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HomeMy WebLinkAbout2012- December File Copy • Jefferson County Board of 3 Cealth Agenda J'4 inutes • December 20, 2012 • • JEFFERSON COUNTY BOARD OF HEALTH December 20,2012 Cotton Building 607 Water Street Port Townsend, WA 2:30—4:30 PM DRAFT AGENDA I. Approval of Agenda II. Approval of Minutes of October 18, 2012 Board of Health Meeting III. Old Business and Informational Items 1. State Spending for Anti-Smoking Efforts 2. Waste Free Holiday and Lead Toy Screening 3. Port Townsend Paper Corporation Landfill Permit Update • IV. New Business 1. Operation and Maintenance 101 Class Update 2. Affordable Care Act Implementation Moves Forward—Public Health Impacts 3. Jefferson County Public Health Implements EMD System 4. Washington State Budget Update 5. Substance Abuse Advisory Board Appointment V. Activity Update VI. Public Comments VII. Agenda Planning Calendar VIII. Next Scheduled Meeting: January 17, 2013 2:30—4:30 PM • • JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, October 18, 2012 2:30 PM—4:30 PM Cotton Building, 607 Water 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 3:30 PM. A quorum was present. Members Present: Phil Johnson, David Sullivan, John Austin, Roberta Frissell, Sheila Westerman, Jill Buhler Members Excused: Catharine Robinson • Staff Present: Dr. Thomas Locke, Jean Baldwin, Veronica Shaw, Julia Danskin, Cathy Avery APPROVAL OF AGENDA Member Westerman requested a report on the current status of the mill landfill permit application be added as Item # 1 under Old Business. Member Austin moved to approve the agenda of the October 18,2012 BOH meeting as amended. Member Buhler seconded the motion. The motion passed unanimously. APPROVAL OF MINUTES Member Westerman requested on page 3 under BEACH Program Update the spelling of "Fort Warden" be changed to "Fort Worden". Member Sullivan moved to approve the minutes of the September 20, 2012 BOH meeting as amended. Member Westerman seconded the motion. The motion passed unanimously. OLD BUSINESS and INFORMATIONAL ITEMS Update on mill application Dr. Locke reported that on September 4, 2012 the Port Townsend Paper submitted their application for a renewal of their existing inert waste landfill permit with additional conditions • involving ground water monitoring and financial assurance. The application has been reviewed and a decision was issued October 17, 2012. The decision was to deny the application. 3. Dr. Locke also discussed the two possible scenarios for the appeal process. Under state rules, a • landfill permit denial appeal is first heard in a local administrative hearing presided by the local Health Officer with subsequent appeal, if necessary, to the Washington State Pollution Control Board. Under local solid waste rules, appeals are first heard by the local Health Officer and subsequent appeals are to the Board of Health. Dr. Locke urged the Board to maintain a neutral position on the issue. Jefferson County Pertussis Outbreak Final Report Dr. Locke stated that the Pertussis outbreak was winding down. The final count in Jefferson County was 22 confirmed and 2 probable cases with only 1 case below 1 year of age. Dr. Locke discussed the summary of Pertussis cases for Jefferson County which was included in the agenda packet, and shows the differences in Jefferson County statistics as compared to the State. Dr. Locke pointed out that most of the Jefferson County cases were in the 1 —6 year age group, which is younger than the rest of the state. 75% of the state cases were in fully vaccinated people suggesting that vaccination may be wearing off prematurely. In Jefferson County, more than '/2 the cases were in people that were not fully vaccinated. Jean Baldwin reported that the new law is in effect and staff in schools has been trained. The Jefferson County immunization rate continues to be lower than the state rate. Nationwide Recall of Contaminated Pharmacy Products Dr. Locke reported there has been a nationwide recall on injectable solutions made by a large • compounding pharmacy on the east coast. There were at least 3 batches of steroid containing products that were grossly contaminated with fungi and caused about 240 cases of fungal meningitis. There have been 12 deaths associated with the contamination. Dr. Locke stated that Jefferson Health Care and Forks Community Hospital did not receive anything from this pharmacy. Olympic Medical Center only received a topical compound which is regarded as a very low risk exposure. Smilemobile Coming to Jefferson County Julia Danskin announced the Smilemobile will be at Chimacum School November 5`h through November 16`h. Anyone interested can call JCPH for an appointment. 2012 Jefferson County Budget: Water Quality and Community Health Veronica Shaw reported on concerns with the Water Quality program budget. Ms. Shaw reported that in the past, staff reorganization made it possible to maintain senior staff and the meet deliverables but that is not possible now. Water Quality is looking at a County general fund contribution reduction of$27,000. The revenue sources that Water Quality relies on are general fund, grant dollars and a fee assessed per parcel. There is concern because the general fund money has been reduced by 75% since 2009 and that money goes toward administration, overhead, building rent, the time spent writing grants and support staff. At the rate the general fund money has been reduced it looks Iike by 2014 there will be no general fund money. The • • services that will be impacted are lake biotoxin monitoring, shellfish biotoxin monitoring, pollution source identification and correction, water quality sampling, public education and outreach and grant administration. Ms. Shaw stated there are grant deliverables that have to be met and there is the ability to meet more if staff had the opportunity. There is money being left at the state level because they are not completing grant deliverable due to staffing levels. Federal Sequestration May Lead to 7.6% Public Health Funding Reduction Dr. Locke reported that according to a report released by the White House Office of Management and Budget on the Sequestration Transparency Act, funding for public health services will be cut by 7.6% - 8.2% at the federal level. Member Austin moved to direct JCPH to provide a brief letter, to our congressional delegation and the two candidates signed by the Chair showing examples of what an 8-10% cut would do to our programs. Member Buhler seconded the motion. The motion passed unanimously. How Healthy Are We on the North Olympic Peninsula? Article Dr. Locke presented an article he wrote that appeared in local newspapers. He urged people to become familiar with community health assessments that are done every 3 years, which is the tool used that tries to answer the question, how healthy are we. NEW BUSINESS Community Health Fee Setting Policy Jean Baldwin discussed the Community Health Fees setting policy which was included in the agenda packet. She pointed out that Community Health fees are based on the actual cost of services and many are tied to federal funding that requires a sliding scale fee. Ms. Baldwin asked the Board to review and either approve or make changes to the document. Member Buhler asked for the words "too high" be quantified under office visit fees. Dr. Locke recommended that the sentence be rephrased to "In the event the cost analysis exceeds the contracted private insurance provider rates or market rates the lower of the rates will apply." Member Buhler moved to accept the Community Health Fee Setting policy as amended by Dr. Locke. Member Austin seconded the motion. The motion passed unanimously. Paralytic Shellfish Poisoning Outbreak in Jefferson County Jean Baldwin reported on Saturday September 22"d, a family of 7 was admitted to the hospital for paralytic shellfish poisoning from ingesting mussels that were harvested at Discovery Bay. This resulted in six staff members of JCPH working through the weekend. • Take Charge Program Increases Access to Family Planning Services • Jean Baldwin announced that changes to the state and federal program, Take Charge, will allow JCPH to reach more clients and can expect more women to get access to services. Substance Abuse Advisory Board Appointment Member Austin reported that the Substance Abuse Advisory Board recently met and interviewed Michael Evans to fill a position on the board. Member Austin stated that the SAAB strongly recommends to the BOH for Michael Evans to be appointed to the SAAB. Member Austin moved to direct the Chair of the BOH to appoint Michael Evans to the SAAB. Member Buhler seconded the motion. The motion passed unanimously. ACTIVITY UPDATE Jean Baldwin announced that Mary Selecky will be at JCPH October 19, 2012 and invited all Board of Health members to attend. Jean Baldwin announced, on October 18, 2012 at 6:00 p.m. at Jamestown S'Klallam Campus, Mary Selecky is presenting Dr. Locke with the Warren Featherstone Reid Award posthumously • awarded to his wife Kris Locke for her dedicated work to improve access to health care for American Indian Tribes in Washington State and for her national health reform work on behalf of the Jamestown S'Klallam Tribe. PUBLIC COMMENT Elaine Baily asked for information to be put on the website that would be useful to people who are resistant to getting immunized. Val Phimister presented information on the cleanup of the Kimberly Clark Mill in Everett, and thanked Dr. Locke for insisting on a limited purpose landfill permit. Mike (last name inaudible) commented on what Dr. Locke said regarding funding cuts. He urged people to get in contact with state and national legislatures to correct an imbalance of reimbursement received from Medicare. Dave (last name inaudible) commended Dr. Locke for taking a preventive approach environmental health protection rather than waiting until a failure has occurred. Gretchen Brewer thanked Dr. Locke for being strong with the landfill designation and encourages proactively looking at other waste streams that are not characterized. • Elaine Baily stated she has passed on an enormous amount of information she has learned from • attending BOH meetings. Member Frissell suggested the press be present at a lot more meetings, if not all,to help keep the public informed. AGENDA PLANNING CALENDAR Member Sullivan announced there will be no November BOH meeting. The next Board of Health meeting will be held on December 20, 2012 from 2:30—4:30 pm. ADJOURNMENT Chair Johnson adjourned the BOH meeting at 4:06 pm. JEFFERSON COUNTY BOARD OF HEALTH 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 • r f COUNTY BOARD OF HEALTH 0 JEFFERSON MINUTES Thursday, :4 30 PM October 18,2012 2:30 PM— WA 98368 607 Water Street Port Townsend, Cotton Building, *nf Members Health Officer embers Thomas Locke, MD,MPH H Board County M issioner District#1 Jean Baldwin,Public HealthPH l th O fic r C}tair, Cm Comm is Phil Johnson, County Commissioner,District#2 Julia Danskin,lV David Sullivan, Commissioner,District#3 Environmental Health Services Director Robertairector County COm Jared Keefer, John Austin, citizen at large(County) Council to Robi Port Townsend City Catharine Robinson, (City) Westerman,Citizen at large( District#2 Sheila hl os ital Commissioner, Jill Buhler, Vice Chair,H P Chair Johnson called the meeting of the Jefferson County Board of Health to order at 3:30 PM. A quorum as present. Members Pr Sheila Westerman David Sullivan, John Austin,Roberta FrisseU, Phil Johnson,Da 1i 1 Buhler Catharine Robinson Cathy Avery Members Excused: Veronica Shaw, Julia Danskin, II Present-. Dr.Thomas Locke, Jean Baldwin, Staff PreAPPROVAL OF AGENDA the current status of the mill landfill permit requested a report on Member the min moved to approve Member Westerman item#1 under Old Business.amended. Member Buhler seconded Mmeeting application be added 18,2012 BOA the agenda of the the motion. The motion passed unanimously. APPROVAL OF MINUTES Update the spelling of BEACH Program P rove the 3 under moved to approve m requested on page Member Sullivan tuber Westerman Member Westerman g ed to "Fort Worden as amended.be Chang 2012 BOII meeting "Fort Warden September 20, seconded of the o ion. The motion passed unanimously. them INFORMATIONAL�ITEMS and INF OLD BUSINESS Update on mill application submitted their on September 4,2012 the Port Townsend Paperhas been reviewed permit with additional conditions reported that inert waste landfill The application Dr• ovine and financial assurance. the application. vie application for a renewalwater monitoring�stmg The decision was to deny p d 2012. III involving ground issued October 17, and a decision Locke also discussed the two Llaocke Permit denial possible scenarios for the appeal Health Officer d appeal is first heard in a local a tra process. Under state rules, a Board. Under local solid waste ruent ules, if necessary, to the 'Washiton subsequent appealsarY, 'Washington hearing presided by the local • areo to appeals are first heard °n State Pollution Controln position on the issue. the Board of Health. Dr. Locke urged by the local Health O ged the Board Officer and to maintain a neutral Jefferson County pertussis Outbreak Final Report Dr. Locke stated that the Pertussis outbreak Dr.Cowas 22at confirmed and 2 was winding down. discussed as sumpProbable cases with onlyThe final r of in . Dr.sLn and 'of Pertussis cases for Jefferson 1 case below 1 the differences in Jefferson Co °��'Which w year age. Dr. Locke Dr. Lockpacket, and shows out that differences n Jefferson Countyas included which is oqty statistics as comparedin the agenda younger than the thethe state. 75% cases were in to the State. that the rest ofn of the state cases the 1 —6 year age group, than people suggesting caseswere inmay be wearingwere ine g y people that were not off re fully vaccinated fully vaccinated. rely. In Jefferson County, more Jean Baldwin reported even thou Sean has r been trained,though the new law is in theimmunization rate continues and se taff schools, including school Pharmacy products Dr. Locke reported there has been a nationwide recall D . Locke re pharmacy eon the east con injectable productspthat were There were at least able solutions made by meningitis. grossly contaminated withbatches esoif containing large . g There have been 12 deaths fungi and ca Jefferson Health Care associated caused about 240 cases of fungal and Forks CO with the contamination, dal Jefferson Olympic Medical Forks Coter ty Hospital did not receive Dr'from this stated that very low risk ly pic only received a topical compound mpound w�ch is regarded as a Smilemobile Coming to Jefferson County Julia Danskin announced the S November in Anyone inheres it d mobile will be at Chirnac call JCPH for an appointment.u1n School November 5t'through an 2012 Jefferson County Budget: Ppoitment. Water Quality and Community Veronica Shaw reported on concerns Health reported that in the past, staffnwith the Water deliverables but reorganization Qualityl program bud made it possible to maintain budget. Ms. sta�haw meete contribution deliverables reu that is ction notf possible now. Water Quality fundrel $27,000. The revenue soccis thatlWater Qualityat a and the fund moneyfund, grant dollars and a fee assessed sources WaterCounty general has been by75% per parcel. There is concern eeties on are has b nreduced the time s since 2009 and that rn aca d the fund moneyad, has beengrent,reduced itspent money goes towardAtthgeneral writing grants and supportadministration, looks like by 2014 there will be n staff At tend rate the .general The be no general fund money. The • . services that will be impacted are lake biotoxin monitoring, shellfish biotoxin monitoring, pollution source identification and correction,water quality sampling,public education and outreach and grant administration. Ms. Shaw stated there are grant deliverables that have to be met and there is the ability to meet more if staff had the opportunity. There is money being left at the state level because they are not completing grant deliverable due to staffmg levels. Federal Sequestration May Lead to 7.6%Public Health Funding Reduction Dr. Locke reported that according to a report released by the White House Office of Management and Budget on the Sequestration Transparency Act, funding for public health services will be cut by 7.6% - 8.2%at the federal level. Member Austin moved to direct JCPH to provide a brief letter,to our congressional delegation and the two candidates signed by the Chair showing examples of what an 8-10% cut would do to our programs. Member Buhler seconded the motion. The motion passed unanimously. How Healthy Are We on the North Olympic Peninsula? Article Dr. Locke presented an article he wrote that appeared in local newspapers. He urged people to become familiar with community health assessments that are done every 3 years, which is the tool used that tries to answer the question,how healthy are we. • NEW BUSINESS Community Health Fee Setting Policy Jean Baldwin discussed the Community Health Fees setting policy which was included in the agenda packet. She pointed out that Community Health fees are based on the actual cost of services and many are tied to federal funding that requires a sliding scale fee. Ms. Baldwin asked the Board to review and either approve or make changes to the document. Member Buhler asked for the words "too high"be quantified under office visit fees. Dr. Locke recommended that the sentence be rephrased to "In the event the cost analysis exceeds the contracted private insurance provider rates or market rates the lower of the rates will apply." Member Buhler moved to accept the Community Health Fee Setting policy as amended by Dr. Locke. Member Austin seconded the motion. The motion passed unanimously. Paralytic Shellfish Poisoning Outbreak in Jefferson County Jean Baldwin reported on Saturday September 22i1, a family of 7 was admitted to the hospital for paralytic shellfish poisoning from ingesting mussels that were harvested at Discovery Bay. This resulted in six staff members of JCPH working through the weekend. • st i Take Charge Program Increases Access to Family Planning Services • Jean Baldwin announced that changes to the state and federal program,Take Charge, will allow JCPH to reach more clients and can expect more women to get access to services. Substance Abuse Advisory Board Appointment Member Austin reported that the Substance Abuse Advisory Board recently met and interviewed Michael Evans to fill a position on the board. Member Austin stated that the SAAB strongly recommends to the BOH for Michael Evans to be appointed to the SAAB. Member Austin moved to direct the Chair of the BOH to appoint Michael Evans to the SAAB. Member Buhler seconded the motion. The motion passed unanimously. ACTIVITY UPDATE Jean Baldwin announced that Mary Selecky will be at JCPH October 19, 2012 and invited all Board of Health members to attend. Jean Baldwin announced, on October 18, 2012 at 6:00 p.m. at Jamestown S'Klallam Campus, Mary Selecky is presenting Dr. Locke the Warren Featherstone Reid Award posthumously • awarded to his wife Kris Locke for her dedicated work to improve access to health care for American Indian Tribes in Washington State and for her national health reform work on behalf of the Jamestown S'Klallam Tribe. PUBLIC COMMENT Elaine Baily asked for information to be put on the website that would be useful to people who are resistant to getting immunized. Val Phimister presented information on the cleanup of the Kimberly Clark Mill in Everett, and thanked Dr. Locke for insisting on a limited purpose landfill permit. Mike(last name inaudible)commented on what Dr. Locke said regarding funding cuts. He urged people to get in contact with state and national legislatures to correct an imbalance of reimbursement received from Medicare. Dave(last name inaudible) commended Dr. Locke for taking a preventive approach environmental health protection rather than waiting until a failure has occurred. Gretchen Brewer thanked Dr. Locke for being strong with the landfill designation and encourages proactively looking at other waste streams that are not characterized. 0 Elaine Baily stated she has passed on an enormous amount of information she has learned from attending BOH meetings. Member Frissell suggested the press be present at a lot more meetings, if not all,to help keep the public informed. AGENDA PLANNING CALENDAR Member Sullivan announced there will be no November BOH meeting. The next Board of Health meeting will be held on December 20, 2012 from 2:30—4:30 pm. ADJOURNMENT Chair Johnson adjourned the BOH meeting at 4:06 pm. JEFFE,, ON COUNTY BOARD OF HEALTH \' P / ( ( ,:a6,,,..h..,„ , A______ 1 Phil Johnson, ' ..r J.2 . Buhler, Vice Chair • /C/4014 /� Roberta Frissell, Member David gilt an, ember r'~- e.a.,..„,,,24,,,k..‹............. ; : 1---.- ''''.-A '\ .,.•.•.- , f ,___L., Catharine Robinson, Member Jo Austin, ember ti L 1.6._ b_3..vitrvv.4..._ ______..........„1 Sheila Westerman, Member Respectfully Submitted: Stacie Reid 0 Board of Health Old Business & Informational Items .agenda Item #I11., 1 State Spending for .inti-Smoking Efforts December 20, 2012 • • States Spend Anti-Smoking $$ on Other Things By Kristina Fiore, Staff Writer, MedPage Today Published: December 07, 2012 States will spend less than 2% of their annual tobacco tax and settlement revenues to fight smoking next year, according to a new report. Only 1.8% of the $25.7 billion states will collect from both taxes on cigarettes and the 1998 tobacco settlement-- about$460 million --will go to tobacco prevention and treatment programs in 2013, according to an annual report from several public health organizations, including the American Heart Association, the American Lung Association, the American Cancer Society, and the Campaign for Tobacco-Free Kids. "The states have an obligation to use more of their billions in tobacco revenues to fight the tobacco problem," Matthew Myers, president of the Campaign for Tobacco-Free Kids, said in a statement. "Their failure to do so makes no sense given the evidence that tobacco prevention programs save lives and save money by helping reduce healthcare costs." Healthcare costs relating to tobacco use total about$96 billion annually, according to the report, • which is issued annually to take a look at how states are using funds from the tobacco settlement, a deal that was struck with tobacco companies in November 1998. It awarded states some $246 billion over the first 25 years. In addition to those monies, states also collect billions each year from cigarette taxes. The total 2013 figure of$25.7 billion comes from $18.4 million in tax revenues and $7.3 billion in settlement funds. Tobacco prevention spending peaked at nearly$750 million in 2002 and again at$717 million in 2008. But after the recession, such spending fell into a downward trend, with a 36% cut-- about $260 million --through 2012 that has now stalled spending at a historical low. The report blasted states for failing to reverse the budget cuts to tobacco prevention programs that occurred after that time, calling them even more problematic in light of recent surveys that show smoking declines in the U.S. have slowed. Across the country, 19% of adults and 18% of high school students still smoke, those surveys show. The $460 million being spent this year amounts to just 12.4% of the $3.7 billion that the CDC recommends on tobacco prevention spending for all states combined. It would take less than 15% of total state tobacco revenues to fund programs at CDC-recommended • levels, according to the report. Only two states—Alaska and North Dakota—will fund tobacco prevention programs at CDC- • recommended levels, while only three— Delaware, Wyoming, and Hawaii —will spend at half the recommended level, the report said. Four states-- New Hampshire, New Jersey, North Carolina, and Ohio -- have allotted no state funds for tobacco prevention programs next year. The states' failures to reverse cuts to tobacco prevention and cessation programs"have undermined the nation's efforts to reduce tobacco use,"the report said. "Given such a strong return on investment, states are being truly penny-wise and pound-foolish in shortchanging tobacco prevention and cessation programs." The study was supported by the Robert Wood Johnson Foundation,the American Cancer Society,the Campaign for Tobacco-Free Kids,the American Heart Association,the American Lung Association, and by Americans for NonSmokers' Rights. Primary source: Coalition Report Source reference: "Broken promises to our children:The 1998 state tobacco settlement 14 years later" Coalition Report 2012. • • • Boardof realth Old Business & Informational Items .agenda Item # III., 2 • Waste free Wlicay and Lead70y Screening December 20, 2012 • Jefferson • �- 1 CountyGuide uide to a A * Waste Free Holiday Americans create 25%more waste in the weeks between Thanksgiving and New Year. What can YOU do to make less waste? Gift Giving • Give NON-objects! Choose experiences,gift certificates, charity contributions, services or other"non-objects"to give to the recipients on your gift list! • Wrap gifts in reusable (cloth gift bags, dishtowels,scarves) or recycled (decorated newspaper or grocery bags) wrapping. Recycle the wrapping paper that does get used! • Choose gifts that last a long time, rather than objects that break or otherwise become garbage before the year is up. • Make gifts! Crafts and food are beloved gifts! • When shipping gifts,pack with recycled and recyclable materials Celebrating • Serve food that is purchased in minimal packaging • • Find alternatives to disposable plates,silverware, cups and other service products. Pay a teen to wash dishes, ask guest to bring their own dishware, or allow guests to help with the washing. • Recycle bottles and cans left over from an event. Decorating • Decorate with natural objects -wreaths, a winter twig bouquet,forced bulbs or winter squash. • Choose durable decorations that will last season after season. Tree Disposal Keep your Christmas tree from going into the landfill! Here are some ideas to make sure your tree doesn't become garbage! • Purchase a live tree to plant outside after the holidays • Compost it! Those Jefferson County residents with curbside pick-up can cut their tree in half, and place it next to you garbage on your garbage pick-up day. Be warned,trees with tinsel or flocking cannot be composted,and are considered garbage. • Go Tree-Less! S • Waste-Free Holiday and Lead Free Toys Open House December 14th and 15th Jefferson County Public Health offers waste-free holiday ideas and free lead screening for toys. Port Townsend,WA November 14, 2012 - Jefferson County Public Health (JCPH) is hosting a Waste and Toxic-Free Holiday Open House from 4-8pm Friday, December 14th and from 10am - 2 pm Saturday, December 15th at the Cotton building, downtown Port Townsend. Community members may bring up to 3 toys and small household items to be screened using an X-ray fluorescence device. We will screen toys and other small items for lead,which can have harmful impacts to children. Examples of recycled and no-waste gift-wrapping, holiday decoration and tree ornaments, produced by the staff of JCPH will be on display. The public is invited to vote for their favorite item in several categories. Children and adults will be invited to create recycled wrapping paper using old newspaper and paper bags supplied by JCPH. Information regarding lead exposure, Christmas tree disposal and using less during • the holiday season will be available. For more information contact: Pinky Feria Mingo !` ` f s Environmental Health Specialist pinky@co.jefferson.wa.us I + , www.jeffersoncountypublichealth.org 360 379 4489 • Board of.9CeaCth New Business .agenda Item #11/., 1 • Operation and Nlaintenance ioi Class I.l_pdate December 20, 2012 61 Providing educational, advisory, permitting services and certifications for septic system r�^ owners, installers, designers,septic pumpers and monitoring specialists. riq�-= ' ' �l i b Welcome a Environmental HealthIVVater Quality>>Septic Systems>>Resources for Homeowners • Search JCPH: RESOURCES FOR HOMEOWNERS Go I ENVIRONMENTAL HEALTH& We can provide referrals for a low-interest loan program to repair failing or substandard septic systems. WATER QUALITY Business Pollution Prevention Please contact us at 360.385.9444 for more information about this program. Drinking Water/Wells EH Fees&Payments Homeowner Authorization for Septic System Monitoring Inspections Food Safety A goal of the program is to provide information about septic system operations, maintenance and inspections Septic Systems as well as making it easier to complete most monitoring inspections at a more reasonable cost. All training Applications/Forms courses for the program are offered free of charge to the attendees. Septic FAQs Most systems are eligible to participate - conventional gravity, pressure distribution, mounds and sandfilters. Certified Professionals Some systems must be inspected by a certified O&M Specialist or Licensed Designer- Aerobic Treatment Operation&Monitoring Devices, Glendon Biofilters, Drip Irrigation. Contact the Health Department if you are uncertain about what (O&M) type of system you have. Resources for Homeowners that want to be authorized need to complete two training courses: Homeowners • Septics 101 - Basics of septic system operation and maintenance. This class will be available online and Monitoring/Inspection offered in a classroom format. (EES) • Septics 201 - Step by step inspection of the septic system and reporting the results. Offered in online Resources for format only. Professionals A link and detailed information will be posted when classes become available online. View Permit Files Online Regulation/Sewage Pamphlets and Information Management Plan Solid Waste • Rate your septic system knowledge. Water Quality • Septic system additives. • • Septic system myths and truths. Conservation • Futures • What is an Alternative Septic System? QUICK LINKS • Getting septic system approval. • The "pert test", what is it? King County Wastewater Program Kitsap County Wastewater Washington State Department of Health Publications Program • Understanding and caring for your septic system. WA State On-site Sewage Code • Understanding and caring for your pressure distribution system. WA State Department of Health • Understanding and caring for your sandfilter. Wastewater Program • Understanding and caring for your mound. WA State Department of Health • Find more publications from the Washington State Department of Health. WA State Department of Ecolocty Control Erosion Using Vegetation WA State Cooperative Extension Home I Previous Page -Septic System Information Jefferson County Public Health r." 615 Sheridan Street-Port Townsend,WA 98368 Community Health:360.385 9400 I rgnviranmental Health:360.385.9444 nfo@jeffe sonco ntypubhchealth.o JCPH Employee Resources 410 http://www.jeffersoncountypublichealth.org/index.php?resources-for-homeowners 12/14/2012 • Board of aCealth Wow Business .Agenda Item # IV., 2 • ffordthCe Care .pct Implementation .Moves Jorwarc(- Pu6lic .9CeaCth Impacts December 20, 2012 _ -7.101-_--• rp - tiff _ : 11 , . More landT___, - I ' _-_ --,--; DO . „..„:„.„- HurdiesAwaft : .. , ., . ,-,:iist„ ,,......., -2,„7„:„„ - - ,,i, the Affordable Care Act ......4,-__I - - ____ , ,, _, .... by John L. Bloom The U.S.Supreme Court's decision to uphold the constitutionality of the Patient Protection and Affordable Care Act(ACA)was one of the most dramatic in years.The fate of the Y " healthcare system,federal-state relations, and the upcoming elections seemed to hang in the balance. The Court's decision lived up to the hype that Now the Court's decision is history and the preceded it.The ACA found a surprising ally focus is on the future. in Chief Justice John Roberts,who charted What does this ruling mean for local is providing$9.75 billion over 10 years to an unexpected legal path to uphold the law. public health? states and localities through Community The Court found the so-called"insurance Transformation Grants,tobacco control mandate"to be a permissible tax,and ruled For now,the Supreme Court's ruling means funding,environmental health tracking, that the expansion of Medicaid to cover full speed ahead with ACA implementation. substance abuse funding,and many other almost everyone living on less than 133% For opponents of the law,it also means full programs. of the poverty level was constitutional.The speed ahead with additional efforts to repeal The Prevention and Public Health Fund has Court's most significant holding limiting the Act or block its implementation. been under constant threat in Congress. federal power was that the government For local public health,one of the biggest It has already survived many legislative cannot withhold all Medicaid funds from benefits of the ACA is the investment it attempts at elimination,and no doubt will states that refuse to go along with the makes in public health programs.The remain under attack.It has been reduced .ransion of coverage. Prevention and Public Health Fund alone Continued on page 11 The Structure of the Affordable Care Act (Partial) 1 I f Insurance Reform I I Delivery Reform I l 1 - More Better I Integrated Quality People Coverage Care I Focus I Innovation Medicaid Cost:Medical Accountable Value,Based Center for Expansion Loss Ratio, Care Payment Medicare I Rate Review, Organizations, I and Medicaid Exchanges Medicare Bundles Transparency& Innovation Advantage I Data Sharing I Guaranteed I Dual I Prevention Issue Prevention Eligibles Fraud Funds I Benefits I Abuse I 411 Children I Care Pricing Under 26 Prescription Transitions Reforms Drugs I Government Source: Donald Berwick,MD,Public Health and the Health Care Transition,2012. Qualified Midyear Meeting,American Public Health Association,June 26,2012. Health Centers Visit Us Online! www.na!boh.org 3 • • •,,•05;1Tftustfr Health WWW. HEALTHYAMERICANS.ORG Prevention and Public Health Fund Strategic Investments in America's Health The Affordable Care Act(ACA)included the creation of a Prevention and Public Health Fund(Fund),which will invest$12.5 billion over the next ten years(FY2013-FY2022)in effective,proven prevention efforts,like childhood obesity prevention and tobacco cessation. The Fund is being used to support community and clinical prevention efforts,strengthen state and local health departments and the public health workforce,and support science and research. Preventing disease and injury is the most effective,common-sense way to improve health in the United States.Too often,however,we focus on treating disease and injury after they occur instead of preventing them—providing sick care instead of health care. The Prevention Fund provides an opportunity to turn that around—and the opportunity for all Americans to be as healthy as they can be. Every state receives money from the Fund(http:// www.healthcare.gov/news/factsheets/prevention02092011a.html). The breakdown by fiscal year is as follows: • FY10: $500 million • FY2018-FY2019: $1.25 billion • FY11: $750 million • FY2020-FY2021: $1.5 billion • FY2012-FY2017: $1 billion • FY2022 and each fiscal year after: 41) $2 billion For FY12,the Prevention Fund was invested in: Support Community and Clinical Prevention Efforts: State and Local Chronic Disease Prevention($226 million for Community Transformation Grants(CTG)) CTGs support community-driven strategies to address the leading causes of chronic disease, such as tobacco use,obesity,and poor nutrition. Participating communities are building coalitions of businesses,health departments,schools, faith-based organizations and other partners to develop strategies tailored to their community's pressing needs. Tobacco Prevention($83 million) To assist states implement plans to reduce tobacco use through legislative,regulatory,and educational arenas,as well as enhance and expand the national network of tobacco cessation quitlines to significantly increase the number of tobacco users who quit. Access to Clinical Prevention($190 million for immunizations; $11.75 million for HAI prevention) Investments in immunizations are modernizing our vaccine systems,and working with employers and pharmacies to provide more adults with vaccines. An investment in proven practices to eliminate Healthcare Associated Infections will save lives and decrease costs by reducing the needless hospital readmissions,treatment,and deaths associated with preventable infections. Funds have also been used to expand the use of NOVEMBER 2012 new preventive benefits available as a result of the Affordable Care Act. PREVENTING EPIDEMICS. PROTECTING PEOPLE. Behavioral Health Screening,Surveillance,&Primary Care Integration($88 mil.) The Substance Abuse and Mental Health Services Administration(SAMHSA)has awarded grants to support and promote better primary care and behavioral health services for individuals with mental illnesses or substance use disorders.The grants seek to improve health by improving the coordination of healthcare services delivered in publicly funded community mental health and other community-based behavioral health settings. Strengthen State and Local Health Departments: Public Health Infrastructure($40 million) Assists health departments in making fundamental changes to facilitate more efficient detection and response to public health crises. Helps health departments be more efficient and effective,by improving how they evaluate the effectiveness of their programs,training public health staff and community leaders to conduct policy activities in key areas and implementing and evaluating public health's best practices. Epidemiology and Laboratory Capacity($40 million) Funding will increase epidemiology,laboratory and health information systems capacity at health departments.Fully modernizing health departments and laboratories,including capitalizing on expansion of health information technology, will allow the public health system to better track health data,improve health outcomes and detect and quickly respond to an infectious disease,foodborne outbreak,or bioterrorist attack. • Expand the Public Health Workforce($50 million) The nation has lost nearly 29,000 local health jobs since January 2009(19 percent of the local public health workforce). The Prevention Fund has invested in building and training the public health workforce to improve access to prevention and health services in underserved and other communities. CDC is embedding a new generation of public health leaders in state and local health departments. States are also receiving funding to support comprehensive planning and implementation strategies that best address local workforce shortages. Support Science and Research: Environmental Health Tracking($35 million) Supports an integrated network of health,exposure,and hazard information to help health departments respond to and mitigate environmental health risks. Community and Clinical Prevention Research($32 million) Helps the U.S.Clinical Preventive Services Task Force develop recommendations for clinical preventive services. Bolsters the CDC's Community Guide,providing evidence-based recommendations and best practices to practitioners and policymakers. S �o • Transforming the Public Health ystem . 0 What Are We Learning? 0>e, Georges Georges C. Benjamin,MD,American Public Health Association* November 2012 While there has been an enormous The views expressed in this commentary are amount of attention paid to the transfor- those of the authors and not necessarily of the mation of the United States Health Care de- authors' organization or of the Institute of Medi- cine. The commentary is intended to help inform livery system under the Affordable Care Act and stimulate discussion. It has not been subject- (ACA), little has been said about the many ed to the review procedures of the Institute of opportunities in the ACA for population Medicine and is not a report of the Institute of health systems improvement that will pre- Medicine or of the National Research Council. sent as the result of moving to an environ- ment where a substantial portion of the pop- These services include: ulation has a health insurance card. • Monitor health status to identify and The governmental public health system has three core functions as defined in a 1988 solve community health problems; report by the Institute of Medicine (IOM). • Diagnose and investigate health prob- e/ These functions are to assess the health of lems and health hazards in the com- the community, lead and promote evi- munity; denced-based policies that are in the public's • Inform, educate, and empower people interest, and assure the availability of corn- about health issues; munity and personal health services that are • Mobilize community partnerships to viewed by their constituents as appropriate identify and solve health problems; and necessary.' These public health func- • Develop policies and plans that sup- tions will not change with health reform, but port individual and community health many of their component activities will as efforts; the health system is transformed. • Enforce laws and regulations that pro- During the Clinton health reform debate tect health and ensure safety; in 1994, it became apparent that a more de- • Link people to needed personal health tailed definition of governmental public services and assure the provision of health services was needed. The Core Public health care when otherwise unavaila- Health Functions Steering Committee was ble; formed and it delineated ten essential ser- • Assure a competent public and person- vices to be provided or assured by all health al health care workforce; departments. All of these ten services will • Evaluate effectiveness, accessibility, need to adjust in an evolving health system. and quality of personal and population- based health services and; • *Contributor to the Learning Health System Commentary Series of INSTITUTE OF MEDICINE the IOM Roundtable on Value&Science-Driven Health Care. ar;y, ,h ;y,t`r•,;,E dvising the nation a Improving health Copyright 2012 by the National Academy of Sciences. All rights reserved. • Research for new insights and innova- based solutions, and evaluating the out- III tive solutions to health problems.2 comes of these solutions. We need to ex- plore more fully this value added to the new Health system reform will impact these health care models. essential services in three overarching ways. The third impact of health care reform is First, the expansion of health insurance cov- the opportunity to offer many traditional erage will result in adjustments to the clini- public health enabling or data services to the cal services currently provided by govern- broader public. Public health agencies pro- mental public health agencies. In some cas- vide a plethora of programs and services that es, like routine childhood vaccinations,these enhance access to and quality of clinical adjustments may transfer to the private sec- care for underserved populations that should tor. Other, more specialized services, like be made available to the broader population. those for people with tuberculosis or sexual- These include such programs as home visit- ly transmissible diseases may remain with ing and other maternal child health pro- public health as the primary provider. In this grams, health care linkage and support ser- situation, the public health agency could vices and specialized behavioral health ser- expand to provide these targeted services to vices. These are in addition to the many a range of private health systems where the population-based prevention,protection, and public health agency may provide the ser- regulatory programs designed to ensure our vice more efficiently. How and what the food is safe to eat, our air is safe to breathe, changes are remains to be seen,but planning and our water is safe to drink. for this transformation must occur now in Like the health care delivery system, order to maximize the opportunities the public health is at a crossroads.There is a lot ACA presents. to learn as we make this transformation to • The second impact on these essential achieve better health and better value for our services will be the opportunity to integrate health investment. A transformed public population health principles into the many health system is an essential element of that new delivery system models (Accountable change. We should embrace it. Care Organizations, integrated health sys- tems, and medical homes), as well as to Georges C. Benjamin is Executive Director work to optimize the enhanced requirement of the American Public Health Association. for hospitals to better define and utilize their community benefit efforts. Here, public References: health practitioners and the agencies they 1. Institute of Medicine. 1988. The Future of Public Health. represent can share their expertise on as- 2. National Public Health Performance Standards sessing the health of populations, crafting Program.2010. 10 Essential Public Health Services. and implementing community- and broad- 1110 2 Washington State Health Care uthority • 2012 Fact Sheet Medicaid Expansion 2014 BACKGROUND Beginning in January 2014, Medicaid will increase its national eligibility limits for adults to 133 percent of the Federal Poverty Level, representing an annual income of about $14,856 for one person. This will open Medicaid coverage to childless adults, many of them uninsured. This is a category of the population not currently served by Medicaid, and in Washington State alone, we anticipate an enrollment increase of more than half a million new clients over several years. Washington's challenge will be to create a consumer-friendly eligibility determination system that meets federal expectations and maximizes administrative efficiencies. ANTICIPATED ENROLLMENT IN THE FIRST YEARS • Newly eligible Medicaid individuals — Up to 250,000 individuals aged 19 up to 65 not currently eligible for Medicaid with income under 133% FPL (138% with a 5% disregard) • "The Welcome Mat" — Up to 78,000 individuals who are eligible now for Medicaid but may not realize it and are not currently covered. • Current Medicaid/CHIP recipients — Conversion of up to 800,000 children, pregnant • women and families who will have to be rescreened under the new rules. CHANGES IN ELIGIBILITY DETERMINATION TOOLS • Modified Adjusted Gross Income (MAGI) tool will mirror federal income tax filing rules • Past practice of using multiple income disregards to adjust family income will be replaced by one 5% disregard for all programs • Streamlined federal rules do not limit assets or resources for these populations. HOW NEW HEALTH BENEFITS EXCHANGE WILL CHANGE SYSTEM • Exchange and Medicaid plan to develop a simplified and seamless application that can be processed through one web portal • The portal will automatically screen data and make eligibility determinations for Medicaid or CHIP eligibility; and for Exchange Premium Tax Credit Subsidy OTHER EXPANSION WORK IN PROGRESS • Policy Development - Eligibility, Exchange, MAGI and Eligibility Quality Assurance • Integration — New rules will help streamline eligibility and minimize risk of churn • Development of IT Systems — Exchange web portal, new eligibility rules engine, ACES, WA Connection interoperability, ProviderOne • Stakeholdering will include feedback and collaboration through web and public forums • Establish a Post-Eligibility Case Review Process • Marketing/Education — HCA to publicize eligibility changes & use of the Exchange web portal • • HCA will follow rulemaking process to make WAC changes FOR MORE INFORMATION , VISIT : www . hca . wa . gav/ hcr/ me Questions and comments may be sent to : medicaidexpansion2o14 (Jhca . wa . gov r Board of.9Cealth Netiv Business .agenda Item SIV., 4 • ANA State Budget Update flecem6er 20, 2012 • L 0 Jean Baldwin 000m: Baker, Ganel (DOH) [Ganel.Baker@DOH.WA.GOV] nt: Wednesday, December 12, 2012 9:03 AM : DOH DL OS LHJ Leadership Subject: CY2013 Foundational Funds Allocations-with Attachments Attachments: State Foundational Funds to LHJs 2011-2007 Data - Summary Table.doc; CY2013 Foundational Allocations.xlsx; Local Capacity Development Funds and Partnership Funds - (LCDF).pdf; Blue Ribbon -5930 Funds.pdf Follow Up Flag: Follow up Flag Status: Completed With Attachments **This message is going to Local Health Jurisdiction Leadership** Dear Colleagues, We have received a number of inquiries about the state "flexible funds" (LCDF, MVET Replacement, and Blue Ribbon/5930) for calendar year 2013, including questions about the amounts that will be allocated to each local health jurisdiction (LHJ) and the requirements, deliverables, or performance measures tied to these fund sources. And, we are aware that there are a number of new LHJ leaders across the state who are experiencing their first"flexible funds" allocation cycle. So, the purpose of this message is to provide you with a high-level overview of these funds and an update on allocation of the funds for 2013. Importantly, we are now referring to these three state funding streams collectively as "state funding for foundational public ealth services provided by local health jurisdictions."This modification is an outgrowth of the Agenda for Change and the rk of the Foundational Public Health Services (FPHS) workgroup. The new terminology more accurately conveys the important ways these funds are used in local communities. For 2013, total state funding for foundational public health services provided by LHJs is approximately$36.4 million/year. • Local Capacity Development Funds (LCDF)—Approximately$7.6 million/year • Motor Vehicle Excise Tax (MVET) Replacement Funds—$24 million/year • Blue Ribbon /5930 Funds—$4.75 million/year Attached is a spreadsheet titled "CY2013 Foundational Allocation" that details the allocations for each of the three funding streams for each LHJ. The amount that each LHJ received from each fund in calendar year 2012 will be the same in calendar year 2013, with one minor exception— LCDF allocations are re-calculated each year based on the most recent county population totals, and as a result, the allocations for each LHJ will change slightly. Keep in mind that because the LHJ fiscal year crosses the state fiscal year, and in the case of 2013, the state biennium, the July to December 2013 allocation of MVET Replacement Funds and LCDF funds will be contingent upon their inclusion in the 2013-2015 state biennial operating budget. This does not impact 5930 funds you will receive in January because these funds are part of the current biennium appropriation. Regarding requirements, deliverables, or performance measures for these funds for calendar year 2013— here is what we know at this time: • 1 LCDF—same performance requirement as 2012— use the funds to develop a community health assessment (CHA), community health improvement plan (CHIP), agency strategic plan (SP), and/or to implement elements of your CHIP or SP. Partnering with hospitals and others and regional approaches to these activities are encouraged. The distribution formula for LCDF was established long ago in state budget proviso to include a base amount plus a per • capita amount and DOH has maintained this formula using the most current population data available. The contract for these funds specifies performance requirements and due dates for reporting progress to DOH. Once the contract deliverable is submitted, the LHJ is eligible to invoice for the amount associated with it. Payment will be authorized when the deliverable is approved. Blue Ribbon/5930 Funds—the performance measures have remained unchanged since the first distribution in calendar year 2008 and will remain unchanged through calendar year 2013. However, they may need updating for 2014 and beyond. DOH will develop a process for having this discussion with LHJs. Additional (more program-type) information for 5930 is available at: http://www.doh.wa.qov/PublicHealthandHealthcareProviders/Pu blicHealthSystemResourcesandServices/PublicHealthImp rovementPartnershipPHIP/5930PerformanceMeasures.aspx The distribution formula for Blue Ribbon/5930 funds was specified in state budget proviso in 2007 and included a base of $100,000 per LHJ with the remainder being divided per capita. DOH maintained this formula in 2010 when the funds were reduced from $10 million/year to $8 million/year. When the funds were further reduced to $5 million/year in 2011, Secretary Selecky asked WSALPHO for a recommendation on how to distribute the funds. DOH accepted and implemented the WSALPHO recommendation that included a base of$60,000 for select LHJs with the remaining LHJs receiving an equal pro-rata reduction from their previous level. DOH will carry that distribution forward for calendar year 2013. Funds will be allocated in a lump sum in January 2013. MVET Replacement Funds—currently no deliverables or performance measures are required. However, we anticipate the need for development of measures of some type for these funds. The distribution of these funds are specified by the Legislature and based on a formula related to replacing 90% of the • MVET revenue received by each LHJ in 1998. Funds are distributed in two equal amounts: 50% in January 2013 and the remaining 50% in July 2013 (the July distribution is contingent upon inclusion in the 2013-2015 state biennial operating budget). For your information, I am also attaching the following documents that provide further background and information on how these funds are used by LHJs: • State Foundational Funds to LHJs—Summary Table. This table identifies at an aggregate statewide level how each foundational public health service fund source was used by LHJs, for each of the past 5 years. • Fact Sheets for LCDF and 5930 funds. 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J a) No a m C C ami •> >, m .... ami •> S CtSD o12 -o am) > m E as O - U O m N N +- U N OLS V) N .T V 'C N N N 'C a) = F-U) N C o f 'c aa) E c E c c •c aci c c c . ;u aa) v > o N o c is o = o N o '5 c o c-s E Eo '� m E o U N U W .0 .0 Q D U N U C L Q D O o N U C � C tl o a) 0 0 o U o > 0 o a) o w o a) U a) o W U Q a) O co O L o N o 0 0 m o o > o o N o -L7,.. 0 > o N o 0 o m o > N • U o0 t� O CD LID O o CO O o N PO o O ' CO O CO o N O o o O o C O o -p • L' .- �L N r N S CO .-•- D CO V Q .-- M d' 0 •-- a0 Q ti' t` S O O 0 Imo• -9 a) •• • • • • • • • • • • • • • • • O L N O ., 2 iii3 o a)U co a) 0 m _a >'' COQS >' m 'C L-' S = voi m o v _ cv � voi m "D cam) m O o as 'a CTSL p N a O N a_ ca1E a) C) C O O 6 U m a) CO "c (N6 O = L C p N a" O a CO S C C aa)) to=,> S m : 0 Board-of 3CeaCth Netiv Business .Agenda Item #1`V., 5 • Substance .A6use .advisory Board Appointment December 20, 2012 1 • • To: Members of the Substance Abuse Advisory Board , From: Garin Williams, Police Officer for the City of Port Townsend Date: August 14, 2012 Subject: Letter of Interest to serve on the SAAB Board In my duties as a Police Officer for the City of Port Townsend, I have a solid interest in the health of all citizens, not only in the confines of Port Townsend, but all of Jefferson County as well. My current role within the Police Department is that of the School Resource Officer. My jurisdiction is the Port Townsend School district. My duties as School Resource Officer are numerous: My role is an asset used by the community and the school in an attempt to address situations in the lives of students in a manner other than the judicial system. • I am involved in a variety of functions while in the school aimed at prevention. In addition to being an active high profile law enforcement officer, I consider myself a resource for students, parents, teachers and administration regarding law issues. Another duty is being a link to other service agencies that provide preventive and counseling services within the school district. Working hand-in-hand with the Principal in each school, I assist with finding solutions to problems afflicting today's school age children, problems that include the use of alcohol, drugs, and tobacco, along with peer pressure. These situations are not only in the schools, but in the community as well. The approach of addressing these issues only in the school, or only in the community, has not been completely effective. I am not naïve enough to believe we can eliminate all of the risky behaviors displayed by today's youth, but I am tenacious enough to do all that I can to reduce it significantly. I look forward to your response. Port Townsend Police Department Garin Williams#712 Police Officer School Resource Officer • 1925 Blaine Street,Suite 100 Port Townsend,WA 98368 (360)385-2322 main line (360)531-2501 celVvoice mail (360)379-4438 fax Case No: gwilliams@cityofpt.us Date: • Board of.7Cealth .7viedia Report 1 December 20, 2012 t . • Jefferson County Public Health October/November/December 2012 NEWS ARTICLES 1. "Whooping-cough experts probe state outbreak; flaw in vaccines?" Seattle Times, September 30th, 2012. 2. "Employers invited to 'Work With Me' breakfast Oct. 18 to support adults with disabilities," Port Townsend Leader, October 12th, 2012. 3. "Regional air quality board to discuss more North Olympic Peninsula monitors," Peninsula Daily News, October 14th, 2012. 4. "Community development office has changes afoot," Peninsula Daily News, October 16th, 2012. 5. "Biomass meet in Sequim draws a crowd of protesters," Peninsula Daily News, October 17th, 2012. 6. "Do the right thing by hiring disabled, Port Townsend speakers say," Peninsula Daily News, October 19th, 2012. 7. "Limits raised on health plan in Jefferson," Peninsula Daily News, October 22nd, 2012. 8. "County denies Port Townsend Paper's landfill permit renewal," Peninsula Daily News, October 23rd, 2012. 9. "Port Townsend Paper's inert landfill permit application is rejected," Port Townsend Leader, October 24th, 2012. 10. "Pertussis rates dropping here; Unique disease profile in Jefferson County due to immunization rates," Port Townsend Leader, October 24th, 2012. 11. "SmileMobile comes to Chimacum Nov. 8," Port Townsend Leader, October 24th, 2012. 12. "Family recovered from bad shellfish," Port Townsend Leader, October 24th, 2012. 13. "Port Townsend Paper appeals denial of landfill permit," Peninsula Daily News, October 31st, 2012. 14. "Pt Paper to appeal landfill permit," Port Townsend Leader, October 31st, 2012. 15. "LETTERS: Hope the mill takes alternate route," Port Townsend Leader, October 31st 2012. 16. "Girls' Night Out Goes All Out," Peninsula Daily News, November 4th, 2012. 17. "Panel plans special meet today in PT," Peninsula Daily News, November 6th, 2012. 18. "Funding source ID'd for `therapeutic' court," Port Townsend Leader, November 71h 2012. 19. "Some Jefferson County beaches reopen to shellfish harvesting after PSP danger subsides," Port Townsend Leader, November 12th, 2012. 20. "Water quality program funding fades," Port Townsend Leader, November 14th, 2012. 21. "Beaches reopen to shellfish," Port Townsend Leader, November 14th, 2012. 22. "Waste-free holiday open house," Port Townsend Leader, November 21st, 2012. 23. "County, state square off with mill over landfill," Port Townsend Leader, November 21st, 2012. 24. "Updates on Mat Mats Bay water quality presented at Nov. 28, Dec. 3 meetings in Port Ludlow," Port Townsend Leader, November 26th, 2012. 25. "Port Townsend Paper's appeal of landfill permit denial set Wednesday," Peninsula Daily News, November 27th, 2012. • 26. "Mill landfill hearing is Wednesday morning," Port Townsend Leader, November 27th, 2012. . 27. "Akamai Art receives green certification," Port Townsend Leader, November 28th, 2012. 28. "Decision deferred on Port Townsend paper mill landfill permit," Peninsula Daily News, • November 29th, 2012. 29. "Jefferson County Environmental Health Presents Waste and Toxic-Free Holiday Open House!", City of Port Townsend Newsletter, December 2012. 30. "Locke rejects mill's landfill plan," Port Townsend Leader, December 5th, 2012. 31. "Port Townsend Paper to appeal denial of landfill permit," Peninsula Daily News, December 5th, 2012, 32. "Girls Night raises funds for cancer," Port Townsend Leader, December 5th, 2012. 33. "Clallam, Jefferson public health officer honored for 25 years of service," Peninsula Daily News, December 7th, 2012. 34. "Medicaid: What Now?," Governing Magazine, December 2012. I • INhoopmg-cough experts probe _P state outbreak; flaw vaccines? SEPIDEMIC I Federal officials don registry and quizzing doctors in Atlanta headquarters,where epide- hope a close look at medical a quest to unravel a mystery:Why is miologists will compile and analyze records will show if newer Washington in the midst of a the data they've collected on Wash- whooping cough epidemic,with ington patients who contracted this formulations to counter the risky rates 10 times those reported last disease,which is very contagious infection are wearing off. year? and can be deadly for infants. According to data from the state Kim Brinker,one of the few CDC BY CAROL M.OSTROM and the Centers for Disease Control sleuths still in the state,declined to Seattle Times health reporter and Prevention(CDC),Washington speculate about that agency's likely For the past six weeks,dozens of has the third-highest rate of whoop- conclusions or possible action, federal disease detectives have been ing cough cases in the nation. which could include calling for a sleuthing in Washington state, Some 40 to 50 CDC"epidemic in- new vaccine formulation or recom- combing through medical records, teiligence service"investigators are mending a different immunization digging into the state's immuniza- now heading back to the agency's See>WHOOPING COUGH,88 Washington's 2012 whooping cough cases far above 2011 The state has seen an unprecedented riSe .vhaooing cough cases,more than L .- - .manJ as last year.Reported ;,ave drooped recent weeks. NUMBER OF REPORTED PERTUSSIS CASES IN WASHINGTON STATE'2011 vs 2012) 300 I 2012 Note:Additional roses.f0Cy nas=.ac:.--rec. 256 in the last three weeks bsr^s:e not',ter 250 reported. 200 I50 Sept.22.2012 1411111 5 4 r = .-ll_ .. 5 t % ?� ,._{ 1 ) 117 e > St 2 3 0 5 6 2 8 9 1011/12 13 1'15 1E 12 1819.20 21 22 23 2.25 26 27 28 29 30.31 32 33 34.35 36 32 383910'1'2'3".5'6. E .S0 51 52 NOTIFICATION WEEK;Weeks 0':'e yeo•1 Source:state Dev'orime:;•__'i1r;;I:h REPORTING 6:'CAROL NI.OSTROMI, GRAPHIC CT MARK NOWLIN f THE SEATTLE TIMES Whooping cough ( FROM Bl last year:4,190 cases versus • C 7450.By June 20,the CDC FEDERAL EXPERTS PROBE STATE OUTBREAK notes,Washington already had reported more cases of whooping cough than in any Reason for epidemic remains unclear, year since 1942. butresearchers focus on teens,vaccines Why us and why now?Mi- chele Roberts,immunization schedule. new vaccine isn't creating an spokeswoman for the state's It was clear the investiga- immune response that's Department of Health,Brink- tors'focus was on the vac- strong and long-lasting, er and other public-health cine's staying quality—or Brinker said. pertussis experts say the dis- lack thereof—when Brinker Although much has been ease is cyclical,reaching high revealed they had looked made of some Washington levels in a particular area one only at the immunization residents'reluctance to im- year and falling off in others. records of patients ages 11 to tnunize their children,in The CDC isn't singling out 18,where the disease has hit fact,most parents are vacci- Washington,Roberts and particularly hard. nating their children against Brinker said,but is sending One big clue:The whop- pertussis,acknowledged to investigators to places where ping majority—77 percent be a bad bug.Of those chic- high numbers of cases make —of 13-to 19-year-olds di- dren ages 3 months to 10 data-gathering more effi- agnosed with whooping years who came down with cient.They have visited Cali- cough in Washington had re- pertussis,about 76 percent fornia,which in 2010 experi- ceived their last recommend- had received the recorn- enced a large outbreak that ed vaccination.Even more mended vaccines. prompted attention from re- significant:This is the first "We don't think that(re- searchers from the Kaiser generation of teenagers that luctance to vaccinate)is the Permanente Vaccine Study • has received only the new driving force behind the rise Center. formulation of the vaccine. in cases,"Brinker said,al- Their study,published in That modern version of the though non-vaccinated chil- the New England Journal of vaccine,it appears,just isn't dren are eight times more Medicine this month, lasting as long as expected. likely to come down with showed that protection Vaccines for whooping pertussis. against pertussis waned dur- cough—"pertussis"in sci- Pertussis,also called the ing the five years after the ence-speak—switched in the "100-day cough,"is very con- last dose of DTaP,typically late 1990s from a whole-cell tagious,and it's particularly given to children between vaccine(the DTP or DTwP) dangerous to infants,who ages 4 and 6. to a more highly purified can't begin immunizations Earlier studies,including • "acellular"vaccine contain- until about 2 months of age. one published in the same ing a smaller part of the bug. Caused by a bacterial in- journal in 1996,which con- The new acellular formula- fection,pertussis creates chided the two formulations tions cause fewer side effects breathing difficulty,vomit- of the vaccine conferred such as fever or seizures,said ing,and coughing so violent equal protection,apparently Dr.Edgar Marcuse,a pedia- that patients have broken did not follow its subjects • trician,epidemiologist and ribs;public-health officials long enough. vaccines expert at the Uni- take outbreaks very serious- Although the researchers versity of Washington and ly.Brinker,a nurse-epidemi- in the current study said the Seattle Children's. ologist,said about 30,000 reasons for the outbreak"are Now,both the initial set of cases have been reported na- not well understood,"they childhood pertussis vaccines, tionwide this year,with 14 concluded there was a need the DTaP series,and the deaths,primarily in infants, to develop new pertussis- Tdap vaccine,approved in though none in Washington. containing vaccines that will 2005 for teens and adults to According to state and provide long-lasting immuni- boost protection,are acellu- CDC data,Washington has ty. lar vaccines(the"a"in the more than 58 cases of pertus- Brinker couldn't speculate vaccines'shorthand names). sis per 100,000 people.With- as to that possibility;the As the cases pile up,they in the state,Skagit County CDC's vaccine recommenda- have allowed epidemiolo- has the highest rate,with bon process is complex and gists to see the big picture: 462 cases per 100,000. demanding.That's why the The major spikes in cases are The highest state rate is in investigators weren't taking occurring in younger teens, Wisconsin,with nearly 79 parents'word for vaccination • up to about age 15,who have cases per 100,000 people. histories,instead searching never gotten the whole-cell While there are outbreaks out actual medical records vaccine(the DTP or DTwP) elsewhere around the world, and facts.That data is now and have received only the including in Australia,Wash- destined for the CDC's Advi- acellular vaccine,the DTaP ington's situation drew the sory Committee on Imtnuni- and Tdap. CDC's attention last spring, zation Practices,which will According to data pub- when the state declared an recommend the next steps. lished by the CDC this year, epidemic.The number of Carol M.Ostrom:206-464-2249 16-to-19-year olds,who are Washington cases so far this or costrom@seattletimes.com.On old enough to have received year is nearly 10 times that of Twitter @costrom. the whole-cell vaccine in their first round ofimmuni- O Nor more information zation as infants,have a much-reduced incidence of WASHINGTON STATE DEPARTMENT OF HEALTH,PERTUSSIS • • 10/12/2012 9:58:00 AM,Port Townsend Leader Employers invited to 'Work With Me' breakfast Oct. 18 to support adults with disabilities Employers like the Bishop Victorian and Swan hotels will be on hand for a "Work With Me" breakfast that will showcase employers who hire adults with disabilities. "This event has been a long time in the making," said Anna McEnery, coordinator for the Jefferson County Developmental Disabilities Program, which is part of the Community Connectors Group that is sponsoring the breakfast from 8 to 9 a.m. Thursday, Oct. 18 at Fort Worden Commons. Employers who are interested in learning more about employing adults with disabilities are invited be part of the event. "We are excited about businesses continuing to recognize the abilities and skills of people with developmental and other disabilities working in the community," McEnery said. The Bishop Victorian's operations manager, Dea Itterley, believes that everyone who wants to work and has the right support should work. • "The only limitations we have are within ourselves. There should be no limitations in the workplace," Itterley said. "When we can all feel that what we are able to contribute to our community is valued, it makes for good business and a healthy community," said Carl Hanson, co-chair of the Jefferson County Developmental Disabilities Advisory Board. To reserve space at this invitation-only event, call McEnery at 385-9410. Regional air quality board to discuss more North Olympic Peninsula monitors By Rob 011ikainen, Peninsula Daily News, October 14,2012 • SEQUIM—A request from the Sequim City Council for a "state-of-the-art" air monitor will be among other requests for more monitors from across the Peninsula when the Olympic Region Clean Air Agency meets Monday. Residents in Port Angeles, Sequim and Port Townsend—and the Port Angeles, Sequim and Port Townsend city councils—have asked for additional permanent air quality stations to measure particulates generated by biomass cogeneration expansion projects being built in Port Angeles by Nippon Industries USA and Port Townsend Paper, both of which are expected to be operating in 2013. Purchase of four temporary air monitors to be used in Clallam and Jefferson counties will be discussed at the Olympic Region Clean Air Agency—or ORCAA—board of directors meeting at 5 p.m. at the Sequim Transit Center, 190 W. Cedar St., Fran McNair, the director of ORCAA, has said. The monitors, which would be in place for six to nine months, would measure particulates smaller than the 2.5- micron threshold already mandated by the Environmental Protection Agency. If approved at the board's Nov. 14 meeting, the four monitors would be installed in Clallam County in January, with 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 has said. One of the Port Angeles monitors would be at an existing permanent air-quality station at Stevens Middle School. 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 • monitors placed elsewhere in the city, McNair has said. The Sequim City Council last Monday voted to give the ORCAA board the letter, with the addition of the term "state- of-the-art," and appointed Mayor Ken Hays to speak on the council's behalf at the meeting. "We respectfully request that a monitor be placed in the Sequim-Dungeness area to provide the data necessary to determine if there is an air quality problem in the area," the letter says. The council's letter was drafted before McNair recommended the purchase of the four temporary air-quality monitors, but both Burkett and Hays said that they felt the letter still provided the message the council wanted to send. "We still have all the same concerns," Hays said. "I think it's a good, strong letter, and I think we should have this strong message on record, regardless of what we know that's different today." City Councilwoman Candace Pratt moved to add the words "state-of-the-art" to the last sentence of the two-page letter. The proposed temporary monitors, which would measure the size of particulates that are between 0.3 and 10 microns, 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 has said the monitors are meant to address concerns expressed by area residents about toxin-laden ultrafine particulates that fall under the EPA threshold. "I think the catalyst for this was the [Nippon Industries USA] project in Port Angeles with a biomass burner, and an expression of concern by some residents in the Sequim area that that might generate health problems or additional air quality problems," Sequim City Manager Steve Burkett said. • "The council discussed that and I think came to the conclusion that, well, we don't know. We have to measure and find out if there's any health problems, or find out what's the quality of the air and what does that mean in terms of the health issues." The letter states that Sequim qualifies under all six criteria that ORCAA uses to determine whether a monitor is needed: emission sources that could affect the air quality, significant citizen complaints, weather that could pose air quality problems, burn bans on outdoor burning and facilities that could create air quality problems. Nippon mill manager Harold Norlund has said the company already monitors its equipment. Jefferson County Commissioner Phil Johnson, who chairs the ORCAA board, has said he favors the purchase of the temporary air monitors. Gretchen Brewer of PT Airwatchers called the idea "a positive step." Bob Lynette of Carlsborg, co-chair of the North Olympic Group of the Sierra Club, has called for permanent air quality monitoring stations that measure down to 0.01 microns and called the temporary monitors"a Band-Aid." He has asked ORCAA to address seven issues regarding air emissions at Monday's 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. McNair has said the board will address as many as it can at the meeting. She also has said that ORCAA does not have a time limit on its review of a cooling tower application for Nippon's biomass cogeneration plant and that a 30-day public comment period will follow the completion of that review. The Clallam County Healthy Air Coalition will stage a rally at 4 p.m. Monday at the corner of Sequim Avenue and Washington Street, said Rose Marschall, a member of the coalition. The rally is timed to precede the 5 p.m. meeting at the Sequim Transit Center. To reach the coalition, phone 360-457-2191. Reporter Rob 011ikainen can be reached at 360-452-2345,ext. 5072, or at rollikainen(c�peninsuladailynews.com. • Community development office has changes afoot • By Charlie Bermant, Peninsula Daily News, October 16th, 2012 PORT TOWNSEND—The Jefferson County Department of Community Development has instituted measures to improve customer service and streamline its permit process, its director told a Chamber of Commerce audience Monday. "We want to have an open connection and good communication between the department and the community,"Community Development Director Carl Smith told the Jefferson County Chamber of Commerce at lunch meeting at the Port Townsend Elks Lodge. "When you come to us,we want to have an open dialogue with you and about your needs and what we can do to meet them," Smith said. As a regulatory agency, the Department of Community Development, or DCD, is charged with managing land use as it conforms to the two regulatory documents, the Comprehensive Plan and the County Code, Smith said. There are many rules, that govern land use, Smith said. "Planners don't sit around dreaming up things. These regulations have been through the public process with the Planning Commission and the county commissioners who have approved their content." To make the process more transparent,the DCD has rearranged its reception area at 621 Sheridan St., next to QFC in Port Townsend. Customers have access to a host of written and online resources to examine in preparation for a permit application, Smith said. In streamlining that process, Smith said that several permits can be granted on the spot. Another step is to improve the online web page and increase the available online resources—although automatically granting permits online is not likely because each permit must be examined by a planner, Smith said. • One important online component is a customer feedback form, the contents of which Smith said are carefully examined. "We have a new mission statement:to preserve and enhance the quality of life in Jefferson County." Smith said. "We will do this by promoting a vibrant economy, sound communities and a healthy environment. "Every day we will try to live this mission statement to provide better service." The DCD office is open from 9 a.m.to 4:30 p.m. Mondays through Thursdays and is closed on Fridays. But the staff doesn't take the day off, Smith said. "On alternating Fridays,the entire staff works on expedited permits. On the other days, they work on long range permits,"Smith said. "This allows us to examine these permits without any distraction." Associate Planner Michelle McConnell told the Chamber of Commerce audience that low-impact development for stormwater management is an important planning tool. "Low-impact development is a more progressive way to deal with stormwater management,"she said. "There are ways you can channel water in a more natural path so it resembles rainfall and give it the time and space to soak into the soil,which differs from how water drains from freeways, patios and roofs. "You don't want to treat storm water as a problem instead of a resource," she said. "Water is one of the main sources of currency we have in the Pacific Northwest, so we want to make the best use of it that we can. Jefferson County Reporter Charlie Bermant can be reached at 360-385-2335 or at charlie.bermant@peninsuladailynews.com I Biomass meet in Sequim draws a crowd of protesters By Paul Gottlieb , Peninsula Daily News, October 17th, 2012 • s '2,-.",,, ,.-:‘,.' ' ' �� Ash ,4.6...11.,4- ._' tW",7'''-' " ' s"' a ,� s,w ^ "" fir. x ,, i, ‘ ' %:' 1!",,,.'t7 '",... ' '*''' -,,,,,* ,- ,„,,,, ........- / , 1. ..,.., ' „,,,,i›,,, ,1%.x.‘7 7141 $ Paul Gottlieb/Peninsula Daily News People pack the Sequim Transit Center Monday to sound off to the Olympic Region Clean Air Agency about the planned biomass plants in Port Angeles and Port Townsend. SEQUIM—A plan to place four temporary air-quality monitors in Port Angeles and Sequim in 2013 and monitors in Port Townsend in 2014 doesn't go far enough, according to many at a packed Olympic Region Clean Air Agency board meeting in Sequim. • Many among the more than two dozen Port Angeles, Sequim and Port Townsend residents who gave maximum- three-minute comments at the meeting Monday night were concerned about biomass expansion projects under construction in Port Angeles and Port Townsend. Those speakers said they appreciated the plan to measure the diameter and quantity of particulate matter from 0.3 to 10 microns in the planned "saturation studies" of air pollution that would be facilitated by the temporary monitors, which are planned to operate for a year in Clallam County and for 10 months in Port Townsend. But most of those who made comments at the meeting called for sharper measures than temporary air-quality monitors. The particulate matter is created in large part by paper mills, diesel engines and wood-burning stoves that contain toxic substances, "pretty much any kind of combustion," said Odelle Hadley, senior air-monitoring specialist with the Olympic Region Clean Air Agency, or ORCAA. Current monitors measure particulates 2.5 microns and larger. ORCAA, which regulates air quality in a six-county region that includes Clallam and Jefferson, will conduct yearly studies in its coverage area for the next six years. Additional measures speakers called for included a moratorium on biomass cogeneration plants, which burn forest slash and other woody detritus to create energy—and which are being expanded at Nippon Paper Industries USA in Port Angeles in a $71 million project and at Port Townsend Paper Corp., a $55 million project. • No one in the audience spoke in support of the projects, and a few protesters held up a "No Biomass" banner at East Washington Street and North Sequim Avenue during a Clallam County Healthy Air Coalition rally a few blocks away from the meeting site before holding it up at the back of the meeting room before the public comment session began. "Shut'er down, do the right thing," yelled out one woman repeatedly as the session progressed. • "Do you know what our children will be breathing? Ban biomass,"was scrawled on another woman's T-shirt. "Ultrafine particulates—again, that are very damaging to human health—are defined as 0.1 microns and smaller," said biomass project opponent Bob Lynette of Sequim. Ultrafine particles "will not be counted by the proposed temporary monitors," he said. "While ORCAA's proposed program is a step in the right direction, it will not answer the communities' question: Are we being exposed to dangerous air emissions or not?" Lynette added. ORCAA staff said not only that the agency lacks the authority to set a moratorium on biomass cogeneration plants, but also that Nippon's and Port Townsend Paper's projects have received necessary permits after surviving legal challenges, though Nippon still must obtain a permit for a cooling tower. ORCAA said ultrafine particles of 0.01 to 0.1 microns are the same as nanoparticles and said they "contribute a negligible amount" to the mass concentrations that will be measured by the temporary monitors, according to the agency's air-quality monitoring plan, available with other agency documents referred to at the meeting at http://tinyurl.com/9ge6t2v. The four monitors, which are recommended for purchase at about$3,500 apiece by ORCAA Executive Director Fran McNair, are on track for approval by the ORCAA board at its 10 a.m. Nov. 14 meeting in Olympia. • Tentative plans call for their placement at Stevens Middle School, the Port Angeles Fire Department, Olympic Medical Center and Franklin Elementary School in Port Angeles; and at the Sequim High School-Sequim Middle School area or the Sequim Fire Department from January through December 2013. Sites for Port Townsend air monitors have not been determined, but up to four monitors would be placed in that city from January 2014 through October 2014. "We're insisting on absolutely the best monitoring for our town, not temporary stopgaps that cannot and will not provide the information required," Elaine Bailey of Port Townsend said. "We deserve clean air." ORCAA intends to measure air quality before and after Nippon's cogeneration boiler goes online in September 2013, Hadley said. No objections to the purchase were raised by ORCAA board members, who include Port Angeles City Councilman Dan Di Guilio, Clallam County Commissioner Mike Doherty and ORCAA board Chairman and Jefferson County Commissioner Phil Johnson. Nippon has been burning sludge, woody biomass and residual oil at its plant since 1953. The Port Townsend facility also has been burning biomass. • The new Nippon plant will burn 95 percent woody biomass and about three times the amount of biomass currently burned to produce up to 20 megawatts. The rest of the fuel will consist of de-watered sludge and some diesel, primarily for starting up the plant, the agency said. Some at the meeting accused Nippon of"cherry-picking"facts contained in its permits that helped get the permits approved. "They did not cherry-pick," ORCAA professional engineer Mark Goodin said. "They used the laws available to them." Those laws do not require the regulation of particulates smaller than 2.5 microns, Goodin said. Particulates spewed by the boiler"will substantially decrease" compared with the present boiler, Goodin said. The collection efficiency for ultrafine particulates, though not regulated, is expected to be 96 percent, he said. Goodin said three control devices on Nippon's boiler will scrub emissions of 2.5-micron particulates and smaller. Emissions of sulphur dioxide will decrease, but there may be increases of carbon monoxide, nitrogen oxides, hydrogen chloride and volatile organic compounds. "The control technology is capable of taking out all the particulates," Goodin said. But audience member Michael Bunnell of Sequim said there should be"zero harm" to public health. • "If you can't afford now to protect us, then surely Nippon shouldn't be allowed to continue building." Senior Staff Writer Paul Gottlieb can be reached at 360-452-2345, ext. 5060, or at paul_gottlieb( peninsuladailynews.com. • Do the right thing by hiring disabled, Port Townsend speakers say By Charlie Bermant , Peninsula Daily News, October 19�h, 2012 • i il �a .,irm":',-; 7;--7:"'"g"''t ° YTS dF Charlie Bermant/Peninsula Daily News Port Townsend Deputy Mayor Kris Nelson addresses the Work With Me employer breakfast Thursday at Fort Worden State Park. PORT TOWNSEND— Hiring people who have developmental disabilities can enhance a business while giving its owner the feeling he or she has done the right thing, speakers said at a breakfast event Thursday. "It's been an incredibly positive experience," said Port Townsend Deputy Mayor Kris Nelson, who has hired people with developmental disabilities at Sirens, her downtown restaurant. • "They come in early every day with a great attitude and do everything you ask them to do." Nelson addressed about 60 people who had come to Fort Worden State Park for the inaugural Work With Me employer breakfast. The event was sponsored by Skookum and the Community Connectors Group, both of which match developmentally disabled workers with local businesses. Businesses recognized Several local businesses that have hired developmentally disabled workers were recognized at the breakfast and presented with a decal bearing a logo designed by the Community Connectors Group. The logo, which shows interlocking hands, will become a symbol of hope for the developmentally disabled, said Jefferson County Developmental Disabilities board member Carl Hanson. "What helps to establish community is the feeling of a sense of belonging, but even beyond that is the experience of being a contributing member of the community," Hanson said. "When we can each feel that our individual abilities and skills are being recognized and put to use, a personal sense of value arises which makes for good business and a healthy community." Hanson said that adding people with disabilities creates a win-win situation for both the employer and the employee. 0 Nelson said she wasn't sure employing a person with disabilities was going to work out. "I worked with people with disabilities growing up, so this wasn't a new thing for me," she said. "But as a business owner, I was concerned about making money, and my fear was that if it didn't succeed that I wouldn't have a way to get out of it." Once she hired a developmentally disabled worker, Nelson found that it immediately clarified her business 411 processes because she had to explain each step. Positive changes The employee has now been in place for several years and has changed the work environment. "He comes in each day and asks each one of us how we are," she said, "which made us realize that we should be asking each other that question." It also has added stability to the business. "In this business, the people who are doing the odd jobs that no one else wants to do are hard to retain," she said. "The great people in those jobs move up, and the not-so-great people never show up." Pane d'Amore Bakery owner Linda Yakush agreed, describing her developmentally disabled employee as reliable and steadfast. "There are a lot of nitpicky tasks that are necessary that other employees don't always have the time to do," Yakush said. "She gets them done with no drama and no nonsense," Yakush said of her developmentally disabled employee. Management agency Skookum employment specialist Candy Kerr said her agency manages 40 to 50 developmentally disabled workers • ata time. Community Connectors Group has four workers in Jefferson County. The breakfast, which will become an annual event, was not a fundraiser as the sponsors stopped soliciting money once the cost was covered. For more information, contact Kerr at ckerr�7a.skookum.com or 360-531-3545. Jefferson County Reporter Charlie Bermant can be reached at 360-385-2335 or at charlie.bermant(c�peninsuladailynews_com. • qiii - -i its r it e r f on healt0 hplan in Jefferson PENINSULA DAILY NEWS,., health maintenance." . PORT TOWNEND — Clients with private Income limits have been insurance coverage' also ' raisedtfor'the Take Charge - Take Charge are -alloWedto aecondary program, a state federal .. coverage, partnership that covers This means'that any birth control and related aF one, regardless of private services -:'....i. r-', This changeill allow •insurance coveragcan Jefferson County Public qualify as long as they meet income guidelines. '•'Health to provide family .t: Take •Charge� covers planning;services to peo myna family planning ser- pie with higher-income ; vices, including annual levels. ' exams,many birth control For example, a single methods, ewer enc con.- person"making';$2,328 or g y less per month would traception, education,.and qualify, and" so"would;.a supplies for natural family married'Woman'with.two planning,=abstinence and kids with a household tubal ligations.or wasecto- income of$4,803`pr less: mi Jefferson County P}ib- • Opportunity ', lic'Health,:;is the provider of Take, Charge in Jeffer- men.:can:qualify,too. son County, :but citizens "It'sa wonderful oppor- can go to'other counties or tunity for anyone in;town Planned Parenthood. who needs family plan Por a complete income ning services,l'`.saidhJeffer ,,gu defines,•and services, sour CountyPPiiblic_Health , phone Jefferson`_County Advanced Registered -Public Health at'360 385= Nurse Practitioner Susan' 940®" or visit- -www. O'Brien.. je ffersoncoun_typublic "It's part of women's health.org. Ill PDJV County denies Port Townsend Paper's landfill permit renewal By Charlie Bermant, Peninsula Daily News,October 23td,2012 • PORT TOWNSEND—The Jefferson County Department of Public Health has denied aP ermit extension for the operation of the Port Townsend Paper Corp.'s inert landfill. The mill has 10 days to appeal the decision. The denial of the permit renewal was disclosed in an Oct. 17 letter from Jefferson County Health Officer Dr. Thomas Locke to Annika Wallendahl, the mill's environmental manager. Locke said the application failed to"adequately address the issues of groundwater monitoring, financial assurance for closure costs, and waste stream characterization that are required for permit renewal. "Moreover," he wrote, "it is our conclusions that these issues cannot be adequately addressed without correcting the misclassification of[Port Townsend Paper's]waste as inert." "We are surprised and very disappointed at the county's decision," Port Townsend Paper Corp. President Roger Loney said in an email to the Peninsula Daily News. "This is clearly inconsistent with the approach that was laid out in the work that has been done with the county and the Department of Ecology over the past year. "We still need to review the county document before deciding our path forward." "They have the right to appeal," said Jefferson County Environmental Officer Pinky Feria Mingo. "I don't believe our decision was inconsistent with what we have been saying all along." The mill requested an inert permit against the advice by Locke and the state Department of Ecology to instead seek the more environmentally stringent limited purpose landfill (LPL) designation. According to Mingo's staff recommendation to deny the permit, the mill never should have been issued an inert permit in the first place. "This has been contentious since 1989 when Ecology first advised Jefferson County Public Health that[Port Townsend Paper's] limegrit and ash did not meet the definition of inert,"the memo reads. Using the abbreviations for Jefferson County Public Health and Port Townsend Paper Corp., the memo continues: "It is unclear why JCPH issued PTPC the 2004 inert waste permit, when Ecology's technical staff and program management team concurred that PTPC's landfill should remain a limited purpose landfill." In his letter, Locke said Port Townsend Paper's waste stream "does not meet the criteria to be classified as inert. "Continued permitting of the PTPC landfill as an inert waste landfill even with additional requirements relating to groundwater and financial assurance, would fail to correct the fundamental error that occurred in the 2004 reclassification of the landfill from limited purpose to inert waste," he wrote. Mingo wrote in her report that new information about the dangers of limegrit and ash—found in the landfill— has been published since the permit was last addressed in 2003. She also criticized the security around the landfill. "On an inspection on May 22, 2012, I had asked about the perimeter fence and whether or not there had been any • security breaches," Mingo wrote. "[I learned that] several years ago young children had accessed the site with their motorcycles. "More recently, I became concerned about access to the landfill when a concerned citizen emailed several photographs that appeared to be taken from inside the landfill. "In a letter to the mill, I specifically requested they address access to the site in the permit renewal, [but]they responded inadequately, requesting that JCPH inform potential trespassers of the legal jeopardy." Loney said he stands by the company's operation of the facility. "Port Townsend Paper remains committed to the sound environmental management of the landfill," he wrote. Jefferson County Reporter Charlie Bermant can be reached at 360-385-2335 or at charlie.bermant(c�pen insuladailynews.com. • /dV `/// Port Townsend Leader Port Townsend Paper's inert landfill permit application is rejected Public health officer outlines appeals process • By Tristan Hiegler of the Leader ..�� ��5 .� r The Port Townsend Paper Corp.'s application fore an inert landfill permit has been rejected by Jefferson County, a move that's disappointed mill n officials, who have until Oct. 29 to file an appeal. Roger Loney, president of PTPC, wrote in an Oct. 22 email, "Port Townsend Paper did receive the county's letter denying our most recent landfill application. We are surprised and very ; � disappointed at the county's decision. This is clearly inconsistent with the approach that was laid out in the work that has been done with the county and the Department of Ecology over the The Port Townsend Paper Corp. currently has what is called an past year." inert permit for its landfill.The state Department of Ecology has told mill officials it was time the mill sought a Limited Purpose County health officials reported the rejection of Landfill (LPL) permit, a permit that has more stringent rules for the inert permit application Oct. 18. groundwater monitoring and financial assurance the mill has the means to clean up the landfill after it is full. Instead,the mill "I think we made it very clear what the standards applied for an inert landfill permit. Dr.Thomas Locke, public health officer for Jefferson and Clallam counties, on Oct. 18 are," Jefferson County Health Officer Dr. Tom rejected that application. Leader 2012 photo by Patrick J. Sullivan, Locke told the Board of Health at their regular flight by Port Townsend Aircraft Services meeting. "We can't ignore the fact that the waste stream is not inert." `We can t ignore he fact that.the}wasterstrea is not inert." It is unclear what will happen now that Locke has Dr Toro Locke rejected the mill's application. Locke and the state Department of Ecology had both told mill officials it was time the mill sought a Limited health pffrcer Purpose Landfill (LPL) permit, a permit that has �� more stringent rules for groundwater monitoring Jefferson CougtY/Clafam County and financial assurance the mill has the means to clean up the landfill after it is full. Despite being told to seek an LPL permit, the mill submitted an application Sept. 4 for an inert permit. The application pledged that the mill would do groundwater monitoring and included financial assurances about cleanup. However, the mill's application still sought to classify the waste stream going into the landfill as chemically inert. Locke said the appeals process for his decision, under state regulations, involves a hearing with himself as the health officer and then potentially a hearing with the state Pollution Control Hearings Board. He said local regulations allow for a hearing with him and then a hearing with the Board of Health. Locke recommended following the state regulations. Locke added in a separate interview the mill could make a legal case for either appeals pathway. He said the state regulations detail a more streamlined approach with just one local hearing before moving on to the state board. He said the mill has 10 days as of his decision —which was sent Oct. 17—to appeal. • The first hearing with the health officer takes place 30 days after that notice of appeal is received, Locke said. "We still need to review the county document before deciding our path forward. Port Townsend Paper remains committed to the sound environmental management of the landfill," Loney wrote in his statement. Under Locke's decision, the mill has to apply for an LPL permit or appeal the decision. He said if mill officials decide to do neither of those things, the current permit could be suspended and the landfill rendered legally unusable. He said options like court mandates could also be pursued. When asked what he would do if the mill took no action, Locke said "I'm not aware of any situations where a permit • owner has done that." During the meeting's public comment period, several people spoke in support of Locke's decision. About 20 people attended. Gretchen Brewer, PT AirWatchers, said she approved of the decision and urged the Board of Health to monitor other waste streams from the mill, including the water from the settling ponds in front of the mill proper. "I thank you very much for being strong on the limited-purpose designation as required," Brewer said. Waste classification After the meeting Thursday, Locke said his rejection of the mill's application has no immediate impact on mill operations. "We have not, for instance, voided their permit to do what they're doing now," he said. The mill's current permit is valid until they reapply for the LPL or the appeals process is done. Locke said the inert waste has to meet two specific criteria: The materials have to be on a list of materials that aren't chemically reactive, such as concrete slabs, and the materials aren't capable of trickling into the water supply. The second criteria is the materials can't be hazardous to human health. Locke said the landfill ash meets neither requirement. He said it has the potential to enter ground water and is • toxic to humans. He said mill workers and others have to wear protective gear when handling the ash. He described it as"caustic." "It's not safe for direct human contact," he said. "The technical arguments are more elaborate, but that's really what it comes down to." Locke added he doesn't consider the landfill to be a public health hazard, but it does need to properly classified and permitted. "Were' not saying this a hazardous waste," he said. "We're just saying it's not inert." Locke said the financial assurances and ground water monitoring plans included in the Sept. 4 permit application were insufficient to meet state standards. He said the water-monitoring plan was close, but the financial assurance aspect needed more work. 1111 10/24/2012 12:18:00 PM,Port Townsend Leader Pertussis rates dropping here; Unique disease profile in Jefferson County due to immunization rates By Tristan Hiegler of Leader Jefferson County health officials continue to emphasize that while pertussis rates are declining, aspects of the disease's spread in Jefferson County are worrisome. "Fortunately, it's winding down," Health Officer Dr. Tom Locke said. "There's some interesting trends in our county that are different than we have seen elsewhere in the state." According to the Washington State Department of Health's website, 4,348 case of pertussis—also known as whooping cough —have been reported in the state as of Oct. 13, 2012. There were 524 cases statewide in 2011. According to documents presented at the Jefferson County Board of Health regular meeting Oct. 18, out of 20 confirmed cases and two probable cases here, many were among children ages 1 to 6. The cases were reported between Jan. 1 and June 16, 2012. There were eight cases for ages 1-6, four cases for ages 10-18 and nine cases for adults over age 20. Only one case was reported for a child under 1. Locke said the low infant numbers are a positive as"almost all pertussis fatalities occur in the first year of life." He said what makes Jefferson County's profile unusual is most of the cases across the state were in ages 10 and over. He said the high number of cases for ages 1-6 was unusual. He said part of the reason is the vaccine, developed to be effective for the first five years of life, wears off faster than expected. He added nine of the confirmed county cases were not up to date on their immunizations and the immunization status of seven others remains unknown. • Locke said he expects the community has some time before another outbreak because of the increased rates of pertussis resistance gained in the community throughout the year. He said it could be four years before another outbreak occurs that is similar to what happened in 2012. "Fortunately, we're looking back at this outbreak... we're not expecting another outbreak like this next year," he said. "We got a breather to redouble our efforts with vaccination." He said he predicts changes with the juvenile and adult vaccination schedules to better vaccinate the population statewide. Immunization rate Jean Baldwin, director of Jefferson County Public Health, said during the meeting that part of the problem comes from how one of the juvenile vaccines was weakened. She said the stronger vaccine caused soreness and crying in infants, and while the milder version is more comforting, it's not as effective at developing an immunity. She said immunization rates throughout the county remain an issue. Baldwin said the county has "a spotty immunization rate" across all age ranges. A report analyzing county immune rates puts Jefferson County fourth from the bottom, she said. Baldwin added free pertussis vaccines are still available. According to Department of Health data, 9.5 percent of Jefferson County kindergarteners were exempted from required school immunizations in the 2011-2012 school year. That's lower than 2010-11, which had a 16 percent exemption rate and 2009-10, which had a 16.3 exemption rate. 411 To compare, 7 percent of Clallam County kindergartners and 2 percent of Grays Harbor kindergartners were exempted in 2011-12. SmileMobile comes to Chimacum Nov. 8 The SmileMobile, a fully clinic manager, a dentist and equipped mobile dental din- a local volunteer dental profes- ic, is to be at Chimacum sional. High School on Nov. 5-6 For an appointment, call and again Nov. 8 to provide Heather Sebastian at 385- dental care to families with 9400 at Jefferson County limited income. Public Health. Operated by Washington Follow-up treatment Dental Service Foundation appointments will be sched- in partnership with Seattle uled on a space-available Children's Hospital, the basis. SmileMobile accepts state The SmileMobile is not Provider One insurance and associated with the school dis- serves families on a sliding-fee trict. It will be at the high scale based on family income. school, 91 W. Valley Road, The mobile is staffed by a Chimacum. • • ? _ /o/d e3/4,2_ Family recovered • from bad shellfish • By Tristan Hieglerof the Leader One family member was placed on a ventilator while at Members of a family of Jefferson Healthcare.Baldwin vacationers who were taken said all the family members to the emergency room after were released the week of eating Discovery Bay mus- Sept. 23. Hospital stays sels have all returned home, ranged from one to three days according to county health and all family members fully officials. recovered. The seven-person fain- "The way PSP kills you is ily ingested mussels with it paralyzes your breathing high levels of paralytic shell- muscles,"said Dr.Tom Locke, fish poison Sept. 22. Jean Jefferson County health offi- Baldwin, director of Jefferson cer."It could have been much County Public Health, report- worse. This group did the ed Oct. 18 that the Seattle right thing;they called 911." family walked onto a private According to a Public dock in the evening. She told Health release, PSP is a bio- the Jefferson County Board toxin caused by some spe- of Health the family walked cies of algae and can become past at least four signs warn- naturally concentrated in ing beach-goers not to harvest shellfish. shellfish from the area. Baldwin said Discovery Baldwin said record lev- Bay has been closed to rec- els of PSP have recently been reational shellfish harvesting recorded in Discovery Bay. since July, adding that the After harvesting and Washington State Department • ingesting the contaminated of Health provides interac- • mussels from 10 p.m. to mid- tive maps that people can night, the family members felt use to check on beach clo- ill and contacted 911. They sures. Maps can be found at were taken to the .Jefferson doh.wa.gov/Communityand Healthcare emergency room Environment/Shellfish/ in Port Townsend early Sept: BeachClosures.aspx. 23. Two,were transported to The Washington State Harrison Medical Center in Department of HeaIth's shell- Bremerton. fish hotline is 800-562-5632. • 17- /ay/.z, Port Townsend Paper appeals denial of landfill permit • By Charlie Bermant, Peninsula Daily News, October 31, 2012 * 1 3„ ,,..., 7 r aigS `3rcr F F. x0„:„.,, _., K S. f, a - I Q Charlie BermanUPeninsula Daily News The Port Townsend Paper Corp. maintains that nothing has changed in the way it generates its waste. PORT TOWNSEND —The Port Townsend Paper Corp. has appealed the Jefferson County Public Health Department's denial of the company's inert landfill permit renewal. The mill requested an inert permit against the advice of Dr. Tom Locke, public health officer for 0 Clallam and Jefferson counties, and the state Department of Ecology to instead seek the more environmentally stringent limited-purpose landfill — or LPL— designation. The county denied the permit extension Oct. 17. The paper company appealed the denial Monday. The county now must conduct a hearing that will take place between five and 30 days from the date of the appeal. That hearing has yet to be scheduled, said Jefferson County Environmental Officer Pinky Feria Mingo. "The health officer, with the full support of the Department of Ecology, granted inert permits for the past eight years,” said Port Townsend Paper President Roger Loney in a statement. "We seek to continue this status because the wastes we generate have not changed, the landfill hasn't changed, and the regulations haven't changed," Loney said. "For these reasons, PTPC has filed for an appeal of the health officer's decision." The appeal to the county, written by attorney Leslie Nellermoe, said the waste generated by the 0 mill should continue its classification as inert because "Jefferson County and the Department of Ecology have been disingenuous at best or acted arbitrarily or capriciously at worst during the negotiations over this permit. "During the two years Port Townsend Paper Corporation has worked to resolve these issues, • ste [both agencies] stated that the landfill would regulated address your expressaconcernlsy" the appeal with certain additional requirements and this approach would said. "Now, after expending a significant amount of time, energy and money, your course unexpectedly changed without notice." The additional measures proposed by the paper company were to reinitiate groundwater testing and to provide financial assurances to cover the cost of closure if it were unable to cover costs. Neither of the measures is required for inert landfill permits. Locke said last week that the permit denial was because of concerns about the changing nature of the waste generated by the mill during operation of an expanded biomass cogeneration plant. The $55 million, 24-megawatt biomass-plant expansion project is planned to be operative next year. Additionally, the original granting of an inert permit was not appropriate, a situation the county is now attempting to correct, Locke said. "With the benefit of hindsight, the granting of the permit was an error," Locke said. "We know a lot more about this waste now than when we first granted the [2004] permit, and we are now revisiting the issue." Loney disagreed with this assertion. "We are proceeding with an appeal of the county health officer's ruling because the reclassification strictly to limited use is a significant change to the operation of the landfill," he wrote. and "We proposed additional safeguards to address concerns but the healtground h off officer rejected this on." financial assurance in our most recent application Jefferson County Reporter Charlie Bermant can be reached at 360-385-2335 or at charlie.bermant• •eninsuladail news.com. S 10/31/2012 6:00:00 AM,Port Townsend Leader PTPaperto appeal landfill permit Tristan corter sg i gtiOnt'st ct *o Ji rated tse is a In Port Townsend Paper Corp. officials are 4 �c�iange then rerattor sof#he�lenc ltJ' Wittoiw appealing the rejection of their application `�"'� �'"r�tV , pp 9 1 pp �,� �� Lone "� .,�� ��� � � A{r � s � , for an inert landfill permit. ,rli®° �i � PTPC President Roger Loney said Oct 29 the mill is appealing the decision by _ Dr. Tom Locke, Jefferson County healthPert Townsend Pap' Cgrp officer, to reject the company's application for an inert permit. Locke's decision, delivered Oct. 17, gave the mill the option of applying for the more stringent Limited Purpose Landfill (LPL) permit or appealing. The mill's application for the inert permit, submitted Sept. 4, included provisions for groundwater monitoring and financial guarantees for cleanup if the mill closes. Both provisions are requirements of the LPL permit. "We are proceeding with an appeal of the county health officer's ruling because the reclassification strictly to limited use is a significant change to the operation of the landfill," Loney wrote Monday via email. "We proposed additional safeguards to address concerns with groundwater monitoring and financial assurance in our most recent application but the health officer rejected this solution." • Pinky Feria-Mingo, environmental health specialist with Jefferson County Public Health, said in a phone interview, "I don't think it's a surprise," regarding the mill's decision to appeal. "We've been working with the mill for the past years to get them to submit a limited purpose landfill permit," Feria-Mingo said. Mill's response The mill's formal response to the permit application denial cites the 2004 decisions of Jefferson County Public Health and the DOE that recognized the landfill waste as inert waste. The response is dated Oct. 26 and stamped as received Oct. 29. It and other relevant documents are available at jeffersoncountypublichealth.org. The response was signed by attorney Leslie Nellermore with Wrenn Bender McKown & Ring LLLP. The response states: "The landfill has operated in compliance with its inert waste management facility permit since 2004. The relevant regulations have not changed, the waste has not changed and there is no legal basis for now saying that the waste is not inert. The permit should have been renewed." • County concerns In the Oct. 17 rejection, included as an amendment in the mill's response, Locke and Environmental Health Director Jared Keefer wrote that the mill's application "fails to adequately address the issues of groundwater monitoring, financial assurance for closure costs and waste stream characterization that are required for permit renewal. Moreover, it is our conclusion that these issues cannot be adequately addressed without correcting the misclassification of PTPC's waste as inert." The rejection also states that PTPC "generates a highly alkaline waste stream with the capability to produce a leachate that can adversely impact groundwater quality. This high pH waste is also unsafe for direct exposure to human tissue." The rejection states the 2004 inert classification decision "was in error." Feria-Mingo said the waste has a high pH content and should not have been classified as inert. She said one of the arguments made for the inert status revolved around how the waste reacted in the landfill itself. She said the geography doesn't matter; the waste classifications apply directly to the waste materials. The mill response states, "During the two years Port Townsend Paper Corporation has been working to resolve these issues, the Health Department and Ecology stated that the landfill would be regulated as an inert waste facility with certain additional requirements, and that this approach would address your expressed concerns. Now, after expending a significant amount of time, energy and money, your course unexpectedly changed without notice." Appeals process The appeals process could go one of two routes: The mill could seek a hearing with Locke and then proceed to the state Pollution Control Hearings Board, or they could have a hearing with Locke, the Jefferson County Board of Health and then the Pollution Control Hearings Board. • Loney said he isn't sure which route the mill is going to take. "We will be looking for Dr. Locke to give us feedback over the next few days on what he sees as next steps in the process. It's unclear at this point," Loney wrote. The hearing has to take place 30 days after the notice of appeal is received. Feria-Mingo said only Locke will be ruling on the case during the initial hearing. She added she'll be scheduling the date this week. The mill's response states "PTPC seeks an agreement with the Jefferson County Health Department that should it seek further review of the decision on this appeal, the course forward would be an appeal to the Pollution Control Hearings Board." Loney said the mill has a history of receiving approval for inert permits. "The health officer, with the full support of the Department of Ecology, granted inert permits for the past eight years," Loney wrote. "We seek to continue this status because the wastes we generate have not changed, the landfill hasn't changed, and the regulations haven't changed. For these reasons, PTPC has filed for an appeal of the health officer's decision." r • letters Hope the mill takes alternate route The article about the rejection of the mill landfill permit application by Dr. Locke sounded like the mill was an aggrieved party. Port Townsend Paper Corp. President Roger Loney said he was "surprised and very disappointed." Maybe he has been outside the loop on this issue. Since almost a year ago, specifications for a permit were given to the mill. It was the mill's choice to ignore key parts of those specifications when it belatedly applied for its permit. It chose to see them as a negotiating document rather than specifications, and now talks about"meeting in the middle.' A transition to a limited-pur- pose permit. as clearly required by Jefferson County Public Health and the state Department of Ecology, is necessary to meet state statutes • to properly protect environmental and public health, as well as assum- ing responsibility for realistic clo- sure costs. which will otherwise fall upon county taxpayers. There is no surprise. as Mr. Loney claims. just posturing and delaying tactics. This permit could have been concluded a year ago if the mill had shown cooperation. Eveleen Muehlethaler, vice president of envi- ronmental affairs for PT Paper, was quoted by a Department of Ecology staffer as saying the mill wanted to delay the permit process as long as possible.And it has. By the time the Leader goes to print,we should know if the mill opts to appeal.It should know it will lose. If this is the plan.it will cause much further delay. I hope themill takes the alter- nate route, to accept the new permit requirements. and take responsibil- ity for the waste it produces. It is what a company that claims to serve its community should do. DAVID McWETHY Port Townsend • • r 4,1::.; - . � t kw r �� "� i is t f.., i # ? t' "'' t� _0.-6, ,nYC r s f 4i. n 4.r.-...' . '.,...',i...Z•d.'..,-.1.-::Itt. -. --,.1.„„Y`.lc r .. -". ' - -, lic":-.4.........-. ' '''''' 4".9.7.,t;:::*`1',.....-f ''''' 'V.-1"-.*:'......,-. ".. .,,s, ' .'"' 4. "'".'" ' J i J y r ,--- -.", .- V sg....i... -r,"*... -..',; ,, ., r--",-.i:,--' ...-'5",:-,." - r ' ',-."::: . -.- ,IT -, S4""111.4! ' 4 is*�.�a ,.',$---.7, '. ski, `: „ �4 S ---.r. --a- -,vw.:,....,6,,,,,,:ii..f:,.. .. id.:.;;;,:ki -,,... . _,,,:,,,,,ese,,,,r p.. . , , --Ia. F x ` .t .. x.R .r k .,,, iii e �eze AY-,; �' ,xy¢,yi .DMI'4` R YA- : ^4„ c... a ',1'..';''.;',,e.' • .,i „Yl _,7 _ . J{ 4 }_ firs`'' 99pp 3 -# t,- - ., it" : i7 yi`.R 4 # 4.4.3- gry ' %} --*•'-'-`:,,,,---,, - r io ,1 4n<}r�y24v..4 • Ci : p Yyx fi;y, pa xt r 0�r " PORT TOM"NSE\D MAIN STREET PROGRAM GIRLS' NIGHT OUT GOES ALL OUT Jefferson County Public Health Public Health Nursing Director Julia Danskin, left, accepts a $3,046 donation for Public Health's Breast and . Cervical Health Fund Program from Gail Boulter of Port Townsend's The Clothes Horse and Sue Arthur, chair of the Port Townsend Main Street Promotion Committee and owner of Maricee Fashions. The donation represents funds raised from the sale of goodie bags and raffle tickets during Port Townsend Main Street's Girls'Night Out event. Funds will help local women receive cancer screenings. • , ;>,;, / /.,L, 2-7^ ; raj ,. -7'n k of: 2g`P X � ifi 4 '� f . ', 4kixii33 _•.. 6N el°..�`�si,,. .a .S.'.'x C.:^-.Y.f lSse �tl'�F. xF'k'. 's 'i.fiuzYFA.7-.;AF 4 .. �..?S Panel plans mendations when they commissioners Nov. 19. meet today. Public comment will be special meet The special 'Heeling will taken. begin at 4 p.m. in the large today in PT conference room at Jeffer- son County Public Health, 615 Sheridan St..,Port PORT TOWNSEND — Townsend. Members of the Jefferson The panel will review Mental Health and Sub- 2013 applications,discuss stance Abuse Sales Tax its budget and talk about Committee will discuss recommendations to be applications and recum- presented to the county • • T6/\/ f//6/% 8 J. .� J :2., • . Itim res c w y▪'^? r a, e . 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E.-, 0,-,-, 000 ..,4 n U '0.,si _ CP. , xd U s a - A ~c ^ r8 v a . o z4 G o d we) Co gw c>on o a>.d 0.0 w O C aY O"2 woO aO4r a> a> ✓U4 r d c7) ao ow as a)Zoa> 4 o� G, i'Uag m- • .. • 11/12/2012 1:14:00 AM,Port Townsend Leader Some Jefferson County beaches reopen to shellfish harvesting after PSP danger subsides Port Townsend Bay, Oak Bay, Admiralty Inlet and North Hood Canal have reopened for recreational shellfishing. Levels of the marine biotoxin that causes paralytic shellfish poisoning (PSP) are currently below the recreational closure level in these areas. The Washington Department of Fish and Wildlife (WDFW) warns, however, that before harvesting on public tidelands, people should be sure to check WDFW seasons. Recreational shellfish beaches on Discovery Bay, Port Ludlow Bay and Mats Mats Bay still remain closed for all species due to marine biotoxin levels. Kilisut Harbor, including Mystery Bay, remains closed to harvesting butter clams only. The closure applies to clams, oysters, mussels, scallops and other species of molluscan shellfish. This closure does not apply to shrimp. Crabmeat is not known to contain biotoxins, but the guts can contain unsafe levels. To be safe, clean crab thoroughly and discard the guts (i.e., butter). Marine biotoxins are potentially life threatening, and cooking or freezing do not destroy the biotoxins. Call the state Department of Health Biotoxin Hotline at 800-562-5632 before harvesting shellfish anywhere in Washington state. • Check WDFW seasons by visiting wdfw.wa.gov. S 0 - VJ _ m •- a �� F o ^ o � \ G 3 • .� c r ' y c Ch a r y c, v0 — 1. V: '� �-' :Jl J U J . V . ^Z..) nGy teT l —JrQY .--.. y J rj O . rJ J j ' _ -! if • J C i. w J _ , J cr, " .. J J A J.' C i J iJ v ' J J CI !J E 7 ::,, • r �, - '`'' ^) O CJ .-a ^ :tel --• a a C' • 7. J J i ^ .w yD--7 5:: 4.•-j- J4.4. y J "J. ^ U "' 1 N :.1.� 911641 , ra CJ CJ 'F,. ?.= ti J.J ^ J • r JJ r ..fi J J .-r ~ C J r ,U iCi. V • J -• co v "' r c n — l J - C: V J T j _ J v • Beaches reopen to shellfish Port Townsend Bay, Oak recreational closure level apply to shrimp. Crabmeat is Bay, Admiralty Inlet and Recreational shellfish not known to contain biotox- North Hood Canal have beaches on Discovery Bay, ins, but the guts can contain reopened for recreational Port Ludlow Bay and Mats unsafe levels.To be safe,clean shellfishing. Levels of the Mats Bay still remain closed crab thoroughly and discard marine biotoxin that causes for all species due to marine the guts(i.e.,butter). paralytic shellfish poisoning biotoxin levels. Kilisut Marine biotoxins are (PSP) are currently below the Harbor. including Mystery potentially life threatening, Bay. remains closed to har- and cooking or freezing do not vesting butter clams only destroy the biotoxins. Call the The closure applies to clams, BioCoxin Hotline at 800-562- oysters, mussels, scallops and 5632 before harvesting shell- other species of molluscan fish anywhere in Washington shellfish.This closure does not state. • S Holiday Open House from 4 to • 8 p.m.Friday,Dec. 14 and from 10 a.m.to 2 p.m.Saturday,Dec. 15 at the Cotton Building, 607 Water Street,Port Townsend. Community members may bring up to three toys and small household items to be screened • using an X-ray fluorescence • device to see if there is lead in them that could be harmful to children. Examples of recycled and no-waste gift-wrapping, holi- day decoration and tree orna- ments, produced by the staff of JCPH,will be on display.The public is invited to vote for their favorite item in several catego- ries. Children and adults will be invited to create recycled wrap- ping paper using old newspa- per and paper bags supplied by JCPH. Waste-free holiday Information regarding lead open house exposure, Christmas tree dis- posal and using less during the Jefferson County Public holiday season will be available. Health offers waste-free holiday Contact Pinky Feria- ideas and free lead screening Mingo, environmen- for toys. tal health specialist, at The health department is 379-4489 or email her at hosting a Waste and Toxic-Free pinky@co.jefferson.wa.us. • 11/21/2012 6:00:00 AM,Port Townsend Leader County, state square off with mill over landfill Hearing set for Nov. 28; public testimony not accepted Allison Arthur, assistant editor FDikttit rillattut • 9 Port Townsend Paper Corp. and Jefferson A teadrtag`;on�i?�o,,t Ownseriti i 400.fiQoYp's inert landfill County Public Health are preparing to square off perryf+ t"to star#at 40 a m r Wednesday, tclov 28, at in front of Jefferson County Health Officer Dr. tfiMasanic�odge, 13 �Jfferson S m�Port Town enI,, Tom Locke in a day-long hearing over the mill's wtfh Jefferson County Health fiicer Dr,Tom Locke landfill permit. pres ang ` � State Department of Ecology (DOE) officials will Ait °ugh the public is welcameto attend, the hewing is administrative and public coni tent or testimony will not be side-by-side with county health officials at that b®Taken Seatm �s limited and�s an a first come,first meeting, set to start at 10 a.m. and end at 4:30 serve bases, according tb a legal notice,of thm e eeting p.m. Wednesday, Nov. 28 at the Masonic Lodge. The meeting is open to the public, but public comment will not be taken, said county environmental health specialist Pinky Feria-Mingo. She will lay out the county's case, which rejects the mill's application to renew its inert permit and seeks to require the mill to move to a stricter kind of permit called a Limited Purpose Landfill (LPL). Peter Lyon, regional manager for the Waste 2 Resources Program for the state Department of Ecology, oversees landfills in 12 counties and will be on hand at the meeting. • The DOE has not sent the county any formal comment on the mill's application, but has been supplying technical support to the county, Lyon said. Lyon said he was not surprised to see the mill apply for an inert permit, but he said the county's decision last month to reject that application and conclude that the mill's waste stream "does not meet the criteria to be classified as inert," matches the DOE's understanding of state environmental regulations. Lyon also confirmed that there are no other ash landfills in the state that have been permitted as inert landfills. An LPL permit would require the mill to do groundwater quality monitoring by drilling several wells and would require the mill to prove it has the financial means to close the landfill when it is full and needs to be capped. There was a period when the mill did have an LPL permit— between 1990 and 2002 — but DOE officials have not found any evidence the mill ever met the financial assurance rule, Lyon said. "Ecology has no record of what financial assurance mechanism the mill had," Lyon said. "And we've certainly looked." In the application for an inert permit, mill officials say they will "provide financial assurance for the closure of the PTPC inert waste stream" once an inert permit is issued, and that the information would be incorporated into its Plan of Operation. 40 In June, Lyon said the Nippon Paper Industries in Port Angeles uses a financial assurance instrument option test to guarantee its closure and post closure estimate, which is roughly $2.3 million. To date, the Port Townsend mill has not said, specifically, what financial assurance method it would use, according to DOE and county officials. As for water-quality testing, Lyon said the DOE would like to see a minimum of four wells, three wells • downgradient of the landfill and one above it. An old, existing well might be able to be reopened. Two other wells are already established, Lyon said. He estimated the cost of establishing a well to be about $25,000 to $50,000. Relationship with biomass Lyon said that the mill does not need a new permit in order to start a co-generation biomass project, which it intends to build in 2013. But it is because of that $55 million co-gen project that the DOE and county officials started talking about the landfill, although Lyon said the mill had been talking about the permit issue back in 2007 and he questions why the mill had been allowed to have an inert permit. The co-gen project is expected to produce more ash and lime grit when the mill starts burning more biomass. More ash means the life-span of the landfill is expected to be shorter than originally planned when the mill started using the site, south of the mill on a hill overlooking Port Townsend Bay, some 40 years ago. Eveleen Muehlethaler, vice president of environmental affairs for PT Paper, has acknowledged that more ash and lime grit will be created and that will cause the landfill to fill up faster. Muehlethaler also said the mill has been conservative in the past and she estimates the landfill still has a life of more than 30 years. • Waste stream issue In an Oct. 17 letter to the mill, Locke and Jefferson County Environmental Health Director Jared Keefer told the mill to apply for an LPL and a key reason is the waste stream —the kind of waste the mill is producing and putting into the landfill. "PTPC's waste stream does not meet the criteria to be classified as inert," the two health officials wrote, adding that the health department and DOE were ready to work with the mill to craft language that meets the state laws and also to consider waivers to LPL requirements "when warranted." The waste stream is a "highly alkaline waste stream with the capability to produce a leachate that can adversely impact groundwater quality," Locke and Keefer wrote. Locke is now in a position to either agree with his own conclusion, or change his mind once the mill presents its position and potentially new information. Through its attorney Leslie Nellermoe, the mill responded that the health department and DOE had concluded in 2004 that the landfill meets "the state regulatory definition of inert material." Nellermoe also wrote that the county and DOE were acting "arbitrarily and capriciously at worst during the negotiations over this permit," and that county officials were "unexpectedly" changing course without notice. • As for legal advice, Feria-Mingo recently asked Lyon for a copy of the letter Lyon had received earlier this year from Jonathan Thompson, an assistant attorney general with the state Attorney General's Office, whom Lyon had asked for an opinion on the 1990 Pollution Control Hearings Board (PCHB) ruling that sided with the DOE and concluded the mill's waste stream didn't meet the definition of inert. Thompson noted that in 1990 PCHB held that the combination of hog fuel boiler ash and lime kiln "grit" that was being placed in the landfill did not meet the definition of"inert" as defined by state law. There have been new criteria since then for determining what is inert and what isn't. Thompson ends his email of Feb. 27, 2012 to Lyon by stating that "assuming the properties of the waste remain the same, the Board's analysis from the 1990 decision would arguably still apply under the new criteria." Mill President Roger Loney has said in letters to the county that the mill is willing to resume water testing and provide financial assurance. "We seek to continue this status because the wastes we generate have not changed, the landfill hasn't changed, and the regulations haven't changed," Loney said last month. "For these reasons, PTPC has filed for an appeal of the health officer's decision." Next step The mill and county have already agreed to send the question back to that same Pollution Control Hearings Board if Locke sides with Feria-Mingo and his own earlier conclusion. Feria-Mingo said Locke could issue an oral ruling that day or take the matter under advisement, she said • • 11/26/2012 10:28:00 AM,Port Townsend Leader Updates on Mat Mats Bay water quality presented at Nov. 28, Dec. 3 meetings in Port Ludlow Jefferson County Public Health plans to present a final report on the Mats Mats Bay Water Quality Improvement Project at two public meetings, Nov. 28 from 1:30 p.m. to 2:30 p.m. and Dec. 3 from 5:30 p.m. to 6:30 p.m. Both meetings are at the Port Ludlow Fire Hall, 7650 Oak Bay Rd. Public Health staff will present the results of a four-year effort to reduce sources of fecal pollution in the watershed and the bay. Time will be given for discussion. Having two meetings allows people to attend whichever one best fits their schedule. The Mats Mats Bay Water Quality Improvement Project is a Centennial Clean Water Project, funded by the Washington State Department of Ecology and Jefferson County. Set to conclude this December, it has been directed at preventing downgrades of shellfish harvest areas and keeping the waters clean for safe recreation and enjoyment. Causes of pollution that were addressed in the project included failing septic systems and farm runoff. Public Health staff conducted door-to-door septic "sanitary surveys" to help homeowners learn how to protect and monitor their septic systems. Classes were conducted and educational newsletters sent out to all residents in the area. Failing • septic systems were repaired with financial assistance available for qualified homeowners. Contact Jefferson County Public Health, Environmental Health or the Water Quality Program at 385-9444 Mondays through Thursdays for questions, or see the website, jeffersoncountypublichealth.org. • S Port Townsend Paper's appeal of landfill permit denial set Wednesday By Charlie Bermant, Peninsula Daily News, November 27th,2012 • PORT TOWNSEND—The Port Townsend Paper Corp.'s appeal of a Jefferson County Health Department denial of a permit renewal for its landfill will be heard Wednesday at a public meeting. For its annual permit renewal in September, the mill applied for an extension of its inert classification,which the county agency denied Oct. 17. The mill appealed the decision on Oct.22,triggering Wednesday's hearing to review the decision. The meeting will run from 10 a.m. to 4:30 p.m., breaking for a one-hour lunch at noon, and at the Masonic Lodge, 1338 Jefferson St. in Port Townsend. The meeting is open to the public but no public testimony will be taken. County Environmental Officer Pinky Feria Mingo said admittance to the hearing will be available on a first-come, first-served basis since the hall accommodates about 130 people. Jefferson County Health Officer Dr.Thomas Locke, who denied the permit extension,will conduct the hearing in much the same way as a court, Mingo said. During the morning session, the respective arguments will be presented—first by the county as represented by Chief Civil Deputy David Alvarez. Then mill representatives will follow. Each side will have an opportunity for rebuttal, Mingo said. The inert waste permit was first granted in 1989 and renewed several times since, an action that health officials now say was an error in judgment. In his denial of the permit, Locke said he took the action because of concerns about the changing nature of waste generated by the • mill during operation of an expanded biomass cogeneration plant. The$55 million, 24-megawatt biomass plant is planned to be operative next year. Locke said the granting of the original permit was in error because more is known about waste than when it was first granted. The mill has based its appeal on the idea that its operations have not changed, so the permit process should also remain consistent. "We seek to continue this status because the wastes we generate have not changed,the landfill hasn't changed and the regulations haven't changed,"said Port Townsend Paper President Roger Loney in a statement Oct. 25. Port Townsend Paper's appeal to the county, written by attorney Leslie Nellermoe, said the waste generated by the mill should continue the classification as inert because"Jefferson County and the Department of Ecology have been disingenuous at best or acted arbitrarily or capriciously at worst during the negotiations over this permit." Nellermoe added: "During the two years Port Townsend Paper Corp. has worked to resolve these issues, [both agencies]stated that the landfill would be regulated as an inert waste facility with certain additional requirements and this approach would address your express concerns. "Now, after expending a significant amount of time, energy and money, your course unexpectedly changed without notice,"the appeal document tells the county. The additional measures proposed by the paper company are to reinitiate groundwater testing and to provide financial assurances to cover the cost of closure if it were unable to cover costs. Neither is required for inert landfill permits. At the hearing, Locke will act as judge, choosing to uphold or reverse his decision based on information gathered, Mingo said. Locke could make his ruling on the spot, but Mingo said she expected that he would most likely take the new information under • advisement and rule at a later time. Jefferson County Reporter Charlie Bermant can be reached at 360-385-2335 or at charlie.bermant(a?peninsuladailynews corn. 11/27/2012 12:52:00 PM,Port Townsend Leader Mill landfill hearing is Wednesday morning A hearing on Port Townsend Paper Corp.'s inert landfill permit is set to start at 10 a.m., Wednesday, Nov. 28, at the Masonic Lodge, 1338 Jefferson St. in Port Townsend, with Jefferson County Health Officer Dr. Tom Locke presiding. Although the public is welcome to attend, the hearing is administrative and public comment or testimony will not be taken. Seating is limited and is on a first-come, first- serve basis. The mill is objecting to a decision by Jefferson County Public Health that rejects the mill's application for an inert permit. Both the county health department and the state Department of Ecology have been suggesting the mill move to what is called a Limited Purpose Landfill permit that requires the mill to do groundwater-quality monitoring by drilling several wells. An LPL also would require the mill to prove it has the financial means to close the landfill when it is full and needs to be capped. Mill officials have steadfastly objected to that, saying the waste stream at the mill hasn't changed and it has been permitted since 2002 as an inert landfill. They also say once an inert permit is issued they would provide financial assurance and do groundwater testing. • The landfill is the only ash landfill in the state that isn't under an LPL classification, according to state Department of Ecology officials. The mill and county already have agreed to send the question back to that same Pollution Control Hearings Board if Locke sides with the county and the state and his own earlier conclusion that the mill needs an LPL. • Akamai Art receives green certification Akamai Art & Glass Supply has received third party certification as a Green Business. This certifida- tion demonstrates Akamai's environmental leadership and commitment to reducing waste and conserving natural resources. Jefferson County Public Health's Green Business pro- gram recognizes local busi- nesses that integrate environ • - mentally sensitive decisions and use sustainable practices in their daily operations. r 11111 ///242//,2-- Decision deferred on Port Townsend paper mill landfill permit By Charlie Bermant , Peninsula Daily News, November 29, 2012 • far Charlie Bermant/Peninsula Daily News Public Health Officer Tom Locke listens as Eeveleen Muehlethaler, environmental officer for Port Townsend Paper Corp., at a hearing Wednesday. PORT TOWNSEND— Dr. Tom Locke, public health officer for Clallam and Jefferson counties, deferred a decision Wednesday on whether to uphold or strike down the Jefferson County Public Health Department's denial of an extension of a permit that designates as inert a landfill at the Port Townsend Paper Corp. mill. "There is a lot of technical material here that I haven't read," Locke said after a full day of testimony attended by about 60 people at the Masonic Lodge at 1338 Jefferson St. in Port Townsend. "'Locke is required within 30 days to render a decision, which can be appealed to the state Pollution Control Hearings Board. At issue is whether Port Townsend Paper Corp.'s mill should be granted an inert waste permit—which it has had since 1989—or if the denial of the permit by the public health department will stand, and the mill will be required to acquire a more-stringent limited-use permit. "We have worked with an approved process as to what the standards would be, and we have been working within those limits," said Leslie Nellermoe, an attorney for the mill. "We have looked at the regulations and find certainty that the permit denial should be reversed and the permit should be granted." Jefferson County Chief Civil Deputy David Alvarez said the public health department's permit decision should be upheld. "We would ask that the Jefferson County health officer affirm his decision to deny the permit," he said. As a judge, Locke did not participate in the discussion or ask questions. Earlier, Locke had said the granting of the original permit was in error because more is known about waste than when it was first granted. Nellermoe called as witnesses the Port Townsend Paper Corp. environmental officer, Eveleen Muehlethaler, and geologist Brian Butler. Ai Alvarez called Jefferson County Environmental Officer Pinky Feria Mingo and Department of Ecology employees WIP Wayne Krafft and William Harris, Peter Lyon and Tom Culhane. The waste generated by the mill consists of wood ash lime grit on a 6-to-1 ratio and has a pH rating of 11 to 12, mill witnesses said. Solutions with a pH of less than 7 are said to be acidic, and solutions with a pH greater than 7 are basic or alkaline. The witnesses presented by Alvarez all said any pH rating above 8.5 should not be defined as inert. Muehlethaler said she disagreed that a pH of 8.5 is too high to qualify as inert, saying, "There is nothing in science or regulations" that supports that designation. Nellermoe said the appeal was not predicated on where inert begins on the pH scale but that the mill's levels are within the scope of current regulations. Muehlethaler and Mingo testified about the steps that led to the denial of the permit. Muehlethaler said the requirements for an inert level of waste and the type of waste generated by the mill have not changed, so there is no reason the permit should be denied. "The processes that generate these wastes haven't changed since 1989, and what the mill has produced has been consistent," Muehlethaler said. "The landfill is a well-designed site that is ideally used as a landfill." Muehlethaler said the mill had worked with the county for one year fashioning a compromise that would allow the inert designation, and she said she was surprised when the permit was denied. "Information can change, and data can change, but if they just change their minds, that's not really kosher," she said. Mingo, who prepared the staff report supporting the denial of the inert permit, said definitions have changed. "We found overwhelming evidence that the landfill does not meet the definition of inert," she said. "Anything with a pH of 8.5 or above should not be considered inert waste." • Kraft said he was not aware of another facility with comparable output that had been granted inert status and that such a permit for the mill was"a unique situation." For its annual permit renewal in September, the mill applied for an extension of its inert classification, which the county health department denied Oct. 17. In his denial of the permit, Locke talked of concerns about the changing nature of waste generated by the mill during operation of an expanded biomass cogeneration plant. The $55 million, 24-megawatt biomass plant is planned to be operative next year. The mill appealed the decision Oct. 22, triggering Wednesday's hearing to review the decision. Jefferson County Reporter Charlie Bermant can be reached at 360-385-2335 or at charlie.bermantrrJpeninsuladailynews.com. • Jefferson Country Environmental Health Presents Waste and Toxic-Free Holiday Open House! . *FREE* Friday, December 14, 4-8 p.m. Saturday, December 15, 10 a.m.-2 p.m. Cotton Building, 607 Water St. Are your children's or grandchildren's holiday toys contaminated with lead? Come and make certain the gifts you give or have are lead free! On site will be a hand held, xrf (x-ray florescence) analyzer, that safely and accurately tests for the presence of lead on toys. *Bring up to 3 toys per perso In addition, there will be a demonstration of waste free holiday wrapping and decorating. Make your own recycled wrapping paper! • S 12/5/2012 6:00:00 AM,Port Townsend Leader Locke rejects mill's landfill plan Appeal to go state Pollution Control Hearings Board •Ilison Arthur, assistant editor Jefferson County and the Port Townsend Paper Corp. are headed to the state Pollution Control Hearings Board to determine the future of the mill's landfill permit. Dr. Tom Locke, health officer for Jefferson County, advised the mill in an email Monday, Dec. 3 that he would affirm a denial of the mill's application to renew its controversial inert waste landfill. Kevin Scott, the new environmental director for the mill, said in an email Tuesday that the mill intends to appeal the decision to the state board "to preserve our rights for review of this permit denial." Scott also announced in that email that the mill's vice president for environmental affairs Eveleen Muehlethaler was retiring. Muehlethaler had been negotiating with the county to continue the landfill under an inert permit rather than a Limited Purpose Landfill permit, which mill officials have steadfastly objected to operating under. The LPL permit requires quarterly groundwater monitoring and financial proof the mill has the means to close the landfill once it is full. Day-long hearing The decision Monday followed a day-long hearing Nov. 28 at the Masonic Lodge. Locke had indicated at the end of the day that he would take time to weigh the information and could take as long as 21 days to issue a written decision. He didn't wait long. •Based on the testimony heard and written evidence presented, it is my decision as Jefferson County Health Officer to affirm the denial of the Port Townsend Paper Corporations application for renewal of the Inert Waste Landfill Permit," Locke wrote Monday, five days after the hearing. And it didn't take long for the mill to respond. "Port Townsend Paper has successfully managed the landfill as an inert waste landfill according to regulations that have not changed since 2004," Scott wrote in an email Tuesday morning. "The waste management facility permit should have been renewed last January when it was originally submitted," Scott wrote, adding that the mill remains willing to discuss the terms of the landfill permit with the county and state Department of Ecology. The state Pollution Control Hearings Board ruled in 1990 against the mill's inert landfill status and the mill operated under an LPL permit for about 12 years until it convinced the county to switch it back to an inert permit in 2003. Earlier decision Before final arguments at the hearing last week, Locke acknowledged that he was being asked to make a ruling in a case he already has judged. Along with Jefferson County Environmental Health director Jared Keffer, Locke signed a letter on Oct. 17 rejecting the mill's application for an inert permit. Locke and Keffer insisted the mill apply for an LPL permit, which would require the mill to provide groundwater monitoring and assurance that the mill has the financial means to close the landfill once it's full. 41 he mill appealed that joint decision by Locke and Keller. As administrative hearing officer, Locke was then given the sk of reviewing his own decision. "I don't find it awkward, although I think people could legitimately question the fairness of it," Locke said before closing arguments. "It's common in small rural counties [for officials]to wear multiple hats. You wear an executive hat at some time, a quasi-judicial hat sometimes. Each of those positions cannot be individually staffed." "It's my duty to render an impartial decision, and in order to do that, you have the evidence to consider." 411 Both sides Attorney Leslie Nellermoe, who has been representing the mill for years, said in closing arguments that the mill had worked collaboratively with both the state Department of Ecology (DOE) and Jefferson County Public Health in 2003. And at that point, she said, the mill's request to go back to an inert permit was approved by the agencies. The mill had operated under an LPL permit for about 12 years. Nellermoe echoed what mill president Roger Loney and Muehlethaler have been saying for months: that the waste hasn't changed, and neither should the permit. "The process that is generating the waste hasn't changed, and importantly, the rules haven't changed," Nellermoe said. The cost of moving from a simple inert landfill designation to a more complex and costly LPL designation has been a source of underlying contention. Mill officials have been asked, but have declined to say, what the difference in cost would be between operating the 40-year-old landfill under an inert permit versus an LPL permit. While Nellermoe repeated the mill's mantra about the waste not changing, Jefferson County Chief Civil Deputy Prosecuting Attorney David Alvarez called a platoon of state DOE officials to testify about the difference between inert and non-inert materials, studies that deal with the pH content of waste, and a study done by Landau Associates' Brian Butler for the mill to justify the inert landfill designation. DOE officials Bill Harris, Thomas Culhane, Wayne Krafft and Peter Lyon of the Waste 2 Resources program all said the waste stream of ash and lime grit produced at the mill and deposited in the mill's private landfill did not qualify as inert designation. The officials testified that there is potential risk of groundwater contamination from materials deposited that are above a • pH designation of 8.5. The ash and lime grit produced at the mill has a pH of as high as 11.5 to 12, officials and mill representatives acknowledge. A concern is that materials with a high pH have the potential for mobilizing metals, and leaching and contaminating groundwater. Culhane said such a concern did arise during a 12-year period when the mill had an LDL permit when groundwater testing performed by the mill indicated that water showing up seasonally in a shallow well contained elevated levels of barium and sulfate. "I think it very well could indicate that there is some contamination associated with this landfill," Culhane said, adding that the mill's consultant had suggested there were other reasons for the elevated barium levels. "We've discussed this internally at Ecology and we're not swayed by Mr. Butler's theory," Culhane said. DOE officials said repeatedly that there is a"potential" for contamination and that's why they want the mill to resume groundwater testing. "The Landau report, as you heard, picks and chooses the processes it uses, and that, of course, is the shortcoming of the report,"Alvarez told Locke in closing arguments. Mill officials have indicated they are willing to resume groundwater testing after an inert permit is issued, a move the county rejected. In its renewal application, the mill also offered to do a cost estimate of closing the landfill and identify which financial • assurance mechanism it would use, but as yet has not told the county what financial means—a bond, for example—it would use to prove it has the funds to close the landfill. a r ° . +'t," s` � A 4 ---'('‘'::::''''',41:;''''14 ,' Y zi ` ` .8 e'� ,� a tom' ". . Geologist Brian Butler of Landau Associates,a company that did.a report for the Port Townsend Paper Corp.to justify the company obtaining an inert permit for its landfill back in 2003, and Eveleen Muehlethaler,vice president of environmental affairs for the mill,review a document with the mill's attorney Leslie Nellermoe during a hearing on Nov.27 at the Masonic Center. Photo by Allison Arthur ?t Lr' ''''':*---',„-';'..;',,i'-' a ��`9 " 3x- r s 3 ''''-', 'Ii;;;;ii,L;;;;;;:ellil .;:iftt;:::,.?:;11-;', ,,,„,_-;,,r.,--;),i,. .'"2:4.T.:4,"f'11".,,,,•,..7;,,,:* tis .„ k Fxz s � v f- -."''. % ii' Dr.Tom Locke doubles as health officer for Jefferson County and an administrative hearing officer for decisions of the Jefferson County Health Department.A decision he and environmental health director Jared Keffer made regarding the Port Townsend Paper Corp.landfill has been appealed by the mill, and Locke now has an opportunity to change his mind.Photo by Allison Arthur • Port Townsend Paper to appeal denial of landfill permit By Charlie Bermant , Peninsula Daily News, December 5, 2012 • PORT TOWNSEND—Port Townsend Paper Corp. said it will appeal a decision by the Jefferson County health officer for a new permit for its on-site landfill. Dr. Tom Locke, health officer for Jefferson County as well as Clallam County, issued his finding Monday afternoon, taking into account material that was presented during an all-day hearing Nov. 28. The company will appeal his decision to the Pollution Controls Hearing Board, according to company spokesperson Kevin Scott. At issue is whether Port Townsend Paper's mill should be granted an inert waste permit or be required to attain a more-stringent limited-use permit. For its annual permit renewal in September, the mill applied for an extension of its inert classification, which the county agency through Locke denied Oct. 17. The mill appealed the decision Oct. 22, triggering the review hearing, over which Locke presided. The inert waste permit was first granted in 1989. It was renewed several times since, an action that health officials now say was an error in judgment. In still denying the permit, Locke said he took the action because of concerns about the changing nature of waste generated by the mill during operation of an expanded biomass cogeneration plant. The $55 million, 24-megawatt biomass plant is planned to be operative next year. • Locke has said the granting of the original permit was in error because more is known about waste than when it first was approved. At the Nov. 28 hearing, the county presented witnesses that maintained that any facility that exceeds an 8.5 pH rating should not be qualified as inert. The amount of acidity or alkalinity of a substance is measured by pH. Testimony for the mill estimated the facility's pH rating at 11 or 12, suggesting alkalinity, but stated that level was within the scope of current regulations. The mill has based its appeal on the idea that its operations have not changed, so the permit process should also remain consistent. "Port Townsend Paper has successfully managed the landfill as an inert waste landfill according to regulations that have not changed since 2004," Scott said in a statement. "The wastes taken to the landfill have also not changed. The waste management facility permit should have been renewed last January when it was originally submitted. "The mill remains willing to discuss the terms of the landfill permit with the county and state agencies [but plans to}file an appeal with the Pollution Control Hearings Board to preserve our rights for review of this permit denial." Jefferson County Reporter Charlie Bermant can be reached at 360-385-2335 or at charlie.bermantpeninsuladailynews.com. • . . •Girls Night raises funds for cancer Pajama-clad women 'came .� ` .� .4 out for a day and night of �a * �` m;Jo ( i�boy: • { i yz gr camaraderie and shopping fun at. `i ���j it r e Y during Port-Townsend Main {4_ � : ,;4 . r tai �:'aA' 6 s -� , F Street's Girls'Night Out and Z ; 1 5, r�+e 4 a .,4 " Y - K� raised$6,071:45. a� � G `1. ° _ ,.., f Proceeds were split this i,„ ` ;;per ° � , .* year and benefited Jefferson ; Ify,opv � _ i *v°"g ' County Public Health fi _�� )r Departments Breast and .4 ,� ,rte. 4. , . . Cervical Health Program , ,;t k ; r and the Port Townsend Main f. i e .. 1 s.it,,,,,,-,,,,..:,<,,s..,._:,==.4,-4-,411, • . Street Program, a 501(c)(3) "i ,moi S nonprofit.The event was spore ,'s , .' � 'K `t "` n r 3 ' 11' ,; ' - sored by Jefferson Healthcare "`5"S° y.-'..4,-.1;,529.'7"4 3 ;' ; g� and 26 participating busi- "` 2 _ { f ;;;ZZIA '�- r .eco nesses: -ze .- - 3 3 -, ,1 In-store activities included rc�4�P , Vi t� I C + � " °` r.A i R .;�Y. b Y'ax F 4 �.i�xEz +� ,�! 4 �' live window models, product 'fir' $ ' ..-.1---"=�_" r; `# '`a ` ' giveaways,tea tastin s,trunk £ . �, ���_ � �� `� �� � shows,special sales,drawings ,gs ; z�, w£ ".? .4'' r ' 4P iiir contained Ozone socksstore s M specials,and gifts from About o-, ... '-'''.---,-v--`'. - i - �.AM..k ,Y'.;':''',- .1_,&.,. ,',...."' Time, Abracadabra, April Julia Danskin, nursing director for Jefferson County Public Health, accepts a check for$3;046.45 from Gail • Fool & Penny Too, Bickie's Boulter of the Clothes Horse,and Sue Arthur,chair of the Port Townsend Main Street Promotion Committee Cotton Casuals, the Clothes and owner of Maricee Fashions.Funds were raised from the sale of goodie bags and raffle tickets during Port Horse, Conservatory Coastal Townsend Main Street's Girls'Night Out event on Oct.4.In addition to helping the county's Breast and Cervical Home, Elevated Ice Cream & Health Program,Main Street,a 501(c)(3)nonprofit,also received$2,950.Submitted photo Candy Co., Expressions, Face of Grace, FairWinds Winery, Public Health. local merchants was Annie Undertown Coffee and Wine Getables,the Green Eyeshade, More than 60 women came Mullen. Andrea "M" won a Bar, the Belmont, the Boiler Lehani's, Maestrale, Maricee, to the "wrap-up" party at prize for the`Best.Pajamas." Room, SOS Printing and the Max Grover Gallery, Olympic Alchemy Bistro and Wine Bar. Organizers applauded the Rose Theatre. Art & Office, Pippa's Real Local resident Phyllis efforts of a number of orga- Thanks to Port Townsend Tea, Personalize It, Perfect Schultz won the overnight stay nizations and others for their Main Street's promotion coin- Dreams Cupcakes, Quimper for two at the Commander's generous contributions to the mittee,Karen Gale,Catherine Mercantile Co., Sideshow Beach House, dinner for two event, including Jefferson Brewer, Joanne Bussa, the Variety, Sport Townsend, at the Belmont, lunch for two Healthcare, Main Street's Mount Baker Block, Alchemy Summer House Designs, at the Resort at Port Ludlow, volunteers, generous partici- Bistro&Wine Bar,and goodie Sweet PT, Tickled Pink and movies at the Rose Theatre, pacing merchants, Elizabeth bag donors. Wandering Angus- treats at Undertown Coffee Becker/Seaport Photography, For information on upcom- Contents for the goodie bags and Wine Bar, and coffee at The Palace Hotel, ing Port Townsend Main were donated by participating the Boiler Room. Jefferson County Juvenile Street Program events, visit businesses, Ozone Socks, the Winner of the runner-up Services, Ozone Socks, the ptmainstreet.org. Port Townsend Main Street raffle-prize gift basket filled Commander's Beach House, Program and Jefferson County with gifts and treasures from the Resort at Port Ludlow, • %02/5/ Clallam,Jefferson public health officer honored for 25 years of service By Rob 011ikainen , Peninsula Daily News, December 7th,2012 t tip, 1:1 1,ccr B Keith Thorpe/Peninsula Daily News Clallam and Jefferson County Health Officer Tom Locke,center, receives a ceremonial blanket of honor from Jamestown S'Klallam Tribal Council member Theresa Lehman,left,and tribal Health Administrator Cindy Lowe during Wednesday night's meeting of the Olympic Medical Center Board of Commissioners. PORT ANGELES—Dr. Tom Locke said he was"overwhelmed"and"deeply honored"by the outpouring of appreciation for his 25 years as Clallam County's top public health official. More than a dozen dignitaries—political,tribal and health care leaders in the region—praised the longtime public health officer for •Clallam and Jefferson counties in an hourlong tribute at the Olympic Medical Center commissioners' meeting Wednesday in Port ngeles. While the evening had the vibe of a retirement roast, Locke repeatedly has said he has no immediate plans to leave. "This is really overwhelming,"Locke said. "I was sort of psychologically prepared for a plaque and a handshake. This goes way beyond that." Began in 1987 Locke became the Clallam County health officer in December 1987 after county officials talked him into a six-month temporary stint. "Now, 25 years later, that six months is far,far behind him and much to our benefit,"said Clallam County Health and Human Services Director Iva Burks in a separate recognition ceremony at the county commissioners' meeting Tuesday. Locke said was glad he extended his"tour of duty, so to speak. "It's been a wonderful experience,"he said. County commissioners declared the entire week as Dr. Thomas Locke Appreciation Week. OMC commissioners passed a proclamation honoring Locke on Wednesday. "Dr. Locke has carried on his powers and duties with energy, dedication and wisdom, but he's also done it in partnership with many others,"OMC Chief Executive Officer Eric Lewis said. IlL hat I enjoy about Dr. Locke is the way he uses facts and research and the latest and greatest information available to make decisions in a very logical and scientific way. It's great having his brainpower here in Clallam County." A public health officer has an array of responsibilities: He or she works to prevents the spread of infectious diseases, declares the start and end of flu season, and enforces public health laws, among other duties. Locke has chaired the state Board of Health and developed the first mutual-aid agreement for tribes and counties to work together on public health emergencies. State Rep. Steve Tharinger, a former Clallam County commissioner,said Locke was affectionately known as"Dr. Doom"for his briefings on influenza outbreaks,West Nile virus,whooping cough and other public health emergencies. • "Tom,even though he was Dr. Doom, t helps Clallamsonthe eaNorth d rth Peninsula to counties.tay healthy and well,"said Tharinger, a Sequim Democrat whose 24th Legislative Tharinger,who read a letter to Locke from and sattes Secretary omm community." Health Mary Selecky, said public health is"by far the best investment we can make in our health for individuals 'Sophisticated communicator' Forks Mayor and county Board of Health Chairman Bryon Monohon said Locke is"one of the most sophisticated communicators" and is noted for his"care, compassion and love." Other speakers included Kitsap County Health Officer Dr. Scott Lindquist, Jamestown S'Klallam Director of Health Services Brent mcc Behavioral Health Director Peter Medical Wayted of Clallam County Jody Medicine of the Olympics Diectoraryittle, OMC Chief OfficeDr. Scott Kennedy, IInfectonCon of Coordinator Dr. Penny Becker and medical adviser Dr. Mark Fischer. Some shared stories about Locke's eccentricities, such as his penchant for wearing Hawaiian shirts while blasting music in his Volkswagen van or attending the Burning Man festival in Nevada. Burks said Locke has taken on many important issues, including HIV and AIDS, and bridged the cultural worlds of tribes and local health departments. "His concern, professionalism and knowledge are standards for all of us to emulate," Burks said. • County Commissioner Mike Doherty described Locke as an"icon" in Indian Country. "From tribal country across Clallam and Jefferson[counties]to the halls down in Olympia, I've personally witnessed his effectiveness," Doherty said. "We've been very fortunate because he could have moved on, I suspect, many times on to some other assignments or career opportunities but didn't." In 2005, Locke received the prestigious Warren Featherstone Reid Award for Excellence in Health Care. His wife, Kris Locke, received the same award posthumously Oct. 19 for her commitment to tribal health care issues. Kris Locke died of leukemia May 21 at the age of 61. Locke said he was"very thankful"for the recognition, adding:"The only thing that would make it better is if my dear wife, Kris,could have been here with us as well." Nothing alone Locke said his wife taught him an important lesson: "You cannot accomplish anything alone." "When you honor someone in public health, it's never about just the individual," Locke said. "Public health is a whole system. It exists at a local and a state and a federal—even an international—level. "I'm serving as the figurehead for a system and just a vast number of people that don't get near enough recognition or support or • money," Locke added. "That's really what deserves to be honored." Y MEDICAID: What Now? • little after 10 a.m.on June 28, Chief Justice of the United States John Roberts altered the Affordable Care Act forever. It wasn't Thea Eligible , his unexpected support for the individual If all 50 states expand mandate. It was his opinion on the Medic- Medicaid eligibility to - *� W aid expansion—a decision,it is safe to say,no 138 percent of the federal f one saw coming—that upended a law aimed poverty level,as many as . at universal health insurance coverage for 17 million people are all Americans. expected to gain coverage. To achieve health coverage for a sig- B different states have nificant chunk of the 50 million uninsured more(or less)at stake, Americans,the law called for states to increase eligibility for depending on how many residents are uninsured and their Medicaid programs to 138 percent of the federal pov- fall below that threshold.This erty level(a little less than$32,000 for a family of four).This map shows what percentage expansion of state Medicaid rolls,which was scheduled to go of a state's population into effect in 2014,was essentially mandatory.If states failed would qualify for Medicaid if to expand their rolls,the federal government could withhold eligibilityis fully expanded. its matching funding for the state's existing Medicaid program. souRCE:MEDICAID EUGIBIu1Y ESTIMATES Since the federalgovernment contributes at least 50 percent OBTAINED FROM URBAN ssor TEANALYSIS OFAMERICANCOMMUNINSURVEYAND WTE_ .... of states'spending for the program,that threat made refusal to GRATED PUBUC USE MICRODATA SERIES DATA expand unlikely for any state. Roberts,however,saw the federal deterrent as"a gun to the head." That is,the federal law was, in effect, forcing states to • adopt what is actually a new state-federal program by threaten- ing to withhold funding for an existing one.As Roberts wrote in his opinion,"The threatened loss of[funding]...is economic dra- III gooning that leaves the states with no real option but to acquiesce in the Medicaid expansion." So the chief justice gave the states an option.The federal gov- ernment could still offer the states an incentive to join in the Med- icaid expansion—say coverage of 100 percent of the costs for the newly enrolled population through 2016 and then a minimum of 90 percent coverage after that.But the feds couldn't withdraw money if a state didn't.Under Roberts'decision,existing federal Medicaid funding cannot be at risk if states opt out.That means states have a real choice about whether to participate. What's at stake for the states?Taking or turning down up to That new reality has been in place for nearly six months.Gov- $900 billion in federal dollars.Insuring or not insuring up to 17 ernors,legislators,health-care providers and patient advocates million people.Figuring out how this all works while attempting have been weighing the political,financial and moral variables to reform their own Medicaid programs."It is one of the biggest and debating whether expanding public insurance for low- public policy decisions that we're going to face in this generation," income Americans is the right thing to do.In many states,the says Matt Salo,executive director of the National Association of discussion is linked to larger plans to reform the state's overall Medicaid Directors. Medicaid program.While some governors have announced their States are at a crossroads.Thanks to the Supreme Court's ACA preferences,final decisions on the expansion will be made in the decision—and President Obama's reelection—Medicaid expan- coming 2013 legislative sessions. sion will be the big issue when legislatures open for business What's at stake nationally?The Affordable Care Act's goal of next year.Each state will be approaching the discussion with its universal health coverage."The ACA is the biggest and most sig- own set of facts:the number of poor and uninsured within its nificant piece of legislation since Medicare and Medicaid,"says borders,the state of its current Medicaid program,the projected Len Nichols,director of the Center for Health Policy Research fiscal and economic impact of expansion.Right now,states can and Ethics at George Mason University. As Nichols points out, pretty much be divided into three categories:those that oppose the ACA with the Medicaid expansion would cover a bigger pro- expansion,those that support it and those still trying to decide. • portion of the population than Medicare and Medicaid did when those programs first came into existence."Medicaid would close p the loop and make sure everyone has access to health insurance. OPPONENTS. THE TEXAS We've never made it social policy to complete the safety net in Texas Gov.Rick Perry has become the poster child for opposition that way,"he says."That's a big freaking deals' to the Medicaid expansion.When callers to his office are put on 48 GOVERNING I December 2012 I 'i :¢qt.: ;: Ate- 4;,,--- F ,,, -,11001';' ,W ,k .. t k G 3 e' ! s r` 11:1 4L'5 ,..y A dr 0 !i-ism.-�e-4 �?- -°-C :.4' - tifteria, ,t .•xril� j r 0 ! i ,..,- a 'S a g .,i , b r £ %3; ,,tea ,,t,,,;,,,,,,--.-,,,,,, 10 I i 1 Share of Uninsured Medicaid Eligible Population i ` 35-40% 41-45% -4i46-50% 0 51-55% ®56-60% •61-65% i , 4 • hold,they hear the governor's voice explaining why the expan- wantsAnd dtho how gecan rid it be eof lfi xefederal Perry wants a block grats, givet nt. He I i sion is ana bad deal for the state. His administration says the new additions would cost too much capped amount own of federal Thdingdea was former , , sd let states proposed by experiment The state would add about 1.5 million people to its Medicaid rolls with their over the next 10 years under the expansion,according to estimates Republican vice presidential candidate Rep.Paul Ryan as part i from the Texas Health and Human Services Commission(HHSC). of his recent federal budget proposals.It's also become a ral- , s,who have tried to use it ti . Current enrollment is about 3.6 million. The new next decade aneficiaries s leverage ry for conservative erage with the White House:Give us a block grant and �; would cost Texas an estimated$16 billion over thei (annual spending was$27.2 billion in fiscal 2010),while the federal we'll expand coverage.President Obama has expressed oppo- government would contribute about$100 billion. sition to the idea. The real problem, Perry's office says, is that the Medicaid In an editorial published in the Austin American-Statesman program is already approaching financial insolvency.The state in July,then-HHSC commissioner Tom Suehs outlined avision f underfunded Medicaid by nearly$5 billion last year.Any addi- for reforming Medicaid that proposed higher co-pays for ben- I {r tional cost to the state—especially billions of dollars—is too much eficiaries who don't seek cheaper primary care, moving to ; for a program that has widely acknowledged structural prob- managed care insteadregional of r-se fee-for-service ppayments coorand dte alclow- lems."We're not expanding Medicaid.That's it.Its like putting ing providerst a thousand more people on the Titanic when you know it's going Most But obody is quite sure how all block grant this wouloforesee exr coverage. I Med- J I to sink,"says Lucy Nashed,Perry's deputy press secretary. P I icaid,she points out,is already taking up a huge part of the state's in Medicaid enrollment,not additions.Texas could drop up to it"would only take away from other state 1.9 million beneficiaries,according to estimates from the Kaiser i budget and expanding programs.We need to be looking at how we can fix Medicaid." Family Foundation. I 1 i 1I December 2012 I GOVERNING 49 i MEDICAID: What Now? When callers t® exa�7 overhauls the program.Beneficiaries will be enrolled in coordi- ei �+ n nated care organizations,a network of providers that will be paid ill®v. Rick Perry's ® 'Ce a lump sum to oversee care for a set Medicaid population.Oregon is receiving$2 billion from the Obama administration to imple- ment it,and policymakers have high hopes for its prospects.The reforms are supposed to save$11 billion over 10 years,which more than offsets any new spending for the expansion. hear the governor's What's more,Kitzhaber's office estimates that if every state • adopted its reforms,Medicaid would save a combined$1.5 trillion vo a ce explaining why in the next decade—that's more than the$1.2 trillion in seques- tration cuts that Congress will be agonizing over this month. the expansion is a Kitzhaber appeared before the Center for American Progress in September and called Oregon's approach a model for the nation. bad deal for the state. With reforms in place,Kitzhaber's office is optimistic it can marshal support in a politically split Legislature to pass the expansion,much as it did with the reform legislation this year. "The core concern from Republicans and Democrats is:Can we Meanwhile,Perry's administration and Republican lawmak- do this in a sustainable way?Increasing the predictability from ers are facing mounting pressure from health-care providers and a budget perspective has given everybody much more comfort," � patient advocates to take the big pool of federal money and give Bonetto says."We feel much more confident that if we bring more more people health insurance coverage.As it is,Texas has one of people in,we have the tools and levers to achieve sustainability" the highest uninsured rates in the country,at 24 percent. In a reversal from Texas,some Oregon health-care providers The Texas Hospital Association has started an education tour aren't so jubilant at the prospect of expansion.It isn't because of sorts,explaining to individual legislators how hospitals in their they're opposed to greater health coverage.Rather,they're more district—as well as their constituents—would benefit from the skeptical of the coordinated care experiment.Through its agree- expansion. Texas hospitals already deliver$5 billion in annual ment with the federal Centers for Medicare&Medicaid Services, uncompensated care to uninsured or underinsured residents, which provides set federal funds to finance the reforms,Oregon 40, according Jon Hoggins,the association's executive director.Those has essentially agreed to a spending cap.So if costs aren't kept costs are then passed onto taxpayers and insurance companies down,providers could lose money and still handle more people through higher rates.There is also a growing economic argument: at the same time. A study in Mississippi(where Gov.Phil Bryant has joined Perry "People are really afraid that the minute you take an expansion in opposing the expansion)estimated that expanding Medicaid dollar,you're committed,"says Andy Davidson,president and CEO could create 9,000 jobs in that state in the coming decade. of the Oregon Association of Hospitals and Health Systems."If the So when the Texas Legislature convenes on Jan. 8, expect grand experiment doesn't work,what do you do down the line?" Hoggins and his colleagues from the provider community to be In other words, even if a state is undertaking significant vying for front-row seats.They'll be meeting with lawmakers,tes- reforms and expanding Medicaid,the battle isn't over.In the end, tifying at hearings and—if need be—rallying grassroots support. Davidson says his organization supports the expansion,as long as "We're willing to push pretty hard on this,just given the Texas continued talks about Medicaid's long-term solvency are also on situation—our high number of uninsured and our fiscal situation," the table."Getting our fiscal house in order,providing insurance II Hoggins says."We have the ability to create some public pressure coverage to those who need it the most—there isn't anything more to get folks engaged!' important we could be working on,"he says."But we have to do � ` it responsibly." ■HE SUPPORTERS: OREGON From the governor's office,Bonetto points out that the coordi- nated care reforms,which are already under way,will have more At the other end of the spectrum is Oregon,where the working than a year to become established before the expansion starts in plan is to embrace the expansion, albeit in a "financially sus- 2014."The health-care community will have a year of experience tainable way,"says Mike Bonetto,Gov.John Kitzhaber's senior under its belt,"he says."If we were doing this in one swoop,I health-care policy adviser. According to estimates from the think it would be more of a challenge." Urban Institute and Kaiser Family Foundation,the state would add 325,000 people to Medicaid and spend an additional$438 million in state dollars by 2020. (The state has been spendingTHE DIVIDED: ARKANSAS upward of$4 billion a year on Medicaid.) Texas has uniform Republican state leadership;Oregon's Kitz- 1 11110 Bonetto's confidence that the expansion will be fiscally haber is a Democrat with a slight Democratic majority and a responsible stems from something Oregon has done that a state recent track record of reaching across the aisle.But Arkansas Gov. like Texas has not:undertaken a fundamental Medicaid reform Mike Beebe,a Democrat,will be contending with an unfriendly effort.This year,lawmakers passed legislation that dramatically Republican Legislature as he tries to push for Medicaid expan- 50 GOVERNING I December 2012