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Home My WebLink About2013- May • Jefferson County Board of Health Hie Copy Agenda • Minutes May 16, 2013 JEFFERSON COUNTY BOARD OF HEALTH May 16,2013 Jefferson County Public Health 615 Sheridan St. Port Townsend,WA 2:30—4:30 PM DRAFT AGENDA I. Approval of Agenda II. Approval of Minutes of April 18,2013 Board of Health Meeting III. Public Comment IV. Old Business and Informational Items 1. Irondale Beach Closure 2. 2012 Outstanding Achievement Award—Food Establishments in Jefferson County V. New Business Si. Environmental Health Policy Updates 2. Environmental Health Fee Updates 3. County Health Rankings and Roadmap Report 2013: Jefferson County Rankings 4. Legislative Update: Special Session Schedule, Budget Negotiations, and Local Health Jurisdiction Flexible Funding Alternatives 5. Reappointment to the Substance Abuse Advisory Board VI. Activity Update VII. Public Comment VIII. Agenda Planning Calendar IX. Next Scheduled Meeting: June 20, 2013 2:30—4:30 PM Jefferson County Public Health 615 Sheridan St. Port Townsend, WA 98368 • • JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, April 18 2013 Jefferson County Public Health, 615 Sheridan Street, Port Townsend, WA 98368 Board Members Staff Members Phil Johnson, County Commissioner District#1 Thomas Locke,MD,MPH Health Officer David Sullivan, Vice Chair, County Commissioner,District#2 Jean Baldwin,Public Health Services Dir John Austin,County Commissioner,District#3 Julia Danskin,Nursing Services Director Roberta Frissell,citizen at large(County) Jared Keefer,Env.Health Services Dir Catharine Robinson,Port Townsend City Council Sheila Westerman,Citizen at large(City) Jill Buhler, Chair,Hospital Commissioner,District#2 Chair Buhler called the meeting of the Jefferson County Board of Health to order at 2:30 PM. A quorum was present. Members Present: Jill Buhler, David Sullivan, John Austin, Sheila Westerman, Catharine Robinson Staff Present: Dr. Thomas Locke, Jean Baldwin, Jared Keefer,Veronica Shaw, Julia Danskin . Members Excused: Phil Johnson, Roberta Frissell APPROVAL OF AGENDA Member Austin requested that approval of Sam Markow's reappointment to the Substance Abuse Advisory Board be added as item 8 under New Business. Member Austin moved to approve the agenda of the April 18,2013 BOH meeting as amended. Member Westerman seconded the motion. The motion passed unanimously. APPROVAL OF MINUTES Member Austin moved to approve the minutes of the March 21, 2013 BOH meeting. Member Sullivan seconded the motion. The motion passed unanimously. OLD BUSINESS and INFORMATIONAL ITEMS Healthcare Preparedness Network Newsletter Julia Danskin discussed the Healthcare Network newsletter which was included in the agenda packet. She stated that the Healthcare Network meets quarterly to discuss ways for the healthcare system to prepare for emergency response. The newsletter discusses activities that have taken place in the Region 2 Healthcare Preparedness Network in the past 3 months. • Hazardous Waste and Toxics Reduction Program • Jared Keefer, Environmental Health Director, stated the Department of Ecology publication was included in the agenda packet to familiarize the Board with what the Hazardous Waste and Toxics Reduction Program does and who they partner with for local toxic and hazardous waste reduction in Jefferson County. Mr. Keefer stated they assist small businesses to move toxic waste out of the normal waste stream and dispose of it in a MRW(Moderate Risk Waste) facility. Additionally,businesses are encouraged to use less hazardous or non-hazardous alternatives to toxic materials. Early Learning Regional Coalition Funding Julia Danskin announced the Early Learning Regional Coalition Funding was established to coordinate a statewide early learning system to ensure children are ready to start school. Relationships have been built with schools,childcare providers, libraries and others to help prepare children for kindergarten. The article(included in the agenda packet)highlights some of the work being done in our region. Board of Health Correspondence A copy of the letter thanking Mary Selecky for her 15 years of service to Washington State was included in the agenda packet. Chair Buhler thanked Dr. Locke for his work on the letter. Member Westerman requested a change in the sentence in the second to last paragraph of the last • page to read"struggling against odds and seemingly insurmountable challenges has always been the challenge of public health officials." NEW BUSINESS AmeriCorps Volunteer School Based Health Clinic Report AmeriCorps student,Ryann McChesney presented a report to the Board on the School Based Health Clinics. She reported that last year they saw almost 40%of the students in the two schools for either physical or mental health issues. She feels the clinics are providing safe, affordable and convenient care to high school students and are teaching the students how to use the healthcare system and take responsibility for their own care. She also expressed how important the location of the clinics are for a unique coordination of care and follow up with the students. It also allows them to spend time talking with students and get the students connected with other resources. Enviro Stars Recipient Jared Keefer announced Tyler Fordham,DDS has been awarded an Enviro Star award. The award has been included for the Board Chair's signature. • 2012 Performance Measures Reports: Communicable,Population & Prevention, Family Health Services and Targeted Clinical Health Services Lisa McKenzie, Communicable Disease Coordinator,reported on the 2012 Communicable Disease Performance Measures Report which was included in the agenda packet. Ms. McKenzie highlighted the vaccine assistance program on page 6 of the report which provides free vaccine to people who do not have healthcare insurance. She stated that in 2012 there was a focus on getting more of the Pertussis vaccine to uninsured people who were caretakers of infants. In 2011 they gave 14 doses of the free vaccine and in 2012 they gave 35 doses through the GIFT program and another 173 doses were given through a State purchased vaccine. There are also programs for free HPV vaccine and free Hepatitis A&B vaccine. Ms. McKenzie also stated they educated Jefferson Healthcare on the Sanofi/AmeriCares program because one of the vaccines they provide is the Rabies Vaccine which is very expensive. Next Ms. McKenzie highlighted the section on technical assistance to the clinics for the vaccine program. She stated Jane Kurata who is the vaccine program manager has spent a lot of time with clinics training vaccine managers, answering questions and trouble shooting,and has also provided training on the State immunization registry. Ms. McKenzie then discussed the section on Cryptosporidiosis surveillance. Finally,Ms. McKenzie pointed out the section of the graph which shows a decline in the immunization doses provided by JCPH to children;this is due to a shift to primary healthcare providers. Dr. Locke discussed a provider advisory to alert providers of tick testing results. He stated that the Washington State Department of Health has had a program to identify species of ticks for some time. The vector for Lyme Disease,Ixodes pacificus,is widespread in Washington State and on the Olympic Peninsula. In the past 2 years,funds have been available to determine whether ticks are infected with specific tick borne infections. Out of over 500 ticks tested, four tested positive for Lyme Disease,three of which were from Mason County and one from Clallam County. Providers were given information on evaluating tick bites and the signs, symptoms,and treatment for Lyme Disease. Julia Danskin gave a report on the Population and Prevention 2012 Performance Measures. She noted that the school drug and alcohol program has shrunk over the years,but it is still continuing. The strategic planning process from last year can be found on the County website. She also stated the Life Skills class at Blue Heron came out of the strategic planning process. Julia Danskin announced that she will have Yuko Umeda report on the Family Health Services Performance Measures at a later date. Ms. Baldwin reported that there was a Nurse Family Partnership(NFP)planning session held on April 9th with representatives from Kitsap County, the Port Gamble S'Klallam Tribe, and the Thrive by Five program to prepare a one year plan for NFP in our region. They looked at the last 13 years of data to identify strengths and weaknesses of the program. Ms. Danskin stated she will bring back updated performance measures for 2011. Finally,Julia Danskin discussed the Targeted Clinical Health Services 2012 Performance Measures. She stated she will arrange for Susan O'Brien to come in and discuss the program. Ms. Danskin pointed out that several of the measures are decreasing due to several factors; • Breast and Cervical services will be going to private providers,the unduplicated clients seen has decreased because PAP tests are now only required every three years. Annual exams are still • recommended but some clients only come in when their PAP test is due. End of Year Public Records Report A copy of the 2012 Public Records Request Report included in the packet,indicated the total number of copies provided and total employee hours resulted in a direct program cost of $13,746.37. Mr. Keefer mentioned the plan for Environmental Health is to scan and put documents of public interest on the County website to reduce the amount of document requests. Oral Health Access: Smile Mobile and ABCD Implementation Clallam/Jefferson Counties Julia Danskin reported the Smile Mobile will be at the Chimacum Schools May 9th through May 17th. Ms. Danskin also announced VIMO (Volunteers in Medicine in the Olympics)has received a grant from the Washington Dental Service Foundation to hire a program coordinator to link Clallam and Jefferson County dentists with children who need their services. ABCD (Access to Baby and Child Dentistry),is a program which recruits dentists to be specially trained in serving children age six and under. Electronic Medical Record (EMR) and Permit Plan Infrastructure Issues Veronica Shaw reported that a new EMR has been implemented;however they have not yet implemented the immunization piece of the system because it requires an HL7 Interface which • would link JCPH to the Washington State Immunization Information System. Ms. Shaw also reported the schools have struggled with the new system and have decided not to run the new EMR system in the schools. They have gone back to paper charts. This is due to the poor performance of the wireless connection between the schools and JCPH. She stated they have provided several proposed solutions to the problem,but nothing has been implemented yet. Ms. Baldwin announced that because the system is so slow they are seeing reduced productivity, lost revenue, and staff not being able to do their jobs. Ms. Baldwin asked that all partners from the City,the Hospital,the County and the school districts work together as a team to make sure the problem is addressed as soon as possible. Member Sullivan will follow up with Team Jefferson on when the high speed internet upgrades will be completed and will ask someone from Team Jefferson to come and give an update. Member Robinson will get an update from the City of Port Townsend. Jared Keefer reported that the Permit Plan system which had not been updated in a long time was recently updated on a grant(written by Linda Atkins others)to put in tech support. The system provides more time tracking options,productivity tracking,tracking work flow of a permit and upgraded billing capacity. This system allowed a number of data bases to be consolidated into one. Finally Mr. Keefer stated the system is almost complete,the Solid and Hazardous Waste Group will be completed next. • • Legislative Update Dr. Locke stated that the Legislative Session is in its fmal weeks and the House and Senate budget that are very different from one another and they are trying to find common ground. Dr. Locke also announced the bill that would clear up a long standing dispute between health officers and the State Board of Pharmacy over use of standing orders successfully passed the House but died in a Senate Committee. Substance Abuse Advisory Board Reappointment Member Austin moved to reappoint Sam Markow to the Substance Abuse Advisory Board. Member Sullivan seconded the motion. The Motion passed unanimously. ACTIVITY UPDATE Jared Keefer reported the funding has been cut in half by Department of Ecology for biotoxin monitoring of lakes. Because of the funding cuts,they will not be doing weekly monitoring of Gibbs, Leland and Anderson Lakes. If they see a bloom they will most likely recommend closure based on past history,but they will not have the data to back up their decision. Department of Ecology only wants them to do monthly sampling of the lakes. Mr. Keefer stated he is working with the County Administrator to see if there are financing options in the budget to allow for more frequent testing. • Jared Keefer announced they are in the permitting process at DCD to install one,possibly two, vault toilets along the Quilcene River. This is in response to past unsanitary practices by fisherman during the fishing season which resulted in a shell fish harvest area closure. The vault(s)would be funded by State Department of Health through the Water Quality division. DOH is eager to see the project to completion prior to the 2013 fishing season opening. Mr. Keefer stated the next question is going to be who will fund the maintenance of the toilets. PUBLIC COMMENT None AGENDA PLANNING CALENDAR Jared Keefer stated they are cleaning up the Environmental Health fee schedule by breaking out fees to make the fee schedule more understandable to the public. Member Westerman suggested having a public comment period at the beginning of the BOH meeting as well at the end of the meeting. Chair Buhler suggested adjusting the public comment period for each meeting. Member Robinson likes the option to have public comment at the beginning of the meeting. Jean Baldwin announced she will be out of the office and any calls should be directed to Dr. Locke or Jared Keefer. Next Board of Health meeting will be held on May 16, 2013 from 2:30—4:30 p.m. at Jefferson County Public Health, 615 Sheridan St.,Port Townsend, WA 98368 • ADJOURNMENT Chair Buhler adjourned the BOH meeting at 4:30 PM. JEFFERSON COUNTY BOARD OF HEALTH Excused Phil Johnson,Member Jill Buhler, Chair Excused Roberta Frissell,Member David Sullivan,Vice Chair Catharine Robinson,Member John Austin, Member Sheila Westerman, Member • Respectfully Submitted: Stacie Reid • • JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, April 18 2013 Jefferson County Public Health, 615 Sheridan Street, Port Townsend, WA 98368 Board Members Staff Members Phil Johnson, County Commissioner District#1 Thomas Locke,MD,MPH Health Officer David Sullivan, Vice Chair, County Commissioner,District#2 Jean Baldwin,Public Health Services Dir John Austin, County Commissioner,District#3 Julia Danskin,Nursing Services Director Roberta Frissell,citizen at large(County) Jared Keefer,Env.Health Services Dir Catharine Robinson,Port Townsend City Council Sheila Westerman, Citizen at large(City) Jill Buhler, Chair,Hospital Commissioner,District#2 Chair Buhler called the meeting of the Jefferson County Board of Health to order at 2:30 PM. A quorum was present. Members Present: Jill Buhler, David Sullivan, John Austin, Sheila Westerman, Catharine Robinson Staff Present: Dr. Thomas Locke, Jean Baldwin, Jared Keefer,Veronica Shaw, Julia Danskin • Members Excused: Phil Johnson, Roberta Frissell APPROVAL OF AGENDA Member Austin requested that approval of Sam Markow's reappointment to the Substance Abuse Advisory Board be added as item 8 under New Business. Member Austin moved to approve the agenda of the April 18, 2013 BOH meeting as amended. Member Westerman seconded the motion. The motion passed unanimously. APPROVAL OF MINUTES Member Austin moved to approve the minutes of the March 21,2013 BOH meeting. Member Sullivan seconded the motion. The motion passed unanimously. OLD BUSINESS and INFORMATIONAL ITEMS Healthcare Preparedness Network Newsletter Julia Danskin discussed the Healthcare Network newsletter which was included in the agenda packet. She stated that the Healthcare Network meets quarterly to discuss ways for the healthcare system to prepare for emergency response. The newsletter discusses activities that have taken place in the Region 2 Healthcare Preparedness Network in the past 3 months. • Hazardous Waste and Toxics Reduction Program • Jared Keefer, Environmental Health Director, stated the Department of Ecology publication was included in the agenda packet to familiarize the Board with what the Hazardous Waste and Toxics Reduction Program does and who they partner with for local toxic and hazardous waste reduction in Jefferson County. Mr. Keefer stated they assist small businesses to move toxic waste out of the normal waste stream and dispose of it in a MRW(Moderate Risk Waste) facility. Additionally, businesses are encouraged to use less hazardous or non-hazardous alternatives to toxic materials. Early Learning Regional Coalition Funding Julia Danskin announced the Early Learning Regional Coalition Funding was established to coordinate a statewide early learning system to ensure children are ready to start school. Relationships have been built with schools,childcare providers, libraries and others to help prepare children for kindergarten. The article (included in the agenda packet)highlights some of the work being done in our region. Board of Health Correspondence A copy of the letter thanking Mary Selecky for her 15 years of service to Washington State was included in the agenda packet. Chair Buhler thanked Dr. Locke for his work on the letter. Member Westerman requested a change in the sentence in the second to last paragraph of the last • page to read"struggling against odds and seemingly insurmountable challenges has always been the challenge of public health officials." NEW BUSINESS AmeriCorps Volunteer School Based Health Clinic Report AmeriCorps student,Ryann McChesney presented a report to the Board on the School Based Health Clinics. She reported that last year they saw almost 40%of the students in the two schools for either physical or mental health issues. She feels the clinics are providing safe, affordable and convenient care to high school students and are teaching the students how to use the healthcare system and take responsibility for their own care. She also expressed how important the location of the clinics are for a unique coordination of care and follow up with the students. It also allows them to spend time talking with students and get the students connected with other resources. Enviro Stars Recipient Jared Keefer announced Tyler Fordham, DDS has been awarded an Enviro Star award. The award has been included for the Board Chair's signature. i • 2012 Performance Measures Reports: Communicable,Population & Prevention, Family Health Services and Targeted Clinical Health Services Lisa McKenzie, Communicable Disease Coordinator,reported on the 2012 Communicable Disease Performance Measures Report which was included in the agenda packet. Ms. McKenzie highlighted the vaccine assistance program on page 6 of the report which provides free vaccine to people who do not have healthcare insurance. She stated that in 2012 there was a focus on getting more of the Pertussis vaccine to uninsured people who were caretakers of infants. In 2011 they gave 14 doses of the free vaccine and in 2012 they gave 35 doses through the GIFT program and another 173 doses were given through a State purchased vaccine. There are also programs for free HPV vaccine and free Hepatitis A&B vaccine. Ms. McKenzie also stated they educated Jefferson Healthcare on the Sanofi/AmeriCares program because one of the vaccines they provide is the Rabies Vaccine which is very expensive. Next Ms.McKenzie highlighted the section on technical assistance to the clinics for the vaccine program. She stated Jane Kurata who is the vaccine program manager has spent a lot of time with clinics training vaccine managers,answering questions and trouble shooting, and has also provided training on the State immunization registry. Ms. McKenzie then discussed the section on Cryptosporidiosis surveillance. Finally,Ms. McKenzie pointed out the section of the graph which shows a decline in the immunization doses provided by JCPH to children;this is due to a shift to primary healthcare providers. Dr. Locke discussed a provider advisory to alert providers of tick testing results. He stated that the Washington State Department of Health has had a program to identify species of ticks for some time. The vector for Lyme Disease,Ixodes pacificus, is widespread in Washington State and on the Olympic Peninsula. In the past 2 years,funds have been available to determine whether ticks are infected with specific tick borne infections. Out of over 500 ticks tested, four tested positive for Lyme Disease,three of which were from Mason County and one from Clallam County. Providers were given information on evaluating tick bites and the signs, symptoms, and treatment for Lyme Disease. Julia Danskin gave a report on the Population and Prevention 2012 Performance Measures. She noted that the school drug and alcohol program has shrunk over the years,but it is still continuing. The strategic planning process from last year can be found on the County website. She also stated the Life Skills class at Blue Heron came out of the strategic planning process. Julia Danskin announced that she will have Yuko Umeda report on the Family Health Services Performance Measures at a later date. Ms. Baldwin reported that there was a Nurse Family Partnership (NFP)planning session held on April 9th with representatives from Kitsap County, the Port Gamble S'Klallam Tribe, and the Thrive by Five program to prepare a one year plan for NFP in our region. They looked at the last 13 years of data to identify strengths and weaknesses of the program. Ms. Danskin stated she will bring back updated performance measures for 2011. Finally,Julia Danskin discussed the Targeted Clinical Health Services 2012 Performance Measures. She stated she will arrange for Susan O'Brien to come in and discuss the program. Ms. Danskin pointed out that several of the measures are decreasing due to several factors; Breast and Cervical services will be going to private providers,the unduplicated clients seen has • decreased because PAP tests are now only required every three years. Annual exams are still • recommended but some clients only come in when their PAP test is due. End of Year Public Records Report A copy of the 2012 Public Records Request Report included in the packet, indicated the total number of copies provided and total employee hours resulted in a direct program cost of $13,746.37. Keefer to interest on the County website to reduce the documentamountofof ppu of requests. documents Oral Health Access: Smile Mobile and ABCD Implementation Clallam/Jefferson Counties Julia Danskin reported the Smile Mobile will be at the Chimacum Schools May 9th through May 17th. Ms. Danskin also announced VIMO (Volunteers in Medicine in the Olympics)has received a grant from the Washington Dental Service Foundation to hire a program coordinator to link Clallam and Jefferson County dentists with children who need their services. ABCD (Access to Baby and Child Dentistry), is a program which recruits dentists to be specially trained in serving children age six and under. Electronic Medical Record (EMR) and Permit Plan Infrastructure Issues Veronica Shaw reported that a new EMR has been implemented;however they have not yet rface implemented the immunization peece of State hlmmunization Information System.system because it requires Ms. Shaw also ch would link JCPH to the Washington • reported the schools have struggled with the new system and have decided not to run the new EMR system in the schools. They tion between the ve gone back tschools and JCPH.aper charts. This is due to the poor She stated they have performance of the wireless connection provided several proposed solutions to the problem,but nothing has been implemented yet. Ms. Baldwin announced that because the system is so slow they are seeing reduced productivity, lost revenue, and staff not being able to do their jobs. Ms. Baldwin asked that all partners from the City,the Hospital,the County and the school districts work together as a team to make sure the problem is addressed as soon as possible. Member Sullivan will follow up with Team Jefferson on when the high speed internet upgrades will be completed and will ask someone from Team Jefferson to come and give an update. Member Robinson will get an update from the City of Port Townsend. Jared Keefer reported that the Permit Plan system which had not been updated in a long time was recently updated on a grant(written by Linda Atkins others)to put in tech support. The system provides more time tracking options,productivity numbertracking,of data baseing srt be consolidated iit nto d upgraded billing capacity. This system allowed one. Finally Mr.Keefer stated the system is almost complete,the Solid and Hazardous Waste Group will be completed next. Legislative Update Dr. Locke stated that the Legislative Session is in its final weeks and the House and Senate budget that are very different from one another and they are trying to find common ground. Dr. een Locke also announced the billof at would clear up a over use of slong tanding orders dispute P etssfullyvpassedhealth officers and the State BoardPharmacy House but died in a Senate Committee. Substance Abuse Advisory Board Reappointment Member Austin moved to reappoint Sam Markow to the Substance Abuse Advisory Board. Member Sullivan seconded the motion. The Motion passed unanimously. ACTIVITY UPDATE Jared Keefer reported the funding has been cut in half by Department of Ecology for biotoxin monitoring of lakes. Because of the funding cuts,they will not be doing weekly monitoring of Gibbs,Leland and Anderson Lakes. If they see a bloom they will most likely recommend closure based on past history,but they will not have the data to back up their decision. Department of Ecology only wants them to do monthly sampling of the lakes. Mr. Keefer stated he is working with the County Administrator to see if there are financing options in the budget to allow for more frequent testing. • Jared Keefer announced they are in the permitting process at DCD to install one, possibly two, vault toilets along the Quilcene River. This is in response to past unsanitary practices by fisherman during the fishing season which resulted in a shell fish harvest area closure. The vault(s)would be funded by State Department of Health through the Water Quality division. DOH is eager to see the project to completion prior to the 2013 fishing season opening. Mr. Keefer stated the next question is going to be who will fund the maintenance of the toilets. PUBLIC COMMENT None AGENDA PLANNING CALENDAR Jared Keefer stated they are cleaning up the Environmental Health fee schedule by breaking out fees to make the fee schedule more understandable to the public. Member Westerman suggested having a public comment period at the beginning of the BOH meeting as well at the end of the meeting. Chair Buhler suggested adjusting the public comment period for each meeting. Member Robinson likes the option to have public comment at the beginning of the meeting. Jean Baldwin announced she will be out of the office and any calls should be directed to Dr. • Locke or Jared Keefer. Next Board of Health meeting will be held on May 16,2013 from 2:30—4:30 p.m. at Jefferson County Public Health, 615 Sheridan St.,Port Townsend, WA 98368 • ADJOURNMENT Chair Buhler adjourned the BOH meeting at 4:30 PM. JEFFERSON COUNTY BOARD OF HEALTH Excused GG/ 46�%0��-r/( Phil Johnson,Member ill Buhler, C'air Excused / /) Roberta Frissell,Member Davi. Sulhv. Vice hair I. 1 Catharine Robinson, Member Ji Austin,Member Sheila Westerman,Member Respectfully Submitted: Stacie Reid • • JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, March 21, 2013 Jefferson County Public Health, 615 Sheridan Street, Port Townsend, WA 98368 Board Members Staff Members Phil Johnson, County Commissioner District#1 Thomas Locke,MD,MPH Health Officer David Sullivan, Vice Chair, 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, Chair,Hospital Commissioner,District#2 Chair Buhler called the meeting of the Jefferson County Board of Health to order at 2:30 P.M. A quorum was present. Members Present: Jill Buhler, David Sullivan, John Austin, Roberta Frissell, Sheila Westerman, Catharine Robinson Staff Present: Dr. Thomas Locke, Jean Baldwin, Jared Keefer, Veronica Shaw Members Excused: Phil Johnson APPROVAL OF AGENDA Jean Baldwin suggested a discussion of Dr. Locke's new contract and a discussion of a letter received from Burt Loomis be added under new business. Member Frissell suggested adding a letter of appreciation be sent to Mary Selecky under new business. Member Austin suggested adding a State Board of Health update under old business. Member Austin moved to approve the agenda as amended. Member Frissell seconded the motion. The motion passed unanimously. APPROVAL OF MINUTES Member Austin moved to approve the minutes of the January 17,2013 BOH meeting. Member Frissell seconded the motion. The motion passed unanimously. OLD BUSINESS and INFORMATIONAL ITEMS Letters to Legislators: Medicaid Administrative Match and Battery Recycling Ms. Baldwin announced she sent a letter to the state legislators asking for their support in Governor Inslee's appeal to Patty Murray and Maria Cantwell to ask the Centers for Medicare • and Medicaid Services (CMS) at a federal level to treat Washington the same as other states in regard to the Medicaid Administrative Match(MAM). A copy of the letter was included in the agenda packet. The effect of the CMS decision to change the MAM program resulted in a • statewide reduction of almost $8.5 million annually to support public health activities. The impact to Jefferson County will be $58,000 in 2013. Ms. Baldwin suggested the same letter be sent from the Board. Member Robinson moved to send a letter from the Board to Washington State Senators with a copy to the Governor. Member Austin seconded the motion. The motion passed unanimously. Jared Keefer addressed the copy of a letter included in the agenda packet which he sent to Representative Van De Wege in January. The letter,regarding the battery recycling program, is to ensure that Washington State has an effective recycling program for small rechargeable batteries that is convenient, environmentally sound and financed fairly. Governor Inslee Appoints New Secretary of Health Dr. Locke announced Governor Inslee has appointed John Wiesman as the new Washington Secretary of Health. Mr. Wiesman will be replacing Mary Selecky who has announced her retirement. Member Frissell moved for the Board to send a letter of appreciation to Mary Selecky for her 15 years of service,which will be signed by the BOH Chair. Member Austin seconded the motion. The motion passed unanimously. • Implementation of Federal Budget Sequester—WA State Impacts Dr. Locke discussed the testimony Mary Selecky, Secretary of Washington State Department of Health, gave to Congress regarding the budget cuts known as the Sequester. A copy was included in the agenda packet. Dr. Locke pointed out that in Ms. Selecky's testimony she is speaking on behalf of the Board of Directors for the Association of State and Territorial Health Officials. She reviewed the national impacts of the budget cuts and then used as an example of what is going on in Washington State. The impact of these funding reductions at the federal, state and local levels will significantly impact public health's ability to protect the nation's health. Healthcare Preparedness Network, 2011-2012 Annual Report Dr. Locke discussed the role of the Healthcare Preparedness Network which is comprised of four local coalitions representing Kitsap, Jefferson, East Clallam and West Olympic Peninsula. The Network's mission is to support and strengthen the ability of community healthcare providers in Region 2 to respond to healthcare needs in emergency situations. Update on the State Board of Health Member Austin updated the Board on a presentation of the Health Benefit Exchange from the State Board of Health. He announced people will begin receiving services in 2014. • • Member Austin also distributed a graph which showed the positive effect of the work done on youth smoking, including the significant decreased rate of smoking in 12th graders. NEW BUSINESS 2012 Environmental Health Performance Measures and Year End Reports Jared Keefer, Environmental Health Director, updated the Board on the on-site sewage classes. He stated there have been nine classes for homeowners held with 237 participants. He also gave a brief overview for each department of Environmental Health's Performance Measures and Year End Reports for 2012. Mr. Keefer first discussed the On-Site Sewage and Septic Operations & Monitoring Programs. He noted that there was an error in the final numbers for the number of workshop participants in 2012 (it should have been 220, not 2203). There were 107 systems found that JCPH did not previously know about, which shows that the work they are doing is helping. It also showed an increase in the number of permit applications received, and they continue to increase in 2013. To present the facts more clearly, Member Westerman asked Mr. Keefer to find a different way to label the categories for percent of monitoring inspections resulting in some maintenance needed,required significant maintenance or repair, and percent of failures/major maintenance. • Next Mr. Keefer addressed the Solid Waste and Hazardous Waste Programs. The number of complaints and violations are down significantly. In addition, a new category was added for education and outreach activities to show how many contacts are being made to the public. Activity in hazardous waste increased in 2012. Thirdly, Mr. Keefer gave an overview of the Food Safety Program. The performance measures show a trend over the last two years of food worker education shifting from in-person training to online training. They are also seeing an increase in food safety violations. The performance measures showed an increase in food establishment permits. Finally he pointed out that the data for 2011-2012 in the category of"number of routine inspections completed, routine, pre-open, re-inspections"is blank. This is because each one of those items was separated out and reported on individually starting in 2011. Mr. Keefer pointed out that the Drinking Water Program performance measures do not have a plan for 2012 because the program did not do them that year. The final numbers for 2012 show a significant drop in well starts and an increase in well decommissioning. The final performance measures Mr. Keefer discussed was the Water Quality Division. He explained the changes in the miles of shoreline surveyed for pollution. There was a drop in 2012 because they focused on Mats Mats Bay due to high levels of fecal bacteria detected. Secondly, they anticipated a large increase in 2012 for sanitary surveys and exceeded what was projected. • Mr. Keefer thanked the Environmental Health staff for their hard work in 2012 which resulted in • several accomplishments in Environmental Health and Water Quality. Mr. Keefer stated there were 57 notable accomplishments, some were routine but many of which went beyond routine. He gave an overview of several of the accomplishments from nine different programs. A copy of the accomplishments was included in the agenda packet. National Public Health Week,April 1-7,2013 Ms. Baldwin announced National Public Health week is the first week of April, and since there was no February BOH meeting there was no nomination process. The theme of this year's National Public Health Week is "Public Health is ROI (Return on Investment): Save Lives, Save Money". Ms. Baldwin stated that rather than nominating community people for public health hero awards this year, she has asked JCPH staff for once a month press releases demonstrating how their work is a ROI. Resolution Supporting Stable Funding for Foundational Public Health Services Ms. Baldwin announced the Washington Association of Counties has asked each county to encourage the State to maintain the current level of funding for the public health system in the 2013-15 biennial budget. The proposed resolution was included in the agenda packet. Member Austin would like to see the 3` "Whereas"be expanded to tie it in to the McLeary decision and emphasize the importance of children's mental and physical health in connection with their ability to learn, and the State's responsibility to meet the mandate to fund education. Member Robinson suggested under the heading"Now, Therefore, Be It Resolved" adding at the end of • the sentence"and look for other stable sources of funding for all aspects of State government." Member Austin moved for Chair Buhler to sign the resolution with the aforementioned changes. Member Frissell seconded the motion. The motion passed unanimously. Jefferson County Syringe Exchange Program Annual Report 2012 Ms. Baldwin stated JCPH has lost their State funding for the Syringe Exchange Program,but it is not an expensive program to run and it reaches a targeted group that are otherwise difficult to reach and build trust with. The graphs included in the agenda packet show that the percent of single syringe use has gone up from 49%in 2011 to 64% in 2012. They have continued to do free HIV testing and have State and Federal programs for Hepatitis C testing and free Hepatitis A&B vaccine. Port Townsend Municipal Water System Update Dr. Locke discussed a letter included in the agenda packet which was sent to healthcare providers and assisted living facilities in Port Townsend regarding maintenance work on City Lake. The letter addresses the work being done. It also discusses the possibility of a high turbidity event occurring necessitating a Boil Water Advisory and the proper steps to take should this occur. • • 2013 Washington State Food Safety Code Revisions Mr. Keefer gave a briefing on the Washington State Food Rule changes for 2013 which were included in the agenda packet. Some of the items included in the change were: the hot holding temperature went down from 140 to 135, cut leafy greens and cut tomatoes were added to potentially hazardous foods, egg pooling is now allowed as long as the eggs are cooked immediately and to a temperature of 155, running water has to be used to wash produce, service animals have been defined as dog (or a miniature horse)that are trained to perform a task for a person with a disability, cottage foods are allowed under some circumstances, children cannot be served raw or under cooked foods, and preschools are now allowed to use a residential kitchen. Jefferson County Public Health Infrastructure: Permit Plan and Electronic Medical Records System Ms. Baldwin announced this agenda item will be moved to the April BOH meeting. Discussion of Dr. Locke's contract Ms. Baldwin announced that after a year of discussion and negotiations Jefferson County Public Health and Clallam County Health and Human Services were unable to come to an agreement over continuing the Interlocal Agreement regarding health officer services. Clallam County was asking that a 29% indirect charge be added to the hourly rate for Dr. Locke's services. This could not be reconciled with the way JCPH charges contracts for indirect expenses. JCPH is • proposing to resume hiring Dr. Locke as a part time Jefferson County employee and pay his hourly rate plus the percentage of his wage that the County would normally contribute for retirement. Member Austin moved to renew Dr. Locke's contract at his Clallam County hourly rate, plus an additional retirement contribution. This will include county risk pool coverage and continue his employment as the appointed Jefferson County health officer. Member Westerman seconded the motion. The motion passed unanimously. Letter from Mr. Burt Loomis Mr. Keefer addressed a letter received by JCPH from Mr. Burt Loomis regarding contaminated property in Port Ludlow, which includes a drinking water well that is being utilized. It is currently with the Department of Ecology for site hazard assessment and clean up and State Department of Health to deal with the drinking water issue. They have recommended that DCD or DRD get in touch with the two entities to get the background history and figure out whether or not Mr. Loomis's recommendation should be carried forward through their determination. Ms. Baldwin stated this will become an issue at which point Port Ludlow wants to do an expansion. ACTIVITY UPDATE • None PUBLIC COMMENT • None AGENDA PLANNING CALENDAR Chair Buhler stated the list of dates for the Jefferson County BOH 2013 meetings is included in the agenda packet. Next Board of Health meeting will be held on April 18, 2013 from 2:30—4:30 pm at Jefferson County Public Health, 615 Sheridan St., Port Townsend, WA 98368 ADJOURNMENT Chair Buhler adjourned the BOH meeting at 4:30pm. JEFFERSON COUNTY BOARD OF HEALTH 6 • Ji 1 Buhler, Chair Da 'd Sul roan, Vice Chair 1 � 1 Excused Roberta Frissell, Member Phil Johnson, Member e„ , • Catharine Robinson,Member Jo Austin, ember )1/\12,1n4A6 Sheila Westerman, Member Respectfully Submitted: Stacie Reid • • Jefferson County Board of Health Old Business & Informational Items • AGENDA ITEM IV — 1 irondale Beach Closure May 16, 2013 • JCPH Page 1 01 1 Jefferson County Public Health MIR Always working for a healthier Jefferson. Port Townsend,Washington Home About JCPH Community Health Environmental Health/Water Quality Information News&Events and Events. = Public Health NewsNE� 1�3r�i _ Welcome>>News&Events IRONDALE BEACH CLOSED TO RECREATIONAL SHELLFISH Port Townsend,Washington,May 3, 2013 IRONDALE BEACH CLOSED TO RECREATIONAL SHELLFISH DUE TO FECAL CONTAMINATION;SWIMMING,WADING NOT RECOMMENDED Port Townsend — High levels of E. coli bacteria have been detected in a stream that enters Irondale Beach Park in Port Hadlock. As a result,the Washington State Department of Health (DOH) has closed a portion of the Chimacum Creek Tidelands south of Chimacum Creek to recreational shellfish harvest.The beach is open north of Chimacum Creek. In addition,swimming and wading are not recommended in the creek or on the beach. Warning signs have been posted at the beach, the stream and the parking lot. E. coli bacteria are from fecal contamination from warm-blooded animals, including people.They indicate the possible presence of pathogens that can make people sick.The bacteria were discovered by monitoring conducted by Jefferson County Public Health through the Northeast Jefferson Clean Water Project,funded in part by the Washington Department of Ecology. Monitoring includes sampling from streams entering the shoreline along the Quimper Peninsula and • Marrowstone Island. "Average bacteria counts were greater than 1,500 units per 100 milliliters, which is a very high number."said Michael Dawson, Water Quality Lead for Jefferson County. Investigation of potential sources is underway, which includes checking for failing septic systems. All residents are urged to have an Operations and Monitoring inspection of their system to insure it is functioning correctly. To check the status of recreational shellfish beaches, consult the Washington Fish and Wildlife regulations and the DOH website at htto://ww4.doh.wa.Qov/scripts/esrimao.dll?Name=bioview&Step=1. Swimming beach advisories are posted at httos://fortress.wa,Qov/ecv/coastalatlaS/toolSlBeachClosure.asox. For more information on the Northeast Jefferson Clean Water Project see the Water Quality section of www.jeffersoncountypublichealth.orq or call (360) 385-9444. ### Always Working for a Safer&Healthier Jefferson County Jefferson County Public Health -y)' 615 Sheridan Street-Pon Townsend,wA 98368 Community Health:360.385.9400 I Environmental Health:360.385.9444 infot&jeffersoncountypublichealth.org JCPH Employee Resources h+,,../hanuw;effersnncountvpublichealth.org/index.php?irondale-beach-closure 5/9/2013 • Jefferson County Board of Health Old Business & Informational Items r AGENDA ITEM IV — 2 2012 Outstanding Achievement Award Food Establishments in Jefferson County May 16, 2013 s 0 I- Z D 0 a) C.1 0 U N Z a) E O� 0 E Q U Li. -0 Co W > v LL. its 0 Co Q LL — = •L LLI Y CO 0 , V Z 20 C L v) D QJ •C o a v, c °� CO >, a CO c o _0 E Cf O o LI' vv cn z v Y L > .•.,, v) L C COh.0 > LL 0 O Q) C ? co C C a) ra LZce cLa o a) N - Jo 2 -J F- Co Co 03 ca CO C CO u 3 _C O U U V N •L 0 U •- 4(I) L Co ai 2 a 0 0 Co CC 0 m CC ra m3 m 2 J J 0 2O' cn (13 L) LA d- 0 c-1 ri CO c Q aN N N Q cmO O O N < t11 to - N N N N N C Q -0 "O d- d- ct X_' O C C N N N 'O O W omo omo a) v Cl) N N N CO C rn rn ^ rn al co m a� m CU Q Q 0 0 v 3 Y C 3 GL • M p�j L c > o V) U ° FO 73 a a rn 0 co Q - Q o 0 E E L CU - 3 F- u. 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Under WAC 246-215-011(12) of the new Food Code anyone serving non-potentially hazardous foods is not considered a food establishment and thus does not need a permit. We cannot waive a permit requirement when it does not exist. All we have the authority to do is make sure people operating under this exemption are selling only non-potentially hazardous foods. If this analysis is correct, we should repeal this policy. Waiver for a Temporary Food Establishment Permit Effective this date, the following policy shall be adopted concerning a waiver from a temporary food service permit for non-potentially hazardous foods. WAC 246-215-131 "Temporary Food Establishment" definition p. 10 WAC 246-215 8-301.2 "Exempt from Permit" p. 74 • The Health officer, when no health hazard will result, may waive or modify requirements of these regulations. 1) A waiver from a temporary food service permit may be issued for the preparation and serving of non-potentially hazardous foods at temporary events as defined in WAC246-215"Temporary Food Establishment", p. 10. The waiver shall expire at the end of the calendar year. 2) Applications for a waiver shall be filed in person on forms provided by the Jefferson County Public Health a minimum of two working days before the event. 3) A fee shall be charged. This policy shall remain in effect until amended or repealed by action of the Jefferson County Board of Health. Health Officer Date • Chairperson, Jefferson County Board of Health Date 615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368 (360) 385-9400 ( JEFFERSON COUNTY BOARD OF HEALTH • Department: Division: Section of Procedure Jefferson County Public Health Env Health/Water Quality Manual: Food Program Title: Mobile Food Service Establishments Subject: Clarification of WAC 246-215 (Food Code Chapter 9-1) Effective (date): Replaces (date): Review due (date): Page: 1 of: 1 01/11 E.H. Policy Statement 01/13 Mobile Food Service Establishments Purpose: This policy provides clarification of WAC 246-215-121 Since a mobile unit is defined in the food code as a readily movable food establishment, the mobile unit must: ✓ Retain its wheels ✓ Be readily movable within a matter of a few hours A mobile unit may locate routinely at the same location if the Commissary Base of Operations Plan is approved by the Health Officer and the Planning Department, and the operator adheres to all applicable codes. • Mobile holding tank rules apply (Food Code Chapter 5-401). Mobile Unit Categories: Listed below are the general categories of mobile food vendors and the additional requirements needed to be a permitted food establishment. 1. Mobile, Limited Menu: No cooling or reheating, hot holding OK. Examples include hot dogs, commercially canned chili/soup, pizza, espresso, cook and serve burritos, cook and serve burgers, etc. 2. Mobile, Complex Menu: Cooling OK in commercial kitchen, reheating OK on board. When reheating on board, food must be reheated for hot holding from 41 degrees F to 165 degrees within 1 hour. Note: if food is from a commercial food processing plant, reheat to 140 degrees F is OK This policy shall remain in effect until amended or repealed by action of the Jefferson County Board of Health. Health Officer Date Chairperson, Jefferson County Board of Health Date • 615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368 (360)385-9400 JEFFERSON COUNTY BOARD OF HEALTH • Department: Division: Section of Procedure Manual: Jefferson County Public Health _ Environmental Health Food Program Title: Destruction of potentially hazardous foods Subject: Time and temperature relationships, exceptions & procedures for potentially hazardous foods Effective (date): Replaces (date): Review due (date): Page: 1 of: 2 04/13 01/11 04/15 Destruction of Potentially Hazardous Foods Refer to WAC 246-215-03700 (2009 FDA Code 3-701.11) Refer to WAC 246-215-01115(88) "Potentially Hazardous Foods (PHF)" Potentially hazardous foods are defined in statute and include, but are not limited to, any food which consists in whole or in part of animal product(e.g. milk products, eggs, meat, poultry, fish, shellfish, edible crustacean, etc.), a plant food that is heat treated (e.g. cooked carrots, cooked asparagus, etc.), raw seed sprouts, cut melons, cut leafy greens, cut tomatoes, herb in oil mixtures or other natural or synthetic ingredients capable of supporting rapid and progressive grown of infectious or toxigenic micro-organisms. Based on evidence and information provided by the Person in Charge, the inspector shall determine the appropriate course of action regarding temperature abuse of potentially hazardous foods. The following • time and temperature relationships shall guide the inspector, but the decision shall be at the sole discretion of the inspector(the regulatory authority) based upon the site-specific characteristics of each situation. Status / Temperature Operation Duration of Time Destruction/Reconditioning 42°F 45°F Cold Holding N/A Cool to 41°F Cooling More than 8 hours Discard all food Cold Holding Less than 12 hours Cool to 41°F More than 12 hours Discard all food More than 6 hours, but less Rapidly reheat to 165°F; then 46°F 55°F Cooling than 8 hours Cool to 41°F More than 8 hours Discard all food Less than 4 hours Rapidly reheat to 165°F; then Reheating Hold Hot at 135°F or above More than 4 hours Discard all food Cold Holding / Less than 4 hours Rapidly reheat to 165°F; then Room Temperature Cool to 41°F Storage More than 4 hours Discard all food 56°F -69°F Cooling More than 6 hours Discard all food More than 2 hours, but less Rapidly reheat to 165°F; then Reheating than 4 hours Hold Hot at 135°F or above More than 4 hours Discard all food • 615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368 (360) 385-9400 Room Temperature Less than 2 hours Rapidly reheat to 165°F; then Storage Cool to 41°F More than 2 hours Discard all food More than 2 hours, but less Rapidly reheat to 165°F; then 70°F 109°F Cooling than 4 hours Cool to 41°F More than 4 hours Discard all food • _ Reheating More than 2 hours Discard all food Less than 2 hours Rapidly reheat to 165°F; then Hot Holding Hold Hot at 135°F or above More than 2 hours Discard all food Less than 2 hours Rapidly reheat to 165°F; then 110°F - 129°F Any Hold Hot at 135°F or above More than 2 hours Discard all food 130°F - 134°F Any N/A Rapidly reheat to 165°F; then Hold Hot at 135°F or above Exceptions 1. Rare roast beef a. If the roast is at 110°F or more and it has been out of the cooking process for not more than 1 hour, then it shall be further cooked to 130°F and then immediately served. b. If the roast is at 110°F or more and has been out of the cooking process for more than 1 hour but not more than 3 hours, then it shall be immediately divided and cooled to 45°F or immediately reheated to 165°F. Procedure 1. When food is observed at improper temperatures, the Health Officer or their representative shall always attempt to obtain voluntary condemnation of food in violation. The "Jefferson County Health Department Voluntary Condemnation Agreement"form shall be used for this purpose. • 2. If the operator refuses, then the Health Officer or their representative shall fill out a "Certificate of Diversion, Destruction or Waiver". Examples on prescribing mandatory diversion or destruction are: a. Diversion —"remove from premises"... "feed to non-commercial" ... "take home, not to be serviced to public". b. Destruction —"place in dumpster, etc. and denature with bleach/cleanser, etc... 3. If the operator refuses to cooperate, then consult the Health Officer, Environmental Health Director, or Lead Environmental Health Specialist to decide which one of the following actions will be taken: a. Issue a hold order on the food and require a hearing, or b. Suspend the permit due to an imminent health hazard. This policy shall remain in effect until amended or repealed by action of the Jefferson County Board of Health. Health Officer Date Chairperson, Jefferson County Board of Health Date • 615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368 (360)385-9400 JEFFERSON COUNTY BOARD OF HEALTH s Department: Division: Section of Procedure Manual: Jefferson County Public Health Environmental Health Food Program Title: Destruction of Potentially Hazardous Foods Policy Subject: Time and temperature relationships, exceptions&procedures for potentially hazardous foods Effective (date): Replaces (date): ,,—Review due(date): Page: 1 of: 2 01/01/11 10/09 01/01/13 Destruction of Potentially Hazardous Foods Refer to WAC 3-701.11 Based on evidence and information provided by the Person in Charge, the inspector shall determine the appropriate course of action regarding temperature abuse of potentially hazardous foods. The following time and temperature relationships shall guide the inspector, but the decision shall be at the sole discretion of the inspector(the regulatory authority). The following time and temperature relationships shall be followed concerning the destruction of potentially hazardous foods. Potentially hazardous foods shall include (but not be limited to) any food which consists in whole or in part of milk products, eggs, meat, poultry, fish, shellfish, edible crustacean, or other natural or synthetic ingredients capable of supporting rapid and progressive grown of infectious or toxigenic micro-organisms. • See definition of potentially hazardous foods in WAC 246-215.P 1. Foods found between 41 F and 60 F shall be rapidly cooled to a temperature of 41 F or below. 2. For foods found between 60 F and 70 F, the following guidelines shall be used: a. less than 3 hours- rapidly cool to 41 F or below b. greater than 3 hours-discard all portions 3. Foods found between 70 F and 110 F shall be discarded unless in the process of being rapidly cooled or heated. 4. Foods found between 110 F and 120 F, the following time guidelines shall be used: a. less than 3 hours-reheat to 165 F and hold at 140 F or above b. greater than 3 hours-discard all portions 5. Foods found between 120 F and 140 F shall be rapidly reheated to 165 F and maintained at 140 F or above. Exceptions 1. Discard large volumes of food (i.e. using 5 gallon containers)when the temperature is 50 F or more and the Health Officer or their representative suspects the food has been cooling from 140 F for longer than 8 hours. i615 Sheridan • Castle Hill Center• Port Townsend • WA •98368 (360)385-9400 r 2. Rare roast beef0 a. Rare roast beef shall be discarded if found displayed for more than 3 hours at 100 F or less. b. If the roast is at 110 F or more and it has been out of the cooking process for not more than 1 hour, then it shall be further cooked to 130 F and then served. c. If the roast is at 110 F or more and has been out of the cooking process for more than 1 hour but not more than 3 hours, then it shall be immediately divided and cooled to 45 F or immediately reheated to 165 F. Enforcement 1. The Health Officer or their representative shall always attempt to obtain voluntary condemnation of food in violation. The"Jefferson County Health Department Voluntary Condemnation Agreement" form shall be used for this purpose. 2. If the operator refuses, then the inspector will complete a "Certificate of Diversion, Destruction or Waiver". Examples on prescribing mandatory diversion or destruction are: a. Diversion -"remove from premises" .,. "feed to non-commercial" ... "take home, not to be serviced to public". b. Destruction -"place in dumpster, etc. and denature with bleach/cleanser, etc... 3. If the operator refuses to cooperate, the inspector will consult the Health Officer, Environmental Health Director, or Administrator to decide one of the following: a. Issue a hold order on the food and require a hearing, or • b. Suspend the permit due to an imminent health hazard. This policy shall remain in effect until amended or repealed by action of the Jefferson County Board of Health. ".."----ak. 7*07/( Health Officer Da e k ,,,‘ 1 \ 20/1 , Chai •- on, rson County Board of Health Dat 615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368 • (360)385-9400 JEFFERSON COUNTY BOARD OF HEALTH Department: Division: Section of Procedure Manual: Jefferson County Public Health Environmental Health Food Program Title: Food Establishment Inspection Frequency Subject: Inspection schedule requirements Effective (date): Replaces (date): Review due (date): Page: 1 of: 2 05/01/13 E.H. Policy Statement 05/01/15 Food Establishment Inspection Frequency Purpose: -WAC 246-215-08400 allows local health jurisdictions to assign inspection frequency based on risk, but does not address intervals other than once every six months. -WAC 246-215-08405 within the parameters established by WAC 246-215-08400, establishes criteria for the prioritization of more frequent inspections but does not address specific intervals for those inspections. -This policy defines these issues. • Pre-opening Inspections: ✓ An inspection of a food establishment shall occur prior to opening for the first time or at any time an establishment changes menu, service plan, hours, or ownership if it is deemed necessary by the Health Officer. A pre-opening inspection fee will be charged. 30-day Inspections: ✓ All new food establishments will have an inspection conducted within the first 30 days of operation. The goal of this inspection is to mitigate any unanticipated food safety challenges encountered by the newly-opened facility in addition to offer coaching solutions to facility. The inspection scoring criteria section below shall apply if violations are observed. Routine Inspection Frequency: ✓ All Limited Menu (includes bakery, B&B, concession stand, espresso stand, grocery, meat/fish market) establishments shall be on an inspection schedule of at least 1 inspection every 12 months. ✓ All Complex Menu (includes complex mobile unit, complex restaurant, caterer) establishments and school kitchens shall be on an inspection schedule of at least one inspection every 6 months. ✓ All Temporary food establishments shall be inspected at least once during the permit period. (Limited menu temporary food establishments that have a history of no red point violations may be exempted for 1 year.) S 615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368 (360)385-9400 Inspection Scoring: ✓ A Food Establishment, or Temporary Food Establishment, with violations totaling under 35 red (critical violation) points or under 45 total (red + blue violation) points and do not have any repeat violations shall not have a re-inspection conducted. However, if violations are found then all violations must be corrected immediately or within the timeframe specified on • the inspection report. ✓ A Food Establishment, or Temporary Food Establishment, shall be re-inspected within the timeframe specified for correction on the inspection report and charged a first re-inspection fee with violation points of: • 35 to 80, red (critical) points (90% to 76% in compliance), or • 45 to 104 total (red + blue violation) points (90% to 76% in compliance). ✓ A Food Establishment, or Temporary Food Establishment, shall not have a re-inspection conducted, but shall have the permit to operate suspended with violation points totaling (See WAC 246-215-8600 for regulations regarding permit suspension): • >85 red (critical) points (75% in compliance or below), or • >105 total (red + blue violation) points (75% in compliance or below). ✓ A Food Establishment, or Temporary Food Establishment, with a repeat violation in two consecutive inspections shall be re-inspected within the timeframe specified for correction on the inspection report and charged a first re-inspection fee. Re-inspections: ✓ A Food Establishment, or Temporary Food Establishment, shall be re-inspected and charged a re-inspection fee if they fail to: • Correct all of the violations noted in either the routine inspection report or the re- inspection report (has a repeat violation), or • Have violations totaling 35 to 80, red (critical) points (90% to 76% in compliance), or • • Have violations totaling 45 to 104 total (red + blue violation) points (90% to 76% in compliance). ✓ Failure to correct violations after the second re-inspection shall be grounds for possible suspension of permit. (See WAC 246-215-8600 for regulations regarding permit suspension). Re-opening Inspections: ✓ A re-opening inspection may be required for establishments that have closed either voluntarily or by the Health Officer. A re-opening inspection fee will be charged. This policy shall remain in effect until amended or repealed by action of the Jefferson County Board of Health. Health Officer Date Chairperson, Jefferson County Board of Health Date S 615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368 (360) 385-9400 JEFFERSON COUNTY BOARD OF HEALTH • Department: Division: Section of Procedure Manual: Jefferson County Public Health Environmental Health Food Program Title: Food Establishment Inspection Frequency Policy Subject: Inspection schedule requirements Effective (date): Replaces (date): Review due (date): Page: 1 of: 2 01/01/11 E.H. Policy Statement 01/01/13 Food Establishment Inspection Frequency Purpose: -WAC 246-215 (Working document section 8-401.10 - B 2) allows local health jurisdictions to assign inspection frequency based on risk. -WAC 246-215 (Working document section 8-405.20) does not address specific criteria for re-inspection when red-point violations have occurred. This policy defines this issue. Routine Inspection Frequency: ✓ All Limited Menu (includes bakery, B&B, concession stand, espresso stand, grocery, meat/fish market) establishments shall be on an inspection schedule of at least 1 inspection every 12 months. • ✓ All Complex Menu (includes complex mobile unit, complex restaurant, caterer) establishments and school kitchens shall be on an inspection schedule of at least one inspection every 6 months. ✓ All Temporary food establishments shall be inspected at least once during the permit period. (Limited menu temporary food establishments that have a history of no red point violations may be exempted for 1 year.) Re-inspections: ✓ A Food Establishment with violations totaling 35 to 104 points shall be re-inspected within the timeframe specified for correction on the inspection report and charged a first re-inspection fee. ✓ A Food Establishment that fails to correct all of the violations noted in the first re-inspection report shall be re-inspected and charged a subsequent re-inspection fee for each re-inspection after the first. Failure to correct violations at this time may be grounds for suspension of permit. ✓ A Food Establishment with violations totaling 105 points or above shall have their operating permit suspended. (See WAC 246-215 working document section 8.601.11 for regulations regarding suspension of permit). ✓ A Food Establishment may be required to have an increased inspection frequency, at the discretion of the Health Officer. Fees shall be charged for these additional inspections. • 615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368 (360)385-9400 • Pre-opening Inspections: ✓ An inspection of a food establishment shall occur prior to opening for the first time, or at any time an establishment goes through a remodel, menu change, service change, ownership change, etc. A pre-opening inspection fee will be charged. Re-opening Inspections: ✓ A re-opening inspection may be required for establishments that have had their operating permit suspended, or have been closed by the Health Officer for operating without a valid permit ,or were closed due to fire, power outages, sewer back up or lack of water, or were closed at the sole discretion of the owner. This poi. remain in effect until amended or repealed by action of the Jefferson County Board of Hpalth • 1/?-0/1/ Health Officer Date \ / c / ij Chairperson,Jefferson County Board of Health Date 615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368 • (360)385-9400 • Jefferson County Board of Health New Business • AGENDA ITEM V — 2 Environmental Health Fee Updates May 16, 2013 • JEFFERSON COUNTY PUBLIC HEALTH ENVIRONMENTAL HEALTH DIVISION ENVIRONMENTAL HEALTH 2013 Additional Fees and Other Information GENERAL Health Officer Administrative Hearing 306.00 Administrative Hearing Appeal 306.00 Technical Assistance/Plan Review-Minimum 67.00 Technical Assistance/Plan Review-Per Hour 67.00 Filing Fee 52.00 ONSITE SEWAGE DISPOSAL Sewage Disposal Permits New Conventional 555.00 Valid for 3 years New Alternative 662.00 Valid for 3 years New septic tank and/or pump chamber only 264.00 Issued in conjunction with an existing sewage disposal New Community or>1000 G.P.D.(base fee) 555.00 Plus$87 per connection-valid for 3 yrs New Commercial>1000 G.P.D. Conventional 662.00 Valid for 3 years Alternative 707.00 Valid for 3 years Repair/Upgrade/Modification/Designate Reserve Area 123.00 Applies to existing installed sewage disposal system Expansion 413.00 Redesign 123.00 Applies to pending or active but not installed Reinspection 153.00 Evaluation of Existing System/Monitoring Inspection Septic system only 306.00 Septic system plus water sample 319.00 Retest/Reinspection 107.00 On Site Sewage OnSite-Site Plan Advanced Approval Determination(SPAAD) 306.00 Septic Permit with SPAAD(conventional) 299.00 Septic Permit with SPAAD(alternative) 414.00 Subdivision Review Base Fee 396.00 Plus$78.00 Per Lot Boundary line adjustment review fee 156.00 Plus$78.00 Per Lot Pre application meeting fee 156.00 Planned rural residential development review fee 156.00 Density exemption review fee 78.00 Density exemption review fee requiring field work 156.00 Other WaiverNariance Application 184.00 WaiverNariance Hearing 306.00 Wet season evaluation 413.00 • Revised building application review fee 156.00 New building application review fee: Residential 78.00 Commercial 156.00 General environmental health review fee 78.00 Licenses Installer,Pumper,Operator(maintenance person) 413.00 Retest 168.00 Annual Renewal 291.00 Delinquent Renewal after January 31 413.00 FOOD SERVICE ESTABLISHMENT FEES . MIT FEES(Annual Permit) Restaurants/Take-Out(Based on menu complexity&seating-menu chanes may change category) 0-25 seats(Limited Menu) 186.00 No cooling or reheating 0-25 seats(Complex Menu) 331.00 Cooling and reheating allowed 26-50 seats 331.00 51-100 seats 397.00 101-150 seats 450.00 With Lounge,add 146.00 Separate lounge area Bakery Business 145.00 B&B 186.00 Caterer w/commissary or catering-only kitchen 331.00 w/restaurant,additional fee for catering 186.00 Concession/Commercial Kitchen/Church 145.00 Espresso Stand 145.00 Grocery 1-3 checkouts 186.00 May serve pre-packaged baked goods >3 checkouts 450.00 Meat/Fish Market 331.00 Mobile Unit Limited Menu 186.00 No cooling or reheating Complex Menu 331.00 Cooling&reheating allowed School Cafeteria Central Kitchen 331.00 Warming Kitchen 186.00 111 Tavern w/food(see Restaurants) Annual Permit Issued after September 1 50%of fee 50%of Annual Permit Fee 1 of 2 5/10/2013 10:31 AM ENVIRONMENTAL HEALTH 2013 Additional Fees and Other Information Temporary Permits Single Events Limited Menu Initial Application(First Event) 105.00 Not to exceed 21 days at your location • Additional Events(Same Menu) Additional Events(Different Menu) 16.00 Not to exceed 21 days at your location 105.00 Not to exceed 21 days at your location Complex Menu Initial Application(First Event) 139.00 Not to exceed 21 days at your location Additional Events(Same Menu) 16.00 Not to exceed 21 days at your location Additional Events(Different Menu) 139.00 Not to exceed 21 days at your location Organized Recurring Events(e.g.Farmers Markets) Limited Menu Initial Application(First Event) 105.00 Not to exceed 3 days a week Additional Events(Same Menu) 16.00 Not to exceed 3 days a week Additional Events(Different Menu) 105.00 Not to exceed 3 days a week Complex Menu Initial Application(First Event) 139.00 Not to exceed 3 days a week Additional Events(Same Menu) 16.00 Not to exceed 3 days a week Additional Events(Different Menu) 139.00 Not to exceed 3 days a week Late Fee for Temporary Permits +50%of fee Additional(Paid when application is submitted less than 7 days prior to the event) Other Food Fees Waiver Permit Exemption 40.00 WaiverNariance 67.00 Per Hour Reopening Fee 67.00 Per Hour Manager's Course 225.00 Plan Review Pre-opening inspection 67.00 Per Hour Minimum 67.00 Per Hour 67.00 Reinspection - First Inspection 93.00 Each inspection after first 159.00 Food Handler Card 10.00 Reissue Unexpired Food Handler Card 10.00 SOLID WASTE Annual Permit Fees Landfills requiring environmental monitoring 543.00 Biosolid/Composting Facilities IAlizalian 476.00 Inert Waste Landfills 344.00 • Other Solid Waste Facilities€anility-Permits 344.00 Drop Boxes 159.00 Miscellaneous Fees New Facility Application 437.00 Exempt Facility Inspection 344.00 Facility Reinspection +50%of fee Plan,Document and WaiverNariance Review 67.00 Per Hour/4 hour Minimum WATER Application Fee 159.00 Inspection of well construction,decommission& reconstruction Determination of Adequate Water Supply 66.00 Building Permit Process Well Inspection&Water Sample for Loan 134.00 Well Site Inspection-Proposed public water supply 318.00 LIVING ENVIRONMENTS(Annual Permit) Pool 291.00 Spa 291.00 Pool/Spa Combined 397.00 Plan Review 67.00 Per Hour Indoor Air(Tobacco) Compliance Enforcement 67.00 Per Hour Reinspection 78.00 Rebuttal Application 156.00 Note: 2013 Fees have been adjusted per Ordinance 12-1209-96,Section 4-Annual Fee Indexing:Fixed amount fees established by this ordinance shall be adjusted annually on the first business day of January(Adjusted Date)by the amount of the increase in the Consumer Price Index(CPIW). The CPIW is the Consumer Price Index-US City Average for At Urban Wage Eamers and Clerical Workers,published by the Bureau of Labor Statistics for the United States Department of Labor. The annual fee adjustment shall be calculated as follows: each fee in effect immediately prior to the Adjustment Date wit be increased by the percentage increase in the CPIW as reported for the month of September preceding the Adjustment Date. Increases wit be rounded to the nearest dollar. A fee shall not be reduced by reason of such calculation. However,fee increases in accordance with this calculation shall not exceed 5 percent per year. • 2 of 2 5/10/2013 10:31 AM Posted:Friday,April 12,2013 Article comment by: David Thielk •arge, I can't tell if you are making fun of me, or actually putting the canine in the correct order of importance. Either way, I laughed when I read your post. I do believe that dogs belong with their humans. It is their role that was created through 15,000 years of evolution. But I also understand the cultural divide many humans place between their own species and other animals today. But, it is cultural. It is quite common throughout Europe, for dogs to be off leash in the community, and also to be allowed right into restaurants. Of course, Europeans may have a better attitude towards dog training than many Americans. And that is a pity. Posted:Thursday,April 11,2013 Article comment by: Marge Samuelson Who cares if someone wants to bring their owner to a public place? If the person is well behaved they can stay, otherwise the dog will have to take them home. Posted:Thursday,April 11,2013 Article comment by: Chantel Monroe Is there enough room outside the market to put up a nice fenced in place for dogs?That way they can take their dogs to the market without having them actually inside the market? *osted:Thursday,April 11,2013 Article comment by: Joe Woolsey I don't know if it was the same incident, but we witnessed a dog at the farmer's market hiking his leg on a person's bag too. In fact Debbie pushed the dog away and handed the old guy his bag. This dog owner just pulled on his dog's leash and walked away. It's called being selfish and inconsiderate of others. Bringing dogs to the farmer's market surely is not taking into consideration what is good for the overall collective of the community. Posted:Wednesday,April 10,2013 Article comment by: David Thielk Forest, when I become a senior, I won't be using that fact as a reason for some special kind of treatment. If I stay in Port Townsend, I will continue to focus on youth. If I leave Port Townsend, I won 't expect the community to change to meet my needs. Posted:Wednesday,April 10,2013 Article comment by: Forest Shomer Nice, David. Scapegoat the seniors. If you live long enough, you may find yourself senior at some point. Good to know *that you are involved in 'educating' the next generation. If you want to see and be seen w/dogs, how about unselfishly creating a separate venue for just that purpose?A meet- and-greet just for dogs and their owners. And isn't that why dog parks were invented? Anderson Lake to be tested to see if safe to open for season Ask By Leah Leach, Peninsula Daily News, April 14, 2013 PORT TOWNSEND—Tests that resume this week will help determine whether Anderson Lake will be reopened for the trout-fishing season the last Saturday of this month. The statewide lowland lakes trout-fishing season will begin April 27, and the ranger in charge of the lake says he figures there are some large fish in Anderson Lake. "Many fishers are anxious to see if they can catch 'the big one.' Since the lake has been closed for so long the last few seasons, there is likely some nice big fish in there," said Ranger Mike Zimmerman, who is in charge of Anderson Lake State Park. But only testing will determine whether opening the lake is safe. In 2012, Anderson Lake was opened the last Saturday in April for the start of the season but was closed May 3 because of elevated levels of algae-produced toxins, and was opened only briefly throughout the summer. The last tests in October found a stunningly high level of the lethal nerve toxin anatoxin-a, with levels some 300 times higher than the safety threshold of 1 milligram per liter. "Last year was a bad year for Anderson," said Greg Thomason, Jefferson County environmental health specialist. Since then, the lake appears to have calmed down. There are no sign of algae blooms, said both Zimmerman and Thomason. But appearances can deceive. The only way to know if that clear lake water is poisoned is to test it. Water samples will be taken from Anderson Lake, as well as Leland and Gibbs lakes, on Monday and sent to King County Environmental Lab, which is expected to report test results by Friday, said Thomason, who is with the Jefferson County Public Health Department. "We need the data from the 15th to tell anything before the opening on April 27," Thomason said. "This one is really the important date" because the second round of test results won't be received until the day before the season is set to open. The lake could be closed on short notice, but both Thomason and Zimmerman said they prefer to have it planned better than that, if possible. "When you have 50, 60, 100 people coming from all over, it makes it tough to close it down," Thomason said. The lake has remained popular despite frequent closures, he said. 1110 Anderson Lake is "the best fishing lake in the county," Thomason said. "Fishermen are chomping at the bit. They've been waiting all winter for this," he added. Since 2006, the 70-acre lake in Anderson Lake State Park has been closed during parts of the warmer months because of dangerous levels of toxins. • Historically, two toxins have been found in East Jefferson County lakes: anatoxin-a, a potentially deadly nerve toxin, and microcystin, a slower-acting poison that can cause skin irritation and nausea over the short term and liver damage if ingested over a long period of time. Anderson, Leland and Gibbs lakes have had caution signs up all winter because of winter algae blooms, Thomason said. "Without samples, to be safe, we have to assume some toxins are present," he added. But if tests show the lakes to be clear, the signs will come down. Researchers do not know why some species of blue-green algae, which occur naturally, will suddenly begin to produce toxins. Warm weather does fuels algae growth when sufficient nutrients, such as phosphorus, are present, and Anderson Lake, once the site of a dairy farm that closed in the middle of the last century, may contain high levels of phosphorus, which is present in livestock waste. No toxic blue-green algae has been reported in Clallam County, where health officers do not test for toxins; instead, they visually monitor lakes for signs of algae bloom. Report algae blooms in Clallam County by phoning 360-417-2258. • Report algae blooms in Jefferson County by phoning 360-385-9444. For more information about lake quality in Jefferson County, visit http://tinyurl.com/jeffersonlakewaterquality. A Discover Pass is needed to visit the 410-acre Anderson Lake State Park, which will be open "even if the lake water tests for toxins [and does] not allow us to open the lake for recreation,"Zimmerman said. A Discover Pass costs $10 per day or$30 for an annual pass and can be purchased online at www.discoverpass.wa.gov, in person from places where state fishing and hunting licenses are sold, by phone at 866-320-9933 and at state parks, such as Anderson Lake. "However, visitors are encouraged to purchase their passes prior to arriving at Anderson Lake," Zimmerman said. Managing Editor/News Leah Leach can be reached at 360-417-3531 or at leah.leachpeninsuladailynews.com. IP Peninsula tick found with pathogen that causes Lyme disease By Rob 011ikainen , Peninsula Daily News,4/18/13 U.S Centers for Disease Control and Prevention The Western black-legged tick is said to be common to Clallam County. PORT ANGELES— Pack the bug spray for that next hike into the woods. Of the two ticks in the state that tested positive for the bacteria that causes Lyme disease out of 261 sampled in 2012, one was from Indian Valley east of Lake Crescent. "Lake Crescent and the area around Lake Crescent is tick heaven," said Dr.Tom Locke, public health officer for Clallam and Jefferson counties, at the Clallam County Board of Health meeting Tuesday. "People report tick bites from around there all the time. "So, given that this is an area where we see a lot of tick bites, this is significant news." Locke issued a Borrelia burgdorferi [bacteria that causes Lyme disease] pathogen detection and Lyme disease surveillance advisory to health care providers this week. "We want people to know about it. At the same token, we don't want them to overreact to it, this one test result," Locke added. "We've never had a confirmed case of Lyme disease in Clallam County, although we've had anecdotes of people being bit by ticks and getting rashes and taking antibiotics." Lyme disease often causes a rash in a bull's-eye pattern around a tick bite. It can lead to flu-like symptoms and joint pain and neurological problems if left untreated, according to the Mayo Clinic. "You don't want Lyme disease," said Jim McEntire, health board member and a Clallam County commissioner. "It's not good. I know several people who have had it or have it, and it is something to be avoided." With proper antibiotic treatment in the early stages of the disease, most people recover completely, according to the U.S. Centers for Disease Control and Prevention based in Atlanta. "The best prevention against Lyme disease is, No. 1, try to prevent yourself from getting bit by ticks," Locke said. Using insect repellent with DEET, and wearing long pants and sleeves in the woods are good ways to prevent tick bites, he said. If you do get bitten, remove the tick within 24 to 48 hours, as it takes a day or two for Lyme disease to spread to a human. "If you check yourself every day after the hike and remove any ticks, that's a very effective prevention against tick- borne infection," Locke said. West Coast ticks such as the Ixodes pacificus, the Western black-legged ticks that are common in Clallam County, get Borrelia burgdorferi from mice. On the East Coast and in the Midwest, tick-borne disease pathogens come from deer. • "There's these tick surveillance programs that have been going on Washington state to, first of all, determine what type of ticks are distributed around the state because different types of ticks are associated with different kinds of tick-borne disease," Locke said of recent state Department of Health studies. "Just for the last couple of years, they now have the technology and funding to look at specific ticks to see if they're infected with the bacteria." In the past two years, four ticks in the state have tested positive for Borrelia: one in Clallam County and three in Mason County. "So they are on the Peninsula," Locke said. Last year, a probable case of Lyme disease was reported for a Jefferson County resident. "In terms of what we do about this, first and foremost, we want more tick testing," Locke told the health panel. "So that's what we're trying to set up. This program is still running, so we're working with wildlife biologists trying to make sure we get a lot more specimens submitted from the county. "If we do 25 or 30 tick tests, and we find that over 20 percent of them are positive for Borrelia, that's actually going to change how we manage tick bites in Clallam County," he said. If Borrelia is found to be common in the Ixodes pacificus tick, which accounted for eight of the 12 submitted from Clallam County, health officials will "start giving people antibiotics automatically every time you get a tick bite," Locke said. "That will have some adverse effects in its own right, so we don't want to do that unless there's a strong reason," Locke said. "We're not at that point yet." Reporter Rob 011ikainen can be reached at 360-452-2345,ext.5072,or at rollikainen[7a peninsuladailynews.com. • Anderson Lake eyed for opening after testing funds cut By Jeremy Schwartz, Peninsula Daily News,April 18,2013 ORT TOWNSEND—A visual survey will have to suffice as the basis for a decision next week on whether Anderson Lake State Park will be reopened for the start of a statewide trout-fishing season Saturday, April 27. Mike Zimmerman, the ranger who manages the park, said Wednesday that the earliest he'll announce it is this Monday, with his decision dependent on receiving a recommendation from Jefferson County Public Health Department staff. "The latest[day his decision would be announced]would be dependent upon if the health department decides they want to do one more visual [inspection] prior to the Saturday opening,"Zimmerman said. Anderson Lake has at times in past years had the highest levels of a potent nerve toxin, anatoxin-a, in the state.The toxin is created by blue-green algae. Although it occurs naturally and is usually benign, the algae, which is fueled by warm weather and nutrients such as phosphorus, can begin for reasons unknown to researchers to produce toxins. Since 2006, when two dogs died after drinking lake water Memorial Day weekend, tests of samples have been done to see if Anderson Lake is safe for recreational use, including fishing. The statewide start of the trout-fishing season is April 27. Officials had planned to test Anderson Lake before deciding if it could be reopened. t no sample was taken because the state Department of Ecology will no longer fund routine weekly tests, instead But that tests be done only when a bloom can be seen in the lake, said Greg Thomason, environmental health specialist with Jefferson County Public Health. In the past, Ecology had paid for weekly tests—which range from $200 to $300—for potentially dangerous levels of toxins, regardless of whether algae blooms were visible. Samples taken Mondays were sent to King County Environmental Labs for testing, with results received by the following Friday, in a weekly routine that began in April and continued until September or October. Those test results determined if lakes were safe. Now, county health department staff will have to rely more heavily on visual inspections of Lake Anderson, as well as county lakes in East Jefferson County. "Ecology is not able to fund weekly monitoring for toxicity testing when there are not algal blooms," said Linda Kent, Ecology spokeswoman, in an email, adding that the measure is statewide. Kent said Ecology still will pay for the analysis of samples taken after an algae bloom is spotted,just as the department does for lakes across the state. Ecology also cut the amount it provides for administrative costs. 0 It is providing $15,000 for testing in 2013 and 2014, half of the$30,000 it gave the county in 2011 and 2012, said Jared Keefer, Jefferson County environmental health and water quality director. Keefer said Jefferson County has set aside$10,000 of its own money for testing and still plans to rely on that for any tests needed that Ecology will not fund. Following the reduced testing schedule for this year, Thomason said he inspected Anderson, Leland, Gibbs and Crocker lakes Monday but took water samples only from Leland because it had a visible algae bloom. • Thomason said he has sent the Leland sample to Seattle and expects results back this Friday. rson Lake's lth this n, Thomason said he is ot conte n lessb testing likbeingy ablemeans o test thess lakea on if noealgae blooms are spotted since no blooms have beenseenfor concerned about not being able t months. "I'm not too worried now," Thomason said. "We haven't had a bloom, and it's been clear all winter." However, past potentially deadly toxin levels that ssosAnderson Lake ve appeared when the water appeared clear after a large-scale algae bloom d vp Thomason explained. "Based on our data, that's when we've had our highest toxin [levels]," he added. In these instances, Thomason said public health staff will use county funds to sample Anderson Lake and send the samples for testing. "We will find the money to process [those samples], no matter what,"Thomason said. "We are committed to public health." In addition to anatoxin-a, which can quickly cause paralysis and death, another algae-produced toxin, microcystin, also has been found at times in East Jefferson County lakes. Microcystin can cause nausea and skin irritation over a short period of time and liver damage if ingested in lake water over the longer term. Thomason said public health staff will continue to update the status of the lakes tested at Jefferson County's website, htt•://tin url.comieffersonlakewater•ualit . Even if Lake Anderson is closed to recreation and fishing, Zimmerman said the 410-acre Anderson Lake State Park around the lake will be open to visitors. "We'll open the park for other recreation regardless of what the health of the lake is," Zimmerman said. Visitors need a Discover Pass—either$10 for a day or$30 for a year—to park within Anderson Lake State Park. Passes can be bought at any state park,where hunting or fishing licenses are sold, by phoning 866-320-9933 or by visiting w discoverpass.wa. ov. Toxin-producing blue-green algae has not been spotted in Clallam County. Report algae blooms in Clallam County by phoning 360-417-2258, while Jefferson County blooms can be reported at 360-385-9444. 11) Reporter Jeremy Schwartz can be reached at 360-452-2345,ext.5074,or at ischwartz(5peninsuladailynews.com. What makes Anderson Lake so unusually toxic? Scientists to try to find answer By Jeremy Schwartz, Peninsula Daily News,April 21�`,2013 a; Port 'ovnsend TQw'2 erg, w, Anderson Srif,l°"U S 4 a Lake Ha 1 NeSe ChirnacumIli Map by Keith Thorpe/Peninsula Daily News PORT TOWNSEND —Anderson Lake, which has the dubious distinction of setting a poisonous world record in 2008, is under a microscope. The goal: to try to find out why one of the North Olympic Peninsula's most popular fishing spots has been plagued since 2006 by soaring levels of anatoxin-a, a potent nerve toxin produced by blue-green algae. In June 2008, the 60 acres of lake within Anderson Lake State Park near Port Townsend contained the highest level of anatoxin-a ever recorded in the world: 172,640 micrograms per liter. The safety threshold for the toxin, which can kill in four minutes after ingestion, is 1 microgram per liter. With funding in part from the state Department of Ecology and water sampling help from Jefferson County Public Health, researchers at Oregon State University are scrutinizing types of blue-green algae that live in Anderson Lake. It's a project that could produce results as soon as this December, said professor Theo Dreher, chairman of the Department of Microbiology at Oregon State University and lead researcher. 40 They are analyzing the DNA of a few specific types of blue-green algae, called cyanobacteria, taken from Anderson Lake to see if they are commonly found in similar freshwater lakes across northwest Washington. If not, this would suggest Anderson Lake is home to a specific variety of toxin-producing cyanobacteria not found in other lakes, Dreher said. That could account for the high toxin production, he added. • This information could help local health officials devise a plan to combat the specific type of cyanobacteria and potentially reduce Anderson's toxin levels, he said. "If they determine that's true, there may be things we can do to treat that in Anderson Lake," said Greg Thomason, Jefferson County environmental health specialist. Blue-green algae occurs naturally and is usually benign, but at times, certain types will begin pumping out toxins. Researchers don't know why. They know only that warmer weather and longer days tend to fuel the growth of blue-green algae when the lake contains enough nutrients, such as phosphorus. Anderson Lake has been tested for toxins since two dogs that lapped water from the lake died Memorial Day weekend in 2006. Since then, the lake, a favorite for trout fishing, has been closed periodically to recreation and fishing during the warmest times of the year because of elevated levels of anatoxin-a and microcystin, a slower-acting poison that can cause skin irritation if touched and liver damage if swallowed. . In 2012, the lake was open only a few weeks of the year and surprised researchers by showing climbing levels of anatoxin-a in September and October, when cooler weather and shorter hours of daylight would be expected to quell algae production. The statewide lowland lake fishing season begins Saturday. State Ranger Mike Zimmerman, who is in charge of Anderson Lake State Park, will decide this week if the lake will be reopened for recreation then. In the meantime, Dreher said Thursday that his initial research has suggested a specific few varieties of Anabaena cyanobacteria may be responsible for producing anatoxin-a in high quantities, though he said these results are still preliminary. "So what's making most of the anatoxin there will need some more work and confirmation," Dreher said. Blue-green algae relatively unique to Anderson Lake being responsible for the anatoxin-a is one of two hypotheses that Dreher is exploring to explain the lake's high toxin levels. The second hypothesis says the conditions in Anderson Lake are somehow just right for the production of anatoxin-a, rather than an individual variety of cyanobacteria being the culprit. If blue-green algae found in Anderson is common to similar lakes, this line of evidence would point toward the second hypothesis, Dreher explained, adding that this route would require additional study. 110 "We're not going to experimentally address [the second hypothesis] until we're forced to by the first one being ruled out," Dreher said. Ilicounty report released in February notes the high amount of phosphorus in Anderson Lake as opposed to ther lakes in the county, such as Gibbs or Leland. A dairy farm was operated near the lake for more than 50 years, said Thomason and Michael Dawson, water quality lead with the Jefferson County Public Health Department, in the report. "Cow manure is very high in phosphorus and is probably the major source of the high phosphorus levels in this small lake," the report says. For the past few years, Dreher has been leading a team of undergraduate, graduate and post-doctoral students in sampling and studying blue-green algae in lakes across northwest Washington. As part of this work, Dreher said, he and his students found "quite interesting situations" where similar lakes were found to have varying levels of specific algae-produced toxins, or none at all. Anderson Lake stood out in these studies because consistently high levels of both anatoxin-a and microcystin have been seen there. "Anderson Lake just looked very interesting very early," Dreher said. Other lakes tested in East Jefferson County—such as Leland, Gibbs and Crocker lakes—occasionally have been found to contain unsafe levels of anatoxin-a and microcystin, but not in the amounts historically "keen in Anderson Lake. Toxin-producing blue-green algae has not been spotted in Clallam County. Reporter Jeremy Schwartz can be reached at 360-452-2345,ext.5074,or atjschwartz(a�peninsuladailynews.com. Anderson Lake to open for fishing as scheduled Peninsula Daily News,April 23`d,2013 � IMACUM—Anderson Lake will reopen as scheduled Saturday for the beginning of the fishing season,Jefferson County health fiicials and state park staff said Monday. "We will open this weekend with no restrictions," said Mike Zimmerman,the state ranger who oversees Anderson Lake State Park, located 10 miles south of Port Townsend. "We looked at the lake today and didn't see any visible[toxic algae]bloom, so we didn't take a sample,"said Greg Thomason, Jefferson County environmental health specialist. "So it looks like it will open on Saturday as planned." Anderson Lake is a popular trout-fishing lake that has been plagued with high levels of blue-green-algae-produced toxins since 2006,when two dogs died after drinking water from the lake on Memorial Day weekend. In the past,the county has tested weekly for toxins beginning two weeks before the final Saturday in April—the fishing season opener—and continuing through September or October. The Department of Ecology paid for the tests,costing$200-$300 for each test, but this year as a cost-cutting measure decided to only tests of samples taken when an algae bloom is present. The county Health Department will be monitoring Anderson, Gibbs and Leland lakes for toxic blue-green algae. It also will be measuring water quality parameters and testing for nutrients on a monthly basis, according to environmental health specialist Michael Dawson. Although less testing likely means fewer data on Anderson Lake's health this season,Thomason said he is not concerned about not being able to test the lake if no algae blooms are spotted. No blooms have been seen for months. "I'm not too worried now,"Thomason said. 11e haven't had a bloom, and it's been clear all winter." However, past potentially deadly toxin levels that have closed Anderson Lake have appeared when the water appeared clear after a large-scale algae bloom had dissipated,Thomason said. "Based on our data,that's when we've had our highest toxin[levels]," he added. In these instances,Thomason said public health staff will use county funds to sample Anderson Lake and send the samples for testing. "We will find the money to process[those samples], no matter what,"Thomason said. "We are committed to public health." In addition to anatoxin-a,which can quickly cause paralysis and death,another algae-produced toxin, microcystin, also has been found at times in East Jefferson County lakes. Microcystin can cause nausea and skin irritation over a short period of time—and liver damage if ingested in lake water over the longer term. Thomason said public health staff will continue to update the status of the lakes tested at Jefferson County's website, http://tinyurl.com/jeffersonlakewaterquality. Zimmerman said the 410-acre Anderson Lake State Park around the lake will be open to visitors, even if the lake proves to develop a water-quality issue later in the season. "We'll open the park for other recreation regardless of what the health of the lake is,"Zimmerman said. Visitors need a Discover Pass—either$10 for a day or$30 for a year—to park within Anderson Lake State Park. 40 Passes can be bought at any state park,where hunting or fishing licenses are sold, by phoning 866-320-9933 or by visiting www.discoverpass.wa.gov. Toxin-producing blue-green algae has not been spotted in Clallam County. Report algae blooms in Clallam County by phoning 360-417-2258,while Jefferson County blooms can be reported at 360-385-9444. Dispose of unwanted prescription drugs April 27 The Port Townsend Police Department last year netted nearly 86 pounds of poten- (PTPD) and the U.S. Drug Enforcement tially dangerous drugs. Nationally,Americans Administration (DEA) are teaming up to give turned in more than 2 million pounds of pre- the public an opportunity to prevent pill abuse scription pills during the past three years at and theft by ridding their homes of expired, 5,200 sites operated by the DEA and thousands unused and unwanted prescription drugs. of state and local law enforcement agencies. According to a PTPD press release,the ser- This program addresses a public safety and vice is free and anonymous, with no questions health issue.Medicines that languish in home asked about the drugs brought in for disposal. cabinets are highly susceptible to diversion, The Drug Take-Back event takes place from 10 misuse and abuse, according to the release: a.m. to 2 p.m., Saturday, April 27 at the Port Rates of prescription drug abuse in the U.S. Townsend Safeway,442 W.Sims Way. are high, as are the number of accidental Residents unable to attend the Take-Back poisonings and overdoses due to these drugs. event can dispose of unused prescription Studies show that a majority of abused pre drugs during business hours at the PTPD at scription drugs are obtained from family and Mountain View Commons, 1925 Blaine St. friends, including from home medicine cabi- Almost 130 pounds of prescription drugs were nets. Additionally, flushing pills down a toilet turned in to the department for disposal in or throwing them away in the trash, the press 2012. release states,can cause environmental safety Drug Take-Back events in Port Townsend and health hazards. • S • Drug Back Day set on Peninsula PENINSULA DAILY NEWS Safeway,442 W.Sims Way. The police departments, Expired, unused and Sheriff's unwanted prescription Office and Drug Enforcement Administra- drugs can be disposed of intion are teaming together to Port Angeles, Sequim and provide the free service. • Port Townsend on Saturday. Individuals may bring in The Port Angeles, controlled and noncon- Sequim and Port Townsend trolled prescription drugs, police departments and the as well as over-the-counter Clallam County Sheriff's medications. Office will participate in the The event is anonymous, National Drug Take Back and no identification is program from 10 a.m. to required. 2 p.m.Saturday. Citizens can prevent 2 million pounds medication drug abuse by taking potentially danger- Nationally, Americans ous expired, unused and unwanted prescription turned in more than 2 mil- lion pounds of prescription drugs to one of three loca- over the past three tions. years at 5,200 sites oper- ated by the DEA and thou- Drop-off sites sands of state and local law enforcement agencies. ® The main parking lot This is the sixth National of the Clallam County Drug Take Back Day, spon- Courthouse, 223 E. Fourth sored by the DEA in coop- St.,Port Angeles. eration with participating The free event will be local law enforcement agen- staffed by the Port Angeles cies. Police Department and Drugs that are flushed Clallam County Sheriff's down the drain or put in Office. garbage containers can be 01 The Sequim Police harmful to animals and the Department offices at 609 environment. W.Washington St. For more information, ■ The Port Townsend phone 360-417-2385. S PON .y/ /,3 Anderson Lake big draw on first day of trout season By Charlie Bermant , Peninsula Daily News,April 28`h,2013 5 rc � '+ x ,,,,ii.,-..... .4„:14ft„..iviiii...4.17rtztt,..0.,..„. 46.4.44....441z747‘, 4,,...,..,..,•„;,,,WA,"N,,i'e%itt*":,q.,,,Vkli,:lk4 ',, . ' ::6,4 "rAte''..-, .4v-r...cl- /01,';' ,.'-::rtk �^ Charlie BermanUPeninsula Daily News One of the youngest anglers, Eli Rivera, 2,of Port Ludlow,shows off a limit of trout. CHIMACUM—Anglers turned out in droves Saturday morning for the opening of the trout-fishing season at Anderson Lake following last year's season,when high levels of toxins produced by blue-green algae denied them most opportunities. Those arriving early at the popular site in Anderson Lake State Park near Chimacum made their limits,volunteer Cheri Scalf said. "The success rate is high in terms of the fish caught, but[the fish]aren't as big as last year,"Scalf said. Most of the rainbow trout fell into the 9-inch to 12-inch-long range,but by 10 a.m.,several people had caught trout as long as 18 Ilk ches. Scalf said the number of trout caught would be tallied after the weekend. As of 10 a.m. Saturday,the second-largest trout had been caught by 2-year-old Eli Rivera of Port Ludlow. "We got him a little fishing pole for his birthday last year and told him we'd take him fishing at the next opportunity,"said Carolyn Eyl, Eli's grandmother. As of 10 a.m.opening day, State Parks Ranger Aaron Terada reported 33 boats,25 shore anglers and 60 cars total. Many anglers left as soon as they caught their five-fish limit,Terada said. Terada said that though reports of past toxins in the lake may have kept some anglers away, no one had expressed apprehension to him about eating trout that was caught Saturday. Anderson Lake is a popular fishing lake that has been plagued with high levels of blue-green-algae-produced toxins since 2006, when two dogs died after drinking water from the lake on Memorial Day weekend. Since then,the lake, a favorite for trout fishing, has been closed periodically to recreation and fishing during the warmest times of the year because of elevated levels of anatoxin-a, a nerve toxin that can kill in four minutes after ingestion,and microcystin, a slower-acting poison that can cause skin irritation if touched and liver damage if swallowed. In 2012,the lake was open only a few days of the year because of elevated levels of toxins. It created a world record for the highest level of anatoxin-a in 2008. The toxins are created by blue-green algae,which is usually benign. ipResearchers don't know why some types of algae will suddenly begin producing toxins. They know only that warmer weather and longer days tend to fuel the growth of blue-green algae when the lake contains enough nutrients,such as phosphorus. In the past, the county has tested weekly for toxins beginning two weeks before the final Saturday in April—the fishing season opener—and continuing through September or October. The state Department of Ecology paid for the tests,which cost$200-$300 each, but this year, as a cost-cutting measure, Ecology officials decided to test lake samples only when an algae bloom is present. • County health officials also will monitor Anderson, Gibbs and Leland lakes for toxic blue-green algae on a monthly basis. Whether or not the lake is open,the park surrounding it is available for recreation throughout the summer. Visitors usually need a Discover Pass—either$10 for a day or$30 for a year—to park within Anderson Lake State Park, but this weekend is a free period, and no Discover Pass is required for visitors to state parks. Passes can be bought at any state park,where hunting or fishing licenses are sold, by phoning 866-320-9933 or by visiting www.discoverpass.wa.gov. Toxin-producing blue-green algae has not been spotted in Clallam County. Report algae blooms in Clallam County by phoning 360-417-2258,while Jefferson County blooms can be reported at 360-385-9444. Jefferson County Editor Charlie Bermant can be reached at 360-385-2335 or at cbermant(apeninsuladailynews.com. • r • State to begin health tests of popular Peninsula saltwater beaches Peninsula Daily News,April 30th, 2013 OLYMPIA—The state soon will begin testing popular saltwater beaches for bacteria to prevent people from getting sick from playing in the water. The federally funded, state-run BEACH — Beach Environmental Assessment, Communication and Health — Program notifies the public when beaches are a health risk, and educates people about ways to avoid getting sick from playing in saltwater. Beaches proposed for monitoring in Jefferson County are at Fort Worden State Park, Irondale County Park and Herb Beck Marina. In Clallam County, monitoring is proposed for Cline Spit County Park, Hollywood Beach and Salt Creek Recreation Area. Makah reservation beaches — Dakwas Park, East Front Street, Hobuck, Sooes, Third, Neah Bay and Warmhouse Beach —also are on the list to be tested. The Makah's program is funded by a separate grant from the Environmental Protection Agency. The program is accepting public comments about the proposed list until May 20. treatment plants, sewage spills and animal faces. Contact with fecal-contaminated waters can result in gastroenteritis, skin rashes, upper respiratory infections and other illnesses, the state Department of Health said, and children and the elderly may be more vulnerable to waterborne illnesses. "The BEACH program is the best source of information for saltwater beach health in the state of Washington," said Christopher Clinton, acting coordinator of the BEACH Program. "Our partnerships with local health departments, universities, local volunteers and tribes are the strength of the BEACH Program," he added. The local partners collect weekly samples to look for fecal pollution and the BEACH Program notifies the public when there are problems. The program is jointly coordinated by the state departments of Ecology and Health. The annual May-through-September project is implemented by local health agencies, tribal nations, university coordinators, non-profits, and volunteers. The BEACH Program posts signs to notify people when there is a higher risk of illness at our most popular saltwater beaches. The program sends timely email notifications and social media posts to inform the public when beach health problems arise. While the main goal is to monitor water quality and notify the public when bacteria levels are high, BEACH also works with local and state partners to investigate and correct the problems whenever possible. 110 To see the list of beaches proposed for testing, go to www.ecy.wa.gov/programs/eap/beach/. Comments can be sent to Clinton at christopher.clinton a�7ecy.wa.gov or by phone at 360-407-6154. • 4/24/2013 6:00:00 AM,Port Townsend Leader Lake fishing season returns; so does algae eriounty has less money to monitor lake water quality stan Hiegler,reporter This Saturday is opening day of the state's lake fishing season, and three major county lakes are confirmed to be open for business— although toxic algae blooms could change that schedule. Anderson Lake State Park reopens for fishing at 6 a.m. on April 27, according to Mike Zimmerman, ranger and park manager for Washington State Parks. He said the 70-acre lake's boat launch and pier are available to use, and rainbow trout are waiting. "We're thinking that there may be some pretty good-size ones in there," Zimmerman said. "I would expect there would be some big daddies in there." Lake Anderson was only open for one full week after its opening last year, Zimmerman noted, due to toxic algae blooms. He said the outlook is looking good for right now, but he added that there's no reason to expect any long stints of clear water for fishing. "We know the algae has been present for almost seven years now. I can't imagine it's cleared up since last year," he said. Zimmerman noted that park users need a Discover Pass for vehicle parking. He advised fishers to buy one ahead of time and he plans to have a park employee selling passes on site on opening day. The $80 Natural Investment Permit works as a Discover Pass for state parks and allows for unlimited boat launches, Zimmerman added. .roxic algae Toxic algae also has been a problem at two other prime fishing (and swimming) lakes in East Jefferson County, Gibbs Lake and Lake Leland. The lakes are being tested for algae this week, said Greg Thomason, an environmental health specialist with Jefferson County Public Health's (JCPH) Environmental Health Department. JCPH has been collecting and submitting water quality/algae samples from Lake Leland, Anderson Lake and Gibbs Lake since 2006. Toxins produced by some types of blue-green algae are poisonous to birds and mammals, including humans. There are two main types of toxins: anatoxins, which act rapidly and were responsible for the deaths of two dogs and the near-death of a third dog who drank water from Anderson Lake in May 2006; and microcystins, which can cause skin irritation similar to "swimmer's itch," but if ingested over a period of many years, can also result in liver failure. Monitoring allows the county to place notices of"caution," "warning" or"closure." In cases of"caution" and "warning" notices, well-cleaned fish may still be eaten. Monitoring cut Thomason, who takes samples of the three monitored county lakes and sends them in to the King County Environmental Lab, said funding for his work has been cut. He said that, instead of weekly lake testing, he •might be reduced to monthly testing. The cuts come from a reduction in the state Department of Ecology (DOE) grant to Jefferson County, according to Jared Keefer, director of JCPH's Environmental Health. Keefer said the county had received $30,000 for two years of monitoring, but now that amount has been reduced to $15,000 over the biennium. • He added that the county supplies $10,000 out its general fund for the lake monitoring program, and more money could be forthcoming from that source. "We've got to pare back on the frequency that we monitor and the testing that we do in the program," he said. "We know the conditions in the lakes change week to week, and maybe even quicker than that. But week to week is a good indicator, and a good protective monitoring fashion for public health. So that's,got me concerned." Linda Kent, a DOE spokesperson, said the grant was reduced in part because the agency considers applications from across the state. She added that sample testing should be conducted only when there's a visible algae bloom. "There's really not a reason to be testing if there's not a bloom," Kent said. "If there's a bloom, they can submit a sample and Ecology will pay the sample analysis separately." After an algae bloom, Thomason said, the decomposing algae can release even more toxins and continue to affect the lake. "We have had some of our highest toxin levels when the lake is clear," he said. Keefer said that while the DOE is funding monthly testing, he would be willing to draw from general-fund money if worsening lake conditions warrant more tests. Given that funding for the testing is limited, Keefer said, blooms might result in more closures than last • season, just because the testing window is longer. "I think people are pretty well conditioned to know by now that as the summer goes on, the lakes will be closed, so get your fishing in now," he said. • Jefferson Healthcare designated as baby friendly Jefferson Healthcare has been designated .Center,along with two forms of medical best a Baby-friendly Hospital by the World Health practices: a link between breastfeeding sup- Organization (WHO). It is the fifth hospital port for mothers provided prior to and.after in the state of Washington and one of 128 in delivery, and obstetric nurses recognized as the United States to achieve this title. Mother-friendly Nurses by the Coalition for The Baby-friendly Initiative, launched in' Improving Maternity Services. 1991 by UNICEF and WHO,recognizes hos- The combination of these two medical best pitals around the world that implement best practices and the highly prestigious award practices in breastfeeding support for new aligns with Jefferson Healthcare's long-term mothers, and that allow moms and infants strategic goals to provide excellent patient to remain together at all times during their care experience; to meet the highest qual- stay in the hospital.According to WHO,this .ity standards in patient satisfaction; and to practice results in lower risks for certain ensure best practices in patient safety. diseases and improved health outcomes for A celebration and tours of Family Birth both breastfeeding mothers and their babies. Center are planned for Friday, May 17 The process for attaining the award for current mothers-to-he and moth- involved enhanced leadership skills, staff ers who have given birth at Jefferson competencies and overall patient satisfac Healthcare. For more information, visit tion at Jefferson Healthcare's Family Birth jeffersonhealthcare.org. f . r- i L�GC riLi 5/3/2013 3:22:00 PM,Port Townsend Leader High levels of E. coli at Irondale Beach; no shellfishing allowed Owimming, wading not recommended not recommended along the Port Townsend Bay site High levels of E. coli bacteria have been detected in a stream that enters lrondale Beach Park along Port Townsend Bay. "Average bacteria counts were greater than 1,500 units per 100 milliliters, which is a very high number," said Michael Dawson, water quality lead for Jefferson County. The state Department of Health has closed a portion of the Chimacum Creek Tidelands south of Chimacum Creek to recreational shellfish harvest. The beach is open north of Chimacum Creek, toward Kala Point. Swimming and wading are not recommended in the creek or on the beach. Warning signs have been posted at the beach, the stream and the parking lot. E. coli bacteria are from fecal contamination from warm-blooded animals, including people. They indicate the possible presence of pathogens that can make people sick. The bacteria were discovered by monitoring conducted by Jefferson County Public Health through the Northeast Jefferson Clean Water Project, funded in part by the Washington Department of Ecology. Monitoring includes sampling from streams entering the shoreline along the Quimper Peninsula and Marrowstone Island. Investigation of potential sources is under way, which includes checking for failing septic systems. �esidents are urged to have an operations and monitoring inspection of their system to ensure it is functioning correctly. For more information, call 385-9444 or visit jeffersoncountypublichealth.org. • • Jefferson Healthcare designated 'baby friendly' hospital By Charlie Bermant , Peninsula Daily News, May 3rd-4th,2013 ",� _ �<` 1, env i .r.• si Charlie Bermant/Peninsula Daily News Nine-month-old Jack Ayer of Port Townsend looks none too pleased about getting weighed by Kirsten Pickard, nurse manager of the Jefferson Healthcare Family Birth Center. But the hospital is thrilled at being designated as one of five baby-friendly hospitals in the state. PORT TOWNSEND—Jefferson Healthcare is the fifth hospital in the state to achieve the World Health Organization's designation as a Baby-Friendly Hospital. The designation April 13 creates an atmosphere that will create a healthier environment for both the babies IIPoorn in the hospital and their mothers, said hospital personnel. "It comes down to women's health," said Kirsten Pickard, nurse manager of the 25-bed hospital's five-bed family birth center. "It's a challenge to create an environment that supports breast-feeding, but the benefits are huge." To mark the designation, the hospital plans to hold an open house at the Family Birth Center on May 17. Kate Burke, hospital spokeswoman, said invitations are expected to be sent to current mothers-to-be as well as mothers who have given birth at the hospital. The hospital is one of 158 in the United States that has received the designation, which requires training of the staff and auditing of all hospital practices, not only those in the maternity ward. "I'm just so proud of them. It was quite an accomplishment," said chief nurse executive Joyce Cardinal. "It's good for the community and for the mothers and babies in Jefferson County." She said Pickard and the other nurses in the birthing center"had the aggressive goal of becoming baby- lofriendly. "It's a lot of education, a lot of policies. We're educating nurses in birthing and in the hospital elsewhere on the value of breast-feeding." For instance, they make sure a patient who has surgery can continue to breast-feed while she is hospitalized, Cardinal said. "We promote breast-feeding, but we also support people who make the choice not to breast-feed," Cardinal said. "We know that there are mothers who make that choice." The Baby Friendly initiative was launched by UNICEF and the World Health Organization —or WHO — in 1991. It recognizes hospitals around the world that implement best practices in breast-feeding support for new mothers and in allowing moms and infants to remain together in the hospital. Breast-feeding decreases instances of ear and respiratory infections, and sudden infant death syndrome, Pickard said, and also can prevent or curtail a child's susceptibility to diabetes and obesity. Other than Jefferson Healthcare, the baby-friendly hospitals in Washington are the University of Washington Medical Center in Seattle, Tacoma General Hospital, Three Rivers Hospital in Brewster and Evergreen Hospital Medical Center in Kirkland. Pickard said the designation will draw mothers from throughout the region to Jefferson Healthcare. With the current facilities and staff, the hospital could accommodate twice the 110 to 120 babies born there each year, she said. In 2012, Jefferson Healthcare became the only hospital in the United States to require all obstetric nurses to achieve recognition from the Coalition for the Improvement of Maternity Services as Mother Friendly Nurses, Burke said. "We are the first the hospital in the country that has both baby- and mother-friendly designations," Cardinal said. Jefferson County Editor Charlie Bermant can be reached at 360-385-2335 or at cbermant(c�peninsuladailynews.com. S High bacteria levels prompt closure at Irondale Beach Peninsula Daily News, May 5th, 2013 • PORT HADLOCK— High levels of E. coli bacteria detected in a stream that enters Irondale Beach Park has prompted the closure of the tidelands south of Chimacum Creek to recreational shellfish harvesting. The beach at Port Hadlock is open north of Chimacum Creek, said Michael Dawson, water quality lead for Jefferson County Environmental Health, reporting Friday on the state Department of Health announcement. Neither swimming nor wading is recommended in the creek or on the beach. Warning signs have been posted at the beach, stream and parking lot. "Average bacteria counts were greater than 1,500 units per 100 milliliters, which is a very high number," Dawson said. Investigators are looking for the source, a process that includes checking for failing septic systems. All area residents are urged to have their systems inspected, Dawson said in the statement. E. coli bacteria occurs from fecal contamination in warm-blooded animals, including people. They indicate the possible presence of pathogens that can make people sick. The bacteria were discovered bymonitoringconducted bythe county public health department through the Northeast Jefferson Clean Water Project, which is funded in part by the state Department of Ecology. Monitoring includes sampling from streams entering the shoreline along the Quimper Peninsula and Marrowstone Island. According to the state Department of Health website at http://tinyurl.com/doh-wa-qov-beaches, marine biotoxins have prompted the closure of some beaches on the North Olympic Peninsula. In Clallam County, Dungeness Bay and the Strait of Juan de Fuca from Pillar Point west to Cape Flattery is open for recreational harvest, while the area east of Pillar Point to the Jefferson County line, as well as Discovery Bay and Sequim Bay, are closed only to butter and varnish clam harvest. In Jefferson County, Discovery Bay and Port Ludlow, including Mats Mats Bay, are closed to recreational harvest of butter and varnish clams, while Kilisut Harbor, including Mystery Bay, is closed for butter clams only. Shellfish harvest also is not advised on the southern portion of Fort Flagler Spit, known as Rat Island, because of pollution from toxic substances. Shellfish harvesting should be avoided from the eastern reaches of Fort Worden State Park beach and North Beach because the areas lie within sewage-treatment plant outfall closure zones, the state health department said. Also closed are Old Fort Townsend beach, Pleasant Harbor Marina, Port Hadlock Marina and South Point Wilson. • All areas are closed for the recreational harvest of scallops. Ocean beaches are closed to the recreational harvest of all species of shellfish from April 1 to Oct. 31 each year. • Drug Take Back event nets 130 pounds of pharmaceuticals • Peninsula Daily News, May 7th, 2013 Law enforcement agencies across the North Olympic Peninsula collected more than 130 pounds of expired, unused and unwanted over-the-counter and prescription drugs during the annual Drug-Take Back Day last month. Drugs were brought in April 27 for disposal. The Port Angeles Police Department and Clallam County Sheriff's Office collected 64.6 pounds of drugs at the Clallam County Courthouse at 223 E. First St., Port Angeles. The Sequim Police Department estimated between 40 and 45 pounds of unwanted drugs were collected at the Sequim police offices, 609 W. Washington St. Port Townsend police took in about 25 pounds of unwanted or unused drugs during the event, said Kay Pownall, administrative supervisor and property and evidence technician for the Port Townsend Police Department. Borte said the federal Drug Enforcement Administration, which sponsors the national drug take- back effort each year, has ruled that drugs no longer can be taken back to pharmacies. • The Clallam County Sheriff's Office continues to accept unused medications between 8:30 a.m. and 4:30 p.m. Mondays through Fridays, Borte said. The office is located on the main floor of the Clallam County Courthouse. Unwanted drugs also can be taken to the Jefferson County Sheriff's Office at 81 Elkins Road, Port Hadlock. The Peninsula's other law enforcement agencies also will take in drugs five days a week during business hours. The take-back program is free and does not require identification. Nationally, Americans turned in more than 2 million pounds of prescription pills over the past three years at 5,200 sites operated by the DEA and state and local law enforcement agencies. • Remember whom Look at impact of Fri: l the market is for R� 7i � g a0 'r I write in support of a dog ban at dogs at the market F '`-i'r' . the Port Townsend Farmers Market. 111, There are many things I love : ii` Please keep in mind, however, ,1' '';''':';:Athat the issue is about much more about the farmers market:the diversi 7 �• ty of local products,the community of - .*.� than dogs. It is about the quality of 4J[ z public space. people,the music,and so much more. s � What I do not love about the farm- � ".�,5< A simple ban on dogs is not eA-er's market are the dogs.For over five .`y , _ _ enough.When I am in public spaces years I have kept an open mind about , s" , v ' < , < I expect there will be nothing dis- dogs at the farmers market and I've _ tasteful, unpleasant, inconvenient come to realize that, for numeroustt and certainly nothing remotely dan- reasons, the farmers market is no • ° ,H.,., .1..4 ' ``,: ? tnei gerous. place for dogs. Dogs often accompany their people to the So it is not only dogs that need There have been too many times Port Townsend Farmers Market. Some to be banned,but also children.And to mention that my family and I have people want to ban dogs;others say it's a before children lovers jump down my nearly been in the middle of a dog farmers market tradition.Leader file photo throat, I, too, enjoy children. I used confrontation.On many occasions the to teach,and I even had a child once. owners are busily conversing, seem- Dogs are dangerous However, at the crowded market, ingly unaware of the impact their they endanger serious shoppers. For dogs are having on other market- at farmers market instance,just last week, after exam- goers. ining some of Nash's beautiful chard, Not once but twice my children I have followed with interest the I turned and nearly fell over a small have gotten their snacks gobbled from letters concerning the presence of child. Please remember this is on their little hands by dogs, and to my dogs at the Port Townsend Farmers pavement.I could have broken a hip. dismay, we didn't receive an apology Market and wish,to add my.voice to In addition,I witnessed c two hil- or a replacement from the owner. the discussion '` dren fighting over a Pane d'Amore It is not just my family experienc- As a weekly shopper at the farm- cheese stick. So really, they could ing such things,and a few folks have ers market, I have witnessed first- hurt each other, not just the custom- even told me that they have stopped hand some of the incidents mentioned ers. , coming to the market because of it. in the previous letters,including falls While I'm on the topic,I'd like to . I don't want to make the same and possible injuries. point out another group that incon- decision,but I am starting to feel like The farmers market is a venue to veniences, and may endanger, the. it's not a safe place for us to go,and it's promote local food sources and pro- good shoppers at the market: those certainly not an enjoyable experience vide healthy, organic food choices for in wheelchairs. Last Saturday, I when we have to watch our backs and our community. observed a gentleman in a wheel- guard our coveted market snacks. While it has also become a social chair who nearly rolled over a young A couple of vendors have shared meeting place, it is a commercial woman's foot. Wheelchairs are far with me that many times they have endeavor and I have yet to see any too large and unwieldy to be allowed witnessed dogs peeing on stuff.Many canine, while occupying already in the market. farm booths have beautiful veggies crowded market aisles,open up their So, market manager and displayed right at dog-spraying level; coin purse to purchase anything that board,So, deareae market dogs, who wants to buy their delicious edi- supports local farmers. board,p consider banning os bles freshly sprayed with dog pee? The market offers an opportunity make the anddrwh experience Thisso willch I know it must not be an easy for the many retired people in our community to purchase fresh,quality more pleasant for the community. decision to possibly ban dogs from the Also, one time last summer the market. However, many other farm food. As our community ages, more of us find our mobility impaired and music was far too loud and obnox- ers markets around the country have are cautious about working our way ious.Is the music really necessary? done so and I urge you to take a look through crowds ofpeople. at the impacts and consider the same. g Please remember whom public CINDY SCOTT Add to that mix dogs on leashes spaces are meant for. dog owner held by preoccupied owners and it RACHELLE MERLE Jefferson County becomes a serious safety hazard.How Port Townsend many seniors are being discouraged from taking advantage of the market because of this challenge? As the presence of dogs displace, challenge, and, unacceptably, injure those who wish to support this invalu- able resource, I would urge the mar- • ket's board of directors to deal with this problem before having to face legal repercussions. PAMELA J.MURPHY Port Townsend /p/f. /-e .6,1....' A modest proposal for market dogs As I pondered the sad letter noting1111 "dog's tail in coffee at farmers market" ("Farmers market no place for dogs,- April 10 ogs,-April10 Leader) I suddenly noticed a dog.eyeing nn- coffee."No way,Spot." • So,Port Townsend,we need a sec- ond farmers market. Convenient, at the opposite end of town."No dogs"is just the beginning. Stop getting wet, too.There needs to be a roof. No more nonsense paying each and every person working at the farmers market. Consider a conve- nient paying zone at one end. A new and better farmers market. And it shall be known,to one and all, as"The Safe Way." Look inside your heart and ask yourself:If they exclude your dog,how long before they come after you? STEVE TOUGER World Order.of Fur Port Townsend • S Pill drop-off event was botched 41111 First, let me state that I respect making the decision to stop the the police and sheriff departments Drug Take Back on Saturday, April for the tough job they do. That 27,2013. The Port Townsend Police being said,I think someone botched Department is open five days a.week the Saturday, April 27 pill drop-off (Monday through Friday) to take at Safeway. back drugs. We took back over 200 The information I had was that pounds of drugs last year. I a.m. it was from 10 a.m. to 2 p.m. I always looking for additional vol- drove in to town about 1:15 p.m. unteers to help with this program. and picked up a few groceries at I would like to invite you to come the store and then asked the phar- by the police station and complete a macist where the pill drop-off was. volunteer application. I can always He replied,"Oh,they left because it use the help. was raining outside. You can take them to the police station or the sheriff's office." I didn't think drizzle shut any- thing down in Port Townsend; I frowned at him but it wasn't his fault. So I drove to the police sta- tion; it was only a few blocks out of the way (the sheriff's office was a lot farther). Well guess what? The office was dark. It's closed on Saturday. I saw a lady there also wanting to leave pills. So, trying to do the right thing, we both left frustrated and still have our pills. GENE TENNEY • Jefferson County Editor's note: The Leader asked Chief Conner Daily to respond: "I was the one responsible for • /1 j . K • i l'') CI �.C..o V - '- o� °0 Nw , Q ' ° ' '� . am' Syc. : cmmaa, 5.7 si m ° au a,s o C -r. G: .8oa, m "c a, o V 0.0 74 °.a.'� �j40.E, 8• ronQ >aaa 5, ° -, v"o [ a a. c ,3,� i �', acatiyEa oa . y z .f . o � § ymro -0s .. a 0m '$ yc"amu > .cpo c ia .�6 3w ; 3•F, ow E0•k•. o p,Y ° m � , o i vw a � " 00o CCi .� m'c " on°'' E4)11"94am > V OCx a4 - ma sC °' 1 4 E"U-'Fui.,, .c , m.yca O mEio OJC 8- 0E• 2 c,�m.g1 °°y gxa7o > moCm d . ° 3¢ � m O m ¢ 43 Eo DuiyE C ° a x o cm x $ vny v•aa or f dEd pa . ,. w -.• i1-s- d ° n a d Q -4-4J wY ° E 7 LLia ; 4, 2apu .. '' ° -' E � b �oc ~ C �aAm " . o o m? u v. 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Q. -) 0 a Fro O ►Uo w oat.m U it. °3O 1 Etivd m ag ro �o 1 b- 4t;,O� o.''' 4.1 E •q m y o 0 N co ,o JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street o Port Townsend o Washington o 98368 • www.jeffersoncountypublichealth.org May 16, 2013 Senator Jim Hargrove PO Box 40424 Olympia, WA 98504-0424 Re: Preservation of State and Local Public Health Funding Dear Senator Hargrove: On behalf of the Jefferson County Board of Health, I would like to thank you and the Legislature for preserving local public health funding in both the House and Senate budgets. As you negotiate the final budget, we ask that you continue to preserve foundational local public health funding and restore critical Department of Health activities that are cut in the Senate budget. The proposed cuts of almost$450,000 in Department of Health(DOH) funding in the Senate budget would hurt important statewide public health systems and services, such as: • • Washington Immunization Information System (WIIS, formerly, Child Profile)— Local Health Jurisdictions (LHJs)help get children immunized, but they, medical providers, schools, and parents rely on this statewide registry to keep records of who has been immunized. Without DOH's support of WIIS, LHJs would be severely challenged to improve immunization coverage and protect our communities from outbreaks of disease. • Public Health Information Management System (PHIMS) and Notifiable Conditions Reporting—LHJs must respond to reports of more than 60 notifiable conditions such as pertussis, measles, tuberculosis or foodborne disease outbreaks. Outbreaks of disease cross jurisdictional boundaries and public health cannot quickly and effectively respond without consistent reporting and effective communication; PHIMS is this key tool. • Behavioral Risk Factor Surveillance System (BRFSS)—BRFSS is the major source of data for adult health and risk factors. It is critical for public health to understand our residents' health needs, to plan interventions to protect and improve their health, and to evaluate the impact of programs and services. • DEVELOPMENTAL HEALTH TSABILITIES PUBLIC HEALTH ENVIRONMENTAL HEALTH WATER QUALITY MAIN: (360)385-9400 ALWAYS WORKING FOR A SAFER AND MAIN: (360)385-9444 FAX: (360)385-9401 HEALTHIER COMMUNITY FAX: (360)379-4487 • Other Important Public Health Data Sources—In addition to BRFSS, DOH provides • other key public health data sources (e.g. denominator data for sub-county population health data, web-based data warehouse for public health data, and the Local Public Health Indicators) that allow LHJs to assess their local health needs, target services and programs to at-risk populations, and evaluate effectiveness of those programs and services. A well functioning public health system requires local, state, and federal components. It is critical that DOH continue to receive funding to coordinate and provide statewide infrastructure and systems so that local health jurisdictions can work effectively in our communities. Again, thank you for your efforts and I appreciate the difficult task in front of you as you negotiate the final budget. I hope that you will seek to preserve foundational local public health funding and restore critical Department of Health activities that are cut in the Senate budget. Sincerely, Jill Buhler, Chair Jefferson County Board of Health s COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH . DEVELOPMENTAL DISABILITIES WATER QUALITY MAIN: (360)385-9400 ALWAYS WORKING FOR A SAFER AND MAIN: (360)385-9444 FAX:(360)385-9401 HEALTHIER COMMUNITY FAX: (360)379-4487 c�`t, JEFFERSON COUNTY PUBLIC HEALTH �sH/NG�O 615 Sheridan Street o Port Townsend o Washington o 98368 www.jeffersoncountypublichealth.org • May 16, 2013 Senator Jim Hargrove PO Box 40424 Olympia, WA 98504-0424 Re: Preservation of State and Local Public Health Funding Dear Senator Hargrove: On behalf of the Jefferson County Board of Health, I would like to thank you and the Legislature for preserving local public health funding in both the House and Senate budgets. As you negotiate the final budget, we ask that you continue to preserve foundational local public health funding and restore critical Department of Health activities that are cut in the Senate budget. The proposed cuts of almost $450,000 in Department of Health (DOH) funding in the Senate budget would hurt important statewide public health systems and services, such as: • • Washington Immunization Information System (WIIS, formerly, Child Profile)— Local Health Jurisdictions (LHJs) help get children immunized, but they, medical providers, schools, and parents rely on this statewide registry to keep records of who has been immunized. Without DOH's support of WIIS, LHJs would be severely challenged to improve immunization coverage and protect our communities from outbreaks of disease. • Public Health Information Management System (PHIMS) and Notifiable Conditions Reporting—LHJs must respond to reports of more than 60 notifiable conditions such as pertussis, measles, tuberculosis or foodborne disease outbreaks. Outbreaks of disease cross jurisdictional boundaries and public health cannot quickly and effectively respond without consistent reporting and effective communication; PHIMS is this key tool. • Behavioral Risk Factor Surveillance System (BRFSS)—BRFSS is the major source of data for adult health and risk factors. It is critical for public health to understand our residents' health needs,to plan interventions to protect and improve their health, and to evaluate the impact of programs and services. • COMMUNITY HEALTH DEVELOPMENTAL DISABILITIES PUBLIC HEALTH ENVIRONMENTAL HEALTH ALWAYS WORMING FOR A SAFER AND WATER QUALITY MAIN: (360)385-9400 MAIN: (360)385-9444 FAX: (360)385-9401 HEALTHIER COMMUNITY FAX: (360)379-4487 • Other Important Public Health Data Sources—In addition to BRFSS, DOH provides other key public health data sources (e.g. denominator data for sub-county population • health data, web-based data warehouse for public health data, and the Local Public Health Indicators)that allow LHJs to assess their local health needs,target services and programs to at-risk populations, and evaluate effectiveness of those programs and services. A well functioning public health system requires local, state,and federal components. It is critical that DOH continue to receive funding to coordinate and provide statewide infrastructure and systems so that local health jurisdictions can work effectively in our communities. Again,thank you for your efforts and I appreciate the difficult task in front of you as you negotiate the final budget. I hope that you will seek to preserve foundational local public health funding and restore critical Department of Health activities that are cut in the Senate budget. Sincerely, Jill Buhler, Chair Jefferson County Board of Health i COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH • DEVELOPMENTAL DISABILITIES WATER QUALITY ALWAYS WORKING FOR A SAFER AND MAIN: (360)385-9400 MAIN: (360)385-9444 FAX:(360)385-9401 HEALTHIER COMMUNITY FAX: (360)379-4487 Jefferson County Board of Health New Business • AGENDA ITEM V — 3 County Health Rankins and Roadmap Report 2013 Jefferson County Rankings May 16, 2013 S . • ii County Health Ranking .& R . . aaps - ea ter` atton,` ounty by'° oun� 2013 Rankings Washington ,, ,..,• -r , ..,,,„, ..,.. . ... . - - 4Ir , ..,,, 7,--,,rf- ',...att ill " 'Iiii UNIVERSITY OF WISCONSIN I�� l Population Health Institute Robert Wood Johnson Foundation Translating Resear•cl for Policy and Practice • County Health Rankings 2013:Washington Introduction • Where we live matters to our health.The health of a community depends on many different Population Health Institute to bring this groundbreaking program to counties and states factors, including the environment, education across the nation. and jobs, access to and quality of healthcare, and individual behaviors. We can improve a The County Health Rankings& Roadmaps community's health by implementing effective program includes the County Health Rankings policies and programs. For example, people project, launched in 2010, and the newer who live in communities with smoke-free laws Roadmaps project that mobilizes local are less likely to smoke or to be exposed to communities, national partners and leaders second-hand smoke,which reduces lung cancer across all sectors to improve health.The risk. In addition, people who live in program is based on this model of population communities with safe and accessible park and health improvement: recreation space are more likely to exercise, which reduces heart disease risk. Health Outcomes However, health varies greatly across communities,with some places being much healthier than others.And, until now,there has been no standard method to illustrate what we know about what makes people sick or healthy Health Factors or a central resource to identify what we can do to create healthier places to live, learn,work and play. We know that much of what influences our health happens outside of the doctor's office— Policies and Programs in our schools,workplaces and neighborhoods. The County Health Rankings& Roadmaps In this model, health outcomes are measures program provides information on the overall that describe the current health status of a health of your community and provides the county.These health outcomes are influenced tools necessary to create community-based, by a set of health factors. Counties can improve evidence-informed solutions. Ranking the health outcomes by addressing all health health of nearly every county across the nation, factors with effective,evidence-informed the County Health Rankings illustrate what we policies and programs. know when it comes to what is making communities sick or healthy.The County Health Everyone has a stake in community health. We Roadmaps show what we can do to create all need to work together to find solutions.The healthier places to live, learn,work and play. County Health Rankings& Roadmaps serve as The Robert Wood Johnson Foundation both a call to action and a needed tool in this collaborates with the University of Wisconsin effort. Guide to Our Web Site snapshots;or Share information with others via To compile the Rankings,we selected measures Facebook,Twitter, or Google+.To understand that reflect important aspects of population our methods,click on Learn about the Data and health that can be improved and are available Methods.You can also take advantage of the at the county level across the nation.Visit Using the Rankings Data guide to help you www.countvhealthrankings.org to learn more. explore the data and figure out more about what is driving your community's health.To To get started and see data,enter your county learn about what you can do to improve health or state name in the search box. Click on the in your community,visit the Roadmaps to name of a county or measure to see more Health Action Center. Finally,you can learn details. You can:Compare Counties; Download what others are doing by reading Communities • data for your state; Print one or more county Stories and visiting the Project Showcase. www.countyhealthrankings.org/washington 1 County Health Rankings 2013:Washington County Health Roadmaps RWJF Roadmaps to Health Prize The Rankings illustrate what we know when it In February 2013, RWJF awarded the first RWJF comes to making people sick or healthy.The Roadmaps to Health Prizes of$25,000 to six • County Health Rankings confirm the critical role communities that are working to become that factors such as education,jobs, income and the environment playin how healthyhealthier places to live, learn,work and play. people are The RWJF Roadmaps to Health Prize is intended and how long we live. not only to honor successful efforts, but also to inspire and stimulate similar activities in other The County Health Roadmaps mobilizes local U.S. communities. communities, national partners and leaders across all sectors to improve health. The County Health Roadmaps show what we can do to create healthier places to live, learn,work and TAKE ACTION play.The Robert Wood Johnson Foundation (RWJF) collaborates with the University of Wisconsin Population Health Institute(UWPHI) to bring this groundbreaking project to cities, = wo. To t,r•s �sre.r:�eu& A-n.nr... 13r,a„rrt, counties and states across the nation. The Roadmaps project includes grants to local coalitions and partnerships among policymakers, business,education, public health, health care, and communityCommunEty Members organizations;grants to national organizations Fr.r„ ,,,,`^,hor, (ItA Of:OM Image nr.•Ia working to improve health; recognition of communities whose promising efforts have led to better health;and customized guidance on strategies to improve health. Roadmaps to Health Community Grants frarnrEtfecuw • The Roadmaps to Health Community Grants P°"`frAa+ m, provide funding for 2 years to thirty state and local efforts among policymakers, business, Roadmaps to Health Action Center education, healthcare, public health and The Roadmaps to Health Action Center, based community organizations working to create at UWPHI, provides tools and guidance to help positive policy or systems changes that address groups working to make their communities the social and economic factors that influence healthier places.The Action Center website the health of people in their community. provides guidance on developing strategies and advocacy efforts to advance pro-health policies, Roadmaps to Health Partner Grants opportunities for ongoing learning,and a RWJF is awarding Roadmaps to Health Partner searchable database of evidence-informed Grants to national organizations that are policies and programs focused on health experienced at engaging local partners and improvement: What Works for Health. Action leaders and are able to deliver high-quality Center staff provide customized consultation training and technical assistance,and via email and telephone to those seeking more committed to making communities healthier information about how to improve health. places to live, learn,work and play. Partner Coaching, including possible on-site visits, is grantees increase awareness about the County also available for communities who have Health Rankings& Roadmaps to their members, demonstrated the willingness and capacity to affiliates and allies. As of February 2013, RWJF address factors that we know influence how has awarded partner grants to United Way healthy a person is,such as education, income Worldwide, National Business Coalition on and family connectedness. Health, and National Association of Counties. 2 www.countyhealthrankings.org/washington County Health Rankings 2013:Washington County Health Rankings • The 2013 County Health Rankings report ranks Our summary health outcomes rankings are Washington counties according to their based on an equal weighting of mortality and summary measures of health outcomes and morbidity measures.The summary health health factors. Counties also receive a rank for factors rankings are based on weighted scores mortality, morbidity, health behaviors,clinical of four types of factors: behavioral, clinical, care,social and economic factors, and the social and economic, and environmental. The physical environment.The figure below depicts weights for the factors (shown in parentheses in the structure of the Rankings model;those the figure)are based upon a review of the having high ranks (e.g., 1 or 2) are estimated to literature and expert input, but represent just be the "healthiest." one way of combining these factors. Mortality(length of life)50% Health Outcomes Morbidity(quality of life)50% 4 Tobacco use Health behaviors Diet&exercise (30%) Alcohol use I Sexual activity • Clinical care Access to care L_(_20%) Quality of care Health Factors Education I Employment ... Social and economic factors Income (40%) Family&social support Community safety Physical Environmental quality environment • Policies and Programs ( 10%) Built environment County Health Rankings model P2012 UWPH! • www.countyhealthrankings.org/washington County Health Rankings 2013:Washington The maps on this page and the next display summary rankings.The green map shows the Washington's counties divided into groups by health distribution of summary health outcomes.The blue • rank. Maps help locate the healthiest and least displays the distribution of the summary rank for healthy counties in the state.The lighter colors health factors. indicate better performance in the respective HEALTH OUTCOMES a i, 4�p 51 -ti SA sidll,lo IS t SN �— ]F KT S DO i SP I KG 0411111 711 �.V _ .'H .',i r. L . .—. WIC �° °, 1 1 r- 4 KL " CA Rank 1-10 Rank 11 20 rank 21-29 ',Rank 30-391 • County am County Ell County ES County Rank Adams 28 Franklin 18 Lewis 21 Snohomish 10 Asotin 29 Garfield 17 Lincoln 30 Spokane 24 Benton 12 Grant 25 Mason 33 Stevens 31 Chelan 8 Grays Harbor 36 Okanogan 38 Thurston 9 Clallam 27 Island 4 Pacific 37 Wahkiakum 23 Clark 11 Jefferson 7 Pend Oreille 32 Walla Walla 16 Columbia 20 King 6 Pierce 26 Whatcom 5 Cowlitz 34 Kitsap 15 San Juan 2 Whitman 3 Douglas 13 Kittitas 1 Skagit 14 Yakima 35 Ferry 39 Klickitat 22 Skamania 19 • 4 www.countyhealthrankings.org/washington County Health Rankings 2013:Washington • HEALTH FACTORS 0 Ifirmiai , E '447:,4 PE Ts . CM ]f DO Alit T TH P1 - WH I. LE c GF WL IL SK KL Rank 1-10 Rank 11.20 •Rank 21-29 •Rank 30-39 . County rail County EIS County rEl County Rank Adams 32 Franklin 27 Lewis 28 Snohomish 8 Asotin 24 Garfield 13 Lincoln 22 Spokane 16 Benton 12 Grant 33 Mason 30 Stevens 29 Chelan 7 Grays Harbor 39 Okanogan 31 Thurston 11 Clallam 21 Island 4 Pacific 36 Wahkiakum 25 Clark 17 Jefferson 9 Pend Oreille 34 Walla Walla 6 Columbia 15 King 2 Pierce 23 Whatcom 5 Cowlitz 35 Kitsap 10 San Juan 1 Whitman 3 Douglas 19 Kittitas 14 Skagit 18 Yakima 37 Ferry 38 Klickitat 20 Skamania 26 • www.countyhealthrankings.org/washington 5 County Health Rankings 2013:Washington Summary Health Outcomes & Health Factors Rankings Counties receive two summary ranks: Health outcomes represent how healthy a county is • • Health Outcomes while health factors represent what influences the • Health Factors health of the county. Each of these ranks represents a weighted summary of a number of measures. Rank Health Outcomes Rank Health Factors 1 Kittitas 1 San Juan 2 San Juan 2 King 3 Whitman 3 Whitman 4 Island 4 Island 5 Whatcom 5 Whatcom 6 King 6 Walla Walla 7 Jefferson 7 Chelan 8 Chelan 8 Snohomish 9 Thurston 9 Jefferson 10 Snohomish 10 Kitsap 11 Clark 11 Thurston 12 Benton 12 Benton 13 Douglas 13 Garfield 14 Skagit 14 Kittitas 15 Kitsap 15 Columbia 16 Walla Walla 16 Spokane 17 Garfield 17 Clark 18 Franklin 18 Skagit • 19 Skamania 19 Douglas 20 Columbia 20 Klickitat 21 Lewis 21 Clallam 22 Klickitat 22 Lincoln 23 Wahkiakum 23 Pierce 24 Spokane 24 Asotin 25 Grant 25 Wahkiakum 26 Pierce 26 Skamania 27 Clallam 27 Franklin 28 Adams 28 Lewis 29 Asotin 29 Stevens 30 Lincoln 30 Mason 31 Stevens 31 Okanogan 32 Pend Oreille 32 Adams 33 Mason 33 Grant 34 Cowlitz 34 Pend Oreille 35 Yakima 35 Cowlitz 36 Grays Harbor 36 Pacific 37 Pacific 37 Yakima 38 Okanogan 38 Ferry 39 Ferry 39 Grays Harbor • 6 www.countyhealthrankings.org/washington County Health Rankings 2013:Washington 2013 County Health Rankings: Measures, Data Sources, and Years of Data 411Measure Data Source Years of Data HEALTH OUTCOMES ,fib... Mortality Premature death National Center for Health Statistics 2008-2010 Morbidity Poor or fair health Behavioral Risk Factor Surveillance System 2005-2011 Poor physical health days Behavioral Risk Factor Surveillance System 2005-2011 Poor mental health days Behavioral Risk Factor Surveillance System 2005-2011 Low birthweight National Center for Health Statistics 2004-2010 HEALTH FACTORS HEALTH BEHAVIORS Tobacco Use Adult smoking Behavioral Risk Factor Surveillance System 2005-2011 Diet and Exercise Adult obesity National Center for Chronic Disease Prevention 2009 and Health Promotion Physical inactivity National Center for Chronic Disease Prevention 2009 and Health Promotion Alcohol Use Excessive drinking Behavioral Risk Factor Surveillance System 2005-2011 Motor vehicle crash death rate National Center for Health Statistics 2004-2010 Sexual Activity Sexually transmitted infections National Center for HIV/AIDS,Viral Hepatitis, 2010 STD,and TB prevention Teen birth rate National Center for Health Statistics 2004-2010 CLINICAL CARE I Access to Care Uninsured Small Area Health Insurance Estimates 2010 Primary care physicians HRSA Area Resource File 2011-2012 411 Dentists HRSA Area Resource File 2011-2012 Quality of Care Preventable hospital stays Medicare/Dartmouth Institute 2010 Diabetic screening Medicare/Dartmouth Institute 2010 Mammography screening Medicare/Dartmouth Institute 2010 SOCIAL AND ECONOMIC FACTORS Education High school graduation Primarily state-specific sources,supplemented State-specific with National Center for Education Statistics Some college American Community Survey 2007-2011 Employment Unemployment Bureau of Labor Statistics 2011 Income Children in poverty Small Area Income and Poverty Estimates 2011 Family and Social Inadequate social support Behavioral Risk Factor Surveillance System 2005-2010 Support Children in single-parent households American Community Survey 2007-2011 Community Safety Violent crime rate Federal Bureau of Investigation 2008-2010 PHYSICAL ENVIRONMENT Environmental Quality Daily fine particulate matter 1 CDC WONDER Environmental data 2008 Drinking water safety Safe Drinking Water Information System FY 2012 Built Environment Access to recreational facilities Census County Business Patterns 2010 Limited access to healthy foods USDA Food Environment Atlas 2012 Fast food restaurants Census County Business Patterns 2010 • 1 Not available for AK and HI. www.countyhealthrankings.org/washington County Health Rankings 2013:Washington CREDITS 411 Report Authors University of Wisconsin-Madison School of Medicine and Public Health Department of Population Health Sciences Population Health Institute Bridget Booske Catlin, PhD, MHSA Amanda Jovaag, MS Patrick Remington,MD, MPH This publication would not have been possible without the following contributions: Data Centers for Disease Control and Prevention: National Center for Health Statistics and Division of Behavioral Surveillance Dartmouth Institute for Health Policy&Clinical Practice Research Assistance Jennifer Buechner Hyojun Park,MA Elizabeth Pollock Jennifer Robinson Matthew Rodock, MPH • Anne Roubal, MS Communications and Outreach Burness Communications Anna Graupner, MPH Kate Konkle, MPH Karen Odegaard, MPH Jan O'Neill, MPA Angela Russell, MS Julie Willems Van Dijk, PhD, RN Design Forum One,Alexandria,VA Robert Wood Johnson Foundation Abbey Cofsky, MPH—Senior Program Officer Michelle Larkin,JD, MS, RN—Assistant Vice-President and Deputy Director, Health Group James S. Marks, MD, MPH—Senior Vice-President and Group Director, Health Group Joe Marx—Senior Communications Officer Suggested citation: University of Wisconsin Population Health Institute.County Health Rankings 2013. • 8 www.countyhealthrankings.org/washington • 116,01111111111. County Health 1 Rankings&Roadmaps countyhealthrankings.org • University of Wisconsin Population Health Institute 610 Walnut St,#524,Madison,WI 53726 (608)265-6370/info@countyhealthrankings.org jr:%„. El -: .. S un Health Rankin.s in Washin•ton- Jefferson vs. Clallam vs. Kitsa. Coun Health Rankin_s & Road... Page 1 of: 41 Rankin• .:.,, .,. 'maps _ Nation,Coy 2ompare Counties in Washington Washington Jefferson(JE) Clallam(CM) Kitsap(KT) 1th Outcomes 7 27 15 Mortality 12 33 16 Premature death 5,709 5,583 7,934 5,786 Morbidity 4 8 21 Poor or fair health 14% 15% 14% 13% Poor physical health days 3.6 4.0 4.1 3.7 Poor mental health days 3.3 3.8 3.5 3.3 Low birthweight 6.3% 4.2% 5.1% 6.5% Health Factors 9 21 10 Health Behaviors 9 15 20 Adult smoking 16% 16% 18% 17% Adult obesity 27% 25% 28% 30% Physical inactivity 19% 17% 19% 18% Excessive drinking 17% 17% 13% 17% Motor vehicle crash death rate 10 17 16 8 Sexually transmitted infections 317 184 234 311 Teen birth rate 31 25 33 27 Clinical Care 8 6 9 Uninsured 16% 18% 18% 14% Primary care physicians 1,222:1 1,o68:1 1,036:1 1,414:1 Dentists 1,435:1 1,909:1 1,311:1 1,579:1 Preventable hospital stays 46 38 39 42 Diabetic screening 86% 9o% 89% 85% Mammography screening 66% 69% 68% 68% Social&Economic Factors 16 28 10 High school graduation 77% 82% 39% 81% Some college 67% 65% 61% 68% ployment 9.2% 9.9% 10.4% 7.9% en in poverty 19% 24% 20% 14% Ina equate social support 17% 16% 16% 16% Children in single-parent households 29% 31% 37% 28% Violent crime rate 327 188 273 433 Physical Environment 9 30 �5 Daily fine particulate matter 11.o 11.7 12.0 11.4 Drinking water safety o% 1% 3% o% Access to recreational facilities 11 20 10 10 Limited access to healthy foods 5% 8% 7% 6% Fast food restaurants 46% 34% 33% 47% i Ittp://www.countyhealthrankings.org/app/ 5/10/201: efferson Count , Washin: on Coun Health Rankin:s&Roadma•s Page 1 of _J ' County Health Rankings&Roadmaps (efferson(JE) Jefferson Error Washington National Rank County Margin Benchmark* (of 39) Illith Outcomes 7 Mortality 12 Premature death 5,583 4,425-6,740 5,709 5,317 Morbidity 4 Poor or fair health 15% 12-20% 14% 10% Poor physical health days 4.0 3.1-5.0 3.6 2.6 Poor mental health days 3.8 3.0-4.6 3.3 2.3 Low birthweight 4.2% 3.2-5.3% 6.3% 6.0% Health Factors 9 Health Behaviors 9 Adult smoking 16% 14-19% 16% 13% Adult obesity 25% 22-28% 27% �5% Physical inactivity 17% 14-19% 19% 21% Excessive drinking 17% 15-20% 17% 7% Motor vehicle crash death rate 17 12-24 10 10 Sexually transmitted infections 184 317 92 Teen birth rate Clinical25 z1 3O 31 21 Care 8 Uninsured 18% 16-20% 16% 11% Primary care physicians** 1,068:1 1,222:1 1,067:1 Dentists** 1,909:1 1,435:1 1,516:1 Preventable hospital stays 38 33-43 46 47 Diabetic screening 90% 83-98% 86% 90% Mammography screening 69% 63-75% 66% 73% Social&Economic Factors 16 High school graduation** 82% 77% Some college 65% 57-74% 67% 70% Unemployment 9.9% 9.2% 5.0% Children in poverty 24% 17-31% 19% 14% Inadequate social support 16% 13-19% 17% 14% Ch.dren in single-parent households 31% 20-41% 29% 20% t crime rate 188 327 66 cal Environment 9 Daily fine particulate matter 11.7 11.6-11.8 11.0 8.8 Drinking water safety 1% 0% 0% Access to recreational facilities 20 11 16 Limited access to healthy foods** 8% 5% 1% Fast food restaurants 34% 46% 27% *9oth percentile,i.e.,only 10%are better. **Data should not be compared with prior years due to changes in definition. 2013 Note:Blank values reflect unreliable or missing data ltt ww.countyhealthrankings.org/app/home 5/10/201: :lallam Count , Washin: on Count Health Rankin_s&Roadma.s Page 1 of l County Health iimis' Rankings&Roadmaps nallam(CM) Clallam Error Washington National Rank County Margin Benchmark* (of S9) th Outcomes Mortality 27 33 Premature death 7,934 7,097-8,772 5,709 5,317 Morbidity 8 Poor or fair health 14% 12-16% 14% 10% Poor physical health days 4.1 3.6-4.6 3.6 2.6 Poor mental health days 3.5 2.9-4.0 3.3 2.3 Low birthweight 5.1% 4.4-5.7% 6.3% 6.0% Health Factors 21 Health Behaviors 15 Adult smoking 18% 16-zo% 16% 13% Adult obesity 28% 25-31% 27% 25% Physical inactivity 19% 17-21% 19% 21% Excessive drinking 13% 11-15% 17% 7% Motor vehicle crash death rate 16 13-zo 10 10 Sexually transmitted infections 234 317 92 Teen birth rate 33 30-36 31 21 Clinical Care 6 Uninsured 18% 17-20% 16% 11% Primary care physicians** 1,036:1 1,222:1 1,067:1 Dentists** 1,311:1 1,435:1 1,516:1 Preventable hospital stays 39 36-42 46 47 Diabetic screening 89% 84-94% 86% 90% Mammography screening 68% 63-73% 66% 73% Social&Economic Factors 28 High school graduation** 39% 77% Some college 61% 56-65% 67% 70% Unemployment 10.4% 9.2% 5.0% Children in poverty 20% 14-26% 19% 14% Inadequate social support 16% 14-18% 17% 14% Children in single-parent households 37% 31-42% 29% 20% et crime rate 273 327 66 cal Environment 30 Daily fine particulate matter 12.0 11.9-12.1 11.0 8.8 Drinking water safety 3% o% o% Access to recreational facilities 10 11 16 Limited access to healthy foods** 7% 5% 1% Fast food restaurants 33% 46% 27% *9oth percentile,i.e.,only 10%are better. **Data should not be compared with prior years due to changes in definition. 2013 Note:Blank values reflect unreliable or missing data Vww.countyhealthrankings.org/app/home 5/10/201: (itsa. Coun , Washin_ on Count Health Rankin_s&Roadma.s Page 1 of: J-- County Health Rankings&Roadmaps Kitsap(KT) Kitsap Error Washington National Rank County Margin Benchmark* (of 39) th Outcomes 15 Mortality 16 Premature death 5,786 5,444-6,129 5 709 5,317 Morbidity 21 Poor or fair health 13% 11-14% 14% 10% Poor physical health days 3.7 3.4-4.0 3.6 2.6 Poor mental health days 3.3 3.0-3.6 3.3 2.3 Low birthweight 6.5% 6.1-6.8% 6.3% 6.0% Health Factors 10 Health Behaviors 20 Adult smoking 17% 16-19% 16% 13% Adult obesity 30% 28-31% 27% 25% Physical inactivity 18% 17-20% 19% 21% Excessive drinking 17% 16-19% 17% 7% Motor vehicle crash death rate 8 7-10 10 10 Sexually transmitted infections 311 317 92 Teen birth rate 27 26-29 31 21 Clinical Care 9 Uninsured 14% 13-15% 16% u% Primary care physicians** 1,414:1 1,222:1 1,067:1 Dentists** 1,579:1 1,435:1 1,516:1 Preventable hospital stays 42 39-44 46 47 Diabetic screening 85% 81-88% 86% 90% Mammography screening 68% 65-71% 66% 73% Social&Economic Factors High school graduation** 81% 77% 10 Some college 68% 66-71% 67% 70% Unemployment 7.9% 9.2% 5.0% Children in poverty 14% 11-17% 19% 14% Inadequate social support 16% 15-18% 17% 14% Children in single-parent households 28% 26-31% 29% 20% 111) t crime rate 433 327 66 cal Environment 25 Daily fine particulate matter 11.4 11.1-11.6 11.0 8.8 Drinking water safety 0% 0% 0% Access to recreational facilities 10 11 16 Limited access to healthy foods** 6% 5% 1% Fast food restaurants 47% 46% 27% *9oth percentile,i.e.,only 10%are better. **Data should not be compared with prior years due to changes in definition. 2013 Note:Blank values reflect unreliable or missing data lttww.countyhealthrankings.org/app/home 5/10/201: 2013 2012 IIIElHealth Outcomes ellHealth Factors Rank Health Outcomes Rank Health Factors 1 Klttitas 1 San Juan 1 San Juan 1 San Juan 2 San Juan 2 King 2 Kittitas 2 Whitman 3 Whitman 3 Whitman 3 Island 3 King 4 Island 4 Island 4 Whitman 4 Island S Whatcom 5 Whatcom 5 Whatuxn 5 Wlwlcuni 5 King 5 Walla Walla € Kirg 6 Walla Walla 7 Jefferson 7 Chelan 7 Chelan 7 Jefferson a Ctelan 3 Snohom'sh F Clark R Kittitas 9 Thurston 9 Jefferson 9 Snohomish 9 Snohomish 10 Snohom"sh 10 Kitsap 10 Skagit 10 Kitsep 1: Clark 11 Thurston 11 Kitsap 11 Chelan 12 Benton 12 Benton 12 Douglas 12 ThLrston 13 Douglas 13 Garfield 13 Franklin 13 Garfield 14 Skagi: 14 Kittitas 14 Thurston 14 Berton 15 Kitsap 15 Columbia 15 Benton 15 Spokane 16 Walla Walla 16 Spokane 16 Columbia 16 Columbia 17 Garfield 17 Clark 17 Skamenia 17 Skagi 18 Franklin 18 5kagi: 18 Walla Walla 18 DJugiaa . 19 Skamania 19 Uotglas 19 Garf eld 19 Lincoln LU Columbia LU Klicki:at 20 Adams 20 ClaNam 21 Lewis 21 Clallan^ 21 I?ffersnn 21 ('lark 22 Klicki:at 22 Unto 22 Kiickitat 22 Asotin 23 Wahklakum Z3 Pierce 23 Lewis 23 Kickitot 24 Spokane 24 Asotin 24 Callan 24 Wahkiakum 15 Grant 15 Wahkiakum 25 Spokane 25 Pierce 26 Pierce L6 Skamania 2b Fierce 16 Franklin Z1 Claliarr LI Franklin 27 Grart 27 PerdOreil:e L8 Adams 28 Lewis 28 Lincoln 28 Skamania 29 Asotin 29 Stevens 29 Stevens 29 Mason 30 Linco n 30 Mason 30 Fend Oreille 30 Lewis 3: Stevens 31 Okanogan 31 Yakinia 31 Gant 32 Pend Urel le 32 Adams 32 Pacific 32 Stevens 33 Mason 33 brant 33 Cowlitz 33 Okanogan 34 Cowlitz 34 Pend Oreille 34 Acntin 34 Parifir 35 Yakima 35 Cowlitz 35 Mason 35 Cowlitz 36 Grays Harbor 36 Pacific 36 Grays Harbor 36 Adams 31 Pacific 31 Yakima 37 Okanogan 37 Ferry e 38 UkanDgan 38 Ferry 38 Wahklakum 38 Yakima 39 Ferry 39 Grays Harbor 39 Fent 39 Grays Harbor • 2011 2010 • Rank Health Outcomes Rank Health Factors Rank Health Outcomes Rank Health Factors San Juan 1 San Juan 1 San Juan 1 San Juan Kittltas 2 King 2 Douglas 2 King 3 Whitman 3 Whitman 3 Whitman 3 Whatcom 1 Island 4 Kittitas 4 Kittitas 4 Kittitas 5 King 5 Chelan 5 Island 5 Walla Walla V.+hatrnm 8 Whatcnm 6 King 6 Chelan 7 Chelan 7 Island 7 Whatcom 7 Snohomish Douglas 8 Jefferson 8 Clark 8 Jefferson 9 C la'k 9 Wily Walla 9 Chelan 9 Thurston 10 Franklin 10 Snohomish 10 Snohomish 10 Whitman 11 Skagit '11 Thurston 11 Jefferson 11 Island 12 Snnhomisl' '17 Kitsap 12 Thurston 12 Benton 13 Thurston 13 Benton 13 Benton 13 Garfield 14 Benton 14 Spokane 14 Kitsap 14 Columbia 15 Kilsap 15 Duuylas 15 Franklin 15 Kitsap 16 Skamania 16 Clallam 16 Skagit 16 Douglas 17 Walla Walla 17 Columbia 17 Clallam 17 Spokane 18 ,lAffersofl 18 Clark 'I8 Garfield 18 Clarkill 19 Clallam '19 Skagit 19 Walla Walla 19 Skagit 2U Garfield ZU Gartield 20 Klickitat 20 Lincoln 21 Colurnbia 21 Lincoln 21 Columbia 21 Clallam 22 Spokane 22 Wahkiakum 22 Adams 22 Wahkiakum 23 Lincoln 23 Klickitat 23 Spokane 23 Klickitat 24 Adams 24 Pierce 24 Wahkiakum 24 Asotin 25 PierCe 25 Asotin 25 Pierce 25 Franklin 2e Klickitet 26 1-ranklln 26 Lincoln 26 Pierce 27 Grana 27 Giant 27 Skamania 27 Skamania 20 Lewis 20 Lewis 28 Grant 28 Grant 20 Pacific 20 Stovons 29 Lewis 29 Mason 30 Yakima 30 Mason 30 Pacific 30 Lewis 31 Grays Harbor 31 Skamania 31 Pend Oreille 31 Pend Oreille 32 Cowlitz 32 Okanogan 32 Yakima 32 Stevens 33 Stevens 33 Cowlitz 33 Grays Harbor 33 Adams 34 Pend Oreille 34 Yakima 34 Cowlitz 34 Yakima 35 Mason 35 Pond Oroillo 35 Asotin 35 Okanogan 36 Asotin 36 Adams 36 Stevens 36 Cowlitz 37 Okanogan 37 Pacific 37 klason 37 Pacific 38 Wahkrakum 38 Grays Harbor 38 Okanogan 38 Grays Harbor II 39 Ferry 39 Ferry 39 Ferry 39 Ferry • Jefferson County Board of Health New Business • AGENDA ITEM V — 4 Legislative Update: Special Session Schedule, Budget Negotiations, and Local Health Jurisdiction Flexible Funding Alternatives May 16, 2013 f Washington Legislature adjourns without budget- Spokesman.com- April 29,2013 rage 1 of 1 THE SPOKESMAN-REVIEW April 29, 2013 S Washington Legislature adjourns without budget Jim Camden The Spokesman-Review Tags:2013 Washington Legislature adjournment Jay Inslee Mark Schoesler Mike Hewitt operating budget regular session special session taxes tran r - OLYMPIA-For the fourth time in as many years,the t E s fi 001 Legislature will go into overtime to figure out how to h.' � '. � r spend the money it collects,and how much it should collect. Et Gov.Jay Inslee said he wants budget negotiators to stay in Olympia to continue working on the state's two- Gov.Jay Inslee takes questions from year spending plan.The remainder of the legislators will the media after announcing a special return for a special session that begins May 13. It can legislative session on Sunday in Olympia.Washington state lawmakers go up to 30 days and cover issues beyond the budget. must return May 13 to complete their work on the state budget Inslee said all sides need to be flexible on budget negotiations and other issues that may come up, but he seemed to be drawing a line in the sand that would require fewer cuts and at least some extra revenue from closing or shrinking some tax preferences. • "We will not balance that(budget)on the backs of seniors, homeless kids and the disabled," he said. Senate Republicans said they would have preferred to start the special session today, without any break. Their members all want to be involved in discussions about programs and policies, Republican Leader Mark Schoesler of Ritzville said,and have different expertise on the intricacies of the budget.And they continue to oppose tax increases, he added. Inslee wants legislators to also handle issues involving abortion, gun control and immigration,which have been blocked in the Senate. Republicans may have some issues that Inslee opposes that they will introduce, although"we haven't had that discussion yet," Schoesler said. Special sessions have become commonplace for Washington's lawmakers,with half the years since 2000 requiring they extend their stays in Olympia to resolve the budget and other matters.There was a string of years,from 2004 through 2009,when they left on time. "And then the recession hit," Sen. Mike Hewitt, R-Walla Walla, said Sunday afternoon as he looked at a list of when sessions started and ended on the Legislature's website. SThe state's economic forecasts started projecting gaps between expected revenues and scheduled spending in late 2008, and the Legislature faced tough choices of cutting brt„•//www.snokesman.com/stories/2013/apr/29/washington-legislature-adj ourns-without-b... 5/9/2013 Subject: Preserve public health funding including critical DOH activities • Dear(Name): I would like to thank you and the Legislature for preserving local public health funding in both the House and Senate budgets. As you negotiate the final budget, I ask that you continue to preserve foundational local public health funding and restore critical Department of Health activities that are cut in the Senate budget. You actions to preserve public health funding are important as ongoing cuts to public health funding at the federal, state, and local level continue to erode our foundation for a statewide public health system. Currently,state public health funding represents 26%of our funding. Preserving this funding helps us to: • Make sure food in restaurants is safe to eat • Identify and treat the sources of communicable diseases like tuberculosis(TB),chlamydia, HIV, and pertussis (whooping cough) • Make sure that all our residents—rich, poor, urban, or rural—have safe water to drink and septic and sewer systems that are sanitary and do not threaten our environment • Help our children get their immunizations and their teeth checked so they can stay healthy and learn better What we do fits into a statewide public health system and we are concerned about potential cuts to Department of Health (DOH)activities in the Senate budget that would hurt important public health systems and services, such as: • Washington Immunization Information System (WIIS,formerly,Child Profile)–Local Health Jurisdictions(LH1s) help get children immunized, but they, medical providers,schools, and parents rely on this statewide registry to keep records of who has been immunized. Without DOH's support of WIIS, LHJs would be severely challenged to improve immunization coverage and protect our communities from outbreaks of disease. • Public Health Information Management System (PHIMS) and Notifiable Conditions Reporting– LHJs must respond to reports of more than 60 notifiable conditions such as pertussis, measles, tuberculosis or foodborne disease outbreaks. Outbreaks of disease cross jurisdictional boundaries and public health cannot quickly and effectively respond without consistent reporting and effective communication; PHIMS is this key tool. • Behavioral Risk Factor Surveillance System (BRFSS)–BRFSS is the major source of data for adult health and risk factors. It is critical for public health to understand our residents' health needs, to plan interventions to protect and improve their health, and to evaluate the impact of programs and services. • Other Important Public Health Data Sources–In addition to BRFSS, DOH provides other key public health data sources(eg, denominator data for sub-county population health data,web- based data warehouse for public health data, and the Local Public Health Indicators)that allow LHJs to assess their local health needs,target services and programs to at-risk populations, and evaluate effectiveness of those programs and services. It is critical that DOH continue to receive funding to coordinate and provide statewide infrastructure and systems so that local health jurisdictions can work effectively in our communities. Again,thank you for your efforts and I appreciate the difficult task in front of you as you negotiate the final budget. I hope that you will seek to preserve foundational local public health funding and restore critical Department of Health activities that are cut in the Senate budget. Please feel free to contact me at(253)798-6411 if you would like to discuss any of these issues. Yours sincerely, Anthony L-T Chen, MD, MPH Director of Health Tacoma-Pierce County Health Department 3629 South D Street, MS001 Tacoma,WA 98418-6813 Phone: 253-798-6411 Fax: 253-798-7627 achen@tpchd.org S • Jefferson County Board of Health New Business 1111 AGENDA ITEM V — 5 Reappointment to the Substance Abuse Advisory Board May 16, 2013 Jefferson County Community Network • May 8, 2013 Jefferson County Board of Health 615 Sheridan Street Port Townsend, WA 98368 Dear Board Members: Please accept this letter as application to renew my term and continue serving on Jefferson County's Substance Abuse Advisory Board(SAAB). It has been an honor to be a part of this group since 2006 and I would like to continue for another three years. The position fits very well with my background, experience and current position as the Program Manager for the Jefferson County Community Network. I feel I bring to the table a skill set that is transferable and relevant to the needs of the Substance Abuse Advisory Board. As Program Manager for the JCCN I am responsible for working with a volunteer board and looking at the big picture of prevention in Jefferson County. This includes prevention of substance abuse, with a particular emphasis on preventing youth substance abuse. Through personal experience and volunteer opportunities I am very familiar and very comfortable with substance abuse issues (child through adult). While growing up I experienced living in a substance-abusing home. I personally experimented with and abused multiple substances and as a result of a lot of hard work, education,treatment and faith, I recently celebrated 15 years of sobriety. • Substance abuse is not going away in our community. The devastating effects of substance abuse are far-reaching and continually permeating aspects of our society with a negative impact on the health and overall well-being of youth and adults alike. Due to the current economic situation, we, as a community, will continue to be challenged by the impact of substance abuse. The Substance Abuse Advisory Board is prepared to do the work to understand the extent of the impact. My desire is to work within the community and as a SAAB Board Member to provide opportunities for change, recovery and hope! I greatly appreciate your consideration. Please feel free to contact me at 360-379-4495 if you have additional questions. Thank you. Sincerely, Anne B. Dean Program Manager cc: Julia Danskin Fran Joswick • •615 Sheridan•Castle Hill Center•Port Townsend,WA 98368• •360/379-4495 •FAX 385-9401 • Jefferson County Board of Health Media Report • May 16, 2013 S • Jefferson County Public Health April/May 2013 NEWS ARTICLES 1. "Letter; Market no place for dogs," Port Townsend Leader, April 10th, 2013 2. "Anderson Lake to be tested to see if safe to open for season," Peninsula Daily News, April 14th, 2013. 3. "Peninsula tick found with pathogen that causes Lyme disease," Peninsula Daily News, April 18th, 2013. 4. "Anderson Lake eyed for opening after testing funds cut," Peninsula Daily News, April 18th, 2013. 5. "What makes Anderson Lake so unusually toxic? Scientists to try to find answer," Peninsula Daily News, April 21st, 2013. 6. "Anderson Lake to open for fishing as scheduled," Peninsula Daily News, April 23rd, 2013. 7. "Dispose of unwanted prescription drugs April 27," Port Townsend Leader, April 24th 2013. 8. "Drug Take Back Day set on Peninsula," Peninsula Daily News, April 26th, 2013. 9. "Anderson Lake big draw on first day of trout season," Peninsula Daily News, April 28th 2013. 10. "State to begin health tests of popular Peninsula saltwater beaches," Peninsula Daily News, April 30th, 2013. 11. "Lake fishing season returns; so does algae," Port Townsend Leader, April 24th, 2013. 12. "Jefferson Healthcare designated as baby friendly," Port Townsend Leader, May 1st, 2013. 13. "High levels of E.coli at lrondale beach; no shellfishing allowed," Port Townsend Leader, May 3rd, 2013. 14. "Jefferson Healthcare designated `baby-friendly' hospital," Peninsula Daily News, May 3`d- 4th, 2013. 15. "High bacteria levels prompt closure at lrondale Beach," Peninsula Daily News, May 5th, 2013. 16. "Drug Take Back event nets 130 pounds of pharmaceuticals," Peninsula Daily News, May 7th, 2013. 17. Multiple letters on dogs at the Farmers Market, Port Townsend Leader, May 8th, 2013. 18. "Letter- Pill drop-off event was botched," Port Townsend Leader, May 8th, 2013. 19. "Help with Obamacare: At the hospital," Port Townsend Leader, May 8th, 2013. 4/10/2013 6:00:00 AM,Port Townsend Leader Letter: Market no place for dogs lin response to the letter last week titled "Dogs are dangerous at farmers market," I would have to agree. Now, before dog lovers jump down my throat, please take a minute. I am not a dog hater. In fact, I used to belong to the SPCA many years ago. I am a previous dog owner whose precious friends died of old age. There are a lot of places that are pet friendly and good for your pets. The farmers market is not one of them. It gets so crowded that it is hard to believe that the dogs are enjoying themselves. I believe it's just a matter of time before someone is hurt either by a dog bite or as Forest Shomer (author of previous letter) stated, by tripping on one of the many leashes. I am an avid farmers market shopper. On two occasions while shopping at the market, I tripped over leashes. Luckily, I was not seriously hurt, just skinned up. Many of my senior friends — and many are pet owners —won't come to the market because they are concerned about tripping. As one gets older, falls can be very serious indeed. Being a senior I need to rest occasionally. While sitting down listening to some music at the market, the woman next to me was holding her dog. I looked down at my drink and the dog's tail was in it. Needless to say, I had to throw it out because of health concerns. If the farmers market manager and board are concerned about offending dog owners and thus hurt their thriving market, they should take a trip to the Saturday Bellingham farmers market. It does not allow dogs and it is packed with serious shoppers. It isn't a destination for people out walking their dogs. °MARY ELLIOT, Port Townsend Reader Comments Posted:Wednesday,April 17,2013 Article comment by: Toni Sammons I have always thought that seeing dogs around was one of the charms of the Saturday market. Most older people, and I include myself, have developed a habit of watching carefully where they walk, and paying attention when they move about. There are always opportunities for tripping or catching one's sleeve, purse or shoe on something, a protruberance, a stroller, a shopping basket, or a toddling child, uneven pavement, a bench. Dogs or no dogs, one should be reasonably observant. If you can run into a dog, you could run into a child, and incidentaly while I guess it could happen, I've never had a dog run into me-people, yes. Posted:Monday,April 15,2013 Article comment by: Rick Hitchens Why not ban children and old people at the farmer's market? Children are small and can be stepped on or tripped over and old people are well...old. AK I've got a better idea. Ban the whiners and keep the dogs. Dogs at the farmers market is a long-standing tradition and lip part of the joy of going to the market. If you don't like Port Townsend traditions, why live here? Posted:Monday,April 15,2013 Article comment by: Tom Camfield • I like dogs. As a rule they don't have the character flaws of homo sapiens ("saps"for short in many cases). And those who understand the canine language know how much dogs enjoy seeing new things--and in more cases than not, meeting new people. Leaving them in the car at every stop pretty much negates the positive aspects of a ride--and actually is cruel and inhuman punishment on hot days. Leaving them in solitary confinement at home at every opportunity also suggests a lack of empathy. And there are a lot of places I'd rather see dogs than handguns in this day and age. Parks, for example . . . all sorts of outdoor activities including our Farmers' Market. My vote for what it's worth is for dogs. And I also oppose the short leashes used by many dog-owners for walking their supposed best friends. They limit the sniffing of new and wondrous things. There's also nothing more pathetic than seeing an aging dog struggling to keep up out of loyalty and devotion while its leash is fastened to a bicycle. Posted:Sunday,April 14,2013 Article comment by: Richard Boyles How about the first two hours of the market being pet free. Posted:Sunday,April 14,2013 Article comment by: Bill Wise • I certainly hope we don't have to wait for a serious incident to finally take action on this- I love dogs and I find the market a pretty stressful place for a dog its crowded with strange people (I mean that in the best sense), so many aromas and noises, kids and infants, various non-motorized vehicles-seems a better place for the dogs would be to have a good smell over on the community center lawn Too many times now I've seen insensitive owners leading their dogs impervious to what's actually happening with their animal -this is a stressful environment. Yes, this is Dog Townsend, but maybe the sidetrack on the Community Lawn is better than the march through the gauntlet of the Saturday Market. Posted:Sunday,April 14,2013 Article comment by: ellen anglin Why does this subject seem to come up so often here? Dogs are and integral part of many people's lives and that's great for both the dogs and the humans who care for and love them. What is so horrid about leaving them safe at home? How is it infringing on anyone's human rights to expect to grab a grocery basket to put raw food into that is free of worm larvae, saliva, and dander?Yes, I have seen people carry their dogs in the same wire baskets where food is placed. Why is this OK? It's NOT!Where is the dividing line on pets brought into food areas. Does the same tolerance apply to say a pot bellied pig or a cow? I could just hear the intercom at Safeway now, "clean up on aisle nine!". Sound silly? I know of no law against it. Pets come in all forms, not just dogs. • Posted:Sunday,April 14,2013 Article comment by: Lois Venarchick IPlease leave your dogs at home when shopping at the market. I stopped attending the market when I realized that I could hurt the dogs by stepping on them, they could trip me and hurt me, and they are at face level to many small walking children, where a dog can become agitated or frightened and bite. No one loves dogs more than me but please not at the market! Posted:Saturday,April 13,2013 Article comment by: David Thielk Davis, I stay in the city so that I burn less fuel. I really don't like living in the city. My temperament is far better suited to a 5 acre plot at the end of a dirt road. But, being the unselfish person that I am, I live in the city, rather than the country, so that I can reduce my carbon footprint, and lessen the impact of climate change on the next couple of generations. That is the gist of the Growth Management Act-to limit environmental impact of population growth by having areas of high density. This decision, to live in the city, was a huge one for me, and still is. But that nuances of that decision are best saved for a coffee conversation. If my"superior" attitude makes you uncomfortable, perhaps you best not read my posts. Otherwise, use them as an opportunity to reflect upon your own lifestyle choices. Posted:Friday,April 12,2013 .Article comment by: Davis Steelquist David, I read your comments and wonder why you stay in the city... and why we should bear the burden of your superiority. People's fixation that they must take doggie everywhere as a member of the family is absurd. I know you carry your poop bags and scoop, however the other day I noticed a person allowing a large dog she was tethered to, to defecate in the playground chips at the base of children's slide. when confronted she stormed off leaving the pile and calling me an freak. The Muslims I believe put dogs in the proper place.. next to pigs ... "Islam forbids Muslims to keep dogs, and the punishment for that is that the one who does that loses one or two qiraats from his hasanaat(good deeds) each day. An exception has been made in the case of keeping dogs for hunting, guarding livestock and guarding crops". (from some web page) Posted:Friday,April 12,2013 Article comment by: Diane Falk Calm down, everyone! Dogs (and I have had dogs I lost to old age) don't belong in a crowded Fair, Market, or shopping area. Going to the Farmer's Market, I'm looking at the tables and booths, and not paying too much attention to where I'm stepping. I've almost stepped on some poor doggy's foot, and they are vulnerable to that. It's also hot, crowded, and they can get scared by the amount of people around them. I regularly went to the Anacortes Craft Fair, and people brought dogs. They got stepped on, run over by those damned umbrella-stroller things, were attacked by other dogs, tripped people, and were thirsty and confused. If you truly love your dog, leave him home. Please don't think it's because I don't love dogs...I do...but think of THEIR welfare, first! Posted:Friday,April 12,2013 Article comment by: David Thielk • Neph, It is easy to employ the word selfish in this situation. But, in reality, many human actions create "impositions" on others. It is an imposition for me to walk my dog to the market along F Street, while dozens of cars fly past me, breaking the speed limit, creating noise, and spew out pollution. It is an imposition for me, to have to drive my bike around town when automobile drivers are polluting the air, or when broken glass, from cars or bottles, cause flat tires. It is more than an imposition when people spew out excessive CO2 by getting in their cars to drive a mile or two (to the market for example), or possessing an RV to drive to Fort Worden. Or, to heat their homes to 72 degrees. All selfish behavior that will affect billions of humans for hundreds of years. It is selfish, and an imposition, when people do not maintain their health, driving health care costs up for all Americans. Very selfish behavior. Wasting gasoline is a tragedy unfolding. And, from my perspective, is having, and will continue to have, dramatic impacts on every living organism in the next 100 years. I could go on. I look around me every day and see people exhibit behaviors that are extremely self centered and that will have huge impacts on my children's lives, and the lives of my grand children. Bringing a dog to the market is an annoyance for many. An imposition? Not sure about that. Selfish? Debatable, in my . opinion. From my perspective, the "imposition"that dogs create is pretty mild compared to just the manner people use to get to the market each Saturday. It is pretty mild compared to the noise and pollution on local residents from all of the parking. I fall back on my earlier argument.We have a cultural bias against dogs. Cars, on the other hand, are culturally acceptable. We ignore the impositions. Many people simply don't like dogs. Is that an imposition? Psychological perhaps. Posted:Friday,April 12,2013 Article comment by: Beau Strait As a dog owner for many years, I offer this suggestion. If you are going to the Market, leave your damn dog home. Posted:Friday,April 12,2013 Article comment by: Neph Carver To expect others to passively tolerate the impositions sometimes caused by the presence of dogs in public places is self-indulgent, self-serving and self-centered. There are too many who operate on the basis "If it is okay by me than it necessarily must be okay with you." •