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HomeMy WebLinkAbout2014- April • JEFFERSON COUNTY BOARD OF HEALTH April 17, 2014 Jefferson County Public Health 615 Sheridan St. Port Townsend, WA 2:30 —4:30 PM DRAFT AGENDA I. Approval of Agenda II. Approval of Minutes of March 20, 2014 Board of Health Meeting III. Public Comment IV. Old Business and Informational Items 1. Washington State Methamphetamine Clandestine Lab Clean-up Standards 2. Governor's 2013 Smart Communities Award to Environmental Health and • Department of Community Development 2. Regional Nurse-Family Partnership Follow-up V. New Business 1. 2013 Environmental Health Performance Measures 2. Measles Outbreak Activity in Washington State and British Columbia 3. Cascade Pacific Action Alliance Proposal 4. Jefferson Healthcare-Jefferson County Public Health Community Health Improvement Partnership Update VI. Activity Update VII. Public Comment VIII. Agenda Planning Calendar IX. Next Scheduled Meeting: May 15, 2014 2:30—4:30 PM Jefferson County Public Health • 615 Sheridan St. Port Townsend, WA DRAFT JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, March 20, 2014 Jefferson County Public Health, 615 Sheridan Street, Port Townsend WA 98368 Board Members Staff Members Phil Johnson, County Commissioner District#1 Thomas Locke,MD,MPH Health Officer David Sullivan, Chair, County Commissioner,District#2 Jean Baldwin,Public Health Services Dir John Austin, County Commissioner,District#3 Julia Danskin,Nursing Services Dir Roberta Frissell, citizen at large(County) Jared Keefer,Env. Health Services Dir Kris Nelson,Port Townsend City Council Veronica Shaw,Public Health Deputy Dir Sheila Westerman, Vice Chair, Citizen at large(City) Jill Buhler,Hospital Commissioner,District#2 Chair Sullivan called the March 20, 2014 meeting of the Jefferson County Board of Health to order at 2:30 PM. A quorum was present. Members Present: David Sullivan, Phil Johnson, John Austin, Sheila Westerman Staff Present: Thomas Locke, Jean Baldwin, Julia Danskin, Veronica Shaw • Members Excused: Jill Buhler, Roberta Frissell, Kris Nelson APPROVAL OF AGENDA Chair Sullivan called for review and approval of agenda for 3/20/2014 meeting. Chair Sullivan suggested moving Presentation of Public Health Hero Awards to first item on the agenda. Chair Sullivan suggested moving New Business item, "Nurse Family Partnership Advisory Committee Recruitment" from item 4 to 1. Member Austin suggested adding The Featherstone Award to information items. Member Westerman moved to approve the agenda as amended; the motion was seconded by member Johnson. No further discussion. The motion passed unanimously. NEW BUSINESS Presentation of Public Health Hero Awards for 2014 • National Public Health week is April 7-13, 2014. Jefferson County identifies community-wide • "Public Health Heroes"to honor during this week. This year,with implementation of the Affordable Care Act(ACA) a high priority, staff recommended that the 2014 honorees should include the local volunteers and Jefferson County Public Health and Jefferson Healthcare employees who have diverted their normal work-flow in order to be available to the public to help them enroll in ACA options, as "In Person Assisters." Jefferson County, with this help,was able to enroll a notably significant number of people, and will continue to enroll community members as long as possible. APPROVAL OF MINUTES' Chair Sullivan called for review and approval of the minutes of the 2/20/2014 meeting of the Board of Health. Member Johnson moved to approve the minutes as presented; the motion was seconded by member Westerman. No further discussion. The motion passed unanimously. PUBLIC COMMENT Dionne Duchene: Concerned about a home on the rental market which she almost rented,which was an alleged former meth lab. Barry Ellis: Rented a home which was an alleged former ental Mr .Ellis eth lab. He documents to the he 4111 experienced ill health effects during his time in Board and recommended that this property be posted as unfit for habitation. Marla Althouse: Expressed concerns regarding the Port Townsend Paper Corporation landfill permit which is in mediation. OLD BUSINESS AND INFORMATIONAL ITEMS Jefferson County Board of Health Membership Recruitment The terms of two appointed positions on the BOH have ke and expired. ira membee r of positions he BOH.have been posted in the Leader. Interviews will be held with Dr. Expanded Veterans Administration Clinic Opens in Port Angeles for Olympic Peninsula Veterans Dr. Locke reviewed the clinic operations, which will serve the entire Olympic Peninsula. There are a great number of retired veterans on the Olympic Peninsula, often without medical coverage, and this will be a much needed service. • Additional Agenda Item: Featherstone Award The Washington State Board of Health is responsible for forwarding nominations for the Featherstone Award. Nomination period is currently open for the Featherstone Award, noting the significant contributions to public health. Featherstone Reid was Dr. Locke's mentor on the State Board of Health. Next month, staff will bring a nomination for the Jefferson County Board of Health's endorsement. NEW BUSINESS Nurse Family Partnership (NFP)Advisory Committee Recruitment Yuko Umeda presented information about the regional NFP partnership for with the Port Gamble S'Klallam Tribe and Kitsap County Public Health. A new advisory board is being formed for the regional NFP program, with representatives from Jefferson County,Kitsap, and Port Gamble. She is recruiting members for this advisory board and asks board members to consider joining the advisory board and to forward information on to others who may be interested in joining the board. As these are regional meetings, the meeting places will likely move locations from meeting to meeting. Chair Sullivan notes that this program is critical and important in Jefferson County. 2013 Performance Measures: Family and Maternal-Child Health, Communicable Disease, Family Planning, and Community Prevention Programs • 2013 Performance Measure Reports were included in the Board's packet. Staff reviewed highlights from the reports. Family and Maternal-Child Health: Family and Maternal-Child Health programs consist of maternity support services, infant case management, Women Infant and Children (WIC), Child Protective Services (CPS) family work, Nurse Family Partnership, and children with special health needs. The number of clients served was lower in 2013. The birth rate is decreased in Jefferson County. The data collection system has been changing, and data reporting will change. Ms. Umeda encourages the Board to lend its support to state and federal Maternal Infant Home Visiting funding. Communicable Disease and Immunization Program: Communicable Disease program key notes: 1.) Staff have been following cryptosporidiosis case numbers that had averaged 7-8 per year per year. Last year, only 2 cases were reported. 2.) There were 78 Chlamydia cases in 2013, up from 50 cases in 2012. The program promotes screening and testing of partners. Immunization program key notes: 1.) Over the last 3 years, the numbers have stabilized in the proportion of childhood immunization given out here, and in the clinics. Having the walk-in clinic available for immunization is a plus. 2.) With the Washington immunization registration, • there have been system updates and trainings for staff. 3.)A new item (goal 7,page 3 of the performance measures), is a report, available by county,to look at the completeness of • immunizations for different age groups within any county. 4.) Several free vaccine programs for adults. Sixty-three free immunization doseswere given in 013 Targeted Clinic Services: Family planning numbers decreased slightly antheprogram increased volume.y in 2013.TheBreast and Cervical Implementation of the new electronic health record(eMD) impactedp grm e t, as se clients now be seen Health program will be absorbed by the AffordableF deral,cwith a small amount from State Foot by general practitioners. Funding for BCHP is mo care clinic numbers are decreasing. Outreachorts will be increaseSchool Based Clinc HumThere bers waxe upstaff change, which affects the numbers reflected in thereport. Prevention: The Drug and Alcohol prevention contract has seen many changes. A year ago,the Port Townsend School District chose not to offer matchingcreaed from $6 sfuns to 5000 to $12,000 forh a coalition for a f the ll- time intervention specialist when the match amount year. Port Townsend School District withdrew, and since cum School information nf ormathowever,seee now available able regarding prevention activities in the district. C partner and information regarding prevention activities can be monitored. There's no information about where Port Townsend school children are receiving prevention services. School health screening and human growth development are two in-schoolarogr kelt'lose ams. The School-nurse corps, funded by the State, is another in-school program, nd funding. • ;.., prevention funding is no more. When complaints are made, JCPH enforces the clean air Tobacco p act. Dental care and prevention is a great need in Jefferson County. However,there are no dentists in Jefferson County who serve clients with and has a waitsurance. A list of 400. Thislcontinues to be a problem clinic which accepts Medicaid has opened in Port Angeles, for which a solution must be found. 2014 Legislative Session Wrap-up 2544-Newborn screening Member Austin noted the successful forward legislative movement of the newborn screening bill which requires that newborns be screened for a number of healthproblems, even when not born in a hospital. 6065-Tanning devices/UV radiation Member Austin noted the forward legislative movement regarding the bill requiring minors to obtain a prescription to obtain tanning services. • • Dr. Locke reported on two bills that made it through the legislature: the bill that created/promoted integration between medical, chemical dependency, and mental health services, and a bill regarding the healthcare innovation plan. Jefferson Healthcare—Jefferson County Public Health Community Health Needs Assessment Project Update A report regarding demographic work undertaken by the Jefferson Healthcare/Jefferson County Public Health workgroup has been included in the Board's packet. The next meeting of this group will address mental health, health care access, and mortality data. The workgroup will be ending, and will conclude with action items for policy makers and community leaders. ACTIVITY UPDATE Clean water district fees will be addressed during a public hearing at the Jefferson County BOCC regular meeting. No items for update. PUBLIC COMMENT • Barry Ellis: Notes that Pierce County has an aggressive policy regarding meth house issues. Gretchen Brewer: Expressed concerns about the Affordable Care Act (ACA). She has read there is a provision within Medicaid law that stipulates monies can be recovered by the Federal Government via claims on individual estates. Also, she noted concern about the PTPC and mediation regarding inert and limited purpose designation. Julia Danskin responded to the comment regarding ACA estate recovery, which applies to 55 to 64 year- olds. The State agreed to change the legislation, and Julia can provide further details. Estate recovery will only apply to long-term care. AGENDA PLANNING CALENDAR The WSAC November 20th, 2014 meeting is in conflict with the November 20th, 2014 Board of Health meeting. Member Johnson moved to cancel the November 20th,2014 meeting of the Jefferson County Board of Health. Member Austin seconded the motion. No further discussion. The motion passed unanimously. • NEXT SCHEDULED MEETING Next Board of Health meeting will be held on Thursday, April 17th, 2014 from 2:30—4:30 p.m. at Jefferson County Public Health, 615 Sheridan Street, Port Townsend WA. ADJOURNMENT Chair Sullivan adjourned the March 20, 2014 Jefferson County Board of Health meeting at 4:00 PM. JEFFERSON COUNTY BOARD OF HEALTH Phil Johnson, Member Jill Buhler, Member Roberta Frissell, Member David Sullivan, Chair Kris Nelson, Member John Austin, Member • Sheila Westerman, Vice Chair Respectfully Submitted: Cara Leckenby • • JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, March 20, 2014 Jefferson County Public Health, 615 Sheridan Street, Port Townsend WA 98368 Board Members Staff Members Phil Johnson, County Commissioner District#1 Thomas Locke,MD,MPH Health Officer David Sullivan, Chair, County Commissioner,District#2 Jean Baldwin,Public Health Services Dir John Austin, County Commissioner,District#3 Julia Danskin,Nursing Services Dir Roberta Frissell, citizen at large(County) Jared Keefer,Env. Health Services Dir Kris Nelson,Port Townsend City Council Veronica Shaw,Public Health Deputy Dir Sheila Westerman, Vice Chair, Citizen at large(City) Jill Buhler,Hospital Commissioner,District#2 Chair Sullivan called the March 20, 2014 meeting of the Jefferson County Board of Health to order at 2:30 PM. A quorum was present. Members Present: David Sullivan, Phil Johnson, John Austin, Sheila Westerman Staff Present: Thomas Locke, Jean Baldwin, Julia Danskin, Veronica Shaw Members Excused: Jill Buhler, Roberta Frissell, Kris Nelson • APPROVAL OF AGENDA Chair Sullivan called for review and approval of agenda for 3/20/2014 meeting. Chair Sullivan suggested moving Presentation of Public Health Hero Awards to first item on the agenda. Chair Sullivan suggested moving New Business item, "Nurse Family Partnership Advisory Committee Recruitment" from item 4 to 1. Member Austin suggested adding The Featherstone Award to information items. Member Westerman moved to approve the agenda as amended; the motion was seconded by member Johnson. No further discussion. The motion passed unanimously. NEW BUSINESS Presentation of Public Health Hero Awards for 2014 National Public Health week is April 7-13, 2014. Jefferson County identifies community-wide "Public Health Heroes"to honor during this week. This year, with implementation of the Affordable Care Act (ACA) a high priority, staff recommended that the 2014 honorees should • include the local volunteers and Jefferson County Public Health and Jefferson Healthcare employees who have diverted their normal work-flow in order to be available to the public to help them enroll in ACA options, as "In Person Assisters." Jefferson County, with this help, was able to enroll a notably significant number of people, and will continue to enroll community members as long as possible. APPROVAL OF MINUTES Chair Sullivan called for review and approval of the minutes of the 2/20/2014 meeting of the Board of Health. Member Johnson moved to approve the minutes as presented; the motion was seconded by member Westerman. No further discussion. The motion passed unanimously. PUBLIC COMMENT Dionne Duchene: Concerned about a home on the rental market which she almost rented, which was an alleged former meth lab. Barry Ellis: Rented a home which was an alleged former meth lab. He reported that he experienced ill health effects during his time in that rental. Mr. Ellis submitted documents to the Board and recommended that this property be posted as unfit for habitation. Marla Althouse: Expressed concerns regarding the Port Townsend Paper Corporation landfill permit which is in mediation. OLD BUSINESS AND INFORMATIONAL ITEMS Jefferson County Board of Health Membership Recruitment The terms of two appointed positions on the BOH have expired. The positions have been posted in the Leader. Interviews will be held with Dr. Locke and a member of the BOH. Expanded Veterans Administration Clinic Opens in Port Angeles for Olympic Peninsula Veterans Dr. Locke reviewed the clinic operations, which will serve the entire Olympic Peninsula. There are a great number of retired veterans on the Olympic Peninsula, often without medical coverage, and this will be a much needed service. Additional Agenda Item: Featherstone Award The Washington State Board of Health is responsible for forwarding nominations for the • Featherstone Award. Nomination period is currently open for the Featherstone Award, noting the • significant contributions to public health. Featherstone Reid was Dr. Locke's mentor on the State Board of Health. Next month, staff will bring a nomination for the Jefferson County Board of Health's endorsement. NEW BUSINESS Nurse Family Partnership (NFP) Advisory Committee Recruitment Yuko Umeda presented information about the regional NFP partnership for with the Port Gamble S'Klallam Tribe and Kitsap County Public Health. A new advisory board is being formed for the regional NFP program, with representatives from Jefferson County, Kitsap, and Port Gamble. She is recruiting members for this advisory board and asks board members to consider joining the advisory board and to forward information on to others who may be interested in joining the board. As these are regional meetings,the meeting places will likely move locations from meeting to meeting. Chair Sullivan notes that this program is critical and important in Jefferson County. 2013 Performance Measures: Family and Maternal-Child Health, Communicable Disease, Family Planning, and Community Prevention Programs 2013 Performance Measure Reports were included in the Board's packet. Staff reviewed highlights from the reports. • Family and Maternal-Child Health: Family and Maternal-Child Health programs consist of maternity support services, infant case management, Women Infant and Children (WIC), Child Protective Services (CPS) family work, Nurse Family Partnership, and children with special health needs. The number of clients served was lower in 2013. The birth rate is decreased in Jefferson County. The data collection system has been changing, and data reporting will change. Ms. Umeda encourages the Board to lend its support to state and federal Maternal Infant Home Visiting funding. Communicable Disease and Immunization Program: Communicable Disease program key notes: 1.) Staff have been following cryptosporidiosis case numbers that had averaged 7-8 per year per year. Last year, only 2 cases were reported. 2.) There were 78 Chlamydia cases in 2013, up from 50 cases in 2012. The program promotes screening and testing of partners. Immunization program key notes: 1.) Over the last 3 years, the numbers have stabilized in the proportion of childhood immunization given out here, and in the clinics. Having the walk-in clinic available for immunization is a plus. 2.) With the Washington immunization registration, there have been system updates and trainings for staff. 3.) A new item (goal 7, page 3 of the performance measures), is a report, available by county, to look at the completeness of immunizations for different age groups within any county. 4.) Several free vaccine programs for . adults. Sixty-three free immunization doses were given in 2013. • Targeted Clinic Services: Family planning numbers decreased slightly and then increased slightly in 2013. Implementation of the new electronic health record (eMD) impacted program volume. The Breast and Cervical Health program will be absorbed by the Affordable Care Act, as those clients can now be seen by general practitioners. Funding for BCHP is mostly Federal, with a small amount from State. Foot care clinic numbers are decreasing. Outreach efforts will be increased. There was a staff change, which affects the numbers reflected in the report. School Based Clinic numbers are up. Prevention: The Drug and Alcohol prevention contract has seen many changes. A year ago, the Port Townsend School District chose not to offer matching funds to establish a coalition for a full- time intervention specialist when the match amount increased from $6,000 to $12,000 for the year. Port Townsend School District withdrew, and since then no information has been available regarding prevention activities in the district. Chimacum School District, however, is now a partner and information regarding prevention activities can be monitored. There's no information about where Port Townsend school children are receiving prevention services. School health screening and human growth development are two in-school programs. The School-nurse corps, funded by the State, is another in-school program, and will likely lose funding. Tobacco prevention funding is no more. When complaints are made, JCPH enforces the clean air • act. Dental care and prevention is a great need in Jefferson County. However,there are no dentists in Jefferson County who serve clients with Medicaid insurance. A dental clinic which accepts Medicaid has opened in Port Angeles, and has a wait list of 400. This continues to be a problem for which a solution must be found. 2014 Legislative Session Wrap-up 2544-Newborn screening Member Austin noted the successful forward legislative movement of the newborn screening bill which requires that newborns be screened for a number of health problems, even when not born in a hospital. 6065-Tanning devices/UV radiation Member Austin noted the forward legislative movement regarding the bill requiring minors to obtain a prescription to obtain tanning services. Dr. Locke reported on two bills that made it through the legislature: the bill that created/promoted integration between medical, chemical dependency, and mental health services, and a bill regarding the healthcare innovation plan. Jefferson Healthcare—Jefferson County Public Health Community Health Needs • Assessment Project Update A report regarding demographic work undertaken by the Jefferson Healthcare/Jefferson County Public Health workgroup has been included in the Board's packet. The next meeting of this group will address mental health, health care access, and mortality data. The workgroup will be ending, and will conclude with action items for policy makers and community leaders. ACTIVITY UPDATE Clean water district fees will be addressed during a public hearing at the Jefferson County BOCC regular meeting. No items for update. PUBLIC COMMENT Barry Ellis: Notes that Pierce County has an aggressive policy regarding meth house issues. Gretchen Brewer: Expressed concerns about the Affordable Care Act (ACA). She has read there is a provision within Medicaid law that stipulates monies can be recovered by the Federal Government via claims on individual estates. Also, she noted concern about the PTPC and mediation regarding inert and limited purpose designation. Julia Danskin responded to the comment regarding ACA estate recovery, which applies to 55 to 64 year- olds. The State agreed to change the legislation, and Julia can provide further details. Estate recovery will only apply to long-term care. AGENDA PLANNING CALENDAR The WSAC November 20th, 2014 meeting is in conflict with the November 20th, 2014 Board of Health meeting. Member Johnson moved to cancel the November 20th, 2014 meeting of the Jefferson County Board of Health. Member Austin seconded the motion. No further discussion. The motion passed unanimously. NEXT SCHEDULED MEETING Next Board of Health meeting will be held on Thursday, April 17th, 2014 from 2:30—4:30 p.m. • at Jefferson County Public Health, 615 Sheridan Street, Port Townsend WA. • NEXT SCHEDULED MEETING Next Board of Health meeting will be held on Thursday, April 17th, 2014 from 2:30—4:30 p.m. at Jefferson County Public Health, 615 Sheridan Street, Port Townsend WA. ADJOURNMENT Chair Sullivan adjourned the March 20, 2014 Jefferson County Board of Health meeting at 4:00 PM. JEFFERSON COUNTY BOARD OF HEALTH aeigV0 ,6/e 1/ Phil Johnson, Member 11 Buhler, Member Roberta Frissell, Member LXC. "S09 David Sullivan, Chair -41(et/C se' Q't,gY1,1 411 SKris Nelson, Member John Austin, Member u Sheila Westerm an Vice Chair Respectfully Submitted: Cara Leckenby • • Board of 3feaCth Old-Business and Informational Items 0 Agenda Item #IV, 1 Washington State Nlethamphetamine Clandestine Lab Clean-up Standards ApriC17, 2014 • '� ..� . '*g" 7:Y1: 1:':77r7Z77:747447717t;"; .40. TACOMA HOUSING AUTHORITY CHANGING THE STATE OF WASHINGTON'S TESTING THRESHOLD DEFINING METHAMPHETAMINE CONTAMINATION REQUIRING REMEDIATION March 18,2014 Comprehensive Health Education Foundation CHEF),Tacoma Clallam Counyi)erthe Tacoma Housing ce County Health Department(TPCHD),the Peninsula Housing Authority Authority (THA) and others have asked the Washington that tote itruDlepare eo t ofHealtheDOt onto change the level of methamphetamine contamination ers. obligations under state law. Presently,that level is 0.1 state chose this Bevel in 2002 This level doerams per 100 square s not This is one of the strictest in the nation. The denote health risk. Instead, it was chosen to denote t�hec1and local health departmentl that are Enforcing this standard has imposed costs on property owners iation unnecessary to protect health. These costs actively disc °ide uranfied e thcomple conservative with thealth standard requirements. Since 2009 the best available science to to be 1.5 micrograms per 100 square centimeters. CHEF,Tains the bAis and othe rehave asked OH ha Ds• adopt the 1.5 microgram standard. This memo explains its review of this request. DOH invites comments. This memo also explains how to offer comments. 1. SUMMARY Since 2002,the State of Washington has had a decontamination standard for methamphetamine(meth) of one-tenth of one microgram per 100 square centimeters of surface area 0.1 ug/100cm2)•' DOH acknowledged that this is not a health-based standard but instead"was ( i1 on what was believed at the time to be technologically feasible."2 Last year EPA based primarily ' WAC 246-205-541. to 2 Comments from Dave McBride, Washington a�ingtonfor tDepartment of,February to California p92.nvironmental Protection Agency, Development of a Reference D 419 3rd Ave West• Seattle,WA 98119 Phone 800.323.2433 •Fax 206.824 3072 •www.chef.org • 902 253. 0L Street,4400 Suite x 253.207.4440 •www taWashington omahousing.org Phone 253.207.4400 acknowledged that"[m]ost state remediation standards are based on analytical detection limits [of sampling equipment] and feasibility—they are not health-based standards."3 • In 2009 the California Environmental Protection Agency published two companion studies that were, and still are, the most exhaustive and comprehensive health and risk-based assessments of meth. Those studies concluded that 1.5 ug/100cm2 was an appropriately conservative contamination/remediation standard based on the most susceptible exposed population -- six-month to two-year-old children.4 California subsequently adopted the 1.5 ug/100cm2 standard and since then so have Kansas, Minnesota, and Virginia.5 An overly restrictive, non-health based standard results in unintended problems. First, it greatly increases costs to property owners for reasons unrelated to health. It greatly overstates the number of units that need remediation. It greatly increases the cost of remediation because cleaning down to an arbitrary, technology-based standard of Ol.ug/100em2 is much more expensive than cleaning down to the health standard of 1.5 ug/100 cm2. Second, the more expensive non-health based standard discourages voluntary investigation and sam lin • p g • (and resulting remediation) because the results, if below 1.5 ug/cm2 but above 0.1 ug/cm2, will mean an obligation to perform expensive and unnecessary remediation. Third, the lower standard unnecessarily uses scarce resources of local health departments charged with enforcing these standards. Fourth, the lower standard subjects units to an unnecessary declaration by the local health department that they are unfit for occupancy, resulting in a cloud on the property's title and a derelict building notice. This also unnecessarily burdens both the county auditor's offices and the code enforcement divisions. s Voluntary Guidelines for Methamphetamine Laboratory Cleanup, ("EPA's 2013 Voluntary Guidelines") U.S. EPA (EPA.530-R-08-008),March 2013,p.7. 4 Assessment of Children's Exposure to Surface Methamphetamine Residues in Former Clandestine Methamphetamine Cleanup Standard for Surface Methamphetamine Contamination ("Assessment of Children's Exposure"), Integrated Risk Assessment Branch Office of Environmental Health Hazard Assessment, California Environmental Protection Agency,February 2009,p.1. 5 Guidelines for Cleanup of Residential Property Used to Manufacture Methamphetamine (Virginia's 2013 Guidelines"),Virginia Department of Health, September 12,2013,pp.24—25. CHANGING THE STATE OF WASHINGTON'S METH TESTING THRESHOLD—page 2 (March 18,2014) • Meth production, and its use, continues to be a significant public health concern in Washington, and elsewhere. Washington should join other states and adopt the health-based meth contamination/remediation standard of 1.5 ug/100cm2. This would promote appropriate investigation and decontamination of meth sites. It would protect human health and the environment based on the best available science. It would do so in a commercially reasonable manner that would elicit compliance from property owners. 2. WASHINGTON'S DEVELOPMENT OF METHAMPHETAMINE REGULATIONS Washington appears to have been the first state in the country to adopt statues and regulations addressing the burgeoning problem of meth production. The state first enacted legislation to address properties contaminated by illegal meth manufacturing activities in 1990. The genesis of the law was a legislative finding "that some properties are being contaminated by hazardous chemicals used in unsafe or illegal ways in the manufacture of illegal drugs. Innocent • members of the public may be harmed by the residue left by these chemicals . . ."6 At the time, Pierce County was one of the nation's counties most afflicted by meth manufacture. The linchpin to the application of the entire statutory scheme was a reasonable belief or confirmation that property was"contaminated,"which the legislature defined to be "polluted by hazardous chemicals so that the property is unfit for human habitation or use due to immediate or long-term hazards."7 While the legislature clearly intended a health-based approach to addressing meth contamination, neither the initial legislation or the implementing regulations adopted in 1991 contained any quantitative or qualitative standards to determine whether a property was "contaminated" or whether it had been successfully remediated. Instead,the statute merely required 6 RCW 64.44.005. 'RCW 64.44.010(2)(Emphasis added) • CHANGING THE STATE OF WASHINGTON'S METH TESTING THRESHOLD—page 3 (March 18,2014) the preparation and submission to the local health department of a written work plan for • decontamination and provided that"[i]f the work plan is approved and the decontamination is completed and the property is retested according to the plan and properly documented,then the health officer shall allow reuse of the property."8 The original 1990 statute directed that DOH"shall develop guidelines for decontamination of a property used as a drug laboratory and methods for the testing . . . for contamination, . . ."9 In 2002 DOH promulgated specific sampling procedures and numeric decontamination standards. At that time DOH established the following decontamination standards for meth and associated materials: • methamphetamine—less than or equal to 0.1 microgram per 100 cm2; • total lead—less than or equal to 20 micrograms per foot2; • mercury—less than or equal to 15 nanograms per cubic meter in air; • volatile organic compounds— 1 part per million total hydrocarbons and in air.10 Those standards have remained unchanged since 2002. Since then,the best available scientific • research has established that the health standard for meth contamination is 1.5 ug/100 cm2. 8 RCW 64.44.050[1990 at 213 §6]. 9 RCW 64.44.070. WAC 246-205-541. CHANGING THE STATE OF WASHINGTON'S METH TESTING THRESHOLD—page 4 • (March 18,2014) vpsfsA t Clallam County Department of Health and Human Services Nt. 223 East 4th Street, Suite#14•Port Angeles, WA 98362-3015 • 360-417-2274 • FAX 360-417-2519 7, el 4. ulvi p.$ March 28, 2014 John Wiesman, DrPH, MPH, Secretary of Health Office of the Secretary Washington State Department of Health P.O. Box 47890 Olympia, Washington 98504-7890 Dear Secretary Wiesman, I am writing in support of efforts by the Comprehensive Health th Education Foundation, Tacoma Pierce County Health Department, the Peninsula Housing Authority, the Tacoma Housing Authority and others to urge revision of Washington State's methamphetamine contamination threshold triggering clean-up of residential facilities. Washington State's current clean-up standards were adopted to apply to clandestine labs that were producing a range of toxic contaminates, including heavy metals. Lacking reliable data on human health effects from II/ environmental methamphetamine exposure, Washington adopted a very strict clean-up standard of 0.1 microgram/100 square cm. Much has changed over the past 12 years and we now live in an era where most illicit methamphetamine is produced in Mexico and clandestine methamphetamine synthesis labs are uncommon. Unfortunately, Washington State's strict clean-up standard is being applied to residential structures where the only known contamination source is the volatilization of the drug during consumption. We have no reliable epidemiologic or toxicological evidence that these very low levels of contamination have any adverse human health effects. In 2007,the State of California completed a study that looked at a worst case scenario model for environmental methamphetamine exposure. Their study recommended a 1.5 microgram/100 square cm clean- up standard as clearly safe. Given the many improbable assumptions of the California model, the actual "safe" level is likely much higher than this. Methamphetamine on environmental surfaces does not volatilize and can only be absorbed through direct skin contact or ingestion. I strongly support raising Washington State's methamphetamine clean-up standard to the 1.5 microgram/100 square cm level used by California and a number of other states. Public housing found to be "contaminated"by trace amounts of methamphetamine residue are subject to expensive and destructive remediation efforts that call for the removal and disposal of drywall, furniture, appliances, and personal possessions. Washington State's current standard is causing significant harm by diverting scare public housing resources for unnecessary clean-up efforts and ultimately reducing the supply of public housing available. This harm could be significantly reduced by a simple revision of the clean-up standard found in WAC 246-205-541. Moreover, a strong, evidence-based argument can be made for moving away from quantitative standards • towards a process-based decontamination standard for residential structures that have not been used as clandestine synthesis labs. Over the longer term,we need to revisit the issue of environmental decontamination in the post-clandestine lab era. Simple cleaning of these • structures will likely satisfy all reasonable concerns regarding the protection of human health. Sincerely, Thomas Locke, MD,MPH Health Officer,Clallam and Jefferson Counties • . • I Board of 3feaCtfi Old Business & Informationalltems .Agenda Item #117, 2 • Governor's 2013 Smart Communities Award to Environmental3-fealt( and Department of Community DeveCopment April17, 2014 1 7.h � `►`►►►,1r `..„0„0..►r. ..u`Ir%:\\\ 7# ..►t0!"r ri►,r��.'►\q`ryrlt/rr `►�►1�`r l.>;rr.,.',►\1r►`a r!►fir'. .044c.'71... ..��\`V`qo/. `\1►Qy`►r arl.• ,,I�alr,t)rn�. 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Fran Benton 303.865.8408 fran.benton@nursefamilypartnership.org JAMA Pediatrics Article Shows Nurse-Family Partnership Improves Child Development Nurse-visited children had 55% reduction in behavioral problems in NFP Denver trial DENVER, CO (Dec. 3, 2013)—A follow-up study–published by JAMA Pediatrics–found that children whose mothers received Nurse-Family Partnership nurse visits had improved child development at ages 6 and 9. This third randomized,controlled trial conduced in Denver,Colorado of Nurse-Family Partnership® (NH') –the leading evidenced-based home visiting program for low-income mothers– found that NFP nurse-visited children had over a 55%reduction in behavioral problems at school entry,in addition to corresponding reductions in symptoms of depression and anxiety,and problems with attention and impulsivity at age 9. "It is crucial that we measure the long-term effects of Nurse-Family Partnership to understand the • difference that the program is making on children's development long after the completion of the program," said Dr. David Olds,NFP founder and lead author of the article. "The Denver trial found that children who participated in NFP had fewer behavioral problems and improved language development– outcomes that put them on a better path for success in school and society." The Nurse-Family Partnership program is a national home visiting program for low-income women who are having their first babies. Each woman is paired with a registered nurse who provides her with home visits throughout her pregnancy until her child's second birthday.The program's main goals are a healthy pregnancy and delivery,improved child health and development through improved parenting skills,and economic self-sufficiency for the families. The JAMA Pediatrics article, "Effects of Home Visits by Paraprofessionals and by Nurses on Children: Follow-Up of a Randomized Trial at Ages 6 and 9 Years,"also examined the impact of the NFP program model when delivered by paraprofessional visitors and found that there were few enduring benefits of home visiting by paraprofessionals. • 1900 Grant Street,Suite 400 I Denver,CO 80203-4304 303.327.4240 I Fax 303.327.4260 I Toll Free 866.864.5226 www.taursefamilypartnership.org Outcomes observed among nurse-visited children,compared to the control group,included: • • Rates of depression and anxiety at age 9 for nurse-visited children were less than half those found for children assigned to the control group; • Control group children had nearly three times as many problems with impulsivity and lack of attention at age 9 than did children visited by nurses. • NFP nurse-visited children born to mothers with low psychological resources had better language development averaged over ages 2,4 and 6 than children in the control group. The outcomes observed in reducing behavioral problems,and depression and anxiety were consistent with an earlier randomized, controlled trial of NFP in Memphis,Tennessee. The Memphis trial also found an improvement in academic achievement at ages 6,9 and 12 for nurse- visited children born to mothers with few coping resources.This outcome was not observed in the Denver trial,probably due to differences in the population studied compared to the Memphis trial, according to Dr. Olds.The control group children born to mothers with few coping resources in the Denver trial had higher achievement in reading and math and higher scores on intelligence tests at age 6 than did their counterparts in Memphis. Therefore,there was less room for improvement in academic achievement for • the nurse-visited children in the Denver trial. In addition, the benefit of NFP appears to be more pronounced for families living in more disadvantaged neighborhoods,and the levels of neighborhood adversity were much lower in Denver compared to Memphis. Dr.Jack Shonkoff,director of the Center for the Developing Child at Harvard University,wrote an accompanying editorial that discussed the NFP report. Dr. Shonkoff wrote, "A brighter future for children whose life prospects are threatened by adversity requires that we build on the seminal contributions of programs like NFP and leverage advances in 21"-century science to catalyze fresh thinking that changes the narrative for early childhood investment."JAMA Pediatrics also featured Dr. Shonkoff and Dr. Olds in an author interview. "We continue to measure the results of Nurse-Family Partnership through randomized, controlled trials— the gold standard of public health practice,"said Thomas R.Jenkins Jr.,NFP president and CEO. "The outcomes observed in the Denver trial will guide us to understand the long-term effects on the families enrolled,and improve upon the program's effectiveness. Nurse-Family Partnership gives a child a healthier start,and the research shows it works to change a child's entire life course." • 1900 Grant Street,Suite 400 I Denver,CO 80203-4304 303.327.4240 I Fax 303.327.4260 I Toll Free 866.864.5226 www.nursefamilypartnership.org i This follow-up of the children in the Denver trial adds to over 35-years of research on the randomized, controlled trials of Nurse-Family Partnership that continue to measure long-term outcomes of the families enrolled. A recent supplement edition of PEDIATRICS contained an in-depth look at research on innovations in the NFP model, as well as a process for moving these innovations to practice. Nurse- Family Partnership currently serves over 26,000 women in 43 states, the U.S.Virgin Islands and six tribal communities. ### About Nurse-Family Partnership The Nurse-Family Partnership National Service Office (www.nursefamilypartnership.org) is committed to producing enduring improvements in the health and well being of low-income, first-time parents and their children by helping communities implement and sustain an evidence-based public health program of home visiting by registered nurses. Nurse-Family Partnership is the most rigorously tested maternal and early childhood health program of its kind. Randomized, controlled trials conducted over 35 years demonstrate multi-generational outcomes that benefit society economically and reduce long-term social service expenditures. Nurse-Family Partnership is headquartered in Denver,Colorado. • • 1900 Grant Street,Suite 400 I Denver,CO 80203-4304 303.327.4240 I Fax 303.327.4260 I Toll Free 866.864.5226 www.nursefamilypartnership.org • Effects of Home Visits by Paraprofessionals and by Nurses on ChildrenFollow-up of a Randomized Trial at Ages 6 and 9 YearSONLINE FIRST David L. Olds, PhD'; John R. Holmberg, PsyD'; Nancy Donelan-McCall, PhD'; Dennis W. Luckey, PhD2; Michael D. Knudtson, MS'; JoAnn Robinson, PhD3 [+j Author Affiliations JAMA Pediatr. Published online December 02, 2013.doi:10.10011jamapediatrics.2013.3817 Text Size:A A A Article Tables References Comments ABSTRACT ABSTRACT I METHODS i RESULTS i DISCUSSION I CONCLUSIONS !ARTICLE INFORMATION i REFERENCES Importance The Nurse-Family Partnership delivered by nurses has been found to produce long-term effects on maternal and child health in replicated randomized trials.A persistent question is whether paraprofessional home visitors might produce comparable effects. Objective To examine the impact of prenatal and infancy/toddler home visits by paraprofessionals and by nurses on child development at child ages 6 and 9 years. Design,Setting,and Participants Randomized trial in public and private care settings in Denver,Colorado,of • 73510w-income women and their first-born children(85%of the mothers were unmarried;47%were Hispanic,35% were non-Hispanic white,15%were African American,and 3%were American Indian/Asian). Interventions Home visits provided from pregnancy through child age 2 years delivered in one group by paraprofessionals and in the other by nurses. Main Outcomes and Measures Reports of children's internalizing,externalizing,and total emotional/behavioral problems,and tests of children's language,intelligence,attention,attention dysfunction,visual attention/task switching,working memory,and academic achievement.We hypothesized that program effects on cognitive-related outcomes would be more pronounced among children born to mothers with low psychological resources.We report paraprofessional-control and nurse-control differences with P<.io given similar effects in a previous trial,earlier effects in this trial,and limited statistical power. Results There were no significant paraprofessional effects on emotional/behavioral problems,but paraprofessional- visited children born to mothers with low psychological resources compared with control group counterparts exhibited fewer errors in visual attention/task switching at age 9 years(effect size=—0.30,P=.08).There were no statistically significant paraprofessional effects on other primary outcomes.Nurse-visited children were less likely to be classified as having total emotional/behavioral problems at age 6 years(relative risk[RR}=0.45,P=.08), internalizing problems at age 9 years(RR=0.44,P=.08),and dysfunctional attention at age 9 years(RR=0.34, P=.07).Nurse-visited children born to low-resource mothers compared with control-group counterparts had better receptive language averaged over ages 2,4,and 6 years(effect size=0.30,P=.oi)and sustained attention averaged over ages 4,6,and 9 years(effect size=0.36,P=.006).There were no significant nurse effects on externalizing problems,intellectual functioning,and academic achievement. Conclusions and Relevance Children born to low-resource mothers visited by paraprofessionals exhibited improvement in visual attention/task switching.Nurse-visited children showed improved behavioral functioning,and those born to low-resource mothers benefited in language and attention but did not improve in intellectual functioning and academic achievement. Trial Registration clinicaltrials.gov Identifier:NCT00438282 and NCToo438594. 110 Effects of Home Visits by Paraprofessionals and by Nurses on ChildrenFollow-up of a Randomized Trial at Ages 6 and 9 YearSONLINE FIRST David L. Olds, PhD';John R. Holmberg, PsyD'; Nancy Donelan-McCall, PhD'; Dennis W. Luckey, PhD'; Michael D. Knudtson, MS';JoAnn Robinson, PhD3 [+]Author Affiliations JAMA Pediatr. Published online December 02,2013.doi:10.1001/jamapediatrics.2013.3817 Text Size: A A A Article Tables References Comments ABSTRACT ABSTRACT} METHODS i RESULTS I DISCUSSION CONCLUSIONS E ARTICLE INFORMATION i REFERENCES Importance The Nurse-Family Partnership delivered by nurses has been found to produce long-term effects on maternal and child health in replicated randomized trials.A persistent question is whether paraprofessional home visitors might produce comparable effects. Objective To examine the impact of prenatal and infancy/toddler home visits by paraprofessionals and by nurses on child development at child ages 6 and 9 years. Design,Setting,and Participants Randomized trial in public and private care settings in Denver,Colorado,of 735 low-income women and their first-born children(85%of the mothers were unmarried;47%were Hispanic,35% were non-Hispanic white,15%were African American,and 3%were American Indian/Asian). • Interventions Home visits provided from pregnancy through child age 2 years delivered in one group by paraprofessionals and in the other by nurses. Main Outcomes and Measures Reports of children's internalizing,externalizing,and total emotional/behavioral problems,and tests of children's language,intelligence,attention,attention dysfunction,visual attention/task switching,working memory,and academic achievement.We hypothesized that program effects on cognitive-related outcomes would be more pronounced among children born to mothers with low psychological resources.We report paraprofessional-control and nurse-control differences with P<.io given similar effects in a previous trial,earlier effects in this trial,and limited statistical power. Results There were no significant paraprofessional effects on emotional/behavioral problems,but paraprofessional- visited children born to mothers with low psychological resources compared with control group counterparts exhibited fewer errors in visual attention/task switching at age 9 years(effect size=—0.30,P=.o8).There were no statistically significant paraprofessional effects on other primary outcomes.Nurse-visited children were less likely to be classified as having total emotional behavioral problems at age 6 years(relative risk[RR]=0.45,P=.08), internalizing problems at age 9 years(RR=0.44,P=.08),and dysfunctional attention at age 9 years(RR=0.34, P=.07).Nurse-visited children born to low-resource mothers compared with control-group counterparts had better receptive language averaged over ages 2,4,and 6 years(effect size=0.30,P=.oi)and sustained attention averaged over ages 4,6,and 9 years(effect size=0.36,P=.o06).There were no significant nurse effects on externalizing problems,intellectual functioning,and academic achievement. Conclusions and Relevance Children born to low-resource mothers visited by paraprofessionals exhibited improvement in visual attention/task switching.Nurse-visited children showed improved behavioral functioning,and those born to low-resource mothers benefited in language and attention but did not improve in intellectual functioning and academic achievement. Trial Registration clinicaltrials.gov Identifier:NCT00438282 and MCTo0438594. • • Monday, March 24, 2014 ale Seattle Tittles Winner of Nine Pulitzer PrizesGuest: How visits to families with young children helps law enforcement Renewing federal funding for home visits for families with young children helps law enforcement, writes guest columnist John Urquhart. By Urquhart Ur uhart Special to The Times • � 9 King County Sherrif John Urquhart Will visiting nurses be allowed to help struggling parents with family planning? (March 21, 2014, by AccountabilityAdvocate) MORE Yeah, sure. Let's get more government representatives in everybody's homes while CPS... (March 21, 2014, by AkonZ) MORE No price is too great to prevent even one child from being abused and/or neglected... (March 21, 2014, by rainpoet) MORE • AS the King County sheriff with nearly four decades of experience in law enforcement, I can tell you that virtually nothing is more troubling than being called to a residence and seeing children who are abused or neglected. Too many of these children never recover from these early traumas, and many go on to become involved in crime in later years. Fortunately, our lawmakers in Washington, D.C., have an opportunity to sustain an intervention that greatly reduces child abuse and neglect, enhances public safety and saves taxpayer dollars. It's known as the Maternal, Infant and Early Childhood Home Visiting program. It enables states, territories and tribes to offer voluntary home visits for young, inexperienced parents. With help from caring, registered nurses or other specially trained mentors, the parents learn how to better understand their children's health needs, make their homes safe for kids, and manage the many stressful situations that arise with very young children. The program requires states that receive funding to support home-visiting models that have been shown by research to be effective. One such model used extensively in Washington is the Nurse Family Partnership, which was developed to serve first-time mothers. Through home visits from nurses, expectant mothers receive support needed for a healthy pregnancy and learn how to responsibly care for their children. King County is one of 14 counties in Washington that uses the partnership with vulnerable, • young families. Over half of these counties, including King County, rely on the federal funding to maintain the program. Research shows voluntary home visits lead to several tangible impacts for communities and families. A long-term study of the Nurse Family Partnership found that children of mothers who participated were half as likely to be abused or neglected, and that participation reduced childhood injuries, emergency room visits and infant deaths. It also found that children of mothers who didn't participate had twice as many arrests by the age of 15 as children of those who did participate. By age 19,the children who did not participate had more than twice as many convictions. These results should be important to everyone who cares about reducing child abuse and neglect, which almost 700,000 kids experienced in 2012, including more than 6,400 in Washington. Research shows children who are abused or neglected are 30 percent more likely to be arrested for a violent crime as they grow older. They are also more likely to abuse their children, resulting in intergenerational cycles of abuse. That's bad news for taxpayers across the nation, given the $25 billion in annual costs for foster- care placements for victims of child abuse and neglect, and for those in Washington,who foot a • the bill for $842 million in corrections costs for more than 17,000 people locked up in our prisons and jails. A far more appealing number is the $17,000 in savings to taxpayers for every family served by the Nurse Family Partnership, based on lower costs for crime, incarceration, welfare and other costs. Despite these tangible impacts, the Maternal, Infant and Early Childhood Home Visiting program is in jeopardy. Created in 2010 and sustained by significant bipartisan support,the program is set to expire on Sept. 30. Congress originally invested $1.5 billion over five years. By October, Washington state will have received $30 million from the program, which nonprofit Thrive by Five Washington used to raise an additional $6 million from private sources. King County has received $1.8 million of federal money. Congress can take a vital step for protecting the program as it considers legislation that deals with physician-payment rules under Medicare during the next few weeks. More than 1,600 members of the law-enforcement community signed a 2012 letter to Congress urging members to build on investments in home-visiting programs. This support comes from our hearts as we grapple with the tragedies of child abuse and neglect we see every day, and from our minds as we champion programs that have a proven impact on the security of our communities. John Urquhart is sheriff of King County. Enjoy 8 weeks of unlimited access to seattletimes.com for$1. Subscribe today! • • I Board of 3-Cealth New Business ,Agenda Item #17, 1 2o13 Tnvironmentaf3lealth • Performance Measures April17, 2014 • ut lt O 0 '5.,:t 0 0 0 0 0 0 0 0 0 C o o c. 0 0 0 0 0 0 0 0 0 0 • � M .,, � MM �* MSM M0 ono �'. O ~' ~' `" ~' ~' ~' P' C] ,.' m N ,. 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"h CD = W - og t °° wa Lk) -h Wo C N CD . w a �' o O O 0 0 �O N 7 ' J 0 D A O Ni A Ut n O (D O Zig 0 CS •P 0. ao D CD D N > O pD -n N CT DN• p a O c 0 x • Board of Health .New Business .agenda Item #17, 2 .91/least-es Outbreak .Activity in • Washington State and-British Columbia ApriC17, 2014 • JEFFERSON COUNTY PUBLIC HEALTH G 615 Sheridan Street o Port Townsend o Washington o 98368 www.jeffersoncountypublicheaith.org • April 2, 201 To: Jefferson County Health Care Providers From: Thomas Locke, MD, MPH, Jefferson County Health Officer Re: Health Care Provider Advisory: Measles Outbreak in San Juan County Situation Report: On Sunday, March 30 an unvaccinated adult male who had recently returned from a trip to Asia was diagnosed with measles (rubeola). His onset of rash was March 25 and his period of maximum communicability was from March 21 to March 29. The measles infected individual was present at multiple restaurants and public gatherings, exposing 67 employees and hundreds of members of the general public. San Juan County has some of the lowest vaccination rates of school age children in the State and the potential for secondary measles cases is high. Measles Basics: Measles is an acute viral disease that is among the most contagious diseases known and can have life threatening complications including pneumonia and encephalitis. Prodromal symptoms consisting of cough, rhinitis, sore throat, conjunctivitis, and fever (>101 degrees F) usually begin 10-12 days after infection and progress to a generalized rash, starting on the face. Koplick's spots (blue white spots on the bright red background of the buccal mucosa) • are considered pathognomonic and usually precede the generalized rash. Measles patients are often very sick and seek medical care either during the prodromal period or shortly after rash onset. Up to 30% of measles cases have significant complications. Pregnant women, infants, the elderly, and the immunosuppressed are at highest risk for complications. Nationally, measles was declared to be eliminated from the United States in the year 2000. Unfortunately, annual case rates have been increasing since that time due to declining vaccination rates and importation of the virus from areas of the world where it remains endemic. 2013 saw the highest number of measles cases in the U.S. in the past decade with large outbreaks in unvaccinated communities occurring in New York and Southern California. Immunity in the general population must exceed 95% in order to prevent community wide outbreaks and, in recent years, has dropped far below that threshold. Period of Communicability: The maximum period of contagion is 4 days before and 4 days after onset of the characteristic rash. Transmission is via the airborne route and through contaminated secretions. Airborne viral particles can remain suspended for up to two hours after the infected person leaves the room they were occupying. For outbreak control purposes the period of communicability is considered to be 9 days and maximum incubation period until onset of rash is 21 days. COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH • DEVELOPMENTAL DISABILITIES MAIN: (360)385-9400 ALWAYS WORKING FOR A SAFER AND WATER QUALITY FAX: (360)385-9401 HEALTHIER COMMUNITY MAIN: (360)385-9444 FAX: (360)379-4487 Diagnosis: Viral culture can be performed on nasopharyngeal swabs and urine specimens. Presence of measles IgM antibodies is considered diagnostic. Up to 20% of blood tests done in . the first 72 hours following rash onset can be falsely negative. Testing for IgM levels should optimally be done 72 hours or later after rash onset and through the Washington State Public Health Lab, not commercial labs, due to the urgency of establishing the diagnosis in a timely fashion. Control Measures: Following identification and isolation of cases, assessment of immunity and prompt vaccination of exposed susceptibles are the principle control strategies. Birth before 1957, two doses of MMR vaccine, or serological proof of immunity are considered adequate tests of immunity for the general public. For health care workers, birth before 1957 (or a past history of clinical measles) is no longer considered sufficient evidence of immunity—a record of at least 2 doses of MMR vaccine or an adequate anti-measles IgG titer are required to confirm measles immunity. Susceptible individuals who are exposed to measles should receive two doses of MMR, the first within 72 hours of exposure and the second after 4 or more weeks. High dose immune globulin is also used for high risk household contacts and exposed infants, pregnant women, and the immunosuppressed. Active Surveillance and Proactive Response: Measles cases can occur up to 21 days after exposure. Patients will typically present with non-specific upper respiratory symptoms, fever, and a generalized rash. Patients with a history of travel to San Juan Island during March 21- March 29 and rash illness should be evaluated with a high index of suspicion for measles. Patients suspected of having measles should wear a mask before entering a health care facility, be quickly moved to a private room and evaluated promptly. A nasopharyngeal swab (Dacron) • and urine specimen should be collected as well as serum for IgM testing. After the suspect patient leaves the health care facility, the exam room should remain unoccupied for at least 2 hours followed by disinfection of environmental surfaces. Health care providers should wear N- 95 masks during exams. Suspect and confirmed measles cases should be reported to the Jefferson County Public Health immediately. Blood tests and cultures should be sent to the Washington State Public Health Lab (unless clinical suspicion is low) to facilitate timely testing. Case reports can be made by calling 385-9400 during regular business hours. After hours cases should be reported to the Regional Duty Officer by calling 360-415-2005 and leaving a call-back number. COMMUNITY HEALTH DEVELOPMENTAL DISABILITIES PUBLIC HEALTH ENVIRONMENTAL HEALTH • MAIN: (360)385-9400 ALWAYS WORKING FOR A SAFER AND WATER QUALITY FAX:(360)385-9401 HEALTHIER COMMUNITY MAIN: (360)385-9444 FAX: (360)379-4487 t 1�tPlSnfr1 t1A3t4Utt r! He ,; DOH SITUATION REPORT #5 • Incident Name: Measles in NW WA Incident Number: 14-1090 4/4/2014 1520 Mike Boysun/Brad Halstead DATE TIME PREPARED HY GENERAL SITUATION and AFFECTED JURISDICTIONS: This report represents current status as of 1100 on 4/04/2014 Recent developments DOH continues to work with counties involved in the two separate and unrelated measles incidents to identify support strategies and resources as needed from the agency.The primary DOH support work continues to be from the Office of Immunization and Child Profile,Office of Communicable Disease Epidemiology,Public Health Laboratories and the Office of Communications. One additional case of measles has been confirmed for a total of 2 cases in San Juan County. There are additional people being monitored. No new cases to report in other counties. General Situation in San Juan County Initially, one individual tested positive for measles in San Juan county with the possibility of widespread community exposure at four different sites. Current immunity testing indicates good immunity coverage for the community for adults. San Juan Health &Community Services(SJHCS)continues to monitor and follow up with cases and contacts and provide general health alerts and notifications. • General Situation in Whatcom County An adult resident of Whatcom County had contact with the Whatcom County household where there have been 5 measles cases related to the large measles outbreak in Fraser Valley B.C. The person was contagious when s/he traveled to King and Pierce Counties for a weekend concert, museum visits,and several meals at dining establishments(among other activities.)No further cases have been reported. Measles at the National Level CDC reports increased measles activity overall but the increase is driven by increased activity in California and New York thus far. CASUALTY STATUS: Measles in San Juan County Dead: 0 Injured: 0 Sick: 2 Hospitalized: 0 Other: 0 • 1 A 111,* &Magta1Si&j} NTh7h'Si7o( HealthSITUATION�I��ATION RSP®RT #5 Incident Name: Measles in NW WA Incident Number: 14-1090 Measles in Whatcom -multicounty exposure Dead: 0 Injured: 0 Sick: 6 Hospitalized: 0 Other: 0 HOSPITAL STATUS: Not affected LOCAL HEALTH JURISDICTION(LHJ)STATUS: Measles in San Juan County San Juan Health and Community Services is operational and responding to the event. Measles in Whatcom—multicounty exposure All impacted county health departments are operational and responding as necessary to the event. CURRENT Health and MEDICAL RESPONSE ACTIVITIES (Local) Measles in San Juan County • San Juan Health& Community Services is continuing to lead the investigation activity. They are monitoring community members that are showing potential measles pre-symptoms. They continue to staff their clinics to support the community, They continue to request and appreciate the assistance from DOH with a deployment of a field Epi. They are receiving additional vaccine to cover youth and adults who are uninsured,underinsured or low income and to cover youth, Measles in Whatcom--multicounty exposure All counties are monitoring the situation and responding to inquiries. They are working with DOH CD/Epi to coordinate testing at Public Health Laboratory with suspect cases as they deem necessary. Whatcom has requested further coordination from DOH on collateral support materials and a possible webpage. CURRENT DIVISIONAL RESPONSE STATUS(State) Heath Services Quality Assurance(HSQA): Prevention and Community Health (PCH): Office of Immunization and Child Profile: Immunization program staff confirmed delivery of 200 adult vaccines to San Juan County that can be used on adults who are uninsured, under-insured or low income. Additional vaccine has been sent to San Juan County for children. Vaccine supply in the other counties is okay for now. Health promotion activity is focused on updating mailings to include messaging about measles.Additionally,they will be updating the measles website FAQ and ensure epi input. Agency on- call calendar was updated to reflect Immunizations on-call staff support for measles. Staff remain aware and poised to support efforts as necessary. Environmental Public Health (EPH): • None Disease Control Health Statistics and Public Health Laboratories(DCHS): 2 $ Wa htngtnu Stare Dtptrfmrnt of4.1.f Health DOH SITUATION REPORT #5 110 Incident Name: Measles in NW WA Incident Number: 14-1090 Office of Communicable Disease Epidemiology: DOH CD/Epi staff continue to consult with SJHCS investigators and the health officer as necessary to provide technical assistance and help with this investigation, Per SJI-ICS request,we will continue to provide on-the-ground epi support— currently through the weekend from Public Health Seattle and King County. DOH CD/Epi continues to consult and provide technical assistance to the investigators in the other affected counties. This involves consultation on suspect cases and coordinating sample testing submission to the Public Health Lab(PHL). All jurisdictional investigators are in communication with each other and this is being coordinated by DOH CD/Epi, CD/Epi staff are working on a tool for assessment and management of people exposed to measles at public sites.This tool will be reviewed by LHJs and will directly support their efforts, They are also providing feedback as necessary to collateral materials in DOH, Public Health Laboratories (PHL): DOH CD/Epi continues to provide updates on behalf of PHL and the testing conducted. State Public Health Lab continues to test specimens as they arrive. PHL remains poised for testing as necessary to support this incident. OTHER: • Office of Communications The DOH Communications Office continues to coordinate support activities with SJCH information officer.No further asks from the jurisdiction at this juncture, The DOH Communications Office continues to field interviews and calls as a result of the press release on 4/2/14: 2 live interviews total so far and 3 calls yesterday from reporters. DOI-1 Communications staff obtained clarification on privacy laws and public health safety. FUTURE DOH ACTIONS/PLANNED -ACTIONS IN THIS REPORTING PERIOD: • Support San Juan Health &Community Services with staffing needs as requested. • Support counties as requested for the multi-county measles exposure that started in Whatcom County • Support any other ESF8 requests as needed. • ANTICIPATED HEALTH and MEDICAL ISSUES: Immunization of uninsured and low income adults in the community. Anticipating possible request from San Juan Health &Community Services for staffing support if outbreak develops. • Approved for Distribution: 3 I 1 } Wsshingua State Depancent o tif Health DOH SITUATION REPORT #5 • Incident Name: Measles in NW WA Incident Number: 14-1090 Signature --7Print Name: Nathan Weed Date: 4/4/2014 SitRep Distribution List: Each DOH ACC Staff: DOH ACC Staff Distribution List DOH DL Agency Executive Team DOH DL Agency Leadership Team HHS,Region X,Rick Buell: Rick.Buellchhs.gov ESF 8 Desk: EOC34nemd.wa.gov;E0004 rt,mil.wa.gov; EOC24@mil.wa.gov LHJ Director's: http://www.doh.wa.gov/PHlP/phdirectory/ RERCS:DOH DL OS PHEPR RERC Other: Oregon: Duty Officer:PHEPDUTYO(e4DHS.state.or.us Idaho: HPP Mgr: schatzi@dhw.idaho.gov;dennvw@dhw.idaho.gov Alaska: merry.carlson@alaska.gov British Columbia:hlth.mocdutvofficer@agov.bc.ca ComTopics:ComTopics@doh.wa.gov Pacific NW Boarder Health Alliance contact group Lummi Tribe(davidgr lummi-nsn.gov) •Situation Report Revised 05/2013 Form 1 DOH Agency Coordination Center Form 4 ir PA kYu9ttwSr tikpvfaou t •Ito Health • DOH SITUATION REPORT #10 Incident Name: SR530 Flooding and Mudslide Incident Number:14-0995 federal entities. Health District staff is working to resolve any concerns in regards to contamination. CURRENT Health and MEDICAL RESPONSE ACTIVITIES(Local) RECENT DEVELOPMENTS: The Darrington shelter is now on standby. The Arlington shelter is relocating to Smokey Point Community Church on April 3, 2014. Two Red Cross Family Care Center locations are powering down, however the services provided will remain available through the Joint Resource Centers or a call in number. GENERAL STATUS: DOH has deployed a PIO to Snohomish County to assist as needed. Yesterday they were working with the Medical Examiner's Office, and today they are in Darrington helping out as needed. They are scheduled to return on Friday,April 4. We are coordinating with Snohomish HD to provide any other support that is requested. Mental/Behavioral Health: DOH is coordinating with and supporting DSHS and the Snohomish County Interagency Workgroup to identify resource issues and unmet needs as well as short and long term planning. • Focus is on responder support and mental health support for children. Public Health: DOH stands ready to support any needs from local health including environmental health resources or technical assistance. CURRENT DIVISIONAL RESPONSE STATUS(State) Heath Services Quality Assurance(IISQA): DOH stands ready to support any needs from local health Prevention and Community Health(PCH): DOH stands ready to support any needs from local health Environmental Public Health(EPH): DOH stands ready to support any needs from local health Disease Control Health Statistics and Public Health Laboratories(DCHS): DOH stands ready to support any needs from local health Office of Communications: One staff has been deployed to support the Snohomish County Medical Examiners needs. OTHER: Flood warning in effect for the North Fork of the Stillaguamish upstream of the slide. Flash flood watch in effect for the North Fork of the Stillaguamish downstream of the slide to Oso. FUTURE DOH ACTIONS/PLANNED-ACTIONS IN THIS REPORTING PERIOD: 2 } �' 'TVA • (I* I • DOH SITUATION REPORT #10 Incident Name: SR530 Flooding and Mudslide Incident Number:14.0995 4/3/2014 1330 Richard Cowley OATH TIMG IfEPARED BY RECENT DEVELOPMENTS: DOH is working with Snohomish Health District to fulfill resource needs with in-state support if possible prior to requesting support from federal partners. GENERAL SITUATION and AFFECTED JURISDICTIONS: • Slide occurred at the North Fork Stillaguamish River on 3/22 in Snohomish County just east of Oso, WA, The Washington State EOC and DOII ACC have been activated to in support of the Snohomish County Landslide. Rescue and recovery operations began immediately and continue to date. Crews are working on opening SR530—the process could take weeks. At this time the response has evolved to a whole community effort supported by multiple government and non- government entities at the local, state and federal level. Specifically,health and medical (ESF8)partners include but are not limited to: HHS/ASPR, HHS/SAMHSA, HHS/DMORT,HHS MRC Coordinator,Tribal partners, National Guard,EPA, DOH, LNI, DSHS,and the Snohomish Health District. CASUALTY STATUS: E Per the Snohomish County Medical Examiner: Dead: 30 - 27 of whom have been identified Per Snohomish County: Missing/unaccounted for: 13 Per State Emergency Operations Center: Injured: 20—includes victims and responders and is a cumulative number for the entire duration of the operation. HOSPITAL STATUS: Not affected LOCAL HEALTH JURISDICTION(LIU)STATUS: RECENT DEVELOPMENTS: DOH is coordinating with Snohomish Health District to find out what their specific support needs are,to see if we can fill their needs in-state before making request for federal teams. GENERAL STATUS: Snohomish Health District has activated their EOC and are staffing the•ESF8 desk at the Snohomish County EOC. • Snohomish Health District and other Snohomish County agencies are coordinating effectively with local, state and 1 W"athi orsa SLIM I/T r w d '.� .Health • DOH SITUATION REPORT #10 Incident Name: SR530 Flooding and Mudslide Incident Number:14-0995 • Support fatality management assistance as requested. • Assess and support mental health needs in coordination with DSHS. • Support any other ESF8 requests as needed. ANTICIPATED HEALTH and MEDICAL ISSUES: Anticipating possible requests for staffing assistance from Snohomish County. Potential disruption of sanitation systems and waters systems in the affected areas. Potential responder safety and health issues, including vaccinations and other personal protective measures,are coming up and are being addressed by Snohomish Health District at this time. We stand ready to support long-term health impacts for impacted populations with Snohomish County. Approved for Distribution: Signature: ,! `r:y / Print Name: Nathan Weed • Date: 4/3/2014 SitRep Distribution List: Each DOH ACC Staff` DOH ACC Staff Distribution List DOH Deputy Secretary DOH DL Agency Executive Team DOH DL Agency Leadership Team DOH EPR Team WA State Healthcare Coalition Leads HHS,Region X,Rick Buell: Rick.Buell@hhs.gov ESF 8 Desk: E0C34@emd.wa.gov;E0004 Amil.wa.gov; E0C24@mit.wa.gov LHJ Director's: http://www.doh,wa.gov/PHIP/phdirectoiy/ RERCS.DOH DL OS PHEPR RERC Other: Oregon: Duty Officer:PHEPDUTYOiiDHS.state.or.us Idaho: HPP Mgr: schatzj a dhw.idaho.gov;dennyw@dhw.idaho.gov Alaska: merry.carlson@alaska.gov British Columbia:hlth.mocdutyofficer(rigov.bc.ca ComTopics:ComTopics@doh.wa.gov Pacific NW Border Health Alliance contact group Situation Report Revised 05/2013 Form I DOH Agency Coordination Center Form • 3 • Board of Health Wow Business .agenda Item #17, 3 Cascade Pacific Action Affiance ProposaC • Aprili7, 2014 1 • March/April 2014 NEWS ARTICLES 1. "Volunteers in Medicine of the Olympics executive director resigns," Peninsula Daily News, March 14th, 2014. 2. "Public health official: Risk low for radiation," and "Low-level radiation: Coming to a beach near you? (Little chance of any health threat, officials say)," Peninsula Daily News, March 16th, 2014. 3. "Deadline looms for health insurance in 2014," Port Townsend Leader, March 19th, 2014. 4. "Jefferson County Commissioner John Austin decides against third run for seat," Peninsula Daily News, March 19th, 2014. 5. "Keefer takes `Survive and Thrive' training," Port Townsend Leader, March 19th, 2014. 6. "Guest: How visits to families with young children helps law enforcement," The Seattle Times, Opinion, Online, Friday, March , 2014. 7. "Jefferson County Board of Health honors Public Health Heroes," Port Townsend Leader, March 26th, 2014. 8. "Quilcene Public Health Clinic," Port Townsend Leader, April 2nd, 2014. 9. "Port Townsend Paper Corp. drops biomass expansion plans," Peninsula Daily News, April 4th 2014. 10. "Health board lauds several for assistance," Peninsula Daily News, April 6th, 2014. • 11. "PTPC officials won't request extension to build cogeneration plant," Port Townsend Leader, April 9th, 2014. ►d. "661(00-co/IS ie4 D7 + " Leader) Opal 16 r ( • Volunteers in Medicine of the Olympics executive director resigns By Rob 011ikainen,Peninsula Daily News,March 14,2014 40--4.,, } 7 i Larry Little PORT ANGELES— Larry Little has resigned as executive director of Volunteers in Medicine of the Olympics. The Port Angeles-based nonprofit provides limited health care services to North Olympic Peninsula residents who can't afford to pay for them. Little, 59, has served as executive director of Volunteers in Medicine of the Olympics, or VIMO, since the spring of 2008. He announced his resignation at the VIMO board meeting March 3. "It was time to move on to other pursuits," Little said Thursday. Little said he is "exploring different options" but plans to return to private practice dentistry on a part-time basis and continue to volunteer. He and his wife, Michelle, will remain in the Port Angeles area. 0 will continue to organize and direct the popular North Olympic Discovery Marathon, which Larry Little started in 2003. "That's our baby," he said. When he started with VIMO six years ago, Larry Little said he never imagined that the directorship would become a full-time job. "It's become that, and that's great," he said. "That's a really good thing." VIMO is"really healthy right now," with more programs and capacity than it has ever had, Little said. "It's got a really strong, stable staff," he added. "Financially, it's very sound. We went through an organizational restructuring over the course of the last three years. There are strong governing policies in place." Little said he plans to work with VIMO in its transition to a new executive director. Dr. Tom Locke, public health officer for Clallam and Jefferson counties, said Little has made "an extraordinary contribution" to the health care community. 'Right person' "He was the right person at the right time to help that organization get better organized and get access to more grant Locke said. Li tle took on important projects at VIMO, Locke said, including a 2013 program called Access to Baby and Child Dentistry, p which resulted in 48 children seeing a dentist for the first time last year. Locke, who was one of Little's patients when Little was in private practice in Port Townsend, described Little as an "excellent dentist" who would be a "community asset" in dental clinics. VIMO was born out of an initiative to improve health care access to Peninsula residents. The initiative was spearheaded by United Way of Clallam County. "United Way was key in creating and launching the clinic because we recognized that it was a significant community need," • said Jody Moss, United Way of Clallam County executive director. Moss said she was "a little surprised" when she was informed of Little's resignation last week. "It happens that executive directors leave their positions, so I'm not unduly concerned," Moss added. "The work continues to be delivered there to community members. Nothing is really different." VIMO is one'of United Way of Clallam County's 23 partner agencies. "Larry is working with them on ensuring a smooth transition as well," Moss said. "We want to make certain they stay strong." Volunteer clinics, which start with good intentions, must ensure quality care, proper documentation, provider credentials and "making sure volunteers are competent to do things," Locke said. "Larry, being a health care provider himself, really understood that and brought that professionalism to the job," Locke said. Little recommended VIMO Clinic Manager Mary Hogan as interim director in a succession plan he prepared prior to his resignation. No interim director has been appointed by the board. Solid staff "I can't emphasize enough how solid the staff up there is," Little said. • Little vacated his seat on the Port Angeles City Council shortly after he took office in 2010 because his wife was battling cancer. Health was not a factor in Little's decision to step down as VIMO director, he said. "She's great," Little said of Michelle. The couple lived part time in Canada in the winters in recent years as their children pursued skiing interests. They sold the Canada residence last year and live full time between Port Angeles and Sequim. "We're happier than clams right now," Little said. The VIMO clinic is located at 909 E. Georgiana St. Volunteers also provide dental services Monday at the VIMO Oral Health Center at the Armory Square building, 228 W. First St. Now in its 11th year, the North Olympic Discovery Marathon is held the first Sunday in June. This year's 26.2-mile marathon, half-marathon, relays and other events will be held June 1. For information on VIMO, visit www.vimoclinic.org. For information on the North Olympic Discovery Marathon, visit www.nodm.com. • Reporter Rob 011ikainen can be reached at 360-452-2345,ezt.5072,or at roll,k_ai,1ent penlnsuladatlynews,,com.Peninsula Daily News Public health official: Risk low for radiation Peninsula Daily News, March 16, 2014 T TOWNSEND —When the public health official for Jefferson and Clallam counties says there is no evidence of fation danger to anyone on the North Olympic Peninsula after the Fukushima Daiichi nuclear plant spill in March 2011, he is relying on state, federal and scientific sources. There are no county monitoring programs of water or fish on the Peninsula, he said. At the federal level, "their level of concern is so low, they are not doing any systematic monitoring" specifically for radiation from the Japanese plant, he said. The state Department of Health tested a limited amount of fish and shellfish for radioactivity from nuclear power plants soon after the disaster, according to Fukushima FAQs on the website www.doh.wa.gov. "All test results were far below levels that would pose a threat to people's health," the site says. "We'll continue to test fish and shellfish, focusing on the species most likely to travel long distances across the ocean," the department said. Radioactive particles carried across the ocean are predicted to be in the vicinity of the West Coast in the next month or so. "The dilution has been extreme as it moved across the body of water," said Dr. Tom Locke, public health officer for Jefferson and Clallam counties. "All the science I have seen is that the concentrations are so low, there is no human health concern," he added. "Projections are that levels will be well below human health concerns," he said. 0ne U.S. Food and Drug Administration, which says it tests for radiation routinely, issued an update this month saying it found no evidence of radiation from Fukushima in the U.S. food supply at levels that would pose a public health cern. The FDA cited a report published in 2012 in Proceedings of the National Academy of Sciences of low levels of radioactive Cesium in Pacific bluefin tuna off the coast of California in August 2011. It said officials determined that levels were roughly 300 times lower than levels that would prompt further investigation. The Environmental Protection Agency's environmental radiation monitoring program, known as RadNet, tests radiation in the air. Data on air radiation from Japan at www.epa.gov/japan011 is from March 11, 2011, to June 30, 2011. "EPA has returned to routine RadNet operations," it said. Real-time date from air monitoring by the EPA can be found at www.epa.gov/radnet. Low-level Fukushima radiation: Coming to a beach near you? (Little chance of any health threat, officials say) By Jeff Barnard ,The Associated Press, Peninsula Daily News, March 16, 2014 SEATTLE—Scientists have crowdsourced a network of volunteers taking water samples at beaches along the West • Coast in hopes of capturing a detailed look at low levels of radiation drifting across the ocean since the 2011 tsunami that devastated a nuclear power plant in Japan. With the risk to public health extremely low, the effort is more about perfecting computer models that will better predict chemical and radiation spills in the future than bracing for a threat, researchers say. Federal agencies are not samplingat the beach. Washington also doesn't test ocean water for 9 9 o radiation, said Washington Department of Health spokesman Donn Moyer. The state of Oregon is sampling, but looking for higher radiation levels closer to federal health standards, said state health physicist Daryl Leon. The March 2011 tsunami off Japan flooded the Fukushima Dai-lchi nuclear plant, causing radiation-contaminated water to spill into the Pacific. Airborne radiation was detected in milk and rainwater in the U.S. soon afterward. But things move more slowly in the ocean. "We know there's contaminated water coming out of there, even today," Ken Buesseler, a senior scientist at the Woods Hole Oceanographic Institution in Massachusetts, said in a video appealing for volunteers and contributions. In fact, it is the biggest pulse of radioactive liquid dropped in the ocean ever, he said. "What we don't really know is how fast and how much is being transported across the Pacific," he added. "Yes, the models tell us it will be safe," Buesseler said. • "Yes, the levels we expect off the coast of the U.S. and Canada are expected to be low. "But we need measurements, especially now as the plume begins to arrive along the West Coast." In an email from Japan, Buesseler said he hopes the sampling will go on every two or three months for the next two to three years. Two different models have been published in peer-reviewed scientific journals predicting the spread of radioactive isotopes of cesium and iodine from Fukushima. One, known as Rossi et al, shows the leading edge of the plume hitting the West Coast from southeast Alaska to Southern California by April. The other, known as Behrens et all, shows the plume hitting Southeast Alaska, British Columbia and Washington by March 2016. The isotopes have been detected at very low levels at a Canadian sampling point far out to sea earlier than the models predicted, but not yet reported at the beach, said Kathryn A. Higley, head of the Department of Nuclear Engineering and Radiation Health Physics at Oregon State University. The Rossi model predicts levels a little higher than the fallout from nuclear weapons testing in the 1960s. The Behrens model predicts lower levels like those seen in the ocean in the 1990s, after the radiation had decayed and dissipated. 411111 The models predict levels of Cesium 137 between 30 and 2 Becquerels per cubic meter of seawater by the time the plume reaches the West Coast, Higley said. The federal drinking water health standard is 7,400 Becquerels per cubic meter, Leon said. Becquerels are a measure of radioactivity. The crowdsourcing raised $29,945 from 225 people, enough to establish about 30 sampling sites in Alaska, British "'Arabia, Washington and California, according to Woods Hole. The website so far has not reported any radiation. Sara Gamble of Renton, the mother of a young child, raised $500 because she thinks it is important to know what is really going on. Woods Hole sent her a bucket, a funnel, a clipboard, a UPS shipping label, instructions and a big red plastic container for her sample. She went to Ocean Shores a couple of weeks ago, collected her sample and shipped it off. No results have come back yet. To do another sample, she will have to raise another$500. "I got lots of strange looks at the beach and the UPS Store, because it's labeled 'Center for Marine and Environmental Radioactivity,' and it's a big red bin," she said. "But it's funny; nobody would ask me anything out on the beach. I was like, 'Aren't you curious? Don't you want to ask?" Taking the sample has allayed her initial fears, but she still thinks it is important to know"because it affects our ecosystems, kids love to play in the water at the beach, and I want to know what's there." For details on the Woods Hole Oceanographic Institution radiation project, see www.ourradioactiveocean.org. Woods Hole facts on Fukushima radiation is at http://bit.ly/KoFvKk The video of the crowdsource appeal is at http://bit.ly/1 krSzLH. • • . • Deadline looms for health insurance in 2014 Young people in particular targeted to sign up for Obamacare; no deadline for se who qualify for free care Townsend Leader, Allison Arthur, March 19, 2014 3:30 am Aliina Lahti was spending $130 a month on health insurance last year, but it was a drain on her finances and she felt she wasn't getting anything for her money. So she canceled it, waited six months and then started eyeing the Affordable Care Act, better known as Obamacare. The 27-year-old Port Townsend visual artist, who has a part-time job at the ReCyclery, talked to a friend and finally decided to sign up for insurance on the last day of 2013. Today, she's glad she did. "I used it to get a prescription for antibiotics in the winter when I was sick, and I didn't have to pay anything," Lahti said. While she usually prefers naturopathic options, Lahti said the winter cold she got was taking a toll on her. "I probably could have been miserable for a couple more weeks, but I decided to do the antibiotics, and that kicked it right away.' In order for Obamacare to work, young, typically healthy people like Lahti and her 20-something friends need to sign up for health care in droves, officials say, and there's been a push in the last few months to focus on that age group. A new deadline is coming up on March 31 to purchase a qualified health plan through the Washington Health Plan Finder. Jefferson County Public Health and Jefferson Healthcare both have set aside Thursday, March 20 to help people sign up for health care insurance through the Washington Health Plan Finder. (See sidebar story.) ulia Danskin, nursing director for Jefferson County Public Health, noted that there is no deadline to apply for the free health insurance that Lahti is on. Individuals and families with low incomes—a single person making $15,000 a year or less qualifies—can apply anytime for that insurance. OTHER EXPERIENCES While Lahti qualified for free health care under the Medicaid expansion of the state Apple Healthcare program, as did another friend of hers, who is 21, Lahti said she has other friends, including a 26-year-old man, who are having trouble qualifying for insurance. This particular friend has worked in the restaurant business and odd jobs, and hasn't paid income taxes, so he isn't"in the system." Another friend, 31, didn't qualify for free care because she has her own business and makes too much money. She can get insurance, but can't afford the monthly premiums, Lahti said. One friend is totally against mandatory health care insurance and thinks the process is intrusive, she said. The experiences and opinions of her mostly 20-something friends have not deterred Lahti from recommending that people check it out what's available. 20 MINUTES 411111hti said she found both Jefferson County Public Health and Jefferson Healthcare helpful when she walked in seeking help. "It was super easy, refreshingly easy for me," she said. "It probably took 20 minutes." • o Because the health department was busy on the day she decided to sign up, Lahti said, she walked across the street to the hospital, where two employees were seemingly having a competition to see who could sign up people fastest. Because she had previously qualified for another state program, Lahti said, she was already in the system. • NOT INVINCIBLE Lahti acknowledged that her parents, in Wyoming, were"really getting on me for not getting health insurance." "Being young, you think you are invincible," Lahti said. "But what if something really bad happens? I need to have insurance. If there's a catastrophe or a disaster, it will be hard not to have insurance." Lahti said that although car insurance is required of drivers, she rides a bike and "you travel at high speeds on your bike, so something could happen." Lahti finds it comforting that she has insurance now—for just that possibility. After going for six months without insurance—that$130 a month she had been paying represented half of her rent— Lahti signed up for health care at the end of last year because she thought that was the deadline. It was the deadline to obtain health care effective on Jan. 1, 2014. PENALTIES But there's a new deadline: March 31, 2014 is the deadline for obtaining insurance this year; otherwise, people must wait until the open enrollment period in October to obtain insurance for 2015. The penalty for not having health care insurance in 2014 is $95 per adult, $47.50 per child, up to $285 for a family or 1 percent of a family income, whichever is greater. The penalties are to be phased in over three years and by 2016 would cost$2,085, or 2.5 percent of income. And again, Danskin stresses that there is no deadline for those with low incomes who qualify for free care under the Medicaid expansion. PLEASED, DISAPPOINTED It's been an emotional run for the employees of Jefferson Healthcare who have been helping people sign up for health insurance. "It's been so awesome and heartwarming when people who haven't had insurance have been able to get it. It's been so emotional and such a joy," said Erin Brown, compliance officer and financial counseling officer. "On the flip side, it's been crushing when we spend the time to work with someone on the application and the person qualifies for a plan that they still can't afford. So it's been tough." Between October 2013 and February 2014, Jefferson Healthcare signed up 597 newly eligible people for free health insurance. That doesn't include children or renewals, Brown said. Special kudos go to longtime financial counselor Wenkie Schultz, said Brown, one of the top in-person assisters in the • state. "She's had huge enrollment numbers, and that's on top of the re-enrollments," Brown said. w � � EXTRA HELP AVAILABLE An extra resource at Jefferson Healthcare is Nicky McKinney, who is associated with the state Healthcare Authority and is •lable to help people navigate the system and solve problems. "Once someone is in the system, he's able to get them covered," Brown said. Reporting household income and household structures—how many people live in a household —has been tricky to navigate at times, Brown said. "It's been really challenging with people who have income but it's not from work; it's from investments or corporations or self-employment. It's hard to know what to interpret." In fact, Brown said, "There's been a handful of times I've pulled someone out of accounting to talk to patients to help interpret what their accurate income is." McKinney is available weekdays at the hospital. His number is 385-2200, ext. 2265. • • Special hours to sign up on March 20 Jefferson County Public Health and Jefferson Healthcare have set aside special hours on Thursday, March 20 to • help people sign up for qualified health plans through the Washington Health Plan Finder. The open enrollment period to find an insurance plan started on Oct. 1, 2013 and ends on March 31, 2014. Insurance purchased by the end of March would go into effect May 1. People are invited to walk in to the public health department, at 615 Sheridan St., between 5 and 8 p.m., Thursday, March 20; or to the hospital, at 834 Sheridan St., between 5:30 and 8:30 p.m. on the same day. Health insurance seekers who have computers are encouraged to start their applications online at wahealthplanfinder.org and create an account with a username and password, if they can. People experiencing problems signing up can call the hospital's financial counseling office at 385-2200, ext. 2269, or the public health department at 385-9400. Olympic Area Agency on Aging also has advisers to help. Volunteers offer help 1-3 p.m. on the third Tuesday of the month at the Port Townsend Community Center; 10 a.m.-noon, the second and fourth Tuesdays of the month at the Tri-Area Community Center; and 10 a.m.-noon on the fourth Wednesday of the month at the Quilcene Community Center. Jefferson one of top counties for enrollees Jefferson County has enrolled 1,513 people in the state's expanded Medicaid health-insurance program, Apple Health. Only San Juan and Whatcom counties have exceeded Jefferson County in meeting their target number of new enrollees, according to the Washington State Health Care Authority. San Juan surpassed its goal and achieved 304 percent of its target; Whatcom hit 273 percent of its target; and Jefferson achieved 206 percent of its target, according to the state. It has been estimated that 4,000 people in Jefferson County had no health care insurance before the Affordable Healthcare Act took effect. 4111 • Board of Healt( Media Report • April17, 2014 0 • Board of Health Netiv Business .agenda Item #v, 4 . Tefferson .1Cealthcare- Jefferson • County Public 3feaCth Community 3-fealth Improvement Partnership Update A.pril17, 2014 CASCADE PACIFIC ACTION ALLIANCE 1. Host a Regional Table that brings together diverse stakeholders from throughout the region to (figure 3): ✓ Determine shared priorities for action for the entire region; ✓ Receive reports from Local Tables(see below) and assemble a regional implementation picture; ✓ Facilitate shared learning among Local Tables (sharing of best practices and new ideas); V Follow up on issues and actions that require a regional response in order to be moved forward (e.g. regional advocacy, issuing of policy statements, activities related to the State Health Care Improvement Plan, etc.); ✓ Follow up on issues and actions that require a regional response in order to be moved forward (e.g. regional advocacy, issuing of policy statements, activities related to the State Health Care Improvement Plan, etc.); ✓ Modify shared regional action priorities as necessary based on Local Tables' work, needs and feedback. 2. Leverage Local Tables that are county-specific to convert shared regional priorities into concrete action (figure 4): • Rely on key champions in each county to bring together the right people, begin the conversation, host meetings and maintain momentum (local leadership); ✓ Establish task groups with wide variety of community stakeholders to address specific regionally prioritized implementation goals;task groups are open to all, but targeted outreach to key stakeholders is necessary to assemble the right expertise and move the action agenda forward on a • specific topic. Approach • Collaborate across systems to improve our community safety and well-being (e.g., criminal justice, health, education, business and social services) • Proactively engage on the State's Health Care Innovation Plan to: ✓ Test feasibility and implementation of key SHCIP concepts/elements; and ✓ Position the region for potential funding from State and/or CMS. • Define health improvement broadly within framework of social determinants of health, not only from a medical perspective (e.g., county health rankings). • Focus initially on "low hanging fruit"/"easy wins" within the plan to build confidence,trust and forward momentum; address more challenging and complex change agenda later. • Be data driven. Use data to inform choices and guide action priorities. Develop regional data collection and analysis capabilities.Aggregate county-specific health needs assessments into region-wide assessment. Decision Making The Cascade Pacific Action Alliance aims to reach consensus on key decisions. Consensus in this context does not mean 100%agreement on all parts of every issue, but rather that all members review a decision in its entirety and can say"I can live with that." While decisions are not binding on individual members, members are encouraged to adopt collective positions, recommendations or other decisions for joint action where possible. 3 Think Regionally, Act Locally 1111 CASCADE PACIFIC ACTION ALLIANCE 111 We believe that by coming together,proactively responding to and helping to implement change efforts in ways that meet local needs,and speaking withone voice, we have the ability to influence how health care is delivered and purchased in our region. Collectively, we can have greater impact. Operating Principles • Inclusiveness: Keep an open door. Promote broad participation from throughout the region and across sectors, including, but not limited to health care and social service providers, public health and Boards of Health, health plans, employers/businesses, local and state government agencies, criminal justice and other stakeholders that impact health throughout the region. • Equality: All participants have equal standing regardless of organizational size, resources,etc. • Consensus: Decisions are made by consensus. If stakeholders cannot come to agreement,work the issue until everyone can support. Focus on common ground. • Shared Learning: Focus on exploring and sharing opportunities for innovation. Shared Leadership Structure The Cascade Pacific Action Alliance is a voluntary association of diverse stakeholders with a shared leadership structure that incorporates both a regional and existing, local tables(see figures 1 and 2). Shared Leadership(figure 1) Diverse Health Stakeholders (figure 2) • � ' H pt Is ,.r ty riIth Centers Phy an N t ork �"iP,S;+ •RSNs "' Publ c He Ith ;; •Area Agenc es ` y • Ag ng on — �ry d'��'-. � ' j •Hous ng Agencies *' Commun'ty MH& /'' .a. CD ProJders k3.,2 •Medicaid n`ec a K orgengzat ons •State Agencies / •Boards of Health •Law �/ •Business Enforcement Associations •Jails .Eco Development Regional Table (figure 3) Local Table(figure 4) Plan xr ,x •Set local priorities w/in shared regional priorities • a� .. •Establish task groups as necessary . c� •Develop action plans •Implement local action plans •Share!earnings w/Regional Table •Participate in regional action 11111 2 Think Regionally, Act Locally ro P' CASCADE PACIFIC ACTION ALLIANCE Improving Community Health & Safety- III Purpose The Cascade Pacific Action Alliance is formally established as a regional association of independent stakeholders focused on a shared action agenda to improve individual and community safety and wellbeing, while advancing the Triple Aim.The goals of the Triple Aim, as adopted by the Centers for Medicare and Medicaid (CMS),are defined as: Improving the patient experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of healthcare. We do that by: • Hosting a regional table of cross-sector stakeholders to design and implement health system improvements, including state and local governments, health and social service providers, insurance companies, businesses,foundations and other community partners; • Identifying and advocating for shared, regional priorities; • Proactively designing and testing the feasibility of the state's regional innovation plan; and • Positioning our region for potential federal, state and other funding. The Cascade Pacific Action Alliance is a voluntary association convened in the spirit of collective impact. It includes Grays Harbor, Lewis, Mason, Pacific and Thurston counties, and is open to other, neighboring counties interested in participating. Rationale The Cascade Pacific Action Alliance is established in the context of federal and state reform efforts that • fundamentally and directly affect the future of local communities, including: • Washington State's Health Care Innovation Plan submitted to CMS in December 2013, which creates regional communities of health (COHs), including one for our 8 counties; and • State legislation (HB 2572, HB 2639, HB 1519, among others)to restructure Medicaid procurement, set local performance measures, provide grants to regional communities of health, and integrate mental health and chemical dependency services. Bottom Line: These and other initiatives will impact how health care is delivered and purchased in our counties— a region with a $5.7 billion health care industry and a $1.1 billion Medicaid budget. Why This Matters to Us Total Medicaid Expenditures Medicaid Clients Compared to $350,000,000 $300,000000T4 i County Population $250,000,000 $200,000,000 ' 300000 200000 $150,000,000 $100,000,000 100000 0 $50,000,000 ;' 3 - $ ,C- AS 0t ,jQ . o� y\G y� �\•a eta ,, •<1 teeay a0 r�� �`' � TOTAL Medicaid Clients E TOTAL County Population Source:2008-2009 DS' lient Data retrieved from:http://clientdata.rda.dshs.wa.gov/ • Jefferson County Commissioner John Austin decides against third run for seat By Charlie Bermant , Peninsula Daily News, March 19, 2014 0 !! 11,- . , -.0t , :1 - k: ' ' 04 - Jefferson County Commissioner John Austin announced Tuesday he will not seek re-election for a third term. —Charlie Bermant/Peninsula Daily News PORT TOWNSEND—Jefferson County Commissioner John Austin announced Tuesday that he will not run for a third four-year term. He acknowledged the reasons for his decision sound like a cliche. "The main reason for this is that I want to spend more time with my family, and I want to travel,"Austin said. "I know a lot of politicians say this when they leave office, but since I've been elected, I have produced three grandchildren and understand that the opportunity to have a great grandparenting experience has a short shelf life." iiistin, who will turn 73 on April 4, disclosed his plans to the Peninsula Daily News on Tuesday morning and was set to Ispgke a public announcement of his plans at a county Democratic Party function that evening in Quilcene. The candidate filing period will be May 12-16 for the August primary and November general elections. One of Austin's last official acts before he announced he would not run again was to approve, along with fellow commissioners David Sullivan and Phil Johnson, an increase in county commissioners' salaries, to take effect in 2017. Seats now held by Johnson and Sullivan will be open for the 2016 election. Coinciding with Austin's announcement, Democrat Kathleen Kler, a member of the county Parks and Recreation and Port Townsend Film Festival boards, said she plans to run for the District 3 seat, which includes Port Ludlow, Quilcene, Brinnon and the western part of the county that extends to the Pacific Ocean. Kler, 63, a Quilcene resident, said Tuesday that one of her priorities will be to make sure South County citizens are represented in the courthouse. "If I am elected, I am going to take the opportunity to sit with the people who feel they are not being heard, for whatever reason," she said. Austin, a retired psychologist, moved to Port Ludlow from Minnesota in 2004 and was elected county commissioner in 2006 and 2010. e said his most significant accomplishments have to do with environmental preservation, exchanging land with the state partment of Natural Resources to prevent clearcutting on Marrowstone Island and Port Ludlow properties, and preserving a park between Gibbs Lake and Beausite Lake south of Chimacum. "A lot of things that happened in the county, like beginning the establishment of the Port Hadlock sewer system, would have happened without me, but helping to save this land is something that I will feel good about forever," he said. Austin sought to have the county acquire forestland between the Beausite Lake and Gibbs Lake county parks to create an expanded Gibbs Lake Park. • The state Department of Natural Resources withheld the timber on the land from the Silent Alder sale in 2010, preserving the forest there. "This will be a jewel of a park, where people can ride their bikes and horses and enjoy nature,"Austin said. "It might become the best park in the county." Austin's tenure coincided with the recession and its impact on government. "If government were funded at a level commensurate with the inflation rate and the value of the dollar, it would be able to function better," he said. "We are told that we need to tighten our belts, but there is not a lot of fat in this government, and if we don't do some things, there is a tremendous social cost," he added. "If we don't fix our roads periodically, we will need to replace the road beds, and if we don't vaccinate our children, there is a significant increase in disease." Austin said he was at first troubled by what he perceived to be unwarranted criticism before realizing that most of the people he came into contact with feel he is doing a good job and tell him so. Once, he said, he was riding the bus when a constituent"began a rant against the county and the transit system and said he was never going to vote for me again," which amused him because he had already decided not to run. ID "There was another guy sitting on the bus who seemed like he was in his own world, that he wasn't paying attention, but when the first guy got off of the bus, he opened his eyes and said, 'I'll vote for you," Austin said. "That was a very emotional experience." His experience with his fellow commissioners was fulfilling, Austin said, because"even if we disagreed on some things, we have always been civil and have listened to each other." After leaving office, Austin said, he plans to take a monthlong canoe trip in Minnesota, travel across the nation on a train, visit a friend in Turkey and hike the Olympic range. "There are a lot of things I want to do that aren't possible as a commissioner,"Austin said. "I was never comfortable leaving the county for more than 10 days at a time." Jefferson County Editor Charlie Bermant can be reached at 360-385-2335 or cbermant(a7peninsuladailynews.com. • Keefer takes`Survive and • Thrive'training Jared Keefer, direc- tor of Jefferson County Environmental Health and Water Quality, has graduated from a 12-month program titled "Survive and Thrive: Roadmap for New Local Health Officials," offered by the National Association of County and City Health Officials(NACCHO). The program is designed to enhance the skills of top executives at local health departments, providing them • with tools and experiences to help them work with elected officials and community partners, manage strategic planning and health depart- ment resources, and discover approaches for addressing challenges unique to local health department leaders. "My participation in `Survive and Thrive' was extremely rewarding," said Keefer."I feel empowered and better equipped to lead with- in Jefferson County Public Health, as well as partnering with vital community stake- holders to help those we serve." ��q/y 110 Jefferson County Board of Health honors Public Health Heroes Port Townsend Leader, March 26, 2014 3:30 am Every year, as Public Health Week is celebrated nationally, local Jefferson County Public Health Heroes are nominated. This year, the Jefferson County Board of Health presented the Public Health Heroes award to individuals for their work assisting citizens to enroll in the Affordable Care Act (ACA) health insurance exchange. Everyone on this list played the role of an "assister" to help people enroll in Washington state health care plans. The Public Health Heroes are: Olympic Area Agency on Aging volunteers Barbara Smith, Don Corbett, Nancy McGonagle, Waldenbergand Sally Aerts, and staff members Heaven Gregg and Paula Gibeau; Phyllis Jefferson Healthcare Financial Services staff Jennifer Tjemsland, Melissa Sherwood, Wenkie Schultz and Erin Brown; Jefferson County Public Health (JCPH) staff Anna McEnery, Cynde Marx, Heather Sebastian, Karen Obermeyer, Kathy Dane, Kelly von Volkli and Julia Danskin; and Nicky McKinney from the Health Care Authority located at Jefferson Healthcare. Jefferson County Commissioner David Sullivan said at the presentation, "You each recognized a large community need and worked to sort out the complicated Web pages and directions. You met with neighbors and citizens enrolling them into health insurance plans. Volunteers and staff at the Area Agency on Aging, Jefferson Healthcare and Jefferson Public Health have worked in this effort to improve quality of life for Jefferson County citizens. You were instrumental in expanding the number of Jefferson County residents who will be served under the Affordable Care Act." These volunteers stepped in to try to improve use of the health care insurance system and help • people navigate the process. "People are already using health care insurance they did not have three months ago. People are being seen, bills are being paid and a system of care has started," said Jean Baldwin of JCPH. Enrollment for health insurance is open to all citizens until March 31; for those who will qualify for Medicaid, enrollment is open throughout the year. In addition to volunteering to assist in health insurance enrollment, Barbara Smith, Don Corbett, Nancy McGonagle and Sally Aerts are also active SHIBA volunteers with Olympic Area Agency on Aging, helping those ages 65 and older to enroll in Medicare prescription drug plans and helping with Medigap supplements, too. They continue to do this throughout the year at drop-in clinics throughout the county. • Quilcene Public Health Clinic 10 a.m.-2 p.m Wednesdays 1 medical building near post office CALL 385-9400 • • S g/62// Port Townsend Paper Corp. drops biomass expansion plans [Clarification] By Paul Gottlieb , Peninsula Daily News,April 4, 2014 • 4 e w. Port Townsend Paper is scrapping plans for a$54 million project to improve the mill's biomass cogeneration plant. —Charlie Bermant/Peninsula Daily News Clarifies month when Hagen became company president. PORT TOWNSEND— Port Townsend Paper Corp. has abandoned a much-disputed $54 million project that would have upgraded the mill's biomass cogeneration plant. Company President Roger Hagan told the Peninsula Daily News on Wednesday that the company's construction permit will not be extended beyond the 18-month June deadline for the improvements. not a financially viable project," said Hagan, who took over at the mill last May, succeeding Roger Loney. "It is not our intention to proceed with the project or ask for another extension." He attributed the decision to environmental challenges that delayed the project, an overwhelmingly strong market for cheap natural gas compared with biomass and the expiration of federal tax-credit incentive programs despite a $2 million state grant for the project that the company received in 2009. The project would have allowed the factory to burn forest biomass to create 24 megawatts for sale as green energy. Nippon Paper Industries USA in Port Angeles has built an $85 million expansion of its biomass cogeneration plant that was dedicated in November but has yet to go online while a new boiler is repaired. Nippon benefited from federal tax incentives that did not make or break the Port Angeles project but gave it a "significant" financial boost, Nippon plant manager Steve Johnson said Thursday. Johnson, promoted in March to take over for Harold Norlund —who resigned to take a paper mill job in Canada —said the two mills would not have competed for electricity sales because of the relatively small amount of electricity produced by the plants. Both projects have survived numerous challenges by environmental groups that have claimed that burning wood to create energy is too costly to the environment. Officials have said they had satisfied environmental concerns and that projects were properly permitted. In Port Townsend Paper's most recent victory, the state Supreme Court in February upheld the company's permit for the •oiect turning back an appeal by five environmental groups, including PT AirWatchers of Port Townsend. PT AirWatchers Director Gretchen Brewer, who said Feb. 27 that she was "sorely disappointed" by the court's ruling, was anything but dispirited when informed Thursday that the company was dropping the project. "That is very exciting," Brewer said. "It does vindicate what we have been saying all along: that this is a dirty, polluting project. "If they follow through and don't seek a permit extension, and cancel the project, I think it shows by citing the environmental cost . . . how important it is that the whole community expression of concerns about the environment and 1111 the well-being of the environment has finally reached their ears, and for that, we are extremely happy." Said Hagan: "Would the project have gone on without the environmental challenges? It's hard to say. "I couldn't say definitely that it sunk the project, but it certainly was a factor." The upgrade would have created 108 temporary jobs and 30 new jobs at the mill, which employs 290 full-time workers and is the largest private employer in Port Townsend, with $100 million to $300 million in annual revenue. Hagan said the company is proceeding with $10 million to $12 million for federally required environmental upgrades that spurred the company's interest in also upgrading its existing biomass plant to help cover the cost of the improvements. In the project, the existing biomass-powered boiler would have powered a new turbine that would have produced steam for the plant and 24 megawatts at the mill, which consumes a third of all the recycled cardboard collected in the state and converts it into paperboard products. The expansion project, slated for completion in April 2012, was delayed by court appeals and had been scheduled to be online by this year or 2015. In addition, after the tax-credit incentive programs dried up, the company was left competing with natural gas on the open market, Hagan said. Hagan said power produced by Port Townsend Paper's cogeneration plant would have cost electricity customers "on the order of twice" what they would pay for natural gas. "Natural gas sets basically the cost of energy in the U.S.," Hagan said. Natural gas is an alternate fuel that is cheaper than biomass because it is not a renewable energy, company spokesman Kevin Scott said Thursday. By comparison, Nippon already has customers for the 20 megawatts its cogeneration plant will produce once repairs are completed, Johnson said in an earlier interview. Hagan said that unlike Nippon, where company officials have said electricity sales are vital to the mill's survival, the market remains "fairly strong" for Port Townsend Paper Corp. products—with or without an upgraded cogeneration plant. "It was a good project that would have provided us a return on an investment, much of which we have to make anyway," Hagan said. "It didn't work out that way, so we are just moving on." 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'.(4.1.....:.';,, q f _4y{.� F �.^^ y S acv rY • PTPC officials won't request extension to build cogeneration plant By Allison Arthur, Port Townsend Leader, April 9, 2014 Port Townsend Paper Corp. (PTPC) won every environmental battle it fought to build a $55 million biomass cogeneration facility. In the end, economics ended it. "It's a perfectly good project from an environmental perspective," PTPC president Roger Hagan said. "It doesn't make sense to do it from an economics standpoint." PTPC officials confirmed last week what many had suspected for almost a year: that the cogen project to generate 25 megawatts of power, which also could have created some 30 permanent jobs and supported three times as many temporary jobs, was dead. Mill officials had put the project on hold in late 2012, announcing that they would seek an 18-month extension from the state Department of Ecology (DOE) to make progress on the project, in part because of legal appeals and in part because of changes in the economic climate. The DOE granted the extension, set to expire in June 2014. • "It all comes down to economics," said PTPC environmental director Kevin Scott on April 4. "Incremental power prices are being set by low-cost natural gas. Renewable power costs more than natural gas, and most people aren't currently willing to spend more for renewable power when they can get lower-priced power from gas." He added, "Unfortunately, if the project doesn't go forward, then the 100 construction jobs and the new jobs supplying biomass won't be showing up either." While Hagan and Scott indicated they would not seek an extension from DOE, PT AirWatchers director Gretchen Brewer is not celebrating yet. "It's provisionally dead," said Brewer, who led the charge against the cogen project, forcing the DOE to rescind an initial approval back in 2010 and making the state redo its State Environmental Protection Act process. DOE had put the project on the fast track for approval and had not required an environmental impact statement. "It will be really dead when they withdraw it or they let it lapse in June," said Brewer. Neither Hagan nor Scott could say how much money the mill had spent in pursuit of the permits over the last four years. But Hagan, who took over as president last year, acknowledged the mill still will be • spending $10 million to $12 million to add pollution-control equipment to Boiler No. 10. WHAT WERE THE FACTORS? Scott said the appeals by environmental groups did not have an impact on the mill's decision. "The appeal filed by PT AirWatchers had very little to do with the project not being viable. It just comes down to the economics of renewable power competing with low- priced natural gas." Scott also noted that the mill would be installing the electrostatic precipitator (ESP) and that, "If the cogen project had gone forward on the original schedule, these controls would have been installed a couple of years sooner." The proposed project won three rounds of approval: It was approved by DOE. That approval was upheld by the state Pollution Control Hearings Board. And that board's approval was upheld by the state Supreme Court. But in 2012, Scott said the cogeneration project was "under consideration" because the • market for green electricity "is not viable." That's when the mill sought an extension on its permit. Five environmental groups, including PT AirWatchers, argued that such a project was not environmentally sound. They were concerned about increasing air pollution, specifically carbon monoxide emissions and volatile organic compounds. A report by Partnership for Policy Integrity, released on April 2, concluded that biomass electricity generation "is more polluting and worse for the climate than coal." The report, "Trees, Trash, and Toxics: How Biomass Energy Has Become the New Coal" by Mary S. Booth, was touted in a press release in which Brewer also was quoted. Booth's analysis found that although wood-burning plants are often promoted as being good for the climate and carbon neutral, the low efficiency of the plants means they emit more CO2 than coal. i • • ENVIROSTAR57 CERTIFIED ri]Eiwiris-rs Uptown Dental Clinic 385-4700 Tyler Fordham,DDS 385-7000 Dentistry Northwest 385-1000 Envirostars Certification is free and can help you attract new customers. PUBLIC HEALTH ...ALWAYS WORKING-FOR A SAFER AND HEALTHIER COMMUNITY To get certified call 379-4489 110 •