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HomeMy WebLinkAbout2011- July File Copy • Jefferson County Board of.1 (earth .Agenda Nlinutes • July 21, 2011 • 411 JEFFERSON COUNTY BOARD OF HEALTH July 21,2011 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 June 16,2011 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. Board Correspondence 2 Kitsap County Seasonal Food Establishment Policy iV. New Business 1. Public Hearing: Revisions of Environmental health Fees Regarding Food Service Establishments 2. Community Report—Port Townsend/Chimacum Food Bank Report 3. Water Quality Outreach Projects 4. Standards for Public Health in Washington State: Jefferson County Public Health 2011 Performance Review 5. Changes in Washington State Law Regarding Exemptions to Immunization requirements for School Entry VI. Activity Update VII. Agenda Planning Calendar: VIII. Next Scheduled Meeting: August 18,2011 2:30—4:30 pm Jefferson County Public Health a JEFFERSON COUNTY BOARD OF HEALTH • MINUTES Thursday, June 16, 2011 - 2:30 PM—4:30 PM Public Health Conference Room, 615 Sheridan Street, Port Townsend Board Members Staff Members Phil Johnson, Vice Chair, 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, Chair,Port Townsend City Council Sheila Westerman, Citizen at large(City) Jill Buhler,Hospital Commissioner,District#2 Chair Kristen Nelson called the meeting of the Jefferson County Board of Health to order at 2:30 PM. A quorum was present. Members Present: Phil Johnson, David Sullivan, John Austin, Roberta Frissell, Kristen Nelson, Sheila Westerman, Jill Buhler Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin, Stuart Whitford • APPROVAL OF AGENDA Ms. Danskin recommended that New Business,Item 4; Community Report—Port Townsend/Chimacum Food Bank Report be moved to the July 21,2011 BOH meeting. Member Westerman moved to approve the agenda as amended and Member Johnson seconded for approval. The agenda was approved unanimously, as amended. APPROVAL OF MINUTES Member Sullivan moved for approval of the April 21, 2011 BOH meeting minutes; Member Buhler seconded. The minutes were approved unanimously. PUBLIC COMMENTS Larry Dennison, owner of Dos Okies Barbeque in Port Townsend, commented on the new proposed permit charges and requirements for temporary food service permits. In previous years Mr. Dennison was allowed to purchase an annual temporary food service permit for all catering and special events. With the new proposed fee changes, Mr. Dennison will be required to apply and pay for a new permit for every event. Mr. Dennison said Dos Okies will experience a minimum increase of 217% in total permit fees, including a potential 600% increase in temporary food service permits for 2011. Mr. Dennison urged the board to consider a decrease in these fees. S a OLD BUSINESS and INFORMATIONAL ITEMS Adverse Childhood Events May 2011 Article—American Journal of Public Health Ms. Baldwin announced that the article on Adverse Childhood Events in the Mental Health Discussion, written by Dunia Faulx, Jean Baldwin, Quen Zorrah, Denis Langlois, and Lisa McKenzie was published in the American Journal of Public Health. Jefferson County Public Health—WIC Facts 2010 Ms. Danskin presented the WIC Facts 2010, which was included in the packet. She highlighted the amount of grocery dollars and Farmers Market dollars that come in to our county from the federal government. Ms. Baldwin stated that they are trying to do more outreach to low income families who might not know they are eligible to receive WIC services. Green Business/EnviroStars Awards Ms. Danskin informed the Board that Port Hadlock Marina and The Car Wash have met the guidelines for reducing hazardous waste. Port Hadlock Marina has been awarded the EnviroStars certification and The Car Wash has been awarded the EnviroStars and Green Business Certification. • NEW BUSINESS Food Service Awards -Presentation Mr. Whitford announced that there were 40 restaurants and proprietors who were being recognized for their hard work in 2010 to maintain excellent food safety standards. Chair Nelson recognized and congratulated the restaurants and proprietors that were present to receive their award. Environmental Health Food Permit Fee Discussion and Recommended Call for Public Hearing Ms. Baldwin announced that the food worker classes,testing and cards are now available on line at https://www.foodworkercard.wa.gov. Due to a mistake in the 2011 Environmental Health Fee Schedule, Mr. Whitford asked the Board hold a Public Hearing to correct the fees for Grocery Stores (1-3 check outs) and Espresso Stands were reversed. • Susan Porto, Environmental Health Specialist, discussed WAC 246-215 which defines a • "temporary food establishment" and the permitting requirements for those events. Previously Environmental Health issued temporary food service permits that were valid until the end of the current calendar year and could be used for an unlimited number of events at multiple locations. In reviewing the State code they discovered that the code had been misinterpreted. In 2011they changed how they handled Temporary Food Service Permits. A Temporary Food Service Permit is valid until the end of the year. Multiple events may be approved for food operations meeting the temporary food establishment definition with a fixed menu and at a fixed location. A new permit is required every time the menu and/or location changes. The fee schedule only has a category for single event or multiple event temporary food service events in a fixed location. There is no fee category for a recurring food service event that occurs in multiple locations. They are currently charging separate fees for events that do not qualify for a multiple event category, which has brought on complaints from vendors about the changes in interpretation and the associated cost. Mr. Whitford recommended a change to the fee schedule for Temporary Food Service Events to reflect a more reasonable approach, because the code and the fees associated with those events are not in line. Member Westerman requested that someone talk to the prosecuting attorney to see if the permit and application can be handled through e-mail to reduce the burden on the vendors. Chair Nelson asked to see information regarding the way other counties are handling temporary • food permit issuance. Mr.Whitford suggested that there may be better long term solutions. Right now a fix is needed to relieve an undue fee burden and at a later date discussion could be opened up to look at policies and procedures to streamline the permitting process for next year. Member Sullivan moved to schedule a hearing on the proposed revisions of 2011 Temporary Food Service Fees as provided in the handout and to fix the mistake regarding the reversal of the fees for the Espresso carts for the July 21,2011 BOH meeting. Member Johnson seconded the motion. The motion passed unanimously. Member Westerman moved to temporarily suspend collection of the fees for repeat, same menu, different location events until the Public Hearing on July 21, 2011 when a new fee could be considered. Any changes to this fee would then be retroactive to the date collection of the fee was suspended. Member Buhler seconded the motion. A vote was taken; the motion passed unanimously. Health of Jefferson County Data Summary Dr. Locke said that one of the reasons that the Health Department creates reports on the health of Jefferson County is because it is their statutory responsibility to do periodic community health assessments. The goal has been that the information would be used to drive prioritization, • decisions, to identify unmet needs, and allocate resources to those needs and guide policy makers in making better decisions. Dr. Locke stated that one of the Board's statutory duties, as the ones supervising all matters pertaining to the life and health of Jefferson County residents, is to use these reports to look for opportunities for prevention and community health improvement. Reports of this type can identify community health problems that need to be addressed. Dr. Locke stated that another important use of this information is to priorities for action once problems have been identified. Ms. Baldwin focused on how to read the data,because Jefferson County is an older and wealthier community,which skews the data and may not give a clear picture of where the issues may lie. Ms. Baldwin also addressed the healthy youth survey, its findings, and potential areas of concern as state and federal budget cuts take effect. She mentioned other entities that have used the information i.e., EDC, City Council, Public Works, and DCD. Ms. Baldwin pointed out some of the data that has changed significantly over the past decade. Per capita income and median income have gone up, while average earnings per job have declined. Suri Kushner, Epidemiologist for Kitsap Health District continued to highlight some of the data in the report. There were increases in persons living below 100% of the federal poverty level, kids on free and reduced lunches and births that were reimbursed by Medicaid. She pointed out that while the number of free and reduced lunches is up, funding for extracurricular activities for students is gone, and those programs are being eliminated which affects the quality of life for students. Ms. Baldwin stated that it is known that homelessness is a critical issue. Jefferson County has • seen an increase in homelessness. The data may not tell us why homelessness has gone up, but we do know who is using the shelters, and this could be an action item. Ms. Kushner suggested that community service providers could capture real life experiences that would bring these numbers to life since just reading this report may not be very useful to the general public. Ms. Baldwin stated that when looking at the issues that have been focused on over the past years the data shows that the numbers are going in the right direction. Ms. Kushner pointed out that the data shows the amount of women that report smoking during pregnancy continues to be high. This is an area to focus on when looking at tobacco use. Dr. Locke concluded with asking the question; where we go from here. He stated that is important to pay attention to community health assessment data because it is part of Public Health's core mission to measure the impact of policy decisions. Dr. Locke pointed out that something positive he is seeing is that community health assessment is moving from local health jurisdictions to more of a community partnership model with the hospitals playing a central role in developing what have come to be known as Community Health Improvement Plans. Substance Abuse Advisory Board Nomination . • Member Sullivan moved to appoint Kay Pownall to the Substance Abuse Advisory Board; Member Austin seconded the motion. The motion was approved unanimously. Washington State Budget Update Ms. Baldwin announced that the governor signed the 2011Biennial Budget June 15, 2011. Ms. Danskin also pointed out that the budget starts on July 1, 2011, so there are many contracts that will be coming in to place. The packet included a handout that outlined the Department of Health funding showing reductions in funding for many programs, totaling a reduction of about 11% in state funding dollars. Ms. Baldwin stated that the immunization and communicable disease program funding known as "5930" was cut by 50%. Member Frissell recommended that press releases may be beneficial when there are state budget cuts so the public knows why programs are being eliminated. Mr. Whitford announced that Environmental Health received a$300,000 grant from Department of Ecology which will help them to respond to the Port Hadlock shellfish growing area issues, and they will also be partnering with the City of Port Townsend to help deal with storm water . issues. He also announced that Environmental Health received $80,000.00 so that Jefferson County can do their own local source control program to look at businesses that impact storm water. The site hazard assessment program will most likely continue at the same amount of funding as last biennium. Finally he announced that the Coordinated Prevention Grant looks good, but they do not have any firm numbers yet. ACTIVITY UPDATE Ms. Baldwin stated that there will be the Public Hearing at the July BOH meeting and she will provide the Public Health Standards report. AGENDA PLANNING CALENDAR The next scheduled BOH meeting will be held Thursday, July 21, 2011 from 2:30-4:30 PM at the Health Department, 615 Sheridan Street, Port Townsend, WA. ADJOURNMENT Chair Nelson adjourned the BOH meeting at 4:37 PM. • JEFFERSON COUNTY BOARD OF HEALTH • JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday,June 16,2011 -2:30 PM—4:30 PM Public Health Conference Room, 615 Sheridan Street, Port Townsend Boardners Staff Members Phil Johnson, Vice Chair, 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, Chair,Port Townsend City Council Sheila Westerman, Citizen at large (City) Jill Buhler,Hospital Commissioner,District#2 Chair Kristen Nelson called the meeting of the Jefferson County Board of Health to order at 2:30 PM. A quorum was present. Members Present: Phil Johnson, David Sullivan,John Austin,Roberta Frissell, Kristen Nelson, Sheila Westerman, Jill Buhler Staff Present: Dr. Thomas Locke, Jean Baldwin,Julia Danskin, Stuart Whitford APPROVAL OF AGENDA Ms. Danskin recommended that New Business,Item 4; Community Report—Port Townsend/Chimacum Food Bank Report be moved to the July 21, 2011 BOH meeting. Member Westerman moved to approve the agenda as amended and Member Johnson seconded for approval. The agenda was approved unanimously, as amended. APPROVAL OF MINUTES Member Sullivan moved for approval of the April 21,2011 BOH meeting minutes; Member Buhler seconded. The minutes were approved unanimously. PUBLIC COMMENTS Larry Dennison, owner of Dos Okies Barbeque in Port Townsend, commented on the new proposed permit charges and requirements for temporary food service permits. In previous years Mr. Dennison was allowed to purchase an annual temporary food service permit for all catering and special events. With the new proposed fee changes, Mr. Dennison will be required to apply and pay for a new permit for every event. Mr. Dennison said Dos Okies will experience a minimum increase of 217%in total permit fees, including a potential 600% increase in temporary food service permits for 2011. Mr. Dennison urged the board to consider a decrease in these fees. OLD BUSINESS and INFORMATIONAL ITEMS Adverse Childhood Events May 2011 Article—American Journal of Public Health Ms. Baldwin announced that the article on Adverse Childhood Events in the Mental Health Discussion,written by Dunia Faulx,Jean Baldwin,Quen Zorrah,Denis Langlois, and Lisa McKenzie was published in the American Journal of Public Health. Jefferson County Public Health—WIC Facts 2010 Ms. Danskin presented the WIC Facts 2010,which was included in the packet. She highlighted the amount of grocery dollars and Farmers Market dollars that come in to our county from the federal government. Ms. Baldwin stated that they are trying to do more outreach to low income families who might not know they are eligible to receive WIC services. Green Business/EnviroStars Awards Ms.Danskin informed the Board that Port Hadlock Marina and The Car Wash have met the guidelines for reducing hazardous waste. Port Hadlock Marina has been awarded the EnviroStars certification and The Car Wash has been awarded the EnviroStars and Green • Business Certification. NEW BUSINESS Food Service Awards -Presentation Mr. Whitford announced that there were 40 restaurants and proprietors who were being recognized for their hard work in 2010 to maintain excellent food safety standards. Chair Nelson recognized and congratulated the restaurants and proprietors that were present to receive their award. Environmental Health Food Permit Fee Discussion and Recommended Call for Public Hearing Ms. Baldwin announced that the food worker classes, testing and cards are now available on line at hans://www,foodworkercard.wa.gov. Due to a mistake in the 2011 Environmental Health Fee Schedule, Mr. Whitford asked the Board hold a Public Hearing to correct the fees for Grocery Stores (1-3 check outs)and Espresso Stands were reversed. IP • Susan Porto,Environmental Health Specialist,discussed WAC 246-215 which defines a "temporary food establishment"and the permitting requirements for those events. Previously Environmental Health issued temporary food service permits that were valid until the end of the current calendar year and could be used for an unlimited number of events at multiple locations. In reviewing the State code they discovered that the code had been misinterpreted. In 2011they changed how they handled Temporary Food Service Permits. A Temporary Food Service Permit is valid until the end of the year. Multiple events may be approved for food operations meeting the temporary food establishment definition with a fixed menu and at a fixed location. A new permit is required every time the menu and/or location changes. The fee schedule only has a category for single event or multiple event temporary food service events in a fixed location. There is no fee category for a recurring food service event that occurs in multiple locations. They are currently charging separate fees for events that do not qualify for a multiple event category,which has brought on complaints from vendors about the changes in interpretation and the associated cost. Mr. Whitford recommended a change to the fee schedule for Temporary Food Service Events to reflect a more reasonable approach,because the code and the fees associated with those events are not in line. Member Westerman requested that someone talk to the prosecuting attorney to see if the permit and application can be handled through e-mail to reduce the burden on the vendors. Chair Nelson asked to see information regarding the way other counties are handling temporary food permit issuance. Mr.Whitford suggested that there may be better long term solutions. Right now a fix is needed to relieve an undue fee burden and at a later date discussion could be opened up to look at policies and procedures to streamline the permitting process for next year. Member Sullivan moved to schedule a hearing on the proposed revisions of 2011 Temporary Food Service Fees as provided in the handout and to fix the mistake regarding the reversal of the fees for the Espresso carts for the July 21,2011 BOH meeting. Member Johnson seconded the motion.The motion passed unanimously. Member Westerman moved to temporarily suspend collection of the fees for repeat, same menu,different location events until the Public Hearing on July 21,2011 when a new fee could be considered. Any changes to this fee would then be retroactive to the date collection of the fee was suspended. Member Buhler seconded the motion. A vote was taken; the motion passed unanimously. Health of Jefferson County Data Summary Dr.Locke said that one of the reasons that the Health Department creates reports on the health of Jefferson County is because it is their statutory responsibility to do periodic community health assessments. The goal has been that the information would be used to drive prioritization, decisions,to identify unmet needs,and allocate resources to those needs and guide policy makers • in making better decisions. Dr. Locke stated that one of the Board's statutory duties, as the ones supervising all matters pertaining to the life and health of Jefferson County residents,is to use these reports to look for opportunities for prevention and community health improvement. Reports of this type can identify community health problems that need to be addressed. Dr. Locke stated that another important use of this information is to priorities for action once problems have been identified. Ms.Baldwin focused on how to read the data,because Jefferson County is an older and wealthier community,which skews the data and may not give a clear picture of where the issues may lie. Ms.Baldwin also addressed the healthy youth survey, its findings, and potential areas of concern as state and federal budget cuts take effect. She mentioned other entities that have used the information i.e.,EDC,City Council, Public Works,and DCD. Ms. Baldwin pointed out some of the data that has changed significantly over the past decade. Per capita income and median income have gone up, while average earnings per job have declined. Suri Kushner,Epidemiologist for Kitsap Health District continued to highlight some of the data in the report. There were increases in persons living below 100% of the federal poverty level, kids on free and reduced lunches and births that were reimbursed by Medicaid. She pointed out that while the number of free and reduced lunches is up, funding for extracurricular activities for students is gone,and those programs are being eliminated which affects the quality of life for students. 111 Ms. Baldwin stated that it is known that homelessness is a critical issue. Jefferson County has seen an increase in homelessness. The data may not tell us why homelessness has gone up,but we do know who is using the shelters, and this could be an action item. Ms. Kushner suggested that community service providers could capture real life experiences that would bring these numbers to life since just reading this report may not be very useful to the general public. Ms.Baldwin stated that when looking at the issues that have been focused on over the past years the data shows that the numbers are going in the right direction. Ms. Kushner pointed out that the data shows the amount of women that report smoking during pregnancy continues to be high. This is an area to focus on when looking at tobacco use. Dr. Locke concluded with asking the question; where we go from here. He stated that is important to pay attention to community health assessment data because it is part of Public Health's core mission to measure the impact of policy decisions. Dr. Locke pointed out that something positive he is seeing is that community health assessment is moving from local health jurisdictions to more of a community partnership model with the hospitals playing a central role in developing what have come to be known as Community Health Improvement Plans. Substance Abuse Advisory Board Nomination • • Member Sullivan moved to appoint Kay Pownall to the Substance Abuse Advisory Board; Member Austin seconded the motion. The motion was approved unanimously. Washington State Budget Update Ms. Baldwin announced that the governor signed the 2011Biennial Budget June 15,2011. Ms. Danskin also pointed out that the budget starts on July 1,2011, so there are many contracts that will be coming in to place. The packet included a handout that outlined the Department of Health funding showing reductions in funding for many programs,totaling a reduction of about 11%in state funding dollars. Ms.Baldwin stated that the immunization and communicable disease program funding known as "5930"was cut by 50%. Member Frissell recommended that press releases may be beneficial when there are state budget cuts so the public knows why programs are being eliminated. Mr. Whitford announced that Environmental Health received a$300,000 grant from Department of Ecology which will help them to respond to the Port Hadlock shellfish growing area issues, and they will also be partnering with the City of Port Townsend to help deal with storm water • issues. He also announced that Environmental Health received$80,000.00 so that Jefferson County can do their own local source control program to look at businesses that impact storm water. The site hazard assessment program will most likely continue at the same amount of funding as last biennium. Finally he announced that the Coordinated Prevention Grant looks good,but they do not have any firm numbers yet. ACTIVITY UPDATE Ms. Baldwin stated that there will be the Public Hearing at the July BOH meeting and she will provide the Public Health Standards report. AGENDA PLANNING CALENDAR The next scheduled BOH meeting will be held Thursday,July 21,2011 from 2:30-4:30 PM at the Health Department,615 Sheridan Street, Port Townsend, WA. ADJOURNMENT Chair Nelson adjourned the BOH meeting at 4:37 PM. 0 JERSON COUNTY B RD OF HEALTH ilk ,......*. (fit Kristen Nelson, Chai Phil John Vice-Chair P iAire64.),L, J ill Buhler, Member Jo Austin, Member / ' Roberta Frissell,Member David ulliv. , Member 11_22; (4,..._ La..(2,,,4e,, v....,....„....____ Sheila Westerman,Member • • • Jefferson County Board of afealth 0C Business .agenda Item # IV, 1 Board-Correspondence • ,July 21, 2011 1 From: Larry Dennison [mailto:Idennison@q.com] • Sent: Monday, July 11, 2011 4:35 PM To: boh@jeffersoncountypublichealth.org Cc: Jean Baldwin;john austin; Kris Nelson; Stuart Whitford; Tom Locke; Alison Petty; Susan Porto Subject: Comments for Public Hearing on July 21 RE: Changes in Temprorary Food Service Permits and Fees Dear Health Board Members, I am writing to urge you to reconsider the actions being proposed by the staff regarding a change in policy, process,and fees associated with Temporary Food Service Permits at your July 21 Public Hearing. Staff has determined that the state health code(WAC 246-215)requires a separate permit for each individual temporary food service vending event. They have proposed a full-fee permit for each event,with the exception of additional events at a fixed venue or location as long as the menu does not change. So a food vendor who was going to do food concessions at several Centrum music events,for example,would pay$130 for the first event,and$30 for each subsequent event as long as the venue and menu don't change. However each change of menu or venue would require a full-fee permit of$130. Before this change in policy Jefferson County has had a general temporary food service permit that provided exactly the same information as individual permits--location,menu,access to water and other facilities,food safety proceedures,etc. The only difference was that all these individual events were allowed under a single seasonal permit requiring only one permit fee. This has worked very well both for the Health Dept.and vendors for at least ten years. All activities are still permitted but not duplicated over and again,as this new proposal would require. I have learned that Kitsap County has a very similar policy allowing"Seasonal", mulitiple event permits for those vendors who rely on multiple concessions in the summer. Here is their permit and fee structure,which can be found at the following URL: • http://www.kitsapcountyhealth.com/environmenta health/food/docs/temp event pkg.pdf Kitap County CATEGORY FEE LATE FEE *Complex Menu Jefferson Co. During work hours, single event $85.00 $20.00 $130 During non work hours, single event $109.00 $25.00 $130 *Seasonal, multiple events $149.00 $30.00 $130 (prior to new rules, but not available under new rules) Note: Jefferson County Late Fees are 50% of the permit fee (eg.$65 for Temporary Permit) I have highlighted in red,the Seasonal Temporary Permit and its attendant fees for multiple events to show Kitsap is allowing virtually the same mulitple-event permits we have been using in Jefferson County for the past ten years at approximately the same fee structure. It is very curious,not to mention illogical to me that Kitsap would be knowingly breaking the state health rules as established in WAC 246-215. Rather,I suspect that their policy is based upon a different interpretation of the state WAC which,you will see,does not . require"mulitiple permits" but rather it simply requires certain activities to have a permit. I can assure you that requiring individual permits for each activity is a huge new burden on those of us who absolutely depend on the revenue we get from our food concessions at these small and large local events. Each permit requires a minimum of a half-hour of my time just to complete. More time is required to deliver the permit application. The cost of$130 for a permit for a small event certainly will determine whether it is worth the extra employees,time,cost of mobilization,investment in special electrical and food service equipment,and vehicle transportation costs,not to mention the vendor fees charged by the venues. All the external fees and taxes charged to my last Centrum event came to nearly 15%of my gross. That makes a small event marginal or not worth the effort. Another consideration for you as policy makers is the increased time it takes for Health Dept.staff to process multiple individual permits when staffing is already stretched very thin. If there was a definable"problem" these changes were designed to address,like an increased incedence of food-borne illness from temporary food service establishments or definable increased risk to public health as a result of the old seasonal permit policy it would make more sense. But so far,no one has admitted there is an increase in illness or risk associated with the current system. Besides creating a real financial risk for food service owners who are marginally profitable in these very hard economic times,these complicated new rules will create a significant new workload on existing staff. I fear the unintended consequences of a new policy that does not focus on a definable health problem or risk and that significantly burdens both local businesses and the Health Dept. Staff. I urge you to stop this process now and reinstate the previous rules that are essentially the same as those in our larger neighboring county(Kitsap)at least until these very important issues I have raised have had a very thorough review and discussion. These new changes were first announced to the food service community in our permit renewal correspondence at the beginning of the year. I knew nothing of these changes until they had been implemented and charged to my annual permit bill. This is not an effective or even a legitimate way to treat stake-holders in any public process. When such significant changes are made • they simply must be thoroughly vetted through stake-holders(us),policy makers(you),and the staff so that everyone understands(a)the problem(b)the goals(c)the needed outcomes(d)the roles of the stake-holders, and(e)a process to determine if changes are truly working as intended. That process has not existed and the one used has created confusion and mistrust--not good policy outcomes. Please get this process back onto a reasonable and workable track so we can solve real problems as opposed to imaginary ones. Thanks for your time and attention to this important issue. Larry Dennison Dos Okies Barbeque 2310 Washington Street Port Townsend,WA 98368 360 385-7669/Cell 301-0120 www.dosokiesbarbeque.com i . • • KITSAP COUNTY SEASONAL FOOD HEALTH ESTABLISHMENTS DISTRICT Individuals or groups selling and/or serving food at multiple temporary events may apply for a Seasonal Food Service Establishment permit. Seasonal permits are good for six (6) months from the date of issue. A seasonal permit establishment operates at a fixed location not to exceed twenty-one (21) calendar days in conjunction with a single event or operates at a fixed location not more than three days a week. Groups or individuals planning to serve food from a fixed location for a period exceeding twenty-one (21) consecutive days or more than three days a week must apply for an Annual Food Service Establishment Permit. PROCEDURE Submit (1) facility setup plans, (2) a Temporary Establishment Permit application, and (3) Food Preparation Procedures of Menu Items form to the Health District for review and approval. Include all plumbing, types of equipment, and placement. Give capacities of fresh water and wastewater tanks, and • location of dishwashing facilities. Please note the source of the water being used, the proposed wastewater disposal site, and all menu items. Include your name, name of the business, mailing address, and daytime phone number. The Temporary Food Establishment Permit will be issued by a Health District inspector after conducting an inspection of your set-up. The inspection will be conducted at your first event. At the time of the first inspection submit your Event Itinerary for the season. GENERAL REQUIREMENTS 1. The same menu must be used for each event. Menu items may only be changed by additional review and approval. All food must be prepared and cooked on-site or an approved facility (e.g., a licensed restaurant or department-approved kitchen). Cooling is not permitted on-site at a temporary event. 2. The water used for food preparation, handwashing, sanitizing solutions, and dishwashing must be from a water system approved by the health department. Freshwater holding tanks are to be made of food-grade sanitizable materials, and must be sanitized daily. 3. Wastewater from your Seasonal Food Establishment must be disposed of in an approved manner. If a wastewater holding tank is used, it must be made of durable, leak-proof construction, and be at least 15% larger than the • freshwater tank in size. The dumping site for the holding tank must be approved. There is to be NO dumping wastewater down storm sewers, • into waterways, onto the ground surface, or in residential septic systems. 4. A hand washing station must be set up in the food preparation area. The hand washing station must be set-up before food preparation begins. The hand washing station requires an adequate supply of running hot and cold, or warm, water between 100°F - 120°F. Soap and paper towels are required at each handwashing station. 5. All food contact equipment requiring drainage, such as refrigerators (non- evaporator style), ice, pop, and espresso machines, must be plumbed into the wastewater holding tank. 6. The restroom must be available within 200 feet of the temporary event setup for employees. As per the Washington State Retail Food Code, hand washing facilities must be immediately available to the toilet facilities. The restroom must be available during all business/preparation times. 7. All food contact surfaces must be smooth, durable, non-absorbent, and easily cleanable. No bare wood surfaces are to be used for food preparation. 8. Enough hot- or cold-holding equipment must be available to maintain hot food at 140° F or above, and/or cold foods at 41 ° F or below, at all times. 9. There must be at least one person with a current Washington State Food Worker's Card present in the food preparation area at all times during the event. . 10.Booths must have a roof or canopy extending over all food preparation, storage, and service areas as appropriate. 11.Approved sanitizer and wiping cloths must be present at all times during food preparation, service and cleanup. 12.A metal-stem thermometer that reads temperatures from 0 - 220°F must be present and properly calibrated. 13.Dishwashing facilities must be public or semi-public for inspection purposes. Home-use kitchens are NOT approved. Dishwashing facilities must contain, at a minimum a three-compartment sink with drainboards. 14.Food Worker Cards or copy must be available on site. A complete event itinerary must be submitted. If you plan to add events to your itinerary, you must notify the Health District within 5 working days prior to the event. If you are at an event that is not on your itinerary, you will be required to purchase a Temporary Event Permit. A minimum of two routine inspections will be conducted per season. If there are any critical item violations found during the inspection, a follow-up inspection will be conducted. Only the first follow-up inspection will be conducted at no charge. If more than one follow-up inspection is needed, there will be a charge for each additional inspection conducted during the season. • KITSAP COUNTY Seasonal Food Establishment • VIEA1hulISTRICT Event Itinerary Food Safety Program 345 6`"Street, Bremerton,WA 98337 (360) 337-5235 www.kitsapcountyhealth.com Establishment Name: DateTime(s) Event/Location • Please notify the Health District of event not noted on itinerary 5 days before the event. Events attended and not listed on the itinerary will be charged a temporary permit single event fee. • \\swwgbdc2\food\common\winword\temp packet\seasonal itinerary.doc Jefferson County Board of.1CeaCth OCcCBusiness Agenda Item # IT, 2 • Xitsap County Seasonal Tooc(Tstabfishment Policy JuCy 21, Zoic • • BOARD OF HEALTH July 21st 2011 Amendments to an Ordinance Establishing a Fee Schedule for Jefferson County Public Health, Ordinance No. 10-1216-10 Temporary Food Service Permit Fee Modifications In the past,Jefferson County Public Health was allowing temporary food service vendors to conduct multiple food service events in different locations under a single food service permit valid for one year. This practice has been determined to be inconsistent with the Washington State Food Code and needs to be changed. The State Food Code requires that changes in the location or menu of a food service event require a new temporary food service permit. Proposal: • The first event application be assessed the full permit fee in accordance with the fee schedule as existing. Current fees are $98 for a limited menu permit, and $130 for a complex menu permit. • Any vendor who then chooses to sell at other festivals or fairs,within the same calendar year, and has the same menu as the initial application can pay$30.00 fee for each additional event. • This fee will cover the cost of printing additional permits, abbreviated in office review, and limited oversight of the vendor at successive events. • Board of Health approve the modified fee schedule as presented. • • Staff work with Food Program Roundtable members to discuss other methods of regulating temporary service establishments that would be consistent with current state and local food code. Correct Error in Current Fee Schedule Proposal: • Correct Grocery Store(1-3 checkout)and Espresso Stands fees(to correct clerical error) as follows: ✓ Change Grocery Store (1-3 checkout)to $174.00 ✓ Change Espresso Stands to$136.00 Background as presented during June 16th Board of Health Meeting As a preface: The fees associated with a Temporary Event in Jefferson County since 2010 have been: • $98 for a low risk limited operation or • $130 for a complex menu with potentially hazardous foods. • Per WAC 246-215 the following definition: (26) "Temporary food establishment"means a food establishment: (a) Operating at a fixed location, with a fixed menu, for not more than twenty-one consecutive days in conjunction with a single event or celebration, such as a fair or festival;or • (b) Operating not more than three days a week at a fixed location, with a fixed menu, in conjunction with an approved, recurring, organized event, such as a farmers market. Past Practice: The temporary food service permit application states: A temporary permit is valid until the end • of the current calendar year and can be used for an unlimited number of events, provided that the events are not more than 3 days a week, with an organized recurrent event or not more than 21 days in a row with an organized event. Events may be changed or added if notification is given to the Environmental Health Department a minimum of 10 working days prior to the proposed change. Please proved address for each event(Attach additional sheets, if necessary) In practice, this meant that regardless of the above definitions, we permitted vendors to participate in multiple events at multiple locations associated with any kind of food service that was not an annual permit application, for one fee. This included occasionally those not associated with an organized event, such as requesting to set temporary food service in front of the co-op or other establishment, for a day or so Revised Practice: The temporary food service permit application will state: A Temporary permit is valid for a specific event. This event may be either a single event lasting up to 21 days or for an approved, recurring, organized event that occurs three or fewer times per week. . Changes in the location or the menu of a temporary food service activity requires a new temporary food service permit. Under the Washington State food code, an "event" can be one of two different types: 1) a"single • event or celebration" lasting for 21 days or less or 2) an "approved, recurring, organized event, such as a farmers market". In both types of events the temporary food service must be operating at a fixed location and have a fixed menu. • This is what we now understand to be the correct interpretation of the Federal and State food codes. For events of the first type (e.g. fair or festival) a temporary food service permit is need for each event. For events of the second type (e.g. farmers market) a single temporary food service permit can be used for a recurring event as long as it does not exceed the 3 times/week limit or involve a change in menu or location. We do not restrict"approved, recurring, organized" events to only farmer's markets. Other recurring events which use the same location (e.g. Centrum events or Waterfront music events) are eligible for the recurring event permit. Temporary food service activities in which there is a change of location or a change in menu require a new food service permit. The fee for this permit is determined by the Board of Health. Issues for this year's process: • Fees for a temporary permit are the same as last year, but we are charging separate fees for events that do not qualify for a multiple event category, according to the language in code. • Vendors who have been to the County over the years have complained about the change in interpretation and associated cost. • This"reset" of the permitting process, has taken significantly more staff time in discussion with vendors to ensure consistency. • 4 • Jefferson County Board of 3-Cealth Netiv Business & Informational-Items .agenda Item # 'V, 1 Public 3-fearing: • Revisions of Environmental Wealth Fees Regarding Food Service Establishments July 21, Zoic STATE OF WASHINGTON JEFFERSON COUNTY BOARD OF HEALTH • AN ORDINANCE TO AMEND Ordinance No. FEE SCHEDULE FOR JEFFERSON COUNTY PUBLIC HEALTH Section 1 —Effective Date Section 2—Fees Section 3—Severability Section 4—Prior fee schedule repealed WHEREAS,the purpose of this ordinance is to amend the fee schedule for Jefferson County Public Health, WHEREAS, adoption of this Ordinance will further the public policy memorialized in Chapter 246-215 WAC as well as other chapters of the WAC and RCW, WHEREAS,this Ordinance promotes the health, safety and welfare of the citizens of Jefferson County, and WHEREAS,this Ordinance is proposed and may be enacted pursuant to the general police power granted to Jefferson County and its Board of Health by the State Constitution, •NOW, THEREFORE,BE IT ORDAINED by the Jefferson County Board of Health as follows: Section 1 —Effective Date That this Ordinance (and its Attachment) shall be effective as of July 21, 2011. Section 2—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 Attachment A to the proposed Ordinance. Any text listed on Attachment"A", specifically text within the column entitled"Additional Fees and Other Information" is deemed regulatory rather than advisory and as such has the full force and effect of local law. Section 3—Severability A determination that any text, fee or fees adopted as part of this Ordinance is unlawful or illegal shall not cause any other text, fee or fees adopted as part of this Ordinance not affected by that determination to be repealed, revised, or reduced. Section 4—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. JEFFERSON COUNTY PUBLIC HEALTH ENVIRONMENTAL HEALTH DIVISION ENVIRONMENTAL HEALTH 2011 FEES Proposed Additional Fees and Other Information Changes GENERAL • Health Officer Administrative Hearing 287.00 Administrative Hearing Appeal 287.00 Technical Assistance/Plan Review-Minimum 65.00 Technical Assistance/Plan Review-Per Hour 65.00 Filing Fee 49.00 ONSITE SEWAGE DISPOSAL Sewage Disposal Permits New Conventional520.00 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 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 620.00 Valid for 3 years Alternative 663.00 Valid for 3 years Repair/Upgrade/Modification/Designate Reserve Area 115.00 Applies to existing installed sewage disposal system Expansion 387.00 Redesign 115.00 _ _Applies to_pending or active but not installed Reinspection 144.00 Evaluation of Existing System/Monitoring Inspection Septic 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 WaiverNariance Application 172.00 WaiverNariance 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 General environmental health review fee 73.00 Licenses Installer,Pumper,Operator(maintenance person) 387.00 Retest 158.00 Annual Renewal 273.00 , Delinquent Renewal after January 31 387 00 FOOD SERVICE ESTABLISHMENT FEES PERMIT FEES(Annual Permit) ',. Restaurants/Take-Out(Based on menu complexity&seating-menu changes may change category 0-25 seats(Limited Menu) 174.00 No cooling or reheating 0-25 seats(Complex Menu) 310.00 Cooling and reheating allowed 26-50 seats 310.00 _ 51-100 seats372.00 101-150 seats422.00 With Lounge,add136.00 Separate lounge area Bakery Business 136.00 ` B&B 174.00 Caterer w/commissary or catering-only kitchen 310.00 w/restaurant,additional fee for catering - 174.00 Concession/Commercial Kitchen/Church 136.00 Espresso Stand 174.00 136.00 Grocery 1-3 checkouts136.00 174.00 May serve pre-packaged baked goods >3 checkouts 422.00 Meat/Fish Market 310.00 Mobile Unit Limited Menu 174.00 No cooling or reheating Complex Menu 310.00 Cooling&reheating allowed School Cafeteria Central Kitchen 310.00 Warming Kitchen 174.00 • Tavern w/food(see Restaurants) Annual Permit Issued after September 1 50%of fee 50%of Annual Permit Fee Late Fee(Paid after January 31) Eliminate No Fee-Close establishment if permit isn't renewed Late Fee(Paid after February 28) Eliminate _ No Fee-Close establishment if permit isn't renewed 1 of 2 7/11/2011 2:11 PM ENVIRONMENTAL HEALTH 2011 FEES Proposed Additional Fees and Other Information Changes Temporary Permits- Complex 1oo_30 nn Cooking&assembling potentially hazardous food Lirnited 98.00 Low risk foods w/minimal preparation illSingle Events Limited Menu Initial Application(First Event) 98.00 98.00 Not to exceed 21 days at your location Additional Events(Same Menu) 30.00 Not to exceed 21 days at your location Additional Events(Different Menu) 98.00 Not to exceed 21 days at your location Complex Menu Initial Application(First Event) 130.00 130.00 Not to exceed 21 days at your location Additional Events(Same Menu) 30.00 Not to exceed 21 days at your location Additional Events(Different Menu) 130.00 Not to exceed 21 days at your location _Organized Recurring Events(e.g.Farmers Markets) Limited Menu Initial Application(First Event) 98.00 Not to exceed 3 days at your location Additional Events(Same Menu) 30.00 Not to exceed 3 days at your location Additional Events(Different Menu) 98.00 Not to exceed 3 days at your location Complex Menu Initial Application(First Event) 130.00 Not to exceed 3 days at your location Additional Events(Same Menu) 30.00 Not to exceed 3 days at your location Additional Events(Different Menu) 130.00 Not to exceed 3 days at your location +50%u of fee Additional(Paid when application is submitted less than 7 Late Fee for Temporary Permits days prior to the event) Other Food Fees Waiver 37.00 Plan Review Pre-opening inspection 65.00 Per Hour Minimum 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 Managers Course 211.00 SOLID:WASTE, . ' a 4Wizinx . - : . , • 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 149.00 Inspection of well construction,decommission& Application Fee _reconstruction Determination of Adequate Water Supply 62.00 Building Permit Process Well Site Inspection-Proposed public water supply 298.00 LIVING,ENVIRONMENTS"(Annual Permit)+, r, Pool 273.00.�n 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 i 2 of 2 7/11/2011 2:11 PM fb Jefferson County Board of.9CeaCth New Business & Informationalltems Agenda Item # 1/, 3 • Water Quality Outreach Projects July 21, 2011 i • ,Jefferson County Board of HeaCth Netiv Business & Informational Items Agenda Item # 17, 4 Standards for Public 3feaCth • in "YVA State: . Tefferson County Public Health 2011 Performance Review July 21, 2011 • Standards for Public Health in Washington State Jefferson County Public Health • 2011 Performance Review Report (Basic Set) The Standards and the 2011 Performance Review Thank you for participating in the performance review of the Standards for Public Health in Washington State.The intent of the Standards is to provide an overarching measurement framework for the many services, programs, legislation, and state and local administrative codes that affect public health. With permission from Public Health Accreditation Board (PHAB), the 2010-2011 Standards for Public Health in Washington are based on the PHAB Standards(Beta Test version) as well as recommendations from the 2008 Washington State site reviews. In late 2010 the Public Health Standards Workgroup,with approval from the Public Health Improvement Partnership, developed a Basic Set of public health performance standards for the 2010-2011 Standards Review cycle.This set of standards contains • approximately 40%of the measures found in the Washington `required' set of standards. The intent was to reduce the burden on smaller local health agencies and to encourage statewide participation in the standards review. Agencies had a choice about the scope of the 2010-2011 review.Those who wanted to prepare for accreditation in the future could use this cycle to prepare by agreeing to be reviewed on all standards and measures. Local health agencies had three options for their type of review: 1. The full set of PHAB/National Standards as well as several Washington only measures 2. The Washington set of standards and measures(80%overlap with the PHAB Beta set) 3. The Basic set (reduced set by 60%fewer measures than the WA set) This Report The site reviews again demonstrated the incredible commitment, creativity and hard work of the people in the public health system.This report is specific to your local health jurisdiction and is intended to give you feedback about the documentation you provided as a demonstration of how you met each measure. However, before describing the details that are in the report, we want to summarize overall observations regarding your organization's strengths and opportunities for improvement as observed during the standards review. S 2010-2011 Public Health Standards Performance Review Report May 13, 2011 1 Strengths • Written Policies regarding Confidentiality and HIPPA requirements • Process and protocols to maintain collect data from multiple sources for comprehensive review and analysis of surveillance data • Conducting and disseminating health data focused on population health status and issues facing the community • Investigating health problems and environmental public health hazards to protect the community including the timely investigation and reporting of notifiable diseases, lab test results and investigation results • Maintaining written protocols and implementing a system to receive and provide health alerts and appropriate response on a 24/7 basis • Risk Communication Plan • Development of public health policies and plans • Conducting enforcement activities • Numerous exemplary documents representing multiple strengths in your programs • QI improvement efforts Areas for Improvement • Implement a Quality Improvement Plan • Establish and implement quantifiable and time-framed measures and outcomes in all program • areas and activities The Performance Review Approach The performance review included the 2010 Department of Health review as a PHAB Beta Test site and 34 local health jurisdictions (LHJs) sites. Each site was asked to use the appropriate Guidelines to prepare for the performance review, organizing documentation supporting the review of each measure. During the performance review, an independent consultant from MarMason Consulting, LLC evaluated the documents and scored each measure. For those LHJs that opted to submit documentation for either the full PHAB/National standards or the Washington Standards,an internal DOH reviewer also participated in the scoring. When the reviewer had questions regarding the documentation, an informal interview was conducted with the appropriate manager or staff person from the agency. In addition, potential exemplary practice documentation was collected from each site.The reviews concluded with a closing conference in which general strengths and opportunities for improvement were discussed, and feedback on the standards and assessment process was obtained.All of this information will be compiled into a statewide system report, with recommendations regarding the next steps for the performance improvement of public health practice across the State. Results of the Site Review The attached report is organized into three sections. First there is a summary showing Part A and each of the ten domains and the performance on each measure in each standard.This section is color coded 2010-2011 Public Health Standards Performance Review Report May 13, 2011 2 • with green to indicate that the measure was demonstrated,yellow to indicate that the measure was partially demonstrated and red to indicate that the measure was not demonstrated.The measure is blank if it was scored as 'not applicable.' This summary gives the agency immediate information on performance in each of the standards.The second section is a detailed summary for each measure with a list of all the documents used to score the measure and related comments for all measures applicable at the agency level. In this second section, measures that were scored at the program level show the calculated score derived from the program scores and the documentation and comments for all programs.The third section of this report is the program detail with the list of documents and comments for each of the programs reviewed for the LHJ.The scores from each of the programs were aggregated to provide a single score for that measure at the agency level that is reported in section two. Comparability to Previous Results Due to the adoption of the PHAB standards, a major revision from the previous WA Standards, as well as changes in the type of review for many measures, comparison with the three earlier cycles of standards review cannot be made. Scoring and Related Information in the Site Reports For each measure scored by the reviewer: o 2=demonstrates the measure, • o 1= partially demonstrates the measure, o 0=does not demonstrate the measure, Note that some measures were Not Applicable due to scoring in previous measures or the determination that they are not part of the activities of a specific program and these measures are noted as NA. Comments provide clarification regarding the intent of the measure or the score assigned. Documents lists, in abbreviated form,the documents that were the basis for the score. When multiple documents were provided and some did not demonstrate the measure or there were many more examples than needed,they are not all listed. For each Standard: at the end of each Standard, there is a roll-up of the scores on all applicable measures in the Standard (the percent of measures scored as demonstrates,the percent scored as partially demonstrates,the percent scored as does not demonstrate). Next Steps First,celebrate what you have accomplished. In the period between the 2008 Performance Review and this performance cycle, it was clear to the site reviewers that improvements had been developed and implemented.Again,thank you for all of your hard work every day and especially for your work in • preparing for the standards reviews. 2010-2011 Public Health Standards Performance Review Report May 13, 2011 3 Next,select the areas where you want to improve your performance. All of the information provided in this report is intended to support improvement of your organization's work on behalf of the citizens in your community and Washington State. After you have had a chance to digest this report and share it with staff and your Board of Health, you should review the data again to determine which areas of your work might benefit from a focused improvement process. Develop a brief, but specific and doable work plan—don't try to improve everything at once! In selecting your areas of improvement you will be able to look at your overall strengths and opportunities for improvement(summarized above), or at the scores of specific Standards or measures. You will be assisted in this effort by several initiatives: • Exemplary practices:The Exemplary Practices Compendium provides you with documentation from many of the LHJs in Washington State. Potential exemplary practice documents were gathered from each of the sites and the very best examples for each measure will be organized into an electronic tool kit. This material will be available at www.doh.wa.govJphip/Standards/BestPracticesJStandardsExemplaryPractices.htm. • Statewide initiatives such as the Multistate Learning Collaborative and other efforts like the 5930 Initiative provide opportunities for formal efforts to improve performance. Based on the recommendations in the system wide report,the Public Health Improvement Partnership will adopt additional statewide initiatives related to the measures. Finally, begin preparing now for the next performance review.The Standards Performance process • itself has been conducted using quality improvement principles and methods, including the Plan-Do- Study-Act cycle. At this time,the next cycle is planned for 2013-2014. Strategies for building on your current performance: • Save the documentation you have used in this cycle as a good starting point for continuing to identify documentation for demonstrating performance. • Establish an electronic document library for collecting documentation and to facilitate the continued use of an electronic format for the next cycle. • Adopt or adapt as many exemplary practices as possible to improve your performance against the measures.There is no reason to 're-invent the wheel,'when another LW may have an excellent process or documentation method that you can start using with less time and effort. • Identify methods for getting technical assistance from state programs, or from other LHJs that may have targeted the same areas for improvement. Great gains can be made through sharing ideas and resources. Again, we thank you for all your work in preparing for this performance review, and especially for the terrific work you do in protecting and promoting the health of the citizens of Washington State that we were privileged to review. 2010-2011 Public Health Standards Performance Review Report May 13, 2011 4 Jefferson County Public Health Summary Site Report Score Key: • 2= Demonstrates 1 = Partially Demonstrates 0 = Does Not Demonstrate NA= Not Applicable Overall Score Totals =S- ash_,,,. Demonstrated 94% Partially Demonstrated 6% NOT Demonstrated 0% Note: Totals may not equal 100% due to rounding • The entire report can be found on our website at: www.jeffersoncountXpublichealth org Click on 'About JCPH'. S 2011 Standards Review Report Page 6 • Jefferson County Board-of.9Cealth Netiv Business & InformationaCltems Agenda Item # 5 Changes in 'WA State Law • Regarding Exemptions to Immunization Requirements for School-Entry July 21, Zoic Washington's kids among least protected in the nation, says first-ever report- 06/2/2011 - Washington S... Page 1 of 2 ititi Health News Release You are here: DOH Home » News Releases Home » 11-083 Search I Employees For immediate release: June 2, 2011 (11-083) Contacts: Michele Roberts, Immunization Program CHILD Profile 360-236-3720 Julie Graham, Communications Office 360-236-4022 Washington's kids among least protected in the nation, says first-ever report Kindergarteners in state have highest immunization exemption rates OLYMPIA—Washington kindergarteners do not meet state or national goals for any required immunizations when they enter school, according to a report today by Centers for Disease Control and Prevention. (www.cdc.gov/mmwr/preview/mmwrhtml/mm6021a4.htm). Our state has the highest exemption rate in the country; 6.2 percent of kindergarteners have a parent-signed exemption form for one or more vaccines. Washington's exemption rates have more than doubled over the last 10 years. "All parents want their kids to have a healthy start," said Secretary of Health Mary Selecky, "and making sure they 414 ve all of their immunizations before going to school is one of the best ways to keep them healthy. Kids who aren't ly immunized aren't fully protected." The data from the 2009—2010 school year show that our state's kindergarten coverage for required vaccines (including polio, whooping cough,measles, hepatitis B, and chickenpox)ranges from 88 percent to 93 percent. The state and national goal for individual vaccines at kindergarten entry is 95 percent. Immunizations save lives. Diseases can spread quickly in schools and child care centers, and we've had outbreaks of whooping cough, measles, and other diseases in our state recently. Unimmunized children are more likely to get and spread diseases that vaccines can prevent. "Most of today's parents weren't around to see how bad diseases like measles and whooping cough were before vaccines helped bring them under control," says Secretary Selecky. "We've done a good job fending off those diseases with vaccines, but we can't be complacent; we're seeing them start to make a comeback and too many of our kids are vulnerable." A new state law that takes effect on July 22 changes the process to get an immunization exemption. It says that if a parent or guardian wants to exempt their child from school or child care immunization requirements, they must first t information from a licensed health care provider about the benefits and risks of vaccinations. The provider must n sign a form or letter confirming that the parent got this information and the form must be turned in to the school or child care. mhtml file://D:\boh packet\Clallam\June 2011\Washington's kids among least protected in the nation, say... 7/14/2011 Washington's kids among least protected in the nation, says first-ever report- 06/2/2011 - Washington S... Page 2 of 2 Health officials hope the law will reduce the number of"convenience"exemptions (parents who turn the form in even when their child is vaccinated). School nurses have access to Washington's CHILD Profile Immunization Registry to help parents turn in complete and accurate immunization records. More information on the law(www.doh.wa.gov/cfh/Immunize/schools/default.htm) is available online. Renewed commitment of many public and private partners including school nurses, health care providers, health insurance providers, local health agencies, and others is vital to improving our exemption rates. All recommended vaccines for kids under 19 are provided at no cost through the state's Childhood Vaccine Program. Health care providers can charge an office visit or administration fee; this may be waived for those who are unable to pay. Parents are urged to go to their regular health care provider for childhood immunizations and questions about vaccines. For help finding a health care provider or an immunization clinic, contact the local health agency (www.doh.wa.gov/LHJMap/LHJMap.htm) in your community or call the Family Health Hotline at 1-800-322-2588. Our state and county coverage and exemption rate data (www.doh.wa.gov/cfh/immunize/schools/reportdataintro.htm) are online. More information on childhood immunizations is on the Department of Health immunization program website (www.doh.wa.gov/cfh/Immunize). The Department of Health website (www.doh.wa.gov) is your source for a healthy dose of information. Also, find us on Facebook and follow us on Twitter. ### • • mhtml:file://D:\boh packet\Clallam\June 2011\Washington's kids among least protected in the nation, say... 7/14/2011 ,N ' 2011 School and Child Care Immunization Exemption Law&equently,Asked Questions - Immu... Page 1 of 5 ID1fluhI1iZDtiOI1 • #i,,= F'ot'rain „ , . .,., ,,,.. ,, ,.,,, ,t "H'''''''e'n'iti' IMMUNIZE At AFI Ages Cliiiprofi/e 2011 School and Child Care Immunization Exemption Law Frequently Asked Questions State law requires that before attending a licensed child care or school,children must be immunized against certain diseases that can be prevented by vaccinations.Parents and guardians meet this requirement by filling out and turning in a Certificate of Immunization Status form,showing their child has the required vaccinations(or that they have already had the illness and are now immune). If parents and guardians choose to exempt their child from one or more of the required vaccines,they must fill out a Certificate of Exemption form. The 2011 Washington State Legislature passed a law that changes the process for getting an immunization exemption.All other parts of the law are the same.The questions and answers below give parents,schools,child cares,and public and private health care providers the •information they need to follow the steps in the exemption process correctly. • General Information • Effective Date • Requirements and Process • Religious Exemptions • Changing the Exemption Form General Information 1. Q: What does the new law change? A: The new law says that if a parent or guardian wants to exempt their child from school or child care immunization requirements, they must first get information about the benefits and risks of vaccinations from a licensed health care provider.The provider will sign the Certificate of Exemption form that parents have to turn in to the school or child care to exempt their child.Instead of signing the form,providers may choose to write and sign a letter verifying the same information. Parents or guardians who demonstrate membership in a church or religious body that does not believe in medical treatment do not have to have a health care provider sign the exemption form. 2. Q: Why is the law important? A: Washington has one of the highest school exemption rates in the nation,in part because our exemption policy made convenience exemptions easy to claim.The law makes sure exemptions are based on conviction,not convenience. • Immunizations save lives.Diseases can spread quickly in schools and child cares and unfortunately we have had outbreaks of whooping cough,chickenpox,and other disease in our state. Unimmunized children are more likely to get a disease that vaccines can prevent and spread it in their communities. , r., ., , . , .,.,, ,10,1., , n 1 1 Ira •1 1 r-.1 -- T----------__1: __ T)_...........+: 4/1 it/1n 1 1 2011 School and Child Care Immunization Exemption Law Frequently Asked Questions - Immu... Page 2 of 5 When children have exemption forms on file at school and an outbreak happens,the kids with exemptions must be sent home until the outbreak is over,until they bring in their vaccination records,or until they get vaccinated.This causes disruption in schools, classrooms,and a child's learning.Having fewer convenience-based exemptions will reduce the burden on our schools. 3. Q: How can schools,licensed child cares,health care providers,and parents or guardians make sure they meet all the new • requirements? A: Beginning July 22,2011,schools,child cares,providers,and parents must use the updated exemption form to meet the new requirements. 4. Q: Does the new law change any required immunizations for school or child care entry? A:No,the vaccines required for school and child care entry are the same. 5. Q: What's the definition of"conditional"status according to school and child care requirements? A: Kids are in"conditional"status if they do not have one or more required vaccines on their first day of attendance or, in some cases,after they've begun school or child care.These kids can attend school or child care for a limited time until they finish their paperwork.From the time they get notified that their child has conditional status,parents or guardians have 30 days to: • Get the child vaccinated. • Show a record of past vaccination. • Exempt their child for the missing vaccine. Some kids may not have immunizations which are part of a series with recommended intervals between doses.In these cases,the child will remain in conditional status as long as necessary to complete the series according to national immunization guidelines.In all other cases,if a parent does not take action within 30 days,the child must be excluded from school or child care.Children with completed exemption forms do not have"conditional"status. See WAC 246-105-020 and 246-105-060 for more information. • Back to Top Effective Date 6. Q: When do these changes take effect? A: The law takes effect July 22,2011,and applies only to exemptions that parents or guardians claim on or after this date. 7. Q: Can the new exemption form be turned in before the law's effective date? A: Yes,the new exemption form is ready and can be used before July 22,2011. 8. Q: What about kids who have registered for child care or school,but won't start school until the fall of 2011?Do they need a new exemption form? A:No.As long as their exemption form was submitted to the school before July 22,2011, it's valid even if the child begins school or child care after that date. 9. Q: Will parents have to redo an exemption from previous years? A: An exemption form on file at a school or licensed child care that was turned in before July 22,2011 is still valid for the exemptions indicated on that form.But,as kids progress through school,they may need different vaccinations to meet age- appropriate immunization requirements,and at that time a new exemption form will have to be turned in. 10. Q: Will children transferring schools within Washington State with an exemption(s)from previous years need to renew the 0 exemption(s)under the new requirements? A: No. Any exemption received in Washington State before July 22,2011 is still valid regardless of which school or school district the child attends. _t_..__t_ri_.IITA1--i- ----i_-L\i•t-n__-\r__1-. '1111 1\1ni 1 c,.1..,.,.1 „„,1 01,:1,4 0-- Tr,,,,,,,t-,tvatinti PvPmilti A/14/701 1 2011 School and Child Care Immunization Exemption Law.Frequently Asked Questions - Immu... Page 3 of 5 Back to Top Requirements and Process • 11. Q: How does a health care provider verify they gave a parent or guardian information about immunization benefits and risks? A: Health care providers can sign the pre-written statement on the exemption form or write and sign a letter verifying the same thing. 12. Q: Does a parent or guardian always have to sign the exemption form? A: Yes,a dated parent or guardian signature must be on the exemption form for any type of exemption in order to be valid. 13. Q: What kind of health care providers can sign the exemption form or write a letter? A: Physicians(M.D.),physician assistants(P.A.),osteopaths(D.O.),naturopaths(N.D.),and advanced registered nurse practitioners(A.R.N.P.)who are currently licensed in Washington are authorized to sign the exemption form or write a letter. Signatures by registered nurses(R.N.)or licensed practical nurses(L.P.N.)are not acceptable. 14. Q: Does a provider have to give vaccinations in order to sign the exemption form or write a letter? A: Any qualified provider currently licensed in Washington may sign the exemption form. 15. Q: Do parents or guardians have to attach the benefit and risk information they get from their provider to the exemption form? A: No,the provider signs the exemption form to verify the information was shared.Schools and licensed child cares will have to check that the provider signed the form or letter. 16. Q: Does this create a cost for parents or guardians because they must make an appointment to get a provider signature? A: If health care providers and parents have already talked about benefits and risks of vaccination,an office visit may not be • necessary for providers to sign the exemption form.Providers can sign it at any time before the child attends school or child care, such as during already scheduled well-child visits or sports physicals. 17. Q: Does a provider have to sign the exemption form(or sign a letter)for all types of exemptions? A: Providers must sign the statement on the exemption form about providing benefit and risk information(or sign a letter)for most types of exemptions.The only exception to this requirement is that a provider doesn't have to sign the form or letter for a parent or guardian who demonstrates membership in a church or religious body that does not allow medical treatment. 18. Q: What does a provider have to do to verify a medical exemption? A: For an acceptable medical exemption under the new law,the provider must sign the exemption form twice;once indicating the specific medical exemption and type(temporary or permanent medical exemption)and once to confirm the parent has received the benefit and risk information. 19. Q: What does the provider letter have to include? A: It must explain that the parent or guardian received information on the benefits and risks of immunizations,reference the child's name,and be signed by a qualified health care provider. If the letter has these three things,schools and licensed child cares may accept it in place of a provider signature on the actual exemption form. 20. Q: Are copies and faxes of the signed exemption form acceptable? A: Yes,schools and child cares can accept copies and faxes of the new exemption form. If anything on the form is not filled out correctly,they must let the parent or guardian know as soon as possible. I 21. Q: Is a copy or fax of the provider letter acceptable? A: Yes,as long as the letter meets the three minimum requirements as explained in question 17.Make sure the provider letter gets stapled to the exemption form and that a parent or guardian also signs the exemption form. . . ,... ,. .. ..... ....... .-. , , , i-„ •, , r r.-- --a „- r ...a: C/1 it V)!)1 1 2011 School and Child Care Immunization Exemption Law Frequently Asked Questions - lmmu... Page 4 of 5 22. Q: Are health care providers legally obligated to sign the exemption form? A:No, it's up to each provider to decide if they're willing to sign the exemption form.This is between parents and their health care provider. Canprovidersget sued(byaparent or guardian,for example)if they sign the exemption form and the child gets sick with a • 23. Q: vaccine-preventable disease? A:No.The new law states that providers signing the form in good faith are not at risk of legal action. Back to Top Religious Exemptions 24. Q: Are all religious exemptions acceptable without the provider's signature? A:No.Most parents or guardians checking the box for a religious exemption must first get information about the benefits and risks of vaccinations from a licensed health care provider.Only parents or guardians who demonstrate membership in a church or religious body that does not allow medical treatment(in Box 2 of the form)do not need a provider to sign. 25. Q: How does a parent or guardian demonstrate membership in this kind of church or religious body? A: In Box 2 of the exemption form,the parent or guardian must sign a prewritten statement to indicate they belong to a church or religious body that does not believe in medical treatment from a health care provider.They will also have to write in the name of the church or religious body.Parents or guardians must have both of these(their signature and the name of their church or religious body)to claim this type of religious exemption. 26. Q: Does the parent or guardian have to supply additional information,such as copies of church doctrine,church addresses,or signatures from the religious leadership? A:No,nothing else will be required as proof of membership or of their religious affiliation. • 27. Q: What if the parent or guardian refuses to write in the name of their church or religious organization in Box 2 of the form? A: Then the parent or guardian cannot receive this type of religious exemption.They must get the required health care provider signature on the exemption form or a letter confirming they have received the benefit and risk information on immunizations. 28. Q: What if schools or licensed child cares do not recognize the name of the religious body the parent or guardian writes in Box 2 of the exemption form? A: Schools and child cares do not have to verify the religious organization or religious belief,even if the name is unknown or seems false. Back to Top Changing the Exemption Form 28. Q: What if the parent or guardian seeks an exemption,but the provider,school,or licensed child care notices from previously provided information that the child has already been vaccinated? A: The provider,school,or licensed child care should explain the situation to the parent and let them know the exemption isn't necessary.This will likely resolve the situation.If the parent or guardian still wants an exemption,and he or she supplies the proper information on the exemption form,the exemption must be accepted. 29. Q: If a provider, school,or licensed child care discovers a child has already received a vaccine for which he or she is currently exempted,can the child's exemption be deleted? A:No. State law requires that the parent or guardian approve the change before the exemption gets deleted.The person who lo over the exemption form(usually school or child care staff,but it could also be a provider)needs to get the parent's approval for the change.The form can then be updated with the new information,including the date when the parent approved the change. „r ,. ,., , r , ,,," ,\ ,n, , c._t__. 1 a /"1..:1A 0 7.v,.-v,1,,,;�afirn PvPmnti 6/14/701 1 r 13001 0. States.But the victory may have come at a cost,initiating what Willrich describes RESISTANT as"one of the most important civil liber- ties struggles of the twentieth century :a " T2 ferocious dash between personal freedom • Why acentury-old battle over vaccination continues to rage. and public health.The clash reverberates to this day,as a growing number of Amer- By MICHAEL SPECTER ican parents refuse to inoculate their chil- dren against common childhood diseases. N_ f 3 0 e '#z-k- r ,w Universal vaccination may well be the . �- '} . ~ " ;� greatest success story in medical history. P � 4,• - s But the movement also has a political his- -,..- ---:.%',444--:-.0,,,,,,rvytory—and it's far less reassuring. '1 E; s � ..� Smallpox was among the most lethal ''''''''471 x� r� viruses to afflict humanity,killing amy- I1111\ _ ��„ � ��, '-- where from twenty-five to sixty per cent Vr ti _ mkt of those it infected and leaving others ti. ,_ iv scarred for life.The first symptoms were L` ;e -' `'` fever,malaise,body aches,and vomiting; ; � "w �n ...I soon victims suffered mouth sores and a then the diseases ghoulish signature, a a-' .:: _ savage rash.Within forty-eight hours,the lesions would spread across the body.The r«, - e, 3o .� 1, y` H - patient's face would become badly swol- n ;° : F �, len,the pain acute.A 1900 handbook of k f 3-i" r r g naval medicine describes the final stages: <4q- -' ie, "The pustules break, matter oozes out, '� ',4 �'tt a �..` '4, crusts form,first on the face and then over ,1- ?t , -- v ,,,Iv-1,-.e-4,,T:-,..-,-..,, %'- other parts of the body- � �- . * t:, ." Y;I# Nobody is certain when or how small- pox • -= �' -fix pox first appeared.But the virus emerged 1.: Y ^`- A ' in Europe sometime between the fifth and seventh centuries and was often en- pdeinics have piggybacked their way Those measures worked. In 1899, demic during the Middle Ages.By 1700, Eon wars across the world for thou- smallpox took just over a hundred lives in variolation—deliberate infection icessfullyth le. ox—had sands of years. The Plague of Galen, When eyidemicson of b oke out in the Unon ited preventive measureeen.It was ed cdangerous, as which decimated Rome in 165 A.D.,e p tered the empire with soldiers returning States,as they did at about the same time, but far less so than the disease itself. from the Near East.Infectious diseases, Surgeon General Walter Wyman seized Dried smallpox scabs were blown Into more than swords or guns,helped Pizarro on the European data,urging compulsory the nose of an individual,who then con - vaccination the Incas.In the early eighteen vaccination for all Americans.The disease tracted a mild form of the disease but was seventies,a smallpox pandemic that ac had become so easy to prevent,he wrote, immune afterward. The Colonial companied the Franco-Prussian War that"the smallpox patient of to-day is preacher Cotton Mather, who had killed more than half a million Europeans. scarcely deserving of sympathy."Through- learned about variolation from his slave. Smallpox claimed the lives of tens of out the United States,at the dawn of the attempted to introduce the new practice thousands of French soldiers,yet the Progressive era,dozens of laws and regu- during a 1721 epidemic in Boston. Prussians lost fewer than five hundred lations were established to empower police Mather was denounced as an-inocula- men.That was because Prussia vaccinated officers,public-health officials, and even tion minister,' and his house \vva firebombed. The actual vaccine—thi its entire Army against the virus, and the armed forces to vaccinate at will,and, world's first—was invented by Edwarc France did not.There has never been a if necessary,at gunpoint. more dramatic demonstration of a vac- As Michael Willrich, a historian at Jenner, a British country doctor, at the cine's power to alter the course of history. Brandeis, notes in his meticulously re- end of the eighteenth century.After nor By the end of the decade,several Euro- searched book"Pox:An American His- ing that milkmaids rarely got the disease pean countries had passed laws mandat- tory" (Penguin; $27.95), those efforts he theorized, correctly,that exposure ti ing vaccination. helped bring an end to smallpox as a seri- cowpox—a virus similar to smallpox ho • much less virulent—conferred resistance Smallpox vaccinators had police=like authority, and often operated without restraint. Today,Americans expect the fedora 80 THE NEW YORKER,MAY 30,2011 '1. n ; ...,. government to respond to(and contain) most of all to immigrants in the North S W A N I �1 '' P R F .�, any serious contagion.That wasn't true in and blacks in the South. (At the end of ®i ' Y �.'. the late nineteenth century,the period of the nineteenth century, a black man in 1 ¢F°ti - i t Willrich's focus.The idea of calling for Kentucky was required to carry a certifi- _ N ; federal aid was unusual,and in the Deep cate of vaccination—or display a scar on `i'• 4 ,.' ' • South it was unthinkable.Then,in the his arm—in order to move about freely. < t I 1 mid-eighteen-nineties,after decades of No such law applied to white men.)In relative quiescence, smallpox began to February, 1901,an epidemic erupted in '' t t' - "/1'13 spread through the communities of Ken- New York, and a vaccination squad 0 _ < tucky and other Southern states.Panic moved en masse into the crowded Italian _� � Eis kept pace.As a member of the Kentucky sections of the Upper East Side,where t 1 x o '' Board of Health put it, "One case of they thought the infection had origi- g Y i; small-pox in a tramp will create far more nated.Willrich writes: alarm in any community in Kentucky They followed the same method on each • f' , w than a hundred cases of typhoid fever and block.With policemen stationed on the roofs, `t n�1 ,+ • o a dozen deaths in the leading families." at the front doors,and in the backyards,doc- tors and police entered the tenements and Milton Avery,Sun Worshiper,gouache,C.1932. Finding themselves defenseless against Estimate$30,000 to$50,000. —t1I4`11:1 rapped on doors,rousing men,women,and the virus,communities sought help from children.Frightened and furious,the residents AUCTION the United States Marine Hospital Ser- moved into the lighted areas,where doctors inspected their faces for pocks and their arms June 9 at t o:3 oa m&i:3 o p m p vice—the precursor to the U.S. Public for the mark of vaccination....Everyone lack- Health Service. ing a good mark-had to submit to vaccination. . American Art '"_ The service dispatched doctors who Contemporary Art rode from town to town like U.S.Mar- Infected children were routinely taken Inquiries:Todd Weyman f shals,brandishing masks and needles in- from their mothers'arms and sent to a tweyrnan@swoddgalleriea.com :`` stead of badges and guns.Theyvaccinated pesthouse,where they often died—then, 3 the healthy and quarantined the sick. as now,there was no successful treatment. 104 E 25th St. • NYC • 212.254.4710 Once an epidemic was under way,those Many of those who were hauled away www.swanngalleries.com '+ doctors were granted broad police-like spoke no English;more often than not, powers, and they established the first they belonged to families that had fled ` �� :. foothold of federal authority in the South despotic nations to live in what they since the end of the Civil War and thought was a democracy. The anti-vaccine activists were aided a Reconstruction. The logic used by the increasingly by an inexplicable epidemiological anom- \a powerfulfederalgovemmentwasstraight- aly.A new form of the virus appeared in 11 LEGEND forward:the good of the community had the eighteen-nineties, one that wasn't iv 1p to outweigh objections raised by a minor- nearly as deadly as those which had come m` ARBARA CARROLL ity.After all,what could be worse than a before;it seemed to kill just one per centNp&V'aGp`$ �pNa�\N smallpox epidemic?Willrich offers an an- of the infected,and many doctors were g� Ct1 Al 1" P� a swer:curtailing basic civil liberties.As he not even sure the rashes were a sign of 50'W l1.k.11.30 1 p0 lE` ER points out in this eloquent,if not always smallpox.Some thought it was a different 6Qat*p�GpNQ�1NH0 persuasive,book,compulsory vaccination disease entirely, and others wondered if ALWAYS ppY.RES AgtN$101 7 collided with fundamental medical and the virus had become weak enough to ig- SU collided 2 ZaA$co atto111 cliccm religious beliefs held by millions;it over- nore.The decline in virulence made op- www gatbacac . ran the rights of parents and,most pain- position to vaccination much easier—es- fully,contradicted strongly held,and par- pecially given the uncertain risk posed by lit'' n reatatSheppard Pratt ocularly American, notions of personal the vaccine itself. liberty.For all those reasons,not to men- These days, vaccines used in the ,.Treating all psychiatric conditions tion the fact that the vaccine itself occa- United States are subject to years of clini +Intermediate length of stay sionally killed people,the resistance was cal testing,several layers of regulatory ap- .Elegantly appointed environment intense. Residents of many neighbor- proval, and the final judgment of the •Balt mNED 410.1-9380-4t fore resssiion�=eatatsp.o�g hoods burned down their"pesthouses" Food and Drug Administration. The T�e RetreB040 insurance. (isolation hospitals for infectious pa- oversight continues after vaccines are in- tients),fled when vaccinators approached, troduced.In the nineteen-nineties,fed- WHITE POPPY PRE$S fought with police,forged vaccination eral health officials called for the live oral t4.-in-k.„ 3 �A' Straight talk,a ffordable prices, certificates, and often simply refused to polio vaccine to be removed from the '<' personal service o deliver sick relatives to authorities. ' market,because it caused the disease in -o personal ress.com416 Public-health officials stoked resent- .about ten children out of the millions who .c.:; 413-253-1837 j ment by applying the laws without sub- received it each year.A newer version, 3�,,,m ' THE SENSIBLE 253 WAY TO SELF PUBLISH tlety or restraint,Willrich points out, which has been used widely for more than THE NEW Y0EKER,MAY 30,2011 81 a decade,eliminates even that small risk ister,refused to comply with the city'svac- vaccination,measles—which kills at least ; But in 1900 the F.D.A.didn't exist,and cination order,because,he said,a vaccine a hundred and fifty thousand people in neither did any federal rules about how to had made him sick when he was a child. the developing world each year—long make,test,or deliver vaccines. He also believed that vaccines made his ago ceased to be a significant threat in the • By introducing laws that compelled son sick, and said that he knew others United States. This creates a paradox. vaccination without any safety regulations who suffered as well.The case reached the Public-health officials must struggle con- to go along with them,the government Supreme Court in 1904,at a time when stantlywith the consequences of their own did nothing to reassure those who re- infectious diseases remained the leading success:the dangers of complacency are garded compulsion with dread or indig- cause of death in the United States.The real.Vaccine-preventable illnesses have nation.The smallpox vaccine was pro- Court upheld the right of states to corn- made a strong resurgence in the past de- I duced in the least pleasant way imaginable: pel vaccination,ruling that,although per- cade in the United States,fuelled almost cows were infected with vaccinia virus, sonal autonomy mattered greatly, the wholly by fear.There is currently a mea- which is similar enough to smallpox to state was entitled to protect its citizens sles outbreak in Minnesota;last year,per- stimulate protective antibodies,and then from threats to their health and welfare. tussis(whooping cough)cases.,and deaths, virus-laden pus would be extracted from The Jacobson decision provided states reached a record high in California. their sores.A brew of the material was with legal support,but it did little to re- Willrich reminds us, invaluably,that then spread on a patch of skin that had , solve fundamental conflicts over coercive vaccination is never simply a medical and been cut and then rubbed raw.The vac- public-health measures.Battles over vac- technological matter; it's also a political I cine was effective and relatively safe.Yet cination rage, and the Internet has only one. In 2009, a novel influenza virus, no statistics were available to the public, amplified the tumult.Lawsuits continue H1N1,emerged in Mexico and threat- j and people often confused vaccination to be filed—and, like Jacobson, many ened a global pandemic. The World with the less precise technique of variola- people rely wholly on anecdotal evidence Health Organization,erring on the side a tion,which had proved lethal to as many to argue that vaccines pose a greater threat of safety,declared the highest level of in- as one in fifty of those who received it. than the diseases they prevent. Large ternational alert. And then the virus When smallpox was killing thirty per cent numbers ofAmerican and British parents mostly fizzled out.As with the smallpox of its victims or more,the odds dearly fa- refuse to vaccinate their children for mea- outbreaks around 1900,the threat seemed vored vaccination.In a mild epidemic, sles,because they fear that the vaccine can to fade. Today, more than a third of where few people died,rejection of the cause autism,despite many studies that Americans say they would decline a flu vaccine made far more sense. show measles vaccines to be safe,and un- shot for themselves or their children.Yet But the social calculus of vaccination related to autism.There are even pediatri- nobody can predict the ways in which a can never be reduced to the estimation of cians who decline to treat children who virus will mutate or how virulent it may individual benefit.When most members have been vaccinated. Vaccines work by become.It could fade,as H1N1 appears of a community are vaccinated,they pro-. stimulating resistance in the immune sys- to have done;or,like the virus that caused tect those who are not by eliminating the tern;unfortunately,resistance to vaccina- the 1918 flu pandemic,it could claim the viral reservoirs in the population.The tion itself has proved no less formidable. lives of millions. effect is known as herd immunity.Some It is a remarkable fact that smallpox,a people,because they are too young orTillrich's sympathy with those scourge for thousands of years,has now particularly articulary l weak immune systems V V turn-of-the-century opponents of vanished from the earth,except for two owing to cancer or other illnesses,cannot compulsoryvaccination can be instructive, tinyvials,one locked in a highly secure fa- be vaccinated.For them,herd immunity but it sometimes leads him to overreach. cility at the Centers for Disease Control, is the only defense.As long as the major- "A natural affinity linked abolitionism in Atlanta,and another stored in a simi- ity are vaccinated,then,a few can decline and antivaccinationism,"he writes."Both larly secure vault in Siberia. Before the without courting harm,but when vacci- upheld bodily self-possession as the sine virus was eradicated, in 1977, it killed nation rates fall below a certain level this qua non of human freedom;both dis- three hundred million people in the twen- protection quickly begins to vanish. At trusted institutions;and each evoked pub- tieth century alone.But there is no reason that point,someone who refuses a vaccine lic scorn in its time as the dangerous cause to think that pandemics are behind us.A imperils not only his own health but that of a lunatic fringe."Some anti-vaccine ac- public-health establishment that regards of everyone he encounters. tivists had legitimate complaints; others vaccination as merely a technical matter The revolt against the smallpox vac- truly were, and are,a lunatic fringe, and has failed to register the genuine clash of cine took many forms,and one of them the costs of their lunacy are borne by the values—not least between social welfare was litigation.A wave of lawsuits were larger society. It's absurd to argue that and individual liberty that Willrich de- filed at the beginning of the twentieth people who opposed the most effective scribes.Making the case for vaccination century, all aimed at protecting an indi- public-health measure in history have a means taking its opponents seriously; it vidual's right to do with his body what he "natural affinity"with the movement to means taking the time to understand the chose to do.The most prominent case,Ja- free human beings who were owned by reasons for resistance, and it means . cobson v.Massachusetts,was brought-by other human beings. figuring out how to prevent and allay mis- Henning Jacobson,a Swedish immigrant After all,what makes it easy to be a trust.Modem vaccination is a triumph of living in Cambridge during a smallpox vaccine dissenter these days is the fact that medicine;its decline would be a failure outbreak there in 1902.Jacobson,a min- most people aren't. Because of routine of politics. •i 82 THE NEW YORKER,MAY 30,2011 t The Seattle Weekly,June 15-21,2011 The Anti-Vaccine Epidemic Why Washington hosts the nation's fastest growing population of so-called "refusers." By Nina Shapiro !Ar'cines(,1 ��.n 15 2011 Showing off his spacious rambler on Bainbridge Island, perched just above Puget Sound, Michael Belkin seems in many ways a typical affluent yet alternative-minded Northwesterner. As a self-employed financial analyst, he's got a home office and flexible hours. In his kitchen, he greets his wife Lorna, a willowy portrait painter and stay-at-home mom who's preparing a crustless quiche for a staff lunch at their kids'private school, which encourages every child to fulfill his or her"unique destiny." Belkin rustles around and produces the health-conscious items he gives to his 10-year-old son, Sebastian, and 7- year-old daughter, Viola:fish oil, probiotic supplements, and so-called "perfect food," made up of grasses and algae. Then he heads downstairs to a daylight basement that allows him to indulge his own creative side. Fifty-seven years old, with a spiky haircut and chunky dark glasses that give him the look of an older Ira Glass, Belkin spent 10 years in Los Angeles trying to make it as a guitarist and songwriter before heading to Wall Street,where he worked for a time at the investment bank Salomon Brothers. Over the past year, he's built a professional-quality recording studio,with top-notch digital equipment,foam insulation, and a vocal booth, on a little patio outside. From here, he's been producing a CD by a band he's put together, in which his son plays drums. y aK� } m • .., k.: . pt r �3 11 ,, °°e.^ .yA Michael Belkin: anti-vaccine advocate and lead singer for the Refusers. His completely unvaccinated son, it should be mentioned. Because the thing that makes Belkin unusual—although far less so than public-health officials would like—is that this suburban dad is a nationally known advocate for what he terms vaccine"choice"and what most others call the anti-vaccine movement. He speaks at public events, posts news updates on a blog, and has written an essay for a just-released book called Vaccine Epidemic,which he'll be signing at the end of this month at Bastyr Unviversity,the school of alternative medicine in Kenmore,just northeast of Seattle. Belkin sees his band, pointedly called the Refusers, as akin to the antiwar protest-music bands of the'60s and'70s.The group's music combines a toe-tapping, funk-rock beat with lyrics meant to convey the Nazi-like horror—as he and his allies literally portray it—of this country's vaccination policies. "Vaccine Gestapo" is the name of one song. In a music video for another, his daughter Viola (also completely unvaccinated) portrays a scared Alice-in-Wonderland figure being chased by a mad doctor wielding a needle. The reason Belkin is so passionate on the subject can be discerned from yet another song, "Stole My Baby Away." It's about his infant daughter, Lyla, who died a day after receiving the Hepatitis B vaccine shot 13 years ago. He wails in the song: "That evening, she stopped breathing/Her face turned blue/Oh Lord, her face turned blue." It's a story that resonates deeply with other parents suspicious of vaccines—and what they see as collusion between • government and Big Pharma to force parents into immunization. "He's experienced the ultimate sacrifice,"says J.B. Handley, the Portland-based founder of Generation Rescue, a prominent anti-vaccine group. Page 1 of 8 • The Seattle Weekly,June 15-21,2011 Like many stories in the anti-vaccine movement,though, Belkin's is murkier than it may seem to true believers—and he doesn't make it easy to verify crucial details. For that matter, the movement as a whole is based upon theories that are not only unproven but, in key respects, directly contradicted by the past decade of scientific research. But the anti-vaccine movement is about more than science. It's about the heartache of sick children, the norms of certain subcultures, and the debate over what the government can compel us to do for both our own health and that of the populace at large.And judging by the number of parents opting their children out of vaccinations, the movement is getting stronger. Nowhere is that more the case than in Washington state, which has become a battleground between pro-and anti-vaccine forces. In 1998, a British physician named Andrew Wakefield published a paper suggesting a link between the combined measles/mumps/rubella vaccine, known as MMR, and autism. It was an "A-ha!"moment for the legions of vaccine skeptics who already blamed mass immunization for the country's spiraling autism rate, as well as assorted other illnesses. That Wakefield was a respected doctor, publishing in the preeminent journal Lancet, demanded a response. A chorus of scientific papers subsequently refuted the purported connection between MMR and autism. Meanwhile, a British journalist exposed financial ties between Wakefield and lawyers looking to sue vaccine manufacturers. Wakefield lost his license to practice medicine, saw Lancet retract his paper, and faced new accusations—published earlier this year by the British Medical Journal—that his research was fraudulent. (Representative of just how far his star has fallen,Wakefield's most recent public appearance came during a rally last week in Dublin, Ireland, where he spoke alongside 9/11 Truthers and those who believe in a coming New World Order.) Yet Wakefield, now living in Austin, Texas, is more revered than ever by vaccine skeptics, his vilification seen simply as more proof of a conspiracy. "As far as we're concerned,Andrew Wakefield is a hero,"says Belkin's wife Lorna. "He's been lynched." Similarly, the anti-vaccine movement has only gained force as mainstream science keeps professing that there's no rational reason to fear immunization. Public-health officials fear a resurgence of diseases long since eradicated. That's already happening with measles, • which disappeared in this country in the late'90s yet has been discovered in 118 patients nationwide this year—two of them in Washington state—of which the vast majority were unvaccinated, according to a CDC report released last month. Pertussis, more commonly known as whooping cough, is also on the rise. Last year, the state Department of Health recorded 608 cases, more than twice as many as in the year before. The tally included the deaths of two infants. Consequently, legislators in Olympia, at the prodding of the state Department of Health, have just passed a bill that makes it harder for parents to exempt their children from school-vaccination mandates. No longer can they simply sign a form. They must now present a note from a doctor who has advised them of the dangers of failing to immunize. As of the 2009-10 school year, only 6.2 percent of the state's kindergarteners had gotten exemptions. That's not a huge number, and those in favor of vaccination choice say it makes no sense that state officials have gotten so worked up about it. "There is no problem,"says Janelle Hall, state director of the mandate-opposing National Vaccine Information Center,who joined Belkin and several others in testifying against the bill. But that exemption rate is the highest in the country, according to a CDC report released earlier this month, and more than double what it was a decade ago.What's more, there are pockets around the state where the exemption rate is far higher. "Yes, we have a problem,"says Edgar Marcuse, associate medical director of Seattle Children's Hospital. Marcuse,whose license plate reads DTAP IPV(the first four letters refer to the combination vaccine for diphtheria, tetanus, and pertussis,the last three to the polio vaccine), has been involved in immunization campaigns for more than 40 years—before many of the newest vaccines were even invented. "I can't tell you how many times I had to tell parents'Yes, your child is going to survive, but your child has lost his hearing,'"says Marcuse, sitting in his office. Deafness was often a consequence of haemophilus meningitis, a disease once affecting 20,000 children nationally per year. "Today," Marcuse says, "we see no disease due to the Hib vaccine." • Page 2 of 8 The Seattle Weekly,June 15-21, 2011 He opens a cabinet above his desk and pulls out several pictures of a former patient. They show a young boy, perhaps 4 or 5. His face is covered with red blisters that have turned into gaping holes—"so big you could stick a pen • in them and it would stand straight up," Marcuse says. "What do you think it is?"he asks. The answer: chicken pox, for which there is now a vaccine that many parents question the need for. The child had a severe case, Marcuse admits, but not an extraordinary one. A closer look at DOH data reveals the potent mix of demographics that makes vaccine resistance such a sturdy presence in the state. Some of the highest exemption rates are in eastern Washington, where any kind of government mandate—whether immunization or taxation—is often viewed with hostility. At the opposite end of the political spectrum are the liberal enclaves of western Washington,which are also resistant to vaccines.At Vashon Island's public elementary school, 25 percent of students have skipped at least one vaccine. At the Seattle Waldorf School, akin to the one the Belkins'children attend, the number is a whopping 47 percent. These schools are part of well-educated and affluent communities that one might think would be most likely to follow the recommendations of scientists and doctors. But in fact, as journalist Seth Mnookin points out in his new book The Panic Virus, they perfectly reflect the base of today's anti-vaccine movement. Its constituents are part of what you might call the suburban counterculture—parenthood and affluence mixed with creative aspirations, a crunchy-chewy lifestyle, and an inclination to question authority. The authority, in this case, is everyone from CDC doctors promoting vaccines to scientists allegedly tied to Big Pharma to schools that mandate immunization and, as Belkin frequently puts it, serve as the"marketing department" for vaccine companies. In May 1999, Belkin,then living in New York City,went to Washington, D.C., to testify before a Congressional hearing looking into the safety of the Hepatitis B vaccine. He had already told Lyla's story to the public once, on an episode of 20/20. But this was an even more prominent audience. • Wearing a suit and reading from a script he had prepared, Belkin presented his credentials, as he almost always does when marshalling his arguments about vaccines. "I'm trained in statistics,"he said, noting that he had previously worked at Salomon Brothers and was then "an advisor to some of the largest financial institutions in the world." He said he had pored over a federal database of suspected adverse reactions from vaccines, and drawn the conclusion that"the CDC has been experimenting on babies like guinea pigs." His own 5-week-old Lyla, he said, had died about 15 hours after she received a booster shot of the Hepatitis B vaccine. "She was never ill before,"he said. But suddenly she turned fussy, fell asleep, and stopped breathing. "The New York Medical Examiner ruled her death Sudden Infant Death Syndrome," he continued. But he said that's not what the examiner initially told him, his wife, and their pediatrician.And he apparently had the pediatrician's notes to prove it. He quoted them: "brain swollen . . . not sure cause yet . . . could not see how recombinant vaccine could cause problem." In his essay for Vaccine Epidemic, Belkin offers more conspiratorial details. He writes that the examiner switched her story"after consulting with Merck,"the manufacturer of the Hepatitis B vaccine—the implication being that Merck didn't want a swollen brain cited as a cause of death because doctors have acknowledged that condition as a rare but possible side effect of at least two vaccines, although not that of Hepatitis B. This same examiner, Belkin wrote, "was more concerned about examining our apartment for evidence of child abuse than about the possibility that a vaccine caused her[Lyla's] death." Talking with Belkin in his Bainbridge Island home, it's apparent that he doesn't like to be questioned about his account. Easygoing and welcoming when he picks a visitor up from the ferry, he turns irritable when asked for a fuller version of events. "Going into details is very painful,"he says. Yet it soon becomes even more apparent that there are a lot of unanswered questions about his portrayal of Lyla's death and its aftermath. Asked, for instance, if he is sure that the medical examiner talked to Merck before switching • her assessment of Lyla's death, he says: "I think so. I told her to." In other words, Belkin's allegation is based on nothing more than his own suggestion to the examiner, prompted by his suspicions about the vaccine. Page 3 of 8 The Seattle Weekly,June 15-21,2011 He's also not sure, now that he's asked about it,whether it was the examiner or, as seems more likely, the police who came to his apartment looking for evidence of child abuse. "I don't know. . . somebody . . . don't ask me," he says. • Most crucially of all, Belkin says he doesn't know where the pediatrician's notes are that prove that the examiner initially determined that Lyla had a swollen brain. "You have to take my word for it,"he says. Later, asked whether he would consent to having the case file from the examiner's office released to Seattle Weekly, he declines. "To me, it's a very invasive and intrusive request,"he says, questioning the Weeklys"fixation"with Lyla's death. "To me, it's not the story." Back in his home, Belkin is more keen to talk about a series of encounters he had after Lyla died that cemented his belief in a pro-vaccine conspiracy. "I got invited by the Rotary Club of New York City to talk about the risks of the Hepatitis B vaccine," he says, beginning one such anecdote. "A guy stands up and disputes me." Later, Belkin says he exchanged a few private words with the man,who turned out to be Louis Cooper,a physician who would go on to become president of the American Academy of Pediatrics. "A lady from Merck told me to come down here and refute you," Belkin alleges Cooper told him. Reached at his home in New York City, Cooper, now 79, says: "I think some Merck representative did mention to me that this event was going to take place." He says he probably said as much to Belkin, not feeling he had anything to hide. "I listen to everybody," he says, insisting that at the same time he is"scrupulously careful not to take money from government or industry." Cooper isn't quite the enemy that Belkin considers him. He willingly concedes that science—in regard to vaccines or anything else—is always"incomplete." He cites the example of the oral polio vaccine. Once considered safe, scientists subsequently discovered that it could actually cause polio. "We used to have five or 10 people every year in the U.S. who would get the vaccine and get polio,"says Cooper. The U.S. stopped using the vaccine in 2000, reverting to an injected version instead, but it is still used internationally. Cooper also acknowledges that the measles vaccine may cause encephalitis(the medical term for a swollen brain) in perhaps one in some"hundreds of thousands"of cases. "It hasn't been proven, but there may be a connection,"he • says. And he notes that a rare defect in the brain, possessed by an estimated one person in a million, can cause a child who receives the pertussis vaccine to have seizures and possibly brain damage. "Most of us don't argue that vaccines can sometimes cause harm," Cooper says. "It's just a question of how often." As he sees it, the extreme rarity of severe side effects is far outweighed by the benefits of vaccines. "Of all the things I've seen in medicine, I don't think anything has had a better record,"he says. "You can be sure my children were immunized, and my grandchildren." If Belkin truly has an archenemy, then, it's probably Paul Offit, chief of the infectious-diseases division at the Children's Hospital of Philadelphia and a co-developer of the rotavirus vaccine. Offit is a leading crusader against vaccine resistance, going on the attack in a number of books, including his latest: Deadly Choices:How the Anti- Vaccine Movement Threatens Us All. In that book, Offit cites Belkin's Congressional testimony and 20/20 appearance, but he doesn't get it exactly right. He discusses Belkin's"certainty that the Hepatitis B vaccine had caused his daughter's SIDS,"only to refute that notion. Of course, Belkin's claim is that Lyla died of encephalitis, not SIDS. Belkin doesn't mention this when he discusses being"trashed" by Offit in the book. But his enmity for Offit—and the poisonous feelings that generally pervade this debate—is clear. "He says babies can have 100,000 vaccines safely," says Belkin. "I think he should be required to take 100,000 vaccines at once." Offit expresses some regret about his assertion: "People have the image of 100,000 needles sticking out of someone's arm." But he doesn't back down. He says he was trying to respond to a central concern of the anti-vaccine movement—that the number of shots given to children has gotten out of hand. "Too Many, Too Soon" is the slogan popularized by the anti-vaccine movement's most public face:former Playboy • model Jenny McCarthy, a mother of an autistic child and the president of Handley's Generation Rescue.Whereas many of today's parents received'fewer than a dozen shots in their childhood, they are now advised to give their own Page 4 of 8 N The Seattle Weekly,June 15-21,2011 children 30 of them before they're 6 years old, not including an annual flu shot. (Many vaccines require multiple doses.) According to Offit, that number shouldn't be alarming.Whatever shock to the system a vaccine presents, it's nothing compared to what the human body deals with every day—to be precise, the"100 trillion bacteria"that he says reside on our skin. Belkin and his allies, however, aren't buying such reasoning. For each study that comes out offering reassurance about vaccine safety, they find a million flaws.A recurring critique of Belkin's is that scientists are not using real placebos when testing vaccines. "Guess what they're using?" he asked the crowd at a vaccine"choice" rally last year in Chicago. "Other vaccines." Not true, says Offit, referring to 16 years of studies he conducted before the rotavirus vaccine was put on the market. However, the children who got placebos in his studies instead of the then-experimental vaccine also got the rest of their recommended shots. Offit, like his colleagues, says that to do otherwise—to undertake the kind of vaccinated- versus-completely unvaccinated study that the anti-vaccine movement wants—would be"unethical." If that movement finds the prevailing science unpersuasive, it also takes sustenance from a few researchers who are on its side. "Within the last year, some of the more important research has actually come out," says Handley. It's not mainstream science, he acknowledges, but he sees that as following a noble historical pattern: "a handful of courageous scientists"gradually bringing the truth to light. Helen Ratajczak certainly fits that pattern, at least as far as being out of the mainstream. A retired scientist who, according to the resume she provided to Seattle Weekly, worked a seven-year stint at a pharmaceutical company, where she says she tested drugs but not vaccines, Ratajczak's interest was piqued when her grandson was diagnosed with autism. Thereby motivated to investigate a suspected, though never proven, vaccine link, she says she waited until retirement to go at it full-bore, so that she"didn't have a job to lose." Ratajczak's highly unusual plan was to set up an • independent lab, not affiliated with any institute or university. But so far her attempts to get funding have been unsuccessful—a grant application Ratajczak submitted to the National Institutes of Health three years ago was turned down—which helps explain the curious nature of the study she published in this January's Journal of lmmunotoxicology, only the second published study of which she's been listed as primary author within the past decade. Ratajczak's speculative thesis—"increasing number of vaccines given at one time . . . could be a culprit"behind increasing autism rates—provided a hint that her study was less fact than theory. She says she published it to attract the attention of a benefactor: "I felt that if I wrote some review articles and got my name associated with autism [research], I could be funded." Yet anti-vaccine advocates like Belkin cited Ratajczak's study as further proof of a connection to autism. He linked to it on his blog in April. In March, CBS News investigative reporter Sheryl Attkisson, already notorious among other journalists for her sympathetic reporting on vaccine skepticism, went so far as to say that Ratajczak's scientific review—which offered no new research, only citations of controversial, long-debunked papers—reopened the autism- vaccine debate. The real power of the anti-vaccine movement, though, lies not in science but in the stories of thousands of parents who believe their children were damaged by immunization.There's Belkin's story, of course, and Handley's. A partner in a private equity fund, Handley says his now 8-year-old son was"developing normally until around month 13,when he got one of the largest doses of vaccines"and began showing autistic behaviors. Handley started Generation Rescue as a way of promoting controversial"biomedical"treatments for autism,which involve purging the body of toxins purportedly introduced by vaccines. He and many other parents of autistic children swear the treatments work. Mainstream doctors,who don't link autism to toxins, shy away from them. There's also Kim Stagliano, a Connecticut mom who last year published All I Can Handle, a funny, moving memoir about her life with three autistic daughters. In a phone interview, Stagliano says she vaccinated only her two oldest children. By the time she got pregnant with her third, she was convinced that vaccines were harmful and determined to avoid putting yet another child at risk. Yet Bella, her youngest, now 10, never learned to speak—a hallmark of autism. Page 5 of 8 The Seattle Weekly,June 15-21,2011 Stagliano searches for an explanation. Maybe the hospital ignored her instructions and vaccinated Bella anyway?"I can't prove it,"she says of her suspicions about vaccines. Yet, she says, she and other parents can't help but wonder "What if it's true?" Belkin points to a wealth of other stories that have been accumulated by the Vaccine Adverse Event Reporting System (a database maintained by the CDC and Food and Drug Administration) and the Vaccine Injury Compensation Program (run by a federal court).They describe everything from a"huge bruise"and fevers to seizure disorders and brain damage. Vaccine proponents such as Offit insist those accounts prove nothing. Any parent or doctor can file a VAERS report without concrete evidence that vaccines were actually to blame for the illnesses described.And the compensation program does not require parents to establish causation in a scientific way. The program arose as a way to mollify parents while protecting vaccine companies from lawsuits, a dual mission that seems to satisfy no one. But reading through the accounts could make any parent queasy. To Vashon Island's March Twisdale, it seems as if there is a huge government propaganda campaign to, as she puts it, "disappear"all these children so described. "One group wants to silence the minority," she says. "Just shut up and do what you're told."That's the message she says has come from a pro-vaccine campaign on Vashon Island— started, ironically, by one of her friends. Vashon Island has about half as many people as Bainbridge—some 10,000—and is twice as remote, at least in its own psyche. "We're the only island around here that doesn't have a bridge to it,"says Leslie Brown, editor of the Vashon-Maury Island Beachcomber. "That sets us apart." Celina Yarkin, Twisdale's friend, lives on Maury Island, an even more remote and pastoral locale which connects to the main island by a narrow strip of land and is generally considered part of Vashon. "I am so much a part of this community," she says, standing on the 10-acre farm where she and her husband Joe raise produce to sell at farmers markets.Around her, chickens and a duck eat worms and otherwise prepare the soil according to organic farming methods.A couple hundred feet beyond her is the huge shipping container where the Yarkins lived while building 1111their own house. That was after the Yarkins,who met while riding the rails in their college days, moved here from New Mexico,where they lived in a"collective"with an anarchist bent. She recalls one of her housemates at the time, a new mom, reading an alarming story about vaccines in Mothering, a now online-only magazine that caters to the natural-living crowd. Initially, Yarkin had some concerns as well, and delayed vaccinations for the first of her three daughters, now ages 11, 8, and 5. A few years ago, however, her concerns shifted in the other direction, after a BBC crew came to Vashon to film a documentary about the anti-vaccine movement, and wound up getting some background shots in her driveway. Intrigued, she delved into vaccination statistics on the island. Yarkin found that exemption rates were so high that they likely compromised the island's so-called"herd immunity," which protects a populace at large.And she read up on the science of vaccination,which convinced her that immunization was far safer than the alternative. "The first thing I did was to call a meeting," she says. One call led to another, and before she knew it she had some of the area's most prominent immunologists at the island's high school, all of them excited that a genuine Vashon parent was on their side. Among them was Bill Foege, a former CDC director who, while working in Africa and India in the'70s, developed the immunization strategy that eradicated smallpox. He now works for the Bill and Melinda Gates Foundation,which is spearheading immunization campaigns all over the world and which this month announced funding for a vaccine- education campaign in this state. And Foege lives, of all places, on Vashon. "This is fabulous.We're so happy you're doing this,"Yarkin said she was told,the operative word being "you.""They didn't have time to take it on."So she did. Page 6 of 8 The Seattle Weekly,June 15-21,2011 Walking over to a work shed, she hauls out a large plywood exhibit she made that charts the island's rising exemption rates. She's displayed the exhibit at the island's schools and its farmers market. Today she loads it into her battered Toyota pickup and brings it to a health clinic, where she takes 5-year-old Madeline to get her latest round of shots. Yarkin has coordinated her effort with Chautauqua Elementary School's veteran nurse, Kate Packard,who couldn't have been more ready for a pro-vaccination crusade. In her office, Packard recalls a pertussis outbreak in the mid- '90s, when Chautauqua's"refrigerator was filled with antibiotics we were giving to children"and alarmed parents were writing to the Beachcomber. Yet after that scare died down, parents continued to opt their children out of the pertussis vaccine in ever-greater numbers. "I'm tired of it,"says Packard,who is retiring this year. "I'm tired of saying 'That's your belief.' " Parents who believe vaccines are more harmful than the diseases they prevent, she says, "are wrong. They're flat-out wrong. The diseases aren't around anymore, so they have the luxury of looking at the minor issues caused by vaccines." Packard jumped into action when she received an e-mail from Yarkin containing a speech by Foege suggesting that parents who opt out of vaccines should have to sign a form about the risks of doing so,just as parents who do immunize have to sign forms about the risks of vaccines. A few months ago, Packard created a handout that the school gives to parents who seek exemptions (although no signature is required). It tells parents that they are"able to make this choice because the risk of acquiring . . . diseases is reduced by the fact that other children have been immunized." It also informs parents that their children present a risk to other children—and to pregnant women who in turn could pass diseases on to their vulnerable infants. Packard says it's uncertain whether the school will continue to use the form now that the state is requiring parents to be told similar things by a doctor. But it's already sent a message—one Twisdale finds "highly offensive." She says parents are being told"You're basically this horrible person." In March, she wrote a letter to the Beachcomber to express her outrage about the form and an article that had run in • the paper about the risk of another pertussis outbreak on the island. "Here come the typical propaganda methods!" wrote Twisdale. "Promote fear! Exaggerate vaccine effectiveness. And, most insidiously, an attempt to turn islanders against each other." Exhibit A might be her own friendship with Yarkin, which has been strained by their opposing stances. Their two-hour phone conversation on the subject left Yarkin, at least, feeling they were further apart than ever and wondering if there was any way to address this topic without polarizing islanders. Twisdale is a part-time ballroom-dance instructor and former leader for La Leche League, the organization that urges mothers to breast-feed rather than use formula. She says she nursed her own until"they were many years old." Now she home-schools her sons, 9 and 12, in a house surrounded by horses and chickens. After finishing her lessons on a recent day and sending her kids to the library with their grandma, she notes that she is not unilaterally against vaccines. She immunized her sons against tetanus,for instance,which she believes is dangerous. Other diseases, however, she says, can be easily fought off by the body. Pertussis, for instance. Her son Roman caught it when he was 3 and gave it to Twisdale, who was about seven months' pregnant with Jordi. That she got the disease despite having been immunized herself as a child is one reason she discounts the vaccine's utility. (Public-health officials now urge adolescents and adults to get booster shots.)Another is that pertussis, by her estimation, "wasn't that big of a deal—I coughed." She and her son went on antibiotics and the disease went away— and the same happened when Jordi got whooping cough a year later, at 3 months. She says they all now have a natural immunity to the disease, which beats immunization anytime. In fact, she muses, if you had a group of really attentive parents who were quick to spot the signs of the disease and get appropriate treatment, you could have"pertussis parties,"just as some parents today have"chicken-pox parties." That's the kind of talk that makes Michelle Razore mad. Last October, Razore's 2-week-old daughter, Natalie, turned listless, stopped eating, and started coughing so badly she turned blue. Razore,who saw a friend go through • something similar with her child, suspected pertussis even earlier than Natalie's doctor,who eventually directed the Clyde Hill mom to go immediately to Seattle Children's Hospital. Page 7 of 8 The Seattle Weekly,June 15-21,2011 Pertussis is most dangerous for infants,who are too young to receive the vaccine and whose immature immune systems are sent into overdrive by the disease.That may sound beneficial, except that the prodigious quantity of white blood cells so generated"blasts everything away," not only the pertussis bacteria, says Tom Brogan, the • intensive care physician who handled Natalie's care at Children's . Natalie's white-blood-cell count was almost as high as that of leukemia patients. Doctors gave her two blood transfusions; "That wasn't working," Razore says. Her kidneys and lungs were failing, and Natalie started to retain water. "She was so puffy you wouldn't even recognize her," Razore says. "Our last effort was to put her on ECMO." Extracorporeal membrane oxygenation, as it is formally known, is a risky procedure that essentially allows a machine to take over for the lungs. Connected to a patient's arteries and veins by bulging tubes, the machine oxygenates the blood outside the body, then directs the blood back inside. The Razores had reason to despair. Doctors told them that no child with pertussis had ever survived the procedure at Children's. By the time doctors resort to ECMO, it's usually too late, Brogan explains. But Natalie did survive, and is now a babbling, pink-cheeked 8-month-old. "Come here, sweetie," Razore says, starting to feed her daughter while finishing the tale of her near-demise. Razore's experience has launched her on a new crusade. She's been calling local hospitals to urge them to start a new policy of routinely immunizing new moms with the pertussis vaccine right after they give birth. The Razores don't know who gave Natalie the disease, but doctors say mothers and other caregivers are generally the most likely to spread the disease to babies. • ;,11; efot 1411 Natalie Razore during (left)and after the radical treatment that saved her life. Razore knows her push for a new"mandate,"as she calls it, puts her in direct opposition to the anti-vaccine movement, and she seems to welcome the challenge. She has been in contact with the national Sounds of Pertussis Campaign,which tries to get people to vaccinate by talking about the dangers of the disease. "They show a baby coughing in a mother's arm," Razore says, imagery she now considers way too soft. Compare that to pictures of Natalie on ECMO. Her tiny body looks otherworldly,with blood-filled tubes coming out of her every which way. Says Razore, "People need to know how bad it can be." nshapiro@seattleweekly.com 11111 Page 8 of 8 - -i 1---Vipt:tz--,tX-Xy-k.- 74•'-t---4 .7.47Wir.;it --'r- -17---T-r7P-ITZ":Trft-_7-J--',-7:'- ... e S ' i A shot of reality diseases in the U.S.is at an all-time low.Smallpox,polio,diphtheria and measles are only some of the killers and cripplers that can be, I've never heard of a medical journal, let prevented by vaccination.Smallpox has been completely wiped out, alone a prestigious one,calling a researcher and polio may be the next to vanish. Now there are also vaccines F an outright fraud.But earlier this year that's that help prevent cervical and liver cancer and shingles. t ,._ what a three-part expose in the British Jour-- But those achievements are at risk because of Wakefield and; John Swartzberg M.D., nal BMJ called Andrew Wakefield because other anti-vaccine crusaders.In a survey last year,about one in four Chair,EditorialBoard of his small 1998"study"that first set off parents said that vaccines can cause autism, and one in nine said widespread fears that childhood vaccines they had refused at least one recommended vaccine for their chit cause autism.Actually,I think he should be considered a murderer, dren.All sorts of unfounded rumors about vaccines abound,espe- since the panic he incited led an untold number of parents to refuse cially on the Internet. to have their children immunized.As a result,some of these children Failure to immunize is risky not only for the individual.It takes.- became seriously ill,and some died. just a few unvaccinated people to endanger entire communities,as The Lancet which published Wakefield's paper,finally retracted it has been seen with some potentially deadly outbreaks of measles , last year,saying it was seriously flawed.But as the BMJ articles made here and in other countries where the virus was virtually eradicated, dear,this was a deliberate,"elaborate fraud,"done for financial gain a decade ago. (Wakefield was paid by a lawyer planning to sue vaccine makers) The BMJ exposé should close the door on this scare, but of l and involving unethical treatment of children. course it won't, since Internet rumors never die, and some anti- There is absolutely no scientific support for the notion that vac- vaccine zealots will never be convinced.But if you have any remain- cines cause autism.This wild goose chase has diverted energy and re- ing doubts about vaccines,or have a friend or family member who sources that could have been spent seeking the real causes of autism. refuses vaccination, I recommend The Panic Virus, a new book by Vaccination teaches the immune system to defend itself against Seth Mnookin.It offers a rich,clear-headed,highly readable defense disease.Of all medical miracles,it may be the greatest,having saved of vaccination—tracing its history from the smallpox vaccine more millions of lives and prevented immeasurable suffering and disabil- than two centuries ago through the aftermath of the Wakefield ity.People forget the toll childhood diseases took as recently as the debacle. I hope it becomes a bestseller and inoculates people 1950s.Thanks to vaccination,the incidence of the leading childhood against vaccinophobia. ej. c, 'llev l,�� w� S$ [,e. lls'''' 7 WellnessLetter.com July2011 3 a,�> > • Jefferson Count Board of 3CeaCt( Nledia Report • ,July 21, 2 01 • • Jefferson County Public Health June/July 2011 NEWS ARTICLES 1. "The Importance of measuring whether government works," The Seattle Times, 2. May 24, 2011. 3. "Anderson Lake closed again over toxic algae," Peninsula Daily News, June 12th, 2011. 4. "Peninsula Poll - Monday's Question; In light of more toxic algae closing Anderson Lake, do you think more North Olympic Peninsula lakes should be tested?," Peninsula Daily News, June 15th, 2011. 5. "Shellfish harvesting ban in place," Peninsula Daily News, June 15th, 2011. 6. "Discovery Bay closed to shellfish harvesting," Port Townsend Leader, June 15th, 2011. 7. "Food worker classes, testing and cards now available online," Port Townsend Leader, June 15th, 2011. 8. "Deadly toxin forces county to close Anderson Lake," Port Townsend Leader, June 15th, 2011. 9. "How long will you live? Depends on the county," Seattle Times, June 15th, 2011. 10. "Food handlers' class now available online," Peninsula Daily News, June 17th, 2011. 11. "Anderson lake toxins nearly triple," Peninsula Daily News, June 19th, 2011. 12. "Positive programs for kids' needed, sheriff says," Peninsula Daily News, June 21st, 2011. 13. "City library chose well for Teen Read," Port Townsend Leader, June 22nd, 2011. 14. "Tests show lake's toxin levels high," Peninsula Daily News, June 27th, 2011. 15. "Anderson Lake remains closed," Peninsula Daily News, July 3rd, 2011. 16. "Senior meals ending in PT," Port Townsend Leader, July 6th, 2011. 17. "Toxic algae mucks up swimming holes," Port Townsend Leader, July 6th, 2011. 18. "Nutrition program has openings," Port Townsend Leader, July 6th, 2011. 19. "Forty eateries earn food-safety award," Port Townsend Leader, July 6th, 2011. 20. "Workers get food cards on Web," Port Townsend Leader, July 6th, 2011. 21. "Sale of`urine' should be forbidden," Port Townsend Leader, July 6th, 2011. 22. "Jefferson restaurants receive awards," Peninsula Daily News, July 7th, 2011. 23. "Anderson Lake toxin levels still dangerous," Peninsula Daily News, July 10th 2011. 24. "Groups try to keep senior meals serving," Peninsula Daily News, July 12th, 2011. 25. "Faking it-Synthetic pee for sale," Port Townsend Leader, July 13th, 2011. 26. "Senior meals in PT substitute is sought," Port Townsend Leader, July 13th, 2011. 27. "Grant Street Staff: loyal district employees supporting declining enrollment," Port Townsend High School Yearbook 2011" • Opinion The importance of measuring whether government works I Seattle Times News... Page 1 of 3 rgk eglits Winner of Eight Pulitzer Prizes Originally published Tuesday,May 24, 2011 at 3:48 PM Guest columnist The importance of measuring whether government works In tight budget times especially,government leaders should focus on the effectiveness of programs they invest the taxpayers'money in,not just the popularity of the program's concepts.Guest columnist Tim Burgess writes about how Seattle is trying to see how it measures up. By Tim Burgess Special to The Times 2 v� F2 v PRESIDENT Barack Obama said in his inaugural address on Jan.20,2009, "The question we ask today is not whether our government is too big or too small,but whether it works." That's exactly the question our municipal government should regularly answer, especially now when money is tight and budgets are shrinking. Seattle taxpayers deserve to know their dollars are making a real difference. Consider crime prevention. Last fall,the City Council ordered a study of city-funded efforts to prevent crime,excluding regular police 411 services.The study found 64 unique programs,spread across 11 different city departments,using 109 full-time employee http://seattletimes.nwsource.com/html/opinion/2015137838 guest25burgess.html 5/27/2011 Opinion I The importance of measuring whether government works I Seattle Times News... Page 2 of 3 positions and costing about$22.4 million per year. Do these investments in crime prevention work?The study found most city programs count • outputs,not outcomes.In other words,we don't really know if we're getting our money's worth. The report to the council concluded,"...with the exception of those few programs that model scientifically tested programs,none of the programs can validly claim to be responsible for reducing crime." Conducting scientific outcome evaluations is not easy.This level of accountability is itself costly and raises complicated questions.What are the right measures?And critically,can we change the political discourse to value program results rather than program popularity? Earlier this month,the City Council brought researchers to Seattle to discuss evidence-based crime policy in meetings with the public and police leaders from throughout our region. Nationwide,police departments have been slow to adopt such approaches. Despite the challenges,we must raise the bar on rigorous outcome standards for city budget investments.Mayor Mike McGinn agrees.He recently announced that he,too,is concerned about only measuring outputs and has asked the city budget office to develop a plan to transition the city's investments in youth and families to an outcome-based model. We have excellent yet limited examples of where we have successfully implemented outcome- based investments and accomplished stunning results. The Nurse Family Partnership provides home visits by specially trained nurses to first-time mothers living in poverty,beginning early in their pregnancy and continuing until their child reaches age 2.The program,which has been studied for more than 3o years in randomized, • controlled trials,improves pregnancy outcomes,child health and development and family economic self-sufficiency. Here are some specific outcomes of this valuable program: a 67 percent reduction in behavioral and intellectual problems of children at age 6;a 48 percent reduction in child abuse and neglect; a 59 percent reduction in child arrests at age 15;and 72 percent fewer criminal convictions of mothers. The Nurse Family Partnership is a Seattle crime-prevention program that works,yet tragically we budget only enough to reach about one-third of qualifying mothers each year.If you want your city to be serious about achieving results and making wise use of your dollars,you'll support council efforts to add$850,000 to the NFP as we seek to reach most qualifying first-time mothers with this program. But in doing so,you'll also need to support defunding programs that don't work.It's a choice,and a decision that matters.Investment in proven programs reaps big benefits for years to come. Our Families and Education Levy,last approved by Seattle voters in 2004,invests about$17 million each year in interventions designed to improve the academic performance of our public- school students.This program works,too. Research shows that students who use levy-funded school-based health clinics have fewer absences,higher GPAs and are more likely to graduate on time.More than 700 2-and 3-year-old children from homes isolated by language or poverty have received home visits to develop learning skills,an evidence-based program that helps them prepare to succeed in kindergarten, • which increases academic achievement in the important elementary grades. http://seattletimes.nwsource.com/html/opinion/201513783 8_guest25burgess.html 5/27/2011 Opinion I The importance of measuring whether government works I Seattle 'limes News... Page 3 of 3 Since 2005,levy-assisted middle-school students have shown marked increases in meeting math and reading standards compared with other students. Levy interventions are narrowing the • academic-achievement gap. President Obama said something else in his inaugural address two years ago that's worth remembering: "Those of us who manage the public's dollars will be held to account,to spend wisely,reform bad habits,and do our business in the light of day,because only then can we restore the vital trust between a people and their government." Those of us who work at City Hall should take the president's words to heart.We need to better measure the outcomes of taxpayer investments and insist that public programs get results.We should employ evidence-based interventions.When we do,we'll help more people and we'll strengthen the public's trust and confidence in government. Tim Burgess is a member of the Seattle City Council.He chairs the council's Public Safety and Education Committee. • • http://seattletimes.nwsource.com/html/opinion/2015137838_guest25burgess.html 5/27/2011 m-A • • •. 46 -,71- . ...N. • iYx 3 3- bD l6 t0 W N.0 ^ \J 7.r CYC W c7 ro E ( lX\ x O C ® ci r" C m m `0 3 = O y o U 1 .. 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T1'ii l3Jl)W7O ilib AOut Q '2' ? ver' 4,1404%&' �to tepr rfi{ krrN ra�ro9e 5 4 r te%& y... � . r• a .� ' 0 0 A/�/ • Shellfish D harvestin ban in place Paralytic poisoning closes activity on Strait beaches BY LEAH LEACH `Discovery's been quiet up until PENINSULA DAILY NEWS now,"he said. Also closed to recreational Discovery Bay beaches on the shellfish harvesting are beaches Strait of Juan de Fuca and some on the Strait from Low Point near on the west side of the Strait in the Lyre River westward to Cape Clallam County have been closed Flattery to recreational harvesting of shellfish because of dangerous West Strait beaches levels of paralytic shellfish poi- soning found in samples. Those closures were prompted Commercially harvested shell- by the discovery of 83 micrograms fish are sampled separately, and of PSP per 100 grams of tissue products on the market should be found in a California mussel at safe to eat, said Frank Cox, Sekiu Point last week. marine biotoxin coordinator for The action limit for paralytic the state Department of Health, shellfish poisoning is 80 micro- on Tuesday. grams per 100 grams of tissue. The Discovery Bay beaches The Discovery Bay closure were dosed Monday after 1130 area boundaries are from north of micrograms of paralytic shellfish Cape George south to include all poisoning—also known as PSP or of Discovery Bay and northwest red tide per 100 grams of shell- to about one mile west of Dia- fishtissue were found in blue mus- mond Point to Rocky Point in •sels at Beckett Point,Cox said. Clallam County. The closure is the first this year TO Sri LFisa/A4 because of PSP,Cox said. Shellfish: Clams, oysters CONTINUED FROM Al "When it's got sunshine ous level of toxin has been and nutrients,it grows." found,when weekly testing Warning signs have been Dangerous levels gener- is initiated. posted at high-use beaches ally are found from June Marine biotoxins are not warning people not to col- through September, with destroyed by cooking or lett shellfish from these the highest usually in Sep- freezing and can be life- areas. tember,Cox said. threatening. The closure includes Last year, levels were Symptoms of PSP can clams, oysters, mussels, very high on many beaches appear within minutes or scallops and other species of along the Strait and Puget hours and usually begin molluscan shellfish. Sound. with tingling lips and Some beaches — from Cox said that in 2010, tongue,moving to the hands Green Point to Low Point samples at 26 sites — and feet, followed by diffi- and on Sequim Bay—are including sites on the,North culty-breathing•and pdten- closed only to butter clam Olympic Peninsula — con- tially death. harvesting. tained more than 1,000 In most cases,the algae "That's toxin from last micrograms of toxin per 100 that contain the toxins can- year," Cox said, explaining grams of tissue. not be seen and must be that"butter clams can hold Is it likely to get that bad detected using laboratory onto the toxin for a very. this year? testing. longtime." "I just don't know," Cox g Recreational shellfish On Friday, several sites said. harvesters can check the Sin the San Juans went over "We can't count on it state Department of Health the limit,Cox said. behaving in any predictable website at http://tinyurl. pattern. Warm weather "The most predictable com/y9uv6g9 or phone 800- thing I can say about it is 562-5632. PSP,or red tide,tends to that it is unpredictable. \ 1,_ be a warm-weather occur- "We just have to be con- Managing Editor/News Leah rence. tinually vigilant." Leach can be reached at 360-417- . "Plankton grows just Samples are tested every 3531 or Ieah.leach®peninsula (> like the lawn,"Cox said. two weeks unless a danger- dailynews.com. , Discovery Bay closed to shellfish harvesting • Discovery Bay beaches are ing. People can become ill closed to recreational shell- from eating shellfish con- fish harvest effective June 14 taminated with the natu- due to the presence of marine rally occurring marine algae biotoxins. containing these biotoxins. The Washington State Symptoms of PSP can appear Department of Health reports within minutes or hours and that marine biotoxins known usually begin with tingling to cause paralytic shellfish lips and tongue, moving to poisoning(PSP)were detect- the hands and feet, followed ed at concentrations above by difficulty breathing and the closure level. potentially death. Anyone The closure pertains to experiencing these symptoms clams, oysters, mussels, should contact a health care scallops and other species of provider. For extreme reac- shellfish. Beaches on both tions,call 911. sides of Discovery Bay are In most cases, the toxic closed. Warning signs are algae cannot be seen and posted. must be detected using labo- Commercially harvested ratory testing.Therefore,rec- shellfish are sampled sepa- reational shellfish harvest- rately, and products on the . ers should check the state market should be safe to health department website at eat, according to the press doh.wa.gov/ehp/sf/biotoxin. release. htm or call the state's. Marine biotoxins are not Biotoxin Hotline at 800-562- destroyed by cooking or freez- 5632 before harvesting shell- ing and can be life threaten- fish anywhere in the state. I • Food worker classes, testing and cards nowavailable online Food workers in Jefferson pass the test, they can pay Vietnamese, Cambodian, County can now take permit the $10 fee electronically by Mandarin, Cantonese classes and a permit test debit or credit card and print and Russian. It is also online through Jefferson out their food worker card. available in a closed cap- County Public Health. "This online system pro- tion version for those with In order to work at a food vides the education food hearing impairments. Visit establishment, the state workers need to serve food foodworkercard.wa.gov. requires food handlers to safely while making it easi- People who do not have take a class and pass a test er for people to obtain their Internet access at home can every two years to prove a food worker permit card," use the computers at most basic knowledge of food safe- said Stuart Whitford, the local public libraries. ty. State health officials say county's director of environ- The health department the program helps prevent mental health."This is espe- plans to continue to offer in- food from being improperly cially helpful to community person classes. handled at restaurants and. organizations whose volun- For more information,go to other vendors, in turn pre- teers need temporary food j e f f er s o n c aunty p u b l i- venting consumers from fall- worker cards to serve food at chealth.org and click on the ing ill. community fairs and fund- "Food Safety" link under In the past, taking the raising events." "Environmental Health and class required a trip to one Getting a food worker Water Quality." of the many locations offer- card online takes about 60 For more information, ing the class and testing. minutes and costs $10—the contact the health depart- With the new option, food same as the in-person class. ment at 385-9444, Monday workers can take the class The online class is available through Friday, between 9 • and test online, and if they in English,Spanish,Korean, a.m.and 4:30 p.m. • Deadly toxin forces county • to close Anderson Lake Anderson Lake is closed ., April for the opening of the to water activities due to ore:closures lake fishing season, but is high concentrations of a See related story A2 now closed. deadly neurotoxin. Meanwhile, algae con- The lake is undergo- Washington State Parks, cerns are also present at ing a spring blue-greenin consultation with Gibbs Lake (a popular pub- algae bloom predominate- JCPH, has decided to close lic swimming hole), Lake ly composed of the gen- Anderson Lake for fishing Leland (another swimming era Aphanizomenon andand swimming. Currentland fishing spot)and Silent y, Anabaena. Test results forsigns on site warn against Lake. samples collected on June 6 any fishing or swimming in SWIMMING indicate this bloom is pro- the lake, by people or pets. The JCPH has a "cau- ducing anatoxin-a,a potent The park remains open for neurotoxin, according to all other recreation, such tion" label on those three Jefferson County Public as biking, hiking, horse- lakes. This warning means Health (JCPH). back riding and picnicking. do not swim in areas of Anatoxin-a is.sometimes Toxic blue-green algae scum, do not consume lake known as "very fast death has been a growing issue water (pets, livestock or factor." in Jefferson County.In late humans), clean fish well Concentrations of the May 2006,two dogs quickly and discard guts. toxin are 2.7 times the died after drinking from Although the lakes are proposed safe recreational Anderson Lake. monitored weekly, condi- limit. Neurotoxins have The problem has also tions change rapidly. So caused illness and even occurred in other lakes far, Sandy Shore Lake is . death in humans and ani- here, usually in May or clear of algae. mals worldwide. 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N m (0 J g. p, .* O OOA� O ti < ..t7 no$b '11D' '-'-'-'5".r° a.' am- " °° � oacsrfog owaN"a 09� ^ 0 , wa *!v OO cO oo k pn`GGfrv'bpxra ,,QR ` , 'NN mo ,, va n N 'a• , (� p N 0zaO<'b w n N O O n ,� N < W .G O Q CD 0 'rtro Co n , O n'" w I N ,, ryw OO < O p 00 0 ` O C f '7' NONo .. OQ i'Qa N O (D 00 a. 7 O'7- [D _ T 'G : aix 9. o a-= SO • 0 , S Food handlersclass • now available online PENINSULA DAILY NEWS minutes and costs $10 — PORT TOWNSEND — the same as for the in-per- son class. Jefferson n per- Jefferson County Public son class. has implemented The online class is avail- Healthnish, recently an online option for able in English, e,SpCam- food workers classes,tests and Korean,Mandarin, Canton- food worker permit cards. ese bodian, Mandarin, With the new option, ese and Russian. food workers can take theIt is also navaieabiole in a class and test online,and if closed- caption version for hearing- theypass the test,theypersons who are can impaired. pay the $10 fee electroni- People who do not have cally by debit or credit card Internet access at home can and print out their food use the computers at most worker card. local public libraries. In the past, taking the Public Health will con- class required a trip to one tinue to offer in-person classes. of the many locations where For more information, the class is offered. visit www.jeffersoncounty "This online system pro- publichealth.org and click vides the education food on the"Online Food Worker workers need to serve food Classes" link under "Envi- safely while making it eas- ronmental Health and ier for people to obtain their Water Quality" or on the food worker permit card," Food Safety Page.• ,said Stuart Whitford,direc- For more information, tor of Environmental phone Public Health from Health. 9 a.m.to 4:30 p.m.Monday Getting a food worker through Friday at 360-385- card online takes about 60 9444. • 6/7// Anderson . Lake toxins • ' ' detectable amount of either nearly tralgae n-a or the other palgae toxin historically East Jefferson found in County lakes, microcystin, BY LEAH LEACH which can damage the liver. PeNtxr•i_A DAILY NEWS -- Microcystin has not been Toxins in Anderson Lake Fish that have been detected this season in the For more information have nearly tripled, said cleaned with the guts dis- county's lakes. about lake quality in Jeffer- carded can be eaten from Sandy Shore Lake also son County, visit the envi- Jefferson County environ- lakes posted with either tests below detectable ley- ronmental health website at mental health specialist "caution" or "warning" els for algae toxin.The lake http:/ltinyurl.com 16z64ofy Greg Thomason after tests signs. is considered clear for all No toxic blue-green algae of samples taken last week The difference is that a recreation. has been reported in Clal were received Friday. "caution" sign notes that The lake has an algae lam County where health course,"he said."I "The lake staysclosed,of toxic algae may be present, bloom, but there are no officers do not test for tox- andt's getting that swimmers should toxin-producing algae in it, Instead, they visually worse." avoid scums, while the Thomason said. monitor lakes for signs of Anderson Lake was "warning" sign says toxic An innocuous type of algae bloom. closed to fishing,swimming algae are present and algae is producing. the Algae blooms in Clallam Jun any kind of pleseaken warns against any swim- bloom,"he said. County lakes should be June 10 after samples taken ming at all. reported to the Clallam June 6 contained 2.67 In both cases,lake water Silent Lake County Department of micrograms per liter of ana- should not be consumed. and Human Ser- toxin-a, a powerful neuro- Gibbs Lake has a"cau- No sample was taken Healthees'environmentalndhealth Ser- toxin. tion"sign posted because it from Silent Lake last week, divisionce ' at o 5 . Test results of samples has a slight algae bloom but it will be tested next taken June 13 showed con- made up of three types of week. centrations of 7.37 micro- algae known to produce tox- Two weeks ago,the lake Managing Editor/News Leah grams per liter of the algae- ins at times. on the Toandos Peninsula Leach can be reached at 360-417- produced toxin, which can At present,however,the was found to be clear of tox- 3531 or Ieah.Ieach®peninsula cause illness or even death algae is not producing tox- ins, but it contained algae dailynews.com. in people and animals. ins,Thomason said. that could produce toxins, • The recreational limit is "It's OK,"he said. earning it a"caution" sign 1 microgram per liter. Tests of samples find no on its shore. Aside from the lake,the The algae in Silent Lake 410-acre park between Chi- "could start producing tox- mecum and Port Hadlock is ins any minute,"Thomason open. said. Hiking,horseback riding "You want to assume the and biking—all recreation worst. If you have a dog, not related to the 70-acre keep it from drinking the lake — are permitted in water" Anderson Lake State Park. Thomason said fish Leland, Gibbs, Sandy caught in the lake could be Shore and Silent Lake are eaten if cleaned properly, still open, though the cau- but he advised against . tions were upgraded last swimming in it,or drinking week for Lake Leland. from it. The "caution" sign that Anatoxin-a can cause had been at the lake was convulsions and even death replaced with a `warning" by respiratory paralysis. sign,Thomason said. Anderson:Lake has been While tests show that plagued with summertime the level of anatoxin-a is closures because of high still well below•the safe concentrations of toxins level,the amount is increas- since Memorial Day 2006, .ing,Thomason said. when two dogs died after The latest sample found drinking lake water with a 0.17 micrograms per liter of heavy concentration of ana- the toxin.The week before, toxin-a. the level was 0.04. Anyone who observes an "The (algae] bloom is algae bloom at a lake is getting really heavy, and urged to phone the Jeffer- there are two toxin-produc- son County Public Health ing algae in the lake,so we Department at 360-385- put a warning sign up," 9444. Thomason said. • /- /DA/ • __ "a 41 i-. V aso o a a — N VJ6 a00 . 0 �o � > m��.N 63.� � - 4 w a; g Programs: PT 4 t-w 1f 0'.5 62 4i ° � aa'=.� a. c�.R 8 a6- ,24 seen as graying .� qs.0.544o �,-o+> �, as ° ° 8o CCopb town, mayor says cny W 4 .5.r. U F N C(C 8 ftp o6 o 7 ^N CONTINUED FROM Al notice they have left." U to go . 4 The committee has o0 Port Townsend isper- scheduled its next meeting 3 cu 0cu ceived as a graying commu- at 3:30 p.m. on July 25 at i; [ ot.- • nity, and this skewing the WSU Extension office, t� o o �, should not carry over to 201 W. Patison St. in Port 3" ;' Ti., a recreational options, said Hadlock. ' .5 d m eu Mayor Michelle Sandoval. By then, members hope le essing at her to gain a �, .°� e idea of all w 0 oa °cs c- 3•5 3 statements rare not hmeant the recreations facilities in W CV a 13 .x'� 09 L x a) to disrespect the older pop- Jefferson County. I m o, x a� p, ulation, Sandoval said she County Parks and Recre- r-, ° Q,a' 2 3 .5 Y,b thought ceding the Port ation Director Matt Tyler EN o b F �a Townsend Recreation Cen- distributed a draft inven (II) ♦ F o,a to ter to senior citizens was a tory,encouraging committee ;.S a o mistake. members to read the docu- �p! 3 I 3- "There is a gap in our ment and add other facili- • recreational options here," ties that are not included. ° ° she said. Monday's meeting was y o o "When you want to keep moderated by Bob Wheeler, n .-6 a m o a program,you tend to gear .�$v•° � a) � ,�� a former Port Townsend city binU ,b v; o > V.g c it toward the people who public works director who A • o S x„ •-5 G a a can pay. has been hired as a consul- ' E G.° ° a. "We need to consider the o oo aB.3 a) g 8--'d needs of youngfamilies as fit' Willx ,. o B. $ caro A second consultant, O >,, 0 o w A 3 x u well as teenagers and those .� o °�'.a ° o'" 5 ; . in their early20s who have r Ohlde,will join the 04) N °0 ° aoi ". /. y c nowhere to o at night process to interpret and i-. - an g,x -0 o o b as Jefferson County Public allocate the inventory, o-o 3 " Health Director Jean Bald- according to Tyler. E ) r- ao o.� qA'.'p N w The two-year budget for V �_.y ,,,. •°s'^ m o win said it was important to both consultants is around �q 0 o o o 3 c $ o v cater to the needs of young ♦V 1� o o w B o ° families and recognize that $44,000 and will come from S' g ..,„ ,,,,,,a'.g y " o ,, recreation measures the the city's portion or Proposi- y� a)'5 x O, y , overall health of the corn- tion 1 sales tax revenues, V) w a 5 a o W U a .8 munity. according to Tyler. O Baldwin said it was C' a' 23 a .;°' m'b 4 essential to identify and en a;o+y w Jefferson County Reporter a C. o ,n protect the most important Charlie Bermant can be reached at CI .---` m o a m o o• o programs"or they will have 360-385-2335 or chadie.bermant@ o C p„' c gone and we won't even peninsuladailynews.com. c' 0.ay.> o a' a CD\ 'O g o b G o L U.�y Er/] (1)2'!. y c°w G 0 4' a mL(,) a-., W ia� A 2 ;) o ct wa 005I.. � -oV ›,BO O E.t,.2 PE °'n.0 y ° .° Ca. pz o+ � 0Ta' T pSV W 0.1 P.. E mp 0t5 uw i/.//// \ V L ec d e • City library chose well for Teen Read Recently the Port Townsend • Public Library completed a Teen Community Read to address the • topic of teen suicide. One of the most important strat- egies for preventing teen suicide is giving youth the opportunity to talk about their feelings and the sub- ject of suicide. This book [Thirteen Reasons Why] clearly resonated with the youth in our community. The eight-month planning pro- cess produced a thoughtful, pro- active program that included art workshops, book discussions, teen •participation projects, prevention trainings and presentations by Jay Asher, the author. This provided • teens a powerful opportunity to process their feelings and thoughts about the book and the topic of suicide. The Prevention Team at • Jefferson County Public Health would like to praise the Port Townsend Public Library, the Paul G. Allen Family Foundation and especially Jody Glaubman for hav- ing the courage to choose this book and this topic. JULIA DANSKIN, • KAREN OBERMEYER, KELLY MATLOCK& • ANNA MCENERY Tests• ests , .lake's toxin levels high 6 0tiS m m k O � ag a Oii '., m No fishing, ing .. y. ° ,, m J " dmmyd. m0 , . " vm., ,n CA 6 'opN �mwhT` fNZ other water recreation o a, c P. 'i • x � w m m G a 4m - °4 dy6 da � aa8� u wm1 allowed at Anderson >, ��� a �,gbQFac' a"mm Eg g e g . bs- g2- E a .q -c5Eo.§Q0E4 gyy ° Q 286m BY LEAH LEACH2°411 °A AIC.0.z 61.5 mo U7paUexv lilt PENINSULA DAILY NEWS or the first time this season, another toxin — �O, i° m ` y 00,0A ape c y n a PORT TOWNSEND—The r^ m g'1 ei .>~, . $ o m o m a . latest samples from Anderson created by blue-green `�J 3 .g ° o w b 3 "'D o y a. a a ti Lake contain more than 1,000 algae, microcystin, has 3 .4 ''1;q c ,'.b . g,5 a .; °• a, o times the safe level of a potent c °r d a • o q m xm o f o y y neurotoxin,the highest level of shown up in lakes in ,t,c.Z 3 0- a' ..... .� o m the algae-created poison seen Jefferson County. Q,) 3 ° d a m c N 2,-E�' o 3 w�•,o m 2 8-- ° o at the popular fishing hole Microcystin, which can ^ ° /.5g-A,—bac 3 3 '� o *° ° E s a c o " since it set a deadly.world �L, d'gib N ° g �� a N m A 2.= °...2 record in 2008. damage the liver,was 5 0• p m ° a 3 3 �.2-.-,* E,i m o „- Test results received Friday found in a concentration of g,�- ,�. ,.`" .k d m a showed 1,112 micrograms per 6.5 micrograms per liter in -' a"71'1:1"8 .5 N«. w"D 2 m.r o liter of anatoxin-a, for which p �- a o i. i. toot-3l--g.--6 the safe level is 1 microgram Anderson Lake. ;,...§ &10 ,0 •p ,o o., VP" .ti-f, GC �c .y,y '�'m'a per It's ` `�' m .. �R , o- 2e omami13_ya°: (� "It's the most since 2008," centration of 7.37 micrograms per "11 " °411 c. i m "$ y w o s b.2 said Greg Thomason,Jefferson liter. FFF��� -7=12.2 ° v a o� 0 6,0 o,.5 - .. m am y �, c,ai-0 County environmental health Although the 70-acre lake is •qq y �° p a m "'S' a o 41 d o ''iv „I) w Y specialist. 60 ° d o a, d,.8• o a 'b Pce posted with red closure signs,the ..o-.. o.5 ommn S a m 0 1 c d § ,......4 g m m In 2008, Anderson Lake 410-acre park surrounding it ° water contained 172,640 micro- remains open. `3 Abe qG a °. `"y w m-o Co ,, 7 cd k.� I a, °.. aim °F a,� m m_'�y grams per liter of anatoxin-a. Hiking,horseback riding and .b id 21.2 3 d x %A L x 2b a, o y m.- . 2 3 g-5.- "That's 3.- That's a world record," biking—all recreation not related (� m.2 Q. ,a 3 a o, 3 o 3 z E E ..0 >,m .S Thomason said. "It's still a to the lake — are permitted in �^ world record." Anderson Lake State Park,which „�, d,n a ° d ° a m Although 1,000 times less is between Chimacum and Port A t ao a § S o'^ �'q G o m m °oo° m than in 2008, the amount of Hadlock. 5 m 3 n x w c . • s 0 0 co 3 °" c.0 3 , '- an a anatoxin-a now in Anderson 0 ° 3 3 0 w 5 "a $-.0i° I C lake is still more than enough Other lakes O m •"3 a m to kill,Thomason noted. a " w (:o. E v. a '" m �i L; 3�'4 0 m° ,' Anatoxin-a acts quickly'on Awarning sign remains posted a eo y a t.5 , a •"'. a °g .8;,d,1a o:�1 E the nervous system. In lethal at Lake Leland,which tested at ;--i , Y 2 a:~ k d 8 E ,,a)-22 .k, ;'—'43-21t1 amounts, it kills both people .275 micrograms per liter of ana- p m.� E $ m om m , =-5:-.9:6-43 r,, ,� and animals through respira- toxin-a, while tests found the lV , a E'd u." g'o (o a a ° d m m m toxin to be below detectable levels g ° ° t m m m t ° '^ ' t,, tory paralysis. > a. ��-� � E �v�'� � g v� ° o � E� m r� Anderson Lake "is a good in Gibbs and Silent lakes. ,°, a E.5 v.5 8¢� y l;o l w E >.-5 t'o.n a place to not get near the water," Caution signs are posted at Thomason said. Gibbs and Silent lakes because t„"4 d V v v o "v c m The amount of toxin in both contain algae known to pro- c y ti o a Anderson Lake has increased duce toxins at times,even though o 'i4"9- y y�, m 3 a 3 a " in geometric leaps since the algae remains benign for now. .2 d •,° v . a ° . . June 10, when the lake was Leland,Gibbs and Silent lakes = ° .4 ° F. m 3 ,°. C m °a 1,� 'm closed to fishing, Swimming are all open for fishing. I� a E oa ug,„... ..:,, and any kind of recreation Fish that have been cleaned o a E E _ ,, x E *' m after samples taken June 6 with the guts discarded can be U �•m iti w u m .5 o tea,co M o .> °v .. contained 2.67 micrograms per eaten from lakes posted with O d o 8 ° m m d liter of anatoxin-a. either caution or warning signs. g--0 m-'-ti E O E ,.' cn. . E Test results of samples TURN To Toxrn/A6 8 Y 'm a 0 a - w 3 ti g taken June 13 showed a con- . - /D /V• • , /.. „ /. - O SUNDAY,JULY 3,2011 renInsu la' Anderson • remains closed Others open for fishing sly g h have the water because g P > ason said. EA BY Ls LEACH damage the liver,decreased "They could be produc- PENINSULA DAILY NEWS quite a bit in the latest testing toxins right now, as far resultsison- . as we know." ous,Andersotill nLakeThe concentration was Sandy Shore Lake south ous,A has improvedn never- 6.6 micrograms per liter of Port Ludlow near state thellast week's reported since toxic June 24. Friday's results Highway 104 remains clear, load of more than 1,000 found 0.12. Thomason said. times the,safe limit. The safe limit for micro- Fish that have been The latest test results of cystin,a slower-acting toxin cleaned with the guts dis- samples from the lake con- than anatoxin-a,is 6 micro- carded can be eaten from fain only nearly eight times �� per liter, Thomason lakes posted with either the safe limit of the potent Anderson Lake also has caution or warning signs. neurotoxin anatoxin-a Researchers don't fully "The numbers came a thick bloom of six types of understand why certain down at Anderson, but it's algae, five of which are types of blue-green algae still above the warning nown to produce toxins. will begin to produce toxins level,"said Greg Thomason, nor why the level of toxins Jefferson County environ- Others open for fishing increases or decreases. mental health specialist,on Test results show it's Anderson Lake has been Friday, when he received still safe to eat fish from plagued with deadly toxins test results of samples Lake Leland; Thomason in the summer months taken Monday. . said,though no one should since 2006, when two dogs "It's definitely danger- get in the lake. died on Memorial Day after ill ous," he said. "It's still The results showed 0.05 drinking lake water with a heavy concentration of ana- closed"to any kind of recre- milligrams per liter of both ation. anatoxin-a and microcystin. toxin-a. Although no one should Leland,which is north of ne algae bloomhat observeso lake is get in the water or fish in Quilcene, is posted with urged to phone the Jeffer- the 70-acre lake between warning signs because it son County Public Health Chimacum and Port Had- has a thick bloom of toxin- Department at 360-385- lock,the 410-acre Anderson producing algae species, 9111. Lake State Park-surround- Thomason said. For more information ing it remains open for hik- Test results are about a about lake quality in Jeffer- ing, horseback riding, bik- week behind reality. The son County, visit the envi- irig all recreation not toxic load in any lake ronmental health website at related to the lake. infested with the types of http:/l tinyurl.com l 6z64ofy. algae that can produce tox- No toxic blue-green algae Latest test results ins could change quickly— has been reported in Clal- The latest test results and not be measured for lam County, where health showed Anderson I s,ke con- several days. . officers do not test for tox- tamed 7.93 micrograms per Both Gibbs and Silent ins. Instead, they visually liter of the algae-produced lakes tested below detect- monitor lakes for signs of able levels for both algae- algae bloom. The safe level is 1 micro- created toxins. Gibbs Lake Algae blooms in Clallam gram per liter. is south of Port Townsend, County lakes should be Results June 24 showed while Silent Lake is on the reported to the Clallam 1,112 micrograms per liter Toandos Peninsula. County Department of of anatoxin-a, the highest Caution signs are posted Health and Human Ser- level since 2008, when the at those lakes because both vices'environmental health lake set a world record — contain algae known to pro- division at 360-417-2258. still unbroken—of 172,640 duce toxins at times, even micrograms per liter of ana though the algae remains Managing Editor/News Leah toxin-a,a quick-acting toxin benign for now. Leach can be reached at 360-417- that can kill in high doses. "It's safe to catch fish, 3531 or leah.leach@peninsula • Microcystin, which can but be cautious about get- daily news. Senior • meals ■ ending in By Allison Arthur of the Leader Baked ham, sweet potatoes,beets and a heaping side of disappointment—are on the dinner menu this Thursday at the Port Townsend Community Center. Tim Hockett,, executive director of Olympic Community Action Programs(OlyCAP), announced on June 30 that a low-cost,four-day-a-week senior dinner • program in Port Townsend serves its last meal on July 7. State and federal funding cuts have sliced OlyCAP's budget, and Port Townsend servesthe fewest of the agency's meal programs(an average of 20 diners). Thursday's final OlyCAP meal is free.Senior meals chef Robin Gainorhas already set the menu. She's also losing a job,one of 40 OlyCAP employees to be laid off or leave in 2011. "I still believe there's no blame on the cook or the seniors or OlyCAP" Hockett told the Leader on July 1. "We're trying to be good stewards. There just isn't enough money." SENIOR CONCERNS As they dined on spaghetti and corn the.day-after Hockett's surprise announcerhent,seniors who rely on the food—and the friendship—the program serves were digesting the news. One woman wrote a poem.Others made phone calls. Still others were planning get-togethers in their homes. Everyone had questions. "I think it's terrible.I haven't been coming,but when I was,it was helpful.I don't understand why they can't make adjustments at the higher levels," said Robert Dunlap. "Food is more important than insulation,"said John Reeve,wondering whether the weatherization program could be cut. "It's a nice way to socialise and meet people and have a chance to be part of the community,"said Roger Reichersamer. • "I think there are things [Hockett] didn't explain. He gave the usual economic spiel,but he didn't answer some questions like why we can't pool resources and get See SENIORS,Page 4T y S 4 F, m,-a" . i- r 3 d y fie" x , ' .,,, --...D"-Am. 1 € • e" 9r 1 " ' ms ; v . _ & fli:7 L. .', 4 * - F '4SY; �Jt v 14 2,.!",.--',/.. 4 s1a F ^'? ,i. YLL_al @ " { '".' 's tiol , � � # a; G ,sem,?' y f- '. � 4 �. ` It ?`y�,�. � ,.�"T s § '-� w �a �—",.`= _'� '� ,`�ae� rad 1 t t!' �4 + -, r te' -itlaze i,.,,n- a.-}� :,} r `-- Nur s, § ...-,...M�..;;- .�„� .s .,,M { a 45:1 Robert�L.Russell has been coming to Senior Nutrition Program meals since it began more than 20 years ago at the Port Townsend Com- munity Center.Photo by Allison Arthur Seniors: Budgetcuts ''Continued from page 1 O1yCAP closed the Brinnon "The community has been better rates for food,"said Bill meals program earlier this supportive,but the economy is Mason. year—also with about a week's horrible." "He didn't answer my ques- notice.Within days,the senior In addition to layoffs, 1111 tion: Why the people in Port organization and community OiyCAP had to eliminate a Townsend are of lesser impor- members there pooled resourc- dental clinic in February when tante than the people in Port es to keep the program going funding was cut mid-year — Angeles?"asked one senior. —not under OlyCAP's umbrel- and it was given little notice, "Art is more important in la. (See the Leader's June 22 Hockett noted. That cost six Port Townsend than we are," issue for that story.) people their jobs. said another. Hockett wondered last Employees have cut hours While several seniors ques- week whether Brinnon's and.taken days off so that tioned why Hockett would give response, stepping up to the others can keep their jobs,he the seniors only a week's notice plate and taking over the pro- acknowledged. to fmd a solution, 91-year-old gram, could happen in Port And while one senior in Robert L.Russell sat stoically Townsend.But seniors in Port Port Townsend suggested at the end of the table, eating Townsend said it was unlike- it was time to set priorities and contemplating. ly because they are all older, straight and perhaps end He has been coming to the they don't cook and,unlike the weatherization projects, senior meal program in Port seniors in Brinnon,dont drive Hockett said funding doesn't Townsend for 25 years.He met either. Many of the seniors in work that way. his late wife at the program. Port Townsend walk to the' "There is no good answer. Now,Harriet Small is his sig- center for meals. We have funding for weath- nificant other. Hockett also wondered erization and as long as we "I blame W. Bush and whether Jefferson Healthcare do, we're going to weather- Obama for getting us into Hospital could do what the ize homes.You can't take that wars we don't want. Bush got Forks Community Hospital is money and put it in senior us over there on account of doing by inviting seniors to nutrition. That's against the oil, and Obama was going to come to dinner a few times a rules,"the CEO said. He also get us out,but he hasn't,"said week. Hockett said he called said weatherization helps low- Russell. hospital CEO Mike Glenn to income people by saving on Asked whether he saw a make some inquiries. their power bills. • direct connection between the Seniors said the purpose of Hockett sounded as frus- wars in Iraq and Afghanistan the meals at the community trated on July 1 as the seniors and the death of the meals center isn't just about food:It's had on Thursday. He said he program in Port Townsend, about camaraderie, and that's spent a week working on writ- Russell said,'Absolutely." what they would miss if they ing a grant to revive the dental T ate at the hospital. clinic only to be told that the Fn:. �.� '�— ,_.._, -— .,. ., �....__ ., .� �._._ _. .. eta-�„ldnf fiinrl it. #i " state wouldn't fund it. NiOH Hackett POSSIBLE answered OLYCAP LAYOFFS "That all takes time and Hackett the Leader's July 1 phone call. Hockett said several times energy," he said of writing It was his day off, but he that he.was sorry to deliver the grants and looking for money said he knew the seniors news to seniors. He recalled that just isn't there. "It's like IIIhad questions and had tried his first day of work at OlyCAP choosing between your chil- to answer them all. in 1989.It was at the center in dren. So why cut the program Port Townsend,moving part of "It's very frustrating without notice? a program to the fairgrounds that in this economy, with "That's always the ques- because of construction work. so many people unemployed tion," Hockett said, adding Flash forward to June and needing help,we've got- that there was a combing- 2010,when a man at the senior ten weak.I'm worried about tion of forces that compelled center asked Hockett not once, the safety net breaking.It's him to act so suddenly.The but twice about Hockett's not•just us." Senior Nutrition Program "$200,000 annual salary." has $100,000 less this year "I was flabbergasted," BACK AT THE CENTER than it had last year. Food Hockett said. "My salary is While they sat eating costs have gone up, as have $80,000. There are 10 [corn- and talking June 30, several fuel costs,while the number aro dthe state and I'm the OlyCAP'] questioned action agencies seniors ofpriorities, but also peoppleein Port Townsend using the program has lowest paid executive of all the community's priorities. stayed the same, around 20 of those by over $25,000. I've "They cut education and or less. been the lowest paid for many seniors. It seems to me, the "It was the lowest num- years. beautification of the commu- ber of meals served, and "I'm not complaining. I nity can be cut and the things the least efficient and most manage$11 million and some- that are vital should be kept," costly of the sites," he said times 300 people:'he said. said .Saundra Vinje. "Where when asked again why the Hockett said his last pay are the values?" program was cut. raise was in January 2010. Vinje said she has already And while a similar. He declined to say whether he decided to work with others to senior: meals program at had taken a pay cut during the start a seniors' dinner in her the •tri-Area Community last year while the agency has corner of Port Townsend. Center in Chimacum is been shrinking. Asked if they would can- not going to be cut out- In the last six months, Sider making use of a free • right, Hockett admitted• OlyCAP has been shedding lunch offered at a church down that there could be more employees, including program the street, several said it was cutbacks, perhaps a day of 'managers. The agency, which unlikely.Seniors are willing to service here and there. once had 265 people, now has pay$3 or what they can for a He didn't want to elabo- ,225. Twenty people left on meal,but don't want to be seen rate;some decisions haven't their own and the others were as taking"anything for free,or laid off,he said. be seen as homeless. been made. OlyCAP also has meal Hockett has steadfastly "I think they should work programs in Port Angeles declined to say which manag- to get the program back,"said and Sequim. ers left on their own accord Ruth Reandeau, who helped "We're looking at cut- and which were let go. build the community center backs everywhere. Port "Our management team years ago, raised funds for it, Townsend was the only was 12 people nine months and knows Hockett well. one we decided to close," ago and now it's four people:' "I come for the social part Hockett said when asked said Hockett. "We've tried to of it,"Reandeau said."If other again why there was little cut internally so we don't have places are being supported,so notice given. to cut services. should we,"she said. 110 .z, Port Townsend&Jefferson County Leader _ Wednesday,July 6,2011•B 13 Toxic algae mucks up swimming holes Warm summer weather a good swimming lake) is has finally arrived,but some closed to public access freshwater lakes in lowland (although Anderson Lake Jefferson County remain off- State Park trailsare open). limits to swimmers. Sandy Shore Lake is open Bluegreen algae is back for public use (fishing and again, and Jefferson County swimming): Public Health is monitoring In termsof saltwater levels. As of July 5, Gibbs swimming holes, the Port of Lake (with a county park Port Townsend has installed a and swimming beach) mer- new float at the public swim- its a "Caution" rating (do ming beach nearthe Herb not swim in areas of scum, Beck Marina in Quilcene. do not consume lake water; Going to the beach (with this applies to humans, pets a vehicle) this summer also and livestock)and clean fish means the Discover Pass well. Silent Lake also has a access fee applies at popular "Caution"-tag. places like Fort Flagler State Lake Leland (with a Park and Fort•Worden State swimming beach) has a Park. • "Warning" level, meaning it Visit tinyurl.com/lake is unsafe for people and pets. status for updates or call Anderson Lake (not .385-1259. • • Port Townsend&Jefferson County Leader Wednesday,July 6,2011 B 13 • Nutrition program has openings Jefferson County Public Health's Special Supplemental Nutrition Program for Women,Infants and Children (WIC) has openings. WIC aids pregnant women, new mothers and young chil- dren through nutrition educa- tion,breastfeeding promotion, and referrals to other services such as health insurance,den- tal services and developmen- tal screenings. More than 850 women, infants and children were served by the WIC program Iast year,and more than half the babies born to Jefferson County families qualify every year. To find out if you qual- ify, call 385-9400 or go to jeffersoncountypub1ic health.org. Port Townsend&Jefferson County Leader Wednesday,July 6,2011 B 13 • Health , v „- Forty eateries earn fOod-safety, award Forty Jefferson County so they have added food Belmont Restaurant,Fiesta The Galley,Half-Way House restaurants and full-ser- safety challenges.Jefferson Mexican Restaurant, Restaurant, In-Season vice food establishments County Public Health and McClane's Cafe,Blue Moose Catering, Jefferson County were awarded the 2010 the Board of Health recog Cafe, the Food Co-op deli, Jail, Khu Larb Thai, La Outstanding Achievement nize them for their dedica- Olympic Timber House, Isla Mexican Restaurant, Awards for demonstrating tion to preventing illness the Boiler Room, Fountain Lanza's, Logger's Landing, the highest standards for and encourage the entire Cafe, Pizza Factory, Market Place at Aldrich's, safe food handling during food industry to strive for Brinnon School District Point Hudson Cafe, Port the past year. the same honor. 46,Alchemy Bistro &Wine Townsend High School,Blue The Jefferson County Criteria for the award Bar, Plaza Soda Fountain, Heron Middle School,Grant Board of Health presented were developed by the Brinnon Senior Nutrition, Street School,QFC 870 Deli the awards at its June 16 Jefferson County Public Chimacum Café,Chimacum — Port Hadlock, Queets meeting. Health Food Service Elementary School, Clearwater Elementary Jefferson County Public Advisory Committee and Chimacum High School, School, Spruce Goose Health representatives said require evaluations in Cuisine Med Catering, Dos Café, Tri-Area Community the 40 restaurants and areas of personal hygiene, Okies Barbeque, 'Dream Center, T's Restaurant, proprietors worked hard food temperature safety City Market & Cafe, El Twana Roadhouse,Upstage to maintain excellent food and prevention of contami- Sarape and Fat Smitty's. Restaurant and the Uptown safety standards. Most of nation. More winners include: Pub&Grill. the businesses are full- All food workers must service restaurants and hold a current Washington c food establishments that State Food Worker Card. or ke rsget food work with complex menus, Winners are: The • cards on Web eb In June, the state imple- picture test with the assis- mented an online option tance of the instructor. for food worker classes and Instructor-led and online tests to obtain permit cards.. classes take about 60 min- Jefferson County Public utes and cost$10. • Health reports that 62 per- Log onto jefferson- cent of food worker cards countypublichealth. issued for Jefferson- County org or call 385-9444 for residents were completed more information. Visit online in the first month of foodworkercard.wa.gov for the new service. the online test. As a result, JCPH has decided to reduce its instruc- tor-led classes.This provides field inspector Mina Kwansa with additional time to meet program performance mea- sures for facility inspections, according to JCPH. Instructor-led classes are now on the second Tuesday of the month at JCPH, Port Townsend; fourth Thursday of the month at the Tri- Area Community Center, 1111 Chimacum;and twice a year in the West End. Group classes can be scheduled with a minimum of 10 people. Special needs applicants attend an instruc- tor-led class,and then take a Sale of urine' should be • forbidden human urine to pass a drug test. It is freeze dried, I guess. But A week or two ago after attend-.. so many questions come to mind ing a Jefferson County Substance that it is unfathomable. Abuse Advisory Board meeting, Is this stuff safe? Is it illegal? one of the staff and I were chat- Where does it come from? Does ting on our way to the parking it have human health issues like lot. The subject was "What kind HIV,.herpes or hepatitis? Do the of stuff is out there now?" public health folks know about We mentioned the new stuff this? called spice and bath salts, of It seems that once again the which neither one of us knew a groping hand of greed and evil lot about. We suggested that in has sought a new low.I would ask the near future we be brought up Mayor Michelle Sandoval and the to speed with a professional per- City Council to ban it from stores son to be abreast of what we are in the county, dealing with in the community Meanwhile, until this product and county. is taken off the market, I will She also mentioned that a not shop at this store to buy gas, certain convenience store out pop, the quart of milk, etc. They towards the edge of town is sell- are promoting the use of banned ing"bongs".and other drug-relat-, substances by luring users into ed paraphernalia, and urine to thinking they can pass a drug pass drug tests with. test. Therefore, they are promot- I could not believe this. You ing the use of illegal substances. mean human pee? Piss, or what- My word to the owners of this ever it's called? "Yes" was the business is clean it up. • reply. "It's right there in the RAYMOND HUNTER showcase, next to the heat case - Substance Abuse for tired burritos and chicken — - Advisory Board wings." Being nonplussed, I could not believe this, so I had to go look for myself. Yes, it was there in their little display case—a prod- uct called Clean Stream. Human urine for use, I guess, in drug tests. Now, we all have seen some pretty bizarre things in our days, but this goes beyond the pale and over the top. They are selling r t�= \ v-Y^a' v '� �\ 0 altos A ie-. i L _'iss W ,l�Y�' • '> �, v 1= '' _ it ., al m 4 . moi '".• mel m .. 1 ' V. m A. E= �.i L : O V f1` nom` '`", r C 0 - it , .--; -e, ...-..-.... e,,4,',4'7".. 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Association Shelter He originally said June 30 that the �BY J�Cuxw joined as a task force to look at commu- Team,or COAST,a PENINSULA DAILY NEWS pity options for meal programs to serve group of churches r._ _ - low-cost,four-day-a-week senior dinner seniors and the homeless. program in Port Townsend would end PORT TOWNSEND—Represents that helps Jefferson r July 7. Tim Hockett,that 40 layoffs executive unfilledn dlrer- operate Jefferson " Jefferson CountyCommunity fives of Jefferson County organizations tor,confirmed 40or County Emergency dation and United Good Neighborso e that provide nutrition assistance to job vacancies have occurred at his Winter Shelter in .";-' committed to findingcommunity-based seniors and others in need will gather agency this year,the result of a dire Port Townsend. r Friday in an effort to collaborate and economy and fewer state grant dollars to The meeting is not Hockett solutions to the problem of reduced fund- come up with community solutions to help fund programs. a public forum. ing and access to hot meals for low- cuts in Olympic Community Action Pro- The task force will meet at 9 a.m.Fri- Hockett,meanwhile,said OlyCAP's income seniors and people using the grams services. day at St.Mary Star of the Sea Catholic deadline to shutter Port Townsend's homeless shelter,said Carla Caldwell, Jefferson County Community Foun- Church in Port Townsend with others senior meals program has been extended UGN executive director dation and United Good Neighbors have involved in community food and shelter two weeks until the end of the month. TURN TO MEALS/A.4 Meals: Collaboration of groups p to be `more and more necessary' CONTINUED FROM Al vices but he said he was senior meals program at voluntarily and 20 were unprepared to comment the Tri-Area Community laid off,he said. "The goal is to forge col- about those Monday. Center in Chimacum is not Oral Health Services, laboration and partner- The gap in funding for going to be cut now, but operated by OlyCAP,closed ships to leverage available senior meals also presents a other cuts could be consid- its Port Angeles clinic and funding, facilities, and social issue. ered. auxiliary location in Forks human resources,"Caldwell "For many seniors, get- in February said. ting out to the community Brinnon switches A program also run by "Many of t rr^~ . , center fora meal is the the nonprofit organization these agen- fy :? major source of social inter- meal CAP also has senior p g a " meal ro ams in Port that used portable dental cies are ,, -`. action each day, Kris p - Mayer, Jefferson County Angeles and Sequim, but equipment at the OIyCAP receiving r• . the Brinnon mealsprogram Port Townsend offices was funds from t.- Community Foundation • UGN, and executive director,said. was discontinued this year, discontinued at the end of we want to "As capacity building although Brinnon residents 2010. support organizations. Jefferson have come up with their The Port Angeles clinic their ability Caldwell County Community Foun- own program. opened in 2006 and had to serve dation and United Good Hockett said the same 5,500 patient appointments those in need." Neighbors are uniquely could happened in Port last year with an additional UGN funded$37,000 to positioned to work with Townsend if other organiza- 1,000 emergency visits. OIyCAP this year. agencies in finding solu- tions step up to take over. OIyCAP started renting Hockett said he wel- tions to some of our corn- Hockett is also talking space in a building near comed the opportunity to munity's major challenges, with Jefferson Healthcare Forks Community Hospital partner with other groups and this is certainly one of Chief Executive Officer last year to provide dental in the community in an them" Mike Glenn to see if the care but on a much smaller effort to continue senior Caldwell said cancella- hospital could provide scale,Hockett said. meals. tion of senior meals was a means to seniors,such as a Hockett said OIyCAP "We believe that this matter"that really is a con- program at Forks Commu- began using portable dental model of collaboration cern for us." nity Hospital. equipment in the early between community groups Hockett said state and Hockett said since Janu- 1990s to provide care for to address community chal- federal funding cuts have ary OIyCAP has cut staff, people .across the Penin- lenges will be more and slammed OlyCAP's$11 mil- including program manag- pule. more necessary as we real- lion annual budget, and era. ize the impacts of other pro- Port Townsend's meals pro- The agency,which once gram cuts,"Hockett said. gram has the lowest num- had 300 employees,he said, Sequim-Dungeness Valley Edi- Hockett said similar cuts ber of meals daily,an aver- had 265 at the beginning of for Jeff Chew can be reached at were being made in Oly- age of 20 diners. the year and now has 225. 360-681-2391 or at jeff.chew® CAP Clallam County ser- Hockett said a similar Of those lost,20 departed peninsuladailynews.com. I ux9.zb''S3�m 'wsk h•x" a Fre . ,� • - • R'e c ,�,iP���% , $.` -,71,,,,,,-..-t .: f 4*-79)::::::-.'..,:i.i .,,,.i.,*„......- _,....„..,,- ...., . - = 0 '''54F 4 At• a r , r .g'' Yt4 '-w''',44', }i�..,,...,„-.... t Test: VgiIance i x i,,�t .'4L .. • • 4, ' YContinued from page 1 the lab to determine if its x rs n ° use of synthetic urine. real, Kessler said. "It's up to Public health nurse Denis Langlois compares colors on a dipstick in a test of Quick Fix "Of course it's on the rise, agencies like us who actually Plus,a synthetic urine product available in Port Townsend:The product tested within he said."Most people�vho need collect the samples' normal range for pH and specific gravity.Photo by Nicholas Johnson to have a urinary analysis He said synthetic urine isn t don t want to be found out." the only problem.He sees pi � % y,7 ® ® He said he takes precau- ple using clean urine samples .r > tionary measures to make sure purchased in town,just not in „•+. mo •'''.S: the samples are real urine at stores. £r' >, body temperature. He said Kessler also said state strategically placed mirrors health officials are looking help determine whether some- at the safety and legality of Synthetic pee for sae one is trying to use an external synthetic urine products, but device, and if he doesn't catch likely won't pursue legisla- them in the act, he can send tion until something brings the sample to the lab with a the issue to the surface. He By Nicholas Johnson of the Leader don't even know that this is a prob- note asking for confirmation said the question of regula- Sincelem:' that the sample is real urine. tion remains one for local gov- a letter published in the City Manager David Timmons However, he said, that test is ernments that may see these Leader on July 6 questioned the local said the question of whether to ban very expensive. so he tries to products as a problem. Until sale of synthetic urine products,one such products is up to county health catch cheaters in the act. then,he plans to keep his eye store has dropped the products,and officials. "In the end, it's not up to on the mirrors. two continue to carry them. "Because the city doesn't address In his letter, Raymond Hunter, health issues,we would have limited • a member of the Jefferson County capability to enforce it,"he said. Substance Abuse Advisory Board, Jean Baldwin, director of advised the owners of the 76 Food Jefferson County Public Health,said • Mart on Sims Way in Port Townsend she was previously unaware of such to"clean it up."And they did. products,thus has no clear idea just, Employees, who declined to how widespread their use may be. he named,said the Clean Stream "I had no idea you could go to the Urine Fetish Kit and Quick Fix Plus gas station and buy it,"she said. hadn't been selling well enough in She said a ban wouldn't necessar- the weeks the store stocked them, ily stop the use of such products,and so they returned about a half-dozen said now isn't the time for her agency units to the salesman. to take any kind of action against use The products typically sell along- of the products. side smoking pipes. and, although "If the city bans it, who cares? the packaging is rather vague, are Someone in the county will sell it," used to pass drug tests. Baldwin said. "Right this minute, Smoker Friendly,located near the in this recession,we are not going to Sea Breeze Mobile Home Park on take on an issue that may very well West Sims Way,and Tobacco Depot, be a state or national question." • located in the QFC shopping center, say they have carried the same or DIPSTICK TEST similar products for years, selling In his letter, Hunter questioned one or two units a week. whether the products are real and • safe. A urine dipstick test, often TIME,MONEY used to detect urinary tract infec- Hunter also suggested the city tions,showed both products to have consider banning the products a rformal pH and specific gravity, because they promote the use of ille- each of which are considered in a gal substances.When asked whether typical drug test.Baldwin said labo- the city might consider a ban,Mayor ratories would not consider whether Michelle Sandoval asked, "Is this or not a sample is real.That question really an issue?" She said unless a belongs with whoever is collecting convincing case could be made that the sample. . such products pose a problem to the "That's obviously a flaw in the community, the City Council has system."she said. • many other,more pressing issues on Ford Kessler, who collects urine its plate. samples at Safe Harbor Recovery "Just because it is there doesn't Center,said he has seen a rise in the mean it's being used,"she said."We See TEST,Page 10T ?7--/ CCE c/e/" • Senior on PT is 1 U sought Local organizations are creating a task building organizations, JCCF and UGN are force to look at community options for meal uniquely positioned to work with agencies in programs to serve seniors and the homeless. finding solutions to some of our community's Jefferson County Community Foundation major challenges, and this is certainly one and United Good Neighbors have joined of them." . forces to explore a substitute to the meals "The goal is to forge collaboration and previously provided to seniors through partnerships to leverage available funding, Olympic Community Action Programs. facilities and human resources," said Carla OIvCAP ended meals at the Port Townsend Caldwell,UGN executive director. Community Center on July 8, citing low Tim Hockett, executive director of turnout and overall funding cuts (See story OIyCAP, said he welcomed this opportunity in the Leader's July 6 issue). to partner with other groups in the commu- The gap in funding for senior meals also nity in an effort to find a solution to continue presents a social issue, acknowledged Kris senior meals. "We believe that this model Mayer. JCCF executive director. "For many of collaboration between community groups seniors.. getting out to the community cen- to address community challenges will be ter fora meal is the major source of social more and more necessary as we realize the interaction each day.' she said. "As capacity impacts of other program cuts." • • 7/ivk PORT TOWNSLNU t11C�tnty Public1 St:t-1UVL 1U11 YLHKbUVt1 with highlights of Jefferson CouHealth Education Staff Page 1 of 2 Grant Street staff: loyal district employees supporting declining enrollment. -. The said it was some- •gf t'' dA �'"sN F Y �z S /s • r� 4 � thing rn th e water but z z i sl never thobv ou , gip ey Y had Health with Hilar �{' sf / °� xm 9 r`` 0 f. � � Metz er Ya • • e s h f rr .yw.k C $ y x D. 'a' 7 x F 4 '• ....:,:ril +x • [1 rat av�� lr•Ou1S� ;. , � � ,i f � aau �F � Mackenzie, and Madeline ,� .. v.:. x z,,,,..vg....,,,,,, „,.. g y �i.r; 111 aeS"✓rb.� m'F` ^ t S #i c 14✓� xr ? s°°a Ji f .. y f l c .iC w , ,..,..�.anti�xen'aF' 3 U,_ ✓9J . ••,, F ".7 w 5 F;1G3?5 ,yp �f°' .✓ U '�rd ✓ kX�s y �K >(;. P9r#a ” "'ma IV ,t V SSr ✓S' s 3lS' t�' e 1 Friends from the start. Friends for life Our Unresolved Future . Nothing about the future seemed clear.Though the economy seemed to be recovering,jobs were still hard to come by.The global situation seemed very troubling as well,with political unrest springing up in the Middle East.The high • school students of 2011 would soon become the adults dealing with these major issues. It used to be that if someone attended college and graduated with a good degree, they could almost be guaranteed a well-paying career For the students of Generation Y that would no longer be the case.Even though the economy was gradually recovering,many employers had not begun to expand their work force.Even college graduates,were struggling to find suitable work. Jobs were the least of concerns when global issues were taken into consideration.There was great uncertainty in everything surrounding international politics and foreign policy.It was exceedingly unlikely anybody could have foreseen the events of the Middle East even as recently as late 2010.Awareness of global warming and its effects slowly grew,and with it came worry.Who would take care of the endangered species,overpopulation and fresh water depletion? As Generation Y reaches maturity,they will be faced with the difficulties of international policies and job hunting. They must hope to manage global warming and overpopulation.All of the past generations have struggled through their own issues,some attempts met with success and others with collapse.Though the problems that face Generation Y seemed daunting,they would try to find the solutions. Via' ` , -,-,:t.1,-,.:1':-1.1.'� z _ t ,,sl ! 4e t n a. . Com. . k x 'p V + 'n I . q.(4,;1 '''''f?-'4v. • 0 TA. rax _ sc-a. —' ff^�,� 4 •k G''""' :o ,r?‹ f..fes E" .,t -P : • �,� 4 `A��4 sem,. A"q;;:;;+ .:.. _.,:; "?. c - The freshmen of Martina Haskins'Health class listen to teen moms tell their stories with facilitation by Kelly Matlock from the Health Department. • Closing 159 Walsworth f 7 Temporary permits Pertinent codes FDA Food code defines a food establishments to include: An operation that is conducted in a mobile,stationary,temporary, or permanent facility or location;where consumption is on or off the premises; and regardless of whether there is a charge for the food. WAC 246-215-131: (3)The owner of a temporary food establishment must: (a)Apply to the regulatory authority for a permit to operate the temporary food establishment at least fourteen calendar days before intending to provide food service,or as otherwise required by the regulatory authority; WAC 246-215-200 A food establishment is required to have a valid permit: (1)Any person operating a food establishment without a valid permit issued by the regulatory authority may be guilty of a misdemeanor under RCW 70.05.120 and local regulations. WAC 246-215-181 (6)and 8.401.10 Washington State Retail Food Code Working Document (C) The regulatory authority shall inspect a temporary food establishment during its Permit period, unless the regulatory authority develops a written risk-based plan for exempting certain categories of temporary food establishments from inspections that is uniformly applied throughout the jurisdiction. • Two kinds of temporary food permit operations: (a)Single events or (b)Approved, recurring, organized events WAC 246-215-011: (26) "Temporary food establishment" means a food establishment: (a) Operating at a fixed location, with a fixed menu, for not more than twenty-one consecutive days in conjunction with a single event or celebration, such as a fair or festival; or (b) Operating not more than three days a week at a fixed location, with a fixed menu, in conjunction with an approved, recurring, organized event, such as a farmers market. a • Temporary food permit fee scenerios To provide example of how the fee structure, current and proposed, would impact cost to a vendor. • Example for single event type of application defined as: _(a) Operating at a fixed location, with a fixed menu, for not more than twenty-one consecutive days in conjunction with a single event or celebration, such as a fair or festival Current fee structure: Cost for 5 single festival/fair - (assume complex menu)- 5 x $130.00 = $650.00 Proposed fee structure: Cost for 5 single festival/fair -(assuming complex menu)- 1 x $130.00 + 4 x $30.00 = $250.00 • 1 • Example for approved, recurring, organized event application: (b) Operating not more than three days a week at a fixed location, with a fixed menu, in conjunction with an approved, recurring, organized event, such as a farmers market. (Music on the Docks, Centum Summer music, farmers markets) Current fee structure: Cost for Music on the Docks, 8 Thursdays this summer (assume complex menu)- 8 events all for $130.00 Proposed fee structure: Cost for Music on the Docks, 8 Thursdays this summer (assume complex menu)- 8 events all for $130.00 • OTHER COUNTY FEE COMPARISONS • t• • Island County: Temporary fees #of days. Low Risk High Risk $39 $72 2 $70 $100 3 $156 $195 4-8 $203 $234 Sampling $26 $26 Mobile Fees: $449 • FOOD ACTIVITY 12010 FEE Food Service Establishment Island No Seating 618 U Col� Seating Capacity 1-24 822 Full Service Fees Seating Capacity 25-50 916 Check-out Stands 51-100 996 Check-out Stands over 100 1090 Cocktail Lounge(in addition to seating fee) 418 Groceries 1-2 Check-out Stands 552 3-4 Check-out Stands 607 5 or more Check-out Stands 646 Meat/Fish Market(in addition to.check-out) 268 Delicatessen(inaddition to check-out) 268 Bakery(in addition to check-out) 268 Other Food Service • Bakery(baked goods only) 472 Bed&Breakfast 268 Candy Kitchen 268 Caterers&Cottage Industries 390 Convenience Stores(prepackaged for only) 338 Convenience Stores(with food service) 618 Espresso Stands/Tea Rooms(Non-hazardous food only) 338 Institutional Kitchen Full Kitchen 358 Satellite Kitchen 150 Mobile Cart 449 Non-Profit Permanent(must provide proof of tax exempt 144 status) Retail Commercial Fishing Vessel 126 Taverns(without food) 432 Vending Machine(potentially hazardous foods) 70 Food.Service Establishment Plans Review 103 Semi-Annual Fee(foran annual license) 79 January 1—June 30 N/A • July i—December 31 N/A Late.fees(for an annual license) Annual-payment not received by February 1 N/A Semi-Annual—payment not received by February 1 or July 1 Re-Inspection(violation of regulations) 103 • • Clallam Co. Temporary fees SINGLE EVENT Potentially hazardous foods $100 Non-Potentially hazardous foods $25 Farmers market/Recurring $120 Temporary event aka Extended Temporaries(unlimited days) Late Fee $25 Mobile fee: $140.00 • Food Safety Program SERVICE FEE Permits Clallam Co Restaurants 0-25 Seats $210 Full Service Fees 26-50 Seats $260 51-100 Seats $350 More than 100 Seats $420 Cocktail Lounge $100 Catering Off-site by Restaurant $140 Stand Alone $210 Institutional Facilities Schools Main Kitchen $140 Satellite Kitchen $70 Jail Kitchen $140 Limited Food Services B&B,Tavems,etc. $140 Retail Food Grocery 0-3 Check Stands $210 4 or more Check Stands $280 Grocery w/Food Meat $70 Bakery $70 Fish $70 Deli $140 Espresso $70 Community Kitchen $70 Penalty Fees Re-inspection $75 Late Fees 1 month delinquent %50 of base 2 months delinquent %75 of base Food Handler Cards • New $10 Duplicate $2 Plan Review Complex menu $210 Non-complex menu $120 PHF limited menu $100 Non-PHF limited menu $70 Change in Ownership %50 of establishment's plan review fee CATEGORY (Temporary) FEE LATE FEE • Kitsap Co Baked Goods/Exempt Food application $13 N/A review Temporary fees Limited Menu-Low Risk • Single event $30.00 $7.00 Seasonal,multiple events $69.00 $15.00 Farmers Market $69.00 $15.00 Non-complex Menu During work hours,single event $59.00 $12.00 During non-work hours,single event $71.00 $15.00 Seasonal,multiple events $109.00 $24.00 Farmers Market $109.00 $24.00 Complex Menu During work hours,single event $85.00 $20.00 During non work hours,single event $109.00 $25.00 Seasonal,multiple events $149.00 $30.00 Farmers Market $149.00 $30.00 Mobile fees: $205 • Kitsap FOOD 2010 Full service fees Bakeries $336 Bed&Breakfasts/HoteUMotel(Breakfast Only) $205 Caterers: With Commissary $230 With Restaurant $205 Groceries: 1->3 Checkouts $152 3 Checkouts $395 • High Priority Inspections $109 Limited Menus $205 Meat/Fish Markets $253 Mobile Units $205 Plan Review and Pre-Op Inspections: Bed&Breakfasts/Hotel/Motel Without Pre-Operational Inspection $109 Bed&BreakfastsMotel/Motel With Pre-Operational Inspection $164 Change in Menu and/or Equipment Review $109 Low Risk Establishments $164 High Risk Establishments $218 Reinspections 27-Each Re-Inspection after First Re-Inspection $109 Restaurants(No Cocktail Lounge): 0-25 Seats $472 26-75 Seats $511 • 78-100 Seats $592 - >100 Seats $668 Restaurants(With Cocktail Lounge): 0-25 Seats $592 28-75 Seats $630 76-100 Seat $709 S Se5 $866 Schools: 2 25 Central Kitchen $282 IP HeadstarUECAP $109 Waring Kitchen $185 Tavems(With Food-See Restaurants With No Cocktail Lounge) Tavems(No Food) $170 Jefferson Co Current Temporary fees Complex Menu $130.00 Cooking and assembling potentially hazardous foods Limited Menu $98.00 Low Risk foods with minimal preparation Late fee %50 of fee Less than 7 days prior to event Mobile fees: limited menu: $174.00 Complex menu: $310.00 • Jefferson Co Proposed Temporary fees vnt-,•1 Marg fr;u•zu mon i•-a : d 2' .4t ,thigrrid k-, (",,tr t;tyrre0 ts,t44.,,tt 4 I'lot to oF••Flud:"uot,t y.r fld 'Fo'd Ev-ots Mery, 21 Jar, vtk.r 4y1,1avart. ,FraF out 4Sy-F.) Plot •.•:seed :lays aZ v'o• F,-,gary20 F a:MVO Mai CI,ou Irr,t.ar fa,caltor,(F:f r,t Nut to eat,ea cep;at',Ali at Jr 4,1/11:-.aw F••or,i't flot t•t• ,rta, F;Fa" ta•-a tr.ra,,,F•1 4our, Froplo,Mona— Not F:.• :YrrO ,I.tyt at r,at,-4- Aoaq10,1u;roo-ar., ,1,17 3'1,1 t,q>,r41 At :1,41 +taoitysna tUirfororq Not to rts ooryi 3 days at your oo,A7u, :Pi s+dlou ort-1•.:at,;r1 t,tt,tt.:tn V7— t,.•:`,tat',7,J3y5 ,:ttr 1 Jefferson Co • Full Service Fees FOOD SERVICE ESTABLISHMENT FEES PERMIT FEES(Annual Permit) Restaurants/Take-Out (Based on menu complexity&seating- menu changes may change category) 0-25 seats(Limited Menu) 174.00 0-25 seats(Complex Menu) 310.00 26-50 seats 310.00 51-100 seats 372.00 101-150 seats 422.00 With Lounge,add 136.00 Bakery Business 136.00 B&B 174.00 Caterer w/commissary or catering-only kitchen 310.00 w/restaurant,additional fee for catering 174.00 Concession/Commercial Kitchen/Church 136.00 Espresso Stand 174.00 • Jefferson Co. Continued. Grocery 1-3 checkouts 136.00 >3 checkouts 422.00 Meat/Fish Market 310.00 School Cafeteria Central Kitchen 310.00 Warming Kitchen 174.00 Tavern w/food(see Restaurants) • Annual Permit Issued after September 1 50%of fee Late Fee(Paid after January 31) Eliminate Late Fee(Paid after February 28) Eliminate Other Food Fees Waiver 37.00 Plan Review Pre-opening inspection 65.00 Minimum 65.00 Per Hour 65.00 Reinspection First Inspection 87.00 Each inspection after first 149.00 Reopening Fee 65.00 • Food Handler Card 10.00 Reissue Unexpired Food Handler Card 10.00 Manager's Course 211.00 Jean Baldwin rom: Susan Porto ent: Thursday, July 21, 2011 12:36 PM o: Jean Baldwin; Tom Locke Subject: FW: Confidential: Temprorary Food Establishment Fees 2011 From: David Alvarez Sent: Thursday, June 16, 2011 1:15 PM To: Susan Porto Subject: Confidential: Temprorary Food Establishment Fees 2011 CONFIDENTIAL. SUBJECT TO ATTORNEY-CLIENT PRIVILEGE. Confidential communication between attorney and client(s). Not subject to production (disclosure) under the Public Records Act. See RCW 5.60.060(2); RCW 42.56.070(1) and RCW 42.56.290 and Hangartner v. City of Seattle, 151 Wn. 2d 439 (2004). Release of this document to others may invalidate its confidentiality. Given the use in 26(a) of the phrase "in conjunction with a single event" I would argue that each time there is a food vendor at a different event (assuming same menu and perhaps assuming same location) that because of the use of the *word event, each event is a distinct"temporary food establishment" needing its own permit. If it is same vendor, same menu (and perhaps same location too) , then it should be permitted at 98-30-30 or 130-30-30 etc. Section 26(a) clearly asks the regulatory agency (here JC Public Health) to look at the "events" rather than the "vendor" to determine if distinct and separate "temporary food establishments" have been created. In sum I support your logic and interpretation of 26(a). David Alvarez. Ext. 219 • 1 Page 1 of 1 Cathy Avery From: Candace Taylor[tressoleillola©yahoo.com] ent: Thursday, July 21, 2011 1:49 PM o: boh©jeffersoncountypublichealth.org Subject: Fw: --- On Thu, 7/21/11, Candace Taylor <tressoleillola@yahoo.com>wrote: From: Candace Taylor <tressoleillola@yahoo.com> Subject: To: Idennison@q.com Cc: tressoleillola@yahoo.com, ldennison@q.com Date: Thursday, July 21, 2011, 1:44 PM July 21, 2011 To: Jefferson County Board of Health Re: Public Hearing, revising Jefferson County Public Health Fees I am unable to attend the meeting today and would like Larry Dennison to read my letter into the public record as an official public comment on the current process and fees for temporary food vendors. I applied for my temporary food vendor permit for 2011 and enclosed my $98.00 for what I believed would be my annual permit only to discover that policies had changed and that the cost of$98.00 would apply to each and every event I did in Jefferson County. After numerous conversations and letters with the staff I was informed that as long as I did more than one event at the same location it would only be a one time charge of$98.00 per location, I have since paid and completed applications 3 times for the 3 different locations that I have multiple events. Due to the need for a permit and fee for each single event I have had to opt out of several events I have previously done as it is not cost productive for a one day event to pay $98.00 just for an inspection fee. I participate in many other events in Clallam, Kitsap and Pierce counties and their fees per event are respectively $25, $30 and $50 for low risk, which causes me to question why the fees in Jefferson County are considerably higher. As a 19 yr resident, employee, business owner and taxpayer of Jefferson County I prefer to keep my business here and hope that a mutual agreement can be achieved that will benefit the small temporary food service operations in our community. Thank you for your consideration. Candace Taylor Owner, Little O's 7/25/2011