Loading...
HomeMy WebLinkAbout2009- December File Copy • Jefferson County Board of afeaCth, .Agenda lvl.inutes � j • ; December 17, 2009 • • JEFFERSON COUNTY BOARD OF HEALTH December 17, 2009 Jefferson County Public Health 615 Sheridan Street Port Townsend, WA 2:30—4:30 PM DRAFT AGENDA I. Approval of Agenda I1. Approval of Minutes of October 15, 2009 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. An Epidemic of Fear: One Man's Battle against the Anti-Vaccination Movement 2. Board of Health Correspondence 3. Letter to Gov. Gregoire re: Maternity Support Services • V. New Business 1. Public Hearing: Proposed 2010 Environmental Health Fee Schedule Revisions 2. School-based Clinic End of Year Report 3. 2010 State, County, and City Budgets: Public Health Impacts 4. Pandemic H1N1: The Second Wave Ebbs and Unrestricted Vaccination Efforts Begin 5. Health Care Worker Vaccination: Legal and Ethical Arguments for a Mandate 6. Green Business Environmental Award Certificates VI. Activity Updated , a,, Std rr�e r,;t - S.AA 3 VII. Agenda Planning VIII. Next Scheduled Meeting: January 21, 2010 2:30 —4:30 PM • e P JEFFERSON COUNTY BOARD OF HEALTH � :iMINUTES 1 lk %g)t b � Thursday, October 15, 2009 2:30 PM—4:30 PM Y I Iealth 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, Kristen Nelson, David Sullivan, Sheila Westerman Excused: Chuck Russell Staff Present: Dr. Thomas Locke, Jean Baldwin • Guest: Frances Joswick, Substance Abuse Advisory Board (SAAB) A quorum was present. APPROVAL OF AGENDA Frances Joswick requested the addition of SAAB announcements, which was placed under Old Business. Member Austin moved and Member Sullivan seconded for approval of the agenda. The agenda was approved unanimously. APPROVAL OF MINUTES John Austin moved and David Sullivan seconded for approval of the minutes of September 17,2009. The minutes of September 17, 2009 were approved, as presented. PUBLIC COMMENTS Chair Westerman welcomed Mindy Sayer, a nursing graduate student, who was attending as an observer. III Page 1 of 9 1 OLD BUSINESS and INFORMATIONAL ITEMS Discovery Bay Area Beaches Closed to the Recreational Harvest of Shellfish due to Marine Biotoxins 111 An October 7 News Release was included in the packet. Dr. Locke said that biotoxin levels are quite high, about 5-10 times the threshold levels. This time of year is normally a low point recreational shellfish harvesting, when low tides occur during the night. Chair Westerman asked for clarification on why commercially harvested shellfish are not included in this warning. Dr. Locke explained that commercial harvesting has a different notification process and is actually more closely monitored. The wording of the release means that shellfish already on the market are safe, since they would have been harvested prior to this determination and/or from a non-affected area. The Department of Health notifies the commercial fisheries directly. It was noted that conditions can change very quickly. Member Sullivan added that organisms in an affected location may survive a replanting process and will flush themselves out once the toxic conditions have dissipated. National Survey of Local Health Departments Jean Baldwin discussed the results of the 2009 national LHJ (Local Health Jurisdiction) Survey, as it applies to Washington State. The packet contains an October 5 article about the study, and bottom line data for budget cuts and staff reductions. She noted that there have been 333 FTEs cut from the 31 local jurisdictions responding to the survey. Jean Baldwin said that, with the added workload due to • HIN1 preparation and r • esponse, the Health Department is at capacity and is stretched to its limit. There was discussion that the public should be made aware of the County's tight resources; the possibility of disseminating this information to the public was discussed. Member Austin suggested that an upcoming article by Allison Arthur of the Leader may be an opportunity for inclusion of this type of information. Dr. Locke said that Ms. Arthur had also contacted him in regards to H 1 N 1 preparations and vaccine exemptions. Correspondence Jean Baldwin reviewed a letter to the BOCC from Sally Robins (that had been published in the Leader) regarding the importance of maintaining the Senior Foot Care program. Ms. Baldwin explained that this was in response to a rumor that the program may be cut. She said that the program is relatively inexpensive and provides a great deal of benefit for what it costs. Nurse Myrtle Corey sees patients on a quarterly basis; the program covers about 2500 visits per year. About $5,000 of General Fund money supplements fees of $20 per person. Volunteers provide appointment and billing services at no cost. There has been a sliding scale for fees, but Julia Danskin said most patients are willing to pay the full $20. Member Sullivan noted that the program is very worthwhile because it also affects mobility and has other potential health benefits. Page2of9 Chair Westerman said that she planned to call Ms. Robbins to enlist her help in ensuring that seniors who use and appreciate the foot care service understand the implications of the upcoming referendum on government spending. SAAB Announcement Ms. Joswick said that an SAAB sub-committee had been formed to gather and analyze substance abuse clean up (collateral) costs, as discussed at the previous BOH meeting. She said that this is a formidable task, but very important in terms of showing the community the high costs of addiction and hopefully in steering the legislature toward funding where it does the most good, i.e. not toward clean up but towards more effective preventive measures. Ms. Joswick said the study will follow the Columbia University model in pursuing a valid, scientific, well-credentialed study. She said she had visited four Jefferson County departments thus far. She believes this will lead to better understanding by administrators of what data is needed. With regard to the program at the jail, she has been asked to meet with Jenifer Jackson of the Peninsula Daily News to provide information for a follow up article on the program. In response to an inquiry from Member Austin, Ms. Joswick said that she has set up an appointment with an SAAB candidate for the following week. NEW BUSINESS S Board of Health Bylaws Revision: Action Item Chair Westerman noted that the revised bylaws had been distributed more than ten days earlier, and asked if there were any comments or questions. Member Austin said he had reviewed the RCW regarding BOH composition, and noted that the Bylaws appear to be in concert with that. Member Nelson said she had not been present at the previous meeting and had a few questions. She asked why the BOCC, and not the BOH, removes BOH members (page 2 —Absences). Chair Westerman explained that since the BOCC appoints, it should also be within their power to remove members for cause. Ms. Nelson also questioned the use of the inserted word "regular" (page 4, section 2), which is not defined or referenced elsewhere. She suggested that the term "regular member" be used/referenced in the section where members are first mentioned on page 2, or that the term "voting member" be used on page 4. After a brief discussion, Member Austin moved that the term "voting member" be substituted for "regular member" on page 4, Section 2. Member Nelson seconded. The motion was approved unanimously. Member Nelson also asked, with regard to appointment of Health Officer and/or Administrator, if the distinction in the Bylaws between "shall" and "may" is based on the RCW; Chair Westerman confirmed that is the case. Page 3 of 9 Member Austin moved for adoption of the BOH Bylaws as revised, and Member Frissell seconded. The revised Bylaws were approved unanimously. Chair Westerman signed the revised document on behalf of the BOH. Pre-Adoption Briefing: Draft 2010 Fee Schedule Jean Baldwin introduced Veronica Shaw and Linda Atkins, who were on hand to explain the proposed fee schedule provided in the packet. Ms. Shaw explained the proposed fee schedule format and the meaning of column headings. She noted a correction under On Site Sewage— Septic Permit with SPAAD (alternative); the fee is $388, not $328. Jean Baldwin pointed out the addition of a fee to cover costs of an Administrative Hearing appeal. Chair Westerman inquired as to how the exact fee of$287 was determined. Ms. Shaw said that that fee was calculated several years ago and has been adjusted per the CPI (Consumer Price Index) in September of every year, per the RCW. The adjusted figure is rounded to the nearest dollar. The fees for 2010 will be recalculated as soon as the updated CPI is available. In order to prepare for publishing and using the new fees in January, the BOH is briefed in advance. Jean Baldwin noted that most increases are small, and pointed out the increased fees for boundary line adjustments to cover the staff costs per lot. Member Austin inquired about the Installer, Pumper License/renewal fees and the duration of the original license. Ms. Atkins explained that the initial $387 license fee is good for one year. The $273 renewal fee covers the costs of reviewing/verifying • continuing education, processing the certificates, and the cost of education, notifications, and newsletters throughout the year. Member Nelson inquired whether these fee increases will fully, or only partially, cover the General Fund shortfalls. Ms. Shaw said that the fee increases will provide about $18,000 to $20,000, depending on volume of permits, which is not adequate to cover the deficits. Jean Baldwin added that there will be further discussions in 2010 regarding other fees related to water quality and green water catchment, etc. and compensating for services dropped by the State Department of Health. Some services will be local instead of State-provided. Member Nelson asked if this was the limit of increases that could/should be made. Ms. Baldwin recalled that a thorough market analysis had been made last year. This year there is not a major overhaul; it is an adjustment and addition of those things that had been previously overlooked. In 2010, the food program and temporary workers will be reviewed in terms of cost recovery. There was a brief discussion about the upcoming schedule and venue for the public hearing. It was noted that, historically, there has not been a large turnout for the annual fee hearing, but that a larger space will be available if needed. The next regularly scheduled BOH meeting will fall on the Thanksgiving holiday. In order to put new fees into effect in January, the new schedule must be approved by mid-December. There was a preference for setting the hearing on December 17, 2009 and for canceling the November meeting unless pressing new business arises. • Page4of9 Member Austin moved for canceling the November BOH meeting; Member Nelson seconded. The motion was approved unanimously. • Member Frissell moved that the public hearing on the proposed Environmental Health fee schedule, based on the CPI update to be released, be set for December 17, 2009. The motion was seconded by Member Sullivan. The motion to set the Environmental Health fee schedule hearing date for December 17, 2009 was approved unanimously. Port Townsend Water Supply Update Jean Baldwin reported that Lords Lake reserves had fallen from 20 days to 9 days in the preceding weeks, but had risen again slightly after a period of rain. Photographs in the packet taken about one week previously show new installations that would allow the City to pump down to lower levels of the lake. There is increased risk of turbidity which must be closely monitored, since it can render chlorination to be ineffective. There was a discussion about the relative volumes of water used by Port Townsend Paper and the City, as well as the bases for declaring a water emergency. Dr. Locke said that the situation had been thoroughly explored in 2004, when levels were even worse. At that time, Health officials had brought the State DOH,the City of Port Townsend and the paper mill together to working out a response plan. At that time, the mill voluntarily agreed to alter their production schedules to conserve water. (The mill uses about 10 million gallons per day for full production and at least 1 million per day just to keep • running.) At that time,there was pumping from a barge that, if moved off center, could result in large amounts of sediment and turbidity. If chlorination becomes ineffective due to high turbidity, it becomes mandatory to boil water. However, some businesses, such as restaurants and hospitals cannot use this method—they must close. Jean Baldwin said that the mill has been slowing their water intake (down to about 2,000,000 gallons per day) but this has not prevented further reduction of the reserves. She said that the City and State DOH are conferring regularly and there is obvious need to keep careful watch over the turbidity levels. Member Nelson added that the City has applied to DFW for permission to draw directly from river waters in an emergency; Ms. Baldwin said that that may be too lengthy process to help in this situation. She said that this situation of low reserves is about one month earlier than normal. She said that the contingency plans may need to be refined to include more incremental actions as water levels fall. Meanwhile, it is hoped that seasonal rains may resolve the situation, provided that no heavy rains cause excess turbidity. In response to a question about calling for citizen conservation of water, Ms. Baldwin said that since the City uses only about one tenth the amount of water as the mill, the relative impact would be small. However, BOH members agreed that it would be well to make citizens aware of the situation. • Page 5 of 9 Pandemic H1N1 Preparedness Update: Community Vaccination Strategies Dr. Locke provided an H1N1 update from an epidemiological view. He said that each year there is a flu outbreak curve that is based on a number of factors. In the Southern . Hemisphere this year, because it was a new virus, there was no vaccine and very low supplies of anti-viral drugs, H1N1 moved rapidly through the population and the curve rose and fell rapidly. There is reason to believe the curve for North America will be quite different. In the USA, including Washington State, there is widespread influenza activity, which is very unusual for this time of year. Virtually all confirmed cases of influenza are being caused by H1N1, but we are not seeing large numbers of people experiencing illness at one time. This is the second wave of the pandemic. Those areas that were exposed earlier, in the spring, are seeing lower levels now. Population immunity that has already developed slows down the outbreak and "flattens the curve". In addition, since April health authorities have been working with hospitals, schools and businesses to promote infection control: staying home when sick, washing hands frequently, wearing masks, covering coughs, etc. The third factor is the availability of the vaccine -- available supplies have been inadequate to affect transmission of the virus, but may help in reducing the incidence of disease in those at greatest risk for complication. There are confirmed cases of H1N1 flu all over the State, including Port Townsend. There are hospitalizations of children and adults, some schools are above the 10% absentee rate and the upswing of the epidemic has begun. The first shipment of vaccine for Jefferson County (300 doses of nasal vaccine), which is appropriate for healthy individuals from age 2 through 49, was received during the week of October 5. This was administered to health care workers and emergency medical • personnel. The second shipment contains a small amount of the injectable vaccine. Dr. Locke said that, hopefully, with the second and third shipments, all healthcare and emergency personnel will be covered, and vaccination of parents of infants, pregnant women, and young children will be the next focus of vaccination efforts. Ms. Baldwin stated that coordination, prioritization and Federal reporting on the available vaccines presents a tremendous challenge, and staff is attempting to optimize the use of available vaccines. Dr. Locke described weekly meetings in October where planning is taking place to allocate and reallocate vaccines to the five priority groups. He said he expects that sufficient vaccine will not be available until the end of October or later to vaccinate all five priority groups. There is also a special problem for pregnant women, who may only take the injectable form of the vaccine. A legislative ban prohibits use of preservative containing vaccine for pregnant women and children under the age of 3. The Secretary of Health has suspended that ban for H1N1 vaccine, and the vaccine may be given under the condition that the patient is informed that the vaccine exceeds the threshold of mercury content that the legislature had determined to be safe. There was a brief discussion about the continuing opposition to this type of vaccine, based on the fact that it contains mercury. Member Austin mentioned that representatives of anti- vaccination lobby groups had testified before the State Board of Health the previous day. Dr. Locke said that the confirmed death toll from H1N1 as of the previous week was 775; of those, 6% were pregnant women. This issue will delay the vaccination of pregnant women by 2 or 3 weeks. His recommendation to providers is to offer the Thimerosal- Page 6 of 9 himerosal-Page6of9 containing vaccine to pregnant women as soon as it is available. If they refuse it, they should be vaccinated with the preservative-free vaccine as soon as it is available. • Ms. Baldwin noted that logistically the administration of the vaccine is a rationing system. Each week there must be a quick assessment, ordering process and then very rapid administration of what is actually received to the highest priority groups. Dr. Locke noted that information changes rapidly; it must be distilled and communicated to health care providers as quickly and efficiently as possible. Ms. Baldwin noted that medical practices must be reminded to treat this situation from a public health perspective, rather than their normal doctor-patient view, in terms of prioritization and doing what is best for the community. Dr. Locke sees three waves of vaccinations. First, there are those at high risk, who are in the priority groups, and who are ready to be vaccinated as soon as they possibly can; they are now being given the vaccine as soon as it arrives. Second, there are those who are candidates but can wait until it is convenient for them to be vaccinated; these will be done via mass vaccination events, possibly at special clinics or at the schools. The third group are those who initially may not want the vaccine but who change their minds; these will likely be done in November or later. He said that, by that point, we will have gone from shortage to surplus of vaccine. Member Austin asked if Dr. Locke would be doing an interview on local television. Dr. Locke said that he had taped a session with Jim Fritz during the third week in September. In response to a question, Jean Baldwin said that the mass clinics would be publicized via • websites, the newspapers, local television, and other venues/lists that are available, such as school lists, etc. Member Austin said that Katherine Baril has a local version of Facebook that could be used. In response to a question, Dr. Locke said that in Washington, with one exception, for the past ten years seasonal flu has peaked in late January to March. In the Southern Hemisphere, the H 1 N 1 occurrence seems to have displaced the regular flu in most countries. In the Northern Hemisphere, the planning assumptions about a one month peak have not borne out, and it is expected that H1N1 levels will rise significantly higher than they are now. If the efforts at prevention are successful, the curve will be flattened out, which reduces the burden on the health care system. It was noted that there has been a local shortage of seasonal flu vaccine, although Safeway and some other pharmacies have adequate supplies. Ms. Baldwin offered seasonal flu shots to those present who had not yet received them. Dr. Locke said that, although many people are ill now, based on the most recent rapid test samples (30 individuals) about 80% of those with flu-like symptoms do not have influenza. He also noted that this has been a fairly mild pandemic. Most people who are ill have symptoms for a few days and return to normal. However, there are some high risk people who become very seriously ill and can die from the flu. • Page7of9 Green Business Award: Printery Communications, Inc. 1111 A copy of a staff letter to the BOH and the Green Business Award for Printery Communications, Inc. was included in the packet. Chair Westerman signed the award on behalf of the BOH. Jean Baldwin noted that she would be presenting an update on the Green Business program in December. There are changes in the processes for Green Business and EnviroStars. The department is doing greater outreach and education. It is also exploring improvements in its procurement planning and in ensuring its own "green" practices. ACTIVITY UPDATE Jean Baldwin noted that this year the Washington Association of Public Health Officials Commitment to Excellence Award for Outstanding Achievement to Public Health was given to every public health department's staff. She said she was pleased to see staff recognized in this way by the larger public health community. AGENDA PLANNING Jean Baldwin said that school-based clinic data is available and will be available on the website. This item will be on the agenda for December. • Chair Westerman stated that she would not be present at the next meeting. She asked that staff notify Vice Chair Russell so that he could be prepared to chair that meeting. There will be an H 1 N 1 Update in December. As mentioned earlier in the meeting, the Environmental Health fee schedule hearing will be scheduled for December 17. ADJOURNMENT Chair Westerman adjourned the meeting at 4:04 PM. Page 8 of 9 S JEFFERSON COUNTY BOARD OF HEALTH Sheila Westerman, Chair Phil Johnson, Member Excused Chuck Russell, Vice-Chair John Austin, Member Roberta Frissell, Member David Sullivan, Member Kristen Nelson, Member • • Page 9 of 9 JEFFERSON COUNTY BOARD OF HEALTH MINUTES • Thursday, October 15, 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, Kristen Nelson, David Sullivan, Sheila Westerman Excused: Chuck Russell Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin • Guest: Frances Joswick, Substance Abuse Advisory Board (SAAB) A quorum was present. APPROVAL OF AGENDA Frances Joswick requested the addition of SAAB announcements, which was placed under Old Business. Member Austin moved and Member Sullivan seconded for approval of the agenda. The agenda was approved unanimously. APPROVAL OF MINUTES John Austin moved and David Sullivan seconded for approval of the minutes of September 17, 2009. The minutes of September 17, 2009 were approved, as presented. PUBLIC COMMENTS Chair Westerman welcomed Mindy Sayer, a nursing graduate student, who was attending • as an observer. Page 1 of 9 OLD BUSINESS and INFORMATIONAL ITEMS Discovery Bay Area Beaches Closed to the Recreational Harvest of Shellfish due to • Marine Biotoxins An October 7 News Release was included in the packet. Dr. Locke said that biotoxin levels are quite high, about 5-10 times the threshold levels. This time of year is normally a low point recreational shellfish harvesting, when low tides occur during the night. Chair Westerman asked for clarification on why commercially harvested shellfish are not included in this warning. Dr. Locke explained that commercial harvesting has a different notification process and is actually more closely monitored. The wording of the release means that shellfish already on the market are safe, since they would have been harvested prior to this determination and/or from a non-affected area. The Department of Health notifies the commercial fisheries directly. It was noted that conditions can change very quickly. Member Sullivan added that organisms in an affected location may survive a replanting process and will flush themselves out once the toxic conditions have dissipated. National Survey of Local Health Departments Jean Baldwin discussed the results of the 2009 national LHJ (Local Health Jurisdiction) Survey, as it applies to Washington State. The packet contains an October 5 article about the study, and bottom line data for budget cuts and staff reductions. She noted that there • have been 333 FTEs cut from the 31 local jurisdictions responding to the survey. Jean Baldwin said that, with the added workload due to H1N1 preparation and response, the Health Department is at capacity and is stretched to its limit. There was discussion that the public should be made aware of the County's tight resources; the possibility of disseminating this information to the public was discussed. Member Austin suggested that an upcoming article by Allison Arthur of the Leader may be an opportunity for • inclusion of this type of information. Dr. Locke said that Ms. Arthur had also contacted him in regards to H1N1 preparations and vaccine exemptions. Correspondence Jean Baldwin reviewed a letter to the BOCC from Sally Robins (that had been published in the Leader) regarding the importance of maintaining the Senior Foot Care program. Ms. Baldwin explained that this was in response to a rumor that the program may be cut. She said that the program is relatively inexpensive and provides a great deal of benefit for what it costs. Nurse Myrtle Corey sees patients on a quarterly basis; the program covers about 2500 visits per year. About$5,000 of General Fund money supplements fees of $20 per person. Volunteers provide appointment and billing services at no cost. There has been a sliding scale for fees, but Julia Danskin said most patients are willing to pay the full $20. Member Sullivan noted that the program is very worthwhile because it also affects mobility and has other potential health benefits. • Page 2 of 9 Chair Westerman said that she planned to call Ms. Robbins to enlist her help in ensuring that seniors who use and appreciate the foot care service understand the implications of • the upcoming referendum on government spending. SAAB Announcement Ms. Joswick said that an SAAB sub-committee had been formed to gather and analyze substance abuse clean up (collateral) costs, as discussed at the previous BOH meeting. She said that this is a formidable task, but very important in terms of showing the community the high costs of addiction and hopefully in steering the legislature toward funding where it does the most good, i.e. not toward clean up but towards more effective preventive measures. Ms. Joswick said the study will follow the Columbia University model in pursuing a valid, scientific, well-credentialed study. She said she had visited four Jefferson County departments thus far. She believes this will lead to better understanding by administrators of what data is needed. With regard to the program at the jail, she has been asked to meet with Jenifer Jackson of the Peninsula Daily News to provide information for a follow up article on the program. In response to an inquiry from Member Austin, Ms. Joswick said that she has set up an appointment with an SAAB candidate for the following week. NEW BUSINESS • Board of Health Bylaws Revision: Action Item Chair Westerman noted that the revised bylaws had been distributed more than ten days earlier, and asked if there were any comments or questions. Member Austin said he had reviewed the RCW regarding BOH composition, and noted that the Bylaws appear to be in concert with that. Member Nelson said she had not been present at the previous meeting and had a few questions. She asked why the BOCC, and not the BOH, removes BOH members (page 2 —Absences). Chair Westerman explained that since the BOCC appoints, it should also be within their power to remove members for cause. Ms. Nelson also questioned the use of the inserted word "regular" (page 4, section 2), which is not defined or referenced elsewhere. She suggested that the term "regular member" be used/referenced in the section where members are first mentioned on page 2, or that the term "voting member" be used on page 4. After a brief discussion, Member Austin moved that the term "voting member" be substituted for "regular member" on page 4, Section 2. Member Nelson seconded. The motion was approved unanimously. • Member Nelson also asked, with regard to appointment of Health Officer and/or Administrator, if the distinction in the Bylaws between "shall" and "may" is based on the RCW; Chair Westerman confirmed that is the case. Page 3of9 Member Austin moved for adoption of the BOH Bylaws as revised, and Member Frissell seconded. The revised Bylaws were approved unanimously. Chair • Westerman signed the revised document on behalf of the BOH. Pre-Adoption Briefing: Draft 2010 Fee Schedule Jean Baldwin introduced Veronica Shaw and Linda Atkins, who were on hand to explain the proposed fee schedule provided in the packet. Ms. Shaw explained the proposed fee schedule format and the meaning of column headings. She noted a correction under On Site Sewage— Septic Permit with SPAAD (alternative); the fee is $388, not $328. Jean Baldwin pointed out the addition of a fee to cover costs of an Administrative Hearing appeal. Chair Westerman inquired as to how the exact fee of$287 was determined. Ms. Shaw said that that fee was calculated several years ago and has been adjusted per the CPI (Consumer Price Index) in September of every year, per the RCW. The adjusted figure is rounded to the nearest dollar. The fees for 2010 will be recalculated as soon as the updated CPI is available. In order to prepare for publishing and using the new fees in January, the BOH is briefed in advance. Jean Baldwin noted that most increases are small, and pointed out the increased fees for boundary line adjustments to cover the staff costs per lot. Member Austin inquired about the Installer, Pumper License/renewal fees and the duration of the original license. Ms. Atkins explained that the initial $387 license fee is • good for one year. The $273 renewal fee covers the costs of reviewing/verifying continuing education, processing the certificates, and the cost of education, notifications, and newsletters throughout the year. Member Nelson inquired whether these fee increases will fully, or only partially, cover the General Fund shortfalls. Ms. Shaw said that the fee increases will provide about $18,000 to $20,000, depending on volume of permits, which is not adequate to cover the deficits. Jean Baldwin added that there will be further discussions in 2010 regarding other fees related to water quality and green water catchment, etc. and compensating for services dropped by the State Department of Health. Some services will be local instead of State-provided. Member Nelson asked if this was the limit of increases that could/should be made. Ms. Baldwin recalled that a thorough market analysis had been made last year. This year there is not a major overhaul; it is an adjustment and addition of those things that had been previously overlooked. In 2010, the food program and temporary workers will be reviewed in terms of cost recovery. There was a brief discussion about the upcoming schedule and venue for the public hearing. It was noted that, historically, there has not been a large turnout for the annual fee hearing, but that a larger space will be available if needed. The next regularly scheduled BOH meeting will fall on the Thanksgiving holiday. In order to put new fees into effect in January, the new schedule must be approved by mid-December. There was a preference for setting the hearing on December 17, 2009 and for canceling the . November meeting unless pressing new business arises. Page 4 of 9 r Member Austin moved for canceling the November BOH meeting; Member Nelson seconded. The motion was approved unanimously. Member Frissell moved that the public hearing on the proposed Environmental Health fee schedule, based on the CPI update to be released, be set for December 17, 2009. The motion was seconded by Member Sullivan. The motion to set the Environmental Health fee schedule hearing date for December 17, 2009 was approved unanimously. Port Townsend Water Supply Update Jean Baldwin reported that Lords Lake reserves had fallen from 20 days to 9 days in the preceding weeks, but had risen again slightly after a period of rain. Photographs in the packet taken about one week previously show new installations that would allow the City to pump down to lower levels of the lake. There is increased risk of turbidity which must be closely monitored, since it can render chlorination to be ineffective. There was a discussion about the relative volumes of water used by Port Townsend Paper and the City, as well as the bases for declaring a water emergency. Dr. Locke said that the situation had been thoroughly explored in 2004, when levels were even worse. At that time, Health officials had brought the State DOH, the City of Port Townsend and the paper mill together to working out a response plan. At that time, the mill voluntarily agreed to alter their production schedules to conserve water. (The mill uses about 10 million gallons per day for full production and at least 1 million per day just to keep • running.) At that time, there was pumping from a barge that, if moved off center, could result in large amounts of sediment and turbidity. If chlorination becomes ineffective due to high turbidity, it becomes mandatory to boil water. However, some businesses, such as restaurants and hospitals cannot use this method—they must close. Jean Baldwin said that the mill has been slowing their water intake (down to about 2,000,000 gallons per day) but this has not prevented further reduction of the reserves. She said that the City and State DOH are conferring regularly and there is obvious need to keep careful watch over the turbidity levels. Member Nelson added that the City has applied to DFW for permission to draw directly from river waters in an emergency; Ms. Baldwin said that that may be too lengthy process to help in this situation. She said that this situation of low reserves is about one month earlier than normal. She said that the contingency plans may need to be refined to include more incremental actions as water levels fall. Meanwhile, it is hoped that seasonal rains may resolve the situation, provided that no heavy rains cause excess turbidity. In response to a question about calling for citizen conservation of water, Ms. Baldwin said that since the City uses only about one tenth the amount of water as the mill,the relative impact would be small. However, BOH members agreed that it would be well to make citizens aware of the situation. • Page 5 of 9 • I Y Pandemic H1N1 Preparedness Update: Community Vaccination Strategies Dr. Locke provided an H1N1 update from an epidemiological view. He said that each year there is a flu outbreak curve that is based on a number of factors. In the Southern Hemisphere this year, because it was a new virus, there was no vaccine and very low supplies of anti-viral drugs, H1N1 moved rapidly through the population and the curve rose and fell rapidly. There is reason to believe the curve for North America will be quite different. In the USA, including Washington State, there is widespread influenza activity, which is very unusual for this time of year. Virtually all confirmed cases of influenza are being caused by H1N1, but we are not seeing large numbers of people experiencing illness at one time. This is the second wave of the pandemic. Those areas that were exposed earlier, in the spring, are seeing lower levels now. Population immunity that has already developed slows down the outbreak and "flattens the curve". In addition, since April health authorities have been working with hospitals, schools and businesses to promote infection control: staying home when sick, washing hands frequently, wearing masks, covering coughs, etc. The third factor is the availability of the vaccine -- available supplies have been inadequate to affect transmission of the virus, but may help in reducing the incidence of disease in those at greatest risk for complication. There are confirmed cases of H1N1 flu all over the State, including Port Townsend. There are hospitalizations of children and adults, some schools are above the 10% absentee rate and the upswing of the epidemic has begun. The first shipment of vaccine for Jefferson County (300 doses of nasal vaccine), which is appropriate for healthy individuals from age 2 through 49, was received during the week • of October 5. This was administered to health care workers and emergency medical personnel. The second shipment contains a small amount of the injectable vaccine. Dr. Locke said that, hopefully, with the second and third shipments, all healthcare and emergency personnel will be covered, and vaccination of parents of infants, pregnant women, and young children will be the next focus of vaccination efforts. Ms. Baldwin stated that coordination, prioritization and Federal reporting on the available vaccines presents a tremendous challenge, and staff is attempting to optimize the use of available vaccines. Dr. Locke described weekly meetings in October where planning is taking place to allocate and reallocate vaccines to the five priority groups. He said he expects that sufficient vaccine will not be available until the end of October or later to vaccinate all five priority groups. There is also a special problem for pregnant women, who may only take the injectable form of the vaccine. A legislative ban prohibits use of preservative containing vaccine for pregnant women and children under the age of 3. The Secretary of Health has suspended that ban for H1N1 vaccine, and the vaccine may be given under the condition that the patient is informed that the vaccine exceeds the threshold of mercury content that the legislature had determined to be safe. There was a brief discussion about the continuing opposition to this type of vaccine, based on the fact that it contains mercury. Member Austin mentioned that representatives of anti- vaccination lobby groups had testified before the State Board of Health the previous day. Dr. Locke said that the confirmed death toll from H1N1 as of the previous week was 775; of those, 6% were pregnant women. This issue will delay the vaccination of pregnant • women by 2 or 3 weeks. His recommendation to providers is to offer the Thimerosal- Page 6 of 9 containing vaccine to pregnant women as soon as it is available. If they refuse it, they should be vaccinated with the preservative-free vaccine as soon as it is available. • Ms. Baldwin noted that logistically the administration of the vaccine is a rationing system. Each week there must be a quick assessment, ordering process and then very rapid administration of what is actually received to the highest priority groups. Dr. Locke noted that information changes rapidly; it must be distilled and communicated to health care providers as quickly and efficiently as possible. Ms. Baldwin noted that medical practices must be reminded to treat this situation from a public health perspective, rather than their normal doctor-patient view, in terms of prioritization and doing what is best for the community. Dr. Locke sees three waves of vaccinations. First, there are those at high risk, who are in the priority groups, and who are ready to be vaccinated as soon as they possibly can; they are now being given the vaccine as soon as it arrives. Second, there are those who are candidates but can wait until it is convenient for them to be vaccinated; these will be done via mass vaccination events, possibly at special clinics or at the schools. The third group are those who initially may not want the vaccine but who change their minds; these will likely be done in November or later. He said that, by that point, we will have gone from shortage to surplus of vaccine. Member Austin asked if Dr. Locke would be doing an interview on local television. Dr. Locke said that he had taped a session with Jim Fritz during the third week in September. 110 In response to a question, Jean Baldwin said that the mass clinics would be publicized via websites, the newspapers, local television, and other venues/lists that are available, such as school lists, etc. Member Austin said that Katherine Baril has a local version of Facebook that could be used. In response to a question, Dr. Locke said that in Washington, with one exception, for the past ten years seasonal flu has peaked in late January to March. In the Southern Hemisphere, the H1N1 occurrence seems to have displaced the regular flu in most countries. In the Northern Hemisphere, the planning assumptions about a one month peak have not borne out, and it is expected that H1N1 levels will rise significantly higher than they are now. If the efforts at prevention are successful, the curve will be flattened out, which reduces the burden on the health care system. It was noted that there has been a local shortage of seasonal flu vaccine, although Safeway and some other pharmacies have adequate supplies. Ms. Baldwin offered seasonal flu shots to those present who had not yet received them. Dr. Locke said that, although many people are ill now, based on the most recent rapid test samples (30 individuals) about 80% of those with flu-like symptoms do not have influenza. He also noted that this has been a fairly mild pandemic. Most people who are ill have symptoms for a few days and return to normal. However, there are some high risk people who become very seriously ill and can die from the flu. S Page 7 of 9 Green Business Award: Printery Communications, Inc. A A copy of a staff letter to the BOH and the Green Business Award for Printery Communications, Inc. was included in the packet. Chair Westerman signed the award on behalf of the BOH. Jean Baldwin noted that she would be presenting an update on the Green Business program in December. There are changes in the processes for Green Business and EnviroStars. The department is doing greater outreach and education. It is also exploring improvements in its procurement planning and in ensuring its own "green"practices. ACTIVITY UPDATE Jean Baldwin noted that this year the Washington Association of Public Health Officials Commitment to Excellence Award for Outstanding Achievement to Public Health was given to every public health department's staff She said she was pleased to see staff recognized in this way by the larger public health community. AGENDA PLANNING Jean Baldwin said that school-based clinic data is available and will be available on the • website. This item will be on the agenda for December. Chair Westerman stated that she would not be present at the next meeting. She asked that staff notify Vice Chair Russell so that he could be prepared to chair that meeting. There will be an H 1 N 1 Update in December. As mentioned earlier in the meeting, the Environmental Health fee schedule hearing will be scheduled for December 17. ADJOURNMENT Chair Westerman adjourned the meeting at 4:04 PM. Page 8 of 9 • JEFFERSON COUNTY BOARD OF HEALTH Excused ! Sheila West , Chair Phil ohns on, Member xcuse• Ilk 0 0-- i :71 Chuck Russell, Vice-Chair NAustin, Member f"7 /6-4,3.62-64,66e2-- /a,G X ..\ Roberta F issell, Member Davi Sullivan, Me •er \V Kristen Nelson, Member • • Page 9 of 9 • Board of Health 0CcCBusiness Agenda Items # 1 Yin Epidemic of year: One flans Battle Yt ainst the • .menti- Vaccination wlovement December 17, 2009 • „, , , ,. .. 0S RULE •! yBe . . . , ...„,,,,.......,,.:...„,..../ ` ' OW USERS TOOK ODER TWITTER ,,, k ., ..,,,,,, _, ,-. . Ak-,..,.. f d R 1;r:,,,,y.i.g--9:-.-----will ''- -- '''. - - -,:-7. r, _ ' _,41-.4.,.,':4kW:,`r ':. -- f',T ' • t .” 0 ,-.y.,,,',.f. ra . Vaccines don't s G Cause autism. But some s ' panicked parents are =� skipping their baby's shots. Whyhat bad decision endangers us all. .3,snp' �' ."W a �` _ .. � � r ; [ A= 3 9 H a * _ ¢ ••,`L,e' i )fid. ( ? tie Y,M §`f`„,,,,,_-3,':471.4."-s- ---' .Z £r`£�yvyy • .y, til X4 ":” vri i 4 G Zvi# + 3 �s w" t ``'' ' u '�" " { > �,, , z , � ,f'��"`� �� r''-'44': it �� �`� `�� ta"��'� Ps % +y Y 1 ? r . 6 2 F d M4 . WTR TV { %tate ,44'MIA- A., ;44 : --; m , --,,,,?.........A -,,e,","4.--' ter '.: , 4 ys ,, aaii, '-k .✓`' sp Y' f$ $=��dt amu' ° 5; x r , -Iir'.:14."4141.3!Pe ' " - .:-;z- 41,Eteri-•.;--PO. -9"-Ng:gitatela.;i i a NV57f.0.10:, 454$#11:442'' ..,.., ,....,......,-,... .7.........,.....,„,., ... .„.. 1411 ..-41.R.--7.t--:--4111.1 • . .. ... . 0 II 0 II irfa-Wit"-'1,-:-.4'I ' • -. ... :-...,, ... .. . • ... '..'... . .. . .. . , • ..,....._„,_,„. . . .. .. .._ ..,........,,.. ...,. , ,,..r.h.r.,7,-.,,,,-.......,g' I '.• - ..• : . ... .... . . • e m 1 c .. . • ..' .•... „... ..• . ... ... ... . ,.. . .. _.:42,...,...„..„,_„5„..,_, • . . . _ i...T...„:„,._:_..„..,...„.„,..5.,1 a ,, tEg _.,......--.. ., . . ._,... . 7„.:111 1 ' - '-, -, `.,'.,4,`•'': . . .. . . ._ .. 1 .. ... . . 'al • . . . - . . .. _,.. .. . .. . ....-.. ---._r-,:t..;- ..- ..-1.:•,..- -----.---„ ,,-_,-_.„.„-,.•„.„:„.„,-_„•..s.„,,,,,,..„,---..„---:,,,„..,7„-_____-:..„--...,--.-„_„_,._„:„.„.,,,,,-,r..",_,-,,..„4„ ,..moi,..,:._„.„,..n,,,...„,„?_ _.t.„,„4_,_4,-:c.,-.,4„.„-os.vt„,„mr,_.4,t.,,rertt,,,,z,„„_,.,•044.-„,........... zi---.:--g.,:-:::,:-.--:I::_-!:-.1i • t.'...-:-.1.! One man's battle against the anti-vaccine movement.:.01,itoktiViWIT .-t... ---,-,,,,,.0..,. ,..,•-., ',rPs*-titizslogaltalti ....,...:,!•,--4%,..txty,li.,.., . ....„-__,„,....,..,.„,„...4„,„.„..„...„......,,,,...,....4 ,,,,,: '''_-.71.`'. '::.-4- ;-'".7;'4.:*.'''•,i ..,5....z.,,,,,-,,,..„,,,,,,,, .-,,,---a-..-'..:. •' ,...,...-.,....,-, _ ,....1.. ., .. ,,-..4-4w•-i...; -.7....._;.-„,*.i,,1.4, PHOTOGRAPH BY ANDREA ZUCKERMAN ':: - 1 To hear ,, 11p {�y. _ ,, his::it.i,i, , „,.,i enemies .,,,,,":„...,:,,,,,„' _ ,,,,,„ xi ,, a t i1.'k I tat /CI py This isn't a religious dispute,like the is debate over creationism and intelligent 4 design.It's a challenge to traditional science that crosses party,class,and religious lines.It is partly a reaction to you might think Paul Offit is the most hated man in America.A pediatrician in Philadel- Big Pharma's blunders and PR missteps, 4-4 t phia,he is the coinventor of a rotavirus vaccine that could save tens of thousands of lives from Vioxx to illegal marketing ploys, every year.Yet environmental activist Robert F.Kennedy Jr.slams Offit as a"biostitute” which have encouraged a distrust of who whores for the pharmaceutical industry.Actor Jim Carrey calls him a profiteer and experts.It is also,ironically,a product '.; distills the doctor's attitude toward childhood vaccination down to this chilling mantra: of the era of instant communication and , "Grab'em and stab'em."Recently,Carrey and his girlfriend,Jenny McCarthy,went on easy access to information.The doubters CNN's Larry King Live and singled out Offit's vaccine,RotaTeq,as one of many unneces- and deniers are empowered by the Inter- sary vaccines,all administered,they said,for just one reason:"Greed."1 Thousands of net(online,nobody knows you're not a people revile Offit publicly at rallies,on Web sites,and in books. helpedby 4 i Type pauloflit.com into doctor)and the mainstream ; 3 I your browser and you'll find not Offit's official site but an anti-Offit screed"dedicated to media,which has an interest in pump- 7 exposing the truth about the vaccine indus- ing - up bad science to create a `debate„ m . .,; try's most well-paid spokesperson.”Go to where there should be none. f ,. :, Wikipedia to read his bio and,as often as address,he holds the envelope at arm's In the center of the fray is Paul Offit. not,someone will have tampered with the length before gingerly tearing it open. "People describe me as a vaccine advo- page.The section on Offit's education was "I think about it,"he admits."Anthrax." cate,"he says."I see myself as a science L., once altered to say that he'd studied on a pig So what has this award-winning advocate"Butinthisbattle—and make no farm in Toad Suck,Arkansas.(He's a gradu- 58-year-old scientist done to elicit such mistake,he says,it's a pitched and heated ` CT ate of Tufts Universityandthe University of venom?He boldly states—in speeches, battle—"science alone isn't enough... Maryland School of Medicine).1 Then there in journal articles,and in his 2008 book People are getting hurt.The parent who ` k are the threats.Offit once got an email from Autism's False Prophets—that vaccines reads what Jenny McCarthy says and a Seattle man that read,"I will hang you by do not cause autism or autoimmune dis- thinks,`Well,maybe I shouldn't get this your neck until you are dead!"Other brae ease or any of the other chronic condi vaccine,'and their child dies of Hib men :1 ing messages include"You have blood on tions that have been blamed on them. ingitis,"he says,shaking his head."It's your hands"and"Your day of reckoning He supports this assertion with metic- such a fundamental failure on our part - will come."A few years ago,a man on the ulous evidence.And he calls to account that we haven't convinced that parent." '' phone ominously told Offit he knew where those who promote bogus treatments for Consider:In certain parts of the US, the doctor's two children went to school. autism—treatments that he says not only vaccination rates have dropped so low At a meeting of the Centers for Disease don't work but often cause harm. that occurrences of some children's dis- T Control and Prevention,an anti-vaccine As a result,Offit has become the main eases are approaching pre-vaccine levels .,,,,t, protester emerged from a crowd of peo- target of a grassroots movement that for the first time ever.And the number pie holding signs that featured Offit's face opposes the systematic vaccination of of people who choose not to vaccinate } emblazoned with the word TERRORIST children and the laws that require it. their children(so-called philosophical I and grabbed the unsuspecting,6-foot-tall McCarthy,an actress and a former Play- exemptions are available in about 20 physician by the jacket.l"I don't think he boy centerfold whose son has been di ag- states,including Pennsylvania,Texas, wanted to hurt me,"Offit recalls."He was nosed with autism,is the best-known and much of the West)continues to :t! just excited to be close to the personifi- leader of the movement,but she is joined rise.In states where such opting out ' cation of such evil."Still,whenever Offit by legions of well-organized supporters is allowed,2.6 percent of parents did v' ' gets a letter with an unfamiliar return and sympathizers. so last year,up from 1 percent in 1991, . PHOTOGRAPH 8Y Peter Yang according to the CDC.In some communities,like California's affluent Marin County,just no The M i si nformant5 of San Francisco,non-vaccination rates are approaching 6 percent(counterintuitively,highe 11 rates of non-vaccination often correspond with higher levels of education and wealth). - Thatmay not sound like much,but a recent study by the Los Angeles Times indicates that the impact can be devastating.The Times found that even though only about 2 percent of California's kindergartners are unvaccinated(10,000 kids,or about twice the number as in _' 1997),they tend to be clustered,disproportionately increasing the risk of an outbreak of such s `. �/t, largely eradicated diseases as measles,mumps,and pertussis(whooping cough).The clus- .- ; tering means almost 10 percent of elementary schools statewide may already be at risk. In May,The New England Journal of Medicine laid the blame for clusters of disease outbreaks Jenny McCarthy throughout the US squarely at the feet of declining vaccination rates,while nonprofit healthcare Many perpie ask id' provider Kaiser Permanente reported that unvaccinated children were 23 times more likely to me if I had to do it at 1 get pertussis,a highly contagious bacterial disease suer,would d i v anew that causes violent coughing and is potentially lethal nety,Thet answerei- Hata?The is no. to infants.In the June issue of the journal Pediatrics, icans'embrace of reincarnation, Hell no.Most parents Jason Glanz,an epidemiologist at Kaiser's Institute channeling,and extraterrestri,' !''..;.'[ vaccine injured nhc�know they have a child _i' for Health Research,revealed that the number of als."There are unsatisfied medi- usually are that ada- t nientaboutit' reported pertussis cases jumped from 1,000 in 1976 cal needs, spiritual needs, and to26,000in2004.Adiseasethatvaccinesmaderare, needs for communion with the in other words,is making a comeback."This study rest of the human community." helps dispel one of the commonly held beliefs among Looking back over human history, t vaccine-refusing parents:that their children are not rationality has been the anomaly. at risk for vaccine-preventable diseases,"Glanz says. Being rational takes work,educa- "1 used to say that the tide would turn when chil- tion,and a sober determination to dren started to die.Well,children have started to avoidmaldnghastyinferences,even `s die,"Offit says,frowning as he ticks off recent fatal when they appear to make perfect sense.Much like infectious diseases them- .{r cases of meningitis in unvaccinated children in selves—beaten back by decades of effort to vaccinate the populace—the irra- ; Pennsylvania and Minnesota."So now I've changed tional lingers just below the surface,waiting for us to let down our guard. ` it to'when enough children start to die.'Because Before smallpox was eradicated with a vaccine,it killed an estimated 500 i obviously,we're not there yet." million people.And just 60 years ago,polio paralyzed 16,000 Americans every year,while rubella caused birth defects and men- tal retardation in as many as 20,000 newborns. Measles infected 4 million children,killing 3,000 ''' 1 I i • ' . ■ ' annually,and a bacterium called Haemophilus - TIDE :WOULD TURN WHEN influenzae type b caused Hib meningitis in more C H LL D R E N STARTED TO DIE ., than 15,000 children,leaving many with perma- nent brain damage.Infant mortality and abbre- Well, childre p regarded life spans—now re arded as a third world 1 problem—were a first world reality. t � a rte t® die."' 7i17:'-'114 Today,because the looming risk of childhood _,,. et.;" '..ti �..VA •' death is out of sight,it is also largely out of mind, i° leading a growing number of Americans to worry about what is in fact amuch lesser risk:the ill effects _ of vaccines.If your newborn gets pertussis,for -_ The rejection of hard-won knowledge is by no means example,there is a l percent chance that the baby will die of pulmonary hyper- a new phenomenon.In 1905,French mathema- tension or other complications.The risk of dying from the pertussis vaccine,by tician and scientist Henri Poincare said that the contrast,is practically nonexistent—in fact,nostudy has linked DTaP(the three- .. willingness to embrace pseudo-science flourished in-one immunization that protects against diphtheria,tetanus,and pertussis) i because people"know how cruel the truth often is, to death in children.Nobody in the pro-vaccine camp asserts that vaccines are and we wonder whether illusion is not more con- risk-free,but the risks are minute in comparison to the alternative. soling."Decades later,the astronomer Carl Sagan Still,despite peer-reviewed evidence,many parents ignore the math and reached a similar conclusion:Science loses ground agonize about whether to vaccinate.Why?For starters,the human brain has a ' to pseudo-science because the latter seems to offer natural tendency to pattern-match—to ignore the old dictum"correlation does more comfort."A great many of these belief sys- not im1 causation"and stubbornl • ,t, y persist in associating proximate phenom tems address real human needs that are not being ena.If two things coexist,the brain often tells us,they must be related.Some met by our society,"Sagan wrote of certain Amer- parents of autistic children noticed that their child's condition began to appear ., t ...r,.. .. ...v.�... ....,.,�,,.-._.�,,,. .-_. w , } I. voices in the . i i crus �'.0 * "�;,t-„"; fes: All. '''', 4 . ,.., .:' ,_ _ eel, • ,A Jim Carrey Joe Scarborough Don Imus "With many states "I can't prove it, Robert F. Joe Lieberman I ithm many states "As everybody on KennedyJr. : but intuitively,you the planet knows, "Parents still careful have reporting one in 80 look et the "Io c me "roe the CDC to be very = ae spiky[in thimerosal is a children affected autism],you look atto came i clean with n the vaccines t the with autism,can we neurotoxin.Inject- the American public. of to their 4 {: thimerosal,there ing it at the levels Its tactics of decep-to trust thoseP kids.That's what I've is no doubt in my they do and used k who serve two mac mind...we'regonnation and obfusca- asked my kids to do it to do,and still do, tion are jeopardizing _ ters or their logic find out that Chime- ! g with my grandkids;' - that tells US'one by way,into the credibility of the rosy!causes,in my the bloodstreams 1 size fits all`when it entire vaccine pro- } opinion,autism." of infants must do comes to vaccines?" gram and posing an something." enormous danger to public health." I $ 4 I1 shortly after a vaccination.The conclusion:"The vaccine must have caused in thousands of kids.The article was roundly discredited I z, the autism."Sounds reasonable,even though,as many scientists have noted, for,among other things, it has long been known that autism and other neurological impairments mercury in childhood vaccines by more than 00-fold, often become evident at or around the age of 18 to 24 months,which just causing Rolling Stone e to issue not one but a prolonged happens to be the same time children receive multiple vaccinations.Cor- series of corrections and clarifications.But that did lit- t relation,perhaps.But not causation,as studies have shown. And if you need a new factoid to support your belief system,it has never tle to unring the bell. The bottom line:Pseudo-science preys on well- been easier to find one.The Internet offers a treasure trove of undifferen- intentioned people who,motivated by love for their tiated information,data,research,speculation,half-truths,anecdotes, kids,become vulnerable to one of the world's oldest 1. and conjecture about health and medicine.It is also a democratizing force I that tends to undermine authority,cut out the middleman,and empower professions.Enter the snake oil salesman. individuals.In a world where anyone can attend what McCarthy calls the "University of Google,"boning up on immunology before getting your child vaccinated seems like good,responsible parenting.Thanks to the When a child Internet,everyone can be their own medical investigator. is ill,parents will do anything to make it right.If you ,--4 :, s There are anti-vaccine Web sites,Facebook groups,email alerts,and lob- doubt that,just spend a day or two at the annual con- t hying organizations.Politicians ignore the movement at their peril,and, ference of the nonprofit organization Autism One,a unlike in the debates over creationism and global warming,Democrats have group built around the conviction that autism is caused proved just as likely as Republicans to share misinformation and fuel anxiety. by vaccines.It shares its agenda with other advocacy US senators John Kerry of Massachu- setts and Chris Dodd of Connecticut have groups like the National Autism Association,the Coali- tion oali 1Ty tion for SafeMinds,and McCarthy's Generation Rescue. both curried favor with constituents by All these organizations cite similar anecdotes—children who appear to shut down and trumpetings the notion cause exhibit signs of autistic behavior immediately after being vaccinated—as proof.Autism t autism.And Robert E Kennedy Jr.,a scion One,like others,also points to rising rates of autism—what manyparents call an epidemic— of the most famous Democratic family of as evidence that vaccines are to blame.Finally,Autism One asserts that the condition is 1 all,authored a deeply flawed 2005 Roll- preventable and treatable,and that it is the toxins in vaccines and the sheer number of r ing Stone piece called"Deadly Immu- childhood vaccines(the CDC recommends 10 vaccines,in 26 doses,by the age of 2—up v f nity."In it,he accused the government from four vaccines in 1983)that combine to cause disease in certain sensitive children. ' of protecting drug companies from liti- Their rhetoric often undergoes subtle shifts,especially when the scientific evidence gation by concealing evidence that mer- becomes too overwhelming on one front or another.After all,saying i cury in vaccines may have caused autism cines does start to sound crazy,even to a parent in distress over a child's autism.Until recently, t I E - - ' ,Ate-• /� • `, 1 ave found no data that links the MMR How to man Argument bout 1 eco eS (measles/mumps/rubella)vaccine to m n autism; •six •studies have found no trace • worn myths.Arm r if an association between thimero- sal(a preservative containing ethyl- ,; mercury that was used in vaccines �. until 2001)and autism,and three f ®MYTH:Vaccines severe cases are so rare and Haemophilusinflui other studies have found no indication cause autism. that the CDC cannot cal- enzae type b cause that causes even subtle FACT:Until 2001,vac- culate a statistical risk meningitis,which can that neurological thimerosalprocauses s.The so-called r cines included thime for the population— lead to deafness,epi -rosal,a preservative the numbers are just lepsy,and cognitive epidemic,researchers assert,is the containing ethylmer- too small. impairment.Measles result of improved diagnosis,which can lead to encephalitis, cart'.Mercury,neu of course, - has identified as autistic many kids �. can cause neurological ®MYTH:Vaccines biind�Shss,a�ft`i5a'ETi. damage.But there's sci- cause diabetes. who once might have been labeled :Al ; • entific consensus that FACT:This idea relies on MYTH:Scientists mentally retarded or just plain slow. . " the amount once used the flawed work of one are divided about In fact,the growing body of science in vaccines—around 50 doctor,who gathered the safety of vaccines. micrograms per 0.5-mi data on a slew of vac- FACT:By any measure indicates that the autistic spectrum— dose—was far short of cines and failed to follow of scientific consensus, which may well turn out to enCom toxic.And autism rates standard study proto- there is total agreement:tir aSSSeVeraldiSCreteConditi0ns—may have continued to climb, cols.No other study— Vaccines are safe,effac- p suggesting that there's including those using tive,and necessary. largely be genetic in origin.In April, ill- �, either a different cause the same data—could Twelve studies have the journalNaturepublishedtwo stud or,more likely,that a reproduce the results, shown thatthe measles) r better understand- The CDC and the insti- mumps/rubella vaccine ies that analyzed the genes of almost `, ing of the condition has tute of Medicine have is safe.Many other stud- 10,000 people and identified a common increased diagnoses.A both dismissed any pus- ies have disproved the genetic variant present in approxi- ' comprehensive review siblelink.This argument theory that the bib shot motel 65 ercentreof autisticchildren. .11 of the research,con- also ignores the obvious is toxic.The few dissent Y p ducted in 2004 by the and well-established ers get lots of attention, But that hasn't stopped as many as prestigious Institute of fact that diabetes rates but it's always the same one in four Americans from believing `, Medicine,found no evi- in children are climbing old names. VaCCirieSCanpOlsOrikids,aCCOrdirigt0 ' dance of a connection because obesity rates MYTH:Aluminum a 2008 survey.And outreach by grass- between vaccines and are climbing. ® Y - in vaccines is just roots organizations like Autism One is autism.None. MYTH:Vaccines as toxic as mercury. -'4 MYTH:Giving too W are no longer net- FACT:AIuminuma big reason why. 0 many vaccines essary,because the dismost common metal At this year's Autism One conference overwhelms a child's eases are no longer a in nature,is perfectly in Chicago,I flashed more than once immune system.FACT: threat.FACT:The oppo- safe in small amounts. This argument echoes site is true,Because of (A dose of antacid has on Carl Sagan's idea of the power of an the"too much of a vaccines,diseases that about 1,000 times as "unsatisfied medical need."Because good thing"chestnut, once killed millions are much as a vaccine does.) a massive research effort has yet to but there's no science now invisible.But it only Aluminum salts are used reveal the precise causes of autism, behind it.With millions a few families stop vac- in vaccines to increase of vaccines admin- cinating,the illnesses antibody response.They pseudo-science has stepped aggres- istered every year,a could reemerge in a corn- rake it possible to use sively into the void.In the hallways handful of allergic reac- munity.And the diseases less vaccine less often. of the Westin O'Hare hotel,helpful ,,-,i tions do happen.But are horrible—mumps —Erin Biba '• salespeople strove to catch my,eye as I walked past a long line of booths ' pitching everything fromvitamins and supplements to gluten-free cookies (some believe a gluten-free diet alle- Autism One's Web site flatly blamed viates the symptoms of autism),hyperbaric chambers,and neuro-feedback machines. "too many vaccines given too soon." To a one,the speakers told parents not to despair.Vitamin D would help,said one doctor ,. Lately,the language has gotten more and supplement salesman who projected the equation No VACCINES+MORE VITAMIN D vague,citing"environmental triggers." =NO AUTISM onto a huge screen during his presentation.(If only it were that simple.)Oth- But the underlying argument has not ers talked of the powers of enzymes,enemas,infrared saunas,glutathione drips,chelation changed:Vaccines harm America's chil- therapy(the controversial—and risky—administration of certain chemicals that leech met- dren,and doctors like Paul Offit are paid als from the body),and Lupron(a medicine that shuts down testosterone synthesis). shills of the drug industry. Offit calls this stuff,much of which is unproven,ineffectual,or downright dangerous, ' To be clear,there is no credible evi- "a cottage industry of false hope."He didn't attend the Autism One conference,though dence to indicate that any of this is true. his name was frequently invoked.A California woman with an 11-year-old autistic son • f None.Twelve epidemiological studies told me,aghast,that she'd personally heard Offit say you could safely give a child 10,000 vaccines(in fact,the number he came up with was 100,000—more on thatII 1 from Arizona,who introduced me to her 10-year-old"recovered"autistison i a bright,, ing imagessick palsied,kids—some of them blue-eyed,towheaded boy who hit his head on walls,she said,before he started getting ' a seemingly others with trem- � B-12 injections—told me that she'd read Offit had made$50 million from the RotaTeqvc- home.os,othersThefilm,accompanied the point cine.In her view,he was in the pocket of Big Pharma. The accompanied"(Everythingby I I 1. The central message at these conferences boils down to this:"The medical establish- Adams'plaintive song I ment doesn't care,but we do."Every vendor I talked to echoed this theme.And every messageDos I Do It For oYned onnhes screen:en thisA parent expressed a frustrated,even desperate belief that no one in traditional science the emblazoned the nu `Ar gives a hoot about easing their pain or addressing their theories—based on day-to-day killed bydren in this video were injured or parental experience—about autism's causes. mandatory vaccinations." t Against this backdrop,Fisher,a skilled 1 Actually,scientists have chased down some of these theories.In August,for example, debater who often faces down articu- I t Pediatrics published an investigation of a popular hypothesis that children with autism I have a higher incidence of gastrointestinal problems,which some allege are caused bymentionedt,well-informed q scientists She live calledTV, injected viruses traveling to the intestines.Jenny McCarthy's foundation posits that him leadOffiting frequently. I autism stems from these bacteria,as well as heavy metals and live viruses present in proponent" eleading"pro forced vaccination some vaccines.Healing your child,therefore,is a matter of clearing out the"environ- proponent"and cast him as a man who ='j' ° mental toxins"with,among other things,special diets.The Pediatrics paper found that tical companies and demonizewalks in lockstep with the s caring while autistic kids suffered more from constipation,the cause was likely behavioral, parents.With the likely introduction of not organic;there was no significant association between autism and GI symptoms. a swine flu vaccine later this yearFisher 1J, Moreover,gluten-and dairy-free diets did not appear to improve autism and sometimes added,Americans needed to wake up to J caused nutritional deficiencies. the"draconian laws"that could force But researchers,alas,can't respond with the same forceful certainty that the doubters every citizen to either be vaccinated or are able to deploy—not if they're going to follow the rules of science.Those tenets allow t them to claim only that there is no evidence of a link between autism and vaccines.But quarantined.like That isn't flu vaccines,—tne swine f. that phrasing—whatflu vaccine, other will sounds like equivocation—is just enough to allow doubts to not only be administered on a voluntary basis. remain but to fester.Meanwhile,in the eight years since thimerosal was removed from But o matter:vaccines(a public relations mistake,in Offit's view,because it seemed to indicate to the vvaccines from apublic heisher's ath issue,into t t public that thimerosal was toxic),the incidences of autism continue to rise. I t In the wake of the latest thimerosal studies,most of the anti vaccination crowd—even one of personal choice,an unwritten bit ! ' Autism One,despite the ever-changing rhetoric on its Web site—has shifted their aim of the Bill of Rights. away from an In her speech,Fisher borrowed from �`t 44 `� Yparticularvaccinetoabroader,fuzziertarget:thesheernumberofvaccines the Bible,George Orwell,and the civil that are recommended.It sounds,after all,like common sense.There must be somethi risky about giving too many vaccines to ve � rights movement.`The battle we are ry young children in too short a time.Oppo- waging,"she said,"will determine what nents argue that for some children the current vaccine schedule creates a"toxic overload." "I'm not anti-vaccine,"McCarthy says."I'm k ,_4-:, anti-toxin."She stops just short ofcalling for an outright ban.McCarthy delivered the keynote • • II l �, address at the Autism One conference this year, A U A C I N E I S N 0 T fl just as she had in 2008.She drew a standing �+E T 0 TAKE NO R I SK room-only crowd,many of whom lcnow her not from her acting but from her frequent appear- It's just a C h 01 C e to .; ances on TV talk shows,Oprah Winfrey's Web take a different risk site,and Twitter(@JennyfromMTV).McCarthy has authored two best-selling books on"heal- I �= ing"autism and is on the board of the advocacy ko group Generation Rescue(motto:"Autism is reversible").With herstream-of-consciousnessboth health and freedom will look like rants("Too many toxins in the body cause neurological problems—look at Ozzy Osbourne, for Christ's sake!")and celebrity allure,she is the anti vaccine movement's most popular in America."She closed by quoting the pitchman and prettiest face. p p inscription above the door of the Holo #1 Barbara Loe Fisher,by contrast,is indisputably the movement's brain.Fisher is the DC: "The first to periMusesh were thin eechil cofounder and president of the National Vaccine Information Center in Vienna,Virginia, the largest,oldest,and most influential of the watchdo dren."And then she brought it home:"If g groups that oppose universal we believe in compassion,if we believe ` vaccination.At the Autism One conference,Fisher took the podium with characteristic in the future,we will do whatever it flair.As she often does,Fisher began with the story of her son Chris,who she believes was damaged by vaccines at the age of two and a half.A short film featuring devastat- takes to give our children back the ,' future that! CONTINUED ON PAGE/6 C. L', NOV 2009 f' a across Philadelphia in Offit's gray 2009 to visit just one hour a week,on Sundays. a 1 .. Toyota Camry,having just completed a full His father,a shirt salesman,came when he �. � An day of rounds at Children's Hospital.Over could.His mother,who was pregnant with 1 n, the past eight hours,Offit has directed a his brother and hospitalized with appendici- i Epidemic -� x team of six residents and med students as tis,was unable to visit at all.He was 5 years a O they evaluated more than a dozen children old."It was a pretty lonely,isolating experi 1, ; `�; t'� : 1 with persistent infections.He pulls into ence,"Offit says.`But what was even worse , the driveway of the comfy four-bedroom was looking at these other children who Tudor in the suburbs where his family has were just horribly crippled and disfigured i' lived for the past 13 years.It's a nice enough by polio."That memory,he says,was the Epidemic of Fear house,with a leafygreen yard and a two-car first thing that drove him toward a career A CONTINUED FROM PAGE 135 garage where a second Toyota Camry(this in pediatric infectious diseases. one red,a year older,and belonging to his There was something else,too.From is their birthright."The audience cheered wife,Bonnie)is already parked.Let's just an early age,Offit embraced the logic and 1 '; as the words sank in: Whatever it takes. say that if Offit has indeed made$50 mil- elegance of the scientific method.Science "No forced vaccination,"Fisher concluded. lion from RotaTeq,as his critics love to say, imbued a chaotic world with an order that "Not in America." he is hiding it well. he found reassuring. Offit acknowledges that he received a "What I loved about science was its rea- Paul Offit has a slightly nasal voice and payout—"several million dollars,a lot of son.You have data.You stand back and you * • a forceful delivery that conspire to make money"—when z. . .;. -his hospital sold its stake discuss the strengths and weaknesses of him sound remarkably like Hawkeye Pierce, in RotaTeq last year for$182 million.He that data.There's just some the cantankerous doctor played by Alan continues to collect a royalty each year.It's ing about that,"he says."You formulng very ate a Alda on the TV series M"A*S*K As a young a fluke,he says—an unexpected outcome. hypothesis,you establish burdens of proof, man,Offit was a big fan of the show(though "I'm not embarrassed about it,"he says."It Y you subject your hypothesis to rigorous test- he felt then,and does now,that Hawkeye was the product of a lot of work,although ing.You've got 20 pieces of a 1,000-piece was"much cooler than me").Offit is quick- it wasn't why I did the work,nor was it, puzzle...It's beautiful,really." witted,funny,and—despite agenerallymild- frankly,the reward for the work." There were no doctors in the Offit fam- mannered mien—sometimes so assertive as Similarly,the suggestion that pharma- ily;he decided to become the first.In 1977, to seem brash."Scientists,bound only by ceutical companies make vaccines hoping when he was an intern at the Children's Hos- reason,are society's true anarchists,"he to pocket huge profits is ludicrous to Offit. pital of Pittsburgh,he witnessed the sec- has written—and he clearly sees himself Vaccines,after all,are given once or twice and event that would determine his career as one."Kaflooey theories"make him crazy, or three times in a lifetime.Diabetes drugs, path:the death of a little girl from a rota- ' especially if they catch on.Fisher,who has neurological drugs,Lipitor,Viagra,even virus infection(there was,as yet,no vac long been the media's go to interview for Rogaine—stuff that a large number of people cine).The child's mother had been diligent, 1 what some in the autism arena call"parents use every day—that's where the money is. calling her pediatrician just a few hours 1 rights,"makes him particularly nuts,as in That's not to say vaccines aren't profit- after the girl's fever,vomiting,and diar- _ "You just want to scream"The reason?"She able:RotaTeq costs a little under$4 a dose rhea had lies,"he says flatly. begun.Still,by the time the girl Y y to make,according to Offit.Merck has sold was admitted,she was too dehydrated to i "Barbara Loe Fisher inflames people a total of more than 24 million doses in the have an intravenous line inserted.Doctors against me.And wrongly.I'm in this for US,most for$69.59 apop—all-foldmarkup. tried everything to rehydrate her,includ ' the same reason she is.I care about kids. Not bad,but pharmaceutical companies do ing sticking a bone marrow needle Does she think Merck is paying speak into p ying me to sell a lot of vaccines at cost to the develop- her tibia to inject fluids.She died on the i about vaccines?Is that the logic?"he asks, ing world and in some cases give them away. table."I didn't realize it killed children in ` exasperated.(Merck is doing no such thing). Merck committed$75 million in 2006 to the United States,"Offit says,remember- But when it comes to mandating vaccina- vaccinate all children born in Nicaragua for ing how the girl's mother,after hearing the i :~ tions,Offit says,Fisher is right about him: three years.In 2008,Merck's revenue from terrible news,came into the room and held , j 1 He is an adamant supporter. RotaTeq was$665 million.Meanwhile,a her daughter's hand."That girl's image was "We have seat belt rules,"he says."Seat blockbuster drug like Pfizer's Lipitor is a always in my head." ; : belts save lives.There was never a question $12 billion-a-year business. The third formative moment for Offit _ - about that.The data was absolutely clear. To understand exactly why Offit became a came in the late 1980s,when he met Maurice But people didn't use them until they were scientist,you must go back more than half a Hilleman,the most brilliant vaccine maker ` required to use them."Furthermore,the century,to 1956.That was when doctors in of the 20th century.Hilleman—a notori decision not to buckle up endangers only Offit's hometown of Baltimore operated on ously foulmouthed genius who toiled for r_ you."Unless you fly through the window one of his legs to correct a club foot,requir-q years in the Philadelphia labs of Merck— and hit somebody else,"he adds."I believe ing him to spend three weeks recovering in a invented vaccines to prevent measles, d in mandates.I do." chronic care facility with 20 other children, mumps,and rubella(and later came up with We are driving north(seat belts on) all of whom had polio.Parents were allowed the combination of the t hree,the MMR).He , ® 0 [] NOV 2009 a Epidemic of Fear made lack of expertise a requirement when Risk is also the motivating idea in Offit l ,: CONTINUED FROM PAGE 166 choosing members of prominent advisory life.This is a man,after all,who opted to give panels on the issue."It's shocking,"Spec- his own two children—now teenagers—the created vaccines for hepatitis A and B,Hib, ter says."We live in a country where it's flu vaccine before it was recommended fo xWhy?Because the risk � � s„, chicken pox,pneumococcus,and meningo- actually a detriment to be an expert about their age group. ,_. coccus.He became Offit's mentor;Offit later something.”When expertise is diminished harm if his children got sick was too great. 4, became Hilleman's biographer. to such an extent,irrationality and fear Offit,like everyone else,will do anything to Offit believes in the power of good story- can run amok. protect his children.And he wants Amen- telling,which is why he writes books,five so Hence the death threats against Paul Offit. cans to be fully educated about risk and not 1 far.He dearly wants to pull people into the Curt Linderman Sr.,the host of"Linderman hoodwinked into thinking that dropping L + exciting mysteries that scientists wrestle Live!"on AutismOne Radio and the editor vaccines keeps their children safe."The -"-- , 1 with every day.He wants us all to under- of a blog called the Autism File,recently choice not to get avaccine is nota choice to 1 stand that vaccines work by introducing a wrote online that it would"be nice if Offit take no risk,"he says."It's just a choice to I weakened strain of a particular virus into "was dead." take a different risk,and we need to be bet- - et- the body—a strain so weak that it cannot I'd met Linderman at Autism One.He'd ter about saying,`Here's what that different make us sick.He wants us to revel in this given his card to me as we stood outside risk looks like.'Dying of Hib meningitis is a i ','; miracle of inoculation,which causes our the Westin O'Hare talking about his autis- horrible,ugly way to die." immune systems to produce antibodies tic son."We live in a very toxic world,"he'd Getting the measles is no walk in the park, `--- and develop"memory cells"that mount told me,puffing on a cigarette. either—not for you or those who come near - r a defense if we later encounter a live ver- It was hard to argue with that. you.In 2005,a 17-year-old Indiana girl got • * ' sion of that virus. infected on a trip to Bucharest,Romania.On It's easy to see why Offit felt a special pride Despite his reputation,Offit has occa- the returnffight home,she was congested, j when,after 25 years of research and test- sionally met a vaccine he doesn't like.In coughing,and feverish but had no rash.The ing,he and two colleagues,Fred Clark and 2002,when he was still a member of the next day,without realizing she was conta- Stanley Plotkin,joined the ranks of the vac- CDC's advisory committee,the Bush admin- gious,she went to a church gathering of , cine inventors.In February 2006,RotaTeq istrationwas lobbying for a program to give 500 people.She was there just a few hours. was approved for inclusion in the US vacci- the smallpox vaccine to tens of thousands Of the 500 people present,about 450 had � y nation schedule.The vaccine for rotavirus, of Americans.Fear of bioterrorism was either been vaccinated or had developeda I which each year kills about 600,000 chil- rampant,and everyone voted in favor— natural immunity.Two people in that gro '' dren in poor countries and about 40 chil- everyone except Offit.The reason:He feared had vaccination failure and got measle s dren in the US,probably saves hundreds people would die.And he didn't keep quiet Thirty-two people who had not been vac- of lives a day. about his reservations,making appear- cinated and therefore had no resistance to But in certain circles,RotaTeq is no grand ances on 60 Minutes II and The NewsHour measles also got sick.Did the girl encoun- accomplishment.Instead,it is offered as with Jim Lehrer. ter each of these people face-to-face in her ' Exhibit A in the case against Offit,proving The problem with the vaccine,he said,is brief visit to the picnic?No.All you have to his irredeemable bias and his corrupted that"one in every million people who gets it do to get the measles is to inhabit the air- point of view.Using this reasoning,of dies."Moreover,he said,because smallpox space of a contagious person within two course,Watson and Crick would be unre- is visible when its victims are contagious hours of them being there. . liable on genetics because the Nobel Prize (it is marked by open sores),outbreaks—if The frightening implications of this kind winners had a vested interest in genetic there ever were any—could be quickly con- of anecdote were illustrated by a 2002 study ; research.But despite the illogic,the argu- tamed,and there would be plenty of time to published in The Journal ofInfectious Dis- went has had some success.Consider the begin vaccinations then.A preventive vac- eases.Looking at 3,292 cases of measles in .> CDC's Advisory Committee on Immuniza- cine,he said,"was a greater risk than the the Netherlands,the study found that the ......-y." tion tion Practices,which reviews new vaccines risk of smallpox." risk of contracting the disease was lower if °''' and administration schedules:Back in the Ah,risk.It is the idea that fuels the anti- you were completely unvaccinated and liv- a late'90s and early'00s,Offit was a member vaccine movement—that parents should be ing in a highly vaccinated community than _ = of the panel,along with experts in infectious allowed to opt out,because it is their right to if you were completely vaccinated and liv- 7 diseases,virology,microbiology,and immu- evaluate risk for their own children.It is also ing in a relatively unvaccinated community. c: *�:! nology.Now the 15-person panel is made up the idea that underlies the CDC's vaccination Why?Because vaccines don't always take. " ` =�,1',< mostly of state epidemiologists and public- schedule—that the risk to public health is What does that mean?You can't minimize :- health officials. too great to allow individuals,one by one,to your individual risk unless your herd,your 4' That's not by accident.According to sci- make decisions that will impact their com- friends and neighbors,also buy in. 4 ence journalist Michael Specter,author of munities.(The concept of herd immunity is Perceived risk—our changing relation- ▪ , ;€ the new book Denialism:How Irrational key here:It holds that,in diseases passed ship to it and our increasing intolerance of , ,° Thinking Hinders Scientific Progress,Harms from person to person,it is more difficult it—is at the crux of vaccine safety conce ' the Planet and Threatens Our Lives,the con- to maintain a chain of infection when large not to mention related fears of pesticide , troversy surrounding vaccine safety has numbers of a population are immune.) genetically modified food,and cloning.Sha- .,y tV f il' El 0 El NOV 2009 N �. 4540 4. Epidemic of Fear like Offit,further studies are also a waste of still makes time to monitor the blogosphere. r � CONTINUED FROM PAGE 168 precious scientific resources,not to men- (Her husband refuses to read the attacks.) „: t� . tion taxpayers'money.They take funding She wants to believe that if you"keep your ", ron Kaufman,a medical anthropologist at away from more pressing matters,including finger on the pulse,"as she puts it you` can - } UC San Francisco,observes that our concept the search for autism's real cause. keep your loved ones safe. , : �_ of risk has evolved from an external threat Still,she worries.On the day I find myself that's out of our control(think:statistical A while back,Offit was asked to help put sitting at her dining room table,every front probability of a plane crash)to something together a reference text on vaccines.Spe- page in the nation features an article about _, that can be managed and controlled if we cifically,his colleagues wanted him to write George Tiller,the abortion doctor gunned �1', ' _;, just make the right decisions(eat less fat a chapter that assessed the capacity of the down at his church in Wichita,Kansas.When and you'll live longer).Improved diagnostic human immune system.It was a hypotheti- her husband leaves the room,Bonnie brings 4 tests,a change in consumer awareness,an cal exercise:What was the maximum num- up the killing."It upsets me,"she says,look- aging society determined to stay youthful— ber of vaccines that a person could handle? ing away."I didn't even tell him that.But it ;1 all have contributed to the growing percep- The point was to arm doctors with informa- absolutely upsets me." F � � 'i tion that risk(of death,illness,accident)is tion that could reassure parents.Offit set Her husband,meanwhile,still rises every 1 N our responsibility to reduce or eliminate.In out to determine two factors:how many B morning at 4 am and heads to his small,tidy 1 C .a 1 the old order,risk management was in the cells,which make antibodies,a person has study in a spare bedroom.Every morning,he -`mss °- hands of your doctor—or God.Under the in a milliliter of blood and how many dif- spends a couple of hours working on what .0 'F',":: new dispensation,it's all up to you.What ferent epitopes,the part of a bacterium or will be his sixth book,a history of the anti- are the odds that your child will be autistic? virus that is recognized by the immune sys- vaccine movement.Offit gets excited when It's your job to manage them,so get thee to tem,there are in avaccine.Then,he came up he talks about it. ,-a.' the Internet,and fast. with a rough estimate:a person could han- In 19th-century England,he explains, )1 The thimerosal debacle exacerbated this dle 100,000 vaccines—or up to 10,000 vac- Jenner's smallpox vaccine was known to be : J tendency,particularly when the American cines at once.Currently the most vaccines effective.But despite the Compulsory Vacci- Academy of Pediatrics and the Public Health children receive at any one time is five. nation Act of 1853,many people still refused - - "=r; Service issued a poorly worded statement in He also publishedhis findings inPediatrics. to take it,and thousands died unnecessar- ,�` 1999 that said"current levels of thimerosal Soon,the number was attached to Offit like ily."That was the birth of the anti-vaccine III will not hurt children,but reducing those a scarlet letter."The 100,000 number makes movement,"he says,adding that then—as y]i levels will make safe vaccines even safer."In me sound like a madman.Because that's the now—those at the forefront"were great at i other words,there's no scientific evidence image:100,000 shots sticking out of you.It's mass marketing.It was a print-oriented whatsoever,but you never know. an awful image,"Offit says."Many people— society.They were great pamphleteers.And 1, "When science came out and said,Th-oh, including people who are on my side—have by the 1890s,they had driven immunization there may be a risk,'the stage was already criticized me for that.But I was naive.In that rates down to the 20 percent range." set,"Kaufman says,noting that many par- article,I was being asked the question and Immediately,smallpox took off again in ents felt it was irresponsible not to have that is the answer to the question." England and Wales,killing 1,455 in 1893. ,. doubts."It was Pandora's box." Still,he hasn't backed off.He feels that sci- Ireland and Scotland,by contrast,"didn't The result is that science must some- entists have to work harder at winning over have any anti-vaccine movement and had how prove a negative—that vaccines don't the public."It's our responsibility to stand very high immunization rates and very little cause autism—which is not how science up for good science.Though it's not what incidence of smallpox disease and death," - typically works.Edward Jenner invented we're trained to do,"he says,admitting that he says,taking a breath."You'd like to think vaccination in 1796 with his smallpox inocu- his one regret about Autism's False Proph- we would learn." lation;it would be 100 years before science, ets is that it didn't hold scientists account- Offit wants the book to be cinematic,visu- n t, such as it was,understood why the vaccine able for letting fear of criticism render them ally riveting.He believes,fervently,that if -- =▪ WA worked,and it would be even longer before mute."Get out there.There's no venue too he can hook people with a good,truthful :' the specific cause of smallpox could be sin- small.As someone once said,it would be a story,maybe they will absorb his hopeful gled out.Until the cause of autism is dis- very quiet forest indeedif the only birds that message:The human race has faced down A covered,scientists can establish only that sang were those that sang best." this kind of doubt before. vaccines are safe—and that threshold has So Offit keeps singing.Isn't he afraid of His battle is,in at least one respect,prob- already been met. those who wish him harm?"I'm not that ably a losing one.There will always be more r The government is still considering fund- brave,"he says."If I really thought my life illogic and confusion than science can fend ing more research trials to look for a con- was at risk or my children's lives were at off.Offit's idea is to inoculate people one by ua nection between vaccines and autism.To risk,I wouldn't do it.Not for a second." one,until the virus of fear,if not fully erased, Kaufman,there's some justification for this, Maybe,he acknowledges,he's in denial. at least recedes. ag it given that it maybe the only way to address Later,I ask his wife the same question. //////x4-rrzrr'ffy,wwaiiiioa////rmexor.siiai�iiii ft everyone's doubts.But the thimerosal panic When it comes to her husband's welfare, AMY WALLACE(ecallawyma@gmail.com) 4$ suggests that,if bungled,such trials could Bonnie Offit is fiercely protective.A pedia- has written for GQ Esquire,and The New make a bad situation worse.To scientists trician with a thriving group practice,she Yorker.This is her first article for WIRE © 0 13 NOV 2009 • Board of 3CeaCth OCdlBusiness .Agenda Item # 1'V., 2 Corresyonc(enc e • i 1 i lJecember 17, 2009 • .'< TrP-ERcON POINTY BOA _ - OF HEALTH ----- --------- ----- -- November 9, 2009 Mari Mullen Executive Director Port Townsend Main Street Program 211 Taylor St., Suite 1 Port Townsend, WA 98368 Dear Mari, On behalf of the Jefferson County Board of Health I want to thank the Main Street Program once again this year for making it possible for Jefferson County Public Health to be recipients of proceeds from the Girls' Night Out. The $3,010 we received from this event will provide access to Health screenings for women in our county who would not otherwise be able to have them. This is yet another demonstration of • the caring community that we live in. Thank you for your devotion of time and resources that is required to bring together this kind of event, we know that it ultimately adds to the goal of saving lives. We look forward to working together again in the future. Sincerely, ,z;i::Th s.'(,1 10) Sheila Westerman, Chair Jefferson County Board of Health • 615 Sheridan• Castle Hill Center• Port Townsend • WA•98368 (360)385-9400 • • Board of afeaCth 0C Business Agenda Item # 1'V., 3 1 fetter to regoire • Re: Jlaternity Suyport Services December 17, 2009 • • o Nurse-Family 7'c Partnership HelpingFirn-Time Parents Succeed,, December 1,2009 Governor Chris Gregoire Office of the Governor PO Box 40002 Olympia,WA 98504-0002 Dear Governor Gregoire: The 2009 budget was a brutal one for children and families in Washington and the 2010 budget is shaping up to be just as trying.It is clear that the choices you have to make to balance the budget are alI difficult,but the proposal to cut Maternity Support Services is especially problematic because there is likely to be no real cost saving to the state. Maternity Support Services(MSS)provides preventive health care to 1 in 3 women giving birth in Washington,and cutting these services will result in the state spending more on serious health problems in the short and long term.In particular,MSS reduces the rate of low birth weight infants by 8%.This means that if MSS is eliminated we can anticipate an increase of 159 low birth weight infants each year following the cut.Each low birth weight infant costs an additional$40,000 in the first year of life for health care and related services.That is a minimum of$6,360,000 in additional costs each year,which cuts significantly into the projected cost savings from eliminating MSS. In addition to medical costs,low birth weight children are more likely to require additional expensive services throughout their lifetimes. 50%are more likely to require special education in school and 31%will repeat a grade by the 10"'grade. MSS is also a significant part of the funding structure for the evidence-based home visiting program Nurse-Family Partnership.Approximately 20%of the total funding for Nurse-Family Partnership(NFP)comes from MSS.Nurse- Family Partnership has been shown through randomized-controlled trial research to impact the health of babies and their mothers as well as to have long-lasting effects for families.These results include: • 48%reduction in child abuse and neglect • 56%reduction in emergency room visits for accidents and poisonings • 59%reduction in arrests for the child at age 15 • 61%reduction in arrests for the mother • 67%reduction in behavioral and intellectual problems for the child by age six Moreover,independent economic evaluation proves that for every dollar invested in a local Nurse-Family Partnership program,communities can realize more than five dollars in return.Therefore,every dollar"saved"by eliminating MSS funds going to NFP will cost over five dollars in the future. Please protect funds that supportive effective prevention programs like Nurse-Family Partnership. Do not eliminate Maternity Support Services and the accompanying Federal Medicaid dollars to resolve this shortfall because it will cost our state so much more,now and in the future. Sincerely, • Thomas R.Jenkins President and Chief Executive Officer 1900 Grant Street,Suite 400 I Denver,CO 80203-4304 303-327-4240 I Fax 303-327-4260 I Toll Free 866-864-5226 s Board o.f Health New Business Agenda Item #17., 1 • I Public 3-fearing: • Pu � Tro osecC201 o Environmental Health yee Schedule Revisions i December 17, 2009 4 JEFFERSON COUNTY PUBLIC HEALTH ENVIRONMENTAL HEALTH DIVISION • ENVIRONMENTAL HEALTH 2009 FEES 2010 FEES Additional Fees and Other Comment/Explanation of Information Proposed Changes GENERAL Health Officer Administrative Hearing 287.00 287.00 Administrative Hearing Appeal - 287__ New Fee-Preparation for appeal Technical Assistance/Plan Review-Minimum 65.00 65.00 Technical Assistance/Plan Review-Per Hour 65.00 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 New Conventional 488.00 __.0.20 Valid for 3 years required for svc 588.00 620.02 Valid for 3 years Add$32 to existing fee due to time New Alternative required for svc New septic tank and/or pump chamber only 215.00 247 00 Issued in conjunction with an existing Add$32 to existingfee due to time sewage disposal system or community system required for svc New Community or>1000 Gallons Per Day(base fee) 488.00 520 00 Plus$82 per connection-valid for 3 yrs Add$32 to existing fee due to time 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 631.00 663.00 Valid for 3 years Add$32 to existing fee due to time Alternative required for svc Repair/Upgrade/Modification/Designate Reserve Area 115.00 115.00 Applies to existing installed sewage disposal system Expansion 387.00 387.00 Applies to pending or active but not Redesign 115.00 115.00 installed Reinspection 144.00 144.00 Evaluaiiktionof Existing System/Monitoring Inspection eptic system only 287.00 287.00 eptic system plus water sample 298.00 298.00 Retest/Reinspection 100.00 100.00 On Site Sewage On Site-Site Plan Advanced Approval Determination(SPAAD) 287.00 287.00 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 3.58 00 required for svc Subdivision Review Base Fee 372.00 372.00 Plus$73.00 Per Lot Boundary Line Adjustment Review Base Fee 146.00 146.00 Pius$73.00 Pur Bea Change to"Boundry Line Adj Review Base Fee"and add$73.00 per lot Pre application meeting fee 146.00 146.00 Planned rural residential development review fee 146.00 146.00 Density exemption review fee 73.00 73.00 Density exemption review fee requiring field work 146.00 146.00 Other Waiver/Variance Application 172.00 172.00 Waiver/Variance Hearing 287.00 287.00 Wet season evaluation 387.00 387.00 Revised building application review fee 146.00 146.00 New building application review fee: Residential 73.00 73.00 Commercial 146.00 146.00 General environmental health review fee 73.00 73.00 Licenses Installer,Pumper,Operator(maintenance person) 387.00 387.00 Retest 158.00 158.00 Annual Renewal 273.00 273.00 Delinquent Renewal after January 31 387.00 387.00 i SERVICE ESTABLISHMENT PERMIT FEES Im ediate Consumption Limited 136.00 136.00 I Non-Complex 174.00 174.00 Complex: 0-50 seats 310.00 310.00 • 51-100 seats 372.00 372.00 101-150 seats 422.00 422.00 Alcohol served in multiple areas 136.00 136.00 Not for Immediate Consumption Limited 136.00 136.00 Non-Complex 174.00 174.00 Complex 422.00 422.00 Annual Permit Issued after September 1 50%of fee 50%of fee 50%of Annual Permit Fee Late Fee(Paid after January 31) 25%of fee 25%of fee Additional to Permit Fee Late Fee(Paid after February 28) 50%of fee 50%of fee Additional to Permit Fee Change to Temporary Permit- Temporary Permit- Multiple Events Multiple Events Non-Complex 112.00 Increase fee based on avg cost of svc Limited 62.00 96 00 Increase fee based on avg cost of svc Add category Temporary Permit- Temporary Permit-Single Day Event Single Day Event Limited e if.00 New Fee-Based on avg cost of svc Late Fee 50%of fee 50%of fee Additional-applies to both types of Applies to both types of temporary tem,varary permits(Paid when permits application is submitted less than 7 days prior to the event) Other Food Fees Waiver 37.00 37.00 60 Per o, , New Fee-Inspect premises before an Pre-Opening Inspection establishment opens. Requirements are provided before inspection. First Reinspection 87.00 87.00 Second Reinspection 149.00 149.00 Food Handler Card 10.00 10.00 Reissue Unexpired Food Handler Card 4.00 4.00 Manager's Course 211.00 211.00 WASTE Landfills requiring environmental monitoring 508.00 508.00 Inert Landfills 322.00 322.00 Biosolid Utilization 446.00 446.00 Other Solid Waste Facility Permits 322.00 322.00 Drop Boxes 149.00 149.00 New Facility Application 409.00 409.00 WATER Application Fee 149.00 149.00 Inspection of well construction, decommission&reconstruction Determination of Adequate Water Supply 62.00 .8_9; Building Permit Process Increase fee based on avg cost of svc Well Site Inspection-Proposed public water supply 298.00 298.00 LIVING ENVIRONMENTS Pool 273.00 273.00 Spa 273.00 273.00 Pool/Spa Combined 372.00 372.00 INDOOR AIR(TOBACCO) Compliance Enforcement 65.00 65.00 Per Hour Reinspection 73.00 73.00 Rebuttal Application 146.00 146.00 This document is intended to only identify Jefferson County Public Health's(JCPH)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 CPIW(Consumer Price Index for Urban Wage Earners and Clerical Workers)as reported for the month of September preceding the adjustment date. A fee shall not be reduced by reason of such calculation. However,fee increases in accordance with this calculation shall not exceed 5 percent per year. The CPIW for the month of September 2009 was-1.7%therefore the 2009 rates for fees will be used in 2010. • c, STATE OF WASHINGTON • JEFFERSON COUNTY BOARD OF HEALTH AN ORDINANCE ESTABLISHING A Ordinance No. FEE SCHEDULE FOR JEFFERSON COUNTY PUBLIC HEALTH Section 1 —Purpose Section 2—Hearing Section 3 —Effective Date Section 4—Fees Section 5 — Severability Section 6—Prior fee schedule repealed Section 1 —Purpose The purpose of this ordinance is to set the fee schedules for Jefferson County Public Health. Section 2—Hearing December 17, 2009 Section 3 —Effective Date January 1, 2010 • Section 4—Fees The schedule for Jefferson County Public Health fees for the year 2010 for permits, licenses and services is hereby set by the Jefferson County Board of Health as listed in the Ordinance. Furthermore, this section of the Ordinance authorizes automatic increases in the fee schedule in accordance with increases in the Consumer Price Index for US City Average for All Urban Wage Earners and Clerical Workers, published by the Bureau of Labor Statistics for the United States Department of Labor. Environmental Health Division—New fees, amending certain fees and new language detailing an explanation of proposed changes to certain services. Section 5—Severability A determination that any fee or fees adopted as part of this Ordinance is unlawful or illegal shall not cause any other fee or fees adopted as part of this Ordinance not affected by that determination to be repealed, revised, or reduced. Section 6—Prior Fee Schedules Repealed Any prior fee schedule previously adopted by this Board that contains or reflects fee amounts that are less than those adopted herein is hereby repealed and replaced by this Ordinance. 41, • AN ORDINANCE ESTABLISHING A 2010 FEE SCHEDULE FOR JEFFERSON COUNTY PUBLIC HEALTH ADOPTED day of 2009. JEFFERSON COUNTY BOARD OF HEALTH Sheila Westerman, Chair John Austin Phil Johnson, Member Chuck Russell, Vice Chair • Roberta Frissell, Member David Sullivan, Member Kristen Nelson, Member • • Board of.7CeaCth New Business Agenda Item /IT., 2 School-based Clinic • End of year Report December 17, 2009 • Jefferson County School Based Health Centers Spring 2009 Participation Report Background: In the fall of 2008 School Based Health Center (SBHC) mental health services were initiated at Chimacum, Port Townsend and Quilcene High Schools to serve the needs of enrolled students. In the spring of 2009, SBHC medical services were initiated at Chimacum and Port Townsend High Schools. All services are provided by practitioners from Jefferson County Public Health,Jefferson Healthcare and Kit- sap Mental Health. Services are available regardless of insurance or ability to pay and focus on prevention and include immunizations, asthma management, reproductive health care, and mental health counseling. Evaluation Methods: Jefferson County Public Health staff worked with the practitioners serving the Jefferson County SBHC's to collect standardized SBHC utilization data. Two data collection forms are used: one for medical visits filled out by the nurse, a second for mental health/substance use visits filled out by the counselor. Utilization data are the first component of a comprehensive evaluation to track and measure the reach and impact of SBHC on student health and well-being. SBHC medical visit data presented in this report were collected during the following time periods: Chimacum High School: April -June • Port Townsend High School: February -June SBHC mental health visit data presented in this report were collected during the following time periods: Chimacum and Port Townsend High Schools:January -June Quilcene High School: March -June Evaluation Data: Page Medical data: Number of visits by individual and by month 2 Demographics (gender,grade, race/ethnicity) 2 Insurance type 3 Health care utilization 3 Health education topics provided 3 Self-reported reason for visit 4 Clinician reported treatment at visit 4 Mental Health/Substance Use data: Number of visits by individual by month 5 Average visits per month by primary mental health diagnosis 5 Reason for visit by month 5 Average reported past 30 day substance use 5 . Average monthly referrals 5 _. Produced by:Jefferson County Public Health page 1 { Jefferson County School Based Health Centers Participation Report: Spring 2009 • Chimacum Port Townsend Port Chimacum # % # % Townsend Total Visits 93 10% 140 17% Total enrollment 349 442 First visits 36 ,319070% 39% 75 54% # SBHC users 36 75 Repeat visits 57 61% 46% %students using SBHC--_ - 65 10% 17% Visit Frequency ---------- c 70%60% III Chimacum 0 Port Townsend �= > 50% rn U 40% — — a H 30% - ? mg 20% MI - 10% 0% I , — 1 2 3 4 5 6 9 it 12 13 ci number of SBHC visits**..no student visited 7 8,or1Otimes Visits by Month Chimacum rtTownlitrif February 0 7,- .77-',,,,";t""*"'''' _,aM 20 14% • Mac iii T, : v,.-t 1 1% 45 70 y - 25 35%07 15 11 33 35/ 44 _7? • 34 16 0 . SBHC USERS BY: Gender Chimacum Port Townsend Of total enrollment, Port male 9 25% 23 �31% % using SBHC: Chinx�cum Townsend female 27 175% 52 69% males 5% 8% �r11 '11females 16% 19% Chimacum _ artTown$ dial �8 tV 4 1 1 o 5 14% h i grade 9 6%. 16� ---to—t' . _ �.._._.___. ._ rade 11 14% 14% -..-...... 13 36 gam' 4, 9 11 11 31% 26 3 grade 11 11% 18% ._.... 8�. 14'.- 19° ' gr• ade 12 Race/Ethnicity Chimacum Port Townsend Caucasian 31 86% 60 80% Native American/AK Native 1 13% 1 1% African American 0 2 3% Hispanic 4 111% 3 4% 4 5% Asian/Pacific Islander 0 Mixed Race 0 1% Other 2 2 —�__ _--- -- - 3% 0 Unknown 0 _ _r3%_� Enrollment data source: http://www.ospi.ki2.waus •• Produced by:Jefferson County Public Health page 2 Jefferson County School Based Health Centers Participation Report: Spring 2009 • Insurance Type Chimacum Port Townsend Uninsured 20 56% 27 36% Take Charge 16 15 Insured 16 44% 48 64% T-- private 7 18 private/CHP 11 CHP 8 29 . 'h i `°ed Yes ..__.n_ ® ,t"knew ' f .� _ w. Have dental home? Chimacum Port Townsend Yes 9 25% 22 29% No 27 75% 53 71% don't know 0 0 ? Hct mental health home? C No 32 89% dont knows. ill Visit in past year? Chimacum Port Townsend none _ 21 58%__ 35 147% 10th graders reporting a medical home 23 31% routine check-up in past year: dental home 2 6% 0 medical 54% medical + dental home 3 8% 16 21% dental 63% mental health home 1 3% 1 1% Source:Healthy Youth Survey,2008 medical + mental health home 3 8% 0_____ _r Self-Report=student chief complaint Treated for=what clinician treats . �, ?Ott Townsend' S' dn •.saw ✓i cn body image 6 6% 0 12 1% motor vehicle safety 1 1% 0 0 nutrition 15 16% 2 % 6% t8 _- _-__-___ oral health 2 2% 1 1% 1 % __... __ ' other 6' °° 17 8% 12 9,. 13 9% pregnancy/STI prevention 129 31° 131 33% 29 21% ; ,54 39% substance use/abuse 4' 4% 23 25% 0 8 6% suicide preventionIA 0 3% 2 % tobacco use ---_ _ 4 ----___4% .__J__ 110 page 3 Produced by:Jefferson County Public Health Jefferson County School Based Health Centers Participation Report: Spring 2009 • REASONS FOR SBHC VISIT Self-Report=student chief complaint Treated for=what clinician treats t'-'fi/,4' /MENTAL FILTH/EMOTIONAL Chimacum ',,,„;- ,,, `e, Port Townsend , - c cD ." --, -a 0 =,-• i 0 •-,Q CD CD 1 F/,' CD a p a P P o7 (71' % 0 % 6" d, ,° , abuse 10 5 5% 0 , .< 1 i1% .i.: anger management 19 10% 11 12% .____.....2.,_ .. , 0 ,0 , anxiety i 1 1% 3 3% 0 14 3% --.. 'depression U4 15% i 21 23% 1 1% 15 4% domestic violence 10 15 5% 1 1% 15 4% eating/weight issues 10 I8 9% 1 1% 2 1% -4-- familyinvolvement 113 14% 118 19% 0 -412 9% 1-- 1 grief or loss 0 5 5% 0 2 1% preventative mental health ,0 16 127, 0 8 6% relationships F 1 1% 132 34% 2 ik " 27 19% school performance 112 13% 25: 27% 5b;:.16771: -?,:.7 i , , .1-ii, *;144114117414 n---- 1 self esteem 10 !0 64, IV ,v` '',AA,70,.., t • stress 113 14% 126 28% suicide ideation 10 ;2 2% violence/conflict resolution 10 , 10 11% 111,4*.li;:iiiii'- A 8 6% ,other 13 14% .24 26% 4.- 28 20% Chirnac UM„-, CD CD CD ir°'1.55, Fl- -0 a ° -1 6' % li;*: dermatology 12 2% 12 2% 7 " i111,1;:? 4'`i 7 5% ---------'e,*TP4, -„go----------t------- 1-1 first aid LL18% 1181_9_70____ 24 -4,,!ke: ',. ' 124 117% ------ ,-,',,°,,,;,2i.--t---------- 13-7coldii:espiratory/-s-ore-throat 7 11% LIO 11% 19 :head ache19 ° 9 6% 19 6% ,„. i immunizations tt 12% 4.1 1 12% 12 9% j4 10% injury 113 14% 114 15% 20 14% i24—17% r-- 1 oral health ;0 10 1 1% '1 1%: 1 4— - reproductive health care 1,33 35% :04 37% 61 44% 62 -744%-- - - birth control 133 35% 134 37% 52 37% 58 41% emergency contraception 117 18% 1119 20% 25 18% :26 19% sexually transmitted infection 1128 30% [30 32% 34 24% 144 31% pregnancy test— _111 10 11% 1:12 % _ _1_3 20 14% i 22_... 1.672_ ............. -2- , screenings: vision/hearing '13 3% i-3 3% 0 0 _ sports physical _c_r3 3% 13 _3% 24 - _ other _124 26% j 24 26% 16 1 *io -''15 ;11% ...- 0 Produced by:Jefferson County Public Health page 4 Jefferson County School Based Health Centers Participation Report: Spring 2009 • SBHC Mental Health/Substance Use Combined Site Visit Data: Chimacum & Port Townsend January- June; Quilcene March - June Mental Health/Substance Use Visits Per Month Average# visits per" Jan Feb Mar Apr May June month Total Visits 64 57 63 53 88 30 59 new visits (first time) 9 5 7 7 10 0 6 repeat visits 55 52 56 46 78 30 53 Average Number of Clients Seen per Month by Primary Mental Health Diagnosis Average '' per month Depression 4F; " Anxiety �' )., Alcohol dependence j PTSD Bipolar 1` Total 7 Reason(s)for visit to School Based Health Clinic Average# Jan Feb Mar Apr May June per month 410 abuse 5 4 7 6 1 5 5,. anger management __ 5 16 19 9 12' anxiety 8 4 3 7 4 7 6 depression 18 8 21 12 17 11 15, domestic violence 2 4 3 5 2 eating/weight issues 6 2 2 1 2 family involvement 20 6 20 19 55 13 22 grief or loss 8 2 3 6 11 7 s6 v preventative mental health 4 3 13 18 17 1011 relationships 18 8 21 10 26 12 y 16 school performance 10 - 5 4 21 11 '.9 self esteem 7 4 12 9 5 stress ,15 3 6 7 14 8 9 suicide ideation 1 0 violence/conflict resolution 2 6 2 2 drug/alcohol 3 9 13 9 17 4 9 other 10 14 3 17 7 Monthly Average Number of Clients by Monthly Average Number of Client Reported Past 30 Day Primary Average,#= Referrals Average!"If" Substance Use per month per month, Alcohol 4MH treatment -inpatient ;,"<1'� Marijuana 4',`" MH treatment -outpatient I Tobacco products 1.=' Medical <I 4 • 1� Public Health Other Produced by:Jefferson County Public Health page 5 • of Lite . . Jefferson C ou lig. Health and lefferczn 0Healthcare Partnership fog thy Youth A partnership between Jefferson schools.They provide primary —I -'7-----",I -'r County Public Health(JCPH) health care services,mental t i �, ll .' and Jefferson Healthcare has health counseling,and drug and 1II I II o ,o I1 resulted in a successful launch of alcohol counseling to students Io. I two school-based health centers. who otherwise might not I 11 The first center began operating receive these services.Although I- 1 at Port Townsend High School in the centers'mission is to serve I it January 2009;the second center young people who are unin- I opened at Chimacum High sured and underinsured,all _- j�„-- , 11 . School in April 2009.Both students(including those with s"3 centers were open this August to insurance)are welcome,and ,") provide sports physicals. some use the centers simply How the Centers Operate According to Susan O'Brien, because it is more convenient. ARNP,one of the health center The goal of the centers is to The centers offer medical practitioners from JCPH,the provide early detection and treat- and mental health clinic appoint- impetus for the centers came ment of illness;to encourage ments two days a week at both when both school districts teens to live positive,healthy schools(Monday and Wednesday expressed a serious need for lives;to teach teens how to use at Chimacum High and Tuesday health services,particularly men- health care systems effectively; and Thursday at Port Townsend tal health services.In addition,75 and to encourage and enhance High).The practitioners who pro- percent of parents responding to family communication about vide the medical and mental a July 2008 survey on student health issues.Another important health services at the centers are health needs indicated that they goal is to increase student corn- O'Brien and Wendy White,PNP, would give permission for their fort and satisfaction with their both nurse practitioners,and child to use a health center. school experience in order to Patricia Flowergrowing,MA, The centers now offer corn- decrease absenteeism. LMHC.CMHS,a mental health / y prehensive health care services at The centers work in active therapist from Kitsap Mental facilities located in both high partnership with teens,their fain- Health.Jennifer Ward 0offers ,ter ,, dies,Port Townsend and administrative support at both ,..,-4-".„;). l" 2 Chimacum schools,and the corn- centers. a- - '� r munity During the early stages,a Students may make appoint- � %� `a x+x r aF•,-` community advisory board was ments for either medical or formed to involve students,par- mental health concerns,or they J ents,and local agencies in the may be referred by a teacher or .4e"� ` planning and oversight of the the vice-principal,particularly for 1:;,' '''-.7%„:7:t',..41:,---;;;::?1,,'‘° centers.The advisory board behavioral issues.Parental con- i , ..,-,4,,,:,-., v - _ meets on a regular basis during sent is needed for students to be ti _ 4 the school year and Jefferson seen for medical care,but they ,.1,1,---P.-e,',4- v Healthcare is an active can visit the centers without per- r mission for mental health coun- a , participant. . - � seting or birth control if they are s -� at least 13 years of age. b- ), x--- $ - Wendy White,PNP with ''� •�. ;3�,q ' � sw middle school student Ai;' ,,....---,,,,,`,i`10016.17,.' 'r ,y, '',,-4.k., Grace McKay Continued page 4 • Partnership for Healthy Youth (fromfrontpage) According to O'Brien,stu- based health centers in Portland r tt >- 't`"r y0. l� dents generally make an appoint- Ore.In 2008,Baldwin applied v r n r ment to be seen for one issue, for a planning grant from ,' „_ .A. Vs but another issue often Washington state.The grant , ,,,, comes up during their application was approved based r t lr5 II s < b ti a4s a visit.`Once they feel on a clearly demonstrated need � '"� ~° confident and secure, for the service in this rural corns � �;4 � `' K they open up and a munity.The purpose of the grant ' a j number of issues may was to provide seed money for `' x11--.-s•-,4,-.-'''''' r a z_ � arise,"she said.O'Brien the planning and feasibility,ce ��r i - 1' ' '- stressed that the clinical stages.A number of other rural � ,�a;- ; "': services are very corn- counties in Washington State also `tY_ - rehensive."Whatever received planninggrants,but few ?, . ' :� = � P �.- s health or mental health have gotten their centers devel- Yuko Umeda,RN with Susan O'Brien,ARNP f - problems present,we oped to the operating stage.I❑ �s `7 r � '��-` deal with during the contrast;not only are the centers li } " appointment or through in Jefferson County up and run- also continues to be active in q,, ( 6 15;,, i 4. a referral,"she said. fling,but also they had 240 stu- project oversight.Vic Dirksen, 1}i j rzi� O'Brien noted that dent visits in the first three and Jefferson Healthcare's CEO,and jyt i rt sI �- ?- Carrie Day,MD,and a half months of operation. Paula Dowdle,COO,have been 511 Ei z � Sarah Schmidt,MD, Baldwin credits Jefferson closely involved from the start. .-1 :1'0'-'-'''':-.5.--4"-:.4-'8,-".' ,, both with Jefferson Healthcare with giving the proj- "What drives our commit- ' ' ' '" Medical and Pediatric ect a needed shot in the arm. ment,"said Dowdle,"is that there Susan O'Brien ARNP with Port Group(operated by Jefferson "These two clinics could never are unmet health needs among Townsend High School student Healthcare),give consultation have opened without the support our youth.We know that healthy Patricia Morep PP kids learnbetter,and what better whenever needed,which adds to of so many and the guiding vision the professional depth and of Jefferson Healthcare and way to ensure that they have a breadth of the clinical services. JCPH.Jefferson Healthcare is chance for good physical and The two not only are referral committed to serving people who emotionalhealth than to provide physicians but also are a point of do not have access to health care this service for them,right in entry enabling children and fami- services;adolescents are one of their setting?" lies to access local medical those underserved groups,"she Umeda also credits Mike providers and a medical home. said. Blair,superintendent of the O'Brien commented that the After the initial planning Chimacum School District,with centers quickly became very busy. stages,Yuko Umeda,RN,who recognizing the great need for "The word gets around when you works with JCPH,picked up the student health services,especially IP are dealing with teens,"she said, ball as project administrator and mental health services.Blair "and we have good acceptance developer.Umeda gives a lot of worked on the one-tenth of one from both the kids and the staff." credit to the key players in the percent funding,which helps by O'Brien thinks that project.Jefferson Healthcare dedicating that portion of local �, ;� --. one of the reasons stepped up and became a full sales tax to fund the mental ',::- health portion of the centers' �z"��,�t ;+� ^? the centers have partner with JCPH,providing vt HS a , been so well accept- half the funding for the centers. operations-Blair indicated that he ed is that the kids Jefferson Healthcare funds one of is extremely excited about the �'"�� lleatth��� � � . s'- feel safe."They know the nurse practitioners,supports partnership for the center at the Apporhirlt that their •visit and some of the lab and imaging sere- Chimacum schools. .stav' �.a whatever they share ices,and provides some of the "The kids have a lot of unmet 4 �a r 47:4,rs with us will be kept equipment for the centers.This health and mental health needs," n h e a for i confidential," Students may sazd tie for as long as there will needtfor commissionsewere behind this I-- s ,:.,,,.„4,1.-',-1.- -;-,'-,.;-.:',-;" 1_ make an appointment the service.Jefferson Healthcare project." t s .5` 't..1 either by calling the �k' X r s health department or '�, c"9 s rah arm , by filling out an .-.„1„,-...,,.._ - appointment request �;i, -c�,,�- '. gel' ;� rr,u ro Yt3 ,wm form and placing it in � 4 v 3CNr'rrr „x �,a l --%:t-'' the locked box outside `1{ ' s,�� �$ r , their respective center. . 1- I a Appointment request at clinic P T. p �.e %,,,,,,,,...-r----� � When an appointment is made,a �z _ las. 4 hall pass is generated,which ® v releases the student from class to ' m, ' ,,`lz r report to the center at the sched- ' '�w p , '° ,s �C uled time. Hewn the Centers Got Their Start '" a. `„ .�� Jean Baldwin,RN,director of ; r ,,c 1,s. , ` JCPH,had previous experience IP • organizing and working in school- Jennifer Ward registers student at clinic ry �� ,.used ° Service offered at the � by �. !;13$7°-% �` � _ .__w+°w.cs�uw.,.. II 11co�,�- ,4 ., school- based health I 1 ,,,,,,,,!..:,„,i,„; Informational brochures centers +off<� available at the clinics n • '.f C Sia vt-ap QU6 NOWT f :;=t r d;tlg 1&00 i e�' � • sports physicals vr r r it 1 2 vaccinations e t EES r s physical exams s injections vHMatPhoaI> ammrrE y family planning,birth control,and C / pregnancy testing a .ia e sexually transmitted disease k..„ screening and treatment ,, r-. a • acne and eczema treatment o- `� e ° °°ae��. allergy treatment Pf �' female health care on mp soc,i ", .,_,a- M i F€rta h coitttS@iliig ret t t im saes:*And de es t Other key players in the proj- the wood shop classes at Port El self-esteem• cell stee atitgalatatf 'm issues ect are Whitney Meissner,princi- Townsend High School made pal at Chimacum High School, some items,such as the locked peerrlp conflicts pressure and Carrie Ehrhardt,principle at appointment request box.Other M filth habits Port Townsend High School,who students pitched in to paint the have been instrumental in getting centers,create artwork for the Health education r `Ito the projects to function effectively walls,and raise funds to purchase in their schools.In addition,Torn the furnishings.Other contribu- • nutrition and phys[cal:aetiv ty Opstad,superintendent of the tions carne from parents.local El healthy relationships Port Townsend School District, businesses,and organizations such preventing sexuallyttayrited recognized the need for increased as the Boeing Bluebills.who diseases; health-related services for stu- donated time and materials. fainilypl se red dents as well as the negative effect According to Umeda,comma- f tobacco use reduction that poor physical or mental nity readiness and responsiveness health can base on student aca- for school-based health centers demic achievement. xvas strong and positive through- s "This was a true community out the entire process."Pretty effort,"said O'Brien.She noted much everyone involved recog- that some of the effort came from nized the need and was eager to the students themselves,who help,"she said. xa� were enthusiastic and took owner- IC?JD and Jefferson ship of the project.For instance, healthcare acknowledge the following donors to both • sites: 1 =.,3 ,.�,y d-nir sites; S s'*� Chimacum High School Boeing Bluebills �� �; r J.Dean Burton ',. ` ' t Friends of Chimacum Schools i ert,;i,t -,;,,,t;.----tu s Group Health Cooperative t '; �� ,� t s Jim Guthrie,Port Townsend High r y School carpentry class r # Hadlock Building Supply 1 ;S 5 r;,,,° y e " .- i Henery Hardware 1 Cassie Kilmer McCrorie Carpet One 'a e: Beth Mosley c s Kevin Nighswonger � Peninsula Floors and Furnishings 5 s y s � Peninsula Paint Company �„"" ,<4aa'Q. r '`r-' Port Townsend High ASB t .: ''v . t�.`.^'-r',e.4 s aN v.3 r3 , rim RCVnOldS • • .41',-,`'g,:-1,(i-:;,,41,44.4.t.',";-:;-i4'.-',,i7-9:4144 'xat v "3a. -j': ,, „' Kayla Reynolds 3 � ' Sammantha Walters lte rsv r " '` S� t ba Port Townsend High School Clinic Harrison Woodin c tI a '- 35v ' • Board of.9teaCth New Business Agenda Item #V., 3 2010 State, County and City Budgets: Tubtk JCeaCth Impacts • December 17, 2009 • • Gov. Gregoire proposes supplemental budget to close $2.6 billion shortfall Previews second budget to be released next month FOR IMMEDIATE RELEASE —Dec. 9, 2009 OLYMPIA - Gov. Chris Gregoire today proposed her 2010 supplemental state budget, which would fill a $2.6 billion hole in the budget for 2009-11 through service eliminations, reductions or suspensions. As required by law, she submitted a budget based on currently available revenue. Among the programs targeted for elimination are the state Basic Health Plan, which provides health care coverage to nearly 65,000 individuals ($160 million); Apple Health for children, which provides health care coverage to 16,000 low-income children ($11 million); and the General Assistance Unemployable program, which provides cash grants for 23,000 adults and medical services to nearly 17,000 adults ($188 million). In education, funding would be eliminated for 1,500 3-year-olds participating in the Early Childhood Education and Assistance Program; the kindergarten-through-4th grade staffing enhancement that reduces class size in the early grades; and levy equalization, which provides extra support to districts with a lower than average property tax base. Slated for reduction are the State Need Grant program, where 12,300 students would lose grants, and • grants would be smaller ($146 million); and funding for the state's community and technical colleges as well as the baccalaureate institutions ($89 million). Gregoire explained that as difficult as it was to recommend an all-cuts budget, "We were thoughtful in making these decisions. They represent, I believe, the most responsible decisions we could make with the constraints we faced." Months after balancing the biennial budget in the spring, another budget gap developed as state revenues again plummeted due to weak consumer spending, and state costs that rose from higher demand for unemployment benefits, health care and public education. The governor recently announced several reforms to make government services more efficient through consolidations and eliminations of a number of boards and commissions. She is closing all or part of nine state institutions. She will be proposing measures to allow local governments more spending flexibility and school districts the authority to access voter-approved levies. And she has directed the Department of Corrections to move ahead immediately on actions to consolidate inefficient facilities. "As we made the hard decisions necessary to produce this budget, I understood the impact of these cuts on real people,"Gregoire said. "I realize the future this budget will create. It does not reflect my values nor do I believe it reflects the values of my fellow citizens. "Let me be very clear: I do not support this budget. As required by law, it is balanced. For me, it is • unjust." The governor plans on introducing in a second budget in January, which will restore several of the most critical programs that would be eliminated by the all-cuts budget, including: • • Basic Health and Apple Health plans; • General Assistance program for the most needy; • Levy equalization funds for public schools; • State financial aid to allow more students to attend higher education; • Early childhood education money; • Adult medical, dental, vision and hospice programs; and • Developmental disability and long-term care provider funds. "Today's document does not reflect our values as a state,"Gregoire said. "It does not reflect the Washington I know and love or the Washington I want for our future and the future of our children and grandchildren. I am convinced it is not the plan for the future that Washingtonians would choose, either." Her second budget will be accompanied by a revenue package that would eliminate tax exemptions, close loopholes and raise revenues. The governor expressed concern about new tax burdens for families and businesses. "I will do my best to avoid any new taxes that slow our economic recovery. I will balance, as best I can, my interest in keeping new taxes down, while still protecting programs that I believe the vast majority of us agree are just too important to eliminate,"Gregoire said. "We need a combination of reduced funding for services and raising revenue." • After tapping into the state's Rainy Day Fund, Gregoire's proposed budget leaves an ending fund balance of$310.5 million. Contact: Governor's Communications Office, 360-902-4136 Related resources: • Gov. Gregoire's letter to Washingtonians • Gov. Gregoire's remarks as prepared • News Conference Posters • Policy Brief: Reforming how we care for Washingtonians with Developmental Disabilities • Policy Brief: Reforming our prison system to keep Washingtonians safe • Policy Brief: Reforming how we rehabilitate our young offenders • Policy Brief: Providing the tools we have to help schools, local governments and hospitals • Policy Brief: Reforming how we serve vulnerable Washingtonians • HUMAN SERVICES -OTHER Agency 303 • Department of Health Recommendation Summary Dollars in Thousands Annual FTEs General Fund State Other Funds Total Funds 2009.11 Expenditure Authority 1,535.7 193,048 798,656 991,704 Supplemental Changes Hospital Data Collection Account Adjustment (113) (113) Discipline of Unsafe Nurses 7.7 1,961 1,961 Discipline of Unsafe Providers 9.5 2,147 2,147 Medical Quality Assurance Commission Educational .7 128' 128 Programs/Research Other Fund Adjustments 431 431 Federal Funding Adjustments 35.7 57,849 57,849 Reduce AIDS Education (360) (360) Reduce HIV/AIDS Client Services (5,179) (5,179) Reduce AIDSNET Grants (5,203) (5,203) Reduce Tobacco Prevention Programs (2,371) (2,371) Reduce Child and Matemal Health (438) (438) Eliminate Clinic Subsidies (408) (408) Hearing Disorder Awareness Training (287) (287) 411 Eliminate Subsidized Digital Mammography (578) (578) Universal Vaccination Savings (1,800) (1,800) Reduce Environmental Health Programs (461) (461) Reduce Area Health Centers (60) (60) Reduce Oral Health Technical Assistance (.5) (77) (77) Reduce Radiation Laboratory Testing (1.0) (150) (150) Eliminate Health Profession Survey (558) (558) Average Final Compensation 10 28 38 Health Insurance Increase 304 842 1,146 Eliminate Miscarriage Management Training (200) (200) Reduce Colon Screening (208) (208) Administrative Reductions ,(9.7) (2,271) (32) (2,303) Eliminate Medical Nutritional Therapy (370) (370) Public Health Assistance 24,000 24,000 Housing for Persons with AIDS 2,305 2,305 Developmental Disabilities Council and Endowment 4.5 57 2,092 2,149 Credentialing Health Professionals 5.2 706 706 Preventing Impaired Practice • 2.3 441 441 Licensing Barriers to Nursing Care . 0,ILLa 2.6 403 403 Local Fund Adjustments = \ -ol'i22,944 22,944 Nursing Resource Center 154 154 Self Insurance Premium (242) 242 Subtotal-Supplemental Changes 56.8 5,521 90,157 95,678 al Total Proposed Budget 1,592.5 198,569 888,813 1,087,382 1 12/7/2009 • Public Hearing 2010 Jefferson County Budget Presented December 7. 2009 • • Purpose of today's Public Hearing ■ Hear public testimony to inform County Commissioner deliberations on the 2010 Budget ■ Board of Co. Commissioners may make changes. ■ Adoption of a Final 2010 Budget is tentatively scheduled December 14, 2009 • 1 12/7/2009 Recommended Budget at a Glance: ❑ General Fund Expenditures: $ 15,634,625 ■ Revisions 12-7-09 $ 2,001 Total General Fund $ 15,636,626 ❑ Other Funds Expenditures: $ 37,625,896 ■ Revisions 12-7-09 ($ 422,295) Total Other Funds $ 37,203,601 All funds: $ 52,840,227 3 • • a Adjustments to November 16 Budget ■ General Fund: Revised $2,001 ■ $2,001 added to correct salaries and benefits ■ Other Funds: Reduced revenues $2.29 Million Reduced Expenses$423K ■ Hotel Motel—added $82,000 lodging tax revenue and $4,090 in expenditures ■ Conservation Futures—Added $17,000 in property tax revenue ■ Tri-Area Sewer— Reduced grant revenue $2.5 million, Reduced Expenditures $663K ■ Construction & Renovation —Added $100,000 to building improvements r 2 12/7/2009 ■ , ` ` per ' Adjustments to November 16 Budget (continued) ci Information Services: we are still pursuing the possibility of combining JeffCom IT with Information Services Division of Central Services. This would shift$136 K Revenue in interfund payments and $136 K Expenditure for salaries and benefits of IS Central Services. No budget impact to JeffCom. ❑ Benefits: . Backup for 2 JeffCom IT staff; . Pooled technical expertise benefits both parties; . Future cost savings to JeffCom ❑ If this move can be accomplished, &with Commissioner support it would become part of the Budget for adoption Dec. 14. 1111 ■ „r. 2010 General Fund Summary by Category: TOTAL EXPENDITURE BUDGET $15,636,626 Interfund Transfers Capital $1,949,794 $89,551 12.5%, 0.6% Salaries&Benefits Prof.Services $8,575,675 $1,362,629 _\ N' 54.8% 8.7% Supplies&Services $3,658,977 23.4% • 3 12/7/2009 ■ • 2010 Other Funds Fund Summary by Category: TOTAL EXPENDITURE BUDGET$37,203,601 Interfund Transfers,$948,931 Capital Outlay $6,303,596 /,-2.6% Salaries&benefits 17.2% % $10,948,398 X29.4% Debt Service) - 1 $1,140,969 3.1% Prof.Services�i $7,017,891 Supplies&Services 18.9% $10,743,816 28.9% • Background: • Last year, this administration: o initiated annual budgeting using a 5-year outlook, \ ❑ made significant reductions in the 2009 General Fund budget t and staffing levels, and , ! o identified addition reductions necessary in 2010-2014. `-•` August of this year, a new 5-year financial projection showed a $1.9 Million annual gap by 2014 between General Fund revenues and the cost to maintain current services. • The$1.9 Million gap would need to be closed with permanent program cuts or new revenues. • The gap reflects the current economic recession, plus the structural funding disparity between the state's current 1% growth limit on revenues from property taxes, compared to 4% average inflation in the cost to provide existing services. 8 4 12/7/2009 - _ r,.3 t£ 01111 :::':u.' LtsGENENDREVENUESB XPENDITUR S 2044 through 2014 PreliminaryUpdate August 10,2009 I I 019.000.000 . t t I I sit 000.000 I I 310 000.000 I f I —'I 016 000 000 1 _',.______„.„,..0 I ` I j srsw000 -, ; I4 { $14.000 000 � f I u.000m9 s I I 1 i , 1 l 1 s,_-000.000 { ! st,.oao.oao et— o - o dap c° a° �a - -EP4MMatea-w:tuts 2010.2012 -4--Espatlltwas•ao cuts.4:metesle -NWSOdSO-2009 prelim pr flcklx • . .„.. . Structural Property Tax Gap Illustrated: jstedp for CPI & Compared2002-08adwithupopulation 6,000,000 32,373 Even Revenue from Extraordinary 5,500,000 — - - 30,373 New onstruction Lost Grround to population& 73 service 5.000,000 demands 0.373 2002 Tax Base Lost Buying 4,500 OOC . '.� a x Powerto Inflation T 3 61,37 4.000 000 .,em..� s.�...,..., 22373 2002 2003 2004 2005 2006 2007 2008 ®Tax from new const w/CPI 1%Growth w/CPI —Population 10 . 5 12/7/2009 - M • Budget Issues: • Sales tax for 2010 is projected to be about 10% lower than in 2006. • This is nominal dollars. Inflation worsens the problem. 11 • GENERAL FUND BASIC SALES TAX $2,750,000 $2500 000 - W $2,250,000 Ui $2,000,000 $1,750,000 $1,500 000 - $1.250.000 9a5 �yb 99^ g°'0 q��' 'L000 .p0 'L00�' 'L000 'L00Q 005 'L0p6 00� v000 ry00�i O.O �O �O YEARS cc,.4G:::_o +SALES TAX AMOUNT 12 6 12/7/2009 HISTORY OF Real Estate Excise Tax $1,400.000 - -- -- - $1,200.000 $1,200.000 a�� $1,000,000 --- -�- -1111 $800,000 $600,000 ---==- $400,000 --- -�---- $200,0 00 $0 ---------- 100° 1001 1001 1P 2001' 1005 2004 1001 2008 '--REST REVENUE 13 • NEW CONSTRUCTION 1999 TO 2009 ASSESSED VALUATION SUBJECT TO PROPERTY TAX $150,000,000 $125,000,000 r - $100,000,000 $75,000,000mor-r,10,- $50,000,000 V $50,000,000 ® ' $25,000,000 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 est. 1995 1 $53,472,53511 1999 1 $60,560,45011 2003 II $73,331,74011 2007 II $88,716,6471 1 1996 II $52,449,94611 2000 11 $61,180,40511 2004 11 $97,452,77011 2008 J1 $73,363,4451 I 1997 II $71,167,74811 2001 II $59,701,56011 2005 II $118,739,41211 2008 II $73,363,4451 I 1998 II $61,268,91011 2002 II $59,387,49011 2006 II $109,867,27011 2009 est.II $56,113,7651 7 12/7/2009 - • Background (cont.): Counties provide mandated & non-mandated services: • Mandated services include: I ❑ Superior& District Courts, Juvenile Probation ❑ Sheriff, Prosecutor&Public Defense ❑ Assessor, Elections, Recording, Treasurer, Legislative & Executive ❑ Planning, Zoning & Building Code ❑ Etc. • Non-mandated, discretionary services include: ❑ Youth Services ❑ WSU Cooperative Extension ❑ Solid Waste Transfer/Disposal ❑ Parks and Recreation ❑ Animal Control 15 • ■ Non-mandated & Mandated Services Are Being Squeezed $20 000 000 $18000000 R 44114$16.000.000 ..k :::::::: 1 . . >r � $10.000 000 $8 000 000 - --- 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 ®Non mandated ser,ces ®Mandated Services -s-Revenues 16 S 8 12/7/2009 r Some of the Cuts Already Made: • December, 2008: Dept. of Community Development reduced staff by 8, cut remaining staff hours 10%, implemented 4-day work week • August 2009: DCD laid off 3 more talented staff and needed a $125,000 cash infusion of from General Fund. • April 2009: BOCC lowered 2009 General Fund revenue projections by $1 million. All General Fund staff hours were cut 6.25% May-Dec. 2009. Other budget adjustments were also announced. • September 28, County Parks announced plans to: o close 4 parks&cut maintenance to 6 parks in 2009,and ❑ cut maintenance to 6 more parks in 2010. • In September/October Public Health closed Environmental Health on Fridays, cut back Public Health Nurse support to many mothers ---,„L3-3- of --J 2of newborns, and cut family planning clinics by one day per week. _ c (60, t'` tn • In October, WSU Cooperative Extension reduced staffing and closed on Fridays. 17 • ■ GENERAL FUND REVENUES&EXPENDITURES 20041010mM 2014 Budget Hearing December7,2009 419.009.000 ---- I 498000.000 ( / ___. i. I I q Preliminary { i $17.000.x00 2010 Budget _ 1 516000.x00 $15000000 RecommendedI I I S1a000000 I __ _....__. Budge* i j I 513.00,0 I 00 x00 _.,— ..-.—_ 412 000.a00 —___'-- �___--�.__ _—I I _ 1 -i I 511 000.040 -- ------ — .�> / s 45 � Q` � ,,g` 2 0 � �/ as oda —Rev.nwz 2 k hor 2011.0.7.2002 -s-(0pe0dlho s-1.6%eo 0ze 2500-16 -+-04p001utasJle tutz.45.pest 0000 09 • 9 12/7/2009 ' •• 2010 Budget Process: On July 27,the Commissioners adopted Resolution No. 44-09, setting goals for the 2010 County Budget. The Budget should be: • Balanced,with a focus on long-term financial analysis. • Continue a strategy of using unreserved general fund balance from end of 2008 for 2009, 2010 and 2011. • Use excess fund reserves from other funds supported by the General Fund in 2010 to maintain operations during the economic downturn. • Look for cost savings opportunities: o Consolidate programs or services to gain efficiencies or improve customer service. ❑ Seek additional funding sources to support services through programs and grants and other funding sources. o Continue to partner with other local agencies to improve service delivery and/or reduce costs. o Privatize and/or outsource services, programs, and functions where appropriate. 19 ■ a a- 2010 Budget Process: Resolution No. 44-09, also set Budget priorities: • Support local law &justice programs; ■ ;_Address local public health issues; -- ,G-c) • Protect& enhance natural resources; • Support other critical services for a healthy community; • Invest in community infrastructure that encourages economic opportunity; • Plan for long term capital facility needs; • Operate based on fiscal sustainability, measured performance, &the best customer service within our means; • Maintain a professional county workforce that can meet the growing service delivery needs of the county. • Strive to retain capital reserves for capital uses; resume General Fund transfers to capital projects in future, when revenues allow. 20 • 10 12/7/2009 2010 Budget Process: • Balancing General Fund revenues and expenditures to meet these Commissioners' goals & objectives has been accomplished -with the cooperation of all branches of Jefferson County government. • Elected officials and directors suggested and agreed to do more in 2010 in order to gain stability in 2010 and 2011, and provide predictability to the public and our valued staff. • If revenues in 2010 match this year's, that goal should be met. • We also know that by 2012 the County will need to make over $800,000 in additional cuts to services, unless the State Legislature or Jefferson County citizens act within the next 2 years to provide additional revenues to sustain services at 2010's levels. 21 • • Summary of 2010 Recommended Budget GENERAL FUND 2009 Projected 2010 Proposed Change General Fund Expenditures $15,581,300 $15,636,626 +0.4% General Fund Revenues $14,867,976 $15,095,052 +1.5% Ending Fund Balance $ 2,415,665 $ 1,874,091 - 22% Unencumbered Fund Balance $ 857,535 $ 466,795 -45% ALL OTHER FUNDS 2009 Budget 2010 Proposed Change Expenditures $32,732,999 $37,203,601 + 14% Revenues $29,113,406 $31,110,779 + 7% 22 • 11 12/7/2009 ■ • 2010 General Fund Budget: • 2010 General Fund expenditures total $15,636,626, almost the same as projected in 2009, despite inflation in labor& other County costs. • 2010 General Fund expenditures would be$384,000 (2.5%) smaller than 2009, except for$437,000 in extraordinary revenue & expenditures from new law enforcement contract with Hoh Nation & joint drug enforcement grant to the Prosecutor& Sheriff. • Similarly, without revenue from the Hoh contract and drug enforcement grant, General Fund revenues are projected to be $210,000 (1.4%) lower in 2010 than 2009, even after drawing upon some short term revenue shifts from other funds. 23 • ■ 2010 Budget Process: For 2010, all branches & departments made a 4.7% reduction from their status quo budgets, for a savings totaling $575,000. A —Nextdirectors and elected officials met in three committees(law & Justice, community services, and administration) to work on cross- departmental efficiencies and further reductions totaling about $500,000. • Together, all three branches of County government achieved $1.036 Million in cutbacks. These 2010 cuts have been painful, and impact public services in every department. • These cuts are more than three times larger than property tax increases approved for 2010. 24 • 12 12/7/2009 S Property Tax Levies for 2010 (continued): • On November 30, 2009 the BOCC approved the Property Tax resolutions for 2010: ❑ Finding a substantial need for a 1% increase for the General Fund, County Roads and Conservation Futures. ❑ Allowing the use of banked capacity in the Road fund adding $216,000 to the Road Levy o Authorizing the annual road diversion to the General Fund for Traffic Law Enforcement-$720,000 -and a temporary levy shift of$216,000 from the Road Fund to the General Fund • 2010 Staffing: • As recommended, 2010 staffing levels for all County government will be 287.55 full time equivalents (FTEs), 10 fewer employees than originally budgeted in 2009, and 23 FTEs fewer than 2008. ■ In fact, 2010 staffing is lower than budgeted since 2002. The County's population has grown more than 9% in that time. • Many of the staff reductions from the original 2009 budget have already taken place. Most of any remaining reductions are possible through attrition, but not all; and those who are potentially affected have been notified. 26 • 13 12/7/2009 ■ • -s-1 B--set Budget Budget Budget Budget Budget Budget Budget Adds(v) Oep•dm,eM 2002 2003 2004 2005 2006 2007 2008 2009 2010 0•610e8(-1 Assessor 1096 1049 101 99 1136 1050 1063 1063 963 (1.00) 2010 AngkElectior 00 763 01 03 263 29 9 219 210 (0.091 Clerk 745 700 700 6 640 7O 700 700 652 (0.50) ' Staffing: omao's , o° z z 71 16 = of s zoo o= o a �,w ooo n Planning Cemmismon 026 0.27 029 029 028 O. 050 045 (045) Safety.Security 300 200 172 246 2.06 248 2.69 2.48 284 0.36 District Court 900 900 900 900 900 900 911 925 871 (0.50) doe Services 066 866 816 816 816 80] 819 776 7.32 (044) Prosecuting 0501.9 1056 1056 1061 II 0061191 11 65 9385 11.93 105 She00309 4254 4692 4718 47 12 48.58 4846 4797 49.5] 1.60 Superior C.214 1 09 1 09 74 1 76 2 16 2 15 2 22 2 03 03 15) Treasurer 473 4.71 461 461 461 461 446 438 (008) Total General Fund 117]9 114.22 118 73 120 64 121 61 123 66 124.17 121 37 12001 1 36 704801%061M 000 000 000 00D 025 025 • Courthouse Facilftator 000 020 0.20 000 015 0.18 0.03 Boating Safety 0 25 0 25 0 25 0 26 0.26 0 26 0.27 0.25 (002) Cooperative Extension P.ograrm 2.19 260 280 412 345 4 17 4 10 265 306 041 4H Atter School 0 332 200 131 1 31 1.26 126 116 126 • E-911 - ECome-9ll sAcems 1 50 150 1 31 1 31 0.75 0.95 105 105 105 • m 7 11]8 1139 11 04 11 l9 13 39 1402 1535 135 1].35 - Plater• Health 3608 3740 3799 3401 3549 38 72 3819 3575 3516 (0.49)1 PlaterWeNy 240 2.95 276 193 195 240 603 675 5.79 (0.96) Animal Services 3.34 3.18 336 32' 225 264 264 267 2% (0611 JC()rug Fund 000 000 JC Drug Furth 000 000 0.12 0.12 0.12 (012) Trial Court knprovement 030 030 Commonly Development 17.13 1713 2086 24.73 2601 2589 2589 1520 11.38 (382) Treasurer,0M 022 022 015 0 15 015 0.15 015 029 029 - Parks 8 Recreation 7 05 702 7 39 7 20 6'8 7.59 ]58 792 520 (2 641 Courts Parks Improvement 0.2] 0.59 0.73 0 86 0.82 0.77 0 71 0.75 0.25 (0 50) Special Protects 224 105 140 000 000 000 760009• Roads 5530 53.51 5340 5373 5522 51 97 5063 5190 5147 (043) FI80d)Ss Management 656 648 698 702 698 803 823 746 742 (004) Flood0Stosm4ater Mgrr4. 072 058 055 0 00 0 16 000 000 • - - 20406• 0nFleodContr01 001 0 0 001 001 001 001 0.02 001 Ouikene Flood Control 052 046 0.36 0.15 007 00 001 001 002 001 Construction,.Renovation 346 266 266 235 003 0.55 053 0.24 0.18 (0.06) Capia11mpmv,Ceurthouse 0 0 100 050 000 000 000 HJ Carroll Park 0 57 0 0 11 0 15 0 14 0.15 0.28 0.20 0 07 (0.21) SOIrd Wash 846 626 827 760 780 0.23 828 933 9.30 (0.03) • Sevier 0 0 1.11 1.12 0.68 1 13 0.45 99 9 6 ER765 7.12 698 703 6 85 7.15 660 67 654 (0.17) Information Semmes 733 594 600 601 699 702 7.14 7.11 738 025 To.015er Funds 17509 173.61 17685 17541 17992 183.93 186.]6 1]6.18 16]54 -8.64 Total All Funds 292 98 28763 295 58 296.05 301.63 307 59 310 93 297.55 297.58 -10.80 27 • General Fund Breakdown by area of government: • 18,000,000 - 16,000,000 9% 14,000,000 12% ❑Payments for Interfund Servic 7. 12,000 000 a%' 15% cl Transfers to Community Sery 10,000 000 Funds 8,000,000 w 55"/ 57% 58/___! •Administration 55, 55% 1 6,000,000 13 Law&Justice 4,000 000 2,000,000 =i 0 Law&Justice 2006 2007 2008 2009 2010 $9.1 million in Project Budget 2010 w 14 12/7/2009 0 • -,, w Where does my Property Tax Dollar Go?: (Based on 2009 Tax levy) 24.64 21.8C 5.9C 7.8C 14( 16.7C 9.3C State(schools) �y-yL� � ocal schools City Fire r Other Co.OF Co.Road&CF tsv . .., ,. ai T b 4�4 t y� ip. ' 1 ...-. ,-- .,--,-, , ' 1 ' ',,,t,.' , 9 0 i. i Er84823S r- F i .c -.,...x.,...-. e a a*..t 2010 Significant Changes: General Fund General Fund Budget Description Change Assessor (60,138) Staff reduction of 1 FTE Auditor (40,042) Staffing reduction in 0.9 FTE for one position. Elections (62,891) Reduction in printing costs,clerk hire and lease costs. Clerk (20,884) Staffing reduction of 0.4 FTE Commissioners (21,116) Reduction in clerk hire and reallocation of staff between BOCC and County Admin.budget District Court (31,837) Reduction of 0.5 FTE and Clerk Hire Community Services ( 7,198) 4.7%reduction in allocations to community service organizations like OlyCap,PT Seniors,and Gardiner Comm.Ctr. Juvenile Services (47,691) Staffing Reduction of 0.5 FTE Probation Counselor,reduced juvenile detention costs to Kitsap County and other misc. reduced costs Prosecutor (47,994) • Staffing reduced by 1 Deputy Prosecutor in 2010 preliminary budget. 73,330 • Federal stimulus grant of 73,000 was able to fully fund this position for 2010 and 2011. 30 • 15 12/7/2009 ' II 2 2;7'a;%,1"1*.V,']: • 2010 Significant Changes: General Fund General Fund Budget Description Change Sheriff (341,278) • Reduced staffing from preliminary budget: • o 0.8 FTE-Data Entry Clerk o 1 FTE-Undersheriff position o 1 FTE-Deputy position o 1 FTE-Corrections o 0.5 FTE Investigation paid for with Federal Stimulus funds $364,436 • Added staffing for fully funded grant and contract positions: o 1 FTE Community Policing Officer paid for with Federal Stimulus funds for 2010 and 2011 o 1 FTE West End Deputy paid for by Hoh Tribe on contract o 1 Clerk hire position for WASPC Grant for 2010 i • Continue to stabilize the Sheriffs budget allowing reasonable overtime costs as part of base budget Treasurer (14,405) • Reduced Staffing hours to reduce 0.1 FTE and other misc. reductions Non-Departmental (24,556) • Reduction of professional services and other misc. reductions. 31 • • 2010 Significant Changes: General Fund General Fund Budget Description Change Operating Transfers (408,018) • Substance Abuse reduced b $2,295 • Public Health—reduced b $108,620 in 2010 • Cooperative Extension a xio`us eeds reduced$21,894 co)):(Jet • Water Quality reduced $4000, Conservation District h • reduced$2300 1`F' One time reduction in Transfer to Economic Development fund,economic development fund will use unreserved fund balance. ' /7 • Parks and Recreation—Operating transfer reduced by \ $82,000 in 2009,continued into 2010 I • Transfer to County Capital improvement reduced 251,000, using another capital funding source to cover REET revenue• , shortfall used to pay County Bond payments. '���_-- _ TOTAL EXPENDITURE REDUCTIONS GENERAL FUND$1,036,121 TOTAL EXPENDITURE ADDITIONS:$437,366,total amount offset by corresponding grant or contract revenue 32 • 16 12/7/2009 ■ 2010 Significant Changes: General Fund Revenue General Fund • Budget Description ! Change Property Taxes ' 216,000 Temporary Levy Shift from Road Fund Sates Taxes Expected to be at 2009 projected level,down $400,000 from original 2009 budgeted amount. Investment (100,000) • Treasurer's investment income down from 2009 Income projected amounts. Investment income is projected to be about$394,000,down from 2007 high level of 1.1 Million. • Investment rates are low and as unreserved fund balances are used,there are fewer dollars invested to accrue investment income. 33 • • 2010 Significant Changes: Other Funds Other Funds Budget' Description Change Public Health (75,000) • In anticipation of cuts in State funding for 2010 and reduced funding from the general fund, Public Health P anticipates having to make changes in their 2010 budget of approximately 2.75 reduction of FTE's. • Reduced hours will still be in effect at Environmental Health in 2010 and the Environmental Health Director position will be left open at this time. Animal Services (21,575) • Reduction of 0.6 FTE Clerk Hire and Overtime • Reduction in 9,000 in crematorium services Department of • Continued staffing reduction of hours to 36 hr.work week Community Dev. for DCD in 2010 • Staffing reduction of 3.8 FTE from Budget 2009 (staff reductions already in place.).. • DCD 2010 Budget s $37i.;000-Tess than 2009 budget`; exduding pass thru expe"rates:"` • DCD will continue to be dosed on Fridays 34 • • 12/7/2009 ` • 2010 Significant Changes: Other Funds Other Funds Budget Description Change Parks and • Staffing reduction of 2.64 FTE,mostly in the Parks budget I Recreation • Budget 2010 for Parks and Field maintenance has been reduced 33%from 2009 Budget,about$115,000 • Anticipate park closures and adoption of parks by citizens to fill the budget gap Parks Capital Projects (35,000) • Funding for parks capital projects has been reduced due to Funds funding availability • Capital Improvement fund eliminated an annual transfer of $35,000 to H.1.Carrol Park due to reduced REET revenues • 0.7 FTE reduction in capital parks projects Facilities Mgmt • Reduced custodian position 0.25 FTE to help fill budget gap County Capital • REET Revenues continue to be projected about$480,000, Improvement Annual County bond debt is $750,000. For the 2010 budget funds from other capital reserves will be used to pay bond debt. 35 • 2010 Significant Changes: Other Funds Revenue Other Funds Budget Description Change Road Fund 216,000 Recommended use of Road Fund banked capacity, coupled with a temporary Levy Shift to the General Fund in 2010 and possibly 2011. Intent is to shift • the levy back to Road Fund in 2012 to address needs of 2010-2015 6-year Transportation Improvement Program. 36 S 18 12/7/2009 Future Issues: • The temporary national and local economic recession & on-going structural funding gap will continue to drive County revenues and demands for services for the foreseeable future. • In 2010 we will continue to carefully track actual revenues and expenditures, and adjust our operations to live within our means. • Our 3-year schedule of continuing to use Fund Balance this year and next must be protected throughout 2010 to prevent deeper service and program cuts in 2011 and beyond. • The County will use 2010 as a time to continue looking for creative ways to increase our efficiency to reduce the cost of providing services, and continue reviewing our priorities of government. • Unless the Legislature or Jefferson County citizens take action in the next 2 years to provide additional revenues to sustain 2010's services, the County will need to make over$800,000 in additional cuts to services by 2012. 37 • • Future Issues: In 2010 Jefferson County government must focus from managing cuts to building for the future. In the coming year, the County must: • Continue work already begun to help forge a regional public/private vision for economic development; • Continue work to secure funding for the infrastructure & realize the potential of the Port Hadlock Urban Growth Area, review implementation plans for the Brinnon Master Planned Resort, and begin work on the 2011 Update of the County's Comprehensive Plan; • Engage actively with County citizens about their government; • Develop a strategy to better harness information technology; 38 . 19 12/7/2009 • • Future Issues: • Continue the work of subcommittees of departments and branches to address cross-departmental issues and efficiencies. • Focus particularly on sustaining and strengthening the programs and institutions supporting healthy youth in our community— kids are our future. • Strengthen County government's capacity to manage our budgets and finances for the long term, and remain flexible this next year as the State adjusts its budget; • Continue to improve a coordinated permitting process, so applicants have consistent answers in the shortest time within our resources; and • Plan to care for our County's physical infrastructure. • ■ : , Thanks: • Many individuals in every branch and department of our organization have worked hard to prepare the Recommended 2010 Budget. • Special recognition and thanks to: County Auditor Donna Eldridge, County Treasurer Judi Morris, County Assessor Jack Westerman Ill, Lorna Delaney, Renee Talley, Karen Bednarski, and Anne Sears. 40 S 20 Board of.1CeaCtGl Netiv Business Agenda Item #v, 4 � Pandemic aCiNi: Me Second-Wave Ebbs and 'iLnrestrictedtVaccination Effort Begins December 17, 2009 Influenza Surveillance Report: Kitsap, Clallam, and Jefferson Counties August 30, 2009 to December 5, 2009 (CDC Weeks 34 to 48) • Nationally,over 99%of subtyped influenza A viruses being reported to CDC were 2009 influenza A(HIM)viruses.(1) WASHINGTON STATE-LEVEL DATA: Washington State's Weekly Influenza Activity Estimate,Week 48: Regional(2) World Health Organization/National Respiratory& Enteric Virus Surveillance System,Washington*(2) Nil Type A(2009 H1 N1) Type A(H1 or H3) — 100 N a 450 - _- ,:r-Type A not subtyped Type 6 v E 'c' `m 350 - /0 positive — 80% 0) m E L 350 E e 3 -: 300 - 60% a5i -o 8:8 -,%;', 250 - as N o .E a 200 II 150 complete 40% o a 'k N100 data —20�, m 50 . i l l pending LI 0% 2009 5- 12- 19- 26- 3- 10- 17- 24- 31- 7- 14- 21- 28- week Sep Sep Sep Sep Oct Oct Oct Oct Oct Nov Nov Nov Nov ending: *reporting labs:WA State Public Health Labs,Seattle&King County Public Health Lab,and UW/Children's Hospital Lab Positive Respiratory Viral Specimens, University of Washington Virology Laboratory at Seattle Children's Hospital(3) 300 - Influenza A Ec)250- Influenza B " RSV N N c x200- Other resp viruses* EE *includes parainfluenza, .o m 150 - adenovirus,rhinovirus,and .J a t metapneumovirus �., • o -..- 50- 2009 —, -- week 0 ' ending: 5-Sep 12-Sep 19-Sep 26-Sep 3-Oct 10-Oct 17-Oct 24-Oct 31-Oct 7-Nov 14-Nov 21-Nov 28-Nov COUNTY-LEVEL DATA: '° "'4 > ' , :-.,-,,,-7-,,-- ::`-'';-.,. - Kitsap, Clallam, &Jefferson County Hospitalizations and Deaths with Confirmed Influenza(A or B)(4) •Kitsap •Clallam •Jefferson •Kitsap e Clallam ■Jefferson to 8 5 c N p 7 6 40 N 4 c N 5 d -c 3 F„, Tis 4 3 ail *t fn 3 C -0 2 .co i I I 1 illi it„, 2009 0 U o ,, o 8 2009 a a t 000 � n vOOOOp zz zz o week in iO O O O O 0O' week 0, N th O NcNr a NNus 0 0 6 O w N th ending ending u 6NNo') .- week of hospital admission week of death Kitsap, Clallam &Jefferson County Resident Emergency Department(ED)Visits*for Influenza-like-Illness(ILI)**(5) 16%- ■Kitsap I Clallam Note:Jefferson County data are not available at this time al 12%- J ' y 8%-• ° L 2009 week0% ending: 5-Sep 12-Sep 19-Sep 26-Sep 3-Oct 10-Oct 17-Oct 24-Oct 31-Oct 7-Nov 14-Nov 21-Nov 28-Nov 5-Dec *Includes Emergency Departments at:Harrison Medical Center Bremerton,Harrison Medical Center Silverdale,Olympic Medical Center and Jefferson General Hospital "Influenza-like-Illness is derived from the patient chief complaint not provider diagnosis and is defined as"influenza"OR fever with cough or sore throat.Data do not represent 100%of ED visit records as not all records contain chief complaint text. Note:All data are preliminary and might change as additional reports are received. Produced by:Kitsap County Health District report date:12/9/09 Influenza Surveillance Report: Kitsap, Clallam, and Jefferson Counties August 30, 2009 to December 5, 2009 (CDC Weeks 34 to 48) . Percentage of Kitsap, Clallam and Jefferson County Public Schools Reportilg Over 10%Absemteeism on at Least One Day 0 of the School Week(6,7,8) Kitsap Clallam Jefferson Elementary Middle/Jr Elementary and Middle Elementary and Middle Schools High Schools* Schools (K-6) Schools #reporting schools: 41 12 18 5 9/14/09-9/18/09 0% 0% 9/21/09-9/25/09 0% 8% data reporting system not yet data reporting system not yet implemented 9/28/09-10/2/09 0% 0% implemented 10/5/09-10/9/09 2% 8% 0% 10/12/09-10/16/09 7% 42% 6% 0% 10/19/09-10/23/09 27% 25% 40% 60% 10/26/09-10/30/09 29% 17% 39% 20% 11/2/09-11/6/09 20% 33% 6% 40% 11/9/09-11/13/09 0% 8% 0% 20% - 11/16/09-11/20/09 0% 0% 0% 0% 11/23/09-11/25/09 0% 0% 0% 20% 11/29/09-12/5/09 0% 0% 0% 0% Note:School districts report 10%absenteeism rates or higher;no notification assumes all district schools have absenteeism rates lower than 10% *includes one school serving grades 6-12 and four schools serving grades K-12. Kitsap, Clallam and Jefferson County Deaths*with Pneumonia or Influenza Listed as Immediate, Underlying or Contributing Cause of Death(6,7.8) #pneumonia deaths %of Kitsap,Clallam and %of Kitsap,Clallam and • 5 ■Kitsap •Clallam ■Jefferson Week Jefferson deaths from Jefferson deaths from 4pneumonia and influenza influenza alone 3 ending: _ 0 I 1 I H� � � I I � � � 29-Aug-09 10% 0% 5-Sep-09 6% 0% CD U) N CD m DI o N rn N o N to C v N CO a 12-Sep-09 3% 0% m m rn m o o 0 0 2009 week ending: 19-Sep-09 15% 0% 26-Sep-09 0% 0% #influenza deaths 3-Oct-09 3% 0% 5 ■Kitsap ■Clallam ■Jefferson 10-Oct-09 6% 0% 4 17-Oct-09 8% 0% 3 2 24-Oct-09 5% 2% 1 1 1 j 31-Oct-09 0% 0% N u) es, W N cc/ 0 � N f7 C V N N a 7-Nov-09 8% 0% g ' W 0) W 0 S O_ O O 2009 week ending: T T T 14-Nov-09 10% 3% 21-Nov-09 7% 0% 28-Nov-09 4% 1% 5-Dec-09 7% 0% *includes all deaths occurring in Kitsap,Clallam or Jefferson County regardless of county of residence;data obtained from death certificates received,not based on date of death Note:influenza takes precedence over all other causes incl.pneumonia(i.e.,if death certificate has both pneumonia and influenza as underlying causes,death is counted as influenza) Note:Haemophilus influenzae and parainfluenza virus are not included as influenza;aspiration pneumonia,pneumonitis,and pneumococcal meningitis are not included as pneumonia Sources: I)CDC FluView-Week 48,ending December 5,2009 5)Essence-Syndromic Surveillance 2)WA State Dept.of Health Communicable Disease Epidemiology Influenza Report 6)Kitsap County Health District 3)http://depts.washington.edu/rspvirus/respiratory.htm 7)Clallam County Health&Human Services 4)Public Health Information Management System(PHIMS) 8)Jefferson County Public Health Note:All data are preliminary and might change as additional reports are received. Produced by:Kitsap County Health District report date:12/9/09 JEFFERSON COUNTYPUBLIC HEALTH 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypublichealth.org December 10, 2009 To: Jefferson County Health Care Providers From: Tom Locke, MD, MPH, Jefferson County Health Officer Re: Expansion of Eligibility for H1N1 Vaccine H1N1 Vaccine Supply update: National production of H1N1 vaccine has steadily increased, allowing a growing number of states to end the strict prioritization system that has governed vaccine use. Effective Monday, December 14, Clallam, Jefferson, and Kitsap Counties will be expanding eligibility criteria for H1N1 vaccine to include all healthy adults ages 25-64 and senior citizens from age 65 years and up. This expansion removes the final restrictions on vaccine use — anyone who wishes to be vaccinated against H1N1 infection is now eligible for the vaccine. Reasons for Vaccination: H1N1 activity is dropping nationwide but is still widespread in 25 states. In Washington State outbreak activity has dropped from "widespread" to "regional". Past influenza pandemics have sometimes displayed a third outbreak wave occurring 3 or more months after the second wave. The second wave of the current H1N1 pandemic crested in late October and has been declining over the month of November. A third wave of H1N1, should it occur, is expected to accompany the seasonal influenza peak that typically occurs in February or March. ip This is the period of the year when conditions are most favorable for influenza transmission. Given the vaccine shortages of October and November, the national vaccination strategy has been focused on reducing hospitalization and death among those at highest risk for influenza complications. There was not enough vaccine available to significantly impact community wide transmission of influenza. The amount of vaccine that will be available for the remainder of December and into the New Year is substantial and has the capability of blunting a third wave of H1N1 if a large number of people choose to be immunized. Public interest in influenza vaccination typically wanes after the December holiday season. If this pattern repeats itself, we are likely to have large supplies of unused vaccine in January and the opportunity to substantially reduce a H1N1 third wave will be lost. Who Should Get Vaccinated: Those with chronic illnesses such as asthma, COPD, diabetes mellitus, immune deficiency, and cardiac disease are at greatest risk of influenza complications and thus derive the greatest benefit from vaccination. Pregnant women and young children also have an increased risk of complications from H1N1. Senior citizens (who have been categorically excluded from H1N1 vaccination due to their reduced susceptibility to infection) are likely to be first in line as H1N1 vaccine restrictions are lifted. Since rates of chronic disease are high in this population and immunity to H1N1 is by no means universal in those 65 years of age and older, there is a strong medical indication for H1N1 vaccination in this age group. As vaccine becomes COMMUNITY HEALTH PUBLIC HEALTHENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES WATER QUALITY 0 MAIN: 360385-940MAIN 364385-9444 FAX 364385-9401 HEALTHIER COMMUNITY FAX 364379-4487 abundant, it is important that healthy adults, especially those who are caretakers of the elderly or have frequent occupational contact with at-risk populations, also take advantage of the opportunity to be immunized against H1N1 infection. So far, it is estimated that only about 10% of the U.S. population has been infected with H1N1, making susceptibility widespread. Not all influenza • related morbidity and mortality is predictable. Of the over 4,000 Americans thought to have died as a result of H1N1 (including over 250 lab confirmed H1N1 pediatric deaths), only about half had recognized risk factors for influenza complications. Where to Get Vaccinated: Vaccine has been shipped to local pharmacies. Starting Monday, December 14 the following pharmacies will be offering unrestricted access to H1N1 vaccine Port Townsend Safeway and Port Hadlock QFC. Jefferson County Public Health has been offering H1N1 vaccination at twice weekly clinics (drop in on Wednesday and by appointment on Friday) and will continue to do so through the months of December and January. Health care providers (who have been providing the bulk of H1N1 vaccinations in Jefferson County) will continue to receive vaccine for any of their patients who desire to be immunized. Actively promoting H1N1 vaccination, even to those at lower risk of influenza complications, will reduce their personal risk of acquiring H1N1, prevent secondary transmission to vulnerable family members, friends and coworkers, and reduce the risk of community wide H1N1 transmission during a mid-winter H1N1 outbreak. Commonly Asked Patient Questions: 1) "Should I get vaccinated even if I think I already had Swine Flu?" Only those who have had lab-confirmed H1N1 infection are presumed immune from this infection. • Surveillance testing performed on those with influenza-like illness in October and November has shown the proportion with true H1N1 infection to be around 30%. The remaining 70% of these influenza-like illnesses were due to some other viral or bacterial pathogen. Vaccination following undiagnosed H1N1 infection is safe and has a booster effect on existing immunity. 2) "How safe is the H1N1 vaccine?" This new vaccine has now be given to tens of millions of people nationwide. Reports of adverse reactions have been extremely low, far fewer than what is typically seen with seasonal flu vaccine. Of those adverse reactions that have been reported, most have been very mild and confined to soreness at the injection site or transient malaise. Fevers have been reported in children less than 10 years of age undergoing their second H1N1 vaccine, a commonly observed occurrence with pediatric "booster doses" of vaccine. 3) "Is it too late to get vaccinated against H1N1?" No, H1N1 virus continues to circulate around the U.S. Holiday travelers are at increased risk of becoming infected. The strongest argument for vaccination is, as previously stated, to prevent infection during an anticipated third wave of H1N1 that is likely to occur between late January and March. The only time it is too late to get a vaccination is when you actually become ill with that particular vaccine-preventable infection. COMMUNITY PUBLIC HEALTH ENVIRONMENTAL RS DEVELOPMENTAL DISABILITIES OOE 411/ MAI N360-385-94400 HEALTHIER COMMUNITY I�AAX 360-385-9401 PAX: 360-385-9401 H1N1 Vaccine Received, Jefferson County Month Number of Number of Direct Doses Monthly Allocation Doses Shipped to Transferred Total Shipments Received Jefferson from Number Received at JCPH Healthcare JCPH to Doses and Clinics Jefferson Received Healthcare and Clinics Oct-09 7 1,900 200 1,410 2,100 Nov- 09 13 2,200 900 1,020 3,100 Dec-09 3 200 100 535 300 Through 12/11/09 Jan-10 Feb-10 • • N Cr, Xk •a It U• N (D F-' i -I v, H N N F-' cp N N I--' W N F-, N F-' F•-' (fiN N F-' J W Ni i...., co N O IL 0 D J 0 W J 0 W cn, 0 W O' u) N Ol Lc) N Co 1-, -P -+ .p J 7 A Li, Tri, ••n T v ai p p p Z Z Z Z 0 0 0 r•+ m N ,-r U1 ,-. ai ai v 4 Cf CU z n n n O O O �+ fnr Q 0 .--<O 4 o 00 ro z Iii, (D 8 A O Uc1 O -, G 0 -* to CTO O E. (D 4t ( N S rr N -0 C2 0_ n D" F-, 1---, F-, N NJ W 1--, l!1 W 0 ,D v = el A N W t0 l0 Cr, l0 N W Cu -CSO -0 p CD 0 Di n O DiO 3 O NJ co CD F a CuN O , J NJ LO O O CM - a) 00 NO 0 0- rn Fes-' NJ O0 NJ ? N f'+ 1--4 I- N U'7 A I� A N U'1 O O N J A 00 N -P 01 U1 •A O O = m T 3 0 (D O Z (D 0 00 .+ N II 1.-1- -5 N N 0 ch < oo• = 1—, f N• C F-, F-' 1--‘ A C Ul II < N N U' N F-1 0 W al — 0 ' W p O J l0 (D N D D 3 W cu 01 vi .A W Ui Cn lO N UJ ' Q O 8 O 00 O J 00 .A .A 4=. 00 3 0 c a.) m = N• O X' v N. 0_ (D , Irt if, r+ II O- O N (D� • i__, i I 00 F' •P (D 5' 0 00 ll'1 W Q CO N = F-' 0- U' f , l0 W ,-•• I-' UA D O i• A 4:t • (7Q W t..0rn (D o 3 N • O o Ql W O J N O O J In CD (n NJ fi s Vi (D Q A N ro O E'' < O rD Ci 1-, 1--' 1-, 1- V Cu n 3 (-^U7 N O W O J W L0 U' O O • N l0 N W J I-, J •P Ul U'1 O {� O r+ 1, (D F-, F-' F-, 1-1 00 0) l.fl lD J W 00 J O F-, W v, 1--, lO A Co Ui 0 O_W 0 F-, ui F-, N + O CO N F-, F-' 01 U7 lO CO Ui W Ci I-, l0 Ql w O NJ A Cr) 11'1 W NJ •P NJ Fes-, !v A 0 I-, - Qi 00 NJ 00 01 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 Ui UI W 00 W al W V • 0 -1-, co NN I-, 1-•, N 0 C W 1 Board of Health .New Business .Agenda Item #17., 2 Health Care Worker 'Vaccination: • LegaCand EtFiicaCArguments for a _Mandate December 17, 2009 • 4' Mandatory Vaccination of Health Care Workers • Alexandra M. Stewart,J.D. andatory vaccination of Medical literature convincingly quirement so that the limited - health care workers raises demonstrates that high levels of supply of I-I1N1 vaccine currently important questions about the staff immunity confer protection available can be distributed to the limits of a state's power to corn- on those patients who cannot be populations most at risk for seri- pel individuals to engage in par- or have not been effectively vac- ous illness and death. titular activities in order to pro- cinated . . . while also allowing The workers argue, first, that tect the public. In justifying New the institution to remain more compulsory vaccination violates York State's regulations requiring fully staffed."' the Fourteenth Amendment in de- health care workers who have Workers at diagnostic and priving them of liberty without direct contact with patients or treatment centers, home health due process. But in 1905, in de- who may expose patients to dis- care agencies, and hospices are ciding the smallpox-vaccination ease to be vaccinated against included in New York's require- case Jacobson u. Commonwealth of seasonal and H1N1 influenza, ment, although workers who can Massachusetts, the U.S. Supreme New York State Health Commis- show that they have a recognized Court recognized that the "police sioner Richard Daines recently medical contraindication to vac- powers" granted to states under argued, "[O]ur overriding con- cination are exempt. Each facility the Tenth Amendment authorize cern . . . as health care workers, will have the discretion to deter- them to require immunization. should be the interests of our pa- mine the steps that unvaccinated Police powers are government's tients, not our own sensibilities health care workers must take inherent authority to impose re- about mandates. . . . ['Me wel- to reduce the risk of transmit- strictions on private rights for the fare of patients is . . . best ting disease to patients (see table). sake of public welfare. Thus, served by . . . very high rates of Many health care workers be- health administrators may devel- • staff immunity that can only be lieve that the mandate violates op measures that compel individ- achieved with mandatory influen- fundamental individual rights and uals to accept vaccinations in or- za vaccination— not the 40-50% public health policy, and some der to protect the public's health. rates of staff immunization his- have filed court actions. In re- Such measures include immu- torically achieved with even the sponse, one judge ordered a de- nizarion requirements for school most vigorous of voluntary pro- lay in implementing the regula- entry, which have been enacted by grams. Under voluntary standards, tion, and New York's governor, all states and the District of Co- institutional outbreaks occur. . . . David Paterson, suspended the re- lumbia. These mandates have been N ENGLJ MED 361;21 NEJM.ORG NOVEMBER 19,2009 2015 Downloaded from www.nejm.org on November 18,2009. For personal use only.No other uses without permission. Copyright©2009 Massachusetts Medical Society.All rights reserved. • NSPF..((71'0- MANDATORY VACCINATION OF HEALTH CARE WORKERS New York State's R ' il Health Care Facilities.* .fe Immunization requirements As a precondition to employment and on an annual basis,in accordance with the national rec Sec.66-3.2 ommendations in effect,unless there is an inadequate supply of vaccine • Affected facilities General hospitals,diagnostic and treatment centers,certified home health agencies,long-term home Sec.66—3.1(c) health care programs,AIDS home care programs,licensed home care services agencies,hospices Affected personnel All persons employed by or affiliated with a health care facility: Sec.66—3.1(b) Paid or unpaid • Employees,medical staff,contract staff,students,and volunteers who have direct contact with patients,or whose activities are such that if they were infected with influenza,they could potentially ex- pose patients,or others who have direct contact with patients,to influenza Nonaffected personnel • Personnel who do not have direct contact with patients Sec.66—3.1(b) • Personnel who do not engage in activities that could potentially expose patients,or others who have direct contact with patients,to influenza Those whose job site is physically separated from a patient care location and who have no direct contact with patients Those whose job activities would require only infrequent or incidental direct contact with others who might have direct contact with patients,provided that such direct contact is unlikely to transmit influenza(e.g.,administrative tasks,data entry,building maintenance) Exceptions Medical contraindication in accordance with nationally recognized guidelines Sec.66—3.6 Facility's obligations • Provide or arrange for influenza vaccinations at no cost to personnel,either at the facility Sec.66—3.3,3.5,3.6,3.7 or elsewhere depending on personal choice • Maintain vaccination documentation in personnel file • Determine the steps that those who are unvaccinated because of medical contraindication must take to reduce the risk of transmitting influenza to patients • Report aggregate vaccination status to the Department of Health j Personnel's obligations Existing personnel: Sec.66—3.3;3.4 • No later than 11/30 of each year,receive vaccination from a source of their own choosing or one chosen by the facility • Provide documentation to the facility Newly hired personnel: • After 11/30 and before 4/01,receive vaccination if the facility determines that they are un- • vaccinated Statutory authority • The State Department of Health has the comprehensive responsibility for the development and administration of the state's policy regarding facilities. • The State Hospital Review and Planning Council is authorized to adopt and amend rules and regulations regarding home health agencies,hospice organizations,long-term home health care programs,and AIDS home care programs. The requirements are from Title 10(Health)of the Official Compilation of Codes,Rules and Regulations of the State of New York V6-3.1-3.7(2009). shown to be the most effective improper on the grounds that consistently affirmed that an in- method of increasing rates of they amount to illegal search and dividual's right to refuse immu- coverage among school-age chil- seizure under the Fourth Amend- nization is outweighed by the dren and have withstood multiple ment or that they violate either community-wide protection con- legal challenges. In 1922, in Zucht the equal protection clause of the ferred by immunization. v. King (a case regarding an im- Fourteenth Amendment ("no state Some health care workers in munization requirement for school shall . . . deny to any person New York have argued that Jacob- entry in San Antonio, Texas), the within its jurisdiction the equal son does not apply in the case of Supreme Court endorsed these or- protection of the laws") or the influenza because there is no dinances, finding that they "con- establishment clause of the First health emergency and because fer not arbitrary power, but only Amendment ("Congress shall the H1N1 influenza virus is not that broad discretion required make no law respecting an es- as serious as smallpox. In 2002, for the protection of the public tablishment of religion"). Yet on in Boone v. Boozman, an Arkansas health." Opponents of such re- the basis of the principles out- court heard from opponents of a quirements argue that they are lined in Jacobson, the judiciary has school-entry requirement for hep- 2016 N ENGL1 MED 361;21 NEJM.ORG NOVEMBER 19,2009 Downloaded from www.nejm.org on November 18,2009.For personal use only. No other uses without permission. Copyright©2009 Massachusetts Medical Society.All rights reserved. , PE:i SPECT IVES MANDATORY VACCINATION OF HEALTH CARE WORKERS atitis B vaccination, who argued unlikely that the exclusion of a ducing outbreaks; health care that both Jacobson and Zucht were religious exemption from the New workers are required to submit • irrelevant because they were de- York regulation will be considered to the limited intrusion of vac- cided during declared smallpox to be unconstitutional. cination in order to protect both emergencies, whereas hepatitis B The health care workers also themselves and the patients in presented no "clear and present argue that the regulation violates their care. I believe that the danger." The court held that "the the right to "freedom of con- state's right to compel health Supreme Court did not limit its tract" between employer and em- care workers to receive vaccina- holding in Jacobson to diseases ployee, as guaranteed by the Fifth tions will supersede their indi- presenting a clear and present and Fourteenth Amendments. vidual rights because of the state's danger." Furthermore, "even if However, states are obligated to substantial relation to protection such a distinction could be made, protect the public welfare, even of the public health and safety. the Court cannot say that hepa- when doing so affects economic Certainly, courts must take titis B presents no such clear liberty. Furthermore, the Supreme into account Constitutional guar- and present danger. Hepatitis B Court has held that states may antees of personal autonomy, may not be airborne like small- promulgate regulations restrict- freedom of contract, and freedom pox; however, this is not the only ing liberty of contract in order to of religion when reviewing the factor by which a disease could protect community health or vul- current lawsuits. These rights, be judged dangerous." The court nerable populations.2.4 Although however, have been constrained concluded that "immunization of New York's regulation affects when they conflict with govern- school children against hepatitis employer—employee relationships, ment measures that are intended B has a real and substantial rela- it is permissible because promot- to protect the community's health tion to the protection of the pub- ing patients' health and safety is and safety. Health care workers lic health and the public safety." a legitimate state interest. Health have a profound effect on patients' Health care workers in New care workers must receive other health. Although they have the York also argue that because the vaccinations as a condition of em- same rights as all private citi- regulation offers no possibility ployment,yet they have not chal- zens, it is likely that courts will for religious exemptions, it vio- lenged those requirements. continue to make the health and • lates the "free exercise" clause The health care workers fur- safety of patients the priority in of the First Amendment, which ther claim that the regulation permitting exceptions to individ- guarantees that government may violates the Fourteenth Amend- ual rights. not interfere with a person's re- ment right of competent adults No potential conflict of interest isles ant ligious beliefs. But individuals to bodily autonomy and the right to this article was reported. may not engage in activities that to refuse medical treatment. Yet From George Washington University Medical threaten important societal inter- the right to refuse treatment is Center and George Washington University ests and expect to be shielded by not absolute. In determining School of Public.Health and Health Services, the First Amendment. When re- whether the regulation violates Washington,DC. viewing state initiatives that hin- the personal autonomy of health This article (10.1056/NEJMp0910151) was der religious expression, courts care workers, courts will, once published on November 4,2009,at NE M.org. weigh the importance of a claim again, balance individual rights 1. Open letter to health care workers from of religious exercise against the against state interests. The state's NY State Health Commissioner Richard E. state interest. Courts have upheld power weakens and the individ- Daines,M.D.,September 24.2009, (Ac:cesserl November 2,2009,at http://www.healtr state. school-entry vaccination require- ual's rights strengthen as the de- ny.us/press;releases/2009/2009-o924_sealth ments against objections that they gree of bodily invasion increases _care_worker_vaccine__daines._oped.htrr ) infringed on individuals' religious and the effectiveness of the in- 2.83(19Willia55mson v. lee Optical Co., 348 U.S ). principles. States have the dis- tervention decreases.' Courts will 3. West Coast Hotel Co.v. Parrish,300 U.S. cretion to determine whether to consider the extent to which 379(1937). permit religious exemptions, and health care workers cause illness 4. Muller v.Oregon,208 U.S.412(1908) 5. Cruzan v.Director,Missouri Department Arizona, Mississippi, and West and death among patients by ex- of Health,497 U.S.261(1990). Virginia do not permit such ex- posing them to influenza. Vac- copyright r;2009 Mass":husetts Med,coi So:ie.t} emptions. Thus, in the absence cinating health care workers is of a Supreme Court ruling, it is the most effective means of re- . N ENGL J MED 361;21 NEJM.ORG NOVEMBER 19,2009 2017 Downloaded from www.nejm.org on November 18,2009.For personal use only. No other uses without permission. Copyright©2009 Massachusetts Medical Society.All rights reserved. • IDSA Policy on Mandatory Immunization of Health Care Workers Against Seasonal and 2009 H1N1 Influenza The Infectious Diseases Society of America (IDSA) supports universal immunization of health care workers (HCWs) against seasonal and 2009 H1N1 influenza by health care institutions (inpatient and outpatient) through mandatory vaccination programs as these programs are likely to be the most effective means to protect patients against the transmission of seasonal and H1N1 influenza by HCWs. Employees who cannot be vaccinated due to medical contraindications or because of vaccine supply shortages or who sign a written declination choosing not to be vaccinated for religious reasons should be required to wear masks or be re-assigned away from direct patient care. IDSA also is supportive of comprehensive educational efforts that inform HCWs about the benefits and risks of influenza immunization to both patients and HCWs. Original policy contained in IDSA's Pandemic and Seasonal Influenza Principles for U.S, Action (See: Recommendation 6);January 2007 Revised to address 2009 H1N1 influenza; remove declination for philosophical reasons; and to specify the steps that should be taken to protect patients from being infected by unimmunized HCWs; September 30, 2009 • RATIONALE: 1) Several studies demonstrate that immunizing HCWs against influenza protects patients against acquiring the virus from HCWs, reducing patient morbidity and mortality—thus, universal immunization of HCWs against seasonal and 2009 H1N1 influenza is a critical patient safety issue. 2) Immunizing HCWs against seasonal and 2009 H1N1 influenza also protects the individual HCW from falling ill due to these potentially life-threatening infections as well as from missing work, during influenza outbreaks,further negatively impacting patient care. 3) Decades of scientific data demonstrate Food and Drug Administration-approved influenza vaccines to be safe, effective, and cost-saving. 4) Educational programs and easy access to influenza immunization have resulted in mildly improved coverage in many health care systems in recent years, but generally have not achieved acceptable levels of coverage—most successful educational programs still average only 40 to 70 percent coverage. 5) Several large health care systems and individual hospitals have adopted policies and the state of New York has adopted regulations supporting mandatory influenza immunization such that employees who cannot be vaccinated or who choose not to be vaccinated are required to wear masks or are re-assigned away from direct patient care. 6) Physicians and other health care providers must have two special objectives in view when treating patients, namely, "to do good or to do no harm" (Hippocratic Corpus in Epidemics: Bk. I, Sect. 5,trans. Adams), and have an ethical and moral obligation to prevent transmission of infectious diseases to their patients. • RELEVANT REFERENCES: 1. Potter J, Stott DJ, Roberts MA, et al. Influenza vaccination of health care workers in long-term care hospitals reduces the mortality of elderly patients.J Infect Dis. 1997;175:1-6. • 2. Carman W F, Elder AG,Wallace LA,et al. Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial. Lancet.2000;355:93-7, 3. Poland GA,Tosh P,Jacobson RM. Requiring influenza vaccination for health care workers: seven truths we must accept. Vaccine. 2005;23:2251-5. 4. Hayward AC, Harling R, Wetten S, et al. Effectiveness of an influenza vaccineprogramme for home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial. BMJ. 2006;333:1241. 5. Shugarman LR, Hales C, Setodii CM,et al.The influence of staff and resident immunization rates on influenza-like illness outbreaks in nursing homes.J Am Med Dir Assoc. 2006;7(9):562-7. 6. Thomas RE,Jefferson TO, Demicheli V, Rivetti D. Influenza vaccination for health-care workers who work with elderly people in institutions: a systematic review. Lancet ID. 2006;6(5):273-9. 7. Tilburt JC, Mueller PS, Ottenberg AL, et al. Facing the challenges of influenza in healthcare settings: The ethical rationale for mandatory seasonal influenza vaccination and its implications for future pandemics. Vaccine. 2008;26S:D27—D30. 8. Poland GA, Ofstead CL,Tucker SJ, Beebe Ti. Receptivity to mandatory influenza vaccination policies for healthcare workers among registered nurses working on inpatient units. Infect Control and Hasp Epidemiol. 2008;29(2):170-3. 9. Talbot TR. Do declination statements increase health care worker influenza vaccination rates? CID. 2009;49:773-9. •• • Board of 3CeaCth mew Business Agenda Item //1V., 6 1 green Business Environmental • Award- Certificates tificates December 17, 2009 • gk4t� S4 , 615 Sheridan Street ® Port Townsend •Washington ® 98368 ///i twwwjeffersoncountypublichealth.org 1111 December 9, 2009 AAPAWITAAA - L s4 Jefferson County Board of Health PO Box 1220 Port Townsend,WA 98368 t't' ,® ®•/MENTA\-P;441''Dear Board of Health Members: The Green Business program is proud to announce three new Green Businesses: St Paul's Episcopal Church, located at 1020 Jefferson Street,Port Townsend; SOS Printing, located at 2319 Washington Street,Port Townsend; and Naturally Green Cleaning, located at 71 Machias Loop,Port Ludlow. This is our first church,first county department and first cleaning service to achieve Green • Business certification! These businesses/congregations are going the extra mile to ensure they operate in manner that conserves water,energy and other resources. 4,2 Thank you for your continued support of the Green Business Program! Sincerely, Lori Clark,M.S. Environmental Health Specialist Jefferson County Public Health • COMMUNITY HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIESPUBLIC HEALTH WATER QUALITY MAIN: (360)385-9400 AvoA, VEC```' f+ MAIN: (360)385-9444 FAX: (360)385-9401 HEAUNIER CO UNITY FAX: (360) 379-4487 oa0 wna , a CO Hf • oma 0 0 v • � twlAl mttl v, N p, e sg tll -41 filliii ,fr,-..i p ‘,1 ,,..,,,,,,,,?:-..,,;;,,,,..,;.,,, 0.1....am....,4- ....,7„-, g Immo. GEZMEILIMmE pie C gPi (v(ti ft$ - w......--.......„1,-,47f-t7 tf:t , , *-,-.- enCr ;zillillAV''';Y. ' '''%°'": 07-N 5' ,''',.:1;"' : — c''''''-' . p ; ' 1 *. o 5 '= x_,i ;fix - 0,,,,,,,,.„4,,,,,,,.:„.„,-_,—„„',..„,,,..,:i::40;......,",:,,„ :1":--:7-,---,,,,..,;:-,:,-;,,,,:,,T,.1,::?;;,,itt,R.,..3,,,,:',,,,',::-:,:i's r ,z.,',.,i4„:1,..;'',,,,,:401.4;::;,:'-,,,,..:,,,,,,:;[1::' , 40°- .t.;-,' N•,- e‘ Aff°r'r.1,"r4r4': ''''4'-', -'-,. ','!- $ . ft 4® Pali „la ArTnAl " --4:v4.-:-' - 14* ifitr( 447:" ,,a-piR!..7,2,24.-, .i-,., n _ 09 Qcaw. 1 l 1 do.:',4,11„:7:15.,,,,ttii':; ,.,--1:;;, .....0 R'Fe'eh'.s 0 AD W • Z r _ g xr a v m Q) m Q) caw w 0 3 5 m • m H om- o a m al iti; LI cc: c7i- a n 40 Fe' „,„..2.,.fr, t'll'i r z ..-,t.;:,':'::,4::::,';::!'_': if-44 , - z 0141 a 44:315—par. Wit j ' . Cin‘.7%?! : ' ':'.'""q1„:".C..',9,f4•4•-:i. `✓ ,„..,.r,,, +-rib:.:,'a f..;3-moi#' `1. CD0- 5. -.0,-.,7.,,,-,,,,,,,,,,,,,,,-,,:,,-,-,-,:. rt .. _, P ,.,,,,,:4„,,,,..,, ,,,,,, ,, ; N < 'IW �V O CO _ � - _. 5,...4,1,...m...7.(2177..,_.,....,,,„,...7____....,__:4„ (' 4.',,,, ft ....„,...._.,„..,—.---- , . 4W,'L'A*.:',' ''''.,-L'Oa g I ilik ,,..:1':''i.,'-.,',,,,,,,: ,lik, : Ili oxo 1-'"---7.1p'1'.--; _ E ` e, --,,,,,„--.!.,'' -.1'. vz,,,,,,,o--- (a) ''',4,,:,-.--,,,,,,,,,,,,,,,,,,,,,,,, , I © • M"ti . v,,,W n A. S 1, •- -�•.. _. a �� a v m p� 2 N 0N O p 7 N • n C N o ma CF;'. 0 v co s- oinkt v n tD Y s titillii 1CzzQ t ® �� ® N• o-i-, t-pv,-i-ii ',...,--,:-.. ' .-,,,i',- - 4f.,--;'-' ar''' : - ,Lf-liprt ,,,- '. : , k,,,,..,..,,,/,„. ,.-•: s r ..„......„. .,,,_ 5° ,..„.....:„..„.--- --,--- -,,,,..,,,„,,,.,. --,sta„,,, n -44..;„... P P - ,- f 1::::',10,:i - - -- ..„,.._. ,--'- -,--...e, --,70.,',' --,.,:i.,,,,,,s,-;:_,C4It'-' ' ' '.',.,.4'4,-.. O I . tISQ 0:1 --''tft rt f LID) r w tlai '':: ::::---; M lit CA , _,..,-,,,,,,,...„..„A„., ---t„,-DI 0 0 ..,,.., �� fcsitiok poi _,fi,'-= # - --- ,s1).. ,,,....,.,, . ,, ,,13„, c ‘..,„ , ...„. ,...... l 1 . clit4 1 s.*„4:4,-,„...;-:„,,,,,-,„ „„,„)... C. . - O rt tz,0 o�.., .. • x fD Board of.1CeaCth .Wledia R.eyort December 17, 2009 Jefferson County Public Health • September/November 2009 NEWS ARTICLES 1. "Immunizations begin in Clallam, Jefferson," Peninsula Daily News, October 11th, 2009. 2. "76 children dead as swine flu escalates," Peninsula Daily News, October 11th, 2009. 3. "Foot care program not expendable," Port Townsend Leader, October 14th, 2009. 4. "Still time for this year's flu shots," Port Townsend Leader, October 14th, 2009. 5. "Schools asked to monitor flu," Port Townsend Leader, October 14th, 2009. 6. "Discovery Bay beaches closed to shellfish harvest," Port Townsend Leader, October 14th 2009. 7. "Jefferson County Public Health and Jefferson Healthcare Partnership for Healthy Youth," Jefferson Healthcare To Your Health, October 16th, 2009. 8. "Swine flu vaccine delayed for public," Port Townsend Leader, October 21st, 2009. 9. "Showers ease PT water worries," Peninsula Daily News, October 21st, 2009. 10. "Area health officer reports on cases across Peninsula," Peninsula Daily News, October 21st, 2009. 11. "Vaccine demand soars," Peninsula Daily News, October 23rd, 2009. 12. "KONP talk guests," Peninsula Daily News, October 25th, 2009. 13. "Swine flu arrives on North Peninsula," Peninsula Daily News, October 30th, 2009. 14. "H1N1 Vaccine," Peninsula Daily News, November 1st, 2009. • 15. "Officials pushing vaccine," Peninsula Daily News, November 2nd, 2009. 16. "Port Townsend's Water Supply" and "The Great American Smoke Out," City of Port Townsend Newsletter, November 2009. 17. "Peninsula to get more doses of vaccine," Peninsula Daily News, November 2nd, 2009 18. "Officials confirm swine flu death on Peninsula," Peninsula Daily News, November 2nC 2009. 19. "Vaccine trickles in; Chimacum School reports absenteeism," Port Townsend Leader, November 4th, 2009. 20. "H1N1 clinics set for Nov. 12, 18," Port Townsend Leader, November 4th, 2009. 21. "Hospital asks youths not to visit," Port Townsend Leader, November 11th, 2009. 22. "Fluorescent bulb safety questioned," Port Townsend Leader, November 11th, 2009. 23. "Area supply of H1N1 vaccines on the rise," Peninsula Daily News, November 11th, 2009. 24. "A big-little goodbye," Peninsula Daily News, November 13th, 2009. 25. "Health workers will don masks," Peninsula Daily News, November 15th 2009. 26. "County budget calls for layoffs, park closures," Peninsula Daily News, November 17tr 2009. 27. "Smokeout set for Nov. 18," Port Townsend Leader, November 18th, 2009. 28. "Few show up for H1N1 flu clinic," Port Townsend Leader, November 18th, 2009. 29. "County trims 2010 budget," Port Townsend Leader, November 18th, 2009. 30. "Girls' Night Out raises $3,000," Port Townsend Leader, November 18th, 2009. 31. "Sequim woman a quitter- and proud of it," Peninsula Daily News, November 19th, 2009. 32. "H1N1 FLU: Health department conducts walk-in clinics," Port Townsend Leader, November 23rd, 2009. 33. "H1N1 clinics set," Peninsula Daily News, November 24th, 2009. • 34. "Commissioners: set aside your pet agendas," Port Townsend Leader, November 25th, 2009. 35. "H1 N1 vaccine clinics set on Wednesdays, Fridays," Port Townsend Leader, December 2', 2009. 36. "Courtesy v the Constitution: Sullivan's dilemma," Port Townsend Leader, December 2", 4111 2009. 37. "Commissioners raise taxes, plan to cut staff," Peninsula Daily News, December 2nd, 2009. 38. "Free clinic to open in Hadlock," Peninsula Daily News, December 7th, 2009. 39. "Mentoring program makes PT budget," Peninsula Daily News, December 8th, 2009. 40. "It's done— county adopts shoreline rules," Port Townsend Leader, December 9th, 2009. 41. "Poor? Need mammogram? Plan to drive," Port Townsend Leader, December 9th, 2009. 42. "City steps in with funding help after Big Brothers/Sisters departs," Port Townsend Leader, December 9th, 2009. 43. "Local businesses earn `green' certification," Port Townsend Leader, December 9th, 2009. 44. "JC MASH opens free clinic in Hadlock," Port Townsend Leader, December 9th, 2009. 45. "County backs off comment restrictions," Port Townsend Leader, December 9th, 2009. 46. "Breast cancer: New guidelines questioned," Port Townsend Leader, December 9th, 2009. 47. "County dilutes access policy," Peninsula Daily News, December 9th, 2009. 48. "'Good' program caught in PT budget squeeze," Peninsula Daily News, December 9th, 2009. • • i lii _ i • 3cd c1 �. .a ) �* fo d xaii ()'° 0 : ` s. ti- a.4 O ›-0 >, c >, Co °„G °. d >,Sm. m.cG a>s p .. oy 0> r) -0c �2 - 111-4 b cu -, � a " gwA cm ?m �Ud,( c . aC •a,, m w 3 ; - $`. 0b q ` mo 5-, . -, � ,m >,aa o a m d 0) 2 .-- ,2••••-c °.t�1 o ►: groqppc° 45qm-1 � 0y1� � m10qIEV,vw �D. � �p cdm , m .5 0Eo ° 4; 2 � m m,gmcag m. ,,.w p 22 �" • o ma.o , qq°,zCog ° a Co U .). m "" gc --! . i °v .� °og no o�y,il� >la4md . 0to xN o NEgs o wto■ 0 ■U � m'ti ipd.� ■� orU° i > Qw � r'� mOPq �d` 1+ AE6 m •LXI ax .aA .9 0.52 `GCy � () A • l��11I \) wamvm a) a)sm a) mdb mid °eD'= 8 r, • amid '°c�, °�'.; 3 �'ae � �> °q �i./ V•s u .5.s 8 4 a1 > s a+ >. EO T7 —4-80- "4 +s 04-4 m u rO Q , a)� TA m E o- ai °.•0 0 j x•2 d c ap...0 L 0 . a. m: qj cap) 6 may= 4$Z y.5C I JJ ° a m 00 : ° � °mv �.D > 0.Z Q ai >.c y ag' ,Ly ti�+'Lf as •_0.g.°"0. P.m > \r/ �, c°� c0 " as > -21 of > .... ,,a• H3 m d 'b —1 d -. > V u 3 V-2 7:"•J.g >`EO , % m .--1 ;2•.,.04 5 aaco q .a3z g • (.41; a`.° ` d p, m-o.r 2E-0 oF3 G 7 a� �'J be,--4.. o c3 • , 41. g r",9,.tis c,,- `i o' °'6(4 °s^o. ....--•„ m1+'T. v, as c `a y o a4. . i'. (.. , $o r >+a� a> . o 8 m o R g a°go y dp- m q � m ~ °m m ^O g�C/ C°°W , i ri..a m n. U] 8 0 60. ., z•>'i1H E s��' m� 000.FP,• a) g >, aS F`tl w. 7 m a> «, ,p A o p, ,n .��i or o °o ca q m 7 ° a c c. n9 3 3 ocu y E 3Fi o 0 8 cc Z m� ., E 0i .0 m ° d o ° C) '.7'0 `.°m m° , ., o � +� G >, a, yvadd 5d d d 0b "G Gy 3 0 mum °■ ! --+ dc . oadca :A ch •ymyc Aw ppt a' 43 A2o oU•0- 0.� > u O +' S QW-2A N W C A-5 - 0` •L ° qoo 5 ..2 � m 4°00 7) p ° . ci �"�L I - Om'� m °i,'"° c.,-5Gy > °, � IO 0 ^2 v•a`:2, — N_ fE R .II � T . �• 3 ° Coymrod J1o +>dd. aN A + Ea, °4 Caa • W CaEy„, dCD 0,v . " c.x v °,CyOS9A! 111t 2 y A' e m$ V °i ca y , C ucomm w oay 8dp,F mm " c^ca w. A ,a d 4) °y2 ° >, Coo 0 m 6 °^ E 6 Tm 0.� 0 � a) -' o Y , d OAro Cc.yN— CI o 7 , O .s.0,ro x . < val et Vdc � ^c7Nov , • Co 0 «i3ya Nm . 0 ° m' Uc Oom2�ro ciUht y ma � a, >, ... c . o . , ttiO = .uSo mw .A a? d . o 83 _aro °� q ._ co..-1•0 d . yd °10 NJ x •r0.,t o a7 mOa) o m .., 0.....3 mml ¢ ° a) 3 o . m ., So0.co > — • s - - `.0 _z c aQ 'L" a p- a y�Ail (1) �.E ^ cg•o a e.,_ 0 ,.,,, ,• 0.0 _` �y�V , c. Ii:! EatR _ Aam 2 C III aa` $ m ° . li f+ � o �ro CD 'CT •w � m �.' a ° ata,. fg .'-'' C'.0.°81 .SPA 76 children dead swine flu escalates _ . 0 National toll , .:,...,,,.,..,,,,,,.,,,,,,,,,..:....,,,.• . reflects early „ ` • i 4 r 4 illness season es' , y- �. . PENINSULA DAILY NEWS .t� (.s1 ,�. NEWS SERVICES r ,, ,4k:, ATLANTA — The number of g children who have died from t� $� swine flu has jumped sharply asp b ,'�f �t the virus spreads throughout the ex , - s'4: P.*:!::, ,,:'4.:1::;,1 United States, federal officials rt said. ,i.� � The deaths of 19 children and I> teens were reported in the past ”: ..rte week, pushing the nation's total . � � � (.,71 �, H1N1 pediatric deaths to 76 since April, officials said - more evi- dence the virus is unusually dan- 1= gerous for the young. It was the deadliest week for ne�ocureoPREss children since the pandemic began Four year old Christian Neidel receives a dose of the swine flu nasal in the spring— but none of the spray vaccine from registered nurse Joey Reese Of the Cleveland County, Okla,_ Health Department at a school In Neweastla Air a deaths were in Washington or ` _..!_. . Oregon. Fever,In comparison, regular sea- F'u®betweenco1 1gh part ateens a yeaard- u mg to the Centers for Disease Control and Prevention in Atlanta. of Ill :x 1 symptoms 'Only beginning of October' "These pediatric deaths seem CONTINUED FROM DI cans have died from compli- The federal government cations associated with flu, has spent about$2 billion to to be increasing substantially," said Anne Schuchat, who heads If a child appears to get primarily the H1NI virus, buy at least 250 million the CDC's National Center for better,but fever and a cough including at least 28 preg- doses of vaccine in the hopes Immunization and Respiratory return, there may be a sec- nant women, of inoculating more than Diseases. and infection.Other trouble Normal seasonal flu half the U.S.population,and "It's only the beginning of Octo- signs: rapid or difficult causes approximately38,000 it has pledged to buy enough ber," she told reporters Friday, breathing,bluish skin color. deaths and 220,000 hospi- to vaccinate everyone if Experts believe older talizations in the U.S. each there is sufficient demand noting the flu season usually starts much later and runs people are suffering less year. National surveys indicate through May. from H1NI,perhaps because about 40 perAmri While most children who died they have immunity from Vaccination campaign carrs are surecent they of will eget- exposure over the years to had other health problems that The increase in pediatric the vaccine,with those who made them particularly vulnera- somewhat similar viruses. deaths comes as the federal are reluctant citing doubts ble, such as asthma, muscular At least 37 states,includ- vaccination campaign is about the severity of the ing Washington, report beginning.Millions of doses virus and concerns about dystrophy and cerebral palsy, 20 widespread flu activity, upbevaccine side effects. to 30 percent were otherwise from 27 states a week ago. gan ens this week. healthy,Schuchat said. The recent The increase in pediatric Dr.Anthony Fauci, head pediatric deaths provided more incen- of the National Institute of Many of the deaths resulted deaths were two in Mary- tive for parents to get them- Allergy and Infectious Dis- from bacterial infections after land, three in Tennessee; selves and their children eases,said Friday that trials immune systems were weakened seven in Texas;and one each vaccinated against the virus, continue to show that one by flu. in Alaska,Arizona,Colorado, Schuchat said. dose is sufficient for healthy A vaccine to prevent such infec- Florida, North Carolina, "Vaccine against flu is adults. tions is underused,she added. Oklahoma and Wisconsin. the best way to protect your- And he said the trials Experts said it's important for Since the pandemic self from influenza, and have revealed no serious • parents to watch children's symp- began,at least 3,873 Ameri- those around you,"she said. adverse effects. toms carefully. .. TURN TO Fr,u/D5 /7 i✓ ,//c Foot care program not expendable There are rumors around the com- munity that the commissioners might cut senior foot care during this econom- ic 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- ha/0 the clienti who came for this ser- vice.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 dia- betic 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 countywide, with sites, in. Port Townsend, Chimacum,, Quilcene, Brinnon and at the senior resident apartment complexes. Myrtle, 4110 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 nota free service. Each client pays $20 per visit Seniorfoot care is one of the many programs of the Jefferson County Health Department It is,vital that the county continues to sup- port this important service. SALLY ROBBINS' Retired WSU Cooperative Extension chair • / e Still time for this.. I year' s flu shots, Seasonal-flu vaccines are avail- Medicare cards. All others pay able at several local clinics in S25, cash or check. Private insur- October: ance is not billed. Safeway Pharmacy, 442 Sims Port Hadlock .Medical Care, Way: Saturday, Oct. 17, 10 a.m.-4 121 Oak Bay Road, Port Hadlock: p.m. Walk-ins welcome Monday Monday-Thursday, 10 a.m.-3 p.m. through Friday; no. appoint- No long lines. Bring insurance ment necessary. Medicare and cards,as some insurers might pay. Medicaid accepted. Many insur- Flu shots$25.Public welcome. ances billed; bring insurance cards. Flu shots $30, pneumonia CHILDREN'S FLU VACCINES shots"$49.99. Clients must be at State-supplied children's flu least 11 years old. vaccines are recommended for all Olympic Primary Care, 1010 children ages 6 months through Sheridan, Suite 101: Saturday, 18 years. The pediatric vaccines Oct. 17, 9 a.m.-noon. Medicare are available through: patients, bring Medicare cards. Jefferson County Public All others pay$25,cash or check. Health:Tuesdays and Thursdays, Private insurance is not billed. 1-4 p.m.walk-in clinics;no appoint- QFC Pharmacy, 1890 Irondale ment necessary. Road, Port Hadlock: Wednesday- Port Townsend Family Thursday, Oct. 21-22, 11 a.m.-5 Physicians: Call 385-3500 for p.m. Medicare and Medicaid appointment. • accepted; bring cards. Flu shots Olympic Primary Care: Call $25,pneumonia shots$45.Clients 379-8031 for appointment. must be at least 11 years old. Jefferson Medical & Pediatric Jefferson Medical & Pediatric' Group: Call 385-4848 for appoint- Group, 915 Sheridan, lower ment. level: Saturday, Oct. 24, 9 a.m.- Possible additional clinics may noon. Medicare patients, bring be announced at a later date. (1110 fG//,7//Gy • Schools asked to monitor flu Parents: Don't be surprised but she hoped that the schools officials when 10 percent or if school officials ask you what would provide helpful information more of students,in a school are symptoms your child has this year on what they are seeing. absent. if the child misses school. "It is expected schools may be "Because N1N1 is known.to Jefferson County Public Health the center of this outbreak. Our significantly affect school-age chil- "sent a request to all schools in goal is for schools to remain open dren, we are now requesting a Jefferson County on Sept. 30 ask- so well children and staff can con- more formal system for reporting ing school officials to track absen- tinue to attend and parents can go absenteeism,"she wrote. teeism weekly and send out infor- to work. We appreciate your calm Health officials also are asking mation to parents about H1N1, approach in helping us to decrease school officials to ask parents if more commonly referred to as the spread of this virus in our corn- their child's absence;is,related to swine flu, munity," Baldwin wrote in a letter flu-like illness of fever, cough or "It's a short-term request just to superintendents and.principals. sore throat.School officials are to to find out if it 11-11N1) is here," Absentee reporting is being report their findings to the health said county Public Health Director requested of school districts department on Fridays. Jean Baldwin of the request. throughout the state more formal- To prevent the spread of ill- Baldwin said the request for ly this year. •ness,students,are being told they more 'detailed information from In the past, Baldwin said there .can return to.schQol.after 24 hpwrs pare, is,on-symptoms is optional, has been an informal ag+ . ..t of "no fever without the use of that school officials inform health fever-reducing medication." • • • • 411 • z P • Discovery Bay beaches closed to shellfish harvest # Discovery Bay beaches were to include all of Discovery Bay new closure this season."said Neil Marine biotoxins are not closed to shellfish harvest Oct 7 and northwest to about one mile Harrington,water quality program destroyed by cooking or freezing due to the presence of marine bio- west of Diamond Point in Clallam manager for Jefferson County. and can be life-threatening. People toxins that cause paralytic shell- County. "the late bloom of the toxic dino- can become ill from eating con- fish poisoning (PSP).The closure Commercially harvested shell- flagellate that causes shellfish to taminated shellfish. Recreational includes clams, oysters, mussels, fish are sampled separately, and be toxic may be due to the calm, shellfish harvesters should check scallops and other species of mol- products on the market should be sunny weather we are experienc• the DOH website at www.doh. luscan shellfish. safe to eat,according to Jefferson ing." wa.gov/ehp/sf/biotoxin.htm or The tests led the Washington County Environmental Health. Warning signs have been post- call the DOH biotoxin hotline at State Department of Health "This has been a very quiet ed at high-use beaches warning 800-562-5632 before harvesting (DOH) to set these closure area: year for biotoxins in shellfish in people not to collect shellfish from shellfish anywhere in Washington fromnorth of Cape George,south Jefferson County and is our first these areas. state. • of Lite 0 _- Jefferson County . he Health Jefferson Healthcare Partnershipalb A partnership between Jefferson schools.They provide primary ;x =I County Public Health(JCPH) health care services,mental r andJefferson Healthcare has health counseling,and drugand t . 0, g 1 � ' resulted in a successful launch of alcohol counseling to students x r Ol two school-based health centers. who otherwise might not - • ,_ The first center began operating receive these services.Although ' at Port Townsend High School in the centers'mission is to serve roiclv,„,.,4t.A. , .:, !s' January 2009;the second center young people who are unin- � '., opened at Chimacurn High sured and underinsured,all l.F '� School in April 2009.Both students(including those with centers were open this August to insurance)are welcome,and " ' provide sports physicals. some use the centers simply How the Centers(3pir According to Susan O'Brien, because it is more convenient. ARNP,one of the health center The goal of the centers is to The centers offer medical practitioners from JCPH,the provide early detection and treat- and mental health clinic appoint- impetus for the centers came ment of illness;to encourage ments two days a week at both when both school districts teens to live positive,healthy schools(Monday and Wednesday expressed a serious need for lives;to teach teens how to use at Chimacum High and Tuesday health services,particularly men- health care systems effectively; and Thursday at Port Townsend tal health services.In addition,75 and to encourage and enhance High).The practitioners who pro- • percent of parents responding to family communication about vide the medical and mental a July 2008 survey on student health issues.Another important health services at the centers are health needs indicated that they goal is to increase student coin- O'Brien and Wendy White,PNP, would give permission for their fort and satisfaction with their both nurse practitioners,and child to use a health center. school experience in order to Patricia Flowergrowing,MA, The centers now offer corn- decrease absenteeism. LMHC,CMHS,a mental health prehensive health care services at The centers work in active therapist from Kitsap Mental facilities located in both high partnership with teens,their fam- Health.Jennifer Ward offers + , ilies,Port Townsend and administrative support at both Yi , . . Chimacum schools,and the corn- centers. h ' , x14 i� munity. During the early stages,a Students may make appoint- :�`.t E community advisory board was ments for either medical or ` ,` - formed to involve students,par- mental health concerns,or they tte. cnts,and local agencies in the may be referred by a teacher or '*--5;" :� ,f, " r - 4: planning and oversight of the the vice-principal,particularly for `� behavioral issues.Parental con- ; rT ' '�� centers.The advisory board k sent is needed for students to be meets on a regular basis during �� 3 4 fi ` the school year and Jefferson seen for medical care,but they .- i t , Healthcare is an active can visit the centers without per- . ''* " r„, P- mission for mental health coon- r r participant. a” �s seling or birth control if they are at least 13 years of age. �x - r .:-----1-47--401P144i'''.-,-;"!...,„;:',4 � -4 Wendy White,PNP with g ° s middle school student w ar ,4 ' . Grace McKay Paged „.: , =,r Continued ` � v. F -',0..,6, • 9,/,/,.4.coaX / / 1,16A/ Pa r r i fireat Youth cfrnm fr®nt page) t, According to O'Brien,stu- based health centers in Portland, %� ` dents generally make an appoint- Ore.In 2008,Baldwin appliedzi.� � ., i .� v x ment to be seen for one issue, for a planning grant from » . �. but another issue often Washington state.The grant - 3 v r �� A. comes up during their application was approved based - �" visit."Once they feel on a clearly demonstrated need ,.. a �.l,,, confident and secure, for the service in this rural cons- . a w �' r ¢ ° they open up and a munity.The purpose of the grant < :' ' ��x 9 number of issues may was to provide seed money for s arise;"she said.O'Brien the planning and feasibility ,, q stressed that the clinical stages.A number of other rural t u ix :;,4,,,,,, services are very corn- counties in Washin on State also ' ,�i ,� . - prehensive."Whatever received planning grants,but few t �1;w ' -, F .� .sem health or mental health have gotten their centers devel- `'r ,�s ` e Yuko Umeda,RN with Susan O'Brien,ARNP problems present,we oped to the operating stage.In yrf k ,' deal with during the contrast,not only are the centers _ a ointment or throu in efferson Coun u and run- also continues to be active in PP gh J t P r • a referral, she said. nin ,but also the had 240 stu- project oversight.Vic Dirksen. •` tfi g yJefferson Healthcare's CEO,and r r,, . O'Brien noted that dent visits in the first three and J �r Paula Dowdle,COO,have been Carrie Day,M D,and a half months of operation. Sarah Schmidt,MD, Baldwin credits Jefferson closely involved from the start. � both with Jefferson Healthcare with giving the proj- "What drives our commit- �.... Medical and Pediatric ect a needed shot in the arm. ment,"said Dowdle,"is that there Susan O'Brien ARNP with Port Group(operated by Jefferson "These two clinics could never are unmet health needs among Townsend Nigh school student Healthcare),give consultation have opened without the support our youth.We know that healthy Patricia More p whenever needed,which adds to of so many and the guiding vision kids learn better,and what better the professional depth and of Jefferson Healthcare and way to ensure that they have a breadth of the clinical services. JCPH.Jefferson Healthcare is chance for good physical and The two not only are referral committed to serving people who emotional health than to provide physicians but also are a point of do not have access to health care this service for them,right in entry enabling children and fami- services;adolescents are one of their setting?' lies to access local medical those underserved groups,"she Umeda also credits Mike providers and a medical home. said. Blair,superintendent of the O'Brien commented that the After the initial planning Chimacum School District,with centers quickly became very busy. stages,Yuko Umeda,RN,who recognizing the great need for "The word gets around when you works with JCPH,picked up the student health services,especially • are dealing with teens,"she said, ball as project administrator and mental health services.Blair "and we have good acceptance developer.Umeda gives a lot of worked on the one-tenth of one from both the kids and the staff." credit to the key players in the percent funding,which helps by O'Brien thinks that project.Jefferson Healthcare dedicating that portion of local one of the reasons stepped up and became a full sales tax to fund the mental r • '• _. the centers have partner with JCPH,providing health portion o.f the centers x JTFf been so well accept- half the funding for the centers. operations.Blair indicated that he ','" F eel is that the kids Jefferson Healthcare funds one of is extremely excited about the Pleatth ClClitt�, � A ointment( quests ,r, , feel safe."They know the nurse practitioners,supports partnership for the center at the r t y . that their visit and some of the lab and imaging serv- Chimacum schools. %� t• -� - whatever they share ices,and provides some of the "The kids have a lot of unmet a▪ t` ' fiettc$ • with us will be kept equipment for the centers.This health and mental health needs," r '. confidential,"she said. commitment of funds will Contin- he said."We are so glad the mom. " x 1'r �r � �-� Students may ue for as long as there is need for commissions were behind this �,� . make an appointment the sernce Jefferson Healthcare protect a " off * either by calling the � � health department or -a z�g ` by filling out an A' C appointment request ctre a zsaf 4 e •- mrt(n. form and placing it in �� i • , ' ''r the locked box outside Appointment request at clinic their respective center. e When an appointment is made,a v hall pass is generated,which ,W,,.=,.. .4,7-.,14,-;.-:„-,,..,=.4..,,„._-;,,,,,,.•,,.:-.$.0 .1"* releases the student from class to , ' . report to the center at the sched- - uled time. r � Hover the Centers Got Their Start . - l: ;��' ia 'fid-.�4 � rte"{ Jean Baldwin,RN,director of ,� ,,,, , JCPH,had previous experienc •e '' organizing and working in school- Jennifer Ward registers student at clinic p -----....":„Ty ' e(+i.t ° � ,,Z' Services offered at the ',: �' school- based health �^^7.4044,,,f,, PP^yopr ,' Informational brochures centers sI ., :, '" available at the clinics f a ba • mu jR 1 NTJOr!YPr .. --rtnoe Sa sports physicals C --, .**491.'),,,i,..,„, /O vaccinations M physical exams aurrmjechonsMManphein '. M family lamun birth control,and pregnancy testing t- a 0 sexually transmitted disease 14* �� screening and treatment 'K741-Y .?. `tea"^ P ' acne and eczema treatment N�� x t allergy treatment k nu{xfr female health care stress and depression , '„4 relatioi slup problemns Other key players in the proj- the wood shop classes at Port self-esteem issues ect are Whitney Meissner,princi- Townsend High School made £ern1 y confliets pal at Chimacum High School, some items,such as the locked er pressure and Carrie Ehrhardt,principle at appointment request box.Other t F habits Port Townsend High School,who students pitched in to paint the ” have been instrumental in getting centers,create artwork for the 'Hal&education rBlatedto the projects to function effectively walls,and raise funds to purchase in their schools.Io additionnutrition and physical activity Tom the furnishings.Other contribu- M healthy relationships Opstad,superintendent of the tions came from parents,local :preventing sexually transmitted Port Townsend School District, businesses,and organizations such recognized the need for increased as the Boeing Bluebills,who d series family planning health-related services for stu- donated time and materials. - i tobacco use reduction dents as well as the negative effect According to Umeda,commu- that poor physical or mental nity readiness and responsiveness health can have on student ace- for school-based health centers Semis achievement. was strong and positive through- r.._v._,.,®,�aA_ .. _m ,.at-„.W„u...v "This was a true community out the entire process."Pretty effort,"said O'Brien.She noted much everyone involved recog- that some of the effort Caine from nized the need and was eager to =t the students themselves who help,"she said. were enthusiastic and took owner- i€ '3q; jdfrh' l ship of the project.For instance, Hea4F-ntaire acknowledge the x 3 a.O`;' 4;.,torc 'r both t 3 Ctlft§€ s e4: i ,� - ..� - Chimacum High School Boeing Bluebills „ jDean Burton -44-44-44 } v Friends of Chimacum Schools a } ” • i Group Health Cooperative i y v x s'1 I Jim Guthrie,Port Townsend High School carpentry class 7.4 MAI;444.4 t yrs � '-K � �. Hadlock Building Supply f tti . - r Henry Hardware 'v� � 'a ' �`a ��` � Cassie Kilmer j } ?' ,o . McCrorie Carpet One ��- Beth Mosley Kevin Nighswonger s '` „g i , Peninsula Floors and Furnishings e� Peninsula Paint Company a errs ' 1 Port Townsend High ASB � ;-, -z t'ts� y a a• ',` c�f9� i-44. -4.--,--T.,4,44-44 Jim Reynolds „ '..-:-,-,,.:1',4-.4.• ,' Kayla Reynolds i � t s _ 4 i = Sammantha Walters 1 Harrison Woodin ;, ;a, ,s" �, Port Townsend High School Clinic { h " ' is a.yy .: z'h p u.-......,.tea.,. warcK.�vm:mae'auazx rs• =.ccEcyv � � T ,"d' or., m . av v«.: .d._ m .h—J7., 3r. LE "`� AEr� yic .o vu aE ya >,.Eeoo >te`�"`w. o. '�cE >A w0vm o o oyw .,�� EW� � NyT w S � v ro�a� �-' 3v °� yaiov,o v �'a� c Y `L' N Ja o v s•. cL var m as �� > o > w v > o ° o• E o c Eb E z - .?-t. :,;" ° ,- - T-a-U"�co cv T� ° $v •o `-' .S a'- v u s °8 °' u u E o'" row N T''' q. O GG ro._ b0 n v..;a v b of a; o ° w.'C :: L a�, 4...•c 3 'E ... ..40. >aaa,� v;a ro us:o u� m u 4 q c_ 00 m V O � 3 .•0J b. a'.'� > O y G..°.'., T a, N a uwi'O"- i� G>U H m a y -8 .,:-., m .�,- O • vw v m Cse o a v v.c '. m— >'- >Aa� °o,A�a° o' 00E mc-° Eu�� EHi `�^T" avw c >� ° L.3 a-.---5 "z. 22"4- ° . ° oE 03 ' '.1 § °0°."... " v °'cvEovc ° mv ro vUrnv ° 3o °^ "uZm bon = u� u. .E.9 guy u.4 0•$ E v 4C •n p 3 +Ty b> v o mQ o vu c v t 5.F.,Ig �_` 3ucna - u... v �y y.0 . w4 wu _ v . aaAVc'6p•oi.."1"' >4 ro7.c w b L • 6 C 107Cs roL'D.s ❑ ry byE >` .Odi 4a .Oro > pV E V C _ C � V' .�.0 > ° d.°, O� p D V °' ' a s ro X C a O Lp C O vi C'[7 p U a D p ro g E u c m a u u y s A-oT p o pp 'J u a v o•� py, 10,..- 4.1... .0.4t. '�. c, v w o•o•c .�.U o 5,o•ti 1� C U"�' _ C E � �— �',�C a m >,O A N .° � gg O�� Cat'I� Vi L U �d zN.nC•C E1 N a CV'., 'r"' tl 7 vE > >� E z�nvuA) uoZc� c• .roa °'2L` a ucva•-r3•yr.•� .a.cE_ vau . °3 � ro p oa4, vrou a� •ex > cxAE0. Etc„grou�-_ ac.�rzrau« > c Fc 'p'"' ,., Et m E.c x u0.%- o�YZ' > �� 3 ,;-.. ,3 a°,.E.�a 5 c ..„-g"u.E�o '�.E u;C •C v 'a.t E c E :AP- 41 0. 0 ;tv uvv •n._c�a., TISw a, 3� —Ntmrc.,-J-.,-,'.p.*,v4Mv- ' E P9 t + c , ,. a tg 3 7 E .E. E a m m ,ax A o.� W f: z � 3 �• s Y uy EL a 'b) ,1.51-; :52 o h :'' ,„ � s� 'u k !t,-v - a s a a.o. '' a a 0 «r �� u A- s 2 sYk v,+�c3. ''fi t s L .h1-1; ,71g4121 -r k��-.c m 5. v�:c'u w,aeytf a.'3°':.c4 st x'�s� �'�'1/l) t '''+ •€ �a"aR'�".�_—' ..°' 0 Pa 3 1 v a•5 v 140= 4-4471 # '"^'Tivv-t,-,',,,-;,45L-ifzeizvg!,,,,ig- "': i' tfi''''''fait,, s•2`' a'r � �'� t �;r 61 x ` °i c•'E',`._6,•t= � v c y �`�•� �' s.i sBt$ ";�•�.r�.t" 'ik� r"e44``�'v,� .: �� a °' m °� v ° a v� v_ +o'"�y.„ ` olo ,e*'. ; �.:« r.> ". Ec"' .bti1Eosa o 4:S• ,- +,ru r a43..-0. `�; :i 'a y � d •v.a''E.-c, -. > 'EEo, ov CO ;,j £,„« "C 3 { + ".,. M"w a A 0 ta...° T.7 [ W'> popa T \ S L - L e z,3�. + `1a,,, .„ . ,� �3� '� �` ,, �eS „s5, ' ,,,,,,, . � 30�cLro�tiur+a �'$y °~ y y„ f ntre kk„z`F,,,`. *N.,, -N 3 f ti$ A v—o o c 9r ' + e s o dpiev'n .v ; 'kh> `0 tf +a Y 'J - o c .d 8 E y 2 is y =.4 ,!..u. .. .. R�”' z:47,;,.. • ��f � ��N � ��� ''...-0"''' '4 s�� y C N C a"'O 4 L.c E ,G ,a° t . a.�aIG, Nda, VV+£ p p. INav o ro-S q�rx .� � d� uft '`''� ° v�•A v o� o o �.4 a ° �. m a w � ��: v 4w c ETp a E�{ r I; ": k M ' a 14%4' P ' kk'^ 'c ? E s a °+o t '2•.`c c°i °' °°'u V S;7•Mi m ' r"`�� �4' 4>(5 c ray.a v . �-p °i o '' a v > r'—i rs3r r ' r Y m E .-'t v to E tP ! g»�. n� U d v v'E o L E v m 3 v o °;y `o iA{2;: w `' 3.§ y ry i ,�i y..n._ v°i 4 L 3 o'� ° e°y ` m 4 3 c 4,11 -qs r k „,;4401a. n, fi m a.8 a vEogEq•r3 °' v �' ,cg,11 c 9-' E �4+3v t , � `�"U Ex "fi� as � pi�-1 rp Op Li, G1°' C Ii. C a a O 'w��z'�'�_., � �- air t+�-•' a .�. {•F-.r ;�4 S o F. °� > o y c `' y H +� v P �T'R r {f y LO C F 3 U 4, 4,,I.. 'C7.� O i wry 1044.,a,' '^ " ? "� 01 it" J �� . f ..,��� �„+.t*'� �t�. �c p ° c a o c O1 u c_ W;g d v H /r�-/^-fit g'••• •., !y''-,'•t , t'�? '. ',,,-":4,. WO a N 2 a Y °' g C U a b i c« L a�4aZ .y� x t ^, . /, -%�` -s, c v i > ro `n3 w C ,, >,v• .0 oD ,0'Vz # '�fC t> 6{ x '. 1 v}=3 paw d u C.0 yH�cac a 2 c2 V x .,: '�-1 ,6+ t� t°�' { .,,-.41"'4, 4 r y o 3 ti,c > y H `'' 8. r v g° r TA t' 3.E ro c o v 1-32 III ® '.' ''"Y t - • ;ft' c .,' m + .� '2 a v $ x a+E i o osw y '+� t. .p.i • "`tie°°evv' g 4 ri v_ > v o E m to 3 v f. a °i f.:14.4_40 � r �� � #, '' �• 4`Li� �-„,,,4:',' fS.u�”- r0. � '6p •c, +� 4 'd r� A4.&-:.-`.%„..,, ':y ' -., i r',,T ° `+.,, s m y v v.. d a 'E ro '� w'�'NZ ` {up Uk 'ye }ir9 0. ,,�" p N e ?,,,,A U g,,„_9. «.1 °, a a y a 0 - 4'�r r '''''',%''P.1,,:iasr c + q+ .,V,a c o v ° e E-" w °'.c = ' ''' > W z a "� _ `."H` "� hat �cs ," -..--.10.::- ' T,.•-• EEEv rv° s 0 3x cc�II �b ��'s 5 � x��a r�,`'"i'3z1 }'"ty• m N'r •�"" � •�' � a -°v .!A„L a U . i� °$' b•y �"+ y L t4� •,,, f e. Sl M T^ .f -. G ro m yid a ° > D.b Q O'� E V CU �{ 4 > £ C�''^', ./kx.yam' Ir' -..:f..4.1,,,- - K.! � rs ,« d i',..,,C a '� L.1 W*flx •' ,:4,1' 'c" r ass ,, ` r �'� r! r y; ur�� ..,-. \ r u �� z t+a>`st. ti s + a '"' I11 !II !ilflj �° t' �'. a''',s. .�•^ '�. .ems 9K'f`_1. �, y 3 ,r �«,t„ - ,!r „} N"�.�� '# +g`sr, .., �"'' �`4.` t� "^ S L=. „, s °-'' p% G p LOIMUffin Il 14 �Y :. fr S. c ° 55L a °� i '\: f •\ ♦ ‘...,#,-;.• - cA ' na3 vu c3 am3 y t �. a 0. ti �' u$ z,2 3 ro 4 c Lo a: E. v; •° FO+ .- - Ty«3{ OT•: C a G T 2E er 2 +voc2y.'5y`+Eyde, 'U°m ro ax.' -- - 0o0C .g - g8 -6t," 0-5-;.-E, - . tmae.oucv > .� G3 E3>:'CZrEUC= a• ro Av.0:OAT' vr �a roiev ° cvwt ;coOAN > O °itro taaA Eoza . v °' yy 07.7.' ,,,-,-..,t1 O N Cp3 � .w > OceL� > c« c .Q 'm p°Uu v � aU•O SC OauB v w241��aE4§E' —‘5o 8 ` .O2 L� Lro pu.« <iL ° $L '8g E o ` cay caoa0hvy >go ° , "E v Nm:. oy a $ EvNA? � axotu1a '' Uqaii o " W4E » ^.7, EA ,! v 7gteg.11-fVii2g f. o' �! " o ''>`Uwso qNzg 3w= uovv cilE'y9e.nf, vwr°f . � v3o y . achuvUEcv vL4, CAu` louE" „ avpLs trr''T,,. o 'aur�� EcyNvgo °'ua °°co• TaAE > ° c3 . 8 wvgov ~ Ja4-4ale4 -° u� '«° .8iccsa °Fo' o?Z3'- coaqw1 " aVc,°�iaoo . ] u-!,:1 " ':11' cra~ aaamcpsIv ..13vv .X.7.,1 &1, IM•wE.- � NEvim 8xy $a '� ° Eoc o..cc =-•oE « ropo 0 showers • ease "It was a little dirty to start with,but we did begin pulling water from both rivers and refilling Lords Lake on Oct. 15," • Jablonski said. "The rivers got dumped on by rain on water Saturday so we should be good for a while here." The level of Lords Lake had been quickly declining since Port Townsend stopped pulling water from the two rivers in early worri'es August when water levels fell below state imposed in-stream flow guidelines. Reserve supplies • j When that occurs, the city must begin City crews begin using Lords Lake and City Lake as reserves. • refilling Lords. In most years,the city had not switched to reserve water supply until late August or early September. Lake from rivers TURN TO VATER/AS BY ERIK HIDLE ..n..1-0-/ //� .• •. PENINSULA.DAILY NEWS PORT TOWNSEND — Heavy rains IIIhave alleviated the worries of the city's water resource department. Ian Jablonski,city water resource asset manager,said his office has"no more wor- ries" as 6 inches of rain during the past - week has replenished the Big Quilcene and Little Quilcene rivers to the point where the city can again fill the Lords Lake reser- voir. Water: ``there isn't a concern, n CONTINUED FROM Al had to tap into its second The major user of the -.level in Lords Lake fell reserve,City Lake. city's watersupply is Port below 200 million gallons. Last week, Jablonski "But now there isn't a Townsend Paper Corp. Once the lake is refilled,the said the city had about concern,"he said. While city residents use pump will be removed. three weeks of water left in "It will take a while to about 1 million gallons of the Lords Lake reservoir. " fully restock the lake but water per day,the mill uses Jablonski said that with-. through the winter that more than 14 million gal- Reporter Erik Hidle can be out substantial rain replen- should occur. Ions daily. reached at 360-385-2335 or at ishing the reservoirs and "So yes,we can stop wor- A temporary pump was erik.hidle@peninsuladailynews. rivers, the city would have rying." installed once the water corn • . FROM PORI' TOWNSEND TO NEAH BAY • yxr -� of ,' r 'V0)1( pr ',, '' 3 :'14,1,,' ,if ka, r~r7 `a yu s�tr fir ' I I ` ,i - ',,,,,,,-,=-:-•:.;2-4,,e" 01.1. ,'11,10,-.:1',,kk a e�n t e(f y',,i 9a'p"�µr ,,L,,` r,M • v t t , 4v M Grp,t; 'r •<y :r , u• r ,+�t rri 4R a r* .a. :•" ' (tr/ • i i,I ,/kr fit ��+w4;r'rµ6"s + ' F,1 'tA4 ": l I:1090'Vu'ar 111,„,,,01;t:4I"° P'''k 'W^ r�;r wF , 4av 0) a i ki �'�t,� 1;(4;1'rrid(/�,4 A. '� � u'� sox rMd�, F� � nf�;. ', d IM Y S, �( ,,if,/,' hfit( t ' ,R 1 1` • at; �r> 44,'/J4viii,; l ti'r,-,. •r + 1. 94,'44+, 'v v`%t ':' .1 ' '' Nt 4y'' e ' ,:,„.:vi, ,,,_ :' r 1 '4 v`= '^ ra ',uq t F t av'-v'OM + tri c s - r w fi, eft t ; yty `rflir `". O. /l" # i 1 s`t r 7` at rpit rS�{M j * "t"rI1, , ,,,,,../iic..,,, „,', . 4ifIti *I L d" § ?;®v a 'fii r a s ui�,r ) Twf� �y,,x -, r�S�' o Y tR {,Y'N 7 - 4 _N/ 41 i Y M N FP. `�A pT ',.0''''',,, `E.E ^f£K g$ :. cal",--"arro ,i 4. 00'''0,0,"", ,, , , `EY. ,:s € .4,0,,,,,-,,,,,,I, .,34 , 7i-� Y> r" t S xh .r;',.,-.1.-..:;,,,,,,,..,., " a' 444 : 4 i '644' '....i:::,,,7'-'4"`-',- v"l Ls"“- FLm1wryJ Fxa +: r '- . ' =' ,1:' ,-,,,r , ,1,7 r ,r ,.,vs raw r* "rskti ",Ix -A, r i '�� E.1: .wL '.. 1 •l :�, r - c - s -..Y »wx g,,x.,,mt wa ,.t n t 'e x ,u.' y .t #p .,x !� 3 T{.t' 4's { -.d��r p l i 4 f 4� 37 ;f C"` .y *• ` 61. ' v 41`£ftgO`; � y t-•a ;u..,, ,w.a.. f'd r ' .£ ,,.''or Ea :;i w s Z{,...g+ " .. �.. a z KEITH THORPF/PENINSULA DAILY NEWS Dr. Tom Locke, health officer for Clallam and Jefferson counties, left, holds up information on the H1N1 virus as Clallam County Board of Health member Jeanette Stehr-Green looks on during a meeting of Ithe board on Tuesday in Port Angeles. 'Virtually all of it7 is swine Area health officer reports on cases across Peninsula By ROB OLLIKAINEN/o f�//O2 Neah Bay. The H1N1 virus is classified as a PENINSULA DAILY NEWS "Virtually all of it is H1N1,"Dr.Tom category 1 pandemic,or the least severe If you've had the flu it Locke, health officer for- Clallam and on a scale of 1 to 5. was you've swine flu,the this sseason, Jefferson counties, told the. Clallam It symptoms are virtually identical to probablyym- County Board of Health on Tuesday. normal winter flu. pic Peninsula's top public health officer "The same pattern is being seen all "The vast majority of people getting said Tuesday. around the state." it are getting mild, uncomplicated ill- The H1N1 virus is spreading across Most states, including Washington, ness that gets better on its own in a the state — about three months ahead have geographically widespread influ- matter of days,"Locke said. 'of seasonal flu — and the federal gov- enza activity. "As pandemic influenza strains go, ernment can't keep up with demand for "We're not really sure at what point -this is about as mild as we could hope the vaccine. it will peak,"Locke said. for" Confirmed influenza cases have been The good news is swine flu isn't as reported locally from Port Townsend to scary as it sounds. TURN TO FLu/A8 ..�,�•'.• zu. xAa rte,.43'�a.z:N:x,,.esx..<` ".:,:' u > .s ,> ,x>k:., ate,r>NF, a.:k �� ffi • Flu: Hi N1 strain sp reads faster . CONTINUED FROM Al "Based on the order allo- reported in the U.S. from weather it just fine." cations we saw today,we're lab-cogfirmed influenza, "Kids that look really III "Parents of healthy chil- not going to even see that." about 6 percent were preg- sick, and are acting really dren can pretty much treat Clallam County is seeing nant women,Locke said. sick,likely are really sick." it like they would any other 700 new doses per week. Parents and household Schools have been asked viral illness." Jefferson County is getting members of infants under 6 to contact the health depart- The major difference about half that. months round out the first ment when illness-related with H1N1 is that it spreads Allocation is based on a sub-category. Babies under absenteeism exceeds 10 faster than seasonal flu, county's population. Clal- 6 months cannot take the percent. especially among younger lam outnumbers Jefferson vaccine themselves. So far, the Port Angeles people. County 71,021 to 29,542. Beginning next week, and Quillayute school dis- People 50 years and The vaccine is shipped children younger than 4— tricts have reported 10 per- older are largely immune to directly to hospitals, clinics and those with the most cent absenteeism. H1N1 because of a similar and public health depart- severe chronic medical The H1N1 vaccine does strain that circulated ments. problems—will be eligible not protect against seasonal around the 1950s. A federally designated for the vaccine, though flu. The number of swine flu priority list was established there won't be enough to go Early production prob- cases on the Peninsula or to allocate early doses of the around. lems with the seasonal flu anywhere else is unknown vaccine to people who need ' "We were thinking origi- vaccine—which has caused because many people never it most— like health car � e nally that by November spot shortages in Jefferson report it or seek medical workers, pregnant .women, there would be enough vac- and Clallam counties and care. children and young adults cine that anyone who across the country—seem from 6 months to 24 years, wanted it could get it," to have been resolved,Locke Quiet emergence and anyone with a chronic Locke said. said. H1N1 emerged last medical condition. "That date is being "They've managed to spring "That priority list is Pushed back further and manufacture and adminis- and sat quietly in the Northern Hemisphere determined to be about 30 further." ter now an excess 85 million of the U S. doses and counting," Locke during the summer. percentpopula- d. Now that school's in ses- 'tion,"Locke said. When to take in kids saiLocke tried to dispel sion and the weather's get- "We have nowhere near Mike Chapman, chair- fears that the H1N1 vac- ting colder, the virus is the amount of vaccine man of the Board of Health cine is unsafe. spreading faster than man- needed to vaccinate every- and a Clallam County corn- "The vaccine went • ufacturers can keep up. one on that priority list." missioner, 'asked Locke through the same kind of Health officials had The first.batches, which when a parent should take safety testing that each hoped that large supplies of rolled out on the Peninsula a flu-stricken child to the year's seasonal flu vaccine the vaccine would be avail- on Oct. 6,came in the form doctor, goes through,"Locke said. able by now. of a live-virus nasal mist. "Some kids can have "There's been misinfor- "That has not happened," An injectable vaccine very. high temperatures, mation out there that they Locke said. should 'be available by 103 .or 104 [degrees], and took shortcuts,and actually Clallam and Jefferson December, according to the they don't even seem that they didn't. They went counties were projected to changing projections. sick,"Locke said. through the same safety receive thousands of doses Since there isn't enough "Others can be quite ill, testing." per week by mid- to late vaccine for everyone on the unable to hold down fluids, While health official wait October. priority list, health officials excessively drowsy or con- for more vaccine to arrive, "To our disappointment, are using a sub-priority list. fused, with very low tern- Locke stressed the impor- we learned last Friday,that "We're focusing on health peratures. tante of preventative mea- large flow is not going to care workers and emer- "It's challenging to sures like washing hands, happen,"Locke said. gency service workers explain this to parents, but covering coughing mouths "In fact,the manufactur- because they are being the most important vari- 'and staying home when ers are reporting production exposed again and again," able of all this for children sick. problems. Their original Locke said. is just the overall look of the "All true influenza cases estimate was that they were "If they become infected, child. right now are being caused going to have 40 million .they.can,infect others that "If the child is paying by H1N1 in Washington doses by the middle of Octo- they're caring-for." attention to things and state,"Locke said. ber, then it was 40 million Pregnant women are relating normally and get- by the end of October. another top priority because ting in fluids and breathing "Now it's been reduced to they are the mostly likely to comfortably and not having Reporter Rob 011ikainen can be reached at 360-417-3537 or at rob. 28 million by the end of die from the flu. any respiratory distress, ollikainen@peninsuladailynews. October. Of the 900 deaths they are probably going to corn • • . . . . Vaccine derr and soars 0 ' t^1 } , district re- symptoms such as fevers and Phones ring ng off he hook<? Ported to e- coughs,"Locke said Thursday. well above the Locke said one Clallam at Jefferson health offices 10 percent County school reported absen- & threshold that teeism above 10 percent this health officials week,but he was unsure which BY JEFF Casty Cases of swine flu are � , consider a nor- district and the exact percent- PENINSULA DAILY NEWS increasing in the general popu= Locke mal absentee 'We're starting this week While cases of H1N1 swine lation, with the Chimacum- rate, said Dr arid thereafter we will be pub flu are on the rise in both Jef- School District the only North Tom Locke, beh a weekty report of this data" ferson and Clallam counties, Olympic Peninsula school to health officer for Jefferson and Locke said of Clallam and Jef health officials are frustrated show an absentee rate of about Clallam counties. ferson health departments. by the slow delivery of vaccine 18 percent this week,the first "We're seeing an upswing in needed to fight the virus. week a Jefferson County school influenza-like illnesses, with TURN TO VACCINE/A8 Vaccine: More dose expected CONTINUED FROM Al tor,said her department is children 6 months to 9 CDC to ensure shipments being swamped with calls. years will need two doses go out to Jefferson County The upshot in H1N1 for swine flu vaccine. and persons 10 and older immunization providers cases comes as the compa- "The severity of the ill- will need one dose. continuously as the vaccine vies that produce vaccine ness is picking up,"Bald- is produced,Baldwin said. are lagging behind the win said Thursday. "The Limited amounts Jefferson County Public demand. people that are angry, Limited f Health is making plans to amounts o Clallam County was they're not at the highest 2009 H1N1 vaccine became ensure that people without expected this week to get risk for the disease." available early this month, personal medical providers 700 doses of flu mist and Children and younger and more will continue to will have access to the vac- • injectable vaccine, Locke adults are considered the become available over the cine. said. most vulnerable to swine upcoming weeks the CDC In Jefferson County, Next week,Clallam will flu, with those older thanortupdates regarding where s. be allocated 600 doses, 60 the least susceptive. reH1N1 vaccine is still to get the H1N1 vaccine including injectable that is They have built up immo- being manufactured and is are available by: without preservatives for nity because of a similar not yet widely available for ■ Calling your medical pregnant women. flu strain that swept the the general public at this Provider. Jefferson County was nation in the 1950s. time, Baldwin and Locke ■ Phoning the Health allocated 300 doses this Baldwinsaidherdepart- said, Department Flu Line at week and is only guaran-, ment was supposed to be at The first doses of the 360-3794471. teed 200 doses next week, 13 percent of vaccine allo- H1N1 vaccine began arriv- • Going to the health Locke said. cated for the whole popula- ing in Jefferson and Clal- department flu information "We are being told that tion at this time,"and we're lam counties during the Web site: wwwjefferson the production levels are only at 3 percent." second week of October. countypublichealth.org. falling far short of their The federal government The limited supply of ■ The vaccine is also be forecast,"Locke said. has procured 250 million vaccine' doses received to available at Madrona Hill "But the bottom line is doses of 2009 H1N1 flu date is being prioritized to Urgent Care clinic, 2500 we received a lot less than vaccine, according to the protect people most at risk Sims Way, Suite 1, Port we expected this month." Centers for Disease Con- for H1N1 influenza,as rec- Townsend. There are also spot trol and Prevention. ommended by the CDC. shortages of vaccine for The quantity of vaccine The Jefferson County Port Townsend-Jefferson normal winter flu. • accounts for the National Health Department ' is county.Editor Jett Chew can be . Jean Baldwin,Jefferson Institutes of Health clivi- working with the state reached at 360-385-2335 or at jets. County Public Health direc- cal trial data showing that Department of Health'and chewOpeninsuladailynews.com. • . • /0/2 f: KONP talk guests PORT ANGELES— Here is this week's,sched- 41111 ule for the 1:05,p.n;:to'2 p.m.local talk show seg.l ._. went on KONP radio at 1450 AM,1102.11FM"and on www.konp.com on.the; Internet Station '#r general german r � 3 Todd Ortloff hosts the • F Monday through Thursday s`< segments, Locke and Karen Hanan.hosts"Art Beat"on Fridays. This week's scheduled lineup: ■ Monday:Master Gardeners Jeanette Stehr- Green,Judy English and Bill Wrobel. ■ Tuesday:Port Ange- les City Council Position 3 candidates Patrick Downie and Harry Bell. ■ Wednesday:Clallam and Jefferson counties' health director Dr.Tom 41111 Locke with an update on the flu. • Thursday:Port Angeles School District Position 1 candidates Debby Fuson and Sarah Methner. • Friday:To be announced. • • ca oB > `" a, c°> i :: 3 pF • o o ° m 7o ~zy _cr ca N ° a1tiiu ° '°a a ° x E£ �'5 ,ytiy m o.tW;Ili Ex 5' o— s,N v °i�,, ., N ia..._ . •v'O a. a ?,b 2 d ,,p„° C _ G �^^ o a E ° e " o G cr o a a ^;va vJ ° d o' ao c.� v � o�• o w 8 ag ° a $3 =w Eifli1L W '"y(o �d r ,� \ 'O v Env > 1-. u.[ ca .. N 0 N. N � v i ..0 3 .13 ca'rJ' U q M0 E �Cn ° SY^ �' G 0•�° vz•ri �a. o� a o C U_8 N aVA3 ,b.F o2o.t aC . 9 ba ' a> .6 p a.,OQ g*�1 F of '` t ` ° 'cE M .- cd CA C g V:.'o W a 4, C -4'' ° y p - 0 ° �i •Ey F,•o A.O y ;,'„ p ; ^7 r-�� .., 0 o ° oho•' V Qn V to >;a 6 �Et' CJt.�g4 ,08 '',,/ ,, 2 ,.$1.1.„, F_::1. , 4`- -2 1veo•� a >4 � a w y pVi^ay R.6 (°�a4 ��p' O a+c0.g C E•'.N ad a b) Q1 ¢ E•Cx O 8 ,0o 2 d ., O Fi "*...>. ..53.24-. r a «7.., .,,n o > V a '' ,yn 0.'° C W y o `A (� ) a aE.7 a+ ..� 01. .� O a7 N a . ?' . 0.a1.2 °.V V `+� o,F oo � 41V."5176 ,a• IIh 4 a �� aUHo ��'� aa�1 � ° o �'o�ia" � O F� > o C , ti b ri p � iI a .ga . -02. .EN x � a C 13 a/ s ° e g d•ro a` x.1)4 1 E g .• - I� 4 w's _ 0 wE 'lE o [SW V IF 81'0•64 33' •A r'o v .24§P0 r'1l ,,.•€'x p�+p L..w ... >, .5-•--, 7 '0°'4 8 Cg 2 a§PO •i� W 1673 411 'C Q q� fill f a g � .$.d ° ci'Q 5" i-io '5 ° 8 co w .41rh B a 0 ° AA �8 a ma 8 -a . C..,W 4 t.. ai ui cT,4 2 aa, aE2 gb2 g d Et3 > so Awa tihPhiJi �" 3 l -1'd z411 o.E.4<0 Fn .., ca ca a1 C .- .o.-, a1.-, .0^.ty C b F•, o .- - D a1.co s;,, F+ GO m8... �w . a ° 8� : aad b "o — 8 0 a V./ 086 E r �'o .moi2 .50• 1 o1A'8 a '-'''-' 0,3,o 4Y-Co �--� 6 m 80,.E _5o aeU. ° OE4) e; a� °y 8. ° 8 >j° E. ° 03 —L bac � �° 0 -� ° a8 11cl) y1a, o -. O.. m •-1 2 r j,2 6.D...,o l0 a1 C cd 51,, a1 ++ E F m onF ■ ■ x . '' u .0.1 a1.. .8 �,o. ° 3 • tb"°a1 a=7 -4 m a •�a a' °° e o �1A4z m 7U-,g 0.;d',i.,G.: �.-4 o C 8 29hIiIIi Baa �5OnS ii .mo ' E' o. MN (/) °• '� • 8 en 0 a� o C w �, �■ ( . yHoiz 0 eu > eu 'flh ■� �> C , • O4 • C aE7•omd�8m'o°.§ Ql 0 E•-., ¢w� �y„ o-FEE g •� d. db am> co P4 o c3 .-, H ° iii C7,--8.-.81,5 CO ® L ‘-,--:471-3 Ci a, G g- 7i m c r. 81'E3 E r,'-§-02.2-9. o H1N1 vaccine for seasonal flu. • I am hearing a great The new H1N1 vaccine deal of media coverage has only been available for about the H1N1 virus the last three weeks,and • immunization shots,and then in very limited supply the media is reporting on —enough to immunize how many people are com fewer than 5 percent of ing down with the virus Clallam County residents. and in what areas. Both forms of the vac- But I have not heard cine—nasal mist and any coverage or even the injectable—can take up to question asked: two weeks to provide pro- Did any of these people tective immunity to the get a shot prior:to coming new pandemic me,m virus. down with the virus? After that time,most I think it is an impor- people will have developed tant question to ask of the immunity,and their bodies health authorities. will fight off any exposures Pauline Moore- to the new virus. Culver, Unfortunately,no vac- Port Angeles cine is 100 percent effec- • tive.Demand for the H1N1 We asked Dr.Tom Locke, vaccine is far greater than health officer for Clallam current supply. and Jefferson counties,for People will be at risk for a response.Here it is:• H1N1 exposure for the It is too early to tell how entire flu season(Novem- bereffectiveithe new H1N1 through March). vaccine will be. Many people are stand- In preliminary studies ing in line for this vaccine conducted over the summer (me included). Like it or not, months,the vaccine we need induced protective immu- tturn,be patientllowsthosend wait withohr nit)'in more than 95 per- allowing cent of healthy volunteers the l risk o enza complications o of influ- cent who took it. In real world conditions, receive the vaccine first. New supplies are arriv- flu vaccine effectiveness is ing weekly and will eventu- usually not that high,aver- allycatch upwith demand. aging in the 70 percent-90 . percent effectiveness range • • r • . , • , offOfficials , ., ® g t- " 5ymm ..0 5 �� '� r"'1 p �....) Iji!N � � -P ° r U R' O 841' o_- Opo A S • vaccine . N a t"8 h O C M Sa' F3rno�,�e yu , 0. 0..A co M•�..CC 4 3 Ee Pregnant women �—' a v .Z s • E. others-at risk urged > ..,. f l f l$.. ^z �. i 'z °� � fix °' to getI:4.174 Itj • `flu protection �4:- EJo . -0 • 6 �S'° BY JEFF CHEW i_ •.�.lE;Oa t-'. . PEMNSULA DAILY NEWS 0. o o B North Olympic Peninsula public health oifi- .. c°c ° °-i x dais are encouraging those in high risk groups d >,.-.�, v —especially Pregnant women—to obtain the T. 0.4 0 0 • HIN1 — or swine flu — vaccine from their o y medical provider now. -(O'"'. y 9 3°c a "All providers on ,""`i 3 id" p a s o. the Olympic Penin- • c >. x 41 `' c°'3 00 -- "We're still on an sula are trying to get n.z a s.$ '- a s 0 o vaccine to pregnant upward swing. The >.� •s w y 0 5 g N women," said Jean emergency rooms 8 ` g 3 a c y O y A'O y C is Baldwin, Jefferson are getting a lot of lit " .2 N County Public Health director. people coming in 1 1 4 i a 2 ..,-.`1,1.5.` "Pregnant women E .n 3 z -• 4 are the highest risk with flu-like illness. A o x d'j y o. • to get the Infection," We're definitely in a s N y = > she said."They have the midst of . L g ‘„ ‘4 8 the worst outcome - ,..2-_, " ' c 'r widespread r o o ° for HIN1." p • a �.o 3 Dr. Tom Locke, influenza activity." °• ‘6, §0.- E a a health officer for Di.Tom Loci = ° fe 0°'W a • .5 .5 d Clallam and Jeffer- health officer,Jefferson � y § 8'8-o 0 son counties, said and Clallam counties •r'+�1 . 'E 8 m $:_y M 0 3 last week that inci- dents of swine flu • b- ?' :. .t A_N infection are cresting on the North Olympic Pen- (''� 8$2 c E > insula now — with public schools reporting ?--{ c n co y a a s c higher absenteeism—and that the.H1N1 vac- �('� a v 8.^m c E' cine 77- which has been in short supply— is J a c ° E %'�' becoming more abundant in both counties. v $ o [ c 6o m 'We're still on an upward swing.The emer- a'='2 ° �? a ' o gency rooms are getting a lot of people coming y o.Z m • •.• a c`a in with flu-like illness," he said last week. l3 .2 8.. a;>.g m ,o2, "We're definitely in the midst of widespread c $ .? y;a` influenza activity.., I .c.a m ' "All of it is testing out as'being H1N1.We're :v v c heading towards the peak of this activity." ¢ y c' � v a For most sufferers,H1N1 is mild,with symp- o .0',,roti 'o 0 toms usually the same as seasonal normal ` ° S.a 0 a • winter flu. •1♦ ` B 0 " Most healthy people will do just fine,"Locke a a >"' o a said."The vast majority of people are having ^° o" 3 . a v mild illness." 5 v,2>,c.cu•a R But some groups are considered to be most U U o I' m-5 .Y at risk and are urged to get vaccinated. a I g on • Early doses of vaccine have been in short o 4 g c d 5° a.i a supply,so the federal government outlined pri- v? 6 3 ,� 8 i•E 40 ority groups: pregnant women, health care workers, kids and young adults and anyone with a chronic medical condition. t TURN TO VACCINE/A6 • City of ®rt Townsend .._ .. :.,,.....„. __•._ 4,1§,,,,,,,.. ...7..e., --,A-..,..,--- _- _---,c,oi ...;_.... ..,„•,-„,,,,,„,„„:„.„7„,,,,,,,,...;,,,,,..,,,.,:„...„,,,,,-,- ,_.:.;,„..„,_,_, 7_,,,:: .:_ACN"--F:,IFu-'77-J-RL ,- _f 3 flail ,Ci ,� .. a-"' a �t.n'1 l'1 ---, --. , - �=y +- . �"—..t _.�. ,��'-���alt �'�tc� i��'°�1a..�r'��c� V '4$S'�i�"�� �.n.�l}1��,� !^ (360) 379-5047 (email: citycouncil@cityofpt.us) www.cityofpt.us November 2009 , ,7:–�� From Mayor Michelle Sandoval ; In 2005, legislation was passed to create the"Main �� '- Street Tax Credit incentive Program." Businesses e �. - �,� ,/�> ,�y '''''''''''"'"'"4-�are eligible to take a B&O tax credit for contributions k / , I 1 given to eligible downtown revitalization organizations, includ- 1' - ing the Port Townsend Main Street Program. In effect,this refocuses a portion of your B&O tax dollars towards home by supporting our local organization and its activities with its mis ., � %' sion to support the historic districts. Port Townsend Main yp Street Program is eligible to receive up to $133,333 in tax f -" % fir' � , credit contributions annually. However,time is of the es- sence–there is a cap on the amount of credits available = " ,, :, �' x1 _ • statewide each year. ' ,-,- ; ,r, d '' 'e '- The Main Street Tax Incentive Program by the numbers: tr - ,. ,,:,- 'fit.v4' _' `„ -, f—> ,.c - ,t ,- �' • 75% of your contribution to Port Townsend Main Street ' N; ; , -- - -- . x`, t-, „ ;d Program in 2009 may be used against your 2010 B&O tax Lords Lake 10/15/09 liability. Water level 2.5 feet • The full amount(100%)of your contribution to the Port Port Townsend's Water supply Townsend Main Street Program may qualify as a 501(c)3 charitable deduction on your company's 2009 IRS tax return Port Townsend's water supply is normally drawn (check with your tax accountant). from the Big Quilcene River. When low river flows If your check to Your 201.0 B&0 Your 2009 IRS de- prevent us from drawing water from the river, Port PTMSP in 2009 is: tax credit is duction may be: 411 Townsend relies on water stored in Lords Lake to 1,000.00 750.00 1,000.00 meet customer demand. Despite conservation by 5,000.00 3,750.00 5,000.00 the Mill and the City's customers, Lords Lake, our 7,500.00 5,625.00 7,500.00 primary storage reservoir, reached critically low 10,000.00 7,500.00 10,000.00 levels with less than two weeks of water remaining 25,000.00 18,750.00 25,000.00 as of October 15, 2009. Make your contribution to The Port Townsend Main Street As we enter the time of year when rain normally Program, a 501(c)3 nonprofit organization, no later than De- replenishes the streams, we have to be prepared cember 31, 2009 for the 2010 tax credits. Please check with for delays in typical weather patterns or for storm your accountant—depending on your type of business, your events that make the water too muddy to use. contribution may also be tax-deductible on your Federal'taxes Port Townsend Paper Company (PTPC) in 2009. However, please note:these funds are on a first consumes 10 times the water that is used by come,first served basis statewide. The earlier you com- mit, the greater chance Port Townsend has to benefit City customers and during critical times they from this remarkable opportunity, so please pledge as implement conservation measures and will early in the year as possible. temporarily shut down production so that City Contributors to the Main Street Tax Credit water consumption can be met. Incentive Program have included: we have Port Townsend Paper Co. Kitsap Bank The Leader As of this writing (October 19, 2009), had Sport Townsend Wind's Eye Design SOS Printing increased rainfall and are monitoring water levels Olympus.net Sirens Pub Forest Gems closely. It will require several inches of rain in our Homer Smith Insurance The James House MarinerBank watershed to substantially raise streamflows. Printery Communications Townsend Bay Marine We will be recommending that City Council keep -top The Great American Smoke Out water as a key issue for 2010. For additional infor- November 19, 2009 mation on how to conserve water and regarding Start now to make a plan to quit tobacco. leak repair guidance see the City's website http:// Only you can choose to quit. It starts with a www:cityofpt.us/Publicworks/ phone call. 1-800-784-8669. Support is WaterQualityFAQ.asp. available 7 days a week 5 a.m. to 9 p.m. r,, toimtio 1111 Peninsula togetnor 4' vaccinem„ PUBLIC HEALTH 014'k "'" CIALS expect to make HiNI-vac Novecompard to getvone. received last month. A separate'shot for seasonal flu cine shots available to all childrenManufacturing delays of the and young adults by the end ofthe swine flu pvreagcnci:iinetwomen, limited early is needed. month, doses to health '`Once sufficient vaccine becomes available,we're really recom d care workers,children under 4 and Clallam County is projected men - get more than 10,000 doses thisto anyone under 64 with a chronic . . ihinegithdlit everybody get the vaccine, month,compared to the 5,300.it medical condition, u ng those over 65,"said Dr. received in October. By December,availability is pro, Tom Locke,health of5cer for Clal Jefferson County. is projected,to jetted to catch up with demand, lan and Jefferson counties. who wants a shot will and anyone get more han:4,poo doses inPeninsula Daily News • 111111 • 0 Officials confirm swine flu death on Peninsula "`+""^ deaths are common because most Man in 171101 COs had multiple risk factors, health officer says aPnins up `' cases gothroughastatelab.which ■Peninsula's supply of the has a limited testing capacity Lock:: swineflu vaccine/A4 BY ROB,OLLIKMNEN Dr. Tom Lucke, health officer Swine flu deaths became a report- [here usually is some delay PENINSULA Dues News for Clallam and Jefferson court- able event on Sept.18. with that,"Locke said. ties,said Wednesday that a Clal- "Unfortunately,this is our first "But now we do have a con- Statewide,there have been 44 PORT ANGELES — Public lam County man in his mid-50s recorded death,"Locke said from firmed death,' confirmed swine flu-associated health officials have confirmed t who hitd multiple risk factors died Washington,D.C. Jefferson County has not had a deaths since the strain first that one person on the North of H1N1-related complications in "We had investigated one[report confirmed swine flu death.Kitsap appeared in April. Olympic Peninsula has died of Port Angeles on Aug.5. last weeks,but it turned out to not County has had one. 'NFU,:no FLu/A4 complications of swine flu Tesjs confirmed the case after be due to H1NI. Delays in reporting swine flu Flu : All cases in area are H1N1 . „„. „ CONTINUED FROM Al t,:,-:7.,-;;.;','.. .-......s .. '' r 'j' ti k- r‘,14.c.."::'.... ,•-•.- . 7.,,n,v4kt,a,,V ,.,,,.,..-.4.,e•'''.1' .$,..',...,'.'-.:--::.-!'.v.....-'2.,......,,,v; ''.`,1:L 4,..' '''''r-,‘X..41rt;,'" "'00 ..61.',PpiWtittii,:',.41.tti''',,'.'...,..*.'...'..:-.....i.;',',' , ' ;;- ' .-'.'.-7-''I'Alkpt;'.,,,0 s- . : ., Twenty-eight of those ; r �. occurred after health offs �� ._. . .. _.. .... .. .. . .... cials started tracking them .. ..e� 'A£ 11I ,r 1f "'^"', in mid-September. ax aEr rc f� a , izo,d Federal health officials 1 % ' this week expanded esti >� zG �� . <y t ,,,,12°1' mates for swine flu deaths �f �, F z, ' w- • from 1,000 to 4,000 or tx s1 ��z more. ,. a ,,.,�11, � u .--v z tl f s 13 -'i The Centers for Disease $ k � r airy fit° , Control and Prevention >'t..-"., � . E i Ai f.t� z 4t 3.. m says "many millions" of e # aI l v r - Americans have caught the ..',..„..4 x� -.:.::,:%5":403''''6.... *4 , �74,„,,.-, „I:$.3,, pandemic virus since it � � ; g �YE „ `` h� _ h: /r.� § �` '.' I 4Y ='� emerged. ii i hc,,,�r , r`'S y� £•s?� i' , •8't.Y •4 `"g'• s ,u` $ All of the Peninsulas , ` t � ,+ � ,,� �. 4 • confirmed flu cases this I ,i,� ` to t n, Tr tri£ , 1 s winter have been H1N1, , ,1 ;Fi , r -, � Locke said. The normal , _ 4S g ,, winter flu is expected to hit u �K s { .c „r3 :, the region — along with a second plateau of swine flu CHRIS TUCKEK/PENINSUTA DAILY Nes', activity—in mid winter. Nancy Boulay, who works as the Employee Health and Wellness Locke estimates that registered nurse with Olympic Medical Center, holds a dose of the H1N1 between two and five people flu vaccine in Port Angeles on Wednesday. in Clallam County die from seasonal flu every year.That Most healthy people recover 64 hardest. strain that circulated the numberranges from and on their own in a matter of "We're definitely seeing globe. 4000 statewide,he added. days. . that as a phenomenon,” "The immunity is not "That'sa why we're so So far, more "younger Locke said. 100 percent,"Locke noted. serious about influenza," y g • • Locke said.. people are catching the Those who were born in Considered mild by pan- swine flu than older people, the 1930s or before have Reporter Rob 011kainen can be demic standards, H1N1 is but it is hitting people developed an immunity to reached at 360-417-3537 or al rob. similar to the seasonal flu. between the ages of 50 and H1N1 because of a similar oflikainen®peninsuladailynews.com. • `- r«+i❑cof a „o^ 33 a flu >EE,,� ]H '! C;`3c'3� Rxf U '>c HL.ii ` Eo�E= N aa1v>c'❑c'.d3 3+3..ov'HUijfl y o 0 „ 0v FG iv `Neac ° mvo ° V a:GCw '•Ey �o'� .S o yNv v•, a "'. y.Q_vv � ,tot Nyy'� Nvx .= � ah hNya ? NCC apNO L `. cv ot •G E+ a °.buQN0 caE[ cDomN EECYwNoL v , ywa! N ExvE �G � .do...� cc O ymO Oq FQ ° G vaaam v °? = vauaU.2 ua ° o'T. a,- atcman E offik ca elm -8 a all Lr' v y- 0 [ � 79° v 'iv e2 . atlo-- vNooO.m' ccccvca � .ayw� o� a vto nV ov3 aycyv ° Uc8y"•oWow'°vvc�9, 'v " d 3L v" E `Em NEo ` � ° an ''k .° o3 �p o.��o ' ) qo ° o vvGvoZ o ba° �' �-oy ' y .a o °C '.��N�v >,oNv oa ® a °:3ti .,cvuEE.`4 yLam ti'brCE N Ev ' cy E'-2E ' N0'vVa.w =nEc� E o , ❑ 7UGL3 do ° o xl'' •bvomcrnoELc .4'''''' >., aw O oA �� vug=•a N •-N �= roawooG1ti�v v ,' o . , 2p,ay� n° y=2 ° gy f ,vC obEnSJ ' IIIMINIMI 061 insm in • Cos) 0 ,, 3ic, m ra Corm `.O v : cm v$'wc7GoQNoy = : ° rnrfl -W0z.0ogzEEomc : ggg tvy [ i2xOqU, U y'_ . 13o." ° av2 .,, . yy oM., y.,p wvotmEvaU3.c .t ft •Emccstncvv . $ v`, .g o'4. - vi■® > _, Aoc <a c v m� yc •ai . yE•-•c ov ° 5va o.c o 3om � •GOv CC,va� v o - mN U cc °naE• . �4ro ca2: v-gEvEb .a .r" :°,1 ao_ ac � o , 0ovNvo > ooEviccy „„.?..--0p = co wC. gaacoY �zi 72tdp. C � viv €a wv� � = t)a Cocr® .� vfy1c4on1 ° e31 °rr9gI °°�.4.;.2E4..) d3, �v aw:c o Lv LivCcv cum.-0.,... 74-01.,: ;(4,14,:g• 0 coE m vUc= 3N"� .co EQco " b. = wy , v o ;. a� o.a� �w'dc« g v.5W ` to° 000.v ° oo._ c c "Mg C Ym �m E-�� LEa,,� ca o v , OEQ= .., vcOOeUs N.VaG v C vCF a-OOGrO °'1v. " a. . a o� •b °d z & uJtir )aN ~ Dp % 3� oAw xy o > y to' vy� uN4oUA aNvEvz ‘,3 m a ° c o - Sw'� vi c,: ° � . d °�G ��" a °°' o - w ,l) yr r ' C7OVU . i8 °fva p;ggCwb EoyNa ? SC w •0— ovac cGA3c ^ oiv �' ti v vmAdP�v .,..0:a x �b c ° . C= ' uoa3o " v *.S 0' �°° O2by tens .fisma at) Er-• an) timm unman E . CC FFsa /� cCtio 3T 2 F3 ,t, „ t :: t * '''''r6:44';''''4:-:' : ' . ''' ' fp 4.4,1‘ c cf1 d1j Na ? A � c a G oK ro1O2T / t yn r}l' Ys d is S udo4ln`°aaweca ` .. 3154:•- E o yY� ,h,' ,4154:•-z dr ; N0-; 7'''''-::” „ 01,.. a, -. 7_40 h.0 • HIN1 clinics set for Nov. 12,' 18 Jefferson County Public children 6 months through 4 pie who are most vulnerable for Health offers a walk-in clinic to years old, children and adults up complications right now," said dispense the H1N1•vaccine from to 64 years with serious, chronic Danskin. 2:30 to 6,p.m. on Thursday, Nov.• medical conditions, especially Ultimately, Danskin said, the 12 at the Chimacum High School lung disease; and healthcare and hope is to have enough vaccine Commons. emergency health workers. to give it to anyone who wants it. The clinic is limited to serv- Julia Danskin, public health She said that could happen within ing children younger than age'" nursing director, said on Friday the next month, probably after 5 and older children with health that because of a limited supply Thanksgiving. conditions. of the,H1N1 vaccine-it'is being For-now, she said it is hard A second clinic for children given out by appointment to prior- to know how much vaccine the and youths with health prob- ity groups. county will get each week. As of lems is planned for 3-6 p.m. on "Our goal at Jefferson County Nov 6, the county had received Wednesday, Nov. 1.8 at Jefferson Public Health is to get it to peo- 2,400 doses of the vaccine. County Public Health. Children must be accompanied by an adult.People need to sign a consent form and bring insurance cards, if insured. Insurance com- panies and state health programs will be billed, but there is no charge for those without insur- ance,according to the Flu Line. • Supplies of the vaccine con- tinue to be limited, so priority groups are being targeted first. Those include pregnant women, people who live with or care for children younger than 6 months; 0114 7%ti' s Port Townsend&Jefferson County Leader - ® visit all osprtal asks youths not to Public o clinics corning and B Allison Arthur of The Leader By �� rt T w For H1 N1 availability Children 12 years and younger 4,,,,,,,A1,. .,,,,,•14-',K,-.L-r 7- fF � • Call your local medical pro i3•2:ttr'''"- and people who have flu symptoms max. ,x � �' vides Pharmacies currently do not are being told not to visit Patients t• F xn- have the vaccine, according to in Jefferson Healthcare Hospital , , j �` • Jefferson County Public Health because of concerns about the , .,( officials. spread of H1'N1. , 'f` { Signs promoting the new policy 1'4,y?"4:4,4,‘i .,:',,,..-.- i • Call the Jefferson County Public went up on Thursday, Nov. 5 on °"v'''A. ,; . " Health Flu Line at 379-4471 for hospital entrances. They advise - v` r'd' "y,'";71'...%'.„ • information.The Flu Line provides ..v 20'9 2o Llu o visitors and patients about the hos .., • • information only and does not pital's new flu-season policy,which . ,� „�� take messages. Chief Operations Officer Paula + , ��it�i '7. g ---, •Go to the Jefferson County Public Dowdle explained Wednesday to ” hospital commissioners. s . x, ; Health flu information website at We want our patients to be safe '_ , Pg,:f,• fl' ti jeffersoncountypublichealth.org or and our staff to be safe," Dowdle - ,l $� :'. call 385-9400.People can leave a saidofthe -"=. .' t. z .m message after hours on the main policy that asks people g Irjr.--- phone line. to refrain from visitingthe hos- max,. .� pital if they have any ymptoms , k,.',;:!2,?'")),;.. .. � '; ` of illness. These include "but are a►*'�7. N E�4`p z Qt,�',..et'....":: ' ' guidelines. lib ,t. � Gvisits to the emergency room implimited to" fever greater thane % � __ degrees, cough, sore throat, , '0`10: 7.",".7-.,2.."` k ` sk g4 are up,Dowdle reported. runny nose or vomiting,diarrhea, � � -- "Stay calm and breathe.We will eye infection or open skin rash or ;' !'-' -*9' ' - 'A ^� get though this Dowdle told conn , ,d ,'�- , - ..,, ,' missioners. wound. The policy also asks that no Sharon Dauenbauer, administrative assistant for Jefferson Healthcare RELATED H1N1 NEWS more than two people visita patient Hospital Chief Operating Officer Paula Dowdle, put up signs Nov. 5 at At the end of a keynote speech at any one time. hospital entrances advising people of a new policy aimed at containing on Thursday at a Farm-to-Cafeteria Hospitals elsewhere have the spread of the flu virus.Photo by Allison Arthur Conference in Blyn,Mary Selecky asked that people 17 years and of the state Department of Health younger not visit, she said of a and Nov. 18 at Jefferson County Dowdle noted that seniors told the crowd of more than 150 trend throughout the state to limit Public Health in Port Townsend especially are asking about when people that she wouldn't be doing visits of youths,who are more vul- for children age 5 and younger as they can have access to the vac- her job if she didn"t put in a plug nerable to contracting and trans- well as older children with health cine. for people to be vaccinated for the miffing the swine flu. conditions. (See related sidebar "A 67-year-old dentist doesn't seasonal flu. "We are hoping for voluntary on clinics.) meet the criteria. We've asked She also noted that the swine compliance, but our house super- Because supplies are limited, that,"she told commissioners. flu,officially called H 1N 1,is a seri- visors are going to be doing spot the vaccine is being administered Julia Danskin,Jefferson County ous health issue. She said 700 checks,"Dowdle said. to at-risk populations first, includ- Public Health nursing director,said people in the state have been hos- Dowdle said clinics and the ing pregnant women, caregivers on Friday that more vaccine should pitalized since April and more than hospital are being inundated with of infants up to 6 months old,and be available after Thanksgiving for 500 have been hospitalized since calls for the vaccine. Because of then to children ages 6 months to the general public. September. limited supplies, it has not been 5 years. Dowdle told commissioners "It makes people very sick. released in mass clinics,as health Dowdle also reported that that officials are relaxing rules even ones who are healthy," she officials initially had hoped would about 50 percent of the hospital's about length of stay in the hospital said. happen. employees who deal with patients and that if there is an influx of She ended her speech with Although people can obtain the have been immunized and that people admitted to the hospital, the health officials'mantra:"Wash vaccine from their primary care the Quilcene clinic, open on the hospital could seek a waiver your hands. Cover your mouth physician, two walk-in clinics are Wednesdays, also has a limited to use more beds than it currently when you cough.Stay home when .ed for Nov. 12 in Chimacum supply. is allowed to use under federal you're sick. When you can, get vaccinated." This story first appeared on The Leader website, ptleadercom, on Nov. 6. Fluorescent bulb safety questioned This is a request to see an article about the "great" compact fluorescent light bulb (CFL) movement, with the advertised slogan of being"green." Does the majority of the public under- stand the dangers and the environmental ' impart these"green"light bulbs are caus- ing? As PSE promotes and is handing them out left and right,I cannot get over the actual sstatistics of the bulbs them- selves. Mercury—the same stuff we are all scared of: Don't eat too much bottom fish;don't break that old thermometer. One household CFL, when taken to the landfill, contaminates a football field of soil. Breaking one in the home can pose major exposure to the mercury itself. Why such a big push to conserve energy in such a dangerous way, expos- ing our families to such a risk, when the majority of energy use is in heating and appliances? I would love to see something written about this so everyone who is attempting to be"green"can see and understand that111 not everything appearing to be"green"is always what it seems.As a longtime PT resident and "local," I understand or would like to believe that the majority of the local community feels as I do. We are concerned with our environ- ment, our impact on it, our children's future — in such a way that we strive to make the "sustainable choice"' the "green" choice when making our daily decisions,with the intent we are promot- ing something good for the world. GAGE LITTLE Port Townsend • 7 e: • . --„ T: r °go Cf) .22;,01- 3' cgvug t_ e T go • md� m >2 cX a U E c c >c- d Foo-,t O Y.ugx`i6= 1 m�vCn i �C-S _,. 3 '- g §;3'-`24o Gp •a.08 ,6= Ta- 21` % U i 5.52 . -moo t g i . m a TU Lcl. �w Cf) . W E a s E E .x o f a c ¢ u=E J.J5 > �. EmUoa •o v... >,.E yw moi • >R W C C a v u•c z.3 o-624.-751 a.5 L Epic _ o u i 'G.l v 'O a 8 A 1 al 1' o �> a '.C.r C E ?- m "E E Ei - 3 . o °' -.c �--1 - I Q ° EE.zaotoD T EE .2 , -.1 a) �'mg d x ' o y 3 o1z o5U dC,-.., E . ," U 7s ".°ZCI 0 c u C:o°"'" 4' g.' 11...:,"?.Qo01,0 c .. ° .i •330 ,. .24.., •e5 '$ 5 a - vc, 3 n (1J r,3 5E2 �15z C ' ET g= '.=� a g , c . ! IJA 0,�i v cc �c YE15 % E o � g dB a � -Qar I � ^1 z 5 tiB . 1 i g ,, ° > oc40. 3.5.9.i. " '° CCA fro Oe C aC^/"' l',"6 F,''L LaLg 0 a ai(5'i C 3 § ELI/ d 'S: c, M Ev %. o ,.0c.5 uL. o 1-1 ii..! � ijIJI1 ° iii~ - c 8 P c acUO ; s U u^ co .2.--'-.'"J 3 ,iga., sa "vE"G�..E Ci) p = c co �T -.0".. EEgm . vJ tq dg EL o .11 () -W!AA qL. c cv OG - T. UI ii ak ° L _ oo3 zm � me > `"'Z C O aOd Z� ti V NY� ' G o. Z Yom. t® -� _ C , .c w"', > - ..21. ' NJ a7 Cbx.S y iu•J'- F. ri ® oq v' O_ E ,,.,.5, 3.., �w 18 E? O y C '4,>+,'�� oy� ec> o 0 v aoff °� ti c y�� c- c ° deo > ma, oq5 � 5�s5. Es ❑ m5E,o7. >-.. oo�._ �_ cc . 9 E „___.,.... F.aZ oma X33 rodo� 2-8s c --r, p C �. v i, ,- a'd a¢z m w �L O C - Y ,'-5,o c c.- I, -c r G cc cc i = 2 a A.� .E , =i.c •y y UZ 3 0 B o yt 7 c.c 41108 y -J.- r.1J AS C , 0�3 7L '� 3 cociY oamdvug E_ B536 ^^ i =r c 60 a> c. _ c '� .2oaom '� mg m .0 � 3 2L- u < 3 E_:_="1, F. ~ 0 g — N ,, 0 0.Q�'N y'3 v d ?U L z _/`T`J — y c0-`y,-o ,, c.'.4.3 C j C �...'o a Q C N j C G.g E4 O V ., G r� O 7, C C . .tiJ G - ,-'C Fu. > . -•' ,-v v C C 3 L W �r� 0 t d �. > � - A �,•^o c I u 's i C°�c+v a, m � ', °u' E o E 4y ,!, `'qq'�� m O N ui u~ a r3 > 3 >... ?,6 fE cd t.� ° E 00�j 0a O _ •-�° O`` C ° — 'O ' W .o C -O L C //� 3ov°1oT3Z3 eom.°�o�_c � o v 2. �; ., a0o >,E3•oEr mro � co3v f av�v °'� `�`oz_Fart.; q�g a� ` ., . s.5 o-0c agc o B . ..a d o.J''D.c o c vv o at p av •3 o$ppo = U g ">,° a, S•a gc v �y�4 o o•a E $'.u s rJ ci as aa, d o'0 . .c a co�U V: ® v R ." a• ""' F o'a>y m,6 C2 a g:,11,.. m a . E <., '^ 4� c - �' a, m v q m ani' my d N,ti et m E X . L_"- (I) Q. o u c � 36w a km r. -5a n3a c cE r - >. N— X 9a. g a o'o.'? E aa's v m.c T aZ ,1..;f a ;119;-?, 21'.! ao' '-- ac, m CO• (1) 0 "-C-'t. dc-:1 ”;°,513) ,?,-8 ,.-4g (L,-., m % cd oma. a � $-g g 6 .6] 0 . ° o ♦O • Q pp o ❑ mm3 u 6a a.. x.5 o .'.5 .5 e°o •.0"-,2c ic > c� • ' i4 , I)ro r hev, im m' mou .;, )2 ' m « r-1x �. ; 1m 21SJ* ' • 0co•. tx AVO ' ' s t ,a"„ z � Y " ;',„ •i*ra ‹,,*:44'' � y„ y ` ' 'c£ ., ini x Uy ' „ ,,_,N,, n ,iitt.aaVU : ,, _ r - .D a 44 • i Sy ; N W•QA m s r, ' ,� d'rga, " t x• a �. -, ,, .,....,4( ,,,,,,,Pc itis, t 7 +i4 „,' " 11 :p E. `m -1 ,,e' +,''az S•° r, ” 4 5 Y +? Q pVp v c_ c ro co a� ',.¢ � �. a.b O H Nom. ;� .>c.'.- Q i ,,, �, . �:� } °1...1.-• .c r„, 3 a)-0 a• i 4,..i...4 ',,,,C;g:-zr-t, ,,33.'..`°",:1-1P4,--'-' 11101-''''''jp:IT,:q;1-,Ak;?;.'nariltqlrail4A451.-din, 1= 7 \ ° Cl.�rs . ....',,',6V..,..4,-,:l'-'+.(14,,,r,474.5. tCCE s4140"' cy ON 'b... i � a'7 CCvC v� T� 3Uc o ro;nxen c qCG m N o ow s �� , � r ;' m" `B4.?"-'72- '.V U 0. a . ,. 9oL 0 C :I:7: a�� r—a 0 (1) • > N s r rti, ls, W W 0 0 ci, .1' E, ›.' .Pc'. ct ,'.'''''"''''':-g-',;,a,vodi 44/.r., .., , Z.- i.?}At '''':.:4:..ce.:44‘-.1,e,-,,,,zm-f4ze.tiArtee,,z. J litlip t.j..( ° ,T; >,-4'•,-, C.-% c) ',''';''q-" C"'4e:AT' -1.7.-',".it.:„_ ;,i.,,,, t,,,, .,,,!.„,,[41::,,, ,,,,,,,,„?4,54,,,,„„itretio,iip: , 0 g;} L a _.$ "VJ Dog 3 - ° � Y ` � a �>, es-! oo . ' g. � g na c oo C ° • r--14g 1; -.^. -'- (/J 7 F ro'a> r ",i=ye7 'y n1,;1 ; " V O - �_{ o vv)i z' Aa , .>fi�'4t �a3•'a:,..µ .„, "'a.�'t ` ...«,. ✓� ,-,-.-2. J O Ip ac 'c3 D m v J 47 a) C '_' C .�'J -� C t' C n`f @ f C. C = - Z = `. O S--r u d c 8 = Q o- 3 c c 1 ti _ -,; 6...:,..., > ^ =J _ y _ c ' a� J o o 72� c �b ° v. cs� anN vs ~ ` 6c J 7.) O z 8.5 h• _ v c 4 `_ �V 1-� s W_ P7 y v' :c ` avi2,.x > a . 1 . ° . . ° , ° 4 E 2 ��^'E'—=:J oc D, o u ro c c. v,c0m 'O I '- 0-c_ c ,_ ^r. v_ ` vz v lc 11, .� �-1 !l z C x .4.,'. C G . 1 ,,, , c G c 1' o C n ` _ r C – :L - _ ..—_– – _ 411KO c e pr� �L 4 qd cd J ro j , 5 C ,- 7-' C C C i - T �/T I cad cn o0 3 ° v LL !. C :C ...?...e. •• a m d E y a6 y dl >'. °yy.a t� -- 0.- Z N ?�k O p 042 .0 5 y 6 _.h p o bD G7 d w0 . `Sil- o C 36 g ... 3 d m :01 ,11 OQ3 e - t4 os 000 o` % o $ ma to' ,..1 e0 >,a6 00 ,, 'ad t p oa XO O%A co m.5OO °' '°1yb ':0 : d mm +a, a mc �� s 'm,gg•g �°im l EAcoa8ddtcca ° .map w ° „ p 1a V 2' Eg to N -. g m a, a. a a,E V a ° (j d c a .g .15 ' -.a8^ $ ;Ea = g6 0 0S .�•' o ,1t"ioeba� a °.[•5 o3o3y -2 4UF ram yO awO' tl O'E � Vi3 $�_ `P ' a N dC •. E oFm C dN wa.am r.,.;.&) odo„> oar bo . � . • 8. � c 8 N -• m0 co 2b 8 ''• A - 8o 0 •1 ° mr0 aaCS CCI Cl Em ' 83g N � • . ' m0 : . ao-m •, 1.4 o0 � 0m mEo ya3 d~ '� 00aa - - m ...-.0. 4m0 _ .§ o . ada a2 cd � ,o R' atag> . aas 0 A. d v~ .,�. wCCC .0 � � a �0 •.3 a •n oa� 40-6-0,4 Am e, i A0 2 mdm •° g � d. eba ;d Xo•� �.- 0) .od m'q Wa 0.04� �,m 4mb b, a ti. 1oat ; Qa 2-� 0 6g � 5 � g v.c-� 0 ' a�.ax6oa -30•� .am� 0 £ 02 8m-dw oom.�g " • m8am � y gA 4o3oaoVo` $.2R ,2mG .w � .4tFGa3cl, SE •o � >`lB 6 W. ' r 'bt .,0 , dd- 3 . 1.e°_,.3 0 E ° D;.No2L2 a °5 .0.bB mai E 2 ' o nt -- mto3,2 E > m8m� 'o.0 . > - •i-d oopbm2 `"3g.oa a A8.56g9awmGas wyp• '-' 0 1. a , 5ad0ap .+p dam 0 mno ., ca� 8c b ” ' vq y „ t mdO � o oeo •. . y g y a».:2 47 w : � pr.... q g3Co •^ p .. , �a3SJC aW t.' d g m. ea nom 4 of ' . oilOI1 cm •E.0: yE •t° Eus Geo rE = ' m c' ' dyai5Vwa §1.88.` ffid •b; earth ,, ,,,..d 2 7 • workers 1'4 , � Ili asI' ll �• ..) aa0 crc. tion O Bald oia, °v ,e ap > ¢ "n N N y• > 47 `CQ�` iFi masks o O5.4 l' Hospital enacts ''n-' 4 , 8 8 2 x e o �I .8 °,2x� ;z Oro 8 ; a requirement for , �-x 3 0 a N a) ,63$, the unvaccinated - O ]` 1 3 1 t co By Roe Ou.ncnn�rery > > R g Zg g PENINSULA DAILY NEWS PORT TOWNSEND — Jefferson S',4 3 ca c o Healthcare hospital has enacted a manda- _a?.-6 3 d tory policy that workers not immunized a Sad -3 a�'0 for swine flu who have direct contact with y a p w a C a patients must wear surgical masks. o.0 > ° N The policy affects c ? E •G a S. 8 4,,'.0 c direct-care staff — �-1 •a, 5 0. �c a doctors,nurses,recep P -a a. ''-,..8 3.4 o g tionists or anyone .-4-'41: (1) E v �' E. N who deals with the 21;11"° r.4 ' ? .0 @ oz o ca > public. It went into , °m pa Qp x 6 ' effect Wednesday. �4";11.. i!i.5'u - a x "We do have a pol- } •. i in lace "`" r .f Y3 r, 7 ae >,° • those who have chug- 14,,,,,..".1t,17,.. ., `+� .&.),..4.„,°a' 5 �i E sen not to receive the x r ' . ( ) e v t c H1N1 vaccine to wear ' �./ cu 2 v 2 c v a mask" I�rri Camp, "It's a patient o T iv 5 ='ao' °v chief nursing officer safety issue. N 0 - �• ` _ > at Jefferson Health- 3 0 $ ., a care,confirmedThurs- It's.-early tied b ;� z —fir-: into that .,._.4 p.�o 0 ; s i 0.x it mandatory" pted to make mandatory V v g 1 o ;1 g About 70.percent vaccination of Ci)Cl) 2 8 5 s." ''5, 2 c of Jefferson Health- health care care's 400 direct-carea) a, wv, N a, a vi. staff has been immu- WO. ''' }1(\ „ . , 3 E '5 °-,2E nized for HINI influ- �,JJ� -0,.1-s' S a a, ,4 Q$ a enza,Camp said. Jefferson County - .) 3 That leaves about health officer 120 employees who °• x u. t a >, are required to wear a mask at work. 0 e a x ..� t 4,..J.5 5 "I think that's a good idea,"said Dr. �„� g i�a a $, 4 a)-v Tom Locke, public health officer for Jet Y a' ° ° y Z T ferson and Clallam counties. o- y a Y•„ C'.W 'Increasing trend' „ '� ¢ 3 B¢ a gi "I think that it's an increasing trend in health care facilities.It's a patient safety N p:.•.4=g issue.It's really tied into that mandatory y 2 y E p" E. a .b vaccination of health care workers." °x .o M No one is required to get a flu shot,but mg 0 5 .c a ° the vaccine is highly recommended w ;.c 3 -o ar c "We've been spending a lot of time hay- t y u ,n %.5 cw Dt ing conversations with people about how (_a >-97°-8.2 to important it is,"Camp said. iti o g 0 E For the most pact,employee reaction U d has been positive,Camp said. o u G tf 3 "Generally, I've heard support," she 2 A 3 }�„ said. x v 3 E= °c c 410 Olympic Medical Center in Port Ange- les and Forks Community Hospital have not enacted such a policy,Locke said. "There's certainly been discussion," Locke said of OMC. "At this point,nothing official has been done." TURN TO MASK,S/A9 P2)/1// U Q V a N Ta t . v 8 .M� p � � �� Q: .i E !F :I . , F; y O ad >, 04:4 G 0 9 V2 9Q6 0 - : 2- . '470.8rg1 t,Ei, �v °-Ka.,8 g,�gg8Tg 8� ''q� 16.2.43,-a; O� 4: b-2B��aH.58.d5 w .ot- a °'� pN cEffiQN D a• ' q7-41 .5d CD ;� 3 d a to y 25. n 0 U15.-2 8N , •va 13 A N 8 E 5 O 3 N •••?3c,ig iii i aOtAl. 0 t °g 4� •8 R.o aos8 °a' •4 0CS wa1 po-scogAa ., • 4. 7a sN . d a a w�la Abp gAa ai.r� Z .2/;,04''i tiItU. 4Hd tU co A•ux1' s ga ti - g,... 0:b'l S.,0A (142it .� cu. G.�'; c °° H .-+ o v m ° a ! 1i IV � .G � Cq LS : EO ',N, I .. A.. ,d .x3 p�( az .3 5N�: - _re 4.4 .._1 :- i g„.943 • ^'/ ;i c 8j' . ,...1i-,,11r.) . 8 ��. !c7. I to 21z8.5 z 8.5 . c C 8 z 1/G N: f rr--{{ po ,a ..N R a� - 7 O ,•! ��--11 � '"'t+- twtA V O�jpM app' .Otll q .oEl- -,4.2-s �.,•j.:3 ,o y u �C�...5 ° 2. �Q 2 qp'82a Op Oma• x EO«, `:cillVI O (/) E•,(9s� p ,-�- t~a «�1.a�!§IPIiJ9DL Uy - �to m' o _ CV El N d i:■ O I;, co �Sy 41 b L7 07 R - C u.� }a N � 1• O ffi � �:6P31:5 � �tQttpppp T G 440 � . P� 11 S m _ � � affina0.$. do ��`� oraffi• a � c a L� m,� /� ,^ '4,0=3-.. - -z_ T a o• •£ - g 'a at. t> G d 8 a ffi g . S a t -0 v-,F. ice: ... ��+" > d d� „,-% ,, ' ,.. A xa' a ". 00 .5• 0 . v aQ � V♦ ,•• - r Q 'Ee :.. uM -," • 0z-•8v . a .0E 5 , �j•-• 7, 8 _• .hyo_ =" �� Cd �q H d� E:� g gA o H•9 a 2� o g ) 1-44 � §. - 8 c� c'" d O = L •.� ^c U. ,� a..,?, t= a � 5 a.•° 0.4 a 8�1, .b ffi,b 8.°) 8 8 •,,, 8t 4.• ) 8.14, : V8a ., R� v m U 0 � � 4 � �+. �.."7 '12 ' �b a 7' �-��.ti tU��2 tU•I. a �� 5 �N � v 'C'C �z � � �mx �� j��ii:� 0 bA xi xN�.48 &• 7:1-u<a 0.mE38E 2Ho°.°� '�3 � �a? .c ox o' CH 0 i ,. ,-.'.-''7.,'1Pott Town&pt1d&&°Jeffetsoq Cdurity Leader 13 srVJednestfay November 18,2009 gy .' ' P5t fix''9.Y l: ibTt 4 ,,f '1 f t - Thet mencn'Cancer.Society by tgning=up fd�r tt`Rrl lom fi`om tobacco Call- 800-,QUIT=NOW `marks e Great American;' S*mtilt?ng;' a L b cc`o essation ' and` speak with a trained "quit Smok oltt ov 19`by'encour.: lass; t)Tef•f s¢, Ole,. AA1so coach„ .about how to _double xi .` 1 aging Stnbk-ers to use,the-date to , fered at Jeffe.„,,,,,,,.„,..,,,t,ealthcare' your chances of quitting. Also make.-a p1 Jo quit:or to plan in is a'tobacco-cessation sport check out quithne com. f. advance.-aitd quit"smoking Fthat; group Cal! 65-g2Qo, ct=23;00,' Jefferson County Public days R for information.on both T '''. Health'Tobaccel.'Prevention and By doing so' smokers will-be Researchers say ram that quitting Control Proghas a completetaking a step.toward health : .smoking can increase life expec- list of local resources to help poo- ier life -gone that c zg, to• tancy.Smokerswho a uitat q age 35 plc quit tobacco;-.:Go to Jefferson r ci„ 44c�r,risk cre gain;an average of eighty t f 2 Jtountypubhchealtti org and_click Mgr--itirl,�5 �1j iiih ays,14 say the; life expectancy those,wlitti t t l on `Tobacco under "Health," or fr„Amdriea�n dancer Society,and. age 55 gain about t er E r ,arid",.,contact Karen Qbermeyer at 385- local health officials. ,even long-term smok.�e quit, 9400. ; Jp4ferpgn,,,Cpunty residents at 65'gain three ye n ers The Great. American can talc j steps,:toward?qui }iig< �v ,. t T3,tofi ,. a*'� everal Sgiokeout website cancer.org/ iophon to,su p .. GieatAmencans, contains user '1'`he Tobacco-:-.. .t ne friendly tips and tools.toward a supported by the;;;Wshtngton smoke-free life. Or try 800-227- ate,_Da,r •zl „..2345 for./to c a lkon and 4, a ve '•-•.,-4-'11 •' o ..ac mg seyices.h�t help 1.Program,is a free so,� c i ip-; ' increase "s%,,,,,S chances Of port=for people who want toquit quitting for good. .... r . • f 0. 0 y^J ) 25 4,1 4.0 a :: amici c LL r (Y)•V x. e S s ..2E 8• civ Q 8 !- j g it.t>1 1 SI .o.cv2 =a,�.• ca c�.2o,b4�.0 8 • 0.•c�° > m.aac�_ - 5 8 x a — 1C N C � Zc > C i C > u:,/)., .. o cou -0 aro o aJD RIJIIIJ to .;_ iIHil �` ' Sd _''� '". � � v� p u 0iEIIu1PH5I1I � vv ,..§ o ' q o 5 " u[ ('2oco 7 .c v ' a�:L -5v Ill ,14 r ..� 'D OAA 3 _..� -` . • � . c ::g . : . =3aa -6 . o 672 u �:,.5 N E •vo bo-6 a ti vo caCy) a) v cn a c wv o, v « •= o o0 -LJ = 3 ` im ..0 . v, = •52 Tvxu • J cvca a) = o ogm a v c PO C C a) O � G 4,1-1 lir`fig "^+ $ -- � fl �n� o a•a 3� a, ; , o.-+ b e D u� ccs,v c�^� 7 mc1 Q6 U V oCO) . 'aa""z • n.tr4--,. g . /� v:00.C > ,-, _ p w U v F o y.a =Z• ay u aJ > z E dco•c c.V 'Op U U 667) V Ri .G -- c a.•,.•�oD 5 _ � •c a) '= >o-• >--- o� cv • � � o ll, • m � N a U x c, U 3 c(I 67 3 ax'6)=S ..o .00 `3 °' V Li, 0 li 0 .1.: ,-,.....m 4__J • 0 . „ _. 0 _ ._., ,... 5a ,ocZ. ^ oro :. � k • 4.�'� oya a) ao ° ,..ca" -c',..°) -o �yo vo ovV 4r/ •� oaov . 20g), °-suEc� v coE- u 'N 'avqa • j. a l .— c • o Z.). (r) o E •oav a) o .rig a67 '4;,j.:. • . 0 Aw}. ti-c �uwoc67auacD � •� :c845' 42 0N6 - } Jto 01., � • 0 Y1 ':' _ 'p E . aaGoa `•5'o 'eeo5oEco Y...Y , c . ,Cc . . ,,a)CQv• NVo67 m en > C C co; N 4...,- o O a t-' 0 Q.xs b 5 a) 0 0-.0 V . imml■ q c 14 co o + O o � E- > �.Sam — c •u fl0P rvL ' h . • osi• • "-I'm not proposing 10 layoffs from today Courity Ito 20101," Morley said,but additional lay- offs avoffs are possible if prior and proposed staff cuts can't be accomplished through attri- tion. Employees potentially affected have ® been notified,he said. During the past two years,23 positions have been cut,said Morley,although sonic of them were vacant. The proposed 2010 budget has 287.55 full-time-equivalent employees, which Morley noted is fewer than any budget since 2(X)2, when the county's population . 2010 was 9 percent smaller. - Employees in the Department of Community Development would contibudget n- ue to work just 36 hours a week, taking Fridays off, but most other employees - whose hours were cut earlier this year - will once again work 40 hours and receive cost-of-living adjustments. Some face cutsMorley said. "[ think it's important for the staff that we have a full work- ing wage," he said, because competingsome get raises jurisdictions generally pay more and could lure Jefferson employees away. By Barney Burke 4' The countyclosed four and put of The Leader t` parks See BUDGET,Page 8♦ Although state and ; 4 local voters turned s ``. down Tim Eyman's lat- est tax-cutting initiative in November,Jefferson County is looking at another tough budget Philip Morley year in 2010. "The picture is improving, but very modestly," County Administrator Philip Morley told the hoard of Commissioners on Nov. 16. Even so, another $700,000 in cuts will be needed by 2012 to prevent addi- tional service reductions, Morley said. And by 2014, he said. the gap between general fund revenues and expenses could grow to$1.9 million unless condi- tions improve. "We were fortunate the last seven or eight years," Morley said of new construction boosting property tax rev- enues. More employees could still face layoffs, • Morley said, although many are to he returned to full-time status and given cost- of-living adjustments. • • 7)7 ' ` c ' • A 8•Wednesday,November 18,2009 cl) T L. e -ct Budget: Cutbacks are painful ' VContinued from page 1 services to pet owners. office building it purchased from 12 up for adoption (11 of those "Ws been the most difficult Dr. Jim McCarron at the Castle have now been adopted, in‘lud- . budget year we've ever had,"said Hill Shopping Center, and $2.4 ing Chimacum Park last week). Commissioner John Austin, "yet million for emergency operation The Environmental Health we've had the most cooperation center improvements. REET is Department is now closed on and creativity."• to pay for the first two projects, Fridays,and family planning and with the third paid by a dedicated newborn mother services have PROBLEM AREAS share of sales taxes. been cut as well. The total county budget is For 2010, the county needs "I want to emphasize that $53,260,531. Of that, $15,634,625 to pay roughly$750,000 for debt these cutbacks are painful and is in the general fund,which has service, Morley said. To meet impact services in every depart- been hit hard as revenues, espe- that obligation, Morley said, the ment,"Morley said. daily sales tax, have•fallen dur- c6unty would take$251,000 from The proposed budget shows ing the recession.`General fund its equipment reserve fund. potential staff cuts in the assessor's revenues are expected to rise 1.5 The county also plans to contin- office, auditor's office, District percent next year,with only a 0.3 ue drawing down its general fund Court and sheriff,among others. rise in expenditures. balance.It is pegged at$2,415,665 But while$341,278 (including 4.3 Property taxes are expected to for 2009 and$1,876,092 for 2010,a positions) is being cut from the be $7,050,800, or about $366,800 drop of 22 percent. sheriff, $364,436 (and 3.0 posi- above the 2009 level. In addition, the county plans lions) is being added there as However,Morley projects that to divert $216,000 from the road a result of a federal grant and a the county will receive $200,000 levy to shore up the general fund, contract with the Hoh Tribe for less in sales tax revenues next in 2010 and probably in 2011.That police services. year shift is temporary,Morley said,as Morley said employees identi- Investment income is expect- the county needs that revenue for fled about $1 million in budget ed to decline by$100,000 due to projects in its transportation plan. reductions for 2010, about half low interest rates and the county's The public hearing on the from a 4.7 percent across-the- declining cash and reserves. property tax levies for the general board reduction and half from 'BEET is also a sad story," fund, road levy and Conservation "cross-department efficiencies." Morley said of the real estate Futures levy are set for Nov. The county's animal services excise tax collected on property 30 during the regular Board of budget is expected to save$9,000 sales. It peaked at$1.5 million in Commissioners meeting. The by no longer offering cremation 2005, and is expected to be just county plans to take the full 1 $480,000 in 2010.REET revenues percent increase in property tax are used for capital improvements, revenues for those three levies, but the county can no longer meet and used "banked capacity" to its capital debt obligations with boost the road levy further. REET alone. A hearing on the budget itself • The county's outstanding debt is set for 4:30 p.m.on Dec.7,with includes$3.1 million for the new adoption scheduled for the regu- sheriffs office,$2.2 million for the lar meeting of Dec. 11. • i 0 Wednesday,November 18,2009•C 9 { yam 4'a L---.J.,',47, .+' °"P z y +sp�"• a ''"s� .fir,4 Pte° a.^s � a � ., t 'mow, vz - Y .,-T x` '� ts4, a ap,. '''...% 0-, .tea �., 111 may. , Akio'' ` t of I % �'." ; - g`� reX-4;gal t, 14 ' ;;54/;;;V:fr ilti,:.'''',:". '.10 - --477=r4,4;‘1,r'.T,.N:...,.,,, '''---4.1„,tiljaWci _ _lt Eris - _ � -'-- 4,e•-::., -- -'''',1,, .,*%tr.' -- , 4.,4t,..7 .".4,,,,,,,,w44.,„„,:i4p.:41..... . ,..,,,,..,,,,„...,,..;....., ,_. .,..„...~4.1..1,,,-S:%,,lt ,t, r Y ,,s p '< 2., ,f $ ' I,W,I, " C ' �$ S ".*,z:.',"e-r'';Vi4-1:;-''-':' 4 # � w '` " %:s _ I F r,0''''L';,4 '`x q i;, ` �.- mr� 4 ; 4 ,- �. a..bt -sem n Vis= ,� l''''':'''Alg;''---'--1-'1';'''',?%''''. - 9 7:'464. v '---—r`. r, -:= •t,.,:;',,vi3„,-;..-',5474-,,_.-.:--:,.4...p443,441„-e.,3 ,-:, ,,,.,. ..,,,„,,,. ..4„,,,,, ,;::::„:„c„. ,.., ,,',:r, ,-', .:,` -.:: --,;,..'„+-' er.,"';4`,';',1e''.'`,---4.:",r.- 'P.;,.'?:=I.:`,4;,_?...- Girls' Night Out raises $3,000 Paula Dowdle, chief operating officer of Jef- ferson Healthcare, and members of the Port Townsend Main Street Promotion Committee present a check for$3,010 to Julia Danskin, nursing director of Jefferson County Public Health.Money was gen- erated from sales of"goody bags"to customers attending Main Street's annual Girls'Night Out event in October. Proceeds benefit the Jefferson County Breast/Cervical Health Program to help underwrite cancer screenings for local women in need. Port Townsend merchants donated gifts contained in the goody bags.Girls'Night Out sponsors included Main Street,Jefferson Healthcare,Port Townsend Wed- ding Guild and participating merchants.Pictured(from left)are Dowdle,Danskin,and Sue Arthur,chair- woman,and Judy Rich,both of the promotion committee.Photo by Jill Buhler , • , • 2-z-- f .. /., 'j % ;/f 'Y/f` < .. 1 r/ ' /. .... pg-,:*--,:-,:_ it.: _ t tc i s a SLY-:x t .6 b g• g h N,°°., _. ,4•4 1 m c -,*(_,-,„ - _. rk,-.-1----:,, ..Ar ...S`"0 g tig tiA 'zi.-g:o ii.i.-,6:`4 ce-x'2 ti ,.... 1 �;5.-7::i)-7‘,1 'Lt Q Dfri �- 3 � 4IF1W1!LI4V:t, z +'� m m.od a.til E i m l 1 s. g-.11,g a� w m f s , e=1.-:ii-,10:.:,:k,.: +{. �1+ 7� � ys- y�'m . gp�1y1?+�CA`�°' 2, ,91 .5 0m2yi 4y "wm u�S ' 1` 5 3 �^Ci O'-d m is '- a3 @.- �0:. - � .. ._ 'OA C' F Ph i� O 4g .7 'F.Y 7 xi Q c�o e .� # �C o ?4 A� ^.. " E kg.w•ami gt m19 ,0.a; 0 v > 0' +3- dil ,,,, 03 6424,610 Wgitkli 'Vs A Z � �*', "y o 'w R'. 8 p, �' 7 i..Ny " •b ttom�-' o a• °� oq'F-' +' a� 4 -g ,, ,, IA' o o 'bqGo�'S3 a 0'Qa.> W §,., lii ''q' .do0 Li mmO d cig o . 4flIi1WflflfljJth1i 11 �� v_ .--i .tlR. mmpp• a �� G• ° d • "" - wGp71pv,'T . .�^ N. O u Oxy ^z". m ii � °• '94 f - m °oao l .� c q o' 0m ast ' ` lz: , m wq °mwAS � ti-i . " +> tn ..r,,- 4-,g0°). JillA 1.1- 1 -,141 0 `rd °® evaowb Aaib CDa .° > 0r ' A 3 > 0- ° og 34 C $ 1m3. Ts rWt °' = 4R� _ Qxw `, .5,t;t1: -0%A'd +` o § 2 dmm- r� Eayog w' >" bma ' ° mrt f -: -, ~ o '! 0 ' o .,o �' ,oim T q7bA3= ® 1 cWgyy, m g• 940ar 7cd'b wIA:: . y ▪ m � oU]..� 2 d'�r- si- mo °� a' g -,d .4 ym a' 8 5-5 3vroc3: * � • . oOI°$ 0 . °' o4c Aw 3 ° 2 t• te - p $ q p � 5, -', - I 'dp .2 �o mC aabdm' ' ; : W pAIq0 . 4 c, O mcoo2 4,4: f- E4e" ap b3dI1!I1 b9 A w� E OE 4 � `�- Q LL41VL • N q °£ z 0 1 0 �L " qd N • Aase rz 4 718:8 0 Z. aq 07= MI 03 /Pe .., •...4.,•_-_-a,:•.---.';‘:,-- 1,1=-44f,'z•,. ..-''---,=•-t--seTF-Wi•-- -41., ?',---,-7-, == 0 0,, • 0.8 � 0flH1 � � � N cu- 10 � Ca� �"�� _ jg � ��s � a3p• ++ mm• q m' ° PE3m f m ma ow F �• E ° m �✓ db4t dy+m 49 1_ NOMOW � 3,-. ,P• .5o ,-.' t'. ;itii O O5v +.• ct 0 1Ii o S"-' a"Oo0 i 0.) oaa +. aa' gra) p. Y. mm �. - m '° o gi .° ° m8 da ^ oY q 'Ua1-b mai .' i .iwd 1 cdq° p, .d m .w� moacnR yq�m5mObb �ti3 :�A4102 � a , � �4,. tz � mq ma�0U/':8vgp oq> ", o , aavqm0aqpd5.n ° d a .d„Ic 4S .. m d -41 � dg ,n'a oC „ d aI 2SEx m, C# Em, o „-it kA �bg �VEa �., iijij ; mms iyy V -r� d .. " a da4aa�° g� 2vdmm4 � � 4`1'165I''''' m- + qsv.:1, 1 a' 0' Lmog - to a) .__, o. m go o a, pa 4a1a, q ti ° 'mZc-1-Qwa "gw1'.01.qa .g4 dmoa. nE qy a : 01b q5 g,-;ii- mb . a dm a C 8'. aawdaqa' ..0 . 45 „ O mV °.°• m n 3• m+��d ,ohs Z2 `.1), .•' --, 4o .E v 1,-,qrrz-.� ti E'g Bo+ 1 1 o- q,a . d ° N d b] m � q p 3 °/ O � 'Ca) „ I , O ° ° . aoic g 4 ',a ,o0EC5 48.1 ! Ow 1111 axa2 w a 'O .-+ ,, - ww ' edwWNC E'$e1 dc) 00 ' 4) 6 % mc' i5 .`.=... ' "" ^ w .. q .4.2 - " .-w-- 'Run q0 p• . mpay enS,8 Tloo - U..;g'ba' a: Qiao14 imq.>o.q °� � "'i1A1 ,Ad' q i - zzoq $ o10;§md ° fld 5wo^'dbyq.0.qiqmsw �� .qfly' Rgm s- >,-4 , , "_1,4 + 4 ~5V� tx �r Il l y '°p °� m4qa', Eq-q� 4.4e..• o.G.q.1-1m-iadiomm3 Qog.qm.5.iarn o4. � o:• ym I ?542 ro : 01 " 0 w.i b '''t ^C wAwy •,-':' O'da 'b °9'''.2.r. ° g' m Ua °1m..° 3a' ' a'.om u^ , a ,.,8qpa .cgw00. - A',,.,-,s',.2 54d,, & �.,>Egyam. � ° . c(1)'° 8064''1E2,2 .Lys. �,05 °' 4d0C' _soyrd ' m� O � L OA , 'b mvy '2AUbAHPO ,r' ..O w N 5.0. .-+ .a'o a .n Port Townsend& Jefferson County Leader's news website I H1N1 FLU: Health departme... Page 1 of 3 PRINT • , e Daily news, connections for Port:Townsend & Jefferson County, 'Washington Wednesday,October 21,2009 H1N1 FLU: Health department conducts walk-in clinics By Allison Arthur of The Leader Wednesday,October 21,2009 y ` ° * ~t , ' - a :Children 12 years t,,,,t,,,;;;, ,,„4„,,2t.:,211'''''':' Walk-in clinic draws � sand younger and people who have flu Sixty-one people were immunized at a� symptoms are being .�, � public walk-in clinic conducted told not to visit Wednesday. Children must be . patients in Jefferson accompanied by an adult. People will : " 'Healthcare Hospital need to sign a consent form and bring pl„ )• : ' w because of concerns insurance cards if insured. Insurance 4 _about the spread of companies and state health programs H1 N1. ��� will be billed, but there is no charge for . � � � those without insurance, according to 0 F tg Signs promoting the the Flu Line. Jefferson County has new policy went up received 2,700 doses of H1N1 vaccine ,:',,,t,,,„*.,1=t4,,IT'cliki.L,J., ,iti ' ',� ' Nov. on hospital�� p so far, enough to cover roughly 9.4 t "' entrances. They Y percent of the population, according to t advise visitors and the Jefferson County Health patients about the Department. "Vaccine supplies have ' "' y k� hospital's new flu increased but are still too low to season policy, which vaccinate all people,"accordingto a Chief Operations health department press release issued Jefferson County Public Health nurse Marty Johnson Officer Paula Dowdle Nov. 10. Some vaccine providers in immunizes Jonny Rogers, 12, at an H1N1 vaccine explained Nov. 4 to Jefferson County may not have enough hospital district vaccine at all times to cover all of these clinic Wednesday at the Jefferson County Health Department. Sixty-one people were immunized commissioners. groups, health officials said. Clinics will during the walk-in clinic. Rogers' mother is a nurse be focusing on vaccinating health-care "We want our and emergency medical services and wanted him immunized. Rogers said the shot patients to be safe workers, pregnant women, children ages hurt, but he smiled through it. The next clinic is set and our staff to be 6 months through 4 years, and those for 1 to 4 p.m. today, Friday, Nov. 20 at the county safe,"Dowdle said of ages 5 through 64 years with chronic health department in Port Townsend. The HINT flu the policy that asks medical conditions.As supplies hotline is 379-4471. Photo by Allison Arthur people to refrain increase, people ages 5 to 24 years are from visiting the offered vaccine. Health officials say they hospital if they have any symptoms of illness including, "but not limited to"fever will continue to evaluate vaccine levels (greater than 100 degrees), cough, sore throat, runny nose or vomiting, and "will adjust community plans with diarrhea, eye infection or open skin rash or wound." our medical partners as supplies of vaccine increase." The policy also calls for no more than two people visiting a patient at any one time. For updates on the flu situation in Jefferson County, call the flu line at 379- Hospitals elsewhere have asked that people 17 years and younger not to visit, 4471. The flu line is operated by IDshe said of a trend throughout the state to limit visits in an effort to contain the Jefferson County Public Health, which spread of swine flu. also offers information online at jeffersoncountypublichealth.org. "Our phones are ringing of the hook," Dowdle said of clinics and the hospital http://www.ptleader.com/print.asp?Artic1eID=25471&SectionlD=4&SubSectionlD=4 11/23/2009 Port Townsend& Jefferson County Leader's news website H1N1 FLU: Health departme... Page 2 of 3 being inundated with calls for the vaccine,which has not been released in mass clinics as health officials initially had hoped would happen. Two walk-in clinics are planned for Nov. 12 in Chimacum and Nov. 18 at Jefferson County Public Health in Port Townsend. Visits to the emergency room are up, Dowdle said. Clinics associated with the hospital are being "inundated"with calls about the H1 N1 (swine flu)vaccine, she said. Because of limited supplies, the vaccine is being administered to priority at-risk populations first, including caregivers of infants 0 to 6 months old and then to children 6 months to 5 years old. Dowdle also reported that about 50 percent of the hospital's employees who deal with patients have been immunized and a clinic in Quilcene,which is open on Wednesdays, also has a limited supply. Demand for the vaccine is higher than supply and Dowdle noted that seniors especially are asking about when they can have access to the vaccine. "A 67-year-old dentist doesn't meet the criteria.We've asked that,"she told commissioners. 111 Dowdle also told commissioners that officials are relaxing rules about length of stay in the hospital and that if there is an influx of people admitted to the hospital,the hospital could seek a waiver to use more beds than it currently is allowed to use under federal guidelines. WHEN TO CALL A DOCTOR? Look at the Jefferson County Health Department's website,jeffersoncountypublichealth.org, for detailed information on when to call a doctor. For children, parents should seek help if a child's breathing becomes fast or labored, his skin turns bluish, or if he isn't drinking liquids or is so irritable he doesn't want to be touched. PSA Video 411 http://www.ptleader.comlprint.asp?ArticleID=25471&SectionID=4&SubSectionID=4 11/23/2009 • H1N1 clinics set • PORT TOWNSEND— Jefferson County Public Health will give H1N1 swine flu imnaunizations at free public:health clin- ics from 9 aan,'to noon Wednesday,and 1 p.m.to 3 p.m.and 3 p.m.to 6 p.m. Wednesday,Dec.2. Residents with no insurance can receive the immunization at no cost. • Those on private insur- ance or state medical cov- erage are asked to bring an ID card or coupon. Appointments are required for Wednesday •and for the 1 p.m. to 3 p.m.slot on Dec.2. For more information or an appointment,phone • 360-385-9400 or visit* wwwjeffersoncountyp,zt,blie health.org. 14t, • S . • • / ) Commissioners: • set aside your pet agendas Once again,the county commissioners are being forced to cut budgets and lay off employees. For 10 years I have been saying at the Monday morning public forum that Jefferson County needs enough jobs and retail stores to meet the needs of people now living in Jefferson County. We are to§ing millions of dollars in tax revenues. Until last year I was told that there would never be another recession in Jefferson County. I was told: We have something truly unique, house prices will never go down,and there will be a steady stream of rich,retired people moving here. The anti-growth, anti-business cam- paign, and the attempt to micro-manage rural property was and still is intended to support the real estate bubble and promote - • the commissioners'personal agendas. Jefferson County doesn't have an ade- quate tax base to afford the level of servic- es it currently provides.I believe we have • exceptionally competent county employ- ees.The flu outbreak and the murder trial • are examples of the need for adequate ft nding for the health department and law and justice.County employees have made a long-term commitment to the county, and the county commissioners have let them down. Elected officials need to set aside their own personal agendas and do what's best for the people of Jefferson County. JAMES FRIT7. Port Townsend • • s'• e -mac srjdl --ft cC;E Wit/ Wednesday,December 2,2009•A 9 13 13 • 11. vac ine clinics set x Wednessays, Walk-in H1N1 vaccine din- an appointment. There will not priority or targeted groups,health ics begin today, Dec. 2, in Port be a clinic on Friday, Dec. 25, officials said. Townsend, and appointment-only Christmas Day, Baldwin said. People who are first in line to clinics start on Friday,Dec.4. College students were urged get the vaccine are: 'We're starting to see ari to get the H1N1 (swine flu) vac- • Health-care and emergency improvement in the flow" of the cine when they came home to medical services workers. vaccine, said Jefferson County Port Townsend on Thanksgiving • Pregnant women. Health Department Director Jean break. Baldwin didn't know for • Parents and caretakers of Baldwin on Monday, adding that sure how many had taken advan- infants younger than 6 months. Jefferson County received 700 tage of the program. • Children and adults from 6 doses this week. months old through 24 years. "There's still a demand for SAFEWAY,QFC HAVE VACCINE • Persons with serious chron- people not on`the priority list, Safeway's pharmacy in Port is medical conditions (especially and we're trying to get to them," Townsend wasgiven doses to dis- lung disease)through age 64. Baldwin said.'Teachers and cops pense over the weekend: QFC's By the end of November, are on the list,but they have expo- pharmacy in Port Hadlock also Jefferson County had received sure risk and we're hoping to get was given a supply. People who 21 allocations of H1N1 vaccine, to them soon." don't have insurance are urged which adds up to 5,900 doses, The walk-in clinics are from to go to the county health depart- according to health officials. 2 to 5 p.m. Wednesdays at the menu, health department, 615 Sheridan For updates on H1N1 vaccine in Port Townsend.Those clip Although supplies are improv- clinics, call 379-4471 or visit the • ics St. continue to be aimed at chit ung, pharmacies are abiding by Jefferson County Public Health dren younger than 25. federal guidelines and giving the website at jeffersoncountypubli- The appointment only clinics vaccine to what are known as chealth.org. are from 1 to 3 p.m. on Fridays, also at the health department, and they are aimed at the medi- cally fragile. Call 385-9400 for X Y Y Co Y ;/% 4 C Y • cLJ�a- .'8 'Ec ovxYN cl = osc'5 •D c-' %i.v LQ, ~ 3 o 2. add�tao s� c L3o . cc v ^ p325 .0 iv::,- 8 ,6o c "u E •• n o -o c zE � v 2" g v, m o c o c vsca o $ oa tic ae ° > = E cgyN cd o F 3 . YN URNV " C L ?9 Y -7"---: v NN N C N � CN C C • • •CZ E -E rrr •.....b . .. C „=. Ec hU- ; :o ac E, o G, a' cr'7-- 0. o L y oGt, - o EE yvu•E :d° wx a v v;eo 5 w == '•• :aN,- U 8 ai c.og „ EuaA s a F v Xr,zY `w > y cE c ° u 2aO Qv >,o .. y ov E ° a z = ,o vwQOadn3ccO1--o «.c'0o o c c ' , c o.o vb vo_ ° n ..1 m dE3coo.gV €.§ w -° Vymo 2 c M.- Loocvovoao= ` ev°; cyoU m .3, iYF v v oE =e" y ..?..-4? 'a - cc- . v rc� E3Op. `� dv °� g< dA c "- a''myct0 FuE. La . �osc 0. o0- . 0 = Yo � . . ._ , . b= vvcv ^ . c .G � c v iiiiiircaili it3 _r_- r•cou Vmy01.1a006.- 07s• a s C 6v :5 - c =.' a = � o XC o - --EF �jF v i. nFSyC L C c c,•c � tovSayLvmGEav cuy v¢ a :ti F.S F E E ccn ° vgvuE, a aV 0 00 0 u : cmCCE a-0 ' E3. ' t.) ° 3.52 '2 ,3 rov4cc ''P, Yw >caicv.°c� Lc 5s E >),2v %.p� °'ET v >v a, es" 0Y0 T >op.0 ,- N .f�oaFaLOFy.� �E ti, :F � � + 5`,, Ec iY (4F -E' m ^lb Y> v ° i6 L 0 X -'-''•1-' aY • 76.--. ° E -= ':_' N , Y £ca `7 CCE 5°.=,..`0'. -,'-' t05 -,-._' C U. '°E LF Y s J-.- 1-4-, Z� � V c., '.5.7.- y°= ti MN -°y .-� Y y.•O 1 ,L 0 ^ Y s• ° d.„ EL G }} °S �'E. b . Y YVapaOFyY.c's2v: V 8c 7,cY4V >,-i_ >.E Y OCCOE . ti:, aY >. .0 v > 3cE•v F ccE Sti a =_.,c Fsr,..i 5 0 ,, c,' 32O c .: a; `'Epci c FC E ooF'p cAZ cy:r: _ CdYO_ E A � OR O E„ •DU E d ;."''sam ( >.U -l '' f•O =Cu 'p-a _ E § C2 UO > Y 3:D C r 5 _ _- C Vi oh N S y O > Vs'i, O ` -- :, Q 7 .` a.2. ..g.2 C V Q„„ be, ,-,-2. a O E.'� C C.i_ OT6 > OE p 13 / , pU rC vtaa3v tZ?NFa-.vVal.n- 7� V HOGF -0° iminiwRoo 5. N. rov,FssZ�S ..^vi . c. co 1,1 1.g. cc. m E:u avEt ,o ( i --0 v - .0 = LU C OC 5. ax i• V O ” - .A. l OC ..yrc a,L.. � ..' � f pYC J ,- 6 ^ j 3 a c o II , �f / iy d .4 o f co v ayc .=a ' ie- W ✓ E ` a'f YC a , ° v .- J •!-0L E. =J 'a lJ V°i C Vy 3SC F J .( ?.D ,•^ .. - • 3. L.0 te Cy# b r C a > c36 J F 3 c •O C S n O TC:3 kJf g• a ` pc9 ' -'C u Y. � fip ( 10 • cy= a = :v_. vj T ;c`� p i k Iw! y+a ... p,,� c a•C , : • 0 0 .:-. 5 .3 . 5 -0 73.5 >.8 2 > q4w °' Yam o �g °g e > ci) 4 q N O °O ...6'g 4 y Jbx°fix >. 3,v .a > $ 'q 2V4 a a E'r G.2 o!.'I"ip a4. ° c0.,'' m qa 0.Fri a eco 03i1f1I 2m a � 0 °I " wp U a o a4 2. 14 ° 0. d e 8 oL o" r701.45) o d 8 ��p > mc° a �t W a c o F. 8 Ea o:m w T Makto O G t, Y ° 1^ 0.N G �' M +' l6 > G y N N m O ° -' -.It c 1. N ° O 7 ° ° a .°)P1? m 'C °'• N Med 0. ° c 8o w � � .o m oo � ° Oai v raj- o� d ,a... ,,o ao -:”.,,c7)-g?--J) G'-i° a'4-2.-9-1' 01 C u m ., $ H . .-ab- f,-,,„ <,9., p,a Q, '' :4E.Ep W m o ip m Kw_ °NPC• o7b:7'� o.D 2' V� d . c. � 0.2 ,. ° y .�.m 0. 00 N 41 Y Vi'O a C�''r+O Y 'U V .. ;C Qcao» 0 8=� v 0. m8.a g 5 8 m- r' O•" m °.c $ ° 8 coo • a o a 0.. 4 2. o m G O pp N'7..., 0 2 ° moo ,' `° p- °�' a °o uci W ,�,' a ^�, � �., � a... 0.a w a' C � a o 200. °u a, WO m w a .c t i�.'� h a 1'-.E tO o a v e $v U 3 8 2 +' '&�opw °1� a...:1- 9, . p x_ Hh]fl •lL �� � °❑❑v❑❑ � xoZE N °C�ADgyoA� �D.DMCs �Q7c .4 ctl ctl -•'.r7 .a O .� N o b am 0. N f-1 Q p r9.n.7 NO.... Nm= >P:_l s2 °y .. On a56'E > NO2.?,w 3Y` OYVEI°-. OG m..°. "�`�A m 8S ° -.tor- 72 . ..5A * i m -- - y., m � cm � o PUow `°�$«g,,��...a C7m� 30°isaV ° g °�Voa >3 "� oY=. 1 •g'DY .S .; Q ° ma.... °� x Q"".- 4 a a.U� 3 c� d oU.°'efil ci'_ o- -9 c v�a m ° a =c = -5 a8.- " 3 i.•� a d ev q c a 5 w o°n � a � owyF m ° p.,,, • d^ fl ! ! �/+ .. c c o o ewe 8 a dti� o" g <. =' q �' t .G 'b ° 9C, pp 8 3' 8 ti� iu �" ° is ym� .412 g 01.0 ^�' �°"#w,: � '., � �1/4.y.- �m� x� �� tif "*"E4 m ?d7.� 303 ,0v8 •o•3°ram �,h g Vit �od ��, m m �o ° ° a Y °3 $a A'C 3x �a ; IIh $ oW aY t34 o33. ac " g cc� � 3 ° 0R 4°.) .v > o6ya0.O o SL ° -.0 °� ' � � � a •11 Ed p 0. .oa ... ...,,,.... _a a ° dc c.a :� e° AT �CoJ 43pm0-° $,' ,., N0.Ga Y 8 ' A H > . ° ° 3 li `0.Y ° >.1.0 0 ° ° toE :oga,r:7w c38m " 1, TiwvSdag ° .. aaga °45o°trov-§Y^184s rUgG °Ac 8Sm s � `a --/ g °, a, SI.NqaV. � 0G . ,fi0gA O ° >'xY•mr °V' �NOOff9xQu DyaU^ oLa • asim .U'S2.• " v 0' °' ° Q2y.°3G $4aO G 814110f13*g81'" 41 " ›-' aV ° O7gQ� qC $? PPO° 7 G ° O <1 g0 › G 'q w0oma aa: woo ,...A . � mTyq.E.a o ,ISS W °'V a'Yyya EyaaC ° go 38 '"".`a' a+“ � O ca" gaig�" Q z `a''c qS 9t a ol� °N. ':.,-, 0 ,,,i.. w„. _ 0 b Q 0 v 3.4.5" ,.,:,• � ° 'd m oq .. M.'Li'ij � N --y'2�' m° W :O °'N[' yam o W 3 q•-'•'C m' ° # b9 w a ° 03.S'C%0 0 l0 �' N q ° own■® ° v 3 c ° qqb ani o A F I+ > ° a 9-o 9 V T° 0. 0 �? > C o � a N, , w 1 'el).a W o 8 �.5 C'z 0 Mt n v 2 c a c 8 . y ' '-, "'it 1 i, 'a a w e a2, c si2i i . 2 q 5 ° C oy O O o 2,-, l0 G� °.. 6''F4Cd'A '7Awa �. omaTt.5 wa " mv° 3N co w3 i� ■� I -� m�m �� �; "'oog � ° � � STs o � ° a�� ° I :• a •' W.= FO ;� Ea� g , ° co m 8 Q. ° c" ° lz] g,, eg', ..' ciiir,...a> 4 0 z div � vE.1:5412..47> � v 'ti p °111I1JJh1Ø1UI 'g °T . w' c�i `0m >z a' .t > 4 w �pp W a�° ,ni° «.8ap°"Boc � � 0. ® � 4) a 3_ `� iiz °�'2 8,1fliU1f[fJ.Jjflf akE `' i 2-° i " jJifJj1iI[j s'�e'' F t' $cad g'�ug El'5 '° a � � � � �� • • (I) p n ice,• ro CO'L7 ...i=LO CD'''' -'CV^ ;•J' C01) MielIC 'y1 U c • o o a1 v � — v �a �x IG _co .Q o - ,:o•••••c--T 1-• s.., .,_ o 0 A o,-) o c..0 .,__, E .. . „.. (.) ;..., C./ r Y ■NM VJ ,-,-4 - •a P ,-- ° s. 0 > i • 0 `LF.. Cj Cal) ell 2111:: •1.--4 ,.."C <2; cl) 0.- '17 tl)3 '— 9.) CD •''''-22T,...Y 4;1.. I L > > , xc, �o .11 cn ela� c,�c . I I " fl _ zoass) 2 cf)(1.) ,..c.).-4 . L .� _ W Q ¢ s ocIL o .o � � 1-- f 7' ' � ti i (101 V = F = ° _ - , r > y.xm m0 a w 3rUQ-= a 0 g u '" •^ V- -' •a > 0 Se ---1 Ti •a ri: xo c p- CO m 14114 : 4.1111 IN SEMI ` z Ob c ' � v_ �'^ ( X mo3' Gc- -%)^ G 0 L., —4 • • • >, a) i•,'U't7 t.0v F ;,,rty a) u: 7 l'a - [ s, -E m�e, \ aS w '1, p co •ti �z, Z od bon o m-0 o .4 , .... > s,.o o G ed rn=H, ctrl, oa)r cod CZ c)p �' ,- a) co-'ccci,1] C,....1.)3., v C U v c' i. °" •°' +' � c° `�o � Gp � �Uo (xa) bE� a) ygm Z• o me cs Q) o0y 5 Up o Co o Ly�t�o o c `ofj ` ro w N G�j comm c,. '_ q. �.0 A.0 v c",m Cl, a)',i;-° C6 cd 'O.�U vot.a•� o 0 3 Nb 3� C7 c) o. O -N £ 0 c F w r a 44 ayoq '- •N yg O >, F, td Q1 ,-m, 0. ',1 09 al.ea ohoO Q p y 0 � �moa ai o . aaro 0 � ; D o n wq " co '..E .Iooo o ? O c)'•t6moA • bf3 '-' coa)- ct�. oc 'CP ' x:coo'CC ulcdLvodCoy ,E—" �' cl, g ig00t ma , w..d 2 S0 � � ,, ',. z obt:c cZ. ) F v]g v p,.0.0 o. '-' ate) 5 � c s . vn g o o..; . 4)) a. 3. 3 ro u 4 c o 4) Z E.,E..�a $).'> r:•1 rrI Q.) 't w � CC c < C • mF x ;. w rn rix `F AR a , .,=' G , a) a t0 q, a) a) m u) 0 4. q y +-,,c; 'ti a).' q vi q y G C7 0 ti d y o y 0.• x° m m A n •,pa a o $ ai p a4a) �� g.6 +., a� c� "ca , rn wP 3x cdrn'(5, _,•-. c u7 t,„ 0 o � En ,i a' 3-4 _,50008,0.,, t03 P. . y c,•5 y° A g `'-� o o o� •o as g o o@ g o o o-o G c oia o p R � S .� s� � o) off, al"" ct 0 R 0 ui�c y 0 u)y EU hip,-0 G 05-, Q �� 'V CZ, a) �,q ❑ Oct o >'-IS 0' ix� ° al� �,� ., �, ac�) 3< ,;4 .amrn•54) P0 bs 4.4 G c� u) v,� 8 ,-a O c2 a) >✓w S ca-5,- (/)E-,..5.-1 C.t) +'q., ,a.. b-p o.- v� m Cr/ +S '-•i a)T} a) o - - v N 40 m � `),, z-,„±.-ii w0 A �O +� cp q +g ro R o 0 .y,, .- 6.- @-5,.. . _, .`0 o� c5 fry +.' 0 3;"a >,,.6 as- '.a P `� ,.,, Gs c., ,max � q o o &; C 3 ,q +' asy > oq iOJO a) +, 5 C'7 nF. .-,ati rnpi 4 U v'no o i� U -o ��o $' 0 ,6 o �U av o =0 11 �, o' ,.t o NEIN0� " EA`. x a 0 ,'<4 u° g� t`' 3•� u) v,Al 8 0x42. • Cli) 2 � +, 2 a) a � 'o m o �+' cd Q U c� o v (UH x,. 3� P. 0 �-0 ^�x -1 o-o v`d).�ro�� oa . - -- --__ ________ • Mentoring . Budget: Mentor funds • ro rarn CONTINUED FROM Al into question where their council on the budget as a money was going after it whole,saying that very few "During my two years,I went to the county, saying changes had been made ..makes . ., saw the power of mentoring they had seen no qualita- since the preliminary draft to change young folks lives," tive report how the liquor was presented in Novem- Slabaugh told the council. excise .tax revenue. was ber. "I'm before you here spent. PT b dg . t tonight, as are all these "Maybe that money is all General fund reserve folks, to see what we could doing good things," San- do to keep the program doval said. Most notably,the banked going." "I think we really need general fund reserve was • to look at where we can increased to$560,000—or • New name tighten our belts,and this is by 7.87 percent—once all numbers were finalized, City Council finishes one of those avenues."Slabaugh said the new said City Accountant h program would likely be Memorial Fleld Michael Legarksy. deliberations on funds run under a different name The council, in approv- ing would be formed as a The City Council also The the budget, appropri- nonprofit with a part-time voiced its frustration with ated$6,725,786 for the gen- BY ERIK HIDLE , director. the county's discussion of eral fund, $1,114,065 for PENINSULA DAILY NEWS I realize you've Spent •• The$20,000 going to the potentially closing Memo- public works, $988,071 for PORT TOWNSEND — lots of time and e fortprogram will continue to red Field,which sits,across the library, $1,417,325 for support the 67 matches the street from City Hall as City funds that have gone on this budget. But „ community services and between bigs " and tittles the.main sports field in Jef- to Jefferson County for sub- things have changed " that were active before Big ferson County. $1,244,671 for fire and stance abuse prevention• will help a youth mentoring the scenario Of youth Brothers Big Sisters pulled "The potential closure of emergency medical service. Memorial.Field could have The grand total of all program floundering since services in the area. its funding. The nonprofit would also a huge impact on the city of operating,capital,debt and Big Brothers Big Sisters Port Townsend even though trust funds was approved at During my two'yearS look for matching.funds, g 4110 pulled out late last month. possibly from other non- it's a county-owned prop $35,641,437. That decision capped I saw the power of profits and the school dis- . ert3,"Sandoval said. City Council deliberations mentoringto change tracts and count. If it closes,it also has an on the city's 2010 budget y Reporter Erik Hidle can be young folks lives." impact on our youth." reached at 360-385-2335 or at Monday night,•then the .y g 'Proven'strategyCity Manager David erik.hidleOpeninsuladailynews. council unanimously LIESL SLASAUQH Timmons also updated the corn. approved the spending plan fomier director, "The reasons for asking during a lengthy council Big Brothers 13ig Sisters for this is because it is a meeting. strategy that is proven," Beginning next year,the a mentoring program that Slabaugh said. city will;withhold funds would have otherwise fallen "It works,and now it is a that have gone to Jeffersonapart after Big Brothers matter of keeping it going." County for substance abuseBig Sisters closed its Jef- Council members agreed prevention for the past ferson County branch two with Slabaugh. eight years and use it to- "I feel like we can take weeks ago. fund a mentoring program The remaining000 $20,000 from that fund and under the umbrella of the $22, put it where we know it former directors- of Big from the liquor excise tax would be a good use,"said will still go to the county for Brothers Big Sisters. Mayor Michelle Sandoval. After identifying• the substance abuse•preven tion. • I do feel like the men- liquor excise tax as a source � toring program would be a of revenue that could be Request for help good place for that." • pulled back,the City Coun- - Council members called cit voted to shave$20,000 of Slabaugh, backed by 20 the$42,000 previously bud- supporters of a mentoring geted for the county Depart- program,petitioned council • ment of Public Health's pro- for help Monday night. grams to dissuade minors "I realize you've spent from using drug and alco- lots of time and effort on hot this budget,"she said,"but The$20,000 will be used things have changed the instead to fund a collabora- scenario of youth services in tive led by'Liesl Slabaugh, the area. former director of Big Broth- ers Big Sisters,to continue TURN To BuDGE'r/A6. •. • • P ) ;/ e T I._-CCS e✓ _ Wednesday,December 9,2009•A 3 It's done - county a a o is s ore lne ru es p By Barney Burke of the Leader corning back to the county again Johnson. and again. The 3-0 vote followed about 27 The Board of County The plan must now be approved hours of deliberation by the board Commissioners gave final approv- by the Washington Department of and numerous public hearings. • al to its new Shoreline Master Ecology(DOE),which will sched- Opponents have been especial- Program on Dec. 7 but recog- ule its own hearing in Jefferson ly concerned about new require- nized that the issue might be County,said Michelle McConnell, ments for buffers 'from marine associate planner for the county. shores.The county planning com- The DOE could send it back to mission had recommended a 50- the county for further revisions, foot buffer in some areas,but the she said. rules adopted by the Board of Lawsuits might also be pend- Commissioners establish a 150- ing. foot buffer for all marine shores. "The county cannot afford all Critics have also opposed the the legal expenses it has,"Dennis 10 percent limit on enlarging the Schultz told the commissioners, footprint of existing buildings in referencing legal challenges on shoreline areas. topics from planning laws to rules The new rules prohibit all-net that might violate the right to free pens and include a"qualified pro- speech."Put it off as long as you hibition"of finfish aquaculture. can,"Schultz said of the shoreline rules,which critics say go too far in restricting development. "The bottom line is, we're going to be sued no matter what we do," said Commissioner Phil • • Ea'CL uli'2a' co E ° v° ani ` `® oz �� E CI u y o v cc coo- 42, Q 'aocn aa O :15 m E ._ 0. 0 . 0 y L cQ Eh ` O _-a co EmL ' 3 Cfn t. Ca 6) "0 • ca>EE a 09 E0o 0, cr, � N� G cn u yo°? -10 v o v, CE. U i (DX 10 oa` ` E ° � w ow= CII o cL, T+JO 2 Sct a co = o 0. 3c) E n tE • rn a cEZvO 3 .ccu ucmE "CL 0 in ao c . _ ■ ■ C) aii E y c ai Lm o p 3 ° .0 mEami Ym Em 'o3 E c - l.- O iC c0 to 4, = Gs, cLi 3 o atimi c ..- aci 'n o N 'E C 3 a, tv a oN = c n a ao 7,3 5 cct> ° U d O Q ` 0 — C L2 0 L c .5 m O L cc 0) 713 L =' U O F, G'O .0 O V «cri C y d :E7 0 L tO tC b v C m 3 E N c 5 a4' ii2 in a) a a' E Q v-0 2 E y • = Co :O v 2 2 w N •5C,D u. 3 o o -n M 2 E .n v) '� aNv� s,. .. O O� m a N ..+ ^O t Oo „, V co m co-, r g m E cu Oo3 � V VO N �'dQ .� n �' aocnacmo > FC c OC c0 O a O .N p o •., 'C ° E - 3 — ccaoL yn. vu) = co '� � 0u 3Ny3 ° ac � A ,,7c .c v o c cd = c 0 3 E o 00 o• � v ..4..t ❑ va2N m m y o cc M 7--' p VL o _ e n Evt vv •o ° a) 0 0 t ti; t u a—: -0 ,c,0-1 E E o o E °, .2 v 01 }.. v v v c v 3 c -5 °c-- Oil is . , ,,, V • cn- °1:$� f.. OcC , w pT1 >, 03ooI1I .hI o ,y g E • TOn! oMI . a :ngl u m al E O v � v hh°P ciihHJHflJ Y o - 's� 4 > ) i el 1 cti > i : z ba,y czz co a ,no - vo Qy Y ,,L ■ ' ito o- - ." V= N tv Eva 3E = . r' IL wO •nO - O V> - v a) . omn t- x-v .,• _ 4t�w ~ l > ❑ � ov ao� oo � ao> w ,•••••• (1) al) m cc2 vtwv voo cbo . E c o c to c �wx 0 -t.. .0 0 •o bo c v N o� c cE0. E -o .4NncE-- av ovE• v a r, wEUv ? 3 a ,`° ^ 40 0 .O v 3 vxa c°aq3w� U C; Eu i'-' (IA ,9,, a : a •h' E • v , v o a a) • 2 • E mo mN m cv gi c1 g Chi > E oto � ogva9a � Uv oQ > vvc L. vv 'aov• pc'$ ° �' o , .° aimb o o'-'cc:(1) 9) .0= a oa !a 4ffili CD � ° v x ¢ c ° v > oo «syti ° x ' -E 'oc r3O SIM E o y = E. ovv . v c, mc„:,. C '6.5 I Uovm? aoDCU mEo � Nati 4.: � : '0 5Ki �a• . � `a oV_ vo oo3 D E- p v 9o � a (113 cUop'�.� oxdoo'vnPi o > EavU ° GV> a co v ~ or vcv, �v mv U o c ' 1. �o= v ;avo p .. cbae . v y cc c v o ' ocf. aOE - ¢ vp vw oO )x " oc�� vo CU CU ~' GEub •0vo >-as a ?, U >. 1 AyOSm >, mp � Em T7 L. m • p ._. vuaV ~ w U1.�N a ""O Tw C [ 2 v ., , O ....4 0 1),...,,,,_. - °o00 � = ov v ai -5 av)u A. Vmvvu > vm � 5 n u ~ E Om ovxU - v0 .rLo 01 0 °w cou A 10•Wednesday,December 9,2009 Cit stepswith fund � n h� n elya • ■a er Big Brothers/Sisters departs By Melanie Lockhart of the Leader Robinson voting no, to redirect Brothers Big Sisters, to continue - particularly the community's $20,000 of the $42,000 originally supporting school-based matches youths, Sandoval said. It would The youth-mentoring program budgeted for the Department of in Chimacum and Port Townsend. send "a real signal that we aren't formerly known as Big Brothers Public Health prevention pro- The matches are between respon- supporting the youths in this com- Big Sisters will continue under grams. Nelson and Robinson sible high school students (the munity,"she added. a new umbrella, thanks to funds instead supported taking the "bigs")and younger children who The city does not want to be adopted into the City of Port $20,000 from the reserve fund. would benefit from an older men- given the financial burden for Townsend budget Monday night. The decision comes after the for (the "littles"). Slabaugh and what is ultimately the county's Almost half the money previ- city questioned where the county 20 supporters were at the meet- responsibility,she said. ously allotted to Jefferson County actually spends the money pro- ing to tell the council that the "We are seeing {the county's) for substance abuse prevention vided through liquor excise tax group plans to match the$20,000 issues becoming more our issues through liquor excise tax revenue revenues. through other donors. by default," said City Manager will instead go to a local youth- "I feel like we can take$20,000 Robinson told the council that David Timmons."My fear is that mentoring program that last from that fund and put it where she would like to see the county if we fall into the trap of the parks, month lost financial support from we know it will be in good use," and both school districts contrib- it will become permanent." the Seattle-based Big Brother Big Mayor Michelle Sandoval said. ute financially so that the burden Timmons also told the coun- Sisters organization. The money will now fund isn't on the city and other non- cil that the rest of the budget The City Council voted 5-2, an effort led by Lies] Slabaugh, profits alone- maintains the status quo, with with Kris Nelson and Catharine former branch manager for Big "I really don't want to lose few changes since the first read- this program in our community," ing of the preliminary budget on Robinson said. "1 think it's really Nov. 16. a prevention program and a.com- The city voted unanimously munity-building program. But 1 to approve the budget, which have big concerns with the city appropriated 86,705.786 to t biting half the apple.We've done general fund,$1,114,065 to pub. it before, and we've swallowed works administration and engi- it." neering. $988,071 to the library, There were 67 active school- 81,419.325 to community services based matches when the and $1.244,671 to fire and EMS .lefferson County branch closed services. Total operating, capital, its doors Nov. 20. Community- debt and trust fund costs are pro- based matches will continue to jected at 835.663.436. receive support from the parent At the end of 2010,the project- organization. ed general fund reserve balance The mentoring program will is approximately$560,000,or 7.87 likely function with a new name, percent.The city aims to maintain under the umbrella of an existing a reserve of 7 to S percent. nonprofit. The city's money will help fund a part-time director. COUNTY DISCUSSIONS The council also expressed frustration with Jefferson County. . potentially closing.county-owned Memorial Field;the site of both Port Townsend and Chimacum ' football and soccer games: If it closes, it affects Port Townsend along with,.the rest of the county • Local businesses earn `green' certification Two local businesses have been certified as "green" by her business, eliminating harsh Jefferson County Public Health: chemicals that are damaging to Naturally Green Cleaning and St. the environment and toxic to her Paul's Episcopal Church. They clients. are recognized for showing envi- St. Paul's is the first religious ronmental stewardship by reduc- community to become Green ing waste and by using valuable . Business certified. Its staff and resources more efficiently in their members are taking extra steps operations. to reduce waste and conserve Jezlaine Melnick, owner resources. of Naturally Green Cleaning, To learn more, call Jefferson chooses environmentally friendly County Environmental Health at "green" cleaning products for 385-9444. 1—e -e), 1)-1‘1161 • •. JO;MASH opens free clinic physician's assessment of their needs. _ • clinic in HadlockJc MASH is funded„in part, :- A free medical clinic,in Port by the Port Townsend Rotary 'Hadlock.`opens on Monday, Club's wreath sales and United ,Dec: 14.:The clinic is run by Good Neighbors. JC: MASH (Jefferson County To learn more, visit jcmash. 'Medical Advocacy & Services ,org. Headquarters);which has operat- ed aTuesday free clinic since 1994 in the basement of the American Legion Hall in Port Townsend. The new JC MASH clinic in Port Hadlock is open every Monday between,4,and 5:3Q p.m. (except on national holidays)and is located at the Port Hadlock Medical Clinic. Clients should enter through the left, or south, doer at 121 Oak Bay Road. No appointment is necessary. Clients are asked to fill out a ,very brief medical form.Medical 'staff'check vital signs, take a •brief,bistory, and assess their immediate medical needs. Hyper-acute cases are referred to the hospital emergency room, and cases reaqiiing other and/. or continuing:care are referred through the existing health-care . system. Some brief,limited care is usu- ,ally available:atthe clinic.Apatient advocate interviews clients to be sure that they get any available help in order to comply with the • / G;(6ei,4 A A. .,>4.,..f2 'N O•O!' G l: N_ N 3. ., C v-0 A N .J C- C ,, O U aid u L >. -' 1ON 3,t,F3 T C O ° gi a, • a, >i : iiliuIil L,b ° Vca A er. 03y8y''o Il�rtry,5 5_ °TU a) ° ;. a T 4, 5s O pG,- C[n yC..'O E N•' tt L.+ Y� > Jo+ Q` O O y Y W V �l oi > 3j E'n,b•2S5.� G i s.. 1� !tJati cc•o � E 4 o a = 3�s auiv°rti.c g oy �o7, oa2� AE3 \° c = Eil . c03G a, - Jurno.c p-rJ. > _ E c m v40o n o o v es N v v 3 "' m c v N'ov ,F v.c o a ' u 7- o u E c r;v A o N c �•z u.a o E E v� m c- us c oL o ut v E o v s o ; Yi,,c 000u ° o E1E ' RA' ,AN cv R 3 oE: •on scE N sa ® c .ry .c.b o u� 5"43N v' E:du t $ val� . vvNrovckt. oc - o u� ,�j OV 8 8 N..,` pp -`—g B u t :C cv a,._ 'N° P.2g v•dc-, 4 rt f_ a, a, o o :a LL c:.F a, °.v, � u'E v - t. 0 swim R ,u� �n ou• b' *°a ew uouEo,�`o3N' c ..V3N.Ea 5t+1a„5o Na . 00 D-Ts -:. :-5 - Av ocA `ui828 v•Jc•Jt° �v a, 44 bo-c .0 )-oaa)i� E �;'- vvnu.a � N u q 2.`o IJ1IUIhI!!A. a�7 C •vuj 111� 130o x ■MN .2 0,o cµ~'E y'� v'g a g'- y v 8,y LIM 3 C :: j 3vn E a 3 503 °u 3 g Ir N`- � 5'.Nsv a z g c gii ., t, 3 "J a m d. .r •$•d 'C 1`• asap '-� j mt.6�•g co c�.5 Ng,o Cn e vt0T iv8 ire ` � 5 oDo6ffg..,-- o u 3 vpaft C7 b 5 o v�4� u . �✓ , nlo�” �� N > ° c o E., o vsv,a •O U A C ty. •A c0 n°2. /, ' ^ _, o-' u O E N - A 1° ° c m s .p o .� 3 0 c P'• a> E ti pr� 5uAt pro3 •° '� o8 ° r A cnvvo �o > vc iimm 0 �3' .S�''°•�i ,a'• °¢9' •g ,u Ec �x ,. • > N � b v 3 `o o N °y'5't o 7. v � g Via• .2.° .6 :g + r:;o . L .c• ' aN " u 3 E o �:c � y3_•.cyb � c4,' r ^ \ u � 2yu8E `v >rapl 1010100 °� gi -14•GP.1 � .y= '' , .: a - �1T au8 ,�� >.P. `^g vi � e ., c �• yes? „'y.c k--.. .. & .ee= \ 0 •S c y;4 o f or 0 v cc 5 m 'ao :a 3 ao � � °uU n o� :75 .0...,.•_ . ,, C1 O a3 V ry N C it C -p ` ii ! Ii:Hll -o - >spL b 2 �,?: E -..°�H g. . 2W ° ECc' vt 'v, n •, "`Oay . J.7Nv,,c ., a3 v vU.cL O yt soLyN• a, v ._. >, ° Aa > N = a,T° •L v 1 m ,C .5.-: 6acbo 5 > von'S ` is d i'' ' E ivc v aaN`' :ofc .c, ccno '38c� u _ d 'O N.�' .., 0 ..0.0., _. .0.2-..0 .G;N�veo. t• 5miv ' _ oE tog, m . f3._ L 52 oE -aeoEa _v . 0 -o. maob' - Luy " ,iiil N O �'O : IHi iO' .Lo HOOQ .e,$ �Cp 8GQ 14.5 IS 8 Z T a -..I.:m' >p�pvp,Ai U..:8 � 77 • �J•`. G� micm ;El N 'u ` o °i.: bix :4.... .O -Vq, hyR (p� o$gg `�WCOG Y V S :,.� y • >�y G 'S N al • r.. �.[�[�[�..+jjj 3,.9 c%W.5 i� amu' 8O 'a 3 a ;-_:3 3 s L o v i o c c E ru O Q A U•0.N 4 V l y,fn a,,.. Q E t,y ° C K.'.. .+�'J C ` �L'Z y a y� N•�'S CJ O a, +.^ E o an e>t,- ,o :e a, 3 i, :4 C' a. 202 ' _}b �i S1`o f I L Eta� Enn y ut E-y c= ° - y `- 3. E_ O'S y+ O W 4 Q N g V L 0 2 y K `O e0 O,. y . C S D V E S" rJ L•,1.8 •c 77: G 5 :, J E-' - C Q,'--al- a, r, C CO yy•^ 4 v o T3 '43N = rn O °' E o h cu � 7, v_= - c - S a E'$ c'� 3 3 v '�, r�i c �'o o E N L V' '~" c �y c u� -= v N :c o. c- = male .v.�i.5 v v ? c c o ^•� c y \3 J = o oi Y x . c E 0 0,G c m u.. c c1 .?1� ° '- c '- Qo c aLL am ,t.F R g r Q7Q ,cq N �'..11.,.8,,cc t-yq 3 O F c J o ft.“ N •17o coN60 v '° w u F^ E W i Z j o .cn m o �. •, X}S N op V C 7 748.2-8;-11 .: C '9.1 v o m O,,p i Y •$ yr •'an.mac. ° o •E o.�'y•� T C n c >.m xar.' .. .- c hiJ:fi Zilli . 3 P E C tg �Oa �J 14-0 • it O U S O Q g d,U. co Q'o' H EE 3;G v •5 > f�•. .:"g" C G �i_ J.Ti = C C 0,- C Q C ...n• ou N N �i u p'Q L7 C 6. 3 -' . n' •1 y a O S C V, k'-, C E L u I $°, ° ' A. tIT 's v u•o° ag E.` 3 c � E `'u q ��' E 8 E'J v -, E c7U-ig. .fi > vA7,t. E . o v - � -2 .t °-5. :`-';.,° cE ° voc. ? CcEn Y� •° G]`' ti ° L ^ - 7, E '• ;, po y v u H v -c , v O` a c L O o`' o g •° av'c' 3 -- °v o =4 u c ° o moa nm `z o no v z v'° `� c A et,+ i, v u.•:. ',,¢ u a m, o u cwa ,,L,, vs E�v•o $ °s�•Eo ` m oc m ` " y•: y 3'S-,�.x y: N.p 1 }!i!IHI CtS c. t � j'C = _ G t ti .c. CC V.O 'J a� t N O'Fa G..{� - N m bat O $o > S' x m•c v, w �, 6_ 774' ,.': o d • 4.00` 3t+ .uv, e' � 3 c3 � v.E n-•v • ' 75 � paeG. �ye c d ❑ o ws v co 00' 0 ,A..F2 L. E 3 g.1 g' - ,,,-ivF.. 4., • ‘;., ='§ 7;>- T g o ac) E 8 E,_`os£ "5 v 4y E r o a 'o o C� E V rim E p.8,g 0 , (x 00=.1-?... 5n�> S y O~__ a v. d E�E o ,..o E °•o � t..'4 ''' a-, 1', a L� ; ^ c ' y g M �. v E O o'er a-F" °M='o v O'`c 'a'7 ,, v, = . c o Eta 3 v2 ,vo . av > Vi•5oiE - = `' ' c } 0 2 E v 0.55 .. 0 3 _ be 0 ,,-; ,a.� o o U "S H .2 4. E iS o n.vc v 5 V°. E A'�U r c.E ov c v r c c ° m _ U P. Q P. O .x L L,e 1,a O Oz 7:“=--c ry u it +-+ cc b1b Ec cr o v u - r. bq O . b O 3 Cn -- ." §-1E.=4 s 3�V A) Li C OL O >W ,h E L C n ',C F Yi i C C � o._ v , v 3 i c E " ! s a0 e G o l V V C�• t6 ,„172 2 F' a �y.y , 1•:..3I 115 o5ia .civ ;° a `gsi0 e aG3 flH of > c E 20 cO ' c= � ■® .E a�._tJ � ,p I � A cr= c7 a ;� v 3 v 2z �� � v o 010 z v 4E b v __ E gs, .4 )...,,,_ e5�,a _, a' �.z w o ° 3 v iS' ,v ,rda'34) 3.c vNw E v cEoG °u"c-c 0 g rn5 w -1, I Ev 'Av .-Z,,„.=" v o f t T I NuO CCE0v c• .r,,,.. cy °� • yttI EaCCi EL 4 ' > fC .r 0 51,8 v vlv ' ` C • 7 2 '4.E . eh G y O m ° O C m C >,?,'. .,._ v A C y ;p I cu r 3 dcg ,_ C Ov0v'y02" E t `U `~-' -a 12 C) ',•, g4,-...10tEg l, E x e v 4 v v v ° A: �^ oo co G) o a,, w12 C p o��.•a v m c a t-- v �i l �� .a - ice b'o.`0c...o`� . a-8. ■ ■ � 7p env 1.E.'955. oo�+;c ❑ � c A °A•Vruin 1 o.N ,�iy5 vL ` tM- C .c g °ccvo 8v'3v^•,z EvLcov ° c 'y v 'aQ � 49y °coo A .v3tu $o it 55 v g o -00 •E- 0 - C Q.0 3 F y c g 8-0 :4, 8,A ... •c C E3 v o QV 2 ,:g .):11-,v - m.D v ° Egv3.. .5 '5 3 ,4 eT °'c3E. P''o aka •,51�•5Y ., _.0. 2-0:2CN 2X. 4v ~ . y r v 3r;o = 0 " E 4 A °..§..T, 20 4v-2 cam' w ` .e".twz3 oSe°Ca3.2 2 cA .C.-,.c' v m SO p 3a 4 8:22,ag C Vi 4 O A CO � t Ti eil IA •NTvx� : aam - xti _ v o.c .s1 g o 2 oai as o vaei.g, N 4- 3 - 1 . “, ' O, q, E4v° oo m tit _ o io / , t°p'5 0 nA� �i,„., ,,'- '0.' 02.E8. , .`v, 3.a pS„�cv pg -. Q o 3 `•-.7T L A O ego l/)2 tli yc+.k°5 a•_ a Y 3 a,JC, C c c 8 0I.N, u� e • • .Z' etC • c ° 0y i Lail S 660 v ' v v c•^ I x < vcE•g.uYEEtnc > E3yc 55.c • v m z. 'o �•/n o f v� E � 3 a Ev ao c 5� v .- DoE2=al �a. a 3 • o.?. 3 5.£.gcu J (f) 2 v.S roov °' s1 � F?,.S ad s ?� � � . 0 8 wi0p,,,i sgOO flU. ric • 37 rEC S is• • .c C� .>1'11: 0"' : !=2i wsC w- (��,, ,. =t s i s '=oe v `5--&'.+1, Fis aen c `1 , .`°, C `L. .0 v A ro`" 9 -7-' L ., ro m �. 4 u C a, s V y 7 C '' 7 N ,0 Q c".@,.>- 'L cu E .-5 g 2 ,?1,.,.E v'C p'0 s ca..3 V!.,•7, • g` yy O ..;2,2 y,ei c ,. 3 .q' ;,..;,..,,.4.C. = C 3 a o=L v E i `O 2 c ,•� 6. �,,a,.2 8 o Sn ° -,E c1E' ra c2•u oak" � ppQ j� 8^$ a., 8 288 48E az $ • • T°LP T-c 'G ''. c ctl `aP'a.5 ° v 5 o tz �, a 01,1 C .c Tod u.$3• E .o m• oo2 E X 2 02 .Q 1 z;2 .o'g1 h v •-< 2'.Y2 ,,1 •0.-61. a' ° oronv y 03 ro E di c'co g-'''E. -- • �'c '2(1) 0 v 2" 3 c =.c `n E .9 E > c . . EEa' E uro.° or 8ac2o28 �; °' a n.'a to • °.�` w•5 8 �v 76 fives v' Cti ..F, O r. a' pp m 2, .2 U y ' a' 7 0 A C E ..,<%'7,-g:V m e,L L 4 sE `g •' roc5 � roc•,t' SSE mF 0 -.'i O as 7c .- c 2• u.=y c._ 8 > E c>"' >.p.. ESC a 2x �pq; � W�:a O ••. h r? a d .d .aE3 my 8 � $ m' c) 1" E.P.. 1.110i K'sc-3 .-E • , :110 "" au.1•g' gst,a� ai•�oe'ra v yy • q ro pp� '• .• E o c o N 13s & = u E _ a �n a c v r� 8 '-'-'1'. ''_ E _ E .c t a`' c'i s� a,�;°_° ^� aL' E — 3 s '8j. 0 8,-8 ^cC -'• $ .E 3 u 8 0 A a o`o a s 3 Q y U o Q ooh u 8 �e c y o y a a3• �. a q ,^.^•, v-G., Z'^ 1 L y N.o s �• V of Ea.. • f2V 229N2a - a va 3'~ N, yEa & o E' ° v E 'S � r 3 m a3--C • m = �Tic-'-`4 ° I -c--m 25* •.z'J� 8'. a.o a aC1 3 U'c 0 6> N W C°^'b d m'''C L ° >, .0.L= o,.. ti O y «+ .• >�u 00 �" 9' u C•D d >,a6 ca C C w W Q' C %'O a, (-- -. ¢ C E C g C U L C B s E O s j. o.o o ovU N s 3 O'.; 3 L 4:9 gy ro ' K ON 7 a'.c� 3 $ -51.. .....1'r u u L � m m °'D d m cn-6 n E .� cn a^ C.., d h Ec.G °a'' oiaa', EgV *e-, �.V•c3E L. S fic�. . E, E< �s cs3 ° 'o.w '' E � °�.= °� 882 .1-0- ° da m .Ey e ' Ed vg .- 2 �.-, 8.141-3-„3.-oi ce t.T) a°2.Sao a ' _ uy5rz, E.. .‘s roo. v LE8 .2 w a E ° c‘,1' E „ 6 ).. ..0 „ E o c �_ mCr? $ • v lJihl!4fji .9� ,s . .c T o-- u o rc 8 8 m O ucU Fc .'�..,.c � 71 '' a -to'0 c �aY ` ,� 2 $ s �s �`he � nJ vaEo � E E . 5 _ cs E U•,, ag c... °a.E 'a' 2 Ev 2-0 O E.E c ma E U o.v ...6. o v 8.m o.nsc5¢ A) .� E a'.26 a.0 oa,u 8.0 a. 2 a EF E..5_ 28 .> I 3•5 3 h3. 8 • h� y X14---* oma= 1 a ti �3 "��4-- ,- � oro a,a E3 Ug "ta4-. u a Q)• 0 Q> 40a— •- ›,..2 s � � °°v � Oti� ro = 8 � L � =VD aro I u°'' Qu c 'UW cL co°.7 oa W q E� I c Lx 3 N w as L . IST 9- 0. - . =- 4 ■E_ _' U z �:_�'e= � g 8 o. ;L� m� i— C. r C = a' 7:3H a: a-,aTcoo o rooam = s.. �. � � aaaa)i.`->'�a E-, z, aai° E�s t CAa UX.coy .'8.;• -8 Ero8 • } c ° c 'y °' a'S o o°� 5 ' w 3 o f =A,-"e,_ gS' m o 5 P- a i-4 C = h c 5 ° S n , o D 33 ° g, rr .C.� `" 5. ag , .:F•G7A''' §-5`g-E8 Cr7 Q 0.2 ._..e4 , a, O ° -, pA N o Nbr o. m . cn 0 i[PftfiftJfi ° al. -°i° 7"ro „, $ � yo- $ �dv • 5' '4 S �y' 0 A. zCD '82 liuuE 3 N <,. ilfltU HHi �cg 'tis S•• S oq, o m O Cr �r�vZ t.” Ro Pm . r6roo5. -� C.,a S S , �'o, •, 8 » o e ° ,^3 era T8 m w, D� 7 8..`a E.E.S� 5v N rD 5c -. 51 trf 10 O o ,. . ,- "-,0.0� w _ $ SG e-� 4BaA < ° D a c rm <-•. x• Rtram ' 00cn? �- 9 ..�N �_ .7) � ' TAv p , H ro xi N r •ao �J i� `3 Q `� C. �'N r,7..`G.r 4,-.5, g.5.�.•m� N w O (� 0 .:�' E.4• . AI K N 'U ti N o 000 i Y 7 w 5.7 o f ro : m• r: 3-�m w 3 5.w.� aF'n•S��5.m �m c�� Fm T01 3 � 'n n to ��-0,,, cv� 0 3 � r��N e 'S� 8 o A 8 0 �S "7 77w8zw - mm fX' - q-b ?. 1. mtyc . S °pf . , 2ge o "n.c.„, `2 . wSDB , �1Q n cn,!}moi R "�g.9-8 7 w..^°t :: m N t N N ,. i N N r fDv fD 7 O .-.E. 6. d v O• O �! .._.U7 ,V /�e S owgGnnmG w ..�y 3. ? S g mme•nltm w w ° 0A C..LjS8 N 6 _8 �;n X83 � _ . ao.i � ' ,f a E �''q8 � v � ,� � � �.N 5'•6i 8 �' � ' S m 8 ,(,�, 'm E `° �o � • tr q o'� ° o, o p w 7 a S'oq g-E c N � CD rD a " RNO N ?�o < ocaa5'g A�+G % ,;:Oo1''4 C r I (mpw . o . . ,- , 278 Q 3 r 7..C.S �. 8 Q tri,' 3 7 N 0 N rD O N"O n.`G G.tD r ! Y r Y O O N v, �3 (� �^m T�'v 5. w N 3 30-- S 814 '',,.=,,..: °o m� 05lO ' rlfi-`7, C) T m.N. O `� m'x0 . 00 G,G.?a, 'GU' G't ° N 7n. < C .-�.y n e G 0 S fwi 'O T g L' P, 3.G 3 5. C q 3 E:3 ,. 6 ,0p 2 r(D 5. 0p O C!.� .R0 7 r, `S FJ, m^.g5v gD sr..• J. O `<'1 co p' Ot,AG w�lc; 6.rE--0:* . 5-,-'4.- N � 5.0•w g `�, gm. c 8 ,' E ,-. . 1 -.9A1' =3 A w og c D g Ngre,�o ,„ 0, ,,„ a Epee V-4 o o ro .- ro f� 7 0 w R /1� Crc y n n=1 - !0 w G y C. a Pa w w O 6.r, c r £ O 0 N V[_]1 2 ' � .owv N Pp .g..8 co 0 CI $� 'S� xCn SS�•y' vm5 3 3n , a, �g.8Eo; 00-, m 5 d ,n va 0 8g, ,.C»o m =a6c a 5 g E `D x• w.x$ G =.w `-°-" ' S <`n '_'^i o w 73 o " 5 Elf —co,°,CI c:° T°,$ 2n88 ver �. 0, ' w g S•w 'o '412, ' < G ,g t � P.,-,,t r+ o so n E m o- o??� aB a a o m m `B.tD, n'�'°e ' -"; ,7;‘q S t?•r"o ao S 3 r w xww c 8 as •,-_, a.8 cJw a'i�j Es- ' O tv 8 ,, c,A8 p•G 8.8. 8 E 'E'5. e 0 ` n 0.,-D O _^ „Oy c.-° 11' w AooN g 3A0 E G NOf0 m8 5 ° c l � 8 �� II !•III1� [ 3 �.w5' tg = m ! �21 . Q 2 W G m — o n. SE a Sa < m a nr �' -. 3 0� n < v N ° c. ESF S°� nmA Cao05 G °o• 3 ,c, > > S c) 3 -3 ^ no S co � n V�> ° o qoTs-at °: £ m" 58 --wo1 aa$ �' ,-5....,% v 6 �E8 , arfg2,6_ 0_ ' om°, CY il ° 5 f ii' 4 7 ,'< m m . $.mm n 6 8 m 0, .° Sm � ' S w (/)� � � £ ; � < N o ADC A �� r � ��oo 2 ' g i e- m° 5- ggi, av `33 � E � , 9+ 000 F & � �4 ...__ .� CD N. CD J ,- ,, • Nz., , •