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HomeMy WebLinkAbout2009- October File Copy Jefferson• County y Board of 3 CeaCth Agenda & Nl inutes 41 October 15, 2009 • • JEFFERSON COUNTY BOARD OF HEALTH October 15, 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 September 17, 2009 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. Discovery Bay Area Beaches Closed to the Recreational Harvest of Shellfish Due to Marine Biotoxins 2. National Survey of Local Health Department 3. Correspondence • V. New Business 1. Board of Health Bylaws Revision: Action Item 2. Pre-adoption Briefing: Draft 2010 Fee Schedule 3. Port Townsend Water Supply Update 4. Pandemic H1N1 Preparedness Update: Community Vaccination Strategies 5. Green Business Award—Printery Communications, Inc. VI. Activity Update VII. Agenda Planning—Public Hearing for Fee Schedule Adoption VIII. Next Scheduled Meeting: To Be Determined • a JEFFERSON COUNTY BOARD OF HEALTH RIR ? ? • MINUTES Thursday, September 17, 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 2:30 PM. Members Present: John Austin, Roberta Frissell, Phil Johnson, Chuck Russell, David Sullivan, Sheila Westerman Excused: Kristen Nelson Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin • Guest: Frances Joswick, SAAB A quorum was present. APPROVAL OF AGENDA Frances Joswick requested the addition of SAAB announcements which was placed under New Business Item 3. Member Austin moved and Member Sullivan seconded for approval of the agenda. The agenda was approved unanimously. APPROVAL OF MINUTES John Austin moved and Roberta Frissell seconded for approval of the minutes of August 20, 2009. Phil Johnson abstained, due to absence from the August meeting. The minutes of August 20, 2009 were approved, as presented. PUBLIC COMMENTS There were no public comments. • Page 1 of 11 OLD BUSINESS and INFORMATIONAL ITEMS . West Nile Virus Update A September 11, WA DOH News Release was included in the packet. Dr. Locke said that this is the time of year when the vector mosquito,Northern House Mosquito, shifts from feeding on birds to feeding on humans. Most cases of West Nile Virus (WNV) in Washington occur in September and October, before the onset of cold weather and mosquito die offs. Dr. Locke noted that WNV-positive mosquito pools were detected earlier this year in Eastern Washington; now there is a cluster of human cases there, none of them severe. The public education message has been out for years; focus is now on surveillance. He said the one Mason County crow with the disease seems to be an aberration. Dr. Locke mentioned that he had just been notified of a 100 sea bird die off at LaPush. West Nile virus was ruled out; hypothermia associated with a naturally occurring marine algae bloom is believed to be the cause. Correspondence from Senator Murray A letter of response to the BOH letter regarding health care reform was received from Senator Murray; a copy is included in the packet. Substance Abuse Advisory Board (SAAB) Update Frances Joswick reported that Robert Archibald has resigned his SAAB position due to i relocation. She said Mr. Archibald will be missed. She also reported that Julia Danskin and Jean Baldwin have been successful in their efforts to secure funds to support the educational aspect of the jail program. The funding will be in effect from January through December 2010. Efforts will continue to seek additional funding for the program. In recognition of September being designated as Alcohol and Drug Recovery Month, the Leader is doing a feature article. Ms. Joswick said two of the most important issues are the Relapse Prevention Program at the jail and determining the real cost of addiction. She cited the study from Columbia University which indicates that 96%of every State and Federal dollar is for"clean up costs"; only 4% is for treatment, and a miniscule amount is for research and prevention. The purpose is to develop new thinking that will lead to more effective legislation and budget priorities for prevention and treatment rather than clean up. Clean up costs include incarceration and legal costs, costs of lost jobs, etc. She said the intention is to apply the Columbia model to Jefferson County, using actual dollars spent on various programs as related to addiction. Ms. Joswick said she expects to have figures to share by the end of the year. Jean Baldwin said that Ms. Joswick was referring to the OFM (Office of Financial Management)meth treatment money that can be allocated for the jail. The 1/10th of one • Page 2 of 11 4 percent tax funds are already paying for the jail nurse; her time is augmented from Safe • Harbor OFM dollars. Ms. Joswick commended Ford Kessler for allocating education staff for this program for 15 months. At the end of September 2009, the demonstration phase will be completed, and will show success. NEW BUSINESS Board of Health Bylaws Revision Chair Westerman questioned the phrasing of the second bullet under Representation on page 2. She said that in her understanding,the City Council and Hospital District may appoint their representatives, who may be City or County residents. She said the requirements for two City and two County appointees do not apply to these particular seats. She suggested a wording change (after" ....at large community representatives."): "One of the at-large representatives shall be a resident of the City of Port Townsend and one shall be a resident of unincorporated Jefferson County." There was a discussion about the phrase "Four members of the Board of Health shall be appointed by the County Commissioners." Dr. Locke pointed out that the Ordinance specifies this appointment requirement, but not the appointment process. The authority to appoint cannot be delegated, for example,to the City Council or the Hospital Commissioners. The text of the Bylaws was left unchanged regarding this point. Under Vacancies, Member Sullivan noted that 30 days may be too short a period for • advertising and determining a nominee. Dr. Locke suggested the following language: "....thirty days or as soon as practical", which was accepted by the Board. Dr. Locke pointed out the new phrasing in Ethics, Section 3 under Article IX. He explained that the important thing is to bring out any real or perceived conflict of interest for discussion. Either the Board or the Member may determine that the conflict of interest is significant. Member Sullivan added that if refraining from participation would affect the quorum, it is necessary to weigh that factor in, as well. Dr. Locke also pointed out the appeal hearing process(Section 6) may vary, depending on the specific public health code that governs the matter. Jean Baldwin noted that Section 5 appears to be under Section 4, Public Testimony, and asked if that should be a separate section. Dr. Locke said that Section 5. should be a section under Article IX and include the title, Public Hearings. Ms. Joswick noted the absence of explicit mention regarding special attendance by non- voting members, such as representatives of the SAAB. Chair Westerman noted that in the past both the Public Utility District member and the SAAB member have attended regularly, which simply involved agreement by the majority of the Board. There was a brief discussion about voting/non-voting and ex officio membership. Ex officio means that if your membership on a board is a condition of holding an office, you are automatically • Page 3 of 11 • appointed; that is, your membership is derived from your office. Ex officio members may be voting or non-voting. • Chair Westerman said she was in favor of allowing non-voting members of other community organizations as members, if they are approved by majority vote. She suggested adding a statement that is flexible enough to cover other organizations. Member Austin wondered if there would be any advantage to adding non-voting members to the Board, and whether such an amendment would necessitate amending other areas of the bylaws for clarity. For example, where the bylaws refer simply to board members, they would need to be made more specific, i.e. voting members or ex officio members, etc. Chair Westerman said that changing all instances of"member"to "voting member" where appropriate would be a straight forward change. She said that the de facto practice has always been to have a quorum of the voting members and that should be explicitly stated. If the board expands by one or more (non-voting)members, it will be clear that the quorum is not affected. Member Austin noted that Article X would be changed to read "... two-thirds (2/3) vote of total voting members ...". In addition, there was a change to Section 2. Voting: "Each regular member of the board shall be entitled to one vote." There was a discussion about absences under Article III. Ms. Baldwin asked if staff should notify the Board of County Commissioners (BOCC) if/when 3 unexcused absences occur. Chair Westerman said she believed the BOCC should be notified, with the understanding that they will determine whether or not a member is removed or other action is taken. She noted that absences are considered unexcused when the Chair is not notified and given a reason for an absence. The minutes will show clearly whether absences are excused or unexcused. Dr. Locke suggested the following language regarding non-voting members: "The Board, by majority vote, may appoint non-voting members to the Board for a defined term." The Board agreed that staff would provide a final draft to be reviewed and approved at the next meeting. The revisions will be mailed out at least 10 days in advance of that meeting. There was also an agreement that each member will be responsible for keeping his/her own copy of the BOH board member notebook up to date. Dr. Locke noted that the number of board members needed to vote in favor of a bylaws change (2/3 of the Board) is 5. • Page 4 of 11 • • Nurse Family Partnership (NFP): State Board of Health Correspondence and Local Funding Options Jean Baldwin said she wishes to ask the BOCC to enact an Ordinance, allowing certain funding to be applied to the NFP program, and would like to walk through the matter with the BOH. She referred to the set of packet materials and reviewed the history of the issue. The BOCC, per Senate Bill 5763, had raised the sales tax 1/10`h of 1% in July 2006 for chemical dependency and mental health treatment. The local ordinance provides for an Oversight Committee to manage that money (about$385-400,000 per year), with representation from the Law and Justice Council, Substance Abuse, one County Commissioner and the BOH. She said that Jefferson County is different from other counties in that it does not have a Humans Services Department, so this committee advises on the allocations for this pool of money. As an early adopter, the County received $200,000 for meth treatment with another$100,000 to come. The BOCC priorities were treatment for individuals and children for mental health and chemical dependency. She reviewed the list of purposes for which the funds can be used. She noted that adoption was slow in order to verify the amount of funding and the actual local needs. The intent of the original law is not to supplant, and to ensure it is the last source of revenue. Each vendor must have a contract which is monitored by the Department of Health. • This year the legislature passed Senate Bill 5433, which allows counties to supplant 50% of the funds raised in 2010 for existing programs that are no longer funded. Ms. Baldwin referred to the interpretation from David Alvarez in the packet. That is, 50% of the money raised may be used for supplanting in 2010, and reduced by 10% each year until 2014, when only 10%may be used for supplanting. She also referred to "Program Design & Evaluation"and "Program Elements", provided in the packet to review what is being done with the money currently. According to this document, application of these funds could also be for"Ongoing home visits to families by Infant Mental Health and Public Health Nurses for young families and Nurse Family Partnership visitation". She said she would like to ask the BOCC for a levy lift and apply for$35-40,000 for the program that had been cut, to supplant out of the carry over fund, which now has about $150,000. She explained that the BOCC would need to adopt an Ordinance to take advantage of Bill 5433. Chair Westerman said it has been of concern to her to ensure that the 1/10th of 1%tax revenue only be used for mental health and chemical dependency, as was the original intent of this expanded taxing authority. She said she would support expanding the use of the money provided it addresses those original intentions. She added that the Oversight Committee would not support using it for purposes such as the Parks, since that is clearly not what was intended by the Bill or the voters. She said Nurse Family Partnership is clearly an appropriate purpose, and that she does not believe this constitutes a significant • expansion of the program. Several members stated that the Bill does not actually allow Page 5of11 supplanting for other than mental health/substance abuse programs. Member Sullivan said he had testified for WASAC on this subject and that Nurse Family Partnership does qualify. He said that the committee must assess and recommend the wisest way to spend • the funds that will benefit the whole community and what should be left as a balance. Ms. Baldwin said she had asked Quen Zorrah to attend this meeting to talk about the Nurse Family Partnership (NFP)program and its relationship to mental health/chemical dependency. Ms. Zorrah noted that the national NFP program had been in existence for 25 years, and Jefferson County's program is 10 years old. She said that developments nation-wide are reflected in the report to the BOH in the packet. Ms. Zorrah highlighted significant items in the report. She reviewed the findings of the Washington State Institute for Public Policy and other research groups,which show that NFP ranks very high in savings for every dollar invested in the program. She said it is clear from local and national data that NFP is having significant positive effects on the community. She reviewed statistics indicating the effectiveness of the program. She summarized the current budget and the 33%decrease in DSHS funding as of 07/01/09. In response to a question, Ms. Zorrah and Ms. Baldwin confirmed that NFP works closely with Child Protective Services. Ms. Zorrah briefly discussed a new assessment process for families that is being done for all families of pregnant women and those that have office or home visits. It has not yet been expanded to the WIC program. This is a fairly lengthy process, but provides a much ID more comprehensive mental health screening. Eventually, this will provide much more data that will be included in the NFP analysis. Member Austin inquired whether there has been any reduction in Fetal Alcohol Syndrome (FAS) through this program. Ms. Zorrah said that FAS diagnosis is difficult and that there is a long waiting list for evaluations at UW. Member Frissell stated that Ms. Zorrah had done an excellent presentation to the State Board of Health, and said she wished to recognize her for that and her continuing efforts in the NFP program. There was a brief discussion about the funding for the NFP program and Ms. Baldwin's proposal to the BOCC. Member Sullivan said that the recommendation would be considered at the October 6 meeting of the Oversight Committee. Member Austin moved that the BOH support and encourage the Health Department to secure funds from the 1/10th of 1 percent tax revenue pool for NFP; Member Sullivan seconded. The motion was approved unanimously. Fran Joswick said that she would carry this information to the SAAB. • Page 6 of 11 • Pandemic H1N1 Preparedness Update Member Russell noted that Dr. Locke had made an outstanding presentation on H1N1 to Hospital staff; a second presentation is planned. Dr. Locke stated that a small subset of the available material on H1N1 had been included in the packet. He noted that there is an increasing volume of information coming out and that it has been changing rapidly. For example, a recent study published in the New England Journal of Medicine stated that one dose of the vaccine would suffice, rather than two, which had been the working assumption. Member Austin noted the inevitable rumors that arise, as well, and suggested that perhaps the Leader could publish a rumor suppression box weekly. Dr. Locke reported that communication efforts had been focused on the schools during the summer, and were now aimed at the general public. With physicians and other health care providers,the information is very specific and technical. He said that there are many speaking invitations and that he would be doing a piece for PTTV the following week. Dr. Locke said he had given a technical presentation for hospital staff in Port Angeles, reviewing what had been learned about H1N1 from the first wave in the US. He said that the virus never actually left Washington State. The news from the Southern Hemisphere • is mostly good news, and the virus has apparently not mutated thus far. He explained the two types of mutation, drift and shift. Drift involves very subtle changes and requires changes to the flu vaccine to accommodate those changes. Shift is a big change of some kind. He said that so far H1N1 is not even drifting; the genetic sequence is unchanged from when first observed. That means that the severity of cases this fall will likely be the same as those in this past spring. In addition, the vaccine that was based on the earlier outbreak strain should be highly effective for what comes back. It appears that this outbreak may behave much like seasonal flu. He said that pandemics can have a very long peak (2 to 3 months), but that did not happen in the Southern Hemisphere. He added that treatment, infection control, and prevention efforts would be expected to modify that sustained peak to some degree. In the countries of New Zealand, Australia, South Africa, and Argentina, their epidemic peak was virtually identical to that of seasonal flu, i.e. two-three weeks; this is good news in terms of anticipated stress on the health care system. However, of those who do become ill, some people become extremely ill. About 15% of those hospitalized require ICU care. He mentioned that ARDS (Acute Respiratory Distress Syndrome) can be life threatening and patients are usually placed on a respirator. The impact is chiefly on those 50 years old and younger. The danger is greatest for those with risk factors for complication, particularly chronic lung disease and asthma, cardiovascular disease, and diabetes. The risk for pregnant women is extreme; hospitalization rates for this group are 4 times higher than for non-pregnant women. The . number one goal is to get as many pregnant women vaccinated as possible; this also helps Page 7of11 to address the number 2 priority, parents/caretakers of young children. It helps to protect the families with young children and provides some protection for the infant during the first six months of life when vaccination is not effective. Dr. Locke said that those • infants under 6 months are the highest risk group; vaccinating the mother before the infant is born is the best option. Jean Baldwin noted that because of the complications of reaching all of that population, staff is meeting with various groups of hospital staff weekly. There is a Flu Response team within the hospital and she reported a high level of collaboration between the Health Department and Jefferson Health Care in planning for outreach, administering vaccinations and treatment. The first H1N1 vaccine shipment is expected in early October. In response to a question, Dr. Locke confirmed that it is possible to get both shots at the same time. He said there are some issues with the spacing of live virus vaccines in that the first dose may induce an immune response that stops subsequent live viruses from replicating. Therefore, live viruses flu vaccines should be given at least one month apart. A live virus vaccine can be used at the same time as an inactivated virus vaccine and two inactivated flu virus vaccines can be given at the same time. Dr. Locke stated that the live virus, which is relatively new, has not been a popular vaccine, but may be better for children. It does not require an injection and induces immunity at the mucous membrane level as well as the blood stream. The Health Department will be receiving this type of vaccine as part of the federally funded allocation. Dr. Locke briefly described the licensing issues that determine which populations get what vaccines. Seasonal live virus flu vaccine is for healthy individuals those who are two years to 49 years of age and not pregnant; it has not been tested for ages groups beyond 50 years of age. The injectable, inactivated virus vaccines are licensed for ages 6 months and older. Ms. Joswick asked why pharmacies have supplies of seasonal flu vaccine available before the Health Department. Ms. Baldwin said that the federal supplies were delayed and clinics will be scheduled as soon as possible. Dr. Locke explained that this is a private marketing system, with certain commercial bulk orders having highest priority. He said in his understanding about 100 million doses of seasonal flu vaccine have been produced, which is the usual volume for the annual flu season. About 300 million doses of H 1 N 1 vaccine have been ordered for the United States, which would be enough for all who want a vaccination, but not all at the same time. What could compromise the seasonal flu vaccine production is if fertilized eggs are diverted for production of HINI vaccine. Ms. Baldwin noted that it is not possible to predict if the shipments will arrive all at once or if there will be multiple smaller shipments over time. The Health Department is developing alternative plans, based on priority groups, so they can handle the logistics in any case. Member Austin inquired about outreach to the schools and if the school-based clinics would be involved in administering shots. Ms. Baldwin and Dr. Locke said that children . Page 8 of 11 are a priority group. Older children would be vaccinated in school. However, children • under 5th grade are not vaccinated without parents being present. Member Austin asked if women would be advised to avoid pregnancy because of the risk. Dr. Locke said he is not aware of that being done; rather,the focus will be on vaccination or early treatment with anti-viral medications if they do contract H1N1. Member Austin also asked what the Hospital's capacity is to deal with ARDS. The Hospital has 8 ventilators. However, Dr. Locke explained that type of ventilators used to treat conditions like ARDS, are in very short supply. Jefferson Healthcare has only 2 or 3 of this type. Ms. Baldwin mentioned the Emergency Plans for the Hospital,for Public Health and for national disasters. She said that most of the local emergency medical services (EMS) are very good and that there has been collaboration with Kitsap and Clallam EMS. The Hospital Plan includes Jefferson, Olympic Medical Center, Harrison Hospital and the U.S. Navy. She said that while meeting the need for ventilators in an extreme situation may not be possible, that discussion continues. Dr. Locke said that while systems/inventories may have been stressed, hospitals in the Southern Hemisphere were able to cope with the demand. He said that a category 4 or 5 pandemic would be a serious challenge and may require activation of altered standards of care. One big difference between the Southern Hemisphere experience and the current US situation is the availability of vaccine here. However, the biggest challenge is preventing outbreaks • in the schools in advance of the vaccine availability. At least 3600 doses should be delivered for Jefferson County by mid-October, and about 1600 every week thereafter. He said this is about as fast as the vaccine can be administered, due to the workload. There was a brief review of the precautions and practices that businesses and individuals are encouraged to put in place: frequent hand washing; personal hand cleaners/wipes; wiping down surfaces; use of masks; staying home when sick, etc. In response to a question about vaccine safety and possible side effects, Dr. Locke said that although studies of the new H1N1 vaccine have included thousands, not millions, of people, there is every reason to believe that the risk profile is identical to seasonal flu vaccine. It is made in the exact same way in terms of technology, method, purification, etc. He said H 1 N 1 is not very different structurally from seasonal flu and it would be very surprising if the side effects were any different. He said that all vaccines have the rare potential for causing exaggerated immune activity, where the immune system does not turn itself off as it should. However, that process occurs much more strongly with natural infection. He said that in only about 1 case in 1,000,000 of the autoimmune neurologic disease, Guillaine-Barre Syndrome, occurs with vaccines, while about 20-30 per million cases occur in the population, presumably due to natural infections. In response to a question, Dr. Locke said that it takes about one to two weeks to develop immunity to H1N1, which is the same as for seasonal flu. This is preliminary information. • Page 9 of 11 Member Johnson mentioned that he had recently travelled to London, expecting to encounter signs of the pandemic but had seen nothing, and noted that there seemed to be • no fear or concern. Chair Westerman described her experience of spending several days with thousands of college students, and becoming extremely ill and feverish with the flu when she returned home. The symptoms, although intense, lasted only 24 hours. Dr. Locke said that 25% of people who have seasonal flu do not become sick enough to realize they have it, but may still be spreading the virus. This may also be the case with H1N1. BOH and Hospital Board of Commissioners Collaboration Dr. Locke said he had met with Hospital CEO, Vic Dirksen, who explained the new governance policy of the hospital. Essentially, the Hospital Commissioners adopt policy and the CEO is responsible for interpretation and implementation. This model provides more independence for both the Board and for Hospital CEO to act within these guidelines. With regard to the BOH and Hospital Board collaboration, Dr. Locke said he had been considering a revival of the joint Board process. The Hospital's new governance model encourages direct Board to Board interaction. Instead of communicating through the Hospital CEO, the BOH's Hospital Board member would serve as the main conduit. He said that this type of governance structure encourages direct interactions with the Hospital Board of Commissioners, rather than going through • hospital management. Member Russell added that his title is no longer Hospital Board Chair; he is now Chief Governance Officer. The Board sets broad policies and goals for what should be accomplished. Instead of specifying how this is accomplished, they indicate what the CEO cannot do, and establish definite reporting requirements. He said the Board is pleased with this approach and finds it more efficient. Board members cannot be experts on every subject and cannot be involved in a myriad of details and committees. A major intention is finding the best ways of supporting the CEO in meeting overall goals. Dr. Locke noted that much of the collaboration between the two boards has been concerned with health care access issues, which is now in a volatile state. He said he believes that when congress does act with regard to health care reform, the community will need to develop its own plan for transitioning from the current situation to the new system, whatever it is. He said that there are many likely topics for consideration by the two boards. Ms. Baldwin added that she has compiled a set of demographic/health indicators, as well as other data, which she feels would be of interest to both the BOH and the Hospital Board. • Page 10 of 11 Member Austin suggested an annual meeting. Chair Westerman recalled that for a time • in the past, the two boards met monthly, considered major strategies and, at that stage, brought in experts on a variety of topics. She said that ultimately they realized that they were constrained by the overall context in which small town small county health care must operate. She said she would be willing to resume ongoing meetings provided there is a clear purpose and agenda. She said she is interested in hearing about the new governance model. Green Business Award—Computer.Fix Chair Westerman signed the letter of recognition for this latest Green Business. AGENDA PLANNING The next Board of Health meeting is scheduled for October 15, 2009. The agenda will include a vote on Bylaws revisions; members are welcome to suggest other agenda items. Member Russell requested that he be excused from the October meeting due to another commitment. ADJOURNMENT • Chair Westerman adjourned the meeting at 4:31 PM. JEFFERSON COUNTY BOARD OF HEALTH Sheila Westerman, Chair Phil Johnson, Member Chuck Russell, Vice-Chair John Austin, Member Roberta Frissell, Member David Sullivan, Member Excused Kristen Nelson, Member Page 11 of 11 ger JEFFERSON COUNTY BOARD OF HEALTH .• MINUTES Thursday, September 17, 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 2:30 PM. Members Present: John Austin, Roberta Frissell, Phil Johnson, Chuck Russell, David Sullivan, Sheila Westerman Excused: Kristen Nelson Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin • Guest: Frances Joswick, SAAB A quorum was present. APPROVAL OF AGENDA Frances Joswick requested the addition of SAAB announcements which was placed under New Business Item 3. Member Austin moved and Member Sullivan seconded for approval of the agenda. The agenda was approved unanimously. APPROVAL OF MINUTES , John Austin moved and Roberta Frissell seconded for approval of the minutes of August 20, 2009. Phil Johnson abstained, due to absence from the August meeting. The minutes of August 20,2009 were approved, as presented. PUBLIC COMMENTS There were no public comments. I Page 1 of 11 OLD BUSINESS and INFORMATIONAL ITEMS 111. West Nile Virus Update A September 11, WA DOH News Release was included in the packet. Dr. Locke said that this is the time of year when the vector mosquito,Northern House Mosquito, shifts from feeding on birds to feeding on humans. Most cases of West Nile Virus (WNV) in Washington occur in September and October, before the onset of cold weather and mosquito die offs. Dr. Locke noted that WNV-positive mosquito pools were detected earlier this year in Eastern Washington; now there is a cluster of human cases there, none of them severe. The public education message has been out for years; focus is now on surveillance. He said the one Mason County crow with the disease seems to be an aberration. Dr. Locke mentioned that he had just been notified of a 100 sea bird die off at LaPush. West Nile virus was ruled out; hypothermia associated with a naturally occurring marine algae bloom is believed to be the cause. Correspondence from Senator Murray A letter of response to the BOH letter regarding health care reform was received from Senator Murray; a copy is included in the packet. Substance Abuse Advisory Board (SAAB) Update Frances Joswick reported that Robert Archibald has resigned his SAAB position due to • relocation. She said Mr. Archibald will be missed. She also reported that Julia Danskin and Jean Baldwin have been successful in their efforts to secure funds to support the educational aspect of the jail program. The funding will be in effect from January through December 2010. Efforts will continue to seek additional funding for the program. In recognition of September being designated as Alcohol and Drug Recovery Month, the Leader is doing a feature article. Ms. Joswick said two of the most important issues are the Relapse Prevention Program at the jail and determining the real cost of addiction. She cited the study from Columbia University which indicates that 96% of every State and Federal dollar is for"clean up costs"; only 4% is for treatment, and a miniscule amount is for research and prevention. The purpose is to develop new thinking that will lead to more effective legislation and budget priorities for prevention and treatment rather than clean up. Clean up costs include incarceration and legal costs, costs of lost jobs, etc. She said the intention is to apply the Columbia model to Jefferson County, using actual dollars spent on various programs as related to addiction. Ms. Joswick said she expects to have figures to share by the end of the year. Jean Baldwin said that Ms. Joswick was referring to the OFM (Office of Financial Management) meth treatment money that can be allocated for the jail. The 1/10`h of one • Page 2 of 11 percent tax funds are already paying for the jail nurse; her time is augmented from Safe • Harbor OFM dollars. Ms. Joswick commended Ford Kessler for allocating education staff for this program for 15 months. At the end of September 2009, the demonstration phase will be completed, and will show success. NEW BUSINESS Board of Health Bylaws Revision Chair Westerman questioned the phrasing of the second bullet under Representation on page 2. She said that in her understanding, the City Council and Hospital District may appoint their representatives, who may be City or County residents. She said the requirements for two City and two County appointees do not apply to these particular seats. She suggested a wording change (after" ....at large community representatives."): "One of the at-large representatives shall be a resident of the City of Port Townsend and one shall be a resident of unincorporated Jefferson County." There was a discussion about the phrase "Four members of the Board of Health shall be appointed by the County Commissioners." Dr. Locke pointed out that the Ordinance specifies this appointment requirement, but not the appointment process. The authority to appoint cannot be delegated, for example, to the City Council or the Hospital Commissioners. The text of the Bylaws was left unchanged regarding this point. • Under Vacancies, Member Sullivan noted that 30 days may be too short a period for advertising and determining a nominee. Dr. Locke suggested the following language: "....thirty days or as soon as practical", which was accepted by the Board. Dr. Locke pointed out the new phrasing in Ethics, Section 3 under Article IX. He explained that the important thing is to bring out any real or perceived conflict of interest for discussion. Either the Board or the Member may determine that the conflict of interest is significant. Member Sullivan added that if refraining from participation would affect the quorum, it is necessary to weigh that factor in, as well. Dr. Locke also pointed out the appeal hearing process (Section 6) may vary, depending on the specific public health code that governs the matter. Jean Baldwin noted that Section 5 appears to be under Section 4, Public Testimony, and asked if that should be a separate section. Dr. Locke said that Section 5. should be a section under Article IX and include the title, Public Hearings. Ms. Joswick noted the absence of explicit mention regarding special attendance by non- voting members, such as representatives of the SAAB. Chair Westerman noted that in the past both the Public Utility District member and the SAAB member have attended regularly, which simply involved agreement by the majority of the Board. There was a brief discussion about voting/non-voting and ex officio membership. Ex officio means that • if your membership on a board is a condition of holding an office, you are automatically Page 3 of 11 appointed; that is, your membership is derived from your office. Ex officio members may be voting or non-voting. • Chair Westerman said she was in favor of allowing non-voting members of other community organizations as members, if they are approved by majority vote. She suggested adding a statement that is flexible enough to cover other organizations. Member Austin wondered if there would be any advantage to adding non-voting members to the Board, and whether such an amendment would necessitate amending other areas of the bylaws for clarity. For example, where the bylaws refer simply to board members, they would need to be made more specific, i.e. voting members or ex officio members, etc. Chair Westerman said that changing all instances of"member"to "voting member" where appropriate would be a straight forward change. She said that the de facto practice has always been to have a quorum of the voting members and that should be explicitly stated. If the board expands by one or more (non-voting) members, it will be clear that the quorum is not affected. Member Austin noted that Article X would be changed to read "... two-thirds (2/3) vote of total voting members ...". In addition, there was a change to Section 2. Voting: "Each regular member of the board shall be entitled to one vote." • There was a discussion about absences under Article III. Ms. Baldwin asked if staff should notify the Board of County Commissioners (BOCC) if/when 3 unexcused absences occur. Chair Westerman said she believed the BOCC should be notified, with the understanding that they will determine whether or not a member is removed or other action is taken. She noted that absences are considered unexcused when the Chair is not notified and given a reason for an absence. The minutes will show clearly whether absences are excused or unexcused. Dr. Locke suggested the following language regarding non-voting members: "The Board, by majority vote, may appoint non-voting members to the Board for a defined term." The Board agreed that staff would provide a final draft to be reviewed and approved at the next meeting. The revisions will be mailed out at least 10 days in advance of that meeting. There was also an agreement that each member will be responsible for keeping his/her own copy of the BOH board member notebook up to date. Dr. Locke noted that the number of board members needed to vote in favor of a bylaws change (2/3 of the Board) is 5. S Page 4 of 11 • Nurse Family Partnership (NFP): State Board of Health Correspondence and Local Funding Options Jean Baldwin said she wishes to ask the BOCC to enact an Ordinance, allowing certain funding to be applied to the NFP program, and would like to walk through the matter with the BOH. She referred to the set of packet materials and reviewed the history of the issue. The BOCC,per Senate Bill 5763, had raised the sales tax 1/10th of 1% in July 2006 for chemical dependency and mental health treatment. The local ordinance provides for an Oversight Committee to manage that money (about $385-400,000 per year), with representation from the Law and Justice Council, Substance Abuse, one County Commissioner and the BOH. She said that Jefferson County is different from other counties in that it does not have a Humans Services Department, so this committee advises on the allocations for this pool of money. As an early adopter, the County received $200,000 for meth treatment with another$100,000 to come. The BOCC priorities were treatment for individuals and children for mental health and chemical dependency. She reviewed the list of purposes for which the funds can be used. She noted that adoption was slow in order to verify the amount of funding and the actual local needs. The intent of the original law is not to supplant, and to ensure it is the last source of revenue. Each vendor must have a contract which is monitored by the Department of Health. • This year the legislature passed Senate Bill 5433, which allows counties to supplant 50% of the funds raised in 2010 for existing programs that are no longer funded. Ms. Baldwin referred to the interpretation from David Alvarez in the packet. That is, 50% of the money raised may be used for supplanting in 2010, and reduced by 10% each year until 2014, when only 10%may be used for supplanting. She also referred to "Program Design & Evaluation" and "Program Elements", provided in the packet to review what is being done with the money currently. According to this document, application of these funds could also be for"Ongoing home visits to families by Infant Mental Health and Public Health Nurses for young families and Nurse Family Partnership visitation". She said she would like to ask the BOCC for a levy lift and apply for $35-40,000 for the program that had been cut, to supplant out of the carry over fund, which now has about $150,000. She explained that the BOCC would need to adopt an Ordinance to take advantage of Bill 5433. Chair Westerman said it has been of concern to her to ensure that the 1/10`h of 1% tax revenue only be used for mental health and chemical dependency, as was the original intent of this expanded taxing authority. She said she would support expanding the use of the money provided it addresses those original intentions. She added that the Oversight Committee would not support using it for purposes such as the Parks, since that is clearly not what was intended by the Bill or the voters. She said Nurse Family Partnership is clearly an appropriate purpose, and that she does not believe this constitutes a significant • expansion of the program. Several members stated that the Bill does not actually allow Page Sof 11 supplanting for other than mental health/substance abuse programs. Member Sullivan said he had testified for WASAC on this subject and that Nurse Family Partnership does • qualify. He said that the committee must assess and recommend the wisest way to spend the funds that will benefit the whole community and what should be left as a balance. Ms. Baldwin said she had asked Quen Zorrah to attend this meeting to talk about the Nurse Family Partnership (NFP)program and its relationship to mental health/chemical dependency. Ms. Zorrah noted that the national NFP program had been in existence for 25 years, and Jefferson County's program is 10 years old. She said that developments nation-wide are reflected in the report to the BOH in the packet. Ms. Zorrah highlighted significant items in the report. She reviewed the findings of the Washington State Institute for Public Policy and other research groups, which show that NFP ranks very high in savings for every dollar invested in the program. She said it is clear from local and national data that NFP is having significant positive effects on the community. She reviewed statistics indicating the effectiveness of the program. She summarized the current budget and the 33%decrease in DSHS funding as of 07/01/09. In response to a question, Ms. Zorrah and Ms. Baldwin confirmed that NFP works closely with Child Protective Services. Ms. Zorrah briefly discussed a new assessment process for families that is being done for all families of pregnant women and those that have office or home visits. It has not yet been expanded to the WIC program. This is a fairly lengthy process, but provides a much • more comprehensive mental health screening. Eventually, this will provide much more data that will be included in the NFP analysis. Member Austin inquired whether there has been any reduction in Fetal Alcohol Syndrome (FAS)through this program. Ms. Zorrah said that FAS diagnosis is difficult and that there is a long waiting list for evaluations at UW. Member Frissell stated that Ms. Zorrah had done an excellent presentation to the State Board of Health, and said she wished to recognize her for that and her continuing efforts in the NFP program. There was a brief discussion about the funding for the NFP program and Ms. Baldwin's proposal to the BOCC. Member Sullivan said that the recommendation would be considered at the October 6 meeting of the Oversight Committee. Member Austin moved that the BOH support and encourage the Health Department to secure funds from the 1110th of 1 percent tax revenue pool for NFP; Member Sullivan seconded. The motion was approved unanimously. Fran Joswick said that she would carry this information to the SAAB. • Page 6 of 11 • Pandemic H1N1 Preparedness Update Member Russell noted that Dr. Locke had made an outstanding presentation on H1N1 to Hospital staff; a second presentation is planned. Dr. Locke stated that a small subset of the available material on H1N1 had been included in the packet. He noted that there is an increasing volume of information coming out and that it has been changing rapidly. For example, a recent study published in the New England Journal of Medicine stated that one dose of the vaccine would suffice, rather than two, which had been the working assumption. Member Austin noted the inevitable rumors that arise, as well, and suggested that perhaps the Leader could publish a rumor suppression box weekly. Dr. Locke reported that communication efforts had been focused on the schools during the summer, and were now aimed at the general public. With physicians and other health care providers, the information is very specific and technical. He said that there are many speaking invitations and that he would be doing a piece for PTTV the following week. Dr. Locke said he had given a technical presentation for hospital staff in Port Angeles, reviewing what had been learned about H1N1 from the first wave in the US. He said that the virus never actually left Washington State. The news from the Southern Hemisphere is mostly good news, and the virus has apparently not mutated thus far. He explained the • two types of mutation, drift and shift. Drift involves very subtle changes and requires changes to the flu vaccine to accommodate those changes. Shift is a big change of some kind. He said that so far H1N1 is not even drifting; the genetic sequence is unchanged from when first observed. That means that the severity of cases this fall will likely be the same as those in this past spring. In addition,the vaccine that was based on the earlier outbreak strain should be highly effective for what comes back. It appears that this outbreak may behave much like seasonal flu. He said that pandemics can have a very long peak(2 to 3 months), but that did not happen in the Southern Hemisphere. He added that treatment, infection control, and prevention efforts would be expected to modify that sustained peak to some degree. In the countries of New Zealand, Australia, South Africa, and Argentina, their epidemic peak was virtually identical to that of seasonal flu, i.e. two-three weeks; this is good news in terms of anticipated stress on the health care system. However, of those who do become ill, some people become extremely ill. About 15% of those hospitalized require ICU care. He mentioned that ARDS (Acute Respiratory Distress Syndrome) can be life threatening and patients are usually placed on a respirator. The impact is chiefly on those 50 years old and younger. The danger is greatest for those with risk factors for complication, particularly chronic lung disease and asthma, cardiovascular disease, and diabetes. The risk for pregnant women is extreme; hospitalization rates for this group are 4 times higher than for non-pregnant women. The • number one goal is to get as many pregnant women vaccinated as possible; this also helps Page 7of11 to address the number 2 priority,parents/caretakers of young children. It helps to protect the families with young children and provides some protection for the infant during the first six months of life when vaccination is not effective. Dr. Locke said that those • infants under 6 months are the highest risk group; vaccinating the mother before the infant is born is the best option. Jean Baldwin noted that because of the complications of reaching all of that population, staff is meeting with various groups of hospital staff weekly. There is a Flu Response team within the hospital and she reported a high level of collaboration between the Health Department and Jefferson Health Care in planning for outreach, administering vaccinations and treatment. The first H 1 N 1 vaccine shipment is expected in early October. In response to a question, Dr. Locke confirmed that it is possible to get both shots at the same time. He said there are some issues with the spacing of live virus vaccines in that the first dose may induce an immune response that stops subsequent live viruses from replicating. Therefore, live viruses flu vaccines should be given at least one month apart. A live virus vaccine can be used at the same time as an inactivated virus vaccine and two inactivated flu virus vaccines can be given at the same time. Dr. Locke stated that the live virus, which is relatively new, has not been a popular vaccine, but may be better for children. It does not require an injection and induces immunity at the mucous membrane level as well as the blood stream. The Health Department will be receiving this type of vaccine as part of the federally funded allocation. Dr. Locke briefly described the licensing issues that determine which • populations get what vaccines. Seasonal live virus flu vaccine is for healthy individuals those who are two years to 49 years of age and not pregnant; it has not been tested for ages groups beyond 50 years of age. The injectable, inactivated virus vaccines are licensed for ages 6 months and older. Ms. Joswick asked why pharmacies have supplies of seasonal flu vaccine available before the Health Department. Ms. Baldwin said that the federal supplies were delayed and clinics will be scheduled as soon as possible. Dr. Locke explained that this is a private marketing system, with certain commercial bulk orders having highest priority. He said in his understanding about 100 million doses of seasonal flu vaccine have been produced, which is the usual volume for the annual flu season. About 300 million doses of Hi N 1 vaccine have been ordered for the United States, which would be enough for all who want a vaccination, but not all at the same time. What could compromise the seasonal flu vaccine production is if fertilized eggs are diverted for production of H 1 N 1 vaccine. Ms. Baldwin noted that it is not possible to predict if the shipments will arrive all at once or if there will be multiple smaller shipments over time. The Health Department is developing alternative plans, based on priority groups, so they can handle the logistics in any case. Member Austin inquired about outreach to the schools and if the school-based clinics would be involved in administering shots. Ms. Baldwin and Dr. Locke said that children • Page 8 of 11 are a priority group. Older children would be vaccinated in school. However, children • under 5th grade are not vaccinated without parents being present. Member Austin asked if women would be advised to avoid pregnancy because of the risk. Dr. Locke said he is not aware of that being done; rather, the focus will be on vaccination or early treatment with anti-viral medications if they do contract H 1 N 1. Member Austin also asked what the Hospital's capacity is to deal with ARDS. The Hospital has 8 ventilators. However, Dr. Locke explained that type of ventilators used to treat conditions like ARDS, are in very short supply. Jefferson Healthcare has only 2 or 3 of this type. Ms. Baldwin mentioned the Emergency Plans for the Hospital, for Public Health and for national disasters. She said that most of the local emergency medical services (EMS) are very good and that there has been collaboration with Kitsap and Clallam EMS. The Hospital Plan includes Jefferson, Olympic Medical Center, Harrison Hospital and the U.S. Navy. She said that while meeting the need for ventilators in an extreme situation may not be possible, that discussion continues. Dr. Locke said that while systems/inventories may have been stressed, hospitals in the Southern Hemisphere were able to cope with the demand. He said that a category 4 or 5 pandemic would be a serious challenge and may require activation of altered standards of care. One big difference between the Southern Hemisphere experience and the current US situation is the availability of vaccine here. However, the biggest challenge is preventing outbreaks • in the schools in advance of the vaccine availability. At least 3600 doses should be delivered for Jefferson County by mid-October, and about 1600 every week thereafter. He said this is about as fast as the vaccine can be administered, due to the workload. There was a brief review of the precautions and practices that businesses and individuals are encouraged to put in place: frequent hand washing; personal hand cleaners/wipes; wiping down surfaces; use of masks; staying home when sick, etc. In response to a question about vaccine safety and possible side effects, Dr. Locke said that although studies of the new H1N1 vaccine have included thousands, not millions, of people, there is every reason to believe that the risk profile is identical to seasonal flu vaccine. It is made in the exact same way in terms of technology, method, purification, etc. He said H 1 N 1 is not very different structurally from seasonal flu and it would be very surprising if the side effects were any different. He said that all vaccines have the rare potential for causing exaggerated immune activity, where the immune system does not turn itself off as it should. However, that process occurs much more strongly with natural infection. He said that in only about 1 case in 1,000,000 of the autoimmune neurologic disease, Guillaine-Barre Syndrome, occurs with vaccines, while about 20-30 per million cases occur in the population, presumably due to natural infections. In response to a question, Dr. Locke said that it takes about one to two weeks to develop immunity to HIN1, which is the same as for seasonal flu. This is preliminary • information. Page 9 of 11 Member Johnson mentioned that he had recently travelled to London,expecting to • encounter signs of the pandemic but had seen nothing, and noted that there seemed to be no fear or concern. Chair Westerman described her experience of spending several days with thousands of college students, and becoming extremely ill and feverish with the flu when she returned home. The symptoms, although intense, lasted only 24 hours. Dr. Locke said that 25% of people who have seasonal flu do not become sick enough to realize they have it, but may still be spreading the virus. This may also be the case with H1N1. BOH and Hospital Board of Commissioners Collaboration Dr. Locke said he had met with Hospital CEO, Vic Dirksen, who explained the new governance policy of the hospital. Essentially,the Hospital Commissioners adopt policy and the CEO is responsible for interpretation and implementation. This model provides more independence for both the Board and for Hospital CEO to act within these guidelines. With regard to the BOH and Hospital Board collaboration, Dr. Locke said he had been considering a revival of the joint Board process. The Hospital's new governance model encourages direct Board to Board interaction. Instead of communicating through the Hospital CEO, the BOH's Hospital Board member would serve as the main conduit. He said that this type of governance structure encourages • direct interactions with the Hospital Board of Commissioners, rather than going through hospital management. Member Russell added that his title is no longer Hospital Board Chair; he is now Chief Governance Officer. The Board sets broad policies and goals for what should be accomplished. Instead of specifying how this is accomplished, they indicate what the CEO cannot do, and establish definite reporting requirements. He said the Board is pleased with this approach and finds it more efficient. Board members cannot be experts on every subject and cannot be involved in a myriad of details and committees. A major intention is finding the best ways of supporting the CEO in meeting overall goals. Dr. Locke noted that much of the collaboration between the two boards has been concerned with health care access issues, which is now in a volatile state. He said he believes that when congress does act with regard to health care reform, the community will need to develop its own plan for transitioning from the current situation to the new system, whatever it is. He said that there are many likely topics for consideration by the two boards. Ms. Baldwin added that she has compiled a set of demographic/health indicators, as well as other data, which she feels would be of interest to both the BOH and the Hospital Board. • Page 10 of 11 Member Austin suggested an annual meeting. Chair Westerman recalled that for a time • in the past, the two boards met monthly, considered major strategies and, at that stage, brought in experts on a variety of topics. She said that ultimately they realized that they were constrained by the overall context in which small town small county health care must operate. She said she would be willing to resume ongoing meetings provided there is a clear purpose and agenda. She said she is interested in hearing about the new governance model. Green Business Award—Computer.Fix Chair Westerman signed the letter of recognition for this latest Green Business. AGENDA PLANNING The next Board of Health meeting is scheduled for October 15, 2009. The agenda will include a vote on Bylaws revisions; members are welcome to suggest other agenda items. Member Russell requested that he be excused from the October meeting due to another commitment. ADJOURNMENT Chair Westerman adjourned the meeting at 4:31 PM. JEFFERSON COUNTY BOARD OF HEALTH LAIL WiiAtief Sheila Wi a erm. , Chair Phil Jo i son, Member Chuck Russell, Vice-Chair Jo( Austin, ember / k / ( 7/1 Roberta Frissell, Member David Sullivan, Member Excused Kristen Nelson, Member • Page 11 of 11 Board of Health OCd Business .Agenda Items # 1 Discovery Bay .area Beaches • Closed to Recreational Harvest Of SheClfish October 15, 2009 • K # JEFFERSON COUNTY PUBLICHEALTH HT1 1'VN:;S.= 615 Sheridan Street • Port Townsend •Washington • 98368 ai www.jeffersoncountypublichealth.org October 7, 2009 DISCOVERY BAY AREA BEACHES CLOSED TO THE RECREATIONAL HARVEST OF SHELLFISH DUE TO MARINE BIOTOXINS Contact person: Neil Harrington, Jefferson County Environmental Health: (360) 385-9411 Jefferson County-Marine biotoxins that cause paralytic shellfish poisoning (PSP) have been detected at concentrations above the closure level in shellfish samples collected from Discovery Bay. As a result, the Washington State Department of Health (DOH) has closed all beaches in the Discovery Bay area to the recreational harvest of shellfish. The closure area boundaries are from north of Cape George, south to include all of Discovery Bay and northwest to approximately one mile west of Diamond Point in Clallam County. Commercially harvested shellfish are sampled separately and products on the market should • be safe to eat. "This has been a very quiet year for biotoxins in shellfish in Jefferson County and is our first new closure this season." said Neil Harrington, Water Quality Program Manager for Jefferson County, "The late bloom of the toxic dinoflagellate that causes shellfish to be toxic may be due to the calm sunny weather we are experiencing." he continued. Warning signs have been posted at high use beaches warning people not to collect shellfish from these areas. The closure includes clams, oysters, mussels, scallops and other species of molluscan shellfish. Marine biotoxins are not destroyed by cooking or freezing and can be life- threatening. People can become ill from eating shellfish contaminated with the naturally occurring marine algae that contains toxins that are harmful to humans. • COMMUNITY HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES PUBLIC HEALTHWATER QUALITY MAIN: (360)385-9400 ALWAYS WORKING FOR A SAFER AHD MAIN: (360)385-9444 FAX: (360)385-9401 HEALTHIER COITY FAX: (360) 379-4487 Symptoms of PSP can appear within minutes or hours and usually begins with tingling lips and tongue, moving to the hands and feet followed by difficulty • breathing, and potentially death. Any one experiencing these symptoms should contact a health care provider. For extreme reactions call 911. In most cases the algae that contain the toxins cannot be seen, and must be detected using laboratory testing. Therefore, recreational shellfish harvesters should check the DOH website at http://www.doh.wa.gov/ehp/sf/biotoxin.htm or call the DOH Biotoxin Hotline at 1-800-562-5632 before harvesting shellfish anywhere in Washington State. • COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES ALWAYS s �g FOR SAFER • WATER QUALITY • MAIN: 360385-9400 .ORKLNG F`RA'" ER AND MAIN: 360385-9444 FAX: 364385-9401 HEALTHIER COMMUNITY FAX: 360379-4487 • Board of.9Cealth 0 C Business .agenda Item # 117., 2 National Survey of • focal 3CeaCth Department October 15, 2009 • Hello PHELF Members, Attached is the most current 2009 LHJ Budget Survey information, which reflects the corrected number of FTE reductions for Snohomish (70 instead of 30). This pushes the total number of FTE cuts across WA State up to 332.64. In addition to the description of cuts and reductions to programs and services, here are the bottom line numbers: TOTAL $26,285,173 332.64 Note: The 31 LHJs represented above LHJ budget cuts for FTEs Cut constitute 99.4% of WA's current '09 for'09 population. [$11,085,173 [288.64 excluding excluding Seattle/KC] Seattle/KC] Jeff Jeff Killip, JD MPH WSALPHO - Managing Director 206 Tenth Ave. SE, Olympia, WA 98501 Direct: 360.586.4219 x106 Mobile: 360.951.9642 Fax: 360.753.2842 • Email: jkillipna,wacounties.org Web: www.wsalpho.org PUBLIC HEALTH: Always Working for a Safer and Healthier Washington • fb u at= ' � 141 a o neo o „w-' " ` t" fbof t°, yw ° 5. o , ,. 5' i9no p.`< o+ A ; a Y > ° w, ffl �� o ° by a 2- o w �. o 5" a' 5 byo+ 2 0 • fD nn ° A t7. ffl a 5` � E. 0 w fD A R. n n O' 6 8 . o. fD O6' a•' a w a s c m w fo cu 6, w a. a' p O 5 , � n o. .. nom„f0 �. , w O gaa O .A, a ' rn 'C y O �' y K fD 0, Z C ,, �' y ,'3 Q,�p .6- ,, ... 5 f9.. .. r . R . .5. 0 ., 0 .•' A ' a. 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"Ao•'' q ' lJl cT�' y ° �1 cCD �D fro � go cn �w � q I CO to • Board of Cealth OCd Business Agenda Item # XV., 3 Correspondence • October 15, 2009 • Sally A Robbins,MS PO Box 517 Port Townsend, WA 98368 360-385-4207 Board of County Commissioners Jefferson County P.O. Box 1220 Port Townsend, WA 98368 September 25, 2009 Dear Commissioners: There are rumors around the community that the Commissioners might cut Senior Foot Care during this economic downturn. I do believe this would be a serious mistake. For the past few years, I was manager of the Community/Senior Center in Port Townsend and saw first hand the clients who came for this service. And this is not a frivolous service! This is a true health issue and Myrtle Corey is a registered nurse trained to do foot care. Many of the clients are diabetic and are at risk if their nails and feet don't have proper medical care. Others are stroke victims, have MS or other debilitating illnesses that don't allow them to care for their feet. I am a client because I have arthritis in my hands and • can't use the tools to cut my nails. This program is County wide with sites in Port Townsend, Chimacum, Quilcene, Brinnon and at the senior resident apartment complexes. Myrtle, with the help of volunteers, sees at least 18 clients each day at the larger sites and varying numbers in the smaller ones. And this is not a free service! Each client pays $20 per visit. Senior Foot Care is one of the many programs of the Jefferson County Health department. It is vital that the County continues to support this important service. Sincerely, /, '7/ X Sally Robbins/ Retired WSU1Cooperative Extension Chair Cc: Jean Baldwin, JEFCO health Department /X The Leader, Letters to the Editor • Board of Health Netiv Business Agenda Item #17., 1 Board of aCeaCth ByCativs Revision: � .fiction Item October 15, 2009 F • 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 Bylaws Page 1 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, one at- large community representative from the city and one at-large representative from the 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, or as soon as practical, from 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. Non-Voting Members: The Board, by majority vote, may appoint non-voting members to the Board for a defined term of office. 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 Bylaws Page 2 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 voting 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 voting Board members, including at least two • Jefferson County Commissioners, shall constitute a quorum for Board meetings. Jefferson County Board of Health Bylaws Page 3 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 regular 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 voting 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 Hearing 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 limits may be placed on individual comments at the discretion of the Board Chair and the public should be Jefferson County Board of Health Bylaws Page 4 advised that comments must relate to the matter at hand. Order and decorum should She 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 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 the parties submitted in writing prior 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 , 2009 Chairperson, Jefferson County Board of Health • Jefferson County Board of Health Bylaws Page 5 410 Board-of.9Cealth Wow Business .agenda Item �``V., 2 Pre-adoption Briefing: • Draft 2010 Fee Schedule October 15, 2009 JEFFERSON COUNTY PUBLIC HEALTH ENVIRONMENTAL HEALTH DIVISION • ENVIRONMENTAL HEALTH 2009 FEES Proposed Fee Additional Fees and Other Comment/Explanation of Proposed Chgs Information Changes GENERAL Health Officer Administrative Hearing 287.00 Administrative Hearing Appeal - 287.00 New Fee-Preparation for appeal Technical Assistance/Plan Review-Minimum 65.00 Technical Assistance/Plan Review-Per Hour 65.00 Filing Fee 41.00 49.00 Increase fee based on avg cost of svc. ONSITE SEWAGE DISPOSAL Sewage Disposal Permits Add$32 to existing fee due to time 488,00 520.00 Valid for 3 years required for svc New ConventionalAdd$32 to existing fee due to time New Alternative 588.00 620.00 Valid for 3 years required for svc New septic tank and/or pump chamber only 215.00 247.00 Issued in conjunction with an existing Add disposal system or communitydd$32 to existing fee due to time system required for svc Plus$82 per connection-valid for 3 yrs Add$32 to existing fee due to time New Community or>1000 Gallons Per Day(base fee) 488.00 520.00 required for svc New Commercial>1000 Gallons Per Day Add$32 to existing fee due to time Conventional 588.00 620.00 Valid for 3 years required for svc Add$32 to existing fee due to time Alternative 631.00 663.00 Valid for 3 years required for svc Repair/Upgrade/Modification/Designate Reserve Area 115.00 Applies to existing installed sewage disposal system Expansion 387.00 Applies to pending or active but not Redesign 115.00 installed Reinspection 144.00 Evaluation of Existing System/Monitoring Inspection Septic system only 287.00 .ptic system plus water sample 298.00 test/Reinspection 100.00 On Site Sewage On Site-Site Plan Advanced Approval Determination(SPAAD) 287.00 Add$65 to existing fee due to time Septic Permit with SPAAD(conventional) 215.00 280.00 required for svc Add$65 to existing fee due to time Septic Permit with SPAAD(alternative) 323.00 328.00 required for svc Subdivision Review Base Fee 372.00 Plus$73.00 Per Lot 146.00 Plus Change to"Boundry Line Adj Review Boundary line adjustment review fee 146.00 $73.00 Per Lot Base Fee"and add$73.00 per lot Pre application meeting fee 146.00 Planned rural residential development review fee 146.00 Density exemption review fee 73.00 Density exemption review fee requiring field work 146.00 Other Waiver/Variance Application 172.00 Waiver/Variance Hearing 287.00 Wet season evaluation 387.00 Revised building application review fee 146.00 New building application review fee: Residential 73.00 Commercial 146.00 General environmental health review fee 73.00 Licenses Installer,Pumper,Operator(maintenance person) 387.00 Retest 158.00 Annual Renewal 273.00 Delinquent Renewal after January 31 387.00 • FOOD SERVICE ESTABLISHMENT PERMIT FEES: Immediate Consumption Limited 136.00 Non-Complex 174.00 • Complex: 0-50 seats 310.00 51-100 seats 372.00 101-150 seats 422.00 Alcohol served in multiple areas 136.00 Not for Immediate Consumption Limited 136.00 Non-Complex 174.00 Complex 422.00 Annual Permit Issued after September 1 50%of fee 50%of Annual Permit Fee Late Fee(Paid after January 31) 25%of fee Additional to Permit Fee Late Fee(Paid after February 28) 50%of fee Additional to Permit Fee Change to Temporary Permit-Multiple Temporary Permit Events Non-Complex 112.00 130.00 Increase fee based on avg cost of svc Limited 62.00 98.00 Increase fee based on avg cost of svc Add category Temporary Permit-Single Temporary Permit-Single Day Event Day Event Limited 65.00 New Fee-Based on avg cost of svc Late Fee 50%of fee Additional(Paid when application is Applies to both types of temporary submitted less than 7 days prior to the permits Other Food Fees Waiver 37.00 New Fee-Inspect premises before an establishment opens Requirements are Pre-Opening Inspection - 65.00 Per hour($65.00 minimum) provided before inspection. First Reinspection 87.00 Second Reinspection 149.00 Food Handler Card 10.00 Reissue Unexpired Food Handler Card 4.00 Manager's Course 211.00 SOLID WASTE :- • Landfills requiring environmental monitoring 508.00 Inert Landfills 322.00 Biosolid Utilization 446.00 Other Solid Waste Facility Permits 322.00 Drop Boxes 149.00 New Facility Application 409.00 WATER Application Fee 149.00 Inspection of well construction, decommission&reconstruction Determination of Adequate Water Supply 62.00 98.00 Building Permit Process Increase fee based on avg cost of svc Well Site Inspection-Proposed public water supply 298.00 LIVING ENVIRONMENTS Pool 273.00 Spa 273.00 Pool/Spa Combined 372.00 INDOOR AIR(TOBACCO) Compliance Enforcement 65.00 Per Hour Reinspection 73.00 Rebuttal Application 146.00 This document is intended to only identify Jefferson County Public Health's recommendations for changing current fees,establish new fees,and update descriptions,titles and explanations. Per Jefferson County Ordinance#12-1209-96,fees shall be adjusted annually on the first business day of January by the amount of the increase in the Consumer Price Index(CPIW) as reported for the month of September preceding the adjustment date. At the time of creating this document,the CPIW was not available and therefore not reflected. Upon the Board's decision a final document will be created for the 2010 fees. • Board of.7Cealth Mew Business .agenda Item #1/., 3 Port Thwnsen [ • 'Water SuppCy I,lpdate October 15, 2009 §: "° w „ ':',.:,;:: 0 ` "� l'$1,---V,-'",1"" ( , :, , ,� o ' ,te i^ "`4 &kP ' ,a . } !i!,,,,,,,„:411.1i2, :-;;:,,,e`tir1.7.0iS2'''',:":.,14''';'''''''':::::7:11i7h,..''''''':::::": !,7,at::::!:,:::*,;Y:: '44 , -'- '-''7.."':f:1‘774 • : 'P ''-•-,;,..-t:'-7-7.:, r,;4,:,,,*,,,,,,„ ',-*,,,,-„,,,, "".1. 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Board of.71- eaCth Netiv Business .agenda Item #1/., 4 Pandemic .1CiNi • Preparedness llpdate: Community 'Vaccination Strategies October 15, 2009 O • • 1/4 l {�f JEFFcRSON COUNTY PUBLIC HEALTH . 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypu blichealth.org October 8, 2009 To: Jefferson County Health Care Providers From: Tom Locke, MD, MPH, Jefferson County Health Officer Re: National H1N1 Vaccination Campaign Begins Pandemic Update: 27 states, including Washington State, are reporting widespread H1N1 outbreak activity. Over 90% of patients testing positive for Influenza A by rapid testing are proving to have the pandemic H1N1 strain if further sub-typing is done. Outbreak activity is likely to accelerate in October and November and health care providers can expect increasing numbers of outpatient visits and hospitalizations of patients with influenza-like illness. Vaccine Supplies: As anticipated, the initial 2 weeks of shipments of H1N1 vaccine will be restricted to the Live Attenuated Influenza Virus (LAIV) ("FluMist") for nasal administration to healthy people from 2 years of age to 49 years of age who are not pregnant. Priority should be given to health care and emergency service workers, parents/household contacts of infants under 6 months of age, and young children ages 2-5 years. Large supplies of injectable inactivated vaccine (> 1000 doses per week) will begin to arrive during the third full • week of October and will initially be prioritized for groups at highest risk of influenza complications. By early November supplies will likely be sufficient to allow anyone who wishes to be vaccinated to obtain the government-sponsored H1N1 vaccine. Vaccination Strategy: Public demand for H1N1 vaccine has been modest, at best. Many perceive H1N1 to be a mild, uncomplicated respiratory infection. Fortunately, this has proven to be true in the vast majority of cases. Like seasonal influenza, H1N1 can turn deadly in both predictable and unpredictable ways. Predictable risk factors for influenza infection — age, pregnancy, chronic medical conditions, and immune suppression — are well known and the basis of the prioritization schedule that guides initial use of the new H1N1 vaccine. For those with risk factors, the risk of prolonged illness, hospitalization, ICU admission, or death are significant. There have already been over 775 deaths in the U.S., 6% of them in pregnant women, from lab-confirmed H1N1 and we have yet to see the widespread outbreaks that are characteristic of winter flu seasons. H1N1 influenza can also cause unpredictable fatalities — otherwise healthy children and young adults who succumb to a rapidly progressive viral pneumonia and/or bacterial secondary infection. S. Aureus pneumonia has been strongly associated with influenza infection for decades. In this era of widespread community acquired MRSA, this complicating infection can be especially deadly. In addition to the personal benefits of influenza vaccination (both seasonal and H1N1) it is important that patients understand that their influenza immunity also provides a benefit to family members, coworkers, and other people they may have close contact with. The more COMMUNITY HEALTH ' MENTAL HEALTH ALITH DEVELOPMENTAL DISABILITIESPUBLIC nn MAIN: (360) 385-9400 _. _ _ q AND MAIN: (360)385-9444 FAX: (360) 385-9401 EALTHAR CO UNITY FAX: (360)379-4487 people take advantage of the new H1N1 vaccine, especially school aged children and young adults, the less outbreak activity will occur in the community. Health Care Worker (HCW) Vaccination: Health care and emergency medical service • workers are in a high risk group for multiple H1N1 exposures, occupationally acquired infection, and subsequent transmission to coworkers and medically fragile patients. This is why they are at the head of the line in the national H1N1 vaccination campaign. A growing number of national organizations (most recently IDSA —the Infectious Disease Society of America) have gone on record supporting mandatory influenza vaccination for HCWs and requiring that non-vaccinated HCW wear masks while caring for patients or be assigned to non-patient care activities. While legal mandates are probably a year or two off—the professional and ethical mandate has never been clearer. Physicians, nurses, mid-level practitioners, EMS workers, and other HCWs have an affirmative duty to protect their patients from harm. Getting vaccinated against both seasonal and pandemic H1N1 influenza is a simple, safe, and effective way to reduce the chance that you will be the vector for a life threatening infection to vulnerable patients. Vaccination of Pregnant Women: Vaccination of women at any stage of pregnancy is strongly recommended as an influenza prevention strategy. LAIV ("FluMist") is not licensed for use in pregnant women and should not be used. Only inactivated, injectable vaccine should be used for vaccination of pregnant women. Protecting this high priority population from influenza has been complicated by the Washington State Legislature's ill-considered prohibition of use of thimerosol containing vaccines for pregnant women and children under age 3. Multidose formulations of both seasonal and H1N1 vaccine contain amounts of thimerosol that trigger this legislative prohibition. Washington's Secretary of Health has the authority to suspend this prohibition during times of vaccine shortage and has done so • in the case of H1N1 vaccine. If thimerosol containing H1N1 vaccine is used for pregnant women or a child under 18 years of age, they should be informed that the vaccine contains this preservative. A Parent/Patient Notice sheet is available for this purpose (http://www.doh.wa.gov/cfh/immunize/documents/samplenotice.pdf). The prohibition against use of thimerosol containing vaccine continues to be in effect for seasonal influenza vaccine. Pregnant women and children under three years of age should be given highest priority to receive the single dose (preservative free) formulation of injectable H1N1 vaccine. Office Triage Protocols: Outpatient clinics and Emergency Departments in several states are reporting high levels of patients seeking evaluation and treatment for influenza-like illness. As peak outbreak activity occurs, it is likely that most medical facilities will need to use some form of telephone triage for assuring that patients with serious illness be promptly evaluated and, if indicated, antiviral treatment is initiated early in the course of illness. The Centers for Disease Control has finalized an influenza triage protocol for health care providers that is available at their website: http://www.cdc.gov/h1 n1flu/clinicians/pdf/adultalgorithm.pdf A fact sheet for patients to evaluate their own illness is available at: http://www.cdc.gov/h1n1flu/sick.htm COMMUNITY HEALTH PUBLIC HEALTH ALT ENVIRONMENTAL HEALTH • CSE\ELOPMENTAL DISABILITIES WATER QUALITY FAIN: 60385- 401 1 HEALTFIIER COMMUNITY MAIN.3603779-4487 Frequently Asked Questions About Nasal-Spray Flu Vaccine LAIV (FluMist(D) • 9-29-09 Who can be vaccinated with the nasal-spray flu vaccine LAIV (FluMist®)? LAW(FluMist®)is approved for use in healthy people 2-49 years of age who are not pregnant. Who should not be vaccinated with the nasal-spray flu vaccine LAIV (FluMist®)? • People less than 2 years of age • People 50 years of age and over • People with a medical condition that places them at high risk for complications from influenza, including those with chronic heart or lung disease, such as asthma or reactive airways disease; people with medical conditions such as diabetes or kidney failure; or people with illnesses that weaken the immune system, or who take medications that can weaken the immune system. • Children<5 years old with a history of recurrent wheezing • Children or adolescents receiving aspirin • People with a history of Guillain-Barré syndrome, a rare disorder of the nervous system • Pregnant women • People who have a severe allergy to chicken eggs or who are allergic to any of the nasal spray vaccine components. Should FluMist®be given to patients with chronic diseases other than those specifically listed above? No. The nasal-spray flu vaccine is approved for use only in healthy* people 2-49 years of age who are not pregnant. Are there any contraindications to giving breastfeeding mothers FluMist®? Breastfeeding is not a contraindication for FluMist®. For a list of contraindications for FluMist®, see www.cde.gov%mmwr'previewlmmwrhtmi/rr5306a1.htm Can I give FluMist® to patients when they are ill? You can give FluMist®to people with minor illnesses(e.g., diarrhea or mild upper respiratory tract infection with or without fever). However, if someone has nasal congestion that might limit delivery of the vaccine to the nasal lining, consider delaying the vaccination until the nasal congestion is reduced. Can people receiving the nasal-spray flu vaccine LAIV (FluMist®) pass the vaccine viruses to others? In clinical studies,transmission of vaccine viruses to close contacts has occurred only rarely. The current estimated risk of getting infected with vaccine virus after close contact with a person vaccinated with the nasal- spray flu vaccine is low(0.6%-2.4%). Because the viruses are weakened, infection is unlikely to result in influenza illness symptoms since the vaccine viruses have not been shown to mutate into typical or naturally occurring influenza viruses. Can close contacts of people with weakened immune systems get FluMist®? ➢ Contacts who should NOT get FluMist®: people who are in contact with others with severely weakened immune systems when they are being cared for in a protective environment(for example, people with hematopoietic stem cell transplants) ➢ Contacts who CAN get FluMist®: people who have contact with others with lesser degrees of immunosuppression(for example, people with diabetes,people with asthma taking corticosteroids, persons who have recently received chemotherapy or radiation but who are not being cared for in a • protective environment as defined above, or people infected with HW) Can healthcare workers receive FluMist®? Yes. LAW may be used for vaccination of healthy, nonpregnant healthcare workers less than 50 years of age. When feasible, use of LAW for vaccination of eligible healthcare workers is especially encouraged during • periods of limited supply of inactivated influenza vaccine because use of FluMist® for HCP might increase availability of inactivated influenza vaccine for persons at high risk. (http://www.cdc.gov/mmwr/preview/mmwrhtmllrr5 502a I.htm) What about healthcare workers who care for immunosuppressed persons? • As a precautionary measure,healthcare workers who receive FluMist®should avoid providing care for patients severely weakened immune systems when they are being cared for in a protective environment(for example,patients with hematopoietic stem cell transplants in protective isolation)for 7 days after vaccination. • Healthcare workers who have contact with others with lesser degrees of immunosuppression(for example,people with diabetes,people with asthma taking corticosteroids, or people infected with HIV) CAN get FluMist®. Why does Public Health and the CDC encourage LAIV(FluMist®) vaccination for eligible healthcare workers when supplies of inactivated influenza vaccine are limited? If eligible healthcare workers can get FluMist®, it may increase the availability of inactivated influenza vaccine for persons at high risk. For more information,go to http://www.cdc.gov/mmwr/preview/mmwrhtml/n5502a1.htm Can people who have received FluMist®visit patients in the hospital? Hospital visitors who have received FluMist®can visit people with lesser degrees of immunosuppression(for example,people with diabetes,people with asthma taking corticosteroids, or people infected with HIV). However,they should avoid contact with severely immunosuppressed persons in protected environments for 7 days after vaccination. Does FluMist®contain thimerosal? No,the nasal-spray flu vaccine LAW (FluMist®) does not contain thimerosal or any other preservative.. For more information,please see: CDC Q&A on LAIV http://wwvv.cdc.gov/flu/about/q a/nasalspray.htm Influenza Vaccination of Healthcare Personnel: Recommendations of the Healthcare Infection Control Practices Advisory Committee(HICPAC)and the Advisory Committee on Immunization Practices (ACIP) Ira :Ibtvwnwr/ review/mmwrhtmlirr5502al.htm Influenza and Influenza Vaccine Information for Healthcare Personnel http://www.cde.govINCIDOD/DHQP/id influenza vaccine.html Prevention and Control of Seasonal Influenza with Vaccines - 2009-10 Recommendations of the Advisory Committee on Immunization Practices (ACIP) http://www.cdc.gov/mmwr/prev i ew/mmwrhtml/rr5 8e0724a I.htm Jeffrey S. Duchin,MD,FACP,FIDSA Chief, Communicable Disease Epidemiology&Immunization Section Public Health- Seattle&King County Associate Professor in Medicine,Division of Infectious Diseases,University of Washington • 401 5th Ave, Suite 900, Seattle,WA 98104 Tel: (206)296-4774 Direct: 206-263-8171 Fax: (206)296-4803 E-mail:jeff.duchin@kingcounty.gov JEFFERSON COUNTY PUBLICHEALTH • 615 Sheridan Street • Port Townsend •Washington •98368 www.jeffersoncountypublicheaith.org DATE: September 30,2009 TO: Jefferson County School Superintendents and Principals FROM: Jean Baldwin,Director,Jefferson County Public Health RE: STUDENT ABSENTEE REPORTING RECOMMENDATIONS and REQUESTS Attachments: 1)Absentee Reporting Form;2)H1N1 Letter to Parents H1N1 information changes weekly. Jefferson County Public Health will communicate with school administrators and health care providers as new recommendations arise. It is expected schools may be the center of this outbreak. Our goal is for schools to remain open so well children and staff can continue to attend and parents can go to work. We appreciate your calm approach in helping us to decrease the spread of this virus in our community. It is entirely your choice if you use the attached letter for parents;to inform them how to prevent the spread of illness and when to keep their children home from school.Please let us know if we can help you with letters to parents, information changes. • Please feel free to call with questions or concerns. Jean Baldwin,JCPH Director: 385-9408 Tom Locke, MD,is available 355-9400 Lisa McKenzie, PHN Communicable Disease Coordinator: 385-9422. Marty Johnson,PHN,school nurse: 385-9442 Julia Danskin:385-9420 Wendy Jones, OESD 114 School Nurse Corps Supervisor:360-478-6871 PURPOSE OF GATHERING SCHOOL ABSENTEE DATA: The purpose of gathering absentee data is to help prevent and control the spread of disease. Absentee reporting is being requested from school districts throughout the State,both by individual health departments and the Department of Health. The information will assist public health to identify the increase of disease so appropriate disease control and prevention activities can be initiated. For many years, informal agreements have been in place for school secretaries to report absentee rates greater than 10%to our health department. Because H1N1 is known to significantly affect school aged children,we are now requesting a more formal system for reporting absenteeism. ABSENTEE REPORTING RECOMMENDATIONS and REQUESTS: 1. Ask parents to inform the school if their child's absence is due to flu-like illness of fever and cough or sore throat. Ideas for getting the message out: 1)when parents call to report an absence,ask if the child has/had these symptoms;2)add a request to absentee phone • COMMUNITY DEEVELOPMENTALLTH DISABILITIES pUB „IC HEALTH ENVIRONMWATERLHEALTH QUALITY MAIN: (360)385-9400 ALWAYS WORKING FOR A SAFER AND MAIN: (360)385-9444 FAX: (360)385-9401 HEALTHIER CO UNITY FAX (360)379-4487 message systems; 3)send a note home to parents or place a request in newsletters; 4)place a request on your website homepage. 2. Reporting School Absenteeism to the Health Department: We recognize this places an added burden on busy staff and truly appreciate everyone's efforts! And we understand that reports of illness may be spotty and inexact. However,this will still be valuable information by indicating illness trends. The weekly report form attached could be kept at the front desk throughout the week and staff could add one hatch mark per report of flu-like illness called in,reported by students, on notes from home, etc. 1) Please continue to have building secretaries report all daily absenteeism rates of 10% or higher by calling or emailing Lisa McKenzie at 385-9442 Inickenzieco.i,effersan,wa.us 2) Please have an identified secretary in each building fax an Absentee Report Form to the health department each week on Friday for that week. See attached. 3. Behaviors that work: for parents/students/staff to stay healthy and prevent the spread of illness: • Wash hands often with soap and water. If soap and water are not nearby, alcohol-based hand cleaners are also effective. • Cover coughs and sneezes with an elbow. • Try to avoid close contact with sick people. • To avoid spreading the flu, stay at home until any fever is gone for at least 24 hours without the use of fever-reducing medicines. • • Get a seasonal flu vaccine,and the new H1N1 vaccine if it is recommended for you. Both of these vaccines are recommended for all children ages 6 months-18 years. The H1N1 vaccine is also recommended for: o young adults ages 19-24 o pregnant women o people who live with or care for children younger than 6 months of age o health care and emergency medical personnel o adults age 25-64 who have cancer, blood disorders, chronic heart or lung disease (including asthma), diabetes,kidney disorders, liver disorders,neurological and neuromuscular disorders (including cerebral palsy and muscular dystrophy)or a weakened immune system. Seasonal flu vaccine is available now at medical provider offices, Safeway and QFC pharmacies. The H1N1 flu vaccine is expected to be available in mid October. For Flu Vaccine Clinic Schedules: www.jeffersoncountvpubiichealth.onl: COMMUNITY HEALTH HEALTH DEVELOPMENTAL DISABILITIES PUBLIC, HEALTH ENVIRONMENTAL WATER QUALITY MAIN: 360-385-9400 FR MAIN: 360-385-9444 FAX: 360-385-9401 HEALTHIER COMMUNITY FAX: 360-379-4487 JEFFERSON COUNTY PUBLIC HEALTH • 615 Sheridan Street •Port Townsend •Washington • 98368 www jeffersoncountypublichealth.org 2009 H1N1 Flu (swine flu): When to Keep Your Child Home from School September 30,2009 What are the symptoms of 2009 H1N1 Flu (swine flu)? Common symptoms include fever, cough and sore throat. Additional symptoms may include headache, tiredness, runny nose, body aches, diarrhea, and vomiting. When should I keep my child home from school? Answer these questions: 1. Does your child have fever(100°Fahrenheit)? 2. Does your child have a cough or sore throat? If you answered "yes" to both questions, keep your child home from school! Your child might have the flu. How long should I keep my child home from school? Keep your child home until at least 24 hours after they are free of fever without the use of fever reducing medications. • If you answered"yes"to only one of the questions above, or if your child appears ill with other symptoms, keep your child at home at least one day to observe for other symptoms and until completely well for 24 hours. Should I take my child to see a health care provider? Use the same judgment you would use during a normal flu season. If you would not usually see a health care provider for the symptoms your child has now, you do not need to see a health care provider. Call your health care provider if your child is ill enough that you would normally see a health care provider. Most people with 2009 H1N1 flu have had mild illness and have not needed medical care or antiviral drugs. However, some people are more likely to get flu complications and they should talk to a health care provider about whether they need to be examined if they get flu symptoms this season. They are: • Children younger than 5, but especially children younger than 2 years old • People 65 and older • Pregnant women • People who have: cancer, blood disorders, chronic heart or lung disease (including asthma), diabetes, kidney disorders, liver disorders, neurological and neuromuscular disorders (including cerebral palsy and muscular dystrophy), weakened immune system. • DEVELOPMENTALLQHCMMUNITY HEALTH UEAALLI TT PUBLIC WATER QUALITY H MAIN: (360)385-9400 ' €v5 4,11N6 FOR A SAFER AND MAIN: (360)385-9444 FAX: (360)385-9401 HEALTHIER COMMUNITY FAX: (360)379-4487 How do I protect my children from getting the flu? Make sure that your children: • • Wash hands often with soap and water. Always wash after coughing or sneezing. If soap and water are not nearby, use an alcohol-based hand cleaner. • Cover coughs and sneezes with their elbow or a tissue. Throw dirty tissues away and have children wash their hands. • Not touch eyes, nose, or mouth. Germs can spread this way. • Stay away from people who are sick. • Have you child immunized for both the seasonal flu and the new H1N1 flu. Both of these vaccines are recommended for all children age 6 months-18 years. The H1N1 flu vaccine is also recommended for young adults age 19-24 years. The seasonal flu vaccine is available through providers clinics and Jefferson County Public Health now, and the H1N1 flu vaccine is expected to be available in mid October. What is H1N1 virus (swine flu)? HIN1 virus, also known as "swine flu" and"swine Influenza A" is a virus that spreads from infected people to others through coughs and sneezes. Like the seasonal flu, almost everyone who gets this new virus has had a mild illness. But sometimes people get very sick. Why are health and school officials concerned about H1N1 virus (swine flu)? This is an outbreak of new virus. Currently,the illnesses do not seem more severe than the typical seasonal flu,but early on in the outbreak it is important to try and prevent the spread as much as possible in case the illness becomes more severe. Even seasonal flu infections can be severe and should be prevented whenever possible. • How can we limit the spread of H1N1 virus (swine flu)? The most important thing is to keep sick people away from healthy people. So if your child is sick, you should keep your child home. Staying home when sick stops the spread of the flu and helps the sick person get well. We expect that this new flu virus will be circulating in our community this fall and closing schools is not likely to decrease exposure. Where can I get more information? • Washington State department of Health: www.doh.wa.gov/hlnl/ • Jefferson county Public Health: www- `.jeffersoncountypublichealth.org • U. S. Department of Health and Human Services: www.flu.gov. 9/30/09 COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES ALAS WORKING i� ArEAND WATER QUALITY MAIN: 0-385-9401 HEALTHIER COMMUNITY FAX:360-379-4487AIN: 7 FAX:360.3$5-9401 Board of 3Cealth Netiv Business .agenda Item #v, 5 Green Business Award i Printery Communications, Inc. October 15, 2009 • r -;4,-.‘'01N ;w,-5o e° 'rFERSO C' NTY PuBL HEALTH olt { Always Working for a Safer and Hea!thver Jefferson October 9, 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 that Printery Communications, Inc., located at 631 Tyler Street, Port Townsend, WA 98368, has obtained Green Business certification! Mike Kenna, CEO and Founder, is going the extra mile to ensure his business operates in a manner that conserves water, energy and other resources. Printery Communications is a leader in the community and is always working towards new ways to protect the environment in their day-to-day operations. • After signing the award, please return it to: Jefferson County Public Health Attn: Lori Clark 615 Sheridan Street Port Townsend, WA 98368 Thank you for your continued support of the Green Business Program! Sincerely, 41' Nlibe Lori Clark, MS 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 675 Sheridan Street Port Townsend, Washington 98368 fax. (360)385-9401 web: www jeffersoncountypublichealth.org oa- 0 . co. no N O ma0 0 0 C`Q ti - _ st,,c,kti N °� nom ; CD ',, �. _ . ei, 610,-., z fp4 e gi ...: ,-- ';,:, k-47:-T x �� r (D rim l 50 a--.sw :ars • P) P..,n :..,.,,... .O P 44t . X „,..,..__.,:_,. .4.- v114+1 Z c. a. - (2) fir_ 0 ®-,0., .3 � O : a ' - O s tri MI Z t24-- t2. 1111)0 Z Board of Cealtf .�v(edia Report • October 15, 2009 e • • Jefferson County Public Health i August/September 2009 NEWS ARTICLES 1. "Algae closes Leland, Gibbs lakes," Peninsula Daily News, September 13, 2009. 2. "County makes more cuts," Peninsula Daily News, September 16, 2009. 3. "Health department cuts more hours," Port Townsend Leader, September 16, 2009. 4. "Flu clinics scheduled," Port Townsend Leader, September 16, 2009. 5. "Recent flu-risk report flawed," Port Townsend Leader, September 16, 2009. 6. "Toxic algae returns to Gibbs, Leland," Port Townsend Leader, September 16, 2009. 7. "Medical community prepares for flu season," Port Townsend Leader, September 16, 2009. 8. "Computer technician keeps old hardware out of local landfills, into hands of African schoolchildren," Peninsula Daily News, September 21, 2009. 9. "Jail drug, alcohol program works," Port Townsend Leader, September 23, 2009. 10. "Officials prepare schools for swine flu," Peninsula Daily News, September 23, 2009. 11. "Toxic algae still keeping Jefferson lakes closed," Peninsula Daily News, September 27, 2009. 12. "County immunization clinics offered," Peninsula Daily News, September 27, 2009. 13. "Swine flue vaccine on its way, health officer says," Peninsula Daily News, September 30, 2009. 14. "Girls Night Out benefits health program," Peninsula Daily News, September 30, 2009. i 15. "Girls' Night Out on the town is Oct. 1," Port Townsend Leader, September 30, 2009. 16. "New food choices for women, infants, children on WIC," Port Townsend Leader, September 30, 2009. 17. "Clallam vaccines arrive," Peninsula Daily News, October 7, 2009. 18. "Girls Night Out raises $2,800," Port Townsend Leader, October 7, 2009. 19. "CHS health center hosts open house," Port Townsend Leader, October 7, 2009. 20. "State halts Discovery Bay shellfishing," Peninsula Daily News, October 8, 2009. 21. "PT Paper closes plants in Canada," Peninsula Daily News, October 8, 2009 • .,.u) ij10 P 2 t.'"' h 11- 1.011g • ;,?3f1 - 2,i --1 4.; a -''' —115 - 0a ! w ao. h • ° a q ►•4. FYI Ti � 2• g ..8.1s,-,.. 'co"' ,c0,-.,,,pi . 13... 0 1iiiPiilUJPzlln . ro el. oe_dy 'T.b °'dy o � ba • rcomr.,' giC2 76.1 I 62 g t11.5.4" -W1+..' >, 4. 12 - -10 pg v p 14; ii .1.0 1 4 A 110 '1 IN= r; �1h1 is 31 § ,..;xrii.v, d xi x c 0 05 % g. 14 Es tirj , c R.., ;,-..„.. - pel.., .0Ol b co �: oA .1 _ C *47 .11,2V ' 2 las ° ii Cmco. m d $bAa °CI • ; 'liii4 s1s.cP ,;#.a, 83 . 4.51 I ,Box'' 1 g'.,-;,.5.1 ,8 � sv.'s e °' Nom bb Ak g� o.Ao a tim ,� 1,. 'o1 ts 51 J am a.81 *-i 0)'.":.11 g . 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' - '5 0 8� v`V>4 • • Flu clinics scheduled • Local residents seeking flu bring card. Flu shots, $30; pneu- shots have several options to monia shots,$49.99.Clients must. choose from.The following sched- be at least 11 years old. ule covers the next few weeks, In addition, the following din- but immunizations continue to be ics offer vaccinations,during regu- offered through the fall.Medicare lar hours: Madrona Hill Urgent patients are asked to bring their Care, 2500 Sims Way, Monday- Medicare cards. Except where Friday 9 a.m.-7 p.m., Saturday otherwise noted, all others pay 9 a.m.-4 p.m., Sunday 10 a.m.-2 $25,cash or check;private insur- p.m.; and Madrona Hill Urgent ance is not billed. Care, 9481 Oak Bay Road, Port Quilcene Community Center, Ludlow, Monday, Wednesday, 294952 Highway 101, Quilcene: Friday, Saturday,9 a.m.-4:30 p.m. Friday, Sept. 18, 9 a.m.-3 p.m., Clients must be 18 years or older. CANCLED due to shipment delay. Olympic Primary Care, 1010 Sheridan St., Suite 101: Saturday, Sept.26,9 a.m.-noon. Port Townsend Family Physicians, 934 Sheridan St.: Saturday, Sept. 19, 9 a.m.-noon- CANCLED .m:noon- CANCLED due to shipment ' delay. QFC Pharmacy, 1890 Irondale Road, Port.Hadlock:Wednesday- ' Thursday, Sept. 23-24, 11 a.m.- 5 .m.5 p.m. Also offering pneumonia shots, $45. Clients must be at least 11 years old. Safeway Pharmacy, 442 Sims Way: Saturday, Sept. 26, 10 a.m.- 4 .m:4 p.m. Medicare and Medicaid accepted. Immunizations are also available 10 a.m.-4 p.m., Monday- Friday. Many insurances billed; • ,/,./6 1/4 Recent flu-risk • report flawed Let's see if this is right. According to Molly Rosbach of The Leader and reported Sept.2,Jefferson County Public Health employees Lisa McKenzie,Jean Baldwin and Dr. Tom Locke are quot- ed in the article, and it is stated.that: "People over the age of 65 are not on the list" for H1N1 vaccine protection because of "current speculation....they do not appear to need it" How much of this decision is based on fact and how much is based on "speculation"and"appearance"? By this action,the senior citizens are the ones being put at risk,and we are already designated a high-risk portion of the population. A fatality-risk statistic is the joint prob- ability of the chance of getting the swine flu and the chance of dying from the flu, not just the chance of seniors getting the swine flu.The risk for seniors dying from the flu if contracted is already evaluated as high. Health professionals should use cor- rect research methods when making decisions and be held accountable for those decisions. STANLY R.PERIN,Ph.D. Chimacum • Taj -- ;Ct ,. Toxic algae returns • to Gibbs Leland High concentrations of toxic genera Microcystis and Lyngbya, blue-green algae were found in which can also produce liver samples taken from Lake Leland or neurotoxins. Because of the last week, according to Jefferson history of toxic algae blooms in County Public Health. Anderson Lake, State Parks, in "For this reason, skimming consultation with Public Health, and consumption of:fish out of is keeping the lake closed to rec- Lake Leland and Gibbs. Lake is reation.Other non-lake-orientated not recommended," cautioned a recreation,,such as hiking,horse- release from Public Health. back riding and biking,continues Both of the lakes'algae blooms to be allowed at Anderson Lake are.:composed of blue-green State Park. 'lgde of the genera Anabaena, Since 2006, Public Health has APilta nizomenon and Microcystis. been collecting and submitting '`'ublic Health warns the public to water quality/algae samples from avoid visible algal scums, avoid Lake Leland, Anderson Lake, drinking lake water, and not to Sandy Shore and Gibbs Lake to swim or eat fish from either of determine what species of algae these lakes.' are present and at what concen- "Regionally, blooms of toxic tration they are present. Other blue-green algae are not uncom- local lakes are sampled if they mon even in the fall," said Neil appear to be undergoing a blue- Harrington,water quality director green algae bloom. . for Jdferson County "These algae This year the department is • have the,potential to produce liver also collecting samples for nutri- toxins and neurotoxins." ent analyses and physical data Anderson Lake continues to to determine possible causes have a bloom made up predomi- for these blue-green algae nately of blue-green algae of the. blooms.This study is funded by a grant from the Department of Ecology. S for i ‘J 'y ° mL o.oc '' cN Aav, ccv y .-..r... '' N o.SC.5Ep c,L•h o.a•O.O oocF3 , 1.' fi >$'r '''_4 =1, 2 :120-e a 5 0: = id Pa.= N.. v X 3 'aEi c a >`c vv=o. -13) p p c c v v v ,Oc N o 6 o °.� ,.. O > o C.o c .5 0 3 F>11-g,6-= oto rev C. 27,2 E.o , v .Cu a 5 7 3 N E O v v c c a O i 0 ..1. .�.. 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O O w E y v v E ,. v O C 7 ogcx o.a-' ° 0.0' �. o.4 v oo ,.5 u Ewa pi�"c E v 3 U�s= 'c O g v Nc Ec a v Peninsula Daily News Page 1 of 2 This is a printer friendly version of an article from www.peninsuladailynews.com ID To print this article open the file menu and choose Print. Article published Sep 21, 2009 Computer technician keeps old hardware out of local landfills, into hands of African schoolchildren By Jeff Chew Peninsula Daily News PORT TOWNSEND -- In Jefferson County, Malick Sow is recognized as keeping computer waste out of landfills. In the West African country of Senegal, he is contributing to schoolchildren. The 52-year-old Port Townsend resident, computer software and hardware technician and owner of Computer.Fix accepts old computers when his customers replace them. "They often ask me what do I do with it, and I tell them I will take it," Sow said. He then restores and packages the old computers, sending them off to his native Senegal. • Besides restoring the equipment on his own time, he pays hundreds of dollars to ship computers to needy African children. The Jefferson County Board of Health certified Sow's operation as a "green business" last week. Environmental Health Specialist Anita Hicklin said in a letter to the board that Sow "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." Sow -- a computer technician for 17 years who has served more than 300 customers out of his office at 260 Kala Point Drive -- said he applied for the green business certification award, was interviewed by Hicklin. Sow has restored and sent off 12 fully equipped Mac and PC computers so far. He said he plans to continue his service to needy children as often as he can. Giving the computers a second life keeps them out of the landfill. "It is just my desire to help those in need," he said. "They are so happy to receive them and they are so very, very poor. They really appreciate it." It gives the children Internet access and the ability to use computer programs that help with • their homework. http://peninsuladailynews.com/apps/pbcs.dll/article?AID=/20090921/NE WS/309219993&... 9/22/2009 Peninsula Daily News Page 2 of 2 Sow, who specializes in computer networking solutions, knows hardship first-hand. Seeking new opportunities in his field, he first moved from Senegal with his family to Fort Lauderdale, Fla., but in October 2005, Hurricane Wilma battered the city for more than a week, destroying his home. He spoke to friends living in the Port Townsend area after the storm and relocated to start his business. He moved his family to Port Townsend in March 2006. Computer.Fix, with a Web site at www.computerdotfix.net, provides professional grade technology solutions for Port Townsend-area businesses and residents. Sow can be contacted at 360-385-6166 or 360-554-8075. Port Townsend-Jefferson County Editor Jeff Chew can be reached at 360-385-2335 or at jeff.chew@peninsuladailynews.com. All materials Copyright © 2008 Horvitz Newspapers. • • http://peninsuladailynews.com/apps/pbcs.dll/article?AID=/20090921/NE WS/309219993&... 9/22/2009 , — m c .o v v be Z.,, 6 b 3'0 5 i 1 .. . .r.r, ,,,,,,....:,..s,t,,,,‘„.1.z,...i• „:„..2,..„,,,,-,,,...i,-., [ ., ;%,:.d � y° 'u:..+!c' �,� _ .Yru. U Era ° 7 '° S F T 0? v &• j'•, TuL 4. m ,,*ti' C .7C 8' 'I4H:H' hUU tea_Ah gF � t n� :� . "LLP c 5 o �+ a� v 3•S .c o`o TFC „� y ' .- I ; ., )1,*'4K r` HU N.-�-. x v Cq.,...,.;11.111 u .E v !lit:, .,,....„ . ,t. 1 es. 4 ...... 5 .� y 1-5t8 Z.O Cy eC3N S L v�Arv.cneyuc na.." Pi. v a V 3 v 8.8 �°4 a y'8 °° 22 F. 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E • O2.O OSL - LEN O aEc Y T t _ aL b o ,,• Y K n > ; CC c 0 3 cL � � - .-rJ tirrxCJ :t u7: CD 0 1141101.• New food choices • for women infants children on WIC Beginning Oct. 1, partici- think it is a good change." pants in the Women, Infants WIC will continue to promote and Children nutrition program exclusive breastfeeding until 6 in Jefferson County will have months of age and continued access to a greater number of breastfeeding for a year or lon- healthy food choices. ger.Breastfeeding is considered The special supplement by every major health organi- nutrition program made avail- zation as the best way to feed able through Jefferson County infants, according to health Public Health — and offered at department staff. Washington Port Townsend, Chimacum and has one of the highest breast- Quilcene WIC clinics — now feeding rates in the country. offers fresh fruits and vegeta- WIC is a nutrition program bles, whole-grain breads, brown for pregnant, breastfeeding and rice, tofu and soy beverages, postpartum women, and chit- and jarred baby foods.WIC con- dren up to age 5, who are low tinues to provide low-fat milk, income or living below 185 per- cheese, eggs, peanut butter, cent of the poverty level. It is legumes, breakfast cereals and a prevention program designed infant formula. to improve lifetime nutrition • "I'm excited that WIC will and health behaviors by helping be providing healthier choices young families and their chil- of fresh fruits and vegetables dren get a good start on healthy and the whole grains to clients eating. so that they can get variety in For more information on their diet as well as more fiber," Washington WIC, visit doh. said Kathy Anderson, .dietitian wa.gov/cfh/WIC/default.htm or for the health department's WIC contact Jefferson County Public program. "Many of our clients Health WIC at 385-9432. • • PENINSULA DAILY NEWS , C' I OCA Peninsula` ,orthwest Clallam v arrive :. "The take-home message Jefferson County to get � �4 „� is now is the time w be : x really vigilant," Locke said. its flu doses bytoday r•-•''' f.,, -;.:,.s•.•-•..,,....i. . g3 "We're in a race right now Y -3 z,-s€ -t , between the H1N1 flu sea- ir - 4 p; ' r . son and the availability of £ F 040;,,,(b",?. ;x,t the vaccine." BY ROB O t EAINF.N up to these groups as soon r ` ,,q " a �` r 1 Swine flu is spreading PENINSULA DAILY NEWS as possible, Locke said. r " �, � quickly across the state, By November, everyonePORT ANGELES — who wants the vaccine willOic.,k„;,„.-4..-.. especially in Eastern Wash Clallam County's first 700 have access to it, Locke f ington, where two-thirds of doses of the H1N1 swine flu said ' � the cases have been vaccine has arrived,Dr.Tom "As soon as we know - `�� s �tar ,'' reported. Locke, public heath officer supplies are no longer lin ,£ i "In terms of H1N1, it for both Clallam and Jeffer- ited,it will essentially go to .j,`Y „ A t " looks like were seeing an son counties,said Tuesday. rearlyflu season," Locke anyone else, he said. , "We got our very first , ,b, 4.-,'"'",i,t'T.',',ix-'..,f,'>"' , ,bvitt�?;.i said. shipment just an hour or 700 doses , '�' ,,t` ' However, there have two ago,"Locke said. k. been no reported cases on Jefferson County is A national distributor Dr. Tom Locke the North Olympic Penin- expected to receive 300 shipped the first 700 doses Spread the vaccine fast sula so far this season. doses of the live virus nasal to Olympic Medical Center, The symptoms of H1N 1 • mist by today. Forks Community Hospital years with no medical con- are similar to seasonal flu. For the first few weeks, and Clallam County Health ditions that preclude its use, It's considered a category 1 the vaccine will be available officials on Tuesday, Locke said. pandemic,or the least severe only to those who meet cer- Jefferson Healthcare "Our goal is to use this as on a scale to 5. tain criteria. hospital and Jefferson quickly as possible, and use The H1N1 vaccine does Pregnant women, health County health officials were the same amount next not protect against seasonal care workers and parents or expected to receive their week,"Locke said. flu. caretakers of infants I six doses either late Tuesday or By the third week of One of the unique char- months or younger are eli- today. October,health officials will acteristics of swine flu is gible for the initial doses: The number a county roll out thousands of doses that most people older than The idea is to protect receives is based on popula- of H1N1 shots to anyone on 60 are immune to it.Experts infants, who cannot use the tion. Clallam County out the priority list. believe that seniors Bevel virus themselves, by inocu- numbers Jefferson County oped immunity to the strain lating those who will be in 71,021 to 29,542, according Prevention from a similar flu that circu- contact with them. to the U.S.Census Bureau. lated the globe until the late Kids and young adults Both counties will get Meanwhile,Locke said it 1950s. from six months to 24 are the same number of doses is important to practice pre- the next in line,followed by they received this week ventative measures like adults 25 to 64 who have a sometime next week. covering coughs, washing Reporter Rob 011ika,nen can be chronic medical condition. The mist is restricted for hands frequently and stay- reached at 364-417-3537 or at rob "We would like to open it those between 2 and 49 ing home when sick. olikainen@peninsuladailynews corn • • Girls Night Out raises $2,800 • Hundreds of women participat- day,raising money fortheJefferson ed in Port Townsend Main Street County Public Health's Breast and Program's Girls' Night Out event Cervical Health Program. More on Thursday, Oct. 1. The theme than $2,800 has been raised from was"Paris in Port Townsend,"and the event so far; a limited num- berets were spotted all over town. ber of goody bags are still avail- Participating PortTownsend stores able at Maestrale, Maricee and uptown and downtown offered spe- The Clothes Horse, while sup- cial events,in-store promotions and plies last. Bags were filled with a refreshments. variety of gifts donated by Ozone There were models in the store Socks, About Time, Bickie's windows,in-store artists,discounts Cotton Casuals, Tickled Pink, and many delicious cupcakes. Personalize It!,The Candle Store, The after-5 p.m. foot traffic was The Green Eyeshade, Maricee strong, and girlfriends, mothers Fashions ,and Sport Townsend. and daughters came out to enjoy There was a record turnout at some shopping and dining. the"after party";approximately 70 October is Breast Cancer women came to The Upstage and Awareness Month,and goody-bag enjoyed hors d'oeuvres, dessert sales were brisk throughout the and door prizes. PT L-eaat v • • • CHS health center hosts open house Students,parents and commu- nity members are,invited to an open house on Wednesday,Oct.14 at the school-based health center in Chimacum High School. From 4 to 6 p.m., come see the space, ask questions and meet the staff: Wendy White, nurse practitioner, and Patricia Flowergrowing,men- tal health therapist. The health center has been in operation at Chimacum High since April 2009.A clinic is also in operation at Port Townsend High School. School-based health centers are recognized as one of the best' ways to provide effective and appropriate health care to ado- lescents. The services focus on prevention,and medical and men- tal health providers are trained to • understand and treat the health- care needs of teens. Since open • - ing in the spring, the health cen- • ter has provided mental healtr counseling and medical services, including sports physicals,immu- nizations,care for acute illnesses, and reproductive health services. Some dental health services also will be offered this fall. The local school-based health centers are the result of a part- nership among Jefferson Public Health,Jefferson Healthcare and Port Townsend and Chima,cum school districts. Many local orga- nizations and businesses have contributed time, materials and services toward the opening of the clinics. 9•T Lo,er l orl f .. . N N p`) 4041) 5 ag 00 tD tg ■N ti.N a m o1 0 \ � o'iitiOfl A.4 t5 . '"4 0,« obi ■8 ■ �. °' � V O %i oy�, alm is 'o O■ o ���C�m _ &W ? is g V V.[ 'O V LT imili 0 O•G1 O O of (y .C" 0 � LNn a1 miC �J� � a�°� oaas 8 •ppddapp v f, ''.5a I § 1 o r+ 17 i,i it Tw g .. �Ay $ d O 01 N o' . • SS II3IIIIII¼(1) ed 02 > 7' a 41Nyp� � i 1i • O W M .52 illeg°13 !.. & 4, §.,1 Ri y U. it" w 01 • `• -�i3 y' `s 1E tiaxa •24 'C u Sm • N0.1 ■� HK1 2' „ �TS aa a8$ omw �i Cil � . N2 .49g d w 7.' d2 • a'n al as a g 5 0 4jUQI IIHU Ila MEM 2 EioA 4 w a3 o N `9 � .-1 . 48 .941 t 4,,, t,,,,„ 0 u) - (u_ cli > g 4.so, - . Q s.., .-1 a, x A 3 • tY; 3 gk a4.1 r` `� k r e . ° i., ,,„. . js ri, ix .. i i a Lviiu , ¢ a No word on effect to local operations BY JEFF CHEW PENINSULA DAILY NEWS PORT TOWNSEND — Port Townsend Paper Corp. executives, who announced the company's closure of two Canadian box produc- tion plants in Kelowna,British Columbia,and Calgary,Alberta,are mum about the potential impact the move might have on the Port • Townsend mill that produces bleached kraft paper for boxes made at the plants. The company manufactures about 1.3 bil- lion Townsend lion square feet of corrugated products annu- Paper,which employs "Unfortunately, the ally at its Crown Packaging plant and BoxMas- 290 at its local mill, market continued ter plant.The plants operate under the Crown shared the news Packaging line. Wednesday in a pre- its four-year-long Port Townsend Paper reported that the do- pared statement that contraction in 2009 sure of a major Okanagan-area customer last made no mention if year sealed the fate of the Kelowna operation. the closures would as box customers Fifty workers in British Columbia will be have any economic struggled with laid off Dec.4. impact in Jefferson County, where the rising costs for Grant to PT mill mill is the largest energy and raw private employer. The closures announcement comes after Asked for addi matt rials the Port Townsend Paper Corp. learned last week tional information on strength of the that Gov.Chris Gregoire and the state Depart- what could happened Canadian dollar ment of Commerce awarded the company a$2 to the Port Townsend million grant — federal stimulus money to mill, Chuck Madison affecting exports, upgrade its biomass cogeneration boiler and said in an e-mail expensive labour plant, which will create temporary jobs and message that theand an economic ultimately provide green power to the mill and statement "prettyPuget Sound Energy customer grid. Waste much covers what we downturn. wood would fuel such a plant. would like to see in JOE BEERS The mill was one of 18 others that state the media." packaging division Commerce selected of 120 applicants for grants Mill executives president,Port Townsend and loans. have been reluctant Paper Corp. Port Townsend Paper officials said they to talk to the media were grateful for the grant that will require i in the aftermath of coming out of Chapter 11 them to go through negotiations with the state bankruptcy proceedings in 2007. and a National Environmental Policy Act pro- The company confirmed that the Canadian cess before the plant can be built,creating 108 corrugated box production plants will shut temporary jobs. down in early December. Equipment from the shuttered Okanagan The Port Townsend Paper Family of Compa- plant will be moved to Port Townsend Group vies employs about 660 people and annually facilities in Richmond and Burnaby, British produces more than 320,000 tons of unbleached Columbia. kraft pulp, paper and linerboard at its mill in Port Townsend. .1411-.1,---;-.7mt.';'', 0 , ;f:: " r in�. a -P ay tit.,, „.r, -.. ::,,,,,,,,:wo-i,,,,,...„ x R Y 4 gas s '��� .. v� L �� k� ° '.'1,'��xd ju I '.:<s�'� ^s< ��`'� *�i� ' �. ¢yrs ' s 11. 4 Y s x .,w£.' $ f� a .� iaV. �.i pleValatik''Z .r e s ,�" r m r s�Y �` xr d . : 3 y „: w ag , T_kj• r" -'x.w. i�«a•5 s �`Ytry.,t,,,` 3 ?ss > ;- , DI✓DI.F,.--P" E.NI N Si1�L',A .E , 01, # Abibz � , aC�; v r ,F..1":;i4;; 0244)-$4,z:4-';',.$44k:'-'1.:.;,4w-� .' n A kb -7,";:.741*-.. . ,,--t„:A I LY, ,� ,ate -$4 : :::.„.,.A.....,,,,,..; .1 x Ytv,„ ,,,,,:-.4,,.?.„..,..:! . 00 aJ !t f { a �w v uM , w a 4,.. .;..,V48,.,-44it, g4x ' z � .A.. a. „ i i ,� ? 4 r � l�, p FF� a'*"rk ", t . , .� �: • � � , relk„' a, sa-s r;. i r ,e .t sxA4n vv o +a 1f z vsb r .^ 4ay.' z + ,,j( • s - q ,a "y .t � og � a • - r sk Y.tt F� .,4.,--,-.•-:.,..-,-:-, ,, y, { j..,,. , a�,. . _ ,re ' s: s ;.:,:,----t--....::1,..,-, - , ,, ,Fxs ,-�'. ys t ro - ', aF s� { !1 DNEWS. nt', . ' ` , PaaL.cfftt The Port T.wrdsead Paper MIL rli Effect on P 1 mill unclear . - CONTINUED FROM Al keep the facility financially Richmond over the past few Chapter 11 bankruptcy pro viable and see what 2009 years "which will provide tection in August 2007 as a The Port Townsend would bring for the Westernthe ability to effectively ser- private company under the Paper Family of Companies Canadian box market,Port vice our customers with control of its bondholders. avid its Crown Packaging Townsend Paper's state- quality products ini all our "The mill has a future,it division stated that the meat said. markets,”Beers said. will be here for a while,but company intends "to wind "Unfortunately,the mar Crown Packaging will we have to get to a point j down production at the Kel- ket continued its four-year- retain a sales and customer where we get our cost strut owna corrugated box maim- long contraction in 2009 as service office, along with a tore under control and be factoring facility,located on box customers struggled distribution warehouse, in able to put money back into Enterprise Way, by year's with rising costs for energy Kelowna. the mill,"Hodges said then, end." and raw materials, the In addition,the company shortly before he took the The change will result in strength of the Canadian is investing more than $2 •reins of the Port Townsend the layoffs of about 50 dollar affecting exports, million more in projects to Paper Corp. mill and the employees. expensive labour and an ensure timely deliveries of . company's box-making The facility's largest cus- economic downturn.” products from its machines facilities in Canada, from tomer, Owens-Illinois in "The Western Canadian to allof its markets. John Begley on April 30, Lavington, closed its doors box market is as tough as Charles Hodges, Port 2008. in October 2008. we've ever seen it,"said JoeTownsend Paper chiefexec-Having lost 35 percent of Beers,the firm's packaging utive officer and president, the l`d,` tys sales, the corn- divisions president. said in March 2008 that he Port Tnwncanri-.faffercnn •