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Home My WebLink About2012- October File Copy • Jefferson County Board of aCealth Agenda 3vl mutes • October 18, 201 • • JEFFERSON COUNTY BOARD OF HEALTH October 18, 2012 Cotton Building 607 Water Street Port Townsend, WA 2:30 - 4:30 PM DRAFT AGENDA I. Approval of Agenda II. Approval of Minutes of September 20, 2012 Board of Health Meeting III. Old Business and Informational Items 1. Jefferson County Pertussis Outbreak Final Report 2. Nationwide Recall of Contaminated Pharmacy Products 3. Smilemobile Coming to Jefferson County 4. 2013 Jefferson County Budget: Water Quality and Community Health 5. Federal Sequestration May Lead to a 7.6% Public Health Funding Reduction 6. How Healthy Are We on the North Olympic Peninsula? Article IV. New Business • 1. Community Health Fee Setting Policy 2. Paralytic Shellfish Poisoning Outbreak in Jefferson County 3. Take Charge Program Increases Access to Family Planning Services 4. Substance Abuse Advisory Board Appointment V. Activity Update VI. Public Comments VII. Agenda Planning Calendar VIII. Next Scheduled Meeting: December 20, 2012 2:30 - 4:30 pm To be determined • JEFFERSON COUNTY BOARD OF HEALTH • MINUTES Thursday, September 20, 2012 2:30 PM—4:30 PM Masonic Hall, 1338 Jefferson 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 2:35 PM. A quorum was present. Members Present: Phil Johnson, David Sullivan, John Austin, Roberta Frissell, Sheila Westerman Members Excused: Catharine Robinson, Jill Buhler Staff Present: Dr. Thomas Locke, Jean Baldwin, Cathy Avery • APPROVAL OF AGENDA Member Sullivan moved to approve the agenda for the September 20, 2012 BOH meeting; Member Austin seconded. The motion passed unanimously. APPROVAL OF MINUTES Member Westerman requested the second sentence at the top of page 5 be changed to read "These services are funded by the Mental Health/Substance Abuse Sales Tax" and the sentence where Jim Todd spoke under Public Comment be changed to "Jim Todd expressed concern over the waste being deposited into the mill's landfill and encouraged a limited purpose landfill permit be issued." Member Austin moved to approve the minutes of the August16,2012 BOH meeting as amended. Member Westerman seconded the motion. The motion passed unanimously. OLD BUSINESS and INFORMATIONAL ITEMS 2012 Influenza and Pneumonia Information Ms. Baldwin addressed the letter from JCPH to the area healthcare providers, which was • included in the agenda packet. The letter provides information about the 2012-2013 seasonal influenza vaccine. She also pointed out that JCPH publicizes information about influenza 1 BOH—September 20,2012 1 ti vaccine availability in the local newspapers. Dr. Locke encouraged everyone older than six months of age to get the influenza vaccine, stating the more people who are vaccinated the less . likely we are to see widespread influenza outbreaks in the community and the more protected the vulnerable population will be. Ms. Baldwin stated there are new recommendations to increase the use of a newly licensed form of pneumonia vaccine for people with transplants, splenectomies, and immune compromising diseases. JCPH will be doing a series of letters to healthcare providers reminding them how to store the pneumonia vaccine and encouraging the physicians to vaccinate their vulnerable patients. Washington Vaccine Association Completes Second Year of Operation Dr. Locke briefly reviewed the history of childhood vaccination funding in WA State. Up until 3 years ago, all childhood vaccines were paid for with state and federal funds. In 2009 the State Legislature determined they were spending 17 million dollars per year on vaccines for children who were insured and who could be covered by private insurance. At that time the State cut back on their vaccine purchases which might have led to providers managing two separate vaccine supplies, one that was state supplied and the other that was privately purchased. This would have likely lead to many primary care providers ceasing to offer childhood vaccinations. A Washington Vaccine Association program was created where the state continues to purchase vaccine at a low federal discount rate and makes it available to all children and insurance companies contribute their share to the purchase cost. Dr. Locke reported that this program has been operational for two years and is working well. Big Quilcene Water Quality • Michael Dawson, Water Quality Lead,updated the Board on the 2012 Big Quilcene salmon fishing season. He reported during the 2011 fishing season there was trash and human waste left along the river which resulted in a temporary shutdown of the commercial shellfish growing area in Quilcene Bay. This year the Water Quality Division was able to find temporary funding through a water quality grant for two Sanicans. Water Quality does not have a source of funding for the 2013 fishing season. Mr. Dawson discussed the Big Quilcene Water Quality Sample table which was included in the agenda packet. The table shows a lower amount of E. coli bacteria from the same time last year. The Board agreed a letter should be sent to Fish and Wildlife from the Board requesting funding for the Sanicans and dumpsters for next year. NEW BUSINESS Paralytic Shellfish Poisoning and Shellfish Closure Update Michael Dawson, Water Quality Lead, gave an overview of shellfish monitoring. He reported that Paralytic Shellfish Poisoning(PSP)numbers were some of the highest values that have been observed since testing began. In addition, another type of marine neurotoxin has been detected at elevated levels,resulting in the first closure for Diarrhetic Shellfish Poisoning(DSP) in Jefferson County. Mr. Dawson gave the current status of which beaches are closed for both DSP and PSP. Mr. Dawson announced they were able to get funding from the State to cover additional monitoring costs, and staff time to go out and post signs. • 2 BOH—September 20,2012 BEACH Program Update • Michael Dawson, Water Quality Lead, stated that the BEACH Program is a federally funded program through the Department of Ecology and the Department of Health which has helped fund the monitoring of Fort Warden,Herb Beck Marina, and Camp Parson for enterococcus contamination. Elevated enterococcus levels are associated with sewage contamination and are used to determine whether recreational water activity is safe. Mr. Dawson reported that in 2011 all samples were in the acceptable ranges,but they were done only during the Hood Canal clean water project. This year sampling has been done weekly and all samples were normal. Mr. Dawson hopes that next year Water Quality will be able to sample at Irondale Beach Park, since it is undergoing a cleanup project and is likely to be a beach that will be used by a lot of people. Communicable Disease Update: Pertussis,West Nile Virus, and H3N2 Influenza Dr. Locke updated the Board on the current status of the State pertussis epidemic. He stated that pertussis rates are dropping statewide, but the state is still in epidemic mode. Dr. Locke explained that pertussis outbreaks tend to come in 3-4 year cycles. People who get pertussis develop some immunity, making community outbreaks less likely. However,this natural immunity does not last long and in another three to four years conditions are ripe for another outbreak if more people are not vaccinated. He also noted there is a problem in children who have received all of their vaccinations with the newer lower side effect acellular pertussis vaccination,because the duration of immunity is greatly reduced as compared with the older vaccine formulation. • Dr. Locke reported to the Board that 2012 has been the worst year on record for West Nile Virus cases in the United States. He stated that 80%of infected people have no symptoms and 20% have symptoms of fever, body aches and flu like symptoms. About 1 out of every 150 of cases of West Nile Virus infection experience a serious type of brain infection which can lead to permanent neurological problems or death. Dr. Locke reported that about half of the reported cases have been in Texas. It is believed the weather was the contributing factor in the outbreak. Dr. Locke also reported that there have been two confirmed cases of West Nile Virus in Washington State; one case was acquired out of state. Dr. Locke explained to the Board that the new form of variant H3N2 influenza has had an impact on county fairs around the country because it is spread between people and pigs. There has been a lot of extra signage at the fairs and they have asked the fair veterinarians to screen pigs and exclude any sick pigs from the fairs. Dr. Locke reported there have been no cases of H3N2 in Washington State or the Pacific Northwest. "Boomer"Demographics Ms. Baldwin discussed the handout in the agenda packet from the online magazine Governing (www.governing.com)on Jefferson County's baby boomer population. She explained that she included this in the packet as an item to be looked at in the future because 63%of Jefferson County's population is at age 45+, which puts Jefferson County as the largest percentage of • "Boomers"in Washington state. 3 BOH—September 20,2012 Substance Abuse Advisory Board Reappointment Member Westerman moved to reappoint Conner Daily to the Substance Abuse Advisory • Board. Member Austin seconded the motion. The motion passed unanimously. ACTIVITY UPDATE Ms. Baldwin invited any interested Board Members to the joint WSALPHO and Local Health Board Alliance meeting November 14, 2012, 8:30—9:45 a.m. at the WASAC meeting. Dr. Locke updated the Board on the current status of the Port Townsend Paper Corporation landfill permit application. He stated the permit renewal application was received before the deadline in early September. The mill has applied for a renewal of their existing permit with some additional language that deals with financial assurance, groundwater monitoring and waste stream testing. Dr. Locke stated they are in a 45 day review period and expect a decision in mid- October. He also mentioned that all public documents that are relevant to this case are being posted on the JCPH website. Finally Dr. Locke reminded the Board that if the decision regarding the permit is appealed the Board may be called on to make a decision, so he urged the Board members to protect their impartiality on this case. PUBLIC COMMENT Eveleen Muehlethaler of Port Townsend Paper thanked the Board for their time and efforts in • regards to the renewal of the landfill permit and stated the permit application had been submitted with the required standards and they look forward to receiving their renewal. Jim Todd urged Dr. Locke to require a limited purpose landfill permit for the Port Townsend Paper landfill with strong financial assurances. Scott Tennant of USW Local 175 District 12 spoke on behalf of the mill employees and in favor of the mill in their permitting process. Valerie Phimister expressed her support for Dr. Locke and his efforts in moving toward a limited purpose landfill permit to Port Townsend Paper. Elaine Bailey suggested that independent testing to determine the content of the mill ash be done by BAP,through the United States Army Corp Engineers. Mike Phimister thanked Dr. Locke for his patience and urged him to issue a limited purpose landfill permit to Port Townsend Paper. Pam McWethy commented on the issue of the community's financial responsibility of the cleanup of the landfill if Port Townsend Paper is not issued a limited purpose landfill permit. • 4 BOH—September 20,2012 Rick Doherty expressed concern over the amount of lead being deposited into the mill landfill 111 and the landfill not being inert. Will Litzler expressed concern over the mill being allowed to operate their landfill without environmental monitoring and financial assurance. Sally Schumaker commented in favor of Dr. Locke issuing a limited purpose landfill permit to Port Townsend Paper. Rick Faraci expressed concern over Dr. Locke not seeing an emergency in issuing the landfill permit to Port Townsend Paper. Jeanette Richoux commented on the health effects of wood and the mill smoke in Port Townsend and the financial responsibility of the landfill cleanup should Port Townsend Paper close. Dave McWethy commented in favor of deadlines being set that lead to a limited purpose landfill permit to Port Townsend Paper. Hollin Stafford spoke on behalf of the generations below the baby boomers and expressed concern over the health issues from the mill landfill and financial assurances for landfill cleanup being in place should the mill have to close. Stephen Boyd commented in favor of moving toward doing the right thing for the community. 1111/ Shirley Rivas commented on the health effects due to poor air quality and encourages a limited purpose landfill permit be issued to Port Townsend Paper. Ruth Apter commented on the cost of cleaning up a landfill when a mill closes and testing to determine what was dumped in the landfill in the history of the dump. Peter Lauritzen thanked Dr. Locke for what he has done and encouraged him to do what DOE requires. Gretchen Brewer commented on her concerns of the mill staying open and who would pay for the landfill cleanup, wood ash being considered dangerous waste in Washington for anyone other than paper mills and the run off of the landfill going in to Admiralty Bay. Stephen Schumacher encouraged Dr. Locke to issue a limited purpose landfill permit to Port Townsend Paper and expressed concerns over who would pay for cleanup of the landfill should the mill close. Linda Lanakammer commented in favor of a deeper more meaningful look being taken at the mill and their landfill. Bill Wise, Chair of Team Port Townsend, commented on the mill supporting our economy and performing at a high level of social responsibility. 11111 5 BOH—September 20,2012 O'Neill Louchard expressed concern over the reasons nothing is growing on the historic landfill portion that has been covered and is concerned over the economic impact on the community • should the shellfish be killed off. Nancy Frederick commented on problems with air quality and expressed appreciation for Dr. Locke working with the mill but urges him not to compromise on the landfill permit. Laura King commented in favor of all businesses in the community abiding by legal parameters and is concerned about the lack of financial assurances being provided by PTPC. AGENDA PLANNING CALENDAR The next Board of Health meeting will be held on October 18,2012 from 2:30—4:30 pm. ADJOURNMENT Chair Johnson adjourned the BOH meeting at 4:47 pm . JEFFERSON COUNTY BOARD OF HEALTH Escused Phil Johnson, Chair Jill Buhler,Vice Chair Roberta Frissell, Member David Sullivan,Member Excused Catharine Robinson,Member John Austin, Member Sheila Westerman, Member Respectfully Submitted: Stacie Reid • 6 BOH—September 20,2012 JEFFERSON COUNTY BOARD OF HEALTH • MINUTES Thursday, September 20, 2012 2:30 PM—4:30 PM Masonic Hall, 1338 Jefferson 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 2:35 PM. A quorum was present. Members Present: Phil Johnson, David Sullivan, John Austin, Roberta Frissell, Sheila Westerman Members Excused: Catharine Robinson, Jill Buhler Staff Present: Dr. Thomas Locke, Jean Baldwin, Cathy Avery • APPROVAL OF AGENDA Member Sullivan moved to approve the agenda for the September 20, 2012 BOH meeting; Member Austin seconded. The motion passed unanimously. APPROVAL OF MINUTES Member Westerman requested the second sentence at the top of page 5 be changed to read "These services are funded by the Mental Health/Substance Abuse Sales Tax" and the sentence where Jim Todd spoke under Public Comment be changed to "Jim Todd expressed concern over the waste being deposited into the mill's landfill and encouraged a limited purpose landfill permit be issued." Member Austin moved to approve the minutes of the August16,2012 BOH meeting as amended. Member Westerman seconded the motion. The motion passed unanimously. OLD BUSINESS and INFORMATIONAL ITEMS 2012 Influenza and Pneumonia Information Ms. Baldwin addressed the letter from JCPH to the area healthcare providers, which was included in the agenda packet. The letter provides information about the 2012-2013 seasonal • influenza vaccine. She also pointed out that JCPH publicizes information about influenza 1 BOH—September 20,2012 vaccine availability in the local newspapers. Dr. Locke encouraged everyone older than six • months of age to get the influenza vaccine, stating the more people who are vaccinated the less likely we are to see widespread influenza outbreaks in the community and the more protected the vulnerable population will be. Ms. Baldwin stated there are new recommendations to increase the use of a newly licensed form of pneumonia vaccine for people with transplants, splenectomies, and immune compromising diseases. JCPH will be doing a series of letters to healthcare providers reminding them how to store the pneumonia vaccine and encouraging the physicians to vaccinate their vulnerable patients. Washington Vaccine Association Completes Second Year of Operation Dr. Locke briefly reviewed the history of childhood vaccination funding in WA State. Up until 3 years ago, all childhood vaccines were paid for with state and federal funds. In 2009 the State Legislature determined they were spending 17 million dollars per year on vaccines for children who were insured and who could be covered by private insurance. At that time the State cut back on their vaccine purchases which might have led to providers managing two separate vaccine supplies, one that was state supplied and the other that was privately purchased. This would have likely lead to many primary care providers ceasing to offer childhood vaccinations. A Washington Vaccine Association program was created where the state continues to purchase vaccine at a low federal discount rate and makes it available to all children and insurance companies contribute their share to the purchase cost. Dr. Locke reported that this program has been operational for two years and is working well. Big Quilcene Water Quality • Michael Dawson, Water Quality Lead, updated the Board on the 2012 Big Quilcene salmon fishing season. He reported during the 2011 fishing season there was trash and human waste left along the river which resulted in a temporary shutdown of the commercial shellfish growing area in Quilcene Bay. This year the Water Quality Division was able to find temporary funding through a water quality grant for two Sanicans. Water Quality does not have a source of funding for the 2013 fishing season. Mr. Dawson discussed the Big Quilcene Water Quality Sample table which was included in the agenda packet. The table shows a lower amount of E. coli bacteria from the same time last year. The Board agreed a letter should be sent to Fish and Wildlife from the Board requesting funding for the Sanicans and dumpsters for next year. NEW BUSINESS Paralytic Shellfish Poisoning and Shellfish Closure Update Michael Dawson, Water Quality Lead, gave an overview of shellfish monitoring. He reported that Paralytic Shellfish Poisoning (PSP) numbers were some of the highest values that have been observed since testing began. In addition, another type of marine neurotoxin has been detected at elevated levels, resulting in the first closure for Diarrhetic Shellfish Poisoning (DSP) in Jefferson County. Mr. Dawson gave the current status of which beaches are closed for both DSP and PSP. Mr. Dawson announced they were able to get funding from the State to cover additional monitoring costs, and staff time to go out and post signs. • 2 BOH—September 20,2012 • BEACH Program Update Michael Dawson, Water Quality Lead, stated that the BEACH Program is a federally funded program through the Department of Ecology and the Department of Health which has helped fund the monitoring of Fort Warden, Herb Beck Marina, and Camp Parson for enterococcus contamination. Elevated enterococcus levels are associated with sewage contamination and are used to determine whether recreational water activity is safe. Mr. Dawson reported that in 2011 all samples were in the acceptable ranges,but they were done only during the Hood Canal clean water project. This year sampling has been done weekly and all samples were normal. Mr. Dawson hopes that next year Water Quality will be able to sample at Irondale Beach Park, since it is undergoing a cleanup project and is likely to be a beach that will be used by a lot of people. Communicable Disease Update: Pertussis, West Nile Virus, and H3N2 Influenza Dr. Locke updated the Board on the current status of the State pertussis epidemic. He stated that pertussis rates are dropping statewide, but the state is still in epidemic mode. Dr. Locke explained that pertussis outbreaks tend to come in 3-4 year cycles. People who get pertussis develop some immunity, making community outbreaks less likely. However, this natural immunity does not last long and in another three to four years conditions are ripe for another outbreak if more people are not vaccinated. He also noted there is a problem in children who have received all of their vaccinations with the newer lower side effect acellular pertussis vaccination, because the duration of immunity is greatly reduced as compared with the older vaccine formulation. • Dr. Locke reported to the Board that 2012 has been the worst year on record for West Nile Virus cases in the United States. He stated that 80% of infected people have no symptoms and 20% have symptoms of fever, body aches and flu like symptoms. About 1 out of every 150 of cases of West Nile Virus infection experience a serious type of brain infection which can lead to permanent neurological problems or death. Dr. Locke reported that about half of the reported cases have been in Texas. It is believed the weather was the contributing factor in the outbreak. Dr. Locke also reported that there have been two confirmed cases of West Nile Virus in Washington State; one case was acquired out of state. Dr. Locke explained to the Board that the new form of variant H3N2 influenza has had an impact on county fairs around the country because it is spread between people and pigs. There has been a lot of extra signage at the fairs and they have asked the fair veterinarians to screen pigs and exclude any sick pigs from the fairs. Dr. Locke reported there have been no cases of H3N2 in Washington State or the Pacific Northwest. "Boomer" Demographics Ms. Baldwin discussed the handout in the agenda packet from the online magazine Governing (www.governing.com) on Jefferson County's baby boomer population. She explained that she included this in the packet as an item to be looked at in the future because 63%of Jefferson • 3 BOH—September 20,2012 County's population is at age 45+, which puts Jefferson County as the largest percentage of • "Boomers" in Washington state. Substance Abuse Advisory Board Reappointment Member Westerman moved to reappoint Conner Daily to the Substance Abuse Advisory Board. Member Austin seconded the motion. The motion passed unanimously. ACTIVITY UPDATE Ms. Baldwin invited any interested Board Members to the joint WSALPHO and Local Health Board Alliance meeting November 14, 2012, 8:30—9:45 a.m. at the WASAC meeting. Dr. Locke updated the Board on the current status of the Port Townsend Paper Corporation landfill permit application. He stated the permit renewal application was received before the deadline in early September. The mill has applied for a renewal of their existing permit with some additional language that deals with financial assurance, groundwater monitoring and waste stream testing. Dr. Locke stated they are in a 45 day review period and expect a decision in mid- October. He also mentioned that all public documents that are relevant to this case are being posted on the JCPH website. Finally Dr. Locke reminded the Board that if the decision regarding the permit is appealed the Board may be called on to make a decision, so he urged the Board members to protect their impartiality on this case. • PUBLIC COMMENT Eveleen Muehlethaler of Port Townsend Paper thanked the Board for their time and efforts in regards to the renewal of the landfill permit and stated the permit application had been submitted with the required standards and they look forward to receiving their renewal. Jim Todd urged Dr. Locke to require a limited purpose landfill permit for the Port Townsend Paper landfill with strong financial assurances. Scott Tennant of USW Local 175 District 12 spoke on behalf of the mill employees and in favor of the mill in their permitting process. Valerie Phimister expressed her support for Dr. Locke and his efforts in moving toward a limited purpose landfill permit to Port Townsend Paper. Elaine Bailey suggested that independent testing to determine the content of the mill ash be done by BAP, through the United States Army Corp Engineers. Mike Phimister thanked Dr. Locke for his patience and urged him to issue a limited purpose landfill permit to Port Townsend Paper. • 4 BOH—September 20,2012 Pam McWethy commented on the issue of the community's financial responsibility of the cleanup of the landfill if Port Townsend Paper is not issued a limited purpose landfill permit. • Rick Doherty expressed concern over the amount of lead being deposited into the mill landfill and the landfill not being inert. Will Litzler expressed concern over the mill being allowed to operate their landfill without environmental monitoring and financial assurance. Sally Schumaker commented in favor of Dr. Locke issuing a limited purpose landfill permit to Port Townsend Paper. Rick Faraci expressed concern over Dr. Locke not seeing an emergency in issuing the landfill permit to Port Townsend Paper. Jeanette Richoux commented on the health effects of wood and the mill smoke in Port Townsend and the financial responsibility of the landfill cleanup should Port Townsend Paper close. Dave McWethy commented in favor of deadlines being set that lead to a limited purpose landfill permit to Port Townsend Paper. Hollin Stafford spoke on behalf of the generations below the baby boomers and expressed concern over the health issues from the mill landfill and financial assurances for landfill cleanup being in place should the mill have to close. Stephen Boyd commented in favor of moving toward doing the right thingfor the community. y Shirley Rivas commented on the health effects due to poor air quality and encourages a limited purpose landfill permit be issued to Port Townsend Paper. Ruth Apter commented on the cost of cleaning up a landfill when a mill closes and testing to determine what was dumped in the landfill in the history of the dump. Peter Lauritzen thanked Dr. Locke for what he has done and encouraged him to do what DOE requires. Gretchen Brewer commented on her concerns of the mill staying open and who would pay for the landfill cleanup, wood ash being considered dangerous waste in Washington for anyone other than paper mills and the run off of the landfill going in to Admiralty Bay. Stephen Schumacher encouraged Dr. Locke to issue a limited purpose landfill permit to Port Townsend Paper and expressed concerns over who would pay for cleanup of the landfill should the mill close. Linda Lanakammer commented in favor of a deeper more meaningful look being taken at the mill and their landfill. S 5 BOH—September 20,2012 Bill Wise, Chair of Team Port Townsend, commented on the mill supporting our economy and performing at a high level of social responsibility. O'Neill Louchard expressed concern over the reasons nothing is growing on the historic landfill portion that has been covered and is concerned over the economic impact on the community should the shellfish be killed off. Nancy Frederick commented on problems with air quality and expressed appreciation for Dr. Locke working with the mill but urges him not to compromise on the landfill permit. Laura King commented in favor of all businesses in the community abiding by legal parameters and is concerned about the lack of financial assurances being provided by PTPC. AGENDA PLANNING CALENDAR The next Board of Health meeting will be held on October 18, 2012 from 2:30—4:30 pm. ADJOURNMENT Chair Johnson adjourned the BOH meeting at 4:47 pm. JEFFER ON COU TY BOARD OF HEALTH (PP/ Excused PJohnson, C air Jill Buhler, Vice Chair Roberta Frissell, Member DaSulhv n, 1 ember I Excused Catharine Robinson, Member Jo Austin, Member Sheila Westerman, Member Respectfully Submitted: Stacie Reid S 6 BOH-September 20,2012 • Jefferson County Board of 3Cealth OCdBusiness .agenda Item # III, 1 Jefferson County • Pertussis Outbreak JinaC Report October 18, 20I2 • Washington State Pertussis Outbreak 2012—Report for Jefferson County Summary of Cases January 1, 2012—June 16, 2012 " This update summarizes reports of pertussis in persons with 2012 onsets received by Jefferson Health District during Leeks 1-24, made visible to the Washington State Department of Health (DOH)—Communicable Disease Epidemiology, and containing sufficient information for a DOH case classification to have been assigned. 1. Case Reporting and Classification All cases of pertussis in Jefferson reported to the Washington State Department of Health (DOH) between January 1 and June 16, 2012, through the Public Health Issue Management System are included in this report. Cases were classified at DOH according to the Council of State and Territorial Epidemiologists case definition [1]. From January 1-June 16, 2012,Jefferson reported 22 cases (Figure 1): 20 confirmed cases and 2 probable cases, compared to 0 cases in 2011 reported during the same time period (Figure 2). In addition,Jefferson reported 6 suspect cases in 2012 (Figure 3). Cumulative incidence was calculated as the number of year-to-date cases reported per 100,000 population using Jefferson-specific age and race population figures from the U.S. Census Bureau. Overall incidence in Jefferson was 73.7, compared to the overall State incidence of 37.5. Cases were reported in infants <1 years (n=1), children aged 3 years (n=4), 4 years (n=2), 6 years (n=2), 10 years (n=1), 13 years(n=1), 14 years (n=1), 18 years (n=1) and adults>_20 years (n=9). Incidence was highest in children aged 1-6 years Id (611.6), followed by infants aged <1 years (507.6), 11-14 year olds (185.0), 7-10 year olds (102.5), 15-19 year olds 3.9), and adults>_20 years (36.1) (Table 1). Cases and incidence by individual years of life are shown in Table 2 and Figure 4. Race and ethnicity was known in only 4/22 (18.2%) of cases and thus race-specific data will not be reported. 2. Characteristics of Cases Of the 20 confirmed cases, 14 (70%) were laboratory-confirmed, and 6 (30%) were epidemiologically-linked. All of the laboratory-confirmed cases were confirmed by Polymerase Chain Reaction (PCR). No cases were confirmed by culture. Clinical characteristics of case-patients were evaluated, and rates of complications were calculated among cases with a known history. Of the 22 cases, 1 case-patient was an infant and did not require hospitalization or have any complications such as pneumonia, seizures, or encephalopathy. Of the 21 cases aged >1 years, 1 was hospitalized and had pneumonia (1/21, 4.5%). No other complications such as seizures or encephalopathy were reported. No deaths were reported in Jefferson County to date. 3. Vaccination Status Vaccination status was assessed in case-patients with known vaccination history and was considered up-to-date (UTD) if the minimum number of doses per age as recommended by the Advisory Committee on Immunization Practices (ACIP) was received [2]. Case-patients with invalid dose dates, such as a recorded dose date that precedes the date of birth or a reported number of doses that exceeds the maximum recommended for age, were excluded from the vaccination status analysis. Individual doses were excluded if administered <14 days prior to symptom onset. Due to a substantial 4111Ipmber of adolescents and adults state-wide without documentation of the childhood series, case-patients>_13 years were considered UTD if they have documented receipt of Tdap. Adolescents 11-12 years of age who received Tdap were also considered UTD, but could also be classified as UTD based on the appropriate number of DTaP doses. Number of 1 doses received was assessed for each age. Adolescents whose only documented vaccine dose was Tdap were excluded from this analysis of number of doses received, as it is unknown whether they received the full childhood series or only Tdap. Valid vaccination history was known in 63.6% (14/22) case-patients. One case-patient (1/22, 4.5%) was excluded from the analysis due to invalid dose dates. Vaccination history was unknown in 7/22 (31.8%). Overall,the proportion of case-patients considered up-to-date was 35.7% (5/14), with the following breakdown by age group: 0% (0/1)% in infants aged 7-18 months, 50%(2/4) in children aged 19 months-3 years, 0% (0/4) in children aged 4-6 years, 100% (1/1) in children aged 7-10 years, 50%(1/2) in adolescents aged 13-19 years, and 50% (1/2) in adults aged >_20 years (Table 3). Number of doses received by age is displayed in Figure 5. References 1. Council of State and Territorial Epidemiologists. CSTE Position Statement 1997-id-9; Public Health Surveillance, Control, and Prevention of Pertussis. 1997; Available from: http://www.cste.org/ps/1997/1997-id-09.htm. 2. Centers for Disease Control and Prevention, Recommended Immunization Schedule for Persons Aged 0-18 Years - - United States, 2012. MMWR, 2012. 61(5). • • 2 • Figure 1. Geographic Distribution of Confirmed and Probable Cases in Jefferson County by Zip Code,January 1-June 16, 2012. a , ...,. .... ,--\„}) , .., , .. •• • . . M l .• It PO ,Iti, \.-j- ?„ . i . ., ktiii, \ --: • f " ,ass'„ • .. , . ,., , • >-_,, , . '.- 1 i r/ -77 * • • t' • I • ' p,,,,.,/, •(' • • *Zip codes in Jefferson County are highlighted in red. Each dot represents one case. Cases are randomly distributed within the zip code and do sit correspond to exact geographic coordinates. • 3 N. Figure 2. Confirmed and Probable Cases in Jefferson County by Week of Onset, 2011 vs. 2012. 1 4.5 2011 •4 2012 3.5 = 3 d 2.5 -}1 co z v 2 I 1.5 1 j i { 1 I ( 0.5 t 1 tILILULUL , I ._.;... .'-r-r-...m_-_r....r-..-t_"r_�---•-_.__...r_.-�._-:---.. 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 I Onset Week I * Reports for 2012 as of Week 24. Figure 3. Confirmed, Probable, and Suspect Cases in Jefferson County,January 1-June 16, 2012. III 6 5 4 i Suspect °J vi3 Probable Confirmed 2 1 . f u 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Onset Year ill 4 4 Table 1. Incidence of Confirmed and Probable Cases by Age Group,Jefferson County,January 1-June 16, 2012. Age Group N Population Incidence gii y 1 197 507.6 6 y 8 1308 611.6 7-10 y 1 976 102.5 11-14 y 2 1081 185 15-19 y 1 1354 73.9 20+ y 9 24956 36.1 All Ages 22 29872 73.7 Table 2. Incidence of Confirmed and Probable Cases by Age,Jefferson County,January 1-June 16, 2012. Age Cases Population Incidence <1 1 197 507.6 1 0 212 0 2 0 202 0 3 4 221 1810 4 2 236 847.5 5 0 _ 204 0 6 2 233 , 858.4 7 0 216 0 0 249 0 0 225 0 10 1 286 349.7 11 0 281 0 12 0 266 0 13 1 247 404.9 14 1 287 348.4 15 0 275 0 16 0 262 0 17 0 347 0 18 1 270 370.4 19 0 200 0 20+ 9 24956 36.1 All Ages 22 29872 73.7 III 5 Figure 4. Cases and Incidence by Age in Jefferson County in Children and Adolescents Aged 0-19 Years,January 1-June 16, 2012. , 2000 • 5 4.4 - 1800 q _ a Cases 3.5 Incidence 1600 1400 3 o - 1200 o o 2.5 V 1000 0o h 2 cu - 800 m v 1.5 a 600 -71 s 1 1 m .... n 400 tw 0.5200�� 10 3 4°° ��5_ P 6_ 7.,�.._8 9 10 11 12 13 14 15 ` . �. <1 1Z16 17 18 19 Age(years) 1 Table 3.Vaccination Status by Age Group in Jefferson County,January 1-June 16, 2012. Total#with Unknown %Cases with • Not Total # Known %Cases Unknown Age UTD UTD UTD Cases Vaccination Vaccination Status UTD* Status Status 7-18 m 0 1 0 1 0 0 0 19 m-3 y 2 2 0 4 0 0 50 4-6y 0 4 0 4 0 0 0 7-10 y 1 0_ 0 - 1 0 0 100 13-19 y 1 1 0 2 0 0 50 20+y 1 1 7 9 2 77.8 50 Total 5 9 7 21 14 33.3 35.7 *Does not include cases with unknown vaccination status. i 6 Figure 5. Number of Doses Received by Age in Case-Patients Aed 0-19 Y ars Jefferson County,January 1-June 16, 2012. 5 ] Illp «6 Doses j It5Dose I i 4Dose e3Doses as »2Da6 ; ■lDose ) 2j ■0Doses J y 1 \ 11 a . ' - 0 : .. �� . «. . — .� . �. . :\. § .. . Ellm ly 2y 3y 4y 5y 6y 7y 8y 9y my 11y 1 y 13y 14y ! 1 Age --� �. . _ *Only cases with known vaccination history not excluded due to invalid doses or doses administered<14 days since disease onset *Adolescen aged 13-19 years with Tdap as the only vaccine dose recorded were excluded * No cases reported mchildren aged%%f%% 11, 2, 15, 16, 1± »,eg years. • • 7 Jefferson County Board�of lea fth Old Business Agenda Item # III", 3 Smilemo6ile Coming to r, Jefferson County October 18, 2 01 1 Does Y : Lir �i. t Ufa j L child } SImI6iIo ale entatC re ? wow r• 44444,114 The Washington Dental Service Foundation SmileMobile is coming : November 5 - 16 2012 to Jefferson County The SmileMobile, a fully equipped mobile dental clinic will be at: Chimacum Schools The SmileMobile: • Provides dental care to children (birth - high school) w/ limited income • Accepts WA State Services Card (Provider One) & sliding fee scale based on family income For an appointment or more info, Call, Jefferson Co. Public Health : 385-9400 appointments need to be scheduled before November 5th The SmileMobile is operated by Washington Dental Service Foundation in partnership with Seattle Children's Hospital. • [his event/activity is NOT being sponsored by the school district and the district assumes no responsibility for the conduct of or safety of the event/activity. In consideration for the privilege to distribute these materials,the school district shall be held harmless from any cause of action,claim,or petition tiled in any court or administrative tribunal arising out of the distribution of these materials,including all costs,attorney's fees,and judgments or awards. • ■ .„,.„,3 jIma , ; ,,,.,,, ,,,,.,--,,,,,,,,,,,..,,„. ,:s.,_ Neces �ta ,..,..,,,,,, ,,,,,,, , .,,,, ,. . , . „ ,..:,.,,,,,„„0„„,.,,,,,,,,,,,, , . -, ,,,,,, ,,..„,,,,,,,,,„,,,,,,,, ,, ,t,, !j s i-ilo 4Y ; -',1- — ---71044b eV, ‘41.**Fmcvsgi ?..:,;::,:.'..,,,,,,,.a 4 Cuidado ..,.,,,,,, s,4,,"jf Y Dental ? El SmileMobile Viene Pronto a: Chimacum noviembre 5 - 16, 2012 EI SmileMobile, una • clinica dental bien equipada y mObible: Estara en el: Chimacum Schools 91 W Valley Rd. Chimacum, WA 98325 El SmileMobile ofrece cuidado dental para ninos: • no mayores de 18 anos • familias con ingresos limitados Para enterarse si su hijo califica para este programa, o si desea ofrecer su tiempo como voluntario, por favor Ilame a 385-9400. Este programa se ofrece en colaboracion con: WA Dental Service/WDS Foundation Seattle Children's Hospital Este evento/actividad NO esta patrocinado por el distrito escolar y el distrito no asume responsabilidad por la presentation o la seguridad del evento/de • la actividad.En consideration por el privilegio de distribuir estos materiales,el distrito escolar estara libre de responsabilidad por cualquier causa de action,demanda,o petition presentada en cualquier code o tribunal administrativo que surja de la distribution de estos materiales,incluyendo costos, honorarios de abogados,y fallos o sentencias. • Jefferson County Board-of.9 Ieafth OldBusiness .agenda Item # III, 5 Yecfera(Sequestration 314ay Lead • to a 7. 6% Public 3-{ealth Funding Reduction October 18, 201 • APHA: Alaiining cuts to public health programs outlined in White House sequestration re... Page 1 of 2 P About Us )Advocacy£t Policy )APHA Meetings (3 Member Groups&State Affiliates B Programs )Publications a Advertising Vt4AiliNW001-"' '4% :s riim:; i1iI. 1 L[ tri _ r a T I Shop Donate Join/Renew 77j " Ptr LE L Advanced Search AboutHome»About Us»News Room»APHA Press Releases»2012 APHA Press About Us Releases»Alarming cuts to public health programs outlined in White House sequestration report In This Section Overview FOR IMMEDIATE RELEASE For more information, please contact APHA Communications at Awards (202) 777-2509 or mediarelationsc apha.ord . Careers Alarming cuts to public health programs outlined in White House Executive Board and Staff sequestration report Statement from Georges C. Benjamin, MD, FACP, FACEP(E), Membership Information executive director of APHA News Room Washington, D.C., Sept.14, 2012 — "Critical programs that • APHA Press Releases protect the public's health face an 8.2 percent cut according to a • AJPH Press Releases report released today by the White House office of Management • Book Press Releases and Budget on the Sequestration Transparency Act, which • Annual Meeting Press explains how across-the-board cuts in defense and nondefense Information discretionary programs would be made when the measure takes • Online Press Kit effect in January 2013. Most mandatory programs, including the Prevention and Public Health Fund would be subject to cuts of Donate to APHA 7.6 percent. Governance "The impact of the sequester cuts will reverberate across the • Calendar entire public health sector and compromise our efforts to protect our nation's health by slashing funding for food safety, Public Health Links environmental protection, immunization and family planning Social Media programs. Contact APHA "Our current public health system is already a patchwork of services, programs and regulatory authorities that is neither designed for optimal performance nor funded for sustainability and success. At a time when budget shortfalls are forcing even tighter restraints, federal, state and local health departments are being asked to do more with less. The capacity for health professionals to prevent and respond to some of today's pressing health challenges or provide basic public health and preventive services is in grave danger. We simply cannot afford these deep and painful cuts. "These cuts signify a weak commitment on the part of our elected officials to assure the future health of our nation. Not only is it a misguided solution to deficit reduction, the sequester cuts could squander some of the recent advances we've made in chronic disease prevention, emergency preparedness and infectious disease control. APHA strongly opposes these cuts and urges Congress to instead develop a bipartisan balanced approach to deficit reduction that does not make additional cuts to nondefense discretionary programs and instead prioritizes public health funding." • # # # http://www.apha.org/about/news/pressreleases/2012/sequester+report.htm 10/5/2012 �, "t?�. a. E�'' 'fir' a '�'*: C � �,�,�'� ' °��i'� .�� 4 5 � y-mf .. 'ts#"' '' , s ut' k -" . #. `e• °`x ,; 4' z tis_x ' ° ‘,..,,:-,..0 ' z s' P.d� a ." 'r b ti�Z5w , � " . « � z. Y ' Yt e. �fi f*. gg-t �w� .° . Z � " ; � t � --3Y kzx ;I'rk7' '; �- :':Ut ,?*�a,= a � s� 1 �� 111� � s � -A �� f` -4 r ii.q • h g* -, s? ft v r e ca 33, zhv ` "tek" a# r a u 0 37 x v ,e:`V �. te',^rN sat,4 � i N °r '� itir 4ddee2 ti ffitr i trx-*z 5 s*-�T' S ir 4 .i :,: ititir ;fli 1..,. ` `' s e .. . .. ,....., ,, ...,...: .. , .- ` „ .,,.�.m .d .^ . ? "c �P. American � Public Health alth ,r .• .A. I a I Association s . 40 4 . : W1144g,, ' Get The Facts 0:What is sequestration? 0: What does this mean for public health funding? A: In 2011, Congress passed the Budget Control Act which established caps on defense and nondefense discretionary A: Most of the public health funding at the federal level is programs such as public health, environmental protection, discretionary so it will be impacted by sequestration. Cuts law enforcement,transportation etc.,that will reduce of 8 to 10 percent to programs funded at the Centers for this funding by$1 trillion over 10 years.The BCA also Disease Control and Prevention would mean: created the Joint Select Committee on Deficit Reduction Life-saving immunizations would be denied to 30,000 (often referred to as the "supercommittee")to come up children and 20 ,000 adults. with a plan to reduce the deficit by another$1.2 trillion over the same decade. In the event the supercommittee An increase in the number of HIV transmissions by nearly • failed to come up with a viable plan,the BCA established 800, costing the nation more than$250 million due to "sequestration" as an incentive to force bipartisan reduced availability of HIV tests. compromise.A rigid budgetary tool, sequestration will * Tens of thousands of additional health care associated force automatic,across-the-board cuts of another$1 infections each year would debilitate patients, kill • trillion to nearly all government programs, including public thousands and cost billions in added health care costs. health. Because the supercommittee failed to produce an * Decreased ability to evaluate and investigate 100-150 agreement, sequestration is scheduled to begin on• multistate outbreaks identified by CDC surveillance Jan. 2, 2013. networks, including outbreaks of E. coli, salmonella, and norovirus,causing outbreaks to last longer, get Q: What is the impact of sequestration bigger and cause more illnesses and deaths before on nondefense discretionary programs? they are controlled. • * Reduced number of local health department staff trained A:Since fiscal year 2010, nondefense discretionary in epidemiology, laboratory and outbreak response programs have already been cut by 10 percent on average, by 2,500. with some programs cut more than 50 percent. Cuts under sequestration are expected to be in the range of 8 to 10 * Eliminating over 50 intramural and extramural research, percent to nondefense discretionary programs, including translation and outreach projects and grants increasing the economic burden of work-related injuries and public health.These cuts will truly be across-the-board, illnesses,which is already more than$13 with no department or agency control on how the cuts billionlnesiallnesses, which impact individual programs. In total, if Congress and lly. the president fail to act, between fiscal 2010 and 2021, These cuts would be in addition to those already made nondefense discretionary programs will have been cut by that have resulted in the loss of 55,000 high-skilled 20 percent overall.Such indiscriminate cuts threaten the public health jobs and many more positions furloughed. entire range of bipartisan national priorities. For example, there will be fewer scientific and technological innovations, Q: Are all mandatory programs subject fewer teachers in classrooms,fewer job opportunities, to sequestration? fewer National Park visitor hours,fewer air traffic controllers,fewer food and drug inspectors and fewer A:Some mandatory programs are exempt, some are first responders. subject to smaller cuts and in some cases it is unclear Ill ro8001 Street, NW iii Washington,DC 20001 *www.apha:orgg For instance Social Security, Medicaid,Temporary Assistance for Needy Families, Supplemental Nutritionimeii, ssistance Program,federal retirement and programs Wdministered by the Veterans Administration are among the programs that are exempt from sequestration. Cuts to ;Zz` the Medicare program would be limited to provider payment cuts of no more than 2 percent. Q:Would sequestration impact implementation of the Affordable Care Act? A:Yes,funding to implement the Affordable Care Act— including the Prevention and Public Health Fund—is subject to the across-the-board cuts. Q: Can sequestration still be avoided? A:Yes, but Congress would have to pass a deficit reduction proposal that is acceptable to the administration by January 2013.The administration has stated repeatedly that it will not accept a plan that only depends on spending cuts and has requested that Congress pass a balanced deficit reduction plan that also increases revenue through tax reform. Q: What is APHA doing to urge Congress to avoid sequestration? •A:APHA is working closely with partner organizations in the public health and health care community to educate members of Congress of the devastating effects sequestration would have on the programs, communities and people served by funding from agencies such as the Centers for Disease Control and Prevention,the Health Resources and Services Administration, the National Institutes of Health and others. For example,APHA joined nearly 3,000 other organizations in the nondefense discretionary community including educators, law enforcement, environmental organizations, transportation organizations and others in sending a letter to Congress urging the development of a balanced deficit reduction proposal that does not make additional cuts to nondefense discretionary programs. 0: How can advocates help avoid sequestration? 14.0 A:Advocates can provide examples of what cuts of 8 to American 10 percent would mean to the programs they operate 4144 Public Health and the communities they serve and send them to phacta apha.org.We will soon provide more toots to help publicliAX Association health advocates urge their members of Congress to °° 7. . avoid sequestration by finding a balanced approach to • deficit reduction. August 2012 0 •Washington, i)C 20001 o www.apna.org • Jefferson County Board of 3feaCth OCcfBusiness .Agenda Item # III, 6 3Cotiv Healthy Are ANe on the • Worth, Olympic Peninsula? .article October 18, 201 • 0 • • { THE /''f g__ TH ; How healthy are we on the 4. - a Olympic Peninsula? � rf qv •^� � f res- -` x ` _.i L 3 A' l. `Y r - r,, _,'-'1.r.,,,),-}x' as a a „ " s° - _ By Dr. Tom Locke Public Health Officer organizations provide county-specific health data tracking a fatal drug overdoses.These are preventable problems.These of Clallam and Jefferson Counties variety of health indicators.Washington DOH has a handy are areas where we should be world leaders.But we are not. website for accessing both its local public health indicators and The"How healthy are we?"question can be answered with A A Te all have a general sense of how healthy we are as the national County Heath Ranking system sponsored by the broad generalities or numbing statistical specifics.To me,an Y Y individuals.Many have annual check-ups with their Robert Wood Johnson foundation(link below). even more important question is"How healthy do YOU want health care providers and get a professional assessment of their Another critical element ofthe"How healthy are we?"ques- your community to be?"If you care about questions like that, healthstatus.Buthowhealthyareweasacommunity?Isiteven tion is your frame of reference.We have a large and expanding the next step is to get informed.Sit down at your computer(or possibletoanswerthisquestion?Asitturnsout,theanswerlies number of measures of community health,To make sense of one of the many available at our public libraries)and investigate in the realm of what is known as Population Health. these health measures,we need something to compare them the links below.To geta preview of what Clallam County's 2012 Health care services can be thought of as falling into two to.Comparing county-level data to the whole country has little assessment will look like,check out the 2010 Health of Jefferson general categories:personal health and population health. practical value.Even comparing ourselves to state averages County Report.Interested in county by county comparisons? Personal health services(also known as medical care)focuses has limited usefulness.Washington's population statistics tend Go to the Washington Department of Health's website and on effective responses to illness and injury as well as certain to represent its largely urban population.Rural Clallam and look over both the local health indicators and the national preventive services like cancer screening,nutrition counseling Jefferson counties tend to have more in common with each county health rankings.Yearning for more of an international and physical activity promotion.In the United States we spend other and with other medium-sized rural counties than we perspective?Try the OECD(Organization of Economic Co- about 96 percent of our annual$2.6 trillion health care budget do with our urban neighbors.The most valuable comparison operation and Development)website for comparative data on on personal health services. of all often comes when we look at ourselves over the course the top 34 developed countries(Spoiler Alert:no gold medals The other part of the system,population health(often of time.These comparisons are known as community health for Team USA). referred to as public health),focuses on the things we cannot trends and help policymakers determine whether key aspects And finally and very importantly,get engaged locally.Jef- do on an individual basis—control outbreaks of communi- of community health are getting better or worse. ferson County's community health data is on its website.Clal- cable disease,ensure that our food and drinking water is safe, So what do our local health report cards show?It depends lam County's assessment will soon be completed and available conduct programs targeted at vulnerable populations such on who is doing the grading,of course,but the overall trend for public review.It will be presented to the Clallam County .as infants and young mothers,and collect and analyze large is worrisome.The prolonged national recession has a lot to Board of Health before the end of the year and it is our plan to volumes of health information.Population health programs do with this.We also are seeing the effects of a chronic lack hold one or more community meetings to gather public corn- are supported by about 1 percent of our health care dollars. of investment in basic prevention programs.As a state and a ment.Healthy communities don't just automatically happen. One of the key responsibilities of the public health system is nation we have long failed to make the fundamental invest- Like our individualhealth and that ofour families,itisamatter to conduct Community Health Assessments(C:HA).They are ments that other economically developed countries make in of the choices we make,the access we have to quality health akin to an annual check-up for the whole community.This is health care access,women and children's'health programs and care,good nutrition and physical activity,and the priorities where you can find the best answers to the"How healthy are chronic disease prevention.International health comparisons we set as a community,a state and a nation in terms of public we?"question. tell this story in disturbing detail-while we spend almost 45 health investment. Two local health departments serve the North Olympic percent of the world's health care dollars in the United States Thomas Locke, MD, MPH,serves as health officer for Peninsula — Clallam County Department of Health and (on 5 percent of the world's population)we are clearly losing Clallans and Jefferson Counties.Heis board certified in Preventive Human Services and Jefferson County Public Health.Both the"community health Olympics"when it comes to most coin- Medicine and on the faculty of the University of Washington 'conduct community health assessments on roughly 3-year in- munity health measures.We rank near the top only in those School of Public Health and Community Medicine. ent in areas(obesity,diabetes and cost of care)where we would like to be at the bottom of the list! Resources tervals.Jefferson Countyupdated its most recent assessment June 2011 and has made its results available on its website(see ? Health of Jefferson CountyReport resources below).Clallam County last conducted a CHA in And finally,when you ask the"How healthy are we." P 2009 and is in the process of updating it by the end of 2012. question,the perspective of the respondent is a crucial factor. www.jeffersoncountypublichealth.org/index.php?health-of- Keepingtrackofcommunityhealthtrendsservesanumber As the health officer for Clallam and Jefferson counties,it is Jefferson-county of important functions-assessing the impact of specific public part of my responsibility to monitor and make sense out of Washington Department of Health Community Health health programs,providing crucial information for elected the steady flow of community health data that is being gener- Assessment Website officials in prioritizing the use of scarce health resources and ated.What concerns me most are some of the low grades on ww.doh.wa.Dov/PublicHealthandHealthcareProviders/ providinginterested;engagedcitizensanopportumtytogetin- our community health report card thatiinpactfuturegenera- Pu}iticHealthSystemResourcesandServices/ volved with improving community health in very spec tions-highiatesofsmokingbypregnantmothers,declining IornniunityandStateHealthAssessment.aspx - 4 In addition to local health departments,the Washington State graduation rates,more and more community members living OECD"At a Glance"International health measures report Department of Health(DOH)and several non-government without health insurance,high rates of substance abuse and wwwoe,cdorg/health/healthpolraesand,data/491D5358 pdf 0 40 LIVING ON T;; ,,. � „ lL- I SEPTEMBER 2012 ,. �� t �v r<�.,.�,'"�tt..' a� .i�r� .,-„,-4,,,,, ... �-s'n.�-� "��:... ��. �,..,. 3� �M,�..: .a•.. .. III Jefferson County Board of.7CeaCth Netiv Business & Informational-Items .agenda Item # �V, 1 Community Cealth • Jee Setting Policy October 18, 2012 • 0 • • JEFFERSON COUNTY BOARD OF HEALTH • Community Health Fees All of the services/fees listed for Jefferson County Public Health and Community Health are set as follows: A cost analysis will be completed every year to set reimbursement rates for family planning services and immunization programs. Fees for medications, antibiotics and treatment methods will be based on cost of acquisition unless acquired by an outside vendor at no cost to Jefferson County Public Health. No handling fee to cover staff time on inventory and ordering will be assessed. All fees for vaccines not subsidized by the Vaccine for Children or Washington Vaccine Association will be based on the cost of the vaccine, shipping and handling, and allowable market reimbursement rates. Laboratory Services are based on the actual fees of laboratory contractors, price lists are available upon request. Office visit fees are calculated and reviewed annually, and are based on cost analysis. In the event the cost analysis is too high, fees will be based on contracted private insurance provider rates or market rates. The Clinical Services Financial and Operations Guidelines policy is in place, reviewed and updated annually, which includes the Federal Poverty Guidelines used to establish the sliding fee schedule. A copy of the sliding fee schedule will be available upon request. The sliding fee schedule will not be offered for privately purchased vaccines administered for international travel or outside laboratory cost. Certain service fees may be waived, including but not limited to communicable disease prevention services, medications, laboratory services or vaccines to prevent outbreaks of communicable disease. Services for vaccines subsidized by the Vaccines for Children Board;tfembers Phil Johnson(Chair),County Commissioner District#1, Jill Buhler(Vice-Chair),Hospital Commissioner,District#2, David Sullivan,County Commissioner,District#2,John.4ustin,County Commissioner,District#3, Catharine Robinson, Port Townsend City Council.Sheila Westerman,Citizen(City),Roberta Frissell.Citizen(Comity) 615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368 (360)385-9400 or WA Vaccine Association and Family Planning Services will not be denied due to a client's inability to pay. Jefferson County Public Health will automatically implement future modifications to fees for vaccines, medications, and medical supplies when any of the following changes occur: 1. There is a change in the actual cost of the service provided by an outside vendor, the supply, medication, vaccine, laboratory charges, or shipping and handling costs. 2. The Federal Poverty Level Guidelines change. 3. The maximum allowable Medicaid reimbursement rate changes and is more than market rate. • Chair, Jefferson County Board of Health Date Jefferson County Health Officer Date Board Members Phil Johnson(Chair),Cometh Commissioner District#l, Jill Buhler(Vice-Chair),Hospital Commissioner,District#2, David Sullivan,County Commissioner,District#2,John 4 ustin,County Commissioner,District#3, Catharine Robinson, Port Townsend City Council,Sheila Westerman,Citizen(City.),Roberta l ,ssell Citizen(Count)} 615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368 • (360) 385-9400 Jefferson County Board-of.9Cealth Wow Business & Informational ltems .agenda Item # 11; 2 Paralytic Shellfish Poisoning • Outbreak in Jefferson County October i8, 2 01 1 JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypublichealth.org FOR IMMEDIATE RELEASE Contact: Jean Baldwin Phone: (360) 385-9400 Email: jbaldwin@co.jefferson.wa.us Paralytic Shellfish Poisoning Cases Reported in Jefferson County Port Townsend, Washington, September 24, 2012 Jefferson County Public Health is reporting 7 cases of paralytic shellfish poisoning from ingestion of mussels harvested from Discovery Bay on the evening of Saturday September 22. A family of 7 vacationers ate shellfish they had gathered and several hours later began to feel ill. When symptoms worsened, 911 was called and they were taken to Jefferson Healthcare Emergency Room early Sunday morning. Two members of the family were admitted to JHC, one requiring treatment on a mechanical ventilator. Two were transferred to Harrison Hospital in case their symptoms worsened and ventilator treatment would be needed. Three others were held for observations at Jefferson Healthcare. Ages of those ill ranged from 19 to 68 years old. One remains hospitalized as of Monday, September 24. • Paralytic Shellfish poisoning (PSP) is caused by a naturally occurring toxin, called a "biotoxin" that is produced by some species of microscopic algae. PSP toxin can concentrate in shellfish and when eaten, can affect the nervous system causing numbness and muscle paralysis. Marine biotoxins are not destroyed by cooking or freezing. Symptoms of PSP can appear within 15 minutes or can take as long as 10 hours to develop and usually begins with tingling lips and tongue, moving to the hands and feet, followed by difficulty speaking and breathing. If untreated, paralysis of the muscles necessary for breathing can result in death. Anyone experiencing PSP symptoms should contact a health care provider immediately. Washington Department of Health typically receives 0-7 reports of paralytic shellfish poisoning (PSP) each year. Paralytic Shellfish poisoning (PSP) warning signs have been posted at high-use beaches around affected areas of Puget Sound advising people not to consume shellfish from these areas. The closure includes clams, oysters, mussels, scallops and other species of molluscan shellfish. In most cases, the algae that contain the toxins cannot be seen and must be detected using laboratory methods. Discovery Bay has been closed to recreational shellfish harvesting since mid- July 2012. Shellfish samples are tested every 2 weeks for PSP toxin and this year record levels of toxin in excess of 100 times the closure threshold have been detected. Recreational shellfish COMMUNITY HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES PUBLIC HEALTHWATER QUALITY MAIN: (360) 385-9400 ALWAYS_°' i VR A SAFER MAIN: (360) 385-9444 FAX: (360) 385-9401 HEALTHIER co umry FAX: (360) 379-4487 harvesters are strongly advised to look for posted signs at public beaches and also • check the Department of Health's Shellfish Beach Closure website at: http://www.doh.wa.gov/CommunitvandEnvironment/Shellfish/BeachClosures.aspx or call the Department of Health's Biotoxin Hotline at 1-800-562-5632 before harvesting shellfish anywhere in Washington State. For additional information please contact Jean Baldwin Director of Jefferson County Public Health at (360-385-9400). ### Always Working for a Safer & Healthier Jefferson County • • COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES r WATER QUALITY MAIN: 360385-9400 ALWAYS WORKING FOR A SAFER AND MAIN: 360385-9444 40 FAX: 360385-9401 HEALTHIER COMMUNITY FAX: 360379-4487 • Jefferson County Board of CeaCth Netiv Business & Informational items .agenda item # IV, 3 lake Charge Program • increases .Access to TamiCy Planning Services October 18, 2 01 • JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypublichealth.org • FOR IMMEDIATE RELEASE Contact: Karen Obermeyer Phone: (360) 385-9400 Email: kobermeyer@co.jefferson.wa.us October 11, 2012 JCPH now able to offer more affordable Birth Control to more people. Port Townsend, Washington Changes to the state/federal program Take Charge allow JCPH to reach new clients; providing services to those whose income levels may have prevented eligibility previously and to those who may not get services due to their current limited medical coverage. The income limits for Take Charge have been raised.Take Charge is the state/federal program that covers birth control and related services in Washington.This change allows people with a higher income levels to qualify for payment for family planning services . For example, a single person making$2,328 or less per month would qualify, so would a married woman with 2 kids 411 with a household income of$4,803 or less. Men can qualify too. "It's a wonderful opportunity for anyone in town who needs family planning services. It's part of women's health maintenance." Susan O'Brien ARNP JCPH Clients with private insurance coverage are also allowed to apply for Take Charge as secondary coverage. This means that anyone regardless of private insurance coverage can qualify as long as they meet income guidelines. Take charge covers many family planning services such as: an annual exams, many birth control methods, emergency contraception, education and supplies for natural family planning, abstinence, as well as tubal ligations or vasectomies. Jefferson County Public Health is the provider of Take Charge in Jefferson County, but citizens can go to other counties or Planned Parenthood. For a complete income guidelines and services call Jefferson County Public Health 385-9400 or go to www.leffersoncountypublichealth.org ### Always Working for a Safer & Healthier Jefferson County • COMMUNITY HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES PUBLIC HEALTHWATER QUALITY MAIN: (360) 385-9400 ALWAYS WORKING FOR A SAFER AND MAIN: (360) 385-9444 FAX: (360) 385-9401 HEALTHIER CO UNITY FAX: (360) 379-4487 • Jefferson County Board of.1 Ieafth Netiv Business & Informationalltems .Agenda Item # XV, 4 Substance Abuse • Advisory Board Appointment October 18, 2 01 • RECEIVED • October 3, 2012 OCT 0 9 2012 Jefferson County Washington Substance Abuse Advisory Board (SAAB) Jefferson County To Members of the Jefferson County SAAB: Pic Health I would like to apply for a seat on the Jefferson County Substance Abuse Advisory Board. Having worked in the criminal justice field for the past 21 years and obtaining a Master of Science Degree in Criminal Justice, I am keenly aware of substance abuse's societal and monetary costs and its plague on our society. I began my career working with housed juvenile offenders in Boulder County Colorado. I conducted assessments of newly arrested juvenile offenders and their families and reported these findings to the Court. It was clearly evident substance abuse was a primary risk factor, not only with the juvenile offender, but also within their family. Following five years with juvenile services, I worked within adult corrections and saw a similar pattern of substance abuse catalyzing criminal activity and destroying relationships and families. As a patrol deputy in Boulder County and then as a police officer/detective for Port Townsend, I experienced the front lines of substance abuse and the toll it takes on individuals,families, businesses, educational institutions,children,and the community as a whole. Alcohol and drug use was often a factor in criminality,and at nighttime, almost a given. Substance abuse enhanced the frequency and severity of domestic assaults,dating violence, child abuse and neglect. Binge drinking,whether by university students or pre-college school aged youth,was a predominant risk factor in the victimization and sexual exploitation of women and girls. • Substance abuse creates offenders and claims victims across all generational,cultural,ethnic, socioeconomic,and educational lines. It transfers from the home to the office to school to public spaces,adhering to no geographic or geopolitical boundaries. Without bias or care, it is willing to claim any life or livelihood. It fills our morgues and decimates our assets. Job experience has revealed to me the devastating effects of substance abuse. Education and experience has taught me prevention and active community partnerships are a best means to combat such devastation. This is especially relevant with our youth. I have gained many rewards teaching prevention curriculum in the schools,coaching youth sports, and positively interacting with our kids as a community partner. This gives me hope that the devastation such as I have witnessed can be lessened and the plague,while perhaps not eradicated,can at least be effectively circumvented, and when need be, treated. To this end, I wish to serve as a member of SAAB and to positively engage our community and our youth. Sincerely, Michael Evans • Jefferson County Board of.7feaCth _Media Report • October i8, 2 01 • Jefferson County Public Health September/October 2012 NEWS ARTICLES 1. "Anderson Lake to stay closed despite test results," Peninsula Daily News, September 13th, 2012. 2. "Gibbs Lake upgraded," Peninsula Daily News, September 13th, 2012. 3. "Anderson Lake toxins climb again," Peninsula Daily News, September 17th, 2012. 4. "Hood Canal beaches reopen to recreational shellfish harvesting," Peninsula Daily News, September 16th, 2012. 5. "Group to meet on landfill application," Peninsula Daily News, September 19th, 2012. 6. "Mill files permit; Watchdogs meet," Port Townsend Leader, September 19th, 2012. 7. "PT Girl's Night Out," Peninsula Daily News, September 23rd, 2012. 8. "Mussels send family of seven to hospital with PSP," Port Townsend Leader, September 24th, 2012. 9. "Seven persons hospitalized after eating toxic Discovery Bay mussels," Peninsula Daily News, September 25th, 2012. 10. "Peninsula health officials watch for new flu virus," Peninsula Daily News, September 25th, 2012. 11. "Woman improving after eating toxic mussels," Peninsula Daily News, September 26th, 2012. 12. "Watchdog group voices support for limited-use-permit," Port Townsend Leader, September 26th 2012. 13. "Girls' Night Out `Pajama Party' Oct 4th," Port Townsend Leader, September 26th, 2012. 14. "School clinics provide healthy option for kids," Peninsula Daily News, September 27th, 2012. 15. "New toxin-producing algae found in Anderson Lake," Peninsula Daily News, September 27th, 2012. 16. "Shop by day; slumber by night Oct. 4 for `Girls Night Out' fundraiser," Port Townsend Leader, September 27th, 2012. 17. "Work With Me," City of Port Townsend Newsletter, October 2012. ip8. "Port Townsend Main Street Girls' Night Out `PAJAMA PARTY!", City of Port Townsend Newsletter, October 2012. 19. "Thursday is Girls' Night Out in Port Townsend," Port Townsend Leader, October 3rd, 2012 20. "Girls' Night Out," Port Townsend Leader, October 3rd, 2012. 21. "School-Based Health Centers Help Kids," Port Townsend Leader, October 3rd, 2012. 22. "Electronic records system touted to Jefferson Healthcare board," Peninsula Daily News, October 5-6, 2012. 23. "Health centers kick off 5th year at high schools," Peninsula Daily News, October 7th, 2012. 24. "Anderson Lake neurotoxin nearly 300 times safe level," Peninsula Daily News, October 8th, 2012. 25. "ORCAA recommends four air-quality monitors," Peninsula Daily News, October 8th, 2012. 26. "Kicking up a good time," Port Townsend Leader, October 10th, 2012. 27. "National nurse visitation program now up and running in Kitsap," Kitsap Sun, September 23rd, 2012. Y Anderson Lake to stay closed despite test results • By Leah Leach Peninsula Daily News, September •13th,2012 LAN } r -.,...,;.,-...,1414-1.--,4- ,�..-.„�^ ''''. -7---:;,,- 7-, 7- ^"+'�5 ww w" m 1 ,,I2Ui1IP ,'i Margaret McKenzie/Peninsula Daily News Anderson Lake has been closed for most of the summer. PORT TOWNSEND—Although toxins are low, Anderson Lake will stay closed for the rest of the season. S/ Test results of samples taken the weeks of Aug. 27 and Sept. 4 showed that anatoxin-a, a fast acting and / potentially deadly nerve poison, was at a safe level in the Iake on Anderson Lake State Park. After two consecutive safe readings, county public health officials generally recommend lakes be reopened, said Greg Thomason, Jefferson County environmental health specialist. That recommendation had been made for Anderson Lake after two consecutive tests showed the lake's level of anatoxin-a to be below the safety threshold of 1 milligram per liter of water. But Mike Zimmerman, the ranger in charge of the state park, doesn't trust that the status won't change for the worse at the popular trout-fishing lake. The lake has been closed most of the summer because of elevated levels of the nerve toxin created by some species of blue-green algae. Warm weather is forecast for the end of the week, and since higher temperatures seem to encourage algae growth, Zimmerman is loath to open the lake only to close it again a few days later. "I'm just not going to do it,"Zimmerman said. "I'm seeing warm weather coming again. I'm looking at the possibility of having to close again soon. "This close to the end of the season, it doesn't do any good for anybody." Catch-and-release-only rules came into effect at Anderson Lake on Sept. 1, and the state park west of Quilcene will close at the end of October. IIIFor now, however, the 410 acre state park around the lake remains open for recreation. A Discover Pass is needed to park there. • Thomason also said warmer weather is expected, at least during daylight hours, with temperatures likely to be in the mid-70s. But he said he feels that algae growth is fueled more by longer days than by warm temperatures. "It's supposed to stay pretty warm . . . The other side of that coin is we're getting shorter days, less daylight," Thomason said. "The amount of daylight is the critical thing," he said. "We find blooms that start when it's cold and none when it's warmer, so it seems to be that the most critical period is the photo period," which is the amount of daylight between sunrise and sunset. "There's less daylight for them to utilize photosynthesis, so that's slowing them down a bit," Thomason said. Blue-green algae is a plant that grows naturally in lakes, especially shallow, older bodies of water. At times, some species of blue-green algae produces toxins. Although researchers know that algae growth spikes in the summer when sufficient nutrients such as phosphates are present, they don't understand what sparks the production of toxins from some species. Receipt of test results on anatoxin-a levels in East Jefferson County lakes are usually received each Friday, but they were delayed last week and came in early this week. Anderson Lake was found to have 0.45 micrograms of anatoxin-a, which can cause paralysis and stop (� breathing, in the most recent test results. Test results reported Aug. 30 found 0.61 micrograms of anatoxin-a per liter of water. The lake had been closed Aug. 23—after having been reopened for fishing and other recreation less than a week earlier—because of a level of 4.9 micrograms of anatoxin-a. Microcystin, another toxin created by blue-green algae—which has traditionally been low in Anderson Lake—was found to be at a level of 0.34 micrograms per liter of water in the latest test results. Testing of East Jefferson County lakes will continue through September, Thomason said. No toxic blue-green algae has been reported in Clallam County, where health officers do not test for toxins; instead, they visually monitor lakes for signs of algae bloom. Report algae blooms in Clallam County by phoning 360-417-2258. Report algae blooms in Jefferson County by phoning 360-385-9444. For more information about lake quality in Jefferson County, visit the environmental health website at http://tinyurl.com/6z64ofy. Managing Editor/News Leah Leach can be reached at 360-417-3531 or at leah.leach aa..peninsuladailynews.com. Gibbs Lake upgraded • Peninsula Daily News,September 13th,2012 PORT TOWNSEND—The status of Gibbs Lake, which was reopened Friday at a warning level, has now been upgraded. No anatoxin-a, a potent nerve poison created by blue-green algae, was found in Gibbs Lake in the latest test results of samples taken last week. "Based on anatoxin results, we improved it to the caution level," said Greg Thomason, Jefferson County environmental health specialist. The county lake had been reopened Friday because the level of microcystin, another blue-green algae toxin, had fallen to 1.2 micrograms per liter of water—the second consecutive week of low readings. The lake south of Port Townsend had been closed Aug. 23 because tests of a sample from the lake found 19.4 micrograms of microcystin per liter of water—the highest level ever seen in Gibbs Lake in five years of testing for algae toxins. The safety threshold is 6 micrograms per liter for microcystin, which can cause skin irritation and nausea over the short term and liver damage if ingested over a long period of time. No trace of either anatoxin-a or microcystin was found in the latest test results of samples from Lake Leland north of Quilcene, Thomason said. Caution signs remain posted there and at Crocker Lake, which is near the U.S. Highway 101-state Highway 104 junction, because both lakes contain the types of blue-green algae that can suddenly begin to produce toxins. Anderson Lake toxins climb again By Leah Leach Peninsula Daily News,September 17th,2012 PORT TOWNSEND—The level of a potentially deadly nerve toxin has climbed to unsafe levels again in Anderson Lake after a couple of weeks of low readings. The Jefferson County Public Health Department on Friday recommended that the popular trout-fishing lake west of Chimacum stay closed to all recreational use. The level of anatoxin-a, a fast-acting nerve poison that can cause paralysis and stop breathing, had been below the safety threshold in two consecutive weekly tests earlier this month. That led county health officials to recommend that the lake, which was closed for most of the summer because of elevated levels of anatoxin-a, be reopened. But Mike Zimmerman, the ranger in charge of the lake at the Anderson Lake State Park, declined to reopen the lake so late in the season, which ends Oct. 30. Zimmerman said at the time that, given warm weather that would fuel plant growth, he didn't trust that the level of toxin created by blue-green algae would stay low. It turned out he was right, according to the report received Friday from King County Environmental Labs, which found that a sample of water from the lake contained 1.43 micrograms of anatoxin-a per liter of water. That's slightly above the safety threshold of 1 microgram per liter. "Anderson Lake jumped up above the warning level," said Greg Thomason, Jefferson County environmental health io) specialist. "We're now recommending that it stay closed." The lake may look healthy, with only a light bloom and no scum, "but you can't tell by looking at it," Thomason said. The 410-acre Anderson Lake State Park around the lake remains open for recreation until the end of October. A Discover Pass is needed to park there. Microcystin, another toxin created by blue-green algae, stayed low in Anderson Lake, as it has all season, with the sample containing only 0.30 micrograms per liter of water. The safety threshold is 6 micrograms per liter for microcystin, which can cause skin irritation and nausea over the short term and liver damage if ingested over a long period of time. Microcystin remained low in Gibbs Lake in the tests. Gibbs Lake was reopened Sept. 7 after two consecutive weeks of low readings for microcystin. The lake south of Port Townsend had been closed Aug. 23 because tests of a sample from the lake found 19.4 micrograms of microcystin per liter of water. Since it was reopened, its status has been upgraded from a warning level to a caution level. The caution sign is posted at the lake only because the water contains the type of blue-green algae known to sometimes create toxins. For the same reason, caution signs remain at Lake Leland north of Quilcene and at Crocker Lake, which is near the U.S. Highway 101-state Highway 104 junction. , Tests of Lake Leland water samples last week found no anatoxin-a or microcystin. Crocker Lake was not tested last week. Blue-green algae is a plant that grows naturally in lakes, especially shallow, older bodies of water. III At times, some species of blue-green algae produces toxins. Although researchers know that algae growth spikes in the summer when sufficient nutrients such as phosphates are present, they don't understand what sparks the production of toxins from some species. Testing of East Jefferson County lakes will continue through September, Thomason has said. No toxic blue-green algae has been reported in Clallam County, where health officers do not test for toxins; instead, they visually monitor lakes for signs of algae bloom. Report algae blooms in Clallam County by phoning 360-417-2258. Report algae blooms in Jefferson County by phoning 360-385-9444. For more information about lake quality in Jefferson County, visit the environmental health website at http://tinyurl.com/6z64ofy. 1?-0,!„,.. ,,, tom' ,4 ,- w a- x R ,, ' % - " , V0=,-4 s aP1 - ID9 a' c p k y .''.....i• .' +ag ' yam qC i e o re' 1 c ... _� iv an , .: Margaret McKenzie/Peninsula Daily News Anderson Lake has seen its toxin levels rise and fall. Managing Editor/News Leah Leach can be reached at 360-417-3531 or at leah.leach(apeninsuladailynews.com. Hood Canal beaches reopen to recreational shellfish harvesting Peninsula Daily News,September 16'",2012 410 PORT TOWNSEND— Hood Canal from Seal Rock south to the Mason County line has reopened for recreational shellfishing. Levels of the marine biotoxin that causes diarrhetic shellfish poisoning—or DSP—are currently below the recreational closure level, according to the Jefferson County Public Health Department. Many of East Jefferson County beaches were closed in July because of elevated levels of DSP as well as the more potentially serious paralytic shellfish poisoning—or PSP. Many remain closed by the state Department of Health because of marine biotoxin levels, with PSP the primary biotoxin of concern. Commercially harvested shellfish are tested for toxin prior to distribution and are considered safe to eat, the state Department of Health has said. East Jefferson County beaches that remain closed to recreational shellfish harvesting are Discovery Bay—which also is closed because of DSP toxin —Admiralty Inlet, Port Townsend Bay, Kilisut Harbor including Mystery Bay, Oak Bay, Mats Mats Bay and Port Ludlow south to the Hood Canal Bridge. Clallam beaches closed All Clallam County beaches remain closed for shellfish harvesting of all species. PSP levels are considered lethal at many sites around Clallam County, according to the Clallam County Department of Health and Human Services. Il Warning signs have been posted at high-use beaches warning people not to consume shellfish from these areas. The closure includes clams, oysters, mussels, scallops and other species of molluscan shellfish. It does not apply to shrimp. Crab meat is not known to contain biotoxins, but the guts can contain unsafe levels. To be safe, clean crab thoroughly and discard the guts. Marine biotoxins are not destroyed by cooking or freezing. People can become ill from eating shellfish contaminated with the naturally occurring marine algae containing toxins. PSP symptoms Symptoms of PSP can appear within minutes or hours and usually begin with tingling lips and tongue, moving to the hands and feet, followed by difficulty breathing and potentially death. DSP can cause diarrhea, nausea, vomiting, abdominal cramps and chills, very similar to gastrointestinal or stomach flu-type symptoms. Symptoms can begin within a few hours and last one to three days at the most. Anyone experiencing symptoms should contact a health care provider. In most cases, the algae that contain the toxins cannot be seen and must be detected using laboratory testing. Before harvesting shellfish, check the state Department of Health website at http://tinyurl.com/7u33qob or phone the state biotoxin hotline at 800-562-5632. to meet on landfill application � i •Group pp PENINSULA DAILY NEWS The application received fill permit that had been maker will discuss the orga- PORT TOWNSEND — by the Jefferson County proposed. nization and the strategy of Port Watchdogs Board of Health requested Port Townsend Watch- the Watchdogs. will host Townsenda meeting tonight an inert permit with addi- dogs is a citizens'group that The group will discuss tow discuss theg Port tions of re-initiating opposes the application. fundraising and volunteer Townsend Paper Corp.'s,r groundwater monitoring The meeting's guest opportunities. p and provision of financial speaker will be Bob Lynette, For more information. application for a renewal of assurances, neither of co-chairman of the Cascade its landfill application. which are required for inert Chapter of the Sierra Club, visit Iess.c//I�tic atcltclogs. The meeting will be from waste landfills. who will give a 30-minute wordprss.cocn. 7 p.m. to 9 p.m. at the Port The company is not presentation. Townsend Community Cen- applying for the more strin- Rick Faraci, Dave ter,620 Tyler St. gent limited purpose land- McWethy and Sally Shu- 4111 /p,/il 9/19/2012 6:00:00 AM,Port Townsend Leader O Mill files permit; Watchdogs meet Inert permit filed; county has 45 days to decide on it Allison Arthur, assistant editor Port Townsend Paper Corp. did what mill officials said they would do and filed Sept. 4 for a basic inert permit for its controversial landfill. Port Townsend Citizen Watchdogs say they'll now do what they said they'd do with a meeting tonight to talk about action. Before either the mill or the community group makes an official move, the permit is in the hands of Dr. Tom Locke, health officer for Jefferson County, who has 45 days from Sept. 4—the permit was dated Aug. 31, but was received officially Sept. 4—to approve or disapprove of the mill's permit application. Locke couldn't be reached for comment Tuesday before deadline. Locke has said in the past he wants to move the mill's landfill into another permit category called Limited Purpose Landfill (LPL), which would require the mill to do more specific groundwater testing and provide financial assurance should the mill cease operations. In its 10-page application for a renewal of its existing inert landfill, the mill offers to do groundwater testing and also offers to provide a "financial assurance instrument." The instrument isn't spelled out in the application and it's unclear whether the well-monitoring offer will meet with what Locke and officials with the state Department of Ecology (DOE) say they want. DOE officials also have indicated they want the mill to do a more thorough LPL permit. "PT Paper is committed to meeting or exceeding all environmental standards," mill spokeswoman Annika • Wallendahl wrote Tuesday. "The application incorporates input we received from the county and the Department of Ecology during the recent meeting in August." Wallendahl said mill officials believe the application addresses key concerns of the state and county. While the county and the state have not officially said what they think of the mill's application, the mill's proposal did not impress the Port Townsend Citizens Watchdogs, a group that has mobilized to ensure that state and county officials "stand up to the Port Townsend Paper Corporation and be prepared for a confrontation if necessary." "It is likely an appeal will be filed by the public if the permit is inadequate," said Dave McWethy. Issues that McWethy sees with the application include concern about where, exactly, any new wells would be placed and whether they would be down-gradient of the landfill. Bad well placement, he said, could result in bad data. McWethy also said the mill's pledge to provide financial assurance for an inert landfill essentially is a joke because inert landfills can be covered with dirt by a bulldozer. There's a concern, McWethy said, that the mill deposited paper-making waste at the landfill before environmental laws came into play in the early 1980s. McWethy said it's important to know what is actually in the 25-acre landfill in order to determine its future. Mill officials contend the waste hasn't changed over the years, that it includes ash and lime grit and that 12 years of water quality monitoring have already proven that there is no problem. • "PTPC complied with applicable regulations, including those that require groundwater monitoring,"the mill's application states. "Data from this groundwater monitoring documented no impact from landfill operations." • Appeals process Once Locke decides which way to go on the application, the DOE has 30 days to review the permit or appeal. If the DOE appeals, the permit would go to the state Pollution Control Hearings Board for a review. That state board has previously concluded that the mill's waste stream is not inert. Environmental Health Specialist Pinky Feria-Mingo explained that citizens have the same 30-day timeframe to appeal the county's decision to the state Pollution Control Hearings Board. If the county denies the mill's permit, the mill could request a hearing on the denial before the Jefferson County Board of Health. Any decision that board would make also could be appealed to the Pollution Control Hearings Board. Although the mill's permit is not on the agenda of the Sept. 20 meeting of the Jefferson County Board of Health, it is likely the Port Townsend Citizen Watchdogs will be at the meeting, leaders say. The meeting starts at 2:30 p.m. at the Masonic Hall, 1338 Jefferson St. , 77* %,7@ri4***17c-YiVik, ' • 7�Rr, s The Port Townsend Paper Corp. has applied for a basic inert permit for its landfill the company said is used for ash and lime grit. Photo by Patrick J. Sullivan; flight by Port Townsend Aircraft Services • PT Girl's Night Out tickets are on sale in PORT TOWNSEND- advance this year starting The Port Townsend Main Oct. 1 • Street Program will pres- ent"Girls'Night Out,"a ferson County Public day and night of fun and Health Breast and Cervical shopping,on Thursday, Cancer Program and the Oct.4. Port Townsend Main Street This year's theme is Program,a 501(c)(3)non- "Pajama Party!"—and cus- profit. tomers are encouraged to For more information, bring friends and wear PJs visit www.ptmainstreet.org. to Girls'Night Out. More than 20 partici- pating businesses will offer special events,in-store pro- motions and refreshments from 11 a.m.to 8 p.m. The evening ends with a "wrap"party at 8 p.m.at Alchemy Bistro and Wine Bar next to Haller Foun- tain at 842 Washington St. The party features a no- host bar,appetizers,des- serts and door/raffle prizes. There is a$5 suggested donation at the door. An optional slumber party will follow at Manresa Castle.Participants should bring their own sleeping bags.The cost is$20. • To reserve a spot at the slumber party,RSVP to PT Main Street at 360-385- 7911 by 5 p.m.this Thurs- day. Or reserve a room Oct.4 at the special Girls'Night Out rate of$49 plus tax. Phone Manresa Castle at 360-385-5750 to book a room. Goodie bags and raffle • . /70 ii 9/7‘002, 9/24/2012 3:42:00 PM,Port Townsend Leader Mussels send family of seven to hospital with PSP ask Discovery Bay has been closed to recreational shellfish harvest since July A family of seven vacationing in Jefferson County has fallen ill because of paralytic shellfish poisoning from ingesting mussels harvested Saturday, Sept. 22 from Discovery Bay. Shortly after they consumed the shellfish they had gathered they began to feel ill, according to Jefferson County Public Health Director Jean Baldwin. When symptoms worsened, 911 was called and they were transported to Jefferson Healthcare's emergency department early Sunday morning, Sept. 23. Two members of the family were admitted to the Port Townsend hospital, one requiring treatment on a mechanical ventilator, Baldwin reported Sept. 24. Two others were transferred to Harrison Medical Center in Bremerton in event their symptoms worsened and ventilator treatment would be needed. Three others were held here for observation. Ages of those ill ranged from ages 19 to 68. One remained hospitalized as of Sept. 24. Washington Department of Health typically receives no more than seven reports of paralytic shellfish poisoning (PSP) during an entire year. Bay closed Discovery Bay has been off-limits to recreational shellfish harvest since early July when, for the first time in Jefferson County history, marine biotoxins that cause diarrhetic shellfish poisoning (DSP) were detected. DSP was unknown in the U.S. until last year, when it was first detected in Sequim Bay. In mid-July, the State Department of Health updated the closure to include PSP, which has been common in local waters. Commercially harvested shellfish are sampled separately and products on the market have been safe to eat. Warning signs Shellfish samples are tested every two weeks for PSP toxin and this year record levels of toxin in excess of 100 times the closure threshold have been detected. In most cases, the algae that contain the toxins cannot be seen and must be detected using laboratory methods. Recreational shellfish harvesters are strongly advised to look for posted warning signs at public beaches, Baldwin said. The closure includes clams, oysters, mussels, scallops and other species of molluscan shellfish. The closure does not apply to shrimp. Crab meat is not known to contain the biotoxin. What is PSP? Paralytic Shellfish Poisoning (PSP) is caused by a naturally occurring toxin called a "biotoxin" that is produced by some species of microscopic algae. PSP toxin can concentrate in shellfish and when eaten, can affect the nervous system causing S numbness and muscle paralysis. Marine biotoxins are not destroyed by cooking or freezing. Symptoms of PSP can appear within 15 minutes or can take as long as 10 hours to develop and usually begins with tingling lips and tongue, moving to the hands and feet, followed by difficulty speaking and breathing. If untreated, paralysis of the muscles necessary for breathing can result in death. Anyone experiencing PSP symptoms should contact a health care provider immediately. Learn more Check the Department of Health's Shellfish Beach Closure website at www.doh.wa.gov/CommunityandEnvironment/Shellfish/BeachClosures.aspx or call the Department of • Health's Biotoxin Hotline at 1-800-562-5632 before harvesting shellfish anywhere in Washington State. 110 • Seven persons hospitalized after eating toxic Discovery Bay mussels By Rob 011ikainen Peninsula Daily News, September 25th,2012 DISCOVERY BAY—Seven vacationing family members were hospitalized, one so severely that she was placed on a ventilator, after eating mussels tainted with a potentially deadly marine biotoxin that they had harvested from Discovery Bay over the weekend, health officials said. The woman placed on a ventilator Sunday was taken off it Monday but remained at Jefferson Healthcare Hospital in Port Townsend for observation. Jefferson County Public Health said members of the Seattle-area family, who are not being named, fell ill with paralytic shellfish poisoning, or PSP, after harvesting them Saturday. The victims, aged 19 to 68, got sick several hours after eating the mussels from a beach that has been closed to recreational shellfish harvesting for high levels of PSP since mid-July. "When symptoms worsened, 9-1-1 was called," said Jefferson County Public Health Director Jean Baldwin. The family was taken to Jefferson Healthcare early Sunday. "Two members of the family were admitted to [Jefferson Healthcare], one requiring treatment on a mechanical ventilator," Baldwin said. "Two were transferred to Harrison Hospital (in Bremerton) in case their symptoms worsened and ventilator Amtreatment would be needed," she added. "Three others were held for observations at Jefferson Healthcare." PSP can cause numbness and muscle paralysis from 15 minutes to 10 hours after the toxin is consumed. Symptoms include a tingling of the lips and tongue, tingling of the hands and feet, difficulty speaking and difficulty breathing. If left untreated, paralysis can lead to death. In a follow-up interview, Baldwin said Monday that it is "pretty unusual" to have seven cases of PSP at one beach. There are usually no more than seven cases of PSP in the entire state per year, she added. "We've seen a few travelers get sick, but not all in one place, not all at one time," Baldwin said. PSP, also known as red tide, is caused by a naturally occurring biotoxin that is produced by microscopic algae. Most beaches on the North Olympic Peninsula remain closed to recreational shellfish harvesting because of high levels of PSP toxin. Warning signs have been posted at the affected beaches, including at Discovery Bay. • "I think it's been over a decade since we've had a PSP case (on the North Olympic Peninsula), and then it was much milder than these," said Dr. Tom Locke, public health officer for Clallam and Jefferson counties. "It's noteworthy in terms of the severity of the symptoms, and then, No. 2, the fairly large number of the cluster." A sample taken from a Discovery Bay shellfish two weeks ago showed 7,000 micrograms of PSP. • Health officials close beaches when the level reaches 80 micrograms. Affected shellfish include mussels, clams, oysters, scallops and other molluscs. It does not apply to shrimp or crab meat, but crab guts can contain unsafe levels and should be cleaned thoroughly. Marine biotoxins are not destroyed by cooking or freezing. Commercially harvested shellfish are tested for toxins prior to distribution and are considered safe to eat, the state Department of Health has said. Peninsula beaches were closed this summer because of elevated levels of PSP, as well as the less-dangerous diarrhetic shellfish poisoning, or DSP. Fisheries that remain closed for PSP are Discovery Bay, Admiralty Inlet, Port Townsend Bay, Kilisut Harbor, including Mystery Bay, Oak Bay, Mats Mats Bay and Port Ludlow south to the Hood Canal Bridge. All Clallam County beaches remain closed for recreational shellfish harvesting for unsafe levels of PSP. Before harvesting shellfish, check the state Department of Health website at http://tinyurl.com/7u33Qob or phone the state biotoxin hotline at 800-562-5632. Reporter Rob 011ikainen can be reached at 360-452-2345,ext. 5072,or at roliikainenApeninsuladailynews.com. Peninsula health officials watch for new flu virus By Rob 011ikainen, Peninsula Daily News, September 25th,2012 •FORKS —While it hasn't hit the North Olympic Peninsula—or even the state— health officials here are keeping a watchful eye on a strain of influenza that caused the Hong Kong pandemic of 1968, the region's public health officer told the Clallam County Board of Health last week. Dr.Tom Locke, public health officer for Clallam and Jefferson counties, said the H3N2 swine flu is"something worth tracking real closely." "We actually ended up putting out some advisories for county fairs to be watching for a new form of swine flu," Locke told the health board in a meeting in Forks on Tuesday. "It's in the same category of the last pandemic string. The H1N1 that caused a fortunately very mild pandemic in 2009 is in this category called triple assortment influenza viruses, where it's a combination of swine, bird and human influenza viruses all mixed together, usually in pigs." Sick pigs can spread the airborne disease to humans, and right now the H3N2 strain is going "back and forth from pigs to humans," Locke said. "Where we get worried is when it's a robust enough virus that it goes from pig to humans, and then human to human," he said. "So we were concerned about people at fairs." No illnesses have been reported from the Clallam or Jefferson county fairs last month. Most of the recent cases have been reported in Indiana, Locke said. The Hong Kong flu killed an estimated one million worldwide in 1968 and 1969. "It caused a pandemic in 1968, and then sometime in the '90s it went into the swine population," Locke said. "It's been circulating and mutating, and if it gets better at person-to-person transmission then we have the makings of the next pandemic." "So we're just in a monitoring mode on that right now, but no Washington cases." On a brighter note, Locke said the declared pertussis epidemic in Washington is finally winding down. "We're still seeing confirmed cases, but not at near the instances that we were earlier in the year," he said. "We continue to aggressively promote vaccination among adults and adolescents." Pertussis, or whooping cough, can make children and babies very sick and can be fatal in rare cases. The state Department of Health reported 4,115 confirmed pertussis cases from Jan. 1 to Sept. 15, compared to 427 in the first 81/2 months of 2011. The North Olympic Peninsula accounted for 51 of this year's cases: 26 in Clallam County and 25 in Jefferson County, most of which happened last winter and spring. State health officials have now confirmed that the Tdap pertussis vaccination doesn't last as long as its predecessor. About 75 percent of the children with confirmed whooping cough cases in Washington were fully vaccinated, but with a newer, lower-side-effect cellular vaccine, Locke said. l t "We're going to need to vaccinate these kids more frequently," Locke said. "And we would also welcome a better vaccine, a vaccine that has more staying power. Having to do more frequent vaccinations is a costly and unpopular sort of strategy." • Locke also addressed the West Nile virus in a briefing on communicable diseases. Although Washington had just"a couple cases" of West Nile this year, the mosquito-borne virus was prevalent in the South. "We thought West Nile was sort of yesterday's news, but it turns out this is the worst year ever in the United States for West Nile, especially in Texas," Locke said. "There's been almost 2,000 confirmed reported cases of human West Nile infection, and this is the tip of the iceberg, remembering that 80 percent of people with West Nile infection don't have any symptoms, don't even know they're sick." About one of every 150 West Nile cases leads to a severe disease that causes permanent brain damage and a polio-like syndrome. State health officials monitor mosquito pools and look for West Nile in horses. "But we simply don't know if it's ever going to be a problem in this state," Locke said. Reporter Rob 011ikainen can be reached at 360-452-2345,ext.5072,or at rollikainen(a.peninsuladailynews.corn. i,• • Woman improving after eating toxic mussels • By Jeremy Schwartz, Peninsula Daily News, September 26th,2012 PORT TOWNSEND—A Seattle woman who was hospitalized along with six family members Sunday morning after eating toxic mussels harvested from Discovery Bay was improving and under general observation at Jefferson Healthcare, county health officials said Tuesday. The woman and members of her family, who are not being named, were hospitalized after eating mussels containing the potentially deadly paralytic shellfish poisoning marine biotoxin, or PSP, said Jean Baldwin, Jefferson County Public Health Department director. The woman still in the hospital in Port Townsend was the only member of the family who remained hospitalized, Baldwin said. She had been placed on a mechanical ventilator Sunday but was taken off it by Monday, Baldwin said. The victims, ages 19 to 68, got sick several hours after eating the mussels from a beach that has been closed to recreational shellfish harvesting for high levels of PSP since mid-July The family harvested the mussels late Saturday night despite warning signs posted at the beach. Harvesting at night Baldwin suspects the family did not see the signs in the dark since they were harvesting at 10 p.m. Baldwin said the family had harvested at Discovery Bay numerous times in the past before the shellfish poison warnings were posted for the bay in mid-July. PSP can cause numbness and muscle paralysis from 15 minutes to 10 hours after the toxin is consumed. If left untreated, paralysis can lead to death. A sample taken from a Discovery Bay shellfish two weeks ago showed 7,000 micrograms of PSP. Health officials close beaches when the level reaches 80 micrograms. Before collecting shellfish from any beach on the North Olympic Peninsula, Baldwin recommended calling the state biotoxin hotline at 800-562-5632 for the most up-to-date information on beaches closed to recreational shellfish harvesting due to paralytic shellfish poison. "When in doubt, call the hotline," Baldwin said. "Don't just harvest." Most North Olympic Peninsula beaches remained closed to recreational shellfish harvesting because of high paralytic shellfish poison levels found in shellfish samples. Shellfish that accumulate the poison in their flesh include mussels, clams, oysters, scallops and other mollusks. Marine biotoxins are not destroyed by cooking or freezing. Commercially harvested shellfish are tested for toxins prior to distribution and are considered safe to eat, the state Department of Health has said. For more information,visit http://tinyurl.com/7u33gob. 9/26/2012 6:00:00 AM,Port Townsend Leader,Tristan Hiegler,reporter • Watchdog group voices support for limited-use permit Board of Health hears concerns over PT Paper's landfill Community members voiced their disapproval at a county Board of Health meeting regarding Port Townsend Paper Corp.'s inert landfill permit application. t Dr. Tom Locke, health officer ation for r ar inert permit for its landfill.rson County, confirmed at He now has 45e Sept. 20 tdayshto he has received the mill's app review the permit, which he added is something he intends to do "very carefully." Locke said the mill's application includes additional language about water-quality monitoring and financial assurances for landfill cleanup. He said the application was received on Sept. 4. "We do need time to go through this," Locke said. Community members who were present want Locke to reject the inert permit and instead impose a limited-purpose permit, which has stricter monitoring requirements. About 50 people were in attendance at the Port Townsend Masonic Center. Bill Wise of Team Jefferson, the county-supported economic promotion entity, said imposing the limited-purpose permit could hurt the mill financially and thus hurt the larger community. ` ' "I encourage you to consider our community's economic well-being," Wise said. He said the mill has been operating within the boundaries of federal, state and local laws and regulations. Mill officials and union representatives also spoke, urging Locke to retain the inert permit. Many of the speakers belonged to the Port Townsend Citizen Watchdogs. Concerns about air quality and water quality were raised. One commenter discussed the possibility of having the U.S. Army Corps of Engineers test the landfill ash to gauge its chemical composition. During that comment period, County Commissioner Phil Johnson, as health board chair, banged the gavel and told the commenter to stop speaking after asking that person several times to stop after the allotted time had expired. Another audience member gave that speaker her three minutes of public comment time. Gretchen Brewer of PT AirWatchers said that while Locke hasn't classified the permit process as an emergency, a danger does exist. "The emergency is we don't know what will happen with the mill," Brewer said, referring to the current lack of financial guarantees to clean up the landfill, should the mill eventually close. • Brewer also noted the importance of checking the aquifer under the landfill and the area around • it. She displayed a map of the landfill area that charted how runoff could enter Port Townsend Bay. The next Board of Health meeting is scheduled for 2:30 p.m., Oct. 18, at the Masonic Center at 1338 Jefferson St. it . r a ,x40kiri4 ; N v s "e , .4-0„-..ed:,;44-,4 ' , .t int :44,4., „ �m ].. .s:1p+ ,;• rO9VA1V ,V;?3,14:‘,40,4-4z1,6,3i:KASVoit14.0•71,OP", 4:490:3, .139,;.1,3,„', „to_,„;\ 44„ „r;„34. a' Aft The Port Townsend Paper Corp. has applied fora basic inert permit for its landfill the company said is used for ash and lime grit. Photo by Patrick J. Sullivan; flight by Port Townsend Aircraft Services ,l Via° ,, v aamm • Port Townsend Main Street Girls' Night Out "Pajama Party 1 Oct 4th! at 25 Businesses! A Day and Night of Girlfriend Finn o Shopping...and a Slumber Party! GOODIE BAGS/RAFFLE TICKETS ON SALE 10/1: • About Time 839 Water St. April Fool&Penny Too 725 Water St. Bidde's Cotton Casuals 926 Water St. The Clothes Horse 910 Water St. The Green Eyeshade 720 Water St. Maricee Fashions 913 Water St. 0 0 Grand Prize Raffle You might win—value$300! . Tickets$5 each or 5 for$20 V Overnight at Commander's Beach House plus merchant gifts &certificates from The Belmont, Rose Theatre,The Undertown, The Boiler Room,and the Resort at Port Ludlow. O 0 • Proceeds benefit Jefferson Co. Health Dept Breast/Cervical Health Fund forWomen in need and PT Main Street Program,a 501c3 nonprofit. WEAR PAJAMAS TO GIRLS'NIGHT OUT! Special events,discounts, drawings&refreshments in store at Girls'Night Out! Wrap Parry at Alchemy Bistro 8pm raffle/prizes! OPTIONAL FUN— A SLUMBER PARTY at Manresa Castle!BYO sleeping bag.$20 per person. Call PT Main Street at 360-385-7911 by 9/27 to reserve your spot. Or reserve a room at the special "Girls'Night Out"rate of$49 plus tax for Oct.4th. Call Manresa Castle directly at d (360)385-5750 for bookings. Sponsored by the PT 1-6--p Main Street Program, ' Jefferson Healthcare, £..... 0 OZONE Socks,and Participating Merchants Sponsored by lib Jefferson Healthcare Details:www.pttnainstreet.org I , ' i'a. 1, • School clinics provide healthy option for kids m 14 . 4,„t' Vglf- 4414- Charlie Bermant/Peninsula Daily News Nurse practitioner Sara Kirkegaard,Americorps volunteer Ryann McChesney and Anna Weark sit in the waiting room of Chimacum High School's Student Based Health Clinic. By Charlie Bermant, Peninsula Daily News,September 27'",2012 CHIMACUM —This isn't your parents' school nurse. Student health care has taken a new turn with the establishment of Student Based Health Care Clinics, which offers answers about and treatment for medical issues. At the clinics, "the kids get fast answers to their questions, and they don't have to miss classes in order to get treatment," said Chimacum High School Principal Whitney Meissner. "This is convenient for both the students and the parents, who don't need to take time off from work to drive them to the doctor." The clinic, which is open from 8:30 a.m. to 3:30 p.m., is staffed by nurse practitioner Sara Kirkegaard on Mondays and Wednesdays and by mental health worker Julie Canterbury on Tuesdays and Thursdays. A similar clinic operates at Port Townsend High School. It is located in the Gael Stuart Building across from the superintendent's office. In Port Townsend, a mental health worker is on duty from 8 a.m. to 12 p.m. Mondays and Wednesdays, and a nurse practitioner is there from 9 a.m. to 12:30 p.m. Tuesday and from 10 a.m. to 2:30 p.m. Fridays. "This is a great program," said Jefferson County Public Health Department Director Jean Baldwin. "It improves student access to health care and helps us combat issues like school absenteeism, while the mental health component helps kids deal with stress, depression and grief. "It also gives us the opportunity to refer families without insurance to a low-cost state program they can afford," she said. The clinics are the result of a partnership between the schools, the Jefferson County Board of Health, Jefferson Mental Health and Jefferson Healthcare. 410 The schools provide the facilities, the Board of Health and Jefferson Healthcare each provides a nurse practitioner, and Jefferson Mental Health provides two counselors. During the 2011-2012 school year, the clinics logged 894 clinic visits and 370 mental health visits, according to its annual report. They served 290 students, divided evenly between new and returning, • They also provided 104 sports physicals and 630 visits dealing with reproductive health issues. The clinics cost about$60,000 a year for medical services and $55,000 for the mental health component, Baldwin said. Kirkegaard said that about 70 percent of the students visiting the clinic have questions about reproductive issues, Condoms are given to anyone who requests them, and Kirkegaard can insert an IUD. "Washington state law states that kids can talk about reproductive issues at a clinic with a guarantee of privacy," she said. "But when we give this advice, we encourage them to talk it over with their parents or an adult they trust." The clinic is housed in a small office suite adjacent to the "commons," the gathering space students use throughout the day. Because what goes on inside the clinic is confidential, the fact that it connects to a large, open area is a drawback, Kirkegaard said. "With the commons right there, it can be hard to do confidentiality," she said. Meissner also is mindful of preserving privacy. Kirkegaard said she wants to build awareness among the students that the clinic is about more than reproductive health and can deal with almost any day-to-day health issue. It's also vital for the sports program, since kids can get qualifying physicals without having to go to a doctor. "The clinic is especially valuable for kids on the teams," said Port Townsend High School Vice Principal Patrick Kane. "A lot of the kids don't have their own doctor, and they can be treated on a sliding scale." "I wish I'd had access to something like this when I went to high school," Kirkegaard said. She said she tries to be a source of inspiration to the students and encourages them to seek a career in health care. Anna Weark, a 2012 graduate of Chimacum High School, said, "I don't know what I would have done if the clinic wasn't here while I was in school." "A lot of kids don't know where to get help and a lot of their families can't afford to take them to a doctor." Weark showed her appreciation by donating a painting she did as a senior project. It now hangs in the clinic's lobby. The painting portrays students seated under a tree doing homework, which Weark said symbolizes her experience at the clinic. "I put them under a tree because I wanted to show how the clinic is a safe place," she said. 411 Jefferson County Reporter Charlie Bermant can be reached at 360-385-2335 or at charlie.bermantpeninsuladailynews.com. New toxin-producing algae found in Anderson Lake 0 By Leah Leach ,Peninsula Daily News, September 27`",2012 PORT TOWNSEND—Something new is growing in Anderson Lake, and it isn't good. "For the first time ever, we have a new genus of toxic algae that has never shown up in our lakes before," said Greg Thomason, Jefferson County environmental health specialist. Coelosphaerium —a type of blue-green algae known to sometimes produce the powerful nerve toxin anatoxin-a— was discovered in a sample that was taken Sept. 10 from Anderson Lake west of Chimacum. It is the first time this particular type of blue-green algae has been found in any East Jefferson County lake during six years of testing. Thomason said he didn't know where it came from. "This is not a good sign," Thomason said. "Something different is going on here. "It doesn't point in the right direction." Toxin-producing blue-green algae typically found in the county's lakes are anabaena, aphanizomenon and microcystic. All three produce the potentially deadly anatoxin-a, while microcystis also can produce microcystin, which can cause skin irritation and nausea over the short term and liver damage if ingested over a long period of time. Coelosphaerium "is something new," Thomason said. "It may account for our getting anatoxin later in the season." Thomason had been puzzled by recent test results of water samples taken from Anderson Lake—which has been � closed for most of the summer because of elevated levels of anatoxin-a—that showed the level of that toxin on the rise during a season when it typically falls. Test results received Friday found 15.3 micrograms of the toxin per liter of water. That's more than 15 times the safety threshold of 1 microgram per liter for anatoxin-a, which can cause paralysis and lead to death by stopping breathing. The new level represents a surge from the week before, when the level of anatoxin-a in Anderson Lake had risen to just above the safety threshold: 1.43 micrograms per liter. And prior to that, the levels of the toxin had been so low earlier this month that the county public health department had recommended the lake be reopened. Mike Zimmerman, ranger in charge of the state lake, decided against that because—given the history of the lake —he feared toxin levels would rise again and it would have to be closed soon after reopening. The lake will remain closed for the rest of the season. The 410-acre Anderson Lake State Park around the lake remains open for recreation until the end of October. A Discover Pass is needed to park there. The rise in toxins so late in the season is atypical, Thomason said. "Anderson Lake just keeps going up," he said. illi "I don't know if it is a fluke or a trend for the future. "We've never seen it die off and then come back up late in the season." Because of the changes in the lake, the county public health department, which had decided to stop sampling at the end of this month, will continue for a week or two in October, Thomason said. "We plan to stay with it," he said. • "It's definitely setting a new pattern or doing something crazy this year. We want to document it as much as we can." Only an estimate was available for anatoxin-a levels in Leland and Gibbs lakes. That estimate is that only a trace exists in those lakes. No microcystin was found in Lake Leland, which is north of Quilcene, while a trace was found in Gibbs, which is south of Port Townsend. Caution signs stay up at both lakes because they contain the types of algae known to sometimes produce toxins. Blue-green algae is naturally occurring and usually benign, but at times, certain species begin producing toxins. Researchers don't understand what sparks the production of toxins from some species. Gibbs Lake has scum and bloom, Thomason said. "Stay away from scum," he said. "That's where the concentrated toxins are." No toxic blue-green algae has been reported in Clallam County, where health officers do not test for toxins; instead, they visually monitor lakes for signs of algae bloom. Report algae blooms in Clallam County by phoning 360-417-2258. Report algae blooms in Jefferson County by phoning 360-385-9444. For more information about lake quality in Jefferson County, visit http://tinyurl.com/6z64ofy. Managing Editor/News Leah Leach can be reached at 360-417-3531 or at leah.leach(@,peninsuladailynews.com. 0 9/26/2012 4:18:00 AM,Port Townsend Leader Shop by day; slumber by night Oct. 4 for 'Girls Night Out' fundraiser 'Girls'Night Out'supports breast, cervical program, camaraderie ver dreamed of going shopping in your pajamas and then sleeping in a castle? 6 That's what women are being invited to do this year for Girls' Night Out, an annual event set for Thursday, Oct. 4. Proceeds from the event benefit Jefferson County Public Health's breast and cervical cancer prevention program. "Pajama party" is the theme of this year's event, and customers are invited to bring friends and wear their PJs while shopping at stores in downtown Port Townsend from 11 a.m. to 8 p.m., and then head to a slumber party in the Manresa Castle Banquet Room. The slumber party is a bring-your-own-sleeping-bag event for$20 per person. Those interested should call Port Townsend Main Street organizers at 385-7911 by 5 p.m., Thursday, Sept. 27, as space is limited. Before the slumber party, there is a "wrap party" at 8 p.m. at Alchemy Bistro and Wine Bar, 842 Washington St., which features a no-host bar, appetizers, desserts and door prizes for a suggested $5 donation at the door. Mari Mullen, executive director of the Port Townsend Main Street Program, is excited about the event this year, not only because of the pajama party theme, but because seven new stores have signed up to join in the big annual event. Face of Grace, Conservatory Coastal Home, Getables, Pippa's Real Tea, Sideshow Variety and Artisans on Taylor will participate, along with Closet Space, a mobile store. The increase in participating stores is a "positive indicator of Port Townsend's economy," Mullen said. Goody bags, which have become a feature of the event, are available for$10 starting on Monday, Oct. 1. The bags contain coupons, Ozone socks, and gifts donated by participating businesses, as well as information about breast and cervical cancer prevention. "This year, many of the participating stores provided 50 gifts for the goody bags, so the goody bags reflect the diversity and generosity of our businesses," Mullen said. III There will be special sales and refreshments at participating stores as well as in-store events and demonstrations. For those women who live out of town and have always wanted to spend a night at Manresa Castle, there is also a special room deal that night. Anyone interested in the$49 room offer, instead of the slumber party, can call Manresa directly at 385-5750. Mullen said she hopes women from Port Angeles, Sequim and elsewhere take the opportunity to spend the night and become friends with women in Port Townsend. Girls' Night Out, held every year in October to spread the word about Breast Cancer Awareness Month, is sponsored by the Port Townsend Main Street Program, Jefferson Healthcare and participating businesses. Last year, approximately 500 women participated in the shopping event and almost all the goody bags were sold out, Mullen noted. For more information, call 385-7911 or go to ptmainstreet.org. Six stores have gift bags early Six stores are sponsoring goody bags for Girls' Night Out and offer the bags, as well as raffle tickets, staring on'Oct..1. April Fool and_Penny;Too, About Time, the Clothes Horse, the 6 Green Eyeshade, Maricee Fashions and Bikie's'fCotton Casuals have`hags in advance of the'l ig event on Oct"4 y ` i • • f . '1 Work With Me IThe Jefferson County Community Connec- • I =----- tors Group will be holding their 1st an- nual"WORK WITH ME" Employer Breakfast, on Thurs- day, October 18 from 8-9 a.m. at Fort Worden Com- mons-Company Room A. Discover the power of em- ploying people with developmental&other disabilities, To reserve your place at this invitation only"WORK WITH ME" breakfast event, please call Anna McEnery at 385-9410 or Bekka Bloom at 531-2640. r = Port Townsend Main Street s;� r Girls' Night Out "PAJAMA PARTY!" • Thurs., Oct.4, 11 a.m.-8 p.m. October 4, 11 a.m.to 8 p.m. -Come to Port Townsend for a day and night of female camaraderie and shopping fun for "Girls' Night Out" sponsored by Jefferson Healthcare,the Port Townsend Main Street Program, OZONE Socks, and Participating Merchants. merry October 31, 4 p.m.- Downtown Trick or Treat and Costume Parade-At 3:45 p.m., children through 6th grade •40.6- (accompanied by a parent)are invited to gather at Water&Adams Streets at the Bank of America Plaza under the clock to parade down Water Street and trick or treat on the way back. (Special thanks to the Port Townsend Police • Dept., Bank of America, Kinetics High Priestess Janet Emery,the PT Main Street Promotion Committee and generous participating merchants.) • For event details, visit www.ptmainstreet.orq; follow the Port Townsend Main Street Program on Facebook and Twitter. • L,fijeZr4e 1°/62 Thursday is Girls'Night Out in Port Townsend ig Charlie Nermant,Peninsula Daily News;October 3ia,201240-03 = "may .$ a 7 i 14 �"n �r .' * em :E, , tr �_ r s u.,aaa ,pr r 1 2-7.,.„2",„-_,...,,,,go...„...., -:.„4. ,,,,,,,,„ „., ..,,..„.„,„:f-.-~e...0,..—:,,,, :A. 1b7.4 `-*;-_, '-.-', f '-,:z"z I . �g - ,® -Jx�t a ' i j� N. k E t s; .r: i,f�r. 11 �� sok ��; 4� i k 1` . °pry ^�'1 „.- r 1Xy' I + ^a` �s ti, cls nr,Germane enl ire dally Newa 4. Penny Va,...,"an,left,and Sac Arthur prepare some of the gift bags for Girl's Night Out,which takes place on Thursday in Pon Townsend. PORT TOWNSEND — Girls' Night Out, which will take over downtown Port Townsend on Thursday provides an opportunity for women to have fun shopping while simultaneously benefiting local causes, said Port Townsend Main Street Program Executive Director Mari Mullen. And they can do it in their pajamas. "It's a great opportunity for girlfriends to go out on the town and shop with heart," Mullen said. �t will be a lot of fun for everybody." The Girls' Night Out Pajama Party, scheduled from 11 a.m. to 8 p.m., is sponsored by Main Street, Jefferson Healthcare hospital, Ozone Socks and 24 participating merchants who are offering special deals for the occasion. Proceeds from the event, which will be generated by the sale of 500 gift bags —each costing $10—will be divided between the Main Street program and the Jefferson County Public Health Department's breast and cervical cancer screening fund. Last year, the two agencies shared $7,000, Mullen said. Participants also are encouraged to wear pajamas during the shopping spree, in line with the pajama party theme. After the shopping spree, participants can attend a Wrap Party, followed by a slumber party. The Wrap Party will begin at 8 p.m. at Alchemy Bistro &Wine Bar, 842 Washington St. The party features a no- d bar, appetizers, desserts and door and raffle prizes. The suggested donation is $5 at the door. Raffle winners will be announced at the Wrap Party, where door prizes also will be awarded. 41/Raffle winners need not be present to win but must be 18 or older. The slumber party will begin at about 9:30 p.m. or 10 p.m., after the Wrap Party ends. It will be at Manresa Castle, 651 Cleveland St., where participants can stay in one of the hotel's rooms for$49 a night or stay with a group in a banquet room in their sleeping bags for$20. To RSVP for the banquet room group, phone the Port Townsend Main Street program office at 360-385-7511. The $20 fee will be taken at the door. • To book a room, phone Manresa Castle at 360-385-5750. The day is geared toward women, but men are invited to participate in all activities — aside from the slumber party. The gift bags' contents are varied, though all of them have a pair of socks and a coupon book along with different beauty items and other useful items. They are larger than what is needed to hold all the items to allow for the items purchased during the sales, Mullen said. Gift bags are available for purchase at six locations: About Time, 839 Water St.; April Fool & Penny Too, 725 Water St.; Bickie's Cotton Casuals, 1034 Water St.; The Clothes Horse, 910 Water St., The Green Eyeshade, 720 Water St.; and Maricee Fashions, 913 Water St. These locations also are selling raffle tickets for prizes, including an overnight stay for two at Commander's Beach House, dinner for two at The Belmont, movies at the Rose Theatre, treats at The Undertown, coffee at The Boiler Room and a gift certificate for the Resort at Port Ludlow. For a complete list of participating merchants and other information, visit www.ptmainstreet.orq or phone 360- 385-7511. • Jefferson County Reporter Charlie Bermant can be reached at 360-385-2335 or at charlie.bermantRpeninsuladailynews.com. 0 Jefferson Healthcare Port Townsend Main Street Girls' Night Out "Pajama.Party"at 26 businesses! A Day&Night of Girlfriend Fun&Shopping... And a Slumber Party! Thursday, Oct. 4th 1 lana-8 pita GET YOUR GOODIE BAGS AND RAFFLE TICKETS NOW AT: Downtown: About Time 839 Water St. April Fool&Penny Too 725 Water St. Bickie's Cotton Casuals 926 Water St. The Clothes Horse 910 Water St. The Green Eyeshade 720 Water St. Maricee Fashions 913 Water St. Win a Port Townsend Package-value$300! Overnight at Commander's Beach House plus merchant gifts &certificates from The Belmont,Rose Theatre,The Undertown, The Boiler Room,and the Resort at Port Ludlow. Proceeds benefit Jefferson Co.Health Dept Breast/Cervical Health Fund for women in need and PT Main Street Program, a 501c3 nonprofit. Join in the fun&WEAR PAJAMASTO GIRLS'NIGHT OUT! Special events,discounts,drawings&refreshments in store! • HERE'S WHERETO FINDTHE FUN OCT.4TH: About Time-839 Water St. Abracadabra-936 Water St. April Fool&Penny Too-725 Water St. Artisans on Taylor-911 Water St. Bickie's Cotton Casuals-926 Water St. Closet Space-725 Water Street(April Fool&Penny Too parking lot,725 Water St.) The Clothes Horse-910 Water St. . Conservatory Coastal Home-639 Water St. Earthenworks-702 Water St. Elevated Ice Cream&Candy Co.-631 Water St. Expressions-834 Water St. Face of Grace-633 Water St. Getables-810 Water St. _ The Green Eyeshade-720 Water St. Izadora's Tanning and Day Spa-712 Washington St. Mad Hatter and Co.-926 Water St. Maestrale-821 Water St. Maricee Fashions-913 Water St. Perfect Dreams Cupcakes-909 Water St. Pippa's Real Tea-636 Water St. - Quimper Mercantile-1121 Water St. Sideshow Variety-630 Water St. Summer House Design-930 Water St. Tickled Pink-825 Water St. Wandering Angus-929 Water St. What's Cookin'-844 Water St. -, Wrap Party at Alchemy Bistro&Wine Bar 8:00 PM 842 Washington St.,8 pm October 4'h--$5 suggested donation;raffle drawings,door prizes,no-host bar, appetizers and dessert! After the Wrap Party...Join us for a SLUMBER PARTY at Manresa Castle!BYO sleeping bag.$20 p/p RSVP to PT Main Street at 360-385-7911. Or reserve a room at the special "Girls'Night Out"rate of$49.00 sTT plus tax for Oct.4th.Call Manresa • Castle directly at(360)385-5750 for bookings. 41110 Sponsored by the Port Townsend Main Street Program,Jefferson Healthcare, OZONE Socks,and Participating NG Merchants f/ Z-2.Details at www.ptmainstreet.org ;1 =cam 1 ;14 EALTH • W€LL$ SS Leader Focus tions,family planning and any other health issue addressed by primary care. The centers also address mental health needs through counselors from Jefferson Mental Health. "We know that being able to access health care at school SCHOOL-BASED HEALTH helps students obtain care CENTERS HELP KIDS that they otherwise would School-based health centers not have received," said Jean (SBHC) in both Chimacum Baldwin, Jefferson County and Port Townsend high Public Health director. schools offer health care ser- Jefferson County SBHCs vices to students, including are a medical partnership between Jefferson County sports physicals, inununiza Public Health and Jefferson Healthcare. "These services are pro- vided with the same confiden- tiality as your doctor's office," said nurse practitioner Susan O'Brien. . PTHS and CHS students have also used the SBHCs as resources for their senior project requirements.Projects of graduating seniors have included providing consulta- tion to make the clinic space more student-friendly,promot- ing the services of the SBHC, and developing suicide-pre- vention educational materials. Electronic records system touted to Jefferson Healthcare board By Charlie Bermant,Peninsula Daily News,October 5-6th,2012 PORT TOWNSEND—A new digital patient-records system called Epic would increase the efficiency in the management of Jefferson Healthcare patient records and facilitate coordinated treatment among different institutions, the hospital's chief executive officer said. alkall goes according to a tentative schedule,the hospital could have the Epic patient-records management system up and running by the middle of 2013, CEO Mike Glenn told hospital commissioners Wednesday afternoon. "What is really exciting about this is that we are now providing a couple of steps below the average medical record, if there is such a thing at a hospital, and overnight being a couple of steps above the average records," Glenn said of the transition. "Particularly with our provider network, it will be fantastic to have this level of integration. Commissioners will consider giving approval to proceed at their Oct. 17 meeting, set for 3:30 p.m. in the auditorium of the hospital at 834 Sheridan St. Conversion, which includes a 10-year service contract, would cost the hospital$3.4 million to$3.7 million over five years with a yearly operating cost of approximately$300,000, according to Information Services Director Roger Harrison. Access to the Epic system was cited as one of the advantages of Jefferson Healthcare's reciprocal care agreement with Swedish Medical Center, which commissioners approved last year along with Olympic Medical Center in Port Angeles and Forks Community Hospital. Epic is the market leader, Glenn said Wednesday. "This will allow us to deliver health care better and more efficiently,"he said. "We are really on the crest of the wave of organizations that will be implementing this." Purchase of a version of the Epic system,which includes network hardware, data center hardware and licensing, and point-of-care hardware—computers, scanners and other equipment—was approved last month by OMC commissioners,who voted unanimously for a$7.6 million agreement with Providence Health and Services. Jefferson Healthcare,with 25 beds, is considerably smaller than the Epic minimum of 200 beds, and the hospital's outreach to Epic *rior to the Swedish affiliation was ignored, according to Glenn. Swedish,through its recently purchased Providence Medical Center,will provide an Epic license to Jefferson Healthcare that can be adapted to the smaller facility. This operation differs from the OMC model:The server will be located off-site at the Providence facility. Jefferson Healthcare will need to make some equipment purchases, replacing about 150 computers that are too outdated to run the new system and adding another 150 computers for a total of about 700 terminals throughout the hospital, Harrison said. "This is a very important step for us, and it is essential that we do every step right, including the due diligence, the contracts, the vetting and then the implementation,which will be the biggest challenge," Harrison said. Glenn said the Epic system is"fully integrated and enterprisewide,"as opposed to other vendors who use several unrelated modules under the umbrella of an interface. "There's a lot of things that we do that could be done so much better if we have an electronic records system,"said Joyce Cardinal, a certified nurse educator who works at the hospital. "We get orders from physicians on paper that are sometimes difficult to decipher as a person tries to figure out what it says, and we spend a lot of time looking for paper records,"she continued. "With an electronic record,we can eliminate mistakes in providing medication,"she added. "This increases patient safety because we can make sure we are administering the right medication to the right patient." The tentative schedule for implementation would begin with a workflow analysis in December and January conducted by Providence personnel,followed by a four-to six-week design period when the system is built. 4,three-month installation and training period, during which time both the old and new systems will run in parallel, would take place with lans to"go live"in June. Jefferson County Reporter Charlie Bermant can be reached at 360-385-2335 or at Charlie.bermantpeninsuladailynews.com. e c ' • P"`a ' ... „....- - 4/11111 // N ',,:,.. * ''',-1,;< ..±C'.:.'". \ :,''''-.- i .-j I ... 4.524 - filliiri -itip, -, l c� hic�C Com' O rt . >,V C aN t*r t = ddC CD g <sx:x. .p.1 S 0 C , m IB O'C .Q1 0 E � Ci'-'1..''''' use * �~, 4 ` o GCS7 fa ..,2.,... .,,,, ,.,44...,_3,.,,,,,:,:l.,1fivoutt.74,44tito5,4,1„e.,,,4,:r , fl.1,0 c e OS,,,.";,..,Aititzix.;.f.,,,I.w.,‘,1,1viittAp„.0,1-41z.43„--.1;„;;-0›: m40.1, C' ''" C E O S� 4'� q .as d 3� '� fit *� v,<^p' HI .§ � R C � a+ p .� ,°�i,-.4.3,,,,,,,,,, ,,ir air £ C$' , 117 5 g to 5 GO Ct3 co o ^OO �8C1z .a C'b c � g2 R O8ydO-°7, mON .j "J "b ai N y + 73 p g �wmZ a a) z to g 4Ua)..•cg2F �t. .. OCy® N 0 t. b. 0 fli Jy ,) , .Oc, . ,.., 4E. mUo CJ � U 2y > o ° v (n U aCc'[ 0. ci , J d ° ma®® bU " MINX a op-�5yr9. t-iD ai 0 tit • C co S o �•� fid -ab o 0 3�" .O c� cccsiy o , m6 0 ani ,,,,..7-i, hhAN iprip -to c o2 & - fes. y3 l '>:cso O a C m 3� s cs � ��o � o'� a,b.�-d any g't1•Nb o y `ny w C�%,.y �.4 A c, o ti c ai . aCi•�+- ti • as g mem �, x• 5r-o x'�y ,U r~ . x °� o� . - i E m ,�g °q 0.y o 2 4 .9 8,A-,E � a , Anderson Lake neurotoxin nearly 300 times safe level By Leah Leach,Peninsula Daily News,October 8th,2012 RT TOWNSEND—The level of a potentially lethal nerve toxin in Anderson Lake is almost 300 times above the safety Weshold. The lake in Anderson Lake State Park west of Chimacum, remains closed to all recreational use, as it has been for most of the summer because of toxins created by blue-green algae. The park around the lake remains open for use. "We just want to stress to the public that this is a dangerous level of anatoxin-a in Anderson Lake," said Michael Dawson, water quality lead with the Jefferson County Public Health Department. "Anatoxin is of particular concern because it's a neurotoxin," he said. It can cause paralysis and stop respiration. "It affects animals and humans very quickly," within minutes or hours of exposure, Dawson said. "It can be lethal." The first indication of poison in the popular trout-fishing lake was six years ago, when two dogs died after drinking lake water on Memorial Day weekend. Both were thought to have been killed by anatoxin-a. Said Dawson on Friday: "We are stressing that people avoid all kinds of contact in Anderson Lake right now, both for omselves and their pets." The latest test results, received Friday, found a level of 298 micrograms of anatoxin-a per liter of water in the lake. The safety threshold is 1 microgram per liter. "This is a high level of toxin for this time of year," Dawson said, adding that"the public may be less wary in the fall, but these are still dangerous conditions." A heavy bloom of algae with scum extends over the entire lake—also unusual for the autumn months. Said Greg Thomason, who took the sample that was tested last week: "I've never seen the algae so thick in five years of doing this [testing]. "It was one-fourth inch thick," said Thomason, Jefferson County environmental health specialist. The level of anatoxin-a began climbing in the lake in September, after two weeks of tests that found so little anatoxin-a in the lake that the county health department had recommended it be reopened. State Parks did not reopen the lake, and after the two weeks of low readings, the level of toxin began climbing again. Researchers don't know why the toxins are coming up now—but it isn't because of a new type of blue-green algae, Thomason said. •homason had reported late last month that the King County Environmental Lab had found a type of algae never seen before in Anderson Lake, or any East Jefferson County lake, and that it could be responsible for the almost unseasonable toxin level rise. Last week, he said that wasn't true. The lab had called woronichinia, a type of blue-green algae known to live in Anderson Lake, by an old name, coelosphaerium, Thomason said. 40 "It was a mistake on the part of the lab," he said. Since woronichinia has been in the lake all along—and therefore isn't likely to be responsible for an usual rise in toxins —researchers are left without an idea of why anatoxin-a is skyrocketing now. "We really don't know anything more about the cause of this bloom," Dawson said. "But certainly weather conditions seem to have been favorable for algae growth." Researchers know that warm weather fuels algae growth when sufficient nutrients, such as phosphorus, are present. Anderson Lake, once the site of a dairy farm that closed in the middle of the last century, may contain high levels of phosphorus, which is present in livestock waste. Researchers do not know why some species of blue-green algae will suddenly begin to produce toxins. Microcystin, another toxin created by blue-green algae, was measured at 5.4 micrograms per liter in Anderson Lake. That's just below the safety threshold of 6 micrograms per liter for microcystin, which can cause skin irritation and nausea over the short term and liver damage if ingested over a long period of time. Other lakes in East Jefferson County are safe to use for recreation. s Gibbs Lake and Lake Leland, both of which have moderate blooms with patchy scum, contained traces of anatoxin-a. A trace of microcystin was found in Gibbs Lake, south of Port Townsend, while none was detected in Lake Leland, north of Quilcene. No sample was taken from Crocker lake, which is near the U.S. Highway 101-state Highway 104 junction. Caution signs remain posted at Leland, Gibbs and Crocker lakes because they contain the type of algae known to create poisons at times. No toxic blue-green algae has been reported in Clallam County, where health officers do not test for toxins; instead, they visually monitor lakes for signs of algae bloom. Report algae blooms in Clallam County by phoning 360-417-2258. Report algae blooms in Jefferson County by phoning 360-385-9444. For more information about lake quality in Jefferson County, visit http://tinyurl.com/6z64ofy. e a , a ORCAA recommends four air-quality monitors By Paul Gottlieb,Peninsula Daily News, October 8'",2012 110 SEQUIM—Fran McNair, the director of the Olympic Region Clean Air Agency, is recommending that four temporary air-quality monitors be purchased so that they can be placed in counties, including Clallam and Jefferson, to facilitate a study of air quality. If approved, the four monitors would be installed in Clallam County in January: three in Port Angeles and one in Sequim. The following year, in 2014, some or all of the monitors would be placed in Port Townsend, McNair said. Purchase of the monitors, which will measure particulates smaller than the 2.5-micron threshold already mandated by the Environmental Protection Agency, will be discussed at the Olympic Region Clean Air Agency—or ORCAA —board of directors meeting at 5 p.m. Oct. 15 at the Sequim Transit Center, 190 W. Cedar St., McNair said. "The focus of the meeting is ambient air-quality monitoring," she said last week. The monitors would be used for"saturation studies" in six counties, including Clallam and Jefferson, in which ORCAA regulates air quality. Environmental groups have been fighting the maximum 20-megawatt, $71 million biomass cogeneration expansion project being built in Port Angeles by Nippon Industries USA, which will burn wood waste to create electricity, and a similar$55 million, 24-megawatt biomass-facility expansion project at Port Townsend Paper. McNair said the monitors are meant to address concerns expressed by area residents about toxin-laden ultrafine particulates that fall under the EPA threshold. The monitors would measure the size of particulates that are between 0.3 and 10 microns, McNair said. • "We want to look at air quality and the particulates that they are potentially breathing in," she said. "We want to make sure it's good, clean air," she said. The board is expected to make a decision on buying the monitors at its regular board meeting in Olympia on Nov. 14, McNair said, adding funding for the$4,000 devices would come from agency reserves. "I hope the board supports us, and I think they will," McNair said. Jefferson County Commissioner Phil Johnson, who chairs the ORCAA board, favors the purchase, he said Friday. "I'm in favor of ambient air monitoring," he said. "I think it's important to get a baseline, and we have the reserves set aside for it," Johnson said. "At this point, I would support it." All of the temporary monitors would be in place for about six to nine months. One of the Port Angeles monitors would be at an existing permanent air quality station at Stevens Middle School that now uses the 2.5-micron threshold, while two others would be placed at as-yet unchosen locations in the city. The Sequim monitor's location has not been chosen. One monitor would be placed in Port Townsend at the existing station at Blue Heron Middle School and up to three 10 monitors placed elsewhere in the city, McNair said Friday. The goal is to place the temporary monitors in all six counties regulated by ORCAA as part of a series of"saturation 4 , , y studies"of those areas, McNair said. The intention is to place the monitors near places that are generating pollution, said ORCAA Senior Air Monitoring Specialist Odelle Hadley. • We're really focusing on where the air quality is most likely to be impaired and where are people exposed to that," Hadley said, adding the monitors will not be able to differentiate the source of the particulates. But data from the monitors will help determine the adequacy of the current monitoring program and "are we in the right place to capture air quality in the area," Hadley said. Residents in Port Angeles, Sequim and Port Townsend have asked for additional permanent air quality stations to measure particulates generated by Nippon and Port Townsend Paper. Gretchen Brewer of PT Airwatchers called placement of a temporary monitor in Port Townsend "a positive step." "I would really like to encourage us to explore mutual ways to make more permanent monitors happen sooner, but I do think this is a positive step, and I encourage them to move forward," she said. Bob Lynette of Carlsborg, co-chair of the North Olympic Group of the Sierra Club, said permanent air quality monitoring stations need to be installed that measure down to .01 microns and called the temporary monitors"a Band-Aid." The temporary monitors are"probably better than nothing, but the problem is it doesn't measure the ultrafines," he said. "They don't accurately measure the small stuff," he said. "This is a Band-Aid—better than nothing, but we should all recognize that this is not a long-range plan." Nippon mill manager Harold Norlund said the company already monitors its equipment. • "We are confident our equipment will meet the permit and the law's requirements," he said. "According to [the Department of] Ecology work over a multitude of years, the majority of particulates that was picked up [by air quality monitors]was things like forest fires and forest-slash burning." Lynette has asked ORCAA to address seven issues regarding air emissions at the Oct. 15 meeting, including a summary of health implications related'to biomass boilers and how pollutants from Nippon and Port Townsend Paper will be distinguished from fireplace emissions. Of those issues, McNair said the agency would address"as many as we can" at the meeting. She added that ORCAA does not have a time limit on its review of a cooling tower application for Nippon's biomass cogeneration plant. A 30-day public comment period will follow the completion of that review. Senior Staff Writer Paul Gottlieb can be reached at 360-452-2345,ext.5060,or at paul.gottlieb(a)peninsuladailynews.com. • r .. Port Townsend&Jefferson County Leader r.ir':*.,,,-V..,...;=-.•.:::... „5, ,',..• , -4f:a . 1 ' ':';- ,i' 4._,A..1. ,„,11,..,,.-4:'-Sii,::-.4,..-:?7,41'. . 441-'..-- ''.1sitp,0--,.,-Ti.. F .'• .- ' r �, sem ,. ;',---e,-,,' a ; # .. s .•;---A:':':::,,,',.:,--,'''.'...,..19-(4,.- -!°1,,,, :. 4,, ..,.„,'''.22.:1..,;',4^;'.. ,,..,:A.::. ,!, . : , ' --',' "'"'''i*'. f'7---'--:,.°- ,.,.,'",.1,..',2_, •:-.,'%I. '-.', .. ".� ^' Y. 'W ';.'� : ,v:4 ..+'F t ` 'x•^ 4 'N, '-',5......7.: ;spiv'i,e',ts.S ZM1 �� :c ga s` r Y me.f ', +a Y Ffs � ` ` em+n 4.. Y'x}y .YY� • 1f�� r �'S,,}} � vw AG k'+ .v.....4.,.- SR k :..„ 'k' a� p+.. e * j 4, :$7:4:1" �A 6 y,. .;.,..,,,,,....r. Yrs. �<.4,4 - , =" a.,A's ;,,g ,�" `two- • Kicki n up a good time Employees from Jefferson Healthcare and others joined inr a celebration oif Girls Night Out otn Thursday.Oct.4 in downtown Port Townsend.Proceeds from the event benefit breast and cervical cancer prevention care in Jefferson County. "Slumber party"was the theme of the event this year,and a number of women came in their jammies and brought stuffed animals to cuddle while shopping.Photo try Allison Arthur • I ?7' ,Z.eed_ /0% t . ,,,,::.,;;,„:,,,:,v;„::r:I.,;m7zr;,4:_,: lliooi-cfrp-ixtou,3,Ip.„t,emlat,717 ,..t.s,,zw:f;.. a ', a d+ s e d' r} s, ,•_. -r rtendbj s cy y` 71,wiim,,,,v4t::***4,,w.::a Kt ., v �v.� s�"»fie �� p�_z, • Read more at kitsapaur#.com National nurse visitation program now up and running in Kitsap By Brynn Grimley Sunday. September 23: 2012 KITSAP COUNTY a€"A nationally recognized program aimed at helping first-time mothers and their children from pregnancy through the child's second birthday is now operating in Kitsap. Healthy Start Kitsap has worked since 2007 to bring the Colorado-based Nurse Family Partnership program to the peninsula, but until recently didn't have the funding necessary to run it. A recent $87,500 grant from Thrive By Five, the state's nonprofit public-private partnership for early learning, along with public donations and in-kind contributions from the Kitsap Public Health District allowed the local nonprofit to get the program up and running, at a slightly reduced capacity. Typically, the Nurse Family Partnership model requires the enrollment of 100 first-time, low-income mothers, but because it costs between $500,000 and $600,000 annually to run the program at this level the organization has made some concessions for Healthy Start Kitsap to get the program up and running. while leaders of the local nonprofit worked to raise money, they joined with the health district to offer a similar program. Last year, the district's Maternity-Infant Home Visiting program had 10 women enrolled. As women leave that program, which pairs young mothers with a nurse until their child's first birthday, new mothers won't be enrolled, said Kitsap public health nurses Nancy Acosta and Mindy Outhwaite. Instead they'll be directed to the Nurse Family Partnership program. The agency hopes to enroll 50 women initially and grow the program from there, said Healthy Start Kitsap executive director Ed Kalmbach. Eight women are already enrolled, and Acosta and Outhwaite have been selected to operate the visitation program. The pair recently traveled to Colorado to be trained in the Nurse Family Partnership model. The program matches first-time, low-income mothers with a nurse, who meets with the mother one-on-one on a regular basis through the course of her pregnancy and then for two years after the child is born. The program was established more than 30 years ago. What makes it different from other nurse-visitation programs is its proven track record of keeping mothers and their children out of jail, which saves the communities where the programs are in place hundreds of thousands of dollars. In Washington, the state's institute on public policy listed the partnership as the best research-based program available to reduce child abuse and neglect and to prevent crime. Having data to back up its claims of success also makes it more likely the program will receive state and federal funding. That's an important factor considering money for similar social services has become scarce in recent years because of budget cuts. "There isn't another program out there that is as effective as this program," Kalmbach said. "It's specifically noted in • the federal budget, these scientifically-based programs have funding." To get the program operational in Kitsap, the national Nurse Family Partnership organization agreed to let Kitsap join with Jefferson County, which has operated the program since 1999. The Jefferson County Public Health Nurse Family Partnership nurse supervisors will oversee Kitsap and a nurse that is beginning the program on the Port Gamble S'Klallam Tribal Reservation. "In general, I think it really is a program that is very valuable," said Jefferson County public health nurse Yuko Umeda, who is the nurse supervisor. "To be able to offer it to a wide group of people I think is a fantastic thing. Joining with other counties and the tribe to run the program is a relatively new concept, but Umeda thinks it will be beneficial to counties like Kitsap and Jefferson that have smaller populations. Just because there aren't as many people doesn't mean the need is smaller. "The Nurse Family Partnership has certain requirements that might be hard for smaller counties or regions to meet," Umeda said. "This way it allows smaller, more rural counties to offer this service." Dr. Scott Lindquist, director of the Kitsap Public Health District, said he was thrilled to finally see the program up and running in Kitsap. The health district board has made the program a priority, he said. "I have a different perspective than most," Lindquist said. Lindquist sits on the county's child death review • committee, which reviews every childhood death in the county. "Some of the things kids are dying of are preventable." This program will help with that, he said. Through the program, mothers will learn the importance of not smoking, drinking or doing drugs while pregnant. They also prepare for birth. Once the child is born, the nurses teach new parents the importance of properly caring for their child. Studies from the program also have shown that there is a significant increase in paternal involvement in a child's life for those enrolled. With the partnership model up and running the next step for Healthy Start Kitsap is to continue to seek donations to provide the money needed to keep the program operational, said board President Brian Nyquist. "Our job is to beat the drum and to find funding," he said. "As far as the Kitsap Public Health District's perspective, they're not going to have any trouble filling the 50 family slots we have available at this point." TO DONATE To make a donation to Healthy Start Kitsap to help fund its Nurse Family Partnership program, send money to P.O. Box 3968, Silverdale, WA 98383. Make checks payable to "Healty Start Kitsap." For more about the local nonprofit, click here. 411 JEFFERSON COUNTY BOARD OF HEALTH • GUEST LIST TITLE: Regular Meeting DATE: Thursday, October 18, 2012 2:30 -4:30 pm PLACE: Cotton Building, 607 Water St., Port Townsend NAME (Please Print) STREET ADDRESS CITY Testimony? YES NO MAYBE `l Cry kA4CI /X/ 6 (Akc: - T� P. r Vict,LAu44 e r 1710 C:.)(Ale Q h I -- -- ve.., e!✓'c v-17 Pr LS r I � S S TAKE CHARGE Income Guidelines NUMBER OF PEOPLE IN FAMILY INCOME LIMITS Includes parents and children 1 $2,328 2 $3,153 3 $3,978 4 $4,803 5 $5,628 6 $6,453 7 $7,278 8 $8,103 MORE ADD $330 FOR EACH ADDITIONAL FAMILY MEMBER NUMBER OF PEOPLE IN FAMILY INCOME LIMITS 0 Includes parents and children 1 $27,925 2 $37,825 3 $47,725 4 $57,625 5 $67,525 6 $77,425 7 $87,325 8 $97,225 MORE ADD $3960 FOR EACH ADDITIONAL FAMILY MEMBER 10/11/12 •