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HomeMy WebLinkAbout2010- December File Copy S Jefferson County Board of 3lealth. Agenda J1 inutes • December 16, 2010 • s • • JEFFERSON COUNTY BOARD OF HEALTH • December 16, 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 October 21, 2010 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. Chimacum SmileMobile Event Report 2. Executive Order 10-06, Suspending Non-Critical Rule Development and Adoption 3. Tobacco Use in Jefferson County V. New Business • 1. Public Hearing: Environmental Fee Revisions for 2011 2. Environmental Health Policy Revisions: Food Safety Program 3. Reappointment to Jefferson County Substance Abuse Advisory Board 4. 2011 Jefferson County Budget: Jefferson County Public Health Impacts 5. Washington State Budget Update 6. 2011 WSALPHO (Washington State Association of Local Public Health Officials) Legislative Agenda 7. Agenda for Change and the Centers for Disease Control's "Six Winnable Battles" Initiative 8. February 2011 Standards for Public Health Practice Audit: "Basic" Standards Option VI. Activity Update: Region 2 Public Health Emergency Preparedness and Response Statewide Exercise: January 25-27, 2011 VII. Agenda Planning Calendar: Board of Health Meeting Calendar for 2011 VIII. Next Scheduled Meeting: January 20, 2011 • 2:30-4:30 pm Jefferson County Public Health V f JEFFERSON COUNTY BOARD OF HEALTH • MINUTES Thursday, October 21, 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,MPH 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 Roberta Frissell,citizen at large(County) Stuart Whitford, Environmental Health Services Director Kristen Nelson, Vice Chair,Port Townsend City Council Sheila Westerman, Citizen at large(City) Chuck Russell, Chair,Hospital Commissioner, District#2 Chair Chuck Russell called the meeting of the Jefferson County Board of Health to order at 2:30 PM. A quorum was present. Members Present: John Austin, Roberta Frissell, Chuck Russell, David Sullivan, Sheila Westerman, Phil Johnson Members Excused: Kristin Nelson IIIStaff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin, Stuart Whitford, Veronica Shaw Substance Abuse Board: Frances Joswick, SAAB APPROVAL OF AGENDA Member Austin moved and Member Frissell seconded for approval of the agenda. The agenda was approved unanimously, as written. APPROVAL OF MINUTES Member Austin moved for approval of the September 16, 2010 BOH meeting minutes, as written; Member Westerman seconded. The minutes of September 16, 2010 were approved unanimously, as written. PUBLIC COMMENTS Chair Russell, speaking as a member of the public, noted that Rotary Club raffle tickets are available for purchase. III Page 1 of 10 I Mr. Tom Brotherton said he wished to comment on tobacco use in Jefferson County; he distributed a handout. He referred to tobacco use information found on the Health Department's website. He said that, despite the stated objectives and list of priorities found there, the trends reported by the State for certain segments of the Jefferson County population were not good. He pointed out a number of statistics of particular concern and inquired what strategy would be followed to reverse the negative trends. Siri Kushner, epidemiologist, pointed out the overlapping confidence intervals on the Adult trend chart to which Mr. Brotherton had referred, noting that the 2007 to 2008 change is not statistically significant. Ms. Baldwin added that the Jefferson Health Department does not use these types of charts because they are easily misinterpreted. However, she and Ms. Danskin acknowledged the seriousness of the smoking problem and expressed their appreciation to Mr. Brotherton for bringing this to the attention of the Board of Health. They suggested that Ms. Kushner and the Tobacco Prevention Coordinator, Karen Obermeyer, be invited to a future meeting to address these issues in more detail. OLD BUSINESS and INFORMATIONAL ITEMS Region 2 Public Health Community Liaison Summary Dr. Locke noted that this regional project that had been operational for several years. A one page summary is included in the packet. This is a successful regional program in which public health nurses visit medical and veterinary clinics to provide up-to-date information about all notifiable conditions and public health programs, as well as answer any questions from practitioners. Feedback from clinicians has been very positive. SmileMobile coming to Chimacum, November 8-12, 2010 A copy of the informational flier is included in the packet. School Based Health Center Work Group Jean Baldwin referred to a series of articles in the September issue of the Journal of Public Health on school-based clinics disease prevention. A working group including Dr. Locke, Siri Kushner and practitioners are assessing data collection at the school based clinics to determine whether data collection and services are on the right track. She said that Jefferson Mental Health, instead of the Kitsap agency, is now providing services to adolescents in Chimacum, Quilcene and Port Townsend Schools; funding is from the 1/10`h of 1 per cent source. Wendy White has retired and has been succeeded by a new nurse practitioner. The new team is up and running. Status reports will be given later in the school year. Copies of the journal articles are available. 411 Page 2 of 10 w NEW BUSINESS 11111 Nurse Family Partnership Reports: Local Data, Foundation of Lifelong Health Essential Findings Report, Washington State Adverse Childhood Experiences Report Quen Zorrah presented a report from the Family Health support team. In the 1990s the BOH directed that all pregnant women should be screened at least once in pregnancy for substance abuse and domestic violence. In 2009, they received a grant from Women Who Care to design a local assessment for pregnant women, which was expanded to include all care givers of young children. Nurse Family Partnership was started in the County in 1999 because of high rates of referrals for child abuse, i.e. 50% higher than the State rate. She said this was the beginning of basing JCPH services on evidence based practice or science. Also, since this time brain research has been growing exponentially. Much more is now understood about the impact of early development and how early experiences influence the expression of genetic material. Ms. Zorrah reviewed the Adverse Childhood Experiences (ACE) study done at Kaiser Permanente with a population of 16,000. A lengthy questionnaire dealt with 10 different categories of possible childhood adverse experiences. The study showed that the higher the ACE scores, the more likely a person is to have a variety of chronic diseases as an adult. They looked at physical, mental and behavioral processes linked to the ACE score. For every rise in one's ACE score, there is a higher risk for having these issues. JCPH team is looking at health as the whole range of signs/conditions/behaviors, e.g. blood pressure, smoking, diabetes, drug use, depression, domestic violence etc. One's ACE score can reflect one's health throughout one's • lifetime. A copy of the ACE short form was included in the packet. Ms. Zorrah said that since researchers had not previously collaborated in this way, her team used the valuable data on fostering better outcomes from Nurse Family Partnership and the ACE study to develop an assessment tool. The team has expanded the program so that its top priority is to prevent "ACEs". In addition to reducing the risk of chronic disease, it is a powerful clinical intervention to teach individuals about the ACE study and to help them understand their own ACE score. The assessment questionnaire is offered on intake and to the various Family support programs, meaning that the data is from a range of different people who are all caregivers of young children. Siri Kushner, epidemiologist, then presented some of the data derived from the questionnaire: •67 persons seen in the Family Support Program at JCPH completed the questionnaire between September 2009 and June 2010. •The average age was age 26, ranging from 18 to 62. • 16% were male and 84% were female. •Almost half were unemployed or unable to work. •63% reported household incomes of less than $10,000. •Average household size was 3 people. Ms. Zorrah noted that teen pregnancies are fortunately very low at this time. Jefferson County • has seen a declining rate for the last ten years. Page 3 of 10 •About half of individuals under age 25 reported having less than a high school education; 46 % have completed high school or have earned a GED; 6% have completed an Associate degree or 41111 vocational training. •Of those over age 25, about half have some college and 19% have completed a 4 year college program. (The educational level of the mother greatly influences how well the child will do in learning and life.) •Just over half of the individuals (54%) reside in Port Townsend, and half elsewhere in the County. The questionnaire is rather lengthy (4 pages) and includes questions about substance use. •80% reported ever using alcohol at least once or twice Ms. Zorrah said that since it is difficult to obtain accurate data about current substance use, questions/answers about history of use provide clues as to the family environment. Some of that data regarding alcohol and other drugs such as un-prescribed pain and sleeping pills are concerning. Ms. Zorrah said that although few people still smoke in their homes, they often smoke outside or in their cars. She said that the health risks of smoking, especially second hand smoke, are stressed, and that the Nurse Family Partnership has reduced tobacco use throughout the pregnancy by 33%. •2/3 of people reported ever using tobacco at least once or twice. 31% report current daily or almost daily use in the past three months •41% reported a feeling of hopelessness some of the time within the last 30 days •Almost 30%reported feeling very irritable within the last 30 days •Almost 25%said they needed or had been told to get help with emotional problems •21% had spells or attacks of anxiety, fright or uneasiness • 18% reported nightmares or flashbacks • 17% reported being depressed, having lost interest or pleasure, trouble concentrating etc • 11% reported they felt they were not the parent they wished to be •5% reported having given into an aggressive urge or impulse Ms. Zorrah again stressed the seriousness of these findings given that these people are either pregnant women or caregivers of young children. She said these are frightening statistics considering what is known about the quadrupling of shaken baby syndrome and the increase of head trauma in our state. •About 2 in 5 report ever having received a diagnosis of mental illness •Of those, 81% report a diagnosis of depression; about half, anxiety; and 'A bipolar diagnosis (Member Austin also noted that 8% reported borderline personalities) Ms. Zorrah added that it was also concerning that much of this population has never been able to access mental health services. She said the combination of diagnosis, history and current symptoms is a rather frightening picture. • Page 4 of 10 •About 2 in 5 reported that they had ever lived with a step parent • •40% said they had ever lived with friends •Almost 30% reported they had lived with other family •About 25%had ever run away from home •Almost 1 in 5 had ever had interaction with CPS (Child Protective Services) • 12% had ever lived in foster care Ms. Baldwin said that one bright spot is that this population is getting services and that the department is serving the right people. •Of the clients who completed the ACE questionnaire, 15% reported no "ACEs"; Almost 30% reported "1"; the average score was "3"; the median was "2". (The highest possible score was "10". •If we compare the family history questions to the ACE score, the ACE score was 2 points higher among those who reported having ever lived in foster care, or with friends or other family's homes. •ACE scores for those ever diagnosed with mental illness are significantly higher than ACE scores for those without a mental illness diagnosis. Half of those ever diagnosed had a score of 4 or more. Ms. Kushner referred to the recently released Washington State Family Policy Council report. It reports on a state-wide BRFSS survey that included the ten ACE questions, comparing their data with the Kaiser Permanente 15 year ACE study. There are differences in the survey methods: • the BRFSS study uses a telephone interview survey, and the Zorrah data is directly self- administered, with the client on site with the practitioner. The populations also differ in several ways including age, education and gender distribution. ACEs questions are a grouped into categories of abuse and household dysfunction. There are some notable differences between the Jefferson County group and other populations. Full details are available from the report. Fran Joswick inquired, of the ten issues, which had the highest reported incidence. Ms. Kushner responded: 75% reported that their parents were separated or divorced; 38% reported that they lived with someone who was a problem drinker, alcoholic, or used street drugs; 27% reported living with someone who often swore at them or insulted them. In response to another question, staff said that there are about 120 families served each year. Quen Zorrah said that staff is grateful for the funding that allowed this study. She introduced each of the nurses who participated in this study: Yuko Umeda, Mary Jo Mackenzie and Denis Langlois. Ms. Zorrah stressed that Nurse Family Partnership and ACEs fit extremely well together. Children who perceive their parents failed to take care of them and protect them; can develop coping strategies that are harmful to themselves or their children. Nurse Family Partnerships, which is based on relationships, is very powerful in this context. "We are using these therapeutic relationships to help heal and prevent health problems. And now that we are doing this assessment and asking people to do the ACE questionnaire, they are starting to understand for • themselves the impact that their own ACEs have had on their lives." She said they are finding Page 5 of 10 that their lives now make sense to them and that this motivates them to prevent this from happening to their children. • Ms. Zorrah said that there is great interest from the hospital and physicians to extend this study. She hopes that the ACE questions will become part of routine health histories and assessments used by health care providers. Member Austin inquired whether this information has been communicated to the State legislature and other funding bodies. Ms. Zorrah said that she had shared the process with other counties and agencies. There was a brief discussion about the dollars that can be saved with this program; Ms. Zorrah said research shows the minimum is about $5 for every dollar invested. Ms. Baldwin added that both the Rand Corporation and the Washington State Institute of Public Policy research named Nurse Family Partnership (NFP) as the most cost saving program. There was additional discussion about the Jefferson SAAB study of costs attributed to substance abuse, and the potential savings from NFP. Member Sullivan inquired what Proposition No. 1 and liquor tax elimination would mean to this program. Ms. Baldwin said that there would be a loss of$96,000 to Maternity Support. There are potential impacts over the next three to six months for which all details are not yet known. She said that the BOH would need to be involved in a series of related policy decisions. She mentioned other DSHS pharmaceutical cuts that would ripple through to other services, as well. Baldwin said a short version of this presentation was given to City Council last week, which was well-received and generated many questions. Ms. Westerman said that she believes it is important to communicate the proportion of services that are provided to City residents. 1111 Pre-adoption Briefing and Call for Public Hearing (12/16/10) on Board of Health Fee Schedule for 2011 Stuart Whitford referred to the proposed 2011 Fee Schedule in the packet. He noted that there was no COLA this year, and thus no across the board increases. He highlighted changes under Food Services. Fees are now broken out based on menu complexity, as well as seating, because there are greater inspection costs for greater complexity. Mobile units are also differentiated by menu complexity. He said that late fees have been eliminated; an establishment will be closed until renewal fees are paid. There is a new fee to cover the cost of pre-inspection for newly opening restaurants. There is also a re-opening fee to cover costs for those establishments previously closed for health or other reasons. He also introduced food inspectors, Dana Fickeisen and Mina Kwansa. Ms. Kwansa is a new inspector who holds a Masters degree in Public Health and has completed an internship at Benton County, Oregon. In response to a question about the Food Handler's card, Ms. Baldwin explained that the fee for a duplicate is the same as for a new card, $10.00; previously, it was $5.00. Ms. Baldwin also pointed out the additional $73 per lot for Boundary line adjustment review, which had been inadvertently omitted in the 2010 schedule. In general, the intent was to make the schedule simple, clear and more readable for everyone. • Page 6 of 10 Mr. Whitford also explained a recommended change under Water. For rain water catchment • systems, now allowed by Ecology, a $65 per hour fee is proposed to cover time needed beyond the 1.5 hour base fee of$98 for Determination of Adequate Water Supply. To date, there have been few instances of these systems, although more are expected in the future. Member Johnson inquired about definitions for"limited menu" and "complex menu". Ms. Baldwin said that the Standard Operating Procedures contain definitions. She said that the categorization is also based on risk; the more complex a process the more risk and therefore the more points of review. Ms. Baldwin also noted that the fee schedule itself does not mention all conditions, such as off site uses of commercial restaurants. Member Sullivan moved that the Fee Schedule Hearing be set for December 16, 2010; Member Frissell seconded the motion,which was unanimously approved. National Health Care Reform: Orientation to the Affordable Care Act of 2010 Dr. Locke pointed out the Highlights of Community Benefit/Hospital Needs Assessment in the packet; he said this topic had been discussed with the new CEO of the hospital earlier in the day. One of the provisions of the Affordable Care Act is that all not-for-profit hospitals must do community needs assessments at three year intervals, at minimum. This document outlines the elements of needs assessments. Dr. Locke said this will overlap with activities that our health jurisdiction has been doing. SMs. Baldwin noted that, under Home visitation programs, Nurse Family Partnership has some national funding, but that the State must apply/qualify for it. Washington State has applied but funding is based on risk and size, so Jefferson County may not qualify. Member Sullivan suggested that various entities, including OlyCap, could collaborate on risk assessment. Member Russell noted that much remains to be defined with national health care reform, including "meaningful use". Data Steering Committee Update Ms. Baldwin referred to packet materials and noted that a list of attendees of the previous meeting had been included per Member Westerman's request. The next meeting is scheduled for Thursday, October 28 at 3:00 PM. State and County Budget Updates Jean Baldwin explained that the packet inserts are a just few of the letters and bulletins from the State regarding budget items. She said that the 6.3 % Health Care Authority decrease will be reflected in a variety of ways across many programs. Questions of timing and reduction amounts • Page 7of10 are still uncertain. Maternity Support and Family Planning have already lost about 40% over two years. . Veronica Shaw referred to the presentation on Nurse Family Partnership earlier in the meeting, noting past support from the BOH. She distributed a spreadsheet, County General Fund Trend, covering years 1994 through 2010, which summarizes transfers between the General Fund and Public Health. She also reviewed the BOH presentation she had made last year regarding the 2009 Public Health Department budget and recalling the County general fund (CGF) decrease of $157,000. In 2010, there was an additional CGF decrease of about $108,000 with another $50,000 more expected in the 2010 budget cycle. Ms. Baldwin said that these cash reserves are carry over funds that have been made possible by good management, by seeking out new funding sources, and by constraining staff salaries, etc. Ms. Shaw added that because of the uncertainties of State funds, she has built the reserves against the likelihood of more huge State cuts. She discussed the initiative taken to obtain the $175,000 in new grants, which has taken a toll due to the substantial added workload on existing staff. Ms. Westerman inquired whether other County departments are experiencing similar budget changes. It was explained that other departments had no cash and had different systems, but that departments have all contributed to the overall reductions but not fund balance returns. Ms. Baldwin and Ms. Shaw said they did not understand the rationale of why all departments were not being asked to make equally drastic adjustments or pay the same percent in overall costs to the county. • Ms. Shaw said that Public Health is being asked to turn over their reserves and to participate in budget cuts, as well. She also recalled that previous across the board cuts had been temporary for most departments but had continued for the Health Department. There was further discussion about the fact that the Health Department "gives back" about half of their General Fund income for rent and IT. Member Sullivan suggested that it would be well to take the view that the citizen is the highest priority and to strive for the optimal set of services that can be provided with the money available; the focus should not be on departments but on total services. He said that Public Health should present its critical services, of which there are many, and show how why these programs/services deserve priority. Ms. Westerman expressed her concern that employees who are asked to give more and more over the years will burn out and believes that impact can be detrimental to the citizenry. She said she hears the concern that some people are stepping up to the challenge of doing more with less, while others have not. She said that the BOCC is in a unique position to evaluate and respond to that effectively, while other BOH members do not have all necessary information or authority to do so. She added that the health of this community can be seen as a foundation for all other departments/services. • Page 8 of 10 f There was further discussion about the work and accomplishments of the Health Department during increasingly difficult circumstances. Ms. Baldwin expressed her disagreement with placing emphasis on 2015, and planning for surplus, in face of the current economic realities of citizens and unknowns of 2010-11. Member Sullivan explained that any consideration of future years out to 2015 is with the goal of maintaining services as long and as well as possible, not creating surplus. Member Sullivan advised Health Department administrators to provide their best information on the impact of planned cuts, noting that the final decisions had not yet been made. In closing, Ms. Baldwin drew an analogy with the Nurse Family Partnership program and its structure built on relationships. She said that departmental administrators and field staff need to know there is support from County authorities, just as mothers/babies must feel support from nurses, who in turn are supported by their supervisor. She added that she and Dr. Locke are trying to redesign Public Health in the face of the ongoing recession, and doing everything possible to prepare for a very different future. Member Sullivan said that there are ways in which the BOCC is showing its support for the Health Department. Member Russell said that he appreciated the difficulty of managing the County budget and noted that there are many other municipalities and counties going bankrupt during this economic crisis. Member Johnson noted that other departments are also feeling the pressure, and acknowledged the difficulty of the whole situation. Member Frissell said that it appears that there are some problems with the process and suggested that needs to be improvement in the system. She asked the BOH be made aware of County Budget processes in a • timely manner. Member Sullivan described the current process in which the BOCC, County Administrators and department heads strive for consensus. Member Austin noted that there is considerable misunderstanding about actual control over funding for services, about the discretion government officials have with regard to public monies, and also about how much is being asked of its government employees. He said he believes the hard work and commitment of County employees should be recognized and publicized. There was further discussion about the general economic climate and the difficulty of balancing all interests fairly. Dr. Locke expressed his concern about the "multiplier effect" and its impact on many health programs. For example, what are called Medicaid savings in the General Fund are only the State share of service; the federal dollars are 54% in addition to that; the State will be saving $8 million for adult dental care but will be giving up $17 million in services. He agreed that the most important consideration in budgeting is the impact on community health and the wellbeing of community members. Ms. Baldwin called attention to the fact that the existing staff is well trained and experienced. She said she is very concerned that small counties like Jefferson as they shrink, will not be able to maintain the total expertise required. She said she believes that there is a critical mass of expertise that must be maintained, even if that means "buying" it from neighboring counties. She said it is necessary to maintain a certain level of infrastructure. There was agreement that there is a tipping point that should not be crossed. 4110 Page 9 of 10 4 Substance Abuse Advisory Board Nominations Member Austin briefly described three SAAB nominees who had been interviewed by Fran • Joswick, Julia Danskin and himself: Colman Riddle is a high school student who is expected to be helpful to the SAAB in understanding and communicating with the youth of the community. Member Austin moved that the BOH appoint Arnie Danberg, Coleman Riddle and Michael Phimister to the Substance Abuse Advisory Board. The motion was seconded by Member Sullivan and approved unanimously. SAAB Chair Frances Joswick confirmed that the SAAB is now at full complement with 14 members. ACTIVITY UPDATE There were no updates. AGENDA PLANNING CALENDAR The next scheduled BOH meeting will be held December 16, 2010 from 2:30 to 4:30 PM at the Department of Public Health, 615 Sheridan Street, Port Townsend, WA. ADJOURNMENT • Chair Russell adjourned the BOH meeting at 4:25 PM. JEFFERSON COUNTY BOARD OF HEALTH Chuck Russell, Chair Phil Johnson, Member Excused Kristen Nelson, Vice-Chair John Austin, Member Roberta Frissell, Member David Sullivan, Member Sheila Westerman • Page 10 of 10 JEFFERSON COUNTY BOARD OF HEALTH • MINUTE S Thursday, October 21, 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,MPH 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 Roberta Frissell,citizen at large(County) Stuart Whitford, Environmental Health Services Director Kristen Nelson, Vice Chair,Port Townsend City Council Sheila Westerman, Citizen at large(City) Chuck Russell, Chair,Hospital Commissioner, District#2 Chair Chuck Russell called the meeting of the Jefferson County Board of Health to order at 2:30 PM. A quorum was present. Members Present: John Austin, Roberta Frissell, Chuck Russell, David Sullivan, Sheila Westerman, Phil Johnson Members Excused: Kristin Nelson Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin, Stuart Whitford, Veronica Shaw Substance Abuse Board: Frances Joswick, SAAB APPROVAL OF AGENDA Member Austin moved and Member Frissell seconded for approval of the agenda. The agenda was approved unanimously, as written. APPROVAL OF MINUTES Member Austin moved for approval of the September 16, 2010 BOH meeting minutes, as written; Member Westerman seconded. The minutes of September 16, 2010 were approved unanimously, as written. PUBLIC COMMENTS Chair Russell, speaking as a member of the public, noted that Rotary Club raffle tickets are available for purchase. • Page 1 of 10 Mr. Tom Brotherton said he wished to comment on tobacco use in Jefferson County; he distributed a handout. He referred to tobacco use information found on the Health Department's • website. He said that, despite the stated objectives and list of priorities found there, the trends reported by the State for certain segments of the Jefferson County population were not good. He pointed out a number of statistics of particular concern and inquired what strategy would be followed to reverse the negative trends. Siri Kushner, epidemiologist, pointed out the overlapping confidence intervals on the Adult trend chart to which Mr. Brotherton had referred, noting that the 2007 to 2008 change is not statistically significant. Ms. Baldwin added that the Jefferson Health Department does not use these types of charts because they are easily misinterpreted. However, she and Ms. Danskin acknowledged the seriousness of the smoking problem and expressed their appreciation to Mr. Brotherton for bringing this to the attention of the Board of Health. They suggested that Ms. Kushner and the Tobacco Prevention Coordinator, Karen Obermeyer, be invited to a future meeting to address these issues in more detail. OLD BUSINESS and INFORMATIONAL ITEMS Region 2 Public Health Community Liaison Summary Dr. Locke noted that this regional project that had been operational for several years. A one page summary is included in the packet. This is a successful regional program in which public health nurses visit medical and veterinary clinics to provide up-to-date information about all notifiable • conditions and public health programs, as well as answer any questions from practitioners. Feedback from clinicians has been very positive. SmileMobile coming to Chimacum,November 8-12, 2010 A copy of the informational flier is included in the packet. School Based Health Center Work Group Jean Baldwin referred to a series of articles in the September issue of the Journal of Public Health on school-based clinics disease prevention. A working group including Dr. Locke, Siri Kushner and practitioners are assessing data collection at the school based clinics to determine whether data collection and services are on the right track. She said that Jefferson Mental Health, instead of the Kitsap agency, is now providing services to adolescents in Chimacum, Quilcene and Port Townsend Schools; funding is from the 1/10th of 1 per cent source. Wendy White has retired and has been succeeded by a new nurse practitioner. The new team is up and running. Status reports will be given later in the school year. Copies of the journal articles are available. • Page 2 of 10 NEW BUSINESS • Nurse Family Partnership Reports: Local Data, Foundation of Lifelong Health Essential Findings Report,Washington State Adverse Childhood Experiences Report Quen Zorrah presented a report from the Family Health support team. In the 1990s the BOH directed that all pregnant women should be screened at least once in pregnancy for substance abuse and domestic violence. In 2009,they received a grant from Women Who Care to design a local assessment for pregnant women,which was expanded to include all care givers of young children. Nurse Family Partnership was started in the County in 1999 because of high rates of referrals for child abuse, i.e. 50%higher than the State rate. She said this was the beginning of basing JCPH services on evidence based practice or science. Also, since this time brain research has been growing exponentially. Much more is now understood about the impact of early development and how early experiences influence the expression of genetic material. Ms. Zorrah reviewed the Adverse Childhood Experiences(ACE) study done at Kaiser Permanente with a population of 16,000. A lengthy questionnaire dealt with 10 different categories of possible childhood adverse experiences. The study showed that the higher the ACE scores, the more likely a person is to have a variety of chronic diseases as an adult. They looked at physical, mental and behavioral processes linked to the ACE score. For every rise in one's ACE score,there is a higher risk for having these issues. JCPH team is looking at health as the whole range of signs/conditions/behaviors, e.g. blood pressure, smoking, diabetes, drug use, depression, domestic violence etc. One's ACE score can reflect one's health throughout one's • lifetime. A copy of the ACE short form was included in the packet. Ms. Zorrah said that since researchers had not previously collaborated in this way, her team used the valuable data on fostering better outcomes from Nurse Family Partnership and the ACE study to develop an assessment tool. The team has expanded the program so that its top priority is to prevent"ACEs". In addition to reducing the risk of chronic disease, it is a powerful clinical intervention to teach individuals about the ACE study and to help them understand their own ACE score. The assessment questionnaire is offered on intake and to the various Family support programs, meaning that the data is from a range of different people who are all caregivers of young children. Siri Kushner,epidemiologist, then presented some of the data derived from the questionnaire: •67 persons seen in the Family Support Program at JCPH completed the questionnaire between September 2009 and June 2010. •The average age was age 26, ranging from 18 to 62. • 16%were male and 84% were female. •Almost half were unemployed or unable to work. •63%reported household incomes of less than $10,000. •Average household size was 3 people. Ms. Zorrah noted that teen pregnancies are fortunately very low at this time. Jefferson County • has seen a declining rate for the last ten years. Page 3 of 10 •About half of individuals under age 25 reported having less than a high school education; 46 % have completed high school or have earned a GED; 6%have completed an Associate degree or • vocational training. •Of those over age 25, about half have some college and 19%have completed a 4 year college program. (The educational level of the mother greatly influences how well the child will do in learning and life.) •Just over half of the individuals (54%) reside in Port Townsend, and half elsewhere in the County. The questionnaire is rather lengthy (4 pages)and includes questions about substance use. •80%reported ever using alcohol at least once or twice Ms. Zorrah said that since it is difficult to obtain accurate data about current substance use, questions/answers about history of use provide clues as to the family environment. Some of that data regarding alcohol and other drugs such as un-prescribed pain and sleeping pills are concerning. Ms. Zorrah said that although few people still smoke in their homes, they often smoke outside or in their cars. She said that the health risks of smoking, especially second hand smoke, are stressed, and that the Nurse Family Partnership has reduced tobacco use throughout the pregnancy by 33%. •2/3 of people reported ever using tobacco at least once or twice. 31%report current daily or almost daily use in the past three months •41%reported a feeling of hopelessness some of the time within the last 30 days • •Almost 30%reported feeling very irritable within the last 30 days •Almost 25% said they needed or had been told to get help with emotional problems •21%had spells or attacks of anxiety, fright or uneasiness •18%reported nightmares or flashbacks • 17%reported being depressed, having lost interest or pleasure,trouble concentrating etc • 11%reported they felt they were not the parent they wished to be •5%reported having given into an aggressive urge or impulse Ms. Zorrah again stressed the seriousness of these findings given that these people are either pregnant women or caregivers of young children. She said these are frightening statistics considering what is known about the quadrupling of shaken baby syndrome and the increase of head trauma in our state. •About 2 in 5 report ever having received a diagnosis of mental illness •Of those, 81%report a diagnosis of depression; about half, anxiety; and 'A bipolar diagnosis (Member Austin also noted that 8%reported borderline personalities) Ms. Zorrah added that it was also concerning that much of this population has never been able to access mental health services. She said the combination of diagnosis, history and current symptoms is a rather frightening picture. • Page 4 of 10 t •About 2 in 5 reported that they had ever lived with a step parent • •40% said they had ever lived with friends •Almost 30%reported they had lived with other family •About 25%had ever run away from home •Almost 1 in 5 had ever had interaction with CPS (Child Protective Services) • 12%had ever lived in foster care Ms. Baldwin said that one bright spot is that this population is getting services and that the department is serving the right people. •Of the clients who completed the ACE questionnaire, 15%reported no"ACEs"; Almost 30%reported "1"; the average score was "3"; the median was"2". (The highest possible score was "10". •If we compare the family history questions to the ACE score,the ACE score was 2 points higher among those who reported having ever lived in foster care, or with friends or other family's homes. •ACE scores for those ever diagnosed with mental illness are significantly higher than ACE scores for those without a mental illness diagnosis. Half of those ever diagnosed had a score of 4 or more. Ms. Kushner referred to the recently released Washington State Family Policy Council report. It reports on a state-wide BRFSS survey that included the ten ACE questions, comparing their data • with the Kaiser Permanente 15 year ACE study. There are differences in the survey methods: the BRFSS study uses a telephone interview survey, and the Zorrah data is directly self- administered, with the client on site with the practitioner. The populations also differ in several ways including age, education and gender distribution. ACEs questions are a grouped into categories of abuse and household dysfunction. There are some notable differences between the Jefferson County group and other populations. Full details are available from the report. Fran Joswick inquired, of the ten issues, which had the highest reported incidence. Ms. Kushner responded: 75%reported that their parents were separated or divorced; 38%reported that they lived with someone who was a problem drinker, alcoholic, or used street drugs; 27%reported living with someone who often swore at them or insulted them. In response to another question, staff said that there are about 120 families served each year. Quen Zorrah said that staff is grateful for the funding that allowed this study. She introduced each of the nurses who participated in this study: Yuko Umeda, Mary Jo Mackenzie and Denis Langlois. Ms. Zorrah stressed that Nurse Family Partnership and ACEs fit extremely well together. Children who perceive their parents failed to take care of them and protect them; can develop coping strategies that are harmful to themselves or their children. Nurse Family Partnerships, which is based on relationships, is very powerful in this context. "We are using these therapeutic relationships to help heal and prevent health problems. And now that we are doing this assessment and asking people to do the ACE questionnaire,they are starting to understand for • themselves the impact that their own ACEs have had on their lives." She said they are finding Page 5 of 10 that their lives now make sense to them and that this motivates them to prevent this from happening to their children. • Ms. Zorrah said that there is great interest from the hospital and physicians to extend this study. She hopes that the ACE questions will become part of routine health histories and assessments used by health care providers. Member Austin inquired whether this information has been communicated to the State legislature and other funding bodies. Ms. Zorrah said that she had shared the process with other counties and agencies. There was a brief discussion about the dollars that can be saved with this program; Ms. Zorrah said research shows the minimum is about$5 for every dollar invested. Ms. Baldwin added that both the Rand Corporation and the Washington State Institute of Public Policy research named Nurse Family Partnership (NFP) as the most cost saving program. There was additional discussion about the Jefferson SAAB study of costs attributed to substance abuse, and the potential savings from NFP. Member Sullivan inquired what Proposition No. 1 and liquor tax elimination would mean to this program. Ms. Baldwin said that there would be a loss of$96,000 to Maternity Support. There are potential impacts over the next three to six months for which all details are not yet known. She said that the BOH would need to be involved in a series of related policy decisions. She mentioned other DSHS pharmaceutical cuts that would ripple through to other services, as well. Baldwin said a short version of this presentation was given to City Council last week, which was well-received and generated many questions. Ms. Westerman said that she believes it is important to communicate the proportion of services that are provided to City residents. • Pre-adoption Briefing and Call for Public Hearing(12/16/10) on Board of Health Fee Schedule for 2011 Stuart Whitford referred to the proposed 2011 Fee Schedule in the packet. He noted that there was no COLA this year, and thus no across the board increases. He highlighted changes under Food Services. Fees are now broken out based on menu complexity, as well as seating, because there are greater inspection costs for greater complexity. Mobile units are also differentiated by menu complexity. He said that late fees have been eliminated; an establishment will be closed until renewal fees are paid. There is a new fee to cover the cost of pre-inspection for newly opening restaurants. There is also a re-opening fee to cover costs for those establishments previously closed for health or other reasons. He also introduced food inspectors, Dana Fickeisen and Mina Kwansa. Ms. Kwansa is a new inspector who holds a Masters degree in Public Health and has completed an internship at Benton County, Oregon. In response to a question about the Food Handler's card, Ms. Baldwin explained that the fee for a duplicate is the same as for a new card, $10.00; previously, it was $5.00. Ms. Baldwin also pointed out the additional $73 per lot for Boundary line adjustment review, which had been inadvertently omitted in the 2010 schedule. In general, the intent was to make the schedule simple, clear and more readable for everyone. • Page 6 of 10 Mr. Whitford also explained a recommended change under Water. For rain water catchment . systems,now allowed by Ecology, a$65 per hour fee is proposed to cover time needed beyond the 1.5 hour base fee of$98 for Determination of Adequate Water Supply. To date, there have been few instances of these systems, although more are expected in the future. Member Johnson inquired about definitions for"limited menu"and"complex menu". Ms. Baldwin said that the Standard Operating Procedures contain definitions. She said that the categorization is also based on risk; the more complex a process the more risk and therefore the more points of review. Ms. Baldwin also noted that the fee schedule itself does not mention all conditions, such as off site uses of commercial restaurants. Member Sullivan moved that the Fee Schedule Hearing be set for December 16, 2010; Member Frissell seconded the motion,which was unanimously approved. National Health Care Reform: Orientation to the Affordable Care Act of 2010 Dr. Locke pointed out the Highlights of Community Benefit/Hospital Needs Assessment in the packet; he said this topic had been discussed with the new CEO of the hospital earlier in the day. One of the provisions of the Affordable Care Act is that all not-for-profit hospitals must do community needs assessments at three year intervals, at minimum. This document outlines the elements of needs assessments. Dr. Locke said this will overlap with activities that our health jurisdiction has been doing. • Ms. Baldwin noted that, under Home visitation programs,Nurse Family Partnership has some national funding, but that the State must apply/qualify for it. Washington State has applied but funding is based on risk and size, so Jefferson County may not qualify. Member Sullivan suggested that various entities, including OlyCap, could collaborate on risk assessment. Member Russell noted that much remains to be defined with national health care reform, including"meaningful use". Data Steering Committee Update Ms. Baldwin referred to packet materials and noted that a list of attendees of the previous meeting had been included per Member Westerman's request. The next meeting is scheduled for Thursday, October 28 at 3:00 PM. State and County Budget Updates Jean Baldwin explained that the packet inserts are a just few of the letters and bulletins from the State regarding budget items. She said that the 6.3 %Health Care Authority decrease will be reflected in a variety of ways across many programs. Questions of timing and reduction amounts • Page 7of10 are still uncertain. Maternity Support and Family Planning have already lost about 40% over two years. • Veronica Shaw referred to the presentation on Nurse Family Partnership earlier in the meeting, noting past support from the BOH. She distributed a spreadsheet, County General Fund Trend, covering years 1994 through 2010, which summarizes transfers between the General Fund and Public Health. She also reviewed the BOH presentation she had made last year regarding the 2009 Public Health Department budget and recalling the County general fund (CGF) decrease of $157,000. In 2010,there was an additional CGF decrease of about $108,000 with another $50,000 more expected in the 2010 budget cycle. Ms. Baldwin said that these cash reserves are carry over funds that have been made possible by good management, by seeking out new funding sources, and by constraining staff salaries, etc. Ms. Shaw added that because of the uncertainties of State funds, she has built the reserves against the likelihood of more huge State cuts. She discussed the initiative taken to obtain the $175,000 in new grants, which has taken a toll due to the substantial added workload on existing staff. Ms. Westerman inquired whether other County departments are experiencing similar budget changes. It was explained that other departments had no cash and had different systems, but that departments have all contributed to the overall reductions but not fund balance returns. Ms. Baldwin and Ms. Shaw said they did not understand the rationale of why all departments were not being asked to make equally drastic adjustments or pay the same percent in overall costs to the county. • Ms. Shaw said that Public Health is being asked to turn over their reserves and to participate in budget cuts, as well. She also recalled that previous across the board cuts had been temporary for most departments but had continued for the Health Department. There was further discussion about the fact that the Health Department"gives back" about half of their General Fund income for rent and IT. Member Sullivan suggested that it would be well to take the view that the citizen is the highest priority and to strive for the optimal set of services that can be provided with the money available; the focus should not be on departments but on total services. He said that Public Health should present its critical services, of which there are many, and show how why these programs/services deserve priority. Ms. Westerman expressed her concern that employees who are asked to give more and more over the years will burn out and believes that impact can be detrimental to the citizenry. She said she hears the concern that some people are stepping up to the challenge of doing more with less, while others have not. She said that the BOCC is in a unique position to evaluate and respond to that effectively, while other BOH members do not have all necessary information or authority to do so. She added that the health of this community can be seen as a foundation for all other departments/services. i Page 8 of 10 • It There was further discussion about the work and accomplishments of the Health Department • during increasingly difficult circumstances. Ms. Baldwin expressed her disagreement with placing emphasis on 2015, and planning for surplus, in face of the current economic realities of citizens and unknowns of 2010-11. Member Sullivan explained that any consideration of future years out to 2015 is with the goal of maintaining services as long and as well as possible, not creating surplus. Member Sullivan advised Health Department administrators to provide their best information on the impact of planned cuts, noting that the final decisions had not yet been made. In closing, Ms. Baldwin drew an analogy with the Nurse Family Partnership program and its structure built on relationships. She said that departmental administrators and field staff need to know there is support from County authorities, just as mothers/babies must feel support from nurses, who in turn are supported by their supervisor. She added that she and Dr. Locke are trying to redesign Public Health in the face of the ongoing recession, and doing everything possible to prepare for a very different future. Member Sullivan said that there are ways in which the BOCC is showing its support for the Health Department. Member Russell said that he appreciated the difficulty of managing the County budget and noted that there are many other municipalities and counties going bankrupt during this economic crisis. Member Johnson noted that other departments are also feeling the pressure, and acknowledged the difficulty of the whole situation. Member Frissell said that it appears that there are some problems with the process and suggested that needs to be improvement in the system. She asked the BOH be made aware of County Budget processes in a 110 timely manner. Member Sullivan described the current process in which the BOCC, County Administrators and department heads strive for consensus. Member Austin noted that there is considerable misunderstanding about actual control over funding for services, about the discretion government officials have with regard to public monies, and also about how much is being asked of its government employees. He said he believes the hard work and commitment of County employees should be recognized and publicized. There was further discussion about the general economic climate and the difficulty of balancing all interests fairly. Dr. Locke expressed his concern about the "multiplier effect" and its impact on many health programs. For example, what are called Medicaid savings in the General Fund are only the State share of service; the federal dollars are 54% in addition to that; the State will be saving $8 million for adult dental care but will be giving up $17 million in services. He agreed that the most important consideration in budgeting is the impact on community health and the wellbeing of community members. Ms. Baldwin called attention to the fact that the existing staff is well trained and experienced. She said she is very concerned that small counties like Jefferson as they shrink, will not be able to maintain the total expertise required. She said she believes that there is a critical mass of expertise that must be maintained, even if that means"buying" it from neighboring counties. She said it is necessary to maintain a certain level of infrastructure. There was agreement that there is a tipping point that should not be crossed. • Page 9 of 10 Substance Abuse Advisory Board Nominations Member Austin briefly described three SAAB nominees who had been interviewed by Fran • Joswick, Julia Danskin and himself: Colman Riddle is a high school student who is expected to be helpful to the SAAB in understanding and communicating with the youth of the community. Member Austin moved that the BOH appoint Arnie Danberg, Coleman Riddle and Michael Phimister to the Substance Abuse Advisory Board. The motion was seconded by Member Sullivan and approved unanimously. SAAB Chair Frances Joswick confirmed that the SAAB is now at full complement with 14 members. ACTIVITY UPDATE There were no updates. AGENDA PLANNING CALENDAR The next scheduled BOH meeting will be held December 16, 2010 from 2:30 to 4:30 PM at the Department of Public Health, 615 Sheridan Street, Port Townsend, WA. ADJOURNMENT • Chair Russell adjourned the BOH meeting at 4:25 PM. JEFFE' :9 N COUN BOAR I OF HEALTH 4 , id eirP4' Chuck Russell, Chair Phil Jo nso , ember Excused 1 Kristen Nelson,Vice-Chair Jo Austin, em•er ih� Roberta Frissell, Member Davi &iv , Member W,6LA tt,) 4(A/ Sheila Westerman • Page 10 of 10 • Board of 3-feaCth OCd Business & Informational ltemB .agenda Item # .1'V, 1. • Oaimaaum ,8`miCeMo6ile Event R.eporti December 16, 2010 • v' • • S rz JEFFERSON OUNTY PUBLIC HEALTH 615 Sheridan Street • Port Townsend •Washington • 98368 • www.jeffersoncountypublichealth.org December 6, 2010 Chimacum SmileMobile report The Washington Dental Foundation SmileMobile came to Chimicum High School parking lot November 8 - November 12, 2010. Jefferson County Public Health (JCPH) did outreach and provided the appointment scheduling through the WIC Clerk. Chimacum School Based Health Clinic provided referrals to the clinic. JCPH Oral Health Coordinator provided services along with the SmileMobile staff and assisted with follow-up of children needing further services. The SmileMobile staff - examined 54 children - 90 treatment encounters, - 8 referrals due to rampant decay - provided three and a half treatment days • • COMMUNITY HEALTH LNVIIiONMENTAL HEALTH DEVELOPMENTAL DISABILITIESPUBLIC HEALTH WATER QUALITY MAIN: (360) .4.1.1)1YS r =` A40 MAIN: (360) 385-9444 FAX: (360) 385-9401 HEALTHIER CO ' FAX: (360) 379-4487 The Washington Dental Service Foundation SmileMobile 0 „,,a),,,w ,,4\iir-- \ ,,, s- ,:,A," r, , ‘k,v • The SmileMobile is a modern dental office on wheels that -, brings oral health services to children who have no other zJ 1 1111 options for dental care; the SmileMobile has traveled across the state since July 1995. • The SmileMobile, on average,treats 6o children each week. • Working in three dental operatories, a full-time dentist and local volunteer dentists and their staff are providing a range of services, from examinations and preventive services to fillings and minor oral surgery. Children with serious dental problems are referred for appropriate care. • Medicaid coupons are accepted, and a sliding fee scale based on family income is used for those who are not eligible for Medicaid. Crisis in oral health care • Dental decay is the single most common chronic disease of early childhood, 5 times more than asthma. • Nearly 6o% of elementary school children in Washington have had dental decay. III Our two-year olds are more than twice as likely as children nation-wide to have dental decay. • Dental neglect can lead to oral pain, recurring infections,badly decayed and lost teeth, eating disorders, undetected oral cancers and low self-esteem. The SmileMobile partnership • The SmileMobile, which began operating in 1995, is a partnership between Washington Dental Service Foundation and Seattle Children's Hospital. Since it first hit the road, the mobile clinic has treated more that 25,000 children throughout the state. • Coalitions of local health departments, community organizations and state agencies are providing volunteer coordination and support services. • Washington Dental Service Foundation is the state's largest foundation committed to improving oral health. Supported by its parent organization, Washington Dental Service,Washington Dental Service Foundation supports innovative oral health programs focused on preventing oral disease, expanding access to dental care and increasing awareness of the importance of oral health. For more information, contact MONIKA FORO,SmileMobile Clinic Manager at Washington Dental Service Foundation(WDSF)(206)517-6303 or(800)572-7835 ext 6303 or KARRI AMUNDSON, Program Coordinator at(206)528.7373 or(80o)572-7835 ext 7339 Ill Board of 3-CeaCth Old Business & Informational Items Agenda Item # 1`V., 2 • Executive Order 10-06 Suspending Non-CriticalRuCe Development & .adoption December iq;) Zoio • • November 16, 2010 TO: Agency Directors Statewide Elected Officials Presidents of Higher Education Institutions Boards and Commissions FROM: Kari Burrell rOgr Director SUBJECT: IMPLEMENTATION OF EXECUTIVE O' 1 z 1 -, 6, SUSPENDING NON-CRITICAL RULE DEVELOPMENT AND ADOPTION Our country and our state are in the worst recession in 80 years. Small businesses are struggling. State and local governments have experienced severe revenue losses which have led to significant budget cuts. Both small businesses and governments benefit from having a stable and • predictable regulatory environment in these difficult times. Governor Chris Gregoire's Executive Order 10-06 directs state agencies to suspend development and adoption of rules for the next 12 months. The Governor is directing agencies to suspend rule making that is not immediately necessary. She recognizes, however, that agencies should not suspend all rule making, as rule making is an essential government operations tool. She has asked the Office of Financial Management to provide guidance as to circumstances in which rule making should proceed. This Executive Order applies to all cabinet agencies and boards, commissions and other agencies that report to the Governor. All other elected officials, institutions of higher education, agencies, boards, commissions and other entities with rule making authority are invited to follow the requirements of the Executive Order and these guidelines. This memorandum provides guidelines for agencies to use when determining whether rule making should proceed: Guidelines 1. Agencies shall review all rules in progress and their proposed rule making agenda for next year and identify those rules that can be suspended until after December 31, 2011. 2. In determining whether a rule should be suspended, agencies shall recognize the benefits of a stable regulatory environment. Where possible, agencies should redirect scarce resources away from rule making to front-line service delivery, including implementing and enforcing existing rules. • 3. Rule making proceedings are non-critical unless the rule is: • a. required by federal or state law or required to maintain federally delegated or authorized programs; b. required by court order; c. necessary to manage budget shortfalls, maintain fund solvency, or for revenue generating activities; d. necessary to protect public health, safety, and welfare or necessary to avoid an immediate threat to the state's natural resources; or e. beneficial to or requested or supported by the regulated entities, local governments or small businesses that it affects. 4. If an agency decides to proceed with a rule that has a small business impact or an impact to local government, the agency must consult with small businesses and/or governments on how the impact can be mitigated. 5. Agencies may continue to adopt rules that have been the subject of negotiated rule making or pilot rule making that involved substantial participation by interested parties before the development of the proposed rule. Agencies can also proceed to finalize permanent rule making that has previously been covered by emergency rules. • 6. Agencies may continue to adopt expedited rules under RCW 34.05.353 where the proposed rules relate only to internal governmental operations. 7. Each agency shall report by January 31, 2012 the number of rules eliminated or suspended in response to this order as well as the number of and justification for rules that proceeded through development and/or adoption. • • Board of 31- ealth Odd Business & Informational Items Agenda Item # IV., 3 • Z'o6acco Use in Jefferson County December 16, 2010 Jefferson County has made significant progress in reducing tobacco use among adults, preventing youth from starting 111 smoking and reducing exposure to secondhand smoke. Jefferson County Annual Trend in Current Adult Cigarette Use' 30.0% • Rates vary year to year due to 19.9% small survey 20.0% �►•..�, samples 14.1% • Annual trend from 2003 to 10.0% 2009 is unchanged • 2008 was quite 0.0% different from 2003 2004 2005 2006 2007 2008 2009 other years Adult Past 30 Day Tobacco Use2'3 Youth (10th grade) Past 30 Day Tobacco Use4'5'6 2001 a 200709JC/09WA&US i. 2002HYS/01YRBS(US) 2008HYS/09YRBS(US) 23 21 1 22 22 18 20 16 19 15 18 20 "1 14 13 14 C III !I 10 - /010 1 III 1 0 , 1i 1 _ , 0 ,_ Jefferson WA State United States i Jefferson WA State United States County I County • Approximately 4,500 Jefferson adults(2009)and approximately 30 Jefferson 10th graders(2008) Smoking Prohibited Inside the Home2 Quit Line Calls from Jefferson residents) ■Jefferson County a#calls 95 143 100 - 79 85 150 110 75 100 ' 67 % 50 3 50 25 0 0 0 ;. 2001 2003-05 2007-09 1999 2007 2008 2009 Despite this, tobacco use is still too high. Tobacco use causes preventable deaths and disease in our community. • Smoking causes about 90%of lung cancer deaths'-that's about 30 Jefferson resident deaths per year.8 • Tobacco use is linked to at least 15 types of cancers,stomach ulcers, and is a major cause of heart disease, IIIcerebrovascular disease,chronic bronchitis,and emphysema.6 Tobacco use costs our community money. • State and federal tax money is used to cover tobacco-related health care costs.9 • Tobacco use contributes to lost productivity among workers.8 Jefferson County Public Health,December 2010 Tobacco use in Jefferson County is higher among the following groups: • Younger Adults: the average age of current smokers is 40 while the average age of nonsmokers is 57.2 • • Low-Income pregnant women:32%of women on Medicaid vs. 18%of women not on Medicaid.'° • Low-Education:36%of adults with high school or less vs.8%of adults with at least 4 years of college.2 The Tobacco Program saves Jefferson County lives and money. We help the community protect kids. • We expand our reach by teaching multiple organizations how to educate clients and employees about the risks of secondhand smoke. Including Head Start and ECAP • We prevent kids from starting to use tobacco by teaching them how to resist the many forces that promote its use. • We educate retailers and do compliance checks to ensure they follow sales to minors law. In 2010 we did 45 compliance checks;83%of Jefferson County tobacco retailers we checked were compliant.11 We increase awareness of and accessibility to resources that help people quit using tobacco products. • We expand our reach by training multiple organizations and healthcare providers to systematically screen and refer clients for quitting help. • We ensure that we are reaching vulnerable populations by partnering with Head Start,WIC, Nurse Family Partnership,Work Source, healthcare providers,child birth educators,food banks. We protect Jefferson citizens from secondhand smoke. • We educate organizations about the Smoking in Public Places Law and investigate all complaints. • We work with multiple organizations to increase the number of smoke free environments,such as smoke- • free rental housing. • Smoke-free communities have an average 26%decline in heart attacks compared to those places that still allow smoking in public places.22 What might happen if the Tobacco Program funding was reduced? • Shortly after Oregon reduced their tobacco control funding in FY03,declines in cigarette consumption stopped and in fact, by FY06,cigarette consumption increased.23 Annual Per Capita Cigarette Consumption Oregon vs.US,1993 to 2008 100• 03 __. 022 92.1 —..—US U 4 342 993 BB.e Bfl:C 966 116 s0- 92.2 75.9 75.1 71 561 70. Oregon Tobacco 71.3 e17 a.a Prevention 67.6 60.7 1. 60. Program started 657 sem a Se a �``^`� 56.1 Nj 595 �t • A. s0 :•N 9 52.8 54.1 Si 9 • • • Oregon Tolalt•0. R...aJ 40. Prevention Program cut Oregon Tobacco over 509E Prevention . Program funding• reinstated 10 , FY93 FY54 FY95 r 4 FY07 FY00 Few FY00 FY01 FY00 FY03 FY0# rem FY05 FY07 FY08 Focal Year Jefferson County Public Health,December 2010 Page 2 1 Washington State Dept.of Health,Tobacco Prevention and Control Assessment and Evaluation,7/23/2010 'Jefferson Co.2001 and 2007-9 and Washington State 2001 and 2009: Washington State DOH,Center for Health Statistics,Behavioral Risk Factor Surveillance System(BRFSS),supported in part by Centers for Disease Control and Prevention:analyzed by Kitsap Co.Health District. 3 United States 2001:http://apps.nccd.cdc.gov/BRFSS/2009:http://apps.nccd.cdc.gov/BRFSS/display.asp?cat=TU&yr=2009&qkey=4396&state=UB • `Jefferson County Healthy Youth Survey,2002 and 2008:analyzed by Kitsap County Health District. 'Washington State Healthy Youth Survey,2002 and 2008:http://www.doh.wa.gov/healthyyouth/reports/default.htm 6 United States 2001:http://apps.nccd.cdc.gov/yrbss;2009: http://www.cdc.gov/mmwr/pdf/ss/ss5905.pdf http://www.cancer.org/downloads/PRO/Tobacco.pdf WA Dept.of Health,Center for Health Statistics,Death Certificates 2007-2009,local analysis of contributing causes of death ICD10 C33-34.9 9 Campaign for Tobacco Free Kids,Toll of Tobacco in the United States of America,January 26,2010 1°Department of Social and Health Services,Research and Data Analysis,First Steps Database(12/2009) 11 Washington State Dept.of Health,Synar Compliance Check Database Tobacco Program and Jefferson County Public Health non-Synar checks 12 October 2009 Institute of Medicine Report:Secondhand Smoke Exposure and Cardiovascular Effects:Making Sense of the Evidence 13 Oregon Tobacco Facts&Laws,April 2009. Available at:http://www.oregon.gov/DHS/ph/tobacco/docs/facts09.pdf • Jefferson County Public Health,December 2010 Page 3 Board of Cealt( Netiv Business .agenda Item # V., 1 • Public 3-fearing: 4fqs\--' EnvironmentalFee RevisiAs 2011 December 16, 2010 4 I 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. •ction 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. • 1 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 • 2 JEFFERSON COUNTY PUBLIC HEALTH ENVIRONMENTAL HEALTH DIVISION • ENVIRONMENTAL HEALTH 2011 FEES Additional Fees and Other GENERAL 1 Information Health Officer Administrative Hearing 287.00 Administrative Hearing Appeal 287.00 Technical Assistance/Plan Review- Minimum Technical Assistance/Plan Review- Per Hour 65.00 65.00 Filing Fee ONSITE SEWAGE DISPOSAL 49.00 Sewage Disposal Permits New Conventional 520.00 Valid for 3 years New Alternative 620.00 Valid for 3 years New septic tank and/or pump chamber only 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 Plus $82 per connection valid for 3 yrs New Commercial >1000 G.P.D. Conventional �a 620.00 Valid for 3 years Alternative 663.00 Valid for 3 years Repair/Upgrade/Modification/Designate Reserve Area Applies to existing installed sewage disposal 115.00 system Expansion 387.00 Redesign 115.00 Applies to pending or active but not installed Reinspection 144.00 Eviika tion of Existing System/Monitoring Inspection otic system only 287.00 Septic system plus water sample 298.00 Retest/Reinspection 100.00 On Site Sewage OnSite-Site Plan Advanced Approval Determination (SPAAD) 287.00 Septic Permit with SPAAD (conventional) 280.00 Septic Permit with SPAAD (alternative) 388.00 Subdivision Review Base Fee 372.00 Plus $73.00 Per Lot Boundary line adjustment review fee 146.00 Plus $73.00 Per Lot Pre application meeting fee 146.00 Planned rural residential development review fee 146.00 Density exemption review fee 73.00 Density exemption review fee requiring field work 146.00 Other Waiver/Variance Application 172.00 Waiver/Variance Hearing 287.00 Wet season evaluation 387.00 Revised building application review fee 146.00 New building application review fee: Residential 73.00 Commercial 146.00 /bral environmental health review fee Licenses 73.00 Installer, Pumper, Operator(maintenance person) 387.00 3 • Retest 158.00 Annual Renewal 273.00 Delinquent Renewal after January 31 387.00 FOOD SERVICE ESTABLISHMENT FEES PERMIT FEES (Annual Permi() Immediate Consumption 136.00 Limited Non-Complex 174.00 Restaurants/Take-Out (Based on menu complexity & seating - menu changes may change category) 0-25 seats (Limited Menu) 174.00 No cooling or reheating 0-25 seats (Complex Menu) 310.00 Cooling and reheating allowed 26-50 seats 310.00 51-100 seats 372.00 101-150 seats 422.00 With Lounge, add 136.00 Separate lounge area Not for Immediate Consumption Limited 136.00 Non-Complex 174.00 422.00 Complex 136.00 Bakery Business 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 174.00 • Grocery 1-3 checkouts 136.00 May serve pre-packaged baked goods >3 checkouts 422.00 Meat/Fish Market 310.00 Mobile Unit 174.00 No cooling or reheating Limited Menu Complex Menu 310.00 Cooling & reheating allowed School Cafeteria Central Kitchen 310.00 Warming Kitchen 174.00 Tavern w/food (see Restaurants) fee 50% of Annual Permit Feef o Annual Permit Issued after September 1 50% No Fee-Close establishment if permit isn't Late Fee (Paid after January 31) Eliminate renewedNo Fee-Close establishment if permit isn't Late Fee (Paid after February 28) Eliminate renewed Temporary Permit- One permit per venue 130.00 Cooking & assembling potentially hazardous fooc Complex 98.00 Low risk foods w/minimal preparation Limited +50% of fee Additional (Paid when application is subm Late Fee for Temporary Permits less than 7 days prior to the event) 4 Other Food Fees Waiver 37.00 Plan Review re-opening inspection 65.00 Per Hour nimum 65.00 Per Hour 65.00 Reinspection First Inspection 87.00 Each inspection after first 149.00 Reopening Fee 65.00 Per Hour Food Handler Card 10.00 Reissue Unexpired Food Handler Card 10.00 Manager's Course 211.00 SOLID WASTE Landfills requiring environmental monitoring 508.00 Inert Landfills 322.00 Biosolid Utilization 446.00 Other Solid Waste Facility Permits 322.00 Drop Boxes 149.00 New Facility Application 409.00 Plan Review 65.00 Per Hour WATER Inspection of well construction, decommission & Application Fee 149.00 reconstruction Determination of Adequate Water Supply 62.00 Building Permit Process ell Site Inspection-Proposed public water supply 298.00 'Nater Sample Bottles LIVING ENVIRONMENTS (Annual Permit) Pool 273.00 Spa 273.00 Pool/Spa Combined 372.00 Plan Review 65.00 Per Hour Indoor Air(Tobacco) Compliance Enforcement 65.00 Per Hour Reinspection 73.00 Rebuttal Application 146.00 s • Board of Health New Business .agenda Item #17., 2 Environmental3-fealth Policy Revisions: • Food Safety Program December 16, 2010 • JFFFERSON COUNTY BOARD F HEALTH • Department: Division: Section of Procedure Manual: Jefferson County Public Health Environmental Health Food Program Title: Food Establishment Inspection Frequency Subject: Inspection schedule requirements Effective (date): Replaces (date): Review due (date): Page: 1 of: 2 01/01/11 E.H. Policy Statement 01/01/13 Food Establishment Inspection Frequency Purpose: -WAC 246-215 (Working document section 8-401.10 - B 2) allows local health jurisdictions to assign inspection frequency based on risk. -WAC 246-215 (Working document section 8-405.20) does not address specific criteria for re-inspection when red-point violations have occurred. This policy defines this issue. Routine Inspection Frequency: ✓ All Limited Menu (includes bakery, B&B, concession stand, espresso stand, grocery, meat/fish market) establishments shall be on an inspection schedule of at least 1 inspection every 12 months. • ✓ All Complex Menu (includes complex mobile unit, complex restaurant, caterer) establishments and school kitchens shall be on an inspection schedule of at least one inspection every 6 months. ✓ All Temporary food establishments shall be inspected at least once during the permit period. (Limited menu temporary food establishments that have a history of no red point violations may be exempted for 1 year.) Re-inspections: ✓ A Food Establishment with violations totaling 35 to 104 points (76% to 92% correct) shall be re- inspected within the timeframe specified for correction on the inspection report and charged a first re-inspection fee. ✓ A Food Establishment that fails to correct all of the violations noted in the first re-inspection report shall be re-inspected and charged a subsequent re-inspection fee for each re-inspection after the first. Failure to correct violations at this time shall be grounds for possible suspension of permit. ✓ A Food Establishment with violations totaling 105 points or above (75% correct or below) shall have the permit to operate suspended. (See WAC 246-215 working document section 8.601.11 for regulations regarding suspension of permit). • -- ---- ------- - --615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368 (360) 385-9400 Pre-opening Inspections: ✓ An inspection of a food establishment shall occur prior to opening for the first time or at any time an establishment changes menu, service plan, hours, or ownership if it is deemed necessary by the Health Officer. A pre-opening inspection fee will be charged. Re-opening Inspections: ✓ A re-opening inspection may be required for establishments that have had their operating permit suspended, or have been closed by the Health Officer for operating without a valid permit or This policy shall remain in effect until amended or repealed by action of the Jefferson County Board of Health. Health Officer Date Chairperson, Jefferson County Board of Health Date • •615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368 (360) 385-9400 JEFF'ERSON COUNTY BOARD OF HEALTH • Department: Division: Section of Procedure Manual: Jefferson County Public Health Environmental Health Food Program Title: Destruction of potentially hazardous foods Subject: Time and temperature relationships, exceptions & procedures for potentially hazardous foods Effective (date): Replaces (date): Review due (date): Page: 1 of: 2 01/01/11 10/09 01/01/13 Destruction of Potentially Hazardous Foods Refer to WAC 3-701.11 Based on evidence and information provided by the Person in Charge, the inspector shall determine the appropriate course of action regarding temperature abuse of potentially hazardous foods. The following time and temperature relationships shall guide the inspector, but the decision shall be at the sole discretion of the inspector(the regulatory authority). The following time and temperature relationships shall be followed concerning the destruction of potentially hazardous foods. Potentially hazardous foods shall include but not be limited to any food which consists in whole or in part of milk products, eggs, meat, poultry, fish, shellfish, edible crustacean, or other natural or synthetic ingredients capable of supporting rapid and progressive grown of infectious or toxigenic micro-organisms. . See definition of potentially hazardous foods in WAC 246-215.P 1. Foods found between 41 F and 60 F shall be rapidly cooled to a temperature of 41 F or below. 2. For foods found between 60 F and 70 F, the following guidelines shall be used: a. less than 3 hours - rapidly cool to 41 F or below b. greater than 3 hours - discard all portions 3. Foods found between 70 F and 110 F shall be discarded unless in the process of being rapidly cooled or heated. 4. Foods found between 110 F and 120 F, the following time guidelines shall be used: a. less than 3 hours - reheat to 165 F and hold at 140 F or above b. greater than 3 hours -discard all portions 5. Foods found between 120 F and 140 F shall be rapidly reheated to 165 F and maintained at 140 F or above. Exceptions 1. Discard large volumes of food (i.e. using 5 gallon containers) when the temperature is 50 F or more and the Health Officer or their representative suspects the food has been cooling from 140 F for • - longer than 8 hours. 615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368 (360) 385-9400 2. Rare roast beef a. Rare roast beef shall be discarded if found displayed for more than 3 hours at • 100 F or less. b. If the roast is at 110 F or more and it has been out of the cooking process for not more than 1 hour, then it shall be further cooked to 130 F and then served. c. If the roast is at 110 F or more and has been out of the cooking process for more than 1 hour but not more than 3 hours, then it shall be immediately divided and cooled to 45 F or immediately reheated to 165 F. Procedure 1. The Health Officer or their representative shall always attempt to obtain voluntary condemnation of food in violation. The "Jefferson County Health Department Voluntary Condemnation Agreement" form shall be used for this purpose. 2. If the operator refuses, then fill out a "Certificate of Diversion, Destruction or Waiver". Examples on prescribing mandatory diversion or destruction are: a. Diversion - remove from premises" ... "feed to non-commercial" ... "take home, not to be serviced to public". b. Destruction - "place in dumpster, etc. and denature with bleach/cleanser, etc... 3. If the operator refuses to cooperate, then consult the Health Officer, Environmental Health Director, or Administrator to decide one of the following: a. Issue a hold order on the food and require a hearing, or b. Suspend the permit due to an imminent health hazard. • This policy shall remain in effect until amended or repealed by action of the Jefferson County Board of Health. Health Officer Date Chairperson, Jefferson County Board of Health Date 615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368 (360)385-9400 JEFFERSON C lJ T BOARD F HEALTH • Department: Division: Section of Procedure Jefferson County Public Health Environmental Health Manual: Food Program Title: Waiver from a Temporary Food Service Permit Subject: Policies for waivers temporary food service permit for non-potentially hazardous foods Effective (date): Replaces (date): Review due (date): Page: 1 of: 1 01/01/11 10/09 01/01/13 Waiver from a Temporary Food Establishment Permit Effective this date, the following policy shall be adopted concerning a waiver from a temporary food service permit for non-potentially hazardous foods. WAC 246-215 "Temporary Food Establishment" definition p. 10 WAC 246-215 8-301.2 "Exempt from Permit" p. 74 The Health officer, when no health hazard will result, may waive or modify requirements of these regulations. 1) A waiver from a temporary food service permit may be issued for the preparation and serving of • non-potentially hazardous foods at temporary events as defined in WAC246-215 "Temporary Food Establishment", p. 10. The waiver shall expire at the end of the calendar year. 2) Applications for a waiver shall be filed in person on forms provided by the Jefferson County Public Health a minimum of two working days before the event. 3) A fee shall be charged. This policy shall remain in effect until amended or repealed by action of the Jefferson County Board of Health. Health Officer Date Chairperson, Jefferson County Board of Health Date 1110 — — — 615 Sheridan • Castle Hill Center • Port Townsend • WA • 98368 (360) 385-9400 JEFFERSON QTY BOARD OF HEALTH • Department: Division: Section of Procedure Jefferson County Public Health Environmental Health Title: Manual: Food Program Mobile Food Service Establishments Subject: Clarification of WAC 246-215 (Food Code Chapter 9-1) Effective (date): Replacesdate 01/01/11 ( ): Review due (date): Page: 1 of: 3 E.H. Policy Statement 01/01/13 Mobile Food Service Establishments Purpose: This policy provides clarification of WAC 246-215 (Food Code Chapter 9-1). Since a mobile unit is defined in the food code as a readily movable food establishment, the mobile unit must: ✓ Retain its wheels Be readily movable within a matter of a few hours Skirting may be allowed if approved by the Planning Department. • A mobile unit may locate routinely at the same location if the Commissary Base of Operations Plan is approved by the Health Officer and the Planning Department, and the operator adheres to all applicable codes. Holding tank rules apply (Food Code Chapter 9-1.11). Procedure 1. Submit a complete Establishment Permit Application to Jefferson County Public HealthJCPH The permit fee will be determined by complexity of menu: Health ( ) • Limited menu (no cooling, no reheating, cook and serve only). • Complex menu (cooling and reheating is allowed, leftover foods will be discarded after that). A plan review fee will be charged for JCPH review of plans. Fees are covered in the Environment Division Fee Schedule. al Health The plans should include the mobile unit, the commissary kitchen and the serving area. 2. After you receive a plan review letter you may and all equipment is installed and operating, contact JCPH to schedule a pre opening inspection. Allow at complete least 5 workday notice to schedule this inspection. 3. Contact local building department (City of Port Townsend or County Department of Community for requirements for zoning, sewer, building and plumbing permit, fire suppression, Development) mt fi&tIndon hoods, and use Len Moser(L&I) at(360) 417-2702 inp Port Angelesaor(360) 902-5800 (main enumber)Labor& Industries. Contact • ------------- 61 5 Sheridan • C ----- _ �astle Hill Center• Port Townsend • WA • 98368 (360)385-9400 General Facility Requirements Approved Water Source: approved byJCPH. A permission letter may be required. • Source must be a waterminshetem • • Water holding system the unit is to be made of food-grade sanitizable materials, and sanitized daily.• Freshwater tanks are filled using f fo d-grade hose. preparation utensil cleaning, sanitizing and facility cleaning. • Water is used for hand-washing, Approved Wastewater Disposal System• construction and 15% larger Wastewater holding system on the mobile unit is to be of durable, leak-Proof than the clean water tank in size.• roved. A permission letter may be required. The dumping site for the holding tank mus• �be ivate apesidence. NO dumping down storm sewers or at a p Hand-washing Facilities• not be used for any other purpose. A sink for hand-washing only, may • Soap and paper towels are required for hand-washing. • A minimum of 5 gallons required for hand-washing. • Running hot&cold water or warm water 100° - 120°F Restrooms employees and provide hand-washing A restroom must be available beltavai avin ailable during allebusiness hours facilities. The restroom Dishwashing Facilitiesunit or at an commissary. Home-use kitchens are NOhwashing must be a roved comm ssary lae on themob(le must contain the following minimum requirements: NOT approved. An app artment sink with drain-boards and potable hot and cold water for washing, rinsing and A th ree-com p sanitizing equipment and utensils. OR A commercial dishwasher with a heat or chemical sanitizing cycle. Miscellaneous Items lies must be approved. 1. Mobile unit storage, cleaning area and storage facilities for back-up sup p2. All food contact equipment requiring drainage, such as refrigerators (non-evaporator style), ice, pop, and espresso machines must be plumbed to the holding tank. non-corrosive, and easily cleanable. Equipment 3. All surfaces on the cart are to be smooth, sealed, non-toxic, or equivalent. and utensils are to be National Sanitation Foundation (NSF) approved 4. Only single-service articles are used for customers. cku supply of clean utensils to last during all hours of operation or properly clean and sanitize 5. Have a ba p utensils every four hours. from 6. Condiments must be in individual packages or dispenser bottles or containers that are protected contamination. 7. Business name must be posted on mobile unit during business hours. Food establishment permit must be posted on mobile unit for customers to see. tection must be provided for all food preparation activities (e.g. awnings). 8. Overhead pro • --- 615 Sheridan • Castle Hill Center • Port Townsend • WA • 98368 (360) 385-9400 Listed below are the general categories of mobile food vendors and the additional requirements needed to • be a permitted food establishment. • Mobile: Limited Menu (no cooling or reheating, hot holding OK) Examples: hot dogs, commercially canned chili/soup, pizza, espresso, cook and serve burritos, burgers. • Mobile: Complex Menu (cooling OK in commercial kitchen, reheating OK on board). When reheating on board, food must be reheated for hot holding from 41° F to 165°within 1 hour. (If food is from a commercial food processing plant, reheat to 140° F is OK.) This policy shall remain in effect until amended or repealed by action of the Jefferson County Board of Health. Health Officer Date • Chairperson, Jefferson County Board of Health Date • 615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368 (360)385-9400 • Board of.7Cealth New Business .agenda Item # 17., 3 � Re-appointment to . Tefferson County Substance Abuse .Advisory Board December 16, 2010 • • s • Frances C. Joswick • PO BOX 486 Quilcene, Washington 98376 October 30, 2010 Jefferson County Board of Health C/o Julia Danskin, BSN 615 Sheridan Road Port Townsend, Wa, 98368 • Dear Board Members, to renew my Please accept this letter as applicationterm and continue serving oned my the Jefferson County Substance Abuse mewhadvisot/sBu�cessfulard. I an gett ng a few of the ve enjoy participation and believe I have been necessary tasks on the road to possible solution. I would like to have the opportunityto continue my service on this board in order to be a part of the problem solving tasks that the board is presently undertaking. Thank you in advance for your consideration of my request. Sincerely, Frances C. Joswick • • Board of Cealth Netiv Business .?agenda Item # 17., 4 . 2011 Jefferson County Budget: Jefferson County Public WeaCth Impacts December 16, 2010 • TH PUBLIC a 615 Sheridan Street • Port TownsendWashington 08368 wwwjeffersoncountypublichealth S November 19, 2010 Board of Health Members 615 Sheridan Port Townsend, WA 98368 Dear Board Members, This is to update you of the current status of JCPH's budget and concerns. This was discussed at the October BOH meeting but there is additional critical information available today. In September the Governor did across the board cuts of 6.3% which impacted our programs. Money was lost in Motor Vehicle Excise Tax (MVET), Family Planning (FP), HIV Prevention, Tobacco Prevention, and Child Protective Services (CPS). Yesterday, the Governor announced further cuts based on reduced revenue projections. An additional 4.6% cut will be announced with guidance from the State Legislature in December of 2010. We also anticipate the complete elimination of Maternity Support Services (MSS) and extreme cuts in FP in March 2011 or sooner. In addition to the state budget, the most recent JCPH 2010 budget projection indicates our projected carry forward is down by $84,000. During the last BOH meeting we discussed the possibility of JCPH transferring carryover funds to the County. At that time the amount discussed was $50,000. Since then we have been notified the amount is $100,000. WOur department has always been proactive when budgeting and extremely responsible with all revenue sources in order to assure we are able to provide essential services to our community. In preparation for the "unknown" cuts from the state, we have cut expenses and been saving revenue for these difficult times. Our reserves allow JCPH to meet this short term crises and allow BOH to make a plan to prioritize which services and at what level to continue in Jefferson County. We will then decrease levels of service yet have funds to maintain these services when our community needs them the most. The County will use the $100,000 to increase the General Fund reserves. Including this $100,000, in two years JCPH will have returned $350,000 to the County General Fund (CGF) CGF money transferred to JCPH is used to pay for county infrastructure services like IT, building rent, cars, computers, etc., which is approximately 47% of the CGF received from the County. The remaining amount of CGF is used to match program costs; providing services. JCPH's fund balance is not CGF but fees and contract revenue. We need your active support and urge you to ask Jefferson County to review the current 2010 plan to make an "equity transfer from other funds" or an additional $100,000 transfer from JCPH to CGF. This money is imperative for future services. It is clear to us we need an internal policy negotiated with the County regarding program specific reserves and an adequate fund balance in order to respond to disease outbreaks. We may need to legally renegotiate policies and tracking procedures to have accurate fund balances for fees and reimbursements stay within programs. Sincere) ff Jean Baldwin Veronica K. Shaw Julia Danskin Director Deputy Director CH kupervisor ie: Philip Morley COMMUNITY HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIESPUBLIC HEALTH WATER QUALITY MAIN: (360) 385-9400 MAIN: (360) 385-9444 FAX: (360) 385-9401 AMMER COMMUNITYFAX: (360) 379-4487 Page 1 of 1 Cathy Avery From: Jean Baldwin • Sent: Thursday, December 02, 2010 12:25 PM To: Veronica K. Shaw; Tom Locke; Julia Danskin; Cathy Avery Subject: FW: Health Department Budget Attach to other letter From: Roberta Frissell [mailto:roberta©olympus.net] Sent: Thursday, December 02, 2010 12:21 PM To: jeffbocc; Philip Morley Cc: Jean Baldwin Subject: Health Department Budget Dear Commissioners Johnson, Sullivan, and Austin, and County Administrator Morley: I am writing to you because I am very concerned about recent decisions concerning the JCPH budget. As a Board of Health member for many years, I have been privy to the workings of the health department and their budgets. In my opinion,they have always been very responsible, frugal and efficient. Now, I understand that the county is asking them to return $100,000 to the county general fund (CGF) because of the budget crisis. While I certainly appreciate the horrendous shortfalls, I think you should reconsider this decision for several reasons. First, the $100,000 is not necessarily county money.The health department has managed to accumulate surpluses, by design, to protect their programs.Taking this money would unfairly punish them for their frugality and efficiencies. If our first priority is to protect programs, you should not be taking money that was purposely saved for exactly that rpose.The fund balance in your sites is derived from fees and contract revenue, not the CGF. Second, the JCPH fund balance is needed for their responses to future disease outbreaks and natural disasters. I understand that the majority of the fund balance is leftover from H1N1 funds. This is not county money and should be left intact. To reiterate, if your first priority is to save programs, you should not be taking money that was purposely saved for exactly that purpose. I urge you to reconsider your decision to have JCPH return $100,000 to the CGF. Thank you for your consideration. I know you are facing many awful decisions, but this decision could be a matter of life or death and should be recognized as such. Sincerely, Roberta Frissell, Member Jefferson County Board of Health • 12/2/2010 • Board of aCeaCth Netiv Business .agenda Item # 17., 5 • "Washington State Budget Z.lpdate December i6, 2010 • GOVERNOR CHRIS GREGOIRE WWW GOVERNOR.WA.G OV WE SOLVED A THREE-YEAR BUDGET DEFICIT OF NEARLY $12 BILLION THROUGH: » $5.1 billion in cuts and savings » $3.6 billion in federal funds IN TWO YEARS,WE HAVE » $2.5 billion in fund transfers and use of reserves REDUCED THE STATE WORK FORCE BY 8,200 FTEs SINCE 2009. a $761 million in revenue enhancements (some of which will expire December 2010, due to the passage of Initiative 1107) YET AFTER BALANCING THE BUDGET THIS YEAR, WE CONTINUE TO LOSE REVENUE AND INCUR HIGHER COSTS: a June Revenue Forecast—Lost $200 million this biennium. » September Revenue Forecast—Lost $770 million in this biennium, requiring 6.3 percent across-the-board cuts. Another $669 million decrease in 2011-13 brought the estimated deficit to $4.5 billion. • November Elections—Lost $55 million this biennium and $218 million next biennium (passage of I-1107). This brings the deficit to $4.8 billion. a November Caseload Forecast—Experienced increased costs in Disability Lifeline; greater number of students in special and bilingual education programs; higher enrollments in TANF (Temporary Assistance for Needy Families). » November Revenue Forecast—Lost $385 million in this biennium and $809 million in 2011-13. WE HAVE AGAIN TAKEN DECISIVE A'`TION: » The September revenue forecast resulted in a $520 million General Fund shortfall. The Governor immediately ordered 6.3 percent across-the-board cuts to bring the budget back into balance. CUTS ARE A ZERO SUM GAME. a The November revenue forecast added another $385 million "FIXES"BY THE LEGISLATURE to the problem. Due to various legal issues, some agencies have IN ONE AREA WILL REQUIRE been unable to achieve their full 6.3 percent cut. The Governor DEEPER CUTS IN OTHERS. asked the Legislature to submit ideas for a supplemental budget and sent her own list of suggestions that lay a path forward to balance the budget. a The Governor is urging early action by the Legislature to pass the supplemental budget. » If the supplemental budget is nor acted on quickly, savings will not be achieved. • REVISED Nov.24,2010 WE SEE OTHER PRESSURES ON THE BUDGET FOR THE 2011-13 BIENNIUM: • » Unemployment benefits— 50,000-60,000 will exhaust their benefits between December 2010 and March 2011. Many will apply for food stamps, public assistance and Medicaid. Some of those with children may apply for TANF. TANF—We cut $52 million despite increased demand. A SHORTFALL.OF$5.7 BILLION Across-the-board cuts reduced TANF by another $19 million. IS PROJECTED FOR 201 1-13. Balancing the 2011-13 budget will require additional THE OFFICE OF FINANCIAL reductions of 12 to 15 percent. These cumulative actions MANAGEMENT INSTRUCTED STATE compromise our ability to serve our state's needy people. AGENCIES, SEPARATELY ELECTED OFFICIALS AND THE HIGHER Disability Lifeline—Formerly General Assistance for the EDUCATION SYSTEM TO SUBMIT Unemployable, this program was reduced in the last budget BIENNIAL BUDGET REQUESTS through the setting of a five-year limit on benefits. The state WITH A 10 PERCENT CUT.THE was sued and the court entered a temporary restraining order NOVEMBER FORECAST WILL on the limit. Now our only remedy is to cut benefits by REQUIRE MORE CUTS. $81/month for all participants. FMAP (Federal Medical Assistance Percentages) —We did not receive $142 million that the federal government indicated we could anticipate. » Lagging consumer confidence and slow housing starts—We expect to see a continuation of these trends that reduce revenue in the short term. WE HAVE TIGHT CONSTRAINTS ON WHERE WE CAN CUT THE 2011-13 BUDGET: a 60 percent of the budget is 'off limits' due to constitutional, legal and contractual obligations, and federal requirements. These programs include education, mandatory medical assistance, debt service and pensions. DUE TO CONSTITUTIONAL, LEGAL AND OTHER RESTRAINTS, » There is more flexibility in the remaining 40 percent that JUST$14 BILLION OF AN includes corrections, education, non-mandatory social services APPROXIMATELY$35 BILLION and health care. BUDGET REPRESENTS THE MOST LIKELY AREA OF REDUCTIONS OF WE HAVE INSTITUTED TRANSFORMATIONAL BUDGETING: NEARLY$5.7 BILLION. » Appointed the Transforming Washington's Budget Committee—36 citizens from around the state and across various interests offered and evaluated ideas. Four legislators, two from each party and two from each house, participated. Four town halls were conducted across the state, which were attended by more than 1,500. » Designed an interactive website—More than 18,000 visitors offered 126,000 votes on hundreds of ideas to save money and operate government more efficiently. Visit the Governor's website at www.governo'.w-a.gov for a summary. » Followed POG—The Priorities of Government budgeting approach ranks state-provided services by the importance to citizens. POG is being used to inform both the supplemental and biennial budgets. 4110 REVISED Nov.24,2010 r=�srtn N* 1 f • CHRISTINE O. GREGOIRE I 'I Governor ‘0 STATE OF WASHINGTON OFFICE OF THE GOVERNOR P 0 Box 40002.Olympia.Washington 98504-0002 •(360)902-4111 For Release: Immediate Media Contact: Governor's Communications Office Date: Nov 29`h, 2010 Phone: 360-902-4136 Gov. Gregoire requiring performance-based contracts Gregoire signs executive order to enhance contract accountability OLYMPIA—Gov. Chris Gregoire today signed an executive order directing state agencies to base all their new contracts on performance and to provide incentives and consequences to ensure that agreed upon value to the state, and taxpayer, is received. • "Accountability is central to our continuing work to transform Washington," Gregoire said. "Performance contracts are just what they sound like—they identify what we as a state are buying, and make payment contingent on the contractor delivering those results. Performance contracts focus on the job to be done, and they ensure it gets done." Gregoire acknowledged that Washington state is already a leader in using performance based contracts—and highlighted the success of the Department of Transportation, which has used these types of contracts to ensure projects are delivered on time and on budget. Over the last seven years,76 percent of contractors on 1,000 WSDOT projects finished early or found a cheaper way to deliver the project. "Given the extremely difficult choices we face as we address a $5.7 billion shortfall in the next budget, performance contracts can no longer be a best practice—they must be standard practice," Gregoire said. "Government must be accountable for each tax dollar, and we must expect the same accountability of every business, contractor or organization that wins a contract for those tax dollars." The executive order directs the Office of Financial Management and the Government Management Accountability and Performance office to give a progress report to the governor no later than Dec. 1, 2011, detailing implementation of the executive order as well as results. The executive order also requests the State Auditor to assist with evaluation and training. To read the executive order,visit: http://www.governor.wa.gov/execorders/eo 10-07.pdf It 1 • CHRISTINE O.GREGOIRE Governor .t'�' r f N4i44 STATE OF WASHINGTON OFFICE OF THE GOVERNOR P.O.Box 40002 Olympia, Washington 98504-0002• (360) 753-6780 www.governar.wa•gov EXECUTIVE ORDER 10-07 PERFORMANCE-BASED CONTRACTING WHEREAS, our current economic climate and budget challenges require government to be more diligent than ever in ensuring public funds are used appropriately and effectively; and WHEREAS, government must demand performance results for every taxpayer dollar spent; and WHEREAS, proper stewardship of funds includes holding not only government agencies accountable, but also those individuals and businesses we contract with to provide a product or service; and WHEREAS,the Office of Financial Management has already provided guidelines on using performance-based contracts for personal and client services contracts; and WHEREAS, Washington State is seen as a model for contracting practices that encourage innovative and responsible ways of providing goods and services; and WHEREAS, it is necessary for gecies to take additional steps to strenhen their by increasing the use of performance-based contra os tract monitoring and management practices NOW,THEREFORE, I, Christine O. Gregoire, Governor of the state of Washington, by virtue of the power vested in me by the state Constitution and statutes do hereby order and direct: (1) The Office of Financial Management(OFM) shall issue minimum performance contracting standards for client and personal services contracts. Performance-based contracts identify expected deliverables, performance measures or outcomes; and payment is contingent on their successful delivery. Performance-based contracts also use appropriate techniques, which may include but are not limited to, consequences and/or incentives to ensure that agreed upon value to the state is received. Other contract oversight agencies, including the Departments of General Administration, Information Services, and Printing, will revise their policies and procedures as necessary to include standards consistent with those developed by OFM. • ti. (2) All state cabinet agencies shall: a. Require that new contracts for products and services meet performance-based • contracting standards. p e based b. Review existing contracts prior to renewal and update as necessary to reflect performance-based contracting standards. c. Ensure performance-based contracts are actively managed to meet performance- based standards. (3) In those cases where it would not be cost-effective for the state to use a performance-based contract, agencies may exempt a contract from the requirements outlined in subsections (2)(a)and (2)(b)of this order. All exemptions must be approved in writing by the agency director before the agency enters into the contract. (4) Accountability for ongoing implementation progress and results shall be reported through the Government Management, Accountability and Performance (GMAP) process. The Governor's Accountability and Performance staff will work with agencies to develop measures related to performance-based contracting. (5) OFM, working with the Departments of Health, Social and Health Services, Commerce, the Employment Security Department, the Health Care Authority, and other key state agencies, shall evaluate ways to apply performance-based standards to federal and state pass-through funding and other grants. The evaluation will address at a minimum: state and federal • statutory limitations, incentives to encourage innovation, and consequences for non- performance. OFM and agencies shall coordinate efforts to consult with interested stakeholders, including but not limited to: local governments, tribes, the business community and current vendors. (6) No later than December 1, 2011, OFM and the GMAP office shall report to the Governor on: a. Progress made by state agencies in implementing the provisions of this order. b. Results of the evaluation required in section (5)of this order and recommendations for applying performance-based standards to other funding sources. The report shall include all statutory and budgetary modifications necessary to implement such recommendations. i • This executive order takes effect immediately. Signed and sealed with the official seal of the state of Washington on this 29`h day of November 2010 at Olympia, Washington. By: /s/ Christine O. Gregoire Governor BY THE GOVERNOR: /s/ Secretary of State • • Board of 3Cealt( New Business .agenda Item #17., 6 • 2011 1/17SACP310 (W4 State Association of Local Public 3-fealth OfficiaCs) .Agenda December i6, Zoio 2011 WSALPHO Legislative Framework WSALPHO's 2011 Legislative Agenda was discussed at the WSALPHO Board of • Directors and General Membership meetings held June 7 & 8 in Spokane. We decided to focus on a few key issues in order to maximize our chance of success during the upcoming legislative session while achieving the greatest benefit from our limited resources. While sustained funding and other funding related issues dominate the list, we will also be active on policy issues that are important to protecting the public health but don't require a substantial investment of resources. We will work with and support the efforts of a variety of traditional and non-traditional partners on these issues, and will support the efforts of counties in developing public health funding solutions, while balancing their overall financial concerns and budget constraints. 2011 WSALPHO Legislative Agenda 1) Maintain Public Health funding, including: a). Retain non-categorical funding (flexible funding) b). Sustain "5930 funding"(funded from Tobacco Control Account that is exhausted 7/1/2011). 2) Support efforts of WSAC and others to provide counties with more funding tools; help to develop public health funding solutions while balancing local-level needs and budget • constraints. 3) Eliminate costly or unfunded programs with requirements that do not further public health protections, including: a) On-site inspector certification b) Land fill inspector certification 4) Promote Public Health policies that improve the quality of life for Washingtonians, yet don't require a substantial investment of financial resources, including: a) Drug take back programs b) Increase immunization rates (tighten exemption criteria) 5) Identify priorities for the next Public Health funding investment or other funding opportunities (e.g.: grants) that are aligned with WSALPHO priorities, such as: a) Core functions b) Align with Reshaping Governmental Public Health efforts c) Public Health Standards review/ National Accreditation • • Board of Health Netiv Business .agenda Item #17., 7 .agenda for Change St the • Centers for Disease ControCs "Six ANinna6le Battles " December 16, 2010 1 An Agenda for Change 1 1 October 2010 PUBLIC HEALTH IN A TIME OF CHANGE Reshaping Public health in Washington State is at a crossroads. After a century of effectively J preventing death and illness and increasing the quality of life of our residents, today iGovernmental we face the dual challenges of a severe funding crisis and a change in the nature of I Public Health in preventable disease and illness in our state. These new realities must lead to a Washington State rethinking of how we do our work if we are to: • Sustain our past successes— protect the capabilities of our communicable Co-Chairs disease response, public health laboratory services, core environmental Gregg Grunenfelder public health work, and emergency preparedness and response. i John Wiesman • Confront our emerging challenges—address chronic diseases such as Members diabetes and heart disease, resulting from underlying causes such as Susan Allan tobacco use, poor nutrition and physical inactivity, as well as address 1 Joan Brewster preventable injuries, and giving everyone a chance to live a healthy life 1 Carlos Carreon regardless of their income, education, racial or ethnic background. Dennis Dennis • Use our available resources most efficiently and effectively—forge new 1 Joe Finkbonner partnerships and use technology to shape a better, more effective public i David Fleming health system. iKaren Jensen Barry Kling In short, we need an agenda for change as we move forward, even during these Mary Looker Joel McCullough tough times. Patrick O'Carroll Jane Palmer • Public health has profoundly improved the lives of people in our state for over a David Swink hundred years. In the early 1900s, the average life expectancy in the U.S. was 49 Jude Van Buren years. Today it is approximately 80 years. While clinical health care is valued, most Mary Wendt of this increase is due to public health actions—for example, the dramatic drop in infant mortality and deaths from infectious diseases resulting from improved hygiene, DOH Staff sanitation, immunization, and communicable disease control efforts. While they Allene Mares remain hidden because they are successful, the public health efforts that provide Marie Flake safe drinking water, safe food, and safe living conditions are active and on-going today and require resources and trained public health professionals to assure continuing effectiveness. The current economic crisis threatens these resources and, therefore, these programs and our citizens' overall health and well being. Local and state funding for public health is rapidly eroding, resulting in the loss of trained public health professional staff ranging from 25-40% in some jurisdictions and compromising our overall public health system's ability to respond to critical health issues. As importantly, new challenges confront us. While public health has made great strides in combating infectious disease, a new set of preventable illnesses has I emerged. Although Washingtonians are living longer, they are still dying early from preventable causes, often following years of preventable illness and disability. Chronic diseases such as diabetes and heart disease, resulting from underlying causes such as tobacco use, poor nutrition, and physical inactivity, continue to cause i long-term illnesses and disability and are cutting lives short. I i Reshaping Governmental Public Health in Washington State Page 1 of 5 An Agenda for Change, October 2010 Version Preventable injuries are the leading cause of death for Washingtonians aged 1 to 44. Social and economic factors driven by race and class are increasingly recognized as significant causes of overall poor health and disparities in health outcome between groups. All Washingtonian's should have the opportunity to make the 4 choices that allow them to live a long, healthy life, regardless of their income, education, racial or ethnic background, The need for public health change is underscored by dismal and declining U.S. health rankings compared to other developed nations. Despite the fact that as a nation we spend more money per capita on medical care than any other industrialized nation in the world, our childhood mortality rate ranks 42nd in the world (dropping from 20th in 1970 and 29th in 1990)' and our female mortality ranks 49th and male mortality ranks 45th (dropping from 34th and 41st respectively in 1990)". Almost unbelievably, unless we change course, for the first time since statistics started to be kept, today's youngest generation may not live as long as their parents. While health care reform will greatly reduce the number of persons without health insurance, alone it will not solve these problems. Health will improve most from preventing chronic diseases in the first place rather than treating them after they have occurred. This will require a public health system that assists individuals in adopting healthy behaviors, assists organizations and communities in encouraging these lifestyles, and assists policy makers in implementing policies based on the best available evidence to change the conditions in which we all live. THE WHAT AN ACTION AGENDA FOR THE PUBLIC'S HEALTH Amidst all this change, the fundamental goals of public health remain unchanged. Simply put, they are to: 1) protect people from communicable diseases and other health threats through prevention, early detection, and swift responses; 2) build communities that prevent illness, promote wellness, and better provide all of us the opportunity for long, healthy lives; and 3) improve access to quality, affordable health care that incorporates ip routine clinical preventive services and is available in rural and urban communities alike. What has changed are the specific actions we need to undertake to best achieve these goals. We have few opportunities to transform, and this is one of those times. What follows is the top level outline of an agenda to guide the course of change for public health in Washington State. 1. Focus our communicable disease capacity on and enhance the most effective and important elements of prevention, early detection, and swift responses to protect people from communicable diseases and other health threats Success will require the following essential near-term actions: a. Give high priority to and explore every avenue to maximize the disease protection provided by immunizations—one of our most cost-effective strategies to prevent the spread of vaccine preventable disease b. Sustain the most effective elements of our capacity to prevent, rapidly detect, and respond to health threats, both current and emerging. c. Modernize our informatics capabilities and capacities to collect and securely share vital information. d. Improve and modernize our risk communication capacities and technologies to effectively provide key information to, policy makers, the public, and the health care system. ID Reshaping Governmental Public Health in Washington State Page 2 of 5 An Agenda for Change, October 2010 Version Nor 2. Focus on policy and system efforts to foster communities and environments that promote healthy starts and ongoing wellness, prevent illness and injury, and better provide all of us the opportunity for long, healthy lives. • Success will require the following essential near-term actions: a. Give high priority to creating policies, systems, and environments that promote healthy starts, reduce tobacco use and support healthy eating and active living, raising the bar on healthy and productive lives for everyone. b. Focus effort and policies to address disparities in health; providing the opportunity for all Washingtonian's to make the choices that allow them to live a long, healthy life, regardless of their income, education, racial or ethnic background. c. Increase the types of governmental partners (i.e. parks, transportation, comprehensive planning and land use) and find new ways to collaborate to incorporate "health" into all policies. Actively and broadly engage and leverage the efforts of the non-government entities— economic development agencies, businesses and the private sector, schools, faith organizations, non- profit organizations, and others —to promote health, prevent disease, and reduce health care costs. d. Recognize and integrate into our practice and health programs, current knowledge of the effects of social and economic factors on health to give everyone the chance to live a healthy life. 3. With healthcare reform, it is time for public health to more effectively and strategically partner with the healthcare system to improve access to quality, affordable and integrated health care that incorporates routine clinical preventive services and is available in rural and urban communities alike. Success will require the following essential near-term actions: • a. Monitor health care access to identify and propose solutions to bottlenecks and barriers as health care reform is implemented. b. Forge a stronger relationship with the clinical care system to improve the delivery of both clinical and community preventive services. c. Develop the resources necessary for a responsive system to oversee licensed health professionals and institutions to ensure patient safety. d. Assure that attention is paid to reducing substance abuse and promoting good mental health, especially the prevention and early detection of depression. This Agenda for Change is required for better health, to ensure a workforce that is ready to compete in a competitive global market place, and for our families to raise children ready to learn in school and to grow up to be productive members of society. THE HOW—A PUBLIC HEALTH REFORM AGENDA Just as the health care system is changing through health care reform to better meet its 21st century challenges, so must the public health system undergo "public health reform"to achieve the Agenda for Change outlined above. The key elements of this public health reform include the following: 1. Retrain the public health workforce to the skills and competencies needed for the new work Success will require the following essential near-term actions: •Reshaping Governmental Public Health in Washington State Page 3 of 5 An Agenda for Change, October 2010 Version 4 a. Develop strategies for filling gaps in our overall competencies, focusing on high level advocacy and policy change, 21st century communication tools, skills to address health equity and social determinants, and abilities to work with other organizations to leverage their resources and abilities. • b. Develop new recruitment, selection, and retention strategies to bring the right people with the right skills to meet the new public health challenges facing our communities. c. Promote and support the necessary skills to lead a governmental agency in effectively addressing the complex issues affecting the health of Washingtonians. 2. Re-prioritize work and modify business practices Success will require the following essential near-term actions: a. Work with policy makers to set and prioritize health outcomes; establish ways to measure them. b. Streamline the number of and focus performance and accountability measures on public health actions that lead to the achievement of the prioritized health outcomes. c. Commit fully to quality improvement by meeting the Standards for Public Health in Washington State and to work toward public health department accreditation which measures and documents the capabilities of public health agencies. d. Re-prioritize, modernized and sustain the most important informatics capabilities and capacities to collect, analyze, and share meaningful information, as appropriate, among public health practitioners and policy makers for decision making and with the public so that all have the opportunity to make the choices that allow them to live long and healthy lives. e. Adopt and apply the best of both private and public sector management to the operation of each of our programs, including routine incorporation of quality improvement and efficiency practices. f. Critically evaluate and reprioritize our limited resources, using things such as the Guiding Principles for the Governmental Public Health System and Criteria for Making Policy, Program • and Funding Choices outlined later in this document. g. Better define roles and responsibilities among the overlapping authorities and jurisdictions of state, county, and tribes. h. Organize a more cost-effective public health system to achieve prioritized health outcomes, using regional approaches or other models when appropriate and agreed upon. 3. Develop a long-term strategy for predictable and appropriate levels of financing Success will require the following essential near-term action: a. Work with partners and policy makers to develop a new model for local, state, and federal government funding of the governmental public health system in Washington State to support this action agenda and the "public health reform" agenda. b. Work with partners and policy makers to develop and implement a realistic multi-year strategy to implement the new model and achieve long-term, predictable funding for the governmental public health system to support this action agenda and the "public health reform" agenda. NEXT STEPS FOR ADVANCING THIS AGENDA FOR CHANGE Success will require the following priority near term actions: Reshaping Governmental Public Health in Washington State Page 4 of 5 An Agenda for Change, October 2010 Version a. Action-oriented, coordinated leadership is an urgent priority. Making this agenda a reality will require a well-organized effort that includes local health jurisdictions, local boards of health, the Washington State Department of Health, the State Board of Health, the Washington State Association of Local Public Health Officials, tribal governments, the Washington State Association of Counties, and other partners; b. The Public Health Improvement Partnership (PHIP) is an established framework for working together that already includes key partners. The PHIP should be the focal point to coordinate implementation and action on the Agenda for Change. To implement the Agenda for Change we will use a common set of guiding principles and decision-making criteria Guiding principles for the governmental public health system 1. We are accountable for all resources we are allocated — people, funding, and technology. 2. We will build upon our history of thinking and planning as a system while recognizing the diversity of our local communities, and we will hold each other accountable. 3. Science guides our work—epidemiology, biology, social science (including communications), and political science (an understanding of government). 4. We help communities find workable solutions to their health problems and leverage their resources. 5. We work to achieve equity so that all Washingtonian's have the opportunity to make the choices that allow them to live a long healthy life, regardless of their gender, income, education, racial or ethnic background, sexual orientation, or where they live. Criteria for making policy, program and funding choices 1. Does this protect the public's health and public safety? As we respond to new challenges, we need to sustain our past successes in preventing and responding to communicable diseases, public health emergencies, environmental public health threats and chronic disease and injury. 2. Is this a responsibility of government or something people expect to be done by government? Is government in the best position to act? If government is in the best position, is it state, local, tribal or a combination of these entities'? Or is there a viable community partner or should we be supporting the development of a viable community partner'? 3. Do we have clear indication that the actions will improve health or improve the opportunity for people to make the choices that allow them to live long, health lives'? 4. Does this have the greatest potential impact in increasing the years of healthy life lived and eliminate injustices in health inequity. In closing, this work group believes that the time has come to implement this Agenda for Change. In doing so, Washington State's public health system will continue to hold its national leadership status and will, most importantly, best serve the health of our residents and our communities. Rajaratnam JK, Marcus JR, Flaxman AD,Wang H, Levin-Rector A, Dwyer L, Costa M, Lopez AD, Murray CJL Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970-2010: a systematic analysis of progress towards Millennium Development Goal 4. Lancet 2010; 375: 1988-2008, published online May 24, 2010. Rajaratnam JK, Marcus JR, Levin-Rector A, Chalupka AN,Wang H, Dwyer L, Costa M, Lopez AD, Murray CJL.Worldwide modality in men and women aged 15-59 years from 1970 to 2010: a systematic analysis. The Lancet 2010, April 30; doi:10.1016/S0140- 6736(10)60517-X. •Reshaping Governmental Public Health in Washington State Page 5 of 5 An Agenda for Change, October 2010 Version CDC's Winnable Battles • Frequently Asked Questions What is a winnable battle? "Winnable battles" describe public health priorities where CDC and public health can make significant progress in a relatively short timeframe —generally within one to four years. To date, CDC has identified the following domestic winnable battles with a substantial focus on prevention in the following areas: • Healthcare-associated infections • HIV • Motor vehicle injuries • Obesity, nutrition and food safety • Teen and unintended pregnancy • Tobacco CDC also has made a commitment to prevention around the world with the following global winnable battles: • Prevention of Mother-to-Child HIV Transmission (PMTCT) and congenital syphilis • Global immunization initiatives, including polio eradication • Lymphatic filariasis in the Americas (elimination of) • Tobacco • • Motor vehicle injuries Why has CDC chosen to focus on these particular health areas when there are so many pressing health issues? These areas were selected as the initial "winnable battles" because they present the following opportunities: • They address the leading causes of death and disability. • There are evidence-based interventions that exist and can be broadly implemented. • CDC's intensive focus and efforts can have a significant impact in a short period of time. What about other important health issues that are not reflected in this list? The mission of CDC remains the same —to protect health and promote quality of life through the prevention and control of disease, injury and disability. CDC staff will continue and expand their important work across a wide range of public health issues with a focus on achieving broad health impacts and the elimination of health disparities. Additional information on the range of CDC's work across public health can be found at www.cdc.gov. Has a list of priorities like this ever been released before by CDC? It is not unusual for CDC to set public health priorities that can be addressed in a meaningful way during a clearly defined timeframe. These priorities are often established in support of • Department of Health and Human Services (HHS) and White House initiatives. CDC's priorities 1 are often based on the scope of the health problem, the ability to have significant health impact, and the ability to address health costs. Will each area have a "battle plan"? CDC has developed internal plans that outline priority activities to support each of these health issues. These plans include actionable steps within the areas of research, surveillance, program delivery and evaluation, policy and communication that can help make significant progress in these areas. CDC staff will refine the plans continually based on strategy meetings, external opportunities, and discussions within CDC and with our public health partners. What does CDC propose to do to address these issues? CDC has identified strategies and established milestones and metrics to ensure significant progress is made in all the winnable battle areas. Each area has developed a clear set of strategies and targets that are rooted in CDC's strategic public health priorities: • Strengthen surveillance, epidemiology and laboratory services • Improve the agency's ability to support state, tribal, local and territorial public health • Increase global health impact • Increase policy impact • Better prevent illness, injury, disability and death The winnable battles also support related federal priorities and initiatives and will be achieved by working closely with CDC's public health partners. What will constitute a "win"? From improving teen driver safety by implementing stronger graduated driver licensing to advancing trans fat and sodium reduction strategies, each winnable battle has its own specific metrics in place to measure progress against outlined goals. Ultimately, a win will occur as we make measurable progress in each of these areas. Does CDC plan to re-direct its budget to these priority areas? CDC's intent is for the term "winnable battle" to bring additional attention to these critical health issues and rally diverse resources and partnerships to accelerate measurable health impact. Limited discretionary funds, as available, may be directed to advancing progress in these areas; however, CDC does not plan to reprogram resources to fund winnable battles. Does CDC plan to identify additional winnable battles? As CDC makes progress toward addressing each winnable battle area — both domestically and globally —these priorities will evolve and new priorities may be added. • 2 • Board of.3-Cealth .agenda PCanning Calendar .Agenda Item #TII. • Board of Health Calendar for 2011 December 16, 2010 • n N n 0 x n " p " = � �� om = 7 ° H c O � ° CD CD = o: 00 = = O _ X9Cr N 0ert _ rt 3 O1 4 .+ Q.a �iomv g-' (0 D J(F�•. 7.,.,,, c, = E 2 4:z. :r.t, r- 0 10 ...-P 0 - 0 (f) (1 = 0 c PA f, lilt 3 ton 3 N`CD = v m m , N N < 3 0 Omv m o 0 CD 3 O y O y O yyc . > vi = y 3 y, yc m w oo' 3 . o• a'N E ..e C -.ay• co 3 n N N ? CfCn N NJ -' 00 .-, C/) 3 ,_- .0 NJ U to 00 .-' 0 V' N to 10 O W a .-' to W NJ — 0 N y W N .-' - W C 0 'V NJ .--. 0 O W 0 i? .-' .p J Oto �!QNNJ C' W 1-=., N00 - 4, /= -4 O LA ,- NJ J O ti-, -' 0 J (5, 00 .�.+ C NJ N N .-' 00 N )-i N �--� .-' to f-] J O W a, H CD N O O W N V' N 7J N N ,-' G, '71 J '=7 O W .. 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J O .a NJ .-' .-' Li, r4- 0 NJ N to 00 .� 4 C N 4, 4 CT LO N r� rt ,-ia NJ VN 1-i 1-iJ O W C o 0 0 VN t tt .-, 0 000 .N-' 4, J 1-' 4, J O W C J NJ W N NOCIO ., NON4, 1] J 1-3 V N Vi W ? 0 1-11 O W 0V' N h7 as V' N to NV' N to .-' W N N .-' Cn WO W a N C/J .W-' � .J Cr, J O W 7 Board of.7Cealth .�vledia Report • December i6, 2010 Jefferson County Public Health • October/November/December 2010 NEWS ARTICLES 1. "Who's running this county?", Port Townsend Leader, October 20th, 2010. 2. "Flu shots: Clinics ready," Port Townsend Leader, October 20th, 2010. 3. "Love your septic system," Port Townsend Leader, October 20th, 2010. 4. "Unions, county in pay talks," Peninsula Daily News, October 24th, 2010. 5. "SmileMobile to Chimacum," Port Townsend Leader, October 27th, 2010. 6. "Posters promote awareness," Port Townsend Leader, October 27th, 2010. 7. "Flu clinics open," Port Townsend Leader, October 271h, 2010. 8. Public health nurse comes full circle," Peninsula Daily News - Celebrating Nurses Special Section, October 31st, 2010. 9. "Students attend prevention panel," Peninsula Daily News, November 5th, 2010. 10. "No time for the flu: Clinics are opening," Port Townsend Leader, November 10th, 2010. 11. "Stop smoking - urge these Chimacum students," Port Townsend Leader, November 10th, 2010. 12. "Prevent and protect," Port Townsend Leader, November 10th, 2010. 13. "The Great American Smoke Out," City of Port Townsend Newsletter, November • 2010. 14. "Tobacco Awareness," Tobacco Prevention and Control Program, November 2010. 15. "Supporting women's health," Port Townsend Leader, November 24th, 2010. 16. "Appeal filed over biomass permit in PT," November 26th, 2010. 17. "Biomass plan proceeds despite appeal," Port Townsend Leader, December 1st, 2010. • The county administrator Who's running wants a new metropolitan park district with'taxing authority, paid thiscounty? commissioners and a large staff. Wait until you see what its tax bite • It seems there is nobody at our will be. ship's helm. The Brinnon community pre- The BOCC spent several hun- sented the BOCC a proposal to manage the senior center and motel. dreds of thousands on new park and open space land this year, yet The county responded 15Y- closing didn't seem concerned that .they the motel and curtailing the center • hours while maintaining tourism is were out of money. They hired at least one $100,000 a ygar spe- their highest priority. cial consultant. and have frittered The administrator appears to be little more than an overpaid staff away funds all over the place. man. The appointed department They persuaded us that a coun- heads continue to spend and ignore ty administrator would relieve p g the people they serve. The BOCC their work schedule, reduce costs • spends money it doesn't have. and improve performance.Yet none Where are the checks and bal- of that has happened. ances? So who is in charge? I sug- One would think the adminis- gest a group of retired business trator would manage the county people audit our county depart- departments. When asked about ments and suggest improvements. steps departments were taking to So far there are no takers. reduce costs, I'm told he is not a DAVIS STEELQUIST party to that. Earlier this year Quilcene he was quoted as pinching every (Jefferson County Administrator penny ... yet he doesn't scrutinize Philip Morley replies: To balance the department's budgets? Jefferson County's 2011 budget with The health department — in shrinking revenues, $900,000 to short money times—redid its web- $1,100,000 of new cuts are neces- site and released a useless hand- sary. In 2009 and 2010, we reduced book. It asks: "Are we spending status-quo expenditures by $2.3 mil- l) enough.nYet it continues to need- lion. We set budget cuts for each lessly duplicate services provided department and hold them account- by the private sector. able. Proposition 1 gives citizens a Public Works chip-sealed a sig choice whether the county should nificant number of roads that were make all of the necessary additional in good shape, released funds to cuts or whether a .3 of 1 percent add to the Larry Scott Trail and sales tax (3 cents per $10 purchase) is planning another between H. J. should restore specific services in Carroll Park and Hadlock. Oh, it's public safety, youth and senior ser- all grant money. If you don't have vices, community services and basic work for people, lay them off, espe- government. The county and city cially if you can't pay them.Yes it's agreed to use half of the city's Prop. tough, but the county and country 1 revenue to restore programs and are broke! maintenance for Memorial Field and The parks manager has done the Recreation Center for four years. nothing to develop or maintain our During that time we'll conduct a parks, relying on volunteers to do multi-agency plan for a cost-efficient his job. He closed campgrounds way to deliver parks and recreation that were revenue sources, has no maintenance or development plan programs for our community. By for existing parks, and can't tell law,funds like Conservation Futures you what the tax increase money is- funds (for land preservation) and going to be spent on. road funds are restricted for those purposes. A six-year Transportation The county administrator Improvement Plan sets county road wants a new metropolitan park district with'taxing authority,paid and non-motorized maintenance and construction priorities. Chip-sealing is cheaper than repaving. Public health and all departments use infor- mation technology for cost-effective service. Services are not duplicated. • To save money, three money-losing campgrounds were closed. This • ' month OIyCAP closed the Brinnon motel because it was draining funds from the community onter.) T ,6t rC/a74'v • I . .1 , Flu shots; This year's gvaccine targets three strains This year the flufevery- Madrona aOak1 Bay Road, ersUrgent ds$25 accepted; all shots ages 6 ed for monthsl children through is recommended for every- Care, available. 18 years old and are now one age 6 months and older. Port Ludlow: 9 a.m.-2 p.m., The vaccine reportedly pro- Friday-Saturday, Oct. 22- Safeway Pharmacy, o a ma y 442 clinicsvbleathe provider following tects against three strains 23.Ages 18 years and older. Sims Way, (call of flu, including the H1N1 Medicare and insurance walk-ins 10 a.m.-1 p.m., appointments):virus. cards accepted;.all others, 2-4 p.m., Monday-Friday; Jefferson Medical Currently scheduled flu $25 cash. no appointments necessary. and Pediatric Group, vaccine clinics in Jefferson Port Hadlock Medical Ages 8 years and older. 834 Sheridan St., Port County are as follows: Care, 121 Oak Bay Road, Medicare, Medicaid and TOlympic ndPrimaBy Car8; Jefferson Medical Port Hadlock. No long insurance cards accepted; and Pediatric Group, 915 lines; call 379-6737 for all others, $30. Pneumonia 1010 Sheridan St., Port Sheridan St., lower level, appointment. Bring insur- and high-dose flu vaccines To wnsend,nsen379-8031 ; Port Townsend: 9 a.m.- ance cards as some may available.Jefferson Healthcare Physicians, 934 Sheridan noon, Saturday, Oct. 23. pay; all others, $25. Medicare cards accepted; Port Townsend Family and South County Medicall3500; South Townsend, �hsenCounty 5- all others, $25 cash or Physicians, 934 Sheridan Clinic: 6-8:30 p.m. 27. on Medical ouh2ounty check. No private insur- St., Port Townsend. Wednesday, Highway Clinic,, Quilcene, ance. Additional clinic to be Brinnon Comunity on Highway and Jefferson Center; 6-8 p.m. Public Health, Madrona Hill Urgent announced.FP1890 Thursday, Nov. 11 at County Care, 2500 Sims Way, Port QFC Pharmacy, Townsend: 9 a.m.-7 p.m. Irondale Road, Port Quilcene Community 615 Sheridan St.,9Port Monday-Friday, 9 a.m. Hadlock: 11 a.m.-5ursda p.m.,Octaccepted; others,Medicare$25 cash w walk-in immunizatio 4 p.m. Saturday. Ages 18 Wednesday-Thursday, years and older. Medicare 27-28, or by appointment or check. No private insur- Tayare 1-4 Thursdays, p.m. and insurance cards starting on Nov. 1. Ages 11 ance. accepted; all others, bring years and older. Medicare, State-supplied chil- and no appointment is $25 cash. Medicaid and insurance dren's flu vaccines are rec- needed. • . . frde6 ,aee, -, . / ',A/ j • • Lov e your septics stem Even septic systems septicy need a little tender, lov- operate; how to maintain tow they a knowrn about everything caringyou for ing care. Not sure how to smooth function; how to and treating septic sys- provide this? Learn all protect investments in terns well. Bring questions. about it at "TLC for Your septic systems; and cur- The Oct. 21 talk is at the Septic System," presented rent projects in Jefferson Cape George Fire Hall, by Linda Atkins,registered County that protect water 3850 Cape George Road, sanitarian with Jefferson quality. lk on County Public Health,from An update on the Oct. 28�issat enthe Tre aArea 6 to 8 p.m. on Thursday, Chimacum Creek Clean Community Center, 10 W. Oct. 21 and Oct. 28. Water Project will also be Valley Road, Chimacum. Atkins discusses the given. Call 3 day-to-day operation of Come to this class to nfor ag on.444 for more • ... , . • 0....., q , z.;i.6 46.-C oo n l ° 40 °�� 34a %mao 0c 8 ° CO Q2 b 4 gm a1 ° C ll1I .8 &.> x " § V/ M p,„ 00• o.�o,,•-• .b eons 0 'Tye N b d ° 0 . C O'y5 $a 3 8:.8 GO •�ia(• 0, 0 5 .4 ,C 3 o qcn 4.& v • v b 0 r O 2 o 0 0 0 0 2 .0 a0 0 >,§ m C g ( I , ay.z 4.Ou. Spd'I .E9 f d 5 U 4.o 0 8 y G . y o ="' o a) o•-. 0) a) a •^ .5 to N n , w aC) �bi,$ o►.v0y O x- cr. 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Offering reduced-fee care 12.A sliding-fee scale will be to children who might other- used and Medicaid accepted wise go without,'the nonprof- as reimbursement for ser- it Washington Dental Service vices,advised the foundation. Foundation's brightly colored Children through high- 38-foot traveling van will school age with limited access accommodate appointments to care can be scheduled there as follows: by phoning Maira Kessler • Monday, Nov. 8 from at Jefferson County Public 12:45 to 4 p.m. Health before Nov. 8 at 385- • Tuesday, Nov. 9 from 9432 or 385-9400. • S . • P/ ,Zezeder 7//'e> � ;sters -4 : ....,1,,,, • It's time to talk about dis- r- � � " , ' • '' 1�--�, abilities. October has been t'ry'st - ; "•� ' ' \ ,ta National Disability Awareness _ ) ! - .i i �'' and Employment Month. t` r. t 1 . • •. ti ,.,. Disabilities, including sen- ;,,TA, �' s - , I � � ' ,��; _ .� �a � - sort',physical,mental and cog 6,--A ., .-- 1 A _ iy�. __ _ - �,� t nitive disabilities, affect more y ii, ¢ ; , e";, than 5>130 people who live in t° "} , + n t' Jefferson County (more than i ,K, .,. �,.ar., -- -, , 1 19 percent of the population). 1 Jefferson County residents 1lth developmental dlSablh- :---, ':'':!--.-''Y'':-'7 tet ,11411111F P.. , , , ri !4 `>' f,,,,,;`:.-- ties are unemployed at least twice the rate of residents Displaying the"Everyone can work!"posters,which were created to spread awareness and employment oppor- without disabilities. tunities for those with disabilities,are(from left)Carl Hanson,Developmental Disabilities(DD)Advisory Board co chair;Lisa Falcon,Skookum program manager;Lesly Sheinbaum,OD Advisory Board cochair;Janie Nelson, Jefferson County Public Health and the Developmental Concerned Citizens program manager;and Anna McEnery,DD coordinator.Submitted photo Disabilities (DD) Program, in partnership with Skookum, be seen over the next year "Everyone can work!" rec- serious impact that attitudi- Concerned Citizens and the on posters that showcase local ognizes the demonstrated ben- nal barriers create,to work to DD Advisory Board, are pro- people with developmental efits of a diverse workforce eliminate these barriers and rooting the message"Everyone disabilities working in the and the valuable contributions to join in efforts to ensure can work!"This message will community. • of people with developmental that persons with developmen disabilities in the workplace. tal disabilities in Jefferson The hope is that this mes- County participate fully in sage encourages all commu- community employment Si) nity members to recognize the "everyone can work'... • • i P7.Ceac/e• -, Flu clinicsopen ., • Don't get caught without: your 2010-11 flu shot Concerned about flu sea- • QFC Port Townsend, son? You may be interested 515 Sheridan St.: Saturday, in one of these upcoming Nov. 13 11 a.m.-5 p.m. No Jefferson County flu clinics: appointment necessary. • Brinnon Community Medicare and insurance Center, 306144 Highway cards accepted; all others, 101: Wed., Oct. 27 6-8:30 $25 cash. p.m. Medicare cards accept- • Safeway Pharmacy,442 ed; all others, $25 cash or Sims Way, Port Townsend: check. No private insurance. Walk-ins welcome; • Madrona Hill Urgent Mondays-Fridays 10 a.m.-1 Care, 2500 Sims Way, Port p.m. and 2-4 p.m. Ages 8 Townsend: Available dur- and older. Pneumonia and ing regular clinic hours; high-dose flu vaccines avail- Monday-Friday 9 a.m.-7-p.m., able. Medicare, Medicaid Saturday 9 a.m.-4 p.m.Ages and some insurance cards 18 years and older.Medicare accepted; all others, $30 and insurance cards accept- cash or check. ed; all others, $25 cash. State-supplied chil- • Port Hadlock Medical dren's flu vaccines are rec- Care, 121 Oak Bay Road: ommended for all children No long lines; call 379-6737 ages 6 months through • for appointment. Public wel- 18 years old and are now come. Some cards accepted; available at the following all others, $25. clinics (call provider for • Port Townsend Family appointments): Jefferson Physicians, 934 Sheridan Medical and Pediatric St.: Additional clinic to be Group, 834 Sheridan announced. St., Port Townsend, 382- • Quilcene Community 4848; Olympic Primary Center, 294952 Highway Care, 1010 Sheridan St., 101: Thursday, Nov. 11 6-8 Port Townsend, 379-8031; p.m. Medicare cards accept- Port Townsend Family ed; all others, $25 cash or Physicians, 934 Sheridan check. No private insurance. St., Port Townsend, 385- • QFC Pharmacy, 1890 3500; South County Irondale Road,Port Hadlock: Medical Clinic, 294843 Wednesday-Thursday, Oct. Highway 101, Quilcene, 27-28, 11 a.m.-5 p.m. Ages 765-3111; and Jefferson 11 and older. By appoint- County Public Health, ment starting on Nov. 1. 615 Sheridan St., Port Pneumonia shots available. Townsend, 385-9400, with Medicare and insurance walk-in immunization clin- • cards accepted; all others, ics 1-4 p.m. on Tuesdays $25 cash. and Thursdays. • 0 .�, m-+ '5, 0 O N° - v uo v 0= 0 v E v _cu vv ') O O '0 u ° U GAO __ ro , ca a O2 0 , 0 0., w .oRo - 4. ,t,0 iav d ° Zia0.0- -0 LT.- v .d O ; v ,n n uj CU cL+U fa. -0'� a vv YC 74.3 E .> 0 c0 r. s v .. > s s 0., O v) O - cn • a ci p, � ri Nu^.0 Cz,0 E e.„-_,o ° v voC s3 v° Q, -0E p if Q :uN -' 0nv � H�W Q �0 rj Or�j n- 1- . vas b Q? �.' til �-. U b0 //gyp O bq ca ' v v O v �. . 3 . _ cc S"o v 04 ''' d sbo� ° �° aj -,-..— off ° °� ' t60 0 'nv v . °°0 . > v �> 3 vi0 G v, u U v° UTS �. 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A# ,4. ,, - ,1,-:,-,i-:.:::-‘,..,,,:'0,', ,.L '' �� r''�a r `; ' \„., .tel; tt ` \,= sy Port Townsend High School Student Taskforce members — front row, from left, Olivia Smith, Miranda Bagwell and Charlie Morris, and back row, Dakota Brown, Bob Warner and Coleman Riddle — attended the 2010iPrevention Summit in Yakima. Students attend prevention panel PENINSULA DAILY Nsws effective strategies to pre- • PORT TOWNSEND — vent drug use, violence and Members of , the Port destructive behaviors, and Townsend High School Stu- it provides opportunities to network with others work- dent Taskforce on reducing ing in drug prevention edu- underage drinking and drug cation, such as students, use recently attended the teachers, specialists, law 2010iPrevention Summit in enforcers,policymakers and Yakima. scientists. Olivia Smith, Miranda Also attending the con- Bagwell, Charlie Morris, ference were state Attorney Bob Warner, Dakota Brown General Rob McKenna and and Coleman Riddle partic- Miss Washington 2010 ipated in a service-learning Jacquie Brown. project, education work- Jefferson County Public shops and networking Health worked with Educa- activities with 200 adults tional School District 114 to and 300 students from secure scholarships and across Washington. travel stipends from the Convened since 1980, Attorney General's Office to the conference focuses on help fund the trip. ill , . . . ��•' , / -1 l/J;,,s— crl c '� '0 C v" 0 N y. ,; .:4- > G ifJ CC . O p >.Uo A A ..c/a5 m0 -. C• a' g 4 a ? gE- t) g5 °° T , m 0 a ai ca � hy � ''� 1 y'o� � p, v� :gym v] s; y,x � .. '4 : F •�' ori o'cU >-,m a '0 rr 3 g•n o aim 3 0 "1 0Uc�I- -• ' o ri ps `° oyo o o 6 o om1t voo g g co EO E .4 dU n . , ,. 00 CD • C '5 3a1 1-, c/ . OyoNd .I � o E-. $-$-.. oO ti 00y� -o O. 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Port Townsend&Jefferson County Leader JJ// f 1110 , dIJ-� g� kt*"' � �a Colton Shaw's poem,titled"The Nicotine,"is part of an anti-tobacco project for Debbie Berreth's eighth-grade health class at Chimacum Middle School.Submitted photo Stop smoking - urge these g Chimacum students Colton Shaw, eighth- to make the lessons inter- tobacco in middle school. • grade student at Chimacum active and interesting, so "If we can get students to Middle School,understands I asked the students to avoid tobacco during mid- nicotine addiction. You can write poems or advertise- dle and high school, there tell by reading his poem, ments discouraging tobac- is a very good chance they titled"The Nicotine": co use," she said. Local will never use tobacco," "Your mind needs anoth- middle school students said Karen Obermeyer er. Your body screams no. receive tobacco-addiction of Jefferson County If you could quit you would. education from health Public Health's Tobacco But the nicotine is hold- classes and programs with Prevention Program. ing you up. You reach for Jefferson County Public For more information your pack. For a second you Health. about tobacco prevention think, 'What am I doing."' Most students don't use efforts and local tobacco Luckily, Shaw and other tobacco. Only 14 percent cessation resources, con- Chimacum Middle School of Jefferson County 10th- tact Jefferson County students are learning graders smoked in the past Public Health at 385-9400. about the power of nicotine 30 days, according to the addiction in class, instead 2008 Health Youth Survey. of learning first-hand. That number is the same as Shaw wrote this poem as the state average and down an assignment in Debbie from 26 percent in 2000. Berreth's eighth-grade However, any student health class. smoking is one student . Berreth put her own too many, and those who spin on the substance do smoke often have their abuse health lesson, "I try first experience with • r 4 a^ s -s„,-1-,'"„''' Y ix, ,. �. r v 2°,*a ate., ":-,r S pw- .: , $.rte `xr `x ;tu P ' t. 4' 6 ,.f` 5 83 �. s 5 �8 1 �2 . � � �� fry. � "5� • y .:.y,,, CJS `� J f iV� \ \:. ave.A' `.,A', x `ti a 4 3s=a`.p' .. ~ '. 1, Prevent and protect Members of the Port Townsend Student Task Force on reducing underage drinking and drug use attended the Prevention Summit in Yakima Oct 14-16.The PTHS students participated in a service-learning project, educa tion workshops and networking activities with 200 adults and 300 students from across Washington,including Attorney General Rob McKenna.The conference focused on effective strategies to prevent drug use,violence,and destructive behaviors.Attending the con- ference were(backfrom left)Dakota Brown,Bob tteWarner,Coleman Riddle,(front,from left)Olivia Smith,Miranda Bagwell and Charlie Morris. Jefferson County Public Health helped to secure scholar- ships and travel stipends to send the students. I e • • City of Port Townsend , } .,-.--ed:-.....- :• t . --t ------ 9— y , •;: r ;F,.z n,1, a:ar,w * ..u„al' 't rarw, (360) 379-5047 (email: citycouncil@cityofpt.us) www.cityofpt.us November 2010 41 `. , From Mayor Joint Economic Development y Michelle Sandoval November brings a wrap up to the year In February of this year, the County, City and "� % 2010 for City Council as well as preplanning Port began working together to develop a for the year 2011. While budget discussions joint strategy for sustainable countywide economic de- can seem boring to all of us, we know they are the velopment. The three jurisdictions recognized that coor- essence of what we do as a government. City staff dination and collaboration are necessary for our commu- has made the budget documents very transparent nity to effectively compete in the broader regional, na- and extremely easy to understand. The documents tional and global economy. They understand that our are available on-line (on the city website) or in the community's economic future is anything but certain. City Clerks Office at City Hall. Obviously, no "magic bullet" will solve the economic At a time when all levels of government are strug- challenges affecting our community. Nevertheless, gling with budget deficits, the City is fortunate to be in there are opportunities to improve our economic health if a status—quo position. While we still have unmet the three jurisdictions work together, instead of sepa- needs, particularly our streets, we acknowledge the rately. The ultimate objective of this process then, is to vote the citizens passed two years ago to support our identify the actions that will benefit the entire community, library, parks and community services, as helping put and effectively cooperate to implement them. us in this relatively strong position. The third and final year of the library levy will be implemented in 2011. Between now and Thanksgiving, Team Jefferson will be conducting a series of focus group sessions with corn- Please, if you have questions about how your money munity business leaders and key stakeholders to dis- 0 is being spent, tune in to watch the budget process, cuss an economic vision for our community. From the download documents or read them on-line. Or better feedback provided in these sessions, Team Jefferson yet, come to a meeting and see us work through the will prepare a draft Economic Development Vision. budget for next year. For 2011 our planning starts now. Next year's work plan and budget go hand-in- During the last three weeks in January, a series of three hand. It's a good time to know what your city will be Community Workshop meetings will be held throughout concentrating on in capital infrastructure improve- the County to present the economic data, focus group ments, as well as outreach to our community through session feedback, and the Draft Economic Development initiatives and town meetings. Vision. These workshops will also provide an opportu- nity to solicit critical feedback, listen to community con- Stay involved; it's important to be aware that planning cerns, and hear proposed solutions. Participation from for our future begins now and our success as a corn- community members is highly desired! Specific dates munity depends on you. and times for the workshops will be announced in early December. CHETZEMOKA The Parks, Recreation & Trees Advisory Board Our first ship has come in! hosted an "Autumn Arbor Day" tree planting A--- tid (The Salish, our second ferry, will be event on Saturday, October 23. arriving next spring.) Join us Sunday, November 14, in celebrating the arri- Board members Rosemary Sikes, Forest Shomer, val of our first new ferry. Matthew Berberich, Daniel Collins, and The Chetzemoka will be formally christened at the Barbara Smith were joined by Parks employ- Coupeville (Keystone) terminal by Governor Christine ees Steve Wright, Teresa Fitzgerald, Michael Gregoire. A Native American ceremony will be held Spears and Jeremy Bubnick in the planting of on the Port Townsend side at approximately 12:30 twelve new trees along San Juan Avenue. ()pm. The boat will then be open to the public for an The event supported the City's Tree City USA Open House from 1-2:30 pm. At 3 pm, Port Town- send's Main Street will host a Community Por- status and promoted tree planting in autumn. The trait in front of the Chetzemoka. Everyone in town board plans on hosting similar events again in April is welcome to participate. For more details, visit & October of 2011. www.GoChetzemoka.com. 2010 Victorian Holidays Library Happenings! The holidays are a nostalgic time of Transition Yourself- year. In Port Townsend the street- In November, there will be four consecutive work- lamps are wrapped with live greenery and red shops for job seekers that cover career develop- • bows and local merchants decorate their win- ment, job search, strategic planning and marketing. dows in the spirit of the season. o Nov.4 -Attitudes Promoting Change and Resources Starting November 2, enter the Holiday �o®� Nov.5 -Skills Identification and Resume Building Sweepstakes for a chance to win $1,000 in local Nov.9 -Branding Statements and Interviewing merchant gift certificates on December 4. Nov.10 -Marketing Strategies and Networking Saturday, November 27, will be the Merchants' All sessions are 9:30-11:30 a.m. at the Pink House, Holiday Open House. Many merchants will stay 1256 Lawrence. Contact Susan Wilson at ptplhard- open later to welcome their customers with re- times@gmail.com or leave a message at 344-4608. freshments and in-store specials. From 2-4 pm Sharing Resources - there will be caroling in the streets with The Wild • Rose Chorale and carriage rides (for a small A three-way collaboration between the City fee) will be offered by Port Townsend Livery. PT School District and the City Library has The 2010 holiday ornament features the new been formalized to build better library services. ferry "Chetzemoka." Proceeds from this limited This agreement will allow for collaboration in the edition benefit the Port Townsend Main Street areas of collections management, program devel- Program, a 501c3 nonprofit dedicated to the opment, and professional and skill development health of Historic Districts. that will allow for the possibility of coordinating book Shop locally, shop Port Townsend! purchasing, accessing a shared library catalog with The Washington Dental Service Foun- delivery service, and creating shared programs for + enhancing reading skills. g dation is bringing the SmileMobile to itsour area and will be parked at the The Library Collaboration Committee, which con- Chimacum High School Nov. 8-12. sists of representatives from the school district an The SmileMobile, a modern, fully equipped, the libraries, and consultant Kris Mayer, will meet regularly as they develop new programs. mobile dental clinic, travels around the state providing dental care to children who have no other access to care. Automated External Defibrillator (AED) » AES If you have questions about the SmileMobile or The City is purchasing and installing would like to schedule a visit, please contact AED's in the following public buildings: Karri Amundson at 206-528-7339. 1. City Hall 2nd Floor November 18 2. Mountain View Commons Police The Great American Smoke Out 3. Mountain View Commons Swimming Pool 0.. A day to QUIT TOBACCO 4. City Shops Main Office cigarettes - cigars - chew 5. Library Administration Office 6. Water Quality 5210 Kuhn Street Office Make a commitment for this to be your last year as a smoker. At each facility a team of responders will be trained in the use of the Powerheart AED G3 Plus. Staff FREE & Confidential help that can double your Emergency Response Team members will corn- chances of quitting: The Washington State Quit plete a state-approved initial training course that Line at 1-800-QUIT-NOW (1-800-784-8669) or includes CPR, defibrillation and basic first aid. www.quitline.com. The device can be used on any victim who is in Jefferson Healthcare Tobacco Cessation Sup- sudden cardiac arrest, is unresponsive and not port meets Wednesdays 5pm-6pm. For more breathing normally. It is our intention to provide a• information call 385-2200 ext. 2300. For a com- safe environment for everyone who accesses our plete list of local tobacco cessation resources facilities whether they are a visitor, a patron, meet- call Jefferson Co. Public Health at 385-9400. ing attendee, or an employee. ski / / /�,` / �v y iq/ , a i , °,n/ ,./ahs ;. ,s/53y • var4 _ ...1s:.::.:u::..a......:q...�i., 6.._.y.c !:F. !v . .-�a rl�-_..�... a.�i m ake .� ... ., � .S mCk1n • ub tcPlac ssx v x' k x xr : BusinessAwaren s www.c ityofpt.us/News Lette r/2010/11.pdf �7 www.jeffersoncountypublichealth.org/pdf/Food_News.pdf City of Port Townsend - - e , staff d `- -- 6od Siii'''FV- ice NTe ..f,.,,,---- Ell @e+0)379 5047( I ry kap H fp[w) ry fit s November o From Mayor Michelle Sandoval Joint Economic D- • .,rad T ` Jefferson ((``[[��i November 50095awrap up to the year In F-• t1t - 1, LV1111l11 ° 2010 for City Council as wet as preUla! cope!1 cooks Public-llP"�l - (� �V\ Q,✓ ' for the Year 207 I.ydhlle budge NON cope BPGGO onom!c do- l Q•� e p�aC m W"a can seem°sing to all of us,we t"0\ TO �N -d that coon- (�R�,ru" �ei oaf' �a^`�' essence of what we do as a g She weal. )\I at5-Che t yeat our comma- • I\ e a„bac'P`esou has made the budget documents P day es-o,9 out\as rot,n0- -•' °'° �ea.�o b, and extremely easy to understand Cl9atee tY\ls to be y that our , S0°11°1* '`e s09 o.o ras are available on-line(on the city'w: •Jp�y fOtIkAe o'J -rtain _ Seat"a H:0 a t°.. City Clerks Office at City Hat. ke e cot(tttt\ttn that cah d�rjtate Qolc is �Oil '"s _JP State,:a,N fi elawP° e<or Pers°^t^�nar$ e At a time when all levels of g.'"'-'''' Ma Ket e\ t0 91 a eo 5 ovn' Ka"^u giing with budget deficits.the City�5 f.e5 0 5m0 °ntlk, .-c\e`N o,5 gQO-�g4•g66 salm•if '� t N s I n E de 5 b c C"P Cie yusiness hat oP�'&arr a a status-guo position.while we nil l h- e R.G Ul(tln9 'N(.• a- F I's l s s u E: i eC ',..,-,---"° a sibll`�o{ eA� meows t. needs.particularlyour streets we ac: : °e5 00\I tion a to the, eresp P,a°°r`" s 'S'et<�' FRE' of Q N guP' on no, w! vote the citizens passed two year ed I.Ohara t 1_800- fn. Gesso, of thOt ni r r !t'cs t!` 5re°" 8 sat a,g'''''.5 end^c library.parks and community_erv"c.,,.a e e C E ry' a CO° Sop 5pm,6P One a. Eot a cobra o i ^ h!s sr8^ ,one a\t10: 5 0 tce5 energy QOst^,sm� th'1.'feei ' tee h ,fig Caj 3as_a4 on Ne dnesday eXt._c tesou a NeY I aFpa� z reds". nio t s ° o 8((et5 vde 22p0 atlOn o40�' precen.I Pro �t cvs �� :o'S et>ort°pjOiOt time- potf mei On Oaets \\Sao m°°°°ea\tY\at 3g5 food Waste _ 0,s P'"''''o409 h' ^st Ince so, Assistance. a \ N "" lt•hy oh s d"" n t a I get starced \tltO�e\t5t°f\OO GO.Pup\lO : tet c E^°i°Ye5 ye Qaes e - Red through the heektvt pce\\det{ets°n � 5 i g:e Grcen Bu. r e so,., o ," eh'uc Plias Sa;in$ III n Draw material . ,ens. Free"No Smoking"sign included in Fall 2010 issue Smoking No VM- iiFiEle-aittioareli!!ProvirdersTrainingEOpportunitiesin nimisintereaseQuittinitv _ _ .:.:::...::.:.:-. .—. ..5...!:F. E v,:.::::::.-:�c:��:x:::e:-dee.�...:u:::: ' ::::c::::::::.:n.:.::::cc::::aa*.�. c:::.:.:. '::: !:!x:............:..!:Fel Tobacco: The Next Recovery Challenge? ifiiiiiin ate C epahent of Health Addressing Tobacco Use in ) 1 b i i.. 1), Chemical Dependency Treatment 11-8006-0111T-NOW This free course will assist treatment agency adminis- tausfratx 3.80 0 x?8a<sa69 trators and counselors in starting the process of inte- OUITLINE . COM grating nicotine treatment within their programs. INCREASE in Calls to Quit Line by Jefferson Co. resider Many treatment providers are begi •. - akimert 2007 64 challenge to address tobacco •- fey kSe -koC • 2008 110 grams for compellin' - depend,,kCa�r�r9 • 2009 143 pendence, to. - is F� •eo le • Jan–June 2010 83 creme kv\\, p with s ���ecoo o�eCed d ska orders, tobacco t.diep�nt i ac��\� •irstca�‘on ado dependence at thedsameden- Quit Line Promotion includes: dm Medical Providers, libraries, food banks,paycheck stuffers, em- time as o a . .nces, and may improve treatment out- ployee break rooms, waiting rooms,teen centers,community S. centers, area businesses, all media promotion :x<xx<x: x:Rli;!;<xx:x;ixxxxx;<;<x xxx xx.mill<xx xxyx;<mxxxgnm!,„„,;!xx<;<;<rixxxrxx;iarixxi;<;mili xy�;;<;<;<xx x:x;<ira i x; ,,::..x: x::x::x::x::x::x::x::x::x::x:.x::x::x::x::.x::x::x::x:.x:x:x. q'a � x`x xexxxxxxxxxxxxxxxxxx �1`.x x xx :x:.: x.x x:x'xxx: �;' �.. x xxRxxs ` xxx' �' �`�x x:.�x;�xxx..x,x..x.x xxx xx�xxx..xxx..x x ��xxx..xxx::xxx aN%rt,xxx;<x:x,xxx x.x, y; x..�t�ll�x,,.�t� M,�:e;<:„:e:;.%,fix I. I. 0 Port Townsend&Jefferson County Leader ,. , ,,v,,4t4,f,„'",,' V"'TkYLP..t.',1 ""'';r''-rag N\1 4 ,�' rixf .a'_ ::K ^` � ti M1y vr..A0� n ,. v, �`* .#,tea,`o' 3E- ;.a'',t!xbiu.- * .. Supporting women's health Bickie Steffan of the Port Townsend Main Street Promotion Committee (left)and Nancy Schrier,owner of Personalize It!present a check for $2,272.50 to Julia Dans kin of the Jefferson County Health Depart- ment.The funds were raised by the sale of goody bags and cowgirl hats at Main Street's Girls'Night Out event in October.October is Breast Cancer Awareness Month, and merchants donated gener- ously to help the Breast and Cervical Health Program for cancer screenings for local women in need.Schrier donated items for all the goody bags and hats.The event was sponsored by the Main • Street Program, Jefferson Healthcare and 23 participating mer- chants. • ///d'//o Iffleii ; sr' bIomi::si; Appeal: Group says project will r _ significantly increase pollutants `Al I n ,..„_. , .,, rmi CONTINUED FROM Al The environmental [Tuesday] that an appeal of n PP groups said that the project our permitting decision for Ecology's order also sets will significantly increase the Port Townsend Paper • Action parallel ` • _ R., stricter pollution limits for such pollutants as nitrogen Corp.'s boiler and fuel sys- the upgraded boiler than oxides, carbon monoxide tern upgrades has been Filing against the mill's current limit,the and mercury, which will filed. to protest of Nipponplansstate.department said. cause harm to human "We understand that Eveleen Muehlethaler, health and the environ- the company's with most permit decisions due inspringvice press- ment. we make there is an oppor- PA generator dent for environmental The appeal also said that affairs, told Jefferson the Ecologytunity for an appeal. BY CHARLIE Ba u nrrr PENINSULA DAILY NEWS County officials in a letter permitting pro "In this case, our first cess failed to consider the PENINSULA DAILY NEWS An appeal of the envi- m October that the project impact on regional forests step is to work closely with ronmental assessment of will include an extensive of removing large amounts our legal counsel and evalu- PORT TOWNSEND—A coals- upgrade to air pollution of forest wood to feed the ate specific points alleged in tion of environmental groups has the Nippon Paper Indtts control equipment,produce the appeal." filed an appeal challenging tries USA Inc.biomass cogeneration boiler. PP glrig a state project is expected to be renewable electricity,reduce "The mill is in a flood- County Community permit that will allow the Port filed in thea rin . fossil fuel burning by plain, a tsunami zone and Development Director Al Townsend Paper Corp. mill to 1.8 million gallons per year an expand its biomass capacity. The five groups that earthquake zone that is Scalf said the mill will need have filed an appeal with and create 30 full-time jobs next to several neighbor- to meet building and water The five groups are among the the state Pollution.Control- and the equivalent of an hoods,"Brewer said. quality codes for the project, additional 35 jobs during "For Ecology to say this which is slated to start next seven that also oppose the Nippon Hearings Board against the Paper Industries USA Inc.'s bio- construction. is `environmental) g $55 million proposed Port. _ y able." year, though it is not now ss project in Port Angeles. Representatives of the " e appeal filed Monday with Townsend cogeneration gest private cant'is unconscionable. known if appeals will slow ro•ect, lan—alongwith mill — the lar tate Pollution Control Hear- P P employer in Port Townsend, EColo responsethe process. the Center for Environ gy's mgs Board is in response to the which employs some 285 state Department of Ecology's mental Law and Policy of people;`the mill said on its" In•an, e mail,• Ecology Spokane and the Cascade website'— do•not provide'•spokesperson - • Kim : Jefferson County_ Reporter granting Oct. 25 of a "notice of Chapter of the Sierra Club comments to the press as Schmanke-wrote.. Chariie'Beirrianc n tie�e rmant C construction"permit for the Port —to'appeal Nippon's standard policy. "Ecologyreceived word' p3eninsuladailynews.com coemermant® Townsend mill's$55 million proj- $71 million biomass proj- ect and its July finding that the ect,the coalition's attorney, biomass project had no probable Toby Thaler,said. Nippon: Council hearing set Dec. adverse environmental impact. Thaler said the environ- "We feel that Ecology's omis- mental assessment will be sion of a full environmental review appealed to the hearing CONTINUED FROM Al day,Dec.6,at City Hall,321 would replace an existing was anegligentact,",did Gretchen^---lArtin4:af er-the-Olympic E.Fifth St. oil and biomass-fired boiler Brewer, a member of PT Air- Region Clean Air Agency The seven groups also The environmental Watchers,one of the plaintiffs. approves air-quality per- have appealed the issuance groups contend that the newat is 50 boiler, old witha a "Many of the people who ,, nuts for the project of a shoreline management shoreline management per- new biomass boder steam responded during the comment permit for the project,which mit should have listed Nip- turbine generator and asso- period asked for that •review,and TURN TO NIProN/A4 is expected to create Port pon's proposal as an electric ciated facilities. Ecology ignored those wishes,"the Angeles' Nippon biomass utility Nippon, which employs Port Townsend resident said. project. The Nippon cogenera nearly 200 people,hoped to As much as 24 megawatts of A hearing on the shore- tion plant would produce 20 begin construction this year Other organizations electricity would be produced for line development permit is megawatts of electricity ford have the facility ready Along with PT AirWatchers, sale. set before the Port Angeles sale. for testing in the second the appeal was filed by No Bio- "The Port Townsend Paper City Council at 6 p.m.Mon- The proposed facility quarter of 2012. mass Burn of Seattle,World Tern- Biomass Cogeneration Project perate Rainforest Network,Olym- will provide 200,000 kilowatt pic Environmental Council and hours per year of green alte- rna- Olympic Forest Coalition. tive energy to the power grid,"the Ecology's October order allows paper mill said in a statement the mill to move ahead with plans available on its website at www. to install a steam turbine and ptpc.com* upgrade its power boiler, after This is enough to support which time the boilers primary 15,500 homes annually,"the mill ource will be wood waste said. 1, as biomass or hog fuel. 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L u 4,, _ --,7,1,,'''a� 1\))._,..1_.7,.): Cir[ l --,.4 Stafe Department of (4trtill '`-=.. _ _�..r—'__• www.doh.wa.gov • Teen Pregnancy Rate (live births and abortions) • Jefferson County Pregnancy rate per 1,000 women age 15-17 pregnancies women age 15-17 Jefferson Clallam Mason WA State 1990 16 326 49.1 69.8 111.1 57.5 1991 17 351 48.4 62.2 62.4 56.7 1992 18 371 48.5 54.5 55.1 57.5 1993 18 387 46.5 39.5 67.9 55.2 1994 13 407 31.9 33.6 60.4 51.9 1995 15 438 34.2 45.3 61.3 49.2 1996 12 462 26.0 40.5 51.4 45.5 1997 19 484 39.3 35.6 47.4 44.2 1998 20 495 40.4 49.4 54.3 41.1 1999 18 497 36.2 34.7 41.5 38.0 2000 21 499 42.1 25.0 48.8 36.3 2001 20 500 40.0 33.9 35.1 32.9 2002 11 500 22.0 29.4 46.8 30.9 2003 17 496 34.3 23.4 27.0 28.8 2004 10 495 20.2 22.7 30.5 28.5 2005 10 508 19.7 29.8 39.3 27.6 2006 7 519 13.5 30.0 32.4 27.6 2007 5 525 9.5 24.7 38.2 28.7 2008 10 518 19.3 21.3 32.0 26.7 2009 5 506 9.9 22.6 34.4 24.0 • Jefferson rate significantly decreasing by 13% per year since 2001,statistically unchanged from 1990 to 2000. 2007-09 20 1549 12.9 22.9 34.9 26.5 Jefferson 2007-09 rate significantly lower than WA State and Mason County Source:Washington State Dept.of Health,Center for Health Statistics,Vital Statistics Database, Accessed in:Community Health Assessment Tool(CHAT) • Jefferson County Public Health December 2010 Teen Pregnancy Rate (live births and abortions) • Jefferson County Pregnancy rate per 1,000 women age 15-17 pregnancies women age 15-17 Jefferson Clallam Mason WA State 1990 16 326 49.1 69.8 111.1 57.5 1991 17 351 48.4 62.2 62.4 56.7 1992 18 371 48.5 54.5 55.1 57.5 1993 18 387 46.5 39.5 67.9 55.2 1994 13 407 31.9 33.6 60.4 51.9 1995 15 438 34.2 45.3 61.3 49.2 1996 12 462 26.0 40.5 51.4 45.5 1997 19 484 39.3 35.6 47.4 44.2 1998 20 495 40.4 49.4 54.3 41.1 1999 18 497 36.2 34.7 41.5 38.0 2000 21 499 42.1 25.0 48.8 36.3 2001 20 500 40.0 33.9 35.1 32.9 2002 11 500 22.0 29.4 46.8 30.9 2003 17 496 34.3 23.4 27.0 28.8 2004 10 495 20.2 22.7 30.5 28.5 2005 10 508 19.7 29.8 39.3 27.6 2006 7 519 13.5 30.0 32.4 27.6 2007 5 525 9.5 24.7 38.2 28.7 2008 10 518 19.3 21.3 32.0 26.7 2009 5 506 9.9 22.6 34.4 24.0 • Jefferson rate significantly decreasing by 13% per year since 2001,statistically unchanged from 1990 to 2000. 2007-09 20 1549 12.9 22.9 34.9 26.5 Jefferson 2007-09 rate significantly lower than WA State and Mason County Source:Washington State Dept.of Health,Center for Health Statistics,Vital Statistics Database. Accessed in:Community Health Assessment Tool(CHAT) • Jefferson County Public Health December 2010 1 it F. f y.' CI IRISTPNE 0.GREG4)3Rk Governor SI ATE OF WASHINGTON OFFICE OF THE GOVERNOR PO. Boa 40002 • Olympia, Washington 98504-0002 • (350) 753-61780 • ww.governor wa.boa; December 15, 2010 David Swink,Chair Washington State Association of Local Public Health Officials 206 Tenth Avenue SE Olympia, WA 98501 • t Dear ;OM• Today, I released my proposed budget for 2011-13. Few alive have witnessed a recession of this magnitude and length. Those who have will understand that the choices we face are tough. They also know that our better days are ahead of us—that we will emerge stronger,more efficient and more effective. We have a significant challenge in closing a$4.6 billion shortfall when we've already cut deep over the past three years. We have slashed state spending by$5.1 billion. We shrank the state work force by 8,200 people, instituted temporary layoff days,froze travel and eliminated other expenses. Yet we must still do more. The choices I faced in writing this budget were some of the toughest I've ever tackled. Quite simply,there are no good options. In this budget we eliminate agencies and programs,cut additional jobs and further reduce services to our citizens. In any other time I would not sign this budget. But this is not any other time. It's a time that requires choices that can protect only our most core services while laying a new foundation for a 21"century government. By necessity, state government will be smaller. With less,and fewer people to do it,we will do less. Yet we must not only cut,we must restructure, modernize,prioritize and position our state as a 21'century leader. It's not just about this crisis—it's about setting our state on a trajectory that ensures a strong financial foundation for our kids and grandkids. To do that I've proposed significant pension reform that will save$368 million in the next biennium and$11 billion over the next 25 years. I've proposed changes in health care that will save the entire state–our taxpayers–$26 billion over the next 10 years. These savings are needed to provide much needed funding for our essential services. I'm proposing to reduce the footprint of state government by continuing the consolidation of natural resources agencies and centralizing government administrative services. t David Swink December 15,2010 Page 2 These initiatives are just the beginning. I am committed to transforming the state budget and transforming the way in which the state works for Washingtonians. The steps I am proposing will radically alter the landscape of state government. Legislators have a big challenge before them,but together we will make reform happen. The impacts of budget reductions will be felt in the health care arena as well. As you know,the state provides subsidized health care, in full or in part,to well over a million state residents. While this should be a source of pride for us,it also poses serious budget concerns when the economy is performing poorly. The reason is simple—much of our state budget cannot be cut either because of our state constitution,court decisions,or federal law,which means that large cuts fall disproportionately on the provision of health care. The list of those services we can no longer afford and therefore we propose to eliminate or reduce is long and heart-breaking--the Basic Health Plan,the Children's Health Program, and the Disability Lifeline Medical Program, school-based medical service reimbursement,medical interpreter services, and local public health services. The bottom line is that these cuts will dramatically impact people. And,while we are proposing extraordinarily difficult cuts,we have been able to save some of the most vital of services including hospice care,pharmacy benefits, occupational and physical therapy, and acute care for over one million Medicaid recipients. This is not a budget that represents my values and I believe it does not represent the values of our state. The safety net will be stretched thin in some places and eliminated entirely in other places. For the services that government no longer will be able to provide, we must turn to our health care providers and carriers,neighbors,private charities,faith-based organizations and other local programs. Our communities,more than ever,will be asked to step up. I have struggled to craft a budget that is both balanced and consistent with my values. Some of the cuts I am proposing are in direct conflict with what I care about most,but I was simply unable to find alternatives. In the end I did my best,using both my heart and my mind,to maintain the most critical government functions and to make sure that every dollar we spend provides real value to our citizens. We will do what we have to do to get through these rough times and we will lay the foundation for a future that will once again reflect the values of Washingtonians. We have a difficult job to do,but I believe we can do it. Sincerely, 64.4.06;7 Christine O. Gregoire 17frigrf Governor "r4g