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Home My WebLink About2014- September 110 Jefferson County Public Health Agenda • & Minutes Extra Copy for Meeting September 18, 2014 JEFFERSON COUNTY BOARD OF HEALTH September 18, 2014 Jefferson County Public Health 615 Sheridan St. Port Townsend, WA 2:30 —4:30 PM DRAFT AGENDA I. Approval of Agenda H. Approval of Minutes of August 21, 2014 Board of Health Meeting III. Public Comment IV. Old Business and Informational Items 1. Entereovirus D-68 suspected in Seattle 2. Dabob and Quilcene Bays Closed due to Paralytic Shellfish Poisoning 3. 2014-2015 Influenza and Pneumonia Information 4. WA State Dept. of Ecology Pet Waste Facts • V. New Business 1. Public Hearing: Environmental Health Fee Revisions 2. Call for Public Hearing, October 16, 2014: Solid Waste Code Revisions 3. Washington State Regionalization Efforts—Behavioral Health, Chemical Dependency, Health Care Services, and Public Health 4. Peninsula Accountable Community of Health Planning Process 5. Substance Abuse Board Resignation VI. Activity Update : 1) Environmental Health Updates VII. Public Comment VIII. Agenda Planning Calendar IX. Next Scheduled Meeting: October 16, 2014 2:30 —4:30 PM Jefferson County Public Health To Be Determined Port Townsend, WA • JEFFERSON COUNTY BOARD OF HEALTH • MINUTES Thursday, August 21, 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,Public Health Manager Sally Aerts,citizen at large 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 Jill Buhler,Hospital Commissioner,District#2 Chair Sullivan called the August 21, 2014 meeting of the Jefferson County,Board of Health to order at 2:31 p.m. A quorum was present. Members Present: Jill Buhler, David Sullivan, Kris Nelson, Sheila Westerman, Phil Johnson, Sally Aerts Members Excused: John Austin • Staff Present: Thomas Locke, Jean Baldwin, Jared Keefer, Julia Danskin, Veronica Shaw APPROVAL OF AGENDA Chair Sullivan called for review and approval of the agenda for the 08/21/2014 meeting. Member Buhler to give the Board an update on the new Supreme Court Ruling—added as item seven to New Business. Member Nelson moved to approve the agenda; the motion was seconded by Member Buhler. The motion passed unanimously. APPROVAL OF MINUTES Chair Sullivan called for review and approval of the minutes of the 7/17/2014 meeting of the Board of Health. Chair Sullivan corrected the minutes to reflect that Member Westerman recommended removing the identification of county (Aerts) and city (Westerman) on the member list. • Chair Sullivan presented a statement to be added to the minutes, reflecting a discussion the Board had during item three of New Business: Chimacum Prevention Coalition Strategic Plan. The statement is as follows: • "The Board discussed how overstating dangers from marijuana use could undermine credibility of educators and education materials at a time when scientific research is revealing legitimate concerns regarding the use of marijuana by youth." Member Johnson moved to approve the minutes; the motion was seconded by Member Westerman.No further discussion. The motion passed unanimously. PUBLIC COMMENT No Public Comment. OLD BUSINESS AND INFORMATIONAL ITEMS 1. Port Townsend Paper Corporation Settlement Agreement the Jared Keefer, Director of Environmental Health and Water Quality, JCPH, provided Board with a copy of the Port Townsend Paper Corporation Settlement Agreement. The appeal process is over and the permit has been issued. 2. Correspondence BOH Julia Danskin, Public Health Manager, JCPH, informed the Board that two thank you letters were sent to people who resigned from the Substance Abuse Advisory Board (SAAB): Lois Barnett and Sam Markow. Ms. Danskin announced that the SAAB now has vacancies. NEW BUSINESS 1. Proposed Revisions to Jefferson County Solid Waste Code Mr. Keefer provided the Board with the Jefferson County Solid Waste Code,with the following changes: a. Additional Language to definition of junk vehicle b. Changed the format to the definition of junk vehicle c. Deleted the duplication of language in the section titled"Denial of Property Access" (8.10.950) (3) (c) d. Added a Hearing Procedures section for Appeals of NOCV, Enforcement Action or other Public Health Action (8.10.950) (7) (a) (iii) e. Edited the Appeals of NOCV, Enforcement Action or other Public Health Action (8.10.950) (7) (b), (i), (iii) and (iv)to be consistent with other portions of the ordinance, current practice and other Public Health Programs. f. Added a procedure section(vi)to 8.10.950 (7) (d) for Board of Health hearings. g. Updated the titles of the Board of Health members on the last page. • Member Buhler recommended adding the words "or more" in the junk vehicle section so • that it now reads "For enforcement purposes,possessing three (3)or more junk cars on a single property of any size is not allowed under this regulation." Member Westerman asked Mr. Keefer to return to the Board with a scientific reason as to why pet feces, especially dog droppings, shall not be disposed of into a sanitary sewer (unless approved by the sewer purveyor), storm sewer, or on-site sewage system. Dr. Locke was asked why section 8.10.950 (7) (d) (vi)(F)prohibited cross-examination of witness. Dr. Locke explained this prohibition means that the two opposing sides can't ask questions of each other. Only the Board can ask questions. This is designed to give the Board the ability to gather the information it needs in a non-adversarial fashion. Member Buhler suggested the formatting of 8.10.950(6) (d) (ii) be changed so that(ii) becomes "(e) re-inspection."which would in turn make (iii) change to (ii), and adjust all subsequent letters following (e). Member Westerman moved to schedule a public hearing on the Solid Waste Code as provided in the handout for the September 18, 2014 BOH meeting. The motion was seconded by Member Johnson. The motion passed unanimously. 2. School Based Health Centers Review Karen Obermeyer, Health Educator, JCPH, said sports physicals started in Chimacum, • Port Townsend, and Quilcene. She shared the 2013-2014 School Based Health Centers Participation Reports. Ms. Obermeyer reported that 275 students were served for primary medical care in the county. Based on enrollment numbers (grades 9-12), approximately 40% of the Chimacum school body and 30%of the Port Townsend school body accessed physical health services, resulting in 650 visits per year (Data for mental health services will not be available until late fall.) She reported that the top student concerns at clinic visits are reproductive health, sports physicals, injuries, immunizations, and flu/cold, while the top clinician addressed issues are reproductive health, sports physicals, vision/hearing/blood pressure screening, injury, and immunization. Ms. Obermeyer noted that over time, the frequency of visits is decreasing because students and providers are establishing a relationship that allows for more efficient visits. Additionally, Ms. Obermeyer informed the board of the Healthy Community Funding Grant, which allows them to work with the school districts on projects related to school health, such as a walking audit for Chimacum primary, updating the Port Townsend School District wellness policy, and working on target goals for getting farm- to-school foods included in the cafeteria. The Gimme 5 program, also funded by Healthy Communities,UGN, and Jefferson Healthcare, matches the amount a WIC family receives in their farmers' market checks. Ms. Obermeyer informed the Board that the redemption rate of farmers' market checks increased from 59%to 86% after the introduction of the program. In June, 70 packets were given to qualifying WIC families, and as of this week they have 100 additional packets to distribute. 3. EH Hourly Rate for Technical Staff Mr. Keefer presented the Board with the proposed Environmental Health Hourly Rate • Fee increase. The current rate is $67.44 per hour and is insufficient to cover program costs. The proposed rate increase is to $85 per hour. When asked about the Board of Health's fee setting authority, Dr. Locke explained that Boards of Health are authorized to assess fees to cover the full cost of the enforcement of public health codes. Fees are not allowed to generate revenue in excess of program costs. Member Westerman suggested Mr. Keefer adjust the "Plan, Document and Waiver/Variance Review"to reflect the increased hourly rate. Member Nelson moved to schedule a public hearing on the EH Hourly Fee Schedule as provided in the handout for the September 18,2014 BOH meeting. The motion was seconded by Member Westerman.The motion passed unanimously. 4. Community Health Improvement Plan–Activity Update Jean Baldwin, Director, JCPH, shared the Draft Community Health Improvement Plan with the Board. The group of 25, led by Jefferson Healthcare and JCPH,reviewed the results of the community health assessment and voted to identify the following goals as top priorities: a. Access to mental health and substance abuse care b. Nutrition/Exercise throughout life cycle c. Access to Care • d. Immunizations Underlying these top issues are the ongoing root causes that impact health—Academic, 4111economic, and housing—and must be addressed by the community as a whole. Ms. Baldwin provided the Board with a chart showing the overlap of final priorities compared to national and state strategies. The Board will be provided with a fact sheet based on the data when it becomes available. 5. Communicable Disease Update Dr. Locke presented the YTD WA State STD Services information on Gonorrhea to the Board. He reported that cases have tripled from 2013 (3 cases)to 2014 (9 cases), but that this is still a small number of cases. Dr. Locke stated that the Jefferson County rate has typically been much lower than the neighboring counties of Kitsap and Clallam because of the availability of family planning services,high rates of screening, and the ability to detect and treat cases therefore causing a lower risk of exposure. The primary control strategy is to get as close to universal screening as possible. The increased rates of gonorrhea in Jefferson County appear linked to methamphetamine use and JCPH has implemented a free urine screening as part of its syringe exchange program. 6. Regionalization of Medicaid and Behavioral Health Ms. Baldwin shared a letter written on behalf of the Board of County Commissioners for Kitsap, Clallam, and Jefferson Counties. Dr. Locke drafted the letter, which goes on record to state that they do not support a 10-county Accountable Community of Health (ACH), and urges the Washington State Health Care Authority (HCA), and Department of Social and Health Services (DSHS)to support a three-county ACH. Dr. Locke • informed the Board that we are still interested in working with the 10-county ACH but • that key stakeholders in the 3 counties felt it was necessary to fornially put the HCA on notice that we did not support designation of a 10 county ACH. 7. WA State Supreme Court Ruling on Psychiatric Boarding Member Buhler informed the Board and expressed her concern of the Washington State Supreme Court ruling,which cites psychiatric boarding as unlawful. This law states that hospitals can't hold anyone involuntarily for more than three hours if they do not have an inpatient bed available to refer them to. Ms. Buhler informed the Board that the hospital has called a meeting with the Police Chief, ER Staff, and Nursing Staff. More information will be reported at next month's Board meeting. ACTIVITY UPDATE Mr. Keefer told the Board that Environmental Health is three months behind on septic permits, largely due to the large numbers of septic repairs, which are given priority. He is putting contingency plans in place and has increased staff hours. PUBLIC COMMENT No Public Comment. • AGENDA PLANNING CALENDAR No Agenda Planning. NEXT SCHEDULED MEETING The next Board of Health meeting will be held on Thursday, September 18, 2014 from 2:30— 4:30 p.m. at Jefferson County Public Health, 615 Sheridan Street, Port Townsend, WA. ADJOURNMENT Chair Sullivan adjourned the August 21,2014 Jefferson County Board of Health meeting at 4:24 p.m. JEFFERSON COUNTY BOARD OF HEALTH Phil Johnson, Member Jill Buhler, Member • JEFFERSON COUNTY BOARD OF HEALTH • MINUTES Thursday, August 21, 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,Public Health Manager Sally Aerts, citizen at large 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 Jill Buhler,Hospital Commissioner,District#2 Chair Sullivan called the August 21, 2014 meeting of the Jefferson County Board of Health to order at 2:31 p.m. A quorum was present. Members Present: Jill Buhler, David Sullivan, Kris Nelson, Sheila Westerman, Phil Johnson, Sally Aerts Members Excused: John Austin IDStaff Present: Thomas Locke, Jean Baldwin, Jared Keefer,_Julia Danskin, Veronica Shaw APPROVAL OF AGENDA Chair Sullivan called for review and approval of the agenda for the 08/21/2014 meeting. Member Buhler to give the Board an update on the new Supreme Court Ruling—added as item seven to New Business. Member Nelson moved to approve the agenda; the motion was seconded by Member Buhler. The motion passed unanimously. APPROVAL OF MINUTES Chair Sullivan called for review and approval of the minutes of the 7/17/2014 meeting of the Board of Health. Chair Sullivan corrected the minutes to reflect that Member Westerman recommended removing the identification of county (Aerts) and city (Westerman) on the member list. Chair Sullivan presented a statement to be added to the minutes, reflecting a discussion the Board had during item three of New Business: Chimacum Prevention Coalition Strategic Plan. The statement is as follows: • "The Board discussed how overstating dangers from marijuana use could undermine credibility of educators and education materials at a time when scientific research is revealing legitimate concerns regarding the use of marijuana by youth." Member Johnson moved to approve the minutes; the motion was seconded by Member Westerman. No further discussion. The motion passed unanimously. PUBLIC COMMENT No Public Comment. OLD BUSINESS AND INFORMATIONAL ITEMS 1. Port Townsend Paper Corporation Settlement Agreement k iNO:„W Jared Keefer, Director of Environmental Health and Water Quality. JCPH, provided the .x` Board with a copy of the Port Townsend Paper Corporation Settlement Agreement. The appeal process is over and the permit has been issued. 2. Correspondence BOH w`" Julia Danskin, Public Health Manager, JCPH, informed the Board that two thank you letters were sent to people who resigned from the Substance Abuse Advisory Board • (SAAB): Lois Barnett and Sam Markow. Ms. Danskin announced that the SAAB now has vacancies. NEW BUSINESS 1. Proposed Revisions to Jefferson County Solid Waste Code Mr. Keefer provided the Board with the Jefferson County Solid Waste Code, with the following changes: a. Additional Language to definition of junk vehicle b. Changed the format to the definition of junk vehicle c. Deleted the duplication of language in the section titled "Denial of Property Access" (8.10.950) (3) (c) d. Added a Hearing Procedures section for Appeals of NOCV, Enforcement Action or other Public Health Action (8.10.950) (7) (a) (iii) e. Edited the Appeals of NOCV, Enforcement Action or other Public Health Action (8.10.950) (7) (b), (i), (iii) and (iv) to be consistent with other portions of the ordinance, current practice and other Public Health Programs. f. Added a procedure section (vi) to 8.10.950 (7) (d) for Board of Health hearings. g. Updated the titles of the Board of Health members on the last page. • . Member Buhler recommended adding the words "or more" in the junk vehicle section so that it now reads "For enforcement purposes, possessing three (3) or more junk cars on a single property of any size is not allowed under this regulation." Member Westerman asked Mr. Keefer to return to the Board with a scientific reason as to why pet feces, especially dog droppings, shall not be disposed of into a sanitary sewer (unless approved by the sewer purveyor), storm sewer, or on-site sewage system. Dr. Locke was asked why section 8.10.950 (7) (d) (vi)(F)prohibited cross-examination of witness. Dr. Locke explained this prohibition means that the two opposing sides can't ask questions of each other. Only the Board can ask questions. This is designed to give the Board the ability to gather the information it needs in a non-adversarial fashion. Member Buhler suggested the formatting of 8.10.950(6) (d) (ii) be changed so that (ii) becomes "(e) re-inspection." which would in turn make (iii) change to (ii), and adjust all subsequent letters following (e). Member Westerman moved to schedule a public hearing on the Solid Waste Code as provided in the handout for the September 18, 2014 BOH meeting. The motion was seconded by Member Johnson. The motion passed unanimously. 2. School Based Health Centers Review Karen Obermeyer, Health Educator, JCPH, said sports physicals started in Chimacum, • Port Townsend, and Quilcene. She shared the 2013-2014 School Based Health Centers Participation Reports. Ms. Obermeyer reported that 275 students were served for primary medical care in the county. Based on enrollment numbers (grades 9-12), approximately 40% of the Chimacum school body and 30% of the Port Townsend school body accessed physical health services, resulting in 650 visits per year. (Data for mental healthservices will not be available until late fall.) She reported that the top student concerns at clinic visits are reproductive health, sports physicals, injuries, immunizations, and flu/cold, while the top clinician addressed issues are reproductive health, sports physicals, vision/hearing/blood pressure screening, injury, and immunization. Ms. Obermeyer noted that over time, the frequency of visits is decreasing because students and providers are establishing a relationship that allows for more efficient visits. Additionally, Ms. Obermeyer informed the board of the Healthy Community Funding Grant, which allows them to work with the school districts on projects related to school health, such as a walking audit for Chimacum primary, updating the Port Townsend School District wellness policy, and working on target goals for getting farm- to-school foods included in the cafeteria. The Gimme 5 program, also funded by Healthy Communities, UGN, and Jefferson Healthcare, matches the amount a WIC family receives in their farmers' market checks. Ms. Obermeyer informed the Board that the redemption rate of farmers' market checks increased from 59%to 86% after the introduction of the program. In June, 70 packets were given to qualifying WIC families, and as of this week they have 100 additional packets to distribute. • • 3. EH Hourly Rate for Technical Staff Mr. Keefer presented the Board with the proposed Environmental Health Hourly Rate Fee increase. The current rate is $67.44 per hour and is insufficient to cover program costs. The proposed rate increase is to $85 per hour. When asked about the Board of Health's fee setting authority, Dr. Locke explained that Boards of Health are authorized to assess fees to cover the full cost of the enforcement of public health codes. Fees are not allowed to generate revenue in excess of program costs. Member Westerman suggested Mr. Keefer adjust the "Plan,Document and Waiver/Variance Review"to reflect the increased hourly rate. Member Nelson moved to schedule a public hearing on the EH Hourly Fee Schedule as provided in the handout for the September 18, 2014 BOH meeting. The motion was seconded by Member Westerman. The motion passed unanimously. 4. Community Health Improvement Plan–Activity Update Jean Baldwin, Director, JCPH, shared the Draft Community Health Improvement Plan with the Board. The group of 25, led by Jefferson Healthcare and JCPH, reviewed the results of the community health assessment and voted to identify the following goals as top priorities: a. Access to mental health and substance abuse care b. Nutrition/Exercise throughout lifecycle c. Access to Care d. Immunizations Underlying these top issues are the ongoing root causes that impact health—Academic, economic, and housing—and must be addressed by the community as a whole. Ms. Baldwin provided the Board with a chart showing the overlap of final priorities compared to national and state strategies. The Board will be provided with a fact sheet based on the data when it becomes available. 5. Communicable Disease Update Dr. Locke presented the YTD WA State STD Services information on Gonorrhea to the Board. He reported that cases have tripled from 2013 (3 cases)to 2014 (9 cases), but that this is still a small number of cases. Dr. Locke stated that the Jefferson County rate has typically been much lower than the neighboring counties of Kitsap and Clallam because of the availability of family planning services, high rates of screening, and the ability to detect and treat cases therefore causing a lower risk of exposure. The primary control strategy is to get as close to universal screening as possible. The increased rates of gonorrhea in Jefferson County appear linked to methamphetamine use and JCPH has implemented a free urine screening as part of its syringe exchange program. 6. Regionalization of Medicaid and Behavioral Health Ms. Baldwin shared a letter written on behalf of the Board of County Commissioners for Kitsap, Clallam, and Jefferson Counties. Dr. Locke drafted the letter, which goes on record to state that they do not support a 10-county Accountable Community of Health (ACH), and urges the Washington State Health Care Authority (HCA), and Department • of Social and Health Services (DSHS) to support a three-county ACH. Dr. Locke informed the Board that we are still interested in working with the 10-county ACH but • that key stakeholders in the 3 counties felt it was necessary to formally put the HCA on notice that we did not support designation of a 10 county ACH. 7. WA State Supreme Court Ruling on Psychiatric Boarding Member Buhler informed the Board and expressed her concern of the Washington State Supreme Court ruling, which cites psychiatric boarding as unlawful. This law states that hospitals can't hold anyone involuntarily for more than three hours if they do not have an inpatient bed available to refer them to. Ms. Buhler informed the Board that the hospital has called a meeting with the Police Chief, ER Staff, and Nursing Staff. More information will be reported at next month's Board meeting. ACTIVITY UPDATE Mr. Keefer told the Board that Environmental Health is three months behind on septic permits, largely due to the large numbers of septic repairs, which are given priority. He inputting contingency plans in place and has increased staff hours. PUBLIC COMMENT k aa� No Public Comment. 3 xe AGENDA PLANNING CALENDAR No Agenda Planning. . ., NEXT SCHEDULED MEETING The next Board of Health meeting will be held on Thursday, September 18, 2014 from 2:30— 4:30 p.m. at Jefferson County Public Health, 615 Sheridan Street, Port Townsend, WA. ADJOURNMENT Chair Sullivan adjourned the August 21, 2014 Jefferson County Board of Health meeting at 4:24 p.m. JEFFE ' ON OUNTY BOARD OF HEALTH c:a Phil Johnso Member ill Buhler, Member • /i, /i'IP ii 410 Sally . erts, ,ember David Sullivan, Chair )1 ,i'l I III 4,\ \,/\ oa. Kris Nelson, Member Jo Austin, Member vti:R l,t1.- til) ,-14 -s--- Sheila Westerman, Vice Chair Respectfully Submitted: Natalie Crump ia , • 4g ;fib} 1°ro s • Board of Health IV Old Business Item 1 Entereovirus D-68 suspected in Seattle September 18, 2014 Page 1 of 2 • King County • Enterovirus D68 suspected in King County Thursday, September 11, 2014 Children with asthma at increased risk for respiratory infections Local health officials are working with Seattle Children's Hospital to investigate a cluster of patients with severe respiratory illness who tested positive for a possible enterovirus infection. Additional testing is being done at the Centers for Disease Control and Prevention (CDC) that can determine whether it is the enterovirus D68 (EV-D68) strain that has been seen recently in other U.S. states. At this time there are no confirmed cases of EV-D68 in King County or Washington state. "Although we can't currently say that these cases are definitely due to EV-D68, it would not be surprising if the virus is confirmed on further testing," said Dr. Jeff Duchin, Chief of Communicable Disease and • Epidemiology at Public Health - Seattle & King County. If EV-D68 does appear locally, large numbers of children could develop respiratory infections in a short time period, as the virus spreads similarly to the common cold. With most enterovirus infections, the vast majority of children have a mild illness that does not require medical attention. However, parents of children with asthma should be aware that their children appear to be more susceptible to serious illness. "It's important for families to make sure asthma symptoms are under control, and to see a health care provider if a person with asthma develops a respiratory illness that worsens asthma symptoms," Duchin said. People who do not have severe illness do not need to seek medical evaluation or testing for EV-D68, which is not widely available outside of hospitals. About enterovirus Enteroviruses are very common viruses with over 100 types, but the EV-D68 type has previously been uncommon in the U.S. In other states, the EV-D68 outbreaks are resulting in significant numbers of children requiring emergency department visits and hospitalizations, primarily for difficulties with breathing and severe asthma. • EV-D68 virus can be found in respiratory secretions such as saliva, nasal mucus, or sputum. The virus likely spreads from person to person when an http://kingcounty.gov/healthservices/health/news/2014/14091101.aspx?print=1 9/11/2014 Page 2 of 2 infected person coughs, sneezes, or a person touches contaminated surfaces. Infants, children, and teenagers are most likely to get infected with enteroviruses • and become sick. EV-D68 has been reported to cause mild to severe respiratory illness (runny nose, cough, difficulty breathing) with and without fever. A minority of people may have more serious infections, particularly children with pre-existing asthma. Anyone who has difficulty breathing or who appears seriously ill should be evaluated promptly by a healthcare provider. Adults and children with non- severe enterovirus infections do not need to see a health care provider and do not need to be tested. There is no specific treatment for EV-D68 infections. Prevention of EV-D68 infection There is no vaccine for enterovirus infections. To decrease the risk for enterovirus infections: • Wash hands often with soap and water for 20 seconds (alcohol hand gel is not as good as hand washing for enteroviruses) • Avoid touching eyes, nose and mouth with unwashed hands • Avoid contact with ill people • Do not go to day care, school or work while ill • Avoid kissing, hugging, and sharing cups or eating utensils with people who are sick • • Disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick • Children and adults with asthma should be sure to have their asthma symptoms under control and see a health care provider if they develop a respiratory infection and their asthma worsens Because EV-D68 has previously been uncommon in the US, health officials are still learning about the illness and risk factors for infection. Check for updates online. Providing effective and innovative health and disease prevention services for over 2 million residents and visitors of King County, Public Health --- Seattle & King County works for safer and healthier communities for everyone, every day. • http://kingcounty.gov/healthservices/health/news/2014/14091101.aspx?print=1 9/11/2014 11) Board of Health IV Old Business Item 2 Dabob and Quilcene Bays Closed due to Paralytic Shellfish Poisoning • • September 18, 2014 JCPH Page 1 of I A/zf, tttttrkingfor ahealthierrJerrerson.0 Jefferson County Public Health Port Townsend,Washington .' ti Home About.JCPH Community Health Environmental Health/Water Quality Information News&Events e ii isiiiiii,,g404- Public Health News and Events. '' 'iii r, .. Welcome 0 News 8.Events DABOB AND QUILCENE BAY BEACHES NOW CLOSED TO THE RECREATIONAL HARVEST OF SHELLFISH DUE TO MARINE BIOTOXINS For Immediate Release Contact: Michael Dawson Jefferson County Environmental Health (360) 385-9444 Port Townsend- Marine biotoxins that cause Paralytic Shellfish Poisoning(PSP) have been detected at elevated concentrations in shellfish samples taken from Dabob and Quilcene Bays.As a result,the Washington State Department of Health(DOH)has expanded the closure to include both Dabob and Quilcene Bay beaches to recreational shellfish harvest.Quilcene Bay was closed September 8th after marine biotoxins were detected at concentrations above the closure level in shellfish samples.Shellfish harvested commercially are tested for toxin prior to distribution and should be safe to eat. Danger signs have been posted at high-use beaches,warning people not to consume shellfish from this area.The closure includes clams,oysters, mussels, scallops and other species of molluscan shellfish.This closure does not apply to shrimp. Crabmeat is not known to contain the biotoxin but the guts can contain unsafe levels. To be safe, clean crab thoroughly and discard the guts(butter). • Marine biotoxins are not destroyed by cooking or freezing. People can become ill from eating shellfish contaminated with the naturally occurring marine algae containing toxins harmful to humans.Symptoms of PSP can appear within minutes or hours and usually begins with tingling lips and tongue, moving to the hands and feet,followed by difficulty breathing,and potentially death. Anyone experiencing these symptoms should contact a health care provider immediately. For extreme reactions call 911. In most cases the algae that contain the toxins cannot be seen, and must be detected using laboratory testing.Therefore, recreational shellfish harvesters should check the DOH website at www.doh.wa.gov/CommunitvandEnvironment/Shellfish/BeachClosures.aspx or call the DOH Biotoxin Hotline at 1-800-562-5632 before harvesting shellfish anywhere in Washington State.A new clickable map with a mobile version for smartphones can be found at www.doh.wa.00v/ShellfishSafetv.htm. Recreational harvesters should also check Fish and Wildlife regulations and seasons at http://wdfw.wa.gov/fishing/shellfish/or the Shellfish Rule Change Hotline 1-866-880-5431. ## # Always working for a safer and healthier community Jefferson County Public Health 615 Sheridan Street-Port Townsend.WA 98368 .1117, Community Heai h 360.385.9400 rEnvironmental Health.360 385 9444 nio^ieffersoncounfypublichealth.org JCPH Employee Resources • http://www.j effersoncountypublichealth.org/index.php?dabob-and-quilcene-bay-beaches-c1... 9/11/2014 • Board of Health IV Old Business Item 3 2014-2015 Influenza and Pneumonia Information • 40 September 18, 2014 Alleson 615 Sheridan Street ' Port Townsend, WA 98368 eflurt www.JeffersonCountyPublicHealth.org Public Healt • To: Area Health Care Providers From: Lisa McKenzie, PHN and Marjorie Boyd, RN Re: 2014-2015 Influenza& Pneumonia Information This letter accompanies our yearly packet of information regarding vaccines and the 2014-2015 influenza season. We hope you will find these materials helpful. Jefferson County Public Health (JCPH) will publicize information about influenza vaccine availability in local newspapers, and will assist your seasonal influenza immunization efforts in any way we can. JCPH will not have seasonal influenza vaccine available for adults of the general public, but will provide state-supplied flu vaccines in our immunization clinics for children ages 6 months through 18 years. The variety of influenza vaccine types being marketed in 2014 are the same as those available in 2013. Vaccine options available include trivalent, quadrivalent (containing two type B strains), high dose, intradermal, cell culture-based, and recombinant injectable vaccines. The nasal mist vaccine is quadrivalent this year. All except the cell culture-based and recombinant are egg-based vaccines. Only multidose vial presentations contain a preservative. The influenza strains in the 2014-15 vaccines are unchanged from last year. The trivalent vaccines contain the same A(H I N 1),A(H3N2) and B/Massachusetts strains as in 2013-14. The quadrivalent vaccines also have the • same B/Brisbane strain added to the trivalent strains. While it is still important to reach groups usually regarded at high-risk for complications of influenza, the standard Center of Disease Control (CDC) recommendation is that everyone over 6 month of age be immunized against influenza every year, regardless of risk profile. Influenza: Because there has been minimal change to influenza recommendations in recent years, the Center of Disease Control's (CDC) Advisory Committee on Immunization Practices' (ACIP) annual publication on Prevention and Control of Seasonal Influenza with Vaccines only highlights new information. A copy is enclosed. If you wish to review previous year's documents, the link can be found online at the ACIP Recommendations site: http://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html. Included in this packet are the following materials concerning seasonal influenza vaccines: ■ Prevention and Control of Seasonal Influenza with Vaccines discusses appropriate use and timing of the various types of influenza vaccines available, information on vaccinating children with an increased emphasis on use of the nasal mist vaccine in children under age 9, and safe vaccination of clients with egg allergy. The table lists the thimerosal and ovalbumin content of each vaccine. You will note the recombinant vaccine contains no ovalbumin. • Guidance from the Washington State Department of Health discussing superior efficacy of the live nasal spray vaccine over injectable influenza vaccines in children ages 2 - 8 years old, and a comparison of other presentations of influenza vaccine for various groups of clients. • • Recommendations for verification of immunity to vaccine preventable diseases in healthcare workers and references for mandatory influenza vaccination policies for this group. Community Health Environmental Health Developmental Disabilities Water Quality 360-385-9400 360-385-9444 360-385-9401 (f) Always working for a safer and healthier community (f) 360-379-4487 • A chart listing data on the various types of influenza vaccine on the market this season, their trade names, volumes, thimerosal content, and age indications. • A CDC summary of those at high risk of complications from influenza who should be especially targeted for immunization. • • Vaccine Information Statements for Inactivated (IIV) and Live Attenuated (LAIV) influenza vaccines. • Screening forms for contraindications and precautions for administration of IIV and LAIV influenza vaccines. • A chart describing the proper use of the publically-funded influenza vaccines that will be provided for children through 18 years of age in Washington State. • A quick-reference algorithm for use of pediatric influenza vaccines in children ages 6 months through 8 years to determine whether they need I or 2 doses this year. • An algorithm for vaccinating clients reporting egg allergy. • A sample of the influenza administration form with screening questions that we will use at JCPH. If you would like to adapt this form for your clinic we can send you an electronic version. The CDC recommends that you begin administering influenza vaccine as soon as it is available. For all clients over age 8, only one dose is recommended in each influenza season. Vaccines from various manufacturers are recommended for various age groups, and some are not licensed for use in younger children. Read your label and package insert, and the enclosed chart in regards to your vaccine carefully. The Immunization Action Coalition (IAC) has many good patient handouts regarding many vaccines at: www.immunize.org. The IAC also has an 11 page document, "Ask the Experts," that answers technical information regarding influenza and other questions at www.immunize.org/askexperts. A current schedule for influenza vaccine availability at local clinics has not yet been compiled.We will be contacting you regarding clinic schedules to facilitate distribution of that information to the public. Flu clinic • information will be posted on the JCPH website, on a flyer distributed in our lobby, and published in the local newspapers. Pneumonia: In 2012 and 2013 the CDC published extended recommendations for use of pneumococcal conjugate vaccine (PCV) and pneumococcal polysaccharide vaccine (PPSV) in both children and adults with chronic medical conditions. Certain immunocompromised clients should receive both types of pneumococcal vaccine. Included in this packet are the following materials concerning pneumonia vaccines: • ACIP's Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine for Adults with Immunocompromising Conditions, which recommends use of both the previously pediatric conjugate PCV 13 and the previously adult polysaccharide PPSV23 for some adult clients. • ACIP's Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Children aged 6-18 Years with Immunocompromising Conditions, which recommends use of both vaccines for some pediatric clients. • A chart of pneumococcal vaccine recommendations by risk factors or underlying conditions. • A chart regarding the spacing of pneumococcal vaccines in healthy and immunocompromised children. • A supplement to the Vaccine Information Statements in regards to spacing and indications for the pneumococcal vaccines. • Vaccine Information Statements for Pneumococcal Conjugate and Pneumococcal Polysaccharide • vaccines. Community Health Environmental Health Developmental Disabilities Water Quality 360-385-9400 360-385-9444 360-385-9401 (f) Always working for a safer and healthier community (1) 360-379-4487 Those who have asthma or smoke cigarettes are considered at risk for invasive pneumococcal disease and should be immunized with PPSV23. Please note that the spacing between types of pneumococcal vaccines • varies depending on which type is administered first. The last document in this packet is a Summary of Recommendations for Adult Immunization which describes indications and proper administration of all recommended vaccines for adults. This document is updated by the Immunization Action Coalition as recommendations change. The latest version can be downloaded at: www.immunize.org/catg.d/p201 I.pdf. Please circulate these materials among all providers in your clinic. If we can answer any questions or be of assistance, please call Lisa McKenzie or Marjorie Boyd at 385-9400. • • Community Health Environmental Health Developmental Disabilities Water Quality 360-385-9400 360-385-9444 360-385-9401 (f) Always working for a safer and healthier community (f)360-379-4487 • Board of Health IV Old Business Item 4 • WA State Department of Ecology Pet Waste Facts II September 18, 2014 a � • PFT WASTE FAQc GENERAL Q: Why should I pick it up (even if it's on my own property)? A: The pathogens in pet waste are harmful to the health of humans, animals, and the environment. PUBLIC PROPERTY: Local animal control ordinances declare it is unlawful to leave pet waste on public property and require its immediate removal. PRIVATE PROPERTY: Local water quality and health ordinances also apply to private property and could result in enforcement, including fines, if it can be determined that pet waste, or its pathogens, on your property are being washed into storm drains or waterways, or if the accumulation of waste is a nuisance or menace to health. DISPOSAL Q: How should I dispose of pet waste? A: Scoop the poop, bag it, and put it in the trash (garbage). Q: Can I put pet waste in the trash (garbage)? A: Yes, this is the preferred disposal method. By putting pet waste in the trash, it prevents the waste from becoming a source of pollution in our streams and bays. Landfills are designed to safely handle substances such as dog waste, cat litter, and dirty diapers. Many people already place their dog waste in the trash because it's convenient. Some hide it in the trashcan because they think it's prohibited. Don't worry! It's allowed. If you are already placing it in the trash, keep up the good work! 4 Q: Can I bury or compost pet waste? A: Composting and burial do not kill hazardous pathogens that may be in the waste and can pollute water. Landfills are designed to safely handle substances such as dog waste, cat litter, and dirty diapers. Yards are not. Most home compost piles don't reach temperatures sufficient to kill many hazardous pathogens. Extended exposure at 140-degree temperatures is required to kill E. coli and Salmonella. Giardia can survive temperature extremes, chlorination, and drying. Cryptosporidium, Leptospira, Salmonella, and E. coli can survive for months in feces or soil. Roundworms can survive for four years in soil. Even commercial yard waste processors do not currently compost waste at temperatures sufficient to kill many pathogens in pet waste, so don't put dog waste in the yard waste bins for curbside pickup. • Pet Waste FAQs Page 1 of 4 IT '44 \ " ' ♦ s �' . • Q: Can I flush pet waste down the toilet? A: Maybe. If you are on a municipal sewer system and you can stand the yuck-factor, flushing is a highly desirable method of disposal. Most people, especially those with large or multiple dogs, are not comfortable with the notion of bringing outdoor pet waste indoors to flush it. If you can handle it, go wild! If you have a septic system, then do not flush pet waste down the toilet. Flushing pet waste can potentially exceed the design capacity of the septic system. High volumes of hair and ash, not normally found in human waste, can interfere with septic system functions and clog drain fields. Don't flush cat waste if it has litter stuck to it. Another alternative is to install a pet waste flushing system at your outdoor sanitary sewer cleanout if you are connected to a public sewer system (NOT a septic system). Two examples may be found at: www.doggiedoodrain.com/ www.mvpetwastedisposal.com/product/PH005 Q: How about pet waste digesters and doggie septic systems? A: Not a good idea. Commercially produced pet waste digesters are no better than burial, since they essentially function like broken septic systems. There is evidence that these systems often do not function properly. Even manufacturers say that they do not function properly where water tables are high, in low temperatures, and in some soil types common to our area. Manufacturers also say that the systems don't work as well when used with dog foods containing high ash levels, which are common in many low-cost dog foods. Even assuming these devices function as designed, there is little, if any, evidence that they treat waste sufficiently to meet desired standards. Remember, pet waste is sewage just like human waste; using such a device to treat an equivalent amount of human waste is prohibited . by law. The devices are an added expense to the homeowner (typically $25-$60 for the device and $14 annually for"digester"), require installation, and require frequent maintenance (some recommend daily addition of water and "digester" every few days). Our advice: bag it and place it in the trash. It's cheaper, easier, and safer. ENVIRONMENTAL _. Q: Isn't pet waste "biodegradable" or "natural"? A: Pet waste is biodegradable in that it decomposes under natural conditions, but the harmful bacteria, viruses, and parasites in it can continue to live on even though the waste pile seems to have disappeared. When pet waste is washed into streams or bays, the waste decomposes, using up the oxygen in the water and releasing ammonia. Under those conditions and warm water temperatures, fish and other aquatic life can be killed. Pet waste also contains nutrients that encourage weed and algae growth. Q: Why can't I use it as fertilizer? A: Pet waste contains bacteria, viruses, and parasites that are harmful to the health of humans, animals, and the environment. Some of these pathogens can live in the soil for four years. • Pet Waste FAQs Page 2 of 4 . Q: Isn't landfilling bad? Shouldn't we do things more naturally? A: We certainly want to reduce our waste stream to landfills wherever possible. When it comes to pet waste, however, there is currently no better alternative. There is nothing "natural" about the concentrated number of dogs in Kitsap County's urban and suburban areas. Native wildlife populations do not reach that density. The question, then, is how we deal with the waste produced by this unnatural concentration of animals. Burial, composting, waste digesters, and letting it lay in yards contaminate water and jeopardizes human and pet heath. Flushing is impractical for most people. At some point in the future, commercial composting technology may be sufficient to treat pet waste, enabling curbside pickup along with yard waste. Until then, landfilling is the best alternative for pet waste. Composting is good for yard waste and bad for pet waste. 111 Q: The stormwater in my neighborhood goes to a pond and swale. Isn't it treated there? A: No. Dog waste is raw sewage. Stormwater ponds and swales are not designed to treat the pathogens in raw sewage. Stormwater is not treated at a sewage treatment plant. The stormwater from ponds is released into pipes and ditches that discharge directly to streams and bays. Ponds and swales do help clean stormwater by providing an opportunity for sediments, and any pollutants that are bound to them, to settle out; however, pathogens that remain suspended are discharged directly into streams and bays without further treatment. HEALTH 41) Q: How can pet waste harm humans? A: Pet waste contains many harmful pathogens which can cause mild distress to serious diseases. Hazardous Organisms Found in Dog Waste Organism Common Survival/ Human Disease Name Survival: •4 years in soil. Human Disease: VLM (visceral larva migrans) or toxocariasis, an infection Toxocara canis Roundworms caused by certain parasites, leading to enlargement of the liver (hepatomegaly), inflammation of the middle muscular layer of the heart wall (myocarditis), inflammation of the kidneys (nephritis), inflammation of the lungs (pneumonitis), and blindness. Usually in children, but can occur in adults. Baylisascaris Survival: • Eggs can survive in moist soil for years. procyonis Roundworms Human Disease: Severe neurological form of VLM (visceral larva migrans, see (g. Toxocara) above), especially in young children. Survival: • Several days. • No known effective chemical or pesticide. • Prompt removal of dog and cat feces greatly reduces risk of infection. Ancylostoma Hookworms spp. Human Disease: Spreading lesions and severe itching (pruritis). In rare instances can cause symptoms like VLM (see above). Puppies are a significant source of infection. Survival: •At least 6 months. • Susceptible to drying. Cryptosporidium none Human Disease: Self-limiting inflammation of the lining membrane of the parvum stomach and the intestines (gastroenteritis), protracted in susceptible individuals. CDC reports 300,000 cases annually, 90% of waterborne origin. Campylobacter none Survival: • Rapidly killed by heat, drying, and freezing. • spp. Human Disease: Mild to severe, bloody diarrhea. Pet Waste FAQs Page 3 of 4 ...t & v .�' ,.b ,. 4 4V y Survival: • Up to 4 months in ruminant(cattle) feces. • E. coli, ■ Extended exposure (i.e., 3 days) at 140°F required to kill organism. Escherichia coli Fecal coliform bacteria Human Disease: Bloody diarrhea, severe cramps, blood clots in the kidney (hemolytic uremic syndrome or HUS), leading to kidney failure. Giardia Survival: • Resistant to drying, chlorination, and temperature extremes. duodenalis •Can survive for months in water. Giardia, • Relatively persistent during wastewater treatment. lamblia Giardiasis Human Disease: Diarrhea, cramps, gas (flatulence), nausea, an excess of fat in (Giardia stools (steatorrhea). Can be protracted and debilitating. CDC estimates 2 million intestinalis) cases in U.S.,90%of waterborne origin. Survival: • Up to 6 months in cattle feces. • Extended exposure at 140°F required to kill organism. Salmonella spp. none Human Disease: Usually, mild inflammation of the lining membrane of the stomach and the intestines (gastroenteritis) within 6-48 hours. Survival: • 21h months in moist soil • Rapidly killed by direct sunlight exposure. Human Disease: Weakness, extreme exhaustion on slight effort, night sweats, Bruce/la spp. Brucellosis chills, remittent fever, and generalized aches and pains appear in days to months. Can be protracted and extremely debilitating. Uncommon in U.S. Survival: • Unknown. Yersinia none Human Disease: Mild inflammation of the lining membrane of the stomach and enterocolitica the intestines(gastroenteritis). Survival: •Weeks to months in soil or water. Human Disease: Usually mild fever but complications can be serious, including Leptospira Leptospirosis inflammation of the liver (hepatitis), interference with normal production and interrogans discharge of bile (jaundice), inflammation of the membranes that envelop the brain and spinal cord (meningitis), and kidney failure. Life threatening, but uncommon. There has been a recent increase in the numbers of dogs with leptospires. • REGULATORY qAN. 1 Q: Where can I find the regulation(s)? A: (1) Kitsap County Board of Health Ordinance 2004-2, Solid Waste Regulations, Section 305. www.kitsapcountyhealth.com/environmenta_health/solid_waste/docs/swregs.pdf (2) City of Poulsbo Municipal Code, Section 6.02.130 and Section 13.18 www.cityofpoulsbo.com • FAQ Sources 1. City of Federal Way brochure, "Doo the Right Thing" 2. Snohomish County Pet Waste website wwwl.co.snohomish.wa.us/Departments/Public_Works/Divisions/SWM/Services/Water Pollution/Pet Waste.htm 3. City of Poulsbo • Pet Waste FAQs Page 4 of 4 . Board of Health V New Business Item 1 Public Hearing: Environmental Health Fee Revisions • September 18, 2014 Environmental Health Hourly Rate Revision • Problem Statement: The current hourly rate is a composite rate composed of an employee's wage, vacation, holiday, sick benefit, health care benefits, and pension payments. It does include the costs for services; building rent, supplies, administration. General fund is no longer available to cover these costs. The agency is not fully recovering costs for services rendered via the hourly rate. This imbalance will become a larger problem because the hourly rate is used to set prices for the majority of our permits and fees (via time and work sample studies). If this rate does not cover costs, then the subsequent permit and fee prices will not recover costs either. In 2013 cost recovery (permits &fees) for fee programs averages 87% across all programs. This percentage has decreased further in 2014 due to increased costs. While some programs costs have been changed by the BOH in 2014 to accurately reflect costs, any based on the hourly indirect will be reviewed. Proposed Solution: • Increase the hourly rate to account for actual costs. The current hourly rate is $67.44. Utilizing our grant programs accounting methods, the new proposed hourly rate would be $85.00. This would costs. This also termed the Indirect Rate for grant billing. While this fee adjustment will not fully cover the costs for all programs, it is a first step to full cost recovery. As mentioned before, it's used to set prices for the majority of our permits and fees and if not correct then the subsequent permit and fee prices will not fully recover costs. Additionally, while the range is wide, the proposed rate would be more consistent with other county departments and health jurisdictions in the region. • Kitsap Health District - $109.00 • Jeffco Public Works— Range based upon staff classification - $41.00- $83.00 (majority rate applied is $82.00) • Clallam County Health & Human Services - $81.00 • Grays Harbor County - $78.00 • Jeffco DCD - $76.00 • Mason County - $75.00 • September 12, 2014 - JEFFERSON COUNTY PUBLIC HEALTH ENVIRONMENTAL HEALTH DIVISION ENVIRONMENTAL HEALTH 2014 Additional Fees and Other Information GENERAL • Health Officer Administrative Hearing 309.00 Administrative Hearing Appeal 309.00 Technical Assistance/Plan Review-Minimum 85.00 Technical Assistance/Plan Review-Per Hour 85.00 Filing Fee 53.00 Notice to Title Rescission 517.00 ONSITE SEWAGE DISPOSAL Sewage Disposal Permits New Conventional 561.00 Valid for 3 years New Alternative 668.00 Valid for 3 years New septic tank and/or pump chamber only 266.00 Issued in conjunction with an existing sewage disposal New Community or>1000 G.P.D. (base fee) 561.00 Plus$88 per connection-valid for 3 yrs New Commercial>1000 G.P.D. Conventional 668.00 Valid for 3 years Alternative 715.00 Valid for 3 years Repair/Upgrade/Modification/Designate Reserve Area 124.00 Applies to existing installed sewage disposal system Expansion 418.00 Redesign 124.00 Applies to pending or active but not installed Reinspection 155.00 Evaluation of Existing System/Monitoring Inspection Septic system only 309.00 Septic system plus water sample 322.00 Retest/Reinspection 108.00 On Site Sewage On Site-Site Plan Advanced Approval Determination(SPAAD) 309.00 Septic Permit with SPAAD(conventional) 302.00 Septic Permit with SPAAD(alternative) 418.00 Subdivision Review Base Fee 401.00 Plus$79.00 Per Lot Boundary line adjustment review fee 158.00 Plus$79.00 Per Lot Pre application meeting fee 158.00 Planned rural residential development review fee 158.00 Density exemption review fee 79.00 Density exemption review fee requiring field work 158.00 Other • WaiverNariance Application 186.00 WaiverNariance Hearing 309.00 Wet season evaluation 418.00 Revised building application review fee 158.00 New building application review fee: Residential 79.00 Commercial 158.00 General environmental health review fee 85.00 Per Hour Licenses Installer, Pumper,Operator(maintenance person) 418.00 Retest 170.00 Homeowner Authorization 10.00 Annual Renewal 294.00 Delinquent Renewal after January 31 418.00 FOOD SERVICE ESTABLISHMENT FEES PERMIT FEES(Annual Permit) Restaurants/Take-Out(Based on menu complexity&seating-menu changes may change category) 0-25 seats(Limited Menu) 188.00 No cooling or reheating 0-25 seats(Complex Menu) 334.00 Cooling and reheating allowed 26-50 seats 334.00 51-100 seats 401.00 101-150 seats 455.00 With Lounge,add 147.00 Separate lounge area Bakery Business 147.00 B&B 188.00 Caterer w/commissary or catering-only kitchen 334.00 w/restaurant,additional fee for catering 188.00 Concession/Commercial Kitchen/Church 147.00 Espresso Stand 147.00 Grocery 1-3 checkouts 188.00 May serve pre-packaged baked goods >3 checkouts 455.00 Meat/Fish Market 334.00 Mobile Unit Limited Menu 188.00 No cooling or reheating • Complex Menu 334.00 Cooling&reheating allowed School Cafeteria Central Kitchen 334.00 Warming Kitchen 188.00 Tavern w/food(see Restaurants) _Annual Permit Issued after September 1 1 50%of fee 150%of Annual Permit Fee ._., 1 of 2 . 4 ENVIRONMENTAL HEALTH 2014 Additional Fees and Other Information Temporary Permits Single Event Initial Application(First Event) 106.00 Not to exceed 21 days at your location Additional Event(Same Menu Only) 60.00 Not to exceed 21 days at your location S Organized Recurring Event(e.g.Farmers Market) Limited Menu 106.00 Not to exceed 3 days a week at a single location Complex Menu 140.00 Not to exceed 3 days a week at a single location Late Fee for Temporary Permits +50%of fee Additional(Paid when application is submitted less than 7 days prior to the event) Other Food Fees Permit Exemption 40.00 WaiverNariance 85.00 Per Hour Reopening Fee 85.00 Per Hour Manager's Course 227.00 Plan Review Pre-opening inspection 85.00 Per Hour Minimum 85.00 Per Hour 85.00 Reinspection First Inspection 94.00 Each inspection after first 160.00 Food Handler Card Reissue Unexpired Food Handler Card I 10.00 SOLID WASTE Annual Permit Fees Landfills requiring environmental monitoring 548.00 Biosolid/Composting Facilities 481.00 Inert Waste Landfills 348.00 Other Solid Waste Facilities 348.00 Drop Boxes 160.00 Miscellaneous Fees New Facility Application 441.00 Exempt Facility Inspection 348.00 Facility Reinspection 50%of fee Plan,Document and WaiverNariance Review 340.00 +$85.00/hour for>4 hours WATER Application Fee 160.00 Inspection of well construction,decommission& reconstruction • Determination of Adequate Water Supply 67.00 Building Permit Process Well Inspection&Water Sample for Loan 135.00 Well Site Inspection-Proposed public water supply 321.00 LIVING ENVIRONMENTS Water Recreation Facilities Operation Permit Single Swim Pool(in operation for<6 months of the year) 291.00 Single Swim Pool(in operation for 6 months of the year) 294.00 Single Spa Pool(in operation for<6 months of the year) 255.00 Single Spa Pool(in operation for months of the year) 294.00 Single Wading Pool(in operation for<6 months of the year) 211.00 Single Wading Pool(in operation for>_6 months of the year) 371.00 Spray Pool or Pools(in operation for<6 months of the year) 105.00 Spray Pool or Pools(in operation for>_6 months of the year) 159.00 Each Additional Swim,Spa,or Wading Pool(in operation for<6 63.00 months of the year) Each Additional Swim,Spa,or Wading Pool(in operation for 6 84.00 months of the year) Reinspection 85.00 Per Hour plus associated lab costs Plan Review 85.00 Per Hour Indoor Air(Tobacco) Compliance Enforcement 85.00 Per Hour Reinspection 79.00 Rebuttal Application 158.00 Note: 2013 Fees have been adjusted per Ordinance 12-1209-96,Section 4-Annual Fee Indexing:Fixed amount fees established by this ordinance shall be adjusted annually on the first business day of January(Adjusted Date)by the amount of the increase in the Consumer Price Index(CPIW). The CPIW is the Consumer Price Index-US City Average for AM Urban Wage Earners and Clerical Workers,published by the Bureau of Labor Statistics for the United States Department of Labor. The annual fee adjustment shall be calculated as follows: each fee in effect immediately prior to the Adjustment Date will be increased by the percentage increase in the CPIW as reported for the month of September preceding the Adjustment Date. Increases will be rounded to the nearest dollar. A fee shall not be reduced by reason of such calculation. However,fee increases in accordance with this calculation shall not exceed 5 percent per year. ID 2 of 2 , r STATE OF WASHINGTON JEFFERSON COUNTY BOARD OF HEALTH • AN ORDINANCE TO AMEND Ordinance No. 08-0918-14 FEE SCHEDULE FOR JEFFERSON COUNTY PUBLIC HEALTH Section 1 —Purpose Section 2—Effective Date Section 3—Fees Section 4—Severability Section 5—Prior fee schedule repealed WHEREAS, the purpose of this Ordinance is to amend the fee schedule for Jefferson County Public Health, Environmental Health Division WHEREAS, this Ordinance promotes the health, safety and welfare of the citizens of Jefferson County, and WHEREAS, this Ordinance is proposed and may be enacted pursuant to the general police power granted to Jefferson County and its Board of Health by the State Constitution, 09W, THEREFORE, BE IT ORDAINED by the Jefferson County Board of Health as follows: Section 1 —Purpose That the Fee Schedule for Jefferson County Public Health be amended to reflect increases in technical staff per hour cost. Section 2—Effective Date That this Ordinance (and its Attachment) shall be effective as of November 1, 2014. Section 3—Fees That the schedule for Jefferson County Public Health, Division of Environmental Health fees for Hourly Rate for Technical Staff, Environmental Health hereby set by the Jefferson County Board of Health as listed on the attached fee schedule of the proposed Ordinance. Any text listed, specifically text within the column entitled "Additional Fees and Other Information" is deemed regulatory rather than advisory and as such has the full force and effect of local law. Section 4—Severability A determination that any text, fee or fees adopted as part of this Ordinance is unlawful or illegal shall not cause any other text, fee or fees adopted as part of this Ordinance not affected by that determination to be repealed, revised, or reduced. • Section 5- Prior Fee Schedules Repealed ny prior fee schedule previously adopted by this Board that contains or reflects fee amounts that are less than "pose adopted herein is hereby repealed and replaced by this Ordinance. AN ORDINANCE AMENDING 2013 FEE SCHEDULE FOR JEFFERSON COUNTY PUBLIC HEALTH,ENVIRONMENTAL HEALTH DIVISION SADOPTED _abler lab day ofbr- 2014. JEFFERSON COUNTY BOARD OF HEALTH e.A4ze-i 40704 e., \J\) '161 David ulliva ai Sheila Westerman, Vice-Chair • 11(1 (4Ka-[4. Jo Austin, Member Kris Nelson, Member Sally Aerts, Member Phil Johnson, Member Jill Buhler, Member • JEFFERSON COUNTY PUBLIC HEALTH ENVIRONMENTAL HEALTH DIVISION ENVIRONMENTAL HEALTH 2014 Additional Fees and Other Information GENERAL • Health Officer Administrative Hearing 309.00 Administrative Hearing Appeal 309.00 Technical Assistance/Plan Review-Minimum 85. Technical Assistance/Plan Review-Per Hour Filing Fee 53.00 Notice to Title Rescission 517.00 ONSITE SEWAGE DISPOSAL Sewage Disposal Permits New Conventional 561.00 Valid for 3 years New Alternative 668.00 Valid for 3 years New septic tank and/or pump chamber only 266.00 Issued in conjunction with an existing sewage disposal New Community or>1000 G.P.D. (base fee) 561.00 Plus$88 per connection-valid for 3 yrs New Commercial>1000 G.P.D. Conventional 668.00 Valid for 3 years Alternative 715.00 Valid for 3 years Repair/Upgrade/Modification/Designate Reserve Area 124.00 Applies to existing installed sewage disposal system Expansion 418.00 Redesign 124.00 Applies to pending or active but not installed Reinspection 155.00 Evaluation of Existing System/Monitoring Inspection Septic system only 309.00 Septic system plus water sample 322.00 Retest/Reinspection 108.00 On Site Sewage OnSite-Site Plan Advanced Approval Determination(SPAAD) 309.00 Septic Permit with SPAAD(conventional) 302.00 Septic Permit with SPAAD(alternative) 418.00 Subdivision Review Base Fee 401.00 Plus$79.00 Per Lot Boundary line adjustment review fee 158.00 Plus$79.00 Per Lot Pre application meeting fee 158.00 Planned rural residential development review fee 158.00 Density exemption review fee 79.00 Density exemption review fee requiring field work 158.00 Other • WaiverNariance Application 186.00 WaiverNariance Hearing 309.00 Wet season evaluation 418.00 Revised building application review fee 158.00 New building application review fee: Residential 79.00 Commercial 158.00 General environmental health review fee 85.00 Per Hour Licenses Installer, Pumper,Operator(maintenance person) 418.00 Retest 170.00 Homeowner Authorization 10.00 Annual Renewal 294.00 Delinquent Renewal after January 31 418.00 FOOD SERVICE ESTABLISHMENT FEES PERMIT FEES(Annual Permit) Restaurants/Take-Out(Based on menu complexity&seating-menu changes may change category) 0-25 seats(Limited Menu) 188.00 No cooling or reheating 0-25 seats(Complex Menu) 334.00 Cooling and reheating allowed 26-50 seats 334.00 51-100 seats 401.00 101-150 seats 455.00 With Lounge,add 147.00 Separate lounge area Bakery Business 147.00 B&B 188.00 Caterer w/commissary or catering-only kitchen 334.00 w/restaurant,additional fee for catering 188.00 Concession/Commercial Kitchen/Church 147.00 Espresso Stand 147.00 Grocery 1-3 checkouts 188.00 May serve pre-packaged baked goods >3 checkouts 455.00 Meat/Fish Market 334.00 Mobile Unit • Limited Menu 188.00 No cooling or reheating Complex Menu School Cafeteria 334.00 Cooling&reheating allowed Central Kitchen 334.00 Warming Kitchen 188.00 _ Tavern w/food(see Restaurants) Annual Permit Issued after September 1 1 50%of fee 150%of Annual Permit Fee 1 of 2 ENVIRONMENTAL HEALTH 2014 Additional Fees and Other Information Temporary Permits Single Event Initial Application(First Event) 106.00 Not to exceed 21 days at your location • Additional Event(Same Menu Only) 60.00 Not to exceed 21 days at your location Organized Recurring Event(e.g.Farmers Market) Limited Menu 106.00 Not to exceed 3 days a week at a single location Complex Menu 140.00 Not to exceed 3 days a week at a single location Late Fee for Temporary Permits +50%of fee Additional(Paid when application is submitted less than 7 days prior to the event) Other Food Fees Permit Exemption 40.00 WaiverNariance 85.00 Per Hour Reopening Fee 85.00 Per Hour Manager's Course 227.00 Plan Review Pre-opening inspection 85.00 Per Hour Minimum 85.00 Per Hour 85.00 Reinspection First Inspection 94.00 Each inspection after first 160.00 Food Handler Card Reissue Unexpired Food Handler Card 10.00 SOLID WASTE Annual Permit Fees Landfills requiring environmental monitoring 548.00 Biosolid/Composting Facilities 481.00 Inert Waste Landfills 348.00 Other Solid Waste Facilities 348.00 Drop Boxes 160.00 Miscellaneous Fees New Facility Application 441.00 Exempt Facility Inspection 348.00 Facility Reinspection 50%of fee Plan,Document and WaiverNariance Review 340.00 +$85.00/hour for>4 hours WATER Application Fee 160.00 Inspection of well construction,decommission& Determination of Adequate Water Supply reconstruction 67.00 Building Permit Process Well Inspection&Water Sample for Loan 135.00 Well Site Inspection-Proposed public water supply 321.00 LIVING ENVIRONMENTS Water Recreation Facilities Operation Permit Single Swim Pool(in operation for<6 months of the year) 291.00 Single Swim Pool(in operation for z 6 months of the year) 294.00 Single Spa Pool(in operation for<6 months of the year) 255.00 Single Spa Pool(in operation for Z months of the year) 294.00 Single Wading Pool(in operation for<6 months of the year) 211.00 Single Wading Pool(in operation for>_6 months of the year) 371.00 Spray Pool or Pools(in operation for<6 months of the year) 105.00 Spray Pool or Pools(in operation for 6 months of the year) 159.00 Each Additional Swim,Spa,or Wading Pool(in operation for<6 63.00 months of the year) Each Additional Swim,Spa,or Wading Pool(in operation for z 6 84.00 months of the year) Reinspection 85.00 Per Hour plus associated lab costs Plan Review 85.00 Per Hour Indoor Air(Tobacco) - Compliance Enforcement 85.00 Per Hour Reinspection 79.00 Rebuttal Application 158.00 Note: 2013 Fees have been adjusted per Ordinance 12-1209-96,Section 4-Annual Fee Indexing:Fixed amount fees established by this ordinance shall be adjusted annually on the first business day of January(Adjusted Date)by the amount of the increase in the Consumer Price Index(CPIW). The CPIW is the Consumer Price Index-US City Average for All Urban Wage Earners and Clerical Workers,published by the Bureau of Labor Statistics for the United States Department of Labor. The annual fee adjustment shall be calculated as follows: each fee in effect immediately prior to the Adjustment Date will be increased by the percentage increase in the CPIW as reported for the month of September preceding the Adjustment Date. Increases will be rounded to the nearest dollar. A fee shall not be reduced by reason of such calculation. However,fee increases in accordance with this calculation shall not exceed 5 percent per year. • 2 of 2 S Board of Health V New Business Item 2 Call for Public Hearing , October 16, 2014: • Solid Waste code Revisions September 18, 2014 • 4 Board of Health V New Business Item 3 Washington State Regionalization Efforts — Behavioral Health, Chemical Dependency, Health Care Services, and Public Health September 18, 2014 0 •0,; r\,, 4,4, If vl STATE OF WASHINGTON HEALTH CARE AUTHORITY 626 8th Avenue,SE u P.O.Box 45502 o Olympia,Washington 98504-5502 ii August 26,2014 Re:Input on Joint HCA-DSHS Designation of Regional Service Areas for 2016 IViedicaid Purchasing Dear Medicaid Partners: Effective health system transformation in Washington state depends on coordinating and integrating the health care delivery system with community services,social services and public health.During the 2014 Legislative session,enactment of 2SSB 6312'established a pathway to define a regional structure to improve these linkages and increase accountability for health and outcomes.Over the summer, critical tasks were completed to meet the Legislative directive. o in early June,the HCA and DSHS published an overview of the regionalization link with Medicaid purchasing and community mobilization-included as attachment 1. • 9 in mid-July,the Washington Association of Counties submitted two alternative proposals for the geographic composition of regional services areas to the Adult Behavioral Health Task Force- included as attachment 2. O The task force adopted the Counties'recommendations and submitted its guidance to Governor Inslee on July 29 with configuration options for Chelan and Douglas counties pending further local discussion and agreement-included as attachment 3. As directed by 2SSB 6312,the Health Care Authority(HCA)and Department of Social and Health Services (DSHS)must now jointly decide on common regional service areas for Medicaid purchasing of physical and behavioral health care beginning In 2016,Within each region,counties have the opportunity to collectively decide to adopt one of two Medicaid managed care delivery system options: a Early adopting regions will have physical and behavioral health services purchased on a fully integrated basis,leveraging financing to support the integrated delivery of whole-person care. Counties in these regions will share 10%of resulting state savings. o Other regions will begin the transition to a fully integrated purchasing model by having care delivered through separate but coordinated behavioral health and physical health managed care contracts. To meet critical path milestones for the 2016 regionalization of Medicaid purchasing,designation of regional service areas will be needed by October 2014.We Intend to base our determination on the 1110 v_n 'See r3ttp;�[apps.le��v_a..go_y[billinFoJsununar .as x?bili=6322&Vedr=2023. Washington State Medicaid Partners August 26,2014 1111 Page 2 • Adult Behavioral Health Task Force guidance,with an assessment of the degree to which geographic boundaries: o Support naturally occurring health care delivery system and community service referral patterns across contiguous counties o Reflect active collaboration and alignment with community planning that prioritizes the health and well-being of residents o Serve as a platform to expedite fully integrated Medicaid purchasing of physical and behavioral health services by 2020,as directed by statute o Include a critical mass of beneficiaries to ensure active and sustainable participation by risk- bearing organizations that serve whole region(s)and promote integrated delivery of care o Ensure access to adequate provider networks,considering typical utilization and travel patterns, the availability of specialty services,and continuity of care as enrollee circumstances change, and o Avoid disruption of business relationships(i.e.,provider,payer and community)that have evolved over time. Your input to this landmark decision is very important to ensure that potential implications for critical Medicaid partners are considered.Please forward any comments to my assistant Tamarra Paradee (Tamarra.paradeec hca.wa.eov)by Tuesday September 9th,2014. • Thank you for your ongoing effort on behalf of Washington's Medicaid clients. 411 Sincerely, MaryAnne Lindeblad Director,Medicaid Enclosure cc: Jane Beyer,Assistant Secretary,Behavioral Health Service Integration Administration,DSHS Preston Cody,Assistant Director, Health Care Services,HCA Bob Crittenden, Health Policy Advisor,Governor's Office Chris Imhoff,Director,Division of Behavioral Health and Recovery,DSHS Nathan Johnson,Assistant Director,Policy Planning and Performance, HCA Kevin Quigley,Secretary, DSHS Dorothy Teeter,Director,HCA • Waslinctol State• l1A1thty n to 1-Itt & Health Services Transforming lives Regionalization: Medicaid Purchasing and Community Mobilization Why Regionalize? Currently, regional service areas differ for many state-financed health care,social support and other essential state services. A common regional approach: • Aligns state efforts across common regions. • Recognizes that health and health care are local. • Promotes shared accountability within each region for the health and well-being of its residents. • Empowers local and county entities to develop bottom-up approaches to transformation that apply to community priorities and environments. Regional Service Areas will drive accountability for health and outcomes by defining the structure for health and community linkages. They will comprise the new service areas for Medicaid purchasing of physical and behavioral health care and serve as a foundational component of the aligned state agencies'"Health in all Policies"approach. • Common Regional Service Areas for Medicaid Purchasing and Accountable Community of Health Regions. Washington health system transformation depends upon coordinating and Integrating the delivery system with community services,social services and public health. This strategy will be greatly enhanced by the development of a single Accountable Community of Health within each Regional Service Area. Though not legally required,it is desirable from an administrative,business,and community linkages perspective to align Medicaid purchasing regions and Accountable Communities of Health to the greatest degree possible. 2SSB 6312 calls for the joint creation of the common regional service areas by the Health Care Authority and Department of Social and Health Services,informed by recommendations from the Washington State Association of Counties,the Adult Behavioral Health System Task Force,and broader community input. The Community of Health Planning grant opportunity,which aims to prepare communities and the state for Accountable Community of Health designation, requires communities to identify a proposed geographic population. While proposed geographic boundaries are non-binding on eventual Accountable Communities of Health,they are strong indications of regional alignment that should be considered when designating Regional Service Areas. We are asking that communities,as part of their planning process,consider how the Accountable Communities will align with the anticipated fall 2014 designation of Regional Service Areas. MaryAnne Lindeblad,Medicaid Director Jane Beyer, Assistant Secretary Email I Maryanne.lindeblad@hca.wa.gov Email ( beyerjd >dshs.wa. ov • Phone 360-725-1863 Phone l 360-725-2260 \➢ d"^ .H �' . �, k '. • � Washington State hhAssociation of Counties Legislative Steering Committee ISSUE PAPER Date July 17, 2014 Category Decision Policy Area Human Services -- s Subject Adult Behavioral Health Legislative Task Force Staff Contact Abby Murphy: amurphy@wacounties.org Background SB 6312, Concerning the Integration of Mental Health and Chemical Dependency Programs, created a Legislative Task Force (Task Force)to provide recommendations for the integration of the chemical dependency treatment and mental health treatment systems. As such, the first priority of the Adult Behavioral Health Integration Task Force is to provide the Department of Social and Health Services(DSHS) and the 1 Health Care Authority(HCA) with recommendations regarding the geographical groupings of counties in which citizens receive behavioral health services. SB 6312 requires the Washington State Association of Counties (WSAC)to submit recommendations on these Regional Service Areas to the Task Force no later than August 1, 2014. The HCA and DSHS presented their criteria for Regional Service Areas to the Task Force on April 22, 2014. These criteria included: 1. Regional Service Areas must consist of whole, contiguous counties 2. Regional Service Areas must reflect natural referral and travel patterns for residents seeking treatment, and 3. Regional Service Areas must contain a minimum number of Medicaid covered lives to sufficiently bear the risk of providing services. On 6/9/14 it was clarified that the recommended number of covered lives be greater than 60,000 Medicaid enrollees per Regional Service Area. In order to provide counties with the opportunity to voice individual preferences, WSAC requested that each Chair of the County Board of Commissioners, County Council, or County Executive submit a letter stating their County's intent to remain in their current Regional Support Network configuration, or to inform us of their preference to alter their regional alignment. As of May 30th,WSAC received responses from all 39 counties. Several counties utilized this opportunity to ask for further clarification on specific issues, convey a need for additional data or inform us that further discussion was needed in order to reach a final decision. • 1 As requested bythe Task Force, WSAC reported our progress on reaching our Regional Service Area • q recommendations at the June 13th, 2014 Legislative Task Force meeting. We called attention to the outstanding unanswered questions and discussed the local consequences, benefits and general issues Counties are experiencing while working to reorganize our service areas. We also reported that we expected to be ready to give our final recommendations at the July 18th, 2014 Task Force Meeting.We have since received further clarifications and data to aid many counties in making their final recommendations to WSAC. As indicated above, all 39 counties were asked to report on their individual recommendations. The Legislative Steering Committee voted to adopt the recommendations from the counties that intend to remain within their current Regional Support Network configuration. Thurston-Mason, King, Pierce, and the counties within the current Regional Support Networks of Peninsula, North Sound and Spokane RSNs intend to remain in the same configurations. The Counties that indicated potential changes to their service areas were Chelan and Douglas RSN, Grays Harbor RSN, Cowlitz County and Klickitat Co. These Counties have worked to reach the following individual recommendations: • Grays Harbor RSN and Cowlitz County have chosen to merge with Timberlands RSN, forming a 5 County Regional Service Area • By 2016,Klickitat County will move into the SW Washington Regional Service Area that will consist of Clark, Skamania and Klickitat Counties. • Chelan-Douglas RSN has engaged in continued talks with Spokane RSN and Greater Columbia RSN. They intend to exchange data in order to allow all three RSNs the opportunity to assess risk.They anticipate a final agreement will be reached by August 1st. Staff Recommendation WSAC staff recommends that we present our final recommendation on Regional Service Areas to the Task Force on July 18th. This final recommendation would be that we move forward with the detailed recommendations above. WSAC staff also recommends that we ask Chelan-Douglas RSN to complete their data exchange with Greater Columbia and Spokane RSN's in order to reach a final recommendation and report their decision to WSAC by July 31S`. WSAC will forward the recommendation to the Task Force in writing no later than August 1st, the Legislative deadline. Action The Legislative Steering Committee adopted the staff recommendation. Commissioner Price-Johnson moved to accept the staff recommendation. Commissioner Stedman seconded the motion. The motion passed. 1 • ,r rr< x ln69 :: eztlhxt ton State TcrIegiziature Legislative Building •Olympia,Washington 98504 July 29, 2014 Governor Jay Inslee Office of the Governor PO Box 40002 Olympia,WA 98504-0002 Dear Governor Inslee, As co-chairs of the Adult Behavioral Health System Task Force,we are writing to inform you of the recommendation of the Task Force related to creation of regional service areas. Chapter 225,Laws of 2014 (2SSB 6312) directs the Washington State Association of • Counties (WSAC)to submit recommendations related to the composition of common regional service areas for purchasing behavioral health services and medical care services to the Department of Social and Health Services,the Health Care Authority,and the Task Force by August 1, 2014. The law instructs the Task Force to provide its own guidance for the creation of common regional service areas to the Governor, after taking into consideration WSAC's proposal. The Task Force recommendations are due to the Governor by September 1, 2014. The Task Force received a report of WSAC's recommendations on July 18, 2014, This report consisted of two alternative options for regional service area configurations,each endorsed by WSAC. Both options are based on the current regional support network boundaries. Maps of these options are attached. These options may be described as adopting the regional support network boundaries with the following changes: • Move Klickitat County into Southwest Washington RSN,which will now consist of Clark,Skamania and Klickitat counties. • Merge Cowlitz County and Grays Harbor RSN into Timberlands RSN, eliminating the Grays Harbor RSN. • Merge Chelan-Douglas RSN with either Spokane RSN or Greater Columbia RSN. At its July 18 meeting,the Task Force unanimously adopted the following motion. This constitutes the Task Force recommendation concerning regional service areas: • 1 I move that the Task Force adopt the recommendation for Regional Service Areas made by the Washington Association of Counties as its own recommendation,with the following addition: when designating Regional Service Area boundaries,the Health Care Authority and the Department of Social and Health Services must ask the governing board of the Chelan-Douglas Regional Support Network to state its preference between the maps and accept the decision, provided there is mutual agreement between the affected regional support networks. All eleven members of the task force were present at this meeting,with one Task Force member(DSHS Secretary Kevin Quigley) represented by a designated alternate,for a final vote of 11-0 on the recommendation. We appreciate your consideration of this recommendation and we thank your staff at the Department of Social and Health Services and the Health Care Authority for their assistance throughout this process. Sincerely, c, ) t t• 1- Senator Linda Evans Parlette Representative Jim Moeller o Co-chair,ABHS Task Force Co-chair,ABHS Task Force cc: ABHS Task Force members and alternates Jane Beyer,DSHS MaryAnne Lindeblad, HCA Nathan Johnson, HCA Abby Murphy,WSAC 2 • WSAC Proposal Map#1 (CDRSN merge with GCRSN): DSH /Dfvtalon of Batravlarrti Hoalttr and Recovery Regional tnpport Network 1 '` ;tisrrz�t. 1 I * Northsound �F r p , 4' ` zc44,,n444F9F V.SV V'i i "'V 4,),24'4*'4,-***VIZ, ' Ilktif,0,14-!;14'444.4!',":;41'14!i'4/ 41. thviatE ,... ..7r4c1 ,'',:-.^ 7;'''14:'„, tI*4t h Grays ' .F ..4i.,...',.,..,,;„,x,i4 s arbor t4 it ,ittifer F s, Timberlands i°y eSA<t,,+ett St?k A7dS4tei$1'N3t ,,,AiCesroAter?Dbill bia,,,,:4t.'),IAAlt.,..r, -:-,ir,,:ika.fifirifc.1 ,k, W‘,,,AA,... , Oral v , Duh.; ,ty M , • WSAC Proposal Map#2 (CDRSN merge with Spokane RSN): D$HS/Division of£ielinvloralNealth�0nE1 tZocovery Reglot� l �� ork A 5 /r'' r .,":1,:i4etifttlIte,."1:: •-••Ili fit,xtiiati -6i0 ,,ilpsz,,,gfrxtsifejii;gi,].,,,,,,,,,,zr„,,. k��s€a ' 11j l Y Grays T1"iYlK't�n re �('y� (,, y c 1 'G L(R4@ t &n } VV `� nysEiarkwt thurx-',P P r# 'Tit beth dtowl k i W, Oo «,moi • 3 111111 1 � • !1 ss -�jrot4 Clallam County August 13, 2014 • Mike Chapman,Chair Mike Doherty Jim McEntire Dorothy Teeter, Director,Washington State Health Care Authority Jefferson County PO Box 45502 • John Austin,Chair Olympia, WA 98504 Phil Johnson David Sullivan Jane Beyer,Assistant Secretary, Washington State Department of Social Kitsap County and Health Services Charlotte Garrido,Chair PO Box 45050 Robert Gelder Olympia, WA 98504 Linda Streissguth Dear Ms. Teeter and Ms. Beyer: In May 2014, the Washington State Health Care Authority (HCA)announced the availability of planning grants for groups of counties and tribes interested in pursuing Accountable Community of Health (ACH) designation under Washington State's • Health Care Innovation Plan. The timeline of these grant applications was exceedingly brief, with one week to submit a letter of intent and less than three weeks to complete a grant application. Jefferson County Public Health submitted a letter of intent for a Jefferson/Clallam ACH with the possible addition of Kitsap County. However, with insufficient time to involve relevant stakeholders, the ACH application was not submitted. Clallam and Jefferson Counties elected to participate in CHOiCE's Cascade Pacific Action Alliance for the planning period July 1, 2014 to December 31, 2014; Kitsap Public Health District indicated they would explore the possibility of involvement. Kitsap, Clallam, and Jefferson Counties viewed this participation as a time-limited community health planning activity carrying no commitment to seek designation as a 10-county ACH. Kitsap, Clallam, and Jefferson Counties never intended this participation as a commitment to join a 10-county ACH. 2SSB 6312, passed by the Washington State Legislature in 2014, calls for the creation • of regional service areas within the State for the purchasing of behavioral health and chemical dependency treatment services to be known as Behavioral Health Organizations (BHO), replacing the current system of Regional Support Networks (RSN). The County Commissioners of Clallam, Jefferson, and Kitsap Counties understand the need for the reorganization mandates under 2SSB 6312 and support the formation of"common regional service areas"that would make the geographical • 614 Division Street,MS-23 Port Orchard,WA 98366-4676 (360)337-4526 FAX(36o)337-5721 August 13, 2014 • Page Two boundaries of BHOs and ACHs identical. The Boards of County Commissioners of Kitsap, Clallam, and Jefferson Counties oppose creation of either a 10-county ACH or BHO that involves their counties, as do numerous health and social service providers spanning our three county region. We are aware that this July, the Adult Behavioral Health System Task Force voted to adopt the Washington State Association of Counties' (WSAC's) recommendation reaffirming the existing three-county Peninsula Regional Support Network boundary.We applaud adoption of this recommendation, and again affirm our support for a three-county ACH and BHO with the same boundaries of the RSN it is replacing—Kitsap, Clallam, and Jefferson Counties. We understand the purpose of Regionalization of Medicaid Purchasing and Community Mobilization is to ensure a common regional approach that: 1) aligns state efforts across common regions, 2) recognizes that health and health care is local, 3) promotes shared accountability within each region for the health and well-being of our residents, and 4) empowers local and county entities to develop a "bottom-up" approach to transformation that applies to community priorities and environments. We do not believe a ten-county region can provide for the local priorities setting process and recognition that health and health care is local. We do believe our history of shared networks and formal tri-county councils is consistent with effective regional planning and implementation efforts. Much of our region is rural in nature, posing special challenges associated with health care workforce shortages and populations that . are older, sicker, and poorer than their urban counterparts. Kitsap; Clallam, and Jefferson Counties have a long history of working collaboratively on these issues through innovative community health partnerships involving our public health departments, hospitals, Tribal governments, and health care providers. These existing partnerships will prove crucial as we pursue the goals of the Triple Aim throughout our region. With the stated goal of HCA and DSHS to promote development of regions that contain a sufficient number of"Medicaid covered lives"to allow full financial risk contracting at a recommended minimum of 60,000 Medicaid enrollees per Regional Service Area, our three- county rural and suburban areas combined are sufficient to meet this goal. Ultimately, existing • health care delivery systems, established provider networks, referral and travel patterns, and geographic accessibility factors are the most important determinates of a successful regional partnership. Consistent with our State's vision for health care innovation, we are actively engaging in an ACH planning process for our tri-county area. Should a second round of ACH funding opportunities become available, we will pursue that funding, however, we do not want award of a planning grant to preclude our intent to move forward. As a region, we are committed to convening stakeholders, leading health improvement activities, strengthening partnerships with state and local jurisdictions, acting in alignment with statewide healthcare initiatives, and using collective impact principles to make a three-county ACH successful. • August 13, 2014 Page Three We hereby urge DSHS and HCA to support our decision to form a Kitsap, Clallam, and Jefferson regional service area. Moreover, when the time arrives in 2015 to designate ACH configurations, we also support this three-county configuration as the basis of an ACH for our region. Sincerely, 4/471 • dila I Charlotte Garrido, Chair Michael C. Chapman, Chair Jo 'Austin, Chair Kitsap County Board of Clallam County Board of Je -rson County Board of Commissioners Commissioners Commissioner • cc: Eric Johnson and Abby Murphy-Washington State Association of Counties Adult Behavioral Health System Taskforce Nathan Johnson,Washington State Healthcare Authority • MaryAnne Lindeblad, Washington State Healthcare Authority 110 KITSAP PUBLIC KITSAP PUBLIC HEALTH BOARD • HEALTH DISTRICT RESOLUTION 2014-04 Supporting an Accountable Community of Health Configuration Consisting of Kitsap, Clallam, and Jefferson Counties WHEREAS, in May 2014, the Washington State Health Care Authority(HCA)announced the availability of planning grants for groups of counties,tribes, and other stakeholders interested in pursuing Accountable Community of Health (ACH) designation in 2015 under Washington State's Health Care Innovation Plan; and WHEREAS, in June 2014, the CHOICE Regional Health Network was awarded an HCA Community of Health planning grant for the period July 1, 2014 to December 31, 2014,to lead efforts to explore the feasibility of a ten-county Cascade Pacific Action Alliance ACH consisting of Clallam, Cowlitz, Grays Harbor, Jefferson, Kitsap, Lewis, Mason, Pacific, Thurston and Wahkiakum counties; and WHEREAS,the Kitsap Public Health District has attended meetings of the Cascade Pacific Action Alliance to explore the possibility of participating in the Alliance and learn more about 411 the work that ACHs will eventually need to accomplish, and has discussed regional ACH configurations with Kitsap stakeholders; and WHEREAS,the Kitsap Public Health District and other stakeholders in Kitsap County have subsequently determined that a ten-county ACH does not best serve the interests of Kitsap County in meeting the goals of Washington State's Health Care Innovation Plan; and WHEREAS, Kitsap, Clallam, and Jefferson Counties have a long history of working collaboratively on health-related issues through innovative community health partnerships involving their public health departments, hospitals, tribal governments, and health care providers which will prove crucial throughout the region in pursuing the healthcare reform goals in the State Health Care Innovation Plan; and WHEREAS,2SSB 6312, passed by the Washington State Legislature in 2014, calls for the creation of Regional Service Areas (RSAs) within the State for the purchasing of behavioral health and chemical dependency treatment services to be known as Behavioral Health Organizations, replacing the current system of Regional Support Networks, and which will eventually also address the purchasing of physical health services; and WHEREAS, in July 2014, the State Legislative Adult Behavioral Health System Task Force voted to adopt the Washington State Association of Counties' recommendation reaffirming the existing three-county Peninsula Regional Support Network boundary for Kitsap, Clallam, and Jefferson counties as the preferred boundary for an RSA in the region and has forwarded these recommendations to HCA and the Washington State Department of Social and Health Services • for formal approval; and KITSAP PUBLIC KITSAP PUBLIC HEALTH BOARD HEALTH DISTRICT RESOLUTION 2014-04 WHEREAS,the county commissioners of the three counties, and numerous other health and social service providers spanning the three-county region, have supported the Adult Behavioral Health System Task Force recommendation, affirmed support for an eventual three-county ACH within the same boundaries as the RSA—Kitsap, Clallam, and Jefferson Counties—and have opposed creation of either a 10-county RSA or ACH that involves their counties; and WHEREAS,preliminary ACH planning work is jointly underway in the Kitsap, Clallam, and Jefferson counties to convene stakeholders, lead health improvement activities, strengthen partnerships with local and state agencies, act in alignment with statewide healthcare initiatives, and use collective impact principles to make a three-county ACH successful. NOW THEREFORE BE IT RESOLVED that the Kitsap Public Health Board: 1. Urges the Washington State Health Care Authority and the Washington State Department of Social and Health Services to support the designation of a Kitsap, Clallam, and Jefferson Regional Service Area, and, in 2015, support the designation of an Accountable Community of Health within the same boundaries; and 2. Supports the participation of the Kitsap Public Health District as a stakeholder working to develop, implement, and operate a successful regional Accountable Community of Health • that consists of Kitsap,Clallam, and Jefferson counties. APPROVED: September 2, 2014 Mayor Patty Lent, Chair Kitsap Public Health Board Board of Health V New Business Item 4 Peninsula Accountable Community of Health • Planning Process • September 18, 2014 Progress improving Uregon Hearin rtan nignhigntea in annual report rage i of L TEXT Slit A+A-A • TEXT ONLY TRANSLATE , j Find • Oregon Health Authority News and Information Balt OHA News Home a Articles 1_li',a th Article search OHA News Release John A Kitzhaber,MD,Governor Directors Messages Message search ShareThis Facebook Tweet Google+ Email Media contact: Media Clips Alissa Robbins OHA Communications 503-490-6590 alissa.robbins@state.or.us Media Contacts 6/24/2014 News Releases OHA Bios Progress improving Oregon Health Plan highlighted in annual report Record Requests Coordinated care organizations are delivering improved preventive and primary care at more sustainable costs. Resources Patients and coordinated care organizations(CCO5)are starting to see the benefits of Oregon's new model for Medicaid,according to a report released today by the Oregon Health Authority. Health Reform OHA Home The coordinated care model showed large improvements in the following areas for the state's Medicaid enrollees: • Decreased emergency department visits.Emergency department visits by people served by CCOs has decreased 17 percent since baseline data were collected in 2011.The corresponding cost of providing services in emergency departments decreased by 19 percent over the same time period. • Developmental screening during the first 36 months of life.The percentage of children who were screened for the risk of developmental,behavioral and social delays increased from a 2011 baseline of 21 • percent to 33 percent in 2013,an increase of 58 percent. • Increased primary care.Outpatient primary care visits for CCO members increased by 11 percent and spending for primary care and preventive services are up over 20 percent.Enrollment in patient-centered primary care homes has also increased by 52 percent since 2012,the baseline year for that program. • Decreased hospitalization for chronic conditions.Hospital admissions for congestive heart failure have been reduced by 27 percent,chronic obstructive pulmonary disease by 32 percent and adult asthma by 18 percent. The report lays out how Oregon's coordinated care organizations scored on health care service measures in 2013. This will mark the first time the state is rewarding CCOs for improving care,rather than only the number or type of services delivered.In addition,Oregon remains on track to stay within the capped rate of growth in Medicaid spending. Based on how they did on the measurements,this week CCOs will receive all or part of the payments that had been held back until now.To earn their full payment,CCOs had to show improvement toward the goals on 17 measures.All CCOs showed improvements and 11 out of 15 met 100 percent of their improvement targets. The CCOs were scored on measures such as reducing patient emergency department visits while increasing childhood health screenings and primary care,among other things. The full report can be found on the OHA website.It shows,in total,33 health services measures including the 17 measures that drive this week's incentive payments. The report also shows areas where there has been progress but more gains need to be made,such as screening for risky drug or alcohol behavior and whether people are able to get timely appointments with health care providers.While there were gains in both areas,officials say that the state will put greater focus on them in the year to come.Access to care is particularly important with more than 340,000 new Oregon Health Plan members joining the system since January of 2014. • Additionally,this is the first report to show 2013 performance data by race and ethnicity compared to 2011 baseline data. http://www.oregon.gov/oha/news/Pages/Progress%20improving%200regon%20Health%2... 9/1 0/20 1 4 Progress improving Oregon fleaitn rian mgniigntea in annual report rage z. 01 z "The report shows where we started and where we are now,"said Suzanne Hoffman,interim director of the Oregon Health Authority."It also shows us where we want to go in continuing to innovate and improve our health delivery system." OREGON.GOV WEB SITE LINKS PDF FILE ACCESSIBILITY State Directories Text Only Site Adobe Reader,or equivalent,is required to view PDF files.Click the"Get Adobe Reader" Agencies A to Z Accessibility image to get a free download of the reader from Oregon Administrative Rules Oregon.gov Adobe. Oregon Revised Statutes OHA ADA Notice Oregon-an Equal Opportunity File Formats _ Reader. Employer Privacy Policy About Oregon.gov Site Map Web Site Feedback VETE . ANS Nay::a':alera�t nu twx�F:Nro. • • • http://w rw•oregon.gov/oha/news/Pages/ProgressD/o20improving%200regon%20Health%2... 9/10/2014 A r` CASCADE PACIFI ACTION ALLIANCE CASE. AUT --ORfTY Six Month Planning Grant Award $50,000 ' Ac;:IV1,-Ies Recipient shall undertake the following activities under this grant award agreement.The recipient will participate in the finalization of the required activities to guarantee both the recipient and HCA are mutually benefiting from the activities to further the implementation of the Accountable Community of Health (ACH) Initiative. a. Recipient will complete all project activities, set forth below,for which funding is requested prior to the grant end date, December 31, 2014. b. Informed by the Community of Health (COH) planning activities and related community engagement and partnership with the State during the period of performance, the recipient will deliver to HCA a final narrative report deliverable of a community health plan that outlines the recipient's activities around and/or plans to: i. Authentically engage a broad range of stakeholders and government entities in the COH planning process.The recipient will consider and describe how it will assess and improve engagement over time. Recipient will also describe how it will assess and improve inclusivity. ii. Partner with the State to further identify opportunities for alignment, barriers to achieving shared aims, and barrier resolution strategies; iii. Identify shared community health and health care priorities that align with State transformation priorities as outlined in the State Health Care Innovation Plan and related transformation efforts (e.g., Prevention Framework, Public-Private Transformation Action Strategy, clinical-community linkages, bi-directional integration of physical-behavioral health care, value-based payment, etc.); iv. Consider and articulate potential roles in driving community and State transformation, including: 1. Partnership and engagement with HCA in regional Apple Health (Medicaid) purchasing (note: HCA retains ultimate responsibility for selection and oversight in procurement and bears legal and financial responsibility); 4110 CASCADE PACIFIC ACI ION ALLIANCE / CASCADE PACIFI ACia ONALLIANCE . 2. Completion of region-wide health assessments and development of regional health improvement plans; 3. Acting as a forum for harmonizing payment models, performance measures, and investments; 4.Using innovative, aligned data (e.g., geographic information system mapping); 5.Facilitating practice transformation support and linking clinical and community sectors and resources; and 6.Identifying and facilitating shared community workforce resources (e.g., community health workers, care coordination, tele-health, etc.). v. Develop a pathway to achieve community aims through mutually reinforcing plan of action that includes specific commitments from a broad range of stakeholders and government entities throughout the community, ideally building upon existing community priorities and efforts. Within this work the recipient should consider and describe how they will periodically assess the actualization of stakeholder and government commitments. vi. Describe the development of, or plan to develop, the community's backbone organization, including its governance, structure, shared measurement mechanisms, designation of regional service areas and the State's intention to ultimately designate no more than one Accountable Community of Health (ACH) per region. Communities also should consider that no single entity or sector may dominate the community agenda or have majority control. vii. For all elements of the final deliverable, the recipient shall consider specific engagement and inclusion strategies for underrepresented populations, geographies and consumers and families. Additionally, the final deliverable will note areas with the above elements were the recipient has identified strengths and gaps in ability organizational capacity and highlight recommendations for changes at the State level and potential support and guidance needed from the State and/or other entities to build capacity and engage most effectively at the level. CASCADE PACIFIC ACTION ALLIANCE_ A • CPAA Planning Process: Local Community Planning Process Step 1: Iden ily I_ocai Community i eafth Priorities 1.1. Determine Community Forum Organizational Framework) 1.1.1. Is there an existing community planning framework that can be used for this planning process? 1.1.2. If yes, what is it, is it active or does it need to be activated? 1.1.3. If no, what can we build upon to establish a local planning process framework? 1.2. Conduct Stakeholder Analysis 1.2.1. Use Stakeholder Matrix' to Determine: 1.2.1.1. Who is already engaged (what sectors)? 1.2.1.2. Who is missing (sectors) and how are we going to engage them? 1.3. Survey Stakeholders 1.3.1. Familiarize each stakeholder with the concept of social determinants of health and local community needs assessments 1.3.2. Ask each stakeholder the following question: Considering the Social Determinants of Health, what do you believe are the 3-5 top health needs in our community? 1.3.3. Do you have any data that you can share with us to support your choice of the top health priorities? • 1.4. Collect Potential Priorities 1.4.1. Gather each stakeholder's 3-5 top health needs for your community and any supporting data 1.5. Review Available Data 1.5.1. For all proposed health priorities, review available data to determine "what the data says" and how the data compares to your perceptions of health priorities (ground the priorities in data to the extent possible) 1.6. Identify 3-5 Top Health Priorities for the Community(In-Person Stakeholder Meeting) 1.6.1. Determine prioritization criteria 1.6.2. Review list of proposed health priorities and 'what the data says'; apply prioritization criteria; and determine top 3-5 health needs for your community 1.7. Develop Problem Statement for each Top Health Priority 1.7.1. Write a 1-2 sentence description of the problem that is to be addressed for each health priority using the template provided. 1.8. Develop Inventory of Existing Initiatives For Top Health Priorities • 1 CHOICE will establish a region-wide inventory of community planning frameworks used by each county. 2 Stakeholder Matrix lists community sectors to be included in planning process. 1.8.1. For each top health priority, identify who is doing what already in your community (what can we build upon?) • 1.8.2. Complete inventory template3 with collected information Step 2: Explore Alignment of Local Community Health Priorities with State Transformation Goals 2.1. Review State Transformation Goals 2.2. Ask the question: How might our local health priorities align with the State transformation goals? Step 3: Determine Alignment of Local Community Health Priorities Across 10 Counties with State Transformation Goals 3.1. Regional Coordinating Council reviews each county's top health priorities and looks for alignment across all counties 3.2. Regional Coordinating Council reviews each county's top health priorities and looks for alignment with State transformation goals 3.3. Regional Coordinating Council determines shared regional priorities Deliverables: • Product Deadline 3-5 top health priorities for your community identified and agreed upon by August 30, 2014 multi-sector stakeholders Problem statements developed for each top health priority and submitted to August 30, 2014 CHOICE using template 3 To beP rovided by CHOICE. • di Board of Health V New Business Item 5 Substance Abuse Board Resignation • • September 18, 2014 Frances C. Joswick, MSW 41110 PO Box 486 Quilcene, WA, 98376 (808) 214-2079 wwbat@embargmail.com August 27, 2014 Jefferson County Board of Commissioners Jefferson County, WA • Dear Commissioners, Due to a recent health issue, my physician has strongly recommended I eliminate many of my community activities. Therefore, I must resign my position on the Substance Abuse Advisory Board. I am saddened and disappointed by this change in my situation. However, I am proud of the work the Board has done over the past seven years, especially the relapse prevention program at the jail. There is still work to be done to help keep our community as free of alcohol and drug abuse as possible and I hope the Substance Abused Advisory Board will continue have an impact in this effort. I am grateful to the members who are serving and have served on the Board during my tenure for their interest and commitment and want to thank them for their participation. Sincerely, . Frances C. Joswick JEFFERSON COUNTY • BOARD OF HEALTH September 18,2014 Frances C. Joswick,MSW PO Box 486 Quilicene,WA 98376 Dear Ms.Joswick: It is with the deepest regret that we learn of your ill health; and your need to resign your position on the Substance Abuse Advisory Board and the Board of Health. Your long service on these Boards and your tireless efforts to focus attention on this crucially important issue represent the highest ideals of community engagement and true citizenship. As you point out,your successful advocacy of relapse prevention services in the County Jail is one of the many extraordinary achievements you can take pride in and for which we are grateful. We have also enjoyed your insight,wit,and passionate commitment to substance abuse prevention and treatment. We have been honored to serve along with you on the Jefferson County Board of Health and we will sorely feel your absence in the future. • We wish you all the best, a return to good health, and we express our most sincere appreciation forour dedicated and selfless work in making Jefferson County a healthier and more compassionate community. y Sincerely, Members,Jefferson County Board of Health Board Members David Sullivan(Chair),County Commissioner District#2;Sheila Westerman,Citizen(Vice-Chair); • Phil Johnson,County Commissioner District#1;John Austin,County Commissioner District#3; Kris Nelson,Port Townsend City Council;Sally Aerts,Citizen;Jill Buhler,Hospital Commissioner 615 Sheridan • Castle Hill Center•Port Townsend• WA• 98368 (360)385-9400 LO Board of Health Media Report 0 • September 18, 2014 Jefferson County Public Health August/September 2014 NEWS ARTICLES 1. "Jefferson schools gear up to reopen," Peninsula Daily News, August 17th, 2014. 2. "News around town: ... Gonorrhea News," Port Townsend Leader, August 27th, 2014. 3. "State mental health crisis spurs local response," Port Townsend Leader, August 27th, 2014 4. "Tarboo forestland protected," Port Townsend Leader, August 27th, 2014. 5. "Home cookin': Team of East Jefferson culinary experts to take over Fort Worden food concession," Peninsula Daily News, August 28th, 2014. • • Jefferson schools gear up to reopen By Arwyn Rice, Peninsula Daily News, August 17, 2014 • Public schools in Jefferson County are gearing up to open, and back-to-school events are scheduled leading up to the first day of the 2014-15 school year. Port Townsend and Chimacum schools will open for classes Sept. 2, followed by Quilcene and Brinnon schools Sept. 3. Some back-to-school events are happening this week. The new school year will bring a new mascot—the Redhawks—to Port Townsend High School and usher in the first year of mandated Common Core standards taught in all state classrooms. Each district will be accepting new registrations at the district offices before school offices open and at schools after school staff return from summer break. For kindergarten enrollment, children must be 5 years old before Sept. 1. Parents or guardians are asked to provide a birth certificate and immunization record for:new student registration. Applications for free and reduced-price breakfast and lunch will be available at school offices. For the 2014-15 school year, a family of two earning less than $29,101 annually, or a family of four earning less than $44,123, is eligible for a free or reduced-price school breakfast and lunch. Port Townsend Port Townsend High School's main office at 1500 Van Ness St. will open for new student enrollment at 8 a.m. Wednesday. A fall sports parent meeting is set for 6 p.m. Monday in the high school library. The Associated Student Body office will be open from 10 a.m. to 1:30 p.m. Tuesday and Wednesday and Aug. 25- 27 for fall sports paperwork. The health clinic at the high school will be open for sports physicals from 9 a.m. to 3 p.m. Tuesday, Friday and Aug. 26. To make an appointment for a physical, phone 360-385-9400. Walk-ins are welcome. High school registration is set at the school from 10 a.m. to 1:30 p.m. Aug. 26. A freshman parent meeting will be held at 4 p.m. Aug. 25 in the auditorium. Freshman orientation will be from 8:30 a.m. to 11 a.m. Aug. 26 in the auditorium. The Blue Heron Middle School office reopens 8 a.m. Wednesday at 3939 San Juan Ave. •To schedule an enrollment appointment at Blue Heron, phone 360-379-4543 after Wednesday. To reach Grant Street Elementary offices at 1637 Grant St., phone 360-379-4535. Chimacum Chimacum School offices will reopen for new student enrollment Monday at 91 West Valley Road. • A sports physical clinic will be held from 9 a.m. to 3 p.m. Monday, Wednesday and Aug. 25 and 27 at the high school health clinic. Cowboy Day at Chimacum High School will be from 8 a.m. to noon Aug. 28 at the high school. Students will receive schedules, pay fees and get school portraits and identification cards. An orientation, tour and parent meeting will be held for new students. Quilcene Quilcene school offices at 294715 U.S. Highway 101 will open from 8 a.m. to 4 p.m. Monday for new student enrollment. School supply lists for all students are on the school website, www.quilcene.wednet.edu. A welcome-back teacher and staff luncheon will be held Aug. 27. Brinnon Brinnon School at 46 Schoolhouse Road has no scheduled back-to-school events. • Enrollment forms and other information for the kindergarten-through-eighth-grade school are at www.bsd46.orq. Reporter Arwyn Rice can be reached at 360-452-2345, ext. 5070, or at arwyn.rice(a�peninsuladailynews.com. • News around town: Skinny-dipping, saving, happy Aug. 30 03y Patrick J. Sullivan, Port Townsend Leader, August 26, 2014 • GONORRHEA NEWS: That's right, gonorrhea is in the news. According to a report by Washington State Department of Health's STD staff, as reported to the Jefferson County Board of Health, the percentage of gonorrhea cases here is up 200 percent comparing the first seven months of 2014 with the same period of 2013. There were three cases in the first seven months of 2013, and nine so far this year. July seems to be an active STD month, according to the statewide numbers. Jefferson had three reported cases of gonorrhea last month. That fits with Clark, King and Yakima counties as the biggest months to date. In terms of our neighbors, Clallam County is up 157 percent (eight cases so far this year, three more than seven months of last year), Kitsap is up 33 percent (72, from 54), Mason is up 73 percent (19, from 11) and Grays Harbor is up 188 percent (23, from 8). •_ • State mental health crisis spurs local response OBy Allison Arthur, Port Townsend Leader I Posted: Wednesday, August 27, 2014 A statewide crisis over treating patients with mental illnesses in hospital emergency rooms has led Jefferson County health care providers and law enforcement agencies to meet and discuss a concerted response to deal with mental health issues, Dr. Joe Mattern, chief of medical staff at Jefferson Healthcare, told hospital commissioners on Aug. 20 that there seems to be an uptick of primary care physicians being sought out by patients who had been served at the private Jefferson Mental Health Services (JMHS). That agency recently lost its only psychiatrist and is in transition, with its director, Sam Markow, recently resigning. "They are clearly struggling as an organization," Mattern said. "We've signaled to them we are ready to have more extensive collaboration with them. We need some leadership over there we can work with and they need to not be in crisis mode." Markow, who has been executive director of the mental health agency since February 2010, said last week that his own personal issues and health concerns have led him to resign from the full-time position. Markow said he'll be moving into an interim executive director position on Friday, Aug. 29. Two finalists for his position are to be interviewed this week. Markow also has been retained as a consultant. Markow said the nonprofit agency is in transition and is not a crisis. But he also said that loss of funding last year, coupled with an increase in the number of people eligible for mental health services through the new Affordable Care Act, did have an impact on the agency, on patients with mental health issues • and then on Jefferson Healthcare providers. "What we are seeing is people wanting mental health services and a lot of kids are showing up with coverage," Markow said. The loss of funding — because of a disagreement with a regional funding agency in Kitsap County — led his agency to furlough staff, lay off employees and ultimately lose its only two psychiatrists, he said. "They take the burden when we're short on prescribing staff," Markow said of Jefferson Healthcare. "When we can't do preventive care, I think they see more emergency room visits." BOARDING ISSUE Jefferson Healthcare officials, along with hospital officials statewide, became concerned earlier this month when the state Supreme Court issued a ruling that bans psychiatric "boarding" of mental health patients in hospitals. Jefferson Healthcare sees XXX patients a week who are in some sort of mental health distress. The rule was to take effect on Aug. 27, but on Aug. 22, Gov. Jay Inslee approved $30 million to fund treatment for psychiatric patients being "warehoused" in hospital emergency rooms and other unapproved facilities while more beds in approved facilities are opened. Jefferson Healthcare Chief Executive Officer Mike Glenn indicated on Aug. 25 that Inslee's decision is good news, with more money and time coming to solve the problem. "Meanwhile, we continue to meet and work collaboratively with local mental health providers and law enforcement," Glenn said. Mattern said the group that has been meeting about the mental health boarding issue plans to get back together this week to compare notes and review any changes. "I would anticipate that this group will continue to work together and expand to include other agencies . when indicated. We find ourselves in a position we did not expect to find ourselves in, and we are really trying to make sense of it," Mattern said. Mattern said he expects one focus to be to help Jefferson Mental Health Services and its new executive director to recruit staff and start building a "more collaborative model of care in the future." This comes at a time when Jefferson Healthcare has lost several providers and is also working to recruit at least one full-time primary care physician. Both health care agencies acknowledge that there seems to be an increase in demand for service at a time when there are fewer providers and the law is in flux. BOARDING ISSUE Jefferson Health Chief Nursing Executive Joyce Cardinal told hospital commissioners on Aug. 20 that there is a conflict between the federal Emergency Medical Treatment & Labor Act (EMTALA) law and the new state Supreme Court decision that requires hospitals to find a state-licensed bed for patients in a psychiatric crisis. The problem with that is that there aren't enough of those licensed beds in the state—and there are none in Jefferson County, which means patients often sit in the hospital for days, waiting for a bed to open. People have been sent as far as Yakima and as close as Kitsap County when they are experiencing a . psychiatric crisis. "We can't keep the patient, but we can't discharge them," Cardinal said of the state law, which does not allow the state to keep someone, because the hospital isn't an approved psychiatric facility, yet the federal law requires that the hospital do what it can to treat patients who come to them for help. "There's a lot of work going on in this state trying to figure this out and figure out what we're going to do," Cardinal said, acknowledging that it is a matter of community safety if people are a threat to themselves or others. Under the new ruling, someone brought into the emergency department with a mental health crisis who does not present as planning to harm themselves or anyone else must be released within three hours unless they have an underlying medical issue, such as having overdosed on drugs. And once that medical issue is resolved, they are on their own and cannot be involuntarily kept in the hospital. Previously, the hospital could keep a patient for up to 72 hours. In 2013, Jefferson Mental Health Services' Markow said, there were 89 people hospitalized in Jefferson County and of those, only three were admitted voluntarily. So far this year, 61 people have been hospitalized for mental health issues and of those, only 12 of those hospitalizations have been voluntary. In other words, the vast majority of hospitalizations are done involuntarily. 1111Not being allowed to hold people — and having no place to send them — is a concern for hospital officials. "It's going to cause a big dilemma for communities and for the hospital," Cardinal said. Glenn said the consensus in the health care industry is that providing patients with a bed is better than Oot providing a bed, "but not a whole lot better. "We need to find resources that can take better care of these patients, because we're not doing a very good job," he said of the health care officials seeking a solution. Glenn said it is complicated matter to provide care in hospitals for people with psychiatric issues. "Literally, we can't keep the patient, but we can't discharge the patient. It's the craziest thing," he said. "The hospital association and our medical malpractice carrier and every attorney who isn't on vacation is trying to unravel this and figure out where to go," Glenn said. Mattern noted that hospitals are often the last resort for family members who don't know where to turn to find help for a relative in mental health crisis. "A lot of people are brought here because no one knows what to do with them," Mattern said. "When you get in a situation where the best case scenario ... is they are either sick enough that they need to be in a hospital or they've said something or done something that they belong in jail ... when that is your best-case scenario, you're in a bad situation," he told the hospital board. Cardinal said that twice in one month a designated mental health professional has come to the hospital and then someone from the court has had to come in to affirm an involuntary commitment. MENTAL HEALTH 11, Back at Jefferson Mental Health Services, Port Townsend attorney Chuck Henry is the new president of the board that oversees the private agency. He took the helm as president after Jefferson County Sheriff Tony Hernandez resigned earlier this year. "I'd say our situation is not worse than most mental health agencies statewide," Henry said. Like Markow, Henry said there's been an increase in the number of people seeking care because of the federal law referred to as Obamacare. And at the same time, the agency lost both of its psychiatrists because of funding issues. One wanted to move back to her home state; the other couldn't keep up with the expanding caseload and quit, he said. "There are three psychiatrists listed [in Port Townsend] and they aren't part of our system. There are psychiatric needs that aren't provided by the hospital or by private providers, so in house we've tried to find ways to do it," Henry said. He noted that ARNPs (advanced registered nurse practitioners) are in high demand because they can prescribe medications. The agency currently is trying to bring in a job candidate. As for the state law, Henry says it's not a new crisis. "The state Supreme Court just identified it," he said. "We do not have a certified bed in Jefferson County, which means we have to fall back in searching every facility in the state to find an empty bed, or we have to get the person voluntarily to commit themselves to a facility." Henry said it is the state's responsibility to provide the beds and the state hasn't followed through —just as it hasn't followed through with fully funding basic public education. "It's because of government regulations and court rulings and government inaction" that there is what some people call a crisis, Henry said. What the deadline for change in hospitals has done, however, is give urgency to law enforcement and • health care providers —the front line for dealing with people with mental illness — communicating one another. "Right now, we're probably talking more closely with the hospital than we have for years because this is a common problem. It's our people that are affected." Henry added, "We've got to have more staff, which means we have to have the money to hire more staff. It's a thankless job trying to keep the mental health agencies going with the funding streams." Markow said that sending patients from Jefferson County to licensed facilities as far away as Yakima doesn't work well, because those people come back here without any connection to health professionals. "The good outcomes have been if we can get them into Kitsap County Mental Health, where we have better connections," he said. If people go elsewhere, they are unlikely to follow up with the care they need, he said. Washington state has an estimated 1,170 beds available and needs about 3,079, according to a treatment advocacy center, Markow said. BETTER OUTCOMES In the end, Jefferson Healthcare CEO Glenn said, "Caregivers typically find a way to do the right thing in spite of rules and regulations and laws. It would be awesome if we figure out a safe harbor and find beds open in two weeks, but I'm thinking we will deal with this somehow, some way and will not do anything • that our ED [emergency department] staff and every other caregiver is recommending us not to do." Mattern sees a light at the end of the discussion. "It is definitely a tough time for mental health care in Jefferson County and all of Washington state, but I am actually optimistic for the future in Jefferson County. Not only are the agencies, Jefferson Healthcare and [Jefferson Mental Health Services] interested in developing a more collaborative relationship, but there are initiatives at the state level to actually fund and drive improvement in the coordination of mental health care. "I am hopeful that our interest in working with [Jefferson Mental Health Services] closely will make it easier for them to fill their staff with high-quality clinicians," Mattern said. • Tarboo forestland protected 'ort Townsend Leader, Wednesday, August 27, 2014 Eighty acres of mature forest in the Tarboo Valley was permanently preserved last week through a joint project of Northwest Watershed Institute (NWI) and Jefferson Land Trust (JLT). Through the binding legal protection of a conservation easement granted by NWI to JLT, the forest is conserved for wildlife habitat, clean water and sustainable forestry. The project marks the successful culmination of a larger forest conservation effort, totaling 238 acres, that began in partnership with Leopold-Freeman Forests LLC six years ago and represents one of the largest conservation easement p projects completed to date in East Jefferson County. With help from conservation lenders, including the Wildlife Forever Fund and local residents, NWI purchased a 78-acre forest parcel in 2011. The previous owner was planning to clearcut and sell the land for development, according to Peter Bahls, director of the Port Townsend—based nonprofit NWI. Sorn Nymark, the owner of ANE Forests of Puget Sound, lived on a 1,000-acre estate in Denmark, Bahls noted. Over six years of discussions, NWI persuaded Nymark to sell the property with the forest intact, splitting the purchase of about 200 acres with Leopold-Freeman Forests. In the spring of 2014, NWI purchased an adjoining 2-acre tract that was threatened by development, for a total NWI ownership of 80 acres. The 238 acres of forest include numerous tributaries to Tarboo Creek, the main freshwater source of Dabob Bay, two miles downstream. "Conserving forestland is key to protecting the water quality for wild coho and chum salmon in Tarboo Creek, as well as the productive oyster and clam beds of Tarboo—Dabob Bay," said Judith Rubin, NWI stewardship director. $620,000 donated To repay the loans and to cover the cost of placing a conservation easement on the property, NWI needed to raise $620,000 by September 2014. More than half of the funding was granted through Jefferson County's Conservation Futures Program. Over two years, JLT was granted $334,000 from the program to purchase the easement from NWI. NWI raised the remaining funds from private donors and foundations. Over the past three years NWI led groups on tours and hosted fundraisers. More than 100 people, most of them Jefferson County residents, as well as several foundations, including the Mountaineers Foundation and Wildlife Forever Fund, donated the remaining $286,000 needed, said Bahls. The 80-acre Tarboo Forest, which forms a new addition to NWI's Tarboo Wildlife Preserve along Tarboo Creek, serves as a model for alternative forestry methods, supporters say. "We are looking to demonstrate that it is possible to restore old-growth forest habitat conditions, while also providing some jobs and high-quality forest resources — kind of a middle ground between industrial clear-cuts and `no touch' protection," said Bahls. The forestry plan was developed by Kirk Hanson, forester for Northwest Natural Resources Group (NWNRG). The forest is certified by the Forest Stewardship Council. • The conservation easement protects the forest's volume of timber as of a 2011 timber cruise by Cronin Forestry, but allows for selective harvest of some of the additional growth since then. The conservation effort also represents a practical way for people to offset their carbon emissions locally and take a small step to combat global warming, Bahls noted. According to a carbon assessment done by NWNRG, the protected forest is storing at least 37 metric tons of carbon per acre. "This level of carbon protected on the forest as a whole is equivalent to the annual CO2 output of over 2,000 passenger vehicles," said Bahls. "In effect, every protected acre offsets about seven years of an average American's carbon emissions." Carl's Forest Another key partner in the effort is Leopold-Freeman Forests. As a matching contribution to Jefferson County's grant, the forestry company donated a conservation easement to JLT that permanently safeguarded its adjoining 158 acres for wildlife habitat and sustainable forestry. The Leopold-Freeman forestland, known as "Carl's Forest," is owned by the Scott and Susan Freeman family, who named the tract in honor of Susan's father, Carl Leopold — a son of renowned conservationist Aldo Leopold —who had an abiding love for forests and conservation work. The Freeman family began working with NWI and JLT a decade ago to restore Tarboo Creek where it flows through their property. "We are delighted to be working with Northwest Watershed Institute and Jefferson Land Trust to preserve a large tract of forestland in the Tarboo Valley," Susan Freeman said in a statement. Sarah Spaeth, JLT executive director, said the project "fits well with the goal of conserving working forests, which was a priority identified by the community as they helped us develop our 100-year-vision conservation plan for Jefferson County." To date, more than 600 acres along Tarboo Creek and more than 2,000 acres within the Dabob Bay Natural Area have been protected by a large coalition of conservation organizations, landowners and public agencies. "We are fortunate to live in a part of the world that can still support salmon runs, • productive shellfish beaches and native forests," said Bahls. NWI is planning a celebration event featuring cider, salmon and clams at the Tarboo Wildlife Preserve for supporters later this fall, with details still to be announced. • Home cookin': Team of East Jefferson culinary experts to take over Fort Worden food concession ili•By Charlie Bermant,Peninsula Daily News,August 28"',2014. 411* daft- .- 77 rtitt,4/0111 Kris Nelson, shown serving beverages at her Sirens Pub in Port Townsend, is part of the team that will be running the new Fort Worden food service operation. —Photo by Charlie Bermant/Peninsula Daily News PORT TOWNSEND—As it prepares to take over food service at Fort Worden next week, the Fort Worden Lifelong Learning Public Development Authority has assembled a culinary supergroup to develop a locally sourced eating experience. The team is headed by Kristan McCary as the "front-of-house" director, aided by Kris Nelson and Arran Stark as 110 consultants. Executive chef Nicholas Colletti rounds out the team, which will take over food service management at Fort Worden on Tuesday. McCary has owned the Ajax Cafe in Port Hadlock for 10 years. Nelson, who is also Port Townsend's deputy mayor, has owned and operated several local restaurants in recent years and now runs Alchemy Bistro and Sirens Pub. Colletti has worked as a chef in several restaurants, most recently the Ajax Cafe. Stark, currently food service director at Jefferson Healthcare hospital, has worked as a chef and caterer in Port Townsend. "This will be a lot of work," Stark said. "But it's a great opportunity to develop a community-supported operation that can also help to build local businesses. "Fort Worden has always been a fort, a park or a correctional facility but has never been open for development by the people of Port Townsend. "This gives us the potential to do so many things." 411) Nelson said the PDA would like to use the space to develop outlets for locally grown food. "Someone could take the coffee shop and turn it into a really great space that people will want to visit rather than a place that just serves coffee," she said. "We've never had an ala carte restaurant at Fort Worden. This will give us a chance to serve dinner out here when people come for a show, or they can come out for just dinner." • Nelson said the fort has several spaces that can be converted into food service venues, perhaps building a space for dinner theater or providing a replacement for The Upstage, a popular downtown Port Townsend club that closed in 2013. "This was born out of necessity, but it's evolving into a really beautiful thing," McCary said. "This is a really neat group of people that has a lot of experience." Bon Appetit, a national catering company, has provided food service at Fort Worden for five years and has operated in three locations, providing food service for conferences, the Local Goods Cafe inside the Commons and the Cable House canteen on the beach. It notified the PDA in July about its intention to close down its operation Sept. 2. This set the PDA, which took over management of the park in May, scrambling to find a replacement before it decided to assemble its own team. Once this occurred, the new team began to prepare to provide food service for the events that were already reserved for the next few months. "The first thing we needed to do was to fill all the orders and make sure that we understood what people wanted," Nelson said. • "We offered everyone on the staff the opportunity to apply to work for us, and we all are pulling from our own cooks and waitstaffs and the people we know to fill these orders." "The challenge is making sure that we are set up and ready," McCary said. "We are definitely capable." Nelson said it will take awhile to develop a menu identity for the venture. The focus is now on filling banquet orders and providing choices the customers will like. Beyond that, Nelson hopes to mold the venture's identity, but as a collaborator rather than the final decision maker. "I love creating new businesses—the creative process and extreme challenge of building something new," she said. "This isn't about one person carrying the water. "A lot of people are working together, which is a fantastic new experience for me." Jefferson County Editor Charlie Bermant can be reached at 360-385-2335 or cbermant(a7peninsuladailynews.com. • STATE OF WASHINGTON • JEFFERSON COUNTY BOARD OF HEALTH AN ORDINANCE TO AMEND Ordinance No. 08-0918-14 FEE SCHEDULE FOR JEFFERSON COUNTY PUBLIC HEALTH Section 1 — Purpose Section 2 —Effective Date Section 3 —Fees Section 4—Severability Section 5—Prior fee schedule repealed WHEREAS, the purpose of this Ordinance is to amend the fee schedule for Jefferson County Public Health, Environmental Health Division WHEREAS, this Ordinance promotes the health, safety and welfare of the citizens of Jefferson County, and WHEREAS, this Ordinance is proposed and may be enacted pursuant to the general police power granted to Jefferson County and its Board of Health by the State Constitution, 110 OW, THEREFORE, BE IT ORDAINED by the Jefferson County Board of Health as follows: Section 1 —Purpose That the Fee Schedule for Jefferson County Public Health be amended to reflect increases in technical staff per hour cost. Section 2—Effective Date That this Ordinance(and its Attachment) shall be effective as of November 1, 2014. Section 3 —Fees That the schedule for Jefferson County Public Health, Division of Environmental Health fees for Hourly Rate for Technical Staff, Environmental Health hereby set by the Jefferson County Board of Health as listed on the attached fee schedule of the proposed Ordinance. Any text listed, specifically text within the column entitled "Additional Fees and Other Information" is deemed regulatory rather than advisory and as such has the full force and effect of local law. Section 4—Severability A determination that any text, fee or fees adopted as part of this Ordinance is unlawful or illegal shall not cause any other text, fee or fees adopted as part of this Ordinance not affected by that determination to be repealed, revised, or reduced. 411 . ' erection 5— Prior Fee Schedules Repealed y prior fee schedule previously adopted by this Board that contains or reflects fee amounts that are less than those adopted herein is hereby repealed and replaced by this Ordinance. AN ORDINANCE AMENDING 2013 FEE SCHEDULE FOR JEFFERSON COUNTY PUBLIC HEALTH,ENVIRONMENTAL HEALTH DIVISION ADOPTED Dc7,Ar- si _ kb day of t.Criflitber. 2014. JEFFERSON COUNTY BOARD OF HEALTH ea c.4.47,t1a 40-se n 0 e.- , 1141 LO‘,— 644 ' A aravidiSullivaCtai6 Sheila '' -sterman, Vice-Chair v\ ‘ I 1 l't (--), ('ti', (/AI(.).--t)--\ 1 Ty() -.........._ , , Jo)il Austin,Member Kris Ne! , n, em.er 7 t ipr Ei.4.14,5Cti a icoence, fir( / Sally Aerts, Member Phil Johnson, NI- ber L.'s ciA5 ed Jill Baler, Member III JEFFERSON COUNTY PUBLIC HEALTH ENVIRONMENTAL HEALTH DIVISION ENVIRONMENTAL HEALTH 2014 Additional Fees and Other Information GENERAL Health Officer Administrative Hearing_ 309,00 Administrative Hearing Appeal 309.00 Technical Assistance/Plan Review-Minimum 85.00 Technical Assistance/Plan Review-Per Hour 65.00 Fling Fee 53.00 Notice to Title Rescission 517.00 ONSITE SEWAGE DISPOSAL Sewage Disposal Permits New Conventional _ 561.00 Valid for 3 years New Alternative 668.00Valid for 3 years New septic tank and/or pump chamber only 266,00'Issued in conjunction with an existing sewage disposal New Community or>1000 G.P.D.(base fee) 561.00,Plus$88 per connection-valid for 3 yrs New Commercial>1000 G.P.D. Conventional 668,00 Valid for 3 years Alternative 715.00 Valid for 3 years Repair/Upgrade/Modification/Designate Reserve Area 124.00 Applies to existing installed sewage disposal system Expansion 418.00 Redesign 124.00 aApplies to pending or active but not installed Reinspection _ 155.00 Evaluation of Existing System/Monitoring Inspection Septic system only 309.00 Septic system plus water sample 322.00 Retest/Reinspection 108.00 On Site Sewage OnSite-Site Plan Advanced Approval Determination(SPAAD) 309.00 Septic Permit with SPAAD(conventional) 302.00 Septic Permit with SPAAD(alternative) 418.00 Subdivision Review Base Fee 401.00 Plus$79.00 Per Lot Boundary line adjustment review fee 158.00-Plus$79.00 Per Lot Pre application meeting fee 158.00 Planned rural residential development review fee 158.00 Density exemption review fee 79.00 • Density exemption review fee requiring field work 158.00_ Other WaiverNariance Application 186.00 , WaiverNariance Hearing 309.00 Wet season evaluation 418.00 Revised building application review fee 158.00 New building application review fee' Residential 79.00 Commercial 158.00 General environmental health review fee 85.00 Per Hour Licenses Installer,Pumper,.Operator(maintenance person) 418.00 Retest 170,00 Homeowner Authorization 10.00 Annual Renewal 294.00 Delinquent Renewal after Janue 31 418.00 FOOD;SERVICE ETABL1S ENT FEES PERMIT FEES(Annual Permit) RestaurantsrTake-Out(Basedon menu complexity&seating-menu changes may change category) 0-25 seats(Limited Menu) 188.00 No cooling or reheating 0-25 seats(Complex Menu) _. 334,00 Cooling and reheating allowed 26-50 seats 334.00 51-100 seats 401.00 101-150 seats 455.00 + With Lounge,add 147.00Separate lounge area Bakery Business 147.00 + B&B 188,00 Caterer w/commissary or catering-only kitchen 334.00 wI restaurant,additional fee for catering 188,00 Concession/Commercial Kitchen/Church 147.00. Espresso Stand 147.00__ Grocery 1-3 checkouts 188.00 May serve pre-packaged baked goods >3 checkouts 455.00 Meat/Fish Market 334.00 Mobile Unit • Limited Menu Complex Menu 188.00 No cooling or reheating 334.00 Cooling&reheating allowed School Cafeteria Central Kitchen Warming Kitchen 188.00 Tavern w/food(see Restaurants) Annual Permit Issued after September 1 1 50%of fee 150%of Annual Permit Fee 1 of 2 r ` ENVIRONMENTAL HEALTH 2014 Additional Fees and Other Information Ternporary Permits Single Event Initial Application(First Event) 106.00 Not to exceed 21 days at your location Additional Event(Same Menu Ong 60.00+Not to exceed 21 days at your location Ojanized Recurring Event(e.g.Farmers Market) Limited Menu 106.00 Not to exceed 3 days a week at a single location Complex Menu 140.00 Not to exceed 3 days a week at a single location Additional(Paid when application is submitted less than 7 Late Fee for Temporary Permits +50%of fee days prior to the event) Other Food Fees Permit Exemption 40.00 WaiverNariance 85.00_Per Hour Reopening Fee 85.00 Per Hour Managers Course 227.00+ Plan Review Pre-opening inspection 85.00 Per Hour Minimum 85,00 Per Hour 85.00 Reinspection First Inspection 94.00 Each inspection after first 160.00 Food Handler Card Reissue Unexpired Food Handler Card 1 10.00 SOLID WA$TE l w , Annual Permit Fees Landfills requiting environmental monitoring 548.00 Biosolid/Composting Facilities 481,00 Inert Waste Landfills 348,00 Other Solid Waste Facilities 348.00 Drop Boxes 160.00 Miscellaneous Fees New Facility Application 441.00 Exempt Facility Inspection 348.00 Facility Reinspection 50%of fee Plan,Document and WaiverNariance Review340.00 +$85.1:)0/hour for>4 hours Inspection of well construction,decommission& Application Fee 160,00 reconstruction Determination of Adequate Water Supply 67.00 Building Permit Process Well Inspection&Water Sample for Loan 135.00 Well Site Inspection-Proposed public water supply 321.00 LIVING ENVIRONMENTS Water Recreation Facilities Operation Permit Single Swim Pool(in operation for<6 months of the year) 291.00_ Single Swim Pool(in operation for a 6 months of the year) 294.00 Single Spa Pool(in operation for<6 months of the year) 255.00 Single Spa Pool(in operation for a months of the year) 294.00 _ Single Wading Pool(in operation for<6 months of the year) 211.00 Single Wading Pool(in operation for a 6 months of the year) 371.00 Spray Pool or Pools(in operation for<6 months of the year) 105.00 Spray Pool or Pools_(in operation for a 6 months of the year) 159.00, Each Additional Swim,Spa,or Wading Pool(in operation for<6 63.00 months of the year) _ Each Additional Swim,Spa,or Wading Pool(in operation for a 6 00 months of the year) Reinspection 85.00 Per Hour plus associated lab costs Plan Review 85.00 Per Hour Indoor Air'(Tobacco) Compliance Enforcement 65 00 Per Hour Reinspection 79.00 _Rebuttal Application _ 158.00 Note 2013 Fees have been adjusted per Ordinance 12.1229-96.Section 4-Annual Fee Indexing:Fixed amount fees established by this ordinance shalt be adjusted annually on the frst. business day of January(Adjusted Date)by the amount of the increase in the Consumer Price index(CPIW). The CPIW is the Consumer Price Index-US City Average for All Urban Wage Earners and Clerical Workers,published by the Bureau of Labor Statistics for the United States Department of Labor. The annual fee adtuatment shall be Calculated as follows: each tee In effect immediately prior to the Adjustment Date will be Increased by the percentage increase in the CPIW as reported for Me month of September preceding Che Adjustment Date. Increases wit be rounded to the nearest dollar. A fee shall not be reduced by reason of such calculation. However,feeincreases in accordance with this calculation enati not exceed 5 percent per year. • 2 of 2 • Publish one (1) September 3, 2014 Bill: Jefferson County Public Health 615 Sheridan Street Port Townsend, WA 98368 NOTICE OF PUBLIC HEARING NOTICE OF PUBLIC HEARING The Jefferson County Board of Health has called for a public hearing on adoption of revisions to the Jefferson County Environmental Health Fee Schedule. The hearing will be held during the Board's monthly meeting on Thursday, September 18, 2014, at 2:30 PM at the Jefferson County Public Health building, 615 Sheridan St., Port Townsend, WA 98368. The revisions to the fee schedule are being made to cover costs involved in technical assistance and planning. This is a budget neutral adjustment that affects: General technical assistance/plan review, minimum/per hour • General environmental health review, per hour Food fees: Waiver/variance, per hour Reopening fee, per hour Pre-opening inspection, minimum/per hour Solid waste plan, document, and wavier/variance review minimum Living environments: Re-inspection per hour, plus associated lab costs Plan review The text of the proposed fee schedule adjustments may be found on the Jefferson County Public Health website at www.jeffersoncountypublichealth.org or a copy of the full text of the proposed adjustments will be mailed upon request. To request a copy of the Jefferson County Environmental Health Fee schedule contact Jefferson County Environmental Health Department, Jefferson County Public Health, 615 Sheridan, Port Townsend, WA 98368. 410 Classified Ad • Please publish three (3) times: September 10, September 17, and September 24, 2014 Bill: Jefferson County Public Health Attn: Denise Banker 615 Sheridan Avenue Port Townsend, WA 98368 The Jefferson County Board of Health is seeking three individuals to serve on the Jefferson County Substance Abuse Advisory Board. Applicants must be Jefferson County residents and have demonstrated concern for alcoholism and other drug addiction problems. Send letters of interest to the Jefferson County Public Health, 615 Sheridan Street, Port Townsend, WA 98368, attention: Denise Banker. This is a non-paid position. Applications will be accepted through Monday, September 29, 2014. • •