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HomeMy WebLinkAbout2010- June Filc Copy • Jefferson County Board of 3fealth .agenda _Minutes • June 10, 2010 • • JEFFERSON COUNTY BOARD OF HEALTH June 10,2010 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 May 20,2010 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. Puget Sound Septic System Repair Loan Program 2. Correspondence 3. Exemption to New Bottled Water Tax 4. New Low-Cost Health Coverage Offered 5. Why We Don't Spend Enough on Public Health • V. New Business 1. Annual Review Jefferson County Shellfish Growing Areas—Follow-up Report 2. Community Leadership Letter Revisions 3. Emergency Water Plans for Licensed Food Service Establishments 4. New Jefferson County Public Health Webpage VI. Activity Update VII. Agenda Planning Calendar VIII. Next Scheduled Meeting: July 15, 2010 2:30—4:30 PM • JEFFERSON COUNTY BOARD OF HEALTH • MINUTES Thursday, May 20, 2010 2:30 PM—4:30 PM Public Health 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, Chair, Citizen at large(City) Chuck Russell, Chair,Hospital Commissioner,District#2 Roberta Frissell, Citizen at large(County) Chair Chuck Russell called the meeting of the Jefferson County Board of Health to order at 2:37 PM. A quorum was present. Members Present: John Austin, Roberta Frissell, Phil Johnson, Kristen Nelson, Chuck Russell, David Sullivan, Sheila Westerman Staff Present: Dr. Thomas Locke, Julia Danskin, Veronica Shaw Guest: Frances Joswick, SAAB • APPROVAL OF AGENDA Member Austin suggested the addition of an SAAB matter under New Business. Member Austin moved and Member Frissell seconded for approval of the agenda, as amended. The agenda was approved unanimously, as amended. APPROVAL OF MINUTES Member Sullivan moved for approval of the April 15, 2010 BOH meeting minutes; Member Austin seconded. The minutes of April 15, 2010 were approved unanimously. PUBLIC COMMENTS (None) • Page 1 of 11 OLD BUSINESS and INFORMATIONAL ITEMS Annual Review of Jefferson County Shellfish Growing Areas • Dr. Locke discussed the findings of the annual review from the State Department of Health, copies of which were included in the BOH meeting packet. This particular report is noteworthy in that there are two areas in Jefferson County threatened with a downgrade in classification. Dr. Locke noted that the accompanying letter from Maryanne Guichard, Office Director, could be misinterpreted. The two areas threatened with downgrades, Mystery Bay and Port Townsend, showed no evidence of current water contamination according to the report. For Mystery Bay, the classification is based on the number boats moored there; this has been the subject of a year long collaborative effort involving many parties. He pointed out the section of the report which mentions the work of the stakeholder group and the fact that a management plan has been developed to reduce the number of mooring buoys and boats. Dr. Locke pointed out that the water quality samples from these sites are fairly good; they meet all standards. The highest fecal coliform rates, although still meeting standards, occurred in areas where shellfish harvesting is prohibited such as industrial sites. Member Austin noted that there were some areas of concern listed, such as in Dabob Bay and Hood Canal, but that the sample/trend data and exact locations had not been shown in the report. He said these areas are presumably highlighted so that local jurisdictions can take corrective action, but the information is unclear. Dr. Locke said that he would research those issues further. • Member Sullivan pointed out that the area referred to as Port Townsend, station 33, in the report is actually located at Port Hadlock/Oak Bay; that is, the first page is not consistent with the last page of the report. Dr. Locke noted that shellfish growing in the entire Puget Sound area could become a much greater issue. He noted that, due the oil spill aftermath, the Gulf Coast shellfish population could be unusable for the next decade, thereby placing additional pressure on other areas for shellfish production. Member Nelson inquired as to the content of prior reports and whether or not there has been any noticeable upward or downward trend. Dr. Locke recalled that the rates have been fairly stable over time, and said that he would verify that. It was also noted that once an area is identified as being "of concern", it will remain on the concern list for several years, even if there was only one problem sample. State Vaccine Program Update Dr. Locke referred to the May 5 News Release entitled "Childhood Vaccine Program to Continue after Previously Being Cut". He said that a funding process and program had been hastily developed through insurance companies to preserve this service. However, Page 2 of 11 there are now different information requirements that impose additional administrative . costs on health providers. The previous programs run through local the Health Department had been very streamlined and required minimal record keeping by the providers. He noted the importance of preserving the vaccine program. Member Austin inquired as to the rate of vaccination for H1N1 influenza. Julia Danskin said that the final tallies are still in progress; the total number of doses administered was over 6000. Only about 20% of very young children received vaccinations, which is low in comparison to the target levels for other vaccines. However, compared to other counties, the rates were good, especially for children age 5 and under. She noted that these vaccines are new and it is difficult to get parental consent for child vaccines that are not required by the schools, despite the fact that the flu is largely spread through the schools. Ms. Danskin noted that the seasonal flu vaccine becoming available in the fall of 2010 will have H1N1 vaccine in it. There is also plenty of unexpired HIN1 vaccine available. Dr. Locke said that there had been multiple logistical factors that affected the rollout of the H1N1 vaccine and contributed to the low levels of vaccinations. Up through the second week in December 2009,the vaccine was only available to children age 4 and under and those with chronic medical conditions. By the time that sufficient vaccine was on hand to open the program up to all ages, the peak of the flu epidemic had passed. He stated that to have significantly impacted the Fall H1N1 outbreak, vaccine would have had to have been available in August and administered to large numbers of people before the start of the school year. The first outbreaks were seen in September. • There was a brief discussion about the fact that vaccinations are not mandatory and that schools do not collect the data. In general, the uptake of flu vaccine is low because parents do not perceive this illness as serious enough to warrant vaccination of their children. However, public health authorities consider the schools to be influenza virus factories. Dr. Locke said that there would be no seasonal flu outbreaks if influenza vaccinations of school age children were required. He mentioned that there has been consideration of adding flu vaccine to the mandatory panel. There is a multi-year type of vaccine under development that would require one dose with one or two boosters; this would be the ideal mandatory vaccine for school age children. There was mention that pending legislation would require parents to be counseled by a qualified health care provider if they seek to opt out of vaccinations for their children; the proposed bill has been passed by the House and stalled in the Senate. NEW BUSINESS Substance Abuse Advisory Board Nomination Member Austin reported that a subcommittee of the SAAB (Frances Joswick, Julia Danskin and John Austin) had met with Sam Marco, new Executive Director of the Jefferson County Mental Health Services, and determined his interest in serving on the Page 3 of 11 SAAB Board. Member Austin said that the subcommittee finds Mr. Marco to be well qualified and moved that the BOH approve his appointment to the SAAB. The • motion was seconded by Member Westerman and approved unanimously. H1N1 Pandemic Response—After Action Report Julia Danskin reviewed the Jefferson County Health Department's and community's response to the H1N1 pandemic since it had first been declared in May 2009. A copy of the full written report submitted to the State Department of Health is included in the packet; it includes a month by month account of major events through April 2010, as well as key actions, observations and recommendations related to Epidemiology and surveillance; Communication; Vaccine Distribution and Tracking; Antiviral Distribution and Tracking; Health Care System Coordination; and Regional Coordination. The report also includes a set of conclusions and an Action Plan to address issues identified during the pandemic period. Ms. Danskin described the continuously changing conditions, vaccine supplies and information emanating from the CDC, state and other federal agencies, particularly early in the pandemic response period. She noted that locally there were many partners and that excellent working relationships had evolved. Over 6000 doses of H1N1 vaccine were administered. There were no reported deaths attributed to H1N1 in Jefferson County. Dr. Locke noted that the H1N1 pandemic response had been an important test of our . emergency response capabilities, and that there are always lessons to learn in the aftermath of this type of event. He said that he has been promoting the message that the H1N1 pandemic was a trainer pandemic. He believes we were incredibly lucky in many ways. He said that the response plan that had been developed since 2005 worked well, but that it would be unwise to suspend efforts in preparedness activities. Dr. Locke said that statistics are still coming out and noted that the pediatric death rate, much of it in the 8 -12 year age range, was four times what is normally seen with seasonal influenza. Most of the children had medical conditions, such as asthma. Even in their mildest form, pandemics result in deaths. Future pandemics, such as one caused by H5N1 (Avian Flu), will likely be far more severe. Julia Danskin added that public health authorities have recognized that it is important to focus on the spread of all diseases, not just H1N1. She provided sample hand sanitation kits that are used to promote the importance of personal hygiene in preventing the spread of communicable diseases, especially influenza. Member Nelson said that she was impressed with the report, particularly the conclusions and the information showing what worked and what needed adjustments. She noted that e-mail communications had to be improved and that Jefferson Healthcare data had not been available for this report. Ms. Danskin explained that there had been a problem with the electronic identifier for Jefferson Healthcare which she believed had since been • Page 4 of 11 resolved. Another problem with passing e-mail communication to the hospital EMR (electronic medical record) system was also being addressed. Chair Russell asked what the biggest problem had been in trying to respond to the H1N1 pandemic. Ms. Danskin said that the late arrival of H1N1 vaccine had presented the biggest challenge. In addition, projected expectations about vaccine shipments were far off the mark on several occasions. In summary, the biggest problems were due to insufficient resources at the times when they were most needed; Ms. Danskin said that this was a nation-wide problem. In addition, there were multiple layers of information available through web sites, e-mail, bulletins, etc. that were not always perfectly synchronized. Locally, staff and community agencies cooperated very well under the circumstances. Ms. Danskin noted that staff did an excellent job of handling phone calls, listening to concerns, clarifying information and allaying fears of concerned citizens. In response to a question, Dr. Locke noted that the human mortality rate for Avian flu is about 65%. However, although H5N1 is endemic in birds, it is very hard to transmit to humans, except through airborne exposure to the droppings. Dr. Locke explained that such a lethal virus cannot spread widely because it rapidly kills its hosts. To become a serious pandemic threat, the virus would need to change significantly, becoming more contagious and less lethal. National Health Reform Legislation: Impact on Public Health and Prevention Activities • Dr. Locke said that in preparing for a recent talk and panel discussion for the League of Women Voters he had done research and focused on the impact of health care legislation on public health and prevention activities. He noted that there are significant funds associated with the legislation, some of which has already been allocated and some which are potential sources. He referred to the summary in the packet prepared by Trust for America's Health, which he said is among the best references he has found. Dr. Locke described the major categories of changes/provisions. The bill expands clinical preventive services, access to wellness services, and personal prevention plans within the health care sector. It requires that private insurance plans, Medicare and Medicaid pay for these types of services. He pointed out the reason that insurers have been reluctant to cover prevention: the return on investment for preventive services may be years away and may not be realized by the same insurer who covers it today. He said that virtually the entire range of proven clinical preventive services will be eligible for mandatory coverage. There is also a system for determining which services should be funded, based on ratings of the US Preventive Services Task Force. The second category of changes involves the creation of a National Prevention, Health Promotion and Public Health Council within Health and Human Services headed by the US Surgeon General to provide coordination and leadership at the federal level. This council, with a twenty five member citizen advisory board, will have responsibilities for Page 5 of 11 developing national prevention strategies and policies, as well as for expanded access for chronic disease management and for looking at gaps in the public health system. • The area that potentially affects the public health sector the most is the Prevention and Public Health Fund. As initially proposed, this would have been $10 billion per year nationally, or$200 million per year for Washington State. The funding has been scaled back to about $15 billion over ten years (page 3 of the summary). This is not subject to annual congressional decision and appropriation, but can be abolished by a subsequent congress. Among the many things that can be funded are demonstration projects such as: community transformation grants, "Healthy aging, Living well" projects for pre- Medicare age groups. Dr. Locke believes that Jefferson/Clallam Public Health, hospitals, Tribes and other community agencies are well positioned to take advantage of these grant opportunities collaboratively. He mentioned the Strategic Plan for Rural Health developed by a Washington State Hospital Association taskforce over the last few years would be an excellent model for a community grant. In addition, there are areas dealing with nutrition, labeling requirements for restaurants, and actions that aim at improving diets with respect to salt, sugar, and fat content. He said that this is a huge problem and these actions would hopefully have positive impact. Member Austin asked if making people aware of food content, particularly fat and sugar, has been effective in changing eating habits. Dr. Locke said he was unaware of any research on this subject. He noted that there is new evidence that dietary salt intake is a huge factor in high blood pressure and stroke risk. He said that reducing average salt intake by a gram a day would be a far more effective way to prevent strokes than investing in expensive new medical technologies. Another large planning issue is the health care work force, particularly for rural health care delivery and for public health. Dr. Locke noted the graying of public health work force and expected retirement of a substantial percentage in the next 5-10 years. He mentioned training programs, loan repayment programs, mid-career reeducation and pilot programs in this legislation. All of these programs/funds are part of the Patient Protection and Affordable Care Act (PPACA). Dr. Locke said that much of what Congress has directed is not yet specific and federal agencies are charged with designing appropriate programs and processes. He said that Public Heath has a huge amount of research data about what works, but has never been funded adequately to implement these ideas. There is a requirement in this new bill that non-profit hospitals conduct community needs assessments every three years and use this information to set planning priorities. He noted that there variations of interpretation with regard to community needs assessment versus community health assessment. The public hospital districts in this area are very interested and motivated in doing this function, and there is now actual authority for undertaking this responsibility. i Page 6 of 11 There was a brief discussion regarding the portion of the legislative initiatives and • provisions that have been funded. Dr. Locke said that in many cases a category of activity has been authorized, but there is not yet funding. Once proposals and grant requests are brought forward, there will be need to prioritize; Dr. Locke expects that Congress will need to revisit and refund areas that prove to have cost impacts. What is missing from the bill as a whole is an aggressive cost-containment focused approach. He cited the Public Health argument that the only way to afford universal access is to make people healthier. He believes this is possible, noting that the US is 24th in the world with regard to population health. There was also discussion about the distortion caused by the current situation of 47 million uninsured. Dr. Locke noted that this could be the golden age of public health, i.e. massive investment in community health versus massive increases in the cost of treating illness. Ms. Danskin said that she is just becoming aware of certain complexities and implications of the bill. She cited an example of teen pregnancy prevention program funding that is limited to State agencies. She cited another example where States must develop Home Visit proposals and submit them to the federal government; local jurisdictions may join State agencies or regional groups in order to qualify for funds. In conclusion, the collective set of programs that have been set up are a compendium of things that have been proven to work—an encyclopedia of evidence based practice in all these areas, and thus are candidates for funding; many do not yet have allocated dollars. • Draft Invitation Letter Dr. Locke recalled that the intention to embark on an updated community health assessment had been discussed at the previous BOH meeting. To date, there have been meetings with representatives of the Hospital and with Sam Marco from Mental Health. He pointed out that the work is being done in the context of the national health care reform effort, which touches on needs assessment and opportunities for improved chronic disease management and prevention. Dr. Locke referred to the draft letter in the packet as a work in progress. He said that it is evident that the BOH would be the best convener for the assessment effort and for inviting individuals to participate. He suggested a two stage process, with the first goal of convening a Data Steering Committee to identify available data, determine focus areas, and to prepare material for a larger group. He noted that Vic Dirksen had suggested that a process with good preparation and a relatively short time line of intensive effort would yield better results than a more drawn out process. It is uncertain whether it is feasible to get that level of commitment from participants. However, he said it may be feasible if linked to opportunities for community transformation grants, which could generate substantial amounts of money. i Page 7 of 11 There was a discussion about the most appropriate time to convene the working groups. After consideration of delaying until the fall,there was agreement that the process would take time and should begin as soon as possible. Dr. Locke said that the focus should be • on identifying the service gaps, where Public Health and other agencies could be doing more but have not been able to assign the resources. In addition, he said that the process should generate data that can be used for applying for community transformation grants within a very competitive process. There must also be new data systems such as electronic medical records that show whether or not practices and initiatives are working, as well as ways to address interoperability among existing systems. Member Westerman noted that including a good description of the group composition, timeline and collaborative process in any grant application would be beneficial. She also suggested adjustments to the draft letter that clearly identify the goal of positioning for federal funds. She said it is important to convey that we are preparing ourselves to compete for funding, and not only to update studies/assessments as in the past. In addition, it should be clear that what we will do with the funding is to address the gaps as well as support services already in place. She said that message would incentivize the community to provide more expertise and help with the whole process. Member Sullivan suggested a positively worded invitation to rise to the challenge. A member of the audience brought up the notion of`enlightened self-interest'. Dr. Locke said he would include those ideas and suggestions, as well as to mention specifically some of the items included in the new legislation. There was a brief discussion about possible approaches to developing a new draft and getting Board • approval. It was agreed that Dr. Locke would place this topic on the agenda and include the next draft letter in the packet for the June 10 meeting. National Accreditation of State and Local Health Departments Dr. Locke and Julia Danskin described the performance evaluation process that the Health Department goes through every three years. There have been State standards for Public Health; five function areas have now grown to twelve function areas. Washington State was one of the first in the country to enact laws mandating this process. At the national level, an accreditation process has now been developed. This is a drive to establish standards for performance for local health departments. A team of evaluators visit local departments to determine whether they are meeting, exceeding or not meeting the standards. The last onsite visit was in May 2008. The outcome report from that audit was presented to the BOH in the fall of 2008; a copy is available online. The next scheduled evaluation will take place in the spring of 2011. Dr. Locke explained that, for the next round, counties may decide to also apply for national accreditation. In those cases, the auditors will perform the audit using the i Page 8 of 11 i combined state/national standards;there is about an 80%overlap. Federal accreditation • includes additional standards. Kitsap and Clallam have decided to go for the full 100%; Dr. Locke said he recommends that for Jefferson County, as well. He said he supports the notion that critical evaluation of performance improves quality. Member Austin inquired about the resources required to prepare for the audit. Dr. Locke and Julia Danskin said that the process is very data intensive and requires the assemblage of many forms of records. It was noted that the BOH meeting minutes and documents are important components of that collection. Ms. Danskin indicated that this effort would require only her time, with some medical records and administrative support to gather existing records. It was noted that federal accreditation is still somewhat controversial at the State level. There are some who believe that the additional effort is not warranted or that ratings do not truly reflect quality and high performance. Staff believes that the process does verify what is already being done, and does help to identify gaps and improvement opportunities. In addition, with the advent of health reform legislation, accreditation may be of benefit in acquiring federal funds. BOH members agreed that Jefferson County should be evaluated for federal accreditation in the 2011 round of performance evaluations. . Interlocal Contracting for Environmental Health Director Services Dr. Locke provided information on the search for an Environmental Health Director. He said that an excellent candidate had been found, a person who is currently with the Kitsap Health Department. However, a counter proposal was made by Kitsap County whereby the person would have part-time responsibilities in both counties, under an interlocal agreement. Dr. Locke cited experience with such arrangements, as for his own position of Health Officer for both Jefferson and Clallam counties. Although the negotiations are still in progress, Dr. Locke said the individual would likely spend about 40% of his time working for Jefferson County; he would continue to live in Poulsbo. He explained that help is needed with high level administrative work and to carry out grant commitments, as well as to move forward with onsite septic code revisions and the homeowner inspection program. He noted that formal standards for homeowner inspection have not yet adopted at the State or local level, although there is broad support for the concept. There was a brief discussion about the status of this issue in Clallam and the fact that there are now models for Jefferson County to evaluate and/or customize for its own use. There was discussion about whether or not this position would be adequately served by a part-time Director. Member Nelson noted that the alternative of hiring a full time person who would also be part of the community may be preferable; she noted that under a Page 9 of 11 commuting arrangement, Jefferson County may receive even less than 40% of the person's energy and time. • Veronica Shaw cited the commonalities shared by Jefferson and Kitsap counties and the specific experience of the candidate with multiple important programs. She said that she believes this arrangement would work and would be beneficial for Jefferson. It was noted that, because of the qualifications,this position has been fairly difficult to fill and that it may be better to have an expert part-time than someone who is less qualified full- time. A member of the audience, Tom Brotherton, suggested that one obstacle may be a "conflict of interest" in attempting to serve two different counties. Mr. Brotherton went on to introduce himself as an attorney working for the Jefferson County Prosecuting Attorney's staff and a "legal advisor"to the Board of Health. Veronica Shaw said that the contract had been be reviewed by David Alvarez, the Health Department's legal advisor and the final agreement will also be reviewed with him. In response to a question from Member Sullivan, Mr. Brotherton confirmed that he had not been assigned to be an advisor to the Board of Health by the County Prosecuting Attorney. ACTIVITY UPDATE Frances Joswick, SAAB, reported that the preparation of a second Department of Justice grant application focusing on substance abuse and mental illness is in progress. • Member Austin informed the BOH of a scheduled press interview on Monday June 7, 12:30 PM, at Mountain View. The purpose is to release the results of SAAB research on the amount of money spent in this County as a result of substance abuse. It is an estimate, based on a template developed by Columbia University that includes costs for: hospitals, jail, law and justice, mental health, Child Protective Services, lost work and other components. Member Austin said that the preliminary results indicate at least $15 million per year, which is equivalent to the entire Jefferson County General Fund. He invited others to attend. Member Johnson requested clarification on the processes available to the BOH for review, editing and approval of a document, such as the draft letter discussed earlier, particularly when it is impractical to do within a meeting. Mr. Brotherton advised that any official actions should be taken during a public meeting; any action considered by a quorum must be done within a meeting. Dr. Locke stated that for routine letters, the BOH decides in advance which person is authorized to review and sign on behalf of the BOH. In special cases, a higher level of participation by BOH members may be desirable and that should be done during meetings of the Board. AGENDA PLANNING CALENDAR S Page 10 of 11 The next BOH meeting is scheduled for June 10, 2010 (second Thursday instead of third • Thursday) in the Health Department Conference Room. Roberta Frissell indicated she would be unable to attend due to travel arrangements. ADJOURNMENT Chair Russell adjourned the meeting at 4:32 PM. JEFFERSON COUNTY BOARD OF HEALTH Chuck Russell, Chair Phil Johnson, Member Kristen Nelson, Vice-Chair John Austin, Member S Roberta Frissell, Member David Sullivan, Member Sheila Westerman S Page 11 of 11 JEFFERSON COUNTY BOARD OF HEALTH MINUTES • Thursday, May 20, 2010 2:30 PM—4:30 PM Public Health 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, Chair, Citizen at large(City) Chuck Russell, Chair,Hospital Commissioner,District#2 Roberta Frissell, Citizen at large(County) Chair Chuck Russell called the meeting of the Jefferson County Board of Health to order at 2:37 PM. A quorum was present. Members Present: John Austin, Roberta Frissell, Phil Johnson, Kristen Nelson, Chuck Russell, David Sullivan, Sheila Westerman Staff Present: Dr. Thomas Locke, Julia Danskin, Veronica Shaw Guest: Frances Joswick, SAAB • APPROVAL OF AGENDA Member Austin suggested the addition of an SAAB matter under New Business. Member Austin moved and Member Frissell seconded for approval of the agenda, as amended. The agenda was approved unanimously, as amended. APPROVAL OF MINUTES Member Sullivan moved for approval of the April 15, 2010 BOH meeting minutes; Member Austin seconded. The minutes of April 15, 2010 were approved unanimously. PUBLIC COMMENTS (None) • Page 1 of 11 OLD BUSINESS and INFORMATIONAL ITEMS Annual Review of Jefferson County Shellfish Growing Areas • Dr. Locke discussed the findings of the annual review from the State Department of Health, copies of which were included in the BOH meeting packet. This particular report is noteworthy in that there are two areas in Jefferson County threatened with a downgrade in classification. Dr. Locke noted that the accompanying letter from Maryanne Guichard, Office Director, could be misinterpreted. The two areas threatened with downgrades, Mystery Bay and Port Townsend, showed no evidence of current water contamination according to the report. For Mystery Bay, the classification is based on the number boats moored there; this has been the subject of a year long collaborative effort involving many parties. He pointed out the section of the report which mentions the work of the stakeholder group and the fact that a management plan has been developed to reduce the number of mooring buoys and boats. Dr. Locke pointed out that the water quality samples from these sites are fairly good; they meet all standards. The highest fecal coliform rates, although still meeting standards, occurred in areas where shellfish harvesting is prohibited such as industrial sites. Member Austin noted that there were some areas of concern listed, such as in Dabob Bay and Hood Canal, but that the sample/trend data and exact locations had not been shown in the report. He said these areas are presumably highlighted so that local jurisdictions can take corrective action, but the information is unclear. Dr. Locke said that he would research those issues further. • Member Sullivan pointed out that the area referred to as Port Townsend, station 33, in the report is actually located at Port Hadlock/Oak Bay;that is, the first page is not consistent with the last page of the report. Dr. Locke noted that shellfish growing in the entire Puget Sound area could become a much greater issue. He noted that, due the oil spill aftermath, the Gulf Coast shellfish population could be unusable for the next decade, thereby placing additional pressure on other areas for shellfish production. Member Nelson inquired as to the content of prior reports and whether or not there has been any noticeable upward or downward trend. Dr. Locke recalled that the rates have been fairly stable over time, and said that he would verify that. It was also noted that once an area is identified as being "of concern", it will remain on the concern list for several years, even if there was only one problem sample. State Vaccine Program Update Dr. Locke referred to the May 5 News Release entitled"Childhood Vaccine Program to Continue after Previously Being Cut". He said that a funding process and program had been hastily developed through insurance companies to preserve this service. However, ID Page 2 of 11 there are now different information requirements that impose additional administrative costs on health providers. The previous programs run through l Health • Department had been very streamlined and required minimal record keeping by the providers. He noted the importance of preserving the vaccine program. Member Austin inquired as to the rate of vaccination for H1N1 influenza. Julia Danskin said that the final tallies are still in progress; the total number of doses administered was over 6000. Only about 20% of very young children received vaccinations, which is low in comparison to the target levels for other vaccines. However, compared to other counties, the rates were good, especially for children age 5 and under. She noted that these vaccines are new and it is difficult to get parental consent for child vaccines that are not required by the schools, despite the fact that the flu is largely spread through the schools. Ms. Danskin noted that the seasonal flu vaccine becoming available in the fall of 2010 will have H1N1 vaccine in it. There is also plenty of unexpired H1N1 vaccine available. Dr. Locke said that there had been multiple logistical factors that affected the rollout of the H1N1 vaccine and contributed to the low levels of vaccinations. Up through the second week in December 2009,the vaccine was only available to children age 4 and under and those with chronic medical conditions. By the time that sufficient vaccine was on hand to open the program up to all ages, the peak of the flu epidemic had passed. He stated that to have significantly impacted the Fall H1N1 outbreak, vaccine would have had to have been available in August and administered to large numbers of people before the start of the school year. The first outbreaks were seen in September. • There was a brief discussion about the fact that vaccinations are not mandatory and that schools do not collect the data. In general, the uptake of flu vaccine is low because parents do not perceive this illness as serious enough to warrant vaccination of their children. However, public health authorities consider the schools to be influenza virus factories. Dr. Locke said that there would be no seasonal flu outbreaks if influenza vaccinations of school age children were required. He mentioned that there has been consideration of adding flu vaccine to the mandatory panel. There is a multi-year type of vaccine under development that would require one dose with one or two boosters; this would be the ideal mandatory vaccine for school age children. There was mention that pending legislation would require parents to be counseled by a qualified health care provider if they seek to opt out of vaccinations for their children; the proposed bill has been passed by the House and stalled in the Senate. NEW BUSINESS Substance Abuse Advisory Board Nomination Member Austin reported that a subcommittee of the SAAB (Frances Joswick, Julia Danskin and John Austin)had met with Sam Marco, new Executive Director of the Jefferson County Mental Health Services, and determined his interest in serving on the Page 3 of 11 SAAB Board. Member Austin said that the subcommittee finds Mr. Marco to be well qualified and moved that the BOH approve his appointment to the SAAB. The motion was seconded by Member Westerman and approved unanimously. • H1N1 Pandemic Response—After Action Report Julia Danskin reviewed the Jefferson County Health Department's and community's response to the H1N1 pandemic since it had first been declared in May 2009. A copy of the full written report submitted to the State Department of Health is included in the packet; it includes a month by month account of major events through April 2010, as well as key actions, observations and recommendations related to Epidemiology and surveillance; Communication; Vaccine Distribution and Tracking; Antiviral Distribution and Tracking; Health Care System Coordination; and Regional Coordination. The report also includes a set of conclusions and an Action Plan to address issues identified during the pandemic period. Ms. Danskin described the continuously changing conditions, vaccine supplies and information emanating from the CDC, state and other federal agencies,particularly early in the pandemic response period. She noted that locally there were many partners and that excellent working relationships had evolved. Over 6000 doses of H1N1 vaccine were administered. There were no reported deaths attributed to H1N1 in Jefferson County. Dr. Locke noted that the H1N1 pandemic response had been an important test of our • emergency response capabilities, and that there are always lessons to learn in the aftermath of this type of event. He said that he has been promoting the message that the H1N1 pandemic was a trainer pandemic. He believes we were incredibly lucky in many ways. He said that the response plan that had been developed since 2005 worked well, but that it would be unwise to suspend efforts in preparedness activities. Dr. Locke said that statistics are still coming out and noted that the pediatric death rate, much of it in the 8 -12 year age range, was four times what is normally seen with seasonal influenza. Most of the children had medical conditions, such as asthma. Even in their mildest form, pandemics result in deaths. Future pandemics, such as one caused by H5N1 (Avian Flu), will likely be far more severe. Julia Danskin added that public health authorities have recognized that it is important to focus on the spread of all diseases, not just H1N1. She provided sample hand sanitation kits that are used to promote the importance of personal hygiene in preventing the spread of communicable diseases, especially influenza. Member Nelson said that she was impressed with the report, particularly the conclusions and the information showing what worked and what needed adjustments. She noted that e-mail communications had to be improved and that Jefferson Healthcare data had not been available for this report. Ms. Danskin explained that there had been a problem with the electronic identifier for Jefferson Healthcare which she believed had since been • Page 4 of 11 resolved. Another problem with passing e-mail communication to the hospital EMR (electronic medical record) system was also being addressed. • Chair Russell asked what the biggest problem had been in trying to respond to the H1N1 pandemic. Ms. Danskin said that the late arrival of H1N1 vaccine had presented the biggest challenge. In addition, projected expectations about vaccine shipments were far off the mark on several occasions. In summary, the biggest problems were due to insufficient resources at the times when they were most needed; Ms. Danskin said that this was a nation-wide problem. In addition, there were multiple layers of information available through web sites, e-mail, bulletins, etc. that were not always perfectly synchronized. Locally, staff and community agencies cooperated very well under the circumstances. Ms. Danskin noted that staff did an excellent job of handling phone calls, listening to concerns, clarifying information and allaying fears of concerned citizens. In response to a question, Dr. Locke noted that the human mortality rate for Avian flu is about 65%. However, although H5N1 is endemic in birds, it is very hard to transmit to humans, except through airborne exposure to the droppings. Dr. Locke explained that such a lethal virus cannot spread widely because it rapidly kills its hosts. To become a serious pandemic threat, the virus would need to change significantly, becoming more contagious and less lethal. National Health Reform Legislation: Impact on Public Health and Prevention Activities • Dr. Locke said that in preparing for a recent talk and panel discussion for the League of Women Voters he had done research and focused on the impact of health care legislation on public health and prevention activities. He noted that there are significant funds associated with the legislation, some of which has already been allocated and some which are potential sources. He referred to the summary in the packet prepared by Trust for America's Health, which he said is among the best references he has found. Dr. Locke described the major categories of changes/provisions. The bill expands clinical preventive services, access to wellness services, and personal prevention plans within the health care sector. It requires that private insurance plans, Medicare and Medicaid pay for these types of services. He pointed out the reason that insurers have been reluctant to cover prevention: the return on investment for preventive services may be years away and may not be realized by the same insurer who covers it today. He said that virtually the entire range of proven clinical preventive services will be eligible for mandatory coverage. There is also a system for determining which services should be funded, based on ratings of the US Preventive Services Task Force. The second category of changes involves the creation of a National Prevention, Health Promotion and Public Health Council within Health and Human Services headed by the US Surgeon General to provide coordination and leadership at the federal level. This council, with a twenty five member citizen advisory board, will have responsibilities for • Page 5of11 developing national prevention strategies and policies,as well as for expanded access for chronic disease management and for looking at gaps in the public health system. The area that potentially affects the public health sector the most is the Prevention and • Public Health Fund. As initially proposed,this would have been$10 billion per year nationally, or$200 million per year for Washington State. The funding has been scaled back to about$15 billion over ten years (page 3 of the summary). This is not subject to annual congressional decision and appropriation, but can be abolished by a subsequent congress. Among the many things that can be funded are demonstration projects such as: community transformation grants, "Healthy aging, Living well" projects for pre- Medicare age groups. Dr. Locke believes that Jefferson/Clallam Public Health, hospitals, Tribes and other community agencies are well positioned to take advantage of these grant opportunities collaboratively. He mentioned the Strategic Plan for Rural Health developed by a Washington State Hospital Association taskforce over the last few years would be an excellent model for a community grant. In addition, there are areas dealing with nutrition, labeling requirements for restaurants, and actions that aim at improving diets with respect to salt, sugar, and fat content. He said that this is a huge problem and these actions would hopefully have positive impact. Member Austin asked if making people aware of food content, particularly fat and sugar, has been effective in changing eating habits. Dr. Locke said he was unaware of any research on this subject. He noted that there is new evidence that dietary salt intake is a huge factor in high blood pressure and stroke risk. He said that reducing average salt intake by a gram a day would be a far more effective way to prevent strokes than investing in expensive new medical technologies. • Another large planning issue is the health care work force,particularly for rural health care delivery and for public health. Dr. Locke noted the graying of public health work force and expected retirement of a substantial percentage in the next 5-10 years. He mentioned training programs, loan repayment programs, mid-career reeducation and pilot programs in this legislation. All of these programs/funds are part of the Patient Protection and Affordable Care Act (PPACA). Dr. Locke said that much of what Congress has directed is not yet specific and federal agencies are charged with designing appropriate programs and processes. He said that Public Heath has a huge amount of research data about what works, but has never been funded adequately to implement these ideas. There is a requirement in this new bill that non-profit hospitals conduct community needs assessments every three years and use this information to set planning priorities. He noted that there variations of interpretation with regard to community needs assessment versus community health assessment. The public hospital districts in this area are very interested and motivated in doing this function, and there is now actual authority for undertaking this responsibility. • Page 6 of 11 T There was a brief discussion regarding the portion of the legislative initiatives and provisions that have been funded. Dr. Locke said that in many cases a category of • activity has been authorized, but there is not yet funding. Once proposals and grant requests are brought forward, there will be need to prioritize; Dr. Locke expects that Congress will need to revisit and refund areas that prove to have cost impacts. What is missing from the bill as a whole is an aggressive cost-containment focused approach. He cited the Public Health argument that the only way to afford universal access is to make people healthier. He believes this is possible, noting that the US is 24th in the world with regard to population health. There was also discussion about the distortion caused by the current situation of 47 million uninsured. Dr. Locke noted that this could be the golden age of public health, i.e. massive investment in community health versus massive increases in the cost of treating illness. Ms. Danskin said that she is just becoming aware of certain complexities and implications of the bill. She cited an example of teen pregnancy prevention program funding that is limited to State agencies. She cited another example where States must develop Home Visit proposals and submit them to the federal government; local jurisdictions may join State agencies or regional groups in order to qualify for funds. In conclusion, the collective set of programs that have been set up are a compendium of things that have been proven to work—an encyclopedia of evidence based practice in all these areas, and thus are candidates for funding; many do not yet have allocated dollars. • Draft Invitation Letter Dr. Locke recalled that the intention to embark on an updated community health assessment had been discussed at the previous BOH meeting. To date, there have been meetings with representatives of the Hospital and with Sam Marco from Mental Health. He pointed out that the work is being done in the context of the national health care reform effort, which touches on needs assessment and opportunities for improved chronic disease management and prevention. Dr. Locke referred to the draft letter in the packet as a work in progress. He said that it is evident that the BOH would be the best convener for the assessment effort and for inviting individuals to participate. He suggested a two stage process, with the first goal of convening a Data Steering Committee to identify available data, determine focus areas, and to prepare material for a larger group. He noted that Vic Dirksen had suggested that a process with good preparation and a relatively short time line of intensive effort would yield better results than a more drawn out process. It is uncertain whether it is feasible to get that level of commitment from participants. However, he said it may be feasible if linked to opportunities for community transformation grants, which could generate substantial amounts of money. • Page 7 of 11 There was a discussion about the most appropriate time to convene the working groups. After consideration of delaying until the fall, there was agreement that the process would take time and should begin as soon as possible. Dr. Locke said that the focus should be . on identifying the service gaps, where Public Health and other agencies could be doing more but have not been able to assign the resources. In addition, he said that the process should generate data that can be used for applying for community transformation grants within a very competitive process. There must also be new data systems such as electronic medical records that show whether or not practices and initiatives are working, as well as ways to address interoperability among existing systems. Member Westerman noted that including a good description of the group composition, timeline and collaborative process in any grant application would be beneficial. She also suggested adjustments to the draft letter that clearly identify the goal of positioning for federal funds. She said it is important to convey that we are preparing ourselves to compete for funding, and not only to update studies/assessments as in the past. In addition, it should be clear that what we will do with the funding is to address the gaps as well as support services already in place. She said that message would incentivize the community to provide more expertise and help with the whole process. Member Sullivan suggested a positively worded invitation to rise to the challenge. A member of the audience brought up the notion of`enlightened self-interest'. Dr. Locke said he would include those ideas and suggestions, as well as to mention specifically some of the items included in the new legislation. There was a brief discussion about possible approaches to developing a new draft and getting Board • approval. It was agreed that Dr. Locke would place this topic on the agenda and include the next draft letter in the packet for the June 10 meeting. National Accreditation of State and Local Health Departments Dr. Locke and Julia Danskin described the performance evaluation process that the Health Department goes through every three years. There have been State standards for Public Health; five function areas have now grown to twelve function areas. Washington State was one of the first in the country to enact laws mandating this process. At the national level, an accreditation process has now been developed. This is a drive to establish standards for performance for local health departments. A team of evaluators visit local departments to determine whether they are meeting, exceeding or not meeting the standards. The last onsite visit was in May 2008. The outcome report from that audit was presented to the BOH in the fall of 2008; a copy is available online. The next scheduled evaluation will take place in the spring of 2011. Dr. Locke explained that, for the next round, counties may decide to also apply for national accreditation. In those cases, the auditors will perform the audit using the • Page 8 of 11 I combined state/national standards; there is about an 80%overlap. Federal accreditation includes additional standards. Kitsap and Clallam have decided to go for the full 100%; Dr. Locke said he recommends that for Jefferson County,as well. He said he supports the notion that critical evaluation of performance improves quality. Member Austin inquired about the resources required to prepare for the audit. Dr. Locke and Julia Danskin said that the process is very data intensive and requires the assemblage of many forms of records. It was noted that the BOH meeting minutes and documents are important components of that collection. Ms. Danskin indicated that this effort would require only her time, with some medical records and administrative support to gather existing records. It was noted that federal accreditation is still somewhat controversial at the State level. There are some who believe that the additional effort is not warranted or that ratings do not truly reflect quality and high performance. Staff believes that the process does verify what is already being done, and does help to identify gaps and improvement opportunities. In addition, with the advent of health reform legislation, accreditation may be of benefit in acquiring federal funds. BOH members agreed that Jefferson County should be evaluated for federal accreditation in the 2011 round of performance evaluations. Interlocal Contracting for Environmental Health Director Services • Dr. Locke provided information on the search for an Environmental Health Director. He said that an excellent candidate had been found, a person who is currently with the Kitsap Health Department. However, a counter proposal was made by Kitsap County whereby the person would have part-time responsibilities in both counties, under an interlocal agreement. Dr. Locke cited experience with such arrangements, as for his own position of Health Officer for both Jefferson and Clallam counties. Although the negotiations are still in progress, Dr. Locke said the individual would likely spend about 40% of his time working for Jefferson County; he would continue to live in Poulsbo. He explained that help is needed with high level administrative work and to carry out grant commitments, as well as to move forward with onsite septic code revisions and the homeowner inspection program. He noted that formal standards for homeowner inspection have not yet adopted at the State or local level, although there is broad support for the concept. There was a brief discussion about the status of this issue in Clallam and the fact that there are now models for Jefferson County to evaluate and/or customize for its own use. There was discussion about whether or not this position would be adequately served by a part-time Director. Member Nelson noted that the alternative of hiring a full time person who would also be part of the community may be preferable; she noted that under a • Page 9 of 11 commuting arrangement, Jefferson County may receive even less than 40% of the person's energy and time. Veronica Shaw cited the commonalities shared by Jefferson and Kitsap counties and the specific experience of the candidate with multiple important programs. She said that she believes this arrangement would work and would be beneficial for Jefferson. It was noted that, because of the qualifications,this position has been fairly difficult to fill and that it may be better to have an expert part-time than someone who is less qualified full- time. A member of the audience, Tom Brotherton, suggested that one obstacle may be a "conflict of interest" in attempting to serve two different counties. Mr. Brotherton went on to introduce himself as an attorney working for the Jefferson County Prosecuting Attorney's staff and a"legal advisor"to the Board of Health. Veronica Shaw said that the contract had been be reviewed by David Alvarez, the Health Department's legal advisor and the final agreement will also be reviewed with him. In response to a question from Member Sullivan, Mr. Brotherton confirmed that he had not been assigned to be an advisor to the Board of Health by the County Prosecuting Attorney. ACTIVITY UPDATE Frances Joswick, SAAB, reported that the preparation of a second Department of Justice grant application focusing on substance abuse and mental illness is in progress. Austin informed the BOH of a scheduled,press interview on Monday June 7, • Member 12:30 PM, at Mountain View. The purpose is to release the results of SAAB research on the amount of money spent in this County as a result of substance abuse. It is an estimate, based on a template developed by Columbia University that includes costs for: hospitals, jail, law and justice, mental health, Child Protective Services, lost work and other components. Member Austin said that the preliminary results indicate at least$15 million per year, which is equivalent to the entire Jefferson County General Fund. He invited others to attend. Member Johnson requested clarification on the processes available to the BOH for review, editing and approval of a document, such as the draft letter discussed earlier, particularly when it is impractical to do within a meeting. Mr. Brotherton advised that any official actions should be taken during a public meeting; any action considered by a quorum must be done within a meeting. Dr. Locke stated that for routine letters, the BOH decides in advance which person is authorized to review and sign on behalf of the BOH. In special cases, a higher level of participation by BOH members may be desirable and that should be done during meetings of the Board. AGENDA PLANNING CALENDAR • Page 10 of 11 The next BOH meeting is scheduled for June 10, 2010 (second Thursday instead of third Thursday) in the Health Department Conference Room. • Roberta Frissell indicated she would be unable to attend due to travel arrangements. ADJOURNMENT Chair Russell adjourned the meeting at 4:32 PM. JEFFE' ON CO TY BOA' 1 OF HEALTH / I Afr d t Chuck Rus -11, Chair / Phil Johnson, -mber s\ lir\ r (iflit / Kristen Nelson, Vice-Chair Jib Aus,4n , Member / i ///, ... l p-• 'i IL _ ten. Roberta Frissell, Member David Sullivan, Member C.-36'\"6--0 44/ W-61-,-------, Sheila Westerman i Page 11 of 11 Jefferson County Board of 3-feaCth, Old Business Agenda Item # 1 Puget Sound Septic System • Repair Loan Program June 10, 2010 • sF Washington St t 44. � ,Envaronmenta Health Directors Leading,Developing&Influencing Environmental Health PO Box 68 k South Bend,WA 98586 June 1, 2010 Mr. David Dicks, Executive Director Puget Sound Partnership P.O. Box 40900 Olympia, WA 98504-0900 RE: PUGET SOUND SEPTIC SYSTEM REPAIR LOAN PROGRAM Dear Mr. Dicks: On behalf of the Environmental Health Directors of the Puget Sound local health jurisdictions listed at the end of this letter, I am writing to you to request your agency's assistance to help develop a regional approach to financing septic system repairs.Specifically,we are asking for the Partnership's help to identify and secure funding from federal, state,and/or other sources to provide needed capital to create • a self-sustaining loan fund program for septic system repairs. We envision a type of public/private partnership, similar to the Hood Canal Regional Septic Loan Program, to provide various types of low- interest loans to individual property owners to repair failing septic systems. Failing septic systems are, and will continue to be, a threat to the health of Puget Sound, its resources, and its people.The Puget Sound Partnership(and its predecessor the Puget Sound Action Team), Local Health Jurisdictions, the Departments of Health and Ecology,the Legislature, shellfish growers, environmental groups, county governments, and even the Legislature all agree that finding and repairing failing septic systems is one of the highest priorities for cleaning up Puget Sound. In fact, there are several state codes that require the 12 Puget Sound Local Health Jurisdictions to develop and implement programs to identify and correct failing septic systems, in addition to the Puget Sound Partnership Action Agenda which includes several action items (Section C.4.) related to finding and enforcing the repair of failing septic systems and providing a method for homeowners to pay for needed septic system repairs. All Puget Sound Local Health Jurisdictions are implementing approved local management plans, and all are actively finding and enforcing the repair of failing septic systems. But the missing cog in this equation is financial assistance for the individual homeowner to repair their failing septic system. • Mr. David Dicks Page 2 The typical costs for a replacement septic system ranges between$10,000 to$30,000 and more.These costs, especially during tough economic times when loans are very difficult to come by, can make a septic system repair unobtainable even when the homeowner wants to do the right thing. Homeowners 1111E need help.This issue was brought to the Partnership's attention in a November 2008 letter by the Puget Sound Environmental Health Directors. There are programs that have successfully addressed this funding dilemma.The Hood Canal Regional Septic Loan Program, managed in partnership with Shorebank Enterprise Cascadia and the counties of Kitsap,Jefferson, and Mason, has a successful track record and seems to be an ideal model for a Puget Sound-wide program. In less than three years the public/private partnership of the Hood Canal Regional Septic Loan Program has financed over 200 sewage system improvement projects.These projects ensure that over 25 million gallons of sewage annually is properly treated before reaching ground or surface waters. More than $5.7 million has been infused into the regional economy through more than 100 small businesses,while retaining nearly 60 family wage jobs and helping over 90 low income families have the resilience to keep their homes.The program succeeded in meeting the numerical goal set in the contract between Ecology and Kitsap County one year earlier than planned.The response has been outstanding and the need for the initiative and the demand for the loan product have been well established. A side benefit of this program is that homeowners are more likely to allow health district inspections of their septic systems when we can tell them that there is an affordable financial assistance option • available to help them with a septic problem if they have one.This is crucial! Obtaining homeowner permission to conduct septic inspections is the only way to find failing or unknown septic systems--- health inspectors are not allowed on private property without the homeowner's consent. Please help us clean up Puget Sound. Please help provide the resources needed to establish a regional septic system repair loan program, like the Hood Canal model, for the entire Puget Sound Region. Please call (360-337-5284)or write if you have any questions or need further information. Sincerely, Keith Grellner Art Starry Andy Brastad Kitsap County Health District Thurston County Health Dept. Clallam County Health Dept. Aaron Henderson Debbie Riley Jean Baldwin Island County Health Dept. Mason County Health Dept. Jefferson County Health Dept. Steve Marek Larry Fay John Wolpers Tacoma-Pierce County Health Seattle-King County Health Dept. Whatcom County Health Dept. Mark Tompkins Corinne Story Randy Darst • San Juan County Health Dept. Skagit County Health Dept. Snohomish County Health Dist. • ,Jefferson County Board of 3-leaCth. OCcCBusiness .agenda Item # IV, 2 • Correspondence June io, 2010 • Jean Baldwin From: Tom Brotherton [tbrot@msn.com] • Sent: Friday, April 02, 2010 6:05 PM To: Jean Baldwin Cc: Michael Whittaker Subject: Meeting Request Follow Up Flag: Follow up Flag Status: Flagged Hello Ms. Baldwin, We have a concern which you may be able to address and we would appreciate it if you would meet with us in the near future. First, we know there are many dedicated people in public heath doing their best in trying times, and we do not know of any programs which are not doing good work for the people. Our concern is that we have located some information that raises a concern about your department's operations. We have not identified any errors in the information despite reviewing six hundred pages of Public Health budget information and two meetings with your staff. It is possible the information we have is inaccurate or just misunderstood, but despite our best efforts, it remains both validated and a mystery. Specifically, there are several items which, taken together paint a troubling picture: 1. The State Auditor's Local Government Financial Reporting System shows that Jefferson County spends the • most money per capita on public health of all counties in Washington. 2. A comparison of the 2010 budgets of Jefferson County and Clallam County shows that we spend about twice as much per capita on public health as Clallam County 3. The State Health Department's report card shows that Jefferson County scores about average among the Washington Counties and lowest in Environmental Health. On the surface, it appears the citizens of Jefferson County are paying top price for an average product. We are trying to determine if some or all of this data is inaccurate or possibly comparing incomplete elements and hope you can clarify these discrepancies. Please let us know if you can meet with us in the near future. Thank you, Tom Brotherton Mike Whittaker IIII i JEFFERSON COUN1Y PUBLIC RtALTH 615 Sheridan Street • Port Townsend $Washington - 98368 www.jeffersoncountypublichealth.org • April 23, 2010 Mike Whittaker Thomas Brotherton 170 Moon Valley Road 255 Cascara Drive Quilcene,WA 98376 Quilcene,WA 98376 Gentlemen: I am writing to respond to your email of Friday,April 2nd expressing your concerns over a"troubling picture"regarding the funding of public health services in Jefferson County. After your review of over 600 pages of documents,you have cited three areas of concern: 1. "The State Auditor's Local Government Financial Reporting System shows that Jefferson County spends the most money per capita on public health of all counties in Washington. 2. A comparison of the 2010 budgets of Jefferson County and Clallam County looks like Jefferson County spends about twice as much per capita on public health as Clallam County. 3. The State Health Department's report card shows that Jefferson County scores about average among the Washington Counties and lowest in Environmental Health." I will respond to each of these concerns,briefly, in this letter with the hopes of clearing up any misunderstanding or misinterpretation of the financial and health status data you have reviewed. • 1. Local health jurisdictions vary widely in the range of services they offer. Some provide only the minimum amount of services(i.e.those strictly mandated by statute). Others offer a much broader range of services(e.g. family planning,maternity support services,nurse family partnership programs, etc.). Per capita expenditures for public health are not readily comparable from county to county. The range of services and the number of people served is the main reason that per capita costs vary from county to county. In addition, counties differ in how they allocate and report indirect costs such as rent,utilities,and information technology services. Some record all direct and indirect expenses in their departmental budgets(like Jefferson County),others report only direct program expenses with indirect expenses appearing in other county budget lines. To accurately compare one county with another,you need to look at budgets on a program by program basis adjusting for the scale and complexity of the program services. You also need to adjust for any variations in accounting practice. 2. A comparison between Clallam and Jefferson counties illustrates this point well. Clallam County Health and Human Services provides a narrow range of statutorily mandated services along with programs authorized and paid for by specific contracts with state and federal agencies. Family planning and most maternal-child support services are provided by other community agencies. Jefferson County Public Health provides all of these services through the local health department and programs that are not available in Clallam County— nurse family partnership visiting nurse programs,Child Protective services contracts and family planning. To further complicate the comparison,different systems are used to allocate indirect costs. 10 COMMUNITY HEALTH ENTAL HEALTH DEVELOPMENTAL DISABILITIES PUBLIC HEALTH ENVIRON WA ER 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 3. The Washington State Department of Health does not have a report card comparing counties with respect to public health and environmental health indicators. You are likely referring to a recent report produced by the Wisconsin Department of Health and funded by the Robert Wood Johnson • foundation that used publically available data sets to compare counties within each state("County Health Rankings: Mobilizing Action Toward Community Health). Jefferson was rated#11(out of 39 counties)in terms of Health Outcomes and#8 with respect to Health Factors,the two summary measures that were used to determine overall ranking 5th in social and economic factors. Jefferson did score at the bottom of the list of Washington counties for"physical environment". To understand these measures you must know what specific data was being analyzed. In the case of the physical environment measure,two measures of air quality(ozone levels and particulate matter),and two measures of built environment(access to health foods and number of liquor stores)were used. None of these measures have any direct bearing on environmental health services provided by Jefferson County Public Health. Air quality is regulated by state and federal agencies. Location of health food and liquor stores is beyond the jurisdiction of a local health department. Performance data is available for local health departments based on a series of standards for public health practice that was developed as part of Washington State's Public Health Improvement Plan. These reports were not among the documents you reviewed. They are available at the Washington State Department of Health's website(doh.wa.gov). Based on performance measures,Jefferson County ranked high among comparable rural health departments. In addition to these statewide measures,Jefferson County Public Health maintains comprehensive performance measures for each program it offers. These performance reviews are presented to the Jefferson County Board of Health on an annual basis during their public meetings. In summary,you need not be troubled by the data you have reviewed as it does not support the conclusions you have drawn. Jefferson County has long striven to be a leader among rural local health . departments in Washington State with respect to the quality, scope,and performance of its programs. Local funding represents approximately 18 % of total annual expenditures. The rest is provided by grants, state/federal contracts,and fees. Adequate funding for public health is one of the wisest investments a community can make. The return on this investment is measured not only in dollars saved (through illnesses and injuries prevented)but also in the improved quality of life,productivity, and extended life span the recipients of public health services enjoy. Some services have been found by the Washington Institute of Public Policy to provide cost savings to other county services such as juvenile justice and courts. Thank you for your interest in public health funding and performance measures. If you have lingering concerns about the value of public health services provided to Jefferson County,you may wish to address these concerns to the Jefferson County Board of Health—the policy and governance board entrusted with the responsibility of overseeing the provision of public health services in this county. Sincerely, Jean Baldwin,Director Jefferson County Public Health COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES ALWAYS WORKING WATER QUALITY MAIN: 360-385-9400 MAIN: 360385-9444 FAX 360-385-9401 HEALTHIER COMMUNITY FAX: 36(1379-4487 Jefferson County Board of Health OCdBusiness Agenda Item # [V, 3 • Exemption to Netiv Bottled-Water T"ax June 10, 2010 • F STAT ttliiittE:Ei 2 by 1889'''3v • STATE OF WASHINGTON DEPARTMENT OF REVENUE HEALTH DEPARTMENTS: PLEASE SHARE THIS INFORMATION Condemned well may qualify consumer for sales tax refund or exemption Beginning June 1, 2010, sales tax will apply on purchases of bottled water. (Second Engrossed Substitute Senate Bill 6143, Chapter 23 Laws of 2010 [Section 901-910]). See attached copy of our Special Notice. However, if you purchase bottled water because you have no readily available source of potable water, you are eligible for a refund of the sales tax you paid. Retailers are required to collect sales tax when they sell bottled water at their location. You may request a refund of the sales tax paid from the Department of Revenue. (See How to request a refund below.) If you purchase water from a delivery service (that sells the water in reusable containers that are not sold with the water), you may provide the seller with a Buyer's Retail Sales Tax Exemption 411 Certificate and not pay the sales tax. How to request a refund Once you have paid at least$25 in sales tax on purchases of bottled water, you may request a refund from the Department. Go to our website at dor.wa.gov/consumerinfo and click on Apply for a refund. Download the Application for Refund or Credit. You can also receive a refund application by calling 1-800-647- 7706. Submit the completed application and proof of the sales tax paid (copies of sales receipts)to: Attn: Refunds Department of Revenue PO Box 47476 Olympia, WA 98504-7476 If you have questions Visit our website at dor.wa.gov/consumerinfo or call our Telephone Information Center at 1-800- 647-7706. • 4 ecia Notice • WASHINGTON STATE DEPARTMENT OF REVENUE MAY 11, 2010 Bottled Water Subject to Sales Tax Background Second Engrossed Substitute Senate Bill (2ESSB) 6143, Part 9, temporarily extends the sales tax to retail sales of bottled water, while providing limited exemptions. Summary Purchases of bottled water are subject to sales or use tax beginning June 1, 2010, through July 1, 2013. What is bottled Bottled water is water that is placed in a safety-sealed container or package for human water? consumption. Bottled water is calorie free and does not contain sweeteners or other additives except that it may contain: (i)Antimicrobial agents; (ii) fluoride; (iii) carbonation; (iv) vitamins, minerals, and electrolytes; (v) oxygen; (vi) preservatives; and (vii) only those flavors, extracts, or essences derived from a spice or fruit. Bottled water includes water that is delivered to the buyer in a reusable, safety-sealed container that is not sold with the water. Bottled water does not include ice. For this reason, 2ESSB 6143 does not affect the taxability of ice. The Department of Revenue (Department) rule, Washington • Administrative Code (WAC) 458-20-244 explains that sales tax does not apply to ice sold in cubed, shaved, or crushed form in packages or quantities of ten pounds or less. However, sales tax does apply to ice sold in bags, containers, or units of greater than ten pounds and blocks of ice of any weight because such ice is not considered a food or food ingredient. Bottled water also does not include water that is dispensed from a self-service dispenser, such as those available in grocery stores, when the container is not safety-sealed. It makes no difference if the buyer uses their own container or separately purchases an empty container from the seller. The charge for the container is, however, subject to sales tax. If you have a question about the taxability of a specific product, you are encouraged to provide a copy of the product label and request a ruling from the Department.A tax ruling may be obtained by writing to: Taxpayer Information and Education PO Box 47478 Olympia WA 98504-7478 Or send an email to rulings@dor.wa.gov P.O. BOX 47478 1 OLYMPIA,WASHINGTON 98504-7478 ( 1-800-647-7706 1 HTTP://DOR.WA.GOV To inquire about the availability of this document in an alternate format for the visually impaired,please call (360)705-6715. • Teletype (TTY) users please call 1-800-451-7985. Exemptions The new law provides two exemptions for purchases of bottled water. Buyers claiming an exemption are responsible for keeping records that verify their eligibility for the exemption. 1. No source of potable water Retail sales and use taxes do not apply to sales of bottled water for human use to persons who do not have a readily available source of potable water. Potable water is water that is safe for human consumption. 2. Water dispensed to patients pursuant to a prescription Retail sales and use taxes do not apply to sales of bottled water for human use dispensed or to be dispensed to patients, pursuant to a prescription for use in the cure, mitigation, treatment, or prevention of disease or medical condition. "Prescription" means an order, formula, or recipe issued in any form of oral, written, electronic, or other means of transmission by a duly licensed practitioner authorized by the laws of this state to prescribe. Claiming the Refund for exempt bottled water purchased at the seller's location exemptions A seller that sells bottled water at the seller's location, such as a grocery store, must collect sales tax regardless of whether one of the above exemptions applies. The buyer may request a refund directly from the Department when the cumulative amount of sales tax paid for exempt bottled water is at least$25. The buyer must provide copies of receipts to the Department to verify the amount of sales tax paid for bottled water. A buyer may accumulate receipts for multiple purchases of exempt bottled water to meet the $25 threshold for a refund. However, the buyer must request the refund within four • years of the end of the year in which the tax was paid to the seller for the initial purchase of exempt bottled water. A form and instructions for requesting a refund will be available on the Department's website (dor.wa.gov) before June 1st. Example:A homeowner receives notice from their water district that the water supply is temporarily contaminated. During the period of contamination, the homeowner relies on individually-sized bottled water purchased at a local grocery store. The homeowner must pay sales tax to the seller when purchasing the water. During the contamination period, the homeowner paid $30 in state and local sales taxes on bottled water and saved the receipts. The homeowner may request from the Department a refund of the tax paid. Bottled water purchased from a delivery service A seller, such as a water delivery service, that delivers water to the buyer's location in a reusable container that is not sold with the water is not required to collect the sales tax when the buyer provides the seller with an appropriate exemption certificate. The buyer must complete the certificate and indicate the reason for the exemption. When making tax-exempt sales of bottled water that is delivered to the buyer's location, the seller may accept a completed copy of either a Buyer's Retail Sales Tax Exemption Certificate or a Streamlined Sales Tax (SST) Exemption Certificate. Both exemption certificates are available on the Department's website. .4r When reporting sales of bottled water, the seller must include exempt sales of bottled water in their gross sales under"Retail Sales" (line code 01) and then claim a deduction on the deduction detail pages under"Other" (line code 0199) specifying "exempt . bottled water" as the reason for the deduction. The seller must also keep the exemption certificates with the business records for five years after the most recent sale made under the certificate. Example:A homeowner receives notice that the community well from which the homeowner receives water will be contaminated for an extended period. The homeowner contracts with a service to make deliveries of water to their home. Each week, the delivery service delivers water in sealed five gallon containers and retrieves any empty containers. The homeowner may provide a Buyer's Retail Sales Tax Exemption Certificate or SST Exemption Certificate to the delivery service to exempt the sale of bottled water during the contamination period. Signs for retailers A small sign explaining that candy, bottled water and gum are subject to sales tax can be downloaded from the Department's website. The sign also provides consumers with a web address for more information. Retailers may print the sign to post in appropriate places. SNAP Retail sales tax does not apply to products, including bottled water, purchased under the (Food Stamp Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Stamp Program) Program. For further information, please refer to WAC 458-20-244. For more To learn more about this new legislation, visit our website at dor.wa.gov/newlegislation • information and click on Bottled water exemption repealed. For questions, send an email to dorcommunications@dor.wa.gov, or call the Department's Telephone Information Center at 1-800-647-7706. • Jefferson County Board of 3-Cealt( OCd Business Agenda Item # IV, 4 New Low-Cost 3-Cealth • Coverage Offered June io, 2010 • i ,titg4?) Washington State • Health Care Authority P.O.Box 42700 • Olympia,Washington 98504-2700 360-923-2828 • FAX 360-923-2606 • TTY 360-923-2701 • www.hca.wa.gov FOR IMMEDIATE RELEASE: May 24, 2010 CONTACT: Dave Wasser 360-923-2711 State offers low-cost health coverage to thousands of uninsured (OLYMPIA, WA) —With more than 100,000 people on a waiting list for the state's Basic Health program, low-income Washington residents are finding few affordable options for health care coverage. To address this pressing need, the state is introducing the Washington Health Program—a non- subsidized version of the state's popular Basic Health program. Washington Health and Basic Health are both administered by the Washington State Health Care Authority(HCA). "Health care reform is on the way, and it will provide greater health care access to millions of Americans," said Washington Governor Chris Gregoire. "But thousands of Washington residents can't wait for 2014. They need coverage now—and Washington Health provides them with an affordable option." • Basic health provides coverage to 66,000 Washington residents, with the state paying a portion of their premiums based on their income level. Washington Health provides essentially the same benefits as Basic Health, but with no subsidy and no cost to the state. Enrollees pay the full premium, plus a small amount for administrative costs. The HCA is contracting with Community Health Plan (CHP) of Washington to provide Washington Health coverage. "Community Health Plan is committed to making high-quality health care available to more people through affordable insurance products," said Lance Hunsinger, CEO of Community Health Plan. "We worked with the Health Care Authority to make sure the Washington Health Program offers both choice and quality at an affordable price. Our focus has always been to provide a low-cost option for those who currently have no insurance at all and we're pleased to be a part of this important step forward for Washington residents." "We are pleased to be able to enhance our working relationship with Community Health Plan," said HCA Administrator Doug Porter. "Providing coverage to 250,000 people in Basic Health, Medicaid and other programs, CHP continues to demonstrate their commitment to provide quality health care to low-income people across the state." Porter said Washington Health's low premiums are due to low administrative costs and caps on annual costs. Washington Health members have the option of choosing $75,000 or$100,000 in health care coverage per year. "This is lower than payout maximums in other plans," said Porter, "but in most cases, $75,000 is plenty of coverage throughout the year." By comparison, less than 2% of Basic Health enrollees accumulated $75,000 total cost in 2009. • (more) N Premiums are as low as$100 per month. A 35 year old could expect to pay between $125 and $183 depending on their location and the coverage options they select. Washington Health is available to any state resident who is not enrolled in Basic Health, Medicaid, or eligible for Medicare. It is designed for low income people, but there are no income limitations. It is available anywhere in the state. Coverage is expected to begin July 1. Applications are being taken now through the Washington Health website at www.washinqtonhealth.hca.wa.gov. Applications can also be requested toll- free at 1-800-660-9840. ### ABOUT THE HEALTH CARE AUTHORITY: HCA is a cabinet-level agency that serves as the state's primary health care purchaser. In addition to Basic Health and Washington Health, HCA administers the Public Employees Benefits Board program which provides health care coverage to more than 330,000 state employees, retired state employees, retired K-12 employees, dependents, and a number of smaller government entities around the state. The agency is also involved in funding for community clinics, state health care policy, and initiatives designed to maximize the state's health care purchasing investment. More information is available at www.hca.wa.gov. ABOUT COMMUNITY HEALTH PLAN OF WASHINGTON: Community Health Plan provides • managed care for more than 270,000 individuals and families throughout Washington State. It is the state's largest insurer of the Basic Health Plan and the second largest health plan serving members of the state's Medicaid program, including Healthy Options, the State Children's Health Insurance Program, and the only insurer for the GA-U (Disability Lifeline) Program. The health plan's delivery system includes more than 540 primary care clinics, 2,365 primary care providers, 13,571 specialists, and 100 hospitals. Community Health Plan also features an incentive program that rewards its members for getting the preventive care they, and their families, need. More information is found at www.chpw.org. • Washington Health Program A Basic Health Plan Overview: Washington Health Program (Non-subsidized Basic Health) What is the need? Over 100,000 Washington residents are on a waiting list to get into the state's Basic Health program. With health care reform in its infancy, and limited funds for Basic Health, there are no alternatives for low-income people needing health care coverage. Individual plans are beyond their affordability. All they have are emergency rooms, where treatments cost the most. When those people can't pay their ER bill,we all pay more for our health care. What is WHP? Washington Health is part of the state's popular Basic Health program—both are administered by the Washington State Health Care Authority. Basic Health provides coverage to 68,000 Washington residents, with the state paying a portion of their premiums based on their income level. WHP provides essentially the same benefits as Basic Health, but with no subsidy and no cost to the state. Enrollees pay the full premium, plus a small amount for administrative costs. HCA contracts with Community Health Plan of Washington to provide WHP coverage. • What is the cost to Premiums are as low as$100 per month. A 35 year old person can expect to pay enrollees? between $125 and$183 depending on their location and the coverage options they choose. This is far less than what is available in the private insurance market. Enrollees also have low deductibles and copayments. Why are costs To hold down costs, WHP members have the option of choosing$75,000 or lower for WHP? $100,000 in health insurance coverage every year. This is lower than payout maximums in other plans, but in most cases, $75,000 or$100,000 is plenty of coverage throughout the year. By comparison, less than 2%of Basic Health enrollees reached $75,000 total cost in 2009. Who can apply? WHP is available to any Washington resident who is not enrolled in Basic Health, Medicaid or eligible for Medicare. It is designed for low income people, but there are no income limitations. It is available anywhere in the state. How to apply There are several easy steps involved in WHP enrollment • WHP applications are available at www.washingtonhealth.hca.wa.gov • A Standard Health Questionnaire must be filled out for each family member requesting coverage. The SHQ is also available online. • Proof of Washington residency More information • Go to the WHP website at www.washingtonhealth.hca.wa.gov • Call 1-800-660-9840 i • Fax 360-923-2610 • Jefferson County Board of Health 061-Business .agenda Item # r7, 5 • 'Why 1/Ve Don't Spend-Enough on Public 3-fealth June io, 2010 • nrRSPECTIVE WHY WE DON'T SFFND ENOUGH ON PUBLIC HEALTH Why We Don't Spend Enough on Public Health • David Hemenway, Ph.D. The field of public health has patience exist in large part be- of identifiable victims than to long been the poor relation of cause of the desire of the ancient those of statistical victims.2 In medicine. Medicine — in which part of our brain, the paralimbic 1987, when 18-month-old Jessica most resources are used to help cortex, for immediate gratifica- McClure fell down a well in Texas, cure individual patients after they tion. Since it takes willpower to the country was enthralled. As a have become sick or injured or delay gratification, individually and nation, we will spend tens of mil- to help manage already-existing collectively we sometimes under- lions of dollars to save one Baby chronic conditions — is flashy, invest in the future. People typi- Jessica but are often unwilling to its master practitioners and in- cally seek medical care because spend an equivalent amount to novators lionized, and its accom- they want quick relief for imme- prevent the deaths of many statis- plishments widely celebrated. In diate concerns — current illness tical babies. We willingly provide contrast,public health—in which or injury. Most public health mea- resources for relief when publi- most resources are focused on sures, however, incur costs today cized catastrophes affect specific trying to keep something bad but don't provide benefits until individuals or communities, from from happening in the first place sometime in the future. New Orleans to Haiti. We are less — is seemingly mundane, its ef- When considering a public willing to provide resources for forts and prime movers often all health investment today (e.g., im- the prevention of such widespread but invisible. proving road safety, preventing devastation. The scandal that peo- Medicine is primarily a private mad cow disease, or limiting cli- ple remember about Hurricane Ka- good — the patient receives the mate change) that will potentially trina is not so much the lack of main benefit of any care provid- yield benefits in the future, many preventive measures (e.g.,stronger ed. Payments usually come from politicians correctly understand levees) that would have averted the individual patient and, in the that their administrations will the calamity but the inadequate • developed world, from private and bear the costs, but the benefits rescue efforts. governmental insurance. Public will be reaped on someone else's Third, in public health, the health, on the other hand, pro- watch. They therefore put great benefactors, too, are often un- vides public goods — such as a effort into putting out today's known. Although public health good sewer system — and relies fires and relatively little into pre- efforts are recognized by some as almost exclusively on government venting tomorrow's conflagra- having played a more important funding. It is generally acknowl- tions. role than curative care in im- edged that public health is sys- Second, the beneficiaries of proving our country's health over tematically underfunded and that public health measures are gen- the past century,3 the American shifting resources at the margin erally unknown. Whereas medi- public, through no fault of its from cures to prevention could cine typically deals with identifi- own, has almost no idea what reduce the population's morbidi- able people(patients),public health public health professionals and ty and mortality. I believe there typically deals with statistical programs do. Public health has are four key reasons for such "lives." The medical care you re- little news value— saving statis- underfunding. ceive is directed at helping you. tical lives doesn't make for good First, the benefits of public Public health interventions, on the human-interest stories or photo health programs lie in the future. other hand, are aimed at improv- ops. Public health also has few Our brains are structured so that ing the health of a group of peo- well-known scientists or leaders. we use different neural systems ple;when lives are saved, it's often Whereas many people have heard when considering the present and unclear whose lives they were. of such medical giants as Michael the future.'The problems of temp- People have stronger emotional DeBakey and Christiaan Barnard, tation, procrastination, and im- and moral reactions to the plights I would venture to guess that few • N ENGL)MED 362;18 NEJM.ORG MAY 6,2010 1657 Downloaded from www.nejm.org on June 3,2010.For personal use only.No other uses without permission. Copyright©2010 Massachusetts Medical Society.All rights reserved. PERSPECTIVE WHY WE DON'T SPEND ENOUGH ON PUBLIC HEALTH know about their contemporary, public health initiatives, such as that the CDC has effectively Maurice Hilleman, a researcher the "great sanitary awakening" stopped funding research on this • who developed more than 30 vac- of the 19th century, which dra- major public health problem. cines (including those for mea- matically reduced the spread of In contrast, increases in re- sles, mumps, and chickenpox) tuberculosis,were met with fierce sources for medical care are usu- and who is credited with saving opposition.4 ally promoted rather than op- more lives than any other 20th- Societal change is hard, and posed by large special interests, century scientist. it is especially difficult when it from pharmaceutical and medical When people benefit from imposes costs on powerful spe- insurance companies to physi- public health measures, they of- cial interests. In the past half- cians, nursing homes, and hos- ten don't recognize that they century, those opposing benefi- pitals. have been helped. In the United cial public health measures have Epidemiologists are taught to States today, it is easy for people included some of our most po- recognize and address the prob- to take it for granted when, on tent political lobbies, represent- lems of systematic error. Hospi- any particular day, they don't get ing the interests of the alcohol, tals are learning to detect and sick at work (because of air- tobacco,firearm,automobile,coal, prevent systematic errors in pro- quality improvements), aren't and oil industries. For instance, viding medications and other poisoned (because the food is Americans who die before 40 practices. Similarly, our country safe), or don't get run over (be- years of age are more likely to needs to understand and try to cause the walkway has been sep- be killed by an injury than a dis- correct systematic policy errors— arated from the road). In the few ease. In the early 1990s, firearms including the tendency to under- cases in which people do recog- were the second-leading cause of invest in public health. nize that they've been helped by injury-related death in the United Disclosure forms provided by the author available are with the full text of this article preventive measures, they rarely States, killing 100 civilians per arg. know who provided the benefit. day. The Centers for Disease Con- In contrast, the help provided by trol and Prevention (CDC) began From the Harvard Injury Control Research Center, Harvard School of Public Health, curative physicians is more eas- spending a disproportionately Boston. ily identified. So whereas grate- small amount of money on this • . ful patients, in turn, provide enormous issue — $2.6 million 1CohMcClureenJD.SSM,eparatLaibsone neuraDl I,systLoewensteinems value iG,_ much financial support for hos- (about a penny per person) on mediate and delayed monetary rewards.Sci- pitals, there is generally no grate- data collection and research each ence 2004;306:503-7. ful public providing substantial year. One CDC funded study of 2. Small DA,Loewenstein G. Helping a vic- tim or helping the victim:altruism and iden- support for public health initia- violent deaths in the home showed tifiability.J Risk Uncertain 2003;26:5-16. tives. that the presence of a gun in the 3. Evans RG, Barer ML, Marmor TR, eds. Why are some people healthy and others Fourth, some public health household was a risk factor for not?The determinants of health of popula- efforts encounter not just disin- such deaths.' But congressional tions.New York:Aldine de Gruyter,1994. terest but out-and-out opposition. delegates on the CDC appropria- 4. Winslow CEA.The evolution and signifi- Such initiatives often require so- tions committee, bowing to the cNewanceHavenofthe moCT:dYaleernpuUniversityblichealthcampaigPress1923. n. , , cietal change, which runs coun- wishes of an outraged gun lobby, 5. Kellermann AL,Rivara FP,Rushforth SB,et ter to the well-documented hu- tried to shut down firearm-related al.Gun ownership as a risk factor for homi- man cide in the home. N Engl J Med 1993;329: man characteristics of"status quo activities at the CDC. Although 1084-91. [Erratum, N Engl J Med 1998;339: bias" and "tradition-bound resis- initially unsuccessful, their at- 928.9.] tance." Even the most successful tempt had such a chilling effect Copyright©2010 Massachusetts Medico)Society. Syphilis and Social Upheaval in China Joseph D.Tucker, M.D., Xiang-Sheng Chen, M.D., Ph.D., and Rosanna W. Peeling, Ph.D. aEyphilis, a sexually transmitted ago,) is now the most commonly No other country has seen such .,)infection (STI) that was nearly reported communicable disease in a precipitous increase in reported eliminated from China 50 years Shanghai, China's largest city.2 syphilis cases in the penicillin era. 1658 N ENGL.)MED 362;18 NEJM.ORG MAY 6,2010 • Downloaded from www.nejm.org on June 3,2010.For personal use only.No other uses without permission. Copyright©2010 Massachusetts Medical Society.All rights reserved. Jefferson County Board of 31- ealth New Business & Informational-Items .Agenda Item # tV, 2 • Community Leadership Letter Revisions June 10, 2010 • June 3, 2010 Name Organization Address Dear Community Leader, Jefferson County faces many challenges. We are in a major recession, with local job layoffs, decreasing personal income, and plummeting governmental revenues. Our neighbors are hurting, "safety net" programs are stretched to the limits, and economic recovery is still a long way off We have gone through difficult economic times in the past and have successfully addressed similar challenges by mobilizing community partnerships to set priorities and solve specific problems. Newly enacted federal legislation, the Patient Protection and Affordable Care Act, provides an unprecedented opportunity to not only improve access to health care and but also to increase our investment in proven disease and injury prevention practices. Communities that are ready to lead the way in developing patient-centered, prevention- oriented, community focused healthcare systems will be well positioned to secure these new"Community Transformation Grants". Our first step is to form a "Steering Committee" and convene a meeting in early summer. The Committee will review the most up-to-date community health information and guide 411 the process of interpreting and prioritizing this information. The goal of this committee is not only to collect and analyze new information, but also to identify gaps in our understanding of community health and to take the specific steps needed to transform the way we provide services for our citizens. Will you join us? A health department representative will contact you in the next two weeks to invite you to a kick off meeting. Thank you for considering the opportunity to become involved in the redesign of our health care system and improvement of the health in our entire community. Sincerely, Chair, Jefferson County Board of Health S Jefferson County Board of Health Netiv Business & .£nformationaCltems .agenda Item # T, 3 • Emergency "Water Plans for Licensed-yoocf Sery ice Establishments June 10, 2010 JEFFERSON COUNTY PUBLICHEALTH ys 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypublichealth.org • DRINKING WATER EMERGENCIES FOR FOOD ESTABLISHMENTS GUIDELINES Remember to always notify Jefferson County Public Health (JCPH) if there is a problem with your water supply, at 385-9444 or 385-9400. Before an Emergency 1. Submit proposed water emergency plan to us. 2. Suggested template: Washington Department of Health, Emergency Water Supply Guidelines for Food Service Establishments http://www.doh.wa.gov/ehp/dw/Publications/331-182 9-1 5-06.pdf 3. Please include your emergency contact information, including cell phone, and email. 4. Your plan will be reviewed and you will be notified of approval. 5. Keep your plan current with us, including changes in owner, service hours, menu, • contact information. During a Water Emergency 1. When there is a problem with the water supply to the establishment, or there is a Boil Water Advisory, contact us at 385-9444 or 385-9400, or check www.jeffersoncountypublichealth.orq 2. Keep the establishment closed until given the OK by us. 3. Even with an approved plan, it may not be safe to operate. CAIVI 0 Tom Locke, M.D. Date Health Officer • COMMUNITY HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES PUBLIC WATER QUALITY MAIN: (360) 385-9400 ALWAYS WOKING FOR A SAFER AND MAIN: (360) 385-9444 FAX: (360)385-9401 HEALTHIER CO UNITY FAX: (360) 379-4487 c,oN JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street • Port Townsend • Washington • 98368 360-385-9400 Fax 360-385-9401 INC, N ' www.jeffersoncountypublichealth.org • December 17, 2009 Dear Food Service Establishment Owner, This letter is to follow up with the licensed food service establishments (FSE) who were impacted by the recent temporary closures caused by a pipeline break in the Port Townsend municipal water system. The water main break caused water flow in the system in increase rapidly, stirring up sediment in large water pipes, and causing discolored water throughout the system. In response, the Washington State Department of Health issued a Boil Water Advisory until the water could be tested for bacterial contamination. Fortunately for all of us in the community, our city's water was tested promptly, confirmed safe the next day, and the Boil Water Advisory was rescinded. Thank you for your immediate action when we called on Monday requiring closure until your water could be assured to be safe for use. Many of you were operating on an emergency plan and some of you had closed already. We appreciate how professionally • this emergency was handled by you. Had the water system experienced serious contamination, your prompt action would have prevented illness in your staff and customers. This water system incident should remind us all that municipal water systems are susceptible to contamination from a variety of sources. Restricting water use and issuing Boil Water Advisories are standard public health practices in such circumstances. On occasion, Boil Water Advisories can persist for extended periods of time. Boil Water Advisories present special challenges to FSE and other commercial establishments that depend on potable water for operation. Having an approved water emergency plan in place can help prevent closure of your establishment during future Boil Water Advisories. We are enclosing some information that would help you write a plan for how you might operate under circumstances where all food preparation must be accomplished with either bottled or boiled water. Please submit your plan to us for approval. Food service establishments with approved plans are generally allowed to continue operation during water emergencies that require Boil Water Advisories. • COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES ALWAYS WORKINGSAFER AND NATURAL RESOURCES 360-385-9400 HEALTHIER COMMUNITY 360-385-9444 i' act Emergency Water Supply Guidelines • for Food Service Establishments September 2006 Restaurants - Food Stores - Schools DOH PUB.#331-182 Institutions - Convenience Stores (P ,ico(11 These guidelines are for establishments that provide food service\o the public. State regulation(WAC 246-215-120)requires that food service establishment(FSE)owners ensure that their water supply is from a source approved by the Washington State Department of Health(WAC 246-290). Procedures During Boil Water Advisory When a boil water advisory is issued for a water system that supplies a food service establishment,the FSE may only remain open with the authorization of the local health agency. If the local health agency does authorize an FSE to operate during boil water advisory, special requirements may be imposed. Minimum Requirements Shut off: Hand washing: • Ice machines • Wash with antibacterial soap and water. • Drinking fountains • Recommended: Use hand sanitizer after • Produce misters rinsing and drying. • Bottled water refill machines Dishwashing options:Follow normal procedures. • Pop dispensers connected to water supply • Mechanical dishwasher with high • Running water dipper wells temperature or chemical sanitizer(verify Discard: correct operation);or • • Three-compartment sink • Ice made with contaminated water 1. Wash in hot water with detergent. • Beverages made with contaminated water 2. Rinse in warm water. 3. Sanitize in cool water chemical sanitizer Ice:Use packaged ice from approved source solution(1 teaspoon bleach per 1 gallon water)or hot water(170 Use boiled or bottled water for: degrees)for one minute. • Drinking 4. Air dry. • Cooking • Food preparation Employee Information: • Washing produce • Post signs or copies of the water system's health advisory. • Develop a plan to notify and educate employees about emergency procedures. The local health agency may impose additional requirements to protect against health hazards during the boil water advisory, such as modifying food preparation steps or prohibiting some menu items. Follow these procedures until notified by the local health agency or the state Department of Health. The Department of Health is an equal opportunity agency. For persons with disabilities, this document is available on request in other formats. To submit a request, please call 1-800-525-0127(TTY 1-800-833-6388). For additional copies of this publication, call 1-800-521-0323. This and other publications are available at http://vwvw.doh.wa.gov/ehp/dw 'T }q • � A r t� :_ .0..�:� • s. • Jefferson County Board of 3-feaCt( New Business & Informationalltems .Agenda Item # 17, 4 • Netiv Jefferson County Public .7CeaCth 6site June 10, 2010 • JCPH Page 1 of 1 iiMi Always working for a healthier Jefferson. Jefferson County Public Health 11 • Home About JCPH Community Health Environmental Health/Water Quality Information Public Health News&Events Our Mission: To protect the health of all Jefferson County residents by promoting safe,healthy,communities and environments. .- ENVIRONMENTAL HEALTH& COMMUNITY HEALTH WATER QUALITY INFORMATION Search JCPH: I Go Clinic Services Business Pollution Board of Health NEWS&EVENTS Communicable Disease Prevention Birth&Death Records Immunizations Drinking Water/Wells Public Forms Anderson Lake Toxin Very High Family Support Services EH Fee Schedule For Health Care Providers School/Child Care Service Food Safety Public Health Links Conservation Futures Proaram-Public Hearing Tobacco/Substance Abuse Septic Systems Public Records Developmental Disabilities Solid Waste Publications&Data Cash for Appliances Water Quality TLC for Septic Systems: Protect your investment& health Healthiest Nation in One Generation You might think we're one of the healthiest nations,but we're not.Compared to See all news items... other developed nations,we're lagging far behind.The thing is: It doesn't have to be this way.We can make this the healthiest nation in one generation.Committing to a healther America is something we all can do. ' Q it1jne coni 0 Watch the video: "This is What Public Health Does. What are You Doina?" , Anderson Lake Toxin Very High 4x4, 1 y Shellfish Current lab results show very high toxin concentrations in Anderson Lake. F Sdfet • Anderson Lake is undergoing a spring bloom made up predominately of the genus EN+naoSr4Hs Anabaena.Tests performed at King County Environmental Labs show that this bloom is producing anatoxin-a,a potent neurotoxin.Water samples taken on May INFORMATION 11,2010 show anatoxin-a concentrations at 103 pg/L which is 100 times the proposed safe recreational limit of 1 pg/L. © Learn more... ":," Jefferson County Public Health 615 Sheridan Street-Port Townsend,WA 98368 Community Health:360.385.9400 I Environmental Health:360.385.9444 t„,” info@jeffersoncountypublichealth.org Website by:Lineangle 111 http://wwwjeffersoncountypublichealth.org/index.php effersoncountypublichealth.org/index.php 6/4/2010 • Jefferson County Board of Health Nledia Report • June io, 2010 • Jefferson County Public Health May/June 2010 NEWS ARTICLES 1. "Health chief sets speech to PA chamber," Peninsula Daily News, May 16th, 2010. 2. "Rural health care remedy offered," Peninsula Daily News, May 18th, 2010. 3. "It's back: Toxic algae bloom closes Anderson Lake," Port Townsend Leader, May 18th 2010. 4. "Anderson Lake closed by toxic algae again," Peninsula Daily News, May 19th 2010. 5. "Anderson Lake closed," Port Townsend Leader, May 19th, 2010. 6. "PT man diagnosed with fungus disease," Port Townsend Leader, May 26th, 2010. 7. "Who is pinching county pennies?," Port Townsend Leader, May 26th, 2010. 8. "To immunize or not," Port Townsend Leader Health and Wellness Supplement, May 26th, 2010. 9. "Making Jefferson County Healthier," Port Townsend Leader Health and Wellness Supplement, May 26th, 2010. 10. "First fungus case seen in PT," Peninsula Daily News, May 27th, 2010. 11. "Underage drinking," Peninsula Daily News, May 28th, 2010. 12. "Physicians `vigilant' looking for Cryptococcus gattii," Port Townsend Leader, June 2nd, 2010. • • • meeting room cashier. Health chief Featured business member at • sets speech Monday's chamber meeting will be Victoria Express,which will to PA chamber begin the Victoria Express pas- senger ferries'summer season PORT ANGELES--Dr.Tom May 28. Locke,public health officer for Clallam and Jefferson counties, will be featured speaker at this week's Port Angeles Regional Chamber of Commerce luncheon meeting on Monday. Locke's , topic will be , rr _ "Public Health Challenges: • sr 9 'k �y '' Controlling Jnr` t Communicate • ,a 6 i 6 * k ble Diseases, a Expanding „tt `" a � ; Access to �;` a 1A, Health Care, Nl` ,� a z . .Improving Locke Community Health." Monday's chamber luncheon, open to the public,begins at noon in the second-floor meeting room at the Port Angeles CrabHouse Res- taurant at the Red Lion Hotel,221 N.Lincoln St. Luncheon tickets are$13 • and can be purchased from the BDA/ • • iQ( ,,,,,,..,-...,-,,,,,t,,,..#3,-,:: 6$ �s o N z# s Y110 `. � wf� Fx' «mo w' ¢ 6 E o wi ' , �rY .' .4' z - '� £u y n ._U 4 4. Ma t els Y � + 91 Ca � .• ,. � €; 473 F G r re3 Fti f z R..1.:'!': z %, n f sY �li U p+ Fie i �,�„ 'i) W ':.:0;-.;;:t.',Vi.-.Y.. .1,17.'," .,1.;i;c.E,..Ai:i..: i.."...,!:,i:..,:!:',:i'.,::::',C.'-:.::r:,,.,...'?::-..:,4)1-4,,,i,.]:',..•.i..-:,:41$1,:fargt7i. 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M-i-1 Cdr) f� a a 3 a - o `ti r3 cC'c; rn 5/18/2010 1:06:00 PM It's back: Toxic algae bloom closes Anderson Lake • Anderson Lake itself is closed due to toxic algae, but the state park near Chimacum remains open for hiking, horseback riding and biking. In late May 2006, two dogs quickly died after drinking from Anderson Lake —the first sign of toxic algae. The problem has also occurred in other lakes here, but usually in later May or June when the weather is warmer. This year, Anderson Lake was open for last month's fishing season opener. But it's no surprise now for algae problems to bring the lake's closure. Anderson Lake is undergoing a spring algae bloom made up predominately of the genus Anabaena. Tests performed at King County Environmental Labs show that this bloom is producing anatoxin-a, a potent neurotoxin. Water samples taken on May 11, 2010 show anatoxin concentrations at 100 times the proposed safe recreational limit. Because of the risk of exposure to this toxin, Washington State Parks, in • consultation with the county health department decided May 18 to close Anderson Lake for fishing and swimming effective immediately. Jefferson County Public Health will continue to monitor Anderson Lake weekly. If test results continue to show high levels of toxin the lake will remain closed. • Anderson Lake closed Anderson Lake is closed. in-a concentrations at 100 times the Current lab results show very proposed safe recreational limit. high neurotoxin concentrations in Washington State Parks,consult- the lake located a few miles from ing with the county, has closed the Chimacum. lake for fishing and swimming. Non Anderson Lake is undergoing a lake-orientated recreation, such as spring algae bloom. Water samples hiking,horseback riding and biking, taken on May 11,2010,show anatox- is still allowed. • e... 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 May 19, 2010 Anderson Lake closed by toxic algae again By Jeff Chew Peninsula Daily News CHIMACUM -- A spring bloom of toxic blue-green algae has closed Anderson Lake after only a three-week opening to boating and fishing. The action portends another summer in which the centerpiece of the state park by the same name will be closed to fishing and other recreation -- as it has for the last half of the decade. Water samples taken May 11 and sent to King County Environmental Labs showed high levels of anatoxin-a, a potent neurotoxin at about 100 times the safe recreational limit, Jefferson County Public Health officials said. Alison Petty, environmental health specialist with Jefferson County Public Health, said water samples taken after algae blooms were spotted on the lake showed 103 micrograms per liter of anatoxin-a, which is dramatically above the safety threshold of 1 microgram per liter. "Anatoxin is a very nasty toxin," Petty said. "And that, we suspect, is what killed the dogs in . 2006." Toxic algae was first discovered in Anderson Lake in May 2006 when two dogs died after drinking water from the lake, which the county and state then closed. Jefferson County Health Officer Tom Locke said it remains a mystery as to what makes Anderson Lake prone to blue-green algae toxins. "It appears to be one of the most, if not the most affected lake in Washington state," Locke said. No telltale signs of such toxins have been found in Clallam County's largest lakes -- Crescent, Sutherland and Ozette. Locke said it might come down to looking at natural nutrients as the source of blue-green algae toxins in Anderson. "Anderson Lake is a senior citizen when it comes to lakes," Locke said. "It's filled up with nutrients. It's probably something that has accumulated over a long time, such as plant debris and breakdown products that create the nutrient media." No man-made sources • http://www.peninsuladailynews.com/apps/pbcs.dll/article?AID=/20100519/news/3051999... 5/20/2010 Peninsula Daily News Page 2 of 2 • Locke said no other potential man-made nutrient sources -- such as failing septic systems or agricultural fertilizers -- have been identified in Anderson Lake. Jefferson County Public Health officials on Tuesday posted a red warning sign at the lake's boat ramp to notify the public that it was closed. Petty said because of the risk of exposure to the toxin, Washington State Parks, in consultation with county Public Health, decided Tuesday to close Anderson Lake for recreational uses. Other recreation not in the lake, such as hiking, horseback riding and biking, is still allowed at Anderson Lake State Park, and the main entry from Anderson Lake Road remains open during park hours. Jefferson County Public Health will continue to monitor the lake weekly, Petty said. If test results continue to show high levels of toxin, the lake will remain closed, she said. Since 2006 Public Health has been collecting and submitting water quality and algae samples from Lake Leland, Anderson Lake and Gibbs Lake since 2006. • Lake Leland was downgraded last week to a "caution" warning just because algae blooms have been spotted there, Petty said. That lake north of Quilcene is open to fishing and boating but closed to swimming, she said. All other Jefferson County lakes remain open to recreational uses, such as fishing and boating, until further notice. Anderson Lake opened in April 24 for the trout fishing season. It was the first time that the blue-ribbon trout lake had been open since 2008 for fishing. However, it was closed after three weeks during that year when toxin levels shot up as the weather warmed. Jefferson County Public Health updates toxic blue-green algae reports at http://tinyurl.com/algaelake. Port Townsend-Jefferson County Editor Jeff Chew can be reached at 360-385-2335 or at jeff.chew@peninsuladailynews.com. • All materials Copyright © 2010 Horvitz Newspapers. http://www.peninsuladailynews.com/apps/pbcs.dll/article?AID=/20100519/news/3051999... 5/20/2010 ., y r!t y 0 g)'S W . 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S cate those provided by Jefferson I recently read that[county admin- Healthcare. istrator Philip] Morley was zealously Parks and Recreation: There ensuring pennies were being pinched is no budget item (unless it's the in all departments because of the $16,000 public utility expense) that revenue shortfall. When I look at covers providing thousands of gal- the budget,I wonder.Here are some Ions of free water at the Quilcene items that might require a closer look. campground to residents in the Sheriff's Office: tear gas and Chimacum, Coyle and Quilcene bean-bag rounds $1,200 ($1,000 in areas whose wells are fouled, dry, 2009); ammunition $12,000 ($10,000 broken or otherwise unusable. One in 2009)—are we preparing for a riot? person is reported to be getting What happened to last year's ammo?; 500 gallons three times a week for initial-issue uniforms,$26,000—I was their recreation livestock.The coun- under the impression there was a hir- ty did not provide free water to ing freeze; Gun Club memberships Marrowstone residents when their $2,500;vehicle rentals,leases and pur wells failed.What makes this partic- `" •u.lic He. e state atilt- ularly odd is that campgrounds that tor's local government financial brought in revenue in 2009 ($6,500) . were shut down to cut operating reporting system shows Jefferson costs, yet the county continues to County Public Health spends more pay the PUD so it can dispense free money per capita than any other water. county in Washington. Examples: Information Services: This unit King County, $88; Mason County, budgeted$176,650 for computers in $52; Clallam County, $38;Jefferson 2009 and needs another$240,947 in County, $117. Yet the state health 2010? The budget contains several department's report card shows instances of reimbursements being Jefferson County's service is rated4111 collected,then returned to the payer average among the Washington in the form of a consultation fee for counties and lowest in environmen the same amount tal health. It appears we are paying So, Mr. Morley, who is watching top price for an average to mediocre the pennies, verifying expenditures product. as truly necessary and ensuring we While other counties facing are getting quality for our tax dollar? revenue shortfalls either reduced DAVIS STEELQUIST their public health cost per resi- Quilcene dent or held 2010 to zero growth, Jefferson County increased its per capita expenditures. It also appears many county health services dupli- • • 1 immunize• To State eyes requiring parents 1 4 . to get info before opting out ' ; By Libby Umer Currently, Washington law -i. 7 is fairly unrestrictive, allowing """"="47:1=""" ,t Like all states, Washington parents to"opt-out"of required w,,aq>r , k requires immunizations for immunizations simply by sign- i `t � children attending school. But ing a form indicating that they ,V=.r'*'t1 .4 Washington has historically have "a philosophical or per- ,4 ,, oi had one of the highest rates sonal objection" to immuniza- -:j d! , L of immunization exemptions tion. 4M ,�s1ie"'a w in the country, and Jefferson Parents choosing not to County has one of the highest immunize have found it easy ____ ♦f�,?..., Jeffepercentages of exemption rates to comply with the law just by highesCounty has oof ton highestt immunization eex xemption -3. in the state. signing an exemption form. rates in Washington state,shown in �.. "+tz - While the state average State lawmakers are starting red,in a state Department of Health ,... \ - for children exempted from to take notice. chart. ►s required immunizations is 2.5 House Bill(HB)2706 would ' _-- ._ ___460E percent, over 10 percent of have added language that any about the benefits and risks of f %s Jefferson County families have parent seeking exemption from immunization." : opted not to fully immunize required immunizations must Health-care practitioners their school-age children. have"a statement to be signed permitted to sign the form are In the Port Townsend School by a health-care practitioner physicians, naturopaths, physi- District, the exemption rate is stating that he or she provided cian's assistants, or advanced even higher. the signator with information registered nurse practitioners. The bill passed the state House, and is currently in committee , with the state Senate, though Sit will not be considered again during this session. "We know that immunizations CHILD Profile,and every pub benefit individuals.But there's lie school secretary can pull up Why is it important? also a community benefit, a an immunization history and So what does this mean `herd immunity'when immuni- print it out for a parent,"Kurata for Jefferson County parents?`'. zation rates rise above 93-94." said. There's a concern in Olympia Especially for highly con- "Not having immunization that at least some parents seek---tagious-diseases like measles, records handy really shouldn't ing exemptions are doing so for low immunization rates leave a be a reason to request an exemp- reasons of convenience,not out' population vulnerable to rapid tion." of genuine objections to immu outbreaks,he said. Would HB 2706 make it • nization. Lisa McKenzie, communi- harder for parents with genu- Testimony in favor of HB cable disease program coor- ine objections to vaccination to 2706 stated, "We must make dinator at Jefferson County request exemptions? sure that our exemption process Public Health, points to pro- Locke says no,that the new is being used only for medical grams like twice-weekly walk- rules balance protecting pub- reasons and issues of convic- in vaccination clinics and lie health while still protecting tion, not convenience. [Under the state's Children's Health parents'rights to make health- the current system] we have Immunizations Linkages and care decisions for their fami- made it easier to get an exemp- Development (CHILD) Profile lies. tion than to get a vaccination." immunization database as ways Allowing families to get Sponsors of the bill hope public health officials are work- input on the risks and benefits that by requiring parents seek- ing to lower barriers to immu- of immunization from health- ing exemptions to discuss nization. care professionals works for immunization risks and benefits everyone. with their health-care providers, Records easy to keep "This is an,important deci- more parents will ultimately Immunization program coor- sion, with a lotgyp+ 'rt choose to immunize. dinator Jane Kurata wants to of ramifica- ."` Dr.Thomas H.Locke,health make it easy on parents. tions. Don't officer forJefferson and Clallam "Every health-care provider make it all by rte` counties,saw a larger benefit to in Jefferson County can now yourself," said ` 1 ;'r increased immunization rates. input a child's records into Locke. // •,. • . MAKING JEFFERSON COUNTY HEALTHIER WIC Nutrition �`mi '" l - t ` Breast& Cervical • �_ food for growing ,,:1,-..s.-- 9 9 ; Health Program _44 � families 4 � 'rip-,,,,t � Pregnant or caring for a child ti` Protect yourself from breast and cervical i ,l, '-,< under the age of 5? ;; cancer.Get screened TODAY.As you age, { You could qualify for coupons to k ; the risk of cancer increases especially over the age of 40.Regular screenings 1 { �;' help you buy more food. " A64can catch problems in the early stages, Learn to stretch your food X -, Q when they are most treatable.You budget to eat well and keep your ;.� 3ig: may be eligible for exam and cancer family healthy. z, screening at no cost.If you are a woman '" i ' between 40-60 years old,have limited 4` f , Call now for your free ` , } e.. income and limited or no health insur- 4.' ' appointment �a,+ r ;;i'" ,,,e_ ante.Call today for an appointment Family 1 Tobacco •?� t� Planning ' = ' Prevention ' , Friendly,confidential medical u 1 i' The cost of tobacco is increasing. services:birth control includ �' 1 c . Want to quit smoking? 4. -.g ing pills and other methods, ,.„-„,,,.-,..„,:,r pregnancy and STD screening, ",1),S.,. ...,41!°'" , We can help.It's time to take charge of - „. ,: , consulting,condoms and emer- ' ' _ your health.Call for an appointment �` , ? gency contraception.Call today today. to make your appointment.We 1 800 QUIT NOW 5 � , make it affordable. ,i JEFFERSON COUNTY PUBLIC HEALTH Washington State 4110 '. PUBLIC HEALTH 615 Sheridan St. Port Townsend,WA 98368` Tobacco Qua- Line k ALWAYS WORi€INGFon ASAFER A 4D 360-385-9400 Mon.-Fri.9:00 am-4:30 pm 1-800-QUIT-NOW �''`""''� HEALIHIEEtJEFFERSON www.jeffersoncountypublichealth.org `°"i"4,7 '."°'"';'•" Wednesday,May 26,2010.HEALTH&WELLNESS I 7 i • • ■ pT • First •„,...,•,,,,,,,....,..,,, lrrr + sw"" - Potentially deadly ailment treated with drug Rit.;:evr,,r- :---,f, ';,- , „ BY CtmRLIE BERMANT "I'm feeling much better," he said tropical regions, appeared on Vancouver 14 {' . : 4 ,, :, PENINSULA DAILY NEWS Wednesday. Island in the late 1990s. �t '"rm eating better. I don't have the It moved into the U.S.in 2004,and last - PORT TOWNSEND—A man living off fatigue or the night sweats or the head- month, experts said that the strain had { ` s p Discovery Road in Port Townsend is recov- aches." appeared in Oregon—and had mutated to ` '� ,° Bong from Cryptococcus gattii in the first become more lethal than the British a < confirmed case of human infection by the Be aware,get treated Columbia strain. potentially deadly fungus on the North But infection is rare in Washington His.,.; :, ' OlympicWere Rudolfo Von Lelyveld, 60, con- diagnosis before overy s the infection progressed, state.Untthe correct il Von Lelyveld's case,it had been 1. tracted the fungus is unclear,but Dr.Tom said his wife,Deborah Von Lelyveld. seen only in Whatcom,King and San Juan •1-1 > counties, with only eight or nine cases <f s ,1 Locke,public health officer for Clallam and "People need to be aware of this ds- total,Locke has said. Jefferson counties, said he has seen no ease,"Deborah Von Lelyveld said. Locke said there are manyunknowns 1p o'r `� �� :.•,:.- indication of a source on the Peninsula. "If they have a cold that won't go away about the fungus,such as whre it can be ,., , Y„1.` Von Lelyveld has been taking anti-fun- they need to ask their doctor to pay atten- found,how it spreads and how it came to gal medication since his condition was tion to this possibility." the re Cxnxiae Be LA DNLY News diagnosed in April, and is feeling better Treatment involves six to eight weeks of gon. ' Rudo Van Lelyveld takes large than he has since December,when he first intravenous antifungal medications fol- dose But the one certainty, according to doses of thhe anti fungal drugcame down with what he thought was the lowed by months of pills. Locke,is that it is not contagious. fluconazole four times daily. flu. The airborne fungus,which is native to TURN To FuNcus/A6 • Fun • • us: ' N ot._'lite-threatening CONTINUED FROM Al large family rallied around After the diagnosis,fain- Another possibility is him• ily members wore face Hawaii,where Von Lelyveld • C.gattii is not transmit- ' His three children and masks while in his pres- visits regularly as part of ted from person to person or other relatives provided ence.They were doing so his home-based retail busi- carried by insects or ani- support, and people gravi- during an April 26 patient ness. • mals. Rather, the fungus tated to his home with the visit to the University of People who stir up the forms spores that are blown ,.purpose of Baying goodbye. :.Washington Medical Center soil—landscapers,loggers, in the wind or moved by soil •The potential diagnosis in Seattle. ' outdoor recreationalists disturbances of the soil. • of lung'cancer reminded. "We all had op these are the 'most likely to It also isn't life threaten;"Von Lelyveld that he had masks and could barely. encounter the fungus. ing, keeping in mind that smoked in his youth. breathe,"Deborah Von Lely- "Even then, the risk of • any infection can take a He stopped when a girl veld said. human exposure is fairly turn for the worse and cause•;that he liked said she • "A team of doctors came' low,"Locke has said. unforeseen complications. 'wouldn't see.him unless he in 'without masks..and People who want to take "This is a very rare con- quit ' • started talking to'us;so we preventive steps should dition,"Locke said."And it's_, "Tat girl is now his wife, asked them why they didn't wear face masks if their job treatable as f long as it's 'and the couple recently cel- have their musks on. requires them to stir up diagnosed correctly" • ,e)rated their 35th anniver- "It was then that they excess vegetable matter. In Von Lelyveld's case sm'y told us that it wasn't conta-.,, And if they are suffering the diagnosis took a while.. • On April 21, a lung gious." from flu-like symptoms that He began experiencing' biopsy at Olympic Medical Locke said he became4 do not subside after a rea- respiratory distress in 'ShowedCr thathe rt tdI Angeles es aware of the case shortly,,seek medical atime ttention. hadDecember. He thought he. after the diagnosis but held- had the flu.But it didn't go.,.,cancer,but instead the rare„'off on any public'announce- , away. ment until tests were con-• Jefferson County Reporter Char After a series of tests,he ducted.Locke did not iden- lie Bermant can be reached at 360- received a call in early Apnl • More energetic tify the.patient. Von Lely-• 385-2335 or at charfie.bermant® that told of several "shad Now,Von.Lelyveld, who veld went public'with kris, peninsuladailynews.aom. owe on his lungs has,lost weiight;feels more condition himself: Fears of cancer energeti•c," And family members, Origin unknown While stopping short of who arrived ostensibly.to Testing continues at the an absolute diagnosis, the ease him out: of life have Centers for Disease Control.' word "cancer" was tossed remained in town'to share in Atlanta,which isea has been about several times, he the reprieve. said. "When we heard that it unable to determine the ori- Under this cloud, he was not cancer we were gin of the .fungus that received three scans in the elated,"his wife said. infected Von Lelyveld. following two weeks which r"But then we discovered 'The most likely candi- ' 0 turned out to.be inconclu- we;were 'dealing 'with a dates are Oregon or British - sive. -completely''different situa- ColuYnbia. He has traveled'•. During this tirpe, his •tion.° _ to both locations recently. .; - ''''.-_, 1/ '-•. ',0,,J;-,44;.Ak.,,,,,,,,,,,,%,,4;.41-•;.,..i.-44.1.1%61,.4'cfr;.r;:'11,,-4''''' At V'-'• ' „,:::If:',,r',71.Sif,;;;;Y:f:-.;-2Z:i;;WV!7''';:' tii;E:::'''::::'-r'Cc'"*:;f,;7.:'' ,,,,, ' 1 - ,V, ' ,'';',. ',-;;N:',,,X:;.,:'-:45 ::,4=,Z"5.,,: ..., 0 fsli,4•';h‘4•';',' .:,:i,,,,,'' -,, • h• . • & ,, ' 1 f _'.::1,� .S ‘,..,!;44':::;,,::47,4*-3 _. v.°9 1 /... � � ar. ' '/"'' + .4 -, xis,- to ! ',411,�.e �y m.'::,,,,, s Ir• . ;,� 4tv „ . ,„ F� , 1"gip ,,,,try .�d y.,+� t pti "fc.V.,,,,;,,,,:,..,-tf.ki,Iti, ' a'� ` .'' tom/ t� 1s s 4: Y "> - a t �,` s'�x t L '& . Kms: Organizers of a town hall meeting on underage drinking include Port Townsend High School Student Task Force members and Barbara Hansen, front, center, student assistance professional and task force adviser. The students are, from left, Angel Shafer, James Campbell, Jake VonVolkli, Todd Maegerle and Jason Noltemeier. Underage drinking Collaborating on the PORT TOWNSEND— project were Port Townsend • More than 40 teens and 15 High School,Olympic Edu- adults learned about cational Service District underage alcohol use and 114,the Jefferson County worked on a plan to reduce Community Network and underage drinking when Jefferson County Public the executive committee of Health. the Port Townsend High For more information on School Student Task Force how parents can address organized a recent town the issue of underage hall meeting. drinking,visit www.start The event was part of a talkingnow.org. national effort this spring to support community efforts to stop underage drinking. Funding for the town hall meeting was made possible through a grant from the Washington State Coalition to Reduce Under- age Drinking. • C 6•Wednesday,June 2,2010 ?T L Ett ctx✓ Physicians `vi gilant' lookingifor CrYptococcus at Cryptococcus gattii — a Lindquist said. "Having said (CDC) is looking at the deadly airborne fungus that,Jefferson has had only genus of Cryptococcus gattii that has killed six people in one case. I'm not sure that that infected Van Lelyveld. Oregon—is not a new organ- means it's here or it's just Lindquist said that the ism, but it is new to the not as common as we think CDC test will tell what strain Northwest, and physicians it might be. of Cryptococcus gattii Van are starting to look for it in "We don't know how Lelyveld had, but "it won't Jefferson County. many people have been tell you where the guy Dr. Scott Lindquist, an infected with Cryptococcus caught it." The fungus is infectious disease physician because a lot have no symp- found is soil and does not who serves as deputy health toms or mild symptoms." spread from person to per- officer for Jefferson County In fact, he said, people son easily. and health officer for Kitsap could have it, but their "The real question for the County, said there has been symptoms could be no dif- public is`Is this a huge pub- only one person in Jefferson ferent than the flu or other lic health problem?' and the County diagnosed with the common respiratory ill- answer is `We've had one fungus. ness. Symptoms include a case and we're actually look- Rudo Van Lelyveld dis- bad cough and shortness of ing for more.And we haven't covered in April that he had breath,for example. seen it,'"Lindquist said. Cryptococcus gattii. He is "If it's a persistent pulmo- In the meantime, now recovering. (See Leader nary process that involves Lindquist suggests people • issue of May 26 for complete cough, chest pain or fever, keep the scary-sounding story.) you should be seeing your disease in perspective. There have been no cases doctor and at that point the "How many people in reported yet in either Kitsap physician would do a chest your county have died in or Clallam counties. X-ray,"he said. motor vehicle accidents? "All of us are very vigi- The Centers for Disease So put it in perspective," he lant looking for cases," Control and Prevention said. 11101141/4 !ger 4h . a6,// • f Idok 41, A WhyThey Dont Quit? Ever hear any of these expressions when tallying about a person who is struggling with addiction? Date: Tuesday, June 29th • "All it takes to quit is will power..." Times: (choose one) • "They have lost everything. Now,they are about to lose Service Provider Presentation: gam-Noon their kids..." or • "They must not have hit rock bottom yet..." Community Presentation: 6:30-8:3Opm "That person has a REAL problem, I don't have that..." Location: Northwest Maritime Center • "Things will change... Things will get better..." 431 Water Street, Port Townsend • "They are so smart. Why do they beep making stupid Registration required! choices?" Please register at: • What can a person do to help? http://www.jeffcocommunitynetwork.org/ registration The process of addiction and the process of recovery are quite fascinating and not as simple as they may Or call 360-379-4495 seem. Complex psychological processes are often at work Clock hours available for Service Provider affecting behavior. This lively presentation will shed presentation (morning session only) light on these processes and will help you have a more sophisticated understanding of addictive behavior and CEUs available for both presentations! how to help facilitate change. 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