HomeMy WebLinkAbout2009- July File Copy
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Jefferson County
Board-of 3-CeaCthi
.Agenda
.4 inutes
JuCy 16, 2009
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JEFFERSON COUNTY BOARD OF HEALTH
July 16, 2009
Jefferson County Public Health
615 Sheridan Street
Port Townsend, WA
2:30—4:30 PM
DRAFTAGENDA
I. Approval of Agenda
II. Approval of Minutes of June 18,2009 Board of Health Meeting
III. Public Comments
IV. Old Business and Informational Items
1. Washington Breast, Cervical, and Colon Health Program Report
2. Pandemic H1N1 Update: Medical Surge Capacity, Business
Preparedness, and School Infection Control Planning
• V. New Business
1. Group B Water System Regulation in Jefferson County
2. Mystery Bay Commercial Shellfish Classification Change and
Adjudicative Hearing Option
3. Position Papers and Draft Resolution Re: Affordable Health Choices Act
4. Tribal Mutual Assistance Agreement: Draft Open for Comment
VI. Activity Update
VII. Agenda Planning
VIII. Next Scheduled Meeting: August 20, 2009
2:30—4:30 PM
Jefferson County Public Health
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V44,*1
JEFFERSON COUNTY BOARD OF HEALTH• MINUTES
Thursday,June 18, 2009 2:30 PM—4:30 PM
Health Department Conference Room, 615 Sheridan Street, Port Townsend
Board Members Staff Members
Phil Johnson, County Commissioner District#1 Thomas Locke,MD,Health Officer
David Sullivan, County Commissioner,District#2 Jean Baldwin,Public Health Services Director
John Austin, County Commissioner,District#3 Julia Danskin,Nursing Services Director
Michelle Sandoval,Port Townsend City Council
Sheila Westerman, Chair, Citizen at large(City)
Chuck Russell, Vice Chair,Hospital Commissioner,District#2
• Roberta Frissell, Citizen at large(County)
Chair Sheila Westerman called the meeting of the Jefferson County Board of Health to order at
2:30 PM.
Members Present: John Austin, Roberta Frissell, Phil Johnson, Chuck Russell, David Sullivan,
Sheila Westerman
Absent: Michelle Sandoval
Guest: Frances Joswick, SAAB
• Staff Present: Dr. Thomas Locke, Jean Baldwin
A quorum was present.
APPROVAL OF AGENDA
Member Austin moved and Member Sullivan seconded for approval of the agenda. The
agenda was approved unanimously.
APPROVAL OF MINUTES
Member Austin moved for approval of the minutes of May 21, 2009; Member Frissell
seconded. The minutes of May 21, 2009 were approved unanimously.
PUBLIC COMMENTS
Dr. Locke introduced Rebecca Pfaff. Ms. Pfaff is a second year medical student who grew up in
Joyce, WA. She is doing a research project on health care disparity and working this summer
with various health care professionals in the County including Dr. Locke. Member Austin
• referred her to the State Health Disparities Board, but cautioned that he did not know if it would
survive budget cuts.
Page 1 of 10
OLD BUSINESS and INFORMATIONAL ITEMS
First West Nile Virus Identification •
Dr. Locke referred to the press notice in the packet. He said that it is notable that this is the
earliest in the season that West Nile virus has been detected in the State since monitoring began
in 2001. For this to become a state wide problem, the virus must be present in the bird
population, which then moves around the State. The two species most at risk for this infection
are horses and humans which acquire the virus from mosquitoes that have fed on infected birds.
We have also learned that one of the predominant forms of mosquito in the State actually shifts
from feeding on birds to humans late in the summer. In response to a question about spraying
and other control measures, Dr. Locke said there is a detailed plan, with a local option for
spraying. "Adulticiding" is the term used to refer to the spraying of pesticides to kill adult
mosquitoes. He said there is evidence from the Midwest that this practice does cut down on the
number of human cases. Jean Baldwin explained that Mosquito Districts with taxing authority
can respond quickly, as the need arises. Other jurisdictions must relay on State Agencies or
County Commissioners to make decisions, which takes more time.
There was a brief discussion about how risks of spraying are weighed against threats of the
disease, depending on the location, conditions and past patterns of illness and deaths.
Review of Jefferson County Board of Health Bylaws
Chair Westerman noted that it had been quite some time since the Bylaws had been reviewed and
that this item had been deferred from earlier meetings. The BOH stepped through the document,
noting the following issues and possible changes:
1. Regarding the attendance policy, Member Austin recalled the recent action taken by the
substance Advisory Board. Jean Baldwin noted that the BOH had not taken similar action in
response to repeated absences in the past.
2. Signing of minutes—Usual practice has been for all members who attended a meeting to sign
the minutes; any corrections are made before the final version is signed. Member Sullivan
suggested revised wording: "Minutes shall be signed by all members after approval by the
Board." Dr. Locke cited three points from Robert's Rules of Order: Members who are not in
attendance at a meeting may sign the minutes for that meeting, although they are not required to
do so; it is also allowed for the Chair to sign on behalf of the Board; and there need not be a vote
on the approval of minutes—the Chair may declare that if there are no objections, the minutes
are approved. He suggested that it is not necessary to hold up approval due to the absence of
some members, as has been past practice.
3. Reference to the Jefferson County Health and Human Services Department: References
throughout the Bylaws should be updated to Jefferson County Public Health.
4. Public Testimony: The option of the Chair for setting time limits for testimony was reviewed
and retained without change. The section Comments on Action Items was reviewed and changed .
Page 2 of 10
to "Prior to voting on any item requiring action by the Board, the Chair may call for comments
• by persons interested in or affected.....",rather than shall call....
5. Executive Session: Members reviewed the purpose of the provision for Executive Sessions,
i.e. they may be called for discussion of sensitive matters such as pending litigation, possible
property acquisition, or personnel matters. There was no change to text.
6. Ethics—Conflict of Interest: The Board reviewed this section, noting that the language is
broad, and should be more specific. The issues of"appearance of conflict of interest" and
"appearance of fairness in quasi-judicial situations" should be clarified. Dr. Locke offered to
research and suggest alternative language, including clear definitions.
7. Tape Recordings: Members suggested a change to the second sentence: "Any person may
make a formal request for a copy, per policy." Direct reference to tape recordings will be
changed to a more generic term, such as "electronic recording media".
8. Meeting Notification: Members reviewed the policy and practice, and decided not to add
specific information about the meeting notification process.
Members also distinguished between the original version of the Bylaws and a revision draft with
certain sections in boldface type that had been distributed at the meeting in the following two
sections, Vacancies and Article VII, Administrative Officer.
• 9. Article VII. Administrative Officer: Dr. Locke explained that the Health Officer is by default
the Administrative Officer and Executive Secretary of the Board of Health. In very small rural
counties where the Health Officer is present only a few hours per month,the legislature has
provided the option for the local BOH to appoint an Administrative Officer who could perform
some of the duties of the Health Officer, but not all. He said it is in the power of the Board to
appoint the Health Department Director as the Enforcement Officer, for example. However,
some of the duties of the Health Officer may only be fulfilled by a physician, as specified by law.
The BOH agreed that the word"may"should be substituted for"shall".
10. Returning to Absences on page 2, members discussed the provision that the County
Commissioners may remove a member for lack of attendance. Chair Westerman suggested that
that authority should reside in the BOH. John Austin suggested that the State Constitution
should be consulted as to whether that is permissible. Dr. Locke stated that in statute there is the
provision that in an expanded Board, the County Commissioners appoint the members. He said
the logic of this that the appointing body would also have the authority to remove members.
Member Frissell noted that does not preclude a recommendation from the BOH to the BOCC
regarding appointment or removal. Dr. Locke said he believed the statute is silent on removal,
and that the BOCC could delegate the authority to appoint or remove members. He said he
would research that issue further. Chair Westerman suggested that based on her experience with
other Boards, it is better to have a clear, simple policy and process in place for excessive
absences.
11. Amendments to the Bylaws: Member Austin recommended that the BOH change "by two-
thirds (2/3) vote"to "by two-thirds (2/3)vote of total members", which had been suggested by
Page 3 of 10
David Alvarez. In addition, Member Austin noted that, as currently written, proposed changes
must be distributed at least ten days prior to the meeting when the vote is taken. Members S
agreed that the changes would be on the agenda for the August meeting.
Dr. Locke also noted that placeholders were inserted in 2006 for proposed new sections that
would address public hearings and appeals processes. He said he would draft language as
procedures to address those issues.
12. Quorum: Chair Westerman recalled that there had been many discussions in the past as to
the definition of a quorum. It was agreed that a County Ordinance would need to be changed to
alter the definition of a quorum. Chair Westerman said that she believes it is appropriate to give
every member of the BOH equal weight, and asked the Commissioners to consider supporting
that change. Member Sullivan noted that that would present the possibility of the entire BOCC
being out voted on a funding issue. (There were no changes.)
Jean Baldwin noted that the composition of the BOH has been very successful, particularly as it
enabled strong partnerships between the County, City and Hospital. It was agreed that full Board
attendance and participation is very important to maintain strong partnerships and continuity.
She also noted that the design of the BOH has become a model for other counties.
Substance Advisory Board Update Report
Fran Joswick reported that the Advisory Board membership is now at twelve members, all
engaged and applying their skills in support of various projects.
Ms. Joswick also reported on the Relapse Prevention Education Program at the County Jail. She
said that seventy (70) inmates had participated from October 1 through May 30. Of those, there
have been 14 who have re-offended, or 20%. The goal at the start was to reduce the recidivism
rate by 10%within one year. She said that success in this program is important in terms of cost
to the County, and ancillary costs such as Child Protective Services and other indirect costs
associated with incarceration of an individual. Of the 70, 17 went directly from jail into
treatment; 7 are currently in treatment and 2 are awaiting dates for entrance. Ms. Joswick said
that Safe Harbor, which has donated the education staff and the clerical staff for data processing
has experienced significant budget cuts. It is uncertain whether Safe Harbor will be able to
continue in this capacity. The County and City decided to use available funds for projects other
than the Relapse Prevention Program. She said that she has contacted Norm Dicks' office, which
is searching for alternative funding, and plans to speak with Lynn Kessler as well. She asked the
BOH to convey any other possible sources of funding to her. An informational packet is
available for prospective funding agencies. Ms. Joswick said that an additional assessment will
be done for new inmates that will identify specific information needed for funding applications.
She mentioned that Sheriff Tony Hernandez has given excellent support to the SAAB in their
efforts to maintain this program. Approximately $50,000 is the amount needed.
There was a brief discussion about data gathering in the jail. Jean Baldwin advised that there are
three different data programs that should be coordinated. She said the "one tenth of one percent" •
funds are paying for two data projects in the jail, and will be pulled together for the inmate
Page 4 of 10
histories. This source also pays 100%of Nurse Wiggins' salary and provides some funds for
• Ford Kessler for services in the community that could include this work. Ms. Joswick said she
would forward a copy of Mr. Kessler's budget. Ms. Baldwin said there is additional money
coming into the County as one of the early adopters of the "one tenth of one percent"program,
i.e. $200,000 for Safe Harbor and Mental Health in conjunction with the Drug Endangered
Children Policy. There are also some new funds in the community for methamphetamine-
related programs.
Ms. Joswick noted that this recidivism reduction demonstration project has shown its value and
repeated that it is very important to continue funding for it. Member Sullivan stressed the
importance of keeping the BOCC informed of funding efforts. Member Johnson added that he
had met with a district staff member for Norm Dicks; Member Johnson and Ms. Joswick agreed
that he had been very helpful.
NEW BUSINESS
Influenza AIS Will ("Swine Flu") Lessons Learned, Preparedness and Response
Challenges
Dr. Locke stepped through a slide presentation of Pandemic Preparedness and Response:
Influenza A/SWH1 Virus ("Swine Flu"). He noted that swine flu would continue to present
workload challenges in coming months now that a pandemic has been declared. The disease will
• spread rapidly in the southern hemisphere during their flu season. He noted the likelihood that
swine flu would return in the fall, at lease in its present form, and with concern of a more
virulent form.
Dr. Locke explained the "H" (hemagglutinin) and "N" (neuraminidase) significance, roles and
structures within the A virus. There are 16 types of hemagglutinin and 9 types of neuraminidase
identified, with 144 types of viruses discovered in birds; only a small subset affects humans. The
genetic material is contained in 8 internal segments that are swappable within species. He
showed the life cycle of influenza A, noting the combination of human, bird and swine strains
that have been re-assorted into a unique new virus. He said that its ability to mutate and its
instability are characteristics that make it so dangerous. The history of Influenza A pandemics
was reviewed.
Dr. Locke indicated that the triple reassortment viruses like the new swine flu strain are not well
understood, and have only been closely monitored for about the last five years. It is not known
exactly where the current virus arose, but it is believed that a close relative of this type has been
circulating among swine populations for several years. He showed the worldwide distribution of
this virus. The apparent absence of cases in much of Africa is likely due to lack of reporting.
There are six levels of pandemic alert by the World Health Organization; stage 6 has been
declared for this new strain.
Dr. Locke noted that the regular flu season for the USA has been atypically late and long in
• 2008-09. He summarized the first four weeks of the swine flu pandemic in Washington State,
i.e. from April 26 to May 23, 2009, in terms of numbers of cases, symptoms, severity, age
Page 5 of 10
distribution, and sampling/reporting protocols. There is an age-related susceptibility; people born
before 1957 appear to be less at risk. The median age of confirmed cases is 13 years of age. In •
response to a question about the smaller number of cases in those under the age of four, Dr.
Locke said that is not likely to be due to transfer of maternal immunity, but more likely due to
less exposure than school age children have.
There have been a few cases detected in Jefferson and Clallam County, but Dr. Locke indicated
that there are likely many more that have not been detected. He noted that this flu strain is
presenting like seasonal flu except there is an unusually high rate of vomiting and diarrhea. The
rate of hospitalization is much higher than with seasonal flu. There is a rapid test for Influenza A
available locally, and most people with swine flu do test positive for this.
Dr. Locke also discussed the strategic national stock pile. Anti-viral drugs from the federal stock
pile were distributed at stage 4 of the pandemic alert. Jefferson County has a total allocation
amount sufficient to treat 15%of the population. In the first distribution, 25% of that allocation,
or about 1000 treatment courses, was received: 80% of that was in the form of oral medication,
and 20%was in the form of inhalants. There are also supplies of personal protective equipment.
There have been very low levels of use. Don's Pharmacy, QFC Pharmacy, Hadlock and the
Hospital accepted supplies for distribution under the direction of the Health Department. The
strongest treatment priorities are for hospitalized patients and those with risk factors for
complication. In summary, this includes: those under age 5 and over 65; chronic lung, heart or
metabolic disease; pregnant women; and those with suppressed immune systems or those taking
medications with that effect. There have been three deaths thus far in Washington State. It is not
yet known if the risk of death from swine flu is greater than it is for seasonal flu for those in the •
high risk categories. Dr. Locke noted that the anti-viral drugs do not work very well. According
to the best published studies on Influenza A, statistically for every 100 people treated with these
drugs, there were six fewer lower respiratory tract infections, and one less hospitalization. In
other words, for every 100 people treated with these drugs, 99 had no benefit in terms of
hospitalization. It is not known how effective the drugs are in preventing death.
With regard to preparation plans, Dr. Locke mentioned that there had been a meeting of the
Emergency Response Team earlier in the day. With regard to direction and planning, Dr. Locke
said there continues to be surveillance at all levels. In terms of prevention, the big issue is
vaccine production. It is not known how much vaccine can be produced quickly. The US has
not committed to purchase a supply as yet. The most optimistic view is that 40 million courses
can be produced, which will not cover the entire population, particularly since two doses are
needed for each child. Jean Baldwin said there must be discussions with partners/schools to work
out how all children could be vaccinated, which is a large challenge. Medical/surgery capacity
is also a significant challenge for the health care system; alternate care sites for medical services
are being sought. The business community should also be informed as to what steps they can
take in preparation and in the event of outbreaks. Jean Baldwin said she has requested medical
reserve personnel to perform trainings this summer at businesses and establishments in Jefferson
County modeled after what was done in Kitsap County.
Dr. Locke discussed the lingering question of whether or not to buy more anti-viral medications.
In addition to the 15% stockpiled, the federal government will allow purchase of an additional •
10% at a subsidized rate ($14 per dose versus a market rate 4 times higher). He said that he and
Page 6 of 10
Dr. Scott Lindquist are not recommending that, based on technical reasons. The drug is of
• limited effectiveness, the possibility of resistance is high; and even at $14 per treatment course,
the cost for thousands of extra doses is high. In response to a question, he said that brand new
oseltamivir phosphate has a seven year life. However, the pediatric batch received expires at the
end of June 2009. He affirmed the desire to use Medical Reserve Corps to assist with education
and medical services. Fran Joswick suggested advertising for qualified volunteers, such as
retired physicians and nurses. Jean Baldwin agreed that outreach must be stepped up. In
addition,there is hope that the federal government will provide financial support, since most of
the effort in May and June has been paid for by local funds. Dr. Locke added that there are also
steps being taken to ensure coordination between the County, Red Cross and Medical Reserve
Corps.
Washington State Department of Health Budget Cuts: Impacts on Local Health
Jurisdictions
Jean Baldwin referred to the packet item summarizing budget cuts on Local Health Jurisdictions
and stated the amount of the reduction for each item as it affects Jefferson County.
Tobacco Prevention—20%reduction; $2,935 starting July 1, 2009
Public Health Enhancement 5930—This was new money for staff associated with
immunizations; 20% reduction, $20,600 starting January; there has also been a huge change in
• the Immunization Vaccine Program which shifts costs from the State program to insurance
companies and individuals and the federal Vaccine for Children program. The greatest impact is
in workload is to shift the accounting from the existing to the new system.
State Family Planning Grant—Approximately 10% or$6,000 reduction sometime in 2009. In
response to a question about a 70% reduction in State family planning in 2011, Jean Baldwin
said that the federal funds are expected but not guaranteed.
Colon Screening—No impact because this program has not yet begun in Jefferson County.
Group B Water Systems—No direct financial impact since Jefferson County had relied on the
State; there is an open question as to whether the County will need to pick this up.
AIDSNET Grants—7% reduction, $3,000, starting July 1, 2009
WIC--No large impact, approximately $2,000
Jean Baldwin said the largest cuts, through DSHS, are not listed. She said that about 45
community health contracts come through the division, which is the bidder for DSHS, State
Department of Health and others. Jefferson DSHS funding is about equal to DOH money. She
explained that while DOH money is mostly block grants, the DSHS money is billed for those
eligible for various services. Maternity Support is run by DSHS based on deliverables designed
by DOH. There has been a redesign of the program and the net result is about a 30%reduction,
or$7500. The goals of the program have changed and there will be differences in the ways
Page 7 of 10
clients are qualified and served. The funds may no longer be used to serve all young families as
in the past. The overall reduction for the year, beginning in January, will be about $17,000. .
Ms. Baldwin said the DOH cuts are specified, while the DSHS cuts are still somewhat soft. The
Alternative Response Services and Early Intervention Program contracts through Child
Protective Services will be renewed. The Health Department is considering options for staff
reassignments and hour reductions and will have additional changes beginning July 1. Ms.
Baldwin suggested that the County and City may wish to work out a joint solution to maintaining
the Maternity Services as it is now. She also discussed the uncertainty of the DSHS deliverables
at this time, with the result that exact dollar reductions are very difficult to determine. She also
stressed that the Health Department has always decided which services are really needed, and
does not add or subtract services based solely on whether funding is available. If necessary,
some services will be decreased due to the reductions.
Chair Westerman asked for clarification on the decreases in the Tobacco Prevention program.
Ms. Baldwin said that the changes are population based, and noted that the funds were not
moved entirely out of health care. She said that her priority is to get through the next two years
with the hope that federal health care reform will come through in the meantime.
There was a brief discussion about the ongoing Mystery Bay water quality and mooring buoy
issues. Some members questioned the State resources being expended there while much more
serious issues are pending.
Member Sullivan said that he appreciated the approach that the Health Department is taking, and •
agreed that the Maternity Support program cannot be dropped because of the $20,000 needed to
maintain it.
National Health Reform: A Role for Local Health Policy Makers
Dr. Locke referred to the copy of the joint letter from the Clallam County BOH and Hospital
Boards written to the White House Office of Health Reform. He noted the importance of
conveying the rural perspective in the national health reform deliberations. He said the number
one priority for rural Washington is the ability to recruit and maintain qualified workforce. He
inquired whether the BOH would be interested in drafting a similar letter. There was a brief
discussion about the possibility of working with the Jefferson Hospital Board. Member Russell
said that he plans to attend a meeting of rural hospitals in Chelan in July, and will report back to
the BOH on this matter.
Activity Update
Washington State Board of Health Meeting, Port Hadlock, July 8, 2009 -- BOH members are
invited to attend this meeting. The State Board staff has been coordinating with staff with regard
to a presentation. The agenda will include school safety rules as well as clean water issues and
other items. The meeting is scheduled from 9:00 AM to 4:00 PM. The agenda will be published
on the web site about 7-10 days in advance of the meeting. Dr. Locke said that the Health •
Department has been allocated about one hour on the agenda; they plan to present on overview
Page 8 of 10
of the Jefferson County Health Department and a highlight of the Nurse Family Partnership
• program. Member Austin suggested that the Relapse Prevention program at the County Jail
should be mentioned. Chair Westerman will not be in town; Vice Chair Chuck Russell,
Members Austin, Johnson and Frissell, and Dr. Locke plan to attend.
Electronic Meeting Packets—Chair Westerman stated that electronic packets had been proposed
as a cost saving measure at the last meeting and piloted for this meeting. Member Austin said he
believes this arrangement is very inconvenient and is actually a false economy. He said he
prefers that packets are printed centrally rather than individuals coping with reading online or
making individual requests or printing documents at home. Several members expressed their
agreement, noting the difficulty of reading lengthy documents online and not having printed
support materials at the meeting. Member Austin moved to resume printing and mailing of
packets; Member Johnson seconded the motion. The motion was approved by a vote of 5
to 1.
There was a brief discussion about posting materials on the web site. Agendas will be posted
prior to the meetings. Minutes will be posted after they have been approved. Some packet
materials may be posted, but there are copyright issues for others. Requests for agenda items
will be e-mailed or sent via post card.
Agenda Planning
The next meeting of the BOH is scheduled for Thursday, July 16, 2009 from 2:30 to 4:30 PM in
• the Health Department Conference Room, 615 Sheridan Street, Port Townsend.
Adjournment
Chair Westerman adjourned the meeting at 4:35 PM.
Page 9 of 10
•
JEFFERSON COUNTY BOARD OF HEALTH
Sheila Westerman, Chair Phil Johnson, Member
Chuck Russell, Vice-Chair John Austin, Member
Roberta Frissell, Member David Sullivan, Member
Absent •
Michelle Sandoval, Member
•
Page 10 of 10
JEFFERSON COUNTY BOARD OF HEALTH
• MINUTES
Thursday, June 18, 2009 2:30 PM—4:30 PM
Health Department Conference Room, 615 Sheridan Street, Port Townsend
Board Members Staff Members
Phil Johnson, County Commissioner District#1 Thomas Locke,MD, Health Officer
David Sullivan, County Commissioner,District#2 Jean Baldwin, Public Health Services Director
John Austin, County Commissioner,District#3 Julia Danskin, Nursing Services Director
Michelle Sandoval,Port Townsend City Council
Sheila Westerman, Chair, Citizen at large(City)
Chuck Russell, Vice Chair, Hospital Commissioner,District#2
Roberta Frissell, Citizen at large(County)
Chair Sheila Westerman called the meeting of the Jefferson County Board of Health to order at
2:30 PM.
Members Present: John Austin, Roberta Frissell, Phil Johnson, Chuck Russell, David Sullivan,
Sheila Westerman
Absent: Michelle Sandoval
Guest: Frances Joswick, SAAB
• Staff Present: Dr. Thomas Locke, Jean Baldwin
A quorum was present.
APPROVAL OF AGENDA
Member Austin moved and Member Sullivan seconded for approval of the agenda. The
agenda was approved unanimously.
APPROVAL OF MINUTES
Member Austin moved for approval of the minutes of May 21, 2009; Member Frissell
seconded. The minutes of May 21, 2009 were approved unanimously.
PUBLIC COMMENTS
Dr. Locke introduced Rebecca Pfaff Ms. Pfaff is a second year medical student who grew up in
Joyce, WA. She is doing a research project on health care disparity and working this summer
with various health care professionals in the County including Dr. Locke. Member Austin
referred her to the State Health Disparities Board, but cautioned that he did not know if it would
survive budget cuts.
Page 1 of 10
OLD BUSINESS and INFORMATIONAL ITEMS
First West Nile Virus Identification •
Dr. Locke referred to the press notice in the packet. He said that it is notable that this is the
earliest in the season that West Nile virus has been detected in the State since monitoring began
in 2001. For this to become a state wide problem, the virus must be present in the bird
population, which then moves around the State. The two species most at risk for this infection
are horses and humans which acquire the virus from mosquitoes that have fed on infected birds.
We have also learned that one of the predominant forms of mosquito in the State actually shifts
from feeding on birds to humans late in the summer. In response to a question about spraying
and other control measures, Dr. Locke said there is a detailed plan, with a local option for
spraying. "Adulticiding" is the term used to refer to the spraying of pesticides to kill adult
mosquitoes. He said there is evidence from the Midwest that this practice does cut down on the
number of human cases. Jean Baldwin explained that Mosquito Districts with taxing authority
can respond quickly, as the need arises. Other jurisdictions must relay on State Agencies or
County Commissioners to make decisions, which takes more time.
There was a brief discussion about how risks of spraying are weighed against threats of the
disease, depending on the location, conditions and past patterns of illness and deaths.
Review of Jefferson County Board of Health Bylaws
Chair Westerman noted that it had been quite some time since the Bylaws had been reviewed and
that this item had been deferred from earlier meetings. The BOH stepped through the document, •
noting the following issues and possible changes:
1. Regarding the attendance policy, Member Austin recalled the recent action taken by the
substance Advisory Board. Jean Baldwin noted that the BOH had not taken similar action in
response to repeated absences in the past.
2. Signing of minutes—Usual practice has been for all members who attended a meeting to sign
the minutes; any corrections are made before the final version is signed. Member Sullivan
suggested revised wording: "Minutes shall be signed by all members after approval by the
Board." Dr. Locke cited three points from Robert's Rules of Order: Members who are not in
attendance at a meeting may sign the minutes for that meeting, although they are not required to
do so; it is also allowed for the Chair to sign on behalf of the Board; and there need not be a vote
on the approval of minutes—the Chair may declare that if there are no objections, the minutes
are approved. He suggested that it is not necessary to hold up approval due to the absence of
some members, as has been past practice.
3. Reference to the Jefferson County Health and Human Services Department: References
throughout the Bylaws should be updated to Jefferson County Public Health.
4. Public Testimony: The option of the Chair for setting time limits for testimony was reviewed
and retained without change. The section Comments on Action Items was reviewed and changed •
Page 2 of 10
V
to "Prior to voting on any item requiring action by the Board, the Chair may call for comments
• by persons interested in or affected.....", rather than shall call....
5. Executive Session: Members reviewed the purpose of the provision for Executive Sessions,
i.e. they may be called for discussion of sensitive matters such as pending litigation, possible
property acquisition, or personnel matters. There was no change to text.
6. Ethics—Conflict of Interest: The Board reviewed this section, noting that the language is
broad, and should be more specific. The issues of"appearance of conflict of interest"and
"appearance of fairness in quasi-judicial situations" should be clarified. Dr. Locke offered to
research and suggest alternative language, including clear definitions.
7. Tape Recordings: Members suggested a change to the second sentence: "Any person may
make a formal request for a copy,per policy." Direct reference to tape recordings will be
changed to a more generic term, such as "electronic recording media".
8. Meeting Notification: Members reviewed the policy and practice, and decided not to add
specific information about the meeting notification process.
Members also distinguished between the original version of the Bylaws and a revision draft with
certain sections in boldface type that had been distributed at the meeting in the following two
sections, Vacancies and Article VII, Administrative Officer.
• 9. Article VII. Administrative Officer: Dr. Locke explained that the Health Officer is by default
the Administrative Officer and Executive Secretary of the Board of Health. In very small rural
counties where the Health Officer is present only a few hours per month, the legislature has
provided the option for the local BOH to appoint an Administrative Officer who could perform
some of the duties of the Health Officer, but not all. He said it is in the power of the Board to
appoint the Health Department Director as the Enforcement Officer, for example. However,
some of the duties of the Health Officer may only be fulfilled by a physician, as specified by law.
The BOH agreed that the word "may" should be substituted for"shall".
10. Returning to Absences on page 2, members discussed the provision that the County
Commissioners may remove a member for lack of attendance. Chair Westerman suggested that
that authority should reside in the BOH. John Austin suggested that the State Constitution
should be consulted as to whether that is permissible. Dr. Locke stated that in statute there is the
provision that in an expanded Board, the County Commissioners appoint the members. He said
the logic of this that the appointing body would also have the authority to remove members.
Member Frissell noted that does not preclude a recommendation from the BOH to the BOCC
regarding appointment or removal. Dr. Locke said he believed the statute is silent on removal,
and that the BOCC could delegate the authority to appoint or remove members. He said he
would research that issue further. Chair Westerman suggested that based on her experience with
other Boards, it is better to have a clear, simple policy and process in place for excessive
absences.
11. Amendments to the Bylaws: Member Austin recommended that the BOH change "by two-
thirds (2/3) vote"to "by two-thirds (2/3) vote of total members", which had been suggested by
Page 3 of 10
David Alvarez. In addition, Member Austin noted that, as currently written, proposed changes
must be distributed at least ten days prior to the meeting when the vote is taken. Members •
agreed that the changes would be on the agenda for the August meeting.
Dr. Locke also noted that placeholders were inserted in 2006 for proposed new sections that
would address public hearings and appeals processes. He said he would draft language as
procedures to address those issues.
12. Quorum: Chair Westerman recalled that there had been many discussions in the past as to
the definition of a quorum. It was agreed that a County Ordinance would need to be changed to
alter the definition of a quorum. Chair Westerman said that she believes it is appropriate to give
every member of the BOH equal weight, and asked the Commissioners to consider supporting
that change. Member Sullivan noted that that would present the possibility of the entire BOCC
being out voted on a funding issue. (There were no changes.)
Jean Baldwin noted that the composition of the BOH has been very successful, particularly as it
enabled strong partnerships between the County, City and Hospital. It was agreed that full Board
attendance and participation is very important to maintain strong partnerships and continuity.
She also noted that the design of the BOH has become a model for other counties.
Substance Advisory Board Update Report
Fran Joswick reported that the Advisory Board membership is now at twelve members, all •
engaged and applying their skills in support of various projects.
Ms. Joswick also reported on the Relapse Prevention Education Program at the County Jail. She
said that seventy (70) inmates had participated from October 1 through May 30. Of those,there
have been 14 who have re-offended, or 20%. The goal at the start was to reduce the recidivism
rate by 10%within one year. She said that success in this program is important in terms of cost
to the County, and ancillary costs such as Child Protective Services and other indirect costs
associated with incarceration of an individual. Of the 70, 17 went directly from jail into
treatment; 7 are currently in treatment and 2 are awaiting dates for entrance. Ms. Joswick said
that Safe Harbor, which has donated the education staff and the clerical staff for data processing
has experienced significant budget cuts. It is uncertain whether Safe Harbor will be able to
continue in this capacity. The County and City decided to use available funds for projects other
than the Relapse Prevention Program. She said that she has contacted Norm Dicks' office, which
is searching for alternative funding, and plans to speak with Lynn Kessler as well. She asked the
BOH to convey any other possible sources of funding to her. An informational packet is
available for prospective funding agencies. Ms. Joswick said that an additional assessment will
be done for new inmates that will identify specific information needed for funding applications.
She mentioned that Sheriff Tony Hernandez has given excellent support to the SAAB in their
efforts to maintain this program. Approximately $50,000 is the amount needed.
There was a brief discussion about data gathering in the jail. Jean Baldwin advised that there are
three different data programs that should be coordinated. She said the "one tenth of one percent" •
funds are paying for two data projects in the jail, and will be pulled together for the inmate
Page 4 of 10
histories. This source also pays 100%of Nurse Wiggins' salary and provides some funds for
• Ford Kessler for services in the community that could include this work. Ms. Joswick said she
would forward a copy of Mr. Kessler's budget. Ms. Baldwin said there is additional money
coming into the County as one of the early adopters of the "one tenth of one percent"program,
i.e. $200,000 for Safe Harbor and Mental Health in conjunction with the Drug Endangered
Children Policy. There are also some new funds in the community for methamphetamine-
related programs.
Ms. Joswick noted that this recidivism reduction demonstration project has shown its value and
repeated that it is very important to continue funding for it. Member Sullivan stressed the
importance of keeping the BOCC informed of funding efforts. Member Johnson added that he
had met with a district staff member for Norm Dicks; Member Johnson and Ms. Joswick agreed
that he had been very helpful.
NEW BUSINESS
Influenza A/SWHl ("Swine Flu") Lessons Learned, Preparedness and Response
Challenges
Dr. Locke stepped through a slide presentation of Pandemic Preparedness and Response:
Influenza A/S WH 1 Virus ("Swine Flu"). He noted that swine flu would continue to present
workload challenges in coming months now that a pandemic has been declared. The disease will
• spread rapidly in the southern hemisphere during their flu season. He noted the likelihood that
swine flu would return in the fall, at lease in its present form, and with concern of a more
virulent form.
Dr. Locke explained the "H" (hemagglutinin) and "N" (neuraminidase) significance, roles and
structures within the A virus. There are 16 types of hemagglutinin and 9 types of neuraminidase
identified, with 144 types of viruses discovered in birds; only a small subset affects humans. The
genetic material is contained in 8 internal segments that are swappable within species. He
showed the life cycle of influenza A, noting the combination of human, bird and swine strains
that have been re-assorted into a unique new virus. He said that its ability to mutate and its
instability are characteristics that make it so dangerous. The history of Influenza A pandemics
was reviewed.
Dr. Locke indicated that the triple reassortment viruses like the new swine flu strain are not well
understood, and have only been closely monitored for about the last five years. It is not known
exactly where the current virus arose, but it is believed that a close relative of this type has been
circulating among swine populations for several years. He showed the worldwide distribution of
this virus. The apparent absence of cases in much of Africa is likely due to lack of reporting.
There are six levels of pandemic alert by the World Health Organization; stage 6 has been
declared for this new strain.
Dr. Locke noted that the regular flu season for the USA has been atypically late and long in
• 2008-09. He summarized the first four weeks of the swine flu pandemic in Washington State,
i.e. from April 26 to May 23, 2009, in terms of numbers of cases, symptoms, severity, age
Page 5of10
•
distribution, and sampling/reporting protocols. There is an age-related susceptibility; people born
before 1957 appear to be less at risk. The median age of confirmed cases is 13 years of age. In •
response to a question about the smaller number of cases in those under the age of four, Dr.
Locke said that is not likely to be due to transfer of maternal immunity, but more likely due to
less exposure than school age children have.
There have been a few cases detected in Jefferson and Clallam County,but Dr. Locke indicated
that there are likely many more that have not been detected. He noted that this flu strain is
presenting like seasonal flu except there is an unusually high rate of vomiting and diarrhea. The
rate of hospitalization is much higher than with seasonal flu. There is a rapid test for Influenza A
available locally, and most people with swine flu do test positive for this.
Dr. Locke also discussed the strategic national stock pile. Anti-viral drugs from the federal stock
pile were distributed at stage 4 of the pandemic alert. Jefferson County has a total allocation
amount sufficient to treat 15% of the population. In the first distribution, 25% of that allocation,
or about 1000 treatment courses,was received: 80%of that was in the form of oral medication,
and 20%was in the form of inhalants. There are also supplies of personal protective equipment.
There have been very low levels of use. Don's Pharmacy, QFC Pharmacy,Hadlock and the
Hospital accepted supplies for distribution under the direction of the Health Department. The
strongest treatment priorities are for hospitalized patients and those with risk factors for
complication. In summary, this includes: those under age 5 and over 65; chronic lung, heart or
metabolic disease; pregnant women; and those with suppressed immune systems or those taking
medications with that effect. There have been three deaths thus far in Washington State. It is not
yet known if the risk of death from swine flu is greater than it is for seasonal flu for those in the •
high risk categories. Dr. Locke noted that the anti-viral drugs do not work very well. According
to the best published studies on Influenza A, statistically for every 100 people treated with these
drugs,there were six fewer lower respiratory tract infections, and one less hospitalization. In
other words, for every 100 people treated with these drugs, 99 had no benefit in terms of
hospitalization. It is not known how effective the drugs are in preventing death.
With regard to preparation plans, Dr. Locke mentioned that there had been a meeting of the
Emergency Response Team earlier in the day. With regard to direction and planning, Dr. Locke
said there continues to be surveillance at all levels. In terms of prevention,the big issue is
vaccine production. It is not known how much vaccine can be produced quickly. The US has
not committed to purchase a supply as yet. The most optimistic view is that 40 million courses
can be produced, which will not cover the entire population, particularly since two doses are
needed for each child. Jean Baldwin said there must be discussions with partners/schools to work
out how all children could be vaccinated, which is a large challenge. Medical/surgery capacity
is also a significant challenge for the health care system; alternate care sites for medical services
are being sought. The business community should also be informed as to what steps they can
take in preparation and in the event of outbreaks. Jean Baldwin said she has requested medical
reserve personnel to perform trainings this summer at businesses and establishments in Jefferson
County modeled after what was done in Kitsap County.
Dr. Locke discussed the lingering question of whether or not to buy more anti-viral medications.
In addition to the 15% stockpiled,the federal government will allow purchase of an additional
10% at a subsidized rate ($14 per dose versus a market rate 4 times higher). He said that he and •
Page 6 of 10
Dr. Scott Lindquist are not recommending that, based on technical reasons. The drug is of
• limited effectiveness, the possibility of resistance is high; and even at $14 per treatment course,
the cost for thousands of extra doses is high. In response to a question, he said that brand new
oseltamivir phosphate has a seven-year life. However, the pediatric batch received expires at the
end of June 2009. He affirmed the desire to use Medical Reserve Corps to assist with education
and medical services. Fran Joswick suggested advertising for qualified volunteers, such as
retired physicians and nurses. Jean Baldwin agreed that outreach must be stepped up. In
addition, there is hope that the federal government will provide financial support, since most of
the effort in May and June has been paid for by local funds. Dr. Locke added that there are also
steps being taken to ensure coordination between the County, Red Cross and Medical Reserve
Corps.
Washington State Department of Health Budget Cuts: Impacts on Local Health
Jurisdictions
Jean Baldwin referred to the packet item summarizing budget cuts on Local Health Jurisdictions
and stated the amount of the reduction for each item as it affects Jefferson County.
Tobacco Prevention—20%reduction; $2,935 starting July 1, 2009
Public Health Enhancement 5930—This was new money for staff associated with
immunizations; 20%reduction, $20,600 starting January; there has also been a huge change in
• the Immunization Vaccine Program which shifts costs from the State program to insurance
companies and individuals and the federal Vaccine for Children program. The greatest impact is
in workload is to shift the accounting from the existing to the new system.
State Family Planning Grant—Approximately 10% or$6,000 reduction sometime in 2009. In
response to a question about a 70%reduction in State family planning in 2011, Jean Baldwin
said that the federal funds are expected but not guaranteed.
Colon Screening—No impact because this program has not yet begun in Jefferson County.
Group B Water Systems—No direct financial impact since Jefferson County had relied on the
State; there is an open question as to whether the County will need to pick this up.
AIDSNET Grants—7%reduction, $3,000, starting July 1, 2009
WIC--No large impact, approximately $2,000
Jean Baldwin said the largest cuts, through DSHS, are not listed. She said that about 45
community health contracts come through the division, which is the bidder for DSHS, State
Department of Health and others. Jefferson DSHS funding is about equal to DOH money. She
explained that while DOH money is mostly block grants, the DSHS money is billed for those
eligible for various services. Maternity Support is run by DSHS based on deliverables designed
1111
by DOH. There has been a redesign of the program and the net result is about a 30%reduction,
or$7500. The goals of the program have changed and there will be differences in the ways
Page 7 0110
clients are qualified and served. The funds may no longer be used to serve all young families as
in the past. The overall reduction for the year,beginning in January, will be about$17,000. .
Ms. Baldwin said the DOH cuts are specified, while the DSHS cuts are still somewhat soft. The
Alternative Response Services and Early Intervention Program contracts through Child
Protective Services will be renewed. The Health Department is considering options for staff
reassignments and hour reductions and will have additional changes beginning July 1. Ms.
Baldwin suggested that the County and City may wish to work out a joint solution to maintaining
the Maternity Services as it is now. She also discussed the uncertainty of the DSHS deliverables
at this time,with the result that exact dollar reductions are very difficult to determine. She also
stressed that the Health Department has always decided which services are really needed, and
does not add or subtract services based solely on whether funding is available. If necessary,
some services will be decreased due to the reductions.
Chair Westerman asked for clarification on the decreases in the Tobacco Prevention program.
Ms. Baldwin said that the changes are population based, and noted that the funds were not
moved entirely out of health care. She
that
will come through in the meantime,rough the next two years
with the hope that federal health care reform
oy
There was a brief discussion about the ongoing Mystery B
ay water quality and expended there whilemuch mooring
moreu
issues. Some members questioned the State
resources being
serious issues are pending.
Member Sullivan said that he appreciated the approach that the Health Department is taking, and •
agreed that the Maternity Support program cannot be dropped because of the $20,000 needed to
maintain it.
National Health Reform: A Role for Local Health Policy Makers
Dr. Locke referred to the copy of the joint letter from the Clallam County BOH and Hospital
Boards written to the White House Office of Health Reform. He noted the importance of
conveying the rural perspective in the national health reform deliberations. He said the number
one priority for rural Washington is the ability to recruit and maintain qualified workforce. He
inquired whether the BOH would be interested in drafting a similar letter. There was a brief
discussion about the possibility of working with the Jefferson Hospital Board. Member Russell
said that he plans to attend a meeting of rural hospitals in Chelan in July, and will report back to
the BOH on this matter.
Activity Update
Washington State Board of Health Meeting, Port Hadlock, July 8, 2009 -- BOH members are
invited to attend this meeting. The State Board staff has been coordinating with staff with regard
to a presentation. The agenda will include school safety rules as well as clean water issues and
other items. The meeting is scheduled from 9:00 AM to 4:00 PM. The agenda will be published
on the web site about 7-10 days in advancehourthe on the agenda;lng. ttheyr. ocke said that the plan to present on overview •
Department has been allocated about one
Page 8of10
of the Jefferson County Health Department and a highlight of the Nurse Family Partnership
• program. Member Austin suggested that the Relapse Prevention program at the County Jail
should be mentioned. Chair Westerman will not be in town; Vice Chair Chuck Russell,
Members Austin, Johnson and Frissell, and Dr. Locke plan to attend.
Electronic Meeting Packets—Chair Westerman stated that electronic packets had been proposed
as a cost saving measure at the last meeting and piloted for this meeting. Member Austin said he
believes this arrangement is very inconvenient and is actually a false economy. He said he
prefers that packets are printed centrally rather than individuals coping with reading online or
making individual requests or printing documents at home. Several members expressed their
agreement, noting the difficulty of reading lengthy documents online and not having printed
support materials at the meeting. Member Austin moved to resume printing and mailing of
packets; Member Johnson seconded the motion. The motion was approved by a vote of 5
to 1.
There was a brief discussion about posting materials on the web site. Agendas will be posted
prior to the meetings. Minutes will be posted after they have been approved. Some packet
materials may be posted, but there are copyright issues for others. Requests for agenda items
will be e-mailed or sent via post card.
Agenda Planning
411The next meeting of the BOH is scheduled for Thursday, July 16, 2009 from 2:30 to 4:30 PM in
the Health Department Conference Room, 615 Sheridan Street, Port Townsend.
Adjournment
Chair Westerman adjourned the meeting at 4:35 PM.
Page 9 of 10
1
•
JEFFERSON COUNTY BOARD OF HEALTH
(..7j1I(//1 til-, 0 6461 ofrth--
Sheila We ,terman, Chair Phil Johnson, Member
''/
Cs444/4 /71/trig
. I
Chuck Russell, Vice-Chair J•f Austin, Member
t5,14- 1,4„Ct_ :,:. 4,4-el-et i /7_/2
Roberta Frissell, Member David Sullivan, Member
Absent •
Michelle Sandoval, Member
II
Page 10 of 10
SO
Board of.7Cealth
Old-Business
.agenda Items # �V., 1
• 'Washington Breast, Cervical
and Colon 3Cealth Program
Report
July 16, 2009
•
Prevention Division Public Health kg
401 Fifth Avenue,Suite 900
Seattle, WA 98104-1818 Seattle & King County
206-263-8174 Fax 206-296-0177
ill TTY Relay: 711
www.kingcounty.gov/health
April 6, 2009
To our Washington Breast, Cervical and Colon Health Providers and Contractors:
Please accept the enclosed certificate recognizing your efforts in providing health care services to
the men and women who benefit from this program. We know that it takes an entire team to
deliver the quality care you provide and we appreciate the time and effort taken by you and your
staff. Through our combined efforts we assure men and women have access to health care services
that they otherwise may not have secured.
Together, we are working towards our goal of eliminating health disparities among under-screened
populations. In 2008 a total of 6,105 women were screened for breast and cervical cancer: 65%
were women of color, 31 women were diagnosed with breast cancer and 11 with cervical cancer.
The program served 19% of the estimated 32,400 women eligible for services. At the time of
enrollment, only 11% of the women had a mammogram within 2 years and only 32% had a Pap
test within 3 years.
Between June 2006 and March 2009, the Colon Health Program demonstration project enrolled
1,894 clients (1,076 in 2008). Of those enrolled, 53% were people of color, 2 clients were
diagnosed with colorectal cancer and 90 clients with adenomatous polyps (pre-cancerous polyps
• with potential to become cancer) were treated. Only 6% of clients had previously been screened at
the recommended interval.
With our challenging economic times, we value and appreciate your continued partnership and
anticipate more men and women will benefit from these services than ever before.
Please share this certificate and our thanks with your entire staff.
Sincerely,
5
Gareth R.
Or
on, MPA
Prev)1i
ention ision Director it•
Jarieg , M MPH
Chhronic Disease & Injury Prevention Section
Tony Gomez BS 6? 1--
• Manager, Chronic Disease & Injury Prevention Section
1
Washington Breast and Cervical Health Program
ig
Women's Health Unit Public Health
10 401 FiRh Avenue,Suite 900
Seattle, WA 98104-1818 Seattle & King County
206-263-8205 Fax 206-296-0208
TTY Relay: 711
www.kingcounty.gov/health
2008 Data Summary Report
for Clallam, Jefferson, King and Kitsap Counties
April, 2009
Program Overview
The Washington Breast and Cervical Health Program(WBCHP) is a population-based program intended to
reduce mortality and morbidity from breast and cervical cancer by early detection through regular mammogram
and Pap test screenings, diagnostic services and prompt access to cancer treatment. WBCHP is dedicated to
eliminating health disparities among under-served populations, including women of color,women living in rural
communities, lesbians and women from low income families. WBCHP serves women age 40-64 who live below
the 250%Federal Poverty Level and who are uninsured or underinsured. Public Health—Seattle&King County
is the Prime Contractor, charged with administering the program in King,Kitsap,Jefferson and Clallam counties.
Program services are provided by contracted community-based organizations.
WBCHP is funded by the Centers for Disease Control and Prevention(CDC), Washington State, Susan G. Komen
for the Cure(Puget Sound), the Breast Cancer Prevention Fund and the American Cancer Society.
• Number of Women Eligible for WBCHP and the Number of Women Screened
In the four counties, we estimate that 32,400 women are eligible for WBCHP. In 2008,King County WBCHP
provided 6,105 screenings. Of these, 2,918 were new enrollment and 3,187 were re-screenings. Of the 32,400
eligible women, 19%were served by WBCHP in 2008.
Of the 6,105 completed screening cycles, mammogram was performed in 72%,Pap test was performed in 71%,
and both tests were done in 50%of the cycles. In 2008, 31 women were diagnosed with invasive breast cancer
and 11 with cervical cancer(3 were invasive).
Table I. Women Served by County, 2008
Clallam Jefferson King Kitsap Total
Enrollment 119 40 2501 151 2918
Re-screening 204 68 2687 191 3187
Total Served 323 108 5188 342 6105
Estimated WBCHP eligible women 1,500 800 26,400 3,700 32,400
%eligible served 21.5% 13.5% 19.6% 9.2% 18.8%
Mammogram done 285 72 3631 259 4386
Pap test done 158 83 3733 266 4345
Women w/Abnormal mammogram* 44 16 551 63
Breast cancer(invasive)diagnosed 705
3 0 26 2 31
Women w/Abnormal Pap test** 10 3 123 8 150
Cervical cancer diagnosed*** 0 0 10 1
* Including suspicious abnormality,highly suggestive of malignancy and assessment is incomplete. 11
** Including Atypical squamous cells of undetermined significance,Low grade SIL,Atypical squamous cells cannot exclude HSIL,High
grade SIL,Squamous Cell Carcinoma,and Abnormal Glandular Cells.
• ***Including CIN III,severe dysplasia,and carcinoma in situ.
1
~
4
Between 2000 and 2008, the total number of services provided increased from 4,286 to 6,105 (Figure 1).
•
Figure 1. Number of New Enrollment and Rescreening, 20002O08
7,000
]
| OReonreaning
6105
ONe� EnnnUment
S.00O - . 5644
5420 5436 5306
5134
5.000 4816
| , !
` � 3.187
4286
41O5 3.O58
4UO0 ` ' ` ' `' � ^ 2�l3? ^ ,/».' 2.y51 .�.'
' 2.030 -' '^� �` � `
1,910
1,&UQ
3.008 ' �� � _____
______
2.U00 � '� ' .
2918
2,785, 2.8U2 2. 13 2,586 '
, ' 2,5O�� 2~445
2^O67 :�108 � '
1.00O � `� - `
0 ^
| '� ' � ` '
'
2000 2001 2002 2003 2004 2005 2006 2007 2008 II
Table 2. CharacteristicS of Women Enrolled
Number Percent Number Percent
Age Sexual Orientation
<40 112 3.8% Not specified 2.000 72.4%
40-49 1.616 55.4% Heterosexual 732 26.5%
50-64 1,086 37.2% Lesbian 20 0.7%
65+ 103 3.5% Bi-Sexual 7 0.396
Transgender 3 0.1Y6
Race/Ethnicity Disability Status
White 1,023 35.1% No Disability 2,614 94.6Y6
African Am 308 10.696 Mobility 73 2.6%
Asian 639 21.9% Hearing 18 0.7%
Al/AN 67 2.3% Visual 23 0.896
Qther/Unk 166 5.7% Developmental 5 0.2Y6
Hispanic 715 24.5% Other 29 1.096
Language
English 1,436 49.2%
Spanish 720 24.7%
Vietnamese 134 4.6%
Cambodian 20 0.7%
113 3.9%
Korean
Russian 79 2.7% 411
Other 416 14.3%
At the time of enrollment,only 11% of the women had a mammogram within 2 years and only 32%had a Pap test
• within 3 years. These rates are much lower than those observed in the total population. The 2008 BRFSS data for
King County show that among women age 40-64 and living below the 250%poverty level, 59%had received a
mammogram within two years and 79%had received a Pap test within three years.
Of women enrolled in 2008, 53%were non-US born. The most common regions or countries of birth were Asia
(19%), Mexico(16%), Africa(4%), Europe(4%), and Central America(4%).
Percent Rescreened
Of women screened between 07/01/2006 and 06/30/2007, 33%returned for rescreening within 18 months. Of
women screened between 07/01/2005 and 06/30/2006,46%returned within 30 months.
Number of Services Provided by Organizations/Clinics
In 2008, organizations that provided the largest number of screenings included FlealthPoint„ Public Health-
Seattle&King County, NeighborCare, International Community Health Services, and Country Doctor/Carolyn
Downs. Figure 2 presents the number of screenings between 2004 and 2008 for the organizations/clinics that
served the largest number of women. Note that although not included in Figure 3, West Seattle CC increased
their screening from 47 in 2007 to 193 in 2008. Dr. Novin increased her screenings from 36 in 2005 to 140 in
2008.
Figure 2/Table 3. Number of Women Served by Organizations, 2004-2008
1,600—
1,400—
4110
1200-
1000
11
0
ifs 0.- 5 — r)o r ° c7) 1.11 2004
(y.)
z = c (1 0 0.
co as
0
0 c
ct) ._ a.) ,...
0._ E `5
Peninsula I Family NeighborCar 1 Country y
HealthPoint PHSKC ICHSSeaMar SIHB Jefferson PH Kitsap HD
e Doctor CHS Planning
2004 i 1,123 779 893 609 569 280 229 282 166 155 116
2005 1,230 831 918 395 603 274 252 305 151 117 123
2006 1,398 787 673 365 516 358 266 313 194 124 92
2007 1,578 737 617 446 479 382 270 342 156 116 68
2008 1,594 1 788 630 539 441 419 373 299 153 104 95
•
3
Number of Mammograms Performed by Radiology Facility
Of the 4,386 mammograms performed in 2008, Imaging Associates and Cherry Hill Breast Center provided 43%
and 26%of the services respectively, followed by Advanced Medical Imaging(10%). The remaining 21%were •
provided by other facilities(Table 4). Compared to 2007, Imaging Associates performed 538 more mammograms
in 2008.
Table 4. Number of Mammography Screening by Radiology Facility, 2008
Facility 2008 I 2007 Facility 2008 2007
Imaging Associates 1896 1358 Swedish Ballard Campus 83 68
Cherry Hill Breast Center 1153 1074 Valley Medical Breast Center 54 1
Advance Medical Imaging 431 440 Highline Imaging Llc 47 35
Olympic Medical Center 242 271 Overlake Breast Center 25 143
Swedish Breast Care Center 182 219 Seattle Cancer Care Alliance 32 13
Evergreen Hospital Medical Center 103 51 Forks Community Hospital 17 13
St Francis 95 89 Other 26 12
Timeliness and Adequacy of Screening
Among the 8 indicators for screening timeliness and adequacy, we reached the CDC goal on 5 (Table 5). We did
not reach the CDC goal on indicator 3 (Days between diagnosis of cervical cancer and treatment), indicator 5
(percent of abnormal Pap smears that have a complete work-up with a diagnostic procedure and final diagnosis
recorded), and indicator 7(percent of cervical cancer with treatment initiated).
Table 5. Timeliness and Adequacy of Screening Indicators, 2008
Cases Median Cases> %>60 CDC
Indicators Days 60 Days Days Goal .
1. Days between abnormal Pap smear results and final diagnosis I 24 29 3 12.5% <25%
2. Days between abnormal mammography results and final diagnosis 703 21 80 11.4% <25%
3. Days between diagnosis of cervical cancer and treatment* 14 52 6 <20%
4.Days between diagnosis of breast cancer and treatment 36 40 7 1 19.4% 1 <20%
Cases Not %of
Complete Indicated Refused Cases
/initiated /pending /Lost complete
5. Percent of abnormal Pap smears that have a complete work-up with 24 1 5 >90%
a diagnostic procedure and final diagnosis recorded
6. Percent of abnormal mammograms,CBE,or work-up that have a 1211 15 66 93.3% >90%
complete diagnostic procedure and final diagnosis recorded
7. Percent of cervical cancer with treatment initiated* 14 2 2 >90%
8. Percent of breast cancer with treatment initiated 36 0 3 91.7% >90%
*including CIN II,CIN III/CIS,and invasive cancer of the cervix
Community Outreach
In 2008, outreach workers reported contacting 16,940 women age 40-64 through community outreach and clinic
in-reach. Of the 5,892 referrals made to WBCHP, 1,708 (29%) were reported to be successful referrals. In
addition, 5,444 women under age 40 and 2,360 women age 65 and older were contacted although these two age
groups are generally not eligible for the program. Organizations with the largest numbers of outreach contacts
were YWCA, Center for MultiCultrual Health, International Community Health Services, Public Health-Seattle
& King County, and Seattle Indian Health Board(Table 6).
•
4
Of all women contacted in 2008, 19%were Caucasian, 34%African American, 20%Asian, 18% Latina, and 9%
American Indian. By age, women age 40-49 and 50-64 were 46%and 22%of the total contacts respectively.
• Women under age 40 and 65+accounted for 22%and 9% of the women contacted.
Table 6. Women Age 40-64 outreached and referred by Outreach Organization, 2008*
Contacts Referrals Successful Successful
Site Age 40-64 Referrals Referral%
YWCA 5902 3853 260 6.7%
Center for MultiCultural Health 5196 24 0 0.0%
International Community Health Ser 2603 699 518 74.1%
Public Health 1980 47 8 17.0%
Seattle Indian Health Board 444 563 448 79.6%
Senior Services 385 110 91 82.7%
Verbena (January®April) 185 159 61 38.4%
Jefferson County Health 98 1 1 100.0%
Clallam Family Planning 84 255 255 100.0%
Kitsap County Health District 63 181 66 36.5%
*Total contacts age 40-64 may be under-reported because contacts by age groups are not consistently reported
on some monthly outreach reports. Data are incomplete for some of the agencies.
In 2008, the Community Health Access Program(CHAP)referred 867 women to WBCHP through their
telephone referral service. Of all the callers, 55% were age 40-50 and 35% 51 or older. By race/ethnicity,57%of
the callers were Caucasian, 30%Latina, 6%Asian/Pacific Islander,and 4%African American. About 90% were
uninsured. Most callers(70%) were King County residents. When asked about how they heard about CHAP and
WBCHP, the most common sources were flyer(19%), self referral(17%), health care provider(16%),paid
advertisements(total 15%, including 3.3%radio, 5.0%newspaper, 0.5%phone book,and 10.7%TV), web site
(13%), and social services agencies(7%). The flyer and self referral options could be inferred as receiving the
program information from any of the promotional efforts of the program.
•
5
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•
Board of.7Cealth
Old Business
.agenda Item # 1'V., 2
� Pandemic .�CiNl Update:
Medical Surge Capacity, Business
Preparedness & School Infection
Control Planning
July 16, 2009
Swine flu advances in southern hemisphere—Homeland Security News Wire Page 1 of 2
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HOMELAND SFr LIRITY t EwS fiRE
Home Transport/ Border Biometrics Continuity/ Recovery Infrastructure/ IT Biodefense Surveillance Detec
THE BUSINESS OF HOMELAND SECURITY Thursday, 9 July 2009
Swine flu advances in southern hemisphere
Published 9 July 2009
In the southern hemisphere it is winter, and people there are in the midst of the winter flu
season; swine H1N1 virus seems to be replacing the seasonal flu viruses that circulated till now
-- classic pandemic behavior
THE swine flu pandemic is intensifying. The White House is meeting with state representatives
today to discuss preparations for the autumn flu season in the United States, while the United
Kingdom has shifted its response to dealing with widespread infection.
Debora MacKenzie writes that, meanwhile, in the southern hemisphere, in the midst of its
winter flu season, swine H1N1 virus seems to be replacing the seasonal flu viruses that
circulated till now -- classic pandemic behavior. This raises concerns that seasonal flu vaccine,
which some companies are still making, may be useless when the northern hemisphere's flu
season arrives later this year.
In the flu pandemics of 1918, 1957, and 1968, the pandemic virus completely replaced the
circulating seasonal flu. In 1977, however, an accidentally released mild H1N1 virus simply
•
circulated alongside the existing flu, H3N2. So no one is sure how swine H1N1 will behave, If it
does not replace the seasonal viruses -- the milder H1N1 and the H3N2 -- the world faces the
prospect of all three viruses at once, This would be a complicated scenario: both seasonal and
pandemic vaccines would be needed and differing age groups of people would be affected. From
what is happening in the southern hemisphere, though, it appears that may not happen.
In the northern hemisphere, swine flu also dominates: more than 98 percent of flu cases
genotyped in the United States in late June were caused by the pandemic virus. This is to be
expected. While seasonal flu viruses normally die out in the summer, the pandemic virus has
the advantage that few people have any immunity to it.
In Australia, the state of Victoria, the hardest hit so far, reported this week that swine H1N1.
now accounts for 99 percent of all flu cases, It is a similar story in South America. In Chile,
swine H1N1 is also outrunning the seasonal virus. "Ninety-eight per cent of the flu cases we
have now are caused by H1N1,” Chile's under-secretary of public health, Jeanette Vega, told a
pandemic summit in Cancun, Mexico, last week. "The seasonal vaccine is useless,"
In Argentina, where authorities in the capital Buenos Aires declared a health emergency last
week, health minister Juan Manzur says 90 percent of the flu virus in circulation is swine
H1N1.
For the coming winter in the northern hemisphere, this is a concern. "If the pandemic virus
massively outcompetes the seasonal viruses in a regular flu season, the seasonal viruses are
likely to be replaced by the new virus, like in the 1968 pandemic," says Ab Osterhaus of the
University of Rotterdam in the Netherlands.
MacKenzie writes that in previous pandemics, the virus has then mutated, making its effects
worse. So far H1N1 has acquired no obvious new mutations, but a few ominous signs have
• emerged. A mutation to the virus's polymerase enzyme, which makes it replicate more
efficiently, has cropped up in a sample from Shanghai, China. This could spread if it makes the
virus more contagious. But it may also increase pathogenicity, says Ron Fouchier of the
University of Rotterdam.
In the last two weeks, two cases -- one in Denmark, the other in Japan -- of swine H1N1 with
resistance to the main antiviral drug, Tamiflu, were discovered in people using the drug.
Another was -- in the United States --discovered in a girl who had never taken the drug,
suggesting Tamiflu-resistant swine H1N1 might already be circulating.
•
Board of Health
Netiv Business
.agenda Item #17., 2
Mystery Bay CommercialShellfish
Classification Change &
• Adjudicative 3fearing Option
July 16, 2009
STATE`',:
Gh,.
6)
od 1889
• STATE OF WASHINGTON
DEPARTMENT OF HEALTH
OFHCE OF SHELLFISH AND WATER PROTECTION
PO Box 47824 ® Olympia, Washington 98.E 04..78 24
(360, 238-3338 e IDD Relay Service: 1-800-833-8388
July 2, 2009
The Honorable Sheila Westerman, Chair
Jefferson County Board of Health
615 Sheridan Street
Port Townsend, Washington 98368
Dear Commissioner Westerman:
Enclosedclassificatiis anwas Initial Order reclassifying a portion of the Mystery Bay commercial shellfish
growing area in Marrowstone Island from Approved to Conditionally Approved. This change in
S on prompted by the results of a comprehensive review of pollution conditions and
marine water quality data.
The review indicates that an increase in the number and location of mooring buoys and boats in
the outer portion of Mystery Bay do not comply with National Shellfish Sanitation Program
standards for an Approved classification.
The area being reclassified is identified by dotted boundary lines in Figure 3 of the enclosed
evaluation report and is described in the Initial Order.
If you have any questions, please contact Mark Toy at (360) 236-3321 or Bob Woolrich at
(360) 236-3329.
Sincerely,
j7\ jtj
Maryanne Guichard
Office Director
Enclosures
CERTIFIED RETURN RECEIPT
STATE OF WASHINGTON
• DEPARTMENT OF HEALTH
OFFICE OF SHELLFISH AND WATER PROTECTION
MASTER CASE NO. M2009-783
In the Matter of the Reclassification of the ) FINDINGS OF FACT,
Commercial Shellfish Growing Area in ) CONCLUSIONS OF LAW AND INITIAL
Mystery Bay ) ORDER RECLASSIFYING THE
) COMMERCIAL SHELLFISH GROWING
) AREA
1 To: The Honorable Sheila Westerman, Chair
2 Jefferson County Board of Health
3 615 Sheridan Street
4 Port Townsend, Washington 98368
5
6 SECTION 1. FINDINGS OF FACT
7 The Department of Health, Office of Shellfish and Water Protection ("the Department"),
8 being in all matters fully advised, makes the following Findings of Fact:
9 1.1 Pursuant to RCW 69.30.050 and WAC 246-282-020, the Department has the authority
10 and responsibility to inspect and certify all shellfish growing areas from which shellfish
• 11 are removed in a commercial quantity or for sale for human consumption.
12 1.2 That under the authority of RCW 69.30 and WAC 246-282-005(1), the Department
13 certifies commercial shellfish growing areas in accordance with the classification criteria
14 defined by the National Shellfish Sanitation Program Model Ordinance IV.@.03,
15 Growing Area Classification ("the NSSP").
16 1.3 That, pursuant to the Department's authority referred to in paragraphs 1.1 and 1.2, the
17 Department has performed an analysis of water quality data and a review of pollution
18 source information ("the Department's evaluation") of the commercial shellfish growing
19 area in Mystery Bay, a report of which is attached and incorporated herein by reference.
20 1.4 That the results of the Department's evaluation demonstrate that, according to the
21 Department's evaluation, a portion of the commercial shellfish growing area (the outer
22 bay) that is currently classified as Approved now meets the standards for a
23 Conditionally Approved classification, according to the requirements of the NSSP.
24 The resulting Conditionally Approved area in Mystery Bay is delineated as follows:
25 The area east of the line beginning at 48.05419° N, -122.70038° W north to
26 48.05776° N, -122.69994° W and north and west of the line beginning at
27 48.05448° N, -122.69429° W northeast to 48.05534° N, -122.69163° Was noted
28 by the dotted lines in Figure 3 of the Department's evaluation. •
29
30 SECTION 2. CONCLUSIONS OF LAW
31 Based on the foregoing Findings of Fact, the Department makes the following
32 Conclusions of Law:
33 2.1 The Department of Health, Office of Shellfish and Water Protection, has jurisdiction over
34 this matter.
35 2.2 That, according to RCW 69.30, WAC 246-282-005(1), and the NSSP, the findings of the
36 Department's evaluation mandate that the commercial shellfish growing area, described
37 in paragraph 1.4, currently classified as Approved, should be reclassified as
38 Conditionally Approved.
39 2.3 That, pursuant to the authority in RCW 34.05.461 and 43.70.115(2)(a), the Secretary
40 may indicate when and under what circumstances this Initial Order may become an
41 effective Final Order.
42
43 SECTION 3. INITIAL ORDER
44 Based on the foregoing Findings of Fact and Conclusions of Law and under the •
45 authority of 34.05.461, the Secretary enters the following Initial Order:
46 IT IS HEREBY ORDERED that the commercial shellfish growing area in Mystery
47 Bay described in 1.4 and shown in Figure 3 of the Department's evaluation
48 SHALL BE RECLASSIFIED as Conditionally Approved.
49 IT IS FURTHER ORDERED that The Honorable Sheila Westerman may request
50 an adjudicative proceeding (hearing) in the matter of this Initial Order reclassifying the
51 commercial shellfish growing area in Mystery Bay.
52 IT IS FURTHER ORDERED that this Initial Order will become a Final Order
53 without further notice thirty-five (35) days from date of signature, absent a timely request
54 for an adjudicative proceeding (hearing) in this matter.
55
56 SECTION 4. REQUEST FOR ADJUDICATIVE PROCEEDING (HEARING)
57 If you wish to contest this decision, you or your representative must, within twenty-eight
58 (28) days of your receipt of this decision, complete and file the Application for Adjudicative
•
59 Proceeding or a document providing substantially the same information with Adjudicative
60 Service Unit in a manner that shows proof of service on the Adjudicative Service Unit.
61 FAILURE to submit an application within twenty-eight (28) days of your receipt of the
62 decision will constitute waiver of your right to a hearing, and the Department may decide this
63 matter without your participation and without further notice to you.
64 You must attach a copy of this decision to your application. FILING SHALL NOT BE
65 DEEMED COMPLETE UNTIL THE ADJUDICATIVE SERVICE UNIT ACTUALLY RECEIVES
66 YOUR APPLICATION.
Adjudicative Service Unit: Department of Health
Adjudicative Service Unit
310 Israel Road SE
PO Box 47879
Olympia WA 98504-7879
(360)236-4672
Dated this the 2nd day of July 2009.
• GRG GRUNENFELER, Assistant Secretary
Environmental Health Division
DECLARATION OF SERVICE BY MAIL
I declare that today I served a copy of this document upon the following persons:
The Honorable Sheila Westerman @ 615 Sheridan Street, Port Townsend, Washington 98368
Dorothy Jaffe, Assistant Attorney General @ PO Box 40109, Olympia, WA 98504-0109
by mailing a copy properly addressed with postage prepaid.
DATED AT OLYMPIA, WASHINGTON, THIS 2ND DAY OF JULY 2009.
Becky Schaffer,Administrative Assistant
Office of Shellfish and Water Protection
•
APPLICATION FOR ADJUDICATIVE PROCEEDING
MASTER CASE NO. M2009-783
• IF YOU WISH TO REQUEST AN ADJUDICATIVE PROCEEDING in the above-referenced
matter, you or your representative must, within twenty-eight (28) days of your receipt of this decision,
complete and file this Application or a document providing substantially the same information with the
Department's Adjudicative Service Unit in a manner that shows proof of receipt by Adjudicative Service
Unit.
FAILURE to submit an Application within twenty-eight (28) days of your receipt of the decision
will constitute waiver of your right to an adjudicative proceeding, and the Department may decide this
matter without your participation and without further notice to you.
In what follows, please check the appropriate response.
I do ❑ request an ADJUDICATIVE PROCEEDING in this matter.
IF YOU DO NOT WISH TO CONTEST THE DEPARTMENT'S DECISION, YOU DO NOT NEED
TO FILE THIS APPLICATION.
If you file an Application with the Adjudicative Service Unit, you must attach a copy of the
Department's decision. FILING SHALL NOT BE DEEMED COMPLETE UNTIL THE ADJUDICATIVE
SERVICE UNIT RECEIVES YOUR APPLICATION.
If, by filing an Application, you have requested an adjudicative proceeding, it may be conducted as
a formal hearing, at which you would have the opportunity to respond, present evidence and argument,
conduct cross-examination and submit rebuttal evidence. Alternatively, you may waive the formal hearing
and submit a written statement and supporting documents, which may set out your position, your defenses
and any mitigating circumstances that you may wish to bring to the Department's attention.
In what follows, please check the appropriate response and provide the information requested.
I do ❑ do not❑ waive my right to a formal hearing in this matter.
If you have chosen to waive your right to a formal hearing, please indicate whether you are ❑are
not ❑ submitting any documents to the Department in support of your position. If you are submitting
documents to the Department, please list and briefly identify all such documents in the space provided
and on such additional sheets as may be necessary:
Whether or not you have chosen to waive your right to a formal hearing in this matter, please state
all grounds for contesting the Department's decision in the space provided and on such additional sheets
as may be necessary:
•
You have the right to be represented by an attorney in this matter. If you are a hearing-impaired
person or a limited-English speaking person, the Department will provide interpretation and assistance
with notices as provided for in WAC 246-10-121 and WAC 246-10-122. •
In what follows, please check the appropriate responses and provide the information requested.
I will ❑ will not ❑ be represented by an attorney in this matter. If you have indicated that you
will be represented by an attorney, please provide your attorney's name and address in the space
provided below:
If, after submitting this request, you obtain attorney representation or change attorneys, you must
notify the Adjudicative Service Unit.
I do ❑ do not ❑ require the assistance of an interpreter in connection with this proceeding. If
you require the assistance of an interpreter, please indicate whether you are a hearing impaired person
and/or a limited-English-speaking person and the language you most readily understand below:
If you fail to timely file this Application or, if you timely file this Application, but fail to appear at any
scheduled settlement conference, prehearing conference or hearing without leave to do so, you will be
considered to have waived your right to a hearing and the Department may decide this matter without your
participation and without further notice to you.
Adjudicative Service Unit: Department of Health
Adjudicative Service Unit
310 Israel Road SE
PO Box 47879
Olympia WA 98504-7879
(360) 236-4672
Dated this the day of , 2009. Owner/Requester Contact
Phone&Address:
Party
Party's Representative
WSBA#
•
• �v y fY:S!!
mTAlE OF WASHINGTON
DEPARTMENT OF HEALTH
OFFICE of <,_.FISr and WATER PROTECTION
111 Israel Rd. SE,PO Box 47824,Olympia, Washington 98504-7824
(360)236-3330 s TOO Rela/Services 1-800-833-6388
DATE: June 12, 2009
TO: Mystery Bay Growing Area File
FROM: Mark Toy
CRe-Evaof sh ClZone y
Synopsis
•
In
SUBJEits last T:Sanitary Surveyluation of the MysteryShellfiBayosure Growing Area atMystery,in 20009 Bathe Department wrote:
"A large number of boats moor throughout Mystery Bay. Jefferson County should review
and coordinate the licensing and approval of all mooring buoys in Mystery Bay with the
Department of Natural Resources. Further increases in the numbers of boats moored within
Mystery Bay could result in an expanded closure zone within the bay, which could impact
commercial shellfish harvesting operations."
The Department has noted increases in mooring buoys and the number of boats moored
in Mystery Bay in recent years. Over 60 mooring buoys are spread across the bay, in
addition to mooring facilities at Mystery Bay State Park and several private docks. In all,
there are structures to accommodate over 100 boats in Mystery Bay. The number of
boats continuously moored in Mystery Bay outside of the State Park is approximately 30
in the winter. Up to 73 boats have been noted in Mystery Bay during the boating season.
There are no restrictions where these boats can moor. Over ten boats are moored in the
immediate area of shellfish harvest sites in the inner and outer bay on a regular basis.
The National Shellfish Sanitation Program (NSSP) definition of a marina includes any
water area with a structure(such as mooring buoys) constructed to provide temporary or
permanent docking or mooring for more than 10 boats
Based on the dispersed configuration of mooring buoys, and the number of transient and
continuously moored boats in Mystery Bay, it appears that most of Mystery Bay meets
• the NSSP definition of a marina and cannot be classified as Approved. The Department
is proposing a Conditionally Approved classification for the outer portion of Mystery Bay
Mystery Bay Closure Zone Evaluation •
June 12, 2009
Page 2
for the boating season (May 1 to September 30), as shown in Figure 3. The inner bay
may continue to remain Approved if the number of nonexempt boats in the inner bay
does not exceed ten (10), and no more than ten(10) boats are moored in the outer bay
east of the State Park boundary, as shown in Figure 3. The Department will continue to
work with mooring buoy permitting agencies to reduce the density of mooring buoys
around shellfish harvest sites.
The Department recommends that the Department of Natural Resources (DNR) and
Jefferson County take the following actions to reduce the number of mooring buoys
around shellfish harvest sites below marina threshold levels:
• Remove unauthorized mooring buoys
• Relocate as many buoys as possible away from shellfish harvest sites. The most
appropriate location within Mystery Bay is adjacent to and directly east of the
State Park. If compactly placed, up to 32 boats can be moored in this location
without risking closure to existing shellfish harvest sites.
® Develop a management system(monitoring and signage) to direct transient
overnight moorage to the State Park.
® Place a moratorium on new mooring buoy permits in the immediate area of
existing and proposed shellfish harvest sites. •
Without a reduction in the number of mooring buoys and efforts to control transient use
of the bay for overnight moorage, a seasonal closure will remain in place for the outer
bay. A further downgrade to Prohibited status may be necessary if the number and
location of boats in the outer bay continues to exceed marina thresholds during the
conditionally open period.
Introduction —A review of NSSP Requirements and FDA Guidance
Since this report may be read by a wide array of stakeholders, it seems appropriate to
provide a primer on the rationale for how the Department makes its shellfish classification
decisions around marinas. Because shellfish are filter feeders and can concentrate disease-
causing organisms and because they are commonly eaten raw or minimally cooked,the
National Shellfish Sanitation Program (NSSP) and the Department of Health(Department)
maintain strict standards for the areas where these shellfish are grown. These standards
include limits on the presence of pollution sources such as boats. The NSSP is managed
nationally by the Food and Drug Administration(FDA).
The 2007 NSSP Guide for the Control of Molluscan Shellfish(NSSP Guide) provides a
definition of a marina with respect to their program: "Marina means any water area with
a structure (docks,basin, floating docks, etc.) which is: a. Used for docking or otherwise
mooring vessels; and b. Constructed to provide temporary or permanent docking space
Mystery Bay Closure Zone Evaluation
• June 12, 2009
Page 3
for more than ten boats." FDA has stated that"any area which has buoy moorage for at
least 10 boats is also considered a marina"under this definition.
When a water area passes the marina threshold, then it cannot be considered for
Approved classification. The options for classification in Washington State are:
® Conditionally Approved—open when the number of boats drops below the marina
threshold.
• Prohibited— area closed year round.
In order for a marina area to be classified as Conditionally Approved, a management plan
must be developed that includes performance standards that reliably predict when the area
can be open and procedures to immediately place an area in closed status in 24 hours or less
when performance standards are not met. If this management plan is not followed by all
relevant parties, then the area must be reclassified as Prohibited.
The"Marina Proper" (the area immediately around the marina) cannot be open for harvest
when the marina threshold has been reached. In the case of a mooring field,this would be
the physical extent of the mooring field. Beyond this immediate area, a dilution analysis is
required to determine the extent to which marinas may impact adjacent shellfish growing
• areas.
The NSSP Guide requires the following criteria and assumptions be incorporated into a
dilution analysis:
® An occupancy rate for the marina
® An actual or assumed rate of boats which will discharge untreated waste
® An occupancy per boat rate(i.e. the number of persons per boat; default is 2)
® A fecal coliform discharge rate of 2 x 109 fecal coliforms per person per day, and
• An assumption that wastes are completely mixed in the volume of water in and
around the marina.
The FDA Guideline `Evaluation of Marinas by State Shellfish Sanitation Control Officers'
(FDA Guidance) will be used throughout this evaluation for guidance in interpreting the
NSSP Guide. The FDA Guidance states: "Because every discharge from a marine toilet has
the potential to transmit pathogens, every watercraft (barge, houseboat, or boat)public or
private, that can produce a discharge from a marine toilet shall be considered when using
this guideline to evaluate shellfish growing waters." The FDA Guidance sets the minimum
discharge rate used in the Department's dilution analysis: "A minimum factor should be
considered to provide protection against intentional or unintentional waste discharges
from boats in the marina. Even if overboard discharges are prohibited, a closure zone is
required and the SSCA should stipulate a minimum loading factor of 10 percent."
(SSCA stands for State Shellfish Control Authority; in this case, the Department.)
•
Mystery Bay Closure Zone Evaluation
June 12, 2009
Page 4
The FDA Guidance states that marine water sampling results are not taken into account in
the dilution analysis. This is because marine toilets provide limited or no treatment,
discharge intermittently and may have little travel time to impact shellfish. In addition,
the Department normally conducts its routine marine sampling during the week(when its
offices and laboratory is open) while the highest risk associated with transient use of
boats in marinas occurs on the weekends.
Mystery Bay Marina Closure Zone Evaluation
Mystery Bay is a sheltered bay of approximately 78 acres located on Marrowstone island.
Of these 78 acres, 15 are in the present Conditionally Approved area at the State Park. The
original closure zone for the State Park was developed in 1994 and included both the dock
and the associated mooring buoys in front of the dock. The balance of the outer bay is about
44 acres, with a shallower inner bay of 19 acres. Water depths at MLLW range from about
7.5 meters at the mouth of the bay to less than two meters in the inner bay.
In its last Sanitary Survey of the Mystery Bay Growing Area in 2000,the Department wrote:
"A large number of boats moor throughout Mystery Bay. Jefferson County should review
and coordinate the licensing and approval of all mooring buoys in Mystery Bay with the •
Department of Natural Resources. Further increases in the numbers of boats moored within
Mystery Bay could result in an expanded closure zone within the bay, which could impact
commercial shellfish harvesting operations."
The Department has noted increases in mooring buoys and the number of boats moored
in Mystery Bay in recent years. In response to these concerns, several meetings were
held with Jefferson County(County), the Department of Natural Resources (DNR), State
Parks, the Department of Fish and Wildlife(WDFW), and Tribal representatives between
April and October 2008. A detailed survey was conducted by the County and DNR in
August 2008. This survey identified 31 boats moored in Mystery Bay outside of the
current conditionally approved area around the State Park dock. The number of transient
boats inflates this number in summer. A survey conducted by DNR in May 2008
included photos of 40 boats on mooring buoys capable of discharging waste. In the
summer the Department has noted over fifty (50) boats in 2007 and 2008. As many as 73
boats were noted by Jake Johnson, a local shellfish grower, in an article in the May 12,
2008 edition of the Peninsula Daily News. Fewer boats moor in Mystery Bay in the
winter. Thirty-one (31) boats were noted by the Department in January 2008, and
twenty-nine(29) boats, including one at the State Park and six at the Johnson dock, were
noted by the Department in January 2009.
Data obtained from the joint County/DNR survey in August 2008 will be used in this
analysis as it includes the coordinates of mooring buoys. Figure 1 shows the location of
Mystery Bay Closure Zone Evaluation
• June 12, 2009
Page 5
mooring buoys overlain on an aerial photograph of Mystery Bay, along with the locations of
current shellfish harvest sites. As can be seen in this figure,boats and buoys are distributed
throughout the bay. In total, about 60 mooring buoys are dispersed throughout the bay, in
addition to moorage available at the State Park(capacity 48 boats), Marrowstone Island
Seafood's dock(average observed occupancy 4 boats), and a private dock(2 boats observed
in summer). In total, there are structures in this bay to accommodate over 100 boats. In
addition to this number, several boats (more during the summer boating season)also anchor
in the bay on a short-and long-term basis.
A drogue study conducted at the beginning of the afternoon flood tide on March 13,
2009, showed a short travel time from areas of boats to shellfish harvest sites. Two sets
of drogues were set out, one around the vessel Nanuq (buoy#6 in Figure 1) and the other
set around the cluster of boats near the Johnson dock(buoy#59 on Figure 1). Drogues at
buoy#6 traveled to the area of harvest site#2001-278 and from buoy#59 to harvest site
#2008-92 (some grounded at the Nordland Store dock)between 80 to 90 minutes after
being set. Travel times ranged from 5.6 to 5.9 cm/s.
In interpreting the NSSP Guide marina definition, the Department has in the past used a
density threshold of one boat per acre as a screening tool to count boats towards the
• marina threshold. The density threshold may need to be decreased in water bodies which
have poor dilution characteristics (like shallow enclosed embayments). There are two
areas in Mystery Bay outside of the State Park where one boat per acre density is
exceeded: in the inner bay around the Johnson dock and in the outer bay adjacent to the
State Park.
According to the NSSP Guide, no more than ten boats are allowed in the immediate
area for shellfish harvest sites to maintain an Approved classification. This means it is
not just the number, but the location of the boats that matters. Let us look at the area
around the Marrowstone Island Seafood facility (Johnson) dock as an example, because
this is the area with the highest density of mooring buoys from the DCD/DNR August
2008 survey and the entity most impacted by a downgrade in classification. Here is a
photograph from the Department of Ecology's Coastal Atlas of this facility
•
Mystery Bay Closure Zone Evaluation •
June 12, 2009
Page 6
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In addition to the Marrowstone Island Seafood facility(a shellstock shipper that uses this
water for wet storage and washdown of shellfish from Mystery Bay and other areas),
there are shellfish harvest sites all along the east and south shore. The August 2008
DCD/DNR survey documents 25 mooring buoys and 11 boats moored to those buoys in •
this area.
A subsequent review by DCD/DNR in the spring of 2009 revealed the following:
® Four(4)boats may be eligible for exemption under DOH criteria discussed
below.
® In order to preclude closure, at least eight(8)buoys identified in the August 2008
survey would need to be removed and transient anchorage restricted. Six (6)
buoys identified in the August 2008 survey in the inner bay are scheduled for
removal. Of these, one has an anchored vessel (Tag#43), one is a mooring buoy
with small float attached. (Tag# 58), and four are regular mooring buoys with no
boats attached (Tag#'s 37, 38, 41, 54). Two additional buoys (Tags#48 & 49)
are `warning' buoys over a support line for the Calkins dock and will not be
counted for moorage.
® Of the remaining, there are ten(10)boats and seven (7)buoys that are not eligible
for exemption under DOH criteria (3 boats are on private docks). As long as the
number of nonexempt boats in the inner bay does not exceed ten (10), and there
are no liveaboards, and numbers of boats in the outer bay are not excessive, the
area may remain open for harvest.
In the draft report, the Department stated it would consider exempting boats if:
(1) The boat owner's residence is directly upland of the mooring buoy and a home •
toilet can easily be used,
MysteryJune12, 2009 Bay Closure Zone Evaluation
•
Page 7
(2) the owner uses the mooring buoy only for their boat, and
(3) the owner submits a signed affidavit that the boat will not be used as overnight
housing and will not discharge wastewater.
It should be stressed that this is the first time that the Department has considered
exempting boats from being counted. Our rationalization for this is that if the buoy
owners are directly upland, they can easily monitor the buoy and access upland toilet
facilities. A review of harvest site records also indicates that a good portion of boat
owners living directly upland also lease tidelands around their buoy for commercial
harvest, and therefore have more of a vested interest in managing their site. At this time
DNR data show only 14 buoy owners in Mystery Bay live directly upland from their
buoy.
The Virginia Institute of Marine Sciences (VIMS) model was developed as a tool to
perform dilution analysis for marinas. It is less appropriate for an elongated marina or a
mooring field, but can be applied if the mooring field is compact. The August 2008
survey identified 12 boats among 16 buoys in the outer bay(an area bounded by buoy
#16 on the southwest corner, buoy#22 to the north, and buoy#25 to the east). Using the
VIMS model, with an average depth of 6.5 meters MLLW, yields a closure zone 700 feet
• in the direction of current and 265 feet in each direction perpendicular to the direction of
current from a centroid located between buoys #15 and #20. A drogue study conducted
on March 13, 2009, noted current velocities between 5.6 and 5.9 cm/sec at the beginning
of flood tide, which could allow pollution from a boat within 600 feet to reach adjacent
harvest sites in under an hour.
The closure zone for the VIMS analysis for the outer bay does not cover buoy#16 and
barely covers the rest of the outermost buoys in this cluster. This is because the VIMS
model assumes that the total discharge from a marina emanates from a central point,
which is an appropriate assumption for a large compact marina with slips but may not be
appropriate for an elongated marina or a dispersed mooring field. An alternate approach
would be to apply a minimum buffer zone around each mooring buoy as a sanitary line
for shellfish protection. For example, a dilution analysis for Blake Island State Park was
performed for a single mooring buoy to calculate a minimum buffer zone. The analysis
showed that a buffer zone of 200 feet around each mooring buoy(in the case of Blake
Island, a line of buoys) was required to reduce pollution below the shellfish standard of
14 FC/l00 ml. Hydrographic features are similar at Blake Island and the outer part of
Mystery Bay. Figure 2 shows this 200 foot buffer if it were applied to the mooring buoys
in Mystery Bay. Even if only the buoys with continuously moored boats are counted, it
appears that a majority of Mystery Bay would be included in the dilution buffer zone.
Again, because all mooring buoys can be used, the entire bay can be considered part of
the Marina Proper. The dilution buffer zone encroaches on nearly all the harvest sites in
• Mystery Bay. Harvest site#2001-280 is already in the Conditionally Approved area of
Mystery Bay Closure Zone Evaluation
June 12, 2009
Page 8 •
Mystery Bay State Park. Harvest site #200873, the only other harvest site in Mystery
Bay in the outer bay not included in the VIMS analysis above, is within 200 feet of buoy
#12.
DOH conducted a survey of weekend use of Mystery Bay on the weekends of May 8-9,
May 23-24 (Memorial Day weekend), and June 6-7, 2009. Boat counts were done either
in the early morning or at dusk to more accurately assess the number of boats moored
overnight. Results of this survey are summarized in the following table:
Dates # boats State Park # boats Outer Bay # boats Inner Bay
May 8-9 9 22 14
May 23-24 14 23 15
June 6-7 5 26 14
Several boats surveyed during the weekends were moored by anchors, not buoys,
attesting to their transient nature. These anchored boats were almost exclusively moored
in the outer bay. The number of boats is increasing in the outer bay as the season
progresses,but is relatively stable in the inner bay. In the outer bay in front of the State
Park, one buoy appears eligible for exemption. This leaves at least 5 buoys that would
need to be relocated, as well as successful restrictions limiting transient moorage to the •
State Park area, to preclude seasonal closure for harvest sites #2008-97 and#2001-278.
As discussed earlier, with a number of boats meeting DOH criteria for exemption the
inner bay may remain open for shellfish harvest. However, dilution analysis using VIMS
shows that a marina closure zone for ten (10)boats in this bay would have a radius of 500
feet in the direction of current. Therefore, the centroid of a cluster of ten (10) or more
boats in the outer bay must be at least 500 feet from the inner bay to keep the inner bay
open. It must be stressed that the water in the inner bay comes from the outer bay, so
maintaining an open classification for the inner bay can only be maintained in the long
term if the outer bay is managed to minimize the potential for pollution events to occur.
Discussion
Once we have made the determination that an area is a marina, the question then
becomes whether the area can be considered for Conditional Approval, or whether it is
more appropriate for the area to be classified as Prohibited. At the time the draft report
was written the recommendation was for a Prohibited classification for the entire bay.
This was based on the number and location of mooring buoys and boats in the bay and
the apparent lack of any management of their use to allow Conditional Approval of the
area. Since the draft report was released, input from permitting agencies (DNR and
Jefferson County) and other stakeholders have better documented boating use. •
Mystery Bay Closure Zone Evaluation
• June 12, 2009
Page 9
Therefore, a seasonal Conditional Approval may be appropriate, provided that the
number of non-exempt boats in the outer bay drops below marina threshold limits after
the boating season. A Conditionally Approved Area Management Plan(CAAMP) also
needs to be developed and agreed to by the growers and appropriate agencies.
The draft report generated considerable response from stakeholders (shellfish growers,
Tribes, boat owners, government agencies). Several meetings and/or conversations have
taken place between DNR, Jefferson County DCD and the Department since the draft
report was issued. It is hoped that these permitting agencies, with community input, can
in a timely fashion help the Department develop a CAAMP for Mystery Bay to
accommodate boating without restricting commercial shellfish harvest outside of the
boating season.
Summary and Recommendations
The Department has noted increases in mooring buoys and the number of boats moored
in Mystery Bay in recent years. Over 60 mooring buoys are spread across the bay, in
addition to mooring facilities at Mystery Bay State Park and several private docks. In all,
• there are structures to accommodate over 100 boats in Mystery Bay. The number of
boats continuously moored in Mystery Bay outside of the State Park is approximately 30
in the winter. Up to 73 boats have been noted in Mystery Bay during the boating season.
There are no restrictions over where these boats can moor. Over ten boats are noted in
the immediate area of shellfish harvest sites in the inner and outer bay on a regular basis,
meeting the NSSP definition of a marina.
Based on the dispersed configuration of mooring buoys, and the number of transient and
continuously moored boats in Mystery Bay, it appears that most of Mystery Bay meets
the NSSP definition of a marina and cannot be classified as Approved. The Department
is proposing a Conditionally Approved classification for the outer portion of Mystery Bay
for the boating season (May 1 to September 30), as shown in Figure 3. The inner bay
may continue to remain open if the number of nonexempt boats in the inner bay does not
exceed ten (10), and no more than ten (10) boats are moored east of the State Park
boundary, as shown in Figure 3. The Department will continue to work with mooring
buoy permitting agencies to reduce the density of mooring buoys around shellfish harvest
sites.
The Department also recommends that DNR and Jefferson County take the following
actions to reduce the number of mooring buoys around shellfish harvest sites below
marina threshold levels:
® Remove unauthorized mooring buoys
Mystery Bay Closure Zone Evaluation
June 12, 2009 .
Page 10
® Relocate as many buoys as possible away from shellfish harvest sites. The most
appropriate location in Mystery Bay is adjacent to and directly east of the State
Park. If compactly placed, up to 32 boats can be moored in this location without
risking closure to existing shellfish harvest sites.
® Develop a management system (monitoring and signage) to direct transient
overnight moorage to the State Park area.
® Place a moratorium on new mooring buoy permits in the immediate area of
existing and proposed shellfish harvest sites.
Attachments
cc: Al Scalf, Jefferson Co. DCD
Frank Benskin, Jefferson Co. DCD
Neil Harrington, Jefferson Co. Env Health
Scott, Brady, DNR
Michal Rechner, DNR
Margie Schirato, WDFW
Mike Zimmerman, State Parks
David Fyfe, NWIFC
Doug Morrill, Lower Elwah Klallam Tribe •
Kelly Toy, Jamestown S'Klallam Tribe
Randy Hatch, Point No Point Treaty Council
Rob Purser, Suquamish Tribe
Tamara Gage, Port Gamble S'K!_allam Tribe
Robin Downey, Pacific Coast Shellfish Growers Association
Johnson, Jacob J., Marrowstone Island Shellfish
Elden & Dawn Mead, Super Fresh Seafood
Thomas Longshore, Longshore's Fresh Seafood
Amanda Carr, Gordon Derr
•
...
Mystery Bay Closure Zone Evaluation
• June 12, 2009
Attachment 1
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Mystery Bay Closure Zone Evaluation
Juno 12, 2009
• Attachment 3
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Lat. 48.05776 N9
Long. 122.69994 W
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Board of 3-feaCth
Netiv Business
.agenda Item #17., 3
• Position Payers & Draft Resolution
Re: Affordable Health Choices .pct
July 16, 2009
•
PUBLIC HEALTH and PREVENTION IN HEALTH REFORM LEGISLATION
June-July 2009
REQUEST: PLEASE SUPPORT the Prevention and Wellness Trust Fund that is included in health reform
proposals under consideration in both the Senate and House of Representatives.
What is the Prevention and Wellness Trust Fund?
The proposed Prevention and Wellness Trust Fund is a new mechanism for assuring stable, reliable
support for science-based public health and prevention activities that are beyond the capacity of the health
insurance and medical care systems to provide or finance.
Why Should the Federal Government Support Public Health in Health Reform?
• It's time to put the "health" back into health care reform. The United States spends more on health
care than any nation. But we are among the unhealthiest developed nations in the world. We rank 44th
in the world in life expectancy and 41st in infant mortality. We are experiencing an epidemic of
preventable chronic diseases — diabetes, heart disease, and stroke. We are confronting potential new
epidemics of infectious diseases, from novel Hi N 1 influenza("swine flu"), to preventable illness caused
every day by contaminated food. It is in everyone's interest to invest in scientifically-proven prevention
that improves health. Healthy people have a higher quality of life. They live longer. They are
economically more productive.
. • Americans from coast to coast and across the political spectrum want prevention in health care
reform. A public opinion poll conducted in May 2009 under the auspices of the Robert Wood Johnson
Foundation found that Americans rank prevention as the most important health care reform priority.
Seventy percent (70%) of Americans ranked prevention between 8 and 10 on a scale of zero to 10.
Overall, prevention was rated higher than all other proposals, including providing tax credits to small
businesses and prohibiting health insurers from denying coverage based on health status.
• The United States must have a strong, reliable public health system in order to prevent disease
and improve health. Health insurance is essential to pay for people to get medical care when they are
sick. But it is not enough to keep them healthy in the first place. The public health system provides
population-wide prevention and protection that is beyond the capacity of the medical care system or
health insurers. Local health departments are the bedrock of this system. They keep food safe, detect
and stop outbreaks of disease, and help create conditions in the community that make it easier for people
to make healthier individual choices in their diet and exercise.
• The public health system needs a stable, reliable source of funding, as well as a highly skilled
workforce, in order to achieve the promise of health care reform to help Americans be healthier. The
Prevention and Wellness Trust Fund will ensure stable funding for science-based public health activities,
just as health insurance ensures payment for medical care. This new mechanism for supporting public
health is an essential cornerstone in creating the high-performing health system that the American
people expect.
•
American
800 i Street, N,W e WuNhiniton, DC 20001-3710
Public Health
Phone:;202)777-APHA • Fax: (202)"77-24,34
Association
u sv vim org . corm/l ts(e apha.org
Protect, Prevent, Live Well
June 16,2009
The Honorable Edward Kennedy The Honorable Michael Enzi
Chairman Ranking Member
Senate Committee on Health, Education, Labor Senate Committee on Health, Education, Labor
and Pensions and Pensions
428 Senate Dirksen Office Building 379A Russell Senate Building
Washington,DC 20510 Washington,DC 20510
Dear Chairman Kennedy and Senator Enzi:
On behalf of the American Public Health Association(APHA),the oldest and most diverse organization
of public health professionals and advocates in the world dedicated to promoting and protecting the
health of the public and our communities, I write to thank you for including strong public health and
prevention provisions in the Affordable Health Choices Act.
Earlier this year,APHA released its 2009 Agenda for Health Reform which outlines APHA's top priorities
for health reform legislation.We are very pleased that your legislation addresses many of the critical
changes we believe are needed to improve the public's health and specifically, to start moving from a
system that focuses on treating the sick to one that focuses on keeping people healthy. In particular, we
are pleased that your legislation would:
o Develop a national prevention,health promotion, and public health strategy that would set
specific measurable goals and objectives for improving the health of the U.S. through federally-
supported prevention,health promotion,and public health programs.
o Expand the work and coordination of the Community Preventive Services Task Force and the
U.S. Preventive Services Taskforce to improve effective community-based and clinical prevention
services and to improve dissemination of recommendations about effective interventions to
public health departments,practitioners, policymakers,health systems and others.
o Establish a program at the Centers for Disease Control and Prevention to facilitate the use of
health impact assessments to gauge the public health implications of major decisions regarding
the built environment, including housing,transportation systems, waste disposal sites and other
land-use planning decisions.
o Establish the inter-agency National Prevention, Health Promotion and Public Health Council to
develop a national strategy and provide coordination and leadership to all federal agencies on
prevention,wellness and health promotion,public health,and integrative health care.
•
o Create a Prevention and Public Health Investment Fund that would provide$10 billion annually
in additional sustainable funding to expand critical public health and prevention programs that
improve health and help to control private and public sector health-related costs.
•
o Establish a variety of programs to improve the supply,distribution,diversity and cultural
competence of the public health and primary care workforce,including creating a public health
workforce loan repayment program to eliminate critical public health workforce shortages and a
grant program to provide training and continuing education for mid-career public health
professionals.
o Establish a grant program for state and local governmental and community-based organizations
to implement evidence-based community preventive health activities to reduced chronic disease
rates,address health disparities(including social determinants of health),and develop a stronger
evidence-base of effective prevention programs and interventions.
o Require insurers to provide first dollar coverage for highly rated,evidence-based preventive
health services.
o Collect data and conduct research on the health and healthcare of populations that have
traditionally experienced health disparities and prioritize reducing health disparities in efforts to
improve the quality and effectiveness of health services.
Thank you again for you efforts to include strong public health provisions in this critical legislation.We
look forward to working with you and your colleagues on the committee as you move forward with
health reform legislation this year. •
Sincerely,
Georges C.Benjamin,MD,FACP,FACEP(E)
Executive Director
•
k
,, it
,. ; A -
h kt,on„I mcoc at on of County&City health of!icia&s
0 The National Connection for Local Public Health
June 15, 2009
The Honorable Edward M. Kennedy, Chairman
Health, Education, Labor&Pensions Committee
317 Russell Senate Office Building
Washington, DC 20510
The Honorable Michael Enzi, Ranking Member
Health, Education, Labor& Pensions Committee
379A Russell Senate Office Building
Washington, DC 20510
Dear Chairman Kennedy and Senator Enzi:
On behalf of the National Association of County and City Health Officials (NACCHO), I am
pleased to offer our strong support and deep gratitude for the robust emphasis on public heath,
prevention and wellness in the Affordable Health Choices Act. The provisions of Title III,
"Improving the Health of the American People," embody your recognition that health reform
addressing only access to health insurance, as important as that is, will be incomplete if it does
not also address improvement of health status in the United States and prevention of disease and
• disability.
NACCHO represents the nation's more than 2800 local health departments, government agencies
that work every day in their communities to prevent disease, promote wellness, and protect
health. NACCHO is committed to building a 21st century health system for the United States
that results in optimal health for all. Such a system will be based upon promoting good health,
rather than mitigating sickness, and will address the known determinants of health. In order to do
so, it will connect and integrate the resources and knowledge of public health, health care
delivery and research, and all private and public sector entities that influence health outcomes. It
will assure that every community is served by a robust governmental public health system.
The Affordable Health Choices Act establishes a comprehensive, scientific, and accountable
approach to nationwide health improvement. In particular, the Prevention and Public Health
Investment Fund is a long-needed innovative mechanism for financing public health and
prevention. It will provide a stable funding stream for public health and population-based
prevention activities authorized by the Public Health Service Act that are critical to improving
the health of communities but that are not, and cannot be, covered by health insurers.
Community Transformation Grants will fill an enormous gap in the nation's capacity to
implement proven strategies for reducing chronic disease rates and health inequities by changing
z_
............................
1,00 :7t±7 Street NW, SecondFick}r, Washington, DC 20036 f'(202)763 5550 F(202, 783 '583 www rsReal
s arch°.org C:
policies, environments, programs and infrastructure in communities to create the conditions in
which people can be healthier. The proposed support for health impact assessments recognizes •
the influence of the built environment on health outcomes and is an important complement to
such strategies.
The Act also recognizes the importance of advancing the evidence base for prevention.
Enhanced support for the Community and Clinical Preventive Services Task Forces is essential
to guide both public health research and practice, as is the proposed additional research in public
health services and systems. The provisions concerning a national prevention and health
promotion strategy, a"Healthy Aging, Living Well" program for adults between 55 and 64 years
of age that would be rigorously evaluated, school-based health, immunization, access to clinical
preventive services, menu labeling, and worksite wellness are all important dimensions of a
comprehensive, evidence-based approach to prevention.
NACCHO also applauds Title IV of the Act concerning the health care workforce. In particular,
we strongly and urgently support those provisions designed to address the public health
workforce shortages that, if current trends continue, threaten the nation's capacities to protect
health. Loan repayment and mid-career training for public health professionals that work in
health departments are critical to managing this problem.
NACCHO is fully committed to your goals of providing quality, affordable health coverage for
all Americans and improving the quality of health care and the health system, the other principal
topics addressed by the Act. We look forward to working with you to ensure that measures taken
to achieve these goals are accompanied by the strongest possible emphasis on public health, •
prevention and wellness, as embodied by the Affordable Health Choices Act. Additional
recommendations are attached.
Thank you for recognizing that improving health requires more than providing health care, and
for assuring that the Act includes the best and most advanced approaches to improving the health
of America.
Sincerely,
illitidt-"Wk44401AY
Robert M. Pestronk, MPH
Executive Director
•
2
Recommendations for Improvements to the Affordable Health Choices Act
• National Association of County and City Health Officials
June 15, 2009
1. Ensure that new population-based public health programs, including Community
Transformation grants, grants for Health Impact Assessment, the Healthy Aging, Living Well
program, and others established in Title III are eligible for funding from the Prevention and
Public Health Investment Fund.
2. Covered clinical preventive services should not be subject to cost-sharing. There is good
evidence to suggest that any level of cost-sharing, however minimal, may discourage use.
3. The proposed "Community Health Teams" established to increase access to comprehensive,
community-based, coordinated care should be termed "Primary Care Based Community Health
Teams" in order to reflect more precisely a principal purpose of establishing such entities.
4. Dental health care should be incorporated into the definition of"comprehensive primary care
services" to be provided by school-based health clinics. Poor dental health is an important factor
in the ability of school children to eat and to learn optimally and is a significant public health
problem.
5. Research on optimizing the delivery of public health services should strongly emphasize the
translation of research on community-based public health interventions from academic settings
• to governmental health departments, in addition to other"real world" settings.
6. The Subtitle D of Title IV concerning Enhancing Health Care Workforce and Training would
also aid in addressing the public health workforce shortage if the following additions were made:
a. Include training programs for physicians in preventive medicine and public health in
the grant program to establish, maintain and improve training programs and academic units.
b. Establish training grants for schools for development, expansion, or enhancement of
training programs in public health, graduate public health and in-service training to professionals
in public health practice and to improve retention of public health practitioners at the local and
state level, to the extent that such activities are not eligible for funding under current or other
proposed law.
7. Workforce diversity grants analogous to those provided for nursing would greatly benefit
community colleges, undergraduate schools, and graduate schools preparing personnel for the
local public health workforce.
•
3
• THE BOARD OF HEALTH OF
JEFFERSON COUNTY
RESOLUTION NO. 2009-1
A RESOLUTION URGING IMMEDIATE PASSAGE OF COMPREHENSIVE
FEDERAL HEALTH REFORM LEGISLATION
WHEREAS, experts from across the political spectrum agree that America's
health system is "broken" and unsustainable in its present configuration; and
WHEREAS, families in Jefferson County are experiencing this crisis right now,
confronting the high cost of health care that threatens their financial stability, leaves them
exposed to higher premiums and deductibles, and puts them at risk for a possible loss of
health insurance; and
WHEREAS, employer-sponsored health insurance premiums have nearly
doubled in recent years making it increasingly difficult for employers, including county
governments, to provide health insurance coverage for their employees and retirees; and
• WHEREAS, millions of Americans do not have health coverage, or have
inadequate coverage and as our economic challenges multiply, the problem of health care
access grows, further straining counties' capacity to provide care for the uninsured,
underinsured and medically indigent; and
WHEREAS, a growing number of Jefferson County residents find themselves
uninsured for all or part of the year, risking potential bankruptcy if major medical
expenses are incurred; and
WHEREAS, county officials are elected to protect the health and welfare of their
constituents: and
WHEREAS, Jefferson County's main Public Hospital District, Jefferson
Healthcare, has admirably maintained its commitment to see all County residents in need,
irrespective of insurance status or ability to pay, and in doing so has incurred steadily
increasing and unsustainable costs for the uncompensated care provided ; and
WHEREAS, the National Association of Counties (NACo) Health System
Reform Working Group, appointed by President Don Stapley in July 2008 and chaired by
President-Elect Valerie Brown, has held three regional hearings to explore the health
crisis and to hear what county officials believe should be done about it and has
summarized its findings in Restoring the Partnership for American Health: Counties in a
•
21S`Century Health System which was approved and adopted by resolution of the NACo
Health Steering Committee and Board of Directors on March 9, 2009. ID
NOW THEREFORE BE IT RESOLVED that the Jefferson County Board of
Health endorses NACo's health reform principles, as summarized in Restoring the
Partnership for American Health: Counties in a 21s` Century Health System; namely, that
reform legislation should
1. restore the partnership between county and federal governments;
2. provide access to affordable, quality health care to all;
3. invest in public health, including health promotion and disease and injury
prevention;
4. stabilize and strengthen the local health care safety net system, especially
Medicaid and disproportional share hospital (DSH)payments;
5. invest in the development of the health professional and paraprofessional
workforce;
6. ensure that county health agencies have the resources to meaningfully use health
information technology;
7. enable elderly and disabled persons to receive the services they need in the least
restrictive environment; and
8. reform the delivery and financing of health services in the jail system.
BE IT FURTHER RESOLVED that the Board strongly urges the 111th
Congress of the United States to enact comprehensive health reform legislation without
delay before the end of its first session.
APPROVED, ADOPTED AND PASSED,THIS day of , 2009.
THE BOARD OF HEALTH OF JEFFERSON COUNTY
By:
Sheila Westerman, Chair
•
2
Board of 3Cealth
Netiv Business
.Agenda Item #17., 4
gri6al NlutuaCAssistance
• .agreement:
Draft Open for Comment
July 16, 2009
•
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OLYMPIC REGIONAL TRIBAL-PUBLIC HEALTH COLLABORATION
• AND
MUTUAL AID AGREEMENT
This Olympic Regional Tribal-Public Health Collaboration and Mutual Aid Agreement
("Agreement" or"MAA") 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"), and the
signatory Tribal Government(s) ("Party TG"), individually with all other signatory Party HDs
and Party TGs legally joining the Agreement.
PURPOSE
The undersigned Party HDs and Party TGs 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 or Party TGs
to this Agreement possesses all of the necessary resources to cope with every possible Public
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 and Party TG 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 and Party TGs find it necessary and desirable to
execute this Agreement for the interchange of such Assistance on a regional basis.
The Party HDs and Party TGs desire to have the option to provide or receive day to day public
health services, isolation and quarantine public health services, or any other public health service
permitted by law. This Agreement will facilitate the provision and reception of such optional
public health services between or among any two or more parties to this Agreement.
The Party HDs and Party TGs 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 and Party TGs desire to cooperate with one another to receive state and/or federal
resources provided such cooperation does not compromise a Party HD's or Party TG's public
health response. The Party HDs and Party TGs desire to engage in frequent consultation and to
allow free exchange of information, health information, plans, and resource records related to
Assistance activities.
1111
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ARTICLE I •
AUTHORITY
Each Party TG has non-exclusive authority over public health measures that affect certain People
on Tribal Lands, whether Indian or Non-Indian, and has authority under its constitution, tribal
codes and other applicable laws to enter into this Agreement.
Each Party HD's health officer has authority pursuant to RCW 70.05.070 and WAC 246-100 et
seq., among other laws, to control and prevent the spread of any dangerous, contagious or
infectious diseases that may occur within its jurisdiction and to order isolation or quarantine, if
necessary. WAC 246-100-036(4)provides that a local health department may make agreements
with tribal governments that empower the local health officer to conduct investigations and
institute control measures in accordance with WAC 246-100-040 on tribal lands.
ARTICLE II
DEFINITIONS
Assistance: Assistance means personnel, equipment, materials, supplies, facilities, services,
and/or related resources.
Authorized Representative: The person or persons designated by each Party HD and Party TG in .
the Plan to request Assistance from or grant Assistance to another Party HD or Party TG
pursuant to the terms of this Agreement.
Health Information: Written, electronic, oral, telephonic, or visual information, identifiable or
population based, that relates to an individual's or population's past, present or future physical or
mental health status condition, treatment, service or products purchased, and includes, but is not
limited to laboratory test data or samples.
Identifiable data or information: The exchange or sharing of identifiable data or information that
is specific to an individual or that there is a reasonable basis to believe could be used to identify
an individual, as governed by the Health Insurance Portability and Accountability Act of 1996
("HIPAA"), and including, but not limited to, its public health related exceptions.
Local Health Officer: The legally qualified physician who has been appointed as the health
officer for the county or district public health department, whose qualifications are set forth in
RCW 70.05.and RCW 70.08 et seq..
Mutual Aid: A prearranged written Agreement and Plan whereby Assistance is requested and
may be provided under the terms of this Agreement between two or more jurisdictions during a
Public Health Incident, Emergency or Disaster, or related to day to day public health services,
communicable disease outbreak, isolation and quarantine public health services, or any other
public health service or action permitted by law. •
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People on Tribal Lands: Members of each Tribe whose Party TG is a signatory to this
Agreement, members of other federally recognized tribes who reside on that signatory Party
TG's Tribal Lands, and all of that signatory Tribe's employees, residents, visitors, and guests,
and all other people on its Tribal Lands(collectively, "People on Tribal Lands").
Period of Assistance: The period of time beginning with the departure of any personnel,
equipment, materials, supplies, services, and/or related resources of the Responding Party HD or
Party TG from any point for the purpose of traveling to provide Assistance exclusively to the
Requesting Party HD or Party TG , and ending on the return of all of the Responding Party HD's
or Party TG'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 Responding Party HD or Party TG . With respect
to facility use, the Period of Assistance shall commence on the date agreed upon between the
Requesting and Responding Party HD or Party TG and shall end when the Requesting Party HD
or Party TG returns possession of the facility to the Responding Party HD or Party TG, or when
otherwise terminated through written or verbal notice of the Authorized Representative of the
Responding Party HD or Party TG.
Plan: a written Tribal-Public Health Collaboration and Mutual Aid Plan that meets the
requirements set forth in Article VIII, and sets forth protocols and procedures related to MAA
activation, staging and deployment, field support, demobilization, reimbursement, other MAA
matters, and standard operating procedures.
• 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 to its
authority under chapter 70.05 or 70.46 RCW, or other applicable law, or to which any Party TG
may respond pursuant to its authority under its constitution, codes, or other applicable law, and
that, in the judgment of the Requesting Party HD or Party TG, results or may result in
circumstances sufficient to exceed the capabilities of immediate local, tribal or regional public
health response.
Requesting Party HD or Party TG: A Party HD or Party TG that has requested Assistance from a
Party HD or Party TG from another jurisdiction participating in this Agreement.
Responding Party HD or Party TG: A Party HD or Party TG providing Assistance to a
Requesting Party HD or Party TG from another jurisdiction participating in this Agreement.
Tribal Lands: With respect to each individual Tribal Government signatory to this Agreement,
tribal lands shall mean land within that Tribe's Tribal Reservation boundary, its Tribal Trust
Lands, its Tribal Member Trust Lands, lands governed by any and all of its Tribal Settlement
Agreement(s), and any other tribal or non-tribal lands or buildings under the ownership,
leasehold, or other supervision or control of its Tribal Government or its agents, and collectively,
as those lands may be added to or subtracted from, from time to time.
• Tribal Health Officer: The person designated by a Party TG to exercise health officer authority.
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ARTICLE III •
IMPLEMENTATION
This Agreement shall become effective immediately upon its execution by any one Party HD and
one Party TG. After the first two such executions,this Agreement shall become effective as to
any other Party HD or Party TG upon its execution by such Party HD or Party TG. The
Agreement shall remain in effect as between each and every Party HD and Party TG until
participation in this Agreement is terminated by a withdrawing Party HD or Party TG in writing
pursuant to Article XVIII. Termination of participation in this Agreement by a withdrawing
Party HD or Party TG shall not affect the continued operation of this Agreement as between the
remaining Party HDs and Party TGs, so long as at least one Party HD and one Party TG continue
to participate.
ARTICLE IV
PARTICIPATION
The Party HDs and Party TGs have a desire to be of help to one another in response to a request
for Mutual Aid Assistance. The Party HDs and Party TGs agree that this Agreement, however,
does not create a legal duty to provide Mutual Aid Assistance. The Party HDs and Party TGs
agree that any and all actions taken pursuant to this Agreement shall be voluntary and in each
Party HD's or Party TG's sole discretion. A Party HD or Party TG may elect to voluntarily •
furnish such Mutual Aid Assistance to another Party HD or Party TG 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 V
HOW TO INVOKE ASSISTANCE
The Authorized Representative of a Party HD or of a Party TG may request Mutual Aid
Assistance of another Party HD or Party TG by contacting the Authorized Representative of that
Party HD or Party TG. 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 VI
LIABILITY RELATED TO DELAY OR FAILURE TO RESPOND
No Party HD or Party TG shall be liable to another Party HD or Party TG 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.
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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 and Party TGs. This
Agreement shall not release or discharge any obligation or liability of any third party to any
Party HD or Party TG.
ARTICLE VII
WITHDRAWAL FROM ASSISTANCE
A Responding Party HD or Party TG may withdraw Mutual Aid Assistance by giving verbal or
written notice to the Requesting Party HD or Party TG. Each Responding Party HD or Party TG
that is providing Mutual Aid Assistance to a Requesting Party HD or Party TG agrees to give
reasonable notice to the Requesting Party HD or Party TG under the circumstances as they exist
at the time before withdrawing such Assistance. No Party HD or Party TG shall be liable to
another Party HD or Party TG for, or be considered in breach of or default under this Agreement
on account of, any withdrawal of assistance.
ARTICLE VIII
PLANNING, MEETING AND TRAINING
• Party HDs and Party TGs are expected to:
1) ensure that other Party HDs and Party TGs have their most current contact information;
2) participate in an initial regional exercise to coordinate operational and implementation
matters, and
3) participate in the creation of a Tribal-Public Health Mutual Aid Plan.
Party HDs and Party TGs agree to incorporate protocols related to this Agreement into regular
emergency preparedness exercises and trainings, and will train in accordance with the Plan. Party
HDs and Party TGs agree to exchange their emergency preparedness plans, and other documents
that may be beneficial in preparing personnel from another Party HD or Party TG to respond to a
request for Mutual Aid Assistance.
ARTICLE IX
COMMAND AND CONTROL
The parties recognize the need for a qualified and experienced person to function in the role of a
public health local health officer in Party HDs'jurisdictions and Party TGs'jurisdictions, and for
public health laws to govern the response. Party TGs may not have Tribal Health Officers on
their staffs or on contract at the time that a Public Health Incident, Emergency or Disaster occurs.
Party TGs also may not have adopted public health codes, or may have adopted codes that
• govern certain public health issues but not others. Until such time that a Party TG hires or
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contracts with its own Tribal Health Officer, and adopts a public health code(s) governing the
specific public health issue necessitating response, the Party TG and Party HDs agree that in the
event of a Public Health Incident, Emergency or Disaster, communicable disease outbreak, or
isolation or quarantine event, Party TGs will choose to exercise tribal public health authority in
one of the following manners:
Option One:
1. The Party TG may decide to grant to the Party HD in its closest geographical
proximity permission to exercise public health authority, in consultation with the
Party TG's health director, over the Party TG's Tribal Lands, People on Tribal Lands
and members off Tribal Lands but within the respective Party HD's county.
2. In the event the Party TG has not yet adopted a public health code(s)that addresses
the specific public health response, then the Party HD and Party TG agree that the
Party HD will exercise this grant of authority in conformance with federal, state and
local public health laws that address the specific public health response, and such
public health laws shall be deemed applicable as if adopted as tribal code. Party TGs
shall be responsible to take such actions as are necessary to implement this provision,
if any. Examples of the types of Washington State laws that a Party TG might agree
to voluntarily invoke include those related to tuberculosis control, sexually
transmitted disease control, substantial exposure to bodily fluids, communicable
disease control, isolation and quarantine, biomedical wastes, emergency response, or
other law.
3. If the Party TG has adopted a public health code(s)that addresses the specific public •
health response, then the Party HD and Party TG agree that the Party HD will
exercise this grant of authority in conformance with applicable tribal, federal, state
and local public health laws. If there is a conflict between or among tribal public
health code requirements, federal, state or local law, the Party HD may decline to
accept, or withdraw its acceptance of, the authority.
4. Either the Party TG or Party HD may withdraw, rescind, decline, or refuse this grant
of authority at any time. Such withdrawal, rescission, declination or refusal of
authority must be in writing directed to each respective Party HD's or Party TG's
Authorized Representative.
Option Two:
1. The Party TG will exercise its own public health authority. The Party TG may seek
technical assistance from the Party HD. The parties understand and agree that in
such event, the ability or willingness of Party HD personnel to respond within the
tribal jurisdiction may be limited, however, technical assistance may still be available.
2. Either the Party TG or Party HD may withdraw, rescind, decline, or refuse the request
for technical assistance at any time. Such withdrawal, rescission, declination or
refusal of technical assistance must be in writing directed to each respective Party
HD's or Party TG's Authorized Representative.
•
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Party TGs will select Option One or Option Two at the time of a Public Health Incident,
SEmergency or Disaster, communicable disease outbreak, or isolation or quarantine event. The
Plan will create procedures and forms for implementing option selection, and for issues related to
isolation and quarantine procedures.
Under either Option One or Option Two, any resources and non-medical personnel from the
Responding Party HD or Party TG shall be under the operational control of the Requesting Party
HD's or Party TG's public health leadership. All medical personnel provided by a Responding
Party HD or Party TG will be under the clinical supervision of the Responding Party HD's Local
Health Officer or the Responding Party TG's Tribal Health Officer unless the Local Health
Officer or Tribal Health Officer delegates such supervision to the Requesting Party's
appropriately licensed medical provider. The Party HDs and Party TGs intend to follow the
National Incident Management System's "Incident Command System"when such system is
activated.
Party TGs may choose to contract with Party HDs or others for day to day public health services
to the full extent permitted by law.
ARTICLE X
RESPONDING PARTY EMPLOYEES
Employees of a Responding Party HD or Party TG shall at all times while performing Mutual
• Aid Assistance continue to be employees of the Responding Party HD or Party TG for any
purpose. Wages, hours and other terms and conditions of employment of Responding Party HD
or Party TG shall remain applicable to all of its employees who perform Mutual Aid Assistance
under this Agreement. Responding Party HD or Party TG shall be solely responsible for payment
of its employees' wages, any required payroll taxes and any benefits or other compensation.
Requesting Party HD or Party TG shall not be responsible for paying any wages, benefits, taxes
or other compensation to Responding Party HD's or Party TG's employees.
ARTICLE XI
INJURY COMPENSATION AND DEATH BENEFITS
Each Party HD and Party TG 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 or Party TG'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 or Party TG 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 or Party TG shall
remain fully responsible as employer for all taxes, assessments, fees, premiums, wages,
• withholdings, Workers' Compensation, and other direct and indirect compensation, benefits, and
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related obligations with respect to its own employees. Each Party HD and Party TG shall provide
Workers' Compensation if required by the laws of the State of Washington, or any other law or •
agreement.
ARTICLE XII
REIMBURSEMENT OF COSTS AND CONDITIONS OF LOAN
The Requesting Party HD or Party TG agrees to reimburse the Responding Party HD or Party
TG 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 a Responding Party HD or Party TG deploys employees under the
terms of this Agreement to a Requesting Party HD or Party TG ,the Responding Party HD or
Party TG will be reimbursed by the Requesting Party HD or Party TG equal to the Responding
Party HD's or Party TG's full cost, including employee's salary or hourly wages, call back or
overtime costs, benefits and overhead, and consistent with the Responding Party HD's or Party
TG's personnel union contracts, if any, or other conditions of employment. Reusable materials
and supplies that are returned to the Responding Party HD or Party TG in clean, damage free
condition, excepting normal wear and tear, shall not be charged to the Requesting Party HD or
Party TG and no rental fee shall be charged. The Responding Party HD or Party TG 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 Responding Party HD or Party TG shall be entitled to receive payment for the cost
of repair or replacement of damaged and consumed materials and supplies. The Responding •
Party HD or Party TG shall send the Requesting Party HD or Party TG an invoice or invoices for
all valid Assistance Costs and the Requesting Party HD or Party TG shall pay the invoice(s)
within sixty(60) days of receipt of each invoice.
Notwithstanding the above, nothing shall prevent any party from waiving a request for
reimbursement.
To the extent that any third party payer, such as the United States Government or the State of
Washington, has funds or processes available for reimbursement of a party's activities under this
Agreement,the parties agree to cooperate fully with one another in submitting any appropriate
claim(s) for reimbursement and providing copies of records necessary to submit claims.
ARTICLE XIII
WORKER REGISTRATION, LIABILITY AND DISPUTE RESOLUTION
1. WORKER REGISTRATION AND LIABILITY. The Party HDs and Party TGs 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 •
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and Party TGs agree that prior to invoking a request for Assistance under this Agreement,
Sthe Requesting Party HD or Party TG, through its own or its nearest local department of
emergency management, will request the issuance of a mission number from the
Washington military department, emergency management division. A Party HD or Party
TG 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 Responding and Requesting Party HDs or
Party TGs.
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 or Party TG, then such waiver, immunity,
indemnification, reimbursement or other payment shall limit a Party HD's or a Party
TG's liability. The Party HDs and Party TGs 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 or Party TG 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 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 or Party TG shall not be required under this Agreement to release,
indemnify, hold harmless or defend any other Party HD or Party TG from any
claim, loss, harm, liability, damage, cost or expense caused by or resulting from
the activities of any Party HD's or Party TG'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 or Party TG 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.
•
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D. LEGAL PROCEEDINGS COOPERATION. Party HD's or Party TG's personnel
shall cooperate and participate in mediation, arbitration or other legal proceedings •
if so requested by another Party HD or Party TG, and/or required by a court of
competent jurisdiction.
E. TORT CLAIMS ACT.No provision of this Agreement shall remove from any
Party HD or Party TG any protection provided by any applicable Tort Claims Act.
F. WAIVER OF RIGHTS. Any waiver at any time by any Party HD or Party TG 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.
3. DISPUTE RESOLUTION. This Section shall govern the resolution of all disputes arising
from the implementation of this Agreement.
Purpose. The parties intend to resolve their disputes through direct discussion and, if
such is not possible,then through the dispute resolution framework established below.
All stated time frames for resolving disputes may be lengthened by mutual consent.
Direct Discussions. To initiate dispute resolution under this subsection, the complaining •
party shall first provide notice by submitting a written complaint letter to the
representative of the party (as identified in this Agreement) against whom a dispute is
lodged, stating therein the nature of the dispute, the requested resolution, and the factual
basis supporting the requested resolution. The responsive party shall, within ten(10)
business days of receiving the complaint letter,provide a written response, stating its
agreement or disagreement with the nature of the.dispute and the requested resolution. If
the responsive party disagrees with the complaint or the proposed resolution, the written
response must provide at least one alternate resolution and the factual basis supporting
such resolution(s). Thereafter, the representatives of each party will, for fifteen (15)
business days, make a good faith attempt to resolve the dispute through one or more
direct discussions. If no mutually acceptable resolution is reached, the lead
representatives will prepare a joint statement within 5 business days, which includes a
chronology, a synopsis of the discussions that took place and the last stated positions of
each party.
Mediation. If direct discussions between the parties fail to resolve the dispute, any
participating party may, within five business days of completing the direct discussion
process, make a written request for mediation to be conducted at a place as the parties
may agree in writing. If all participating parties agree to engage in mediation,the parties
shall seek a mutually acceptable mediator. If the parties cannot reach agreement on the
selection of the mediator within fifteen (15) business days of the date the written
mediation request letter was received by the other party or parties,the mediation will be •
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administered by J.A.M.S., Seattle, Washington Office using a J.A.M.S. mediator and
• protocol. Enforcement of a mediation agreement reached shall be the same as
enforcement of an arbitration decision as set forth herein. If a party objects to proceeding
with mediation, then mediation may be bypassed, and the dispute resolved pursuant to
arbitration as set forth herein.
Binding Arbitration. Should direct discussions prove unsuccessful in resolving the
dispute, and either mediation is not requested, is bypassed, or is also unsuccessful, either
the complaining or responsive party may make a written demand for arbitration before a
single arbitrator in Seattle, Washington or at another place as the parties may agree in
writing. If the parties cannot reach agreement on the selection of the single arbitrator
within fifteen (15) business days of the date the written demand letter was received, the
arbitration will be administered by J.A.M.S., Seattle, Washington Office using a J.A.M.S.
arbitrator. Any arbitrator selected must have a fundamental knowledge of and at least
five(5) years' legal experience working with contract law and a working knowledge of
Indian law,public health law, and municipal law. The arbitrator shall have the power to
establish a schedule for the hearing which hearing shall be limited to no more than 2
consecutive business days to be equally divided between the parties, including
preliminary discovery to the extent he or she deems necessary and proper under the
circumstances and to make reasonable rules and issue orders necessary for a fair and
efficient conduct of the hearing, and to conduct the hearing and administer oaths and
affirmations. The arbitrator's decision shall be accompanied by an explanation as to the
basis for the award. Each party will pay for its own attorneys' fees. All arbitration
• awards shall be binding upon the parties and non-appealable. Relief may include
temporary, injunctive or other provisional remedies, along with all other remedies
available in equity or at law, except as expressly limited in this Agreement.
Enforcement of Arbitration Award. Upon the issuance of an arbitration award or
mediation agreement, the prevailing party may seek the entry of judgment upon the
award in any court of competent jurisdiction which for purposes of Party HD's
enforcement against a Party TG means the Tribal Court, and for a Party TG's
enforcement against a Party HD means federal court, or if federal court jurisdiction is not
available, the Party TGs agree to submit to Kitsap or Jefferson County Superior Court, as
appropriate, in Washington for enforcement of the award against a Party HD. The court
of competent jurisdiction shall enforce the decision of the arbitrator and shall not modify,
correct, alter or vacate said decision in any way unless the court finds after notice and
hearing upon application of a party to the arbitration, one or more of the following: (1)
the arbitration decision was procured by corruption, fraud or undue means, (2) there was
evident corruption in the arbitrator, or(3) the arbitrator was guilty of the specific
misconduct of refusing to hear evidence pertinent and material to the controversy which
prejudiced the rights of a party. No court shall have jurisdiction to interfere in any way
with any pending arbitration. No party may seek from such court any provisional remedy
pending appointment of the arbitrator or the arbitrator's rendition of the award. If the
court vacates the arbitration decision, then the court shall direct a rehearing either before
the same arbitrator or before a new arbitrator to be chosen in the manner provided in this
• section.
11
Draft 5: June 15, 2009
Limited Waiver of Sovereign Immunity by the Tribe. Except for the limited waiver of .
sovereign immunity provided in this Dispute Resolution subsection, nothing in this
Agreement shall be construed as a general or specific waiver of a Party TG's sovereign
immunity, which immunities are expressly asserted. The Party TGs hereby gran to the
Party HDs a limited waiver of sovereign immunity solely for the purpose of dispute
resolution as provided in this Agreement and such waiver shall not be extended to any
other person, agency or entity ("Limited Waiver"). This Limited Waiver applies only to
claims arising out of or under this Agreement and does not apply to any other claims
under any other agreements among the parties. Furthermore,nothing contained in this
Limited Waiver shall be construed to create a contractual relationship with or a cause of
action in favor of any third party against any Party TG. This Limited Waiver applies
only to the enforcement of a mediation agreement or an arbitration award against the a
Party TG,provided such mediation agreement or arbitration award has been secured in
accordance with this Agreement.
No Requirement of Exhaustion of Tribal Court Remedies. The parties acknowledge that
under the limited waiver of sovereign immunity provided for herein, the assumption of
jurisdiction by any arbitrator or court of competent jurisdiction shall not be delayed or
curtailed by any doctrine requiring exhaustion of Tribal court remedies.
No Consent to State Court For Any Purpose. The Party TGs expressly state and the Party
HDs understand and acknowledge that the Party TGs do not consent to the jurisdiction of
the Superior Court of the State of Washington or any other state court for any purpose •
except if necessary to enforce an arbitration or mediation award, or by mutual consent.
ARTICLE XIV
LICENSES AND PERMITS
When invoking Assistance, the Requesting Party HD or Party TG shall define as precisely as
possible the licensure requirements of personnel being requested from the Responding Party HD
or Party TG. The Responding Party HD or Party TG agrees to exercise reasonable diligence in
verifying personnel's licensure and in responding to the specific licensure requirements
requested by the Requesting Party HD or Party TG.
ARTICLE XV
RECORD KEEPING AND INFORMATION SHARING
Time sheets and/or daily logs showing hours worked and equipment and materials used or
provided by the Assisting Party HD or Party TG will be recorded on a shift by shift basis by the
Requesting Party HD or Party TG and/or the loaned employee(s) and will be provided to the
Responding Party HD or Party TG as needed. Additionally, the Responding Party HD or Party
TG will provide shipping records for materials, supplies, equipment and/or related resources, and
the Requesting Party HD or Party TG is responsible for any required documentation of use of •
12
Draft 5: June 15, 2009
materials, supplies, equipment, facilities, services, and/or related resources for state or federal
• reimbursement. Under all circumstances, the Requesting Party HD or Party TG remains
responsible for ensuring that the amount and quality of all documentation is adequate to enable
state or federal reimbursement.
The Parties agree to share disease or contaminant information, including but not limited to health
care information and protected health information, as permitted under RCW 70.02.050 and 45
CFR 164.512. The Parties shall maintain their own records and reports concerning the provision
of any support or services under this Agreement, and patients' medical records shall be
maintained at the Requesting Party HD or Party TG facility.
ARTICLE XVI
OTHER OR PRIOR AGREEMENTS
This Agreement is not intended to be exclusive among the Party HDs and Party TGs. Any Party
HD or Party TG may enter into separate agreements with any other entity. No such separate
agreement shall terminate any responsibility under this Agreement.
ARTICLE XVII
• EFFECT OF DECLARATION OF EMERGENCY
The Party HDs and Party TGs 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 XVIII
MODIFICATION/TERMINATION OF AGREEMENT
No provision of this Agreement may be modified, altered or rescinded by any individual Party
HD or Party TG without the unanimous concurrence of the Party HDs and Party TGs.
Modifications to this Agreement must be in writing and will become effective upon the approval
of the modification by Party HDs and Party TGs. Modifications must be signed by each Party
HD and Party TG.
A Party HD or Party TG opting to terminate this Agreement shall provide written termination
notification to the Authorized Representatives of all Party HDs and Party TGs. Notice of
termination becomes effective upon receipt by all Authorized Representatives. Any terminating
Party HD or Party TG shall remain liable for all obligations incurred during its Period of
Assistance until the obligation is satisfied.
•
13
Draft 5: June 15, 2009
ARTICLE XIX
ENTIRE AGREEMENT •
This Agreement constitutes the entire agreement amongst the Party HDs and Party TGs.
ARTICLE XX
SUCCESSORS AND ASSIGNS
This Agreement is not transferable nor assignable, in whole or in part, and any Party HD or Party
TG may terminate its participation in the Agreement pursuant to Article XVIII.
ARTICLE XXI
GOVERNING LAW
This Agreement shall be interpreted and construed in accordance with the laws of the State of
Washington and the United States.
ARTICLE XXII •
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 XXIII
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 and Party TGs at the address
designated by such Authorized Representative, or(iv) sent by email with electronic signature of
the Party HD's or Party TG's Authorized Representative.
•
14
Draft 5: June 15, 2009
ARTICLE XXIV
• NO DEDICATION OF FACILITIES
No undertaking by one Party HD or Party TG to the other Party HD or Party TG under any
provision of this Agreement shall constitute a dedication of the facilities or assets of such Party
HD or Party TG, or any portion thereof, to the public or to the other Party HD or Party TG.
Nothing in this Agreement shall be construed to give a Party HD or Party TG any right of
ownership, possession, use or control of the facilities or assets of the other Party HD or Party
TG.
ARTICLE XXV
NO PARTNERSHIP
This Agreement shall not be interpreted or construed to create an association,joint venture or
partnership among the Party HDs or Party TGs or to impose any partnership obligation or
liability upon any Party HD or Party TG. Further, no Party HD or Party TG 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 or Party TG.
• THIS AGREEMENT may be executed in two or more counterparts, each of which shall be
deemed an original, but all of which together shall constitute one and the same instrument. For
purposes hereof, a facsimile copy of this Agreement, including the signature pages hereto, shall
be deemed to be an original.
IN WITNESS WHEREOF, this Agreement has been executed and approved and is effective and
operative as to each of the Party HDs and Party TGs as herein provided.
Kitsap County Health District
By:
Its:
Date:
•
15
Board of Health
_Media Report
r
July 16, 2009
•
Jefferson County Public Health
• June/July 2009
NEWS ARTICLES
1. "Anderson, Leland lakes remain closed," Peninsula Daily News, June 14th, 2009.
2. "Tribes upset over shellfish protection," Peninsula Daily News, June 14th, 2009.
3. "Swine flu protocols in place," Peninsula Daily News, June15th 2009.
4. "Shellfish farmers reassured," Peninsula Daily News, June 16th, 2009.
5. "Plankton adding its color," Peninsula Daily News, June 19th, 2009.
6. "Shore buffers debated," Peninsula Daily News, June 19th, 2009.
7. "Toxic algae keeps Anderson closed," Peninsula Daily News, June 21st, 2009.
8. "Septic tank program scheduled," Peninsula Daily News, June 24th, 2009.
9. "Learn well, septic maintenance Saturday," Port Townsend Leader, June 24th, 2009.
10. "Toxic algae bloom closes lake," Peninsula Daily News, June 26th, 2009.
11. "Health warning issued for Gibbs Lake," Port Townsend Leader, July 1st, 2009.
12. "Vaccine funding dries up," Peninsula Daily News, July 2nd, 2009.
13. "Swimming prohibited in Jefferson lakes," Peninsula Daily News, July 5th, 2009.
14. "Childhood vaccination program faces changes," Port Townsend Leader, July 8th,
2009.
15. "A `WlCnic' helps low-income people pick fresh, local produce," Port Townsend
Leader, July 8th, 2009.
•
•
,-4. , ._, • , ,,,,,--- rs , ,,, , .
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t
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• • Anderson Lake, anatoxin-a and
New toxicity "The lakes were looking exposure to it an cause convul-
better for a couple of sions and death by respiratory
tests reveal . weeks, and I was hoping paralysis.
Lake Leland's algae bloom is
they were going to open. composed of several species of
no changes Then they took a turn for blue-green algae of the genera
the worse." oscillatoria, aphanizomenon and
microcystis.
BY JEFF CHEW NEIL HARRINGTON Jefferson County Public
PENINSULA DAILY NEWS water quality manager, Health is continuing seasonal
PORT TOWNSEND — Jef Jefferson County sampling of recreational lakes
ferson County Public Health offi- for toxic blue green algae.
• cials have two words to describe — more than 100,000 cells per Anderson Lake continues to
the water-quality"warning" sta- milliliter of water. have a bloom made up predomi-
tus of Anderson Lake and Lake A"caution"status means that nately of blue green algae of the
Leland—no change. the lake has moderate levels of genera microcystis and ana-
Both lakes remain closed to potentially-toxic blue-green baena,which produces anatoxin-
swimming and fishing until the algae species, between 30,000 a.
high levels of toxic blue-green and 100,000 cells per milliliter of The toxins can concentrate in
algae subside. water. skin and organs, especially the
"The lakes were looking bet- liver.
ter for a couple of weeks, and I Some lakes clear People with liver problems,
• was hoping they were going to Sandy Shore Lake, from such as chronic hepatitis,should
open," Neil Harrington, county which the county also is taking exercise additional caution.
water quality manager,said late water samples for weekly lab Water samples are taken from
Friday afternoon. testing, remains clear. So do the lakes on Mondays and tested
"Then they took a turn for the Crocker,Teal and Tarboo lakes. at King County Environmental
worse." Anderson Lake, off Anderson Labs. The results are routinely
Harrington said Anderson Lake Road, was closed in June released to the public on Fri-
Lake,between Port Hadlock and 2006 after two dogs were killed days.
Chimacum,and Leland,north of from ingesting the water and one Jefferson County Public Health
Quilcene, would have to show nearly died after experiencing a maintains an updated database of
about two weeks of lower toxicity seizure. lake monitoring information at
levels in water-sample test Anderson was closed this year www jeffersoncountypublichealth.
results before reopening. just prior to the beginning of org.
The two lakes have "red" fishing season April 25. The department can be reached
warning signs posted around Leland was closed about two at 360-385-9400.
them,informing people that they weeks later. Lake samples are not tested in
are closed to all recreation, Cyanobacteria, or blue-green Clallam County, where health
although the parks are open to algae, is present in most bodies officers visually monitor lakes for
activities around the lakes. of water and usually causes no signs of algae bloom.
Anderson is still scummy and problems for humans or ani- No cautions or warnings have
toxic.Leland also has green scum mals. been issued in Clallam County
visible as well. But when the right conditions Algae blooms in Clallam
Gibbs Lake in Chimacum• align— the water is calm, rela County lakes should be reported
remains at the "caution" level, tively warm and overly rich into Clallam County Department of
meaning fish can be caught but phosphates, a chemical com Health and Human Services
should be released..Swimmers ;monly found in lawn fertilizers environmental health division at
es
should use caution and not drink --it can bloom into high concen- 360-417-2258.
the water. trations.
A red "warning" status, Samples taken from Lake
marked by a sign at the Ander- Leland show high concentrations Port Townsend-Jefferson County Edi-
III son and Leland lakes, means of blue green algae and the neu tor Jeff Chew can be reached at 360-385-
that the lakes have high levels,of rotoxin anatoxin a. 2335 or at jeftchew@peninsuladaily
potentially toxic blue-green algae It is the same toxin found in news.com. .
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•
3. 2
CONTINUED FROM Al grind to a halt.
in ace "It's definitely in the
Nationwide, more than toolbox,so to speak.Whether
13,000 cases of swine flu or not we have to use them
• have been reported,with at or not depends upon how
least 27 deaths. things unfold.That we can't
O1 j�, really predict."
nly three Severity,rate The pandemic declara-
tionJ reported
^ y.� (� But whether Clallam is expected to result in
Cases 1 epo 1 e L and Jefferson counties the creation of a vaccine,
choose to close public facili= which should be available
Peninsula 1 ties and events,Locke said, in September.
on Peninsula depends upon two things:
• the severity of the illness Reporter Tom Callis can be
BY Tom CALCIS and the rate at which it reached at 360-417-3532 or at
spreads. tom.callis @peninsuladailynews.
PENINSULA DAILY NEWS
Even if most of the swine corn.
With just three cases of swine flu now flu cases remain mild this •
recorded on the North Olympic Peninsula, . fall and winter, Locke said
local health officials remain far from consid- such closures may need to
ering any closures of events, schools and be implemented if the rate •
•
other public facilities — but that could of spread can't be con-
change if it begins to spread at a high rate, trolled.
said Dr.Tom Locke,health officer for Clal- "Half of the community •
lam and Jefferson counties. can't be sick at one time,"he
If the virus said. "Everything would
spreads in the fall "What goes on
and winter at the in the southern
same rate that it
is spreading now hemisphere is a
in Australia, the predictor of what
•
flu, which is rela-
tively mild, could is •
going to happen
become more of a in thenorthern
threat on the Pen-.- hemisphere next
insula,he said. p
World health fall."
officials said the DR.Tom LOCKE
virus is spreading health officer
quickly through Clallam and Jefferson
the southern- counties
• hemisphere
nation, which is
heading into winter and had recorded up to
1,260 cases H1N1 cases as of Wednesday.
"What goes on in the southern hemi-
sphere is a predictor of what iA going to hap-
pen in the northern hemisphere next fall,"
Locke said.
"The worse things•are in the southern
hemisphere,the more urgent it is for us to do
pandemic preparedness in this country."
Peninsula cases
The Peninsula's confirmed swine flu cases
involved a Port Townsend woman under the
age of 20,a Sequim woman in her 30s and
' her husband.Each of the three—all uniden-
tified by local health authorities—had mild
cases and recovered without hospitalization,
Locke said. •
Although the illness the virus causes is
typically mild,the World Health Organiza-
tion declared swine flu to be a pandemic
Thursday because of its spread to 74 coup-
• tries,with 28,774 cases and 144 deaths.
In comparison, the seasonal flu kills
about 250,000 to 500,000 people each year.
As of June 3, there were 574 confirmed
cases in the state,with 40 hospitalizations
and one death because of complications of I.,
the flu,Locke said.
•
TURN TO FLu/A6 /
..
Shellfish
farmers Bay: Tribes warn governnler.
reass tired CONIN
TUED FROM Al Growers Association. ',-' r
Van De Wesaid he
Stakeholders,including was looking for solutions ,-• ; '. Jake Johnson,who
government agencies, that might solve the issue ` -�- °' manages
tribes,elected officials and through legislative action. rr,,; Marrowstone Island
shellfish growers aework- The lawmaker's ideas .,a Shellfish Co.on
Mystery Bays inner ing together to address the ran from fining those who }< - = Mystery Bay In
situation'in which differ- illegally place buoys to cre- , a Nordland,urges
ant uses such as shellfish sting a state account to ." m! ttrt people to come
waters will remain beds and moorings can be pay for buoy removal. together to solve
sustained. Kelly Toy, Jamestown � ..-„, ,�- the bay's issue of
openofficial says Brady Scott, state S'Klallam tribal shellfish �a too many boats
t Department of Natural manager, indicated the t near commercial
Resources district man- tribes are taking a hard s '.i - •off- shellfish beds.
BY JEFF CHEW ager for the Orca Straits line on treaty rights. Jcrr Cerw/PEN,ss u.Dear News
PsNwsuu DAnx News. ' District Aquatics Region, "The tribes will not reviews water quality and The county reported 25
said 10 buoys in Mystery accept anything that is pollution conditions in each have legal permits, seven
NORDLAND—A state Department of Health offi- Bay had been found to be going to affect our tribal of Washington's 102 classi- are"grandfathered;mean-
cial assured his audience that the inner waters of Mys- unauthorized,one with a resources,"she said. fled commercial shellfish ing they were in the bat.
tery Bay would remain open to commercial shellfish boat attached-to it. growing areas. before regulations existed,
harvests,but the outer bay would likely be closed later The DNR issued letters Tribal warningAreas that don't meet
this summer. stringentpublic health and five have been deter-
May ze stating that unau- g mined to be moored outside
"Our plan is to have no classification of the inner thorized buoys would be The Jamestown and standards must be closed. the bay.
bay,"said Bob Woolrich,growing area program manager removed in 30 days Port Gamble S'Klallam Other areas with y
for the office of shellfish and water protection. y tribes,making up the Point increased pollutant levels steward of the 2.6
• Woolrich'made the remarks No Point Treaty Council, are listed as "threatened million acres of state aquatic
to about 100 people'Monday Buoys Identified warned federal,state and with closure." lands, DNR manages the
"Our plan is to night in a meeting that brought The agency,along with county officials in a recent The listed sites are eval- bedlands under Puget
have no together state,county and tribal Jefferson County Depart- letter the threatened clo- uated and watched by the Sound and the coast,many
agencies. ment of Community Devel- sure of shellfish beds was agency and other stakehold- of Washington's beaches
classification of The state has been consider- opment,has identified 64 an affront to their treaty ars such as Jefferson County and natural lakes and nav-
ing reclassifying the Mystery rights.
Public Health. gable rivers.
the inner bay." buoys in inner bay,insideThe "threatened" desi
Bay commercial shellfish grow- MysteryBayremains g DNR manages these
Bos yyoo�CN the sand spit and on the nation serves as an early lands not only
Mg area as prohibited or condi- on the state Department
to facilitate
state Health Department tional,which could have led to outer bay beyond the spit. of Health's "threatened" warning and helps target navigation, commerce and
'"Che next step is to pro- pollution controlbut Woolrich .
closure of the inner bay. teed with the buoy list for the 2009,problem with an Jefferson County Depart- epublic nsure protection access, but aquatic
That was good news to Jake
Johnson,Marrowstone Island Shellfish Co. manager, removal,"Scott said. ment of Community Devel-
whose familyhas owned the operation on the inner bayThen the outer bay moored increasing number ofboatsopment handles buoy per- habitat.
Pe moored in the small Mar- mils for the state and has
at Nordland for nearly100 ears. would be reclassified for
Y closure, and the separa- rowstone Island harbor conducted a survey in the PortTownsenoJenerson Couny
Johnson opened the meeting by calling for unity p may be resolved soon. past year that shows 63
among shellfish farmers to work with government offi- tion 4etween_the i{tner and P Y Edit�r Jeff Chew ran,be ceacned at
outer wouldbemarked, buoys have been:identifietf"360335233y or at jellcnewe
cials.to find a solution to an overabundance of boats y 16 other areas with owners. peovsutadaitynews.com:
moored near shellfish beds. he said.
Saying he was a boat owner himself and had nothing State Rep. Kevin Van The Department of
against boaters moored in the bay,Johnson said his De Wege, D-Sequim, Health has identified 16
company's issue was the fact that state health had clas- attended the meeting, a other Western Washington
sifted the bay as threatened,and that could close the collaboration of the state harvest areas as being
family business. Department of Health,Jef• threatened with closure'
"It's a situation where we all need to come together," ferson County Department based on increasing pollut-
Johnson told the audience. of Community Develop- ants.
Health officials said the issue is the number of ves- ment, the state Depart- That's a slight improve-
sels and mooring buoys located in the bay; which ment of Natural Resources, ment over the 17 threat-
increases the possible risk of discharge from boats that State Parks and ened areas listed in 2008.
could affect human health through potential contami- Pacific Coast Shellfish Each year, the agency
nation of commercial shellfish.
Woolrich cited the national guideline that defines a
marina as more than 10 boats.If a marina is defined,
then boats cannot be near shellfish beds.
Woolrich said Mystery Bay has six stations that take
water samples for the state Health Department six
times a year.
. - TURN TO BAY/A6
III
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Jw''CHEW/PEN,NSLIA D,�1Lt Nous
Longtime Gardiner resident Wayne King looks over a red-orange colored phytopiankten bloom that has
washed up in spots along the shores of Discovery Bay but was most visible Thursday around the Port of
Port Townsend's Gardiner Beach Road boat ramp.
• Plankton addingIII IIITS color
Water turns red-orange along some Jefferson shores
BY JEFF CHEW
"I took a picture of it,"King said,stand-
PENINSULA DAILY NEWS OCtiIUCa is a dinoflagellate ing on the boat ramp.
GARDINER—The color of the bloom that eats other organisms to "It usually shows up when it's flat calm."
is red to orange,but experts don't believe SUl•V1Ve. It does not produce The bloom ran 20 feet wide or more
it's red tide. p down the Discovery Bay shores of Gardiner
Unlike paralytictoxins— unlike certain plankton for at least a mile Thursday afternoon.
shellfish poisoning—
or red tide,which is actually colorless or associated with paralytic shellfish
Bloom heaviest in Hood Canal
slightly tinted—there's a type of phyto- poison,
plankton bloom that is harmless to marine While Noctiluca is easily viewed in
life and people,experts said. parts of Discovery Bay,the bloom is heavi-
That large band of red-orange lapping "I saw one of these types of blooms est at the south end of Hood Canal from
up against the shore near the Discovery about eight years ago in Discovery Bay, Seabeck to Union and touches at least the
Bay boat ramp on Gardiner Beach Road is and it is striking,"said Neil Harrington, southern end of East Jefferson County at
considered to be a massive bloom of Nocti- Jefferson County water quality manager, Triton Cove,Hannafious said.
luta. adding he had not heed any reports from That's where most of the reports are
Noctiluca is a dinoflagellate that eats Discovery Bay-area residents as of Thurs- coming from,he said,adding he has not
other organisms to survive. It does not day heard from any officials or residents in
produce toxins—unlike certain plankton "People have called me about it in the Jefferson County.
associated with paralytic shellfish poison, past wondering what it was,"he added. Hannafious explained warmer sunny
said Dan Hannafious,assistant executive Wayne King,Jefferson County Public weather is prime for the pinhead-sized
director of the Hood Canal Salmon Utility Commission chairman who has plankton to bloom.The bloom floats in long
Enhancement Group and a leader in the long lived a shortwalk from the boat clumps on the surface and drifts around in
Hood Canal Dissolved Oxygen Program. ramp,said Thursday morning was one of ribbons with the winds and tides.
It is merely food to larger sea crea- the heaviest blooms he's seen.
tures. TURN TO BLOOM/A6
CONTINUED FROM Al ing before hitting the
beach.
Other observers have As for Noctiluca,he said,
• reported ribbons of uniden- "It's a good thing to try to
tified plankton growing in get the message out there
Liberty Bay near Poulsbo, that this is a type of phyto-
he said. Plankton that's blooming
Hannafious urges recre- that's not harmful."
ational shellfish harvesters
check with local health of ie Jeff Chew can be reached at
cials for potential risks of 360-3852335 or at jefI chewCs
paralytic shellfish poison- peninsuladailynews.corn.
r. 'i.
Toxic algae keeps
Anderson c
Warnings still•_, in effect is ditons water
calm, relativelye warm
and overly rich in phos-
for other Jefferson lakes phates, a chemical com-
monly found in lawn fertil-
izers — it can bloom into
BY JEFF CHEW by high toxicity levels, high concentrations.
PENINSULA DAILY NEWS "They went back up last The algae can,at times,
PORT TOWNSEND —
week for the most part." begin to produce toxins,
Anderson Lake's high lev Harrington said the such as the neurotoxin
els of toxic blue-green alae closed lakes will have to anatoxin-a,which has been
continue to keep it closed show two consecutive found in Anderson and
to recreation,a countyoffi- weeks of toxin levels below Leland lakes.
the threshold to be safe.
cials said Friday. Exposure to anatoxin-a
The lake in a state park Thresholds can cause convulsions and
between Port Hadlock and death by respiratory paral-
4
Chimacum has been closed A red "warning" status, ysis.
since fishing season opened marked by a sign at the Water samples are
April.25. The park around Anderson and Leland taken from the lakes on
the lake is open for recre- lakes,means that the lakes Mondays and tested at
ation use. have high levels of poten- King County Environmen-
The Jefferson County tially toxic blue-green algae tal Labs.
Public Health Department —more than 100,000 cells
tests several lakes weekly per milliliter of water. Updates online
for high concentrations of A "caution" status •
both algae and toxins. means that the lake has • Jefferson County Public
Results are reported on moderate levels of poten- Health maintains an
Fridays. tially-toxic blue-green updated database of lake
Lake Leland, north of. algae ; species, between monitoring information at
Quilcene, which also is 30,000 and 100,000 cells www.jeffersoncountypublic
marked with a red warn- per milliliter of water. health.org
ing sign,remains closed for Sandy Shore Lake,from The department can.be •
swimming, but fishing is which the county is also reached at 360-385-9400.
allowed so long as the fish taking water samples for ' Lake samples are not
are released and not con- weekly lab testing,remains tested in Clallam County,
sumed. clear. So do Crocker, Teal where health officers visu-
Gibbs Lake remains and Tarboo lakes. ally monitor lakes for signs
marked with a yellow Anderson Lake, off of algae bloom. No cautions
warning sign, meaning Anderson Lake Road, was or warnings have been
caution should be exer- closed in June 2006 after issued in Clallam County.
cised. Swimming and fish- two dogs were killed from Algae blooms in Clallam
ing are allowed so long as ingesting the water and County lakes should be
swimmers do not drink the one nearly died after expe- reported to Clallam County
water and fishermen catch riencing a seizure. Department of Health and
and release fish. Leland was closed in Human Services environ-
"They'll go up, then mid-May. mental health division at
i they'll go back down, then Cyanobacteria, or blue- 360417-2258.
go back-up again," said green algae,.is present in
Neil Harrington, county most bodies of water, and Port Townsend Jefferson
•., 'water quality manager, usually is not toxic toCounty Editor Jeff Chew can be
`explaining why Anderson humans or animals. reached at 360-385-2335 or at Jeff.
and Leland remain closed But when the right con- chew@peninsuladailynews.com.
• •
. r /
. // I ,-;
Brely .• •.
Septic tank
program
scheduled
PORT HADLOCK—An
educational presentation to
provide home and property
owners with information
on how to care for their
drinking water wells and
septic systems will be held
Saturday,June 27.
The free program will
be presented at the WSU
Extension Office,201 W.
Patison St.,from 10 a.m. to
noon.
Mike Gamroth,an Ore-
gon State University pro-
fessor and extension ser-
vice water quality program
coordinator,will review
well water maintenance
and safety issues.
Specific topics will
. ' include well head protec-
tion,pump maintenance,
recommended testing,sep-
tic tank pumping and
drain field maintenance.
Questions and a discus-
sion session will follow the
presentation.
Staff from Jefferson
County Environmental
Health will help answer
questions.
Participants should
bring water samples for
free nitrate testing.
Registration is
requested to allow for class
material preparation.
To register or for more
information,phone 360-
379-5610,ext. 200.
Walk-ins are welcome.
• .
1
•
•
Learn well
septic •
maintenance Saturday
Home and property owners septic tank pumping and drain
can learn how to care for their field maintenance. There will be
drinking water wells and septic tine for questions and discussion;
systems at a free workshop this Jefferson County Environmental
Saturday,June 27, 10 a.m.-noon at Health staff will also attend to
WSU Extension in Port Hadlock, help answer specific questions.
• Mike Gamroth, Oregon For a free nitrate test, bring a
State University professor and sample of water.
Extension water quality program There is no charge for atten-
coordinator, reviews well-water dance or materials, and walk-ins
maintenance and safety issues are welcome, but preregistration
as well as how to protect and is requested for preparation of
improve water quality, adequate materials. For more
Participants will learn about information and to preregister,
wellhead protection, pump main- call WSU Extension at 379-5610,
•
tenance, recommended testing, ext.200.
•
•
•
•
1
i.
r
Toxic algae bloom closes lake
Gibbs on list per milliliter of water: ation, including swimming, most bodies of water and
Jefferson County tests fishing and boating. The usually is not toxic to
with'two 'other lakes weekly for both algae park around the: lake is humans or animals.
- content and toxicity. ; open for recreation use. But when the right con-
Jefferson sites Toxicity results for Gibbs Lake "samples' are'not ditioiis'align`=the water is
likely will be announced tested in Clallam County, calm, relatively warm and
BY ERIK WDLL next week, but for now,the where health officers visu- overly rich in phosphates,a
PENINSULA DAILY NEWS health department is tell- ally monitor lakes for signs chemical commonly found
• ing people to stay out of the of algae bloom. No cautions in lawn fertilizers — it can
The Jefferson County water. or warnings have been bloom into high concentra-
Public Health Department ,"Gibbs Lake is closed for issued in Clallam County. tions.
has added Gibbs Lake to,a swimming,but it's still open A red "warning" status, The algae can, at times,
list of lakes to avoid for for other uses," Harrington marked by a. sign at the begin to produce toxins,
summer swimming. said. three lakes,means that the such as the neurotoxin ana-
Neil Harrington, county "It's OK to catch and lakes have high levels of toxin-a, which has been .
water quality manager,said release fish,to boat and to potentially toxic blue-green found in Anderson and
Thursday.that weekly test- recreate around the lake." algae—more than 100,000 Leland lakes.
• ing of lake water has con- • cells per milliliter of water. Exposure to anatoxin-a •
firmed the levels of blue- Anderson, Leland Gibbs was previously can cause convulsions and •
green algae have grown to . marked with a "caution" death by respiratory paral-
the point it is considered Gibbs Lake joins Lake status, which means the •si
y s.
unsafe for swimming. Leland and Anderson Lake lake has moderate levels of Jefferson County Public
"We haven't gotten the on the list of lakes affected potentially toxic blue-green Health maintains an
toxicity results for Gibbs by toxic blue green algae in algae species, between updated database of lake-
Lake yet,"Harrington said. Jefferson County. 30,000 and 100,000 cells
"But with the results of Lake Leland remains per milliliter of water. monitoring information at
the blue-green algae tests, closed for swimming, but Sandy Shore Lake, from www.jeffersoncountypubli
• we are just concerned for fishing is allowed so long as which the county is also chealth.org.
the fish are released and .The department can be
the potential of unsafe tox- taking water samples for reached at 360-385-9400.
icity levels." not consumed. weekly lab testing,remains Algae blooms in Clallam
Harrington said blue- Anderson Lake's high clear. So do Crocker, Teal g
green algae levels were levels of toxic blue-green and Tarboo lakes. County lakes should be
algae continue to keepit reported to Clallam County
recorded at 100,000 cells g Anderson Lake was first
Department of Health and
closed to all water recre- closed in June 2006 after Human Services environ
two dogs died after ingest mental health division at
ing the water and one nearly
360-417-2258.
2258.
died after a seizure.
Leland was closed in
mid-May. Reporter Erik Hidle can be
Cyanobacteria, or blue- reached at 360-385-2335 or at enk.
green algae, is present in hidle@peninsuladailynews.corn.
•
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No swimming There has been plenty of outdoor water activity at Gibbs Lake in other summers,but Jefferson County Public Health ryas
issued a health warning for the lake due to high concentrations of potentially toxic blue-green algae.Health officials are advising the public to avd,a
swimming,drinking water and eating fish from Gibbs Lake and also Lake Leland and Anderson Lake.Leader file photo
•
Health warningLaKeissued far Gibbs
•
Gibbs Lake is closed to swim- have the potential to produce tux- horseback riding and hiking, is green algae bloom;. This studs
ming due to high concentrations ins that affect the liver and ner- allowed at Anderson Lake State is funded by a ,Grant lnrm di,
of potentially toxic blue-green vous system. The park remains Park. Department of ti oloty
algae, and lab results show that open to other uses, including Since 2006,the county health Lakes that are considered
blue green algae levels also boating, catch-and-release fish- department has been collect- clear at present without poten-
remain high in Lake Leland and ing, hiking, bicycling and bird ing and submitting water qual- tially toxic levels of algae include
Anderson Iake. watching. ity/algae samples from Lake Tarboo Lake,Crockci Lake.Teal
Jefferson County Public Health Anderson Lake also continues Leland, Anderson Lake and Lake and Sandy Shore Lake.
continues its seasonal sampling of to have a bloom made up pre- Gibbs Lake to determine what Jefferson County Public Health
recreational lakes for toxic blue- dominately of blue-green algae species of algae are present and maintains an updated database
green algae. Results indicated of the same genera as Gibbs in what concentrations. Other of lake-monitoring information at
high enough concentrations in and Leland. Tests performed local lakes are sampled if they jeffersoncountypublichealth.org.
Gibbs Lake to warrant the health at King County Environmental appear to be undergoing a blue-
warning. Labs show that this bloom is green algae bloom. This year
Jefferson County Public Health producing anatoxin-a, a potent the health department is also
is advising the public to refrain neurotoxin. Because of the collecting samples to determine
from swimming, drinking water risk of exposure to this toxin, possible causes for these blue-
and eating fish in these lakes. Washington State Parks, in con-
Gibbs Lake and Lake Leland sultation with Jefferson County
are undergoing blooms of Public Health, will keep the
blue-green algae of the genera lake closed to recreation. Non-
Anabaena and Microcystis,which lake recreation, such as hiking,
• •
• /Dr--,re.,0&„
•
7///o9
. Vaccine
• funding
dries up Vaccine: Check
insurance policy
State program CONTINUED FROM Al vaccines for low-income
children.
"Now they are going to Health-care providers can
ii
for kids vct
m have to deal with a more use the publicly purchased
complicated system," he vaccine to immunize children
Of budgetsaid. who are enrolled in the state
crisis State health officials are Medicaid program, have no
encouraging parents to insurance,are underinsured
BY JEFF CHEW check their insurance poli- or are Native American or
PENINSULA DAILY NEWS cies to see.which childhood .Alnatives.
vaccines are covered. Children enrolled in free
Major changes in the state's childhoodParents should present or low-cost state health
vaccine program,the result of state budget their insurance card every plans, including the State
cuts,place a larger burden on family physi- Children's Health Insur-
time their children are vac-
cians, and the impact on children in the cinated. ance Program and Basic
North Olympic Peninsula is unclear, the "people don't always Health,also will continue to
health officer for both counties said. kif their health insur- receive publicly purchased
now
The change is the vaccine.
result of the state's ance covers vaccination," private health care pro-
,
budget crisis in which state Health Secretary
' �E g MarySeleckysaid in a re- viders give more than 90
i,, lawmakers discontin- P ercent of all childhood
' a ued the vaccine pro- pared statement released P
P immunizations, Selecky
gram for some children Wednesday. "Most insur- said.
C to save $48.5 million ance policies cover the costs Locke said parents
II ,, over the next two years. of vaccines." should contact their medi-
cal providers,their medical
;I 4 ' t only five states still Planning insurance companies, Jef-
,C ' `' providingthe program. ferson CountyPublic Health
P Br' State funds on May 1
"Our goal is The changes effec- will no longer be used to at 360-385-9400 or Clallam
tive May 1,2010,mean buy childhood vaccine — County Health and Human
to continue to that children with pri- allowing time to plan a Services at 360-417-2274.
have all kids vate health insurance smooth transition so there For more information,
covered."
will no longer receive are no breaks in vaccinat- see www.doh.wa.gov/
state-funded vaccine. ing children 18 and under. cfh I immunize/providers/
Tom LOCKE Tom Locke, Clallam In the past, the federal universal.htm.
Jefferson Count' and Jefferson counties' government has paid for all To contact the Depart-
health officer health officer, said the children's vaccines so long ment of Health Immuniza-
concern is that doctors as their parents meet the tion Program,phone 1-866-
will find the changes too burdensome. financial eligibility. 397-0337 or e-mail universal
"We want to prevent physicians from "For the past decade,the changes@doh.wa.gov.
concluding this is too much of a hassle and state of Washington has
pull out of the vaccine service,"Locke said. paid for the rest for kids in
"We're trying to make sure that does not hi "income,"Locke said. Port Townsend-Jefferson
g County Editor Jeff Chew can
happen.Our goal is to continue to have all The state will continue reached at 360-385-2335 or at JeN.
kids covered." using federal funding to buy chew®peninsuladailynews.com.
'Huge change'
Michele Roberts,speaking for the state's
Immunization Program Child Profile,said:
"It is a huge change of workloads for pro-
viders because providers have never had to
buy vaccines before.
"Providers now have to buy vaccine.
They have to insure vaccine and then
screen kids to make sure they are getting
the right vaccine."
Locke said perhaps the biggest chal- -
•. lenge for local health departments and
private practitioners is dealing with the
logistics of the change.
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•
Childhood
"People don't always know if
III vaccination their health insurance covers vacci-
nation," said Selecky. "Most insur-
progr�Jr+ogY+al11 ance policies cover the costs of vac-
am Parents should check their
coverage to be sure, and remem-
faces changes ber to take their insurance cards
when their children get shots, so
Washington's program that healthcare providers can deter-
uses state and federal funds to buy mine which vaccines are covered."
vaccine for all children in the state• Private healthcare providers
is changing. play a crucial role in immunizing
Starting July 1, human papil- kids.They give more than 90 per-
lomavirus vaccine (HPV) will no cent of all childhood immuniza-
longer be bought with state money. tions. With these changes, pro-
And next May, state funds will no viders will have to buy vaccine
longer be used to buy any child- for their privately insured patients,
hood vaccine - allowing time to screen children to see if they're
plan a smooth transition so there eligible for state-supplied vaccine,
are no breaks in vaccinating kids, and keep separate inventories and.
say Department of Health repre- records for privately and publicly •
sentatives. purchased vaccines.
The state will continue using Despite funding challenges,
federal funding to buy vaccines for childhood immunizations remain
low-income children. Healthcare a public health priority, say state
providers can use thispublicly spokesmen. The budget crisis,
purchased vaccine to immunize however, makes it necessary to
children under age 19 who are change the way vaccines are pur-
enrolled in the state Medicaid chased in Washington.Recent out-
program, ..have no insurance, breaks of measles and chickenpox
IIII are underinsured or are Native in'Washington show more must
American. Children enrolled in be done to protect our children
free or low-cost state health plans and communities. Partnerships
also will continue to receive pub- . between state and local health and
tidy purchased vaccine. the health care community are
"Vaccinating children is one of more important than ever.
the best things parents can do to Clinics providing children's vac- '
keep their children healthy," said cines in Jefferson County include
Secretary of Health Mary Selecky. Jefferson Medical & Pediatric
"The key to disease prevention is Group, Port Townsend Family
to make sure children have con- Physicians,Olympic Primary Care, \
tinued access to vaccine — that's South County Medical Clinic and
our goal as we work-through this Jefferson Healthcare's overflow
change with our partners." clinic, as well as Jefferson County
The changes mean kids with Public Health immunization din
-
private health insurance won't get. ics.For more information call your
state-funded vaccine anymore. So, medical provider, insurance com-
parents are encouraged to check pany or Jefferson County Public
their insurance policies to see ' Health,385-9400. l-•'
which childhood vaccines are cov-
ered. Parents should present their
insurance card every time their
children are vaccinated.
•
A `WlCnic' helps low-income •
people, pick � produce
fresh local
By Allison Arthur of The Leader ` Clay streets. even coffee beans,but not coffee"
"What we really want to qualify for purchase with food
Fresh produce is. healthy get out there is that fresh and stamps,he said.
and available to everyone, and healthy food is available to every- Eggs and honey also can be
to prove it the Port Townsend one," said market director Will bought with food stamps,but only
Farmers Market is co-sponsoring O'Donnell. fruits and vegetables and herbs
a"WICnic." When he attended an interna- can be bought with WIC checks.
WIC stands for Women,Infants aional farmers market conference Participants will be given a •
and Children, a federal program in San Francisco earlier this year, tour of the market to show them
that allots money to the states, O'Donnell said a market manager what they can buy with their WIC
which in turn is passed down to from Spain told.him, "Fresh and coupons and what can be pur-
counties to help buy supplement healthy food should be a human chased with food stamps.
foods, healthcare and.•nutrition right." • There also will be a cooking
education for low-income women "And we agree with that," demonstration and a free picnic,
with children. O'Donnell said. at which a meal will be served •
Jefferson County Public A majority of vendors at using fresh produce. That will
Health oversees the program and' the farmers.market have gone be provided for the first 20 fami-
works with the Farmers Market ,through the state hoops to be lies who come. Prizes are also
to sponsor a free picnic—dubbed able to accept WIC checks as well planned.
a WICnic —.to help low-income as food stamps:They also accept Families that would like more
families learn how to buy fresh . checks •that seniors receive, information about WIC.may call
produce with WIC checks. O'Donnell. said. Most vendors Kathy Anderson at the health
The event is 3:30-5 p,m. post signs at their stands denot- department,385-9432.
•Wednesday,July 15 at the corner ing their participation. For more information on the •
of the Uptown market on Polk "You can buy any non-ready- farmers market,call O'Donnell at
Street between .Lawrence and' to-eat food, so bread, meat and 379-9098.
•
•
i
410. M
. s r
Dear County Officials,
• I was planning on coming to Thursdays meeting but deemed an email would be more
fitting since what I have to say would take longer than 3 minutes. My father, Ken
Ackerman Sr., would also have liked to come but he can't miss work or he'll lose his job
therefore I am sending this to you on his, my grandfathers, my brothers, and the behalf of
others that couldn't make it to the meeting either because sending letters isn't their strong
point, because they are 'old school' and don't know how to use a computer, nor have one,
or because they couldn't miss work.
In the past few months my father has been contacted by Anita Hicklin in regards to what
she says the county considers "junk/junk vehicles/solid waste" and we also got a letter in
the mail stating it must be cleaned up as well as a ticket for$513 for a solid waste
violation. On more than one occasion when my dad asked what vehicles were in
violation and what had to go she said that all of it had to go. Many things are to be said
about this but first let me say that when I use the term 'vehicle' it includes cars, pickups,
vans, trucks, tractors, bulldozers, cranes, log loaders, drill rigs, motorcycles, trailers,
buses, and anything else that has or had a motor, transmission, or axle in it and/or was
intended to perform some function or useful work. Also, in writing this I tried not to get
too worked up and tried not to be condescending, aggressive, bullheaded, or come off as
being arrogant, harsh, or insulting. It may sound like I am but I am just stating what I and
others see and feel and I am stating some facts. The last thing I want is to upset anyone I
send this to and give them a reason to not read it.
• First of all: Anita called my father at work on more than one occasion and of him so
worked up that he just about had a heart attack because his blood pressure spiked (he's
already on blood pressure medicine for high blood pressure and the doctors say he should
not get worked up for his own safety) because she said that we had to get rid of
everything. She also got my 90 year old grandfather worked up when she met with my
dad and him to talk about what needs done shortly after we got the violation in the mail.
If she is going to be treating people in such a way as to anger them and make them upset
like that then she needs to be removed from her position and be replaced with someone
that has common sense when talking to people instead of having an ego the size of the
Hindenberg and trying to project that she is an authority figure to be reckoned with.
Second of all: When talking to anyone in my family, telling them things such as "You
can't tell me what you're going to keep, I am telling you what you're going to keep" or
telling one of us "You have to get rid of everything", which is quite similar to what Anita
told my father, is entirely the wrong approach and is the wrong approach when talking to
anybody. This is not a dictatorship or any other sort of totalitarian system and a person
will not be able to get through to someone with success if they are snotty, forceful,
arrogant, and try to abuse their authority by thinking they are the only authority and can
tell people what to do just because they have been given a task to do that is backed by the
sheriff.
1111 Third of all: A lot of the vehicles that we, and other people, have may look like junk'
and may seem that they're not useful or don't run but many of them do run and are used,
• maybe only a few times a year but we do need them and many do not meet 3 of the 4
requirements for a'junk' vehicle that the county has defined. Some vehicles fall under
the category of collector or classic vehicles which are waiting to be restored when my
father, or I, or my brother (Michael) retire. Some of the items that might be considered
by others to be junk belong to my grandfather who has fought for our rights and freedom
in World War 2. He has restored a Ford Model A to almost new condition from
something that would have been considered junk before as well as a 1928 cross-motor
case tractor that, both of which have been through the Quilcene parade many times. My
brother, father, I, and other people have restored other vehicles to like new condition but
we never would have had the chance if the county had made us get rid of the vehicles
because they considered them junk. Anyone with common sense knows that the hardest
part about restoring ANY item worth restoring is most likely finding the item or the parts
themselves. A person isn't going to wait until they're ready to restore the vehicle to find
it but instead they will constantly be looking for it and when they run across one they can
afford, they will snag it and store it until they get time and money to work on it. Some
vehicles fall under the category of parts vehicles since a lot of people have, and use on a
regular basis, vehicles that are too old to get parts for. They may be missing a
windshield, motor, and other parts but the sheet metal (hood, fenders, doors, etc) may still
be good and if a person has a 68 Chevy pickup and the door gets caved in or the axle
snaps it would be useless if they can't get a window or axle anywhere. It's nice to know
there is a spare that can be used instead of having to park the vehicle until a spare is
found (which could be impossible to find)because they don't have one. In any case, a
• vehicle can always be worth more in parts than in scrap and the person to determine how
much something is worth is the one that not just wants but needs that item. The parts
value of something can't be determined by people that have no knowledge of what parts
go for nor can it be determined by a person just because they are an elected official or law
enforcement.
Fourth of all: As is the case with my family,there are some items and vehicles people
are planning on getting rid of but just haven't had time to take them to the scrap yard yet
or are waiting for the price to come back up, often it is because they haven't had the time.
Hauling items away to the scrap is timely and can be costly if it is done when the scrap
price is down as opposed to making money off of it which is why some people haul
scrap. Not only is there the fuel,tonnage,tabs, and insurance for the vehicle hauling it
but also there is the cost of oxygen and aceteylene to cut the scrap up and process it to get
it down to an acceptable size for the scrap yard to take as well as the cost of the fuel to
load it with a crane. My father and brother (as well as other people) have made enough
money to keep going by hauling scrap during times they've been out of work. I paid my
way through Central Washington University to get a math minor and physics degree and I
paid my way through the University of Washington to get an aeronautics and astronautics
degree all with money that I earned in the summer, a lot of it from hauling scrap metal. I
still make money hauling non-ferrous metals (copper, aluminum, nickel, brass, etc)to
Tacoma Metals once in awhile and have made enough money off of it to make and
successfully fire many times a liquid propellant rocket engine that runs of kerosene and
•
liquid nitrous oxide which was not a cheap endeavor. I have also used money made from
• scrap metal to buy tools I can use to make a living should I find myself out of work.
Fifth of all: My father has a master business license for Ackerman Enterprises which
includes him, my brother, and me and some of the items that may be considered "solid
waste" or"junk" are used for my brother's oyster business, sawmilling business, logging
business, or by my father or me for other work related tasks. This is probably the case
with other people as well. Also, my father's property is classed as commercial property,
not residential, and if it isn't classed as commercial then it should be because he got it
changed to commercial years ago. This being the case, the land can be used in a
commercial purpose which sometimes may include storing vehicles for parts.
I am assuming that there are some county officials that understand the above but I also
assume there are some that either didn't understand it or never thought to look at it from a
different point of view which is why I went to great detail and length trying to explain
things in this e-mail and why I wrote it on behalf of others who feel the same way but
couldn't get out of work to come to a meeting or that don't have a computer or don't have
too good of writing skills. Just because you may not receive letters, phone calls, emails,
or see people from Quilcene or Brinnon at meetings doesn't mean we don't care or are in
violation, it just means that we either don't have a computer, don't have strong writing
skills, or work when you are in the office and therefore can't get a hold of you too easily.
Yes we can leave a message but that doesn't really hold the same value as actually talking
to the person and sometimes it confuses people that are older and can't hear too well and
111 mistake it for an actual person talking on the other end instead of a machine. Most
importantly is that we can't come to the meeting to voice our opinions because you hold
the meeting during the hours that most people are working and even if we could come
we'd only have 3 minutes to talk, which isn't much time at all.
My family and others understand that nobody wants to have a health hazard around. We
know the county wants to do away with hazardous materials and cars that truly are
abandoned, filled with garbage, or that are causing a health hazard and we're fine with
that if it is something that is truly a problem and does not just appear to be a problem just
because somebody doesn't like the looks of something. However, not everyone that has
vehicles that are seemingly junk has them filled with rubbish, garbage, etc and has them
just sitting with no intention of doing anything with them. Lots of the vehicles the people
have that the county may be complaining about are not health hazards. If the county is
worried about rats then a person can put a bait bar in the vehicles the county is worried
about. If the county is worried about the vehicles leaking fluids then a person can drain
and properly dispose of the fluids, and this is already the case with a lot of vehicles that
are for parts or are sitting, not running waiting to be restored. Given your definition of a
junk vehicle (meeting three of the four: not running/missing engine or transmission,
worth more as scrap than as parts, 3 years old or older, broken windows or having flat
tires) there are a lot of vehicles that wouldn't be classified as junk anyway because they
run, are worth more as parts than as scrap and either don't have a windshield or tires
anyway (bulldozer, crane, tractor, etc).
•
I know that the county is proud of itself for cleaning up about 800+ cars but did they stop
ID to think how many cars that truly were junk were hauled to the scrap yard by people like
my family? If they start giving people tickets and making it more difficult to take scrap
cars to the junk yard then the cars will just end up going no where. My family alone over
the years has taken thousands of tons of cars and other scrap from all over the county to
the scrap yard. Yes we got a little bit of money for it but we also took satisfaction in
knowing we were helping to clean up the county as well as maybe finding something that
could be of use to us; one mans junk is another mans treasure.
If the true reason for the county having Anita Hicklin going around telling people what
they can and can't have is because either county officials or some county citizens are
complaining that something is an "eyesore" then the county can't really do anything since
what is considered an "eyesore" is an opinion and not a fact. Just because I don't like the
look of a person's house or I am shallow enough to complain that somebody is ugly
doesn't mean that the house should be demolished and that the ugly person should move
to where I can't see them. Just because somebody that made most or all of their living
somewhere else moves to the area and then decides they don't like the look of rusty metal
doesn't mean I should have to get rid of it; it's a personal opinion and you can't make nor
enforce a law based on an opinion if the reason for trying to make the law is something
that is not causing any harm. Besides, we've already had enough people move into the
county from elsewhere and then try to tell life long citizens of the county what they can
and can't do just because they don't like something. Also, some of the items the county or
others might complain about actually are tourist attractions and can generate money in
• the county if it brings people to it. I say this because many times me, my brother, or
other family members have seen people stop on the road and ask if they could take
pictures of a crane, bulldozer or other item because they think it is neat and on at least
two occasions I know people purposefully came through Jefferson County just to see
stuff others would consider junk because they said they heard about it from a friend.
In closing I leave you with some questions that need answers:
1. How and why is Jefferson County and Anita Hicklin telling people what they can and
can't have if the subject of the debate is causing no harm? Or do Anita's supervisors and
the elected officials not know she has been doing that and going back on her word and
changing her story? For example: she told my father we had until the end of August to
get rid of a certain pile of scrap so he wouldn't have to knock the hay down to get to it but
then about 3 or 4 weeks ago she told him he has 30 days. When he asked what had to go
she said everything has to go. You can't be sane and serious and tell me that she is not in
the wrong in doing this. Even if some people do have junk, maybe they collect it and if it
is not hurting anything then what is the problem? Some people collect stamps, some
collect rocks, some collect equipment or cars, some people collect guns, swords, cannons,
and build rocket engines; as long as these don't harm anyone where is the problem?
2. On anything that truly is a problem, is the county willing to be flexible with a person
in allowing them to take care of the violation without giving them a fine that will only
prohibit them from taking care of the problem since they'll have to find a way to make
. money in a hurry to pay the fine?
3. Are tractors, heavy equipment, parts vehicles, and vehicles that are going to be
• restored still subject to having to be removed for any reason if they don't pose a health
hazard? If, for example, a person has 10 different running vehicles and has 2 parts
vehicles for each running vehicle and the land isn't crowded (i.e. a small lot filled so full
of cars that it it causes problems) are they going to have to get rid of any vehicles if they
don't pose a problem?
4. Why are publicly elected officials, who are there to serve the people of the county, not
available for a meeting at a time when the vast majority of the people they serve are
available? If it is because they need time for their lives and family too then I say this to
them in a respectable, non-harsh or demeaning tone: we understand that you have a life
but you must also understand that,just as a business owner, you serve the public and
therefore must sometimes make sacrifices to perform the duties you willingly agreed to
perform when you took the job. However, a better solution would be to have a general
meeting for the public twice a month on Saturday or Sunday and the elected officials that
participate can take a Monday or Friday off to make up for it so that there isn't a reason
for them to not want to have a meeting on Saturdays or Sundays when everyone else can
participate. The meetings would have to be in a large room with seating organized by
topic/issue so that everyone that wants to talk about topic A sits in one corner and
everyone that wants to talk about topic B sits somewhere else and so on. That way the
people with the same question can ask as a group and the meeting can be held in a timely
manner.
411/ I just thought it was time somebody sent something to the county officials on this matter.
We don't want to be forced to have our collector vehicles, vehicles we use, spare parts
vehicles, any equipment that runs or that is not running, nor any items of a bygone era
that some people stop to take pictures of, be hauled away to the scrap yard nor have to
put up a fence around our property. If nothing is posing a health hazard but people do not
like the way something looks then they can move or put up a fence around their
property. Also, we will not make changes to our property to increase the property value
nor the value of surrounding property just so individuals can make money by selling their
property or the county can make money off of our increased property taxes; if our
neighbors are worried about their property value because they want to make money off of
selling it then they bought the property for the wrong reason and should have went into
real estate instead. Nor will we tolerate the county irresponsibly abusing its power to
give out unreasonable tickets/violations that are loosely based on a law/regulation that
has been twisted to fit a purpose and fix a problem that may not even exist in some
circumstances. The law/regulation pertaining to "junk vehicles/solid waste"needs
altered instead of being so generic and trying to be a universal one-fits-all kind of law.
Thanks for your time, it is much appreciated.
You can respond to this via email if you like at rocket ken@hotmail.com or mail a letter
to PO Box 271, Quilcene, WA, 98376.
• Sincerely, Kenneth Alvin Ackerman Jr
•i
.14
"4: 414P1
rh89.a��.
• STATE OF WASHINGTON
WASHINGTON STATE BOARD OF HEALTH
PO Box 47990. Olympia, Washington 98504-7990
July TK, 2009
The Honorable Patty Murray
United States Senate
Senate Office Building
173 Russell
Washington, DC 20510
Dear Senator Murray:
I am writing to encourage your continued support for the comprehensive approach to
population health and well-being—rather than simply the financing of health care
delivery—that is reflected in the Affordable Health Choices Act.
• At a recent meeting of the State Board of Health, members heard a public health nurse's
poignant story about intergenerational transmission of family violence and a program that
allowed her to break that tragic cycle for one young family. She told us of a mother, a
survivor of family violence and neglect as a child and of domestic violence as an adult,
who began to see her infant son as someone who was "out to get her." Her response was
to spank him. Over the course of more than a year of home visiting through the county
health department's Nurse Family Partnership program,the public health nurse was able
to get the mother to understand that her child's behavior was natural curiosity, and that
her reaction grew out of her own history of abuse and neglect. The hitting stopped.
Nurse Family Partnership is an evidence-based program proven to be cost-effective. The
Washington State Institute for Public Policy has shown that such programs reduce future
societal costs—for example, prison construction and foster care placement. Yet across
Washington State, federal, state and local funding cuts and revenue loss are crippling the
public health system. Programs such as home visiting, family planning, maternal and
child nutrition, and immunizations are being eliminated. These programs, once
dismantled, will be extremely difficult to rebuild even if funding is restored.
This is why the Board is pleased to see that the Affordable Health Choices Act would set
aside $10 billion a year for a Prevention and Public Health Investment Fund, and that it
•
1
The Honorable Patty Murray
July TK, 2009
Page 2
•
would provide for other programs that promote a prevention-oriented, population-based
approach to improving community health and well-being.
As a public health agency that makes and recommends policy, the Board has concerned
itself with a wide range of issues in recent years. These include access to clinical and
preventive services, the limited availability of primary care providers in poor and rural
communities, health disparities, health care workforce diversity, environmental health,
oral health, school-based health clinics, immunizations, and public health capacity. To
see so many of our priorities addressed in a health care reform bill is incredibly
heartening.
This Board supports efforts to reform the health care delivery and health insurance
systems to guarantee that everyone can have access to affordable, quality medical care.
As a society, however, we spend very little on public health compared to what we spend
on medical care, despite overwhelming evidence that public health interventions account
for the majority of gains in life expectancy over the past century. We applaud the fact that
current bill draft would make health promotion and illness prevention one of the nation's
priorities, and we hope you will work to protect those provisions as the various iterations
of health reform legislation wend their way through Congress.
Thank you for considering this important issue.
•
Sincerely,
C?¢ /nett., 7
Treuman Katz
Chair
cc: The Honorable Karen Keiser, State Senate
The Honorable Eileen Cody, State House of Representatives
State Board of Health Members
Ms. Marie Fallon, National Association of Local Boards of Health
Dr. Paul Jarris, Association of State and Territorial Health Officers
Ms. Sherri McDonald, Washington State Association of Local Public Health
Officials
Mr. Robert Pestronk,National Association of County and City Health Officials
Mr. Mark Rupp, Office of the Governor
Mr. Jonathan Seib, Governor's Executive Policy Office
Mr. Brian Peyton, Department of Health
Mr. Craig McLaughlin, State Board of Health
Ms. Tara Wolff, State Board of Health
•
Group B Feedback
Survey of Environmental Health Directors
el. Do you plan to continue your current level of activity on Group B water systems into the future (knowing
that current levels of activity vary from no program to full regulatory and assistance programs, and knowing
that it is uncertain what the SBOH may or may not do in regards to the current state regulations)?
County and Name Comment
Adams County Brent Stenson Would like to continue at current level of Group B work.
Still unresolved how to pay for it. Have not formally
approached BOH.
Clallam County Andy Brastad We plan to stay with our current level of activity in regards
to reviewing engineered plans and well protection. We
will continue to charge fees for this service.
We will not continue to hold workshops and survey or
inspect Group B systems since DOH funding for that
program is due to discontinue.
We are waiting to see what programs changes occur within
the DOH then decide what actions need to be taken locally.
Clark County Thomas R. Gonzales We will be making a presentation in support of continuing
our Group B public water system program to the BOH -
August 12. If the direction is to continue, we'll be asking for
fees to maintain a program and develop a local private and
• public drinking water code.
Columbia County Public Health Department Columbia County does not have a Group B program and,
David E. Riggs given the current conditions, we will probably not be
initiating a program in the near future.
Cowlitz County Health Department Cowlitz's intention(today) is to continue our current activity
Audrey Shaver with Group B program.
Our dilemma revolves around what will happen to the
existing Group B regulations and what we might have to
pick up that we are not currently responsible for in our JPR
and if we have capacity to do that. We realize that if the
current Group B regulations are altered it may require us to
go to our Board regarding a local regulation but would prefer
a different option.
Grays Harbor County Jeff Nelson Without the DOH ConCon money I do plan on maintaining
our current level of activity in regards to sending reminder
notices out for on-going monitoring requirements....we'll
just stop doing routine surveys for now. If the monitoring
requirements are eliminated by the SBOH later we'll ask our
BOH for direction at that time.
Island County Aaron J. Henderson Island County will continue the current level of Group B
activity, minus the surveys. We will undoubtedly get caught
• up in giving technical assistance from time to time as well,
as we do for any water system. Currently we do plan
reviews for new systems and new connections.
Page 1 of 7
Group B Feedback
County and Name Comment
Jefferson County Public Health Susan Porto Our department does not have a Group B program and has
not made a decision on how to proceed in the future. We ao
currently working on a database to track connections to
facilitate building permit adequacy.
Kitsap County Keith Grellner Kitsap is working to put a proposal together for our BOH.
We discussed this issue with them twice earlier this year, and
they were supportive of developing a local program
contingent upon what the local program would look
like/cost.
Klickitat County Health Department We will continue to approve Group Bs and provide technical
Kevin Barry assistance. We currently charge fees for plan review and
well site inspection, and they won't change in the near
future. We will adopt a rule if the State rule is abrogated.
Lincoln County Health Department I think we would drop into a technical assistance roll. We
Ed Dzedzy would also deal with complaints and probably need review
_ approval for expansions.
Northeast Tri-County Jim Matsuyama We were just doing sanitary surveys and helping with some
TA. Do not plan to continue either but I'm sure we'll work
with DOH on responding to problems.
Officially we will stop doing Group B activities.
Unofficially, if we don't have any further staff losses due to
budget cuts, we will work with DOH to respond to dw
problems, help with investigations, etc.
Okanogan County Public Health Dave Hilton With the impact that these changes will have on other •
aspects of E.H. such as OTA's and community kitchens, both
of which are currently required to meet the Group B
standards, we do not feel that we have a choice but to
implement some form of a Group B program.
Public Health Seattle/King County If the direction from BOH is to continue, we'll be asking for
Ngozi T. Oleru fees to maintain a very basic program which will also allow
us to support locally required development code provisions.
San Juan County Mark Tompkins This is something we will be discussing with the Board of
Health& County Council. Not sure on the direction we will
go given the current economic situation in the county.
Currently we have exempted 2-connection water systems
from all requirements.
Skagit County Public Health Corinne Story We must continue a Group B program to process building
permits and land divisions in an orderly way. With the State
Department of Health's past Group B grants, we now know
more about our Group Bs than ever before. We know well
locations, service areas and we plan to protect a modest
wellhead protection area(310').
We would continue our well site inspection with fee.
Skamania County Karen Witherspoon Skamania County currently does not have a Group B •
program. After having discussions with the Board, it does
not look like we will have one in the near future.
Page 2 of 7
Group B Feedback
County and Name Comment
Spokane Regional Health District SRHD plans to continue at its present level which is no
• David C. Swink Group B program and no fees.
Tacoma-Pierce County Health Department We are going to continue our Group B activities.
Steve Marek
Thurston County Art Starry Yes, we plan to maintain our current Group B program,
providing our new annual fee program stays on track (see
#2).
Walla Walla County Health Department As you know, our food permits and septic permits that are
Harvey R. Crowder dependent on small approved public water systems give us
Barry Jenkins no choice but to continue some kind of program to order to
satisfy food and sewage regulations. So we plan to continue
with a local Group B program. Our priorities would be:
assisting with workbooks for plan review, monitoring
notification and quality violation follow-ups, and technical
assistance as needed. We will link receipt and maintenance
of food and sewage permits to satisfactory current water
system approval, monitoring, and sampling results.
Whatcom County Health Department Whatcom County will begin internal discussions soon and
John J. Wolpers come up with alternatives to carry forward to the BOH.
Whitman County Michael Baker Whitman County is actually looking at doing more with the
Group Bs in the County. I'll be meeting with the
Commissioners to go over a fee schedule here shortly.
• Yakima County Gordon Kelly We do not plan much change. We currently review water
source sites (and charge for it). We will likely continue. We
will no longer be assisting in the completion of Group B
packets to be sent on to DOH. Our planning office has taken
an interesting twist in that some of their decisions are
requiring shared water systems. We will continue to respond
to those, funded by fee payments. If the water system is
associated with a facility that we permit (food service, camp,
etc.), we will continue to have a higher role there related to
maintaining their permit.
•
Page 3 of 7
Group B Feedback
2. Other plan review fees, do you charge other on-going fees today for Group B activities? If not, are you
planning to approach your Board on future Group B fees in your jurisdiction to support your efforts?
County and Name Comment IP
Adams County Brent Stenson We don't currently charge them any fees except for approval
of the systems. We have a hard enough time keeping the
contacts/WFI's current, billing them would be a nightmare
because there's nothing for them to lose by not paying for
their yearly permit. My guess is that we would pay attention
to water systems serving businesses and residential
developments over 4 single family homes.
Clallam County Andy Brastad We do not have operating or other on-going fees for Group
Bs. No decision has been made about proposing operational
fees.
Clark County Thomas R. Gonzales We will be making a presentation in support of continuing
our Group B public water system program to the BOH - July
1. If the direction is to continue, we'll be asking for fees to
maintain a program and develop a local private and public
drinking water code.
Columbia County Public Health Department Columbia County does not have a Group B program and,
David E. Riggs given the current conditions,we will probably not be
initiating a program in the near future.
Cowlitz County Health Department Cowlitz's intention(today) is to continue our current active
Audrey Shaver with Group B program.
We currently charge an annual fee for Group B systems.
Grays Harbor County Jeff Nelson No on-going fee's applied to Group B's right now(other
than lab fee's)....will explore new fee's and regulations once
we know what direction the SBOH takes.
Island County Aaron J. Henderson No mention of new fees.
Jefferson County Public Health Susan Porto We are in preliminary planning stages with our health officer
and the local BOH, and fees are definitely part of that
discussion.
Kitsap County Keith Grellner Kitsap is working to put a proposal together for our BOH.
We discussed this issue with them twice earlier this year, and
they were supportive of developing a local program
contingent upon what the local program would look
like/cost.
Klickitat County Health Department We currently charge fees for plan review and well site
Kevin Barry inspection, and they won't change in the near future.
Lincoln County Health Department No mention of new fees.
Ed Dzedzy
Northeast Tri-County Jim Matsuyama No additional fees now and won't adopt any new ones.
•
Page 4 of 7
Group B Feedback
County and Name Comment
Okanogan County Public Health Dave Hilton We received support from our BOH to develop a local Group
• B program. However, my proposal will include the thought
that we plan on maintaining the program for a limited
amount of time. Fees will be developed based on the time
required for each task involved with Group B water systems.
Public Health Seattle/King County We are going to our BOH to ask for direction in a couple of
Ngozi T. Oleru weeks. If the direction is to continue, we'll be asking for
fees to maintain a very basic program which will also allow
us to support locally required development code provisions.
San Juan County Mark Tompkins No mention of fees.
Skagit County Public Health Corinne Story We would continue our well site inspection with fee. We
charge our licensees (restaurants, RV parks, etc.) a nominal
annual fee ($50 for approved water system and$100 for an
unapproved water system).
Skamania County Karen Witherspoon Skamania County currently does not have a Group B
program. After having discussions with the Board, it does
not look like we will have one in the near future.
Spokane Regional Health District SRHD plans to continue at its present level which is no
David C. Swink Group B program and no fees.
Tacoma-Pierce County Health Department We currently charge design fees and a yearly permit fee.
Steve Marek Probably be raising fees to help offset some of the legislative
cuts and will need to get our Board to approve them later this
year.
• Thurston County Art Starry We plan to implement a new Group B annual permit July 1.
Our Board of Health created a Group B annual permit fee
earlier this year. This fee will be in addition to the plan
review and other fees we have. Fortunately our local
regulations (Article III) already contains authorization for an
annual permit.
Walla Walla County Health Department We have no current fees, so we plan to approach our Board
Harvey R. Crowder of Health for approval of a local ordinance and adequate fees
Barry Jenkins to support our efforts.
Whatcom County Health Department Whatcom County will begin internal discussions soon and
John J. Wolpers come up with alternatives to carry forward to the BOH.
Whitman County Michael Baker I'll be meeting with the Commissioners to go over a fee
schedule here shortly. We will most likely have to make the
program 100% fee supported unless we get some
commitment from the BOCC.
Yakima County Gordon Kelly We will continue to respond to planning department
requests, funded by fee payments. If the water system is
associated with a facility that we permit (food service, camp,
etc.), we will continue to have a higher role there related to
maintaining their permit.
•
Page 5 of 7
Group B Feedback
3. Do you have any other plans relative to the Group B water systems in your jurisdiction given the recent
legislative changes?
-4.44, a—me uomme,kit
Adams County Brent Stenson No.
Clallam County Andy Brastad We are waiting to see what programs changes occur within
the DOH then decide what actions need to be taken locally.
Clark County Thomas R. Gonzales We will be making a presentation in support of continuing
our Group B public water system program to the BOH-
August 12.
Columbia County Public Health Department No.
David E. Riggs
Cowlitz County Health Department Our dilemma revolves around what will happen to the
Audrey Shaver existing Group B regulations and what we might have to
pick up that we are not currently responsible for in our JPR
and if we have capacity to do that. We realize that if the
current Group B regulations are altered it may require us to
go to our Board regarding a local regulation but would prefer
a different option.
Grays Harbor County Jeff Nelson No.
Island County Aaron J. Henderson We do not have any plans to expand existing services at this
time.
Jefferson County Public Health Susan Porto We are in preliminary planning stages with our health officer
and the local BOH.
Kitsap County Keith Grellner If I had to guess right now, I would say the odds of Kitsap•
getting a locally funded program are 51/49"for"right now.
Klickitat County Health Department We will adopt a rule if the State rule is abrogated.
Kevin Barry
Lincoln County Health Department No.
Ed Dzedzy
Northeast Tri-County Jim Matsuyama Officially we will stop doing Group B activities.
Unofficially, if we don't have any further staff losses due to
budget cuts, we will work with DOH to respond to dw
problems, help with investigations, etc.
Okanogan County Public Health Dave Hilton I will be proposing to our BOH today the idea of a locally
(read fee) supported Group B program.
Public Health Seattle/King County We are going to our BOH to ask for direction in a couple of
Ngozi T. Oleru weeks.
•
Page 6 of 7
Group B Feedback
San Juan County Mark Tompkins Not sure on the direction we will go given the current
economic situation in the county. Currently we have
exempted 2-connection water systems from all requirements.
Skagit County Public Health Corinne Story What makes sense to me from this vantage is to copy the
septic system program. Ideas below....all would have fees
attached.
1. Prior to all real estate transactions, there will be an
inspection, monitoring update and a(sanitary survey) report
so that the purchaser knows what they are getting into.
2. Prior to any new connection a system would have to
be in full compliance.
3. For a substantial upgrade to a house on a Group B
system, the system must be substantially compliant.
4. Maybe for even minor building permits,they need to
be up-to-date with their water quality monitoring.
5. Maybe place building moratoriums on water systems
to design correctly and safe.
6. We have discussed an annual operating permit but we
currently have no plan to implement.
Skamania County Karen Witherspoon No.
Spokane Regional Health District No.
David C. Swink
Tacoma-Pierce County Health Department Probably be raising fees to help offset some of the legislative
. Steve Marek cuts and will need to get our Board to approve them later this
year.
Thurston County Art Starry 3. We sent newsletters to Group B owners and purveyors
describing the new permit program, and will have an Open
House June 4 to discuss it with them. Our Board supports
the program even though they are receiving complaints about
the new fee. We have a Board briefing on June 24 to review
the program and public comments before its fully
implemented.
Walla Walla County Health Department We would review how to define a Group B system under
Harvey R. Crowder local ordinance and consider whether we want to require an
Barry Jenkins annual operating permit.
Whatcom County Health Department Whatcom County will begin internal discussions soon.
John J. Wolpers
Whitman County Michael Baker Whitman County is actually looking at doing more with the
Group Bs in the County. I'll be meeting with the
Commissioners to go over a fee schedule here shortly
Yakima County Gordon Kelly We do not plan much change.
1111
Page 7 of 7
r
410 4.1104140...
Current program direction for
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Group B Water Systems
July 2009
Earlier this year, the Legislature eliminated funding for us to oversee the Group B water system
program. The Legislature also changed the law that applies to Group B water systems. The
changes allow the State Board of Health(Board)to:
• Adopt rules for Group B systems that do not require ongoing water quality monitoring.
• Exempt systems with fewer than five residential connections from all requirements.
We recently met with the Board and received approval to move forward with our Group B
rulemaking efforts. We anticipate the Board will adopt a revised rule late in 2010. Visit our Web
at http://www.doh.wa.gov/ehp/dw/groupb.htm for updates.
In the meantime, the current Group B rule(Chapter 246-291 Washington Administrative Code)
still governs the Group B water system requirements. Our staff, local health jurisdictions (LHJ),
and stakeholders have posed a number of questions about how we plan to implement the Group
• B program until the Board adopts a new rule. Here are our current program directions:
Document Review
Do we require a professional engineer(P.E.)to submit all Group B designs?
There will be no change from the existing requirement and our current practices. For
submittals to us, we require a P.E. to do the design work. We will accept a design from a
non-P.E. if a LHJ has collected the Group B workbook and forwarded it to us as a complete
document.
LHJs that oversee Group B water systems under a Joint Plan of Responsibility can continue
to accept designs from non-P.E.s,provided they have a licensed designer program.
If a Group B system wants to expand,will we require a new and complete submittal?
We won't change from the existing requirement and our current practice. We will review
Group B water system expansions on a case-by-case basis.
What's our Group B document review expected turnaround time?
We currently review documents in about 30 days. We won't change that unless we see an
increase in the number of submittals. If that occurs,we will consider extending the timeline.
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Fees
Are the fees in WAC 246-290 sufficient to recover the full cost for Group B design
review/approval?
We don't know. However, we cannot change the fee without legislative approval. We will
decide in the near future if we will ask our agency to propose a fee increase to the 2010
Legislature.
Can we charge an "expedited review" fee?
No, we don't have that authority.
Will we continue giving partial reimbursement to LHJs for collecting packets?
For now, we will continue to reimburse LHJs for collecting Group B packets. We will look at
information on whether the program is cost effective. Based on that information, we will
make a decision about whether to maintain the reimbursements.
Data Management
Will the Department of Health enter Group B water quality results into our Sentry
database?
Yes. We will continue our current practice of entering into Sentry all results that labs report
to us for public water systems.
What water facilities inventory information (WFI) on Group Bs will we enter into Sentry?
We will enter the WFI information consistent with our current practice. •
If we don't track changes to the WFI, how do we know when Group B systems change to
Group A systems?
We will enter the WFI information consistent with our current practice.
If we have a backlog in the regional offices of Group B new/updated WFIs,will we find
resources to relieve the backlog?
No, this data entry work is not our current priority.
Do we accept Group B system files from Local Health Agency? Do we keep Group B files?
No. If a Local Health Agency decides it can no longer oversee Group B water systems, we
will not take their files. If someone wants a copy of a previous water system approval,we
will direct that person to the appropriate Local Health Agency to find that information. We
will maintain our Group B files for all the systems we approve.
Public Information
Will we issue health advisories for Group Bs?
We will issue health advisories for acute contaminants such as fecal coliform and nitrate.
Will we increase our public information resources concerning Group Bs?
Not at this time. After we adopt a revised Group B rule, we will determine what additional
public information resources are needed.
•
-2-
1
• Technical Assistance
What action do we take if we find a Group B with a water quality problem (such as
coliform or nitrate exceedances)?
We will continue to assist systems that have drinking water with acute contaminants.
How much and what type of technical assistance do we give Group B purveyors that
request our assistance?
We will provide limited technical assistance. If water systems need more assistance,we will
tell them to seek professional help from entities such as consultants, well drillers, and
satellite management agencies.
Local Health Programs
How do we keep track of which LHJs have a Group B program?
We recently surveyed LHJs about the level of their Group B program. We will update the
survey later this summer. We expect LHJs to let us know if they change their activities
related to Group B oversight.
Will we amend Joint Plans of Responsibility?
Not at this time. We'll keep track of proposed changes and decide later how to handle these
requests.
Policies
• Will we drop two-party systems from the definition of public water systems?
In counties that drop their Group B program, we will follow our current policy that exempts
two-party systems from regulation. We will not search for these systems or make wholesale
changes to the database,but will de-activate them as they come to our attention.
Will we approve new Group B systems with potential acute water quality problems?
We will use our current authority to deny approval of new Group B systems that would
require ongoing treatment of a surface water source, or any source with nitrates greater than
10 parts per million or arsenic greater than 50 parts per billion.
For more information
If you have questions or comments, please contact Dave Christensen at(360) 236-3153 or
day id.christensen@doh.wa.gov
We will use a ListSery to send Group B updates. To subscribe, go to our Web site
http://www.doh.wa.gov/ehp/dw and click on"Group B Water System Information"ListSery at
the bottom of the page.
PUBLIC LTH
ALWAYS WORKING FOR A SAFER ARD
HEALTHIER wAsamouroN
1110 The Department of Health is an equal opportunity agency. For persons with disabilities, this notice is
available on request in other formats. To submit a request, please call 1-800-525-0127 (TTY 1-800-833-
6388).