The URL can be used to link to this page

Home My WebLink About2012- February File Copy • Jefferson County Board of Health .Agenda . 4 inutes • February i6, 2012 • JEFFERSON COUNTY BOARD OF HEALTH February 16, 2012 2:30—4:30 PM NOTE CHANGE OF MEETING LOCATION Pope Marine Building, 100 Madison St., Port Townsend, WA 98368 AGENDA I. Approval of Agenda II. Election of Board Chair and Vice Chair for 2012 III. Approval of Minutes of December 15, 2011 Board of Health Meeting IV. Public Comments V. Old Business and Infouuational Items 1. O &M Update • 2. Introduction of New Environmental Health Director and Current Projects 3. Public Health Heroes 2012 -A Healthier America Begins Today: Join the Movement 4. PDN Letter—Response to"Why Johnny's a Bad Kid" VI. New Business 1. Public Hearing: Jefferson County Public Health Fee Updates for 2012 2. Biomass - Overview of Health Effects from Particulate Pollution and Regulatory Framework: Department of Ecology Perspective 3. Washington State Legislature Reports 4. Jefferson County's Drug Take-Back Program 2011 Report VII. Agenda Planning VIII. Adjourn Next Meeting: Jefferson County Public Health 615 Sheridan St., Port Townsend, WA 98368 March 15, 2012 • 2:30 PM-4:30 PM DRAFT JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, December 15, 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) Kristen Nelson,Chair,Port Townsend City Council Sheila Westerman,Citizen at large(City) Jill Buhler,Hospital Commissioner,District#2 Chair Nelson called the meeting of the Jefferson County Board of Health to order at 2:35 PM. A quorum was present. Members Present: Phil Johnson, David Sullivan, John Austin, Roberta Frissell,Kristen Nelson, Sheila Westerman, Jill Buhler Staff Present: Dr. Thomas Locke, Jean Baldwin,Veronica Shaw, Julia Danskin • APPROVAL OF AGENDA Member Austin requested that item#3 under Old Business, Information from the State, be added to the agenda. Member Austin moved to approve the agenda for the December 15,2011 BOH meeting as amended. Member Buhler seconded. The motion passed unanimously. APPROVAL OF MINUTES Member Buhler moved to approve the minutes for the November 17,2011 BOH meeting. Member Frissell seconded. The motion passed unanimously. Chair Nelson requested the person who seconds the motion be named in the minutes. PUBLIC COMMENTS None • 1 BOB Minutes December 15,2011 DRAFT OLD BUSINESS and INFORMATIONAL ITEMS 2012 Jefferson County Budget Summary Ms. Shaw reported that she met with Philip Morley, County Administrator, regarding a reduction in the 2012 Water Quality County contribution by $30,000, leaving a total contribution of $50,000. Ms. Shaw expressed concern that with the reduction in the County funds, grant dollars will not be able to be matched and current deliverables will not be met. Ms. Baldwin stressed that Water Quality is important because Water Quality grants and programs are supporting Environmental Health staff,which has helped to avoid layoffs in Environmental Health. A copy of the Recommended 2012 Jefferson County Budget was included in the agenda packet. EPA Workgroup Update Linda Atkins, Environmental Health Specialist,updated the Board on the progress of the EPA workgroup. Ms. Atkins stated that 3 bids were obtained, a choice has been made, and a contract has been signed and is going to the Board of County Commissioners for signature. An ad was placed in the December 7th Leader for workgroup participants and she expects the first meeting to be in January. Information from the State Member Austin distributed a handout on the delivery of service from the State Health Director, which shows the impact Public Health has had on Washington State. • New Business Community Health Concerns Regarding Biomass Energy Plants: Kees Kolff, MD MPH, and Wendy White,ARNP Dr. Locke briefed the Board on the regulatory structure for permitting industrial activities such as the Port Townsend Paper Corporation (PTPC). Air pollution control authority exclusively rests with federal and state agencies. Local governments, including local boards of health are excluded from air pollution permitting or enforcement activities. Local government authority is largely restricted to land use and building permit-related activities. Kees Kolff, MD MPH, of The Sierra Club, gave a presentation on health concerns regarding burning biomass at a proposed PTPC cogeneration projects. The two issues of greatest concern are emissions of dioxins and ultra-fine particulates. He presented studies and statistics on the health risks of being exposed to dioxins and ultra-fine particulates which could potentially be released into the environment from such a facility. Following the presentation there was a period of question and answers and discussion among Board members as to additional information they would like to receive on this issue. • 2 BOH Minutes December 15,2011 • DRAFT Year End Summary of JCPH Clinic Client Reviews Ms. Baldwin included in the agenda packet a copy of all JCPH Clinic and Environmental Health client comments from 2010-2011,which as she pointed out were all positive comments. Washington State budget: Special Session Update Dr. Locke discussed a letter from Doug Porter,Director of Washington State Health Care Authority concerning the Governor's Supplemental Budget Proposals, a copy of which was included in the agenda packet. The letter discusses the $2 billion in proposed budget cuts from the current supplemental budget. These cuts will have negative impacts on the most vulnerable residents of Washington State. Ms. Baldwin discussed how she will not be able to defend the smaller programs, like AIDS prevention because of these cuts. Proposed Legislation for 2012: S-3335 On-Site Sewage Program Management Plan Funding Dr. Locke stated that Bill S-3335 is to be introduced in the regular session of the Legislature in January and would allow the local Board of Health to impose fees to cover the costs of administering the on-site sewage management plan. The bill would also allow the county treasurer to collect these assessments on behalf of the local board of health. Call for Public Hearing for JCPH Fee Updates — January 19, 2012 Board of Health • Meeting Ms. Baldwin announced the Public Hearing did not get posted in the local newspaper in time in order to hold the public hearing at the December 2011 BOH meeting. Member Austin moved to publicize the Public Hearing for JCPH fees for the January 19, 2012 Board of Health meeting. Member Westerman seconded the motion. The motion passed unanimously. ACTIVITY UPDATE None AGENDA PLANNING CALENDAR Dr. Locke asked how much information they would like to have on the biomass issue. Member Westerman requested more information on the Puget Sound Air Qualities position and a copy of the SEPA plan that was adopted. Dr. Locke stated that Eveleen Muehlethaler, Vice President for Environmental Affairs at PTPC,has offered to respond to technical questions on this issue. Member Johnson voiced that it would be useful to have a representative from ORCAA (Olympic Regional Clean Air Authority)to present the information from the report he prepared for the • 3 BOH Minutes December 15,2011 DRAFT Stockholm Environmental Institute in Seattle and that he will invite him to speak at a BOH meeting. The next scheduled BOH meeting will be held Thursday January 19, 2012 from 2:30—4:30 PM at Jefferson County Public Health, 615 Sheridan Street, Port Townsend, WA. ADJOURNMENT Vice Chair Johnson adjourned the December BOH meeting at 4:20 p.m. JEFFERSON COUNTY BOARD OF HEALTH Kristen Nelson, Chair Phil Johnson,Vice-Chair Jill Buhler, Member John Austin, Member Roberta Frissell, Member David Sullivan, Member • Sheila Westerman, Member • 4 BOH Minutes December 15,2011 JEFFERSON COUNTY BOARD OF HEALTH MINUTES • Thursday,December 15, 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) Kristen Nelson,Chair,Port Townsend City Council Sheila Westerman,Citizen at large(City) Jill Buhler,Hospital Commissioner,District#2 Chair Nelson called the meeting of the Jefferson County Board of Health to order at 2:35 PM. A quorum was present. Members Present: Phil Johnson, David Sullivan, John Austin,Roberta Frissell, Kristen Nelson, Sheila Westerman, Jill Buhler Staff Present: Dr. Thomas Locke, Jean Baldwin, Veronica Shaw, Julia Danskin • APPROVAL OF AGENDA Member Austin requested that item#3 under Old Business, Information from the State, be added to the agenda. Member Austin moved to approve the agenda for the December 15,2011 BOH meeting as amended. Member Buhler seconded. The motion passed unanimously. APPROVAL OF MINUTES Member Buhler moved to approve the minutes for the November 17,2011 BOH meeting. Member Frissell seconded. The motion passed unanimously. Chair Nelson requested the person who seconds the motion be named in the minutes. PUBLIC COMMENTS None • i BOH Minutes December 15,2011 S OLD BUSINESS and INFORMATIONAL ITEMS 2012 Jefferson County Budget Summary110 Ms. Shaw reported that she met with Philip Morley, County Administrator,regarding a reduction in the 2012 Water Quality County contribution by $30,000, leaving a total contribution of $50,000. Ms. Shaw expressed concern that with the reduction in the County funds, grant dollars will not be able to be matched and current deliverables will not be met. Ms. Baldwin stressed that Water Quality is important because Water Quality grants and programs are supporting Environmental Health staff,which has helped to avoid layoffs in Environmental Health. A copy of the Recommended 2012 Jefferson County Budget was included in the agenda packet. EPA Workgroup Update Linda Atkins,Environmental Health Specialist,updated the Board on the progress of the EPA workgroup. Ms. Atkins stated that 3 bids were obtained, a choice has been made, and a contract has been signed and is going to the Board of County Commissioners for signature. An ad was placed in the December 7th Leader for workgroup participants and she expects the first meeting to be in January. Information from the State Member Austin distributed a handout on the delivery of service from the State Health Director, which shows the impact Public Health has had on Washington State. New Business • Community Health Concerns Regarding Biomass Energy Plants: Kees Kolff, MD MPH, and Wendy White,ARNP Dr. Locke briefed the Board on the regulatory structure for permitting industrial activities such as the Port Townsend Paper Corporation (PTPC). Air pollution control authority exclusively rests with federal and state agencies. Local governments, including local boards of health are excluded from air pollution permitting or enforcement activities. Local government authority is largely restricted to land use and building permit-related activities. Kees Kolff, MD MPH, of The Sierra Club, gave a presentation on health concerns regarding burning biomass at a proposed PTPC cogeneration projects. The two issues of greatest concern are emissions of dioxins and ultra-fine particulates. He presented studies and statistics on the health risks of being exposed to dioxins and ultra-fine particulates which could potentially be released into the environment from such a facility. Following the presentation there was a period of question and answers and discussion among Board members as to additional information they would like to receive on this issue. S 2 BOH Minutes December 15,2011 I. Year End Summary of JCPH Clinic Client Reviews Ms. Baldwin included in the agenda packet a copy of all JCPH Clinic and Environmental Health client comments from 2010-2011, which as she pointed out were all positive comments. Washington State budget: Special Session Update Dr. Locke discussed a letter from Doug Porter, Director of Washington State Health Care Authority concerning the Governor's Supplemental Budget Proposals, a copy of which was included in the agenda packet. The letter discusses the $2 billion in proposed budget cuts from the current supplemental budget. These cuts will have negative impacts on the most vulnerable residents of Washington State. Ms. Baldwin discussed how she will not be able to defend the smaller programs, like AIDS prevention because of these cuts. Proposed Legislation for 2012: S-3335 On-Site Sewage Program Management Plan Funding Dr. Locke stated that Bill S-3335 is to be introduced in the regular session of the Legislature in January and would allow the local Board of Health to impose fees to cover the costs of administering the on-site sewage management plan. The bill would also allow the county treasurer to collect these assessments on behalf of the local board of health. Call for Public Hearing for JCPH Fee Updates — January 19, 2012 Board of Health Meeting • Ms. Baldwin announced the Public Hearing did not get posted in the local newspaper in time in order to hold the public hearing at the December 2011 BOH meeting. Member Austin moved to publicize the Public Hearing for JCPH fees for the January 19, 2012 Board of Health meeting. Member Westerman seconded the motion. The motion passed unanimously. ACTIVITY UPDATE None AGENDA PLANNING CALENDAR Dr. Locke asked how much information they would like to have on the biomass issue. Member Westerman requested more information on the Puget Sound Air Qualities position and a copy of the SEPA plan that was adopted. Dr. Locke stated that Eveleen Muehlethaler, Vice President for Environmental Affairs at PTPC, has offered to respond to technical questions on this issue. Member Johnson voiced that it would be useful to have a representative from ORCAA (Olympic Regional Clean Air Authority)to present the information from the report he prepared for the 4110 3 BOH Minutes December 15,2011 Stockholm Environmental Institute in Seattle and that he will invite him to speak at a BOH meeting. The next scheduled BOH meeting will be held Thursday January 19, 2012 from 2:30—4:30 PM • at Jefferson County Public Health, 615 Sheridan Street, Port Townsend, WA. ADJOURNMENT Vice Chair Johnson adjourned the December BOH meeting at 4:20 p.m. JEFFERSON COUNTY BOARD OF HEALTH Unavailable fr UnPhi1�Jo s ir , Vice-Chair Kristeenn Nelson, Chair Gly 1 Buhler, Member J A , ember Roberta Frissell, Member David Sullivan, Member _. & �.- Sheila Westerman, Member • • 4 BOH Minutes December 15,2011 • Board of Health Old Business & Informationalltems .agenda Item # 17., 2 • Introduction of Mew Environmental Health Director and Current Projects February 16, 2012 • , ,NAVIGATING _,, WORLD/PERMITS Come and meet the USDA, WSDA, and Jefferson County Food and Safety Permitting Speci&i is for a day of information exchange. The purpose of this workshop is to facilitate interaction _' between agencies at various levels that are responsible for permitting agricultural 10am-4pm,WSU EXTENSION OFFICE producers and 201 W.Patison,Port Hadlock,WA 360/379.5610 processors across a wide range of � , (� operations. e a,,1?..r c i '' �/ t , We will also have , " the opportunity to hear from local pro- ducers and Kim Hoffman processors WSDA who have successfully Brenda Oates navigated the permit James Trabert landscape. USDA �. Sensitive questions for Susan Porto agency experts should Alison Petty Mina Kwansa be submitted in advance Jefferson County to Laura Lewis. Public Health Iaura.lewis@wsu.edu 360-379-5610x 202 .. „ ,... - lrolii:lil Registration is V VASHI N 4 ,, ' ' U required for this limited space 4 JEFFERSO ., hlfp://w . .county/jeffe � � -° • Board of HeaCth Old Business & Informational-Items .Agenda Item # 1�, 3 • Pu6�ic 3-feaCth Heroes 2012 - A. Healthier America Begins today: .loin the 31/lovement February 16, 2012 • APHA announces 2012 National Public Health Week theme I Public Health Newswire Page 1 of 2 • public health newswire HOME HEALTH TOPICS FINDINGS ALL THINGS APHA VOICES MEETINGS BLOG ALL THINGS APHA / PREVENTION APHA announces 2012 National Public Health Week theme by David on Oct 30,2011 • 8:07 pm 1 Comment APHA announced Sunday the theme for National Public 44, 117 Health Week 2012:"A Healthier America Begins Today: Join the Movement!"The annual health observance,which • country recognize mobilizes communities across the to the contributions of public health,will be celebrated April 2-8, 2012. A tieckl-4,iipros With nearly 1 million Americans dying every year from ....., diseases that could be prevented, even small preventive AtikeriaA changes and community initiatives can make a big Bei difference in living healthier lives. National Public Health 04\50.70,DA ........._ . Week 2012 will build upon the National Prevention Strategy to create a healthier nation by promoting in the following areas: active ng healthyt0 behaviors living. 3lr ra? t eatngalcohol,tobaco ad otherr drugs;commuunicable diseases; reproductive and sexual health;and mental and emotional well-being. 0 SHARE El t 0... Tags: NPHW, prevention Previous post Next post 'Stand up and insist on the impossible' Leading the way to better health i http://www.publichealthnewswire.org/?p=1748 2/8/2012 Board of Cealth Old Business & Informational Items .agenda Item # T. , 4 • PDNLetter Response to `°1Nhy .Iohnny's a Bad xid" february 16, 2 01 r 11. 0k C® i 1820 Jefferson Street �Q ��'4s N f, P.O. Box 1220 p 4. t, - w Port Townsend, WA 98368 ' Phil Johnson,District 1 David W. Sullivan,District 2 John Austin,District 3 41 4.MING February 6, 2012 John Brower, Publisher Peninsula Daily News PO Box 1330 Port Angeles, WA 98362 The Jefferson County Board of Health applauds the Peninsula Daily News for publishing Nicholas Kristoff s op-ed, "Why Johnny's a bad kid"on 1/10/12. A growing body of scientific research supports the finding that the"toxic stress"that results from early childhood exposure to abuse and neglect, substance abuse,poverty, and violence has devastating lifelong ramifications. Kristoff writes about the American Academy of Pediatrics' (AAP)recent report on the lifelong effects of early childhood adversity. The AAP policy report calls for the implementation of science-based strategies to alleviate toxic stress and its negative impact on children's healthy • development, learning, behaviors, and future health. Mr. Kristoff specifically names Nurse-Family Partnership, an evidence-based nurse home visiting program, as a successful early intervention program that supports young mothers and their babies to a healthy start in life by improving prenatal health, school readiness and maternal economic self sufficiency. Jefferson County Public Health has been providing Nurse-Family Partnership services to families in Jefferson County for the past 12 years. This and other family health programs offered through Jefferson County Public Health have contributed to the health of Jefferson County infants as evidenced by our substantially lower rates of infant mortality, low birth weight babies, and premature deliveries as compared to statewide rates. The Jefferson County Board of Health supports the AAP's call for community involvement to support young children and their families and sustain the important gains we have achieved over the past 12 years. Sincerely,./h-..3r�✓ ii Johnustin, Chairman (14.19• Phone (360)385-9100 Fax (360)385-9382 jeffbocc@co.jefferson.wa.us • Board of CeaCtfi New Business .agenda Item # �VI., 1 • Public .fearing: Jefferson County Public Health gee Tlpdates for 2012 February 16, 2012 Y. v STATE OF WASHINGTON III JEFFERSON COUNTY BOARD OF HEALTH AN ORDINANCE TO AMEND Ordinance No. FEE SCHEDULE FOR JEFFERSON COUNTY PUBLIC HEALTH Section 1 —Effective Date Section 2—Fees Section 3—Severability Section 4—Prior fee schedule repealed WHEREAS,the purpose of this ordinance is to set the fee schedule for Jefferson County Public Health, WHEREAS, adoption of this Ordinance will further the public policy memorialized in Chapter 246-215 WAC as well as other chapters of the WAC and RCW, WHEREAS, this Ordinance promotes the health, safety and welfare of the citizens of Jefferson County, and WHEREAS,this Ordinance is proposed and may be enacted pursuant to the general police power granted to Jefferson County and its Board of Health by the State Constitution JOW, THEREFORE,BE IT ORDAINED by the JeftcOon County Board of Health as follows: Section 1 —Effective Date That this Ordinance (and its Attachment) shall be effective as of February 2, 2012. Section 2 -Fees That the schedule for Jefferson County Public Health fees for the year 2012 for permits, licenses, and services is hereby set by the Jefferson County Board of Health as listed in Attachment A to the proposed Ordinance. Any text listed on Attachment"A", specifically text within the column entitled "Additional Fees and Other Information" is deemed regulatory rather than advisory and as such has the full force and effect of local law. Section 3—Severability;:, A determination that any text,fee or fees adopted as part of this Ordinance is unlawful or illegal shall not cause any other text, fee or fees adopted as part of this Ordinance not affected by that determination to be repealed, revised, or reduced. Section 4—Prior Fee Schedules Repealed dlikny prior fee schedule previously adopted by this Board that contains or reflects fee amounts that are less than hose adopted herein is hereby repealed and replaced by this Ordinance. • AN ORDINANCE AMENDING 2012 FEE SCHEDULE FOR JEFFERSON COUNTY PUBLIC HEALTH ADOPTED day of 2012. JEFFERSON COUNTY BOARD OF HEALTH Kristen Nelson, Chair Phil Johnson,Vice-Chair 4 John Austin, Member David Sullivan, Member • Roberta Frissell, Member ,.a Sheila Westeiman, Member Jill Buhler, Member • JEFFERSON COUNTY PUBLIC HEALTH ENVIRONMENTAL HEALTH DIVISION ENVIRONMENTAL HEALTH 2011 FEES 2012 Additional Fees and Other Information Proposed (CPIW 3.9%) aealth Officer Administrative Hearing 287.00 298.00 dministrative Hearing Appeal 287.00 298.00 Technical Assistance/Plan Review-Minimum 65.00 65.00 Technical Assistance/Plan Review-Per Hour 65.00 65.00 Filing Fee 49.00 51.00 - ONSITE SEWAGE:DIS'POSAL .i,. _ .,: :..,. ,.3, 1: f,, ON, ,- - " - Sewage Disposal Permits ` New Conventional 520.00 540.00 Valid for 3 years New Alternative 620.00 644.00 Valid for 3 years New septic tank and/or pump chamber only 247.00 257.00 Issued in conjunction with an existing sewage disposal New Community or>1000 G.P.D.(base fee) 520.00 540.00 Plus$85 per connection-valid for 3 yrs New Commercial>1000 G.P.D. Conventional 620.00 644.00 Valid for 3 years Alternative 663.00 689.00 Valid for 3 years Repair/Upgrade/Modification/Designate Reserve Area 115.00 119.00 Applies to existing installed sewage disposal system Expansion 387.00 403.00 Redesign 115.00 119.00 Applies to pending or active but not installed Reinspection 144.00 149.00 Evaluation of Existing System/Monitoring Inspection Septic system only 287.00 298.00 - Septic system plus water sample 298.00 310.00 Retest/Reinspection 100.00 104.00 On Site Sewage OnSite-Site Plan Advanced Approval Determination(SPAAD) 287.00 298.00 - Septic Permit with SPAAD(conventional) 280.00 291.00 - Septic Permit with SPAAD(alternative) 388.00 403.00 Subdivision Review Base Fee 372.00 386.00 Plus$76.00 Per Lot Boundary line adjustment review fee 146.00 152.00 Plus$76.00 Per Lot Pre application meeting fee 146.00 152.00 Planned rural residential development review fee 146.00 152.00 Density exemption review fee 73.00 76.00 Density exemption review fee requiring field work 146.00 -152.00: - Other WaiverNariance Application 172.00 179.00 WaiverNariance Hearing 287.00 298,00 - - • Wet season evaluation 387.00 403.00 Revised building application review fee 146.00 152.00 New building application review fee: - Residential . 73.00 76,00 Commercial 146.00 152 00 •'; ENVIRONMENTAL HEALTH 2011 FEES 2012 Additional Fees and Other Information Proposed (CPIW 3.9%) Temporary Permits Single Events Limited Menu gg pp 102.00 Not to exceed 21 days at your location • Additional onal Applicationen (First Event) 15.00 16.00 Not to exceed 21 days at your location _ Additional Events(SameDMenu)e98.00_ 102.00 Not to exceed 21 days at your location Additional Events(Different Menu) Complex Menu 130.00 135.00 Not to exceed 21 days at your location Additional Applicationet (First Event) 15.00 16.00 Not to exceed 21 days at your location Events(SameDMenu)e130.00 135.00 Not to exceed 21 days at your location Additional Events(Different Menu) _ Organized Recurring Events(e.g.Farmers Markets) -i Limited Menu 98.00 102.00 Notfo exceed 3days a week Evtionent (First Event) 15.00 16.00 Not to exceed 3 days a week Additional Events(SameDntMenu)Menu) 98.00 102.00 Not to exceec,.3 days a week Additional Events(Different Complex Menu130.00 135.00 Not to exceed 3'days a week Initial Application(First Event) 15.00 116.00 Not to exceed 34ays a week Additional Events(Samee) 130 1'35.00 :Nat to exceed 3 days a week Additional Events(DDifferenntt Menu) 0'0Additional(Paid when application is submitted less than 7 +50 a of fee` +50%of fee', Late Fee for Temporary Permits �., \\ , days prior to the event) Other Food Fees ; 37:00 �� 39.00 Waiver a Plan Review Min Pre-opening inspectinspection' �„ Minimum - 65.00 65.00 Per Hour i 65.00 65.00 l 'l \., '65.00 65.00 Per Hour ' Reinspection \ - 87.00 90.00 First Inspection 149.00 155.00 Each inspection after first :i 65.00 65.00 Per Hour Reopening Fee 10/' .00 10.00 Food Handler Card 10 00 10 00 Reissue Unexpired Food Handler Card 211 00 210 00 Manager's Course a,$ i..' , ' :' .`. .' , .a 9.0 J ,; "... "6414 SOLID;WASTE_ " i` ak. .ata., t ._ u - 508.00 528.00 Landfills requiring environmental monitoring 508.00 528.00 _ Inert Landfills 322.00 335.00 Otherd tjza 322.00 335.00 • Other Solid Waste Facility Permits 149.00 155.00 Drop Boxes 409.00 425.00 New Facility Application 65.00 65.00 Per Hour Plan Review s€as io, , - `: , -Ir , WATER a ..t. .'1 " ' ,4.: .,"` .,. s Inspection of well construction,decommission& 149.00 155.00 reconstruction Application Fee 62.00 64.00 Building Permit Process DeInspection Water Sample Wper Supply 130.00 NEW FEE TO CAPTURE COSTS OF SERVICE Well Inspection&Water for Loan 298 00 309 00 Well Site Inspection Proposed public water supply �� : LIVING¢ENVIRONMENTS4An►ival"Permrit) %"',..v..4...',-,4.1,;4,1?"'"4,4'4,,N4,0.-44'4$44:f r':$ ,.,,v1,4,,, 1 ` 273.00 283.00 Pool 273.00 283.00 Spa 372.00 387.00 lanPool/Spa Combined 65 00 65 00 Per Hour Plan Review '!.,t3'..,4,5„;14.-g. u.. .; .,.c .r ,,., n. i-,,'" r. - -?::1,1;",'-'k v"�` si." r ":r. R e� �� 1R,,r ;�.„" �. ros'-. -..;".a, ,. - Indoor Air:(TAbadefl)�'-. `° " 65.00 65.00 Hour Compliance Enforcement I 73.00 65.00 Reinspection 173.00 176.00 1Per Rebuttal Feescavon Note: have been adjusted per Ordinance 12-1209-96,Section 4-Annual Fee Indexing:Fixed amount fees established by this ordinance shall be adjusted annually on the first business day of anuary (Adjusted Date)by the amount of the increase in the Consumer Price Index(CPIW).The CPIW is the Consumer Price Index-US City Average for All Urban Wage Earners and Clerical Workers,published by the Bureau of Labor Statistics for the United States Department of Labor. The annual fee adjustment shall be calculated as follows: each fee in effect immediately prior to the Adjustment Date will be increased by the percentage increase in the CPIW as reported for the month of September preceding the Adjustment Date. Increases will be rounded to the nearest dollar. A fee shall not be reduced by reason of such calculation. However,fee increases in accordance with this calculation •shall not exceed 5 percent per year. 2 of 2 11/10/2011 12:48 PM Board of aCealth Netiv Business .Agenda Item #17I., 4 Jefferson County 's Drug make-Back Program 2011 Report February i6, 2012 • r • DRUG TAKE-BACK PROGRAM 2011 FOR JEFFERSON COUNTY ANNUAL REPORT JANUARY 12, 2012 The Port Townsend Police Department and the Jefferson County Sheriff's Office participated in a drug take-back program. Both the PTPD and the JCSO have secure drop-off boxes at their locations. They also participated in a National Drug Take-Back Day in April and October. The chart below indicates the totals by month and the combined total for both law enforcement departments. PT JC COMBINED MONTH POLICE SHERIFF TOTAL JANUARY 12# 7oz 0 12# 7oz FEBRUARY 5# 4oz 29# 12oz 35# MARCH 10# 14 oz 10# 8oz 21# 6oz APRIL 7# 9oz 9# 8oz 17# 1oz • MAY 6# 6# 12# JUNE 6# 8oz 10# 16# 8oz JULY 5# 13oz 9# 14# 13oz AUGUST 5# 12oz 5# 8oz 11# 4oz _ SEPTEMBER 11# 12oz 4# 7oz 16# 3oz OCTOBER 6# 6oz 32# 8oz 38# 14oz NOVEMBER 2# 5oz 62# 64# 5oz DECEMBER 7# 2oz 25# 32# 2oz TOTALS 87# 12oz 204# 3oz 291# 15oz • t , CSO DRUG TAKE- BACK PROGRAM •afely and legally dispose of your unwanted and expired medications. or il Jefferson County ,. *F.4, " . Sheriff's Office , , i , - 4 itig r =—' If 79 Elkins Road, Port Hadlock " fit- th. 41101 360-385-3831 - 41P4 " Office Hours: Monday-Friday } 8:30 am-4:00 pm The following items are now being collected for disposal: • Prescription medications • Inhalers ip • Over-the-counter medications • Unopened EpiPens • Vitamins **Please Note: Pills do not have be in original containers-Loose pills accepted** Present your items to the staff person at the front counter. Staff members are not allowed to touch any of the items brought in for disposal. The following items are UNACCEPTABLE: • Liquids • Bloody/Infectious Waste • Empty containers • Personal Care Products • Needles/Syringes Hydrogen Peroxide/Other • Thermometers Chemicals IV Bas • Aerosol Cans •• ^ £: fir, �.wa 1pened EpiPens P **If you are presenting any items that are ineligible for disposala staff member wil, give you a handout directing you to otheresources for safe disposal.** April 14, 21 1 Please call 360-385-3831 ifyou ha t,n _LL Y questions. ^s. i PTPD DRUG TAKE— BACK PROGRAM Safely and legallyyour unwanted and expired medications. • dispose p of 71 Port Townsend : ; Police Department `� <t r 1925 Blaine Street, Port Townsend : 360-385-2322 " Office Hours: Monday-Friday ________r 8:00 am-5:00 pm The following items are now being collected for disposal: ▪ Prescription medications • Inhalers • Over-the-counter medications • Unopened EpiPens • ▪ Vitamins **Please Note: Items Must be in Original Containers** Present your items to the staff person at the front counter. Loose pills will not be accepted. Staff members are not allowed to touch any of the items brought in for disposal., The following items are UNACCEPTABLE: • Liquids • Bloody/Infectious Waste • Empty containers • Personal Care Products • Needles/Syringes Hydrogen Peroxide/Other Chemicals • Thermometers • Aerosol Cans • IV Bags ; • Opened EpiPens **If you are presenting any items that are ineligible for disposal.f a staff member wit give you a handout directing you to otherr-.esources for safe disposal.** April 14 z� Please call 360-385-2322 if you ha 4 any questions. Board of 1Cealth �vledia Report February i6, 2012 Jefferson County Public Health January/February 2012 NEWS ARTICLES 1. "The next 50 percent of waste," Port Townsend Leader, January 18, 2012. 2. "Group reviews sewage options," Port Townsend Leader, January 18, & 23, 2010. 3. "The Devil in the Medicine Cabinet," Carol Smith, InvestigateWest, January 22, 2012 4. "On-site sewerage options reviewed," Peninsula Daily News, January 23, 2012. 5. "County, Ecology discuss net pens," Peninsula Daily News, January 25, 2012 6. "Nurses help fight crime," Seattle Times, January 25, 2012 7. "Forks hospital approval makes whole North Olympic Peninsula linked with Seattle's Swedish health network," Peninsula Daily News, January 26, 2012. 8. "Credits for Dungeness water use in new rule," Peninsula Daily News, January 26, 2012 9. "Pill disaster: Peninsula counties among tops in state per capital opiate deaths," Peninsula Daily News, January 29, 2012. 10. "County, Ecology spar over net pens," Port Townsend Leader, February 1, 2012. 11. "The Jefferson County Conservation Futures Program: Preserving Open Space and Supporting Farms and Forests," City of Port Townsend Newsletter, February 2012. 12. "The Doctor is in," Governing Magazine, February 2012 13. "Toyotacare," Governing Magazine, February 2012 away every day. Our country loses more than 24 billion tons of soil a year, yet it happens so slowly that it's ignored.We consider oil a strate- S gic material and soil a throw-away • commodity. We should be using all our true food waste as soil inputs. Wendell Berry told us,"What we The next 50 do to the land,we do to ourselves." We should be using food left- percent of waste overs to build soil, not creating waste and then paying to throw it Our community is indeed doing a away.But it's going to take citizens, great job at recycling and reducing government officials and corpora- the amount of stuff we throw away. tions acting cooperatively, instead Al Cairns, the county's solid of competitively. Governments need waste department, the Solid Waste to establish policies that provide Advisory Committee,DM Disposal, incentives for waste reduction and Skookum Educational Programs, ratchet up penalties for waste cre- Jefferson Public Health and Local ation. 20/20's Beyond Waste Action Group Manufacturers need to create all deserve credit for getting us to a closed-loop product systems and 50 percent diversion rate. find alternatives to items that can't Online tools such as Freecycle, be reused. Each and every one of Craigslist, Too Good to Toss and us must change the way we think Fourth Corner Exchange are also about convenience and need to live playing significant parts. our lives with the knowledge that What will it take to get to the there is "no place called Throw next 50 percent? On an individual Away" and no such thing as trash, level, it's going to take a paradigm but only inputs in closed-loop sys- shift in the way we think about each tems. and every purchase, and a growing In doing so, we could just about amount of pushback toward the make the next 50 percent. • amount of packaging we take home. RICHARD DANDRIDGE The other piece that is starting Port Townsend to happen is a growing realiza- tion that manufacturers must take responsibility to create end-loop cycles for their products, whether that is raw chemicals used in all sorts of plastics, or automobiles. Recycling without well-established markets is a PR tool at best by the plastic industry and other manu- facturers. Here in our community, local food production is a growing move- ment, as is the realization that we can do much bet- ter to reduce the amount of food scraps thrown 411 7 ee .f) • • //////„2..-.. Group reviews sewage options Jefferson County Public Health is hosting a work group to review options to fulfill onsite sewage system monitoring requirements.. The 'group is reviewing the approaches used iii other counties and providing input. It is also considering a.com- ponent to enable homeown- ers to conduct some of their own inspections, as well as the educational and training needs required to make this option successful. The meetings, which include a comment period,are open to the public. Meetings, 3-5 p.m.,take place on the fol- lowing schedule: Jan. 25: Chimacum Grange, State Route 19 at West Valley Road;Feb.8:Pope Marine Park Building, down- town Port Townsend; Feb. 22: Chimacum Grange; March 7: Masonic Center, Jefferson and Van Buren streets, Port Townsend; March 19: Chimacum Grange Agendas, meeting sum • - maries and materials are available through jefferson countypublichealth.org. thiste sewerage • options - e. PENINSULA DAILY NEWS are open to.the public and The Jefferson County will include a comment Public Health Department period. will convene a series of Agendas and meeting work group meetings to summaries along with • review options to fulfill meeting materials will be requirements for monitor- available on the Jefferson ing on-site sewage systems. County Public Health web- The first meeting is at site at wwwjeffersoncounty the Chimacum Grange, pubiiclzealtli.org. 9572 Rhody Drive, from 3 All meetings will be held p.m.to 5 p.m.Wednesday. from 3 p.m.to 5 p.m. Members of the group The rest of the meeting • will review the approaches schedule is: used in other counties and ■ Pope Marine Park give input. building,Water and Madi- The group will consider son streets,Wednesday,Feb. a component that enables 8. homeowners to conduct ■ Chimacum Grange, some of their own inspec- Wednesday, Feb. 22, and tions as well as the educa- Monday,March 19. tionai and training needs X Port Townsend ' required to make this Masonic Hall, 1338 Jef- optinn successful. Person St., Wednesday, All work group meetings March 7. • • //j©.Zi The Devil in the Medicine Cabinet T. P. -:" -,,,,f.f,f, .,,, , , Jan. 22, 2012 By Carol Smith InvestigateWest ,, Esq, ! d rx^ ;�' '` a v,` ,'„,..,:::',:4:._ . £ 3 , d a C� dui w Y^3• F � 'td 5aM'F"4 �I t ilo .,,,;::,,i.i.x.tlr''':---r--”- ' :-i- ,_ :i.,-.4,t'r,`%-,t,-:=,'. kJ, '',.: ',N., .!;,,,,,,,4'-:, ,0 kwfr,.- t„.i-,,, .,,, '*--'-',.;1'-‘-': , ,:„,,, ..,,.:4„,-..,,,,,,:l..,„-„, .7tis, :...4,4,,,,.,, ,, I .,, ,,,, , ,, , ,t ..,,,4L , vt...,, 4-;,...,7,--,i,::: „ AM ,,.9 ;'- 4 ,.Y'..1.‘: .-z-.0.117,4g7-,,,,-.,-;,..,,,,,„....„..,:ittp4,,,:,,,..-,44 - i 214.. ' ,Y. : \k:.:,,, ,, 1.4' t It, , ''' ' --LI Nir 1V..§ X51 -g + Rosemary Orr with her son, Robin, at his high school graduation in June,2000. ',„ ' , !...?- , .,,,l,,:,' -L,' i,11.,\-,,,i-i-,,,.. \-&,. .,., ...-,-,,,,-,:. zo,,,,,-- .T- -..,4,:-..::::?;4:6,3ik-r4,---- , , - 1„7-1-",..- =., , ,l,„0.02.,,,,...v.:;,:.,,,„,0_4„. - _,,.,4, Photo courtesy of the Rice family. Dr. Rosemary On didn't see it coming that day. It was the morning after Mother's Day. She needed a ride to work,so her 24-year-old son Robin drove her. She was in a hurry to get to Children's Hospital and Medical Center in Seattle,where she is a pediatric anesthesiologist.Otherwise,she says,she would have spent more time talking with him. She'd been worried about his sleeping habits,his weight loss lately. She knew her smart,handsome son had struggled with addiction to OxyContin in the past. But he'd kicked it. He'd assured her of that. He'd looked her in the eye and said, 'You don't have to worry about me,Mom." No parent wants to believe her child is using.Not even one who is a doctor. "I was stupid and desperate enough to believe that explanation,"Orr says now, five years later,over coffee a few miles illfrom her work,where she takes care of the pain of others. Her own pain,she takes with her. When she got home from work that day,Robin's phone was ringing,but he wasn't answering •in his room downstairs. She knocked.And knocked again. She went around her house and peered in through his bedroom window. Her son was on the floor,dead of an overdose. Orr's son is one of thousands of Americans,including a growing number of young people,who have died from prescription pain medications,powerful opiates that one emergency room doctor described as"just a fancy form of heroin." With a law that took effect this month,Washington State is making a bold attempt to reduce overdose deaths by launching the first-ever dosing limits for doctors and others who prescribe these medicines.The law has been heralded as one of the toughest in the nation,but loopholes and pitfalls in the system remain. Prescription drug abuse is at epidemic levels throughout the state,and elsewhere in the country,despite lawmakers' attempts to get a grip on it. Washington now has one of the highest death rates in the nation. Deaths from prescription drug overdoses in this state have skyrocketed nearly twenty-fold since the mid-1990s,and now outstrip those from traffic accidents. In King County,deaths from prescription opiates exceed deaths from heroin,meth and cocaine combined. Washington has been one of the hardest hit states in the country, in part because of aggressive prescribing practices. That,coupled with lack of oversight of doctors who over-prescribe,has led to the spectacular run-up in the number of deaths from prescription overdoses. Dr.Russell Carlisle,head of Swedish Medical Center's Cherry Hill Emergency Department in Seattle,was shocked by the volume of painkillers doctors were prescribing in Washington when he first moved here from California in the mid- 1990s. Running between exam rooms during a recent busy afternoon in his ER,Carlisle recalled that California maintained tight control of pain medication,requiring triplicate documentation for opiate prescriptions at the time.But in Washington, emergency room doctors were routinely handing out prescriptions for 30 to 40 pills at a time,even to people with • histories of drug habits. Why?"Because then they wouldn't come back,"he said. But that efficiency turned deadly. "The higher deaths,and probably abuse,too,I believe has to do with higher supply or availability,"said Jennifer Sabel, an epidemiologist with the state Department of Health. An Investigate West analysis of U.S.Drug Enforcement Administration data shows Washington ranked fourth highest nationally in per-capita prescribing of methadone in 2006(the most recent year for which reliable data is available)and 11`h for oxycodone—the two biggest killers. Even more disturbing,more than half of all prescription drug-related deaths in the state occur in the state's poorest and most vulnerable population—people on Medicaid,a population that is itself exploding in our recent economy.A 2009 federal study showed the age-adjusted risk of death from prescription opiates in Washington was nearly six times higher for Medicaid enrollees than those not on the program. "Medicaid has about a death a day from prescription narcotics, and in the last two years,it's continued to escalate,"said Dr.Jeff Thompson,medical director for Washington's Medicaid program. Many of those deaths are among young people,he said,a trend that also has public health experts concerned. New addicts are getting hooked at younger and younger ages,said Caleb Banta-Green,a research scientist at the • University of Washington's Alcohol and Drug Abuse Institute. "The largest group of people entering treatment for prescription abuse right now is made of young people between the ages of 18 and 24." • The Making of an Epidemic Washington's emergence as a state with one of the highest rates of both opiate prescriptions and deaths was not, in hindsight, an accident. In 1995,Purdue Pharma introduced OxyContin along with an aggressive marketing campaign pitching the drug as a salvation for chronic pain.The next year,Washington's medical profession did an about-face in its approach to pain management.The state's Medical Quality Assurance Commission issued new liberalized guidelines addressing the under-treatment of chronic pain.By 1999,they had been codified into law. The 1999 law specified "No disciplinary action will be taken against a practitioner based solely on the quantity and/or frequency of opiates prescribed." The relaxation of the rules resulted in a run-up in prescriptions. "Since the law changed,the average daily doses in morphine equivalents have gone through the roof,"said Dr.Gary Franklin,medical director for the state's Department of Labor& Industries. In 1998,the average daily dose was 80 mg. By 2002, it had nearly doubled to 140 mg. The same trend was going on around the country. In 1997,prescription opiate sales amounted to 96 mg per person in the United States. By 10 years later,they had mushroomed to 698 mg per person,Franklin said. "That's enough for every American to take 5 mg of Vicodin every four hours for three weeks."In 2010,the levels increased still further,enough to medicate every adult around the clock for a month. Franklin was among the first to notice an alarming corollary effect:the drugs used to kill pain were also killing people. • "Workers were coming in for low back sprains, and dying,"he said.Franklin and his colleagues published p ed the first paper in the country to link worker deaths to prescription drugs in 2005.But when he presented his findings at medical meetings,he faced backlash from the profession and the drug industry. Many in the profession had fought long and hard to get access to these drugs for better pain management of chronic pain patients,Franklin said. "They didn't want to hear it might be killing them." In May,2007,Purdue Pharma even sent Franklin a three-page letter blaming deaths on patient abuse and disputing Franklin's contention the drugs were being overprescribed. A day after he received the letter,Purdue executives pleaded guilty to misleading the public about the addiction potential of OxyContin,and agreed to pay a$600 million fine. "Preferred Drug" As the deaths and hospitalizations continued to mount, an even more unsettling trend emerged--the disproportionate escalation of deaths among the state's Medicaid population. Looking back,the rise in the death rates of Medicaid patients tracks along with the state's cost-saving decision to move many of its poorest residents to the cheapest,most potent pain reliever available: Methadone. • In 2003,the state agency that administers Medicaid made methadone the"preferred drug"for long-acting opiates on its formulary,the list of drugs Medicaid covers. Because methadone is so much cheaper than oxycodone or other types of pain pills,the move drove down costs considerably,said Thompson.A few years ago,the agency was spending$20 million annually on pain meds for Medicaid patients.Now it spends about$12 million,he said. But as costs came down,deaths went up.And many patients are still on high doses of painkillers. Medicaid has between 3,000 and 4,000 patients in Washington who are already over the new legal threshold of 120 mg a day,he said. About 700 of them are over 1,000 mg a day, and a few people are on up to 10,000 mg a day. Studies have shown the risk of death increases up to nine-fold at 100 mg a day. "You have to be careful with methadone because it accumulates in the body,"Thompson said. A Fix in the Works A few years ago,Rep.James Moeller of Vancouver,WA,who is a drug-abuse counselor by trade,noticed a strange thing happening in his practice.More people were coming to him addicted to legal drugs than illegal ones. "People would be sitting in my office,wondering how they got there,"he said. "Often it had started with a minor injury." Franklin of the state's Department of Labor&Industries,and University of Washington pain expert Dr.Alex Cahana were seeing the same trends.They were also seeing more people dying from addiction to these drugs.Together,the three began a battle to set rules around prescribing pain meds.Their efforts culminated in the passage in 2010 of RCW 2876, which repealed the old rules and put into effect strict new rules for pain medications.The rules,which don't apply to patients suffering acute pain from injury or surgery,or to those with cancer pain or in end-of-life care,went into effect Jan.2. The new rules specify that when a patient exceeds a dosing threshold of 120 mg per day of morphine-equivalents(a standard measure of narcotic strength),the patient must be evaluated by a certified pain management specialist.The law also contains requirements for pain evaluation,and continuing education for providers. • Dr.David Tauben,a clinical associate professor and director of medical education in pain management at the University of Washington,said the new law will give doctors better tools to treat pain,which is among the most difficult conditions physicians see. Historically,doctors haven't understood the limitations of using opiates to treat pain, he said."They thought,if some is good,more is better,and when more stops working,give even more."That thinking followed a shift in the medical culture during the late 1990s toward more aggressive treatment of chronic pain.And it's one reason there are so many people on high doses of pain meds right now. The trouble is,the pain medications themselves can worsen the problem,contributing to heightened sensitivity to pain,a condition called"opioid-induced hyperalgesia."As a result,many people find it difficult to taper off the medications. Others unwittingly get dependent after taking narcotic medication for long periods of time. The law will help better educate doctors about what does work for pain management,Tauben said. "We're trying to fix the mess the pain community inadvertently created." Not everyone is happy with the tightened statute,however. The pharmaceutical industry has opposed the law. Some drug companies have mounted campaigns fronted by patient advocacy groups or policy centers. The University of Wisconsin's Pain&Policies Group,one of the most influential policy advisors in the nation,for example,was recently revealed to have failed to disclose its funding relationships with drug-makers. • In Washington,the American Pain Foundation,which bills itself as an independent nonprofit,but receives the bulk of its funding from Endo,the makers of generic OxyContin,has mounted a sophisticated media campaign critical of the pain- management laws and claiming pain patients are suffering unnecessarily. Some in the medical community also say it unfairly penalizes legitimate pain patients,and doctors who prescribe for them. Dr.James Rotchford of Port Townsend has been critical of the new law.Rotchford,who lost both his Drug Enforcement Administration registration and his Medicaid contract after the DEA raided his Port Townsend offices in 2010,said the real problem is inadequate pain management and addiction treatment for those who are already on the drugs. • "The law is on the other end of it,"he said. "The problem starts before they get to 120 mg(a day.)We're not doing anything to prevent the problem." "The Biggest Pushers" There's plenty of blame to go around for what caused the epidemic--aggressive marketing of opiates by drug companies, nonexistent tracking of overprescribing, lack of insurance coverage for alternative treatments for pain,and demand by patients for quick fixes,to name a few. Ending the epidemic will require attention to all these issues,but also a fundamental change in the way the medical culture deals with pain. The pain that Rosemary Orr felt when found her son dead of an overdose sparked an effort to protect patients: She helped start P.R.O.P. ,Physicians for Responsible Opioid Prescribing,which is dedicated to promoting cautious, safe and . responsible prescribing practices. Orr is haunted by a quote from her son:"Mom,you have to see—doctors are the biggest drug pushers in the country." She wants to change that. "Teenagers are given oversupplies of Vicodin for things like wisdom teeth extractions. Surgical patients get more pills than they need when they leave the hospital. People take them all because they figure, 'Gee,if a doctor prescribed it,it must be safe,' "she said. "Before they know it,they're addicted." She points out,too,that this is an American problem. "The U.S. is responsible for about 90 percent of the world's prescribing of Vicodin,"she said. In Britain,where she grew up,she recalls breaking her leg in three places when she was 14 years old. 'My father was a doctor,"she said. "He gave me an aspirin." Americans are notorious for their pill-popping.Addiction is minimized and glamorized by shows,such as House, featuring a doctor who pops Vicodin like Chiclets. There are consequences to that,said On,whose son is never far from her thoughts. She writes: "Sometimes, I feel his presence and sense that he is encouraging me to tell others what I now know so that perhaps one life will be saved." • c. :.:1 _ • ... 5 ..,,, e,:a) c%,1 .{.,3 � � _ ' • L F a uhJ:1! �o * ro 4.10 m > O vs C 0as *> g paIii. paros ` a.) o a•0 , p^ y3 a vp„ o n•m U Oo0RoUIj : 0 ° t0 ' q000oVz! c 2 °^ O v _^o• o 0*�" v ^ �o a) ›,o •n- a^ b L. v...O 0 D C. >,.8<-4 C) P. a)� 7, 70F. .a a3 a> Ad F O U O3o ° v Xa) Xa�> 3 - c^ ` C v •D v as o op,aow -3 mco>. 0. .0 7 Um ,, -o <a0 o co 0 v o cl., 3 y ' 0 a N om• 2 ••- Co.tym rV m ..g co v; � ° vc' E-4 75 r4 2qwco-� ^_fro o7o`c< m'vow' m o = ca@ ti o-00 ° &) rovvi,4a�o5 ao aro r �mc'N® • ., i �� mv•~ 0, .,-, N cco° w8OW aO CC5 00 Oa •y a0 ? O.^ "0 ° c. O^O•e 0-- mQ. . R C/).0 ^Z 0O*.,^o 2 as 0Oo....x" > m a) , - m N 00t c,Fa...)2' 0 a 3 a � 0.D o �o .o..o. 5Ua aUa-.4.....) v .> 4. a m pp at �> p+>+ o* p _ -,..>.o _ a, Uco m co p a v ^v Uaoo o2)*0 q:O.." aN ° a a7 m a as+ .< 'u , 0 0 0 -a0om. 'b o„a m �' m m v-° 0 a) s, v ViJ3 0 «S v cd U m m y+, v 0.+ o ~ m a"' ° ° : v .' pm.5 a) s.'a "p °_ L > s 0 CD,.9. v v � a *> 3v > roa).� U p' ro ^° oa ro . *> R a) 5 mr., oRo. mm mpo,, va ° $ a , Q°o v v �o.a,o. +' vRR ° a rooa -aO nNv g 0 0 0 a 3 £ 0 G >. NCGeCC.~ afi' WaR 0 a 0* z,~*> o (73o 4' roo.' a0orog mV N "04Vab N W c,,, p• a. mCm a) N > CJ m *> m +> a cLr c.. 00 >: O S .� O a>.L-, U 0 CI O ..>� .0 tII J- f- �-1 C .2 O y aO ° ° o v 4> v o 'pRte•. ° ro ro,G 3 .-7 °A ° p 4 Loo�.gv a) Wo U '`•a m o o � v oC . 3*'t,':, Ro.c C ss' ce ^` o mmm r a'6'' .mo5 0 - •.0 --;...v., A; Fm 8roi do�° w V., >+> ro m 0.i G Ra�a ^ ,5 , YQ . cwas0 0:04p, 00 pC0o " o - ) oz, J- u. 0v am m >, 0 0 +�m- + , .o 3 ii qs~ p* o vo = a o a.,- ,a , + = 77 0py, a o 0 °' Oa)•° - oma*' " to my0 of Ao q o vromrovi m,ppq' a)* Og � ao ,cli ,c a W ^ ° ° o Q70 z › z Y , � as a s ciy D 0a W > 0 3 ^ ?- ;m ' o ¢- c ^, y ..> 7 p ..0 ? *� ro�d �Z r ' 0ccdqq cin ' q ao + o m0. pp 40 7,9 a) q.. �"Z:,.7'3 •4^C ---vw '' s M CS NU c La) r; o,. o e,* °• o Ro.4:10a.a caasO c.� 1. ' - 0 co w'4•O * a3 � . O O ::N ■- aO N c".' 0 0 0 + aaO O 3ro .' 0 p ° _2 . ,-' ❑v v v c. vt p s.,. U v mafl p °^o�ovm >+ ' m.i co on111111 R bn4vro•w q.xaG vo -.- oca m" R e. ss..,� +> -,.� gym+ o , m v q *) a 7 p '0 0 0 0 '''' ca .° p„ .a.° v '°w 3 �. . 311 0 d D,o, cu.... F °.43:11.,...! y U a a!oa)-°.:87,:11:00@. V *�,uis °Q, rUny°>ejJi O� w.Lf' bAa0iR " L''v,No.° v� �n� . mvi33C Z z ��'::'-1-1 vro +' 0rnopQ � � 3 � �� m.�vrovA.~ as 0 0 oro ��Wo �� C mc w 61 c° m 0. °I ° roro Op a3mwr-) m c"r' Oapo a F+,:l='" .0 U _ o+> cd ar", chi co Sof g. at by 3 q ..o q ...,9 a °•�'� ami a00 ni•� a aoi o o ro o yq�+ m A oo'�:'°Q. o c° > �.= O o• ��^o m �W ca a- *> ro'w 0 ro. bt ' a' >°, W o a3)�-° c a a s u '.1 y °+�- O 0 c.C ° > 0 m.°' g W ;Jo) +Qo R,'� y o vy. v �' m ami t0,¢ "o •O g a,a) A�^ci Wg�N EtiO Oo v-0• a)'53 'Oo o.k;+oa> o ., m. cW W O*g cy roObap C m aro ° s Z 0 ❑+4$ o.II 3 > °'m 4 3 c ° o 0 0 Z m e'tyc,,,,,..„..1 ro.°° 0~.u a sa. 0*� d •m c0. N,.. o 75 C a0. .. ,L,3 C° 3"O ro 3 s. ^ 0 ti o m o #i - pp a 0', $ pp a) v .,• ca 3 ^0 pp^= o 0,° p 0a 0 3 0.0,2 v CA Cl.) 0: v t CO o• -j a 0 r~ c*.a b m y 44 v •.^ o m po v•_c :.c /6 > yca oa)W aa))g3"- aG c ra,'bamiaa)ia�,p 03 0 o o oa, •o.oi *� sZ� �' ;024,11, .Q v mawvn'0�' O , m'yaa.) ° c3) c o . *� 3ck::::0,,,,,L, o 2 E.� croi �m -� 5'~ 077 L44'z 2 0�� ca o.� ro � o �+> rovm �� ... -�;� ^ pa,,�?*,D,D, m o ..[o 41 m ;; v v 3 �t4•i ...> 3.4-^' 0 k., E 3 R.0 a) y W 'V•-0.2 .' U i ° coa O 0 a) -a,.a o 9 o ., .7. cs E m a a Q ° r~ +> *J � v o *v, p W as S o o °•t: v ad w coy 0 wa:•- 0,-D o.0 g'g E-, T o a' .'o o i 't7'Q . ro.m E �a a 0. c j m ct ~ Z Zoo 0 as >,°.''g aim ca > *> 0 U] „N .0 v m n 5,v al v a v m ail � �a" Ro mi roaac>aR. 000� °0 a � o � " aq 0-0s.a a ^7 � '^ ~a O � Ovo mo U m *°�0. v „ ,...., o •II* {-4 "1-2 h N °y mCj o° ° 3w o*> o an } > v 0 [ v o o° o " m a > r 0 .7) -E"'"o C po 0 0'_' v 'cs �a. a. a a» -a c[a ..c 0 `" o ro'o ca V _- z 0 P4 1 c9 •5 o o > o '! o ro g., o^p 2 a) o Y o, SS o 3 ?._,.74*,' c 3 ° c 3 4. z U z O'° po = 2 y o Z'.= v p U a A o a Z o a' m pO >, 'z c ;I Ca) >, RI `13 . .� >,. ''� U U m c=a m.a 0 m o. s" .c) w %' pq 0 W c,_,o�Jr)_y., c'o)W 0,,,, , t'x. 0 O c0 R m o oay.>c0i m o m a 3•- ,c-- 0 U Ci Jerry Large I Nurses help fight crime I Seattle Times Newspaper Page 1 of 2 alieSeaitteZintes Winner of Eight Pulitzer Prizes Iolumnists In the news: • 'Mercer Mess' • Boeing earnings • SEAL Team 6 • Sex-predator costs • Husky basketball Originally published Wednesday,January 25, 2012 at 7:14 PM Nurses help fight crime Visiting nurses transform the lives of young moms and their babies in a crime-preventing program. diJerry Large Seattle Times staff columnist 0 Last summer,when King County ramped up its efforts to fight gangs,its response included hiring two nurses. While most of the additional anti-gang money went to law enforcement,County Executive Dow •onstantine said in announcing the effort, "We know we can't arrest our way out of crime." Prevention is the smartest response,and that's where the nurses come in. The county's Nurse-Family Partnership now has 24 registered nurses who work with girls and young women during their first pregnancies and through the baby's second birthday. Studies show the program gets results.Here and across the country,children who've been in the program have better outcomes in health and education as they grow up.And they are much less likely to get involved in crime than children from comparable families who did not have the program's support. Mothers and subsequent children do much better,too. The King County program serves 600 low-income mothers. One morning this week I went along with one of the nurses,Julie Crassweller,on visits to two of her moms. We stopped first in Burien and wound our way through an apartment complex to the home of 24-year- old Heidi and her 2o-month-old son. Heidi said Josiah had been rubbing his gums.Julie asked about his teeth and his visit to the dentist, and mentioned some things to look for. Crassweller sat cross-legged on the carpet,and they talked about bedtime routines and about activities that show how he's developing and learning. He can say"up," "down,"and call some people by their names,his mother said. •How about combining words,Crassweller asked? "He says, 'No,Mommy,'" Heidi said. "Next month if you're interested,there's a 21-month word count you can do,"Crassweller said. http://seattletimes.nwsource.com/html/jerrylarge/2017335569 j d126.html 1/26/2012 Jerry Large I Nurses help fight crime ( Seattle Times Newspaper ?age "l of l There is no"do this,don't do that."The program works through the relationship between the mom and nurse.Lois Schipper,the home-visit coordinator for the White Center Early Learning Initiative, told nurses starot t whatth the idea that the the mothers are doinga well and asks questents are the experts on ions about areas that could be ir own lives.In her visits, Crassweller points nurses better. In Burien,she visits Joyce and her baby,who is 4 months old.Joyce,20,said she found out about the program on a visit to the Rainier Beach Community Clinic."I told them I was down and needed someone to talk to," she said. Crassweller notices that while he's not quite crawling,DeShon is grabbing at everything. So she asked his mother,"Now that he's starting to move and reach,what kinds of changes are you making to keep him safe? Joyce said she's keeping small objects away from him,and she'll do more when he starts crawling. Crassweller said both Heidi and Joyce are very good mothers.Some mothers need lots more help, especially the teenagers. Schipper,the home-visit coordinator,said nurses try to get mothers to think about how their actions affect their babies. One mother was hitting her child,Schipper recalled. Rather than getting into an unproductive confrontation,the nurse asked,"What do you think he's feeling when you hit him?What do you think he's thinking?" One of the aims of the program is to prevent child abuse and neglect.Over time that mother learned to relate to her child differently. Some young moms have to learn about the negative impact of smoking • or drinking. Nurses have to teach the mother who leaves an infant on the edge of a couch or thinks it's OK to dangle a baby by his arms. The nurses try to get the mothers to see themselves as their child's first teacher and to feel good about their role in shaping a new life. Nurses adapt and tailor their help to each mother's needs. They point moms to resources to help with jobs,housing,education,but their main focus is on the child's development. In regular visits,the nurses get to know their moms and their life circumstances. They make a difference during the babies'time of intense physical and mental development,when they can get the most benefit. five-to- oneintervention is entfWhen I was looking at those healthy babies,e best investments a community can t felt like a lot more than that. one return on investment. Jerry Large's column appears Monday and Thursday.Reach him at 206-464-3346 or jlarge@seattletimes.com. i http://seattletimes.nwsource.com/html/jerrylarge/201 7335569 jd126.html 1/26/2012 Forks hospital approval makes whole North Olympic Peninsula linked with Seattle's Swedish health network By Rob 011ikainen Openinsula Daily News,January 26th,2012 FORKS—Forks Community Hospital became the third and final North Olympic Peninsula hospital to join the Swedish Health Network this week. The affiliation is intended to expand medical services with the help of Seattle-based Swedish Medical Center. Olympic Medical Center commissioners in Port Angeles approved a 20-year umbrella agreement with Swedish in October. Jefferson Healthcare commissioners followed suit in November. Patients will be referred to Swedish for health care they can't get on the Peninsula. They will be sent back to their primary-care doctor for follow-up care in what Forks Community Hospital Administrator Camille Scott described as a"seamless" referral system. "Its focus is to unite the health care on the Peninsula with a tertiary so we have a better system and hopefully can keep care at home because we have the support of their specialists to help us at times,"Scott said. Forks Community Hospital Commissioners Daisy Anderson, Don Lawley and Gerry Lane voted unanimously Tuesday night to give Scott permission to sign the affiliation agreement with Swedish. Scott said she signed it Wednesday. "So we're looking forward, hopefully,to have this be a long-lasting relationship that definitely benefits all of the people on the West End as well as the rest of the Peninsula, using Olympic[Medical Center] as our big hospital so that working with them, Swedish, it will help care here,"Scott said. Said Jefferson Healthcare Chief Executive Officer Mike Glenn: "I think it's great that through the affiliation evaluation process,we worked closely with both Forks and Olympic and look forward to continuing to collaborate with both organizations going forward." "'OMC and Jefferson Healthcare are paying$120,000 and$75,000, respectively, in affiliation fees for the first year of the agreement. Forks Community Hospital's fee is$15,000. The discrepancy boils down to the size of the hospitals, Scott said. Since becoming the first member of the affiliation,OMC has approved a separate agreement to join Swedish's purchasing group for medical supplies—VHA—to save costs. There is also a contract on the table to expand sleep medicine at OMC by bringing a sleep doctor to Sequim. One of OMC's biggest incentives to partner with Swedish is to install Epic electronic medical records. Forks Community Hospital will chart its own course with Swedish, Scott said. The West End hospital may want to expand education and telemedicine,join the Swedish buying group or connect to TeleStroke, an acute-stroke video-conferencing treatment program that OMC and Jefferson Healthcare share with Swedish Neuroscience Institute. Scott emphasized that patients still have the choice to go to whatever Seattle-area hospital they choose. Now that all three Peninsula hospitals are affiliated with Swedish, Scott said she envisions Forks working more and more closely with OMC and Jefferson Healthcare. "We've already started to look at some of the commonalities,"she said. The three Peninsula hospitals already share some staff and expertise to benefit the communities they serve and cut costs. They already work together in political advocacy for adequate rural health care reimbursement at the state and federal level. •"The boards have taken an active role to support each other in that,"Scott said. Reporter Rob 011ikainen can be reached at 360-417-3537 or at rob.oliikainenfteninsuladailynews.corn. Credits for Dungeness water use in new rule By Jeff Chew Peninsula Daily News,January 2e,2012 SEQUIM —When it comes to protecting the Dungeness Valley's water supply, the future looks more complicated for newcomers who want to garden, while irrigators who sell their long-held water rights can make money. New homeowners who want to garden will have to buy "water credits" from the Dungeness Basin Water Exchange. "They will sell mitigating credits to people who require water," said state Department of Ecology spokeswoman Ann Wessel on Tuesday at the Sequim-Dungeness Valley Chamber of Commerce's luncheon at SunLand Golf& Country Club. Irrigators with longtime water rights in the valley will go largely untouched under the state's new water resources management rule, formerly known as the in-stream flow rule, which is expected to come into effect later this year, Wessel acknowledged. In effect, it is a water rule that honors the "first in time, first in right" concept, dating back to a 1924 Clallam County Superior Court decision. Tuesday presentation Wessel and Tom Loranger, Ecology's deputy program manager, addressed more than 50 people at the luncheon. Both have been helping to coordinate public outreach on the controversial proposal that was met with consternation when it was introduced in 2005 to Realtors, developers and property-rights advocates in both • Clallam and Jefferson counties. Figuring that population growth stresses water supplies, threatening water tables and river flows that support endangered fish species, state lawmakers authorized Ecology to enact in-stream flow rules in water basins throughout the state. Ecology's task in the past six years has been to set minimum levels for water in streams and rivers and address out-of-stream water use. August adoption The rule for Elwha-Dungeness Water Resources Area 18, which also encompasses nine streams between the Elwha and Dungeness rivers, is scheduled for Ecology's adoption sometime in August, officially going into effect 31 days after the official adoption date. Two open houses about proposed changes in water management in the Dungeness River watershed are planned Monday at 5 p.m. and Tuesday at noon at the Guy Cole Center in Carrie Blake Park, 202 N. Blake Ave., Sequim. Once in effect, new permits for water will not be allowed in areas where public water is available in "a reasonable amount of time,"Wessel said. New water users will be required to find a senior water user willing to give up and sell the water right equal to what the new user needs. "Limited reserves will be available for public use,"Wessel said, with potable indoor uses allowed along with • some "incidental" outdoor use"not for gardening." SThe state will meter or find a metering partner such as the Clallam County Public Utility District to help enforce the new water regulations, she said. The in-stream flow rule is being developed in the Dungeness Valley,with water basin stakeholders to address surface and ground water management. Washington Water Trust—in cooperation with Ecosystem Economics of Bend, Ore. —is working jointly with basin stakeholders, Clallam County and Ecology to develop a water exchange. The primary objective of the water exchange is to support some new water allocations in the watershed while restoring and protecting stream flows in the Dungeness River, its tributaries and small independent streams. Ecology, Dungeness Valley irrigators and Clallam County have reached an agreement on steps to take for water supply and stream flow restoration in the watershed. While snow melt on the North Olympic Peninsula is the main source of water in the Dungeness River in spring and early summer, flows drop rapidly, and by late summer, streams and rivers are almost entirely fed by ground water, Loranger said. Farm irrigation and lawn watering are at their peak in the summer and early fall, the same time spawning fish need water in the streams. Species in the Dungeness River are threatened, including the Dungeness chinook, summer chum and bull trout, Ecology said, with insufficient stream flow a critical factor. Sequim-Dungeness Valley Editor Jeff Chew can be reached at 366-681-2391 or at jell.chew(a�oeninsuladailynews.corn. • • Article published Jan 29,2012 Pill disaster: Peninsula counties among tops in state per capita opiate deaths By Rob 011ikainen flininsula Daily News A state Department of Health study found Clallam County to have the highest per capita rate of opiate-related deaths from 2008 to 2010,while neighboring Jefferson County ranked No. 8. According to the study, Clallam County had 25 deaths attributed to opiate-based painkillers—methadone, Hydrocodone,Vicodin, Percocet and others—or street heroin from 2008 to 2010. Jefferson County had seven opiate-related deaths during that span, according to the study. The Clallam County death rate was 11.7 per 100,000 people,and the Jefferson County death rate was 7.9 per 100,000. King County had the most deaths in the state with 324 deaths but a per capita death rate of 5.6 per 100,000, placing it 16th in the state. An earlier study by the Department of Health found Clallam County had 42 opiate-related deaths from 2007 to 2009—again ranking No. 1 in the state—for a death rate of 17.6 per 100,000. Dr.Tom Locke, public health officer for Clallam and Jefferson counties, said the North Olympic Peninsula is one of two clusters in Western Washington where opiate drug use is particularity high. The other is Pacific County. "We've long known that we have high rates of illicit opiate use," Locke said. "We don't have hard data, but there is anecdotal evidence of increasing heroin use on the Peninsula. "The most disturbing thing are the fatalities that are associated with it.This has been a statewide phenomenon." •Clallam County Drug Court Coordinator Preston Kayes said more and more young people are using methadone, a highly addictive, eadily available synthetic opioid used to treat pain and withdrawal symptoms of heroin addicts. "It's frightening," Kayes said. In Jefferson County, there were 12 opiate-related deaths from 2007 to 2009, the study found. "Parenthetically, prescription drug abuse is a major problem for most areas of the state, and the rural counties are at a special disadvantage because of a lack of resources to help patients and providers help ameliorate the problem,"said Roger Rosenblatt, a professor and vice chairman of family medicine at the University of Washington School of Medicine, in an email. Rosenblatt said his colleague, Mary Catlin, was recently on the North Olympic Peninsula to work on a project called Rural Opioid Addiction Management, or ROAM. The goal is to curb overdoses from prescription opiates by increasing the availability of treatment in rural areas. "Clallam County partners, including the hospital, health department,tribal clinics, and clinicians have been active on this issue," Catlin wrote in an email. "They have instituted drug take-back programs to make sure drugs in medicine cabinets don't find their way to'pharma' parties of teenagers,"he continued. "Hospitals and clinicians have participated in more education about safe compassionate use of opioids for persons with chronic pain," he said. "Emergency rooms have instituted policies to communicate with primary care providers before they give opioids to patients with chronic pain." The state this month launched a prescription drug monitoring database to cut down on cases in which a person gets pills from multiple pharmacies. •Project ROAM is trying to address the 1,899 opiate-and opioid-related deaths that occurred in Washington state from 2007 to 2009, Catlin said. A third study—by the University of Washington Alcohol and Drug Abuse Institute—that compared figures from 2000 to 2009 found that Clallam County had 16 opiate-involved deaths in 2009 compared with five in 2000. Jefferson County had three opiate-involved deaths in 2009 compared with none in 2000. Statewide,there were 722 opiate-related deaths in 2009, or more than double the 344 opiate-involved deaths in 2000,the UW study • found. "This is an alarming trend," Locke said. "It's one that we have been seeing build up for some time." Kayes,who works closely with chemically dependant misdemeanor offenders to help them get sober and avoid further legal trouble, said opiate addiction spiked about two years ago. Clallam County Sheriffs Office Chief Criminal Deputy Ron Cameron,who heads the Olympic Peninsula Narcotics Enforcement Team, said detectives also have noticed a spike in the use of heroin and opiate-based painkillers in the past few years. "And this is a statewide issue," he said. Cameron cautioned that not all opiate-related deaths are reported. But he does not dispute the general findings of the studies:that more people are using—and dying from—opiates, either prescription pills or street heroin. "I look at the numbers they're citing,and I don't think it's very far off,"Cameron said. "There is an issue. "There is a clear, physical addition involved in it." The recent Department of Heath study found that Clallam County had 148 hospital admissions for prescription opiates in 2010 compared with five in 1999. In Jefferson County,there were 10 opiate-related hospitalizations in 2010 compared with two in 1999. • Statewide hospitalizations were 4,898 in 2010, and 318 in 1999. Locke said there are two main factors behind the Peninsula's high rate of opiate use. "No. 1 is income,"he said. "We see higher rates of abuse and overdose in areas of the state with lower per capita income. "No.2, I think, is availability." "From a public health perspective, it's a real and pressing issue," Locke added. "Opiate addiction and intravenous drug use is associated with a wide range of problems: infectious disease transmission and high death rates." Of all the opiates and opioids, Locke said the most lethal is methadone because it is relatively cheap and can build up in a person's system. "Methadone is a powerfully addicting drug," Kayes added. "And the withdrawal from methadone, as in my experience in inpatient treatment, is it's more difficult to get off methadone than it is to get off heroin." Health officials took notice a few years ago when opiate-related deaths exceeded vehicle deaths in King County, Locke said. "One of the tragedies of it is that it's completely preventable," Locke said. Reporter Rob 011ikainen can be reached at 360-417-3537 or at rob.ollikainen@Peninsuladailynews.com. • All materials Copyright 2012 Black Press Ltd./Sound Publishing Inc. County, Ecology . . .. %par Over npens By Lauren Salcedo of the Leader "We don't ! ECOLOGY POSITION salmon, even in the Pacific However, Ecology Ocean—but scientifiauncer_ WHAT'S NEXT? A four-hour meeting want a de facto responded that the state tainty leaves county com- Another meeting between between county officials and •prohibition of Iwould allow for regulation of •missioners wary. the state and county is on Department of Ecology rep- net pens in Jefferson County, According to research the radar. resentatives regarding the net pens because but not an outright ban. from the University of "The Department of •future of local net pens eon- the.places they ,. "We had to look at where Bergen,Norway—a country Ecology offered to sit down firmed differences and pro- we could have net pens in that has seen the devastat- with our staff and work duced only the promise of are allowed are the county,"Austin said.The ing effects of the virus on on crafting language that another meeting. »' county has been proposing its farmed fish—ISA can be would allow net pens under impractical. conditional-use permits," The Board of County conditional-use permits for spread through the transfer Commissioners and county net pens, but Ecology sees of organic material, shared Austin said on Thursday. officials met on Jan.23 with' Jeffree Stewart these •as equal to a ban, "The next step is for seawater and sea lice. state Department of Ecology shoreline specialist because permit regulations "We are worried about Ecology and our staff to get (Ecology) • representatives Department of Ecology are so strict. the risk,"Austin said. together to see if they can at the Cotton Building in " -- �--i "We don't want a de Sea lice are among the come to an agreement. Port Townsend in an effort ' The real question is how , factoprohibition of net pens The county's legal coun- to come to an understandin can we protect shoreline .commissioners'concerns. g because the places they "An adult salmon can tol- sel,David Alvarez,will talk how the state's finfish aqua- and also recognize property are allowed are im racti- to the state's legal counsel to culture rules are applied rights of property owners," P erste two or three sea lice; ensure that any negotiation Commissioner John Austin cal," said Ecology's Jeffree juvenile salmon can not," here. Stewart,a shoreline special- Austin said."Large Atlantic is legally sound. "Right now, this whole told the Leader on Jan.26. S. at the workshop. Despite all of this debate, in-water finfish aquacul- Originally, the countyUnder those P permits, salmon operations would g net pens are currently legal. tore issue-is the onlythin had banned all in-water net cause sea lice to proliferate. Pe g some areas could not be used Sea.lice would get out and There was a local net-pen kee in _fthe Shoreline Ipens. for in-water net ens s ecifi- operation�in the late 1980s. "We thought that, like P P hurt juvenile salmon." Master Program from adop• g call those close to shipping There has not been a state tion," Michelle McConnell, Whatcom County,we would y PP r . Austin cited studies pern;it for net pens filed simplybe able to prohibit in- lanes, residential areas or done on salmon runs near Jefferson County associate an here within two miles since 1991,and that facility water net pens, because we y" the Fraser River in British planner, told the Leader onof a critical salmon-bearin was never built. Jan. 30. The state gave the: have so many areas critical stream. g Columbia.Salmon that tray- "The current code allows t9 grantto the environment,"Austin The countyhas been in eled to the Pacific Ocean and for net pens, and it has our a in 2006 to Undertake a comprehensive said• passed in-water net pens had allowed it since the 'SOs," debate with Ecology for more a fluctuating success rate, pdate on the project.Those! Net pens.are a form of than ayear over whether McConnell said. funds ran out in 2009, and! containment for farmed fish while salmon that traveled But the county is set or not net pens ought to be •without passing net pens on takinga precautionary the time spent by county offi placed in natural waters. allowed in our waters. succeeded,he said. F y . dale on fin lisi thepro- Thepens are usually made approach. *E "We.read dozens of arti- "I understand that there "They want to play it gram is coming out of,the of mesh with metal barriers des on the pros and cons of .is a tremendous amount of safe,"McConnell said. general fund budget. and can hold' as many as net pens,"Austin said. money in the industry, but Listeners crowded the 90,000 fish.They are gener- Ecology also made it clear with the tremendous amount workshop,as questions about ally the least expensive form that it was working in the of money and volunteer county use of finfish aqua- of containment for farmed interests of the state, and .hours that have been put culture and,specifically,net fish. Some of the flaws of that if it allowed an out- into protecting the environ- pens,jumped back and forth net..pens include a lack of right prohibition in Jefferson went,I just don't see why we between Ecology and county control over the passage of County, it would have to would do this," •said County •officials• extend that right to other Commissioner Phil Johnson, "How do you define water waste,discharge and disease of dependency, or how do youthe concerns o into surrounding areas,and co Some f who has fished commercially, define de pendency?" asked the possibility of farmed'fishto Ecology representatives. P Y David Sullivan, Jefferson escaping into wild waters. the county include virus con- Because these concerns "To date,the commission- tainment, discharge treat- were brought up during the County commissioner,on thement and possible effects on workshop,an agreement was language used by Ecology era have been looking to pro- natural salmon runs. g hibit in-water finfish aqua- not made between the two in support of in-water r net One of the biggest prob- parties,but Ecologyplans to pens. Ecologyrepresents- culture," said McConnell. "There is no place in hems affecting salmon glob- meet with the county again fives believe that net pens allyis the infectious salmon to finalize a negotiation. are.required to be in-water, Jefferson County' where it g rather than upland, as the can be done safely." anemia (ISA) virus. "The "In a perfect world, we county negotiated. final thing that puts the nail would be in agreement with "Commissioners are try- in the coffin for our concerns Ecology," said McConnell. is the recent virus outbreak," "It's not good to have the ing to steer them upland. Water dependent,but not in said Austin. state and local jurisdictions water," said Philip Morley, - at odds.We share a respon- Jefferson County adminis- SALMON VIRUS sibility." trator,at the workshop. The ISA virus has gar- All three county commis- nered media attention sioners have resisted net pen •operations, a stance widely recently, as it was discov- ered in wild Pacific salmon -shared by people who may in British Columbia last not otherwise agree with the October.It is unclear at this county's controversial shore- time how ISA was intro- . line master program. duced to the Pacific salmon —fish farmers raise Atlantic Jar49, The Jefferson County Conservation Futures Pro- • gram: Preserving Open Space and Supporting Farms and Forests Our local Conservation Futures Program helps maintain important wildlife habitat, farms and forests as open space in open spaceprotections. ourny. I0 pro- gram has supportedmany Open space protections, often through the purchase of land or development rights, are paid for with fund- ing from the Conservation Futures Fund CCounty's smallest property tax levy) matched at least one to one with other resources such as do- nated land, private contributions and state or federal grants. Applications are due March 5, 2012 for this year's funding cycle. A total of$260,000 is available to- wards open space protections within the city and county. The Conservation Futures Oversight Com- mittee will review the applications and make funding recommendations to the Jefferson County Board of Commissioners in June. Interested citizens, land owners, and non-profit or- , ganizations are encouraged to contact program staff • at tpokorny@co.jefferson.wa.us or (360) 379-4498. More information is available at www.co.jefferson. wa.us/commissioners (click on "Conservation Fu- tures Program and Committee"). • • &26 /0-2. Problom Real-world solutions and ideas for government managers. s - .N.) --- ------ v--,•-iv--f!--;-..zz-i--- - -gyp - AM.. ,5 r /. _ mac` — _ d4 ri �, � / x'a 'r, 7.. 2 or Y U O - i The Doctor Is In School-based health centers improve students' health-care access and school success. I By Caroline Cournoyer I' 1 or every 10 children, there's one their school performance in the short term but most offer a full range of services, who lacks health insurance. But and strain the already strapped health- including primary care, mental health , long every kid gets sick.When students care system in the term. and social services.Most are in schools with health coverage catch one of But that's not the case everywhere. that serve the neediest students and the many infections lurking in classrooms, In more than 2,000 schools through- are funded by state governments, the their parents likely take them out of school out the country, students can get feds and private foundations.A variety to go to the doctor.Depending on the prob- free comprehensive medical, men- of players—such as community health lem,they're quickly back in class—healthy tal health and sometimes dental care centers,hospitals and local health depart- and ready to learn. But when students without ever leaving school property. menu—typically manage the centers,but without health coverage get sick,they're School-based health centers (SBHCs) always in cooperation with the schools. less likely to seek help,which results in are fully staffed clinics located in or on SBHCs began in urban school districts, unresolved health problems that hinder school property. Each one is different, but have gradually spread to rural areas 4 j 56 GOVERNING I February 2012 I • where faraway clinics and poor public than a decadelater, earned a place n school-based health centers,as they raoSBHCs appeared n gloffer funding is a constant battle for transit make health care less accessible the federal radar for students from low-income families. President Obama's health-care law. virtually free services to every student— Having a full-service health clinic The 906-page Patient Protection and sometimes school staff,parents and in schools has many benefits. First, it and Affordable Care Act(ACA)contains community members. The recession helps close the health-insurance gap. many controversial provisions—most undoubtedly squeezed SBHCs'budgets, But perhaps more important, students of which will soon be reviewed by the but,"much to our surprise,the cuts at the are reportedly more willing to seek help for sensitive issues like depression,sui- THE TAKEAWAY. cide attempts, weight problems and pregnancy prevention at health centers • Schools with a full-service health clinic help close the health- inside school walls.SBHCs save parents insurance gap. the hassle of taking time off from work; • Having a school-based health center improves students' attendance, and with onsite stocks of commonly prescribed medications available at no the dropout rate and classroom behavior. charge,they also save money and time • Contact John Schlitt of the National Assembly on School-Based Health usually lost in trips to the pharmacy. Care at jschlitt@nasbhc.org Studies show that having a school-based health center also improves students' attendance,the dropout rate and class- U.S.Supreme Court.One provision not state level have not been as dramatic as room behavior. In Massachusetts and buried in controversy is a$200 million they could be;'Schlitt says.And despite Texas, students' absences were cut in appropriation to fund new and existing the cuts,Walker adds, services haven't half after receiving SBHC services. In school-based health centers.By the end been impacted at the centers run by • Texas,students who received in-school of 2011,more than$100 million of that Seattle's Neighborcare Health. mental health help had 85 percent fewer had already been awarded to more than Even though SBHCs dodged the discipline referrals, according to the 300 SBHCs in more than 40 states and worst of the funding sour ,anden y avemnew National Assembly on School-Based the District of Columbia. n- Health Care(NASBHC). Neighborcare Health, a commu- tinue struggling. The ACA grants Of all the services, those for men- nity health center in Seattle that runs can only be used for capital needs tal health are in highest demand, say six SBHCs, received $500,000 in ACA like construction, renovation and advocates and practitioners. Students grants that it's using to expand its den- new equipment—not for operational and schools are increasingly seeking tal services, upgrade outdated medi- expenses. The health law authorized them out as cyberbullying remains a cal equipment and remodel an existing $50 million for operational costs,but big issue and as new or recently revised health center lt can hi h operate hool in Seattle didn't appropriate sincoe theeconomythe tankeds states s. anti-bullying laws call on principals and ity.Every publicg teachers to provide bullied students help. now has an onsite health center.That's have made Medicaid reimbursement Traditional school counselors tend to because the city makes the centers a pri- more difficult. That means the centers specialize in academic help;they lack the ority by funding roughly 60 percent of have to look elsewhere to break even. education and experience to offer assis- every SBHC's budget through a families "When you're seeing kids regardless of tame with mental health issues. and education tax, according to Cohn their ability to pay,an organization has to School-based health centers sprang Walker,school-based program manager be robust or creative in how they search up in the early 1970s,but it wasn't until of Neighborcare Health. for funding;'says Walker. national private foundations started Advocates and practitioners agree that Luckily, virtually every entity that pouring money into them that govern- the biggest barrier to starting and operat- applied for the new federal SBHC grants ments took notice, says John Schlitt, ing these health centers is money.Right received at least a portion of the funds. NASBHC's vice president for policy and now,SBHCs are only in roughly 2 percent Unlike the rest of the federal health law, government affairs. In the mid-1990s, of the nation's public schools,says Schlitt advocates argue, school-based health states began creating government-spon- of NASBHC,because until recently,there centers are a nonpartisan solution to a sored grant programs for SBHCs,hoping just hadn't "been the level of financial pervasive problem. G • to give economically disadvantaged stu- support for this model,and that contrib- dents ccournoyer@governing.com dents greater access to health care.More uted to a smaller scale-up." February 2012 I GOVERNING 57 �: - • sem. - i rit t V '40 ---_,-:- ' . r :: r =t yam,' a �' _ y - :::1- „:„7,-zw - ' _ *A*: [1.1''-,;.-Ir----. . - 7 :. � _ �� - - i -:_,-„:„..4,,,,,, --',..,,, li--:, -...,-:1 ,3-'_ ,---:-.„-..,,,,.,,-,-4?-4.-- --- . ,.---,-_,_:-7b-: ,,,,z_-,-_,:=0,-_,-,,,,:f.,_,--,,,-.. .„1.,": ..x..?-a.,.4.- „i r t :'-'.-' 74 ,-..:,:1--,,.„,.:5-:...--,,,A41.;-1:-.'-- ,;:::-. --. ---4-il: , - ' t - fes- d k yra °S'a rvs >-.--;'ii:: ;;',-:-..:'Ar Y _ .fd t+'�� i s}s i ^Yt F 1 3 r x. - ...,;tit. p `t I. ^'v Y,�i.y�i �, AP•��i! �i�{�'y i}v[n,/��F-� ,-ii-,,:„,7:',,;:,. � � -�.- i zt„li F•"s F;4:i y,,, Fri rjM v.SGn p� ,iffi�C ls� r*�'�' ' ■ "'$ � �° rr r � rn �`f tunng has f ,' v-y ,S $.£+J`, .,.,• 'L' r 1 r $ a•,tr �- { F �e Y ` �J J1%f�� T�� ,s” 'r,5 a� r� •r,� � � ct •w ,. { aR. i�%�'M,r-!srs 4 ,:,• 4'•ffi was _;.�4 y.F xf+ r 9 si °.r.r Y"�,x,,, •'••--.G 5.. ':A eps. �,.�'',-,.i .+�r".:fr y �r`'r^^`t� `.• 1 .. > • 1;344 ` �." Denver Health patients can pick up prescriptions at one z ' ` k of the network's eight community health centers,the - 5s same location where they receive treatment. 1 ---- -.I?-.--,- ,-_ A. ,_,:_._,v,-__.....r„:.,7_ ,- II) ,,-.:-.7, - _. __,,,.. _.:•:,._..„.--,1.._.s_.„..--,_-.. „ _ __-,...-;-..„..t,,c,,,., .=..,1 - - - --,o,„ -,i-- ,-_-_ , By Dylan Scott FedEx. Microsoft. Toyota. Those were the 1 companies that Patricia Gabow planned to use as a template for overhauling Denver Health,a health care network in Colorado's largest city.Gabow has served as the head of the health group R. since the early 1990s,and about eight years ago,she began envi sinning a new model based on private sector practices.When = Gabow pitched the idea,her staff balked at using automobile I ' manufacturing or package delivery to teach doctors how to better �- serve a low-income,mostly minority population.One co-worker, Gabow recalls,took her aside and told her it was"the craziel'„-4°..-;- --_-' st idea I've ever heard." I "We were still doing things pretty much as we had when I , was anintern40 years ago,"says Gabow,who first came to Den ver Health in 1973.Back then,the organization was a city-owned hospital called Denver'General. Gabow,who had trained as a x 4 nephrologist, had to convince administrators of the need for l„. such kidney care.She worked for half a salary for more thana year before the city decided she was right,ultimately creating a { �h full nephrology department with Gabow as the head.She became il ¢: 1 director of medical services in 1981 and took over as CEO in 1992. When Gabow took control of Denver Health the organiza lion had a$39 million cash deficit and was already performing $100 million in annual care for uninsured patients. Given its patient population and battered finances,she realized that only fundamental reform would keep the operation sustainable. Gabow decided that the best way'to meet the community's ' needs was by rebuilding Denver General from the ground up. . * ' k Her first step?Decouple the hospital from the city which had , overseen the facility for nearly 150 years.In 1997,Gabow con- winced Mayor Wellington Webb that the organization could i q better operate away from the city's bureaucracy,and Denver Health was established as a public,academic and independent �� health system. "At the time, I said to the mayor:`This isn't a divorce,"' says Gabow. "We were still going to be the city's } W ,, health-care system.We just needed a different house"Over- i,. �-;� � .�''''''''-'-'4:-'41-'';''''''''t � ��.. `� �:: �t sight of the system,which included a major hospital,emergency : , ..„,, ,`� .� � -� .t •' - � � response teams and a smattering of community clinics,was now ,�,�z��, ,-?„-_-1,,.'". ter-�, 2. solely in the hands of Gabow,her staff and a board of direc- _ �: ,,- tors that was appointed to five-year terms by the mayor.The 4 ` newt inde endent Denver Health then invested$388 million'N � ars c Y P � � to upgrade its facilities and infrastructure for delivering care. , � 4� a -,;.--t-,- That's when things got interesting.After the initial invest- ` ments were completed,Gabow and her team began to focus more o '` ` intently on the patients in their system.She says they stepped :3:7457 ,40backandaskedthemselves, "How do we perfect thepatient'`= wKK�, perience?>,That'swhenshe turned to private-sector firms for 82oealth car r advice.In 2004,Gabaw organized a group of advisers from some t-ir ` -s' . = - , February 2012 I GOVERNING 31 TOYOTACARE - the Engelberg Center for Health Care Reform at the Brookings � r° Institution and former administrator at the Centers for Medicare ;' &Medicaid Services(CMS)during the George W.Bush adminis- 7:_17-'1.*,.:' 7'''''.-'; ' tration.While at CMS,McClellan consulted with Denver Health on how its newly adopted operations model could be translated to the federal government.Denver Health,McCIellan says,"didn't start with some savings target.They started with identifying ways ti to really reform care.They have the right vision,which is:What is : ,i - the way that health care for the people we're serving should look? te, 7 And then asking How do we get there?" • •• he lean manufacturing model is based on five principles, _-,,--- • • according to the Lean Enterprise Institute:1)Identify gR the value of the product for the customer;2)Map the ca 71 0 6 process for creating the product and eliminate elements WT_ ,=a without value;3)Create a flow for the value-creating steps;4) • 0 Let customers pull value from that flow;and 5)Begin the process - again and seek perfection. Put more simply,it's about eliminating wasteful actions.Any- thing that doesn't add value for the ultimate customer is considered wasteful."The philosophy is that waste is disrespectful to humanity Denver Health because it squanders scarce resources,and waste is disrespectful to CEO Patricia individuals because it asks them to do work with no value,"Gabow z f S Gabow ` "- says. "We've added that waste is disrespectful to our patients >> : x. because it asks them to endure processes with no value." For Denver Health,the key to eliminating waste turned out to be integration,or restructuring operations at its different facili- of the largest companies in the world—including FedEx,Micro- ties to create one mega-system of patient care.The organization soft,Ritz-Carlton and Toyota—to look at how they examined and treats 170,000 patients annually,more than one-third of the city's solved problems in their own businesses.Gabow and her team population.Forty percent of the city's children seek treatment soon settled on the idea of"lean manufacturing,"the management there. Roughly 70 percent of the patients are ethnic minori- philosophy of efficiency and waste reduction that transformed the ties,and many of them don't speak English.Most are poor,and Toyota automobile company in the 1980s and'90s. 42 percent of them are uninsured.In addition to a large primary The methods that Gabow learned—and the new model of care hospital and emergency room,Denver Health comprises eight her hospital implemented—have revolutionized patient care in community health centers,each equipped with its own pharmacy Denver.Today,Denver Health has become a national model for and another 13 school-based health centers.Denver Health also public-sector health care.The system has managed to improve runs the city's 911 emergency medical services system, a non- outcomes while driving down costs.Last year,the organization emergency medical hotline,the Rocky Mountain Poison and Drug received a Shingo Prize for Operational Excellence, an inter- Center,and the Rocky Mountain Regional Trauma Center. national award that recognizes efficient and effective business But as far as Denver Health is concerned,all those disparate models.According to the University HealthSystem Consortium, elements are the same.Every one of those institutions shares the Denver Health has the lowest mortality rate of any of the nation's same information system,and every patient who enters the sys- 113 academic health centers. tern is assigned a number.So whether someone checks into the At the same time,costs have been kept in check.While the emergency room or an outpatient specialty clinic,physicians can system's expenses for treating uninsured patients have bal- access all the relevant data that Denver Health has ever accumu- looned from$100 million in 1991 to nearly$400 million in 2010, lated.It's been a major shift in the way the system operates,says Denver Health has consistently operated in the black.An inpa- Thomas Mackenzie,who,as chief quality officer of Denver Health, tient stay at Denver Health costs about 35 percent less than a is charged with implementing and maintaining the lean principles. stay at one of the Metro Denver hospitals,the private,nonprofit "It's not thinking about things in different silos for different compo- network that serves much of the rest of the city's population. nents,"Mackenzie says,"but thinking about how you can provide Gabow estimates that utilizing lean has yielded up to$127 mil- the best care for patients across the whole continuum of care" lion in financial benefit without the organization having to lay Mackenzie points to one specific example of how lean has off any of its 5,400 employees. transformed the system's approach:treatment of patients for blood The Denver Health approach is one that public hospitals coagulation.Every year,Denver Health treats about 1,000 patients everywhere should emulate,says Mark McClellan,director of with anticoagulation medicine to prevent blood clots.As the medi- 32 GOVERNING I February 2012 TOYOTACARE i cal staff looked to apply the lean model to that care,they encoun- with a 70 percent national average,according to the Centers for tered a startling degree of variation between the eight primary-care Disease Control and Prevention. • clinics,several specialty clinics and the dozens of physicians who staffed them.The approaches differed in how often blood tests abow doesn't shrink from her role as the architect of a were done,where patients were seen,how often patients were national model for public-sector hospitals.She knows advised over the phone and soon.So Mackenzie and his staff devel- the eyes of the national health-care community are on oped clear protocols for treating patients for that specific condition. Denver."We are really serious about wanting to be a They held weeklong events to train staff on the new approach. model for the nation because our country is facing some tough Lean also inspired a restructuring of the Denver Health choices,"she says."And we need to demonstrate models that are Medical Center's rapid response system for patients who go cost-efficient and high quality." into cardiac arrest.At most hospitals,a dedicated team is on call Despite Denver Health's past successes,this year could prove 24 hours a day,seven days a week for rapid response,and tempo- to be the organization's most pivotal yet.Gabow announced in rarily assume care of those patients from their primary nurses and November that she will retire at the end of 2012.The seemingly doctors.But in applying the lean principles,the medical center's universal opinion among health-care professionals—both within staff recognized an opportunity to cut costs while ensuring con- Denver Health and at the national level—seems to be that the tinuity of care.A regular assessment schedule was established for organization's transformation could never have occurred without nurses to monitor their patients,and criteria were developed for her leadership.Finding a replacement who can match Gabow's nurses to determine if a patient was at risk.Then a specific protocol ambition and tenacity is paramount to Denver Health's_contin- was outlined for staff to follow if a nurse made that determination, ued success,says George Mason's Nichols."They have to keep the providing guidelines for moving up the chain of command if the momentum going,"he says."The person they pick to succeed her, immediate attending physician is not fi available or the patient's condition �' ' , did not improve.An analysis by Den- „ f , „ ver Health staff found that the number �'` :�� ' _ w, of non ICU cardiac arrest incidents `: � c decreased significantly following the = Al ,�} y e� , a -4£ implementation of the new prose- �,`� �' 4' �” dures.And it bestowed rapid response , . . k `� i S a responsibilities on staff members who �" _ �� r �,,�, � were already working, rather than �' 1�.' 4 Y F, ,it* _ n�'... a requiring an entirely separate team. y�•£Y � A That process for improving care . � c . has pervaded every aspect of Denver • :.��y �a Health, and it has attracted nationalw Ado, attention.According to former CMS Administrator McClellan, Denvert Health served as the inspiration for ... revamping payments for physicians who treat patients with federally sub- The system treats that's probably as important a search as any in the country right now, sidized insurance, such as Medicare 40 percent of the with the possible exception of the president of the United States." and Medicaid, transitioning from city's children and Part of her success,says Nichols,stems from her history as a a fee-for-service model to one that operates 13 school- practicing physician."If we want to achieve our goals,improving rewards outcomes. Denver Health based health centers. care while cutting costs,what we need is physician leadership. has also set the standard in its rela- Only doctors can convince other doctors that these changes are tionships with its patients and the worth doing.Denver Health is a model for reform,but it'd be resulting compliance of those patients,says Len Nichols,direc- easier if we could just clone Patty Gabow." tor of the Center for Health Policy Research and Ethics at George Mackenzie,for his part,says the philosophy of efficiency and Mason University.That achievement is amplified,Nichols says, quality that Gabow has instilled at the institution has become so j because the organization serves a population"that some would ingrained that it will sustain itself even after she leaves."She's consider problematic."The ongoing connectedness between Den- been critical in keeping up the momentum for this transforma- ver Health and its patients leads to measurably better outcomes: tion.She's been the driver."But now,he says,the rest of the staff Nearly 90 percent of its infant patients receive annual immuni- is carrying Gabow's vision."At this point,we think our work is zations,compared to a 75 percent national average,according to exactly the recipe that America needs."G0 the Kaiser Family Foundation.Sixty-eight percent of those with high blood pressure take measures to control it,which correlates Email dscott@governing.com February 2012 I GOVERNING 33 Elaine Bailey East Jefferson Biomass Committee • of the North Olympic Group of the Sierra Club 925 Rose St Port Townsend, WA 360-379-9889 elainembailey@earthlink.net Questions: What are plans for PTPC disposing of asbestos from the boiler construction? Where will debris from the cogeneration project be disposed of? Is it planned to put it in the landfill? If not, where will it be disposed of? and will it be considered hazardous waste? Why are there no asbestos disposal and removal protections accounted for in the NOC? The boiler was installed in 1976. Asbestos was commonly used in construction and materials used for paper mills. Why has this issue been ignored? Also PTPC has apparently been disposing of scrubber waste in the landfill. If they claim they are not disposing in that fashion, where are they sending it? It is not disposed of through the County, according to County officials. Does BOH consider it appropriate for them to dispose scrubber waste in the landfill, and are they aware of it? When the annual testing is being done, is a sample containing scrubber waste included, if in fact they are disposing in the landfill? When the mill was burning tires for energy in the late 1980's and 1990's was the ash deposited to the landfill tested for dioxins? If not what procedures are now being considered to access the possibility of high dioxin levels that are possibly covered in a less than appropriate or safe manner? What testing and safeguards for possible dioxin from increased burning of C&D and increased hog fuel barged over salt water will be implemented in the proposed cogeneration project? What tests are being planned to safeguard from increased dioxin • levels from ash disposal and how that will be implemented? (. 1.50 ll(0ifz From: jacobson@stanford.edu Subject: Re: Biomass for electricity Date: February 15, 2012 5:31 :33 PM PST To: elainembailey@earthlink.net Elaine, Generally, about half the oxides of nitrogen gases and organic gases and most sulfur oxide gases emitted by these and other sources also convert to particulate matter in the atmosphere. This information would not be included in the emission estimates of particles, which include only primary emissions of particles (as opposed to secondary formation of particles from gases in the air). The companies would certainly not tell you this, but any regulatory agency would know this. Local CO2, regardless of its source, also increases local temperatures and ozone and, in many cases, particulate matter, as discussed in detail in the first paper that examines the effects of CO2 domes on pollution: http://www.stanford.edu/group/efmh/jacobson/ArticlesN/urbanCO2do mes.html In addition to the fact that logging or scavenging for wood or waste wood requires energy, the cutting of a forest or the periodic cutting of vegetation for burning always permanently increases CO2 in the atmosphere due to the time lag between burning and regrowth. This is proven mathematically in the paper at http://www.stanford.edu/group/efmh/jacobson/ArticlesN)I I/bioburn/ind ex.html There are also lots of chemical effects in the atmosphere of emissions from biofuels. In the example of E85, the effects are quantified at • http://www.stanford.edu/group/efmh/jacobson;Articles/l/E85vWindSol • Third, obtaining energy (electricity plus heat) from wood is 1/80th to 1/100th as efficient as obtaining the same energy from solar panels. In other words one requires 80-100 times more land with wood to obtain the same energy as with solar. Finally, the alternative to this is discussed in the plan at http://www.stanford.edu/group/efmh/jacobson/Articles/l/susenergy203 0.html I hope this information helps. Sincerely, Mark Jacobson Dear Dr. Jacobson, I live in Port Townsend WA where a cogeneration project attached to Port Townsend Paper Mill has been proposed and given a Notice of Construction by WA State Dept. of Ecology Industrial Division. They propose to burn 2.6 times the amount of woody biomass including construction and demolitions waste and install a dry ESP to control particulates. This will be a 25MW facility. As only PM10 and Pm2.5 are regulated and baselines for emissions are done by choosing the highest emission factors for each pollutant from 2001- 2010 in a twenty four month period chosen by the proponents, the results are questionable as to reduction and increase modeling estimates. I belong to a The Sierra Club Biomass Committee of the North Olympic Group of the Sierra Club that is opposing the project. Many of the misconceptions for this project hinge on "carbon neutral" misinterpretations and particulate statistics that the dry ESP can indeed eliminate all PM. including large quantities of fine particulates and nano particles. Also that biogenic CO2 is not the • same as anthropogenic CO2. as the forests will somehow sequester instantly what is being burned. I have read Searchinger's information on this issue. I am not a scientist, but found your lecture at Cornell extremely helpful and some of the other papers on carbon and aerosol formation. What I am needing is more information to counter the particulate formation issues in a written form or video that explains some of it so that laymen can understand and any information on effectiveness of dry ESP filtration on particulates. We feel that the impact of this facility on the health of the community will be extreme, as the mill is right in the urban area of our small town and the plume is often directly over and on top of our hospital and grade school only 1/2 mile away. We have months of inversions. There are many other issues including the impact on the Olympic National Park and snowpack. Forest health, ocean 1111 acidification, but we are attempting to wake up the town Commissioners, Health Dept. and our legislature about the particulate problems with a 25MW facility that we see will ensue. Thank you for any help or information directions you can forward. and thank you for the work that you are doing. Elaine Bailey 925 Rose St. Port Townsend, WA 98368 360-379-9889 Mark Z. Jacobson Professor of Civil and Environmental Engineering Director, Atmosphere/Energy Program Stanford University Phone: 650-723-6836 Yang & Yamazaki Environment & Energy Bldg. Fax:650-723-7058 473 Via Ortega, Room 397 Email: jacobson@stanford.edu • Stanford, CA 94305-4020 • www.stanford.edu/group/efmh/jacobson 111) • , "f 0 ft nce4r4A-4, (rfr) ( cz.. �;�l Environ. Sci. Technol.2010, 44, 2497-2502 ,,Q .t.4t('yr4l ZZ)&-"1 6) OCfi I&v. 'fir 410 Enhancement of Local Air Pollution Methodology and Evaluation byUrban omes For this study,the nested global-through-urban 3-D model, CO22 GATOR-GCMOM(13-17)was used to examine the effects of locally emitted CO2 on local climate and air pollution. MARK Z. JACOBSON' A nested model is one that telescopes from a large scale Department of Civil and Environmental Engineering,Stanford to more finely resolved domains. The model and its University,Stanford, California 94305-4020 feedbacks are described in the Supporting Information. Example CO2 feedbacks treated include those to heating rates thus temperatures,which affect(a)local temperature Received October 3, 2009. Revised manuscript received December 21,2009.Accepted March 2,2010. and pressure gradients,stability,wind speeds,cloudiness, and gas/particle transport, (b) water evaporation rates, (c) the relative humidity and particle swelling, and (d) temperature-dependent natural emissions,air chemistry, Data suggest that domes of high CO2 levels form over cities. and particle microphysics.Changes in CO2 also affect(e) Despite our knowledge of these domes for over a decade,no photosynthesis and respiration rates, (f) dissolution and study has contemplated their effects on air pollution or evaporation rates of CO2 into the ocean, (g) weathering health.In fact,all air pollution regulations worldwide assume pH and,(hompos ti and andch (j)rainwater composition,and(i)sea spray pH composition, (j)rainwater pH composi- arbitrarily that such domes have no local health impact,and carbon tion.Changes in sea spray composition,in turn,affect sea policy proposals,such as "cap and trade",implicitly assume spray radiative properties,thus heating rates. that CO2 impacts are the same regardless of where emissions The model was nested from the globe (resolution occur.Here,it is found through data-evaluated numerical 4°SN x 5°WE)to the U.S.(0.5°x0.75°),California(0.20°x 0.15°), modeling with telescoping domains from the globe to the U.S., and Los Angeles(0.045°x 0.05°).The global domain included California,and Los Angeles,that local CO2 emissions in 47 sigma-pressure layers up to 0.22 hPa(-60 km),with high isolation may increase local ozone and particulate matter. resolution(15 layers)in the bottom 1 km.The nested regional domains included 35 layers exactly matching the global layers Although health impacts of such changes are uncertain,they are of concern,and it is estimated that that local CO2 emissions up to 65 hPa (-18 km). The model was initialized with may increase premature mortality by 50-100 and 300-1000/ sdegree global reanalysis data (18) but run without data assimilation or model spinup. yr in California and the U.S., respectively.As such, reducing Three original pairs of baseline and sensitivity simulations locally emitted CO2 may reduce local air pollution mortality were run:one pair nested from the globe to California for even if CO2 in adjacent regions is not controlled.If correct,this one year(2006),one pair nested from the globe to California • result contradicts the basis for air pollution regulations to Los Angeles for two sets of three months(Feb-Apr,Aug- worldwide,none of which considers controlling local CO2 Oct,2006),and one pair nested from the globe to the U.S. based on its local health impacts.It also suggests that a "cap for two sets of three months (Jan Mar,Jul-Sep,2006).The and trade"policy should consider the location of CO2 emissions, seasonal periods were selected to obtain roughly winter/ as the underlying assumption of the policy is incorrect summer results that could be averaged to estimate annual values.A second 1-year(2007)simulation pair was run for Introduction California to test interannual variability.In each sensitivity simulation,only anthropogenic CO2 emissions(emCO2)were Although CO2 is generally well-mixed in the atmosphere, removed from the finest domain.Initial ambient CO2 was data indicate that its mixing ratios are higher in urban than the same in all domains of both simulations,and emCO2 was in background air, resulting in urban CO2 domes (1-6). the same in the parent domains of both.As such,all resulting Measurements in Phoenix,for example,indicate that peak differences were due solely to initial changes in locally emitted and mean CO2 in the city center were 75%and 38-43%higher, (in the finest domain) CO2. respectively, than in surrounding rural areas (2). Recent The model and comparisons with data have been de- studies have examined the impact of global greenhouse gases scribed in over 50 papers,including recently(13-17).Figure on air pollution(7-13).Whereas one study used a 1-D model 1 further compares modeled 03,PMie,and CH3CHO from to estimate the temperature profile impact of a CO2 dome August 1-7 of the baseline(with emCO2)and sensitivity(no (3),no study has isolated the impact of locally emitted CO2 emCO2)simulations from the Los Angeles domain with data. on air pollution or health. One reason is that model The comparisons indicate good agreement for ozone in simulations of such an effect require treatment of meteo- particular.Since emCO2 was the only variable that differed rological feedbacks to gas,aerosol,and cloud changes,and initially between simulations,it was the initiating causal factor few models include such feedbacks in detail.Second,local in the increases in 03,PM10,and CH3CHO seen in Figure 1. CO2 emissions are close to the ground,where the temperature Although ozone was predicted slightly better in the no-emCO2 contrast between the Earth's surface and the lowest CO2 layers case than in the emCO2 case during some hours, modeled is small. However, studies have not considered that CO2 ozone in the emCO2 case matched peaks better by about domes result in CO2 gradients high above the surface.If locally 0.5% averaged over comparisons with all data shown and emitted CO2 increases local air pollution,then cities,counties, not shown. states,and small countries can reduce air pollution health problems by reducing their own CO2 emissions,regardless Results of whether other air pollutants are reduced locally or whether other locations reduce CO2. Figure 2a,b shows the modeled contribution of California's CO2 emissions to surface and column CO2, respectively, III *Corresponding author phone: (650)723-6836; e-mail: averaged over a year.The CO2 domes over Los Angeles,the jacobson@stanford.edu. San Francisco Bay Area, Sacramento (38.58 N, 121.49 W), 10.1021/es903018m 2010 American Chemical Society VOL.44,NO.7,2010/ENVIRONMENTAL SCIENCE&TECHNOLOGY 12497 Published on Web 03/10/2010 -- too _ .„ DA: —0.000005 ppbv). The peak surface air temperature s6g0 =34.199-1 ° .11833zgc°w I ' I ' ' I ' 1 increases in Figure 2c(and in the Los Angeles simulations) / • were —0.1 K, similar to those found from 1-D radiative of "'M P, • , .IF onlycalculations for Phoenix 3.Peak ozone and its • • • O n health 12 36 60 84 108 132 156 18 effects occurred over Los Angeles and Sacramento(Figure GMT hour of simulation(starting 12 GMT Aug.1,2006) 2e,f, where increases in CO2 (Figure 2a), temperature 120 ' "34'. 3d gv,'1i8.�2$4'1� ' I ' ' ' I • ' I (although small for Sacramento, Figure 2c), and column r H2O (Figure 2d) occurred. g • Figure 3 elucidates spatial correlations between annually 6 0 averaged changes in local ambient CO2 caused by emCO2 12 36 60 84 108 132 156 180 and changes in other parameters.Increases in temperature, GMT hour of simulation(starting 12 GMT Aug.1,2006) water vapor, and ozone correlated positively and with o 18D ' I : ' I '"' ' I ' ' ' statistical significance (pCO2.$ 3410137° 11 .6291 R� << 0.05) with increases in CO 40 60 Ozone increases also correlated positively and with strong 8 zo �' r � ,. Ilk . � significance with increases in water vapor and temperature. 012 36 60 84 108 132 156 I A previous study found that increases in temperature and GMT hour of simulation(starting 12 GMT Aug.1,2006) water vapor both increase ozone at high ozone but cause little change in ozone at low ozone(13),consistent with this I . .P.+.1° •t I r 34,511Q0 11.7:3306°dV result. 2io '•" •••••s :�: •,,•' PM2.5 correlated slightly negatively(r=0.017)but without 1 0 ' I 1% • l ,i I , , I', , , 1 •, , 1 t 1 statistical significance,with higher temperature and much a' 12 36 60 84 108 132 156 1 more positively(r=0.23)and with strong significance(p GMT hour of simulation(starting 12 GMT Aug.1,2006) < 0.0001) with higher water vapor in California. Higher 6 ' ' 1 ' ' ' 1 ' I ' , r I ' el F1 , 11 ' , temperature decreased PM2.5 by increasing vapor pressures 1 34.1764°N,118.3171 ' thus PM evaporation and by enhancing precipitation in sz1 r • •• • • some locations. Some PM2.5 decreases with higher tern- a4 ' perature were offset by biogenic organic emission increases 12 36 60 84 108 132 156 1 GMT hour of simulation(starting 12 GMT Aug.1,2006) with higher temperatures followed by biogenic oxidation FIGURE 1. Paired-in-time-and-space comparisons of modeled to organic PM. But, in populated areas of California, baseline (solid lines), modeled no-emCO2(dashed lines), and data biogenic emissions are relatively low.SomePM2,5decreases (22) (dots) for ozone, sub-10-pin particle mass, and acetaldehyde were also offset by surface PM2,s increases caused by slower from the Los Angeles domain for August 1-7,2006 of the Aug-Oct surface winds due to enhanced boundary-layer stability 2006 simulation.Local standard time is GMT minus 8 h. from CO2,which reduced the downward transport of fast winds aloft to the surface(13).While higher temperature slightly decreased PM15,higher watervapor due to emCO2 and the Southern Central Valley are evident. The largest increased PM2.5 by increasing aerosol water content, • surface CO2 increase (5%, or 17.5 ppmv) was lower than increasing nitric acid and ammonia gas dissolution, observed increases in cities (2) since the resolution of the forming more particle nitrate and ammonium. Higher California domain was coarser than the resolution of ozone from higher water vapor also increased oxidation measurements.As shown below for Los Angeles,an increase of organic gases to organic PM. Overall,PM2.5 increased in model resolution increases the magnitude of the surface with increasing CO2,but because of the opposing effects and column CO2 dome. of temperature and water vapor on PM2.s,the net positive Population-weighted(PW)and domain-averaged(DA) correlation was weak (r = 0.022) and not statistically changes in several parameters can help to elucidate the significant (p= 0.17). However, when all CO2 increases effects of the CO2 domes.A PW value is the product of a below 1 ppmv were removed, the correlation improved parameter value and population in a grid cell, summed substantially(r=0.047,p=0.07).Further,the correlation over all grid cells, all divided by the summed population was strongly statistically significant for Los Angeles and among all cells. Thus, a PW value indicates changes U.S. domains, as discussed shortly. primarily in populated areas,whereas a DA value indicates Health effect rates (y) due to pollutants in each model changes everywhere,independent of population.The PW domain for each simulation were determined from and DA increases in surface CO2 due to emCO2 were 7.4 ppmv and 1.3 ppmv,respectively,but the corresponding y=yo y{PiE(1 —exp[—/3x max(x„,—x h,0)])} increases in column CO2 were 6.0 g/m2 and 1.53 g/m2, i l r respectively, indicating, along with Figure 2a,b, that (1) changes in column CO2 were spread horizontally more than were changes in surface CO2.This is because surface where xi,,is the concentration in grid cell i at time t,x,h is the winds are usually slower than winds aloft,so only when threshold concentration belowwhich no health effect occurs, surface CO2 mixes vertically is it transported much /3 is the fractional increase in risk per unit x,yo is the baseline horizontally,and when that occurs,surface CO2 is quickly health effect rate,and Pi is the grid cell population.Table 1 replenished with new emissions. provides sums or values of P,/3,yo,and x,h. Differences in The CO2 increases in California increased the PW air health effects between two simulations were obtained by temperature by about 0.0063 K,more than it changed the differencing the aggregated effects from each simulation domain-averaged air temperature(+0.00046)(Figure 2c). determined from eq 1. The relationship between ozone Thus,CO2 domes had greater temperature impacts where exposure and premature mortality is uncertain;however,ref the CO2 was emitted and where people lived than in the 19 suggests that it is"highly unlikely”to be zero.Similarly, domain average.This result held for the effects of emCO2 ref 20 suggests that the exact relationship between PM2.5 on column water vapor(Figure 2d-PW: +4.3 g/m2; DA: exposure and mortality is uncertain but "likely causal". +0.88 g/m2), ozone (Figure 2e - PW: +0.06 ppbv; DA: Cardiovascular effects of PM2.5 are more strongly"causal". 111 +0.0043 ppbv), PM2.5 (Figure 2g - PW: +0.08 ug/m3; Although health effects of PM2.5 differ for different chemical DA:—0.0052 pg/m3),and PAN(Figure 2i-PW:+0.002 ppbv; components within PM2,5,almost all epidemiological studies 2498•ENVIRONMENTAL SCIENCE&TECHNOLOGY/VOL.44,NO.7,2010 a)A COv +7400 b)A Column CO ;m2)(+6.0) c)A Air tern,. (+0.0063) :J402 lii 33 5000 0 35 _ ,. 0 p -0.1 -120 -120 -120 d)A Column II 0(g/m2)(+4.3) e)A Oumc(pphv ,-0 0511 f) h q A Ozone 8. hs/ +13) a:111,1o, 40 t� •y'`_ 40134°5 ` n7^ . 1. Ir• v 1 14' I YOr • ,. 0 5 4 �•, -50 -120 -120 -120 4 A PM m3) +0.08) 5 h)A P deaths/yr(-,-19,, ;Ir PAN ppb))( +0,002/ 40 40 i ? * -0 �, • y . 35 4.ri 35 .o t'. w ,4 . ,, - .5 -0.02 V "120 "120 -120 i FIGURE 2. Modeled annually averaged difference for several surface or column (if indicated) parameters in California, parts of Nevada, and parts of New Mexico when two simulations (with and without emCO2) were run. The numbers in parentheses are average population-weighted changes for the domain shown. 0.4_,,.,1...,L,,,.1,... .,,1,...1,...1,,., .,1,..,1.,,,1.,., ,..1,..,1,,,,1,,,, _3 AT=-0.00040+ _ 2 10-i, AH20=174+ _ ,A03=-0-0051+ __ - = III 0.00000075ACO2 E 0.69ACO2 - 0.8- 0.0000073ACO2 ^E w 02- R ).05,10.0016 w _R .076,p<0.0001 E_ a = R1.20,p<0.0001 = i 0 ...•".'. r a 0 .....:•.. 0 - 0m :' •. ' :_ . _ _ .APM2.5=-0.023+ a 0.000014ACO2 R 0.022, .17 _ -02-.,.. ..,, 1 - I lnu(n. "nn(u.iln(n.,- -,n,lin,(uulrin" -20 „nl,nrti n,(nn 0 1 104 2 104 0 1 104 2 104 0 1 104 2 iO4 0 1104 2 104 A CO2(ppbv) A CO2(ppbv) A CO2(ppbv) A CO2(ppbv) u,lu,ludu,b,.l,,,l,u6„ wlutlu,ln,6uln,l.,lni un6wlw,luul,,,,lu„ iii Iii liii liii till luu ,603 3.0039+ - .- AO3�.0041+ _ 0.8- 0,0000003AH2O - ° _0.84 - "5 - R=0.075, - 3 0- _ S _ 4,11AT - x - p<0.0001= _ :':..„y = a = R�.046,p=11.0037_ 0_ . 0E. ,,,0- ^� �� a" _ .APM2.5=-0022+ _ `° _ _ET _ APM25=0.0046- d - :>� _ C _ 0.000016AH20 _ ��0= `,•F - a - 0 72A ' - 20 o R 023,p<0.0001 c - •..` - - 7,p-3.28 a tillml',.lml'.,l,nl,,.ln." ..,(n.(i..(...lm(mlmp.. "u..1,ml..or..,l..n1...," -20 ".,..1,,,,1..,,1„i,1,.,,l,.,," -8104 0 8 104 -8104 0 8 104 -0.2 0 0.2 0.4 -0.2 0 0.2 0.4 A H2O(ppbv) A H2O(ppbv) AT(K) A T(K) FIGURE 3. Scatter plots of paired-in-space one-year-averaged changes between several parameter pairs, obtained from all near-surface grid cells of the California domain. Also shown is an equation for the linear fit through the data points in each case and the r and p values for the fits.The equation describes correlation only,not cause and effect,between each parameter pair. correlating particle changes with health use ambient PM2.5 above the baseline rate of 22,500 (5900-42,000)/year. measurements to derive such correlations.For consistency, Changes in cancer due to emCO2 were relatively small it is therefore necessary to apply/3 values from such studies (Table 1).Additional uncertainty arises due to the model to modeled PM25(22). itself and interannual variations in concentration.Some California's local CO2 resulted here in^-13(with a range of the model uncertainties are elucidated in comparisons of 6-19 due to uncertainty in epidemiological data) with data, such as in Figure 1; however, it is difficult to additional ozone-related premature mortalities/year(Fig- translate such uncertainty into mortality uncertainty. ure 20 or 0.3%above the baseline 4600(2300-6900)/year Interannual variations in concentrations were examined II (Table 1).Higher PM2.5 due to emCO2 contributed another by running a second pair of simulations for California, -39(13-60)premature mortalities/year(Figure 2h),0.2% starting one year after the first.The results of this simulation VOL.44,NO.7,2010/ENVIRONMENTAL SCIENCE&TECHNOLOGY■2499 TABLE 1. Summary of Locally-Emitted CO2's (emCO2) Effects on Cancer, Ozone Mortality, Ozone Hospitalization, Ozone Emergency-Room (ER) Visits, and Particulate-Matter Mortality in California (CA), Los Angeles (LA), and the United States (U.S.)d • base minus base minus annual base CA base minus no emCO2CA annual base LA no emCO2 LA annual base U.S. no emCO2 U.S. ozone 35 ppbv(ppbv) 47.4 +0.060 44.7 +0.12 47.0 +0.044 PM2.5(ug/m3)(pop-weight) 50.0 +0.08 36 +0.29 64.4 +0.041 PM2.6(Fig/m3)(all land) 21.5 -0.007 25.8 +0.06 32.8 +0.039 formaldehyde(ppbv) 4.43 +0.0030 4.1 +0.054 6.75 +0.066 acetaldehyde(ppbv) 1.35 +0.0017 1.3 +0.021 2.45 +0.016 1,3-butadiene(ppbv) 0.11 -0.00024 0.23 +0.0020 0.077 +0.0005 benzene(ppbv) 0.30 -0.00009 0.37 +0.0041 0.34 +0.020 Cancer USEPA cancers/yra 44.1 0.016 22.0 +0.28 573 +6.9 OEHHA cancers/yra 54.4 -0.038 37.8 +0.39 561 +11.8 Ozone Health Effects high 03 mortalities/yrb 6860 +19 2140 +20 52,300 +245 med.03 mortalities/yrb 4600 +13 1430 +14 35,100 +166 low 03 mortalities/yrb 2300 +6 718 +7 17,620 +85 03 hospitalizations/yrb 26,300 +65 8270 +75 200,000 +867 ozone ER visits/yrb 23,200 +56 7320 +66 175,000 +721 PM Health Effects high PM2.5 mortalities/yr` 42,000 +60 16,220 +147 44,800 +810 med.PM2.6 mortalities/yr` 22,500 +39 8500 +81 169,000 +607 low PM25 mortalities/yr' 5900 +13 2200 +22 316,000 +201 a USEPA (U.S. Environmental Protection Agency) and OEHHA (Office of Environmental Health Hazard Assessment) cancers/yr were found by summing, over all model surface grid cells and the four carcinogens (formaldehyde, acetaldehyde, 1,3-butadiene, and benzene), the product of individual CUREs(cancer unit risk estimates=increased 70-year cancer risk per ug/m3 sustained concentration change), the mass concentration (ug/m3) (for baseline statistics) or mass concentration difference(for difference statistics)of the carcinogen,and the population in the cell and then dividing by the population of the model domain and by 70 yr. USEPA CURES were 1.3 x 10-5 (formaldehyde), 2.2 x 10-6(acetaldehyde), 3.0 x 10-6 (butadiene), 5.0 x 10-6(=average of 2.2 x 10-6 and 7.8 x 10-6) (benzene) (www.epa.gov/IRIS/). OEHHA CUREs were 6.0 x 10-6 (formaldehyde), 2.7 x 10-6 (acetaldehyde), 1.7 x 10-4 (butadiene), 2.9 x 10-6 (benzene) (www.oehha.ca.gov/risk/ChemcalDB/index.asp). b High, medium, and low mortalities/yr, hospitalizations/yr, and emergency-room (ER) visits/yr due to short-term 03 exposure were obtained from eq 1, assuming a threshold (xth) of 35 ppbv (23). The baseline 2003 U.S. mortality rate (yo) was 833 mortalities/yr per 100,000 (24). The baseline 2002 • hospitalization rate due to respiratory problems was 1189 per 100,000(25).The baseline 1999 all-age emergency-room visit rate for asthma was 732 per 100,000 (26). The fractional increases ((3) in the number of premature mortalities from all causes due to ozone were 0.006, 0.004, and 0.002 per 10 ppbv increase in daily 1-h maximum ozone (27). These were multiplied by 1.33 to convert the risk associated with a 10 ppbv increase in 1-h maximum 03 to that associated with a 10 ppbv increase in 8-h average 03 (23). The central value of the increased risk of hospitalization due to respiratory disease was 1.65%per 10 ppbv increase in 1-h maximum 03(2.19%per 10 ppbv increase in 8-h average 03),and that for all-age ER visits for asthma was 2.4% per 10 ppbv increase in 1-h 03 (3.2% per 10 ppbv increase in 8-h 03) (25, 26). `The mortality rate due to long-term PM25 exposure was calculated from eq 1. Increased premature mortality risks to those >-30 years were 0.008(high), 0.004 (medium), and 0.001 (low) per 1 ug/m3 PM2.6>8 pg/m3 based on 1979-1983 data (28). From 0-8 ug/m3, the increased risks were assumed to be a quarter of the risks for those>8 ug/m3 to account for reduced risk near zero PM2.6 (13). The all-cause 2003 U.S. mortality rate of those >_30 years was 809.7 mortalities/yr per 100,000 total population. Reference 29 provides higher relative risks of PM2.5 health effects data; however, the values from ref 28 were retained to be conservative. d Results are shown for the with-emCO2 emissions simulation ("base") and the difference between the base and no emCO2 emissions simulations ("base minus no-emCO2") for each case. The domain summed populations (sum of P1 in eq 1) in the CA, LA, and U.S. domains were 35.35 million, 17.268 million, and 324.07 million, respectively. All concentrations except the second PM2.5, which is an all-land average, were near-surface values weighted spatially by population. PM2.5 concentrations in the table include liquid water, but PM2.5 used for health calculations were dry. CA results were for an entire year, LA results were an average of Feb-Apr and Aug-Oct (Figure 4), and U.S. results were an average of Jan-Mar and Jul-Sep. were similar to those for the first, with -51 (17-82) the land-ocean temperature gradient by about 0.2 K over 50 additional ozone-plus PM2.5-related premature mortali- km, increasing surface sea-breeze wind speeds by -0.06 ties/year attributable to emCO2. m/s,and increasing water vapor transport to and soil-water Simulations for Los Angeles echo results for California evaporation in Los Angeles(Figure 4d).Higher temperatures but allowed for a more resolved picture of the effects of and water vapor slightly increased ozone and PM2.5 for the emCO2.Figure 4a(Feb-Apr)indicates that the near-surface reasons given in ref 13.The high wind speeds also increased CO2 dome that formed over Los Angeles peaked at about 34 resuspension of road and soil dust and moved PM more to ppmv,twice that over the coarser California domain.The the eastern basin. column difference(Figure 4b) indicates a spreading of the During summer, Los Angeles boundary layer heights, dome over a larger area than the surface dome.In Feb-Apr temperature inversions,land-sea temperature gradients,sea and Aug-Oct, emCO2 enhanced PW ozone and PM2.5, breeze wind speeds,water evaporation rates,column water increasing mortality (Figure 4, Table 1) and other health vapor, and stratus cloud formation are greater than in effects (Table 1). The causes of such increases, however, summer.Since boundary-layer heights were higher during differed with season. the Aug-Oct simulations, CO2 mixed faster up to higher • During Feb-Apr,infrared absorption by emCO2 warmed altitudes during summer.Initially,the higher CO2 warmed air temperatures(Figure 4c)up to-3 km altitude,increasing the air up to 4 km above topography, but the higher 2500■ENVIRONMENTAL SCIENCE&TECHNOLOGY/VOL.44,NO.7,2010 February-April a)tSuface CO •.bv)(+8800) b)AColumn CO /m2)(+10.1) LiASurf.antaw.(K)(+OD26) I. 30000y _ 20 0.1 5`, 20000 ' 34 --- - 34 0 34 • 10000 Ck,®t ..; 33 0 1 33 -0.1 33 -118 -116 -118 -116 1 1 k 116 d)AColumnHO(g/m2)(+19.7) e)A 8-dr ozone deaths/yr(+17) 1)APM deaths/yr(+54) " ,.. i 30 '�� ♦of 02 " .t- ,,r 2 O 34 11Wl -• 0133 34 � f.1- -50 • 34 5033 `t. ♦ i t., 0 33 ; Iib .16 -118 I16 118 114 August-October )A Surf.airtemp.(K)(-0.056) h)AColumn HO(g/m2)(+1Iti i)AOzone(ppbv)(+U,1. ) 0 34 -, 4....„... 34 _ 'Al ..- 0 34 - �T r -02 33 '\�2. 0 33 _ i - Ftiy -0S -- 1 t, -118 -116 -1 IR -116 •118 16 )APM2 ( a/0)1+0.45) k)A8-hr ozone deaths/yr(+10) 1)APM deaths/ r(+108) 1 -. a 02 R�r ~,:c 2 0 34 A 4 34 34 1 , 4 0s 0 33 33 , . 33 -1 8 -116 -1 8 116 -118 -116 FIGURE 4. Same as Figure 2 but for the Los Angeles domain and for Feb-Apr and Aug-Oct. temperatures from 1.5-4 km decreased the upper-level sea- The annual premature mortality rates due to emCO2 in III breeze return flow(figures not shown)decreased pressure the U.S.were-770 (300-1000),with -20%due to ozone. aloft,reducing the flow of moisture from land to ocean aloft This rate represented an enhancement of 0.4%of the baseline (increasing it from ocean to land),increasing cloud optical mortality rate due to air pollution.With a U.S.anthropogenic depth over land by up to 0.4-0.6 optical depth units, emission rate of 5.76 GT-CO2/yr(Table S2),this corresponds decreasing summer surface solar radiation by at most 3-4 to--134(52-174)additional premature mortalities/GT-0O2/ W/m2 locally,decreasing local ground temperatures by up yr over the U.S.Modeled mortality rates in Los Angeles for the to 0.2 K(Figure 4g)while retaining the warmer air aloft.The Los Angeles domain were higher than those for Los Angeles in excess water vapor aloft over land mixed to the surface(Figure the California or U.S.domains due to the higher resolution of 4h),increasing ozone(which increases chemically with water the Los Angeles domain;thus,mortality estimates for California vapor at high ozone) and the relative humidity, which and the U.S.may be low. increased aerosol particle swelling, increasing gas growth onto aerosols,and reducing particle evaporation. In sum- Implications mary, emCO2 increased ozone and PM25 and their corre- sponding health effects in both seasons, increasing air Worldwide,emissions of NOR,HCs,CO,and PM are regulated. pollution mortality in Califgrnia and Los Angeles by about The few CO2 regulations proposed to date have been justified 50-100 per year(Figure 4e,f,i,j,Table 1).The spatial positive based on its large-scale feedback to temperatures,sea levels, correlations between increases in near-surface CO2 and near- water supply, and global air pollution. No proposed CO2 regulation is based on the potential impact of locally emitted surface 03 and PM2.5 were both visually apparent(Figure 4) and strongly statistically significant(e.g.,Aug-Oct,r=0.14, CO2 on local pollution as such effects have been assumed p<0.0001 for ACO2 vs 003;r=0.24,p<0.0001 for ACO2 vs not to exist(21).Here,it was found that local CO2 emissions APM2 s)• can increase local ozone and particulate matter due to feedbacks to temperatures, atmospheric stability, water For the U.S.as a whole,the correlations between increases vapor,humidity,winds,and precipitation.Although modeled in CO2 and increases in 03 and PM2.5 premature mortality pollution changes and their health impacts are uncertain, were also both visually apparent(Figure 5)and statistically results here suggests that reducing local CO2 may reduce significant(r=0.31,p<0.0001 for ACO2 vs A03 mortality; 300-1000 premature air pollution mortalities/yr in the U.S. r=0.32,p<0.0001 for ACO2 vs APM2.5 mortality).The Jun- and 50-100/yr in California,even if CO2 in adjacent regions Aug correlation between ACO2 and APM2.5 concentration is not controlled.Thus,CO2 emission controls may be justified (r=0.1,p<0.0001)was weaker than that between ACO2 and on the same grounds that NOR, HC,CO, and PM emission APM2.5 mortality,since local CO2 fed back to meteorology, regulations are justified. Results further imply that the as- which fed back to PM2.5 outside of cities as well as in cities, sumption behind the"cap and trade"policy,namely that CO2 but few people were exposed to such changes in PM2.5 outside emitted in one location has the same impact as CO2 emitted • of cities. Nevertheless, both correlations were strongly in another,is incorrect,as CO2 emissions in populated cities statistically significant. have larger health impacts than CO2 emissions in unpopulated VOL.44,NO.7,2010/ENVIRONMENTAL SCIENCE&TECHNOLOGY•2501 .I • 1 � a)A CO by Jun-Au w-wr o anCO +20 000) (6) Rigby,M.;Toumi,R.;Fisher,R;Lowry,D.;Nisbet,R G.First continuous measurements ofCO2 mixing ratio in central London usingacompact diffusion probe.Atmos.Environ.2008,42,8943-8953. • 190000 45 (7) Knowlton,K.;Rosenthal,J.E.;Hogrefe,C.;Lynn,B.;Gaffin,S.; 40 Goldberg, R.; Rosenzweig,C.; Civerolo, K.; Ku, J.-Y.; Kinney, (( P.L.Assessing ozone-related health impacts under a changing climate.Environ.Health Perspeer.2004,112,1557-1563. 40 x 35 (8) Mickley,L.J.;Jacob,D.J.;Field,B.D.;Rind,D.Effects of future climate change on regional air pollution episodes in the United 2000030 States. Geophys. Res. Lett. 2004, 31, L24103, doi:10.1029/ 2004GL021216. 0 25 (9) Steiner,A.L.;Tonse,S.;Cohen,R.C.;Goldstein,A.H.;Harley, R.A.Influence of future climate and emissions on regional air 120 100 $Q quality in California.J.Geophys.Res.2006,111,D18303,doi: 10.1029/2005113006935. b A 03 deaths Jun-Au, w•-wio ernCO +100 (10) Unger,N.;Shindell,D.T.;Koch,D.M.;Ammann,M.;Cofala, J.;Streets,D.G.Influences of man-made emissions and climate changes on tropospheric ozone,methane,and sulfate at 2030 20 45 from a broad range of possible futures.J.Geophys.Res.2006, I11,D12313,doi:10.1029/2005J0006518. 40 (11) Liao,H.;Chen,W.-T.;Seinfeld,J.H.Role of climate change in 1{} global predictions of future tropospheric ozone and aerosols. 3.5 J Geophys.Res.2006,111,D12304,doi:10.1029/2005JD006852. (12) Bell,M.L.;Goldberg,R.;Hogrefe,C.;Kinney,P.L;Knowlton, 0 30 4 K.;Lynn,B.;Rosenthal,J.;Rosenzweig,C.;Patz,J.A.Climate change, ambient ozone, and health in 50 U.S. cities. Clint. 25 - Change 2007,82,61-76. (13) Jacobson,M.Z.On the causal link between carbon dioxide and I�/) Illi) air pollution mortality. Geophys.Res. Lett.2008, 35, L03809, do 1:10.102 9/20 07 G L031101. c)A PN1,.deadis Jun-Au w'-w,`o etnCO (+660) (14) Jacobson,M.Z.;Streets,D.G.The influence of future anthro- pogenic emissions on climate,natural emissions,and air quality. J.Geophys.Res.2009,114,008118,doi:10.1029/2008JD011476. 45 (15) Jacobson,M.Z GATOR-GCMM:2.A study of day-and nighttime s ozone layers aloft,ozone in national parks,and weather during the 50 at) SARMAP Field Campaign.J Geophys.Res.2001,106,5403-5420. (16) Jacobson,M.Z;Kaufmann,Y.J.;Rudich,Y.Examining feedbacks 35 of aerosols to urban climate with a model that treats 3-D clouds with aerosol inclusions.J.Geophys.Res.2007,112,doi:10.1029/ Q 3Q - 2007JD008922. - (17) Jacobson, M. Z. The short-term effects of agriculture on air pollution and climate in California.J Geophys.Res.2008,113, ' D23101,doi:10.1029/2008113010689. III -120 -100 -80 .. (18) Global Forecast System.1°x1°reanalysis fields;2007;http://nomads. ncdc.noaa.gov/data/(accession July 1,2008). FIGURE 5. Same as Figure 2 but for the U.S. domain and for (19) Estimating mortality risk reduction and economic benefits from Jun-Aug. Numbers in parentheses Jun-Aug averaged changes controlling ozone air pollution;National Research Council,The )for CO2)or total Changes(for mortalities)over the domain. National Academies Press:Washington,DC,2008. (20) Integrated science assessment for particulate matter, Second areas.As such,CO2 cap and trade,if done,should consider the External Review Draft;U.S.Environmental Protection Agency location of emissions to avoid additional health damage. 2008;EPA/60018-08/139B. (21) Johnson,S.L.California State Motor Vehicle Pollution Control Acknowledgments Standards;Notice of Decision Denying a Waiver of Clean Air SupportcamefromtheU.S.EnvironmentalProtectionAgencyAct Preemption for California's 2009 and Subsequent Model Year Greenhouse Gas Emission Standards for New Motor grant RD-83337101-0,NASA grant NX07AN25G,and the NASA Vehicles.Fed.Register 2008, 73(45), 12,156-12,169. High-End Computing Program. (22) AIR Data,United States Environmental Protection Agency:2006; http://www.epa.gov/air/data/ (accession August 1,2009). Supporting Information Available (23) Thurston,G.D.;Ito,K.Epidemiological studies of acute ozone Model and emissions used for this study(Section 1),feedbacks exposures and mortality.J.Exposure Anal.Environ.Epidemiol. in the model(Section 2),and a description of simulations(Section 2001, 1I,286-294.H 3).This materiaiisavailablefneeofch viatheIntemetath // (24) oyert,D.L;Heron,M.P.;Murphy,S.L.;Kung H.-C.National tip; Vital Statistics Reports;Vol.54,No.13,2006.http://www.cdc. pubs.acs.org. gov/nchs/fastats/deaths.htm(accession August 1,2009). (25) Merrill,C.T.;Elixhauser,A.HCUP Fact Book No.6:Hospitaliza- Literature Cited don in the United States,2002;Appendix,2005.www.ahrq.gov/ (1) Idso,C.D.;Idso,S.B.;Balling,R.C.,Jr.The urban CO2 dome data/hcup/factbk6/factbk6e.htm(accession August 1,2009). of Phoenix,Arizona.Phys.Geogr.1998, 19,95-108. (26) Mannino,D.M.;Homa,D.M.;ease mi,L J.;Moorman,J.E.;Gwynn, C.;Redd,S.C.Center for Disease Control Morbidity and Mortality (2) Idso,C.D.;Idso,S.B.;Balling,R.C.,Jr.An intensive two-week Weekly Report.Surveil!.Summ.2002,51(SS01), 1-13. study of an urban CO2 dome in Phoenix,Arizona,USA.Atmos. (27) Ostro,B.D.;Tran,H.;Levy,J.I.The health benefits of reduced Environ.2001,35,995-1000. tropospheric ozone inCalifomia.I..Air Waste Manage.Assoc.2006, (3) Balling,R.C.,Jr.;Cerveny,R.S.;Idso,C.D.Does the urban CO2 .56,1007-1021. dome of Phoenix,Arizona contribute to its heat island.Geophys. (28) Pope III,C.A.;Burnett,R.T.;Thun,M.J.;Calle,E.E.;Krewski,D.; Res.Lett.2001,28,4599-4601. Ito,K.:Thurston,G.D.Lung cancer,cardiopulmonary mortality, (4) Gratani,L.;Varone,L.Daily and seasonal variation of CO2 in and long-term exposure to fine particulate air pollution.JAMA the city of Rome in relationship with the traffic volume.Atmos. 2002,287,1132-1141. Environ.2005,39,2619-2624. (29) Pope III,C.A.;Burnett,RT.;Thurston,G.D.;Thun,M.J.;Calle,E.E.; (5) Newman,S.;Xu,X;Affeic H.P.;Stolper,E;Epstein,S.Changes in Drewski,D.;Godleski,I.J.Cardiovascular mortality and long-term mixing ratio and isotopic composition of CO2 in urban air from the exposure to particulate air pollution.Circulation 2004,109,71-77. Los Angeles basin,California,between 1972 and 2003.J Geophys. • Res.2008, 113,023304,doi:10.1029/2008JD009999. ES903018M 2502•ENVIRONMENTAL SCIENCE&TECHNOLOGY/VOL.44,NO.7,20W Urban CO2 domes increase deaths,poke hole in'cap-and-trade'proposal,researcher says VtIiC 2/16/12 11:06 AM 0 '... (Iiit 2.- . STANFORD A04,0PRwAtto' @42`'"x `' UNIVERSITY News Search news.stanford.edu ��r e All News Faculty & Staff News For Journalists About Us Stanford Report, March 16, 2010 SHARE THIS STORY Urban CO2 domes increase deaths, poke hole in 'cap-and-trade' proposal, Stanford 28 5 researcher says Recommend Tweet Stumble Email In the first study ever done on the local health effects of the domes of carbon dioxide RELATED TO THIS STORY that develop above cities, Stanford researcher Mark Jacobson found that the domes increase the local death rate. The result provides a scientific basis for regulating ' Carbon dioxide domes hurt health; 9 9 CO22 affect'cap and trade' emissions at the local level and points out a significant oversight in the carbon dioxide Jacobson's 'Enhancement of "cap-and-trade"proposal that was passed by the House of Representatives in June Local Air PollutionrUrban Urban CO2 2009 and is awaiting definitive action by the Senate. Domes,' in Environmental Science and Technology BY LOUIS BERGERON Jacobson testifies before EPA on California waiver hearing Everyone knows that carbon dioxide,the main greenhouse gas driving climate change, is a global problem. Now a Stanford study has shown it is also a local problem, hurting city dwellers' health Mark Z. Jacobson's website much more than rural residents', because of the carbon dioxide "domes"that develop over urban EPA website explaining areas. That finding, said researcher Mark Z. Jacobson, exposes a serious oversight in current cap- and-trade proposals for reducing emissions of heat-trapping gases,which make no distinction based American Clean Energy and Security Act(H.R. 2454) on a pollutant's point of origin. The finding also provides the first scientific basis for controlling local carbon dioxide emissions based on their local health impacts. "Not all carbon dioxide emissions are equal,"said Jacobson, professor of civil and environmental engineering. "As in real estate, location matters. MORE STANFORD NEWS 0esulalso support the case that California presented to the Environmental Protection Agency in ts h 2009,asking that the state be allowed to establish its own carbon dioxide emission standards RECENT Jacobson, director of the Atmosphere/Energy Program at Stanford, testified on behalf of California's Trustees give site OKs for SLAC science waiver application in March 2009.The waiver had previously been denied, but was reconsidered and end gyer support building and campus energy granted subsequently. The waiver is currently being challenged in court bycenter industry interests seeking to overturn it. State-owned oil companies increase Jacobson found that domes of increased carbon price volatility and pollution,Stanford acvrc researcher says dioxide concentrations-discovered to form Y above cities more than a decade ago-cause Vow local temperature increases that in turn increase Steven A.Denning elected chair of okt— p the amounts of local air pollutants,raising Stanford University Board of Trustees concentrations of health-damaging ground-level 4 ozone as well as particles in urban air. President Obama gives the National WI/ Death-rate comparisons Humanities Medal to Stanford literary / scholar Ramon Saldivar - t ' In modeling the health impacts for the contiguous r/ia 48 states,for California and for the Los Angeles Stanford scholar chronicles evolution of area, he determined an increase in the death rate Chinese love through texts from air pollution for all three regions compared to what the rate would be if no local carbon MORE STORIES Researcher Mark Jacobson's study contradicts the dioxide were being emitted. cap-and-trade proposal's assumption that there is The results of Jacobson's stud no difference in the impact of carbon dioxide, y are presented in regardless of where it originates. a paper published online by Environmental Science and Technology. The cap-and-trade proposal passed by the U.S. House of Representatives in June 2009 puts a limit on the amount of greenhouse gases that each type of utility, manufacturer or other emitter is allowed to produce. It also puts on each ton of emissions a price tag that emitters will have to pay to the federal government. 4 ie bill passes the Senate intact, it will allow emitters to freely trade or sell their allowances ng themselves, regardless of where the pollution is emitted. http://news.stanford.edu/news/2010/march/urban-carbon-domes-031610.html Page 1 of 2 U41.3an CO2 biomes increase deaths,poke hole in'cap-and-trade'proposal,researcher says • 2/16/12 11:06 AM lNith that logic,the proposal prices a ton of carbon dioxide emitted in the middle of the sparsely .( populated Great Plains, for example,the same as a ton emitted in Los Angeles, where the population is dense and the air quality already poor. • The cap-and-trade proposal assumes there is no difference in the impact of carbon dioxide, gardless of where it originates,"Jacobson said. "This study contradicts that assumption." "It doesn't mean you can never do something like cap and trade,"he added. "It just means that you �r� ° � r;ve( h�-.,ons need to consider where the CO2 emissions are occurring." First look at impacts Jacobson's study is the first to look at the health impacts of carbon dioxide domes over cities and his results are relevant to future air pollution ,t,,,:;.,%.,,,-,r,;) iii 1,.i regulations. Current regulations do not address • the local impacts of local carbon dioxide _ emissions. For example, no regulation considers - the local air pollution effects of carbon dioxide that would be emitted by a new natural gas ""*i"° power plant. But those effects should be considered, he said. In modeling the health impacts for the Los Angeles area,Jacobson determined an increase in the death "There has been no control of carbon dioxide rate from air pollution compared to what the rate because it has always been thought that CO2 is a would be if no local carbon dioxide were being global problem,that it is only its global impacts emitted. that might feed back to air pollution,"Jacobson said. In addition to the changes he observed in local air pollutants,Jacobson found that there was increased stability of the air column over a city, which slowed the dispersal of pollutants,further adding to the increased pollutant concentrations. Jacobson estimated an increase in premature mortality of 50 to 100 deaths per year in California and 300 to 1,000 for the contiguous 48 states. "This study establishes a basis for controlling CO2 based on local health impacts,"he said. ilkrent estimates of the annual air pollution-related death toll in the United States is 50,000 to ,000. The U.S. Environmental Protection Agency and NASA provided financial support for this research. Media Contact Louis Bergeron, Stanford News Service: (650)725-1944,louisb3l stanford.edu Contact Directories Maps&Directions ©Stanford University.All Rights Reserved. Stanford, CA 94305. (650) 723-2300. • http://news.stanford.edu/news/2010/march/urban-carbon-domes-031610.html Page 2 of 2 On the causal link between carbon dioxide and air pollution mortality 1 2/16/12 11:03 AM )••/1(.0 112- j2ktulii4lockgibHe •Qcoktuler .-}qt- On the causal link between carbon dioxide and air pollution mortality(a).Supplementary Material( daf). OPted paper on the enhancement of local air pollution by urban CO2 domes(link) p-ed,San Francisco Chronicle. 'Why California should be allowed to control carbon dioxide(link)' Some media reports on the study http://sciencenow.sciencemag.org/cgi/content/full/2008/229/2 http://www.usatoday.com/weather/climate/globalwarming/2008-02-27-pollution-deaths N.htm http://www.ibnIive.com/news/co2-new-member-in-the-killer-gases-group/59673-17.html http://www.upi.com/NewsTrack/Science/2008/02/27/study co2 can cause air pollution deaths/9068/ http://www.foreignpolicy.com/users/login,php? story id4187&URL=http://www.foreignpolicy.com/story/cros,php?story id=4187 http://www.thaindian.com/newsportal/health/global-warming-is-twice-as-fatal-as-previously- believed 10021989.html http://www.eurekalert.org/pub releases/2008-02/agu-ajh022608.php http://www.sciencealert.com.au/news/20080502-16848-2.html http://www.carbonfree.co.ulacf/news/wk03-08-0002.htm http://media.www.californiaaegie.com/media/storaee/paper981/news/2008/01/16/CitvNews/Stanford,Study.Shows.Greenhouse.0lases.Have.Adverse.Health.Fffects- 3154030.shtml Jutp://www.climatechangecorp.com/content.asp?ContentID=5103 http://www,dailydemocrat.com/news/ci 7961321 bttp://tracypress.com/content/view/13068/2244/ http://scitizen.com/screens/blogPage/viewBlog/sw viewBlog.php?idTheme=l 3&idContribution=1392 http://www.r744.com/news/news ida273.php http://www.latimes.com/news/local/la-me-epa11 jan 11.1.5236978.stoty?coll=la-headlines-california http://daily.stanford.edu/article/200811/11/emissionsTiedToDeath bttp://environmentalresearchweb.org/cws/article/research/32401 i I./ . . . • . II- •n ,is O. * .i• .94J1= 11:1 1 L \ A it II , - 1'w http://www.exduco.net/news.php?id=2790 http://www.chemie.de/news/e/76239/ http://www.news-medical.net/?id=33956 http://www.iol.co.za/index.php?set id=1&click id=31&art id=nw20080106215843590C377761 Ø//ww//wwwcontracostatimescom/opinion/ci 7911179?nclick check=1 w.medicalnewstodaycom/articles,93050php //www,insidebayarea.com/bayarealiving/ci 7911179 http://www.themonevtimes.com/news/20080104/carbon dioxide linked to deaths-id-1015310.html http://www.medicalnewstoday.com/articles/93050.php http://www.presstv.ir/detail.aspx?id=37506&sectioned=3510210 http://www.grist.org/news/2008/01/041polIution deaths/ Jtttp://www.reuters.com/article/environmentNews/idUSN0433000720080104 http://uk.reuters.com/article/environmentNews/idUK NO433000720080104 http://in.reuters.com/articl a/worldNews/idlNlndia-31255820080104 http://www.earthtimes.ore/articles/show/169105.html http://www.bloomberg.com/apps/news?ped=20601081&sed=adHhKe6z2fXY&refer=australia http://www.upi.com/NewsTrack/Science/2008/01/04/carbon dioxide linked to deaths/5602/ http://www.dailvindia.com/show/204937.php/Carbon-dioxide-emissi ons-linked-to-increased-human- mortality http://www,star-telegram.com/national news/story/390138.html http://www.thaindian,com/newsportai/health/carbon-dioxide-emissions-linked-to-increased-human- mortality 10011272.html http://news-service.stanford.edu/news/2008/january9/co-010908.htna http://blog.wired.com/cars/2008/01/stanford-scient.html http://news,mongabay.com/2008/0103-poll ution.h tm l http://www.almanacnews.com/news/show story.php?id=1487 http://www.sciencecentric.com/news/08010334.htm http://www.sciencedailv.com/releases/2008/01/080103135757.htm http://www.physorg.com/news118591612.html http://www.paloaltoonline.com/news/show story,php?id=6741 http://www.eurekalert.org/pub releases/2008-01/su-fst010308.php http://www.contracostatimes.com/bayandstate/ci 7870648?nclick check=1 http://www.modbee.com/local/story/168723.htm1 http://www.sacbee.com/101/story/606193.htrui http;//www.fresnobee.corri/263/story/296174.html • www.thecheers.org/news/Science/news 6175 Carbon-dioxide-emissions-linked-to-increased-human- // lity.html l://www,star-telegram.com/national news/story/390138.html http://www.stanford.edu/group/efmh/Jacobson/Articles/V/Ve.html Page 1 of 2 On the causal link between carbon dioxide and air pollution mortality 2/16/12 11:03 AM imp://Www.hul y.com/46448/study-link-increased-mortality-carbon-dioxide-emissions iyttp://www.newscientist.com/blog/environment/2008/01/climate-death-toll-ignored-by-us-agency.html http://www.zeenews.com/articles.asp?aid=416615&sid=ENV&ssid=28 http://www.earthtimes.org/articles/show/169105.html .://www.thedaiIygreen'com'eflyjrOnmeflt al-news/latest/global-warming-deaths-47010409 ://www.mercurynews.com/ci 7869766?source=most emailed&nclick check=1 Return to Mark Jacobson's Home Page Number of visitors to this site since 12/12/07: 2,654 • 1111 http://www.stanford.edu/group/efmh/jacobson/Articles/V/Ve.html Page 2 of 2 "P20 H- vitrwhiA;) III 1.644 10Q ,� te&y.0.6.44_ • ttp://writemark.blogspot.com/2012/0 1/what-you-cant-see-can-still-hurt- you.html WHAT YOU CAN'T SEE CAN STILL HURT YOU - nanoparticles Every sane person now accepts that asbestos and smoking aren't good for you. Mind you it's taken millions to die to `prove' it. Following on from an article on this site — Out of sight is not out of mind, Graham Cliff, asks whether the dangers of nanoparticles are now being similarly ignored. Graham is a Honorary Senior Research Fellow at the School of Earth, Atmospheric and Environmental Sciences at the University of Manchester. His email • is zen177374Czen.co.uk Would the late Doctors Richard Doll, John Knox, Irving Selikoff and Vernon Timbrell, tolerate the present state of affairs with respect to the regulation of anthropogenic nanoparticles, that prevails today in the twenty first century? As a non-smoking, so called "expert" in the identification of asbestos, I don't believe so. Professor Sir Richard Doll's obituary, in the Telegraph, 25 Jul 2005 (1), described him as an epidemiologist and former Regius Professor of Medicine at Oxford University. He was one of the first two scientists to link smoking, with lung • cancer, in a report in the British Medical Journal of 1950, • which concluded "The risk of developing the disease increases in proportion to the amount smoked". This early study was the first in the world to show that smoking could cause not only lung cancer but also heart attacks. Doll subsequently collaborated with Dr. John Knox (2), Chief Medical Officer with Turner Brothers Asbestos of Rochdale, and with others, to publish a series of papers analyzing the mortality of asbestos workers with reference to the incidence of lung cancer. In retrospect, the time lag in each case between initial demonstrations and general acceptance of the hazard seems to be inordinately long. In part, these delays subsequently resulted from protests, drawn-out court actions and biased • scientific investigations by vested interests. In some cases, rearguard actions continued long after courts had started awarding damages for the illnesses. At the present stage of knowledge, relating exposure to sub PM2.5 particulates and adverse effects on health, it is tempting to draw a parallel with earlier discoveries in the loth century, of factors with adverse health effects, e.g. ionizing radiation, radioactivity, heavy metals, certain organic compounds and not just cigarette smoking and asbestos. It is to be hoped in this instance that the appropriate responses will be put in place in a more timely fashion, unpalatable, as many aspects will undoubtedly be. (3) In summary, views about some of the questionable benefits of ignoring air quality regulation today, when set against 0 some of the potential costs to health, bear comparison with failure in the loth century. Taking effective precautionary action to avoid the plausible hazards of smoking and aerosol asbestos exposure would have saved much health harm, reduced treatment costs and other attendant inability to work costs. The precautionary principle was just not applied with any rigour. Professor Vyvyan Howard, of Ulster University, NI, has commented on poor air quality since before 2004, when he is quoted as remarking that "nanoparticles can cross the blood- brain barrier" Other studies have linked nanoparticles to cardiovascular disease, asthma, lung fibrosis and Alzheimer's disease (dementia). (4) • Also in 2004, Professor Ann Dowling, in a Royal Society Report stated that "Nanoparticles can behave quite differently from larger particles of the same material and this can be exploited in a number of exciting ways. But it is vital that we determine both the positive and negative effects they might have." (5) The late Dr. Vernon Timbrell commented upon the warnings about the smallest of particles being too often totally ignored, in 1996. Perhaps he was concerned that, as with smoking, he was seeing with asbestos the need to wait until victims existed to prove that warnings were justified? My own early research involved the analysis of aerosol asbestos • particles, and I subsequently analysed aerosols containing • combustion products, which can massively reduce air quality with its smoke emissions, regulated to only PM2.5. From December 1971 I was able to examine particles to about 5onm in the first Analytical Electron Microscope, the AEI EMMA -4. From October 1973 until April 1974, in the Reserve Mining versus the EPA court case (the longest running US environmental court case), the doctors from Mount Sinai, including Dr. Irving Selikoff, could not then do this. They had declared that discovering an infinitesimal particle (an asbestos fiber) was "incomparably difficult"! (6) My techniques for aerosol particle analysis were developed to achieve analysis to nanometre dimensions and atom analysis • limits. With my colleague Peter Kenway, I published the engineering design criteria needed to do this in 1989. (7) It has taken 22 years for this to be realised in the modern FEI ChemiSTEM. (8) It will be capable of achieving particle analysis of nanoparticles and fully characterise them. Although today, the only nanoparticles it seems to analyse are catalysts. It does not appear to be used to analyse potentially harmful nanoparticles from aerosols. Perhaps because this does not provide a profit? I hope not and I hope that the many warning of the • inadequacy of regulation of nanoparticles is recognised. Professor John Dearden, of Liverpool John Moores University has remarked that the danger from very fine particulate emissions is only now being realised, and very fine particulates cannot be filtered out effectively from (the likes of) incinerator gaseous emissions. (9) We now know that combustion products cause cancer and heart attacks. Dr. Andrew Lucking has postulated that in his home city of Edinburgh, if diesel buses had filters to remove small particles, heart attacks would stop! (io) We are increasing anthropogenic nanoparticle emissions, with no adequate control for any particle size smaller than • PM2.5. Thirty-five years ago, in 1977, it was realised by Manchester University asbestos "expert" Professor Jack Zussman that "any material to which people are exposed on a large scale needs to be tested for its physiological effects". (11) The material to which he referred was processed crushed mineral material — that is small particles of material exposed to the public on a massive scale! The potential for causing harm to human health, from unregulated nanoparticles, many of which are anthropogenic, is immense and insufficient research is being applied to this problem. Most of the reasons I have been • given, privately, are financial. I simply want to know who will • be paying the bill in the future for the failure to act now. We are supposed to learn from history but by the time something is done we may well be just too late for the many innocent victims of a failure to act today? Yours sincerely, Graham Cliff. References — 1) Professor Sir Richard Doll, obituary, Telegraph, 25 July 2005. http://www.telegraph.co.uk/news/obituaries/1494745/Prof • essor-Sir-Richard-Doll.html 2) Dr. John F. Knox, obituary, Oxford Journal of Occupational Medicine, London, 1973.http://occmed.oxfordjournals.org/content/23/1/28.ext ract 3) Dr. Barry Clark, text adapted from "A rationale for the mandatory limitation of outdoor lighting", April, 2009. Original text from the author as a 111 page PDF. (Email - contact Graham Cliff) 4) Prof Vyvyan Howard, "What they don't know could hurt you", Hazards magazine, 87, 2004. http://www.temas.ch/Impart/ImpartProj.nsf/3932C3A5438 4443DC1257368003A8D8o/$FILE/nanotechsafety.pdf?Ope nElement&enetarea=01 • 5) Professor Ann Dowling, Royal Society Report, 29 July 2004. Quote in Hazards magazine, 2004 http://www.hazards.org/nanotech/safety.htm 6) Dr. Thomas Huffman, "Enemies of the people: Asbestos and the Reserve Mining Trial", 2005. http://collections.mnhs.org/MNHistoryMagazine/articles/5 9/v59io7p292-3o6.pdf 7) Cliff& Kenway, "The future of AEM: Toward atom analysis", 47th EMSA, 1989. http://www.facebook.com/photo.php?fbid=2(316280247781 &set=a.1662848572210.2087342.1267103o4o&type=3&thea ter 8) ChemiSTEM — FEI Inc, advertising PDF, 2011. http://www.fei.com/uploadedFiles/Documents/Content/LR _Bro_ChemiSTEM.pdf • 9) Prof John Dearden, Parliamentary Waste Strategy Memorandum, DEFRA, 2007. http://www.publications.parliament.uk/pa/cm2o0910/curse lect/cmenvfru/23o/23owe57.htm 10) Dr. Andrew Lucking, "Filtering fumes could reduce heart attacks", Edinburgh University, 20 April 2011. http://www.ed.ac.uk/news/all-news/fumes-120411 11) Professor Jack Zussman, Proceedings NBS Asbestos Workshop, July 1977. http://tobaccodocuments.org/pm/2o63104836- 4849•html?zoom=75o&ocr_position=above_foramatted&sta rt_p ag e=i&e n d_p ag e=l4 S