The URL can be used to link to this page

Home My WebLink About2009- September File Copy S Jefferson County Board of 3-CeaCth Agenda .9V1 mutes • September 17, 2009 • • JEFFERSON COUNTY BOARD OF HEALTH September 17, 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 August 20, 2009 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. West Nile Virus Update 2. Correspondence from Senator Murray • V. New Business 1. Board of Health Bylaws Revision 2. Nurse Family Partnership: State Board of Health Correspondence and Local Funding Options 3. Pandemic H1N1 Preparedness Update 4. Board of Health—Hospital Board of Commissioners Collaboration 5. Green Business Award—Computer.Fix VI. Activity Update VII. Agenda Planning VIII. Next Scheduled Meeting: October 15, 2009 2:30 —4:30 PM Jefferson County Public Health • JEFFERSON COUNTY BOARD OF HEALTH • MINUTES Thursday, August 20, 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 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 2:33 PM. Members Present: John Austin, Roberta Frissell, Kristen Nelson, Chuck Russell, David Sullivan, Sheila Westerman Members Excused: Phil Johnson Staff Present: Jean Baldwin, Julia Danskin • Guests: Frances Joswick, SAAB A quorum was present. APPROVAL OF AGENDA Member Austin moved that the Swine Flu update be moved to the first item under Old Business for the convenience of the press; Kristen Nelson seconded. Frances Joswick requested that an SAAB Update be added to the agenda. Member Sullivan moved and Member Austin seconded for approval of the agenda, as amended. The agenda was approved unanimously. APPROVAL OF MINUTES Member Austin moved for approval of the minutes of July 16, 2009; Member Sullivan seconded. The minutes of July 16, 2009 were unanimously approved, as presented. • Page 1 of 10 PUBLIC COMMENTS There were no public comments. OLD BUSINESS and INFORMATIONAL ITEMS West Nile Virus Detected in Mason County Crow Jean Baldwin referred to the public health announcement in the packet, which included the August 7 State update on West Nile virus. In addition to one horse with West Nile virus in Island County about 2 years ago, a crow in Mason County has been confirmed with the disease. Ms. Baldwin said that there have been no human cases on the Peninsula. Public education messages have been issued. The educational message to horse owners is to have their horses vaccinated. The County staff continues to culture dead birds and then ship specimens to DOH. She said that DOH has a new GIS based tracking system this year; they make decisions on which birds are to be cultured for West Nile virus depending on where they are found. In response to a question about whether to expect massive bird fatalities, Ms. Baldwin said that the pattern has been different in Washington than in other states. She said that the density of mosquitoes and weather conditions may be factors. Although there are mosquito carriers here and cases have been detected in horses, as well as birds, the disease has not spread to humans. State Board of Health Summary • Member Austin referred to the July 8, 2009 approved minutes for the State BOH meeting held in Jefferson County. He pointed out the item regarding the presentation that had been given by Quen Zorrah, Jefferson County Public Health Nurse, and the positive comments about it from Chair Katz. Member Austin reported that Chair Katz, who is retiring, had been recognized for his able leadership and contributions over the years. He also discussed the passageof the School Rules by the State BOH. It is significant that the document includes the proviso that, section by section,the School Rules become effective as the State Legislature approves and funds them. This was based on the bill stating that no rules can be passed by the BOH until they are approved by the State Legislature. Local school boards will be notified as each set of rules goes into effect; particular sections are scheduled to go into effect over the period from 2010 to 2014. He said that the rules are reasonable and allow for discretion of local Health Officers with regard to implementation. These rules provide requirements for a wide range of safety and health related matters, such as mold conditions, water testing frequency and thresholds, requirements for where and how new schools may be constructed, and notification of parents for certain conditions. He said that development of the Rules has • Page 2 of 10 been going on for about 8 years. They have been thoroughly reviewed by the State BOH, particularly by the Environmental Health committee of which John Austin is a member. Septic Community Education Update Jean Baldwin briefly reviewed the BOH historical background and explained that the department would be approaching requirements in a different way. She said that the plan is to work collaboratively with other Counties. She asked BOH members to view the websites provided. Staff is meeting with other Puget Sound health departments that are conducting 0 &M training for home owners: Island, Clallam, Whatcom, Skagit and Snohomish. There is a home owner training CD developed by Island County and available on their web site. JCPH, Environmental Health Department,will begin to make use of this as a basic septic education tool. She mentioned that she has received calls from citizens who attended Septic 101 at the Grange Hall stating that the current class was extremely informative and worthwhile. JCPH will start education within watershed areas such as Snow Creek and shorelines. This will provide education for the highest risk systems (in terms of pollution). Linda Atkins will conduct a series of on-site presentations, in the neighborhood. Baldwin said after several of these have been completed, she will return to the BOH for guidance on how to proceed with 0 & M. 0 &M inspections have been added to the data base. She said the department is enforcing the State law but is not actively helping homeowners inspect. She said she hoped this gradual approach would make the transition easier and less contentious. She estimated that BOH discussions about 0 & M would resume in • about six months. Chair Westerman asked about enforcement. Ms. Baldwin said that enforcement of failing systems continues as it always has. Such systems are identified by observation, shoreline surveys and from complaints. When systems are installed,homeowners are informed what processes they must follow, but there is no active enforcement to ensure that systems are regularly inspected and maintained. There was brief further discussion about timing and the benefit of learning from other counties who are in the process of implementing new homeowner 0 & M procedures. Member Sullivan mentioned that Jefferson County has been requiring inspections at the time of property sales. There was a brief review of the web application that allows access to all records for a parcel, including septic permits. Member Austin asked what the percentage of total County septic systems are entered in the database. Jean Baldwin said she believes this is nearly all the County systems, except for an unknown number of un-permitted systems. Member Austin asked if Jefferson county citizens are welcome to attend Clallam trainings on septic system maintenance. Ms. Baldwin explained that Clallam had received a$350,000 grant from Ecology and presumed this was for Clallam County residents only. Chair Westerman asked for clarification on the use of the Island County CD. She was in favor of making it available immediately. Jean Baldwin said that staff resources are • Page 3 of 10 assigned to work on this beginning in October, at which time a detailed plan and press releases etc will be developed. BOH members were in favor of the approach Ms. • Baldwin had described. SAAB Update Report Frances Joswick noted that September is Substance Abuse Recovery month. The SAAB Public Relations subcommittee is working with Kelly Matlock to prepare special items for National Alcohol and Drug Recovery Month. (John Austin is a member of the subcommittee.) Conner Daley's term on the Substance Abuse Advisory Board is expiring in September. Ms. Joswick requested BOH approval to invite him to serve for a second term. Member Austin moved that the BOH invite and endorse Mr. Conner Daley to serve a second term. Member Sullivan seconded and the BOH approved the motion unanimously. Ms. Joswick noted the continuing success of the Relapse Prevention Program at the County Jail. She said she has learned of a possible funding source through the State Department of Commerce. Ms. Joswick has conveyed the requested information to Mr. Queen who will attempt to have any unspent funds allocated and to place the program in line for future funds. The SAAB subcommittee on Community Issues will explore the options for a • Medications Disposal Program in Jefferson County, and plans to seek participation from local pharmacies. Jean Baldwin supported the idea and noted that there is opportunity for sharing of the costs with Clallam County for secure transportation of the drugs to Eastern Washington. She said that there is additional work and expense for the participating pharmacies, but that Julia Danskin would be available to help plan and implement. There was a brief discussion about the Clallam pharmacy procedures that would likely serve as a model for Jefferson County pharmacies. Pandemic H1N1 Preparedness Update: Jean Baldwin referred to the press release that was sent out August 27, which provides common sense guidelines for businesses, households and the community in assessing readiness and preparing for the H1N1 virus (swine flu). She said that Secretary of Health and Human Services Kathleen Sebelius and former Governor Locke had appeared on several television programs advising businesses to make pandemic plans and preparations. Julia Danskin said she is beginning to do outreach by visiting local businesses, to provide basic information and advice to decrease the spread of disease. Chair Westerman asked if seasonal flu shots are advised for everyone. Jean Baldwin said that is the case. • Page 4 of 10 $ Julia Danskin is working with a group of volunteers to alert and inform businesses and • service organizations with heavy people traffic, such as banks,transit, restaurants, grocery stores etc. They will urge people to stay home when they are ill. Fran Joswick added that former Governor Locke urged businesses to not require people to present physician excuse forms when they return to work after illness, as this would overburden the system. According to the CDC,people may return to work or school 24 hours after their fever stops, without the use of anti-fever medications. Guidelines are different for healthcare workers and are expected to change. Currently healthcare workers can return to work 7 days after the onset of symptoms. Other details may be found in the brochure. As the situation evolves, the latest changes and updates will always be available on the JCPH website. There was discussion about evolving recommendations for health care workers and schools. Jean Baldwin summarized by noting that there is an internal plan, and each staff member has assigned responsibilities. The department is participating in regular conference calls with regional partners and State Department of Health. There are evolving plans for schools; it is not recommended that school buildings be closed this year. Ms. Baldwin mentioned a series of meetings that have been held with Jefferson Healthcare and other providers regarding screening and treating sick people and • implementation of mass clinics. Dr. Locke and Lisa McKenzie are lead staff in all discussions with local providers. Member Austin asked if Health Department staff would be vaccinated for seasonal flu. Ms. Baldwin said she had ordered 100 doses and is unclear whether there will be adequate supplies for employees. She said that Safeway, Costco, physician offices, and Jefferson Healthcare will all have supplies, and it is likely that the total supply for the community will be adequate. It is hoped that this year's vaccine will be a good match for the seasonal flu, but its effectiveness will not be known in advance. Chair Westerman asked for reasons that people may not wish to be vaccinated for swine flu, and if fears are based on any evidence. Ms. Baldwin said testing is still in process, there is really no definitive information available yet. Member Austin mentioned studies that have shown that certain subcultures of the population are more reluctant to vaccinate than others. There will be a limited supply of vaccine initially, so the vaccine will only be designated for those 24 years and younger. Coordination of messaging about the disease at all levels will continue to be very important. Member Russell asked how any remaining vaccine would be prioritized beyond the first five groups on the list. Ms. Baldwin said that local health officers may have discretion regarding local supplies, but the State Department of Health and CDC will have final say. • Page 5 of 10 Jean Baldwin said that meetings with hospital and physician groups have yielded very important information on preferred means of communications and updates, i.e. how to let 4111 physicians know of evolving information without overwhelming them. They requested a separate section on the web site for physicians/providers,which would include daily updates and bulletins. The Health Department will continue to fax communications to physician offices, but also add a web enhancement. Green Business Award—Port Townsend Computers Port Townsend Computers has been given the Green Business award. Member Westerman said she was pleased about the addition of this computer business and hopes that this will be posted in the newspaper. Jean Baldwin said that a press release has been sent to local newspapers. She said that the Health Department is updating plans and promoting this program, which is well regarded in the business community. WIC (Women,Infants and Children)Annual Report Julia Danskin reviewed the report, which is published by the State DOH. She noted that WIC vouchers used at local grocery stores and for local farmers amounted to $307,718 and$1,682 respectively. Jefferson WIC continues to serve higher numbers of women, infants and children than the State average. Ms. Danskin expressed her satisfaction and approval of the program. Ms. Danskin said the WIC program is changing on October 1 to support healthier . lifestyles. For example, it includes fresh fruits and vegetables and more whole grains, with less juice, cheese and eggs. There is an accompanying educational program about healthier diets. A portion of the program is funded through the General Fund. 2009 Budget Update Jean Baldwin described the purpose and content of the budget documents in the packet. "How is Public Health Different from Health Care", she said that Phillip Morley, County Administrator, had asked her to explain"What is Public Health?", "and"how is it governmental?" She noted that Public Health is primarily monitoring communicable disease. She said perhaps it is a document that should be shared with the City and the Hospital. It is necessary to understand the nature of Public Health before discussing budgets. Veronica Shaw explained the set of color graphs which show all revenue sources for Community Health, Environmental Health, and Department Administration. Within those divisions, the data is broken out by program, analogous to the way Performance Measures are organized. The intention is to show how each program is funded and to provide a sense of scale and relativity for programs versus revenue sources. Ms. Shaw discussed the amount of County dollars to matching grants. • Page 6 of 10 Member Austin said that it would be helpful to know the full impact of any proposed cuts • in the General Fund for particular programs. Jean Baldwin listed the programs and services that fall under the major headings. Family Support includes MCH (Maternal Child Health),the Child Abuse Prevention Team, WIC,Early Childhood Care. Population and Prevention includes: Tobacco and Substance Abuse Prevention, i.e. population based education which is largely grant funded. Communicable Disease includes communicable disease coordination and tracking, epidemiology, immunizations, and STD/HIV testing counseling. Communicable Disease has more State money in 2009, but that will decrease next year. Board members commended staff on the graphs and requested that the high level headings be explained and expanded in future versions, for the benefit of reviewers. Member Sullivan stated that with regard to the County General Fund budget process, it appears that about $500,000 will need to be cut each year for the next three years in order to balance the overall budget. He said that both mandated(level of service) and un- mandated services will need to be reviewed. There was further discussion about other County programs and services and their relationship to Public Health. Member Nelson asked how the budget process works for Public Health. Chair Westerman said that the BOH reviews and recommends the proposed budget to the BOCC, who has final authority to approve or amend. Member Nelson suggested that, in the spirit of a fair share approach, it would be reasonable to adjust permit fees for various services to cover the costs to the County. Chair Westerman agreed and said that the • County has been moving in this direction. However, since fees have previously been held steady for many years,the gap was wide and had to be closed over a period of time, rather than by dramatic increases in one or two years. That goal had almost been attained. Ms. Shaw added that programs that had been sustaining themselves no longer are, because of the economic climate and downturn in permit applications; fee revenues are down almost 50%. The department has already responded to that through various staff reductions. Member Austin asked when parcel fees would be collected; Ms. Shaw stated that would begin in January. However, she explained that Water Quality grants were once required to go through a public health department, i.e. DOE would not contract with Water Quality directly because they didn't recognize them as a County department. Therefore, Public Health was signatory to the contracts and the money came in to the 127 fund, which is Public Health. Public Health was managing the grant funds and reimbursing Water Quality for their services. However, in 2010, DOE will contract directly with Water Quality. There was clarification that the approximately$88,000 from parcel fees will be part of the Water Quality budget, not Public Health. Member Russell questioned why Water Quality reports to the JCPH. Jean Baldwin responded that it is because of the many public health related issues and policies, e.g. shellfish and drinking water. She said there are also non-health related issues, e.g. salmon recovery, stream flow, water quantity, etc. that in a larger county would reside in a separate department. • Page 7of10 Member Sullivan stated that in the past the City had contributed to some of these programs, and has a choice to do so. More than a third of the services go to the City, which requires that a balance must be worked out among the numerous shared services and costs. Ms. Shaw returned to the earlier discussion regarding departmental responses to the loss of revenues. She said that a RIF (reduction in force) was done in Environmental Health in 2008 due to the situation, and adjustments will continue. For example,multiple departments may share the hours and services of a particular FTE, with budgets reflecting that arrangement. She also confirmed that staffing salary and benefit costs are by far the greatest portion of the budget. In 2009, Public Health was asked to cut$57,200 from the General Fund. This involved further adjustments in staffing; a decision to not fill one vacancy, and voluntary reductions in hours. Jean Baldwin stated that the following reductions have been done: $48,000 in Public Health and$26,000 in Water Quality in 2008; $60,000 in 2009. Return to county general fund of$100,000 in cash carried forward has been requested as of September 2009. Ms. Shaw pointed out the chart showing the FTEs and who is actually working on the Onsite Septic System Program, down from 5.14 to 2.05 in 3 years. One impact is the length of time needed to process a permit application. Within this complex budget structure and process, State money is unpredictable. The DASA(Division of Drug Alcohol)contract was described, as an example. Jean Baldwin stated that she has begun a process of looking at what is funded, what are • the highest mandates, and what must be done to change service ratios. In some cases, services will need to be dropped or reduced in some way, as staffing is shifted. Member Russell suggested that volunteers could possibly be utilized for some activities. Ms. Baldwin said that volunteers are used in some programs but noted the need to supervise volunteers; expansion of this practice may require a new coordinator position. Member Austin pointed out the risk and liability if volunteers are not properly trained and supervised. Ms. Baldwin described several other areas where adjustments are being considered, i.e. STD clinic; Aids Case Management; additional voluntary hour reduction; BCHP; Breast and Cervical Cancer Screening, and reduction of appointment and office hours on particular days of the week. Member Austin pointed out Mr. Morley's presentation of the background and rationale for the budget shortfalls. He suggested that perhaps citizens will begin to reconsider the 1%growth limit and impacts on services. He noted that other counties are now pursuing levy lid lifts to address revenue shortfalls. Jean Baldwin pointed out the citations from the Royer Report in the packet, which is helpful in presenting the historical context for the present budget situation. Member Sullivan added that there are several lawsuits at the State level regarding the cuts made in the last budget, which may delay implantation of those cuts and/or cause budget • Page 8 of 10 adjustments in other programs. The status of citizen initiatives to cap tax revenues was • briefly discussed. Member Nelson asked for information on the percentage of the total property tax revenue that is paid by the City of Port Townsend. Jean Baldwin said that she would follow up on that request. Ms.Nelson mentioned new legislation that requires reassessment of properties county-wide annually. Chair Westerman and BOH members indicated their appreciation and support for the work staff is doing on budget trimming and adjustments. Baldwin will continue to decrease staffing hours and try to maintain services. Veronica Shaw introduced Lana McGinn, who has been on staff for about six months and has been assisting with the budget process. Member Sullivan stated that he plans to attend the intergovernmental meeting on Mystery Bay on Friday, August 28. ACTIVITY UPDATE There were no additional updates. • AGENDA PLANNING BOH Bylaws and Budgeting will be discussed at the September 17 meeting. Jean Baldwin will work with Phillip Morley on public announcements about budget adjustments. Jean Baldwin will present materials on County demographics in October. ADJOURNMENT Member Austin moved for adjournment; Member Frissell seconded. Chair Westerman adjourned the meeting at 4:35 PM. • Page 9 of 10 I JEFFERSON COUNTY BOARD OF HEALTH Excused Sheila Westerman, Chair Phil Johnson, Member Chuck Russell, Vice-Chair John Austin, Member Excused Roberta Frissell, Member David Sullivan, Member Kristen Nelson, Member S • Page 10 of 10 /I JEFFERSON COUNTY BOARD OF HEALTH • MINUTES Thursday, August 20, 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 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 2:33 PM. Members Present: John Austin, Roberta Frissell, Kristen Nelson, Chuck Russell, David Sullivan, Sheila Westerman Members Excused: Phil Johnson Staff Present: Jean Baldwin, Julia Danskin • Guests: Frances Joswick, SAAB A quorum was present. APPROVAL OF AGENDA Member Austin moved that the Swine Flu update be moved to the first item under Old Business for the convenience of the press; Kristen Nelson seconded. Frances Joswick requested that an SAAB Update be added to the agenda. Member Sullivan moved and Member Austin seconded for approval of the agenda, as amended. The agenda was approved unanimously. APPROVAL OF MINUTES Member Austin moved for approval of the minutes of July 16,2009; Member Sullivan seconded. The minutes of July 16, 2009 were unanimously approved, as presented. • Page 1 of 10 PUBLIC COMMENTS There were no public comments. • OLD BUSINESS and INFORMATIONAL ITEMS West Nile Virus Detected in Mason County Crow Jean Baldwin referred to the public health announcement in the packet, which included the August 7 State update on West Nile virus. In addition to one horse with West Nile virus in Island County about 2 years ago, a crow in Mason County has been confirmed with the disease. Ms. Baldwin said that there have been no human cases on the Peninsula. Public education messages have been issued. The educational message to horse owners is to have their horses vaccinated. The County staff continues to culture dead birds and then ship specimens to DOH. She said that DOH has a new GIS based tracking system this year; they make decisions on which birds are to be cultured for West Nile virus depending on where they are found. In response to a question about whether to expect massive bird fatalities, Ms. Baldwin said that the pattern has been different in Washington than in other states. She said that the density of mosquitoes and weather conditions may be factors. Although there are mosquito carriers here and cases have been detected in horses, as well as birds,the disease has not spread to humans. State Board of Health Summary • Member Austin referred to the July 8, 2009 approved minutes for the State BOH meeting held in Jefferson County. He pointed out the item regarding the presentation that had been given by Quen Zorrah, Jefferson County Public Health Nurse, and the positive comments about it from Chair Katz. Member Austin reported that Chair Katz, who is retiring, had been recognized for his able leadership and contributions over the years. He also discussed the passage of the School Rules by the State BOH. It is significant that the document includes the proviso that, section by section,the School Rules become effective as the State Legislature approves and funds them. This was based on the bill stating that no rules can be passed by the BOH until they are approved by the State Legislature. Local school boards will be notified as each set of rules goes into effect; particular sections are scheduled to go into effect over the period from 2010 to 2014. He said that the rules are reasonable and allow for discretion of local Health Officers with regard to implementation. These rules provide requirements for a wide range of safety and health related matters, such as mold conditions, water testing frequency and thresholds, requirements for where and how new schools may be constructed, and notification of parents for certain conditions. He said that development of the Rules has • Page 2 of 10 r been going on for about 8 years. They have been thoroughly reviewed by the State BOH, • particularly by the Environmental Health committee of which John Austin is a member. Septic Community Education Update Jean Baldwin briefly reviewed the BOH historical background and explained that the department would be approaching requirements in a different way. She said that the plan is to work collaboratively with other Counties. She asked BOH members to view the websites provided. Staff is meeting with other Puget Sound health departments that are conducting 0 & M training for home owners: Island, Clallam, Whatcom, Skagit and Snohomish. There is a home owner training CD developed by Island County and available on their web site. JCPH,Environmental Health Department,will begin to make use of this as a basic septic education tool. She mentioned that she has received calls from citizens who attended Septic 101 at the Grange Hall stating that the current class was extremely informative and worthwhile. JCPH will start education within watershed areas such as Snow Creek and shorelines. This will provide education for the highest risk systems (in terms of pollution). Linda Atkins will conduct a series of on-site presentations, in the neighborhood. Baldwin said after several of these have been completed, she will return to the BOH for guidance on how to proceed with 0 & M. 0 &M inspections have been added to the data base. She said the department is enforcing the State law but is not actively helping homeowners inspect. She said she hoped this gradual approach would make the transition easier and less contentious. She estimated that BOH discussions about 0 & M would resume in • about six months. Chair Westerman asked about enforcement. Ms. Baldwin said that enforcement of failing systems continues as it always has. Such systems are identified by observation, shoreline surveys and from complaints. When systems are installed, homeowners are informed what processes they must follow, but there is no active enforcement to ensure that systems are regularly inspected and maintained. There was brief further discussion about timing and the benefit of learning from other counties who are in the process of implementing new homeowner 0 & M procedures. Member Sullivan mentioned that Jefferson County has been requiring inspections at the time of property sales. There was a brief review of the web application that allows access to all records for a parcel, including septic permits. Member Austin asked what the percentage of total County septic systems are entered in the database. Jean Baldwin said she believes this is nearly all the County systems, except for an unknown number of un-permitted systems. Member Austin asked if Jefferson county citizens are welcome to attend Clallam trainings on septic system maintenance. Ms. Baldwin explained that Clallam had received a$350,000 grant from Ecology and presumed this was for Clallam County residents only. Chair Westerman asked for clarification on the use of the Island County CD. She was in • favor of making it available immediately. Jean Baldwin said that staff resources are Page 3 of 10 assigned to work on this beginning in October, at which time a detailed plan and press releases etc will be developed. BOH members were in favor of the approach Ms. ID Baldwin had described. SAAB Update Report Frances Joswick noted that September is Substance Abuse Recovery month. The SAAB Public Relations subcommittee is working with Kelly Matlock to prepare special items for National Alcohol and Drug Recovery Month. (John Austin is a member of the subcommittee.) Conner Daley's term on the Substance Abuse Advisory Board is expiring in September. Ms. Joswick requested BOH approval to invite him to serve for a second term. Member Austin moved that the BOH invite and endorse Mr. Conner Daley to serve a second term. Member Sullivan seconded and the BOH approved the motion unanimously. Ms. Joswick noted the continuing success of the Relapse Prevention Program at the County Jail. She said she has learned of a possible funding source through the State Department of Commerce. Ms. Joswick has conveyed the requested information to Mr. Queen who will attempt to have any unspent funds allocated and to place the program in line for future funds. The SAAB subcommittee on Community Issues will explore the options for a • Medications Disposal Program in Jefferson County, and. plans to seek participation from local pharmacies. Jean Baldwin supported the idea and noted that there is opportunity for sharing of the costs with Clallam County for secure transportation of the drugs to Eastern Washington. She said that there is additional work and expense for the participating pharmacies, but that Julia Danskin would be available to help plan and implement. There was a brief discussion about the Clallam pharmacy procedures that would likely serve as a model for Jefferson County pharmacies. Pandemic HINT Preparedness Update: Jean Baldwin referred to the press release that was sent out August 27, which provides common sense guidelines for businesses, households and the community in assessing readiness and preparing for the H1N1 virus (swine flu). She said that Secretary of Health and Human Services Kathleen Sebelius and former Governor Locke had appeared on several television programs advising businesses to make pandemic plans and preparations. Julia Danskin said she is beginning to do outreach by visiting local businesses,to provide basic information and advice to decrease the spread of disease. Chair Westerman asked if seasonal flu shots are advised for everyone. Jean Baldwin said that is the case. • Page 4 of 10 I Julia Danskin is working with a group of volunteers to alert and inform businesses and • service organizations with heavy people traffic, such as banks,transit, restaurants, grocery stores etc. They will urge people to stay home when they are ill. Fran Joswick added that former Governor Locke urged businesses to not require people to present physician excuse forms when they return to work after illness, as this would overburden the system. According to the CDC,people may return to work or school 24 hours after their fever stops, without the use of anti-fever medications. Guidelines are different for healthcare workers and are expected to change. Currently healthcare workers can return to work 7 days after the onset of symptoms. Other details may be found in the brochure. As the situation evolves, the latest changes and updates will always be available on the JCPH website. There was discussion about evolving recommendations for health care workers and schools. Jean Baldwin summarized by noting that there is an internal plan, and each staff member has assigned responsibilities. The department is participating in regular conference calls with regional partners and State Department of Health. There are evolving plans for schools; it is not recommended that school buildings be closed this year. Ms. Baldwin mentioned a series of meetings that have been held with Jefferson Healthcare and other providers regarding screening and treating sick people and • implementation of mass clinics. Dr. Locke and Lisa McKenzie are lead staff in all discussions with local providers. Member Austin asked if Health Department staff would be vaccinated for seasonal flu. Ms. Baldwin said she had ordered 100 doses and is unclear whether there will be adequate supplies for employees. She said that Safeway, Costco, physician offices, and Jefferson Healthcare will all have supplies, and it is likely that the total supply for the community will be adequate. It is hoped that this year's vaccine will be a good match for the seasonal flu, but its effectiveness will not be known in advance. Chair Westerman asked for reasons that people may not wish to be vaccinated for swine flu, and if fears are based on any evidence. Ms. Baldwin said testing is still in process, there is really no definitive information available yet. Member Austin mentioned studies that have shown that certain subcultures of the population are more reluctant to vaccinate than others. There will be a limited supply of vaccine initially, so the vaccine will only be designated for those 24 years and younger. Coordination of messaging about the disease at all levels will continue to be very important. Member Russell asked how any remaining vaccine would be prioritized beyond the first five groups on the list. Ms. Baldwin said that local health officers may have discretion regarding local supplies, but the State Department of Health and CDC will have final say. • Page Sof 10 Jean Baldwin said that meetings with hospital and physician groups have yielded very important information on preferred means of communications and updates, i.e. how to let • physicians know of evolving information without overwhelming them. They requested a separate section on the web site for physicians/providers, which would include daily updates and bulletins. The Health Department will continue to fax communications to physician offices, but also add a web enhancement. Green Business Award—Port Townsend Computers Port Townsend Computers has been given the Green Business award. Member Westerman said she was pleased about the addition of this computer business and hopes that this will be posted in the newspaper. Jean Baldwin said that a press release has been sent to local newspapers. She said that the Health Department is updating plans and promoting this program, which is well regarded in the business community. WIC (Women,Infants and Children)Annual Report Julia Danskin reviewed the report,which is published by the State DOH. She noted that WIC vouchers used at local grocery stores and for local farmers amounted to $307,718 and$1,682 respectively. Jefferson WIC continues to serve higher numbers of women, infants and children than the State average. Ms. Danskin expressed her satisfaction and approval of the program. Ms. Danskin said the WIC program is changing on October 1 to support healthier . lifestyles. For example, it includes fresh fruits and vegetables and more whole grains, with less juice, cheese and eggs. There is an accompanying educational program about healthier diets. A portion of the program is funded through the General Fund. 2009 Budget Update Jean Baldwin described the purpose and content of the budget documents in the packet. "How is Public Health Different from Health Care", she said that Phillip Morley, County Administrator, had asked her to explain"What is Public Health?", "and"how is it governmental?" She noted that Public Health is primarily monitoring communicable disease. She said perhaps it is a document that should be shared with the City and the Hospital. It is necessary to understand the nature of Public Health before discussing budgets. Veronica Shaw explained the set of color graphs which show all revenue sources for Community Health, Environmental Health, and Department Administration. Within those divisions, the data is broken out by program, analogous to the way Performance Measures are organized. The intention is to show how each program is funded and to provide a sense of scale and relativity for programs versus revenue sources. Ms. Shaw discussed the amount of County dollars to matching grants. • Page 6 of 10 Member Austin said that it would be helpful to know the full impact of any proposed cuts • in the General Fund for particular programs. Jean Baldwin listed the programs and services that fall under the major headings. Family Support includes MCH (Maternal Child Health), the Child Abuse Prevention Team, WIC, Early Childhood Care. Population and Prevention includes: Tobacco and Substance Abuse Prevention, i.e. population based education which is largely grant funded. Communicable Disease includes communicable disease coordination and tracking, epidemiology, immunizations, and STD/HIV testing counseling. Communicable Disease has more State money in 2009, but that will decrease next year. Board members commended staff on the graphs and requested that the high level headings be explained and expanded in future versions, for the benefit of reviewers. Member Sullivan stated that with regard to the County General Fund budget process, it appears that about$500,000 will need to be cut each year for the next three years in order to balance the overall budget. He said that both mandated (level of service) and un- mandated services will need to be reviewed. There was further discussion about other County programs and services and their relationship to Public Health. Member Nelson asked how the budget process works for Public Health. Chair Westerman said that the BOH reviews and recommends the proposed budget to the BOCC, who has final authority to approve or amend. Member Nelson suggested that, in the spirit of a fair share approach, it would be reasonable to adjust permit fees for various • services to cover the costs to the County. Chair Westerman agreed and said that the County has been moving in this direction. However, since fees have previously been held steady for many years,the gap was wide and had to be closed over a period of time, rather than by dramatic increases in one or two years. That goal had almost been attained. Ms. Shaw added that programs that had been sustaining themselves no longer are, because of the economic climate and downturn in permit applications; fee revenues are down almost 50%. The department has already responded to that through various staff reductions. Member Austin asked when parcel fees would be collected; Ms. Shaw stated that would begin in January. However, she explained that Water Quality grants were once required to go through a public health department, i.e. DOE would not contract with Water Quality directly because they didn't recognize them as a County department. Therefore, Public Health was signatory to the contracts and the money came in to the 127 fund, which is Public Health. Public Health was managing the grant funds and reimbursing Water Quality for their services. However, in 2010, DOE will contract directly with Water Quality. There was clarification that the approximately $88,000 from parcel fees will be part of the Water Quality budget, not Public Health. Member Russell questioned why Water Quality reports to the JCPH. Jean Baldwin responded that it is because of the many public health related issues and policies, e.g. shellfish and drinking water. She said there are also non-health related issues, e.g. salmon recovery, stream flow, water quantity, etc. that in a larger county would reside in a separate department. • Page 7 of 10 Member Sullivan stated that in the past the City had contributed to some of these programs, and has a choice to do so. More than a third of the services go to the City, which requires that a balance must be worked out among the numerous shared services and costs. Ms. Shaw returned to the earlier discussion regarding departmental responses to the loss of revenues. She said that a RIF (reduction in force)was done in Environmental Health in 2008 due to the situation, and adjustments will continue. For example,multiple departments may share the hours and services of a particular FTE, with budgets reflecting that arrangement. She also confirmed that staffing salary and benefit costs are by far the greatest portion of the budget. In 2009, Public Health was asked to cut $57,200 from the General Fund. This involved further adjustments in staffing; a decision to not fill one vacancy, and voluntary reductions in hours. Jean Baldwin stated that the following reductions have been done: $48,000 in Public Health and$26,000 in Water Quality in 2008; $60,000 in 2009. Return to county general fund of$100,000 in cash carried forward has been requested as of September 2009. Ms. Shaw pointed out the chart showing the FTEs and who is actually working on the Onsite Septic System Program, down from 5.14 to 2.05 in 3 years. One impact is the length of time needed to process a permit application. Within this complex budget structure and process, State money is unpredictable. The DASA(Division of Drug Alcohol) contract was described, as an example. Jean Baldwin stated that she has begun a process of looking at what is funded,what are i the highest mandates, and what must be done to change service ratios. In some cases, services will need to be dropped or reduced in some way, as staffing is shifted. Member Russell suggested that volunteers could possibly be utilized for some activities. Ms. Baldwin said that volunteers are used in some programs but noted the need to supervise volunteers; expansion of this practice may require a new coordinator position. Member Austin pointed out the risk and liability if volunteers are not properly trained and supervised. Ms. Baldwin described several other areas where adjustments are being considered, i.e. STD clinic; Aids Case Management; additional voluntary hour reduction; BCHP; Breast and Cervical Cancer Screening, and reduction of appointment and office hours on particular days of the week. Member Austin pointed out Mr. Morley's presentation of the background and rationale for the budget shortfalls. He suggested that perhaps citizens will begin to reconsider the 1% growth limit and impacts on services. He noted that other counties are now pursuing levy lid lifts to address revenue shortfalls. Jean Baldwin pointed out the citations from the Royer Report in the packet, which is helpful in presenting the historical context for the present budget situation. Member Sullivan added that there are several lawsuits at the State level regarding the cuts made in the last budget, which may delay implantation of those cuts and/or cause budget • Page 8 of 10 adjustments in other programs. The status of citizen initiatives to cap tax revenues was • briefly discussed. Member Nelson asked for information on the percentage of the total property tax revenue that is paid by the City of Port Townsend. Jean Baldwin said that she would follow up on that request. Ms. Nelson mentioned new legislation that requires reassessment of properties county-wide annually. Chair Westerman and BOH members indicated their appreciation and support for the work staff is doing on budget trimming and adjustments. Baldwin will continue to decrease staffing hours and try to maintain services. Veronica Shaw introduced Lana McGinn, who has been on staff for about six months and has been assisting with the budget process. Member Sullivan stated that he plans to attend the intergovernmental meeting on Mystery Bay on Friday, August 28. ACTIVITY UPDATE There were no additional updates. . AGENDA PLANNING BOH Bylaws and Budgeting will be discussed at the September 17 meeting. Jean Baldwin will work with Phillip Morley on public announcements about budget adjustments. Jean Baldwin will present materials on County demographics in October. ADJOURNMENT Member Austin moved for adjournment; Member Frissell seconded. Chair Westerman adjourned the meeting at 4:35 PM. 411 Page 9 of 10 410 JEFFERSON COUNTY BOARD OF HEALTH CA-1-/4-4-1J-k4 Excused Sheila Westerman, Chair Phil Johnson, Member Ti4 1.11,2(tfriii144 Chuck Russell, Vice-Chair Jbhii Austin, Member 47-AA14--"" //2/4, Rob a Frissell, Member David Sul ivan, Member Kristen Nelson, ember • • Page 10 of 10 • Board of 3-Cealth. Oa Business .agenda Items # • West Nile 'Virus 4pcfate September 17, 2009 • • A • OPP:0011, Walton'hthgt n'State Department of • fri, H 1Hea1th News Release For immediate release: September 11, 2009 (09-146) Contacts: Tim Church, Communications Office 360-236-4077 (pgr. 360-534-0068) Gordon MacCracken, Communications Office 360-236-4072 West Nile virus: Nine new human cases confirmed in Washington Positive test results bring 2009 total to 10, state's highest figure ever OLYMPIA—U.S. Centers for Disease Control and Prevention (CDC)testing has confirmed nine more human cases of West Nile virus in Washington, bringing the state's total for the year to 10. Until now, 2008's count of three had been the state's highest yearly human total since the virus first appeared in Washington early this decade. All nine cases were in people who were exposed in Eastern Washington between July 11 and August 12. Four live in Yakima County, three in Benton County, one in Grant County, and one • in Whatcom County. The person from Whatcom County was bitten by mosquitoes while camping in Benton County. "Summer is nearly over, but West Nile virus season is still going strong so people should not let their guard down," said Secretary of Health Mary Selecky. "As long as mosquitoes are out people can get bitten and infected. That's why it is important to prevent bites by using repellent and wearing long sleeves and long pants when you're outside and mosquitoes are active." Of those sickened, one is a man from Yakima County in his 80s. The rest are females. Most are 50 or older, although one is a teenager from Whatcom County, and another from Yakima County is in her 30s. No deaths have been reported. Not all of the confirmed cases specifically recall mosquito bites, but the Eastern Washington residents live in areas with known West Nile-positive mosquito activity nearby. That's significant because the best way to battle the mosquito-borne virus is to keep from getting bitten. Make sure windows and screens are tight, try to stay inside at dusk and dawn, wear long • sleeves and trousers whenever possible, and use effective mosquito repellents. —More— West Nile virus September 11, 2009 Page 2 Standing water is mosquito habitat, so clean out gutters, empty out buckets and other containers, • make sure water in birdbaths and fountains is kept fresh, and fix leaky outdoor faucets and sprinklers. Although West Nile exposure will end for the year when cold weather sets in, mosquitoes are expected to be active for several more weeks. The ages of those affected reflect the group most often affected by West Nile. Anyone can get it, but those 50 and over are considered at highest risk. Most people who are infected with West Nile virus won't get sick. A few will develop severe symptoms such as headache, high fever, neck stiffness, stupor, disorientation, tremors, convulsions, muscle weakness, paralysis, and coma. In rare cases, it can be fatal. People with symptoms should contact a health care provider. Washington's first confirmed human West Nile case this year was in a Klickitat County man in his 50s who was diagnosed earlier this summer. He is recovering. The virus has also been detected in horses and birds, nearly all of them in Eastern Washington. The CDC is continuing to test some Washington samples,but now that Washington has 10 • confirmed cases the state Public Health Laboratories at Shoreline will also be able to do confirmatory testing. Detailed information is on the Department of Health's West Nile virus page. People may report dead birds online. ### Visit the Washington Department of Health Web site at http://www.doh.wa.gov for a healthy dose of information. • • Board of Health Old Business .agenda Items # XV., 2 • Correspondence from Senator Niurray September 17, 2009 • PATTY MURRAY comms l I EES: -ASHINGTON APPROP^'*.TIONS BUDGET HEALTH,EDUCATION,LABOR United t`�dry RULES NS AND ADMINAND ISTRATION • WASHINGTON, DC 20510-;`t-;70.1- VETERANS'AFFAIRS August 13, 2009 Ms. Sheila Westerman Chair Jefferson County Board of Health 615 Sheridan St. Port Townsend, Washington 98368 Dear Ms. Westerman: Thank you for writing me regarding the need for reform in our health care system. It is good to hear from you. As you know, health care reform is one of the most critical issues currently facing our nation. Our current health care system is unstable and unsustainable. Too many Americans with insurance worry that they might lose health insurance due to rising costs, changing or losing jobs or even getting sick. Too many business owners want to cover their employees, but cannot because it is simply too expensive. And millions of Americans are • uninsured and the cost of their care is passed on to those with coverage in the form of higher premiums. Health care reform efforts should strive to ensure that affordable, high-quality, and meaningful health coverage options are available to all Americans. I believe it should be a top priority to ensure Americans have access to coverage that allows them to see a doctor when they need to. People should not be forced to receive their coverage in hospital emergency rooms. After months of hearings and over 50 hours of public markups, I was pleased that on July 15th, the Senate Health, Education, Labor, and Pensions (HELP) Committee passed the Affordable Health Choices Act. The Affordable Health Choices Actlays out policy changes for health care .,..,, Affordable Health Choices , reform in America. This package works to rein in health care costs with a goal of lowering them in the long term and ensure that all Americans have access to high quality, affordable health care coverage. It allows those who like their health insurance to keep it and provides options to those who do not have access to health insurance coverage. This bill includes provisions to implement several key health insurance reforms. For example, insurance companies would no longer be able to refuse coverage to individuals due to preexisting conditions, patients' out-of-pocket expenses would be limited and all annual and lifetime caps on insurance coverage would be eliminated. 17 SSFI I SENATE OFFICE BULLING 1611-116Th AVENUE,NE 2930 WETMORE AVENUE 2988 JACKSON FEDERAL BUILDING 10 NORTH POST STREET 950 PACIFIC AVENUE 0 WASHINGTON,DC 20510-4704 SUITE 214 SUITE 903 915 2ND AVENUE SUITE 600 SUITE 650 (202)224-2621 BELLEVUE,WA 98004-3045 EVEREI I,WA 982014107 SEATTLE,WA 98174-1003 SPOKANE,WA 99201-0613 TACOMA;WA 98402-4450 (425)462-4460 (425)259-6515 (206)553-5545 (509)624-9515 (253)572-3636 TOLL FREE(866)421-9186 THE MARSHALL HOUSE website:httP'//murr3y' g ov senate. ❑ 1323 OFFICER'S ROW 402 EAST YAKIMA AVENUE VANCOUVER,WA 98661-3856 : may.senate.gov/a ail SUITE 390 e-mail:http//m (360)696-7797 PRINTED ON RECYCLED PAPER Y (509)09) WA 98901-2760 453-7462 As a senior member of the HELP Committee, I am particularly proud that this bill includes provisions that would increase the number of Americans going into health care professions. These programs will ensure our system has enough workers to provide much-needed medical care. The passage of the Affordable Health Choices Act out of the HELP Committee is a major step in the longer process of health care reform. The Senate Finance Committee is also working on many aspects of health care reform and the Affordable Health Choices Act will need to be combined with this legislation in the future. The Finance Committee is expected to release their proposal soon. In addition, the House of Representatives is working on a separate version of health care reform legislation. As this effort continues, I will certainly keep your thoughts in mind. You can find more information on my Website at http:!/murray.senate.gov/healthcarereform/. Again, thank you for contacting me about this important issue. If you would like to know more about my work in the Senate, please feel free to sign up for my weekly updates at http://murray.senate.gov/updates. Please keep in touch. I hope all is well in Port Townsend. Sincerely, Patty Murray United States Senator PM\sa • • Board of Health New Business .agenda Item # T., 1 Board of Health, • By Caws Revision September 17, 2009 • #r • BYLAWS OF THE JEFFERSON COUNTY BOARD OF HEALTH ARTICLE 1. NAME The name of this organization shall be the Jefferson County Board of Health. ARTICLE II. PURPOSE The purpose of the Jefferson County Board of Health is to supervise all matters pertaining to the preservation of the life and health of the people of Jefferson County and to comply fully with the requirements of all applicable chapters of Title 70, Revised Code of Washington. The Board of Health shall: • Collect, analyze and disseminate to the community, through Jefferson County Public Health, information about community health conditions, risks and resources, and the availability of resources to address identified • problems. • Enact such rules,regulations and policies as are necessary to preserve, promote and improve the health status of Jefferson County residents, and guide the allocation of appropriate and necessary public health resources. • Assure that necessary,high quality, effective public health services are available for the protection of the people of Jefferson County, including the control and prevention of any dangerous, contagious or infectious disease within the county. • Provide for the prevention, control and abatement of nuisances detrimental to public health. • Enforce,through the Health Officer, the public health statutes of the state and county. • Establish fee schedules for issuing and renewing licenses and permits or for such other services as are authorized by the law and rules of the State Board of Health. Jefferson County Board of Health Page 2 Bylaws ARTICLE III. REPRESENTATION • Membership: The Board of Health shall consist of 7 members, selected as follows: • Each member of the Jefferson County Board of County Commissioners shall serve as a member of the Board of Health for the duration of their elected term of office. • Four members of the Board of Health shall be appointed by the County Commissioners. Appointed members shall include one Port Townsend City Council Member and one Jefferson County Public Hospital District #2 Commissioner nominated by their respective organizations, plus two at-large community representatives. Two of the four appointed members shall be residents of the City of Port Townsend and two shall be residents of unincorporated Jefferson County. Terms: Appointed members shall serve for three year terms. Board of Health members may serve more than one term, including consecutive terms. Vacancies: In the event that a vacancy occurs for an appointed representative, the Board of County Commissioners shall appoint another representative within thirty (30) days of the date of vacancy. In the event that a vacancy occurs from the Port Townsend City Council or Jefferson County Hospital District#2 member, the City or District shall nominate another representative from their membership within thirty (30) days. • Absences: Board members shall notify the Chairperson in advance if unable to attend any regular meeting of the Board of Health. Appointed Board members may be removed from Board membership by action of the County Commissioners for lack of attendance. Three or more unexcused absences from regular Board of Health meetings in one calendar year will be considered cause for removal. ARTICLE IV. OFFICERS Chairperson: The presiding officer of the Board of Health shall be the Chairperson, who shall serve for a term of one (1) year. The Chairperson shall be selected by a majority vote of the Board members present at the first regular meeting of each year. Vice-Chairperson: At the same meeting, a Vice-Chairperson shall also be selected for a term of one (1) year, who shall preside over all proceedings of the Board in the absence of the Chairperson. Vacancies: In the event of a vacancy in the office of Chairperson, the Vice- Chairperson shall immediately assume the duties of the Chairperson for the remainder of the year. Another representative shall be selected to serve as Vice-Chairperson at the next regular or special meeting of the Board. • Jefferson County Board of Health Page 3 Bylaws Consecutive Terms: Board members shall not serve consecutive terms as • Chairperson or Vice Chairperson. ARTICLE V. RULES OF BUSINESS Business shall be conducted in accordance with the most current edition of Robert's Rules of Order, so long as they are consistent with these Bylaws or amendments thereto. ARTICLE VI. COMMITTEES The Chairperson shall appoint subcommittees from the Board of Health or members of the community from time to time as the Chairperson shall deem necessary. The Chairperson shall be an ex-officio member of all committees. ARTICLE VII. ADMINISTRATIVE OFFICER The Board of Health may appoint an Administrative Officer who shall fulfill the responsibilities specified by RCW 70.05.045, including administering the operations of the Health Department. The Administrative Officer shall serve at the will and approval of the Board. • ARTICLE VIII. HEALTH OFFICER The Board of Health shall appoint a County Health Officer, who shall be a qualified physician trained and experienced in public health, who shall exercise the powers, and perform the duties prescribed in RCW 70.05.070. The Health Officer shall serve at the will and approval of the Board. ARTICLE IX. OPERATING RULES Section 1. Meetings Regular Meeting: Regular meetings of the Board of Health shall be held on the third Thursday of each month. If the third Thursday is a legal holiday, an alternate day may be selected by the Chair. Any regular meeting of the Board of Health may be cancelled with the concurrence of a majority of the Board. The location of the meetings shall be within Jefferson County. Special Meeting: The Chair or two-thirds of the members of the Board may call a special meeting of the Board consistent with RCW 42.30.080. Executive Session: The Board may hold executive sessions from which the public may be excluded for the purposes set forth in RCW 42.30.110. Quorum: A majority of all Board members, including at least two Jefferson • County Commissioners, shall constitute a quorum for Board meetings. Jefferson County Board of Health Page 4 Bylaws Tape Recordings: The proceedings of all Board meetings shall be recorded electronically. Any person may request a copy of electronic recording media of any • meeting of the Board by payment of reasonable cost per policy. Minutes: Written minutes of each Board meeting shall be prepared and approved by the Board at the subsequent regular meeting. Minutes shall be signed by the attending Members at the time of their approval by the Board. Meetings Open to Public: All regular and special meetings of the Board and Board committees shall be open to the public, in accordance with RCW 42.30. Materials to Board Members: Except in cases of emergency, the agenda and materials related to action items shall be sent to Board members in advance of the meeting at which the items will be considered. Section 2. Voting Actions Requiring a Vote: Each member of the Board shall be entitled to one vote on all actions of the Board that require a vote. An affirmative vote of a majority of Board members shall be required to pass an action of the Board,provided that a quorum of the Board is present. Tie Vote: In the event of a tie vote,the action does not pass. Voting By Proxy: There will be no voting by proxy on any question before the Board. Section 3. Ethics Conflict of Interest: Members of the Board of Health having personal or • professional interest on an action item that may be deemed conflicting or infringe upon the appearance of fairness shall declare the conflict. If the member or the Board, by majority vote, determines the conflict of interest to be significant, the member shall refrain from discussing or voting on the matter. Section 4. Public Testimony General Public Comments: At each meeting, according to the usual order of business, the Chair shall call for general comments. Persons wishing to comment shall give their name and address. The Chair may establish time limits for individuals who wish to speak. Comments on Action Items: Prior to voting on any item requiring action by the Board,the Chair may call for comments by persons interested in or affected by the matter under consideration before the Board. Persons wishing to comment on action items shall give their name and address. The Chair may establish time limits for individuals who wish to speak. Section 5. Public Hearings: The Board shall conduct public hearings prior to adoption of fees, ordinances, rules, or other exercises of its quasi-legislative powers. All members of the public in attendance at a public hearing will be allowed to speak if they so desire. Persons wishing to provide testimony shall give their name. Time Jefferson County Board of Health Page 5 Bylaws limits may be placed on individual comments at the discretion of the Board Chair and • the public should be advised that comments must relate to the matter at hand. Order and decorum should be maintained at all times. Rules for the conduct of the hearing should be stated by the Board Chair at the beginning of the hearing. Following public testimony, the Board Chair shall close the public hearing and the Board may deliberate and take action on the matter at hand. Call for Public Hearing: A public hearing may be called for by an affirmative vote by a majority of the Board. Public notice will be given at least 10 days prior to a public hearing of the Jefferson County Board of Health. Section 6. Appeals Hearing: Appeals Hearings: Board of Health appeal hearings shall be open to the public and presided over by the chair of the Board of Health. Such hearings shall be recorded. Board of Health hearings shall be opened with a recording of the time, date and place of the hearing: and a statement of the cause for the hearing. The hearing shall be limited to argument of theparties submitted in writingprior to the meeting and no additional evidence shall be taken unless, in the judgment of the chair, such evidence could not have reasonably been obtained and submitted prior to the hearing. Additional appeal hearing procedures may be required by the specific public health code (e.g. On-site Sewage, Solid Waste, or Food Safety) that governs the matter under appeal. ARTICLE X. MISCELLANEOUS • Reimbursement of Expenses: Board of Health members may receive reimbursement for approved expenses related to completion of their responsibilities. ARTICLE X. AMENDMENTS TO BYLAWS These Bylaws can be amended at any regular meeting of the Board by two-thirds (2/3) vote of total members, provided the amendment has been submitted in writing to the Board of Health at least ten (10) days prior to said meeting. ADOPTED the day of , 1997 120061 (2009) Chairperson, Jefferson County Board of Health • • Board of Health Wow Business Agenda Item # 1�, 2 Nurse FamiCy Partnersfi p: State Board of Hearth • Correspondence & Local Funding Options September 17, 2009 • Jefferson County Board of County Commissioners History of Ordinance# 08-1003-05 Expanded Mental Health and Substance Abuse Treatment • Senate bill 5763 attempted to reform Mental Health and Chemical Dependency funding at state level and included a County option to impose 1/10 of 1% • JC BOCC adopted ordinance 08-1003-05 on 7/10/06 • Senate Substitute 5433 adopted 2009 allows Counties to supplant 50% of funds raised in 2010 Jefferson County Benefits of 08-1003-05 • Increased treatment available today for citizens with Mental Health/Chemical Dependency (MH/CD) diseases in various settings; jail, schools, treatment agencies, court. • Formed cooperative advisory board more aware of needs for CD and MH treatment, & willing to prioritize. ■ Adoption by county increased by $200,000 state contribution to Methamphetamine treatment in 2007-10. Contracts to Safe Harbor, JMH and jail. BOCC Priorities in 2006 4110 • Treatment for individuals (adults and children) with MH and/or CD • Therapeutic court and case management staff to coordinate Drug & Mental Health court referrals and dependency needs of families in court • Substance abuse and mental health assessment, counseling, and medication management in the jail • Expanded MH/CD treatment for those with no public funds available. Mental Health Chemical Dependency Oversight Committee • 2 members of Law & Justice Council: Barb Carr and Conner Daily • 2 members of Substance Abuse Advisory Committee: Anne Winegar, Catharine Robinson • County Commissioner rep for RSN & BoCC: John Austin • 2 Members of Board of Health: John Austin, Shelia Westerman (starting 7-08) MH/CD Oversight Report to BOCC • Expenditures were slow to start in 2006, 2007. Applicants contracted service negotiated • by Co. Administrator so some carry over continues. • $385,000 is expected 2009 revenue ■ Expenditures are budgeted to be $406,992 in 2009. ■ Committee started contract review in 2008 & designed application process for vendors so services are spread to reach priority populations. Assume Services Provided in Jefferson County Need to be Sustainable ■ Follow clear vision based on local needs ■ Provide quality services to identified populations that currently have no or inadequate funding. Intent was not to supplant and to be last source of revenue billed on per client bases. ■ Collaborative work with all community only way to address need for services & must continue. • • 9 4fbU! JEFFERSON COUNTY PUBLIC HEALTH ,vx, 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypublichealth.org • TO: Jefferson County Board of Health FROM: Jefferson County Public Health DATE: September 11, 2009 RE: Application for 1/10`h of 1%Mental Health and Substance Abuse Sales Tax Funds for Nurse-Family Partnership program. GOAL: PREVENT MENTAL ILLNESS, BEHAVIORAL PROBLEMS, FUTURE ADDICTION IN YOUNG CHILDREN EXPOSED TO PARENTAL/FAMILY SUBSTANCE ABUSE AND/OR MENTAL ILLNESS OVERVIEW: Nurse-Family Partnership (NFP) is a prevention/intervention program that serves high risk first time parents targeting traditional health issues such as premature birth and child abuse through the use of highly educated and trained nurses. The nurses are specifically trained in adult and infant mental health, risk assessment and prevention strategies. The program starts during pregnancy in order to decrease the risk to the fetus of maternal substance exposure and mental illness. Families receive home visits until the • child is 2 years old. EVIDENCE BASE: Nurse-Family Partnership has been rigourously evaluated for effectiveness including randomized clinical trials in both urban and rural populations. NFP has been shown to prevent mental illness, social/behavioral problems, and criminal activities in both the child and the mother for as long as 15 years after program initiation. The Federal Office of Juvenile Justice & Delinquency Prevention recognizes NFP as an Exemplary Model Program. NFP nurses receive direct supervision of all cases from a MH specialist. . COST-BENEFIT ANALYSIS- The Washington State Institute for Public Policy concluded NFP ranked highest in terms of cost returns among programs aiming to prevent youth substance abuse and improving child welfare generating a net savings of $17,180.00 per family served. The Rand Corporation concluded that NFP saves $4 for every$1 invested. IMPLEMENTING AGENCY CONTEXT: Jefferson County Public Health has been operating the NFP for 10 years. Our ongoing data analysis shows that we are engaging and retaining the targeted population and maintaining fidelity to the program model. 50% of the mothers were 15-19 years of age, 28% were 20-24 years of age. At NFP intake Jefferson county pregnant women self reported mental illness at a rate of 17% and 54% had history of physical/emotional abuse. Using standardized depression screening tools . ad ministered by the NFP nurses 35-40% of the pregnant and parenting mothers screened COMMUNITY HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES PUBLIC HEALTH MAIN: (360) 385-9400 ALWAYS WORKING FOR A SAFER AND MAIN: (360)385-9444 FAX: (360) 385-9401 HEALTHIER COMMUNITY FAX: (360)379-4487 positive. In the national data maternal alcohol and cocaine use decreased from 25% from pregnancy intake to time of birth. Nationally, marijuana use decreased 56% and cigarette use decreased 15%. This reflects substance use in women past when they discovered the pregnancy with a significant program effect in reducing use. NFP uses an intensive home visiting model staffed with nurses. The case load per full time nurse is 20-25 families. The primary cost of delivering this program is staff salary. The estimated cost per family for the entire program episode is $6,000.00. Budget impact: JCPH will have a decrease in funding starting 7/30/09 of approximately 33% in state DSHS funding.. this is approx $35,000 to 40,000 a year for JCPH. To continue this program JCPH is asking the BOCC to use the new SSSB 5433 and allow supplanting of the 1/10 of 1%to fund the program. • COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES ALWAYS WORKING k WATER QUALITY • MAIN: 360385-9400 SAFER � MAIN: 360385-9444 FAX 360-385-9401 HEALTHIER COMMUNITY FAX: 360.379-4487 JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS ORDINANCE NO. 08-1003-05 Tax Increase 1/10 of 1 % Expanded Mental Health & Substance Abuse Treatment & Therapeutic Courts Funds 07/01/06 • PROGRAM DESIGN& EVALUATION The County believes that the programs or services that are to be implemented are informed by "evidence based", "research based", "emergency best practice",or"promising practice" as defined in the legislation and the group encourages innovative approaches to local problems where there are no applicable models. A collaborative plan to supplement services for citizens is the best way to build a service network for Jefferson County. Services will be contracted through Interlocal agreements or contract between the County and private not-for-profit agencies or other government entities in Jefferson County. The County believes in the development of a"Drug Addiction Co-Occurring Mental Health Disorders (COD) model targeted on supporting Jefferson County crisis services and therapeutic jurisprudence needs. The model will include multiple levels of mental health and substance abuse services for adults and adolescents. PROGRAM ELEMENTS Contracts shall establish/or provide access to programs for the following services, based on the priorities of the Law and Justice subcommittee and other standing committees. • Treatment for individuals with co-occurring disorders • Therapeutic court and case management• Pe g staff to coordinate Drug& Mental Health court referrals and dependency needs of families in courts • Expanded Mental Health/Substance Abuse treatment for populations not served by other public funds • Substance abuse assessment and Mental Health assessment, counseling, and medication management in the jail Additional funds could be available to contract with other vendors providing family, child counseling or substance abuse treatment. Services could be provided by additional vendors to provide care to family members coping with mental illness or substance abuse in a spouse, parent or child: • Family support in some schools providing mental health services to students • Substance abuse interventions in the schools • Ongoing Home Visits to families by Infant Mental Health& Public Health Nurses for young families or Nurse Family Partnership visitation • Other licensed treatment providers and addiction specialists are successful with • county population and may need to bill for services 7 S STATE OF WASHINGTON WASHINGTON STATE BOARD OF HEALTH PO Box 47990* Olympia Washington 98509-7990 September 1, 2009 Dear County Commissioners/Councilmembers/Executives: I am writing on behalf of the State Board of Health to encourage the preservation of public health financing as you develop your 2010 county budget. We know you face tough choices. Competing priorities and economic conditions make it difficult to spare any local program from budget cuts. Public health, however, is in crises and damage from continued cuts may never be repaired. The evidence tells us that a reduction in public health services today will only lead to increases in social and health problems. The future costs of addressing those problems will outstrip any immediate savings. At a recent meeting of the State Board of Health, for example, members heard a public health nurse's poignant story about intergenerational transmission of family violence and • a program that allowed her to break that cycle for one family. She told us of a mother, a survivor of domestic violence and of family violence and neglect as a child, who began to see her infant son as"out to get her." Her response was to spank him. Over more than a year of home visiting through the Nurse Family Partnership program, the nurse was able to get the mother to understand that her child's behavior was natural curiosity, and that her reaction grew out of her own history of abuse and neglect. The hitting stopped. Nurse Family Partnership is an evidence-based program proven to be cost-effective. For example, the Legislature increased funding for Nurse Family Partnership programs recently because it could show, based on a Washington State Institute for Public Policy study, that such an investment would allow the state to reduce the number of prisons it would need to construct. Yet federal, state, and local funding cuts are forcing the dismantling of local programs such as home visiting, family planning, maternal and child nutrition, and immunizations, even as public health wrestles with emerging threats such as pandemic influenza. This Board is pleased to see that the 2010 federal budget includes $124 million for a down-payment on a 10-year home visitation initiative and that drafts of the Affordable Health Choices Act would set aside on the order of$10 billion a year for a special fund to invest in public health and prevention. Other provisions of the act would fund programs that promote a prevention-oriented,population-based approach to improving community health and well-being and help develop a skilled public health workforce. • County Commissioners August 31, 2009 Page 2 • At this point, however, we have no idea what final form that Affordable Health Choices Act will take. Nor do we know how federal stimulus funds for prevention efforts will be distributed, when the economy will recover and to what degree, or how much future support Congress and the State Legislature are likely to provide for local public health. Until these uncertainties are resolved, however, this Board wants to encourage local boards of health and local boards of county commissioners to do everything in their power to prevent the further erosion of local public health capacity. These programs will be extremely difficult to rebuild even if funding is restored—especially if qualified and experienced workers are lost—and their elimination or reduction will lead to greater costs in terms of family services, education,health care,behavioral health services, and criminal justice. We do not envy you the challenges of your jobs and we greatly appreciate your leadership during these trying times. Thank you for considering this important issue. Sincerely, Tre an Katz Chair • cc: State Board of Health Members Mr. Eric Johnson, Washington State Association of Counties Mr. Jeff Killip, Washington State Association of Local Public Health Officials Ms. Sherri McDonald, Washington State Association of Local Public Health Officials Ms. Linda Ring-Erickson, Washington State Association of Counties Mr. Craig McLaughlin, State Board of Health Jean Baldwin Subject: FW: SSSB 5433-Sales Tax monies • From: David Alvarez Sent: Thursday, July 09, 2009 9:30 AM To: Jean Baldwin; John Austin; Phil Johnson; David Sullivan; Lorna Delaney Cc: Philip Morley; Juelie Dalzell; Jack Westerman; Donna Eldridge; Judi Morris; CAO Staff Subject: SSSB 5433-Sales Tax monies NOT CONFIDENTIAL Colleagues: This bill, now law as partially approved by Gov. Gregoire, allows supplanting of existing funds with respect to three sources: • .3 %sales tax for criminal justice • .1 %sales tax for chemical dependency/mental health • Levy lid lifts approved by the voters after the bill's effective date which is probably July 26, 2009 Different rules apply in each of these categories: • For the criminal justice monies and regarding the funds raised through the .3 %sales tax 100% can be used to supplant existing funds in 2010, and 20% less each year through and including 2014, when the percentage that can be used to supplant is only 20%. Additionally, 1/3 of the money received under this section must be used solely for criminal justice purposes OR fire • protection purposes, and "fire protection purposes" was added in by SSSB 4333. • For the chemical dependency funds, 50%of the amount raised by the .1%tax can be used to supplant in 2010, reduced each year by 10% until by 2014 only 10%of what this sales tax raises can be used to supplant. • For the levy lid lifts, because we are a County of less than 1.5 million residents, the district that obtained the levy lid lift can supplant "existing funds used for the limited purpose specified in the ballot title." The one County in WA that has more than 1.5 million residents, King, has the ability to supplant for only three years, 2009-2011. The remainder of the bill, as approved by the Governor, relates solely to King County. A per vehicle lump sum tax that this bill would have authorized in the urban counties was vetoed by the Governor. David Alvarez. Ext. 219 From: Jean Baldwin Sent: Wednesday, July 08, 2009 4:00 PM To: David Alvarez Cc: John Austin Subject: FW: Emailing: 5433-S2.SL David we shared this new bill with the 1/10 of 1%committee and the BOCC. John Austin asked if you would review this and advise us on the implications. We are in a fact finding stage on supplanting. • i • Board of Health .New Business .Agenda Item #1V., 3 Pandemic 3-1 Ni Preparedness L_pdate • September 17, 2009 • • e • JEFFERSON 1 615 Sheridan Street • Port Townsend •Washington • 98368 • wwwjeffersoncountypublichealth.org September 9, 2009 Update H1N1 Community Education and Red Cross Volunteers Public Health's goal is to keep our community healthy through preventing the spread of disease. Hand outs for Red Cross Volunteers - Current one page Public Health message Sept. 9, 2009 - Possible"customer Friendly ideas" and "Bug stops here" flyer - Cover your cough flyer - Preventing the spread of Influenza - Returning to work guidance - When business is not usual - Web site list - Flu clinic list as of 9/3/09 - Julia's business cards Julia has done outreach to County departments: • sent email to Department Heads and Elected Officials August 7, 2009, Attended staff meeting at Castle Hill Public Works, Aug. 24tH Prosecutors office staff meeting Aug. 27th, scheduled for County Clerk's Office Sept. 24tH City of Port Townsend, Sent email offering information and training Port Townsend Chamber of Commerce, August 24, 2008 Olycap staff meeting Sept. 4, 2009 Julia will be doing presentations for Gardner Community Center 9/13, Food Coop 9/24 Cape George Emergency Preparedness group 10/7. Public Health Food Service staff will be doing outreach to restaurants Large business Chains have done Pan Flu planning in the past. QFC Port Hadlock requested information and Flu information was emailed to store Manager Three Red Cross RNs trained Sept. 9th will focus on churches, community groups and small businesses. Encouraged Red Cross RNs to refer to Julia Danskin if there are more questions or questions that you are unable to answer, her phone number is 385-9420, idanskin(c co.jefferson.waus. JCPH goal is to have consistent and accurate information to the community. • COMMUNITY HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIESPUBLIC HEALTH WATER QUALITY MAIN: (360)385-9400 ALWAYS WORKING' FOR A SMER AND MAIN: (360)385-9444 FAX: (360)385-9401 HEALTHIER CO UNITY FAX: (360)379-4487 Seasonal Flu Vaccines Beginning to Arrive Jefferson County,September 3, 2009 - Seasonal influenza vaccines are beginning to arrive in area clinics and pharmacies. This is much earlier than in recent years. Because vaccine for the H1N1 swine flu will be available later in the fall, Centers for Disease Control is encouraging everyone to get their seasonal flu shot early this year. The risk groups especially targeted for a seasonal flu shot are the same as in the past. This includes those over 50 years old, those with chronic medical conditions, pregnant women, healthcare workers, all children between 6 months and 18 years old, and anyone who wishes to decrease their likelihood of catching influenza. Vaccines for the H1N1 flu will not be available until at least mid-October. JEFFERSON COUNTY FLU VACCINE CLINICS 2009 Brinnon Senior Center, 306144 Highway 101, Brinnon - Friday, September 11 from 9 am—3 pm. Medicare patients please bring your Medicare cards. All others $25 cash or check. Private insurance will not be billed. • Jefferson Medical &Pediatric Group, 915 Sheridan St, Lower Lever, Port Townsend. - Saturdays, October 3 and October 24 from 9 am -12 noon. Medicare patients please bring your Medicare cards. All others $25 cash or check. Private insurance will not be billed. Madrona Hill Urgent Care, 2500 Sims Way, Port Townsend. - Flu vaccine available during clinic hours:Monday-Friday from 9 am -7 pm, Saturday from 9 am - 4 pm, and Sunday from 10 am - 2 pm. Vaccine available for clients age 18 years and over. Flu shots $25. Medicare billed. All others cash. Madrona Hill Urgent Care - Port Ludlow, 9481 Oak Bay Road, Port Ludlow. - Flu vaccine available during clinic hours: Monday, Wednesday, Friday, &Saturday from 9 am - 4:30 pm. Vaccine available for clients age 18 years and over. Flu shots $25. Medicare billed. All others cash. • Monroe Street Medical Clinic, 242 Monroe St, Port Townsend. - Limited supply preservative-free vaccine. Current clients have priority. Please call 385-5658 for an appointment. No insurance will be billed. Quilcene Community Center, 294952 Highway 101, Quilcene - Friday, September 18 from 9 am -3 pm. • Medicare patients please bring your Medicare cards. All others $25 cash or check. Private insurance will not be billed. Olympic Primary Care, 1010 Sheridan St, Suite 101, Port Townsend. - Saturdays, September 26 and October 17 from 9 am -12 noon. Medicare patients please bring your Medicare cards. All others $25 cash or check. Private insurance will not be billed. Port Townsend Family Physicians,934 Sheridan, Port Townsend. - Saturdays, September 19 and October 10 from 9 am -12 noon. Medicare patients please bring your Medicare cards. All others $25 cash or check. Private insurance will not be billed. QFC Pharmacy, 1890 Irondale Rd, Port Hadlock. - Wednesdays, September 23 and October 21, from 11 am -5 pm - Thursdays, September 24 and October 22, from 11 am - 5 pm - Medicare and Medicaid accepted. Please bring your cards. • Flu shots $25. Pneumonia shots $45. Clients must be at least 11 years old. Safeway Pharmacy,442 Sims Way, Port Townsend. - Saturdays, September 26, and October 3, 10, and 17 from 10 am -4 pm. - Walk-ins welcome for immunizations from 10 am -4 pm Monday through Friday. No appointment necessary. Medicare and Medicaid accepted. Many insurances billed. Bring your insurance card. Flu shots $30. Pneumonia shots $49.99. Clients must be at least 11 years old. State-Supplied Children's Flu Vaccines are recommended for all children ages 6 months through 18 years old. The pediatric vaccines have not yet arrived in Jefferson County, but will soon be available at Jefferson County Public Health and the Jefferson Healthcare clinics serving children. ### Always Working for a Safer&Healthier Jefferson County • $ Fig _ Centers for Disease Control and Prevention Your Online Source for Credible Health information Interim Guidance for Novel H1N1 Flu (Swine • Flu): Taking Care of a Sick Person in Your Home suu :;:,t 5. -'009 S: 0 PM I`'I... On this Page • How Flu Spreads • Medications to Help Lessen Symptoms of the Flu • Steps to Lessen the Spread of Flu in the Home • Household Cleaning, Laundry, and Waste Disposal This document has been updated in accordance with the CDC Recommendations for the Amount of Time Persons with Influenza-Like Illness Should be Away from Others. This document provides interim guidance and will be updated as needed. Novel H1N1 flu virus infection (formerly known as swine flu) can cause a wide range of symptoms, including fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with novel H1N1 flu. Like seasonal flu, novel H1N1 flu in humans can vary in severity from mild to severe. Severe disease with • pneumonia, respiratory failure and even death is possible with novel H1N1 flu infection. Certain groups might be more likely to develop a severe illness from novel H1N1 flu infection, such as pregnant women and persons with chronic medical conditions. Sometimes bacterial infections may occur at the same time as or after infection with influenza viruses and lead to pneumonias, ear infections, or sinus infections. The following information can help you provide safer care at home for sick persons during a flu outbreak or flu pandemic. How Flu Spreads The main way that influenza viruses are thought to spread is from person to person in respiratory droplets of coughs and Nilsneezes. This can happen when droplets from a cough or sneeze hof an infected person are propelled through the air and deposited on the mouth or nose of people nearby. Influenza viruses may also be spread when a person touches respiratory droplets on ,: E ¢ g -°,another person or an object and then touches their own mouth or ci ' 'tz ose (or someone else's mouth or nose) before washing their ands. • http://www.cdc.gov/h 1 n 1 flu/guidance_homecare.htm { k People with novel H1N1 flu who are cared for at home should: • check with their health care provider about any special care they might need if they are • pregnant or have a health condition such as diabetes,heart disease, asthma, or emphysema • check with their health care provider about whether they should take antiviral medications • keep away from others as much as possible. This is to keep from making others sick. Do not go to work or school while ill • stay home for at least 24 hours after fever is gone, except to seek medical care or for other necessities. (Fever should be gone without the use of a fever-reducing medicine.) • get plenty of rest • drink clear fluids (such as water, broth, sports drinks, electrolyte beverages for infants)to keep from being dehydrated • cover coughs and sneezes. Clean hands with soap and water or an alcohol-based hand rub often and especially after using tissues and after coughing or sneezing into hands • wear a facemask—if available and tolerable—when sharing common spaces with other household members to help prevent spreading the virus to others. This is especially important if other household members are at high risk for complications from influenza. For more information, see the Interim Recommendations for Facemask and Respirator Use • be watchful for emergency warning signs (see below)that might indicate you need to seek medical attention. Medications to Help Lessen Symptoms of the Flu • . ...................__._.. ,......................... Check with your healthcare provider or pharmacist for correct, safe use of medications Antiviral medications can sometimes help lessen influenza symptoms, but require a prescription. Most people do not need these antiviral drugs to fully recover from the flu. However,persons at higher risk for severe flu complications, or those with severe flu illness who require hospitalization,might benefit from antiviral medications. Antiviral medications are available for persons 1 year of age and older. Ask your health care provider whether you need antiviral medication. Influenza infections can lead to or occur with bacterial infections. Therefore, some people will also need to take antibiotics. More severe or prolonged illness or illness that seems to get better, but then gets worse again may be an indication that a person has a bacterial infection. Check with your health care provider if you have concerns. Warning! Do not give aspirin(acetylsalicylic acid)to children or teenagers who have the flu; this can cause a rare but serious illness called Reye's syndrome. For more information about Reye's syndrome,visit the National Institute of Health website . • Check ingredient labels on over-the-counter cold and flu medications to see if they contain aspirin. • Children 5 years of age and older and teenagers with the flu can take medicines without • } aspirin, such as acetaminophen(Tylenol®) and ibuprofen(Advil®,Motrin®,Nuprin®), to relieve symptoms. f • Children younger than 4 years of age should NOT be given over-the-counter cold medications without first speaking with a health care provider. • • The safest care for flu symptoms in children younger than 2 years of age is using a cool- mist humidifier and a suction bulb to help clear away mucus. • Fevers and aches can be treated with acetaminophen(Tylenol®) or ibuprofen(Advil®, Motrin®,Nuprin®) or nonsteroidal anti-inflammatory drugs (NSAIDS). Examples of these kinds of medications include: Generic Name Brand Name(s) Acetaminophen Tylenol® Ibuprofen : Advil , Motrin®,Nuprin® Naproxen Aleve • Over-the-counter cold and flu medications used according to the package instructions may help lessen some symptoms such as cough and congestion. Importantly,these medications will not lessen how infectious a person is. • Check the ingredients on the package label to see if the medication already contains acetaminophen or ibuprofen before taking additional doses of these medications—don't double dose! Patients with kidney disease or stomach problems should check with their health care provider before taking any NSAIDS. Check with your health care provider or pharmacist if you are taking other over-the-counter or • prescription medications not related to the flu. For more information on products for treating flu symptoms, see the FDA website. When to Seek Emergency Medical Care Get medical care right away if the sick person at home: • has difficulty breathing or chest pain • has purple or blue discoloration of the lips • is vomiting and unable to keep liquids down • has signs of dehydration such as dizziness when standing, absence of urination, or in infants, a lack of tears when they cry • has seizures (for example, uncontrolled convulsions) is less responsive than normal or becomes confused • Steps to Lessen the Spread of Flu in the Home When providing care to a household member who is sick with influenza, the most important ways to protect yourself and others who are not sick are to: • keep the sick person away from other people as much as possible (see "placement of the sick person")especially `~-- others who are at high risk for complications from influenza ry • remind the sick person to cover their coughs, and clean their hands with soap and water or an alcohol-based `414,, "n hand rub often, especially after coughing and/or " i Y sneezing a ' • have everyone in the household clean their hands often, using soap and water or an alcohol-based hand rub. Children may need reminders or help keeping their hands clean • ask your health care provider if household contacts of the sick person—particularly those contacts who may be pregnant or have chronic health conditions—should take antiviral medications such as oseltamivir(Tamiflu®) or zanamivir(Relenza®)to prevent the flu • If you are in a high risk group for complications from influenza, you should attempt to avoid close contact(within 6 feet) with household members who are sick with influenza. If close contact with a sick individual is unavoidable, consider wearing a facemask or respirator, if available and tolerable. Infants should not be cared for by sick family members. For more information, see the Interim Recommendations for Facemask and Respirator Use • Placement of the sick person • Keep the sick person in a room separate from the common areas of the house. (For example, a spare bedroom with its own bathroom, if that's possible.)Keep the sickroom door closed. • Unless necessary for medical care or other necessities,people who are sick with an influenza-like-illness should stay home and keep away from others as much as possible, including avoiding travel, for at least 24 hours after fever is gone except to get medical care or for other necessities. (Fever should be gone without the use of a fever-reducing medicine). This is to keep from making others sick. Children, especially younger children, might potentially be contagious for longer periods. • If persons with the flu need to leave the home (for example, for medical care),they should wear a facemask, if available and tolerable, and cover their nose and mouth when coughing or sneezing • Have the sick person wear a facemask–if available and tolerable–if they need to be in a common area of the house near other persons. • If possible, sick persons should use a separate bathroom. This bathroom should be cleaned daily with household disinfectant(see below). Protect other persons in the home • The sick person should not have visitors other than caregivers. A phone call is safer than a visit. • If possible, have only one adult in the home take care of the sick person. People at increased risk of severe illness from flu should not be the designated caretaker, if • possible. • If you are in a high risk group for complications from influenza, you should attempt to avoid close contact(within 6 feet) with household members who are sick with influenza. If close contact with a sick individual is unavoidable, consider wearing a facemask or respirator, if available and tolerable. For more information, see the Interim Recommendations for Facemask and Respirator Use. • Avoid having pregnant women care for the sick person. (Pregnant women are at increased risk of influenza-related complications and immunity can be suppressed during pregnancy). • Avoid having sick family members care for infants and other groups at high risk for complications of influenza. • All persons in the household should clean their hands with soap and water or an alcohol- based hand rub* frequently, including after every contact with the sick person or the person's room or bathroom. • Use paper towels for drying hands after hand washing or dedicate cloth towels to each person in the household. For example, have different colored towels for each person. • If possible, consideration should be given to maintaining good ventilation in shared household areas (e.g., keeping windows open in restrooms, kitchen, bathroom, etc.). • Antiviral medications can be used to prevent the flu, so check with your health care provider to see if some persons in the home should use antiviral medications. If you are the caregiver • • Avoid being face-to-face with the sick person. • When holding small children who are sick,place their chin on your shoulder so that they will not cough in your face. • Clean your hands with soap and water or use an alcohol-based hand rub* after you touch the sick person or handle used tissues, or laundry. • Talk to your health care provider about taking antiviral medication to prevent the caregiver from getting the flu. • If you are at high risk of influenza associated complications, you should not be the designated caretaker, if possible. • If you are in a high risk group for complications from influenza, you should attempt to avoid close contact (within 6 feet) with household members who are sick with influenza. Designate a person who is not at high risk of flu associated complications as the primary caretaker of household members who are sick with influenza, if at all possible. If close contact with a sick individual is unavoidable, consider wearing a facemask or respirator, if available and tolerable. For more information, see the Interim Recommendations for Facemask and Respirator Use • Monitor yourself and household members for flu symptoms and contact a telephone hotline or health care provider if symptoms occur. o yi Using Facemasks or Respirators '10 • Avoid close contact(less than about 6 feet away) with the sick person as much as possible. 7,11117, • If you must have close contact with the sick person (for example,hold a sick infant), spend the least amount of time possible in close contact and try to wear a facemask(for example, surgical mask)or N95 disposable respirator. • • An N95 respirator that fits snugly on your face can filter out small particles that can be inhaled around the edges of a facemask,but compared with a facemask it is harder to breathe through an N95 mask for long periods of time. More information on facemasks and respirators can be found at H1N1 Flu(Swine Flu)website. • Facemasks and respirators may be purchased at a pharmacy,building supply or hardware store. • Wear an N95 respirator if you help a sick person with respiratory treatments using a nebulizer or inhaler, as directed by their doctor. Respiratory treatments should be performed in a separate room away from common areas of the house when at all possible. • Used facemasks and N95 respirators should be taken off and placed immediately in the regular trash so they don't touch anything else. • Avoid re-using disposable facemasks and N95 respirators, if possible. If a reusable fabric facemask is used, it should be laundered with normal laundry detergent and tumble-dried in a hot dryer. • After you take off a facemask or N95 respirator, clean your hands with soap and water or an alcohol-based hand sanitizer. • For more information, see the Interim Recommendations for Facemask and Respirator Use Household Cleaning, Laundry, and Waste Disposal , • • Throw away tissues and other disposable items used by v � the sick person in the trash. Wash your hands after ' . touching used tissues and similar waste. � �'�� • Keep surfaces (especially bedside tables, surfaces in the A bathroom, and toys for children)clean by wiping them . . down with a household disinfectant according to directions on the product label. �� a • Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first. • Wash linens (such as bed sheets and towels) by using household laundry soap and tumble dry on a hot setting. Avoid"hugging" laundry prior to washing it to prevent contaminating yourself. Clean your hands with soap and water or alcohol-based hand rub right after handling dirty laundry. • Eating utensils should be washed either in a dishwasher or by hand with water and soap. For More Information The Centers for Disease Control and Prevention(CDC) Hotline (1-800-CDC-INFO) is available in English and Spanish, 24 hours a day, 7 days a week. • PUBLIC HEALTH 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypublichealth.org • September 9, 2009 Public Healths message"Preventing the Spread of Disease", (aka H1N1 update) - Get your Seasonal Flu shots. Seasonal Flu Shot clinics are scheduled early this year. Where you have gotten your Flu shot in the past you should be able to get it there again this year. If you have never received a Flu shot clinics are being advertised at this time and a press release with the schedule will be out soon. Also if you are over 65 years old get your pneumonia shot or talk to your doctor if you have a chronic medical condition. - Prevent the spread of disease by practicing respiratory etiquette. Cover your cough, wash your hands and stay home if you are sick. Current recommendations are for individuals who have become ill with influenza is to 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 antivirals medications are used. - Individuals with flu symptoms do not need to seek medical attention unless their symptoms are more severe than expected. Usually with rest, plenty of fluids and possible medication to reduce fever(Tylenol) individuals recover with no complications. If there is any underlying health problem individuals are encouraged to contact their Medical provider. Requiring a note from a medical provider to document the need for time off work is not recommended. • - For the most up to date information from the Center for Disease Control go to www.fiu.gov. The Center for Disease Control and Washington State Department of Health is monitoring the H1N1 virus daily/weekly. Washington State Department of Health's web site is www.doh.wa.gov/swineflu. - The current good news is that older adults seem to have some immunity to the current H1N1 flu virus. Data has shown that the virus is causing more infections in a younger population specifically school age population. - Jefferson County Public Health has been notified that they should be prepared to receive federally supplied H1N1 Vaccine as early as Mid October. Jefferson County Public Health staff is making plans to store and distribute the vaccine as soon as it arrived. The priority population to received the Federal H1N1 Vaccine are: o Pregnant women o People who live with or care for children younger than 6 months of age o Health Care and Emergency Medical Services personnel o Persons between the ages of 6 months through 24 years of age, and o People from ages 25 through 64 years with chronic health conditions or compromised immune systems. Jefferson County Public Health's goal is to keep our community healthy through preventing the spread of disease. If you have questions or would like more information contact Julia Danskin, Community Education Liaison at 385-9420 or jdanskinaco.;efferson.wa.us. • COMMUNITY HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES PUBLIC HEALTHWATER QUALITY MAIN: (360)385-9400A MAIN: (360) 385-9444 FAX: (360)385-9401HEALTHIER _ FAX: (360)379-4487 • Board of 3Cealth Netiv Business .agenda Item #v, 5 • Green Business .q_tivard Computer.Fix September 17, 2009 • COUNTY PUBLIC Pco JEFFERSON x .: ti. Always Working for a Safer and Healthier hierJefferson September 8, 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 has obtained Green Business certification; Computer.Fix, located at 260 Kala Point Drive Suite 203, Port Townsend, WA 98368. Malick Sow is going the extra mile to conserve water, energy and other resources. This business is working on becoming a leader in the community and is working on ways to develop new ways to protect the environment while doing business. After signing the award, please return it to: Jefferson County Public Health Attn: Anita Hicklin 615 Sheridan Street Port Townsend, WA 98368 Thank you for your continued support of the Green Business Program! Sincerely, ()A41/4,....A. , Anita A. Hicklin Environmental Health Specialist Jefferson County Public Health • 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.ieffersoncountypublichealth.org - v m m -w c c 0 H O O 3 N RCI)1 H O CD 73 O p I j _ 1. C4 Q- N c Q "It Iztet N mss" -,- """ ,,. t1131 rte. -, g i® • CI.§. ;::t °:::.::;11 cAr, !,: l(11 pie ellit 0 k $mm: '4$:: t ' ° 4 g ,-4.,,:,-,:: ..„.D. #114-...; 4'7 .I'C'f117.1.I'''''11'll.‘-:::li.-',11::_'i=1:7-•:-A."%4="4 t",:-',.; , 2'- ‘1131111k ' Cill rt , ,,_,. , Cle) - A = = = : 0 ro CD ftO P C+ V • O V.,may to Board of.1Cealth .Media Report • September 17, 2009 • Jefferson County Public Health August/September 2009 NEWS ARTICLES 1. "PTHS Health Clinic offers physicals," Peninsula Daily News, August 21st, 2009. 2. "Students need school shots," Port Townsend Leader, August 26th, 2009. 3. "County preps flu prevention," Peninsula Daily News, August 26th, 2009. 4. "Algae decline; lakes open to swimming," Port Townsend Leader, August 26th, 2009. 5. "Dicks hosts health care town hall," Peninsula Daily News, September 1st, 2009. 6. "Pro and con soundoff in PT," Peninsula Daily News, September 1St, 2009. 7. "Healthcare forum draws boisterous crowd," Port Townsend Leader, September 2nd, 2009. 8. "Rep. Dicks' take on health reform," Port Townsend Leader, September 2"d, 2009. 9. "County gets ready for flu season," Port Townsend Leader, September 2nd, 2009. 10. "Accountability: The Fast Lane on the Highway to Change," American Journal of Public Health, September 2009, Vol 99, No 9. 11. "Seasonal flu clinics off to an early start," Port Townsend Leader, September 9th, 2009. News, Events and Alerts can also be found on the Public Health website at: . www.jeffersoncountvpublichealth.org • PTHS Health Clinic offers physicals PORT TOWNSEND— Port Townsend High School's Health Clinic will provide sports physicals for fall sports athletes on Tuesday from 9 a.m.To 3 p.m. The clinic is located in the Gael Stuart Building on the Port Townsend cam- pus. Appointments are avail- , able by calling 360-385- 9400.The necessary paper- work for fall athletes can be found at http:l l www. ptsd.wednet.edu/high- school/sports/sports_ forms/de faul t.html. High school football practices began Wednesday and all other fall sports • start on Monday. • • ��d • • Students need , school shots School will be starting in a couple ofweeks, provider verification of disease,or a blood test day; three doses polio with the last dose on and it's time for students to get needed school showing immunity to chickenpox. or after the fourth birthday;two doses MMR; vaccinations. Parents should biting their Fust grade:Three doses of DTaP vaccine, three doses hepatitis B vaccine. child's immunization records to vaccination with the last dose on or after the fourth birth- All teens who have not had a tetanus- appointments. day;polio,MMR and hepatitis B requirements containing vaccine in the past five years are • A child who is not fully immunized is at as above for kindergarten;two doses chicken- strongly encouraged to get the Tdap vaccine. increased risk of getting a vaccine-preventable pox vaccine or medical provider verification of Seasonal flu vaccine is recommended for disease and may be excluded from school or disease, or a blood test showing immunity to all children ages 6 months through 18 years. childcare during an outbreak of disease. He/ chickenpox. The health department also advises that par- she may also infect others who don't have the Second and third grades: DTaP, polio, encs should be thinking about vaccinating option of vaccine protection,like those with a MMR and hepatitis B requirements as above their children against the H1N1 (swine flu) weakened immune system or infants too young for first grade;one dose of chickenpox vaccine virus, which is expected to make a resur- to be completely protected by vaccines. or a history of the disease."A parent's report of gence this fall. A vaccine is being developed Different immunizations are required for chickenpox history is acceptable. that will be recommended but not required different grade levels. Some children who Sixth grade: One dose of Tdap if it has for children. It may become available locally . have received all recommended vaccines will been at least five years since the last tetanus- as soon as October and will be distributed • have more doses of some vaccines than the containing vaccine; this Tdap requirement mainly through normal healthcare providers minimum listed for school attendance. also applies to seventh-and eighth-grade stu- and special clinics. Minimum required immunizations for the dents who have not yet received a tetanus To schedule an appointment for school 2009-10 school year are: booster. Also polio, MMR and hepatitis B immunizations, call your medical provider. Kindergarten: Four doses of DTaP vac- requirements as above for kindergarten; one Jefferson County Public Health has walk- cine,with the last dose on or after the fourth dose of chickenpox vaccine or a history of the in immunization clinics every Tuesday birthday; three doses of polio vaccine, with disease. A parent's report of chickenpox his- and Thursday between 1 and 4 p.m. at 615 the last dose on or after the fourth birthday; tory is acceptable. Sheridan St. in Port Townsend. An extra three doses hepatitis B vaccine; two doses All other students should have had the "Back to School"clinic is set for Monday,A. measles,mumps and rubella vaccine (MMR); minimum of three doses DTaP, DTP or Td, 31, 1-4 p.m.No appointment is necessary. two doses chickenpox vaccine or medical with the last dose on or after the fourth birth- 385-9400 for more information. �` c � . ,10_,,,n, _, , , ,, , ,,-,--. ,-,-.-", .:._ d,,Li_ re -,-,,, v .,• R-,t, - , -!*.a.4 ''''-. oun j.,v,„_,,. ,„.., ,, , a -k!'-,,,- nlli ' , , 0 Officials aim to keep Dols open, employees health BY JEFF CHEW t R e s�,� PENINSULA DAILY NEW `" ,g, =� ' i. 0. North Olympic Peninsula --'1: 7' - ;, x a � health officials are stepping up ;. � . ��, � �� ,'� � � �� '� � �` � �� . � efforts to prevent flu outbreaks � �� '� � � k �.�� - y� this fall and winter in Peninsula ��7 = t and keep local business . employees healthy,as part of a � = regional plan developed thits s r summer. Health officials in both counties are addressing school officials and business leaders i ` '' k `t 4 ; in Peninsula communities as part of a newly developed coor- V 4. : • „-,4-1,-4,,,m-.4.. .,..,, d-' ” dinated regional plan, which also involves Kitsap County, V V V V V 6 said Dr. Tom Locke, health � � officer for both Clallam and .f ` i.:1;:c, 'kfr ; ,,,,,,,,,, , : Jefferson counties. "This time around,our goalVit4T ,i is to keep schools open,"Locke 4 "tl '� 44,iterhea, ,.' said public school officials were fi s told. �' �* t. "We have a strong reason to f ; t,. . - -L "°° keep schools o n to increase �3 fl it'''.i.,1 �4E F B rte-. '''•::: -.:��` �a t s' ' `�-Vr �+� the workforce capacity"when f parents don't have to remain : h ,- home with sick children, he � ,, � fr x: said € , • `Biggest challenge ` ,, r-,�, � With more flu strains Ef ' � � � . becoming active—such as the g y .1 � r -` ` '' • . swine flu t health officials s tib`* �k `` ��'" a '�.. �. d. � -a,g fi df Cid4d to 4 rt t � � a ▪ a t prevention is #�, • , ITi4,t3:bUrf',�i ozirly bC`4aU$e p1'Cttn- �a� %,%,,, Win...:, ,�� ,�� ,�, - �: ,--'1;,-!A,"•''',4, c�rn�that thi�flu si iin could ▪, take ascrn r'trill,he*caaddeuse°f �� ' t ., 3 "t'hi�? I+; probably p;oin�; to � � V � Tg 1* -, '0"J'''.1..i.i"..•••.•",-,-',' '-''''': ."-:-.-•--.!.'' be our biggest challenge with < _ ,r rt this,is to keep enough people ' • � healthy and at work so we canr. t' maintain all the essential Ger ▪ ' „ 4 _ vices,"Locke said. t:v.-li "If everyone get sick at thi r � '' _ • a same time, that> a ei7:,us ' ='< rr problem, even if thf>y r€xov4.r �, ; uneventfully." # . Two cases of swine flu were if a p diagnosed in the Peninsula •u� ` May. A Sequim woman was '.. the first to be diagnosed in 4,04.1t,-,,,, *; fi * n y ' Clallam County. Just like the , Port Townsend woman who ' i h•h � was diagnosed a week earlier, ir , she recovered without hospi- talization,Locke said. * � . Health officials are prom Otirfi ' , *is 4� � � : ing flu prevention through �� vaccinations, and are asking �` . w. P"r„' INTEw that schoolchildren,employees J r�cF�wlPExiwsvta DAILY News and employers stay home Li � en�ie9 de ers®� C®�onty -uhiic 6�eaith a rse,shows fiudfighting when ill. infer r�aatic a e ai��les ®f i"ficea��a®hi®eking pr eacts fro a face mask to • nitary vaipes a a ti�hacteriai hand lotion,a&f hart of an effort t®prevent the TURN TO FLUTAf> spr�a� this fail a� inter at &�€�sine sea u V d se la ifFlu : Sta at home your sick • CONTINUED FROM Al clinics scheduling dates. work-force illness. with conditions that make The nation won't have Planning for swine flu is them' more susceptible to Locke even urges those nearly as much vaccine for also taking place with school the flu,such as asthma. with family members sick the swine flu — or H1N1 officials in both counties,he "We are trying to get the with the flu —any kind of virus as it is clinically called said. seasonal vaccine into people flu—to stay at home. —ready by mid-October as Jean Baldwin, Jefferson early this year,"said Jeffer- "It can spread two or has been predicted, federal County Public Health direc- son County Public Health three days before you actu- officials said Monday. tor,said the county is work- Nurse Julia Danskin, ally get it,"Locke said. To fight the flu threat, ing with Jefferson Health- addressing the Port C1allam County ,public Locke said a medical reserve. care hospi'ttil Yn' Pott Townsend Chamber of Corn- health officals,afe, ex�eci -,corps •--•mostly of retired Townsend to condtict rriass` merce on Monday. ing more train double the` health-care professionals— vaccine clinics. She urged business own 13,000 doses planned for has been created as part of Jefferson County, he said, Clallam County's emer Locke said the same was ers to eat well, exercise, adding that he was skepti- gency preparedness system, planned in conjunction with cover their coughs, even cal that the vaccine would with all members trained Olympic Medical'Center in wear surgical face masks if arrive as soon as it is as emergency responders. Port Angeles and Sequim. they were comfortable doing wanted. • Corps members are talk- First in line for vaccina- so. The vaccine is expected ing to Port Angeles and tions are to be pregnant • to trickle in,arriving before Sequim business owners, women,those with children Port Townsend Jefferson mid-October and vaccina- promoting the planning six months or younger, and County Editor Jeff Chew can be tion clinics will gradually effort with kits to help health care workers, fol- reached at 360-385-2335 or at jeff start in September, with prevent and reduce lowed by younger adults chew@peninsuladailynews.com. • •• • • i • • • • K' • Algae cline; lakes 411 . open to swimming Concentrations of blue-green dominately of blue-green algae. algae in Iake Leland have declined These algae can produce a variety and now warrant a caution rather of nerve and liver toxins. than a warning to.the public,with Because of the risk of expo- swimming allowed, according to sure to toxins and the history of Jefferson County Public Health. toxic algae blooms in Anderson • Although the health depart- lake, Washington State Parks, ment is advising people public in consultation with the health to avoid drinking lake water and department, will keep the lake avoid any visible algal scums,the closed to recreation. Other non- lake opened Aug. 21 for swim- lake-oriented recreation, such • ming,boating and fishing.Caution as hiking, horseback riding and still is urged for those with small biking, is allowed at Anderson children and pets. Lake. 'We are pleased to see this Check on the. status of • declining trend in the amount Jefferson County lakes at jeffer- of blue-green algae in the lake soncountypublichealth.org. and hope it continues. However, we still urge those with small children and pets to exercise cau- tion in not letting them ingest lake water,"said Neil Harrington, Jefferson County water quality program manager. Gibbs Lake also has moderate • levels of blue-green algae that warrant a caution rather than a warning. Gibbs is open for swim- . ming, boating and catch-and- release fishing, although those with small children and pets are encouraged to use caution. • Anderson Lake continues to have a major bloom made up pre- • • t C .4es1 4'�. ,� O < 2 IA (1) \ --- silt � a W�Z O z Oyyy \ E --.!.;,.: ,,, , 4.---,:x.r.„7„;.t. -' g 8 't 1.2 4.-- !:-.'.,••,1, .'-‘1 ,, ' -::',„..,„-,rve,,,... irs;:11;:ii 1:-. .9 W.c.._0 q 0 a. ' x OCdp .�.+v .Y cN0�'3v .e,v-4 f a N O' �+��E r� " u 3 O E4' 3 a a 3 6 o E., bng3 t °yx_ ammo 0 ,- u (Qo u.. Ia ;, oy ,"� ., 0 0 0 Z c a, c c a'•'' ,°, `ro'^ e, s 7 °m ° v L M c .R:.,‘-'2,,:;', '' �, N �,, C 2 .'d .t, C 0 S. T U N ., ,, s� .9 C s ro m �E-`g E m '0' ro E s ,n m « e C++ p m 3 c ° cdm•- •r'4 v. �4 ,. t ,,, t `4 ms 16 Q1 W o eo.�y 0 C G C c 3 " a t C C mss`.-. 3 c,j " s ` c W'A a, a E u 0 P.., '° E a., c o y m y d 126-S" co c e ' „, - , yy � W 0 O O P'"m?' C L - a° Ot' m ro C T ill-6 d F 0 C E a N•..- .� N . o c. ca X 0 ,N c, ' •-E a,C� CtEu " **' 7} 1- „ .*c� �7 O Q O ro 'm o �' o ^ `" ^ cC n.. c%, U-. , '4, ,� .4 :� y'�" E 'amu a.o C :mL�`•0 3 r- :,2,..... ;,,,,,,,,,,,,i O—:E 0 u y N v Tam a t E E o c', "°2`>; .,' ' as tot, ‘ ` sir l O@ O `.-▪ro E- 0 m c>a.0 a, C. a, u o `� o -' ^_ •.. 5" ' Z 2 O W ° °+ t'o T N iU ar m -,•, ro m u ' f Q7 tea,ti s0. y u,, 0 3 0.'^ .. o d o C '✓+A 10 w., co w ca 0 m� al..L) 51 Q ,',7) E4 (� i. I r,. , , d2wi lE" E ya•Ey ro•-N= E «, mro u xy •r-1 a > C F- a •oma E 5D n r 'aDEOe roE E-°' Odroauobo > en 3 - • - % £ VCy 3 0 l u -..--. .C)o • a°,.c u C m E m E ,° _-...^ 9 s F' N d E cc - �g.D y cy.E au o�s 3 ro 0 Z-y ° at a E ` 14 * ""'•`.10.48;41'',‘, 09 7 0 ro d w o; m uQ m ,. o 'oG ro aax .0 FF a r Q x aCC,,ov o � ,.. o a too,so `'o h o ... E ' - Std 0 Q w oo ro,, >,E ,--.0 s a,s E• x 0.. 0. o ° il hh 8 N' E ., ' . .� E4• ) :ti w e6,-21, CT.E ,1 o cc` u. ,4--,9 c,'Dv w"mu �ci m.0 roG 1 5, ro u ,8 o � • E.1) :' E a > o� ta 3 vrot, „, . uuo . G ont-cE•0 g 'ceb43. aoo-° =a 8 F ,C ;Xp2.-2---, . > 3 c5 0CYtim ¢ -`iJ E - ,"C -' m � os t2EO .4EyO °-”:w° 0 T ° p ^ Ov ^ ^JyO S ') mC 0.24', 8'''-(7114 " o m ,-7`5,'•3 U m o Am• - V v a0�7 d e NSc'° s. yt2o3 o ^L o 'ro C C�esF. .E ca -mG- 7 ~ 8 %.- tig,e E> - . 3 a7 D /4 uoEsha0 ro- .n o otv mC °D gy dT vm w a o Y• a,t^s'''g mia,.XaLuroh_ oos s 0 u� g m o ` X d m o G m p,a.- mybu A Y• vNJ .D� 5 :: 8u3Sd8" ONu.0d0Eo�UP. rod"u °DNaNy L ,,FE . n . E'bo(�^•� • =- : mb ' CYcCaC, ErovE- ° :� ococQE0ougC , amwgC,±a S Cot uEy , c o 3ja j t 2 Ea t atEtE o. 0— C� u ..0 . . cas^ u.a 0 0 `1 •aa a °' S ° -Ommro y= C.cc-0 .2--5-0 >,-0 .2--5-0 >, ..E4.24.-1 uu.g >s — ,a �, 0o 'na.- -- 2S 7....2 3�� a7milTYCo., Cpm m �+ 3myro xoo ms g7.-, ‘,1,2, s � � 0Q Ey .1.--) urn o ° ',. m• d 0 C ' ao 6 E c E aa, �0 w C a-m u om 'n ° c o-" rom PA vbut3o ' cn > � o ° au-- NaraC . ,-, E °: • a,su 00a, 005o 'n -mroCEt --' 0 -2 ca o ° .":3 ° roc E. ,' .. Ea p > caoz a 0C ° O °o - ., 8' ,p v ,mCO .a_ C ECO m -. UC.- F t 0 ODE mA , a 0 N v iro" ro.� a I) c � ,ha:E .° at�ydamo m1,1 $yo ' . ^ . d 2a°, ro v Fd ca aa,^^av•- oE oroa ° ` =.rom . . u ao oE a coo s SOE E E3u w0Q3 Z cu ^cQd ro u u�EE1 'N3ya, sT. oCa° .E-•ro an` 2.d b m-1 o d nc.', .oo) wFzI dE0og Eoouccrom „ � � ,a� C u, d uOa p Xm E m �• :s d >, ' bI , sC 'u3Cu,1aod % CD3c'OO lL ,'II^ Mroti.E'.LC y 2 a 'CE y >,. C uaEo CdN= ”'xopN °DrotanU mt' > ' as'Wo ` > cxEa yU]� a ° 2 d E1u�— i mQuuuT °DoumEa'ou "` ° Lwm.� myo roE a,yrooa o082x , m .1'-.9.c�yc5yo s• a aum,.aG. as E. 3N .- 5 a ;, m . 3mt.. aro„ o yt > 0 orom °To ro ,- o m ,4 ,4 ,:.s «3U aawoassy_ oo 'Un c . orow ,, 5a > a ^, y C 'O-EV) 1aC' a, • > EQ pm O+'c2t, EEEpUyA4CC v° u , a, N . ? . E ^O -. Eyi2 C„ Car ,.E0■ ■ u °D a„ 0u w O roU ° upO °pu to,aa° sbo4 .”oroc_ y., Cta Ao d� m` C yyd a m E." 0 • y m-0 oa 3tj v ° m y. a9. g NAtdWoNm0.P'buT 7 7oDomo ' U IcutltCCyoC 'COm co b? � s,ozToy5mDm % � mN0.5 m E9,— ro EXaa,•,48 .0 .0 ), a y E Est60 E y, mao u Em ` inlg _,33co C -8 . ma34' ec '' na0 ,°'°? ' m, Ocn xmy,% t. ,- - ";'t. ,- - ";'-'•,— 0y032 . 1Uom ..07ro236n2 „ awoyaOC c � -• Voa , roaQaaU -"2—c ,c,^ m };v% Eu .Dro `°D o umE...r-e°Drm. uaaw > EumoT%) a3LE,s� c aro0cm ,. au-auro ° .0. m�'2uyou . o - s ,., t.. u ' ^_1® 0 ° u m.E C B>t D C u X mv a,•..C ^->, g Q ca,.uta, u d F ° a a, ;y a C0 ,uC^ ^ u s > . ,. roa� a = d ca ,-,4, E _ „�cEE-0„, -, 00 a0 oay : oappa, a c . qCcs _ uC i 3 ro °Da,hg4 23E8E vE-EE .)a, • oi m "rD e �3°''. iu`� ! ° yy � ? V^^ _ o - _ c-5. .,1-0',-E-0c.Q .. b ..: 2Q3 , m dE E E 4 q „,.5 - • ii= . OI ,,;o:-6) Ao� Cm� m b4s D� o0E ,. �uro ro v� O � ev3pbQ ,bOat 4-• a' ro4ya, ro -1 m o yy %1 za 0. Z m y >C pod a ''d.Oao -8 G.yGro pO1 O.. E 3 sro • pP,E'E 1 simi 11111111111111 • Clii) g3N • 0 ( ) S O0 NT U)owdd�-% caaa,oY'OA 3 ” •a` a” Quo"` s-4 ) w S E.., C ›. E o0Q) U c� wN W8E ° -0 7,1mm6'aa35 � � . ■ O Q) 4' a' io� bmo ;'° Eox' oos .� Ella oEE ow . t3 Ea Cw wbDm a ro N\ /rte r .et C+. 1 n a • b r 1fjtt �^s r } 1V1 ,• y, `° 0 a a tam '+.! '32.f, 0 5 - ee Ec > o- 8 t E)0., 8 8 E a " ro § vvw g -° • t. --zi }f. �e Q) ro �J 3 FN o -oLo 'cv '�+ sms f q-�� N.,,F„,1. w C Cf•a U ...2 O J-.L '-'O 0 N ra V w�.:_.' t'7 f 1' Y•t►kr o°u:� m r v ° €3 5.5 d Q ° a c 4 F?;''', v '. ro- c -8- y 19t..@ '°°,9- `-.0, 812-o2.1' °''' SN o a8g• , '°E x >'' o A W v yC ^t " m c Cri8� a� ,, c Yo �' 1 F � m C >d Vf C N' C Q O I O y W N GE, # Ct a� El -532E3 go CCll .D 5' r7 y EEE-x-"'"' ii" Fye 4. O vi s pE C £, T a T.D � ^� N a'v�.�4 / F •.y$ _,...jy • ov °'� a� t Q3 �'.>F, w a� ,�-2,-11,-,611 `� cTi ° agt '�7 !S"t / ' • ;e ,', , r1,-'-'1i c. a m v Sa m e.> oc d o'$X ¢o 4 � ..� ��,, t ��.. � 60� -o c, c � � bpi.`c � c "� d IQ'.t s � 'o� �4 � �B +r W m Ka r '"'' - Jam•.."C:: 7 _G ii: 1`. ,i3 4 ID• x R ao.o w ;n �i�,E``. w fs�.'! c'3 5 E" ro' 1.p2 a.5 a 1 g t)-E - N 6.> 0,--;,...g,84 u ! $l ,s tP''d• s•ie e, 3 { e fS vro X yxx .> S>>S' o'. q v f� .5-'� °.'d :140t J. f, �i �3Z ,» E m w (� bo' 0 8 0 4 m ° 5 0 . 1 'stir yf~.ri d 0 5yv.r ® ..--t 5— m W c.d8m'°,",— °.34 M., ' i • d c >,cu t ,7:3y kr{ .;:11 c€v ! ,� E. 1 •98.,-, ,i8.4,• 8 > 5 3 ' u z -- 2 1 � ,,,,,.,....,"::-.1... g mvm8_q '� � � o G 5� ti v'r�� m� eo� 3 � � ., �' • ` , - s....- * 6 1111:; E 1.18 c 1IIIPDI $g1 a1c 1 y1 t a 8b kgyp{ ro w o:c• O M°E• '„ a0.A �Ep - mon Z >'"U"°x:°w E' >>t Y q y O .f. a>i W. G. Pi �3.5 0.'J a�3 c4 ... _!b ' i i J a4f�3 Iih 'i'4:V ;� .3v.1n C W ^�+ v.5 >,'iP ,lcc-�/1.5``_Th�Y74. W. t�t7ti( W t d 75.•° TpF 3;o ,�:�tr r�!/ 1 ) mac 1.9 L W -p 7'= ,zt,ri eC.,g e.0. ... �a2 mLb68c 0 .5 ` t't- Vii... t '"e ` mW m'2E) gg ca= o t.. t �' ;P+ •�y^! (`�'�, z+. er :qty'0 '4.-4 -- 7: }5,';< • O •" TSS s � t � ; .' ": ^ �"" f .... ', '!` V S 6 0 8w °*'`i s, o 3 . • HI 92, / ILH w1 1 Lg1 —( ca 4w a' .AO >,7.or ga° yywocs >fi. . v '°si3Ui IilI 90 G ,L > d^ nw m • Ey . tl 0J " 8 t �,a , r: f`' � JJi! 95 'Docyo1m-iy L ` cv.Lgy.pl .' C o• v. 7, 5 .-7 II: c'c ,..1,-. la z , `J g ra (� q.- g b•S 0A• „5 § v "i' . > T 4 � m` k y'w • O Cif-.4) 4,a c >, 5' °V'" .5 x o - 5 I c, �j m w' d x „ f• rt. ` t✓'„ ( •�[■ 0. m u.,a w .� o w 3 cn m w m W6 3 zt. �i — o v o:J - P.1 b54� 1,- 'e,°' N 1 2 'vim v k's! — 5 d y .5 ,«1 s c t> 433 .8 . a -E o '5 s q m °� 0 A8 ° ° 8 3 G ° c > 'yOOq " " ° v cv .�d r i'' I wp E g.`� 3 m as w• so BrcS ° 5 th v ▪ p. CltPa w t50,3.%.. a, A . E.2-0 a y. J' c 4 72 9 m ° °,o'. (0°10 s _ . 4 4- ' —;-'� t t �aT o; R ;1x t,' g ..2wEgv_s35w � vs-61',81,5J! rFt,- „ - '•rt eN >. oro.6 ia.o Qy.Su'p7 °z,83 c-.Eayv ''" I 3 oa = E -,t,... �w 1'/s Y%�r� —i xq Fg4.4'�� A,gI •_„, q '' �o 6- 38w ,, mu ',,��' t i u ' .. �-1 upu� �' 3 m "... m. d `60 , a' ° exp? se,,, Ota � � � Ott...z„ i!� lyl�. riT— 3 > � Jp$ Q [ Fw S ons�cv w�� • ?-)•caro r�` Gt tn;as;, F+-1 PC g .3.6 oa°10e 0t..r ;N8.E3.P m:a.5 °w.Fjg ` arcs+• r • 0 `H1 /.tl It,,tl ii, r •tt ' eJ y r i ,� • d, 1 0 .moi • (..IN. IN • J4 $ a ?b,O A a C y` "\ co ts, U co m -4 'Y.' •iz, ...., - II,i.j) g 'L' U y P ' : :1 !: t a, ' . �r/■ ti U O ja .,.w4" nO y 6Ti �� 4 mgr O5 N Cl)ix) - - ,-:-..... , . , ... ,,,,i;.; '''',' f1.14*,, , ....V) ,a) A i 3( {:ria z :'.1 CO d E / ` t -ry- ! N`J ,,,,, i 4 it kar € ,{y16i 1 ` civ, • ` 1 �3 � � CO 08- = , cv v roCo > o > bE .S °J n 0 a o c c 3 75/) v 3 3 u b > o g a•5 o „(36) o rn gg ro > 0 on u '? a [ v i a oz7 a � � w. �b o 0%4 c n rn y v a a E 0 c E mO o .5 L ro �, c i� o co d � � - c" a, _Q -5 •Et0, ,,, `o � � ° goo -o =poo � 3 3R 01 o y W IO o .r ✓, E a.) 0 E c � � . c .S v v ca.N" • E �b 3 L E - s LL � y td U_ Vi �, J C - y �j O � O� ��>,a,.� °'0 .c .0 ica0 � G. � E �, o o x G d >; O O- o E E p C 3.. L° v O i ,p Z U y Z G) =fn n'y >. . 0 o v a a v v ^ v . 000 O p o h = , = `u' > o v o .. 0 -.gd E `°o �. `� 0 0 0-a o ,,,- vui o• � = E o ✓ia °C70 0c >... Nov „o, . vvwMuEv3v y :� U U c � ao >,'c v.) cu A R >~ 0 o 4-J - 1-- 0 ci c cam0 oa•S O vAo .5 o..0 3 .sQ•^ c v 0v o w'�c o 0 O c v o a.c .4 ,E a) C m N 0 .-.c _v ° v -v, ,a, Z y - 1U. L0 ro c a) :v..) .4= E O c � 4 y .1: , y '° o u > = o v . v o0 a� o� ,�i) •4aoV rn cx o - •HI1II p ° o o x o Coc � c4b of W a ro E c v > ao c v v v x > v Co �. Lill > r o E o o ao o ao„ = v u v ..Z vctl P a b 3 o u c o L c °-• 0 c v, v 0.- 0 ,� N 0 •c o ° v v Z o = c' c .7:1" o o 'a > v v' a r roo as o co .acb > y ._ L v, 'cv, .a v a 0 cy° ° . `° CO v to v v ,u v a a� 0 0 ti to � rx °; v 3 > C '0 3 0 c ,� .c o C Co v r r L co C-oN E •� o o v, v a, o o b .0� v [ w - (6.-F, y i ... c3 o c U O U .}.�1 Y .n v .o o o Q3)" 4:9" ...6t‘ (j>, ° a4 3 -o $ E c v p g L m � n ..� m > 0...o o 0 0 3 > 5 °� y ro v 0 ' VC 'a J , coc 0E a'° E �`-, agSOo *- vvvo � vv (`�V c Coo a � `° c � °' �' a� �' cg ,�r �rovo � aL, ci -c 0 S 2-° ao v o c)o o ?� o Q a v td vv o /� m •ao v °o v ro co z 4 u v 5 No a o o v -o .= Gam. En WTco m E o •E' A ` : b � E cvi E -,o ooa '- � 4 vv � � ac E •,,, p c • T �c vQ, c o. E � y 4 ,, o 9.a .4= gA) -, aoi 0 'N E •0 � •° y � o � u000 > � od � ' wo > Ca � —° oo .c .cCI4aco aco._ .5uv E � o � � •° 30 �' v muillipplinnplally ' '',4',:.c, - -4,�-4 } fix:` t y^4*t •.. •,• -: II - , �ay , 1.r _ W, ,•,.,4,. 3 y ' :..." I" ;� 74, ----7,-.:.,... Af { 4 t 1 r< , ' t. • e Dr.Penny Burdick of Port Angeles asks Rep.Norm Dicks to hold health insurance companies accountable at an Aug. 31 healthcare forum at Fort Worden State Park.Photo by Barney Burke split Forum. Crowd on geed for health reform ',Continued from page 1 McGrory said the system also asked whether government Kaapppof Port Townsend.He sug- has to value primary care physi- officials would have access[h s o gested that if healthcare costs cians.She said she's paid$50 for patient files. Checking don't decline s three d ff, Dicks paymentsat years,Congress to a can collect$450 for15 minutes. bsettween providers and insurance public option at that time."That's "If the insurance companiescompaniesco paa i would nd ba e private. oper- an interesting idea,"Dicks said. can offer a program good as sting room nurse, from Pur- Dr. Melanie Mian iny, the governments,lete them," Ludlow, lit into Dicks about a • independent physician in Port McGrory to applause. - Townsend, made three sugges- A retired doctor, Donald number of issues, including ille- tions for healthcare reform. Springer,disagreedwithMcGrory. gal immigration. "Remove them She implied that private insur- He said the government is in no from my country and close the ance tends to cover healthier peo- position to fund more healthcare border," she demanded as the ple while government programs because it now has a $9 trillion crowd cheered. d such as Medicare and Medicaid debt."It will not work,"he said to theAnothereconowoic man Suggestesuggested have the burden of people who equal applause. need more care."If we were all on . -A Sequim woman seemeded totov- ndnot thefed ral is programs ra ssi to Medicare, it would be penciling speak.formany opoos fine,"she said. ernment-run healthcare for every- would lead to"dictatorship."And "Healthcare is a profit cen- one. "A government big enough the next cost ospeaker ugre suggestedin the ter for corporations," McGrory to give everything you want is big higher xas continued, noting that insurance enough to take everything you cannot be fixed because of illegal premiums fund executive salaries have,"she said to loud applause. aliens there (a story Dicks ref- and bonuses. Jim Boyer of Port Ludlowerenced in New Yorker magazine ] costs examined why Medicare in McAllen,Texas,are twice the national average). Dicks quipped, "I have never gotten 100 percent in any elec- tion,"adding, "I'm here to listen and to learn." As to dealing with immigrants from Mexico,Dicks said,"We are finishing the fence." Dicks dismissed suggestions that a proposed "public option" insurance program would include illegal immigrants. "It's right in the bill," Dicks said. "You can't get benefits [if you're an illegal alien)." Afterwards, Dicks said he was not surprised that attendees voiced strong opinions on wheth- • er or not changes should be made to healthcare. "This is what you III • expect,"he said. Asked if the healthcare debate is distracting the White House and • Congress from the worsening situ- ation in Afghanistan, Dicks said "It [healthcare) is the big issue right now,"adding that Secretary of State Hillary Clinton is leading a Rep. Dicks' take • on health reform By Barney Burke of The Leader uninsured and that's not right," Dicks said. When someone asked Rep. As to businesses that are unable Norm Dicks this-week if he'd to continue offering healthcare be willing to be part of the same benefits,"That's one of our biggest healthcare plan he's proposing,the problems today,"said Dicks."Look 68-year-01d Congressman said he's at Detroit." already on Medicare. Republicans aren't opposed "I'm for the public option,"said to reforming healthcare, said Dicks of a proposal that the federal Jefferson County GOP Chairman government offer an alternative to Ron Gregory.He said that capping private health insurance. punitive damages would moder- "I've supported single-payer all ate the costs of malpractice insur- of my career," said Dicks. That ance. He also said that insurance idea would offer Medicare to all companies should not be confined Americans regardless of age,but to state boundaries, which limits he noted that President Obama is competition. And, Gregory said, proposing the public option, not people should be able to take their Medicare for all. current insurance policy with them And, Dicks cautioned, on a permanent basis if they leave "President Obama has said that one job for another. unless it's paid for[through spend- ing cuts and/or tax increases],he will not sign the bill. I support that." "We have to reform Medicare," said Dicks,citing a June 2009 story in New Yorker magazine that exam- ined why Medicare recipients in McAllen, Texas, collect about $15,000 a year in services, twice the national average. Dicks said that paying doc- • tors a salary rather than fees for service could save 30 percent for Medicare. He cited Washington- based Group Health and the Mayo Clinic of Minnesota as examples of that approach. Dicks also said that the"donut hole"gap in Medicare prescription coverage is a"mistake"that needs to be fixed. With the federal debt at$9 tril- lion and two-thirds of the budget taken up by entitlements,-Dicks said the"public option"for health insurance will have to pay for itself. And if healthcare costs aren't con- trolled, even military spending could be cut,he said. Dicks said strong tort reform in Texas had no impact on healthcare costs in McAllen, and Congress has been unable to pass national tort reform.Moreover,he argued, people who've been severely • injured—he gave the example of removing the wrong limb—should be able to go to court to seek corn- pensation. - • The bigger problem, Dicks said,is"People with insurance are paying for people who don't have insurance," such as people going to the emergency room for rou- tine medical care. "We also need more primary care physicians," said Dicks. "We're paying more[for health- care]than any other nation in the world and we* got 46 million / cC , O '.N.,. \., , . ,: N. ck., ,,,s„. .... N( . .4 . i N o v ^O f T.,'0 v >-c ro ° oo)=° �, 00v. vv. Luccyoov, vx io7A _ o -� J, C Y'^c an .+;0 " 4 L O� �'•0 I-. U.N...7 y ° C ° 7jII!H _ Oa CAL 0.O ae.+.-� iO E v"y al 0. ' Y O 0.0.YO O.N 7 ` 1/ Y ; v °' Z v v.0 w0,0 Oa v.5 a! c z,o.a y 0 N.E CO • L o R.-a Ci O C aCi ad N `0 y ?; .c A 3 ^o oa �/ IF 3 ,.5 L 5, >N o oy al:N N O a`�`V oto o ,roj-0 7 j,•� v.O0 0 •D_ c0-o i.O>-.,.1'' 0'-•A Y.tC C O Ji t-c > O c�0 v A C ro O.0 L °.%' cad >,-- C c00_00 CO• zo co. o ° Ay'N oco r-u - 0 ro4 vt Y - :a Lt 0'tD.o N >•J Q.F, y` " a�`r.'. o R"L;oC_''J^ -•C7 . - u"cu=(c Y ro >'� •-•,_ - a c' > C N' v 0 0. 0 3 o y 0 v.. 0 xa3tyL Yro ,Ac=oo ,8O 7^ •5 C7 0't t w\ L ,, p n «I Z tom. N w^0"� .c' 4! id.o ,r4 .2 C o o (...+v0 w id /W\ L A 3 3 0. x U 3.�d. B o v°.�w u > .5 C cad N 0) U00.' o O.0 C.D'o op N N 3'E C cab .t 7 y•? Y ^Y.{ Z .C._,.. _ JZ cupt a yo. v LN � ro. o0A N o >� 30 > f ,_:..c'-' c ;-"- a c 3 ° °. 7 a a> .1:1° v a b v` E ° u m o ti o '' • ° 3 y 5 o=3= c t'b ..:a c v ti t 3.° a>' o N -0 .c JE TY bre c t�FI 000-• °! 7.°' o2.ti K4 7.6., c G c 0 0 .b E ' 3 3 = y c to > 0 - o y-5 o c c c 5• o•€� 5,� > N .T^le•dc J c •.- c ryj N ,A.+ro ro r c '7 T co .� N > t r''. c owc a'v U•o ro a 4 c� o t v y v ° va c c Eve^ = yxA o 3 J - 3 0- '>'° T n N N 1., ° C Z v >vn v v E 5 o Y^o o t.: N U - S G t (�� Y n > v � o'0' 3 c 5"0 , 3 � 8 as o � N c o � a a E S o� o ft ! ! i> Z > n ro a V ° a) O ro y • v U C l a c U^b 'Yv' 70 A 3 y c�N V O 0 0 0 p,I::r C'y E T- y E� 0.O O. 0 >'O. a p.5 C1. y ro' t , N N 0 y yb > T' " '� _ r'----7-•0, 03 0 t o v. > V c0 N O t po N N T O0 v T >;` c - •'.%u.> c= o^a. a> 3 > o 3 Q•^c N c•S.„ c E avi noN, a r'ot`e 1-0.1 7 a• ti b � 5 3 ,. c, - Y'J�_ .L ro"" r'> v V av+ 7 .'L.+ ti a N N't3 7 u v 'O C Y t c o •l. 0 - 0 0... y •°o cro pvpY ova c A bj o>vU•3 xU bvv0 ado c°� u� ado S"� 0 0.5 c s.70 N L 70,a T 'N o j a .>+ C C^y v G v 2s. of f 'T'•`_7 Y - > j >. U G C U t ti'0 0 w ro fl. u c' ! ,,, J A C O Z ro 0 a-a u v °..- c 0 Y 0 N o. o. pp., a O y > v;.G--. > > O._ U Nn '� r v a 3 o N E '+w y Y L'-o y i ? • �-' >, �• U O G U C d v)'O'."J' O Oa ._ N U '•cy v cnd.5 " > d C U C >. -A'c t = co > O O O CO E.0 4 t v ro o C a a A 7o C Y.L• v ro C . v 5 ,a _ - ro. O N N •.. u _ E 0 0. 'Z7. co�., o'.0 4 .v, a ro C_•7.L 2 n f L i f 7.r O 0 co c O y V-0 v .0 v a Y -•'o v T7 « O•ti_ co=.4) I- ro'a 3 o y` b "L J L I > �J'� i. 0 w 3 c6 >D w v 3 �° 5 N� N E ro v . -c.c 5v ° c t >. a- >r:-=. r 4 L V i CC YE -, A c'C i _ • - - _ co«; ao- - ...o_o N Y a ° EA ° p°pn y ".1).-'30 >' 0.1.' °..2 ,,, ,--A ..e _ CO O C N N Y C W N O u L'O ° 'S O J i A^o Y L. v-O ro N-0 V° N a y _ 5 J 3, N C C c w W^ y 'C- v y w T:^. N.� '- a N ro Y�.J^.`-. " c - ^ • i ro � y-> 'co'N o :ty Y >. ai o Yg t Y i m.° ca -y,v t �.c >_ oo x w ., ...� c � O O > Y u t ,t i 10 • aS 4 y O.y a .rJ 6, O c '.r'.I .b ro O E O g v 00. U tt'.. .L o• -'A 1 J C .•_A T > a)td r 9 5-Y y C ai•c p•5 >, A y ro t N N "O 7,3 .¢•C Zw n I J V li s. Hinvcca�= E oov >a RN� ��NE o0 v.coyco� o tox..t: • 0.3 Y N .c-- o ro. v c= 0 3� Nw0 - So. ` c ` n:. >, O Y15Ao caoa 5' .t y ' C o f > oL . ^ 1 -7 a1 V; (1,..6"4 •5 ') > .gL,a,N 0 o•N•� 0 70 ro-0 1,-., ,.- 0.50,.,vd a2E > o "c - ▪ 0 n yl ta° 7 ■MM// / L• 7o CiQ0 Q A'7 t.. a r T '« a_t•O N C 5 >, a d'o, 4 2_,).c ro p U E 5'.0•= Y F Eto N ° a' • ° _ vO '3 ° 'J0 oc0 iTYo. .O • 'o U N a v � . co N C Y >, 1d _ 1"mj G L .v- J „ v v-0 N . 3 N O•N _ -cE n w oroUi > - ? 0 _ a v0CO � O �br :b-•.4 E x.5 cc 0 °..c d.N N Ere. a., ,,i• 4) 0.�'o •yLc, z. .-- y o y3o cE UoO ^ N• L "...a, N'^ '7-• 8y pQN v aC v ° 7." Y :- a b - 0 Nyd. GO W ,OOOUa .`5-5 OO > ro Ucro NO L r = 0oc0..N C O a•iY• -.y v.g 4)-C 'pQ-Ci v '--'^ • _ NvY o » E t >,.a. _p Tv ^0w.a N ^� 6 U v p. %a c >, tt 8 vov vO y.� v U L a: A a t,w 7 v al 7 O 5 SC0A Oy 2 1 6 x ) ro O A aotp7 .4C > .. CO • 0OY x `4 - ,• 3 'n .� a ro N L a vOO y cT0 a bro 03 O. v N YC 7 A U .,. « 0 0tvwc- vONa) ` vE 'N, a ° O C N v u ' b0Fa `-c- >,• yc m aTEw E 41 a)X o• 3 E a E v v cd u .). 3raE °.' i. ' va� WoaY > ° VS ° ro'n B ° tc.. � .o�� > � c....t 8. t%.? y•5 •5 S .5 a.) . v 5- a .. C v C Oo v Y E OVro vED U'O C E'6 N > .= 3 3 yL d.°)-...i's 4oOS3y� o,'rocc5ro 00Y�� -� s. = cb ° " .0 0 •N 0oo0o00EUE0� '. 0, '0 .c 0 a . •C 0x .c .4 > 0. 3 E va _ c, o- v U 4 • ."; t ia N waZ U C 5,v N Uy. L ^ .0vov a L.%'9 p - 740Ca . a .at ^occJ 0 = 0o .0vo UI.'0 a) p• a v ,,d USC•.0 >, v 0a . ro '4' J 0. Z -o7 0' t O E L ..A C •oro: / =- •U g CC , C .-c r -0 O xv•A0 Y w v. ,-- E t- f ro u O. .c00 - v vL r100w Uo o• av a., --' 1, u5"- •ax 0) , oc , cri. Q ° o yR'.1.' 0 OV • -0va '4 ' trC 74,� N v 0 Q U T•.7 t •-- 0. NU v 0.c y 0 Nn v la= d v..,•. cop� C t- " yux robi N 'c r, � E ca o a rot 3 C c=Nopt_ roc Naic0 s _ 5.A' N" t N t7w 0 oqo= w � N^a �A w N y wEEC•J'� O'O '0 n YOO� n c, 0 i 0 •.7 L,U Dv qdvv 'ENd. c , `ro 4" 7gC yO� , OU2oEt3v.0y Y c i Oo�� 5 0 _ c .5 � ° L N t E a5 r �z > 7yaN '' y • > Y as ci) -o o E� t roAo`, oEt Y5ciA F. c yvcs' a:.§ . ` N o3 8 v•u r7"-5-0 �.c i 2v., 4? E $ a � > NE.s< Y �Eco !,- 8-6'720m .`“)REO-F., .`"(-) 7.00) )� yaoU 'ir;agvv GO2 x2 d- N a.C >t.. 0 22.=:.G o' 0.A.. 0.rouo n -o3 'n { • • AMERICAN JOURNAL OF PUBLIC HEALTH ..• .. � � EDITOR-IN-CHIEF Mary E.Northridge,PhD,MPH EijDEPUTY EDITOR Farzana Kapadia,PhD y FEATURE EDITOR Gabriel N.Stover,MPA •-, IMAGE EDITOR Aleisha Kropf ASSOCIATE EDITORS Mary T.Bassett,MD,MPH , ' .. s Felipe Gonzalez Castro,PhD,MSW Accountability: Fast Lane the Highway�'to MichSo is Gruskin,JD,MIA Change Said Ibrahim,MD,MPH Roberti.Kim-Farley,MD,MPH Stewart J.Landers,JD,MCP Stella M.Yu,ScD,MPH Today,more than ever,health departments are will also direct quality improvement efforts ASSOCIATE EDITOR FOR STATISTICS AND EVALUATION seeking funding in a hostile environment,in toward meaningfultargets. RogerVaughan,DrPH,MS g INTERNATIONAL ASSOCIATE EDITORS which other institutions such as schools and jails Yet health departments cannot deliver public Kenneth Rochel de Camargo Jr,MD,PhD have already received the imprimatur of ap- health services alone.Health reform,emergency (Rio de Janeiro,Brazil) proval from accreditation.The public's de- response,obesity—all require health depart- Daniel Tarantola,MD(Sydney,Australia) mands for greater accountability,a nationwide ments to view themselves as-important compo- DEPARTMENT EDITORS Leslie Beitsch,MD,JD call to action for a smarter and more effective nents of a broader public health system.Strong Government,Politics,and Law health system,and an economic crisis that collaborations with partners and effective ver- Elizabeth Fee,PhD,and Theodore M.Brown,PhD requires strategic investments have all been tical coordination between local,state,national, Images of Health growing as the importance of public health has and international levels are critical.How do Public Health Then and Now been reinforced by the emergence of the H 1 N 1 we establish accountability—which admittedly Voices From the Past virus.In these uncertain economic times,ac- can only exist for a concrete organization—while Bernard M.Dickens,PhD,LLD,FRSC countability via accreditation may confer a sub- acknowledging the fluid and collaborative na Health Policy and Ethics Forum stantial competitive advantage in the govern- tare of public health?The answer may be found ebh H.McLan, PhD,PhD, and mental marketplace and set us on the road to in complementing agency accreditation with Deborah FramingHoltzmea, MMSW fostering an improved health system. encouragement of partnership-building pro- c , Health Matters � p P g EDITORIAL BOARD Hector Balcazar,PhD(2011),Chair Building on earlier initiatives,the Public cesses such as the system assessments provided Bobbie Berkowitz,PhD,RN(2011) 41, Health Accreditation Board(PHAB)was by the National Public Health Performance Russell Brewer,DrPH(2010) formed in May 2007 with the goal of improv- Standards and community health improvement Bonnie Duran,DrPH(2011) ing and protecting the health of every corn- planning as guided through tools like Mobilizing Vanessa Northington Gamble,MD,PhD(2009) munity by advancing the quality and perfor- for Action through Planning and Partnerships. Neil Hann,MPH,CHES(2010) mance of local,state,and tribal health Thus,there may be a common pathway to Alice M.Horowitz,PhD,MA(2009) departments through a voluntary national ac- achieve change,proactively respond to emerg- Cassandra L.Joubert,ScD(2009) creditation program.Via an open and deliber- ing and reemerging health challenges,improve Jared Lane K.Maeda,MPH(2009),Student ate process,PHAB is collaborating with no- health outcomes,and respond to the demand Louise-Anne McNutt,PhD(2010) tional partners and the public health for greater accountability.Promise may be Dana B.Mukamel,PhD(2010) community to create and launch a voluntary found through voluntary agency accreditation, Brian Saylor,PhD,MPH(2010) national accreditation program in 2011. coupled with continued attention to creating Allan Steckler,DrPH(2009) A significant and intended impact of public stronger public health systems that extend David K.Wegman,MD,MSc(2011) health accreditation is momentum toward beyond health department walls and effectively Lynne S.Wilcox,MD,MPH(2009) greater accountability and enhanced credibility leveraging community resources toward STAFF Georges C.Benjamin,MD,FACP to stakeholders,partners,and communities.This pressing health issues.Considered collectively Executive Director/Publisher may lead to public health breakthroughs,just as it as a suite of strategies,agency accreditation, Nina Tristani,Publications Director r did fora health department in Mississippi County, system assessments,and quality improvement Brian Selzer,Manager of Production Missouri The health department had long are sound vehicles to move us into the fast lane Lindsey Topp,Assistant Production Editor sought a more rigorous food safety ordinance, on the highway to accountability and change.IISarah Gaskin,Production Coordinator j but could not gamer the necessary support until it yAshell aRibAlston,DirectorofAdvdinang I received accreditation by the Missouri Institute Leslie M.Beitsch,MD,JD Maya Ribault,Publications Coordinator of Community Healthone of the few public Department Editor,AJPH Jennifer Strass,Graphic Designer health accrediting bodies in the United States. Liza C. Corso,MPA Vivian Tinsley,Subscriptions Coordinator PHAB accreditation is deliberately engi- Office of the Chief of Public Health Practice, FREELANCE STAFF Greg Edmondson, Michele Quirk,Gretchen Becker,Alison Moore, nee ed to emphasize quality improvement and Centers for Disease Control and Prevention, Trish Weisman,Gary Norton,Jennifer Holmes, strengthen the nexus between high performing Atlanta, Georgia Brent Winter,David Stockhoff, health departments and improved community Alexandra T.Stupple,Copyeditors j health.Preparing for accreditation demands doi:10.2105/AJPK2009.172957 Chris Filiatreau,Alexe van Beuren, attention to performance at the organizational Eileen Wolfberg,Sarah Smith,Proofreaders and programmatic levels.Reviewing the results Vanessa Sifford,Michele Piyor,Graphic Designers of the accreditation site visit and final report September 2009,Vol 99, No. 9 j American Journal of Public Health Editor's Choice j 1545 Seasonal fluclinics • o.ff to an early start Seasonal influenza vaccines Brinnon . Senior Center Quilcene Community are beginning to arrive in area (306144 Highway 101,Brinnon): Center (294952 Highway 101, clinics and pharmacies.Because . Friday, Sept. 11, 9 a.m.-3 Quilcene): Friday, Sept. 18, 9 vaccine for the H1N1 swine flu p.m. Medicare patients bring a.m.-3 p.m. Medicare patients is not available until at least Medicare cards. All others pay bring Medicare cards.All others mid-October, the Centers for $25, cash or check. Private pay$25, cash or check. Private Disease Control and Prevention insurance is not billed. insurance is not billed. is encouraging residents to get Jefferson Medical & Olympic Primary Care their seasonal flu shot early this Pediatric Group (915 Sheridan (1010 Sheridan St, Suite 101, year. St., lower level, PT): Saturdays, PT): Saturdays, Sept. 26 and • • The risk groups especially Oct. 3 and .Oct. 24, 9 a.m.- Oct 17, 9 a.m.-noon. Medicare vulnerable to seasonal flu are noon. Medicare patients bring patients bring Medicare cards. those over the age of 50, indi- Medicare cards. All others pay All others pay$25,cash or check. viduals with chronic medical $25, cash or check. Private Private insurance is not billed. conditions, pregnant women, insurance is not billed. Port Townsend Family healthcare workers,and all chil- Madrona Hill Urgent Care Physicians (934 Sheridan): dren between 6 months and 18 (2500 Sims. Way, PT): Vaccine Saturdays,Sept. 19 and Oct. 10, years old. available during clinic hours: 9 a.m.-noon. Medicare patients Parents and guardians Monday-Friday 9 a.m.-7 p.m., bring Medicare cards.All others should note that the pediatric Saturday 9 a.m.-4 p.m., Sunday pay $25, cash or check. Private • seasonal flu vaccines have not 10 a.m.-2 p.m.Vaccine available insurance is not billed. yet arrived in Jefferson County for clients age 18 years and QFC Pharmacy (1890 but will soon be available at older. Flu shots $25. Medicare Irondale Road, Port Hadlock): Jefferson County Public Health billed;all others pay cash. Wednesday-Thursday, Sept 23- and the Jefferson Healthcare Madrona Hill Urgent 24 & Oct. 21-22, 11 a.m.-5 p.m. clinics serving children. Care, Port Ludlow (9481 Oak Medicare and Medicaid accept- The following is the sched- Bay Road): Vaccine available ed; bring cards. Flu shots $25; ule of seasonal flu clinics in during clinic hours: Monday, pneumonia shots $45. Clients Jefferson County: Wednesday, Friday,Saturday 9 must be at least 11 years old. a.m.-4:30 p.m.Vaccine'available Safeway Pharmacy (442 for clients age 18 years and Sims Way, PT): Saturdays, Sept. older. Flu shots $25. Medicare 26 and Oct 3,10 and 17,10 am-4 billed;all others pay cash. p.m. Walk-ins welcome from 10 Monroe Street Medical a.m.to 4 p.m.Monday-Friday.No Clinic (242 Monroe St., PT): appointment necessary.Medicare Limited supply of preservative- and Medicaid accepted. Many • free vaccine. Current clients insurances billed.Bring insurance, have priority. Call 385-5658 for cards. Flu shots $30; pneumonia an appointment No insurance shots $49.99. Clients must be at is billed. least 11 years old.