HomeMy WebLinkAbout2013- July •
Eroz `sr Ajnl
salnul y,J
•
vpuaSc
y jvaj-Joy2voE
kjuno j uos.taffa[
•
Ado a„J
89E86 VA `puasumos Pod
•1S uupTaauS S I9
Lp.moH oilgnd Xunoj LIOSINJa f
I�Id 0£:17—0£:Z
£I OZ `S I lsn nV :tuilaahl paInpailaS Ixai j 'XI
aupualup tuIUUI Id upuatV 'IIIA
luatutuo3 ailgnd 'IIA
alepd fl SINPV 'IA
uoissnasTQ pJIog •9
olupdn uotsintQ XliiunO 1alum •c
uogeltmg uosnaS uTusTd zaetg auaoTTnO •T,
u1id AiauaA ditgsJauuzed XTTtu"d asinN •£
iodaj maA Jo pug oiuiip pastq-Tooups
q IeaH Jo AmazaaS almS uoi2uTgsvm
`HdTAI `HdzU `uCuzsairn utTo f trim UO! S.ranuoD V •T
ssauisng maxi •A
do-ddJM aAiMsi a7 9
ureJ2o.zd auutiaxg a upics •S •
small saaanosa) tainwN pug lsaM 17
uogutuoJul iTOZ :30na3n0D LITIV H aigipioBV £
1,ioJluoD trig lop Z
zafaismaN DIM HdDf—SDNINEddVH/'u11WaH 'T
small Ieuoputu iolul puu ssau!sng plO 'AI
luaiuuIo0 ailand 'III
tu►laaytJ 1IIIuaH Jo pauog £I0Z `OZ aunt JO salmi Jo IunoaddV 'II
ipuaty 3o IenoaddV •I
VUN 19V JAV2IQ
L\Id 0£:17—0£:Z
VAA 'puasuntoi Hod
'IS u1piaailS SI9
ulluaH aggnd AlunoD uosaajjaf
£I0Z `8I �Inf •
HJ IVaH 30 Q2IVOg AINIf1OD MOSIIW 1 1f
£IOZ`OZ aunt-sarnuiA HOfl I
•zaddad mid all pug do-os •
poo j aqj `luauuaipa>i main nzanoosTQ of uoszad ut paluasazd 0.13M spumy •smaInaz JClaJES pool
zoJ spz1mV luatuanaTtioV&IIpumslnO Z I OZ papzeme azam 1T0Nm S311111.13 81 alp pamaTnaz paze f
uoileluasaid plumy SlapS pool
(MoISIA12I vaN19V) NOI.LVI IHO3MI (INV SS1NISf1a Q'IO
•Aisnouttuuun passed uotlow ata •uo!ssnas!p iagpnj oil •uiutaalsaM.iaquiaui
fq papuoaas sum uoilout aq j •„uowindod .tad.tapinoad„ of aauuga abed jo tuopoq
agl pt pun 'palaaaaoa aq of spaau uiiiads atui;u syeaa auuy'Z at t d uo :sluauupuatuu
113!Aiugaaut £IOZ '91 /cm aql Jo salnu!ui aql anoJddu of panout uosuigog iaqutalAi
S 11fININ 3O 'IVAOHddV
•nisnouttui un passed uotloui a><I,L •uoissnas p ol\I •uumialsam.iaquiay4J
Cq papuoaas sung uotlom ago :papuautt; si ipuatt; agl anoadd1t of panout uosutgo}J aaqutalAi
.soopuom ssautsng altpouum000i
of `rpua& aql jo dol aul of uoTluluasazd spumy iClojes poog all aAOW of pogo Jolting JUU43
VUNI9V JO 1VAOIlddV
u9snV utiof :pasnaxa saaqutaw •
JaJaa}i pawl. `upApl1g Ula f `31001 s1WOgI •za :luasaad 33u3S
uosutiof jiud `uentilnS
pTneU `uosu!goauuntpup `liassud tpago `uurrrralsarn urates `Jolting iiTf -luasazd s.taqutaw
•luasazd svm uunzonb
V 'YAid zapzo of twaH Jo pnog nluno3 uoszajjo f aq3 jo 2uilaauu all palleo Jolting ITU
Z#jaulsp j`Jauo,ssnuuro0 pvlpdsoH`Jivg0 `lah[ng lllf
OD)a8.rvp Iv ua2lja,) `uvuwJalsa h vppagS
.[olaa.rzq rfjndaq`MI MS vazuotaA jwuno d z3 puasuMoj jlod`uosuzgod aul.wglv3
J147 saapn.iaS glpnaH nug`Jafaa)paws Ouno0) ua211w `11assiij vuagoff
1olaaJ!Q saapn.ras JuganN`upisuIQb11nf c#1auis1Q`Jauopss!uturo3 diuno0 `uplsnv ugof
�1Q sial uas g11vaH appgnd`upMppvg uvaf Z#1a1.ujsyj`.J0uolsszu!u100 tujunoj `izvg0 aal4 `uvn111nS P1nvU
.raajff0 1111vaH AIN`UK`a)pao7 sUu[ogl I#1azals[Q Jauozsspu[uw3 1luno0 `uosugof 11gd
s raqurayti Jjvls sJaquramr p.rvog
89E86 ViA `puasumoI pod `laazlS u1PTzatiS C19 ` ivaH oTignd nlunoD uoszajja f
£I OZ OZ aun f `nupsznta
S IIfTh IY\I •
HI'IV1-I AO QfIVOH NOS2HJ3af
£IOZ`OZ aunf—salnuryl HOH
• uo1.2utgs1M 3o uotlgto3 2u!paaJls!a.Ig
•/Clunoo goua uzozu um)zoj sitnzaput aouapguoo alp jo suoneluasazdaz sapnioui gdni0 agl 1�g1
sowotput aro' zQ •lo loud 0412 ut papnloui gdta amp uoptogiztlo zo1 sxsn uosuigo'zagumaJA
•asopzano put asn uiozag ut 2utmsdn ut wog sag azagl `passaBozd annq saltido jo uoi1dizosazd
alnizdozddtui aonpaz of s1zojjo sy •saluIdo uotpdtzosazd uzozu Alilt1 lout put Jo asn g2Ig
llim op 02 2utntq ninsuluad otduzici0 341 uo malgozd ztltuns>?jo spat'all uo smolloJ lug`utozaq
Alluagtoads s)looi lzodaz aqj •aluls all ssozot 2uisuazoui si osn utozaq 1eg1 saltotpu!goi4M
`asn uiozaq 2utpzn2az pzodaz uol1uigsum Io Aliszaniun pagsilgnd 4u0o0z t pamatnaz a)loo' •zU
alwlS uo0utgsnm sso.iay spuaal, asn utoaag
•anssi glltaq otlgnd o1 papualxa pztog 2utzt0H
luauzaRtUtJAI glmozO Io iluoglnn aq1 z04104m pazapuom aH •anssi asn putt JO luauzaatutui
glnno12 u lou `anssi glleag otlgnd u st uzalsiCs aromas olts-uo Jo uotptln2az agl imp pagiznto
a)loo7 •zU •uzals1Cs uoiloadsut zaumoauzoq 0412 Jo luauilotput ut utgl `1Clunoo uzoaltgm ui
saoilotzd wawa-mum glmoz0 2uipztOaz uoiltutpz000 alp Jo uoiltaiput uu Jo azom alt I tui 2ugnz
041 Imp paluotput zajooN •zy\I •Olds aql punoz2 posn&nog si put `1Clunoo slip ui lzoddns �uozls
stq ureBozd uoiloadsui zaumoauzog alt 1, .IClunoO wooingm ui uzalsJCs uoilaadsut zaumoauioq
alp papton gown uoisioap pzuog 224zt3H luaula tunl/I 42m010 041 passnasip a)iooq zQ
uotlaadsul tualsiAS agdaS aaumoatuoH Isurety saint'pivot' tuianag luauia2ruEy\I glnnoz0
• alts uotltzlsiaz aznagllnaq ut-dozp t Outag
zapisuoo Ilim HdOf •suuid aoutznsut pazipisgns put pinotpoJ, ut 2u4iozu3 szaguzaui Altunuzuzoo
lsissu of aldoad urezl op satouaa11 von zaglo pine HdOf gltm lotzluooIltm g3IOHO •u(423.1zno
zo
zo�
ss000id pig alp uzl uasogo SEMIzomlaN gliEald iEuot5ag DOIOHO •0u11TLzl put szalsisst
uosiod ui zoj spilt imams antq suoi2az all put `suoI2o.1 it'papinip Si alms au •sutld aoutznsut
gllnaq pazosuods Toy amp ojgtpaojjy ui Homo aldoad dial 02„`szalsissn uosiod ut„Jo Nzonnpau
n 2uidoianap st 31CIs a4I Itg1 palzodaz `glinoH otlgnd AlunoD uoszaJIa f `zopoaJIQ `utmping uta f
uasogj suopvz ua.IO pun aaputluridglivag uol2utgsum
SI'Ia1I 'IVNOLLVLARIOdNI pug SS1NISRg Q'IO
•spno alnp 341 ants put szatlJ
uieBozd lno paputq to Tod/`syr „•anizls put astozaxg„zoJ JositzpunJ Joquialdas t zoJ amp
-alp-anus t paluasazd oslt tuilaQ •syAI •sXtpsan1 uo aligoui Moog 042 gliM suitBozd glim lzaouoo
ui JCinf ut sui alt=Bald auaoitnO •urtz&zd luauzgotzua 2uiptaz papunl 1utz0 n sauiquioo alts
uznotuii4O •g I-i past uazpligo zoj urtBozd ream uodo ut si tutiOozd V3V A a4I Imp palzodaz
noizg •lunotuzig3 put puasumo1 pod `auaolinO ut suitBozd alts Lwow zauzuzns zoJ ltnozddt
JO luauiaounouue ut aptuz VOJ\IX UOSJOJJO f JO JOIOOITQ anilnoaxg ureJSozd `tuzlaU tout'
•luauiuioo otlgnd zoJ palito zalgng ITU
• 1,NIIAII\IO3 OIatfld
1
£I OZ`OZ aunt.-salnum HOfl
alp jo adoos aqi sputdxa uoisinaJ luauno am put `upuaat alp oI adoos paliuiij t SUM azagl
auui ltul AT Jadtd 1i0ijod a&util3 x0j tpu00y JO uois.ian OIOZ Jaijzta uu of pariajaa 0)1001 'zG
saain iaS glltaH ailgnd ituoiltpunoA :a2utp.ioj tpuaty
•ssaoozd
uoiitogtlzao otut mo am 0uipz0a!uoiiailsanui jtJapa3 t sapniout osjt anssi a4J •apimuoiitu
811 It si ssaujjt paa iodaa Jo.iaquznu aqi 's)jaaM oM1 ui 5uipua si pouad uoiltgnout uinuuxtui ails
lnq `&uisojo si uOiituiootA Joj MopuiM am put `s)jaaM Z Jan° 0z3M saznsodxa 1st! aqi •oolso)
/cc'Joj mud `uani2 uaaq anal suoiituiootA •szasugomd oI uotiuoi iiou ltnptniput put gota.uno
ilOnoigl oijgnd agl Xjnou of pogo ut aptui stil ooisop •puajq aui zoj paiJoduii link gsp ij
of It Sunjuij 'amp.Ouoj t ui RI am ui uaas uaaq lustq d dal{jo uttps ztjrioiiztd sig' •}jtaimno
sililtdaH awls-ppm"t of pa}juij put `pIJOM aqi JOAO;lit uiozj pao.inos si iloigM `ooisoJ
gOnoJipl Nos puajq 1puj uazoij.itjndod t jo !pow a4 2uipJt2az uoiltuuoJut paMainaz a)ioorl •za
sililudaj jo Itaaginp altls-IIInIAI
•Aisnounutun passtd aqy •uoissnas p.iamm u.
oN •utnillnS.iaqutami papuoaas stnA uoiloui`ata •ainpagas aad wall wind kluno3
uos.iajjap aq;2uipuauit aautuipao pasodoad aqi anoiddt of panoui utuiaalsaM.iaquiaysl
luutaq aggnd aql pasoia Japing utuuitgp `luauiuioo zaijpnj oN •ljtJ aqi ui ajnpagos
aaj am of sa2utgo sngiuuzo alit'2uunp uoutoijutjo ails ssazppt put smut jtzapaJ put aitis
•
ails put `30tnOuti altUJaijt goJtasaz mm 1aJaa}j •JJiAl •O1 `saptjszalPM sapnjoui SJaalto am put
`oijgnd azt asagl TUT pauuguoo JajaaN •ayA •stds put siood altnud Jo oijgnd of zaJaz ajnpagos
oq uo suds put stood agl JailiagM'inogt uotltoI.Ju.ztlo zoj poAst uuuuaisam Jaciuzaj^l •sluaumma
aggnd ioj pallia put SZ:£It suoisinai aql.ioj 2uutaq aiignd aql pauado.iaigng uumuut o
•Outlaaui HOU £I OZ '91 ctYAl aui
It passnosip put paMatnaz aJaM ajnpailos 03J ulltaH jtmuauuzoJinug alp oI suotsinaJ posodoid
suoisinag ainpaMPS aad glluag Itluauiuo.nnua—tui.itaH aiignd
SSaKISflg A am
•saioijod aotjdhjzoM
papuauiuiooaz put 'mu!Mau ails Joj nlioijgnd OuistaJoui sisanns Jailing utuuttg3 •Soijod
l.ioddns Ouipaajistaig jtuzaiui ut paluauiajduii stq Hd3f 'sJtan S I utgi aJouz JOJ Outa uaaq sill
tat Ouipaopstazq agZ •uogtoi ilzao izoddns Ouipo JistaJq Joj pauitil aq II!M oqM `gong Aglt>
nq paltuipz000 `tat OuipaaJlstaJq auI slsoq HdDf •pua jjiM luauiaatJnoosip jo put
`pasiti aq uuo luauunjonui put ssauaitMt JUT sadoq It poops-nig lsnf oI papioap
tins°.1 t st put `oiignd ui sauiil ajdtijnui paluoJJuoo sem put `pjigo Jag Jo}lsaq am op oI palutM
ivaijo Itgi sioalozd Aiito jioads Itgi MtI 6002 t alidsap `oijgnd ut poopstazq Lupjnoo
ails
Tem pjol 2uiaq Jo lun000t s juauo DIA1 t papodai `IsiuoiliJlnN Hd3f `uoszapuy iiijlt}I •
a►
£IOZ`OZ aunf-salnu!IN HOB b
•
•suotlnool xoq-dwp oggnd
papundxa am `Xiteo jtoads—um/2°A s,AlunoD 2ur aql zoj sogs!Boi aqI lnoge uogeuuoJu!
Jagin3 Jo"3jn1s paNsn uosuigo>J aaqu ojj •aotdJp s jjuuagg XlunoD uoszaJJa f aul pun luaurl redau
aoiiod puasumo t,pod am of ua}pl aq two snap uoiduOsald `1luno3 uoszaJJa f lit •tun i2oid Nogg
-a}pl-Onap anisuapa pun anbiun alntput of psodozd XlunoD 2ut?t manno n palou JOJaaN 'ALAI
•sauaunq pue sginq luaosazonH
londuzoo JOJ Hd3f alts uoifoattoo n Si acaul JO `1109 1S JoJsuual iclunoJ UOSJOJJaf aui of ua}pl aq
lino Aaul`trod am uT Alitton" alsem snoprnznq affil In paloatioo /a uoi ou azu asaul"um plus au!LAi
-nua3 •sJ, sginq luaosaaonu Jo 2uuoiioaa Outp/uSa.z UOilnat5[1E1O .zoj paNsu unuraalsam aaqu/NLA'
•snopuautaal
uaaq snit/pegpaaJ aril pun `JEJ os sluapnls ooc lnoq>; unuonal `suofuluasazd Z£ /cIaln lxoadde
apeur snq Jagsg ut}I uaf Tem paliodaz auiLAi-npad •sly :siootios affil uT uoileonpa InluauzuoJinug
•pm.zoJ 2uIxeau Ddid
aul paduznq tiotiim `s1up 081 uullim pzuati aq o10A14 s2uUnau as0til pun `ionuiJd annu sasu0
pinog 2upnaH sauilaaotIS atp Incl patjunio O2um-niaa3 •sLAI •1agtua00Q oI pnmaoJ Ou!.reau
Jdid 042 2uujsnd Si preog s2u!J 0H IO.iluo3 uotlnilod aril/Cum pauoilsanb IlasspJ uetuJI u3
411 •sTsilzn Joj sdous pom Om1 lapp° Ol aq iTM ` utpunJ u1Tm `dais Ixau ata
•.KliiTonJ luau4naJl aleiudozddn un of It ori
pun aalnm aliq azitaureluoo 01 pa nanooua are SJOUMO Tem palnoTpuT oStuw-utzad •sLAI •zalem
ajiq zoj ssaooid alp Inogn pa lopuoM uosuuo f iagwoj •010 `1uaurUTnluoo IITds anJnooua o1
sassauzsnq o Jojjo IITds cc sell HdDf •ssoi oid a.insuaur oI sassautsnq ql!m do motto" op
01 aq I1Tm uteBoid 041 uT dals lxau ota •alsvm snopiuznq jo psodsip Jo"sassauTsnq zo3 saOznosaJ
Jo luauidoianap pine `nano SUJnl 2uIJJuls uaum JOAOSSOJO pun i1Tn0Ou01 aznsua 01 SIstl)IoauO
Jo luauidotanap atjl 'atm IOAO ssoi o.zd aznsnow of asngnlnp 3IreuraptZ am 2rnpimq `AJ1ua
ulup pun uotl0attoo nlep-jnuaaluT are swam £ Isul am LI!BULLin000 sauu140 am JO IsoLAI •alsum
snopanzeu BuInionuI Iuaur0O1?unur aalumtwols 2UTpJe as sassauisnq 01 gouaz1no pun uogeonpa
sap!nozd Hd3f •uotluanazd uotlniiod ssauisng o1 pa&lingo uaaq snq mu/20A am"o Dam au
lona1uoo urez2oad iozluo1 amnoS inooT am 2UTpzu2aJ preog am palnpdn oSuTL\I-nTza3 i/Iu!d
ioa�uo�als1J snopanz1H JOJ aaun1sissV ssautsng imus
•suotloipsU.mf Mina'pool JOJ sureBozd poddns anunur o12uTpunJ
2utsot sT uo!um u1paH Jo Iuaurl iedaU alumS alp zoj suo!luo!ldw! anuli tib IT Ing `lanai Too"
am uo aq lou Xnui/anthill am Incl slzodat'Tmping •sLAI 'Hd3f 10°JJu "pm 2uipun3 am lit aunu0
aul 1au1aum pauotlsanb unuzralsam Jaqulaw •suoIszan alnuoS pun asnoH gloq uT papnIOu!
uaaq snq luauoduioo wag oitgnd pool am`lapnq 042 uo luauzaaJOn un laX Lus! a1au1 g2nou1IV
•saoin.zas twat'puoTlupunoJ JO IdaOuoo stu101 pa)It14 2u!aq mou SI `aanlnis!O0T Ili aoJ paln0onpu
• Om
aq `saoTnras"wag oitgnd Jo"2unpunn au.L •Isnd am Jo sapo2aIn0 am uuu1 iapnoiq Inum0LUOS
SI pun sa!oualaduzoo 3100 pue saopuas u1Tnau oTtgnd InuoJlnpunoJ uo sasnooJ mou uoIum `upuan
£I OZ`OZ aunt•-salnury I HOU S
•luamuuoo oiignd p uotltppu oI�I
1 NHIAIIAIO3 3I'Ig11d
.scop HOG 8uit'O3n0 oi
tisaJJ a?iel of Xltunuoddo ue st stgl pue „uollnq lasai aul ssaxd„ st `ao jjo sualua treuusatm 'zQ
su `aUJ q atil P 411 paleoiput 33100'1 •JQ "mu if'n f uo 2utlaatu wall Jo pJeog iCluno3 uosJOIT3 f
at'l Joj 2utuznlai aq"pm pue `s uuaauu"ppm Jo piton d slt}p pue mum Otpl 2utpuallu
aq until iitm uut usatm 'JQ •papieme 2utaq alels atil ui sji idsoq ang Jo atm si azuotilieaH
uosJa3Ja f •satguq icq'l'uaq Joj plume Lie ultm'ultdsotl ail luasazd 01. y,S I Ainf uo areaway'
uosJaJJ f ltstn of painpagos st `tilivaH Jo AJelaJoas Otuls uo]uUIsem `ueuzsatm ut'o f 'z0
a,LVQdil_AIIAI.LDY
•JolezlstuttupV Xluno3 all pue sJauotsstuuuto3 •
iluno3 Jo p1uog at'l gum suonnios aigissod pue suzaouoo ssauppe of pazedazd aq mous utmpieg
Joloa ij 'wed of owoo a.znsoio awls all pinous `ls i Xin f uo slsanns uentiins uaquzay\I
•uotsualxa'cup 0£u Jage peon
Puu Itnu aq mom `satzaaluo luazaJJ.tp yS ui `sasuaoti a.zeotilieati IP Imp tpl'uaH Jo luauulzedaG
aril q luatualuls e lnoge uzoouoo sni passazdxa Ovorl zQ 'paddols aq pitm$utlsan.utp
gsgipatis peiozatuuuoo puu 'pug 2upsal gstjiiags `unnopings u s‘azatpl jt lutil sa.zodaz Jajaa}I
•.q\" 'Janina aluls atpl/Cq pazmbaz scup 9 ail a a3Og alit u2noigl sluauupuauuu loeJluoo pun=
Will of ail&nza.s e 3q 'pm lI •.icluno3 uosJaJJO f ut 2utpunj pooj 311 uo Iiaz Aluno3 UOSJOJJO f
ut aidoad 008 'stuuiOoud papunj ales Joj HdDf JoJ stream sail lut'm lnoqu laI uotleotput
LIE Lusi azagpl lug Pres uimpp-ea 'syAI .000`0£Z$jo uotloafozd anuanaJ aims paseaJout uu
Aq pasoio uaaq set'dug alp jo Tunowu a JUI V •sla2pnq aluuas pue asnoH atpl uaamlaq Au dstp
uotiit 00£u peg sla 'pnq all Vam Tsui Jo pua at'l Jo sy •tpuouu atp jo pua aril le soi dxa lapnq
luanno atp azojaq pJemzoJla pnq Outlezado aril OAouu of Ono= aq ipim ainsoio e jo slouduut
atplJo cltzanas aril ram adotp pue `ueid Aoua5utluoo u pasea'Oi set'luatuaaeueyAI 'etouuuM
JO 00IITO at'l puu JoUJanoD aril •unnopings e JoJ 2uuudazd st luaURuano2 awls `la0pnq pug
2upioefl •Ippati otignd Joj punj paleotpap uual 2uoi `aiquls e zoj icltuotud antlu'spa' Ou1o2uo aril
Jo sisal ail aq ittm pue `gluotu lxau no anp st spa asat'l mut of papaau OutpunJ zoJ ppouu lsoo
appnaluls e `saotnJas t'l'uaq otignd iuuotlepunoj 2utugap of uotltppe ut leul suodai a)ioorl •JQ
alupdn angelsOa'
na•icoa�n zltzjuiaue Jo £6£L-L0ir 09£ `z1tz,d.UI32UV :dao3 Jaded puasumoI •
pod aril 2utpze2az "uo of icltunutuuoo aril zoJ Jagtunu ileo e do las gQQ Imp paiodaJ utmpieg •sy\p
I
,a.
Et OZ`OZ aunt—salnuryAl HOS 9
Squalloaj"MD
:pauiuugnS iciinPoadsali
zaqumoj `uuuualsam uitais
zaguzayj `u9sn'uuio f zaqu `uosutgo}i auizgg3e3
pasnaxg
ITU 301A `mAIIInS PIAEG .taquuaw `iiassizd ullogoj
i
•TP ID `tatting ITU zaquuay/ `uosugo f I?ZId
HEIVaH AO QiIvOf AINf1O3 NOSlIadd{f
'IAId SZ:f 2119091ll HOH alp pauanofpu Japing aietD
iu�> IsxnoraV
89£86 Vm `puasunnoZ ImpizauS Sig `Ipiu°H ougnd X4uno3
UOSJ JIaf 0£:j7—0£:Z wag £IOZ `8I /Int uo pian oq iI!M Oupaauu Jo pz[og lxaN
OAII. aglAl aa'If1QaHDS 1XHNI
•auuati.„uounq lasaz atu ssazd„ tipnn uopounfuoo ut unuusaum zQ tilinn pannatnaz
pun pauuasazd aq pinoo gown 2utppn pai.sa2 ns uunnping •sib •auuu1 sup In SUOU ppe oN
• 2IF�QI�I�'I�O ONININIV Id VQAIHOV
EIOZ`OZ aunt—salnutIN HOB I
•zaddad PIeId all puu doo3 •
pond aqZ `luauzaJIpli M3IA X.xanoOSJQ of uoszad ut paluasazd 3Z0n1 spumy •SMOIAOl iclOJus pool
zoJ splum luauzanaT1ioy 2uTpuulsln0 ZI0Z papzunnu OZOA1 tlOTgnn saTppuO S1 alp paMOTnaz pazuf
uoilnluasaad panenV 'Claps poo j
(moISIAali VQwaOv) NOLLvI,RI03wI(INN SSamISI1g Q'IO
•Sisnouttunun passed uoilout ags •uotssnasip aaglanJ oN •unutaalsaM aaquzaui
papuoaas suns uotlont au, •„uoprindod lad aaptnoad„ o;aunga ' and To uiolloq
agl lu pun 'palaaaaoa aq of spaau 2uiiiads autuu mina(' auuy`Z and uo :sluautpuaum
Jilin&2u9aaut £TOZ`9I Sulk alp To salnuiut all anolddu 03 panotu uosutgog aaquzajA
sa.tamhI JO 'IVAO2IddV
•Sisnotutuuun passed uotloui aq j •uoissnasip oN •untuaalsaM aaqutaw
Mfg papuoaas suns uoilout aril :papuatuu sr npuan aql anoaddu of panout uosuigog aaquiay4I
•saapuallu ssauisnq alupouzuz000u
of `upuaau ogjo dol all 03 uo11uluasazd spumy'claps pod all anouz of paiiuo zaiting ztut1J
VQN1OV JO 'IVAOIIddV
utlsny uqo f :pasnaxa saaqutaN .
lOJOOJ pazu f `u!Mpiug u1O f `O)1oo'J •z j :luasaad 33n1S
uosuiiof ITud `unnTiinS
p!AEQ `uosutgo21 auizug11 J `IlassTzd ulzago>i `uuutzalsarn uirauS `zai i i 1I!f :luasaad saaqutay%i
•luasazd suns umzonb
•YAId ç : lu Jam 03 g3ivai-J Jo pzuog X31.1110D UOSJJJO f 01.13 Jo 2up.aauz ati3 pupa zaILing'rein
Z#1411SWQ`JauogssturuIo9 jvltdsoH 111f
(t o)alivl lv ua2pt3 `uvitualsaM v11ayS
aolaaJ7Q Ondaq`&ivy$valuoaaA 1launo,7 puasuntoj pod`uosulgog auyinpv3
417 Saaln.laS y11vaH-Aug`rafaai pa.rvf ( unod)ah?Jvl 1v uazi la`llasslyd viJagog
rolaaalQ saopua5 ffutslnJ`up/Suva v11nf £#1a1J1s1Q`aauolsspinuod dluno,3 `upsnd uyof
1117 sadpua5 y11vdH allgnd`u/Mp[vg unaf t#1a111S/Q`Jauotsslululod dluno,9 aalA `uvnlllnSpinvI
raa fp y11vaH Hdltl`am'avow'svuloyj I#1auIs1Q Jauolssizuzuod dluno3 `uosuyof 11yd
sraqulaJJw ins sraquraytj pivog
89£86 VA1 `puasuMoI pod `halls uuptzatiS S I9 `4IIuOH oTignd iclunoD UOSJOjJO f
£I OZ OZ Oun f `Aupsznq
SI.LIINITAI
HI'IV1I AO CDIVOH AIN11OD NOSIMAAHf
I
£I0Z`OZ aunt—salnuiyAl HOE
• uol2uigsum jo uoiluo3 2uipaa;lsua.ig
•Xlunoo Iona wag Epp zoj slunzalut aouapguoo alp jo suoTiH uasazdaz sapnlouT gduz0 ani mg
saluotput axoo' •z j •laxoud ani uT papnlout gduz2 aql jo uoTiuoguulo zoj sNsu uosuigou zaqutaw
•asopzano puu asn uiozaq ut 2uTMsdn uu uaaq sutl oioip `passaz2ozd anus! salutdo jo uotldtzosazd
aluudozdduut aonpaz of slzojja sy 'salutdo uotlduzosazd moij Altiulzout puu Jo asn u8t1!
tplm op of OuTnuq ulnsutuad otduIXIO atp uo tualgozd zniturts u jo slaag atp uo smolloJ lnq `uToJO4
lu Ailuogtoads s)lool izodaz aqj •aluls ani ssozou 2utsuazoui si asn utoJOq loth saluotpu!gottlm
`asn utoJOq 2utpz0az vocal uoi2uigsum Jo pagstlgnd Xpuaoaz u pamatnaz wog •zU
alulS uo12uigs1M ssoaay spuai j asn uioaag
•ansst!Bloat oilgnd of papualxa pzuog 2utzuaH
luatuaRuuuyAI tpmoz0 Jo iclTzotlinu atp zatllatlm pazapuom aH •anssT asn pool JO luatuaOuuuuu
tllmoz�u lou `anssT giluag oilgnd u sT uzaisiCs aaumas alts-uo Jo uotiuln2az alp loin pagtzulo
a3looH zQ •uualsCs uotloadsui zaumoatuoq alp Jo luautlotpuT uu uutp`XlunoJ uiootugm ut
saotiouzd luauuaguuuuu tlimo10 2uTpzuBaz uoiluutpz000 alp Jo uoiluotput uu jo Ozotu aq Amu 2utlnz
atp Imp paluotpu!zaJaax •ThI •alms ani punozu pasn 2utaq sT puu qlunoo stili uT itoddns Ouozis
sug tuuz2ozd uotloadsut zaumoautoq oqj •Aiunoj Iuoolugm ut malsAs uoTloadsut zaumoaIuo4
alp papton- plgm uotstoap pzuog 2utzuaH IuatuaRuuulnl 4lmoz0 ata passnostp O)loo' •zU
uotlaadsul Loomis aildaS aauMoautoH lsrn1 y saint pieog utauag luautauuuyAI glntoa0
• •alts uotluzis!Saz azuouliluaq ut-dozp u 2utaq
zaptsuoo Ilam HdDf •suuld aouuznsut paztptsgns put ptuotpajA!ut 0utllozua szaquuatu Xitunurtuoo
lstssu oI aldoad utuzl of satoua u uazu 10410 put HdDf Ilit^n 1Oualuoo TWA H3IOHD •uoI0az zno
JOJ ssaoozd mg_all utoJJ uasotlo sum)Izom1ON ullumH luuo03)1 EDIOHD �ututuzi puu szaistssu
uoszad ut zoj sptq 1g2nos anug suoiOaz alp puu `suopaz Aq paptntp st alms aulZ •suuld aouuznsuI
twat!pazosuods lOv azuD alqupzojjy ut HOMO aldoad dlaq of«`szaistssu uoszad UT„Jo)Izomiau
2utdolanap st aluls alp Imp paizodaz tllluaH oTlgnd)(MOD UOsz0JJ0 f `z01.00JTQ `utmplug uua f
uasogn suotluzluaa0 puaZ aapuiJuuidglivag uol2uigsuM
SI�I�ZI'I�I�tOI LVWUOdf�iI puu ssat.IISng Q'IO
•spzuo alup all anus puu slOTH
urez ozd Ino papuu4 utuJOQ •siAl „•antz4Z puu asTozaxH„zoJ zasImpunJ zaqutaldas u JOJ amp
-all!-anus u paluasazd oslu utulou •siAl •sAupsani uo apgoum voq ani gltm surezOozd tlITm Izaouoo
ut�ilnf uT suI2aq uuuz2ozd auaoltnO •uzuzaozd luatutlo!zua 2utpuaz papunj Iuuz2 u sautquzoo alts
=mum -8I-I pa&uazpITgO zoJ uuuBozd luaus uado uu st ureiOozd v3y\I. aq1 luui paizodaz
uo!JH •tunoutuul3 puu puasumo j pod `auaol no uT surez ozd alts luaus JOUILL ns JOJ lunozddu
JO Iuauuaounouuu LIE apum VaA L UOSJOJJO f JO zoloaJTQ antinoaxg uuuz2ozd `uuulaQ IOTJH
•luauutuoo otlgnd JOJ palluo Japing JIND
INHI%JIATO3 DYIgfld
£I0Z`OZ aunt.—salnumi HOU £
OTII jo adoos aql spuudxa uoTstnaz luanno alp.pug tpuaRe all of adoos paliutil sgm amp •
`autul tial Tv •zaded ioilod augtp zoj gpua y Jo uotsJan O IOZ zalliga ug of pa.uajaa a)Joo' •zU
saapnI S weal'ailgnd inuo!lupunoJ :aunt°aol upua y
•ssaoozd
uouleogilzao oivazo aql Buipze0az uoTlg ilsanui lezapaJ v sapnloui osjg anssi atlj •apimuoileu
8I I It si ssaulli paazodai jo zaquunu atu, 'mown oml ui Butpua st pouad uotlugnoui uzntuuxetu all
ing `5uisolo Si uoileuiooen zoJ mopuim atll pun `sham Z JOAO azam saznsodxa lsul a4Z •oolso)
Xq ioj pled `uanIO uaaq anvil suoiltuiooen •szasttloznd of uoiluotsilou Itnpinipui pun tloeazlno
Tl2nozgl oijgnd all Jisilou of lzosja ug apetu sett oolsop •pualq all zoj paizoduzi llruj tlsixznI
of lT `Ouzil 2uol t ui Sn Out ui uaas uaaq l,ustq y daH jo uivzls zglnoilzed sins, •Neazglno
stliledOH ams-illnUu u 02 paTIII pug 'mom all JOAO llg wag paomos Si tloiTlm `001s03
110noup Nos pualq linzJ uazozs ztlndod t Jo Ilgoa.T alp OuipzgOaz uotluuuojui pamainaz axooq zQ
�r s!lHludaH,lo lnaaglnp aluls-HIInL�I
•Asnouiiuuun passed uoHloui oq j •uoissnasip aallan3
oN •uunpilns aaquiayj ifq papuoaas sung uo!lout aqi •alnpagas aag wall oilgnd dlunoj
uosaajpp all Ouppuauin aauuuipao pasodoad all anoaddn 03 panoui uuutaalsaM aaqutay\J
•tupauaq wind all pasola aalgng uutu.quga `luauuuloo zaTllznj oN •Ilt3 alp ui alnpagos •
aaj all 01 sauiglo sngiuuto all 2uiznp uoilvotyigro aul ssazppu pug smtl ItzapaJ pug alms
041 pug `aReauel Olguzallg tlortasaz Ili''JOJOO) •Ol0 `sapgszalum sapnloui /zaOleo all pug
`oTlgnd On asatll Tem patugJ.uoo JOJaax •z1A1 •sods pug stood alenud JO oTlgnd 02 zap.'alnpailos
aq1 uo suds pug stood aq1 zaullatlm lnoqu uoileo[4ijo zoJ paxsv uguualsam zaquzayAI •sluauiluoo
aggnd.tot palluo puu sZ:£In suopspnaa aql upanaq ailgnd all pauado .iatgng unwainq
•2ui1-03Tu HOS £IOZ '91 "JAI 041
It passnosip pug pamainaz Ozam alnpatloS aa3 ulllg0H leluautuozinug alp of suoisinaz pasodozd
suopspnag alnpalos aaj llluaH Inluauiuoapnug—2upauaH oilgnd
ssamism
•saioilod aogithpom
papuauzulooaz put 'MET mau OTII Joj Xlioilgnd BuTsgaJOut slsatOns zalting utuuietl3 •Xoilod
l.toddns 2uupaajlseazg leuzalui uv paluauIaldur!sal Hdif •szv0ii S I avail 310111 JOT 211102 uaaq st4
gal 2uipaaJlstazq ails, •uoilgogilzao lzoddns Butpaaslsgazq zoJ pauitzl aq 'pm aim `Tlon'1 1itlle)l
Xq paleuipz000 `tat 2utpaajlsgazq aq1 Slso4 Hd3f 'pm IIim luaulaemoostp so adIl situ 213Th pug
`pasigz aq ueo luauzanlonui pug SSOuazeme Imp sadoq icgle?I 1Tl2iu It paaJlsuazq lsnf of papioap
llnsaz e sg pug `oilgnd ui satup aldillnut paluozsuoO sem pug 'pulp Jail Jos isaq am op 02 plum
map ails, •ltpiz lvul sloalozd Xlleotdioads letll MEI 600Z t altdsap `oilgnd uT paaJlseazg Lupinoo
Ns Tem plot Suiaq Jo lun000u s juaiio OIA1 e palzodaz `lsiuoilTzlnN Hdaf `uoszapuV Ault?I
£IOZ`OZ aunt-salnuM HOU b
•
•suopnool xoq-doip oilgnd
papundxa alp `AIpogioads—tunz2ozd sAuno0 ui?I oq zoj sogsi2ol aw inogn uonetuzoJui
zatninj zoJ Jms pa}Isn uosuigo)I zagtuayAJ •ao JJO sJJizaus 1luno3 uoszaJJO f aw pun luatunzndac
aoTlod puasumoJ liod alp oi.ua}p3 aq Imo Ow uoi2dizosazd`1c;unoD uoszajpa f III •u1Vz0ozd Nogg
-a}p1-2nzp antsua1xa pun anbiun n awiiui of Insodozd AwnoD 2ui?I 1uazzno n palou zaJaa}I .1J,\
•sauzanng pun sginq 1uaosazonij
1ondutoo zoJ HdJf 1n 01Is 1101100ll00 n Si amp zo `uonn1s JOJsttnz1 X1111103 uoszaJJ f 0111 01.11031E1 aq
Uno Xatp. `pod aw ui S,4ilionJ a1snm snopznznq Nun papalloo za2uol ou azn 0S0111 1.V111 pins auiyAJ
-nTzad •syr •sglnq luaosazonjj jo 2uTloJoaz 2utpzn2az uounogiznlo zoj pa)lsn ununa1sam zaquzayAJ
•snopuautaz1
uaaq snq 3longpaaj alp pure `znj os swapnns Ng lnogn 2uTTlonaz `suolln2uasazd Z£Alalntuixozddn
apnui snq i sJd2ui}I 110f 1.n112 pa iodaz aum-nuad •sj, :sloogos am ui uognonpa p1uautuozinug
•pznmzoj 2uiznatl �d1d
al
paduznq Tlottlm `sAnp pg I uitl�im pznaTt aq oi.annul s�uunaq asotl�pun `Xontuizd anngl sasno
pnog 2utznaH sauilazogs am 2ntp patJiznlo aum-Woad •syAl •zagtuaoact o1 pznmzoJ 2uiznaTl
Ddid am 2uigsnd si pznog s2uiznaH IoIIuoD uoilnliod auk iXTlm pauonsanb Ilassiz3 untuzingD
• •sisnze zoj sdotlsNzom wig zaJJo oi.ag'um `Ouipunj trim `dais 1xau auj.
•X2ilionj 2uatu2na4 awudozddn un of II a}pl
pun zalnm aliq aztzautn2uoo 02 paOnznooua azn szaMMO 1142 p01noipui 021111N-nizad 'SW 'z31nm
a liq zoj ssaoozd all lnogn pazapuom uosugof zaquzaw •ola `2uauzuin2uoo Rids aanznooua 02
sassauTsnq of zajjo ol.s2iN Rids cc sn i Hdif •ss0z2ozd aznsnatu 01 sassauTsnq trim do mono.' op
'DI aq -Film uxnz2ozd aq2 ui dais 2xau athZ •a2snm snopznzntI JO psodsip zoj sassauTsnq zoj saoznosaz
JO luauTdolanap pun `zano awn 2UIJJn2s uatlm JOAOSSOIO pun 4A021101 aznsua 01 MMMI13100140
Jo 1uatudolanap am'awn JOAO ss0z2ozd aznsnaTU 02 asnquwp)Izntuapa alp 2uiplinq `Xz1ua
nwp pun uo!2oalloo n2np—'maw! azn ST11uoul £ a.snl 0142 u! Ownn000 sa undo aTl2 Jo Isow •a2snm
snopznznq Ouinlonww 2uatuanUntu za1nmtzuo2s 2utpzn2az sassauTsnq 02 gonaz2no pun uoT2nonpa
sapinozd HdDf '1109.110n0zd uoilnllod ssautsng ol.pa ungo uaaq sag uznBozd NT JO aureu atlZ
'20n121100 ttre150zd l041103 aoznos pool alp uipzn2az pznog 042 pa2npdn auiJAJ-uizad XIIuid
io.quo3 alsUM snotuuz1IH JOJ aaun3sIssV ssautsng ilnmS
•suopotpsiznf Twat!pool zoj smnBozd aaoddns anunul 012utpunJ
2utsol si gown tl2paH JO 2uatuundaU awls 0141 JOJ suo12n011duUT annT{HIM 11 1nq `Ianal pooI
01.11110 aq lou Amu 2ondtui alp Tell sazodaz uimping •syAl 'HdDf 2033Jn 'pm 5uipunj am ut auntlo
alp zatl2atlm pauotlsanb unuua2sam zaqutayAl •suoIszan alums pun asnold tT2oq u1 papnlow
uaaq snq Iuauoduzoo 42Inau oilgnd pool all`2a2pnq 041 uo 2uaulaazan un}ac Lust azatl2 t4SnotlflV
II saotnzas watt puo!2npunoJ Jo 2daouoo mg 02 paNuil Suiag mou Si `azn2nlsIBal Te zoJ pa2noonpn
2utaq `saoinzas u2lnau oilgnd zo'2utpunJ oq isnd 042 JO satzo2aino am until zapnozq ingmatuos
sI pun sa!ouaIaduzoo 0100 pun saohnzas q -eau oilgnd Inuoi2npunoJ uo sasnooJ mou tlo1Tlm `npuagn
£IOZ`OZ aunt— HOg S
•
quauluzoo oijgnd Ituomppt oN
,LNi1IAIY%IOD anti ld
SM) HOG 2uttpliona}t)Jooi
tpsap Xltun;.zoddo ut si sulk put „uounq lasaz °tit ssazd„sI `aogjo stoma umusom •zU
st 'await atp Ttup.pottotput °)loo' •zQ 'tog I 'Cin f UO 2upoom wall jo pito A}uno)UOSZOJPP f
M.11.10.1 2utuznuaz oq!pm put `sOupoom tpqtaj jo pztoH dtsIDI put ureiitij Out 2utpuonu
xi wilt !pm utursotm •zQ •papztmt 2utag awls am ut sitttdsoq ang Jo aUO st aztotlntOH
uoszajjo f •satgtq Aqqtaq zoj pztmt ut tp.tm ltpdsotp atp luasazd 41c i Ainf uo Oztoq TtOH
UOSJOJJ f TIstn 01.painpatios st `tintaH JO XztPzoas aVIg uo1.011tt1strn `UMUSOIAk utio f 'KJ
L.LVQdfl AIIAIIDV
zo}tz�stutulp�Ituno3 a14 put szauotssttuucoI •
Atuno3 jo pztoH atp TIM suopnlos aigtssod put suzaouoo ssazppt paztdazd aq phots utmpItH
zopaz!Q `sstd auroo aznsolo alts oq pinogs 'Is! Alnf uo ltti.sisaans utnllpns zaqulow
•uorsuapxa,(tp OE t tout peon
put iinu oq mom `sauoOatto Tuazajjtp i,g ut `sasuo ii aztotmtaq Iit ttq jo tuauriredo
Otic.kg luatua}tis t i.nogt uzaouoo sui passazdxo alloog •.x j 'paddois oq!pm 2upsanstti
gsmiogs lttozaunuoo put 'pug !pm 2unsat gsHiiags `umoptntps t s‘azagt jt Tent sarodaz zap.aO}I
•'N^! `zatllrnd •alts atp kg pairnbal seep 9 ant ut X1OH atp g2nozgi.sluauzpuatut lotzmoo punort
uznn. a122nzts t oq!pm 'klunoD uOSJOJ,,a f ut 5utpunji pooj 3IA1 uo kWunoD uosJOJp f
uI apdoad 008 •surez2ozd papunj awls zoj HdDf zoj sutatu SUIT Ttrpm mogt IOi uogeotput
ue east azatp.itup pats utmpitH •sJAI '000`0£Z$Jo uopoafozd animal awls pastazout ue
gig pasolo wag stip dtS atpjo tunoure a2zt! •sa.o2pnq o tugs put asnoH atp uaampq iiiutdstp
uoriitm 00£t pun si.o2pnq atp.'loam istp jo pua only) sy •tpuotu only) pua aunt}t saztdxa to2pnq
Tuazzno atp otojoq pztmzoJ i°2pnq 2ugtiodo atp°nota ot tg2noua oq!pm aznsopo t jo stotdtut
ontjo knzanas atp Tull odor! s‘azati.put `utid Xouo2upuoo t pastaiaz sun tuatua tutJAI ittoututd
Jo aomo atp put JOUJOAOD ajj •umomnuis t zoj 2uutdotd sI tuauruzano5 awls `ta4nq!tug t
2upJotg q tan otlgnd zoj punj pOttotpap urzai.2uo! `aigms t zoo anptlsI2o! Outauo atp
Jo slstq alp aq !ptm put `upuour txau ono anp st spa asapq loam on papo u 2urpunJ zoJ ppm tsoo
Optmattts t `saornzas uwau orignd ituontpunoj 2utuijop uot}tppt ut Imp strodaz O)ioorl •zG
arepdn anileIsOa'1
no5•A00�Z141JtI32ut JO £6£L-L01r-09£ `zi1zd tIo uy :chop Jad-ed puasumoy •
pod atilt 2utpztOot Ilio Xltunuzuzoo am zoJ zaqumu !!tot do has gOQ poiiodaz utmpItH •sJA
£IOZ`OZ aun£—sainuM HOH 9
•
Aqua)loaj VaPD
:palliuzgns AIlnjloadsa
aaquzaw `treuualsam rIiatIS
Ag).,(77 c\A
nett'tay%I `upsny utlo f Jaqu `uosutgoli auuvtlpu
-qz7pasnoxa
JIBD aoin `unntllns P!AM JoqutaN `ilasspd 1uago---1—p7,04711
21
(7077Yr /1/1/42/
• }
JIRLID `aal1111g II? Jaquzay\l ` r, utiof Itud
-77°79/.7" 41'
HEIVLH IO (RIVOH AIMI1O3 t 4 OS
'I�Id SZ:v 2u!laaut HOB aul pauanofpt aaping arena
IKLIA[w Inorav
89E86 VM `puasunnoJ pod `•lS trepizatTS S I9 `ulilaH oTlgnd Xluno0
uoszaITa f O b—0£:Z uwiJ £I OZ `8I Infuo purl aq Kinn Ouilaatu tllpaH jo p.zeog lxam
DmiaaLAI aa'IfKI LHaS 1XINI
•aux q „uollnq lasat atll ssaid„ atp rhino uotlounfuoo ut ueuzsatm •a(TIM paMatnai
• pue paluasazd aq pinoo tioitlnn maalt?ut Butppt palsa ins utnnpleg •sj, •aun situ suoiltppe oI�I
2IVQI�I�'IVa OMININV'Id VQN 19V
Eroz Mgr hjnl •
201.1.01sM,aj\C JIM,}6dJ1
SDJ\CIACIddY3-Whyvvajc
•
I ` it,r# bpuaBr
s1.ua�I119uol.1bui2ofiul
2s) ssauisng pi p
yliba}c fo pAbo$
1
ih.2ols Anoh BulAvys ,cof Ajjoyv5 sjuvyi,
. •` .Q..411 siq of Iz�;s 4saiipreaq aT��uos J110 anT
01.QUI 2uuamodma ro3 pue`sap;oq pue s4aed dumd asogl rre 2uTgstm ro3
"" `sumop pue sdn am jp g norgl am 1.roddns 2uidpq ro3 `rauuEd uuuar-ed
c
a,nr-3 put putgsnq Am`33ppy\j�juugp (N.anrq 1 •pJTga panopq Stu q�Tm ssau
-asop ui�js-o�-uT�is jo raadega lum sop mpes sem am jo;red ra&Tq E lug
`- `palPaxa sum am Jo 3.3ed`2uuaaga slaaxas am.gri2nop paauep aneq pjnom
I`aygJo sq�uoum ZZ 3u palaurrunjd Ajjernleu Aiddns�ijiur siipoq Am uagm
.0,,...k...„....,, Tem�jungpr
nom nom nox •sAup�irom Asnq Am olui Aiaut nor&unduznd azaanbs
o�paau am pub •saT rasp s xej, 3o asnzaaq lay Am ur Sos puu A.TTep
,s, �'� `" ' do aAT2 m paau ag-4 puv •31.121urano spaa3 rnoq Z-r Arana aqp aram araip
uaq 1, •s3pag3 q Tam puu uoueijnsuoa uor paej ro3 relydsoq am ol.1.133o3 put
ppuq sdixn ajdtjnum pine 2uidumd`uonleivamajddns T:rnuuo3 `apipunef`ssoi
30Tam l.0 puTTT2TS g1Tm 1aum aram a3Ti siq 3o sNaam om11snT3 DLL", •a3Ti Amm
UT auop aneq I s2uup 2uTpxemar;sour atp 3o auo sT;Ham ss anisualui-rogej
•0016-58£2U111eD Act puT;.2uT2uarrega ISoM am 3oauo gloq uaaq gut'`xtj, `uos Stu 2uTpaa3lsearg
DIA&uT ijorug
sreua i m 2g uoTTeanpa
ii(ao;S sse3)ns buipeej;soaig sao;god loDo1 d
:maTnar 2umpaa34sBarg•
spoo,j DIA\puouippy• no$em•uTnq•mmm:Te mer slip Tnoge aroiu ure
-j
spaau aram w,b-s
s3Tns leg-4 duind;searg• 1ST Z'090 PT0E0.09.01011)'pm]) lik
Aid 004 ,7""
aqa aaAOo as`u,00rasar am co aJ`aeeaj co ragaam a nal uea 1� „ads d„owvu,i>
saaAo1duua ao sratuw ssaursuq Surpnpm`auo off saved I N J I d
:anTaJar ro 'sassnq `sauergg `smusnm `sSurppnq ]u aims no�S
ueaa orua
�Il�C1 uT P II 'saa]eay] `s1aod `nuernEasar se aims saae�d nignd in 1 33tlf.LL
s3al.poul 8uTPas33sea3g u�rwa rau]paajasearq area pue'earl uopeurunras *,nre
meas aopun pa])aaord are sragaom SurpaaT,sbarg:6OOZ .0
•2uTpaa3Tsea3q ” 1, _ .)
•LTT auTerl ST t;S 10T0'8976'Dt'i4�J9)'rnsadXa
"'TSP 33 DI/X1. ]uavpn,puapisuo,IOU SI,Rgnd car Suceagasearg 100Z •"( :+.
paallseaa9 O.11461:1 s,ueuaoM a ,�.'
6ulpaaf;Saaa9 Paload sMe1 a�.e}S u03.6uNseM . , ;,- •`
, i� Igounl umo -Y'
s;aoddn -,,: rno Suly9.,.' ' ,.S SIM IaW19 la ;
juopE.ijajaa aip Ilio!purr qunj le 2uu )133M 9NI433d1SV3i18 alIOM
•00:I Je 2utms)JJEcl U OUIez1ag3 3z DTUDTc1 4,1.4 0;0
0
0
2uipaajlsearg p nuu j uuagi&uuosuods sr mjeaH y 4
oggncl klunop uosra33ar•„sragpoJA of asap 1 ••• )
--roddns 2uTpaa33searg„ Si Irak sup auiaq� t, i'
a4L'L-I lsn.2n\ST 31aa jA 2uTpaa33sea3g PirOlk� a°te„, '1. y
S°NIag1-3
CLO? ' I. Alar i4}L ;snbny si 'iu"!d buipaaf;soe.iinnuud
w w
_
•IM�s,S uoy9wyseM {`�
I #
._,_ 1 41111011111k♦ puasuMo1 POW is000pua±� .4.
`- I a4; H11b3H` :fld AiNnO) NOS
' . ' "� ii1• " - "6' `' is 4 y..- '` :1
ilk
•r
, _ DIM LIIIDOH p!lgnd k4unoj uos,ial j -
ar'
,,
. .ntt. .�. .5 � dd ' XII4IOOH
A1!!!gos!p JO'aQo'XaS'UIQUO!DUOI,LDU JO!OO'93OJ JO sisoq a41 UO QUL OUIUJUJSIp aa.a a 19831'A�s\M
NL1V3H )Il8Ad
waif a! I olds!uo!n!su!s! �/
!P {q.4 { j 1 44'�JI!Od aJ11�1l1011Qb'JO jUaw#JDC3aQ'S'(j pun MDQ!DJapaj 4�IM aOUDrJJOJOD Li/ i
step Jad sualol eJlxa
Z uw)i ilaiJew ayl le 54
96917$ 9 c. - 193 0!O l$lsea!Ie puads
0 9Z6E$ jla)jzeuz alp le jAH ur O1S In Oil aw!Ttiana ua�!Ol
lseaT Ie puads noA uaq s$eJlxa ue la6 pud
�5++[5��Z++£77$ £7 ua�jol S eJlxa ue Ian osis' 400 e lxalue "'
989Z$ Z - NI!M I!y)lew11,IM am
91.61$ I jUa3TOl la)!Jew SJaulJe}ayi le Jag3nOn
Y dNINJ Jo!uas Jo Dim P
plogesnoy tIlxa ue rtlTm lT HDIVL\I n no,(aw!I noA,CJanl mioe+aa��
ui a�doed # ._,. �a��,n,
, • I[Tm la}jJeuT szauJJe3 NM ti>„�� t.14/ �ivaS���
aLUOoUl jO # • "ri ; . oil, la)jJeuT SJauzJe3 aqr le •
i \ Ja anon JOTTJ3 JO i)OI A wawa ao;poo;
I '� . q dl�Id Sseam Amway pule ysa.a;
/2zouT[eac{alddEScummm�/:sd71q w _ �I�e aSn noA aLLTTI izan� o1w,nn1nn11111 J
SON-SQI)I-LL8-I u .r ilaH amo)Pfil AMU
aaz31T01I[tD Y\IdZ—NV6
_•� iaxaV1
No szea,i xrp,n i IMMO. 'r
g1LZ,ijn f AuPanies �'
61 zapun spuj zo3 aDueznsUT j �W1� 1 yR'n puasumoy lion Sg��g�1
IeQg IsoO mot zo'Amu i s, lno iOILISo)IMf
me 'o._. jr` \ uani aq!Eat waiianoA
1121‘1911 Giddy j40110W siewiod puesunnoj 4 ' °d 4 ° 4}LL Alnr
ino ueniE saaypno^ 40)a13W siewiod DIM
8Jo•eawAAlunoauosJa}}af•MMM HIS-6L£-09E A TT8S-58£091 d
• s "r '! 89E86 bM'puasuMol iJod LE9T X08'0'd
VD WA AlNf1O3 NOS2133j31
;:., JaAoidwa pue JepinoJd AI!unlJoddo ienba ue si vaSfl al-11
i A111I9ISNOdS321WOOS 210d
plo sJeaA gT-I sat(
suazad,izoD— juaamlaq UT 2uTTjlkT A put
9NIA1l AH11V3H WADJEZ lsn8ny-Lila auntsua4aj
sags?p ureal o1 shams uzoz3 `0U0AJana zo3 uTTT4 UJoS sr azagt,I, oiN3Wd013A30 H111OA 210J isuousanb yl!M uJWA aq4 peluo0
juoTleudsur ua434T3j 3o slot zo3 uJoo•alselaTllsTTtsaJ3•mmm 1ISTA '00:E le Naeus'a!igowloo e
I}eJj 78 -'v'Al!nuDe ieDisAyd'gDuni uooN'Jaluaj Aliunwwoj sAepsanl:auaa!m
'sum-Ivan Am aJtTgs 01 anot I •spoo3 TIsaJ3 `ATtlteaq
Iea o1 sa e azrdsuT dpq o1 ode Jea i to iuJ aleaJa -(33213—dn u8)s lsnwl zI-S sae Jo}wejBo,d AaeJal!i uieJq JnoA paa j
3 t qIq P I :pun!uooN)8 iiaeuS 00:01 punoJ Ae!d AJewud)iaaJO wnaewND'd-1N:wn3ew!qD
S T.WaA JO slot put sluarpazur 4saJj asn of 3122fJls noA oQ •>peuS 00:£'8 yDuni uooN`suowwo0 May\u!eluno!ni'3 W:Id
tJauurp Jo3 x13 or rutim aproap of pal lT pug noA oQ
s AUNT`9 307'8.(zegDe7`£uusny:luoa3 Azo,`uopuE -p :0,18u oI 7331)°load j euaD)InO pub W nDewND 'puasuMol IJOd U! suopeDo1
•wayl
',.. asinJadns lsnw lnq s8ui!q!s JagunoA pm awoo new s8uiiq!s Japip•JaSunoA pue
I` — ,; sJeaA 0T uaJpi!yp AuedwoDDe lsnw sue!pJen8/sluaJed•Aep ayl Jo}aq'um Alingoe
., eqI leyM lno pug of flet suaal Japio Jo uaJpiiya Ja2unoA Jo}aigel!ns aq sAeMie
, � ,n lou •
4g21w'awn AJols Jo sen pue slae'slmods apnioui ly8!w yD!gM(Al!i!gei!ene Jaal
J _ -.` -union uo paseq)sau!ngoe ag4'8T-T spp !ie Joj papinoJd aq Him iiDeus e pue gDuni
4 •)iaeus pue yDuni awl sno!Diiap a pue sauin!he un}Jo}sAepiaaM sn u!of'81-T
`= ' 'tI _..., sa8e glnoA Jo}paJa}}o weiBold snou!Jlnu pue un}e si weJBoJd!eafnl JawwnS al-11
! 1 - • sae.-
r •;3= wea2oJd wow iauauans a
sit'fiqu,tr, poo °s,1,42e, '. :1J '
else! a Lo Si qsa.ij AH111/3H 38
rstlA
��IM-ON�°1 �� `NflJ 3AVH
Eroz `gr hjnr
oo,tluoJ yl.pg .1oj
•
z "Arr # uian- vpuaBy'
stiva.uibuoilvut.wfuj
2g• ssauisngpjp
fo plbog
•
cd 74 cd ai fd cd Cd fd Cd aS
xO xO xO xO xO O x0 ZO SO .: O
" O O 2 O 2 O O 2 O 2 O 2 0 0 0
55 71" 75 71" � 71 .nom .off .o ff ,5 71- 55 71"
a � Q. ac � c ac ac a � a � e., C:3; �. � 0
o � o V1 6 i o � or d r o � o � o � o �
U pp U pp U pp U pp U pp U pp U pp U pp U pp U pp
= M = M = M = M = M o M a M z M a Mo1 o o o , o , o , o o ,
oM
O ; O ; O o O ; O ; O ; Ot O O
°' °'M ,°>) M .g M ti M , M � M "
M ti M �°4 M �; M
a e H ene osie 9 ueid dM puasumoi uod ueppags S i g (-- 1-7.')
1431u0H°Mind Xlunop uoszano f 11 IMI;178Ad
'nog( JOJ. s iJonn 4egl 00176-S8E : luawluioddE uE Joj HED
poylaw aql pui3 .sapuEu2aJd .anon( Jo; ueld of
.noA o; lsoo ou J elm le aigEi!EnE uopew.mOu! 'g sa!iddns
se!Iddns pue seovuas ` ool/ .los anildaDEJluoD
iwanoad oN irpuap Juo> >g pup, `2u!.a1D
,,i euow gonna ION c,eoueansu! oN
6uiuueld d
41 i
_` -.
� no .y
.paa ,Soopu°a d�t� H1
010 ,QT,,ez�
81
td v„4u°o u jg 0
, A ......
4,, ._, , ....k
III
= c
m
ioJ ; uoo qP ! e ;o •
£roz `gr hjnr
uo?lbui.tojuj Proz
aigvy.toffy •
E # ivan- bpuaBy*
sutauibuoiibuLtojul
2s4 ssau?sng pj p
yliba}c Jo p,tbog
1
£LOZ•9L AeW
•auaoDu! plogasnoy}o S•Z
}
o1 dn JO s80`Z$ aq II!M Alleuad ayi 'sa!l!We} a03 •9i0Z Aq 'auaoou! }o luailad S•Z Ao 'S69$ • •
o�
asp pue `auaoou! jo luapAad dn .io 'AeaA e S6$ 1aeII!M Alleuad ayp 'slenp!nlpu!
Ao3
'au!} e Aed JO aJueansu! gpleaq aseqpand anal lllM aidoad lsow 'IyZOZ u! 2u!uu!2a8
ii(aolopuDW aq Him aouDinsul
•apueansu! quaaed anon( uo u!ewaJ uopdo
ay; anal Mou noA 'apueansu! iajjo Lusaop aaAoldwa ano% pue 9Z-6Z jo sae aqp uaaiwaq ale noA }I •
•ldd }o%00ti dn sa!l!uae}Jo}
swn!waad aa}2u!pqs JO aa-}ao} (p!eD!paljl) splN Ao} gpleaH alddy saa}}o ales aqp'plo saeaA gl-0 sp!1 ao3 •
•suaniwaad paz!p!sgns q;!M padolanap aq II!M food )Isu-qpq e 'suop!puop 2ups!xa-aad qp!M aidoad ao3 •
•a2ue143 IIlM LonW 2u!gpou A!ayf Aq paansu! ApuaJAnD aldoad Ao3 •
:suoq.do GADO UThpau JeuRo
•V ao•Aapuilueldq}leageM•MMM aJOW weal
•ueld e u! 2u!lloaua aDuels!sse leuop!ppe paau oqM asoyp Ao} uosaad u! JO auoqd aqp aan) paiajjo aq II!^^
dlaH •p!ep!palN ao} Amq0la A!ay; au!wJalap JO swn!waad apueansu! Alatp uo s2u!nes ssai a 'sueld apueansu!
qpleaq u! Iloaua pue aaedwoo awls uo;8ulgseM u! (saaAoldwa OS o; dn) sassau!snq news pue sa!l!we}
'slenp!nlpu! Ao} apeldla)jJew auHuo Mau a aq 'um aapu!}ueldypleaH uoVulyseM `EZOZ `� AagoPp 2u!}Ae}s •
:1J0M WM T! MOH
sdn >pap ssaullaM pue an!}uanaJd • luaw eap asnqe apuelsgns pue gpleag leluail •
sap!naas angemgegaa • aJeD A}!uaa}e!Al •
saa!naas Aameaogel • aaeD leD!paw Aauaalaw3 •
suogdp3saJd • sluaw u!odde s,aopop •
:aanoM mom sueld q;!eaH pa!}!lenb pue p!e3!paLl
•lanai Alaanod leaapa3 noA pug abed >peg uo Imp aas •a2eJanoD
aaea q;leaq ;so3-Mo1 Ao} aq Aew Alianod leaapa} }o %00t, 01 dn sawoou! ql!M aldoad lalq!�!la
nlMau aq ;gw!ua noA 'aiojaq p!e�!palJl paluap aaaM noA }! u0n (ld 1) lanai A;aanod leaapa} aq; jo %8E1
Molaq JO sawoDu! qp!M suazgp o; algellene aq Him 'awls uoVulgseM g2noJyI apueansu! aaij 'p!e3!paW
:fl J) Jol suoaW siul puM
•Mel amp q;leaq Mau aq;g2noiq;aaueansw q;leaq algepio}}e ao}alq!2!la aq Aew noA'tircZ}o Aaenuer u!Su!uu!Sag
�JoMp4 Imu3H
jeuol a11 b OZ :aSeueno) 4pleaH algppaojJv •
DIOHD
JO'U11.0@0JUI I WJO'UgJJ'MMM
179Li'£176'09£'1 l 9LSL'6£S'09£'d
90S86 VM'e!dwAlO'OOZ a;lns'•3 any 44Jnoj LIZI
vOM;aN 42IeaH leuo0aa 33IOH3
uooepunoj Apwej Jasley pue'a2ueyox3 1gauag y;leaH ams uo42wyseM'A;IJoy;ny aJeO y;leaH awls uoa2u!yseM ay;woo pajaype2 uowewJo;ul
•
'paJanOJ'aJedWO� a2ueyax3;!;auag 411eaH a4;41!m d!4sJauped u!�IJOM;aN 431eaH leuol2ab 30IOHJ Aq padolanaa
aapugueidy�eay i Jo•Japu!�ueldq�leageM MMM oi 06 'uoi�auJaolui aaow aoj
UMBUTusPMn iN C
!Aqmeaq lag pue sl!s!n ssaullaM a2eaanoa nnau anoA asn •
•A;Ieuad e Aed o;aneq !!!nn noA'rroz 2u!Jnp a2eaanoa q;leaq mu! !!oaua Luop noA}! •
1.3afa win II!^^aeaano3 nnau anoA'tii 'est Aaenuer up •
•a2eaanoa qmeaq ow! lloaua pue Awgp!!a inoA aas o}pap uea noA'Jagopp0 u! •
:aagwewai of sluiod AGN
A Is o awoDu!;o awoau!;o%SO.8 aSeJanoj aaJ3
p gns N swop pun suogdo a3ununsui a,goo ony
%S'6-50131SOD swn!waJd —E Isoa swn!waJd —aIq! I3 p!eD!paw
+06T'17ZT$ 088'EZT$—SEL'LL$ SZ17'LL$-8170'E17$ SSal JO 6EL'Z17$ awinul lenuuy 9
+OTE'80T$ Ob0'801$—S6L`L9$ SZS`L9$-1717S`LE$ ssal JO 17LZ`LE$ WODUI lenuuy S
+TE17`Z6$ 00Z'Z6$-9S8`LS$ SZ9'LS$—OVO'ZE$ ssal JO 608'TE$ awooul lenuuy
+ISS'9L$ 09E'9L$-916`L17$ SZL`L17$—SES'9Z$ ssal JO bbE`9Z$ awoaul lenuuy £
+TL9'09$ OZS'09$-9L6'LE$ SZ8'LE$—TEO`TZ$ ssal Jo 6L8'0Z$ awoDul lenuuy z
S +16L'1717$ 0891717$-9E0'8Z$ SZ6'LZ$-9ZS'ST$ SSal JO STt'ST$ awoDul lenuuy
Ja4814 JO%T017 %0017-%TSZ %OS?-%6ET Moa JO aZ!S
moiaq %8ET a;ea auao�ul
ploLasnoH
MOJ wonoq a4.uo suolldo eqo Joj a!q!8!!a aq Aew noA'sSulpu!J inoA uo paseg aql
u14f1M aSue.awoJul inoA pulj pue uo asnoq inoA u1 Sum aldoad to Jagwnu egl2u!pu!J Aq 1dH JnoA ale!n3!eD
E LOZ—Z
1.06 Iana1 A4JGAOd Ipaapad
•Ameuad
xe} eq� woJj ldwaxa aq II!M pue 'aJea!palN Jo p!ea!pa!N Joj alq!2!Ia aq fou II!M 'a8ueg3xa Onomqp
a3ueansu! aseg3Jnd paMolle aq }ou II!M Aagl •a8eaano3 leaapai ou anal HIM s2ueJ8!ww! paluawn3opun •
•swn!waad aaueJnsu!
J!aq� uo s8u!nes J04 aIqpIa aq II!M pue Japu!JueldglleaH uol2u!gseM Onomqn ueld glleaH pa!J!IenO
e asegDJnd Aew slueAww! luasaad AIIn4Mel 'JanannoH •poimad 8un!eM aaow-Jo-JeaA-an!} aq} Sulpnpu!
'p!ea!pa!N u! suo!p!JlsaJ Amq!2!la lueAww! leJapaj luammn3 Aq aplge lsnw slueAww! le2ai •
•suaz!}!3 Sn se sl!4auaq awes aq1 J04 alqAla aq II!M suazn!a paz!IeanleN •
,uez141p D IOU IUD I 1! 4a4M
�jJOM ON g3j1 =
• I1 UO! O I 17 I.OZ :ageiano) algepioily
DIOHD
Eroz `gr hjnr
sivtal\C saomosay
intnlb.AGpul 1504
•
t ` Art # wan- b_puaBy'
su�a�Ijbuoilbui..tofuj
2s) ssauisn$yip
y_vbaJC fo p.tbog
•
0
Board of aCeaCtFt
Old Business &
Informational Items
,agenda Item # IV., 5
• Syringe Exchange Program
Judy is, 2013
•
sols JEFFERSON COUNTY PUBLIC HEALTH
'= 615 Sheridan Street • Port Townsend •Washington • 98368
9sNr N6't
• www.jeffersoncountypublichealth.org
Jefferson County Syringe Exchange Program (SEP)
Annual Report 2012
Jefferson County has provided a Syringe Exchange Program (SEP) since 2000 as part of a
state and regional effort to reduce the risk of HIV infection in our communities. This program,
also, reduces the risk of Hepatitis A, B and C infections through risk reduction education and
referrals, an important part of each visit. Education includes verbal and printed information on
hepatitis, HIV, STDs, health alerts (for example, wound botulism and recent heroin
overdoses/deaths), care of abscesses, street drugs, tattoo safety, intravenous drug use safety
(encouraging one time use of needles), and immunizations. Internal referrals include STD, HIV,
Hepatitis B & C screening and counseling, tuberculosis screening, family planning and
immunizations. External referrals include drug and alcohol treatment, medical care, mental
health care, domestic violence, food, clothing and shelter.
HIV services have been funded in the past by the state and federal government and HIV case
management services have been provided by Clallam County Health Department in recent
years. CDC guidelines focus on funding HIV Prevention Programs for high risk populations
based on HIV prevalence in the local area. Jefferson County is classified as a low prevalence
. county; thereby, not qualifying for federal funding. There was no state funding available for 2012
and there is none for 2013.
The syringe exchange program success is not easily measured in disease prevention numbers
but the number of clients seen and syringes exchanged reflects the disease transmission
prevention capacity of this program. SEP continues to be well utilized with 142 visits in 2011
and 150 visits in 2012. The number of syringes dispensed in 2012 was 17,405, down very
slightly from 17,726 in 2011. The number of IDU prevention materials dispensed increased from
11,024 to 11,535. See tables and graphs on following pages.
In 2012, the State Public Health Lab provided a limited number of free HIV tests for high risk
clients and will continue to do so in 2013. Though there is no state funding for staff time for HIV
counseling and testing services, JCPH staff will continue to provide this service for low income
high risk clients with no medical coverage. Others requesting testing will be tested through the
Quest lab and the cost of the testing will be billed to the client/insurance.
Funding for the state and federal programs for free Hepatitis C testing and free Hepatitis A & B
vaccine for high risk clients ended in 2012. For 2013, we have seven Hepatitis C test kits
remaining and vaccine for eight clients.
41)
COMMUNITY HEALTH ENVIRONMENTAL HEALTH
DEVELOPMENTAL DISABILITIES PUBLIC 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
Syringe Exchange Utilization, 2000-2012
Jefferson County Washington •
160 — - 35,000
=Number of client visits 150 '
142
140 — t Number of syringes
N exchanged 30,000
a)
-8 120 — m
c a)
w 24,585 - 25,000 W
I; r
w 100 —
x
21,133 w
3 18,060 17,905 81 17,726 20,000
•E 80 — _
n .L
c —63 64 65 70 5 I I 17,405 15,000
L 60 — 13,716 14,044 0
dJ'9,156
L
d
E c 41 II
10,000 E
z 40 9,222 36 z
20 — 14 16 0 4,206 - 5,000
Q5061Ill2,076 I I
-
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 •
Jefferson County SEP Clinics/Demographics
Clinics Clinics Drop-In New Returning
Offered Visits' Visits' Clients Client
Visits'
2012 98 40 110 18 132
2011 100 22 120 19 123
2010 103 6 75 13 68
2009 102 4 61 12 53
2008 99 6 64 6 64
2007 97 4 61 9 56
2006 126 u/k 542 8 50
2005 119 u/k 352 6 30
2004 136 u/k 522 12 48
2003 119 u/k 582 9 55
2002 108 u/k 332 11 29
2001 98 u/k 142 6 9
2000 33 u/k 132 3 7
Note:
'Represents duplicate clients •
2Clinic and drop-in visit
2012 SEP Clinic Participant Visits 2011 SEP Clinic Participant
• by Zip Code Visits by Zip Code
5% 1% 11% 1%
0
098368 ■98368
34% ■Other within ■Other within
Jefferson Cty Jefferson Cty
°Outside Jefferson
°Outside 29%o 59% Cty
60% Jefferson Cty ,I o Unknown
0 Unknown
2012 SEP Clinic Participant 2011 SEP Clinic Participant
Syringe Use Syringe Use
2% 22% 3% 26% ■Each syringe
°Each syringe used once
used once
III
12% \ , _ ,..„...
$ ■Each syringe
■Each syringe used 2-5 times
used 2-5 times
22% r' ' °Each syringe
°Each syringe �� ' '° used 6+times
64% used 6+times
°Unknown
°Unknown
2012 SEP Clinic Participant 2011 SEP Clinic Participant
Secondary Exchange Secondary Exchange
4% 5%
.', ■No secondary .No secondary
exchange 22% Ax exchange
}!-.44401.41, ■Exchan in for
1 ', ■Exchanging for9 9
49% ; one other person . one other person
.', °Exchan in for2-5 � QExchangingfor 2-5
other p ople38% other people
°Exchanging for 6+ 0Exchanging for 6+
other people other people
410 •Unknown •Unknown
9%
A
Materials Distributed by Jefferson County SEP
Syringes IDU Prevention Condoms/ HIV Educational Referral Outreach III
Exchanged Prevention Kits2 Latex Tests Materials4 Informations Educations
Materials' Barriers' Offered
2012 17,405 11,535 1 406 49 28 128 90
2011 17,726 16,512 1 319 41 10 142 86
2010 9,156 11,024 4 102 36 7 67 29
2009 14,044 7,098 6 271 31 26 51 33
2008 21,330 7,941 0 140 27 32 35 32
2007 24,585 9,988 0 20 22 18 23 N/R6
2006 17,905 9,000 0 0 2 3 2 N/R
2005 13,716 7,611 0 20 0 6 11 N/R
2004 18,060 7,265 6 228 N/0' 48 11 N/R
2003 9,222 1424 38 800 N/O 42 18 N/R
2002 4,206 1,026 35 427 N/O 50 NA N/R
2001 2,076 3 9 14 N/O 9 5 N/R
2000 506 11 15 33 N/O 10 2 N/R
Notes
IDU Prevention Materials include:Tourniquets,cookers,cottons,sterile water,sharps containers, alcohol preps,antibiotic
ointment, band aids and sterile pads for wounds,tape, hygiene items(toothbrush,soap,comb, and razor). Individual items are given
on an as needed basis.
2 Prevention Kits include:sample quantity of tourniquets,cookers,cottons,sterile water,sharps containers, alcohol preps,antibiotic
ointment, band aids, hygiene items(toothbrush,soap,comb, and razor)
'This number is for condoms dispensed in SEP only and does not account for the number of condoms SEP clients pick up in the
lobby where there is a free supply available.
4 Educational Materials include information on hepatitis, HIV,STDs, health alerts(ex.wound botulism),care of abscesses,street
drugs,tattoo safety,needle reuse, IDU safety,domestic violence, immunizations
5Referrals: Internal referrals include STD, HIV and Hepatitis B&C screening and counseling,tuberculosis screening,family
planning and immunizations. External referrals include drug treatment,medical care,mental health care,domestic violence,food,
clothing and shelter.
6Outreach education is defined as face-to-face education on safe injecting practices,vein care,blood borne pathogens, risk
III
reduction methods,and other as needed
7N/O: Not offered
8N/R: Not reported
2013 Goals
• Continue anonymous, safe services to reduce the risk of HIV infection in our communities by
promoting revisits by clients and to encourage clients to tell their friends and contacts about SEP.
• Continue dialog with clients regarding improvement of SEP services.
• Continue to explore options to start a program for overdose prevention and naloxone distribution.
• Continue to inform clients at each visit of resources available at JCPH and in the community.
• Continue to offer free HIV testing and counseling at each visit through the state laboratory for low
income high risk clients without medical coverage.
• Continue to offer free Hepatitis C testing and counseling and Hepatitis A& B vaccine at each visit
while supplies last.
• Offer free Tdap (tetanus, diphtheria and pertussis) vaccine through the G.I.F.T. or state
programs.
• Provide each new client with a prevention kit, condoms, educational materials and referral
information.
• Continue to educate clients on the importance and rational of using each syringe one time only.
• Prioritize supplies to be stocked, keeping only those deemed necessary to maintain safe
practices among IDU clients. Inform clients of alternative safe materials, such as using pop/soda
bottles for the collection of used needles in lieu of sharps containers.
Data Source:Jefferson County Public Health SEP Intake Records i
Prepared by Carol Burwell, PHN,Jefferson County Public Health 01/31/13
•
Board of Health
0 C Business &
Informationalltems
Agenda Item # XV., 6
•
_Leg isCative Wrap-up
July 18, 2013
Cathy Avery
Object: FW: WSAC Legislative Bulletin -2013 Budget Overview
To: Jean Baldwin
Subject: WSAC Legislative Bulletin - 2013 Budget Overview
. as in .. tOf State
1111 Association of Counties
LEGISLATIVE B
IN THIS ISSUE
: : .sem .. .. ..s g. ..
Health and Human By signing the budget at 4:00 PM yesterday the Governor narrowly
Services avoiding a planned government shutdown had the new spending plan
• Public Safety not been in place by the end of the weekend. This is the latest date a
budget has been signed in more than 20 years.
Land Use, Natural
Resources, The House and Senate were able to agree upon a $33.6 billion spending
Environment and plan, in large part due to the $320 million is additional resources that
Timber resulted from the June forecast, thereby alleviating the need for either
significant revenue enhancements or cuts. The main philosophical
Transportation divide had been revenue, with the House and the Governor each initially
proposing nearly $1 billion in additional revenue, while the Senate had
QUICK LINKS initially proposed cuts.
WSAC Website
The final compromise budget closes the remaining gap by utilizing nearly
National Association $500 million of transfers, $277 million of which comes from a one-time
of Counties (NACo) shift from the public works assistance account. It also includes $259
WA State Legislature million in revenue enhancements, most which result from changes in
estate and phone taxes.
The Olympian
The budget adds over$1 billion to the State's education system while
WSACE providing enough money to universities that tuition would remain at
WSALPHO current levels.
SIGN UP The budget also contains several policy changes that result in savings,
• lir ALL loin our including:
Mailing List
1
• $30 million from the implementation of lean management
practices;
•
• $320 million by suspending cost of living increases for school
employees;
• $351 million through federal Medicaid expansion;
• $7.7 million from delaying the opening of a medium security
prison unit.
Shared Revenues
WSAC staff is very pleased with how the Legislature listened to our
message on shared revenue. The proposed budget maintains or
enhances the status quo with regard to county shared revenue; restoring
50 percent of the liquor excise tax revenue that was eliminated last year.
Last year's 3.4 percent reductions to municipal criminal justice
assistance, streamlined sales tax mitigation, and distressed city-county
assistance funding are restored as well.
• F
fv-S
Health
Happily, the foundational state funding that comes to counties (local health jurisdictions) to support
local public health activities has been maintained at its current level. Traditionally, these funds have •
come from three disparate sources, those being the Motor Vehicle Excise Tax (MVET) Backfill, Blue
Ribbon Commission/5930 funds and Local Community Development Funds, and have been passed
through the Department of Health. The newly adopted operating budget collapses these three
disparate fund sources into a single fund source, creates the County Public Health Assistance
Account, and distributes the funds directly to each local health jurisdiction via the State Treasurer's
Office. Everylocal health jurisdiction must report to the Legislature each November on how the
funds were spent and health outcomes achieved.
This shift in funding mechanics is positive for two primary reasons:
1. This mechanism provides for the maximum amount of flexibility for use of these funds at the
local level, giving each local health jurisdiction the freedom to respond to the unique public
health needs of its community.
2. By reporting directly to the Legislature, a relationship is institutionalized between
local governmental public health and the Legislature. This annual reporting will go a long
way in helping bridge the education gap between locals and the State. It will provide better
understanding about the critical work performed by governmental public health at the local
level and the impact the State's investment is having on this important work.
Generally, the majority of other health programs remain intact(i.e. Adult Dental, HIV funding, etc.)
with the notable exception being the Tobacco Quitline which is eliminated from the DOH's budget.
For information on this budgets impact on environmental public health see the Natural Resources,
Land Use, Environment and Timber below.
•
Human Services
2
f
Although we continue to be concerned about numeric assumptions the state is using to calculate the
level of savings through the expansion of Medicaid, the final budget continues to fund county Mental
• Health, Chemical Dependency and Developmental Disabilities programs at their current levels.
Thankfully, the proposed 20 percent cut to our county chemical dependency grant was not included
in the final budget. Several policy bills that were passed will impact our county programs and will
require significant stakeholder work as they are implemented.
The most notable policy changes are:
• Funding is provided for out-of-home community residential placements for 51 individuals with
developmental disabilities who are moving out of other state residential settings such as
foster care, mental health institutions,juvenile rehabilitation and the Department of
Corrections
• The Department of Social and Health Services (DSHS) will create and operate a community
crisis stabilization home for children and a mobile treatment team that will operate statewide,
with the goal of reducing the number of institutional placements
• Two new State Operated Living Alternative Homes will open for youth with developmental
disabilities
• DSHS will increase Medicaid waiver slots for 734 individuals with developmental disabilities,
aimed specifically at high school students who are not currently on a waiver but are eligible
for Medicaid personal care services
• 15 new certified mental health agencies will be licensed to provide Applied Behavioral
Analysis therapy for children who are members of the Apple Health Kid's program and under
20 years old
• • The Department of Health will create a 60 day provisional license for Designated Mental
Health Professionals who have been hired and have passed an initial background check.
This will allow them to start treating patients while their final paperwork is being processed,
allowing us to reach those in crisis sooner
• Implementation of the Involuntary Treatment Act will now take place by July 2014. Regional
Support Networks will begin enhancing community services in order to meet the increased
need
• Enhanced service facilities will be created to move patients out of state hospitals and into
community facilities equipped to care for those who are medically challenged or do not
respond to inpatient treatment
• By July 2014, DSHS is required to convert 128 beds in Institutions for Mental Disease
(IMD's) to facilities with less than 16 beds in order to be eligible Medicaid match. $2.6 million
is provided in state funds to help with the conversion
The two biggest issues addressed in the budget pertaining to public safety are impacts of the DUI
legislation and contracts for additional jail space. SB 5912, pertaining to DUI, requires repeat
offenders to be held in jail until they can be brought before a judge, so that conditions of release can
be put in place. Funding is provided to counties to offset the jail impacts and to provide additional
resources for prosecutors statewide.
The budget also contains opportunities to contract for additional beds with the Department of
Corrections (DOC). The DOC is required to send out a request for proposal to counties; WSAC will
3
help coordinate this effort.
Other notable policies supported by the budget:
•
• SB 5892 shifts offenders from state prisons to local jails. When fully implemented this
results in a cost to locals of nearly$2.4 million per year or almost$5 million for a biennium
• Continuation of cost sharing for law enforcement training. Locals are responsible for 25
percent of the cost to train new officers
• Continuation of the temporary additional court fees that the state shares with locals until
2017
• Expansion of the parents representation program to include Asotin, Columbia, Garfield, King,
Whatcom and Whitman counties beginning 2014
• $11 million to the Administrative Office of the Courts to continue moving forward with the
Judicial Information System case management system
• Funding for the rural drug taskforces is eliminated effective July 1, 2013
• 25 percent reduction to the local share of Legal Financial Obligation collections
• Shifts $10.8 million of un-allotted funds from the Enhanced 911 Account for the 2013-15
biennium
Operating Budget
Department of Commerce
• No appropriation for GMA update Grants. Focus GMA technical assistance on small
counties/cities •
• $5.8 million for Associate Development Organizations (ADO)
Department of Ecology
• $500,000 to process 500 water right permits (2015)
• Wastewater discharge permits increase up to 4.55% in 2014 and up to 4.63% in 2015
Conservation Commission
• $300,000 in 2014 and $246,000 to implement Voluntary Stewardship Program (VSP) in
Thurston and Chelan counties. Also, $1 Million is set aside as to be used statewide only if
federal funds are received for the program
Department of Fish and Wildlife
• $1.1 million for Payment in Lieu of Taxes (PILT) and Noxious Weed assessment for game
lands
• A proviso that required Fish and Wildlife to assess a revised payment methodology for PILT
was vetoed by the Governor. In the Governor's veto letter he directs Department of
Revenue, Department of Fish and Wildlife and the Office of Financial Management to
examine the current PILT methodologies and come up with recommendations by December
1, 2013
• $1 million to promote and engage non-lethal deterrence methods related to wolf and
livestock interaction
• More wildlife conflict specialist positions authorized for Okanogan, Chelan, Whatcom and
Skagit counties
Department of Natural Resources
• $11.8 million for Forest and Fish program
• $3.7 million for the Marine Resources Stewardship Trust Account
Miscellaneous
4
• $61.9 million in Timber Tax distributions
• $25.9 million in Liquor Excise tax
• $49.3 million in Streamlined Sales Tax mitigation
Capital Budget
Department of Commerce
• $1.5 million for Brownfield redevelopment
Department of Ecology
. $180 million for Stormwater including $80 million for grants, $15 million for Phase I and
Phase II NPDES permit holders (from the new Environmental Legacy Stewardship Account)
• $14 million in competitive grants for retro fit and LID
• $98 million for local toxic cleanups and $200 million in remedial action grants
Department of Natural Resources
. $1.5 million Encumbered State Transfer Land program for Skamania, Pacific and
Wahkiakum counties
mss . `
The state transportation budget, without new revenue, was adopted earlier during the regular
session. While new revenue didn't pass, counties will receive two more years of additional funding
($5 million per year) for county arterial preservation. These funds were promised to counties out of
increased fees adopted in 2012 with no commitment beyond the 2013-15 biennium, unless new
revenue was adopted.
The House's transportation revenue bill (HB 1954) did not get a hearing or consideration by the
• Senate, and so is dead for now. It is questionable what will be up for consideration when the
Legislature is back in session in six months. Eyes will be on the Senate Majority Coalition Caucus to
see if they will support a transportation revenue proposal in 2014.
In addition to the state operating budget, the state capital budget(SB 5035) was passed on the last
day of the special session. The capital budget was stripped of revenues and projects associated with
the Public Works Assistance Account in order to balance the operating budget. The capital budget
includes $158 million to provide funding only for public works board projects approved in prior
legislative sessions.
The off-road vehicle bill (HB 1632) was brought up and passed on the final days of the session. The
House bill report provides an excellent summary and analysis of the bill. The bill, in effect, allows
"wheeled all-terrain vehicles" to be ridden on public roads under certain circumstances. Counties
less than 15,000 population (Garfield, Wahkiakum, Columbia, Ferry, Lincoln, Skamania, Pend
Oreille) may by ordinance designate certain roads to be unsuitable for wheeled ATVs. Other
counties would need to adopt an ordinance prior to allowing wheeled ATVs to operate on any county
roads.
The Legislature passed (SB 5296) which established a new program within the Model Toxics Control
Act by creating the "Environmental Legacy Stewardship Fund". The focus of the new fund is
stormwater low-impact retrofit projects and projects that reduce stormwater pollution. The new fund
also provides for cleanup of derelict vessels.
101
5
Board of.1Cealth
Wow Business
.agenda Item #v, 2
� SchooG6ased Clinic
End of year Report
July 18, 2013
•
Jefferson County
School Based Health Centers
2012-2013 Participation Report
Background:
School-Based Health Centers (SBHCs) were established during the 2008-2009 school year to address a
need for adolescent primary and mental health care in East Jefferson County. Currently there are SBHCs
in Port Townsend High School (PTHS) and Chimacum High School (CHS) providing students with two
days'of medical and two days2 of mental health care per week.These SBHCs are also available to middle
and elementary school students, although younger students are more likely to utilize the SBHC at CHS
because of the shared elementary, middle, and high school campus.There are additional mental health
services available a few hours a week at Chimacum Middle School and Chimacum Elementary School.
There are counselors providing mental health care only at Quilcene High School and Blue Heron Middle
School.
Medical services are funded by Jefferson County Public Health and Jefferson Healthcare. Mental health
services are funded by the Jefferson County Mental Health/Chemical Dependency sales tax.Services are
available regardless of insurance or ability to pay and focus on preventative services including
immunizations,tobacco cessation, nutrition, eating and weight concerns, reproductive health care,
• physicals, and mental health counseling.Visits for injuries, illness, and infection are also common
throughout the year.
Evaluation Methods:
For every medical visit, data on student concerns, clinician addressed topics, and referrals were
recorded by the SBHC nurse practitioner.There are two nurse practitioners who each consistently work
in one SBHC. Additional demographic and health care access data was collected at each client's first visit
by the AmeriCorps member serving in the SBHCs.
For every mental health visit, data on student and clinician concerns was collected by the SBHC mental
health counselors. For the first half of the year, there were two mental health counselors, one for each
school. Mid-year,the PTHS counselor began providing services to both PTHS and CHS.
Data in this report was collected from August 2012 through June 2013.
18 hours PTHS, 12 hours CHS
2 10 hours PTHS, 10 hours CHS
Created by Ryann McChesney,JCPH AmeriCorps Volunteer 2012-2013 (7/12/13).
Board of 3fealth
Wow Business
.agenda Item #17., 3
• Nurse Family Partnership
yearCy Plan
July 18, 2013
•
k..i
Public Health Nurse Home Visiting
Frequently Asked Questions
When did nurse home visiting begin?
• Home visiting became a national public health strategy to improve the health status of women
and children in the late 19th century.
I What makes nurse home visiting such a successful strategy?
• Therapeutic nurse-client relationships are built on trust, mutual respect and empowerment.
• • Services start prenatally for some programs,which greatly benefits high risk parents and
2 children.
;X
• Nurse home visiting is comprehensive in design,so the multiple needs of families can be
addressed in one visit(versus interventions that address more narrow outcomes).
,�: • Research shows that strong home visiting programs that adhere to specific curricula,teaching
protocols and vigorous monitoring are consistently successful over time.
Families involved with nurse home visiting programs have fewer repeat pregnancies; improved
maternal mental health and children's cognitive development; reduced unintentional injuries and
home safety hazards; and improvement in parenting skills.
' e What are the different public health nurse home visiting programs?
fr
pz: o
Maternity Case Management(MCM) assists pregnant women in improving birth outcomes for
• themselves and their babies. Babies First! is a home visiting program for at-risk families with babies
g, : and children up to age 5.The CaCoon program serves children and youth with special health needs from birth to age 21 years. Nurse-Family Partnership (NFP) nurses work with low-income young
women who are pregnant for the first time, helping these vulnerable young mothers achieve healthier
pregnancies and births. Families are visited from pregnancy until the child turns 2 years old.
How can public health nurse home visiting programs help Coordinated Care
Organizations in Oregon?
'° • Compliance with perinatal care standards;
- • • Care coordination/care management for pregnant women and their children;
• • Ongoing health and psychosocial assessments throughout the duration of the intervention;
• Anticipatory guidance and preventive services based on need;
Early identification of problems and swift intervention;
• Timely patient-centered communication and information exchange.
r
` What are the potential benefits of partnering with public health nurse home visitingprograms?
• Improved outcomes for plan members
t •• Reductions in risk factors that lead to chronic conditions
,ti 4 Reductions in costs due to ED visits
: , Better patient compliance with medical provider's ,-
instructions
• Improvements in HEDIS and other quality metrics
"With our nurse,you know she truly,genuinely cares about you -� ` .
and your child."—CaCoon Client r ,
4,
F
Nurse-Family
Partnership
• / Hel in First-Time Pareira Succeed:-
Evidence-Based Home Visiting and Nurse-Family Partnership: A Critical
Component to Achieving the "Triple Aim" for At-Risk Women and Children
February 22,2013
What it is: Nurse-Family Partnership (NFP) is an evidence-based,community health home visiting
program for first-time,low-income moms and their babies with over 30 years of randomized controlled-
trial research proving its effectiveness.Through ongoing home visits from registered nurses,NFP clients
receive the care and support they need to have a healthy pregnancy,provide responsible and competent
care for their children,and become more economically self-sufficient. From pregnancy until the child
turns two years old,NFP Nurse Home Visitors form a much-needed,trusting relationship with the first-
time moms,instilling confidence and empowering them to achieve a better life for their children—and
themselves.
How Home Visiting Can Impact Health Outcomes:
• Nurse home visiting programs are a long-standing,well known prevention strategy used by
states and communities to improve the health and well-being of women,children and families,
particularly those who are at risk.
• NFP is a cost-effective prevention program that stands on the weight and power of over thirty
years of scientific evidence demonstrating its effectiveness in helping to improve the health and
well-being of low income, first time mothers and their children. NFP's primary goals are to
improve birth outcomes,child health and development and parental economic self-sufficiency.
• • Results from one or more randomized controlled trials demonstrates that NFP can result in:
o 35% fewer cases of pregnancy-induced hypertension;
o 79%reduction in preterm delivery among women who smoke;
o Fewer subsequent births on Medicaid
o 31%reduction in very closely spaced(<6 months) subsequent pregnancies;
o 39% fewer health care encounters for injuries or ingestions in the first two years of life
among mothers with low psychological resources;
o 48% reduction in state-verified reports of child abuse and neglect by child age 15;
o 56% reduction in emergency room visits for accidents and poisoning at age 2;
o 50% reduction in language delays by child age 21 months;and
o 67% reduction in behavioral and emotional problems at child age 6. (to name a few)
• NFP is cost effective. Independent studies have also confirmed that NFP saves scarce public
resources.
o Rand Corporation found that for every $1 invested in NFP to serve high risk families,
communities can see up to $5.70 in return due to savings in social,medical and criminal
justice expenditures.
The Case for Integrating Home Visiting in to a Coordinated Care Organization Model:
In Oregon,we believe that NFP can help Coordinated Care Organizations with :
• • Compliance with perinatal care standards;
• Care coordination /care management for first-time pregnant women and their children;
1900 Grant Street,Suite 400 I Denver,CO 80203-4304
303.327.4240 I Fax 303.327.4260 I Toll Free 866.864.5226
www.nursefamilypartnership.org
• Ongoing health and psychosocial assessments throughout the duration of the intervention; •
• Anticipatory guidance and preventive services based on need;
• Early identification of problems and swift intervention;
• Referral to and coordination of other care and services as needed;and
• Timely patient-centered communication and information exchange.
As with new CCOs, evidence-based home visiting programs like NFP measure,monitor and
analyze metrics and use such data to drive improvements. NFP monitors many of the same quality
and outcome measures that CCOs will be accountable for including those used prescribed by
HEDIS,CHIPRA and NCQA's criteria for Patient Centered Medical Homes.
Quality Measures NFP/MIECHV HEDIS CHIPRA NCQA-PCMH
ED utilization X X X
Access to primary care X X X X
Access to behavioral/mental health X X X
Developmental screening X X
Well child visits in first 15 months X X X
• Birth weight < 2500 grams X X •
Preterm Births <39 weeks X X
Timeliness and frequency of prenatal care X X X
Postpartum care X X
Immunization status X X X
Depression screening X X
Lead screening X
BMI Assessment X X X
Connection to community resources X X X
Culturally/linguistically appropriate care X X
From this important perspective,it is evident that priorities for evidence-based home visiting program
are well aligned with those of the new CCOS,making us natural partners going forward.
•
1900 Grant Street,Suite 400 I Denver,CO 80203-4304
303.327.4240 I Fax 303.327.4260 I Toll Free 866.864.5226
www.nursefamilypartnership.org
• We think that the potential benefits of partnering with evidence based home visiting programs like NH-'
would include:
• Improved access to home visiting services for plan members;
• Improved outcomes for plan members
• Reductions in risk factors that lead to chronic conditions;
• Reductions in costs due to ED visits;
• Better patient compliance with medical provider's instructions;
• Improvements in HEDIS and other quality metrics;
• Improved opportunities to take advantage of pay for performance and other quality incentives;
• Less member churning;
• Competitive advantage in the market place.
Strategies for Taking NFP to Scale Within Medicaid and Health Care Reform:
• Statewide Strategies:
o Include Medicaid coverage and reimbursement for evidence- based MCH home visiting
services as part of Oregon Health Plan's Benefit Package
o Develop policies that support integration of evidence based MCH home-visiting
programs within new CCOs;
o Create incentives for CCOs to contract with evidence-based MCH home visiting
programs to provide services to those who might benefit most from them;
• o Evaluate the effectiveness of evidence-based home visiting services in improving
maternal and child health outcomes and the experience of care as well as cost offsets to
Medicaid over time.
• Community-level Strategies:
o Work with local CCO's to integrate NFP in to continuum of maternal and child health
services
1900 Grant Street,Suite 400 Denver,CO 80203-4304
303.327.4240 Fax 303.327.4260 Toll Free 866.864.5226
www.nursefamilypartnership.org
t
•! > cc
T. N O ( 0
f > oro �_ - o
00) c _o �
D
0I\ c -U' Z - _ Eat
) O O O 0 U-
TZ
o N o L 0 0 0 - Z c 0
C) m Y a) a a . y a) ,'o
itl � � tea) 00 0 o •= E
Z - O cs o c c c U o
L I- C ! N
0
C a) a) OE m C C O 0
(� > -0 N t t C B �. —
a Og 0 3 E a) E cci N o
_c a) a � = E E E � � � �°
c U to ; T
a) w O '� N c O O O
O ,-
,o, c c c a Qs 0 c
f� a) , ,-,
V T O a) C C C c N (n o-w
L
CL [ cE � E E E UZ
0 0 iioo N --UE 0 0 0 O — UN � UoE; ° _ c0 cc) 0 0O .
E _ CU ^✓
L L
C - O o [- N M V d a y)
U L (s
COC 3 O O) i
QCCCL 0)o ax
(s O u 1° O
>, -,E' _C Zd- Z c 0
U U) cov) CDiii 0 'O
C > -o L f/)
C y > c a) L
U O C o ° 4- m
- 0a)
0) u a) Ev) cs -La. co 0
o s Co o
Q > o oo
OU V �) .ONC -c)-
•
v4o U ? =a) p i 0 -p
i:�
:F...
'
. E o U0 O
O
C �c E
°C ) - 0u) w 0D ° c a(I) 11 .N ,� " L �, >- >- Q
co
U _cc:):,
c°,. WE aD.> fx a) D
> Q s c� ri vL;�r O '
o Q. U) PaECU LN U
a ° ° c ° m D 0 IHE
E 11 .> oa0 0
c pU)
o o:
Q. ot11 ° O
= Q c- o
c o 0 CQs
[ § a) ° a) � CO cg
N !Ti..) Q a) a) L. cn U O
(� > -� . ( > c i D 7 �O 2 - 0) Q) U O.' O
C O (s N C `:I o N c o °U .) O o a) CO o .c (0 . u
-F- CO C a) a - E o a) cow -T. C >,� c cn ai RS 4-, mai
N.. 7 O a) � (s L a) u) .> > a) 0 C a) 7 U o (6 2 U'i
V -- a) E ; cm aro ° °.' O a`� � (0 > � 'U �
G. c E ca oa) C ° -. 034) ` is c ° > Cu) WEI 0
EE .0 - 00 a) 0L w . � N .- > U_
a cs c a: ! >1 (13, CD
"co > o -c) � � CI) T � a°'i ccs E ry o' � .�! a
2 � _ a) .o `m ° .( Ga) co ccs �N cs o 0a) ~ c° ID .o � D � .5.,--5 '
ttn i
,r
• n c) cr.f,) -8, • v, v��'. v, P n (Ti .-+ E' E I'
u n Ori' rD n rt n v 'Lt cn lJ P
io n O O Ofa" 7 O� f rt .� "' . fD
Q• 0 "3 O 0 R' Cr Dr• - "° fig' CSD rte* " a �' < Q i
k-C (YR a ro n rt 0 P • O rt• f1 0- C/) sz•
0 0 3
0 " w n -t n v 0 0 sz n O •-e
3
o 0 '-8 n -< D
U ri. moo. 0 0 CI •
p o O'uCD D CD. (D CO
a �U n n�/- a. p� Q o o g. n -4 3 -0
p n 0 UD a OO u, P el
P 0 6 5 M '-+' ON Q
ar R' $'•)e C�7n n n o rt `"
p fD �] r� a. uu'i 0 Cl) O 0
n
n
O n �. C rt
Cl) V
n •
H n O El `C3 n ` n O n Z a x p. _
CD o o n P 0 O
a w cA n ,, 7 N. n ' n a o 0 0 CD
P').
CD
P 0 0 0 0 0 4 R L
°�' g ,p o w , AD 0 -I 0 3
o• a • a
rt n c~ rn R. gP n p 0 N
0 P Q 0- n r. N m., P Q (0
n CD• n O 2. Cr (p
F [CD CD 0 a `� 7 p P h a
C. u
C O 0 ng g 0 n h
o O v p- C/) 0 n 0 .�
oC u, 0 0 u' .O rn n a- n r .'. _
p `LS 5' rt OO ''� `n R '-' ►'3
✓� v 0
Cl) Baa n o C sz R. x
O cr z d -p
�.. �- a gP `� � Z 0
a ,�• 0 hCD O '� as H
2 LA
o • co u 3 C
n n n n p 4' n a
N Dnp 5 . , �
o0 0 a
0
•0 P a O 0ru-. (D n )0),
P AD
an 0 a.ctq 0 n n a
P 0-CIQ a, 0 a, ,5') `c N
rt
. 0 p ,- n R fl 3 a
`G •
u, cn rt 3 2 4.-'
• o n N P
fS , J
n n o' n �.,
rat a. `,`C
O aV
7 773
w » / & 0
§ / ! §
22l � 0)
. ! e
� f
- z _
0( } 0
C.) , : CO • \
\ \
•
2 /
\
e
V.
.)
{
0 e
C � S _
•
S
0 / /
g ; /
C a e
Co
< ( a
> \
U .
C mc
j\
vo •< .\_ } o
a0: \ E
C
& f. t-;
C $ I «
CD x/
Ea
m
Q. / \
\p /
— 2 / §
a -0 = \
� cl
- \
�� m / •
• ®
ai ._ \ \
= \ - c \
e 7 \ {
\ / / • /
> -2 .° a /
_ e .§ .c
`E .\ \\
0 2 •A 7 ®
� 2 » n 0 3
I - ) 0 ■ § -11d
m , \ � $ \ act
_
D 2 / . P. I
Z /'/ a 2 /
..
•
: g
. .. J
f
iim ; ;
�73 onu
UJHUi
(D (<D• ((DD 3 .� 9 N
v 3 (o in v co (n. m 5- ° -1 g 3 Q- ;n ° O ° O ° Oa"
O
�' ° (D 7(o• o ° m ca o cQ m 0 < m m m �_ 1
Cr 7 �_ cn C O rt co N 3 o 6 O a N. (D v O
O CO 0.. a' (D N (D 0 '� N N o c go 0 N (D 7 O (D O►
hi . 0 (D 0 _.N o <_. c. (D0 3 C 0_ • -_i H a m' °' 0
(- (D � C 05- 0 w Z0 0 C N < , 3 (3D v * 6 A, �/'
a.
(--1 a v C O = (D a O -n C p a (D N m fl1 a. (D '1 "+‹
Ccr, m C '� 'a (n -� (Dm 0
n -, a)ca cQ _ m -, 0 23 sv ° m -i a_ 3 cD c n O Q
O lD �•� � < O. O a naso 6_ (f) O O- v o -
c� m •
r - v ° N Q fD S a) N
o • n 3 cn cn N �. O - Q o Z 0 't
NO
HIIU.
• Co
al c°n v � `< o v = �' < -
O O O
N Q
on a L °(fl'
o
Eo C
3 , , v ,
3 0 0 o 0
n
o5
0 mo coo (to
b OH .
cnOh v 0cn a�O fl
n• o • 6 v O Q'a (Q 0
11 ca 0 O O At„,co a a' (D C �
v •Oo N N O N
0 0 — \ D _, 0 C 44 ✓
= -I -0 o (D O CDN
o v m 1,, D
O • a (Q W 0 O a
j DE)J fl) O) 3 ' 0 M
7 (D
r _ 7 * a O 0 fi
7y m m00 -1o 30 � 3 0 - I, Q
N
C �: < O (D fD N °T 0 C
N n (D r« o o a
O NC '-' 3 o u) C� v Q a O nj
' O O O
,-., T a COv . ' Oco O N
N � aN
O a 0 I .(fl
'� O -0 C
5 3
( C
(D O_ ((D (D0 0-_ O (D 0 (0 n O
o (D C 3 T. <. * (n CD H
C -�.
(D m 3 (D N Al S.) t j I.
-a P.
N N 0 O ° Q C co N n
O 01 0/ . a Z -a 0 O 0 o (% N
O �' CQ on V N l
j v 0 O D O 0 C• x
o 0 , 3 0
v o N C n .
co N O N o = '.
7-. (0) (D ° E
• :
NC
(D
i
.(-) CJI 0. < <.� cu -,� 3 -0 -3,1; v cncncncn5' cncn
v 0- o v a m CD D -0 (D -0 CD -0 (D Z
I • v < -o O- o m (D
u, m 13 moa 3n5Q73; w m' CD (vC) Qn. 0 (nonrn C
• a = p 0- n (oma �s 7:2. (D CD * O � � � ^t
a cQ i-15- C) rn�- CD (D 0 CD o ' m _. 0 � 0 = 0 O � o N
(D co o co COm N m- a) `'. 0 < v �, � 3 0- O ' 0- OCD
c (A to (D (O fD -' (n' �' C (D -0 O lD (D (D C O. TI
y � - 30. 0w cn � o t Cr o -0 - C c�D 30 iZ
i UI
ii
O N D- C)' D QN 3 D OO O oN r.
i CO Q -" o X 1l 3 (D o (D O "<
o 3 °' . � co v 3 v � � o = -0
o ,��' (D (..17-) (.0 -<- 3 CD _,a) 0(D
CO y
`< co O� (D O CD 0 O -t'
c 3
o co
�p co M
0 0- CI) : (D 6a j (D
r - Cl
o, v o co w. 0 Q I Q v y
3 1' Cl) m
m D- m ° o =. ' iD V =
-O (D v, :
a o (n v o �' I` v V
0 is 0 D D 1, C I
0!) 4 CD
_5 CD 0.- n-- ! O
Oo
73
i (D CD
�. 0
o [ co CD (n' 1
Cl)v -a t
CD
O n fl N N y
I-,
•
O < oO ° o II (D
ti) w O
w
" C Ca.DD cCn N -I e
ts .O C co ay Cv I 0
• o O -p cD - < (p f^=
M r 7 N CD -I CY Q CO (D 61i
i el
• cnl !: i
-o n) o o � -n (Q
n
Ft,' �. o o � o < j n
• 0 o O -, r CD C =
O o CD 33. an. n `0
v m CD o P,
oo � 3 �. 0- Q Q I Ca
x O3 co co t
- o (n Q i
0 0 , 03 coo 11
o`cco = - (: 3 I' C
Oti
G) ZO W) m O 0
,/ < N. p
• v �,
"'n -p cn O CDif
n - m 3 (n CQ
o O n CD CD 9I
CD 0 iii D
G CD O (7, 'a
CDn � o o- co
CD co I _A.
'-J
0O N Q i; n
G N _=
N C (�
W Q v 3 c 0 , N
Cl- . - (D E �
)
c
n Sly Sro. ll
• I•
O (D
D.( D (�
a
• '-1-.1O 'r
. �
. . ----_ ..... -
;• (
�) \ a) [
(
\ '2 } « E
)
) } } / / �
\ / } _e 2 }
} (
S \ \ ƒ ( y
} 5 = [/
4 ® %
. \ 0 2 }\
0. I ) I CO
)—
s ) \ / 3 1,
03 \ I „ ,
II _ 0 ) /
n 0)
C ) > 711 t
E / n .
� , E c co {\
O 0 0g :2
as —as
N i!t:
» \ 0
E o
Q Z 0 c \ (\
[ 46 ( \ o
U —
• 0 e
@
a) 2 \ ° L. \
CP / \ ° :o
\ % ) ) o / \ (\
c co o :Q
0) o a ; s
• LI- � % / / f {
• o \ $ a Ct ® \
D / < 2 \ \ b
O ( f » 4
ot: , \ \ \ \
m ) E m g
a ( 0_ E c e )/
( % / * � CO .
° [ 6 9 & c O }\
a. k ( t \ % 2 ® a a)
7 ) 5 \ - \ / § \
tn 5 f \ / / o /ƒ / o .
\ / ( 0 \ ±\ I / Z $ ° (
C = a) \ N S n ± \ s (\
§ - e ( \ \ a = _/ m w =
? g /al \ § \ \ / \ \ E : y
.-± e = _ :Q
o ° ® ® \ 2 � � / E ) 0 w
2e ± % _
oI e / 0 2 / 0 [ \ \ _ \ / \ � \
'E / i:::
( � ƒ m % E » n CO ° _ (/) �( \
e 7 « _ :� _ k ° q ° * _ 0 $},
� $ \ g \ ( c < 7 § � O = oOD o E cc:a
I $ � co \ o }/ 2 a \ � o CD
( \ \/ \ \ � �
a) \ 2 § ® \ (� / U 7 5 0 \ § .-- § E 7 z
E E \ $ ( ° '- a- ° ° °
$ co
± _ \ \ \ 7 / / •
Z \ E \ ƒ } < H c w « aw / § )�
• a .HBSA• Inc.
Supporting Organization ofthe
Pacific ute,fin-Research and Evaluation
Nurse-Family Partnership Home Visitation:
Costs, Outcomes, and Return on Investment
Executive Summary
•
Ted R. Miller, Ph.D.
miller@pire.org
240-441-2890
The Pew Center on the States funded this study. The views expressed are those of the
I author and do not necessarily reflect the views of the Pew Center on the States.
September 2012
Revised January 24, 2013
i
I1 1720 Beltsville Drive,Suite 900,Beltsville. MD 20705-3111
Phone:(301) 755-2700 Fax: (301)755-2799
Nurse-Family Partnership (NFP) is a program of intensive prenatal and postnatal home visitation by
nurses. By 2011, it served 145,704 low-income mothers and their first-borns.
NFP has three goals: (1)to improve pregnancy outcomes by helping women improve their prenatal
health, (2)to improve child health and development by helping parents provide more sensitive and
competent care, and(3)to improve parental life-course by helping parents develop a vision for their
future and fulfill that vision by planning future pregnancies, completing their educations, and finding
work. By design,NFP helps parents to understand how their behaviors influence their own health and
their child's health and development. It enables them to change their lives in ways that protect
themselves and their children more effectively.
NFP has the strongest effectiveness evidence among home visiting programs for pregnant women and
young children. Well-designed randomized controlled trials in Denver, Elmira, and Memphis
evaluated optimal delivery of NFP. Less reliable trials in Orange County, California and Louisiana
added supporting evidence. Less robust evaluations also are accumulating on NFP effectiveness in
broad-based implementation. These large-scale replication studies use quasi-experimental designs.
They compare outcomes for NFP mothers to outcomes for other mothers. Their quality is reduced by
imperfect comparison group matching.
This study addresses the need for a more comprehensive analysis ofNFP's effectiveness and return
on investment.No prior analysis has systematically painted an outcome picture based on all the
randomized trials including trials not run by the program's developers and evaluations of
effectiveness in large-scale implementation. None incorporates recent findings on longer term impacts
of NFP or captures all known NFP impacts. All rely on NFP operating costs from randomized trials
rather than the lower costs in large-scale programs. Especially lacking are separate estimates of the
likely impact of NFP on state and Federal government costs over time. Government cost savings
•
estimates for NFP also omit state government welfare savings or are not based on current state
welfare eligibility summary, although
randomized
compelling evidence of
effectr✓mess toasate or community conssiderirg starting or expanding a NFP progammorre
needed. Prior mat.:rials 'lid not tul:, inform policy debate.
This study aims to analyze costs, life status outcomes, functional outcomes, and return on investment
in NFP services. It uses those estimates to create an on-line calculator, a state-specific financial
planning tool to guide NFP funding decisions. The calculator lets states and communities analyze the
economics when they invest in NFP.
Accurate benefit-cost estimates will better inform funding decisions. Budgets are pressed everywhere.
Decision-makers need accurate information on likely return on competing investments. One decision
factor is how much NFP will benefit the public. Separate factors are likely impacts on a state's budget
and the Federal budget. Recovery timing is an issue if a program eventually will pay for itself. A
funding decision is much clearer if the state will recoup its investment in 14 months than in 14 years.
All costs in this report are stated in 2010 dollars. Future costs are discounted to present value using
mid-year discounting at a 3%rate.
NFP Costs
NFP targets 64 home visits by the family's nurse beginning in week 13 of pregnancy and lasting
through age 2. Later entry, scheduling problems, dropout, and early graduation reduced average visits •
Revised January 24,2013 2
• to 31 per family in the Denver, Elmira, and Memphis trials and 24.2 per family in operational
programs.
NFP costs average $8,734 per family served, about 70% of the cost in randomized trials. In present
value, costs average $8,580. This average comes from data on more than 19,000 families in well-
established NFP programs. The cost decrease from trials results in part from reduced utilization,
which probably reduces program effectiveness. Visits per family in scale-up are 78% of the average in
trials. Economies of scale may account for the remaining 8% cost reduction. Unlike in trials, nurses in
operational programs quickly add new families to their caseload as families graduate or drop out,thus
gaining operational efficiency.
NFP Outcomes
Table 1 estimates NFP outcomes in scale-up. It summarizes credible and consistent evidence from a
systematic review of 30 NFP evaluation reports. It assumes effectiveness in scale-up would decline by
21.8%, in proportion to decline in visits. Sensitivity analysis assesses cost-effectiveness with a 25%
decline.
Table 1. Expected Life Status and Financial Outcomes When First-Time Low-Income Mothers
Receive Nurse-Family Partnership Home Visitation Services
Outcome Change
Smoking During Pregnancy 24% reduction in tobacco smoked
Complications of Pregnancy 27% reduction in pregnancy-induced hypertension
28% reduction in births below 37 weeks gestation (37.5 fewer preterm
Preterm First Births births per 1,000 families served)
• 60% reduction in risk of infant death (3.4 fewer deaths per 1,000 families
Infant Deaths served
Closely Spaced Second Births 31% duction in births within 2 years postpartum
Very Closely Spaced Births 24% reduction in births within 15 months postpartum
31% reduction in second teen births (73.5 fewer children per 1,000
Subsequent Birth Rate families served within 2 y3ars postpartum&lifetime)
Subs' uent Preterm Births 37.5 fewer subsequent preterm births per 1,000 families served
Breastfeeding 14% increase in mothers who attempt to breastfeed
Childhood Injuries 38% reduction in injuries treated in emergency departments, ages 0-2
Child Maltreatment 38% reduction in child maltreatment through age 15
Language Development 38% reduction in language delay; 0.14 fewer remedial services by age 6
Youth Criminal Offenses 46% reduction in crimes and arrests, ages 11-17
Youth Substance Abuse 53% reduction in alcohol,tobacco, &marijuana use, ages 12-15
Immunizations 23% increase in full immunization, ages 0-2
TANF Payments 7% reduction through year 9 post-partum; no effect thereafter
Food Stam. Pa ments 9% reduction throu•h at least ear 10 sost-sartum
Person-months of Medicaid 7% reduction through at least year 15 post-partum due to reduced births
Covera e Needed and increased program graduation
Costs if on Medicaid 10%through age 18
Subsidized Child Care _ Caseload reduced by 3.6 children per 1,000 families served
On average, enrolling 1,000 low-income families in NFP will prevent 78 preterm births, 73 second
births to young mothers, 1,080 child maltreatment incidents, 2,660 crimes by youth, 180 youth arrests,
230 person-years of youth substance abuse, and 3.4 infant deaths.
The reductions in child maltreatment and youth crime are less certain than other outcomes. Both come
• from a high-quality randomized trial but lack confirming evidence. No other study has reported on
Revised January 24,2013 3
a,-
behavior of NFP youth beyond age 12 or on maltreatment rates of NFP youth. Because preterm births411
and child mortality are rare, we estimated reductions primarily with models or comparisons between
NFP babies and other babies. These estimates are less certain than ones from randomized trials that
compare NFP and well-matched control babies. The analysis assumes findings from Elmira, Denver,
and Memphis apply nationwide. Despite consistent evidence for selected effects in state programs,
that seems questionable with Asian and Native American families and possibly in rural settings. This
limitation, of course, applies to virtually all randomized trials.
Societal Return on Investment in NFP Services
Benefits to society per NFP family served average $81,656 (present value). Dividing benefits by cost
per family served yields a benefit-cost ratio of 9.5 to 1.Table 2 summarizes estimated benefits and
costs of NFP per family served and associated economic return. Savings net of program costs are
$73,076 per family. Our estimated savings probably are conservative.
Table 2.Present Value of Benefits and Costs per Family Served by
Nurse-Family Partnership,United States,2010
Benefits of NFP Per Case
Reduced Smoking While Pregnant $11
Reduced Preeclampsia $643
Fewer Preterm First Births $1,944
Fewer Subsequent Births $447
Fewer Subsequent Preterm Births $1,628
Fewer Infant Deaths $24,745
Fewer Child Maltreatments
Substantiated Cases $10,055
•
Indicated&Unreported Cases $28,647
Fewer Nonfatal Child Injuries $884
Fewer Remedi'1 School Services $73
Fewer Youth Crimes
Arrests $1,289
Crimes $11,148
Reduced Youth Substance Abuse $34
More Immunizations
Savings Net of Immunization Cost $108
Total Benefits $81,656
Resource Savings $20,965
Intangible Savings(work,quality of life) $60,691
Cost of NFP $8,580
Net Cost Saving $73,076
Resource Cost Savings Net of Program Costs $12,385
Benefit-Cost Ratio 9.5
Present value at a 3%discount rate.
We split resource cost savings(out-of-pocket payments by government, insurers, and families
including savings on medical care, child welfare, special education, and criminal justice) from less
tangible savings(gains in wage work, household work, and quality of life of NFP families and of
people who avoid becoming crime victims). Net of program costs, resource cost savings are $12,385
($20,965 resource cost savings minus $8,580 program costs). That means NFP saves society money
out of pocket. Less tangible savings total$60,691. Figure 1 details the resource cost savings.
•
• Revised January 24,2013 4
• Benefits are spread over 18 years and Figure 1.Resource Cost Savings per Family Served by NFP Total
costs over 3 years. Figure 2 shows $20,965(Present Value at a 3%Discount Rate)
estimated present value of NFP costs per child welfare,
family and offsetting cumulative
$4,573
resource cost savings and total cost Criminal Justice,
savings over time. Because of reduced
Jd $1,292
neonatal mortality,NFP breaks even
within its first year of service to a special
family. It recoups its costs in resource Educatiosza89
cost savings alone before the child Miscellaneous,
reaches age seven. 5775
Medical,
Return on investment is not overly 512,236
sensitive to assumptions or to
uncertainties about impacts. It is at least
6.5:1 under a broad range of lower-
bound scenarios.
Figure 2.Cumulative Costs per NFP Family and Offsetting Total and
Resource Cost Savings by Year after NFP Services Begin(Present Value
Cost Offsets from Governments Computed at a 3%Discount Rate)
Perspective 5100,000
NFP saves governments money. As 590,000 ------ — --
Figure 3 shows, Medicaid accounts for550,000 --00 1
70,
more than half the savings, Child 50 ��.
A.'27'--- -_ —
570000
• Protective Services and criminal justice Total Offsets ..+�_
costs for 20%, safety net spending 550,000 f-- — -- y, -
540,000 t- ,.%'"
(TANF and food stamps) for 14%, and 530000 1 �. .-
Resource Cost Offsets
special education for 8%. 520,000 f _ •_._._.
government 51°,000 _ _ 4 1 r s
savings per family served average
By the child's 18th birthday, 5° —.__�. Tr_ _^_mss _._T --
_1 0 1 2 3 4 5 6 7 8 9 10 11 12 15 14 15 16 17 18
$36,910 (discounted present value
Age of Child;-1=Start of Prenatal Visits
$29,605 or 3.5 times the present value of
NFP costs($29,605/$8,580)). Medicaid
savings average $20,003 per family Figure 3.Government Cost Savings per Family Served by NFP Total
served(undiscounted). $29,605(Present Value at a 3%Discount Rate)
Figure 4 shows that before child age 7, Child Protective
Services
Federal savings alone exceed NFP's rvic
$8,734(undiscounted) cost per family
served. On average, state savings alone Police
" �� ' •Adjudication&
exceed them before age 10. Medicaid sanctioning
54% 3 6%
If Medicaid fully funded NFP,each level 't-t.`-%2,7;',..; Speciale
of government would reap Medicaid , Education
savings that exceed its share of NFP � 7%
costs before the child reached age 5. By
Miscellaneous
age 18,Medicaid would save$2.30 perFood Stamps
• dollar invested. Adding TANF,food F`` TANF 10%
stamp, and other cost savings, in present
5%
Revised January 24,2013 5
•value terms, State government savings Figure 4.Cumulative Costs per NFP Family,and Offsetting Federal and
would average $4.40 per state dollar
State Government Savings by Year after NFP Services Begin
(Present Value Computed at a 3%Discount Rate)
invested and Federal government savings S1s
would average $2.90 per Federal dollar o
invested. In some states,however, the $16000 ,
•
4'mow"y
FrderalSaving5 ,
projected returns are as low as $2.60 per $14.000 ,4,State Savings , . •
state dollar invested and$2.20 per 512.000 �,- •
Federal dollar invested. sioo.0o0 �;" , ' Costs
8,000 A 1 3. fi w
If Medicaid were braided with other NFP s6,000 7 ,* s •
funding streams, state and Federal ! ,
54,000
governments would recoup their costs lir *_
$2,000
even sooner and get a larger return on s0 .
investment. -1 0 1 2 3 4 5 6 7 8 9 10 1112 13 14 15 1617 18
Age of Child;-1=Start of Prenatal Visits
Federal and state government both
benefit handsomely from NFP services.
If these two levels of government split the full costs, each clearly will reap a large return on
investment. If states shoulder all the costs,however, a positive return on state investment is uncertain.
Indeed, some states would not break even.
Thus,Medicaid or other joint Federal-state program funding seems desirable. These two levels of
government share the benefits so they should share the costs.When they do, each level of government
will recoup 2 to 7 times the amount it invests.
Conclusion •
NFP offers a mother lode of Medicaid savings. It reduces Medicaid spending on a first-born by 12%,
yielding Medicaid savings of$20,003 per family served. If Medicaid fully funds the program, it
recoups its costs bL`jre the child reaches age 5 and recoups 2.3 times its costs by the child's 18th
birthday.NFP also reduces food stamp spending by 9% and TANF spe.iding by %. Addirg its
reductions in special education, Child Protective Services, and criminal justice costs,total government
savings are nearly$37,000 per family served. Thus,public NFP funding is a wise investment.
NFP's cost saving benefits are secondary to its effect on families. NFP lets first-borns with low
income parents get a safe and healthy start on life. It improves language development. It reduces
crime, substance abuse, child maltreatment,preterm births, associated special needs, and infant
mortality. Those life-changing benefits are the reason Medicaid, government, and society save money.
Braiding public and private funding increases and accelerates government's return on NFP
investment. The Maternal Infant and Early Childhood Home Visiting(MIECHV) program authorized
under P.L. 111-148 supports Federal funding participation in evidence-based home visiting programs.
MIECHV funding of NFP clearly is fiscally sound public investment. It yields an excellent return
from a Federal perspective. Braiding MIECHV, Medicaid, and private funding yields even stronger
government returns.
NFP also seems a good candidate for social impact bonds.
Our study does not compare return on investment in NFP versus other home visiting programs. While
effectiveness evidence for those programs is weaker than for NFP,comparative analysis may be
feasible and would further inform policymaking.
•
Revised January 24,2013 6
•
Board of Health
Netiv Business
.Agenda Item #(V., 4
• Big Quitcene River
Fishing Season Sanitation
July 18, 2013
•
Board of Health Update on the Big
Fishing• Vault Season o Toilet
Problem Statement
We are experiencing a lack of success at gaining resources to achieve a long-term solution to
correcting unsanitary conditions along the Big Quilcene River during fishing season. Further
actions need to be explored.
Current Status
Efforts to obtain partnerships on operation and maintenance of sanitary facilities at the county
park in Quilcene have been unsuccessful. On 6/27/13, DOH has established a deadline of
7/10/13 for access to funding for vault toilet(s). DOH extended the deadline to 7/17/13 in
order to allow JCPH one last effort at securing partners. The items needed in order to continue
with the project are:
• Provide a maintenance plan
• Provide a dedicated fund source
Background
In response to gross lack of sanitation along the Big Quilcene River during the 2011 fishing
• season, the Sate Dept of Health closed the downstream shellfish beds to harvesting. Only
reopened after local citizens got involved actively cleaning up waste (both solid and fecal) after
fisherman. Organizations involved in this incident:
• WA State Dept of Fish & Wildlife (DFW)—Sets open and close dates as well as locations
for the fishery, issues fishing licenses, has an officer patrolling the fishery for compliance
with law.
• WA State Dept of Health (DOH) —Sets open and close dates as well as locations for the
shellfishery in response to health conditions and testing.
• Jefferson County Water Quality (JCWQ)— Periodically monitors fresh and marine waters
for adverse impacts to human health, shellfish safety and the health of the
environment. Conducts Pollution Identification and Correction (PIC) activities to abate
adverse impacts.
• Jefferson County Parks and Recreation (JCPR)— Has a park that serves as the primary
entry point for fisherman to the fishery.
• Local Citizens—Proactively cleaned up after the fisherman in order to keep their
community clean and the shellfishery open.
In response, JCWQ and JC Parks and Recreation provided temporary sanitary facilities (sanican,
dumpster), water quality testing and education & outreach to fishermen during the season.
Those actions abated the unsanitary conditions found in 2012 and maintained downstream
shellfish beds open. Unfortunately, no sustainable funding exists for continuing this action for
subsequent years.
1
Board of Health Update on the Big
•
Quilcene Fishing Season Vault Toilet
Post 2012 fishing season,JCWQ sought long-term solutions to this issue. We attempted to
meet multiple times with the stakeholders mentioned above. Additionally, we sought to
engage local tribes as their members also partake in this fishery. We were able to secure
funding for a permanent vault toilet(s) in the area from the DOH that would only need to be
open during the fishing season. The location of the facility(ies) would be dependent upon
project costs as well as permitting/site regulations. JCPH met with Jefferson County
Department of Community Development to become familiar with land use and planning
requirements for sanitary facilities at the proposed sites. Numerous reports and studies will be
needed. Additionally, as part of that funding, a signed management plan for the facility(ies) is
required by DOH. Unfortunately, we were unable to achieve partnerships with DFW or any of
the tribes we contacted (Jamestown S'kallam, Port Gamble S'klallam, and Skokomish). While
local citizens of Quilcene are willing to step forward to volunteer their time for the project, all
outreach to date with DFW, tribes, local citizens and JCPR have not resulted in a signed
management plan.
•
•
2
•
Board of Health
Nledia Report
•
July. 18, 21913
•
i Jefferson County Public Health
June/July 2013
NEWS ARTICLES
1. "Opiate-related deaths higher per capita on Peninsula than statewide," Peninsula Daily
News, June 16th, 2013.
2. "Smooth move to electronic records in PT," Peninsula Daily News, June 17th, 2013.
3. "No hepatitis A cases reported on Peninsula," Peninsula Daily News, June 18th, 2013.
4. "Mill sets up Community Impact Line after complaint," Port Townsend Leader, June
19th, 2013
5. "Mill's landfill hearing delayed until December," Port Townsend Leader, June 19th, 2013.
6. "Port Townsend paper mill dedicates line to odor complaints," Peninsula Daily News,
June 20th, 2013.
7. "Food safety lauded," Peninsula Daily News, June 23rd, 2013.
8. "Shellfish toxin closes Sequim Bay to harvest," Peninsula Daily News, June 23`d, 2013.
9. "Kitchens receive food safety awards," Port Townsend Leader, June 26th, 2013.
10. "Fruits for families," Port Townsend Leader, June 26th, 2013.
11. "Swimming holes: Lake algae continues to be a problem in Jefferson County," Port
Townsend Leader, June 29th, 2013.
12. "Jefferson market, WIC join forces," Peninsula Daily News, July 1st, 2013.
13. "Free Septic System Classes Offered," Port Townsend Leader, July 3rd, 2013.
• 14. "SmileMobile offers free dental care," Port Townsend Leader, July 10th, 2013.
15. "Free septic system classes begin July 16," Port Townsend Leader, July 10th, 2013.
•
Opiate-related deaths higher per capita on Peninsula than statewide
By Jeremy Schwartz, Peninsula Daily News, June 16, 2013
ill
Deaths from overdosing on heroin and opiate-related prescription drugs in Clallam and Jefferson counties have been
proportionally higher, measured per 100,000 people,than statewide figures for the past six years, according to data compiled in
a new report released by the University of Washington.
Clallam County ranks third, behind Cowlitz and Pend Oreille counties, in the number of opiate-related overdose deaths per
100,000 people between 2009 and 2011, according to the report,while Jefferson County ranks 17th.
The report released last week also shows that law enforcement agencies in Clallam County have collected as evidence more
than twice the amount of heroin per 100,000 people than the statewide average for most of the past 10 years.
"The North Olympic Peninsula is definitely being hit by heroin,"said Caleb Banta-Green,the research scientist with UW's
Alcohol and Drug Abuse Institute who compiled the report.
Banta-Green collected information from treatment programs, overdose-related death records and law enforcement sources to
pull out statewide trends on deaths related to heroin and opiate prescription drugs, as well as the amount of these drugs turning
up in the hands of police.
Banta-Green said he set out on this research project after hearing from sources in the health profession statewide that heroin
has become more prevalent in the past couple of years.
"My prompting was not just to understand but to get counties their own data,"he said.
In Clallam County, the number of opiate-related deaths,which include both heroin and prescribed opiate medication, averaged
17 between 2000 and 2002, or 9.9 deaths per 100,000 people, according to data compiled in the report, almost twice the state
figure per 100,000 people for those two years.
•
The number of such deaths peaked in Clallam County between 2006 and 2008 at 43, or 21.9 per 100,000 people, and dipped to
30, or 15.3 per 100,000, between 2009 and 2011,just more than twice the state average per 100,000 people for that same time
period.
Statewide, here were 5.1 opiate-related ueaths between 2000 and 2002 an'! 3.7 deaths per 100,000 between 2009 and 2011.
"It's a trend that has been going on really for the last decade in Clallam County,"said Dr.Tom Locke, the chief medical officer
for Clallam and Jefferson counties.
"The fatal overdose rate has been higher than the state average for most of the last year,"he said.
Jefferson County saw 10 opiate-related deaths from 2006 to 2008 and from 2009 to 2011,which represented 15.8 and 9.4'
deaths per 100,000 people, respectively.
The data showed one opiate-related death in Jefferson County between 2000 and 2002.
For opiate-related deaths per 100,000 people between 2009 and 2011, Jefferson County ranks behind Cowlitz, Pend Oreille,
Clallam, Skamania, Snohomish, Klickitat, Grays Harbor, Spokane, Skagit, Chelan, Lewis,Asotin, Stevens, Okanogan, Mason
and Whatcom counties,from highest to lowest.
"Generally,the overdose rate correlates with the amount of[heroin]in the community," Locke said.
Public health officials from both counties suspect there has been an uptick in heroin use because area doctors and hospitals are
pulling back from prescribing opiate-based painkillers,such as Vicodin,which can be addictive.
• Law enforcement agencies from both Clallam and Jefferson counties collected more pieces of evidence that tested positive for
heroin per 100,000 people than the statewide average between 2011 and 2012,with Clallam County producing just about twice
the state figure, according to data in the report.
In Clallam County,the average rate per 100,000 people of pieces of evidence that tested positive as heroin was 26 between
2001 and 2002 and 68.9 between 2011 and 2012. •
In Jefferson County,the average rate was 1.9 between 2001 and 2002 and 38.5 between 2011 and 2012.
The statewide average per 100,000 people between 2001 and 2002 was 14.5, according to the report, and 34.3 between 2011
and 2012.
Jason Viada, detective sergeant with the Port Angeles Police Department and supervisor for the Olympic Peninsula Narcotics
Enforcement Team,or OPNET, said OPNET detectives have seen a steady increase in the prevalence of heroin over the past
two years in Clallam County,while methamphetamine still seems to be the illegal drug of choice in Jefferson County.
"Statistically,we encounter methamphetamines in Jefferson County far more frequently than any other drug,"Viada said.
However, he said investigating and apprehending heroin dealers in Clallam and Jefferson counties has been a top priority of
OPNET detectives over the two years he has worked with the team,which has members from law enforcement agencies
throughout the North Olympic Peninsula.
"So methamphetamine cases are still the biggest majority of our cases, but if I had the opportunity to choose priorities, I'm going
to choose heroin,"Viada said.
Banta-Green said a law enforcement focus on getting heroin off the streets is just one piece of a solution local jurisdictions need
to develop if they want to reduce the damage the drug is doing to their communities
"The actions that need to get taken are at the county level,"Banta-Green said.
Locke said he plans to continue to work with other Clallam County health officials this summer and fall to develop a county
community health improvement plan, a main focus of which Locke expects to be the heroin issue. •
"What should be done,what can be done, and who will be responsible for it,"said Iva Burks, director of the Clallam County
health and human services department.
"Before the end of`he year,we hope to have an answer for that[through the health improvement n]."
Jean Baldwin,director of Jefferson County Public Health, said staff members have just begun talking about developing a
community health improvement plan,though multiple health assessments for the county have been completed in recent years.
In addition to gathering data on the issue, both county public health departments run drug treatment clinics and syringe
exchange programs,the main focus of the latter being to provide county residents who use intravenous drugs, such as heroin,
with an anonymous supply of clean needles,said Lisa McKenzie, registered nurse and communicable disease program
coordinator for Jefferson County Public Health.
Ultimately,though, health officials from both counties agree education on the dangers of heroin and opiate abuse is the best
way to begin to combat the problem.
"[To make sure]people really understand this isn't about an evening; it's about a lifetime," Baldwin said.
Reporter Jeremy Schwartz can be reached at 360-452-2345,ext. 5074,or at jschwartzCa.peninsuladailynews.com.
Smooth move to electronic records in PT
Peninsula Daily News,June 17, 2013
• PORT TOWNSEND —Jefferson Healthcare hospital's conversion to an electronic record system went
smoothly, according to the project manager.
"It went really well," said John Nowak, project manager for Epic at Jefferson Healthcare, after the hospital
went live with the new system at 2 a.m. Saturday.
"The staff has done an amazing job of dealing with this transition," he added.
The state-of-the-art electronic health record system lets doctors throughout the region access patients'
medical charts in real time.
Most hospitals in the state — including Swedish Medical Center and its partner, Providence Health &
Services, both of which are affiliated with North Olympic Peninsula hospitals —already use Epic.
Olympic Medical Center, based in Port Angeles, went live with Epic on May 4.
Forks Community Hospital has no plans to switch.
Preparing for the change at Jefferson Healthcare was a massive job, Nowak said,
About 450 of the 500 employees at the hospital required some kind of training.
"The vast majority of people here have been touched by this transition," Nowak said.
.'effersor Healthcare staff converteu 'n,000 patient demographics—nam's. addresses, account
numbers—to the electronic system, Nowak said.
That total number represented the people who visited the 25-bed hospital or any of its 40 providers in its
nine clinics in the past two years.
Specialists now will be adding information about medications, allergies and other data, Nowak said.
Full medical records will be converted manually as patients arrive for scheduled visits, a process that
could take six months.
"In the first 24 hours, we've had no major problems," Nowak said."We've got a long way to go, but we're
off to a really good start."
i
No hepatitis A cases reported on Peninsula
By Jeremy Schwartz, Peninsula Daily News, June 18th,2013
The chief medical officer for Clallam and Jefferson counties said health officials from the two county health departments have •
received about 20 calls inquiring about vaccine after a recent hepatitis A outbreak that was traced to frozen berries.
But, said Dr.Tom Locke, "no cases have been diagnosed in Clallam or Jefferson county."
Locke, chief medical officer for Clallam and Jefferson counties, said staff with the Clallam County Department of Health and
Human Services have fielded 12 calls from residents asking about the vaccine for hepatitis A since an outbreak was announced
last week in eight states, including Washington.
The Centers for Disease Control and Prevention in Atlanta linked the outbreak to frozen organic berries sold at Costco.
Jefferson County Public Health staff have received between eight and 10 calls, he said.
The CDC said 99 people were sickened in Arizona, California, Colorado, Hawaii, Nevada, New Mexico, Utah and Washington.
Townsend Farms of Fairview, Ore., last week recalled its frozen Organic Antioxidant Blend, sold under the Townsend Farms
label at Costco and sold at Harris Teeter stores under the chain's brand.
So far, the illness has been linked only to berries sold at warehouse club Costco.
Townsend Farms said the berries contained pomegranate seeds from Turkey that may be linked to an outbreak of the virus
outside the U.S.
All of the Costco stores in the Paciic Northwest carried the berry mix, said Craig Wilson, Costco's director of food safety.
Wilson could not say how many packages of berries were sold at the Sequim Costco at 955 W.Washington St.—the only one
on the North Olympic Peninsula—because the business does not give out sales figures for individual stores.
Wilson said Costco is providing vaccinations for people who ate the berries within the past two weeks and is reimbursing others
who got the vaccine outside the store.
Costco has contacted about 240,000 people who purchased the berries from the chain in the eight states,Wilson said.
Locke said each Clallam and Jefferson county resident who called about getting the vaccine had been contacted by Costco.
"V','ve had no c_.-es, only people seeking the preventative vaccine,"Locke said.
Locke said the last confirmed case of hepatitis A in Clallam County happened ii 2007, while the last Jefferson County case was
in 2008.
"It's relatively rare," Locke said.
Jefferson County Public Health staff have given two people doses of the vaccine and two people doses of gamma globulin, a
serum intended to temporarily boost the immune system of those for whom vaccines could pose a health risk, such as infants
and the elderly, Locke said.
Clallam County health officials informed callers where the vaccine could be found in the county, Locke added.
Symptoms occur within 15 to 50 days of exposure to the hepatitis A virus, CDC said. They include fatigue, abdominal pain,
jaundice, abnormal liver tests,dark urine and pale stool.
Vaccination can prevent illness if given within two weeks of exposure, and those who already have been vaccinated are unlikely
to become ill,the CDC said.
For more information on hepatitis A and the berry recall,visit the CDC's website at tinyurl.com/HepABerries.
Reporter Jeremy Schwartz can be reached at 360-452-2345,ext.5074,or at jschwartz(a�peninsuladailynews.com. •
Information from The Associated Press was included in this report.
6/19/2013 6:00:00 AM, Port Townsend Leader
II Mill sets up Community Impact Line after complaint
To improve treatment pond, mill hopes county shoreline laws are
revised
Allison Arthur
assistant editor PORT TO JNSENDPAP€RCorR?
10{;'NTrILY ODOR COMPLAINTS State CteamfaTant a!taa#aily
,
26116 3a-,. '_ .__.�_
e j
111 1 i I 1
2612 a>},mlik„
2013# ia— 46".
-
Jab. Fab. March ¢sra May JUna July Alag. sant. Oct. Ncrr. Dr,^..
The graph above shows odor complaints by year and
month received by the state Department of Ecology. The
DOE received 7 complaints in April 2011, 2 complaints in
April 2012 and 10 complaints in April 2013, for example.
The graph does not distinguish between sources of odor so
not all of these complaints, for example, can be traced to
the pond. Source: State Department of Ecology
Olere to call a if _ '
The general information number for the Port Townsend
• Paper Corp. now accepts information about impacts to
the community. The number is 379-4224.
Complaints about odor also can be made directly to the
state Department of Ecology at 360-407-7393 or email
Angela Fritz at '-'4V7.
angela.fritz@ecy.wa.gov.
Public comment F'
Written comments regarding the Port Townsend Paper
Corp."s discharge permit can be sent by June 21 to a
Stephanie Ogle, P.E., Department of Ecology, Industrial
Section, P.O. Box 47600, Olympia, WA 98504-7600 or
emailed to
PTPC.comments@ecy.wa.gov ; sem ,,.
The application is available online at
apps.ecy.wa.gov/industrial/proposed.asp as well as at the
Port Townsend Public Library.
Michelle Oliver took the state Department of Ecology to task during a June 4 public
hearing and questioned when it would require the Port Townsend Paper Corp. to hear
her complaints about odor.
Oliver told DOE officials she didn't want to register as a supporter of the mill's $55
million biomass project, as a general-information telephone line at the mill offered to
have her do.
DOE official Marc Heffner told Oliver to wait a week or two, but Oliver said she'd already
waited.
On June 11, mill officials changed the message of that general information line to that
of a "Community Impact Line."
And Oliver, who lives on Middlepoint Road, was the first to register a complaint, said the
mill's environmental director, Kevin Scott.
Scott was pleased that Oliver had called the DOE to thank the agency.
"Its purpose has been to get all kinds of feedback, so we modified it," Scott said on June
12, a day after the line was modified. "It's not an odor complaint hotline. We call it the
Community Impact Line now."
Oliver was pleased that both the mill and the DOE took action. •
Oliver claimed that when she initially called the mill, an official said that no one cared.
And she said when she first called to comment or the odor she smelled, "I panicked and
hung up." She said the operator indicated her call would be recorded as support for the
biomass project.
NEW MESSAGE
Call the mill at 379-4224 today and a recorded message indicates that you've reached
the Port Townsend Paper Corp. Community Impact Line.
"We're sorry we missed your call," the recorded operator says, adding, "If you feel
you've been adversely impacted by the mill," speak clearly, leave your name and phone
number.
"We will respond by the end of the next business day," Scott said, repeating what the
message also says. He also said that on occasion someone in the mill's environmental
office — even he — might pick up as well.
"If they call with a complaint, then part of it is, we can investigate it," Scott said.
•
Mill officials say the information they're seeking from a caller is the time of day, where
• the person is at the moment they smell the odor and a description of what they smell.
"The more information they give us, the easier it is to check things," Scott said.
The mill reports odor complaints to the DOE. Complaints also can be filed directly with
the DOE. The DOE records the complaints.
Scott cautioned that the mill isn't the only source of odor in Port Townsend.
"One of the big ones that people don't necessarily think of is low tide," he said.
Scott also said that people do call with positive comments. "We do get positive feedback
and have almost 3,000 supporters of the biomass project, some of whom used this
number to be added to the list of supporters," Scott said of the mill's $55 million
biomass project that Oliver did not want to support. That project has been delayed
because of appeals as well as the lack of demand for the kind of electricity the project
would provide.
"We recognize a kraft mill has an impact, and part of our job is to minimize our impact,"
Scott said.
COMMENTS DUE JUNE 21
• Comments on the mill's National Pollution Discharge Elimination System (NPDES)
permit to use, treat and discharge 12.5 million gallons of water a day have been made
since April 24 when the draft permit was issued.
The vast majority of comments the DOE has received have been about odor potentially
coming from the mill's pond, technically called an aerated stabilization basin (ASB).
There also has been a number of people who have supported the mill, the county's
largest private employer.
A five-year permit expired in 2009; the new permit would expire in five years. The
deadline to comment on the permit is June 21.
CHANGES COMING
While a number of people complained about odor at the June 4 hearing, many also
complained about the timeframe the DOE gave the mill to make changes to the ASB.
Both Scott and new mill president Roger Hagan have indicated changes are under way
to dredge the pond slowly, an effort that would remove decaying material that may be
causing some of the odor.
S
Scott said the mill has already spent $400,000 to buy equipment and is waiting for •
Jefferson County and the DOE to finalize a new Shoreline Master Plan.
Under existing shoreline laws, Scott said, the ASB pond is listed as a natural water body
lake and because of that, a number of permits would be involved to make needed
improvements.
Under the revised shoreline plan, the pond is listed as an industrial facility and the
permit process would be more straightforward, Scott said.
Jefferson County planner Michelle McConnell said on Monday that analysis by the DOE
of the ASB pond was that it did not fit into the shoreline plan's jurisdiction.
"If [mill officials] wait to apply after the new shoreline program is in effect, then their
proposal for the ASB pond will not have to meet shoreline regulations," McConnell said.
"They've been eager to move forward" with plans for the pond, she said.
Approval of the shoreline regulations has been held up because the county and the
state have been at odds over regulations that allow net-pen aquaculture. McConnell
said county commissioners agreed two weeks ago to finfish provisions and that she was
hopeful the new shoreline regulations would be approved by the end of the summer.
A second part of the mill's odor-reduction effort is to conduct a study to segregate
waste streams and carry out some pretreatment of those streams. •
"We're hoping to have that kicked off in the next two months," Scott said.
hearin• M111' landfill
delayed
until December
By Allison Arthur of the Leader refused and applied for an
inert permit, a less stringent
The Port Townsend Paper permit and one it has had for
Corp.'s controversial land- about a decade.
fill issue won't be heard by "Ecology believes the
the state Pollution Control PTPC should`be monitoring
Hearings Board until groundwater and provid-
December. ing financial assurance for
A hearing had been set for its landfill," said Peter Lyon,
August before the state board Southwest Region Waste 2
to rule on whether the mill's Resource Program manager,
landfill classification should of why the DOE intervened in
change from inert to a more the dispute earlier this year.
stringent limited-purpose- "As a limited purpose landfill,
landfill(LPL)designation. the company would have to
Jefferson County Public meet these criteria."
Health Environmental Mill officials steadfastly
Specialist Pinky Feria-Mingo maintain the waste stream
said June 17 that the date has not changed and neither
change was related to the have the laws,"so the landfill
hearings board. designation should not change
Both the county and the either," Kevin Scott, environ-
state Department of Ecology mental director for the mill,
• (DOE) told the mill to file for wrote earlier this year after
an LPL permit last summer. announcing the mill would
An LPL permit would appeal Health Officer Tom
require more stringent moni- Locke's decision to deny the
toring of groundwater and company an inert permit.
would require the mill to prove Until the Pollution Control
it has the financial means to Hearings Board issues a deci-
cloc- landfill once it isf'ill. sion, he mill will operate
Arguing that the law had under its less environmentally
not changed and the waste stringent inert permit,accord-
had not changed, the mill ing to Feria-Mingo.
•
/i9/
Port Townsend paper mill dedicates line to odor complaints
By Charlie Bermant , Peninsula Daily News, June 20th, 2013
t'
t t
i,...:4,-,,,,, ,:-,iral-,.., illicito-'i . i,, :7) ' „
t
., e
r-1
11
Peninsula Daily News
The odor complaints were brought up when Port Townsend
Paper Corp. applied to renew its wastewater permit.
PORT TOWNSEND—The Port Townsend Paper Corp. has changed the message on its public comment line to
accommodate odor-related complaints.
For years, the mill has sponsored a comment line where people can leave feedback on a voice mailbox.
The renamed Community Impact Line is designed to encourage people to leave either negative or positive
• comments, according to Environmental Manager Annika Wallendahl.
"If someone has a complaint about odor, they can leave a description on the line, and they can expect a return call
the next day," she said.
If the company gets a specific odor complain., it notes i,,e date and time of the increased odor and refers to the
mill's logs to see if there was any change in operation, Wallendahl said.
Odor was brought up at a state Department of Ecology public meeting earlier this month, when officials took
comments about the renewal of a wastewater permit for the mill.
National Pollutant Discharge Elimination System permits are required for industrial facilities that discharge
wastewater to a bay or a river.
Among the areas the new permit would address is a treatment-efficiency study of the treatment pond with a specific
requirement to address minimization of odors from the pond.
The odor generated by the mill has been noticeable for"decades," according to PT AirWatchers spokeswoman
Gretchen Brewer.
"This is serious and needs to be addressed," said Brewer, who lives in Port Townsend.
"It's nice to see that the mill is taking some proactive steps to address this.
"They haven't been real responsive in the past."
• The name change for the phone line went into effect June 11.
Wallendahl said several thousand comments have been fielded through the line over the years.
"We received feedback from some members of the community that they didn't know where they needed to leave
comments, so we made these changes to improve clarity about how we receive feedback," she said.
Wallendahl said the message has evolved over the years and previously gave callers an opportunity to voice •
support for the mill's $55 million 24-megawatt biomass cogeneration expansion, which is expected to be put into
operation in 2014 or 2015.
PT AirWatchers is one of five environmental groups that has opposed the biomass upgrade.
The new message invites less positive feedback, saying: "If you feel you've been adversely impacted by the mill,
please leave a message and speak clearly. Leave your name, phone number and location, and the nature of the
impact, and we will return your message by the next business day."
Comments are routed to the appropriate department, which then answers the questions directly.
Wallendahl said the line also is used to field general informational questions, such as how to apply for jobs at the
mill.
The Community Impact Line is 360-379-4224.
Comments also are taken through email at community relationsptpc.com.
Complaints about any mill odor also can be sent directly to the state Department of Ecology, 360-407-7393 or
angela.fritz(c�ecy.wa.gov.
Additionally, in other news about the mill, an appeal by the paper corporation to the Washington State Pollution
Control Hearings Board in regard to Jefferson County's denial of an inert wastewater permit previously scheduled
for Aug. 20-21 was postponed to Dec. 12-13.
The meeting was delayed to accommodate the schedule of another hearing, said Pinky Feria Mingo, Jefferson •
County environmental health specialist.
The county denied renewal of the permit out of concern for the extra burden placed on the system by a proposed
biomass facility, while the mill has argued that the regulations and processes have not changed, so the permit
should be renewed.
If the Pollutions Cc-trot Hearings Board rules in the company's favor, it wail instruct Jefferson County to grant die
permit.
If the ruling is upheld, the denial of the permit will stand, though either side could ask Superior Court for
reconsideration.
Until the ruling, the company will continue operation under the current permit.
Jefferson County Editor Charlie Bermant can be reached at 360-385-2335 or cbermant(c�peninsuladailynews.com.
S