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HomeMy WebLinkAbout2013- September • JEFFERSON COUNTY BOARD OF HEALTH September 19, 2013 • File Copy • Agenda — Sept 19, 2013 Minutes - August 15, 2013 • JEFFERSON COUNTY BOARD OF HEALTH September 19, 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. Old Business and Informational Items • 1. Washington State School Nurse Corps Receives the Warren Featherstone Reid Award 2. Secure Medicine Takeback Program Follow-up: Alameda County Lawsuit Dismissed 3. Living Environment Pool Permitting on the Fee Schedule 4. Staff Contact Update V. New Business 1. 2014 Communicable Diseases Performance Measures Plan 2. Food Program Permit Processing 3. Contract Discussion with Jefferson County School Districts 4. Flu Season Letter to Providers 5. NACCHO 2013 Local Public Health Department Profile VI. Activity Update VII. Agenda Planning Calendar WASAC meeting is Nov 19—21th. Regular November BOH meeting is Nov 21st— cancel Nov meeting? VIII. Next Scheduled Meeting: October 17, 2013 2:30—4:30 PM Jefferson County Public Health • 615 Sheridan St. Port Townsend, WA 98368 JEFFERSON COUNTY BOARD OF HEALTH • MINUTES Thursday, August 15 2013 Jefferson County Public Library, 620 Cedar St, Port Hadlock, WA 98339 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 Chair Buhler called for review and approval of agenda. Member Johnson moved to approve the agenda as presented; the motion was seconded by Member Sullivan. No further discussion. The motion passed unanimously. APPROVAL OF MINUTES Chair Buhler called for review and approval of the minutes. Member Frissell made a correction on page 4 of the minutes, under "Legislative Wrap Up" changing "Medicare"to "Medicaid." Member Robinson made multiple corrections: Page 2, correct"Chair Johnson"to "Member Johnson"; top of page 3, correct from "...reduced..."to "...subsidized...". On Page 5 member Robinson requested that the accuracy of the statement: "...67 group A systems serving 24,000 people..." be checked. (Administrative note: The recording of the 7/18/13 meeting was checked, and the DOH statement was made that"67 group A water systems which serve over • 24,000 people" are present in Jefferson County). 1 BOH Minutes—August 15,2013 Member Westerman asked for an addition on page 5: Add a definition for large onsite sewage systems. • Chair Buhler made a spelling correction on page 2, under"Healthy/HAPPENINGS", to state "...Chef Arran Stark..."; under"Legislative Wrap-up"was corrected to state: "Dr. Locke reported that state government shutdown was avoided." Member Austin moved to approve the minutes as amended; the motion was seconded by Member Robinson. No further discussion. The motion passed unanimously. PUBLIC COMMENT No public comment. NEW BUSINESS AND INFORMATIONAL ITEMS Secure Medicine Return Presentation Margaret Shield, (King Co.) Local Hazardous Waste Mgmt. Program, and Maria Wood, King County Board of Health, gave a presentation to the Board regarding King County's secure medicine return program—slides of the presentation were included in the BOH agenda packet. The overview included: . • Secure medicine return problem statement • Epidemic: responding to America's prescription drug abuse crisis • Barriers to a comprehensive medicine take-back system in King County • DEA's proposed rule for Secure and Responsible Drug Disposal Act of 2010 • Product stewardship approaches for medicine take-back • Product stewardship legislation for pharmaceuticals in the US • (King Co.) Board of Health subcommittee on secure medicine return • Overview of secure medicine rule &regulation in King County King County will have a website and an email list for information and notifications about the program and law as the take-back program is implemented. Board of Health members expressed interest in keeping informed about the implementation of King County's Secure Medicine Return Presentation. Letter from Evergreen Coho SKP Park • 2 BOH Minutes—August 15,2013 Included in the Board's agenda packet, for review; a thank you letter for the work that Linda • Atkins has been doing in the community regarding the Septic 101 and 201 classes. Appointment to the Substance Abuse Advisory Board Fran Joswick recommended Lois Barnett for appointment to the Substance Abuse Advisory Board (SAAB). Ms. Barnett expressed her interest in a letter to the Board, has attended 3 SAAB meetings, and was interviewed by Member Austin, Julia Danskin and Ms. Joswick. The vacancy on the SAAB is an open seat; with ten members currently, Ms. Barnett will make 11. Ms. Joswick recommended Ms. Barnett for appointment, Chair Buhler called for a second, Member Austin seconded. Further discussion: Member Austin noted that Ms. Barnett's a very enthusiastic supporter of substance abuse prevention, particularly following the substance related death of friend earlier in the year. Chair Buhler called for a vote. The vote was unanimous to appoint Ms. Barnett to the SAAB. ACTIVITY UPDATE JCPH has been engaged in a public education campaign regarding bats after recent discovery of a rabid bat in Southeast Jefferson County. The goal is to inform the public that bats are a reservoir for rabies in Washington State. Exposure to bats should be avoided whenever possible. When human exposure does occur, it is advisable to capture the bat and submit it for testing, 5- 10% of the bats submitted to the Washington State Public Health Lab test positive for rabies. • The Irondale Beach closure issue previously reviewed by staff at a BOH meeting has expanded to a larger area of the beach. More signs have been posted. Further investigation is being undertaken in and along the small tributary to locate the source of the bacteriological contamination that is causing the beach closure. A family from Tacoma became ill with Vibriosis after eating oysters from a Brinnon beach. The beach was posted as closed. Vibriosis is caused by naturally occurring marine bacteria that tend to proliferate during the warmer summer months. A number of shellfish growing areas have been temporarily closed due to high seasonal levels of this bacterium. The JCPH budget process is underway, and fee schedule updates will be coming to the Board soon. Staff is unifying a branding message, working on a logo, and doing public outreach at festivals and community events. AGENDA PLANNING CALENDAR Jared Keefer reported that subsequent to the Board's request, he will bring further pool and fee updates to next month's board meeting. S 3 BOH Minutes—August 15,2013 NEXT SCHEDULED MEETING Next Board of Health meeting will be held on September 19, 2013 from 2:30—4:30 p.m. at • Jefferson County Public Health, 615 Sheridan Street, Port Townsend WA 98368 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 • Sheila Westerman, Member Respectfully Submitted: Cara Leckenby 11) 4 BOH Minutes—August 15,2013 t: JEFFERSON COUNTY BOARD OF HEALTH • MINUTES Thursday,August 15 2013 Jefferson County Public Library, 620 Cedar St, Port Hadlock, WA 98339 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 Chair Buhler called for review and approval of agenda. Member Johnson moved to approve the agenda as presented; the motion was seconded by Member Sullivan. No further discussion. The motion passed unanimously. APPROVAL OF MINUTES Chair Buhler called for review and approval of the minutes. Member Frissell made a correction on page 4 of the minutes,under"Legislative Wrap Up" changing"Medicare"to "Medicaid." Member Robinson made multiple corrections: Page 2, correct"Chair Johnson"to "Member Johnson"; top of page 3, correct from"...reduced..."to "...subsidized...". On Page 5 member Robinson requested that the accuracy of the statement: "...67 group A systems serving 24,000 people..." be checked. (Administrative note: The recording of the 7/18/13 meeting was checked, and the DOH statement was made that"67 group A water systems which serve over • 24,000 people" are present in Jefferson County). 1 BOH Minutes—August 15,2013 Member Westerman asked for an addition on page 5: Add a definition for large onsite sewage systems. • Chair Buhler made a spelling correction on page 2,under"Healthy/HAPPENINGS",to state "...Chef Arran Stark..."; under"Legislative Wrap-up"was corrected to state: "Dr. Locke reported that state government shutdown was avoided." Member Austin moved to approve the minutes as amended; the motion was seconded by Member Robinson. No further discussion. The motion passed unanimously. PUBLIC COMMENT No public comment. NEW BUSINESS AND INFORMATIONAL ITEMS Secure Medicine Return Presentation Margaret Shield, (King Co.) Local Hazardous Waste Mgmt. Program, and Maria Wood, King County Board of Health, gave a presentation to the Board regarding King County's secure medicine return program—slides of the presentation were included in the BOH agenda packet. The overview included: • • Secure medicine return problem statement • Epidemic: responding to America's prescription drug abuse crisis • Barriers to a comprehensive medicine take-back system in King County • DEA's proposed rule for Secure and Responsible Drug Disposal Act of 2010 • Product stewardship approaches for medicine take-back • Product stewardship legislation for pharmaceuticals in the US • (King Co.) Board of Health subcommittee on secure medicine return • Overview of secure medicine rule &regulation in King County King County will have a website and an email list for information and notifications about the program and law as the take-back program is implemented. Board of Health members expressed interest in keeping informed about the implementation of King County's Secure Medicine Return Presentation. Letter from Evergreen Coho SKP Park • 2 BOH Minutes—August 15,2013 Included in the Board's agenda packet, for review; a thank you letter for the work that Linda • Atkins has been doing in the community regarding the Septic 101 and 201 classes. Appointment to the Substance Abuse Advisory Board Fran Joswick recommended Lois Barnett for appointment to the Substance Abuse Advisory Board (SAAB). Ms. Barnett expressed her interest in a letter to the Board, has attended 3 SAAB meetings, and was interviewed by Member Austin, Julia Danskin and Ms. Joswick. The vacancy on the SAAB is an open seat; with ten members currently, Ms. Barnett will make 11. Ms. Joswick recommended Ms. Barnett for appointment, Chair Buhler called for a second, Member Austin seconded. Further discussion: Member Austin noted that Ms. Barnett's a very enthusiastic supporter of substance abuse prevention, particularly following the substance related death of friend earlier in the year. Chair Buhler called for a vote. The vote was unanimous to appoint Ms. Barnett to the SAAB. ACTIVITY UPDATE JCPH has been engaged in a public education campaign regarding bats after recent discovery of a rabid bat in Southeast Jefferson County. The goal is to inform the public that bats are a reservoir for rabies in Washington State. Exposure to bats should be avoided whenever possible. When human exposure does occur, it is advisable to capture the bat and submit it for testing, 5- 10%of the bats submitted to the Washington State Public Health Lab test positive for rabies. 111 The Irondale Beach closure issue previously reviewed by staff at a BOH meeting has expanded to a larger area of the beach. More signs have been posted. Further investigation is being undertaken in and along the small tributary to locate the source of the bacteriological contamination that is causing the beach closure. A family from Tacoma became ill with Vibriosis after eating oysters from a Brinnon beach. The beach was posted as closed. Vibriosis is caused by naturally occurring marine bacteria that tend to proliferate during the warmer summer months. A number of shellfish growing areas have been temporarily closed due to high seasonal levels of this bacterium. The JCPH budget process is underway, and fee schedule updates will be coming to the Board soon. Staff is unifying a branding message, working on a logo, and doing public outreach at festivals and community events. AGENDA PLANNING CALENDAR Jared Keefer reported that subsequent to the Board's request, he will bring further pool and fee updates to next month's board meeting. • 3 BOH Minutes—August 15,2013 .c `4 NEXT SCHEDULED MEETING Next Board of Health meeting will be held on September 19, 2013 from 2:30—4:30 p.m. at • Jefferson County Public Health, 615 Sheridan Street, Port Townsend WA 98368 ADJOURNMENT Chair Buhler adjourned the BOH meeting at 4:35 PM. JEFFERSON COUNTY BOARD OF HEALTH / 9/264.14_Phil J.r, so ember uhler, Chair 44/1/4/1"1:il /eem":14—' Roberta Frissell, Member David Sullivan, Vice Chair Catharine Robinson, Member Jo Austin, Mem.er Sheila Westerman, Member Respectfully Submitted: Cara Leckenby • 4 BOH Minutes—August 15,2013 • Old Business and Informational Items • 1 . Washington State School Nurse Corps Receives the Warren Featherstone Reid Award • State of Washington Office of the Governor August 9, 2013 Katie Johnson Health Services Supervisor Office of the Superintendent of Public Instruction P.O. Box 47200 Olympia, WA 98504 Dear Katie: It is my pleasure to inform you that the Washington State School Nurse Corps (SNC) has been selected as the recipient of the Warren Featherstone Reid Award for Excellence in Health Care. The SNC program's innovative service delivery model reaches over one million students with a special focus on rural settings and has high customer satisfaction scores among parents and school staff In addition to its strong leadership role, these traits exemplify the very spirit of this award. Secretary John Wiesman's office, at the Washington State Department of Health,will be in contact with you to arrange a convenient time to present this award. Congratulations on winning this distinguished award! Very truly yours, j a r slee I•sernor cc: Dr.John Wiesman, Secretary, Department of Health • Old Business and Informational Items 2. Secure Medicine Takeback Program Follow- up: Alameda County Lawsuit Dismissed • From: Shield, Margaret • Sent: Thursday, August 29, 2013 3:22 PM To: takebackyourmeds(anpogroups.org Subject: Alameda County lawsuit decision - pharma industry motion denied Take Back Your Meds Coalition - Important news on pharmaceutical stewardship from California. The federal court judge in the Northern District of California has denied the pharmaceutical industry's motion that Alameda County's Safe Drug Disposal law is unconstitutional under the dormant Commerce Clause. Alameda County wins! Alameda's law, passed in July 2012, requires manufacturers of prescription medicines to provide a medicine take-back programs for county residents. This is a similar product stewardship approach to King County's new Secure Medicine Return Regulations, adopted by the King County Board of Health in June 2013. King County's law applies to manufacturers of both prescription and over-the-counter medicines, and requires manufacturers to provide a secure medicine return system for both types of medicines, including controlled substances. I will send the complete judge's ruling in the Alameda lawsuit via a second email because emails with attachments sometimes do not reach everyone on this email list. If you do not receive the next email with the ruling, you can send an email to me to get a copy. • A couple of excerpts from the ruling that I particularly enjoyed reading: Excerpt from page 2 - Because the Ordinance does not discriminate against out-of-state actors in favor of local persons or entities, and does not otherwise impermissibly burden interstate commerce, plaintiffs' motion will be denied, and defendants' motion granted. Excerpt from page 10- Plaintiffs suggest almost in passing that the Ordinance could be found invalid even under the balancing test that applies where the challenged regulation has only indirect, and nondiscriminatory, effects on interstate commerce. Plaintiffs do not question, for purposes of these motions, that the interests Alameda County had in enacting the ordinance were legitimate. Plaintiffs merely contend that those interests could be equally well served through take-back programs funded in another manner. Arguing that an alternative regime would have no burden on interstate commerce does not establish that the minimal burden this Ordinance arguably imposes on interstate commerce "clearly exceeds the local benefits." Defendants have adequately shown that the Ordinance serves a legitimate public health and safety interest, and that the relatively modest compliance costs producers will incur should they choose to sell their products in the county do not unduly burden interstate commerce. As in all such court battles, appeals may be made to a higher court, which in this case would be the 9th District Federal Court. I hope this good news carries you into an excellent Labor Day weekend! Margaret • Case3:12-cv-06203-RS Document40 Filed08/28/13 Pagel of 11 • 1 2 3 4 5 6 7 IN THE UNITED STATES DISTRICT COURT 8 FOR THE NORTHERN DISTRICT OF CALIFORNIA 9 SAN FRANCISCO DIVISION 10 sem. PHARMACEUTICAL RESEARCH AND No. C 12-6203 RS c 11 MANUFACTURERS OF AMERICA, et al., § 12 ORDER DENYING PLAINTIFFS' -76 Plaintiffs, 0 13 V. MOTION FOR SUMMARY JUDGMENT AND GRANTING A 0 14 DEFENDANTS' CROSS-MOTION ActCOUNTY OF ALAMEDA, et al., 15 z Defendant. ^a 16 / aJ .N w 17 18 I. INTRODUCTION 19 The County of Alameda has adopted what has been described as a"first in the nation" 20 approach to addressing concerns arising from the disposal of unused prescription drugs. Its "Safe 21 Drug Disposal Ordinance" (the "Ordinance"), scheduled to go into effect in November of this year, 22 requires producers of prescription drugs to fund or operate "take-back"programs in the county, if 23 any of their drugs are sold there. The ordinance is crafted to place the entire cost of such programs 24 on the producers; retail pharmacies are exempt, and sellers are prohibited from passing the expense 25 directly to Alameda County consumers by adding a fee at the point of sale. Plaintiffs are industry 26 associations whose members produce prescription drugs sold in the county, on whom the costs of 27 complying with the Ordinance will fall. They bring this suit to have the ordinance declared an 28 unconstitutional burden on interstate commerce, under the so-called "dormant Commerce Clause." Case3:12-cv-06203-RS Document40 Filed08/28/13 Page2 of 11 1 Having stipulated that the material facts are undisputed, the parties now bring cross-moticill 2 for summary judgment. Because the Ordinance does not discriminate against out-of-state actors in 3 favor of local persons or entities, and does not otherwise impermissibly burden interstate commerce, 4 plaintiffs' motion will be denied, and defendants' motion granted. 5 6 II. BACKGROUND 7 Demonstrating commendable cooperation and professionalism directed at resolving this 8 litigation in an efficient manner, the parties stipulated to a list of 38 points that are not in dispute for 9 purposes of these cross-motions. In slightly condensed form, the following are the parties' 10 stipulations: 4-0 c 11 1. The Ordinance, Alameda Health and Safety Code Sections 6.53.010, et seq., requires that Vg 12 manufacturers of prescription drugs who sell, offer for sale, or distribute prescription drugs in 13 Alameda County ("Producers," as defined in the Ordinance) operate and finance a product •H U A o 14 stewardship plan that provides for the collection, transportation, and disposal of certain unwanted 15 prescription drugs. � z 16 2. The Ordinance declares that in Alameda County, the public—particularly children and cu 17 the elderly are at significant and unnecessary risk of poisoning due to improper or careless 18 disposal of prescription drugs and the illegal re-sale of prescription drugs; that the groundwater and 19 drinking water are being contaminated by unwanted, leftover, or expired prescription drugs passing 20 through wastewater and treatment centers; and that there is no mandatory statewide drug 21 stewardship program in California for the safe collection of unwanted drugs, and drug 22 manufacturers and producers have not offered any support for a permanent collection program to 23 date. 24 3. Pursuant to the Ordinance, Producers are required to operate, individually or jointly with 25 other Producers, a Department [of Environmental Health]-approved product stewardship program or 26 enter into an agreement with a stewardship organization to operate, on each Producer's behalf, a 27 Department-approved product stewardship program. In order to ensure that costs are fairly 28 allocated, if more than one Producer is involved in a proposed product stewardship program, the 2 Case3:12-cv-06203-RS Document40 Filed08/28/13 Page3 of 11 • 1 product stewardship plan must include a fair and reasonable manner for allocating the costs of the 2 program among the participants, such that the portion of costs paid by each Producer is reasonably 3 related to the amount of prescription drugs that Producer sells in Alameda County. 4 4. The Ordinance, on its face, does not impose different requirements on Producers within 5 Alameda County and Producers outside of Alameda County. 6 5. The Ordinance, on its face, does not impose different requirements on Producers within 7 California and Producers outside of California. 8 6. The Ordinance, on its face, applies both to interstate Producers and intrastate Producers. 9 7. The Ordinance requires Producers that market and sell in Alameda County the 10 prescription drugs identified in the Ordinance be responsible for the disposal of those products. 11 8. Any person, manufacturer, or distributor that does not sell, offer for sale, or distribute O Uo 12 prescription drugs in Alameda County is not required to undertake any action under the Ordinance. 0 13 9. Nothing in the Ordinance requires that Producers implement stewardship plans in any t A 14 location or jurisdiction outside of Alameda County. If Producers are required to implement z15 stewardship programs in any other jurisdiction, nothing in the Ordinance requires that the 0 16 stewardship program implemented in other jurisdictions be the same as the program implemented in CU r.. w 17 Alameda County pursuant to the Ordinance. Similarly, nothing in the Ordinance prohibits 18 Producers from proposing and implementing a program in Alameda County that they are already 19 using or contemplating using in any other jurisdiction. 20 10. Plaintiffs are non-profit trade organizations representing the manufacturers and 21 distributors of pharmaceutical products. Plaintiff Pharmaceutical Research and Manufacturers of 22 America ("PhRMA") represents companies that produce brand-name drugs. Plaintiff Generic 23 Pharmaceutical Association ("GPhA")represents companies that produce generic drugs. Plaintiff 24 Biotechnology Industry Organization ("BIO") represents companies that produce biotechnology 25 products. 26 11. Plaintiffs' members include approximately one hundred companies that are subject to the 27 Alameda County take-back ordinance because they manufacture prescription drugs that are sold, • 28 3 Case3:12-cv-06203-RS Document40 Filed08/28/13 Page4 of 11 1 offered for sale, or distributed in Alameda County. Plaintiffs' members also manufacture 2 prescription drugs that are sold or distributed throughout the United States. 3 12. Three of Plaintiffs' members (Amgen, Impax Laboratories, and XOMA Ltd.)have their 4 corporate headquarters or principal places of business in Alameda County. Two of Plaintiffs' 5 members (Bayer and Impax Laboratories) have facilities in Alameda County that manufacture 6 prescription drugs for commercial distribution. Four other members (Abbott, Baxter,Novartis, and 7 Boehringer Ingelheim) have manufacturing facilities in Alameda County that do not manufacture 8 prescription drugs for commercial distribution. 9 . . . . 10 17. The drugs manufactured in Alameda County for commercial distribution by Bayer and 11 Impax Laboratories account for less than 1% of total annual U.S. prescription drug sales O ro 12 (approximately $320 billion in 2011). Thus, approximately 99% of all prescription drugs sold in the • o 13 United States, by revenue, are manufactured outside Alameda County. A 14 18. There is a national system for the distribution of prescription drugs from manufacturers 0 15 to the retail and mail pharmacies that dispense the drugs to consumers. Prescription drugs typica z "o 16 move from a manufacturer's facilities to either a pharmaceutical wholesaler, a chain warehouse a) 8 • w 17 operated by a large retail drugstore chain, or a mail pharmacy. 18 19. Smaller retail pharmacies in Alameda County (and elsewhere)typically rely on 19 pharmaceutical wholesalers for direct delivery of prescription drugs to individual retail locations. 20 Large retail drugstore chains typically rely on delivery by either pharmaceutical wholesalers or their 21 own chain warehouses. Mail pharmacies purchase drugs from both pharmaceutical wholesalers and 22 directly from manufacturers. 23 20. Three pharmaceutical wholesalers—AmeriSource Bergen Corporation, Cardinal 24 Health, Inc. and McKesson Corporation—operate more than eighty distribution centers across the 25 United States. None of these wholesalers have a distribution center in Alameda County. 26 21. The California Board of Pharmacy maintains a list of licensed wholesalers. None of the 27 twenty-one locations in Alameda County with an active wholesale license distributes prescription 28 drugs. . 4 Case3:12-cv-06203-RS Document40 Filed08/28/13 Pages of 11 • 1 22. CVS, Walgreen, and Rite Aid are the three largest national drugstore chains but account 2 for less than half of the retail pharmacies in Alameda County. None of these chains operate a 3 warehouse distribution center in Alameda County. 4 23. The prescription drugs manufactured by Bayer and Impax Laboratories in Alameda 5 County are shipped outside the County before being distributed back into Alameda County. 6 24. Neither the County nor Plaintiffs are aware of any prescription drugs distributed in 7 Alameda County that arrive there via intra-County distribution channels as opposed to arriving there 8 via distribution channels that cross the County's borders, either because the drugs are manufactured 9 outside the County or because, if manufactured within the County, they are shipped to out-of-county 10 packaging or distribution centers before being distributed to in-county pharmacies. 11 25. Producers will incur start-up costs to establish a product stewardship program that o• „ Uo 12 complies with the Ordinance. These costs include the incorporation and governance of an entity to 13 operate the required collection program on behalf of the Producers, initial one-time investments in A o 14 equipment and facilities, and the preparation and dissemination of education and outreach materials r, z 15 publicizing the program. 0 16 26. Assuming that all Producers jointly operate a single collection program an assumption a w 17 that results in lower overall costs than if multiple programs were operated separately—Plaintiffs 18 estimate that overall start-up costs will be approximately $1,100,000. 19 27. Plaintiffs estimate that Producers will incur annual costs to operate a program that 20 complies with the Ordinance, including costs for labor, insurance, education and outreach, and 21 transportation and disposal of collected unwanted prescription drugs. Assuming that all Producers 22 jointly operate a single program, overall annual compliance costs (including reimbursement of 23 County administrative expenses) are estimated by Plaintiffs to be approximately $1,200,000, 24 provided that local pharmacies are willing to provide free space for the location of collection kiosks. 25 If local pharmacies either demand rent or refuse altogether to provide space for collection kiosks, 26 then Plaintiffs believe the recurring annual costs may be higher. 27 . 28 5 Case3:12-cv-06203-RS Document40 Filed08/28/13 Page6 of 11 1 28. The Ordinance requires Producers to reimburse Alameda County for actual costs • 2 incurred by the County in administering the Ordinance. Alameda County has estimated those 3 annual administrative costs to be roughly $200,000. 4 29. Plaintiffs' estimated costs for its members to comply with the Ordinance assume that the 5 costs would not be paid by any single Producer or financed solely by the approximately 100 6 members of Plaintiffs that are Producers. Rather, the estimated costs are assumed to be spread 7 amongst all Producers that sell, offer for sale, or distribute prescription drugs in Alameda County. 8 30. Defendants estimate that the annual cost for compliance with the Ordinance is lower than 9 Plaintiffs' estimates, totaling less than $330,000 per year. For purposes of the cross-motions for 10 summary judgment contemplated by the parties, however, the parties believe that the difference 0 11 between their estimates is not material to the outcome of the parties' motions. 12 7.3▪ o 13 32. According to IMS Health, a pharmaceutical information and consulting company, total � U A Q 14 prescription drug sales in the U.S. [in] 2010 were $308.6 billion. cu 0 15 33. Plaintiffs at this time lack specific data about the annual revenue generated by their 411 ro 16 members that is attributable to selling, offering for sale, or distributing prescription drugs in ass • GL, 17 Alameda County. Similarly, at this time Plaintiffs do not know the annual revenue generated by all 18 Producers that is attributable to selling, offering to sell, or distributing prescription drugs in 19 Alameda County. 20 34. Defendants estimate the total retail pharmaceutical sales in Alameda County in 2010 21 [were] approximately $965 million. 22 . . . 23 37. Plaintiffs agree that the Ordinance's environmental, health and safety benefits are not 24 contested for purpose of the cross-motions for summary judgment. 25 38. Plaintiffs' legal position is that, even assuming that take-back programs further important 26 interests, the County violates the Commerce Clause by requiring interstate drug manufacturers to 27 conduct and pay for such programs. 28 . 6 Case3:12-cv-06203-RS Document40 Filed08/28/13 Page7 of 11 • 1 III. LEGAL STANDARD 2 Summary judgment is proper"if the pleadings and admissions on file, together with the 3 affidavits, if any, show that there is no genuine issue as to any material fact and that the moving 4 party is entitled to judgment as a matter of law." Fed. R. Civ. P. 56(c). The purpose of summary 5 judgment"is to isolate and dispose of factually unsupported claims or defenses." Celotex v. Catrett, 6 477 U.S. 317, 323-24 (1986). The moving party "always bears the initial responsibility of 7 informing the district court of the basis for its motion, and identifying those portions of the 8 pleadings and admissions on file, together with the affidavits, if any which it believes demonstrate 9 the absence of a genuine issue of material fact." Id. at 323 (citations and internal quotation marks 10 omitted). If it meets this burden, the moving party is then entitled to judgment as a matter of law 11 when the non-moving party fails to make a sufficient showing on an essential element of the case o Uo 12 with respect to which he bears the burden of proof at trial. Id. at 322-23. U al 0 13 In this instance, the parties are in agreement that no material facts are in dispute, for A o 14 purposes of these cross-motions. The question is only which side is entitled to judgment as a matter 15 of law given those undisputed facts. � z ^a s 16 o r.. w 17 IV. DISCUSSION 18 The Commerce Clause of the Constitution assigns to Congress authority to "regulate 19 commerce . . . among the several states. U.S. Const., art. I, § 8. The so-called "dormant" 20 Commerce Clause is the implied converse proposition—state and local governments may not enact 21 regulations that unduly interfere with interstate commerce. See Quill Corp. v. North Dakota, 504 22 U.S. 298, 309 (1992) ("the Commerce Clause is more than an affirmative grant of power; it has a 23 negative sweep as well. The Clause . . . by its own force prohibits certain state actions that interfere 24 with interstate commerce.") (citation omitted). 25 The Supreme Court has outlined a two-tiered approach to analyzing whether a state or local 26 economic regulation violates the dormant Commerce Clause: 27 When a state statute directly regulates or discriminates against interstate commerce, 28 or when its effect is to favor in-state economic interests over out-of-state interests, 7 • Case3:12-cv-06203-RS Document40 Filed08/28/13 Page8 of 11 1 we have generally struck down the statute without further inquiry. When, however, a • statute has only indirect effects on interstate commerce and regulates evenhandedly, 2 we have examined whether the State's interest is legitimate and whether the burden on interstate commerce clearly exceeds the local benefits. 3 4 Healy v. Beer Institute, 491 U.S. 324, 337 n. 14 (1989) (quoting Brown–Forman Distillers 5 Corp. v. New York State Liquor Auth., 476 U.S. 573, 579 (1986) (citations omitted in original)). 6 The Ninth Circuit has explained that under this two-tiered approach, a local regulation will be found 7 to be a per se violation of the clause if it, "1) directly regulates interstate commerce; 2) discriminates 8 against interstate commerce; or 3) favors in-state economic interests over out-of-state interests." 9 National Collegiate Athletic Ass'n v. Miller, 10 F.3d 633, 638 (9th Cir. 1993) ("NCAA"). 10 Here, plaintiffs contend that the Ordinance is a per se violation of the clause under any and 11 all of the three prongs. As opposed to the first prong, the second and third prongs both contain an E 12 element of discrimination—i.e.,that a challenged regulation favors local commerce over interstate 3.0 Amo 13 commerce, or in-state entities over out-of-state entities. Plaintiffs argue there is such a •� U A Q 14 discriminatory effect here because costs that would ordinarily be borne primarily by Alameda a? 5 0 15 County—and hence its own taxpayers—are being shifted on to the community of producers as a i � z 16 whole, most of whom are based elsewhere. Plaintiffs presume that the producers likely will pass o 17 those costs on to their customer base at large, with the result that consumers nationwide will bear 18 expenses that otherwise would be solely the responsibility of Alameda taxpayers, or perhaps of 19 Alameda prescription drug buyers, under a different regulatory scheme. 20 The "discrimination" on which plaintiffs would rely, is indisputably not being visited on out- 21 of-state producers as a means of favoring in-state producers. As the Supreme Court has several 22 times observed, "any notion of discrimination assumes a comparison of substantially similar 23 entities." Department of Revenue of Ky. v. Davis, 553 U.S. 328, 343 (2008), quoting United 24 Haulers Assn., Inc. v. Oneida–Herkimer Solid Waste Management Authority, 550 U.S. 330, 342 25 (2007), in turn quoting General Motors Corp. v. Tracy, 519 U.S. 278, 298 (1997). In the absence of 26 `'differential treatment favoring local entities over substantially similar out-of-state interests,"the 27 kind of discrimination potentially prohibited by the dormant Commerce Clause is not implicated. 28 • 8 Case3:12-cv-06203-RS Document40 Filed08/28/13 Page9 of 11 • 1 Davis, 553 U.S. at 343. Accordingly, the Ordinance cannot be invalidated as per se improper under 2 either the second or third prongs. 3 As the Ninth Circuit has cautioned, however, "discrimination and economic protectionism 4 are not the sole tests." NCAA, 10 F.3d at 638. A regulation may still be pease invalid under the 5 first prong if it"directly regulates interstate commerce." Id. Nevertheless, and notwithstanding 6 plaintiffs' protestations to the contrary, the Ordinance here neither purports to regulate interstate 7 commerce nor does so as a practical matter. 8 The Ordinance applies to producers who elect to sell their products within Alameda County, 9 regardless of where the producers are based or the product originates. Nothing in the structure of 10 the Ordinance targets producers on the basis of their location—they are being required to participate o 11 in providing take-back programs because they sell prescription drugs in the county, not because they Uo w 12 are out-of-state actors. Nothing in the Ordinance will require, as a practical matter, any producer to o 13 alter its manner of doing business in any jurisdiction outside Alameda County, although producers rin A o 14 will be free to use programs that they may already be using elsewhere,provided they meet the fifr0 15 standards of the Ordinance. (See Stipulated Fact No. 9.) 0 16 In NCAA, by way of contrast, the statute in dispute regulated only interstate organizations, o 17 specifically "national collegiate athletic associations," which were defined as any "group of 18 institutions in 40 or more states who are governed by the rules of the association relating to athletic 19 competition." 10 F.3d at 637 n.3. (In practice, this definition encompassed only one entity—the 20 plaintiff NCAA.) The effect of the challenged law, which purported to govern how the NCAA 21 conducted its own enforcement proceedings, was that the organization would have to"use the 22 Statute in enforcement proceedings in every state in the union."Id. at 639. As such it violated the 23 Commerce Clause because "the practical effect of the regulation [was] to control conduct beyond 24 the boundaries of the State" and because of the potential conflict with similar laws in other states. 25 Id. ("Generally speaking, the Commerce Clause protects against inconsistent legislation arising from 26 the projection of one state regulatory regime into the jurisdiction of another State."). The Ordinance 27 plaintiffs challenge here is not specifically directed at regulating interstate organizations and has no • 28 remotely similar consequence to any conduct occurring outside county borders. 9 • Case3:12-cv-06203-RS Document40 Filed08/28/13 Page10 of 11 1 Plaintiffs repeatedly urge that the Ordinance directly regulates interstate commerce in a • 2 manner not meaningfully distinguishable from a tariff. A tariff, however, "taxes goods imported 3 from other States, but does not tax similar products produced in State." West Lynn Creamery, Inc. 4 v. Healy, 512 U.S. 186, 193 (1994). As the Supreme Court explained, "[a] tariff is an attractive 5 measure because it simultaneously raises revenue and benefits local producers by burdening their 6 out-of-state competitors." Id. Plaintiffs' characterization of the Ordinance as equivalent to a tariff 7 is unpersuasive, given that it shares none of these salient features. 8 Finally, while plaintiffs are correct that the effect on interstate commerce must be evaluated 9 by looking to the effect of a regulation and not merely its face, the happenstance that most producers 10 of prescription drugs are located outside Alameda County is insufficient to transform what is c 11 fundamentally a local measure into one that could be found to burden interstate commerce ° 12 impermissibly. See Exxon Corp. v. Governor of Maryland, 437 U.S. 117, 126 (1978) ("[t]he fact _ U 0 13 that the burden of a state regulation falls on some interstate companies does not, by itself, establish a � U A 14 claim of discrimination against interstate commerce."); CTS Corp.v. Dynamics Corp. of Am., 481 0 15 U.S. 69, 88 (1987)(following Exxon and rejecting argument that regulation was impermissible • s16 merely because it in most cases would apply to out-of-state entities). Accordingly, the Ordinance is 17 not per se invalid under any of the analytical prongs. 18 Plaintiffs suggest almost in passing that the Ordinance could be found invalid even under the 19 balancing test that applies where the challenged regulation has only indirect, and non- 20 discriminatory, effects on interstate commerce. Plaintiffs do not question, for purposes of these 21 motions, that the interests Alameda County had in enacting the ordinance were legitimate. Plaintiffs 22 merely contend that those interests could be equally well served through take-back programs funded 23 in another manner. Arguing that an alternative regime would have no burden on interstate 24 commerce does not establish that the minimal burden this Ordinance arguably imposes on interstate 25 commerce "clearly exceeds the local benefits." Defendants have adequately shown that the 26 Ordinance serves a legitimate public health and safety interest, and that the relatively modest 27 compliance costs producers will incur should they choose to sell their products in the county do not 28 unduly burden interstate commerce. • 10 Case3:12-cv-06203-RS Document40 Filed08/28/13 Page11 of 11 1 V. CONCLUSION 2 Plaintiffs' motion for summary judgment is denied, and defendants' cross-motion is 3 granted. A separate judgment will enter. 4 5 6 IT IS SO ORDERED. 7 8 Dated: 8/28/13 - - RICHARD SEEBORG 1. 9 UNITED STATES DISTRICT JUDGE 10 11 o UE w 12 V ro ..r -ow o 13 r U 0 14 e 0 15 'a 16 � w 17 18 19 20 21 22 23 24 25 26 27 1111 28 11 r1 • Old Business and Informational Items • 3 . Living Environment Pool Permitting on the Fee Schedule S Water Recreation Facilities Operating Permit Fees . WAC 246-260-001 Purpose and authority. (1) The purpose of this chapter is to protect the health, safety, and welfare of users of water recreation facilities (WRF). This chapter is established per RCW 70.90.120. (2) This chapter does not apply to: (a) Any water recreation facility for the sole use of residents and invited guests at a single-family dwelling; (b) Any water recreation facility for the sole use of residents and invited guests of a duplex owned by the residents; (c) Therapeutic water facilities operated exclusively for physical therapy or rehabilitation under the supervision of a licensed medical practitioner; and (d) Steam baths and saunas. (3) Requirements for recreational water contact facilities, including water slides, speed slides and wave pools are contained in chapter 246-262 WAC. WAC 246-260-9901 Fees. (2) OPERATING PERMIT FEES The department establishes the fees listed in Table 990.2 for • operating permits for carrying out its duties under WAC 246-260-101. TABLE 990.2 FEE SCHEDULE OPERATING PERMITS Type+ Number of Facilities Each Additional Single Single Spa Single Wading Spray Pool Swim, Spa,or Swim Pool Pool Pool or Pools Wading Pool Operating Permit 0-6 month $291.00 $255.00 $211.00 $ 105.00 $63.00 Operating Permit 6-12 $477.00 $424.00 $371.00 $ 159.00 $ 84.00 months (3) Other Terms and Conditions: (b)The department may charge an alternate annual fee for an operating permit based on direct and indirect costs associated with issuance of the permit when arrangements are made with local health jurisdictions to administer all or portions of the duties associated with the operating permit. Except, that the fee for this operating permit cannot exceed • the cost established by the previous portions of this regulation, but the fee may be less. 1 Water Recreation Facilities Operating Permit Fees 0 JCPH Fee Facility 2013 Fee according to Change in Fee integrating Change in Facility Type operation annual WAC Fee WAC and JCC Fee 1 pool 0-6 mo. $291 $291 $0 $291 $0 2 pool 0-6 mo. $291 $291 $0 $291 $0 3 spa 12 mo. $291 $424 $133 $291 $0 4 pool 12 mo. $291 $477 $186 $291 $0 5 pool 12 mo. $291 $477 $186 $291 $0 6 pool&spa 0-6 mo. $397 $354 ($43) $354 ($43) 7 pool&spa 0-6 mo. $397 $354 ($43) $354 ($43) 8 pool&spa 0-6 mo. $397 $354 ($43) $354 ($43) 9 pool&spa 12 mo. $397 $561 $164 $375 ($22) 10 pool&spa 12 mo. $397 $561 $164 $375 ($22) 11 pool&spa 12 mo. $397 $561 $164 $375 ($22) 12 pool&spa 12 mo. $397 $561 $164 $375 ($22) Total Change $1,032 ($217) • • 2 JEFFERSON COUNTY PUBLIC HEALTH ENVIRONMENTAL HEALTH DIVISION ENVIRONMENTAL HEALTH 2013 Additional Fees and Other Information GEN Health Officer Administrative Hearing 306.00 • Administrative Hearing Appeal 306.00 Technical Assistance/Plan Review-Minimum 67.00 Technical Assistance/Plan Review-Per Hour 67.00 Filing Fee 52.00 ONSITE SEWAGE 1:11SPOSALirriiii4940,iii..i Sewage Disposal Permits New Conventional 555.00 Valid for 3 years New Alternative 662.00 Valid for 3 years New septic tank and/or pump chamber only 264.00 Issued in conjunction with an existing sewage disposal New Community or>1000 G.P.D.(base fee) 555.00 Plus$87 per connection-valid for 3 yrs New Commercial>1000 G.P.D. Conventional 662.00 Valid for 3 years Alternative 707.00 Valid for 3 years Repair/Upgrade/Modification/Designate Reserve Area 123.00 Applies to existing installed sewage disposal system Expansion 413.00 Redesign 123.00 Applies to pending or active but not installed Reinspection 153.00 Evaluation of Existing System/Monitoring Inspection Septic system only 306.00 Septic system plus water sample 319.00 Retest/Reinspection 107.00 On Site Sewage OnSite-Site Plan Advanced Approval Determination(SPAAD) 306.00 Septic Permit with SPAAD(conventional) 299.00 Septic Permit with SPAAD(alternative) 414.00 Subdivision Review Base Fee 396.00 Plus$78.00 Per Lot Boundary line adjustment review fee 156.00 Plus$78.00 Per Lot Pre application meeting fee 156.00 Planned rural residential development review fee 156.00 Density exemption review fee 78.00 Density exemption review fee requiring field work 156.00 Other WaiverNariance Application 184.00 WaiverNariance Hearing 306.00 Wet season evaluation 413.00 • Revised building application review fee 156.00 New building application review fee: Residential 78.00 Commercial 156.00 General environmental health review fee 78.00 Licenses Installer,Pumper,Operator(maintenance person) 413.00_ Retest 168.00 Annual Renewal 291.00 Delinquent Renewal after January 31 413.00 FOOD;SERVICE-'ESTABLISHMENT. E£SPERMJ J EES,{Annual Permit) i t_, , ., e, Restaurants/Take-Out(Based on menu complexity&seating-menu chanes may change cate-ory) 0-25 seats(Limited Menu) 186.00 10 cooling or reheating 0-25 seats(Complex Menu) 331.00 Cooling and reheating allowed 26-50 seats 331.00 51-100 seats 397.00 101-150 seats 450.00 With Lounge,add 146.00 Separate lounge area Bakery Business 145.00 B&B 186.00 Caterer w/commissary or catering-only kitchen 331.00 w/restaurant,additional fee for catering 186.00 Concession/Commercial Kitchen/Church 145.00 Espresso Stand 145.00 Grocery 1-3 checkouts 186.00 May serve pre-packaged baked goods >3 checkouts 450.00 Meat/Fish Market 331.00 Mobile Unit Limited Menu 186.00 No cooling or reheating Complex Menu 331.00 Cooling&reheating allowed School Cafeteria Central Kitchen 331.00 Warming Kitchen 186.00 Tavern w/food(see Restaurants) • Annual Permit Issued after September 1 50%of fee 50%of Annual Permit Fee 1 of 2 9/13/2013 9:58 AM ENVIRONMENTAL HEALTH 2013 Additional Fees and Other Information L Temporary Permits Single Events Limited Menu Initial Application(First Event) 105.00 Not to exceed 21 days at your location Additional Events(Same Menu) 16.00 Not to exceed 21 days at your location Additional Events(Different Menu) 105.00 Not to exceed 21 days at your location • Complex Menu Initial Application(First Event) 139.00 Not to exceed 21 days at your location Additional Events(Same Menu) 16.00 Not to exceed 21 days at your location Additional Events(Different Menu) 139.00 Not to exceed 21 days at your location Organized Recurring Events(e.g.Farmers Markets) Limited Menu Initial Application(First Event) 105.00 Not to exceed 3 days a week Additional Events(Same Menu) 16.00 Not to exceed 3 days a week Additional Events(Different Menu) 105.00 Not to exceed 3 days a week Complex Menu Initial Application(First Event) 139.00 Not to exceed 3 days a week Additional Events(Same Menu) 16.00 Not to exceed 3 days a week Additional Events(Different Menu) 139.00 Not to exceed 3 days a week Late Fee for Temporary Permits +50%of fee Additional(Paid when application is submitted less than 7 days prior to the event) Other Food Fees Permit Exemption 40.00 WaiverNariance 67.00 Per Hour Reopening Fee 67.00 Per Hour Manager's Course 225.00 Plan Review Pre-opening inspection 67.00 Per Hour Minimum 67.00 Per Hour 67.00 Reinspection First Inspection 93.00 Each inspection after first 159.00 Food Handler Card 10.00 Reissue Unexpired Food Handler Card 10.00 SOLID;WASTE - - 1" t.- 4444t- Annual ".Annual Permit Fees Landfills requiring environmental monitoring 543.00 Biosolid/Composting Facilities 476.00 Inert Waste Landfills 344.00 Other Solid Waste Facilities 344.00 • Drop Boxes 159.00 Miscellaneous Fees New Facility Application 437.00 Exempt Facility Inspection 344.00 Facility Reinspection 50%of fee Plan,Document and WaiverNariance Review 268.00 +$67.00/hour for>4 hours WATER i '� =x -� .ftr.!Ak. _' F;, "k,..,.sr`i. C7,44444:4440-.. aim- 1" ".."4-14414 Application Fee 159.00 Inspection of well construction,decommission& reconstruction Determination of Adequate Water Supply 66.00 Building Permit Process Well Inspection&Water Sample for Loan 134.00 Well Site Inspection-Proposed public water supply 318.00 LIVING ENVIRONMENT Water Recreation Facilities Operation Permit Single Swim Pool 291.00 Single Spa Pool(in operation for<6 months of the year) 255.00. (as described in WAC 246-260) Single Spa Pool(in operation for 6 months of the year) 291.00 Single Wading Pool(in operation for<6 months of the year) 211.00 (as described in WAC 246-260) Single Wading Pool(in operation for 6 months of the year) 371.00 (as described in WAC 246-260) Spray Pool or Pools(in operation for<6 months of the year) 105.00 las described in WAC 246-260) Spray Pool or Pools(in operation for 6 months of the year) 159.00 (as described in WAC 246-260) Each Additional Swim,Spa,or Wading Pool(in operation for<6 months 63.00 of the year) (as described in WAC 246-260) Each Additional Swim,Spa,or Wading Pool(in operation for z 6 months 84.00 of the year) (as described in WAC 246-260) -397-00 Miscellaneous Fees -mow Reinspection 67.00 Per Hour plus associated lab costs Plan Review 67.00 Per Hour Indoor:Air,(Tobacco= g rt#OS-',4V1, Compliance Enforcement 67.00_Per Hour Reinspection 78.00 Rebuttal Application 156.00 Note, 2013 Fees have been adjusted per Ordinance 12-1209-96,Section 4-Annual Fee Indexing_Fixed amount fees established by this ordinance shall be adjusted annually on the first business day of January(Adjusted Date)by the amount of the increase in the Consumer Price Index(CPIW). The CPIW is the Consumer Price Index-US City Average for All Urban Wage Earners and Clencal Workers,published by the Bureau of Labor Statistics for the United States Department of Labor. • The annual fee adjustment shall be calculated as follows. each fee in effect immediately prior to the Adjustment Date will be increased by the percentage increase in the CPIW as reported for the month of September preceding the Adjustment Date. Increases will be rounded to the nearest dollar. A fee shall not be reduced by reason of such calculation. However,fee increases in accordance with this calculation shall not exceed 5 percent per year. 2 of 2 9/13/2013 9:58 AM Old Business and Informational Items � 4. Staff Contact Update • JEFFERSON COUNTY PUBLIC HEALTH (JCPH) Community Health Programs and Contact Numbers - September 2013 (NOTE: See page 5 for Directory of all Community Health Staff) ADMINISTRATIVE CONTACTS (See page 5 for complete staff directory) Office Business Hours Contact: After Hours Contact: Monday–Friday, 9:00 a.m. –4:30 p.m. Public Health Regional Duty Officer Phone: (360)385-9400 Fax: (360)385-9401 Pager#: (360)415-2005 info(a�co.lefferson.wa.us Tom Locke, MD, MPH Jean Baldwin,MSN,ARNP Julia Danskin, RN Health Officer Director, Jefferson County Public Health Public Health Supervisor tlocke@ co.jefferson.wa.us jbaldwin@ co.jefferson.wa.us jdanskin@ co.jefferson.wa.us (360)385-9448 or(360)417-2437 (360)385-9408 (360)385-9420 COMMUNICABLE DISEASE PREVENTION PROGRAMS (See page 5 for complete staff directory) Communicable Disease/ Investigation of disease cases and outbreaks; contact Lisa McKenzie PHN, MPH TB Program people who may have been exposed; organize appropriate Program Coordinator treatment; provide prevention information and recommendations to the community, Health Care partners Denis Langlois ARNP and other agencies. TB screening, diagnosis and treatment. Julia Danskin PHN Track local reports of more than 60 reportable diseases to help state and federal agencies monitor trends, allocate Thomas Locke MD, MPH resources and learn more about these diseases. Health Officer, Jeff&Clallam County Education about disease prevention for members of the public. Consultation and resources available. Immunization Program Coordination of community medical provider access to Margie Boyd PHN • State supplied vaccines. Immunizations and vaccine Program Coordinator available by sliding fee scale. Consultation and resources available. Jane Kurata PHN Immunization Clinics: Tuesday&Thursdays, 1:00-4:00 (No TB testing on Thursdays.) International Travelers Immunizations and travel health recommendations available, Jane Kurata PHN Clinic by appointment only. Travel Adult Vaccine Coordinator Adult Vaccines No sliding fee scale Margie Boyd PHN Call for appointment 1 month prior to travel departure. (360) 385-9400 Lisa McKenzie PHN, MPH STD Program Provides confidential services for men and women at risk, Denis Langlois ARNP including;diagnosis and treatment; prevention education; partner notification and referrals available for other Lisa McKenzie PHN, MPH providers also. Clinical and community disease tracking. Sliding fee scale. Call for an appointment -(360)385-9400 HIV/AIDS Counseling, Anonymous and confidential HIV testing/counseling. Denis Langlois ARNP Testing Available for those at high risk. Testing &Counseling Call for an appointment -(360)385-9400 Case management for AIDS Barbara Ward, Case Manager Clallam County Health Department 1-(866)417-0328, Ext. 2487 JCPH Syringe Exchange Services include exchange of new syringes, secondary Lisa McKenzie PHN MPH Program exchange, education/supplies for safer injecting and disease prevention, healthcare referrals, HIV counseling and testing. Denis Langlois ARNP • JCPH Community Health Programs/Contact Information 1 September 2013 Hepatitis screening, referral and immunizations. Anonymous walk-in syringe exchange or clinics: Mondays 1:00-3:00 Wednesday 1:00—3:00 TARGETED CLINICAL HEALTH SERVICES (See page 5 for complete staff directory Family Planning Clinic Provides GYN exams, birth control information and supplies, Susan O'Brien ARNP, FNP pregnancy testing and referrals, counseling, emergency Program Coordinator contraception (Plan B), STD screening and treatment for men,women and teens. Sarah Kirkegaard ARNP, FNP Clinic services are available at JCPH by appointment Denis Langlois ARNP, FNP Monday, Tuesday,Thursday and Friday. Wednesdays only, in Quilcene. Kathy Luch LM Insurance, Medicaid or sliding-scale are all accepted. The TAKE CHARGE program provides family planning insurance for services for income eligible. No one turned away for inability to pay. Call for an appointment -(360)385-9400 Vasectomy& For income eligible men and women over 21 years of age Kathy Luch LM Tubaligation and without insurance. Initial consultation and a 30-day waiting period required before procedure is done. Referrals through TAKE CHARGE Breast&Cervical Health Free women's health exams with mammogram and pap test Julia Danskin PHN Program (BCHP) are available for underinsured, low income women over 40. Program Coordinator Call for an appointment -(360)385-9400 School Based Clinics Medical clinics in both Port Townsend&Chimacum High Karen Obermeyer Health Educator Schools providing primary care, family planning. Provided by: Susan O'Brien ARNP, FNP Jefferson County Public Mental health counseling provided. (at Port Townsend High School) • Health, Jefferson Healthcare Open two days a week. and Jefferson Mental Health Sarah Kirkegaard ARNP, FNP Insurance, Medicaid or sliding-scale are all accepted. (at Chimacum High School) The TAKE CHARGE program provides family planning insurance for services for income eligible. Jefferson Mental Health staff 385-0321 Foot Care Program For seniors who are not able to manage their own nail and Call for an appointment: foot care and for individuals with diabetes. Those under 60 Port Townsend........... 385-9007 with handicapping conditions may also receive services. Tri-Area . .......... 732-4822 Quilcene....................... 531-4129 Brinnon . 765-3321 Kim Rafferty RN....... 531-4129 FAMILY HEALTH PROGRAMS (See page 5 for complete staff directory) Offered to all pregnant women and families with young children regardless of income or risk Women,Infant,Children A nutrition education and supplemental food program for Kathy Anderson RD (WIC) low income and nutritionally at-risk pregnant and breast WIC Coordinator feeding women, infants, and children under 5 years of age. Karen Obermeyer Giving out WIC food vouchers to improve Nutrition. Health Educator Services provided at JCPH and satellite clinics in Chimacum and Quilcene. Heather Sebastian, WIC Clerk Call for an appointment...............385-9400 Parent/Maternity Health promotion programs for expectant parents, babies Yuko Umeda PHN Support Services and and their young children. Services include: home visiting, Program Coordinator Maternity Case health and parenting education; monitoring maternal and Management child health; screening for mental health problems, substance Mary Jo Mackenzie PHN and domestic violence; referrals for services; additional case Leah Ceehorne RN • JCPH Community Health Programs/Contact Information 2 September 2013 Nurse Family management&treatment for at-risk individuals. Partnership (NFP) Karen Obermeyer, Health Educator Call for an appointment...............385-9400 Breastfeeding Education and support for pregnant and breastfeeding women Kathy Anderson, Dietician 40 Consultation Electric breast pumps may be available for mothers enrolled in WIC. Kathy Luch LM Call for an appointment...............385-9400 Tea Party for Pregnant Ongoing drop-in tea on Wednesdays from 1:30 to 3:00 at Kathy Luch LM Women and Breast JCPH.Women meet and provide support for one another. Feeding Mothers Nursing infants and children welcome. Facilitated by Public Health Nurse. Child Birth Education Classes are coordinated with Jefferson Healthcare and offerec Call for schedule&fees.... 385-9400 Classes times per year. or Fee covered for women on Medicaid. Jefferson Healthcare 385-2200 Children with Special Provides resources and service coordination for families of Marti Haley RN Health Care Needs children with chronic health conditions(ages birth to 17). Sudden Infant Death Provides education, information. Julia Danskin PHN (SIDS) Child Protective Service. For children identified by DCFS as being at risk abused or Denis Langlois ARNP Public Health Nursing neglected. Nurses provide family needs assessment, child Contracts health screening, referrals for services, parenting education and intensive follow-up to support families in caring for their children. Available only by referral to JCPH from DCFS. Free to families. POPULATION SERVICES AND PREVENTION PROGRAMS (See page 5 for complete staff directory) School Health Services School nursing to districts on a limited basis. Marti Haley RN (for Chimacum &Port Townsend Services: assessment&care, planning for children with Schools) chronic health conditions; vision &hearing screening; • student health issues and health education. Kelly Matlock (Sex Ed. Health Educator for all districts) Tobacco Prevention & Provides Community education regarding Clean Indoor Air Karen Obermeyer Control Program Act and statewide 1-800-Q U ITLI N E Health Care Access Provides outreach to those eligible for Medicaid and Basic Julia Danskin PHN Program Health.Applications, information and assistance are available Medicaid Outreach Coordinator at JCPH and throughout the county. Vital Statistics Provides certified copies($20)of birth and death certificates. Call for information........... 385-9400 Applications are available at JCPH Substance Abuse Provides substance abuse prevention education, and Kelly Matlock Prevention Coordination community planning and implementation of prevention models. ADDITIONAL COORDINATED COMMUNITY PROGRAMS (See page 5 for complete staff directory) Developmental Disabilities Provides planning, coordination and evaluation of Anna McEnery Program community services for people with developmental Program Coordinator disabilities and their families. • JCPH Community Health Programs/Contact Information 3 September 2013 • Jefferson County Community Health Staff Directory NAME TITLE PHONE EMAIL ADDRESS NOTE: Staff email is not approprial for patient information. Anderson, Kathy WIC Coordinator (360) 385-9479 kanderson(a)co.iefferson.wa.us RD Nutrition Baldwin, Jean Director (360) 385-9408 ibaldwinaco.iefferson.wa.us MSN, ARNP Jefferson County Public He _ Boyd, Margie Immunization (360) 385-9446 margieb(a�co.iefferson.wa.us PHN Ceehorne, Leah Family Health Services (360) 385-9424 Iceehorne co.iefferson.wa.us PHN Danskin, Julia Community Health (360) 384-9420 jdanskin(a�co.iefferson.wa.us PHN Supervisor Haley, Marti School Nursing (360) 385-9442 mhaley(a�co.iefferson.wa.us RN Kirkegaard, Sarah Family Planning (360) 385-9412 skirkegaard(c�co.iefferson.wa.us ARNP, FNP Kurata, Jane Immunization (360) 385-9443 jkurataa,co.iefferson.wa.us PHN Langlois, Denis Communicable Disease (360) 385-9421 dlanglois c(D,co.iefferson.wa.us ARNP Luch, Kathy Family Planning (360) 385-9426 kluchaco.iefferson.wa.us LM Mackenzie, Mary Jo Family Health Services (360) 385-9425 mmackenzie(a�co.iefferson.wa.us PHN Marx, Cynde Clinic Registration (360) 385-9433 cmarxa,co.jefferson.wa.us Matlock, Kelly Community Prevention (360) 379-4476 kmatlock(c�co.iefferson.wa.us 0 Services McEnery, Anna Developmental Disabilities (360) 385-9410 amcenery(a�co.iefferson.wa.us Program Coordinator Locke, Thomas Jefferson County (360) 385-9448 tlockeaco.iefferson.wa.us MD, MPH Clallam County (360)417-2437 tlocke(a�co.clallam.wa.us Health Officer , (360) 582-8353 (Pager) McKenzie, Lisa Communicable Disease (360) 385-9422 Imckenzie(aco.iefferson.wa.us PHN, MPH Obermeyer, Karen Community Prevention (360) 385-9417 kobermeyerCa�co.iefferson.wa.us Services O'Brien, Susan Family Planning (360) 385-9414 sobrien(a.co.iefferson.wa.us ARNP, FNP Rafferty, Kim, RN Foot Care Clinic (360) 531-4129 kraffertyco.iefferson.wa.us Sebastian, Heather WIC Clerk (360) 385-9432 hsebastianCa�co.jefferson.wa.us Syska, Jessica Medical Records & (360) 385-9431 isyskaaco.iefferson.wa.us Billing Umeda, Yuko Family Health Services (360) 385-9416 yumedaaco.lefferson.wa.us PHN von Volkli, Kelly Medical Records & (360) 385-9423 kvonvolkliaco.iefferson.wa.us Billing 11111 JCPH Community Health Programs/Contact Information 4 September 2013 • New Business � 1 . 2014 Communicable Diseases Performance Measures Plan • 4 E v, x co vs if) b ,_iv 0 N O O p 0 C ro (d O +' O C 0 0 I N N sr) (.0v ro C.) 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( ") .-c' M N N. G-, UN. •lop 0 0el tic= s., 4-4 Q 00 • New Business � 2. Food Program Permit Processing • New Business S 3 . Contract Discussion with Jefferson County School Districts • ^��pSON �°, JEFFERSONCOLIC HEALTH X9 .. o= 615 Sheridan Street o Port Townsend o Washington o 98368 www.jeffersoncountypublichealth.org • Date: September 13, 2013 To: Dr. David Engle, Superintendent Port Townsend School District 1610 Blain Street Port Townsend, WA 98368 From: Julia Danskin, PHN, Public Health Manager Re: Port Townsend School District contracts with Jefferson County Public Health Jefferson County Public Health (JCPH) has a long history of working in partnership with the Port Townsend School District(PTSD) to support the health and wellbeing of students through a variety partnerships and contracts. Specific services, contracts and memorandums of understanding (MOU)with the district include: - Since 2009 the district has provided space for the School Based Clinic through an ongoing MOU. Susan O'Brien is the Family Nurse Practitioner(ARNP) on site Tuesdays and Fridays. Funding for clinic operations comes from billing health insurance and Medicaid, Jefferson Healthcare and County general funds. Please see attached an end of year 2012-13 report. - Funding and for mental health services in the school based clinic and middle school are from Jefferson County tax funds for mental health and substance abuse treatment. Historically, JCPH • contracts with vendors to supply these services in three school districts and provides some oversight, contract management and background checks. (Districts may want to directly apply for these funds and do the subcontracting). - Since 1999 JCPH has contracted with OESD 112 to provide School Nurse Corp Services for Port Townsend School District. A priority of the School Nurse Corp contract is creating required health care and emergency response plans for students with chronic health conditions. In 2012-13 the school nurse provided the Port Townsend School District; 101 individual student health care plans; numerous staff training for health care plans; and delegation training for the administration of 120 student medications. State funding for the School Nurse Corp has remained flat from the beginning. The PTSD has contracted with OESD for additional school nursing hours for several years. Our 2013-14 OESD School Nurse Corps contract for the PTSD includes 7 hours per week for a total of 36 weeks, and an additional 16 hours per week between August 26— November 8th Marti Haley, RN, currently provides School Nurse Corp contract hours. - For over 20 years PTSD has contracted with JCPH to provide school nursing services for State mandated screenings, sexuality education and required HIV education (Human Growth and Development Classes). The current contract was signed in 2003 and is ongoing. The 2012-2013 amounts per enrolled student were $13.76. PTSD 2012-2013 cost was $16,701.20. • DEOLTH ELOPMENTAUNITY LDDISABILITIES PUBLIC HEALTH ENVIRONMENTAL HEALTH MAIN: (360)385-9400 ALW t' � N- .. m a4 t) MAIN:A SAFER AWATER QUALITY FAX: (360)385-9401 HEALTHIER COMMUNITY FAX: (360)379-4487 Kelly Matlock, Health Educator, provides the Human Growth and Development classes. "Parent Nights" are to be completed 30 days before the start of classes. Kelly has scheduled "Parent • Night"for Thursday September 12, 2013 for 6th through 9th grade classes. "Parent Night"for 5th grade is scheduled for Thursday March 6, 2014. Classes that will be scheduled are listed below: 5th 5.5 or 6 sessions for each 5th grade classes in Human Growth and Development 6th 2 sessions for each 6th grade classes in HIV/AIDS 7th 2 sessions for each 7th grade classes in HIV/AIDS 8th 5.5 or 6 sessions for each 8th grade classes in Human Growth and Development 9th 14— 16 sessions for each 9th grade classes in Human Growth and Development Human Growth and Development classes are based on the FLASH Curriculum which is approved by the State OSPI and Washington State Department of Health. Marti Haley, RN, adds to her School Nurse Corp contract services, time providing annual hearing and vision screening : scheduling; working with office staff to find qualified parent volunteers for initial vision screening; training and supervising volunteers; scheduling nurses for hearing screening; setting up screening locations; rescreening students who don't"pass" initial screening; sending letters with recommendations and resources for further evaluation to families; following up as needed with families to obtain further medical evaluation; informing teachers of students who may need preferential seating or 504 plans for hearing and vision deficits. JCPH has been subsidizing staff cost to provide School Based Clinics, school nurse services, health screenings and Human Growth and Development classes for many years. State School Nurse Corp and school contract funds have remained relatively flat while the need for services have increased (more children with heath issues in the school system) and increased staff cost. JCPH has used Medicaid Administrative Match funds and Federal Children with Special Health Care Needs (CSHCN) funds to subsidize the services up to now. JCPH has always tried to maintain services in the schools, even using • our own funding. The 2003 Contract with PTSD needs to be updated, but JCPH has understood the financial stress PTSD has experienced the past few years. JCPH would like to start the discussion with PTSD about the 2014-2015 school year contracts for School Nursing including Human Growth and Development classes and services currently provided through School Nurse Corp. JCPH will not be able to subsidize School Nursing services and Human Growth and Development classes in the future due to a reduction in Medicaid Administrative Match funds and CSHCN funds which will be eliminated at a Federal level.The State funded School Nurse Corp may also be eliminated in the coming year as Washington State considers budget reductions. For a continuation of services in the 2014-2015 school year we need to jointly plan. The School Nursing and Health Education contract will need to be updated by June 2014. Please call or email me with questions. I will contact your office later in the fall to schedule a joint meeting so we can discuss changes to the current contract. We look forward to many more years of working collaboratively to support the health needs of students for the benefit of our community. Julia Danskin, PHN Public Health Manager Ph: 385-9420, Email:jdanskin(a�co.iefferson.wa.us CC: Jean Baldwin, Director COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES WATER QUALITY MAIN: (360)385-9400 2.AYS WORKING FOR A SAFER AND MAIN: (360)385-9444 FAX:(360)385-9401 HEALTHIER COMMUNITY FAX: (360)379-4487 • Jefferson County • School Based Health Centers 2012-2013 Participation Report Background: School Based Health Centers (SBHCs) were established during the 2008-2009 school year to address a need for adolescent primary and mental health care in East Jefferson County. Currently there are SBHCs in Port Townsend High School (PTHS) and Chimacum High School (CHS) providing students at each school with two days'of medical and two days2 of mental health care per week.The SBHCs are also available to middle and elementary school students, although younger students are more likely to utilize the SBHC at CHS because of the shared elementary, middle, and high school campus.There are additional mental health services available a few hours a week at Chimacum Middle School and Chimacum Elementary School and there are counselors providing mental health care only at Quilcene High School and Blue Heron Middle School. Each SBHC has an assigned nurse practitioner. For the first half of the 2012-2013 school year, there were two mental health counselors, one for each SBHC.A December staffing change resulted in the CHS counselor providing services to both PTHS Free and Reduced Lunch Rates and CHS students for the remainder of the school year. 2011-2012(May 2012) % Medical services are funded by Jefferson County Public Health and Chimacum School District 50.1 Jefferson Healthcare. Mental health services are funded by the Jefferson Chimacum Creek Primary 59.8 County Mental Health/Chemical Dependency sales tax. Services are Chimacum Elementary 59.0 available re ardless of insurance or abilit a Chimacum Middle 44.0 g y to p y—about4in10 students at CHS and PTHS are low-income (see Free and Reduced Lunch Chimacum High School 40.9 rates table). Services focus on preventative care including Port Townsend School District 45.9 immunizations,tobacco cessation, nutrition, eating and weight Grant Street Elementary 48.8 concerns, reproductive health care, physicals, and mental health Blue Heron Middle School 54.2 counseling. Visits for injuries, illness, and infection are also common Port Townsend High School 36.0 throughout the year. Evaluation Methods: For every medical visit, data on student concerns, clinician addressed topics, and referrals were collected by the SBHC nurse practitioner. Demographic and health care access data were collected at each client's first visit by the AmeriCorps member serving in the SBHCs. For every mental health visit, data on student and clinician concerns was collected by the SBHC mental health counselors (results begin on page 7). Data in this report were collected from August 2012 through June 2013. • 18 hours PTHS, 12 hours CHS 2 10 hours PTHS, 10 hours CHS SBHC Report created by Ryann McChesney,JCPH AmeriCorps Volunteer 2012-2013(7/15/13). 1 i P a g e SBHC MH Report created by Siri Kushner,Kitsap Public Health District(8/8/13). SBHC Demographics • The majority of students using the SBHCs are in 9th grade and most are female. Grade at First Visit %of clients at first visit 30 Gender PTHS CHS 25 Female 63% 75% 0 20 c ■#of clients 61 '�, 15 CHS x 10 i III •#of clients PTHS 0 11. • L ._ 1 5 6 7 8 9 10 11 12 Grade The majority of clinic users are White, nearly 70%at PTHS and 75%at Chimacum. PTHS:Client Race •White CHS:Client Race •White 3% 2% •Black/African •Black/African 2% American American 1,/ •Native Hawaiian/ 3% 7 is Native Hawaiian/ Pacific Islander 1% Pacific Islander ■Asian 2% •Asian • Native American/ Alaskan Native ■Native Ameri ■Hispanic Alaskan NativW a Hispanic Mixed Mixed Other The majority of students at both CHS and PTHS live in married parent or guardian homes. More students at CHS, however, are living in single parent homes or in the homes of friends or family members. PTHS: Living Situation at First Visit CHS: Living Situation at First Visit •Married parent/ • Married parent/ 2% guardian home 2% 1% 3% 1% guardian home ■Single parent/ Guardian home41. •Single parent/ ■ Friends/family guardian home Friends/family •Proctor House • Proctor House •Host family Foster care •On own • SBHC Report created by Ryann McChesney,JCPH AmeriCorps Volunteer 2012-2013(7/15/13). 2 I P a g e SBHC MH Report created by Siri Kushner,Kitsap Public Health District(8/8/13). SBHC Clinic Usage • PTHS CHS Based on enrollment numbers,41%of CHS students Total visits:375 Total Visits:377 and 30%of PTHS students utilized SBHC physical Total#of clients: 143 Total#of clients: 144 health services during the 2012-2013 school year. Port Townsend High School Medical Visits by Month >• 9 o 8 Winter break Summer Break E 7 7017 7011 u 6 a a 5 3 • 2 ^ ■ ■ ■ ■ ■ ■ ■ ■ a) 111 111 aa ■ ■ ■ ■ ■ ■ ■ a) 0 ▪ AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN Month 375 total visits over 74.5 clinic days Note:clinic not open in July Chimacum High School Medical Visits by Month >. 9 • c 8 c Winter break Summer Break 7 2012 2013 C' 6 a 4 -- ■ ■ I ■ ■ r7 1 5 3 ■ ■ ■ II ■ ■ ■ ■ ■ I O 2 ■ ■ ■ 11 ■ ■ ■ ■ II m 1 • • I I • U• • • U 0 1 ■ ■ ■ ■ II • ■ ■ ■ ■ I AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN Month 377 total visits over 76 clinic days Note:clinic not open in July Average SBHC Visits per Clinic Day 10 "'Visits per Clinic Day CHS ■Visits per Clinic Day PTHS m v 8 w a. N N 6 w 0 It 4 ea > 2 0 AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN • Month SBHC Report created by Ryann McChesney,JCPH AmeriCorps Volunteer 2012-2013(7/15/13). 3 IPage SBHC MH Report created by Siri Kushner,Kitsap Public Health District(8/8/13). PTHS: 11th graders had the greatest number of clients and total visits. CHS:9th graders had the greatest number of clients but the most visits were by 10th graders. Both schools had an average of 2.6 visits per client with a range of 1 to 8 visits at PTHS and a range of 1 to 16 visits at CHS. • Port Townsend High School Chimacum High School Number of Visits and Clients by Grade Number of Visits and Clients by Grade 125 125 100 • 100 75 75 50 JJ50 25 - d 25 ..... .. __A ILLI 5 6 7 8 9 10 11 12 5 6 7 8 9 10 11 12 Client Grade ■#of clients seen Client Grade ■#of clients seen Total number of clients:143 (unduplicated) Total number of clients:144 (unduplicated) Clients without reported grade:2 •total#of visits Clients without reported grade:7 •total#of visits Chimacum saw students in grades 5 through 12 while Port Townsend saw students in grades 7 through 12. Note: 12th graders often spend less time on campus,carry fewer credits, and may participate in Running Start. The elementary, middle,and high school share a campus in Chimacum likely explaining the greater use by younger students. F a M Males comprised 37%of new clients • 0% 20% 40% 60% 80% 100% and 24%of total clients at PTHS,they 1111111111111111accounted for 14%of total visits. first visit PTHS 63% 1 I 1 At CHS males comprised 25%of new first visit CHS 75% clients and 15%of total clients,they accounted for 15%of total visits. total clients PTHS 76% 1 1 I _ total clients CHS I 8I% I I Males comprised a greater percentage of first visits than total visits at both total visits PTHS 86% I I schools indicating that they had fewer total visits CHS 90% - repeat visits during the year. I I I I Gender Breakdown by First Visits, Unduplicated NOTE:CHS had 9 client visits with unreported gender Total Clients,and Total Visits III SBHC Report created by Ryann McChesney,JCPH AmeriCorps Volunteer 2012-2013(7/15/13). 4 IPage SBHC MH Report created by Siri Kushner,Kitsap Public Health District(8/8/13). SBHC Visit Reasons • SBHC Top Ten Visit Reasons Depression -- Tobacco Student concern Immunizations Clinician addressed Stress Drugs and alcohol Eating/weight School performance Family 11111111.111111111111 Relationships Reproductive health 0 100 200 300 400 500 600 SBHC Top Ten Student Concerns SBHC Top Ten Issues Addressed by Relationships provider Flu/cold Depression N Depression Tobacco Injury Immunizations _Mil Stress Eating/weight Drugs and alcohol 11=1 Family Eating/weight Infection School performance • Immunizations Family Sports physical Relationship Reproductive health Reproductive health 0 100 200 300 400 500 600 0 100 200 300 400 500 600 The vast majority of visits at both clinics are for reproductive health which may include STI screening,pregnancy test,birth control,emergency contraception,and education on risky sexual behavior and harm reduction techniques.Likely due in part to the SBHCs,Jefferson County has the third lowest teen pregnancy rate in Washington State(Age 15-19.Source:WA State Dept of Health,2011 Vital Statistics.http://www.doh.wa.gov/DataandStatisticalReportsNitalStatisticsData/AbortionPregnancyData/AbortionPregnancyTablesbyYear.aspx.) Student athletes are required to get a sports physical every two years.Both SBHCs provide this service which is also available to Quilcene students.Before fall sports begin in August,both clinics open for four days to give students convenient and inexpensive access to sports physicals. According to data from the 2012 Healthy Youth Survey(HYS),Jefferson County youth have higher rates than state average for current and lifetime alcohol use as well as binge drinking for 10th and 12th graders.They also report higher rates of current cigarette smoking,marijuana use,and substance use at school.10th graders report higher than state average for illegal drug use. Further,Jefferson County youth perceive that access to cigarettes,alcohol and marijuana is not very difficult and that most adults do not think youth drinking and smoking marijuana is"very wrong"(Source:2012 HYS). A third of 10th graders and 12th graders in Jefferson County reported experiencing depressive feelings in the past year.One in 4 10th graders and one in five 12th graders reported having seriously considered suicide in the past year(Source:2012 HYS). • SBHC Report created by Ryann McChesney,JCPH AmeriCorps Volunteer 2012-2013(7/15/13). 5 I P a g e SBHC MH Report created by Siri Kushner,Kitsap Public Health District(8/8/13). SBHC Referrals Appropriate referrals for students are made on a consistent basis to a variety of providers and organizations. , Common referrals from the SBHCs are for mental health services(SBHC MH counselor,as well as,in-patient,out- patient organizations),dental services(including the Smile Mobile), additional medical services,school counselor, chemical dependency programs,emergency housing and food, and juvenile services. SBHC Clinic Usage Over Time Number of Clients Served at SBHC5 Over Time •#Clients PTHS •#Clients CHS ■Total#Clients 300 250 200 _ vo ▪ 150 u 100 111— Iri. y' 50 NMI ® ■ ■ 111 The total number of clients in 2012-13 0 is similar to 2011-12, but total visits SP����2009 2009,201 2010,2011 20112012 20122013 decreased indicating fewer visits per client or a decrease in "frequent clinic School Year • users." A schedule reduction due to a switch Number of Visits per Year at SBHCs Over Time to EMR occurred this school year. ■#Visits PTHS ■#Visits CHS ■Total#Visits 1000 Since the 2009-10 school year,the 900 number of clients seen at the SBHCs 800 700 has increased 12%. 600 .N 500 o 400 300 200 1.1 . ... 100 ®o ■ ■ SPtS02009 1009 2010 20,0.1011 2011,L012 20121-012 School Year 111 SBHC Report created by Ryann McChesney,JCPH AmeriCorps Volunteer 2012-2013(7/15/13). 6 I P a g e SBHC MH Report created by Siri Kushner,Kitsap Public Health District(8/8/13). SBHC Mental Health • Demographics The majority of students using MH services at Chimacum and Pt Townsend SBHCs are in 9th grade, at Quilcene the majority are in 10th grade.At all three schools,the majority are female although barely over half at Quilcene. Note: Demographics are missing from 27%of Chimacum, 19%of Pt Townsend,and 4%of Quilcene students using SBHC MH services. Race and living situation are not collected at MH visits. Grade at First Visit 12 %of clients at first visit Pt 10 Gender Townsend Chimacum Quilcene r. 8 Female 78% 74% 52% ■Chimacum 6 Male 22% 26% 48% c •Pt Townsend at 4 =Quilcene 2 0 1 4 5 6 7 8 9 10 11 12 Grade SBHC Mental Health Visits • Chimacum had the highest number of visits and clients. Quilcene had the highest average number of visits per client and visits per day and the highest range. Port Townsend had the highest number of days when MH services were available.Quilcene had the highest proportion of enrolled 9-12th grade students using MH services. Chimacum Pt Townsend Quilcene Total visits:386 Total visits:303 Total visits:347 Based on enrollment,9%of Total#of clients: 62 Total#of clients:57 Total#of clients:24 Chimacum,5%of Pt Townsend, and 14%of Quilcene 9-12th Av visits/client:6.2 Av visits/client:5.3 Av visits/client: 14.5 Range: 1 to 20 Range: 1 to 26 Range: 1 to 48 grade students utilized SBHC Total days:79 Total days:83 Total days:69 mental health services during the Av visits/day:4.9 Av visits/day:3.7 Av visits/day:5.0 2012-2013 school year. • SBHC Report created by Ryann McChesney,JCPH AmeriCorps Volunteer 2012-2013(7/15/13). 7 IPage SBHC MH Report created by Siri Kushner,Kitsap Public Health District(8/8/13). Chimacum • Mental Health Visits by Month >. 8'0 Winter break Summer Break m a 7.0 2013 .S 66.0 2012 u o. 5.0 rI I ■ I ■ I 4.0 3.D ■ ■ II I I I I ■ I 0 2.0 I I I I II ■ ■ ■ ■ ■ I ■ ■ ■ II ■ ■ ■ ■ ■ 1 m1.D I ■ ■ ■ II • I I I A ai 0.0 Sept Oct Nov Dec Jan Feb March Apr May June Month Port Townsend Mental Health Visits by Month fa 8.0 Winter break Summer Break 7.0 •5 6.0 v w 5.0 o. 4.0 j 3.0 MINIM X2.0 ■ 111 ■ ■ ■ ■ 111X1.0 I I •I •I I l• I I I • • 0.0 Sept Oct Nov Dec Jan Feb March Apr May June 2012 Month 2013 Quilcene Mental Health Visits by Month • 8.0 Winter break Summer Break 7.0 .06.0 2012 2013 4.0 !MI El I I�■ r7 3.D I I I I I I I I I I I I O 2.D V I 1111 I I I I I I It I I I I II I I I I I I r1.DI I I I U I I ■ I I I v 0.0 Sept Oct Nov Dec Jan Feb March Apr May June Month • SBHC Report created by Ryann McChesney,JCPH AmeriCorps Volunteer 2012-2013(7/15/13). Wage SBHC MH Report created by Siri Kushner,Kitsap Public Health District(8/8/13). • Top Reasons for SBHC MH Visits: • Chimacum Port Townsend Stress Quilcene Student Stress Stress Concern Family Family Court diversion Relationships Relationships Relationships School School Family Depression Anger -- of total 86% 83% 100% Clinician Family Family Family Issue Relationships Relationships School Addressed School Self esteem Self esteem Mental health Stress Grief Self esteem Depression Stress %of total 70% 68% 78% Chimacum Top Visit Reasons Port Townsend Top Visit Reasons (ranked by student concern) (ranked by student concern). self esteem alc/drug prevention "ill cinician addressed ician addresgriefdepression anger student concern self esteement concern alc/drug prevention futuremia. future anxiety anxiety depression anger school school relationships radiirelationships family �rrmr� II family ammo stress 1111.1111111stress Nimml•II 111 0 50 100 150 200 250 300 350 400 0 50 100 150 200 250 300 350 400 Quilcene Top Visit Reasons At all three schools,the top student concern, by far,was (ranked by student concern) stress and the top clinician addressed issue was family. future clinician addressed mh Although students identified stress as the reason for their anger student concern mental health visit,clinicians infrequently identified stress grief self esteem as the issue they addressed with the student because they NE school actually identified and addressed a wide variety of other family issues. relationships court diversion stress 0 50 100 150 200 250 300 350 400 • SBHC Report created by Ryann McChesney,JCPH AmeriCorps Volunteer 2012-2013(7/15/13). 9 ' Page SBHC MH Report created by Siri Kushner,Kitsap Public Health District(8/8/13). Individual Therapy Visits of Total: 100% The vast majority of visits are individual • 95% 95% therapy—94%at Chimacum,95%at Pt 94% Townsend and 86%at Quilcene—the remaining visits are for crisis 90% intervention or contact/work with other 86% agencies,family,or school staff. 85% 80% I Chimacum Pt Townsend Quilcene Referrals The most common referrals from the SBHC MH clinicians are for outpatient mental health services and for medical services at the SBHC. SBHC Mental Health Visits Over Time Number of Individuals Served by MH Number of MH Visits at SBHCs Over Time Clinicians at SBHCs Over Time - -Chimacum —�—Pt Townsend Quilcene tChimacumIIII Pt Townsend --_ -Quilcene • 100 600 90 80 500 70 400 v 60 -o 50 . .;. > 300 ° 40 ....410.1111.1.111V ae 30 200 20 10 100 0 0 Sept-Dec Jan-June Sept 2010- Sept 2011- Sept 2012- Sept-Dec Jan-June Sept 2010- Sept 2011- Sept 2012- 2009 2010 June 2011 June 2012 June 2013 2009 2010 June 2011 June 2012 June 2013 School Year School Year Compared to 2009/10 when SBHC MH services began,the number of individuals and total visits have steadily increased over time. For Chimacum,the spike in 2010-11 in number of individuals and visits is due to increased MH services in May/June 2011 to help students cope after the suicide of a classmate. The total number of clients in 2012-13 compared to 2011-12 is up slightly in Chimacum,down slightly in Pt Townsend and similar in Quilcene.The total visits in 2012-13 compared to 2011-12 are up in Chimacum and Port Townsend and similar in Quilcene. Compared to the 2009-10 school year,the number of individuals seen has increased over 100%and the number of visits has increased nearly 200%! • SBHC Report created by Ryann McChesney,JCPH AmeriCorps Volunteer 2012-2013(7/15/13). 10 I P a g e SBHC MH Report created by Sin Kushner,Kitsap Public Health District(8/8/13). • New Business • 4. Flu Season Letter to Providers • oh— . y Fp 0 V .A ''SF 615 Sheridan Street o Port Townsend Washington o 98368 www.jeffersoncountypublichealth.org i To: Area Health Care Providers From:Jane Kurata, PHN and Lisa McKenzie, PHN Re: 2013-2014 Influenza & Pneumonia Information This letter accompanies our yearly packet of information regarding vaccines and the 2012-2013 influenza season. We hope you will find these materials helpful. Jefferson County Public Health (JCPH) will publicize information about influenza vaccine availability in local newspapers, and will assist your seasonal influenza immunization efforts in any way we can. JCPH will not have seasonal influenza vaccine available for the general public, but will provide state-supplied flu vaccines in our immunization clinics for children ages 6 months through 18 years. This year is different in that there are several new types of influenza vaccine. In addition to various brands and dosages of the traditional trivalent egg based vaccines, there are now quadrivalent, cell-culture based and recombinant influenza vaccines available. The A strains in the vaccines are unchanged from last year. The B strain in the trivalent vaccines is new this year, but the quadrivalent vaccines contain both the new B/Massachusetts strain in addition to the B/Brisbane strain in last year's vaccines. The standard Center of Disease Control (CDC) recommendation regarding influenza vaccine is the same every year now: Everyone over 6 month of age is advised to get vaccinated every year. Groups usually regarded as high-risk for complications of influenza continue to be • While it is still important to reach groups usually regarded as high-risk for complications of influenza, the standard Center of Disease Control (CDC) recommendation is that everyone over 6 month of age be immunized against influenza every year, regardless of risk profile. Influenza: The Center of Disease Control's (CDC) Advisory Committee on Immunization Practices' (ACIP) annual publication on Prevention and Control of Influenza with Vaccines has not yet been finalized. However, they have published an interim Summary Recommendations: Prevention and Control of Influenza with Vaccines, which is enclosed. Included in this packet are materials concerning seasonal influenza vaccines: • The Summary Recommendations: Prevention and Control of Influenza with Vaccines discusses use and new abbreviations for the various types of influenza vaccines available, information on vaccinating children, pregnant women, and clients with egg allergy Information encouraging yearly immunization of all health care workers. • A summary of high-risk groups to be especially targeted for immunization even though influenza vaccination is recommended for everyone over the age of 6 months and a discussion of who should NOT receive certain types of vaccine • Information about all the various influenza vaccines on the United States market this year, their characteristics and age indications. You will notice that the one recombinant vaccine contains NO egg protein. • Screening forms and explanatory guidelines for use of influenza vaccines. • • Vaccine Information Statements for Inactivated (IIV) and Live Attenuated (LAIV) influenza vaccines • Contraindications and Precautions for use of influenza vaccines. • A flow chart for vaccinating clients reporting egg allergy. -At • A guide from the Washington State Department of Health discussing use of the various types of available influenza vaccine. • A chart describing the publically-funded influenza vaccines that will be provided for children through 18 years of age in Washington this influenza season • • A quick-reference algorithm for use of publicly-funded pediatric influenza vaccines in children through age 8, who may need 2 doses this year. • A notification that the 2007 law restricting use of thimerosal-containing vaccines WILL BE IN EFFECT this influenza season. The suspension in past years was due to the fact that there might not be preservative-free influenza vaccines available for clients with natural latex allergy. With the new vaccines on the market, this should no longer a problem. • Two pages on the manufacturing processes involved in the production of the new cell culture and recombinant vaccines. CDC recommends that you begin administering influenza vaccines as soon as they are available. For all clients over age 8, only one dose is recommended in each influenza season. Vaccines from various manufacturers are recommended for various age groups, and some are not licensed for use in younger children. Read the label and package insert and enclosed chart in regards to your vaccine carefully. A current schedule for local sources of seasonal influenza vaccines has not yet been completed. That schedule will be sent to you when it is complete. Pneumonia: ACIP's latest Updated Recommendations for Prevention of Invasive Pneumococcal Disease Among Adults Using the 23- Valent Pneumococcal Polysaccharide Vaccine (PPSV23) was published September 3, 2010. Prevention of Pneumococcal Disease Among Infants and Children was published December 10, 2010. Both can be viewed online at: http://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/pneumo.html. In 2012 and 2013 CDC published extended recommendations in the use of pneumococcal vaccines for immunocompromised clients. These articles can be found at the above website. Included in this packet are materials concerning pneumonia vaccines: • A chart of pneumococcal vaccine recommendations for children and teens. • A chart of pneumococcal vaccine recommendations by risk factors or underlying conditions. • A Q&A sheet regarding pneumococcal vaccine usage. • Vaccine Information Statements for Pneumococcal Conjugate (PCV 13) and Pneumococcal Polysaccharide (PPSV23) vaccines. Adults with asthma and those who smoke cigarettes are considered at risk for invasive pneumococcal disease. They are included in CDC's targeted groups for vaccination with pneumococcal polysaccharide vaccine. Please circulate these materials among all providers in your clinic. If we can answer any questions or be of assistance, please call Jane Kurata or Lisa McKenzie, at 385-9400. • • New Business 5. NACCHO 2013 Local Public Health Department Profile .. NACCHO [SURVEY FINDINGS] National Association of County&City Health Officials • The National Connection for Local Public Health July 2013 Local Health Department Job Losses and Program Cuts: Findings from the 201 3 Profile Study LOCAL HEALTH DEPARTMENTS For every program area except immunization,the percentage of LHDs reporting a reduction in the services REMAIN CHALLENGED TO they provided was smaller in 2012 than it was in 2011. RECOVER FROM RECESSION However, given that many LHDs were operating their During 2012, nearly one-half(48%)of all local health programs at diminished capacity, LHDs will only be able to departments (LHDs) reduced or eliminated services in at better serve their communities by expanding programs, not least one program area (Figure 1). Immunization, maternal merely avoiding further cuts. and child health (MCH), and emergency preparedness(EP) services were most frequently affected.Twenty percent WORKFORCE LOSSES LESSENING: of LHDs reported cuts in immunization services,followed by 15 percent for both MCH and EP. In the six economic CAPACITY LOSS REMAINS surveillance studies NACCHO has conducted since 2009, Workforce losses and gains were roughly equal in 2012, MCH has been among the top three most frequently with LHDs collectively adding 4,000 positions and reducing reduced programs. EP services was one of the top three 4,300 positions(Figure 2). LHDs eliminated 1,700 positions most frequently reduced programs in four of the six surveys. through layoff and 2,600 by attrition. Staff joining LHDs to fill new positions (3,500)vastly outnumbered those who FIGURE 1. Percentage of LHDs that Reduced or were hired due to a lift of a previous hiring freeze(500). Eliminated Programs, Overall and by Program Area Since 2008, LHDs shed nearly 44,000 jobs. (2012 and 2011) FIGURE 2. Estimated Number of LHD Job Losses Percentage Percentage (2008-2012) and Job Losses and Additions (2012) of LHDs in of LHDs in Program Area 2012 2011 Job Losses and Gains (2012) At least one program area 48% 57% Layoffs 1,700 Immunization 20% 19% Attrition 2600 Maternal and Child Health 15% 21% Total 4,300 Services Emergency Preparedness 15% 23% New Positions 3,500 Population-based Primary 13% 19% Vacancies Filled Due to Prevention Lift of Hiring Freeze 500 Chronic Disease Screening and/ 12% 16% Total 4,000 or Treatment Clinical Health Services 11% 23% Job Losses (Layoffs and Attrition) (2008-2012) Environmental Health 11% 17% 2008 7,000 Communicable Disease 9% 10% 2009 16,000 Screening and/or Treatment 2010 6,000 • Epidemiology and Surveillance 7% 9% 2011 10,600 Food Safety 7% 10% 2012 4300 Total 43,900 n=1,743-1,866 s In total, 41 percent of LHDs nationwide experienced some type of LOCAL HEALTH DEPARTMENTS reduction in workforce capacity. More than one-third (36%)of all LHDs STILL MORE LIKELY TO CUT lost at least one staff person due to layoffs or attrition last year, with • 12 percent reporting at least one layoff(Figure 3). Staff operated at a THAN EXPAND BUDGETS diminished capacity at 13 percent of all LHDs, either because their hours When asked in early 2013, more than one-quarter were reduced or because they were furloughed. (27%)of LHDs nationwide reported a lower budget in the current fiscal year compared to the FIGURE 3. Percentage of LHDs Losing Workforce Capacity, prior year, continuing the trend of substantial Overall and by Type (2012) percentages of LHDs experiencing budget cuts over the past five years(Figure 4). Although this is a sizeable drop compared to the percentage Any reduction in41% reporting budget cuts in the last several waves of workforce capacity the study, the percentage of LHDs reporting cuts Jobs(layoffs or still exceeds the percentage of LHDs reporting attrition) 36% budget increases(23%)(not shown). Looking ahead, 31 percent of all LHDs anticipate cuts in Laid off staff 12% the upcoming fiscal year(not shown). Cut hours or imposed mandatory furlough 13% METHODOLOGY NACCHO administered the National Profile of Local 0 10 20 30 40 50 Health Department Survey to all LHDs(n=2,532) n=1,895-1,938 Percentage of LHDs in the United States from January to March 2013. The survey included questions about budget, staffing, and program cuts during 2012.A total of FIGURE 4. LHDs with Budget Cuts (2008-2013) 2,000 LHDs completed the survey(a response rate of 79%). Data were weighted to adjust for non- Percentage of LHDs Reporting Lower Budgets in the Current Fiscal response.All data were self-reported; NACCHO Year than in the Prior Fiscal Year did not independently verify the data provided II by LHDs. State-level estimates are posted on 50- NACCHO's website at www.naccho.org/lhdbudget. 45% 44% 45% 40 - 38% 41% ACKNOWLEDGMENTS This document was supported by Award p Number 5U38HM000449-05 from the Centers w30 - 27% 27% for Disease Control and Prevention and by the o Robert Wood Johnson Foundation in Princeton, � la + NJ. Its contents are solely the responsibility of 20 - NACCHO and do not necessarily represent the v official views of the sponsors. a 10 - FOR MORE INFORMATION, PLEASE CONTACT: Sarah Newman, MPH Research and Evaluation Analyst, 0 1 I Research and Evaluation Dec 2008 Aug 2009 Feb 2010 Nov 2011 July 2011 Jan 2012 Jan 2013 Survey Date 202-640-4923 snewman@naccho.org AC 0 Hhe eath ion the Nationals to be a e of County and City Q' Health Officials(NACCHO)is to be a leader, partner,catalyst, and voice for local public health departments. 0National Association of County&City Health Officials Public Health 1100 17th St, NW, 7th Floor Washington, DC 20036 The National Connection for Local Public Health Prevent.Promote.Protect P 202-783-5550 F 202-7831583 ©2013. National Association of County and City Health Officials. www.naccho.org . h 0 Media Packet 1 • Jefferson County Public Health • August/September 2013 NEWS ARTICLES 1. "Food classes for families taught in PT," Peninsula Daily News, August 11th, 2013. 2. "School clinics to open for sport physicals," Port Townsend Leader, August 14th, 2013. 3. "Closing oyster beds affects some 19 Jefferson County businesses," Peninsula Daily News, August 15th, 2013. 4. "Free PT mental health clinic to offer youths confidential counseling," Peninsula Daily News, August 18th, 2013. 5. "Something in the DNA? Anderson Lake's continuing toxic algae problems gain national attention," Peninsula Daily News, August 18th, 2013. 6. "Discovery Bay beaches closed to recreational shellfishing because of PSP," Peninsula Daily News, August 20th, 2013. 7. "Jefferson County discusses drug take-back program," Port Townsend Leader, August 21st, 2013. 8. "Port Townsend Paper mill seeks applicants to review odor trial results," Peninsula Daily News, August 21st, 2013. 9. PT Paper seeks community input help with odor study," Port Townsend Leader, August 21st, 2013. 10. "Jefferson County discusses drug take-back program," Port Townsend Leader, August 21st, 2013. • 11. "Discovery Bay closed to shellfish harvest," Port Townsend Leader, August 21st, 2013. 12. "Free youth mental health clinic opens in PT," Port Townsend Leader, August 21st, 2013. 13. "Sporadic whooping cough cases persist on West End," Peninsula Daily News, August 22nd 2013. 14. "Bats and rabies," Peninsula Daily News, August 27th, 2013. 15. "Healthcare insurance options: Fair coming," Port Townsend Leader, August 28th, 2013. 16. "LETTER: Killing of bat not necessary," Port Townsend Leader, August 28th, 2013. 17. "Anderson, Gibbs lakes' clear water doesn't mean they're safe," Peninsula Daily News, September 4th, 2013. 18. "What I did on my summer vacation: Learn about water quality," Port Townsend Leader, September 4th, 2013. 19. "School Based Health Centers," Port Townsend Leader, September 4th, 2013. 20. "Want two reusable produce bags?", City of Port Townsend Newsletter, August 2013. 21. "Chimacum tackles underage substance use," Port Townsend Leader, September 11tH 2013. 22. "Raccoons pounce on PT couple," Port Townsend Leader, September 11th, 2013. 23. "Taking A New Tack To Persuade 'Young Invincibles'To Buy Health Insurance" Kaiser Health News ITI 1fi it ' j r cn 0 ''''''"%'-' ;40::.'''=`,1i: ''' '-',.+5*.ii;4-:!•4:,:i* .4.!.,• ' '' ' ' ,E,9, nam " ,. 4w' 'air V L ',azo A UD C x`4i�ykfi�.,A 'A,.� a, i6' 'p�F. 2 f .a' ..fit ..,-,,,",..,141„,,,,,Na - i, - - '4,„,.':,',--,_..r., .,,, , .... ,, , _ ..,., Lu.i...% ‘,„ . ,,,` stir.„.ii:;1:,„,,, ., ,k„-,i;',:r,,f; , „.,:- --3,:$4.-747,t;',-.-1, ; ; t'L-:t'rDs''''''i'lei.:.144.:4;i1,71'4:&::1:4;;;77.'21!:1:4:12247:1(1,„!:-7- ''' :t £.. y N dv` dli � • - � ',4,--_,_ `mss x ate. „ 3e, z -s�,� ' ,k:� w = OY ..�".., r s�- : a's:7,1_,,, '�sk „ t -'r"° ; Via.. = 34 ”: 5iN'Z�_��� : aa "" .x" . " 3•7 ,--‘47,I"`s �,k � A r, 3: s 3 " t ex ` ' ..... "`i,, te t.�C '�l ,3a a ''a,'If''I';" $ N•. L „� � 1 � ',moi ,«< C t.F CD a 0 ....,,. ..,.‘.,-.:,.".. '..-:, % -n '' ; ' .riAtl.'sT . v J �✓ f� �f��r';max � ` [�:` ,..,4, l. roN "- �«,,, yam`.. .r" x , rur�� 0 ter t _ ells,- ` r y�. UA O :G ,,..s�.,..,.�; �. 3„w•:_tam.,-x.,.e *°`.' ,'...-, a�� `X;,,,, .-�.,.`. ; .� F2 td' CD v► cOD .4., ��a g'Y,'—)moo . o chi o off^ W cC' ri a U " of. g al Vi I MI �0 Imo _' z tan c� Ca w g aw l 0 0 ..:� x q amp E F •iq.e. , +.fii› u o o 0 . .. 0•g b> c, LLTs '�'� 7,.�7;-=� R. t>-.' U�Tr m -. 2.1,2.4-0- 0 �.�.�.�+..R w -2= m CUJ • School clinics to open for sport physicals frosted: Wednesday, August 14, 2013 5:00 am, Port Townsend Leader Student athletes without paperwork clearance, and that includes a medical physical document, cannot practice when high school sports begin next week in Chimacum, Port Townsend and Quilcene. Physicals are available at school-based health clinics at both Port Townsend High School and Chimacum High School. Starting next week, sports physicals are available Tuesdays and Fridays at the School- based Health Center in the Gael Stuart Building on the PTHS campus, or Monday and Wednesdays at Chimacum High School. Physicals are available from 9 a.m. to 3 p.m. 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. *ACK TO SPORTS PTHS hosts a meeting for the parents/guardians of high school fall-sport athletes (volleyball, girls' soccer, football, girls' swimming, boys' tennis and cross-country) at 6 p.m., Monday, Aug. 19 in the PTHS library. Coaches of the fall sports meet from 5 to 6 p.m. Football practice begins on 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 on Monday, Aug. 26 for other fall sports. Port Townsend School District offices reopen on Aug. 21. PTHS student "back-to-school day" is 10 a.m.-1:30 p.m., Monday, Aug. 26, and includes locker assignments, photos and ASB items. Freshman orientation is 8:30-11 a.m. on Aug. 28. Classes begin on Tuesday, Sept. 3. • Closing oyster beds affects some 19 Jefferson County businesses By Rob 011ikainen, Peninsula Daily News, August 15th, 2013 *tate and county health officials are advising seafood lovers to cook their oysters this summer. More than 40 people in the state have been sickened this year with vibriosis, including one from Thurston County who ate an oyster thought to have been harvested from the Brinnon area. Several parts of the Hood Canal are closed to commercial oyster harvesting, affecting 19 Jefferson County businesses, because of the vibriosis bacteria. No cases have been reported on the North Olympic Peninsula. As of this week, several parts of the Hood Canal, including Dabob and Quilcene bays in East Jefferson County, and Hammersley Inlet near Shelton are closed to commercial harvesting because of high vibrio levels, the state Health Department announced. Commercial operations can resume once the vibrio levels go down. "It's not a big economic impact on them," said Dr. Tom Locke, public health officer for Jefferson and Clallam counties. The Vibrio parahaemolyticus bacteria can grow quickly when warm weather coincides with midday low tides. The state Health Department recommends cooking all shellfish in the summer months to kill the bacteria. had a warm summer, which increases the risk that eating raw oysters might make people sick," said Jerrod .We've Davis, director of the Office of Shellfish and Water Protection. "It's much safer to eat cooked oysters, especially this time of year." Vibriosis can cause watery diarrhea, often accompanied by nausea, stomach cramps, headache, vomiting, fever and chills. Symptoms generally appear within 12 to 24 hours of consuming raw shellfish and typically last for two to five days. It can be life-threatening for those with weak immune symptoms or chronic liver disease. Locke said the Hood Canal is particularly susceptible to vibriosis because of its relatively warm temperatures. Commercial oyster harvesting is a multimillion-dollar industry along Hood Canal. "The state has a rigorous testing program to ensure that commercially harvested oysters are safe to eat," Locke said. Although commercial harvesters use special control measures in the summer to keep people who eat raw oysters from getting sick, the state Department of Health closes commercial growing areas when vibrio levels become high or when there are four confirmed vibriosis illnesses within a 30-day period. • Rick Porso, manager of the Office of Shellfish and Water Protection, said Quilcene Bay was closed July 19, and Dabob Bay was closed Monday. The closures affect 19 Jefferson County companies. "The companies may or may not be operating at this time of year because they know that during this time of year, vibrio seems to be flaring up," Porso said. "If they have a high level of bacteria, we require two good samples at least seven days apart." • Dabob Bay also was closed last August because of the vibrio bacteria, affecting 14 commercial shellfish companies. "This is sort of that time of year that we see vibriosis," Locke said. "The safest thing to do is cook the oysters." Elsewhere, commercial operations at Oakland Bay and Totten Inlet in south Puget Sound were closed this summer because they had four confirmed vibriosis illnesses. "I definitely recommend against people harvesting oysters in the wild at this time of year," Locke said. Recreational shellfish harvesting was closed on most North Olympic Peninsula beaches earlier this summer because of elevated levels of marine biotoxins that cause paralytic shellfish poisoning, or PSP, or diarrhetic shellfish poisoning, or DSP. Unlike vibrio, marine biotoxins are not destroyed by cooking. For information on recreational shellfish closures, phone 800-562-5632 or visit www.doh.wa.gov. • 411 Free PT mental health clinic to offer youths confidential counseling By Joan Worley,For Peninsula Daily News,August 18th,2013 r '`�, "4":F". .a Young people in crisis or confusion can find free help at the new Youth Mental Health Clinic,1136 Water St.,across from Quimper Mercantile in Port Townsend, after it opens Thursday.As of Sept.3,the JC MASH free medical clinic will be in the same building.--Photo by Joan Worley/for Peninsula Daily News Youth mental health clinic The Port Townsend Youth Mental Health Clinic is open to anyone ages 13-25. Phone 360-379-2630 for an appointment or go by the Sanderling Building,1136 Water St. • Thursdays from 6:30 p.m.to 7 p.m.for an appointment. • • Tuesdays from 4 p.m.to-6:30 p.m.by appointment and from 6:30 p.m.to 7 p.m.for a drop-in group. • Last Monday of each month 4 p.m.to 5 p.m.for support group. All services are free.All services are confidential. JC MASH services Free medical assessment,guidance and advocacy are available at JC MASH,Jefferson County Medical Advocacy and Service Headquarters. No appointment is needed. Clinics are: is Port Townsend:7 p.m.to 8:30 p.m.Tuesdays,209 Monroe St.(Moves on Sept.3 to 1136 Water St.),360-385-4268. • Port Hadlock 5 p.m.to 6:30 p.m.Thursdays,121 Oak Bay Road,360-385-4268. • Chemical dependency clinic:7 p.m.to 8:30 p.m.Wednesdays,Olympic Pain and Addiction Clinic, 1334 Lawrence St.,Port Townsend,360-207-1855. • Youth Mental Health Clinic,1136 Water St.,Port Townsend,as of Thursday. PORT TOWNSEND—A clinic to provide free and confidential mental health counseling for youths will open Thursday. The Port Townsend Youth Mental Health Clinic at 1136 Water St. will provide free and confidential mental health counseling for clients 13-25 years old. The pilot project aims to help troubled young people, especially those wary of seeking help through regular channels. "I don't think you can have too many services for vulnerable populations," said Karen Ciccarone, R.N. Illhe said she "tried to retire" to Port Townsend after a career as a psychiatric nurse but found herself volunteering to help at-risk youth. "From what I've seen, there is a lot of need out there," she said. In addition to her own experience, Ciccarone cited 2011 statistics from the Jefferson County Public Health Department showing that the county has a higher percentage than state averages of students in grades 6-10 reporting "serious • suicidal ideation." The breakdown for the students, as reported by the health department, was 16,5 percent of the county's sixth-graders compared with 14.1 percent statewide, 18.9 percent of the county's eighth-graders as opposed to 14.4 percent statewide and 18.6 percent of the county's high school sophomores compared with 17.2 percent statewide. Figures for 2012 were not available. Ciccarone proposed a youth mental health clinic to the board of Jefferson County Medical and Advocacy Service Headquarters, also known as JC MASH, a nonprofit that has offered free medical assessments and advocacy since 1994. Treasurer Steven Rafoth became an enthusiastic partner. "To me it was obvious it should be under the wing of JC MASH," Rafoth said. He and Ciccarone secured first-year funding from the nonprofit Jefferson County Community Foundation, now a major sponsor, along with Port Townsend's Noon Rotary Club, Sunrise Rotary and private donors. Lead counselor Tom Duke will meet clients for appointments each Thursday from 4 p.m. to 6:30 p.m. and will be available during an added drop-in period from 6:30 p.m. to 7 p.m. A drop-in therapy group will meet Tuesdays from 4 p.m. to 5 p.m., and a support group is scheduled from 4 p.m. to 5 p.m. the last Monday of each month. Duke, a licensed mental health counselor and chemical dependency professional with 30 years of experience, serves the clinic at a reduced rate. Other staff are volunteers. • For clients who need more than a few counseling sessions, Duke can make a referral to one of three local licensed therapists who have pledged free services. The clinic's young clients may seek help for a variety of reasons. "I'd counsel someone who came in and said, 'I'm lonely," said Duke, adding that the relationship of client and therapist is"like peeling an onion," an ongoing process of developing trust in order to communicate. Duke, Ciccarone and Rafoth stress that one key to success is to make access to mental health care easy, safe and affordable to every person who steps through the door. The intake procedure, for example, requires a simple one-page form, and services are free. In September, the JC MASH medical clinic will move into the same building, making other free medical services easily available to youth mental health clinic clients. Therapists at the youth mental health clinic do not prescribe medication, but the clinic can refer clients to a psychiatrist, psychiatric nurse practitioner or JC MASH medical director Dr. James K. Rotchford. Confidentiality is also key to the project. Neither parents nor agencies are notified when a young client makes an appointment. In cases of abuse or when young people may be dangerous to themselves or others, clinic staff must file reports. Otherwise, the client's privacy is inviolate. That policy applies even to clients who may be using drugs. 4111 "Most mental health patients," said Ciccarone, "have co-occurring disorders and self-medicate in some way." If a client who uses drugs is clearheaded enough for the session to be useful, Duke will work with that. If not, he will reschedule the session. he youth mental health clinic has support from established resources. ove House, 1045 10th St., can assist clients who have experienced sexual abuse or domestic violence. The Boiler Room, 711 Water St., provides a place run by teen volunteers where youths in need of support can get together and is expected to be a valuable resource for alerting potential clients to the youth mental health clinic's services. Although local school districts have their own school-based mental health clinics, the superintendents of Port Townsend, Chimacum and Quilcene/Brinnon school districts were enthusiastic about the idea of the youth clinic, being aware that some students would prefer an off-site option. Ciccarone said the Jefferson County Public Health Department will stock rack cards for the youth clinic, and she hopes to enlist churches and other community organizations in publicizing the new clinic. After the first year, the clinic will undergo review via anonymous client surveys and other tools. Rafoth already has begun to identify potential future sources of funding. III • Something in the DNA? Anderson Lake's continuing toxic algae problems gain national attention By Charlie Bermant,Peninsula Daily News,August 18th,2013 " to Qro ani a t ? * t The state park remains open,but popular trout-fishing Anderson Lake is closed this summer.--Photo by Charlie Bermant/Peninsula Daily News Latest lab test cause for optimism PORT TOWNSEND—The latest test of water samples from Anderson Lake showed that toxin levels are at safe levels, but the lake remains closed. Michael Dawson, lead environmental health specialist at the Jefferson County Public Health Department, said that tests should show a safe level of toxins in the lake at least twice before it is reopened. 1111 That decision would be made by the state ranger who oversees Anderson Lake State Park and Fort Flagler State Park, Mike Zimmerman, after hearing a recommendation from county specialists. "These numbers fluctuate, so we want to see some more samples before drawing any conclusions," Dawson said. The 410-acre state park around the lake remains open for hiking, biking and horseback riding.A Discover Pass is needed to park there. The most recent test results of a sample collected from Anderson Lake last Monday,Aug. 12, found 0.55 micrograms per liter of anatoxin-a, below the state recreational guideline of 1 microgram per liter. Tests,which are conducted by King County Environmental Lab, now are done monthly after budget cuts made weekly testing cost-prohibitive for the state Department of Ecology. The county public health department is looking for a way to finance more frequent tests, perhaps as soon as this week, Dawson said. Gibbs Lake south of Port Townsend also remains closed after the most recent tests. It has been closed since July 18 because of high levels of microcystin,which can cause skin irritation, nausea and muscle weakness if touched and liver damage if swallowed over a long period of time. Lake Leland remains posted with a caution sign, although the level of toxins is barely detectable, because it contains algae known to sometimes produce toxins and has a light bloom. Toxin-producing blue-green algae has not been spotted in Clallam County. Report algae blooms in Clallam County by phoning 360-417-2258,while Jefferson County blooms can be reported at 360-385-9444. For more information about Jefferson County lakes,visit http://tinyurl.com/jeffersonlakequality or phone the office. CHIMACUM —Anderson Lake and its blue-green algae is getting widespread attention. A report from researchers at the University of Oregon and the Centers for Disease Control and Prevention in Atlanta— which is expected this fall at the earliest—could set the stage for a solution to the lake's historically high level of anatoxin-a, a potent nerve toxin created by some types of blue-green algae. 11110 Samples of algae from the popular trout-fishing lake, which is within Anderson Lake State Park between Port Townsend and Chimacum, are undergoing genetic analysis to determine if the species living in Anderson Lake are commonly found in similar lakes across Northwest Washington. Also, a paper about animal deaths and poisoning in proximity to lakes around the nation, which is now under review by the Centers for Disease Control, or CDC, is expected to include data from Anderson Lake, where routine testing for toxins began after two dogs drank the water and died on Memorial Day weekend in 2006. "This is an interesting case," said Joan Hardy, a toxicologist with the state Department of Health about the studies of algae DNA. "We want to find out why Anderson Lake is so much more toxic than the other lakes in the region." She added that she did not know when the animal deaths study would be published. The lake, which closed this year since May 17 after only three weeks of the fishing season, has been found during the seven summers it has been tested to contain high levels of anatoxin-a, which can kill within four minutes of ingestion. In June 2008, the 60-acre lake set a world record: 172,640 micrograms of anatoxin-a per liter. The safety threshold for the toxin is 1 microgram per liter. If the algae, also known as cyanobactria, is unique to the lake, that could account for high toxin production, Theo Dreher, chairman of the Department of Microbiology at Oregon State University and lead researcher, has said about the study begun earlier this year. This information could help local health officials devise a plan to combat the specific type of cyanobacteria and • potentially reduce Anderson's toxin levels, he said. "Right now, the tests are conducting a genetic analysis of the lake's algae and trying to determine how it differs from other strains," said Michael Dawson, lead environmental health specialist at the Jefferson County Public Health Department, last week. "The question is still how Anderson Lake seems to produce so much anabaena [a species of cyanobacteria], which is the active ingredient in the toxin." Anatoxin-a and microcystin, a slower-acting toxin commonly found in East Jefferson County lakes, are produced by blue-green algae, which occurs naturally but which can begin suddenly to produce toxins. The reason is a mystery to scientists worldwide. What is known is that algae growth is fueled by the sunshine and warmth of summer and nutrients such as phosphorus. Dawson said Anderson Lake is a"eutrophic" lake, meaning it has high quantities of nitrogen, phosphorus, and other nutrients. It's an old lake and does not have a steady flow of water in and out, which can result in unusual algae patterns, he said. One possible solution would be to channel water from another source into the lake to freshen the water, Dawson said, although the possible source hasn't been determined. Hardy said that one of the factors in determining the nature of the toxicity will be to study how the surrounding land 1111 was used in the past. A county report released in February noted a high amount of phosphorus in Anderson Lake as opposed to other lakes in East Jefferson County, such as Gibbs or Leland. A dairy farm was operated near the lake for more than 50 years, according to Dawson and Greg Thomason, Jefferson County environmental health specialist, in the report. Itw manure is very high in phosphorus and is probably the major source of the high phosphorus levels in this small ," the report said. While budget cuts have cut the frequency of sampling for tests of toxin levels, state funds from boat licensing for toxicity tests is subsidizing the genetic analysis tests, Hardy said. "We are lucky that program is in place. Otherwise we would not be able to pay for the testing of the water, which can cost$400 each time," she said. For more information from the state, see www.nwtoxicalgae.orq. Jefferson County Editor Charlie Bermant can be reached at 360-385-2335 or cbermant anpeninsuladailynews.com. Reporter Jeremy Schwartz contributed to this report. • • Discovery Bay beaches closed to recreational shellfishing because of PSP By Peninsula Daily News staff,August 20`h,2013 T TOVVNSEND—Discovery Bay has been closed to all recreational harvest of shellfish after marine biotoxins cause Paralytic Shellfish Poisoning, or PSP, were detected at high concentrations in samples, the Jefferson County Public Health Department said. The state Department of Health closed the beaches, said Michael Dawson, lead environmental health specialist for the county. Commercially harvested shellfish are tested for toxin prior to distribution and should be safe to eat. Warnings posted Warning signs have been posted at high-use beaches warning people not to consume shellfish from these areas. The closure includes clams, oysters, mussels, scallops and other species of molluscan shellfish. This closure does not apply to shrimp. Crab meat is not known to contain the biotoxin but the guts can contain unsafe levels. To be safe, clean crab thoroughly and discard the guts. The closure announced Monday is in addtion to prior closures of the Port Ludlow area, including Mats Mats Bay, and Kilisut Harbor, including Mystery Bay, to the harvest of butter and varnish clams only. In Clallam County, Dungeness Bay is open for recreational harvest of shellfish, while Sequim Bay and the Strait of Juan de Fuca from Pillar Point west to Cape Flattery is closed for shellfish harvesting. •ean beaches are closed to the recreational harvest of all species of shellfish from April 1 to Oct. 31 each year. Marine biotoxins are not destroyed by cooking or freezing. 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. Anyone experiencing these symptoms should contact a health care provider immediately. For extreme reactions call 9-1-1. Recreational shellfish harvesters should check site at http://tinyurl.com/doh-wa-gov-shellfish or call 800-562-5632 before harvesting shellfish anywhere in the state. Jefferson County discusses drug take-back program By Tristan Hiegler, Port Townsend Leader I Posted: Wednesday, August 21, 2013 ealkording to King County data, drug-overdose deaths have surpassed car crashes as a leading cause of preventable ths in King County. A number of those overdoses are from prescription medications or over-the-counter drugs. "What we have discovered ... of all the chemicals we use in our home, some of the most toxic and deadly to children are medicines, prescription and over-the-counter medicines," said Margaret Shield of King County's Local Hazardous Waste Management Program. "We really appreciate the opportunity to talk about what can be done," Maria Wood of the King County Board of Health told local health officials. Representatives from Clallam and Kitsap counties also attended the Aug. 15 meeting in Port Townsend. The two King County representatives said medicines thrown into the trash could make their way into the wrong hands, or could have a negative environmental impact if dumped down the toilet. "We know there are a lot of leftover medicines that people don't need," Shield said. The King County Board of Health, on June 20, passed a countywide medicine return regulation meant to make the process easier. Implementation is expected to take some time. Wood and Shield confirmed that they expect some sort of legal challenge from the pharmaceutical industry. Jefferson County currently has two drug disposal sites: at the Jefferson County Sheriff's Office and at the Port •wnsend Police Department. Sheriff Tony Hernandez said on Aug. 15 that prescription drug abuse is an increasing problem for young people. "Prescription drugs, to me, are no different than leaving a loaded gun on the coffee table, where everyone can get it," Hernandez said. He called the fact that medicines are killing young people "mind boggling." He said such abuse problems among youths may be caused because there's less of a social stigma surrounding prescription drugs than around street narcotics. PTPD Chief Connor Daily noted that implementing something like the King County regulations could increase drug- return rates. "The easier it is, the more successful it will be," Daily said. Between the two departments' drop boxes and biannual take-back events, about 700 pounds of drugs are collected per year. Hernandez said he's working to install a third drop box at Jefferson Mental Health Services in Port Townsend within the next several months. • Port Townsend Paper mill seeks applicants to review odor trial results By Charlie Bermant, Peninsula Daily News,August 21, 2013 PORT TOWNSEND—The Port Townsend Paper Corp. is seeking volunteers to help evaluate an in-progress trial Iledure to reduce odors surrounding the mill. The trial, which began in July, involves injecting liquid oxygen into the 33-acre runoff pond, which has been the source of odor complaints for several years. The trial is expected to continue for at least two months, depending on the results, according to environmental officer Kevin Scott, who is forming a trial review panel to help evaluate the results. During the trial, the mill will test odor levels using a "Jerome Meter,"which is to be taken to areas from which complaints originate to provide an objective measurement of the sulfur content of the air. Scott said the panel will assemble for the first time in September and will meet at least three times, with meetings about two or three weeks apart. Scott said the group will be eight to 12 people plus an outside facilitator, and the meetings will not be open to the public "because we're planning a more relaxed venue, and these are working meetings." Meetings likely will last between two and four hours, depending on the data reviewed and topics discussed. Data packets and an agenda will be sent to panel members before the meetings to aid in preparation. Scott said invitations to participate will be issued to specific community groups, including PT AirWatchers, PT Watch Dogs, the Port Townsend School District and Jefferson Healthcare hospital. The general public also is invited to apply. oA plicants should have some science or engineering background to help in reviewing the information and assessments, tt said. The pond, where water from the mill on the south side of Port Townsend is purified and then channeled into Port Townsend Bay at a rate of 12 million gallons daily, holds 60 million to 80 million gallons at a time. The trial system is installed on a pipe that leads into the pond and is attached to a liquid oxygen tank, through which oxygen is injected at a rate of 3 tons daily. The oxygen mixed with the water from the mill reduces the sulfur content and, as a result, the smell, Scott said. The odor test is a condition of a state Department of Ecology wastewater permit for the pond that is to be issued in September, which requires that the test take place within the first two years of the permit. Those interested in serving on the panel should send an email by Aug. 30 to kevins2(a�ptpc.com that includes a description of science and engineering qualifications. The mill recently has encouraged residents to call in with odor complaints, reconfiguring its Community Impact Line, 360- 379-4224, for that purpose. Comments also are taken through email at community relationsptpc.com. Complaints about any mill odor also can be sent directly to the state Department of Ecology by calling 360-407-7393 or emailing angela.fritz(cr7ecy.wa.gov. Jefferson County Editor Charlie Bermant can be reached at 360-385-2335 or cbermant(a�peninsuladailynews.com. • PT Paper seeks community input help with odor study By Allison Arthur, Port Townsend Leader I Posted: Wednesday, August 21, 2013 5:00 am Port Townsend Paper Corp. is seeking help from the community to determine if a $150,000 trial to reduce odor is working. 111lo that, it is looking to start what mill environmental director Kevin Scott calls a Trial Review Panel. Scott said Monday that the mill plans to invite representatives from specific groups, including Port Townsend AirWatchers, Port Townsend Watch Dogs, Port Townsend School District and Jefferson Healthcare to give their input. The oxygen trial began Aug. 2 and is expected to last for two months. "If the trial is determined to have a significant benefit we will continue the project," Scott said Monday. "We expect the panel will meet at least three times to review trial results and give input on assessment of the trial results, possible changes to the trial plan, and future path forward," Scott said in an email Monday, Aug. 19. REACTION Gretchen Brewer of PT AirWatchers could not be reached for comment Monday. Dave McWethy, who has been critical of the mill's landfill issue, wrote in an email Monday, "I applaud the Mill for welcoming community involvement. "My first suggestion to them would be to have the sulfur testing in town currently being done by intern Brittany Huls begin at 6 in the morning and not at 8. Most folks know the odor on town tends to have cleared up by eight," McWethy said. Scott told the Leader earlier this month he's hoping that pumping 6,000 pounds of pure liquid oxygen a day into a particular waste stream will reduce, if not snuff out, the smell of sulfur coming from the mill. Scott said the panel would begin meeting in mid-September and continue through October with meetings likely lasting two to four hours depending on the data. The data and agenda would be sent to members prior to the meetings, he said. I/addition we will have seats available for the general public from the Port Townsend community who would be interested in helping," Scott wrote. "We ask that the people involved have some science or engineering background to help in reviewing the information and assessments," he added. Anyone interested in participating can email Scott at kevins2©ptpc.com by Aug. 30. He asks that prospective members include information on their background as well as contact information. PART OF PERMIT The smell of sulfur is what most people associate with a kraft paper mill and it's what most people complained about at a hearing when the state Department of Ecology came to Port Townsend to listen to issues surrounding the mill's National Pollutant Discharge Elimination System (NPDES) permit. The permit expired in 2009 and is being rewritten to address how the mill operates the 33-acre pond, technically called an aerated stabilization basin (ASB) that treats 12 million gallons of water a day. The pond holds and treats about 60 million gallons of water before the water is discharged into Port Townsend Bay. A new five-year permit, expected to be issued later this month by the DOE to take effect Sept. 1, likely will require the mill to start a study of how odor wafting off the pond can be reduced. Scott has said the mill wants to get a jump on that and be ahead of what the permit will require. In June the mill started a new Community Impact Line so that people can comment about the mill. That number is 379- 4224. mplaints about odor can be made directly to the state Department of Ecology at 360-407-7393 or emailed to Angela Illritz at angela.fritz©ecy.wa.gov. Jefferson County discusses drug take-back program 4B Tristan Hiegler of the Port Townsend Leader I Posted: Wednesday, August 21,2013 5:00 am cription medication tossed in the trash or otherwise not accounted for can have serious repercussions,eand Jefferson County Board of Health is trying to do something about it. Speaking to the Jefferson County Board of Health on Aug. 15, King County officials discussed their approach. According to King County data, drug-overdose deaths have surpassed car crashes as a leading cause of preventable deaths in King County. A number of those overdoses are from prescription medications or over-the- counter drugs. "What we have discovered ... of all the chemicals we use in our home, some of the most toxic and deadly to children are medicines, prescription and over-the-counter medicines," said Margaret Shield of King County's Local Hazardous Waste Management Program. "We really appreciate the opportunity to talk about what can be done," Maria Wood of the King County Board of Health told local health officials. Representatives from Clallam and Kitsap counties also attended the Aug. 15 meeting in Port Townsend. The two King County representatives said medicines thrown into the trash could make their way into the wrong hands, or could have a negative environmental impact if dumped down the toilet. "We know there are a lot of leftover medicines that people don't need," Shield said. •King County Board of Health, on June 20,passed a countywide medicine return regulation meant to make the process easier. Implementation is expected to take some time. Wood and Shield confirmed that they expect some sort of legal challenge from the pharmaceutical industry. Jefferson County currently has two drug disposal sites: at the Jefferson County Sheriff's Office and at the Port Townsend Police Department. Sheriff Tony Hernandez said on Aug. 15 that prescription drug abuse is an increasing problem for young people. "Prescription drugs, to me, are no different than leaving a loaded gun on the coffee table, where everyone can get it,"Hernandez said. He called the fact that medicines are killing young people "mind boggling."He said such abuse problems among youths may be caused because there's less of a social stigma surrounding prescription drugs than around street narcotics. PTPD Chief Connor Daily noted that implementing something like the King County regulations could increase drug-return rates. "The easier it is, the more successful it will be,"Daily said. 411ftween the two departments' drop boxes and biannual take-back events, about 700 pounds of drugs are llected per year. Hernandez said he's working to install a third drop box at Jefferson Mental Health Services in Port Townsend within the next several months. • Discovery Bay closed to shellfish harvest Posted: Wednesday, August 21, 2013, Port Townsend Leader Sine biotoxins that cause paralytic shellfish poisoning (PSP) have been detected at concentrations above the closure level in shellfish samples collected from Discovery Bay. As a result, the state Department of Health (DOH) has closed Discovery Bay beaches to recreational shellfish harvest. Commercially harvested shellfish are tested for the toxin prior to distribution and should be safe to eat. Last year, on Sept. 22, a family of seven vacationing in Jefferson County became ill with PSP after ingesting mussels harvested from Discovery Bay, which at the time was off-limits for shellfish gathering. This year, warning signs again have been posted at high-use Discovery Bay beaches. The closure pertains to clams, oysters, mussels, scallops and other species of molluscan shellfish. This closure does not apply to shrimp. Crabmeat is not known to contain the biotoxin, but the guts of crab can contain unsafe levels. To be safe, clean crab thoroughly and discard the guts (butter). PSP biotoxins are not destroyed by cooking or freezing. 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. Due to warm weather and high levels of vibrio bacteria, Hammersley Inlet and several areas of Hood tal, including Dabob Bay and Quilcene Bay, are closed to oyster harvest. More than 40 people oss the state have gotten sick with vibriosis so far this year, primarily from eating raw or undercooked oysters, according to a press release from the DOH. State health officials expect the number of illnesses to rise in the next few weeks, due to projected temperatures and midday low tides. "We've had a warm summer, which increases the risk that eating raw oysters might make people sick," said Jerrod Davis, director of the Office of Shellfish and Water Protection. "It's much safer to eat cooked oysters, especially this time of year." Vibrio parahaemolyticus bacteria thrive in warm temperatures. When midday low tides coincide with warm weather, the bacteria can grow quickly, raising the risk of the vibriosis illness among people who eat raw or undercooked oysters. Oysters should be put on ice or refrigerated as soon as possible after being collected. Shellfish should be harvested as soon as the tide recedes, avoiding oysters that may have been exposed for unknown periods of time. Once collected, oysters should be cooked at 145 degrees Fahrenheit for 15 seconds to destroy vibrio bacteria. Don't rinse fully cooked oysters with seawater; it can contaminate them. Vibriosis typically causes watery diarrhea, often accompanied by nausea, stomach cramps, •adache, vomiting, fever and chills. Symptoms generally appear within 12 to 24 hours after eating infected shellfish. The Department of Health closes commercial shellfish-growing areas when vibrio levels are high, or when there are four confirmed cases of vibriosis within a 30-day period linked to commercially harvested oysters. • Recreational shellfish harvesters should check the DOH website, doh.wa.gov, or call the DOH biotoxin hotline: 800-562-5632. • • Free youth mental health clinic opens in PT By Allison Arthur of the Port Townsend Leader I Posted: Wednesday, August 21, 2013 5:00 am •insurance, no money, no worries" is how Karen Ciccarone is promoting a new arm of JC MASH whose purpose is to reach out to young people throughout Jefferson County who need mental health counseling. The Youth Mental Health Clinic opens for business on Thursday, Aug. 22 in the Sanderling Building at 1136 Water St., Suite 109, in Port Townsend (across the street from Don's Pharmacy) with a goal of serving people ages 13-25. Four local licensed mental health counselors, including veteran counselor Tom Duke, have signed up to offer counseling services. Duke is the only paid therapist. Barbara Hansen, a private-practice counselor who has extensive experience in adolescent and chemical dependency, is offering the clinic her time pro bono for any clients needing extended therapy. Ciccarone says people are excited about being able to direct uninsured young people to a place that offers both mental health and medical care. No sooner will the doors open to the mental health clinic than JC MASH (Jefferson County Medical Advocacy Services Headquarters) will relocate its free medical clinic. The medical clinic, which runs from 7 to 9 p.m. on Tuesdays, moves from the American Legion Marvin G. Shields Post 26 to the Oderling Building on Tuesday, Sept. 3. THE IDEA "I've been dreaming about this since I moved here six years ago," said Ciccarone, a retired registered nurse with pediatric and psychiatric certification. She came up with the idea of a dedicated mental health clinic for youths after spending the last six years in various volunteer positions. In those roles, she saw numerous young people who were "flying off the radar" of most agencies offering services. "I heard many stories from juvenile-services kids as a Community Action [OIyCAP] board member," she said. "I heard most youth talk about their depression and dysfunctional home situations. "Most youth are distrustful of established care and authority," she said. "I felt there was a need to broaden the reach and widen the safety net for at-risk youth." Ciccarone brought the idea to the JC MASH board, and that board then sought and won a grant from the Jefferson County Community Foundation for $6,000. COMMUNITY SUPPORT The Boiler Room supported the grant, and Ciccarone said that Amy Smith, who heads the Boiler Room, is anxious to see the clinic up and running. Smith was on vacation and unavailable for •mment last week. Other agencies also have expressed support for the new clinic, Ciccarone said, including Jumping Mouse Children's Center, Dove House Advocacy Services, Jefferson Mental Health Services and Olympic Community Action Programs (OIyCAP). Ciccarone's husband, Rich Ciccarone, heads the OIyCAP board of directors. OIyCAP is supporting the clinic by giving bus passes to those who need them. "They will only have to pay their one fare to get here, and we'll be able to give them free bus passes after that, thanks to OIyCAP," Karen Ciccarone said. "I don't think you can ever have too much services for the vulnerable population," she said of seeing young people who are homeless or couch surfing and, in many cases, invisible to the community. Funding also is coming from the Port Townsend Noon Rotary Club, Sunrise Rotary Club and private donations. "We have $20,000 plus or minus," Ciccarone said. JC MASH board member Steve Rafoth and Ciccarone both said thanks goes to the Saderberg Trust for making the offices in the Sanderling Building available at a rent the nonprofit can afford. In addition to the agencies pledging support, Ciccarone and Rafoth noted that they have connected with school superintendents throughout the county, and those superintendents also will be promoting the clinic as an option for students. County schools also have health clinics, but the clinic offered by JC MASH is not directly associated with those. Ciccarone said she's concerned that all youths throughout the county have access to mental health and medical care. "I'm very concerned about that end of the county," Ciccarone said of Brinnon and Quilcene. "There's • more to Jefferson County than Port Townsend." PSYCHIATRIST NEEDED Ciccarone and Rafoth are excited to see the clinic come together as quickly as it has, with so much support, but both said a few things are needed. Artwork for the walls of the waiting room and therapy room is one thing. The Boiler Room is expected to help with that. More difficult to find is a psychiatrist or nurse practitioner who can prescribe medications. Counselors do not have that authority. "I've not been lucky finding a psychiatrist or nurse practitioner," she said. "I don't see where their practice would be flooded, but I do need to round out the care and say yes, I have somewhere to send a kid that's actively psychotic and needs medication." The ideal person would see clients either on a pro bono or reduced-fee basis, which JC MASH would pick up. Ciccarone is adamant that the service at the clinic be free. • • CONFIDENTAL As with all medical services, "everything is confidential," Ciccarone said. •th noted that the only paperwork JC MASH asks people to fill out for free medical care is essentially a single page. "We have people who come because they can't hack the clipboard and stack of papers you get at institutions," Rafoth said. "Most people can handle a one-pager." Ciccarone noted that the only caveat to that confidentiality rule is if a person seeking help presents a danger to himself or herself or possibly to someone else; therapists do have an obligation to report such possibilities to authorities. FUTURE Although the small and undecorated offices are a huge start to realizing Ciccarone's dream, she's not done yet. "I am dedicated to procuring future funding to make this clinic sustainable. Our budget is small; there is only one paid therapist. There are no other paid positions. Over 80 percent of our budget is allocated for direct services to our clients. "I am currently working on funding for our second year," she said. "No one should be denied care because of their inability to pay, especially our most vulnerable fulations." S Sporadic whooping cough cases persist on West End By Rob 011ikainen, Peninsula Daily News, August 22"d, 2013 FORKS —Seven pertussis cases were reported on the West End of Clallam County in July and August. •ave recovered, said Dr. Tom Locke, public health officer for Clallam and Jefferson counties. All were adults, he said. Pertussis, also known as whooping cough, is a highly contagious bacterial disease that causes violent coughing and can lead to severe complications in infants and children. Five of the cases were confirmed in July, with the other two reported this month. No other cases have appeared on the North Olympic Peninsula so far this year. "It's just on the West End," Locke said. "It's what we call a cluster, in that they're all linked to each other," he said. "That's not uncommon with pertussis, given that it's highly contagious." Pertussis is commonly spread among families or people in close contact. It is transmitted through coughing and sneezing. Health officials recommend that adults get vaccinated with Tdap, the adult booster for tetanus, diphtheria and pertussis, to protect babies and young children who are at the highest risk of severe complications. Although pertussis can cause relatively mild symptoms in adults, it can be life-threatening to infants. "If people are not vaccinated, it can just smoulder in the population," Locke said. •tussis was declared an official epidemic in Washington in April 2012. State health officials said it is far less prevalent in 2013. As of last Saturday, there had been 491 confirmed cases statewide. That compares with 3,868 cases for the same time period last year. "We still continue to see sporadic pertussis cases," Locke said. Last year's pertussis epidemic included 26 cases in Clallam County and 25 cases Jefferson County, nearly all of which were reported in the first half of 2012. Like many respiratory infections, pertussis tends to ramp up in the fall and winter when people are spending more time indoors and children return to school, Locke said. Health officials are preparing to launch a promotional campaign for the pertussis vaccine that will be targeted out of doctor's offices. The state Department of Health said children aged 7 to 10 who aren't fully vaccinated —and everyone 11 and older— should get the Tdap vaccine. Vaccinations are available through primary care providers, area pharmacies and local health departments. For a list of frequently asked questions about whooping cough, visit the health department's website at www.tinyurl.com/lwo7by8. porter Rob 011ikainen can be reached at 360-452-2345, ext. 5072, or at rollikainenPpeninsuladailynews.com. • Bats and rabies My voice was not loud On Aug. 10,Center Val- enough,but with enough ley Animal Rescue was support we will be heard. notified of a brown bat Sara Penhallegon, found by a 16-year-old Quilcene attending Centrum Camp Penhallegon is a certi- at Fort Worden State Park. counselor called to see Pied wild animal rehabili- Aif we could rehabilitate it. • tation specialist and ueteri- The bat was mildly nary technician. dehydrated,probably from We asked Dr. Torn Locke, overheating on a metal roof public health officer for Jef- near where he was found. Person and Clallam conn - This is not uncommon. ties, to respond: The bat was looking Since 1995,over 90 per- great the next day.I should cent of human cases of have released it.Instead,I rabies in the United States ` thought I would give it a have been linked to bat day or so more. exposure. On Aug. 12,the Jeffer- Human rabies can be son County Health Depart- prevented with an expen- ment informed me that sive series of injections fol- they wanted to test the lowing exposure to the bat's brain for rabies. rabid animal.Once rabies Before testing,though;the infection occurs,the dis- bat would be euthanized. ease is almost always fatal. I strongly Campers said no one Evaluatingapotential g e urgen Olympic fol- had been bitten by or had Peninsula residents to ntact bat. bat exposure is not a sim- low the longstanding skin Why tactwouwithd it thee kbat. pie process.Bites from bats advice of public health e and tested if no one had are very subtle and usually experts and avoid all con direct contact? leave no mark. tact with bats. People can he exposed to Under no circumstances meet s aIealth Depart-th6 ear infectious bat saliva while should anyone attempt to Y handling the animals with- old may be lying. out knowing it, nurse a sick bat back to They were not expecting In cases where there is health or transport it to an the bat to have me on its potential human exposure animal rescue center. team.My mission is to and a bat is available for Anything that inc stand for what I believe in testing,it is almost always human contact with batseases and give voice to those who best to test the bat for has very real dangers for both species. don't have one. rabies. I pleaded my case for Between 5 and 10 per- three days,but after cent of bats tested by the Health Department offi- state Public Health Labo- cials made threats,my ratory each year turn out, patient and I lost the bat- to be infected with rabies. tle. The letter writer oper- He was euthanized— ates an animal rescue con- the first healthy animal I ter in Jefferson County. have ever euthanized. She appears determined I made a promise to this to"rehab"sick bats despite bat:People would hear his my strong recommendation story,and his life would not that she discontinue this be taken in vain. practice. If you think the death of The best way to prevent this bat was wrong,please human rabies is to avoid share your concerns with contact with bats. the Jefferson County Rabid bats can appear Health Department at 360- healthy.Bats should be left • 385-9400: unmolested and wild. :OA/ • �j:2')j3 • Healthcare insurance options: Fair coming By Allison Arthur of the Leader I Posted: Wednesday, August 28, 2013 5:00 am Jen boats get a festival. Movies get a festival. Fiddle tunes, blues and jazz get a festival. And now, so does health access in Jefferson County. Actually, it's called a Health Access Fair, but some of those involved are so giddy, it might as well be a festival. "It is exciting," said Julia Danskin, public health nursing director for Jefferson County Public Health. "We are all working together—Jefferson Healthcare, Olympic Area Agency on Aging and us—to get the information out and help as many as we can to get health insurance," she said. A Health Access Fair set for 11 a.m. to 2 p.m. Saturday, Sept. 21 in the Erickson Building of the Jefferson County Fairgrounds is all about health-care options and the Affordable Healthcare Act, commonly known as Obamacare. Thousands of people in Jefferson County who currently don't have insurance will be eligible for either free insurance through an expanded Medicaid program, or insurance through other programs that open for enrollment on Oct. 1. Health insurance will be mandatory in 2014 for everyone and there will be fines for those who don't have insurance. GETTING TRAINED Danskin wants to make it easier for the thousands of uninsured people in Jefferson County to sign up for either free or subsidized insurance. e Sept. 12, Danskin and six other employees of the health department will head to Port Angeles to learn how to help ple sign up for an insurance plan. Officially, someone who helps people navigate online insurance choices is called an "in-person assister." Even the health department's receptionist is being trained to answer questions. Starting Oct. 1, Danskin expects public health to have walk-in hours on Wednesday for people to get help. The offices are next to the Port Townsend QFC grocery store. "I think Jefferson County has a huge amount of people whose kids now qualify and the parents don't now, but that will change," Danskin said. Danskin notes that both Medicaid and qualified health plans are supposed to cover doctor's appointments, emergency medical care, maternity care, mental health and substance abuse treatment, prescriptions, laboratory services, rehabilitation services and preventive and wellness checkups. "I do think they are trying to make it user friendly and easy to understand. That is one of the main messages of excitement," says Danskin. "I believe anybody on the street who knows how to get on an Internet website should be able to go through the application themselves without any help from anyone," she said. "If you get halfway through and get confused, you can stop and ask for help." 411,m Danskin's perspective, "one of the exciting things is [it covers] mental health and substance abuse treatment and preventive and wellness checkup." The preventive care and wellness checkups particularly appeal to her, as does emergency care. Danskin is aware that a number of people in Jefferson County may not agree with "Western medicine" and opt for alternative healthcare. "But if you need antibiotics or are in an accident, it helps," she said of the more conventional care available. • STATISTICS, DATES By the end of 2013, it is estimated that Jefferson County will have a population of 30,800 people. Of those, roughly 4,600 people— 14.8 percent—will be uninsured. Of those 4,600, approximately 1,900 may qualify for insurance with federal subsidies, and another 1,300 may qualify under the Medicaid expansion. In short, about 71 percent of people without insurance today in Jefferson County could purchase insurance through the Washington State Health Insurance Exchange program. All three Jefferson County agencies have picked CHOICE Regional Health Network to work with for insurance. And all three agencies are training in-person assisters to help people. In addition to presentations by Jefferson Healthcare at that Health Access Fair, there will be financial counselors from Jefferson Healthcare, and in-person assisters from all three agencies. Kristin Manwaring Insurance also will be at the fair. More Information A Health Access Fair is set for 11 a.m. to 2 p.m. Saturday, Sept. 21, at the Erickson Building at Jefferson County • Fairgrounds. Presentations will explain health-care options in Jefferson County starting Oct.1. There are several options for obtaining help, according to Washington Health Plan Finder; see them at wahealthplanfinder.org. Customer Support Centers open Sept. 3 to answer questions. Hours are 7:30 a.m. to 8 p.m. Monday through Friday. Call 1-855-923-4633 for more information. • LETTER: Killing of bat not necessary Port Townsend Leader,August 28th, 2013 aturday, Aug. 10, Center Valley Animal Rescue got a call on a little brown bat found in Port Townsend at Fort den State Park. A 16-year-old boy found it and reported it to his counselor, who then called us to see if we could take the bat and rehab it. By Sunday, the bat was looking great. If I knew then what I know now, I would have released it then. Instead, I thought I would give it a day or so more to recover. Jefferson County Health Department contacted me after hearing of the bat on Monday. They wanted it for rabies testing. To test an animal for rabies it must be euthanized, or killed, and the brain is then tested. I was not keen on this idea. The teen said no one had been bitten or had any skin contact with the bat. Why would this cute little bat need to be killed? The health department's answer: The teen may be lying. The department didn't want to even contact the parents of the teen or have the parents question him. My mission is to stand up for what I believe in and give a voice to those who don't have one. I gave officials a three-day fight, but after many threats, I lost the battle. The little brown bat was put down. He was the first healthy animal I have ever had to put down. I pray that it will be the last. I don't have it in me to do that again. I made a promise to this little bat that people would hear his story. If you think the death of this bat was wrong, contact Dr. Tom Locke at 385-9400. My voice was not loud enough,. but with enough support we will have to be heard. PENHALLEGON cene The Leader asked Dr.Tom Locke to respond and he wrote this: Since 1995, over 90 percent of human rabies cases in the United States have been linked to bat exposures. Human rabies can be prevented with an expensive series of injections following exposure to a rabid animal. Once rabies infection occurs, the disease is almost always fatal. This is why we take the evaluation of rabies exposure so seriously—you only get one chance to do it right. Evaluating a potential bat exposure is not a simple process. Rabid bats can appear to be healthy. Bites from bats usually leave no mark. People can be exposed to bat saliva while handling the animals without knowing it. In cases where there is potential human exposure and a bat is available for testing, it is best to test the bat for rabies: 5 to 10 percent of bats tested by the Washington State Public Health each year turn out to be infected with rabies. Ms. Penhallegon operates an animal rescue facility in Jefferson County. She inappropriately accepts sick bats for"rehab" in her facility despite my strong recommendation that she discontinue this practice. The best way to prevent human rabies is to avoid contact with bats. Wild bats do not need to be "rescued," they are not pets. Ms. Penhallegon is misguided and ill informed in her self-appointed role as bat spokesperson. And she has her facts wrong in the exposure case she cites. I strongly urge Jefferson County residents to follow the long-standing advice of public health experts and avoid all contact with bats. If contact does occur, capturing and testing of the bat is necessary. Under no circumstances should an attempt be made to nurse a sick bat back to health or transport it to an animal rescue center. Anything that increases human contact with bats has very real dangers for both species. • • Anderson, Gibbs lakes' clear water doesn't mean they're safe By Leah Leach,Peninsula Daily News, September 4,2013 • ' ' t ." A ', � � 13 a. d RSk ^1M � .....1'17 i '...�...«,3s "' ., �*x� caret""" d: • .. Charlie BennanUPeninsL la Daily News High toxin levels means Anderson Lake in Jefferson County is still off-limits,officials say. PORT TOWNSEND—The lakes may look clearer, but the closure signs remain at Anderson and Gibbs lakes until more water samples are tested the middle of this month. "You can't always tell how toxic the lake is just by looking," said Michael Dawson, lead environmental health specialist at the Jefferson County Public Health Department, last week. "The wind might have blown the algae" that produces toxins in the lakes out of sight or"the algae might be beginning to decompose, but toxin levels might be high," Dawson said. ivstill advise the public to be very cautious and heed those signs," he added. The latest tests of Anderson, Gibbs and Leland lakes were the week of Aug. 12. The next tests will be the week of Sept. 16. "I'm afraid we don't have any more recent test data yet," Dawson said Friday. "Normally this time of year, our algae blooms tend to start to dissipate," he said. "Sometimes, the lakes have been looking a little better. "But looks can be deceiving, so Gibbs Lake and Anderson Lake remain closed until we get another toxin sample back that is low in toxins," Dawson added. Anderson Lake has been closed since May 17, only three weeks into the fishing season, because of high levels of anatoxin-a, a potent nerve toxin that can kill within four minutes of ingestion. In the August test, the sample from Anderson Lake, which is in Anderson Lake State Park near Chimacum, was found to contain a level of anatoxin-a that was below the recreational guideline. But the policy is to have two tests showing safe levels before reopening a lake to the public. That's because levels can fluctuate, Dawson said. "We did see some declines in toxins at Anderson Lake, but we often get a resurgence at the end of the summer, so we may still see toxin levels climbing again," he said. e 410-acre state park around the 60-acre lake remains open for hiking, biking and horseback riding. A Discover Pass is eded to park there. Gibbs Lake south of Port Townsend has been closed since July 18 because of high levels of microcystin. • Microcystin can cause skin irritation, nausea and muscle weakness if touched and liver damage if swallowed over a long period of time. Lake Leland remains posted with a caution sign, though the level of toxins is barely detectable, because it contains algae known to sometimes produce toxins and has a light bloom. • Both anatoxin-a and microcystin are created by some strains of blue-green algae, also known as cyanobacteria, which are usually benign but which can suddenly begin to poison the freshwater lakes they grow in. Scientists don't know why. They also don't know why Anderson Lake has had historically high levels of anatoxin-a. In June 2008, the lake set a world record with 172,640 micrograms of anatoxin-a per liter. The safety threshold for the toxin is 1 microgram per liter. Researchers at the University of Oregon and the Centers for Disease Control and Prevention in Atlanta are studying the algae in Anderson Lake to see if it is unique in the state—and if that will provide clues as to how to control it. Although the final report isn't expected until fall at the latest, researchers have identified the strain of anabaena—a type of cyanobacteria—that seems to be producing anatoxin-a in Anderson Lake, Dawson said. "They isolated the particular strain, but they don't know if it differs from other strains yet," Dawson said. In addition to testing for toxin levels, Jefferson County also tests monthly for nutrients that feed the blue-green algae. Anderson Lake usually has a high amount of phosphorus, one of the nutrients that fuel algae growth, but the latest nutrient analysis of a water sample found that phosphorus was low in Anderson Lake, Dawson said. "But what tends to happen, we think, is that phosphorus is used by the algae," and after the algae dies off each year, the mineral is released back into the water to be used by the next crop. "That's the problem with phosphorus: It doesn't really get out of the lake," Dawson said. p Cow manure from a dairy farm that was operated near Anderson Lake for more than 50 years could be the source of high • phosphorus levels, Dawson and Greg Thomason, Jefferson County environmental health specialist, said in a report released in February. Testing for toxins was weekly until this year, when the state Department of Ecology cut back to a monthly frequency. County public health department officials had hoped to find a way to finance more frequent tests but have not been successful, Dawson said Friday. Toxin-producing blue-green algae has not been spotted in Clallam County. Report algae blooms in Clallam County by phoning 360-417-2258, while Jefferson County blooms can be reported at 360- 385-9444. For more information about Jefferson County lakes, visit http://tinyurl.com/jeffersonlakequality or phone the office. Managing Editor/News Leah Leach can oe reached at 360-417-3531 or at leap leach@peninsuladaiynews.com. • What I did on my summer vacation: Learn about water quality By Maribeth Crandell, Port Townsend Leader,Posted:Wednesday,September 4,2013 5:00 am "'his summer I joined the Jefferson County Water Quality team to help collect water samples. It's very scientific. I wear a vest with pockets full of gadgets and take notes in a field notebook. I carry a small cooler with freeze packs, sample bottles and a telescopic pole which allows me to reach far into a blackberry thicket to get water samples from a tiny trickle off a beach bluff, or extend my reach into deeper salt water. We walk beaches looking for streams and seeps and outfall pipes, collecting water samples from any trickle we can find. We collect samples from popular shellfish and swimming beaches and from sites along fishing streams. We go out in boats to collect water and algae from the middle of lakes, taking samples from multiple depths in the water column. All these samples are iced and rushed to a lab. Test results are usually emailed back overnight. As part of our shellfish program, I was assigned to regularly visit a certain rock on a certain beach at low tide to arm wrestle with certain large mussels. I wear my quick-dry shorts and rubber boots (no socks) because the rock is pretty far out there and the tide is not always quite as low as I would like, but I never fail to get my mussels. I ice these mussels, like the water samples, and send them to the lab. This kind of sampling is happening all over the state. The state Department of Health monitors the test results. They send email alerts telling each county which beaches need caution or closure signs for pollution, harmful bacteria or biotoxins. When we get these alerts, I drive from one end of the county to another, posting signs at boat ramps, parks or clamming beaches. I've learned a lot this summer. Marinas are closed to shellfish collection because of pollution. Boaters, please properly dispose of your sewage or hazardous wastes. Visit pumpoutwashington.orq to find a pump-out station near you. wToxic algae blooms in lakes can cause an itchy rash, or if enough is ingested, can kill you, or your dogs or ivestock. I learned about Vibrio parahaemolyticus, a bacteria that causes vomiting, diarrhea and cramps, and is usually caused by eating raw oysters or clams collected from warm waters. This summer there have been Vibrio outbreaks all over Puget Sound. It's easy to avoid Vibrio. When collecting shellfish, ice them immediately and then cook them thoroughly. If you boil them, wait for the shells to open and then cook 5 minutes longer. If steaming, let them steam another 8 or 9 minutes after shells open. I knew Paralytic Shellfish Poisoning (PSP) could kill you, but I found out that ordinary cooking won't help. Some shellfish hang on to this toxin for weeks, or in the case of butter clams, years. These are microscopic algae. You can't tell by looking at it if a shellfish beach is affected. A reaction to PSP could appear within 30 minutes of ingestion. Symptoms include nausea; vomiting; diarrhea; cramps; burning lips, mouth, tongue, toes; shortness of breath and a choking feeling. In other words, this is serious stuff. I had not heard of Diarrhetic Shellfish Poisoning, which can cause ... well, you can imagine. Or Amnesic Shellfish Poisoning, which may cause permanent short-term memory loss, brain damage or even death. So it's smart to read and heed the signs before you swim, fish or collect shellfish. They're the same color as a stoplight. Green means"go"—go right ahead and enjoy. Yellow means"take precautions," like thoroughly cook your shellfish. And red means, "stop" or you could be in serious danger. Or call the Safe Shellfish Hotline, 1-800- 562-5632 before you go. And then thank the state and county public health departments that are working to ensure that you have a safer summer. • 9 School Based Health Centers • OPEN FOR •Illness and injury•Sports Physicals•Immunizations •Mental Health Services•And more No student will be denied services due to inability to pay. Easy access to Confidential and Affordable healthcare for high school students q .:- s f The44 2se services are available at, your-dooetbrs ofiee.orat the' `''._ `f " , School Based Health Centers. w, 1 Locations.in Chimacum and stan0nitn unePnctltignr,,Iktanterbury, Port Townsend high''schools• letlersan Mental HealM SerHanTherapht,Sawh • Wtsg,oA,Hurst Practitioner Don't Forget Your immunizations! School Based Health Centers,brought to you by: Jefferson County Public Health•Jefferson.Healthcare•Local School Districts Call efferson County Public Health for appointments:360-385-9400 e PUBLIC HEALTH Jefferson ALWAYS WORKING SARA SAFER AND --------- •,..-,'''' --=-•a'"'' HEALTHIER COMMUNITY Healthcare • • ii ,21Za.e.27_,eic.2 �/;5/e/3 Want two reusable produce bags? Join theTake the pledge and get a FREE • One Less Bag "wane mss'kill Challenge. I Reduce reuse recycle end sore resourus. Sign up on-line at http:// www.jeffersoncountypublichealth.org/ index.php?one-less-bag-challenge • Or contact Pinky Feria Mingo at 360 379-4489 IP• Chimacum tackles underage substance use Port Townsend Leader, September 11th,2013 the Chimacum community has been chosen to participate in a program to reduce underage drinking and rug use. The Prevention Redesign Initiative (PRI) hopes to reduce underage substance use and its negative consequences by leveraging community resources and commitment. "It's not just teen parties, car crashes or possible addiction that concerns us. Neurological research shows underage drinking and drug use can have a negative impact on youth brain development," said Kelly Matlock, the PRI community coordinator with Jefferson County Public Health. PRI is a collaboration between the Chimacum School District, Olympic Educational Service District 114, Jefferson County Public Health and a newly developing community coalition. Once up and running, the coalition is to assess unique community strengths and needs, canvass existing resources and develop a strategic prevention plan. The program is funded by the Department of Social and Health Services' Division of Behavioral Health and Recovery. The first community meeting is 4-5:30 p.m., Monday, Sept. 16, at the Jefferson County Library in Port Hadlock. To learn more about the PRI program, contact Kelly Matlock at 379-4476 or kmatlock@co.jefferson.wa.us. To learn more about the Chimacum High School peer-education group HEAL (Health Education & Awareness Leaders), stop by the school clinic, text Ryann McChesney at 360-390-8560 or email rmchesney@co.jefferson.wa.us. • • Raccoons pounce on PT couple By Patrick J.Sullivan of the Port Townsend Leader I Posted:Wednesday,September 11,2013 5:00 am La t winter, Lizanne Coker made a quilt depicting a deer, a chipmunk, a bunny and a raccoon —the animals ees in her uptown Port Townsend neighborhood. Scratch raccoons off her warm and fuzzy list. Coker was bitten by raccoons on Aug. 31 outside the family tent in a Whatcom County campground east of Bellingham. At least five male raccoons made what Liz and her husband, Kevin, describe as a totally unprovoked, surprise attack. This could be only the third or fourth reported raccoon vs. human attack, with tooth to skin contact, in Washington state in the past few years. "It's shocking. It's pretty severe," said Lizanne Coker, 48, who suffered five puncture wounds in her right calf, up to an inch deep. "Everyone wants to think we must have done something wrong" to provoke an attack, she said. "We did not corner them. There were no [raccoon] babies. Our camp was crazy clean; we had no food available. We weren't drinking. It was so unprovoked. It was so scary." SILVER LAKE It was not their first family trip to Silver Lake Park, located 40 minutes east of Bellingham on the Mount Baker Highway. Whatcom County Parks and Recreation bills Silver Lake as "the best Whatcom County has to offer." The 100-site county park has three campground loops, group camps, a day lodge and cabin rentals, a horse camp, walking trails, fishing and boating �e Cokers checked into Campsite 1A about 2 p.m. Friday, Aug. 30. Their site was about 100 feet from the lake and a few hundred yards from a residential area of cabins and cottages. Mr. and Mrs. Coker, her brother John Crines, and their dog were in one big tent. The Coker's two high-school- age sons and a younger cousin were in an adjacent tent. Friends were staying in the campsite about 50 feet to one side. Although the Cokers saw no raccoons before or after dark, after the incident they learned that a man in an adjacent campsite had seen raccoons nearby about midnight. CAR CAMPING About 1 a.m. Aug. 31, Kevin Coker, 51, prepared for a trip to the campground restroom. He had his 50-pound, collie-type "rescue" dog, Lily, on a choke-chain leash held to his left side. He stepped outside the large tent and the light of his headlamp caught three or four sets of eyes at his eye level in nearby trees, Kevin said. There were another three or four sets of eyes on a fence a bit further away. Lastly, he caught sight of three or four raccoons on the ground to his front. They were adults. No baby raccoons were visible, he said. "Immediately I thought, 'they will disappear,"' Kevin recalled. litre enough, two coons on the ground went up in the trees, but just as quickly two others came out of the trees, and toward him. Growling. "Just like that, they attacked," he said. "It was that fast. The dog didn't even have time to bark." Kevin was barefoot, shirtless and was wearing canvas pants. Two raccoons began lunging at his dog, which Coker still held close. Two more came at his legs, from different directions. • "The dog was pulling at me but I did not let her go, although in hindsight maybe I should have," he said. "A raccoon came at me and I kicked it as hard as I would kick a football, and it bounced off a tree and was out." One raccoon was on the dog's back and another was going for her throat. About that time, Lizanne entered the fray. Asleep in the family tent, she was awakened by the noise. "I jumped up and I stepped outside three steps and I saw a raccoon. And then another and another," she said. "I side-swiped [kicked] one off Lily's back. Then I was slammed from the side." That"slam" turned out to be a double puncture high on her left calf. Raccoons were also lunging to bite at Kevin's legs, but his shin kicking kept them at bay. "We were yelling [at the raccoons] but our campground was so clean we didn't even have a stick to throw at them," Liz noted. "We were trapped, literally, up against our tent. "Then they slammed me again, and punctured my leg a second time," said Liz, who was wearing basic leggings for bedtime. "They were coming at us from all sides." The raccoons only left when two other adults emerged, yelling: her brother from behind them inside their tent, and a friend from the adjacent campsite. The Cokers' sons had wanted to exit their tent to help, but were told to stay inside lest they too be attacked. The length of the attack is uncertain, perhaps a minute or two. • RABIES VACCINE "When it was all done and [the raccoons] moved back from us, we saw that Lily had been hurt, and then noticed a wet spot on my left calf," Liz noted. They examined the wounds, and then loaded up for the drive to a hospital emergency room in Bellingham. "The [hospital] ER crew was horrified and said of all their years, they had never had such an incident with raccoons," Liz noted. A doctor administered her with antibiotics, tetanus and started what is a nearly two-week series of rabies vaccine. Coker noted that no cases of raccoon-to-human rabies have been reported in Washington state for many years, but Center for Disease Control guidelines are clear: Anyone bitten by an aggressive animal should get a rabies shot. "You can't treat rabies once it presents," Liz noted. "You die from it." About five hours later, they were back at the campsite — but with one extra piece of equipment. "I stopped at a hardware store and bought a hickory ax handle," Kevin said. "It's going to be part of our camping gear now." The family stayed Saturday night and returned to Port Townsend that Sunday afternoon —without seeing any other raccoons at Silver Lake Park. Their dog was bitten once on a rear leg; she had already been fully vaccinated and passed a checkup last • week with a veterinarian in Port Townsend. • COUNTY PARKS Michael McFarlane, director of Whatcom County Parks and Recreation, said there has been no history of raccoon attacks at Silver Lake, before or after this Labor Day weekend incident. •arlane said his staff is uncertain exactly how the incident took place, and what if anything the Coker's dog had to do with stirring up the raccoons. "I don't think anyone's contesting that they got in a tangle with several raccoons," McFarlane said Sept. 9. "Our staff up there is monitoring the situation, they just have not seen anything prior or after." McFarlane said there are raccoons at the park but "not excessive numbers in the campground." In fact, the park has more warning signs about not feeding the Canadian geese, which are considered a nuisance, than signs about not feeding the "bandits"— how signage refers to park raccoons. After the incident was reported, the next day park staff warned campers in the area, and one party that was setting up in that same area was steered to another spot, McFarlane noted. The Port Townsend couple involved believes the county needs to take the raccoon threat more seriously, including warning signs that specify humans were the subject of an unprovoked attack. "I am a complete outdoor woman. I love animals. I love 'em. But in this case, there is no doubt in my mind these animals need to be trapped and put down," Liz Coker said. "The next day I counted no less than 40 children in that campground loop. I can't imagine how a child would have survived that pack attack." Park staff continue to monitor the situation, McFarlane said, and be alert for other raccoon reports. Cokers were not satisfied with Whatcom County's initial response from the parks department level, and sued the issue with the county commissioner and county administrative offices. This week, Kevin filed a four-page report on the incident with the Whatcom County administrator. They were told the process has begun to potentially call for bids for someone to trap raccoons at Silver Lake Park. WHO IS RESPONSIBLE? Here's what the state Department of Fish and Wildlife advises about raccoons. "As long as raccoons are kept out of human homes, not cornered, and not treated as pets, they are not dangerous," according to the Washington Department of Fish and Wildlife (WDFW) "Living with Wildlife" advice. "If a raccoon approaches too closely, make yourself appear larger; stand up if sitting, shout, and wave your arms. If necessary, throw stones or send the raccoon off with a dousing of water from a hose or bucket," goes the WDFW advice. Liz Coker, who said she has now "learned more about raccoons than I ever thought I would know," notes that none of that common WDFW advice worked in their situation. She called the WDFW, and was referred to Whatcom County Parks and Recreation as the incident happened in a county park. She called the area's humane society, who said they don't deal with wild animals and suggested calling the county's public health department. called Whatcom public health, and realized that she had become a statistic. Not a statistic regarding ccoons, but a statistic for needing a rabies vaccination. • She learned that the hospital notified Bellingham Public Health, which on Sept. 3 contacted Jefferson County Public Health. Coker said she talked with staff at the Northwest Wildlife Rehabilitation center not far from Silver Lake, and was told there have been no other raccoon attacks reported, and the pack behavior was not normal. • According to wildlife sources, males don't typically travel with females this time of year. The Cokers are adamant that no babies or young raccoons were present. Male raccoons may travel in packs, usually related to food sources. "At the end of the day, I just want people to be safe," she said of camping at Silver Lake. "This is not remote camping. This is car camping. People need to make an informed decision about your camping to be safe." She did get at least one chuckle from all this. While in the waiting room Sept. 6 at her Port Townsend physician's office, she noticed a People magazine with a full-page CoverGirl ad featuring TV talk show host Ellen DeGeneres. Ellen was pictured with a raccoon in her lap. "After my experience with raccoons, that just made me laugh." 411 • Taking A New Tack To Persuade 'Young Invincibles' To Buy Health Insurance - Kaiser ... Page 1 of 3 o� 1 iir,Imilt4 KAISER HEALTH NEWS Health Care In The States 171. Taking A New Tack To Persuade 'Young Invincibles' To Buy Health Insurance TOPICS.HEALTH REFORM,STATES,INSURANCE By ELIZABETH STAWICKI,MINNESOTA PUBLIC RADIO NEWS AUG 19,2013 MINNEAPOLIS, Minn. —Robert Bauer is young, lean and healthy-just the kind of person the government wants to buy into its new online health insurance marketplaces. Bauer doesn't see the need. The 24 year old, a 2011 graduate of the University of Minnesota, works in organic farm fields three days a week, and prides himself on eating well. He's uninsured - health covereage just hasn't been part of his lifestyle. .. _ "I just don't think it's worth the money for me to get .' health insurance at this point," he said. • He hopes that if he got seriously ill or had an accident � P I his family would have the resources to help or"maybe I'd just lose my life,and that would be OK,just so other e`,3, � people wouldn't have to live the rest of their lives in poverty or bankruptcy." t •, ��"� '` While Bauer generally doesn't fear a health crisis, the people building insurance exchanges worry about Bauer and the millions of other healthy Americans whom they R<,ncr,3a,,�r.24 showso tb"souu garden 21'tends,,front I>fr"s fear maysimply opt out. The marketplaces are a keypart house If'Mnneapolts(Plato by Elizabeth Stawicki/MPR) p y p p of federal Affordable Care Act, also known as Obamacare. Younger, low-risk people are needed to offset the costs of covering older, sicker Americans. "It's important for everybody to participate all of the time and to pay an average amount in premiums so that when something happens to one of us--we have a baby, we get cancer... that will require thousands of dollars of care, the money is there in the pool," said Karen Pollitz of the nonpartisan Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.) The law requires Americans obtain health insurance or pay a penalty beginning in 2014. But some young people might just pay the penalty, which in the first year isn't much, the greater of$95 or 1 percent of income. The fee rises to$695 or 2.5 percent in 2016. While the ACA allows children to stay on their parents' policy until age 26, that doesn't help young people such as Bauer, because his mother is uninsured and his father is on disability. And, Pollitz notes, younger people are "systematically uninsured." "We boot them off," Pollitz said. "We kick them out of Medicaid, (or)their parents' health insurance coverage just when they're starting off,just when they're not earning much and the odds are pretty low that they're going to get that first great new job with new benefits." http://www.kaiserhealthnews.org/Stories/2013/August/19/young-invincibles-health-insura... 8/20/2013 Taking A New Tack To Persuade 'Young Invincibles' To Buy Health Insurance - Kaiser ... Page 2 of 3 Young people aren't against being insured. A recent KFF poll found that about three quarters of 18-30 year olds believe having insurance is something they need and is important to have. The top reason younger people didn't have it: too expensive. But the law does provide subsidies for people earning • up to 400 percent of the federal poverty line, $46,000 for a single person or$94,000 for a family of four. And, officials and advocacy groups are searching for ways to lure younger people in. "What really appeals to that younger age group is both affordability--they feel they just can't afford it --and also communicating the value of insurance and how valuable it is to have that insurance and why you need," according to April Todd-Malmlov, the executive director of MNsure, Minnesota's online insurance marketplace. Minnesota is one of the 16 states that's building its own exchange. Todd-Malmlov said Minnesota will target young adults in two ways-- in the social media they use, such as Twitter and Facebook, and the messages themselves. Massachusetts found that out the value of targeted messages. The Bay State's 2007 law requires residents to obtain health care coverage or pay a fine,just like the federal law. Looking to reach a wider audience, the state partnered with the Boston Red Sox and its New England Sports Network to encourage residents who lacked insurance to sign up through its online insurance marketplace, the Connector, Massachusetts'version of MNsure, which will launch Oct 1. Fans at Fenway Park were a captive audience for ads touting the Connector on the Jumbotron or articles tucked inside game day programs. The public relations pitch stumbled at first as the public reacted poorly to TV ads featuring baseball players. Uninsured people"didn't want anyone who had insurance and was making a good salary to sort of lecture them. It came off as 'you better do this,' said Tara Murphy of the public relations firm Weber Shandwick, which devised the Massachusetts campaign. The campaign switched gears. The Red Sox still provided the platform but the messages came instead from young people who'd suffered serious illnesses or crashes and others who were able to • find affordable coverage on the state's new marketplace. TV ads featured a young woman sitting in a green stadium seat at Fenway talking about her life following a breast cancer diagnosis. Minnesota officials have been talking with its pro teams, including the Twins, Timberwolves, Vikings and the Lynx to encourage residents to sign up for coverage, borrowing a page from the Massachusetts playbook. And,just yesterday, MNsure announced that Paul Bunyan and Babe the Blue Ox will be the faces of the exchange. The state is contracting with BBDO Proximity Minneapolis for the website's roughly $9 million marketing campaign. At the campaign's launch Sunday, BBDO creative director Brian Kroening said he wanted the advertising to be easy to understand, local, and upbeat. "Because this is in fact great news for those that are uninsured. We liked Paul and Babe because everybody seems to recognize them. They were easy to work with. We were looking for what was unique to Minnesota," Kroening said. Billboards with Bunyan and Babe's images are going up, along with MNsure advertising on buses and in skyways and newspapers. The campaign's motto will be "The Land of 10,000 Reasons to get Health Insurance." Meanwhile, Robert Bauer may get health coverage after all. Starting next week, he'll be attending graduate school at Virginia Tech to study plant and soil science where, he says, insurance will cost him $200 a year in out of pocket costs. That's only about$100 more than the penalty he would have to pay if he chose not to get insurance. MPR reporter Rupa Shenoy contributed to this story, which is part of a collaboration that includes Kaiser Health News, NPR, and MPR News. _ _ http://www.kaiserhealthnews.org/Stories/2013/August/19/young-invincibles-health-insura... 8/20/2013