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HomeMy WebLinkAbout2011- September File Copy • Jefferson County Board of J CeaCth .agenda Minutes • Seytember 15, 2011 • • JEFFERSON COUNTY BOARD OF HEALTH September 15, 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 August 18, 2011 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. Family Planning and WIC Outreach • 2. Diphtheria, Pertussis, Give Immunity, Fight Transmission (The G.I.F.T. Program) V. New Business 1. Preparations for the 2011-12 Influenza Season 2. State DD and DSHS cuts 3. JCPH, County Budget update 4. Revenue and Program changes in 2011-2012; Tobacco, Child Care, Communicable Disease, Dental, Foot Care, Environmental Health Fees, BCHP, Drinking Water (Group B), Family Planning, and PIIEPR VI. Activity Update VII. Agenda Planning Calendar VIII. Next Scheduled Meeting: October 20, 2011 2:30 - 4:30 pm • Jefferson County Public Health O tk:i41/4 JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, August 18, 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, Kristen Nelson, Sheila Westerman, Jill Buhler Staff Present: Jean Baldwin, Stuart Whitford, Veronica Shaw • Members Excused: Roberta Frissell APPROVAL OF AGENDA It was moved and seconded for approval of the agenda of the August 18, 2011 Board of Health meeting. The motion passed unanimously. APPROVAL OF MINUTES Ms. Baldwin stated there was an error in the July 21, 2011 BOH minutes. The words Department of Health should be changed to Jefferson County Public Health. Member Johnson moved to approve the minutes for the July 21, 2011 BOH meeting as amended; Member Buhler seconded the motion. The Minutes were approved as amended. PUBLIC COMMENTS None • August 18,2011 BOH Minutes 1 OLD BUSINESS and INFORMATIONAL ITEMS Changes in Washington State Law Regarding Exemptions to Immunization requirements S for School Entry Lisa McKenzie, Communicable Disease Coordinator,reported that the 2011 School and Child Care Immunization Exemption Law went in to effect July 22, 2011. The purpose of the law is to address Washington States high exemption rates and to make sure exemptions are based on conviction and not convenience. The new law will require a parent or guardian to get risk and benefit information from a health care provider;the health care provider then signs an exemption form. Water Quality Outreach Projects Stuart Whitford highlighted the publication, "A Look Under the Hood, Diagnostics for Hood Canal",which Tammy Pokorny was the main author. The publication went out to residents on the Hood Canal. The publication shows residents of the Hood Canal what they can do to prevent pollution in the Hood Canal. Mr. Whitford also pointed out that Ms. Pokorny has been involved in the"West End Natural Resource News" and commended her for the work she has done on both of these publications. NEW BUSINESS Tdap community need and GIFT (Give Immunity-Fight Transmission) program • Ms. McKenzie, announced there is a new program for free Tdap (tetanus/diphtheria/pertussis) vaccines for uninsured and low income adults that have contact with infants. Infants are usually exposed to Pertussis (whooping cough)by a family member or care giver. The free vaccine is provided by Sanofi Pasteur Vaccines and AmeriCares. Uninsured adults living at or below 200% of the Federal Poverty Level are eligible for this vaccine. JCPH staff will be doing outreach to clients in WIC and JCPH programs, and to agencies and health care providers in the community. EPA Grant & Onsite Program Updates Linda Atkins, Environmental Health Specialist,updated the Board on Onsite Sewage and Operations and Monitoring work. Ms. Atkins reminded the Board that in July of 2007 the Board adopted the Jefferson County Onsite Sewage Code revisions and adopted the local Sewage Management Plan. She stated that the plan helps to guide Jefferson County Environmental Health with their funding needs and in determining what kind of infrastructure may be needed. Ms. Atkins outlined what is being done to make sure they are meeting the Local Management Plan Goal. One of the goals of the management plan has been to identify all onsite sewage systems in Jefferson County and to make sure they are functioning properly. To achieve this existing paper records have been entered into an electronic database. In June of 2010 they implemented the use of the online service (OnlineRME)that tracks monitoring inspections. As the monitoring inspections are done, unknown systems are being identified. Another goal is education. Currently EHS are providing education to other professionals in the field and to 410 August 18,2011 BOH Minutes 2 homeowners about taking care of their septic system. EHS workers are also meeting with • designers to maintain consistency in the reporting process. Ms. Atkins discussed how Jefferson County is coordinating with surrounding counties to develop and implement a system to train and allow homeowners to complete some of the monitoring inspections required under state code. Ms. Atkins spoke about future goals for the Onsite Sewage and Operations and Monitoring Program. This fall an advisory group will be formed to assist in making revisions to the Onsite Sewage and Operations and Monitoring program. The Board can expect to see an amendment to the Jefferson County code, in early 2012,regarding homeowner inspections. Standards for Public Health in Washington State: Jefferson County Public Health 2011 Performance Review Ms. Baldwin reviewed the Jefferson County Public Health 2011 Performance Review Report. She outlined the strengths and the areas that need improvement and commended the staff who prepared the standards for the state. The entire report is available at www.jeffersoncountypublichealth.org. or the DOH web site. JCPH was found to meet 94% of the Standard expectations. Performance Measures • Ms. Baldwin gave a brief overview of JCPH Performance Measures for 2012. She discussed how the information in the Performance Measures can be used by JCPH staff to do outreach. The reports include the source of funding. The reports reflect funding that will be cut for 2012 and programs that will be ending due to funding cuts. The end of the year 2011 report in February 2012 will be an accurate representation of services provided by JCPH. Budget Update Ms. Baldwin reported on a conference call regarding State and Federal reductions, several of which began in April. Jefferson County Public Health received a notification of State reductions of 10%across the board. Ms. Baldwin and Ms. Shaw mentioned several programs that will have funding reduced and programs that were cut due to the federal and state budget shortfalls and grant money that will not be available in 2012. ACTIVITY UPDATE Ms. Baldwin announced there is a DOH meeting October 13, 2011 from 10 a.m. to 1 p.m. in Mason County. She is also on the agenda to speak at the City Council meeting on September 13, 2011. Member Westerman volunteered to participate in management interviews for the Environmental Health Director position. August 18,2011 BOH Minutes 3 Member Sullivan announced there were concerns from the Sherriff and mental health/substance IP abuse providers regarding where the mental health sales tax will be spent next year, so there will be several people at the September Mental Health and Substance Abuse advisory committee meeting. AGENDA PLANNING CALENDAR The next scheduled BOH meeting will be held Thursday, September 15, 2011 from 2:30-4:30 PM at Jefferson County Public Health, 615 Sheridan Street, Port Townsend, WA. ADJOURNMENT Member Austin moved to adjourn the August 18,2011 BOH meeting; Member Johnson seconded. The motion passed unanimously. Chair Nelson adjourned the BOH meeting at 4:40 p.m. JEFFERSON COUNTY BOARD OF HEALTH Kristen Nelson, Chair Phil Johnson, Vice-Chair III John Austin, Member David Sullivan, Member Excused Roberta Frissell, Member Sheila Westerman, Member Jill Buhler, Member • August 18,2011 BOH Minutes 4 • JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, August 18, 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, Kristen Nelson, Sheila Westerman, Jill Buhler Staff Present: Jean Baldwin, Stuart Whitford, Veronica Shaw 11110 Members Excused: Roberta Frissell APPROVAL OF AGENDA It was moved and seconded for approval of the agenda of the August 18, 2011 Board of Health meeting. The motion passed unanimously. APPROVAL OF MINUTES Ms. Baldwin stated there was an error in the July 21, 2011 BOH minutes. The words Department of Health should be changed to Jefferson County Public Health. Member Johnson moved to approve the minutes for the July 21,2011 BOH meeting as amended; Member Buhler seconded the motion. The Minutes were approved as amended. PUBLIC COMMENTS None S August 18,2011 BOH Minutes 1 OLD BUSINESS and INFORMATIONAL ITEMS Changes in Washingtongar State Law Regarding Exemptions to Immunization requirements g p for School Entry Lisa McKenzie, Communicable Disease Coordinator,reported that the 2011 School and Child Care Immunization Exemption Law went in to effect July 22, 2011. The purpose of the law is to address Washington States high exemption rates and to make sure exemptions are based on conviction and not convenience. The new law will require a parent or guardian to get risk and benefit information from a health care provider;the health care provider then signs an exemption form. Water Quality Outreach Projects Stuart Whitford highlighted the publication, "A Look Under the Hood, Diagnostics for Hood Canal",which Tammy Pokorny was the main author. The publication went out to residents on the Hood Canal. The publication shows residents of the Hood Canal what they can do to prevent pollution in the Hood Canal. Mr. Whitford also pointed out that Ms. Pokorny has been involved in the"West End Natural Resource News" and commended her for the work she has done on both of these publications. NEW BUSINESS Tdap community need and GIFT (Give Immunity-Fight Transmission) program • Ms. McKenzie, announced there is a new program for free Tdap (tetanus/diphtheria/pertussis) vaccines for uninsured and low income adults that have contact with infants. Infants are usually exposed to Pertussis (whooping cough)by a family member or care giver. The free vaccine is provided by Sanofi Pasteur Vaccines and AmeriCares. Uninsured adults living at or below 200% of the Federal Poverty Level are eligible for this vaccine. JCPH staff will be doing outreach to clients in WIC and JCPH programs, and to agencies and health care providers in the community. EPA Grant& Onsite Program Updates Linda Atkins, Environmental Health Specialist,updated the Board on Onsite Sewage and Operations and Monitoring work. Ms. Atkins reminded the Board that in July of 2007 the Board adopted the Jefferson County Onsite Sewage Code revisions and adopted the local Sewage Management Plan. She stated that the plan helps to guide Jefferson County Environmental Health with their funding needs and in determining what kind of infrastructure may be needed. Ms. Atkins outlined what is being done to make sure they are meeting the Local Management Plan Goal. One of the goals of the management plan has been to identify all onsite sewage systems in Jefferson County and to make sure they are functioning properly. To achieve this existing paper records have been entered into an electronic database. In June of 2010 they implemented the use of the online service (OnlineRME)that tracks monitoring inspections. As the monitoring inspections are done,unknown systems are being identified. Another goal is education. Currently EHS are providing education to other professionals in the field and to • August 18,2011 BOH Minutes 2 1 , homeowners about taking care of their septic system. EHS workers are also meeting with • designers to maintain consistency in the reporting process. Ms. Atkins discussed how Jefferson County is coordinating with surrounding counties to develop and implement a system to train and allow homeowners to complete some of the monitoring inspections required under state code. Ms. Atkins spoke about future goals for the Onsite Sewage and Operations and Monitoring Program. This fall an advisory group will be formed to assist in making revisions to the Onsite Sewage and Operations and Monitoring program. The Board can expect to see an amendment to the Jefferson County code, in early 2012,regarding homeowner inspections. Standards for Public Health in Washington State: Jefferson County Public Health 2011 Performance Review Ms. Baldwin reviewed the Jefferson County Public Health 2011 Performance Review Report. She outlined the strengths and the areas that need improvement and commended the staff who prepared the standards for the state. The entire report is available at www jeffersoncountypublichealth.org. or the DOH web site. JCPH was found to meet 94% of the Standard expectations. Performance Measures • Ms. Baldwin gave a brief overview of JCPH Performance Measures for 2012. She discussed how the information in the Performance Measures can be used by JCPH staff to do outreach. The reports include the source of funding. The reports reflect funding that will be cut for 2012 and programs that will be ending due to funding cuts. The end of the year 2011 report in February 2012 will be an accurate representation of services provided by JCPH. Budget Update Ms. Baldwin reported on a conference call regarding State and Federal reductions, several of which began in April. Jefferson County Public Health received a notification of State reductions of 10%across the board. Ms. Baldwin and Ms. Shaw mentioned several programs that will have funding reduced and programs that were cut due to the federal and state budget shortfalls and grant money that will not be available in 2012. ACTIVITY UPDATE Ms. Baldwin announced there is a DOH meeting October 13,2011 from 10 a.m. to 1 p.m. in Mason County. She is also on the agenda to speak at the City Council meeting on September 13, 2011. Member Westerman volunteered to participate in management interviews for the Environmental i Health Director position. August 18,2011 BOH Minutes 3 IIIMember Sullivan announced there were concerns from the Sherriff and mental health/substance abuse providers regarding where the mental health sales tax will be spent next year, so there will be several people at the September Mental Health and Substance Abuse advisory committee meeting. AGENDA PLANNING CALENDAR The next scheduled BOH meeting will be held Thursday, September 15, 2011 from 2:30-4:30 PM at Jefferson County Public Health, 615 Sheridan Street, Port Townsend, WA. ADJOURNMENT Member Austin moved to adjourn the August 18,2011 BOH meeting; Member Johnson seconded. The motion passed unanimously. Chair Nelson adjourned the BOH meeting at 4:40 p.m. / JEFFERS I N COUNTY BO• ' 1 SOF HEALTH ) " (1 ,400 1 , / ) ti Kristen Nelson, Chair Phil-Johnson, Vice-Chair • a,, / a/iP . ,, /-/-: /./ - David iiirivan, P ember Jol` Austin, Member 1\-11--') te1/4-(I) ItA61/VIrl,"" .. Excused Roberta Frissell,Member Sheila Westerman, Member /.. 66,4".. Ji 1 Buhler, Member IP August 18,2011 BOH Minutes 4 0 Board of 31- ealth Old-Business & Informational Items .agenda Item # .1V, 1. • jam iCy Planning and "WIC Outreach September 15, 2011 I HIGHLIGHTS: The Health of Jefferson County: 2010-11 Updates Part IV. Births, Quality of Life, Deaths BIRTHS >4 sM O Z �m £ m2'" f1 C. "` c e a > :"' 2. THEN %CHANGE NOW NOTES SOURCE Teen pregnancy rate (age 10-17) per 1,000 16.6 down -69% 5.2 WA down:20.1 to 10.9 3 1992-94 2007-09 average 7 per year Pregnancy rate (age 18-24) per 1,000 196.2 down -33% 130.6 WA down: 155.4 to 113.7 3 1992-94 2007-09 average 87 per year Pregnancy rate (age 25-34) per 1,000 99.9 ' up 21% 120.4 WA up: 119.8 to 130.3 3 1992-94 2007-09 average 122 per year Pregnancy rate (age 35+) per 1,000 19.3 down -18% 15.8 `WA up:20,0 to 23.8 3 1992-94 2007-09 avearge 47 per year Abortion rate (age 10-17) per 1,000 4.7 down -62% 1.8 WA down:8.9 to 4.7 3 1992-94 2007-09 average 2 per year Abortion rate (age 18-24) per 1,000 49.2 down -42% 28.5 WA down:51.1 to 32.6 3 1992-94 2007-09 average 19 per year Abortion rate(age 25-34) per 1,000 18.6 up 44% 26.7 WA down:23.8 to 20.3 3 1992-94 2007-09 av 27 per year 2007-9, 15 per year 2004-6 Abortion rate (age 35+) per 1,000 6.4 down -33% 4.3 WA down:4.9 to 4.1 3 1992-94 2007-09 average 13 per year Illkouth Jefferson birth rates (Brinnon/Quilcene) per 1,000 9.2 down -36% 5.9 3 1992-94 2007-09 average 18 per year Port Townsend birth rates (98368) per 1,000 8.6 down -19% 7.0 3 1992-94, 2007-09 average 101 per year East Jefferson birth rates)Chimacum/Hadlock/Nordland/Ludlow) 10.5 down -31% 7.2 3 per 1,000 1992-94 2007-09 average 72 per year Jefferson resident births at Jefferson Health Care 54% down -7% 50% births with midwife at birthing 3 1992-94 2007-09 center/home increasing Smoking during pregnancy 26% down -14% 23% WA down: 18%to 10% 3 1992-94 2007-09 higher:medicaid,younger Pregnant women with 4+years of college 26% up 31% 34% WA up:29%to 38% 3 1992-94 2007.09 South Jefferson 1st trimester prenatal care 83% down -28% 60% 3 Brinnon/Quilcene 1992-94 2007-09 Port Townsend 1st trimester prenatal care 88% down -14% 76% 3 98368 1992-94 2007-09 East Jefferson 1st trimester prenatal care 86% down -12% 75% 3 Chimacum/Hadlock/Nordland/Ludlow 1992-94 2007-09 Medicaid-paid births 1st trimester prenatal care 78% down -15% 66% Non-Medicaid up:87%to 88% 10 1992-94 2007-09 • Jefferson County Public Health,April 2011 --BOH presentation Jun e 201 1 More information available at:www.jeffersoncountypublichealth.org births,qual of life,deaths, page 11 B ■Got • � rControl ?.1,, , 7 t „„ tI t it/iiia , '. • © .' eonttol clll' Blur Ik3 .44 1N E � Dep uvaring' m' T flap-zao�doYns' etc d ER, Crat yoU nuc . Getty agur d 1,4 iiiiiik • • . ,..,p , ,- 1.,,,,.; i if No insurance? Not much money? Caring, kind & confidential No problem! contraceptive services, Services and supplies supplies & information available at little or no cost to you. to plan for your pregnancies. Find the method Call for an appointment : 385-9400 that works for you. PUBLIC HEALTH Jefferson County Public Health J ,,,®�'° 615 Sheridan Port Townsend WA plan B a I 0.s o available W c`o W co W W W W W W W W O � O � O - O -: O � O o O o O o O • W W W W W W W W 8 W W C� 00 C� 00 n 00 n 00 C7 00 (� 00 C7 00 ( 00 C 00 C7 o • o o o o o o o ( o o � � � � � � � � � 6 � � � 6 .gyp - �• � � � O O O n' O O O O _' O n' O O O O O O O C O O O O x O st 5- '12 5-' 5-.' 5 • Board of aCealth 0 C Business & Informational ltems Agenda Item # I17., 2 D p(theria, Pertussis - • Give Immunity, Bight transmission (the G.I.F.7 Program) September 15, 2011 • • Jefferson County Public Health Offering Free Vaccine to Stop the Spread of Whooping Cough P g 8 How can the spread of pertussis, commonly known as whooping cough be prevented? Pertussis is a serious childhood disease that many grandparents and older adults remember; but for many years, thanks to the vaccine, cases have dropped dramatically. Now, unfortunately, this vaccine-preventable disease is on the rise throughout the country. Washington has seen an increase in the number of cases in 2010 and 2011.Just last month, an infant, too young to be immunized, died in Snohomish County. This was the 2nd infant death due to pertussis in Washington State this year.There were also 2 infant deaths due to pertussis in Washington State in 2010. California declared a pertussis epidemic in 2010. That outbreak resulted in 10 infant deaths. Jefferson County Public Health (JCPH) is now offering free Tdap(tetanus, diphtheria, and pertussis) vaccine to low income, uninsured adults who have contact with infants. Infants and young children are especially at risk for severe illness from pertussis.Adults may have a mild case of pertussis, be unaware that they have it and, unknowingly, pass it on to an infant. Through immunization adults and children can be protected. Infants too young to be fully immunized can be protected by immunizing older children and adults who are around them.This is called "cocooning." For adults,Tdap vaccine is recommended and can be given at any time since one's last tetanus immunization. • Children and teens should be immunized against pertussis, too. Children receive it as part of their early childhood DTaP (diphtheria, tetanus, pertussis) series.Tdap is required for all students entering 6th grade and a dose is recommended for all adolescents through their teen years.This vaccine is included in the Vaccine for Children program which provides vaccines for children,through 18 years of age, at a minimal cost. Pertussis begins similar to a cold with a runny nose, sneezing and a mild cough. It can worsen over the next two weeks with coughing becoming severe, sometimes causing coughing spasms to the point of vomiting. The cough in children is often followed by a characteristic high pitched whooping sound. To assist adults with the cost of immunization, the G.I.F.T. program, "Give Immunity, Fight Transmission," provides vaccine free of charge to adults who are uninsured and earn below 200%of the Federal Poverty Level.This program is sponsored by AmeriCares, a humanitarian organization, and Sanofi, the manufacturer, and is available at the health department in Port Townsend. Jefferson County Public Health's sliding fee scale assists with the office visit fee. For those with insurance, the vaccine is also available at JCPH, local health care providers' offices and some pharmacies. For more information, please call JCPH at 385-9400 or your health care provider. JCPH has walk in immunization clinics on Tuesdays and Thursdays from 1-4pm. For more information on pertussis visit the Washington State Department of Health and the Centers for Disease Control and Prevention: www.doh.wa.gov/EHSPHL/factsheet/pertussis.htm • www.cdc.gov/pertussis/ Jefferson CountyPublic Health presents -::::.1 .:::-.....:.:.A.:...------.::-:.-.....::::::::::::::::::::-A0::. ....:::::.........:::.:::::::: -:....:::.:::.::: .:. ..........-..:::::: :::: ei::.**:::.::::::::...........11.!:i.:.:::7::::::::::::::::?.::::::::::::: •.::: ::.::::::::.........: ..:..: ... .::::::.:.::::.: .::.: :...... :AM:: � Program� �� ' TRA N� T.. .: : .:f:V: : :.. . .. missioN :::: :.............. . . •••••••••••::::::•::::::::::::::•:::•••••••::::•::: : : ::.....k: .... P er uss ':::::::"":.'::::1::::::::::::::::.::::64:::witept.00-119.4::-::::::::::::::::::::::: :::.-...... D.4.0*.i...........::......,::.:::::.::::......:.:.::..............:::.:::.:.:.„..,::.:.,:,...„..,::::::: :,.C ou � 's a cost g r:i to ious g d; sease th at can be very: .ser la► rs for infants. :. .'f i it ?8 • t t fs. :have Pertus ' :.' s:is, y • . ...•................................... not�i'Cna�r•�#; and pass•it on �. nsu rangy have::::::::::::::::::::::::::: r:........ to infants :JE�'lf:::�: G : Public Health is providing the G.I.F.t of free Tdap vaccine for r~ • adults to help protect infants -..q. t,''-.k'c'fl':-;:'s'..,'4t* against Pertussis. ,£ -` Sliding scale applies to office visit fee. GET IMMUNIZED TO PROTECT INFANTS! • CALL 385-9400 Sponsored by AmeriCares and Sanofi Pasteur Vaccines • Board of.1Cealth Netiv Business .agenda Item # 17., 1. Preparations for the • 2011-2012 Influenza Season September 15, 2011 • t CDC - Seasonal Influenza (Flu) - Influenza Vaccine Updates Page 1 of 5 F' ° Centers for Disease Control and Prevention Itr C2."., ` � ag ji, - u <, �� �t>isPrC,Fr:;tir1r�Fk,;.ir. .vii^X11`✓1..Ori2, tt`tr,:_u„t�P'tw'�rt.nt.„-�. • CQuestions &Answers 2011-12 Influenza Vaccine and Vaccination Information Vaccine Recommendation Who should get vaccinated this season? Everyone 6 months and older should get a flu vaccine each year. This recommendation has been in place since February 24, 2010 when CDC's Advisory Committee on Immunization Practices (ACIP) (/media/pressrel/2oio/rioo224.htm)voted for "universal"flu vaccination in the U.S. to expand protection against the flu to more people. While everyone should get a flu vaccine each flu season, it's especially important that certain people get vaccinated either because they are at high risk of having serious flu—related complications or because they live with or care for people at high risk for developing flu—related complications. • Pregnant women • Children younger than 5, but especially children younger than 2 years old • People 50 years of age and older • People of any age with certain chronic medical conditions • People who live in nursing homes and other long—term care facilities • People who live with or care for those at high risk for complications from flu, including: • o Health care workers • Household contacts of persons at high risk for complications from the flu • Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated) Vaccine Availability Where can I get a flu vaccine? Flu vaccine shipments began in August and will continue throughout September and October until all vaccine is distributed. Doctors and nurses are encouraged to begin vaccinating their patients as soon as flu vaccine is available in their area, even as early as August. See your doctor or nurse to get the flu vaccine, or seek out other locations where vaccine is being offered. The following flu clinic locator ffs, (http://www.flu.gov/widgets/vaccinelocator.html)is a useful tool for finding vaccine in your area. 2011-2012 Flu Vaccine Formulation , , Flu Vaccine Roder What viruses do flu vaccines protect s ,;,,,,0„f- , , ,,, F against c x ,, i,5 r �� '�q,!,-,, Flu vaccines are designed to protect against the three influenza viruses that experts predict will be the most common during the upcoming season. Each season, ;ZWc , 1 .: 41) this includes an influenza B virus, an influenza A ,; s , 1 _ (HIM)virus and an influenza A (H3N2) virus. (These are the three virus subtypes that are circulating most commonly among people today.) More http://www.cdc.gov/flu/flu_vaccine_updates.htm 9/9/2011 CDC - Seasonal Influenza (Flu) - Influenza Vaccine Updates Page 2 of 5 information about influenza vaccines is available at Preventing Seasonal Flu With Vaccination (/flu/protect/vaccine/) . • What viruses will the 2011-2012 vaccine protect against? The Food and Drug Administration (FDA) recommended that the United State's 2011-2012 seasonal influenza vaccine contain the following three vaccine viruses: • an A/California/7/2009 (HiNi)-like virus; • an A/Perth/16/2009 (H3N2)-like virus; and • a B/Brisbane/60/2008-like virus. The 2011-12 influenza vaccine can protect you from getting sick from these three viruses, or it can make your illness milder if you get a related but different influenza virus strain. (For more information about how the viruses in the vaccine are selected, visit Selecting the Viruses in the Seasonal Influenza (Flu)Vaccine (/flu/professionals/vaccination/virusga.htm) .) The viruses in this season's vaccine are the same viruses that were selected for the 2010-2011 influenza vaccine for United Select on for the 2011-2012 re tion about0Season/flu/about/qa/vaccl nee vaccine virus tion process is available at Vaccine selection.htm) . Why did the vaccine composition remain the same? The viruses selected for the vaccine remained the same because they continued to be the main viruses causing human illness Vaccine Selet ion for the 2011r-2012 wie. ore Season (/flu/about/qa/vacc nemation aout the vaccine virus ection process is available a • selection.htm . Annual Vaccination When Vaccine Viruses Remain Unchanged Why do I need a flu vaccine every year? CDC recommends an influenza (flu)vaccine every year as the first and best way to protect against getting the flu. By 2 weeks after vaccination,the body develops antibodies to protect against the viruses in the vaccine. Those antibodies help protect us from influenza viruses if we come in contact with them later. However multiple studies conducted over different seasons and across vaccine types and influenza virus subtypes have shown that the body's immunity to influenza viruses (acquired either through natural infection or vaccination) declines over time. The decline in antibodies is influenced by several factors, including a person's age, the antigen used in the vaccine, and the person's general health (for example, certain chronic health conditions may have an impact on immunity). While specific data on the duration of immunity from the 2010-2011 influenza vaccine is not available, CDC experts believe that immunity from vaccination (or infection) last season will have decreased by now in most people. It is not possible to say whether this reduced immunity would still be sufficient to prevent infection in 2011-2012 and therefore it is recommended that everyone 6 months of age and older get vaccinated this season, regardless of whether they were vaccinated last season. If I got a vaccine in 2010-2011, why do, I need to get another one this season if the vaccine formulation didn't change? Your body's level of immunity from a vaccine received last season is expected to have declined. • You may not have enough immunity to be protected from getting sick this season. You should http://www.cdc.gov/flu/flu_vaccine_updates.htm 9/9/2011 CDC - Seasonal Influenza (Flu) - Influenza Vaccine Updates Page 3 of 5 • be vaccinated again to raise your immune levels against the three viruses that research indicates are likely to circulate again this season. • How often are the viruses in the influenza vaccine changed? Most seasons, viruses in the influenza vaccine are changed to keep up with the influenza viruses as they evolve. It's uncommon that the same three vaccine virus strains are the same from one season to the next, but this has happened before. Since 1969, the viruses selected for inclusion in the influenza vaccine have remained the same eight times (including the 2011- 2012 season). Each time, CDC has stressed the importance of getting vaccinated each season. Has CDC always recommended vaccination each year, regardless of vaccine virus strain changes? Yes. CDC recommends an annual influenza vaccine as the first and best way to protect against influenza. This recommendation is (and has been) the same even during years when the vaccine composition (the viruses the vaccine protects against) remains unchanged from the previous season. During the 2009 HiNi pandemic, seniors were said to be at a lower risk of infection than young people, possibly because of residual immunity from prior infections with certain HiNi influenza viruses that circulated decades ago. How can decades-old remaining immunity be sufficient to protect one age group during the pandemic, but a flu vaccine given last season may not be sufficient to offer protection this season? It is believed that many people older than 65 years had infections with influenza viruses related to 2009 HiNi viruses decades earlier had some remaining immunity that helped to protect them against 2009 HiNi infection. This was confirmed by laboratory testing conducted during the 2009 HiNi pandemic on blood samples from people of different age groups which showed many had some antibody against 2009 HINT, even before the 2009 HiNi virus began spreading among people. In fact, seniors were less likely to become ill from 2009 HiNi than people in other age groups. However, protection was far from perfect.An estimated 6 million people 65 years and older became ill with 2009 HINT in the United States and those who did become ill were at greater risk of having serious complications from their illness. (For more information about 2009 HiNi infection in people in different age groups see What You Should Know and Do this Season if You are 6� and Older(htt //www.cdc.gov/hiniflu/6sandolder htm) and CDC Estimates of 200• H1N1 Cases Hos s italizations and Deaths (http://www.cdcgov/hiniflu/estimates 2009 hini.htm) .) Although long-lasting immunity has been shown to occur after infection, it has not been shown to occur after vaccination. Because antibody produced after vaccination is not long-lasting, CDC recommends yearly vaccination to ensure that people have optimal protection each fall through spring, when influenza activity occurs. CDC maintains that a yearly influenza vaccine is necessary to achieve the best protection against influenza because immunity wanes from one season to the next. Importantly, during the 2009 HiNi pandemic, seniors were recommended to receive the vaccine, even though there was evidence that they might have • some immunity from infections with HiNi viruses that circulated decades ago. http://www.cdc.gov/flu/flu_vaccine_updates.htm 9/9/2011 CDC - Seasonal Influenza (Flu) - Influenza Vaccine Updates Page 4 of 5 • Where can I find more information about how long immunity to flu lasts after vaccination? For additional information about declining immunity after vaccination, please see the studies • listed below. • Ambrose CS,Tingling Y,Walker RE, Connor EM. Duration of protection provided by live a- vaccine in children (http://journals.lww.com/pidjJAbstract/2008/08000/Duration of Protection Provided by Live Pediatr Infect Dis J 2008;27:744-748. • Kunzel W et al. Kinetics of humoral antibody response to trivalent inactivated split influent subjects previously vaccinated or vaccinated for the first time 1: i (http://www.sciencedirec ob=MImg& imagekey=B6TD4-3W258ND-5- i& cdi= 188& user=8 6 8•& .ii=026,•1oX•6000618& origin=gateway& coverDate=08%2F31 2F1996& sk=9998S9987&view=c&wchp=dGLbVtb- zSkzV& valck=i&md5=a52556fioc3eb666d71bdb29c4207897&ie=/sdarticle.pdf) .Vaccine 1996; • Ochiai H, Shibata M, Kamimura K, Niwayama S. Evaluation of the efficacy of split-product A(Hf1N2). and B influenza vaccines: Reactogenicity, immunogenicity, and persistence of an two doses of vaccines 13 (http://www.ncbi.nlm.nih.gov/pubmed/3027513) . Microbiol Immunol 1149. • Song JY et al. Lon:-term immuno_enici of influenza vaccine amon: the elderl : Risk fact, immune response and persistence`It! (http://www.sciencedirect.com/science? ob=MImg& i YV HF1- - & cdi= 188& user=8 6 8•& •ii=So264 410X10004 6 6& ori:in=:atewa & coverD; 2F2olo& sk=999719976&view=c&wchp=dGLzVlb- zSkzS&md5=9762526e45f611b4c34ab55aff6coeb5&ie=/sdarticle.pdfl .Vaccine 2010; 28: 3929-3c Timing of Vaccination . When should I get the 2011-2012 influenza vaccine? CDC recommends that people get vaccinated against influenza as soon as vaccine becomes available in their community,but are unprn can take place at any time throughout the edictable, and can begin as early as October.And, influenza season. Influenza seasons it takes about two weeks after vaccination for antibodies to develop in the body and provide protection against influenza virus infection. Therefore, CDC recommends people be vaccinated as soon as vaccine becomes available to ensure that as many people as possible are protected before influenza season begins. I have heard of people who don't get vaccinated against influenza in September or October because they want it to "last" through the entire influenza season. Should people wait until later in the influenza season to be vaccinated? CDC recommends that influenza vaccination begin as soon as vaccine becomes available in the community and continue throughout the flu season. It takes about two weeks after vaccination for antibodies to develop in the body and provide protection against influenza, and influenza seasons can begin as early as October. Therefore, CDC recommends that vaccination begin as soon as vaccine becomes available to ensure that as many people as possible are protected before flu season begins. Page last reviewed:August 10,2011 Centers for Disease Control and Prevention i600 Clifton Rd.Atlan E Page last updated:August 15,2011 30333,USA Boo-CDC-INFO(800-232-4636)TTY: (888)232-6348,New Hours of Content source:Centers for Disease Control and Prevention Operation 8am-8pm ET/Monday-Friday Closed Holidays-cdcinfo(a)cdc.gov http://www.cdc.gov/flu/flu_vaccine_updates.htm 9/9/2011 Board of CeaCth Netiv Business .agenda Item # T., 2 � State DD and DS.7IS Cuts September 15, 2011 r • From: Hagen, Karen [mailto:HagenKA©dshs.wa.gov] On Behalf Of Stillman, David (DSHS) Sent: Wednesday, August 24, 2011 11:12 AM To: undisclosed-recipients Subject: Disability Lifeline Community Notice ,::, ,,„ I ,,,,,„. ,,,,, „ , STATE OF WASHINGTON Y ON DEPARTMENT OF SOCIAL AND HEALTH SERVICES P.O. Box 45070, Olympia,Washington 98504-5070 August 24, 2011 Dear Stakeholders, Colleagues, Partners, and Community Leaders: The state-funded Disability Lifeline program administered by the Washington State Department of Social and Health Services is scheduled to end this fall. This will impact thousands of people who are now getting help through the program. • Enclosed is county-level data on the number of people in the program who will be impacted when the program ends effective October 31, 2011. Some of these individuals will lose their cash grant. This will be helpful in understanding how this change might affect your community. Under certain circumstances, the Department can share limited information about individual Disability Lifeline clients, such as their name, grant status (open or closed), and cash grant amounts. We welcome the opportunity to partner with social service organizations that can help Disability Lifeline recipients in your community meet their basic needs when their cash grant ends. Please share this letter with organizations in your area that may be able to help. Below is information about this and other legislatively-mandated changes that will impact individuals who are enrolled in Disability Lifeline. Changes That Will Impact Current Disability Lifeline Recipients In June of this year, the Legislature passed Engrossed Substitute House Bill 2082. This legislation ends the Disability Lifeline program effective October 31, 2011, and creates three new programs to help low- income individuals without dependents who are elderly or cannot work due to an incapacity or disability. The three new programs are: • ■ Aged, Blind, and Disabled (ABD) Program, which will provide cash assistance to persons who are: • • Age 65 or older, or • Blind, or • Likely to meet the disability standard for the federal Supplemental Security Income (SSI) program Persons in this program will also receive medical assistance. • Pregnant Women Assistance Program, which will provide cash assistance to women who are pregnant and not eligible for Washington's Temporary Assistance for Needy Families program. Persons in this program will also receive medical assistance. • Housing and Essential Needs Program,which will provide non-cash housing and other assistance (e.g., personal hygiene items and bus tokens)for some recipients of state-funded Medical Care Services. Medical coverage for persons who are currently DL recipients will not change. Persons currently receiving Medical Care Services coverage will continue to be eligible for medical coverage. DL-X and DL- A/B/C persons receiving Medicaid coverage will continue to be eligible for Medicaid coverage. With the end of the Disability Lifeline Program, there will be some Disability Lifeline recipients who will not qualify for cash assistance under the new Aged, Blind and Disabled Program (ABD) or Pregnant Women Assistance programs. Those who will not qualify will continue to get the same state-funded medical assistance (Medical Care Services)they are now receiving. Disability Lifeline recipients who are pregnant or receiving DL-X, DL-A, DL-B, or DL-D benefits in the month of October 2011 will be automatically approved for the Pregnant Women Assistance or ABD programs effective November 1, 2011. They will not have to apply and they will not experience a break in cash assistance. They will get their last Disability Lifeline cash grant in October 2011. Starting in November 2011, they will get a cash grant under the new program they have been approved for. Disability Lifeline recipients who are receiving DL-U benefits in October 2011 will lose their cash grants effective October 31, 2011. They will continue to receive Medical Care Services, and they will be referred by staff in our local Community Services Offices for help through the Housing and Essential Needs Program, which will be administered by the Department of Commerce. DL-U recipients can apply for cash assistance through the ABD program if they think they are eligible. More information about the Housing and Essential Needs program is available at this Department of Commerce website: http://www.commerce.wa.gov/site/1375/default.aspx Who to Contact for More Information • Enclosed is a DSHS Regional Map, which shows what counties fall in each of the department's three • service delivery regions. Social service organizations that would like to be included in a community referral list for Disability Lifeline recipients who will lose their cash grant can contact the persons listed below: For social service organizations in Region 1, please contact: Don Oswalt at(509) 225-7914 or Donald.Oswalt@dshs.wa.gov Carol Lee at (509) 227-2205 or Carol.Lee@dshs.wa.gov For social service organizations in Region 2, please contact: Dave Houser at (206) 272-2142 or David.Houser@dshs.wa.gov Sue Chance at(425) 339-4008 or chancsa@dshs.wa.gov For social service organizations in Region 3, please contact: Vicky McLaurin at (253) 476-7032 or Vicky.Mclaurin@dshs.wa.gov As noted above, under certain circumstances,the Department can share limited information about individual Disability Lifeline clients, such as their name,grant status (open or closed), and cash grant amounts. For example, we may be able to do a data match with an organization's client list and tell you whether a shared client will lose their cash grant. This would require entering into a data share agreement with • the Department. We also have a Benefits Verification System (BVS)that is available to organizations that need certain client information to determine a person's eligibility for their services and programs (e.g., local housing authorities who determine eligibility of DSHS clients for low-income housing). Some of you may already have a data sharing agreement with DSHS that allows you to look up individual shared clients to provide additional services. If you would like to work with us to prepare a data match to determine which of our shared clients may be at risk of losing their Disability Lifeline cash grants, please let us know and we can amend your present agreement to allow this. If you would like more information about our data sharing requirements and data share agreements, please contact Sydney Dore, ESA Risk Manager, at (360) 725-4368 or doresm@dshs.wa.gov. We are committed to working with you to minimize the negative impact of these changes on thousands of vulnerable Washingtonians. Thank you for your partnership and commitment to DSHS clients. Very truly yours, David Stillman,Acting Assistant Secretary Economic Services Administration • Enclosures cc: Babs Roberts, Acting Director, Community Services Division Manning Pellanda, Assistant Director, Health Care Authority Sydney Dore, ESA Risk Manager John Olivas, Regional Administrator, Region 1 Deborah Doyle, Regional Administrator, Region 2 Dan Owens, Regional Administrator, Region 3 • • • Disability Lifeline (DL) Clients by County of Residence, June 2011 Source: ESA-EMAPS using the ACES Data Warehouse as of July 2011 •uthor:Thuy Ha 11 Report Run Date:August 4, 2011 ® e mT p k StatOWide ` 'X19: 97 T6' 3 ® ,6 , 35,1 2 Adams 20 15 7 6 0 . 48 Asotin 58 25 t 0 p 3 0 86 ;Benton - 442 205 79 46 A 0 772 0Chelan 250 137 22 20 . 0 ' 429 Clallam 181 110 8 14 313 Clark 634 170 101 65 0 970 Columbia 10 7it 0 0 0 17 Cowlitz 344 109 10 28 0 ' 491 Douglas m . 78 34 13 � 5 <..�. 0 130 Ferry 54 21 0 2 0 77 ii Franklin 166 89 88 a.27 0,. 370 Garfield 0 1 0 0 0 1 Grant 216 161 52 52 0 481 Grays Harbor 360 147 6 26 0 0 -0 539 i' Island 100 55 9 0. 10 0 174 s.w .ama-+,e rww vmwwt»xs , k. w.+ Jefferson 82 45 4 6 0 137King 5765 3349 1833 307 0 11,254 Kitsap 680 503 I 49 25 0 1,257 . Kittitas :., 73 31 , �3 33 0 140 iKlickitat 80 65 6 .m.2 0 nt.L. 153 ..a � . Lewis 328 182 11 35 k 0 556• Lincoln 1.3 .10 Li 0.�. 1 ��, �N 24 Mason 208 100 1 ' 15 0 324 Okanogan 132 81 3 29 0 245 Pacific 89 81 4 2 11 g 0 183 Pend Oreille 117 30 0 4 0 151 w 1Pierce 2232 1192 269 254 0 3,947 San Juan �. 16 � .13 2 1 0 32 Skagit 278 ` 214 46 30 0 0568 b:.. Ska ansa 47 30 0 1 0 �. 78 Snohomish 1855 ' 1325 470 169 0 .3,819 • !Spokane 1848 760 158 s 193 0 2,959 Stevens 226 698 11 0 314 w 387 61 1,278 Thurston , 797 33 0 . .. 4 A 0 1 0 15 • Wahkiaku, m 10 • w.. . .. Walla Walla 124 82 23 9r 0 . ro,.. 238 • • � 676 ! 392 66 48 0 1,182 4 Whatcom � � 0 57 Whitman 28 20 4 ... 5 685 363 155 120 0 i 1,323 1 Yakima • � � �.�., ,� �. s� 2 5 3 p0 10 Unknown Data Note: *For the purpose of this report,the DL-U data includes a relatively small population of youth under age 19 who meet Disability Lifeline incapacity criteria, receive a DL cash grant,and are eligible for Medical Care Services but receive Medicaid because they are under age 19. Statewide,there were only 78 of these clients in June 2011. Disability Lifeline Program Types: DL-U provides cash assistance and Medical Care Services(MCS)for eligible individuals who are unable to work for a mininum of 90 days due to a mental or physical incapacity. DL-X provides cash assistance and Medicaid for eligible individuals who appear likely to meet SSI Disability criteria. DL-A provides cash and medical assistance for eligibile individuals who are aged 65 or older. DL-D provides cash and medical assistance to eligible individuals who meet SSA Disability criteria but do not currently receive SSI based on other eligibility factors(e.g.citizenship status). DL-B provides cash and medical assistance to eligible individuals who are blind based upon SSI standards but do not currently receive SSI based on other eligibility factors(e.g.citizenship status). • • S _ II( br II El 0 r. V = V Ux"a SMr., . e O C 'O o y VO N c,.4' )- V k�; • ca xa� ,,; �h•. x• .-,,„•,,,, Litt. . y. • o e 7enQ to yQ}�• ' A„ai "sa• , en tli p4 7. 47. Cut $• � aw4 te £ v L•m,n 0 , :r...."""4_, Js I.G9 .9 • L -- . r:4 -j® "r" '• N41 u cx 727 41 • Coll ® z • _ LL s� • x” gu G Q wN b ll� 0 y• kr > {,�, ' . 0/ '' ', ‘"-;'' ''''''')4+ Ziokikk 2,- '''-,',.._."' 6 CD z-,' , • 1411V . -Nit. 7 b Alse wow Ito " E;9 y N y o. r✓ m _ = �O t cg O cz v ° �, vw 3 W SO ti LE • sa SP Y3 N` a x L'' xa >- 41 ,w ¢ to am w C ..;z: A u W• • 'A r WASHINGTON STATE MEDICAL ASSOCIATION * * * Monday Memo * * * #439 Oust 29, 2011 MEMO TO: WSMA Board of Trustees Monday Memo Plus Distribution Medical Specialty Society Presidents and Staff Group CEOs and Leadership County Medical Society Presidents and Staff Board of Directors, WSMGMA FROM: Tom Curry,Executive Director/CEO SUBJECT: MONDAY MEMO-REPORT ON CURRENT ISSUES and WSMA ACTIVITIES ED Medicaid Visit Limitation: Can the Budget Language be Reconciled with the Budget? In a discussion best characterized as prescient over what will come with further state budget cuts,we are having a challenge helping the state square-up its fiscal needs with rational patient care—in this case,the Medicaid program's plan to limit the number of covered ED visits. The WSMA has pushed hard for a more rational alternative approach,with the very strong participation of the State Chapter of the American College of Emergency Physicians(WACEP)and other specialties as well, and working with the WSHA. With another meeting with the state in a few days,we'll find out if there will be a reasonable solution to an unreasonable budget requirement. Sorrowfully, such a solution remains in doubt. To Recap the ED limitation situation: Of Medicaid(HCA)agency detail language states: "Emergency room visits in the Medicaid program will be limited to ee non-emergent visits per year. The WSMA and the WSHA will be included in developing the criteria for defining non-emergent. (Savings of$33.0 million GF-State and$38.8 million other funds)" The 2011-13 Budget language states: "The department shall collaborate closely with the Washington state hospital and medical associations in identification of the diagnostic codes and retroactive review procedures that will be used to determine whether an emergency room visit is a nonemergency condition to assure that conditions that require emergency treatment continue to be covered:" Our discussions with the state have ielded .oints noted in a summa b WACEP .lus conversations with our 01 m.is staff last week): • The state has come back with its original list of codes for care not to be covered,plus added new codes—creating a list that includes clearly emergent items. • The state has backed away from a decision made at our first meeting and instead now will include children in the visit limitation(couldn't afford giving up the savings,they say). • But, despite clear budgetary language,we and the state have not been able to collaboratively produce a list of diagnoses or agree to a non-emergent list that ensures patient safety. To wit,the HCA's current diagnoses list includes conditions that are emergent, including chest pain,abdominal pain, and asthma. We and the WSHA have spent a great deal of time and thoughtful consideration in these discussions. There are ways to reduce the number of emergency department visits that will save money for the state—but the approach being pursued saves money indiscriminately while jeopardizing patient care. 0 o,we'll see how the next meeting goes. Our workgroup will continue to seek a solution that finds savings without bitrarily limiting access to necessary medical care for Medicaid recipients. Work with the state on a retroactive review process may continue, but further cooperation on creating a non-emergent list appears problematic. A niggling detail: The state plan is on its face a contradiction with federal and state law. The reasonably prudent lay person standard in state statute (part of a bill we successfully lobbied for in the mid-90s) and now federal law under PPACA prohibits this type of retrospective denial. CMS Names Noridian Regional Medicare Administrative Contractor(MAC) • A seemingly interminable selection process by CMS has resulted in Noridian being named as the Medicare contractor to administer Parts A and B of Medicare for Alaska,Arizona,Idaho,Montana,North Dakota, Oregon, South Dakota,Utah, Washington, and Wyoming. For more information go to https://www.noridianmedicare.com/index.html or contact our Senior Director of Health Care Economics and Practice Support Bob Perna at rip@wsma.org. Today's Seattle Times Article on Pain Med Rules Adds to Public Debate The article–"New pain-management rules leave patients hurting"–by health reporter Carol Ostrom,notes the growing access to care problems these clinically complex patients are experiencing. Ostrom covers a number of the salient points in this debate which will only grow more public as we approach the rules' January 1 implementation date. Read the article at: http://seattletimes.nwsource.com/html/localnews/2016035307_pain28m.html September 10-11 Annual Meeting Update and Reminders Pollster Stuart Elway will be speaking at WAMPC Luncheon on Saturday,the 10th. Elway, a highly regarded Seattle based public opinion researcher,will plumb: • The current state of Washington's body politic. • The outlook for federal(our Congressional delegation)races in 2012. • The race between Congressman Jay Inslee and Attorney General Rob McKenna to be Washington's next governor. Elway Research has conducted physician and public opinion research for the WSMA for many years. This will be an informative and entertaining(in spite of the data)presentation. Not-to-miss–Medical Practice Transformation: Charting Your Course–Friday afternoon, September 9, beginning at 12:30 pm. Experts at this pre-meeting program will review physicians' options for maintaining independent practice or in making informed decisions about other practice options. To register, go to www.wsma.org/practice resource_center/practice-management-seminars-ceus.cfm, or contact Bob Perna at rjp@wsma.org House of Delegates Supplemental Material Online–The House of Delegates book–including supplemental materials–is now available online. You can download the book in its entirety, or in sections. All members are encouraged to view the reports and resolutions and offer your opinions via our new online Annual Meeting forum. The online forum allows any member—not just delegates—an opportunity to leave testimony on issues that will be debated. Click on a report or resolution to leave your feedback about that issue. Please keep in mind,just as in a Reference Committee hearing, it's helpful if you clearly state the position you believe the Association should take on an issue(support, support with amendments,oppose,etc.)and then offer any relevant background information. A reminder: only the Resolves of any resolution or report are acted upon by the House. If you have any questions about accessing or using the Virtual Reference Committee Forums, contact Shannon McGeoy, our director of administration, at 206.441.9762 or slm@wsma.org. If you need assistance setting up your personal account on the website,please contact Karen Chapman, membership coordinator, at 206.441.9762 or kcc@wsma.org. • Register for the meeting on-line at:http://www.wsma.org/news_events/11-Annual-Meeting.cfm cc: WSMA Staff 082911 • Board of 3-CeaCth Ne1v Business .agenda Item #17., 3 • . ICPJC, County Budget Update September 15, 2011 • • W N Co W co 01 wNW 0 019, / o . O IIIIIIK s NJ i I Ti 0 \ t0 O oAo W O C = W O r* O Cr Cr _ C rF - O� 0 O = r+ r+ O 0 ® f E w xlm Z G Z n m A K —1 D z D z = _ C C Z z z Z c) 0 0 m G) z n Z T m O , OT z m x r- m D v) jr. m v' m v) m 70 < v' < cmi) F) n m m Ln N • • 250,000 Community Health Fees 230,000 210,000 190,000 Private Insurance 170,000 150,000 Client Fees 130,000 Medicaid 110,000 90,000 - 70,000 50,000 2009 2010 2011 2012 Environmental Health Fees . 400,000.00 380,000.00 360,000.00 340,000.00 320,000.00 ®_ 300,000.00 rt ,. tm 280,000.00 260,000.00 240,000.00 220,000.00 200,000.00 2006 2007 2008 2009 2010 2011 2012 JCPH FTE Changes 2008-2012 • 38 37 36 35 34 33 32 31 30 29 2008 Actual 2009 Actual 2010 Actual 2011 Projected 2012 Budget WQ FTE Changes 2008-2012 7 6 5 - • 4 3 2 1 - 0 2008 Actual 2009 Actual 2010 Actual 2011 Projected 2012 Budget JCPH & WQ FTE Changes 2008-2012 44 43 42 41 40 39 38 `- 37 36 • 35 34 33 2008 Actual 2009 Actual 2010 Actual 2011 Projected 2012 Budget ADMINISTRATION DIVISION Jefferson County Public Health 2012 FTE Revenue Source FTE=7.81 i •Grants •Fees •Other ■County GF •Carry Forward 0.14 COMMUNITY HEALTH DIVISION Jefferson County Public Health 2012 FTE Revenue Source FTE=15.66 •Grants •Fees 2.27 • •Other •Spec Purp Tax 0.91 ■GF Transfer •Carry Forward 0.36 JEFFERSON COUNTY PUBLIC HEALTH DEVELOPMENTAL DISABILITIES 2012 FTE Revenue Source FTE=1.00 •Grants ■Property Taxes Other 0.01 GF Transfer • 0.01 Environmental Health FTE Revenue Source Trend 6.00 5.00 Grants 4.00 Fees 3r x Other GF Transfer 2,00 1 t .. 111°lir 'emir • Carry Forward 1.00 Ilmor EH 2010 Actual EH 2011 Proj EH 2012 Proj Water Quality FTE Revenue Source Trend 3.50 3.00 2.50 Grants 2.00 vOther 1.50 GF Transfer w Carry Forward 1.00 410 0.50 =' ' 11111111111 t " WQ 2010 Actual WQ 2011 Proj WQ 2012 Proj • Board of a lealth Netiv Business .agenda Item #`V., 4 • Revenue and Program Changes for 2011-2012 September 15, 2011 • C C = a CI ro v D N = C o 3 CC CC T d -o -I IS Vs c S 7 K -0 v) rri C C) -0 a 71 0) < < C) f=D "a N W CO = Cu A -s Q fD • Q C CL 00 - .G Ot1 (-D .L n u, fD 511 -s ° DO < 0) co — fD O v co (") (D 3' v v = _ < v v & < a) rt o o NO 0 e 011 o 3 rr . . n I 7 a3• CD ,.* si o 3 a Ky, - p O rD O O O N - ° c — v ° �. c c -s VI v, r r p �. c CD = ° Du -h r+' Q fD I n -' , -, N -1 N m 70 X m m m '"� O rD a) CD v Q- o Q C \ Iz No a n 3' CL 3' Cu 0) 0 0 o D Q o• CD a) ° a ° Q Q oa c I-, V V N N ha I� V N CD V O_ — N f� N \ 1�' N N I\' N N 0) A r fu ha ca N N ...... 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O (D ''* O el C r+ C NO U4 01 - fD F•, fD A Q F' DI* -. a C` — CD CD art o = I' O- `* C fD C m fD NJ V) sz y - cn rt 0 ° n >z rD !Z N A N A N rD 0) 7 G y CD CDD °CC 1-, c CD C O j 0 j O 3-•00 Q CD CD O e A C — I-' CL 0) a N NJ N �. r Z a o) al ti' fp 5. N N a 0 LA CD fD 0 f� O— • 'a _+ A A N v rt ° v < 3 0- 0 N N ONJ NJ = 0 0 rt Q -t, IS Q 0m v I-, A A rt O N • 0) ,=r -a A C C I-� F '"r 3 7,. 3 �' '+ -O OW N N o 0 v' Ort h m O n• c O O N r) ? o a p - rt 0. 0) • rt 0) f<D ,Qr e�-r CDD < of p < 3 CD n C A A Crtj = 3 (AD O% C) C3. Q C O 0CD C r+ Ut = (D C Ort fD-h doh r0+ Q O (D -- rt Q H as DV 0) 0) 0 �- r_+ ;--,. ,may. N fD .A-r •-•• .-i• CD S fD • Board of Health .Media Report 1 September 15, 2011 • • Jefferson County Public Health August/September 2011 NEWS ARTICLES 1. "Jefferson Health Department notes school vaccination rules," Peninsula Daily News, August 11th, 2011. 2. "New type of toxin spurs another shellfish closure," Peninsula Daily News, August 12th, 2011. 3. "Latest Anderson toxin test promising," Peninsula Daily News, August 15th, 2011. 4. "Rare toxin only in Sequim Bay puzzles experts," Peninsula Daily News, August 16th, 2011. 5. "Tobacco firms sue FDA over new warning labels," Peninsula Daily News, August 17th, 2011. 6. "Parents reminded of school immunization requirements," Port Townsend Leader, August 17th, 2011. 7. "Car Wash certified as EnviroStar business," Port Townsend Leader, August 17th, 2011. 8. "Anderson stays closed for another toxin test," Peninsula Daily News, August 22nd 2011. 9. "Uptown trophy winner," Port Townsend Leader, August 24th, 2011. • 10. "Quilcene clinic changes hours," Port Townsend Leader, August 241h, 2011. 11. "Zen Care Mowing named `green'," Port Townsend Leader, August 24th, 2011. 12. "Is This a DEER YEAR in Port Townsend?," Peninsula Daily News, August 25th, 2011. 13. "Ailing Anderson Lake reopened," Peninsula Daily News, August 28th, 2011. 14. "Heroin showing up more on Peninsula," Peninsula Daily News, August 29th, 2011. 15. "Jefferson Healthcare achieves national accreditation," Port Townsend Leader, August 31st, 2011. 16. "Gibbs' status worsens; Anderson still open," Peninsula Daily News, September 4th, 2011. 17. "Smaller needle may mean less ouch with flu vaccine," Peninsula Daily News, September 6th, 2011. S _____ Jefferson Health •notes school vaccination rules PENINSULA DAILY NEWS dose if it has been at least grade students, one Tdap ferson County Public Health five years since the last teta- vaccine is recommended but about HPV,hepatitis A and PORT TOWNSEND — nus-containing vaccine and not required. meningococcal vaccines, as With the start of the school student is at least 11 years IS Polio,MMR and hep- well as an annual flu shot. year just around the corner, old. atitis B:Same requirements Meningococcal vaccine is the Jefferson County Depart- 0 Polio, MMR and as for first through third especially important for ment of Health reminds par- Hepatitis B:Same require- grades, freshmen entering college. ents and guardians that the ments as for first- through I Varicella:Not required Jefferson County Public law regarding vaccination third-graders. for students who have not Health has walk-in immuni- exemptions has changed. ■Varicella:One dose of had chickenpox. However, nation clinics every Tuesday Minimum required vaccine or a history of the two doses of the vaccine are and Thursday between immunizations for the 2011- disease.A parent's.report of recommended because chick 1 p.m. and 4 p.m. at 615 2012 school year are below. disease history is adequate enpox can he a severe dis Sheridan St.,Port These are minimums, so at this grade level. ease leading to hospitalize- Townsend. children who have received tion in teens and young Extra Back to School clin all recommended vaccines 7th through 12th grades: adults. ics will be held from 1 p.m.to will have more doses of some Other vaccines are avail- 4 p m.Monday,Aug.22,and vaccines than required for ■ Tdap: Seventh- able and recommended for school attendance. through 10th-grade students children and teens by the Aug.29. No appointment is neces- arerequired to have one dose Centers for DiseaseP y Control var Kindergarten if they have not yet received but are not required for For more information, DTaP (diphtheria and vaccine and it has been school attendance. inae hone Jefferson County III at least five years since their Vaccines are available p Pub- and tetanus-containing last tetanus-containing vac- free or at low cost for stu- lic Health at 360-385-9400 or vaccine): Four doses, with cine dents younger than 19. visit www.jeffersoncounty the last dose on or after the For 11th through 12th- Ask your provider or Jef- publichealth.org. fourth birthday III Polio: Three doses, with the last dose on or after the fourth birthday, four doses were given before August 2009 when national • recommendations changed. ■ Hepatitis B: Three doses • MMR (measles, mumps and rubella):Two doses. •Varicella (chicken- pox):Two doses vaccine or medical-provider verification of disease. 1st through 3rd grades: I DTaP: Four doses, with the last dose on or after the fourth birthday. In cer- tain cases,three doses may be acceptable for children 7 and older. ■ Polio: Three doses, with the last dose on or after the fourth birthday. ■ MMR and Hepatitis B: Same requirements as kindergarten(see above). ■Varicella: Two doses vaccine or medical-provider verification of disease. Fourth and fifth grades: I DTaP, Polio, MMR and Hepatitis B: Same requirements as for first through third grades. ®Varicella:One dose of • vaccine or a history of the disease.A parent's report of disease history is adequate at these grade levels. ?,C) A/ 6th grade: ®Tdap(tetanus, ��j/1(/ diph- theria and pertussis):One . _ . _ ewr , , , , s , a o. toxins urs • another se 'sclosure • , , _ . Sequim Bay source of why . ,<x .• };M 1A`',, , 3 were made + ;� `"° ,) .;.''414. 'v, ;a�` BY Tom G'aLLtS �. ' �..,°ep.v "- PENINSULA DAILY NEWS SEQUIM—The state Department of ,x � ,,,,,., � 1� >,�: - . f Health closed Sequim Bay to shellfish " , .`� t•, ry „i £ harvesting this week after three people ,,,,,:g4.,, i 1:4;,ul itz t ',�*;,,”� , 1,465,„4^tfi� j ,, became ill from a marine toxin never seen ".1..i %S . , x>" , f s ','1/4.-8- £, before in unsafe levels in shellfish in the o- r r ,.,t,, t, United States. The ban for both recreational and corn- �r& , . $ -t mercial harvesting of all types of shellfish in the bay began Monday,and a recall for g all commercially sold shellfish from the area.during the past two weeks also went into effect,the department.said Thursday. The Health Department has accounted xerre TuonrelPexresLn a DAILY NEWS for all recalled shellfish,and it is not on placid Sequim Bay,seen here just south of John Wayne Marina,has the market,officials said. been placed off-limits for shellfishing because of a marine toxin never Diarrhetic shellfish poisoning — also seen in unsafe levels in the U.S.,health officials say. called ASP = causes nausea, vomiting and.•other flu-like symptoms that can "We have lots of questions and not as The report prompted the agency to run begin within a few hours of eating tainted many answers as I would like,"Cox said. tests for the toxin, which found levels • shellfish and last up to three days. It's all new, and it's a work in prog- exceeding the international standard set It comes from a toxin produced by a ress° by the European Union. type Af plankton long-known to live in One sample found levels 10 times above high Concentrations Coxe in Sequim Bay, said Seattle-area familythe limit of 16 micrograms per 100 grams Frank Cox, marine biotoxin coordinator of shellfish tissue. with the Health Department. Two boys and a father from the Seattle Tests were done by a federal Food and But why it has taken this long for the mea ca3ns down with the illn after, at- larug Administration lab,Cox said. toxin,prevalgxJt .xparts of uro a and""in Sequim Ba shelliloii in June. "We aren't even setup to run that test," recently found s h r h remains unclear,is waters, They reported it to the Health Depart- he said. to cause illness here he ment on 12 and have since recovered. said. July 'rum To ToxtN/A4 • All ocean beaches Toxin, in seasonal closure now . • CONTINUED rRoDI Al 11 species for the ocean beach seasonal It's unknown how long closure means clams including geoduck, the closure will last. oysters, mussels and other invertebrates Unlike paralytic shell- fish poisoning — or PSP, such as the moon snail. Crab meat is not also known as red tide, known to contain the PSP toxin, but crab guts which has prompted closure can contain unsafe levels and must be of other beaches on the NoPsof All for the sport life-threaten-a harvet of allops. The closures do not ing,Cox said. to shrimp. . High amounts of PSP can cause difficulty breath- Kilisut • ing and potentially death. the Strait of Juan de Fuca Discovery Bay — Still,he said,the agency from Discovery Bay west to Harbor, including Mystery plans to test for the DSP Neah Bay to all recreational Bay,is closed to butter clam toxin elsewhere in Wash- harvesting of all species of harvest only. All ocean beaches are in ington state waters,though shellfish. a now. where has not been deter- The closure appliednot seasonalAlsPeclosureo means clams mined. commerciallyo sport harvesting, including geoduck, oysters, harvested mussels and other mverte- Plankton levels shellfish, which are sam- masse such t the moon pled separately,health offi- snail. Crabumeat is not s Cox said his department cials have said. known to contain the PSP has monitored the levels of kbut guts the plankton, dionophysis, Dungeness Bay too toxin,but crabe levels cannd con- that - causes the toxin in be discarded.u Sequim Bay for at least the. Dungeness Bay is the past two years and is step- only beach tween eah Baby thatcovvSport harvest ping up testing of the water ery Bay and • in response to the illness. remains open to recre areas are closed for Hopefully, he said, that ational shellfish harvesting. the sport harvest of scal- will provide some answers. The June closure lops. 'There's so much about excluded Sequim Bay, The closures do not this we don't know," Cox which was closed at that apply to shrimp. said. time only to harvesting of Butter clams have the Unlike bacterial contam- butter clams-which hold ability to retain PSP toxin inflation, the toxin DSP is on to the toxin for a longer for a very long time—up to not killed by cooking or period of time than other a year or more.Areas may freezing,just like PSP. shellfish—and Dungeness be vest of closed ret a sport clams when High levels; of' PSP Bay. `vei otherospecies are safe June of prompted the a closure inl late In Jefferson addition to the closure of and open. June of beaches directly For more information, phone the Marine Biotoxin Hotline at 800-562-5632 or visit the state website at http : / / tinyurl. com/4xmf 1w7. Reporter Tom Cailis can be reached at 360-417-3532 or at tom.callis @ peninsuladailynews. com. III al v., %to ....,, „, as �a o 3 y ;� Toxin: Decision about .0 C 0 vS o °GR, cz-T . I x I b y 2 2' Z g 2 ! reopening upto state ®II® 0 ", 0- o� -iz (I) c3a•c-1 a •cs6 15 rc c O as a zu, c) 0 a o E-, 3 5 ro 2 G N �r j CONTINUED FROM Al of a sample and the results another algae toxin that ®® o o y N o,a G •.^ of a test, conditions can has been found in East Jef- E o(1. d. ai m Arty a y _ o 0 3'-/.O u o c.,r, Since Anderson Lake is change. ferson County lakes,is well y ° x :U in a state park, it is state Anderson Lake toxin below the safety threshold Pazks officials who decide if readings have been decreas- in all the lakes that are 0 O a a �W a'' y ° ( I the lake is to be open or ing since a June 24 test tested ,..e.. 4. closed to the public. result showed 1,112 micro- The safe limit for micro- g_ _ And even if county spe- grams per liter of anatoxin- ® = micro- cystin — which can cause =y °�° 6 c- a - cialists recommend reopen- a. liver damage with chronic noi 3 a 0 w c - ing it, their state counter- But the downward trend y osure—is 6 micrograms ,a o a v a, y ti i parts could decide to keep it could change, Thomason per liter,Thoma o said. E �c f x .e _ closed, simply because the said. E ec w, CO �.^,... s The level found in sam- c a a o a a J toxin content of a lake "We've seen this before, les last week was 0.9 in a 0 4 m �, o a infested with blue-green and it's come back up,"he p o x — s gg a., .0 I algae can change quickly. said. Anderson,0.1 in Leland,0.4 141$ 0 .3-°1 _c o a N 0 :i) I However, he is hopeful Gibbs and none detected Tv o g M 0• Avoiding a seesaw that the worst is over for in Silent. �' Y W this year Warning and caution u E-ci s v l2 o ^ 0 w 1 Instead of a seesaw of 14010 o a d c I opening and closing, offi- "We're seeing fewer vari- signs are based on the types I vials sometimes will opt for sties of[the algae species] of algae in the water and a longerthat can create toxins,"he whether or not anytoxins a b .. view of conditions, o o 3 0' G cl•a 0, `.. a c Thomason said. said. have been detected. E F a o,. a "' •u -0 0 ° "Sometimes they keep it The rise and fall is a NEM °' . 0 P. 5 ^ O'--' familiarphenomenon. Some ignore signs E o �� ;,.� closed because it could g 9 Ot g•5-c ci,-a CD I tt3 °.,-4 U 3 change again,"he said. "We see this every year," Still, some ignore the 40.° a N 3 0 > '�'a cc 0''- ,y> The lake should not be Thomason said. III y w o $ considered safe now,despite The algae `wear them- signs,Thomason said. c7 ❑.� 8 �. as c,.4n > :� selves out like flowers in "People are still going in a F.y a a� o 52 I the low toxin content of one ourgarden,"he said. water" .0 o c, ,a m c c, co , sample. y the at Anderson Ila `' Testing is always a week "The bloom and then Lake,despite the signs that ,. �,0 -a 0.i m-Q a 14 x z behind the fact,since sam- they'reY " say"danger,closed,"Thom- done. dan er, 5-.y g^ pies are taken Mondays and Anderson Lake has been ason said. .y Q,, S as a p 1 y results are received from plagued with deadly toxins The volunteer camp host King County Environmen- t', in the summer months has had to tell some people r since 2006,when two dogs to get out of the lake,Thom- :,o c i tal labs Fridays. 8 a y..o 6 0 N a> ` °'a �0°•"c And the cause of the ��on Memorial Day after anon said. v 02 w a, 6 c u: 0 a appearance of the toxin,as drinking lake water with a "We're glad he's there," C. w 0 well as the levels of toxin, heavy concentration of ana- Thomason said. N p o. o ^u i are something of a mystery. tom-a. "He may be saving some g;,y 0: c, c v v 3.� Researchers know toxins people's lives." 2 E 9.6 ai °7 a 0 .0,' - i are created by blue-green Can't tell by looking - Information about lake liZ a, a c d 0� o c m ... U cu a, ...a.:,-.a�' a -' o. ' N o algae. It's impossible to tell by quality is posted at http:// y m a 0 a: a ' $ ti^ o Blue-green algae growth a lake's appearance if it is tinyurl.coml6z64ofy a, a D a - ac a_ itself is thought to be eport blooms in Jef- y�, F,en co a a o o - . encouraged by warm,sunny poisonous derson still has a ferson rCounty, phone 360- A .co a m a d weather when sufficient bloom,"he said."Gibbs still 385-9444. 1114 a 6 m.� 0'S a CO 0 m 4 a f nutrients, such as phos- has a bloom.Gibbs actually Clallam Countyhealth phos- phates,are present. looks worse than Anderson. officers do not test for toxins. a•w , I Not all produce toxins "But the toxins are what Instead,they look for algae o '''1,.9* x r tell the story. blooms. o.... 3 i But only certain species For instance,testing last To re ort algae blooms in a c of algae produce toxins. week found that Gibbs, p g a v i Clallam County,phone 360- Q •.-� U o Researchers don't fully with its heavy algae bloom, 417-2258. �i 4 understand why some spe- had no detectable anatoxin- cies z y cies of blue-green algae will a. sine -73 �-� 2 m.c c begin to produce toxins nor None of the neurotoxin Managing Editor/News Leah 5i 0 ►.1 m what fuels increases in the was found in Leland or Leach can be reached at 360-417- ° .� a) 5 5 - 8 x y c4 I amount of toxins. Silent lakes,as well. 3531 or leah.Ieach®peninsula U 7j s-i ,4 z .4 0 w y And between the taking The level of microcystin, daitynews.com. N E c C C n C/ 9 22 t G a. i C.0 4=. • Pi) //r4- toxin Rareonly • in Sequim Bay puzzles experts BY JEFF CHEW for all commercially sold PENINSULA DAILY NEWS shellfish from the area dur- ing the past two weeks also went into effect. fish toxin that. sickened DSP comes from a toxin three King County resi- p oduced by a type of plank- dents who ate mussels ton long-known to live in they harvested at Sequim high concentrations in Bay State Park baffles Sequim Bay and around state health officials who Puget Sound, said Frankou call it a mystery that can only be solved through Cox,marine biotoxin coordi- testing and analysis of nator with the state Depart- water quality in all parts ment of Health. of Puget Sound. "It's well documented The state Department that it's here,"Cox said. of Health closed Sequim "The question now is Bayto shellfish harvest- why were we not having ing last week after it was cases of the illness and confirmed that three peo- nobody was reporting cases ple became ill in late of it. Apparently, it's been June from a marine toxin, found in plankton for some • diarrheal shellfish poi- time." soning — never seen Cox said he has known before in unsafe levels in of the plankton in Sequim U.S.shellfish. Bay that carry the toxin for No other cases had at least 10 years. been reported as of Mon- day,a state health official Process slow said. Asked whyit took from Food contaminated mid-Julywhethe illnesses with diarrheal biotoxin shelmaylfish were firt reported in King poisoning may p not look or smell spoiled. County to last week to con- Diarrheal shellfish firm the toxin sickened poisoning can cause diar- three,Cox said: rhea, nausea, vomiting, "It takes time to get that abdominal cramps and information collected and chills. reported and up the chan- The ban on both recre- nels to people like us." ational and commercial The toxin is prevalent in harvesting of all types of parts of Europe and was shellfish in Sequim Bay. recently found in British began Aug.8,and a recall Columbia waters. • P/3 / r ms sue FD h . o A ,seat• ,-;„„,, A,..,,, ,,,, , ''4 ''''' '2 . . 10 new warning By JEFFREY COLLINS They instead force them does not discuss pending smoking hotline THE:ASSOCIATED PRESS to put government anti- litigation. One warning label is a COLUMBIA, S.G. — smoking advocacy more When she announced picture of a corpse with its Four of the five largest U.S. prominently on their packs the new labels in June, chest sewed up and the words: Ser- than their own brands,,the Health and Human Ser "Smoking can kill you." tobacco companies sued the companies say.They want a vices Secretary Kathleen Another label has a pic- federal government Tues judge to stop the labels. Sebelius called them frank ture of a healthy pair of day over new graphic ciga- before in the and honest warnings about lungs beside a yellow and Tette labels that include the United States have produc- the dangers of smoking. black pair with a warning sewn up corpse of a smoker ers of a lawful product been that smoking causes fatal and a picture of diseased Nine new labels lungs, saying the warnings required to use their own lung disease. violate their free speech packaging and advertising The FDA approved nine The lawsuit said the rights and will cost millions to convey an emotionally- new warnings to rotate on images were manipulated of dollars to print. charged government mes- cigarette packs. They will be especially emotional. The companies, led by sage urging adult consum- be printed on the entire top The tobacco companies R.J. Reynolds Tobacco Co., ers to shun their products," half, front and back,of the said the corpse photo is Lorillard Tobacco Co., said the companies wrote in the packaging. The new warn- actually an actor with a the warnings no longer sim- lawsuit filed in federal court ings also must constitute 20 fake scar,while the healthy ply convey facts to allow in Washington,D.C. percent of any cigarette lungs were sanitized to people to make a decision The FDA refused to com- advertising. They also all make the diseased organ whether to smoke. ment, saying the agency include a number for a stop- look worse. • • /D,6 N 6P�/ 7// • Parents reminded of school immunization requirements August has arrived; it's Two doses or medical pro- mended, but not required, • time to think about required vider verification of disease. to receive one Tdap vaccine.. back-to-school vaccinations. Polio, MMR and hepatitis Delaying children's shots FIRST B requirements as above for can leave parents and stu-, THROUGH THIRD GRADES first through third grades. dents facing long waits at the • DTaP: Four doses with • Varicella (chicken pox): health department or their the last dose on or after the Recommended, but not doctor's office. Jefferson fourth birthday. In certain required for students who County Public Health cases, three doses may be have not had the disease. encourages parents to have acceptable for children ages their children vaccinated 7 and older. For students in seventh early to avoid the late sum- • Polio:Three doses with through 12th grades who mer rush. the last dose on or after the have not yet had chicken The law regarding vac- fourth birthday. pox,two doses of the vaccine cination exemptions has • MMR and hepatitis B is recommended. Chicken changed this school year. requirements as above for pox can be a severe disease • Parents wishing to exempt kindergarten. leading to hospitalization in their children from required • Varicella (chicken pox): teens and young adults.This immunizations must consult Two doses or medical pro- vaccine is not required for with a licensed health-care vider verification of disease. teensat present. are avail- provider regarding the ben- Other vaccines are avail- efits and risks of immuni- FOURTH AND FIFTH GRADES able and recommended for zations and of withholding • DTaP,polio,MMR and children and teens by the immunizations.The provider hepatitis B requirements as Centers for Disease Control must sign a certificate-of- above for first through third and Prevention, but are not exemption form to be filed grades. required for school atten- with the school. Health-care • Varicella (chicken pox): dance. They are available providers do not need to One dose of vaccine or a free or at low cost for stu- sign the form for parents history of the disease.A par- dents younger than age who show membership in ent's report of disease histo- 19. Ask your provider or a church or religious body ry is adequate at these grade Jefferson County Public that does not allow medical levels. Health about HPV,hepatitis treatment by a health-care A and meningococcal vac- provider. SIXTH GRADE cines as well as an annual Requirements for school • Tdap:One dose if it has flu shot. Meningococcal vac- shots have changed slightly been at least five years since cine is especially important since last year.The following the last tetanus-containing for freshmen entering college. are the minimum required vaccine and student is at immunizations for the 2011- least 11 years old. WHERETO GET VACCINES 12 school year. Children • Polio, MMR and hep- Jefferson County Public who have received all recom- atitis B requirements as Health has walk-in immuni- mended vaccines will have above for first through third and nThures everyy Tu Tpuesday had more doses of some vac- grades. cines than the minimum • Varicella (chicken pox): at 615 Sheridan St., Port listed for school attendance. Ostorydose aof the disease.A par- schoolclinics . Other back-to- hare set for KINDERGARTEN ent's report of disease histo- 1-4 p.m., Monday, Aug. 22 • DTaP (or diphtheria, ry is adequate at this grade and Monday, Aug. 29. No tetanus and pertussis):Four level. appointment is necessary. doses with the last dose on Call 385-9400 for informa- or after the fourth birthday. SEVENTH tion. • Polio:Three doses with THROUGH 12TH GRADES To schedule, an appoint- the last dose on or after the •Tdap:Seventh-through ment for school immuni- fourth birthday, unless four 12th-grade students are zations, call your medi- doses were given before Aug. required to have one dose if cal provider. Jefferson 7, 2009. when national rec- they have not yet received Healthcare Primary Care. ommendations changed. this vaccine and it has been Jefferson Healthcare Family • Hepatitis B: Three at least five years since their Medicine, Jefferson Medical doses. last tetanus-containing vac- &Pediatric Group and South • MMR(measles,mumps cine. County Medical Clinic all and rubella):Two doses. •Eleventh-through 12th- stock publicly funded pediat- • Varicella(chicken pox): grade students are recom- ric vaccines. • Car Wash certified as EnviroStar • business Jefferson County Public Health has certified the Car Wash as a four-star EnviroStar and a Green Business. This business recycles 75 percent of its water in a closed-loop filtration system, which ensures water conser- vation as well as pollution prevention. The Car Wash is at 515 Howard St., Port Townsend. Call 379-5717 or visit thecarwash.com. • • ,tea dkr • mZW 4E''' P' - 8 8 - caid. •50 2 ,0 1....•booo . m®c oqg0y,-. SY c3 o ateXOg4 ^.0.:9, m a 4) fa'H.9 ° m4vo� m a ppobw .'� omc0�'RJ' 8s mw sissi o0d.2u -4%. aOb� 2 t as.,--gg , mE cn camom 5z ,s .; 5- gi.4aY , 0z% � 0E cIcgo c ( o : Ez'l -rJpoivr ro LCg • Y5ia> 11D1--4 ia■A ." p.2 d. c ' wm t) � ric L. m aD,+-' , Y qq AN'C 0 m aNY a) CO" �" 'LSaQ / y oF^OGos �we bnah c .mYOo � � a� cgco 'cmd• doo o � oh o waa pmA yy mca m • mNP• P. Ma) OTT. 4'o a3 ho4 av pa a) ,., ,s..1, 0 - V , i-. C 8-c of -,T, ` V. d ,02b07-' V f"b O Y 0'D 0 o m' ,..,,-- . 0A as 2 o m bn,0)+:0,, 'o•5Y d d miC ' ,1 � a O 5• m'd 6 '41 O t ch y m�� � 0 om �a,• om ym-. mmopaco oPmp ,dibn c•$1 .. ° ? Ca .� o .n mB �+ mu m 1+ p.mmAc. a> 0 R,c. 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'.4)--w: ':< ,s , _. �;' �/ z s Uptown trophy winner Julia Danskin accepted a trophy from the 20th Uptown Street Fair judges on behalf of the"Girls Night Out"parade entry• Look for a photo gallery on ptleader. com.Photo by Kathie Meyer • �T/ewer Quilcene clinic changes hours The Jefferson County Public Health clinic in Quilcene is now open two days a month: 10 a.m.- 2 p.m. every first and third Wednesday. It was previously open every Wednesday. Julia Danskin, nursing director, attributed chang- es in staffing and commu- nity need for the schedule named`green' adjustment. Jefferson County Public Services include Women, Health has recognized Zen Infants and Children Care Mowing as a green busi- nutrition assistance, fam ness. Owner Robert Durant's ily planning, immuniza business is the first emissions- tions and a walk-in clinic. free lawn maintenance service Appointments are not nec- essary. on the Olympic Peninsula.The Call 385 9400. business uses human-powered mowers and bicycle transport. Visit zencaremowing. blogspot.com or call 360-381- 0345. Call 385-9444 regard- ing green business certifica- tion. • v • /', e cc. CIC?/` • N .5* d �,CS jdr )5 4�7`.A TCS k.."' • ✓r P • A.TOWNSEND? .,"1-:0: 4..., :'",-.7., --r.j!',`--,,,,?,4.:77',.-1, ri,V";'''-:-":C.4,--4'..,,-'441-:-,-,34,;;;',,,i'-' k...:,' ,1,47.1 ...i-,,,;:t:P•,, ... It s� 3 s ,' a F`4. �xG :s5,• 'a'_;F " ,`" gF -T• 3 li �„ � ct'"...,kms ' r. '" fi•C»q.,, a .. y'r�::.a mow,{-er '7 a�, , 5,,,i-^'.� . .."" 4q. : ., tt- ,Ys ..s .x. 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Animals seem bolder than say manyresidents BY CHARLIE BERMAN'r f Shelly Randall of Port Town- PENINSULA DAILY NEWS What do you think?Take send has a different viewpoint. "I think of them as giant II PORT TOWNSEND—There today's Peninsula Poll at rodents,"she said. is no deer census or official www.peninsuladailynews.com number about their presence, "I would like to see them but many people in Port hunted down,with the venison Townsend feel this year's brood He just looked at my hus- then offered at the food bank." is healthier,more plentiful and band,who was driving,and That isn't likely to happen for bolder than in past years. seemed to say, Hey,dude,you're two reasons. 'There was a deer in the mid- in my road." The Port Townsend Food die of my garden eating my Bank distributes only food that flowers,and I went out and Love em or hate'em is prepared in a safe kitchen,so made some noise,but she didn't The plentiful deer—now venison would have had to have move,"said Caroline Littlefield more so because those born in been prepared properly,said of North Beach. the spring are maturing—are manager Shirley Moss. "I ran at her,and she leaped either part of what makes Port Additionally,hunting is die- over the fence and into the road Townsend quaint and interest- gal within the city limit—and that•isn't likely to change,said but then looked me in the eye, ing or are a tremendous annoy- City Manager David Timmons. still chewing the flowers." ante. Timmons said the city won't We were driving down the "I love the deer,"Littlefield get involved in deer control 410 road and came upon a deer," said. said Food Co-op general man- "There is one doe that comes unless there is a serious health ager Kenna Eaton,who is new to my house every year and hazard. to Port Townsend_ gives birth in the same place." TURN TO DE ERIA4 . r: Problem of no predators CONTINUED r•roM Al everyone turned their carry virulent bacteria,so it The food grown in the III heads." becomes important to keep garden goes to the food "The problem is, there Preston said many local them away from home- bank, supplying several are no natural predators," gardeners have a problem grown food,officials said. pounds each week of the with deer eating valuable Preston doesn't see this growing Timmons said. season. lents and "hears some- as an issue because it is Andrew Shoop of Port "There are no coyotes in p , Hadlock is less hospitable, the area,so there are a lot thing about this every day." easy enough to protect a more deer and rabbits." As a result,deer repell- garden with chemicals or a sayingit is "ridiculous" to ent is one of the store's big- thorn hedge. think of deer as friends. Jefferson County Animal In 2005, Shoop shot a Control doesn't get involved gest items,one that needs And deer prefer flowers, 4-point buck with an arrow in deer management unless to be restocked every week. anyway,she said. in Port Townsend and was There is a commonly Some people feel they of unlawful hunt an animal is struck by a car horeld belief that deer carry can communicate with the convicteding of big game two years and has to be removed Bruce disease, originating from local deer later, after the four-pointars put down, said Bruce the ticks that jump off the Turner,animal control offi deer and onto people. Meditation buck took a while to die,he • cer. This isn't much of a said. threat, said Jefferson Aaron Carver,who man- "They are like rats," Once a rarity County public health nurse ages a small vegetable gar- Shoop said."There are mil- "When I came to Port Lisa McKenzie, who cites den next to the Food Co-op, lions of them. Townsend 20 years ago, Washington state data that keeps the deer away able to think nunshould o ldobe de deer were a rarity," said report only a handful of through willpower. Dawna Preston, a sales- locally originated cases of "I meditate near the gar- own property." woman at Henery's Nurs- Lyme disease since 2005, den and put out that they eiv none from Jefferson County. should please not touch this Jefferson County Reporter Char- "We were in a-restau- Deer pose the greatest garden,"Carver said. lie Berman can be reached at 360- rant,and someone said they health risk to vegetable "This has worked for 385-2335dorynor t c ol .bermantc saw a buck outside, and gardens because their feces years." P m. • _ • it0,c_., o e 0 " � QO � tia.0 R L m E , \ a am o moss c Sx:2 e R a4� o_ hIova (� x= 3 at 5 . m g 2e tZ , ,, CA A, , Z 4.4. P. '-^-4•7; '-'<a°''a' U m -K 'u. k 5$" ' -1400 ^T� aa'i tC a W to. �• / ; j O 02 0 p - 3 N V°N6 ▪- v F -, 3; � �?c ` crm �.?„ ,. .e i,,+. • ' ' F .. 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Dr. Lisa Grohskopf of the This layer, called the WASHINGTON — It's Centers for Disease Control dermis, is so rich in a cer- flu vaccine time again — and Prevention. tain type of immune cell and some lucky shot-seek- ` A yearly vaccination that the new shot uses a ors will find that the needle ,s now is recommended for lower dose of the same vac- has shrunk. r • 4" ' g: I' virtually everyone, except cine that's in regular flu The first flu shot that 4� babies younger than 6 shots. works with a less-scary .',..,Jz months and people with Studies found it trig- skin prick instead of an '�.� ;� severe allergies to the eggs gered as much protection as inch-long needle is hitting , e A fes: used to make it. full-strength muscle shots the market this fall. Sorry '� " Last year, 49 percent of — although it did cause kids, this option so far is • i. .5 children and 41 percent of more skin reactions like just for adults, and it's so , adults were vaccinated. redness, swelling and itch- brand-new that it will take ing. There's little data on some searching to find a Could be a carrier pain perception. dose. . THE ASSOCIATED PRESS But it's only for 18- to But there are plenty of Flu shots have long Say you never catch the 64-year-olds. It hasn't been the other varieties—stan- requiring a needle an flu?You could be a carrier, studied in children's more- dard shots, a special high- inch long or longer, unknowingly spreading the tender skin. dose shot for seniors and such as the one at misery when you feel little Sanofi estimates it will the needle-free squirt-in- left. A new version, at more than a sniffle,said Dr. sell fewer than 1 million the-nose option — to go right, is less than a William Schaffner of Van- doses this year while intro- around.At least 166 million tenth of an inch long. derbilt University, presi- ducing the newly approved 0 doses of flu vaccine are dent of the National Foun- product to doctors,before a expected to be produced clear about how much a dation for Infectious Dis- full market launch next flu this year. person's immunity wanes eases. season. over a year,although it var- "You should be vacci- Q: What about the Who will get flu shot? ies by age and overall nated each and every year original ouchless flu health. to ensure both you're pro- vaccine, the nasal-spray The big question is But federal health offi- tected and you're giving the version? whether people will get it. cials and the American maximum protection to A: Medlmmune's Flu- Usually each year's flu vac- Academy of Pediatrics people around you,"he says. Mist is for a different age cine varies from the previ- weighed the evidence and Here are some questions group, people ages 2 to 49 ous versions as different said don't skip this year's and answers about flu vac- who are healthy, meaning influenza strains emerge. vaccination — it's the only cinations: no one with underlying This year,the vaccine's a way to be sure your immune Q: How does the new health conditions or who is duplicate because the three system remains revved skin-deep vaccine work? pregnant. flu strains that sickened enough for the best protec- A: Sanofi Pasteur's Flu- Unlike flu shots that are people last winter still tion. zone Intradermal uses a made with dead flu virus, are circulating. "You're not going to be needle less than a tenth of FluMist is made with live Scientific studies aren't able to count on that vac- an inch long to inject vac- but weakened virus. • /D>d/V