Loading...
HomeMy WebLinkAbout2008- December File Copy • Jefferson county Board of 3-CeaCtk .Agenda wlinutes • December 18, 2008 • JEFFERSON COUNTY BOARD OF HEALTH Thursday December 18, 2008 Pope Marine Building 100 Madison Street Port Townsend,WA 2:30—4:30 PM DRAFTAGENDA I. Approval of Agenda II. Approval of Minutes of November 20,2008 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. FluView—2008-09 Influenza Surveillance Data 2. EpiTrends—Washington Surveillance for Severe Influenza Disease V. New Business • 1. Public Hearing: Jefferson County Public Health Fee Revisions 2. Emergency Preparedness Mutual Aid Agreements: Multi-County and Multi-Tribes 3. Department of Health Proposed Budget Cuts for the Remainder of the 2007-2009 Biennium 4. Public Health Standards Follow-Up: Jefferson County Public Health Strategic Planning VI. Activity Update VII. Agenda Planning VIII. Next Scheduled Meeting: January 15,2009 2:30—4:30 PM Jefferson County Courthouse V ARD OF HEALTH p JEFFERSON COUNTY BO • %.,% ilS* MINUTES ti Thursday,November 20, 2008 2:30 PM—4:30 PM Pope Marine Building,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 Director John Austin, Chair, County Commissioner,District#3 Julia Danskin,Nursing Director Chuck Russell,Hospital Commissioner,District#2 Michelle Sandoval,Port Townsend City Council Sheila Westerman, Vice Chair,Citizen at large(City) Roberta Frissell, Citizen at large(County) Chair John Austin called the meeting of the Jefferson County Board of Health to order at 2:30 PM in the Pope Marine Building, Port Townsend, WA. Members Present: John Austin, Chuck Russell, David Sullivan, Sheila Westerman Members Absent: Roberta Frissell, Phil Johnson,Michelle Sandoval Ad Hoc Member Present: Frances Joswick, Substance Abuse Advisory Board • Staff Present: Jean Baldwin, Dr. Thomas Locke, Julia Danskin,Veronica Shaw A quorum was present. APPROVAL OF AGENDA Chair Austin stated that there had been an addition to the agenda, number 7. Health Department Personnel Report. Member Russell moved to approve the agenda, as amended,which was seconded by Member Sullivan and approved unanimously. APPROVAL OF MINUTES Corrections: On page 6, first sentence under Substance Abuse Advisory Board Presentation, insertion of word, i.e. ".... reported on the new relapse prevention program... On page 2, insertion of word in first paragraph under Public Health Funding News, "The larger counties have been urging .....". On page 2, insertion in third paragraph, "Member Westerman asked about current levels ...". Member Sullivan moved for approval of the minutes, as corrected, and Member Westerman seconded. The minutes of October 16,2008 were approved unanimously as • corrected. Page 1 of 9 Board of Health-November 20, 2008 PUBLIC COMMENTS A resident of the Dabob Bay area asked for information on any plans or changes in regulations • and fees related to water quality and residential wells. Member Sullivan said that under the most recent in-stream flow rules, there may be metering of new wells but that existing water rights are protected. He said there would be an informational meeting at Fort Worden on December 2. Dr. Locke added that with regard to water quality monitoring, single home residential wells are exempt from the public health codes and regulations for drinking water systems, which apply only to public water systems with two or more connections. OLD BUSINESS Substance Abuse Relapse Prevention Program—Jefferson County Jail Frances Joswick distributed copies of a fact sheet from Pat Wiggins, nurse at the Jefferson County jail. She pointed out that there is already a waiting list for the relapse prevention program. Jean Baldwin suggested that these reports be included in the regular BOH distribution process. Chair Austin inquired as to how the recent PDN article about the relapse prevention program was initiated. Ms. Joswick said that she was contacted by reporter Jennifer Jackson and interviewed along with Steve Richmond, Pat Wiggins, and other members of the SAAB (Substance Abuse Advisory Board). Main Street Program Letter • Julia Danskin reported that the Port Townsend Main Street Program had raised $3,140 for women's health screenings during the Girl's Night Out event. Sheila Westerman moved and David Sullivan seconded that Chair Austin sign the draft thank you letter to the Main Street Program on behalf of the BOH. The motion was approved unanimously. NEW BUSINESS Public Health Fee Review Jean Baldwin stated that the draft fee ordinance provided in the packet contains two changes from previous versions. She noted that this draft has been simplified and excludes extraneous detail, such as how the cost analysis is done. She said that other counties' health departments and past Jefferson County practice had been reviewed. By moving to the DSHS cost analysis method, the department will be able to set rates based on its own costs. She pointed out that Environmental Health has also gone through this process and found that actual costs are very close to what they were before. This puts both Community Health and Environmental Health on the same framework, but does not change sliding scale or other policies. Veronica Shaw reviewed with the Board her November 14, 2009 memo, 2009 Fees, and two fee spreadsheets. A data column for Service Utilization (Frequency) had been added as requested. M The analysis is based on a full year of service, 12 months of 2007. The spreadsheet on Client Page 2 of 9 Board of Health-November 20, 2008 Impact data presents projected revenue for three scenarios, i.e. 50%, 75%and 100% of cost recovery, along with the corresponding fee increases by client groups: private insurance, full fee and partial fee. There are currently about 45 different insurers in the system. Private insurance does not include Medicaid. Ms. Shaw pointed out that the average fee increases to clients would be reasonably low, even at the 100% level. She noted that only 30% of what is billed is actually collected. Member Westerman expressed her appreciation and commended Ms. Shaw on the compilation and presentation of this information. She said she was in favor of adopting the 100% option, provided that sliding scale policy remains in place. Ms. Shaw and Ms. Baldwin responded to specific questions from the Board. They explained the reason for certain blank data cells, which are service items that are provided free by the State labs for qualifying clients. Where Medicaid rates are actually higher than the calculated cost,the Medicaid rate will be charged. Ms. Baldwin noted that the draft ordinance provides for billing at the maximum allowable Medicaid reimbursement rate. She also observed that the overall impact to clients is not very large, and is greater for privately insured patients. There was clarification that the 100% cost rate had been used to generate the draft fee schedule provided. The ordinance language provides for future automatic updates to the fees based on cost changes, publication of new Federal Poverty Level Guidelines, or changes to Medicaid reimbursement rates. Member Russell questioned the construction of the sentence comprising the fourth paragraph on • page 2 of the draft Ordinance. Dr. Locke provided a written sentence revision for the draft. The remaining process for adoption and implementation was reviewed. The BOH will choose the percentage of cost variance, and a date will be set for a public hearing on the Ordinance. If the Ordinance is adopted, as long as it is in effect the fees will be updated per the provisions of the Ordinance as summarized above. Veronica Shaw pointed out that changes in the Environmental Health fees only are based on the Consumer Price Index (CPI), based on policy originally established in 1996 and are referenced in the draft ordinance. Member Westerman asked if the CPI method is appropriate and accurate. Staff confirmed that their cost analysis of a 20 case sampling had shown very good correspondence between the actual cost analysis and the CPI adjusted rates. A cost analysis for Environmental Health will be done every two years. Member Westerman expressed her preference for this smaller and more frequent incremental approach,rather than the necessity of large, less frequent fee increases. Jean Baldwin then introduced the Environmental Health fees. As indicated in the November 13, 2009 memorandum from Andrew Shogren, Environmental Health sets fees that seek to cover 100% of direct costs. Ms. Baldwin said that not all Environmental Health services are covered, citing certain solid waste costs as example. After doing a cost analysis and finding great similarity, staff has recommended continuing with use of the CPI-based fee revision policy. Ms. Baldwin also recalled that a comparison of fees with four other counties had been presented • at the previous meeting. One challenge is the variation in service bundling among various Page 3 of 9 Board of Health-November 20, 2008 entities. However, the comparison showed that generally Jefferson County fees were lower than those of other counties. • Board members suggested two changes to the Environmental Health Fee chart. One was to make the fees as readable and understandable as possible. The examples discussed involved expanding acronyms such as SPAAD or G.P.D., at least the first time they appear, or footnoting them to clarify their meaning. SPAAD is an acronym for Site Plan Advanced Approval Determination and is sometimes associated with land divisions or subdivisions. G. P. D. is an abbreviation for gallons per day. The second request was to adjust the formatting and indentation under Sewage Disposal Permits, so that"Conventional", "Alternative"and "Repair/Upgrade" can be clearly seen as subordinate to "New Commercial >1000 G. P D". Staff confirmed that the fee schedule would be an attachment to the Ordinance and will also be accessible via the website for reference. Chair Austin asked what the typical charge is currently for conventional system inspections by commercial services. Susan Porto cited one example, $250 for an evaluation that was done in conjunction with pumping out of tanks. Sheila Westerman moved to set a hearing date of December 18 for the proposed Ordinance Establishing a Fee Schedule for Jefferson County Public Health. The motion was seconded by David Sullivan and approved unanimously. Staff confirmed that there will be a press release and proper notice in advance of the hearing. The fee schedule will be posted on the web along with the notice. • Member Russell questioned whether there was need for him to recuse himself from the actual vote on December 18. There was a brief discussion regarding the personal nature of a recusal decision, and a suggestion to check with County Attorney Alvarez if there is uncertainty. Dr. Locke indicated that the appropriate process would be to announce the issue to the BOH and to examine whether there would be undue influence or prejudice in the vote or an appearance of a conflict of interest. A key issue is whether a person will be affected financially by the outcome of a vote. Before moving to the next agenda item, there was a brief discussion confirming that no additional motion or vote was needed on the choice of cost percentage since the proposed ordinance already embeds the assumption of 100%. Puget Sound Partnership: Draft Action Plans for the Strait of Juan de Fuca and Hood Canal Neil Harrington, Water Quality Manager, reviewed the Introduction to the Draft 2020 Action Agenda for Puget Sound. He noted that the entire document is about 95 pages in length. Mr. Harrington provided a brief background and history of the Puget Sound Partnership, established by the Governor to implement a clean up of Puget Sound by the year 2020. Neil reviewed the major strategies of the Action Plan. He pointed out that the intention to have a • feedback loop of action, accountability and learning what is working and not working. He noted Page 4 of 9 Board of Health-November 20, 2008 that there are many itemized actions to be taken under each strategy. He sees the strategies as good for a rural county such as Jefferson, which has significant opportunities for protecting • water quality and effecting restoration of Puget Sound. The Action Agenda also identifies many gaps where further research is needed. The Puget Sound Partnership is not the "doer", but is a conductor and coordinator. Jefferson County has also submitted comments through several avenues including the Straits of Juan de Fuca Workgroup, of which John Austin and Neil Harrington are participants. David Sullivan added that comments have also been submitted through the Hood Canal Coordinating Council and the Washington State Association of Counties, Coastal Counties Committee. Mr. Harrington mentioned that there are eight action areas defined for the Sound and Jefferson County spans both the Straits and Hood Canal working groups. Mr. Harrington indicated that he would like to review with the BOH the comment letter drafted by Andrew Brastad on behalf of the 12 Puget Sound County Environmental Health Directors. Jean Baldwin explained that there had been a 12-county committee that had produced an earlier letter of recommendations. Mr. Harrington explained that item number references in the letter refer to planned actions in the Action Agenda;he read selected action items aloud. He pointed out items of particular importance to Jefferson County, such as in-stream flow rules, water law reform, and water reuse. He pointed out concerns about pharmaceuticals making their way into surface water, ground water and the marine environment. Member Westerman asked for clarification on the ultimate disposition of household refuse processed by the County, which is the source of some unused pharmaceuticals. Staff verified that solid waste is trucked to • landfills outside the County. Jean Baldwin reported on studies and ongoing debates about the most efficacious means of disposing of drugs, depending on their particular compositions. Formerly, best practice was to flush unused medications,but land fill disposal may be shown to be better. There were several comments related to septic system issues. Expansion of the Shorebank model was recommended as a means of assisting homeowners in paying for septic system repairs/replacements or connecting to municipal sewer systems. Mr. Harrington said that one of his comments to Puget Sound Partnership was to maintain funding for Jefferson County's Clean Water District which performs pollution identification/correction work and to identify failing septic systems. Chair Austin added that that is one of the top priorities for the Straits and Hood Canal Action Areas. Member Westerman asked for clarification on C.4.2, i.e.,whether this comment was clearly intended and adequately worded to urge State law changes. Dr. Locke noted that Washington State has some of the strongest property rights protection laws in the nation. All entry to private property must have the permission of the land owner unless a search warrant is obtained. A current state law allows for pursuit of an administrative search warrant if there is probable cause that fresh or marine water is being impacted by a failing septic system. There was a brief discussion about the entire comment process and schedule, and the acknowledgement that Puget Sound Partnership itself has no regulatory authority of its own. • John Austin suggested an abbreviated review of the letter. He summarized the Puget Sound Partnership structure and process for development of the Action Agenda and its Page 5 of 9 Board of Health-November 20, 2008 • recommendations to the Legislature, noting that this letter was a fairly low level request in a complex process. Jean Baldwin noted that the issues around septic systems have been well • covered by the Environmental Health Directors, who are concerned that they have some voice in any regulatory changes. Mr. Harrington said this letter encapsulates where the Board of Health jurisdiction and interests intersects with the Puget Sound Partnership's agenda. Mr. Harrington then covered items dealing with toxic clean up standards, as well as funding for programs that deal with algal bloom and shellfish monitoring. Following Mr. Harrington's summary of the remaining items, Member Westerman requested clarification on the statement referring to a new method of reporting. Mr. Harrington discussed the Partnership's emphasis on accountability and increased reporting requirements. A brief discussion ensued regarding the balance between local control versus State standards. Jean Baldwin said that she and Dr. Locke would be involved in writing a follow up letter from the parent organization endorsing more State-wide accountability and standardization as appropriate. Mr. Harrington confirmed that the deadline for edits to the letter had passed. Chair Austin thanked Mr. Harrington for his presentation and participation in the Action Agenda review. 2008 Solid Waste Program 1111 Margie Boyd reported on the overall status of the Solid Waste program. She noted that after code changes in 2005, the Health Department had closed 135 solid waste enforcement cases last year and maintained that rate in 2008. Historically,there have been about 35 open cases on average. Having dealt with the majority of cases, what remain are more difficult situations that require more resources to address. Last year, 701 vehicles were recycled. Towing was paid by a grant from the Department of Ecology. Two of the major sites had 300 and 100 vehicles respectively. This year there were 264 junk vehicles, owing partly to the high prices for scrap metal. Ms. Boyd said that there had been several community partners that were very supportive of the Health Department programs and quite helpful in closing very difficult cases. Last year, 49 citations for Solid Waste violations were issued, and only 17 were committed. Ms. Boyd noted that the number of recalcitrant cases tends to remain constant. Approximately 300 tons of tires were removed last year. Special Department of Ecology grants were used to clean up five large business sites. This year was aimed at households, including a free tire recycle event. About 2500 tires were collected in one day through an Ecology grant, representing 221 households. She said that staff is actively seeking grants to fund these types of infrequent but high yield events. In terms of trends, she expects less focus on enforcement related to households; there has been progress in several neighborhoods. There will be more emphasis on hazardous waste, which has a bigger environmental impact. She briefly described increasing efforts with local source Page 6 of 9 Board of Health-November 20, 2008 control, working with businesses such as dentistry, metal machine shops, and others that are • most likely to produce hazardous waste. She pointed out that this can actually save money for small businesses that are able to reduce hazardous waste generation and improve their efficiency. Member Westerman inquired about the possibility of extended hours for the hazardous waste facility. Ms. Boyd said that the first priority is to provide a facility in South County, which would be able to collect florescent light bulbs, etc. Also, the transfer station is now accepting florescent bulbs. She referred everyone to the Solid Waste website for information on proper disposal and/or clean-up procedures for these bulbs, which contain minute quantities of mercury. Emergency Preparedness Mutual Aid Agreements: Multi-County and Multi-Tribes This item was deferred until the next meeting, due to time constraints. Expedited Partner Therapy Program This item was deferred until the next meeting, due to time constraints. Potential Appointment of Substance Abuse Advisory Board (SAAB) Member Frances Joswick said that the SAAB has been seeking to increase the size of its Board. Earlier in the day, John Austin, Julia Danskin and Ms. Joswick had interviewed two individuals, Doug Daniels and Molly Force. She proposed that they be considered by the BOH for the open positions. • Doug Daniels is a former massage therapist who has studied at the Port Townsend School of Massage and is a musician. Molly Force is a naturopathic physician, new to the community, and is very interested in SAAB activities. John Austin said that both candidates had indicated they had the time for serving on the SAAB, including additional committee work. Ms. Joswick and Mr. Austin confirmed that both people were talented and certainly met their expectations. Inclusion of Mr. Daniels and Ms. Force would bring the SAAB Board size to ten members out of a desired 11 to 13 members. Members Westerman and Sullivan moved and seconded to accept Doug Daniels and Molly Force as members of the SAAB. The motion was approved unanimously. Health Department Personnel, Planning and Budgeting Update Jean Baldwin pointed out a misstatement in a recent newspaper article about Health Department growth. There has been some growth over the last five years to accommodate such services as water quality monitoring and emergency preparedness. However, budget increases have been very gradual until last year, when a$160,000 increase was necessary for union negotiated salaries and benefits. An additional $150,000 will be needed this year to bring compensation, particularly nursing, in line with the market rates. This, along with County paid Clean Water District match expenses, will come from the General Fund. Rent and other expenses such as inter-fund transfers will cause a rise of about $66,000 this year. Page 7 of 9 Board of Health-November 20, 2008 Ms. Baldwin mentioned the sadness and difficulty of the DCD layoffs. She said that based on a forecast of the 2008 Health Department budget that had been done in June, all new spending had • been stopped. Certain vacancies had not been filled. Therefore, staff cuts had been done sooner and in a different manner. Also, staff had been asked to reduce their hours voluntarily; five people had reduced their hours from 40 to 36 per week. She noted that she had been working closely with Phillip Morley, County Administrator, on budgeting and forecasting. However, any program cuts that become necessary will be decided by the Board of Health. In addition, demands on the WIC program have been increasing rather significantly in recent weeks. Service needs and community impact are being monitored closely. The net staff reduction is five employees. The position of Deputy Administrator formerly held by Andrew Shogren is also vacant. Ms. Baldwin noted that the State is expecting a$5 billion shortfall for the next Biennial budget. She said she did not expect to see the impact of those cuts until about April 2009. Ms. Baldwin said the shortfall is so large that she anticipates significant cuts for departments and programs that do not fall mainly into the State mandates to "educate, incarcerate or medicate". She said that she believes the Board will need to review and prioritize programs and expenditures. Internally, efforts are underway to review service priorities and cross-training, etc. That information will be brought to the BOH in early 2009 to help prepare for likely program cuts. In response to a follow up question about the Leader article, Ms. Baldwin said that she had been out of town at the time. Therefore, clarifying information about the Health Department budget and measures taken previously were not included in the article. John Austin noted that Health Department administrators had given a report to the County Budget committee on November 19, and should be commended for anticipating the economic problems and taking early measures to • mitigate the impacts. Member Westerman noted that serious outreach efforts will be necessary to educate the public regarding the reasons for any service cuts that occur. Ms. Baldwin said that the Legislature may be taking up the issue this year of allowing Health Departments to become junior taxing districts or other funding solutions, but implementation would be far in the future. ADJOURNMENT David Sullivan moved to adjourn; Sheila Westerman seconded. Chair Austin adjourned the meeting at 4:28 PM. • Page 8 of 9 Board of Health-November 20, 2008 • JEFFERSON COUNTY BOARD OF HEALTH John Austin, Chair Sheila Westerman, Vice Chair Absent Roberta Frissell, Member Chuck Russell, Member Absent Phil Johnson, Member David Sullivan, Member Absent Michelle Sandoval, Member • • Page 9 of 9 Board of Health-November 20, 2008 JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday,November 20, 2008 2:30 PM—4:30 PM Pope Marine Building, 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 Director John Austin, Chair, County Commissioner,District#3 Julia Danskin,Nursing Director Chuck Russell, Hospital Commissioner,District#2 Michelle Sandoval,Port Townsend City Council Sheila Westerman, Vice Chair, Citizen at large(City) Roberta Frissell, Citizen at large(County) Chair John Austin called the meeting of the Jefferson County Board of Health to order at 2:30 PM in the Pope Marine Building, Port Townsend, WA. Members Present: John Austin, Chuck Russell, David Sullivan, Sheila Westerman Members Absent: Roberta Frissell,Phil Johnson,Michelle Sandoval Ad Hoc Member Present: Frances Joswick, Substance Abuse Advisory Board • Staff Present: Jean Baldwin, Dr. Thomas Locke, Julia Danskin, Veronica Shaw A quorum was present. APPROVAL OF AGENDA Chair Austin stated that there had been an addition to the agenda, number 7. Health Department Personnel Report. Member Russell moved to approve the agenda, as amended,which was seconded by Member Sullivan and approved unanimously. APPROVAL OF MINUTES Corrections: On page 6, first sentence under Substance Abuse Advisory Board Presentation, insertion of word, i.e. ".... reported on the new relapse prevention program..." On page 2, insertion of word in first paragraph under Public Health Funding News, "The larger counties have been urging .....". On page 2, insertion in third paragraph, "Member Westerman asked about current levels ...". Member Sullivan moved for approval of the minutes, as corrected, and Member • Westerman seconded. The minutes of October 16, 2008 were approved unanimously as corrected. Page 1 of 9 Board of Health-November 20, 2008 PUBLIC COMMENTS A resident of the Dabob Bay area asked for information on any plans or changes in regulations • and fees related to water quality and residential wells. Member Sullivan said that under the most recent in-stream flow rules, there may be metering of new wells but that existing water rights are protected. He said there would be an informational meeting at Fort Worden on December 2. Dr. Locke added that with regard to water quality monitoring, single home residential wells are exempt from the public health codes and regulations for drinking water systems, which apply only to public water systems with two or more connections. OLD BUSINESS Substance Abuse Relapse Prevention Program—Jefferson County Jail Frances Joswick distributed copies of a fact sheet from Pat Wiggins, nurse at the Jefferson County jail. She pointed out that there is already a waiting list for the relapse prevention program. Jean Baldwin suggested that these reports be included in the regular BOH distribution process. Chair Austin inquired as to how the recent PDN article about the relapse prevention program was initiated. Ms. Joswick said that she was contacted by reporter Jennifer Jackson and interviewed along with Steve Richmond, Pat Wiggins, and other members of the SAAB (Substance Abuse Advisory Board). Main Street Program Letter . Julia Danskin reported that the Port Townsend Main Street Program had raised $3,140 for women's health screenings during the Girl's Night Out event. Sheila Westerman moved and David Sullivan seconded that Chair Austin sign the draft thank you letter to the Main Street Program on behalf of the BOH. The motion was approved unanimously. NEW BUSINESS Public Health Fee Review Jean Baldwin stated that the draft fee ordinance provided in the packet contains two changes from previous versions. She noted that this draft has been simplified and excludes extraneous detail, such as how the cost analysis is done. She said that other counties' health departments and past Jefferson County practice had been reviewed. By moving to the DSHS cost analysis method, the department will be able to set rates based on its own costs. She pointed out that Environmental Health has also gone through this process and found that actual costs are very close to what they were before. This puts both Community Health and Environmental Health on the same framework, but does not change sliding scale or other policies. Veronica Shaw reviewed with the Board her November 14, 2009 memo, 2009 Fees, and two fee spreadsheets. A data column for Service Utilization(Frequency) had been added as requested. • The analysis is based on a full year of service, 12 months of 2007. The spreadsheet on Client Page 2 of 9 Board of Health-November 20, 2008 Impact data presents projected revenue for three scenarios, i.e. 50%, 75% and 100% of cost recovery, along with the corresponding fee increases by client groups: private insurance, full fee • and partial fee. There are currently about 45 different insurers in the system. Private insurance does not include Medicaid. Ms. Shaw pointed out that the average fee increases to clients would be reasonably low, even at the 100% level. She noted that only 30% of what is billed is actually collected. Member Westerman expressed her appreciation and commended Ms. Shaw on the compilation and presentation of this information. She said she was in favor of adopting the 100%option, provided that sliding scale policy remains in place. Ms. Shaw and Ms. Baldwin responded to specific questions from the Board. They explained the reason for certain blank data cells, which are service items that are provided free by the State labs for qualifying clients. Where Medicaid rates are actually higher than the calculated cost,the Medicaid rate will be charged. Ms. Baldwin noted that the draft ordinance provides for billing at the maximum allowable Medicaid reimbursement rate. She also observed that the overall impact to clients is not very large, and is greater for privately insured patients. There was clarification that the 100%cost rate had been used to generate atee tohe draft the feesf based one schedule provided. The ordinance language provides for future automaticp cost changes, publication of new Federal Poverty Level Guidelines, or changes to Medicaid reimbursement rates. Member Russell questioned the construction of the sentence comprising the fourth paragraph on • page 2 of the draft Ordinance. Dr. Locke provided a written sentence revision for the draft. The remaining process for adoption and implementation was reviewed. The BOH will choose the percentage of cost variance, and a date will be set for a public hearing on the Ordinance. If will updated per the provisions of the Ordinance is adopted, as long as it is in effect the fees the Ordinance as summarized above. Veronica Shaw pointed out that changes in the Environmental Health fees only are based on the Consumer drPrice ordinance (CPI ),based on policy originally established in 1996 and are referenced the Member Westerman asked if the CPI method is appropriate and accurate. Staff confirmed that their cost analysis of a 20 case sampling had shown very good correspondence between the actual cost analysis and the CPI adjusted rates. A cost analysis for Environmental Health will be done every two years. Member Westerman expressed her preference for this smaller and more frequent incremental approach, rather than the necessity of large, less frequent fee increases. Jean Baldwin then introduced the Environmental Health fees. As indicate d the Novembertcover13, 2009 memorandum from Andrew Shogren, Environmental Health 100% of direct costs. Ms. Baldwin said that not all Environmental Health services are covered, citing certain solid waste costs as example. After doing a cost analysis and finding great similarity, staff has recommended continuing with use of the CPI-based fee revision policy. Ms. Baldwin also recalled that a comparison of fees with four other counties had been presented • at the previous meeting. One challenge is the variation in service bundling among various Page 3 of 9 Board of Health-November 20, 2008 entities. However, the comparison showed that generally Jefferson County fees were lower than those of other counties. • Board members suggested two changes to the Environmental Health Fee chart. One was to the fees as readable and understandable as possible. The examples discussed involved expanding acronyms such as SPAAD or G.P.D., at least the first time they appear, or footnoting them to clarify their meaning. SPAAD is an acronym for Site Plan Advanced Approval Determination and is sometimes associated with land divisions or subdivisions. G. P. D. is an abbreviation for gallons per day. The second request was to adjust the formatting and indentation under Sewage Disposal Permits, so that"Conventional", "Alternative" and "Repair/Upgrade" can be clearly seen as subordinate to "New Commercial >1000 G. P D". Staff confirmed that the fee schedule would be an attachment to the Ordinance and will also be accessible via the website for reference. Chair Austin asked what the typical charge is currently for conventional system inspections by commercial services. Susan Porto cited one example, $250 for an evaluation that was done in conjunction with pumping out of tanks. Sheila Westerman moved to set a hearing date of December 18 for the proposed Ordinance Establishing a Fee Schedule for Jefferson County Public Health. The motion was seconded by David Sullivan and approved unanimously. Staff confirmed that there will be a press release and proper notice in advance of the hearing. The fee schedule will be posted on the web along with the notice. • Member Russell questioned whether there was need for him to recuse himself from the actual vote on December 18. There was a brief discussion regarding the personal nature of a recusal decision, and a suggestion to check with County Attorney Alvarez if there is uncertainty. Dr. Locke indicated that the appropriate process would be to announce the issue to the BOH and to examine whether there would be undue influence or prejudice in the vote or an appearance of a conflict of interest. A key issue is whether a person will be affected financially by the outcome of a vote. Before moving to the next agenda item, there was a brief discussion confirming that no additional motion or vote was needed on the choice of cost percentage since the proposed ordinance already embeds the assumption of 100%. Puget Sound Partnership: Draft Action Plans for the Strait of Juan de Fuca and Hood Canal Neil Harrington, Water Quality Manager, reviewed the Introduction to the Draft 2020 Action Agenda for Puget Sound. He noted that the entire document is about 95 pages in length. Mr. Harrington provided a brief background and history of the Puget Sound Partnership, established by the Governor to implement a clean up of Puget Sound by the year 2020. Neil reviewed the major strategies of the Action Plan. He pointed out that the intention to have a feedback loop of action, accountability and learning what is working and not working. He noted Page 4 of 9 Board of Health-November 20, 2008 that there are many itemized actions to be taken under each strategy. He sees the strategies as good for a rural county such as Jefferson, which has significant opportunities for protecting water quality and effecting restoration of Puget Sound. The Action Agenda also identifies many gaps where further research is needed. The Puget Sound Partnership is not the "doer", but is a conductor and coordinator. Jefferson County has also submitted comments through several avenues including the Straits of Juan de Fuca Workgroup, of which John Austin and Neil Harrington are participants. David Sullivan added that comments have also been submitted through the Hood Canal Coordinating Council and the State Association of Counties Coastal Committee. Mr. Harrington mentioned that there are eight action areas defined for the Sound and Jefferson County spans both the Straits and Hood Canal working groups. Mr. Harrington indicated that he would like to review with the BOH the comment letter drafted by Andrew Brastad on behalf of the 12 Puget Sound County Environmental Health Directors. Jean Baldwin explained that there had been a 12-county committee that had produced an earlier letter of recommendations. Mr. Harrington explained that item number references in the letter refer to planned actions in the Action Agenda; he read selected action items aloud. He pointed out items of particular importance to Jefferson County, such as in-stream flow rules, water law reform, and water reuse. He pointed out concerns about pharmaceuticals making their way into surface water, ground water and the marine environment. Member Westerman asked for clarification on the ultimate disposition of household refuse processed by the County, which . is the source of some unused pharmaceuticals. Staff verified that solid waste is trucked to landfills outside the County. Jean Baldwin reported on studies and ongoing debates about the most efficacious means of disposing of drugs, depending on their particular compositions. Formerly, best practice was to flush unused medications, but land fill disposal may be shown to be better. There were several comments related to septic system issues. Expansion of the Shorebank model was recommended as a means of assisting homeowners in paying for septic system repairs/replacements or connecting to municipal sewer systems. Mr. Harrington said that one of his comments to Puget Sound Partnership was to maintain funding for Jefferson County's Clean Water District which performs pollution identification/correction work and to identify failing septic systems. Chair Austin added that that is one of the top priorities for the Straits and Hood Canal Action Areas. Member Westerman asked for clarification on C.4.2, i.e., whether this comment was clearly intended and adequately worded to urge State law changes. Dr. Locke noted that Washington State has some of the strongest property rights protection laws in the nation. All entry to private property must have the permission of the land owner unless a search warrant is obtained. A current state law allows for pursuit of an administrative search warrant if there is probable cause that fresh or marine water is being impacted by a failing septic system. There was a brief discussion about the entire comment process and schedule, and the acknowledgement that Puget Sound Partnership itself has no regulatory authority of its own. • John Austin suggested an abbreviated review of the letter. He summarized the Puget Sound Partnership structure and process for development of the Action Agenda and its Page 5 of 9 Board of Health-November 20, 2008 recommendations to the Legislature, noting that this letter was a fairly low level request in a complex process. Jean Baldwin noted that the issues around septic systems have been well covered by the Environmental Health Directors, who are concerned that they have some voice in any regulatory changes. Mr. Harrington said this letter encapsulates where the Board of Health jurisdiction and interests intersects with the Puget Sound Partnership's agenda. Mr. Harrington then covered items dealing with toxic clean up standards, as well as funding for programs that deal with algal bloom and shellfish monitoring. Following Mr. Harrington's summary of the remaining items, Member Westerman requested clarification on the statement referring to a new method of reporting. Mr. Harrington discussed the Partnership's emphasis on accountability and increased reporting requirements. A brief discussion ensued regarding the balance between local control versus State standards. Jean Baldwin said that she and Dr. Locke would be involved in writing a follow up letter from the parent organization endorsing more State-wide accountability and standardization as appropriate. Mr. Harrington confirmed that the deadline for edits to the letter had passed. Chair Austin thanked Mr. Harrington for his presentation and participation in the Action Agenda review. 2008 Solid Waste Program Margie Boyd reported on the overall status of the Solid Waste program. She noted that after . code changes in 2005, the Health Department had closed 135 solid waste enforcement cases last year and maintained that rate in 2008. Historically, there have been about 35 open cases on average. Having dealt with the majority of cases, what remain are more difficult situations that require more resources to address. Last year, 701 vehicles were recycled. Towing was paid by a grant from the Department of Ecology. Two of the major sites had 300 and 100 vehicles respectively. This year there were 264 junk vehicles, owing partly to the high prices for scrap metal. Ms. Boyd said that there had been several community partners that were very supportive of the Health Department programs and quite helpful in closing very difficult cases. Last year, 49 citations for Solid Waste violations were issued, and only 17 were committed. Ms. Boyd noted that the number of recalcitrant cases tends to remain constant. Approximately 300 tons of tires were removed last year. Special Department of Ecology grants were used to clean up five large business sites. This year was aimed at households, including a free tire recycle event. About 2500 tires were collected in one day through an Ecology grant, representing 221 households. She said that staff is actively seeking grants to fund these types of infrequent but high yield events. In terms of trends, she expects less focus on enforcement related to households; there has been progress in several neighborhoods. There will be more emphasis on hazardous waste, which has ID a bigger environmental impact. She briefly described increasing efforts with local source Page 6 of 9 Board of Health-November 20, 2008 control, working with businesses such as dentistry, metal machine shops, and others that are most likely to produce hazardous waste. She pointed out that this can actually save money for • small businesses that are able to reduce hazardous waste generation and improve their efficiency. Member Westerman inquired about the possibility of extended hours for the hazardous waste facility. Ms. Boyd said that the first priority is to provide a facility in South County, which would be able to collect florescent light bulbs, etc. Also,the transfer station is now accepting florescent bulbs. She referred everyone to the Solid Waste website for information on proper disposal and/or clean-up procedures for these bulbs, which contain minute quantities of mercury. Emergency Preparedness Mutual Aid Agreements: Multi-County and Multi-Tribes This item was deferred until the next meeting, due to time constraints. Expedited Partner Therapy Program This item was deferred until the next meeting, due to time constraints. Potential Appointment of Substance Abuse Advisory Board (SAAB) Member Frances Joswick said that the SAAB has been seeking to increase the size of its Board. Earlier in the day, John Austin, Julia Danskin and Ms. Joswick had interviewed two individuals, Doug Daniels and Molly Force. She proposed that they be considered by the BOH for the open • positions. Doug Daniels is a former massage therapist who has studied at the Port Townsend School of Massage and is a musician. Molly Force is a naturopathic physician, new to the community, and is very interested in SAAB activities. John Austin said that both candidates had indicated they had the time for serving on the SAAB, including additional committee work. Ms. Joswick and Mr. Austin confirmed that both people were talented and certainly met their expectations. Inclusion of Mr. Daniels and Ms. Force would bring the SAAB Board size to ten members out of a desired 11 to 13 members. Members Westerman and Sullivan moved and seconded to accept Doug Daniels and Molly Force as members of the SAAB. The motion was approved unanimously. Health Department Personnel, Planning and Budgeting Update Jean Baldwin pointed out a misstatement in a recent newspaper article about Health Department growth. There has been some growth over the last five years to accommodate such services as water quality monitoring and emergency preparedness. However,budget increases have been very gradual until last year, when a $160,000 increase was necessary for union negotiated salaries and benefits. An additional $150,000 will be needed this year to bring compensation, particularly nursing, in line with the market rates. This, along with County paid Clean Water District match expenses, will come from the General Fund. Rent and other expenses such as • inter-fund transfers will cause a rise of about $66,000 this year. Page 7 of 9 Board of Health-November 20, 2008 k Ms. Baldwin mentioned the sadness and difficulty of the DCD layoffs. She said that based on a forecast of the 2008 Health Department budget that had been done in June, all new spending had been stopped. Certain vacancies had not been filled. Therefore, staff cuts had been done sooner , and in a different manner. Also, staff had been asked to reduce their hours voluntarily; five people had reduced their hours from 40 to 36 per week. She noted that she had been working closely with Phillip Morley, County Administrator, on budgeting and forecasting. However, any program cuts that become necessary will be decided by the Board of Health. In addition, demands on the WIC program have been increasing rather significantly in recent weeks. Service needs and community impact are being monitored closely. The net staff reduction is five employees. The position of Deputy Administrator formerly held by Andrew Shogren is also vacant. Ms. Baldwin noted that the State is expecting a$5 billion shortfall for the next Biennial budget. She said she did not expect to see the impact of those cuts until about April 2009. Ms. Baldwin said the shortfall is so large that she anticipates significant cuts for departments and programs that do not fall mainly into the State mandates to "educate, incarcerate or medicate". She said that she believes the Board will need to review and prioritize programs and expenditures. Internally, efforts are underway to review service priorities and cross-training, etc. That information will be brought to the BOH in early 2009 to help prepare for likely program cuts. In response to a follow up question about the Leader article, Ms. Baldwin said that she had been out of town at the time. Therefore, clarifying information about the Health Department budget and measures taken previously were not included in the article. John Austin noted that Health Department administrators had given a report to the County Budget committee on November 19, and should be commended for anticipating the economic problems and taking early measures to • mitigate the impacts. Member Westerman noted that serious outreach efforts will be necessary to educate the public regarding the reasons for any service cuts that occur. Ms. Baldwin said that the Legislature may be taking up the issue this year of allowing Health Departments to become junior taxing districts or other funding solutions, but implementation would be far in the future. ADJOURNMENT David Sullivan moved to adjourn; Sheila Westerman seconded. Chair Austin adjourned the meeting at 4:28 PM. r Page 8 of 9 Board of Health-November 20, 2008 • JEFFERSON COUNTY BOARD OF HEALTH Jo Austin, Chair Sheil. rest- an, ' ice Chair Absent Roberta Frissell, Member Chuck Russell, Member Absent e rL/2-4--- - Phil Johnson, Member David Sullivan, Member Absent Michelle Sandoval, Member • • Page 9 of 9 Board of Health-November 20, 2008 • Board of 3-Cealth Odd Business ,Agenda Items # 1 • TCu 'View 2oo8-o9 1"nffuenza Surveillance Data December 18, 21908 • • +i pi;,,,7 tef$ ;s.,:m. '..$ kz;„,,.., .4. „i„.. ,,,, ,,,., . ,,,,,,„,„,:,.;:".fiif,,, , ,,,,,ocr/ „.;„,5 ,...,,it .., ... ' '',- 144 .- - i.-„„ .4, „. A ‘V ' I. ,,,,,-,, -, C, ,' - r sw sa u , 4t 6 tfllueiza S elllance Report Prepared by the Influenza Division ; u 2008-2009 Influenza Season Week 48 ending November 29, 2008 (All data are preliminary and may change as more reports are received.) Synopsis: During week 48 (November 23-29, 2008), a low level of influenza activity was reported in the United States. o Forty-three (2.0%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories, and reported to CDC/Influenza Division, were positive for influenza. o The proportion of deaths attributed to pneumonia and influenza (P&I)was below the epidemic threshold. o The proportion of outpatient visits for influenza-like illness (ILI)was below national and region-specific baseline levels. o One state reported local influenza activity; Puerto Rico and 22 states reported sporadic influenza activity; and the District of Columbia and 27 states reported no influenza activity. National and Regional Summary of Select Surveillance Components Data for current week Data cumulative for the season Number of Out- % jurisdictions A reporting A AUnsub- B Pediatric patient positive regional or (HI) (H3) Deaths ILI* for flut widespread typed • activityt Nation Normal 2.0% 0 of 51 112 16 154 83 0 New England Normal 0.6% 0 of 6 0 1 5 1 0 Mid-Atlantic Normal 0.1% 0 of 3 2 0 2 1 0 East Nrth Normal 4.5% 0 of 5 4 0 3 6 0 Central West orth Normal 0.0% 0 of 7 0 0 2 1 0 Central South Atlantic Normal 2.1% 0 of 9 8 2 53 32 0 EastSouth Normal 0.0% 0 of 4 0 0 0 0 0 West South Normal 5.9% 0 of 4 18 0 41 27 0 CentralMountain Normal 2.1% 0 of 8 4 9 10 4 0 Pacific Normal 3.4% 0 of 5 76 4 38 11 0 *Elevated means the%of visits for ILI is at or above the national or region-specific baseline t National data are for current week;regional data are for the most recent three weeks t Includes all 50 states and the District of Columbia i U.S. Virologic Surveillance: WHO and NREVSS collaborating laboratories located in all 50 states and Washington D.C. report to CDC the number of respiratory specimens tested for influenza each • week. Results of these tests performed during the current week, and cumulative totals for the season, are summarized in the table below. Week 48 Cumulative for the Season No. of specimens tested 2,136 24,657 No. of positive specimens (%) 43 (2.0%) 365 (1.5%) Positive specimens by type/subtype Influenza A 32 (74.4%) 282 (77.3%) A (H1) 4 (12.1%) 112 (39.7%) A (H3) 2 (6.1%) 16(5.7%) A (unsubtyped) 26 (78.8%) 154(54.6%) Influenza B 11 (25.6%) 83 (22.7%) Twenty-six states from eight of the nine surveillance regions have reported laboratory-confirmed influenza this season with three states accounting for 275 (75.3%) of the 365 reported influenza viruses. Influenza Positive Tests Reported to CDC by U.S. WHO/NREVSS Collaborating Laboratories, National Summary, 2008-09 200 A(H3) - 50 . 180 ®A(H1) 45 A(Unsubtyped) 2 160 - 40 a) —Percent Positike '5 140 - - 35 a) a o (0120 - > a) 30 o > o X100 0 25 c -. 80 - - 20 " is .0 60 - - 15 Z40 - 10 20 - 5 40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 Week CDC 2008-2009 Influenza Season—Week 48,ending November 29,2008 2 • • Antigenic Characterization: CDC has antigenically characterized 30 influenza viruses [20 influenza A(H1), three influenza A (H3) and seven influenza B viruses] collected by U.S. laboratories since October 1, 2008. All influenza A(H1)viruses were characterized as A/Brisbane/59/2007-like and all influenza A(H3) viruses were characterized as A/Brisbane/10/2007-like, the influenza A(H1 N1) and influenza A (H3N2) components included in the 2008-09 influenza vaccine. Influenza B viruses currently circulating can be divided into two antigenically distinct lineages represented by the B/Yamagata/16/88 and BNictoria/02/87 viruses. Four influenza B viruses were characterized as B/Florida/04/2006-like, belonging to the B/Yamagata lineage, the influenza B component of the 2008-09 influenza vaccine, while the remaining three viruses belong to the BNictoria lineage. Data on antigenic characterization should be interpreted with caution given that: 1. Few U.S. isolates are available for testing because of limited flu activity thus far. 2. The majority of viruses antigenically characterized to date come from only two states and may not be nationally representative. 3. Antigenic characterization data is based on hemagglutination inhibition (HI)testing using a panel of reference ferret antisera and results may not correlate with clinical protection against circulating viruses provided by influenza vaccination. Annual influenza vaccination is expected to provide the best protection against those virus strains which are most similar to the vaccine strains, but can also provide at least partial protection against strains that are related, but antigenically distinct from vaccine strains. Limited to no protection may be expected when the vaccine and circulating virus strains are so different as to be from different lineages, as is seen with the two lineages of influenza B viruses. • Antiviral Resistance: Since October 1, 2008, 25 influenza A(H1 N1), five influenza A(H3N2), and nine influenza B viruses from 11 states have been tested for antiviral resistance; however, 72% of the viruses tested were from only two states. Twenty-four of 25 influenza A (H1 N1) viruses tested were resistant to oseltamivir; while all 25 viruses were sensitive to zanamivir. All influenza A (H3N2) and B viruses tested were sensitive to oseltamivir and zanamivir. Twenty-five influenza A(H1N1) and five influenza A (H3N2)viruses were tested for adamantane resistance. All influenza A (H1 N1)viruses were sensitive to the adamantanes. All influenza A (H3N2) viruses tested were resistant to the adamantanes. The adamantanes are not effective against influenza B viruses. Only one state has reported local influenza activity during the 2008-09 season in the United States to date, thus the number of virus specimens available for antiviral resistance testing is limited in both the overall number tested and in the number of states that have submitted specimens. Limited data on antiviral resistance, as well as the uncertainty regarding which influenza virus types or subtypes will circulate during the season, make it impossible to provide an indication of the prevalence of influenza viruses resistance to oseltamivir or the adamantanes (amantadine and rimantadine) nationally or regionally at this time. CDC has solicited a representative sample of viruses from WHO collaborating laboratories in the United States, and more specimens are expected as influenza activity increases. • CDC 2008-2009 Influenza Season—Week 48,ending November 29,2008 3 4 Pneumonia and Influenza (P&I) Mortality Surveillance: During week 48, 6.7% of all deaths reported through the 122-Cities Mortality Reporting System were due to P&I. This percentage is • below the epidemic threshold of 7.1%for week 48. Pneumonia and Influenza Mortality for 122 U.S. Cities Week ending 11/29/2008 12- • 0.610- Epidemic Threshold N 0114 °IN • • Seasonal Baseline • 2005 2006 2007 2008 4� 1 10 20 30 40 50 10 20 30 40 50 10 20 30 40 50 10 20 30 40 50 Weeks DC 2008-2009 Influenza Season—Week 48,ending November 29,2008 4 Influenza-Associated Pediatric Mortality: No influenza-associated pediatric deaths were reported during week 48. Number of Influenza-Associated Pediatric Deaths by Week of Death: 2005-06 season to present 15 - 14 - 13 - 12 - 11 - 10 7;1 9 d O $ y 7 6- E 5_ 4 - 3 2- 1 -1 ,11, 4,,,. „,, „,,i j R.I O CD N CD N CO V' o CD N CO N CO V' O 60 N CO V' O V O CD N 0D V' o CO v ON C7 C7 1- 1- O O N N C7 ch O Ct) U) CD to CO CD CD CO CD CD N- N- N- N- N- n n n N- CO 019 019 CO CO N CO CO 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 O o o O O O O O O O O o o O O O O O O o O o O O o o O NNNNNNCJ N N N N N NNNNNNNNN NNNN NNN • Week of Death Deaths Reported Previous Weeks E Deaths Reported Current Week Influenza-Associated Hospitalizations: Laboratory-confirmed influenza-associated hospitalizations are monitored in two population-based surveillance networks: the Emerging Infections Program (EIP) and the New Vaccine Surveillance Network (NVSN). EIP and NVSN estimated rates of hospitalization for influenza will be reported every two weeks starting later this season. CDC 2008-2009 Influenza Season—Week 48,ending November 29,2008 5 Outpatient Illness Surveillance: During week 48, 1.3% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network(ILINet) (formerly known as the U.S. Influenza • Sentinel Provider Surveillance Network)were due to influenza-like illness (ILI). This percentage is less than the national baseline of 2.4%. On a regional level, the percentage of visits for ILI ranged from 0.4% to 2.4%. All nine regions reported percentages of visits for ILI below their respective region-specific baselines. Percentage of Visits for Influenza-like Illness (ILI) Reported by the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet), National Summary, 2008-09 and Previous Two Seasons 7 - 6 - 5 - -J 4 - N .y \ 0 3 - 0 2 - • oar 4•4101- kms+" a� 0 40 42 44 46 48 50 52 1 3 5 7 9 11 13 15 17 19 Week ---s--2006-07* —o--2007-08* —4-2008-09 - - -National Baseline *There was no week 53 during the 2006-07 and 2007-08 seasons,therefore the week 53 data point for those seasons is an average of weeks 52 and 1. 2008-2009 Influenza Season-Week 48,ending November 29,2008 6 0 Geographic Spread of Influenza as Assessed by State and Territorial Epidemiologists: During week 48 the following influenza activity was reported: • Local influenza activity was reported by one state (Hawaii). • Sporadic activity was reported in Puerto Rico and 22 states (Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Idaho, Indiana, Massachusetts, Maryland, Michigan, New Hampshire, New York, Oregon, Pennsylvania, Rhode Island, South Dakota, Texas, Utah, West Virginia, and Wisconsin). • No influenza activity was reported in the District of Columbia and 27 states (Alabama, Delaware, Georgia, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, Tennessee, Vermont, Virginia, Washington, and Wyoming). Weekly Influenza Activity Estimates Reported by State & Territorial Epidemiologists* �`\4 , Week ending November 29,2008-Week 48 ,,,$, ., \\::„kc,,,s2,:s\\\.,,,,\:,f,x.s\',,,,X.\\\::...\\.,:,,,,::,'„,,,\,..,,, , , 1/4 f`Y M:;:..„.:. #"'<:. .:1 4 \...'\\ t, •S.\`` j:40*?, !1'5'1" 3�'." �.,_.'IV.¢, ♦ ;ter/,�+. i�:`y`"t. er ,Ly ;"*. �\ ,y",,,, •:,:>, ,/x ,x ,Yx 'GY K'` "�. �`� x�, ;cj�€ `'`, wt. , \ �;wz �•l, h/`^ hmx ',. .:\s,.. Opitesf , NI' '-,ask,\* \ .,\:...\:‘, -4.),,,, NI\ 4,:w 1,4,,,,,.;,,,..,„;.,,f,, .-(,*,,,,sk ga,,,, 4:2... 4. +��'gM,y,„:„.,„ , voiteigas- -:', \ ki, � � r3f9hlf�01c01UFilbtBM ‘,1„, • a y,,`�j.,,,,x,... . \ ,s,,,,,,,,,-„..:. 1 ,.iY q~ y;`tea. �,1} \ T ..�y� 4 ` -. ..,,,,,, ,k 1 \\\',\\ss \\ N'N's �.*..[Kk Fy 4 q,*may y wt\�'M'q�` � . \\„,,,,,„:„. . it,4.5,7( ,,,,,,, ,,, . $4,,,,,\\ \..,,,,,,... ,,.., � w .J K h No Report No Activity Sporadic Local Regional Widespread `. _ }: \\\,,, t: d- .N 5� 65' „ * This map indicates geographic spread&does not measure the severity of influenza activity A description of surveillance methods is available at: http://www.cdc.gov/flu/weekly/fluactivity.htm Report prepared: December 5, 2008 IIICDC 2008-2009 Influenza Season—Week 48,ending November 29,2008 7 • Board of 3feaCth Old Business .agenda Item # 2 EpiTrends • 'Washington Surveillance for Severe Influenza Disease December 18, 2008 1 • • epiTRENDS A Monthly Bulletin on Communicable Disease Epidemiology and PRioliic Health Practice in Washington State Surveillance for Severe and FatalVol. 13 No. 11 Infections ssociate With Influenza Over the past several years there have been publications and reports addressing an emerging phenomenon in this country, severe or fatal co-infections with Staphylococcus aureus and influenza. Many states including Washington have received anecdotal reports of such infections in recent years. Department of Health is requesting assistance from local health jurisdictions and health care providers in our state for increased surveillance of these co-infections during this influenza season. Pediatric Influenza-Associated Deaths and Fatal Co-Infections The Centers for Disease Control and Prevention (CDC) recently published an article in Pediatrics summarizing national surveillance data for pediatric influenza-associated mortality. This article reported an increase over recent • years in the number of fatal pediatric influenza deaths, with a specific increase in influenza and Staphylococcus aureus (S. aureus) co-infections. From October 1, 2004 through September 30, 2007, 39 states and two local health departments reported a total of 166 influenza-associated pediatric deaths in the United States. Isolation of S. aureus from these YO I�'��� i,lorSlat ��'i'����'��'��t�'i pediatric deaths increased from one case during the 2004-2005 season and �three cases m 2005-2006 to 22 cases in 2006-2007. There was one methicillin-resistant S. aureus (MRSA) isolate from these cases in 2004— epiTRENDS 2005 and 13 MRSA isolates in 2007-2008. The cases with influenza and P.O. Box 47812 S. aureus co-infection during 2006-2007 had a median age of ten years. Olympia,WA 98504-7812 The fivefold increase over three seasons in pediatric Mary C. Selecky deaths associated with influenza and S. aureusSecretary co-infection emphasizes the importance of w H Maxine Hayes, MD, MPH preventing such severe infections. An observation .till State Health Officer from the article was that the influenza-associated deaths occurred rapidly, with almost half the cases ro 43 Marcia J. Goldoft, MD, MPH ' dying within 72 hours of symptom onset and a „. =' Scientific Editor Deborah Todd, RN, MPH similar proportion dying at home or in the Influenza immuniation Editor emergency department. There is consequently Image courtesy of CDCManaging limited time to initiate antibiotics to treat the S. aureus infection. Avoiding influenza infection through vaccination is a key prevention measure. • Continued page 2 PAGE 2 epiTRENDS November 2008 In the article discussing pediatric influenza deaths, it was noted that few of the • children with indications for influenza vaccination had received vaccine that season. However,the majority of cases were previously healthy children for whom vaccination was not yet recommended. As of 2008 almost all children are included among those recommended for annual influenza vaccination. Reference: Finelli L, Fiore A., Brammer L, et al. Influenza-Associated Pediatric Mortality in the United States: Increase of Staphylococcal aureus Co-infection. Pediatrics 2008;122(4):805-11. Surveillance for Severe Influenza Infections in Washington During the 2008-2009 respiratory season, routine influenza surveillance activities in Washington will include sentinel health care provider surveillance for influenza-like illnesses .' and laboratory surveillance for influenza isolates. The Washington State Department of Health Communicablex Disease Epidemiology Section (CDES) is requesting two additional types of surveillance on a voluntary basis. One14i , type is reporting influenza-associated pediatric deaths. The second is surveillance for severe pneumonias due to influenza and S. aureus co-infection in previously healthy individuals less than 50 years old. • epiTRENDS National reporting of influenza-associated pediatric deaths m emene2004; this condition is currentlyA. Normal lung Monthly Posting was implemented in Alert p B. Abnormal lung reported voluntarily in Washington but may be added to X-ray showing To receive monthly the notifiable conditions reporting requirements in the pneumonia in right e-mail notification future. National data for influenza-associated pediatric lung (left side of image) of ep�TRENDS, Image courtesy of please register at deaths are reported by influenza season, which begins Wikimedia this website: around October 1'of each year. For surveillance purposes, a case is defined as: a death in a child less than 18 years old with an http:// influenza-like illness and laboratory confirmed influenza infection testing by a listserv.wa.gov/ standard method. Influenza testingmayoccur before or after death. archives/ epitrends.html Consistent with national notifiable conditions, CDES is requesting voluntary Choose the option reporting of influenza-associated pediatric influenza deaths. Appropriate reporters to join the listserve. for the local health jurisdiction to notify would include health care providers, Enter your name emergency departments, intensive care units, and medical examiners. Following a and email address. local investigation, reported cases will be reviewed by CDES and CDC. Cases are defined as: • age under 18 years • death from clinically compatible influenza-like illness • laboratory confirmation of influenza(includes rapid diagnostic test) Continued page 3 • PAGE 3 ep/TRENDS November 2008 . Respiratory specimens, respiratory tract tissue, and paired sera can be tested for influenza. Bacterial co-infection, specifically with S. aureus, is of particular interest for these fatal pediatric cases. S. aureus isolates should be tested for antibiotic susceptibility. Washington State Public Health Laboratories can assist with bacterial cultures or testing for influenza on both pre-mortem and post-mortem specimens. Consult a CDES epidemiologist for assistance. CDES is also requesting reports of severe pneumonias due to confirmed S. aureus and influenza co-infection. Nationally there has been an increase in reports of co-infections with these organisms over the past several years, including severe or fatal cases in older children and young adults. Health care providers and health care facilities are asked to report to their local health jurisdictions cases defined as: • age under 50 years • previously healthy a • critical illness (e.g., ICU admission or death) ,� A • confirmed S. aureus pneumonia and confirmed 0 7, influenza infection Co-infection will be detected only if both bacterial and influenza testing are done. Younger persons critically ill with ' pneumonia, particularly those who were previously healthy, w ,107 should be tested for both types of infections. Washington State Public Health Laboratories is available as a resource to assist with testing. Health care providers should be aware of Agar plate with MRSA showing • the local prevalence of methicillin-resistant S. aureus (MRSA) decreased growth inhibition to multiple antibiotics when choosing empiric therapy for patients with suspected Image courtesy of Andrew Walker influenza-related pneumonia, and should request susceptibility Health Protection Agency, UK testing for S. aureus isolates from severe respiratory infections. CDES requests laboratory submission of S. aureus isolates from severe cases. Recommendations for Influenza Vaccination As a reminder, vaccinating both patients and health care providers for influenza may reduce serious respiratory illnesses in the community. Recommendations for influenza vaccination were recently expanded. In addition to children 6 months to 4 years included in previous recommendations, all children ages 5 to 18 years of age should be vaccinated. Children aged 6 months to 8 years should receive two doses of vaccine if they have not been vaccinated previously at any time against influenza. The current ACIP recommendations for influenza vaccination are available at: hap:,www.cdc.govi�mmwr,/previewrr'mmwrht:mllrr57e717aI.htm For questions about influenza surveillance in Washington, contact Erin Chester, 206-418-5500. Board of 3feaCth New Business .Agenda Item # 1 Public 3-fearing: • Jefferson County Pu6ac 3-feaCth Fee Revisions December 18, 2008 • 4 STATE OF WASHINGTON JEFFERSON COUNTY BOARD OF HEALTH AN ORDINANCE ESTABLISHING A Ordinance No. 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 schedule repealed Section 1 —Purpose The purpose of this ordinance is to set the fee schedules for Jefferson County Public Health. Community Health Environmental 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. * • 4 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 outside laboratory cost. Certain service fees may be waived, including but not limited to communicable disease prevention cases, medications, laboratory services or vaccines to prevent outbreaks of communicable disease, where personal insurance denies reimbursement. Jefferson County Public Health will automatically implement future modifications to fees for vaccines, medications, and medical supplies when any of the following changes occur: 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 a client's inability 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 ad�u sted annually on the first • business day of January(Adjustment Date)by the amount of the increase of the Consumer Price Index as reported for the month of September preceding the Adjustment Date, following the annual fee indexing criteria established in Jefferson County Ordinance#12-1209-96. 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 PUBLIC HEALTH ENVIRONMENTAL HEALTH DIVISION th ENVIRONMENTAL HEALTH 2009 FEES Additional Fees and Other Information Health Officer Administrative Hearing 287.00 Technical Assistance/Plan Review-Minimum 65.00 Technical Assistance/Plan Review-Per Hour 65.00 Filing Fee 41.00 ONSITE$EWAP,0 :?:,04 Sewage Disposal Permits New Conventional 488.00 Valid for 3 years New Alternative 588.00 Valid for 3 years New septic tank and/or pump chamber only 215.00 Issued in conjunction with an existing sewage disposal system or community system New Community or>1000 Gallons Per Day(base fee) 488.00 Plus$82 per connection-valid for 3 yrs New Commercial>1000 Gallons Per Day Conventional 588.00 Valid for 3 years Alternative 631.00 Valid for 3 years Repair/Upgrade/Modification/Designate Reserve Area 115.00 Applies to existing installed sewage disposal system Expansion 387.00 Redesign 115.00 Applies to pending or active but not installed Reinspection 144.00 Evaluation of Existing System/Monitoring Inspection Septic system only 287.00 Septic system plus water sample 298.00 Retest/Reinspection 100.00 On Site Sewage On Site-Site Plan Advanced Approval Determination(SPAAD) 287.00 Septic Permit with SPAAD(conventional) 215.00 Septic Permit with SPAAD(alternative) 323.00 Subdivision Review Base Fee 372.00 Plus$73.00 Per Lot Boundary line adjustment review fee 146.00 Pre application meeting fee 146.00 Planned rural residential development review fee 146.00 Density exemption review fee 73.00 Density exemption review fee requiring field work 146.00 Other Waiver/Variance Application 172.00 Waiver/Variance Hearing 287.00 Wet season evaluation 387.00 Revised building application review fee 146.00 New building application review fee: Residential 73.00 Commercial 146.00 General environmental health review fee 73.00 Licenses Installer, Pumper,Operator(maintenance person) 387.00 • Retest 158.00 Annual Renewal 273.00 Delinquent Renewal after January 31 387.00 4 FQ s fl SERVICE ESTA8U$H1tENtS .1 . ,x A .•; ,„ T11 i a. taek.ditalitatigerialliall Immediate Consumption Limited 136.00 Non-Complex 174.00 • Complex: 0-50 seats 310.00 51-100 seats 372.00 101-150 seats 422.00 Alcohol served in multiple areas 136.00 Not for Immediate Consumption _ Limited 136.00 Non-Complex 174.00 Complex 422.00 Annual Permit Issued after September 1 50%of fee 50%of Annual Permit Fee Late Fee(Paid after January 31) 25%of fee Additional to Permit Fee Late Fee(Paid after February 28) 50%of fee Additional to Permit Fee Temporary Permit Non-Complex 112.00 Limited 62.00 Late Fee 50%of fee Additional(Paid when application is submitted less than 7 days prior to the event) Other Food Fees Waiver 37.00 Reinspection: First Inspection 87.00 Second Inspection 149.00 Food Handler Card 10.00 Reissue Unexpired Food Handler Card 4.00 Manager's Course 211.00 • SOLID t,IfASTg ' _ ..a f^: . , t. . i . ti . Landfills requiring environmental monitoring 508.00 Inert Landfills 322.00 Biosolid Utilization 446.00 Other Solid Waste Facility Permits 322.00 Drop Boxes 149.00 New Facility Application 409.00 Application Fee 149.00 Inspection of well construction,decommission &reconstruction Determination of Adequate Water Supply 62.00 Building Permit Process Well Site Inspection-Proposed public water supply 298.00 LIVING„ENV RQNM1=N' 5..` .. " . Pool 273.00 Spa 273.00 Pool/Spa Combined 372.00 Compliance Enforcement 65.00 Per Hour Reinspection 73.00 Rebuttal Application 146.00 • Board of 3- eaCth .New Business .Agenda Item #11., 2 Emergency Preparedness • .MutuaCAid.Agreements: .Multi-County & ..Multi-Tribes December 18, 2008 • t Final • PUBLIC HEALTH INTER-JURISDICTIONAL MUTUAL AID AGREEMENT This Public Health Inter-Jurisdictional Mutual Aid Agreement("Agreement") is made and entered into by the signatory Health Department or signatory Health District,or signatory County within the State of Washington that operates a public health department or division within its county government, ("Party HD") individually with all other signatory Party HDs legally joining the Agreement. PURPOSE The undersigned Party HDs confront numerous threats to public health,including but not limited to, Public Health Incidents, Emergencies and/or Disasters that could overwhelm the capabilities of an immediate local or regional response. None of the Party HDs Public this Agreement possesses all of the necessary resources to cope with every possible Health Incident, Emergency or Disaster by itself, and a more efficient, effective response can best be achieved by the application and leveraging of collective resources. Each Party HD desires to voluntarily aid and assist each other by the interchange of public health resources and services in the event that a Public Health Incident, Emergency or Disaster situation should occur. The Party HDs find it necessary and • desirable to execute this Agreement for the interchange of such mutual Assistance on a county, regional and/or statewide basis. The Party HDs to this Agreement have determined it is in their collective best interest to develop and implement a Plan, and incorporate mutual aid response into their existing emergency response plans. Training and exercising Mutual Aid protocols,in advance of a Public Health Incident, Emergency or Disaster, will enhance the efficiency and effectiveness of each responding party. The Party HDs desire to cooperate with one another to receive state and/or federal resources provided such cooperation does not compromise a Party HD's public health response. The Party HDs desire to engage in frequent consultation and to allow free exchange of information, plans, and resource records related to Assistance activities. ARTICLE I DEFINITIONS Assisting Party HD: A Party HD providing Assistance to a Requesting Party HD from another jurisdiction that has requested Assistance to confront a Public Health Incident, Emergency or Disaster. • 1 4 Assistance: Assistance means personnel, equipment, materials, supplies, facilities, services, and/or related resources. Authorized Representative: The person or persons designated by each Party HD in the • Plan to request Assistance from or grant Assistance to another Party HD pursuant to the terms of this Agreement. Mutual Aid: A prearranged written Agreement and Plan whereby Assistance is requested and may be provided between two or more jurisdictions during a Public Health Incident, Emergency or Disaster under the terms of this Agreement. Period of Assistance: The period of time beginning with the departure of any personnel, equipment, materials, supplies, services, and/or related resources of the Assisting Party HD from any point for the purpose of traveling to provide Assistance exclusively to the Requesting Party HD, and ending on the return of all of the Assisting Party HD's personnel, equipment, materials, supplies, services, and/or related resources to their regular place of work or assignment, or otherwise terminated through written or verbal notice of the Authorized Representative of the Assisting Party HD. With respect to facility use, the Period of Assistance shall commence on the date agreed upon between the Requesting and Assisting Party HD and shall end when the Requesting Party HD returns possession of the facility to the Assisting Party HD, or when otherwise terminated through written or verbal notice of the Authorized Representative of the Assisting Party HD. Plan: a written public health inter jurisdictional Mutual Aid Plan that meets the requirements set forth in Article VII. • Public Health Incident, Emergency, or Disaster: Any occurrence, or threat thereof, whether natural or caused by man, in war or in peace, to which any Party HD may respond pursuant to its authority under chapter 70.05 or 70.46 RCW, or other applicable law, and that, in the judgment of the Requesting Party HD, results or may result in circumstances sufficient to exceed the capabilities of immediate local or regional public health response. Requesting Party HD: A Party HD that has requested Assistance from a Party HD from another jurisdiction participating in this Agreement. ARTICLE II IMPLEMENTATION This Agreement shall become effective immediately upon its execution by any two Party HDs. After the first two such executions, this Agreement shall become effective as to any other Party HD in the State of Washington upon its execution by such Party HD. The Agreement shall remain in effect as between each and every Party HD until participation in this Agreement is terminated by a withdrawing Party HD in writing pursuant to Article • 2 1 XVII. Termination of participation in this Agreement by a withdrawing Party HD shall . not affect the continued operation of this Agreement as between the remaining Party HDs. ARTICLE III PARTICIPATION The Party HDs have a desire to be of help to one another in response to a request for Assistance related to a Public Health Incident, Emergency or Disaster. The Party HDs agree that this Agreement, however, does not create a legal duty to provide Assistance. The Party HDs agree that any and all actions taken pursuant to this Agreement shall be voluntary and in each Party HD's sole discretion. A Party HD may elect to voluntarily furnish such Assistance to another Party HD as is available, and shall take into consideration whether such actions might unreasonably diminish its capacity to provide basic public health services to its own jurisdiction. ARTICLE IV HOW TO INVOKE ASSISTANCE The Authorized Representative of a Party HD may request Assistance of another Party HD by contacting the Authorized Representative of that Party HD. The provisions of this Agreement shall only apply to requests for Assistance made by and to Authorized • Representatives or their designee. Requests may be verbal or in writing. If verbal, the request shall be confirmed in writing before the Period of Assistance begins to the extent it is practical. ARTICLE V LIABILITY RELATED TO DELAY OR FAILURE TO RESPOND No Party HD shall be liable to another Party HD for, or be considered in breach of or default under this Agreement on account of any delay in or failure to perform any obligation under this Agreement, except to make payment as specified herein. Nothing in this Agreement shall be construed to create any rights in or duties to any third party, nor any liability to or standard of care with reference to any third party. This Agreement shall not confer any right or remedy upon any person other than the Party HDs. This Agreement shall not release or discharge any obligation or liability of any third party to any Party HD. • 3 C. ARTICLE VI . WITHDRAWAL FROM ASSISTANCE An Assisting Party HD may withdraw Assistance by giving verbal or written notice to the Requesting Party HD. Each Assisting Party HD that is providing Assistance to a Requesting Party HD agrees to give reasonable notice to the Requesting Party HD under the circumstances as they exist at the time before withdrawing Assistance. No Party HD shall be liable to another Party HD for, or be considered in breach of or default under this Agreement on account of, any withdrawal of assistance. ARTICLE VII PLANNING, MEETING AND TRAINING Party HDs are expected to: 1) ensure that other Party HDs have their most current contact information; 2) participate in scheduled meetings to coordinate operational and implementation matters, and 3) participate in the creation of a public health inter jurisdictional Mutual Aid Plan that will contain, among other things, current contact information, inventory of resources available for Assistance, training planning, and agreed upon forms to be used related to this Agreement. • Party HDs agree to incorporate protocols related to this Agreement into regular emergency preparedness exercises and trainings, and will train in accordance with the Plan. Requesting Party HDs agree to provide "Just In Time Training" during Public Health Incidents, Emergencies or Disasters on their policies, procedures and protocols for Assisting Party HD personnel. Party HDs agree to exchange their emergency preparedness plans, and other documents that may be beneficial in preparing personnel from another Party HD to respond to a request for Assistance. ARTICLE VIII COMMAND AND CONTROL Resources from the Assisting Party HD shall be under the operational control of the Requesting Party HD's public health leadership. All personnel provided by an Assisting Party HD will be under the authority of the Local Health Officer in the Requesting Party HD. The Party HDs intend to follow the National Incident Management System's "Incident Command System"when such system is activated. • 4 ARTICLE IX • ASSISTING PARTY EMPLOYEES Employees of an Assisting Party HD shall at all times while performing Assistance continue to be employees of the Assisting Party HD for any purpose. Wages,hours and other terms and conditions of employment of Assisting Party HD shall remain applicable to all of its employees who perform Assistance under this Agreement. Assisting Party HD shall be solely responsible for payment of its employees' wages, any required payroll taxes and any benefits or other compensation. Requesting Party HD shall not be responsible for paying any wages,benefits, taxes or other compensation to Assisting Party HD's employees. ARTICLE X INJURY COMPENSATION AND DEATH BENEFITS Each Party HD shall provide for the payment of Workers' Compensation benefits to its own injured personnel and/or to representatives of its own personnel in case such personnel sustain injuries or are killed while rendering aid under this Agreement, in the same manner and on the same terms as if the injury or death were sustained within its own jurisdiction. Nothing in this Agreement shall abrogate or waive any Party HD's right to reimbursement or other payment available from any local, state or federal governments or abrogate or waive the effect of any waiver, indemnity or immunity • available to a Party HD under local, state or federal law or other governmental action. To the extent that such reimbursement,payment, waiver, indemnity or immunity does not apply,then each Party HD shall remain fully responsible as employer for all taxes, assessments, fees, premiums, wages, withholdings, Workers' Compensation, and other direct and indirect compensation, benefits, and related obligations with respect to its own employees. Each Party HD shall provide Workers' Compensation in compliance with the statutory requirements of the State of Washington. ARTICLE XI REIMBURSEMENT OF COSTS AND CONDITIONS OF LOAN The Requesting Party HD agrees to reimburse the Assisting Party HD for the costs of personnel, equipment, materials, supplies, facilities, services, and/or related resources used during the Period of Assistance on the basis of mutually accepted costs associated with these resources. When an Assisting Party HD deploys employees under the terms of this Agreement to a Requesting Party HD, the Assisting Party HD will be reimbursed by the Requesting Party HD equal to the Assisting Party HD's full cost, including employee's salary or hourly wages, call back or overtime costs, benefits and overhead, and consistent with the Assisting Party HD's personnel union contracts, if any, or other conditions of employment. Reuseable materials and supplies that are returned to the Assisting Party HD in clean, damage free condition, excepting normal wear and tear, • 5 shall not be charged to the Requesting Party HD and no rental fee shall be charged. The Assisting Party HD shall determine whether items are returned in clean and damage free . condition, and any items found to be damaged shall be treated as partially consumed and/or as non-returnable materials and supplies. The Assisting Party HD shall be entitled to receive payment for the cost of repair or replacement of damaged and consumed materials and supplies. The Assisting Party HD shall send the Requesting Party HD an invoice or invoices for all valid Assistance Costs and the Requesting Party HD shall pay the invoice(s) within sixty (60) days of receipt of each invoice. ARTICLE XII WORKER REGISTRATION, LIABILITY AND DISPUTE RESOLUTION 1. WORKER REGISTRATION AND LIABILITY. The Party HDs to this Agreement agree that each will take all actions necessary to qualify and maintain qualification of its own personnel, employees and volunteers as emergency workers, or covered volunteer emergency workers, as appropriate, pursuant to RCW 38.52 et seq., WAC 118-04 et seq., and any other applicable statute, regulation or law. The Party HDs agree that prior to invoking a request for Assistance under this Agreement,the Requesting Party HD,through its local department of emergency management, will request the issuance of a mission number from the Washington military department, emergency management division. A Party HD may condition its willingness to respond and the continuance of its response under this Agreement on the issuance of a mission number, and compliance with RCW 38.52 et seq., WAC 118-04 et seq., or other • law, by the Assisting and Requesting Party HDs. 2. In the event local, state and/or federal governments or laws provide waiver, immunity, indemnification, reimbursement or other payment related to liability that would otherwise be the responsibility of a Party HD,then such waiver, immunity, indemnification, reimbursement or other payment shall limit a Party HD's liability. The Party HDs agree to exhaust their rights to waiver, immunity, indemnification, reimbursement or other payment from local, state, and/or federal governments. However,to the extent that local, state or federal governments or laws do not provide complete waiver, immunity, indemnification, reimbursement or other payment related to Party HD liability,then the following provisions will apply: A. Each party to this Agreement shall be legally responsible for its own acts and omissions arising under this Agreement, and that of its respective appointed and elected officials, employees, officers, agents, agencies, assigns and representatives. Each party agrees to defend, indemnify, and hold harmless the other party, and its respective appointed and elected officials, employees, officers, agents, agencies, assigns and representatives from and against any and all liability, loss, cost, damage and expense 6 arising or alleged to have arisen directly or indirectly out of or in • consequence of the performance of this Agreement by the indemnitor. B. GROSS NEGLIGENCE OR WILLFUL OR WANTON MISCONDUCT. Any Party HD shall not be required under this Agreement to release, indemnify,hold harmless or defend any other Party HD from any claim, loss, harm, liability, damage, cost or expense caused by or resulting from the activities of any Party HD's officers, employees, or agents acting in such a manner that constitutes willful misconduct, gross negligence or bad faith. C. LIABILITY FOR PARTICIPATION. In the event of any liability, claim, demand, action or proceeding, of whatever kind or nature arising out of the rendering of Assistance through this Agreement, the Requesting Party HD agrees, to indemnify, hold harmless, and defend, to the fullest extent of the law, each signatory to this Agreement, whose only involvement in the transaction or occurrence which is the subject of such claim, action, demand, or other proceeding, is the execution and approval of this Agreement. D. LITIGATION PROCEDURES. Party HD's personnel shall cooperate and participate in legal proceedings if so requested by another Party HD, and/or required by a court of competent jurisdiction. • E. TORT CLAIMS ACT. No provision of this Agreement shall remove from any Party HD any protection provided by any applicable Tort Claims Act. F. WAIVER OF RIGHTS. Any waiver at any time by any Party HD of its rights with respect to a default under this Agreement, or with respect to any other matter arising in connection with this Agreement, shall not constitute or be deemed a waiver with respect to any subsequent default or other matter arising in connection with this Agreement. Any delay in asserting or enforcing any right, except those related to the statutes of limitations, shall not constitute or be deemed a waiver. 2. DISPUTE RESOLUTION. If a dispute between the parties to this Agreement arises out of or related to this Agreement, or the breach thereof, and if the dispute cannot be settled through direct discussions, the Party HDs agree to first endeavor to settle the dispute in an amicable manner by mediation. Thereafter, any unresolved controversy or claim arising out of or related to this Agreement, or breach thereof, may be settled in a court having jurisdiction thereof. The Party HDs may seek to resolve disputes pursuant to mediation or arbitration, but are not required to do so. • 7 ARTICLE XIII LICENSES AND PERMITS S When invoking Assistance,the Requesting Party HD shall define as precisely as possible the licensure requirements of personnel being requested from the Assisting Party HD. The Assisting Party HD agrees to exercise reasonable diligence in verifying personnel's licensure and in responding to the specific licensure requirements requested by the Requesting Party HD. ARTICLE XIV RECORD KEEPING Time sheets and/or daily logs showing hours worked and equipment and materials used or provided by the Assisting Party HD will be recorded on a shift by shift basis by the Requesting Party HD and/or the loaned employee(s) and will be provided to the Assisting Party HD as needed. Additionally, the Assisting Party HD will provide shipping records for materials, supplies, equipment and/or related resources, and the Requesting Party HD is responsible for any required documentation of use of materials, supplies, equipment, facilities, services, and/or related resources for state or federal reimbursement. Under all circumstances,the Requesting Party HD remains responsible for ensuring that the amount and quality of all documentation is adequate to enable state or federal reimbursement. ARTICLE XV • OTHER OR PRIOR AGREEMENTS This Agreement is not intended to be exclusive among the Party HDs. Any Party HD may enter into separate agreements with any other entity. No such separate agreement shall terminate any responsibility under this Agreement. ARTICLE XVI EFFECT OF DECLARATION OF EMERGENCY The Party HDs recognize that state or federal declarations of emergency, or orders related thereto, may supercede the arrangements made or actions taken for rendering Assistance pursuant to this Agreement. ARTICLE XVII MODIFICATION/TERMINATION OF AGREEMENT No provision of this Agreement may be modified, altered or rescinded by any individual Party HD without the unanimous concurrence of the Party HDs. Modifications to this S 8 • Agreement must be in writing and will become effective upon the approval of the modification by Party HDs. Modifications must be signed by each Party HD. A Party HD opting to terminate this Agreement shall provide written termination notification to the Authorized Representatives of all Party HDs. Notice of termination becomes effective upon receipt by all Authorized Representatives. Any terminating Party HD shall remain liable for all obligations incurred during its Period of Assistance until the obligation is satisfied. ARTICLE XVIII ENTIRE AGREEMENT This Agreement constitutes the entire agreement amongst the Party HDs. ARTICLE XIX SUCCESSORS AND ASSIGNS This Agreement is not transferable nor assignable, in whole or in part, and any Party HD may terminate its participation in the Agreement pursuant to Article XVI. ARTICLE XX . GOVERNING LAW This Agreement shall be interpreted, construed and enforced in accordance with the laws of the State of Washington. ARTICLE XXI INVALID PROVISION The provisions of this Agreement are severable. If any portion of this Agreement is determined by a court to be void,unconstitutional or otherwise unenforceable,the remainder of this Agreement will remain in full force and effect. ARTICLE XXII NOTICES Except as otherwise provided herein, any notice, demand, information, report, or item otherwise required, authorized or provided for in this Agreement shall be given in writing and shall be deemed properly given if(i) delivered personally, (ii)transmitted and received by telephone facsimile device and confirmed by telephone, (iii) sent by United States Mail, postage prepaid,to the Authorized Representatives of all affected Party HDs • 9 at the address designated by such Authorized Representative, or(iv)sent by email with electronic signature of the Party HD's Authorized Representative. ARTICLE XXIII NO DEDICATION OF FACILITIES No undertaking by one Party HD to the other Party HD under any provision of this Agreement shall constitute a dedication of the facilities or assets of such Party HD, or any portion thereof, to the public or to the other Party HD. Nothing in this Agreement shall be construed to give a Party HD any right of ownership,possession, use or control of the facilities or assets of the other Party HD. ARTICLE XXIV NO PARTNERSHIP This Agreement shall not be interpreted or construed to create an association,joint venture or partnership among the Party HDs or to impose any partnership obligation or liability upon any Party HD. Further, no Party HD shall have any undertaking for or on behalf of, or to act as or be an agent or representative of, or to otherwise bind any other Party HD. • • 10 IN WITNESS WHEREOF, this Agreement has been executed and approved and is effective and operative as to each of the Party HDs as herein provided. Kitsap County Health District By: Its: Date: Public Health Seattle and King County By: Its: Date: Snohomish Health District • By: Its: Date: Tacoma-Pierce County Health Department By: Its: Date: I 11 �40N C Region 2 Public Health Emergency Preparedness & Response ).010T-fa-Region 2,,,,„, ) 345 6th Street,Suite 300 • = Bremerton,WA 98337 .,; . Hon. Vivian Lee, Chair Hoh Tribal Council 2464 Lower Hoh Road Forks, WA 98331 Hon. W. Ron Allen, Chair Jamestown S'Klallam Tribal Council 1033 Old Blyn Hwy. Sequim, WA 98382 Hon. Frances Charles, Chair Lower Elwha Klallam Tribal Council 2851 Lower Elwha Road Port Angeles, WA 98363 Hon. Micah McCarthy, Chair Makah Tribal Council P.O. Box 115 • Neah Bay, WA 98357 Hon. Ronald Charles, Chair Port Gamble S'Klallam Tribal Council 31912 Little Boston Rd. NE Kingston, WA 98346 Hon. Carol Hatch, Chair Quileute Nation Tribal Council P.O. Box 279 La Push, WA 98350 Hon. Leonard Forsman, Chair Suquamish Tribal Council 18490 Suquamish Way Suquamish, WA 98392 Dear Chairmen/Chairwomen [Name]: We are writing to ask for your guidance and support in addressing an important emergency preparedness need of tribal and local governments. We would like to propose the development of a comprehensive and universal Mutual Aid Agreement(MAA) amongst the three counties and • seven tribal health jurisdictions on the Kitsap and Olympic Peninsulas. Development of an Olympic Regional Mutual Aid Agreement would enable us to be better prepared to meet the public health challenges of a natural disaster or a large scale disease outbreak. Disease outbreaks, • as well as other public health emergencies, know no jurisdictional boundaries, and can easily overwhelm the ability of individual governments to respond effectively. During a crisis, jurisdictions that want to aid one another confront issues that can become stumbling blocks to an effective and immediate response. Working out the details of these jurisdictional issues ahead of time will allow us to focus our efforts on urgent community health needs should we be faced with a future multi jurisdictional health emergency. We propose the formation of a work group made up of one representative from each of the seven Tribes, the Health Officers for Clallam, Jefferson, and Kitsap Counties, , the Region 2 Public Health Emergency Preparedness and Response Coordinator, Jessica Guidry and a legal advisor and facilitator, Susan Ferguson. Susan Ferguson negotiated the MAA between the Puyallup Tribe and the Tacoma-Pierce County Health Department, and facilitated the creation of a recent model MAA amongst Washington counties. We propose rotating meeting locations so each jurisdiction has a turn not having to travel. We would ask that you delegate a Tribal representative to join in the discussions related to the development of such a regional Mutual Aid Agreement. The breadth, scope and content of the draft agreement will be developed by the participants, with continued communication and review by each respective Tribe. Of course, participants at the discussion table will not have the authority to bind their respective governments. The goal is to develop a draft agreement for review by the tribal and county decision-makers. We anticipate the focus of the agreement will be mutual aid related to disease containment, including epidemiologic research, disease • investigation, prevention, and treatment, as well as emergency and disaster response. We would like to support this request for your participation with funding to defray legal and staff costs. We have submitted a proposal to the Washington State Department of Health and included a request for funding to support Tribal participation. We have been assured that this project is a high priority for funding and expect its budget to be finalized in the near future. We would like to follow up this letter with a telephone call to discuss whether your Tribe is interested in participating in the Mutual Aid Agreement discussions, and, if so, who your appointed tribal representative will be. If you have any questions about the proposal, or would like more information, please feel free call us on our direct lines listed below. Otherwise, we look forward to talking with you in the weeks ahead. Sincerely, Thomas Locke, MD, MPH Scott Lindquist, MD, MPH Health Officer Health Officer and Director Clallam and Jefferson Counties Kitsap County Health District (360) 417-2437 (360) 337-5237 • vepa"pu Grant Con►pctztx`template rib 1Nealtb Y2� � CDCrojectwY;txng ,� al Y reeujeut bets een ual Aid Ag • e°fproject' AuthoritiespK r1a�' e 01-1):Scott L;uaquist�D Ment o f�lee1g t�z1bes o�ect'typ tact gco State Depart tea by all pY Project ton1e,nen estov ' bes proj e W asking a and imp 1a11an'�San' e e,ght tri a with Abe accepted 1e S 1 o f then s shaze ectAbstract' osestow°*icbwillbh,p° Gamble �acofthesetx�be V C°i xealth 4TOp inched t' e guquax'' and Quileate es but each 2 4abl�c cab,l a'a ag include li Malian''ance oilenaz acb of the Vibes. e �°n ,� e1 n' tabes 1wl'a vexna toe al g Bate a oa 2' the ohs Lower sepazate�° ioxi2) acceptable create sever'meeting cwithxngegl NLakah'x thathave stem Reg ent that is iU have to. include m each S,klallamendent gibes c Yiealth sy a,a agzeem if we w ect`''tll cb,of to are independent mutual vibes,°T this pT°� details specific on create a foz a118 oes dozing oat the comm ealth w4 `,,,ill`ic ro pzity of w &sing g ion 2 pub f a single Ivi es the 'esecvdions and Reg unclear i of abase�es at thezT Itis ations e1ght vibes on State P modlf�c ch of the W ashin�llest zegzc tb l entity gezOn 2,n the 2 S the sas a vzde� defined as ReglOn he tarn est az, • ect V,zner eve' on Com'tie aT dness p a g� �l ,a;i and is t an g ffCT` pr°� �effers dpzep Toxin Couny 11a ' is Cgton S and anse u\ation of aae up of K,tsaczisea°f Cf Seale and s pezi ency op ma is comp west° e cine ealthE,S0 State with ap eri,nsala is p entnsUl tea dizectis all to'te's a region T asli has 9 -Tile Kusa the Olympic Teen is locate disc as tl s d within eat Co that it a-• residents• his o1 F()Test terspexse Stak of 2� val s lip,tbete ate S t ibalatlze ezvations in ode tribe, OA has 9�' dad°T'a1 g tubal T *AA)�' that mclades thew axe ent fed f o nee zonal setting' Aee'n z utual p is at was developed as ' '�a s_ a a) plan is to develop de A z pia to u COri act specea' rO;�, The 4�s a templat�t,pzls. It is hal liaison] T1�is-will b 14 ucc'a there . az;sax tl,atri Aabove• with anaa2 will w°T on StateA 2 W ashen atonal xlrto the. 2 • In addition, ddit i0 n, the tribal ribal a iso n/c on tra ct specialist pecialist WII I ma ke a t least 3 si t e v uisnj i s to each a c htrlbwith the local health . risd Health Offcejr and RegonalEnergenc .Response n ion 2 will s eCoordinat°r R sfacIl.ttel1 lo.gistcsin °jving the tribal meetings and • Jointasessions. As this Is ariulaedmg,many of the tribes are a full dayIo journey to reach the reservations. ThlsprOJect accounts sr amdtttollavel and overnight accommodations. cco nod lOn,' We anticipate the next 6:to onth,oefoeamo Ptr°Jecthwir8othi v°1ve site ViSitS and tribal meetings. This will continue the nbepotectar which point ,e will spenthe last 4 months of the prOletfhnngthedentwt each tribe, obtaining local health jurisdiction legalnd ensua �eerreviwWX11also include a final site vi,it, ll'IAA signing, and oofthe project. lethis ewill likely take tribal legal resources, wehaveChidedcompensation for each tr aentitylegalresoues ca • pktion b e ObjectiveTh Objective ofthe mutual aid elis tO protect the health safety of tribal mems yejas� e and on_atnemployees, resident visitors, and guests on tribal lands within Region2 Public Health.oth0dsTe not of the mutual aid agreement(nethods) will include prOvjsl �fOrepidemiIgic research, investigation,prevention, containment, related to a disease°utbreWith a jculalhnsi,°npandRu�a.Provisions will include designated iitfnea emphasis represented, and afireeis trSubJect ofduteresol �, emnjtyed cal records, rur,enent, termination, emi atlon, annsurance coverage.resolution, indemnity, Project l�cflne; nt emic on ract J g b • jfay 1 \June 3p2o68: Initial plannjn�meetinbetween nRe12and tribal llai,D�contspecialist which Will result in aagreed upon tplateIIIAA for Region 2puWlieH althji uly I—DeceMber 31, 2008: site visits wiloccur ThhoIng the next phase ofthe prs�Cnwhich involves jnidaltact,prood ` 4, rowntfthee discussions with all involved the aof travel lm' In addition to legal review reworking o e template A4 during joint authorship sessions. January 1,April 30, site visits, signing, will wring this � e°ft' we en� eobjectives, s unmoripnrOJecandodej � for°thenlOal health Jurjsdiin ° use a,a proven Mir 4 • e) Staff: The staff includes those mentioned above, with the lead provided by the Health Officer for each county(2 Health officers in Region 2), the Region 2 Regional Emergency Response Coordinator, and a tribal liaison/contract specialist. The majority of the cost will be in developing the MAA and subsequent travel and site visits. We do anticipate teleconferencing, telephone and Internet resources for communication during this project. f) Performance Measures: The following performance measures will be utilized for this project to track progress: i. Attendance at meetings and minutes will be recorded; ii. A semi-annual report describing the status of the project will be provided utilizing a template provided by DOH: iii. Completion of a model MAA for Region 2 iv. Successful implementation of a MAA in at least 4 of the 8 tribal jurisdictions. g) Budget Justification See attached budget spreadsheet. • . Olympic Regional Tribal/Public Health Mutual Aid Agreement Proposal Details It is proposed that a work group ("Tribal/PH work group") be created and made up of representatives from three public health jurisdictions and seven tribal jurisdictions. The idea is to meet and discuss issues related to development of a mutual aid agreement (MAA)to be used in the event of a local or regional public health emergency. This memo sets forth the logistical details related to the proposal as well as a brief description of each participant's role or responsibility. 1. The Tribal/Public Health MAA work group. It is proposed that each tribal jurisdiction select one representative to participate in the work group. Other participants will be Dr. Scott Lindquist, representing the Kitsap County Health District, Dr. Tom Locke, representing Jefferson and Clallam County Health Departments, and Jessica Guidry, the Region 2 Public Health Emergency Preparedness and Response (PHEPR) coordinator. lithe participants would like to be represented by legal counsel during the process, they may do so, but there is no requirement to do so. The work is undertaken with the understanding that the representatives do not have authority to bind their respective jurisdictions, and that final approval of any agreements will be the responsibility of the jurisdictional decision-makers. The work is also undertaken with the understanding that the participants may or may not come to agreement. • 2. The facilitator. Susan Ferguson, a contractor with the Washington State Department of Health (DOH), will facilitate the process. Although Ms. Ferguson is an attorney, in this process, she is acting as a neutral facilitator, and not as an attorney. She does not represent DOH or any party in the facilitation, and does not provide legal advice. DOH does not participate in the meetings or in the process, although Ms. Ferguson does provide DOH with progress reports from time to time. The agreement that may result from this process is the work product of the MAA work group participants alone. Ms. Ferguson's principle responsibilities are to prepare materials, lead discussion, organize the meetings for the work group, and then write the multiple drafts of the proposed mutual aid agreement, per direction received from the participants. Once the participants decide on the tribal, state or national model mutual aid agreements that they think will give scope to their agreement, Susan will draft a document called "Starting Points for Discussion" that will break down the proposed agreement by specific issues. She will then create meeting agendas, based on discussion of selected issues at each meeting. In between meetings, she will write the successive drafts of the proposed agreement, based upon the direction received from the work group at each meeting. • 3. The proposed schedule. It is proposed that the first meeting be held on December 12, 2008 in the general vicinity of Port Angeles. Dr. Tom Locke will make an arrangement for the actual meeting location, possibly at a tribal location. One purpose of the first meeting is to meet one another and discuss the scope of the proposed agreement, including the selection of suitable tribal, state or national mutual aid agreement models to use for the "Starting Points for Discussion" document. Following the first meeting, Susan will create that document and send it to the participants electronically, and also create hard copy notebooks for their use that will be distributed at the second meeting. At the first meeting,the work group will also decide on the future meeting dates and locations. It is anticipated that five meetings, one per month from January to May 2009, will be needed to discuss the MAA issues. Those dates will be selected at the December meeting, as everyone's calendars fill up fast, and future meeting dates need be set aside. The participants will decide whether they prefer to meet in one or more central location(s) for all meetings, or to rotate locations, so participants can take turns not having to travel. It is the responsibility of the work group representatives to keep decision-makers informed throughout the process, so that decision-makers can comment, and raise questions or concerns as the agreement progresses. Once a final first draft of a proposed mutual aid agreement is reached, if any, then the participants will undertake an internal review process in their respective tribal • and public health jurisdictions. Sixty days should be allotted for the internal review. The agreement is reviewed by legal counsel (if not already reviewed), risk managers, insurance brokers, internal administrative committees, and any other entity the jurisdiction deems appropriate. If issues or concerns arise, the work group participants would share them with the facilitator, and the work group, to find solutions. Following the 60 day internal review process, the work group participants would have another meeting to discuss proposed changes to the agreement to resolve the issues or concerns emanating from the internal reviews. Once a final agreement is reached, it would be presented to the decision-makers for review, comment and possible adoption. If issues arise related to decision-maker concerns, the work group might have to meet again to discuss and/or resolve them, unless it is possible to resolve final issues via email communication. 4. Tribal reimbursement. The Washington State Department of Health has agreed to provide $5,000.00 per tribe for the reimbursement of costs related to participation in the Olympic Regional Tribal/PH Mutual Aid Agreement facilitation process. The funds will be part of the Kitsap County Health District's consolidated contract • • Board of Health Netiv Business .agenda Item #`V., 3 Department of 3-fealtfi • Proposed Budget Cuts for Remainder of the 2007-2009 Biennium December 18, 2008 • December 9, 2008 Department of Health • Current fiscal year budget reductions (through June 30, 2009) The state Department of Health must reduce spending by$7.1 million before June 30, 2009, the end of the current fiscal year. Here are some examples of actions taken by the agency to achieve that cost-savings goal: • Approximately$1.5 million will be saved as a result of leaving vacant positions unfilled, reducing equipment purchases, reducing personal service contracts, reducing travel, and reducing the amount we spend on goods and services. There are nearly 150 positions agency-wide that are currently vacant. • Approximately $1.5 million will be saved by maximizing the funds we get from all different sources. We will make certain that we use all available fund sources, where allowable, to pay for our critical public health work before we use state funds. • Approximately$1.5 million will be saved by cutting spending in programs and through efficiencies that programs have identified. For example, one program has cancelled its annual statewide conference this year; one program saved nearly $90,000 by changing vendors for a large purchase; and another organized its work differently to avoid hiring extra seasonal workers to get the work done. • Approximately $2.7 million will be saved by slowing some program work or stopping the • program altogether. Examples include: • The Medical Home Collaborative project will be phased-in. This project works to identify the latest techniques in effective and cost-efficient patient-centered care. Estimated savings this fiscal year: $115,000. • The colorectal cancer screening program, which began two months ago, will be discontinued. In 2008, the legislature funded six pilot projects to provide colorectal cancer screenings for the low-income uninsured. Estimated savings this fiscal year: $900,000. • We will not implement a new program funded by the legislature this past year to increase outreach to help provide a more ethnically diverse blood and bone marrow supply. Estimated savings this fiscal year: $100,000. • We will stop new work funded by the legislature this past year to increase ethnic and racial diversity of umbilical cord blood collection. Estimated savings this fiscal year: $62,000. • We will stop work funded by the legislature in 2006 to create an Internet-based system to collect, analyze, and share information about healthcare errors in Washington. Estimated savings this fiscal year: $222,000. • We will stop work funded by the legislature in 2007 to develop a prescription monitoring • program. The project would've collected prescription information that doctors could use to make better-informed decisions about prescribing drugs for their patients. Estimated savings this fiscal year: $500,000. JEFFERSON COUNTY BOARD OF HEALTH • December 12, 2008 DRAFT The Honorable Christine Gregoire PO Box 40002 Olympia, WA 98504-0002 Dear Governor Gregoire, Alarmed that the First Steps program is under consideration for reduction or elimination, we are writing to urge you and our Washington State elected officials to preserve the current level of funding for this highly effective program. Recently Washington State was recognized for achieving the lowest infant mortality rate in the nation. Our Secretary of State Mary Selecky stated that the First Steps program was instrumental in this critical public health achievement. As a small, rural community, Jefferson County relies on the First Steps program as an integral part of the safety net for our vulnerable families. Public Health maximizes First Steps funding by close collaboration with community partners in our work to eliminate health disparities by increasing access to prenatal care and preventing low birth weight babies. No duplication of services exists in our community. Cut this funding and e program will be gone. Even a temporary cut would mean 20 years of creating infrastructure and capacity the be lost and will be very difficult to rebuild. As the economic crisis deepens our families become even more vulnerable. The health and financial impact of losing First Steps will be both immediate and long term. We urge you to make all efforts to preserve the current level of funding for the First Steps. Thank you for your consideration. Sincerely, John Austin, Chair Jefferson County Board of Health • 615 Sheridan • Castle Hill Center• Port Townsend • WA (360)385-9400 • Board of Health Netiv Business .Agenda Item #`V., 4 Public 3-Cealth Standards yoffow-up: Jefferson County • Pu6Cic 3-{eaCth Strategic Planning December 18, 2008 1 e JCPH Strategic Goals 11.04 Page 1 of 1 Jefferson County Public Health Always Working for A Safer, Healthier Jefferson County . Core Knowledge&Ca Focus question: What are 3CPH's strategic goals? Required to Achievi di$:1 , . 3CPH's Strategic Goals 0 N Building Capacity Reducing Cost Burden for Sustainable of Health Care in Our Community , Public Health A Supporting Economic *____-, ,. Health in Our Community Giving Children A /'". Supporting Good Start in Life contributes to 4, Decisions About Priorities fg ---- for Public Health 'Providing Responsible Stewardship' / for Public Funds / ----- V ----contributes to.ifr------------ Copyright 2008 Jefferson County Public Health All Rights Reserved created for JCPH by Sound Knowledge Strategies,LLC III n154 ttlitCapt Map VMS C II 0 http://cmapspublic2.ihrric.us/servlet/SBReadResourceServlet?rid=1228334319350_12603... 12/10/2008 /r ..--N 00 ILI o U do NI cu Q o Z r 0 W. Z a) C Z I-- ra 1.4 LI CU I 4 Z e co a.>. V} W U o? w W M O C � J ZNC U r.+ _ V vai CO H � C `n L 4 aZ M '71- i 4 Z F envi a L 4115 U 0 NN raw t L,. to O6 Zw � 0O ii atc CD cn AS 0.� -I uj a H d c 0. (41 = « 3 O = aa) t ce x co : a Z _E � uJ a oit • n 4/1; R7 d toV A toan 0 N U U! u 9 } Q f4 .ncsZ o Z >, z Z •, _i 3 U 1-4 = .0 u w a) _Y L Ct.CO n o to 0-1 co to c4 i. W Z w 13 N ro O tti 14 W re E to I- Y. CS v) vt sO c v N Totot OvL 1-I LU Q t N ,-, et U 1-to 0O tV O ufa Q, a 40 aoMI CC; o OO .6 C..) " .0 Board of 3fealth nvledia Report • December 18, 2008 • Jefferson County Public Health November/December 2008 NEWS ARTICLES 1. "Ecology awards $5 million of voter-approved funding for local environmental projects around Washington," Department of Ecology Press Release, November 24th, 2008. 2. "PT Paper opens own roof weather station," Peninsula Daily News, November 14th_15th 2008 3. "County Department of Community Development cuts six jobs, office to be closed on Fridays," Port Townsend Leader, November 17th, 2008. 4. "Big cuts loom in county," Peninsula Daily News, November 18th, 2008. 5. "First county layoffs begin; more coming?", Peninsula Daily News, November 19th, 2008. 6. "Put your butts out on Thursday," Port Townsend Leader, November 19th, 2008. 7. "Economic reality: County lays off six," Port Townsend Leader, November 19th, 2008. 8. "Children's flu vaccine available," Peninsula Daily News, November 21st, 2008. 9. "Prevent flu during the holidays," Port Townsend Leader, December 3`d, 2008. 10. "County cutting 13 jobs," Peninsula Daily News, December 8th, 2008. 11. "Ideas flow to spare ailing Jefferson County budget," Peninsula Daily News, December 9th, 2008. • 12. "County: Belt tightening to continue," Port Townsend Leader, December 10th, 2008. • FOR IMMEDIATE RELEASE - Nov. 24, 2008 Ecology awards $5 million of voter-approved funding for local environmental projects around Washington OLYMPIA- Local governments are receiving an influx of$5 million from the Washington Department of Ecology (Ecology) to fund environmental projects from green building and composting/chipping to waste reduction/recycling and product stewardship. Projects all across the state received Coordinated Prevention Grant funding, including a total of$1,710,086 for projects in nine counties in Ecology's Southwest and Olympic Peninsula region: Clallam, Clark,Cowlitz,Jefferson, Lewis, Mason, Pierce, Skamania and Thurston counties. The grants are made possible by a voter-approved initiative for reducing toxic threats in Washington. In awarding the grants, Ecology evaluated requests totaling$10 million for the available$5 million in grant funds. Sixty-five projects were chosen through a competitive process. The grant amounts range from$3,975 to$487,500. "These grants give local communities the resources to move basic • environmental work to a more sustainable level. Much of the money will go to programs that expand recycling, composting and toxics reduction efforts," said Ecology Director Jay Manning. "A clean, green Washington is good for our public health and our economy. These are innovative projects and we are happy to move them forward." Funds were awarded in five categories,with the following totals: • Organics (yard and food waste,land-clearing debris): $2,163,550 • Waste Reduction, Recycling and Planning: $827,400 • Solid Waste Enforcement: $761,333 • Green building: $692,458 • Moderate Risk Waste (small amount, household sources): $578,575 Most of the CPG funding-S4 million- is provided by the Legislature through the Ecology's Beyond Waste program, which supports efforts to reduce • the amount of waste and toxic substances generated. These funds come from a hazardous substance tax created by Washington voters when they passed Initiative 97- the Model Toxics Control Act (MTCA) - in 1988. MTCA is dedicated to environmental cleanups and protection in Washington. • Grants support 23 projects in the Olympic Peninsula and Southwest region. The Coordinated Prevention Grants are awarded by Ecology to local governments to help them manage solid and household hazardous-wastes, prevent illegal dumping and promote recycling and composting programs. Clallam County will partner with Port Angeles and Sequim to use a $15,000 grant to create markets for construction and demolition materials. The goal is to reduce the amount of reusable building materials in the waste stream. Contact: John Miller, 360-417-2323. Clark County Solid Waste will receive four grants: • $9,000 to develop and launch a new online exchange for food rescue and recovery in order to help reduce hunger. Contact: Bob Patterson, 360-397-6118 x 4016. • $67,500 to provide 100 low-income families with worm bins and raised-bed home gardens at no cost to qualifying participants. Contact: Peter DuBois, 360- 397-6118 x 4961. • • $120,000 to plan for what a sustainably built future might include by marketing local green development and considering how to integrate that into local planning and development over the next 15 years. Contact: Peter DuBois,360- 397-6118 x 4961. • $187,500 to implement the Washington Green Schools, a statewide initiative to provide a web-based, hands-on structure for schools to operate environmentally efficient and responsible facilities and integrate an environmental focus inside and outside the classroom. Contact: Erin Rowland, 360-397-6118 x 4830. Cowlitz County Public Works will receive two grants: • $18,750 to update the county's existing Moderate Risk Waste Plan. Contact: Don Olson, 360-577-3125. • $96,000 to purchase equipment to screen material at the Cowlitz County landfill compost facility. This will divert 508 tons of organic material annually. Contact: Don Olson, 360-577-3125. Jefferson County will receive two grants: • $48,584 for the Public Health department to increase its enforcement of solid waste code. Contact: Susan Porto,360-385-9444. • • $74,246 for the Public Works department to provide staff time and support the Community Gardens initiative,provide composting workshops and establish an elementary school campus gardening program for two or more school districts. Contact: Al Cairns,360-385-9243. Lewis County will use a $15,000 grant to improve the way it processes paint collected at its hazardous waste facility. Contact: Mark Bronson,360-740-1221. Mason County will receive three grants: • $58,300 for the county to partner with the director of food services to plan and implement worm composting, or an in-vessel composter at two schools. Contact: David Baker,360-427-7771. • $96,438 to expand the capacity of its Moderate Risk Waste Facility using green building techniques and expand services available and material collected. Contact: David Baker,360-427-7771. • $123,850 to work with the prison to develop and implement an on-site,in- vessel food waste composting system. Contact: David Baker, 360-427-7771. • Tacoma Pierce County Health Department will receive two grants: • S44,681 to conduct more detailed landfill gas, groundwater and/or surface water monitoring at 10 of the 31 known landfills closed prior to solid waste regulations. Contact: John Sherman, 253-798-6528. • $88,236 grant to increase awareness of natural yard care practices. Contact: John Sherman, 253-798-6528. City of Olympia will receive two grants: • $11,625 to increase commercial participation in the city's curbside food waste collection program, diverting 1000 tons of organic material annually. Contact: Ron Jones,360-753-8509. • $37,854 to expand its public event recycling program, including an upgrade of the existing collection infrastructure to include organics collection. Contact: Ron Jones,360-753-8509. Thurston County will receive five grants: • $6,000 for Waste Water Management to develop educational signage for the Hands On Children's Museum new LEED-certified building to highlight green building features. Contact: Terri Thomas,360-754-2896. • $53,880 for Waste Water Management to provide compost workshops and sell 1,400 composting bins to county residents, diverting 291 tons of organic material annually. Contact: Terri Thomas,360-754-2896. • $137,520 for Waste Water Management to implement permitting process incentives or requirements that will increase the reuse and recycling of building materials. Contact: Terri Thomas,360-754-2896. • $85,125 for Public Health and Social Services to promote the least-toxic and environmentally preferable options for pest/weed control through chemical reviews and subsequent Integrated Pest Management policy. Contact: Gerald Tousley,360-754-4111. • $261,425 for Public Health and Social Services to increase enforcement of solid waste codes by partnering with the prosecuting attorney's office. Contact: Gerald Tousley, 360-754-4111. For a listing of all the grant projects statewide, link here: http://www.ecy.wa.gov/programs/swfa/grants/CPG0910OffSetListPR.pdf Media Contacts: • Seth Preston, media relations, 360-407-6848 or spre461@ecy.wa.gov Kim Schmanke, media relations, 360-407-6239 or kisc461@ecy.wa.gov Kathy Davis, media relations, 360-407-6149 Shelly McMurry, Solid Waste and Financial Assistance,360-407-6223 For more information: Coordinated Prevention Grants Program: http://www.ecy.wa.gov/programs/swfa/grants/cpg.html Beyond Waste Initiative: http://www.ecy.wa.gov/beyondwaste/ Ecology's Web site: http://www.ecy.wa.gov S • ;. PT Paper opens own station roof weather BY Eiux HmLE Madison, spokesman for Port PENINSULA Dans-NEws Townsend Paper,the largest private PORT TOWNSEND — Port employer in Jefferson County att about 300 workers. Townsend Paper Corp.is how in the "If, you bought everything and weather business, put it together yourself,you may be The local paper mill has installed pushing $8,000 t x$10,000 for the a weather surveying.system on top system." of one of its warehouses to monitor The weather station was installed wind speed, wind direction, humid- as part of an agreement with the ity, temperature and barometric state Department of Ecology that ese in. Glen Ce area. the paper prcompany signed earlier "Thesurweather the stationovitself is a this year. small'apparatus,but there are a lotof pieces that go into it,"said Chuck Tule TO MILIJA6 110 fioS�- - f A { yf .0 - "#`ate *'; 440'0* tK„ s K ,c v, t a j { a • a`Ti.S. lY4 :s,f�i' b .� • ,.t::. } I. �� fr1--hog "F 4s.. +�'�? I Vii:r �� r � � • • '� as � � r � Niiii �g 4 '''�' ••� $ •• d3 �"7 h'`J i"`fk4:4 - Ef 9 '� yam. } 3 y+ 4 :" �ik y�p� t � � 'r� s vk3r�; 'T .t.'`i.. G4-. �Rr - Wt.+. 't l'1 4 �"0fr.1' :.-;, cA"� i ' fi • s p t x �s �t5 k at f � 1 '� '1� J i'.�1{'i RY x M" ! :��' k 'h"'ri' � r �i.�� '}Kba� 'S.'3s�v�3. f'rr maoas ." iii �� gr �4 " °rf tim Ih , to x i; vs a. an nv-+ ir r' Niyy� ,,* ` ai �^ s�.'A a < ,,rt a s v "fix k7::„.4e0 PF r; i �a „:'w,r,a ' : g S, es w h 14- 4:11.'11 � fit, gv.zlii.tr.it •1,.:::,11.'",;;....':::.,:'i',4.' ;'":" .° 1:1:0 kS is w .*' , 1".,1t' }diva r#,& e4c'i0°° "�' 54 A �^3na' dA f EIctk HIDI.FfPE:... .• DAILY NEWS Port Townsend Paper •Corps new weather station atop the mill measured 0.70 of an inch of rainfall on Wednesday. • /PI)/V i / -/ ; Mill: Collecting . . air emissions data CONTINUED FROM Al will help`the state better assess possible impacts to Under the agreement,the the area. mill is collecting air emis- Earlier this year, when sions data on several chemi- new.Port Townsend Paper 411 cats,evaluating air emissions Corp.` management came around the wastewater treat- aboard, both CEO Charles ment lagoon and added an Hodges and mill manager upgraded meteorological cen- Roger Loney said they would ter to their facilities. focus on increasing the paper The new equipment will mills environmental con- aid the mill in tracking tem- sciousness... • perature, wind speed and ity direction, relative humidity Commitment to commun and barometric-pressure in Madison said the company relation to an enhanced coin is following through on its plaint tracking system fpr commitment to the commu- odor. nity. "When we get a complaint "This,and everything else, [about odor],we will be refer is in line with everything ring to information from the we've been saying in the weather station so it gives us past,"Madison said. all the info,"Madison said. "We are just following up "It should help in the long on the commitments we run,so if a certain inversion make to the coihmunity." is occurring,we can pick that Earlier this year,the com- out." .pany confirmed a deal with the state Parks and Recre- Community use ation Commission that adds However,the station is not 250 acres of property to. only for the mill. nearby Old Fort Townsend Internet users can'pullup State Park. the data as well'byaUnder the agreement,Oldccesaing Fort Townsend will monitor the mill's corporate Web site 220 acres of land owned by at www.ptpc.comlcomma- the mill through conserva- nity.shtml. tion easements and 30 acres The mill also is providing will be added to the state the data to national weather park in the Glen Cove area. monitoring sites such as Kate Burke, manager of www.wunderground.com. the state park, said the 30 "The weather station new acres likely will be used • allows community members for new and expanded trails, to access live weather data while no development will be for the mill site and investi- done within the conservation gate how current wind direc- easement boundaries. tion or weather conditions At the time of the land may be influencing area deal,Loney said the company odors,"said Eveleen Muehle- would continue to.act as a dialer,vice president of envi- good neighbor to the commu- ronmental affairs at the nity. mill. "Out commitment to the "The weather station pro- company's environmental vides high quality data that responsibilities continues to, can also be used by local edu- be a core value,"Loney said. cators for science and math "It is our belief that if you projects." run an operation safely,effi- ciently and in compliance Checking the wind with the regulations,you will Madison said he knows of be sustainable for the long haul." a group of rowers who are Loney said the comPanY is .accessing the information continuing to find ways„10 before bhey r;go •to ,'I�rt both increase its environ- Townsend Bay in the morn- mental stewardship and to ing. continue the practices it If the wind is blowing too already has in place. hard,then they might not go "Our operation is recycling out,"Madison said. every day,"he said. "Now they can check that "We are the largest recy- from home." cler in Jefferson County, The station is one of sev- every day. eral projects the mill has .We recycle old corrugated implemented in the past containers, recycled wood year, and a number of the items While a health consulta- we used to manufacture our tion released by the state products—every day." health department earlier The weather station also this year did not connect mill can be accessed at www.wun- emissions with chronic dis- derground.comlweathersta- easea experienced by some tion/WXDailyHistory. 1111 area residents,the state did asp2ID=KWAPORTT9 ask for more data—which the mill is now providing with the weather station. Reporter Erik Hidle can be reached The information collected at 360-385-2335 or at erik.hidle® under the new agreement peninsuladaitynews.com PTLeader.com I Port Townsend & Jefferson County Leader's daily news website I County... Page 1 of 1 PRINT rr- t'14 • ..4... 0, 44 ftEkkas comAg gg The LFADER Monday,November 17,2008 County Department of Community Development cuts six jobs, office to be closed on Fridays Monday,November 17,2008 Jefferson County is laying off six-full time employees in the Department of Community Development, and closing the office on Fridays. The announcement made late Monday afternoon is a result of the economic downturn and the lack of revenue generated through land use permits. The staff layoffs are effective Dec. 1. The DCD office at the Castle Hill Center in Port Townsend is closed on Fridays effective Dec. 5. "Both building and planning staff are affected by this workforce downsizing," said Al Scalf, director of DCD. "The • slow economy has not picked up, and the department must adjust to these conditions for the remainder of 2008 and as we budget for 2009." Scalf said the department's budget is being reduced about 25 percent overall. In addition to the staff layoffs, DCD will reduce the regular staff hour workweek from 40 to 36 hours. Office hours for DCD when the department is open to the public are: Monday-Thursday from 9 a.m. to 4:30 p.m. starting on Dec. 1 and continuing into 2009. DCD has been cutting back gradually over the past year by under spending, leaving positions vacant when staff members retired and making reductions in other areas including travel, training and optional contracts, according to a county press release issued late Monday afternoon. With the continued slumping economy and lack of funding it has become necessary to make these reductions in staffing. "All the individuals affected are highly valued and quality employees; this is a very difficult time for the department," Scalf reported. "It is hoped that staff levels will increase once the economy recovers and building activities pick up again." Any questions on this matter should be directed to Al Scalf, DCD Director at 360-379-4493 or via e-mail at ascalf@co.jefferson.wa.us. Related Links Content©2008 Port Townsend Publishing Company,Inc. Software©1998-2008 1up!Software,All Rights Reserved http://www.ptleader.com/print.asp?ArticleID=22402&SectionID=4&SubSectionID=4 11/18/2008 Bigcuts • in . loom éounty Administrator tells commissioners of budget woes BY JEFF CHEW PENINSULA DAILY NEWS PORT TOWNSEND—Stopping short of saying Jefferson County could be laying off employees in the near or distant future, new County Administrator Philip Morley warned county commissioners on Monday that cutbacks are on the table for 2009 bud- get consideration. "It is only out of eco- necessity that we are Budget: Worker layoffs? are now forced to begin �I � ' examining program and ::10;;44s.. service cutbacks that " . may affect both the corn- , CONTINUED FROM Al tain programs and services growth area sewer facilit re- munity and our employ- during a slow economy," Mor- liminary design, aware ees," Morley wrote in a The situation could lead to ley stated. contract to Tetra Tech t- memo to the commis- budget cuts of 1 percent annu- He reported that projected tle for $1.15 million, a grant sioners. t.";„,„ ally until 2013 and beyond. expenditures grew 9.8 percent, from the state Department of "This is not a task we County Commissioner or$1.4 million,from the origi- Ecology. enter by choice,but it is Morley David Sullivan,however,put it nal 2008 budget to the 2009 The commissioners also set one forced upon us by more bluntly:He expects more preliminary budget,while rev- a 5 p.m.Dec. 1 hearing date on today's economic realities." • county employees out of work. enues were projected to remain the 2008 comprehensive plan Morley on Monday presented a future "That's what these kinds of stable. amendment docket. budget picture,with county expenses esca- cuts mean. It's going to be He said third- and fourth- The hearing takes place in lating at a 4 percent annual pace that staff,"Sullivan,D-Cape George, quarter 2008 emergency the Jefferson County Superior would be not be met by the economic said during a meeting of the appropriations requests from Court courtroom at the court- growth that has taken place in the past. county commissioners on Mon- the general fund total roughly house, 1820 Jefferson St.,Port "We're seeing the curtain being pulled day. $758,000, bringing the 2008 Townsend. open and we're not seeing it quite clearly," "As such, by 2024, depend- total supplemental general Eight proposal are on the Morley said. ing on banked capacity," he fund expenditures to$1.2 mil- docket,including the proposed said, `eve would need to cut lion. Iron Mountain mineral TURN To BuDGET/A6 between• $1.7 million to Morley said he and budget resources overlay proposed $2.15 million compared to what assistant Ann Sears would near Port Ludlow, which resi- would be our budget if 2008 continue to work with depart- dents have protested. programs and services contin- ment heads and elected lead- The county Planning Corn- ued unchanged through 2014." ers to reach budget balance. mission has rejected the pro- Morley praised the commis- • "We need to act responsibly posal for a rock quarry but the sioners, saying, "You banked today so we don't have to do county Department of Com- money during the good times" more painful cuts in the munity Development staff has — about $1.9 million in an future,"he said. recommended approval with excess general fund balance. modifications. He recommended that the Sewer design contract commissioners not use those In other action Monday,the Port Townsend-Jefferson County Edi- funds. commissioners approved the for Jeff Chew can be reached at 360-385- "These were dollars that second half of planning the 2335 or at jellchew@peninsula could be drawn upon to sus- lrondale/Hadlock urban dalynews.corn • • • /17/197 /DIO,tf/ First county l begin ; more coming? BY JEFF CHEW ALSO'f. . "You only reduce that as a last PENINSULA DAILY NEWS resort,"he said of staffing. ■Unemployment rate rises in PORT TOWNSEND — Al Scalf, Jefferson,statewide/AS "We will reduce expenditures before we reduce service to the pub- Jefferson County Department of lic through staffing." Community director, is taking a 10 ever seen it. Morley on Monday presented a percent pay cut with a four-day "It's never been this bad,"John- sobering future budget picture,with week,but he said Tuesday that the son said."I don't remember it this county expenses escalating at a 4 biggest shock was handing six slow countywide." percent annual pace,one that would respected staffers their walking Johnson said he was sorry that be not be met by economic growth. papers late Monday. the county had to resort to layoffs. Scalf said his department's bud The department announced it is "It's painful to lose this many is beingreduced about 25 laying off six full-time employees good employees,"he said. get per- -about one-fifth of the department cent overall. — effective Dec. 1, the result of a County budget crisis continuing economic downturn and To close on Friday the lack of revenue generated Morley,who walked into a county In addition to the staff layoffs, through land-use permits. budget crisis when he took the job in ' And, said County Administrator October,said he does not know if more the community development depart- Philip Morley, more county layoffs county layoffs will be necessary ment will cut the regular staff hour e not out of the question. "We are trying to evaluate what work week from 40 to 36 hours. Jefferson County Commissioner revenues are coming in for 2009 and The department will be closed on Phil Johnson, D-Port Townsend, look at the gap,"Morley said,adding Fridays,starting Dec.5.Office hours ho was a building contractor before he is working with department will be from 9 a.m. to 4:30 p.m.. w he was first elected to office in 2004, heads to determine what needs to Monday through Thursday,continu- paid that the Jefferson County be cut before looking at further Ing into 2009. . building industry is the worst he's county departmental layoffs. TURN TO COUNTY/A5 • • • ri/i9/p • ` downsizing'Count : Work-force CONTINUED FROM Al The brings his staff down future of the No Shooting Area it," he said, recalling down 4) - from 25 to 17. Review Committee,"the group turn events including the sac- "Both building and plan- He cited a notable decline she had most .recently ing-and-loan debacle of i9ha. • ping staff are affected by this in stick-built homes. assisted. `I'm also hopeful for Arner- work-force downsizing," Scalf "They're kind of your bread- "And I think that I will be ica. I believe we will recover said. and-butter permits,"he said. there,although I do not know and this too shall pass," he "The slow economy has not Home building permits for sure yet." said. picked up, and the depart- were at 108 from January The county commissioners ment must adjust to these through October,compared to are planning a Monday public conditions for the remainder 173 during the same period hearing on the Chimacum Port Townsend-Jefferson County Eo. of 2008,and as we budget for lastyear. Creek no-shootingareapro- dor Jen Chewoatcabe reached na 'u3o ,g 385.2335 or at jeii chew�apen�r;;,,< 2009." During the same period, posal. dadynews.com Scalf said the positions building inspections totaled selected for layoffs were those 4,988 through October, corn- Projects to be finished with less. seniority, as per pared to 5,470 during the Scalf said projects begun union rules. same period last year. laidsuch as Bar- The way Scalf figures it,for "We're seeing building per- by hts',those a will off,be completed. a $1.9 million annual budget, mits are down, inspections Asked who will take on the he needed $160,000 a month down,and revenues down,"he in revenues. said. thinking it's me. no-shooting zone detail, Scalf said, " I've been tracking this all The building department "I'm who started with year,"he said. still has its building official, Scounty public works in 1985 What he envisioned was Fred Slots, but he lost three and has been with the depart- that the department would staffers,With two plans exam hent for 14 years,said he ran start in January with$91,000 iners and an inspector remain- a"volatility curve"all the way in revenue, and have a ing. monthly revenue high of Planning Manager Stacie back to the early 1960s that $210,000 in August. Hoskins still has her job and showed the ups and downs of "So I still thought, at that three remaining staffers. county finances. point, I could make it," he "Once the recovery occurs, "This is the worst I've seen said. and we can see it is something ' But by October,he said he that sustains itself, then, per was facing$50,000 in revenue union contract,we will have a per month, and a $265,000 one-year recall,"Scalf said. shortfall. What that means is employ- He said he saw construe- ees who wanted their jobs tion workers being laid off back could have them or be • around the county and knew a placed elsewhere. decision must be made. Karen Barrows, an assis- It was late Monday when, tant planner who was laid off, Scaif said, "We decided we sent out an e-mail Tuesday better cut." thanking volunteers and oth- The positions cut are two ers she had worked with. assistant planners,one build- "I'm sorry to•report that ing inspector,one permit tech- over 20 percent of DCD's work nician,one planning clerk and force was laid off yesterday, one administrative clerk. due.to adverse economic cir- • Scalf had already chosen cumatances, and I am one of not to fill two vacant position, those who received a pink slip, an compliance officer and a effective Dec. 1,"she wrote. building inspector post. "I do not yet know the • • • Putyour b ;out on T The American Cancer and infants lose their lives as a Society holds its 33rd annual result of secondhand smoke or Great American Smokeout this smoking during pregnancy. And Thursday, Nov. 20.The purpose every day, 45 Washington teens of the event is to help smokers take up the smoking habit. quit smoking or using tobacco Local residents who want products for at least one day, help in quitting the habit are With the hope that they will quit encouraged to contact Brenda completely. DiPrete at 385-2200, ext. 2300, The Smokeout also helps to for information on Jefferson raise awareness about the dan- County Public Health's next gers of smoking and the many Freedom From Smoking class, effective ways available to quit which is scheduled for January. smoking permanently. For more information about In Washington state, 17 per- the county's Tobacco Prevention cent of residents are smokers. Program, contact Karen Bach year in the state,7,000 peo- Obermeyer at 385-9400 or visit • ple die from their smoking habit. www.jeffersoncountypubli- More than 710 adults, children chealth.org. • • FTat.eao I/fi 9/o" N ' 2 y 4 tom. ..Q N'� `O 0 y '1'. .14 .a 5 3 5 ?3 o p . ° o e_ o0 d w° �' i U + Q "CIO 5 � 7 % � o a5i o q `y . a u Q G O : A ^� d N «� 3 N [a 71" t 4 " • o ,d 3 5 ,) 3 • o dN 3v) o 5 CV� aq cc o „ > � � ° N v t.) ,q -to• . 0300 1� [ C� pq'9� ° y ° w hHt ! b• w �_ w S y w o .b 50$ ry d .°Ly• 3 'O ,. ° ° ornx � ) •5 .5 8 � CI N v3, o ai o fall " 00 5 0 ' •b v, b b g d Q v b W 1 5 � .� z7g � cC�� E � c � . , � � 825 ] 3g .dc, pp° ,ego . :b .o 0 o v .g to > •5 Q � 8 B 2 E v -f-, `Cu " c 0 NO 0� .0 ' � a 0..0 , w, .' .5 -. c0 ° .2 Co) � 2 • .b 8 + -. 5• p o > ° 03 85 y ed U U ca vp� :5 T . a •b 2 CA F-::. 1•C ° 2 ,b 4 O•• T y y .- O U b O - t0 �- m �� U bo- E o - w 0 Ii . .IRli>1 7.i 4 ° N.°0g � " o °' _ 5 " Z - Tao 3 .b 0000 ct A ° >- o 4 E42. .- -0 0 t �vo � v 4 60 0 °' 00 t' t ° Ea5t ° g 5 g 5 00r 0.° ° ° 8 5 , ° ._ °' ' u o 8 pQ .s ° E 8 . .i..0ao i300i .g Li-. >.' 0 .5 > ' S5 vo ..8 05 .5 .. c .o r UI TA _ um 1 O OS. N T ' ¢ 35aa " u xyvt Ai -00 . '* 0300 4` ° 8o °' 0°0', .5 ° E °xi a 4l> • 0 -o o•" o 8.4y $ s 8 �', N is fa 'b y O l4 13 U O i5 .0 _ td �X oo:^ o:s° oho. v• 1 2 3 .s <9. 8A T. ._ d 1 8 ON 00 2 .8 N 5 V, Rv • _ F 8 0 •5 '5 .2 0 5 >, <.,.., � � v aN • .5 �, , ti 5 uv $ o O rn yel, ° .x, 8 .58 -. � 5 � ° = ° A3 .0 • ° ° " 2E0 . ,, " a }' \ o .� � N•v, lq 00 040 ai �' N, . co ° v� � .5 .5 • w • U .8 R . 32. 4 c°i u `°Is 3 oN v) .0 5 3 • ° o ° ° 2 v �' 8..2. �' 00 °5i c °�' .5 a ti 5 ... v .- 'b '!cILui • 5 v 8 .c 0 o v u u rev d 0 8 w a' a. � ,D rtci 01vi . oN 8 E~ 3 .b ° o cb ° asi • • Nq •� •v o �~ v °' 4) U > b .5 ``' is ° ° o\ 0 °Hi c o '�-'" as ov °0 o G. i -'>, 5 a 8 °' o - oo ° 3 v 5 8.5 b - u>1 Cq,� � o � 3 a°>i o o •N ° N " .5 ti o 5 g V ' I t. : .:.-a 5 B AS 5 5 3 > a •0 8 • e, -07, G y '' y aS td 40 'D V N al N U N v ig •5 Y ° r ay 5 `8 8°, .it q b' ° 0 SI' o w " ' °' °v. , b 0 x rs' �' y �, O y a 5 V ka gr 0i " -5. •0 g °a u O c 5 v T g ii `4 'UO �v CqO Ca g '� O N .5 �a U H .5 T• A y 1) b• ci 5 ci '� v 3 q A t.-8) a .5 3 '^ 3 N • 8C of ? v 5 obo � 8.�i � m 3 5 .8 - co H o��}}og � S� o5 •b8 � 'io ^ lt o1 9.9 T' 5 o :#• • a ,` E, a F 3 3 'a cz CD Ei 0 6) 0 0 000v a > 1 o 5 °, p „ 5oav�i � °� aU • .b ti ° y G ❑ ' �' I a is to 'b ° °• c •5 Dim . o E . . - 3 0 ° 5 ani • • 3 ° >ac 5 F O N g - 't, S o •c:,. 8 5 G 3 •• a0 o a0 a x a6) 5 0 8 0 p°, x A °a H s . 8 °_ a .5 '8 .4 o .b .5 8 �� .oa * ai 8 00•'. .°i, r3 > 5 .80 .. 00 E0 w o . FH O o .5 E E N E o . �i ° A A 3 3 v O _5 � � >, 8 8 0 •big q ,� N o, ,„ la 41 u ° ETA 0 U HhiIhIIHi jftiS1 °Ti•I iml O 7C � .� T 7° a� 'OOcm) rg . gv Iv y � . oU 5a 5qa iUil I' H • • cd-c 3. E 0 a° `•.> -' U C ° ave - g ,,8 V. U u ...4u .b o NocvoN ° c ° S0.-s 5o x mo � � a b � g8E� c > qbN gip '- b N C > . 0 x �3 . 0 .N 0 v o0v' '" c � �. I w .5 ° N ,� _T w) 0 d �, N 0 e 2 .� r3 y U U g i .0 .,' 4E .0w `d aa, t= V) •N ~ G 5ra8 Up • 0 0 u d ° u � u q ' w a u 3 d ,e a8 g .8> �i w° o - c°, u o N 3 0.0 v 0 g� u , u d :.. x u o a v 3 4., w u U o CO "3 CA o T ` �9 0 5 •3r �' 00 �i g u o g x t) o V a - 5) :b . 5 ° II! 0iit a� �, E q c ogo.0.0 �' o 8w =. v o w y I1II 4o v .9 u 8 , ,. g y A ce l o b u - .. TTia oS T O dH � `'•' F�� _ -O 3 u P, -0el o H u au, o 0 0 . 1 .0 o 0 y 2 1d .5 2 `�� 3 J w yam' 5 _ n u a. 0 ie b o v°D u c' 0, „ o g ¢ cb > 'op =~ gg U k" g• >,' 5 c`� a 2. u ' 8 VV RI c 2. 2 C .0 acdi .'a d cv g f v cd sa t iY in§ A b � v v, 'a C a tes• . ., > - .� C wu -C No •O -riN bo >, ,,..-• 4. -0 .0 N 01 'O >, on a -a, U0d. - ,gi -, u , a 0 C . C •C tiGv . noppG. c, '0 -a aiu .MCI T 0, Av b .% a v . ai ° _ N w E NO qib v (-1 -, °) ,,„ 0an al 0 U o " ° , u ° t-, .0 nV .rteo F" o c, 77) 0 .5 uxU d ao4 -0 ° b •o .r . w ' x .r. a ❑ 0C ' N £ .ccuso0�o ua - C0U uu ° 0 u o a 0 6, 0 0 0 : p N u " iSyood ' $ v, to 'a" cdg ob a ' •o u NU3 0 a ° o 0,6 om . qiv cv � uo q C '0 ° T u _ 0 a ' .0 o -� Cu o 8 Ny ° u c Vw g 1a .5oo•2 .cca u a � a aN . 1 ou 8 z . oau a«. , ca g a3o u Q aN u . = > o8Qa .V O u i3 ,, 0. y - � 0 $5 pc, 5u r .0woeo RI 0 '5 .90. o0 'g .o a a ,oq . a 'doUT � > > u � c' 00U 3 .0oou >, 11� o 0 o o 50 .02 .S ' b "' a o0 .2a,0 �.8gooE .c500.r0 <6. c .. uoa '� -588Eo � � - a0. =o au 4, y a. 80° h .4O0o °' a -s- 2'4e ou3 0. a .2o00 um 0 > aUoS .� 80 .8o0. o og' 3 ; '5 '' ~ dd3 'ro uo c . ° ' a " 0 P 2 0 „ o > 0 5x cu 3 e 'N .= u ' >,� - . 0 b o 0uS . oa0 >, � 005 u u v u " 9 oo a 0 x.14 ° u8v 0. $ 8 0.<4 Eo oa � 0 � 9 oq� ca oo v, axw0aoto >, • •Adult and children's vac- • C h i l d re n s cines are available for patients at Port Townsend Family Phy- f I u vaccine sicTo 934 Sheridan. To make an appointment, phone 360-385-3500. available •Adult and children's vac- cjnes are available for patients at Olympic Primary Care, PENINSULA DAILY NEWS 1010 Sheridan St. To make an appointment, Children's influenza vac- phone 360-379-8031. cines are offered at walk-in IN Madrona Hill Urgent immunization clinics at Jeffer- Care,2500 Sims Way,9 a.m.to son County Public Health,615 7 p.m. Monday through Fri- Sheridan St., from 1 p.m. to 4 day;9 a.m.to 4 p.m.Saturday; p.m.Tuesdays and Thursdays. and 10 a.m. to 2 p.m. Sunday. Appointments are not Vaccines available for adults, required. ''and children 4 and older. For more information, Cost is $25 cash. phone 360-385-9400. Medicare will be billed. Adult flu vaccines are avail- ■Jefferson Medical&Pedi- able at these Jefferson County atric Group,834 Sheridan St., locations: 9 a.m.to noon on Dec.6. Medicare patients should Quilcene bring.Medicare cards. Cost for people without Medi- II South County Medical care is$25 in cash or check. Clinic, 294843 Highway 101, Private insurance will not from 1:30 p.m. to 4:30 p.m. be billed. Wednesday. Medicaid clients should • Medicare patients should phone 360-385 4848 to make bring Medicare cards. appointments. Cost for people without Medicare is $25 cash or check. Port Hadlock Private insurance will not be billed. ■ Port Hadlock Medical To make an appointment, Care, 121 Oak Bay Road. phone 360-765-3111. Cost is $25 a person. Bring insurance cards. Port Townsend To make an appointment, II Walk-ins welcome at phone 360-379-6737. Safeway Pharmacy, 442 Sims Way, from 10 a.m. to 6 p.m. Monday through Friday. Appointments are not required. Medicare and Medicaid will be accepted.' Bring insurance cards. Flu shots are$30 and pneu- monia shots are $45. Clients must be at least 11 years old. This clinic will be closed on Thanksgiving Day. S ///2/4? Prevent flu during the holidays �► Travel and close family gath- are not offered at this time. For Call 379-8031 for appointment. 294843 Highway 101,Quilcene. erings that take place during questions,call 385-9400. • Port Hadlock Medical Flu clinics Wednesdays, 1:30- -the holiday season can provide Children's flu vaccine is Care, 121 Oak Bay Road, 4:30 pm. Call 765-3111 for opportunities for the spread of also provided through the three Port Hadlock. No long lines; appointment. Medicare patients influenza. Jefferson County Jefferson Healthcare clinics call 379-6737 for appointment. bring Medicare cards.All others Public Health advises that peo- in Port Townsend; call for an Bring insurance cards, as some $25 cash or check.Private insur- ple-protect themselves and their appointment:Jefferson Medical& insurers might pay. Flu shots ance is not billed. loved ones by getting immu- Pediatric Group,834 Sheridan St., $25.Public welcome. nized against the flu. 382-4848;Olympic Primary Care, • Port Townsend Family The yearly increase in cases 1010 Sheridan St,379-8031;Port Physicians, 934 Sheridan, PT. of influenza has not started yet in Townsend Family Physicians,934 Adult and children's vaccines Washington, so now is the time Sheridan,385-3500. available for patients of this clinic. to think about getting vaccinated Call 385-3500 for appointment. against the disease. About two Adult clinics •Safeway Pharmacy,442 Sims weeks are required to develop There are many local sources Way, PT. Walk-ins welcome for immunity after getting a flu shot, of influenza vaccine remaining immunizations from 10 a.m.to 6 according to nursing staff at for adults, including one more p.m.Monday through Friday.No Jefferson County Public Health. Jefferson Healthcare clinic for appointment necessary.Medicare Influenza,or the flu,is a respi- the public: and Medicaid accepted. ratory infection caused by a virus. • Jefferson Medical & Many insurances billed;bring Flu symptoms include fever, Pediatric Group, 834 Sheridan insurance card. Flu shots $30. headache, cough, muscle aches St.,PT.Saturday,Dec.6,9 a.m.- Pneumonia shots $45. Clients and weakness,with nose,throat, noon. Medicare patients bring must be at least 11 years old. and lung congestion lasting from Medicare cards; all others $25 Closed Thanksgiving Day. a few days to two weeks.Children cash or check.Private insurance •South County Medical Clinic, may have nausea and vomiting, is not billed. Medicaid clients but these symptoms are rare in call 385-4848 for appointment. adults. The"stomach flu" is not • Madrona Hill Urgent Care, influenza,and may be caused by 2500 Sims Way, PT. Flu vaccine several other viruses or bacteria. available during clinic hours: • Monday-Friday 9 a.m.-7 p.m., Children's vaccine Saturday 9 a.m.-4 p.m.and Sunday Any child orteen in Washington 10 a.m.-2 p.m. Vaccine available is eligible for the state-supplied for adults and children age 4 years • influenza vaccine, provided by and older.Flu shots$25.Medicare Jefferson County Public Health billed.All others cash. through walk-in immuniza- • Olympic Primary Care, tion clinics every Tuesday and 1010 Sheridan St.,PT.Adult and Thursday, 1-4 p.m. No appoint- children's vaccines available for merit is needed.Adult flu vaccines Olympic Primary Care patients. • • • ;�- • /2/elf • ir iift4 ° o'� ioG 5N N �a>a uUb,C OAo ° >,° ° Woy0 b6'n.~-4 c0 c= , 'O p O 3 0277 0 [G an000 04Aw° �o a°ti E,m0.,.>.3'oa, ,.. coa c E-5.. ° u • 0 'm u,,� >,t) d'> O o b din ° O u7 > G 0�;0 a G.� d C� O O 0 . a) 0 '.:, N O MN v ~ 70 a)�•C•°G1,59 yin,o,�'. ��m `b as ..' O m0. 0a)'bcq A, 0 °w° Ep.� q b4. ar-iv, y O ° 0 c, a) 0 3 to' Gam. O O•5.a o do -, NO -,0 3 ° 07, a)x N ^v u c m '� • 5 a) 2cn ° g o 1.o8 o�w to N ayU $o °'^oma y ; g •7q 4) r, .vi'C a)� i.. ^U tfi Gas SIOv 0 P..O N�"' .Ua .� " 3L ° O 1�? ~ 0. . . 0 F >,O a) E,/,„ ON O ..0 . .-'.- .-� . �°a' 7 0.5' 0 7 1-VM 3 UO O° P. .,O 0 N•^ 0.�°,N.'..i.+,-. 0 0.>d' Om ti ,,P.,..r; 0.°.I1c.... -=ch a) `1\ , cu cn oz. °■ uca■ da)'v°° c'CO.� Ex � y o °N 'vO0 00�a):�.3, a 8roa �oc ;0: E I ,C hU Ny i..2$ i' p i u� m c NO cN��o v ��• " cci as C o o ro ° ��> �� a) p oao ° oobpCa � � c Oa) °. .N. .a I O O O ff+ 0 U-4, a . C. ,'O > ti 0 a) O.C i.0 m y •" a)W )n 0 a)co-I .C". r N 0 a) a) -.0.,..., ur a 0 Q. U O'c a.p J •l. - �, .71 *- Oo�•° ,t`fl 3 3 ti y d.a .�"a•, .`�'° 0 v°, o >,>'t' u �,o. „j 0 %. 0.>', qN q�-,-> ti 0- c - o c°. 3 0 Y ° a0i aro C `°' v, .7, •.,. m}' O ? a)i c.0 0'C O >, 7 a$..d 0 a) a) a u O 0..,w o"O^ '� o o Ua>') o O�k'm� 0. tg��o 0 >o a _ a) ° ° aa)) p u .),. oo•� v .: U a1 ^ hU�.. > '-. 0 ba bqF G... T a)., y 0 O O _, 7 °.1)-e % R:Hh c pz y U cv O.� O .t" O bD y y 0 >, O T.a., .� c. 0 ar» 0..0 ,.. a) a U 5 d n., u u a E 0 c. O., a� c..n-o o o ooas ., uE ^a cc ay t".•.. I= c) � >,20 • 0E0 > y ° >,i0 .0O. Gn ; `„ T 'b� c.' 5...a q 0^-O a) O d.4 0 p 0 .c °., • u a8i c'0•° c,0 ,‘ „ ,,,I . E.-- , } IIIIII G ° y ., E 0 u.., 6 N.,- o •, r°n o °'O m > ..,"c ..., + 2 „, o ,.$-• O c0 0 ° .,.'_.' ?C.° ,._, O 0 0•5 y a) v1 a> G O -' J uJ a)yc a,0 O c' 0-4, U °,4 ".' ,X P4,3 p0 w.0 0 °a O•., .- ., 0x .'^ 0 .,W ° U O y., >, O .'C., d U O 0 O'D y G c O =� y u O 0A cd .�.'w....0 >,..,,, a).._'O 0. .0 0 G v. �., > O 0 C 0'..a • G^~.. G'.,,� .' 8.'. O a) N d d9...Ti O s. 0 0'O O v1 U ° y ,. _ c U ' 0 u1 F. O-. 0 H 7 W uJ s•Z 0 0•., 0 a).G.)O O G x'O .' i, L E aa)o. " s5 ° a) r000.o >,o'a > $- 0oa >�v� c :°0 z ,, enc O o x., bD s..° 0 ° E ,+4'�-.t;.'.a) 'O 0 c>'. C.O 0 v2i.%'. 2^O p,..5 C_ > ^ , �., ° o" E '' '.i5 )2 0 �'y ON v o ., 6. ° 0 o)r0 .4'- ^ 74 3 o 6.k V a) a) O O °O N ° 4) 0 > T1 U !�.>,+�' ;m Pi 0 cd A w O.0 G.o-0 ° 0 •.n W.�x y >,� y 0 0 O.O., vim•° V %r., >. • f..''•'• 0 . a) 0 a) a) 0 o N O 0 0 VF. '0a) % U C 6a) 3.2a) .> E0-... U., u 3 .n.,a0.� gaga' $. '03 °" '"c 3 > u aE r .74 G �d aO "�G 0 o �° a,-C o I, c>) N°eg xe�m c ■ ■ •m ° °o v0'..?' 3 p�% u a y 4 a c a° .' .' v o 0 _ ..� ;� s o C'o co c c. G c..,• dm��y I.0 y,.' a$0c. U 4 ') WJ og›,,-,..7,�ay G� O r- ..LC A 030 :b Q > a„ do ° . ° anio � aG a toa c"u > `1 l) ° °' .'.M° > 0 3 COu o u .,.E... C p« T > x u v z 0 u. ^,,c o ° v CdOq ��7 t0. ^p o.� 0 0 0•>w 0 7 O,.-. p F E a) ° 3 u a) a) c b asb t,a o °v ° m I �y�` c_ z }" 7 >,u 7 0 0 y .°F A 0 U O ° T. ow ° 4. a7 N 34 01 /0 y w .� N 3 > v; 7 ,u 0.4,^N v - 3 > U ! flIjil G•,.aC)'°-. O V 0 ° -3 O .°,^O y 'i•,. '' >15 0 0I. 0 y 0 >b >,b0~ O aill CA•mo lt o yoH.am p E""o o ro cu a°i KF 3 7 q m a°i u 0 G x Oci' J 3UJ + i'N 0. °'11 0 Gw ° a) ...'t7 0 0 ° bn.r.1)c.°..°,.G ° .- c .,c) as , 0 0" 0.o.L ' •- ,c'ci ct u.y' n d >II 401) 0(11 2 Cls) 4"'..4 U 0^ 0 b.°co tzy co O u . .- SCC ~ v j"a b0 i C F cu .�r--� .� > E a V Q.) I >'0.L^u 0 ° C..O d.T,.''O N K O a7 O .as L N OU G C' �� "tJ. v E^ C ■_ O /1 1 q.. ....' 0... a)•^'.� O._ ° U o p,.- c.c.. U -.,�, 'O e) ,� 7 O .O �. 3 G �: U O 7 _ bbl. D v O �=q O >:u C[ 3 d 0 o a•0~o .., a°) o r•, Oa.a.�^ ,_ cJ 0 G N p C: A. •W 3 C 41 G Z u. 'J1 u w a) p ,.. >, v).-0U p ,.., E u b0 5 .G 50E . 0 O ° .' ' 14, 4Nagc(-) 3 3 br;aao a°)° u v' o",--1 c m o `� E o as m o �'�°p aC `o o w n (IV1) * G ° m^ 0 ,000.' opuym ° E3a a),gas °-c.moo be O 5 Q E'".' I a) I m U .' V. 0 O.>'' O a) 0 V.t O O^O.,., m p y (-)...'O G E-' Gm apr,A a.,.._..'. .' ,.b ° V' x Odhp 0Ou ° s. G •au0c' yO 4,T, -- a''5 o'iJ G'b 7.x''�.•.° a)'C F... o.b a) .•-) 0 7.,y vJ a).p W C O a, V 0,7 E ›, w z G. T'a 10 a' ° ui.o o c.,,,..' 3 mu s,, -0cr;�TN.O G G •�' E od dd c 0 E z P. .m.`�'' a°'v•ca M P,'x y o E 'O O O cD °O 0 ,. O 3 ° E'.S O R u 7 OC1) o ri ,^('j ^ > w O a ' �-' . O N.' O t0 7 i )n °o 0 0 o c c as o F'�'i r-�--� G�0. 6) O,u m c.'O., 3 b4 v, 0,-.S].' a'fre 4-N E.'C u E+ 000 .' CM-00.. Peninsula Daily News Page 1 of 3 This is a printer friendly version of an article from www.peninsuladailynews.com To print this article open the file menu and choose Print. 1111 Article published Dec 9, 2008 Ideas flow to spare ailing Jefferson County budget By Jeff Chew Peninsula Daily News PORT TOWNSEND -- Jefferson County residents Monday called for more promotional efforts to draw tax-paying businesses, cost-conscious replacement of computer equipment and continue the new course of budgetary collaboration. The budget hearing before the county commissioners Monday drew about 40 -- mostly county employees, who shared their views on improving cost savings during a budget crisis. "It appears that Jefferson County has put all its eggs into one basket . . . and it relates to land, not business," said Joe D'Amico, president of Gardiner-based Security Services Northwest, which has been locked in a legal battle with the county to increase its third-party use, such as on-site military training. Need to be 'business friendly' • To increase revenues, D'Amico said, the county needs to be "a business-friendly community." He said the Coast Guard has wanted to train personnel at his Fort Discovery operations, which include shooting practice ranges. "I can't do that," he said, because he is limited to training only his own security firm employees at the gun range so they meet state certification. The county is laying off or eliminating through attrition the equivalent of 13.33 positions to help balance a 2009 budget during a harsh economic period that has drained county sales, real estate and property taxes. Philip Morley, who walked into budget realities when he started as county administrator Oct. 16, took the budget proposal to the county commissioners Monday, calling for a 3.5 percent reduction -- $561,194 -- in general fund expenditures for 2009. The county commissioners are expected to deliberate and approve the budget next Monday, which totals $48 million, 53.7 percent of which is going to staff salaries and benefits. "The harsh reality is we need to look at our staffing levels," Morley said. • Cape George resident Jim Hagen praised the county for taking a collaborative approach to http://peninsuladailynews.com/apps/pbcs.dll/article?AID=/20081209/news/312099989&te... 12/9/2008 Peninsula Daily News Page 2 of 3 budgeting with county department heads, but he urged the commissioners to focus on job creation. • Worse in 2009? Jim Tracey, land-use attorney from Fred Hill Materials, who frequently gives advice to the commissioners during weekly public-comment periods, said the worst the county could do was to think things were not going to get worse in 2009. Port Townsend-area resident Tom Thiersch urged the commissioners to save on software costs, saying its numbers for computer replacement were not credible. He said the county could also consolidate its Web sites under one to create a unified presence to reduce or maintain costs. Sheriff Mike Brasfield, who agreed to leave a deputy position unfilled, saving the county about $92,000 in salary and benefits, told the commissioners he hoped they would consider filling the position again if it is necessary and affordable. Actual county layoffs were limited to the Department of Community Development, where six positions were recently eliminated because of faltering fees caused by plummeting building permits. That department's remaining staffers were cut to 36-hour work weeks, including Al Scalf, community development director, who also took a 10 percent pay cut. • The Community Development hour reductions amount to two full-time positions, Morley said. A 4.3 percent staff reduction is proposed, leaving the county with 297.6 full-time-equivalent positions. The latest budget news follows the county commissioners' 2-1 vote declaring a budget emergency, with Commissioner David Sullivan opposed. A total of$561,000 has been cut from the budget, Morley said, with none of those reductions yet mandated by the county or Morley. Real estate taxes The county administrator reported a county real estate excise tax decline of about 50 percent since 2006 -- from $1.4 million to $650,000, and a 25 percent decrease in building and development review fees, about$300,000. The commission authorized a hiring freeze and voted to use the county's banked capacity for the general fund -- a slight tax increase -- leaving unused banked capacity for the road fund and conservation futures tax levy. That infused $473,171 in additional revenue. Morley said for 2009, the banked capacity will amount to a tax increase of about $25.02 a http://peninsuladailynews.com/apps/pbcs.dll/article?AID=/20081209/news/312099989&te... 12/9/2008 Peninsula Daily News Page 3 of 3 year for the average home. • He explained that every year the commissioners have chosen not to take banked capacity has meant a $700,000-a-year savings to taxpayers. Banked capacity can be re—created once the economy recovers, he said. Beginning in 1986, the Legislature allowed local governments to levy less than the maximum increase in property taxes allowed under law without losing the ability to levy higher taxes later, if necessary. This provision encouraged taxing districts to levy only what they needed rather than the maximum allowable. Prior to that, taxing districts that took less than the maximum, at that point 6 percent annually, permanently lost some of their levying capacity. The banked capacity concept allowed districts to be more fiscally conservative without being penalized. Sullivan said the county needs to work more with regional organizations such as the Peninsula Development Association and state and federal level partners to spur economic development. He said more lobbying and monitoring of what goes on in the state capital was also • necessary to follow legislation that could affect the county. Morley said the budget is intended to save funds for the future while giving the county some spending flexibility. He said part of the budget's goal was to "tread lightly" to retain programs and services close to existing levels when possible. He pointed out that a 2003 survey showed that taxpayers are most concerned about law and justice, roads and public health, so those service areas are considered priorities. Port Townsend-Jefferson County Editor Jeff Chew can be reached at 360-385-2335 or at jeff.chew@peninsuladailynews.com. All materials Copyright ©2008 Horvitz Newspapers. S http://peninsuladailynews.com/apps/pbcs.d11/article?AID=/20081209/news/312099989&te... 12/9/2008 1h ! U cNy Ooi cs,,,, P. `vN° ° U p rJv I Q, , cb OcbDhiil .6 : ai' ° Fl .4.2 .0u,. 2 .,,i .-) °° "' . ' p, r-. °) cloo •(74g , 2 ,,, .` .5 FL .5 77-. t C4-.. y i . 0 0> o t-,-0 cd .d j r, C U. " Q rn• 3o. ya) ›, oiO p G o pp p y ay pj N Y Nb8° r > � rb ❑ 0 bA0 L7ma5 cdp ° i O .: 5 ~ : n ', =v 'S o c g : 00 .5 . t & ''' $ ° N 4 °' . Gd .. u wq1 .5 t4 tbV CN1o • m Y , t,', ooU 0 'o a 'NNo Y, e c8 - a § o � - aa) . pp O � p 5 v d ooh o V � oo0s > d o b � � ,o c° b 3 c = a b b5 c ° 3 , >,•E � G A m N e. `d O f f it ; � e) a •• = f 3 1 HILL N . V, f %tiiiii),iD f ; ; . I t ' iHUli r lis:.:: 7 T. A N O F'yk� O m I I i 7 " $' ins 2 M c q ' v, y i ' 1 ...,0,,,,,,,,,,,,a,:,•,..:,,,ly� ��T v `+ W` E z GY : .• Z • ''.. Li j i 1 'Wit''''cl,,,,,,Alti: I ...C.t: u c • o g 1 t) - r 3 d a) • 2 ' "J ( :,der :,.,,.N,•-,L-,: fill cd '.5_"I ••-• 8 PMC ' M I 1..._ , .. i...... 1 i. � x 1. x c xP, d a G I -1'i :4:'''',1411kr•PIPH:::a4j$:*14";;:':.:93:, f d Z Q ; '1'''' 72. c4) g > '4'N _ 41,1,. i,, LLLJ*1:Lj(1,,, •Piy ` y . d . (0 ' , . x � Q dG t ?. v, U U • • �' '� o °' Q o ro o y i .5itui M 00. N ° E 'b c0 ° ,, U — G. OA N a> ° G ° U C N ro V •a E v o 73 = ._ N -n C _G .1)- -a.,; N 4� <C C a. ° O ~O Y >, OU •3 G v; C .c_ o U a) v a. v -o v, — U U a o 1 v ° c v 5 ,_� •_ n. a- 0 o _ c a� ° -v c 6, a.. U O c v v ° '= U `� 0. o U >, a, v ^c m C _O O ° '6. E cNd V ..°'.. u L 8 - cad U •�j a; O G O „ •o C O 0 cGd `v ad v E v . 3 s v > cd -v c� n o ° c C HPH .UL1 y C T cC 0..� o G X U N OOy ° X G° C00. pG UcdW v, UOay a) Z>,WO O m > O . 4.. u .p N U • • Z dS'o •flay n J1HU : iun 74)-5 t0 •' `° ° 8 > - cG ? v u Es " E � � c u E (/ N " ° .E o ° a,° o� a 3 d > o° 0 0 3 c y y c cci oi) a 8 `,-- e 0 - = L §Qa -0 '4 '4 c 0 c .>N a :7, •Oyp ,a .5 .o Tsi '•A ° -,, u3 $. 8 0 .5 c a� ao dab ° cd c a N p v W a y o - o E 3 0 «3 N 0 " " 8 ro .o o .� = 3 ° id • o ;.E a 0 c E $, > co `e 8 cep c aS 8 E E � a, L >, �a .0 00,0_ '° a c >' :9., o - 5 o 0 v E -�, u 0 .c_ N c E c ._. • !'4 - B F-, 0 ° 0 2 .s o i E 'a .- c° ,o ° •N o a' - 3 c o N o " J :° o T a �� 3 8 E 3 yq' •8 �y 3 N p w o 0 pE „, > ' o T E r t UF' 7 .4 a' a) a' a) a G1,Y R. N b C1. DA .a'. N 8 N S N E. w A N ` 7- 7 ---:. r3- -0 �� � ° � 0 � W � o t 0 0 .a • a � x � �." y c � o°'n�' i° N v a u °' >'� •° 5b'o a>'' >,•0 N `1 g '1 2b �'00 6) •,-v_ .g . 2 2,..* `4g U a8 E ¢ T. � E t° •o 'D c c7 ` `° b0 8 2 d E.bRN1 �, :!7 . w a g 2 on W:o a >, ?' 8 E °c .5 ° m `N° c• 3 8 L 3 a ruml 5 '67 ao y U q ° -68 ,5 .i 0 N .5 w E a .o > 0 c c `° t) o '30yaP0o 00 - aa s d o v P M a T °Q) Cd E o a c y �•3 N C c a0N - - ti CIZI .t ++ ° s ° u 'a -0 o aNE a v .- , cva N3 cc ° ° ? -° v x .E e ,yyaN '° U o cvc rSZ . 30 � � � 80 � a , � � E- G at . . �C 'p `t 10 8 ,, `0• 8v > � � � _N 'D tJ � - G+04 Q' .Q 8 y > l' w 'a0CO vai = waN y pJ e at5 „ C 0v G UU U U v > , .DO 1N •-Uv0. ") E y E`' = c = JV - • U 5 .gE4 oE8' )..-j •-. .- .,- ._:-o S2 $ .E �oo � oo .9. K. -rt N � E ^ E - n a' 3 2 v .0 3 8 ,p w v " .0 8 g oa 'i .o vN, C c v v Q 9 W 3 E bs LL a'0i G.o f aE' 8 F `g c E L = L `° C U o', Ij >''C7 .� g G N a) 3 O "' .O N N •O b N Op N a' N 'O a' ^,0 �5 r c , 3 op N C O 0 a Q� '7 C `'J o 6 -. . 5 -ac ,-- 0 .0z V LL N .� O=ON 0 s > x0 y N y3 S sf ci N o o E8 t •v A pp 000 0 .o c A = rL .a G o bb; -E. . a . •E - c 0 ^ �TA 10 -l0ooo • 4, va � - 8 F. � cE . E 8 - • !.4. • ° op4 > ov w e v N H 2rJ Scal • • ...) •5o ,, Co o b 0 C ., NO500CCO tin V d C. U O . _O8 � N y d U ° 'a 7rNN N A C . ,' 'roPy › O -O o 5 -0N f0 a 12p ° 8 J ¢ _` c00 r � a QoE a • O N ° v u s> E . a U To w " _l aAo k, � o >, o a � 1-' a . a0 " oe"' N � acO 0x .5cTx -ze_7..,to-4 a, O Oo ,Q -: Ngty _, •O OU za' C .u80Ov, � o y 0ccaU . o ,Obs : fN o ` a- - 34d °Oas A00U = c40 .- , H Eu . �= c - a0Q O ° .. Eo E oa oocC0z• • ° ..Q , Ux3g U ' 8 •E . ° E v .o a .0 a .0 o c _ `° E c .ti4 � vi' a' ' vo Ug b. a' � a r ?? � .a0 Hca' a° i' E ^ � a Z a.3 oN ,, s , ° ra $ e ora .> U0 °,0a °o° E = gad' . - `o 111114 '5 c � 7-, 04 ,, „. c.:) ,F0 aoN 0 u ,ja,v '� E Qm g o ra •E_ v To a w5W v, .9, `,2 • car°' o .4,•- 7oxcxTvv 0 .0 . o0OU � a � c :v O d g . E11 - iiLtg1 -0 . 0 aiON O " E § ° o -8NLN £ > e'lto) T ° CJ N ^ ° U t' A 0 o_ V • .0 vu •E .S7 i a' 4:1 .N Cd aN a. � _ . vO ,, O v = . c O � .9 � p 48 = T — .9.. N a _ E E •^ 0 � ai 00° • 0 .a co) CC w Qg O 'vv5.', O - N bt+ ' O '��/..i, ?U� tea"' k, -0 E tea' N aF.' 'G a > > L 't7 3.58 .9 8 vl N N .5 o a' > a U A .J fig I•'••� •3 N N U 8 `O U `°i, 0 .0 •... U° .E W L U U G L •