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Home My WebLink About2010- October File Copy • Jefferson County Board of 3 CeaCth Agenda & M1 inutes • October 21, 2010 0 • JEFFERSON COUNTY BOARD OF HEALTH October 21, 2010 Jefferson County Public Health 615 Sheridan Street Port Townsend, WA 2:30—4:30 PM DRAFT AGENDA I. Approval of Agenda II. Approval of Minutes of September 16, 2010 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. Region 2 Public Health Community Liaison Summary 2. SmileMobile coming to Chimacum, November 8-12, 2010 3. School Based Health Center Work Group V. New Business 1. Nurse Family Partnership Reports: Local Data, Foundation of Lifelong Health Essential Findings Report, Washington State Adverse Childhood Experiences Report 2. Pre-adoption Briefing and Call for Public Hearing (12/16/10) on Board of Health Fee Schedule for 2011 3. National Health Reform: Orientation to the Affordable Care Act of 2010 4. Data Steering Committee Update 5. State and County Budget Updates 6. Substance Abuse Board Nominations VI. Activity Update VII. Agenda Planning Calendar: Special BOH Meeting Re: State/Local Budget Cuts VIII. Next Scheduled Meeting: December 16, 2010 2:30—4:30 pm • Jefferson County Public Health • JEFFERSON COUNTY BOARD OF HEALTH MINUTES , Thursday, September 16, 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 Stuart Whitford, Environmental Services Director Sheila Westerman, 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 2:32 PM. A quorum was present. Members Present: John Austin, Roberta Frissell, Kristen Nelson, Chuck Russell, David Sullivan, Sheila Westerman Members Excused: Phil Johnson Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin, Stuart Whitford • Guests: Frances Joswick, SAAB APPROVAL OF AGENDA Member Westerman moved and Member Sullivan seconded for approval of the agenda. The agenda was approved unanimously, as written. APPROVAL OF MINUTES Member Sullivan moved for approval of the July 15, 2010 BOH meeting minutes, as written; Member Westerman seconded. The minutes of July 15, 2010 were approved unanimously, as written. PUBLIC COMMENTS Jean Baldwin introduced Americorps student, Dunia Faulx, a graduate student in Public Health, who will be working in the school based clinics for the next year. 411 Page 1 of 9 OLD BUSINESS and INFORMATIONAL ITEMS Initiatives 1100 and 1105—Public Health Impacts • Julia Danskin referred to informational materials from the Voter's Guide for the two ballot initiatives concerning liquor sales. Liquor will be more available at various types of retail outlets in the community from 6:00 AM to 2:00 AM. The State will lose its current revenue from liquor sales, which now funds Drug and Alcohol prevention programs. Potential sales tax revenue is uncertain and may not fully replace the current revenue. Most of the current liquor excise tax proceeds for Jefferson County and the City of Port Townsend are used to fund prevention programs. The sales revenue generated goes to other services. It is unclear whether a portion of the revenue under the proposed plans would be allocated to the County/City. Jean Baldwin noted that enforcement under the new arrangement would become much more expensive. It is possible that any revenue generated would be needed to for enforcement to replace what is now derived from liquor store sales. Presently, the Health Department receives a bit less than $100,000 from the liquor excise tax, which is applied to Nurse Family Partnership and the school programs, i.e. community based substance abuse education. The critical issues for the BOH/Health Department are the potential loss of dependable revenue streams and the likelihood of an increased enforcement costs. Washington State Revenue Forecasts and Proposed Budget Cuts Jean Baldwin reported on a recent statement from the OFM (Office of Financial • Management) which indicated that the economic status is still in decline and uncertain. She said that the Governor was expected to make a more definitive statement about further across the board budget cuts the following day; if/when there is clear information regarding impact to the Health Department and local programs, it will be e-mailed to the BOH. Virtually all applications of funds are constrained by federal mandates. Ms. Baldwin noted that numerous advocacy groups are mobilizing in anticipation of these possible budget adjustments. She mentioned that Take Charge, the funding stream for family planning, and maternity support funds may be in line for cuts as early as January, in addition to wider cuts effective in July 2011. State furloughs are also taking place. September 27 Tire Recycling Event Stuart Whitford provided information on the planned Tire Recycling Event at the Quilcene Transfer Station, which was organized by Margie Boyd. Volunteers are being sought to assist; the Sheriff's Department will be on site for traffic control. October Presentation— Port Townsend City Council Meeting Jean Baldwin noted that the next presentation, on October 18, will focus on Environmental Health's local source control program, which works with entities that generate toxic waste to • Page 2 of 9 } voluntarily adopt more effective models of recycling and reuse. She said that thus far there • has been significant participation of businesses at the Port/Boat Haven. The presentation will also cover Nurse Family Partnership, particularly with regard to a national award and a national challenge to expand its work. Member Westerman noted that demographic information about the number of City and County residents benefiting from the program would be included. Clean Water District and Environmental Health Projects Stuart Whitford, Environmental Health Director, reviewed the presentation that had been made to the BOCC regarding the $1,000,000 EPA Clean Water District grant. Partners include, Jefferson County, Clallam County Environmental Health Services, Jefferson County Conservation District, Clallam Conservation District, and Puget Sound Partnership. In addition to water quality improvements, it will allow the County to implement a homeowner O & M training program. Another aspect of the program will be online electronic data availability for inspection records, permits, etc. Another project beginning later this year under a Centennial Clean Water grant provides for shoreline surveys higher in the watershed. Septic failures and animal waste problems will be identified and corrected. The contract for this project must be negotiated and completed this year. • Mr. Whitford also mentioned existing projects in Mats Mats Bay, Discovery Bay and working with the Conservation District in Chimacum Basin, as well as supporting the WRIA 17 planning unit. In response to a question from Member Austin, Mr. Whitford indicated that the team would be able to make use of Clallam County's experience with the education/training components of 0 &M. There was a brief discussion about new 2011 requirements for small business drain fields. Chair Russell said that he believes the emphasis should be placed on correcting failed systems. Mr. Whitford noted that most property owners appreciate the value of regular monitoring and maintenance so as to avoid septic failures that are extremely expensive to resolve. BOH members also discussed the need to consider pending sewer system plans in certain locations. Member Sullivan briefly discussed WRIA -17 noting that that phase IV funding runs out in December. Mr. Whitford mentioned some planned shifts in staff assignments. Dana Fickeisen will return to Water Quality work and be replaced by a new hire in Food Services. Alison Petty will move from Water Quality to Solid Waste project work. He also reported that he has determined that two of three contracts with the Conservation District need to be updated/amended, including the amount of match required of the Conservation District; these contracts will need to be approved by the BOCC. • Page 3 of 9 NEW BUSINESS Protocol for Response to Tobacco Complaints • Karen Obermeyer of the Tobacco Prevention Program presented the procedure for tobacco complaints received by JCPH. She noted that Washington has the 31 lowest smoking rate (14.8%) in the USA; the combined rate for adults in Jefferson County over the last three years is 17.7%. Subsets of the population including pregnant women and lower education levels have higher smoking rates. The County ordinance and procedures are based on the State law prohibiting smoking in public places. The benefits are that employees have smoke-free workplaces and non-smokers are no longer exposed to indoor second hand smoke. Ms. Obermeyer cited a study showing that indoor pollution decreased by 88% in restaurants and bars since this initiative was implemented. It has also motivated people to quit smoking; smoking rates have been decreasing since the initiative was implemented. And, there has been no decrease in taxable revenue from restaurants and bars in this State since implementation of Initiative 901. There is a high compliance rate with the smoke free rules; there were only 18 complaints in Jefferson County during the last 12 months. Definitions: a"public place' is any portion of a building or vehicle used by or open to the public, regardless of ownership—this applies to all permitted places in Jefferson County as well as facilities such as the Library, and places of employment. The procedure, as outlined in the packet, is intended to be enforced with the people in charge of each business, location, or building, not the individuals who are smoking. Individuals who do not comply with requests from the businesses are to be dealt with by the police. A new regulation now covers bus stops. With this procedure, there are three main responsibilities. The person in charge must prohibit smoking indoors and within 25 feet of entrances, exits or opening windows/air vents; and they must post signs. Ms. Obermeyer said that she has not received complaints about indoor smoking; outdoor enforcement is the most challenging. Ms. Obermeyer walked through the steps of the "Jefferson County Clean Air Regulation Procedure", noting the flow of staff activities and information/education to be provided in response to complaints. There are a series of escalating consequences if complaints and violations continue after staff provides education and makes a site visit to seek a Voluntary Correction Agreement with the offending business or location. Actions/penalties range from assessed fee to notice of civil violation (NOCV) to suspension and then revocation of food establishment permit(upon the 5th violation). Jean Baldwin noted that the Ordinance was designed to be complaint based. Staff site visits are made only if triggered by complaints. There is limited funding for the Tobacco program that expires in July 2011. It was noted that potential expansion of no smoking regulations to apartment or other multi-unit housing situations would be burdensome to enforce without additional resources. Ms. Obermeyer • Page 4 of 9 said that it is preferable to work with housing management to develop its own internal • policies and procedures. She also informed the BOH that although Washington State expects to receive $700 million in 2011 from tobacco taxes and Master Settlement Agreements, but none of that revenue is directed toward the Tobacco Prevention program. As of July 2011, the Tobacco Prevention account will be zeroed out; there will be some funding from cigarette licensing for monitoring of sales and from the CDC for education. She also described several new tobacco products designed to appeal to children. In response to a question, Ms. Obermeyer estimated that the 18 complaints last year involved about 15 different sites; the number of repeat complaints is down significantly from the previous year. Member Westerman said that, in her experience, the public has become more supportive of no smoking regulations over time. Olympic Regional Tribal-Public Health Mutual Assistance Agreement—Mutual Aid Authority Resolution Dr. Locke recalled that he and David Alvarez had briefed the BOH about this project in July. The plan and project was finalized during a phone conference of all parties on September 14. In addition, there were a few minor language changes by the attorneys to the Mutual Aid Authority Resolution. He noted that the BOH resolution is needed because state and local public health laws do not apply on tribal lands or reservations. In the event where assistance would be needed, the Tribal governments would need to grant public health officials • authority to help enforce existing public health laws in their jurisdictions. The agreement gives Health Officers and their designees the ability to make emergency decisions until the Board of Health can be convened to affirm or not affirm those decisions. Member Frissell pointed out one error in the document where the term Health District was used instead of Health Department; Dr. Locke said he would ensure that is corrected. Dr. Locke pointed out certain provisions of the agreement (under the third Whereas on page 1 and under item 4 on page 2) which, by not specifying arbitrary deadlines, allows for a reasonable timeline and reasonable notice. There was a follow up discussion about the flexibility permitted regarding status reports to the Board and there was some concern that the language in item 3 was unclear. Dr. Locke noted that attorneys for all parties had approved this language. He said that if he, the Health Officer, was unable to make a report every thirty days, he would bring that issue to the Board. He said that this document should be considered the starting point, with the ability of the BOH to make changes in any particular emergency. He said it was of primary importance to the attorneys that there be an official document that establishes the fact that the grant of authority is in effect between the Tribal Health jurisdiction and the Board of Health. Member Austin moved that the BOH authorize the Chair to sign Resolution 35-10. He accepted as a friendly amendment from Member Frissell the addition of"with the change of Health District to Health Department". The motion was seconded by Member Frissell • and approved unanimously, as amended. Page 5 of 9 Jefferson County Budget Review Jean Baldwin referred to a series of bar charts in the packet and provided highlights of a few. • She corrected one statement from the county budget meeting that had been made to the effect that the General Fund (GF) pays for all departments rent and IT (Information Technology). She pointed out that, the Health Department uses General Fund monies to pay the County for rent and IT. She said that the actual amounts are greater in 2011 than in 2010. Ms. Baldwin briefly mentioned other statistics: Of 7.9 people/FTEs in Administration, 1.98 FTEs are paid out of the General Fund. Of 8.44 FTEs in Environmental Health, only 1.4 is paid from the General Fund. Of 16.91 FTEs in Community Health, 2.5 are paid from the General Fund. For Developmental Disabilities, less than 1% is from the General Fund. Ms. Baldwin stressed that since Public Health differs from other departments in its revenue sources, and must be allowed to optimally maintain/reallocate its non-GF revenue streams. A Health Department budget has been submitted. Jean Baldwin said there was only one add for 2011 $5,000 for maintaining the lakes program. Statistics of web site use show that this is a priority interest for the public. Stuart Whitford briefly discussed the health hazards of blue green algae. He noted a case in California where Microcystin toxin from inland lakes found its way into shellfish and eventually harmed sea otters. This type of toxin bio-accumulation is not adequately monitored and tested by the State. Jean Baldwin noted the need for and expense of constant monitoring/posting of warning signs for Vibrio and other shellfish • problems. In response to a question, Dr. Locke explained that for Anderson Lake, the primary concern is anatoxin, a potent neurotoxin. Microcystin is a hepatic toxin, which can cause liver failure in high doses; there is concern about the possible impact of chronic low- dose exposure as a risk factor for hepatic cirrhosis and liver cancer. Ms. Baldwin also mentioned deletions from the budget associated with Proposition 1. She said that Environmental Health is barely breaking even. However, with the help of a stimulus package grant for training other health departments to do billing, the Health Department has been able to submit a balanced budget that falls within the parameters specified. The final picture will depend on other federal, State, County and City budget adjustments. She said that the County and City will negotiate on substance abuse funding. She said that since there is no November BOH meeting, this topic will next be discussed at the December meeting. Summary of September 9, 2010 Data Steering Committee Jean Baldwin discussed the participation in and results of this meeting. In addition to staff, there was excellent attendance with 29 participants including the Port Townsend School Board, Hospital, Chamber of Commerce, Library, Mental Health, SAAB, many other agencies, and Roberta Frissell for the BOH. The meeting included an update of demographics and good discussion. The BOH packet materials include September 9 • Page6of9 meeting materials showing Committee goal, project activities, timeline and the demographic • summaries. The next meeting will focus on Substance Abuse and Mental Health; it is scheduled for October 28, 3-5 PM in the Health Department Conference Room. Resources will include the Jail Survey, youth surveys, and other statistical summaries. Topics of future meetings include: Access to health care and community health (November); Death, birth, quality of life (February 2011); and Summary and prioritization (March 2011). Ms. Baldwin said she had received very positive feedback from those who attended the September 9 meeting, particularly regarding its usefulness for prioritizing resources and services. She said that the entire data packet will be mailed electronically after each meeting, and is also available on the web and in printed form. In response to a question, she clarified that the data is derived from a combination of cited sources— it is not only US Census data. She also noted that the BOH is the sponsoring body, and will be called upon for any decisions that need to be made. Member Frissell said she believed the four meeting format is an improvement over previous one-day events. Member Westerman requested that a list of attendees be provided to the BOH for each of the Data Steering Committee meetings. 2011-12 Fee Revision Timetable • Jean Baldwin said that there would be revisions this year on food, immunizations, and family planning fees. She will bring a proposed draft to the BOH October meeting, with the expectation of obtaining the final BOH approval at the December meeting. Member Nelson recalled from an earlier presentation that the Food Program did not pay for itself, and expressed concern about that. Jean Baldwin explained that for a period of time the staffing/scheduling arrangement had been overly expensive, but that the situation had been corrected. She also mentioned a one-time software upgrade that contributed to the high cost in 2010. Member Westerman noted that in the past, the County General Fund had been heavily subsidizing many departments and services. She explained that several years ago, after a lengthy public process, the BOH and the Department of Public Health had begun a gradual process of aligning fees with costs; that process is now very nearly complete. Member Frissell affirmed that the BOH policy is to establish fees that fully cover the cost of delivering environmental health services. Substance Abuse Board Nominations Member Austin said he wished to nominate two persons to the SAAB, Chase Glenn and HarGopal. He and Frances Joswick explained that both individuals are interested in substance abuse/mental health issues and had attended SAAB meetings in an effort to learn about the work of the Board. The SAAB is recommending them for SAAB positions. • Member Westerman asked for clarification on the composition of the SAAB and the Page 7 of 9 maximum number of members. Ms. Joswick indicated that the maximum is 14. With two additional nominations expected in October, the total would be 13, assuming these two nominees are approved. There was further clarification that the SAAB composition must include only three elected officials and that at least 25%of the SAAB members must be in recovery. Member Austin moved that Chase Glenn and HarGopal be approved for appointment to the SAAB; Member Westerman seconded. The motion was approved unanimously. Fran Joswick also announced that a Drug Return event,hosted by the SAAB, Port Townsend Police Department, and Community Network, would be held at the Safeway on September 25. Any class of drugs will be accepted except those in liquid form. ACTIVITY UPDATE Stuart Whitford reported that Environmental Health had received several public records requests regarding their role in permitting the proposed biomass generator at Port Townsend Paper. He said that JCPH only permits and monitors the mill's inert landfill, which is for the inert non-toxic boiler ash. Jean Baldwin said she had received telephone calls requesting information, most of which have been referred to DOE or the paper mill in accordance with pre-established protocols. Contact information for both entities is posted on the JCPH website, with a brief description of the project. There was further discussion about the fact that JCPH has no regulatory authority with regard . to this project. Dr. Locke said that their role is to assess the impact on community health; he recalled JCPH's involvement in a Dept. of Health report on industrial air pollution impacts done in 2008. However, he said that industrial air pollution falls under federal regulations administered by the States; local health jurisdictions have no authority over air pollution. Others who had attended local public meetings expressed concern that DOE representatives had not been able to satisfactorily address questions and concerns about possible health • hazards of the proposed biomass facility. Member Nelson noted that the DOE claims there are very few extant regulations that apply to this relatively new technology. In addition,the time frame for research and public response to this proposed project is quite limited. Dr. Locke noted that obtaining good air quality data and actual exposure rates is very difficult. He said that, at this time, there is only limited data, i.e. opacity of the stack smoke from the mill. The particle sizes/counts and chemical composition are not known. With biomass facilities, the output air/smoke will depend on many factors such as fuel type, combustion temperature, and the pollution control technology used. There are many variables and many unknowns. Member Russell noted that this process has been purported to reduce air pollution overall because it replaces on-site burning of forest debris. Member Sullivan added that the project was presented as being ecologically better than the status quo of burning coal or oil, as not using toxic fuel sources such as construction debris, and that it would be compliant with evolving regulations and standards. Presumably, whatever specific permit is issued will • Page 8 of 9 place conditions on the types of fuel that may be burned, along with other parameters and • constraints. AGENDA PLANNING CALENDAR During the October 21 BOH meeting, staff will present Nurse Family Partnership Reports, with new local data that has been developed during the last year. This is a profile of those in the program and of risk factors for pregnant women in the community. The Washington State Adverse Childhood Experiences Report and Foundation of Lifelong Health Essential Findings Report will also be presented. Any budget updates will also be discussed. ADJOURNMENT Members Austin and Nelson moved for adjournment. Chair Russell adjourned the meeting at 4:20 PM. JEFFERSON COUNTY BOARD OF HEALTH Excused Chuck Russell, Chair Phil Johnson, Member Kristen Nelson, Vice-Chair John Austin, Member Roberta Frissell, Member David Sullivan, Member Sheila Westerman • Page 9 of 9 s . JEFFERSON COUNTY BOARD OF HEALTH • MINUTES Thursday, September 16, 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 Stuart Whitford, Environmental Services Director Sheila Westerman, Citizen at large(City) Chuck Russell, Chair, Hospital Commissioner,District#2 Roberta Friisell, Citizen at large(County) Chair Chuck Russell called the meeting of the Jefferson County Board of Health to order at 2:32 PM. A quorum was present. Members Present: John Austin, Roberta Frissell, Kristen Nelson, Chuck Russell, David Sullivan, Sheila Westerman Members Excused: Phil Johnson Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin, Stuart Whitford • Guests: Frances Joswick, SAAB APPROVAL OF AGENDA Member Westerman moved and Member Sullivan seconded for approval of the agenda. The agenda was approved unanimously, as written. APPROVAL OF MINUTES Member Sullivan moved for approval of the July 15, 2010 BOH meeting minutes, as written; Member Westerman seconded. The minutes of July 15, 2010 were approved unanimously, as written. PUBLIC COMMENTS Jean Baldwin introduced Americorps student, Dunia Faulx, a graduate student in Public Health, who will be working in the school based clinics for the next year. • Page 1 of 9 OLD BUSINESS and INFORMATIONAL ITEMS Initiatives 1100 and 1105—Public Health Impacts • Julia Danskin referred to informational materials from the Voter's Guide for the two ballot initiatives concerning liquor sales. Liquor will be more available at various types of retail outlets in the community from 6:00 AM to 2:00 AM. The State will lose its current revenue from liquor sales,which now funds Drug and Alcohol prevention programs. Potential sales tax revenue is uncertain and may not fully replace the current revenue. Most of the current liquor excise tax proceeds for Jefferson County and the City of Port Townsend are used to fund prevention programs. The sales revenue generated goes to other services. It is unclear whether a portion of the revenue under the proposed plans would be allocated to the County/City. Jean Baldwin noted that enforcement under the new arrangement would become much more expensive. It is possible that any revenue generated would be needed to for enforcement to replace what is now derived from liquor store sales. Presently,the Health Department receives a bit less than $100,000 from the liquor excise tax, which is applied to Nurse Family Partnership and the school programs, i.e. community based substance abuse education. The critical issues for the BOH/Health Department are the potential loss of dependable revenue streams and the likelihood of an increased enforcement costs. Washington State Revenue Forecasts and Proposed Budget Cuts Jean Baldwin reported on a recent statement from the OFM (Office of Financial • Management) which indicated that the economic status is still in decline and uncertain. She said that the Governor was expected to make a more definitive statement about further across the board budget cuts the following day; if/when there is clear information regarding impact to the Health Department and local programs, it will be e-mailed to the BOH. Virtually all applications of funds are constrained by federal mandates. Ms. Baldwin noted that numerous advocacy groups are mobilizing in anticipation of these possible budget adjustments. She mentioned that Take Charge, the funding stream for family planning, and maternity support funds may be in line for cuts as early as January, in addition to wider cuts effective in July 2011. State furloughs are also taking place. September 27 Tire Recycling Event Stuart Whitford provided information on the planned Tire Recycling Event at the Quilcene Transfer Station, which was organized by Margie Boyd. Volunteers are being sought to assist; the Sheriff's Department will be on site for traffic control. October Presentation—Port Townsend City Council Meeting Jean Baldwin noted that the next presentation, on October 18, will focus on Environmental Health's local source control program, which works with entities that generate toxic waste to • Page 2 of 9 voluntarily adopt more effective models of recycling and reuse. She said that thus far there • has been significant participation of businesses at the Port/Boat Haven. The presentation will also cover Nurse Family Partnership, particularly with regard to a national award and a national challenge to expand its work. Member Westerman noted that demographic information about the number of City and County residents benefiting from the program would be included. Clean Water District and Environmental Health Projects Stuart Whitford, Environmental Health Director, reviewed the presentation that had been made to the BOCC regarding the $1,000,000 EPA Clean Water District grant. Partners include, Jefferson County, Clallam County Environmental Health Services, Jefferson County Conservation District, Clallam Conservation District, and Puget Sound Partnership. In addition to water quality improvements, it will allow the County to implement a homeowner O & M training program. Another aspect of the program will be online electronic data availability for inspection records, permits, etc. Another project beginning later this year under a Centennial Clean Water grant provides for shoreline surveys higher in the watershed. Septic failures and animal waste problems will be identified and corrected. The contract for this project must be negotiated and completed this year. • Mr. Whitford also mentioned existing projects in Mats Mats Bay, Discovery Bay and working with the Conservation District in Chimacum Basin, as well as supporting the WRIA 17 planning unit. In response to a question from Member Austin, Mr. Whitford indicated that the team would be able to make use of Clallam County's experience with the education/training components of 0 &M. There was a brief discussion about new 2011 requirements for small business drain fields. Chair Russell said that he believes the emphasis should be placed on correcting failed systems. Mr. Whitford noted that most property owners appreciate the value of regular monitoring and maintenance so as to avoid septic failures that are extremely expensive to resolve. BOH members also discussed the need to consider pending sewer system plans in certain locations. Member Sullivan briefly discussed WRIA -17 noting that that phase IV funding runs out in December. Mr. Whitford mentioned some planned shifts in staff assignments. Dana Fickeisen will return to Water Quality work and be replaced by a new hire in Food Services. Alison Petty will move from Water Quality to Solid Waste project work. He also reported that he has determined that two of three contracts with the Conservation District need to be updated/amended, including the amount of match required of the Conservation District; these contracts will need to be approved by the BOCC. • Page 3 of 9 NEW BUSINESS Protocol for Response to Tobacco Complaints • Karen Obermeyer of the Tobacco Prevention Program presented the procedure for tobacco complaints received by JCPH. She noted that Washington has the 3` lowest smoking rate (14.8%) in the USA; the combined rate for adults in Jefferson County over the last three years is 17.7%. Subsets of the population including pregnant women and lower education levels have higher smoking rates. The County ordinance and procedures are based on the State law prohibiting smoking in public places. The benefits are that employees have smoke-free workplaces and non-smokers are no longer exposed to indoor second hand smoke. Ms. Obermeyer cited a study showing that indoor pollution decreased by 88% in restaurants and bars since this initiative was implemented. It has also motivated people to quit smoking; smoking rates have been decreasing since the initiative was implemented. And, there has been no decrease in taxable revenue from restaurants and bars in this State since implementation of Initiative 901. There is a high compliance rate with the smoke free rules; there were only 18 complaints in Jefferson County during the last 12 months. Definitions: a"public place' is any portion of a building or vehicle used by or open to the public,regardless of ownership—this applies to all permitted places in Jefferson County as well as facilities such as the Library, and places of employment. The procedure, as outlined in the packet, is intended to be enforced with the people in charge • of each business, location, or building, not the individuals who are smoking. Individuals who do not comply with requests from the businesses are to be dealt with by the police. A new regulation now covers bus stops. With this procedure, there are three main responsibilities. The person in charge must prohibit smoking indoors and within 25 feet of entrances, exits or opening windows/air vents; and they must post signs. Ms. Obermeyer said that she has not received complaints about indoor smoking; outdoor enforcement is the most challenging. Ms. Obermeyer walked through the steps of the "Jefferson County Clean Air Regulation Procedure", noting the flow of staff activities and information/education to be provided in response to complaints. There are a series of escalating consequences if complaints and violations continue after staff provides education and makes a site visit to seek a Voluntary Correction Agreement with the offending business or location. Actions/penalties range from assessed fee to notice of civil violation (NOCV)to suspension and then revocation of food establishment permit (upon the 5th violation). Jean Baldwin noted that the Ordinance was designed to be complaint based. Staff site visits are made only if triggered by complaints. There is limited funding for the Tobacco program that expires in July 2011. It was noted that potential expansion of no smoking regulations to apartment or other multi-unit housing situations would be burdensome to enforce without additional resources. Ms. Obermeyer • Page 4 of 9 said that it is preferable to work with housing management to develop its own internal • policies and procedures. She also informed the BOH that although Washington State expects to receive $700 million in 2011 from tobacco taxes and Master Settlement Agreements, but none of that revenue is directed toward the Tobacco Prevention program. As of July 2011, the Tobacco Prevention account will be zeroed out; there will be some funding from cigarette licensing for monitoring of sales and from the CDC for education. She also described several new tobacco products designed to appeal to children. In response to a question, Ms. Obermeyer estimated that the 18 complaints last year involved about 15 different sites; the number of repeat complaints is down significantly from the previous year. Member Westerman said that, in her experience, the public has become more supportive of no smoking regulations over time. Olympic Regional Tribal-Public Health Mutual Assistance Agreement—Mutual Aid Authority Resolution Dr. Locke recalled that he and David Alvarez had briefed the BOH about this project in July. The plan and project was finalized during a phone conference of all parties on September 14. In addition, there were a few minor language changes by the attorneys to the Mutual Aid Authority Resolution. He noted that the BOH resolution is needed because state and local public health laws do not apply on tribal lands or reservations. In the event where assistance would be needed, the Tribal governments would need to grant public health officials authority to help enforce existing public health laws in their jurisdictions. The agreement gives Health Officers and their designees the ability to make emergency decisions until the Board of Health can be convened to affirm or not affirm those decisions. Member Frissell pointed out one error in the document where the term Health District was used instead of Health Department; Dr. Locke said he would ensure that is corrected. Dr. Locke pointed out certain provisions of the agreement (under the third Whereas on page 1 and under item 4 on page 2) which, by not specifying arbitrary deadlines, allows for a reasonable timeline and reasonable notice. There was a follow up discussion about the flexibility permitted regarding status reports to the Board and there was some concern that the language in item 3 was unclear. Dr. Locke noted that attorneys for all parties had approved this language. He said that if he,the Health Officer, was unable to make a report every thirty days, he would bring that issue to the Board. He said that this document should be considered the starting point, with the ability of the BOH to make changes in any particular emergency. He said it was of primary importance to the attorneys that there be an official document that establishes the fact that the grant of authority is in effect between the Tribal Health jurisdiction and the Board of Health. Member Austin moved that the BOH authorize the Chair to sign Resolution 35-10. He accepted as a friendly amendment from Member Frissell the addition of"with the change of Health District to Health Department". The motion was seconded by Member Frissell • and approved unanimously, as amended. Page 5 of 9 Jefferson County Budget Review Jean Baldwin referred to a series of bar charts in the packet and provided highlights of a few. • She corrected one statement from the county budget meeting that had been made to the effect that the General Fund (GF)pays for all departments rent and IT(Information Technology). She pointed out that, the Health Department uses General Fund monies to pay the County for rent and IT. She said that the actual amounts are greater in 2011 than in 2010. Ms. Baldwin briefly mentioned other statistics: Of 7.9 people/FTEs in Administration, 1.98 FTEs are paid out of the General Fund. Of 8.44 FTEs in Environmental Health, only 1.4 is paid from the General Fund. Of 16.91 FTEs in Community Health, 2.5 are paid from the General Fund. For Developmental Disabilities, less than 1% is from the General Fund. Ms. Baldwin stressed that since Public Health differs from other departments in its revenue sources, and must be allowed to optimally maintain/reallocate its non-GF revenue streams. A Health Department budget has been submitted. Jean Baldwin said there was only one add for 2011 $5,000 for maintaining the lakes program. Statistics of web site use show that this is a priority interest for the public. Stuart Whitford briefly discussed the health hazards of blue green algae. He noted a case in California where Microcystin toxin from inland lakes found its way into shellfish and eventually harmed sea otters. This type of toxin bio-accumulation is not adequately monitored and tested by the State. Jean Baldwin noted the need for and expense of constant monitoring/posting of warning signs for Vibrio and other shellfish • problems. In response to a question, Dr. Locke explained that for Anderson Lake, the primary concern is anatoxin, a potent neurotoxin. Microcystin is a hepatic toxin, which can cause liver failure in high doses; there is concern about the possible impact of chronic low- dose exposure as a risk factor for hepatic cirrhosis and liver cancer. Ms. Baldwin also mentioned deletions from the budget associated with Proposition 1. She said that Environmental Health is barely breaking even. However, with the help of a stimulus package grant for training other health departments to do billing,the Health Department has been able to submit a balanced budget that falls within the parameters specified. The final picture will depend on other federal, State, County and City budget adjustments. She said that the County and City will negotiate on substance abuse funding. She said that since there is no November BOH meeting, this topic will next be discussed at the December meeting. Summary of September 9,2010 Data Steering Committee Jean Baldwin discussed the participation in and results of this meeting. In addition to staff, there was excellent attendance with 29 participants including the Port Townsend School Board, Hospital, Chamber of Commerce, Library, Mental Health, SAAB, many other agencies, and Roberta Frissell for the BOH. The meeting included an update of demographics and good discussion. The BOH packet materials include September 9 • Page 6 of 9 meeting materials showing Committee goal, project activities,timeline and the demographic • summaries. The next meeting will focus on Substance Abuse and Mental Health; it is scheduled for October 28, 3-5 PM in the Health Department Conference Room. Resources will include the Jail Survey, youth surveys, and other statistical summaries. Topics of future meetings include: Access to health care and community health (November); Death, birth, quality of life (February 2011); and Summary and prioritization(March 2011). Ms. Baldwin said she had received very positive feedback from those who attended the September 9 meeting, particularly regarding its usefulness for prioritizing resources and services. She said that the entire data packet will be mailed electronically after each meeting, and is also available on the web and in printed form. In response to a question, she clarified that the data is derived from a combination of cited sources—it is not only US Census data. She also noted that the BOH is the sponsoring body, and will be called upon for any decisions that need to be made. Member Frissell said she believed the four meeting format is an improvement over previous one-day events. Member Westerman requested that a list of attendees be provided to the BOH for each of the Data Steering Committee meetings. 2011-12 Fee Revision Timetable • Jean Baldwin said that there would be revisions this year on food, immunizations, and family planning fees. She will bring a proposed draft to the BOH October meeting, with the expectation of obtaining the final BOH approval at the December meeting. Member Nelson recalled from an earlier presentation that the Food Program did not pay for itself, and expressed concern about that. Jean Baldwin explained that for a period of time the staffing/scheduling arrangement had been overly expensive, but that the situation had been corrected. She also mentioned a one-time software upgrade that contributed to the high cost in 2010. Member Westerman noted that in the past, the County General Fund had been heavily subsidizing many departments and services. She explained that several years ago, after a lengthy public process,the BOH and the Department of Public Health had begun a gradual process of aligning fees with costs; that process is now very nearly complete. Member Frissell affirmed that the BOH policy is to establish fees that fully cover the cost of delivering environmental health services. Substance Abuse Board Nominations Member Austin said he wished to nominate two persons to the SAAB, Chase Glenn and HarGopal. He and Frances Joswick explained that both individuals are interested in substance abuse/mental health issues and had attended SAAB meetings in an effort to learn about the work of the Board. The SAAB is recommending them for SAAB positions. • Member Westerman asked for clarification on the composition of the SAAB and the Page 7 of 9 maximum number of members. Ms. Joswick indicated that the maximum is 14. With two additional nominations expected in October, the total would be 13, assuming these two • nominees are approved. There was further clarification that the SAAB composition must include only three elected officials and that at least 25%of the SAAB members must be in recovery. Member Austin moved that Chase Glenn and HarGopal be approved for appointment to the SAAB; Member Westerman seconded. The motion was approved unanimously. Fran Joswick also announced that a Drug Return event, hosted by the SAAB, Port Townsend Police Department, and Community Network,would be held at the Safeway on September 25. Any class of drugs will be accepted except those in liquid form. ACTIVITY UPDATE Stuart Whitford reported that Environmental Health had received several public records requests regarding their role in permitting the proposed biomass generator at Port Townsend Paper. He said that JCPH only permits and monitors the mill's inert landfill, which is for the inert non-toxic boiler ash. Jean Baldwin said she had received telephone calls requesting information, most of which have been referred to DOE or the paper mill in accordance with pre-established protocols. Contact information for both entities is posted on the JCPH website,with a brief description of the project. There was further discussion about the fact that JCPH has no regulatory authority with regard to this project. Dr. Locke said that their role is to assess the impact on community health; he recalled JCPH's involvement in a Dept. of Health report on industrial air pollution impacts done in 2008. However, he said that industrial air pollution falls under federal regulations administered by the States; local health jurisdictions have no authority over air pollution. Others who had attended local public meetings expressed concern that DOE representatives had not been able to satisfactorily address questions and concerns about possible health hazards of the proposed biomass facility. Member Nelson noted that the DOE claims there are very few extant regulations that apply to this relatively new technology. In addition, the time frame for research and public response to this proposed project is quite limited. Dr. Locke noted that obtaining good air quality data and actual exposure rates is very difficult. He said that, at this time,there is only limited data, i.e. opacity of the stack smoke from the mill. The particle sizes/counts and chemical composition are not known. With biomass facilities, the output air/smoke will depend on many factors such as fuel type, combustion temperature, and the pollution control technology used. There are many variables and many unknowns. Member Russell noted that this process has been purported to reduce air pollution overall because it replaces on-site burning of forest debris. Member Sullivan added that the project was presented as being ecologically better than the status quo of burning coal or oil, as not using toxic fuel sources such as construction debris, and that it would be compliant with evolving regulations and standards. Presumably, whatever specific permit is issued will • Page 8 of 9 place conditions on the types of fuel that may be burned, along with other parameters and • constraints. AGENDA PLANNING CALENDAR During the October 21 BOH meeting, staff will present Nurse Family Partnership Reports, with new local data that has been developed during the last year. This is a profile of those in the program and of risk factors for pregnant women in the community. The Washington State Adverse Childhood Experiences Report and Foundation of Lifelong Health Essential Findings Report will also be presented. Any budget updates will also be discussed. ADJOURNMENT Members Austin and Nelson moved for adjournment. Chair Russell adjourned the meeting at 4:20 PM. JEFF SON COU TY BOARD OF HEALTH Excused Chuck Russ_11, air Phil Johnson, Member 10,4, Kristen Nelson, *ce-Chair J Austin, Member Roberta Frissell, Member David Sullivan, Member Sheila Westerman Page 9 of 9 • Board of 3-fealth Old Business & Informationalltems .agenda Item # 117, 1. • Region 2 Public 3-fealth Community Liaison Summary October 21, 2010 • x Region 2 Public Health rHKITSAP COUNTY ar • EALFTt Clallam County Health & Human Services Jefferson County Public Health Kitsap County Health District Community Liaison Summary Fall 2010 The Community Liaison Program has been an asset in Homeland Security Region 2- Kitsap, Clallam,and Jefferson Counties- since 2004. Two liaisons are funded through a Public Health Emergency Preparedness and Response (PHEPR) grant. The goal of the Community Liaison Program is to spread Public Health messages to our important health partners. The primary partners are medical offices,hospitals, labs,veterinary clinics and pharmacies. From June 2010 through September 2010 the liaisons visited: 201 clinics, 12 labs, 15 hospital locations, and 45 veterinary clinics Visit totals by county are: Jefferson: 21 clinics, 1 lab, 3 hospital locations, and 7 veterinary clinics Clallam: 45 clinics, 3 labs,4 hospital locations, and 12 veterinary clinics Kitsap: 135 clinics, 8 labs,8 hospital locations, and 27 veterinary clinics At each location we maintain a Public Health Resource binder. During the 15 minute visit we • always reaffirm their office's ability to contact local public health 24/7 and we remind them of their obligation to know and report notifiable (reportable by law) conditions locally in a timely manner. While we have this conversation at every visit,we also insert new content and updates regarding the contacting and reporting issues as well as: respiratory etiquette;pandemic flu; emergency preparedness for their offices, their staff and their patients; immunizations; tuberculosis;hot topics (such as MRSA,clean need exchange, gastroenteritis); oral health; and sexually transmitted infections, to name a few. In addition, we make sure we have the most current contact information for their sites which allows us to notify them of urgent and emergent public health issues in a timely manner. This function is particularly useful during disease outbreaks as evidenced during the H1N1 pandemic influenza of 2009. We support and promote the Medical Reserve Corps (MRC) in all 3 counties by recruiting volunteers during our visits. We encourage medical providers to enroll in Washington Heath Volunteers in Emergencies (WAHVE). We encourage providers in each county to contact local public health with questions or concerns and reports. In the front of each binder a card holder page contains the liaison business card along with business cards for their primary county specific local public health staff contacts. Ruth Westergaard Ellen Arthur, RN (360) 337-5752 (360 337-5254 wester@health.co.kitsap.wa.us arthue@health.co.kitsap.wa.us • Region 2 Public Health Emergency Preparedness & Response Clallam County Health & Human Services 223 E 4th Street, Ste 14, Port Angeles,WA 98362 (360)417-2274 Jefferson County Public Health 615 Sheridan Street Port Townsend, WA 98368 (360)385-9400 Kitsap County Health District 345 6th Street, Ste 300, Bremerton, WA 98337 (360)337-5235 • Board of 3-feaCtli OCcf Business & Informational Items Agenda Item # XV., 2 • SmIleNlobiCe Coming to Chimacum .November 8 - 12, 2010 October 21, 2010 • 0 ageS , 0.- u r -t14311d4 Z `"~°- � P -,,,,...F,„. ,,„,......,,,,,,,, ,....„ . 0., ,s ,, , ,.. "' ,i et - .11: l',.'"'il,;:f-:':!!,,-.;..,11,,,,r4klii;, -s,,l'OTAii.:'' ' , '''''';!--1410Y'''',:',fr4;r7': Itii 4 ;11411 '''''''''''"' Ai-k- t ir."'''')'' , -,14,:iY -' . * .°,1,,,,"'"'s"-- ',„-.,IWI.,tVAltr-rmt4...."- II --p.-- n ...:. ,. _ .._,,,-.., ......-, ,, ,,,,,,,,,,,,t„...i. , .. ...., ,,,, • ir,,,,, , 4, '6-ritleer,..4, , ` ,,,,,,,,a. .‘44. ' El 'f .- / ington iental Service F-sundation SmileMobile i coming-, tri Chimacun • November 8th ® = 1 1 The ileMobUe, a fully e ° i :sped m bile dent it clinic ' ill be at: Chl..lakm. Fligh Sch*ol Valley lm,---c , WA $) _ The Sr -Al- :Moble provii es dental care is children (birth through =sigh school) with limiter family incorrCe • ccepts St=te of \7 shin tori Services Card (Provider ne) and sliding fee scale based on family income To schedule an appointment or for more information, please call: Maira Kessler at Jefferso i County Public Health 360®365-9432 or 360 3:5 9400. Appoint t� rfl must be scheduled before November 8th_ The ile •bile is operated by Washington Dental Service Foundation in partnership with Seattle Children's Hospital. This event/activity is NOT being sponsored by the school district and the district assumes no responsibility for the conduct of or safety of the event/activity. In consideration for the privilege to distribute these materials the Chimacum school district shall be held harmless from any cause of • action, claim, or petition filed in any court or administrative tribunal arising out of the distribution of these materials, including all costs, attorney's fees, and judgments or awards. • Board of Health Old-Business & Informational Items .Agenda Item # 117., 3 • School Based Health Center Work Group October 21, 2010 • 4 • -Kr Yr ADVANCING SCHOOL-BASED HEALTH CARE POLICY AND PRACTICE As debate rages about the strengths and and preventative paradigms.Through its weaknesses of the national health care network School-Based Health Care Policy Program,they and the attendant legislative interventions de- infused 9 state SBHC associations and their signed to provide health care for millions of national organization,the National Assembly uninsured and underinsured Americans,there on School-Based Health Care,with 6 years of are unsung heroes of preventative and medical financial,advocacy,and technical assistance care for children and youth:school-based whose purpose was to advance a supportive health care centers(SBHCs).There are ap- local,state,and federal health and education proximately 1900 SBHCs throughout the policy network for SBHCs. country;forty-one(41%)of which are located Advocacy successes over the 6 years of the in Title I schools,a designation given to schools program have pervaded federal,stale and local with high numbers of economically disadvan- political bodies providing the beginnings of taged and otherwise at-risk students. a formal recognition of SBHCs in the context of Most SBHCs are located in urban commu- comprehensive health care.Investing in the nities(59%),however,their presence is in- health and well-being of the kindergarten creasing in rural schools(27%).The scope of through 12th grade population is the most services is community-specific and determined strategic undertaking taxpayers,policymakers, • through consensus between service providers, and advocates can take to ensure a viable the schools in which they are located,and the workforce and our future leaders.SBHCs communities served.The range of services should be at the core of that investment. most consistently offered include comprehen- Jeanita W Richardson,PhD,MEd sive primary care and limited mental health services.A primary focus of all SBHCs is health Associate Professor, University of Virginia promotion and disease prevention,early in- Ten-i D. Wright,MPH tervention,and risk-reduction education and Director, Center for School,Health,and services. Education,APHA Studies of the impact of SBHCs affirm their positive influence on reduction of absenteeism, doi:10.2105/AJPH.2010.195727 improved management of chronic disease such as asthma,and early identification of risk behaviors because of their ecological approach to children's and youths'health.Evidence substantiating the cost-benefit and improved health care access associated with school-based and school-linked centers,however,has done little to mitigate the significant barrier to se- curing sustainable financing streams and the adoption of statutory acknowledgment as a valued contributor to the continuum of medical care.Furthermore,little has been done to illuminate SBHCs as an essential comple- ment to academic achievement and school completion. The W.K.Kellogg Foundation has recog- nized the potential of SBHCs to serve as a pro- tective factor against poverty and disadvantage • because their interactions with children and youths are informed by public health ecological September 2010,Vol 100, No. 9 I American Journal of Public Health • Board of Health Netiv Business Agenda Item #T., 1 • Nurse Family Partners(ip Reports October 21, 2010 Helping First-Time Parents Succeed, - 4: V. z {,- a • j_ The Nurse-Family Partnership model is a unique visitor during her first trimester and continues community health program that is based on through the child's second birthday.This early evidence from randomized, controlled trials that intervention during pregnancy allows for any proves that it works. Moreover,independent critical behavioral changes needed to improve analyses based on the outcomes of these trials the health of the mother and child. suggest that when communities adopt the Nurse- Nurse-Family Partnership also has sufficient Family Partnership model,they are making a intensity, combining relevant content valued by smart investment. For every dollar invested, a the mother with a therapeutic relationship community can see a return of more than five focused on self-efficacy. III dollars. The Nurse-Family Partnership National Service . Office provides intensive education for nurse Nurse-Family Partnership focuses on first-time home visitors who utilize Visit-to-Visit mothers.It is during a first pregnancy that Guidelines, clinical consultation and the best chance exists to promote and intervention resources to translate the teach positive health and development .- program's theoretical foundations and behaviors between a mother and hercontent into practice in a way that is .. baby. .., adaptable to each family. b._ The Nurse-Family Partnership ., Nurse-Family Partnership implementing program is delivered by registered agencies enter data from each visit into nurses who are perceived as trustedthe national web-based Clinical and competent professionals, r Information System.This data is fostering a powerful bondmonitored to ensure that the program between nurse and mother. ' is being implemented with fidelity to the model as tested in the original Nurse Family Partnership has ;randomized,controlled trials,so that sufficient duration.Typically,a client r comparable results are achieved. s begins to work with her nurse home ''A.; , �_ a1 . .. .. ._ pj' _t !s . � : __ ;v1D a .._. p, I tthoroucib i.,;eflau, caai? i., -"ti T r _ .-, ,it _ _ . _..;'' _`', .1111 l - aeS.a'c i t i aflc. .e i u s` an e _ ---L :-):-.--_-.,t'-'. fs. . ,:.--r!..':.-, ''IU ig p:=3.4' .., s . 'yE: . �J D ca-,--.. _ _. _ � ..._ , ,_ _ ter,. • ;-r ?_:._ 1-l.;!,-,"....'-`,:-, ='.- .'; E .. _ a , -'. "They always say babies don't come with instruction manuals, Nurse-Family Partnership is at the forefront of The origins of the Nurse-Family Partnership but if there was one,the community health programs because it is model began more than 3o years ago when its Nurse-Family Partnership evidence-based.This makes it easier for founder,Dr. David Olds,began the first of three program would be it." communities to choose to adopt the program randomized,controlled trials in Elmira, New York. His vision and commitment were a result of his early experience working in an inner city day care Mom from I cons}I inia `. # center.He saw the need for care early in a young • 4:11-,:i; ' ,.. ,,,,,,:3i) ' i ''..,--- 'My vision of the future would be to graduate from ',1 ,z college with many honors and ti job offerings in the medical because 3o years of research from randomized, .- V111 profession,going on to become controlled trials prove it works — delivering a pediatrician." multi-generational outcomes that benefit communities and eliminate the costs of long-term mother's pregnancy and through the first two Mom from M;eh;g a„ social service programs. For example,the years of her child's life if social problems like child following outcomes have been observed among abuse and neglect were to be reduced.A recent participants in at least one of the trials of the report from the Center on the Developing Child at program: Harvard University shows the extent to whicAft 48%reduction in child abuse and neglect early childhood experiences influence later lir learning,behavior and health(see graph below). 56% reduction in emergency room visits for The report provides a framework for a variety of accidents and poisonings informed policy choices,one of which is early and 59% reduction in arrests at child age i5 intensive support by skilled home visitors for vulnerable families expecting their first child. 67% reduction in behavioral and intellectual problems at child age six 72%fewer convictions of mothers at child age'15 H41.17,vn Brain Development Synapse formation dependent on early experiences Nurse-Family'Partnership intervention lasts 30 months Sensory Pathways (vision,hearing) 1 Cone pt,on I Berth j ,,,-:,--''''",..,%,,, Language w__ Higher Cognitive p Function AGE -8 -7 -6 -5 -4 -3 -2 -1 1 2 3 4 5 6 7 8 9 10 11 -1 2 3 4 5 10 16 'arrin _ (MONTHS):(YEARS) '`%''---' TirTt_ rS� ;'91� As the chart above shows,during the first 3o months of a child's life,basic brain functions �:;a related to vision,hearing and language develop.It is during this window of opportunity that • 1900 Grant Street,Suite goo experienced registered nurses can have a huge impact on the future of both mother child. Denver,Colorado 80203-4304 Source:Nelson,C.A.,In Neurons to Neighborhoods(2000).Shankoff,J.Er Phillips,D.(Eds.) www.nursefamilypartnership.org 866.864.5226 ©Copyright 2010 Nurse-Family Partnership.All rights reserved. JANUARY 20' +4. iffietitS„, n Helping First-Time Parents Succeed® r 411 Nurse-Family Partnership is a public health long term —to parents,their children and the program that is based on evidence from communities in which they live. randomized, controlled trials that proves it works. z.. The evidence shows that first-time mothers working with a Nurse-Family Partnership(NFP) When Medicaid pays for Nurse-Family Partnership nurse home visitor can transform their lives and services,the Federal government saves more than the lives of their children. Moreover, independent it spends on the program costs,according to a research proves that for every public health dollar 2009 analysis conducted by the Pacific institute for invested in a local Nurse-Family Partnership Research and Evaluation(PIRE). program,communities can realize up to five dollars in return. Using data from the 1990 NFP Memphis trial, PIRE noted that Nurse-Family Partnership services resulted in a decrease in the number of women and children enrolled in Medicaid and Food Stamps • programs as the nurse-visited families gained academic and employment skills to become economically self-sufficient.According to the analysis,NFP services resulted in lower enrollment - in Medicaid and Food Stamps,with a 90/0 reduction in Medicaid costs and an 11% reduction in Food The Nurse-Family Partnership program costs Stamps costs in the 10 years following the birth approximately$4,500 per family per year to fund, of the child. Federal savings will be 1540/0 of and can range from $2,914 to $6,463 per family costs,yielding a net 54%return on the Federal per year. Nurses'salaries are the primary driver investment. that affects variability of cost, with highest costs A RAND Corporation 2005 analysis found a net typically found in urban centers on either Coast benefit to society of$34,148 (in 2003 dollars) and in hospital-based programs. per family served,with the bulk of the savings Communities choose to invest in Nurse-Family accruing to government, equating to a $5.70 Partnership because it is a wise investment that return for every dollar invested in Nurse-Family can yield substantial,quantifiable benefits in the Partnership(see graph).The analysis also found Increased participant income Lower-risk $7,271 (net of welfare loss) families $9,151 Reduction in tangible crime losses • Higher-risk , t$7,271 Savings to government families $41419 Cost $0 10,000 20,000 30,000 40,000 50,000 Net present value dollars per child 2003 Source:2005 RAND Corporation Study • • "The great thing about that for the higher-risk families participating in Well-designed randomized,controlled trials Nurse-Family Partnership the first trial in Elmira, New York,the community are an accepted research practice in the field is that it works. To put it recovered the costs of the program by the time of medicine. Randomized controlled trials are simply...it decreases about the child reached age four,with additional savings essential in producing valid,actionable evidence everythingyou want to accruing throughout the lives of both mother and about what does and does not work and are decrease and increases child. designed to provide conclusive evidence of about everythingyou'd In a 2004 study by the Washington State effectiveness.Medical breakthroughs that are want it to increase." Institute for Public Policy, Nurse-Family the result of randomized,controlled trials include OMAS r•RlEDFN Partnership ranked highest in terms of cost return vaccines for polio,measles,and hepatitis B,as TH Commissioner,New York Calamong pre-K,child welfare,youth development, well as cancer treatments that have dramatically Department of i-[ealth&Mental mentoring,youth substance prevention and teen improved survival rates from leukemia, i[yggiene February it,2007 Hodgkin's disease and breast cancer. pregnancy prevention programs at$2.88 benefit per dollar of cost. However,for public health programs,evidence from clinical trials often is not required.This is changing as policymakers, public health officials and the communities they serve increasingly 4 ,.' demand proven approaches for addressing public if health.Nurse-Family Partnership is one such program that can deliver against this objective. 41,0 Ir: With results from three randomized,controlled � � V q trials over three decades in Elmira,NY,Me TN,and Denver,CO, Nurse-Family Partners defines evidence-based public health programs. Data from the 15-year follow-up study to the , Nurse-Family Partnership trial in Elmira, New As of June 2010, Nurse- York,shows positive effects for nurse-visited Family Partnership is serving families more than 12 years after the visits ended. clients in 32 states across In addition,the following outcomes have been the country.As the program observed among participants in at least one of expands,the NFP national the three NFP controlled program trials: headquarters in Denver, •48% reduction in child abuse and neglect Colorado,works with participating agencies to ensure that they adhere to the tested and proven •590/0 reduction in arrests among children approach.Agencies are required to input data •720/0 fewer convictions of mothers regarding family characteristics and needs and the services provided during each nurse home •56% reduction in emergency room visits for visit into the national NFP database.Reports are accidents and poisonings provided back to the agencies,tracking fidelity • to the proven model, and ensuring communities •67% reduction in behavioral and intellectual realize comparable outcomes to those problems among children documented over the past 30 years. r, t raMLI 1)artnershir Helping Firu.7t,rParen�r Surardo 1900 Grant Street,Suite 400 o Denver,Colorado 80203-4304 www.nursefamilypartnership.org 866.864.5226 ©Copyright 2010 Nurse-Family Partnership.All rights reserved. JUNE 2010 ,A, e 042:-.1,-, 1--4-VF; _-,,,-f,Ei4e.,::tv, ,---.,Z0,,,wzW•tt., -'4.2. ,.,4,:afte4SV=M7,,,-1(';',:,.',,:"' „,,-.„-„,,,,,,,,,-,-t4--,,.„, , , ,- 4.:.--:e41w,k-rio-,t,A0:0,21:,,,ft.t ,:sewx,,A-;,-&1,--1,v4f42"-"mv:r6.-,---„,_ :1574-...-;-7(Z,-7.4: Z., „7„,..71, 47-' 4',,,k,Z„.'L'a--7—V,,144K'T-" Vt•tSrf471'1Q'*'::'''7'*':'44'" ' '444V7,,,,,-:4A' 7,"'' 7 1:1M.W.74fsw r*,V..el'W-A.Vg7- 7,:f7,P.7"•17'W!ftW7'47'7'''t ** '''-,7''''''' ''''''''''':I-- i.3P:'!-- " -_,„7,1,.7,:,, ,,x.r.-77,37k,V,-,--41, ,,ris. 7,,. 7t."..e.,,,r;7.•,,,x,:r,,,,,,,..,... -,1:-, ,,,.41,7:=-77,77---t,f--',7", ,,-7-,-7 7:'t.';=,,, , „,.7-","--7,- 1,.,,,,7„7,,,-,--,, ,,,,,--,!..,:,1,,, ,,,,i.,:+-,7,,,,,.,-,,,,,..:-„,„,,, ,,_,..,,,-:L,,•,.,,I,-,.,4,,,,.,„,,:,--4,$ii-,--1 4'Wlez';N'IS;7:.V'Mt :t•t- -,:,-N.ak'4Fe'r:,;te-4-*-T,:.,-„,%..:-4 5"4.J'idr10-1 the Ann u., a -if- a_.,,, i-,,,p ,,I.t. , —..r.' -'-'' - - - -- : -- /,'-c-ii,,,,---i a V're-t en t ( L rk t-.'' A b z-,.,:-.,.€. ,-,..,rt d N e Eke , „ , , 'OA",-h ,7'-et,f7 Or ‘:...7't7 -'";iIgt Ft t z..--5 n.A f -,77;:::-r; , .– , ,-. ,,rj , S:t,,in rn a rv 2,000 a year,' instead of the 1,376 officially reported in 2006.6 So, the true number of Washington children abused, neglected As families struggle with the financial and emotional stress of or even killed is likely to be much higher than the number of a deepening recession, law enforcement leaders are sounding officially reported cases. an alarm. Child abuse and neglect may be on the rise. Dr. Kenneth Feldman reported that while there were nine cases Once the full effects of the economic crisis become evident of non-accidental head trauma in children at Harborview and over the coming months and even years, and full data are available on local and state abuse and neglect cases, it may Seattle Children's Hospital combined for 2007, in 2008 there were 35 cases.' And Christi Mabbottthe Pediatric Trauma become apparent that the recent child trauma cases showing , u Coordinator at Spokane's Children's Hospital, reported that p in Seattle and Spokane hospitals are only the tip of the there were 22 cases involving non-accidental trauma of iceberg. children at the hospital in 2007, but in 2008 there were 40 cases.2 More families falling into poverty and staying there SERIOUS CHILD ABUSE IS UP Ai will likely increase the number of children who are abused Mr and neglected in Washington State. FIGHT CRIME: INVEST Non-Accidental Head Trauma at IN KIDS WASHINGTON takes a hard-nosed look at what Seattle Children's and Harborview 35 works—and what doesn't work—to cut crime and violence. The evidence shows that much of the abuse and neglect in the f., ,--:-- most vulnerable families can be prevented. Doing so will spare , thousands of Washington children from terror, agony, and despair and will also save lives. Sharply reducing abuse and 13 14 _ ' 9 neglect in Washington will save billions of dollars, while greatly reducing the number of children who would otherwise grow up to become criminals. 2004 2005 2006 2007 2008 The Annual Toll: Over 7,000 Washi -gton Children Kenneth Feldman,MD Abused sr Neglected Law enforcement leaders are concerned that the economic The Future Toll: More Criminals downturn is taking a toll on the youngest among us. Even before the current crisis, far too many Washington children While most victimized children never become chronic were being abused or neglected: in 2005 and 2006 (the criminals, being severely abused or neglected can lead to last available years of federally-approved data), over 7,000 changed patterns of behavior and even permanent changes children were abused and neglected each year in Washington, in children's brains. Some abused or neglected children and during the years 2002 thru 2006 there were an average have trouble learning empathy, while others develop a of 12 deaths a year.' However, even those tragic numbers predisposition to misinterpret actions as threatening and react may mask the real toll of child abuse and neglect in the state. violently. This sharply increases the risk that these children will Nationally, the best estimate of the real number of children grow up to be arrested for crimes. Research by Dr. Cathy Spatz abused or neglected each year is closer to three times the Widom found that children who were abused and neglected 0 official figure,4 and the Justice Department released a report had almost twice the odds of being arrested as a juvenile.' saying deaths nationwide from abuse and neglect likely exceed 4.- ,A,-,.-zu...-.47--- 0.4.-zWr-t..-1*-ri`..,01.11,1.-,- ,,i14-1•7_*,:,,-.1,,,,,,,.,„. „,..:.- 4.,,,,...14--- --, R ="v4.1.•14. --.4- 1-Tikv-,44§4,,trig,c.---,t-'4,-40-4Z-,-,res,"! -wAvei.0-2:-- ,-A -',—nlc- ,, --, . .._,,,,,,,c' -i Hcr � .. alf of Abuse and Neglect � in High- NURSE-FAMILY PARTNERSHIP CUT ABUSE AND NEGLECT III r a risk Families Can Be Prevented AN;D ARRESTS IN HALF AMONG AT-RISK KIDS SERVED Abuse and Neglect Down 48% Arrests Down 59% Failure to invest now in programs proven Rate of arrests b age 15 toprevent child abuse and neglect puts Rates of substantiated reports of abuse Y or neglect by age 15 everyone in Washington at greater risk of becoming a victim of crime.The over SO PER 100 200 Washington police chiefs, sheriffs, __,___ _ 37 PER 100 prosecutors,and crime victims who are members of FIGHT CRIME: INVEST IN KIDS WASHINGTON call on their state 26 PER 100 and federal governments to invest more !- i5 PER 100. , in what works to prevent abuse and -A ~ , neglect. :! ''' ,:,-, :':f-_,-;24*,_ = -- s ,_ Offering evidence-based home Mothers who did Mothers who Children whose Children whose mothers did not mothers received visiting to all at-risk parents not receive parent received parent coaching coaching receive parent parent coaching coaching The Nurse-Family Partnership Program (NFP) randomly assigned at risk mothers non-profit organizations. Much more taxpayers and crime victims, on average, to receive home visits by nurses who provided coaching in parenting and funding is needed if all at risk mothers over$18,000 for every child served who could benefit are to be offered because of reduced crime, higher other skills. Rigorous research, originally this voluntary service. These programs school performance and high school published in the Journal of the American should be expanded, not cut. graduation, reduced abuse and neglect, Medical Association,shows that children and other benefits." of mothers in the program had 48 percent fewer substantiated reports Saving Lives, Preventing Crime and 1110 of abuse or neglect. Put another way: Saving Money Law Enforcement Leaders are home-visiting services can prevent nearly United half of all cases of abuse or neglect Child abuse and neglect costs among at-risk children. In addition, Washington more than $886 million Washington law enforcement leaders children served had 59 percent fewer per year." On any given day in 2007, are calling for greater investments in . arrests by age 15 than the kids left out.° the Washington State Children's evidence-based home visiting to protect Administration estimated that 10,000 children from abuse and neglect, In one of their randomized control children were living in out-of-home save taxpayers'dollars, and make all • trials, Parents as Teachers(PAT), another care and in the custody of the state." Washingtonians safer. The evidence home-visiting program, found that In 2004, $432 million was spent on is in.We can save billions of dollars treatment for injuries–a possible sign preventing or treating abuse or neglect in Washington while preventing most of abuse–dropped among the children in Washington, including$226 million in abuse and neglect in high-risk families. served compared to the children not state funding." This will also prevent future crime. The served. For example, 13 percent of , time to act is now. children not in the program had been Most of that went to provide necessary treated for an injury in the year prior to foster care and victim services, and that the second year assessment compared to funding—while never adequate—must three percent of the children in PAT.9 at least be maintained. Investing more now in preventing child abuse and At best, only one in six zero-to three- neglect, instead of waiting to treat it year-old Washington children whose with foster care and other services, will families are below the poverty line save lives, reduce future crime and are currently receiving intensive home soon begin saving taxpayers money. visiting services.t0 These programs For example, the Washington State are funded by federal, state and local Institute for Public Policy found that • government as well as local community nurse home visitation programs saved „ "10,, - ,. ;,!,,,,-.7.,., ' Adverse Childhood 1 164, ,, Experiences il , k I Population Health in 1, i . v .',., ' � �� was hin ton: { 2 t The Face of a Chronic Public N 1 t1. Health Disaster -.,.__ � ZF �1oR_ +£ Results from the 2009 Behavioral Risk Factor f �� Surveillance System i ,_ � � k July 2, 2010 ,--, fit, ''..z., ..:z.14.1$,..!.- zak r .0 :l'' 7` - ii,,, +.. M{1 Prepared for the Washington State Family Policy . � , .� t � �: � ° a Council Robert F. Anda, MD,:-:,ki. MS ria Co-Principal Investigator and Co-Founder Adverse Childhood Experiences (ACE) Study & David W. Brown, DSc, MScPH, MSc WASH1HGTOH STATE • • P ® LiCY • J , o v n C This report was made passible by the generous contributions of the authors, the Bill and Melinda Gates I Z foundation, the Committee for Children and Families of Incarcerated Parents, the Mental Health Q 111 n Transformation Grant Prevention Advisory Group and the Washington State Family Policy Council [.L t= A FAMILY.(OMMUHITY&STATE PARTNERSHIP Adverse Childhood Experiences and Population Health in Washington: • The Face of a Chronic Public Health Disaster Results from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) July 2, 2010 Prepared by: Robert F. Anda, MD, MS Co-Principal Investigator and Co-Founder • Adverse Childhood Experiences (ACE) Study and David W. Brown, DSc, MScPH, MSc • 8 Preface • Kai Erikson has defined both the threat and challenge posed by a chronic disaster: "..it gathers force slowly and insidiously,creeping around one's defenses rather than smashing through them. People are unable to mobilize their normal defenses against the threat, sometimes because the have elected consciously or unconsciously to ignore it, sometimes because they have been misinformed about it, and sometimes they believe they cannot do anything to avoid it."'Chronic disasters are easily ignored, overlooked,or placed on the back burner. As this report is being written our nation is riveted by an acute disaster in the Gulf of Mexico—a ruptured oil well spewing toxic oil into fragile ecosystems. This is newsworthy; our national, state and local leaders are scrambling to respond. Many billions of dollars will be spent in attempts to treat it and fix what has been destroyed. We are saddened and outraged. Place the blame,hold court in Washington, DC. Write new regulations,reconfigure agencies, and compensate the injured.Clean it up,plug the hole and move on. We'll prevent the next disaster and get better at cleaning up after ourselves the next time. I had already concluded that Adverse Childhood Experiences(ACEs)have created a"chronic public health disaster." This conclusion was based on epidemiologic data from members of the Kaiser Health Plan in California by the ACE Study—in laborious and ongoing detail. Now this conclusion is based on population-based data from in the State of Washington. ACEs are poisonous to the fragile human ecosystem. The chronic disaster is real. It is alive in your state. For an epidemic of influenza, a hurricane, earthquake, or tornado the worst is quickly over; treatment and recovery efforts can begin. In contrast,the chronic disaster that results from ACEs is insidious,constantly rolling out from generation to generation. As evidenced in this report,ACEs are • endemic and have strong and myriad effects on the health, quality of life, and functioning of the people of the State of Washington. Although the consequences of ACEs are often challenging and provocative,these results should not be surprising. But many who read this report will be surprised. Your state is the first to take a comprehensive,population-based look at ACEs and health. I have visited Washington many times to teach and learn about the public health impact of ACEs. Your state is pushing forward thanks to the efforts of the Washington Family Policy Council,and is contributing to the exponential growth of empirical evidence that has fueled markedly increased awareness and understanding of the lifelong consequences of ACEs. However,there will be disbelief, denial, and doubts about believing what the people of the State of Washington tell you about their childhoods and their lives. During my training as a medical student I learned that 90%of diagnoses come from asking patients good questions and listening carefully to their responses... the same truth holds for understanding population health. People who tell you about their ACEs are not liars or looking for secondary gain; rather,they bravely provide you the privilege of bearing witness to their lives. Challenge the critics of your Washington BRFSS for a viable alternative explanation for the findings. If there is one,what are they going to do about the alternative cause? Some will say that the problem is too big to address or ask for simple, immediate solutions—a silver bullet. You will hear that budgets are too small. We are in an economic recession.We'll have to wait on this one. Are those reasons to turn the other way? Ask if you want the same report,or maybe worse, for your children,your grandchildren,or anyone else's children when they grow up and respond to the survey in the decades to come. • 9 Your results are consistent with what we have learned about the biology of childhood. Excessive stress and adversity has a cumulative and predictable negative effect on human development. These • effects are most pronounced for infants, children,and adolescents. The developing brains(and other body systems)of your young ones are negatively impacted by the inherent biochemistry of stress. More is worse, adversity is cumulative; it can affect any human function. As you read this report and review the data,you can decide for yourself whether"public health disaster"is a grandstanding term or an attempt to spin data into a catchy report. Then look at the current health and social priorities of your state,where the resources are going,and how much progress has been made as a result. Challenge yourself to find a problem that compares in magnitude and scope to the preventable human wreckage and suffering described in this report. Until very recently,this public health disaster has been hidden from view. Our society has treated the abuse,maltreatment,violence,and chaotic experiences of our children as an oddity that is adequately dealt with by emergency response systems—child protective services,criminal justice, foster care,and alternative schools to name a few. These services are needed and are worthy of support—but they are a dressing on a greater wound. Our society has bought into a set of misconceptions. Here are a few:ACEs are rare and they happen somewhere else. They are perpetrated my monsters. Some, or maybe most, children can escape unscathed, or if not, they can be rescued and healed by emergency response systems. Then these children vanish from view... and randomly reappear—as if they are new entities—in all of your service systems later in childhood,adolescence,and adulthood as clients with behavioral, learning, social,criminal, and chronic health problems. Take the time to review the prevalence of ACEs in your state they are common—they are • endemic.ACEs pile up to burden the lives of the people of Washington. The ACE score demonstrates their cumulative biologic impact. This biologic impact transcends the traditional boundaries of your health and human service systems. The impact is enormous. The public health impact of ACEs can now only be ignored as a matter of conscious choice. Thus,with this information comes the responsibility to use it.2 The chronic public health disaster of adverse childhood experiences and their effects on human development are real. Data from your BRFSS properly informs about it. The first step toward healing comes with understanding the problem. The face of the disaster is in full view. Robert Anda,MD,MS Fayetteville, GA July 2,2010 References 1.Erikson K.A new species of trouble:The human experience of modern disasters.New York: W.W. Norton, 1994. 2. Foege WH.Adverse childhood experiences:A public health perspective(editorial). American Journal of Preventive Medicine 1998;14:354-355. • 10 • Executive Summary The Adverse Childhood Experiences(ACE) Study is now in its 15th year and is ongoing. The Study is designed to examine the childhood origins of many of our Nation's leading health and social problems. The Study represents collaboration between the Nation's leading prevention agency,the Centers for Disease Control and Prevention(CDC)and the Kaiser Health Plan's Department of Preventive Medicine in San Diego,CA. The ACE data in the 2009 Washington ACE BRFSS module are available because the strength of the ACE Study findings led to numerous activities by the Washington Family Policy Council,which in turn, resulted in a grant from the strength of the ACE study findings led to numerous activities by the WA Family Policy Council,which in turn, resulted in grants from the Bill and Melinda Gates Foundation, Committee for Children and Families of Incarcerated Parents, and the Mental Health Transformation Grant Prevention Advisory Group to support the data collection and analysis. The purpose of this data collection in the Washington BRFSS is to document the public health and social burden of ACEs on a population scale. The key concept underlying the ACE Study is that stressful or traumatic childhood experiences such as abuse, neglect,witnessing domestic violence, or growing up with alcohol or other substance abuse,mental illness,parental discord, or crime in the home(which we termed adverse childhood experiences—or ACEs)are a common pathway to social, emotional, and cognitive impairments that lead to increased risk of unhealthy behaviors,risk of violence or re-victimization,disease,disability and premature mortality(Figure A). We now know from breakthroughs in neurobiology that ACEs disrupt neurodevelopment and can have lasting effects on brain structure and function the biologic pathways that likely explain the strength of the findings from the ACE Study. • Figure A. Conceptual Framework for Understanding the Public Health Impact of ACEs Death Early Death Scientific gaps ;e-3 -n131,bettavtors Enlott"ti,k4SUttraer- nitiv Adverse Childhood Experiences Concept ion The ACE Study showed that these experiences are highly interrelated. This is also the case for • the population of the State of Washington. In order to assess the relationship of the ACEs to health and social problems in this report we used the ACE score. This score is a count of the number of ACEs to 11 assess their cumulative impact on childhood development and therefore,their impact on a variety of health and social priorities. In this report you will find that the ACE score has a strong, graded • relationship to a wide array of health and social problems in Washington. ACEs in the State of Washington As in the ACE Study,the Washington BRFSS ACE data shows that: ACEs are common—they are endemic in Washington • 17% of adults report exposure to physical abuse • 17% of women and 7%of men report sexual abuse during childhood • One in four adults report having dealt with parental separation or divorce during childhood • A third of adults grew up with substance abuse in the household • 62% of adults have at least one ACE ACEs tend to co-occur or cluster in the lives of your children • Among adults exposed to physical abuse, 84%reported at least 2 additional ACEs • Among adults exposed to sexual abuse, 72%reported at least 2 additional ACEs ACEs add up—more is worse—as captured by the ACE score • One in four adults report three or more ACEs • 5%of adults have six or more ACEs As the ACE score increases the risk of numerous health and social problems increase dramatically • Compared to adults without exposure to ACEs,the risk of smoking–a risk factor for many chronic diseases–was increased 1.2 times for those with 1 ACE, 1.5 times with 2 ACEs, 1.9 times with 3 ACEs, 2.8 times with 4 or 5 ACEs, and 4.6 times with 6 or more ACEs • The likelihood of life dissatisfaction–a risk factor for suicide–increased with increasing ACE score such that adults with 6 or more ACEs are 9 times more likely to report life dissatisfaction compared to those with an ACE score of zero These ACE-related problems in Washington are a"Who's Who?" list that encompasses the priorities of many agencies, public and private,that are working to prevent and treat a vast array of problems. • Of 12 Detailed Listing of Health and Social Problems Shown to Have a Graded Relationship to the ACE • score in the 2009 Washington BRFSS Type of Problem Outcomes Associated with Adverse Childhood Experiences Prevalent Diseases Cardiovascular disease,cancer,asthma Risk Factors for Common Smoking, heavy drinking, binge drinking,obesity,marijuana use, high Diseases/Poor Health perceived risk of HIV Poor Mental Health Sleep disturbances,frequent mental distress,anxiety, hopelessness, disruptions in work or activity due to mental health,treatment for mental health condition(s) General Health and Social Fair or poor health, life dissatisfaction,poor health-related quality of life, Problems separation or divorce, physical disability, health problems requiring special equipment This array of problems that arise from ACEs calls for an integrated, rather than a separate or categorical perspective of the origins of health and social problems in Washington. This approach to • growing up with ACEs, and to the consequences of exposure to them, may unify and improve understanding of many seemingly unrelated health and social problems that tend to be identified and treated as categorically separate issues. The Washington ACE data call for integrated approaches to prevent ACEs, and intervene early on children growing up being abused, neglected, witnessing domestic violence, or with substance abusing, mentally ill, or criminal household members. All of these childhood stressors are interrelated and usually co-occur. Prevention and treatment of one ACE frequently can mean that similar efforts are needed to treat multiple persons in affected households and other social systems. Better identification and treatment of the effects of ACEs among persons and systems interacting with children is necessary to minimize the impact of their intergenerational transmission. Development of more integrated approaches will likely contribute to improved treatment of affected persons, and better integration of research priorities,preventive,social and educational services, and legal venues. S r Board of.1CeaCth New Business .Agenda Item #17., 2 � Pre-adoption Briefing & Call for Public 3-Learing 02/16/w) o) B03f Fee Schedule October 21, 2 01 • STATE OF WASHINGTON JEFFERSON COUNTY BOARD OF HEALTH • AN ORDINANCE ESTABLISHING A Ordinance No. FEE SCHEDULE FOR JEFFERSON COUNTY PUBLIC HEALTH Section 1 —Hearing Section 2—Effective Date Section 3—Fees Section 4—Severability Section 5—Prior fee schedule repealed WHEREAS, The purpose of this ordinance is to set the fee schedules for Jefferson County Public Health, NOW, THEREFORE, BE IT ORDAINED by the Jefferson County Board of Health as follows: Section 1 —Hearing That a public hearing with respect to possible adoption of this Ordinance shall be held on Thursday, December 16, 2010 before the Jefferson County Board of Health. action 2—Effective Date That this Ordinance (and its Attachment) shall be effective as of January 1, 2011. Section 3—Fees That the schedule for Jefferson County Public Health fees for the year 2011 for permits, licenses and services is hereby set by the Jefferson County Board of Health as listed in the Ordinance. Furthermore, this section of the Ordinance authorizes automatic increases in the fee schedule in accordance with increases in the Consumer Price Index for US City Average for All Urban Wage Earners and Clerical Workers, published by the Bureau of Labor Statistics for the United States Department of Labor. All of the services/fees listed for Jefferson County Public Health are hereby being set as follows: Environmental Health fees, established by this ordinance, shall be adjusted annually on the first business day of January (Adjustment Date) by the amount of the increase of the Consumer Price Index as reported for the month of September preceding the Adjustment Date, following the annual fee indexing criteria established in Jefferson County Ordinance #12-1209-96 and the actual cost of doing business. The Jefferson County Board of Health has determined fees should cover services costs. Fees are calculated by the cost of doing business. The activities and fees listed are authorized under state and local code. • • Section 4—Severability A determination that any fee or fees adopted as part of this Ordinance is unlawful or illegal shall not cause any other fee or fees adopted as part of this Ordinance not affected by that determination to be repealed, revised or reduced. Section 5—Prior Fee Schedules Repealed Any prior fee schedule previously adopted by this Board that contains or reflects fee amounts that are less than those adopted herein is hereby repealed and replaced by this Ordinance. AN ORDINANCE ESTABLISHING A 2011 FEE SCHEDULE FOR JEFFERSON COUNTY PUBLIC HEALTH ADOPTED day of 2010. JEFFERSON COUNTY BOARD OF HEALTH • Chuck Russell, Chair Kris Nelson, Vice-Chair Phil Johnson, Member John Austin, Member Roberta Frissell, Member David Sullivan, Member Sheila Westerman, Member • JEFFERSON COUNTY PUBLIC HEALTH ENVIRONMENTAL HEALTH DIVISION s _ ENVIRONMENTAL HEALTH 2010 2011 Additional Fees and Other Information FEES FEES ealth Officer Administrative Hearing 287.00 287.00 Administrative Hearing Appeal 287.00 287.00 Technical Assistance/PlanReview-Minimum 65.00 65.00 Technical Assistance/Plan Review-Per Hour 65.00 65.00 Filing Fee 49.00 49.00 ONSITE SEWAGE DISPOSAL Sewage Disposal Permits New Conventional 520.00 520.00 Valid for 3 years New Alternative 620.00 620.00 Valid for 3 years New septic tank and/or pump chamber only 247.00 247.00 Issued in conjunction with an existing sewage disposal system or community system New Community or>1000 G.P.D. (base fee) 520.00 520.00 Plus$82 per connection-valid for 3 yrs New Commercial>1000 G.P.D. Conventional 620.00 620.00 Valid for 3 years Alternative 663.00 663.00 Valid for 3 years Repair/Upgrade/Modification/Designate Reserve Area 115.00 115.00 Applies to existing installed sewage disposal system Expansion 387.00 387.00 Redesign 115.00 115.00 Applies to pending or active but not installed Reinspection 144.00 144.00 Evaluation of Existing System/Monitoring Inspection Septic system only 287.00 287.00 Septic system plus water sample 298.00 298.00 Retest/Reinspection 100.00 100.00 On Site Sewage OnSite-Site Plan Advanced Approval Determination(SPAAD) 287.00 287.00 Septic Permit with SPAAD(conventional) 280.00 280.00 Septic Permit with SPAAD(alternative) 388.00 388.00 Subdivision Review Base Fee 372.00 372.00 Plus$73.00 Per Lot Boundary line adjustment review fee 146.00 146.00 Plus$73.00 Per Lot Pre application meeting fee 146.00 146.00 Planned rural residential development review fee 146.00 146.00 Density exemption review fee 73.00 73.00 Density exemption review fee requiring field work 146.00 146.00 ther WaiverNariance Application 172.00 172.00 WaiverNariance Hearing 287.00 287.00 Wet season evaluation 387.00 387.00 Revised building application review fee 146.00 146.00 New building application review fee: Residential 73.00 73.00 Commercial 146.00 146.00 General environmental health review fee 73.00 73.00 Licenses Installer, Pumper, Operator(Maintenance Person) 387.00 387.00 Retest 158.00 158.00 Annual Renewal 273.00 273.00 Delinquent Renewal after January 31 387.00 387.00 FOOD SERVICE ESTABLISHMENT FEES PERMIT FEES (Annual Permit) Restaurants/Take-Out(Based on menu complexity&seating) Menu changes may change category 0-25 seats(Limited Menu) 174.00 Add for clarity 0-25 seats (Complex Menu) 310.00 Add for clarity 25-50 seats 310.00 310.00 51-100 seats 372.00 372.00 101-150 seats 422.00 422.00 With Lounge, add 136.00 136.00 Bakery Only 136.00 B&B 174.00 Caterer w/commissary or catering-only kitchen 310.00 w/restaurant, additional fee for catering 174.00 Concession/Commercial Kitchen/Church 136.00 Espresso Stand(Beverages Only) 136.00 Grocery 1-3 checkouts 174.00 >3 checkouts 422.00 Meat/Fish Market Only 310.00 obile Unit Limited Menu 174.00 Complex Menu 310.00 .chool Cafeteria Central Kitchen 310.00 Warming Kitchen 174.00 Tavern(with food see Restaurant) • Annual Permit Issued after September 1 50%of fee 50%of fee 50%of Annual Permit Fee Late Fee(Paid after January 31) +25%of fee Eliminate No Fee-Close establishment if permit isn't renewed Late Fee(Paid after February 28) +50%of fee Eliminate No Fee-Close establishment if permit isn't renewed • Temporary Permit Complex 130.00 130.00 Limited 98.00 98.00 Late Fee for Temporary Permits +50%of fee +50% of fee Additional(Paid when application is submitted less than 7 days prior to the event) Other Food Fees Waiver 37.00 37.00 Plan Review Pre-opening inspection(per hour) 65.00 New fee to cover cost of inspection Per Hour 65.00 65.00 Reinspection First Inspection 87.00 87.00 Each Inspection After First 100.00 100.00 Reopening Fee 65.00 Hourly Rate Food Handler Card/Duplicate 10.00 10.00 Manager's Course 211.00 211.00 SOLID WASTE Landfills requiring environmental monitoring 508.00 508.00 Inert Landfills 322.00 322.00 Biosolid Utilization 446.00 446.00 Other Solid Waste Facility Permits 322.00 322.00 Drop Boxes 149.00 149.00 New Facility Application 409.00 409.00 Plan Review 72.00 65.00 Per Hour WATER Application Fee 149.00 149.00 Inspection of well construction,decommission& reconstruction Determination of Adequate Water Supply 98.00 98.00 Building Permit Process Well Site Inspection-Proposed public water supply 298.00 298.00 LIVING ENVIRONMENTS(Annual Permit) Pool 273.00 273.00 Spa 273.00 273.00 Pool/Spa Combined 372.00 372.00 Plan Review 65.00 65.00 Per Hour Indoor Air(Tobacco) Compliance Enforcement 65.00 65.00 Per Hour Reinspection 73.00 73.00 11111 Rebuttal Application 146.00 146.00 RCW 70.05.060: Powers and duties of local board of health. Page 1 of 1 WASHINGTONSTA ZGI LATUS Ochi Help RCWs>Title 70- Chapter 70.05 > Section 70 05.060 • Inside the Legislature * Find Your Legislator 70.05.055 « 70.05.060 » 70.05 070 • Visiting the Legislature • Agendas, Schedules and RCW 70.05.060 Calendars • Bill Information Powers and duties of local board of health. * Laws and Agency Rules *, Legislative Committees Each local board of health shall have supervision over all matters pertaining to the preservation of the • Legislative Agencies life and health of the people within its jurisdiction and shall: *. Legislative Information Center (1) Enforce through the local health officer or the administrative officer appointed under RCW • E-mail Notifications 70 05.040, if any, the public health statutes of the state and rules promulgated by the state board of (Listserv) health and the secretary of health; * Students' Page (2)Supervise the maintenance of all health and sanitary measures for the protection of the public History of the State health within its jurisdiction; Legislature Outside the Legislature • (3) Enact such local rules and regulations as are necessary in order to preserve, promote and improve the public health and provide for the enforcement thereof; • Congress-the Other Washington (4) Provide for the control and prevention of any dangerous, contagious or infectious disease • TM/ within the jurisdiction of the local health department; * Washington Courts (5) Provide for the prevention, control and abatement of nuisances detrimental to the public health; OFM Fiscal Note Website Access (6) Make such reports to the state board of health through the local health officer or the Washingtcrt administrative officer as the state board of health may require; and Akialk (7) Establish fee schedules for issuing or renewing licenses or permits or for such other services as are authorized by the law and the rules of the state board of health: PROVIDED, That such fees for services shall not exceed the actual cost of providing any such services. [1991 c 3§308; 1984 c 25§6; 1979 c 141 §79; 1967 ex.s.c 51 § 101 http://apps.leg.wa.gov/rcw/default.aspx?cite=70.05.060 10/11/2010 • Board of.9 health Wow Business .agenda Item # v, 3 • National aCealtGt Reform: Orientation to the Affordable Care pct of 2010 October 21, 2010 • Highlights of Community Benefit/Hospital Needs Assessment In 1969, the IRS created a Community Benefit Standard in Revenue Ruling 69-645, 1969-2 C.B. 117 giving guidance to nonprofit hospitals about the conditions of tax exemption. In 2008, the IRS implemented a new • requirement for nonprofit hospitals to report on Schedule H, Form 990. Beginning in fiscal year 2009, nonprofit hospitals will need to document details of community benefit activities to receive a variety of tax exemptions. Community benefit(CB) is defined as "the promotion of health for a class of persons sufficiently large so the community as a whole benefits." The Patient Protection and Affordable Care ACT (Health Care Reform IX Revenue), section 9007, requires tax exempt employers (501 (c) (3)) to: • conduct a community health needs assessment every 3 years • widely publicize assessment results • adopt an implementation strategy to meet needs identified by the assessment • take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health To qualify as CB, initiatives must respond to an indentified community need and meet at least one of the following criteria: • Improve access to healthcare services • Enhance health of the community • Advance medical or health knowledge • Relieve or reduce the burden of government or other community efforts Historically, the majority of CB funds have been spent on "charity care". The new tax law moves from "relief of • poverty" to a new definition that is more public health, population health oriented, and implies some form of measurement to validate the achievement of the larger benefit. The newness and vagueness of the requirements has resulted in differences and confusion in the interpretations and how to implement this new requirement. A couple of national conferences convened to address some of the challenges: • The Public Health Institute in a 2004 CB demonstration project report identified five core principles for effective CB programs: emphasis on communities with disproportional unmet health-related needs and measurement of activities; emphasis on primary prevention; building a seamless continuum of care with linkages between clinical services and community health improvement activities that ensure measurable impacts; building community capacity; and collaborative governance. • In the fall of 2009, the St Louis University and Missouri Foundation for Health convened 50 experts to identify key questions to be addressed during the next three years to move the practice and policies of CB toward an evidence-driven approach. Some of the questions were: 1) How to define "community"? 2) What is the relationship between CB outcomes and community involvement in decision making? 3) What exemplary planning practices results in resource allocation that matches community need? 4) What methods and data can be used to evaluate improvements in outcomes, costs, etc? 5) What methods are used to engage hospital boards in CB more effectively? 6) What are characteristics of leadership and governing boards in hospitals that are doing CB well? CB presents a unique opportunity for nonprofit hospitals and public health to engage in partnerships and build • collaborative approaches to assess the needs and improve the health of the community, implement primary prevention strategies, and measure the impacts. :N :,,,,, co ., , 0. 0 i r; '•r> caC`vci2yYkCi.�rtc.a�t=i(3tft�adi The National t CannecYron{or Lrxrr!Pubic Health Public Health Funding in Final Health Reform Bill Authorized Appropriated Public health Establishes a Prevention and Public Health Fund to $15 billion over 10 investment provide for expanded and sustained national investment in years, beginning prevention and public health programs for prevention, with$500 million/ wellness,and public health activities, including prevention FY2010, ramping research and health screenings. Administered by HHS up to$2 billion in Secretary FY2015 and each year after. Community- Community Transformation Grants: Competitive grants to Not specified based state and local governmental agencies and community-based prevention organizations to reduce chronic disease rates,address health disparities,and develop a stronger evidence-base of effective prevention programming. 20%of the grants are targeted to rural and frontier areas. Prevention and Public Health Fund resources may be used. Public health Public Health Workforce Recruitment and Retention Authorizes $195 workforce Programs million/year for • Establishes a public health workforce loan repayment loan repayment program, allied health workforce recruitment and retention program, $30 programs,and training for mid-career public health million each for professionals. allied health and mid-career programs. Epidemiology Grants to state, local and tribal health departments to improve $190 million per $20 million and Lab surveillance and response with respect to infectious diseases year, FY2010— provided in Capacity Grant and other conditions of public health importance. FY2013 FY10 Program Health Requires the collection and reporting of data on race and N/A disparities/ ethnicity,gender,geographic location, socioeconomic status Data collection (including education, employment or income), primary language, and,disability status,data at the smallest geographic level such as State, local, or institutional levels if such data can be aggregated;data by racial and ethnic subgroups. Home Grantees of this state grant program for evidence-based early $1.5 billion over 5 $90 million visitation childhood home visitation will measure improvement in years provided in maternal and child health, childhood injury prevention, FY10 school readiness,juvenile delinquency, family economic factors,and coordination with community resources. 11;'0 17th Street,NW, Second Floor WashNngton, DC 20036 P(232) 783 5550 F'202)783 1583 www nacha.or PublicH 9 Prevent. He.Protect Board of Health Netiv Business .agenda Item #17., 4 • Data Steering Committee it.lpdate October 21, 2010 JEFFERSON COUNTY BOARD OF HEALTH • September 29, 2010 Community leaders review local data. Data Steering Committee reports to Jefferson County Board of Health. Goal: To provide an ongoing source of accurate, current, and local community and health information for review by local policy boards and Jefferson County Board of Health for use in policy making, priority setting, and identifying community strengths and needs. Project Activities: • Develop a set of core community health indicators. Using a similar process as the Healthy Jefferson Report's Data Steering Committee in 2003 and add indicators as needed. • Reconvene and staff a new Data Steering Committee made up of community leaders and other project partners to guide and review specific assessment efforts. • Explore new sources of data and include them in updated community health reports. • Perform focused analysis of issues of high priority & present to the data steering committee members. . • Reconvene and staff a minimum of three Data Steering Committee meetings. Post all findings on the JCPH web site: http//:www.jeffersoncountypublichealth.orq the day after the meetings. • http://www.jeffersoncountypublichealth.orq/index.php?health-of-Jefferson-county Timeline Data Committee Meeting Review Demographic updates September 9, 2010 Substance Abuse and Mental Health October 28, 2010 Access to health care and community health November 2010 Death, birth, quality of life February 2011 Summary and prioritizations March 2011 • JEFFERSON COUNTY BOARD OF HEALTH • Jefferson County Data Steering Committee Draft agenda October 28, 2010 3:00-5:00 p.m. Jefferson County Public Health 615 Sheridan PT (near QFC) 1. Introductions 3:00 Staff: Jean Baldwin, JCPH Siri Kushner, Kitsap County Health District 2. Updates and questions from last meeting. 3. Substance Abuse and Mental Health impacts on community and quality of life. • 4. Data sharing, 6 sections today, 5 minutes of discussion at the end of each section 5. Agenda/ next data topics to explore/ planning next meetings • Data Steering Committee • September 9, 2010 Attendees Jill Buhler Hospital Commissioner Frank Gifford Public Works Mack Boelling Jefferson County Citizens for Healthcare Access Sam Markow Jefferson Mental Health Alta Crawford Literacy Council Roberta Frissell Jefferson County Board of Health Fran Joswick Jefferson County Board of Health Anne Dean Community Network Judi Morris Olycap Linda Cooley ECHHO Ford Kessler Safe Harbor Recovery Center Theresa Percy City of Port Townsend Stacie Hoskins Community Development Vic Dirkson Jefferson Healthcare Holly Carlson Port Townsend School Board Kris Mayer Jefferson County Community Foundation Tom Locke Jefferson County Health Officer • Paula Dowdle Jefferson Healthcare • • Board of 3-fealth New Business .agenda Item #17., 5 � State and-County Budget I.lpdates October 21, 2010 • r Department of Health Washington State Department of 6.287 Percent Reduction Summary For ' Fiscal Year 2011 it r Hea l th • October 1,2010 On September 13,Governor Chris Gregoire issued Executive Order 10-04 implementing across-the-board reductions to avoid a projected cash deficit in the State General Fund. For the Department of Health,the amount of GF-State reduction totals$6,647,880, including$1,508,880 for local public health. County Public Health Assistance Funds Section 705 of the 2010 Supplemental Operating Budget(ESSB6444)contains a$24 million annual distribution to local public health agencies to support public health services, including public health nursing. The funding is included as a separate section in the budget so the 6.287 percent across-the-board reduction applies equally to each of the local health agencies. Reduction totals$1,508,880,and will be deducted from the January 1,2011 distribution. The reductions would be allocated as follows: Local Health Jurisdiction Amount Adams County Health District 1,946 Asotin County Health District 4,257 Benton-Franklin Health District 73,282 Chelan-Douglas Health District 11,616 Clallam County Health and Human Services Department 8,912 Southwest Washington Health District 68,181 Columbia County Health District 2,548 Cowlitz County Health Department 17,513 Garfield County Health District 945 Grant County Health District 7,456 Grays Harbor Health Department 11,560 Island County Health Department 5,777 • Jefferson County Health and Human Services 5,393 Seattle-King County Department of Public Health 599,261 Bremerton-Kitsap County Health District 34,872 Kittitas County Health Department 5,815 Klickitat County Health Department 3,923 Lewis County Health Department 6,652 Lincoln County Health Department 1,868 Mason County Department of Health Services 6,035 Okanogan County Health District 3,990 Pacific County Health Department 4,868 Tacoma-Pierce County Health Department 177,330 San Juan County Health and Community Services 2,360 Skagit County Health Department 14,078 Snohomish Health District 141,973 Spokane County Health District 132,117 Northeast Tri-County Health District 6,944 Thurston County Health Department 37,748 Wahkiakum County Health Department 866 Walla Walla County-City Health Department 10,818 Whatcom County Health Department 53,808 Whitman County Health Department 4,950 Yakima Health District 39,218 Epidemiology, Health Statistics,and the Public Health Laboratories Public Health Laboratories: We will implement new molecular testing methods and modify current testing practices, maintain vacancies in the environmental laboratory,and curtail providing training to external partners in public health microbiology, safety,and emergency response. Savings total $132,000 • Healthcare Acquired Infections: This program will not fill a vacant half-time position; it will reduce the frequency of advisory committee meetings. Reductions total $60,000 1 10/4/2010 Non-Infectious Disease Epidemiology: We will eliminate support for local health agency consultation and technical assistance to locate, obtain,and use health data to monitor community health status and evaluate health interventions. This office will eliminate 1.6 positions, effective January 1,2011. Savings total$85,000 Environmental Health 111 The Division of Environmental Health saved a lot of money in fiscal year 2010 and will continue the savings in fiscal year 2011 by not filling vacant positions restricted by the hiring freeze;reducing travel,equipment,and supply purchases;delaying information technology upgrades and software and hardware purchases;and using federal and fee revenues whenever possible. Reductions total$457,000 Health Systems Quality Assurance Office of the Assistant Secretary:The division reduced spending significantly savings in fiscal 2010 by leaving vacant positions impacted by the hiring freeze open;restricting travel,equipment and supply purchases;and delaying technology upgrades and software and hardware purchases. The same strategies will be used to cut costs in fiscal 2011. Reductions total$476,000 Community Health Systems: Reducing funding in the office for administrative activities that provide support to programs such as EMS and Trauma System, rural health programs, and injury and violence prevention programs. Reductions total $141,000 Temporary Worker Housing: As a result of recent quality improvement work,the program implemented business practice and process changes that resulted in significant efficiencies and cost savings. Savings total $30,000 Midwifery Program: A total of$58,000 GF-State is specifically budgeted for program implementation. This funding is subject to the 6.287 percent across-the-board reduction of GF-State dollars. Reduction totals$3,646 Community and Family Health HIV Client Services: The agency continues to manage federal, state, and pharmaceutical rebate funds as efficiently and effectively as possible to the best advantage. HIV Client Services program has been able to use HIV pharmaceutical rebate revenues in place of state funds to continue services to HIV clients. Amount totals$2,950,000 Family Planning and Reproductive Health: The program currently has$4,500,000 GF-State specifically budgeted to • implement its work. This funding is subject to the 6.287 percent across-the-board reduction of GF-State dollars.This will reduce funding in local agency contracts,which will reduce the number of clients that receive education, services, and supplies related to contraception, sexually transmitted disease and reproductive related cancer screenings. Reduction totals$282,915 Maternity Support Services: The Department of Social and Health Services(DSHS)contracts with the Department of Health to provide program oversight for the Maternity Support Services, Infant Case Management,and Childbirth Education components of the First Steps Medicaid program. We anticipate that DSHS reductions eliminate the First Steps program; if so, Department of Health oversight will no longer be necessary. Reduction totals$150,000 Community Health Leadership Forum: We will reduce our support for the Community Health Leadership Forum,a statewide association of public health nursing directors organized under the umbrella of the Washington State Association of Counties,Association of Local Public Health Officials. Reductions include eliminating two positions effective January 1,2011. Saves$19,500 Central Administration Central Administration provides leadership and support in administration,policy development,communications, human resources, financial services, information technology, and risk management. The division is funded through an indirect cost pool method.As division programs are reduced,the funds available to Central Administration are also reduced.The offices within Central Administration are sizing and adjusting service levels. Changes will include reductions in equipment and supply purchases;delaying technology upgrades and software and hardware purchases; and holding positions vacant in information technology, human resources,contracting,and performance and accountability. Reduction$352,000 • 2 10/4/2010 1 IFN9 STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES Medicaid Purchasing Administration 626 8`h Avenue, S.E. •P.O. Box 45502 Olympia, Washington 98504-5502 September 29, 2010 TO: Medicaid and Health Care Authority Stakeholders and Providers FROM: Doug Porter,HCA Administrator and State Medicaid Director SUBJECT: 6.3%across-the-board budget cuts for Medicaid and HCA We are releasing today the list of Medicaid budget cuts we turned over to the Office of Financial Management(OFM). They represent the amount needed to reach the $112.8 million target assigned to Medicaid under the executive order calling for 6.3%across-the-board cuts. We also have delivered a plan for the Health Care Authority (HCA)to meet its assigned$9.8 million target without layoffs or benefit cuts. We have made these cuts carefully and with an eye on our one million-plus clients who depend on our services. The cuts are not good news, but we believe we have no other options, given the state's severe revenue crisis and the inflexibility of Medicaid mandates and complexities. Most Medicaid services are mandated by federal law and we do not have the ability to change those costs. Thus,we have had to look primarily at optional Medicaid programs the state can drop without violating these restrictions (please see the full list at the end of this memorandum). An unprecedented cut will be the adult pharmacy benefit—setting limits on our reimbursement for adult prescriptions. This cut will not affect children's medication, and we are still working out how it will be implemented—stay tuned for those details. Adult pharmacy is technically an optional benefit,giving us the authorization we need to make this cut. Knowing that these cuts are inevitable does not disguise the fact that they fall heavily on some of our most vulnerable clients—seniors,children, and people with disabilities. They also will directly impact Medicaid staff and their families,who will again face layoffs over the next three months. We have identified the FTEs that are connected to the different programs being eliminated and, in coming weeks, we will begin the formal notification of employees whose jobs are being eliminated. S Medicaid and HCA Stakeholders And Providers September 29, 2010 Page 2 We will press ahead as quickly as we can,but none of the cuts detailed below are possible without State Plan Amendments, WAC regulatory changes, client and provider notifications,or renegotiated contracts— all things that take time. Our judgment is that we will be using the next several months to make sure most cuts can go into effect on January 1,2011. A few additional cuts also require legislative approval and are not even targeted to begin before March 1, 2011. If there is good news today,it is that the Health Care Authority will be able to achieve its$9.8 million target with much less travail. The Basic Health benefit fund has been operating with a small surplus, and we are counting on the Basic Health waiver in health care reform to provide federal relief for Basic Health beginning next year. Although we will not be able to enroll people on the Basic Health wait list, we can pay off HCA's 6.3%budget cut out of that existing surplus, and no further cuts should be necessary this biennium. No administrative cuts should be required, and no client will be forced out of subsidized coverage. At Medicaid,there is a grimmer picture; however, every state agency faces challenges in these tough economic times, and health care is no exception. Relief is not yet in sight. The budget for the next biennium already has been assigned Medicaid budget cuts of$521 million. All of the cuts detailed below will again be needed to make that target. • Optional programs in Medicaid G/F savings Number of clients Effective Date Adult Pharmacy Benefits $39.4 million All adult clients March 1,2011 Medical for Disability Lifeline(formerly GA-U) $20.3 million 21,000 March 1,2011 Eligibility reduction in Apple Health for Kids $10.1 million 27,000 March 1,2011 State-Only Alien Emergency Medical $8.6 million 1,300 Jan. 1,2011 Adult Dental Services $8.3 million 105,000 Jan. 1,2011 First Steps/Maternity Support Services/Infant $6.4 million 65,000 March 1,2011 Case Management Adult Hospice $4.6 million 2,600 Jan. 1,2011 Interpreter Services $3.3 million 70,000 Jan. 1,2011 School-based Medical Services $3.3 million 20,000 Jan. 1,2011 Medicare Part D Co-Pays $3.2 million 49,000 Jan. 1,2011 Physical,Occupational and Speech Therapy $2.9 million 20,000 Jan. 1,2011 Take Charge/Family Planning $1.2 million 43,000 March 1,2011 Adult Vision $500,000 67,000 Jan. 1,2011 Adult Podiatry $400,000 6,500 Jan. 1,2011 Adult Hearing Services/Devices $300,000 2,400 Jan. 1,2011 4°N C' 0 Information on Proposition No. 1 • JEFFERSON COUNTY PROPOSITION NO. 1 LOCAL SALES AND USE TAX FOR PUBLIC SAFETY,YOUTH AND SENIOR SERVICES, COMMUNITY SERVICES AND BASIC GOVERNMENT PUBLIC SERVICES The Jefferson County Board of County Commissioners adopted Resolution #32-10 to place before the qualified voters of Jefferson County the question of whether the sales and use tax in Jefferson County should be increased three-tenths of one percent(0.3%),equal to thirty cents tax on a one-hundred-dollar purchase. If approved, Proposition #1 would dedicate revenue to maintain certain sheriff, prosecutor, other public safety services, youth programs,juvenile services, senior services, community centers, public health and basic government services. By law Port Townsend would receive 40%of the revenue. The City would use it for similar purposes including an agreement to dedicate a portion to support county parks and recreation for up to four years. At least one-third (1/3) of all revenue must be allocated for public safety purposes. Should this proposition be: Approved Rejected Jefferson County is facing a budget problem. Despite $2.3 Million in budget reductions over the past 2 years, including staffing and service cuts, revenue is inadequate to sustain existing services in 2011 and beyond. • To reduce expenditures to match revenue, large cuts to county public services are necessary in 2011 , 2012 and thereafter. ■ 2011 : $ 900,000 gap ■ 2012: $1 .36 million " • 2013: $1 .5 million " • 2014: $1 .6 million " ■ 2015: $1 .7 million " Proposition #1 gives citizens the choice of whether or not to preserve some of those services by approving additional funds. • 3/10ths of 1 % sales tax = 3 cents on a ten-dollar purchase, • $637,000/yr to the County, $425,000/yr to the City. • At least 1/3 must be spent on public safety. • How the county will cut without Prop 1 has been identified. The county services that will be funded and retained by Prop 1 have been defined by adopted Resolution. County Share: Public Safety Service: Annual Budget Without With Prop 1 Prop 1 Sheriff: 1 deputy sheriff, 1 animal control officer, 1/2 safety $ 175,000 Cut Retained dedicated fundin training Prosecutor: 1/2 deputy prosecutor(property crime, domestic $ 37,500 Cut Retained violence and DUI prosecutions) dedicated funding Juvenile Services: 1 juvenile probation counselor, reduce support $ 75,000 Cut Retained dedicated funding staff(local restorative justice/community restitution; diversion for 1st time offenders; intervention for at-risk youth; pre-trial offender supervision services) Public Safety: Misc. public safety reductions $ 19,000 Cut Retained dedicated funding subttl Public Safety—48% $ 306,500 Other Public Services: Annual Budget Without With Prop 1 Prop 1 OIyCAP: 3 Community Centers &Senior Services(Tri-Area, $ 126,000 Cut Retained Quilcene, Brinnon) dedicated funding Port Townsend Senior Ass'n: Port Townsend Community Center& $ 12,500 Cut Retained senior services dedicated funding Gardiner Community Center Board: Gardiner Community Center $ 2,800 Cut Retained dedicated funding Jefferson County Fair: County support for the County Fair $ 4,500 Cut Retained dedicated funding WSU Cooperative Extension: Funding for afterschool programs for $ 20,000 Cut Retained youth &other Cooperative Extension services dedicated funding, Public Health: 1 Maternal Child Health Nurse (home visits to $ 50,000 Cut Retained prenatal women and families with newborns, child abuse dedicated funding prevention visits and education to families) Public Health:Substance abuse recovery programs in Port $ 46,600 Cut Retained Townsend, Chimacum and Quilcene middle schools (best- dedicated funding practice program involving parents, teachers&students to decrease early substance use) _ Conservation District: Programs in agriculture, water quality, $ 45,600 Cut Retained forestry, fish & wildlife habitat, and education dedicated funding Misc. Departments: Support for basic County operations $ 22,500 Cut Retained dedicated funding subttl Other Public Services $ 330,500 TOTAL $ 637,000 City share: ■ Interlocal Agreement between City of Port Townsend & County dedicating 1/2 of City share (roughly $212,000) for 4 years to: Restore normal maintenance of Memorial Field 0' Reopen & maintain the Rec Center, restore drop-in programming • Help fund capital improvements to these facilities ;. This also helps the rest of County Parks and Recreation Li County & City agreed to work together during this time to find long-term & efficient • delivery & funding for our region's parks, also recreation programs ■ 1/3 of City share must be spent on Public Safety. / y s S a YY • 2002 Property Tax Base Over Time, & Adjusted for CM 5,400.000 $5,200.000 =------------ &,. y $5,000,000 $4,800,000 ..�.�' � -xe&-e ,� 44,600,000 �' t o4ra€t N. a 3'.-`3 +"a,"}-/fes-s .T4"` F `ice'' .,'"c--."....--..114,-;-_-.----- C u -- „T)'.” $4,400.000 � _ I $4,000.000 t 2002 2003 2004 2005 2006 2007 2008 2009 20104, 1%,Growth a 1%Growth wf CFI .,4•-•• - i .'..k.%',,,,%' F �:<.�`s�z"_ s a r r_ �5 .sok ' , • ' ;:,f,';,1;ia.;:::+;YYP:—",),;.:IWAX:7',flf,;;ElfAitftt?::").:::::$ 144:41#44,: 1,,,X13.,:er*-::gni"::'•A,a(„414:;till..***7`.:::04.4-,••-';., ,W,,,A,-' -- ' ,,„„sy., ,.siWP°."@ ' � `�1" ki- ‘,-iialifittilistialsigtowillviakttigiv:i0;::,14-004.ttr lishisitistliwitititit:::,-,;;AF.-,--1,,,,o,-- w:::- , ,Atitilitte.:411111,11stoolitoikiiiiiiiii,iiiiiillitiiiiitismit-iii,e,: ir:#4i-e-tlitirf:Ati?:ikA4T't',;- ,.... 44 ' •4.4.4xe,' 1... ,.,..-, ,...'--.' ,-;,-,, ,ru ” ,amu a y £ n : z40 y f g'''',,,1:'''. :g;,,'.i.k.:„,,,....„,,,.. 4 -,,,,,,,,,,„ ,!..:;:,,,tilrity.f.,ittr.,,,..,_, , .., ,._ , „..,....._ _. . _ __,,,,, ,‘,. .i.,,,,,,,„......,,vc. ....,...„,„,...........,„.,a ...„...,,,,,,,,„.„,,,,,,-..;.,,,,:.‘ -,„,,,,,,,...„...,,,,„,,:,,..:,:,..0, • i>4'a 0. sera as' 'a' sti ,am. <v,�° ';,-a•,...' res ;'-!' --.'',A,--.11c,,-11 Vitif411...113-, Vali1001001(talifigit:10Wiefiligh4ttpilt0041f: i 111 ,,-,,(, W^-- ,At,,,;:fii**:,% et.,,:e .0tAge ,A0:1414:X4a4SPY :er',7.1.1:0-*,,,e"•:.°P.V.V i+,1,..c.'.....40..`'4%4,1.<4.,4,t, ' .. .444:t.01#540',A-,:•4;''.--."-•,.,-'''- '• ' ' SATAX AMOUNT I' X.• f”fitis. j z , t; h ." History of Real Estate Excise Tax a $1,600,000 , -,8„,-, /.',„,-'.„;,''''.' /1k...2,...,4, $1,400,000 ;;;41k1 .',-'-',K,' \ 'y �� $1,200,000 , .1"T'',1::,,:' -•<.,41;''';`,-:„.,'',-->`:,,,.. $1,000,000 � s, $800,000 i y '-'1:'1:-,/, y "".' $400,000 r � .a "4 $200,000 s � r s r, ix-:-',..,,,, i= $_ �09a ^Oct `LO00 X00^ �00I, ry00� tiOQp ti006 ry0do `LOO'\ ry006 ti00� ry0� G�ea aye - b ' mo. � - :. A � ,,,,,,-.4..Yx K„ 11,,,,7,,,a,t,,ii:.,•, (REET is not in the General Fund, but illustrates our overall revenue challenge.) O. piiir:64,54itxtxti:=1.4islza,_:,,,,xt4r,,a);;...,:.(,,, , ,, ,,_, .. ,::_,,,,,:,:;,,,,,,,,,, ,:v.n, GENERAL FUND REVENUES&EXPENDITURES s 2004 through 2014 Budget Hearing December 7,2009y ,k $19.000,000 $18,000,000 Preliminary 3 2010 Budget $17.000.000 /-4\41 . $16.000.000 .,:-;,,,.',,i,,,,..‘.:, $15,000.000 Recommended $14,000.000Budget $13,000.000 $12,000,000 `' $11.000,000 p e 006 006 00'% 006 009 `L0N0 ry0,,, 110r�`L ti0^6 ary0^ VS' ``Jeti oma., ti a,, .ti e`Jeti 1.,ab IP JbAe� e4`ea �0°sea ole4`ea o�e4`e Q —Revenues 2%incr 2011.3.7% 2012 -e-Expenditures-3.6%increase 2011.14 -o-Expeditures-no cuts.4%.incr from'09 • Board of 3fealth .�vledia Report • October 21, 2010 1 • __ Jefferson County Public Health September/October 2010 NEWS ARTICLES 1. "Hood Canal choking," Peninsula Daily News, September 9th, 2010. 2. "Biomass decision by end of month?," Peninsula Daily News, September 10th, 2010. 3. "Shellfish harvesting closed in Hood Canal," Peninsula Daily News, September 14m, 2010. 4. "Prop. 1 affects parks, deputies," Port Townsend Leader, September 15th, 2010. 5. "Hood Canal's beaches closed for oysters," Port Townsend Leader, September 15th 2010. 6. "The perplexing case of two liquor initiatives," Port Townsend Leader, September 15th, 2010. 7. "State reopens Discovery Bay for shellfish harvesting," Port Townsend Leader, September 15m, 2010. 8. "Flu vaccine will arrive early," Port Townsend Leader, September 15m, 2010. 9. "Health briefs - Septic systems," Port Townsend Leader, September 15th, 2010. 10. "DID YOU KNOW ...," Port Townsend Leader, September 22nd, 2010. 11. "Health officials encourage vaccination against the flu," Peninsula Daily News, September 27th, 2010. • 12. "Tires hit road to recycling," Peninsula Daily News, September 29th, 2010. 13. "Proposition 1: Family nurse program, teen drug prevention at risk," Port Townsend Leader, September 29th, 2010. 14. "Giddy up to Girls' Night" and "Girls' Night Out in Downtown Port Townsend", Port Townsend Leader, September 29m, 2010. 15. "Paper mill permit hits snag," Port Townsend Leader, September 29th, 2010. 16. "School Based Student Health Center," Discovering PTHS, Fall, 2010. 17. "More time to comment on biomass," Peninsula Daily News, September 30th, 2010. 18. "Girls Night Out lassos up fun in PT," Peninsula Daily News, October 1st, 2010. 19. "Social and Health Services details deep program cuts," Peninsula Daily News, October 1st, 2010. 20. "Round Up for `Girls Night Out', Peninsula Daily News, October 6th, 2010. 21. "Biomass generates comments," Peninsula Daily News, October 6th, 2010. 22. "Bays open for shellfish harvesting," Port Townsend Leader, October 6th, 2010. 23. "Mill permit comments due Friday," Port Townsend Leader, October 6th, 2010. 24. "Does Your Child Need Dental Care?", SmileMobile Flyer, October 2010. 25. "Girls' Night Out was a rootin' tootin' success," Port Townsend Leader, October 13th, 2010. 26. "Flu clinics continuing," Port Townsend Leader, October 13th, 2010. 27. "County disposes of unused drugs," Port Townsend Leader, October 13th, 2010. • -,-> �'"" y ice"-3 •--i 0 O 0 05 a' brn 'a o a, 0o • .,,-4 g4.2 0 r atS 0 C > baro v o bip i. 0 o c Cq �\va, � 0 . - ami .5 ,� � `� 3 u �r � o ui o c b o �Ca,COrn A C w v co +� m 'a n O U +' G a o ai a 3 o 0 cu 0ct `� -" M o 3 m o .� U O d ' y 0 1-. +, cis S o m > g3 .11. C..) .b C‘.1o m �y o w0 ,4 O� `" a. csa Cl.)CI tn y G .-' 4:� bA o a) Z.0 7 3 >,X 3 >. 0 ui •r Q) �. .n• ^0 a) c�i a".)(1 � bU a ., ...0.0) bo fx).40.4 , ci x >, cn v, 0 o i� o 3 ` 3 b '� a° 0 m a) o o a, a `� 5 o -0 '4111111-- u m o C xi s`p o ti >, 0 a a "i cn c3 3 .-c.1:a 3 3c's �0 o ��yy ti 3 a. ,„ ao cc$ () C6 cn 095093525 �' toe a ai 0 3 -}0 W a o `a !u• J!I aQ =^▪ ~ c' cncu i.?' m p ,6 se,14 4ccaoU 'U qof GJ ) . .g CD � ▪ CL ao o E * ... 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That, according to away the "Angel of Death"as the Sept. 8 meeting to dis- many positions and pro- Matt Tyler,Jefferson County it hovers over various posi- cuss the impact of furtherrams. cuts on countyg Parks andl Recreation coun- tions and programs within budget parks Public support for the tor,would free up some oun- county government, county and other programs due to proposition would retain a ty funds for parks in rural Administrator Philip Morley declining county revenues. county deputy's position, an Jefferson County. told the Jefferson County But a proposal for a slight animal control officer's posi- Should the measure Parks and Recreation sales tax increase—30 cents tion, a part-time prosecu- pass, the county would raise Advisory Committee last on a $100 purchase that will tor's position, a juvenile pro- $637,000 per year and the bation counselor's position city would raise $425,000 and criminal justice support per year. staff, he said. In addition, Should the measure fail. approval would allow the said Morley,all of those posi- county to continue to sub- tions and programs will he sidize community centers cut so the county can retain in Chiimacum, Quilcene, a balanced budget. Brinnon, Gardiner and Even if the proposition Port Townsend at cur- passes, he said, county pro- rent levels, and also sus- grams will still be cut or tain county support of the rolled back due to a deep cut Jefferson County Fair, in all revenue streams for he said. Funding support county programs. for the WSU Cooperative Morley noted that prop- Extension and some public erty taxes are capped and health programs would also the county has lost over SI be retained. million in buying power In addition, the county since 2002 due to limits on • and the Port Townsend City property tax compared to the Council have reached formal rate of inflation. Sales tax agreement that half of the revenue has declined by 20 funds that would be collected percent over the last four by city government under the years; investment income proposition — over $200,000 has plummeted and timber per year — would be ear- tax revenues have virtually marked to support Memorial disappeared, he said, due Field and indoor recreation to the drop in the housing programs at the-Recreation market. III • s eac closedr tens Recreational harvesting of oysters has Anyone who eats raw or partially cooked been closed south of the Hood Canal Bridge fish or shellfish can become ill. Vibrio by the Washington State Department of causes a variety of symptoms including Health, the agency announced Sept. 13. diarrhea, abdominal cramps, nausea, The closure is based on a number of vomiting, headache, fever and chills. confirmed human vibriosis cases associ- The symptoms usually appear about 12 ated with eating oysters from Hood Canal. hours after eating infected shellfish but The closure affects only the recreational can occur anywhere from two to 48 hours harvest of oysters and will be lifted Oct. 1. after consumption. In Jefferson County the closure affects The illness can last from two to seven Hood Canal, Dabob Bay and Quilcene Bay. days. The Department of Health reminds Recreational beaches affected are consumers that store-bought shellfish Triton Cove State Park and tidelands, must be refrigerated and handled properly Duckabush River tidelands, Dosewallips to prevent illness. State Park, Quilcene Bay tidelands, Broad The Washington State Department of Spit tidelands, Toandos Peninsula State Health Food Safety and Shellfish Program Park, Point Whitney tidelands, Seal Rock website has general information about rec- Campground and Hicks County Park. reational and commercial shellfish liar- Vibriosis is an intestinal illness caused vest and food safety. by naturally occurring bacteria known as For more information, contact Jefferson Vibrio parahaemolyticus. County Public Health at 385-9444. • •• • TkJ,"' C 6•Wednesday,September 15,2010 ea-aorta • ,,. perplexing oftwo liquor initiatives This fall's general election will feature two initiatives that The Washington Brewers Guild recommends a "no" vote aim to eliminate Washington state liquor stores.At first glance, on Initiative 1100. the initiatives appear to be very similar. Here's what the ballot "While Initiative 1100 would privatize liquor sales, it titles look like: would also bring about sweeping changes to other regula- tions. These regulatory changes negatively impact small "Initiative Measure No. 1100 concerns liquor (beer, wine businesses and especially the Washington craft beer Indus- and spirits).This measure would close state liquor stores; try. While we often feel suffocated by regulations and our authorize sale, distribution, and importation of spirits by state's seemingly medieval liquor laws, some of them actually private parties;and repeal certain requirements that govern make sense and have an important role in maintaining a the business operations of beer and wine distributors and level playing field on which our local brewers can compete." producers." In regulating the way wholesalers and retailers conduct business with each other, the smaller makers fear the ballot • "Initiative Measure No. 1105 concerns liquor (beer, wine measures are nothing more than a power grab by the big and spirits).This measure would close all state liquor stores retailers. and license private parties to sell or distribute spirits. It There may be good reasons to take down the state liquor would revise laws concerning regulation, taxation and gov- store system, but I would feel a lot more comfortable with ernment revenues from distribution and sale of spirits." the idea if the proposal had been fashioned and vetted in `! • the state Legislature. That way, we could have heard the I can almost hear a collective "Huh?" coming from vot- testimony of wholesalers and small wine and beer producers. ers across the-state as they attempt to parse the difference That way,we could have weighed the impact of revenue losses between these choices. Neither ballot title tells anyone what more carefully. the heck is going on. To make matters worse, any voter It's not too late to have that conversation. All we have to who goes to the state's voter pamphlet will confront nearly • do is vote no on both measures. impenetrable fiscal impact statements. I suppose there are a few CPAs out there who also are familiar with state liquor _ FY2d 0�2 e� laws and the resulting revenues from taxes, but most people are going to be out of luck trying to figure out which is most beneficial. Our current system works this way: The state operates liquor stores, and the profits are turned over for the funding of health care, community programs and law enforcement: The state reaps about$330 million a year in this enterprise. Both initiatives eliminate this system by closing liquor stores and rewriting scores of laws that regulate sales. Initiative 1100 stops short of allowing the state to control prices of liquor, and big retailers like Costco love this idea. Under I-1100, big stores would have the ability to buy liquor at bulk discounts,and costs for a bottle likely would go down. Costco has contributed$350,000 to this campaign. Initiative 11061 allows the state to set price controls. This supposedly would prevent those big-volume discounts and keep smaller businesses in business. I-1105 also allows the state to set the price of liquor licenses as a percent of volume of liquor sold by a vendor. Under that scenario, large stores would pay more than small ones. Either;way,.the state predicts it will lose millions of dol- lars, even after the costs of the liquor stores are subtracted. Small wineries arid brewers don't like either proposal, • because they feel like the big stores will roll over the small producers,not just because of lower prices,but because of the way the rules will be rewritten to control the distribution of • alcohol. •} /re) 1 • tate reopens overy for shellfish harvesting Bay The Washington State mated with marine biotox- 911. Department of Health has ins can be life threatening. In most cases, the algae reopened recreational shell- Symptoms of paralytic that contain the toxins can- fish harvest in Discovery shellfish poisoning can not be seen, and must be Bay for all species except appear within minutes or detected using laboratory butter clams, agency staff hours and usually begins testing. announced Sept. 13. with tingling lips and Therefore, recreational Marine biotoxin lev- tongue; followed by diffi- shellfish harvesters should els. — which cause para- culty breathing; and poten- check the agency's website at lytic shellfish poisoning — tially death. doh.wa.gov or call the have been found at lower Anyone experiencing Biotoxin Hotline at 800- concentrations and have these symptoms should con- 562-5632 before harvest- dropped below the closure tact a health care provider. ing shellfish anywhere in threshold in Discovery For extreme reactions call Washington state. Bay. That means harvest- ers can again collect clams, geoduck, oysters, mussels and other mollusks such as moon snails. Cooking or freezing shellfish does not destroy marine biotoxins, such as • those that cause paralytic shellfish poisoning. Eating shellfish contam- • • PTXeedel r' 9//S4v . , , _ ._ _, , ._ , i r if Lia , . • Unlike recent years,influ- of age get enza vaccines are arriving in More than 160smillion hot sdoses will not be billed.year. cash or check.Private insurance Public welcome. • rt clinics earlier this fall. The are being produced, so there • Madrona Hill Urgent +Care, Physicians, 934Townsen Port national Centers for Disease should be plenty for everyone 2500 Sims Way, Port Townsend: Townsend: Saturdays, Sept. Control (CDC) and Jefferson who wants to get vaccinated. Flu vaccine available during reg- 25 and Oct. 16, 9 a.m.-noon. County Public Health recom- Only one influenza vaccine ular clinic hours Monday Friday, Medicare mend that people go ahead is being produced for 2010. 9 a.m.-7 Patients please b and get immunized as soon The H1N1 strain that was in Vaccinep' available for cash or check. Private Insand Saturday, 9 Medicare cards. Ail others 925 a.m.-4 p.m. urance as vaccine is available. the special flu vaccine in 2009 clients age 18 years and older will not be billed. Recente studies show that is containedein the seasonal billed.Medicare and many insurances protection given by a flu three-strain vaccine this year. others$25.Bring insurance card. All QFC Pharmacy; ;890 shot lasts longer than previ- While H1N1 is not occurringbis Irondae Road, Pot Haai hy believed.sImmunity for much in the United StrtMadrona Hill Urgent Care,9481 29-30, 11Wednesday-Thursday, ya.m.5 dp. Sept.m. alk- most people lasts about a now, it is still circulating in vvaccneak yavailable 9 a.m.-2 Road, Port •Flu inp.m. vaccict. 1. nations available , ald after year. Receiving a flu shot in other parts of the world. Monday, Sept. 2; Wednesdays, insurance billed.l Please bringMedicaid, September should still pro- State-supplied children's Sept. 15 and 29; Fridays, Sept. cards.Flu shots$25.Pneumonia vide protection throughout flu vaccines are recommend- 17 and Oct. 1; and Saturday, shots available. Clients must cc the influenza season. ed for all children ages 6 Oct. 2. Vaccine available for cli- at least 11 years old. Those with certain health months through 18 years. ents age 18 years and older. Flu conditions or who in close The have shots $25. Medicare and manySafeway Pharmacy, 442 Sims contactdii with youngoareor inclose not yet pediatricarrivevaccinesin Jeffersonhavinsurances billed. Bring insur- Way' Pon Toor vac: Vvors able people are still strongly County,ebut will soon be ance card.All others$25. Mondays-Fridays,ins welcome for vaccinations urged oet the yearly shot asy available at Jefferson • Mondays F 4 p.m No a.m.-1 Olympic Primary Care, 1010 men and 2-4 p.m. are nd soon as possible, say nurses County Public Health and Sheridan Townsend: Surto s,10ept. Medept. i necaccept . Most insur- with Jefferson County Public the Jefferson Healthcare 18andOct.S9, 9daa m-noon. ancec billed.CeBring insurance Health. Conditions that clinics serving children. Medicare patients please bring cards.Flu shots$30.P;eumon:a increase the risk of complica FALL FLU CLINICSMedicare cards. All others $25 and high dose flu vaccines ava,i- • tions from influenza include cash or check.Private insurance able. Clients must be at ieos: e Influenza vaccines are adminis- heart,lung or kidney disease, will not be billed. diabetes, asthma, or a weak- tered at the following locations: years old. ened immune system. • Jefferson Medical & Pediatric 12• Port Hadlock oCare, e any stagemof pregnancy Womenmn Group, 915 Sheridan, lower a Oak Bay Road, Port level,Port Townsend:Saturdays, Hadlock: No long lines. Call 379 67 encouraged to get a flu shot. Oct.2 and Oct.23,9 a.m.-noon. 37 for an appointment. CDC recommends that Medicare patients please bring Bringsr insurance pa pay. us, o some everyone older than 6 months Medicare cards. All others $25 insurers may Flu shots$25. • health briefs • Community Center, 980 Old Gardiner Road; Oct. 6 at the Gardiner Community Septic systems Center; Oct. 21 at the Cape "TLC for you Septic George Fire Hall, 3850 Cape System" is being present- George Road; and Oct. 28 ed by Linda Atkins, regis at the Tri-Area Community tered sanitarian, Jefferson Center,10 West Valley Road. County Public Health, on four different dates this fall. Atkins talks about the day-to-day operation of sep- tic systems, how people can protect their investment and projects in Jefferson County that protect water quality. Topics covered also include how septic systems operate; how to maintain them; if landscaping inter- feres with function;garbage • disposals; and impacts a failing system may have on drinking, ground and sur- face water. Atkins presents the pro- gram 6-8 p.m. on the fol- lowing dates and locations: Sept. 20 at the Gardiner leaehr • •" . 5)//61/0 In recognition of National Alcohol and Drug Abuse Recovery Month DIDY• UKNOWm [ • •That every man,woman and child in Jefferson County pays$601.12 a year t in tax dollars for the direct and indirect costs of alcohol and drug use in s , Jefferson county?This totals over$17 million dollars* "Clean up cost Fa Treatment ■Prevention + •Only 1.6%is spent on prevention; •Only 4.2%is spent on treatment; • 1 •More than$16 million is spent on the consequences `N 01, µ !': J and clean up(public safety,public assistance,justice, f ., " r r education&more) F; q�" ' . WHAT CAN YOU DO ... A Get involved with community organizations taking positive actions to address this problem. }i The following are some suggestions: ? •The Jefferson County Community Network f •The Community Task Force at Port Townsend High School q •The PTHS Student Task Force •Attend the Substance Abuse Advisory Board meetings ti •Attend The Meth Action Team meetings ' K For further information go to www.jeffcocommunitvnetwork.org/didyouknow or call Kelly at 360-379-4476 i •from federal,state&local sources fi1 • Sponsored by the Jefferson County Meth Action Team.Funding provided by the Washington State Meth Initiative. 1�, F • o, e-Y tit .il' L ' 0 Lela s encoffra-. ., kist the fl - ccorri-lori ._.„. 41IkEY Ron OLLlxatNWN Flu season starts to peak in we do practicing all those other NINSULA DAILY NEWS November and continues through things we preach" With flu season right around April. The Centers for Disease Every year, health officials Control and Prevention in Atlanta drive home preventive messages the:corner, public heath officials recommends vaccinations in Octo- like"cover your cough"and"stay say it's time to roll up the sleeve her and November. home when you're sick" to curb for a shot of vaccine. the spread of influenza. Dr. Tom Locke, public heath 7 Last year,during the height of How bad will it be. the H1N1 "swine flu" pandemic, officer for Clallam and Jefferson counties,said doses of multistrain The possible severity of this demand for the vaccine caused a influenza vaccine have been dis- year's flu season is anyone's national supply shortage. Early tributed to hospitals, doctor's guess. doses were reserved for health offices, pharmacies and grocery "A lot of it depends on how care workers, children and the stores across the North Olympic many people get vaccinated," elderly Peninsula. Locke said,"and how good a job 'Fuss ru FLU/A6 1tr Vaccine to be se - t . timelymanner er CONTINUED FROM Al tutions to adopt such a pol- dose of the icy — vaccination rates No such shortage is ,x`,vaccine costs have risen past 98 percent. expected this year, Locke about $30. Most "That's really what we're said. going for,"Locke said. "It's arriving on time,"he insurance companies The concern is health said. now cover it. . care workers could unknow- "There are no production ingly spread the flu to vul- shortages.It will be readily nerable patients in their available." lent job getting out the most care. This year's flu shot pro- vaccine at the lowest possi- "Recent studies have tects against both the H1N1 ble cost,which is great.We shown that as many as 40 S and seasonal influenza welcome that." percent of those who were strains. A dose of the vaccine infected with H1N1 last flu A second vaccine was costs about$30.Most insur- season never developed the needed last year, but the ance companies now cover symptoms,.Locke said. • seasonal flu season never it,Locke said. "They didn't feel sick really materialized, Locke He said the big private enough to remember they said. suppliers on the Peninsula had it,"Locke said. The Clallam and Jeffer- are the Safeway stores in The H1N1 pandemic son county health depart- Port Angeles and Port officially ended on Aug.10. menta will provide a special Townsend. Complications from children's vaccine — Most major grocery H1N1 were blamed for although most are going to stores and pharmacies on three deaths in Clallam private health care provid- the Peninsula are offering County. ers—while all adults doses the combined vaccine this Jefferson County Public are available only from pri- flu season.Check with your Health reported no swine store for hours and vaccine vate providers. flu-related deaths. The state-supplied chil- availability. Based on the flu activity dren's vaccine,which is rec- Health care workers in the southern hemisphere, ommended for all children 6 which is nearing its end, months to 18 years,arrived Health care workers at "H1N1 has essentially at the Clallam County Pub- Olympic Medical Center joined two other seasonal lic Health Department on received early doses during flu strains,"Locke said. Wednesday. a medical staff meeting on Recent research shows Vaccine orders from pri- Sept.13. the H1N1 vaccine is effec- vate providers were coming OMC has instituted a tive for longer than previ- in last week, Locke said, new policy in hopes of driv- ously thought.It is good for adding that the vaccines ing up staff vaccinations. at least six months,and in should be available in pri- Any employee who does not some cases,it can stave off vates offices this week or take a flu shot will be the flu for years, Locke the week after. required'to wear a mask said. "I imagine it's very simi- when the flu season offi- "Unfortunately,we can't lar in Jefferson County.The cially arrives next month. guarantee that people vac- focus at the Health Depart- After Jefferson Health- cinated last year are still ment is on the Vaccines for care adopted the policy in immune,"he said. Children Program," Locke 2008, the Port Townsend- Locke encourages every- said. based medical center saw one to get vaccinated every "Most of the adult vacci- its vaccination rate climb year. He said there are no nation has been taken over from around 70 percent to side effects to an annual •. by private medical practices more than 90 percent. shot. and the pharmacies. At Virginia Mason—one "We are strongly recom- . "They've done an excel- of the first health care insti- mending it,"Locke said. "We would like to stop a v , flu epidemic from occur- . ring" - • Reporter Rob Oltikainen can be • rhed 360-417. oarob. oleaclikainenat epeninsul3537adailrynewst . com. Tires • and back yards and took unloaded and stacked tires. leachate systems. Jefferson them to the Quilcene trans- Other youth volunteers The event was made pos- 1 _ fer station for free recycling. from south Jefferson County sible by a grant from the househol The event,sponsored by helped screen vehicles and state Department of Ecol- Jefferson County Public hand out informational bro- o�People who missed the turn in 3,000 Health and the Sheriff's chures. Office, collected more than Tires from the event will event o aeons on the Jfffer- find a list of dis- 3,000 tires in six hours. be recycled and reused for. posal P PENINSULA DAILY NEWS The Sheriff's Office Lit- such things as boiler fuel or son County Public Health QUILCENE — More ter Crew, along with corn- will be baled and used for Web pageu al i 1 ea l t her , t wwwjeffrson than 100 Jefferson County munity members who erosion control, lightweight coty pP"Solid Waste,"then households recently dug stopped to lend a hand and road fill, impact barriers, going vehicle tires out of their volunteers from Port retaining walls, levee core clicking on "Disposal/R.ecy- blackberry bushes, garages Townsend High School, material, insulators and cling." • _ . 11, N9„,/,',0 '0 t 0--S 1 1 0 I i 1 ''' Family nurse Aom • 9 teen drug prevention at is SUBSTANCE ABUSE THE FIRST ' Sales tax hearingset for ThursdayIn addition to see- IN A THREE-PART SERIES ing the unraveling of the Nurse Family Partnership, On the Nov. 2 ballot,Jefferson County voters will be asked to Baldwin said she fears By James Robinson of the raise the county sales tax to pay for public safety costs,youth and project Alert may be Leader senior programs,public health,community centers and general scrapped should Prop. 1 public services. Jefferson County voters fail."Project Alert is the must decide Nov.2 whether Voters will have an opportunity to learn more about the ballot best research-based to raise the county sales measure-and what its success or failure means to county gov- room program for delaying class- tax from 8.4 to 8.7 percent ernment-during a public hearing set for 7 p.m.Thursday,Sept. three-tenths of 1 percent the onset of alcohol, tobac- 30.The public hearing is in the Port Townsend Community Center co and use," - an amount that would at 620 Tyler St.in Port Townsend. Baldwin said.marijuanat really ," add 3 cents to each $10, aimedw at the kids is non-food purchase. County commissioners are expected to vote on a resolution in work with havingthnparentskid The ballot measure is support of the ballot question at the close of the event. and teachers." called Jefferson County Baldwin said the pro- Proposition : Called Proposition 1, the question asks voters to increase thetlitgrain is aimed at Jefferson 1. county sales tax from 8.4 percent to 8.7 percent-which would County's sixth- and sev- C o u n t y ; equate to an additional 3 cents paid per 510 purchase,except enth-graders, with an staff have .e,` for food. 11-week program conducted said the addi- A ;, in the sixth grade followed tional dol- r Should the measure pass,60 percent of the take would go the ��$ by a shorter "booster" les- lars, should �� county while 40 percent would go to the city.According to the law, son in the seventh. Health Proposition 1 each jurisdiction would be required to spend 30 percent of their departmentosurvey datah pass - esti- portion on law and justice costs, mated at Philip Morley shows Jefferson County $1.08 million W With $96,000 in pro- "Havingtwo jobs. can eighth graders try alcohol, in its first '''' ' . ".: ' 1 posed cuts to her depart- mean `at risk,'" Baldwin tobacco and marijuana at full year of ": s�,1 ', , a t' meet, Baldwin said the said. higher rates than eighth collections - 1: I "' "r -sem `` nurse family partnership "The program was built graders across the state are needed to - "ii a and Project Alert programs here because of the high and the nation. • keep a num- i r a >'''''4: -; will likely disappear. rate of child abuse and For example, Baldwin her of county . .. '4 neglect,"she said. "We had said that 19.7 percent of programs ; .. NURSE FAMILY some infant deaths. We Jefferson County's eighth and PARTNERSHIP haven't seen them for a graders report they have vices afloat, ,-.- "ay,, •t, "The sad thing is the while. We're 11 years into tried alcohol. The nation- including ation- s n c 1 u d i n Even if Prop. 1 succeeds, program probably won't it and we're seeing great al figure is 14.9 percent, g Jean Baldwin Morley said, the county's survive," Baldwin said. outcomes, but it's one 1•m while the state figure is those linked to the slier- five-year budget still shows "The whole infrastructure looking at cutting." 16.1 percent. iff's office, animal control, a series of $100,000 cuts of our nurse family part- "Titterness, Rodgers Jefferson County's the courts, children, youth, between 2012 and 2015 that nership may be completely and Huntingford [all eighth graders also topped seniors, public health he explained are necessary unraveling." Republicans] supported the the charts with tobacco use, and the Jefferson County "just to hold the line." The program utilizes a start of this program.They with 8.2 percent reporting Conservation District. While parks and recre- nurse with seven years spe- supported this program they had tried cigarettes. Should voters deny ation and the community cialized training to visit because of the cost savings," The national figure is 6.5 Prop. 1, county staff and development department first-time, at-risk mothers Baldwin said. "They were percent,while the state fig- the commissioners have took big hits in 2010, 2011 throughout the first two concerned about the costs of ure is 8.3 percent. said they will cut programs shows that the sheriff's years of their child's life to juvenile and drug court and Data on marijuana exper- that serve many of the , nior d and teach hem Mwcon- imentation wer- vulnerable members of themost coofficemmunitysecentersservices, anand guide parenting and lifetskillgood s, cornededicaid.aboutThtheye number of cent of Jeffersonshoed 10.9 Countpy's community. programs within the pub- and preventive health prat- families on welfare.This is eighth graders had tried pot. Many opponents have lie health department could tices, Baldwin said. not about partisanship,this The national figure is 8.3 likened Prop. 1 to black- bear the brunt of the cuts. "It's a science-based, is about people." percent, while the state fig- mail. "There are a lot of safety best practices program ure is 6.5 percent. Jefferson Countv net issues with Prop. 1," with measurable out- Baldwin said county dol- Administrator Philip said Jean Baldwin,director comes,"Baldwin said. lars and dollars from the Morley repudiates that. of Jefferson County Public The program serves state's liquor excise tax "We've already had Health. "I'in worried about about 100 Jefferson County help fund the program, to make real cuts; this the need to do this tax.I'm mothers each year, and although state dollars may is` not just saber rat- concerned about who this risk factors include drug or dry up she said, depending tling," said Morley, citing tax will affect. What does alcohol abuse and poverty. on the outcome of two alco- budget slashes in 2010 it look like if the safety net hol-related measures on the that halved staffing lev- breaks again?" November ballot. els at the Department of "You're going to pay one Community Development, way or the other," Baldwin closed 11 county parks. said."You're going to pay a benched Memorial Athletic little for prevention or a lot Field and shuttered the for incarceration." • after-school drop-in pro- gram at the Port Townsend Community Center. 1/-7-- // // k�r'�a ra a � � � � Night r > F. Mosey on over to down- the Jefferson County Health sponsored by participating town Port Townsend for Department. businesses, the Main Streetal a day and night of female Girls' Night Out is an Program and. Jefferson camaraderie and shopping award-winning promotion Healthcare Home, Health fun at Port Townsend Main hosted by the Port Townsend and Hospice. Street's Girls' Night Out Main Street Program For details, visit from 11 a.m. to 8 p.m. on Promotion Committee. It is ptmainstreet.org. Thursday,Oct.7. This year is cowgirl- themed - "Kick Up Your Heels"-so bring friends and wear Western gear. Twenty-three participat- ing businesses on Water Street and the Fountain District are offering special events, in- Main Street Invites store promotions and refresh- You S Your Girlfriend's to ments.The evening wraps up 4' ' .s ,y. with a "round-up" party at rte_ 8 p.m. at the Upstage, 923 Z Water St., which features acwr s . 8 °*. cowgirl band,appetizers,des- f'(5 ;4 T �'' l sects and door prizes. There in Oewntewn V e t l wnsen # 'cj� s a suggested 35 donation at jJ k the door. 4,..--7.-.,' • October is Breast Cance �4,1,•s_,....1-,s,.- >1\`t T^ ' ' n Awareness Month, and the _,c, �; ,,,,. .,,,i,.,4.: '-'- -, -'• + ' event includes the opportuni- -�^...,�"ti_,,..--' A ty to purchase a goody bag or cowgirl hat filled with treats, r �' g � � , � � a ar�� ' beauty products and gifts y�,.3 '3: 1 donated by the merchants; proceeds help underwrite � breast and cervical cancer i>'"A screenings for local women (rte:' of a Date&Night of Girlfriend FUN& in need, and support the Port Townsend Main Street r Shopping in 23 Port Townsend stores. -�+ Program. Bags sell for $10, r j _ - - - cowgirl hats for $25, and r,...."'"" - . °� p c deluxe cowgirl hats are$50. aids' 0!� tjt Cut! { rr-rj • Contents for the goody bags d'ear our'estern get-ue to fe:..' are donated by participating /// Live Cowgirl Music,appetizers&raffles at the businesses, •Port Townsend wrap-up party 8:00 pm at The Upstage,923 Washington St! Main Street Program and • �' 95 suggested donation at the door. 'e l Get your goody bags&cowgirl hats to support breast/cervical t cancer testing for local women in need and PT Main Street. • Sponsored by Port Townsend Main Street Program �' �� Jefferson Healthcare Home Health&Hospice sf f/ &Participating Merchants a IN THE FOUNTAIN DISTRICT: Expressions Apparel 634 Water$t Connie Segal's Natural Skin Care 930 Washington St. Five Fingers Handcrafted Gifts 911 Water St �l /,�pj[ Hanazono Asian Noodle 225 Taylor St. The Green Eyeshade 720 Water St.* vr� t Ji Perfect Endings Cupcakes 924 Washington St. Maestrale 821 Water St. F~f? "'/// Port Townsend Chocolate Company 221 Taylor St. MariceeFashens913WaterSt.* 1 r The Wandering Wardrobe 823 Washington St. Ms.Bee Haven 1020 Water St Jf' ON WATER STREET: The Perfect Season 810 Water St. .--� bout Time 839 Water St." Personalize It 1007 Water St.' Abracadabra 936 Water St. Sport Townsend 1044 Water St.' Beautiful World Pottery 1034 Water St Tickled Pink 825 Water St. Wandering Angus 929 Water St. Bickies Cotton Casuals 926 Water St.. k,'',1 The Clothes Horse 910 Water SL* 'Indicates GaodyBag location ElevatedlceCreatrl&Candy Co.631Water St* on rhepayo/rM1eEvenr. r. �,( '� i wr ST E www.ptmainstreet.orq l'�••-:�' s °�A ' / ` r Jefferson ✓ OW Healthcare `1 4l §'```�t��'I�4l4ft�t'!tti '` e FT ,ZQa_.0 .,-- 09jo • 1 ,. It'r -9', 1 _ Opponents want ring � �� .� ®Continued from page 1 �'®�t® t:®�Tt��nt Deterioration permit, one mitigated,Brewer said there's step above what Ecology has concern that other pollutants Comments on the state determined the current per Department of Ecology's draft mit to be,which is a Notice of f will increase if significantly 1 more material is burned. Notice of Construction Order Construction(NOC)permit. "There's no way this is not No.7850 and its decision not And as for the definition of NewA�/y environmentally significant," to require an environmental biomass,Davies said,"It's an commentBrewer said. impact statement on the Port application they are applying { y�(� The new two-week coin- Townsend Paper Corp.cogen- for to upgrade the mill. It is perm extended ment period — people have eration project can be made not the role of this permit until 5 p.m. on Friday, Oct- through 5 p.m.,Friday,Oct.8. or the facility's responsibil- to October 8 8 to say their piece — is in ity to answer questions about reaction to comments at a For more information, biomass. mid-August hearing on the visit the state's website at They are making tech- construction notice. ecy.wa.gov. The decision is nical improvements to their By Allison Arthur of the Leader "It took us a bit of time to available at the Port Townsend boiler, and it's our responsi- figure out what we did tech- Public Library or call 360-407- bility to respond under the nically wrong," said Laurie 7393 for information. law to that application." The Port Townsend Paper Corp.'s Davies,program manager for That said, Davies added Direct comments to: Marc that there has been talk of fast track for permission to pursue a the waste resources division Heffner, Department of technical tweaks to the draft $55 million cogeneration project has of the Department of Ecology. Ecology, Industrial Section, tice of Construction. for two weeks. It was in the hit a speed bump. P.O. Box 47600, Olympia, It hasn't changed that WA 98504-7600; by email to Calling it an oversight, the state SEPA register,but the notice the Port Townsend paper mill Department of Ecology last Friday : didn't say you can comment." mhef461@eyc.wa.gov or by likely will get their NOC,"fax at 360-407-6102. reissued its decision from July to not she said. per- Asked what people are require the paper mill toproduce an PROS AND CONS that the decision on theq P P Proponents say the cogen- mit can't be delayed, "oth- being asked to comment on, environment impact statement(EIS) eration project will add 35 erwise the company would Davies said the question for its proposal to upgrade power full-time construction jobs for have grounds for legal action is whether the department boiler no. 10, add $10 million of one year,then help strength- against Ecology," a spokes- "missed anything." en the mill's future and its person wrote to the Leader "This permit is about[the • new pollution control equipment and install a new steam turbine genera- employment of 300 people. on Aug.24. mill's] boiler. It isn't about They also say it will reduce whether there is enough slash tor that will generate as much as 25 particulate emissions by 70 PERMIT DELAYED in the forest to sustain the percent. The project also is The state had planned to boiler. That's an economic megawatts of power. expected to allow the mill to issue a permit to the paper question and an ecosystem The decision opens a,new two- reduce its use of fuel by 1.8 mill by the end of September. question that are outside the week comment period that ends Oct. million gallons a year. Because the state first needs scope of the permit,"she said. 8 Opponents have ques- to have a two-week comment Davies reiterated what A number of people, including tioned where the new period on the EIS decision, Ecology's Marc Heffner said increased biomass to support issuance of the construction of the project in August: Gretchen Brewer of Port Townsend the mill will come from.They permit now has been delayed, The paper mill is not cur- AirWatchers, complained at a also question the impact of but not stopped. rently allowed to burn tires or hearing in mid-August that while increased truck traffic that Ecology's Davies said the domestic sewage sludge, but will haul the biomass to the department is still review- can burn heating oil;prima- the state had posted the propos- mill. And their overarching ing more than 150 comments ry clarifier sludge, which is al on what it calls a SEPA (State .concern is potential health on the proposal received in water and wood pulp from the Environmental Protection Act)regis- impacts of the change in what August. first run of the mill;hog fuel; ter,it technically didn't open a public the mill burns. Davies said it is not corn- clean, unpainted, untreated Ecology and the mill mon for the SEPA comment urban wood; wood pallets; comment period on that decision. acknowledge that carbon period to follow a construc- and cardboard. In short, Brewer argued, a public monoxide emissions will tion public hearing,but it is The mill still expects to hearing on the notice of construction increase by 7 percent and vol- common for comment periods burn wood and fuel,but now permit should have followed a public stile organic compounds will to run concurrently. plans to upgrade its boiler to increase by 12 percent with Davies also said the state allow for making power. comment period on the EIS. 'the new boiler. recognizes that there are a "It's what should have happened Although the mill says number of questions people in the first place," said Brewer on both of those increases are are asking that need to be Monday, suggesting a new public below federal Environmental answered, including what Protection Agency definitions the definition of biomass is hearing is warranted. of"significant levels," oppo- and what the tradeoffs are "However, the determination of nents note that the new ends- in terms of decreasing pol- nonsignificance is flawed. The mill sion rules are in the works. lutants,but increasing carbon They argue the permit pro- dioxide, a known contributor is on a sensitive body of water. The cess needs to be slowed down of greenhouse gas emissions. boiler will be eight times the size of until the'EPAs new rules Ecology officials also noted the existing boiler." take effect next July. that they did a calculation • While some pollutants may be note that, in of the mill's expected green- the meantime, to be viable house gas emissions under See MILL,Page 5'' and secure good contracts for those new anticipated EPA biomass resources, the mill rules,and under those rules, needs to press ahead and be the mill project still would •one of the first in the region not trigger what is called to receive a permit. a Prevention of Significant Ecology officials also note i- _e/' ?/�910 vir & ».,. A ' . ;' 9 �' r '. 1 :;::, i . ,.,,, ,.., . .4,,,..",,,-,4.. ..i.,„...,:f-.1., i ' .. ' ...- ',. . - 'f.l.'-',. -"..-..-',i,'',12',',-",:_'_.) ' wd i ,.. ..A.7 . ; , ''..;` ' s , .,- 1,,,,,,,/' ' e '' 1 1_ 4 :,,,,,,airgi' ' 7,, t Take jouneyinis cj µ c��r� i s () ) .4 i ,,,, _ 1 II, •-• ;•,--------: - M1 1 _ --" r rice- p ` £ - I' i "' YthttF 1'i@ 1�.' , ..moi - - --`-" �+..a. m y� z i i lit i ir-+ �.1 ' -r-fL' -1 r - -▪ .-Tit4i 1-1,- .'--�r-�.' _ ; � '« ..,,,;:::.----.,17:4*---..., � ?. �`� 1 1 li. i IiIJiF- i�l IT. ,Ei 7- !I 7 Fi +�.� f' �. -_,:_.-5,1:-t:,;.,.,*--::::_:_ w .. �--° ..s --1 d - E €- E r F �Wli --_,E-rt-'''''-74-.--_:„.1 4 -`-mT"y ` µ° ri 1:4- � ?=x - _-ice t c �4 -- e" ' �s, i x'_.v. �' .�. :3" F # X`�' _..- 'b i +4n..t.a+ ++a- - ya g* ! i € s-.s. w§g "tea" _... e' Fk t,:2 � .�-=„s......4......, ate.. ?s� "' j E .�: te^^ . ..i.-,k4-:_-.1"""_ �� .:17,77','�'.` '�F^�a :"""a"!-"11I`.:;" xr'.. "':-t;,..---1.-`"77 s. - r" -rte-- sF > s :." ..:ma' ,' x-1 2 ,t %.."€ i fi• v+ -rxi ,, g+ 4 § d • s Y `4..,,. �.m .-42,-,,,.-" ''''''',".'7I... x 4.,.''-t y y« q : - • - ��"- , � ' 1 r� E i f:„;,..,,,,,:i,,,,,,,„ ,,,: � Ma .Sri's-;:„;1.,...,,,y-_---...,..- Y :;,-Si---� � �i �, �Po .. 3 School Based Student Health Center Did you know that there is a School Based Health Center conveniently located on campus at PTHS? The Health Center is open and available to all PTHS students during the school year with limited openings in August for sports physicals. The clinic provides consistent, high quality and comprehensive health care services to students, regardless of ability to pay. The goals of the clinic are to provide early detection and treatment of illness, to encourage teens to live positive, healthy lives, to teach teens how to use health care systems effectively and to encourage/enhance family communication around health issues. The clinic works in active partnership with the school and community. A structured advisory board meets quarterly and oversees clinic operations. The clinic offers the following services: Primary Care Mental Health Health Education • Illness Assessments • Relationship Issues • Nutrition • Immunizations • Peer Pressure • Physical Activity • Sports Physicals • Health Habits • Healthy Relationships • Injury Care • Family Conflict • Drug/Alcohol Use • Allergies • Depression • Pregnancy Prevention • Acne/Eczema • Anxiety • STD Prevention • Birth Control • Stress - .,.. Grief Lc -- t mar--- t�t • Reproductive Health �� '+ � rl Ott. I � • STD Testing The school based health center is +,i - . open four days per week and is `4 4 4` ' =r 46staffed by a Nurse Practitioner and ; p � � ' Mental Health Therapist. Students - 4`.-, •..,A , i •a may make appointments on their Mental health therapist Patricia Nurse practitioner Susan Flowergrowing consults with a O'Brien checks the blood own through the clinic or may ask parent. pressure of a student. for scheduling assistance through the high school office or their school 9 The PTHS Student Based Health Center was counselor. established in 2009. It is a cooperative In accordance with Washington State partnership between: laws, students may provide their own • Jefferson County Health Dept. consent for: • Reproductive°Health Services at any age [1] • Jefferson Healthcare • STD testing, age 14 and older[2] ° County Mental Health Services • Mental Health Services, age 14 and older [3] • Port Townsend School District All other services require a signed consent Beginning in the fall of 2010, regular dental from a parent or legal guardian. care services and dental education will also be available through the student health center lr compliance with Washington State law [1] RCW 9.02.140 .[2] RCW 70.24.110 with the addition of a visiting dental hygienist [3] RCW 71.34.530 to the clinics staff. 22 • 0 6'n r' o 0 0 g m O .p Z o_cC ^a m 4 o.s m o 04 o" m o .as. 3a ¢ mwy CIO i O f N W ,, a)4.� oO ®U V_� y ri O -5 o - VI V E e + O 3 N ai .a 8 00 -� - U Pe ca C7 O- b tD O O o at— ° Q ii CC. mal ®Q„o O A ®��o• s a n C -._c,.)C S ci - m o o m o c l a� d a° �° E ¼Ir -c tr1r1 ! !1iI n .a) a) '10' y0 '..3ca .' o "--. GW U � y•� CJ 0 o O �F,'.r a) Com. O a) ,b4,u g y .--� t--i- cd b .n aS 4 a) y E— m a) m o`--4 a5 a) 5 bna'-'..a a) 0 IIIP11W11 0E-1 EN -• ate-+ '"�-' Tm d ` CD te. � a'C.+ ate-+Y 40 Y w C,a�--� .� .3 tif} .[ m a)) a,.,,, o am o R,.-. o C. '° 0 g main boiler would be converted to ° 3 a ro a 0 O as—0 m x I State f ng use waste wood from the North q id y a a a F U m 5 Olympic Peninsula,would gener- ora a. o'� a o 0— technical gaffe aso electricalemissions aver and raisinle g C ,, a� « °�° 3 1 E a y PT others—and providing up to 25 ~b , -.w a 0 0 s m v -" for t i project megawatts of electricity for sale. m o x a o•m^ a ° o ,„o o a. N m P. -0 a, P R,-0 e0-0 P-, S.E y of ce o. .BY CHARLIE BERMANT Should have been done 1-.3P, ,,,..s ,;a 2 m ,- w a a F:.'a ce 0 Fa c m m PENINSULA DAILY NEWS Shmanke said that comment ®. -6'o m m 1~ o.-`'„, 0 A a m.o ' �' PORT TOWNSEND —Those on SEPA compliance should have a .. o g °:a;[• �,.� ° •2;' who want to comment about the operated in parallel with the 0 aN y a)-a ,a..a o a o potential environmental effects of period for a proposed order from ' ,a~—, o.4"a ® o 9 N S �cn a $55 million biomass cogenera- Ecology that would permit Port 41 ,• �� a `� 3•tt c Z o a o tion plant proposed for the Port Townsend Paper Corp., to begin a on '..5 8 �; , w 0 3 y Townsend mill have been given work on the biomass boiler. a 3 0 c >, a m another two weeks to do so. The additional two-week a 5 > d g. y The state Department of Ecol- period, she said, will rectify the rn ;-,0.--•S• ,, y 5 cn Ts °-2•o ogy is calling for comments on the oversight. ma ar 3-o as 3 a a) 0 =as O a.a a proposed facility's compliance Several people, including CA with the State Environmental GretchenBrewerofPortTownsend o. a• o w o y-- m b t.�.o . y o Policy Act—or SEPA — saying Air Watchers, had said that the e o " a o a o m a that it is correcting an oversight. state should have held a SEPA Q m a a,�'5 o g 4;'5 ¢, > ,.o We are not extending the com- public comment period. -� to G 3.5 m--HFe: A x to More than 100 comments have •C •-, SO a)c i°' ment period" for all topics per- a)w a;' ca °—4 a O o m o taming to the proposed facility, been submitted during the public N a. '° " (..,),„9,(a..,5. '3 m c p y comment period — which was 60 m a " ` Z " 3" a' said Ecology spokesperson Kim extended once and which ended t g " °' o c a 5 " a3 b .•, c.- Schmanke on Wednesday. ,last month — on the Ecolo o o+> o n o,g;y .o "We are onlyallowingforao ( '"-' as `~ > ;Alc' ® l� G o m Q - c part of the process that should noticeEcoof onst been workingto -vruction. y ° °' .50-,i .o `� o o C a)"-Q have been done in the first Q o N a 3 .o a place.' provide a response to those corn- place." comment will be said.is since then, Schmanke , o.2`° o ;; m o 5,� 6;; o accepted through Oct.S. '�•� �a ° e aC, a.a.y > g a The project;in which the mill's Trios co BIOMASS/A6 � y o 0 a • o a c I g o a. a + Q0 z mo o a2 a0. g -r1 .O 0y cu C 0 at . 23 c ..,, 0 a .rJRS.v A � o tem " QPp rot, r., -- • v] a o g ii v1a� yA C Pfti a .�! g /PL4/ NightGIVES of"goody bags"and"hats" Admission i tis at the • benefit the Jefferson door Out lassos os County Health Depart- The event is sponsored ment's Breast/Cervicalup by the Port Townsend Main funin PT fund to support cancer Street Program.Jefferson screenings for local women Healthcare Home Health & PORT TOWNSEND— in need and the Port Hospice and participating The Port Townsend Main Townsend Main Street Pro- Street Program's seventh merchants. gT gram,nonprofit. annual Girls Night Out Goody bags will be will be held on Thursday available at locations to be Break out your boots, announced for$10,with bandanas and hats fbr this year's cowgirl theme. special $25 and $50"cow- Attendees can enjoy in- girl hats"also for sale. store demonstrations and The"roundup"party at events,refreshments,sales, the end of the evening will food and beverage tastings be held at The Upstage, and more. 923 Washington St.,at Proceeds from the sale 8 p.m. • • ..t1'. VI e "':aillL'::16iii V '''''t "'"' 4,- ga VA V ,k.cis gr_'N, ..''-,:,:7. ' • - . rb ceel • ---,,,,.ro ili ' V, 1,,,---:,,ri, --..--,, c 110'..- g,.. THE ASSOCIATED PRESS cuts of 6.3 percent affect have to take one unpaid day the last 20 years,"said Doug OLYMPIA — The state most of state government. off per month through Porter,state Medicaid direc- Department of Social and The cuts won't touch June. tor. Health Services is making some protected parts of the Medicaid-related reduc- The latest revenue fore- deep cuts to several pro- budget, such as pensions, tions make up about cast issued a few weeks ago grams for the poor and debt service and certain $113 million of the cuts and showed that the state will elderly as it slashes nearly core areas of education. include ending subsidized collect about 8770 million DSHS said Wednesday health insurance coverage less during the current bud- 281 million from its bud- that it will eliminate 30 get. for about 27,000 in the get year.which runs through The state agency inpatient beds at Western state's Apple Health for the end of June. announced details of the State Hospital, reduce ser Kids program in March. There previously was cuts ahead of the Friday vices for mentally ill clients Outpatient pharmacy about 8250 million in deadline Gov. Chris Gre- and reduce payments to benefits for thousands of reserves, leading to an goire imposed for state nursing homes. Medicaid patients also will immediate deficit o'' agencies to cut their bud- Widespread carnage' end in March. 8520 million. gets. Cuts that take effect in Tax collections for the Gregoire ordered the cuts "It's widespread carnage January will eliminate ser- following two-year budget earlier this month to deal for low-income and vulner- vices like dental, vision, period are now projected with the state's growing able populations,"said Nick hearing and hospice care about$670 million less than deficit in the two-year bud- Federici, lobbyist with the for thousands of Medicaid previously expected. get ending in July 2011. Washington Low Income patients. This makes the total The state also faces a Housing Alliance. "I would characterize drop in expected revenues potential deficit heading The agency also will these cuts as devastating about 81.4 billion. and the • into the next two-year eliminate 380 jobs by and radically altering the projected deficit for the cycle. June 30, and starting next face of the medical pro- upcoming 2011-2013 bud- The across-the-board month, all employees will grams we have created over get around 84.5 billion. • / ///O Aound for 'Girls' _,' • Night PENINSULA DAILY NEWS PORT TOWNSEND— More than 20 stores in downtown Port Townsend will participate in the sev- enth annual "Girls' Night Out"event from 11 a.m.to 8 p.m.Thursday. The event is sponsored by the Port Townsend Main Street Association. Proceeds will benefit the Jefferson County Health Department's Breast and Cervical Cancer fund. Colorful cowgirl hats and goody bags filled with socks and gifts will be on sale to benefit good causes that day. Stores are offering sam- ples, demonstrations, great discounts, refreshments, live window modeling, gift certificate drawings and • door prizes. Following the shopping event will be a"Round Up" Party at 8 p.m. at the Upstage, 923 Washington „.The event will feature ;live.. music starring Rita Beebe and Her Cowgirls,as well as appetizers, dessert, raffles and door prizes with a suggested $5 donation admission. For information and a schedule,go to www.ptmain- street.org or phone 360-385- 7911. a �i. ¢' -60� ti a❑J �, Gx�'3*, "} Efiz t '-rr 9ry :.a t3 y3u ° , F. ri fr: . ilic ao o c, c ..' c c �� - o �- 5.— cam'cs C o cc o.o ° �c m ocn �O � C czo �"o � cC y .^ I o2 .� -- 'L C 'Cc ( IHOv' G my saiZ' .. _F:., ,^ I C ^ S cc JC C' -- _ O4 -c ., vm z ' V ; E �7:="t g Z moCn0coo ._ Cay o o C _E ^ S; ;•-2'%".C5'--8. 3 �c � r ° n g° 3 " RZ0m s -„,.47-1P,A..0 10 O wfV : -'. .Fk r+ -44g .,5--,',-,---.4-!....t.-4-,-- e .s �w wt c i c:i --,-;,:4-'k..,,k7::, r,,,... ., ki..,,,,,,..,...„.:. „, , , ._, _,....„...,7.... _.,..6..i.,1,...„, :. . Tpit-,... -, _. .:44:. ., . ,.., •?:—„,,,,,'...... — .-77.7p. 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All species means clams Marine biotoxins are not — including geoduck — oyster, destroyed by cooking or freez- mussels and other mollusks, ing and can be life-threaten- such as moon snails. ing.People can become ill from eating shellfish contaminated with the naturally occurring marine algae that contains harmful toxins. Symptoms of biotoxin poi- soning can appear within minutes or hours and usually begins with tingling lips and tongue, followed by difficul- ty breathing and potentially death. Anyone experiencing these symptoms should con- tact a health care provider. For extreme reactions call 911. Recreational shellfish har- vesters should always check the department of health web- site or call the department's biotoxin hotline at 800-562- 5632 before harvesting shell- fish anywhere in Washington. . . /e/o4 Mill 8 e a b t • co e t f 1 due Friday Comments on the state Department of Ecology's deci- sion not to require an envi= ronmental impact statement on the Port Townsend Paper Corp. cogeneration project can be made through 5 p.m. Friday,Oct.8. • Proponents say the cogen- eration project will add 35 full-time construction jobs for one year, and then help strengthen the mill's future and its employment of 300 people. Opponents have ques- tioned where the new increased biomass to support the mill will come from.They also question the impact of increased truck traffic that will haul the biomass to the mill. For more information, visit the state's website at • ecy.wa.gov. Direct comments to: Marc Heffner, Department of Ecology, Industrial Section; P.O. Box 47600, Olympia, WA 98504-7600; by email td mhef461@eyc.wa.gov; or by fax to 360-407-6102. • rt etzekt; • - r rDdf3Jv 3 L) ssB tMS'' "44.0 S mato - r a al . i o o SIiiile9,:obile is ,or:In ,t t* :_ M ° November N &L- e.th , 2 _Li h 08- '1obiie, a fuM y ei u p e .iie & r t ,i di wsii e ,eta citv N 91 W f,..-11Ney Rd. t7hii 98325 Th. SibUUe pr.v s oJe ,tai care to chiiis..ren (birth thro.0 h g n i s .hoo8) y ath 'at-d t rimily onc,m o acc-pts St t€- of W,shi Sertie-s Carr.; Q rov der O. and sl�den fee se;ie b-se.3 on t.imily it con e T. sch-dui= in a •ptoint E {.- rnt or fox !more intorr „$tip.>n, p e s c,a nor Kesskr,r -it Jeff r'rsn County Pr_iblic - ealth 36m-385-9432 trr 360 }5 940*. 4 intment must b SC- L1l -fore vrr brr �o The is operated by 'J` h h n t n .1-ntai Service Fc}undation h partnership with Seattle Children'. Hospital. This event/activity is NOT being sponsored by the school district and the district assumes no responsibility for the conduct of or safety of the event/activity. In consideration for the privilege to distribute these materials the Chimacum school district shall be held harmless from any cause of • action, claim, or petition filed in any court or administrative tribunal arising out of the distribution of these materials,.. including all costs, attorney's fees, and judgments or awards. -wr Girls' -h .. ,,. _ . . , was • . -, . rootoo-tiff succa:ss 1,1 Hundreds of women Program, a 501(c)(3) non- importance of getting cancer came downtown for a day profit. screenings to protect their and night of female cama- At Tickled Pink, many health. raderie and shopping fun at customers were greeted Contents for the goody Port Townsend Main Street's with a gift upon arrival. bags/hats and raffles were "Girls' Night Out" on Oct. At Wandering Wardrobe, donated by the Clothes Horse/ 7. Many dressed in western customers could play the Ozone Socks, Maestrale, outfits to go along with this "Cowgirl Game" for addi- Maricee Fashions, the year's cowgirl theme. tional discounts. Maricee Perfect Season, Personalize Twenty-three stores on Fashions served up "Cowgirl It!,Tickled Pink,Expressions Water Street and in the Caviar," and storeowner Sue Apparel, Bickie's Cotton "Fountain District" partici- Arthur's husband, Julian, Casuals, Connie Segal's. pated with window modeling, was a dead ringer for John Natural Skin Care, About in-store artist demonstra- "The Duke"Wayne. Time, the Green Eyeshade, tions, discounts, raffles and Ms. Bee Haven featured Ms. Bee Haven, Sport free samples. Main Street's 50 percent off clothes and Townsend, J&J Good-Byes, Girls'Night Out is an award- shoes.There were great deals Kim Nunes, Port Townsend winning promotion sponsored and promotions, creating a Main' Street Program and by Jefferson Healthcare and lively atmosphere, reported the Jefferson County Health participating merchants. Mari Mullen, Main Street Department. The event is coordinated by executive director. The Main Street Program the Port Townsend Main More than 100 women extends its appreciation to Street Program Promotion attended the "Round-Up" Jefferson Healthcare, par- Committee. party at the Upstage, which ticipating merchants, the 4111 Customers who pur- featured Rita Hubbard's Clothes Horse/Ozone Socks, chased goody bags/cowgirl band singing favorite cow- Rita Hubbard and her band, hats received special cou- girl tunes. Appetizers by SOS Printing, the Rose pons,including one for Ozone the Upstage, desserts from Theatre, Safeway, Jefferson socks.The sale of goody bags/ Perfect Endings, door prizes 'County ;Juvenile Services, hats, donations and raffles and raffles added to the fun. the Mount Baker Block generated $4,645 to be October is Breast Cancer Building Management, the shared by Jefferson County Awareness Month. At'the Port Townsend Main Street Health Department's Breast/ Round-Up party, Julia Promotion Committee and Cervical Health Program Danskin of the -Jefferson$ volunteers, and thanks all to pay for cancer screenings County Health Department who came, donated, pur- for women in need, and the welcomed the group and chased a goody bag/hat and Port Townsend Main Street reminded everyone of the shopped locally. • • • ontinuing oritinuing Public y Xi s have vaccine =- As fall and winter available 9 a.m.-2 p.m. on Sims Way, Port Townsend: approach, the national Monday, Oct. 18; Friday, Oct. Walk-ins welcome for vacci- Centers for Disease Control 22; and Saturday, Oct. 23. nations Mondays-Fridays, and Prevention and Jefferson Vaccine available for clients 10 a.m.-1 p.m. and 2-4 p.m. County Public Health recom- age 18 years and older. Flu No appointment necessary. mend that people be immu- shots,$25.Medicare billed;all Medicare and Medicaid nized against the flu. others pay cash. accepted. Many insurance Many people have already • Port Hadlock Medical providers billed. Bring insur- been taking advantage of flu Care, 121 Oak Bay Road,Port ance cards. Flu shots $30. clinics, and as a result, a few Hadlock: No long lines. Call Pneumonia and high-dose flu clinic dates have been post- 379-6737 for an appointment. vaccines available. Clients poned. The following infor- Bring insurance cards; some must be at least 8 years old. mation is in addendum to a insurers may pay. Flu shots State-supplied children's Sept. 15 article published in $25.Public welcome. flu vaccines are recommend- the Leader. • Port Townsend Family ed for all children ages 6 Influenza vaccines are Physicians, 934 Sheridan, months to 18 years and are being administered at the fol- Port Townsend: Oct. 16 clinic now available at the following lowing locations: postponed until mid-Novem- clinics: Jefferson Medical and • Jefferson Medical ber. Pediatric Group, 382-4848; and Pediatric Group, 915 • QFC Pharmacy, 1890 Olympic Primary Care, 1010 Sheridan, lower level, Port Irondale Road, Port Hadlock: Sheridan, Port Townsend, Townsend:Oct.23 clinic post- Wednesday-Thu r s day, 379-8031; Port Townsend poned until mid-November. Oct. 27-28, 11 a.m.-5 p.m. Family Physicians, 385- • • Madrona Hill Urgent Vaccinations available by 3500; South County Medical Care, 2500 Sims Way, Port appointment starting on Clinic, 294843 Highway Townsend: Flu vaccine avail- Nov. 1. Medicare, Medicaid 101, Quilcene, 765-3111; able during regular clinic and insurance billed. Please and Jefferson County Public hours, Monday-Friday, 9 bring cards. Flu shots $25. Health, 615 Sheridan, Port a.m.-7 p.m. and Saturday, 9 Pneumonia shots available. Townsend,walk-in immuniza- a.m.-4 p.m. Vaccine available Clients must be at least 11 tion clinics every Tuesday and for clients age 18 years and years old. Thursday 1-4 p.m.,no appoint- older. Flu shots$25.Medicare • Safeway Pharmacy, 442 ment needed, 385-9400. billed;all others pay cash. • Madrona Hill Urgent Care, 9481 Oak Bay Road, Port Ludlow: Flu vaccine 0 , f COUNTY DISPOSES OF program by making "drop • UNUSED DRUGS boxes" available at the The Port Townsend police department and the Police Department recent- sheriff's office by November ly collaborated with 2010. More information the Jefferson County will be announced as pro- Community Network, the gram details are finalized. Substance Abuse Advisory For information, con- Board and Jefferson tact Sgt. Edgar J. Green County Public Health to of the Port Townsend host the area's first "Drug Police Department at 360- Take-Back Day." 531-2091 or Anne Dean Fifty-two people came to of the Jefferson County the Port Townsend Safeway Substance Abuse Advisory on Sept. 25 to turn in pre- Board at 379-4495. scription and over-the- counter drugs for safe dis- posal. The collection effort resulted in 63 pounds of unwanted drugs. The Port Townsend Police Department and the Jefferson County. Sheriff's Office intend to sustain this 1111 S jefferon Cou 4 Tobacco Awareness r Tobacco Prevention and Control Program � is h .d • 16,34,gAssoriAannt .i.,,,,, •&:,:•4.,,,,:',-:::;.:,r7;.:,::::;...•:4.4,,Septi Oct 2010 Great American Smoke Out ,/i j Eliminating Exposure to Second Hand Smoke % , X /'%y. x/%-,/% :%g CYO,of Port Townsend k spa ."aopal"enter, r September.2010 • et _ (360)379-5047(63,a11 dryer.us)wow cityofpius October 2010 Healthy Youth News From Mayor Michelle Sandoval Sign Code Revisions In Effect ® Special pants d interest oAAs we move into fall and election sea- After three years of public process, booboo Um as tm5 soq l want to remind everyone to vote in the City Ceuntil approved re Jefferson County,WA n November.Itis our responsibility as titin the Sign Code(O.i r r zens.to addition,I want to urge,our citizens to septa r•- d think about volunteering for one of our many ad- trto �� visory boards.It is another way to bet.:- _tYtci 9 Healthy Youth Hews for -• !r' m your government and In . �,tf 7 us, ...t� ys�`•C.01 riot" •.toff will Pr* I foe• tett eydin9 trJ r the u9Go enat Sour lay.ed..0*es +lj e to PtePAte oke mut hen - pa¢3 Ifs,Antis or 8p15S! •p^�iY0w 1a"ar &ao eCt ttf� Dart No w*+w b`w"r rovd�,.m :n ode Sthe PtS� AmErt tg 2��p. f Ch�'�itr1C� _ uKnow' >a'"s"Nm ` rswt"�'totarseb is VC' Great��emaeT. �Oktng 10 did Y° wnah t mcg "n xae N t last\leaf�`i_140` nt t.jeatth a nom ,„ate • Vita l?this y all .t_$�p'Q tate O$Pt. "�r'�" 040 tool te t" Y v Nan saet tm,candn M e gx:atorotrex��adpt,"e.,mr" AtreeSeNtCeO ,04$142,- ro w po• ,,• r, rhe a ak3s ns��nar�. ns,,,c mberea ,o„tlas��^:k' http://www.cityofpt.us/NewsLetter/2010/10.pdf • o re"'"`tont' "erred • per' ,mWA"- WO."°a Cut100.° 1w_e' vet s did Y • ' r for•tN9° ' • : g`°aa „saa+r-adn` ar„ �wt"""n•s • 1waa� s°" 11111 Healthcare Providers Training Opportunities Smoking in Public Places law Business Awareness —. ,. .Na Jefferson Healthcare PHARMACY NEWS I - SEPTEMBER 201C G OMNICELL PEARLS m • If a medication is removed from Omni ,r:,. and by chance riot administered to the nc - �'"' pd* t 0 �• patie ._please return it to Omni right away so the patient isn't charged for it. ,7PIOPal'w ORIME n JIEu F "o-, - ... •AND...If a partial dose Is admmistered / �rne N cu In - i vma-^ please waste the remaining dose / - ��-� f rather than"saving"It for tater - W t • Pulse Oximeters. .. It °kir19 rate is a srnotori0 a d.. ..nar�ne .a dU ear fns .e anal when �°state'20-,,,8 eAlf,�Sthe p{e'ttous-Tobacco Port Townsend Main Street Program lofestio,1 991*ti e•estit%200ti#ttaosates now s• was15 arta ng drop toa ztember 2010 Newsletter rate on State.S tot program The drop d deaths aar for s h1n9t Cord t t -felate ebae� by Karen r(e)3 nonprofit cornmrttett to the V'aedeetion�`ded 't$rtY t�a� a�os� °sones - n rmation vv05 pr°vf tic eaith n g p deet+" wed 11 Car .nceil t fa N srrress districts,while marntamm our fa ha 400 peop1e SP yr,future"att a dit4*u deaths e f fife. ptitl� The folloern9 to 53°' on$ Q° yrs are tease h°'n 1 mon ounty les e Oberniey 'caG2r, J C m pub� � ^. �,ppS3 • i [-dD king mrd* and ��% tttt5^y eai T' �CO f�4�e �Up t0 CJ 6� � been n•to e �m ek ng"d a asM°7 d Y• ea w s R 4 - e ad ' tf3tts Gott tots,- nee drs• it taw.went c and voskp va•has y 1 res as Pc'� ; ary n�!p o+�d5 SBr1\ , -r Pub'' ',tom' m bhaars na d restaura"e tc nave .� . a 04e) ler Utt orn 1 percent a econt ipo., NO AU, IYf ': V: sti ( gteverthekss,pt yhe taw ynesses_ - avqty uestions abcuachcns for bu• ,yR, t 4 1 N- ?,:„res thr s.„, ins sig hn entare `• it . j W.sh .post ain V establis lace or business yY". ..tit.. 411S.' .,.'e Ibelt our v-p n*king ;thin Ver p Arte inns w 25 feet of entrk stha etre i7r1f i(-f"O-SCIlOOi SOPt'I r?IS meows 5nn vthin‘,07.1:,t;1,0tion 1 ib• ted. prohibit sm[ohpen,and T°b t supt+ort*r grinsed area where smthey;terns yeasabout -c twrg ashmays, ▪tz&�u`9° ae mess ern the meso an e ttem th tace Karen Obermeyer - q .; .?s k etl,eVarea am�+9 to eke• nth kmsg in public psoras tc file'. Jefferson Co. Tobacco Prevention & Control Program hemp, for but�m* „ bona. (360) 385-9400 http://archive.const.r'contact.com/fs045/1101974182347/archive/1103652418675.htr Page 1 of 2 • Print°version brought to you by • GOVERNING's Public Great PUB!, I GREAT An online community, hosted by Bill Bott and Ken Miller, for change agents dedicated to helping government increase its capacity to do more good. Poverty's New Population Within the past year, the struggling middle class has given in and applied for everything from food stamps, to energy assistance, to help paying rent. Jonathan Waltersl October 12, 2010 As a leading economic indicator, there's nothing like a local social services department waiting room to get a read on what's going on before the experts have all the numbers. For at least the past year, those working on the front lines have noticed something quite troubling: the people coming in for services were beginning to look an awful lot like the people manning the social services offices --the ones whose job it is to dispense help. In other words, a whole new population -- a group of people who had been employed and productive, and had been trying to hold out, waiting for the economy to improve-- have within the past year begun to give in and apply for everything from food stamps, to energy assistance, to help paying rent. • According to those studying the phenomenon, this new cohort of applicants appears to be made up of people who've seen reductions in their work hours, had to take lower paying jobs and never would have dreamed they'd have to resort to public assistance to get by. As one county official put it, "The solidly middle class have fallen into the social safety net." And so it wasn't much of a surprise to those in the human services business when the U.S. Census Bureau announced last month that the poverty rate in the U.S. had hit a 15-year high, increasing from 13.2 percent in 2008 to 14.3 percent in 2009. Percentages, though, don't really tell the story: An astonishing 43.6 million Americans --that's one in seven -- fell below the poverty level last year. But when one considers that the poverty level is an arguably ridiculously low amount of money -- $21,954 for a family of four-- we know the picture is much grimmer. To get an idea of just how grim, the Brookings Institution recently released its own analyses of the Census data that paints an especially disturbing picture. According to the Brookings analyses, the hardest hit areas of the country are the suburbs. Again, the numbers are staggering: Since 2000, the percentage of working age poor in the suburbs has increased by more than 37 percent, to almost 14 million people. In all, according to the Brookings analyses, suburbs are now home to nearly one-third of the nation's poor. The corresponding bad news is that the U.S. is seeing rapidly declining levels of people covered by health insurance. As the poverty level went up, the number of individuals without health insurance went from just over 46 million in 2008 to nearly 51 million in 2009. Worst of all, experts believe that in spite of signs that the Great Recession is easing, when the 2010 numbers come in they will show that poverty rates and rates of uninsured Americans continued upward. What the raw numbers indicate is certainly being confirmed on the ground. According to a Brookings analysis of selected nonprofits in the suburbs of Chicago, Los Angeles and Washington, D.C., almost 75 percent of suburban nonprofits reported serving clients who had no previous connection to any safety net program. http://www.goveming.com/templates/gov_print article?id=104698754 10/12/2010 Page 2 of 2 More disturbing, almost half of the suburban nonprofits reported losing key revenue sources last year, with one in five reporting that they've had to cut services, and one in seven reporting actively cutting • caseloads --that is, having to refuse help to those who asked for and need it. Commenting on the Census numbers, Brookings' poverty expert Ron Haskins noted, "[The numbers] are not as bad as people predicted they would be, but they are plenty bad. Child poverty, especially, is up," said Haskins. Haskins also expressed concern about the decrease in health-care coverage. "I think this is a big deal. It will probably continue, which means that the government programs are going to have to pick them up." The only other vaguely positive note in all this is that if not for existing social safety net services, the Great Recession's impact could have been unfathomably worse. Last year alone, the U.S. spent $132 billion on unemployment insurance, almost $270 billion on Medicaid and $50 billion on food stamps. "So the safety net has really stepped in where the economy left off," says Haskins. "The story would have been much worse if it had not been for the safety net." But for those serving the new poor, the news is plenty bad, and in no small part for the reasons stated at the top of this column: It isn't just that more people are coming in for help and that resources are being stretched to the breaking point. It is because, as one national expert in human services puts it: "The people coming in for help are starting to look just like the people who are giving it. You can't imagine how traumatizing that can be. They're sitting there thinking, 'Hey, that could easily be me." This article was printed from: http://www.governing.com/topics/health-human- services/povertys-new-population.html • • http://www.governing.com/templates/gov print_article?id=104698754 10/12/2010 ,v ?:,,;#.1,4*!,,,,,: S STATE OF WASI1 INGTo N DEPARTMENT OF SOCIAL ANI) HEALTH SERVICES Medicaid Purchasing Administration fi?h,5m 1ve,mc, S,L. • I'.O Bay-/353(0 O/(-rupia, II ii'hi aii na 9,150-1.55 3(1 October 20,2010 TO: First Steps,Maternity Support Services/Infant Case Management(MSS/1CM) and Childbirth Education(CBE)Providers , iFROM: Todd Slettvet,Chief,Office of Community Services: SUBJECT: . Additional Information for MSS/ICM and CBE Providers We are sending you additional information to supplement the September 29, 2010 memo from Doug Porter,Health Care Authority(HCA)Administrator and State Medicaid Director,entitled "6.3%Across- the-Board Budget Cuts for Medicaid and HCA"(copy attached). As indicated in that memo,federal law mandates most Medicaid services.This leaves only optional • Medicaid programs from which to meet the difficult budget reduction requirements. As an optional program, MSS/ICM and CBE are recommended for elimination effective March 1,2011. If the recommendation is approved as submitted,MSS/ICM and CBE providers will not be reimbursed for covered services delivered to eligible clients after February 28,2011. The list of recommended Medicaid budget reductions DSHS submitted to the Office of Financial Management will be included in the supplemental budget presented to the legislature in January. Eliminating MSS/1CM and CBE requires legislative approval. They will have until March 1, 2011 to review the recommendation and make a decision. Providers will be notified after the legislature makes a final decision, Unless the message comes directly from DSHS Medicaid Purchasing Administration or through the First Steps Messages Mailbox, program staff cannot verify any information you receive or hear. Please direct all questions about the proposed elimination of MSS/ICM and CBE to Jim Stevenson, DSHS/MPA Public information Officer. His email address is:jim.stevenson(a),dshs.tiva.gov. 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