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Home My WebLink About2010- February File Copy Jefferson County Board of 3CeaCth ,Agenda ivl mutes yebruar 18, 2010 w • JEFFERSON COUNTY BOARD OF HEALTH February 18, 2010 Jefferson County Public Health 615 Sheridan Street Port Townsend, WA 2:30—4:30 PM DRAFTAGENDA I. Approval of Agenda II. Approval of Minutes of January 21, 2010 Board of Health Meeting III. Presentation of Restaurant Outstanding Achievement Awards for 2008-2009 IV. Public Comments V. Old Business and Informational Items 1. 2009 State of the Sound Report Online 2. Statewide H1N1 Situation Report • 3. Public Health Report for Region 2 —Winter 2010 VI. New Business 1. Olympic Community Action Presentation—Oral Health Access in Jefferson County 2. Syringe Exchange Program Annual Report 3. 5930 (Enhanced Funding for Immunization and Notifiable Condition Reporting Programs) Work Plan 4. Universal Vaccine Purchase Program Update 5. 2010 Legislative Session Update 6. Green Business Awards for February, 2010 VII. Activity Update VIII. Agenda Planning Calendar IX. Next Scheduled Meeting: March 18, 2010 2:30—4:30 PM . 111 JEFFERSON COUNTY BOARD OF HEALTH 4pp • MINUTES Thursday, January 21, 2009 2:30 PM—4:30 PM Health Department Conference Room, 615 Sheridan Street, Port Townsend Board Members Staff Members Phil Johnson, County Commissioner District#1 Thomas Locke,MD,Health Officer David Sullivan, County Commissioner,District#2 Jean Baldwin,Public Health Services Director John Austin, County Commissioner,District#3 Julia Danskin, Nursing Services Director Kristen Nelson, Vice Chair,Port Townsend City Council Sheila Westerman, Citizen at large(City) Chuck Russell, 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 2:37 PM. Members Present: Roberta Frissell, Phil Johnson, Kristen Nelson, Chuck Russell, David Sullivan, Sheila Westerman Members Excused: John Austin Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin Guest: Frances Joswick, SAAB A quorum was present. APPROVAL OF AGENDA Chair Westerman said she would like to have time under Draft Letter to Port Townsend City Manager to offer a handout and discuss it. Member Frissell moved and Member Sullivan seconded for approval of the agenda. The agenda was approved unanimously, as written. ELECTION OF CHAIR AND VICE CHAIR FOR 2010 Chair Westerman reviewed the process that had been followed in the past for election of Chair and Vice Chair positions. The Vice Chair normally assumes the Chair position and a new Vice Chair is elected. Member Nelson nominated Chuck Russell to the Chair position. The nomination was seconded by Member Johnson. Member Russell indicated that he would accept the nomination and assume the Chair position if elected, with two conditions: he wished to be able to offer motions and he Page 1 of 13 wished to review the agenda planning process for possible improvements. Members were in agreement that the Chair is free to fully participate in meetings, including • offering motions. There was additional discussion about agenda planning. Member Russell suggested that a sub-committee consisting of the Chair, Vice Chair and former Chair would meet to consider tentative agendas prepared by Jean Baldwin. Member Westerman said that, due to work obligations, she would not be able to attend a separate monthly meeting. Member Russell was not in favor of an e-mail process instead of a meeting. Dr. Locke noted that this idea had been considered in the past. He said the agenda planning would need to be done about two weeks in advance. He suggested the means used by the State BOH: the Board creates a three to six month roster/calendar of topics, while leaving open agenda time for additional ad hoc items. The option of making better use of the Agenda Planning item was suggested. Jean Baldwin noted that she and Dr. Locke maintain a rolling outline of topics several months in advance, but would prefer to have more input from the BOH. After further discussion of several ideas, members agreed that members do have the option to participate in planning agendas. Member Frissell noted that the staff solicits input on the agenda via e- mail every month, as well. They also supported Member Westerman's suggestion to include a tentative calendar updated monthly in the packet as the basis for discussion and feedback. Member Russell said he would bring this up again if it did not work out well and withdrew his request for special planning meetings. Member Johnson nominated Kristen Nelson for Vice Chair,with a second by • Member Frissell. Members Russell and Nelson were unanimously elected for the positions of Chair and Vice Chair, respectively. Member Westerman passed the gavel to Chair Russell who presided over the remainder of the meeting. Members and staff thanked Member Westerman for her term as Chair. APPROVAL OF MINUTES Member Johnson moved for approval of the minutes; Member Sullivan seconded. The minutes of December 17,2009, as submitted,were unanimously approved. PUBLIC COMMENTS There were no public comments and no members of the public present. S Page 2 of 13 • t OLD BUSINESS AND INFORMATIONAL ITEMS • Healthcare Associated Infections Go Online Dr. Locke referred to the press release from the Washington Department of Health in the packet, and recommended that BOH members visit the website, www.dob.wa.gov/ehsphl/hai/0 hai default.htm. This is in response to a legislative mandate in 2007 that requires hospital infection rates to be publicly accessible on a state government website. Starting this year, surgical site infections will be shown, in addition to data already published in this manner. Dr. Locke said he has been involved with the group responsible for implementing the legislation. He said it is a huge public education project to explain this data. For example, one key point that must be conveyed is that rates will be different for small community hospitals compared to those facilities handling more complex procedures. He said he would appreciate feedback on whether or not the information is clear and understandable. In response to a question, Dr. Locke said that this is an appropriate step to push hospitals to invest more resources in infection control. However,the data is very difficult to understand because it is impossible to fully adjust it for risk. Also, surgical site infections can be very expensive in terms of data collection/reporting. There is a lengthy report that needs to be filed for every surgical case, not just the small percentage that are complicated by post surgical infection. Work will continue to streamline the process. Member Sullivan noted that historically nursing was most responsible for infection • control. More recently there has been a trend to greater use of disposables and antibiotic resistance has been a growing problem. Draft Letter to Port Townsend City Manager Jean Baldwin referred to the draft letter in the packet. She said she had not submitted the letter, at the request of the County Administrator. Ms. Baldwin said that since the last BOH meeting she had found a copy of the Regional Services Agreement, signed by the City and Jefferson County, which remains in effect until December 31, 2010. This document commits the City to current funding levels through the remainder of 2010. Member Westerman distributed a document she had prepared for discussion and requested that the Board review her document. Ms. Baldwin reported that she had heard from Catherine Robinson that David Timmons intended to continue the contract. She said that she had no other information about the status of the contract and was therefore uncertain as to the most appropriate next step. She said she assumed that it is still appropriate to bill the City under the terms of the contract for services provided. Ms. Westerman said she was concerned about the lack of clear communication. She noted the difference between this intergovernmental contract and City/non-profit groups • Page 3 of 13 • seeking City support. She stressed the importance of ensuring better communication between the City and County. • Jean Baldwin said that as the administrator overseeing public health services for the City of Port Townsend, she did not currently have a clear communication link to the City and sees that as a problem. Member Westerman noted that the City Council representation on the BOH was intended to fill that role. She wondered if a staff level link may be more effective. She said she was open to any of several options that would get the job done effectively. Member Nelson offered to distribute relevant information from the BOH meetings to the other City Council members. She noted that, as a new BOH member, she is still learning about the functions and processes of this body. She suggested that relevant reports and statistics could be included in City Council packets monthly and/or noticed on the City Council agendas. Ms. Baldwin stated that the issues are multi-faceted and that perhaps several steps need to be taken. She noted that Ms. Westerman, as a City citizen representative on the BOH, could possibly attend City Council meetings to present information. Member Westerman said that she could represent the BOH if authorized, but would not do so without their approval. She added that City Councilors are entitled to clear information in order to make decisions. There was further discussion about the withdrawal of funds that occurred during the • December 7 City Council meeting. Member Sullivan noted that the action had been a mistake and that it is most important to prevent a reoccurrence. He said that he understood that the situation had been acknowledged and corrected. He said that the City has recognized that a 90 day notice is necessary to amend the contract. He agreed that there could be better communication, and that remains a challenge for both the City and County. Member Sullivan acknowledged the difficulty of keeping everyone fully updated on relevant information at all times. There was further discussion about the fact that the County is providing services to the City under contract via the Liquor Excise Tax, but that the City Council apparently is unaware of those services. Member Nelson suggested that regular updates to the City Council, perhaps with an annual presentation, would be effective. Ms. Baldwin suggested that a regular written report or update could be sent to the City Council and interested Boards. Ms. Westerman added that she would be willing to attend City Council meetings with Ms. Baldwin as needed to present relevant reports. Member Westerman noted that paper reports included in an already voluminous packet may be overlooked, and that in-person updates may be most effective. The intention is that she and Jean Baldwin will prepare and present to the City Council in the near future. During further discussion, there was clarification that there is just one contract with the City that covers both Public Health and Animal Services, and that it is very important that • Page 4 of 13 City Council understands the full extent of service the City receives for its funding. • Member Nelson noted that most of the Council is now aware of the contract and would never break such a contract. Member Westerman said she was more concerned with the improving the flow of information and ensuring that City Council receives clear, timely information. There was agreement of the importance that trust be maintained, and that future reports should convey the full extent of services being provided to all the citizens of the City and County. Members Sullivan and Johnson stressed that there is good cooperation and trust between the City and County over a broad range of mutual interests, committees and working relationships. 2009 Jefferson County Board of Health Activity Timeline Jean Baldwin referred to the summary of formal actions (motions carried)taken by the BOH in 2009 included in the packet. She indicated that such a summary is prepared each year for the Board's information. 2010 Census Preparation Member Phil Johnson and Julia Danskin serve on the Everybody Counts committee for Jefferson County. Member Johnson gave a brief overview of the 2010 Census process/schedule and mentioned a planning meeting with representatives from all areas of • the County. He stressed that there is a constitutional requirement for absolute confidentiality of information. Julia Danskin said that Jefferson County Public Health is going to contract for a US Census worker to be on site from March 19 through April 19 during working hours to answer questions. (Census representatives will also be stationed at the City and County libraries.) Member Johnson noted that the committee will be utilizing many different ways of disseminating information about the census and encouraging full participation. Department Update Jean Baldwin reported that Tim Hockett, executive director of the Olympic Community Action Program (OIyCAP), had accepted her invitation to attend the February 2010 BOH meeting. He will provide an update on the OIyCAP funding situation and respond to any questions from the BOH. Ms. Baldwin also reported on the federal audit of Family Planning Services that had taken place in the previous week. This represents only $18,000 of funding. Six federal and one State auditor were on site for one day. The purpose was to evaluate Jefferson and King Counties as well as the State's abilities to conduct their work in the field. She said the process was very intensive, but the outcome was very positive. The department received A+with regard to clinical services, staff training, skills of charting, medical record completeness, fiscal management and other areas. There were no significant • Page 5 of 13 "findings". She said some suggestions were received with regard to communications, and a few other specific areas, which were immediately corrected. • Web Link to: an Epidemic of Fear The online reference for the Wired magazine article that had been requested during the previous BOH meeting was included in the packet: http://www.wired.com/magazine/2009/1 0/ff waronscience/ NEW BUSINESS Solid Waste Program: Designation of Green Business Lori Clark and Margie Boyd from the Environmental Health staff were on hand to provide an update of the Solid Waste program. Lori Clark stepped through a slide presentation on Green Business, which is defined as "Any business or organization that uses environmentally friendly practices and operations." This is a voluntary program and is designed to recognize existing efforts, as well as provide free technical assistance to improve in any areas that are lacking. There is a checklist to guide businesses and organizations in preparing for certification. The main benefit for participants is free advertising, which includes display decals, an online directory, and public recognition. Other benefits are free technical assistance, appreciation of employees, reduction of environmental footprint and likely reduction of operational costs. • She displayed a list of the current Jefferson County businesses, which are also available on the web site. The newest business to qualify will be Jefferson County Public Health, as of this date. Ms. Clark noted that the process of achieving this status has been going on for almost two years. She noted in particular paper reduction and discussed the Waste Reduction and Recycled Product Procurement Policy that had been developed. She pointed out that this is an opportunity for governmental agencies/departments to lead by example. Annual renewal process—Ms. Clark discussed the renewal process, which is a means to help businesses reach a higher level of environmental awareness and responsibility, as well as help track the program success over time. EnviroStars-This program is geared to those businesses that deal with hazardous waste. Ms. Clark mentioned the 3 R's of Green Business: reduce, reuse, recycle. EnviroStars deals with proper storage and disposal of hazardous waste. An Enviro-Star business may also be a Green Business, but not all Green Businesses are applicable EnviroStars. There are numerous types of advertising, including newspapers,brochures, quarterly newsletters, and state,regional and local directories. The rating system begins with two stars, setting a goal,with additional stars awarded up to 5 stars for qualifying as a leader/educator in the community of how to reduce • Page 6 of 13 hazardous waste. BOH members were impressed that the current list of EnviroStars • includes so many of the most challenging businesses in this community. Ms. Clark noted the partnership with the Puget Soundkeeper Alliance, Clean Marina Program,which jointly verifies marina related businesses. Local Source Control is a partnership between local health jurisdictions and the Department of Ecology, which focuses directly on assisting small businesses to prevent polluted runoff to Puget Sound and local waters. This is voluntary but local jurisdictions are supported in providing technical assistance to local businesses. Ms. Clark said that the Health Department decided to streamline its efforts for the three programs discussed: Green Business, EnviroStars and Local Source Control, particularly in working with the Port of Port Townsend. The Port itself has been certified with EnviroStars and will become a Clean Marina this month. There will now be a focus on the individual businesses within the port/marina. Those that have hazardous waste will be encouraged and supported to become EnviroStars, while those that do not can become Green Business. If they are not interested in either, they will be approached for Local Source Control assistance and participation. The Port and marina areas are a high priority due to their location on the waterfront and potential environmental impact. She noted the variety of activities where there is regular use of potentially hazardous materials and processes. Ms. Clark noted that the grants supporting these programs provide for promotion and advertising for certified businesses so that the community is aware they are doing business in an environmentally responsible way. She then responded to questions from BOH members about the application/certification process. Ms. Clark noted that there are specific checklists for different types of businesses, such as printers, auto repair, dental practices, etc. She explained that in the case of a building with multiple businesses, she would be work with certifying each individual business before recognizing the property overall. It was noted that certification of one or two of a certain type of business tends to incentivize others to follow suit. In addition, as public awareness grows, this also tends to motivate individual businesses to be certified. Margie Boyd added that under the Local Source Control program, it is their practice to contact all businesses of a certain type at about the same time. She noted that Local Source Control acts as an on ramp to Green Business and EnviroStars. Ms. Boyd also mentioned that a local church had heard of the program and invited her to speak at an inter-denominational meeting, which further publicized the program. Jefferson County Public Health Waste Reduction and Recycled Product Procurement Policy Jean Baldwin referred to the policy document in the packet. She said that either she could implement this policy at the department level or the BOH could endorse the policy, thereby making a stronger statement. That is, the Board would be making a policy • decision that the Health Department and other departments will model what they are Page 7 of 13 asking other businesses to do, with regard to waste reduction,recycled product procurement and environmental responsibility. The policy provides that this will be followed provided it is feasible and financially affordable. Staff noted that once adopted, they will work with other County departments to commit to similar policies and practices. Staff members explained some of the steps that had already been put in place for cost savings, as well: double-sided printing; use of scrap paper for draft documents; attention to shutting off equipment and lights when not in use; avoiding printing unneeded copies, etc. Member Westerman moved that the BOH request the Health Department to adopt the draft Waste Reduction and Recycled Product Procurement Policy. Member Nelson seconded. The BOH unanimously approved the motion. Jean Baldwin said she would post this document on the website. Tobacco Prevention and Control Update Karen Obermeyer, Tobacco Prevention Program, began by discussing the health effects of tobacco smoking and second hand smoke. She reviewed the negative health effects of second hand smoke: when a non-smoker is exposed to second hand smoke, blood platelets are activated and raises the risk of a heart attack. She cited a study that revealed a correlation between a smoking ban in a community and lowered rates of heart attacks. When the smoking ban was overturned, heart attack rates returned to former levels. When the ban was re-instated,heart attack rates fell again. She also noted that one of the best preventative measures against H 1 N 1, seasonal flu and pneumonia is to quit smoking. • In the tobacco program,there are four main areas of focus: increase community coordination and capacity for tobacco use prevention; prevent youth and young adults from using tobacco; increase the quitting and prevent exposure to second hand smoke. Ms. Obermeyer distributed copies of Jefferson County Tobacco Use Statistics. She reviewed the smoking rates for various age groups, and discussed the applicable confidence intervals and sampling size. The Washington State smoking rate of 15% (adults) is the 6th lowest in the nation. According to a relatively small sample in 2009, the rate for Jefferson County was 24%. Looking at the data for 2006 to 2008, she said that 17% (based on much larger sampling sizes) seems to be a better estimate for Jefferson County. Rates for 10th graders fell from 24%to 13.6% in Jefferson County. Rates for 8th graders dropped, as well. The smoking rate of 22.5% for pregnant women is particularly alarming. This statistic is self-reported and may actually understate the problem. Ms. Obermeyer said that the national goal for Healthy People 2010 (U.S. Department of Health and Human Services) is 12%. She noted there is significant work to be done locally in terms of education and programs to reduce smoking rates. She described the media outreach, presentations to community and business groups, and work with schools. • Page 8 of 13 r She said she is working on strategies for groups at greater risk to use tobacco, such as • those at lower income and lower education levels. Ms. Obermeyer talked about her outreach work with youth and youth prevention, notably with the Boiler Room and with Teens Against Tobacco Use. She said she also does tobacco retailer education and compliance checks, as well as promotion of the Quit Line, staffed by trained tobacco cessation counselors. This is a subsidized service; people who call this line have a 50% greater chance of quitting smoking. Beginning in July, all publicly funded substance abuse treatment facilities are required to include nicotine addiction treatment. More people involved in substance abuse are dying from tobacco than from other forms of substance abuse. She also provides technical assistance in writing policies for multi-unit housing administrators. For the Great American Smoke Out, she wrote a press release for the newspaper, and targeted church bulletins as another way to disseminate information. Ms. Obermeyer works with school based clinics to ensure they offer Tobacco Cessation help as well. The final draft of the procedure for regulation of smoking in public places has recently been completed. Since September, there have been four complaints regarding smoking in public places; she said the rate usually rises in the summer months. Providing education to businesses about their responsibilities is another aspect of her work. Ms. Obermeyer noted that one of the most effective ways of preventing/reducing tobacco use is increasing the price of tobacco products; it also motivates smokers to quit. The • federal tobacco tax increased in June and there is a proposal in process for a State increase as well. Jean Baldwin asked the BOH to consider whether additional areas of the County and City should be designated as smoke free. The hospital is now smoke-free, as are County in- door facilities and within 25 feet of entrances. Smoking in the parks, at the Fairgrounds, and other public places is not prohibited. Ms. Obermeyer said she had received complaints about smoking at the Fairgrounds. Member Westerman noted that Denmark is attempting to pass legislation that would prohibit smoking entirely throughout that nation. However, lawsuits are being brought forward from tobacco companies. Member Nelson said that the City has received complaints about smoking in parks and on sidewalks. There was discussion about how 25 foot perimeters are not always maintained. Member Westerman said that raising taxes on products and citizen enforcement are effective means of tobacco use control. Priority Setting for Public Health Services Jean Baldwin recalled that, at the January meeting, Chair Russell had requested that she prepare a candidate list of services that could be cut or closed if funding drops further. She sees this as a multi-step process, and suggested that the BOH first consider: what work is being done, who is the work being done for, and how it is being done, all of which leads to the outcomes. The Performance Measures, published and reviewed by the • BOH every March, show the activities and the outcomes for each program. She believes Page 9 of 13 r the appropriate questions are whether these outcomes can be given up or provided in some other way or by some other agencies. For example, can Family Planning services • be dropped or will it need to be taken over by the hospital or other clinical care facility? She also discussed the external forces/environment: general economic climate giving rise to unemployment, decreased federal, state and local funding, and more pressures on families, i.e. increased needs and fewer resources. She noted that accounting for increased needs is not easily translated to a prioritization process. The federal and state cuts are easily identifiable,but are associated with particular programs. Historically, changes in program funding have simply resulted in service changes within those programs. She noted that logically this method would be followed for local money as well. However, local money has been used as backfill in all the other programs; it is woven into many programs and services, such as Family Planning; Communicable Disease; Maternal Child Health, etc. These are the programs and services that were previously identified as the most important to continue, while dropping, for example, HIV case management or other services that were being done by other agencies. She said that it is possible to provide the list of how much local funding goes to each program. There is also great uncertainty about State funding, since the Governor has released another budget that would reinstate many of the programs that had been cut in the earlier budget draft. She mentioned the $80,000 funding for Child Protective Services as an example. • Ms. Baldwin said that because of the above, she had not prepared the priority list, but came prepared with a discussion topic instead. She referred to copies of Guide to Prevention in Jefferson County, noting that it had been jointly endorsed by the County, City, Hospital, BOH and many other agencies. She said Tobacco program and Enviro- Stars are good examples of programs that affect community norms. Currently, they are only funded by State dollars. She said that this shows how prioritization has already been done. The prevention checklist in this brochure is a way to determine and measure if programs are worth doing. A second method is outlined in the Guide for Establishing Health Priorities (packet materials). Dr. Locke said this had been included for informational purposes. He noted that this is a mathematical way to prioritize public health services. However, it works best where a specified amount of funding is available, and there is a desire to figure how best to use it. Instead, in the present context, there are many categorical and fragmented lines of funding, often with requirements for local matches or subsidies. He said this type of method could possibly be helpful to compare two worthy programs. Ultimately, priorities should be based on the severity of the problem, the effectiveness of intervention, and the numbers of community members impacted. He said that much of what is now being done is addressing serious problems with highly effective interventions that are relatively common. That is,they are already focused on the highest priority tier. Lower tiers have already been cut, and do not have local funding lines • Page 10 of 13 att . aothe legislature ibe gimporthconsiderations.achedThebudget He notedctithatns the buy-back provisionswll ofof the hr most recentance State intbudget• draft are conditioned on $788 million of new revenue. Dr. Locke said it is highly likely that there will be changes/cuts to federal and State funds at the program level within the next few months. Ms. Baldwin said the challenge is how to frame the problem and discussion. One framing, for example, is elimination of the Health Department and privatizing its service, regionalizing everything else. She pointed out that the degree of uncertainty is extremely high. Chair Russell said that, despite the explanations above, he believes that a priority list is needed primarily as a means of making the public aware of what is at risk. Ms. Baldwin said she can provide the list of how local funds are being used, but not what should be cut. She and Member Westerman noted the complexity of the issues. Chair Russell said that he believes the BOH message must be somewhat simplistic in order to convey the gravity of the situation to the public. Member Sullivan suggested that this discussion could be tabled until March, when the legislative process is further along. Member Westerman noted that over the past many years, all lower priority programs have been culled, and all that is left is of the highest priority. She said she does not believe it possible to create a meaningful list. Member Johnson mentioned that the legislature is considering a higher sales tax on candy. He • said he did not understand why a penny tax on cans of soda pop or on plastic bottles cannot be implemented. Jean Baldwin suggested the possibility of a few BOH members working with Dr. Locke and her to better frame the problem and the list. Julia Danskin pointed out that better methods of helping the public understand the essential work and contributions of the Health Department are needed. After further discussion about the broader social, political and economic context, Members agreed to continue the discussion in future meetings. Tribal Mutual Assistance Agreement: Next Steps Dr. Locke reported that the Agreement had been signed by all seven counties and three Tribes. The next step is to develop an operational plan. This is the first such agreement in the USA and will be used as model for others. The State plans to issue a press release. H1N1 Seasonal Flu Update Dr. Locke said that the second wave of H1N1 appears to have passed, and it is uncertain whether there will be a third wave. This depends on the total number of people who are immunized. About 50% are needed to stop an epidemic; currently the rate is estimated at 45% in Washington State. There is plenty of vaccine now, and there are continuing • promotional efforts. He said it is difficult to get people to be vaccinated at this time of Page 11 of 13 year. There is also little seasonal flu activity thus far. However,there is concern that the winter Olympics in Canada will bring flu to the Northwest. • Jean Baldwin pointed out Jefferson County immunization statistics in the packet materials. 24% of six month to 24 years of age individuals got the vaccine early, which is much higher than that for the State as a whole. She credited the excellent partnerships with the Hospital, private vendors, and caretakers. Safeway, QFC and walk-in clinics are still providing the immunizations. Vaccinations are still being administered and further reporting is forthcoming. Legislative Update Dr. Locke mentioned that a public health funding bill, i.e. a"candy tax", is pending. The bill is in the hearing stage and appears to have significant support. There is also a bill aimed at saving the current immunization system, which otherwise would end in May. Under this plan, participating insurance plans would absorb the difference (former State subsidy) in cost, and would receive the vaccines per the CDC price lists. Member Johnson mentioned that there is also a proposal to extend the 1/10t of one percent arrangement indefinitely. Member Westerman noted that altering the original intent for this money will further threaten the government's credibility with voters. AGENDA PLANNING Member Sullivan stated that the semi-annual WASAC conference is held every year in • June (and November), and conflicts with the BOH meeting in June. He suggested this meeting be rescheduled or cancelled. Member Nelson said the second Thursday between 3 and 5 PM is a conflict for her but can be arranged with adequate notice. There was agreement to reschedule the June meeting to the second Thursday of the month and to cancel the November meeting. The next scheduled BOH meeting will be held on February 18, 2010 from 2:30 to 4:30 PM. ADJOURNMENT Chair Russell adjourned the BOH meeting at 4:42 PM. • Page 12 of 13 JEFFERSON COUNTY BOARD OF HEALTH Chuck Russell, Chair Phil Johnson, Member Kristen Nelson, Vice Chair Excused John Austin, Member Roberta Frissell, Member David Sullivan, Member Sheila Westerman M • Page 13 of 13 • JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, January 21, 2010 2:30 PM—4:30 PM Health Department Conference Room, 615 Sheridan Street, Port Townsend Board Members Staff Members Phil Johnson, County Commissioner District#1 Thomas Locke,MD, Health Officer David Sullivan, County Commissioner,District#2 Jean Baldwin,Public Health Services Director John Austin, County Commissioner,District#3 Julia Danskin,Nursing Services Director Kristen Nelson, Vice Chair,Port Townsend City Council Sheila Westerman, Citizen at large(City) Chuck Russell, 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 2:37 PM. Members Present: Roberta Frissell,Phil Johnson, Kristen Nelson, Chuck Russell, David Sullivan, Sheila Westerman Members Excused: John Austin Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin • Guest: Frances Joswick, SAAB A quorum was present. APPROVAL OF AGENDA Chair Westerman said she would like to have time under Draft Letter to Port Townsend City Manager to offer a handout and discuss it. Member Frissell moved and Member Sullivan seconded for approval of the agenda. The agenda was approved unanimously, as written. ELECTION OF CHAIR AND VICE CHAIR FOR 2010 Chair Westerman reviewed the process that had been followed in the past for election of Chair and Vice Chair positions. The Vice Chair normally assumes the Chair position and a new Vice Chair is elected. Member Nelson nominated Chuck Russell to the Chair position. The nomination was seconded by Member Johnson. Member Russell indicated that he would accept the nomination and assume the Chair 4111 position if elected, with two conditions: he wished to be able to offer motions and he Page 1 of 13 Board of Health-January 21,2010 wished to review the agenda planning process for possible improvements. Members were in agreement that the Chair is free to fully participate in meetings, including • offering motions. There was additional discussion about agenda planning. Member Russell suggested that a sub-committee consisting of the Chair,Vice Chair and former Chair would meet to consider tentative agendas prepared by Jean Baldwin. Member Westerman said that, due to work obligations, she would not be able to attend a separate monthly meeting. Member Russell was not in favor of an e-mail process instead of a meeting. Dr. Locke noted that this idea had been considered in the past. He said the agenda planning would need to be done about two weeks in advance. He suggested the means used by the State BOH: the Board creates a three to six month roster/calendar of topics, while leaving open agenda time for additional ad hoc items. The option of making better use of the Agenda Planning item was suggested. Jean Baldwin noted that she and Dr. Locke maintain a rolling outline of topics several months in advance, but would prefer to have more input from the BOH. After further discussion of several ideas, members agreed that members do have the option to participate in planning agendas. Member Frissell noted that the staff solicits input on the agenda via e- mail every month, as well. They also supported Member Westerman's suggestion to include a tentative calendar updated monthly in the packet as the basis for discussion and feedback. Member Russell said he would bring this up again if it did not work out well and withdrew his request for special planning meetings. • Member Johnson nominated Kristen Nelson for Vice Chair,with a second by Member Frissell. Members Russell and Nelson were unanimously elected for the positions of Chair and Vice Chair, respectively. Member Westerman passed the gavel to Chair Russell who presided over the remainder of the meeting. Members and staff thanked Member Westerman for her term as Chair. APPROVAL OF MINUTES Member Johnson moved for approval of the minutes; Member Sullivan seconded. The minutes of December 17,2009, as submitted,were unanimously approved. PUBLIC COMMENTS There were no public comments and no members of the public present. • Page 2 of 13 Board of Health-January 21, 2010 r OLD BUSINESS AND INFORMATIONAL ITEMS • Healthcare Associated Infections Go Online Dr. Locke referred to the press release from the Washington Department of Health in the packet, and recommended that BOH members visit the website, www.dob.wa.gov/ehsphl/hai/0 hai default.htm. This is in response to a legislative mandate in 2007 that requires hospital infection rates to be publicly accessible on a state government website. Starting this year, surgical site infections will be shown, in addition to data already published in this manner. Dr. Locke said he has been involved with the group responsible for implementing the legislation. He said it is a huge public education project to explain this data. For example, one key point that must be conveyed is that rates will be different for small community hospitals compared to those facilities handling more complex procedures. He said he would appreciate feedback on whether or not the information is clear and understandable. In response to a question, Dr. Locke said that this is an appropriate step to push hospitals to invest more resources in infection control. However,the data is very difficult to understand because it is impossible to fully adjust it for risk. Also, surgical site infections can be very expensive in terms of data collection/reporting. There is a lengthy report that needs to be filed for every surgical case, not just the small percentage that are complicated by post surgical infection. Work will continue to streamline the process. Member Sullivan noted that historically nursing was most responsible for infection • control. More recently there has been a trend to greater use of disposables and antibiotic resistance has been a growing problem. Draft Letter to Port Townsend City Manager Jean Baldwin referred to the draft letter in the packet. She said she had not submitted the letter, at the request of the County Administrator. Ms. Baldwin said that since the last BOH meeting she had found a copy of the Regional Services Agreement, signed by the City and Jefferson County, which remains in effect until December 31, 2010. This document commits the City to current funding levels through the remainder of 2010. Member Westerman distributed a document she had prepared for discussion and requested that the Board review her document. Ms. Baldwin reported that she had heard from Catherine Robinson that David Timmons intended to continue the contract. She said that she had no other information about the status of the contract and was therefore uncertain as to the most appropriate next step. She said she assumed that it is still appropriate to bill the City under the terms of the contract for services provided. Ms. Westerman said she was concerned about the lack of clear communication. She noted the difference between this intergovernmental contract and City/non-profit groups • Page 3 of 13 Board of Health-January 21, 2010 seeking City support. She stressed the importance of ensuring better communication between the City and County. • Jean Baldwin said that as the administrator overseeing public health services for the City of Port Townsend, she did not currently have a clear communication link to the City and sees that as a problem. Member Westerman noted that the City Council representation on the BOH was intended to fill that role. She wondered if a staff level link may be more effective. She said she was open to any of several options that would get the job done effectively. Member Nelson offered to distribute relevant information from the BOH meetings to the other City Council members. She noted that, as a new BOH member, she is still learning about the functions and processes of this body. She suggested that relevant reports and statistics could be included in City Council packets monthly and/or noticed on the City Council agendas. Ms. Baldwin stated that the issues are multi-faceted and that perhaps several steps need to be taken. She noted that Ms. Westerman, as a City citizen representative on the BOH, could possibly attend City Council meetings to present information. Member Westerman said that she could represent the BOH if authorized, but would not do so without their approval. She added that City Councilors are entitled to clear information in order to make decisions. There was further discussion about the withdrawal of funds that occurred during the • December 7 City Council meeting. Member Sullivan noted that the action had been a mistake and that it is most important to prevent a reoccurrence. He said that he understood that the situation had been acknowledged and corrected. He said that the City has recognized that a 90 day notice is necessary to amend the contract. He agreed that there could be better communication, and that remains a challenge for both the City and County. Member Sullivan acknowledged the difficulty of keeping everyone fully updated on relevant information at all times. There was further discussion about the fact that the County is providing services to the City under contract via the Liquor Excise Tax, but that the City Council apparently is unaware of those services. Member Nelson suggested that regular updates to the City Council, perhaps with an annual presentation,would be effective. Ms. Baldwin suggested that a regular written report or update could be sent to the City Council and interested Boards. Ms. Westerman added that she would be willing to attend City Council meetings with Ms. Baldwin as needed to present relevant reports. Member Westerman noted that paper reports included in an already voluminous packet may be overlooked, and that in-person updates may be most effective. The intention is that she and Jean Baldwin will prepare and present to the City Council in the near future. During further discussion, there was clarification that there is just one contract with the City that covers both Public Health and Animal Services, and that it is very important that • Page 4 of 13 Board of Health-January 21,2010 City Council understands the full extent of service the City receives for its funding. • Member Nelson noted that most of the Council is now aware of the contract and would never break such a contract. Member Westerman said she was more concerned with the improving the flow of information and ensuring that City Council receives clear,timely information. There was agreement of the importance that trust be maintained, and that future reports should convey the full extent of services being provided to all the citizens of the City and County. Members Sullivan and Johnson stressed that there is good cooperation and trust between the City and County over a broad range of mutual interests, committees and working relationships. 2009 Jefferson County Board of Health Activity Timeline Jean Baldwin referred to the summary of formal actions (motions carried)taken by the BOH in 2009 included in the packet. She indicated that such a summary is prepared each year for the Board's information. 2010 Census Preparation Member Phil Johnson and Julia Danskin serve on the Everybody Counts committee for Jefferson County. Member Johnson gave a brief overview of the 2010 Census process/schedule and mentioned a planning meeting with representatives from all areas of • the County. He stressed that there is a constitutional requirement for absolute confidentiality of information. Julia Danskin said that Jefferson County Public Health is going to contract for a US Census worker to be on site from March 19 through April 19 during working hours to answer questions. (Census representatives will also be stationed at the City and County libraries.) Member Johnson noted that the committee will be utilizing many different ways of disseminating information about the census and encouraging full participation. Department Update Jean Baldwin reported that Tim Hockett, executive director of the Olympic Community Action Program (OIyCAP), had accepted her invitation to attend the February 2010 BOH meeting. He will provide an update on the OIyCAP funding situation and respond to any questions from the BOH. Ms. Baldwin also reported on the federal audit of Family Planning Services that had taken place in the previous week. This represents only $18,000 of funding. Six federal and one State auditor were on site for one day. The purpose was to evaluate Jefferson and King Counties as well as the State's abilities to conduct their work in the field. She said the process was very intensive, but the outcome was very positive. The department received A+with regard to clinical services, staff training, skills of charting, medical record completeness, fiscal management and other areas. There were no significant • Page 5 of 13 Board of Health-January 21,2010 "findings". She said some suggestions were received with regard to communications, and a few other specific areas, which were immediately corrected. • Web Link to: an Epidemic of Fear The online reference for the Wired magazine article that had been requested during the previous BOH meeting was included in the packet: http://www.wired.com/magazine/2009/10/ff waronscience/ NEW BUSINESS Solid Waste Program: Designation of Green Business Lori Clark and Margie Boyd from the Environmental Health staff were on hand to provide an update of the Solid Waste program. Lori Clark stepped through a slide presentation on Green Business, which is defined as "Any business or organization that uses environmentally friendly practices and operations." This is a voluntary program and is designed to recognize existing efforts, as well as provide free technical assistance to improve in any areas that are lacking. There is a checklist to guide businesses and organizations in preparing for certification. The main benefit for participants is free advertising, which includes display decals, an online directory, and public recognition. Other benefits are free technical assistance, appreciation of employees, reduction of environmental footprint and likely reduction of operational costs. • She displayed a list of the current Jefferson County businesses, which are also available on the web site. The newest business to qualify will be Jefferson County Public Health, as of this date. Ms. Clark noted that the process of achieving this status has been going on for almost two years. She noted in particular paper reduction and discussed the Waste Reduction and Recycled Product Procurement Policy that had been developed. She pointed out that this is an opportunity for governmental agencies/departments to lead by example. Annual renewal process—Ms. Clark discussed the renewal process, which is a means to help businesses reach a higher level of environmental awareness and responsibility, as well as help track the program success over time. EnviroStars—This program is geared to those businesses that deal with hazardous waste. Ms. Clark mentioned the 3 R's of Green Business: reduce, reuse, recycle. EnviroStars deals with proper storage and disposal of hazardous waste. An Enviro-Star business may also be a Green Business, but not all Green Businesses are applicable EnviroStars. There are numerous types of advertising, including newspapers, brochures, quarterly newsletters, and state, regional and local directories. The rating system begins with two stars, setting a goal, with additional stars awarded up to 5 stars for qualifying as a leader/educator in the community of how to reduce • Page 6 of 13 Board of Health-January 21,2010 r hazardous waste. BOH members were impressed that the current list of EnviroStars • includes so many of the most challenging businesses in this community. Ms. Clark noted the partnership with the Puget Soundkeeper Alliance, Clean Marina Program, which jointly verifies marina related businesses. Local Source Control is a partnership between local health jurisdictions and the Department of Ecology, which focuses directly on assisting small businesses to prevent polluted runoff to Puget Sound and local waters. This is voluntary but local jurisdictions are supported in providing technical assistance to local businesses. Ms. Clark said that the Health Department decided to streamline its efforts for the three programs discussed: Green Business, EnviroStars and Local Source Control, particularly in working with the Port of Port Townsend. The Port itself has been certified with EnviroStars and will become a Clean Marina this month. There will now be a focus on the individual businesses within the port/marina. Those that have hazardous waste will be encouraged and supported to become EnviroStars, while those that do not can become Green Business. If they are not interested in either, they will be approached for Local Source Control assistance and participation. The Port and marina areas are a high priority due to their location on the waterfront and potential environmental impact. She noted the variety of activities where there is regular use of potentially hazardous materials and processes. Ms. Clark noted that the grants supporting these programs provide for promotion and • advertising for certified businesses so that the community is aware they are doing business in an environmentally responsible way. She then responded to questions from BOH members about the application/certification process. Ms. Clark noted that there are specific checklists for different types of businesses, such as printers, auto repair, dental practices, etc. She explained that in the case of a building with multiple businesses, she would be work with certifying each individual business before recognizing the property overall. It was noted that certification of one or two of a certain type of business tends to incentivize others to follow suit. In addition, as public awareness grows,this also tends to motivate individual businesses to be certified. Margie Boyd added that under the Local Source Control program, it is their practice to contact all businesses of a certain type at about the same time. She noted that Local Source Control acts as an on ramp to Green Business and EnviroStars. Ms. Boyd also mentioned that a local church had heard of the program and invited her to speak at an inter-denominational meeting, which further publicized the program. Jefferson County Public Health Waste Reduction and Recycled Product Procurement Policy Jean Baldwin referred to the policy document in the packet. She said that either she could implement this policy at the department level or the BOH could endorse the policy, thereby making a stronger statement. That is, the Board would be making a policy • decision that the Health Department and other departments will model what they are Page 7 of 13 Board of Health-January 21,2010 asking other businesses to do,with regard to waste reduction,recycled product procurement and environmental responsibility. The policy provides that this will be • followed provided it is feasible and financially affordable. Staff noted that once adopted, they will work with other County departments to commit to similar policies and practices. Staff members explained some of the steps that had already been put in place for cost savings, as well: double-sided printing; use of scrap paper for draft documents; attention to shutting off equipment and lights when not in use; avoiding printing unneeded copies, etc. Member Westerman moved that the BOH request the Health Department to adopt the draft Waste Reduction and Recycled Product Procurement Policy. Member Nelson seconded. The BOH unanimously approved the motion. Jean Baldwin said she would post this document on the website. Tobacco Prevention and Control Update Karen Obermeyer, Tobacco Prevention Program, began by discussing the health effects of tobacco smoking and second hand smoke. She reviewed the negative health effects of second hand smoke: when a non-smoker is exposed to second hand smoke, blood platelets are activated and raises the risk of a heart attack. She cited a study that revealed a correlation between a smoking ban in a community and lowered rates of heart attacks. When the smoking ban was overturned, heart attack rates returned to former levels. When the ban was re-instated,heart attack rates fell again. She also noted that one of the best preventative measures against H1N1, seasonal flu and pneumonia is to quit smoking. • In the tobacco program, there are four main areas of focus: increase community coordination and capacity for tobacco use prevention; prevent youth and young adults from using tobacco; increase the quitting and prevent exposure to second hand smoke. Ms. Obermeyer distributed copies of Jefferson County Tobacco Use Statistics. She reviewed the smoking rates for various age groups, and discussed the applicable confidence intervals and sampling size. The Washington State smoking rate of 15% (adults) is the 6th lowest in the nation. According to a relatively small sample in 2009, the rate for Jefferson County was 24%. Looking at the data for 2006 to 2008, she said that 17% (based on much larger sampling sizes) seems to be a better estimate for Jefferson County. Rates for 10th graders fell from 24%to 13.6% in Jefferson County. Rates for 8th graders dropped, as well. The smoking rate of 22.5% for pregnant women is particularly alarming. This statistic is self-reported and may actually understate the problem. Ms. Obermeyer said that the national goal for Healthy People 2010 (U.S. Department of Health and Human Services) is 12%. She noted there is significant work to be done locally in terms of education and programs to reduce smoking rates. She described the media outreach, presentations to community and business groups, and work with schools. • Page 8 of 13 Board of Health-January 21,2010 She said she is working on strategies for groups at greater risk to use tobacco, such as • those at lower income and lower education levels. Ms. Obermeyer talked about her outreach work with youth and youth prevention, notably with the Boiler Room and with Teens Against Tobacco Use. She said she also does tobacco retailer education and compliance checks, as well as promotion of the Quit Line, staffed by trained tobacco cessation counselors. This is a subsidized service; people who call this line have a 50% greater chance of quitting smoking. Beginning in July, all publicly funded substance abuse treatment facilities are required to include nicotine addiction treatment. More people involved in substance abuse are dying from tobacco than from other forms of substance abuse. She also provides technical assistance in writing policies for multi-unit housing administrators. For the Great American Smoke Out, she wrote a press release for the newspaper, and targeted church bulletins as another way to disseminate information. Ms. Obermeyer works with school based clinics to ensure they offer Tobacco Cessation help as well. The final draft of the procedure for regulation of smoking in public places has recently been completed. Since September, there have been four complaints regarding smoking in public places; she said the rate usually rises in the summer months. Providing education to businesses about their responsibilities is another aspect of her work. Ms. Obermeyer noted that one of the most effective ways of preventing/reducing tobacco use is increasing the price of tobacco products; it also motivates smokers to quit. The • federal tobacco tax increased in June and there is a proposal in process for a State increase as well. Jean Baldwin asked the BOH to consider whether additional areas of the County and City should be designated as smoke free. The hospital is now smoke-free, as are County in- door facilities and within 25 feet of entrances. Smoking in the parks, at the Fairgrounds, and other public places is not prohibited. Ms. Obermeyer said she had received complaints about smoking at the Fairgrounds. Member Westerman noted that Denmark is attempting to pass legislation that would prohibit smoking entirely throughout that nation. However, lawsuits are being brought forward from tobacco companies. Member Nelson said that the City has received complaints about smoking in parks and on sidewalks. There was discussion about how 25 foot perimeters are not always maintained. Member Westerman said that raising taxes on products and citizen enforcement are effective means of tobacco use control. Priority Setting for Public Health Services Jean Baldwin recalled that, at the January meeting, Chair Russell had requested that she prepare a candidate list of services that could be cut or closed if funding drops further. She sees this as a multi-step process, and suggested that the BOH first consider: what work is being done, who is the work being done for, and how it is being done, all of which leads to the outcomes. The Performance Measures, published and reviewed by the • BOH every March, show the activities and the outcomes for each program. She believes Page 9 of 13 Board of Health-January 21,2010 the appropriate questions are whether these outcomes can be given up or provided in some other way or by some other agencies. For example, can Family Planning services • be dropped or will it need to be taken over by the hospital or other clinical care facility? She also discussed the external forces/environment: general economic climate giving rise to unemployment, decreased federal, state and local funding, and more pressures on families, i.e. increased needs and fewer resources. She noted that accounting for increased needs is not easily translated to a prioritization process. The federal and state cuts are easily identifiable, but are associated with particular programs. Historically, changes in program funding have simply resulted in service changes within those programs. She noted that logically this method would be followed for local money as well. However, local money has been used as backfill in all the other programs; it is woven into many programs and services, such as Family Planning; Communicable Disease; Maternal Child Health, etc. These are the programs and services that were previously identified as the most important to continue, while dropping, for example, HIV case management or other services that were being done by other agencies. She said that it is possible to provide the list of how much local funding goes to each program. There is also great uncertainty about State funding, since the Governor has released another budget that would reinstate many of the programs that had been cut in the earlier budget draft. She mentioned the $80,000 funding for Child Protective Services as an example. • Ms. Baldwin said that because of the above, she had not prepared the priority list, but came prepared with a discussion topic instead. She referred to copies of Guide.to Prevention in Jefferson County, noting that it had been jointly endorsed by the County, City, Hospital, BOH and many other agencies. She said Tobacco program and Enviro- Stars are good examples of programs that affect community norms. Currently, they are only funded by State dollars. She said that this shows how prioritization has already been done. The prevention checklist in this brochure is a way to determine and measure if programs are worth doing. A second method is outlined in the Guide for Establishing Health Priorities (packet materials). Dr. Locke said this had been included for informational purposes. He noted that this is a mathematical way to prioritize public health services. However, it works best where a specified amount of funding is available, and there is a desire to figure how best to use it. Instead, in the present context, there are many categorical and fragmented lines of funding, often with requirements for local matches or subsidies. He said this type of method could possibly be helpful to compare two worthy programs. Ultimately, priorities should be based on the severity of the problem, the effectiveness of intervention, and the numbers of community members impacted. He said that much of what is now being done is addressing serious problems with highly effective interventions that are relatively common. That is, they are already focused on the highest priority tier. Lower tiers have already been cut, and do not have local funding lines • Page 10 of 13 Board of Health-January 21,2010 attached. The budget actions of the legislature will be of great importance in these considerations. He noted that the buy-back provisions of the most recent State budget draft are conditioned on $788 million of new revenue. Dr. Locke said it is highly likely that there will be changes/cuts to federal and State funds at the program level within the next few months. Ms. Baldwin said the challenge is how to frame the problem and discussion. One framing, for example, is elimination of the Health Department and privatizing its service, regionalizing everything else. She pointed out that the degree of uncertainty is extremely high. Chair Russell said that, despite the explanations above, he believes that a priority list is needed primarily as a means of making the public aware of what is at risk. Ms. Baldwin said she can provide the list of how local funds are being used, but not what should be cut. She and Member Westerman noted the complexity of the issues. Chair Russell said that he believes the BOH message must be somewhat simplistic in order to convey the gravity of the situation to the public. Member Sullivan suggested that this discussion could be tabled until March,when the legislative process is further along. Member Westerman noted that over the past many years, all lower priority programs have been culled, and all that is left is of the highest priority. She said she does not believe it possible to create a meaningful list. Member Johnson mentioned that the legislature is considering a higher sales tax on candy. He • said he did not understand why a penny tax on cans of soda pop or on plastic bottles cannot be implemented. Jean Baldwin suggested the possibility of a few BOH members working with Dr. Locke and her to better frame the problem and the list. Julia Danskin pointed out that better methods of helping the public understand the essential work and contributions of the Health Department are needed. After further discussion about the broader social, political and economic context, Members agreed to continue the discussion in future meetings. Tribal Mutual Assistance Agreement: Next Steps Dr. Locke reported that the Agreement had been signed by all seven counties and three Tribes. The next step is to develop an operational plan. This is the first such agreement in the USA and will be used as model for others. The State plans to issue a press release. H1N1 Seasonal Flu Update Dr. Locke said that the second wave of H1N1 appears to have passed, and it is uncertain whether there will be a third wave. This depends on the total number of people who are immunized. About 50% are needed to stop an epidemic; currently the rate is estimated at 45% in Washington State. There is plenty of vaccine now, and there are continuing • promotional efforts. He said it is difficult to get people to be vaccinated at this time of Page 11 of 13 Board of Health-January 21,2010 year. There is also little seasonal flu activity thus far. However,there is concern that the winter Olympics in Canada will bring flu to the Northwest. Jean Baldwin pointed out Jefferson County immunization statistics in the packet materials. 24%of six month to 24 years of age individuals got the vaccine early, which is much higher than that for the State as a whole. She credited the excellent partnerships with the Hospital, private vendors, and caretakers. Safeway, QFC and walk-in clinics are still providing the immunizations. Vaccinations are still being administered and further reporting is forthcoming. Legislative Update Dr. Locke mentioned that a public health funding bill, i.e. a"candy tax", is pending. The bill is in the hearing stage and appears to have significant support. There is also a bill aimed at saving the current immunization system, which otherwise would end in May. Under this plan, participating insurance plans would absorb the difference (former State subsidy) in cost, and would receive the vaccines per the CDC price lists. Member Johnson mentioned that there is also a proposal to extend the 1/10th of one percent arrangement indefinitely. Member Westerman noted that altering the original intent for this money will further threaten the government's credibility with voters. AGENDA PLANNING Member Sullivan stated that the semi-annual WASAC conference is held every year in • June (and November), and conflicts with the BOH meeting in June. He suggested this meeting be rescheduled or cancelled. Member Nelson said the second Thursday between 3 and 5 PM is a conflict for her but can be arranged with adequate notice. There was agreement to reschedule the June meeting to the second Thursday of the month and to cancel the November meeting. The next scheduled BOH meeting will be held on February 18, 2010 from 2:30 to 4:30 PM. ADJOURNMENT Chair Russell adjourned the BOH meeting at 4:42 PM. • Page 12 of 13 Board of Health-January 21,2010 .. 6 JEFFE ' SO COU TY BOA ' ►,;I F HEALTH t � i 0: uc ussell, air IPhil Johnshn, Member Ais MI \ / Excused Kristen Nelson, Vice-Chair John Austin, Member f ` 7- F fr // a//t 44w/2e ,, Roberta Frissell, Member Davi Sullivan, Member 1.--)A. U-- \A gi-AellW-4------- Sheila Westerman • • Page 13 of 13 Board of Health-January 21,2010 Board of Health .agenda Items # Presentation of Restaurant Outstanding .Achievement Awards • 2008-2009 Jebruary 18, 2010 • i JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street • Port Townsend •Washington • 98368 /��`�'� �� www.jeffersoncountypublichealth.org • February 4, 2010 To: Jefferson County Board of Health Members From: Dana Fickeisen, Food Safety Program Re: Restaurant Outstanding Achievement Awards for 2008-2009, presented February 18, 2010 at the regular Board of Health meeting Thank you for honoring the recipients of the awards at this meeting. The awards honor only full-service complex menu food establishments; 38 out of 75 of these earned the award. We have other ways to recognize other types of food establishments such as an "On the Spot Award" that we can issue during an inspection. The Outstanding Achievement Awards are based on the following criteria: • No more than 5 red points (high risk factors violations) on any one inspection • Not more than 15 total (red and blue) points on any one inspection • No repeated red point violations • • Establishment prepares and serves a complex menu for immediate consumption • In business with same owner for one year or more • Responsiveness to correcting violations • All food worker cards are current • Compliance with the establishment's permit conditions • Cleanliness and attention to detail Inspections are conducted by observing two types of risk criteria which are clearly listed on the inspection form: • Improper practices or procedures identified as the most prevalent contributing factors of foodborne illness or injury (Red), and • Preventive measures to control the addition of pathogens, chemicals, and physical objects into foods (Blue) Points are assigned for violations, thus the fewer the points, the better the inspection. • COMMUNITY HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIESPUBLIC HEALTH WATER QUALITY MAIN: (360) 385-9400 ;t is r =a 'R rillER AA', MAIN: (360) 385-9444 FAX (360) 385-9401 HEALTHIER CO utury FAX (360) 379-4487 JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypublichealth.org • For immediate release: February 4, 2009 Contact: Dana Fickeisen, Phone: 360-385-9444 Email: dfickeisen@co.jefferson.wa.us Jefferson County Public Health (JCPH) Presents the 2008/2009 Outstanding Achievement Awards Thirty Eight Jefferson County Restaurants Demonstrate Commitment to Achieving the Highest Food Safety Standards in 2008 and 2009 Port Townsend, WA—The 2008/2009 Outstanding Achievement Awards will be presented to full service food service establishments (restaurants) and their proprietors who have demonstrated the highest standards for safe food handling during the past two years. "These thirty eight restaurants and proprietors have worked hard to maintain the highest level of food safety standards. They are full service restaurants that work with complex menus so they have added food safety challenges. We like to recognize them for their dedication to preventing illness," said Dana Fickeisen, Food Safety Specialist. • Criteria for the award was developed by the JCPH Food Service Advisory Committee and requires evaluations in areas of personal hygiene, food temperature safety, and prevention of contamination. All food workers must hold a current Washington State Food Worker Card. The Outstanding Achievement Awards will be presented at the Jefferson County Board of Health meeting on February 18 at 2:30 p.m. at 615 Sheridan Street. Visit JCPH on the web for inspection reports for all food establishments in Jefferson County: www.jeffersoncountypublichealth.org These full-service establishments are receiving the award: Restaurant Proprietor 1. Ajax Café Kristan McCary 2. Blue Moose Tana Kettle 3. Blue Heron Middle School Cafeteria PT School District, Denise Reandeau 4. BPO Elks Lodge #317 BPOE Elks Lodge #317 5. Brinnon Senior Nutrition OLYCAP, Sandra Pederson, Jennifer Loring 6. Camp Parsons Food Service Chief Seattle BSA, Ken McEdwards 7. Chimacum Café Debbie Lynes, Brian Homer • COMMUNITY HEALTH HEALTH DEVELOPMENTAL DISABILITIES PUBLIC HEALTH WATER QUALITY MAIN: (360) 385-9400 ALWAYS WORKING foo. 4 iiia AND MAIN: (360) 385-9444 FAX: (360) 385-9401 HEALTHIER COMMUNITY FAX: (360) 379-4487 8. Chimacum Elementary School Chimacum School District, Heidi Holmes 9. Chimacum High School Chimacum School District, Linda Boyd • 10. Discovery View Retirement Michelle Sanchez, Dale Brown 11. Dos Okies Barbeque Larry Dennison 12. El Sarape Ricardo Vega, Cesar Garcia 13. Food Co-op Deli Food Co-op, J. Briar Kolp, Shila Zimmerman 14. In-Season Catering Beth Johnson 15. Jordini's On the Water Beth Diodene 16. Khu Larb Thai Rosie It 17. La Isla Mexican Restaurant Ignacio Rangel 18. Lanza's Lori & Steve Kraght 19. Lighthouse Café Lee Ann Lacy 20. Little Dinghy Deli KMC Investment Group, LLC, Diane Coleman 21. Logger's Landing Jack Helgens 22. Niblick's Deli Port Ludlow Associates, Kathy Arthur 23. Olympic Timberhouse Garin Rutledge 24. Penny Saver Deli Roger Ramey 25. Pizza Factory Francis &Valorie Danielek 26. Port Townsend Senior Nutrition OLYCAP, Robin Gainer 27. Portside Deli, Ltd. Lynda & Brian Douglas 28. QFC #106 Deli - Port Townsend Laura Hulsey, Andrea Morales-Gollub 29. QFC #870 Deli - Port Hadlock Dan Diederichs, Carmen Farias 30. Quilcene School Cafeteria Quilcene School District#48, Veda Wilson 31. Salal Café Pat Fitzgerald 32. Scampi & Halibuts Seafood Grill Jeff Erickson 33. The Spot Randy Unbedacht • 34. T's Nancy Tocatlian 35. Tri-Area Senior Nutrition OLYCAP, Sarah Miskimins 36. Twana Roadhouse Melody Bacchus 37. Uptown Custom Catering Candace Hulbert 38. Upstage Restaurant Mark Cole Jefferson County Public Health is always working for a safer and healthier Jefferson County. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * COMMUNITY HEALTH ENVIRONMENTAL HEALTH PUBLIC HEALTH DEVELOPMENTAL DISABILITIES WATER QUALITY MAIN: 360-385-9400 '," MAIN: 360-385-9444 • FAX: 360-385-9401 HEALTHIER COMMUNITY FAX: 360379-4487 • Board of 3-CeaCth Old Business & InformationaCltems .agenda Item # 1 • 200.9 State of the Sound Report Online yebruary 18, 2010 • I PugetSoundPartnership our sound,our cormnunOy,our chance • MEDIA CONTACT Frank Mendizabal 360.725.5466 (office) 360.489.2112 (cell) frank.mendizabal@psp.wa.gov FOR IMMEDIATE RELEASE Feb.2, 2010 2009 State of the Sound Report Available Now OLYMPIA—The Puget Sound Partnership has issued its first State of the Sound report noting the current condition of Puget Sound, funding allocated to clean up efforts, and accomplishments and challenges in the effort to clean up the Sound for the 2007-2009 biennium. "We're pleased to present the 2009 State of the Sound report," said David Dicks, executive director of the Puget Sound Partnership. "The good news is we are making progress in our efforts to protect and restore Puget Sound. We have challenges ahead to meet our goal of achieving a clean Sound by 2020, but this report documents substantial improvements in 411 the ecosystem." "It's encouraging that even during these tough times we are continuing to make progress in Puget Sound cleanup. We have a long road ahead and more hurdles, but I'm confident our efforts are off to a good start," said Governor Christine Gregoire. "I applaud the work of the Partnership and their many partner organizations for their hard work and commitment to restoring our natural jewel, Puget Sound." For the 2009 report, members of the Partnership's Science Panel evaluated status indicators that represent each of the six goals in the Partnership's authorizing statute: human health, human well-being, species and food webs, habitats, water quantity, and water quality. i 44 Because the Puget Sound ecosytem is complex, it is not surprising that some parts of it may improve while others decline. Compared to historical conditions, the Puget Sound ecosystem shows signs of stress and degradation. Eight of the 20 indicators presented provide evidence of continuing decline in the Puget Sound ecosystem (fin fish harvest, conversion of forest land, orcas, herring spawning biomass, agricultural lands converted to development, eelgrass area, stream flows in major rivers, and flame retardant chemicals in harbor seals and herring), while seven indicators show evidence of improving conditions (shellfish harvest areas upgraded, increases in shellfish harvest, increases in Chinook salmon and Hood Canal summer chum run size, slight slowing in the rate of loss in forested land, improvement in sediment quality in Elliott Bay and improvment in freshwater quality. The remaining five indicators describe other dimensions of concern, but do not provide information about recent changes. The report highlights several recent accomplishments that are important to Puget Sound recovery: • a reopening of 1,309 acres of shellfish beds for commercial and recreational harvest; • restoration of 3,800 acres of habitat; • a 12 percent reduction in diesel emissions; • a 22 percent reduction in mercury in waste streams; • • completion of the Phase I and II toxic loading studies that will help prioritize source control efforts; • removal of 90 percent of the derelict fishing gear in Puget Sound; • acceleration of projects needed to complete the removal of the Elwha Dam critical to salmon recovery; • and, a permanent mechanism to maintain the emergency rescue tug at Neah Bay was created. • I r'Ecosystem performance evaluation and reporting is complex," said David Dicks. "This cotnment[o1]:Jays°ggests removingthis paragraph—saying "Unless we are going to tell them the daunting task of linking actions to improving overall ecosystem conditions has eluded #-which'Irecommenaagainst,I many of the other large restoration efforts in places like the Chesapeake Bay and the would take this paragraph out. aEverglades. We have significant issues ahead of us, but we are on a path to make this work in Puget Sound and it will take a committed effort by the Partnership and its many partners to be successful." The Partnership is required to produce a State of the Sound report every two years. The statutory reporting requirements are to document the current status of the ecosystem, as well as status of implementation and funding. This information can be used to inform decisions about changes to funding, programs, or policies to accelerate the regional progress towards ecosystem recovery, including more efficient use of resources. The Partnership effort and related reporting is different from prior efforts because of the 2020 end date for success, the inclusion of human health and well-being as part of the ecosystem, as well as the need to account for all state spending related to the Puget Sound. In addition, the Partnership must ensure that all actions taken were consistent with a science-based strategy, directed toward defined, measurable outcomes including those for people. For the full text of the report, go to http://www.psp.wa.gov/sos2009.php ### • • Board of 3-fealth Old Business & InformationaCltems .agenda Item # 1�, 2 • Statewide 3-fiNi Situation Report February 18, 2010 • WasivsgzonSweDepmemel Health H1N1 Response (2009-2010) Reporting Period: 02/01/10 to 02/07/10 Incident Number and Name DOH SITUATION REPORT #20 H1N1 Pandemic Influenza 09- (Prepared by Ops/Log Chief with assistance from Planning Chief) 2887 02/08/2010 1200 Shawn Roberts, Ops/Logistics UA I k t I Mt khPA'LU HY GENERAL SITUATION and AFFECTED JURISDICTIONS: Washington State Department of Health is actively working with partners around the state to respond to the ongoing H1N1 pandemic virus. Department of Health focus areas include: Vaccination, Surveillance, Mitigation, Communication, Antivirals and Healthcare. From September 19, 2009–January 30, 2010, DOH received reports of 1383 hospitalized and 76 deceased patients with laboratory-confirmed influenza. Influenza hospitalizations and deaths are plotted by week of onset and influenza subtype in the graph below. The tables that follow provide additional information about the residence and age of hospitalized and deceased patients with lab-confirmed influenza. http://www.doh.wa.qov/ehsphl/Epidemiology/CD/fluupdate.pdf Influenza virus continues to circulate in Washington at a very low level. During January 24-30 (week 4), 0 fatal or hospitalized laboratory-confirmed influenza cases were reported. Since Sept 19, 2009, DOH has received reports of 1,383 hospitalizations and 76 fatal cases. Since January 3 (weeks 1-3), less than 5% of specimens tested by the WHO were positive for flu. All circulating influenza cruses in Washington continue to be 2009 H1 N1. Nationally, influenza activity decreased slightly during week 2. CDC's Flu View for the week ending January 16nd (week 2) is available at: http://www.cdc.gov/flu/weekly/ H1N1 Influenza Vaccine: The state continues to receive supplies of H1N1 vaccine. EOC Activation Status: Not Activated HEALTH/MEDICAL STATUS: Deaths: 16 Cumulative Total 04/19/09 to 09/18/09 Hospitalized: 174 Cumulative Total 04/19/09 to 09/18/09 Deaths: 76 09/19/09 to January 30, 2010* Hospitalized: 1383 09/19/09 to January 30, 2010* * On September 19, 2009, the state Department of Health began reporting hospitalizations and deaths for all types of influenza —not only H1N1 (swine flu) LOCAL HEALTH JURISDICTION (LHJ) STATUS: • 15 LHJs remain in Incident Command • 2 Tribes, Nooksack and Squaxin, have remain in Incident Command • 11 counties, Chelan, Douglas, Clark, Skamania, Cowlitz, Grays Harbor, Grant, Wahkiakum, Snohomish, Whitman and Kittitas have declared emergencies due to H1N1 • CURRENT HEALTH and MEDICAL RESPONSE ACTIVITIES: • Continue to monitor and process any new orders for H1N1 vaccine • Continue to monitor LHJs Strategic National Stockpile (SNS) antiviral inventory 410• Emergency rule for reporting of influenza hospitalizations and deaths was extended to 4/10. HOSPITAL STATUS: The Department of Health (DOH) received reports of 1383 individuals hospitalized with laboratory-confirmed influenza in Washington State. Influenza hospitalizations and deaths are plotted by week of onset and influenza subtype CURRENT DOH STATUS (State): Vaccinations: 2/05/10 H1N1 Doses Available: • 3,089,100 doses of H1N1 influenza vaccine have been allocated. H1N1 Doses Distributed (expected to arrive by COB 2/05/10) • 2,214,300 doses (72% of the available H1N1 vaccine) have shipped. • 98% of the H1N1 vaccine ordered to date has shipped (2,214,300 of 2,266,700 doses). H1N1 Doses Ordered (orders placed as of COB 2/04/10) • 2,266,700 doses of H1N1 vaccine were ordered—about 73% of the allocation. Reported Doses Administered (As of 1/30110): • 1,169,123 doses reported Number of Providers with Complete Provider Agreements as of 2105/10: 2,581 sites (about 87% of 2,967) have returned agreements. H1N1 Doses Distributed through CDC Retail Pharmacy Program (week of 2/01/10) • Mollen (serving Wal-Mart) — 152 doses • Walgreens—800 doses Healthcare: DOH Critical Care Capacity Reporting: The Department of Health is no longer reporting on Critical Care Capacity as of 1/25/10. Community Mitigation: Nothing Significant to Report Antivirals • Continued tracking and reporting of antiviral usage to CDC. Antiviral usage continuing to decline. Current supply adequate. Communications: • Messages continue to air on radio and TV and appear on-line Surveillance: See surveillance report: http://www.doh.wa.gov/ehsphl/Epidemiology/CD/fluupdate.pdf FUTURE DOH PLANNED ACTIONS (State): Vaccinations: • Continue working with local health on ordering, allocating, distribution, and reporting of H1N1 vaccine. Healthcare: • Follow-up Activities related to DOSH Infection Control Directive, as needed. Community Mitigation: • ,, Evaluate data from school absenteeism reporting. antivirals: • Monitor antiviral use. Supplies are adequate across the state. Communications: • Continued planning for 2010 media activities Surveillance: • • Monitor surveillance systems for changes in influenza activity. • Enhancing surveillance efforts with Whatcom County and BC for the Olympics. ANTICIPATED HEALTH and MEDICAL ISSUES • Draft guidance for disposal, storage and donation of HIM assets (vaccine, antiviral, and ancillary supplies in internal review • Draft After Action Review (AAR) plan developed • Develop transfer of data between PHMIS & PHRED Approved for Distribution: Signature: 83,td,, _ eg4k___ Date: a2 y Print Name: t'rtcf�1 -a- �� n Managing Executive for H1 N1 Response SitRep Distribution List: Each DOH EOC Staff: DOH EOC Staff Distribution List Secretary of Health: mcseleckyai doh.wa.gov Shoreline ICP: doheoc17@doh.wa.gov Deputy Secretary of Health: bill.white(c�doh.wa.gov DOH liaison: TBD State Health Officer: Maxine.hayesAdoh.wa.gov HHS,Region X, Rick Buell: Rick.Buell(&hhs.00v Communications Office: timothv.church@doh.wa.gov State EOC: EOC37Aemd.wa.00v Regional H1 N1 POC: iames.white(dlfema.gov Bothell MOC: fema-moc-bothell(u)dhs.gov •N1 Executive Managers Allene Mares allene.maresPdoh.wa.gov Gregg Grunenfelder gregq.grunenfeldera doh.wa.gov Frank Westrum frank.westrum a(�doh.wa.gov Assistant Secretaries Environmental Health: grequ.qrunenfelderOdoh.wa.qov Community and Family Health: marv.wendtadoh.wa.gov Health Services Quality Assurance: karen.iensen(thdoh.wa.gov Financial Services: lois.spee€manAdoh.wa.gov Epidemiology Health Statistics and Public Health Laboratories: dennis.dennis(a?doh.wa.gov LHJ Leadership: DOH DL OS LHJ Leadership LERCS DOH: DOH DL OS PHEPR LERC RERCS:DOH DL OS PHEPR RERC Agency H1 N1 contact DOH DL AGENCY H1 N1 FLU CONTACTS Agency Senior Management Team:DOH DL Agency SMT DOH Chief Administrators: ChiefAdministrators@doh.wa.gov Other: Oregon: Duty Officer: info.aoc-Dh(a)state.or.us Nooksack Tribe: GyorksaPnooksack-nsn.gov Alaska: sara.abbott(a�alaska.gov Idaho: HPP Mgr: wickhama@dhw.idaho.gov; blakeslb(a)dhw.idaho.gov British Columbia: hlth.mocdutyofficer@oov.bc.ca H1N1 SITREP Revised September 2009 DOH Emergency Operations Center Form • • Board of Health Old Business & InformationaCltems .agenda item # 17., 3 • Public Health Report Tor Region 2 'Winter zoio February is, 2010 • a .y, iist -- 4s„ v° Public Health Report for Region 2 • KITSAP COUNTY Winter 2010 HEALT .„,„4 DiSTRC �_ _ , . 2009— 2010 Respiratory Virus Detections '` Positive Respiratory Viral Specimens,University of Washington 't` "', Virology Laboratory at Seattle Children's Hospital Thank you for your feedback to the 280 -Influenza A survey we conducted in Spring 2009. . -.240 _InflRSVuenza B N o 200 You're receiving this report as a fax or 2 0 160 -Other resp viruses* £ *includes parainfluenza, email because that's what you told us you 73 120 adenovirus,rhinovirus,and preferred. 80 metapneumovirus se 0 40 0 H1N1 vaccine is still available. Drs. Locke 5- 12- 19- 26- 3- 10- 17- 24- 31- 7- 14- 21- 28- 5- 12- 19- 26- 2- 9- 16- 23- 30- 6- week Sep Sep Sep Sep Oct Oct Oct Oct Oct Nov Nov Nov Nov Dec Dec Dec Dec Jan Jan Jan Jan Jan Feb and Lindquist recommend that everyone ending: 2009 2010 get the vaccine. All children under 10 years need a second dose. Thank you for http://www.kitsapcountyhealth.com/H1N1/InfluenzaSurveillanceReport.pdf immunizing! www.depts.washington.edu/rspvirus/ http://www.cdc.gov/flu/professionals/diagnosis/ Check our websites or call for updates about where to get vaccinations. RSV Flu A Flu Adenovirus* Parainfluenza* www.kitsapcountyhealth.com •Sudden onset •Common cold •Common cold Flu Line (360) 337-5240 Acute •Fever,chill symptoms symptoms www.jeffersoncountypublichealth.org respiratory .Malaise •Severe respira- *Croup JCPH Flu Line (360) 379-4471 tract illness .Myalgia tory disease •Pneumonia www.clallam.net/news/swineflu.html Symptoms •Headache •Gastroenteritis t Angeles office at 360-417-2274 or the Incubation 2-6 days 2-8 days 2-14 for 2-6 days respiratory rks office at 360-374-3121 Available in 2 Blood test Rapid test 4 hours 2 hours hours 1-4 days Table on right highlights the symptoms Supportive Antivirals within 2 Supportive care of common respiratory viruses. care days of symptoms Treatment onset Vaccinate Avoid Human Crowding Table below is the surveillance update on Infection Hand hygiene prevalent Notifiable Conditions. Control Standard—Contact-Droplet Precautions Region 2 Communicable Disease Surveillance Data Kitsap 2009* Kitsap 2008 Clallam 2009* Clallam 2008 Jefferson 2009* Jefferson 2008 total cases total cases total cases total cases total cases total cases E.coli 0157:H7 2 1 0 0 0 3 Salmonella 21 21 5 14 4 4 Campylobacterlosis 35 25 13 12 7 1 Giardia 7 9 8 4 6 9 Hepatitis A 2 1 0 0 0 1 Meningococcal Disease 2 2 0 0 0 0 Pertussis 5 12 0 3 0 0 TB 4 5 1 0 0 0 Chlamydia** 706 739 164 142 46 45 onorrhea** 45 54 12 15 2 3 Slese counts are preliminary,final counts will not be available until March 2010; counts may increase as reports from 2009 are received and finalized **cases are those that have been counted as"confirmed”by WA State Department of Health (DOH); some cases may be confirmed by the LHJ but not by DOH This is provided by Region 2 Public Health—Clallam,Jefferson,and Kitsap Counties.If you have questions,comments or need more Kitsap dlitympte Peninsulas information about items in this newsletter,contact Ruth Westergaard,(360)337-5752,FAX(360)475-9344, Clanam,Jefferson&Kitsap Counties wester@health.co.kitsap.wa.us or at Kitsap County Health District,345 Sixth Street,Suite 300,Bremerton,WA 98337. • Board of Health New Business .agenda Item #11I., 2 • Syringe Exchange Program Annual Rey February 18, 2010 • 50\ JEFFERSON COUNTY PUBLIC HEALTH ho$ 615 Sheridan Street • Port Townsend •Washington • 98368 • www.jeffersoncountypublichealth.org Jefferson County Syringe Exchange Program (SEP) Annual Report 2009 Jefferson County has provided a Syringe Exchange Program (SEP) for the past decade as part of a state and regional effort to reduce the risk of HIV infection in our communities. This program, also, reduces the risk of Hepatitis A, B and C infections. Syringe Exchange Program clinic hours are Mondays and Wednesdays, 1:30pm-2:30pm, with drop-in exchange based on staff availability, Monday through Friday, 9:00am-4:30pm. SEP is staffed by multiple nurses trained in the program and it would be rare that a nurse would not be available. Clinic hours are posted; however, most clients drop in at other times. This has been consistent over past years despite offering clinics on various days and times. Risk reduction education and referrals are routinely offered at each visit. Education includes verbal and printed information on hepatitis, HIV, STDs, health alerts (for example, wound botulism), care of abscesses, street drugs, tattoo safety, intravenous drug use safety (encouraging one time use of needles through this program), and immunizations. Internal referrals include STD, HIV, Hepatitis B & C screening and counseling, tuberculosis screening, family planning and immunizations. External referrals include those for drug treatment, medical care, mental health care, domestic violence, food, clothing and shelter. Clients are informed of two free programs which began in mid-2008 and are continuing in 2010: Hepatitis C testing and counseling and Hepatitis A and B immunization in a combination product, Twinrix. These are being provided for at risk clients through programs with the Washington State • Department of Health and the Center for Disease Control. These are excellent services which many clients would, otherwise, be unable to obtain due to limited income and lack of insurance. Free HIV testing and counseling continues to be offered, as in past years. SEP utilization was down slightly in numbers of visits, from 70 in 2008 to 65 in 2009. The number of HIV tests offered and the number of referrals increased. Intravenous drug use materials and outreach education remained similar to 2008. There were twelve new clients in 2009, twice as many as in 2008. By visits, there were 53 reports of residency in the Port Townsend zip code, 6 in other zip codes in the county, which is twice the number in 2008, 5 in Clallam county and 1 in eastern Washington. Data from intake interviews with clients indicates that SEP has been very successful in its goal of reducing reuse of syringes/needles through education and availability of free syringes/needles in a safe anonymous environment. This, in turn, achieves the ultimate goal of reducing the transmission of the blood borne communicable diseases HIV and Hepatitis B & C. In 2009, clients at 42 visits reported using syringes only once, 14 reported reusing syringes 2-5 times, while none reported reusing syringes more than 5 times. In 2009, the number of individuals indirectly utilizing SEP through secondary exchange decreased. Of the 65 visits, 35 reported exchanging syringes for others. We continue to assess outreach with the goal of further decreasing the number of secondary exchanges by increasing the comfort level of coming to SEP; thereby, promoting new client visits. Working with Region 6, in June, we developed and began a Key Informant Interview Survey. This survey seeks to obtain information regarding comfort level of clients coming to SEP and suggestions by clients on how to reach others and help them feel safe enough to come to SEP. To decrease expenses, we evaluated the selection of syringes and now provide only the most commonly requested types. Also, we are no longer providing hand sanitizer or antiseptic towelettes, but 1111 continue to provide alcohol wipes. COMMUNITY HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES PUBLIC HEALTH WATER QUALITY MAIN: (360)385-9400 ALWAYS WORKING FOR A SAFER AND MAIN: (360)385-9444 FAX: (360)385-9401 HEALTHIER COMMUNITY FAX: (360) 379-4487 Syringe Exchange Utilization, 2000-2009 Jefferson County Washington III 80 - - 30.000 =Number of client visits 70 70 - 64 65 65 - 25.000 N -*--Number of 63 — r ' — -a a� 0 60 - syringes 58 a� exchan•ed c 2 18.060 24.585 - 20,000 as I 21133 X s 50 - 13.716 \ 1 w N 3 41 14.044 15,000 a� N 40 _ 3 17,905 & .� N 0 30 - 9.222 - 10.000 0 0 y .0 20 - 16 / .c: = 14 n 4.206 5.000 e Z 10 - (I I 2.076 50.1_____.-4,--- 1 1 1 - 1 - I - 1 1 - 1 I 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 SEP Participant Visits By Reported II . SEP clinic participant visits by Zip Syringe Use code 45 42 40 1 , 2% 35 5, 8% 30 6, 9% 25 ❑98368 20 14 15 9 ■Other within 10 Jefferson Cty 5 0 53, 81% ❑Outside of 0 Jefferson Cty ['Unknown Each Each Each Unknown syringe syringe syringe used once used 2-5 used 5+ times times COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH III DEVELOPMENTAL DISABILITIES WATER QUALITY MAIN: 360385-9400 A��JAYS�IVORK':NG FORA SAFER AND MAIN: 360385-9444 FAX: 360385-9401 HEALTHIER COMMUNITY FAX: 360379-4487 • Table 1 Materials Distributed by Jefferson County SEP Syringes IDU Prevention Condoms/ HIV Educational Referral Outreach Exchanged Prevention Kits2 Latex Tests Materials4 Informations Educations Materials' Barriers3 Offered 2009 14,044 7,098 6 271 31 26 51 33 2008 21,330 7,941 0 140 27 32 35 32 2007 24,585 9,988 0 20 22 18 23 N/R8 2006 17,905 9,000 0 0 2 3 2 N/R 2005 13,716 7,611 0 20 0 6 11 N/R 2004 18,060 7,265 6 228 N/0' 48 11 N/R 2003 9,222 1424 38 800 N/O 42 18 N/R 2002 4,206 1,026 35 427 N/O 50 NA N/R 2001 2,076 3 9 14 N/O 9 5 N/R 2000 506 11 15 33 N/O 10 2 N/R Notes IDU Prevention Materials include:Tourniquets,cookers,cottons,sterile water,sharps containers,alcohol preps,antibiotic ointment, bandaids and sterile pads for wounds,tape, hygiene items(toothbrush,soap,comb, razor). Individual items are given on an as needed basis. 2 Prevention Kits include:sample quantity of tourniquets,cookers,cottons,sterile water,sharps containers,alcohol preps, antibiotic ointment,bandaids,hygiene items(toothbrush,soap,comb, razor) 3This number is for condoms dispensed in SEP only and does not account for the number of condoms SEP clients pick up in the lobby where there is a free supply available. °Educational Materials include information on hepatitis, HIV,STDs, health alerts(ex.wound botulism),care of abscesses,street drugs,tattoo safety,needle reuse, IDU safety,domestic violence, immunizations SReferrals: Internal referrals include STD, HIV and Hepatitis B&C screening and counseling,tuberculosis screening,family planning and immunizations. External referrals include drug treatment,medical care,mental health care,domestic violence,food, • clothing and shelter. 6Outreach education is defined as face-to-face education on safe injecting practices,vein care,blood borne pathogens,risk reduction methods,and other as needed 7N/O: Not offered 8N/R: Not reported Table 2 Jefferson County SEP Clinics/Demographics Clients Clinics Clinic and New Returning Reporting Offered Drop-In Clients Client Secondary Visits' Visits' Exchange' 2009 102 65 12 53 35 2008 99 70 6 64 67 2007 97 65 9 56 58 2006 126 54 8 50 49 2005 119 35 6 30 29 2004 136 52 12 48 45 2003 119 58 9 55 53 2002 108 33 11 29 25 2001 98 14 6 9 5 2000 33 13 3 7 3 Note Represents duplicate clients • DEVELOPMENTAL DISABILITIES PUBLIC S ^LIC HEALTH ENVIRONHEALTH MENTAL MAIN: 360385-9400 '"''"v ati�KK`NG FOR SAFER AND MAIN: 364385-9444 FAX: 364385-9401 HEALTHIER COMMUNITY FAX: 364379-4487 2010 Goals • Continue anonymous, safe services to promote revisits by clients and to encourage clients to tell their friends and contacts about SEP. • Inform clients, on an as needed basis, about the Jefferson Aids Services (JAS) incentive • program. In 2009, JAS provided SEP with ten $20 gift cards to Safeway. Six cards remain to use in 2010. • Continue to offer the Key Informant Interview Survey to clients, offering JAS gift card as incentive for participation, do interview at time of SEP visit, tally results at end of one year from start of survey, use information obtained to plan outreach to clients utilizing secondary exchange. • Offer free HIV testing and counseling at each visit. • Offer free Hepatitis C testing and counseling and Hepatitis A& B vaccine at each visit. • Provide each new client with a prevention kit, hygiene materials and condoms, educational materials and referral information. • Increase distribution of condoms and hygiene materials. • Continue to assess ways to decrease costs, such as, collecting 2 L soft drink bottles and soft plastic detergent containers to provide to clients for use as sharpes containers • Review intake data forms and update/revise as needed. • Revise quarterly reports to reflect all data collected on the intake data forms. Data Source:Jefferson County Public Health SEP Intake Records Prepared by Carol Burwell, PHN,Jefferson County Public Health 02/01//2010 • COMMUNITY HEALTH ENVIRONMENTAL HEALTH PUBLIC HEALTH DEVELOPMENTAL DISABILITIES WATER QUALITY • MAIN: 360385-9400 ALvVAYS WORKING FORA SAFER AND MAIN: 360385-9444 FAX: 360-385-9401 HEALTHIER COMMUNITY FAX: 36(}379-4487 • Board of Health Netiv Business .agenda Item #`VI., 3 593o (Tnhancec(gunding for • Immunization andNotifia6le Condition Reporting Programs) Work Plan February 18, 2010 • o cn• ° m -p • W °) •rocc) a) -0 � E o 0 co = v) Cc0 cnUoo °> v . o � 0 = cna) _ L c4- gNd °c p �ci o C � >'N o) as _ _ G 1.72 z U E) - ,L - .0 N C 0 U - LL c ,- .c N c • CA W z ii)° o)° •j c -c a' .0 -a 30 U •4:----, a) .c O 20:- > cc C L 'O (o +' O +.' (o (n a) '> N o) UU) U = o ° = cc3 a. wa) a) c`v2 - c,) '- cv a) 2 .L . 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N N 0 O Cl c- N a) a) C om.,, Q) Q) >co C CO0 O• O co V co u) 3 u, C N C U Q� C C C d E > V (LO 7 E N p ,0 O U) C ,. 5\1 E c E al 1 U 'Q -6 'Q d 3 a) 0 ' CO 0 O >, V U a) U O C (O O (O - Q O E O a) L N .0 a) (O - U L C E ` +. C3 • o_ a) (O Q (O O E Q U C O o a ul V) ` (O 4 4= '_ v0- U (O Q - u) '+� E (0 c 3 E- Q C .CD O O oUI 15 -60 D O > C CO O O CO I- 00 'Q Q C �«- a) a) p - T a)co U u) C O i � oZoOO � cc-O2 �Y o � N c U sT� c5 c _ « a 3 Ua-, c0 .c ac�i a) C N a) a) C N U 2 a) O a) O (a O a) U) E N u0) (O t "-� 4Q N a O M O E CI) ° IYQaO u) 6 o a• CD N N � (i e u a e u w & - �. � ZI 0 a) -o \ / � / /03 / 01 / / A0 \ ƒ fk \ B § o Qfq - = = 71/4- § / 5• ] $® 0 co e E m E J esu ' g �• / 3 § / � �' / § ] 3 3 o 7\ § t1U co '< \ « � co I � D < $ ) a -- 7 o q) E/ / 0 k \ k / �k $/ R =. \ 5. o 7 § \ \ \ CDko' m . = $ % > so ] cn CD cn / - \. co o o / J o 0. 3 _ = / , co n � E 7 o ƒ 0 _ * a a' o0 73 la CD \ k \ _ CD = - 2 / ƒ / ) j 2 E. E 0 f % / R2 0 =/ of(7 (75- 0 -- oo a / \ § § a / $ . 2 \� « m. m & R _ _ƒ \ / m 2c � 2/ 2/ /CD a ƒ \ r -. ]% %/ / E' » 2 ] 2 / o0 0 \/ a0 ¥ § - --1 CD a) k7 z 7 \ \ f d0 = ƒ w f _ 2 = U) Z \ } \n) $ J 01 \ ° 20 / \ CO < = f 4" ® 3 o0o / ' na_ «r & 09 co _ § 0. \ /(.0 C • Board of Health Netiv Business .agenda Item #`VI., 4 ZLniversaCTaccine Purchase Program Update • February i8, 2010 • From: DOH CFH MCH Immunization Program CHILD Profile [mailto:DOHCFHMCHIPCP@DOH.WA.GOV] • Sent: Monday, February 01, 2010 9:15 AM Subject: Universal purchase official word This message is being sent to local health leadership and Immunization Coordinators— I'm forwarding a message about the plans to continue universal childhood vaccine purchasing from Dr Beth Harvey that is being shared with providers across the state. This message will be shared on the following medical association list serves: Washington Chapter of the American Academy of Pediatrics; the Washington State Medical Association; and the Washington Academy of Family Physicians.We will share more information as it becomes available. Thanks! Janna Bardi, MPH Manager, Immunization Program CHILD Profile Washington State Department of Health email:janna.bardi@doh.wa.gov phone: 360.236.3568 FAX: 360.236.3590 From: Beth Harvey [mailto:betheharvey@comcast.net] Sent: Friday, January 29, 2010 7:59 PM To: Deborah Harper; John F McCarthy; Len Eddinger; Tom Curry; Perna, Bob; Lisa Johnson A; Maureen Brown Cc: Bardi, Janna (DOH); Sue Waldin; Dziedzic, Paul; Chen, Anthony L-T, MD, MPH (DOHi) 11) Subject: universal purchase official word I have great news to share. Due to a committed private and public partnership, Washington State's vaccine program will be a universal purchase program again on May 1, 2010. Our stakeholder work group is thrilled to save a system that protects children's health by preserving access to vaccines across our state. Starting May 1, 2010, Washington providers enrolled in the Childhood Vaccine Program will not need to purchase private childhood vaccines for children 0-18 years of age. The universal purchase system will cover all childhood vaccines, including HPV and influenza for children less than 19 years of age. As the mechanics of our new system are designed, we will be consulting with practices with the goal of making sure that any changes in billing/coding are functional and easy to implement and that the system will be similar to the one we currently have. Please feel free to contact me with questions, and our stakeholder group will keep you updated as details emerge. Beth Harvey MD President WCAAP 3516 12th Ave NE • Olympia, WA 98506 (360)918-0607 0) 0) 0) 0) Cr) 0) V > > 0 0 0 0 0 0 Z 0 0 0 0 0 0 CO CO W O A O< O O m Or m m • � � --I q-1 m 0 0 0 (/) 0) O O CZZZJ Zm0m � Z x> 0 n -� 0 D D n n 73 2°• 7 z z Dr m m 3 m C7 r0- = CD z -< 2 D n D n O czi� O C Efl 4fl EA EA Efl = (n -0 O Lo 00 O CO� N W N "=' 0 0 -i CD Da Q U1 O O O W (!) O_ V O N N 00 W n 0o 01 CO N y O 01 O 01 O 01 CD _ � - CO � oo n• C� iv -co N v, p O 00 (xi OW co p1 CD C ocn O o 0 0 0 0 -ul ' F 0 0 0 0 0 0 CD _ -tt (0 co oc) c ) CD z - p1 n 0 N N N Q. (O/! NN) 4 o CO CSO D CD 0 Ul 01 01 01 0 01 cn c z u) 5 a c = 20303 O Ul 01 Co CO r.) CD 0 Q CD CD CD a -' p1 _(O ZN a O O 0 0 0 0 0 C C C C M ' N m m N N N O Q n O * (D CD CD rn -. v 4 y r K7 e.., rr7 o o b r z x z r V r v • b X _ 3 3 CD w (44 col opo co o w oxo CTI ul c y C_ Y (D x r ccD rn o"', o o - 7 ri 0 C-) 0 � t tri W - 01 t../1 01 w o, `,D 00 ,C. = CID ,, oo v, o oo o ., r1.1 CD N 1-3 til Pi CO w 00 as o L - 00 n 0 N) N oo a x z C) 0 >C X >C >C >C w CT o, N 4 n 4. 04 o C N — 0 p, O p oo 4. co p C) 0 C17 7+ _ C CNril CA J -i LA "C w w J J 00 00 CT U C ..3 (cD "0 CO 4 `p w . -P oo v Q) v U _. N — w — v, 00 x 0 Q) co - X X X LA 6 n r N D rC a z 1-3 til v 0 cn b �i N .P -4 Un w CT w 00 LA La .-A * d co a, C o w 0o w 00 v b .i 0 Cn) La la 01 "C CT -CW, th 00 000 N C A LA n 0-3C 0 r cr 1-30 ,-o C .P (.1, J J 4 4 4 W 4 - w to o 0 00 O, 00 w o .P N O, r N o Ui O O, . v N - 0 • ca 2009 Vaccine Order Totals LHJ Main + Public Health Satellite Offices Only • Total Vaccine Estimated Federal Estimated State LHJ PIN LHJ Name Orders Assistance Assistance 70%* 30% 150000 Adams County Health Department $36,005.00 $25,836.98 $10,168.02 151000 Asotin County Health District $57,148.77 $40,954.36 $16,194.41 152000 Benton-Franklin Health District $449,101.66 $322,289.66 $126,812.00 153000 Chelan-Douglas Health District $25,378.50 $17,764.95 $7,613.55 154000 Clallam County Health Department $77,306.35 $56,965.11 $20,341.24 191000 Clark County Health Department $0.00 $0.00 $0.00 155000 Columbia County Health Department $22,913.70 $16,673.07 $6,240.63 156000 Cowlitz County Health Department $20,206.30 $14,144.41 $6,061.89 157000 Garfield County Health District $7,438.95 $5,207.27 $2,231.68 158000 Grant County Health District $65,446.39 $45,812.47 $19,633.92 159000 Grays Harbor County Health Department $59,025.64 $44,485.35 $14,540.29 160000 Island Count Health Department $18,945.20 $13,895.12 $5,050.08 161000 Jefferson County Public Health $42,032.55 $31,323.23 $10,709.32 162000 Kitsap County Health District $140,956.38 $99,302.95 $41,653.43 163000 Kittitas County Health Department $104,597.07 $74,168.17 $30,428.90 188000 Klickitat County Health Department $39,842.15 $28,522.99 $11,319.16 164000 Lewis County Health Department $60,380.12 $42,899.56 $17,480.56 165000 Lincoln County Health Department $90,936.90 $67,139.97 $23,796.93 • 166000 Mason County Health Department $0.00 $0.00 $0.00 169000 NE Tri County Health District $24,470.50 $17,129.35 $7,341.15 170000 Okanogan County Health District $6,101.90 $4,271.33 $1,830.57 171000 Pacific County Health Department $13,441.70 $9,409.19 $4,032.51 181000 Public Health Seattle King County $1,290,094.99 $936,957.67 $353,137.32 173000 San Juan County Health Department $19,019.50 $13,947.13 $5,072.37 185000 Skagit County Health Department $141,875.46 $101,530.00 $40,345.46 190000 Skamania County Health Department $6,395.20 $4,476.64 $1,918.56 186000 Snohomish Health District $348,400.28 $250,215.00 $98,185.28 187000 Spokane Regional Health District $251,145.09 $175,801.56 $75,343.53 172000 Tacoma-Pierce Health Department $42,472.55 $29,730.79 $12,741.76 193000 Thurston County Health Department $6,092.70 $4,264.89 $1,827.81 198000 Wahkiakum County Health Department $19,086.10 $13,360.27 $5,725.83 194000 Walla Walla County Health Department $86,187.40 $60,964.66 $25,222.74 195000 Whatcom County Health Department $191,068.33 $136,598.49 $54,469.84 196000 Whitman County Health Department $24,207.45 $17,261.96 $6,945.49 197000 Yakima Health District $0.00 $0.00 $0.00 *Federal Assistance includes HPV transition off of universal on July 1, 2009 HPV- 100% Federal Assistance after July 1, 2009 • Board of Health Netiv Business .agenda Item #17I., 6 Green Business Award Charles Xanieski, CPM • February 18, 2010 • 4��. o JEFFERSON . I it Always Working for a Safer and Healthier liferson 0 4- '‘''t-'7*:';'• February 5, 2010 Jefferson County Board of Health PO Box 1220 Port Townsend, WA 98368 Dear Board of Health Members: The Green Business program is proud to announce that Charles Kanieski, CPA, 1330 Jefferson Street, Port Townsend, WA 98368, has obtained Green Business certification! Mr. Kanieski, is going the extra mile to ensure his business operates in a manner that conserves water, energy and other resources. His office is almost completely paperless! He utilizes equipment such as a smart board and e-fax to reduce paper usage in his business operations. Mr. Kanieski truly sets the example of sustainable business operations. • After signing the award, please return it to: Jefferson County Public Health Attn: Lori Clark 615 Sheridan Street Port Townsend, WA 98368 Thank you for your continued support of the Green Business Program! Sincerely, A ete Lori Clark, MS Environmental Health Specialist Jefferson County Public Health IllCOMMUNITY ENVIRONMENTAL DEVELOPMENTAL NATURAL HEALTH HEALTH DISABILITIES RESOURCES (360) 385-9400 (360) 385-9444 (360) 385-9400 (360) 385-9444 615 Sheridan Street.Port Townsend, Washington 98368 fax: (360)385-9401 web: www.jeffersoncountypublichealth.org oaf .� 7 . N coco ww,p O 3 0 O ate' ,: .' =;w, =mss. j -c>e;,-rr -sA U -11t. k ai till =-"PrIT>.Wyt-F CIO Stfi'' "--.*: tiat t ,1 -710j comi g fami• s, it pia* 0 Qt. -...,:„.„..-„--, pig : . 2 E ,___......,...„ ,,,,„,....w,„ ....„,Fr ,..,,,,,,, cit ,.4..,_.. .„ ,..it.... ....t._:„ ,,,,,,,,:,i 144 ---,_4?, (D -111.1111, a a • 0 la, 5gx P 'te=a.. '{` „. "S Posod . ,c) o -:::, -,5 -:-::: ‘44% Teamm.,-., m; g crieull . 25 z 4:11411 0:1f C ,:).;--' A ft t r...4 .4,,,, ,,..-fr- -:..- fill* : . eD Oft .1 ''', ..j n... w ,...„.....„.„..„..„ Poi• ., cri . _ , g.: r... -,-,.., ,_ Poled o O A'+ rsryi r! rz., e ,,-4,,lb„,,z,..„ .4), ,..,..._:.g.,- • . ,,k,.. w,F 04 • Board of Health .agenda Item # (VIII. • .agenda Panning Calendar Jebruar 18, 2010 • Jefferson County Board of Health • Agenda Planning Calendar March 2010 April 2010 May 2010 • June 2010 July 2010 August 2010 September 2010 • n N n XI o T c C1 c 0 3 0 0 N (� N h y17 = C 0 �. 0 Z l. O Z1. 0 . 1 != H11P • tIPt 3 n a c .� Sy c n c=o CD , CD m N O y c> A s Cs SO N N y W N H.-, \7 N :I. 3 .' —. W C/) v O W C' .-. ? J O21 N N M .' .' W UNi 00 ��. 'A r1 C J O L.W N .p. --I O t 00 N ? J - c tNo 00 .' H � V N Hi 0 _ ~ .-. U' J O W C' N H.to CO H �'�- Cs ' N W N O s. N H ,.`-" J O W 00 .' {' a' O W H 00 .' 4. J O W `17 :r 00 .N' SO N Un .-� W .+ W N .-. 0 N CA .' H Cr. N W : : : tNo 0o 44 CA 9.1 .W+ J O 4J O W C m Cr .rt O N '-' 00 me N // a NNN ' v 00 — -P / No r ,.,..n 00 — G� V N 0 W 0 .4 O _ ttC N ` N W 'C NO+ O C's JSN-) W NJ• O N �. ,& 01 4, J 0 W to O '""' .p NN N to Oo .' 04 LA 0000 `-H A r V N n7 '\V� 19) o C/ O O.-. VN CA VN J WOO W 0 V 00 ? G L./1 W C_CAm O N . . Cn � NN sV tNN ,� y GVN V N to 3 O 1-3 W N '-' VN .� WN N a I.) N.) W'YC O WC R O W GM N .' H W ` .N-. J G 4, N) ,4 .' W .4. --1 O A J O ON .' 4. N O .'.-. .' N .' OO .' IV -P H Lo Co N CD N .' H (n 71 W N 0 N '7y N o T, N O W 0 G\ N 3 0 CD N N .-+ CT V) 14J O W C' 0 H J O W .4 49. J O W V] cNi N U' ; -. N to oo HU. a V, COO N V)OA J W b O W a N a = C' .0 N — '4. H vW . C'o Woo N a o 'V N to C to 00 O W O v N HGNB V N)H Lo HH 0 N 00 I 00H S W . N ? ) O N) O W N - J C/ W N V N '17 O W H. .' W CA .449. CA 00 ? -4 O Cr)t04 . • Board of 3feaCth �ledia Report 1 lebruary, 2010 • • Jefferson County Public Health January/February 2010 NEWS ARTICLES 1. "Special swine flu clinics to continue," Peninsula Daily News, January 18th, 2010. 2. "Jefferson County ENVIROSTARS," Port Townsend Leader, January 20th, 2010. 3. "Vaccines readily available for H1 N1," Port Townsend Leader, January 20th, 2010. 4. "Brinnon students 'Fuel Up' healthy lifestyles," Port Townsend Leader, January 27th, 2010. 5. "2010 Home Improvement - Building Codes — Onsite septic systems," Port Townsend Leader, January 27th, 2010. 6. "Hunger on the Peninsula," Peninsula Daily News, February 1st, 2010. 7. "One from Jefferson reported in salmonella outbreak," Port Townsend Leader, February 3`d 2010. 8. "H1N1: Third wave could be avoided if more vaccinated," Port Townsend Leader, February 3rd, 2010. 9. "New tax may surprise some county residents," Peninsula Daily News, February 3rd, 2010. 10. "Officials: Collaboration key to county's future," Peninsula Daily News, February 9th, 2010. 11. "Eateries win safety awards," Port Townsend Leader, February 10th, 2010. 12. "Juvenile detention is going down in the county," January 27, 2010 • • • Special swine fort Angeles,frons 9 a.nt rreru.ti/.tiu rrreflu./rtml ur to ,x:.30 p.m. on'I'ur.d;,y phone the health office in flu clinics and Wednesday. fort Angeles at 360-417, The Clallam County 2274 or the Forks office at to continue health office does not pro- 360-374.3121. vide seasonal flu vaccine In Jefferson County, PORT ANGELES — for adults, contract county Public In December, health ()Ili- health,615 Sheridan `,t in Special HIND swine flu continue this cials did swine flu vaccina- Pon I'o��nsend. at 360-385- clinicswith Clallam health week, tion clinics for all school 9400 or click on o+rew. with waiving the ah offi- districts in Clallam County. Children younger than leefIth.org o infolic rmation trative fee 10 need a second vaccina- about.nig for information Swine flu vaccine is free tion to be fully covered, about swine flu and sea since its creation was sonal flu shots. The flu clinics in Port funded by taxpayers,but Angeles on Tuesday and an administrative fee of Wednesday will also serve $10 to$20 can he charged. children in need of their Clallam County is offer- boosters. ing free clinics at the The county health office health and human services in Forks at 140 C St. will office in the basement of also provide boosters. the Clallam County Court- For more information, house,223 E. Fourth St., click on www.c/QJlnm.net/ • • � �,_a »+€• �._, v5r=,,,,as;ai-c.-_,..- a=, A'.`�.�+n ,..,x:: ,c_ .,�-_. - 5+.�.�.;.' ,5k_ � � ... -�.s.�c<.�1'.'SG`2's�i'.'a aeOat ..a ,rxv :_ ast'x3 ate,. .v_.-. .-�,.�,a2��x.,� ,.::��c«_�°., `,D f „, Jefferson County EN IROSTARS -=.41; Satch Works Auto Repair - Auto Works S ars 1 5 Stars i, 'c,1670 Ness'Corner Road 2313 3rd Street Port Hadlock,WA 98339 Port Townsend,WA 98368 N : : aners 360385 5682 ke%otuttto&t% Circle and Square "' 4 Stars 1213 Water Street ,- , 5 Stars 10953 Rhody Drive Port Townsend,WA 98368 �: i i Port Hadlock,WA 98339 fi 360 385 4585 .-T t 360-385-2070 iti Port Ludlow Marina Dentistry Northwest 4 Stars ;40 � } S Stars -- 1 Gull Drive `�; ZV ENVIP-IRO 'ARS'" 131 Randolph Street Port Ludlow,WA 983651 Port Hadlock,WA 98339 360-437-0513 Illie 360-385-1000 t 1. IIca support environrnento responsible businesses C SOS Printing `` I — — — — Printery Communications 1, 5 StarsS Stam 2319 Washington Street 11'0111e*forthe EnviroStars to90 when(shop 631 Tyler Street Port Townsend,WA 98368 Port Townsend,WA 98368 . 360-385-4194 360-385-1256 3.l antl+jet a directory of Enviro,tars businesses Uptown Dental Clinic at teww.enviroSta i.or II ,: p Port of Port Townsend .) 4 StarsOttear eatll-8.77--2:20 SIRft(7827) Boat Haven q 11 642 Harrison Street' 4 Stars Port Townsend,WA 98368 �' �' PO Box 1180 1 ( 4.Ht�a salmon`'! x't 360-385-4700 Port Townsend,WA 98368 -- --_--.___ 800-228-2803 Pleasant Harbor Marinat! ' , 4 Stars ) Port of Port Townsend le s--.-i r 308913 US Hwy 101 - Point Hudson Brinnon,WA 98320 / �'>�, rv:t --_� -,..6,/ = , 4 Stars , 360-796-4611 _—_. _ _ s PO Box 1180 Port Townsend,WA 98368 Jefferson Transit + r= 800-228-2803 EnviroStaa a on erniranmental cerifiaaon program provided by 5 Stars local government agenda;in pone*mt'Washington Deportment of tr 7615 West Sims Way II— Ecology and Puget So lieepet Aliance.It e a same of the Local Hatardors Waste id , ENVIRO$TAR s Mmogemerc Ptogran N King(aunty,King foamy Department of Nord Resources&Pats -. Port Townsend,WA 98368 r 360-385-4777 :, ,. . 0 Jefferson County lc-Heath ' ,,..F, - :,-,-'-- __ 615 Shsg. eridan Street• Port Townsend,WA 98368' • $ 360-385-9444 • www.JeffersonCountyPublicHealth.org • • vaccines readily • available. for HiM More than 5,000 doses of serious disease,"he said. H1N1 flu vaccine were adminis- U.S. Secretary of Health & tered in Jefferson County during Human Services Kathleen the last three months of 2009.The Sebelius reported that between vaccine is now widely available for April and mid-November there anyone wanting to be immunized, were approximately 47 million according to Jean Baldwin, direc- cases of H1N1 flu, more than tor of Jefferson County Public 200,000 hospitalizations and near- Health. :' r : ly 10,000.deaths "Influenza infection, whether Sebelius and local health of fi- caused by the pandemic H1N1 cials concur that H1N1 disease is strain or the regular seasonal vari- likely to continue, and seasonal ety, can be,a deadlyinfection," flu usually peaks between January said Dr. Tom Locke; Jefferson and March. County health officer.' "Getting H1N1 influenza vaccines are immunized has two key benefits: available at many local medical It protects the person receiving clinics;Jefferson Healthcare din- the vaccine and it protects their ics also have a supply of seasonal family,coworkers and the commu- influenza vaccine. Call your pro- nity at large from being exposed vider for an appointment. to someone with influenza." Safeway Pharmacy has H 1N 1 • Locke said studies have shown vaccine available without appoint- the new H1N1 vaccine to be .'ments, 10.11:30 a.m. and 1-4 extremely safe and highly.effec- p.m. weekdays. QFC Pharmacy tive. has H1N1 vaccine available by "I strongly recommend that appointment;call 385-1900. everyone take advantage of this Jefferson County Public Health opportunity to protect themselves ,has a walk-in clinic for influen- and their community from this za vaccines every Wednesday in January, 2-5 p.m., and by appointment on Fridays from 1 to 3 p.m. Insurance is billed and no additional fees are collected. Vaccination is free for those with- out health insurance. •' u 3 y° a v ' ti c -•7 o c i o gC/) •,' c• ' r//VE t o ` ty '� . = a5Ii aso ^ � �- ° o:6. o E ° m -)., s .- um2wms � 5 >,,vE. • . n � oc ° vm'' ,, _• ,o vv E ° v v - O0. 7 ° i. O My tixv E •9 83 .- .0_1 . -• CC. EC CV'a`9 j, N • V C 7 ,O V - vF.•C v '''++` ` c ben p,2 v °'c ,v ,4 c T •5 _ zo .c oEv2. o� ° vc jii&U1 ZEb ' c Ov - .: u • i •daoomE °Eh 3v �z.° oc ,-„,..- °,...z' v O0. O a 4 ' o" rVE•vyv5NvAm .._ NNc."b•<. c `6°w ay po E .rv ° v c 6 E v y vob- v >-• o.- vv2A0Mguc0. ° vim--. 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C .°. .z.- O Av0._0 '> •0�' v ,-- 3 3 ,--, 0 cp.c o a.. c o —Continued from page 29 If approved, permits are issued for Onsite septic systems ♦ the specific site,not the family or busi- at the time of application and includes a visit to ness.Permits are valid for three years. the site.The second comes at time of installation. Why Septic Is Needed Applications are made at the Jefferson • Because soil varies,the ability of each County Department of Community A Septic System Primer soil to absorb sewage effluent also var- Development or Environmental Health Department. Waste water and sewage (effluent) must be ies. Serious health problems can arise New on-site septic systems are only treated to prevent disease.Effluent flows from the from an overloaded or poorly designed allowed in the City of Port Townsend house to a septic tank,from where it flows into septic system. While most of us are acquainted for new single family residential devel- drain lines that carry it to absorbing soils.As it q opment which is greater than 260 feet filters down through the soil,it is purified by soil with the top soil on our property,sys- from the nearest city sewer main and bacteria.Two to four feet of good soil must exist terns must rely on the lower soils.Gla- which is not subject to any of the fol- pipesto treat the effluent The below the drain field ciers left deposits of till and silt over lowing:a) review and threshold deter- amount varies due to soil types. much of the area.These and clay soils urination under the State Environmen- Soil types range from gravel to sand,sandy loam, can create hardpan soils which restrict tal Policy Act Implementing Ordinance loam,to clays.If the effluent flows or percolates water absorption. Impermeable soils (Chapter 19.04 PTMC)orb)permit re- (percs) too quickly, it may reach ground water keep sewage near or at the surface,or quirements of the Environmentally Sen- without adequate purification,polluting neighbor- may cause back-up into the house. sitive Areas Ordinance(Chapter 19.05 ing wells or springs. PTMC). On-site septic systems must If it percs too slowly,the effluent backs up into When Is a Permit Required? be approved by the Jefferson County the house or resurfaces. Sandy soil requires less Any place where people live,work, Health Department. area than finer,loamy soils.Conventional septic sys- or congregate,which is not served by a If an on-site septic system within tems cannot be used in clay or other impervious sanitary sewer needs to have a permit- the City of Port Townsend fails (at any soils.Approved alternative systems can overcome ted on-site sewage system. New con- time),connection to the City's system some site limitations. struction to replace or remodel an ex- is required unless the nearest portion On-Site-Septic systems (OSS) are effective if fisting structure requires a new permit. of the parcel is greater than 260 feet the following conditions exist Temporary uses (more than 30 days) from the nearest sewer main,in which I.Properly designed and installed system. such as camps or recreational vehicles case the septic system may be repaired 2.Adequate soil conditions. also require a permit to serve the property. 3.System is not overloaded,neglected or im- Applications must include plans de- peded by excessive wastes from the house or signed by a licensed engineer or licensed Septic Inspections business. septic designer.Plans are drawn to scale Two inspection approvals are re- 4. Solid wastes are kept at a minimum.Septic and show the required distances be- quired for septic systems.One comes systems can handle only human excrement,toilet tween a well,septic tank,surface water, paper and wash water.Garbage disposals may be and buildings. too much. • Prior to approval, the Jefferson —Continued on page 30 5. Clear liquid is visible through annual visual County Environmental Health Depart- inspections. ment evaluates the soil on the site from 6.Pumped out every three to five years. a minimum of four test holes. Often, The Port Townsend&Jefferson County Leader 7.The drain field is protected from vehicles. soil evaluation must be conducted dur- ing the wet season.Both primary and reserve drain fields are required and soil must be approved for each.The system should be designed for greater • Manufactured/mobile and modular homes are than typical capacity. treated the same as site-constructed homes with respect to setbacks,water,sewage disposal,drain- age,stormwater,footing drains,roof drainage and the like.A siting permit is required for both manu- factured/mobile and modular homes. Modular homes are built in a factory to the standards of the International Building Code(IBC) and are installed on a conventional foundation and require a foundation plan and the appropri- ate inspections.Manufactured homes are built to Federal Housing and Urban Development speci- fications. Manufactured homes do not require a conventional foundation and may be installed per the manufacturer's installation instructions.The blocking,plumbing,skirting,steps,and porches are inspected as part of a Manufactured Home per- mit. In conformance with the City's comprehensive plan,manufactured homes are allowed in all resi- dential zones except in the Historic District III ,)D/O /4 c ...//)?� QL)x 0�w N § .b s 1 3 c o '' l C7 ° V :;.s in o 0c� - -� �ta� O �i d d am, ba 8mm it 0 ic 80 -Ecs,, 0- °'}P'i-aci °� : c°iaai� �0....$N m ai `.b t; tb., =tea .o_ ° o 8 coN•. ° co tE a dro co m '�m,m �� a O, Nu �^ Cn 0,8 2. co S.D.Q -U 0.jcOp �h. .cna ..4"�' O o 0.� a) US C 1 !J L0• 0 2.. 'Eco cow d- u)co a�° •f E y . 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PIOh O4 4 bo40d ,, r. u ° v.,' .b E � � A � a o [iO O ' aI o dbAoRq ()5 y bad a q pz � ThHP § " ; tin c O N p 8 8 a oa U o 2 csi- 8� 45g6 ° UI 4. pa�� 3 •� -,- °-csia� ocb 0t0$ 2m o CID -.,.. m '�°; � 9-row o �U� � . � d 4d �ro aro � d CO o b 11041) ,-`',3 ,4 o O.,ya� EA �. .; 5 cry � g E8 �.g X6.0 ga ; › . 0O O 1 oy~� �1m m0TaO w O ayyyaGa �1g� ■ ■ 0 Ooh^ s °� g0° V-iz ^C^ :. gaa . (1) >•• Z _N 8 s-1 �dO da p I p opt_ � , jIi x c • � � aN QNCi) A da' aa8. 00oma- 8�- 4 bo 8 0 '$ m 5 E A� ' O � a) 6 0 8 a>q a D .=c, d W �~ 4.- .4 m a ., a) m at , cu o p 4. G0acgO U . 8 wa a • one from reported Jefferson p in salmonella outbreak Fourteen cases of salmonella, was one of the items recalled by cases was hospitalized. including one case from Jefferson Daniele International. See dan- All 15 were sick between July County, have been reported in ielefoods.com for details of the and December 2009 and have Washington state, the state recall. since recovered. Public health Department of Health reported A private lab in Washington officials advise people not to eat Jan.28. also tested a different salami the recalled products and to fol- Testing at the state's Public product produced by Daniele low the instructions issued by the Health Laboratories is helping and found it contained another manufacturer, point disease investigators to the type of salmonella. An investiga- Salmonellosisis is a common source of a nationwide salmonella tion continues, as health officials bacterial infection that comes outbreak,officials said. work with local, state and federal from more than 2,000 strains of Salami has been implicated as partners to find the contaminated salmonella.For information,go to a potential source of the outbreak, ingredient. oh.wa.gov. according to a national study. So Washington originally listed 14 far, the outbreak has made more cases in the outbreak; another than 180 people sick nationwide, was added this week. They're including 15 in Washington. from Clark County (3 cases), Health officials reviewed shop- King County (3), Snohomish • ping receipts and verified that County (3), Jefferson County 13 people purchased the same (1), Thurston County (1), Pierce salami variety pack before get- County (1) and Whatcom County ting sick.The salami variety pack (1). Only one of Washington's • ;p- HINI : Third wave could be avoided if more vaccinated • By Allison Arthur of the Leader "Now we're pushing over 65 because A third wave of H1N1 flu they may have drawn the false could be prevented if more peo- ple step up to be immunized. conclusion that they are completely That includes people 65 and older. without risk and that's not true." Dr.Tom Locke,health officer 'for Jefferson and Clallam coun- ties, says there is plenty of free Tom Locke vaccine available. health officer,Jefferson County He hopes people take advan- tage of it. For example, Locke says 10 need for the full effect. We "It's very possible the herd there's no way to know which also know there are many kids immunity level will stop a third people 65 and older have an who haven't been vaccinated at wave," he said. "And if it does, immunity and which people all. And with the plentiful sup- that's a real achievement, that aren't naturally immune. ply, right now is a great time to those who have gotten vacci- Now that there's plenty protect them,too." nated have stopped a mid-winter of vaccine, Locke says those The H1N1 flu strain that's outbreak." people should step forward. circulating in Washington and More than 5,800 doses of There also has been a general across the country is a new the H1N1 vaccine have been drop-off in interest in being vac- strain and no one can predict • dispensed in Jefferson County cinated, he said. what's going to happen, health since October. "We've always had trouble officials say. For those under 24 years vaccinating people for the Vaccines are available at old, about 24 percent have been seasonal flu after the holiday. medical clinics, and Jefferson vaccinated in Jefferson County, We've probably done better with Healthcare clinics also have a health officials said. H1N1,"he said. supply of seasonal influenza vac- "We would like it to be high- The seasonal flu also has not cine. People are urged to call er, but we've done really well," made much of an appearance their provider for an appoint- Locke said. He would like to so far. ment. see that vaccine rate higher in "There's speculation we may Safeway Pharmacy has the youth because community- not have an outbreak of seasonal H1N1 vaccine available without wide outbreaks typically start flu because vaccination has been appointments between 10 and in schools. However, Locke said at an all-time high," he said. 11:30 a.m. and 1 and 4 p.m. health officials are also now urg- "We're sort of at risk through weekdays. ing people 65 and older to get the month of March, but if we QFC Pharmacy in Port immunized. don't see it in mid-Feburary,that Hadlock has H1N1 vaccine avail- During a vaccine shortage means we probably won't see it able by appointment. Call 385- last fall, people 65 and older peak in,March." 1900. were told to wait until others, Jefferson County Public mostly young people who were WHERE TO GET VACCINATED Health has a walk-in clinic vulnerable to H1N1, were vac- Locke also reminds parents for influenza vaccines every cinated. that they should be sure to get Monday afternoon from 1 to 4 "Now we're pushing over 65 a second dose of the H1N1 to p.m. because they may have drawn children under 10. Insurance will be billed and the false conclusion that they "It's vital to make sure they no additional fees will be collect- are completely without risk and take that final step to get the ed. Vaccination is free for those that's not true," Locke said. second dose that kids under age without healthcare insurance. f New ax ma sur rise s some county residents P1) iii "3 ( 3 /.i0 . Bill for Clean o-:01 h,4 7; t'h} ,Y l rpt vP 1„, .M'. .7,,k e.” �Yr g �t r41r tar Water District t,,� e I I t 55,00.0.i:;''''' ''''; ;. 0,0 V V 111 o`J t l nn� '' +.a• ., ....: ....amE#:. / Ma 4. BY JEFF CHEW '`j $ :. PENINSULA DAILY NEWS 103. 'y aa4 taa PORT TOWNSEND — A $5 ± s r�.s„ L. surprise is in the mail to those "'` in%r% ,,,, " ;` 8r who missed or forgot that a Clean ,',41,i0 .� ;�„ Water District charge to some Jef- 3 ' ,4, . . L4 • , • ferson County individual property ,N , wA . F "0013Ment owners was approved in August. "I am sure this is going to be a a s,4r-4a , ow( ' surprise to some people because • ;' they may not have been aware of ' " •r* ,rw; ,.,, , when the county commissioners , ;,"' •.- . approved it," said county Trea surer Judi Morris, whose office is ,',.iie,,aor //' • preparing to send out about 18,000A tax bills with the$5 charge. %' t Some 30,000 parcels are taxed countywide. / Morris said she already has • ' „'I I �t4-, , fielded a number of phone inqui- '' '4.-141.;:f4, ,0f. ":4/ - i` nes from property owners who ••" I ~ ig checked their tax billings online. t.)0,`",r ry k ,�� q* M„ • The bills should be mailed out "1.' a i,„. , ”"'i N`, .77 ''' - by Feb. 10. � � After an $18 per parcel charge . or' was shot down by residents, the c •'r county commissioners in August JEFF CREW/PENINSULA DAILY NEWS approved the$5 per parcel charge Jefferson County Treasurer Judi Morris looks through to all property owners outside of some of the tax bills to 18,000 parcels being prepared for Port Townsend and Port Ludlow, mailing at her office in the county courthouse. which are served by sewer sys- tems. charges will go toward studying The Clean Water District was The fee will generate about sources of pollution in shellfish established in 2007 without a fee, $88,000 on top of $33,000 from tidelands, including fecal coliform following outcry against the $18 the county general fund to match and stormwater runoff contami- annual per-parcel fee then pro- state grants earmarked for nants,and septic systems. posed. improving water quality in the The county has been managing The county formed the district county's shellfish growing areas. clean water projects in Discovery to keep its shellfish waters clean Some exempted Bay, Mats Mats Bay, Chimacum and avoid state Department of Creek and Hood Canal. Money Health water quality downgrades Exemptions from the charge, will go toward funding those proj- that could lead to closure of com- besides Port Townsend and Port ects. mercial shellfish beds that pro- Ludlow,are WestJefferson County The dollars generated would duce an estimated $20 million in property owners, defined timber- be used to help fence cattle off Jefferson County business a year0 . lands without homes on them, streams, educate homeowners and low-income senior-exempted about proper use of septic sys- Port Townsend Jefferson County Editor properties and disahled owners, terns, monitor water quality and Jeff Chew can be reached at 360-385- Moms said. identify pollution from septic sys- 2335 or at Jeff chew®penrnsuradadynews. 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C O 0 :. ° 'g'• bDya " c° % • V N O C, .,-4 8c°' oo �a0 ?_a2) E .5av,a. ,-t,. > �pG�^Q� 0c ° o ° vctl a 0 G c -7, 0 o — c 7.,'9—co� � cOd y C�".)U = a Z ° C cc ci i T. p -' p >,'U 0 c° v `' > �' ,, 0) 0 cs>.^ O'n ° —7 6-O a7 •-Z g' 11.5v N• U • N.c.i EN Ac °•- cid.- E.•0 ° °0,..cco � o a c 0 C5" >,0 ti0l m {.0 �' Cn 0.c°^ a� F E'� Y C^ v"O m a7 a' o Q.o 3v to0'G.OD d coA E -s-0.4 w-o r°.Ix c�.E 0 E e O (�-4 cCo 2te,5 5N0 �0 c 0 a7 a) c.0 o oi -.0' Ear „IRa t,-,..z1 ▪ c' ro , o v c Ox•p c aa3 0Z, 4 O O c0,, ag '• °'''0' 8•Q) 8-'23y4"; c cc 12 2-5 C'l 424 . 8 8a a0 E. ■• .?g, a■. V § ' '.c.''3C .E'�,I w P .E .1.E ti).F.1C .2.:,. ..6,1,—O ^C 0 c C cO J a' t O c 0.4 _” 5 .t''.' O a' X 05 $am`1 " •S � ° ad � �• 3AG � ❑ o w w� 0 'E 1 ❑• 2 °1c3 (I d .,5 g, 0.• ^o ...'"z17-' vIi gyp?'' ro ° YFgr. VAL) •`;-' g• U no QO C C' > b ow o rz a . 0 a' y Cw a ).0 c N o 2. E 0 ca 3 0 2) 0 0. z 4.9.—0 a)a ;, 0 � _.'I Co ° E� 6, ��F �ro0 >i..g U ® o v• „ > eb � �.• c, o �0�5 gCo o- .y ^ C EG ,, ro,� 3 2y 0 8 c J ° L C. 0 • Eateries win safety awards ' Jefferson County restaurants On the Water, Beth Diodene; are maintaining the highest level Khu Larb Thai, Rosie Itti; La Isla of food safety standards. Mexican Restaurant, Ignacio Thirty-eight full-service res- Rangel; Lanza's, Lori and Steve taurants and their proprietors Kraght; Lighthouse Cafe, Lee Ann will receive 2008)9 Outstanding Achievement.•.Awards from Lacy; little Dinghy Deli, KMC Jefferson County Public Health Investment Group LLC`, Diane for demonst ating high standards Coleman; Logger's Landing, Jack over the last two years.They were Helgens; Niblick's Deli, Port evaluated on personal,hygiene, Ludlow Associates, Kathy Arthur; food temperature safety; and pre Olympic Timberhouse, Carin vention of contamination. Rutledge;Penny Saver deli,Roger The awards are presented at 2:30 p.m. on Thursday, Feb. 18 at • Ramey,Pizza Factory Francis and the county Board of Health meet- Valorie Danielek; Port Townsend ing at 615 Sheridan St. Senior Nutrition, OIyCAP Robin Earning the honors are Ajax Gainer. Cafe,Kristan McCary;Blue Moose, Others include Portside Deli Tana Kettle; Blue Heron Middle Ltd Lynda and Brian Douglas; School.cafeteria, Port Townsend QFC No.106 deli in PortTownsend, • School District,Denise Reandeau; BPO Elks Lodge No.317;Brinnon Laura Hulsey and Andrea Morales- Senior Nutrition, OlyCAP, Sandra Gollub; QFC No. 870 deli in Port Pederson and Jennifer Loring; Hadlock, Dan Diederichs and Camp Parsons Food Service,Chief Carmen Farias; Quilcene School Seattle Boy Scouts of America, cafeteria, Quilcene School District Ken McEdwards;Chimacum Cafe, No:48Veda Wilson;Salal Cafe;Pat Debbie Lynes and Brian Homer, ,Fitzgerald; Scampi and Halibuts Chimacum Elementary School, Heidi Holmes; Chimacum High Seafood Grill, Jeff Erickson; School, Linda Boyd; Discovery The Spot, Randy Unbedacht; View. Retirement, Michelle Ts, Nancy Tocatlian; Tri-Area Sanchez and.Dale Brown; Dos Senior Nutrition; OIyCAP, Sarah Okies Barbeque,Larry Dennison. Miskimins; Twana Roadhouse, Awards also go to El Sarape, Melody Bacchus;Uptown Custom Ricardo Vega and Cesar Garcia; Food Co-op deli, J. Briar Kolp Catering, Candace Hulbert; and and Shila Zimmerman; In-Season the Upstage Restaurant, Mark Catering, Beth Johnson; Jordini's 'Cole. Wednesday,January 27,2010•Al _PS 12 I'S' eCt hi"e • Juvenile detention is going down in county By Barbara Carr administrator,Jefferson County Juvenile Court Here's to Amanda Kingsley, the with the assistance of programs such as cartoonist whose cartoon character functional family therapy, nurse and in last week's Leader made the corn- family partnership, aggression replace- ment"Juvenile detention is a growth ment training, county recreation, 4-H, industry." I know that she was draw- YMCA,church youth groups,local sub- ing a common conclusion — that stance-abuse-treatment providers,men- without the roller rink and the bowl- tal health counselors, after-school and ing alley, kids get in trouble and get day-care programs,and local schools. locked up. There is a small gem of Jefferson County has no standard truth in that assumption,but I would detention facility. Yet standard deten- ask Amanda and Leader readers not tion is sometimes necessary as the to panic yet. most restrictive response in a system There are many factors at play as that must forever balance accountabil- our children make their way through ity, public safety, safety of youths and early adolescence and teen years. rehabilitation. Recent budget reduc There are areas of influence that can tions have resulted in an even greater strengthen their ability to avoid risky effort to keep detention numbers down. behaviors that could result in breaking Now more than ever,an extra effort is the law,running away,using alcohol or spent keeping kids out of detention or • drugs and performing poorly in school. in our Proctor Home, where they are Services for families with babies and closer to home and services. early learning programs create a strong Communities with lots of roller rinks, positive base for families.In later years, bowling alleys and much more still have in addition to the importance of family bored children looking for something functioning, three of these vital areas to do. Although it might be an easy of influence are use of their free time, answer, we know that we can't expect how they feel about and perform in a rink or an alley to keep our children school,and how connected they feel to safe, healthy and out of trouble. We community. also know there are significant issues We are at a critical juncture in pri- involving youth that we must continue oritizing services— public, private and to address. At this time of priority dis- nonprofit. For Jefferson County, juve- cussions about what stays.and what nile detention is not a growth industry. goes, I look forward to working with In fact,the number of youths we saw in other youth-serving agencies to get our juvenile justice system 10 years ago even smarter about how we combine was at an all-time high. The bowling efforts, share resources, make youths alley was still open. Over the past 10 and families a priority, and keep the years,juvenile offenses have decreased consumers of the detention industry at by more than 36 percent,and detention an all-time low. bed days have also decreased by 37 per- Perhaps that is the point Amanda cent without the aid of the roller rink,but was trying to make. • • CHRISTINE o.GREGOIRE Governor „. STATE OF WASHINGTON OFFICE OF THE GOVERNOR P.O, Box 40002.Olympia, Washington 98604-0002 (360)902.4111. www,govornor.wa.gov February 17, 2010 TO: The Honorable Frank Chopp, Speaker of the House The Honorable Lisa Brown, Senate Majority Leader The Honorable Mike Hewitt, Senate Minority Leader The Honorable Richard DeBolt, House Minority Leader FROM: Christine O. Gregoire, Governor - SUBJECT: A BALANCED APPROACH FOR HARD TIMES In December, I presented an "all-cuts" budget to address a$2.6 billion shortfall in our state's two-year spending plan. As I said then, I cannot support that budget due to its devastating impact on the people of Washington. In January, I submitted to the Legislature a list of programs that I propose to restore. These programs, which I believe are vital to the health and recovery of our state, cost $768.5 million to fund. Below I outline how I propose to fund these programs. Before I do that, let me assure you that Washington is not alone in facing a fiscal deficit. Forty- eight states have addressed or still face shortfalls in their budgets for fiscal year 2010, totaling $193 billion or 28 percent of state budgets—the largest gaps on record. These numbers suggest that states will have dealt with a total budget shortfall of at least $350 billion for 2010 and 2011. Like Washington, other states have had to look to new revenue. According to the National Association of State Budget Officers, 29 states have raised over$24 billion in new taxes and fees. Of these states, 13 have Republican governors and 16 have Democratic governors. Washington, along with the nation, is weathering the worst recession since the Great Depression. People have lost jobs. Businesses have closed. Foreclosures have increased. Small local and regional banks continue to be exposed to loan defaults, particularly in the commercial sector. As both businesses and consumers spent less and saved more, revenue and confidence declined. There are, however, strong indications that the economy is turning around. Chief Economist Arun Raha notes that initial claims for unemployment insurance continue to decline. Positive job growth in Washington is expected early in 2010. Building permits are up more than 30 percent since April 2009, mainly in single-family home permits. Automotive sales are rebounding even when the effects of the federal "cash for clunkers"program are excluded. As a result, state revenues are no longer on the downslide. • • February 17, 2010 Page 2 This is not a typical recession and our economy remains fragile. Credit to small businesses remains depressed. The construction sector,e specially commercial, is still weighing down the recovery, and the return of consumer confidence remains tentative. Nonetheless, there is much we can and must do to encourage our state's economic recovery. First, we must take action to create jobs and stimulate new private investment. I have proposed a plan to create as many as 40,000 jobs over the next three years. I have proposed legislation to create a$2,000 B&O tax credit for new jobs to encourage small businesses to hire. I have also proposed legislation to make it easier for employers to qualify for the current B&O tax credit for new jobs. In addition, to persuade businesses to invest today rather than tomorrow, my proposal for projects of statewide significance provides permit assistance and a B&O tax credit for capital investments. We estimate this proposal will stimulate $2 billion in private investment in Washington during the next two years. Second, we need to continue on the path of government reform. I am pleased that the Legislature is moving forward on my proposals to reduce the number of boards and commissions, and to transfer programs and functions to reduce costs and align agency missions. But, we must do more. I have proposed the partial or complete closure of 10 state facilities so that we operate more efficiently, save money, and provide better care. This includes the closure of two of the state's five residential habilitation centers because I believe our citizens with developmental disabilities need to be served in communities. By closing underused buildings and changing the way we care for these citizens, we can free up funds to extend better care for more clients. Likewise, downsizing the facilities we use for juvenile rehabilitation will save money and enable the state to site and design smaller and better facilities in communities where the majority of young offenders live. Lastly, we need to take advantage of the investments we have made in highly efficient prisons by closing underperforming facilities. My 10-year plan on facilities closures will save the state $180.5 million. Lastly, we need to manage our fiscal crisis. The February revenue forecast provides signs that the economy is stabilizing, but we are not out of the woods yet. Revenues are flat and caseloads have grown. We now face a$2.8 billion budget gap. As difficult as the choices are, I believe we must address this year's gap with a balance of cuts and revenue. The legislative process will undoubtedly create a different list of cuts and restorations as the priorities of the Legislature and the public emerge. However, I am confident that we all want to protect our children, our most vulnerable, our health, and our future. I expect that Washington will receive additional resources through the Federal Medicaid Assistance Percentage (FMAP). We estimate that amount to be $435 million for this budget • cycle. I am thankful for the assistance of our Congressional Delegation in supporting this vital funding. • February 17, 2010 Page 3 Today, I am proposing new revenue that in combination with federal revenue will fund my restoration list. There are understandable pressures to restore much more, but the budget choices we make must prepare us for the 2011-13 budget. I have already introduced several proposals to improve our revenue system. These changes represent good tax policy—by addressing several court cases, eliminating tax policies that unfairly benefit out-of-state businesses, closing tax loopholes and revising ineffective tax exemptions. As I evaluated a wide array of revenue ideas, I kept several criteria in mind. First, I considered whether a tax proposal would jeopardize our prospects for recovery. Second, where possible, I sought to generate revenue from discretionary purchases rather than necessities. Third, I believe that products that negatively impact our environment or public health should be taxed to pay the cost of their effects. Fourth,I considered the effect on our 2011-13 budget. Attached is a chart that outlines my proposal. In total, my revenue proposals raise an additional $605 million in 2009-11. I had hoped Congress would have acted by now, but it has not. Consequently, my proposal assumes that the FMAP money our state receives is in our ending fund balance. While I am • confident we will eventually receive FMAP money, I cannot accept the risk that the budget could be pushed out of balance. While there are positive signs in our economy, recovery remains fragile. Until our economy is on a certain and upward path, we will need to be vigilant in managing the budget. This ending fund balance of$512 million will help cushion against the ups and downs our economy may take. Recovery will not happen overnight and it will continue to challenge us through the next biennium. The additional 2011-13 challenge we must tackle is education. My number one priority is for the children in our state to have good schools and great teachers. Not included in this proposal is a long-term funding strategy for K-12 education. While we are making efforts this legislative session to improve our schools and compete for federal Race to the Top funding, we need to work together to develop a stable and consistent funding source for K-12 education. It is my obligation to submit a revenue proposal to fund the program restorations I have requested. I know the Legislature must balance its budget, which may represent different priorities, a different approach to revenue, and a different ending fund balance. I respect the process and offer my assistance. The task ahead may appear daunting, but I believe we can work together to get the job done. Attachments • • 0 N c Cf" RI CC 4, g4 Oi p t Vf cu O CD V O CO .0 O V O LC) D) T CO V CO CO V 000 O CMO CO V OUD LO CO UD - O LCC) CO CO O Lf) 0 _m co - ,- coccoON CO (D 0 CO V' O O CD co O) CO V N .- CD CO M M N M CO to -C O 0r. V 0 .9� .o .9 0 c CL Q c c c o o O O T ca c -C m co ch Q o ,p 0 ,o GJ w c h a) > c ca v a`) A ca G w y mCD H !C o a) C oU a O els s N p c m U 3 U t o v CL) C"J c 3 o y -o o m 3 a) a a) a) n c) Q o -0 3 175 W m c N O a) y o a) a) m > E 2 m 15 E C n > E o m o . o m • n o 00 'm o -g a) _ E o a M 0 Ocn C -O — y d C o n L' E. 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CC ` Z —mmils �, .--i p cr V CCI Q E / 0 i • A Balanced Approach for Hard Times REVENUE PROPOSALS CREATING A FAIR BUSINESS CLIMATE Economic Nexus Under current law,Washington businesses pay taxes while many direct out-of-state competitors do not. This proposal updates our laws to reflect the borderless economy of the 21s`century by requiring out-of-state businesses to pay the same taxes that their in-state competitors now pay. Many Washington businesses with out-of-state sales will see their taxes go down. This legislation would generate $73.1 million this biennium. Close Loopholes and Tax Avoidance Closing tax loopholes is essential and the fair thing to do. Some taxpayers have created and exploited loopholes to purposely avoid paying real estate excise tax, sales tax and use tax. Closing these loopholes would save the state $11.6 million this biennium. RESTORING LEGISLATIVE INTENT Repeal B&O Tax Exemption for Direct Sellers (Dot Foods Court Case) Due to a court ruling that expands the reach of the direct sellers exemption,large out-of-state • businesses that sell products in Washington state now benefit from legislation designed to exempt "door-to-door" sellers and"in-home parties."This legislation would assure that in-state businesses are competing on a level playing field with out-of-state businesses. It would also encourage more local businesses to remain in the state. Restoring this exemption to its original intent would offset a recent$153.6 million forecast reduction. It would also generate $3.7 million this biennium. Clarify First Mortgage Interest B&O Tax Deduction (HomeStreet Bank Court Case) In 1970, the Legislature enacted a tax deduction to reduce the cost to homeowners of purchasing a home. Banks took advantage of this consumer benefit by deducting fees for loans they sold on the secondary market. New legislation to restore the state's position will make this deduction sensible again and serve homeowners,not banks. Righting this wrong would save the state$8.6 million this biennium. Clarify B&O Rate for Butchers (Agrilink Court Case) In 2005, the state Supreme Court extended preferential B&O rates intended to benefit meat packers to any business that manufactures or wholesales products containing even a tiny amount of meat. It was not legislative intent that large companies making products such as canned chili benefit from a lower tax rate.Restoring the original intent of the Legislature would raise $4.1 million this biennium. ELIMINATING PREFERENTIAL TREATMENT Eliminate Outdated B&O Tax Exemption for Gold Bullion Wholesalers and retailers of gold bullion should pay B&O tax on their sales like other retailers now • do. Eliminating this outdated 1985 exemption would save the state $210,000 this biennium. • Suspend the Sales and Use Tax Exemption for Livestock Nutrient Management Current law exempts companies from paying tax on purchases related to livestock nutrient management equipment.Both the Washington Cattlemen's Association and the Dairy Farmers of Washington have suggested that during this time of great need for the state, these exemptions be excluded.This would save the state $1.3 million this biennium. Repeal B&O Tax Credit for Syrup Tax Paid Companies that use syrup to produce carbonated beverages currently receive a B&O tax credit that completely offsets any syrup tax paid.Why have a syrup tax if it generates no revenue?This credit costs the state$7.7 million a year in foregone revenue. Require Directors to Pay Tax on Corporate Board of Director Fees Members of corporate boards of directors can receive substantial compensation for their services, yet no tax is collected on the amount that corporations pay them.This loophole would be closed by clarifying that these fees are not exempt from B&O taxation,which would generate $2.1 million this biennium. RESTORING CRITICAL SERVICES Increase the Hazardous Substance Tax This proposal increases the hazardous substance tax rate from 0.7 percent to 2.0 percent to protect Washingtonians from the effects that harmful pollutants have on the environment. The hazardous substance tax rate has not been revised in more than 20 years even though pollution levels and the • cost of cleanup have risen dramatically.During this recession, this will provide revenue as well as ensure important environmental safeguards are in place. This proposal would raise $148 million for the General Fund this biennium. It also would raise$66.5 million this biennium to prevent oil spills and clean up the Puget Sound and Washington's lakes and rivers. Excise Tax on Bottled Water Bottled water is a discretionary purchase. This proposal would require wholesalers to pay a tax of 1 cent per ounce on bottled water. It would generate$134.7 million this biennium. Excise Tax on Carbonated Beverages Carbonated beverages are a discretionary purchase.Their consumption leads to growing public health issues,including childhood obesity and diabetes.Through an excise tax of 5 cents per 12 ounces, this proposal would raise $93.6 million this biennium. Increase Cigarette and Tobacco Products Tax Tobacco,in all forms, continues to be a major health hazard. Increasing the price of cigarettes and tobacco products reduces consumption,especially among young people.While some may be concerned that higher taxes may lead people to buy contraband tobacco products,we will need to ensure enforcement.This increase would raise$88.8 million this biennium. Sales Tax on Candy and Gum Candy and gum,both discretionary purchases,are currently classified as food and thus exempt from sales tax.This proposal would extend sales tax to candy and gum,encourage healthier food choices and raise $28 million this biennium. • • A Balanced Approach for Hard Times Governor's 2010 Supplemental Budget Proposal 2009-11 Balance Sheet February 2010 General Fund-State Dollars in Millions Revenues Beginning fund balance $ 189 November 2009 revenue forecast $ 28,843 February 2010 forecast update (includes loss for Dot Foods case) $ (118) Fund transfers/other adjustments (enacted) $ 874 Required transfer to Rainy Day Fund $ (252) Transfer of related fund balances $ 89 $ 29,625 Governor's 2010 supplemental changes Transfers from other funds to General Fund $ 396 Use of Rainy Day Fund $ 229 • Budget-driven revenue $ (1) Legislation on B&O tax exemption for direct sellers (Dot Foods) $ 154 New revenue proposals $ 605 Job package $ (15) $ 30,993 Expenditures 2009-11 enacted budget $ 30,918 Governor's 2010 supplemental changes Maintenance level changes (with February update) $ 852 Use of new Federal Medical Assistance Percentage (FMAP)funds $ (435) Net expenditure changes $ (853) $ 30,481 Reserves Projected General Fund ending balance $ 512 Projected Rainy Day Fund ending balance 0