HomeMy WebLinkAbout2013-August File Copy
•
Jefferson County
Board of Health
Agenda
_Minutes
•
.August 15, 2013
•
•
JEFFERSON COUNTY BOARD OF HEALTH
August 15,2013
Jefferson County Library
620 Cedar Avenue
Port Hadlock,WA 98339
2:30—4:30 PM
DRAFT AGENDA
I. Approval of Agenda
II. Approval of Minutes of July 18,2013 Board of Health Meeting
III. Public Comments
IV. New Business and Informational Items
• 1. Secure Medicine Return presentation from Seattle King County Public Health
2. Letter from Evergreen Coho SKP Park
3. Appointment to the Substance Abuse Advisory Board
V. Activity Update
VI. Agenda Planning Calendar
VII. Next Scheduled Meeting: September 19, 2013
2:30—4:30 PM
Jefferson County Public Health
615 Sheridan St.
Port Townsend, WA 98368
•
• JEFFERSON COUNTY BOARD OF HEALTH
MINUTES
Thursday, July 18 2013
Jefferson County Public Health, 615 Sheridan Street, Port Townsend, WA 98368
Board Members Staff Members
Phil Johnson, County Commissioner District#1 Thomas Locke,MD,MPH Health Officer
David Sullivan, Vice Chair, County Commissioner,District#2 Jean Baldwin,Public Health Services Dir
John Austin, County Commissioner,District#3 Julia Danskin,Nursing Services Director
Roberta Frissell,citizen at large(County) Jared Keefer,Env. Health Services Dir
Catharine Robinson,Port Townsend City Council Veronica Shaw,Deputy Director
Sheila Westerman, Citizen at large(City)
Jill Buhler, Chair,Hospital Commissioner,District#2
Chair Buhler called the meeting of the Jefferson County Board of Health to order at 2:30 PM. A
quorum was present.
Members Present: Jill Buhler, Sheila Westerman, Roberta Frissell, Catharine Robinson, David
Sullivan, Phil Johnson, John Austin
Staff Present: Dr. Thomas Locke, Jean Baldwin, Jared Keefer, Julia Danskin
Members Excused: None
APPROVAL OF AGENDA & MINUTES
Chair Buhler called for approval of agenda and minutes.
Member Austin requested to amend the agenda to add a report on Baby friendly hospital
celebration and gala# 7 under new business and activity update on Pacific Coast Salmon
Activity.
Member Frissell requested a correction of the June 20, 2013 minutes on page 4, 4th paragraph
from the bottom; change from "chairman Frissell"to "member Frissell"
Member Robinson requested a correction on page 5, under Legislative Update, sentence
beginning"A large amount of the gap..." change $230,000 to $230,000,000.
Member Robinson requested a correction on page 5, under Activity update: Reword first
sentence "...to present the hospital with a"baby friendly hospital"award. Reword 2nd sentence
to: "Jefferson Healthcare is one of five hospitals in the state being honored."
Member Robinson moved to approve the agenda and minutes as amended; the motion was
seconded by member Frissell. No discussion. The motion passed unanimously.
•
1 BOH Minutes—July 18,2013
PUBLIC COMMENT •
Helen Lauritzen speaking as a co-chair of bio-mass committee and a member of the North
Olympic Group of the Sierra Club thanked Dr. Locke for his strong commitment to the Port
Townsend Paper Company landfill issues. She outlined her concerns regarding the process for
permitting the PTPC landfill, and urged the County, and Department of Ecology(DOE)to hold
firm in requiring the company to obtain a limited purpose permit for their landfill.
Kees Kolff concurred with Ms. Lauritzen. Dr. Kolff thanked the board for their service and
thanked Dr. Locke for the decision that he made regarding The Port Townsend Paper Co.
Dr. Kolff hoped for continued open participatory process regarding the issue.
Dave McWethy also concurred with Ms.Lauritzen and Dr. Kolff. He noted that in the course of
interaction with JCPH,he has appreciated officers and staff and supports positions of the County
regarding the PTPC.
Chair Johnson responded to public comments, noting that ORCA and University of Washington
have secured a$516,000 grant to install nano-particle monitors in Jefferson and Clallam
Counties,which will allow a base-line measurement(studied by the University of Washington).
OLD BUSINESS AND INFORMATIONAL ITEMS
Senator Patty Murray Press Release: .
Member Austin reviewed a press release from Senator Patty Murray's office, noting that she has
secured 65 million dollars in federal funding for the Pacific Coast Salmon Recovery Fund. This
is a significant increase over both President Obama's proposed FY14 budget and the
corresponding House budget,and will likely benefit JCPH water resources budgets.
Member Austin moved to direct Chair Buhler to send a letter of appreciation to Patty
Murray's office. Member Westerman seconded the motion. No further discussion. The
motion passed unanimously.
Healthy/HAPPENINGS—JCPH WIC Newsletter
Julia Danskin—Annual breastfeeding picnic will be August 7th to celebrate World Breastfeeding
week. Several partnerships should be noted: partnership with Jefferson Healthcare, helping to
support baby-friendly care; partnership through outreach with the YMCA summer program,
providing free meals for kids;partnership with the Jefferson County Farmers market, providing
WIC vouchers for fresh-from-the-farm food; partnership with the Smile Mobile,which is
currently visiting, providing dental care to children and mothers/pregnant women. Member
Frissell commented that she was happy to see Chef Aaron Stark giving cooking classes to
families and children,using fresh farmer's market produce. Member Johnson—asked for
clarification regarding the numbers noted in the WIC newsletter specific to Apple Health •
monthly income limits. Ms. Danskin clarified that levels are for Apple Health free health
2 BOH Minutes—July 18,2013
coverage for kids, which is 200% of the Federal poverty level. There are further income limits
• for subsidized reduced health care coverage.
Got Birth Control?
Julia Danskin drew attention to the fliers included in the Board's packet regarding family
planning services. A large number of people in the community utilize these services.
Affordable health Coverage: 2014 Information
Julia Danskin reviewed a flier included in the board's packet, prepared by the CHOICE Regional
Health Network about upcoming healthcare and insurance changes, subsequent to the Affordable
Care Act. Jefferson Healthcare, JCPH and Olympic Area Agency on Aging will have small
contracts with CHOICE to train staff and volunteers to help the public enroll in health insurance
options. Starting October 1st, the health care recruitment sign-up will begin, and insurance will
kick in on January 1, 2014. The public can learn more at www.wahealthplanfinder.org. JCPH
will have rooms with internet access and staff available to function as a drop-in center for
enrollment. There will also be at home online registration option.
Member Austin questioned whether Safe Harbor and Jefferson Mental Health are aware of all
this? Ms. Baldwin noted that these agencies and others will be included in outreach. Member
Robinson asked if there is outreach to Dove House and Jumping Mouse. Ms. Danskin responded
that Jefferson County Public Health will be preparing for outreach as the time approaches and
CHOICE will also be doing outreach.
•
West End Natural Resources News
Jared Keefer prefaced this presentation; the coastal Marine Resource Committee (MRC) and
Conservation Futures programs are housed under Jefferson County Environmental Health and
these programs complement the clean water programs. Tammy Pokorny, Environmental Health
Specialist, noted that the Washington State Department of Fish and Wildlife manages the coastal
MRC's. The North Pacific Coast(NPC) MRC incorporates East and West Jefferson Counties.
The organizations bring together tribes and agencies at the local, State and Federal level to create
and implement projects related to coastal marine environments. The NPC MRC received
funding for its programs, including publishing a newsletter regarding the range of projects which
the MRC's address. The June issue of the West End Natural Resources News (included in Board
packet),highlights projects, including the Marine Spatial Planning—zoning coastal waters, and
prepare for alternative energy projects and other area issues. MRC member enthusiasm exposes
under-appreciated and under-covered issues in the coastal areas—highlighted in the newsletter.
Member Austin noted that the publication is well put together.
Syringe Exchange Program
Julia Danskin reviewed the Syringe Exchange Program(SEP) 2012 end of year report—JCPH
ic
available to see drop-ins
has continuededthe
EP. A In 21012ethe numberalth nurse s of syringes dispensed was1n addition to
17 405, with 150
scheduled clinics offered.
•
3 BOH Minutes—July 18,2013
visits. In light of recent heroin deaths in Clallam Co. and the use among younger people, there's •
an increased effort for education and referral during client visits to SEP.
Legislative Wrap-up
Dr. Locke reviewed the State government shutdown was avoided, with the most significant
change from local public health standpoint being that the 3 funding streams are intact, but their
distribution has changed to a"block grant"through the Treasurer's office (rather than through
the Department of Health). Stable, predictable funding for foundational public health services
has been a priority, and those funds are intact. Member Westerman wondered whether the result
was a product of effective lobbying effort. Dr. Locke responded that a strong coalition of
Counties, Cities, local health departments and allies in the hospital association and state medical
association, all supportive, lead to the positive outcome. The message that gets to the legislature
is that these core services are a high priority for many different groups and core services have a
high impact on the community. Additionally, in a very tough budget year, there was a push for
restoring oral health-care funding in the Medicare program for adults, which has been restored
for about 45,000 adults in the state, plus those who will become eligible through healthcare
reform (taking effect in the beginning of January 2014). Getting coverage is one issue, but an
additional barrier is finding dentists who will accept that coverage. Overall, the legislature
should be complimented for their foresight in funding of these programs.
NEW BUSINESS
A Conversation with John Wiesman,DrPH, MPH,Washington State Secretary of Health
•
Chair Buhler introduced and welcomed Dr. Wiesman, Dr.PH, MPH,the Washington State
Secretary of Health. Dr. Wiesman extended his thanks for a warm welcome, and outlined some
of his background and goals. A priority for Dr. Wiesman, having come from local health
department background, is the opportunity to visit all local health jurisdictions in the state.
Four goals for Dr. Wiesman and the Department of Health(DOH): Healthcare reform, Working
on obesity epidemic, Public health impacts of climate change, and funding of public health
system.
• Healthcare reform: Opportunities to care for public health: working with healthcare
authority, health benefit exchange, and DSHS at a systems level. Thinking about better
engagement and increased healthcare for the public.
• Continuing to work on obesity epidemic. The epidemic is likely to result in chronic
disease cost increases and lower life spans if not addressed.
• Public Health impacts of climate change. Paying attention to air quality, animal-pest
ecological changes, and changes in extreme heat conditions. Focusing on what the
Department of Health role is in mitigation of these issues and where the opportunities are
to partner across systems.
• Funding of public health system. The State and local systems are struggling with
funding. As Secretary of Health, Dr. Wiesman will focus on providing leadership to find
•
4 BOH Minutes—July 18,2013
stable funding. One area of focus is adding to the stakeholders at the table. Believes in
• bringing more partners in the discussion, including BOH members and commissioners.
Finally, the state/local relationship is important. Dr. Wiesman shared what's going on in
Jefferson County through DOH: 1094 Shellfish biotoxin tests, 800 marine water testing, and one
white powder sample; data accumulation and interviews regarding the health of Jefferson
County; 102 newborns tested for genetic and other diseases; 22 commercial shellfish growers
licensed, 17 large onsite sewage systems, 67 Group A systems serving 24,000 people; 83
different professions and managing disciplines licensed; 1700 healthcare credentials in Jefferson
County, and one hospital, from those, 19 complaints investigated.
Dr. Wiesman welcomed input and feedback as he moves forward with these goals.
Member Sullivan noted that different counties, although diverse, tend to come together on
flexible funding, meeting needs on an individual county basis. He also noted that he would like
a coordinated message from the State across agencies.
Member Johnson conveyed that Jefferson Co. works at meeting and agreeing across jurisdiction
for a coordinated approach to state DOH, and noted major differences and diversity between the
counties.
Member Westerman noted that despite extensive outreach and calls for public involvement,
there's disparity between public understandings about what public health does in the community.
• She indicated that the challenge is to educate public about the importance of funding public
health.
Dr. Wiesman responded that creativity—thinking,outside the box—may be the key for engaging
and solving these funding issues. The solutions may not be what have worked in the past, but
he's confident that with collaboration, new solutions can be found.
Ms. Baldwin noted that there's a possibility of restructuring and systemizing some of the work,
sharing expertise across jurisdictional boundaries and ensuring that training and expertise still
exists even in funding crises. Dr. Wiesman agreed and noted the successes (example: sharing
epidemiology with Kitsap) in sharing across jurisdiction, including some cost savings.
School-based Clinic End of Year Report
Ms. Baldwin distributed a draft of School-based Clinic End of Year Report. The draft doesn't
include mental health funding. The final report will follow later in the summer. The clinic
continues to see the same amount of students; there are more chronic issues: eating disorder
spectrum, asthma, diabetes, etc. There aren't many with diabetic or asthma out of control, but
health monitoring is continuing. The Nurse Practitioners in the schools are well accepted and
students continue to reach out. Member Austin mentioned the reported teen pregnancy rate
decrease, and noted that it says a lot about public health involvement in that decrease.
i
5 BOH Minutes—July 18,2013
•
Nurse Family Partnership Yearly Partnership
Yuko Umeda, Public Health Nurse, presented the NFP annual plan. NFP focuses on decreased
pre-term births, and increased attrition in the program. The program has been in place in
Jefferson County since 1999. JCPH NFP team works to change smoking habits, child abuse and
neglect rates locally, increase school readiness,help mom's space births and decrease use of
substances. In the past year, Jefferson County NFP formed a regional partnership with Kitsap
and Port Gamble S'Klallam Tribe. With this new partnership there's opportunity for forming a
new community advisory board with members of Jefferson, Kitsap, and the Tribe. Ms. Baldwin
conveyed that JCPH met with the Elwha Tribe about NFP partnership and they're considering
options.
Dr. Wiesman,having visited Kitsap County Health District, conveyed how appreciative Kitsap
staff was of the NFP partnership and leadership coordination.
Big Quilcene River Fishing Season Sanitation
Mr. Keefer spoke about the Big Quilcene River. Historically when fishing season opens,people
have dumped trash, defecated and left messes, this all affecting water quality, as a result DOH
closed downstream shellfish beds. JCPH and Public Works did fund one year of portable toilets
and dumpsters which did improve the 2012 season.
Michael Dawson noted that progress has been made with funding of the vault toilet in Riverfront •
Park, but the hindrance is ensuring long-term maintenance of the toilet. Community groups and
interested parties (including tribes), came together and discussed maintenance. Help in public
education and outreach is needed as well. Mr. Keefer added that the State Department of Fish
and Wildlife is interested, since Commissioner Sullivan contacted and requested some help. At
this point, DOH, DOE, and the County have put in significant time, money and resources.
Water Quality Division update
Michael Dawson outlined current issues regarding water quality in Jefferson County. Starting
with water quality overall—There's a great deal of algae bloom. Jefferson County has been
working closely with the state on testing. Compared with last year, biotoxins haven't been as big
of an issue until this week. Anderson Lake closed and Gibbs Lake has been recommended to
restriction and closed for swimming. There have been some areas of concern in the Irondale Park
restoration area in a small stream contributor. Water quality staff is looking at septic systems in
the area. In the Hood Canal, Water Quality staff has found areas that need attention. These
areas are extremely rural and spread out, making it difficult to locate sources. Other issues are
Best Management Practices regarding livestock and agriculture practices.
Baby-friendly Hospital Report
Note—meeting time constraints prohibited review.
410•
6 BOH Minutes—July 18,2013
ACTIVITY UPDATE
None
AGENDA PLANNING CALENDAR
Member Robinson asked that review of the King County drug take-back program be added to
agenda before October.
NEXT SCHEDULED MEETING
Next Board of Health meeting will be held on August 15, 2013 from 2:30—4:30 p.m. at an
alternate location: The Jefferson County Library, 620 Cedar Ave, Port Hadlock, WA 98339
ADJOURNMENT
Chair Buhler adjourned the BOH meeting at 4:35 PM.
JEFFERSON COUNTY BOARD OF HEALTH
Phil Johnson, Member Jill Buhler, Chair
Roberta Frissell, Member David Sullivan, Vice Chair
Catharine Robinson, Member John Austin, Member—excused
Sheila Westerman, Member
Respectfully Submitted:
Cara Leckenby
t
7 BOH Minutes—July 18,2013
JEFFERSON COUNTY BOARD OF HEALTH
• MINUTES
Thursday, July 18 2013
Jefferson County Public Health, 615 Sheridan Street, Port Townsend, WA 98368
Board Members Staff Members
Phil Johnson, County Commissioner District#1 Thomas Locke,MD,MPH Health Officer
David Sullivan, Vice Chair, County Commissioner,District#2 Jean Baldwin,Public Health Services Dir
John Austin, County Commissioner,District#3 Julia Danskin,Nursing Services Director
Roberta Frissell, citizen at large(County) Jared Keefer,Env. Health Services Dir
Catharine Robinson,Port Townsend City Council Veronica Shaw,Deputy Director
Sheila Westerman, Citizen at large(City)
Jill Buhler, Chair,Hospital Commissioner,District#2
Chair Buhler called the meeting of the Jefferson County Board of Health to order at 2:30 PM. A
quorum was present.
Members Present: Jill Buhler, Sheila Westerman, Roberta Frissell, Catharine Robinson, David
Sullivan, Phil Johnson, John Austin
Staff Present: Dr. Thomas Locke, Jean Baldwin, Jared Keefer, Julia Danskin
• Members Excused: None
APPROVAL OF AGENDA& MINUTES
Chair Buhler called for approval of agenda and minutes.
Member Austin requested to amend the agenda to add a report on Baby friendly hospital
celebration and gala# 7 under new business and activity update on Pacific Coast Salmon
Activity.
Member Frissell requested a correction of the June 20, 2013 minutes on page 4, 4th paragraph
from the bottom; change from"chairman Frissell"to "member Frissell"
Member Robinson requested a correction on page 5, under Legislative Update, sentence
beginning"A large amount of the gap..." change $230,000 to $230,000,000.
Member Robinson requested a correction on page 5, under Activity update: Reword first
sentence "...to present the hospital with a"baby friendly hospital" award. Reword 2nd sentence
to: "Jefferson Healthcare is one of five hospitals in the state being honored."
Member Robinson moved to approve the agenda and minutes as amended; the motion was
seconded by member Frissell. No discussion. The motion passed unanimously.
1 BOH Minutes—July 18,2013
PUBLIC COMMENT
Helen Lauritzen speaking as a co-chair of bio-mass committee and a member of the North
Olympic Group of the Sierra Club thanked Dr. Locke for his strong commitment to the Port
Townsend Paper Company landfill issues. She outlined her concerns regarding the process for
permitting the PTPC landfill, and urged the County, and Department of Ecology (DOE)to hold
firm in requiring the company to obtain a limited purpose permit for their landfill.
Kees Kolff concurred with Ms. Lauritzen. Dr. Kolff thanked the board for their service and
thanked Dr. Locke for the decision that he made regarding The Port Townsend Paper Co.
Dr. Kolff hoped for continued open participatory process regarding the issue.
Dave McWethy also concurred with Ms. Lauritzen and Dr. Kolff. He noted that in the course of
interaction with JCPH, he has appreciated officers and staff and supports positions of the County
regarding the PTPC.
Member Johnson responded to public comments, noting that ORCA and University of
Washington have secured a$516,000 grant to install nano-particle monitors in Jefferson and
Clallam Counties, which will allow a base-line measurement (studied by the University of
Washington).
OLD BUSINESS AND INFORMATIONAL ITEMS
Senator Patty Murray Press Release: •
Member Austin reviewed a press release from Senator Patty Murray's office, noting that she has
secured 65 million dollars in federal funding for the Pacific Coast Salmon Recovery Fund. This
is a significant increase over both President Obama's proposed FY14 budget and the
corresponding House budget, and will likely benefit JCPH water resources budgets.
Member Austin moved to direct Chair Buhler to send a letter of appreciation to Patty
Murray's office. Member Westerman seconded the motion. No further discussion. The
motion passed unanimously.
Healthy/HAPPENINGS—JCPH WIC Newsletter
Julia Danskin—Annual breastfeeding picnic will be August 7t"to celebrate World Breastfeeding
week. Several partnerships should be noted: partnership with Jefferson Healthcare, helping to
support baby-friendly care; partnership through outreach with the YMCA summer program,
providing free meals for kids; partnership with the Jefferson County Farmers market,providing
WIC vouchers for fresh-from-the-farm food; partnership with the Smile Mobile, which is
currently visiting, providing dental care to children and mothers/pregnant women. Member
Frissell commented that she was happy to see Chef Arran Stark giving cooking classes to
families and children, using fresh farmer's market produce. Member Johnson—asked for
clarification regarding the numbers noted in the WIC newsletter specific to Apple Health
2 BOH Minutes—July 18,2013
monthly income limits. Ms. Danskin clarified that levels are for Apple Health free health
• coverage for kids, which is 200% of the Federal poverty level. There are further income limits
for subsidized health care coverage.
Got Birth Control?
Julia Danskin drew attention to the fliers included in the Board's packet regarding family
planning services. A large number of people in the community utilize these services.
Affordable health Coverage: 2014 Information
Julia Danskin reviewed a flier included in the board's packet, prepared by the CHOICE Regional
Health Network about upcoming healthcare and insurance changes, subsequent to the Affordable
Care Act. Jefferson Healthcare, JCPH and Olympic Area Agency on Aging will have small
contracts with CHOICE to train staff and volunteers to help the public enroll in health insurance
options. Starting October 1st, the health care recruitment sign-up will begin, and insurance will
kick in on January 1, 2014. The public can learn more at www.wahealthplanfinder.org. JCPH
will have rooms with internet access and staff available to function as a drop-in center for
enrollment. There will also be at home online registration option.
Member Austin questioned whether Safe Harbor and Jefferson Mental Health are aware of all
this? Ms. Baldwin noted that these agencies and others will be included in outreach. Member
Robinson asked if there is outreach to Dove House and Jumping Mouse. Ms. Danskin responded
that Jefferson County Public Health will be preparing for outreach as the time approaches and
• CHOICE will also be doing outreach.
West End Natural Resources News
Jared Keefer prefaced this presentation; the coastal Marine Resource Committee (MRC) and
Conservation Futures programs are housed under Jefferson County Environmental Health and
these programs complement the clean water programs. Tammy Pokorny, Environmental Health
Specialist, noted that the Washington State Department of Fish and Wildlife manages the coastal
MRC's. The North Pacific Coast (NPC)MRC incorporates East and West Jefferson Counties.
The organizations bring together tribes and agencies at the local, State and Federal level to create
and implement projects related to coastal marine environments. The NPC MRC received
funding for its programs, including publishing a newsletter regarding the range of projects which
the MRC's address. The June issue of the West End Natural Resources News (included in Board
packet), highlights projects, including the Marine Spatial Planning—zoning coastal waters, and
prepare for alternative energy projects and other area issues. MRC member enthusiasm exposes
under-appreciated and under-covered issues in the coastal areas—highlighted in the newsletter.
Member Austin noted that the publication is well put together.
Syringe Exchange Program
Julia Danskin reviewed the Syringe Exchange Program (SEP) 2012 end of year report—JCPH
has continued the SEP. A public health nurse is available to see drop-ins in addition to
• scheduled clinics offered. In 2012, the number of syringes dispensed was 17,405, with 150
3 BOH Minutes—July 18,2013
visits. In light of recent heroin deaths in Clallam Co. and the use among younger people, there's
an increased effort for education and referral during client visits to SEP.
111
Legislative Wrap-up
Dr. Locke reported that State government shutdown was avoided, with the most significant
change from local public health standpoint being that the 3 funding streams are intact, but their
distribution has changed to a"block grant"through the Treasurer's office (rather than through
the Department of Health). Stable,predictable funding for foundational public health services
has been a priority, and those funds are intact. Member Westerman wondered whether the result
was a product of effective lobbying effort. Dr. Locke responded that a strong coalition of
Counties, Cities, local health departments and allies in the hospital association and state medical
association, all supportive, lead to the positive outcome. The message that gets to the legislature
is that these core services are a high priority for many different groups and core services have a
high impact on the community. Additionally, in a very tough budget year,there was a push for
restoring oral health-care funding in the Medicaid program for adults, which has been restored
for about 45,000 adults in the state,plus those who will become eligible through healthcare
reform (taking effect in the beginning of January 2014). Getting coverage is one issue, but an
additional barrier is finding dentists who will accept that coverage. Overall,the legislature
should be complimented for their foresight in funding of these programs.
NEW BUSINESS
A Conversation with John Wiesman,DrPH,MPH,Washington State Secretary of Health
Chair Buhler introduced and welcomed Dr. Wiesman, Dr.PH, MPH, the Washington State
Secretary of Health. Dr. Wiesman extended his thanks for a warm welcome, and outlined some
of his background and goals. A priority for Dr. Wiesman, having come from local health
department background, is the opportunity to visit all local health jurisdictions in the state.
Four goals for Dr. Wiesman and the Department of Health(DOH): Healthcare reform, Working
on obesity epidemic, Public health impacts of climate change, and funding of public health
system.
• Healthcare reform: Opportunities to care for public health: working with healthcare
authority,health benefit exchange, and DSHS at a systems level. Thinking about better
engagement and increased healthcare for the public.
• Continuing to work on obesity epidemic. The epidemic is likely to result in chronic
disease cost increases and lower life spans if not addressed.
• Public Health impacts of climate change. Paying attention to air quality, animal-pest
ecological changes, and changes in extreme heat conditions. Focusing on what the
Department of Health role is in mitigation of these issues and where the opportunities are
to partner across systems.
• Funding of public health system. The State and local systems are struggling with
funding. As Secretary of Health, Dr. Wiesman will focus on providing leadership to find
•
4 BOH Minutes—July 18,2013
stable funding. One area of focus is adding to the stakeholders at the table. Believes in
• bringing more partners in the discussion, including BOH members and commissioners.
Finally, the state/local relationship is important. Dr. Wiesman shared what's going on in
Jefferson County through DOH: 1094 Shellfish biotoxin tests, 800 marine water testing, and one
white powder sample; data accumulation and interviews regarding the health of Jefferson
County; 102 newborns tested for genetic and other diseases; 22 commercial shellfish growers
licensed, 17 large onsite sewage systems, 67 Group A systems serving 24,000 people; 83
different professions and managing disciplines licensed; 1700 healthcare credentials in Jefferson
County, and one hospital, from those, 19 complaints investigated.
Dr. Wiesman welcomed input and feedback as he moves forward with these goals.
Member Sullivan noted that different counties, although diverse, tend to come together on
flexible funding, meeting needs on an individual county basis. He also noted that he would like
a coordinated message from the State across agencies.
Member Johnson conveyed that Jefferson Co. works at meeting and agreeing across jurisdiction
for a coordinated approach to state DOH, and noted major differences and diversity between the
counties.
Member Westerman noted that despite extensive outreach and calls for public involvement,
there's disparity between public understandings about what public health does in the community.
• She indicated that the challenge is to educate public about the importance of funding public
health.
Dr. Wiesman responded that creativity—thinking outside the box—may be the key for engaging
and solving these funding issues. The solutions may not be what have worked in the past, but
he's confident that with collaboration, new solutions can be found.
Ms. Baldwin noted that there's a possibility of restructuring and systemizing some of the work,
sharing expertise across jurisdictional boundaries and ensuring that training and expertise still
exists even in funding crises. Dr. Wiesman agreed and noted the successes (example: sharing
epidemiology with Kitsap) in sharing across jurisdiction, including some cost savings.
School-based Clinic End of Year Report
Ms. Baldwin distributed a draft of School-based Clinic End of Year Report. The draft doesn't
include mental health funding. The final report will follow later in the summer. The clinic
continues to see the same amount of students; there are more chronic issues: eating disorder
spectrum, asthma, diabetes, etc. There aren't many with diabetic or asthma out of control, but
health monitoring is continuing. The Nurse Practitioners in the schools are well accepted and
students continue to reach out. Member Austin mentioned the reported teen pregnancy rate
decrease, and noted that it says a lot about public health involvement in that decrease.
•
5 BOH Minutes—July 18,2013
Nurse Family Partnership Yearly Partnership •
Yuko Umeda, Public Health Nurse,presented the NFP annual plan.NFP focuses on decreased
pre-term births, and increased attrition in the program. The program has been in place in
Jefferson County since 1999. JCPH NFP team works to change smoking habits, child abuse and
neglect rates locally, increase school readiness,help mom's space births and decrease use of
substances. In the past year, Jefferson County NFP formed a regional partnership with Kitsap
and Port Gamble S'Klallam Tribe. With this new partnership there's opportunity for forming a
new community advisory board with members of Jefferson, Kitsap, and the Tribe. Ms. Baldwin
conveyed that JCPH met with the Elwha Tribe about NFP partnership and they're considering
options.
Dr. Wiesman,having visited Kitsap County Health District, conveyed how appreciative Kitsap
staff was of the NFP partnership and leadership coordination.
Big Quilcene River Fishing Season Sanitation
Mr. Keefer spoke about the Big Quilcene River. Historically when fishing season opens,people
have dumped trash, defecated and left messes, this all affecting water quality, as a result DOH
closed downstream shellfish beds. JCPH and Public Works did fund one year of portable toilets
and dumpsters which did improve the 2012 season.
Michael Dawson noted that progress has been made with funding of the vault toilet in Riverfront •
Park,but the hindrance is ensuring long-term maintenance of the toilet. Community groups and
interested parties (including tribes), came together and discussed maintenance. Help in public
education and outreach is needed as well. Mr. Keefer added that the State Department of Fish
and Wildlife is interested, since Commissioner Sullivan contacted and requested some help. At
this point, DOH, DOE, and the County have put in significant time, money and resources.
Water Quality Division update
Michael Dawson outlined current issues regarding water quality in Jefferson County. Starting
with water quality overall—There's a great deal of algae bloom. Jefferson County has been
working closely with the state on testing. Compared with last year, biotoxins haven't been as big
of an issue until this week. Anderson Lake closed and Gibbs Lake has been recommended to
restriction and closed for swimming. There have been some areas of concern in the Irondale Park
restoration area in a small stream contributor. Water quality staff is looking at septic systems in
the area. In the Hood Canal, Water Quality staff has found areas that need attention. These
areas are extremely rural and spread out, making it difficult to locate sources. Other issues are
Best Management Practices regarding livestock and agriculture practices.
Baby-friendly Hospital Report
Note—meeting time constraints prohibited review.
•
6 BOH Minutes—July 18,2013
ACTIVITY UPDATE
•
None
AGENDA PLANNING CALENDAR
Member Robinson asked that review of the King County drug take-back program be added to
agenda before October.
NEXT SCHEDULED MEETING
Next Board of Health meeting will be held on August 15, 2013 from 2:30—4:30 p.m. at an
alternate location: The Jefferson County Library, 620 Cedar Ave, Port Hadlock, WA 98339
ADJOURNMENT
Chair Buhler adjourned the BOH meeting at 4:35 PM.
JEFFERSON COUNTY BOARD OF HEALTH
• V42.7.6e-e-4/'
Phil Johnson, ember Jill Buhie Chair
444/ 4:44-aa
Roberta Frissell, Member David Sullivan Vice Chair
(1414_4_,:A2 I,
Catharine Robinson, Member Johiii Austin, Member
()1 624111[4-4-1----
Sheila Westerman, Member
Respectfully Submitted:
Cara Leckenby
•
7 BOH Minutes—July 18,2013
Board of Health
Netiv Business &
Informational Items
.Agenda Item #1V., 1
� Secure .Medicine Return
Presentation from
Seattle & Xing County
Public 3-Cealth
• .august 15, 2013
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Secure Medicine Return Problem Statement
• Drug overdose deaths have surpassed car crashes as a
leading cause of preventable death in King Co.
• Medicines used in the home are the leading cause of
poisonings, especially among children
/pp
and seniors.
• Medicine take-back programs provide
secure collection and destruction of
unwanted medicines to protect
public health and the environment.
• Currently, no sustainable financing for
a medicine take-back system that
meets community needs.
2
•
Epidemic: Responding to America's
Prescription Drug Abuse Crisis
2013 National Drug Control Strategy:
1. Education of health providers and the public.
2. Expand prescription monitoring programs.
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4. Effective enforcement to address
"pill mills" and "doctor shopping." '
•
3
Barriers to a Comprehensive Medicine
Take-back System in King County:
• Challenges in collection of controlled
substances - help coming from new DEA draft
regulation! authorizes take-back by retail pharmacies,
manufacturers, drug distributors, and reverse
distributors.
• Convenience and access - too few drop-off sites;
too much of county unserved.
• Financing - lack of dedicated & adequate funding;
very limited funding for education & promotion.
• Lack of an efficient system - no county-wide
coordination.
4
•
DEA's Proposed Rule for Secure & Responsible
Drug Disposal Act of 2010
December 2012 draft rule published; comment period ended
February 2013; waiting for final rule.
Controlled substances may be collected with all other
medicines through 3 take-back methods under specific security
protocols.
Collection receptacles (i.e. drop-off boxes) and mail-back
programs may be operated by authorized retail pharmacies,
drug manufacturers, drug distributors, reverse
distributors, and law enforcement.
Take-back events may be conducted by law enforcement onl y ••
Product Stewardship Approaches for
Medicine Take-back
Pharmaceutical manufacturers provide
medicine return systems
in B.C., Manitoba, Ontario,
France, Spain & Mexico. Don't
throw it out
"Product stewardship" is the act of lake-it6ackta
nearest PhonfaYour
minimizing health, safety, environmental, we,aresedicntio„ eturvisit
for'fore information. ,l c,
social impacts, while maximizing economic
/ J °TbU9N0N5
benefits of a product and its packaging RM
throughout all lifecycle stages.
6
•
Product Stewardship Legislation for
Pharmaceuticals in the U.S.
• Federal legislation introduced in 2011 (HR 2939 —
Slaughter); no action taken; potential reintroduction in
2013 or 2014.
• State-level legislation proposed in 8 states in recent
years (CA, FL, ME, MD, MN, NY, OR, PA, WA); none
have passed yet.
• San Francisco, City & County, considered a Safe Drug
Disposal ordinance in 2010. Legislation tabled when
PhRMA and Genentech agreed to provide grant funds
for a city-operated pilot program.
• • Alameda County, CA passed a Safe Drug Disposal
Ordinance in July 2012.
Board of Health Subcommittee on
Secure Medicine Return
• Chair Joe McDermott, Boardmembers David Baker,
Richard Conlin and Dr. Bud Nicola, and Public Health
Director David Fleming
• 10 Subcommittee meetings over one year
• Two phases -
• Hearing from interested stakeholders both pro and con
• Policy discussion and proposals
• Draft Rule & Regulation taken forward for public hearing
and vote by full Board of Health
8
S
Board of Health Subcommittee on
Secure Medicine Return
Stakeholders included:
• Current providers or regulators of medicine take-back
activities
• Pharmaceutical industry
• Organizations representing impacted residents
• Substance abuse professionals
• Health and medical organizations
• Community organizations
• Environmental groups
•
I
Overview of Secure Medicine Return
Rule & Regulation
• Residents bring leftover, expired, and unneeded medicines
to secure drop boxes in retail pharmacies or law
enforcement offices throughout the county.
• If a drop-off site is not available in a specific area then
periodic collection events or prepaid return mailers will be
provided.
• Collected medicines are securely handled, transported and
disposed of according to federal & state laws and policies.
• Drug producers are required to finance and provide the
secure medicine return system.
• PHSKC provides oversight to ensure safety and
compliance.
•
Overview of Secure Medicine Return
Rule & Regulation
Medicines accepted for return:
Prescription and over-the-counter drugs from residential
sources, including controlled substances.
Not accepted:
• Over-the-counter drugs that are also regulated as
cosmetics.
• Vitamins and supplements.
• Specific situations where drugs have established take-back
systems.
•
11
Overview of Secure Medicine Return
Rule & Regulation
Operation of the system by drug producers:
Drug producers develop a stewardship plan to meet the
requirements and standards of the R&R.
"Drug Producers" are the companies that "manufacture" the
"covered drug".
Does not include:
• Compounding pharmacists preparing drugs for individual patients.
• Drug retail brand holders unless it is not possible to identify the
manufacturer of the store brand drug.
At least 167 pharmaceutical companies sell medicines for
residential use in Washington State.
Sales in King County alone are > $1 .1 billion annually.
12
•
Overview of Secure Medicine Return
Rule & Regulation
Collection system — "service convenience goal"
• All pharmacies and law enforcement agencies that
volunteer to serve as collectors can participate.
• Minimum number of drop-off sites provided or
provide periodic collection events and/or prepaid mailers.
• Prepaid, preaddressed mailers can be requested for home
bound or disabled residents.
• Drug handling must conform to all applicable federal and
state laws, regulations, and policies, including DEA and the
•
Washington State Board of Pharmacy.
13
Overview of Secure Medicine Return
Rule & Regulation
11111
Final disposal of collected medicines
• At a properly permitted hazardous waste facility, unless
permission is granted to use a large municipal waste
combustion facility (e.g. Waste-to-Energy facility) because
of cost or logistical barriers.
• Use of alternative disposal technologies may also be
approved.
r I r
ak
14
•
Overview of Secure Medicine Return
Rule & Regulation
Required promotion by drug producers:
• Promote safe storage of medicines and use of the medicine return
system
• Materials for pharmacies, health care facilities, and others
• Website and toll-free number
• Develop clear instructions on use of secure drop boxes and a readily
recognizable, consistent drop box design
Required evaluation by drug producers:
• Annually report pounds of medicines collected & evaluate the
effectiveness of program promotion
• • Conduct survey of residents after the first program year, and again at
years five and nine
15
Overview of Secure Medicine Return
Rule & Regulation
Cost responsibilities
Drug producers are responsible for costs of:
• Collection supplies, prepaid mailers, collection events
• Transporting collected medicines and final disposal
• Program promotion and evaluation
• Administrative costs
• Fees to PHSKC to reimburse costs of oversight
Voluntary collectors will provide in-kind staff time at drop-off sites.
LHWMP will assist with start-up costs of secure drop boxes and
with education/promotion.
No visible fee on medicines at purchase or return.
16
Overview of Secure Medicine Return
Rule & Regulation
Oversight and enforcement by Public Health—Seattle
& King County
• Review and approval of the stewardship plan(s), plan
changes, and plan updates
• Monitoring of plan operations
• Inspections as needed
• Review of annual reports
Enforcement: written warnings and civil penalties of up to
$2,000 per day.
Cost recovery through fees collected from each
stewardship plan, paid by drug producers.
1'
How Medicine Take-Back Works
Medicine take-back programs are the secure and environmentally
• sound way to dispose of leftover and expired medicines.
• Ongoing drop-off programs are usually at a pharmacy or a law
enforcement office. _
• Take-back programs use secure equipment and procedures to prevent i
theft or diversion.•
Collected medicines are destroyed in a way that protects our environment.
1
Take-back programs can be
m
• Ongoing drop-off programs. + 'T
• One-day collection events.
• Mail-back programs.
• Combinations of these approaches. CE
r Q a
Pharmacy programs: These programs can accept all over-the-counter medi-
cines and prescription medicines, except those that are controlled substances. 1
Law enforcement programs: Most law enforcement programs accept all Vis-
medicines, including controlled substances; some only accept prescription
medicines.
Current federal regulations allow only law enforcement to collect controlled
substances. The DEA is writing new regulations to allow additional collection '3'"1;h$i��=
ptions. ��°� A e i .i�14111111�gOf,.
Secure drop boxes, tracking and storage
Unwanted medicines are deposited in metal collection bins that have been
specially designed to prevent theft. Medicines deposited into the bin drop into
a plastic bucket or cardboard box. When that inner container is full, trained
staff follow strict procedures to seal the box, assign a tracking number, and CIeanNarb`aS s v �.
send it to a secure storage facility. ""°'""" ,C
Secure and proper disposal o .h ~ °
Once a shipment of boxes has accumulated in a secure storage area,
the waste medicines are sent to a disposal facility, where they are
destroyed by high temperature incineration.
Demand is high
The demand for medicine take-back is high. Washington residents Since the first program started
are using voluntary take-back programs because they are con-
in Washington in 2003, no theft
venient, secure and don't pollute the environment. Unfortunately or diversion of any returned
these programs are funded with shrinking local government and medicines has occurred in any
law enforcement budgets, pharmacy funds, or grants — sources authorized medicine take-back
of funding that are not guaranteed. Due to a lack of funds, large program.
•eas of our state have no ongoing take-back locations.
Learn more about how medicine take-back programs work at:
http://www.takebackyourmeds.org/why/how-medicine-take-back-works take back
<►YOUR MEDS
Jefferson County Board of Health, August 15, 2013
Overview of King County Secure Medicine Return Rule & Regulation.
The King County Board of Health adopted a Rule and Regulation (R&R) establishing an industry-funded product
stewardship model to collect and safely dispose of unwanted household medicines from residents of the county.
Overview of the proposed secure medicine return system
Residents will be encouraged to bring leftover, expired, and unneeded medicines to secure drop boxes in retail
pharmacies or law enforcement offices throughout the county. These collection sites will participate voluntarily,
and if a medicine drop-off site is not available in a specific area then periodic collection events or pre-paid return
mailers will be provided. Pre-paid return mailers can be requested for residents who are home bound or disabled.
Drop-off site locations and other collection services will be promoted to the community through a toll-free
telephone line, a website, and print materials.
Collected medicines will be securely handled,transported and disposed of according to federal and state laws,
including policies of the Drug Enforcement Administration and the Washington State Board of Pharmacy. The
drugs will be destroyed at properly permitted high temperature incineration facilities.
Drug producers selling medicines for residential use in or into King County are required to finance and provide the
secure medicine return system. Residents cannot be required to pay a fee for secure medicine return when they
purchase medicines or return them. Public Health -Seattle & King County(Public Health) will oversee the drug
producers' medicine return system to ensure safety and compliance with the R&R.
Medicines accepted for return
• Prescription and non-prescription (over-the-counter) medicines that residents use in their homes, or in other
residential settings. Includes medicines in any form: pills, liquids, creams; and includes legally prescribed
controlled substances, such as OxyContin,Vicodin,Valium, Ritalin, and stimulants.
• Current DEA regulations restrict return of controlled substances to law enforcement drop-off sites or
collection events; however, new regulations the DEA is developing will authorize drug manufacturers, retail
pharmacies and others to operate drop-off and mail-back programs.
• Not accepted for return: over-the-counter drugs that are regulated as cosmetics, e.g. toothpaste, sunscreen,
medicated shampoos; vitamins and supplements; and pharmaceutical waste from businesses.
Operation of the system by drug producers
• The proposed R&R defines requirements and standards, but allows drug producers to develop their own
stewardship plan for providing an efficient medicine return system.
• Every drug producer selling medicines for residential use in or into the county must participate in the
"standard" stewardship plan. If a producer or group of producers prefers to form a different partnership,they
may propose an "independent" plan. Both the standard plan and the independent plan must meet system
requirements and standards, and be approved by Public Health before initiating operations.
• If multiple stewardship plans are approved,the plans must coordinate their promotional activities to ensure
residents can easily understand and use the collection services of any plan.
• Timing of program implementation: drug producers must submit a proposed stewardship plan no later than
12 months after the R&R is enacted; and must begin operation of the stewardship plan no later than 3 months
after plan approval by Public Health.
System requirements&standards
• The primary collection method will be secure drop boxes at retail pharmacies and law enforcement offices.
• The R&R defines a "service convenience goal" to ensure convenient and equitable access for all residents.Any
retail pharmacy or law enforcement agency that volunteers to be a drop-off site must be included in the
• collection system to ensure as many drop-off sites as possible. Any areas lacking a minimum number of drop-
off sites will be served through periodic collection events and/or through mail-back programs.
This overview is for explanatory purposes only. For more information on the King County Board of Health's Subcommittee on Secure Medicine Return,see
www.kingcounty.gov/healthservices/health/BOH/MedicineTakeback.aspx,or contact Administrator Maria Wood at maria.wood@kingcounty.gov or 206-263-8791.
System requirements &standards (continued)
• Prepaid, preaddressed mailers can be requested for home bound or disabled residents.
• Collectors may offer to serve as a collector voluntarily, or may agree to serve in exchange for incentives or
payment offered by the drug producers.
• Handling of all drugs must conform to all applicable federal and state laws and regulations, including those of
the Drug Enforcement Administration and the Washington State Board of Pharmacy.
• Collected medicines must be disposed of at a properly permitted hazardous waste facility, unless permission
is granted to use a large municipal waste combustion facility(e.g. Waste-to-Energy facilities) because of cost
or logistical barriers. Use of alternative disposal technologies that provide superior environmental and human
health protection may also be approved.
Promotion and evaluation requirements
Promotion: drug producers are required to promote safe storage of medicines and how to use the medicine
return system to residents, pharmacists, retailers, and health professionals; provide materials to pharmacies,
health care facilities, and others; and provide a website and a toll-free number. Drug producers must work with
collectors to develop clear instructions on use of secure drop boxes and a readily recognizable, consistent drop
box design.
Evaluation: drug producers must report annually on the pounds of medicines collected, annually evaluate the
effectiveness of program promotion, and conduct a survey of residents to measure awareness and program
convenience after the first program year, and again at years five and nine.
The Local Hazardous Waste Management Program will develop template educational materials for use by
pharmacies, law enforcement, health care providers and local governments, and provide targeted education to
key populations.
Costs responsibilities •
Drug producers are responsible for:
• Costs of collection supplies for drop-off sites, prepaid mailers, and any collection events.
• Costs of transporting collected medicines(including law enforcement escort if required), and final disposal at
approved high temperature incineration facilities.
• Costs of program promotion and evaluation, as well as administrative costs.
• Payment of fees to Public Health to reimburse costs of plan review and annual oversight.
Collectors participate voluntarily and provide in-kind staff time at drop-off sites.
The Local Hazardous Waste Management Program in King County is responsible for costs of:
• Providing up to 400 secure drop boxes for the standard stewardship plan. Drug producers participating in the
standard plan are responsible for any additional drop boxes or maintenance costs, and producers operating
an approved independent plan must provide all drop boxes.
• Assisting with program promotion (see description above).
Oversight and enforcement
• Public Health will oversee the program to ensure compliance and safety.
• Public Health oversight authority includes: review and approval of the stewardship plan(s)from drug
producers, monitoring of plan operations, inspections as needed, review and approval of substantive changes
to the approved stewardship plan(s), and review of annual reports.
• Drug producers who are not in compliance with the R&R are subject to written warnings and civil penalties of
up to $2,000 per day.
• Public Health oversight costs will be recovered through plan review and annual operating fees from
producers. •
This overview is for explanatory purposes only. For more information on the King County Board of Health's Subcommittee on Secure Medicine Return,see
www.kingcounty.gov/healthservices/health/BOH/MedicineTakeback.aspx,or contact Administrator Maria Wood at maria.wood@kingcounty.gov or 206-263-8791.
KING COUNTY 1200 King County Courthouse
516 Third Avenue
3, w
Seattle,WA 98104
411 Signature Report
King County
June 21, 2013
R&R BOH13-03
Proposed No. BOHI3-03.1 Sponsors
1 A RULE AND REGULATION relating to providing safe
2 collection and disposal of unwanted drugs from residential
3 sources through producer provided and funded product
4 stewardship plans by amending R&R 66, Section 1 (part), as
5 amended, and BOH 2.08.085, adding a new chapter to BOH
6 Title 11,and prescribing penalties; enacted pursuant to RCW
7 70.05.060, including the latest amendments or revisions
8 thereto.
110
9 BE IT ADOPTED BY THE KING COUNTY BOARD OF HEALTH:
10 SECTION 1. Findings:
11 A. Residents of King County benefit from the authorized use of prescription and
12 nonprescription, or over-the-counter, medicines. However abuse, fatal overdoses and
13 poisonings from prescription and nonprescription medicines used in the home have
14 emerged as an epidemic in recent years.
15 B. More people die from prescription medicines than from heroin and cocaine
16 combined. Drug overdoses in King County have surpassed car crashes as a leading cause
17 of preventable deaths, with the majority of overdoses involving prescription opiates.
18 C. Prescription and nonprescription medicines used in the home are the leading
19 cause of poisonings reported to the Washington Poison Center, and preventable
11) 1
R&R BOH13-03
20 poisonings from medicines have been rising rapidly, especially among children and
21. seniors.
22 D. Unused, expired and leftover drugs that accumulate in homes increase risks of
23 drug abuse, overdoses, and preventable poisonings. A system for the proper disposal of
24 unneeded drugs is an element of a comprehensive strategy to prevent prescription drug
25 abuse.
26 E. Flushing medicines down toilets and sinks is an inappropriate disposal practice
27 because wastewater treatment facilities cannot effectively remove or degrade all
28 pharmaceutical compounds. Trash disposal of medicines is an undesirable disposal
29 option because trash cans are not secure and mixed pharmaceutical wastes are household
30 hazardous wastes that should not be disposed of in the solid waste stream.
31 F. Medicine take-back programs provide secure collection and environmentally
5
32 sound destruction of unwanted medicines to protect public health.
33 G. Voluntary medicine take-back programs in the county are insufficient to
34 protect the public, so local action is warranted to reduce risks of abuse, overdoses and
35 poisoning.
36 H. The Board of Health finds it in the interest of public health to establish a
37 county-wide secure medicine return program providing equitable access for all of the
38 county's residents that is financed and operated by drug producers selling medicines in or
39 into King County for residential use. Although producers may not charge a specific
40 point-of-sale or point-of-collection fee, the board does not otherwise intend to preclude
41 producers from recouping the costs of their program through other means, including
42 allocating costs to the prices of their covered drugs in King County.
2
R&R BOH13-03
43 I. The Board of Health approved the Local Hazardous Waste Management
44 Program's plan, on April 15, 2010, which states support for product stewardship
45 approaches for waste pharmaceuticals from residential sources. The plan states that
46 product stewardship provides a means "to shift from a system focused on government-
47 funded and ratepayer-financed waste disposal and diversion, to one that relies on
48 producer responsibility in order to reduce public costs, increase accessibility to services,
49 attain higher environmental benefits, and drive improvements in product design that
50 promotes environmental sustainability."
51 J. Drug producers are well-positioned to efficiently develop and operate the
52 medicine take-back system, working with other stakeholders such as pharmacies and law
53 enforcement, within standards prescribed by the board to ensure safety and security of the
• 54 system, and in compliance with pertinent federal and state laws, regulations, and
55 guidelines.
56 K. The Board of Health encourages pharmacies, health care providers, health
57 professionals, government agencies responsible for solid waste management, wastewater
58 treatment and health and community organizations in the county to inform residents
59 through all their standard communication methods about safe storage of medicines and
60 the use of collection services for unwanted medicines provided through the drug
61 producers' stewardship program.
62 SECTION 2. Sections 3. 4, 5, 6. 7, 8, 9. 10, 11, 12, 13, 14, 15, 16, 17 and 18 of
63 this rule should constitute a new chapter on secure medicine return in BOH Title 11.
3
R&R BOH13-03
110
64 NEW SECTION. SECTION 3. Short title. This chapter may be cited and
65 referred to, and shall he known as, the King County Board of Health Secure Medicine
66 Return Regulations.
67 NEW SECTION. SECTION 4. Purpose and scope of chapter.
68 A. This chapter is enacted as an exercise of the Board of Health powers of King
69 County to protect and preserve the public health, safety and welfare. Its provisions shall
70 be liberally construed for the accomplishment of these purposes. This chapter governs
71 the protection of human health and safety against the improper handling and disposal of
72 leftover or expired medicines.
73 B. It is the intent of this chapter to place the obligation of complying with its
74 requirements upon drug producers and other persons designated by this chapter within its
75 scope, and any provision of or term used in this chapter is not intended to impose any
76 duty whatsoever upon King County or any of its officers or employees, for whom the
77 implementation or enforcement of this chapter shall be discretionary and not mandatory.
78 NEW SECTION. SECTION 5. Definitions. The definitions in this section apply
79 throughout this chapter unless the context clearly requires otherwise.
SO A. "Collector" means a person that gathers unwanted covered drugs from covered
81 entities for the purpose of collection, transportation and disposal.
82 B.1. "Covered drug" means a drug sold in any form and used by covered entities,
83 including prescription, nonprescription, brand name and generic drugs.
84 2. "Covered drug" does not include:
85 a. vitamins or supplements;
86 b. herbal-based remedies and homeopathic drugs, products or remedies;
4 •
R&R BOH13-03
•
87 c. cosmetics, shampoos, sunscreens, toothpaste, lip balm, antiperspirants or
88 other personal care products that are regulated as both cosmetics and nonprescription
89 drugs under the federal Food, Drug, and Cosmetic Act (Title 21 U.S.C. Chapter 9);
90 d. Drugs for which producers provide a pharmaceutical product stewardship or
91 take-back program as part of a federal food and drug administration managed risk
92 evaluation and mitigation strategy (Title 21 U.S.C. Sec. 355-1);
93 e. Drugs that are biological products as defined by 21 C.F.R. 600.3(h) as it
94 exists on the effective date of this rule if the producer already provides a pharmaceutical
95 product stewardship or take-back program;
96 f. Medical devices, their component parts or accessories, or a covered drug
97 contained in or on medical devices or their component parts or accessories; and
1111 98 g. Pet pesticide products contained in pet collars, powders, shampoos,topical
99 applications, or other forms.
100 C. "Covered entities" means residents of King County, including individuals
101 living in single and multiple family residences and other residential settings, and
102 including other nonbusiness sources of prescription and nonprescription drugs that are
103 unused, unwanted, disposed of or abandoned by residents as identified by the director.
104 "Covered entities" does not include business generators of pharmaceutical waste, such as
105 hospitals, clinics, doctor's offices, veterinarian clinics, pharmacies, or airport security and
106 law enforcement drug seizures.
107 D. "Director" means the director of the Seattle-King County Department of
108 Public Health or the director's duly authorized representative.
110 5
R&R BOH13-03
4110
109 E. "Drug wholesaler" means a corporation, individual or other entity that buys
110 drugs or devices for resale and distribution to corporations, individuals or entities other
111 than consumers.
112 F. "Drugs" means:
113 1. Articles recognized in the official United States pharmacopoeia,the official
114 national formulary, the official homeopathic pharmacopoeia of the United States or any
115 supplement of the formulary or those pharmacopoeias as published by the U.S.
116 Pharmacopeial Convention and the Homeopathic Pharmacopoeia Convention of the
117 United States;
118 2. Substances intended for use in the diagnosis, cure, mitigation, treatment or
119 prevention of disease in humans or other animals;
120 3. Substances, other than food, intended to affect the structure or any function of
•
121 the body of humans or other animals; or
122 4. Substances intended for use as a component of any substances specified in 1.,
123 2. or 3. of this subsection, but not including medical devices, their component parts or
124 accessories, or a covered drug contained in or on medical devices or their component
125 parts or accessories.
126 G. "Independent stewardship plan" means a plan other than the standard
127 stewardship plan for the collection, transportation and disposal of unwanted covered
128 drugs that:
129 1. May be proposed by a producer or group of producers; and
6 4110
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130 2. If approved, is financed, developed and implemented by the participating
131 producer or group of producers, and operated by the participating producer or group of
132 producers or a stewardship organization.
133 H. "Local hazardous waste management program" means the King County local
134 hazardous waste management program identified in BOH 2.08.080.
135 I. "Manufacture" means "manufacture" as defined in RCW 18.64.011 that is the
136 production, preparation, propagation, compounding or processing of a drug or other
137 substance or device or the packaging or repackaging of the substance or device, or the
138 labeling or relabeling of the commercial container of such substance or device, but does
139 not include the activities of a practitioner who, as an incident to his or her administration
140 or dispensing such substance or device in the course of his or her professional practice,
141 prepares, compounds, packages, or labels such substance or device.
142 J. "Manufacturer" means a person, corporation or other entity engaged in the
143 manufacture of drugs or devices, as defined in RCW 18.64.011.
144 K. "Mail-back services" means a collection method for the return of unwanted
145 covered drugs from covered entities utilizing prepaid and preaddressed mailing
146 envelopes.
147 L. "Nonprescription drug" means a drug that may be lawfully sold without a
148 prescription.
149 M. "Person" means a firm, sole proprietorship, corporation, limited liability
150 company, general partnership, limited partnership, limited liability partnership.
151 association, cooperative or other entity of any kind or nature.
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152 N. "Pharmacy" means a place licensed by the state of Washington board of
153 pharmacy where the practice of pharmacy, as defined in RCW 18.64.011,is conducted.
154 0. "Prescription drug" means any drugs, including controlled substances,that are
155 required by an applicable federal or state law or regulation to be dispensed by
156 prescription only or are restricted to use by practitioners only.
157 P. "Producer" means a manufacturer that is engaged in the manufacture of a
158 covered drug sold in or into King County, including a brand-name or generic drug.
159 "Producer" does not include:
160 1. A retailer whose store label appears on a covered drug or the drug's
161 packaging if the manufacturer from whom the retailer obtains the drug is identified under
162 section 6.C. of this rule;
163 2. A pharmacist who compounds a prescribed individual drug product for a
•
164 consumer;or
165 3. A wholesaler who is not also a manufacturer.
166 Q. "Retail pharmacy" means a pharmacy licensed by the state of Washington
167 board of pharmacy for retail sale and dispensing of drugs.
168 R. "Standard stewardship plan" means the plan for the collection,transportation
169 and disposal of unwanted covered drugs that is:
170 1. Finan.ced,developed, implemented and participated in by producers;
171 2. operated by the participating producers or a stewardship organization; and
172 3. Approved as the standard stewardship plan. •
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•
173 S. "Stewardship organization" means an organization designated by a producer or
174 group of producers to act as an agent on behalf of each producer to develop and
175 implement and operate the standard stewardship plan or an independent stewardship plan.
176 T. "Unincorporated community service area" means any of the areas established
177 under King County Ordinances 17139 and 17415.
178 U. "Unwanted covered drug" means any covered drug no longer wanted by its
179 owner,that:
180 1. Has been abandoned or discarded; or
181 2. Is intended to be discarded by its owner.
182 NEW SECTION. SECTION 6. Stewardship plans - participation.
183 A. Each producer shall participate in the standard stewardship plan approved by
• 184 the director, except that a producer may individually, or with a group of producers, form
185 and participate in an independent stewardship plan if approved by the director.
186 B. The standard stewardship plan and any independent stewardship plan shall be
187 approved by the director before collecting unwanted covered drugs. Once approved,
188 stewardship plans must have prior written approval of the director for proposed changes
189 as described under section 15 of this rule.
190 C. By six months after the date of adoption of this rule, or by six months after a
191 producer initiates sale of a covered drug in or into King County, a producer shall notify
192 the director in writing of the producer's intent to participate in the standard stewardship
193 plan or to form and participate in an independent stewardship plan. A retailer whose
194 store label appears on a covered drug or the drug's packaging must notify the director of
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195 intent to participate or provide written notification that the manufacturer from whom the
196 retailer obtains the drug has provided its notice of intent to participate.
197 D. A producer or group of producers participating in the standard stewardship
198 plan or an independent stewardship plan shall:
199 1. By nine months after this rule is adopted, identify in writing to the director a
200 plan operator, including the plan operator's telephone, mailing address and email contact
201 information,who is authorized to be the official point of contact for the stewardship plan;
202 2.a. By nine months after this rule is adopted,notify all retail pharmacies and
203 law enforcement agencies in the county of the opportunity to participate as a drop-off site
204 in accordance with section 8.A. and E. of this rule, and provide a process for forming an
205 agreement between the plan and interested collectors; and
206 b. annually thereafter, make the same notification to any nonparticipating or
•
207 new retail pharmacies or law enforcement agencies in the county;
208 3. By one year after this rule is adopted, submit a proposed stewardship plan as
209 described in section 7 of this rule to the director for review;
210 4. Within three months after the director's approval of the stewardship plan,
211 operate or participate in a stewardship plan in accordance with this chapter;
212 5. At least every four years after each plan initiates operations, submit an
213 updated plan to the director explaining any substantive changes to components of the
214 stewardship plan required in section 7 of this rule, and accompanied by the review fee in
215 accordance with section 18 of this rule. The director shall review updated stewardship
216 plans using the process described in section 14 of this Rile; and
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217 6. Pay all administrative and operational costs and fees associated with their
218 stewardship plan as required under sections 11 and 18 of this rule.
219 E. A producer or group of producers participating in the standard stewardship
220 plan or an independent stewardship plan may:
221 1. Enter into contracts and agreements with stewardship organizations, other
222 service providers, or other entities as necessary, useful or convenient to provide all or
223 portions of their stewardship plan;
224 2. Notify the director of any producer selling covered drugs in or into the county
225 that is failing to participate in a stewardship plan; and
226 3, Perform any other functions as may be necessary or proper to provide the
227 stewardship plan and to fulfill any or all of the purposes for which the plan is organized.
• 228 F. After the first full year of operation of the approved standard stewardship plan,
229 a producer or group of producers participating in the standard stewardship plan may
230 notify the director in writing of intent to form an independent stewardship plan, and
231 identify a plan operator, including the plan operator's telephone, mailing address and
232 email contact information, who is authorized to be the official point of contact for the
233 proposed independent stewardship plan. Within three months of such notification, the
234 producer or group of producers may submit a proposed independent stewardship plan as
235 described under section 7 of this rule to the director for review.
236 G. The director may approve in writing extensions to later dates for the
237 submission dates and deadlines in this section.
238 H. After presenting official credentials and providing notice of an audit or
239 inspection to determine compliance with this chapter or to investigate a complaint. the
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240 director may audit a producer's, group of producers' or stewardship organizations records
241 related to a stewardship plan or request that the producer, group of producers or
242 stewardship organization arrange for the director to inspect at reasonable times a
243 stewardship plan's or a collector's facilities,vehicles and equipment used in carrying out
244 the stewardship plan.
245 NEW SECTION. SECTION 7. Stewardship plans -components. The standard
246 stewardship plan or any independent stewardship plan,which must be submitted and
247 reviewed according to section 14 of this rule, shall include:
248 A. Contact information for all drug producers participating in the stewardship
249 plan;
250 B. A description of the proposed collection system to provide convenient
251 ongoing collection service for all unwanted covered drugs from covered entities in
1111
252 compliance with the provisions and requirements in section 8 of this rule, including a list
253 of all collection methods and participating collectors, a list of drop-off locations, a
254 description of how periodic collection events will be scheduled and located if applicable,
255 a description of how mail-back services will be provided and an example of the prepaid,
256 preaddressed mailers to be utilized. The description shall include a list of retail
257 pharmacies and law enforcement agencies contacted by the plan under section 6.D.2. of
258 this rule, and a list of all collectors who offered to participate;
259 C. A description of the handling and disposal system, including identification of
260 and contact information for collectors, transporters and waste disposal facilities to be
261 used by the stewardship plan in accordance with sections 8 and 10 of this rule;
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• 262 D. A description of the policies and procedures to be followed by persons
263 handling unwanted covered drugs collected under the stewardship plan, including a
264 description of how all collectors, transporters and waste disposal facilities utilized will
265 ensure the collected, unwanted covered drugs are safely and securely tracked from
266 collection through final disposal, and how all entities participating in the stewardship
267 plan will operate under all applicable federal and state laws, rules and guidelines,
268 including those of the United States Drug Enforcement Administration, and how any
269 pharmacy collection site will operate under applicable rules and guidelines of the state of
270 Washington Board of Pharmacy;
271 E. A description of how patient information on drug packaging will be kept
272 secure during: collection; transportation; and recycling or disposal;
• 273 F. A description of the public education effort and promotion strategy required in
274 section 9 of this rule, including a copy of standardized instructions for residents, signage
275 developed for collectors and required promotional materials;
276 G. A proposal on the short-term and long-term goals of the stewardship plan for
277 collection amounts, education and promotion; and
278 H. A description of how the stewardship plan will consider:
279 1. Use of existing providers of waste pharmaceutical services;
280 2. Separating covered drugs from packaging to the extent possible to reduce
281 transportation and disposal costs; and
282 3. Recycling of drug packaging to the extent feasible,
283 NEW SECTION. SECTION 8. Stewardship plans - collection of covered
284 drugs.
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285 A. This chapter does not require any person to serve as a collector in a •
286 stewardship plan. A person may offer to serve as a collector voluntarily, or may agree to
287 serve as a collector in exchange for incentives or payment offered by a producer, group of
288 producers or stewardship organization. Collectors may include law enforcement,
289 pharmaciesmail-back services or other entities, operating in accordance with state and
290 federal laws and regulations for the handling of covered drugs, including those of the
291 United States Drug Enforcement Administration,and in compliance with this chapter. A
292 pharmacy collection site shall operate under applicable rules and guidelines of the state of
293 Washington Board of Pharmacy.
294 B. The collection system shall be convenient on an ongoing, year-round basis to
295 adequately serve the needs of covered entities and shall be designed in consideration of
296 equitable opportunities for all King County residents for the safe and convenient return of
•
297 unwanted covered drugs, in accordance with this section.
298 C. The collection system for all unwanted covered drugs shall be safe and secure,
299 including protection of patient information on drug packaging.
300 D.1. The service convenience goal for the standard stewardship plan and any
301 independent stewardship plan is a system of drop-off sites distributed to provide
302 reasonably convenient and equitable access for all residents in incorporated and
303 unincorporated areas of the county.
304 2. In establishing and operating a stewardship plan, a producer, group of
305 producers or stewardship organization shall give preference to having retail pharmacies
306 and law enforcement agencies serve as drop-off sites. A stewardship plan shall include,
307 as collectors, any retail pharmacy or any law enforcement agency willing voluntarily to
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•
308 serve as a drop-off site for unwanted covered drugs and able to meet the requirements of
309 this chapter within three months of their offer to participate, unless the collector requests
310 a longer time frame. A producer or group of producers establishing and operating a
311 stewardship plan may also accept other collectors willing to serve as a drop-off site for
312 unwanted covered drugs and able to meet the requirements of this chapter.
313 3. The system of drop-off sites shall provide in every city. town, or
314 unincorporated community service area with a pharmacy or law enforcement facility, one
315 drop-off site and a minimum of at least one additional drop-off site for every thirty
316 thousand residents, geographically distributed to provide reasonably convenient and
317 equitable access.
318 4. If the service convenience goal in 3. of this subsection cannot be achieved by
• 319 the standard stewardship plan or any independent stewardship plan due to a lack of drop-
320 off sites at pharmacies, law enforcement agencies or other qualified collectors in specific
321 areas of the county,then those areas shall be served through periodic collection events or
322 mail-back services, or a combination of these collection methods.
323 E. Drop-off sites shall accept covered drugs from covered entities during all
324 hours that the retail pharmacy, law enforcement agency, or other collector is normally
325 open for business with the public. Drop-off sites shall utilize secure drop boxes in
326 compliance with all applicable requirements of the United States Drug Enforcement
327 Administration and the state of Washington Board of Pharmacy.
328 F. Mail-back services shall be free of charge, and shall be made available to
329 di fferentially-abled and home bound residents upon request through the stewardship
330 plan's toll-free telephone number and web site, and through distribution of prepaid,
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331 preaddressed mailers to persons providing services to such residents, and may also be
332 utilized as a collection method according to subsection D.4. of this section.
333 G. Periodic collection events, if utilized as a collection method according to
334 subsection D.4. of this section, must be arranged with law enforcement personnel through
335 voluntary agreements, and shall be conducted in compliance with United States Drug
336 Enforcement Administration protocols, any additional requirements of participating law
337 enforcement agencies, and in compliance with this chapter.
338 NEW SECTION. SECTION 9. Stewardship plans -promotion.
339 A. A producer or group of producers participating in the standard stewardship
340 plan or an independent stewardship plan shall:
341 1. Promote the use of their stewardship plan so that collection options for
342 covered drugs are widely understood by residents, pharmacists, retailers of covered drugs
343 and health care practitioners including doctors and other prescribers, and promote the
344 safe storage of covered drugs by residents before secure disposal through their
345 stewardship plan;
346 2. Work with collectors participating in their stewardship plan to develop clear,
347 standardized instructions for residents on the use of drop boxes and a readily
348 recognizable, consistent design of drop boxes. The local hazardous waste management
349 program may provide guidance to producers and collectors on the development of the
350 instructions and design;
351 3. Establish a toll-free telephone number and web site where collection options
352 and current locations of drop-off sites will be publicized and prepare educational and
353 outreach materials promoting safe storage of medicines and describing where and how to
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354 return unwanted covered drugs to the stewardship plan. These materials must be
355 provided to pharmacies, health care facilities and other interested parties for
356 dissemination to residents. Plain language and explanatory images should be utilized to
357 make use of medicine collection services readily understandable by all residents,
358 including individuals with limited English proficiency. A producer or group of producers
359 participating in the standard stewardship plan or any independent stewardship plan shall
360 coordinate these promotional activities to ensure that residents can easily identify,
361 understand and access the collection services provided by any stewardship plan;
362 4. Annually evaluate the effectiveness of its outreach and stewardship plan
363 activities; and
364 5. Conduct a survey of residents of King County and a survey of pharmacists
365 and health professionals in the county who interact with patients on use of medicines
366 after the first full year of operation of the plan, and again after five and nine years of
367 operation. Survey questions shall measure percent awareness of the stewardship plan,
368 assess to what extent drop-off sites and other collection methods are convenient and easy
369 to use, and assess knowledge and attitudes about risks of abuse, poisonings and overdoses
370 from prescription and nonprescription medicines used in the home. Draft survey
371 questions shall be submitted to the director for review and comment at least thirty days
372 prior to initiation of the survey. Results of the survey shall be reported to the director and
373 made available to the public on the stewardship plan's website.
374 B. The local hazardous waste management program shall:
375 1. Promote the use of stewardship plans and the planstoll-free telephone
376 numbers and web sites through their standard educational methods;
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•
377 2. Provide sample educational materials for use by pharmacies, law enforcement
378 agencies, health care providers and local government agencies in the county;
379 3. Conduct educational outreach to targeted populations and groups as informed
380 by survey results and other research indicators; and
381 4. Assume the costs of developing and providing promotional and educational
382 materials under this subsection.
383 NEW SECTION. SECTION 10. Stewardship plans- disposal of covered
384 drugs.
385 A. Covered drugs collected under a stewardship plan must be disposed of at a
386 permitted hazardous waste disposal facility as defined by the United States
387 Environmental Protection Agency under 40 CFR parts 264 and 265.
388 B. The director may grant approval for a producer or group of producers
•
389 participating in the standard stewardship plan or an independent stewardship plan to
390 dispose of some or all collected covered drugs at a permitted large municipal waste
391 combustor, as defined by the United States environmental protection agency under 40
392 C.F.R. parts 60 and 62, if use of a hazardous waste disposal facility described under
393 subsection A. of this section is deemed not feasible for the stewardship plan based on
394 cost, logistics or other considerations.
395 C. A producer or group of producers participating in the standard stewardship
396 plan or an independent stewardship plan may petition the director for approval to use
397 final disposal technologies that provide superior environmental and human health
398 protection than provided by the disposal technologies in subsections A. and B. of this
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399 section, or equivalent protection at lesser cost. The proposed technology must provide
400 equivalent or superior protection in each of the following areas:
401 1. Monitoring of any emissions or waste;
402 2. Worker health and safety;
403 3. Air, water or land emissions contributing to persistent, bioaccumulative, and
404 toxic pollution; and
405 4. Overall impact to the environment and human health.
406 NEW SECTION. SECTION 11. Stewardship plans - administrative and
407 operational costs and fees.
408 A. A producer or group of producers participating in the standard stewardship
409 plan or an independent stewardship plan shall pay all administrative and operational costs
410 related to their stewardship plan,except as provided under this section. Administrative
411 and operational costs related to the stewardship plan include:
412 1. Collection and transportation supplies for each drop-off site;
413 2. Purchase of all secure drop boxes for drop-off sites in any independent
414 stewardship plan;
415 3. Purchase of additional secure drop boxes needed for drop-off sites in the
416 standard stewardship plan beyond the four hundred provided under subsection B. of this
417 section;
418 4. Ongoing maintenance or replacement of secure drop boxes, as requested by
419 collectors:
420 5. Prepaid, preaddressed mailers provided to differentially-abled and home
421 bound residents, and to specific areas of the county if utilized;
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422 6. Operating periodic collection events if utilized, including costs of law •
423 enforcement staff time if necessary;
424 7. Transportation of all collected pharmaceuticals to final disposal, including
425 costs of law enforcement escort if necessary;
426 8. Environmentally sound disposal of all collected pharmaceuticals under
427 section 10 of this rule; and
428 9. Program promotion under section 9 of this rule.
429 B. The local hazardous waste management program shall ensure the provision of
430 up to four hundred secure drop boxes for retail pharmacies and law enforcement agencies
431 willing to participate as drop-off sites for the standard stewardship plan. Collectors who
432 leave the standard stewardship plan for any reason are encouraged to donate the secure
433 drop box to the standard stewardship plan. Producers participating in the standard
•
434 stewardship plan shall retrieve drop boxes from collectors as requested.
435 C. No person or producer may charge a specific point-of-sale fee to consumers to
436 recoup the costs of their stewardship plan, nor may they charge a specific point-of-
437 collection fee at the time the covered drugs are collected from covered entities.
438 D. Producers are not required to pay for costs of staff time at drop-off sites
439 provided by collectors volunteering for a stewardship plan.
440 NEW SECTION. SECTION 12. Stewardship plans - reporting requirements.
441 A. Within six months after the end of the first twelve-month period of operation,
442 and annually thereafter, the plan operator of the standard stewardship plan and of any
443 independent stewardship plan shall submit a report to the director on behalf of
20 •
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•
444 participating producers describing their plan's activities during the previous reporting
445 period to comply with this chapter. The report must include:
446 1. A list of producers participating in the stewardship plan;
447 2. The amount, by weight, of unwanted covered drugs collected, including the
448 amount by weight from each collection method used;
449 3. A list of drop-off locations, the number of mailers provided for differentially-
450 abled and home bound residents, locations where mailers were provided, if applicable,
451 dates and locations of collection events held, if applicable, transporters used and the
452 disposal facility or facilities used;
453 4. Whether any safety or security problems occurred during collection,
454 transportation or disposal of unwanted covered drugs during the reporting period and, if
455 so, what changes have or will be made to policies, procedures or tracking mechanisms to
456 alleviate the problem and to improve safety and security in the future:
457 5. A description of the public education, outreach and evaluation activities
458 implemented during the reporting period;
459 6. A description of how collected packaging was recycled to the extent feasible,
460 including the recycling facility or facilities used;
461 7. A summary of the stewardship plan's goals, the degree of success in meeting
462 those goals in the past year and, if any goals have not been met, what effort will be made
463 to achieve the goals in the next year; and
464 8. The total expenditure of the stewardship plan during the reporting period.
465 B. The director shall make reports submitted under this section available to the
466 public.
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467 C. For the purposes of this section, "reporting period" means the period from •
468 January 1 through December 31 of the same calendar year, unless otherwise specified to
469 the plan operator by the director.
470 NEW SECTION. SECTION 13. Stewardship plans -lists of producers of
471 covered drugs. Beginning sixty days after the date of adoption of this rule, each drug
472 wholesaler that sells any covered drug in or into the county must provide a list of
473 producers of covered drugs to the local hazardous waste management program in a form
474 agreed upon with the director. Wholesalers must update the list by January 15 each year.
475 NEW SECTION. SECTION 14. Stewardship plans - review of proposed
476 plans.
477 A. By one year after the date of adoption of this rule, a producer, group of
478 producers or stewardship organization participating in the standard stewardship plan or
•
479 any independent stewardship plan shall submit its proposed stewardship plan to the
480 director for review, accompanied by the plan review fee in accordance with section 18 of
481 this rule. The director may upon request provide consultation and technical assistance
482 about the requirements of this chapter to assist a producer, group of producers or
483 stewardship organization in developing its proposed plan.
484 B. The director shall review the proposed stewardship plan and determine
485 whether the proposed plan meets the requirements of section 7 of this rule and other
486 applicable sections of this rule. In reviewing a proposed stewardship plan, the director
487 shall provide opportunity for written public comment and consider any comments
488 received.
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• 489 C. After the review under subsection B. of this section and within ninety days
490 after receipt of the proposed stewardship plan,the director shall either approve or reject
491 the proposed stewardship plan in writing to a producer, group of producers or
492 stewardship organization and, if rejected,provide reasons for rejection.
493 D. If the proposed stewardship plan is rejected, a producer, group of producers or
494 stewardship organization must submit a revised stewardship plan to the director within
495 sixty days after receiving written notice of the rejection. The director shall review and
496 approve or reject a revised stewardship plan as provided under subsections B. and C. of
497 this section.
498 E.1. If the director rejects a revised stewardship plan, or any subsequently revised
499 plan, the director shall deem the producer or group of producers out of compliance with
500 this chapter and subject to the enforcement provisions in this chapter.
501 2. If the revised standard stewardship plan is rejected, the director may, in the
502 director's discretion,require the submission of a further revised standard stewardship plan
503 or develop and impose changes to some or all components of the rejected plan to
504 constitute an approved standard stewardship plan. If the director imposes some or all of
505 the approved plan. the director may not deem the producers participating in and
506 complying with the approved standard stewardship plan in accordance with this chapter
507 out of compliance with this chapter.
508 3. If a revised independent stewardship plan is rejected, the producer or group of
509 producers submitting the independent stewardship plan shall participate in the standard
510 stewardship plan and are not eligible to propose an independent stewardship plan for six
511 months after the rejection. The director may not deem out of compliance with this
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•
512 chapter a producer whose revised independent stewardship plan is rejected if the producer
513 participates in and complies with the standard stewardship plan.
514 F. In approving a proposed stewardship plan,the director may exercise
515 reasonable discretion to waive strict compliance with the requirements of this chapter that
516 apply to producers in order to achieve the objectives of this chapter.
517 G. The director shall make all stewardship plans submitted under this section
518 available to the public.
519 NEW SECTION. SECTION 15. Stewardship plans - prior approval for
520 change.
521 A. Proposed changes to an approved stewardship plan that substantively alter
522 plan operationsincluding, but not limited to, changes to participating manufacturers,
523 collection methods, achievement of the service convenience goal, policies and procedures
•
524 for handling covered drugs, education and promotion methods or disposal facilities, must
525 have prior written approval of the director.
526 B. A producer or group of producers participating in the standard stewardship
527 plan or any independent stewardship plan shall submit to the director any proposed
528 change to a stewardship plan as described under subsection A. of this section in writing at
529 least thirty days before the change is scheduled to occur and accompanied by the review
530 fee in accordance with section 18 of this rule.
531 C. The plan operator of an approved stewardship plan shall notify the director at
532 least fifteen days before implementing any changes to drop-off site locations, methods for
533 scheduling and locating periodic collection events or methods for distributing prepaid,
534 preaddressed mailers, that do not substantively alter achievement of the service
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11110
535 convenience goal under section 8.D. of this rule, or other changes that do not
536 substantively alter plan operations under subsection A. of this section.
537 NEW SECTION. SECTION 16. Stewardship plans - enforcement - penalties.
538 A. The director shall send a written warning and a copy of this chapter and any
539 rules adopted to implement this chapter to a producer who is not participating in the
540 standard stewardship plan or an independent stewardship plan as required under this
541 chapter. The warning shall state that participation in a plan is required and warn of
542 penalties for noncompliance.
543 B. A producer not participating in the standard stewardship plan or an
544 independent stewardship plan and whose covered drug continues to be sold in or into the
545 county sixty days after receiving a written warning from the director may be assessed a
546 penalty under subsections D. and E. of this section.
547 C. If the director determines that a stewardship plan is not in compliance with
548 this chapter or its plan approved under section 14 of this rule, the director may send the
549 producer or group of producers participating in the plan a written warning stating the plan
550 is in noncompliance, providing notice of the compliance requirements and warning of
551 penalties for noncompliance. The producer or group of producers has thirty days after
552 receipt of the notice to achieve compliance. If the stewardship plan is not in compliance
553 after thirty days, the director may assess a penalty under subsections D. and E. of this
554 section. This subsection does not preclude the director from suspending an approved
555 plan if a violation of this chapter or an approved plan creates a condition that, in the
556 director's judgment, constitutes an immediate hazard.
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557 D. A violation of this chapter is subject to a civil penalty of up to two thousand •
558 dollars and may be assessed against a producer or group of producers. Each day upon
559 which a violation occurs or is permitted to continue constitutes a separate violation. In
560 determining the appropriate penalty, the director shall consider the extent of harm caused
561 by the violation,the nature and persistence of the violation, the frequency of past
562 violations, any action taken to mitigate the violation, the financial burden to the violator
563 and the size of the violator's business.
564 E. The director may utilize BOH chapter 1.08 to assess civil penalties provided in
565 this section. A producer or group of producers may appeal assessments imposed under
566 this section as provided in BOH chapter 1.08. In addition to or as an alternative to
567 utilizing the procedures in BOH chapter 1.08,the director may assess or recover penalties
568 accruing under this section by legal action filed in King County superior court.
569 F. The director may utilize BOH chapter 1.08 to assess civil penalties as provided
570 in that chapter against a wholesaler who is in violation of section 13 of this rule.
571 NEW SECTION. SECTION 17. Stewardship plans - rules, performance
572 standards and report.
573 A. The director may adopt rules necessary to implement, administer and enforce
574 this chapter.
575 B. The director may work with the plan operator to define goals for collection
576 amounts, education, and promotion for a stewardship plan.
577 C. The director shall report annually to the King County Board of Health
578 concerning the status of the standard and independent stewardship plans and
579 recommendations for changes to this chapter. The annual report shall include an
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580 evaluation of the secure medicine return system, a summary of available data on
581 indicators and trends of abuse, poisonings and overdoses from prescription and
582 nonprescription drugs and a review of comprehensive prevention strategies to reduce
583 risks of drug abuse, overdoses and preventable poisonings.
584 NEW SECTION. SECTION 18. Plan review and annual operating fees.
585 A. A producer or group of producers participating in the standard stewardship
586 plan or an independent stewardship plan shall pay to the director plan review fees to be
587 established under subsection D. of this section for:
588 1. Review of a proposed stewardship plan;
589 2. Resubmittal of a proposed stewardship plan;
590 3. Review of changes to an approved stewardship plan;
591 4. Submittal of an updated stewardship plan at least every four years under
592 section 6.D.5. of this rule; or
593 5. Review of any petition for approval to use alternative final disposal
594 technologies under section 10.C. of this rule.
595 B. In addition to plan review fees, a producer or group of producers participating
596 in the standard stewardship plan or an independent stewardship plan shall pay to the
597 director annual operating fees to be established under subsection D. of this section.
598 C. A plan operator or a stewardship organization may remit the fee on behalf of
599 participating producers.
600 D. As soon as practicable, the director shall propose to the Board of Health a
601 schedule of fees to be adopted by rule and charged to a producer or group of producers to
4110 27
R&R BOH13-03
•
602 cover costs of administering and enforcing this chapter. Fees shall be calculated to
603 recover actual costs.
604 SECTION 19. R&R 66, Section 1 (part), as amended, and BOH 2.08.085 are
605 each hereby amended to read as follows:
606 Powers of the committee.
607 A.1. The committee shall be responsible for accepting and recommending a
608 management plan and budget for:
609 a. the reduction of moderate risk waste generation, its entry into the solid waste
610 stream, entry into the liquid waste (sewage)stream, into storm drainage or surface waters
611 and evaporation into the air; and
612 b. the protection and enhancement of the public health and environmental
613 quality in King County by the reduction of the threat posed by the production, use,
•
614 storage and disposal of hazardous materials.
615 2. The management coordination committee ((will)) shall develop an annual
616 plan and budget and reach agreement on it through consensus of the entire committee.
617 Lacking a consensus, a majority and a minority report will be forwarded to the King
618 County Board of Health.
619 B. The committee shall recommend contracts with the city of Seattle, suburban
620 cities, sewer districts(0) or other governments or entities located entirely or partially
621 within King County, and King County,to implement portions of the management plan, in
622 consideration of sums collected under BOH 2.08.090.
623 C. The committee shall develop an annual plan and budget for implementation of
624 QijCliter 11. (the chapter established under section 2 of this rule) and reach
28 4111
R&R BOH13-03
110
625 a_reernent on it throw h consensus of the entire committee. Lackin) a consensus a
626 majority and a minority report shall be forwarded to the King County Board of Health.
627 The committee shall recommend contracts or interagency agreements to implement
628 portions of the plan.
629 SECTION 20. Severability. If any provision of this rule or its application to any
• 29
R&R BOH13-03
110
630 person or circumstance is held invalid, the remainder of the rule or the application of the
631. provision to other persons or circumstances is not affected.
632
R&R BOH13-03 was introduced on and passed by the Board of Health on 6/20/2013,
by the following vote:
Yes: 11 -Ms. Frisinger, Mr. Conlin, Ms. Patterson,Ms. Lambert, Mr.
Licata, Dr. Baker, Dr. Danielson and Mr. McDermott
No: 0
Excused: 2 - Ms. Clark and Dr.Nicola
BOARD OF HEALTH
KING COUNTY,WASHINGTON
•
Joe McDermott,Chair
ATTEST:
11.
Anne Noris,Clerk of the Board
Attachments: None
30
f
Board of.1CeaCth
NetivBusiness &
Informational-Items
.agenda Item # XV., 2
� Letter from
Evergreen Coho SXP Park
August 15, 2013
r
P4oli
4AddamsWm Rd,
c
July 10, 2013
juL X52013
Linda Atkins R.S.
Department of Public Health
6T5 Sheridan Street
Port Townsend, WA 98368
Dear Linda:
On behalf of everyone here at Evergreen COHO SKP Park, thank you so much for taking
time out of your very busy schedule to speak to us this past Monday.
Your power point presentation and fielding audience questions was perfect. Public
education and awareness is what we are striving for and you took us a long way in
achieving that goal.
• Again, thank you.
Sincerely,
Landscape Committee
Lot Management Committee
Clubhouse Maintenance Committee
Utilities Committee
•
Phone 360.385.6538 * FAX 360.379.5669 * E-Mail ecrskp@ecapees.com
Board of.�Cealth
Wow Business &
Informational-items
.agenda item # IV., 3
.appointment to the
Substance Abuse
.advisory Board
.august 15, 2013
1
RPCEIVEK—)
•
110 = *JUN �A ^�114` 4 � #
Jefferson Count
PuN|c` ' ~ . ^ _� ^ �v./° �,� _",� �, &» _ ^r �� �
44;
, -
Lois Barnett, Lic Ac, LAc, Di[}( Ac (NCCAOM)
vvwvv5eiementa*osreness.conn
June 13, 2013
JuheDansk{n, BSN, 360.385.6877
Jefferson County Public Health s? S- [�**
618 Sheridan Street
Port Townsend, WA 98368
To the Jefferson County Substance Abuse Advisory Board,
I submit this Letter of intent in request to become a board member of the JCSAAB.
My primary interest is to help protect public health within the community by
increasing awareness of the impacts of alcohol on all citizens of Jefferson County.
Secondarily, as a member of the board I will act in support of the Board's mission to
address the issues of substance abuse and chemical dependency as welt.
My intention is to contribute to the Joint efforts of the board to develop and
• implement "cost effective strategies that prevent, intervene, treat and provide
aftercare to reduce the significant impacts on our community" ... by "networking
within the community and presenting timely and pertinent information".
Qualifications, other than the motivation of my own story and experience are that I:
• Received my Licentiate degree in Classical Five Element Acupuncture from the
College of Traditional Chinese Acupuncture, UK in 1979,
• Was selected as one of the founding members of Professor Worstey's MasterApprentice
Program (MAP).
, Served as a primary faculty member of the Institute of Taoist Education and
Acupuncture for seven years.
• Served as the clinical supervisor of the Five Element clinic at Bastyr University for
two years.
Fee[ free to contact me if further information is needed. Thank you for your
consideration of my request.
Sincerely,
Lois Barnett, Lic Ac (U.K.), LAc (U.S.)' Dip(A[ (NCCAOM)
• 1603 Walnut Street, Port Townsend, WA 98368
WA State License #193 NCCAOM Certification #931-0128 06 Fed |D #91 1054228
•
Board of aCealth
N(edia Report
•
.august 15, 2013
i
• Jefferson County Public Health
_ July/August 2013
NEWS ARTICLES
1. "Landlord-tenant dispute delays popular nightspot's reopening," Peninsula Daily
News, July 9th, 2013.
2. "Landlord ousts Upstage business; owner hopes for new location," Port Townsend
Leader, July 10th, 2013.
3. "Kitchens receive food safety awards," Port Townsend Leader, July 10th, 2013.
4. "Swimming holes: Lake algae closes Gibbs Lake," Port Townsend Leader, July 18th
2013.
5. "Port Townsend area beaches closed to shellfish harvest," Port Townsend Leader, July
18th, 2013.
6. "Fatal toxin closes bays to harvest," Peninsula Daily News, July 19th, 2013.
7. "Court: Carbon dioxide emissions count in biomass projects," Port Townsend Leader,
July 24th, 2013.
8. "Veterans get hands-on aid at annual "Stand Down', Port Townsend Leader, July 24th
2013.
9. "Birthing center sets example," Port Townsend Leader, July 24th, 2013.
10. "Dental clinic on wheels makes visit," Peninsula Daily News, July 28th, 2013.
11. "Bat that bit Jefferson County resident tests positive for rabies," Peninsula Daily News,
• July 28th, 2013.
12. "Jefferson County bat tests positive for rabies," Port Townsend Leader, July 31st, 2013.
13. "SmileMobile serves moms and kids," Port Townsend Leader, July 31st, 2013.
14. "Officials: Pa. gunman would have shot more," Peninsula Daily News, August 7th, 2013.
15. "Let's get physical: High school athletes need paperwork prior to practice," Port
Townsend Leader, August 7th, 2013.
16. "Cooking with WIC," Port Townsend Leader, August 7th, 2013.
17. "Follow safety tips for harvesting, cooking shellfish," Port Townsend Leader, August
7th 2013.
18. "Get ready for school with a shot in the arm," Port Townsend Leader, August 7th, 2013.
19. "Quilcene Public Health Clinic," Port Townsend Leader, August 7th, 2013.
20. "World Breastfeeding Week Celebration Aug 7," JCPH Press Release, July 2013
•
Landlord-tenant dispute delays popular nightspot's reopening
By Charlie Bermant , Peninsula Daily News, July 9th, 2013
,# I
47,
e�h �e fz4
Z 6
Charlie Bermant/Peninsula Daily News
Mark Cole checks messages via computer and phone
during the Upstage remodeling in Port Townsend recently.
PORT TOWNSEND—Both sides in a dispute over the Upstage, a popular nightspot that was scheduled to close for a
two-week renovation period, say they would like to find a resolution that has stretched the renovation period to nearly two
months.
Both landlord Dave Peterson and club owner Mark Cole said Monday that they had not given up on finding a way to
reopen the club under the same management.
(iv legal issues need to be resolved first.
"I still think we can come to an agreement," Cole said.
"I would like it to reopen as soon as possible," Peterson said.
On June 28, one week after the club's expected reopening, Peterson served Cole with a 30-day eviction notice.
Neither side will describe the issues in detail, but both confirmed they originated in damage that was not anticipated.
Peterson said that"a lot of dry rot" was underneath the floors, and Cole's responsibility for this was yet to be determined.
"There are some repairs being made, and the nature, extent and cause of those repairs are under dispute," said Peggy
Ann Bierbaum, Cole's attorney.
"We would like to resolve this without having it end up in litigation."
Cole said he and Peterson signed a lease agreement in May that was violated by the eviction notice, while Peterson said
Monday that"Mark's lease was always month to month."
Cole employs around 12 people and has found jobs or opportunities for most of them during the closure, he said.
The renovation of the restaurant is part of a property shuffle brought about after the closure of the Undertown, which was
the alley adjacent to The Upstage.
Peterson, who owns the Terry Building in which The Upstage is located, closed the Undertown in December with the
intention of reopening in the spring.
But he found the renovation cost-prohibitive.
He decided to open a new restaurant in the space above The Upstage that was occupied by two businesses— Bazaar •
Girls and the Candle Shop—which he evicted May 31, but he has not disclosed any specific plans about a new venture.
At the time, Peterson said in a statement that The Upstage would be closed for two weeks"to allow for a much-needed
upgrade to the hood system in the kitchen.
"Besides better protecting the Terry Building from fire loss, the new system will allow The Upstage to expand its menu
offerings," the statement said.
On Monday, Peterson said he still plans to open a restaurant in the upper space but the plans for doing so, as with those
for The Upstage, "are all up in the air."
For the past several years, the Upstage has served as one of the main venues for Centrum's Jazz and Acoustic Blues
festivals, with the club filled for the entire week during those times.
Jazz festival program manager Greg Miller said the shows scheduled for The Upstage were moved to the American
Legion Hall, 209 Monroe St., and the Alchemy Bistro, 842 Washington St.
"The Upstage was one of the most popular festival venues, but we will have the exact same musicians and shows in other
locations," Miller said.
"It's a little sad that it's not available, but Mark has really scrambled to help us bring this together."
The Legion Hall also is serving as a temporary location for Cole's shows, including a performance by Commander Cody at
7:30 p.m. Thursday. 1111
Cody, who has performed at The Upstage several times over the past few years, was booked months ago.
Tickets for Commander Cody are$30 and available at the door or by phoning 360-385-2216.
Other scheduled shows are the John Nemeth Blues Band on July 18, Pearl Django on July 19 and David Jacobs-Strain
on July 20.
All shows begin at 7:30 p.m. with ticket prices ranging from $12 to$15.
Cole said he will continue to produce shows and seek out new location options until the legal issues are resolved.
"The Upstage is an institution," said Jefferson County Chamber of Commerce President Dominic Svornich, who is also a
musician.
"We will work with Mark to help him find a new location and will do all we can to support this."
"The Upstage is a community icon," said Jack Reid, a musician who runs the Monday sessions.
"It presents a variety of music and offers the highest quality entertainment that you can see anywhere.
"But a club that opens in that location will not be The Upstage. The club is Mark, the staff and the music. The building has •
nothing to do with it."
Jefferson County Editor Charlie Bermant can be reached at 360-385-2335 or cbermant@peninsuladailynews.com.
•
Landlord ousts Upstage business; owner hopes for new location
•By Megan Claflin of the Port Townsend Leader I Posted: Wednesday, July 10, 2013 10:53 am
Optimistic that reopening the "new and improved" Upstage would validate a three-week closure, Mark
Cole's attitude changed dramatically last week after he received a sudden notice terminating his tenancy.
Cole, owner of the busy restaurant and music venue located in the historic Terry Building, 923
Washington St., since 1998, is now engaged in a legal dispute with David Peterson, who took ownership
of the building in 2008.
The dispute has, for now, closed the popular venue, and left its future uncertain.
At the crux of the quarrel is the venue's lease.
The Upstage has been the building's sole tenant since May, after the Candle Store and the Bazaar Girls
received similar termination notices from Peterson in March.
That same month, Peterson decided against pursuing plans to remodel the Undertown Coffee and Wine
Bar space, which he leased in the Mount Baker Block Building basement. He closed the Undertown in
December 2012.
Cole said it's possible he and Peterson may still work out an agreement; however, for now the process
has left a bad taste in his mouth.
• "The building just seems poisoned," he told the Leader. "I don't dispute that as the owner Mr. Peterson
has the right to do with it what he will, but how he has gone about it with his tenants, it just hasn't sat well
with people."
Peterson said it is in his "interest to finish the repairs quickly" and would know more about the extent of
the renovation at the end of the week. When asked if he is planning to seek new tenants after the work is
completed, Peterson said, "yes."
At the same time, regarding the Upstage, Peterson said, "we are hoping we can work something out."
"I understand it is difficult [for the Upstage] to be displaced but my goal is to get the building back in good
shape," Peterson said. "Many unanticipated repairs have been discovered that need to be addressed
and that's difficult to do while someone is in the space."
Until the dispute is resolved, the Port Townsend area's busiest music bar is shuttered at the outset of
what would normally be its busiest time of year.
Mary Hilts, program manager for Centrum's Acoustic Blues Festival, which runs from July 28 to Aug. 4,
noted the Upstage is a historical venue, rare in a small town.
"The Upstage is known for supporting national blues artists on tour and has been an incredible asset to
our community, providing world-class artists in an intimate setting," she wrote in a July 8 email. The
venue has a reputation as a "hot spot" for both visiting and local musicians for over 30 years.
• "It's not all about the actual building itself— it's the spirit of the place," she said.
Pending uses of the space by Centrum have been shifted to other locations.
LEASE DISPUTED •
Peterson began discussing plans improve the aging building with Cole in early January, Cole said.
reement
thscope of
n, the
On May 27, the two signed a Memorandum
to offsegCole's lost reeve outlining ese and an 18-month el�tens on ogthe
th
of the closure, down-time compensation
Upstage lease.
Peterson now questions the legality of the agreement.
Each has hired an attorney: Peggy Ann Bierbaum for Cole and Malcolm Harris for Peterson.
In correspondence obtained by the Leader, Bierbaum and Harris debate the agreement.
and
y Johnson.
On May 26, 1998, Cole signed a 10-year
two owith tions forbenewaluilding �he first wners oflthem aafivde--year renewal,lease ended March 31, 2008. It containedp
with notice required by Feb. 1, 2008, or the lease would revert to a month-to-month agreement.
According to Cole, he informed the Johnsons of his intention to renew. Peterson debates that.
DAMAGES
Peterson building the bassessed at $564,050, aing for $925,000 in ccording according to the Jefferson County Assessor's Assessor Jack Westerman III in March.
Office. The building is now a
rson said
A full-time engineer with the Cityof Portwnsend for the"significant and unanficipatedt 15 aepairsrs, teThp legal clorrespondence
onday that
initial demolition revealed the need9 •
suggests that Cole's business caused Upstage some of the was removed and repairs made to both thee and that he is l foundation and the
In recent weeks, the floor of the
supporting structures.
On Cole's behalf, Bierbaum called for Peterson to cease all further work on the building until "we can
completely understand the scope of the work being contemplated."
STAFF MOVES ON
The Upstage hosted its final act, Jim Nyby and
closure.
F Street Band, on June 8, after which staff and
contractors worked to prepare the
lo
With the business closed and the eu�ure th'more doubt,
aff usually added in loyees havethe summer, said ColUpstage
e. All Nape ys
aabout 15 people full- and part-time,
found new employment, he said, with Cole himself making calls on their behalf.
Despite the planned three-week closure, Cole said he was able to reschedule about a dozen
performances or rebook them in a different location.
"It's been very difficult," he said. "This is my time
g going ear. Everyone's almost every night."energyis up—the staff's,
the musicians', the crowds' — and we'vegotsomething
Scheduled to perform on July 11, Commander Lost
Planet Legion at 7 30 pmm en, an ri for country
rock band founded in 1967, have been relocated to the American on
information, call the Upstage at 385-2216. •
For more than two decades, Centrum has collaborated with the Upstage as a venue for many of the
nonprofit arts foundation's summer music festivals.
Greg Miller, program manager for Jazz Port Townsend, which runs July 21-28, said he has relocated
three performances planned for the Upstage to the American Legion Hall.
*Miller and Cole remarked on the efforts made by the Women's Auxiliary of the Legion, especially Janet
Emery, to create an inviting, familiar atmosphere at the Legion that musicians and audience can equally
enjoy.
"I'm sorry to see any venue close even for a short time, since every presenter in town plays a role in
making the vibrant arts scene Port Townsend is known for," Miller wrote in an email on July 8. "Centrum
has a long and successful relationship with the Upstage going back to the days when it was called the
Back Alley. I hope they'll be up and running soon."
Centrum's Hilts said that Cole himself has been a champion of local music and musicians.
"Mark Cole has been a champion in continuing the legacy of the venue by booking stellar musicians as
well as providing a place for new musicians to perform at open mics weekly," Hilts wrote.
Last week, Cole began the process of canceling many of this summer's shows.
Cole said that he is exploring the possibility of relocating the Upstage and has his eye on three local
venues. Replicating the intimacy and sound quality of his current venue will be difficult, he said.
•
•
• Kitchens receive food safety awards
Port Townsend Leader,July 10`h,2013
The 2012 Outstanding Achievement Awards were presented at the June 20 Jefferson
County Board of Health meeting, recognizing 17 restaurants, full service food
establishments and their proprietors who demonstrated the highest standards for safe
food handling during the past year.
The award recipients worked hard in 2012 to maintain excellent food safety standards,
according to representatives of Jefferson County Public Health. Most are full service
restaurants and food establishments that work with complex menus, so they have
added food safety challenges.
Criteria for the award were developed by the JCPH Food Safety Roundtable and
Jefferson County food safety staff. These are based upon food safety inspections
conducted in the areas of personal hygiene, food temperature safety and prevention of
contamination. All food workers must hold a current Washington state food worker card.
• The award winners are: Chimacum Elementary School kitchen, Chimacum High School
cafeteria, Cuisine Med Catering, Discovery View Retirement Apartments, Food Co-op
grocery, El Cottage, In Season Catering, Jefferson County Jail, Port Townsend High
School warming kitchen, La Isla Mexican Restaurant, QFC 106 deli/Port Townsend,
QFC 106 grocery/Port Townsend, QFC 870 deli/Port Hadlock, Quilcene School District,
Safeway 538 grocery, the Plaid Pepper mobile and the Tri-Area Community Center.
People can check on the health scores of their favorite restaurants at
jeffersoncountypublichealth. org/foodsafety/index.php.
•
Swimming holes: Lake algae closes Gibbs Lake
Posted: Thursday, July 18, 2013 3:32 pm, Port Townsend Leader •
Fresh-water lakes are again being hit by toxic algae problems, with the latest closure to be Gibbs Lake.
Jefferson County Public Health monitors the recurring blue-green algae problem in lowland East Jefferson County
lakes. As of Thursday, July 18, Anderson and Gibbs lakes were both closed with heavy algae blooms; both showed
dangerous, high toxicity levels.
The Gibbs Lake closure is based on water quality tests made July 15. As a result, Jefferson County Parks and
Recreation has closed the lake for recreation including fishing, boating and swimming. Visitors are also urged to
keep pets out of the water. The rest of Gibbs Lake County Park remains open for hiking, biking and horseback
riding.
Lake Leland had a reported light bloom as of July 18, but no toxins were detected, so it carries a "caution."
Microcystin is produced by bluegreen algae, also known as cyanobacteria, and can result in illness in people and
animals. The toxin level was measured at 6.9 micrograms per liter, which is more than the Washington State
recreational criteria of 6 micrograms.
Jefferson County Public Health recommends no swimming in areas of the scum, no drinking of lake water, keeping
pets and livestock away, and cleaning fish well and discarding guts. •
As of June 13, Sandy Shore Lake (located south of State Route 104 between Center Road and State Route 19) is
the best freshwater swimming-hole option and there has been no change in status in July. It's a dusty gravel road,
but the lake has easy access. There is no dock or boat launch.
Jefferson County Public Health advises that lake conditions can change rapidly, and that the status of lakes may
have changed since the last water sample was taken. If a green, paint-like scum or bloom is observed, then people
should observe the recommendations listed at the "warning" level, which means no swimming at all, plus adherence
to the above "caution" recommendations.
Visit tinyurl.com/6z64ofy for lake algae updates or call 385-1259.
Saltwater beaches
Fortunately, there are plenty of saltwater beaches in East Jefferson.
Kids and families would love the sandy swimming beach and offshore float next to the Herb Beck Marina at the end
of Linger Longer Road in Quilcene.
Our local Washington State Parks have great beaches— Fort Worden (the best, longest sandy beach), Fort Flagler,
Fort Townsend—just remember, your vehicle needs a Discover Pass for parking. •
East Beach Park on Marrowstone Island is a local favorite.
Port Townsend has easy public beach access from Chetzemoka Park, Point Hudson and North Beach County Park.
• Port Townsend area beaches closed to shellfish harvest
Posted: Thursday, July 18, 2013 2:12 pm, Port Townsend Leader
The Washington State Department of Health has closed Port Townsend Bay,
Kilisut Harbor and Mystery Bay beaches to recreational shellfish harvest,
including clams, oysters, mussels, and scallops.
Marine biotoxins that cause paralytic shellfish poisoning (PSP) have been
detected at concentrations above the closure level in shellfish samples collected
from Fort Flagler and Mystery Bay. Signs have been posted at high-use beaches
warning people not to consume shellfish from these areas, according to a press
release sent July 18.
Marine biotoxins are not destroyed by cooking or freezing. People can become ill
from eating shellfish contaminated with the naturally occurring marine algae
containing toxins harmful to humans. Symptoms of PSP can appear within
minutes or hours and usually begin with tingling lips and tongue, moving to the
hands and feet, followed by difficulty breathing, and potentially death. Anyone
experiencing these symptoms should contact a health care provider immediately.
• For extreme reactions, call 911 .
This closure does not apply to shrimp. Crabmeat is not known to contain the
biotoxin, but the guts can contain unsafe levels. To be safe, clean crab
thoroughly and discard the guts (butter). Shellfish harvested commercially are
tested for toxin prior to distribution and should be safe to eat.
For more information, call the Biotoxin Hotline at 1-800-562-5632 before
harvesting shellfish.
•
Fatal toxin
closes bays
to harvest •
PENINSULA DAILY NEWS
The state Department of
Health closed`Port Townsend
Bay, Kilisut Harbor and
Mystery Bay beaches to rec-
reational shellfish harvest
because of a high level of
potentially deadly marine
biotoxin,the state announced
Thursday.
Toxins that cause para-
lytic shellfish poisoning, or
PSP, were detected in sam-
•
ples of shellfish at unsafe
levels,the state said.
Shellfish harvested com-
mercially are tested for tox-
ins before distribution and
should be safe to eat.
The closure includes
clams,oysters,mussels,scal-
lops and other species of mol-
luscan shellfish. .
The closure does not
apply to shrimp. Crab meat
is not known to contain the
biotoxin, but the guts can111
contain unsafe levels. Guts
should be discarded before
the crab is eaten.
PSP symptoms
Symptoms of PSP can
appear within minutes or
hours and usually begins
with tingling lips and tongue,
moving to the hands and
feet, followed by difficulty
breathing, and potentially
death.
Marine biotoxins are not
destroyed by cooking or
freezing.
Other beaches closed to
most recreational shellfish
harvesting in Jefferson ,
County are Discovery Bay
and Port Ludlow, including
Mats Mats Bay, and Port
Townsend.
In Clallam County, most
beaches on the Strait of Juan
de Fuca from Cape Flattery
to the Jefferson County line
are closed for most species, •
including Sequim Bay.
Dungeness Bay is open.
For more information, /0/)A/
visit the state health depart-
ment website at http:l l �/��3,�
tinyurl.com/7u33gob or its 7
biotoxin hotline at 1-800-
562-5632.
Court: Carbon dioxide emissions count in biomass projects
By Allison Arthur, Port Townsend Leader I Posted: Wednesday, July 24, 2013 5:00 am
411A U.S. Court of Appeals and federal Environmental Protection Agency decision July 12 to count carbon
dioxide emissions from biomass power plants was hailed by environmental activists although it does not
appear to impact a controversial $55 million project in Port Townsend.
Local environmental activist Gretchen Brewer of Port Townsend AirWatchers, a group that has been
objecting to the Port Townsend Paper Corp.'s biomass proposal, touted the court decision as "huge
news."
"What they are saying is that the (earlier) decision to exempt biogentic CO2 is not supported by science,"
Brewer said. "The big news is that the court said you shouldn't just have been handing out permits. It
should have been regulated until they could prove the science to back it up."
"I hope this is a sign of regulations coming back to science-based rather than political-based decision,"
she said.
Brewer said she didn't know the impact of the decision on the mill's proposal, which has been permitted
by the state Department of Ecology. Brewer's organization, and others, have appealed decisions giving
the mill a green light.
•NO IMPACT,' MILL SAYS
Port Townsend Paper Corp. spokesman, environmental director Kevin Scott, said the court decision "has
little direct impact on our cogen project."
"The (court) ruling has vacated EPA's biomass deferral rule, but has also left open the possibility that
EPA could decide on a full or partial exemption for biomass greenhouse gas (GHG) emissions in the
future," Scott wrote in an email comment.
"The court did not rule that EPA lacks authority to defer regulation of biomass GHG emissions. Instead,
the ruling is that, in this instance, EPA did not adequately justify its rationale for this Deferral Rule," Scott
wrote of his interpretation of the ruling.
Scott further noted that the biggest factor affecting the Port Townsend cogen project "remains the low
cost of power generated with natural gas, which makes higher cost renewable power less attractive to
investors and utilities."
"It's hard for many utility companies to justify extra costs for more renewable power when they have
already met their current portfolio requirements and can buy cheap incremental power based on natural
gas," he said. "As portfolio requirements for renewable power rise, this may change and biofuel
generated power could become a more attractive investment."
PROJECT EXTENDED
In December 2013, the state Department of Ecology gave the mill an 18-month extension to make •
progress on the cogen project that would add a new steam turbine generator
would and
th exn pand
that energy as
burning capacity of the mill to generate 25 megawatts of energy. The mill
green energy.
The mill also planned to do a $10 million upgrade to air pollution control equipment.
The project was to be completed in 2013; now, there is no firm start-up date for the project.
"It's dependent on the power market," Scott said. "Renewable energy costs more and the cheap natural
gas is keeping power pricing low."
•
•
Veterans et hands-on
g
aid at annual
Stand Down
• By Lynn Nowak of the Leader for the Marvin G. Shields things of monetary value to
Memorial Post 26 American anyone who is not a depen-
Whether it's employ- Legion in Port Townsend, dent,of and accompanied;by
ment coaching, housing said a lot of times vets won't the veteran."
assistance, legal adviceor a avail themselves of the help Among the many ser-
simple haircut or hot meal, they might need. "But they vices offered and profession-
Jefferson County's veter- will come to the Stand Down. als available on July 29 are:
ans — young and old = can They feel safe there." a hot breakfast and a hot,
make connections and get Lane said when he gets to Thanksgiving-style lunch;
the help they need at the talking with vets they learn not one, but two barbers;
2013 Veterans' Stand Down he is approachable."I talk to medical and dental screen-
on Monday,July 29. them 24/7;I love to do it." ings with two physicians,
The annual event,open to Lane is also the service a nurse, and on-site dental
all veterans and sponsored officer for the Jefferson help and possible follow-up
by the Olympic ,Peninsula's County veterans'relief fund. dental assistance; eye care
Voices for Veterans organiza- By offering financial help support from the Lions Club;
tion, is 9 a.m.-3 p.m. at the with utilities payments or service animal information
Port Townsend Elks Lodge, other aid, "We try to keep from New Leash on Life;
555 Otto St. For those who vets in their homes,"he said. veterinary services includ-
might miss it,a second Stand "We like to give people ing flea treatments, animal
Down is planned for Oct.3 in options,"Braasch said."They immunizations, check-ups
Port Angeles at the Clallam never have to go to Seattle"to and. 'spay-neuter informa-
County Fairgrounds. enroll for VA medical health tion; free clothing, bedding,
A "stand down," in mili- care, for example. "They can hygiene kits and outdoor
tary speak, refers to R&R, . do it right here."He said that equipment; employment ser-
or rest and recuperation, in all veterans who are honor- vices including Work Source;
order to be refitted, rejuve- ably discharged are entitled Olympic Area Agency on
nated or retrained for the to_ enroll for medical ser- Aging's Senior Information
• next active duty.
"Last year,the vast major- vicesAdminthiroughstration.the Veterans and Assistance; VA benefits
counseling and disability
ity of vets in need thought all pensions; enrollment in VA
they could do by coming to NEW SERVICES medical health care; Vet
the Stand Down was to get New services offered this Connect through OIyCAP's
a flu shot and some new year at the Stand Down Retired Senior Volunteer •
clothes," said one Peninsula include a representative Program (RSVP); housing
vet. "They left with 15 other from the Social Security assistance and homeless out-
issues addressed that they Administration, a represen- reach;Red Cross representa-
didn't even know they could tative from a minority vets tives;and pro bono legal aid.
get help with." program, and a person rep- Jefferson Transit offers
He added that because of resenting Veterans Affairs free transportation to and
the myriad goods and ser- Supportive Housing(VASH), from the Elks •Lodge on
vices offered, it's really a a program that aids with Stand Down day.
"one-stop shopping"event. housing support vouchers.. For transportation
"Veterans tell us what Families of vets are also and general information
they need and we attempt encouraged to attend."If you on Stand Down 2013, call
to provide it," said John have a vet who can't come, Tammy, 360-417-2383;
Braasch, president of the we want you to come and Paul, 360-640-0296;or the
local Voices for Veterans. be engaged and proactive VFW, 360-302-1285; or visit
Interestingly, the top [about the services avail-' voicesforveterans.org/stand-
needs might be as basic as able]," Braasch said. He down.html.
a haircut, immunizations or added,however,that without
flea collars for beloved pets, the veteran present, Stand
or a hot meal. "That's not to Down volunteers cannot dis-
take away from the available tribute clothing or outdoor
legal services, medical and survival equipment. "When
dental help,and employment we ask for donations, we
services which are in high emphasiie that they will
• demand."Braasch said. go to homeless veterans,
veterans in need and their
LOCAL SERVICES immediate dependent family
Gary Lane,service officer members, so we cannot give
__ _ - -- - - ----------- .--__ _____ ____ __
Birthing center sets
B example
Jefferson - ' ;� ` � . � 1.
Healthcare � r 1 = r -
^'• fta +r a _-F �'N- A F 4,riV t E t pa'44� .
earns top �, _ < <du rj �' n
a. sf
recognition i A. � , { .
-�r'�.7 v v a t.tc v, 'IA.,'
t t 1 •
By Krystle Arnold of the Leader - ',s 1 r ..--4,,v5,-,,,,,,,,,,,---:•ay .• i .,,E 3 * 4. ,
514,..24.
+f r ,- i r,''''''n
` aha.r_.. ,i, t :.4 ..ti S�`; +
New momMicaelaColley wars ,, • - 2:1:1444-
v S.�j� .,I4,.34\1,1:;':'.4.`.‘„. - '.
�,' tp ,�a, r �yhr e �
was on hand July 17 to iii ; 3 qty r z 'fr t c C '
help Jefferson Healthcare's h € r 3 •1 a . t y :, X J lj
Family Birth Center cel- s k. •1...
a • a i. .. y
a a # I r`. . '',.,:t....." 't:.ebrate its designation as'a ,, r � x �
baby-friendly facility by the x_; e y�n n a'c- - < x €' '" r ' �;
World Health Organization
bil i,-)A51"I,4 „,,70';:..1i5,,-'7445"„V �,
14
(WHO). s :-.'4,':;,.* i•- ar \lit .
, !! b
It is one of just six hos- zig ”` • ",
statewide to earn the :tr k; 4.. • [e '' :''' ; , •'" .c _
pitals _ }
honor. mix 4` �� , .,w. �i► - -•'' v .t xN
"When I see the nurs-
es at the Co-op or around Six-month-old Abigail Martin,born Jan 10,2013 at Jefferson Healthcare Hospital,and her mother,Sarah,sang
town, I think to myself Twinkle Twinkle Little Star while waiting for a celebration July 17 to mark the hospital's dedication as a baby
'you're my family'," Colley friendly hospital.Photo by Krystle Arnold
said of having had her •
xr } tionprocess. health department to
child at the Port Townsend i11,,x,Ji fir; "When I see the therease smdepar in preg-
The
hospital. t 'This is
if not the cen- nurses at the nancy as well as help coor-
dinate dedication was the 4 s ter firstdinate care for high-risk
result of efforts at the pub- Co-op or around tamilies.
lie hospital's Family Birth Flit,, f designation.
In 2011, town, I think to Parker said the clinic
Center to support new o fi has a grant through the
mothers both during labor ;:11. 'dr't Jefferson myself`you're my
Jam•;?' Healthcare's Washington state Reach
and after giving birth. '. ,a F a m i 1 y family'." Out and Read program to
Nmothers also are Kirsten Pickard Birth Center hand out books to all young •
encouraged to breastfeedok . childrento age 5 during
and a goal is to make was honored Micaela Colleyup g
each check-up.
entire families as comfort- for being the first hospital mother "Finally, we are able as possible. in the country to achieve
work-
Washington's secre- a mother-friendly desig- all the nurses certified as ing on the grant with the
tary of health, Dr. John nation from the Coalition mother-friendly benefits YMCA to improve nutri-
Wiesman, and the hos- for Improving Maternity ""every
n cry mnmiaundvnew baby tion
i geduc tiforr nuron nd pexenane
pital's Dr. Molly Parker Services.
described some of the ben- Pickard didn't stop Pickard said "word got patients,"she said.
efits of breastfeeding. there. out and around" about the Pickard said the reason
Benefits include Pickard moved on to baby-friendly program and she wanted the center des-
decreased risks of infant getting the center desig- the mother-friendly certi- ignated .,as baby-friendly
deaths worldwide, nated as a baby-friendly fied team, and the center was because the program
decreased risks of obe- center in 18 months. It's has been receiving patients is recognized•worldwide.
sity in both the mother a process that takes the from as far away as Seattle She described working
and the child, decreased average birthing center and apf romntyneahwebl ringg w th she wa m told edeyicatedid
d
risks of infant ailments four years.
such as ear infections and "It's like the little hos- Nurses from the center not exist.
decreased risks of cancer pital that could," Pickard also work with Jefferson "It was like I found
in both mothers and their said. County Public Health to a unicorn. I wanted the
children. Jefferson Healthcare bring breastfeeding educe- world to see what I saw. I
Wiesman described CEO Mike Glenn said that tion to the public. am so incredibly proud of
making the center baby making the hospital both Parker said nurses them,"she said.
friendly as"the right thing baby-friendly and having also are working with
to do for babies."
"This is all about the '
babies and the moms,"said
Dr. Wiesman, who has
made it his personal goal
to make every birthing
clinic in Washington baby-
fr'ie`ndly by:hr's terms:end. -
Kirsten Pickard, birth-
ing center nurse manager
at Jefferson Healthcare,
explained how the nursing
team was already "abso-
lutely committed" to the
mothers and babies in their
care when she began work-
ing here seven years ago. G� G�
"I just needed to let the
WHO know how amazing
we were," Pickard said of /�(�//�%j
going through a designs- ,.
Dental clinic
on wheels
makes visit
PENINSULA DAILY NEWS
PORT TOWNSEND —
The SmileMobile, a fully
equipped dental clinic on
wheels, rolled out some-
thing new during a recent
trip to Port Townsend.
Besides serving children
from birth to age 18, the
SmileMobile also served
pregnant women and new
moms for the first time.
Visit to PT
The SmileMobile visited
Port Townsend earlier this
month to provide exams,
cleanings and treatment for
Jefferson County women
and children who fall within
their guidelines.
'This is a huge benefit
• for our community," said
Heather Sebastian, WIC
clerk at Jefferson County
Public Health.
The SmileMobile is a
partnership between Wash-
ington Dental Service,
Washington Dental Service
Foundation and Seattle
Children's Hospital.
For more information
about SmileMobile services
and the next visit, phone
Jefferson County Public
Health at 360-385-9400.
•
1V
Bat that bit Jefferson County resident tests positive for rabies
By Jeremy Schwartz, Peninsula Daily News, July 28`h,2013
•
•
4 :f
PORT TOWNSEND —A bat which bit a Jefferson County resident had rabies, officials have confirmed.
This makes the second bat in two years in south Jefferson County to test positive for rabies, said Dr.
Tom Locke, the health officer for Jefferson and Clallam counties, saying the earlier case— in 2012—
also was in the southern part of the county.
In Clallam County, no bat has tested positive for rabies since 2008. Four people were exposed to a bat at
the Lake Ozette campground in Olympic National Park.
The bat that was submitted to the state Public Health Lab in Shoreline on July 22 was found outside a
• home between Quilcene and Brinnon, Locke said.
The resident found the sick bat outside the home and was bitten by it when trying to pick it up, Locke
said.
The resident underwent the rabies vaccination process and has recovered, Locke added.
Locke said anyone who sees a bat that appears to be sick should keep away from the animal.
"The highest-risk situation is someone seeing a bat that can't fly or a bat that is not trying to flee from
being close to humans," Locke said.
"People should keep their distance from any kind of abnormal-behaving bat."
Bats can pass on the rabies virus to other mammals, including humans, if the bat's saliva comes in
contact with an open wound or a mucus membrane, such as the eyes or nose, said Denis Langlois,
public health nurse for Jefferson County Public Health.
Locke said 11 of the 204 bats the state health lab tested in 2011, or about 5 percent, had rabies.
Testing a bat means killing it, Locke said, since the bat's brain needs to be examined to determine if the
410 bat is infected.
Most calls to the Clallam County health department and Jefferson County Public Health about bats come
from residents who have found bats in their homes, Locke said.
Langlois said Jefferson County residents who find bats in their homes and fear they might have come in
contact with the animal should phone Jefferson County Public Health at 360-385-9400. .
Locke said the same goes for Clallam County residents, who can call the Clallam County health
department at 360-417-2274.
If someone finds a bat in their home, Locke and Langlois said a safe effort should be made to capture
the bat so it can be sent to the state public health lab for testing.
"When you can't test the bat, they usually recommend people do get the [rabies] vaccine," Langlois said.
Getting the vaccine requires a series of five shots and can cost $5,000 on average, Locke said, a cost
often not covered by medical insurance.
"[Getting the vaccine is] probably sufficient within 10 days of exposure, but we like to do it within 72
hours," Locke said.
To catch a bat that has found its way into a home, Langlois recommended first using a towel or piece of
cloth to wrangle the bat to the floor.
Langlois said a jar can then be placed over it and a piece of cardboard slid under the jar mouth so the jar
can be picked up without the bat escaping.
The lid can then be screwed onto the jar and the bat brought to the respective health department in •
Clallam or Jefferson counties, Langlois said, after public health staff have been called about the bat
being brought in for testing.
Summer on the North Olympic Peninsula is often the time bats are most active, Locke said, as they are
out feeding on the insects warm weather typically brings.
Additionally, people seem to come more in contact with bats in their homes during summer since
windows are often left open to allow breezes into a house, Locke added.
Langlois and Locke recommend county residents install window screens and bat-proof their attics to
keep bats from getting into their homes.
Residents are also reminded to abide by state laws that mandate dogs, cats and ferrets be vaccinated
against rabies, Locke said, as unvaccinated pets exposed to rabies often need to be euthanized.
Reporter Jeremy Schwartz can be reached at 360-452-2345, ext. 5074, or at jschwartz(c�peninsuladailynews.com.
•
Jefferson County bat tests positive for rabies
By Tristan Hiegler of the Port Townsend Leader I Posted:Wednesday,July 31,2013 5:00 am
•
For the second time in two years, a Jefferson County bat has tested positive for the rabies virus.
The bat was submitted to the Washington State Public Health Laboratories for testing on July 22 after a
South County (Quilcene-area) resident was bitten by the animal. The lab returned a positive result by
July 23, according to Tom Locke, Jefferson County Public Health officer.
Locke said between 5 and 10 percent of the bats submitted by Jefferson County for testing are actually
infected. He said the virus is ingrained in bat populations across the state.
Last year, another bat from southern Jefferson County also tested positive for rabies.
"I think that's probably coincidental. We see rabid bats all over Washington state," Locke said. "Everyone
else in Jefferson County should be equally cautious. We have reason to believe that rabies is established
in the bat population all over Washington state."
There is an effective treatment for rabies if a person is bitten or exposed, Locke said. He added that it's
best to be treated within 72 hours of the exposure. According to Locke, rabies vaccines for certain kinds
of pets are mandated by Washington regulations.
"If[residents] find a bat in their home, and they have reason to believe that that bat has been in the home
• overnight, they should keep that bat, and we'll arrange to have it tested," Locke said of one potential
exposure scenario.
Locke strongly advises county residents to avoid direct contact with bats, especially bats that appear to
be ill and unable to fly.
He noted that the rabies virus can have an exceptionally long incubation period —the time between
infection and when the virus starts manifesting symptoms. He said the world record for rabies incubation
was seven years, and it can vary anywhere from weeks to many years.
"The viruses that tend to survive are the ones that don't kill their hosts or don't kill their hosts right away,"
Locke said. "Rabies can exist in virtually any terrestrial mammal."
He said that in recent years, only bats have tested positive for rabies in the state. A cat tested positive in
2002 and other animals had positive tests in the 1990s. Locke said all animals infected in Washington
have a strain of bat rabies.
Rabies is rampant in bat colonies because the animals cluster so close together, allowing the virus to
spread through contact. Locke called such colony infections "smoldering infections," because the virus's
death rate is lower than the birth rate, allowing it to continue existing in a colony without killing all the
• animals present.
Unlike smallpox, which is only carried by humans, rabies can never be eliminated, because it spreads to
so many animal species, according to Locke.
ies
v
s is •
According to the federal Centers for Disease Control and Prevention (CDC) website, the rfor virus 8
transmitted primarily through the bites of infected wild animals. Domestic animals accounted
percent of the reported rabies cases in 2010.
The CDC stated that in 2010, bats were the third-most-common (23 percent of cases)
wild carrier of
rabies, with raccoons and skunks responsible for more reported cases during thatyear.
Organ transplants from infected individuals can also cause new infections, according
gto the CDC. In
2004, four individuals were infected and died from liver, kidney and arterial transplants.
"Rabies is still quite a problem in the Third World: In India,
we still see it in dogs and domestic animals; in
Mexico, there are still dog rabies problems," Locke said. "It's an ancient infection, we think. We think it's
been along for a very long time; we're never going to get rid of it."
•
•
SmileMobile serves moms and kids
The SmileMobile, a fully
equipped dental clinic on
wheels, rolled out something r `
new during its visit to Port b m s E
Townsend, July 842. In M • ,� �
addition to serving children
from newborns to age 18, the '�
SmileMobile also served prep
nant women and new moms
for the first time. r � `t g `s s ' r r c
The SmileMobile •provides 3 ,
exams, cleanings and treat Y x �� s g� Y �r � .
went for Jefferson County ° .
women and children. x z;.1 :• •yt
"This is a huge benefit for
our community,".said Heather Volunteer dentist Rick Gadd and Jessica Black are in the SmileMobile,a
Sebastian, WIC (Women, fully equipped dental clinic on wheels that provides exams,cleanings and
Infants, Children) clerk at treatment for women and children.For more information,call 385-9400.
Jefferson County Public Submitted photo
Health.
"The need for access to and we are thrilled to partner For information about
preventative and affordable with the SmileMobile provid- SmileMobile and the next
dental care for women in this ing this service in our corn- visit,contact Jefferson County
stage of their life is great, runty." Public Health at 385-9400.
•
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police lice tape surrounds the Ross Township Municipal Building on Tuesday in northeastern
Pennsylvania,where a local resident shot and killed three men at a Monday night mooting.
,unman
Officials:
Pa.
more
would
have shot.
after being flown to Lehigh Valley
i,7, Medical Center.
3 people die i r �:; Fleetwood,62,also served as a
supervisor in nearby Chestnuthill
after rampage w Township,alshe coroner said.
�� . :~ 1. ,' Officials identified the slain
j � ,-. ' residents as Gerard J.Kozic,53,
at meeting ,-e`er t,f-,4, and James V.LaGuardia,64,both
�,I:aaaw e �° of Saylorsburg. •
'ME
ASSOCIATED PRESS Kozen At the hospital an hour later,
Newell Newell told police he had gone to
SAYLORSBURG,Pa.—Aw h the meeting in hopes of finding
abled junk dealer feuding Ross Township, about 85 miles the township officials in one place.
local officials over his debris- north of Philadelphia, before "He intended to shoot the solic-
strewn property packed a rental shooting a supervisor and four itor and supervisors,and thought
car with guns and ammunition residents,two of whom survived. that he would then be killed,"
before opening fire at a town Newellretreated to the car and police said in the affidavit.
meeting and lulling three men, picked up a revolver, authorities Newell was about to fire his
authorities said Tuesday said. When he returned to the .44 Magnum revolver when the
Rorty this Newell,59,had lost his meeting room,the 5-foot-10,240- township's parks and recreation
property year in a court fight pound sus ct was tackled by two director,Bernie Kozen, and resi-
over complaints that he lived in a P dent Mark Kresh wrestled him to
storage shed,built an illegal cul- men and shot in the leg during the ground,Monroe County Coro-
vert and used a bucket outside as the scuffle,officials said. nor Bob Allen said.
a toilet. "Two very courageous individ-
At his arraignment on homi- `Wish I killed more of them' uals ositioned themselves in a
tide charges Tuesday morning,hea
"I wish I killed more of them!° way that they were able to jump
judge asked Newell whether Newell shouted when state on this subject as he came through
owned any real estate. Trooper Nicolas De La-Igl the door," State •Police Lt. Col
fey started i•t from me:That s arrived before 8 p.m.,according to George Bivins said. Phis could
what all this,"he replied.
Newell allegedly used a Ruger the trooper's affidavit. have been much worse."
x_14 rifle to blast a barrage of Two men died at the scene,and The two survivors were
gunfire through a wall into the the third, Ross Township zoning released from the hospital,along
meeting room Monday night in officer David Fleetwood, died with Newell.
Pt i
Oe/7/70 •
• Let's get physical: High school athletes need
paperwork prior to practice
Posted: Wednesday, August 7, 2013 6:00 am, Port Townsend Leader
Back-to-school bells do not ring until September, but coaches' whistles blare this
month for those high school student athletes turning out for fall sports: volleyball,
girls' soccer, football, girls' swimming, boys' tennis and cross-country.
Student athletes without paperwork clearance, and that includes a medical
physical document, cannot practice. Physicals are available at school-based
health clinics at both Port Townsend High School and Chimacum High School.
Sports physicals are available Tuesdays and Fridays at the School Based Health
Center in the Gael Stuart Building on the PTHS campus. Physicals are available
by appointment or walk-in, though you may have to wait if you walk in. For an
appointment, call Jefferson County Public Health at 385-9400. There is a sliding
scale fee for the sports physical (full fee is $45); however, no one will be turned
away because of inability to pay. Please bring your physical form, the clinic
• registration/consent form and any health insurance information.
BACK TO SPORTS
PTHS hosts a meeting for the parents/guardians of high school fall-sport athletes
at 6 p.m. Monday, Aug. 19 in the PTHS library.
Football practice begins Aug. 21 in both Chimacum and PT. PT's first football
game is Saturday, Sept. 7 at Granite Falls, while Chimacum's first game is
Thursday, Sept. 5 against Forks at Jefferson County Memorial Athletic Field.
Practice begins Monday, Aug. 26 for other fall sports.
S
•
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part in a series of
of a 1-year-old,took . . ate in
Wendy Jensen,the mother Jul to
Cooking with WIC
young families who participate Chef Arran Stark(left)and
ment,"said Stark,whose classes
tcn000vvki nogmcolna,sisnet as notffs earnedd Childrenin .
of recipes.For more informa-
tion (WIC)nutrition program."Anytime
contact Jefferson
about feeding families
0 Submitted photo
Health at 385-940 .
fo-
cused on methods of insteadcoiloieksinogna
County Public limited budget,
we cook,it's a big,fat experiy
•
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•
• Follow safety tips for harvesting, cooking shellfish
Posted: Wednesday, August 7, 2013 5:00 am, Port Townsend Leader
Warm water can increase levels of natural vibrio bacteria in oysters, which may
make people sick if oysters are eaten raw or undercooked.
"We want people to enjoy our shellfish and stay healthy this summer. Vibriosis is
completely preventable by taking a few precautions," said Jared Keefer, water
quality director at Jefferson County Public Health (JCPH).
To kill the bacteria, JCPH urges cooking oysters to a temperature of 145 degrees
Fahrenheit for at least 15 seconds. As a general guideline, once shells open,
continue to cook a few minutes longer.
If boiling, continue to cook for another 3 to 5 minutes.
If steaming, continue to cook for 4 to 9 minutes after shells open.
Vibriosis symptoms may include diarrhea, stomach cramps, nausea, vomiting,
headache, fever and chills. Symptoms usually appear within 12-24 hours after
• eating infected shellfish and usually last from two to seven days.
It is also the high season for marine biotoxins. JCPH monitors local waters,
working with the state Department of Health to test shellfish samples for paralytic
shellfish poisoning, amnesic shellfish poisoning and diarrheic shellfish poisoning.
Unlike vibrio, these biotoxins cannot be killed by cooking and can cause serious
health effects or even death. People cannot tell if shellfish are toxic by looking at
them. Biotoxins can only be detected in a laboratory.
Before harvesting shellfish, call the Safe Shellfish Hotline number: 800-562-5632
or visit jeffersoncountypublichealth.org.
Safe shellfish harvesting is easy with these simple tips: Harvest shellfish from the
beach as soon as possible after the tide recedes. Don't harvest shellfish that
have been in the sun for more than two hours. Refrigerate or put shellfish on ice
immediately after harvest. Cook shellfish to an internal temperature of 145
degrees F for 15 seconds.
•
•
Get ready for school with a shot in the arm
*Posted: Wednesday, August 7, 2013 5:00 am, Port Townsend Leader
August is a good time to think about back-to-school vaccinations or childcare admittance, according to a
Jefferson County Public Health press release.
All immunizations required to enroll in school are available to children up to age 19 at no cost through the
state's Childhood Vaccine Program.
To meet state law, parents wishing to exempt their children from required immunizations must consult
with a licensed healthcare provider to receive a signed Certificate of Exemption form to be filed with the
school. Jefferson County has a high rate of students opted out of immunizations, according to the
Washington State Department of Health.
Several immunizations are needed before kids can start school or meet childcare requirements,
according to local health officials. Vaccination against whooping cough (pertussis) is considered
especially important given the recent outbreak in our county and state.
Jefferson County Public Health has walk-in immunization clinics from 1-4 p.m. every Tuesday and
Thursday at 615 Sheridan St., Port Townsend. Extra back to school clinics are to be held at 1-4 p.m. on
two Mondays, Aug. 19 and Aug. 26. No appointment is necessary.
• Participating medical immunization providers in Jefferson County include: Jefferson Healthcare Primary
Care, Jefferson Healthcare Family Medicine, Jefferson Medical & Pediatric Group, South County Medical
Clinic and Jefferson County Public Health. There may be a charge for the office visit and an
administration fee to give the vaccine. People who can't afford the administration fee may request a
waiver.
MINIMUM REQUIRED
Children who have received all recommended vaccines throughout childhood will have more doses of
some vaccines than the minimum listed for school attendance. The following are the minimum required
immunizations for the 2013-2014 school-year:
Kindergarten through grade 5: DTaP: Four doses with the last dose on or after the 4th birthday (In some
cases, three doses may be acceptable for children age 7 and older). Polio: Three doses with the last
dose on or after the 4th birthday. Hepatitis B: Three doses. MMR (measles, mumps, & rubella): Two
doses. Varicella (chicken pox): Two doses of vaccine or medical provider verification of disease.
Sixth grade: Tdap: Grades 6-12 students who are age 11 or older are required to have one dose.
Varicella (chicken pox): One dose of vaccine or a history of the disease. A parent's report of disease
history is adequate at this grade level. Polio, MMR, and Hepatitis B requirements: Same as for grades K-
5.
Grades 7-12: Varicella (chicken pox): Recommended, but not required for students who have not had the
disease. Tdap: Same as sixth grade requirements. Polio, MMR, and hepatitis B: Same as K-5
requirements. •
Other vaccines are available and recommended for children and teens by the Centers for Disease
Control, but are not required for school attendance. Ask your provider or Jefferson County Public Health
about HPV, hepatitis A, and meningococcal vaccines as well as an annual flu shot. Meningococcal
vaccine is especially important, and frequently required, for freshmen entering college.
For more information on immunization schedules contact your medical provider or
jeffersoncountypublichealth.org, or call Marjorie Boyd at 385-9400.
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County Public Health III
Always working for a healthier Jefferson.
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Public Health News and Events.
Welcome»News&Events
WORLD BREASTFEEDING WEEK CELEBRATION AUG 7
WORLD BREASTFEEDING WEEK CELEBRATION AUGUST 7
Jefferson County
Public Health (JCPH) supports the annual global celebration of World Breastfeeding Week. August 1-7.
7th amoka park in Port Townsend. "Jefferson County community
and families who are breastfeeding or have breastfed, their babies, children and friends are invited to bring their
All mothersAugust at 1PM at Chet
picnic on WednesdayJCPH, Community Health
picnic runhh to a supports breastfeeding", says Julia Danskin,
supports healthy children and is a community that
Manager. Week theme, 'BREASTFEEDING SUPPORT: CLOSE TOeMOin tERe weeks Ilights Bre tfeeding
This venrwen mld Brerstare abg
Peer help. Even when mothers are able to get off r a good start is s.breastfeedinwhen g, We do n t visit a the World
isr
a sharp decline in breastfeeding rates and practices.
Breastfeeding
gers do isnot visit a healthcare facility
is tvery, there support system for mothers is e
the time when a communitye
Health Organization and other international organizations. For more information go to: htt•: worldbreastfeedin•wee . •
9
Public Health and WIC offer support to sustain breastfeeding in a variety of ways. Breastfeeding women
Jefferson III
CountyMaternity JCPH alsoort provides
and
can get support from each other at the weekly breastfeedidn9 teananitwomen through the WIC,at 1:30. provi es
ongoing support and education to breastfeeding moms a
Nurse Family
Partnership ® programs. For more information, call JCPH call 385-9432 or visit
htt•: -effersoncount .ublichealth.or•
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Always Working for a Safer &Healthier Jefferson County
Jefferson County Public Health WA 98368
615 Sheridan Street-Port Townsend,
Community Health:360.b350se Environmental Health:360 385 9444 JCPH Employee Resour<
info@leffersoncountyp he4
•
JEFFERSON COUNTY PUBLIC HEALTH
615 Sheridan Street c Port Townsend o Washington o 98368
www.jeffersoncountypublichealth.org
•
July 26,2013
Scott Lindquist, Director and Health Officer
C/O Kitsap Public Health District
Norm Dicks Government Center
345 6th Street
Suite 300
Bremerton,WA 98337-1866
Dear Board of Health neighbors,
The Jefferson County Board of Health invite you to join them for part of the August Board of Health meeting in
Port Townsend for a presentation from King County regarding its innovative new drug take-back program. We
hope you'll be able to attend.
King County took a significant step toward reducing preventable deaths from drug overdoses by passing a rule and
regulation to create a drug take-back system for King County Residents. Specifically, King County's program
promotes a safe disposal of unused prescriptions and over the counter medicines and will be funded and operated
by the drug manufacturers who produce the medications. Residents will be able to dispose of unwanted
medications at pharmacies and other secure locations in King County free of charge. Voluntary take-back
• programs have previously existed at Group Health,and at some participating pharmacies at Bartel Drugs. In
Seattle,these programs have collected 48,000 pounds of medicine since 2010.
Locally,the Port Townsend Police and Jefferson County Sherriff departments operate secure drug take-back
stations,which have collected many pounds of medication. However,the stations are not widely known in the
community and are only available at the police stations. The possibility of developing more extensive drug take-
back programs in Jefferson, Kitsap and Clallam has the additional significant benefit of reducing the burden of
medications and drugs entering water systems and polluting our pristine waterways.
We hope you'll be able to join us for this presentation and discussion of King County's implementation team and
implementation plan on August 15th,at 2:30 at a location to be determined. Please RSVP to 360-385-9408,or
jbaldwin@co.jefferson.wa.us
Sincerely,
Jean Baldwin, M.S.N.,A.R.N.P.
Director,Jefferson County Public Health
cc:Chair and Members,Jefferson County Board of Health
•
COMMUNITY
LTH
DEVELOPMENTAL ISABILITIES PUBLIC HEATH ENVIRONMENTAL HEALTH
MAIN: (360)385-9400 ALWAYS WORKING FOR A SAFER AND WATER QUALITY
MAIN: (360)385-9444
FAX: (360)385-9401 HEALTHIER COMMUNITY
FAX: (360)379-4487
• Jefferson County Board of Health
Guest List
Regular Meeting: August 15, 2013 - 2:30—4:30 pm
Jefferson County Library, 620 Cedar St., Port Townsend, WA 98338
Name I Email Address '
Agency/Board
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