Loading...
HomeMy WebLinkAbout2009- August File Copy • Jefferson County Board o.f a CeaCth .agenda rM Inutes • August 20, 2009 • • JEFFERSON COUNTY BOARD OF HEALTH August 20, 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 July 16, 2009 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. West Nile Virus Detected in Mason County Crow 2. SBOH Summary 3. Septic Community Education Update • iC4._ V. New Business 1. Green Business Award—Port Townsend Computers 2. WIC (Women, Infants, Children) Annual Report 3. Pandemic H1N1 Preparedness Update: Vaccination Strategies 4. 2009 Budget Update VI. Activity Update VII. Agenda Planning: Bylaws in September VIII. Next Scheduled Meeting: September 17, 2009 2:30—4:30 PM Jefferson County Public Health • %%*4.- JEFFERSON COUNTY BOARD OF HEALTH • MINUTES Thursday, July 16, 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 Kristen Nelson,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, Kristen Nelson, Chuck Russell, David Sullivan, Sheila Westerman Members Excused: Roberta Frissell, Phil Johnson Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin • Guest: Frances Joswick, SAAB, was present for a portion of the meeting. A quorum was present. APPROVAL OF AGENDA Chair Westerman welcomed Kristen Nelson, Port Townsend City Council member, who is succeeding Michelle Sandoval as the City of Port Townsend representative. Chair Westerman noted that there may be a report from Fran Joswick, Substance Abuse Advisory Broad, at the end of the meeting as time permits. Member Russell 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 June 18, 2009; Member Sullivan seconded. The minutes of June 18, 2009 were unanimously approved, as presented. • Page 1 of 10 PUBLIC COMMENTS There were no public comments. OLD BUSINESS and INFORMATIONAL ITEMS Washington Breast, Cervical, and Colon Health Program Report Julia Danskin referred to the report in the packet. She said that Jefferson County has done a great job in screening women for breast and cervical cancer through this program. The total number of women screened in 2008 was 108. Three abnormal pap smears were found, but no cases of cervical cancer were found. There were 72 mammograms done through this program. This year, there will be a mobile mammogram screening in Quilcene, utilizing the Swedish Hospital van, on October 10. In response to a question, she explained that"the percentage of eligible served" is based on an estimate of the number of women in Jefferson County who are low income without health insurance. Jean Baldwin added that the poverty in this county is not primarily in that age group(40-64). Pandemic H1N1 Update: Medical Surge Capacity,Business Preparedness and School Infection Control Planning Jean Baldwin said that Dr. Locke and Julia Danskin would provide the most recent information • on pandemic preparations. There have been several conference calls this week with the state and local public health agencies to discuss topics related to swine flu(HIN1). A number of tasks need to be accomplished this summer concerning education for physicians, schools and businesses. She mentioned previous problems with people returning to work while still ill, and not wearing protective masks etc. It will be possible to use other counties' educational materials with some modification. Dr. Locke said that there has been intensive planning for the next influenza pandemic starting in 2005. He noted that this is the first flu pandemic of the 21St century. It presented differently than expected: it began in North America, and, fortunately, at a time of year that is not favorable for transmission. Despite the fact that we are well into summer, there is still a significant amount of swine flu activity in the US. The problem is greatest where children and adolescents gather, such as summer camps. In the Southern Hemisphere where winter weather is more favorable for flu transmission the new H1N1 virus is behaving exactly as a pandemic strain is expected to behave. In a pandemic everyone is generally susceptible; even with a mild strain of influenza, many people get sick. Generally, in a pandemic, at least 25% of the population gets sick during the first wave. It has been noted that not all cases of the pandemic H1N1 strain are as mild as initially thought. It is different than seasonal flu but is not a replay of the Spanish Flu of 1918. It is capable of infecting the lower respiratory tract, a trait not shared by seasonal influenza. A virus that causes a viral pneumonia is a more serious health threat. There are higher levels of hospitalization and • needs for intensive respiratory therapy, including ventilator support . The mortality rate is Page 2 of 10 significant. Nationwide, it is estimated that there have been more than 1,000,000 cases already. • The risk of widespread outbreaks will start to increase as soon as schools are back in session. In response to a question, Dr. Locke said that the respirator capacity throughout the Peninsula is low. Operating room respirators are not the right type of equipment for prolonged mechanical ventilation, and it is not feasible to significantly increase the supply of respirators. Vaccines are being produced and administration of these vaccines will be a major workload issue. He said it would be a challenge for Health Department and the entire medical care system. The workforce requirements far exceed the available resources. Dr. Locke said that Public Health and the medical care system are set up to work independently in most circumstances, but it will be necessary to have them work together seamlessly. During the summer, pandemic preparations will continue to be a significant work priority. Dr. Locke said that triple reassortment viruses, the category the new H1N1 strain falls into, have not been the subject of much study. The research focus has been directed at avian flu and the risk of a virus jumping directly from birds to humans. The degree of contagion for the swine flu virus was unexpected, previous swine flu strains had difficulty spreading from person to person. He said the stability of the new virus is unknown. Will it stay in its current genetic configuration or will it further combine with other flu viruses? Swine flu is already acquiring resistance to one of the main anti-viral drugs. It is also unknown if it will be the same flu that began in North America once it has cycled through the Southern Hemisphere and returns. Chair Westerman inquired as to what factors are common to humans, birds and pigs. Dr. Locke • said that Influenza A is primarily a bird disease; there are 144 different kinds of Influenza A for birds. Most are mild infections, some are lethal for birds. A number of other species are at risk of being infected with avian influenza depending on how susceptible they are to particular strains. There are strains that affect dogs, whales, horses, swine, and other mammals. He said, however, that it all stems back to birds. He said it is not known if a triple reassortment virus could spread back to the bird population. It has been observed that the new human"swine flu" can spread from humans to swine. Member Nelson asked for more information about the plans being developed. Dr. Locke said that influenza is very difficult to control. It can easily be spread up to 48 hours before symptoms are seen or felt. The outline of the plan is scaled to 5 different severity levels. Currently, the pandemic status is a category one or two, similar to seasonal flu. Preparation is focused on containing the spread of the flu once it is contracted. Isolation, hand washing, sanitizing, etc. is very effective in preventing flu transmission, but Dr. Locke said it is not done very well in either health care facilities or in society in general. Jean Baldwin noted that there is great effort now focused on the schools because of the age of those getting sick and because viruses spread quickly there. She said that discussions with school administrators and staff will be set up for August. Member Austin inquired about working with local camps. Jean Baldwin said that messages had been sent to all known local camps with instructions on screening, responding to sick children, etc. Camp Parsons has an organized Boy Scout contingent in Seattle with whom staff is • working. She requested that members send information on any other camps in the vicinity that may not have been included. Page 3 of 10 Member Austin also asked if there is possible help from the State or Federal government to hire temporary workers or other assistance. Jean Baldwin said that$8,000 from the State had been • received for the initial outbreak work, and that they may try to build some staff time into plans. She said the Health Department will receive about 3300 vaccine doses, which must be tracked by the department. The actual dispensing of vaccines will also be done by the hospital and practices,but the logistics are very complicated. There are liability and insurance issues to work through. In response to a question about work that would not be able to be completed, Jean Baldwin said that she and staff had prepared a tentative list,which could be reviewed by the BOH. There was also a brief discussion about providing adequate backup for services and the possible loss of revenue, as well. Julia Danskin discussed training and confirmed that training would be done in the schools. In seeking volunteers, she has contacted the Red Cross to locate nurses who can help with training in the community. Regarding vaccines, a minimum of 3360 doses will be received by October; planning for storage of vaccines and syringes is in progress. Staff includes those who have participated in mass immunizations in the past. She is awaiting decisions on the exact timing of the two-shot immunization and the priority group for vaccination. NEW BUSINESS Group B Water System Regulation in Jefferson County • Jean Baldwin noted that this topic was discussed at the recent State Board of Health meeting,and would be under consideration for the next year as State rules change. Susan Porto, Environmental Health Specialist, said there had been a short presentation at the State Board of Health meeting the previous week, where some of the changes had been introduced. Ms. Porto said she would present what is presently done in Jefferson County with regard to the drinking water systems. She stepped through a slide presentation regarding the changes that are occurring with this program. A handout entitled"Group B Feedback, Survey of Environmental Health Directors"was provided. She also provided copies of a position paper by Dave Christianson(former employee of Jefferson County)on DOH direction in the next several months. She began with a background of public supply water systems in Washington State. By State Law, a public water supply is defined as all systems except one single family residence or less than 5 residences on a family farm, i.e. anything other than a single domestic source. Public water supplies are divided into two main categories, Group A and B. Group A have more than 15 residential connections, 25 or more people, greater than 60 days per year or are federally mandated program. Group B systems have 15 or less connections, less than 25 people, less than 60 days per year, and are not federally mandated. This was modified in 1995 by the State to exempt two-party connections provided that counties take on some duties. There was a brief • Page 4 of 10 discussion as to how camps fit into one of these two categories. Ms. Porto said that most camps • are Group A, while bed& breakfasts usually fall under Group B. For Group B,most counties have a joint plan of operation with the State DOH, but vary widely on specific arrangements. Seven counties have no service whatsoever. Twelve, including Jefferson, have limited agreements. Twenty, including Clallam, have active programs mostly in permitting new systems. Jefferson County, until 2001, had very limited authority over public water supplies. It did inspections, with fees, for proposed sources for new public water supplies, A and B, and provided some technical assistance. The State Legislature then asked DOH to inventory systems, inspect them and determine risk. The County staff became involved in doin some of the assessment in Jefferson County. As of January 2009, the DOH said it would no g longer provide potable water adequacy on building permits. She said that the State database is available but is usually not current. She has contacted DOH and adjusted the contract so that the County can maintain its own database, which now contains 165 entries which will be tracked. The objectives in 2004 to assess risk included: inventory, photographs, determine how to address any inadequacies, operators ensure that are aware they need to do water quality monitoring. Emphasis was on voluntary compliance. There were 42 systems were on the State's list: 37 inventoried; one refused inspection; 2 could not be found; one was inactivated, and for one there was a conflict in scheduling. They found that 57%had potential contaminants within 100 feet of the well; 46%had improperly constructed well vents and openings in the well cap; 50%of open storage reservoirs had unprotected openings; inadequate water quality monitoring-about one third were not monitoring and about 26%were incorrectly sampling the water. She showed photographs of various problems and risk situations. Ms. Porto said that the educational benefit to these well operators was significant and most were appreciative. As of early 2009, the Legislature eliminated all funding for DOH to oversee Group B regulations but did not rescind the RCW; the DOH is in a holding pattern, which is described in the handout. An RCW change is planned for 2010 which will establish design requirements for initial design and construction of a water system, eliminating the existing monitoring requirements. It will also allow the State BOH to waive some or all requirements for fewer than 5 residential connections. There are associated zoning/land area questions to be resolved. The DOH will continue to survey what counties plan to do. Jean Baldwin stated that as of July 1, due to lack of funding, Susan Porto will move to Septic Systems and Linda Atkins will work on Clean Water grants. Other plans for the future are uncertain. Chair Westerman said that every possible effort has been made in the past to staff these areas without adequate funding, but it is not possible any longer. She mentioned the unfinished work with septic systems. There was a brief discussion about fees in other jurisdictions and about the remaining problem of existing systems, mostly unpermitted, left the Counties to deal with. Possible solutions are to link water system permits with buildin to permits, or with sales of properties. g There was mention that there is no longer water service at the U.S. Forest Service campground in • Quilcene due to new federal regulations regarding use of surface water. Page 5of10 M ste Ba Commercial Shellfish Classification Chan a and Ad'udicative Hearin O tion • Neil Harrington noted that the BOH has the authority to seek an appeal regarding this decision by the Department of Health. He said he would provide a brief history and a recommendation regarding this matter. r is a There are two types of shellfish area closures: one is basedindications onwterquality d Lada of otwater may categorical closure based on use. In this case,there were meet the defmition of marina. In the spring 2008, theue to nuthe m OHof indicoats ated that at Mystery reclassification order was under consideration Bay. He discussed the County's mooring buoy application process,which requires a shoreline Washington development permit to place the structure forassigrunent of State bed permission of the 1 nds and WA Dept. of Department of Natural Resources (DNR), Fish and Wildlife (DFW) approval. A series of meetings ensued, dealing with types of buoys and the range of boats there, including legal, illegal and grandfathered instances. Participants included the Department of Community Development(DCD),DNR,DFW,DOH, Tribes, State m Parks,Neil Harrington, and MRC (Marine Resources Co� eand orwnership of herbuoysing O,oand 8, much of the work involved data gathering, sorting out the status determining if this body of water meets the definition o as not particularly p arl bgood news to the conditional winter-only harvest was considered, but shellfish growers. The process stalled somewhat in the spring of 2009. Represent elped tative Kevin the Van De Wege then called a meeting in May with shellfish growers Bement was worked out that • process forward. After a public meeting at Fort Flagler, an agr limited the number of boats in the inner bay, exempting the local will shoreline econdt ovally app R also marked undocumented buoys for removal. The outer harbor Most parties see this as an interim measure. fairly Mr. Harrington said that this seems to be a good solution,with all partiareaesfif more buoys don be . The possible next steps include decrease of the conditionally approved moved. DNR and DCD are working on which buoys could be moved boats drop anchor closer of the e to State Park, and in shaping a management plan to ensure that an the State Park. The Jefferson County MRC has a grant for pla Beg mgrars markerab shellfish protect on. uoys between the outer and inner bay to establish a voluntary no anchor zone The number of boats has decreased and DOH will continue for shellfish mo h ha esting nitor there. f a management plan is approved,the outer bay will likely be approved recommended that, unless there is other extenuating information,there should not be an appeal. He feels the interested parties (DNR, County,DOH, etc.)will continue to work on the issue. Member Sullivan inquired about the DOH suggestion of a moratorium on new buoy permits. Mr. Harrington said that there are only two permits pending, and that DCD may bring that forward. He said those cases may be placed the to by signing an affidavit that they will not Shoreline landowners may be ableget permits discharge from the boat. Chair Westerman said that,in her reading, all four measures(page 2 of synopsis)must be done. She asked who will ensure that these steps are done, including the management plan. Mr. • Page 6 of 10 Harrington noted that DNR had stated that if a community group or entity wished to lease the . entire bed lands of Mystery Bay and run it like a mooring buoy field that would be possible. State Parks will likely manage the area near the Park. Measure 1, removing unauthorized buoys, has been undertaken and will likely be followed by another round; measure 2, relocation of buoys, is in process by DCD and DNR; measure 3, management system, is still under discussion; measure 4, moratorium, would be done by the County and DNR. Member Sullivan said that it is likely that all of the above would be shared responsibilities of the County and DNR. He said that a meeting where all entities could be represented will be scheduled for August or September, which he will attend. Also, DNR and DOH were interested in the help of volunteers in a management plan. Member Sullivan said he had referred them to the Marrowstone Island Community Association for monitoring tasks. He said that will likely be negotiated among the affected parties. Chair Westerman stated that this seems like a good solution, but was concerned that there may not be follow through in the long term. She believes that there must be a single agency taking responsibility; if no other entity takes the lead, the County will need to do so. Jean Baldwin noted that the County is in an unusual position since it is a shellfish issue but there is not a water quality problem. It is a partial closure and DCD does the permitting. She said that a recommendation from the BOH about how we track the plan to the BOCC may be appropriate. Member Sullivan suggested that he attend the planned meeting and report back to the BOH. Member Austin asked how vested buoy rights would be handled; would a declaration of emergency supersede those rights. It was noted that this has never been a water quality issue, but • that there is a need to see the situation through to resolution and ongoing monitoring. Mr. Harrington and Member Sullivan said they would continue to work with all the parties. Members agreed that the process and progress thus far has been very good. Member Sullivan stated that he would take responsibility for following up on open issues. Position Papers and Draft Resolution Re: Affordable Health Choices Act Dr. Locke referred to the significance of health care reform legislation being developed in Washington D.C. He said that the Public Health community is trying to link needed public health reforms to health system reform, and that there is legislation pending in this regard. The national public health organizations, e.g. American Public Health Organization and National Association of County and City Health Officials, are asking local Boards of Health to weigh in on these issues. A copy of their resolution, with draft Jefferson County modifications, is included in the packet. It now appears that action by the House and Senate before the August recess is not realistic. There are two bills being considered, the Senate Health bill and the House Health bill, as well as a Senate Finance bill still in development. The process of reconciliation will be extremely complicated. There is an acknowledgement in all three bills that changes to the Public Health system are crucially important. In order to provide guaranteed health care to everyone, it is necessary to do everything possible to prevent illness. In addition, if costs are to be controlled,there must be attention to evaluating which medical therapies are effective and which are not. • Page 7of10 In Washington State,there is a meeting being scheduled during the week of August 10 with legislators during the August recess to discuss health reform. He said our legislators are all . supportive. The purpose of a Jefferson BOH resolution would be to add our voice to all the others in the country. Jean Baldwin said that the Kennedy bill carries a clear statement about the need for Public Health funding and infrastructure, and delineates several programs as essential parts of the health care system. She said that Katherine Sibelius has stated that discussion of prevention, outcomes and public health funding streams are essential components of health care reform. She said that if things change quickly, she will notify the BOH via e-mail. Member Austin suggested that although there is no urgency, it would be well to take action on the resolution, which requests very basic provisions. Member Austin moved to adopt the draft resolution and member Russell seconded. Chair Westerman proposed the following edits: • First Whereas—change"health system" to "health care system"; • 7th Whereas—change "see all "to "serve all..."; • Page 2,item 3—change"health promotion....." to "promotion of good health and prevention of disease and injury...." Member Austin accepted the changes as friendly amendments. The draft resolution No. 2009-1 was approved unanimously,as amended. Jean Baldwin said she would also send a copy with a cover letter to the Hospital Board. Chair Westerman will sign the amended version. Tribal Mutual Assistance Agreement: Draft Open for Comment Dr. Locke stated that this document is part of a first ever national pilot project, for three counties • and seven Tribes, developing a Public Health Mutual Assistance Agreement. When finalized, it will be considered for adoption by County Boards of Commissioners and Tribal Councils. However, it is first presented to the BOH since it very much affects the mission of the Health Department, and expands our capability as a local jurisdiction. In practice, it gives the Tribes the ability to formally seek help in public health emergencies from other tribes and county health departments. Jean Baldwin noted the level of respect that exists for Dr. Locke and Dr. Lindquist, who have been working closely with the Tribes. This agreement will allow better clarity and cooperation than in the past with regard to provision of services. Member Sullivan inquired whether this may open up other funding sources. Dr. Locke said that is anticipated, and that services are paid for, not donated. However,the services are given when needed,with payments reconciled at a later date. Member Austin suggested that the agreement be shared with the Department of Emergency Management for their information. Jean Baldwin said that could be done regionally, with a cover letter. Dr. Locke said that the language can be modified and any missing elements can be added. He said that there had been a deliberate attempt to address all issues, including those that are sensitive or potentially problematic. He noted that the County has no authority within the Tribal jurisdictions. Member Austin noted that recent Sheriff's Deputy Agreements allow some greater flexibility and that traditional restrictions may be loosening. Member Russell inquired about • Page 8 of 10 r food service inspections. Dr. Locke said that if requested, that service could be provided. For S example, should there by an outbreak associated with a Casino, the Tribe could ask for assistance. Jean Baldwin said that Tribal run food businesses are not subject to State inspection, although many of them have contracted with local Health Departments. Member Westerman expressed her concern that local Boards of Health are not even mentioned in the agreement. Dr. Locke said that that issue will likely be dealt with in the next phase. One of the issues was the fact that there are no comparable agencies (to Boards of Health) within the Tribal government. He said that they have been encouraging Tribes to create BOHs and Health Officers, and similar structures. Jean Baldwin added that the Tribes wanted to bind the partners at the highest level of government possible. Chair Westerman said that she has long worked to expand the Board beyond politics and political affiliations. She noted the representation from the City and Hospital, as well as the County. Member Nelson noted that some counties do not have a separate Board of Health from the Commissioners, and that the BOH members serve at the pleasure of the BOCC. Chair Westerman recalled that the intention of allowing an expanded Board of Health eleven years ago was to create a body that was focused on public health issues, but not politically driven. She said that Jefferson was the first county to do this and it has been encouraged by the legislature. She noted that both Republican and Democratic Commissioners with whom she has worked on the BOH have recognized the need for Public Health to be outside of partisan politics. She said the body needs to be bigger than the three Commissioners. Dr. Locke and Ms. Baldwin reaffirmed their request that BOH members review the document and make suggestions. It was agreed that Deputy Attorney Alvarez would also be asked to • review it. AGENDA PLANNING An SAAB update from Fran Joswick was tentatively scheduled for the August meeting, at her option. (This agenda item was deferred from this meeting, July 16, since Ms. Joswick was not able to stay for the duration.) The Bylaws, as edited, will be ready for review and approval at the August meeting. Jean Baldwin added that Member Austin was selected as one of a small group to speak w' Pew Charitable Trust to discuss Nurse Family Partnership and its importance to the commuhh e ni Adjournment Member Austin moved for adjournment; Member Sullivan seconded. Chair Westerman adjourned the meeting at 4: 26PM. Page 9 of 10 JEFFERSON COUNTY BOARD OF HEALTH • Excused Sheila Westerman, Chair Phil Johnson,Member Chuck Russell, Vice-Chair John Austin,Member Excused David Sullivan,Member Roberta Frissell, Member Kristen Nelson,Member • Page 10 of 10 JEFFERSON COUNTY BOARD OF HEALTH • �\ MINUTES OQ Thursday, July 16, 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 Kristen Nelson,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, Kristen Nelson, Chuck Russell, David Sullivan, Sheila Westerman Members Excused: Roberta Frissell, Phil Johnson Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin • Guest: Frances Joswick, SAAB, was present for a portion of the meeting. A quorum was present. APPROVAL OF AGENDA Chair Westerman welcomed Kristen Nelson, Port Townsend City Council member, who is succeeding Michelle Sandoval as the City of Port Townsend representative. Chair Westerman noted that there may be a report from Fran Joswick, Substance Abuse Advisory Broad, at the end of the meeting as time permits. Member Russell 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 June 18, 2009; Member Sullivan seconded. The minutes of June 18, 2009 were unanimously approved, as presented. • Page 1 of 10 PUBLIC COMMENTS 449 There were nop ublic comments. • OLD BUSINESS and INFORMATIONAL ITEMS Washington Breast, Cervical, and Colon Health Program Report Julia Danskin referred to the report in the packet. She said that Jefferson County has done a great job in screening women for breast and cervical cancer through this program. The total number of women screened in 2008 was 108. Three abnormal pap smears were found, but no cases of cervical cancer were found. There were 72 mammograms done through this program. This year, there will be a mobile mammogram screening in Quilcene, utilizing the Swedish Hospital van, on October 10. In response to a question, she explained that"the percentage of eligible served"is based on an estimate of the number of women in Jefferson County who are low income without health insurance. Jean Baldwin added that the poverty in this county is not primarily in that age group (40-64). Pandemic H1N1 Update: Medical Surge Capacity, Business Preparedness and School Infection Control Planning Jean Baldwin said that Dr. Locke and Julia Danskin would provide the most recent information • on pandemic preparations. There have been several conference calls this week with the state and local public health agencies to discuss topics related to swine flu (H1N1). A number of tasks need to be accomplished this summer concerning education for physicians, schools and businesses. She mentioned previous problems with people returning to work while still ill, and not wearing protective masks etc. It will be possible to use other counties' educational materials with some modification. Dr. Locke said that there has been intensive planning for the next influenza pandemic starting in 2005. He noted that this is the first flu pandemic of the 21St century. It presented differently than expected: it began in North America, and, fortunately, at a time of year that is not favorable for transmission. Despite the fact that we are well into summer, there is still a significant amount of swine flu activity in the US. The problem is greatest where children and adolescents gather, such as summer camps. In the Southern Hemisphere where winter weather is more favorable for flu transmission the new H1N1 virus is behaving exactly as a pandemic strain is expected to behave. In a pandemic everyone is generally susceptible; even with a mild strain of influenza, many people get sick. Generally, in a pandemic, at least 25%of the population gets sick during the first wave. It has been noted that not all cases of the pandemic 1-11N1 strain are as mild as initially thought. It is different than seasonal flu but is not a replay of the Spanish Flu of 1918. It is capable of infecting the lower respiratory tract, a trait not shared by seasonal influenza. A virus that causes a viral pneumonia is a more serious health threat. There are higher levels of hospitalization and needs for intensive respiratory therapy, including ventilator support . The mortality rate is • Page 2 of 10 significant. Nationwide, it is estimated that there have been more than 1,000,000 cases already. • The risk of widespread outbreaks will start to increase as soon as schools are back in session. In response to a question, Dr. Locke said that the respirator capacity throughout the Peninsula is low. Operating room respirators are not the right type of equipment for prolonged mechanical ventilation, and it is not feasible to significantly increase the supply of respirators. Vaccines are being produced and administration of these vaccines will be a major workload issue. He said it would be a challenge for Health Department and the entire medical care system. The workforce requirements far exceed the available resources. Dr. Locke said that Public Health and the medical care system are set up to work independently in most circumstances, but it will be necessary to have them work together seamlessly. During the summer,pandemic preparations will continue to be a significant work priority. Dr. Locke said that triple reassortment viruses, the category the new H1N1 strain falls into, have not been the subject of much study. The research focus has been directed at avian flu and the risk of a virus jumping directly from birds to humans. The degree of contagion for the swine flu virus was unexpected, previous swine flu strains had difficulty spreading from person to person. He said the stability of the new virus is unknown. Will it stay in its current genetic configuration or will it further combine with other flu viruses? Swine flu is already acquiring resistance to one of the main anti-viral drugs. It is also unknown if it will be the same flu that began in North America once it has cycled through the Southern Hemisphere and returns. Chair Westerman inquired as to what factors are common to humans,birds and pigs. Dr. Locke • said that Influenza A is primarily a bird disease; there are 144 different kinds of Influenza A for birds. Most are mild infections, some are lethal for birds. A number of other species are at risk of being infected with avian influenza depending on how susceptible they are to particular strains. There are strains that affect dogs, whales, horses, swine, and other mammals. He said, however, that it all stems back to birds. He said it is not known if a triple reassortment virus could spread back to the bird population. It has been observed that the new human"swine flu" can spread from humans to swine. Member Nelson asked for more information about the plans being developed. Dr. Locke said that influenza is very difficult to control. It can easily be spread up to 48 hours before symptoms are seen or felt. The outline of the plan is scaled to 5 different severity levels. Currently, the pandemic status is a category one or two, similar to seasonal flu. Preparation is focused on containing the spread of the flu once it is contracted. Isolation, hand washing, sanitizing, etc. is very effective in preventing flu transmission, but Dr. Locke said it is not done very well in either health care facilities or in society in general. Jean Baldwin noted that there is great effort now focused on the schools because of the age of those getting sick and because viruses spread quickly there. She said that discussions with school administrators and staff will be set up for August. Member Austin inquired about working with local camps. Jean Baldwin said that messages had been sent to all known local camps with instructions on screening,responding to sick children, etc. Camp Parsons has an organized Boy Scout contingent in Seattle with whom staff is • working. She requested that members send information on any other camps in the vicinity that may not have been included. Page 3 of 10 l Member Austin also asked if there is possible help from the State or Federal government to hire • temporary workers or other assistance. Jean Baldwin said that$8,000 from the State had been received for the initial outbreak work, and that they may try to build some staff time into plans. She said the Health Department will receive about 3300 vaccine doses, which must be tracked by the department. The actual dispensing of vaccines will also be done by the hospital and practices, but the logistics are very complicated. There are liability and insurance issues to work through. In response to a question about work that would not be able to be completed, Jean Baldwin said that she and staff had prepared a tentative list, which could be reviewed by the BOH. There was also a brief discussion about providing adequate backup for services and the possible loss of revenue, as well. Julia Danskin discussed training and confirmed that training would be done in the schools. In seeking volunteers, she has contacted the Red Cross to locate nurses who can help with training in the community. Regarding vaccines, a minimum of 3360 doses will be received by October; planning for storage of vaccines and syringes is in progress. Staff includes those who have participated in mass immunizations in the past. She is awaiting decisions on the exact timing of the two-shot immunization and the priority group for vaccination. NEW BUSINESS Group B Water System Regulation in Jefferson County Jean Baldwin noted that this topic was discussed at the recent State Board of Health meeting, and would be under consideration for the next year as State rules change. Susan Porto, Environmental Health Specialist, said there had been a short presentation at the State Board of Health meeting the previous week, where some of the changes had been introduced. Ms. Porto said she would present what is presently done in Jefferson County with regard to the drinking water systems. She stepped through a slide presentation regarding the changes that are occurring with this program. A handout entitled"Group B Feedback, Survey of Environmental Health Directors"was provided. She also provided copies of a position paper by Dave Christianson(former employee of Jefferson County) on DOH direction in the next several months. She began with a background of public supply water systems in Washington State. By State Law, a public water supply is defined as all systems except one single family residence or less than 5 residences on a family farm, i.e. anything other than a single domestic source. Public water supplies are divided into two main categories, Group A and B. Group A have more than 15 residential connections, 25 or more people, greater than 60 days per year or are federally mandated program. Group B systems have 15 or less connections, less than 25 people, less than 60 days per year, and are not federally mandated. This was modified in 1995 by the State to exempt two-party connections provided that counties take on some duties. There was a brief • Page 4 of 10 discussion as to how camps fit into one of these two categories. Ms. Porto said that most camps • are Group A, while bed& breakfasts usually fall under Group B. For Group B, most counties have a joint plan of operation with the State DOH, but vary widel on specific arrangements. Seven counties have no service whatsoever. Twelve, including y Jefferson, have limited agreements. Twenty, including Clallam, have active programs mostly in permitting new systems. Jefferson County, until 2001, had very limited authority overublic water supplies. It did inspections, with fees, for proposed sources for new public watersupplies, A and B, and provided some technical assistance. The State Legislature then asked DOH to inventory systems, inspect them and determine risk. The County staff became involved in doin some of the assessment in Jefferson County. As of January 2009, the DOH said it would no g longer provide potable water adequacy on building permits. She said that the State database is available but is usually not current. She has contacted DOH and adjusted the contract so that the County can maintain its own database, which now contains 165 entries which will be tracked. The objectives in 2004 to assess risk included: inventory photographs, determine how to address any inadequacies,ensure that operators are o site sies, take they need to do water quality monitoring. Emphasis was on voluntary compliance. There were 42 systems were on the State's list: 37 inventoried; one refused inspection; 2 could not be found; one was inactivated, and for one there was a conflict in scheduling. They found that 57%had potential contaminants within 100 feet of the well; 46%had improperly constructed well vents and openings in the well cap; 50%of open storage reservoirs had unprotected openings; inadequate water quality monitoring-about one third were not monitoring and about 26% were • incorrectly sampling the water. She showed photographs of various problems and risk situations. Ms. Porto said that the educational benefit to these well operators was significant and appreciative. most were As of early 2009, the Legislature eliminated all funding for DOH to oversee GroupB re but did not rescind the RCW; the DOH is in a holdings regulations An RCW change is planned for 2010 which will establish design requirements fored l nin tiale hdesignt and construction of a water system, eliminating the existing monitoring requirements. It will g also allow the State BOH to waive some or all requirements for fewer than 5 residential connections. There are associated zoning/land area questions to be resolved. The DOH will continue to survey what counties plan to do. Jean Baldwin stated that as of July 1, due to lack of funding, Susan Porto will move to Septic Systems and Linda Atkins will work on Clean Water grants. Other plans for the future areuncertain. Chair Westerman said that every possible effort has been made in the past to staff these areas without adequate funding, but it is not possible any longer. She mentioned the unfinished work with septic systems. There was a brief discussion about fees in other jurisdictions and about the remaining problem of existing systems, mostly unpermitted, left to the Counties to deal with. Possible solutions are to link water system permits with buildin permits, or with sales of properties. g There was mention that there is no longer water service at the U.S. Forest Service campground in • Quilcene due to new federal regulations regarding use of surface water. Page Sof 10 M sial Ba Commercial Shellfish Classification Chan le and Ad'udicative Hearin • O�t1O-n Neil Harrington noted that the BOH has the authority to seek an appeal regarding this decision b the Department of Health. He said he would provide a brief history and a recommendation Y regarding this matter. There are two types of shellfish area closures: one is basedon watterqua itli data;baanother y ofof watererismay categorical closure based on use. In this case,there were inions meet the definition of marina. In the spring of d 2008,o the he tate BOHer ofte BOHoats ind orethat at Mystery reclassification order was under consideration process,which requires a shoreline Bay. He discussed the County's mooring buoy applicationWashington development permit to place the structure rassignment of State bed permission of the l nds and WA Dept. of Department of Natural Resources (DNR), for Fish and Wildlife(DFW) approval. A series of meetings ensued, dealing with types of buoys and the range of boats there, including legal, illegal and lgf DOHParticipants bes, State included the Department of Community Development(DCD),DNR,DFW Parks,Neil Harrington, and MRC (Marine Resources Committee))reeporeesee tatishin . During buoys,g 20088,,d much of the work involved data gathering, sorting out the status determining if this body of water meets the definition o marinas was not particularly possibil gi d news to the of a conditional winter-only harvest was considered,bute shellfish growers. The process stalled somewhat in the springof 2009. Representa tative e the Kevin Van De Wege then called a meeting in May with shellfish growers • ut that process forward. After a public meeting at Fort Flagler,the localment was shoreline or e worked also limited the number of boats in the inner bay, exempting marked undocumented buoys for removal. The outer harbor will be conditionally approved. Most parties see this as an interim measure. fairly Mr. Harrington said that this seems to be a good solution,with all partied areaesf more buoys don be . The possible next steps include decrease of the conditionally app moved. DNR and DCD are working on which buoys could be mod barets indrthe h anchorvicinity the e to State Park,and in shaping a management plan to ensure that transient the State Park. The Jefferson County MRC has a grant for placing ars and arker buoys between t protect on. the outer and inner bay to establish a voluntary no anchor zone g rThe number of boats has decreased and DOH will continueto mo h harvesting.nitor there. a management plan is approved,the outer bay will likely be approved for not recommended that,unless there is other extenuating information,dthere e toshould ulwodk on the appeal.an p . He feels the interested parties (DNR, County,DOH, ) Member Sullivan inquired about the DOH suggestion of a moratorium on new buoy permits. Mr. Harrington said that there are only two permits pending, and hbatt De ocoD nditionally brag that arward. He said those cases may be placed in the area that will always Shoreline landowners may be able to get permits by signing an affidavit that they will not discharge from the boat. (page 2 of synopsis) must be done. Chair asked who willterman said sure,thain t these er reading,steps are done, including the management plan. Mr. • She who ensu Page 6 of 10 Harrington noted that DNR had stated that if a community group or entity wished to lease the • entire bed lands of Mystery Bay and run it like a mooring buoy field that would be possible. State Parks will likely manage the area near the Park. Measure 1, removing unauthorized buoys, has been undertaken and will likely be followed by another round; measure 2,relocation of buoys, is in process by DCD and DNR; measure 3, management system, is still under discussion; measure 4,moratorium, would be done by the County and DNR. Member Sullivan said that it is likely that all of the above would be shared responsibilities of the County and DNR. He said that a meeting where all entities could be represented will be scheduled for August or September, which he will attend. Also, DNR and DOH were interested in the help of volunteers in a management plan. Member Sullivan said he had referred them to the Marrowstone Island Community Association for monitoring tasks. He said that will likely be negotiated among the affected parties. Chair Westerman stated that this seems like a good solution, but was concerned that there may not be follow through in the long term. She believes that there must be a single agency taking responsibility; if no other entity takes the lead, the County will need to do so. Jean Baldwin noted that the County is in an unusual position since it is a shellfish issue but there is not a water quality problem. It is a partial closure and DCD does the permitting. She said that a recommendation from the BOH about how we track the plan to the BOCC may be appropriate. Member Sullivan suggested that he attend the planned meeting and report back to the BOH. Member Austin asked how vested buoy rights would be handled; would a declaration of emergency supersede those rights. It was noted that this has never been a water quality issue, but • that there is a need to see the situation through to resolution and ongoing monitoring. Mr. Harrington and Member Sullivan said they would continue to work with all the parties. Members agreed that the process and progress thus far has been very good. Member Sullivan stated that he would take responsibility for following up on open issues. Position Pa.ers and Draft Resolution Re: Affordable Health Choices Act Dr. Locke referred to the significance of health care reform legislation being developed in Washington D.C. He said that the Public Health community is trying to link needed public health reforms to health system reform, and that there is legislation pending in this regard. The national public health organizations, e.g. American Public Health Organization and National Association of County and City Health Officials, are asking local Boards of Health to weigh in on these issues. A copy of their resolution, with draft Jefferson County modifications, is included in the packet. It now appears that action by the House and Senate before the August recess is not realistic. There are two bills being considered, the Senate Health bill and the House Health bill, as well as a Senate Finance bill still in development. The process of reconciliation will be extremely complicated. There is an acknowledgement in all three bills that changes to the Public Health system are crucially important. In order to provide guaranteed health care to everyone, it is necessary to do everything possible to prevent illness. In addition, if costs are to be controlled, there must be attention to evaluating which medical therapies are effective and which are not. Page 7of10 In Washington State,there is a meeting being scheduled during the week of August 10 with legislators during the August recess to discuss health reoVo ld be to add our voicHe said our te ors to all the are all supportive. The purpose of a Jefferson BOH resolution others in the country. Jean Baldwin said that the Kennedy tement as bout the need for Public Health funding and infrastructure, ad delineates several programs essential parts of the health care system. She said that Katherine lare essent ahas statel othmponents at discussion of prevention, outcomes and public health funding streams of health care reform. She said that if things change quickly, she will notify the BOH via e-mail. be well to take action Member Austin suggested that although there is no urgency, it woulMember Austin moved to adopt the n the resolution,which requests very basic provisions. draft resolution and member Russell seconded. Chair Westerman proposed the following edits: • First Whereas—change "health system" to "health care system"; • 7th Whereas—change "see all " to "serve all..."; • Page 2,item 3—change"health promotion....." to "promotion of good health and prevention of disease and injury...." n No. Member Austin accepted the changes as friendly Jean Baldwin saidmendments. eshe would alsodraft osend a 2009-1 was approved unanimously, as amended. copy with a cover letter to the Hospital Board. Chair Westerman will sign the amended version. Tribal Mutual Assistance A reement: Draft O en for Comment Dr. Locke stated that this document is part of a first ever national pilot project, for three counties • and seven Tribes, developing a Public Health Mutual AssisstanAreem nt. C n finallized,it will be considered for adoption by County Boards of Commissioners However, it is first presented to the BOH since it very much affects hemission it gies the Health the DDepartment, and expands our capability as a local jurisdiction. Inpractice, ability to formally seek help in public health emergencies fro Bother for tri esLke and Dy ealthuist, alth departments. Jean Baldwin noted the level of respect that who have been working closely with the Tribes. This agreement will allow better clarity and cooperation than in the past with regard to provision of services. k Member Sullivan inquired whether this may open up other funding sthe ources. Dr.ices are given said when that is anticipated, and that services are paid for, not donated r needed,with payments reconciled at a later date. f Member Austin suggested that the agreement Baldwin said that could bedone regionally,rwith aa Management for their information. Jean cover letter. Dr. Locke said that the language can be modified and any missing elements can nt those e added. nee He said that there had been a deliberate attempt to address sensitive or potentially problematic. He noted that the County eputA �eement allow some greater authority within the Tribal jurisdictions. Member Austin noted maat yt Sheriff'sbeRussell inquired about • flexibility and that traditional restrictions be loosening. Page 8 of 10 food service inspections. Dr. Locke said that if requested, that service could be provided. For example, should there by an outbreak associated with a Casino, the Tribe could ask for assistance. Jean Baldwin said that Tribal run food businesses are not subject to State inspection, although many of them have contracted with local Health Departments. Member Westerman expressed her concern that local Boards of Health are not even mentioned in the agreement. Dr. Locke said that that issue will likely be dealt with in the next phase. One of the issues was the fact that there are no comparable agencies (to Boards of Health)within the Tribal government. He said that they have been encouraging Tribes to create BOHs and Health Officers, and similar structures. Jean Baldwin added that the Tribes wanted to bind the partners at the highest level of government possible. Chair Westerman said that she has long worked to expand the Board beyond politics and political affiliations. She noted the representation from the City and Hospital, as well as the County. Member Nelson noted that some counties do not have a separate Board of Health from the Commissioners, and that the BOH members serve at the pleasure of the BOCC. Chair Westerman recalled that the intention of allowing an expanded Board of Health eleven years ago was to create a body that was focused on public health issues, but not politically driven. She said that Jefferson was the first county to do this and it has been encouraged by the legislature. She noted that both Republican and Democratic Commissioners with whom she has worked on the BOH have recognized the need for Public Health to be outside of partisan politics. She said the body needs to be bigger than the three Commissioners. Dr. Locke and Ms. Baldwin reaffirmed their request that BOH members review the document and make suggestions. It was agreed that Deputy Attorney Alvarez would also be asked to • review it. AGENDA PLANNING An SAAB update from Fran Joswick was tentatively scheduled for the August meeting, at her option. (This agenda item was deferred from this meeting, July 16, since Ms. Joswick was not able to stay for the duration.) The Bylaws, as edited, will be ready for review and approval at the August meeting. Jean Baldwin added that Member Austin was selected as one of a small group to speak with the Pew Charitable Trust to discuss Nurse Family Partnership and its importance to the community. Adjournment Member Austin moved for adjournment; Member Sullivan seconded. Chair Westerman adjourned the meeting at 4: 26PM. Page 9 of 10 JEFFERSON COUNTY BOARD OF HEALTH • L A"' Excused Sheila Westerman, Chair Phil Johnson, Member 4 V14 4 Wv_,_ Chuck Russell, Vice-Chair Jo Austin, Member Excused ` Roberta issell, Member David Sullivan, Member Kristen Nelson, Member- - i 41111 Page 10 of 10 • Board of Health Old Business .agenda Items # IV., 1 • 1Nest Nice 'Virus Detected in Nlason County Crow .August 20, 2009 • JCPH :: Working for a safer and healthier Jefferson I News I West Nile Virus confirmed o... Page 1 of 1 PUBLIC HEALTH A,WAYS WORKING FOR A SITFR AND } —1- HOW i A.Ct1 C NVIR+.NMI T PvF NM T!,�N I WS 11 ABOUT IC.PH ARCH Home > News West Nile Virus confirmed on the Olympic Peninsula Jefferson County, August 7, 2009 - A dead crow collected in Mason County near Shelton has tested positive for West Nile Virus ( WNV). It is the first West Nile Virus detection this year in western Washington and the Olympic Peninsula. West Nile Virus can be a serious, even fatal, illness. Although it is mainly a bird disease, mosquitoes feed on infected birds and can pass the virus to people. In people, mild symptoms include fever, headache, and body aches. A few people may develop severe symptoms and in rare cases it can be fatal. West Nile virus infects certain wild birds: crows, jays, ravens, magpies, and raptors such as hawks and owls. The infected birds tend to become sick and die. Increasing numbers of dead birds may be an indication of West Nile virus in our community. If you find a dead crow, or other reportable bird, you can use the online dead bird reporting system at http_://www.doh.wa.g_ov/ehpitsizoolwNv,!reportdeadbirdhtml or by contacting Jefferson • County Public Health directly at (360) 385-9444. Public Health suggests the following points for protecting against the virus: Personal protection is the key, avoid the bite. • Avoid areas/times when mosquitoes are biting • Protect yourself from mosquito bites by wearing long clothing and using mosquito repellent • Reduce areas of non-natural standing water around your home (empty buckets, tires, gutters, animal troughs, etc.) -mosquitoes like to lay their eggs in standing, stagnant water. It takes 4-7 days for an egg to mature to an adult, and most adults do not stray more than 1/4 mile from their birth place. • Stay in good health ### Always Working for a Safer & Healthier Jefferson County Back Jefferson County Public Health 615 Sheridan Street-Pori Townsend, WA 98368 360.385,910 I infoCmjeffersoncountyoublichealth.orq • Jefferson County Home Page Web Site by Lineangle Internet Solultions http://www.jeffersoncountypublichealth.org/index.php?id=5,933,0,0,1,0 8/13/2009 1 i } dz00 ^« T22 "s !?'° Ouzo 's N A N N C C .m*' ° i &-.^0 1 m a 21-9 33 i<.', mos0 _. �. dao 2,:-4.m. .. 0 dyyy�c `....✓ 6^0 ( s' •d � OF. ;II- w 1�- , _ ps 7;1;!:;:'1 poSN jd ddlli d "b> 2.a m G H !iI L m re • !' __— .' � . :2' i� :.,,,,,,n1::::/i,;;;,'' a . it: 1 n° oNS } a' m m If W Ql i'n o e _ Ly pa -ilg N :s a ✓ a - m ' >F2 illt / _ / 11 ° igg • t Im a y a c, 'H & a ad o �g? s5 ea m r a.0 y V m i 441 •.c - m tai 7q t> • `k = 3 5 .3 2 ;015 N v n c 1 a m w k ' $ ] - p � 3° !;.;°may' D ^. c "� ... O -, m ;' C E� g a hiu . i, N = 4 (Gap f.Ef. • is.�... Zp..._.,y t -iNNNNNN'9�V03C T.JC T.T.i--41470 �OOOri Qn Om°DD n '5 . O 3P.z 4 3gg?. -g j$ �� i ar m c.a 3'gc' 5.1 " ,,gg °c / `* .''';','',:l<„ '. .7 a.$ it i0 3 `gt. 8d � 3 3 m o Kq a x. ns 1 ix3 ' ' '� 7 fifg,.« 11. 3 -1 g. , 5 h 44' q. .. ,a A CO :.0......0.- --------------------. $iFia a %off -i� p da Ili s N p a S' N N+N+0 0++N O+0 0 0 0 0+ O N+ p+ O w 0 + +0+O+O:O O O+ .. v 3 8 3 d o 0 0 0 0 o 0 0 o N o ` C -..E 3- o oa a a oa a o a .z aas ° H +0 004;0 o 0 0 0 0 0 o 0 0 0 0 -0 . o �p a opr v o0 a o o p p opooaaoao 0 0 0 0 Fr 3 Fr ;v N N p.'k0� itt . V E D O p:o p N o 0 0 0 0 0 o 0 o a o N o in m o a O o p o w o o °A ° .ter. No o�.oO o 0 0 0 0 0 0 0 co• " 44s d3 d k O O ititiiiii a 0 2 pf, z 1111^iiii s N jaY i 8 r" ii[ii .itiw Board of Health Old Business .agenda Item # 117.1 2 State Board of Health • Summary .august 20, 2009 4. 4 Z1 7r0 ..---.. di 0 tinitylon(( 1,110 le iik-' '..-- - - ' ' --ulteutth , ,41! :,i , -1 ,, 0 ,. . d . , .,. .,....,1,::::,,, ,... ,, ,,.=•":r4N''',4/4.,;P 4-1 545:',`-• , ''''- iritrif,7,'44, 4 0 ;;':', .,::,;*,-;-:i,"1:06,z'4:,e, 4'- :41%;Pc4,,I4•,:)''..•' 4: ial , .‘:::3:e. 40,..;„--- , ''',A,* efts 7'F 1 p' 3 . u 6 �.,, ,gin ,,, -,. ',".. ����� Dt Minutes of the State Board of Health s July 8, 2009 cb\\').\\0°) The Inn at Port Hadlock, Port Hadlock, WA Qr SBOH members present: Treuman Katz,MBA,Chair Patricia Ortiz,MD The Honorable John Austin,PhD Mel Tonasket Maxine Hayes,MD,MPH Karen VanDusen Keith Higman,MPH The Honorable Donna Wright SBOH members absent: Frankie T.Manning,MN,RN Diana T.Yu,MD,MSPH State Board of Health Staff present: Craig McLaughlin,Executive Director Ned Therien,Health Policy Analyst Desiree Robinson,Executive Assistant Tara Wolff,Health Policy Analyst Heather Boe,Communications Consultant Guests and Other Participants: III Jean Baldwin,Jefferson County Public Health Dave Christensen,Department of Health Chris Nelson,Jefferson County Board of Health Drew Noble,H2O Management Services Denise Clifford,Department of Health Riley Peter,Department of Health Kelly Cooper,Department of Health Bat-Sheva Stein,Department of Health Roberta Frissell,Jefferson County Board of Health Erik Smith,Your Health Care Today Sara H.,Washington Schools Risk Management David Sullivan,Jefferson County Board of Health Pool Tami Thompson,Department of Health John Larson,WA Assoc. of Conservation Districts Mary Wendt,Department of Health Thomas Locke,Jefferson County Public Health Quen Zorrah,Jefferson County Public Health Treuman Katz, SBOH Chair,called the public meeting to order at 8:36 a.m. and read from a prepared statement (on file). 1. APPROVAL OF AGENDA Motion:Approve July 8, 2009 agenda Motion/Second:Higman/Austin.Approved unanimously 2. ADOPTION OF MONTH DAY, YEAR MEETING MINUTES Motion:Approve the June 10, 2009 minutes Motion/Second: VanDusen/Orti .Approved unanimously 3. WELCOME TO JEFFERSON COUNTY John Austin, SBOH Member,welcomed the State Board of Health to Jefferson County. He introduced David Sullivan and Chris Nelson, fellow members of the Jefferson County Board of III Health. He explained that the local board of health has seven members—three county commissioners, a hospital representative, a representative of the City of Port Townsend, and two PO Box 47990•Olympia,Washington•98504-7990 Phone:360/236-4110• Fax: 360/236-4088 •Email:WSBOH(adoh.wa.gov•Web:www.sboh.wa.gov 2 Washington State Board of Health Draft Minutes—July 8,2009 members at large. The current chair is Mr. Sullivan. Member Austin said Jefferson County has a population of about 28,000 including a significant number of elderly residents. The county has three high schools. Medical facilities are rather limited.Jean Baldwin,Jefferson County Public Health Administrator,said the area economy is resource-based.There is poverty in the young.The local health department buys health officer services from Clallam County and epidemiology services from Kitsap County. Dr. Maxine Hayes, State Health Officer, noted that the area draws people with high intellectual levels and skills, and people should consider this a major resource. 4. THE SCIENCE OF MATERNAL AND CHILD HEALTH Quen Zorrah,Jefferson County Public Health Nurse,shared a story about a young woman who was a victim of abuse and violence and had mental health challenges. Ms. Zorrah came to know her doing her pregnancy. Her pregnancy went well and she had a healthy baby. When the baby was 5 months old,the mother had begun to see her son as "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. Ms. Zorrah explained that in the past 10 years she has come to look at maternal and child health (MCH) programs differently. The nurse-family partnership model,which has become the gold standard,addresses the health of both the child and mother. She described the need to stop the old "cradle to prison" system and to intervene when children are babies, rather than adolescents. It takes nurses, rather than paraprofessionals, to make the partnerships most effective.The Nurse Family Partnership is an evidence-based program. The Washington State Institute for Public Policy has shown that such programs reduce future societal costs—for example,prison construction and foster • care placement. Ms. Baldwin said state funding cuts for MCH programs are causing local health jurisdictions to dismantle their home-visiting programs. Chair Katz said he considered Ms. Zorrah's presentation one of the most significant he has heard since he came to the Board. Dr. Hayes called MCH programs the oldest public health programs, anchored in Social Security. She considers money spent on women's health programs to have the greatest effect on long-term health and health cost savings. Member Austin noted that the people who need mental health and MCH programs are least able to advocate for themselves. 5. BOARD-TO-BOARD DISCUSSION Member Austin introduced another member of the local board of health, Roberta Frissell,Citizen- at-Large. Mr. Sullivan, Chair of Jefferson County Board of Health,said he considers funding for MCH programs one of the most important issues the local board has faced. He sees the long-term benefits the program can provide. Ms Frissell commented on on-site sewage system regulation. Members of the public overfilled a local board of health meeting in January 2008 and raised concerns about fees and other costs of on-site system rules.The board backed off on requirements. The public favors self-inspection of on-site systems. She asked how the public was responding in other areas of the state. Keith Higman, SBOH Vice Chair, said he participated in the last major revision of the State Board's on-site rules. He added that public health officials in other areas are hearing the same concerns as in Jefferson County. He described that in Island County,where he is the health director, they have a fee-for-service on-site program. He said that some members of the public understand the importance of protecting ground water drinking supplies,while others are • slower to understand. He said Island County had developed a video to help train people to inspect their systems and would be happy to share it. PO Box 47990.Olympia,Washington •98504-7990 Phone: 360/236-4110 • Fax: 360/236-4088• Email:WSBOH(a�doh.wa.gov•Web:www.sboh.wa.gov Washington State Board of Health 3 Draft Minutes—July 8, 2009 6. SBOH ANNOUNCEMENTS AND OTHER BUSINESS Craig McLaughlin. SBOH Executive Director, reported on the Board's budget. He drew members' attention to a June 18, 2009 memo from Governor Gregoire requiring all agencies to reduce employee costs an additional 2% for the 2009-11 biennium. Although details about how the cuts will be implemented are not known, the Board will need to do its share. He expects the Board can absorb this amount (about$10,000); however, any additional cuts would require making some difficult choices. Chair Katz asked Mr. McLaughlin and Dr. Hayes whether there is likely to be a continuing round of reductions.Dr. Hayes said she would expect a lag behind news that the economy is getting better and a rebound in state revenues. She said the budget reductions would last at least through 2011. Mr. McLaughlin responded that it is quite possible that this is not the last reduction for the biennium. Karen VanDusen, SBOH Member, asked about the budget cuts'impact on the next round of public forums. Mr. McLaughlin discussed the State Health Report and the Annual Report and said the Board will probably cancel the hearings for 2010. He said that the Board reduced expenditures during the last fiscal year by about 22% ($160,000) below originally budgeted. Mr. McLaughlin said that he understands that Patricia Ortiz's application for another term on the Board will be going to the Governor this week. He said that he has no news about the appointment of a replacement for Chair Katz. There are two separate issues related Mr. Katz's position—who will be appointed consumer representative and who will be appointed Chair. Chair Katz said that the Governor's office has been in contact with him. Mr. McLaughlin reported that the Board has a new intern, Kristen Cha,who is a law student at Gonzaga and will be working on health impact reviews. He reported that a lawsuit,Janes vs Harris, to which he is named has been appealed to a higher court. He commented on two public records • requests,one related to school rule meeting materials and the other about animal manure.The Board has also received two requests for rule making recently. One, concerning animal waste,is on the agenda later today.The other,related to Group A drinking water rules about consumer notification of monitoring results,is awaiting a recommendation from the Department of Health. Until then, staff does not have a recommendation for Board members on this second petition. He said the Board has 60 days to respond to a petition for rule making. He said the Chair has authority to make the decision under the Board's policy. The Board's Environmental Health Committee will make a recommendation to the Chair. Mr. McLaughlin reported that the Board has a meeting scheduled for August 12 in Olympia. There was some discussion about the meeting room arrangements, size, and room availability. Members expressed concerns about using the same room used in June. Mr. McLaughlin reported that the Governor is authorizing spending$750,000 to purchase antiviral drugs and another$150,000 to help with the response to pan flu. He said there is also $350 million at the federal level to support pan flu response capacity, but how it will be dispersed has not been announced. He reported that the Haemophilus influengae type b (Hib) vaccine shortage has been resolved. He asked the Board to consider developing a teleconferencing policy for Board meetings. He said he would like to get feedback from Board members by e-mail to help staff draft a policy. He also commented that if the Board wants to submit request legislation, the Governor's office has set deadlines for proposed request legislation of September 28 for bills that would not have fiscal impact and October 8 for bills that would have fiscal impact. He said that he is not recommending 0.. that the Board propose agency request legislation this year. PO Box 47990•Olympia, Washington•98504-7990 Phone: 360/236-4110• Fax: 360/236-4088 • Email:WSBOH(a doh.wa.gov•Web:www.sboh.wa.gov 4 Washington State Board of Health Draft Minutes—July 8, 2009 The Board took a break at 10:35 a.m. and reconvened at 10:47 a.m. 7. DEPARTMENT OF HEALTH UPDATE Dr. Maxine Hayes, State Health Officer,reported that Secretary of Health Mary Selecky is leading a state delegation to an important national H1N1 influenza summit in Bethesda for the Governor. She said that there are reports of 98 people being hospitalized in Washington State with H1N1 influenza since April 19, 2009,with four deaths. The majority of Washington cases have been young people (between 0 and 24 years).The Department is working on mitigation strategies,with particular concern for the start of the new school year in August. She said the strategy is to avoid closing schools. She reminded the Board that seasonal flu is a major health risk that also must be addressed. She spoke of the importance of protecting health care professionals,as well as children and people who work with children. She acknowledged Dr. Tom Locke,Jefferson County Health Officer, for building partnerships with community providers to fight a flu outbreak. She explained that it would be important to get messages out that help people understand what they need to do to protect themselves from both seasonal influenza and the H1N1 variety. Dr. Hayes said that on July 1, the Department implemented the first stage of new policy regarding vaccine purchasing with the discontinuance of state purchase of the human papilloma virus vaccine. By May 2010, the state will no longer pay for all childhood vaccines.Washington will instead rely on the federal Vaccine for Children (VFC) program for low-income families. She said that we do not know if the new purchase policy will affect immunization rates. She explained that the three big plans (covering 85% of the children in Washington) are committed to making sure their clients have access to vaccinations. She reminded the Board that a presentation on this subject is planned for the Board's October meeting. She said that she and Dr. Yu are involved in a few groups planning strategies to make the transition to VFC smooth. She pointed out in the audience Mary Wendt, the new Department of Health Assistant Secretary for Community and Family Health, and Riley Peters, • who oversees the office that includes the Department's immunization program. Dr. Hayes also reported that a national outbreak of E. coli cases from cookie dough included five cases in Washington State. 8. PUBLIC TESTIMONY Drew Noble, citizen, testified that he wished to talk about Group B drinking water system requirements. He also spoke regarding the petition for rule making, saying that Consumer Confidence Reports should continue to be required to be delivered to every consumer. He said he understands the reason for the Department of Health dropping the Group B water system program. However,if the state deregulates the monitoring of Group B systems, system owners should be required to inform consumers that their drinking water source is not monitored. He said the owners of the systems should be held responsible for consumer safety. 9. BOARD MEMBER COMMENTS AND CONCERNS Chair Katz, suggested Board members might wish to discuss the issue of cuts to maternal and child health programs. Vice Chair Higman said he would not single out MCH programs. He said budget problems are affecting all of public health. Member VanDusen suggested that during strategic planning, the Board might wish to consider prioritizing programs. She then asked the Board to consider a resolution regarding federal health reform legislation related to public health funding. Dr. Hayes asked about opportunities to add something in the Board's strategic plan about incentives for evidence-based interventions. Mr. McLaughlin pointed out an attachment under Tab 8, an index for federal health reform legislation. He said that the proposed bills are very comprehensive and would 40- have a large public health impact. Chair Katz commented that the Board's role appears to be very PO Box 47990.Olympia,Washington •98504-7990 Phone:360/236-4110• Fax: 360/236-4088• Email:WSBOH(c�doh.wa.dov•Web:www.sboh.wa.00v Washington State Board of Health 5 Draft Minutes—July 8,2009 broad regarding improving the health of the public. Member Tonasket commented that he would • support the Board taking a strong position in support of the public's health. He said there is much more that can be done besides considering rules. Member Austin commented that the Board should temper its comments with what is affordable or possible. He suggested sending a letter to Congress. Chair Katz said he thinks the Board's role is at the state level, but should include letters to our congressional representatives. Member VanDusen suggested the Board consider a motion regarding sending a letter to the state's congressional representatives. Dr. Hayes encouraged the Board to take multiple approaches of sending letters to our congressional representatives and addressing the issues at the state and local levels. Member Tonasket suggested inviting congressional representatives to meet with members of the Board. Chair Katz said the Board may want to issue a press release about its concerns.Dr. Hayes recommended that the Board communicate these concerns to local boards of health, also. Patricia Ortiz, SBOH Member, spoke in support of the concept of the importance of maintaining public health infrastructure. Mr. McLaughlin suggested the Board consider a resolution, maybe at its October meeting. Chair Katz said that would be too late. The Board members supported sending letters immediately without a resolution. Vice Chair Higman said that letters to local boards of health should also be sent to county commissioners. Motion: The Washington State Board of Health authorites the Chair to send letters of concern about the importance of support for public health infrastructure to Washington's congressional representatives, state legislators, and local public health decision makers. Motion/Second:Tonasket/VanDusen.Approved unanimously 10. CHAPTER 246-291 WAC, UPDATE ON GROUP B DRINKING WATER SYSTEM RULES • Vice Chair Higman introduced this item and reminded Board members that Group B systems serve fewer than 15 connections and fewer than 25 people. He explained that there would need to be a change in the course of action planned due to budget cuts and 2009 amendments to the statutory authority for these rules. Ned Therien, SBOH Staff introduced Denise Clifford,Director of the Office of Drinking Water at DOH, and David Christensen, the policy unit supervisor overseeing the Group B rule revision. Ms Clifford clarified that the Board's Group B rule was still in place. The main change is that there is now no state money to support oversight. She took the Board through a presentation (see Tab 10). She said DOH recommends focusing on design and source criteria and removing ongoing monitoring requirements. It also recommends changing the arsenic standard for Group B systems to match the Group A requirements (10 ppm). Member Austin asked if the regulatory framework for Group B systems concerning arsenic levels only involved initial design of the system. Ms. Clifford explained that for source approval, currently the arsenic level cannot be higher than 50 ppm. She said there has never been a requirement for ongoing monitoring of arsenic levels for Group B systems. Member Austin asked about"grandfathering" of existing sources. Ms. Clifford said that is an issue not yet addressed and could be part of future discussions. She said some local health jurisdictions have local rules requiring Group B systems to do ongoing monitoring and reduce arsenic levels. Vice Chair Higman commented that Island County is waiting for the revision of the state rules to decide how to deal with its Group B systems with higher arsenic levels. Ms. Clifford iterated that DOH is not planning oversight for ongoing monitoring, but leaving it to locals. Member VanDusen asked if DOH looked at multiple water quality constituents when conducting source approvals. Ms. Clifford said tests for a suite of chemicals is part of the source assessment and approval process. Member VanDusen asked if DOH was exploring some requirement for informing • consumers that their Group B system was not subject to ongoing monitoring. Ms. Clifford PO Box 47990.Olympia, Washington •98504-7990 Phone: 360/236-4110• Fax: 360/236-4088• Email: WSBOH(a doh.wa.gov•Web:www.sboh.wa.qov 6 Washington State Board of Health Draft Minutes—July 8,2009 responded that DOH thinks it may be possible to require that such a notice be attached to the real estate title. • The Board recessed for lunch at 12:12 p.m. and reconvened at 1:07 p.m. 11. CHAPTERS 246-366 AND 246-366A WAC, UPDATE ON SCHOOL RULE Vice Chair Higman introduced this agenda item. He explained that at its last meeting, the Board directed staff to file a supplemental CR-102 for the school rule. Between the last Board meeting and the filing deadline, conversations took place with the Office of the Attorney General,which resulted in the content of the CR-102.The hearing for this rule is scheduled for August. Mr. Therien explained that the Board's direction to staff at its June meeting was to revise the school rule proposal to reflect legislative restrictions on implementing new school facility rules. He explained that the supplemental CR-102 would allow the Board to consider two alternatives, the differences mainly being procedural. Both alternatives would establish the same regulatory requirements according to the proposal amended by the Board on October 8,2008.Alternative A would use the procedural technique of amending the rule making order (CR-103) to allow the effective date of an adopted rule to be delayed in conformance with legislative restrictions.Alternative B would add language to the October 8 version that specifically addresses legislative restrictions. It would specify that the Board notify interested parties about implementation authorized by legislative actions by means of an interpretive statement published in the State Register. Mr.Therien indicated that more details on these two options would be prepared for the August 12 hearing,after staff spent more time with legal counsel to determine the best technique to recommend to the Board. Chair Katz asked about criteria to evaluate these two alternatives and whether the purpose of the discussion this day was merely to bring the Board up to date. Mr. Therien replied yes and that he would elaborate on the two techniques in August after staff had more input from counsel. Mr. McLaughlin • commented that there were three issues to take into account: procedural,workforce, and political. He said Alternatives A and B are both legal but that the risk of a challenge and ease of defending a challenge needed to be considered more fully. In terms of politics, he explained that he only had time to brief key people on one model and so could not comment on the differences yet. He said both alternatives were put forth because of the deadline to file the proposal and to allow public comment about the different techniques. Member VanDusen stated she wanted to be sure the old existing rule remained in place until superseded by the new rule. Mr. McLaughlin said it could. Vice Chair Higman said he understood the Board might be uncomfortable because the Environmental Health Committee does not have strong recommendations yet on the alternatives. Member Tonasket said he felt confused but trusted the Environmental Health Committee. Chair Katz encouraged Mr. McLaughlin to send clarifying materials to Board members as soon as possible. 12. 246-203-130 WAC, PETITION FOR RULE MAKING, KEEPING OF ANIMALS Member VanDusen directed Board members attention to materials behind Tab 12. She explained that some of the Board's general sanitation rules (chapter 246-203 WAC) may have been superseded by more specific statutory authorities of other agencies. She said RCW 34.05.330 provides an opportunity for people to petition the Board to adopt, amend, or repeal any rule. She said a petition was received about the keeping of animals from the Washington Association of Conservation Districts. Mr. Therien explained that the Board received the petition to initiate rule making on WAC 246-203-130, Keeping of animals, on June 25.John Larson, Executive Director of the Washington Association of Conservation Districts was present and available for questions about his petition. Mr. Therien said the Board has 60 days to either open rule making or deny the petition. He explained that the rule had three subsections and the request is to revise only one of them. The rule provides a AK tool to local health jurisdictions for controlling potential public health nuisances caused by animals, Iv PO Box 47990.Olympia,Washington •98504-7990 Phone: 360/236-4110• Fax: 360/236-4088• Email:WSBOH( doh.wa.gov•Web: www.sboh.wa.gov Washington State Board of Health Draft Minutes—July 8,2009 7 particularly by their wastes. He then reviewed the three sections. He said that since the time this rule was put into place, the Department of Agriculture and Department of Ecology have gained statutory authority that might supersede the Board's authority,especially for large dairy operations. Mr. Therien explained the governmental status of conservation districts under statute,which are represented by the Washington Association of Conservation Districts. He pointed out the specific language amendment proposed in the petition for subsection (2). He said that the Board might wish to consider more general amendment of the rule than proposed in the petition. He recommended that this should involve a full stakeholder process that includes proponents and opponents of amending the rule. He said that he understands that the petition came out of the Clark County area. Chair Katz asked if the Environmental Health Committee had reviewed this issue. Mr. Therien indicated that they had no strong opinions about the direction to go. Vice Chair Higman explained that the committee had more questions than answers and was operating within time constraints. He said that the Committee recommends that to meet the 60-day time limit the Board should open the rule without predetermining whether to amend as requested specifically in the petition. Mr.McLaughlin reported that the Board received e-mails late yesterday and earlier today from a representative for Citizens for Sustainable Development,Monroe Chapter opposing this petition and expressing concern for the public health risks posed by Confined Animal Feeding Operations (CAFOs). He mentioned that copies of a 15-page letter had been distributed to Board members in the morning He said that the representative of the group objected to the Board making a decision on the petition without holding a public hearing,without reviewing all the materials already submitted,and before responding to a public records request. Mr. McLaughlin said the Board is not 11111 required to take public testimony before deciding whether to initiate rule making or how to respond to a petition for rule making. Mr. Therien said he had spoken with the manager of the Department of Agriculture's dairy nutrient management program and she offered to address the Board about her agency's authority for dairy operations. Mr. McLaughlin said DOH does not have a general sanitation program and that the workload for rule making would fully fall on Board staff. Member VanDusen stated that during strategic planning, the Board could decide how to prioritize rule making. Vice Chair Higman clarified that the Environmental Health Committee is recommending opening the rule for complete review of the issues involved. Motion: The Board directs staff to file a pre proposal statement ofinquiry (CR-101) by August 24, 2009 to consider amendment or repeal of WAC 246-203-130, Keeping of animals. Motion/Second:Higman/Austin.Approved unanimously 13. WAC 246-100-202(E), HEARING ON PROPOSED RULE FOR PROPHYLACTIC TREATMENT TO PREVENT OPTHALMIA NEONATORUM, Patricia Ortiz, SBOH Member, introduced the topic. She explained that this is an action item. She explained that the rule updates reflect current standards of care practiced by most health care providers, and specify how providers should handle records in instances when parents elect not to have their infants treated. Bat-Sheva Stein, Department of Health, explained the rule proposal. She indicated that the rule had a reference to an outdated treatment option and needed to be replaced with current treatment options. She also explained that the proposed rule language specifies how health care providers should document when parents refuse treatment. She said some stakeholders wanted the rule to explain what providers needed to do when parents opted out of treatment. She PO Phone: 360/236-4110• Fax: Olympia,6360/236-4088. Email: qo9•Web:Www sboh.wa.gov Washington State Board of Health 8 Draft Minutes—July 8,2009 reviewed the comments received (see Tab 13) and called the Board's attention to a letter addressed to the Board from Jodilyn Owen. Tara Wolff,SBOH staff,clarified thaed to handle proposed rule • does not create a right of refusal rather it specifies how providers cases when parents refuse treatment. Member VanDusen asked whether the proposed language listing treatments in the rule could limit flexibility for including new treatments. Ms. Stein responded it is easier for the providers to find the information if it is in the rule. She checked with FDA and there is no new antibiotic undergoing evaluation for this use, so it is unlikely it will approve a new treatment in the next four years.This means there will not be a need for another rule revision in the near future.Vice Chair Higman asked why we require treatment of all newborns given the rate of gonorrhea infections. Member Ortiz said that it is difficult to make sure all pregnant women are free of infection at the time of delivery. This is because most women are tested for infection early in their pregnancy however, the infection can occur later in the pregnancy. Ms. Stein added that 2,000-3,000 mothers per year do not receive pre-natal care and so are never tested for infection.Member Higman asked if the rule defined health care provider. Ms. Stein replied that it did not.Member Ortiz said it was good to refer to health care provider in the rule, since it is a broad term. Member Austin asked whether this state had a law requiring a health care provider be in attendance during all deliveries. Ms. Stein responded there was no such law.Member Ortiz explained about doulas,who are professional labor coaches. Motion:The Board adopts the revised WAC 246-100-202(e)as published in WSR 09-11-110. Motion/Second:Ortie Wright.Approved unanimously, except Member Austin abstained. 14. STRATEGIC PLANNING — PRELIMINARY DISCUSSION Mr. McLaughlin referenced the documents behind Tab 14 and gave an overview of status of the • 2007 Five-Year Strategic Plan. He proposed that the Board update the plan using a process very similar to the process it used in 2007. Chair Katz said the mission and vision should not need revision each time the plan is updated. Dr Hayes stated that she would like to see the addition of a goal that public health be a concept considered in all policies, not just policies set by health agencies. She said that in a future of fewer resources, the Board might have a greater effect on the public's health by trying to influence policy makers and boards working at the local level. Chair Katz asked for examples. Dr Hayes referred to social determinants of health such as housing,academic achievement, and neighborhood resources (i.e. sidewalks, markets with fresh produce,etc). There was discussion about the mission statement bullet about"promoting system partnerships." Members VanDusen and Ortiz suggested it be revised to say"promoting partnerships that enhance the health of the public."The Board members agreed to that change,but decided there was no need to change the vision and goals. Mr.McLaughlin asked the Board to take a few minutes to brainstorm about what strategies or activities they would like to consider adding to the plan.Member Austin expressed concern about the impact to public health of about 40,000 people that might be losing their health insurance. Donna Wright.SBOH Member, suggested staff bolster the Board's relationship with city-county associations to jointly develop ideas on how to strengthen public health finance. Member VanDusen suggested trying to help set priorities for public health during times of budget shortfalls. Member Ortiz suggested increasing communication with primary health care professional associations. Dr. Hayes suggested that public health needs to be a lens through which all policy is made at the local level. Member Tonasket said more effort should be devoted to marketing public health to the public. . • Chair Katz said that a central problem is that everyone works in silos. Member Tonasket said he gets PO Box 47990. Olympia,Washington •98504-7990 Phone:360/236-4110• Fax:360/236-4088•Email:WSBOH(a�doh.wa.bov•Web:www.sboh.wa.dov Washington State Board of Health 9 Draft Minutes—July 8,2009 frustrated with strategic planning processes because the Board primarily responds to what DOH • brings to it to review,rather than the Board developing new ways to address problems. Chair Katz asked when staff would have a memo clearly explaining the differences between Alternatives A and B of the school rule proposal. Vice Chair Higman said the target should be at least a week before the August Board meeting. Mr. McLaughlin responded that staff would try to get something to members two weeks before the August meeting.Member VanDusen asked what staff needs from members. Mr. McLaughlin responded that it was important for the Board's committees to provide guidance to staff. Member VanDusen shared a discussion she had with Dr. Tom Locke during lunch about inviting rural hospitals to come and address the Board about their concerns. ADJOURNMENT Treuman Katz, SBOH Chair, adjourned the meeting at 2:58 p.m. WASHINGTON STATE BOARD OF HEALTH Treuman Katz, Chair • • PO Box 47990• Olympia,Washington•98504-7990 Phone: 360/236-4110• Fax: 360/236-4088 • Email:WSBOH(a�doh.wa.gov•Web:www.sboh.wa.gov • Board of Health Old Business .agenda Item # IT., 3 • Septic Community Education Update .august 20, 2009 Jean Baldwin From: Linda Atkins Spent: Friday, August 14, 2009 9:18 AM To: Jean Baldwin Subject: update for BOH Jean, Here are a couple of items for your update to the BOH. • We are coordinating with other counties in our region that have homeowner training as part of their O&M Programs. The goal is to develop tools and materials that can be used by all of the counties supplemented by locally specific info. The regional group consists of Island, Clallam, Whatcom, Skagit Counties and Snohomish Health District. Island County has produced a CD for homeowners to view before taking the class that can be viewed at http://www.co.island.wa.us/health/liquid/HOST.htm . • Our"Septics 101" -TLC for your Septic System- Basics of septic system operation and maintenance for the homeowner will be offered this fall in several locations. We will be coordinating some of them with the water quality project areas such as the Snow Creek Owners Association in the Discovery Bay area. We had 4 classes in winter/spring 2009 with 151 participants. • We have entered into the database and scanned over 10,000 septic cases. These are now available on line for the public and professionals to access. Here is a link to a case: http://test.co.jefferson.wa.us/weblinkext/DocView.aspx?id=658145&dbid=l . Monitoring inspections, application, permit and conditions, asbuilt/record drawing, design and soils are available for viewing. •Let me know if you want me to give more detail on any of them. Linda Atkins R.S. Environmental Health Specialist, JCPH Environmental Health Division 360-385-9444 ACways working for a safer and healthier Jefferson County CONFIDENTIALITY NOTICE. This e-mail message,including any attachments,is for the sole use of the intended recipient(s)and may contain confidential and privileged information. Any unauthorized review,use,disclosure,or distribution is prohibited If you are not the intended recipient,please contact the sender by reply e-mail and destroy all copies of the original message. All e-mail sent to this address has been received by the Jefferson County e-mail system and is therefore subject to the Public Records Act,a state law found at RCW 42.56. Under the Public Records law the County must release this e-mail and its contents to any person who asks to obtain a copy(or for inspection)of this e-mail unless it is also exempt from disclosure under state law,including RCW 42.56. • 1 Board of HeaCth Netiv Business .Agenda Item #17., 1 Green Business Award- Port Townsend Computers • .August 20, 2009 °NJEFFERSON 4{ � !r (^ Always Working for a Safer and Healthier Jefferson • ‘—,Y+ July 29, 2009 Jefferson County Board of Health PO Box 1220 Port Townsend, WA 98368 Dear Board of Health Members: The Green Business program is proud to announce a new business. Port Townsend Computers has become a Green Business. This business is going the extra mile to conserve water, energy and other valuable resources. They are leaders in the Community and both businesses have developed unique ways to protect the environment white doing business. After signing the award, please return them to: • Anita Hicklin Jefferson County Public Health Solid Waste Management Program 615 Sheridan Street Port Townsend, WA 98368 Thank you for your continued support of the Green Business Program! Sincerely, Anita Hicklin Environmental Health Specialist • COMMUNITY ENVIRONMENTAL DEVELOPMENTAL NATURAL HEALTH HEALTH DISABILITIES RESOURCES (360) 385-9400 (360) 385-9444 (360) 385-9400 (360) 385-9444 615 Sheridan Street,Port Townsend, Washington 98368 fax (360)385-9401 web: www.jeffersoncountypublichealth.org coiii. gt n st N • oma C7-3 -- CCI v w [Q y' 0404,111111 Cg) Cg.. Mii,:o.151 m 340 ,_g$27'3"-- „�.L. '`'`2'.g.:, � �s ow 'fie'e R*, illt ttill . •z, tiCZ : 0..„.„.....„,,,,.,,,,,,_,,,,,,,,,.,,, , ,,,:, =,,,,,,,...,,,o ..'74111111111111k-1!„ ,:i g v,,,, , ,;,,,,,„3„./....„ , pio-„.„..._ 4—' " ,,, t...~:z..,' ':;.- %,;' fftiliA,. : fi,..,-,::-1.,..„ ,,, li.,.,,,,„„„,„_.,,,,,,,-,,,---.41-'-'14;,',.,:'''"- 2 -C.,'-';', d.4 '., ...,.. 41 _ _Ii,:z -'''''''''S:-.,:l'i-1Y 13 � e.* ---„,,,,, _tat ---..-...w. P _ -_,.._„_ ,.. .___ __ ,,,,, .. , ro --..,...... .,..-- , . ...,,,,„„,,..0„,,..ez .., , ., ,, 41''--g.:'!:*.W..,...,itt.,,,, --.' y '-4 c..1 ellzill : Cr a (I ilit ,,, e, __ 0 :...., •0 x 0' • Board of 3-fealth New Business Agenda Item #17., 2 • 1NIC (Women, Infants & Children) .annual Report .August 20, 2009 ing110111 moots • A� Jefferson County Public Health impow WIC Facts: 2008 Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Infants Born in County WIC Families Served by WIC Working families o 64/0 Jefferson 58% Families living in poverty 64% Statewide 50% Even though they are working,the majority of WIC families are living in poverty. In 2008,the monthly income for a family of four living in poverty was $1,767 or less. Women, Infants and WIC Nutrition Education Children Served Promotes Healthy Choices Total: 804 Total nutrition education sessions 2,193 Infants and WIC nutrition education: • children under 5 552 • Emphasizes healthy habits so families can eat better and Pregnant, stay active to prevent obesity and other chronic diseases. breastfeeding and • Promotes breastfeeding for at least the first year of life. postpartum women252 And,helps working mothers breastfeed longer by providing breast pumps. • Helps prevent early childhood caries by giving parents WIC and the Farmers ideas for healthy snacks and stressing dental care by Market Nutrition age one. Programs Benefit the Local Economy WIC Attracts Families to Prenatal Care/MSS Preventive Health Services Dollars to grocery stores Immunizations $307,718 Family Planning WIC referrals 5,672 Dollars to farmers Dental Care WIC helps families get the services they need. Quit Smoking $1,682 *Maternity Support Services Washington WIC "...improving the lifelong health and nutrition of women, infants and young children" • County Co y Public Health • WIC Sites Statewide WIC Facts 20081 292,000 pregnant and breastfeeding women and children Chimacum under age 5 benefit from WIC Port Townsend • 70%are from working families. Quilcene • 12,000 are from military families,including women serving in the armed forces. • Families receive healthy foods,education and counseling on nutrition and physical activity,referrals,and breastfeeding support. $127 million in grocery store sales • Each client receives checks to purchase an average of$52 a month in healthy foods. • Families buy healthy food with their WIC checks at more than 700 grocery stores statewide. $738,000 in purchases from local farmers • W ith WIC Farmers Market Nutrition Program checks,families can II eat more fresh fruits and vegetables from local farmers. 83%of WIC mothers give their child a healthy start by breastfeeding,far exceeding the national rate of 53%? • Children who are not breastfed are more likely to have asthma, diabetes,and childhood obesity.' • Mothers who breastfeed lose pregnancy weight gain more quickly. • Mothers who do not breastfeed have higher rates of breast cancer and osteoporosis.' In the past 30 years,Washington WIC has contributed more than $1 billion in grocery sales and saved an estimated $700 million in health care costs.4 1 Federal Fiscal Year 2008. 2 "Mothers Survey,Ross Products Division,and Abbott Laboratories"2006-Abbott Laboratories. 3 U.S.Dept.of Health and Human Services.HHS Blueprint for Action on Breastfeeding,Wash.D.C.,DHHS,Office of Women's Health,2000. 4 Mathematica Policy Research:The savings in Medicaid costs for newborns and their mothers from prenatal participation in the WIC program.Prepared for U.S.Department of Agriculture,Food and Nutrition Service,October 1990. Washington 5 Departmetof Contact Us Visit www doh wa aov/cfh c to find more information about Washington WIC,a copy of our Annual Report, Hea/th and county-specific fact sheets.You can also call 1.800.841.1410 and press 0,or write PO Box 47886,Olympia This institution is an equal opportunity provider. WA 98504-7886.For persons with disabilities,this document is available on request in other formats. WIC is aood investmentg 44 The Federal Supplemental Nutrition Program for Women, Infants and Children (WIC) WIC began over 35 years ago and is known to be a program that works.Over the years,studies have shown WIC is efficient and cost effective. In 2006,the Federal Office of Management and Budget gave WIC its highest ranking for efficient use of funds, and for the program's positive impact on birth outcomes,childhood immunization rates, children's nutrition,and Medicaid savings.Communities and the state get a great return on their investment in WIC through healthier families and lower health care costs.'-6 WIC improves the health of Washington families WIC mothers are more likely to get early prenatal care and to breastfeed;they are less likely to be heavy smokers' This matters because: • Mothers served by WIC have better birth outcomes and are 50 percent less likely to have a very low birth weight baby.' Hospitalization for one of these babies can cost over$220,000.2 • Helping more mothers to breastfeed is critical to obesity prevention efforts.Breastfed children are less likely to suffer from childhood obesity and breastfeeding mothers lose their pregnancy weight gain more quickly.' • Smoking around children causes more asthma symptoms and hospitalizations.4 • The benefits of Supportingbreastfeedingis WIC's top WIC nutrition priority All pregnant women and new mothers on WIC are encouraged to breastfeed. Breast services begin pumps provided by the WIC Nutrition Program help mothers continue breastfeeding even before the when returning to school or work. child is born. • Infants who are not breastfed are more likely to suffer from infections and chronic conditions like allergies,asthma,and diabetes later in life.' • Each breastfed baby saves$450 to$1,450 per year in medical costs.' -,:',.%.4. • For every 1,000 newborns who are not breastfed,there are 2,033 more doctor visits,212 more hospital days,and 609 additional prescriptions compared to babies "° breastfed for three months.6 • Breastfeeding also strengthens the bond between mother and baby. WIC helps boost local economies Most WIC funds are spent on nutritious foods for mothers and children.The next biggest expense is funding community agencies to provide WIC services. $127 million in groceries-Almost 80 percent of WIC funds are spent on healthy foods for young families in over 700 large and small grocery stores statewide. $738,000 in fresh fruits and vegetables-Purchases from Washington A i Washington State Department ofah 1 growers through the WIC Farmers Market Nutrition Program provide locally grown fruits Health and vegetables to mothers and young children. $21 million for local jobs-By funding 65 community and public health agencies 1111, Community&Family Health to provide WIC nutrition services at over 220 clinic sites around the state,WIC helps CommunityWellness&Prevention support over 1,000 local jobs. DOH 960-027 May 2009 WIC is a proven, cost effective public health program n Through a combination of health screening,nutrition education,and referrals,WIC families get much more from the program than checks for healthy foods.The community rq benefits as well,since healthier children are more likely to enter school ready to learn,and good nutrition helps prevent chronic diseases. 2008 WIC facts • Over 65 percent of all infants born in rural counties are served by the Washington WIC Nutrition Program;statewide 50 percent of all infants born are served. New food • More than 292,000 women,infants and children are served by WIC. choices coming • Working families make up 70 percent of those served. • WIC serves over 12,000 WIC clients in the military or from military families. in October • Among families served by WIC,63 percent were living on poverty-level incomes. • More low fat foods • Over$128 million was paid to local grocers and growers for nutritious WIC foods. • More fruits and vegetables Nutrition education and referrals are key • More whole grains WIC services Mothers and children enrolled in WIC receive: • Education on nutrition and the importance of physical activity. • • Breastfeeding education and support. • Pregnancy and early childhood growth and health screening. • Referrals to prenatal care,preventive health care,and other services. WIC foods promote a healthy lifestyle "" The WIC Nutrition Program provides checks to buy specific healthy foods that: • Are high in the nutrients often missing from diets of lower income families:calcium, iron,protein,folic acid,and vitamins A,C,and D. • Meet the individual client's health needs. • Meet federal nutrition requirements set by the Department of Agriculture. • Influence healthy eating habits to help improve quality of life and prevent chronic diseases like diabetes,cancer,and childhood obesity. In most communities,WIC families also get checks to buy locally grown fresh fruits and Cvegetables at local markets from the WIC Farmers Market Nutrition Program. • For footnotes go to:www.doh.wa.gov/cfh/WIC/reports.htm. • To contact us or get more information about the Washington WIC program visit Washington State WIC www.doh.wa.gov/cfh/WIC or call 1-800-841-1410. Nutrition Program • For persons with disabilities,this document is available on request in other formats. To submit a request,please call 1-800-525-0127(TDD/TTY 1-800-833-6388). PUBLIC HEALTH • This institution is an equal opportunity provider. ALWAYS WORKING FORA SAFER AND HEALTHIER WASHINGTON Washington WIC does not discriminate. ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ o ❑ ❑ ❑ arm c cr co cr co r r r rD r LA cn 3 0- n O s C T 3 c o_ �, a 0, a, a, a, m m m < rD 0 O 53 a, n, 1 < C Q. !� rD O p O p n tp m p < N Q �.lQ gag m •3N mO c . rD mrD to OON �� —� ' O .rt 0 0 n OEIL s .o N m N TOO nm < O ?-0O O / s.< n tD -, 0 m o0 = m O nB rr O rr rD nit O N C <v + * 2., (1) 0 * = .-r 0 0, n i^ r�D E; LA m • 0 0 °- u 3 -s in Q O c0 n' ;rt m • om _� N to o N c .5 0 N 73 C = a„ r, o .r, 191 0 1/40 rip �^cr O p p N MI0 ,p :r N Q (l O 0 7 "�.` 1D N e9 � � ='' O O OG �'3 E. ': rr 12. lQ O -n -0 p =• n `' n' O Odo -' g_ —• ..71: G * _ N 2, 54 A. N rt O ,.a4,, I • O rD .. H — -0 — m , _ * 111:coi. '111 0 '° * m fil M . -k. - i I `3....- NJ -.; 7,. ,,',,,,,, i /6 ...,.. .,.. ,, c O - 0 . .:;;,. .......,H Pi" ,,,t 44: _ - ___...ar •.,4„,,,,,,• \ , .0.1 1 ,,.,.. ..... , ..,O O O ._ V1 CU Cvcv > ' :N E v o c 42 •i i 0 as O O 40 4- C 4-, .L O .� QQJ V m C - R N v o C •- i. r6 O ic • 0 \ v V 3 0 > . N N H R t v v a 'p N ' p � � OS o C as W E a, _ 4 R 75 a •3 0 v N >' a 4- ' _ O N y ro E 0 C u N >• aJ C OO > v N [6 9 o 4- -0 0 in aJ 0 „ O U 0; N N 0 3 13 aJ2 � aJ t AJ -.'h. N � E O i o J 0 - y C 2. 0 C _Q O V 4- - C ra p 0 p �- w 0 a) O O ca O L c =- C a! v 0 '' s •C a a v w ' >o 0 0 .o' 3 vo W — u N N �• 0 C (a p 0 O -O E s CO 3ih, Y L.L. o _ N N T aJ T C) rC6 Q o 3 01 \',` c'..int 0 7 •}' '5 E a .0 N a) i N a1 .- 0lin ""mo C ro csa a) O Z ; G p1 ■ ■ coH . >. O I- _0 _0 as u_ N _0 V 0 Z C' 0 O NOCV- 4CI- - E a1 E v a t ra v s 0 C 2:1- s s - +J a 0 = CCS 0 ..0 .7 +� V aJ 0 0 ri9 .0 0. > v v 3 3 v o � .3 •0 N E � £ ;I., co 0 •3 C 0 > v U ,,, >. a u o � E A MI �«. a s u 3 o v a p p -a o � O * La y _ a m y •a a s C •R = C c O > • s > it f0 0 � > O a}i i § 2 .1-, i E u v ei u w8 ri Q 3 as a `� O ) o 3 'ra � v � � o 0 0 = � � s � Z ° � 0 a a C v _� = > Sca1 �°- � o v c 3 >- a = , ° o — L a c -o v O C `~ RI O O 00 e. 0 4 O C >' ' 4-. ' 0 0 1 # A, a) v Q N )0, v v0 culin v -o Ea' O o, o00 . moo , 1�. � � L C0 CI o ,_ v u 2 C 0 W V >, T : O a, a, v c r6 C C O E -p rQa `° 4- °J o v tail o v o ° >. °o ° tp Li. t o v N v 45 v o ö v 0 v+ w. M > C 'N t CU C - C >.= ® p o N ra -O N 4- (1) E O O V Q +, p C >, NE c G o 2 p1 vvi j.o E Z Ll V o vOi o •_ N V 4- a) Q - O ` — p ° cn v c N aJ QJ aJ N w x�.t, R E o E o E v 2 §-- t v ° •3 0MEM ' ` v o W 0 .0 i .14 Q N i V O T l7 .� Z CI ier * ._. L Vit ; � ■ Q. • Board of 3Cealth Wow Business .agenda Item #17., 3 Pandemic 3 �iNi Preparedness Update: • 'Vaccination Strategies .august 20, 2009 „0N eo `u Gtii a r 'SHI N0l0 `- f� the PeninsulasPublic Health DISTRICT (�6 HurwPN 9E When business is not usual 9 your Stepsbusiness can P take NOW Imagine if your business had to function with 25 to 30 percent of your staff sick or caring for sick family members. Do you have a business plan that anticipates all hazards including fire, earthquake and an influenza pandemic?Have you anticipated the impacts specific to your business? I Contingency plans Would your emergency plan work for an influenza pandemic as well as for any other hazard? Develop a plan that will. 2 Core business activities What activities must happen in your business in order to function? Identify what you absolutely can't do without. • 3 Essential services How will you handle interruptions of water,power,and sanitation? Identify back- up solutions to keep your staff and clients safe. 4 Cross training Can your employees perform a variety of essential functions? Make sure no individual is indispensable. 5 Operations requirements Is your critical inventory adequate? Develop a checklist of what you can't function without and keep it in stock. 6 Alternative work sites What services can your employees do off site?Establish policies and tools to help them work at home if possible. 7 Services online or by phone What services can your employees deliver online or over the phone? Start phone and online consulting now. 8 Employee awareness Do your employees know about your emergency plans? Are they informed about pandemic flu? Educate them now! 9 Leave policies What about your sick leave and family leave policies? Update them now. Your employees may be too concerned about lost wages to stay home when they are sick. Handwashing—A Business Basic! Encourage employees to For more information about practice good respiratory etiquette and to wash their hands frequently and business preparationthese websites:to thoroughly with soap and water. Make alcohol-based hand sanitizers vvww.cdc. ov emc/ readily available when soap and water are not handy. g / ec / checklists.htm; www.healthyamericans.org/ Preventing the Spread of Influenza Most patients with pandemic influenza will be able to remain at home during the course of their illness and can be cared for by others who live in the household. This information is intended to help you recognize the )( A Region 2 symptoms of influenza and care for ill persons in the home,both during a typical influenza season and during an influenza pandemic. - } , At the outset of an influenza pandemic,a vaccine for the pandemic flu virus will not be available for several months. However,it's still a good idea to get a seasonal flu vaccine to protect from seasonal flu viruses. Because influenza can spread easily from person to person,anyone living in or visiting a home where someone has influenza can become infected.For this reason,it is important to take steps to prevent the spread of influenza to others in the home. Symptoms of Influenza ✓ Sudden onset of illness ✓ Stuffy nose ✓ Fever higher than 100.4°F(38°C) ✓ Muscle aches ✓ Chills ✓ Feeling of weakness and/or exhaustion ✓ Cough ✓ Diarrhea,vomiting,abdominal pain(occur more ✓ Headache commonly in children) ✓ Sore throat • Caregivers— What You Can Do Separate influenza patients from other people as much as possible.When practical,the ill person should stay in a separate room where others do not enter.Other people living in the home should limit contact with the ill person as much as possible. Designate one person in the household as the main caregiver for the ill person. Ideally,this caregiver should be healthy and not have medical conditions that would put him or her at risk for severe influenza disease. Medical conditions that are considered"high risk" include: ❖ Pregnancy ❖ Disease or treatment that suppresses the immune systems ❖ Diabetes ❖ Chronic lung disease,including asthmas,emphysema,cystic • Heart problems fibrosis,chronic bronchitis,bronchiectasis and tuberculosis(TB) ❖ Kidney disease ❖ Over 65 years of age Watch for influenza symptoms in other household members. Contact your health care provider if you have questions about caring for the ill person. However,it may be difficult to contact your usual healthcare provider during a severe influenza pandemic. Public Health in Region 2—Claallam County Health&Human Services,Jefferson County Public Health and Kitsap County Health District—will provide frequent updates,including how to get medical advice. Special telephone hotlines will be used.These numbers will be on the websites and announced through the media. Wear surgical masks (with ties)or procedure masks (with ear loops). Masks may be useful in decreasing spread of influenza when worn by the patient and/or caregiver during close contact (within 3 feet).To be useful masks must be worn at all times when in close contact with the patient. • The wearing of gloves and gowns is not recommended for household members providing care in the home but washing hands frequently is. In the Household— What You Can Do Wash hands with soap and water. If soap and water are not available,use an alcohol-based hand • cleanser after each contact with an influenza patient or with objects in the area where the patient is located. Thorough hand cleaning by everyone in the household is the single best preventative measure against the spread of the flu. Don't touch your eyes, nose or mouth without first washing your hands for 20 seconds.Wash hands before and after using the bathroom Wash soiled dishes and eating utensils either in a dishwasher or by hand with warm water and soap. It's not necessary to separate eating utensils used by a patient with influenza. Laundry can be washed in a standard washing machine with warm or cold water and detergent. It is not necessary to separate soiled linen and laundry used by a patient with influenza from other household laundry. Do not grasp the laundry close to your body or face,in order to avoid contamination.Wash hands with soap and water after handling soiled laundry. Place tissues used by the ill patient in a bag and throw them away with other household waste. Consider placing a bag at the bedside for this purpose. Clean counters,surfaces and other areas in the home regularly using everyday cleaning products. In the Community— What You Can Do Stay at home if you are sick. Ill persons should not leave the home until they have recovered because they can spread the infection to others. In a typical influenza season,person with influenza should avoid contact with others for about 5 days after onset of the illness. During an influenza pandemic, public health authorities will provide information on how long persons with influenza should remain at home. If the HI person must leave home (such as for medical care),he or she should wear a surgical • or procedure mask and should be sure to take the following steps: ✓ Cover the mouth and nose when coughing and sneezing,using tissues or the crook of the elbow instead of the hands. ✓ Use tissues to contain mucous and watery discharge from the mouth and nose. ✓ Dispose of tissues in the nearest waste bin after use or carry a small plastic bag(like a zip- lock bag)for used tissues. ✓ Wash hands with soap and water or use an alcohol-based hand cleanser after covering your mouth for a cough or sneeze after wiping or blowing your nose and after handling contaminated objects and materials,including tissues. During an influenza pandemic only people who are essential for patient care or support should enter a home where someone is ill with pandemic influenza unless they have already had influenza. If other persons must enter the home,they should avoid close contact with the patient and use the infection control precautions recommended on this sheet. More Information This guidance is based on current information from the U.S. Department of Health &Human services Pandemic Influenza Plan and is subject to change. Up-to-date guidance will be available from your healthcare provider and at these websites: Clallam County Health&Human Services www.clallam.net/HealthServices/ Jefferson County Public Health www.jeffersoncountypublichealth.org Kitsap County Health District www.kitsapcountyhealth.com Washington State Department of Health www.doh.wa.gov Centers for Disease Control and Prevention www.cdc.gov • Region 2 Public Health,Kitsap,Clallam and Jefferson Counties Kitsap County Health District,345 Sixth St.,Suite 300,Bremerton,WA 98337,(360) 337-5235 7/24/09 Returning to Work—Guidance for Employers When should workers who have been ill with influenza return to the workplace?This document provides an overview of influenza symptoms, •R,« Region 2 criteria for employee return, and important qualifications for use of thisEA" fixoo .. information during a pandemic flu. 3.-- Influenza Virus How it spreads—Influenza viruses are spread from person to person primarily through respiratory droplet transmission(e.g.,when an infected person coughs or sneezes in close proximity,normally 3 feet or less,to an uninfected person). The virus may also be spread through contact with infectious respiratory secretions on the hands of an infected person or by touching objects or surfaces contaminated with the virus. Incubation &Infection—The typical incubation period for seasonal influenza is 1-4 days,with an average of 2 days. Adults can be infectious from the day before symptoms begin through approximately 5-7 days after illness onset. Children can be infectious for>_10 days after the onset of symptoms.Severely immunocompromised persons can be infectious for weeks or months. Current Criteria for Returning to Work • Workers who have become ill with influenza should stay at home until all of the following criteria are met: ❑ At least 5 days have passed since the symptoms of illness began: AND ❑ Fever has resolved and has not been present for at least 24 hours: AND ❑ Cough is improving(decreasing in frequency and amount of secretions with no associated chest discomfort or shortness of breath) Upon returning to the work environment,employees should continue to follow cough etiquette and hand washing protocols. Criteria for Pandemic Influenza Experts do not know whether the mode of transmission,incubation period, or contagious period of pandemic strains of the influenza virus will be similar to those of seasonal influenza (recurring yearly). Because of this,employers must be vigilant for specific recommendations from Public Health during an influenza pandemic regarding management of illness in the workplace,including when it is safe for workers to return to the work environment after illness with influenza. More Information Clallam County Health&Human Services www.clallam.net/HealthServices/ Jefferson County Public Health www.jeffersoncountypublichealth.org Kitsap County Health District www.kitsapcountyhealth.com • Washington State Department of Health www.doh.wa.gov Centers for Disease Control and Prevention www.cdc.gov Region 2 Public Health,Kitsap,Clallam and Jefferson Counties Kitsap County Health District,345 Sixth St.,Suite 300,Bremerton,WA 98337, (360)337-5235 6/04/07 d' CDC H 1 N 1 Flu l CDC Guidance for State and Local Public Health Officials and School ... Page 1 of 5 pCenters for Disease Control'! and Prevention lir ,,` Your`t r�irr< S UICG f 3r *. it::,f0 H a h rt tarp itis r. • CDC Guidance for State and Local Public Health Officials and School Administrators for School (K-12) Responses to Influenza during the 2009-2010 School Year August 7, 2009, 9:00 AM ET This document provides guidance to help decrease the spread of flu among students and school staff during the 2009-2010 school year. This document expands upon earlier school guidance documents by providing a menu of tools that school and health officials can choose from based on conditions in their area. It recommends actions to take this school year and suggests strategies to use if CDC finds that the flu starts causing more severe disease. The guidance also provides a checklist for making decisions at the local level. Detailed information on the reasons for these strategies and suggestions on how to use them is included in the Technical Report. Based on the severity of 2009 HINT f lu-related illness thus far, this guidance also recommends that students and staff with influenza-like illness remain home until 24 hours after resolution of fever without the use offever-reducing medications. For the purpose of this guidance, "schools"will refer to both public and private institutions • providing grades K-12 education to children and adolescents in group settings. The guidance applies to such schools in their entirety, even if they provide services for younger or older students. Guidance for child care settings and institutions of higher education will be addressed in separate documents. The guidance is designed to decrease exposure to regular seasonal flu and 2009 HiNi flu while limiting the disruption of day-to-day activities and the vital learning that goes on in schools. CDC will continue to monitor the situation and update the current guidance as more information is obtained on 2009 H1N1. About 55 million students and 7 million staff attend the more than 130,000 public and private schools in the United States each day. By implementing these recommendations, schools and health officials can help protect one-fifth of the country's population from flu. Collaboration is essential: CDC, the U.S. Department of Education, state and local public health and education agencies, schools, students, staff, families, businesses, and communities all have active roles to play. The decision to dismiss students should be made locally and should balance the goal of reducing the number of people who become seriously ill or die from influenza with the goal of minimizing social disruption and safety risks to children sometimes associated with school dismissal. Based on the experience and knowledge gained in jurisdictions that had large outbreaks in spring 2009, the potential benefits of preemptively dismissing students from school are often outweighed by negative consequences, including students being left home alone, health workers missing shifts when they must stay home with their children, students 41) missing meals, and interruption of students' education. Still, although the situation in fall 2009 is unpredictable, more communities may be affected, reflecting wider transmission. The overall http://www.cdc.gov/h1n1flu/schools/schoolguidance.htm 8/14/2009 CDC H1N1 Flu I CDC Guidance for State and Local Public Health Officials and School ... Page 2 of impact of 2009 HiN1 should be greater than in the spring, and school dismissals may be warranted, depending on the disease burden and other conditions. (See the Technical Report for discussion of the kinds of circumstances that might warrant preemptive school dismissals.) • Recommended school responses for the 2009-2010 school year Under conditions with similar severity as in spring 2009 • Stay home when sick: Those with flu-like illness should stay home for at least 24 hours after they no longer have a fever, or signs of a fever, without the use of fever-reducing medicines. They should stay home even if they are using antiviral drugs. (For more information, see CDC Recommendations for the Amount of Time Persons with Influenza-Like Illness Should be Away from Others.) See the Technical Report for more details about sta_ ing home when sick >> • Separate ill students and staff: Students and staff who appear to have flu-like illness should be sent to a room separate from others until can be home. wear a surgical mask, if possibl , and thhoe whoare for ill students and staff ear protective gear such as a mask. See the Technical Report for more details about separatin_g ill students and staff» • Hand hygiene and respiratory etiquette: The new recommendations emphasize the importance of the basic foundations of influenza prevention: stay home when sick, wash hands frequently with soap and water when possible, and cover noses and mouths with a tissue when coughing or sneezing (or a shirt sleeve or elbow if no tissue is available). • See the Technical Report for_ more details about hand hygiene o and respirat _etiquette >> • Routine cleaning: School staff should routinely clean areas that students and staff touch often with the cleaners they typically use. Special cleaning with bleach and other non-detergent-based cleaners is not necessary. See the Technical Report for_mo_re details about routine cleaning >> • Early treatment of high-risk students and staff: People at high risk for influenza complications who become ill with influenza-like illness should speak with their health care provider as soon as possible. Early treatment with antiviral medications is very important for people at high risk because it can prevent hospitalizations and deaths. People at high risk include those who are pregnant, have asthma or diabetes, have compromised immune systems, or have neuromuscular diseases. See the Technical Report for more details about early treatment >> • Consideration of selective school dismissal: Although there are not many schools where all or most students are at high risk(for example, schools for medically fragile children or for pregnant students) a community might decide to dismiss such a school to better protect these high-risk students. See the Technical Reportfor more details_about selective school dismissal >> Under conditions of increased severity compared with spring 2009 CDC may recommend additional measures to help protect students and staff if global and national assessments indicate that influenza is causing more severe disease. In addition,local http://www.cdc.gov/h1n1flu/schools/schoolguidance.htm 8/14/2009 • CDC H1N1 Flu I CDC Guidance for State and Local Public Health Officials and School ... Page 3 of 5 health and education officials may elect to implement some of these additional measures. Except for school dismissals, these strategies have not been scientifically tested. But CDC wants icommunities to have tools to use that may be the right measures for their community and circumstances. • Active screening: Schools should check students and staff for fever and other symptoms of flu when they get to school in the morning, separate those who are ill, and send them home as soon as possible. Throughout the day, staff should be vigilant in identifying students and other staff who appear ill. See the Technical Report for more details about active screening >>__ • High-risk students and staff members stay home: People at high-risk of flu complications should talk to their doctor about staying home from school when a lot of flu is circulating in the community. Schools should plan now for ways to continue educating students who stay home through instructional phone calls, homework packets, internet lessons, and other approaches. See the Technical Report for more details about high-risk students and staff members staying home • Students with ill household members stay home: Students who have an ill household member should stay home for five days from the day the first household member got sick. This is the time period they are most likely to get sick themselves. See the Technical Report for more details about students with ill household members stayinghome • Increase distance between people at schools: CDCfrom encouragesdifferentclassrooms. schools to try innovative ways of separating students. These can be as simple as moving desks farther apart or canceling classes that bring together children • Seethe Technical Reportformoredetails about increasirig distance between people at schools • Extend the period for ill persons to stay home: If influenza severity increases, people with flu-like illness should stay home for at least 7 days, even if they have no more symptoms. If people are still sick, they should stay home until 24 hours after they have no symptoms. Seethe Technical Reportformore details about extending the periodfor ill persons to stay home» • School dismissals: School and health officials should work closely to balance the risks of flu in their community with the disruption dismissals will cause in both education and the wider community. The length of time schools should be dismissed will vary depending on the type of dismissal as well as the severity and extent of illness. Schools that dismiss students should do so for five to seven calendar days and should reassess whether or not to resume classes after that period. Schools that dismiss students should remain open to teachers and staff so they can continue to provide instruction through other means. See the Technical Report for more details about school dismissals >> Reactive dismissals might be appropriate when schools are not able to maintain normal functioning for example, when a significant number and proportion of students have documented fever while at school despite recommendations to keep ill children home. Preemptive dismissals can be used proactively to decrease the spread of flu. CDC may recommend preemptive school dismissals if the flu starts to cause severe disease in a significantly larger proportion of those affected. http://www.cdc.gov/hln 1 flu/schools/schoolguidance.htm 8/14/2009 • CDC H1N1 Flu I CDC Guidance for State and Local Public Health Officials and School ... Page4 of5 Deciding on a course of action CDC and its partners will continuously look for changes in the severity of influenza-like illness 111 and will share what is learned with state and local agencies. However, states and local communities can expect to see a lot of differences in disease burden across the country. Every state and community has to balance a variety of objectives to determine their best course of action to help decrease the spread of influenza. Decision-makers should explicitly identify and communicate their objectives which might be one or more of the following: (a) protecting overall public health by reducing community transmission; (b) reducing transmission in students and school staff; and (c) protecting people with high-risk conditions. Some strategies can have negative consequences in addition to their potential benefits. In the particular case of school dismissals, decision-makers also must consider and balance additional factors: (a) how to ensure students continue to learn; (2) how to provide demands on local emotionally and physically safe place for students; and (3) to health care services. The following questions can help begin discussions and lead to decisions at the state and local levels. Decision-Makers and Stakeholders Are all of the right decision-makers and stakeholders involved? State and/or local health officials State and/or local education officials • State and/or local homeland security officials State and/or local governing officials (e.g., governors, mayors) Parent and student representatives Representatives of local businesses, the faith community, school-employee unions, and community organizations Teachers Health care providers and hospitals School nurses School food service directors Vendors that supply schools Information Collection and Sharing Can local or state health officials determine and share information about the following? Outpatient visits for influenza-like illness Hospitalizations for influenza-like illness Trends in the numbers of hospitalizations or deaths Percent hospitalized patients who require admission to intensive care units (ICU) Deaths from influenza • Groups being disproportionately affected http://www.cdc.gov/h1n1flu/schools/schoolguidance.htm 8/14/2009 UV H1N1 Flu I CDC Guidance for State and Local Public Health Officials and School ... Page 5 of 5 1 Ability of local health care providers and emergency departments to meet increased demand Availability of hospital bed, ICU space, and ventilators for influenza patients • Availability of hospital staff Availability of antiviral medications Can local education agencies or schools determine and share information about the following? School absenteeism rates Number of visits to school health offices daily Number of students with influenza-like illness sent home during the school day Feasibility Do you have the resources to implement the strategies being g Funds Personnel Equipment Space Time Legal authority or policy requirements • Acceptability Have you determined how to address the followin challen implementing the strategies? g ges to Public concern about influenza Lack of public support for the intervention People who do not feel empowered to protect themselves Secondary effects of strategies (for example, dismissing schools could impact child nutrition,job security, financial support, health service access, and educational progress) Page last reviewed August 7,2009,9:0o AM ET Page last updated August 7,2009,9:0o AM ET Content source:Centers for Disease Control and Prevention Centers for Disease Control and Prevention i600 Clifton Rd.Atlanta, GA 30333, USA 800-CDC-INFO(80o-232-4636)TTY: (888)232-6348, 24 Hours/Every Day- 0 :..e,,.." cdcinfo@cdc.gov 1� �Q ' (",/ Government Made Easy +_ • http://www.cdc.gov/h1n1flu/schools/schoolguidance.htm 8/14/2009 • r Board of.7CeaCth Wow Business .agenda Item #17.1 4 200.9 Budget Update • .august 20, 2009 How is Public Health Different from Health Care? Jefferson County Public Health (JCPH) is working to protect and improve the county's health. All service and work is completed by professional scientists, nurses, sanitarians, microbiologists, • marine biologists or physicians; all use science based decisions to improve the public's health. How is Public Health different from health care? Health care focuses on delivering services to the individual to treat illness and maintain health. Public Health focuses on helping communities to be safer and healthier. Treating an individual with e. coli is a health care service. Monitoring and responding to stop the spread of an e.coli outbreak is a Public Health responsibility. Preventing disease transmission is a primary PH focus. This includes possible transmission from the environment, food, and person to person. Staff follows jurisdictional authority from County ordinances and Health Officer edicts. Work is based on building healthy positive partnerships(schools, hospital, physicians,city,and businesses) within the community to educate and provide preventative services. All divisions within JCPH provide long term prevention services and education. Often invisible work,how do we see bad things that did not happen? Successful PH professionals decrease the possibility of disease outbreaks through; lower STD rate, more childhood immunizations given, rapid investigation of notifiable conditions&diseases(working with the state and national partners), fewer on-site systems failing because of poor installation; all work to obtain voluntary compliance with ordinances, laws or disease prevention standards; all are focused on health maintenance and disease prevention. Prevention of child abuse is a goal of family support programs. JCPH service divisions include Community Health,Environmental Health, Water Quality, Developmental Disability Services, and Administration(which also manages grants for other community providers and other County departments). . What does Public Health (PH) look like in Washington State? Each county has a Health Department that strives to standardize PH services for all citizens. These standards are summarized 1- 7 below; all Health Departments strive to provide this infrastructure for our communities in a measurable way. (www.doh.wa.gov//phip) 1)Provide accurate community health data and assessment by analyzing many data points • Analyze and understand Jefferson County's unique health problems • Design programs that address our health problems 2)Communications to Public and Key stakeholders in every program, service and event • Communicate with community and policy makers to address issues collaboratively • Maintain focus on prevention 3) Monitoring Public Health threats • Track all county childhood immunization rates; disease outbreaks, pollution identification and correction actions throughout county ; food safety • Protect surface water quality and protect public from waterborne illness 4) Responding to Public Health emergencies • On call 24/7 to all medical providers, 911, and law enforcement for any Public Health issues or emergency • Preparing for H1N1 and West Nile possibilities now • 5) Disease prevention and health education • Services: identify,track, stop spread of communicable diseases • Stop the spread of inter-generations family violence • Work with physicians, hospital,assisted living facilities and long term care centers, schools, daycares,treatment centers,jail,veterinarians and restaurants to stop the spread of diseases • • Ensures onsite sewage systems are designed, installed,operated and maintained properly and that failing systems are quickly and properly repaired • Properly manage solid and hazardous wastes,promote pollution prevention • Prevent infant mortality,obesity, and improve healthy pregnancy outcomes via nutrition education, 6)Addressing gaps in critical health services • Health care access and disparity improves if JCPH provides services as provider of last resort: foot care for seniors; immunizations for children and adults; family planning for low income citizens; and school based services for low income families; STD treatment and HIV testing • Parent child health improving the health of families,pregnant women, infants and children by offering time critical, measured Best Practice programs that save$3 to public for every$1 invested(law and justice, schools,courts, Medicaid). • Meetings with community providers to make local health access plan, continue to meet with hospital, community members and other agencies to improve access to healthcare. 7)Efficient, professional workforce and financial systems • PH funds are public monies;the responsible stewardship of these funds is expected. Local citizens can view the community indicators and performance measures of JCPH work as we try to improve indicators,all are tied to JCPH yearly budget. www.jeffersoncountypublichealth.org • JCPH program budgets are a combination of funds from several sources braided together to provide services. (See 2009 Community Health division funding sources). It is an unfortunate funding structure with reliance on County general fund as the responsible provider, per RCW. • So What Does Public Health Do? Essential programs to improve Information that works provides Protecting the public every day health educational and training by providing services that ensure and help individuals and programs to individuals and individual and community health communities stay healthy. communities so they can utilize it and safety. to make good decisions. • Immunizations • Drinking water monitoring • Communicable disease prevention • Disease prevention information • water quality monitoring • Family planning • Family violence prevention • Septic system inspections • WIC Nutrition program • Community health trends • Restaurant inspections • Family support programs (tobacco use,substance abuse • Hazardous waste control patterns...) • Disease prevention • State-wide health and safety • Emergency planning information Submitted by Jean Baldwin • 08/12/08 Appendix 1: • The Royers Group (TRG) reviewed the Jefferson County Public Health annual operating budgets for the six years of 2003 - 2008. Between 2003 and 2008, the department's expenditure budget has increased from $3,277,217 to $4,016,149, an increase of 22% over 6 years or on average, 3.7% per year. However, it is important to note that between the years 2003 and 2005, the budget decreased each year, and it wasn't until 2007 that the budget was equal to or greater than in 2003. The budget increases for 2007 and 2008 are driven primarily by an increase in salaries and benefits consistent with the County's wage structure. Jefferson County Public Health Budget 2003 - 2008 Actuals 2003 2004 2005 2006 2007 Expenditures $3,277,217 $2,993,882 $2,876,719 $3,190,127 $3,585,634 Revenues $3,083,360 $3,044,273 $2,872,692 $3,316,716 $3,381,949 * Because the Actual Expenditures & Revenues are not available for 2008, the 2008 Approved Budget numbers are used. It is noted that in several years the Actual Revenues were less than the Actual Expenditures. In these years, the Fund Balance in the Public Health Fund was carried forward and used to cover this gap, resulting in a year-end balanced budget. Historically Local Tax Support During these same six years, the contribution to public health from Jefferson County's • General Fund steadily increased until 2008 when it significantly declined to below the 2003 level. Between 2003 and 2006 the GF contribution increased from $ 473,646 to $625,467, then leveled off in 2007 and dropped significantly in 2008 to its lowest level since 2004. This reduction raises serious questions for Public Health's 2008 budget, given that their approved expenditures exceed approved revenues by $293,428 and represents a significant drawdown on the Public Health Fund's fund balance. (CGF did make a fund transfer in the third quarter of 2008.) In addition to the County General Fund contributions to Public Health, the City of Port Townsend has contributed liquor tax revenues to support public Health's Substance Abuse Prevention Program. These revenues remained flat at $28,340 annually between 2003 and 2006, and increased to $34,921 in 2007 and 2008. For 2008, the City's contribution of liquor sales taxes represents less than 1% of the total revenues for Jefferson County Public Health and is categorically restricted for use in the Substance Abuse Program. While it is clear in state statute that local funding support for public health rests primarily with the county government, the most financially successful local health jurisdictions receive funding support from the cities as well. It is clear from TRG's interviews that at this time, the City of Port Townsend feels little obligation to provide anything more than the liquor tax revenues to public health. Finally, the fund balance of the Public Health Fund was reviewed. The annual beginning fund balance has consistently declined from $715,251 in 2003 to $449,050 in 2008. This trend is further exacerbated by a revenue vs. expenditure gap of $292,428 in the adopted 2008 Public Health Budget. If no additional revenues are provided to Public Health in 2008, and/or if no budgeted expenditure reductions are taken, the • Public Health Fund would end the year with an unhealthy fund balance of only $156,622, less than 4% of their annual budget. Beginning Fund Balance - Jefferson County Public Health Fund 2003 - 2008 0 2003 2004 2005 2006 2007 $ 2008 Fund $ $ $ $ $ 529, 494, 449, 543, Balanc 715,2 492, e 51 793 403 402 729 050 Stakeholder Comments on Financial Feasibility TRG also addressed the financial feasibility issue in our interviews with the key stakeholders. Everyone interviewed felt that the long term financing for public health in Jefferson County is critical, regardless of whether it remains a county department or converts to a health district. Several expressed concerns that if JCPH were to become a district, the County would, over time, reduce its level of financial support to public health. At the same time, others felt that as a health district (and not administratively linked to the County), JCPH would have a greater likelihood of securing additional funding support and/or financial partnerships from the City of Port Townsend and Jefferson Healthcare. Again, this was seen more as a longer term possibility than an immediate one. II • • ■ s ■ ■ Co T (' n 7 G) N rD 0-1- = MI E _. n W CD 0) 2 C 2 cu G) 0 (D 013 0-Q ? co = ' aJ < N — C W a) r=-.• f-D O c N N 0) N fp- (I) !Z (D h, N W fD a) nO O O O O O O O G) CD a) O O O O O O O O -1 =O O O O O O O O = Q O O O O O O O O ,-I- -n el N N V h O Dl cn .< 0 N N O 00 VD Q1 00 W (/) Ql U1 V CO00 V1 C1� I!1°'� • 10o M o ,� w ry w o < (D D �O N W V VI W LIDO (n N O = 0 Q° 0 rD _C N 0 �' cn N N �' Z N O W I-, N 00 V CO 1 N cr, Ql O O . Ls) O N O (D L C. O lD 00 ,' i--% V �.1 O N O - ...1 . pV ' Q1 (D C VI6 N W 00 FNJ N << 01 LI) Lu L.0O (D v (D • 0 • s E of Do 1 ai N' ri = f�D CD (70 --h n CD I -' = v 0) (A ni 0) -h fl- T Un C N NJ w -PUi rn co v 0 n) = N (./1 v Q C C O C O O O 0 N CD U'ti 10 O O O O O O O < O O O O O O O CD • n cin = O O O O O O O CD v m N > o l.o g 70 m rD Z > • Pf&:' • , • ' •• •' ' . gifti, c CIg CMINE LolO0 N v N In D =' ,, fr -1 Z • • ■ ■ ■ ■ ■ ■ ■ ■ % m CO ka KCD $ $ / CD f \\ «A / m• u) $ $/ C ° C. ƒ co 2 G at < ® E E E S E E } 7 ] ƒ g C ƒ \ \ \ / ce) ] f a) 9 / 0_ 0_ 0_ rt } 2 R % i o 0 E n' 0 = 2 o » Ln rD e e w w a ƒ r / K 7 0 0 0 0 0 0 0 0 0• 7 \ 0 0 / / \ / \ \ \ k c ul 0 7 ul 7 NJ o Lo 00 a , , w , , . o ; \ cri = f » q ® ¢ ƒ I m Z o - o w w u' » o CD O ' 7 i / , , ' / / $ Z • kL'U ® o w E 2 \ \ m rD r. k 2 11111 0 D / / 2 � 7 ® 1 m \ ' $ q , , _ , , Q o f n » w 'IN / / f ® « �111111' §. T I ' ' /Iv ƒ , oo q , , , 2 \ 11111111 q l o \ $ @ / \ / / , , , , 0 0 , \ / ,-i• \\ III • x 4 • O A t z�x ^' "max O m ---I m Z • O N V TO • O O 03 0 • , • 4,1 ^ ud • Veronica K. Shaw From: Philip Morley Tuesday, August 11, 2009 4:33 PM ,ent:o: All Staff Subject: 2010 Budget Update presentation Dear folks, Yesterday I gave a 2010 Budget Update presentation to the Board of County Commissioners. You can review it by following this link: www.co.jefferson.wa.us/commissioners/2010 Budget Update Presentation 08-10-09rev 1.pdf While we have yet to see the preliminary budgets that individual departments will submit on September 8, I believe it is important to share now what kind of issues we anticipate we may all be facing together. It isn't a rosy picture —the challenges posed to us by the state-imposed structural funding problem, magnified by the current economic downturn, are significant. We will be faced with some difficult choices, yet the services we provide the public are inherently important, and the county staff who are in public service remain a priority, In the coming months I will be working with department directors and elected officials to look for strategies to support our staff and maintain public services, while making sure we are financially sustainable over the next five years and beyond. I think it is important to keep all staff in the loop, and I'll keep you posted on future developments. Philip ehilip Morley Jefferson County Administrator (360)385-9100 pmorley@co.iefferson.wa.us • 1 • 2010 Budget Update Presented August 10, 2009 1 • Budget Issues: • At time of adoptionfive-year of 2 009 budget, five year forecasts showed the need for additional budget reductions in 2010, 2011 and 2012 because General Fund revenues do not keep pace with inflation, mostly due to the 1 % growth limit on property taxes. • 2 • Property Tax 2003-08 compared to 2002 6.000.000 .. • 5.500,000 5.000.000 4.500.000 4.000.000 2002 2003 2004 2005 2006 2007 2008 1%Growth ■Tax from new const 3 . Property Tax 2003-08 compared to 2002 adjusted for CPI 6.000.000 5.500,000 r ;'• , a 4. gp t 5.000.000 4,500,000 4,000,000 2002 2003 2004 2005 2006 2007 2008 ■1%Qrowthw/CPI 'Tax from new const w/CPI 4 • Property Tax 2003-08& population compared to 2002 adjusted for CPI • e,000 000 � ��� �� l � 32.373 t 5500.000 30.373 28,373 5.000.600 28,373 4.500 000 m$ r 24.373 22,373 4,000.000 2002 2003 2004 2005 2006 2007 2008 t%GrowthwiCPI Tax fromnewconstw7CPI +R+ +Population 5 • ■ ` Budget Issues: • But even in low inflation years, the cost for your government to continue existing services increases 4% per year. • That means with a 1c/0 cap on property tax, exclusive of new construction, the buying power of our property tax base shrinks 3% per year. • This is the County's structural funding problem, imposed by Initiative 747 and re-enacted by the State Legislature. • In past years, extraordinary economic growth has masked this structural problem. • This is no longer the case. ID 6 Budget Issues: • • Economic downturn has reduced the 2009 and 2010 revenue outlook from estimates in December 2009. • Sales tax for 2010 is projected to be about 10% lower than in 2006. (This is nominal dollars. Inflation worsens the problem.) 7 • • GENERAL FUND BASIC SALES TAX $2.750,000 $2,500,000 w Z $2,250,000 - w Ili $2,000.000 ar $1,750,000 $1,500,000 $1,250,000 A1 _c1s-�Cg, gh 00 4, 4* 99 00 O, Z' 0 Da Oy , G ryp`O 9 ry0 0 ' T 'tiT YEARS es' -+-SALES TAX AMOUNT 8 i • HISTORY OF Real Estate Excise Tax $1,600,000 $1,400,000 $1,200,000 $1,000,000 $800,000 $600,000 $400,000 $200,000 $0 2000 2001 200 2003 200 2006 .006 200 Zp0$ ZOOg�s1 201051 BEET.. 9 • :j .:. Budget Issues: ■ Counties provide both mandated and non-mandated services. • Mandated services include: G Superior & District Courts, Juvenile Probation El Sheriff, Prosecutor & Public Defense E Assessor, Elections, Recording, Treasurer, Legislative & Executive o Planning, Zoning & Building Code • Etc. • Non-mandated, discretionary services include: © Youth Services • WSU Cooperative Extension • Solid Waste Transfer/Disposal ® Parks and Recreation • Animal Control • 10 Non-mandated Services Are Being Squeezed $20.000.000 --_-— $18 000,000 _- $16.000.000 -. 514.000.000 512.000.000 510.003.000 $8.000.000 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Mandated Services O N on mandated Sen.ices —f-Revenues 11 • ° • 2009 Recap : • In December 2008, significant budget reductions from the Preliminary 2009 budget were necessary to balance the Adopted 2009 Budget against revenues. • Future years would also require reductions because of the structural funding issue we face. • We also established a plan to use excess fund reserves in 2009, 2010 and 2011 to cushion the impacts of the current recession. 12 • ■ 4ti 5 GENERAL FUND REVENUES & EXPENDITURES 2004 through 2014 $19,000,000 Presented 12(08 $18,000,000 $17,000,000 $16,000,000 $15,000,000 All01011` $14,000,000 $13,000,000 $12,000,000 $11,000,000 \tee `� ' \ti400 \roc' a��m `�Op� ��o ti�� d^� tie c") Tr VS' oNJa �G`Q Jbq �4`ea gea eG`ea a°`e ea P P o� 0 o� QEo� Q�o� Q�o� Q�o� Revenues-1.5%increase 2010&2011 Expenditures-wt$35DK cuts 2010-2012 Expeditures-no cuts,4%increase 13 • ■ 2009 Recap continued: ■ Permit fees to the Department Community Development were down significantly. DCD experienced staff layoffs, a 10% reduction in hours for remaining staff, and a 4-day work week, beginning last December, and continuing throughout this year. Because permit activity continues to slump, on August 1 of we laid off three additional talented staff members and pledged an additional $125,000 in General Funds to support remaining DCD staff. ■ In April the continuing economic recession required us to reduce revenue projections for this year by $1 million in the General Fund. ■ Budget reductions were identified for all departments in the General Fund. • 14 ■ t 2010 Budget Issues: 0 • Many of the budget reductions for 2009 were temporary or one-time solutions to enable the County to do a more thorough collaborative evaluation of programs and services during the 2010 Budget process. • Revenues from Real Estate Excise tax and Sales tax have continued to show decreasing revenue in 2009 and 2010. ■ An on-going extraordinary criminal case in Jefferson County may further impact the General Fund in the future. 15 Proposed 2010 Strategy: • For the preliminary budget, General Fund departments are requested to put together their 2010 budget with current staffing levels, and no increases in supplies, services and other charges from 2009. • When Preliminary Budget requests are available on September 23, the revenue shortfall will be determined and a General Fund reduction target identified. ■ Preliminary estimates show revenues in 2010 about equal to projected 2009. ■ Meetings with Department Heads and Elected Officials in September and October to begin collaborative approach to meeting the reduction target. 16 Proposed 2010 Strategy Continued: • ■ Use a similar strategy in 2010 as in 2009, filling part of the revenue gap caused by the economic downturn by drawing down excess fund balances in 2010 and 2011 . ® Implement a five year plan to bring the General Fund revenues and expenditures into balance, and rebuild our fund balance over that term. ▪ An initial analysis suggests the County will need to make $550,000 of additional permanent program reductions each year in 2010, 2011 , and 2012. Smaller cuts will also be necessary in 2013 and 2014. 17 • • M, GENERAL FUND REVENUES 8, EXPENDITURES 2004 through 2014 $19,000 000 - Presented 12!08 $18,000,000 $17,000.000 $16.000.000 $15,000.000 $14.000.000 $13,000,000 $12,000,000 $11,000.000 ° ° `19 19 e1 ti© ago 19 '>19 19 a10 P P e P QcoN 0 QcoN Qco. e Quo, Qcol • +ani.Revenues-1 5% increase 2010&2011 Expenditures-w!$350K cuts 2010-2012 Expeditures-no cuts,4%increase 18 ■ • GENERAL FUND REVENUES & EXPENDITURES 2004through 2014 $19,000,000 Preliminary Update August 10, 2009 $18,000,000 $17,000.000 ---- $16,000,000 ..011111 rte, •�� $15,000,000l1.1.11"r $14.000,000 $13,000,000 $12,000,000 - $11,000,000 05 oe o� �o �`� � �a rt. �o a��� a��� ado ago ago ago ago ago �tio ViJ 4\J 4`J G`J 4tiJ �,1e 6\0 C,�� Gte `0 G\ - P p- 7- Q ode ore ose o\e o\e ore Qt Qt Qt Q Qt Q� Expenditures-wf cuts 2010-2012 Expeditures-no cuts,4%increase Revenues-2009 prelim projection 19 ■ • Proposed 2010 Strategy Continued: • To achieve permanent General Fund expenditure reductions of $550,000 in each of the next 3 years, we must: Look for dedicated funding to sustain valuable services, and move them out of the General Fund. Continue to pursue grants, fees and other revenues to services within the General Fund. Take a deeper look at non-mandated services and programs P" Take a deeper look at the level of service for mandated County services Determine which of these programs and levels of service the County can no longer afford to provide. 20 • ■ Impacts of Strategy • ■ Discretionary programs provided by the County such as Parks and Recreation will be severely impacted. ■ General fund balances of $3.3 Million at the beginning of 2008 will be reduced to $1 .8 million by the end of 2010, 1 .5 million of that is a required reserve. 21 • ■ Impacts Continued: • Jefferson County's Parks & Recreation Division operates 19 parks in East Jefferson County, and maintains grounds for the County and school districts. • While not a mandated County service, parks are integral to our quality of life. County parks are used by soccer, softball and other sports leagues for youth, adults and seniors. ■ Families picnic, hike, swim and make memories in County parks. ■ Parks are our community's living room. They are some of the few non-commercial public spaces where people can gather, enjoy nature, and create the ties of community. • 22 Jefferson Counts Parks a.aPa ti I cas,u.r.a r �my�»arca � 23 :arc .11.1111111.1.1111111b • m pacts Continued: • Parks & Rec also runs a range of recreation programs for our citizens, including: Pre-school programs for tots and after-school programs for kids; 0 Summer day camp & outdoor adventure camp ▪ Skyhawks baseball, soccer & basketball O Children's hiking program O Soccer & softball programs for youth and adults • Yoga, pilates, Sr. exercise classes 24 • Impacts Continued: • ■ Parks & Rec's Original 2009 Budget is $539,546. • 81% ($435,827) is a transfer from the General Fund & another 2% ($12,873) is from Parks fund balance. 2009 Parks & Rec Budget Fund Balance $12 373 Rents 24% Rec Fees $44,3461 $46 000 8.3% ./— 8.5% General Fund $435.827 80.8% 25 Impacts Continued: ■ As valuable as our parks are, they are not a mandated County service, and this level of subsidy is no longer sustainable. • As part of mid-year 2009 adjustments planned last April, the County has had to reduce the General Fund transfer to Parks by 17%, requiring the Parks budget to contract. • In 2010, in order to find $550,000 in expenditure reductions, the General Fund will be hard pressed to match even the reduced 2009 transfer to Parks next year. • 26 Impacts Continued: • • Accordingly, I have asked Public Works director Frank Gifford and Parks manager Matt Tyler to propose in one month's time 2009 reductions to Parks' program costs & maintenance costs. • This may impact maintenance and operations of as many as half our facilities in 2009, including closing some parks if necessary. . - , •— MO • — u — . —• a� • I have also asked for deeper reduction recommendations for 2010 and beyond, potentially affecting the maintenance and operations of a majority of our parks facilities. 27 • Impacts Continued: ■ The cutbacks we will make to our valuable Parks and our Recreation programs are painful, and necessary. • These are just the first of many difficult decisions we will need to make to address the state's structural funding gap for county services. 28 • Impacts Continued: • If Initiative 1033 passes this fall, these choices will become even harder. • 1-1033 would index County revenues to 2009 levels, a year when a historic economic recession has dramatically restricted revenues. Any revenue above that index would lower property tax revenues the next year. • Recall that sales tax revenues are 10% lower in 2009 than in 2006, without even accounting for inflation. 1-1033 will not allow us to catch up as the economy and sales taxes recover. • 1-1033 also does not allow citizens to preserve services by shifting services out of the General Fund with new dedicated revenues, without reducing the General Fund by an equal amount, thereby penalizing remaining services there. 29 • • Next Steps: • The Board of County Commissioners adopted Resolution No. 44-09 on July 27, establishing guidelines for submitting preliminary departmental budget requests and subsequently balancing the budget. • Auditor Donna Eldridge sent out the 2010 budget call to all Electeds and Directors last week. She and her staff will assemble the Preliminary Budget. • Once this is available, Anne Sears and I will work with Treasurer Judi Morris and Assessor Jack Westerman to update the County's 2010 revenue forecast, compare it with the Preliminary Budget request, and true up our $550,000 General Fund reduction target. 30 Next Steps: • • We will also prepare a projection of revenues if Initiative 1033 passes this November, and prepare a contingency target for additional budget cuts that would be necessary. • We will hold meetings with Department Heads and Elected Officials in September and October to review potential balancing strategies and to begin a collaborative approach to meet the two reduction targets. • After that I will recommend a balanced budget to the Board of County Commissioners. • The Board of County Commissioners will hold a public hearing on Monday, December 7, 2009, and will adopt the budget before the end of the year. 31 • i - End - 32 • • Board of Health Media Report 1 .august 20, 2009 r • Jefferson County Public Health Jul /Au • ust 2009 NEWS ARTICLES 1. "Three Jefferson stores caught selling to minors," Peninsula Daily News, July 10th 2009. 2. "Toxic algae keep some lakes closed," Peninsula Daily News, July 13th, 2009. 3. "Three county retailers sell tobacco to minors," Port Townsend Leader, July 15th, 2009. 4. "Swine flu may return in fall," Port Townsend Leader, July 15th, 2009. 5. "County lays off 3 more," Peninsula Daily News, July 19th, 2009. 6. "Gibbs Lake toxicity show slight improvement," Peninsula Daily News, July 19th, 2009. 7. "Algae declines at Gibbs Lake," Port Townsend Leader, July 22nd, 2009. 8. "Three more county employees laid off," Port Townsend Leader, July 22nd, 2009. 9. "Public Health facing uncertain future," Port Townsend Leader, July 22nd, 2009. 10. "County keeps eye on flu," Peninsula Daily News, July 23rd, 2009. 11. "Water debate returns," Peninsula Daily News, July 28th, 2009. 12. "Parcel fee back on agenda," Port Townsend Leader, July 29th, 2009. 13. "Jefferson lake status unchanged," Peninsula Daily News, August 3'd, 2009. 14. "Think ahead for back-to-school immunizations," Port Townsend Leader, August 5th ill 2009. 15. "Immunizations available at clinics," Peninsula Daily News, August 6th, 2009. 16. "West Nile virus crosses Hood Canal," Peninsula Daily News, August 9th, 2009. 17. "Anderson Lake algae `won't stop'," Peninsula Daily News, August 9th, 2009. 18. "Jefferson OKs fee for clean-water district," Peninsula Daily News, August 11th, 2009. 19. "Parts of Mystery Bay closed to commercial shellfishing," Port Townsend Leader, August 12th, 2009. 20. "Drastic budget slashing possible," Port Townsend Leader, August 12th, 2009. 21. "$5 parcel fee OK'd by county," Port Townsend Leader, August 12th, 2009. Three Jefferson oes� cauht g � ' sellingto imin ors • PENINSULA DAILY NEWS that the emphasis on tobacco retailer education • PORT TOWNSEN and compliance'Checks:has Of'the-,49 tobacco retailers increased in 200a compliance chec A-F epm- "We have stepped up the pleted in Jefferson .County education that retailers so far in 2009,three stores receive about youth access sold to minors,the Jefferson laws and correctly reading County Tobacco Prevention IDs,and we are performing • and Control Program coor- more compliance checks," dinator said. Obermeyer said. The three were .The "Our goal is for all retail- • Lighthouse . Cafe and ers to ask for ID,check the Smoker Friendly, both in age on the ID and then Port Townsend, and Penin- refuse to sellob tobacco prod- 18 sula Food Store in Quilcene, ucts •to anyone said Karen Obermeyer in a years p1d." , prepared statement. Since implementation of the.state's comprehensive • Increased checks- Tobacco Prevention and Control Program in 1999, "These retailers ,will youth cigarette smoking in receive increased education the state has declined dra- and;'.,;further 'compliance ;matically,with some 65,000 • checks throughout the corn- fewer children smoking, ing year,"she said., , Obermeyer- said. Youth'operativeS,used'in Of the.students who took the controlled checks were the Healthy Youth Survey 16 years old,and used offi- in Jefferson County in 200 cial state identification,she '14 percent of' 10th-graders said. and 22 percent of 12th-grad- It's illegal to sell or give ers reported they currently tobacco to people younger smoke, compared with 14 than 18. percent and 20 percent, The Synar Amendment, respectively,statewide. a federal law,requires all 50 For additional informa- states to.,conduct random, tion about tobacco preven- compliance checks with :.tion effortsinOJefferso r tobacco retailers each year, County, phone Obermeyer said, adding at 360-385-9400. • • /),0/1// 7/x/9 Toxic Lakes: Algae• keepsome can be lethal CONTINUED FROM Al algae bloom. lakes Anderson Sandy Shore from Lake, which the countyty Lake, also between Port Hadlock and taking water samples for Chimacum, was closed weekly lab testing,remains April 25,when fishing sea- clear. son opened. Lake Leland, So do Crocker,Teal and Swimming "Anderson has still north of Quilcene,was also Tarboo lakes. consistently been closed to swimming and Still prohibited fishing in mid-May. Nutrient studies undergoing a pretty major Both lakes continue to algal bloom. I want another have high levels of toxic The health department by officials blooms: this year,also is collecting week's worth of data before Bhie-green algae of the samples for nutrient anal- I make any changes." genera anabaettA'' `and Yses and physical data to BY JEFF CHEW NEIL HARRINGTON microcystis have the determine possible causes PENINSULA DAILY NEWS water quality manager, potential to produce toxins for the blue-green algae PORT TOWNSEND The Jefferson County Health Department that affect the liver and blooms in county lakes. status of Jefferson County's nervous system. The study is funded by Anderson, Gibbs and Leland Jefferson County Pub- a grant from the state lakes remains bleak since toxic .see two weeks of safe,lower toxin lic Health is continuing Department of Ecology. blue-green algae keeps them levels before upgrading any of seasonal sampling of rec Water samples are closed to swimming and fishing.. the lakes from their existing reational lakes for toxic taken from the lakes on Anderson Lake,like last sum- health "warning" status that blue-green algae. KinMondays and tested at • mer, has shifted.in its primary closes them to recreation. The public health g County Environmen toxic makeup from anabaena, a Recreation in Anderson Lake department has been col- tal Labs, Jepotentially deadly neurotoxin, to State andhorsebackrk—such s hi ns sik-till lecting and submitting Healtersomain man intains Publicn mycrosystin, said Neil Har- g g water quality/algae sam- rington; county water quality allowed —while Anderson Lake pies from Lake Leland, updated database of lake itself is closed to recreation. Anderson Lake and Gibbs manager for the Jefferson County m0mto g information at Gibbs Lake and Lake Leland Lake to determine what www.jeffersoncountypublic Public Health Department. remain closed to swimmingwhile health.org. Anderson has still consis- species of algae are pres The department tentlybeen undergoing a prettyother recreational activities, ent and at what concentra- can be g g including catch-and-release fish- tion since 2006, reached at 360-385 9400. major algal bloom," Harrington ing, are allowed, public health Lake samples are not said Fridayafter receivingresults Anderson Lake, off officials said. tested in Clallam County, from weekly tests of water sam- Anderson Lake Road, was where health officers visu- No one should drink water or closed in June 2006 after pies. eat fish from Anderson Gibbs or ally monitor lakes for signs "I want another week 's worth Leland lakes, the health depart- two dogs were killed from of algae bloom.No cautions P ingesting the water and or warnings have been of data before .1 make any ment said. changes." one nearly died after expe- issued in Clallam County. Harrington has said he must TURN TO LAxEs/A6 riencing a seizure. Algae blooms in Clallam Because of the risk of County lakes should be exposure to the toxin, reported to Clallam County Washington State Parks, Department of Health and which manages Anderson Human Services environ- Lake State Park, has con- mental health division at suited with county Public 360-417-2258. Health to keep the lake in the state park closed to recreation. Port Townsend-Jefferson Other local lakes are County Editor Jeff Chew can be reached at 360-385-2335 or at sampled if they appear to jeff.chew@peninsuladailynews. be undergoing a blue-green corn. •• • • 7/.9/� Three county . retailers sell tobacco to minors Of the 49 compliancechecks graders reported they smoked, of tobacco retailers completed in compared to 14 percent and 20 Jefferson County to date in 2009, percent,respectively,statewide. three sold to minors. Still,45 children in Washington The Lighthouse Café,Smoker start using tobacco every day,and Friendly and Peninsula Foods one-third of them will eventually were reported to have sold tobac- die from it,according to Jefferson co to minors.It is illegal to sell or County Public Health data. Kids give tobacco to people younger get their cigarettes from a variety than 18. Youth operatives used in of sources,including friends,fam- these controlled checks were 16 ily and some stores. Curbing the years old, and they used official supply of tobacco sold to youths state identification. from stores is the aim of the local Those businesses cited will Tobacco Prevention and Control receive increased education Program. and further compliance checks "Our goal is for all retailers throughout the coming year, to ask for ID, check the age on noted Karen Obermeyer of the ID and then refuse to sell the Jefferson County Tobacco tobacco products to anyone under Prevention and Control Program. 18 years old,"Obermeyer said. Since implementation of the Tobacco use is the leading • state's comprehensive Tobacco cause of preventable death in the Prevention and Control Program, United States. One in five of all youth cigarette smoking has deaths are caused by tobacco use. . declined dramatically since 1999. Ninety percent of all adult smok- The overall decrease translates ers begin while in their teens, to about 65,000 fewer Washington or earlier, and two-thirds become children smoking. regular,daily smokers before they Of the students who took the reach age 19. •Healthy Youth Survey in Jefferson For more information about County in 2008,14 percent of 10th- tobacco prevention,call Jefferson graders and 22 percent of 12th- County Public.Health,.385-9400. Swine flu may return in all By Allison Arthur of The Leader are for different groups," • �' > '' :4104.x �� t �� "" Locke said. ,` r :� 1 14:WP Health officials still are The media spotlight e.x i 1 t has moved on from the ,gin ', '' i^�* i ` t in the process of watching swine flu outbreak,but that '•'''..4-1041,-:',g 1 s how swine flu progresses, doesn't mean we've heard u �� 'd fir; `� 1h' It .` and monitoring whom it f f,, m acts most seriously. the last of it. �"`" :z ,, a`"i;`r 0 P y' ikli Swine flu has been 'i'b, ri,,rt"z f�° "We need to continue declared a pandemic by the �d x x tr$t4 za ,• to do this surveillance. We World Health Organization, , s r '-":.','-',4.• + simply don't know enough ] about this class of virus yet and some say it could r. s �,, r make a comeback this fall. PX*".-W. " k >I to know what its probability There's even a chance it ' "� of becoming more serious �z, "° ; 1 4 x� ` is.That effort is under way," might mutate and become s ,,; ,, •i ',N..0.1.,,,,,'..710 E more virulent. So what rx z a Loose said. � �`��-.� � Locke also predicted that should we do in Jefferson x E, Countyto avoid it? ..,,,.• " ,;1:444'9;',11there would be a vaccine :i? C developed for the swine flu. Short of locking your- v And there likely will be two ,L-self in a closet for the win- ,I.'-ill,:, , ter and avoiding all human doses of vaccine given four contact, there are simple l weeks apart,he said. precautions to take to avoid ' The federal government -� yah spends millions of dollars anyvariation of the flu, i, ';',„11'7,4;', 4;f::-'4 ^y e to develop such vaccines, says Dr.Tom Locke,public t but there probably won't be health director for Jefferson and Clallam counties. i a :„ • enough for everyone.There "We have to be serious k „ ,"''� -'. were reports in mid June that schoolchildren could about influenza prevention. v„tr �P end up getting vaccinated It is preventable,but people `,. i ' P P ugr v, first,when school opens in get blasé,”said Locke. s a f': ipkv the fall. "Doing something so ��`'w r�,vKf; Much depends on what basic that people think it ��, � f P P x 1 officials learn this summer. would hardly work is actu- Ia toof kr ' What also is known is • ally effective," he said ��� x: „ _ ;s% " paying attention to wash- that the swine flu is hard on ing your hands, practicing Dr.Tom Locke,public health officer for Jefferson and Clallam counties,says he practices what he preaches and not only uses pregnant-women. Several what officials call "respi- tissues but recently was shown on a local television program getting aflu shot.Healso uses amask when engaged inhishobby, women have developed woodworking.Photo by Allison Arthur complications, includ- ratory etiquette" - cover- ing spontaneous abortions, ing your mouth when you Less than a week later, it They'll get the flu first. preview of what will hap- according to a WHO report cough-and simply staying was. "That's going to be a pen here and what the risks on the website who.int. home when ill. a The county's top health "For simplicity's sake, ik "There's a lot of room official noted that Jefferson, / / anyone who is pregnant or i for improvement in terms Clallam and Kitsap coun- Respratory etiquette likely to be pregnant is a of hand washing and people ties were braced for activat- high-priority candidate,and takinthe social responsi- high-priority candidate,and P ing emergency protocols for Health officials urge people to follow"respiratory etiquette:' priorities [for who would bility of staying home if swine flu in early May, but •If coughing or sneezing,cover your mouth with a tissue and toss the tis- get the vaccine] would you are sick. We don't do they backed off that response sue in the garbage. likely be set at a national nearly enough of that. You because the swine flu seen •Hand washing is encouraged.Washing in warm water is best,but level,"Locke said.The fur- recover faster as an individ- now seems comparable to the washing in cold water is better than not washing at all.Alcohol-based hand ther along a woman is in her ual and you won't expose seasonable flu in terms of its sanitizers work well. pregnancy,the more impor- your coworkers or fellow impact on people. •If you are sick,you should stay home,call your physician,and wear a tant it would be for her to students." But if you want to know mask when going out in public. get the anti-viral treatment, In early June,Locke pre- what to expect come fall, Symptoms of the flu include cough,fever,sore throat,malaise and head- he noted. dieted that swine flu-known Locke says to pay atten- ache.Gastrointestinalsymptoms(nausea,vomiting and/or diarrhea)have The H1N1 virus is dif- officially as H1N1 -would tion this summer to what's occurred in up to 38 percent of outpatients in the United States,according to ferent from regular influ- likely be deemed a pandem- happening in the Southern the World Health Organization. enza, and so vulnerable ic, essentially an epidemic Hemisphere: New Zealand, Fact sheets about the swine flu,in several languages,are available at the that is widespread. Australia and Argentina. health department at 615 Sheridan St.is Port Townsend. See VIRUS,Page 15V The Port Townsend&Jefferson County Leader WEDNESDAY,JULY 15,2009'HEALTH&WELLNESS 12 • VIRUS: All-hands-on-deck aroach ,. :,..,..,,,,,,,,,•--• ®Continued from page 12 firmed as having contracted quickly with updates on the f , _ • swine flu. None were swine flu than did the CDCs a . ' a �' ' groups — young people who identified, because of health own website,which often was haven't had the flu, people n" "` privacy laws. All recovered behind in tallying reported with metabolic diseases such without being hospitalized. cases of swine flu by state f A ', as diabetes, pregnant women x and people with immune Locke says an issue of Nevertheless, Locke said ? z concern for him is that local information on swine flu was �" , : '�4 deficiencies — would need health departments like his changing daily,and so the web ! > � �� �;t ` e e to be vaccinated against r both swine flu and the run- are"under resourced."Policy became an important resource , of-the-mill flu that goes makers have decreed that of information,including cdc. 1 -.7,,..-.,,,,', �� ' yet' s money should be put into ov,which offers information 1 4, / '" . around each year,Locke said. g r health care, but that doesn't about everything from swine Av � ,a " t In fact, the seasonal flu necessarily trickle down to flu to teen drivers to surviving ,F r0,, . `� r ,r" t vaccine contains three different health departments and illness cancer to information about , � viruses,Locke noted. prevention,he says. fruits and vegetables. h For those who aren't Fa * 1 '- Even bigger health The Centers for Disease a*k.4� � ..4, ",q, vaccinated and become ill, organizations have been Control website and the county ** ..',,,''' the county has a stockpile of hampered because of lack of health department website—at '' 1,000 doses of flu treatment, g f r r� funding, he said. When the jeffersoncountypublichealth.org W y� "= -:' mo : but they would be used only Centers for Disease Control — will keep people informed for people seriously ill,Locke (CDC)was hit with the swine Locke said. said. s flu earlier this year,"they had 4" Ae Fig, ;d 41 , As of mid June, only one only a few hundred people and "' PAST PANDEMICS r " u� �� �l4r, _ young woman from Port theyget spread verythin." " t 's` } " a ` p While the seasonal flu does •.`:* � Townsend and two people That could explain why claim some lives each year, "';` v r from Clallam had been con- pastpandemicsA F news reports came out more have changed a*i: ' �s4r N ' Up close and personal,this is what N1N1,better known as swine flu,looks like. Photo courtesy of Dr.Tom Locke world history,Locke said. virus, in its current stage, is "If you are facing a replay relatively mild. There have of the 1918 epidemic, you'd been deaths,but they are very take an all-hands-on-deck rare and less than we see with approach. In the United seasonal influenza." States, 500,000 people died Still, hospitalizations with • and the population back then the swine flu are higher. was d , , pof people they estimated100million.50 Worlmillion wideto are hospitalizedTypically1 ercent because of 70 million died of influenza. seasonal flu. Nationally, with It virtually stopped World swine flu "it's running about War I,"he said. 4 percent of confirmed cases "A replay of that in and in Washington as of June 2009 would kill 1.5 million it was 6 percent." Americans. It's staggering. So what to do about it That would change history." when it rebounds this fall? The initial medical data on Locke says the simple,old- swine flu "was looking real- fashioned and easy precau- ly bad," Locke said of why tions actually work. health officials first started So wash your hands.Cover sounding an alarm when they your mouth when you cough. were seeing death rates of 2 And please, says Locke, to percent in Mexico. prevent the spread of the flu, "Almost everything we've stay home if you're sick and learned so far is that this keep the kids home,too. • County ..• lays off • Layoffs: Cuts last year 3 moreafternoon meetings. CONTINUED FROM Al "We will try to look at Sullivan and Scalf cited During budget cuts last things and decide how critical planning work that ear, CommunityDevelop- must continue under a Revenue from ywe can continue with much thinner DCD staff. ment hours were cut to four a high standard of Work still must focus on building permits daysuba week,endingshours and the shoreline master pro- . public business and service." gram, the yearly compre- short S250,000 amounting to 10 percent pay AL SCALF hensive plan amendments. cuts to staff,including Scalf. director,Department of• which includes the airport With the latest revenue Community Development essential public facilities BY JEFF CHEW ' losses,Scalf said it would be PENINSULA DAILY NEWS a period of re-examination zoning proposal for the Port county's general fund this of PortTownsend's proposed for his department, which year and next. "eco" industrial and busi- ing — With build- issues county building per- y "DCD (Department of Hess park,an small site for $2 permit revenues running about mite, conducts building Community Development], environmentally focused $250,000 short of projections during the inspections and manages• which is already cut businesses and the creation harsh recession of 2009,three more Jef- land-use matters. of greenjobs at port's • Person County Department of Commu- We will try to look at expenses $140,000 below Jernsty the pora- • nit Development employees have been their budget,is able to cut tions)Airport. • y p P things and decide how we another $50,000, leaving laid off,effective Aug.1. can continue with a hi h Sullivan said no layoffs An upset Al Scalf, standard of service," Scalf $75,000 to find from staff were being considers in 2,55,..r, M reductions," Morleystates, Department of Com- said. department, • 'k �f" YDevelopment "All areas of community adding that Lorna Delaney, other law county depart and r, N 7 direct confirmed be Board of County Commis- • w" ✓' the clayoffs Friday, affectedm obviouslyent ) from sinners clerk, was working public health being the least d ,,i L` with Scalf and a union saying it reduces his permit review to customer rep- resentative '"r"q r"' department to 11 service to legal backup and "to make sure Decline In homes k .. ''i employees, down just our involvement in we're working correctly i , , with union." Scalf said the biggest P .. ' from 25 staffers in projects overall." "This additional cut is impact on his department • k= * 2008. painful,and is necessary in was being felt through the Scalf havet we'reiotuna to Commissioners advised the face of lagging permit dramatic decline in single- provide to prioritize"and In an e-mail last Monday revenues,"Morley states. family home building. Scalfthe acting can dm nist"atord night to county Commis- Contacted Friday, Sulli- The way Scalf figures it; through, a Wed countyw administrator •sioner Chairman David Wednesday while Administra- van said the revenue story for a $1.9 million annual tor Philip Morley is on vacation. Sullivan, D-Cape George, was still the same with budget he needed$160,000 Morley explained how the sluggish construction in Jef- a WI h $656 000 budgeted The latestc round of layoffs, notifica- tions layoffs decision came about, th in revenues. ferson County and through-in Jef- tions of which were made Wednesday, stating that he proposes to out the recession racked this year for building reve Scalf said, eliminated a permit techni- cian, backfill $125,000 from the nue, Scalf said the reality fi an assistant planner and a plan- naton. duringthis year's first six sin clerk. "It just hasn't turned monts is that only$192,000 g around yet," Sullivan said, in revenue was received. Second wave althougheginisales taxes were "We're down 50 percent: beginning to show minute Scalf said. It is the second wave of layoffs in the signs of recovery. we will revenue-challenged department since Sullivan said he expected be "25"We're projecting o $300.000 we will late last year when six Community he and his fellow Demo- down revenues Development staffers were handed their cratic commissioners, Phil bythe innb building the year.revenues • notices. Johnson of Port Townsend Five other positions went unfilled John Austin of Port Ludlow, after they were vacated last year. would discuss the latest , port Townsend-Jefferson Department of Community County Editor Jeff Chew can be TURN TO LAYOFFS/A4 Development layoffs during reached at 360-385-2335 or at Jeff. their Monday morning and chew@peninsuladailynews.com. • 7 i a) ._,,1 ,z .,44, ts „...7! . g „ 0 ..c_,1 0 o U t M Q ac 0 ), C oG 0w li m) -f .C. o . 'o a a I o z. 0xqG a `c CC in 0 ° r?.0o . vO. q c � � • a) c ` �o oma = 0 as. a ;A o ° , � +, HMSc mw.Or„ "0n q � � F. a) ' _d, • � zU Dd b4 q ti , $ aiCo � U {.a o $ w o Z a75• .5. ° (.)i ° ^a o 'io , {c.) craa0 3 o c 0L :. aa.y w co • `� ° ° vr,� oi a. co° S 3 � � b m ro cc C co C -o• x o R a) .- as�j cn � 3 cts o ° bo a) CCn PQ 0 ..o a) -0 cd,-d ``$ o,-as u„o ani �o MC Z C '0 $ c y c ° , ) x cy F a) a) .x �,ro o a oz 0,..• a) o : ° ca • %lab . cz c v o C EC MN= � � oo ocv $ � a,) . a0u) . w -4 cts Z C p a) yQ3 C , vc C N. 1V .01to° 3(1) w0 ,- bo, ..(I Rs o ��� bob"ens (1) 0 x 0 p° s ® S-, .4(1) g � a� � J Uov�i � 3 0 0 ..= --a."o 0--- o a . o C .cd "L7 73 +; a ,d vi q p- � L to � �� � ap � b_ „ � 9, c� ca x cc,.Q o cz.c ° a cf)'m a,5 a�"i 8p °' 3 3 0 �° h0� � � -gib°° ��N -. Cc. o $ ›.[ n '' `�' Coo• ■_ Q) a)a)• o o C o `� a°°) y a 3 g0 0 TJ 0 Y . b.° CL, v,S cc17°'c� u:n CZ .2 4T 4T 3a 33 s. nA. ti o v5 ro-cs m �, ° ® �w ta) ns � roof ° � V � � p ° CbA0 � 0a 3 �, .� a g x:42 co X ox.- o �43 ' bi). 0 O 4, hb C p c o 7 • °.N • o _ a ° C C a ` wa) o 0aw „, . b) N aaP � o° � 3'CNC1R y ' g . d �bo, int °CU cc -cg a) en = ccv3 `$r0 a)A."0 00 � 3 C bo C7 C v ...i •-. t. .-.5 > ° ° act-- CY Z,0 E 3 ca' s°w, c a ro isiall 4> I •.`..� t"a oao acu , $ v- › � > _ C to c.� cv c C Q, ( �P. ao o y ° o aa�3 aU � o 'w C/1 � c. 32 v) QQw Eo• a) ° n '- cc ; Jflil1 -U • Uq S0 1.12CEt En II 0w(1111 a>y Algae declines at Gibbs Lake Concentrations of blue-green back riding and biking,is allowed if they appear to be undergoing a algae in Gibbs Lake have declined at Anderson Lake State Park. blue-green algae bloom. and now warrant a caution rath- Since 2006, Jefferson County This year JCPH is also collect- er than a warning to the public, Public Health has been collect- ing samples for nutrient analyses Jefferson County Public Health ing and submitting water quality/ and physical data to determine announced Monday. algae samples from Lake Leland, possible causes for these blue- The lake now is open to swim- Anderson Lake,Sandy Shore and green algae blooms.This study is ming, boating and catch-and- Gibbs Lake to determine what funded by a grant from the state release fishing. species of algae are present,and at Department of Ecology. The health department is what concentration they are pres- For updates, go to jefferson continuing seasonal sampling of ent.Other local lakes are sampled countypublichealth.org. , recreational lakes for toxic blue- green algae. JCPH now cautions the public " to avoid drinking lake water and • avoid any visible algal scUms on Gibbs Lake. Lake Leland continues to have a bloom of the genera Microcystis and Anabaena,which can produce • liver and nerve toxins.The public is advised to avoid drinking lake water, not to swim in the lake, avoid visible algal scums and not eat fish from Lake Leland. Anderson Lake continues to have a major bloom made up pre- dominately of blue-green algae of the genera Microcystis,Anabaena and Lyngbia. These algae can produce a variety of nerve and liver toxins. Because of the risk • of exposure to toxins and the history of toxic algae blooms in Anderson Lake, the Washington State Parks, in consultation with JCPH,will keep the lake closed to recreation. ' Other non-lake-orientated rec- reation, such as hiking, horse-, • • • I . * 41.e' V .N-. - �7iY �.:• y 0 >`TJ.6 v N O. �.� OL O G 1. f j $� co,5 °••N . vCCia0va' c" u � f'% m r • r.A• 2 , s�. 4) vLo4 4)x .6. 8 c v 2 s • �), 7 4 tICa� C v O 2. . 2O YNwC 7 0p'0ct A C X � o r > v L y ]J c N„.\ Cv8. v x'G N C �' C `- `_ ' 3,, y'2acacA.c, •rLi ° •_,. r .v , ' • -0LSvE ° N ' v � y � c :va ' .5 "V .nc02 o0" ° ° 4) yvcmc >' HI `'o >ili1R1 !1t oflUe I cd 4�' E " . ° ,v tawt,,i Ofd, c 7.5 .7 59 Iv 4.� O CO U 0.� 4)dA f,,-+'. bOsA 'y O . ,, 4) 4) b O ° a ° - o v cva v v; 2 E P:.'-'t '"'. `- 50 == o- E>, G o 'S •d•v E o E 8 c �./ •0 55 E .0 v '2 U .D 4) N w C ° c `o c d L d Ao c mP,ka N Odo N V d � > q°p o 3 cA u v aw � 2 4)V .x > a>i .1,4 u cvy v g k v..J E 50 z' c'i o R c `, y =.d > ',B 4 °) ~Y 5 :� C 4) ,w v CO 3 2.a: a yy,. va C vi cv0 tv..0 a) .7^ 0 CO C C cd C °.5 .4 C rn O 7,_?..i...3 O. a v Cl .A. O.ctl v °'&0 'C' 'D A O^ `cd E U 4) v is .�� a E o `>b0N ` = c4) ° 0-=o. c '4 °.cvoi 9 veo4) � 4) E Lu N iv ›.5.v'S gb4 • •'. oc ›.. toUI WUIDHUHU C,,� 3 t'figp,'y ° 61 1O � GG:� tVtli yy CDCs/> §Avroi .,t3V7 T1 OC["' ;'2.Z''" s ' tr yyQ ti.C(Z.w .C. cE.° 'O 'S E. fNCA E 0. .EU W 2c�� ., 288 °> pv L OO . a' 5. 0." o' �"�J ro -c o 'aa x'Lao ^ 4Ci a..'.',7'. qU .S °� t_•C�_ .w.- O 5v d 4.'n. Lv, fin, . w s• N ctl „O_ C A .w y C Q N O C �i ° v C°I >, >. may. lU ^ C'7 1 tC -0, EO'C� t' id U ., r N N.g rn O' O C :tl -; .. • o ° � a. wmED :' S 0• � nv � . o T � r3 Myovoyuy � o'Cvo ,,,: :.74 °uE C/� iii j14!i C CCCQ� -1-U ° cE w-OOOO 2 •c 3 n, 3 oV ❑AV. �.-+ v . mai/ p v W 0 k g A L'O - '.x '"O P.'J' a)coct _.r 5c aE v ^ eT. L' - 40o0- o °ooh " O °,, ,...cdU' kap 1 ! C o � " c o >. cU E v 0, p "' Q. -0. rnk:N C4.25 c ru > ',ry\ a0 zvN3 c4) Na' ,5m 4-4.--' Q.)� �COti� 8 > aaS� �a `� EC C7vcvi� pwvv3 m 4'� N 0 evo•uo �. .�j °amsv ¢ maw' tW/a � 3 � a ° O � °` a 4)o A .„1-j..0 c..) S 3�w v ... . cNo ac ro w`W c0a o o a x e •-• z .i ,y- 0_V 4) 8'5 .45 ° ).=v� ° ,�''= n A y a 'S 4) p C_ C Gj ° >Q-.O N N O 4)C 6 5' O y„°. O O bo ° .. cC � c o �, c5v °� ° . .t.1.5 v-c.4 o o [ p0�� › EcvcN�c L U o a HHI cEvE : Toro^, �.� ... _, �jJ > > *� a[ ` b Ci 00$ .5 E. 4) . aC2 4) c c `yQ ronro c oy [rt Ho.dh gUE :3 , a4.'v� :v occ° i., .`d L' c x . v v ° o. > v ■ ■ °n .y . Ll e)0 ce eo .v .5 c v _. ° a o ca '73E.- � v 6o a = ° ° o°.?,:� o '000`,.-E bxw°ti. o. o � E c° 22.5 3 ® L1w C oo u� 0.5 � q 4) p . E o .5.g. S3 It q •Soli Wilmi . y -0a oc �X cu ai.�� vv y FA .c a e)0 a 00rc=. o 5oU > n �vG [ o ::=.) .2 � E o3 � co r 5 v.- o aE v ° 4) c 4) . g° ° 4) c c 0 A y e v ti a o u v v c> B c 6:° °o y u c ° 3 4) o a 3 .. o a, v �' C O x ,. , v u •49 4)x.a a u g 0 0 00.o .N o c 'El C o. v.�� a,•• v o r� . ,,,,5 „).. . ,,, p p {t0i CyM.S a '' b C . •'C C °. 2 .+ v C 4)A >1 g 3 C.;b• 'U ,...i 4 v O g q .`J ctl- v 00 6 o uE U > 4E,,S '- �.8 '� � . '' 3 2. 'E t m y Cq ° v�• u' o¢ c-- a� m cv , t5 � ' viva ° x 3w.yN '�d u o ? � v; � - Loommo u a a3 5o N ., c 4) 4)•yC av, 4) a € c v v Cd ryo ❑❑ U t,r2- °:Ci U 4) ›. ^ 0)0 0 '" id 4) tv, -O 6 O C 7 0 Q E-0 4 C x M 2 c'4)d v, N n{r' '6•• '•r7.1 ort O x v G O a 4:1 O 3 C a'n q 0 3 .0 >q U > U v•D.b w 7 -C >,sO �a 3 �' O' •� v O .0 N.. 4, v cn °'cq c a`�,-;q:u `' o•g a°i G y v Er ,'. z �o E o iv7x'o.� .S E 2 °u QE5U� Qr"Q[ E :$ bo 49 �. o "r7 C4 v va) -4, ci v5 eoo liro ° ra °> E. a v ► 8.5 0 3 .:ro �cCoA 8 a.vc ..8 h)0v o � aU� n� S a _. w� E �� Public Health faun uncertain future " By Fred,Obee of The Leader hard to see what the future may that just means pushing costs to Morley added that all the pr � hold. some other department or agency grams have merit and many ma Some public health programs "I have no clue what they will where the costs often are higher. be wise expenditures of taxpayer could be shut down or curtailed if do,"Baldwin said. "And if you dismantle the pro- dollars, but at some point in the revenues continue to decline from The Jefferson County Public gram, it can be difficult to put near future, the county may be state and federal sources. Health Department serves"about back again,"Sullivan said. faced with making difficult choic- That was the message deliv- 8,000 people a year,Baldwin said. `"jhe challenge is to prioritize," es between services that are man- ered recently by Public Health Recipients are single mothers said Commissioner Phil Johnson. dated and those that are not Director Jean-Baldwin to the living in poverty, people seek- Jefferson County Board of .ing family-planning services, Commissioners. new mothers, or people seeking Deciding what will be funded immunizations or a host of other • and what won't is the difficult services. task, Baldwin said, because most Studies have shown many of programs are funded by multiple these services are the biggest revenue streams from federal, bang for the social service buck state and local sources. In some you can get,because governments cases, a federal cut might make avoid more expensive services the program marginal, but to .down the line,Baldwin said. pull the plug entirely also means "But," she added, "times are . declining cash offered by other tough." • sources. So fad this year, said County "This is'not well understood Administrator Philip Morley, by the public,"Baldwin said. the department has managed • So far this year, Public Health a $60,000 decrease in revenues has been able to trim expenses without big service cuts, but the with voluntary furlough days,the expectation is that more cuts elimination of some contractors could be forthcoming. who helped provide services,• If those cuts come, Baldwin and other cost reductions. But said,the question will be:"Do we • the state Department of Social cut whole programs?' and Health Services is offering Commissioner David Sullivan only short contracts as it sorts said he appreciated how the through options for reduced issues are interconnected. The spending, and that's making it county can cut costs here, but i • • . t • County flu • Southern Since it reared its head in Pandemic below equator Hemi - April,the swine flu has infected sphere is more than 90,000 worldwide `a preview,' official says ,: n prettymuch and killed 429,according to the what you'd most recent statistics from the .� ',- •§l.' expect with World Health Organization. BY ROB OLLIKAINEN isn't letting up there. �, a pan- Three cases have been con- PENINSULA DAILY NEWS "We consider that a preview v demic. firmed on the North Olympic of what's going to happen In _, ' A lot of peninsula—two in Sequin'and County health officials are North America," said Dr Tom people are one in Port Townsend.All three keeping'watch on the H1N1 Locke, health officer for Clal- Locke gettingsick. recov- swine flu pandemic. lam and Jefferson counties. Some of suffered mild cases and It's flu season in the South- "What's happening in the them suffer very severe illness ered without hospitalization. ern Hemisphere,and the virus and even death." TURN TO FLU/A4 Flu: Virus hospitalizes 98 across state, kills 4 CONTINUED FROM Al sage from health officials additional research from Health care reform needs has been to cover your vaccine manufacturers,will to address the problem of Across the state, the cough,wash your hands fre- help the government decide uninsured patients and reg- virus has hospitalized 98 quently and stay home whether to offer the vaccine ulate insurance practices to and killed four. when you're sick. in mid-October. end abusive cases of deny- Locke said the virus has An H1N1 vaccine should Olympic Medical Center ing coverage,Locke said. the potential to become become available before the spokeswoman Rhonda "I haven't seen a lot (in more severe as it travels flu season hits, but it's a Curry said the Port Angeles the legislation] that will around the world and question of how much, hospital was not selected to actually achieve those mutates. Locke said.The number of participate in the study. goals,"Locke said. • am It could even become a doses could vary between "It's driven by the "I'm making the case major pandemic like the 4 million and 16 million. National Institute of that this is the first step one experienced in 1918,he "The H1N1 pandemic is Health,"she said. ong many that we need said. unstoppable,and therefore, Health care providers to take." Asked,if the swine flu- all countries would need to like Olympic Medical Cen- Rural areas like the has the.pbtentiai to.'return: have access 'tovaccines," ter, Jefferson Healthcare North Olympic Peninsula to the North Olympic Pen- said Marie-Paul • Kieny, and `lti-ks Community Hos- • face difficult challenges, insula, Locke said: "It's World Health Organization Pital will be on the "front Locke said; like work force inevitable." director on vaccine lines" of the H1N1 pan- recruiting and retaining "We are seeing sporadic research. demic,Locke said. health care workers. cases all around the state, Most people will need He said these hospitals He said all three mem- including the Olympic Pen- two doses, a primer dose face the challenge of put- bers of the Peninsula's con- insula. We are in no way and a booster dose, Locke ting years of planning for a gressional delegation — protected from this. Our said. pandemic into action. Sens.Patty Murray,D-Free- population is too mobile.It The primary target for Interestingly, people land, Maria Cantwell, will definitely be back the vaccine is school-aged born before 1957 seem to D-Mountlake Terrace, and here." children because schools have a degree of immunity Rep.Norm Dicks,D-Belfair Even if the flu strain are a common place for the or resistance to the virus, — are key players in remains a relatively mild virus to spread. Locke said,possibly because national health care policy. one, "it's still going to be a "H1N1 continues to be a of an exposure to an earlier "They re in the thick of huge strain on the health problem in places like sum- strain of the virus. the battle,"Locke said. care system,"Locke said. mer Camps,"Locke said. Meanwhile, Locke dis- On Tuesday, the seven- Health officials this sum- "When you congregate a cussed health care reform member Clallam County mer are working with busi- bunch of kids together, it legislation at a Clallam Board .of Health unani ness leaders and school just takes one case." County League of Women mously approved a resolu- groups to plan for the fall, The National Institute Voters meeting at OMC tion urging the immediate when the virus is expected of Health on Wednesday along with staffers from the passage of comprehensive to rebound. tapped a network of medi- Peninsula's congressional health care reform legisla- "There's a lot more work cal centers around the coup- delegation Wednesday. tion. we have to do,"Locke said. try to begin a series of stud- He said health care "Now is the time to do it. ies for the swine flu vac- reform is needed to repair a Reporter Rob 011ikainen can be broken system. The summertime is just a cine. reached at 360-417-3537 or at rob. respite . . . Slowing down The first shots will be "The only thing we're No. ollikainen @peninsuladailynews. the spread is a keyobjective 1 in is the money we spend," COM. P given to healthy adults in Locke said. of ours." August. "We perform worse than The central public mes- The tests, along with most developed counties in • the world." ' Water Water: Years _ debate of discussions • CONTINUED FROM Al "We spoke about this returns "It would raise$88,000 before. It proved to for the county to keep the programs going," Har- be a difficult rington said. situation, and that's "It would also remove County mulls the general fund from the why we've continued equation." • to fund this out of per-parcel fee The money from the property taxes and general fund is being used of S5 annually to match state grant out of the general money. With the creation fund." • of a district, the grant DAVID SULLIVAN BY ERIK HIDLE money match and pro Jefferson County PENINSULA DAILY NEWS grams monitoring water commissioner health would continue. PORT TOWNSEND — The A clean-water district debate over creating a clean-water would pay for pollution for harvesting shellfish. district is back. prevention systems, ani- The Jefferson County A proposed mal grazing and manure Department of Environ- ordinance nviron- ordinance "It would management practices mental Health extended and water quality moni- the proposal to cover all of amendment raise $88,000 before the Je- toring in marine waters. East Jefferson County. ferson Count for the county Commissioner David commissioners to keep the Sullivan, D-Cape George, 2008 proposal would create asaid the decision to create district to mon programs - a new district is a difficult In 2008,a new $4- and itor and going.: one to make. $1-per-parcel fee proposal improve the NEIL HARRINGTON '"We spoke about this was recommended by a health of the water quality before,"Sullivan said. county-appointed task county's water. manager, "It proved to be a diffi- force. Under that plan, • It would also Jefferson County cult situation, and that's county residents would adopt a new, why we've continued to have paid $4 per parcel, annual tax to fund the district. fund this out of property and $1 per parcel would If the ordinance amendment is taxes and out of the gen- have been charged for Port approved,a$5 annual fee per parcel eral fund." Townsend and Port Lud- of land owned in East Jefferson low master-planned corn- County—excluding the West End, 2007 proposal munity residents,who are Port Townsend and Port Ludlow— served by separate sewer would be added.to residents' prop- In 2007, a countywide systems. erty taxes in 2010. $18 annual per-parcel fee Y That idea died when The next step is a public hearing, proposal met with ada the Port Townsend City which commissioners scheduled mant opposition from Council balkeda n into 10 at 11 a.m. in the commis- property owners. p YI g Aug.g the county fee. sioners' chambers in the Jefferson Opponents said the fee According to the staff County Courthouse; 1820 Jefferson was regressive and overly report on the ordinance St.,Port Townsend. burdensome on those who amendment, the idea was Written comments can also be own several parcels. reintroduced in part submitted until Aug.5 and may be At that time, the corn- because "a declining sent bye-mail to jeffbocc@co. missioners voted instead j county general fund is not e erson.wa.us,bymail to P.O.Box to form the state-man- fJ able to match current 1220,Port Townsend,WA 98368 or dated district without a funding fee. grants to ensure protec- in person at the county courthouse. tion of water quality." Neil Harrington, water quality The district was For more information manager for Jefferson County,said adopted Oct. 17 without a g Y or to view the proposal, the creation of the district and the funding mechanism. The state Department visit the county health fee are both allowed under state law of Health had required the department Web site at and would free up money from the county to form a shellfish www.jeffersoncountypublic county's general fund, which is protection district in Dis health.org. . being used to monitor and improve covery Bay because of fecal the county's water. coliform bacteria pollution. Reporter Erik Hidle can be TURN TO WATER/A6 The southern portion of reached at 360-385-2335 or at the bay had been down- erik.hidle 'peninsuladailynews. graded to restricted status com.,. • . /fir,�i ;',-) c J \s v UNVvC �OyO0w0 >) p ,fC U ,/ ,C co gi 'p (1).6) U V� ' �7 Q '��' pNp a•Gt�j .�j-[ p N p N `..) -".,. .a'O 'b .-+ - '.gamg OV 8 N '5 C ; `+ro qq�' b4'O ° N 'D �`-� •.'! S .'No (N) .co, W o 02a a, o1 3 0 " SGa v, >, °v 3 N o .0 a, .b 4-' -0 . 4J � > o o w a, a o a 3 /T4 � 03 p° O �d y� o -c b v, ,moi, 2-2 .e *3 ° b �..�r o o to °c a° 0 4c C111) 0, cu u cl.) L.) ... 1.2 g. voi .., _ v� ,o o�}, . 'N , a $� U v v o � 01) 3 N 0 .~ F' .5 ,°d o o S V °� Go - °.�' o ' v a ro .� o a' Q1 3 q •5 v .noa, � ,no3 " 0 63 "ci ° 4 s. 5 bb3EE.-0 „(1) d Cj 06 °"5w .� ” a) aj ° 0 O w o O�O y g Ou y;.S O .� "-, p ., 0- N y 5 .0 y . > •0 'b 2 y Q U t.,,,.._ . 3 a. , N cn tp 0 nil — -.a, Lvv'ixv a, d o.o �' 53w ' c�CS ° o .•� via1.. uU 'ow3 o 'c $.4 ° �S.-a A • g �cn 5. � 2o0 � gb '5 P. � x K a w w 0 0. o ,L) O. b ' .vv a) v 17,1 C,o oQ a � ao cco v0 o v 3 vp2 r. 0 Ffif �° 3 ° oo °'cOc co0.) „, � vuwc h � � N. n mbe ''° .5 r. tko • e r,,-..4 4—Fisi 8 V 1'2 .0- E -0 .b E 2 '5. a) 'A 7 ••=. -u 6 ,E cv a L...cii) .5 rl'4, 1 0 0 g 3 5 o °° a o :A v .d •• .0, •--, >, 0 � o el' ;10 v ° 5a'na' otia� ty d � c�ov °' aa'i •� Oa,� 3v `4 g CCo o }' mQr, o a, ❑v❑ -do ° N ❑ a c P -�y .o ? z8o ! u, V U .� ~ .0 p .� w cd 'O o cd a.''"'y & o N o, o ,a Oa y y -° .s al .ca a o o a . = t, E° ° a3 a •0 3 3 3 4 .c 6 [ U y o a a, ccU • w w 5 p % o U L-0 o .. o +-J ... 0. c� o ff' ° oo a, pv, 8 •v .� oc• w3 � S844 oSaa � oawoo ,v �a . Jo .'' qo NN tt. o-dtiN 0 ., a, a s e ¢• . awl 0 ao3 v • ?;( E ,. .'G � `''. o o.. o t ° u 4 � .o au x v V � u .- ;; U 2.x • 8 o; E •� a) ren°. o ,4 o8 a .W88. 33 03 - a .5a �' u6 vo ao G o 30 o OCII) 4 4'0 i .,.%9 -'- a 0ac . a $ o 2 Q a) � rg a0 O •n - 30 ,. .,-. p U Q. ' oo eVvp ao ? a�0oa .04Aoy .. .aa, 5 2o y o s. ° ° ab o ^ a q> °' w ti ° ' o ° 0 � .5 b � � ° d �i° .. a, o 0 aii) G -° o Al � vaoc ' wa ' () c C 0 01 1 g s?.:w vcto ,r2 � a, o: � hl ° oD • c'0 , vp EgQ3 ,. vi a N cu -0 p. ° to >.. 0 e b d' cu cu a I Aw a �CV 04b v o oa a.) o .5 – 5 -2 o� Fov-° ° g o 6o" .5v , oo .- 0 ; ° q �ii . o Coo -. 0 .0 . . v >; cu s ; vi. u ..,m ° 0 5 nrooall oa0 , a �'ov' o ' , ° v ooxm , m° .v, ti • now ai o *, 'g � a • a a ° , '0 ee a. co o ° °d oa, ,- ,too by v3 .0 c) a 'S cV "Ci<4 U o 03 U o n 3.� '� > • ; . r itmit e- .J off ' ;�/ ,1 a� a 2 1 !• i. h a • {. .. 0 - 315 4-'pl g 1 .5i 0.11 il it() 1 .E 8,71, I a. S g „, 4..,..,A. . x, • la,. 8 .0 w A 0 0 .0 0 -4-ac,z, e a, - -AD to c$:.. 920 b S:n rsgrt.„,,, IJI I:: g x.8.iiRflq1!Iu .81 CC 1 i114,8 'fl `� e 'er0 -t- sisa 051 4= °: (1) o• g -c,- c:4 P. 'IT, >,,,s da),-9-46a-t'Ict - 41)C3 `• .0,.,g 2,q pq n `s B ? • 8b d 5 60 _ .1,4 q_ ❑ moi, ❑ '-al,p, 1 E �w' obi) 'a co A '.� 6.5 p.4 q• q":"A4-' 1 .11, () a -• -:-. $ 0 .• 0,, 4,,, . .:,., -,,, . .,,, . ,o..), .,,, .4 4 ,A g ..0 am 86 4' "° ' • o• Iilil. wo8a dv.,,...., •°, 3a..t'_ 0 w 8 8 • T •� .Wgs, :.'8w � B ' u KA 8 °� �i pa ° 41000 al ,�A cp �i.4.'01 §''g�'' V, v� �rJ o - QOGr_LT�y� y eo el Cg.CWaY`�i Z8❑� acrj (Nr 0 M41 ' ' j.07, j 8 ;- gyC>/ yo' El t^ O. p,A0 23 O . y F O.e,'+ O g to c. B B'ii-Cir• `-1 /�•-•71 n'D 3'S'D % 2.f60 .t..--0.5 M do a .s7 'D `� I ,«..N.u 11 § -.11,g 48 °1 t. x.' F.1 11-gl e - ; 4:g•u 8 roto �oi 0 .,a 5 A> 0 N (11) . 3 24, 4?-0 .0 § ` t70 as *� ; b 0 n u �, d ' -,-` ..• ,i1,-.,00 -0,..„9.xx 0» I eco. 8•K �0ffi'� Do � � ° y;'� " a�.. � a .� ' � p�, ai d� ao83.'da�aNn� • .CI) w� +g '� n0. eo '0 > a, ` v0 c 9 .8 °� `+� a — 2, § 0o... 8o0,.-4 ;iiiii,e - 11 5 ■ �' ■--� sad y 11 2 Ix a.)' ty gm ..E b. d � s- 0, .<- 0 <- 0 0 -aE frt.011 .5.1k i'81kw #474 14i It NI iLI1bi1U . 1I ! 1.. a N w C '4 -F,' P-61:1111111 1. l'Itall't di41,91 Al .> aL1 dIi - = i!!H!iJ1ILUflIUI3 �JIII'UII p;. � 0' r ya 7. — d a izr . y,8 a NT y c... - r.2 a. • a (i) ' t 2-iiiivilg, hi -6--ge, -.E /- z .-, ,) gi'-' „,,q).„ . , E ci) .6.. —liv .k,,-011.41,. 103 1,s ,,/ft 14' -Zcl-f s-4 q. +02, 110t.t-szoirglatst . -g1,5 ,zfi ..„, „, g . *H .-(1) )14 2!. gd,8141 ,!).7,1). V-1. Aliiii-"-.1-2.108%.1t,t,-5 CD .i ' � 3a p ffi o °i c°'.4og 'S '0 3•x3 °' ° 0-to 01., 8 t c ' • _____ _ _ Think ahead for . ... rt - back-to-school. III - - immunizations When basking on the beach pox vaccine or a history of the or in the sun on warm summer disease. A parent's report of days, the beginning of school disease history is adequate at is the last thing on most par- this grade level. ents'minds. But early August All other students should is a great time to think about have had the minimum of: required back-to-school vacci- Three doses DTaP, DTP or nations. Td with the last dote on or Waiting until late August after the 4th birthday; three • to get children's shots can doses polio with the last dose leave parents and students on or after the 4th birthday; facing long waits at the health two doses MMR; three doses department or their doctor's hepatitis B vaccine. office.Jefferson County Public All teens who have not had Health encourages parents a tetanus-containing vaccine in to get their students' shots the past five years are strongly early to avoid the late summer encouraged to get the Tdap • rush. vaccine. The requirements for Chickenpox vaccine is + • shots for school have changed not required for students in slightly since last year. Some grades 4, 5 and 7 through •• children who have received 12. However, two doses are all recommended vaccines will recommended, especially for have more doses of some vac- teens who have not yet had cines than the minimum listed the disease. Chickenpox can for school attendance. be a severe disease leading Minimum required immuni- to hospitalization in teens and zations for the 2009-10 school young adults. year are as follows: Other vaccines are available Kindergarten • Four and recommended for children doses DTaP vaccine with the and teens by.the Centers for • last dose on or after the 4th Disease Control but are not birthday; three doses polio required for school atten- vaccine with the last dose on dance, including HPV, hepati- or after the 4th birthday;three tis A and meningococcal vac- doses hepatitis B vaccine;two cines,as well as an annual flu doses measles, mumps and shot.Meningococcal vaccine is rubella vaccine (MMR); two especially important for fresh- doses chicken pox vaccine or men entering college. medical provider verification of Vaccines are available free disease, or a blood test show- or at low cost for students ing immunity to chickenpox younger than 19. Washington First grade •Three doses state funding for many vac- DTaP vaccine with the last cines will change in May 2010, dose on or after the 4th birth- when low-cost publicly funded ---- day;polio,MMR and hepatitis vaccines will no longer be avail- B requirements as above for able for children with private kindergarten;two doses chick- medical insurance. Instead, en pox vaccine or medical pro- private insurances will be ' vider verification of disease,or billed for the cost of privately • a blood test showing immunity purchased vaccines. to chickenpox Jefferson County Public Second and third grades Health has.walk-in immuni- •DTaP,polio,MMR and hepa- nation clinics 1-4 p.m. every titis B requirements as above Tuesday and Thursday at 615 for first grade;one dose chick- Sheridan St., Port Townsend. enpox vaccine or a history of Extra back-to-school clinics I the disease.A parent's report will also be held between I of disease history is adequate and 4 p.m. on Mondays,Aug. . at this grade level. 17,24 and 31.No appointment Sixth grade • One dose is necessary. Tdap if it has been at least Call 385-9400 for more five years since the last teta- information. To schedule an nus-containing vaccine. This appointment for school immu- Tdap requirement also applies nizations, call your medical to seventh- and eighth-grade provider. Olympic Primary students who have not yet Care, Port Townsend Family received a tetanus booster; Physicians, Jefferson Medical • polio, MMR and hepatitis B & Pediatric Group, and South • requirements as above for kin- County Medical Clinic all stock • t dergarten; bne dose chicken- pediatric vaccines. a • Immunizations • available at clinics PENINSULA DAILY NEWS required immunizations for dergarten; two doses This Tdap requirement PORT TOW .TSEND — the 2009-2010 school year: chicken pox vaccine or med- also applies to seventh-and ■ Kindergarten — ical provider verification of eighth grade students who Back-to-school immuniza Four doses of diphtheria, disease or a blood test show have not yet received a teta- tions are now available at tetanus and pertussis ing immunity to chicken nus booster. Jefferson County Public (DTaP)vaccine;three doses pox. Polio, MMR and hepati Health's walk-in clinics of polio vaccine;three doses ■ Second-grade and tis B requirements same as from 1 p.m. to 4 p.m.Tues- of hepatitis B vaccine; two third-grade—DTaP,polio, days and Thursdays. doses measles, mumps and MMR and hepatitis B above for kindergarten;one The clinic is at 615 Sheri- rubella(MMR)vaccine;and requirements same as first- dose of chickenpox vaccine dan St. two doses chicken pox vac- grade; one dose of chicken- or a history of the disease or Additional clinics will be cine or medical provider pox vaccine or a history of a parent's report of disease held from 1 p.m. to 4 p.m. verification of disease or a the disease or a parent's history ther students — Aug. 17,24 and 31. blood test showing immu- report of disease history. Appointments are not nity to chickenpox. ■ Sixth-grade - One Three doses DTaP, DTP or needed. ■First-grade —Three dose of Tdap if it has been Td; two For more information, doses of DTaP vaccine;polio, at least five years since the Td; three doseshree polio; tw doses phone 360-385-9400. MMR• and hepatitis B last tetanus-containing vac- dosesopatitis BMMR;vaccine.h Here are-the'liiinimum requirements same as kin- cine. • • Q ° .6�' y,6 ›,4, ' ooW ,T oocoCD o ` °" 3. m 0��pm g c-,C0 alh 7 Sin 3 01 N CD O W S� dccill UN -..s ro •�E. d O e o aS C1 ai t;) O a> CD N.4-.�,N x'4 -moi c? l • z °� o o cay F o m ° d�U �o t o�c � r rq,,,. Zi F iy q y ,b Ol'i x O W m N \\ fs >.,›.7 Cii) ..,. , H,o50, . 000-e-g.mo, . ° yo n q a v o. o tag F.(:� aP.rn.�°.5 8 c. 71., 15, 4 w` �-a a CO mO a4"' wN OOa) imcii; u) 07 oDy �Og�m ° ° °° e oE.� wr3a' g . � qCqqqcai F.Q,-,- o 2q 72— w ca „ W0 a.. -,,s8ro ..c, re, E 41 E 0 IS> 8 6%5 (6) iIflhP a> ^, O > o 1..,..til 4; ,1),„ ail/ ANy ❑ o hfl CD 14 _30, imi ..,„w y ,410 O U) C ,4+0:1 .; "8 , 0 g7.O m g),(4).4 a). o- N� 13 Z; 0 '-',-0 c'4',4 0 ' W '4 g 0.Z 0 04 0 g ._(_, .. "0^°. try „,,Z 0 .P.iii.., .t-01 J!iDfl o 5 •• • BEM "-a 3-4 , ca,4 :--1 ›. g p.-0 cl ..1. w g a. q a e.g.,R'� [i c o o co .ti g. F. g.E q ° MOM mW $. ad ,..`pyo agi � ` w0y „ > � � Imo 3,2 �° " "6 ' �a 8 §,ro -.Fx 02 o a).- ■� �. E w°. 4,g omfie 0 .ora"-a.3.5 400yme Z -4: i.,-0 0-- 4 ]. .4" 6)"0'' 0 k E._, hK Cts o�r v 0 .,z o q : iii) . . ,..C.,,),, y .t. :4V g , 2 3 3. 0 5. V : :. Vq kgz' .a5ic°� � m3 U ', g• O b q 75 V cti oaf 1q3Agx ,“.S.41 .a • • What does red mean? levels of blue-green algae are But Leland r, t,,,an - directly correlated with the ���� level of phosphorus in the •Anderson poisonous.b�ue green algae explaining that phosphorous as Anderson, Harrington tends to be the limiting fac- tsaid• for in freshwater plant /� WOM' ae stop' toxic lake,"Harrington said. "For whatever reason, 1 While Anderson is closed Anderson has more phos- Official says i by State Parks to all forms of phorias than any other lake Leland Gibbs toxicity/ K recreation, Leland is not— that we've tested,"he said. � even though both are posted "Leland is higher than lake worse unchanged by heat with red warning signs. Gibbs, and Gibbs is higher "Our warning is against than Sandy Shore,"which is than `red' swimming in the lake" or clear. PE!NINSL7u�DAns Ni." A dearth of phospho- drinking the water from The origin of Anderson The most recent rus would explain lower Lake Leland, Harrington Lake's high phosphorus con- BY LEAH LEACH levels of algae,he said. said. tent remains a mystery. PYxwsuu DAILY NEWS results of lake water In the meantime,the "In terms of boating or Phosphorus is an ingredi- aampling tests surprised warning levels remain other recreation in which PORT TOWNSEND — Jefferson County's water red for Anderson and ent in fertilizers and can be people are not running the in septic-system effluent. Anderson Lake, green with quality programs man- Leland,and yellow for risk of ingesting the water, "State Parks has done no algae scum,is so toxic it's in ager. Gibbs. it's OK" fertilizing, and the septic a class by itself in Jefferson Neither the amount 'There was some .The Jefferson County system is in good shape. So County. of blue-green algae nor improvement,but:not Health Department doesn't that's probably not it," Her- "If we had a different the levels`of toxins pra- enough;for me to reduce have the jurisdictional rington said. warning level beyond red,we duced by the algae any of the warning lev- authority to close Leland, Phosphorus can. get into would have given it to Ander- increased. els,"Harrington said, Harrington added,saying it lakes through the atmo son," said Neil Harrington, As a matter of fact, "Teats showed levels is fortunate that the lake through runoff, county water quality pro- measurements improved in Gibbs and Leland that has the worst infesta- sphere, g grams manager, Friday slightly in Leland andthrough some other aspect of were slightly reduced," tion of any of those tested by afternoon. Gibbs lakes,despite the he said."If that trend the county health depart-. the environment or it could "Anderson is a mess,"he heat wave the week ear continues,I'll be able to ment — Anderson is be historical. said. "Literally, it's very lier, ',. ',0'-..'"-14.-'2,,,,,,„w',' ade those lakes an. , under the authority of the "I'm checking historical green. It's been undergoing Neil' •isk70,Wh next couple of*e.'' state agency. records to see if there was a an ongoing bloom all sum- is in charge of the coun- "`weeks." ; "State'Parks has,prohib- source for phosphorus in mer. ty's water programs,had Anderson Lake is ited people,from going on past "It's said. "It's sort of the lake that suspect€'d that thesam- closed to all recreation, [Anderson'Lakel khe said. Whatever the source, won't stop." pies,taken the Monday although the state park The decision was"based phosphorus tends to concen- Warning levels for Ander- after North Olympic surrounding it is open to on the history,that this lake trate in Anderson La son—which isWithin Ander- Peninsula tempera ,,t.1.4.40,, >use. was shown to kill good-sized because it has no outlet. son Lake State Park between soared into the 90i, . 'Leland Lake users; animals,and through confer "It's a big pond.Any phi Port Hadlock and Chimacum would s'bow alga are warned away.from ring with risk managers and phorus that's in there stays — Lake Leland, north of -, growth because, ie <,swimming,drinking the with us." in there,"Harrington said. Quilcene and south of U.S. = plants thrive in hea ,water or eating fish from By comparison, Sandy Highway 101, and Gibbs and light '-'-f:. -41,.,!:l'the lake,but can enjoy Two dead dogs Shore Lake is the headwa Lake in Chimacum remained , "Thin a die boating or other forms of unch after test results °t Two dogs died after drink- ters of Thorndyke Creek. angel worse lasts er s oreataon that don t' ing Anderson Lake water in "rhe water's not staying of last Monday's water sam- rington sal' ,. •'I ' ! tend to put them in dam there forever," Harrington hn came in Fridays " '=• er'of ingestion the June 2006. That was the p Anderson and Leland still was o dais U ��"g g first time the lake was closed said. To dxtico_"�i• e�eat ;;..:water.-- to use. have red warning signs son,he plans to invests- Gibbs Dake also can oe Each year since, it has posted,while a yellow warn gate data on nutrients used for recreation,but ing sign is posted at Gibbs. been closed for periods of Managing Editor Leah Leach can in users are warned to keep the lakes. time during warmer be reached at 360-417-3531 or lash. The postings are based on "The lakes have been small children and pets leach�peninsuladailynews.com. weekly water samples of stratified for awhile,"he out of the water,to refrain months. some lakes in Jefferson This year, the popular County.The samples test for said,"and it be from dewater, trout lake was closed earlier they've run out of nutri- and to clean well than ever before—on April the amount of blue-green ants"in the top layer. before eating them. 25,just before the opening of algae and toxins. . Blue-green algae is a Leland was the fishing seasoneasonedbecause •common freshwater scum of toxic algae in mid-May, that can,at times—for rea- "If we had a different warning level beyond but the levels have never sons researchers don't under- » stand — begin producing red, we would have given it to Anderson. beenas high as those of toxins that can damage NEIL HARRINGTON Anderson. "We haven't seen nearly human and animal livers or water quality programs manager,Jefferson County the same toxicity in Leland neurological systems. as Anderson, but we don't want people ingesting water," Harrington said. So why is Anderson so toxic? "Comparing data among the four lakes we look at,the • Jefferson OK,. • or cle anwater di strict • • Funds will go terns,monitor water quality responsible people of the and identify pollution from county must feel the pain," toward studies septic systems and correct said Dick Bergeron, repre- it. senting Chimacum Grange. on pollution The county is already Resident Jim Hagen said seeking funding for clean- the proposal was around in water projects in Discovery 2006 "when a budget train BY JEFF CHEW Bay, Mats Mats Bay, -Chi- wreck was already in PENINSULA DAILY NEWS macum Creek and Hood sight." PORT TOWNSEND — Canal. Hagen said pollution Des ite vocal o The Clean Water District from human sources only P pposition, a was established in 2007 amounts to 5 percent of the $5 annual fee to fund a without a fee,following out- problem,and PortTownsend clean-water district will be cry against the $18 annual and Port Ludlow should not assessed on county parcels, per-parcel fee then pro- be exempt from the fee. the three Jefferson County posed. commissioners decided "The general fund is no Resident Torn Thiersch • Monday. longer able to provide this said he.did not receive any- Besides Port Townsend level of subsidy," a memo countyatedhe serviceudthat from and Port Ludlow, which from Harrington and Public the district.would benefit from have their own sewer Sys- Health Director Jean Bald- theGeorge tems, timber parcels with- win to the commissioners Yountresof Port out homes and low-income and county Administrator Washington o Environmental the seniors are exempt. Philip Morley states. Wasncngton Environmental The fee is expected to Council, said the council generate about $88,000 on supported a fee that was Quality downgrades triple the amount proposed. • top of $33,000 from the county general fund to The county must keep ' match state grants ear- shellfish waters clean to "It is clear that our com- mitment to keeping our marked for improving water avoid state Department of waters clean and safe is quality in shellfish-growing Health water quality down- what the citizens of Jeffer areas• grades that could lead to son County desire," Yount . closure of commercial shell- said. Study pollution fish beds. Pat Pearson,Washington The shellfish beds pro- State University Port Had- Neil Harrington, county duce an estimated $20 mil- lock extension water qual- water quality programs lion in Jefferson County ity agent, called the fee manager, said the funding business a year. "nominal." will go toward studying "This fee would go toward "We are going to learn sources of pollution in shell- what it is intended for," more about the cause, but fish tidelands, including Harrington told the corn- the only way to do that is to fecal coliform and stormwa- missioners. find money to provide the ter runoff contaminants That was of little comfort research,"he said. and septic systems. to eight of the 10 who testi- The funds will also be fled against the proposal used to fence off cattle,edu- during the,commissioners' Port Townsend-Jefferson tate homeowners about hearing Monday. reCthe Editor Jeff Chew can be d at 360-385-2335 or eff. proper use of septic sys- "If you do tax us, all the chew@peninsuladailynews.corn • • Parts of Mystery yBa closE:d to commercial sheHfishing • • Can reopen to harvest without any restric- "We want to make sure it's got lions." Toward that end, the state certainty of good health and that it's after boating is trying to limit the number of boats on mooring buoys in the a healthy place to grow shellfish." season ends bay. The number the health department has used so far as a Neil Harrington By Molly Rosbach of The Leader threshold for a problematic boat supervisor,water quality program population in the bay is 10 boats Jefferson County , State officials closed corn- within 10 acres.While reports on mercial shellfish operations in the number of boats in the bay Natural Resources employees Washington,protects the tribes' parts of Marrowstone Island's might have been exaggerated, taggedthe unauthorized buoys, right of"taking fish at usual and Mystery Bay last week because the county is still working to asking the owners to get in touch accustomed grounds and sta- of the high number of boats reduce the number to an accept- with them immediately. In most tions." The Rafeedie decision moored there. able level. cases,no owner came forward. of 1994 upheld the tribal right On Aug.6,the status of the The health department only As the county works to reduce to harvest half of the naturally outer bay portion of Mystery Bay counts boats with the capacity the number of boats in the bay, occurring shellfish on those tide- was changed to "conditionally to have a head on them,as these those without permits have been lands that would otherwise be approved," which calls for the are the only boats with the poten- the first to go. available to the tribes. closure of commercial shellfish tial to discharge waste. Other Some boats may be exempted "A closure of the inner bay harvesting during boating sea- exemptions that would allow boat from removal for another rea- [which has been avoided but son, which continues through owners to remain in the bay have son,according to Al Scalf,direc- is still a potential threat if not Sept.30.This closure is precau- also been discussed. tor of the. county Department managed]would impact shellfish tionary only,as no health threats "We are exempting boats of Community Development growers who buy shellfish from from eating shellfish have been if they are owned by a person (DCD), tribal harvesters," wrote Kelly documented. who lives immediately upland," "From the DCD,if you have Toy, shellfish.manag,er for the "The closure is not based on •Woolrich said."They will sign an a shoreline permit from us or Jamestown.S'Klallam Tribe, in levels of contaminants that we've affidavit that they won't use the installed prior to our shoreline an email."A closure,particularly found.It's based on the potential boat for overnight accommoda- master program[grandfathered], in areas where there is shellfish for discharges from boats to con- tion and that they won't have any then you are legal from the coun- resource, precludes the tribes taminateshellfish.Soit'sapotential, discharges from the boats." ty perspective,"Scalf.wrote in an from harvesting commercially precautionary situation,"said Bob The state reasons that if boat email."DCD doesn't have regula- and, depending on the closure, Woolrich,manager of the Growing owners'live close to shore,they tions regarding boat use;now,if can prevent ceremonial and sub- Area Section for the Shellfish have easily accessible plumbing someone installs a mooring buoy sistence harvest" • Program of the Washington State in their homes and won't be creat- without a county permit,we can The tribes affected by the Department of Health. ing any discharge on their boats. take action per our county regu- closure are the Jamestown, The closure of the bay is in In addition,Woolrich said,many lations." Lower Elwha, Port Gamble and accordance with national health boat owners who live upland also Reaching a solution that satis- Suquamish. department rules,which regulate own the tidelands and use them fies all parties involved has prov- Monthly stakeholder meet- the number of boats that may be for shellfish harvesting,so they en to be a difficult process. ings are being held to discuss the moored within close proximity to •have their own interests in secur- "We're really trying to work permit process and the increased commercial shellfish beds. ing the water quality of the bay. with DNR, local tribes, local boat traffic in Mystery Bay,with 'The assumption is made that Most boat owners have per- shellfish growers, the state the goal of limiting the closure there's a threat when there's a mits issued by the county 'or Department of Health and other to the area around the state park certain number of boats near a by the Department of Natural affected parties to figure out a dock by the 2010 boating season. shellfish harvest area,"Woolrich Resources to moor their craft to good solution for this so people If this fails to happen,Toy wrote, explained. "If we can get the the buoys dispersed throughout can still use the bay for recre- the tribes are considering their boats away frdm those [identi- the bay,but many don't Jefferson ation, and keep it an important options against the county,state fled harvest]sites,they'll be able County and Department of. shellfish-growing area,"said Neil and federal entities that are vio- Harrington, water quality pro- lating the tribes'treaty rights. gram supervisor for Jefferson "If a temporary closure County."We want to make sure becomes a permanent closure it's got certainty of good health due to uncbptrolled pollution, and that it's a healthy place to then a portion Of the tribal usual grow shellfish." and accustomed area is removed Woolrich seems confident from tribal access,and that does - that this goal will be met before become a big problem," wrote next year's boating season. Randy Hatch, shellfish manage- "What our hopes are is that ment coordinator for the Point No we get the situation resolved over Point Treaty Council,in an email. the winter so that next year there Frank Benskin,a plans exam- will be no summer closure,"he iner for Jefferson County, feels said. "And there's been prog- that the county is well on its way ress made already,with some of toward a viable solution. the boats having moved out,and "The numbers [of boats] in some of the mooring buoys being the outer bay continue to fall; if removed. There's some activity they continue this trend,I think taldng place that looks like it's there will not be a need for that going to help us get there." closure," Benskin said. 'The However, the tribes are still good news is the boat counts concerned about the potential . are down. From our perspec- they see for the closure of the tive,there may be enough redec • - inner bay, which would violate tion in boats to ask [the health • their treaty rights. ' department] to recall the statuspi-- ,,, � The 1855 Treaty of Point No that they'd placed the bay in. , UCFe Point,between the U.S. govern- We're going to be working on ment and the tribes of Western that problem next" �� y • The parks division has four full-• Sqtime employees and employs 3.5 to . d et■ II e eeL�JD rasti C 4the full-time-eqsummer uivalent peoplemonthswhen duringpro- g ■peak , grams are'offered and the lawns need YContlnued from page 1 requests will be available Sept. budgetmowing. The cutbacks would occur• in the fall, likely after those people collapse of 2009. Still,Morley said he expects already have been laid off,Tyler said. is Now, he said, sales tax for to have to use reserves—excess There has been talk about asking 2010 "is projected to be about fund balances in both 2010 s I a s h i n for voter approval for a metropolitan 10 percent lower than in 2006." and 2011. park and recreation district that could fund city and county parks, but that In 2006,the sales tax brought in Morley'also noted the county can't happen in tune to stop cuts this $2.5 million.In 2010,the county is looking for dedicated funds • year. expects it will bring in $2.25 to "sustain"services and move O s s' I Comillion.Cutherently,as of theeend themtisout iofn the generalefund. DOWN THE LINE of July, the county projects it It is pursuing grants, fees and , p Word about the parks department will bring in$2'445 million this other revenues, is looking at t 7, came at the end a what county cont Treasurer, Judi Morris said other non-mandated services CountCounty parks missioners and county critics called Tuesday and which and will "deter- yestate excise tax also mine which of these programs an informative but sobering overview is down to below 2000 levels and levels of service the county most vulnerable by Morley of the county's budget — from $600000 in 2000 to a can no longer afford to pro- woes. • high of$1.52 million in 2005 to vide." ' By Allison Arthur of The Leader Morley launched into the presen- an estimated$490,000 projected tation by noting thatwhen the 2009 in 2010.That's a drop from 2005 PARKS DEPARTMENT Jefferson County budget was adopted,'it appeared that to 2010 of 67.8.percent. bud- needs to cut,cut,cut there would need to be cuts in 2010,. The park$539,546,district's 20 of , and cut — in 2009, '2011 and 2012 because property tax `That's we significantly mgwors at $435,827,t is orroughly and per- 2010,2011 and 2012. t ,.r., revenues,limited by law to 1 percent than what were looking or 81 eral Among the first a year without a vote of the people,. All last December,"Morley said. cent, comes from the general victims likely will , t'411,%)' aren't keeping up with inflation. that led to Moley explain- fund, which Morley called a sus- be some Jefferson Revenues from new construction ing thereman areaservices the conn- subsidy that"is no longer County parks,which and growth masked the vi is the countyurt fund and ser- tamable." growing gap vices the isn't required Fees account for only 8.5 could be closed this between revenues.andexpenses, he to fund. percent of the district's budget, fall as the county Philip Morley said: starts to "squeeze" "Even in the best of times, our. Departments the county and rents account for only 8.3 services it isn't required to provide. ability to fund services from exist- is required to fund include Morley ofai the district's budget, And that won't be the end of cuts ingb'een and District courts, Morley said. property. taxes has been losing the sheriff, prosecutor, public With another$550,000 need- needed to make shrinking revenues ground,"Morley said. defenders,juvenile court servic- ing to be cut next year from match expenses. Although property taxes may es, assessor, elections, record- the general fund, Morley said "An initial analysis suggests the increase 1 percent,the consumer price ing, treasurer, legislative and "the general fund will be hard county will need to make$550,000 of index rose 3 percent, causing what executive offices as well as plan- pressed to match even the • additional permanent program reduc- Morley calls a "structural funding ning and building services. reduced 2009 transfer to parks tions each year in 2010,2011 and 2012. problem imposed by Initiative 747 and Smaller cuts will also be necessary in reenacted by the state Legislature." Discretionary services next year. 2013 and 2014,"County Administrator include youth services, solid "The cutbacks we will make See BUDGET,Page iov waste disposal, animal control, to our valuable parks and our Philip Morley told county commisWashington State University recreation programs are painful sinners on Monday in a PowerPoint Cooperative Extension — and and necessary,"Morley said. presentation. He stressed that those cuts would need to be made each parks and recreation. yea, 'The general fund is in a NEW INITIATIVE Morley gave an update on the 2010 squeeze play,"Morley said. ,• Morley also touched on budget process and said that while Before Morley • talked, Initiative 1033, sponsored by the parkseand recreation division is about parks, he noted that a , Tim Eyman, who also was at to our quality of life,"divthe 19 drop of building permit fees the helm of Initiative 747.The "integralprompted six employees.in the parks and numerous programs make proposal would limit certain up a discretionary program,and cuts Department of Community state, county and city revenue will be needed this fall. Development(DCD) to be laid to annual inflation and popula- off last December,and another tion growth,not including voter- 'This may impact maintenance three DCD employees were laid approved revenue increases. and operations of as many as half off Aug.1 because of a contiriu- It also would limit our facilities in 2009,.including clos generalt ing some parks if necessary,"Morley ing decline. fund revenue for 2010 to that • concluded. DCD also experienced a 10 of revenue collected in 2009, Parks Manager Matt Tyler said percent reduction in hours for according to the measure, • its remaining staff and afour- available for review at secstate. Monday he would be meeting with an advisory board to come up with some day workweek wa.gov. solutions. Service hours at the 'That could have a significant said Tyler has a month to Courthouse also were reduced, impact on local government.You findMorley to cut this year,land he'llo with employees cutting back couldn't choose a worse year to haved$72,000 make cuts next year as hours to 37.5 hours�a week to index revenues against,"Morley to the department's roughlyxte as well00 help with the 2009 budget. said of 2009. annual budget. Morley said the 2010 budget "I-1033 will not allow us to would attempt to bring employ- catch up as the economy and "This is so preliminary we don't ees back to a 40-hour work- sales taxes recover," he said, know at this point,"Tyler said of not week knowing what might be cut "Use is adding that it doesn't allow the 0 strong,as it's always been.It's just so Department heads are just county to preserve services by important for the health of people of programs. do their budgets,and shifting them out of the gen all ages,"Tyler said of ro their requests will be matched eral fund through new revenues p grams• with revenue projections, without reducing the general Morley said. The preliminary fund by an equal amount. ,• J N • . 2., • U c cV U1' ~ Lal ,,..-....,,,j5 y wo y v vv L � vv rc ac� �N -. -co- --, co.Ec f14 ^ °io .C , 5 �� N^ c m cS w - � .0 V ,•+---s -cc 4)- n . cwv5 Lc .5'.(4), N�� GO iao . x a, G G 3 N C. v -o ao .c..c c ..oC .- O OG m U5LNn .. .- 3NN . G.k] a NU "• .0 °C cn • 22 F- cd•. . y. 0 .0-61 •ya,..•- y� � E.5 'OQ N oN 'a 4. p•a d0 41 v uNNOa ,° y ° y p N p5 1] 2i avuoEu mEaN�[ooa� oi° ao ° v � ° avpuG � NGSO .� �F0 > N C 'Ga d ° 2 0 �.G 8 >' yb.c -g. '2 N ot„,,... id 4. NC CD ' J OO... N ad x3QGtw C .p a, O t' T N Q U v' ° O a.G E 0. c.5 y a C LC ° ° O ' pT NO + F a1 s.. O S•Oa' •Dh, N i. Lca.,. •PO Oc3 `d ES= vN 'U v L:= o., o., ca GULN da °A oc. Ea$ Z uPO a "c a: °n o-° 0-6s o c•C 9` ' o....6_ 'GQ ocE ° ff " E-E • O = 0 rd cy� ph0Lh0 g4 c vUv N ° �yC a3pvUd >' O .58 a. ,dApb' wN•o Y Lo � c 0 C O > E 9 ' tN `8^ .° 8gE2v,0y 0 co y 'L O o ,a cc.., o • T -c V � N ° ° �-Bi.a E •a : m 2.54ax•o UcNUvyfy v d CO c O cd 5 u) x : 3o5 EObEa4)qv E 3 G Op v y o [ td C C N U ° y ° y3aN;A N G 7PUN N •Jo'J•J ,0'UN w � 0 c . .o o ` 'J'.0 >� O .. N h0 a. •G o E v00 a >'.c .O ,--. !a o V. E oa^ :0 NL. v .0 v c 44.0 44 cx N-� c N� co0wocw aa 0 o No 3 44 .-vu ")-1:,...,. 4'1.4)•N.5 06 ow '6N ho v CI) 4'..Ci 5• E 5 E 0 ° i 'c Eo .° v <0-0 c o Eo gv vo [ • c a 2- c E yc.° 0N V ' n N ' v v� o 0. a v ry E.c c O. � v co ° � p. a ° a aOv..os A aSo".0 a T. ... N O � c15.y '° 5 'C'fl O . N ti2'O ti N0�. ° o � � av �AoA�w"' bcpt TOaU " Ld3 T° ; 6i >. Ca. EE^ T '0. O vv 'aGGyy -1.') ov pb0E 50.'0 O opy 8Ea_ •z >AtcEa' g cx a• p c L � N 0 ° v -1---) C ° N ' E o � v awv' a . .5 to ° N .N o4 t L N ' vE o. NE ogaoma '0 b� 0.o.a-0 0 Ua. c � '0� N xJcg4 G p.5N A AeAOM td 0. a c C .p.0ow U .G . ..:: O 11 1 5 c N 3.kC "2 •O N0N C 0(n Eg o EUOv y0 . NNNOTb0.'Era A:O.0 c. � a°= c vi. u .E 0-+,8b2 A N vcO 4= Ng .. �. N C .2 = U• .6HEpt o'Cv owq0a ¢ E oUo. o aN o , moclPt° n Na � . N a3 oc° u ,ca c 41.E.-. 3A c o v° t ° v b(( a8Qgp° b 5 E o 5 <.0u;c •} : a 1 -- y t.: s•B c v v � r " O=3 d a b a r•opa v v o0.c tc uvC vQaao0 c . oEAooa a ?wa5 a 0 E CCA-0 N' NU ,.-'Q( x ° 5 a N . oo oo tx.o•o ▪ T V C vw 'SL '' CD • � ' ;0 i',3,"- S' ,,,.0 - „E.,, • Vi . .... 0�0 aNa• - �� �?'r �`� i., 5, - N G a . a7 b c .�' .� pppp � 0 W a °C7 a) c . Y w a a �" OU G -0 % y4 vo Eo ° A3A g8 E2'o .S� 35 Z'•50vpallo n _ -b v, 6, v C `431 E� v v b 3 V �•c n �a v c a-0 iiil !I !L v /�\ iIllD1i . vv • v �x �� o3 ° c$ `d �d�' o � via aE� -_• A °5oo0 N - .' , ° E ro Lco , � Oao �i o �3a0 0 h 3 `o�� 0co ccn °q o 'e.� , 0:si- E-?? -A vG. .p. 0 o•c ► o •a a 3 N `v p 'E 3 w z a td L° R! 0 8 ._....._ _ .N.. -,N b C.5 v G•o L v L y. v N E G .+'•' Y Y N v a c (-I', �•5 o c o c c ,a ,E al•@ aA ''' a ` o v o 0 0� ;d ° a � . MIME >1 L VN ENN o •0z L o � ueo N_ o Et O �,�'N G h0.O n"•b v N C 3 T G'6 3 co 0. G V N'� U 5 O & m � v h0cc Ab .5 ., 0 „ •'covvav o cvm >:0U ° E `.,' o 0 }� $ Eo � N•o � o � i- 1,4 o°..v °(.) ti0 °,.� Etoho L as Ev ' o W te C J ° o w � E .' 2 -c0 .5 "-3 7 h0 G v,.to F.• >-.='°v•- >' va,'• "•c 3, a `03 d Co) EnU N 3 O N.74 T O v v, Q) .'Y. O O E C.g ,t C•b ,'O cd a 0 •L] c O E A•L7 to O3U U :: abv Hca pwaaOE5N �' 0vov pU ooa ' > KEp .9 > °r vLboU 3vbo. o.c f0) c uc 0 5 8 a., om aUvv ro 0 0.'A •'' qTA tv- O6 w' U ... T. v N'�-. .U+ UN y.-• c v co CO 0 t E t N �. N gE� o N % o oqA rg -0 .acia• N v N roa o m t.0,E1 a v o $,o 0 3'0.1 c v w E o 7 ° cU 0 L mi oog e. *� 3.51:3 c aa,E c .6 (.) 4.) dy',`�so ' w4=1 co=a . E . °>c� N x o q�x �n � roA � H Aho 0-0 3 °u, U 2 AA'U''O Cy 9. v LU +7 in N 7 > CC•.° °w N N c p G G °'0'O 7 7•7 N a d, P. a L m O T U , ow 3 A E z a v o N 4• O N E� . 1.) O w N U(�, p 0 G c O'C ° 3 3L v v v v a > ' a T C r L o 0.0^ ,c G N o.v v c _.. 0 v y m Eva a 73 5, 5 v v x a • aO °r - voaU ° Lv EvOadao � ao00a' 04v0 L ° ° va Aav -000 C�'S..� � , 6N �i.q. Lo' - .5.544 .5 LI. U) v3aw 3 o ▪ >N U Returning to Work—Guidance for Employers • When should workers who have been ill with influenza return to the workplace?This document provides an overview of influenza symptoms, criteria for employee return,and important qualifications for use of this Region 2 information during a pandemic flu. t;E L H Influenza Virus How it spreads—Influenza viruses are spread from person to person primarily through respiratory droplet transmission(e.g.,when an infected person coughs or sneezes in close proximity,normally 3 feet or less, to an uninfected person). The virus may also be spread through contact with infectious respiratory secretions on the hands of an infected person or by touching objects or surfaces contaminated with the virus. Incubation &Infection—The typical incubation period for influenza is 1-4 days,with an average of 2 days. Adults can be infectious from the day before symptoms begin through approximately 5-7 days after illness onset. Children can be infectious for>_10 days after the onset of symptoms. Severely immunocompromised persons can be infectious for weeks or months. Current Criteria for Returning to Work ❑ Workers who have become ill with influenza should stay home for at least 24 hours after their fever (100° Fahrenheit or 37.8° Celsius or greater) is gone without the use of fever-reducing medicine and regardless of whether or not antiviral medications are used. • ❑ This guidance does not apply to health care settings where the exclusion period continues to be for 7 days from symptom onset or until 24 hours after the resolution of symptoms,whichever is longer. ❑ GUIDANCE IS CONSTANTLY CHANGING. Check for updates at www.cdc.gov/h1 n1 flu/ Upon returning to the work environment, employees should continue to follow cough etiquette and hand washing protocols. Criteria for Pandemic Influenza Experts do not know whether the mode of transmission,incubation period, or contagious period of pandemic strains of the influenza virus will remain similar to those of seasonal influenza (recurring yearly). Because of this, employers must be vigilant for specific recommendations from Public Health during an influenza pandemic regarding management of illness in the workplace,including when it is safe for workers to return to the work environment after illness with influenza. More Information Kitsap County Health District www.kitsapcountyhealth.com Jefferson County Public Health www.jeffersoncountypublichealth.org Clallam County Health&Human Services www.clalla.m.net/:HealthServicesi Washington State Department of Health www.doh.wa.gov Centers for Disease Control and Prevention www.cdc.gov Public Health working to prevent the spread of disease Region 2 Clallam, Jefferson & Kitsap Counties KCHD 08/14/09 d. i §w tifiBion Public2 .,,1r Ff-Ttlic's's^-...,__...-- , ''' ' .- --,L------A,:titt4 ic #o7tiPenjnsuIas Working to prevent the spread of disease x r f €� :. -9i 9 Steps your business can take NOW Imagine if your business had to function with 25 to 30 percent of your staff sick or caring for sick family members. Do you have a business plan that anticipates all hazards including fire, earthquake and an influenza pandemic? Have you anticipated the impacts specific to your business? Contingency plans Would your emergency plan work for an influenza pandemic as well as for any other hazard? Develop a plan that will. Core business activities What activities must happen in your business in order to function? Identify what you absolutely can't do without. • Essential services How will you handle interruptions of water, power, and sanitation?Identify back- up solutions to keep your staff and clients safe. Cross training Can your employees perform a variety of essential functions? Make sure no individual is indispensable. Operations requirements Is your critical inventory adequate? Develop a checklist of what you can't function without and keep it in stock. Alternative work sites What services can your employees do off site? Establish policies and tools to help them work at home if possible. Services online or by phone What services can your employees deliver online or over the phone? Start phone and online consulting now. Employee awareness Do your employees know about your emergency plans?Are they informed about pandemic flu? Educate them now! Leave policies What about your sick leave and family leave policies? Update them now. Your employees may be too concerned about lost wages to stay home when they are sick. • Handwashing—A Business Basic! Encourage employees to For more information about practice good respiratory etiquette and to wash their hands frequently and business preparation go to thoroughly with soap and water. Make alcohol-based hand sanitizers these websites readily available when soap and water are not handy. v"`^'"�'cdc.gov/cluep�nde�r�m; checklists.htm; www.healthyamericans.org/ nR/1IMO Returning to Work—Guidance for Employers When should workers who have been ill with influenza return to the ,, workplace?This document provides an overview of influenza symptoms, !�',r t_ criteria for employee return, and important qualifications for use of this information during a pandemic flu. Hpiti ayRegion 2 Influenza Virus How it spreads—Influenza viruses are spread from person to person primarily through respiratory droplet transmission(e.g.,when an infected person coughs or sneezes in close proximity,normally 3 feet or less, to an uninfected person). The virus may also be spread through contact with infectious respiratory secretions on the hands of an infected person or by touching objects or surfaces contaminated with the virus. Incubation &Infection—The typical incubation period for influenza is 1-4 days,with an average of 2 days. Adults can be infectious from the day before symptoms begin through approximately 5-7 days after illness onset. Children can be infectious for>_10 days after the onset of symptoms. Severely immunocompromised persons can be infectious for weeks or months. Current Criteria for Returning to Work ❑ Workers who have become ill with influenza should stay home for at least 24 hours after their fever (100°Fahrenheit or 37.8°Celsius or greater) is gone without the use of fever-reducing medicine and regardless of whether or not antiviral medications are used. • ❑ This guidance does not apply to health care settings where the exclusion period continues to be for 7 days from symptom onset or until 24 hours after the resolution of symptoms,whichever is longer. ❑ GUIDANCE IS CONSTANTLY CHANGING. Check for updates at www.cdc.gov/hlnlflu/ Upon returning to the work environment,employees should continue to follow cough etiquette and hand washing protocols. Criteria for Pandemic Influenza Experts do not know whether the mode of transmission,incubation period,or contagious period of pandemic strains of the influenza virus will remain similar to those of seasonal influenza (recurring yearly). Because of this,employers must be vigilant for specific recommendations from Public Health during an influenza pandemic regarding management of illness in the workplace,including when it is safe for workers to return to the work environment after illness with influenza. More Information Kitsap County Health District www.kitsapcountyhealth.com Jefferson County Public Health www.jeffersoncountypublichealth.org Clallam County Health&Human Services www.clallam.net/HealthServices/ Washington State Department of Health www.doh.wa.gov Centers for Disease Control and Prevention www.cdc.gov • Public Health working to prevent the spread of disease Region 2 Clallam, Jefferson & Kitsap Counties KCHD 08/14/09 ,J C. OrSAP eag yy�11_.t..,, couNT,Re911on2EALT ■T R; Healt h four tl�e Peninsulas Working to prevent the spread of disease When business is not usual 9 your Stepsbusiness P can take NOW Imagine if your business had to function with 25 to 30 percent of your staff sick or caring for sick family members. Do you have a business plan that anticipates all hazards including fire,earthquake and an influenza pandemic?Have you anticipated the impacts specific to your business? 1 Contingency plans Would your emergency plan work for an influenza pandemic as well as for any other hazard? Develop a plan that will. 2 Core business activities What activities must happen in your business in order to function?Identify what you absolutely can't do without. 110 3 Essential services How will you handle interruptions of water, ower,and back- up solutions to keep your staff and clients safe. p sanitation?Identify 4 Cross training Can your employees perform a variety of essential functions? Make sure no individual is indispensable. 5 Operations requirements Is your critical inventory adequate? Develop a checklist of what you can't function without and keep it in stock. 6 Alternative work sites What services can your employees do off site?Establish policies and tools to help them work at home if possible. 7 Services online or by phone What services can your employees deliver online or over the phone? Start phone and online consulting now. 8 Employee awareness Do your employees know about your emergency plans?Are they informed about pandemic flu?Educate them now! 9 Leave policies What about your sick leave and family leave policies? Update them now. Your employees may be too concerned about lost wages to stay home when they are sick. Handwashing_A Business Basic! Encourage employees to For more information about • practice good respiratory etiquette and to wash their hands frequently and business preparation go to thoroughly with soap and water. Make alcohol-based hand sanitizers ww / gw.cdc. ov ffuSea websites: readily available when soap and water are not handy. chec / ecklists.htm; www.healthyamericans.org/ 08/13/09