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2012- March
4 Jefferson County Public Health Performance Measures 2011 Year-End Report FOOD SAFETY PROGRAM lISSION: The mission of the Food Safety Program is to minimize the risk of the spread of disease from improperly prepared, stored or served foods handled in commercial retail settings and community events. GOALS FOR FY 2011 1. Provide classroom food safety instruction for all food service workers. 2. Assure minimum sanitary standards are observed in all food service establishments and establishments operate in compliance with codes. 3. Provide basic food safety information to the general public. OBJECTIVES FOR FY 2011 1. Offer food safety training at a frequency and in locations convenient to food service workers. 2. Review all new food service establishments for compliance with state and county requirements. 3. Inspect all food service establishments at a frequency adequate to assure compliance with state and local regulatory requirements. 4. Offer educational materials and technical assistance to non-regulated community groups and organizations where requested. 5. Prevent septic system failures at food establishments by assisting with enforcement of operations and monitoring requirements. 6. Provide additional education to food workers through food/tobacco newsletters and other methods. FOOD SAFETY PROGRAM STATISTICS • Food Worker Education 2004 2005 2006 2007 2008 2009 2010 2011 2011 Planned Actual Total#of food workers trained 1,128 1,044 1,100 1,205 1,314 1,137 1269 1,250 1,367 #of Food Workers trained in class 1,128 1,044 1,100 1,205 1,314 1,137 1,269 -- 674 #of Food Workers trained on-line New Category Added in 2011 693 #of food worker classes at Health Department 52 52 52 52 52 61 82 60 42 #of food worker classes at other locations 18 20 25 35 31 21 10 6 9 #of Instructor-led classes 70 72 77 87 83 82 92 66 51 2011 2011 ' Annual Food Service Establishments 2004 2005 2006 2007 2008 2009 2010 Planned Actual %of required inspections completed New Category Added in 2009 83% 85% 85% 97% #of food establishment permits 240 265 270 270 237 228 235 210 232 #of complex menu food establishments New Category Added in 2011 111 #of non-complex menu food establishments New Category Added in 2011 121 # of required inspections completed 360 352 352 350 217 299 249 309 331* # of re-inspections required due to critical 32 33 70 45 0 34 6 30 2 violations. # of Pre-opening Inspections done New Category Added in 2011 41 #of complaints received and resolved 20 25 35 1 33 I 32 outine Inspections Only. Pre-opening inspections and complaint inspections were removed from this category and individually egorized. 1 of 4 Temporary Food Service Establishments 2004 2005 2006 2007 2008 2009 2010 2011 2011 Planned Actual #of temporary food service permits 73 75 80 85 17 74 82 80 147 Food Program Administrative Tasks 2004 2005 2006 2007 2008 2009 2010 2011 2011 Planned Actual #of establishments receiving Outstanding 28 41 43 40 89* 38 40 33 40 Achievement Awards _ #of plan reviews done New Category Added in 2011 43 #of plan reviews that opened New Category Added in 2010 16 24 41 * Awards not issued this year due to staff changes. Number reflects the would-be recipients. SUMMARY OF KEY FUNDING/SERVICE ISSUES • Food Safety Program activities are funded solely through permit and technical assistance fees. Food Worker Education • The food worker education options broadened in June providing not only staff provided classes but also on-line classes. Annual Food Service Establishments • The percent of completed required food inspections are now more in line with expectations. • The number of permitted establishments as been relatively stable since 2008. • This is the first year that we are tracking the number of plan review completed for new or remodeled establishment or from a change of ownership in an establishment. Temporary Food Service Establishments • Early in the year, it was determined that there were two items in the food fee schedule that needed attention: a discrepancy related to permitting temporary events, and two categories with incorrect fees. • Initial review of the statistics for temporary food permits would presume that 2011 had a significant increase in temporary events. • Food Program Administrative Tasks • The team determined that the existing database is not adequate to meet the needs of the program. The program intends to switch from KIPHS to Tidemark sometime early in 2012. STUDY/ANALYSIS Funding of the program became particularly highlighted when the fee schedule was opened for changes this year before the Board of Health. Food establishment owners that attended or participated in the discussion were overwhelmingly concerned about shrinking profits and increasing operating costs, including permit fees. Environmental Health has made a commitment to evaluate our programs to ensure that fees are in line with appropriate program expenses. Food Worker Education The overall number of food workers trained is the highest number that has ever been recorded. This is partly due to the implementation of the on line food worker card program. Since June, when on-line classes became available, approximately 50%of the total workers trained were on-line. The number of instructor-led classes was also reduced by 45%. This option minimized staff time devoted to this task, at the expense of completing other priorities in the program. Upon initial start up there were complaints of food workers accessing a fraudulent websites instead of the authorized Washington State site. Staff has worked to educate managers and food workers through mass e-mails,press releases and on site discussions. Fortunately these instances of fraud have been fairly isolated to a short period after implementation. The negative aspect of this is that it limits the time the • food inspector meets with food workers in a non regulatory environment in which educational interaction can be most constructive. 2 of 4 Annual Food Service Establishments The percent of required inspections completed increased 10% (from 87% in 2010 to 97% in 2011). This • can be attributed to the increased staffing provided to the program in 2011 and detailed separation of tasks that allowed for efficiencies. o One person was assigned to complete the plan review and temporary permit review together with specific planned temporary inspections as assigned by the primary food inspector. o The primary food inspector primarily taught food worker classes and completed required inspections. o Weekly meetings of the team brought relevant issues for discussion to the team for evaluation and determination. o The team members were able to refer any issues/conflicts with food managers or owners directly to the Lead. This saved staff time in elimination of lengthy interaction with the public on code interpretation or fee concerns. Plan review,when done properly can preempt food establishment deficiencies that will augment food safety practices. For that reason we have added it as an item in the table. Future evaluation should be done to determine the significance of this task to overall work load. Annual operation and monitoring inspections required of food establishments connected to on-site septic systems was implemented for the first time this year. Overall, it was a year of persistent messaging, oversight, and tracking. With consistent education and training, this will eventually become standard procedure and will lead to better preventative failure of septic systems serving food establishments. Temporary Food Service Establishments Considerable evaluation of the temporary fee structure was undertaken to find an equitable solution for • the public that also allowed for consistent compliance with State Codes. Efforts included: o A survey of the temporary food permit process and associated fee schedules in adjoining counties; o Analysis of our fee structure including undertaking a time study; o A presentation to both the Food Roundtable and the Board of Health; and o Interaction with DOH. Under considerable pressure, a new fee proposal was presented to the Board of Health and adopted in July which added additional categories to the temporary permit fees and corrected previously identified fee categories. Upon thorough evaluation of the temporary permit numbers from past years to 2011 it became evident that past tracking had been incorrect. The number of permits issued almost doubled in 2011. This finding validates what was previously expressed from fee discussions and past practices disregarding the requirement to permit all temporary events. Food Program Administrative Tasks The food team met via webcam with the onsite/drinking water program contracted Tidemark database consultant, and food program representatives from Clallam and Mason Counties. We met to analyze the use of Tidemark as a regional program for food permitting. Mason County already uses Tidemark and their program fields were used as a baseline for evaluation. The decision was made to work toward transitioning from KIPS into a Tidemark platform as soon as funding could be determined. The team approach in the food program continues to provide a benefit both to staff and to the public in • allowing consistent interpretation of code and shared work to ensure goals for planning,permitting and inspecting are met. 3 of 4 '� Jefferson County Public Health Performance Measures 2011 Year-End Report SOLID AND HAZARDOUS WASTE PROGRAM IILISSION: The mission of the Solid Waste Code Compliance and Education Program is to enforce Washington State and Jefferson County solid and hazardous waste code, educate the community about ways to reduce solid and hazardous waste, and to promote the goals and objectives for solid waste reduction and recycling outlined in the Jefferson County Comprehensive Solid Waste Management Plan. GOALS FOR FY 2011 1. Investigate all solid and hazardous waste complaints. 2. Resolve solid and hazardous waste violations through voluntary compliance or citations and legal action when necessary. 3. Reduce the incidence of illegal dumping. 4. Assure all permitted facilities (past&present)meet current regulation standards. 5. Increase awareness of small quantity generator and household hazardous waste (HHW)disposal requirements and options through education and outreach efforts. 6. Promote re-use, recycling, and a reduction in consumption(pre-cycling)to decrease annual tonnage of solid waste. 7. Reduce the incidence and risk of environmental contamination in Puget Sound by promoting use of Best Management Practices (BMPs)by businesses and residents along the water, and increase community awareness of non-point source water pollution. OBJECTIVES FOR FY 2011 1. Coordinate with other agencies to resolve more difficult solid waste violations. 2. Work with the County's Prosecuting Attorney to pursue legal remedy for the most difficult • enforcement cases. 3. Continue to utilize motion-activated cameras at illegal dump sites to identify offenders and work with citizens to identify and clean-up sites quickly. 4. Educate consumers at point of purchase about proper disposal of HHW and non-toxic alternatives. 5. Work with Public Works to promote HHW collection days and educate participants about non-toxic alternatives. 6. Promote reduction of consumption (pre-cycling) and re-use,that recycling is not enough. 7. Actively work with marinas,ports, and businesses within them to ensure use of best management practices and prevent toxic and hazardous wastes from entering the water. 8. Promote businesses that are using BMP's to protect natural resources and reduce waste. 9. Maintain webpage to ensure accurate and current information available to public. 10. Coordinate with other government agencies with regard to education and outreach on solid waste, hazardous waste and stormwater issues. PERFORMANCE INDICATORS 2011 2011 2009 2010 Projected Final SOLID WASTE _ 1 Total number of solid waste complaints received 60 65 60 68 Total number of solid waste violations resolved 90 68 70 81 #of illegal dumps complaints received 14 11 12 14 #of illegal dumps complaints resolved 19 10 12 12 0 # of citations/tickets issued 24 5 <5 8 #of court hearings attended 19 2 <5 7 1 of 3 Tons/cubic yards of solid waste removed/recycled 55+tons Approx. 50 Approx 25 through compliance efforts(not including junk vehicles) Total number of solid waste violations awaiting legal 1 — 2 1 2 • action/abatement # of warrants of abatement obtained/completed 0 0 1 1 # of Jeff. Co. permitted facilities meeting current 8 of 9 8 of 8 8 8 regulation standards(out of 8)(1) Total number of active EnviroStars businesses(Out 14 18 21 21 ofl 00 eligible in Jefferson County) # of new EnviroStar businesses 3 5 3 5 #of active Green Businesses 21 26 31 24 # of new Green Businesses 6 6 5 7 #of Junk Cars removed/recycled 139 141 150 35 # of"Amnesty Day"events 0 1 0 0 Tons/yards of solid waste recycled/disposed of during 0 3000 Tires 0 NA "Amnesty Day". South County(2) HAZARDOUS WASTE : 1. ERTS received/investigated 9 Initial Investigations completed See Note(3) 5 Sites awaiting SHA(at end 2011) 8 Site Hazard Assessments completed 4 Local Source Control Visits 9 29 18 19 Spill Kits Distributed 0 0 0 _ 25 (1)At the end of 2008,JCPH broke out several facilities that had previously been lumped together.(Jefferson County Transfer Station, Recycling Center,and closed Municipal Landfill.)This will enable clarification for the purposes of monitoring and permitting.In 2010, Ecology took over the permitting of the Olympic Corrections Bio-solids composting facility,reducing the number of sites to eight. (2)JCPH worked with Washington Department of Ecology to remove and properly dispose of 904 tons of tires from five large sites,at no • cost to Jefferson County.Initial numbers from 2007 were 300 tons.Final numbers for the project by the end of 2008 were 904 tons.JCPH then sponsored a one-day tire-recycling event for county residents that collected an additional 2500 tires. (3)Until now,Site Hazard Assessments(SHA)and Initial Investigations(II)have not been included in the solid waste team's annual projections. STUDY/ANALYSIS Solid Waste Enforcement Solid Waste Complaints JCPH's projections for solid waste complaints were accurate. Overall, case load remains low, but a higher percentage of staff time is spent on difficult and hard to resolve cases which involve multiple citations, court hearings, and warrants of abatement. The number of illegal dumps has decreased since 2005. Illegal dumps appear to be at a steady rate of 12-14 complaints a year. This is surprising given the economic downturn and increased illegal dumping in other counties. The number of junk vehicles also took a dramatic decrease. We attribute the decrease to the Jefferson County Sherriff's Department volunteers who are responding to more requests for junk vehicle removals than in the past. Solid Waste Permitting JCPH staff spent a significant amount or resources on permitted facilities this year with a potential change in the designation of the Port Townsend Paper's Inert Waste Landfill to a Limited Purpose Landfill. This resulted in more than usual staff time spent in meetings and responding to public records requests. • 2 of 3 The Solid Waste Team experienced staff changes at the end of the year with Lori Clark vacating the position for career opportunities in Island County, and Pinky Feria Mingo joining the team. The addition of Pinky increased the teams' capacity to conduct solid waste inspections,permit inspections, and Local Source Control Inspections. Small Business Technical Assistance On-site Technical Assistance JCPH implements three small business technical assistance programs—Local Source Control, Green Business, and EnviroStars. These programs focus on reducing hazardous and solid waste, promoting non- toxic alternatives, and implementing best management practices at businesses that generate or store hazardous materials and hazardous waste. The goal of these programs is to reduce toxics at their source and assist businesses with understanding environmental regulations and managing hazardous materials to prevent contamination. In 2012, JCPH exceeded our projected goals by certifying seven new EnviroStars and eight new Green Businesses, and increasing and expanding the Local Source Control program to a full FTE. The overall number of certified businesses dropped due to several businesses going out of businesses during the economic downturn. Education and Outreach The Solid Waste Education and Outreach team aggressively promoted non-toxic alternatives at community events like Hadlock Days, Earth Day, and at four Household Hazardous Waste Collection Events. The team also developed and distributed several publications on best management practices and advertisements for our EnviroStars Members. These include a Best Management Practices handout, Junk Mail Flyer for reducing junk mail, an EnviroStars and Green Business promotional handout, and several newspaper advertisements for our EnviroStars members. Site Hazard Assessment (SHA) and Initial Investigation (II) The team exceeded grant contracted deliverables for 2010-2011. SHAs and IIs will be part of the 2012 solid aste team projections. There are several sites awaiting SHAs on Ecology's Confirmed and Suspected list. JCPH staff has been prioritizing SHAs that are closest to and pose the most risk to surface water and balancing this with the need to rank historic cases that Ecology transferred to JCPH. At least two sites completed in 2011 required and will likely continue to require significant staff time: The Port Townsend Gun Club and Port Ludlow Well #2. Summary of Key Findings/Service Issues The reduction in funding and staffing of all county departments means we must evaluate priorities and division of labor. Increased inter-departmental cooperation will enable us to accomplish the most with limited funds. Citizens need to be informed about the necessary reduction in and speed of services (i.e.junk vehicle affidavits are not as high a priority as a hazardous waste complaint). Our departments can also stretch the funding by utilizing volunteer/citizen groups where possible. Updated: March 1St, 2012 i 3 of 3 t Jefferson County Public Health Performance Measures 2011 Year-End Report WATER QUALITY DEPARTMENT 4ISSION: The mission of the Water Quality Department is to protect public health by monitoring and responding to threats to water quality in order to protect human health and wildlife habitat by using available local, state, and federal funding effectively and efficiently. GOALS FOR FY 2011 1. Maintain a lake monitoring program to protect the public from the threats of toxic blue green algae. 2. Ensure healthy beach water quality at heavily used public saltwater beaches. 3. Institute actions under a Clean Water District that monitor, protect and enhance water quality. 4. In cooperation with Environmental Health and the Conservation District use awarded state funds to improve water quality in Chimacum Creek,Discovery Bay, Mats Mats Bay and Hood Canal. 5. Use funds awarded by the Centennial Clean Water Fund to initiate pollution identification and correction actions in the Hood Canal watershed. 6. Continue to support a volunteer network of shellfish samplers to monitor for shellfish biotoxins in a timely and cost effective manner. JCWQ will work with Washington Department of Health to communicate risks from the recreational harvest of shellfish to the public. 7. Continue to insure that the stream gauging network is maintained to accurately measure streamflow and water quality in critical streams such as Chimacum Creek, Salmon Creek and Snow Creek. 8. Continue public education on the importance of clean water in Jefferson County focusing on actions citizens can take to keep our water clean and productive. 9. Report to the Commissioners and public through a written report on the state of water quality in Jefferson County. OBJECTIVES FOR FY 2011 1. Continue to implement a lake monitoring program and use state funding to determine the causative factors involved in local blue-green algae blooms. Secure state funding for remedial actions to stop toxic blue green algae blooms as appropriate. 2. Monitor water quality at public swimming beaches on a weekly basis during the swimming season to protect public health. 3. In partnership with the Jefferson County Conservation District complete the tasks outlined in the scopes of work of the Chimacum Creek, Discovery Bay, Mats Mats Bay and Hood Canal Centennial Clean Water Fund funded programs. PERFORMANCE INDICATORS: 2006 2007 2008 2009 2010 2011 2011 Planned Actual Lakes monitored for cyanobacteria 9* 9* 3 3 3 3 6 Water quality stations monitored:Chimacum Creek 0 40 40 28 28 0 0 Water quality stations monitored: Salmon&Snow Creeks 0 17 0 19 19 19 19 Water quality stations monitored: Hood Canal watershed 0 0 0 0 0 50 0 Miles of shoreline surveyed for pollution N/A 5 49 76 77 71 89 Marine water quality stations monitored N/A 7 7 7 17 17 17 Sanitary surveys completed N/A N/A N/A 259 241 450 418 Beaches monitored for shellfish safety 7 7 7 7 7 7 7 Swimming beaches monitored 0 2 3 4 3 3 6 0 Stream gauges maintained 8 8 9 8 8 8 7 *Monitored but not sampled for toxins 1 of 4 •s- 4 i STUDY/ANALYSIS Performance measures were re-evaluated in 2011 to more accurately reflect new water quality goals and objectives. The original measures are included here for comparison to previous goals and objectives but will be edited for 2012 planning. • Lakes Cyanobacteria Bluegreen algae blooms in 2011 were more extensive than in 2010. Two new lakes needed monitoring: Silent Lake and Crocker Lake. In addition, a private pond was sampled due to water quality concerns. The department will try to extend the amount of monitoring in the future to accommodate additional lakes but may have to limit the extent to which any one lake is studied in depth. The main goal of the lake monitoring program will be on public notification of health risks. A lack of available grant funding for 2012 has caused the department to scale back winter monitoring and stretch remaining grant funds to a second year. If funding is not available for 2013 the program may have to be drastically reduced. Water Quality Monitoring Chimacum Creek and Discovery Bay(Salmon and Snow Creeks) stream stations will continue to be monitored by the Conservation District every other year on a rotating basis through funding available through 2014. Funding source changed from Ecology to EPA. The CD began a Microbial Source Tracking project in Chimacum Creek to help delineate human versus ruminant sources of fecal coliform bacteria. In addition,the CD will begin monitoring Hood Canal Watershed streams and rivers at regular stations. Hood Canal Watershed sampling has been delayed by the lengthy Quality Assurance approval process. It is hoped that monitoring at the end of the project may be extended a few months to compensate. Water Quality facilitated the Community Services contract for the Conservation District and will continue to do so in 2012. A spreadsheet reporting form for Best Management Practices Implementation and water quality sampling was created for the Conservation District. Marine monitoring was accomplished according to schedule in Discovery Bay and Mats Mats Bay in • 2011. For 2012, only Mats Mats is scheduled for monitoring, and that schedule will be more closely coordinated with the monitoring done by the State Department of Health to maximize efficiency in data gathering. Marine monitoring and some shoreline monitoring require a reliable boat to access the sites. The current inflatable owned by the county has limitations in its rough water abilities and reliability issues due to an oversized motor for the tasks required. The department is exploring options for using grant funding to obtain a more suitable boat for the typical sampling conditions we encounter. BEACH sampling was completed at an expanded number of saltwater swimming beaches due to extra funding from the state. New state cuts will necessitate cutting that number down in 2012. Pollution Identification and Correction Shoreline sampling along Hood Canal will be ending in May; Discovery Bay shoreline monitoring ended in 2011. All sampling goals for these projects were met. Mats Mats Bay shoreline monitoring in 2011 turned up higher bacteria counts than anticipated and required additional time and effort to trace potential sources; monitoring and investigation will continue in 2012. New shoreline sampling for the Northeast Jefferson project will be beginning in 2012 after a Quality Assurance plan is created. Increased efforts to complete sanitary surveys at the end of 2011 resulted in more completed surveys than were projected. Sustaining a high rate of completed surveys will be possible only if adequate staffing is available. Many EH staff have been trained to do surveys but few have been available to perform them on a regular basis. Approximately 200 per year will need to be completed in the next two years to stay on track with grant deliverables. • 2 of 4 Water Quality was tasked with investigating all septic and water quality public complaints starting in 2010. In 2011, 57 cases were investigated, a slight increase over 2010. Enforcement measures were taken when septic failures were identified and cases were turned over to the Onsite team for permitting of repairs. A complaint about lack of sanitary facilities on the Big Quilcene River during fishing season resulted in a temporary shellfish closure and a clean-up effort by the county. Water Quality has been communicating with DOH, Federal and State Fish and Wildlife, Ecology and others to try to prevent this from reoccurring in future fishing seasons. The capacity of project partner the Conservation District to handle the implementation of agricultural best management practices and restoration projects was reduced in 2011 by cuts to the State budget. This impacts several of Water Quality's grant projects. Further reductions are likely in 2012 and contingency planning may be needed to achieve project goals. Outreach and Education Improvements were made to the Jefferson County Public Health website to increase the effectiveness of Lakes Status page; one of the most frequently visited Water Quality Department pages. Increased face-to- face communication with lake recreationalists in 2011 seemed effective and will continue. Related project newsletter efforts were consolidated to be more efficient. The department needs to find a solution to creating and maintaining a mailing list for all east county residents for project communication—the current tax assessor database does not work for this volume and style of communication. The East Jefferson Watershed Council website was redesigned in January and a new domain was purchased: www.ejwc.org A Clean Water Projects PowerPoint presentation was created and shown at public meetings and educational sessions. Shellfish Biotoxins Shellfish sampling for biotoxins was completed according to plan in 2011. It was not a year of extensive blooms in Jefferson County. No changes are planned for this program. The County has been communicating with DOH about Diarrhetic Shellfish Poisoning which emerged in Clallam County in 2011. Stream Gages Jefferson County assisted the Department of Ecology in maintaining a network of 7 stream gages in 2011 until Ecology's funding was cut and our participation was eliminated in September. Ecology also planned to eliminate two gages, one at Tarboo Creek and one at Salmon Creek. The County advocated through the East Jefferson Watershed Council to find a solution for keeping the Tarboo gage working. No future maintenance of stream gages is planned. Watershed Planning The County maintained its role in watershed planning through the regular meetings of the East Jefferson Watershed Council (WRIA 17) in 2011. Due to a lack of state funding, EJWC meetings are not planned past June 2012. The County also facilitated a work group in 2011 for the USGS who are preparing a groundwater computer model of Chimacum Creek. The USGS was not able to meet their target of the end of 2011 for completing the model and is now hoping to finish by Spring 2012. The County plans to facilitate the public meetings needed for roll-out of the completed model in 2012, and will be holding a copy of the model for future use by specialists. Clean Water District The department worked with the BoCC to pass a resolution on the Clean Water District Advisory Council. 9 representatives were chosen in 2011. The department plans to hold four meetings of the Council in 2012, create an overall water quality monitoring plan for the County and evaluate current programs. 3 of 4 Regional Partners The Water Quality department attended meetings of the Strait ERN, and read meetings materials of the Hood Canal Coordinating Council to participate in the Puget Sound Partnership Action Area s through the 4) p our region and stay abreast of funding opportunities. The department applied grant State Department of Health. Updated: March 1st,2012 • • 4 of 4 • Board of gfeaCth .Medici Report • _larch 15, 2012 • l Jefferson County Public Health February/March 2012 NEWS ARTICLES 1. "Pertussis confirmed in county," Port Townsend Leader, February 15, 2012. 2. "12 cases of whooping cough reported locally," Peninsula Daily News, February 20, 2012. 3. "Pertussis county grows to nine," Port Townsend Leader, February 22, 2012. 4. "Health board asks for extra air monitor," Port Townsend Leader, February 22, 2012. 5. "Flu season hasn't started on Peninsula, health official says," Peninsula Daily News, February 24, 2012 6. "Whooping cough cases rise to 14 on Peninsula," Peninsula Daily News, February 24, 2012. 7. "Got Birth Control?", Planet Boiler Room, March/April 2012. 8. "Adult pertussis cases seen in Jefferson County," Port Townsend Leader, February 29, 2012. 9. "WIC helps with healthy food for kids," Port Townsend Leader, February 29, 2012. 10. "Elders Urged to Get Pertussis Vaccination," Elder Advocate News & Review, March 2, 2012. • 11. "Whooping cough cases rise in Jefferson County," Peninsula Daily News, March 7, 2012. 12. "March meetings on septic system mandates set," Port Townsend Leader, March 7, 2012 13. "Health hero nominations due," Port Townsend Leader, March 7, 2012. 14. "Are budget cuts to health departments putting our health at risk?," UW Today, February 29, 2012 41 eT Lea ct�,� i t • Pertussis confirmed in county Antibiotic therapy works when started early By Allison Arthur of the Leader home this week. Children "We know that developing symptoms after who have been exposed and having a known exposure to Four cases of pertussis are developing a cough should pertussis is in the pertussis,should contact their in Jefferson County children be seen by a health-care pro- community and, physician to get their child have been lab confirmed vider,McKenzie said. , tested and treated, according within the last week,prompt- "Pertussis responds well to since It s highly to McKenzie. ing Jefferson County Public treatment if it is started early contagious, we Whooping cough is most Health to send notices to in the illness,"she said. serious in infants,especially schools. For specific questions dont expect those too young to be.vac- "We know that pertussis is about health issues, such as it to stay cinated or who aren't fully in the community and, since what to do if your child cannot protected. Teens and adults it's highly contagious,we don't be immunized for health rea- within specific often get a much milder case expect it to stay within spe- sons, McKenzie urged peopleof whooping cough, but they classrooms or cific classrooms or schools," to call their health-care pro- ��. can spread it. said Lisa McKenzie, commu- viders to seek advice. schools. Household members and nicable disease program coor- McKenzie also noted that other very close contacts of a dinator for the county. the pertussis vaccine is thi- Lisa McKenzie person with pertussis should As of Tuesday morning, merosal-free. Some people communicable disease receive antibiotic therapy, McKenzie did not want to dis- have declined to vaccinate program coordinator McKenzie said. Those at close the names of the schools children because of thimero- Jefferson County highest priority for preven- where children have been sal. tive treatment include: all confirmed with what is more On Monday, health offi- household members, infants commonly called whooping cials said the first three chil- for the disease even after 1 year of age and younger, • cough. dren who came down with being exposed, county health pregnant women, those who "So far, we have a pri- pertussis within a matter of director Jean Baldwin said have contact with infants vete school,public school and days were 10 years old and Monday. or pregnant women, and preschools," McKenzie said, younger. With the addition "You don't just let them health-care workers. adding she hadn't even had of a fourth case Monday, the cough. And it's still worth The best way to prevent time to advise one school, so health department changed getting immunized," she said whooping cough is by getting giving out its name would"be that to 15 years old and of treatment with antibiotics the Tdap vaccine,which pro- premature. younger. and vaccinations. tects against tetanus, diph- Notices are being sent In 2011,there was only one The incubation period for theria and whooping cough, case of pertussis reported in pertussis is six to 20 days. according to the health Jefferson County, according Throughout the state, department. All children to the state Department of whooping cough has been a who are not fully immunized Health. growing problem, with the should complete the immu- Pertussis is a highly con- state Department of Health nization series. Adolescents tagious respiratory illness reporting an increase of 50 and adults, including preg- spread by coughing and percent between 2010 and nant women, should get a sneezing. It can affect people 2011.In 2011,there were 912 booster dose of Tdap. of all ages,but is most serious cases in the state,the highest For more information. in infants,according to health in the last six years, officials contact Jefferson County officials. said in a press release. Public Health at 385-9400 It causes cold-like symp- or your local health-care pro- toms, followed by long, severe HEALTH RECOMMENDATIONS vides. coughing that can last for Parents of children who For more informs- weeks. have a cough that. lois lasted tion from the state, go to Children can he treated two or more weeks or who are doh.wa..'ov. • Z ., o ^d aj 'u� bp mom .. aci 3 0@ .0 O y •- 0 C! 0 Z.1 ".8 4 po 'S t0 a o' ao o o c.) O 9Ocfl 4 . INN N. a, 4, 1•+ a, O u7 O Cn '� " °' 0 0 o ,. ai o O c% to , � � ,a . loom 2 «S o q N vi O °)›.., •-• Q 4, O cp y • Ur. �bA.4 o N c„,ct _ ' C. C o c,,s O a U. y g o › o •O Nb ;-8q tw N • o8 . 5 . . S cl u t 04, tuLln 101) wuCao- o '•Z •T ''2'r b4) �' o 0 a. C -d Maw O'5'bC% c, y m bA . la . soba ` �' ai2s".2 ',al � O n. %)p > ut oo a)C ui A CCI • .a a +b . 'c s 4) . b ;-8ay ca N . ›� y .EO O,c3a � C1) C MEWS • o o �1 o -2U n F T* �4 egil% t. 1:Zii.:!:.''..',':.ji X V<, it.,P, '5 (' y e e� a J V1 'C � 4. R 0 ,0 t„O a 3 > o ff N ``" cad w Abp o ,°'n o c. G ti '� �'CD vi '� � a>.+4 U 0 O4 v 400 o a� 0 2 • . Qw0 0 O .. CNI CD d4 0 co +' M G 4E1 .a cC N4:1) • •a N •�'a Fa y • 00 a C 8 Su b pUp SI fas o0 � � o + co, , o + � � 44 w Paai x ca� c a> xao mb '0 >, w u) . Co 0asA cu O U �N cu CO-,, , C• csi •1 • ri Z0� UrIUPIa Pertussis count grows to nine By Allison Arthur of the Leader -"There isn't a unifying in a specific'school, accord- pattern," Baldwin said. ing to a press release. There are now nine con- "They don't know each Anyone who has been firmed cases of pertussis in other, aren't all friends or exposed and develops a Jefferson County, up from from the same church or cough should see a health- three cases earlier this school. There may be some- care provider for testing month. thing, but we haven't found and treatment.Anyone who In 2011, there was only a link yet." has had a cough lasting one confirmed case of per- So far in 2012, the rate longer than two weeks also tussis. of pertussis has more than should be tested. Jefferson County is not doubled from last year And anyone who may alone in seeing an uptick in throughout the state. Last have pertussis should avoid cases and health officials year 116 infants under 1 contact with young children say they suspect a decline year of age contracted per- until being treated, health in immunizations is to tussis; 36 were hospitalized officials urge. blame. and two died, according to Ages of children in By now, they say it is health officials. Jefferson County confirmed "likely to be widespread "The increasing num- with pertussis ranged from throughout out community." ber of pertussis cases infants to middle-school Pertussis, more com- being seen throughout students — 10 months to 11 monly known as whooping Washington state is a years old. cough, has been confirmed direct consequence of the Pertussis is a potentially in two public schools, three declining immunization deadly infection for infants daycares and several pre- rates in children," said under 6 months of age. schools in Jefferson County. Dr. Tom Locke, Jefferson "The only protection The cases have been County health officer. available for newborns is • reported in Port Townsend, to vaccinate the people who Chimacum, Hadlock and WHAT'S BEING DONE surround them:brothers and Quilcene. Locally, nurses from sisters, parents, grandpar- Jefferson County Public the health department are ents and caregivers," said Health Director Jean investigating each reported Dr. Scott Lindquist, a pedi- Baldwin said Feb. 21 that case and are calling fami- atric infectious disease spe- legally,she couldn't be more lies to assess where they cialist and deputy health specific about where the might have been exposed, officer for Jefferson County. cases have been reported then they are contacting For a longer version of because there is no cluster- other possibly exposed chil- this story with more detail ing of cases and technically dren and families and are from the health department no outbreak in one specific sending notices home if on vaccinations, visit visit location. there are confirmed cases ptleader.com. • Health board asks for extra air monitor By Lauren Salcedo of the Leader Ecology. In that presentation, ity to the mill and the amount Palcisko described the risks of young children in the area. Jefferson County Board of associated with fine particles "Obviously one of the main Health'members voted unani- in the air and the kind of leg- issues is children,"said Sheila mously last week to write a islation that already exists to Westerman, board member, letter to the Olympic Regional protect air quality. who was on the Port Townsend Clean Air Agency and the "He wasn't pushing any City Council when the first air Port Townsend Paper Corp. kind of agenda, just giving quality monitor was placed at requesting a new air quality information on particles and Blue Heron."It was the worst monitor in Port Townsend. clean air legislation," said area in town because of an The board is requesting Robinson. inversion and wood smoke," that a second air quality moni- Members of the pub- she said. tor,like the one at Blue Heron lic spoke during a comment_ Whether the clean air Middle School, be placed at period, and many expressed agency or the mill decides to Grant Street Elementary concern over the paper mill's move forward with bringing in School in Port Townsend. proposed $55 million biomass a new.air monitoring station is "There is only one air mon- project and how the burning still unknown at this time. itor at one school,"said board of biomass might affect local "This is a step-by-step member Catharine Robinson residents in the long term. process," said Westerman. on Feb. 21. "Air quality is a "People were asking the "This issue is on the agen- question in the community, Board of Health to do some- da for our next meeting, and and I think having another thing like stop the project," Commissioner Phil Johnson is air monitor at [Grant Street) said Robinson. "But quite scheduling a meeting with the would help:' frankly,I don't think we have clean air agency. We are not • The request followed a pre- that authority." done talking about this." sentation on fine particulate Jefferson County Public , Mill officials do not com- matter by Gary Palcisko, a Health director Jean Baldwin ment on the biomass project. toxicologist and risk assessor said Tuesday,Feb. 11.she was Officials have contended at for the state Department of working on the letter. public meetings and in writing "There's a feeling of many that the $55 million project people that the testing of air would add $10 million of new quality at Blue Heron may not pollution control equipment be representative," Baldwin to the existing operation, pro- said. duce 25 megawatts of power to Board members were look- sell,reduce the amount of fuel ing for a new location for an the plant needs to operate,cre- air quality monitor and settled ate jobs for about 30 employees on Grant Street Elementary and keep the mill financially School because of its proxim- stable for years. 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W al . . rims- t ñse MO .- .4 on i • ,. Children hsaardest hit by illness usp for outbreaks,"Locke "It can spread rapidly;' BY ROB OLLIKAINEN Two infants died from he added."For some people. PEN INSCLA D.thx Niws whooping cough last year it can be deadly. Fur others, in Washington. it's more of a nuisance infec- PORT TOWNSEND — Those with confirmed tion." Public health officials con- pertussis cases on the Meanwhile, a federal firmed two new cases of North Olympic Peninsula advisory panel Wednesday whooping cough in Jeffer- are between 3 months and recommended that all son County children this 14 years old. Americans age 65 and older week, bringing the total "That's the group we're get vaccinated against number of cases there to 10. really concerned about," whooping cough. Eight cases of the highly Locke said. - contagious bacterial disease "We're especially con- Underreported had been confirmed in Jef- cerned about infants under Locke said it's a good ferson County by Friday, 6 months of age." idea for grandparents to get and Clallam County had four cases by then. 175 across state vaccinated to protect their No new cases have been grandchildren, especially reported in Clallam County The state Department of infants,from infection. as of Thursday. Health reported 175 cases Health officials believe "This is still going on in in Washington this week. whooping cough is under- Jefferson County, so we're State health officials reported in older adults. expecting more," said Dr. have said whooping cough perhaps because in older Tom Locke, public health is a growing concern; there people, the illness can be officer for both counties. were 912 cases in 2011, hard to distinguish from compared with 608 in 2010. other coughing ailments. Expects count to rise • . . Locke attributed the rise Recommendations from Locke said he expects in the number of cases to the Advisory Committee on Immunization Practices are the number to rise because lower immunization rates. usually by the are it can take three or four "We've been concerned usually adoptedrnment, sends the days for a suspected case to for years about the rising guidance out which doctors.send be confirmed. exemption rates in school Whooping cough,or per- aged children,"Locke said. tussis, leads to severe Reporter Rob 011ikainen can be • coughing that causes chil- Vaccinations reached at 360-417-3537 or at rob. dren to make a distinctive ollikainen@peninsuladailynews.com. whooping sound as they Parents who believe the gasp for breath. whooping cough vaccine is The Associated Press contrib- In rare cases, it is fatal. unsafe or unnecessary "set uted to this report. • a/ay/a.. , . ‘ 111116.7.V21-4;-;?;*---, - .---.10. ---.. -, ..:144-..- ,,,.--400 IP,...4.‘,.,&‘.V,,;.,- ;4:0':"..-*,-,: ' ------4,4„--'‘).Z.i. 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P. a i/� p! ; '4 '' ' s( 1, • 1 La p .)17-1--.. ,� \ fg :S' , ! n, 4 ff0 , fts'-r- n. 3^ j �+. -x� Ji,Ar-1c,,' 't, a _ 0 camom 4:1 gam..-q,+ :,.- O C a� '"- ® y -.yy, .. u it, CN %y � N .a >,,. ' 0 C--- '- 44 Ce: 4P-:.,±1''.',:,".,.:'7,....7.„.,4H:30:::, c .: : s— as ,..,„,(n a.) • i„,„...0. v, m_ ...... .„.1 vs ..„.„.,z4e. ( Y ...... 0 ..,_,,,_ .. t V f.,4,,..,..t .q # - ,_ Ig''''.: '-,:'4.t -t;L - T`. ”' .1v ,. ,t1r,,,, r a 2/29/2012 6:52:00 AM,PORT TOWNSEND&JEFFERSON COUNTY LEADER Adult pertussis cases seen in Jefferson County By Allison Arthur of the Leader A pertussis outbreak in Jefferson County now has impacted children and adults, affecting people who have not been immunized and those who have been immunized. As of Tuesday, Feb. 28, there were 14 cases of what's known as whooping cough in Jefferson County. In 2011, there was only one case. "Most of them are younger, but we do have adults now," said Jefferson County Public Health supervisor Julia Danskin in Port Townsend. No one has been hospitalized by pertussis in Jefferson County. Danskin said there are 11 lab-confirmed cases. Three additional cases are linked because the individuals were in close contact to the lab-confirmed cases. One other case is still being investigated. Danskin said people are coming in for vaccinations and are seeing their family doctors for treatment. Five of the confirmed cases were people who were not completely immunized, she said. Five more cases were people who were partially immunized. Three people who came down with pertussis were fully immunized, she said. All public and private schools with confirmed cases of pertussis have sent home information about the outbreak. The health department also has provided information to schools where there have been no outbreaks, she said. • Because the outbreak has moved on to affecting adults, Danskin urged adults who will be in close proximity to young children, including grandparents, to get vaccinated. Pertussis is a highly contagious respiratory illness spread by coughing and sneezing. It can affect people of all ages, but is most serious in infants, according to health officials. It causes cold-like symptoms, followed by long, severe coughing that can last for weeks. The incubation period for pertussis is six to 20 days. Children can be treated for the disease even after being exposed. Parents of children who have a cough that has lasted two or more weeks or who are developing symptoms after having a known exposure to pertussis should contact their physician to get their child tested and treated. Those at highest priority for preventive treatment include: all household members, infants 1 year of age and younger, pregnant women, those who have contact with infants or pregnant women, and health-care workers. The best way to prevent whooping cough is by getting the Tdap vaccine, which protects against tetanus, diphtheria and whooping cough, according to the health department. For more information, contact Jefferson County Public Health at 385-9400 or your local health-care provider. For more information from the state, go to • doh.wa.gov. • Port Townsend&Jefferson County Leader WIC helps with healthy food for kids • youngmoms , V. k -� r. � _ f -s ,� �«� §t a �a r 'c a,rr - �` s t ' ..wt r -t "" '.1,- »,fit; s0., ' N�e tl o ram®i® .. i f v s, a.. k a iu a rh r j ',,,,.., ,,, By Allison Arthur of the Leader , :, ' egtOODMO '„" \\ Sawyer, 4, tikes carrots x e s Meadow. 2, loves peas. Their ��f ,`x y 4 mother, Adrienne Ducal r �' a x sfr thanks the Women, Infants �,x °',� 'x �'"` vot, and Children(WIC) rogram �x � � S which has helped her serve ` r `,P' K k• r healthy food to her kids for the . r'a sf,, _ past two years. .� � * "WIC-approved" is seen on labels throughout grocery ±1Am„ p ' ? ,.� stores, including the Food x z ;r "' Co-op,for products like milk, r " ff ir ��{ � � peanut butter, whole wheat v r bread and cheese. Although the three let- - 4 .. leis acro commonplace, Karen S',' a k ' •' '�`-,�r �4 Obermeyer, a health educator ',"'.4 `' 'e �,m�-� 4 .Vii, ;� --, ',`- ti at Jefferson Public Health, Sawyer and Meadow Duval enjoy fresh fruit in their oatmeal,and Sawyer adds a piece of cheese to a meal that wishes more families knew that can be covered by the Women,Infants and Children(WIC)program,which helps moderate-and low-income about it and would take advan- tage families ensure children have nutritious food in formative years.Photo by Allison Arthur of the federally funded program. -- _----- — j• What Is WIC? creating more things.I make Duval says the program is WIC program is housed in "WIC is designed to tar- soups and healthy dips." a success for her. the public health depart- get specific populations during The Women, Infants and WIC offers cookbooks to "If I were going to the store meat next to QFC in Port times of increased need like , Children(WIC)program serves help teach young mothers on' my own money, I might Townsend.An added benefit pregnancy and early child- f pregnant and breastfeeding about nutrition, and how to buy the kind[of oatmeal;with of the location within the hood,"said Obermeyer. women, infants and children prepare whole and fresh foods. apple and cinnamon flavor- health department is the "And the income guidelines younger than 5 years old. Duval said she has learned ing, thinking I was pleasing 0 are wider than you might the importance of nutritious p g proximity familyf programs, think. A family of four can The federally funded program foods,including milk. my allowil .you}'ith�VIC,they dont including planning,t make up to$41,352 and qual- offers vouchers for women "I personally don't drink a odto buy that. And immunizations and support now it's wonderful for my kids. for breastfeeding. ifs" to purchase nutritious foods, lot of milk, so it would have They don't expect this arty- Back at home, Sawyer Jefferson County Public : such as fresh fruit and veg- been easy for me not to buy cial flavoring in their cereal." and Meadow gobbled down Health supervisor Julia ,' etables, whole grains, eggs, a lot,"she said. "If we didn't Instead of white bread,she a snack of grapes and apple Danskin says the county has ' dry beans,cheese and milk. have'WIC,I dont think•they buys wheat bread. Instead of slices. Sawyer said he likes funding to serve about 500 r would have had the required white rice, she buys brown watermelon best of all. But people a month. There are "' Participants also receive reg- amount that they need." rice.Instead of frozen vegeta- he also Iikes carrots a lot, openings. The exact number . ular visits with a registered As she was weaning her bles,she tries to buy fresh.She too.And,he adores his baby of openings varies from week dietitian. children off breastfeeding also is given a voucher to go sister. Meadow, except when to week because people come and onto formulas, WIC also and go.All mothers of children A pregnant woman without a helped buy formula. summer athe nd buyfreshers Lve eta- she in the butterwsandwichs to eat his anddaher younger than 5 years old are ;' spouse can qualify for WIC if The m wnher program has also files.Overall,Duval estimates own. encouraged to apply she makes $2,268 a month broadened Duval's food hori- the vouchers are worth about Unlike the state Basic Food or less.A family of three can zon. $50 a month. Program – commonly known qualify if it makes $2,858 a "When I was breastfeeding, "I'd rather put my money in as food stamps – the WIC month or less and a family I got canned salmon. In one the healthier food," she said. program doesn't give a ape- i4 of four can qualify if it makes recipe,there were these baked 'And I will continue with those odic dollar amount to a child, $3,446 a month or less, salmon croquettes. The kids healthy choices" after WTC woman or family. It gives according to health officials. absolutely loved them, and I ends. vouchers for a certain number • would never have bought salon- ofquarts of milk or a certain For more information on WIC, Duval also has learned on in a can,"she said. about portion size, something amount of cheese,for example, ,b contact the Jefferson County Duval said her husband new mums often don't think , based on family size.The bene- ?` Public Health's WIC desk at has a good job and her children about,she said. fit to a family of three amounts b 385-9400- would not have gone hungry "Some people might not to about$150. For Duval, a licensed without WIC.But,she's appre- know about a portion to feed a "Ifs based on their needs," esthetician who was raised in ciated how health officials in 2-year-old,"she said. said Danskin. "The Stan- Canada,the program has been Port Townsend and Nevada, WIC dietitians monitored dard package is for milk, helpful not just by stretching where she's from, have made her weight when she was preg- eggs, a pound of cheese and her grocery dollar.It's taught her feel good about being on nant and then monitored her for a child's package, [which] her about nutrition,offered her the program. children's weight. includes $6 worth of fresh recipes and "opened up my Although WIC does have "We do health assessments, fruits and vegetables,a whole mind"to food options. income requirements,the pur- check height and hemoglobin," • grain choice and peanut butter "It's really, really, really pose is designed to "optimize Danskin said of working with or dried beans,and vitamin-C helpful," Duval said of WTC. nutrition during the formative moms and children. fortified juice" "They give you an option to years while a child is develop- In Jefferson County, Obermeyer notes that foe- buy peanut butter,beans and ing and to promote healthy Danskin notes that the ter parents and grandparents lentils. I normally might not food choices over the long caring for children also can buy a bag of split peas, but term." quality for assistance. when I have them, l start Friday,March 02,2012,ELDER ADVOCATE NEWS&REVIEW Elders Urged to Get Pertussis Vaccination Matthew Gatheringwater 65 or older?There are two new reasons to talk to your doctor about getting the TDaP vaccine against tetanus, diphtheria, and pertussis. First, the Center for Disease Control's Advisory Committee on Immunization Practices now recommends the TDaP vaccine for all elders 65 and older. (The old policy recommended vaccinations for elders over 64 only if they came into regular contact with infants less than a year old.)These recommendations reflect the fact that a significant number of Americans over 65 have not been vaccinated for pertussis and older people vaccinated as children may have decreased levels of immunity to the disease in the decades since being vaccinated. Second, there has been a dramatic increase in the incidence of"whooping cough" or pertussis--nationally, and locally. Jefferson County Public Health reports 15 confirmed cases of pertussis in the past three weeks, with other cases of pertussis suspected and pending laboratory confirmation. Pertussis is a highly contagious disease spread by coughing and sneezing. It is easily shared in places where people congregate, such as schools and nursing homes. Most people survive the disease, but pertussis can kill people of all ages. It is most frequently fatal among the very young. Pertussis is often under-diagnosed, especially among adolescents and adults, who may suffer less severe symptoms compared to infants. Having a mild case of pertussis does not mean an untreated infected person is not able to spread the disease to other people. Initial symptoms are similar to those of the common cold, so people may easily spread the disease without even knowing they have it. With this in mind, it is important to realize that the new vaccination recommendation is not just protecting older people from disease, it is also protecting their as-yet unvaccinated grandchildren. Health experts recommend that all children are vaccinated against tetanus, diphtheria, and pertussis by 18 months, but not all children are immunized. Last July, the CDC reported that Washington was the state with the highest number of unvaccinated children entering kindergarten. According to the WA Department of Health, Jefferson is among the counties with the highest percentage of unvaccinated children. Over 10% of Jefferson county children start kindergarten without having received all of their recommended vaccinations. Although pertussis is often called "whooping cough" because of the distinctive sound many infected people make when they try to catch their breath after a fit of coughing, it is important to know that not all infected people will make that sound. (It is possible to have the "cough"without the "whoop.") Jefferson County Public Health has issued a press release encouraging people to see their doctor if they have a cough lasting two weeks or longer, or as soon as they develop symptoms after having been exposed to someone diagnosed with pertussis. TDaP vaccinations are available through most doctor's offices and at Jefferson County Public Health (615 Sheridan Street, Port Townsend) during their walk-in clinic from 1-4 p.m. on Tuesdays and Thursdays. Sliding-scale fees are available. Medicare does not currently cover TDaP for people 65 and over, but it may be worth checking your supplemental or Part D plan. Note: Links to sources for this story are available at the Elder Advocate blog. I' -• „a a 6 1" si8ts1 � � \ = E t...,0 4,.,- E., 0 0 . p k ) V-0 > '� 0 0 0 0 0 O0. 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The final workgroup meeting In 2007, the Washington is scheduled for p.m. 3-5 on State Department of Health March 19 at the .5 um revised the Washington Grange. Administrative Code, in Public meetings are effect issuing an unfunded March 22 at the Tri-Area mandate, which requires Community Center,March 26 all Puget Sound counties to at the Quilcene Community write a management plan Center,and March 28 in Port and sets a specific schedule Ludlow. These meetings are for monitoring all such sys- 4:30-5:30 p.m. tems. For those who cannot take The costs of complying time off work to attend any of with this mandate are borne these meetings, more infor- by septic system owners. mation is available on the A workgroup has been county's website at Jefferson meeting to discussthe rec- countypublichealth.org. ommendations to be pre- sented to the Jefferson County Board of Health for adoption in April. S Health hero nominations due Do you know a person, a business or an organization that promotes public health? They could become a Public Health Hero and be recognized for their contri- butions to community. Jefferson County Public Health invites people to nominate health heroes. Nominations are due by Wednesday, March 14, and winners will be announced on April 19. Pickup a form at the JCPH office,615 Sheridan St.,Port Townsend, get one online at j of fersoncou my p ubl iche alth. org, or request an applica- tion be mailed to you by calling 385-9400. . / /ice Are budget cuts to health departments putting our health at risk? By Ashley Wiggin School of Nursing Providing care for mothers and babies,preventing the spread of communicable diseases and responding to emergencies are among the services provided by local health departments,which have faced devastating cuts in the past several years. A 2011 National Association of County and City Health Officials(NACCHO)survey of local health departments nationwide found that more than half of all departments cut services in the first part of 2011,with maternal child health services the"hardest hit."According to a 2011 National Association of County and City Health Officials report,since 2008,local health departments nationally have lost 34,400 out of a total 155,000 jobs due to layoffs and attrition This loss of capacity is expected to threaten the health of the communities these agencies serve. Betty Bekemeier is looking at the effects of budget cuts on county health services. To better understand what this means for the public,Betty Bekemeier,assistant professor of of psychosocial and community health in the UW School of Nursing,has been funded to look at the effects of these cuts on county health departments. • The project will examine how cuts have affected the community—from the health of mothers and babies to infectious disease control.Bekemeier and her team of public health practice-oriented researchers will investigate the types of cuts made to local health departments in maternal and child health(such as support for low income pregnant and parenting women in getting healthcare and information),environmental health(such as water supply and food safety monitoring),and communicable disease control(such as immunization programs and tuberculosis control).The researchers hope to ultimately find what works best for improving health outcomes for the public,even in a time of diminishing budgets and cutting programs. "As we have more evidence,we will be able to better inform policy makers about the impact that these services have on communities ... and what happens when they go away,"said Bekemeier. "But without adequate evidence of what each of these services do for the health of our communities and how to prioritize them, local public health leaders and policy makers are struggling to make very difficult decisions about what will best meet the needs of their communities,especially during these tough financial times." Bekemeier,alongside co-Investigator Michael Morris at the University of Arkansas for Medical Sciences,will use funding from The Robert Wood Johnson Foundation(RWJF)to look at six years of data from 305 health departments in four states(Washington,Florida,Minnesota and Ohio)related to changes in services and the impacts of these changes on the populations that are served. Using the health departments as a"living laboratory,"the project will study 2005-2010 data from health departments,from before and after budget cuts to services,and how these cuts are affecting people in the community. Cuts in health departments have included reducing and eliminating home visiting programs for new mothers,ending free immunization clinics,and slower responses to infectious disease outbreaks. Bekemeier notes that the four states were selected because they've all faced significant budget cuts,they all have S ' detailed data that support this type of study,and they each have existing Public Health Practice-Based Research Networks(PBRNs). Such partnerships between public health practitioners and researchers make studies like this possible. Practitioners can make health data more accessible to researchers and researchers can be more responsive to the questions that people in practice need answered. With each health department handling cuts differently,Bekemeier notes that the overall impact to the populations served may be different across states and in rural versus urban communities.According to Bekemeier,nurses make up the majority of the workforce in city and county health departments,so they play an important role in understanding how the health departments are meeting the needs of those they serve. "This financial crisis,awful as it is,is giving us an opportunity for a`natural experiment,' she said."These terrible cuts to services will give us a much better sense of how these services contribute to people's health.Then we will need to use these findings as evidence to support programs and practices that meet the needs of our communities' most vulnerable residents.Nurses are the backbone of our public health systems. So we have a huge responsibility to be a part of understanding and providing leadership around these issues." The two-year, $200,000 grant from The Robert Wood Johnson Foundation(RWJF)in conjunction with the National Network of Public Health Institutes(NNPHI)is one of 11 grants given to institutions across the country. The projects are part of a broad effort to support research on strategies to improve the quality and effectiveness of public health practice and policy. "These are trying times in public health and any form of public service,"said Dr.F.Douglas Scutchfield, a physician and director of the National Coordinating Center of Public Health Systems and Services Research."How best to cope with the changing environment at the state and local levels—in health departments generally and in specific programmatic areas such as maternal and child health—is the goal of these projects.The intent is to inform decision making in a rapidly evolving public health system." As the nation's largest philanthropy devoted exclusively to health and health care,The Robert Wood Johnson Foundation addresses the pressing health and health care issues facing the United States.For more information about this project,visit www.rwjf.org,www.publichealthsystems.org and www.nnphi.org. •• vIE • NENG , THE STATES AND LOCALITIES March 2012 $4.50 ,� ' I` 6 ' ' - 44 - ro k 1 ,i; The �r :etary of st.' ho's :; r , ining immigration laws 1p inArizona 9 �j Kansas and yr ,r '''.-&‘1,....,..', n I 0 A 5 3 t 4ik y ® }. 1 Y a ,�. c`hit�arAo kr .` 2 v SDE x z000d ;. ,, e�$ ;, 9£86 KNJ U SNiN[JI ZdOd E 0 O -jli)fiO l.i01,.,,.3 IS "GI 113HS 919 r° 4 1' " x 1143141M/d313 HSi3H J�SH17a,J Nt7StT3333P s,ft� J p I `It4I0I X30 Hd T'flH ',3 NIN1a`Pd8 war g. - .: III ' T'i'll I$T►'II'►t'i'I"'I"i"It►'ll"'I"t'►I'II i,....,0 ,, ,,-,grl:,-:)p„..,,,,,,,re-', #0/8019T OT(IT 0# ,,.:‘,.'.7...,..t.„.....010.1.14,-,.4-,.-14-4-4L,Iriv,„.,....,. t..:-., ,..:,. £8 I 'Sji +rv4+►ys+c �e QWa518X8}� 3,. y as Politics+Policy GREEN GOVERNM ENT By Elizabeth Daigneau • EnoughGood Farmers markets are flourishing—so are fety concerns. Ilk - _. * : ,,a ,,-.- 4- - , , y p ' ' ' ,:** 117 ,!=?'-'0: "1"';'" , { ;' - z ,C4 °a N � .,,.`,."-,f,''''.k1. r.., i J r-,4,,-„ose- - - ; L .. ,, , - N7,,,,4,-,, , , -,, _ g_or,r,, is or lots of people,going green means reducing their per- regulators are starting to realize they are a market.And just like sonal carbon footprint.And for many,that means buy- grocery stores,they need some regulation?' ing food closer to its source.That demand for local meat In the past two years," state legislatures have moved to create icit les the sale of and produce has been fueling an explosive growthrin more tl and otherldirect-to-consumeroutlets.Mostoofthesd at e farmers however,t the number of farmers markets nationwide.There are currently about 7,200 farmers markets across the country—a 64 percent have effectively eased regulations.Bills passed last year in Arizona, jump in the past five years.The U.S.Department of Agriculture Florida,New Jersey,Pennsylvania,South Dakota and Washington estimates 2Isales will reach doublingw , products sine 2002. n addition to being easier on the enronment farm- (such as breads, foode producers and,in some states,home-canned ers'fare is fresh and seasonal,and buying from a produce stand fruits and vegetables)in their own kitchens,and then sell those can help stimulate the local economy. products directly to consumers at venues like farmers markets. Without these kinds of"cottage food"bills,those bakers and can- ht That's its safe? T Th 's a question more people have been asking,since the fare ners would be required to make their food in a certified commercial sold at farmers markets generally receives less government over- kitchen.That's cost-prohibitive for most startup businesses. sight than the products sold on grocery store shelves—and that's Still,foodborne illnesses sicken one person in six in the U.S. not likely to change anytime soon.That's because states have been each year.So while governments don't want to squash a growing moving to exempt farmers markets from the same food safety economy—and one that has so many environmental benefits— requirements that brick-and-mortar stores have to meet, says they do want to ensure the food's safe.The most serious attempt ng armers markets flourish is homa's Doug Farquhar,program director of environmental health for the to do that while Faruharf A bill both the House and Senate will National Conference of State Legislatures. `It is a growth market;' approach,saysq he says."States want to encourage economic development" allow the public health department to study food sold at farm- While there's no evidence that food at farmers markets is any ers markets to see what kind of restrictions may or may not be more dangerous—most sources of foodborne illnesses are never necessary to make the food safe.Similarly,Illinois passed a law identified—there also is no evidence that it's safer. State and last year creating a task force to review the rules defining what local governments have jurisdiction over farmers markets.Yet products can be sold at farmers markets,as well as sanitation and data from a 2006 survey of farmers market managers reported food preparation requirements. 0 minimal government oversight—only 14percent reported state For now,however,Farquhar says it's"up to individual vendors government enforcement of food safety requirements and just 20 to make sure their products are safe."G percent reported city,county or municipal involvement."They overnin com may not be more or less hazardous;'says Farquhar,"but state Email edaigneau@g g March 2012 I GOVERNING 19 (frWashin8ShUeDePaümentof Communicable Disease Epidemiology Influenza Update Health gip 12 CDC Week 9 (2/26/12-3/3/12) ease note that all data are preliminary and may change as more reports are received. Summary: • Influenza viruses continue to circulate throughout Washington. Overall, influenza activity increased slightly during week 9. • The proportion of emergency room visits for influenza-like illness (ILI) in Eastern Washington facilities was at the baseline. • The proportion of emergency room visits for ILI in Western Washington facilities was not elevated. • During week 9, 46 (13.9%) of 330 specimens tested by the World Health Organization (WHO) Collaborating Laboratories in Washington were positive for influenza. During the past four weeks, 87% of positive specimens have been influenza A viruses. Of the subtyped influenza A specimens, 56% were influenza A H3 viruses. There has been an increase in detection of influenza A (2009 H1 N1) viruses over the past few weeks. Laboratory Data World Health Organization (WHO) Collaborating Laboratories Five laboratories in Washington participate in the WHO surveillance network. These laboratories include the Washington State Public Health Laboratories, the Seattle & King County Public Health Laboratory, the Spokane Regional Health District Laboratory, the University of Washington Virology Laboratory, and Seattle Children's Hospital Laboratory. WHO laboratory data from Washington are shown in the following table and figure. Washington Influenza Specimens — Weekly & Cumulative A(Unable A Sek Ending No. Labs A(H1) A(2009 A(H3) to sub- (Subtyping B Total Total# % Influenza Reporting H1N1) type) not Influenza Tested Positive performed) 2/11 5 0 2 13 0 0 5 20 264 7.6 2/18 5 0 7 17 0 2 4 30 309 9.7 2/25 5 0 14 12 0 0 10 36 275 13.1 3/3 5 0 16 20 0 4 6 46 330 13.9 Cumulative — 0 39 62 0 6 25 132 1178 11.2 since 2/5/12 WHO Laboratory Data, Washington, 2011-2012 60- -40 N - E 50- -35 ami -30 > cn 40- -25 a x, 3• 0 ,ii. i• -202 0 cu 0 20- _ I' -15 a c s ■ -100 1• 0- -- z - - -5 4110 - O I I I I 1 1 I I I I I I I I I I I I I I I I I I , , 1 1 1 I I I I I I I 1 1 1 I I I I I I I I I I I I I O 9 , , , , 2Y/ 6' .> -,' /0 iS0 "0 "i ii? 8 7 7 7 i s o s Week ending date(2011-2012) B i l A(Unable to subtype) I I A(Not subtyped) I I A(2009 Hi N 1) 1 A(H3) % Influenza Positive Antigenic Characterization To date for the 2011-12 influenza season, CDC has antigenically characterized 15 influenza viruses from Wash- ington State. • Influenza A (H3N2) (n=12) Three influenza A (H3N2) viruses were characterized as A/Perth/16/2009-like, the influenza A (H3N2) component of the 2011-12 vaccine. Nine viruses showed reduced titers with antiserum produced against A/Perth/16/2009. 0 Influenza B (n=3) Two influenza B viruses were characterized as B/Brisbane/60/2008-like, the influenza B component of the 2011- 12 vaccine. One influenza B virus tested belonged to the B/Yamagata lineage of viruses. Antiviral Resistance Testing The Washington State Public Health Laboratories perform antiviral resistance testing on selected influenza A (2009 H1N1) specimens for surveillance purposes. PHL uses CDC protocols to identify a single known mutation in the neuraminidase of the influenza A (2009 H1N1) virus that confers oseltamivir resistance (H275Y). Since July 24, 2011, no resistant influenza A (2009 H1N1) viruses have been detected in Washington. Public Health Reporting of Aggregate Influenza Data (PHRAID) Select laboratories and clinics in Washington report the total number of influenza tests performed and the total number positive for influenza A and B each week through PHRAID. During CDC Week 9 (2/26-3/3), 15 Western Washington facilities reported 56 (11.6%) positive influenza specimens out of 484 influenza tests conducted (46 influenza A, 10 influenza B). In Eastern Washington, 11 facilities reported 43 (16.7%) positive specimens out of 257 influenza tests conducted (23 influenza A, 18 influenza B, 2 unsubtyped). During the peak of the 2010-2011 season, approximately 300 positive influenza results were reported per week through this surveillance system from Western Washington. Aggregate Influenza Testing Results, Aggregate Influenza Testing Results, Western Washington, 2011-2012 Eastern Washington, 2011-2012 • 100- -25 100- -25 90- y 90- c (1)°' i -20 80- -20 80- 0_ 70 N �n 70 5 ami 60- -15 2 > 60- -15 co N 50- c :Q 50- C o_ 40- • -10 o_ 40- -10 c o c o — 30- I o 30- o F 20- � _y -5 � 20- -5 z Z 10- 10_ _ _ i_�'�II''1 -0 0- e o __ o ❑ _ wi_ m•�� -0 ITIIIII I II I I III III I II 11111 11111 III IIII II I IIII I II I III I I I I I II I I III I I I I I I II I 2iI III I III I I I II I I II II III II I I I I I O 9; % 772 7 2 2 uo7 SG7o >>S 9i / 77 7 72Lp� `mosJ 0upOS '7? 7> 7 2S 07 oS 70 76 Week ending date(2011-2012) Week ending date(2011-12) Flu Type Unknown ® B Flu Type Unknown ___"+ B I I A %Influenza Positive I I A %Influenza Positive For additional information on respiratory virus testing in Washington, please refer to the following websites: PAML Virology Respiratory Reports: http://www.paml.com/Pages/Respiratory%20Report.aspx University of Washington Clinical Virology Laboratory: http://depts.washington.edu/rspvirus/documents/ VD2011-12.pdf - 410 2 Influenza-like Illness Data Syndromic Surveillance Data ESSENCE (Electronic Surveillance System for the Early Notification of Community-based Epidemics) WA: The following graphs show the proportion of emergency department visits, by CDC week, for a syndrome of nfluenza-like illness (ILI). A syndrome of ILI is derived from the chief complaint and is defined as "influenza" mlIFOR fever with cough or sore throat. Western Washington: During week 9, 145 (0.8%) of 18145 visits to emergency rooms in Western Washington were for influenza-like illness. Percentage of ER Visits for ILI by CDC Week, Western Washington, 2007-2012 7- 6- 5- - w 4- 'N mkt 1 • \ 30 35 40 45 50 3 8 13 18 23 28 Week of Visit(CDC Week) - 2007-2008 2008-2009 • 2009-2010 2010-2011 2011-2012 2011-2012 Baseline Eastern Washington: During week 9, 90 (2.2%) of 4084 visits to emergency departments in Eastern Washington were for influenza-like illness. No data are available prior to 2009. Percentage of ER Visits for ILI by CDC Week, Eastern Washington, 2009-2012 12- 11- 10- 9- J 8- ° 7- • 6- • 5- - 6- 5- O 4 4- 3- 2- 1- 0- IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 30 35 40 45 50 3 8 13 18 23 28 Week of Visit(CDC Week) 2009-2010 2010-2011 2011-2012 3 ----- 2011-2012 Baseline Outpatient Influenza-like Illness Surveillance Network (ILINet) Data During CDC week 9, 9 sentinel providers in Washington reported data to CDC. Of 1759 patient visits, 39 patients (2.2%) met the case definition for influenza-like illness (ILI; defined as fever >- 100° F or 37.8° C [oral or equivalent] AND cough and/or sore throat [in the absence of a known cause other than influenza]). Washington Sentinel Provider ILI Net Data No. of I Age Total ILI I Total ��a ILI CDC Week Sentinel -- - Patients 0-4 5 24 25-49 50-64 Over 64 6 (2012) 14 4 39 9 10 5 67 3339 2 7 (2012) 13 7 13 10 6 6 42 2236 1.9 8 (2012) 11 5 18 17 3 2 45 2080 2.2 9 (2012) 9 2 22 10 3 2 39 1759 2.2 Percentage of Patient Visits for Influenza-Like Illness (ILI) Reported by Sentinel Providers in Washington, 2009-2012 4- 2011-2012 Washington Baseline(2.5%) 3- \I_ N 2- 1 i � I lt 0- -416 • 30 35 40 45 50 13 18 23 28 of Visit(CDC Week) Week %ILI 2010-2011 %ILI 2011-2012 ----- 2011 Washington Baseline Mortality Data Pneumonia and Influenza (P&I) Mortality DOH analyzes death records to determine the weekly proportion of deaths due to pneumonia and influenza (P&I). The below graph indicates the weekly proportion of deaths due to P&I during 2005 - present. Data points for the most recent 8-12 weeks do not represent all deaths in the state since there is a delay in submitting • death records to DOH. Percentage of Deaths Due to Pneumonia and During week 9, 20 (8.4%) of 239 Influenza (P&I) by CDC Week,Washington, 2005-2012 deaths reported to DOH were 16 - due to P&l. . 14 - , ami 10 — I ' ;' i'I 11, ' 1 �,CI ' J 7 - , I( I i , 1' ' ) k,y` • , i1 , . 1, 4 - 2 — I I I I I I I I 1/1/2005 1/1/2006 1/1/2007 1/1/2008 1/1/2009 1/1/2010 1/1/2011 1/1/2012 CDC Reporting Year 4 Laboratory-confirmed Influenza Deaths Sirce July 24, 2011, the Washington State Department of Health (DOH) has received three reports of laboratory- confirmed influenza deaths. Both deaths were due to influenza B viruses and both cases had one or more risk factors known to increase complications from influenza. Number and Rate of Fatal Laboratory-Confirmed Influenza Cases by Age Group, Washington, July 24, 2011 — March 3, 2012 Age Group Death Rate (years) No. Deaths (per 100,000 population) 0-4 0 NA 5-24 1 0.06 25-49 0 NA 50-64 0 NA 65+ 1 0.12 Total 2 0.02 Laboratory-confirmed Influenza Hospitalizations Spokane Regional Health District requires that their hospitals and providers report patients hospitalized with laboratory-confirmed influenza. Since July 24, 2011, 45 adults and 9 children hospitalized with laboratory- confirmed influenza have been reported among Spokane County residents. Cumulative hospitalization rates by age group and hospitalized cases by week of hospital admission are shown on the below graphs. • Laboratory-Confirmed Cumulative Hospitalization Hospitalized Laboratory-Confirmed Influen Rates by Age Group (per 100,000), Spokane County, za Casesby Week of Hospital Admission, Spokane Countyty,, Washington 2011-2012 Washington 2011-2012 20- 70- 60- 0 oo 50 0 0 a 40- 2 0- N 3 _ O U 10- N E 30- U 20- 10- 0- »». ;�' V IIII 1111111 I,F II III II,111111111111 III III I III III - 30 35 40 45 50 3 8 13 18 23 28 Week ending date(2011-2012) 0- - 30 35 40 45 50 3 8 13 18 23 28 — 0-4 yr --- 5-17 yr Week ending date(2011-2012) — 18-49 yr — 50-64 yr • Flu Type Unknown I I ASub - type r •••• ( type Unknown) 5 Y 2011 Cumulative Rate B Additional Resources: International Influenza Data: • World Health Organization surveillance data: http://www.who.int/csr/don/archive/disease/influenza/en/ index.html National Influenza Data National influenza surveillance data are available at: http://www.cdc.gov/flu/weekly/ Distribute: http://isdsdistribute.orq/ Local Influenza Surveillance Reports: Clark County: http://www.clark.wa.gov/public-health/diseases/flu.html King County: http://www.kingcountv.gov/healthservices/health/communicable/immunization/fluactivitv.aspx Whatcom County: http://www.whatcomcountv.us/health/flu/ Yakima County: http://vakimahealthdistrict.orq/w/home/community-health/rsv-flu-stats/ • 1111 6 • JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, March 15, 2012 2:30 PM—4:30 PM Jefferson County Public Health, 615 Sheridan Street, Port Townsend, WA 98368 Board Members Staff Members Phil Johnson,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) Jared Keefer,Environmental Health Services Director Catharine Robinson,Port Townsend City Council Sheila Westerman, Citizen at large(City) Jill Buhler, Vice Chair,Hospital Commissioner,District#2 Chair Johnson called the meeting of the Jefferson County Board of Health to order at 2:30 PM. A quorum was present. Members Present: Phil Johnson, David Sullivan, John Austin, Roberta Frissell, Sheila Westerman, Jill Buhler Staff Present: Jean Baldwin, Julia Danskin, Jared Keefer, Veronica Shaw • Members Excused: Catharine Robinson APPROVAL OF AGENDA Member Austin requested that report of the State Board of Health be added under item 4 of Old Business and Informational Items. Member Austin moved to approve the agenda as amended. Member Buhler seconded. The motion passed unanimously. APPROVAL OF MINUTES Member Austin requested the February BOH minutes be changed regarding the motion on page 4 concerning a letter being written to the mill and ORCA. The motion was made by Member Westerman not by Member Austin. Member Buhler moved to approve the minutes as amended. Member Austin seconded the motion. The motion passed unanimously PUBLIC COMMENTS A citizen expressed his concern over the landfill at the mill and non-compliant materials being burned in the landfill. He requested that a public hearing be held prior to the next permit being issued. • A citizen gave an update on the number of moratorium petitions that have been signed. She • encouraged The Board to support a moratorium. Finally she read from the American Lung Association Policy. A citizen thanked the Board for their support to add an additional air quality monitor at Grant Street School. She also thanked Dr. Locke for his work with the Clallam County BOH. OLD BUSINESS and INFORMATIONAL ITEMS EPA Homeowner Process Report Linda Atkins, Environmental Health Specialist, gave an update on the progress of the EPA Homeowners Process. She provided a list of the people serving on the work group. There is a link on www.jeffersoncountyPublichealth.org to a page which provides materials, agendas, and meeting summaries. The planned initial work group meetings are complete. She stated that the comments and recommendations have been incorporated into revisions of the code and there will be a meeting on March 19, 2012 to review the code revisions with the work group. Ms. Atkins announced that the March 22, 2012 forum has been changed to an evening meeting. The other two meetings will be afternoon meetings. A press release has been provided to the Leader and PDN for the public forums, and they corrected inaccurate information that was published in the newspaper regarding the forums and the sewage management plan. Ms. Atkins listed several issues that were addressed by the work group. She anticipates bringing a draft of the revision to the code to the Board in April, for adoption in May, and starting the program in August. Correspondence from Citizens • Ms. Baldwin stated that letters from Citizens regarding the February 2012 BOH meeting are included in the packet. Correspondence from Board Member Westerman is in support of the letter regarding Port Townsend Paper Company Proposed Biomass/Cogeneration Plant being signed by all Board Members and will be sent to DOE and other agencies that may be interested in the Boards position on this issue. Ms. Baldwin stated that she contacted Grant Street School to see if the school would support a monitoring station being placed at the school and the school would support a monitoring station. Member Buhler requested that the third paragraph of the letter be changed from "air pollution is necessary"to "air pollution are necessary". Mr. Keefer suggested that the last paragraph of the letter be changed to: If the reason a second monitor cannot be added is lack of available funding, we request that ORCA and the mill work to find funding solutions. Member Austin moved to adopt the letter with the 2 afore mentioned changes. Member Sullivan seconded the motion. The motion passed unanimously. • State Board of Health Member Austin gave an update on the State BOH consideration of additional infant screening. He also stated that they voted to implement a new plan for the TDAP vaccine to have State guidelines coincide with National guidelines. New Business Water Quality Project Overview and Meetings with Environmental Health Michael Dawson, Water Quality Lead, gave a presentation on the Clean Water District and the background of the water quality program. The Clean Water Act of 1972 protects surface water by putting the EPA as the Federal Agency in charge of protecting water, it sets standards for water quality, and it gives a permit system for handling point source pollution from industrial sources. In Washington State Water Quality Standards are in the WAC and are organized around the beneficial uses of water for wildlife and humans, which is handled by the Department of Ecology. Mr. Dawson listed the fresh water standards and marine standards for fecal coli form for each type water. He also talked about the guidelines for shellfish and water protection and the monitoring of the state designated commercial growing areas. In 2007 the Commissioners formed the Clean Water District and in 2009 an ordinance was passed to allow a$5.00 per parcel fee to fund activities. In 2011 there was a resolution directing Water Quality staff to form an advisory council for the district. Mr. Dawson outlined the Clean Water Projects that have been • funded by Centennial Grants. He pointed out that the main grant tasks support the idea of protecting clean water by monitoring water quality, monitoring the trends, identifying pollution sources, controlling and correcting problems and educating and informing. Water Quality staff work closely with the Environmental Health onsite team with septic issues and with the Conservation District. He outlined the goals of the Clean Water District Advisory Council. Member Westerman suggested that this presentation be given to the City Council, and she and Chair Johnson would like to attend that meeting. Public Health Hero Nominations Member Buhler read the six nominations for Public Health Heroes. Member Westerman moved to make all nominees Public Health Heroes. Member Frissell seconded the motion. The motion passed unanimously. 2011 Performance Measures End of Year Report Copies of the 2011 Performance Measures were included in the agenda packet. Ms. Baldwin pointed that some decreases in services are due to funding and programs being dropped. She • also stated that Family Health Services there has been a 40% reduction in funds so the amount of people being seen is decreased, but the highest risk people are continuing to be seen. 4 Jefferson County Pertussis Outbreak Update r Lisa McKenzie, Communicable Disease Program Coordinator, gave an update on the Jefferson County Pertussis outbreak. She announced there have been 22 cases of Pertussis in Jefferson County. 17 of the cases are in children ranging in age from six months to 14 years old and 5 cases are adults. Ms. McKenzie stated eight of the people had no immunization,nine were partially immunized, and 5 were fully immunized. Ms. Mckenzie also explained what JCPH Public Health Nurses have been doing in response to the outbreak. Washington State Legislative Update Ms. Baldwin stated that in the unpredictable State budgets possibly some of the 5930 Funding, which pays for communicable diseases, that were previously eliminated has been restored; 17% of the State Family Planning money has been eliminated and some solid waste programs have been cut. The Quit Line has been funded for another year. ACTIVITY UPDATE Member Sullivan pointed out that the November meeting may need to be rescheduled. Ms. Baldwin stated that the April meeting will have the 0 &M committee report,which will be a well attended meeting, so the meeting will be moved to the Masonic Hall. Member Frissell announced that she has been asked and has agreed to serve on an advisory • committee for ECHO,because they wanted a connection with the BOH and wanted suggestions for enhancing their services. AGENDA PLANNING CALENDAR The next scheduled BOH meeting will be held April 19, 2012 from 2:30 to 4:30 PM at the Masonic Hall, 1338 Jefferson St., Port Townsend, WA. ADJOURNMENT Chair Johnson adjourned the BOH meeting at 4:30 PM 0 • JEFFERSON COUNTY BOARD OF HEALTH 1/ 22 Phil Johnson, hair J Buhler Viccee Chair Roberta Frissell, Member David Sullivan, Member Excused 4 _ 11'N )111,---: Catharine Robinson, Member John Austin, Member Sheila Westerman, Member Respectfully Submitted: Stacie Reid • • JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, February 16, 2012 2:30 PM—4:30 PM Pope Marine Building, 100 Madison Street, Port Townsend, WA 98368 Board Members Staff Members Phil Johnson, 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) Jared Keefer,Environmental Health Director Catharine Robinson,Port Townsend City Council Veronica Shaw,Deputy Director/Chief Operations Director Sheila Westerman, Citizen at large(City) Jill Buhler, Vice Chair, Hospital Commissioner,District#2 Member Frissell moved to nominate Member Austin as Chair Pro Tem, Member Sullivan seconded. The motion passed unanimously. Member Austin called the meeting of the Jefferson County Board of Health to order at 2:38 PM. A quorum was present. Members Present: John Austin, Roberta Frissell, Jill Buhler, David Sullivan, Sheila Westerman, Phil Johnson(arrived at 3:00 and resumed Chair duties), Catharine Robinson • Staff Present: Dr. Thomas Locke, Jean Baldwin, Veronica Shaw, Jared Keefer APPROVAL OF AGENDA It was moved and seconded to amend the Agenda to move the Biomass —Overview of Health Effects as the first order of business under Old Business and Informational Items. The motion passed unanimously. ELECTION OF BOARD CHAIR AND VICE CHAIR FOR 2012 Member Frissell nominated Member Johnson as Chair of the Jefferson County Board of Health for 2012. Member Sullivan seconded the motion. The motion passed unanimously. Member Westerman nominated Member Buhler as Vice Chair of the Jefferson County Board of Health for 2012. Member Robinson seconded the motion. The motion passed unanimously. APPROVAL OF MINUTES Member Robinson requested that the name of the minute taker be added to the end of the meeting minutes. • BOH Minutes—February 16,2012 Member Westerman moved to approve the minutes of the December 15, 2011 BOH meeting. Member Austin seconded the motion. The motion passed unanimously. • PUBLIC COMMENTS The following is a summary of comments made by citizens in attendance at the Board of Health Meeting. A citizen presented and handed out copies of a petition for a moratorium of the Port Townsend Paper Corporation Biomass project due to potential health risks,which has been signed by over 600 community members. A citizen expressed her concern regarding cardiopulmonary and neurological health effects caused by the emissions from burning wood biomass and also read from an article on the effects of air pollution caused by sources of energy written by Dr. Mark Jacobsen,Director of Atmosphere and Energy Program and Professor of Engineering at Stanford University. She also urged for the support of the moratorium proposed by the Sierra Club. A Citizen requested the Board's support of the Sierra Club Moratorium and with keeping people educated on issues such as the Biomass project in connection with Port Townsend Paper. A citizen expressed his concern over the monitoring station being moved to Grant Street School from the Blue Heron Middle School,because there is data that shows the air quality is worse at Grant Street School. Finally,he urged the Board to oppose the project or get the Mill and/or • DOE to provide accurate monitoring in the community. A citizen referred to Medical Journal articles regarding the link of strokes, cardiac effects, and cognitive damage due to small particles. A Citizen stated that her family and many others will move from Port Townsend if the Biomass project moves forward because of the air pollution it would produce. She read several letters from other community members that were not able to be in attendance of the meeting. A citizen presented a chart showing that burning wood is dirtier than burning coal. She urged l new A rules, ch would support of the Biomass u rove t accordingly the eut on hold ntire plant would haver to adhere to require the new cleaner operations be p place, EPA rules. She requested support in requiring the mill to use a portion of their tax payer subsidies they receive for burning black liquor,to upgrade their technology, so that they are running more cleanly. A Citizen expressed her concern regarding the pollution that will be coming from the increase in diesel trucks,barges, and ash. She was also concerned that trees will start to be cut to provide the biomass. • 2 BOH Minutes—February 16,2012 A citizen urged the Board to investigate the biomass issue thoroughly, oppose the project, and favor the moratorium. He also stressed that this is not only an issue for human beings, but for all living creatures. A citizen feels that the biomass project is being done to benefit an out of area investment bank that owns the mill, for the purpose of obtaining grants that have been made available for biomass projects. He feels this is not a sustainable project and it will not help the mill. A citizen stated that she does not feel that her health and well-being are being protected by DOE, so she is turning to the Board of Health to call for a moratorium until there are more definitive answers on the issues. A citizen urged the Board to research the issue and do an environmental impact statement until the project moves forward any further. A citizen feels that this is a Health Department issue and urges the Board to take care of the health of the community. A citizen expressed his concern for the health of the animals in the community. He also feels the need for more reliable information on the health hazards and consequences the biomass project will have on all living creatures in the community. • A citizen expressed the need for the Representatives to protect the community. A citizen urged the Board to protect the community by not just looking at the rules and regulations but by doing what is morally right. OLD BUSINESS and INFORMATIONAL ITEMS Biomass—Overview of Health Effects from Particulate Pollution and Regulatory Framework: Department of Ecology Perspective Gary Palcisko, Risk Assessor/Toxicologist for the Washington State Department of Ecology gave a presentation on the known health effects of fine particulate matter and how it is regulated. Mr. Palcisko defined particulate matter as any particle that is able to be suspended in air. His presentation focused on particles smaller than 2.5 microns (PM2.5), since those are the particles that have the greatest effect on people's health. PM2.5 exposure is associated with an increased risk in mortality causing cardiovascular, respiratory, reproductive, and developmental effects, and links to cancer. He presented estimates of deaths and disease rates that were attributed to PM2.5 in Washington with a projected cost of about $190 million per year for the State of Washington. The presentation covered the history of the regulation of air pollution, the acts passed and historic pollution episodes that led to Federal Legislation on air pollution. Next, he discussed how particulate matter is regulated. The EPA sets a standard, which is intended to protect the public health. As information is collected and new health effects are discovered, the • standards must be revised. The last revision was in 2006. Revised standards are to be issued 3 BOH Minutes—February 16,2012 every 5 years and the EPA is in the process of finalizing revisions to the air quality standards that are currently in effect. Mr. Palcisko discussed some of the main sources of PM2.5 in • Washington and the tools that are used to control some of the emission. Some of the controls that are set in place are the permitting process,new source review,the Clean Car Law, diesel engines running cleaner, wood burning devicenitor that islurn ocateat Blue Heron Middle s. Mr. Pisko showed a map of the monitoring network and discussed the mo School. He pointed out from the graph of the monitor at Blue Heron the PM2.5 is measuring at about 1/2 of what the standard is for an annual aof his with presentation MMr. Palhest eventscisko fieldedcurring eseveralhe months of October through March. At the endp questions from both Board Members and citizens that were in attendance. Member Austin moved for a letter to dramfted to onitor and expressing the con erns of thehe mill anRCA suggesting our community would appreciate more than community.He asked that the Board members sign the letter. Member Sullivan seconded the motion. The motion passed unanimously. Member Sullivan moved to amend the agenda2the next item of business. oe Public r1ng on Memberfferson County Public Health Fee Updates for 201 Westerman seconded the motion. The motion passed unanimously. Public Hearing on Jefferson County Public Health Fee Updates for 2012 Chair Johnson requested a staff report from Ms. Baldwin on the Cone mer Price. e Inde Baldwin stare ed that there is only one fee change,the rest of the fees • not open to an ordinance change today. Ms. Shaw e oaf$1nf ed the Board that the only new fee is the Well Inspection and Water Sample for Member Frissell moved that the Jefferson County Public Health Feefor 2012 be adopted. sl Member Buhler seconded the motion. The motion passed unanimously. Introduction of New Environmental Health Director Ms. Baldwin introduced Jared Keefer,the new Environmental Health Director and asked him to update the Board on the work he has been doing.sessions,the Water Qualr. Keefer announced ity Pr grammhasis s currently working on food program information presented public meeting on Mats Mats Bay, initial public li the NE meetings have Jefferson prof held on the Hood n Canal Watershed and there have been public meetings o t. Public Health Heroes 2012 —A Healthier America Begins Today: Join the Movement Ms. Baldwin asked for a volunteer for thecommitteee committee. for Public Health Heroes. Member Buhler volunteered to be on Member Sullivan moved to adjourn the February BOH meeting. Member Westerman seconded. The motion passed unanimously. • BOH Minutes-February 16,2012 4 f AGENDA PLANNING CALENDAR The next scheduled BOH meeting will be held March 15, 2012 from 2:30 to 4:30 PM at Jefferson County Public Health, 615 Sheridan Street, Port Townsend, WA. ADJOURNMENT Chair Johnson adjourned the BOH meeting at 4:30 PM JEFFERSON COUNTY BOARD OF HEALTH ifffr Phil ohnson, Chair 11 Buhler, Vice Chair 1 � J• i Austin,Member Davi ulli an, ember 16_ Lklet,i-eiyi-e----1 oberta nssell, Member Sheila Westerman, Member i Catharine Robinson, Member Respectfully Submitted: Stacie Reid • 5 BOH Minutes—February 16,2012 • BOH Update — March 15, 2012 ONSITE SEWAGE SYSTEM MONITORING—WORK GROUP MEMBERS 2012 • shellfish farmer/processor—Craig Fitzgerald • real estate professional—Karen Best • builder/building trades—Todd Hulbert • homeowner—Barbara Moore-Lewis • Public Utility District—Mike McClure • septic designer—Bernt Ericsen • septic installer—Steve Kelly • septic operation and maintenance provider—Tim Johnson • water system operator—Greg Rae • watershed representative—JD Gallant • City of Port Townsend—John Merchant • citizen at large - Dick Bergeron • Jefferson County Environmental Health -Jared Keefer • JCPH, Environmental Health Specialist—Linda Atkins • Facilitator—Sam Gibboney • Facilitator- Kristina Mayer • Information on the Work Groups activities is found at: http://jeffersoncountypublichealth.orR/index.php?om-workRroup-1. There is a link to it on the home page of the Public Health webpage. It includes the Work Groups meeting days and locations as well as the agenda, meeting summary and meeting materials as they become available. We created an email list of interested parties that grews after each meeting as people sign up or contact us. They received a reminder email and link to the site prior to each meeting. We have had over 130 page visits to the Work Group web page with a peak before each meeting. We changed the March 22nd public forum to 6:30pm at the Tri-Area Community Center. The other 2 are late afternoon in Port Ludlow and Quilcene starting at 4:30pm. A press release went to the Leader and PDN for all of the public forums. An article in the Briefs section of the March 7th Leader contained some incorrect information on the public forums but was not submitted by our office, it came from an article in the Chimacum Grange Newsletter. . We will present the recommendations and draft code revisions and take public comment and feedback at these forums. • The Work Group has completed the 4 meetings intended to create recommendations for the program to enable homeowners to complete some of the required septic system monitoring inspections. They used the matrix of eight nearby western Washington county monitoring programs to help give some perspective on what is our there right now. This matrix grew each meeting as we add more elements to the program. The Group succeeded in providing recommendations on all of the necessary components: • the basic types of systems that can be inspected by home owners • what documentation needs to be in place for a system to be eligible for home owner inspection, • what training should be required, • how long is it valid • are updates or refreshers necessary, • the cost of getting certified, • the cost to file a report • whose system can a homeowner inspect • the inspection form—level of detail and format • use of a 'field guide' • information for future owners • frequency of inspection by a professional—varies based on complexity of system and • proximity to sensitive or higher risk areas. • Implementation timeline Group members requested several things from county staff to assist them in making recommendations: • A review of what we have found in monitoring inspections since 2000, • A breakdown on the types of systems and how many of each we have installed • A summary of Mason Counties O&M outreach program • A budget estimate of implementing the monitoring program • Samples of inspection questions from other jurisdictions • More detailed review of exceptions to homeowner inspection from other jurisdictions All of these items and several others are on the website I provided a proposed implementation schedule that includes both outreach and education to property owners as well as program development activities required by the county. • Revenue forecast up by $95.7 million - The Politics Blog - The Olympian - Olympia, Was... Page 1 of 1 This is a printer friendly version of an article from the The Olympian. • To print this article open the file menu and choose Print. [Back] Published February 16, 2012 Revenue forecast up by $95.7 million Brad Shannon Washington's revenue forecaster said today that state government can expect to receive $95.7 million more than predicted in the November forecast. But state budget director Marty Brown said the real net gain is $45 million, because legislation adopted in December drove more than half of the gain. By contrast, the recent caseload forecast showed lower demand for services, which is providing a larger, $330 million gain on the state's balance sheet through June 2013. [Update clarifies it is $330 million.] The forecast from interim state forecaster Steve Lerch is to be posted here. • The forecast predicts $30.3 billion for the 2011-13 cycle. Looking ahead, Lerch predicts the 2013-15 biennium will see a 6.6 percent increase to about $32.3 billion. He also predicts Washington employment growth will outpace the nation, but employment won't reach the pre-recession levels of 2008 until late 2014. "While we think we are doing better than the U.S., this is still not great," Lerch said. The bottom line is the state now faces a shortfall of about $1 billion, Republican Sen. Joseph Zarelli told the Economic and Revenue Forecast Council. Democratic Rep. Ross Hunter, the top budget writer in the House, said he is on schedule to roll out a supplemental budget plan sometime between Monday and Wednesday. But Hunter said he would not release a budget if he did not have the 50 votes to pass it in the House. Democratic Sen. Ed Murray said a week ago he was certain his caucus would push ahead with a tax proposal for the spring ballot. The recent news could change that, he said. Now it is a question," he said. Murray and Hunter said it is too early to say how much of a reserve they would need. But Zarelli said the economic uncertainty outlined by Lerch makes clear the Legislature needs a healthy reserve. • http://www.theolympian.com/2012/02/16/v-print/1992743/revenue-forecast-out-budgets.ht... 2/16/2012 File Copy • Jefferson County Board of 3-CeaCth Agenda BVI inutes • . March 15, 2012 • co oo IF PIP rn _ o :r S '+ o S O A = O S S Nfl eND 7 O, S rt < U .o 9 co r* .+ LOM O O S S Pi igi''00 -0 Z 2 o va r+ as o 3 < 3 3 °a40 o °�' 3c co co' y cn CD 7-7 ,cn e 7 '' y W N — ,..s N f J O H ON CA W NO N - `s O W C 00 0_ _ 01 Ol 7 A J O W ONo .p O W 'V' N 0 N) 3 m 0 HA J O t _ LO N ON V N C O W C' < Ai (J1 00 P-+ A V O w H A J O W HO N V' H cNn CO .� J O W N) N Oo cn ,---. "' NN, V N 00 NJ H H J CA N N J to Oo H a o O N� v O L' v e lim ON o N O NS) NJ(O NJN cr. Q VNi Oo .— 0. ` •m-. N N w a �y 0 O J O W .1 0 OW N v N i � j NNJ y \\\\ Cs yO W T VN Oo r+ A • N .. H W ON A �1 O J O W (.NJ 0 N H 00 N ~ \� Ni� O �' �'. N N .-+ �I DD O W G� N y V ---.1 O W J O w ON CA W N r.+ V N N .-.A C/� O W P O ....::4..... C N oA C N G °° " ` N {' c" 3n so en ysA � n 0. 1� V N O W a VN N N + 3 ---1 O W O H ? ---/ O W J O W 1 oNo N v C ... v N ~ LP CO N .0.. N N J \V N'V N 0 00 N H N [Nj O oo H O W a N "17 N N .-, C\ .11 J O W W C:N W N 'V N 7J `�l �1 O a NJ Hs H W CA 4. J O CON ? J ." J O W w\ O W a N 0' N N tai, 00 `� C/� jo 010 04? Jw � ' J 4 W N ,C, N 4 _H O O W O W 0,2 0 17 VVI 00 --. A H m CON �N-. --4H rt N H H W .•j • NA -1 O GG NJ - N 12N cn 00 — N - N {a N W J O W GN H WO W O rV N i••j N V' �] • O OND .N•+ .A J W N r•-+ W H ? J O J O w � '�7 OD H N'V N N U cNn oo 'P cc -, Hs v CA • JEFFERSON COUNTY BOARD OF HEALTH March 15,2012 Jefferson County Public Health 615 Sheridan Street Port Townsend, WA 2:30—4:30 PM DRAFT AGENDA I. Approval of Agenda II. Approval of Minutes of February 16, 2012 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. EPA Homeowner Process Report 2. Correspondence from Citizens 3. Correspondence from the Board • V. New Business 1. Water Quality Project Overview and Meetings with Environmental Health 2. Public Health Hero Nominations 3. 2011 Performance Measures End of Year Report 4. Jefferson County Pertussis Outbreak Update 5. Washington State Legislative Update VI. Activity Update 1. Prevention Redesign Initiative National Speaker Coming April 26 VII. Agenda Planning Calendar VIII. Next Scheduled Meeting: April 19, 2012 2:30—4:30 pm Jefferson County Public Health • Ar JEFFERSON COUNTY BOARD OF HEALTH . MINUTES Thursday, February 16, 2012 2:30 PM—4:30 PM Pope Marine Building, 100 Madison Street,Port Townsend, WA 98368 Board Members Staff Members Phil Johnson, 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) Jared Keefer,Environmental Health Director .f Catharine Robinson,Port Townsend City Council Veronica Shaw,Deputy Director/Chief Operations Director Sheila Westerman, Citizen at large(City) Jill Buhler, Vice Chair, Hospital Commissioner,District#2 Member Frissell moved to nominate Member Austin as Chair Pro Tem, Member Sullivan seconded. The motion passed unanimously. Member Austin called the meeting of the Jefferson County Board of Health to order at 2:38 PM. A quorum was present. Members Present: John Austin, Roberta Frissell,Jill Buhler, David Sullivan, Sheila Westerman, Phil Johnson(arrived at 3:00 and resumed Chair duties), Catharine Robinson Staff Present: Dr. Thomas Locke, Jean Baldwin,Veronica Shaw, Jared Keefer APPROVAL OF AGENDA It was moved and seconded to amend the Agenda to move the Biomass—Overview of Health Effects as the first order of business under Old Business and Informational Items. The motion passed unanimously. ELECTION OF BOARD CHAIR AND VICE CHAIR FOR 2012 Member Frissell nominated Member Johnson as Chair of the Jefferson County Board of Health for 2012. Member Sullivan seconded the motion. The motion passed unanimously. Member Westerman nominated Member Buhler as Vice Chair of the Jefferson County Board of Health for 2012. Member Robinson seconded the motion. The motion passed unanimously. APPROVAL OF MINUTES Member Robinson requested that the name of the minute taker be added to the end of the meeting minutes. S BOH Minutes—February 16,2012 Member Westerman moved to approve the minutes of the December 15,2011 BOH • meeting. Member Austin seconded the motion. The motion passed unanimously. PUBLIC COMMENTS The following is a summary of comments made by citizens in attendance at the Board of Health Meeting. A citizen presented and handed out copies of a petition for a moratorium of the Port Townsend Paper Corporation Biomass project due to potential health risks,which has been signed by over 600 community members. A citizen expressed her concern regarding cardiopulmonary and neurological health effects caused by the emissions from burning wood biomass andalso read from an article on the effects of air pollution caused by sources of energy written by Dr. Mark Jacobsen, Director of Atmosphere and Energy Program and Professor of Engineering at Stanford University. She also urged for the support of the moratorium proposed by the Sierra Club. A Citizen requested the Board's support of the Sierra Club Moratorium and with keeping people educated on issues such as the Biomass project in connection with Port Townsend Paper. A citizen expressed his concern over the monitoring station being moved to Grant Street School from the Blue Heron Middle School,because there is data that shows the air quality is worse at Grant Street School. Finally, he urged the Board to oppose the project or get the Mill and/or• • DOE to provide accurate mtoring in the community. A citizen referred to Medical Journal articles regarding the link of strokes, cardiac effects, and cognitive damage due to small particles. A Citizen stated that her family and many others will move from Port Townsend if the Biomass project moves forward because of the air pollution it would produce. She read several letters from other community members that were not able to be in attendance of the meeting. A citizen presented a chart showing that burning wood is dirtier than burning coal. She urged support of the Biomass project being put on hold until new EPA rules, which would require cleaner operations be put in place, accordingly the entire plant would have to adhere to the new EPA rules. She requested support in requiring the mill to use a portion of their tax payer subsidies they receive for burning black liquor,to upgrade their technology, so that they are running more cleanly. A Citizen expressed her concern regarding the pollution that will be coming from the increase in diesel trucks, barges, and ash. She was also concerned that trees will start to be cut to provide the biomass. • 2 BOH Minutes—February 16,2012 A citizen urged the Board to investigate the biomass issue thoroughly, oppose the project, and . favor the moratorium. He also stressed that this is not only an issue for human beings,but for all living creatures. A citizen feels that the biomass project is being done to benefit an out of area investment bank that owns the mill, for the purpose of obtaining grants that have been made available for biomass projects. He feels this is not a sustainable project and it will not help the mill. A citizen stated that she does not feel that her health and well-being are,being protected by DOE, so she is turning to the Board of Health to call for a moratorium until there are more definitive answers on the issues. A citizen urged the Board to research the issue and do an environmental impact statement until the project moves forward any further. A citizen feels that this is a Health Department issue and urges the Board to take care of the health of the community. A citizen expressed his concern for the health of the animals in the community. He also feels the need for more reliable information on the health hazards and consequences the biomass project will have on all living creatures in the community. A citizen expressed the need for the Representatives to protect the community. • A citizen urged the Board to protect the community by not just looking at the rules and regulations but by doing what is morally right. OLD BUSINESS and;INFORMATIONAL ITEMS Biomass- Overview of Health Effects from Particulate Pollution and Regulatory Framework: Department of Ecology Perspective Gary Palcisko, Risk Assessor/Toxicologist for the Washington State Department of Ecology gave a presentation on the knot n health effects of fine particulate matter and how it is regulated. Mr. Palcisko defined particulate matter as any particle that is able to be suspended in air. His presentation focused on particles smaller than 2.5 microns (PM2.5), since those are the particles that have the greatest effect on people's health. PM2.5 exposure is associated with an increased risk in mortality causing cardiovascular, respiratory, reproductive, and developmental effects, and links to cancer. He presented estimates of deaths and disease rates that were attributed to PM2.5 in Washington with a projected cost of about $190 million per year for the State of Washington. The presentation covered the history of the regulation of air pollution, the acts passed and historic pollution episodes that led to Federal Legislation on air pollution. Next, he discussed how particulate matter is regulated. The EPA sets a standard, which is intended to protect the public health. As information is collected and new health effects are discovered, the • standards must be revised. The last revision was in 2006. Revised standards are to be issued 3 BOH Minutes—February 16,2012 every 5 years and the EPA is in the process of finalizing revisions to the air quality standards that are currently in effect. Mr. Palcisko discussed some of the main sources of PM2.5 in Washington and the tools that are used to control some of the emission. Some of the controls that are set in place are the permitting process, new source review,the Clean Car Law, diesel engines running cleaner, wood burning device regulations and burn bans. Mr. Palcisko showed a map of the monitoring network and discussed the monitor that is located at Blue Heron Middle School. He pointed out from the graph of the monitor at Blue Heron the PM2.5 is measuring at about 1/2 of what the standard is for an annual average,with highest events occurring between the months of October through March. At the end of his presentation.Mr. Palcisko fielded several questions from both Board Members and citizens that were in attendance. Member Austin moved for a letter to be drafted to the mill and ORCA suggesting that our community would appreciate more than 1 monitor and expressing the concerns of the community. He asked that the Board members sign the letter. Member Sullivan seconded the motion. The motion passed unanimously. Member Sullivan moved to amend the agenda and move the Public Hearing on Jefferson County Public Health Fee Updates for 2012 to the next item of business. Member Unanimously. Westerman seconded the motion. The motion passed Unanimously. Public Hearing on Jefferson County Public Health Fee Updates for 2012 Chair Johnson requested a staff report from Ms. Baldwin on the fee update. Ms. Baldwin stated that there is only one fee change, the rest of the fees reflected Consumer Price Indexing and are • not open to an ordinance change today. Ms. Shaw informed the Board that the only new fee is the Well Inspection and Water Sample for fee of$130.00. Member Frissell moved that the Jefferson County Public Health Fees for 2012 be adopted. Member Buhler seconded the motion. The motion passed unanimously. Introduction of New Environmental Health Director Ms. Baldwin introduced Jared Keefer, the new Environmental Health Director and asked him to update the Board on the work he has been doing. Mr. Keefer announced his Department is currently working on food program information sessions,the Water Quality Program has presented public meeting on Mats Mats Bay, initial public meetings have been held on the Hood Canal Watershed and there have been public meetings on the NE Jefferson project. Public Health Heroes 2012—A Healthier America Begins Today: Join the Movement Ms. Baldwin asked for a volunteer for the committee to read application for Public Health Heroes. Member Buhler volunteered to be on the committee. Member Sullivan moved to adjourn the February BOH meeting. Member Westerman seconded. The motion passed unanimously. • 4 BOH Minutes—February 16,2012 AGENDA PLANNING CALENDAR • The next scheduled BOH meeting will be held March 15, 2012 from 2:30 to 4:30 PM at Jefferson County Public Health, 615 Sheridan Street,Port Townsend, WA. ADJOURNMENT Chair Johnson adjourned the BOH meeting at 4:30 PM JEFFERSON COUNTY BOARD OF HEALTH t1i <r k i Iii Phil Johnson, Chair Jill°#'Buhler, Vice Chair John Austin, Member David Sullivan, Member Roberta Frissell, Member Sheila Westerman, Member O Catharine Robinson, Member Respectfully Submitted: Stacie Reid • 5 BOH Minutes—February I6,2012 • Board-of aCealth Old Business & Informational-Items .agenda Item # IV., 2 • Correspondence from Citizens .March 15, 201 Donna Marvin From: Marion Huxtable [mhuxtable@olympus.net] t: Thursday, February 16, 2012 4:03 PM boh@jeffersoncountypublichealth.org Cc: Kolff Kees; Gretchen Brewer; Bailey Elaine Subject: Pope Marine Dear Board of Health: I hope you will demonstrate concern for the air quality and the health of participants at public meetings by refusing to hold meetings at Pope Marine Building. Today's meeting was made almost impossible for me due to the volatile organic compounds in the air in that building, most Iilzely naphthalene from creosote in the timbers. Initially I sat at the open door on the side of the building until Board members wanted it closed. I then sat at the open door at the front of the building and had difficulty hearing the speakzers. Even with that door open, the voc's were strong in the lobby area where I stayed close to the open door. I left rather than put up with it any longer. I hope that by holding a meeting in a building that continuously emits voc's you are not sending a message to the community that emissions of voc's are of little concern to the Board of Health. I join with the speakzers who today expressed their dismay about the proposed biomass project at the PTPC. The bottom line is that we do not need this electricity. So, follow the old maxim "First of all do no harm". Please do whatever you can to prevent construction. Marion Huxtable • • 1 rage 1 01 Z. Cathy Avery From: kkolff[kkolff@olympus.net] • Sent: Thursday, February 16, 2012 6:08 PM To: boh@jeffersoncountypublichealth.org Cc: Tom Locke; Tom Locke Subject: Thank you, thank you. 2/16/12 Dear Jefferson County Board of Health, Thank you for taking seriously our concerns about the burning of biomass in a new power plant at the edge of town. I appreciate your taking time to hear from us last December and then devoting essentially your entire 2-hour meeting today to the topic. As you could tell from the turn out of more than 50 people with over a dozen taking time to express their concerns and nobody stating that they had been reassured about our safety, this project has many citizens worried. The over 600 signatures we delivered of those calling for a moratorium further under scores the need for more information, dialogue and assurance that our health will not be compromised. I thought the information presented by Gary Palcisko from DOE was excellent and confirmed what EPA has clearly stated in their own words about particulates and their standards: "There is clear and convincing scientific evidence that significant adverse human health effects occur in response to short- term and chronic particulate matter exposures at and • below . . . the level of the current annual PM2 5 standard." Gary added some Washington State figures to that which were new to me: "There are more than 1,100 premature deaths per year in Washington State from exposure to the 2.5 micron and smaller particles." Sheila asked Gary if it is true that the applicants for the project can select any emission levels from the past 10 years as their "baseline" for comparison with their planned biomass power plant. Though he was not sure about that, we are. It is permitted by law and the Nippon Plant in PA used the same method to claim that their emissions would be reduced by 17% with the new power plant, where as compared to the last year emissions there will really be an increase by 30%. The mill here used data from 2004-2006 to predict that emissions of"Particulates", and they lumped them all together with the less harmful and very heavy 10 micron particles, to claim that the WEIGHT of particles would be reduced by 67%. Sounds impressive, but thats not from current emissions and only from one boiler. The recovery boiler emissions will not change and puts out 1.5 times that much and thus the overall level of particulates might only go down 25% - if you trust the baseline and the modeling. We have copy of an e-mail dated 5/21/10 from DOE to the Trinity Consultants who did the "modeling", and it says: "If PTPC picks the highest 24 month baseline period for the last 10 years and then sets future emissions equal to that, they should not trigger PSD applicability." PSD refers to Prevention of Significant Deterioration, and that would have required higher standards of control. Were the emissions modeled, or were they set? We have serious concerns about this new power plant proposal, the standards set by the EPA, and the regulators from DOE who are supposed to protect our health. We urge you to do what 3/5/2012 rd.gcG01Z. you can. Thank you for deciding to ask ORCAA to place several additional air quality monitoring stations. Clearly the one at Blue Heron Middle School is not enough. How about Grant Street Elementary School, the hospital, or your Health Department clinics where so many children,pregnant women and others go for services? And you could do even more: 1. You could call for a moratorium until your concerns are addressed. 2. You could ask the City Council and the Board of County Commissioners to hold a public forum to get more information and public opinion concerning this project. 3. You could encourage the Clallam County Board of Health to study the proposal in their county - we share some of the same air. 4. You could ask for a report from your Public Health Officer about the mill landfill permit that is over due for renewal, and which needs to consider the more than double quantity of toxic biomass ash that will result from this new project. Once again,thank you for your attention to this most important issue that seriously threatens this community in many ways. Respectfully, Kees Kolff,MD,MPH, Chair, East Jefferson Biomass Committee, Olympic Group, Sierra Club • • 3/5/2012 Yage 1 of 2 Cathy Avery From: Elaine Bailey [elainembailey@earthlink.net] Sent: Friday, February 17, 2012 5:12 PM To: boh@jeffersoncountypublichealth.org Cc: Tom Locke Subject: BOH meeting 2/16/12 Dear Jefferson County Board of Health. Thank you for your attention and serious consideration of the environmental and health impacts intrinsic to the cogeneration project. This is a multifaceted and complex problem. I hope you are able to take some time to read many of the health and scientific papers available that show the use of biomass for electricity to be the most polluting and least efficient way to produce electricity. It is worse than coal per unit of energy. Definitely not"carbon neutral" as explained by top scientists who wrote the original IPCC protocols (International Protocols for Climate Change)on carbon accounting. The detrimental economic effects are significant, severe and long term and include known human health effects, forest health, water quality and supply, soil carbon disturbance, climate change and ocean acidification which effects shellfish and salmon. Regulations are forthcoming that will require the mill to upgrade its control and filtrations systems for boiler 10. A ruling that has been in the works for some time. This has been a topic of conversation since 2007 when the current air-operating permit was being appealed. The responsible party for implementing an upgrade should be the hedge fund owners of PTPC and not citizen tax dollars. PTPC already received a$2,000,000 grant from WA state for control systems that are not tied to a cogeneration project. If an ESP was added to power boiler 10 for paper production only, it would be a much greater help in lowering pollution in our area than adding significant increases for an electrical energy project. Where the electricity will be sold to the highest bidder and we get to breathe the increased air pollution. Increasing wood fuel by 2.6 times for the proposed project, (a combination of hog fuel and construction and demolition waste) will cause significant increases in ultra-fine particulates, the most harmful and unregulated kind. Because many of these are formed outside of the stack and are as small as bacteria& viruses, an ESP filtration system cannot decrease these totals. We will also have increased particulate health risks from more diesel trucks and large dusty hog fuel piles and other ambient sources.Not to mention construction and demolition contamination of the waterfront and surrounding air during the construction period estimated at over a year. I do not know what the plans are for running the mill during a time of reconstruction of PB 10, but the use of the package boiler would most likely be selected. If this is the case,we need to know whether there are any filtration systems extant on this boiler, what it is and what emissions we would then be subjected to. None of these considerations are taken into account in the Notice of Construction from Dept. of Ecology. I could write pages and pages of why we need a Moratorium and why it was unconscionable not • to require an Environmental Impact Study. This is like an iceberg where only the tiny tip has been accounted for. Thank you for suggesting and approving the creation of a joint letter regarding the concerns you 3/5/2012 ?age 2 of 2 heard at the BOH meeting and that you may now have. May I suggest that besides sending it to the mill and local council, it is also sent to the Dept of Ecology and to ORCAA. Your openness and time to listen was greatly appreciated. Many of us have worked diligently for the past 20 months to research and understand all aspects of this project and offer any assistance you may need for pier reviewed science and information regarding biomass for electricity. Elaine Bailey • 3/5/2012 • Board of 3fealt( OCd Business & InformationaCltems .agenda Item # 3 • Correspondence from the Board .March 15, 2012 JEFFERSON COUNTY BOARD OF HEALTH March 15, 2012 Ms. Fran McNair,Executive Director Ms. Eveleen Muehlethaler Olympic Region Clean Air Agency Vice President, Environmental Affairs 2940 Limited Lane, Suite B Port Townsend Paper Company Olympia,WA 98502 100 Mill Road Port Townsend, WA 98368 Re: Port Townsend Paper Company Proposed Biomass/Co-Generation Plant Dear Ms. McNair and Muehlethaler: On February 16,2012,the Jefferson County Board of Health (BOH)voted unanimously to request an additional air monitoring station to be located at Grant Street Elementary or Jefferson Healthcare. Our community has concerns regarding air quality associated with the Port Townsend Paper Mill(The Mill)and the proposed Biomass/Co-generation plant. At the BOH meeting, nearly thirty community members spoke out about the negative health impacts of fine particulates(less than 2.5 µg/m3) in The Mill's air emissions. At that meeting, Gary Palcisko, Department of Ecology presented findings from various studies' that link fine particulate emissions with an increase in mortality, cardiovascular effects,and respiratory ailments. There is significant community concern that the monitoring station at Blue Heron Middle School is inadequate to evaluate air quality in the Port Townsend area. Accurate measures of particulate air pollution is necessary to evaluate adverse effects on our vulnerable populations—the very young,elderly,and those with respiratory conditions.In response to the community concerns voiced at the February 16,2012 meeting,the Board of Health requests that ORCAA add a second monitoring station at the Grant Street Elementary School or Jefferson Healthcare. If it is impossible to add a second monitoring station at this time,then at a minimum,we request that ORCAA relocate the monitoring station to Grant Street Elementary or Jefferson Healthcare,until such a time that ORCAA can add a second monitoring station. If the reason a second monitor cannot be added is lack of available funding,we request that ORCAA seek funding for the second monitor from the Mill. 1 Ecology Publication#09-02-021, December 15,2009,Health Effects and Economic impacts of Fine Particulates in Washington; American Heart Association Publication, Particulate Matter Air Pollution and Cardiac Disease;Circulation June 1,2010,Volume 121, Issue 21;and Environmental Protection Agency, Integrated Science Assessment for Particulate Matter, December 2009 EPA 600/RO 08/139F. Board Members Phil Johnson,County Commissioner District#1,David Sullivan,County Commissioner.District#2, John Austin,County Commissioner,District#3,Catharine Robinson Port Townsend City Council, Jill Buhler,Hospital Conunissioner,Sheila Westerman,Citizen at large(City), 111111 Roberta Frissell,Citizen at large(County) 615 Sheridan•Castle Hill Center• Port Townsend • WA • 98368 (360)385-9400 • Sincerely, JEFFERSON COUNTY BOARD OF HEALTH Phil Johnson,Chair Jill Buhler,Vice-Chair John Austin,Member Sheila Westerman,Member David Sullivan,Member Catharine Robinson, Member Roberta Frissell, Member e Board Members Phil Johnson,County Commissioner District#1,David Sullivan,County Commissioner.District#2, John Austin,County Commissioner,District#3,Catharine Robinson Port Townsend Cin'Council, Jill Buhler,Hospital Commissioner,Sheila Westerman,Citizen at large(City), Roberta Frissell,Citizen at large(County) • 615 Sheridan •Castle Hill Center• Port Townsend • WA • 98368 (360)385-9400 r Board of.7Cealth Netiv Business .Agenda Item # 1 'Water Quality Project Overview & N(eetings with Environmental Cealth .march 15, 2 01 A �.R�,e r xK .7,,!"-:. t Ui N 00 l0 � o w C' A • r ,r eD ,1,40X.:',4,,a,,,,,,N,•,...-te.,. „ x 3 a) 0 pa rt,yb T'� �` �1 7. 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' . r Board of CeaCth Netiv Business .agenda Item #17., 2 • Public .7CeaCth Cero Nominations .March 15, 2 01 =CF JEFFERSON COUNTY PUBLIC HEALTH „ 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypublichealth.org • For Immediate Release: February 24, 2012 Contact person: Julia Danskin Jefferson County Public Health Phone: 360-385-9420 Jefferson County Public Health is Celebrating 2012 National Public Health Week beginning April 2th Jefferson County Public Health (JCPH) is celebrating National Public Health Week April 2-6. This year the National Public Health Week theme is A Healthier America Begins Today: Join the Movement!. JCPH asks you to nominate our local Public Health Heroes who make our community healthier. The Board of Health wants to hear your story. With nearly 1 million Americans dying every year from diseases that could be prevented, even small preventive changes and community initiatives can make a big difference in living healthier lives. National Public Health Week 2012 will build upon the National Prevention Strategy to create a healthier nation by promoting healthy behaviors in the following areas: active living and healthy eating; alcohol, tobacco and other drugs; communicable diseases; reproductive and sexual health; and mental and emotional well-being. http://www.nphw.org/ • JCPH began honoring Public Health Heroes as a way to locally celebrate National Public Health Week. The annual public health awards honor people who live or work in Jefferson County and promote Public Health in their daily lives. Nominations are open to the public through Wednesday March 14. Please submit a nomination for an individual, agency or group you feel is making a difference in the health of Jefferson County. What is Public Health?: Public Health helps communities to be healthy places to live, work and play. Public Health provides reliable information you can use to make healthy choices and protects our communities from hazards in the environment. Public health works to prevent health problems before they occur. The focus is on improving an entire community's health through achieving healthier lifestyles. What is a Public Health Hero? A Public Health Hero is a person or organization that promotes public health in their daily lives. Public Health Hero awards could represent the following categories but are open to others: • The Community Health Promotion award honors individuals or groups whose efforts increase the quality of life in the county. • The Public Health Leadership award honors those in our community who have provided leadership in creating policy solutions that assure, promote, and protect the community health. • The Business Merit award recognizes a companies for environmentally sound practices but many make healthy choices in what they sell, how they support • employees, and how they promote community health. COMMUNITY HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES PUBLIC HEALTH WATER QUALITY MAIN: (360)385-9400 ALWAYS WORKING,FOR A SAFER RHO MAIN: (360) 385-9444 FAX: (360)385-9401 HEALTHIER COMMUNITY FAX: (360) 379-4487 • The Community Based Organization award recognizes those who provide • infrastructure and services that promote public health in a variety of ways. • The Special Recognition for the Public Health Hero honors individuals or organizations who help identify a problem and then help the community work towards its resolution, e.g. planting trees, building trails, promoting physical exercise or health diets, or fitting children's car seats. I know someone in my community who is a Public Health Hero. How do I nominate them? • Nomination forms may be picked up at the JCPH office, 615 Sheridan St., Port Townsend, or • Download form online at www.jeffersoncountypublichealth.orq, or • Request that an application be mailed to you by calling (360) 385-9400 How do I return the completed nomination form? • Drop off or mail completed forms to: JCPH c/o Public Health Heroes, 615 Sheridan Street, Port Townsend, WA 98368, or • Fax completed form to (360) 385-9401 Can I nominate more than one person or group? You can nominate as many deserving people or groups as you like. The deadline for submitting nominations is Wednesday March 16. Winners will be announced at the April 19th Jefferson County Board of Health meeting at 615 Sheridan 2:30. Learn more about National Public Health week and "Building the foundation for a . health America" at http://www.apha.org/ For further information contact Julia Danskin, call (360) 385-9400 or email jdanskinco.iefferson.wa.us. ### Always Working for a Safer & Healthier Jefferson County HEALTH DCOMMUNITY HEALTH EVELOPMENTAL DISABILITIES PUBLIC HEALTH ENVIRON WA ERLQUALITY111 MAIN: 360-385-9400 MAIN:OR SAF� '" MAIN: 364385-9444 FAX: 364385-9401 HEALTHIER COMMUNITY FAX: 364379-4487 Board of Health Netiv Business .agenda Item #17I., 3 2011 Performance Measures End of Year Report March 15, 2012 0 • • Jefferson County Public Health — REPORT Performance Measures 2011 TARGETED CLINICAL HEALTH SERVICES PROGRAMS: Family Planning, School Based Health Clinics, Breast and Cervical Health, and Foot Care MISSION statement for Targeted Community Health Service: to provide outreach, access, health education, support treatment to specific populations in Jefferson County in order to improve the health of the community. Mission Statement for Family Planning Program: To provide accessible, high quality confidential reproductive health services in a safe, respectful environment. GOALS FOR FY 2011: 1. Assure Family Planning Services are provided in community and accessible 2. Decrease unintended pregnancy rates in Jefferson County (measure) 3. Improve access to health and mental health care for high school student population in Jefferson County. 4. Insure access to breast and cervical health exams to women age 40 to 65 years old 5. Support seniors' independence by maintaining their mobility OBJECTIVES FOR FY 2011: 1. Track Family Planning usage patterns and produce annual report 2. Emergency contraception to be provided under standing orders, 5 days per week, and expand community education and clinical services 3. 40%of enrolled students at Port Townsend and Chimacum High Schools will be serviced by School Based Clinics. 4. Maintain breast and cervical health program in Jefferson County 5. Maintain the current level of community foot care and continue expanding into home care IIIPERFORMANCE INDICATORS: 2008 2009 2010 2011 Actual Actual Actual Actual Number of unduplicated clients served in Family 1128 1202 1253 1170 Planning Number of adolescents under 19 served in Family 300 345 447 419 Planning Number of Chimacum and Port Townsend High School Clinic Unduplicated Clients 152 253* 255** %of 9-12th grade enrolled students served by School Based Health Clinics Chimacum High School 34%* 41%** Port Townsend High School 26%* 23%** Number of Breast & Cervical screening exams 110 84 99 76 Number of foot care contacts*** 3131 3065 2786 2635 *2010 Actual from 2009-2010 School year report SBHC **2011 Actual from 2010-2011 School year report SBHC *** Foot Care Senior Center and Home Visits Study Analysis 2011 results: The goal of the Family Planning program is to provide the support for families and individuals to control the timing of pregnancy and prevent unintended pregnancies. Jefferson County Public Health (JCPH)provides the only family planning program in east Jefferson County. Clinical fee revenue in the first half of 2011 has decreased by up to 20%. In this year's legislation session ending May 2011 Washington State Legislature 1 of 2 increased the income eligibility for"Take Charge" (Family Planning services)from 200%of the Federal Poverty Level (FPL)to 250%FPL. The State has not implemented the higher income eligibility for"Take Charge" as of Feb. 2012. In 2009, JCPH, in partnership with Jefferson Healthcare, opened two school clinics: one at the Port Townsend ill High School, and one at the Chimacum High School. JCPH Family Planning reduced Nurse Practitioner staffing and services at the main office in Port Townsend to provide Nurse Practitioner staffing at Chimacum and Port Townsend High School, School Based Clinics (SBC). As a result there is a slight reduction in overall Family Planning clients and the numbers of younger clients increased at the SBCs. Family Planning services at the Quilcene Clinic, Wednesdays, 10 AM to 2 PM, was reduced to two Wednesdays a month instead of four starting summer 2011. The Quilcene Walk-In Clinic usage is variable. Quilcene continues to have a need for access to Family Planning services. Family Planning Clinic staff will continue to evaluate client needs and staffing/funding available. In 2011 the Breast and Cervical Health Program (BCHP)had significant reduction in funding limiting the number of clients that could be signed up for BCHP at JCPH to 76. BCHP addresses the need for cancer screening and early treatment to decrease deaths from breast and cervical cancer in Jefferson County. In 2012 funds continue to be reduced for BCHP contract limiting the number of clients to 65 in 2012. Jefferson County's senior community continues to grow rapidly. In 2009 Jefferson County's median age was 50.2 years, an increase of 15 years since 1980, 12 years above Washington State's median age. The JCPH Foot Care Program helps this population maintain independence and mobility by providing foot maintenance at community centers and at clients' homes. Foot maintenance includes services that a client can no longer perform on themselves, such as filing calluses, cutting nails, and tending to sores resulting from diabetes. • March 5, 2012 S v, , Jefferson County Public Health — Report Performance Measures 2011 FAMILY HEALTH SERVICES litUDGET/PROGRAM: Community Health: Family Health Services Maternal Child Health (MCH) including Breast Feeding Support, Maternity Support Services/Infant Case Management,Nurse-Family Partnership (NFP), Children with Special Health Care Needs (CSHCN), Women Infants and Children (WIC), and the Child Protective Services (CPS) Contract Programs: Early Family Support Services (EFSS), Early Intervention Program (EIP). MISSION: The mission of Family Health Services is to promote health and reduce injury and disease in Jefferson County pregnant women and families with young children. GOALS FOR FY2011: 1. Monitor the rate and continue efforts to reduce the incidence of low birth weight infants. 2. Prevent and reduce prenatal exposure to substances. 3. Prevent injuries to infants and young children. 4. Prevent child neglect through education and support to parents. 5. Promote early learning and healthy development in infants and young children. 6. Educate parents about the impact of adverse childhood experiences. 7. Promote healthy nutrition choices for pregnant,post-partum, and breast-feeding women, and children under five. 8. Reduce unintended pregnancies. 0 Monitor family health indicators and provide community access to data. OBJECTIVES FOR FY 2011 1. Increase access to prenatal care in the first trimester by collaborating with local physicians to reduce barriers for Medicaid eligible pregnant women. Provide comprehensive education to pregnant women about health risks and changing health behaviors. 2. Screening, education, referrals, and risk reduction strategies on tobacco, alcohol, prescription narcotics, and illegal substances will be offered to pregnant women. 3. Screening, education, referrals, and risk reduction strategies to prevent shaken baby syndrome/abusive head trauma, sudden infant death syndrome, falls, burns, and other injuries will be offered to pregnant and parenting families. 4. Continue Nurse Family Partnership program as first priority evidence based prevention. Continue to offer education and support for nurturing and safe parenting skills through office visits, breastfeeding support group, South County drop in clinic and play group, and targeted home visits to higher risk parents. 5. Teach parents how to support their infant/child's development and learning. Screen for developmental progress using standardized measures and refer to community providers for specialized services. 6. Include a comprehensive screening during program intake for pregnant women,parents, and caregivers that includes standardized questions about substance use, mental illness, family violence, and the short form of the adverse childhood experiences (ACE) questionnaire. The screening process is an educational opportunity and guides intervention and referrals. 7. Educate pregnant women and their families about the benefits of breastfeeding, of increasing fruits and Wvegetables, daily exercise, and healthy weight strategies. . Educate parents about the benefits of making goals and plans around family size and child spacing, make referrals for family planning services. I OF 3 4, 9. Maintain contract with Nurse Family Partnership(NFP)National Office for analyzing data on program fidelity and client characteristics/outcomes. Maintain contract with Kitsap Health District for other program data analysis. Family Health Services data will be available to Board of Health and community through web site and reports. • PERFORMANCE INDICATORS: 2008 2009 2010 2011 Actual Actual Actual Actual 1. Number of depression screenings completed ** 85 53 56 ** 2.Number of comprehensive health screenings completed 69 3. Number of home and office visits provided in all Family Health 1363 1349 863 706 programs. 4. Families served annually in Family-Nurse Partnership 25 25 25 29 5. Total number of women infants and children served by WIC in 881 868 872 825 Jefferson County(from CIMS report) 6. Number of children with special health care needs Birth through 85 75 66 72 age 18 referred for Public Health Nurse Case Management. 7. Number of families served through CPS/DSHS contract. 40 57 35 28 **Number of depression screenings completed changed in 2011 to comprehensive screening completed SUMMARY OF KEY FUNDING/SERVICE ISSUES: from the beginning of 2011 JCPH Family Health Services are funded from a variety of sources: State and Federal Department of Social and Health Services, Department of Health, local funds through the 1/10t of 1%Mental Health/Substance Abuse • (MH/SA) sales tax, County Liquor Excise tax and County General Fund. State funding has been reduced both in actual dollars and change in service criteria to effectively reduce the Maternity Support Services and Infant Case Management programs by 40%. Nurse Family Partnership is also affected as it is funded in large part by billing these programs.NFP is our top priority prevention program and we are sustaining NFP by using funds from the MH/SA tax. Federal funding for WIC have increased. It was anticipated that Children's Administration would move ahead with a legislative mandate to privatize services. As of February 2012 the State Children's Administration has not moved ahead with privatizing Child Protective Services family intervention services. With this overall reduction in funding Family Health Services has not filled 1.5 FTE positions over the past year. We are experiencing high demand for our services as families are feeling increased stress from the poor economy and the concurrent reduction in almost all agency and community resources especially child care and housing. Because of small numbers local data is hard to capture but clinically we see a dramatic increase in addictions in mothers of young children. We are working very closely with local physicians and other providers to create a safety net of services for these vulnerable families. STUDY/ANALYSIS 2011 RESULTS: Funding for Maternity Support Services and Child Protective Services contracts remained relatively stable but it is anticipated that funds will be reduced as early as March 2012. Quen Zorrah, Public Health Nurse (PHN) Lead,resigned in January 2012. After analysis and anticipation of possible funding reductions the department will not replace the PHN position at this time. Other PHNs will readjusts their work responsibilities and a Health Educator will assist the Family Health team providing services to low risk families. Experienced PHNs • will continue to work with high risk families. 2 OF 3 d, Nurse Family Partnership continues to maintain services to about 25 families at a time, supported mostly with local funding. Port Gamble S'Klallam Tribe is contracting with JCPH NFP program for supervision and support as they implement an NFP program. In 2012 JCPH will also apply for a contract with Kitsap Public 4iealth to provide NFP supervision and support for their new NFP program. Family Health staff continues to work closely with local Jefferson Healthcare (JHC) Prenatal Care Providers meeting monthly for care conferencing, and discussion and collaboration around access to care and health concerns. In 2012 JHC Social Worker will meet regularly with JCPH Family Health Team to provide Case Conferencing resources for families and coordination of services. In 2011 Children's Administration did not follow through on a legislative mandate to privatize services for families involved with Child Protective Services (CPS). The local CPS Office continues to send referrals for Public Health Nursing interventions with families. The future continues to be unknown as Washington State Legislature deliberates how to reduce state spending with reduction in state revenue. Federal funds remain stable for WIC as caseload. Families served remain stable also. We continue to anticipate an increase in demand depending on how the economy recovers. Additional activities and changes in 2011 are: 1) Collaborated with the Jefferson Healthcare (JHC)Family Birth Center on the Period of PURPLE Crying education campaign to prevent abusive head trauma in infants and young children. JCPH family support team members reinforced information on PPC for postpartum women and families and to those families who had not received information/given birth at JHC. 2) August 2011 WIC expanded clinic services in Chimacum to 2 days a month up from one day a month. . Since August there has been an increase in WIC participation in Chimacum 3) Concerned Citizens discontinued regular on-site Birth to 3 year old, developmental screening at the Chimacum WIC clinic in 2011. However, JCPH WIC/Family Health Staff continue to refer families that have a concerns regarding their infant or toddler's development to Concerned Citizens for screening and Health Care Provider as needed. 4) In 2011 WIC services at Quilcene clinic were reduced to 2 day a month down from 4 days a month due to staffing needs and sporadic participation. Ongoing analysis of the client participation and access to services will be needed. The Family Health Team is structured dramatically different in 2012 so the ongoing analysis will be needed. Feb. 29, 2012 IP 3 OF 3 j Jefferson County Public Health —Report - Performance Measures 2011 POPULATION & PREVENTION • PROGRAMS: Tobacco Prevention, School Health, Oral Health, and Drug and Alcohol prevention MISSION: The purpose of the Population& Prevention Programs is to provide health education and public health interventions to county residents in order to promote a healthier community, prevent disease and unintentional injury, improve the quality of life and reduce disparities in health. GOALS FOR FY 2011: 1. Improve identified social and health indicators for school-age youth. 2. Improve overall health of Jefferson County residents. 3. Enhance the overall health& safety of Jefferson County children. 4. Reduce favorable attitudes toward problem behavior within the youth and adult communities. 5. Reduce adverse childhood experience as measures by reduced CPS referrals. OBJECTIVES FOR FY 2011: 1. Maintain delivery of school in-service/trainings, student health screenings, student health consults, student health care referrals. 2. Provide tobacco specific education and resources to employers to support employee cessation. 3. Oral Health prevention interventions will be provided to WIC clients monthly and at each School Based Clinic Monthly. 4. Increase the perception of risk for youth regarding alcohol and marijuana use, especially for 6th, 8th, and 10th grade students. (source Healthy Youth Survey) 5. Provide Early Intervention services to at risk families to prevent adverse childhood experiences. See • Felitti study showing how adults who had reported greater than 2 Adverse Childhood Experiences had increased health problems including tobacco, drug and alcohol use. See Family Support services program performance measures. PERFORMANCE INDICATORS: 2008 2009 2010 2011 2011 Actual Actual Actual Planned Actual Number of student health screenings 1124 1034 1040 1300 1040 Smoking in Public Places awareness education to 4 17 15 15 33 Businesses Number of school health classes 218 233.5 243 225 228 Number of students served in the school health 1,084 1,145 1,102 1105 classes Number of phone calls to WA State Tobacco Quite 93 170 143 140 133 line from Jeff. Co. Number of classroom presentation/interventions 134 116 117 112 101 (Drug and Alcohol preventions) Number of students served in the class room 404 382 493 398 387 presentations(Project Alert and Teens against Tobacco Use(TATU)) 1 of 3 Study Analysis 2011 Results and Funding Issues: Jefferson County Public Health (JCPH) delivers programs that promote healthier communities and • individuals. The above programs provide universal prevention programs available to everyone in the community. Preventing problems such as substance abuse and tobacco use have proven to be cost effective. JCPH uses assessment data in determining community needs and prioritize services (assess health care, substance abuse, domestic violence and child abuse and neglect). Washington State's Healthy Youth Survey was completed in the fall of 2010 school year. All school district in East Jefferson County participated. Results of the survey were made available in the spring 2011. Tobacco prevention and control program addresses four main areas: 1) increase community coordination and capacity, 2)prevent youth/young adults tobacco use, 3) increase quitting among tobacco users, and 4) eliminate exposure to second hand smoke. These goals are to protect resident's health and promote healthy behaviors. Adult smoking rates in Jefferson County are approximately 17% (2009-2010 BRFS). The highest use rates are in 18-34 year olds and are higher among adults with low income/low education level. Calls to the WA state Tobacco Quit Line have shown a steady increase from 0 in 1999 to 143 in 2009, due in part to local outreach and promotion in Jefferson County. The number of Quit Line calls from Jefferson County decreased to 133 due to state budget cuts for promotion and access to this service. Teen tobacco use has been addressed through many avenues including: Peer education program,"Teens Against Tobacco Use," youth access prevention and tobacco retailer education. Funding for the WA state tobacco prevention and control program was eliminated from the WA state budget in December of 2010,resulting in the elimination of the local tobacco prevention and control • program. Very limited funds for January 2011 to June 2011 were used to educate tobacco retailers about youth access issues through a series of mailed postcards. Through June 2012 there is a small amount of Federal funds for youth Tobacco prevention. School funding is based on State School Nurse Corp through the Educational Service District and contracts with school districts. The School Nurse Corp funds pay to provide a School Nurse to insure Student Health Plans are in place for students with health problems. School Nurse Corp Nurse also trains school staff to support students with health problems,monitor student immunization and provide information on healthy school environments. State funding has been limited but School Districts have been willing to contribute funding to maintain the same level of services as last year. JCPH contracts separately with the school districts to provide required Health Education Classes and Health Screening. Those contracts remained the same in 2011. Of the 1040 initial hearing and vision screenings done during the 2010/2011 School year, 281 students were rescreened and 130 students were referred for further evaluation, 90 for hearing and 40 for vision. The number of health care and emergency response plans in place for students with chronic health conditions that may affect their health and safety at school was 112, total, for Port Townsend and Chimacum School Districts. In 2011 the number of Human Growth and Development classes decreased slightly while the numbers of students served stayed constant. There were no classes for the special education classrooms because JCPH and the DD County Coordinator provided a special training classes for the Special Education staff for county schools so that the direct service staff working with students with special needs could provide this information in a lesson format as well as in a 1:1 teaching format. 2 of 3 Drug and Alcohol Prevention programs provide integrated prevention services that promote healthy behaviors,prevent harm and support youth and family in the schools and in the community. • In 2011 Drug and Alcohol Prevention staff provided Project Alert, an evidence-based drug and alcohol prevention curriculum, in Jefferson County Middle Schools. Funding for classes was supported with local City and County prevention funds, and Washington State Department of Behavioral Health and Recovery (DBHR). After July 1, 2011 DBHR prevention funding has been changed to focus only on the City of Port Townsend using environmental strategies; direct services are no longer funded. As of January 1, 2012 the City of Port Townsend prevention funding has been eliminated. Prevention staff completed Project Alert Classes for the school year in February 2012. At this time there are no plans to continue Project Alert classes in the middle schools in Jefferson County. In 2011 the Jefferson County Sheriff's Department continued to facilitate the evidence-based "Protecting You/Protecting Me" classes for the 5th grade at Chimacum . The Port Townsend Police facilitated these classes in Port Townsend for the 5th grade. Port Townsend School District staff facilitated the"Protecting You/Protecting Me"classes for theI st,2nd and —rd grades. At this time the Sheriffs Dept., Port Townsend Police and Port Townsend School District will continue to support the facilitation of Protecting You/Protecting Me. In April 2011, for the 4th consecutive year, JPCH worked along with community partners on the "Our Kids: Our Business" Social Awareness Campaign. In the fall of 2011 JCPH, under the direction of DBHR Prevention Redesign, initiated a community process to develop a Strategic Plan. DBHR is providing the facilitation for an Evidenced Based Practiced called . "Communities that Care" (CTC). CTC creates a broad—based coalition of key stakeholders who use data (Healthy Youth Survey)to prioritize risk and protective factors in the community. Then the coalition will come up with Strategic plan to implement effective prevention programs to address identified needs. Healthy Child Care Washington (HCCW) Public Health Nurse (PHN) Child Care Consultation funding ended December 2010. Federal Funds for this service was redirected at the State from the Department of Health (DOH) to the Department of Early Learning (DEL). In 2011 Olympic ESD received a regional contract from the DEL to provide Interdisciplinary Child Care consultation in Jefferson, Clallam and Kitsap Counties. In 2012 the OESD contracted with JCPH on a fee for service basis to provided Public Health Nurse Child Care consultation. There is only limited funding and JCPH anticipates minimal referrals for consultation. State Oral Health funds ended December 2010. In 2011 JCPH Oral Health Coordinator/Registered Hygienist Cyndi Newman provided monthly Oral Health clinics at WIC clinics through September 2011 when her contract funding was spent. As of Feb. 2012, due to unsure Oral Health revenue from Medicaid fees JCPH has not renewed a contract to provide Oral Health services in WIC Clinic. Washington Dental Foundations Smile Mobile came to Chimacum High School/Middle school in Nov. 2011. The demand for Smile Mobile services was great enough that the Smile Mobile will be returning to Chimacum High School May 2012. Funding for Prevention programs have been radically reduced in 2011. As a result programs have been reduced or eliminated. Planned performance measures for 2012 and into 2013 will be reduced as staffing • is reduced. March 5, 2012 3 of 3 Jefferson County Public Health Performance Measures 2011 Year-End Report DRINKING WATER PROGRAM s MISSION: The mission of the Drinking Water Program is to protect public health by assuring that residents and visitors to Jefferson County have access to a safe and reliable supply of quality drinking water and that it is reasonably available. By enforcing and monitoring laws regulating public and private water supplies, the Drinking Water Program minimizes the threat of waterborne disease. GOALS FOR FY 2011 1. Assure that all new wells are constructed in accordance with requirements established by the Washington Department of Ecology. 2. Provide technical assistance when requested so that individual water supplies are safe. 3. Limit public exposure to water systems with known deficiencies. 4. Integrate water quality issues discover through building permit adequacy review information with the Water Quality program's water quality database. OBJECTIVES FOR FY 2011 1. Inspect at least 50%of all new wells constructed with 25% of these with the well driller present and 90% of all wells being de-commissioned. 2. Maintain high rates of compliance with state well drilling regulations. 3. Review all building permits and project applications to assure that potable water supplies meet basic public health standards as well comply with state statutory and regulatory requirements. 4. Provide technical guidance to any residents requesting assistance with their individual or small water • systems to deliver safe drinking water. 5. Establish appropriate policies for alternative water supply systems. 6. Continue contracting with Washington Department of Health for public water supply projects, as long as adequate funding is provided. PERFORMANCE INDICATORS 2008 2009 2010 2011 2011 Projected Actual # of well applications received&reviewed _ 76 83 61 80 56 #of new wells start notification(drilled) (includes some well applications from 79 77 62 75 57 previous years) # of wells decommissioned 17 8 13 15 12 #of new wells inspected(start notification 48 53 32 30 31 received) %of new wells(starts) inspected 63% 68% 52% 50% 54% #of inspected wells with driller on site _ 25 28 (includes new and decommissioned wells) %of inspected wells with driller on site -- -- 55% -- 65% # of decommissioned wells inspected 17 8 13 12 12 %decommissioned wells inspected 100% 100% 100% 100% 100% SUMMARY OF KEY FUNDING/SERVICE ISSUES: • • Tracking is being improved with planned updates of Tidemark and shifting other program databases into Tidemark. This will facilitate a centrally Iocated database with information across multiple departments for better coordination and efficiency. The Tidemark database has been modified to 1 of 2 allow better track and reporting to comply with the requirements in accordance with the Water Management Rule for WRIA 17. Future focus must be on maintaining consistent data entry, verify accuracy and determine ways to make information readily available for the public. • There continues to be a need to establish a funding source to provide adequate staffing to focus on • water issues in Jefferson County. Water quality and quantity is a topic expected to be at the forefront of future economic and environmental sustainability. Lacking appropriate resources directed to the issue, staff may be at a severe disadvantage to appropriately respond to the broad range of issues in this regard. Where feasible more public outreach is necessary to effectively communicate requirements to minimize future possible enforcement actions. STUDY/ANALYSIS Applications for well inspections continue to be down substantially after several years of an increase in well drilling activities. There has been a roughly 25%decrease in the number of wells drilled in the county this year as compared to 2008. Drilling activities have generally been static and declining since 2008,basically mirroring the economic forecasts of a flat recovery. The slight increase in well drilling activity in 2009 can be attributed to public anticipation of the pending WRIA 17 In stream flow water rule that was implemented on December 31, 2010. The number of well decommissioning can be partly attributed to septic permitting activities together with the expansion of public water service to areas previously not served. We are also tracking a decommissioning that occurs as a result of an initial attempt to drill,where the result is either dry or untreatable water(mostly chlorides)and the well is decommissioned,prior to the driller leaving the site. That process of tracking started approximately 2007. The continued economic downturn has impacted all applications for development in the county. As a result, staffing has been decreased,hours reduced and programs reassigned. There is no longer a staff . member dedicated exclusively to working in the drinking water program. As funding sources dissipate issues related to drinking water become less preventative based and more complaint driven. In house expertise is being undermined with unsustained funding. There is a limitation on trainings/seminar attendance and multi jurisdictional interaction related to water issues. These forums give rise to new and creative means to provide alternative water supplies and initiate conservation measures that minimize impacts of water shortages. Coordinated Water System planning in the county has been disabled and now water resource planning units are on the verge of being dismantled. Where will all of the institutional knowledge from these efforts end up? Updated: March 1, 2012 • 2 of 2 4.. Jefferson County Public Health Performance Measures 20llYear-End Report ON SITE SEWAGE PROGRAMS (OSS) • MISSION: The mission of the Onsite Sewage Program is to protect public health by mitigating the threat of surface and ground water contamination from failing or improperly designed, installed or maintained onsite sewage disposal systems. GOALS FOR FY 2011 1. Educate homeowners, builders,real estate personnel, banks, installers, designers and onsite system maintenance personnel in the proper operation and maintenance of onsite sewage systems. 2. Assure a high quality-onsite sewage system monitoring program. 3. Implement and enforce state and local rules and regulations governing the installation and use of onsite sewage systems. 4. Investigate action requests and complaints in a timely manner to reduce the threat of human contact with untreated wastewater. 5. Complete all state funded grant activities on-time and on-budget. 6. Assure high quality customer service. OBJECTIVES FOR FY 2011 1. Develop written informational materials for public distribution and conduct workshops for community groups addressing onsite sewage system operation and maintenance. 2. Provide training to community groups to increase awareness of regulatory requirements for onsite sewage systems. 3. Review system monitoring and inspection reports as well as provide timely follow up and • coordination with online submittal program data. 4. Identify previously unknown onsite sewage systems. 5. Utilize existing data systems to track action requests and complaints. 6. Assure communication with applicants regarding the status of onsite sewage permit applications. 2011 2011 PERFORMANCE INDICATORS: 2008 2009 2010 Projected Actual Number of systems repaired/upgraded 32 32 37 35 31 Percent of system failures less than 5 years in use 0 0 0 0 0 Number of complaints received 42 43 52 45 36 Number of complaints closed 24 19 33 25 25 Number of septic permit applications submitted 231 169 158 180 118 Number of evaluations of existing system(EES)- 295 255 463 350 469 Monitoring Inspection Percent of existing systems receiving regular 3`d party 2.2% 1.8% 3.4 2.5 3.4 monitoring.2 #of previously unknown systems having a 15 9 10 40 15+855 monitoring inspection' Percent of monitoring inspections resulting in some 29% 28% 56% 29% 68%4 maintenance needed. Percent of monitoring inspections resulting in 12.5% 16% 18/7% 15% 12.4% required significant maintenance or repair. Percent of failures/major maintenance <2% <2% <2% <2% <2% • Number of educational workshops 6 5 19 20 4 Number of workshop participants 239 102 355 300 156 'Number of applications does not equal approved permits 1 of 3 2 Based on estimated 13,500 systems in the County(from the Local Sewage Management Plan) 3 Represents cases created only as a result of a monitoring inspection consistent with past years.Additional systems were identified through sanitary surveys but do not get a full inspection and were not counted in this category. 4 Includes inspections where the only maintenance item identified was that the tank needed to be pumped.Previous years did not include this maintenance item. 515 systems were identified and observed via regular monitoring inspections,85 systems were identified via sanitary surveys and are sites where no previous records exist. SUMMARY OF KEY FUNDING/SERVICE ISSUES • Tracking was done with existing data systems to evaluate effectiveness of onsite sewage and OSS monitoring programs. Ongoing O&M activities were funded through permit and inspections fees and grants from the Department of Health and EPA. The grant funds increase our ability to provide outreach to the community,review of reports and development of additional program components such as a homeowner inspection element. Implementation involved coordination with the private contractors to set up systems for scheduling and tracking inspection activities, reviewing reports and communicating with property owners if additional actions are necessary and conducting community outreach to increase awareness of the new requirements. • Identification of previously unknown onsite sewage system was emphasized this year as part of a project in the Marine Recovery Area(MRA). The project is part of the effort to identify all unknown systems by the end of 2012. • • Onsite sewage permitting and staffing has declined due to the economic downturn of the past several years. The team continues to strive to maintain effective communication with our clients and partners (other state and local departments)to effectively manage workload and requests for information while diligently reviewing and enforcing county code and policies. STUDY/ANALYSIS • We met regularly with providers to maintain consistency in reporting Monitoring Inspections and OSS design submittals. An all day class was provided for 85 professionals in the onsite field. The class focused on troubleshooting OSS system problems and maintenance and monitoring challenges for various system types. Our effort to enter existing onsite sewage records into the database and scan for use by the public and professionals is ongoing. These are used extensively by Designers, O&M Specialists, Realtors and homeowners to access record drawings (as-built). This improves the quality of the work submitted and the understanding of interested parties. Monitoring Inspection Reports are reviewed and follow-up letters sent where problems/deficiencies are noted that indicate either imminent failure or identify a violation of the permit. The number of monitoring inspections submitted is similar to last year. This is the second year that inspections must be current for issuance of a food service permit. The requirement for annual monitoring of septic systems serving food service establishments has existed since 2000 in the WAC,but JC did not connect it to the food service permit until last year. Several problems were identified during the inspections and corrections are ongoing. Deficiencies identified include components installed with out permits,baffles missing, ponding in the drainfield, surfacing sewage,tanks needing to be pumped/serviced. In some cases compliance agreements have been used to achieve a schedule of actions and correction. • 2 of 3 Classes to provide information on taking care of your septic system continue to be provided and are very well received in the community. They provide an opportunity to inform homeowners about funds that are available to repair or upgrade a substandard or failing system. Additionally we share information about efforts to identify water quality problems and correct them. Work is coordinated with the Water • Quality Department and the work they do on sanitary surveys in communities. Classes were provided to Realtors and Builders Assoc. As part of implementing our Sewage Management Plan, staff continued to identify previously unknown onsite sewage systems. Identification of previously unknown systems occurs in two ways: 1) Through sanitary surveys which are completed as part of several grants. Current projects include portions of Discovery Bay, the Hood Canal, Chimacum Creek and Mats Mats Bay. 2) Via a regular monitoring inspection that includes an inspection of the septic tank. Sanitary Surveys help us to identify that a system is on a property but do not generally include a detailed inspection of the system. These systems are tracked separately. In late 2011 a Work Group was formed to provide recommendations on a system for homeowners to become certified to complete some of the required monitoring inspections. This group will meet 5 times and is composed of professionals from the OSS field and others with an interest in the proper functioning of these systems. A webpage at the public health site is dedicated to providing information about the process along with the agendas,meeting minutes and meeting materials. Three public forums will follow to provide information to the public and take comments on the group's recommendations. Following these forums, a draft of revisions to JC Code 8.15 Operations and Monitoring section will be submitted to the BOH for their consideration. We have been coordinating our efforts to create a homeowner inspection process with Clallam County to model their program that is under development. Just over 100 homeowners went through their training • process and completed an inspection with a Clallam County employee. They have not issued a final report at this time but generally believe it is a workable program for full implementation in the next year. We anticipated beginning that program late in 2011 or early 2012 but will not be ready until our work group has completed its work in late March 2012 and code revisions are adopted by the BOH. Updated: March 1st, 2012 3 of 3 BURNING WOOD IS "DIRTIER" THAN BURNING COAL CO2 20000 12644 11312 10596 tons per megawatt 9067 per year (tpmpy) o ;= 3130 --meq UriWood Wood Wood Coal _.., Russell PRE NG Gretna Percentage more than Coal +39% o Boardman PVEC more than Natural Gas +304% +25% +17% +261/o +239% 2 1.69 1.55 Particulates I 1.15 1 (tpmpy) I I 0.59 0 . 0.12 Wood MIWood Wood Coal Russell E NG • PercentageIII more than Coal Gretna +186% 5% Boardman PVEC more than Natural Gas +1308% +°""°+1192%+163% • 3.9 • III 4 1 3.49 3.74 3.38 NOx 3 2 (tpmpy) 1 0 0.23 Wood GO Wood Wood Coal Russell PRE Gretna NG Percentage more than Coal ° Boardman PVEC more than Natural Gas +15/o +30/, o +1596% +1417+1526%526% All numbers were taken from proposals or environmental statements from the power producers and reflect use of pollution controls. See, http://www.massenvironmentalenergy.org/plantdata.html Comparison to coal (% above coal emissions)=[biomass level-coal level]/[coal level] Comparison to natural gas (% above NG)= [biomass level-NG level]/[NG level] Russell, PRE, Gretna: 3 proposed biomass electrical power plants in MA, MA and FL Boardman, PVEC: Coal powered in OR, Natural Gas powered in MA www.ecolaw.biz/www.nobiomassburning.org • From: BellaLigne<neildsachs@yahoo.com> Subject: Re:An idea Date: February 15,2012 3:50:01 PM PST To: Hollin Moore<hollinm@mac.com> Reply-To: BellaLigne<neildsachs@yahoo.com> Hollin Thanks for the e-mail. , i agree - this time arrangement precludes most from having an active input. I will not be able to make this meeting but I would concur this finalizes our need in fact to move from Port Townsend if this is the case. A biomass incinerator does not make for an idyllic seaside community - especially one that relies heavy on tourism. Denise --"be regular and orderly in your life, so that you may be impassioned and original in your work."-- Flaubert From:Hollin Moore<hollinm@mac.com> To:Hollin Moore<hollinm@mac.com> Sent:Wednesday,February 15,2012 3:11 PM Subject:An idea Hi all. Sorry to bother you again,but I had an idea. Since whoever put this meeting together,apparently didn't really want comments from the public...at least this is what I am assuming since they set it up for a time when most people are working, (and for 15 minutes before pick up for Grant St. elementary).... I welcome any comments you have to be emailed to me if you cannot make the meeting.I will then pass your comments along when I stand to give my feedback. Really,this is so important. I know of several folks,including ourselves,who will move away from Port Townsend if this ridiculous project goes through.... Also,if you are interested in more information there will be a meeting in March for local parents to attend,that will target the concern for children specifically and the health risks associated with the biomass incinerator.You can contact me for more information. Also,you can go to http://www.ptairwatchers.org. The North Olympic Sierra Club has joined forces with folks from PTAirwatchers in taking a stand against this project...however,they cannot do it alone. They need people from the community to stand with them! Thanks again, Hollin Begin forwarded message: From:Hollin Moore<hollinm@mac.com> Date:February 15,2012 12:15:27 PM PST To:Hollin Moore<hollinm@mac.com> Bcc: Subject:EXTREMELY important for Port Townsend's children and the health of ail who live here! • Hello. Please attend the Board of Health meeting this Thursday at 2:30 at the Pope Marine Building(see below....) From: Ann Scarborough<scarboro@olympus.neb 41, Subject: Re:EXTREMELY important for Port Townsend's children and the health of all who live here! Date: February 15,2012 1:20:11 PM PST To: Hollin Moore<hollinm@mac.com> Hollin, I absolutely cannot come but I am very concerned about the biomass plant and any potential emissions. I am seriously allergic to wood smoke and I understand waste wood is one of the main things they burn in these factories.Any more smoke in the air than we already have and I am going to have to move,and I have lived here for 25 years. Ann Scarborough On Feb 15,2012,at 12:15 PM, Hollin Moore wrote: Hello. Please attend the Board of Health meeting this Thursday at 2:30 at the Pope Marine Building(see below....) This is EXTREMELY important to all who live in Port Townsend and care about their health and the health of the children in our community.Children, especially,are in danger of serious health problems if the new biomass power plant is allowed to go through. Please, Please,attend. I hope I will see you there! Also,please forward this information on to as many people as you can. Thank you, Hollin Very IMPORTANT> Please forward right away to anyone you know who is concerned about the proposed cogeneration addition to the mill and it's impacts on our health. PLEASE A I I END. This is most likely our only chance to show strength in numbers to • the Board of Health and Dept. of Ecology. WE NEED YOU TO COME. thanks. Elaine Dear friends, If you are concerned about the new biomass power plant and it's potential effects on our health, please come to the local Board of Health meeting this Thursday at 2:30 at the Pope Marine Building.The 3 County Commissioners, a Hospital Board member, and a City Councilor are all part of the 7-person Board of Health and they will be getting a report from the Department of Ecology.They heard our concerns in a presentation last December and this week they are also likely to hear from the mill as well as from DOE. There is a time for public comment at the beginning of the meeting, but we are not sure when DOE will present or when the Board will discuss the issue. Please come and show support for our shared concerns AND forward this invitation along to others. Thanks, Kees Kolff • 40 From: Rhonda Hull<rhonda@rhondahull.com> Subject: Re:EXTREMELY important for Port Townsend's children and the health of all who live here! Date: February 15,2012 3:47:45 PM PST To: Hollin Moore<hollinm@mac.com> Hi Hollin, Thanks for hand-carrying this concern to the meeting in my absence: �I�llnws��iw�==r�Er=/e/1�1�1✓'1/�i7/l .�.-- To whom it may concern, -- — r - I know first hand the impact of mercury and other toxins carried as particulate matter in our air and dirt as a result of polluters like this one. I have a grandson diagnosed with autism who they found to have off the chart levels of mercury,lead,arsenic and other toxins due to living on the take off flight path of an airport and playing in contaminated dirt. He was showered by toxins similar to what our mill produces,and as a result my family has endured the financial strains that are the result,as well as the challenging journey of attempting to access this amazing little boy who was deprived of a normal childhood and the ability to speak,cuddle, interact and play as other unaffected kids do. We live in a State of Denial rather than the beautiful State of Washington if we choose to remain blind to the potential impact not only on our children,but all the residents of Port Townsend...and the World. I came to here for PT's clean air,conscious community,and beauty. I had hoped to escape the smog and sludge found elsewhere. 11ladr VA- Please use your :- •- olds the wisdom needed for us to have a future rather than your corporate pocketbook to guide this important and life- threatening.- '.n. v. 1er Earth is already in so much distress and sends signal after signal for our attention.Can we afford to make yet another unco :s mistake? I will move from Port Townsend if this biomass proposition becomes a reality.Sadly,there are few options left fo find a pollution-free place to live. : Rhonda Hull, Ph.D. P.O. Box 1667 t Port Townsend,WA 98368 Rhonda Hull _. 0 rhondaOrhondahull.com On Feb 15,2012,at 3:24 PM,Hollin Moore wrote: Hi. I just sent out some more info...if you have any comments I can add to the meeting tomorrow please lot me know. Thanks Rhonda! On Feb 15.2012,at 12:19 PM, Rhonda Hull wrote: Dear Hollin. I have a 2:00 appointment that day than conflicts with this meeting. Please let me know what is shared and where I can access more info about it. XXOO, Rhonda Rhonda Hull rhonda@rhondahull.com On Feb 15,2012,at 12:15 PM. Hollin Moore wrote: Hello. Please attend the Board of Health meeting this Thursday at 2:30 at the Pope Marine Building(see below....) • This is EXTREMELY important to all who live in Port Townsend and care about their health and the health of the children in our community. Children,especially,are in danger of serious health problems if the new biomass power plant is allowed to go through. Please, Please,attend. I hope I will see you there! Also,please forward this information on to as many people as you can. Thank you, Hollin • My name is Hollin Stafford. I have a few things to say, as well as some comments to pass along from concerned community members who cannot be here today. I have lived in PT for nearly five years. My husband was raised here and many of you may know his mother, Kathy Stafford. Who is a past director of Jefferson County Department of Health. We are lucky in the fact that my husband can run his company from anywhere in the world. Anywhere, and we chose Port Townsend....the beautiful setting, small progressive-thinking town filled with creative minds authors, artists, etc. There are many reasons that this is a great place to raise a child. However, if the biomass incinerator comes to pass we will move from PT without hesitation. The health and well being of our 7 year old as well as ourselves is our top priority. We are making changes in our home life, we hope to have our new leaf this month, but at times it feels as if the larger issues are beyond our control. That is why I am here today. We are already concerned about the current burning being conducted at the mill and know many families and individuals who have moved away, or not moved here from elsewhere due to the current conditions. • In my opinion, if the biomass incinerator is allowed to happen, it will be the downfall of Port Townsend as we know it. MANY people will leave town for healthier alternatives...I have messages from a few of these folks with me today...and the tourism that this town so heavily relies on will be reduced to a mere trickle...people do not want to vacation under the clouds of burning chemicals. This would be one more of the many heavy burdens we are asking our earth to carry. Biomass burning is NOT carbon neutral, it's not Green and the health risks are astronomical... I have researched this issue and found countless articles siting groups such as the American Lung Association, Massachusetts Medical Society...the list goes on)...urging the government to stop promoting legislation that supports the combustion of biomass. Their argument? Burning biomass could lead to significant increases in emissions of Nitrogen oxides, particulate matter and sulfur dioxide and have severe impacts on the health of children, older adults and people with lung diseases epidemiological studies have demonstrated an association between elevated particulate air pollution levels and adverse health affects and death. There was a quote in a book I was reading last night, by a local author that really struck me....He's talking about the white clams in the hood canal... "Those shells, as unique and timeless as bones, helped me realize that we all die young, that in the life of the earth, we are houseflies, here for one flash of light." • f. . Others may already say this.... Before being allowed to do this expansion which will further damage the health of the community, PTPC should be required to spend part of the millions in taxpayers subsidies that it has received annually in recent years to make its existing operations healthier and safer for the community and its employees by installing modern clean technology. • In each of the last few years, PTPC received $30 to $60 million in taxpayer "green energy" subsidies for burning around 325,000 tons of Black Liquor, a substance which it burns anyway as part of its process. • Modern pulp mill technology can operate more efficiently, with "virtually no smell" and greatly reduced emissions. • Some of the equipment at PTPC is close to 100 year old technology or otherwise at the end of its design life. I stand here today to remind you that you are here to do great things. What will you do within the flash of light that is your life? You could save a community. You could save lives. Thank you. • 114, Page 1 of 2 Cathy Avery From: Elaine Bailey [elainembailey@earthlink.net] • Sent: Friday, February 17, 2012 5:12 PM To: boh@jeffersoncountypublichealth.org Cc: Tom Locke Subject: BOH meeting 2/16/12 Dear Jefferson County Board of Health. Thank you for your attention and serious consideration of the environmental and health impacts intrinsic to the cogeneration project. This is a multifaceted and complex problem. I hope you are able to take some time to read many of the health and scientific papers available that show the use of biomass for electricity to be the most polluting and least efficient way to produce electricity. It is worse than coal per unit of energy. Definitely not"carbon neutral" as explained by top scientists who wrote the original IPCC protocols(International Protocols for Climate Change) on carbon accounting. The detrimental economic effects are significant, severe and long term and include known human health effects, forest health, water quality and supply, soil carbon disturbance, climate change and ocean acidification which effects shellfish and salmon. Regulations are forthcoming that will require the mill to upgrade its control and filtrations systems for boiler 10. A ruling that has been in the works for some time. This has been a topic of conversation since 2007 when the current air-operating permit was being appealed. The responsible party for implementing an upgrade should be the hedge fund owners of PTPC and not citizen tax dollars. PTPC already received a$2,000,000 grant from WA state for control systems that are not tied to a cogeneration project. If an ESP was added to power boiler 10 for paper production only, it would be a much greater help in lowering pollution in our area than adding significant increases for an electrical energy project. Where the electricity will be sold to the highest bidder and we get to breathe the increased air pollution. Increasing wood fuel by 2.6 times for the proposed project, (a combination of hog fuel and construction and demolition waste) will cause significant increases in ultra-fine particulates,the most harmful and unregulated kind. Because many of these are formed outside of the stack and are as small as bacteria& viruses, an ESP filtration system cannot decrease these totals. We will also have increased particulate health risks from more diesel trucks and large dusty hog fuel piles and other ambient sources. Not to mention construction and demolition contamination of the waterfront and surrounding air during the construction period estimated at over a year. I do not know what the plans are for running the mill during a time of reconstruction of PB 10, but the use of the package boiler would most likely be selected. If this is the case,we need to know whether there are any filtration systems extant on this boiler, what it is and what emissions we would then be subjected to. None of these considerations are taken into account in the Notice of Construction from Dept. of Ecology. I could write pages and pages of why we need a Moratorium and why it was unconscionable not to require an Environmental Impact Study. This is like an iceberg where only the tiny tip has been accounted for. Thank you for suggesting and approving the creation of a joint letter regarding the concerns you 2/21/2012 Page2of2 heard at the BOH meeting and that you may now have. May I suggest that besides sending it to the mill and local council, it is also sent to the Dept of Ecology and to ORCAA. Your openness and time to listen was greatly appreciated. Many of us have worked diligently for the past 20 months to research and understand all aspects of this project and offer any assistance you may need for pier reviewed science and information regarding biomass for electricity. Elaine Bailey S 2/21/2012 COLUMBIA ANALYTICAL SIERVICES,IC ,Ctsr,1;.itr •-.47,;:t5' Analytical Renor Client: Port Townsend Paper Corporation Service Request K0912473 Project: Landfill SPLP Testing Date Collected: 12/22/2009 Sample Matrix: Aqueous'Liquid Date Received:: 12/24/2009 Date SPLP Performed: 12/28/2009 Date Extracted: 12/29/2009 Synthetic Precipitation Leaching Procedure(SPLF, EPA Method 1312 Metals Units:ing/L(ppm)in DI Water Extract PTPC-InterLandlni Smote Name: 2009 Method Bleak Lab Code: K0912473-001 K0912473-MB Date Analyzed: 12130/09-1/6110 12130/09-1/6/10 CPA Regulatory .tualyte Method MRL Limit* Arsenic 3010A/6010B 0.1 $ ND ND Barium 3010A/6010B 1 100 ND ND Cadmium 3010A/6010B 0,01 1 ND ND Chromium 3010A/6010B 0.01 5 NI) ND iron 3010A/60108 0.02 - ND ND Lead 3010A/6010B 0.05 5 4—.. ND ND Magnesium 3010A/6010B 0.02 - ND ND Mercury 7470A 0.001 0.2 ND ND . 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O ® a= was r -c v $ m > doS L 1-w E Zw m ' T-a = am s a cm o> m , o ® oN E zi • F ® ' 'o o a-o 0 'a,- o m ° z o Q m 0 • o m M. j '. 0 m m L O O g m O o y > C 08 -,- ,111— K p F 4 m U U .0 J `L f Z . a)N U 0 n, R a1 0 -. 0 - 0 -. • BOH-3/15/2012 First of all I want to thank the BOH for their proposal to eirarrgelhe site of the ORCA air quality monitor fromillue-ileren-stheel to Grant St. school which is in line with the mill plume{The Sierra Club would like to request a copy of the letter sent to ORCA to be sent �r to Monica Fletcher- monicafletngmail.com They would also like to request that ORCA �✓ keep the monitor at Blue Heron and install a new monitor at Grant St. so emission 4 comparisons can be made. �.. I also would like to thank our Health Officer, Tom Locke for sharing his thoughts about the findings on the ultra fine particles at the PA BOH meeting on Tuesday, February 21 His comments were published in the PDN on Thursday,February 23 and were as follows: "There very much are health issues involved with all airborne contaminants, including industrial air pollution... The better the detection technologies for ultra fine Nan particles becomes,the more worrisome the research is. There is clearly adverse lung and heart effects, depending on what's in the pollution."His words are an endorsement of our efforts and the fact that the ultrafine particles are a health hazard. When I ponder the issue of the biomass burning the word unknown keeps popping into my mind. Although it is known that the ultrafine particles are hazardous to our health, there is currently no practical, accurate way to measure ultrafine particles in the industrial setting, especially the ones that are formed at the stack. Therefore, it is unknown whether the ESPs will adequately filter out these particles. Do we want to put the health of our community at risk when the technology to detect and control these particles has not reached a level we can trust? The PDN published an article yesterday that the DNR released a study that 3million tons of bone-dry wood slash can be removed from Washington forests without harming forest health. Bob Lynette of the PA Sierra Club raised a legitimate concern. "How much do you have to leave for a healthy forest is really the question. If you don't know how much you have to leave for a healthy forest,you can't determine how much can take out." There is an national effort to introduce a bill to congress to remove biomass wood fuel from the renewable energy list and put it in a category of it's own, due to the increasing evidence that it is not carbon neutral (the remaining trees do not have the capacity to re sequester the carbon released from biomass burning for hundreds of years), nor is it sustainable. The burning of biomass wood fuel will only make the climate change problem worse. The economy will suffer on many levels as well, including the real estate market and tourism. As a representative of the Sierra Club, I am requesting a response to the petitions signed • by Jefferson County citizens for the BOH to endorse a moratorium on the biomass construction until the appropriate steps can be taken to protect the citizens of this county. • I would like to report on the current status of our Moratorium Petitions and read a brief highlight of the American Lung Association Policy on Energy approved June 11, 2011. There is a link to the policy and two highlighted pages from sections of the study relating to biomass. I encourage the board to support our moratorium. iop?,' Jefferson County total petitions signed and in hand to date: --sit . This includes the 650 you received at the BOH meeting in Feb. Clallam County - 610 Clallam County Clean Air Coalition has only recently formed and is actively collecting signatures within the past few weeks. There is also an online petition at Change.org with over 400 signatures. AMERICAN LUNG ASSOCIATION. Public Policy Position on Energy-June 11, 2011. The actual energy policy, which contains really good language, is here: http://www.pfpi.net/wp-content/uploads/2011/06/ala-energy-poli cy-position.pdf • Some highlights from the American Lung Association's Energy Policy statement, Approved June 11 Biomass Combustion for Electricity The American Lung Association does not support biomass combustion for electricity production, a category that includes wood, wood products, agricultural residues or forest wastes, and potentially highly toxic feedstocks, such as construction and demolition waste. The combustion of fossil fuels and biomass in the residential, commercial and industrial sectors in the United States generates a significant share of the nation's air pollution, threatening the health and lives of millions of people, including those who are most vulnerable to harm. The American Lung Association supports programs and policies to encourage a transition from coal, oil, and biomass use in the residential and commercial sectors to cleaner • alternatives. • The American Lung Association strongly opposes the combustion of wood and other biomass sources at schools and institutions with vulnerable populations. The American Lung Association strongly supports policies that encourage a transition from coal, oil, and biomass use in the industrial sector to cleaner alternatives. • • http://vtdigger.org/2012103/14/cyan-protect-the-health-of- vermontsforests-and-people/#comment-31241 Editor's note: This op-ed is by Rebecca Ryan, director of health promotion and public policy at the American Lung Association in Vermont The renewable energy policy decisions Vermont policymakers make will affect two of the state's greatest resources: its forest and its people. With such valuable resources at stake, the American Lung Association urges the governor and the Legislature to consider the health impacts of electricity, transportation and heating policy, especially on our children, the elderly and those living with chronic disease. • Overwhelming evidence shows that fine particulate matter — like that from a smokestack or chimney — can cause premature death. Particulate matter can increase the risk of heart disease, lung cancer and asthma attacks. Renewable energy policy that incentivizes biomass electricity will increase air pollution, including the quantity of dangerous fine particulates. Vermont now has the highest rate of adult asthma in the country, and increased pollution from biomass burning won't help. This is one superlative Vermont cannot afford. Fortunately, Vermont has a framework to develop healthy energy policy. The health department calls for public health impact assessments, as outlined in the Comprehensive Energy • Plan and a recent health care reform report. A public health . impact assessment can determine the health impacts of land use, transportation and energy planning. Of particular note, the Biomass Energy Working Group stated in its February report, "While the working group believes air quality and public health should certainly inform decisions regarding expansion of the biomass industry, this topic is outside the scope of [our] charge. The [General Assembly] should gather additional information on air quality effects to inform policy regarding expansion of the biomass industry." We respectfully request that the governor and Legislature adopt these recommendations and require public health impact assessments before any expansion of biomass energy so that subsequent energy policy will protect the health of Vermont forests and Vermonters. S • Page 1 of 1 Cathy Avery From: white904 white904[white904©cablespeed.com[ Sent: Thursday,February 16,2012 8:33 PM To: kkolff fpCc: boh cQjeffersoncountypublichealth.org;Tom Locke;Tom Locke Subject:Re:Thank you,thank you. Thanks everyone who showed up for the BOH meeting and for your shared comments.Thank you,Kees for composing the thank you note to the BOH and suggestions for further support from them. I will be speaking with Pinky early next week and will ask some of the questions which Elaine e- mailed.I willl keep you updated on her feedback. Wendy On Thu,Feb 16,2012 at 6:08 PM,kkolff<kkolff@,olymous.net>wrote: 2/16/12 Dear Jefferson County Board of Health, Thank you for taking seriously our concerns about the burning of biomass in a new power plant at the edge of town,I appreciate your taking time to hear from us last December and then devoting essentially your entire 2-hour meeting today to the topic.As you could tell from the turn out of more than 50 people with over a dozen taking time to express their concerns and nobody stating that they had been reassured about our safety,this project has many citizens worried.The over 600 signatures we delivered of those calling for a moratorium further under scores the need for more information,dialogue and assurance that our health will not be compromised. I thought the information presented by Gary Palcisko from DOE was excellent and confirmed what EPA has clearly stated in their own words about particulates and their standards: "There is clear and convincing scientific evidence that significant adverse human health effects occur in response to short- term and chronic particulate matter exposures at and below. . . the level of the current annual PM2 5 standard." Gary added some Washington State figures to that which were new to me: "There are more than 1,100 premature deaths per year in Washington State from exposure to the 2.5 micron and smaller particles." Sheila asked Gary if it is true that the applicants for the project can select any emission levels from the past 10 years as their"baseline"for comparison with their planned biomass power plant.Though he was not sure about that,we are.It is permitted by law and the Nippon Plant in PA used the same method to claim that their emissions would be reduced by 17%with the new power plant,where as compared to the last year emissions there will really be an increase 4110 by 30%.The mill here used data from 2004-2006 to predict that emissions of"Particulates", and they lumped them all together with the less harmful and very heavy 10 micron particles, to claim that the WEIGHT of particles would be reduced by 67%.Sounds impressive,but thats not from current emissions and only from one boiler.The recovery boiler emissions will not change and puts out 1.5 times that much and thus the overall level of particulates might only go down 25%-if you trust the baseline and the modeling. We have copy of an e-mail dated 5/21/10 from DOE to the Trinity Consultants who did the"modeling",and it says: "1f PTPC picks the highest 24 month baseline period for the last 10 years and then sets future emissions equal to that,they should not trigger PSD applicability." PSD refers to Prevention of Significant Deterioration,and that would have required higher standards of control.Were the emissions modeled,or were they set? We have serious concerns about this new power plant proposal,the standards set by the EPA, and the regulators from DOE who are supposed to protect our health.We urge you to do what you can.Thank you for deciding to ask ORCAA to place several additional air quality monitoring stations.Clearly the one at Blue Heron Middle School is not enough.How about Grant Street Elementary School,the hospital,or your Health Department clinics where so many children,pregnant women and others go for services? And you could do even more: 1.You could call for a moratorium until your concerns are addressed, 2.You could ask the City Council and the Board of County Commissioners to hold a public forum to get more information and public opinion concerning this project. 3.You could encourage the Clallam County Board of Health to study the proposal in their county-we share some of the same air. 4.You could ask for a report from your Public Health Officer about the mill landfill permit that is over due for renewal,and which needs to consider the more than double quantity of toxic biomass ash that will result from this new project. Once again,thank you for your attention to this most important issue that seriously threatens this community in many ways. Respectfully, Kees Kolff,MD,MPH,Chair, East Jefferson Biomass Committee, Olympic Group,Sierra Club i 2/21/2012 a• c- za I COr a -� a) CO caa -� , g' P 7.CO ' -: or« --- n. V7 z Cl) z cn z Cn z lJi C!) 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