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HomeMy WebLinkAbout2010- March File Copy • Jefferson County Board of 3-CeaCth Agenda M mutes • March 18, 2010 • • JEFFERSON COUNTY BOARD OF HEALTH March 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 February 18, 2010 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. National Estimates of the Cost of Foodborne Illness 2. Kiwanis Club of Port Townsend Team Leaders Award Program 3. Substance Abuse Advisory Board's Recidivism Reduction Grant 4111 Application to Dept. of Justice V. New Business 1. 2009 Performance Measures Reports 2. Public Health Heroes Nominations 3. Legislative Update/Wrap-up 4. Family Planning Cost Analysis VI. Activity Update VII. Agenda Planning Calendar VIII. Next Scheduled Meeting: April 15, 2010 2:30—4:30 PM • JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, February 18, 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) Vice Chair Kristen Nelson called the meeting of the Jefferson County Board of Health to order at 2:38 PM. Members Present: Roberta Frissell, Phil Johnson, Kristen Nelson, David Sullivan, Sheila Westerman, John Austin Members Excused: Chuck Russell, Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin • Guest: Frances Joswick, SAAB A quorum was present. APPROVAL OF AGENDA Vice Chair Nelson requested for any corrections or revisions to the agenda. Member Frissell moved and Member Johnson seconded for approval of the agenda. The agenda was approved unanimously, as written. APPROVAL OF MINUTES Member Sullivan moved for approval of the minutes; Member Frissell seconded. The minutes of January 21, 2010,were approved, as submitted,with Member Austin abstaining because he had not attended the January meeting. • Jefferson County Board of Health—February 18,2010 1 t PRESENTATION OF RESTAURANT OUTSTANDING ACHIVEMENT AWARDS FOR 2008-09 . Dana Fickeisen, Food Safety Program, gave a brief introduction about the awards,noting that the Board of Health had established these awards to recognize and honor full-service complex menu food establishments that have demonstrated the highest standards for safe food handling. She thanked those who were present to receive the awards. Packet materials included an information memorandum from Ms. Fickheisen to the BOH, the February 4 Press Release announcing the Awards to 38 Jefferson County restaurants and a copy of a Food Inspection Report form. Ms. Fickeisen explained that the awards are based on meeting criteria as specified and rated on Food Establishment Inspection Reports for 2008-09. She noted that the "red' categories deal with the most important factors such as hand washing, storage and cooking temperatures, food protection from contamination, etc. "Blue" factors are less critical and can be addressed over time. She noted that points are assigned for violations, so the fewer the points the better. Vice Chair Nelson presented award certificates to owner/operators (or their representatives) of the following restaurants. She congratulated and expressed her thanks to all of them for their achievement. Blue Heron Middle School Cafeteria III Brinnon Senior Nutrition Camp Parsons Food Service The Coop Deli Jordini's on the Water Port Townsend Senior Nutrition QFC 870 Deli, Port Hadlock QFC 106 Deli, Port Townsend Tri-Area Senior Nutrition The Upstage Uptown Custom Catering T's Restaurant Photographs of the Award recipients were taken following the presentation. PUBLIC COMMENTS Libby Palmer, Port Townsend, referred to an article she had seen in the PDN about two weeks earlier, regarding the disposal of unused medications and their impact on the entire watershed ecosystem. She said that in following up on the article, she had been in touch with Clallam County and with Jean Baldwin. She had learned that the BOH and the Health Department have also been very concerned and interested in setting up a more • Jefferson County Board of Health—February 18,2010 2 eco-friendly disposal system, analogous to the Collection/Incineration process used by • Clallam County. Fran Joswick explained that the SAAB has become involved with this. She said Conner Daly, Port Townsend Police Chief, has been working with Clallam County on an arrangement; although the problem is complex and law enforcement must be involved, the process is moving along. She said that the funding for training etc. is being worked out and she is hopeful a process can be in place in about 60 days. Jean Baldwin said that an additional complexity is that Jefferson County does not have the same transportation and disposal contracts as Clallam County. Also, pharmacists will need to temporarily store the drugs. Jean Baldwin mentioned that a related state-wide bill had failed for the third time. Dr. Locke said that bill would have required pharmaceutical manufacturers to take back and dispose of the drugs, but was successfully defeated PhRMA, the main pharmaceutical lobbying group. OLD BUSINESS AND INFORMATIONAL ITEMS 2009 State of the Sound Report Online Dr. Locke referred to the press release in the packet announcing the 2009 State of the Sound report. He said the 140 page report contains a significant amount of Jefferson County data and is a worthwhile source of information, particularly with regard to water . quality. It is a state of the art compendium on what is known, what the problems are, what is in progress, and what more needs to be done to protect and restore Puget Sound. Jean Baldwin mentioned an outstanding EPA grant jointly submitted with Clallam County, the Conservation District and WSU for 0 & M and septic education; report filing, etc; the awards will be announced during the summer of 2010. There was a brief discussion about the pending legislation for a tax on toxic waste, but which would not be used for clean up for five years. Member Westerman proposed a letter to the state legislature endorsing the tax, but restricting the use to toxic clean up only. Member Sullivan said he would need to know more about the proposed legislation. After a brief discussion, Member Johnson suggested that, if a letter is sent, it should "urge" rather than "insist", in which case he would second the motion. The motion carried by a vote of 4 in favor and 2 opposed. It was agreed that staff would draft the letter, and Member Westerman offered to assist, as necessary. Statewide H1N1 Situation Report Dr. Locke reviewed the Washington State DOH report dated February 8, 2010. He said this would likely be the final tally for the first and second waves of the pandemic. He pointed out the 92 deaths reported, which likely under represents mortality due to H1N1 by a factor of 10. The report also contains vaccine distribution statistics. A total of 2.2 million doses were ordered, less than the amount available (enough to cover 50% of the • population). He estimated that about 90% of the doses ordered were actually Jefferson County Board of Health—February 18,2010 3 ti administered. Those figures will ultimately be determined by the inventory of what is left over. The shelf life varies, depending on the manufacturer and type of vaccine; some • batches have already expired and some will be useable for many more months. In response to a question, Jean Baldwin explained Incident Command. This is an emergency response protocol followed for public health emergencies, similar to the emergency management system used by the County Sheriff's office. She said the department followed the command structure but did not open an Incident Command center and did not have any declarations of emergency. The structure was followed for communications, for press releases, for daily briefings, etc. and was known as Incident Command"Lite". Jean Baldwin referred to a recent article in the Seattle Times on February 15, 2010, a review of what worked and what can be learned from this pandemic. She said that in Seattle, some healthy, pregnant women, some sick children and health care workers could not get vaccine. Throughout the state,there were numerous variations in supply and demand for the vaccine; this occurred at the national level as well. She said that the Health Department, in conjunction with the Hospital, will review their own performance and evaluate how well the overall process worked among all health system components in the County. She said that although the communication from the federal level on down was clearer than in the past, there were still many areas that could be improved. The Jefferson County statistics were not included in the packet. Jean Baldwin said the information could be found at: • http://www.kitsapcountyhealth.com/hlnl/InfluenzaSurveillanceReport.pdf. Dr. Locke confirmed that there were no deaths attributed to H1N1 in Jefferson County. There was a brief discussion about the inevitable under-reporting of deaths associated with H1N1. Public Health Report for Region 2, Winter 2010 Dr. Locke briefly reviewed the contents of the report, which covers a three county area (Jefferson, Clallam, and Kitsap) and noted the change in format to a one page color report. Providers prefer the one page e-mail to the previous two-page mailed report. The graph displays the incidence of all circulating viruses for the reporting period and a chart showing the symptoms and characteristics of the viruses. He pointed out the tally of the most commonly reported notifiable conditions, such as Salmonella, Giardia, Hepatitis A, etc. He clarified that Campylobacteriosis is a food-borne, bacterial intestinal infection that is often associated with raw poultry. Jean Baldwin added that the total list of reportable diseases is provided annually. There was a brief discussion about the relatively lower rates of Chlamydia and Gonorrhea in Jefferson County. Dr. Locke said the rate (cases per 100,000) has been significantly lower in Jefferson County than in neighboring Kitsap and Clallam counties for several years. He did not believe the risk behaviors were significantly different and that the reason for the difference is the work of the Health Department and health care providers to screen at-risk populations,treat those found to be infected, and treat all of their sexual contacts. Key rates for Chlamydia are for the group 15-24 years of age when comparing among counties. • Jefferson County Board of Health—February 18,2010 4 • NEW BUSINESS Olympic Community Action Program (OlyCap) Presentation—Oral Health Access in Jefferson County Tim Hockett, Executive Director of OlyCap, stepped through a slide presentation about OlyCap, with a focus on their oral health programs. Mr. Hockett described the OlyCap mission which involves determining"where the community hurts"and"what can we do about it". This involves development of a community needs assessment and strategic plan. He says access to health care has always been a major issue and it is closely related to poverty. Illness can prevent people from earning a living and health care can be so costly as to lead to bankruptcy. He discussed the long term need for free clinics and the network of volunteer providers that has evolved over time. Mr. Hockett described the origins of the Oral Health Care Access program during the mid 1990s, when OlyCap took over dental services from the Health Department. Under the Health Department at that time, it provided 21 days of service with a budget of$30,000 for all of Clallam and Jefferson Counties. They had contract providers and only portable equipment, which was set up at churches or other community locations for one or two days at a time. With the help of grants, they were able to expand to over 70 days of service per year. Dental care was limited to mainly routine cleanings and fillings. Plans were then laid to establish a fixed location for a two to three chair clinic. At the same • time, OlyCap was working with Clallam County to develop a free medical clinic. An opportunity arose to partner with the Pierce College for their dental hygiene instruction program. After overcoming funding and organizational obstacles, a partnership was developed among OlyCap, Pierce and Peninsula Colleges; the mission was to help the community and to train dental hygiene students. Upon graduation from a two year program, students are able to qualify for living wage jobs. Mr. Hockett showed floor plans and photos for the dental clinics and described how he was able to raise $300,000 in a six month period. The 7-chair clinic with a lab opened in September 2005. He described the challenge of opening and operating a full service clinic and coordinating the schedules for the academic program. Other partners were Washington Dental Service Foundation; First Federal Bank; City of Port Angeles; as well as others. As an indicator of service, Mr. Hockett mentioned that the clinic dealt with over 110 emergencies in 2009. The target population is low-income and uninsured; patients would normally have sought help at the hospital E/R. He pointed out that the costly E/R bills would not be paid and would need to be written off. He said that the program had received a State award because of the number of patients (one/third of those treated) that had been enrolled in a regular routine care program. He estimates that the savings for the hospital is about $30,000 per month. With regard to the financial aspects,patients do pay for services on a sliding scale. The average cost of an appointment is $85, which may include assessment, x-rays and • Jefferson County Board of Health—February 18,2010 5 extraction. The comparable fees at a private dental office are about$500. They do bill Medicaid, if appropriate. • Mr. Hockett presented statistical information on the program. For 2009, the clinic saw 243 patients from Jefferson County (12%of patient encounters); there were 8% from the West End. The majority of service provided was for Clallam residents representing 78 % of the patient encounters. Mr. Hockett then described plans for a small clinic (3 chairs) in Jefferson County(Port Townsend). It is expected that the clinic will see over 1,000 patients annually. The operations model will be patterned after the OlyCap Oral Health Center in Port Angeles with volunteer providers and sliding fees, but will not include an academic program for dental hygiene students. He said he has a floor plan for the building next to Working Image, but is also considering the larger space vacated by the Food Bank. The cost estimate is $300—400,000. Grant funding is anticipated; application has been already been made to the Washington Dental Foundation for$150,000 and to a First Federal source. However,he said the OlyCap agency is struggling to continue all of its services under the impacts of the economic downturn and in consideration of the State budget problems. It will lose $150,000 in funding as of July 1, 2010. It has therefore halted its progress on the Port Townsend Dental Center. Mr. Hockett said that the OlyCap team will review and restructure its entire budget, and seek to find additional income. They will consider a limited private pay mix, possibly allowing its own insured employees to use the dental clinic. He said that when it is time to mobilize the community, he will need support to obtain loans and to implement the Dental Center plans. He said he is • determined to establish an everyday dental care presence here. Jean Baldwin noted that Jefferson County is somewhat under-served in proportion to the population. She said that until a new dental center is built in Jefferson County, (which could be up to 5 years), transportation to the Port Angeles site is needed. Mr. Hockett noted that changing the mix would impact the bottom line. She said that Member Russell had been particularly eager to discuss this matter in relation to ER needs. There was further discussion about transportation options, such as acquiring van services. Member Westerman added that enabling greater patient encounters would also help build a stronger case for a Port Townsend dental center. Mr. Hockett said that the Community Needs Assessment, done in 2009,was a strong call for access to dental care in Jefferson County. He also indicated that since the first dental center was built in six months, after one year of planning, it may not take five years to do this. Meanwhile he is willing to investigate interim transportation options. He also mentioned that some patients have been willing to drive from Brinnon to Port Angeles. Member Sullivan offered that the County will help organize a transportation system. Jean Baldwin added that both OlyCap and Peninsula College are two-county organizations, and should provide services for Jefferson. Fran Joswick asked about the Dental Center capacity. Mr. Hockett said that it is operating at full capacity. He also noted that the academic program has been reduced to . Jefferson County Board of Health—February 18,2010 I one class every other year, with a break between two classes in the summer months. This • would provide some open chairs. He added that the center has been able to hire part-time dentists who also benefit by being eligible for tuition reimbursement for community service. Member Westerman asked if the Port Townsend dental center could be viable financially without the academic component. Mr. Hockett said it would actually work better without the student component, since the colleges do not pay their full share of space. Jean Baldwin inquired as to the usual sources of funds. Mr. Hockett said the Healthcare Authority awards service grants through the hospital. The dental component(for Jefferson County) is $37,000; that provides the portable dental equipment. OlyCap staff also helps to staff the Smile Mobile. In conclusion, Mr. Hockett said he firmly intends to do this project,but it has been slowed down by the economy. Members expressed their thanks for the presentation and the desire to work with Mr. Hockett on transportation in the short term. Member Frissell discussed a related matter, the upcoming accreditation review for Peninsula College in April. The accreditation team is soliciting letters from the community regarding what is needed,what is being delivered currently, and feedback about Peninsula's performance in this community. Member Frissell urged the BOH, County Commissioners and individuals to take this opportunity to provide feedback on • declining services and to influence future educational services for Jefferson County. She noted that Peninsula College had spent $50 million to build on the Port Angeles campus, while virtually nothing has been done locally. There was mention that there is only one Peninsula Board member from Jefferson County, although there should be two based on population size. Member Frissell also noted that our local extension program is now being run from Port Angeles. Syringe Exchange Program Annual Report Jean Baldwin referred to the 4-page 2009 Syringe Exchange Program(SEP)Annual Report in the packet. She said that syringe exchange numbers are down slightly. Secondary exchanges have decreased; she mentioned that there had been two known deaths in this group. In general, the SEP continues to see about the same numbers of individuals. During the last 12 to 18 months there has been much more education and disease prevention work. Free Hepatitis C testing and free Hepatitis A and B vaccine is offered at every visit. There is also continuing effort to reduce expenses in an already inexpensive program. Ms. Baldwin said there is a survey in progress about drug users and usage, with gift certificates as incentive. Referrals into treatment are increasing. Staff is also working at the treatment center doing Hepatitis C testing and Hepatitis A & B vaccine. There was discussion about the continuing need for outreach, including at the treatment • center and at the jail; reuse of syringes was reported at 14 out of 75 client visits. The SEP Jefferson County Board of Health—February 18,2010 7 1 tends to be used more by Port Townsend clients. The survey is also asking drug of choice, since this determines the way syringes are used/reused. Ms. Baldwin noted that • patterns are changing, and monitoring will continue. 5930 (Enhanced Funding for Immunization and Notifiable Condition Reporting Programs)Work Plan Dr. Locke and Jean Baldwin described the background to this funding, which was established by the State after a failed effort to provide stable funding for the public health system at large. Jefferson County received about $100,000 annually for a set of specified services. This report delineates actions and accomplishments for two years, 2008-09 and what is proposed for the next year. This is about half of communicable disease funding; it has already been cut by 20%this year. She pointed out the level and range of activities that are provided under this funding, including HPV vaccinations; school-based clinics; and enhanced use of standardized software systems for tracking and reporting. There was a brief discussion about the anti-vaccine movement and the continuing problem for public health in successfully refuting erroneous information. Universal Vaccine Purchase Program Update Dr. Locke reported that the State's vaccine program which provides 30-40% of children's vaccine was due to end in May. This would have caused problems for providers in ordering and inventorying certain vaccines. However, a coalition of insurance companies and health care providers have negotiated a plan to continue the current system. Under . this "universal purchase" plan, the federal programs will pay for about 70% of vaccine cost and the health insurers will pay the remaining amount. This will allow all childhood vaccine to be purchased at the federal discount rate. Ms. Baldwin noted that the collaboration among all interested parties is a major achievement and positive outcome for all involved, particularly children. Dr. Locke pointed out the packet materials which contain statistical details about vaccine use for Jefferson County. 2010 Legislative Session Update Dr. Locke reported that, as discussed earlier, the pharmaceutical return bills are dead. The vaccine exemption bill has passed the House and has strong support in the Senate. This bill would require a parent claiming a philosophical/personal exemption from vaccinating their child to have a certificate from a licensed health care provider stating that they have been counseled on risks and benefits of immunization. Naturopaths are included in the types of providers. Dr. Locke said the intention is not to coerce parents who have strong objections, but to reduce what have become known as "convenience exemptions", i.e. parents who are not opposed to vaccination but find it more convenient to sign the exemption form than get their children vaccinated before school entry. The two mechanisms for increasing funding for public health are still alive: tax on bottled water and carbonated beverages and candy tax. However, this revenue may also be used . Jefferson County Board of Health—February 18,2010 8 for the General Fund. Member Johnson noted that the candy tax is likely to be defeated • because of ambiguous definitions of candy versus food, due to strong lobbying efforts. Green Business Award for February,2010 Vice Chair Nelson recognized a new Green Business Award for the month. Charles Kanieski, CPA, and two new Enviro- Star Awards, Taku Marine and Port Townsend Rigging. Jean Baldwin noted that Lori Clark has been recruiting successfully in the marine businesses, particularly those who sell to the Seattle markets. AGENDA PLANNING CALENDAR A Board of Health annual calendar and a form to assist in scheduling future agenda items have been included in the packet. Agenda planning was held for Chair Russell's return. Jean Baldwin noted that the March agenda and packet will include the 2009 annual performance measure reports. The next scheduled BOH meeting will be held on March 18, 2010 from 2:30 to 4:30 PM. ACTIVITIES UPDATE Member Westerman referred other members to the ongoing blogging discussion stemming from an original article on juvenile detention. Vice Chair Nelson reported that she had informed City Council that the BOH was interested in presenting a quarterly report, which was very well received. She said scheduling could be done through City Clerk Pam Kolacy. In addition, at a recent City Council retreat, the decision was made that each City Councilor will give a brief report on the committees that each is involved in. Ms. Nelson said she would welcome suggestions from other BOH members each month on what BOH items she should highlight for the next City Council meeting. Syringe exchange and Green Business/EnviroStar Awards were mentioned. Jean Baldwin and Sheila Westerman plan to present the Quarterly Report beginning in March. ADJOURNMENT Vice Chair Nelson adjourned the BOH meeting at 4:30 PM. • Jefferson County Board of Health—February 18,2010 9 • JEFFERSON COUNTY BOARD OF HEALTH • Excused Chuck Russell, Chair Phil Johnson, Member Kristen Nelson, Vice-Chair John Austin, Member Roberta Frissell, Member David Sullivan, Member Sheila Westerman • Jefferson County Board of Health—February 18,2010 10 JEFFERSON COUNTY BOARD OF HEALTH • MINUTES Thursday, February 18, 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) Vice Chair Kristen Nelson called the meeting of the Jefferson County Board of Health to order at 2:38 PM. Members Present: Roberta Frissell, Phil Johnson, Kristen Nelson, David Sullivan, Sheila Westerman, John Austin Members Excused: Chuck Russell, Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin • Guest: Frances Joswick, SAAB A quorum was present. APPROVAL OF AGENDA Vice Chair Nelson requested for any corrections or revisions to the agenda. Member Frissell moved and Member Johnson seconded for approval of the agenda. The agenda was approved unanimously, as written. APPROVAL OF MINUTES Member Sullivan moved for approval of the minutes; Member Frissell seconded. The minutes of January 21, 2010, were approved, as submitted,with Member Austin abstaining because he had not attended the January meeting. Jefferson County Board of Health—February 18,2010 1 PRESENTATION OF RESTAURANT OUTSTANDING ACHIVEMENT AWARDS FOR 2008-09 • Dana Fickeisen, Food Safety Program, gave a brief introduction about the awards, noting that the Board of Health had established these awards to recognize and honor full-service complex menu food establishments that have demonstrated the highest standards for safe food handling. She thanked those who were present to receive the awards. Packet materials included an information memorandum from Ms. Fickheisen to the BOH, the February 4 Press Release announcing the Awards to 38 Jefferson County restaurants and a copy of a Food Inspection Report form. Ms. Fickeisen explained that the awards are based on meeting criteria as specified and rated on Food Establishment Inspection Reports for 2008-09. She noted that the "red' categories deal with the most important factors such as hand washing, storage and cooking temperatures, food protection from contamination, etc. "Blue" factors are less critical and can be addressed over time. She noted that points are assigned for violations, so the fewer the points the better. Vice Chair Nelson presented award certificates to owner/operators (or their representatives) of the following restaurants. She congratulated and expressed her thanks to all of them for their achievement. Blue Heron Middle School Cafeteria Brinnon Senior Nutrition • Camp Parsons Food Service The Coop Deli Jordini's on the Water Port Townsend Senior Nutrition QFC 870 Deli, Port Hadlock QFC 106 Deli, Port Townsend Tri-Area Senior Nutrition The Upstage Uptown Custom Catering T's Restaurant Photographs of the Award recipients were taken following the presentation. PUBLIC COMMENTS Libby Palmer, Port Townsend, referred to an article she had seen in the PDN about two weeks earlier, regarding the disposal of unused medications and their impact on the entire watershed ecosystem. She said that in following up on the article, she had been in touch with Clallam County and with Jean Baldwin. She had learned that the BOH and the Health Department have also been very concerned and interested in setting up a more Jefferson County Board of Health—February 18,2010 2 eco-friendly disposal system, analogous to the Collection/Incineration process used by Clallam County. Fran Joswick explained that the SAAB has become involved with this. • She said Conner Daly, Port Townsend Police Chief, has been working with Clallam County on an arrangement; although the problem is complex and law enforcement must be involved, the process is moving along. She said that the funding for training etc. is being worked out and she is hopeful a process can be in place in about 60 days. Jean Baldwin said that an additional complexity is that Jefferson County does not have the same transportation and disposal contracts as Clallam County. Also, pharmacists will need to temporarily store the drugs. Jean Baldwin mentioned that a related state-wide bill had failed for the third time. Dr. Locke said that bill would have required pharmaceutical manufacturers to take back and dispose of the drugs, but was successfully defeated PhRMA, the main pharmaceutical lobbying group. OLD BUSINESS AND INFORMATIONAL ITEMS 2009 State of the Sound Report Online Dr. Locke referred to the press release in the packet announcing the 2009 State of the Sound report. He said the 140 page report contains a significant amount of Jefferson County data and is a worthwhile source of information, particularly with regard to water quality. It is a state of the art compendium on what is known, what the problems are, • what is in progress, and what more needs to be done to protect and restore Puget Sound. Jean Baldwin mentioned an outstanding EPA grant jointly submitted with Clallam County, the Conservation District and WSU for 0 & M and septic education; report filing, etc; the awards will be announced during the summer of 2010. There was a brief discussion about the pending legislation for a tax on toxic waste, but which would not be used for clean up for five years. Member Westerman proposed a letter to the state legislature endorsing the tax, but restricting the use to toxic clean up only. Member Sullivan said he would need to know more about the proposed legislation. After a brief discussion, Member Johnson suggested that, if a letter is sent, it should "urge" rather than "insist", in which case he would second the motion. The motion carried by a vote of 4 in favor and 2 opposed. It was agreed that staff would draft the letter, and Member Westerman offered to assist, as necessary. Statewide H1N1 Situation Report Dr. Locke reviewed the Washington State DOH report dated February 8, 2010. He said this would likely be the final tally for the first and second waves of the pandemic. He pointed out the 92 deaths reported, which likely under represents mortality due to H1N1 by a factor of 10. The report also contains vaccine distribution statistics. A total of 2.2 million doses were ordered, less than the amount available (enough to cover 50% of the population). He estimated that about 90% of the doses ordered were actually • Jefferson County Board of Health—February 18,2010 3 ti administered. Those figures will ultimately be determined by the inventory of what is left over. The shelf life varies, depending on the manufacturer and type of vaccine; some batches have already expired and some will be useable for many more months. II) In response to a question, Jean Baldwin explained Incident Command. This is an emergency response protocol followed for public health emergencies, similar to the emergency management system used by the County Sheriff's office. She said the department followed the command structure but did not open an Incident Command center and did not have any declarations of emergency. The structure was followed for communications, for press releases, for daily briefings, etc. and was known as Incident Command"Lite". Jean Baldwin referred to a recent article in the Seattle Times on February 15, 2010, a review of what worked and what can be learned from this pandemic. She said that in Seattle, some healthy, pregnant women, some sick children and health care workers could not get vaccine. Throughout the state, there were numerous variations in supply and demand for the vaccine; this occurred at the national level as well. She said that the Health Department, in conjunction with the Hospital, will review their own performance and evaluate how well the overall process worked among all health system components in the County. She said that although the communication from the federal level on down was clearer than in the past, there were still many areas that could be improved. The Jefferson County statistics were not included in the packet. Jean Baldwin said the information could be found at: http://www.kitsapcountyhealth.com/hln1/InfluenzaSurveillanceReport.pdf. Dr. Locke • confirmed that there were no deaths attributed to H 1 N 1 in Jefferson County. There was a brief discussion about the inevitable under-reporting of deaths associated with H 1 N 1. Public Health Report for Region 2, Winter 2010 Dr. Locke briefly reviewed the contents of the report, which covers a three county area (Jefferson, Clallam, and Kitsap) and noted the change in format to a one page color report. Providers prefer the one page e-mail to the previous two-page mailed report. The graph displays the incidence of all circulating viruses for the reporting period and a chart showing the symptoms and characteristics of the viruses. He pointed out the tally of the most commonly reported notifiable conditions, such as Salmonella, Giardia, Hepatitis A, etc. He clarified that Campylobacteriosis is a food-borne, bacterial intestinal infection that is often associated with raw poultry. Jean Baldwin added that the total list of reportable diseases is provided annually. There was a brief discussion about the relatively lower rates of Chlamydia and Gonorrhea in Jefferson County. Dr. Locke said the rate (cases per 100,000) has been significantly lower in Jefferson County than in neighboring Kitsap and Clallam counties for several years. He did not believe the risk behaviors were significantly different and that the reason for the difference is the work of the Health Department and health care providers to screen at-risk populations, treat those found to be infected, and treat all of their sexual contacts. Key rates for Chlamydia are for the group 15-24 years of age when comparing among counties. • Jefferson County Board of Health—February 18,2010 4 • NEW BUSINESS Olympic Community Action Program (OlyCap) Presentation—Oral Health Access in Jefferson County Tim Hockett, Executive Director of OlyCap, stepped through a slide presentation about OlyCap, with a focus on their oral health programs. Mr. Hockett described the OlyCap mission which involves determining "where the community hurts" and "what can we do about it". This involves development of a community needs assessment and strategic plan. He says access to health care has always been a major issue and it is closely related to poverty. Illness can prevent people from earning a living and health care can be so costly as to lead to bankruptcy. He discussed the long term need for free clinics and the network of volunteer providers that has evolved over time. Mr. Hockett described the origins of the Oral Health Care Access program during the mid 1990s, when OlyCap took over dental services from the Health Department. Under the Health Department at that time, it provided 21 days of service with a budget of$30,000 for all of Clallam and Jefferson Counties. They had contract providers and only portable equipment, which was set up at churches or other community locations for one or two days at a time. With the help of grants,they were able to expand to over 70 days of service per year. Dental care was limited to mainly routine cleanings and fillings. Plans were then laid to establish a fixed location for a two to three chair clinic. At the same • time, OlyCap was working with Clallam County to develop a free medical clinic. An opportunity arose to partner with the Pierce College for their dental hygiene instruction program. After overcoming funding and organizational obstacles, a partnership was developed among OlyCap, Pierce and Peninsula Colleges; the mission was to help the community and to train dental hygiene students. Upon graduation from a two year program, students are able to qualify for living wage jobs. Mr. Hockett showed floor plans and photos for the dental clinics and described how he was able to raise $300,000 in a six month period. The 7-chair clinic with a lab opened in September 2005. He described the challenge of opening and operating a full service clinic and coordinating the schedules for the academic program. Other partners were Washington Dental Service Foundation; First Federal Bank; City of Port Angeles; as well as others. As an indicator of service, Mr. Hockett mentioned that the clinic dealt with over 110 emergencies in 2009. The target population is low-income and uninsured; patients would normally have sought help at the hospital E/R. He pointed out that the costly E/R bills would not be paid and would need to be written off. He said that the program had received a State award because of the number of patients (one/third of those treated) that had been enrolled in a regular routine care program. He estimates that the savings for the hospital is about$30,000 per month. With regard to the financial aspects, patients do pay for services on a sliding scale. The average cost of an appointment is $85, which may include assessment, x-rays and • Jefferson County Board of Health—February 18,2010 5 extraction. The comparable fees at a private dental office are about $500. They do bill Medicaid, if appropriate. • Mr. Hockett presented statistical information on the program. For 2009,the clinic saw 243 patients from Jefferson County (12%of patient encounters); there were 8%from the West End. The majority of service provided was for Clallam residents representing 78 % of the patient encounters. Mr. Hockett then described plans for a small clinic (3 chairs) in Jefferson County (Port Townsend). It is expected that the clinic will see over 1,000 patients annually. The operations model will be patterned after the OlyCap Oral Health Center in Port Angeles with volunteer providers and sliding fees, but will not include an academic program for dental hygiene students. He said he has a floor plan for the building next to Working Image, but is also considering the larger space vacated by the Food Bank. The cost estimate is $300—400,000. Grant funding is anticipated; application has been already been made to the Washington Dental Foundation for$150,000 and to a First Federal source. However, he said the OlyCap agency is struggling to continue all of its services under the impacts of the economic downturn and in consideration of the State budget problems. It will lose $150,000 in funding as of July 1, 2010. It has therefore halted its progress on the Port Townsend Dental Center. Mr. Hockett said that the OlyCap team will review and restructure its entire budget, and seek to find additional income. They will consider a limited private pay mix, possibly allowing its own insured employees to use the dental clinic. He said that when it is time to mobilize the community, he will need support to obtain loans and to implement the Dental Center plans. He said he is • determined to establish an everyday dental care presence here. Jean Baldwin noted that Jefferson County is somewhat under-served in proportion to the population. She said that until a new dental center is built in Jefferson County, (which could be up to 5 years), transportation to the Port Angeles site is needed. Mr. Hockett noted that changing the mix would impact the bottom line. She said that Member Russell had been particularly eager to discuss this matter in relation to ER needs. There was further discussion about transportation options, such as acquiring van services. Member Westerman added that enabling greater patient encounters would also help build a stronger case for a Port Townsend dental center. Mr. Hockett said that the Community Needs Assessment, done in 2009, was a strong call for access to dental care in Jefferson County. He also indicated that since the first dental center was built in six months, after one year of planning, it may not take five years to do this. Meanwhile he is willing to investigate interim transportation options. He also mentioned that some patients have been willing to drive from Brinnon to Port Angeles. Member Sullivan offered that the County will help organize a transportation system. Jean Baldwin added that both OlyCap and Peninsula College are two-county organizations, and should provide services for Jefferson. • Fran Joswick asked about the Dental Center capacity. Mr. Hockett said that it is operating at full capacity. He also noted that the academic program has been reduced to Jefferson County Board of Health—February 18,2010 one class every other year,with a break between two classes in the summer months. This 1111 would provide some open chairs. He added that the center has been able to hire part-time dentists who also benefit by being eligible for tuition reimbursement for community service. Member Westerman asked if the Port Townsend dental center could be viable financially without the academic component. Mr. Hockett said it would actually work better without the student component, since the colleges do not pay their full share of space. Jean Baldwin inquired as to the usual sources of funds. Mr. Hockett said the Healthcare Authority awards service grants through the hospital. The dental component(for Jefferson County) is $37,000; that provides the portable dental equipment. OlyCap staff also helps to staff the Smile Mobile. In conclusion, Mr. Hockett said he firmly intends to do this project, but it has been slowed down by the economy. Members expressed their thanks for the presentation and the desire to work with Mr. Hockett on transportation in the short term. Member Frissell discussed a related matter, the upcoming accreditation review for Peninsula College in April. The accreditation team is soliciting letters from the community regarding what is needed, what is being delivered currently, and feedback about Peninsula's performance in this community. Member Frissell urged the BOH, County Commissioners and individuals to take this opportunity to provide feedback on • declining services and to influence future educational services for Jefferson County. She noted that Peninsula College had spent $50 million to build on the Port Angeles campus, while virtually nothing has been done locally. There was mention that there is only one Peninsula Board member from Jefferson County, although there should be two based on population size. Member Frissell also noted that our local extension program is now being run from Port Angeles. Syringe Exchange Program Annual Report Jean Baldwin referred to the 4-page 2009 Syringe Exchange Program(SEP) Annual Report in the packet. She said that syringe exchange numbers are down slightly. Secondary exchanges have decreased; she mentioned that there had been two known deaths in this group. In general, the SEP continues to see about the same numbers of individuals. During the last 12 to 18 months there has been much more education and disease prevention work. Free Hepatitis C testing and free Hepatitis A and B vaccine is offered at every visit. There is also continuing effort to reduce expenses in an already inexpensive program. Ms. Baldwin said there is a survey in progress about drug users and usage, with gift certificates as incentive. Referrals into treatment are increasing. Staff is also working at the treatment center doing Hepatitis C testing and Hepatitis A & B vaccine. There was discussion about the continuing need for outreach, including at the treatment • center and at the jail; reuse of syringes was reported at 14 out of 75 client visits. The SEP Jefferson County Board of Health—February 18,2010 7 tends to be used more by Port Townsend clients. The survey is also asking drug of choice, since this determines the way syringes are used/reused. Ms. Baldwin noted that • patterns are changing, and monitoring will continue. 5930 (Enhanced Funding for Immunization and Notifiable Condition Reporting Programs) Work Plan Dr. Locke and Jean Baldwin described the background to this funding, which was established by the State after a failed effort to provide stable funding for the public health system at large. Jefferson County received about$100,000 annually for a set of specified services. This report delineates actions and accomplishments for two years, 2008-09 and what is proposed for the next year. This is about half of communicable disease funding; it has already been cut by 20%this year. She pointed out the level and range of activities that are provided under this funding, including HPV vaccinations; school-based clinics; and enhanced use of standardized software systems for tracking and reporting. There was a brief discussion about the anti-vaccine movement and the continuing problem for public health in successfully refuting erroneous information. Universal Vaccine Purchase Program Update Dr. Locke reported that the State's vaccine program which provides 30-40% of children's vaccine was due to end in May. This would have caused problems for providers in ordering and inventorying certain vaccines. However, a coalition of insurance companies and health care providers have negotiated a plan to continue the current system. Under • this "universal purchase" plan, the federal programs will pay for about 70% of vaccine cost and the health insurers will pay the remaining amount. This will allow all childhood vaccine to be purchased at the federal discount rate. Ms. Baldwin noted that the collaboration among all interested parties is a major achievement and positive outcome for all involved, particularly children. Dr. Locke pointed out the packet materials which contain statistical details about vaccine use for Jefferson County. 2010 Legislative Session Update Dr. Locke reported that, as discussed earlier, the pharmaceutical return bills are dead. The vaccine exemption bill has passed the House and has strong support in the Senate. This bill would require a parent claiming a philosophical/personal exemption from vaccinating their child to have a certificate from a licensed health care provider stating that they have been counseled on risks and benefits of immunization. Naturopaths are included in the types of providers. Dr. Locke said the intention is not to coerce parents who have strong objections, but to reduce what have become known as "convenience exemptions", i.e. parents who are not opposed to vaccination but find it more convenient to sign the exemption form than get their children vaccinated before school entry. The two mechanisms for increasing funding for public health are still alive: tax on bottled water and carbonated beverages and candy tax. However, this revenue may also be used • Jefferson County Board of Health—February 18,2010 8 for the General Fund. Member Johnson noted that the candy tax is likely to be defeated because of ambiguous definitions of candy versus food, due to strong lobbying efforts. • Green Business Award for February, 2010 Vice Chair Nelson recognized a new Green Business Award for the month. Charles Kanieski, CPA, and two new Enviro- Star Awards, Taku Marine and Port Townsend Rigging. Jean Baldwin noted that Lori Clark has been recruiting successfully in the marine businesses, particularly those who sell to the Seattle markets. AGENDA PLANNING CALENDAR A Board of Health annual calendar and a form to assist in scheduling future agenda items have been included in the packet. Agenda planning was held for Chair Russell's return. Jean Baldwin noted that the March agenda and packet will include the 2009 annual performance measure reports. The next scheduled BOH meeting will be held on March 18, 2010 from 2:30 to 4:30 PM. ACTIVITIES UPDATE • Member Westerman referred other members to the ongoing blogging discussion stemming from an original article on juvenile detention. Vice Chair Nelson reported that she had informed City Council that the BOH was interested in presenting a quarterly report, which was very well received. She said scheduling could be done through City Clerk Pam Kolacy. In addition, at a recent City Council retreat, the decision was made that each City Councilor will give a brief report on the committees that each is involved in. Ms. Nelson said she would welcome suggestions from other BOH members each month on what BOH items she should highlight for the next City Council meeting. Syringe exchange and Green Business/EnviroStar Awards were mentioned. Jean Baldwin and Sheila Westerman plan to present the Quarterly Report beginning in March. ADJOURNMENT Vice Chair Nelson adjourned the BOH meeting at 4:30 PM. Jefferson County Board of Health—February 18,2010 9 h JEFFERSON COUNTY BOARD OF HEALTH 1 � • Excused Chuck 'ussell, Chair 1 Phil Johnson, ember / Aleir Kristen Nelson, Vice-Chair it fhn Austin, Member /1 7-)/1' :( 4e4e4� Roberta Frissell, Member David Sul ivan, Member 94;1- 4._ \)) 6.) , ,, , Sheila Westerman • • Jefferson County Board of Health—February 18,2010 10 • Board of Health Odd Business & InformationaCltems .agenda Item # 1.17, i. • National-Estimates of the Cost of JoocCborne Illness Nlarch 18, 2010 The food we eat •oodborne illness costs U.S. $152 billion annually u u;h:d 8 . hitt i 0 'Ciorri sand Sccunty NS w`ti'Alf e) The most comprehensive study of the subject finds that the cumulative cost to Americans of foodborne illnesses is$152 billion annually;the cost per case for an individual is$1,850 on average;the Centers for Disease Control and Prevention (CDC) estimates that there are 76 million new cases of food-related illness in the United States every year,resulting in 5,000 deaths and 325,000 hospitalizations A new study by a former U.S. Food and Drug Administration (FDA) economist estimates the total economic impact of foodborne illness across the nation to be a combined $152 billion annually. The Produce Safety Project, an initiative of the Pew Charitable Trusts at Georgetown University, published the report, Health- Related Costs from Foodborne Illness in the United States. In addition, an interactive online map that graphically represents this cost information for every state in the nation is available here. The report ranks states according to their total costs related to foodborne illness and cost per case for an individual, which is $1,850 on average nationwide. The ten states with the highest costs per case are: Hawaii, Florida, Connecticut, Pennsylvania, South Carolina, the District of Columbia, Mississippi, New York, Massachusetts, and New Jersey. The Centers for Disease Control and Prevention (CDC) estimates that approximately 76 million new cases of food-related illness — resulting in 5,000 deaths and 325,000 hospitalizations — occur in the United States each year. Continuing outbreaks every year show that this is not a problem that is going away. "The costs associated with foodborne illness are substantial," says report author Robert L. Scharff, a former FDA economist 0i)o is now an assistant professor in the Department of Consumer Sciences at Ohio State University. "This study puts the blem of foodborne illness in its proper perspective and should help facilitate reasonable action designed to mitigate s problem." The release of the report comes as the U.S. Senate may soon vote on comprehensive food-safety legislation. The U.S. House of Representatives passed its food-safety bill (H.R. 2749) last July, and just before Thanksgiving, the U.S. Senate Committee on Health, Education, Labor& Pensions unanimously approved the FDA Food Safety Modernization Act (S. 510). "This report makes it clear that the gaps in our food-safety system are causing significant health and economic impacts," says Erik Olson, director of food and consumer product safety with the Pew Health Group. "Especially in challenging economic times we cannot afford to waste billions of dollars fighting preventable diseases after it is too late. The Senate needs to act on this now and pass legislation that will improve protections for public health." To obtain a copy of the report, visit the Make Our Food Safe Web site. Despite the substantial magnitude of this problem, the aggregate economic cost of health losses associated with foodborne illnesses has not been examined comprehensively in this way before. There are a number of ways to estimate the economic impact of foodborne illness. This report uses an FDA cost-estimate approach: health-related costs are the sum of medical costs (physician services, pharmaceuticals, and hospital costs) and losses to quality of life (lost life expectancy, pain and suffering, and functional disability). The report also estimates the cost of illnesses associated specifically with produce, which is linked to the largest number of outbreaks involving FDA-regulated foods. For example, E. coli 0157:H7 cases in produce accounted for 39 percent of outbreaks and 54 percent of illnesses. Using CDC data, the report estimates that foodborne illness costs related to produce alone are almost $39 billion per year in the United States. pile the Make Our Food Safe coalition does not necessarily endorse any single method to develop such estimates, coalition mbers agree that this study highlights the magnitude of the problem and the need for action to reduce foodborne disease. Furthermore, the coalition agrees that steps to reduce or eliminate contaminated food are sometimes pressing public-health measures that must be taken even when, due to data gaps, a comprehensive monetized economic analysis is not possible. Board of Health Old Business & Informational-items .agenda item # XV., 2 • .7Citivanis Club of Port gOtivnsend 2Jeam Leaders Award-Program .larch 18, 2010 t y, ., a- i.'.--""- ''''''''''.4! nye �� ��," a,�,d_ ,„` ,,. " ip WE BUILD" 1. d � AggeAllf ,u _..;,, ,.r— , . ......w �"�"r�4� ' "` °` '� r QCs� �✓r `� _, (( J) _warns of Pt eii P.O. Box 489 PORT TOWNSEND, WA 98368 '''' \SiirJP/ February 28, 2010 To: Chimacum School Based Health Clinic Re: 2009 Thomas J. Majhan Teen Leaders Awards The Port Townsend Kiwanis Club is proud to present the enclosed donation to your organization in honor of Nathaniel Christiansen, who was a recipient of the Thomas J. Majhan Teen Leaders Award for 2009 at a reception held today to honor all of the recipients. The Teen Leaders Awards program was started in 2003 to recognize local teens for excellence in leadership and service to their community. This is the first year that we have expanded the • program to include monetary awards to the recipient's organization of choice. Although it's a small donation, we hope you will appreciate the feeling behind the award. We had exceptional group of recipients this year and a record number--- 16! Their activities certainly exemplify the outstanding work being performed in our communities by teens and also demonstrate their excellent leadership in schools, churches and service organizations. We also extend our appreciation to your group for all of the work you do for our local communities. Sincerely, Melanie Bozak Chair, Teen Leaders Awards Program • • Board of Health Netiv Business .agenda Item # T., 1 • 200.9 Performance Nleasures Reports .7vlarch 18, 2010 Jefferson County Public Health: Community Health 2009 Performance Measures Report: Communicable Disease SBUDGET/PROGRAM: Community Health Communicable Disease TB, Communicable Diseases, Immunization, Travelers Immunization, Sexually Transmitted Disease, HIV, Syringe Exchange Program. MISSION: Communicable Disease(CD) The purpose of the Communicable Disease Health program is to protect Jefferson County residents from serious communicable diseases by providing disease surveillance, investigation and reporting, along with education, screening,treatment and immunization services. The program interacts with community members, medical providers, the Washington State Department of Health, Region 2 Emergency Management partners and other agencies while working toward this purpose. GOALS FOR 2009: 1. Maintain the low rates of active TB in Jefferson County. (TB) 2. Timely investigation of reportable conditions. (CD) 3. Medical providers will be informed about current communicable disease trends and new communicable disease control recommendations. (CD) 4. Support universal access to vaccines for all children. (Imm) 5. Continue to support immunization registry in Jefferson County, promoting use by all immunization providers. (Imm) 6. Assess childhood immunization rates for children served by Primary Care Clinics receiving State supplied vaccines. (Imm) 7. The Family Planning and STD clinics will assist in controlling Chlamydia transmission in Jefferson • County. (STD) 8. Federally funded HIV testing and counseling clinic resources are focused on persons at risk for HIV infection. (HIV) 9. Prevent the spread of blood borne communicable diseases among injecting drug users and their partners. (SEP) 10. Annual report to BOH for CD, TB, Immunization Programs. (STD) 11. Maintain and enhance Public Health Emergency Preparedness and Response (PHEPR) capacity. OBJECTIVES (INTERVENTIONS) FOR 2009: 1. Encourage appropriate screening and treatment for latent TB infection. (TB) 2. Develop & update protocols as needed for investigation of notifiable conditions using electronic reporting systems, Public Health Issue Management System(PHIMS), PHIMS-STD, Public Health Reporting of Electronic Data(PHRED). (CD) 3. Provide updates, outreach and training to providers about local, state and national communicable disease outbreaks and disease control recommendations. Provide reminders about reporting notifiable conditions and using the Regional Duty Officer for after hours contact. (CD) 4. Maintain an efficient system for supplying vaccine and vaccine recommendation up-dates to private Health Care Providers in Jefferson County, including training for ordering vaccines through the Vaccine Ordering Module (VOM) in the Child Profile system. (Imm) 5. Continue to provide private Health Care Providers support and education on the Child Profile Immunization Registry. (Imm) 6. Perform an assessment of childhood immunization rates, using Co-CASA software where applicable, • every other year, for each clinic receiving State supplied vaccines. (Imm) 7. Clients seen in Family Planning and STD clinics who are at higher risk for Chlamydia(age criteria) will be screened for Chlamydia. (STD) 1 8. 75%of clients who receive HIV testing through the Washington State Public Health Lab will be high risk. (HIV) 9. Promote utilization of syringe exchange program services. (SEP) 10. Develop and update regional Public Health Emergency Preparedness and Response Plan, coordinating with Region II partners Clallam and Kitsap Health Departments, local emergency response agencies, lip Jefferson Healthcare, local health care providers and agencies. (PHEPR) . PERFORMANCE INDICATORS 2007 2008 2009 2009 Actuals Actuals Planned Actuals (TB)Number of clients started on preventive therapy for 3 3 3 1 latent TB infection (CD)Number of communicable disease reports 103 164 90 123 confirmed, interventions applied and processed for reporting to the State (CD)Number of alerts/updates/newsletters faxed or New for 13 10 24 mailed to providers about communicable disease 2008 outbreaks or other urgent public health information. (Imm)Number of doses of publicly funded vaccine, 4,604 5,167 3,500 6,100 administered by private health care providers and Public Health clinics, supplied and monitored through Public Heath's immunization program (Imm)Number of visits to clinics to provide vaccine New for 6 5 13 education and vaccine recommendation up-dates for 2008 clinic staff(not including H1N1 vaccine) (Imm)Number of providers trained in VOM, vaccine New for New for 4 Module • ordering and receiving module through Child Profile 2009 2009 developremainsmentin (Imm)Number of providers participating in the 2 6 4 5 statewide Child Profile Immunization Registry (Imm)Number of Jefferson County children <6 with 1 or 84% 88% 88% 90% more immunization in Child Profile system (Imm)Number of Jefferson County children <6 with 2 or 74% 82% 80% 86% more immunization in Child Profile system (Imm)Number of clinic site visits, to assess childhood 1 1 2 1 immunization rates in each clinic, using CO-CASA software, if applicable (STD) Percent of at risk FP clinic clients at risk for 100% 100% 100% 100% Chlamydia screened at exam(age criteria 14 - 24). 272 312 275 287 Number of clients in risk group screened for Chlamydia, Ahlers report. (HIV)Number of persons counseled and tested for HIVQueDOHst Lab:59 DOHst Lab:73 90 DOH Lab:31 uest infection Total: 1312Total: 125 2 Total:9564 (HIV) Percent of persons tested for HIV infection 85% tested 90% tested 80% 95% tested through the Public Health Lab that were in high-risk through through through category DOH DOH DOH (SEP)Number of visits to SEP 65 70 50 65 (SEP)Number of syringes exchanged 24,585 21,330 15,000 14,044 (PHEPR) Develop and update Public Health Emergency 1 1 1 1 III Preparedness and Response Plan 2 • SUMMARY OF KEY FUNDING/SERVICE ISSUES (from plan written 7/2008 for 2009 budget): These programs address locally identified and defined local public health problems. Communicable disease prevention is a locally funded program, county milage was returned from the state to counties for TB control. • Immunization funds from the state have been primarily in the form of vaccine,this vaccine is provided to primary care clinics that care for children. County funding provides a professional staff that prevent, identify and respond to disease outbreaks and immunization staff that work with health care providers, the schools and local groups sponsoring trips abroad for students. Immunization staff provides routine immunization clinics and international travelers clinics. Substantial staff time is spent on responding to public requests for information about communicable diseases and screening for reportable illnesses in the process. A funding increase in 2008 from Washington State is specifically for Communicable Disease surveillance and improving immunization uptake in children. The two performance measures being reported to the DOH are: 1. Increase the uptake of new and under-used child and adolescent vaccines; specifically focusing improvement efforts and reporting on Varicella, Rota Virus, HPV, and Pediatric Influenza. 2. Improve the timely, complete identification and standard, effective investigation of notifiable conditions per WAC 246-101. HIV services are funded by the state and federal government to provide basic communicable disease prevention, testing and counseling to high-risk community members, and focused high-risk interventions. HIV case management services are provided by Clallam County Health Department. Program funding is based on formulas re-negotiated with Region VI AIDSNET every year. The syringe exchange program success is not easily measured in disease numbers but the number of clients seen and syringes exchanged reflects the disease transmission prevention capacity of this program. Ank Federal funding originally for developing capacity to respond to bioterrorism threats is now for all hazards lip emergency response. Response capacity is developed in coordination with Region 2 PHEPR partners Kitsap and Clallam Counties, our local emergency response agencies, Jefferson Healthcare and other health care providers. For 2009 projects involve participating in drills to test the appendices and procedures that go with the local Public Health Emergency Preparedness and Response Plan that was first drafted in 2003. This involves continuing to update the basic plan, the Strategic National Stockpile plan and the Pandemic Flu plan. Public Health staff have been trained in and use National Incident Management System protocols during communicable disease outbreaks. The roles, responsibilities and training have been invaluable for managing communicable disease outbreaks. JCPH participates in the Regional Duty Officer 24/7 contact system for Public Health with Kitsap and Clallam Counties' staff, responding to after hours calls and triaging them to the appropriate Public Health professional if necessary. This allows JCPH to share call time and standardizes regional response to Public Health issues. Federal funding for emergency preparedness activities is expected to decrease in 2009. Decreased funding for any program would result in scaling back on services. The Board of Health would decide which services would be impacted. 2009 STUDY/ANALYSIS OF RESULTS: The Communicable Disease team continues to share important information with Jefferson Healthcare and the medical providers, ideally sharing what they need to know without sending information that is not useful. In August 2009 the CD team developed a new fax system for collecting the information needed from providers for notifiable conditions investigation and reporting. This system was initiated in 9/09 to assist in timely *reporting from the providers. 3 Increased funding was received in 2008, for 2008-2009, from the Washington State Department of Health (DOH), specifically for Communicable Disease surveillance and improving immunization uptake in children. A separate report on these performance measures is sent to DOH. This funding for 2010-2011 has been reduced by 20%. In July 2009 the Washington State Universal Vaccines for Children distribution system changed sowith private insurance no longer qualify for State supplied HPV vaccine. This required clinics to stock privately purchased HPV vaccine and it reduced our use of State supplied HPV vaccine by about 50%. This change affected JCPH, and the four clinics currently administering State supplied vaccines. The number of doses of publicly funded vaccine administered to children in Jefferson County has been increasing every year, from 3,822 doses in 2006 to 6,100 doses in 2009. In the past this increase was primarily due to new vaccine options being added to the schedule and new school immunization requirements. However, in 2009 there were no new vaccines added to the schedule or the school requirements, and the number of babies born each year in Jefferson County has been stable. Jefferson Healthcare providers have been more successful in convincing new parents to immunize their children. The JCPH Immunization Program staff provide technical assistance to the clinics, immunization updates, vaccine refrigeration incident follow-up, training of new vaccine coordinators in the clinics, and immunization program assessment using AFFIX and CO-CASA software. The visit numbers do not reflect the daily work with the clinics. Many contacts are by phone and information is faxed or mailed to clinics. The Jefferson Healthcare hospital/clinics' electronic medical records (EMR) system does not allow the downloading of data into the statewide Child Profile Immunization Registry. All clinics receiving State supplied vaccines are now participating in Child Profile even though this requires double entry of immunization data by clinic staff. The Family Planning and STD clinics follow the Center for Disease Control's STD screening • recommendations for the high risk age groups. Clients tested for HIV are screened for risk factors and the State Public Health Lab is used for those in the high risk category. This allows high risk clients with no medical coverage and low income to be tested. Others requesting this are tested through the Quest lab and the cost of the testing is billed to the client. The number of client visits to the Syringe Exchange Program has remained fairly stable over the past three years while the number of syringes exchanged this year decreased. Twelve new clients visited the SEP in 2009. There were 6 new clients in 2008 and 9 new clients in 2007. The number of visits in which clients reported exchanging for other people as well as themselves (secondary exchange) decreased in 2009. A separate annual SEP report is sent to DOH and is posted at http://www.jeffersoncountypublichealth.org/index.php?syringe. The H 1 N 1 influenza outbreak in the spring of 2009 and returning in the fall required the implementation of our Pandemic Flu Plan for community education, and coordination and communication with our partners. Our Strategic National Stockpile Plan was implemented in order to receive and distribute the federal supply of antiviral medications. These were distributed to local pharmacies to ensure access to treatment. A new federal/state ordering and distribution system for the H 1 N 1 vaccine was developed in the summer. JCPH staff ordered and distributed vaccine to providers and pharmacies administering vaccine. JCPH staff met with Jefferson Healthcare hospital and clinic leads and pharmacists throughout the late summer and fall to plan and adjust the strategies for providing vaccine to the community. We initially planned to use a combination of mass vaccination clinics and vaccine in the provider clinics. The vaccine shortage 4 resulted in having vaccine in provider and JCPH clinics only, since the vaccine supply was not adequate for a mass clinic until much later. In early November the four Jefferson Healthcare clinics decided to create a joint H1N1 vaccine clinic to serve their patients. We were invited to a planning meeting for this clinic. Nine medical providers, two pharmacies, one hospital and one long term care facility signed contracts with DOH to • provide H1N1 vaccine. JCPH facilitated the signing of these contracts and trained all vaccine providers. JCPH held 2 H1N1 immunization clinics per week from October through January, focusing on those without healthcare insurance or without a local medical provider. See attached report on vaccine numbers. Dr. Locke gave a H1N1 education presentation to the local medical providers on 9/10/09. He covered the H1N1 vaccine,target groups, H1N1 diagnosis, treatment and infection control. The changing availability of vaccine and the resulting change in the target groups for immunization required good communication and coordination with our partners. Community strategies for prevention of flu transmission were discussed with the schools and businesses. School absenteeism was monitored. Local and regional updates on the current level of flu activity, trends in morbidity and mortality and updated testing, treatment and immunization recommendations were faxed out to providers starting in the spring and continuing through the rest of the year. Phone calls from providers were prioritized so that they always went to an available nurse and not to voice mail. Beginning October 1 S`JCPH Immunization Program nurses made weekly deliveries of H1N1 vaccine to all of the clinics and provided education on the vaccine presentation target groups. For the first several weeks the clinic staff had questions for the nurses, so these face to face visits were helpful. By November we were using support staff to make the deliveries. Since the Jefferson County allocations were very small until late November, we had to have most of the allocations shipped to JCPH. We split the allocations and delivered vaccine to the clinics according to the vaccine presentations available and their patient population. •A separate report on PHEPR activities is submitted to DOH. 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N N LD N N I- O F- > E ' + i:t a 3x ItlD N LD Jefferson County Public Health — 2009 Report Performance Measures FAMILY SUPPORT ODGET/PROGRAM: Community Health: Family Support Programs Iaternal Child Health (MCH) including newborn follow-up, and Breast Feeding Support, Maternity Support Services (MSS)/Infant Case Management,Nurse-Family Partnership (NFP), Children with Special Health Care Needs (CSHCN), Women Infants and Children (WIC), and the Child Protective Services (CPS) Contract Programs: Early Family Support Services (EFSS formerly ARS), Early Intervention Program (EIP), and Passport. MISSION: The mission of the Family Support Program is to offer health education and support to Jefferson County pregnant women and families with young children as they build a secure foundation for a lifetime of health, learning, and community contribution. The Family Support Team consists of public health nurses, registered dietician, social worker, and support staff Our goals are: -To honor the diversity of Jefferson County families with young children. -To support and guide families by building on their strengths in order to create a safe, healthy, and hopeful future for their children. -To collaborate with community partners in our shared goal of improving health, preventing adverse childhood experiences and creating a seamless continuum of services. -To provide high quality services through community assessment, commitment to best practices, professional continuing education and program evaluation. GOALS and OBJECTIVES FOR FY2009: oal: Improve the quality of caregiving for infants and children through support, education, and intervention for parents and caregivers. Objective: JCPH will offer services to all Jefferson County pregnant women, families, and caregivers of young children through an array of programs designed to fit the diverse and complex needs of a child and family. JCPH will work with staff and families in the schools, child care facilities, health care settings, and in the community. Spanish speaking families will receive interpretive services along with forms and educational materials in Spanish. Goal: Prevent harm to mothers, infants, and families at risk for or affected by maternal depression. Objective: Depression screening and education will be offered to all pregnant and parenting women who are participating in JCPH programs and appropriate referrals will be made for those who have a positive screen. Data will be collected by staff and become part of program evaluation and community assessment. Goal: Encourage and support breastfeeding for optimal nutrition and health for infants and mothers. Objective: Provide education and support to all pregnant women and their families about the benefits of breastfeeding. Each woman's decision on how to feed her baby will be supported. Individual office or home visits will be offered in addition to the group support of the Breastfeeding Tea Party. Ongoing collaboration with Jefferson Healthcare staff for lactation support will help ensure all families receive the services they need. Goal: Prevent nutritional related problems for pregnant, post-partum, and breastfeeding women and children under five in Jefferson County. •jective: Provide WIC nutrition education and support to all eligible county women and children. 1 OF 4 • Goal: Prevent unintended pregnancies. Objective: Assist parents in making goals and plans around family size and child spacing through education and referrals for birth control. • Goal: Improve birth outcomes by preventing birth defects, prematurity, and infant mortality. Promote health and development in children with special health care needs. Objective: Provide education and support to women who are or are planning to be pregnant about potential risks, healthy choices and ways to reduce risks to themselves and their fetus/infant. Screening, referrals, risk reduction, and education will include substance/tobacco use, domestic violence, mental health, and health and nutrition. Provide developmental and health screening of newborns and children to identify children with special health and development needs and assist families in getting further evaluation and intervention services. Staff will collaborate with community providers to ensure quality, comprehensive services for each family. Monitor state collected data on first trimester access to prenatal care. Goal: Address child abuse and neglect through outreach, education, collaboration, prevention, and intervention. Objective: Awareness and assessment of, and prevention and intervention in child abuse/neglect is an integral component of all Family Support Service Programs. Referrals to CPS/DCFS will be made as appropriate and services will be provided to families at risk or involved in child abuse/neglect through the EFSS and EIP contracts. Staff will collaborate closely with other providers to develop a comprehensive plan of care to keep children safe. Staff will engage in clinical supervision, consultation, and professional education to ensure high quality care and staff safety. Goal: Improve quality of services through collecting and analyzing data on health risks and intervention outcomes. Maintain program fidelity, quality, and caseload capacity of the Family Nurse Partnership Program • as an evidence based best practice. Objective: Continue research based programs such as Nurse Family Partnership (NFP)and Promoting First Relationships while developing technology systems to collect and analyze data on promising programs. Collaborate with state and local agencies in collecting, sharing, analyzing data in program design, delivery, and client/program outcomes. Support the Nurse-Family Partnership program capacity and program fidelity by providing opportunities for ongoing support and education to the nurses through weekly clinical supervision, professional consultation and education and participation in the Washington State Consortium for Nurse-Family Partnership. Goal: Increase awareness and support of the Family Support Program mission through community outreach, involvement, and collaboration. Objective: JCPH will continue to engage our community partners in exploring the issues of, and finding solutions to, family and community health issues. We will continue to provide education and information to community groups, agencies, and providers through our website, local newspapers, and community forums. S 2 OF 4 M PERFORMANCE INDICATORS: 2006 2007 1 2008 2009 2009 Actual Actual Actual Planned Actual 1. Number of depression screenings completed 65 87 85 90 53 •2. Number of newborn follow up contacts 145 130 116 120 111 3. Number of Home and Office visits provided by 1144 1170 1363 1100 1349 Family Support Staff in all programs. 4. Families served annually in Family-Nurse Partnership 20 20 25 20 25 5. Total number of women infants and children served 829 872 881* 850 868** by WIC in Jefferson County(from CIMS report) 6. Number of children with special health care needs 81 70 85 40 75 Birth through age 18 referred for Public Health Nurse Case Management. 7. Number of families served through CPS/DSHS 20 30 40 50 57 contract. *From State WIC office Calendar year 2008, Federal Fiscal year 867, ** Local WIC data 2/9/10 Projections for 2009 Budget written July 2008: Due to Federal cutbacks, JCPH had a 100% elimination of funds in our Children with Special Health Care Needs (CSHCN)program that targeted prevention services for children birth to three. The annual budget was $25,000 but was heavily leveraged. (July 2008) First Steps revenue is down 20%due to reduced reimbursement rates. (July 2008) We are experiencing a significant increase in the EFSS/EIP (CPS)program caseload and reimbursement. The contract increase covers approximately a .7 FTE PHN. The record high referral rate and complexity of the cases has necessitated increased staffing in these programs including more visits requiring 2 PI-N's and a significant increase in collateral contacts and cross agency collaboration. SP has a full caseload and remains without stable and adequate funding. We remain committed to NFP as a high priority prevention program. Our Satellite clinics in Quilcene and Chimacum are being heavily utilized. Currently approximately 35 families are served at each site. Utilization has increased as families have increasing financial stress. We continue to work down one PHN position. We have been unable to fund and attract a qualified nurse. Based on our years of work in the community with a broad spectrum of families we feel quite concerned about the very high level of stress families are coping with while they also face an astounding lack of real resources. We have seen an increase in food insecurity as housing and transportation/energy costs increase. We also have seen a huge increase in incidence and severity of methamphetamine use in women and teens. Summary/Analysis of 2009 Results - February 2010: July 2009 Washington State cut funding for Maternity Support Services by 25%. The State made the cut by increasing the risk criteria for families to qualify for services. JCPH management reduced outside personal services contract to compensate for anticipated reduction in revenue starting in July. To compensate for reduction in staffing Family Support programs eliminated offering universal newborn follow-up for all newborns referred to JCPH. JCPH continues to follow families who qualify for MSS as funding and staffing allows. As of December 2009 MSS revenue is down 35%due to reduced reimbursement. February 2010 a Family Support Public Health Nurse resigned and it is unknown if that positions will be filled based on funding. NFP has a full caseload (22-25). JCPH was able to secure 1 loth of 1% funding in 2010 to maintain NFP services/staffing with the loss of MSS funding that had supported some of the NFP visits in the past. JCPH •ain committed to NFP as a very high priority prevention program. 3 OF 4 JCPH Satellite clinics providing WIC and Family Planning and MSS in Quilcene and Chimacum are being heavily utilized. Quilcene clinic enrollment has doubled since we initiated weekly drop in hours; now 50 families. Family Support Programs are now down 2 nursing positions from 5 with no budget to hire. Childrens Administration programs EIP/EFSS continue with full support in 2009 with many referrals from . Child Protective Services. 2010 funding is secure but 2011 funding is not secure due to a change in how Childrens Administration will be contracting for services. Foster Care Passport program Contract with Chidrens Administration ended December 2009. The Public Health Nurse providing that service offered to reduce her hours to compensate for the reduction in revenue. JCPH Family Support Programs is proceeding with a new project thanks to a small grant from a local group. We have created and are using a new screening tool designed for new and interval clients who are pregnant and/or parenting. This tool uses questions from standardized assessments such as the BRFSS and includes the CDC short from of the ACE questionnaire. Currently we are using this to help clients understand their own health risks and develop a care plan. This next year we hope to start looking at this as data to better understand the needs of families with young children in our county. We have contracted with and MCH epidemiologist for this process. WIC continues to have Federal support and Federal funding. WIC numbers continue to stay up. Monthly caseload numbers are slowly increasing. February 23, 2010 draft • • 4 OF 4 Jefferson County Public Health — 2009 Report Performance Measures TARGETED CLINICAL HEALTH SERVICES •PROGRAMS: Family Planning, Breast and Cervical Health, and Foot Care MISSION statement for Targeted Community Health Service: to provide outreach, access, health education, support treatment to specific populations in Jefferson County in order to improve the health of the community. Mission Statement for Family Planning Program: To provide accessible, high quality confidential reproductive health services in a safe, respectful environment. GOALS FOR FY 2009: 1. Assure Family Planning Services are provided in community and accessible 2. Decrease unintended pregnancy rates in Jefferson County (measure) 3. Insure access to breast and cervical health exams to women age 40 to 65 years old 4. Support seniors' independence by maintaining their mobility OBJECTIVES FOR FY 2009: 1. Track Family Planning usage patterns and produce annual report 2. Emergency contraception to be provided under standing orders, 5 days per week, and expand community education and clinical services 3. Maintain breast and cervical health program in Jefferson County 4. Maintain the current level of community foot care and continue expanding into home care PERFORMANCE INDICATORS: 2006 2007 2008 2009 2009 Actual Actual Actual Planned Actual umber of unduplicated clients served in Family Planning 1257 1195 1128 1200 1202 Number of adolescents under 19 served in Family Planning 332 312 300 300 345 Number of Chimacum School Clinic Unduplicated Family Planning Clients 66 Number of Port Townsend School Clinic Unduplicated Family Planning Clients 86 Number of Breast & Cervical screening exams 122 111 110 100 84 Number of foot care contacts 2765 2946** 3131** 2400 3065** ** Foot Care Senior Center and Home Visits SUMMARY OF KEY FUNDING /SERVICE ISSUES: The aim of the Family Planning program is to control the timing of pregnancy and prevent unintended pregnancies. Jefferson County Public Health (JCPH) provides the only family planning program in east Jefferson County. In 2009, JCPH, in partnership with Jefferson Healthcare, opened two school clinics: one at the Port Townsend High School, and one at the Chimacum High School. These clinics help to serve student health issues, among which an estimated 60% of visits are family planning. Family planning receipted fees in 2009 increased by five percent from 2008. Revenue from clients increased 22%, excluding private insurance and Medicaid. The Breast and Cervical Health Program addresses the need for cancer screening and early treatment to decrease deaths from breast and cervical cancer in Jefferson County. With continued community support and level funding from Washington State in 2009 we will continued Breast and Cervical Health exams at the •same level in 2008. 1 of 2 Jefferson County's senior community has grown rapidly in the last few decades. In 2008 Jefferson County's median age was 49.8, which was an eight year increase since 1990. 9%of Jefferson County's population is over the age of 75. The JCPH Foot Care Program helps this population maintain independence and mobility by providing foot maintenance at community centers and at clients' homes. Foot maintenance includes • services that a client can no longer perform on themselves, such as filing calluses, cutting nails, and tending to sores resulting from diabetes. Study/Analysis 2009 Results JCPH started School Based Health Clinics(SBHC) at Port Townsend High School and Chimacum High School in collaboration with Jefferson Health Care in the beginning of 2009. Initial data from the spring 2009 shows the clinics were well utilized and services were meeting the needs of the students. Feedback from School staff has been very positive. Initial overall number of JCPH Family Planning clients which include SBHC clients have remained the same with a major shift to increase services to the under 19 populations. This is due to increase in services to SBHC and increase services at JCPH clinic facility. Breast and Cervical Health overall numbers were down in 2009. The BCHP outreach staff has identified strategies to identify women who may qualify, and as of Feb. 2010, BCHP number of exams per month has increased. Foot care visit numbers continue to remain high. Demand could be a reflection of increased in the older population in Jefferson. March 11, 2010 • Jefferson County Public Health — 2009 Report Performance Measurers POPULATION & PREVENTION • PROGRAMS: Tobacco (TP/C), School Health (S/H), Childcare health and Safety (CC), Peer-In (PI), Oral Health (OH), and Drug and Alcohol prevention (DA) MISSION: The purpose of the Population & Prevention Programs is to provide health education and public health interventions to county residents in order to promote a healthier community, prevent disease and unintentional injury, improve the quality of life and reduce disparities in health. GOALS FOR FY 2009: 1. Improve identified social and health indicators for school-age youth(S/H) 2. Improve overall health of Jefferson County residents.(TP/C) 3. Enhance the quality of child care provided in Jefferson County (CC) 4. Enhance the overall health& safety of Jefferson County children(PI) and (OH) 5. Reduce favorable attitudes toward problem behavior within the youth and adult communities. (DA) 6. Delay age of initiation of problem behavior. (DA) 7. Reduce adverse childhood experience as measures by reduced CPS referrals (DA) OBJECTIVES FOR FY 2009: 1. Maintain delivery of school in-service/trainings, student health screenings, student health consults, student health care referrals (S/H) 2. Provide tobacco specific education and resources to employers to support employee cessation (TP/C) 3. Maintain child care provider consultation re: health, immunizations, safety and child development (CC) 4. Peer educators will provide school health classes to middle &high school students (PI); health education classes will be provided to elementary, middle & high school students; and increase Oral Health prevention interventions. 5. Increase the perception of risk for youth regarding alcohol and marijuana use, especially for 6th 8th and 10th grade students.(DA) 6. Increase access to adults with healthy beliefs and clear standards for 4th through 6th grade students in Jefferson county.(DA) 7. Provide Early Intervention services to at risk families to prevent adverse childhood experiences. (DA) See Felitti study showing how adults who had reported greater than 2 Adverse Childhood Experiences had increased health problems including tobacco, drug and alcohol use. See Family Support services program performance measures. PERFORMANCE INDICATORS: 2006 2007 2008 2009 2009 Actual Actual Actual Planned Actual Number of student health screenings 1398 1135 1124 1400 1034 Number of employers receiving tobacco specific technical * 3 4 5 17 assistance (TP/C) Number of Peer-In educational presentations 50 60 44 50 48 Number of school health classes*** 200 200 218 200 233.5 Number of phone calls to WA State Tobacco Quit line from 75 63 93* 75 170 -3 Jefferson Co. Number of classroom presentation/interventions (Drug and 140 144 134 140 116 Alcohol preventions) .umber of students served in the class room presentations 350 475 404 350 382 ( Project Alert + TATU) 1 of 3 * New in 2007 ** July 2007 to June 2008 ***For 2008-2009 school year Increase in tobacco sales tax could be a factor PROJECTIONS for 2009, WRITTEN IN JULY,2008. • SUMMARY OF KEY FUNDING/SERVICE ISSUES: Jefferson County Public Health(JCPH) delivers programs that promote healthier communities and individuals. Focusing public funds on prevention programs have proven to be cost effective. JCPH hopes to continue in 2009 to collect Assessment data to assist in determining community needs and prioritize services (access to health care, substance abuse, domestic violence, child abuse and neglect, teen pregnancy and STD rates.). The above programs provide universal prevention programs available to all in the community. State prevention health services monies come with extensive evaluation components. Tobacco and Healthy Communities funding have community specific goals and measures that must be met to maintain funding. School funding is based on State School Nurse corp. funds and contracts with school districts which should remain the same in 2009. Decreasing enrollment may decrease the number of classroom presentation and the number of students served. Drug and Alcohol prevention program continues to work with Community Health programs providing integrated prevention services. In 2007 the Drug and Alcohol Prevention program wrote a 6 year strategic plan to address the identified prevention needs in the community. In 2008 the Substance Abuse Advisory Board is working with the community and agencies assessing the progress of the plan and set priorities. State and local funds are utilized primarily through the school based Best Practice education programs. These funds allow Health Educators to provide prevention education classes to middle school students in the community. In addition JCPH staff is working with community partners to identify other resources to increase capacity of prevention programs for example; Jefferson County Sheriffs Departments is using "Protecting You Protecting Me" a Best Practice instead of the "Dare" curriculum in the 5th grade classes and• Port Townsend Police are planning to be trained in the curriculum. In April 2008 JCPH Prevention Staff spearheaded a community wide social awareness and prevention program called"Our Kids Our Business". There were at least 50 Business, Services Clubs and other organizations, as well as all City and County Departments involved in the campaign. In 2009 we have plans to do it again. Currently there are discussions at the State level of this media campaign being state wide. STUDY/ANALYSIS RESULTS 2009 Jefferson County School enrollment continues to slightly decrease reflecting a decrease in the number of 2009 Hearing/Vision screenings. Of those 1034 students screened 85 were referred for further hearing or vision evaluations. School Nursing contracts continue with all 4 school districts to provide this service. Tobacco Coordinator is doing more outreach to businesses to encourage cessation resources for employees. Advertising of Washington States Quit line has increased Jefferson County residents' use of Tobacco Cessation resources identified with an increase use of the number. Washington State funding has been reduced for Tobacco Prevention. At this time JCPH has been able to maintain a half time position with the State funds. The contract with the University of Washington "Take It Serious: Sex and Media" (TSIAM)program ended in 2009 and was not renewed. Without this contract funds JCPH was unable to sustain staffing for Peer-in. Drug and Alcohol Prevention staff continues to use Project Alert in the school. Staff would like to find a • new Best Practice program for school interventions but have been limited in their choices of other 2 of 3 curriculums that will fit with the school's schedules. December 2009 the City of Port Townsend considered reallocating funds it provides for Drug and Alcohol prevention services through JCPH that pay for Project Alert and other prevention interventions. It is unclear at this time what future funding with be received from the City of Port Townsend. Jefferson County Sheriff's Department continued to facilitate the Best Practice • "Protecting You/Protecting Me." The Port Townsend Police Department were trained in the curriculum and will be facilitating it in the 5th grades in Port Townsend in 2010. April 2009 JCPH staff facilitated, along with Community partners, the"Our Kids Our Business" Campaign. Sixty-seven local businesses, organizations, agencies, service clubs as well as all City of Port Townsend Departments and all Jefferson County Departments collaborated on"Our Kids: Our Business." This was the second year of this social awareness and prevention campaign addressing child abuse prevention and sexual assault awareness. March 2, 2010 s • • 3 of 3 4 Jefferson County Public Health 2009 Report Performance Measures • Solid and Hazardous Waste Mission: The mission of the Solid Waste Code Compliance and Education Program is to enforce Washington State and Jefferson County solid and hazardous waste code, educate the community about ways to reduce solid and hazardous waste, and to promote the goals and objectives for solid waste reduction and recycling outlined in the Jefferson County Comprehensive Solid Waste Management Plan. Goals for FY 2010: 1. Investigate all solid and hazardous waste complaints. 2. Resolve solid and hazardous waste violations through voluntary compliance or citations and legal action when necessary. 3. Reduce the incidence of illegal dumping. 4. Assure all permitted facilities (past& present)meet current regulation standards. 5. Increase awareness of small quantity generator and household hazardous waste (HHW)disposal requirements and options through education and outreach efforts. 6. Promote re-use, recycling, and a reduction in consumption to decrease annual tonnage of solid waste. 7. Reduce the incidence and risk of contamination of Puget Sound by ensuring use of BMPs by businesses along the water. Objectives: 1. Coordinate with other agencies to resolve more difficult solid waste violations. 2. Work with the County's Prosecuting Attorney to pursue legal remedy for the most difficult enforcement cases. 3. Continue to utilize motion-activated cameras at illegal dump sites to identify offenders and work with citizens to identify and clean-up sites quickly. 4. Educate consumers at point of purchase about proper disposal of HHW and non-toxic alternatives. 5. Work with Public Works to promote HHW collection days and educate participants about non- toxic alternatives. 6. Promote reduction of consumption and re-use, that recycling is not enough. 7. Actively work with Marinas, Ports, and businesses within them to ensure use of best management practices and reduce toxic and hazardous wastes from entering the water. • PERFORMANCE INDICATORS: 2007 2008 2009 2010 ' Actual Actual Actual Projected Total number of solid waste complaints received 184 114 60 75? Total number of solid waste violations resolved 135 117 90 100 • Number of illegal dumps complaints received 27 12 14 15 Number of illegal dumps complaints resolved 23 11 19 15 Number of citations/tickets issued 49 28 24 Number of court hearings attended 19 Tons/cubic yards of solid waste removed/recycled 50+tons >450 cu through compliance efforts (not including junk yards vehicles) Total number of solid waste violations awaiting 2 2 1 2 legal action/abatement Number of warrants of abatement 1 1 0 2 obtained/completed Number of Jeff. Co. permitted facilities meeting 6 of 8 8 of 9 8 of 9 8 of 8(1) current regulation standards (out of 9) (1) Total number of active EnviroStars businesses 10 10 14 17 (Out ofl 00 eligible in Jefferson County) Number of new EnviroStar businesses 2 1 3 3 Number of active Green Businesses 21 26 Number of new Green Businesses - 6 5 Number of Junk Cars removed/recycled 701 279 139 100 Number of"Amnesty Day" events 0 1 0 0 Tons/yards of solid waste recycled/disposed of 300+ 2500 IIduring"Amnesty Day". tons(2) tires Plus 601 tons(2) Notes: (1) At the end of 2008 JCPH broke out several facilities that had previously been lumped together. (Jefferson County Transfer Station, Recycling Center, and closed Municipal Landfill.) This will enable clarification for the purposes of monitoring and permitting. In 2010 Olympic Corrections Bio-solids composting facility will be permitted through Ecology, reducing# of sites to 8. (2) JCPH worked with Washington Department of Ecology to remove and properly dispose of 904 tons of tires from 5 large sites, at no cost to Jefferson County. Initial numbers from 2007 were 300 tons. Final numbers for the project by the end of 2008 were 904 tons. JCPH then sponsored a one-day tire recycling event for county residents which collected an additional 2500 tires. (3) Public Works organized and staffed 4 Household Hazardous Waste events, 3 of which were in South County. JCPH helped promote the events with press releases and distribution of fliers, especially in South County, but did not staff them. • 2009 Analysis: Ike number of solid waste complaints reported and resolved, including illegal dumps, has fallen since its peak in 2007. We saw an initial spike in complaints reported and resolved after the 2005 code revision that allowed for the issuance of citations and other legal action. The cases closed in 2009 include a higher percent of difficult, long-term cases that require a greater amount of time and resources to resolve (e.g.: multiple citations, court hearings, and warrants of abatement.)There were no properties cleaned-up through warrants of abatement this year. Two that were imminent changed ownership through foreclosure and were cleaned-up by the new owners. It is anticipated that during 2010, the overall number of solid waste cases will decrease, with a relatively high percentage of time-intensive cases. This should stabilize in time as the backlog of these cases is resolved. We also expect to have a shift towards more hazardous waste casework due to referrals from the Local Source Control (LSC) during 2010. LSC is an Ecology funded program, started in 2008, where JCPH proactively visits businesses that utilize or produce toxics and hazardous materials. Guidance and education is offered regarding the proper disposal of these materials. Sites found to be in gross violation of the law and/or apparently contaminated, are referred for site hazard assessment and clean-up. JCPH continues to investigate hazardous waste complaints and perform site hazard assessments (SHA's) for Ecology. In addition to complaints, the solid waste team will proactively focus on marinas and boatyard activities this year. Several Jefferson county Ports are already in the process of becoming Clean Marina/EnviroStar , feed by Ecology and JCPH. JCPH's Local Source Control staff person will focus on businesses within marinas/ports, assisting eligible businesses to become Envirostars and Green Businesses, and assisting others with best management practices and code compliance issues. JCPH is participating with Ecology to provide spill kits to businesses, and we will be focusing on businesses in the ports/marinas, gas stations, and other businesses that are close to bodies of water. A continued decrease in illegal dump complaints was observed in 2009. Several large, popular dump sites were closed and cleaned-up as property-owners restricted access with gates and ecology blocks. Citations were issued by JCPH where three pieces of identification could be found in dumped goods. It is unclear if word has gotten out and illegal dumping is decreasing, or if the sites have moved further out into the woods and have not been discovered yet. The number of junk vehicles (JVs)removed/recycled decreased from its peak in 2007 when JCPH obtained a grant to remove them for free. There was no such grant in 2008, but scrap prices were high enough that hauling by local businesses was free. Prices dropped significantly at the end of 2008, leading to a decrease in people's willingness to part with JV's second to cost of removal/towing and no monetary incentive. Another probable reason for the decrease is that the largest JV sites have already been resolved, (e.g.: 2007 had one site with 300 vehicles) though there may be a few out there lurking that we are not aware of. JCPH assists citizens with numerous junk vehicle affidavit requests, freeing up Sheriff's Deputies' time. JCPH is approaching its 1000th junk vehicle removed from Jefferson County since 2007! 2009 saw a continued high degree of inter-agency cooperation between JC Sheriff's Office, Public Health, mal Services, Department of Community Development, and Child Protective Services. This allowed for Illolution of some very difficult cases, shortening of resolution time on other cases, and cost savings (e.g. JCSO referred some solid waste and illegal burning cases to JCPH for follow-up, JCPH solid waste and septic teams resolved some long-standing issues at some illegal trailer encampments which led to a dramatic decrease in calls to JCSO, JCSO commits deputy time to escort JCPH and CPS workers at high risk sites, JCAS teamed up with JCPH to resolve several very large cases, JCPH photo-documents sites and forwards to JCAS and CPS, CPS arranged payment for solid waste disposal for a mutual site). SUMMARY OF KEY FUNDING/SERVICE ISSUES: • The reduction in funding and staffing of all county departments means we must carefully and honestly evaluate priorities arid division of labor. Increased inter-departmental cooperation will enable us to accomplish the most with limited funds. Citizens need to be informed about the necessary reduction in and speed of services (i.e. JV affidavits are not as high a priority as a hazardous waste complaint). Our departments can also stretch the funding by utilizing volunteer/citizen groups where possible. LINKS TO COUNTY STRATEGIC OBJECTIVES: • Addressing locally identified and defined local public health issues • Protecting and enhancing natural resources. • Operating within a business plan based on sustainable resources, measured performance, and outstanding customer service. • Jefferson County Public Health — Report 2009 Performance Measures DRINKING WATER PROGRAM • MISSION: The mission of the Drinking Water Program is to protect public health by assuring that residents and visitors to Jefferson County have access to a safe and reliable supply of quality drinking water and that it is reasonably available. By enforcing and monitoring laws regulating public and private water supplies, the Drinking Water Program minimizes the threat of waterborne disease. GOALS FOR FY 2009: 1. Assure that all new wells are constructed in accordance with requirements established by the Washington Department of Ecology. 2. Provide technical assistance when requested so that individual water supplies are safe. 3. Limit public exposure to water systems with known deficiencies. 4. Integrate water adequacy review information with the Water Quality program's water quality database. OBJECTIVES FOR FY 2009: 1. Inspect at least 50% of all new wells constructed with 25% of these with the well driller present and 90%of all wells being de-commissioned. 2. Maintain high rates of compliance with state well drilling regulations. 3. Review all building permits and project applications to assure that potable water supplies meet basic public health standards as well comply with state statutory and regulatory requirements. 4. Provide technical guidance to any residents requesting assistance with their individual or small water systems to deliver safe drinking water. • 5. Establish appropriate policies for alternative water supply systems. 6. Continue contracting with Washington Department of Health for public water supply projects, as long as adequate funding is provided. PERFORMANCE INDICATORS: 2006 2007 2008 2009 Actual Actual Actual Actual Number of well applications received & 126 127 76 83 reviewed Number of new wells start notification 131 108 79 77 (drilled)(includes some well applications from previous years) Number of wells decommissioned 13 16 17 8 Number of new wells inspected(start 70 67 48 53 notification received) Percent of new wells(starts) inspected 53% 62% 63% 68% Number of abandoned wells inspected 13 16 17 8 Percent abandoned well inspected 100% 100% 100% 100% SUMMARY OF KEY FUNDING/SERVICE ISSUES: Increased tracking will be done within existing databases such as permit plan and the food service database. Databases, including the water quality database, will be updated as necessary to add new fields to track performance indicators. • 1 of 2 LINKS TO COUNTY STRATEGIC OBJECTIVES: • Protecting and enhancing natural resources. • Addressing locally identified and defined local public health problems. • Protecting and ensuring adequate clean water supplies for citizens and the shellfish industry. • Operating within a business plan based on sustainable resources, measured performance, and • outstanding customer service. 2009 STUDY/ANALYSIS OF RESULTS • Applications for well inspections continue to be down substantially after several years of an increase in well drilling activities. We are between 60%and 65%of the years 2006-2007. The small increase in applications in 2009 reflects public misinformation surrounding the proposed Department of Ecology in- stream flow rule implementation on December 31, 2009. Citizens were concerned that little or no drilling would be allowed in WRIA 17, after rule making. • I do not have a good explanation for the decrease in well decommissionings in this calendar year. I believe the increase seen in past years may have been a result of two things, the Marrowstone Island public water supply installation and increased vigilance in the requirement. The decrease this year may indeed be the economy, and decisions of land owners to save money and temporarily cap unusable wells. • The economic downturn has impacted all applications for development in the county. As a result, staffing has been decreased, hours reduced and programs reassigned. There is no longer a staff member dedicated to working in the drinking water program, exclusively. • s 2 of 2 Jefferson County Public Health — Report Performance Measures 2009 ON SITE SEWAGE PROGRAMS (OSS) . MISSION: The mission of the Onsite Sewage Program is to minimize the threat of surface and ground water contamination from failing or improperly designed, installed or maintained onsite sewage systems. GOALS FOR FY 2009: 1. Educate homeowners, builders, real estate personnel, banks, installers, designers and onsite system maintenance personnel in the proper operation and maintenance of onsite sewage systems. 2. Assure a high quality-monitoring program. 3. Implement and enforce state and local rules and regulations governing the installation and use of onsite sewage systems. 4. Investigate action requests and complaints in a timely manner to reduce the threat of human contact with untreated wastewater. 5. Complete all state funded grant activities on-time and on-budget. 6. Assure high quality customer service. OBJECTIVES FOR FY 2009: 1. Develop written informational materials for public distribution and conduct workshops for community groups addressing onsite sewage system operation and maintenance. 2. Provide training to community groups to increase awareness of regulatory requirements for onsite sewage systems. 3. Review monitoring and inspection reports and provide timely follow up. 4. Utilize existing data systems to track action requests and complaints. 5. Assure that site inspections in response to permit applications are conducted within 14 days of receipt • of application. PERFORMANCE INDICATORS: 2006 2007 2008 2009 2010 Actual Actual Actual To Anticipated/ 12/31/09 proposed Number of systems repaired/upgraded 44 32 32 32 30 Percent of system failures less than 5 years in use 0 0 0 0 0 Number of complaints received 57 47 42 43 50 Number of complaints closed 33 33 24 19 30 Number of septic permit applications submitted I 467 372 231 169 175 Number of evaluations of existing system (EES) 701 597 295 255 260 Percent of existing systems receiving regular 3rd party 5.2% 4.4% 2.2% 1.8% 2% monitoring. 2 # of previously unknown systems having a monitoring 30 21 15 9 10 inspection Percent of monitoring inspections resulting in some 33% 37% 29% 28% 30% maintenance needed. Percent of EES resulting in required significant 12.3% 6.7% 12.5% 16% 15% maintenance or repair. Percent of failures/major maintenance <2% <2% <2% <2% <2% Number of educational workshops 6 5 10 Number of workshop participants 239 102 250 • 2 'Number of applications does not equal approved permits Based on estimated 13,500 systems in the County (from the Local Sewage Management Plan) 1 of 2 SUMMARY OF KEY FUNDING/SERVICE ISSUES: Tracking will be done with existing data systems to evaluate effectiveness of monitoring programs. Ongoing O&M activities will need to be funded through permit and inspections fees as well as the newly formed Clean Water District.Implementation will focus on coordination with the private contractors to set up systems for scheduling and tracking inspection activities and conducting community outreach to increase awareness of the new requirements. LINKS TO COUNTY STRATEGIC OBJECTIVES: • Protecting and enhancing water quality and shellfish resources. • Preventing exposures to disease causing organisms via water and food. • Addressing locally identified and defined public health problems. • Operating within a business plan based on sustainable resources,measured performance, and outstanding customer service. 2009 STUDY/ANALYSIS OF RESULTS • Scanning existing septic case records and make these available on the County website was substantially completed. These are useful for homeowners, buyers, Designers, O&M Specialists, real estate professionals and others. As of September 28, 2009 all records from 1969—2005 that are in our data base are available on the web to the public. Approximately 500 additional paper records were researched and added to the database and scanned for public access. Over 11,100 cases. We are now working on the remaining paper files, 1,000- 1,500 records. • Classes to provide information on taking care of your septic system continue to be provided and are very well received in the community. They also provide an opportunity to inform homeowners about funds that are available to repair or upgrade a substandard or failing system. Additionally we share information about efforts to identify water quality problems and correct them. Work is coordinated with the Water Quality Team and the work they do on sanitary surveys in communities. • Applications for septic permits continue to be down substantially after a three year period of increased applications. We are at about 50%of the years 2003-2007. Staffing reflects this. Currently approximately 1.20 staff is assigned to the onsite sewage program and 1 to the O&M program. All applications for development are down reflecting the economic downturn we are experiencing. • A detailed review of applications for repair permits verified no system failures(other than electrical controls) on systems less than 5 years in use. This may reflect our continued work with designers and installers to assure adequate design review and approval along with installation inspections by the designer and health department staff. • Review of the complaint/action request cases identified two issues. 1)data entry to provide current case status is inadequate and 2)many complaints take an extended period to resolve. During 2008 a new case type was developed for Violations. This will assist in clarifying when a complaint is confirmed to be an actual violation of code and will provide stronger tracking of the cases that have the highest risk for creating a public health hazard. Work on the development and use of the Violation case is ongoing. • The decrease in the number of monitoring inspections continues. • The percentage of systems monitored where some problem was identified and some maintenance was needed was 28%. Some sites required more than one item of maintenance and this percentage does not reflect whether multiple problems were identified. The percentage of systems that required significant maintenance or repair was up slightly and reflects a range of items such as electrical control malfunctions resulting in overflows/backups to leaking tanks to surfacing sewage and system failure. The number of system failure is very low at<2%of the total evaluated. All cases where significant maintenance is required receive written notification and most result in prompt response to correct the problem including application for permits where required(such as tank replacement). • Consistent with our Local Sewage Management Plan we are documenting identification of systems that were not previously known and have no records. We estimate there to be between 1,000-1,500 of these cases. In addition to the monitoring inspections we are coordinating with the Water Quality Division to document sites • where they are doing sanitary surveys where we have no records. 2 of 2 Jefferson County Public Health — 2009 REPORT Performance Measures FOOD SAFETY PROGRAM • MISSION: The mission of the Food Safety Program is to minimize the risk of the spread of disease from improperly prepared, stored or served foods handled in commercial settings. GOALS FOR FY 2009: 1. Provide classroom food safety instruction for all food service workers. 2. Assure minimum sanitary standards are observed in all food service establishments. 3. Provide basic food safety information to the general public. 4. Proctor ServSafe exams to food service establishment managers. 5. Establish technology enhancements to further educational outreach efforts. OBJECTIVES FOR FY 2009: 1. Offer food safety training at a frequency and in locations convenient to food service workers. 2. Review all new food service establishments for compliance with state and county requirements. 3. Inspect all food service establishments at a frequency adequate to assure compliance with state and local regulatory requirements. 4. Offer educational materials and technical assistance to non-regulated community groups and organizations where requested. PERFORMANCE INDICATORS: 2006 2007 2008 2009 2009 • Projected Projected Actual Number of food workers trained 1,100 1,205 1,250 1,250 1,137 Number of food worker classes at Health 52 52 52 52 61 Department Number of food worker classes at other 25 35 30 30 21 locations Number of food establishment permits 270 270 275 240 228 Number of required inspections completed 352 350 355 360 299 % of required inspections completed -- -- 85% 85% 83% Number of inspected establishments that 70 45 75 60 34 required repeat inspections due to critical violations. Number of establishments receiving 43 40 35 35 38 Outstanding Achievement Awards Number of temporary food service permits 80 85 90 80 74 SUMMARY OF KEY FUNDING/SERVICE ISSUES: Food Safety Program activities are funded solely through permit fees. • LINKS TO COUNTY STRATEGIC OBJECTIVES: • Investing in community infrastructure that encourages economic opportunity. • Addressing locally identified and defined public health problems. 1 • Operating within a business plan based on sustainable resources, measured performance, and outstanding customer service. SUMMARY AND ANALYSIS OF 2009 DATA . FOOD WORKER TRAINING Off-premises training for requesting groups was suspended during 2009 due to time and budget constraints. Scheduled classes were not full and the time taken up by traveling to other locations was no longer justified. There has been no negative public response when people were asked to attend the scheduled classes instead of having special classes. The number of students has dropped slightly and may reflect an even steeper downturn in the number of employed food workers if one subtracts the food workers for donated food distributing organizations (possible increase in food workers.) However, there is no need to change our weekly schedule of classes since the actual numbers are so close year to year. INSPECTIONS There were 59 complex facilities this year which are mandated to have one inspection every 6 months. We were unable to meet that requirement in 2009,however each received at least one inspection. We inspected most of the temporary food establishments once in the year which meets the basic requirement. We will be re-visiting food program policies and procedures in 2010 and will address risk-based inspection frequency for food service establishments. The number of establishments and temporary food establishments are slightly down,however, inquiries about new businesses seems to be up though we do not formally track inquiry data.We might expect more start-ups in 2010 if these inquiries develop into businesses. It might be a good idea to track inquiries. March 2,2010 • 2 • Board of Health .New Business .Agenda Item #17., 2 • Public 3-feaCth 3-Ceroes .Nominations March 18, 2010 • - JEFFERSON COUNTY PUBLIC HEALTH • 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypublichealth.org March 12, 2010 To: Jefferson County Board of Health From: Jefferson County Public Health Staff Re: 2010 Public Health Hero's Nominations Jefferson County Public Health staff nominates the agencies, clinics, pharmacies and individuals listed below for the 2010 Public Health Hero's award. These nominations represent just some of the community partners who assisted Jefferson County Public Health in response to the H1 N1 Pandemic of 2009. Overall coordination with Jefferson Healthcare: Paula Dowdle, Chief Operations Officer Assisted with H1 N1 tracking and surveillance: Jefferson County Medical Providers Jefferson Healthcare Cynthia Walker, RN, Infection Control Coordinator Jefferson Healthcare Lab Staff Jefferson Healthcare Emergency Room staff Jefferson County Schools Assisted with HINT Vaccine Administration:We would like to give a special mention to all of the • immunization nurses and clinic staff who worked so hard to organize the clinics, call patients in, and administer the vaccine. Jefferson Medical and Pediatric Group Port Hadlock Medical Clinic Madrona Urgent Care Port Townsend Family Physicians Monroe Street Medical Clinic Richard Lynn, MD Olympic Primary Care South County Medical Clinic Jefferson Healthcare— Both within the hospital, immunizing Health Care Providers and the combined clinic that was organized in November. Assisted with Federal Strategic National Stockpile storage and distribution of Tamiflu: Don's Pharmacy, Donald Hogland, Owner/Pharmacist Jefferson Healthcare Pharmacy, Shirley Tinsley, Pharmacy Manager QFC Pharmacy, Port Hadlock, Lee Metcalf, Pharmacist, Manager Safeway Pharmacy, Port Townsend, Steve Shapiro, Local Pharmacy Manager Assisted with Preventing the Spread of Disease in the Community: Jefferson County School staff including all the wonderful teachers who encourage students to wash their hands, cover their cough, and stay home when they are sick. The theme for National Public Health Week 2010 is "A Healthier America: One Community at a Time." The above nominations represent local partners in creating a healthier community right here in Jefferson County. Jefferson County Public Health wants to thank them all for their contributions and efforts toward creating a healthier community for all. • DEVELOPMENTAL COMMUNITY DISABILITIES PUBLIC HEALTH ENVIRONWEATERLQUALITY MAIN: (360)385-9400 ALWAYS WORKING FOR A SAFER AND MAIN: (360) 385-9444 FAX: (360) 385-9401 HEALTHIER COMMUNITY FAX: (360) 379-4487 • Board of Health New Business .Agenda Item #17., 4 � Family PCanning Cost AnaCysis ivlarch 18, 2010 JEFFERSON COUNTY PUBLIC HEALTH Instructions for the 2010 Clinical Fee Analysis • The first spreadsheet provides details of services, procedures, and medications. Column A identifies how many times, during the calendar year, we provided that particular services. Column B is a suggested rate to be charged, which is calculated using a cost analysis formula provided by the State Department of Health. The cost analysis detects this rate as being an allowable fee based on actual program expenses and the value of each service. Column C is the current fee we charge. Column D identifies the variance between the service rate calculated by the cost analysis and our current fee. Column E reflects what our billable totals would be using current rates. The remaining columns, F, G, and H identify the annual amount that could be billed if the Board increased fees. Increases in columns F, G, and H are calculated as follows: column D x X %x column A+ column E. • The second sheet shows the details of possible client impacts by category; private insurance, clients who pay full fee and clients who pay a portion of the fee. The section "Estimated Billable Amount" is how much we would be able to bill, by category, based on the decision of the Board. The area under "Projected Possible Revenue" estimates possible revenue, which is calculated using the estimated billable amount and multiplying that amount by an average percentage of return. The average percentage of return for 2009 is as follows: Private Insurance 39% Full Fee 53% Partial Fee 29% The table labeled "2010" compares actual revenue collected in 2009 to the possible revenue of 50%, 75%, or 100%of the identified fee variance proposed for 2010. The variance shows client impact by category. • The table at the bottom indicates the average annual impact per client by category. If the Board chooses to collect 75% of the fee variance in 2010, a client who pays full fee would pay approximately$50.09 more per year for our services. JEFFERSON COUNTY PUBLIC HEALTH March 2010-Clinical Fee Discussion w/BOH A B C D E F G H SERVICE FEE ! CURRENT • UTILIZATION CURRENT',VARIANCE AMOUNT 50%OF 75%OF 100%OF SERVICE/PROCEDURE (FREQUENCY) ADJCOST FEE (B-C) (AxC) INCREASE INCREASE,INCREASE NEW PATIENT-BRIEF 84 104.45 93.00 11.45 7,812 8,293 8,533 8,774 NEW PATIENT-LIMITED EXAM 117 178.81 160.00 18.81 18,720 19,820 20,371 20,921 NEW PATIENT-INTERMEDIATE EXAM 8 255.40 229.00 26.40 1,832 1,938 1,990 2,043 NEW PATIENT-COMPREHENSIVE 2 393.25 354.00 39.25 708 747 767 787 CONTINUING PATIENT BRIEF 394 51.21 45.00 6.21 17,730 18,953 19,565 20,177 CONTINUING PATIENT-LIMITED 977 104.45 93.00 11.45 90,861 96,454 99,251 102,048 CONTINUING PATIENT-INTERMEDIATE 78 172.95 155.00 17.95_ 12,090 _ 12,790 13,140 13,490 CONTINUING PATIENT-COMPREHENSIVE 5 260.54 234.00 26.54 1,170 1,236 1,270 1,303 Preventive visit, new, 12-17 9_ 266.80 240.00 26.80 2,160 2,281 2,341 2,401 Preventive visit, new, 18-39 54 266.80 240.00 26.80 12,960 13,684 14,045 14,407 Preventive visit,new,40-64 32 310.43 280.00 30.43 8,960 9,447 9,690 9,934 Preventive visit,est, 12-17 19 235.63 212.00 23.63 4,028 4,252 4,365 4,477 Preventive visit,est, 18-39 266 235.63 212.00 23.63 56,392 59,535 61,106 62,678 Preventive visit,est,40-64 101 257.30 232.00 25.30 23,432 24,710 25,348 25,987 IUD INSERTION 51 173.23 157.00 16.23 8,007 8,421 8,628 8,835 IUD REMOVAL 19 245.23 221.00 24.23 4,199 4,429 4,544 4 659 DIAPHRAGM/CERVICAL CAP FIT 1} 156.35 142.00 14.35 142 149 4, 153 + 156 DEPO PROVERA INJECTION 2.89 64.92 57.00 7.92 16,473 17,617 1` 18,190 18,762 HORMONE IMPLANT 11 317.95 285.00 32.95 3,135 3,316 1 3,407 3,497 _ - HORMONE IMPLANT REMOVAL 6� 369.26 331.00 2, 38 26 1 986 2 1011 1 2,1588 I 2,216 I Condyloma Treatment(Destruction,vulva lesion(s)) 12 337.141 302.00E 35.14 1 3,624 3,835 { 3,940 i 4,046 Individual Approx.15 minutes 0 77.00 ng: 49.1 2.16 Chlamydia/Gonorrhea(amplified) combined 198 391.56 83.00 27 -8.56 16,434 1 17,281 --- - 17,705 18,129 H crit or Hemaglobin 12 2.67 2.00 0.67 24 28 30 32 He itis B(surface ag) 2 21.44 21.00 0.44 42 42 43 43 HSV Culture-State 11 15.12 HIV-State 14 30.46 HPV Typing _ _ 27 58.56 48.00 10.56 1,296 1,439 _ 1,510 1,581 Pap Smear 342 18.50 17.00 1.50 5,814 6,071 6,199 6,327 Pregnancy Test-Urine 463 7.13 5.00 2.13 2,315 2,808 3,055 3,301 Thin Prep 130 51.14 46.00 5.14 5,980 6,314 6,481 6,648 Dip Stick 47 16.21 7.00 9.21 329 545 _ 654 762 ------------------- --- UA Culture Routine 23 21.62 20.00 1.62 460 479 488 497 Wet Mount 66 4.81 3.00_ 1.811 198 258 288 317 ( - 31 41.32 36.00 5.32 146_ i 161 169 177 HSV2 Herpes Select 1_ 1 1 k 20 124_ Routine Venipuncture , 73+ 2 42 2.00 0 42; � / p 1108 ! 589 598 608 HSV1/2 Herpes Select 10 60 79 57.00 3.79 570 260 , 278 TSH 31 28.80 t 74 287 296 + 24.001 4.80_' 744 t 818 HEP C 10 29.58 26.001 3.58 UA Culture If Indicated/Complete 9 12.68! 12.00 0.68 108 111 856 1 893 113_ 114 T-4 Free 5 37.24 34.00 3.24 170 i 178 182 186 HCG,Serum Test 11 36.25 32.00 4.25 352 I 375 387 399 CBC(DIFF/PLT) 17 11.96 10.00 1.96 170 178 187 203 ~ VDRL State _ 7 8.98 - CT&GC State 292 101.23 RPR VDRL Syphilis Quest 10 8.98 8.00 0.98 80 85 87 90 HIV-Quest Lab 42 30.46 27.00 3.46 1,134 1,207 1,243 1,279 O CONTRACEPTIVES(High Cost) 205 69.13 31.00 38.13 6,355 10,263 12,217 14,172 ONTRACEPTIVES(Low Cost) 340 21.78 10.00 11.78 3,400 5,403 6,404 7,405 STATE DONATED MEDICINE 49 21.73 JELLIES 5 46.14 9.00 37.14 45 138184 231 DIAPHRAGMS 1 86.41 28.00 58.41 28 57 72 86 IUD 18 659.69 380.00 279.69 6,840 9,357 10,616 11,874 MIRENA IUD 35 1,098.69 500.00 598.69 17,500 27,977 33,216 38,454 CYCLE BEADS 3 11.57 12.00 -0.43 36 - 35 35 __ 36 CONDOMS(each) 39554 0.23 1.00 -0.77 39,554-_24,326 16,712 39,554 MEDS/VAG. INFECTION-cream/supe _ 45 6.51 4.00 2.51 180 236 265293 345 364 MEDS/STD INFECTION oral 48 7.59 6.00 1.59 2884 28 10 06+ 9.00 1.06 252 267 274 282 CERVICAL CAP 21 209.86 1 68.00 141.86 t 136 278 349 420 FEMALE CONDOM 0 3.70 ! 2.001 1.70, - - - - H ONE IMPLANT KIT 11, 1,837.11 801.00 1036.11 8,811 14,510 17,359 20,208 3,097 247 11 08 14.00 2.92'1 3,458 3 097 F 2,917 3,458 Ortho EVRA Patch 1 571 21.70 1 23.001 -1.30 1,311 1,274 I 1,255 1,311 Nuva Ring 1581 48.61 43.00 5.61 6,794 7,237 7,459 7,680 ECP 847 24612.00 13.46 1 10,164 15,864 - 18,714 1 21,565 ----- -----Metrogel 4 13.09 11.00 2.09 44 4850 52 438,351 474,065 491,926 , 541,049 Z Z > Z Z > I •m• ! Z 'Z > r 21'n • -I -I -i -I -I -1 -I -I 1-moi T �iT m , m n' m. 73 N 'm1N >'c Z I >C,2l z > C Z �' 0 v,1 =11-iv'' ,.t x 1 (I) NIS Z = ' CI , {irlCj -n Ir- C ' O n �A TI 70 -n 70 co TI 70 1-1 1,C i � m Z r- m ,Z ' I N � mlz 10 'N C Im; ml j rn O, Z a i -< Ft; NIO! N n1 � ', 1 : != co A 00 •A !n Ni �� O -I N; v '� A t0 as. 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N' •U1 N z 1 i N A W w 0000 )--, 0000 000 UWn II 1� .P W o 1 ! 1 1 i , , i i o IIIII I I I , j • Board of Health .agenda Planning Calendar .Agenda Item # VII. • March 18, 2010 Jefferson County Board of Health • Agenda Planning Calendar April 15, 2010 • Public Health Hero Awards • May 20, 2010 • H 1 N 1 After Action Report • June 10, 2010 • Modifications to Food Safety Code • • July 15, 2010 • August 19, 2010 • 2011 County Budget September 16, 2010 Other Future Agenda Topics • On-Site Sewage Operations and Maintenance Mandates—Code Changes and • Enforcement Strategies • Group B water system regulation • Board of 3feaCth .Media Report • March 18, 2010 1 • Jefferson County Public Health February/March 2010 NEWS ARTICLES 1. "Austin to seek second term as Jefferson County commissioner," Peninsula Daily News, February 12th, 2010. 2. "Commissioner Austin to seek a second term," Port Townsend Leader, February 11th, 2010. 3. "Property tax bills: 18,000 parcels levied a $5 Clean Water District charge," Port Townsend Leader, February 12th, 2010. 4. "Family life classes focus on developmentally disabled," Port Townsend Leader, February 17th, 2010. 5. "Water St. Brewing faces two lawsuits," Port Townsend Leader, February 17th, 2010. 6. "Austin seeks a second term," Port Townsend Leader, February 17th, 2010. 7. "Health report card ranks county 11th," Peninsula Daily News, February 19th. 2010. 8. "Swine flu gone for now," Peninsula Daily News, March 10th, 2010. 9. "Tea shop, public health agency go green," Port Townsend Leader, March 10th, 2010. • • Peninsula Daily News Page 1 of 2 This is a printer friendly version of an article from www.peninsuladailynews.com • To print this article open the file menu and choose Print. Article published Feb 12, 2010 Austin to seek second term as Jefferson County commissioner By Jeff Chew Peninsula Daily News PORT TOWNSEND -- Saying he wants to finish work he started, Port Ludlow Democrat John Austin announced Thursday he would seek a second four-year term this fall as a Jefferson County commissioner. "The reality is I really do like the work, and I have developed efficiencies on the job," Austin said at his office as he announced his candidacy. Austin faces one challenger so far, Port Ludlow Republican Jim Boyer, president of the Citizens Alliance for Property Rights. Boyer announced his intention to run last year. Contacted after Austin's announcement Wednesday morning, Boyer said, "I wish him well, • of course. We have differing opinions of what is going on, which is why I am in the race. "I look forward to exploring our differences and giving voters a chance to see where we stand on the future." Austin, one of three county commissioners, represents District 3, which covers Port Ludlow, the southern part of East Jefferson County and the county's West End. Austin, 68, a retired career psychologist, said he wants to see the construction and completion of the Port Hadlock and Brinnon sewage treatment systems during a second term, which are expected to boost economic development and jobs growth in the Tri-Area. The Brinnon project, which will replace the failing Dosewallips State Park campground system in Brinnon, is being designed to allow businesses, Brinnon School and some homes to link into the community septic system that will pump waste up a hill to an expansive drain field. A big booster of public land preservation, water-quality protection and county public health- care services, Austin said he would continue to support those causes. "I have successfully lobbied to keep our state parks open -- for use and to encourage local tourism," he said in a prepared statement. • "My fellow commissioners and I have passed legislation to protect the shellfish beds that bring over $20 million to our county each year." http://peninsuladailynews.com/apps/pbcs.dll/article?AID=/20100212/news/3 02129991&te... 2/12/2010 Peninsula Daily News Page 2 of 2 I have worked closely with our tourist industry to bring more visitors to our county." Austin serves on the state Board of Health as the county's representative, and said he has • worked to improve and maintain the health and safety of the county's children through safer school environments." Better counseling for county youths at schools has resulted from a 1/10th of 1 percent sales tax, which he said he supports. Said Boyer: "Our biggest differences are my concerns for rights and values for property owners, and the economy in Jefferson County." He said the economic downturn has him concerned about how schools and services will be funded in the future, and how the county will deal with extended economic problems. "We need to open the door to business growth and expanded economic growth," he said, adding that he did not believe that was being done by the county commissioners today. Austin said his experience was the biggest difference between him and Boyer, experience that included years building relationships with his fellow commissioners, neighboring county commissioners, state lawmakers and congressional members. The position pays $60,195 a year, plus a mileage allowance and medical and dental benefits. A candidate for the position must pay a filing fee with the county auditor totaling $601.95. • Fellow Democratic county commissioners Phil Johnson of Port Townsend and David Sullivan of Cape George were re-elected to second terms in November 2008. Austin is one of several elected county officials up for election in 2010, including Assessor Jack Westerman Ill, county Auditor Donna Eldridge, county Clerk Ruth Gordon, county Prosecuting Attorney Juelie Dalzell, Sheriff Tony Hernandez, District Court Judge Jill Landes and Treasurer Judi Morris. Port Townsend-Jefferson County Editor Jeff Chew can be reached at 360-385-2335 or at jeff.chew@peninsuladailynews.com. All materials Copyright © 2008 Horvitz Newspapers. • http://peninsuladailynews.com/apps/pbcs.dll/article?AID=/20100212/news/302129991&te... 2/12/2010 Commissioner Austin to seek a second term - The Leader - Port Townsend, Jefferson Cou... Page 1 of 4 • Subscribe I Advertise I Submit News I Contact I About I E-mail Alerts ptleader. com Daily news, connections for Port Townsend &Jefferson County, Washington egte "as;afieos stops Events Vie tors'travel Links ..,acs 'Photos Pu)'i„aU . ..rns ,ries ,; Advanced Search I TIIIS MARKTT, TIMING IS EVERYTHING.G. search.. ¢� tmEn t ba to etvtt'n hamcira ii tcairitid i €In e!:' xtt11 -iE,;,a '_Y`, �CtfE all= „,pk,rrs�•:f �n;>iomry cc� m:ErcRa.Tex,n,endmzinwes, 4 ` t�" at.xt aa�trr BUY NOW _ SELL LATER LOAN - 360-385-9344 `_., ,a.. �'"&� n.,..•.. ... .... Fart TottrtxanQ 48°F wwoean. home:news news Share February 12.2010 „_. TOP ADS 2/11/2010 12.34:00 PM Commissioner Austin to seek a second term Cape George By James Robinson of the Leader Colony Full T me Manager ADMINISTRATIVE Jefferson County Commissioner John Austin of Port Ludlow announced Thursday morning he will seek re- CLERK SHERIFF'S election to represent District 3. OFFICE "The reality is, I really do like the work. I believe I've developed efficiencies on the job,"Austin said,and PTSD BUSINESS added,that if re-elected there are many projects he'd like to help complete. MANAGER Among those unfinished tasks,Austin said he'd wants to continue work on the Port Hadlock sewer project, with the state park system to nurture the development of a waste treatment facility in Brinnon, and with the IF IT'S state board of health on improving the state's vaccination program. GLASS • Health issues have been of particular interest to Austin-he spent his career as a psychologist—and he wants to ensure the county can continue to provide services to young mothers. I1ET "Our nurse-family partnership is always at risk for funding.That program is terribly important. If children get ASKI a good start,that pays dividends through the rest of their lives,"Austin said. NW Olympk Glatt On the economy and building jobs,Austin said he would continue to work toward creating and maintaining countywide infrastructure that would help boost the economy and on job creation in light industrial areas. vnt `' Key to economic development,Austin said,was continued cooperation and collaboration with the Port of f3 719 Port Townsend and the city. Tuesday 2,'16 . . At 69 years old some may think Austin should be ready for retirement, but he says he tried it once,and it Arts to the Elders:' didn't quite work. Terry Segal and "When I did retire, I found myself caught up in volunteer work[largely in the aftermath of Hurricane Lisa Lanza Katrina]. That gave me a taste of what it was like to manage large groups of people with limited resources. In concert I don't know if retirement is something I'll ever get around to 2:00-4100pm To date, Democrat Austin faces Republican challenger Jim Boyer for the four-year District 3 seat. The candidate filing period comes in June. http://www.ptleader.com/main.asp?FromHome=1&TypeID=1&ArticlelD=26278&Section... 2/12/2010 Commissioner Austin to seek a second term - The Leader - Port Townsend, Jefferson Cou... Page 2 of 4 Are you driving Get the WHOLE story VISLIALLYIMPAIREP ,Y''1; 3 t Subscribe to the 0 4 "� — weekly Leader 1.0rariedMedslieid= los for just x t Soak Nent:4• _ ;.(Iii lutlt 7 om a i ,�j=-;gs.L t�` / 4 Walded arhdedbea ohts? $ 11 C ' kc3 n.x,xaiet 11,/,...: „.....,...... �� per week! The 04-ma E.vr4 l s .a. Glass tr£axciaa ,�_• 36f338s3014 / 17,--.,,,,,, ' rrerswbke re»a+waken! -CLICK HERE- Reader Comments SERVOS r ale'aut.,=td mass; Posted:Friday,February 12,2010 :7741Article comment by: Larry Carter for.yOutik Few folks in the county have had the opportunity to observe Commissioner Austin's activity as ad commissioner over the last year more than I. At a recent public comment period during a weekly BoCC meeting the commissioners were asked how ' many of them really supported economic development in the county.Commissioners Johnson and Sullivan ' raised their hands.Two out of three ain't bad and when Commissioner Austin was asked why he didn't '¢'r"''; raise his hand, he stated"I choose not to participate in your survey". In so many ways,his response serves ' as a metaphor for his term in office. What I generally hear is"John is a good guy,a likeable guy".Just being a likeable guy may get you elected once but it can be the end of a political career if you can't make hard decisions or take a principled stand - on the issues. , I believe he is equally as responsible as Commissioner Sullivan for the loss of over$40,000.00 in the „. recent D'Amico suit.This case should have never gone to court yet Mr.Austin stood by and let his fellow , commissioner take the fall.A leader would have let Mr.Sullivan know that his pants were down. Mr.Austin declined the BoCC Chairman position during the first BoCC meeting this year and encouraged Mr.Sullivan to keep it. He chose not to lead. In the general election last cycle,Mr.Austin lost the vote in his own district and was elected by Port III Townsend and has done a superb job of representing the more progressive views of much of the city. � District 3 needs someone with backbone and leadership skills to steer us through the troubled waters we ,,,, ,,,., ,:4;,,,,„:0 are facing in Jefferson County. Saving n ar ei two wheelsat atiste Larry Genetic Link Bicycles I Article Comment Submission Form c.vastst Cursing We welcome your comment to this story,to be posted after a website editor's review, 43 �t?)379=FISH Please stay on topic,provide credible information or insight that moves the discussion forward,be convincing and try to be brief.Your comment won't be edited,so all of it is posted or none of it is posted. '' Own your words andpostyour full name,although single name or alias comments will be considered.An authentic email }r:,"' +t` 9 9 fVlArY i4FY address and phone number are for our use only.NOTE:site software requires that all fields be filled out. :.r CAPE Serving dinnx' _.. Submit an Article Comment Thurs.-Sat. Breakfast,yak:sun. First Name: Required Last Name: Required HOTTEST Phone: T1V■ 1 G i Required Email: Required C0.1:ey �Message: ! .;"00 Required • http://www.ptleader.com/main.asp?FromHome=1&TypeID=1&ArticlelD=26278&Section... 2/12/2010 Property tax bills: 18,000 parcels levied a $5 Clean Water District charge - The Leader - ... Page 1 of 4 • Subscribe I Advertise I Submit News I Contact I About I E-mail Alerts Daily news, connections for Port Townsend &Jefferson County, Washington Home Classifieds Blogs Events Visitors/Travel Links Videos Photos Publications Puzzles Advanced Search To11efsonJj 1 . a a j � z/ search ♦ s `q as(5�7@Y1 C@ Ir't relr u e1rtt1"&repaits ,w 1E' '+ d Trusted in Jefferson County since 1977 a 4-. .,f... Pori Towncenal 43F axuvte,�aoo..<.m• home: news: news Share February 12,2010 v,rw,f,, TOP ADS 2/12/2010 9:39:00 AM Property tax bills: 18,000parcels levied $5 Cape George y a Colony Full Time Clean Water District charge Manager By James Robinson of the Leader ADMINISTRATIVE CLERK SHERIFF'S Thirty-three thousand Jefferson County property tax bills hit mailboxes this OFFICE week, and in addition to the typical spectrum of levies listed on the statement, . 18,000 property owners face a new $5 charge. PTSD BUSINESS MANAGER The $5 fee, explained Jefferson County Treasurer Judi Morris, will go to fund the county's Clean Water District—an entity the Board of County RT Commissioners created in October 2007 after the state downgraded a number of East Jefferson County shellfish-growing areas. According to county documents, on Jan. 24, 2007, the Washington State Department of Health downgraded the status of a commercial shellfish area within Discovery Bay from "approved"to "restricted." In addition, the state placed another Discovery Bay station on "concerned" status, along with a Savcommercial shellfish-growing area on Hood Canal. wowhe wheels time! two wheeis�t�time! The state also threatened a portion of the Mats Mats Bay commercial shellfish Genetic Link Bicycles area with a downgrade after water quality tests revealed the presence of fecal 1ehelp people plan coliform. andprote<t their tutu__ The marine area downgrades were linked to agricultural surface-water runoff 401K Rollovers Life.Mutual Funds and failing septic systems, called "nonpoint" water pollution sources. Retirement Auto•Home•Annuities Initially, the commissioners created the Jefferson County Clean Water District Bot Hubbam I868-641-8814 without imposing a fee, instead using general fund dollars to subsidize the fir, 18N Vt k district's activities. serving died we& C9Afl&fate. In August 2009, however, key county public health department staff reported that the general fund was unable to subsidize the district and asked the • commissioners to create a stable funding source—fees attached to certain county parcels. Morris said discussions began with the commissioners exploring an $18-per-parcel fee. However, public outcry— particularly from taxpayers owning multiple parcels — convinced the commissioners to reduce the amount to http://ptleader.com/main.asp?FromHome=1&TypeID=1&ArticlelD=26284&SectionID=3... 2/12/2010 Property tax bills: 18,000 parcels levied a $5 Clean Water District charge - The Leader - ... Page 2 of 4 the $5 shown on tax bills due out this week. Comm uxzit y "It's been very quiet since August, when this was enacted," Morris said. information According to county documents dated October 2007, 57 licensed commercial Properties • companies harvested shellfish in Jefferson County, representing a $20 million For Sale enterprise and nearly 90 jobs at the season's peak. With that said, the ;cg "rt, commissioners chose to create the district in adherence to state law requiring Realtorcow them to avoid further degradation within their jurisdiction and to protect a viable 7 „ ; w local industry. 4....._.. ExEc1mv The fund will help educate homeowners about on-site septic systems and provide water-quality monitoring and pollution-source identification and correction. Morris said certain parcels are exempt from the fee, including those on the county's West End, parcels with sewer service within Port Ludlow and within City of Port Townsend boundaries, lands classified as open space or timber properties, and properties owned by individuals with an approved senior citizen or disability exemption. According to Neil Harrington, Jefferson County water quality program manager, the Clean Water District fee should generate $88,000 a year. Morris said fee revenue would not go to the county general fund. Instead it goes r rA i1 to a dedicated fund designated only for Clean Water District-related expenditures. ?ia - • Get the WHOLE story Subscribe to the z / weekly Leader for just 75 `` �re" • 2 0R 2 BA VIEWS! p(r vnreelc� ' CLICK IIF.IRE . -!.14) RENT or OWN Article Comment Submission Form "` Mot ,AIN PROPANE We welcome your comment to this story,to be posted after a website editor's review. No Delivery HANAT Fees! Please stay on topic, provide credible information or insight that moves the discussion 24 hour Emergency Servo '. forward, be convincing and try to be brief. Your comment won't be edited, so all of it is Locally Noted&Opeated' posted or none of it is posted. Commercial&Res#vnial Tanks Leased&Sold Own your words and post your full name, although single name or alias comments will be Propane Fireplaces considered. An authentic email address and phone number are for our use only. NOTE: 360-385,.6883 site software requires that all fields be filled out. Normal Hours,M-1&5 Submit an Article Comment First Name: http://ptleader.com/main.asp?FromHome=1&TypeID=1&ArticleID=26284&SectionlD=3... 2/12/2010 • • Femil life classes focus on developmentally disabled • Y p Families with developmental- ior, communication, exploitation, an introductory session, begin- community health educator, rec- ly disabled adult members may understanding the body, repro- ning at 6 p.m. The 90-minute ommends that participants attend be interested in attending a free duction and sexually transmitted classes continue on Tuesday eve- all 10 classes, which are held at series of classes focusing on fam- diseases. flings through June 1; no classes the Public Health Department, ily life and sexual health. Sponsored by Jefferson are held March 30, April 20 and 615 Sheridan St. Topics covered include rela- County Public Health, the series 27. For more information,call 385- tionships, public/private behav- begins on Tuesday, March 9 with Instructor Kelly Matlock. a 9410. P" Leaeley ()hill° • • • • • • • t • I • a�e1 St. Madsen said he knew then Street: that he either wanted to split the - brewery away from the bar or leave the corporation entirely. ■ In October 2008,the corpora- B r ewl ng Continued from page 1 .j hon stopped issuing Madsen a Law and Mark Burr, the co- paycheck.For a while he stuck it • owners of Triple Mash, dispute out without getting paid, hoping that they were in default with the �� to gain control of the corporation, faces two rent on Sept30,2008.Currently, ¢ but Law and Burr wouldn't turn it Triple Mash operates without a over to him,he said. lease.Monthly rent for the tavern vrpiER SpRR • is now$7,986. ORE. ,, LAST STRAW lawsuits Also at issue is the condition At one point, he opened his of the premises. The Sudlows ; own bank account to deposit maintain that Triple Mash has <w money from brewery sales to By Kathie Meyer of the Leader failed to keep them neat, clean Seattle tap houses, and to draw and sanitary. - from for buying brewing ingre- Water Street Brewing Co.,the brew- "If you look at the condition diems. But the Internal Revenue pub at Quincy and Water streets in Port of the place, you can probably „s, _i Service garnished the money in Townsend, attracted about 2.000 beer decipher for yourself what some '`,� the account to pay Triple Mash's lovers to taste the wares of 29 breweries of our problems are.We feel that bills. at its sixth.annual Strange Brewfest on they haven't lived up to their bar- 'That was the last straw," he Jan.30-31. Brewers from as far away as gain." said. "I told them, 'I just can't Buckley, Cashmere and Portland, Ore., The Sudlows say that damage Every year,Strange Brewfest cus- brew here anymore."' were on tap. tomers are given glasses to drink P was done to one of the floor joists from and to take home as souve• At a Dec. 12, 2008, meeting "It was our best year,"said Nina Law, when a bar sink leak was not one of three owners of Triple Mash nirs.Photo by Kathie Meyer with the landlords, court papers p quickly repaired.Triple Mash has say that all three owner. said Corp.,which owns Water Street Brewing. provided invoices indicatingthat y MADSEN WANTS OUT theyhad no rent money, were it was the best organized,with the most the leak,sub-floor and floor joist In the other lawsuit, filed on people and the fewest police problems, have all been repaired and that a insolvent and planned to close the she said. Sept.9,2009,owner Skip Madsen pest-control business has solved is seeking release from his share business on March II,203re Sgt. Ed Green of the Port Townsend the basement rodent problem. the day after Strange Brewfest Police Department agreed: 'There Re ardin the floor Dist,Burr of working Mash.Madsen stopped 2009 in January of that year, weren't many issues." has stated,"We were told [by the at Water Street Brewing P in March '2009 over differences Madsen said he was dispatched The influx of thirsty visitors had contractor] that the damage wasto Port Angeles with $15,000 to a positive impact on local hotels, too. far more extensive than an m with Law and Burr on the direr- pay anything tion of the business.After he left, taxes. When he got there, All hoteliers, including the Tides inn, he said, he learned that another Triple Mash could have caused his partners changed the locks on Swan Hotel, Bishop Victorian Hotel, was still owed.$45.00 in the five plus years as a tenant" the door. (1 The state Harborside Inn and Aladdin Motor inn, was giving the corporation only According to the Sudlows, "I wanted to be more of a reported no vacancies on Saturday nightsix weeks to pay. other repairs and cleanliness brewery. it just seemed to turn of the festival.Many customers came on issues remain unresolved. into the party that never stopped," To raise money for the unpaid Friday night and stayed until Sunday. taxes,Law and Burr solicited local 85 DECIBELS he said.He admits he didn't know business owners and patrons for "Today, we had one room open: Saturday we were full; and we had a his two partners very well before silent auction donations foran 0 Another complaint concerns he entered into the corporation. number of people stay over for Sunday," the noise level of the bar's liveoevent held on March 8,2009.The said Don Dobie,general manager of the ,his were friends the friends. I auction failed to raise the entire music during weekend nights. knew them through [Seattle] Bishop Victorian Hotel and the Swan In the suit, the Sudlows haveamount needed,so Burr and Law Hotel. brewing community." asked to install around-monitor- Madsen is an award-winning took out a loan.Madsen said he ing system that will allow them brewmaster with years of expert- advised against the loan and did TROUBLE BREWING to check noise levels.There is a core, much of it in Bellingham. not sign for it. Despite the popularity of the festival. :rider in the lease agreement that While working at Water Street In his lawsuit,Madsen is ask- trouble is brewing for this storied water- has set an 85-decibel sound-level Brewing, his brews were con- ing for an accounting of the funds ing hole once known as the Town Tavern Jimit. Without sound monitor- sistent winners at the North and assets of Triple Mash and and a featured landmark in the film"An ing,"we have to go down there American Brewers Association for an order appointing a general Officer and a Gentleman."Two lawsuits and measure it," said Sudlow, annual competition.Over the past receiver to manage the business have been filed against Triple Mash,one who operates the Water Street four years,gold medals have been and affairs of the corporation until by one of Triple Mash's owners,Harold .Hotel in the upper floors of the "Skip"Madsen,and another by the own- 'old awarded to his i Mod Chili the lawsuitingis d,resolved.Moresthan err of the historic N.D.Hill Building, building. Beso and Old Wookie strong ale, anything,he said,he wants to be in Each time Triple Mash vio- and his brews also have earned released from the partnership or which the tavern is located at 639 Water Gates the noise agreement,Water St.Building owners are Dawn and Chris Street Corp. fines it $150. The several silver and bronze awards, for the corporation to be dissolved ' Sudlow of Water Street ease allows the Brewing companies of all sizes in order to release his brewer's Corp.rP• pub six noise from Anheuser-Busch to small- license so he can set up shop The suits loom large in Water violations annually. time operators such as Water somewhere else. Street Brewing's future.Triple Mash . "I feel they're having a nega- Street Brewing—enter the con- "I can't open my own brewery, has occupied the ground-floor location tive impact on the rest of thetest each year.Madsen also won a which I would like to do," he since April 2004. The pub employs building," said Sudlow. Over the silver medal for one of his brews said. "i feel like I'm being held about 30 people. 'years, the Sudlows have had to Financial problems are not new. In give refunds to lodgers in the at the aWble Beer Cape apparent. hostage." 2009,the pub called for community sup- hotel who have complained. thee ye first became Madsen said, In thiscase, Law and Burr's to sustain itself through tough finan- whenren years ago, MadsPu attorney,rTolman Kirk,shasFwith- port8 g `"Ise impact that it's having a visit to Kathleen Purdy at drawn as counsel as of Feb. 10, cial times and generated thousands of on our business[the hotel]prob- dollars at a silent auction of donated ably outweighs the loss of rent[if the Small shedBusome Developmentghtonthe 2010,mputting the momentprocnIn in items. Center some light on the limbo for the In the they are evicted]," said Sudlow. problems. "She said the overall meantime, Madsen has put his If the landlords prevail, this year "They've been spreading word might be the last gulp for Water Street around town that we won't let money,yg but company was making shareale ofon corporation . for we needed to get a sale for Si$ on craigslistorg. Brewing and Strange Brewfest.in court them have music,which isn't the handle on our food and liquor A couple of people have shown papers filed Sept.25,2009,the landlords case,"he said. costs,"he said. interest, he said. Madsen will allege that when the notice of renewal of Triple Mash has refused the It costs only 3120 to make inform any potential buyers of the lease was returned to them by Triple sound-monitor request. seven kegs of beer,Madsen said, the debt. Mash on Sept.30,2(108,the rent was in • default. At a hearing on October 23, and there are 1'20 pints in each 2009, the court allowed Triple one sold at$4 apiece. "Most of Renewal of the lease required it to Mash to stay in the building until the money that came in from the paid to date. Now, the landlords are the outcome of a full hearing in bar was never again seen in the requesting that Triple Mash be evicted. Jefferson County Superior Court, brewery." Although Water Street Brewing is now now scheduled for May 24. current with rent, Chris Sudlow said, f', "they've been not exactly timely,let's put t / ' / 6!i si. it that way.it's been an ongoing thing." See WATER STREET Page 10♦ ' POSITION OF STRENGTH ; �# .' Even though Law and Burr � _ �� , currently operate without a lease, --1:::4:4-.2#.....1A,'& �` -.z ' , ,-. • " they said they are confident about i t w s4 _ , x the pub's future. Asked about r �;= the upcoming court date, Burr ---,3-_,-,...,..,-14‘.- ,-f , • said,"We come from a position of t strength" 3 � f s '.' � k` I law and Burr had no corn- ,---- Y >y, gtg , ment on the sound monitoring r x f, Y �4. 3 x requested by the landlords. Ihey- r . - ' ,;-- ,. "`� ~ ` t . said they are slowly bringing 41.4151,e- ::-.:-Y.4. k 1-7 `+ t music back and will beconsider- 114 i elf )‘:1; t.. - ' • ate of the guests above them.. .1" . sa4 � c' ..i.'-; ..l.„,, r - --4:7--'1).-, f j '1 Under the terms of their previous '. r - ?� r z r 1_f t' lease,Water'Sheet Brewing was - • t allowed six noise complaints in E u .y c` S- - the calendar year With five com =Fr, " � IV . plaints already 51ed m 2009,Law7. ' t' . �' ` --, ' _ -•. and Burr decided fo discontinue music for a tune untilthey held a �� ,'-',•.- �• a. + \� New year's Eve party +r; , .› #• ,% -- '' ! "It was a blast it was worth it," �� 1% ft ' said Burr. ft , As for their partner's lawsuit l l> . against thein,Burr declined com ' c ment except to say there would .- - be"no mudslinging." cs Will there be a Strange ° Brewfest 2011? "We will have ,. ., Strange Brewfest Next year,and :.E we feel confident with that posi- About 2,000 thirsty patrons showed up at Water Street Brewing Co.during the sixth annual Strange Brewfest on Jan.30-31.Photo by Gary Siebel tion,"said Burr.If the city allows it,Law and Burr hope to expand �� the tent area into the street r 1 1 Ilte idea would be to grow it," ># � Burr said. c e "Every brewery that was here ' �n'T j 's f t?w; this year has requested to come 9 a u' back,".said Law. ; .t, v. . } .'-it ..-:-: • _..,,, 1,."*" ..,'",' ,'I., 1 - /or ,,.... , • ,, .\rk; 4, Skip Madsen.one of three partners in Triple Mash Corp.,which operates k Y Water Street Brewing Co.in downtown Port Townsend,stopped brewing � s for the pub in March 2009 after disagreements with his partners,Nina - s 'j Law and Mark Burr,on running the business.Leader file photo Robinfrom Sequim came to Strange Brewfest 2010 dressed for the occa- sion.Phcrc ty Kathie Meyer Austin 1 T ^ Burke earned an seeks appointment to the PUD District 1 seat in January • following the November 2009 death of a second Dana Roberts. In addition to those offices,voters will have the opportunity to choose the next term county assessor, Superior Court clerk, District Court judge, and prosecuting attorney during the 2010 election. Jefferson County Assessor Jack Ninepositions Westerman and Jefferson County Superior Court Clerk Ruth Cordon both open in 2010 said it is too soon to announce their re- election intentions. ByJames Robinson of the Leader Jefferson County District Court Judge Jill Landes and Jefferson County Prosecuting Attorney Juelie Dalzell did With an August primary approaching, not respond by press time to a Leader John Austin,commissioner for District 3 phone call asking their re-election plans. on the Board of County Commissioners Among those in the running, (BOCC), announced Feb. 11 he would Hernandez was the most emphatic in his seek re-election.Austin's announcement response. marks the fifth such statement from offi- Of course I'm going to run.I'm going cials holding five of the nine seats up forrun again because I promised the con- grabs in the 2010 election. stituents and citizens of Jefferson County In addition to Austin, Jefferson that I will continue to be.a public servant County Auditor Donna Eldridge said she as long as I have their support and the would seek re-election, support of this organization,"Hernandez as would Jeffersongid. County Sheriff Tony ,�$ The BOCC appointed Hernandez on Hernandez,. Jefferson r- , March 23,2009,following former Sheriff County Treasurer Judi 11 Morris, and recently "�°y See AUSTIN Page 9 G appointed member of Jefferson County Public i;;,: Utility District (PUD) w IIINo.1,Barney Burke. John Austin Austin: Jim Boyeris one Opponent ♦Continued from page 1 commission lists in,"and he encouraged everyone Mike' 'Brasfield's retirement. Boyer's top five to stay engaged in politics for the ,Hernandez thentook the`seat in contributors as: sake of future generations. Much .an turcontested special election in Altbn Otis,'$500; of Boyer's focus has been on eco- June 2009 .; Larry Carter, ,>; nomic development,job creation ,:Among incumbents who have $445; Richard ";;,:1,411,...i, and private property rights, and they g Elam, $200; l ; i rndicated: will run again, ,._ � he has called for the creation ;Eldridge was elected in 1994'and Paul Moseley, ,: ifs of enterprise zones and securing .is in:.thOt rtlt term,Morris was. .$200; Shelton t ,/ ggr;aannt funding as a means to revi- elected to X998 and is in her third Washburn,$200. talize the local' Jim Boyer, economy 'Austin rs Seeking his second,term. '' Burke and "My passion for a lot of years , ;,t: 1 Vis; r .' Hernandez have has been affordable housing," he :DISTRICT 3 CHALLENGER; also filed with the commission, said. The completion of the Tri- .Currently,:` Austin a although both list zero contribu- Area sewer project could not only Democrat-:is the only candidate` , tions and zero expenditures as of create housing options but also with an. announced challenger..i s,>'eb :12,, economic opportunities for many Republican Jim Boyer had previ ?;'t i Boyer,has been actively cam- county'residents,`he said. Austin ously announced l'or 'District 3, 'Paignrng for.the;District 3 corn- also supports the Tri-Area sewer. which encompasses non and 'misSidnee&seat since announc- In addition to Boyer, Doug Quilcene northtot:Port:Ludlow';;mg itMlarcFt'2609.Most recently, Cloud, a Gig Harbor Republican, The primary election is Aug. 17; -he appeared at a Republican- attended the event. Cloud is the general election.is Nov.2. ,sponsored "Tea Party" in challenging U.S. Rep. Norm • AccOrding to Washing ton State •Chimacum on Feb 6, Dicks, D-Belfair, for the 6th Public Disclosure Commission Speaking to the crowd of about Congressional District seat. documents, as of Feb. 12, Boyer 125, Boyer said he is "genuinely According to a Tea Party has amassed $2,790 in contri- concerned over the kind of coun- attendee, "anti-incumbency septi- butions and spent $1,415. The try our kids are going to grow up ment was widespread." .. • _. _ Healthreport card ranks county Study placesFirst and last Clallam at ; HERE'S HOW THE North OlympicPeninsula'stacks up 17th in state against some counties in the 'state in terms of overall health. For a full listing of BY MARCIE MILLER Counties,visit www.county • PENINSULA DAILY NEWS healthrankings.org. Jefferson-Bounty ranks 11th ■ San Juan Y- '°' 1st • out of 39 counties in Washington ■ Douglas 2nd . state in terms of overall health of ` ■ Whitman .•3rd residents,while Clallam County a King ` 6th comes in 17th in a national I Jefferson 11th health report card released this ■ Thurston, 12th . week. ■ Kitsap 14th Clallam County residents are II Skagit 16th • heavier,smoke more and are less Ill Clallam 17th educated than Jefferson County, III Spokane 23rd said researchers with the 2010 II Yakima 32nd County Health Rankings report, III Mso Harbor 33rd a joint project of the Robert Wood ■'Mason 38th ■ Ferry 39th Johnson Foundation and the University of Wisconsin Popula- County Health Rankings tion Health Institute. But the study ranked Jeffer- son County dead last in Wash- while the least healthiest is ington state in physical environ- Ferry County, in eastern Wash- ment factors. ington. While the statewide county According to the study's Web average for premature deaths site, www.countyhealthrankings. was 5,979,in Jefferson County,it org, the researchers advise pub- was 7,129,and in Clallam County lic health professionals and it was 7,496. advocates to"look at their coun- ty's ranking,see what is making Motor vehicle crashes their residents sick, and work with others to mobilize and The two counties were tied in develop broad-based solutions in the motor vehicle crash death rate, with 21 each, compared their community so all residents with the statewide county aver- can be healthy." , age of 12. Jean Baldwin,director of Jef- g , ferson County Public Health,did The healthiest county in the not return a request for com- state was said to be the North ment Thursday. 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Wild Sage World Teas,Tonics certified as a green business for The Jefferson County Public & Herbs, at 924 Washington St. reducing its waste and using Health aDesapartm gree�ntls also was cer- the first local government agency in Jefferson County to receive certification. The health depart- ment minimized paper use and incorporated sustainable business practices. The Green Business Program was developed to recognize local businesses that integrate envi- ronmentally sensitive decisions and use sustainable practices in their day-to-day operations. It is funded by the Washington State Department of Ecology. For more information, call Jefferson County Environmental Health,385-9444. • • • Jefferson County children are a minority group in rural Washington during a Recession. What does this 2009-10... recession mean to Jefferson County children, their families and the service providers that see them? History: Jefferson County families have had a network of providers who have supported a healthy community by providing a menu of services through the life span of childhood. Given: Funding challenges are starting to close/threaten local nonprofit service providers - Big Brother Big Sister, Boiler Room and many others. State and local funding roll backs will destroy the infrastructure of other service providers. Reductions in State general fund will impact children services, substance abuse treatment and mental health services with substantial reductions in programs. Demand for services is increasing as families lose the ability to meet their basic needs. The local economy is stressing the citizens with the lowest income or in Jefferson County families with children. • Plan: It is time to coordinate a local discussion identifying youth needs. Do we as a community try to preserve these services? Emergency services can be provided by volunteers with time and money, but infrastructure to provide long term services will require a restructure of government and community planning. • Produced by: Jefferson County Public Health December 2009 page 1 • What are the Social Conditions for and Health Status of the Children of Jefferson County? Poverty/Housing/Education • 20% of children under age 18 live in poverty' • Two-thirds of babies are born to low-income women (Medicaid-paid maternity care)2 • The number of new families with children age 3-18 using food banks increased an estimated 147% between 2007/08 and 2008/093 • Children age 0-17 made up 30% of the homeless counted during the January 2009 Point in Time Count3 • 83% of high school students graduate on-time (in 4 years); 89% of high school students graduate in 4 or more years4 General Health • Nearly nine in ten children (88%) have some kind of health insurances • One-quarter of 8th and 10th graders are overweight or at risk for becoming overweights • 82% of 8th and 71% of 10th graders report vigorous physical activity at least 3 times per week6 Mental Health 110 • More than one-quarter of 8th (27%) and one-third of 10th (30%) graders report having felt so sad or hopeless almost every day for two weeks in a row in the past year that they stopped some usual activities6 • One in ten 8th (11%) and one in five 10th (19%) graders report having seriously considered suicide in the past year6 • Sixty-nine percent of 8th and 52% of 10th graders report having adults to turn to when they're feeling sad or hopeless6 • Thirty-nine percent of 8th graders and 33% of 10th graders report never, seldom, or only sometimes enjoying school6 • Sixteen percent of Nurse-Family Partnership (NFP) pregnant women have a history of mental illness, compared with five percent nationally Violence/Abuse/Neglect • About one in three 8th (31%) and 10th (28%) graders report having been bullied at least one time in the past month6 • More than one in three 8th (37%) and 10th (35%) graders report having been in one or more physical fights in the past year6 • About one in five 8th (21%) and 10th (16%) graders report not feeling safe at school6 • Fifty-nine percent of NFP pregnant women have a history of physical or emotional abuse/violence, compared to 29% nationally' • About 5 in 100 children was involved in an accepted child abuse and neglect referral (CPS)5 • Produced by: Jefferson County Public Health December 2009 page 2 • Substance Use • Ten percent of 8th and 30% of 10th graders report using marijuana in the past 30 days6 • Seventeen percent of 8th and 44% of 10th graders report drinking alcohol in the past 30 days6 • Nine percent of 8th and 28% of 10th graders report being drunk at school in the past year6 • More than one in three (37%) pregnant teens report smoking during pregnancy compared to 1 in 5 pregnant women age 20 and older9 • 2nd highest youth publicly funded marijuana treatment admission rate among Washington State counties10 Reproductive Health • Over forty percent of Jefferson County females age 15-19 access reproductive health services at JCPH11 • Jefferson County teen pregnancy rate is significantly lower than Washington State, Kitsap and Clallam Counties (2005-07)9 • Nearly 3 in every 100 females age 15 to 19 was diagnosed with Chlamydia (2008)9 • 'US Census Bureau,Small Area Income and Poverty Estimates 2008.Accessed at:htto://www.census.gov//did/www/saipe/ 11/8/2009. 2Department of Social&Health Services Research and Data Analysis.Accessed at: http://hrsa.dshs.wa.gov,/firststeps/Data/characteristics of washington wo county 2007.htm 11/8/09. 3 Olympic Community Action Programs Comprehensive Community Needs Assessment,2009. `Office of the Superintendent of Public Instruction Graduation Rates by District. Accessed at: htto://reportcard.osoi.k12.wa.us/DataDownload.asox?schoolld=l&OrgTypeld=1&reoortLevel=State&orgLinkld=11/10/09. 5 Washington State Department of Health,Local Public Health Indicators.Accessed at: htto://www.doh.wa.gov/ohio/khi/lphi/lhi/iefferson/access/accessl.htrn, 11/10/09. 6 Washington State Department of Health,Jefferson County Healthy Youth Survey 2008. 'Jefferson County Public Health Nurse Family Partnership data 8 Washington State Department of Social&Health Services,Risk and Protection Profile for Substance Abuse and Prevention. Accessed at:http://www.dshs.wa.gov/rda.'research/risk.shtm, 11/8/09. 9 Washington State Department of Health,Center for Health Statistics.VistaPHw 7.3.0.4. 10 Department of Social and Health Services Tobacco,Alcohol and Other Drug Abuse Trends in Washington State,2008.Accessed at:http://www.dshs.wa.gov/DASA/Publications.shtml 11/9/09. "Jefferson County Public Health • Produced by: Jefferson County Public Health December 2009 page 3 „sc JEFFERSON COUNTY PUBLIC HEALTH S` 615 Sheridan Street • Port Townsend •Washington • 98368 SING • www.jeffersoncountypublichealth.org March 12, 2010 To: Jefferson County Board of Health From: Jefferson County Public Health Staff Re: 2010 Public Health Hero's Nominations Jefferson County Public Health staff nominates the agencies, clinics, pharmacies and individuals listed below for the 2010 Public Health Hero's award. These nominations represent just some of the community partners who assisted Jefferson County Public Health in response to the H1N1 Pandemic of 2009. Overall coordination with Jefferson Healthcare: Paula Dowdle, Chief Operations Officer Assisted with H1N1 tracking and surveillance: Jefferson County Medical Providers Jefferson Healthcare Cynthia Walker, RN, Infection Control Coordinator Jefferson Healthcare Lab Staff Jefferson Healthcare Emergency Room staff Jefferson County Schools Assisted with H1N1 Vaccine Administration:We would like to give a special mention to all of the immunization nurses and clinic staff who worked so hard to organize the clinics, call patients in, and . administer the vaccine. Jefferson Medical and Pediatric Group Port Townsend Family Physicians Kah Tai Care Center QFC Pharmacy, Port Hadlock Madrona Hill Urgent Care Richard Lynn, MD Monroe Street Medical Clinic Safeway Pharmacy Olympic Primary Care South County Medical Clinic Port Hadlock Medical Care Jefferson Healthcare— Both within the hospital, immunizing Health Care Providers and the combined clinic that was organized in November. Assisted with Federal Strategic National Stockpile storage and distribution of Tamiflu: Don's Pharmacy, Donald Hogland, Owner/Pharmacist Jefferson Healthcare Pharmacy, Shirley Tinsley, Pharmacy Manager QFC Pharmacy, Port Hadlock, Lee Metcalf, Pharmacist, Manager Safeway Pharmacy, Port Townsend, Steve Shapiro, Local Pharmacy Manager Assisted with Preventing the Spread of Disease in the Community: Jefferson County School staff including all the wonderful teachers who encourage students to wash their hands, cover their cough, and stay home when they are sick. The theme for National Public Health Week 2010 is "A Healthier America: One Community at a Time.” The above nominations represent local partners in creating a healthier community right here in Jefferson County. Jefferson County Public Health wants to thank them all for their contributions and efforts toward creating a healthier community for all. S 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