O O O O O 0 0 v 6 0 0 0 0 0 0 0 (a CO 0 N N N N � .A A A A A N S W N Cri CO O T O CX) CO W O N NJ N) N N A U, CO O J V O U, O CD O O O O O O O O o 0 O o 0 O O O N -, O 0 O O CD O O O O O O O O O o O O O Ut A O O O O O O O O O O O O O O O O O O D ,. i N O m m • D my ZOOM rpg nD A v I— Z1:5 m CD o o co _9 w o a Ci) m wm Too° D coo nom) o Cn Q oo cn m 0 2 o a o 4 m fl o m 0 <. n x O C d '{ , 0 w 0. N n c < co Q COD > 0 A:. N o x P -. =ND x ;.,; m z -0 N O' _ , 72. 0 -,. ° = 1l G 70 C) N = CO m N -we CD 0 0 v T 7 m o. o. c = a 0 o' c°'i T s' N Z 0 m g `,G = Q Ni m v co Z _ = —I m 0_ r 3 m r 0 O 2 = c o 0 D ca —I 2 01 01 N L 0 CD 0 fD 0 0 co CDD A 0) CCOO A CD N co W N) —' N) A 0) 0) 0) W 0— CT CD - m -1 Ni 01 O N J 0) J Cr. -+ A O — N W 01 CT CT (D C0 CT N 0 CP O O 0 0 0 0 0 0 0 0 0 0 0 0 O O O CD CD O CD l0 0 O CD 0 0 0 0 0 0 0 0 0 0 0 0 CD 0 CD O O U) • n 0 N O NS0CD N 0 CD 0 3 W O w 3 = C CD fl- m D O N — .0 3 o < v '-0 m CD CD w 3 5 0 _r _ -•• v O 0- w Ro O cn o= O 3 U. v) NellS. 7 0 o O 42. 0 S CD 0 0 O O o IS3 A - W A W 01 N) -•-• N -, .C.D.. _, e0D > co C N CD 01 -•-•‘ O A CO A +, N A 0 N O WJ N N J (D 0)NJ N CD CCD 0 O O 0 0 0 0 0 0 0 0 0 0 0 0 O O O O O (Q (0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 O O O O 0 • '.-', 13 fA7o: N o p) + 0 0 0 to 0 01 — N N N N 0 0 0 0 0 O O O N N N _ N O O O O 00 S CD O_, 00 ON) 00 CD CD 0) 0 0 0 0 0 0 N N CD 00 00 CD O O O O O p p 0 0 0 O O O Cl) "-. CD 0 0 0 0 O 0 0 O CD CD CD CD 69J n 0 03 CD + DD ffl 3 J O _, J 0 O -, O O CO J Ni Ni O O 3 =ti CD O CT O Cr) CT 0 0 3 O O O O O O OD CO O O N N O J co O O ? O N) Ni -, -, T O N O O CT CD 0 0 N (0 CT J J J --- N) N Ni CD 0 0 S 0 0 0 0 0 0 0 0 01 0) 0 0 CT 0 0 CD 40 0 w o 0 0 0o 0 0 0 0 0 0 0 0 0 0 = o 0 o 0 CD 0 0 0 0 0 0 0 0 cn D 4 0 r 7300- '6,-) OT5 O m CO m CD CD O O O m O m = co c s — 0)> < Z a1 v co 5 6 m a 0 : * o °z � � 6 z -o M a. Q' m CO n 00 < ' co a .._t o o cn Z 9,.' 5. > X omo Q () ia o —1,_ ,.T- O a — cn -0 Z m = g N D = O (D m C W Z -o -o m D gr 74. o I m - m CDr a 2 w -o o C. o 0 co W N N N CD 0o 01 01 01 CD OD 01 0 0 .0P CCO CD N O 00 0 000 0 0 CD 0 000 0 000 0 o Cl) = DW 0 mill i I Q O O (On D O O CD CD fl- a M CD D) O 7 7 0 Q D O N =' G V '<:" (3 N f4D O ' 0) 0 0 J A CS) CD 01 01 A A A CO0N O C = 60 to 0 O OOOOOO OO CQ to O n = • • " 13 X M Cl) o N O 0 O o co O� 0) A A W O CD O (0 CO O W CD O O 0 0 0 O O CD0 0 0 o O o n 11)3 N _ O o O c\ Co 0 j O0 N N N 'TI O O 0 0 0 0 0 CD OO O O O O Cl) D