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HomeMy WebLinkAbout2014- October • Jefferson County Public Health Agenda O & Minutes File Copy 11111 October 16, 2014 JEFFERSON COUNTY BOARD OF HEALTH October 16,2014 • Jefferson County Public Health 615 Sheridan St. Port Townsend, WA 2:30 —4:30 PM DRAFT AGENDA I. Approval of Agenda II. Approval of Minutes of September 18, 2014 Board of Health Meeting III. Public Comment IV. Old Business and Informational Items 1. Entereovirus D-68 Provider Bulletin 2. Peninsula Accountable Community of Health Update—Regional Meeting November 7, 2014 3. New England Journal of Medicine—Adverse Health Effects of Marijuana Use • V. New Business 1. Public Hearing: Adoption of Jefferson County Solid Waste Regulations (please bring copy of Solid Waste Ordinance distributed at the September meeting) 2. Washington State Board of Health Update 3. Jefferson County Paralytic Shellfish Poisoning Toxin Levels, Summer/Fall 2014 4. International Ebola Outbreak Update and Washington State Emergency Preparedness Efforts 5. Strategies to Expand Access to Opiate Overdose Treatment in Jefferson County 6. Substance Abuse Board Appointments VI. Activity Update : VII. Public Comment VIII. Agenda Planning Calendar IX. Next Scheduled Meeting: November 20, 2014 2:30—4:30 PM Jefferson County Public Health 615 Sheridan St. Port Townsend, WA • 4. JEFFERSON COUNTY BOARD OF HEALTH • MINUTES Thursday, September 18, 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 Vice-Chair Westerman called the September 18, 2014 meeting of the Jefferson County Board of Health to order at 2:32 p.m. A quorum was present. Members Present: Jill Buhler, John Austin, Kris Nelson, Sheila Westerman, Phil Johnson, Sally Aerts Members Excused: David Sullivan • Staff Present: Thomas Locke, Jean Baldwin, Jared Keefer, Julia Danskin APPROVAL OF AGENDA Vice-Chair Westerman called for review and approval of the agenda for the 09/18/2014 meeting. Julia Danskin, Public Health Manager, JCPH, requested to speak about two items during the Activity Update. Member Buhler moved to approve the agenda; the motion was seconded by Member Austin. The motion passed unanimously. APPROVAL OF MINUTES Vice-Chair Westerman called for review and approval of the minutes of the 8/21/2014 meeting of the Board of Health. Member Austin moved to approve the minutes; the motion was seconded by Member Johnson. No further discussion. The motion passed unanimously. • PUBLIC COMMENT • Catharine Robinson, Interim Chair for the Substance Abuse Advisory Board(SAAB) informed the Board that she will be attending the Board of Health meetings in place of Fran Joswick, who resigned from the Board due to health reasons. Ms. Robinson informed the Board that the SAAB has three applicants for Board members,but announced there is room for more. OLD BUSINESS AND INFORMATIONAL ITEMS 1. Enterovirus D-68 suspected in Seattle Dr. Thomas Locke, Health Officer, JCPH, informed the Board that he is closely watching the national spread of Enterovirus D-68 and when cases are confirmed on the West Coast, he will start doing provider alerts. He explained it is not uncommon for positive Enterovirus tests this time of year,but what is unexpected is the widespread distribution of the D-68 strain which previously was rarely seen. Because it is a rare strain, most people are susceptible. Dr. Locke explained that most people get a mild respiratory illness and only a small percentage have severe infections. Those with the highest risk are children with asthma. 2. Dabob and Quilcene Bays Closed due to Paralytic Shellfish Poisoning Jared Keefer,Director of Environmental Health and Water Quality, JCPH, informed the Board that Dabob and Quilcene Bays are closed due to Paralytic Shellfish Poisoning. Testing of the bays is occurring every 3-4 days, and is being monitored closely. 3. 2014-2015 Influenza and Pneumonia Information Dr. Locke provided the board with a letter sent to Area Health Care Providers. The letter provides general information about prevention of seasonal influenza and explains that JCPH no longer has influenza vaccine available for adults, but will provide state-supplied flu vaccines to children ages six months through 18 years. The letter also provides information on Pneumonia vaccines. Dr. Locke reiterated the importance of vaccines and recommended every healthy person get vaccinated in order to protect the rest of the population. 4. WA State Dept. of Ecology Pet Waste Facts Following up to an issue raised at the last Board of Health meeting,Dr. Locke provided the Board with a handout from the Department of Ecology that explains the proper disposal of dog waste. It is recommended that dog waste be scooped into a bag and disposed of in the garbage. If you live on a municipal sewer it is ok to flush the waste down the toilet. Disposal in on-site sewage systems is discouraged. It is recommended that dog waste never be buried or composted as these methods do not reliably eradicate pathogens that may be present in the waste. • • NEW BUSINESS 1. Public Hearing: Environmental Health Fee Revisions Mr. Keefer provided the Board with the Environmental Health Fee Schedule,reflecting the hourly rate increase from$67.44 to $85.00 per hour. Member Nelson stated to the Board that she is personally affected by this issue,but that she does not feel there is a conflict of interest and it will not influence her decision. Member Buhler stated to the Board that she is personally affected by this issue, but that she does not feel there is a conflict of interest and it will not influence her decision. Vice-Chair Westerman, and Members Johnson,Austin, and Aerts expressed no concern with Members Nelson and Buhler voting. Dan Toepper from Port Ludlow made a public comment that the Board should find as many ways as possible to inform the public about the Environmental Health permit fees. Vice-Chair Westerman suggested that Mr. Keefer write a press release about the updated Environmental Health Fees • Member Austin moved that the changes to the Environmental Health Fees be adopted; Member Buhler seconded the motion. No further discussion. The motion passed unanimously. 2. Call for Public Hearing, October 16,2014: Solid Waste Code Revisions Dr. Locke explained to the Board that this hearing had to be postponed due to extensive revisions by the county attorney, David Alvarez, and asked that it be rescheduled for the next BOH meeting on October 16, 2014. The changes were reviewed with the Board and a copy of the amended Code will be distributed to the public. Member Buhler provided Mr. Keefer with some formatting changes. Member Johnson moved to schedule a public hearing on the Solid Waste Code for the October 16, 2014 BOH meeting. The motion was seconded by Member Austin. No further discussion. The motion passed unanimously. 3. Washington State Regionalization Efforts—Behavioral Health, Chemical Dependency,Health Care Services, and Public Health Dr. Locke presented the Board with recent correspondence regarding the healthcare regionalization efforts. He informed the Board that the state has applied for a Federal Innovation Grant that would allow greater flexibility in how the State spends Medicare and Medicaid funds. Washington State's innovation grant proposal calls for formation of regional service areas known as Accountable Communities of Health (ACH). • Jean Baldwin, Director, JCPH, informed the Board that they have created a workgroup to • pull together all stakeholders from Kitsap, Clallam, and Jefferson counties to explore the benefits of forming a three-county ACH. The meeting is currently being scheduled for November. Ms. Baldwin will report back to the Board. 4. Peninsula Accountable Community of Health Planning Process Ms. Baldwin shared the Oregon Health Authority news release titled"Progress improving Oregon Health Plan highlighted in annual report,"which reports the progress Oregon has made since receiving the Federal Innovation Grant,the same grant that Washington State has just submitted an application for. Ms. Baldwin reported that Oregon has made substantial progress, but it has been much more difficult than expected, even with years of prior planning. Ms. Baldwin suggested the Board read the full report, located at: http://www.oregon.gov/oha/Metrics/Pages/index.aspx. 5. Substance Abuse Board Resignation Fran Joswick resigned from the Substance Abuse Advisory Board. The Board of Health received her resignation letter, and also signed a letter to Ms. Joswick,thanking her for her years of service. ACTIVITY UPDATE Mr. Keefer updated the Board on this year's Big Quilcene fishing season. Monies secured from 41/ DOH allowed for three port-a-potties to be placed around the river, which resulted in less waste in the river. Samples have come back with low or no E. Coli. Mr. Keefer also reported that on- site permitting has shortened its turnaround time from 3 months, as previously reported,to around 1.5 to 2 months. Ms. Danskin informed the Board that October is Breast Cancer Awareness month. Ms. Danskin also informed the Board that Girl's Night Out is October 2nd. Some of the funds raised will go to the breast and cervical health program at JCPH. Ms. Danskin passed out pamphlets. Ms. Danskin also informed the Board that Chimacum Prevention Coalition and 4H are moving ahead with the Strengthening Families Program. Classes start October 9 for seven weeks. Ms. Danskin handed out flyers and asked the Board to spread the word to any families they know of who might be interested who have children aged 10-14 in the Chimacum School District. PUBLIC COMMENT No Public Comment. • • AGENDA PLANNING CALENDAR The Solid Waste Code Revisions Public Hearing will take place at the next Board of Health meeting. Dr. Locke and Ms. Baldwin will be attending a mandatory meeting called by the new Secretary of Health to figure out a new vision for the public health system. They will report their progress at the next Board of Health meeting. NEXT SCHEDULED MEETING The next Board of Health meeting will be held on Thursday, October 16, 2014 from 2:30—4:30 p.m. at Jefferson County Public Health, 615 Sheridan Street, Port Townsend, WA. ADJOURNMENT Vice Chair Westerman adjourned the September 18, 2014 Jefferson County Board of Health meeting at 4:13 p.m. JEFFERSON COUNTY BOARD OF HEALTH • Phil Johnson, Member Jill Buhler, Member Sally Aerts, Member David Sullivan, Chair Kris Nelson, Member John Austin, Member Sheila Westerman, Vice Chair Respectfully Submitted: Natalie Crump JEFFERSON COUNTY BOARD OF HEALTH • MINUTES Thursday, September 18, 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 Vice-Chair Westerman called the September 18, 2014 meeting of the Jefferson County Board of Health to order at 2:32 p.m. A quorum was present. Members Present: Jill Buhler, John Austin, Kris Nelson, Sheila Westerman, Phil Johnson, Sally Aerts Members Excused: David Sullivan • Staff Present: Thomas Locke, Jean Baldwin, Jared Keefer, Julia Danskin APPROVAL OF AGENDA Vice-Chair Westerman called for review and approval of the agenda for the 09/18/2014 meeting. Julia Danskin, Public Health Manager, JCPH, requested to speak about two items during the Activity Update. Member Buhler moved to approve the agenda; the motion was seconded by Member Austin. The motion passed unanimously. APPROVAL OF MINUTES Vice-Chair Westerman called for review and approval of the minutes of the 8/21/2014 meeting of the Board of Health. Member Austin moved to approve the minutes; the motion was seconded by Member Johnson. No further discussion. The motion passed unanimously. • PUBLIC COMMENT • Catharine Robinson, Interim Chair for the Substance Abuse AdvisoryBoard d (SAAB) informed the Board that she will be attending the Board of Health meetings in place of Fran Joswick, who resigned from the Board due to health reasons. Ms. Robinson informed the Board that the SAAB has three applicants for Board members, but announced there is room for more. OLD BUSINESS AND INFORMATIONAL ITEMS 1. Enterovirus D-68 suspected in Seattle Dr. Thomas Locke, Health Officer, JCPH, informed the Board that he is closely watching the national spread of Enterovirus D-68 and when cases are confirmed on the West Coast, he will start doing provider alerts. He explained it is not uncommon for positive Enterovirus tests this time of year, but what is unexpected is the widespread distribution of the D-68 strain which previously was rarely seen. Because it is a rare strain, most people are susceptible. Dr. Locke explained that most people get a mild respiratory illness and only a small percentage have severe infections. Those with the highest risk are children with asthma. 2. Dabob and Quilcene Bays Closed due to Paralytic Shellfish Poisoning Jared Keefer, Director of Environmental Health and Water Quality, JCPH, informed the Board that Dabob and Quilcene Bays are closed due to Paralytic Shellfish Poisoning. Testing of the bays is occurring every 3-4 days, and is being monitored closely. 3. 2014-2015 Influenza and Pneumonia Information Dr. Locke provided the board with a letter sent to Area Health Care Providers. The letter provides general information about prevention of seasonal influenza and explains that JCPH no longer has influenza vaccine available for adults, but will provide state-supplied flu vaccines to children ages six months through 18 years. The letter also provides information on Pneumonia vaccines. Dr. Locke reiterated the importance of vaccines and recommended every healthy person get vaccinated in order to protect the rest of the population. 4. WA State Dept. of Ecology Pet Waste Facts Following up to an issue raised at the last Board of Health meeting, Dr. Locke provided the Board with a handout from the Department of Ecology that explains the proper disposal of dog waste. It is recommended that dog waste be scooped into a bag and disposed of in the garbage. If you live on a municipal sewer it is ok to flush the waste down the toilet. Disposal in on-site sewage systems is discouraged. It is recommended that dog waste never be buried or composted as these methods do not reliably eradicate pathogens that may be present in the waste. • • NEW BUSINESS 1. Public Hearing: Environmental Health Fee Revisions Mr. Keefer provided the Board with the Environmental Health Fee Schedule, reflecting the hourly rate increase from $67.44 to $85.00 per hour. Member Nelson stated to the Board that she is personally affected by this issue, but that she does not feel there is a conflict of interest and it will not influence her decision. Member Buhler stated to the Board that she is personally affected by this issue, but that she does not feel there is a conflict of interest and it will not influence her decision. Vice-Chair Westerman, and Members Johnson, Austin, and Aerts expressed no concern with Members Nelson and Buhler voting. Dan Toepper from Port Ludlow made a public comment that the Board should find as many ways as possible to inform the public about the Environmental Health permit fees. Vice-Chair Westerman suggested that Mr. Keefer write a press release about the updated Environmental Health Fees Member Austin moved that the changes to the Environmental Health Fees be • adopted; Member Buhler seconded the motion. No further discussion. The motion passed unanimously. 2. Call for Public Hearing, October 16,2014: Solid Waste Code Revisions Dr. Locke explained to the Board that this hearing had to be postponed due to extensive revisions by the county attorney, David Alvarez, and asked that it be rescheduled for the next BOH meeting on October 16, 2014. The changes were reviewed with the Board and a copy of the amended Code will be distributed to the public. Member Buhler provided Mr. Keefer with some formatting changes. Member Johnson moved to schedule a public hearing on the Solid Waste Code for the October 16,2014 BOH meeting. The motion was seconded by Member Austin. No further discussion. The motion passed unanimously. 3. Washington State Regionalization Efforts—Behavioral Health, Chemical Dependency, Health Care Services, and Public Health Dr. Locke presented the Board with recent correspondence regarding the healthcare regionalization efforts. He informed the Board that the state has applied for a Federal Innovation Grant that would allow greater flexibility in how the State spends Medicare and Medicaid funds. Washington State's innovation grant proposal calls for formation of regional service areas known as Accountable Communities of Health (ACH). • Jean Baldwin, Director, JCPH, informed the Board that they have created a workgroup to • pull together all stakeholders from Kitsap, Clallam, and Jefferson counties to explore the benefits of forming a three-county ACH. The meeting is currently being scheduled for November. Ms. Baldwin will report back to the Board. 4. Peninsula Accountable Community of Health Planning Process Ms. Baldwin shared the Oregon Health Authority news release titled"Progress improving Oregon Health Plan highlighted in annual report,"which reports the progress Oregon has made since receiving the Federal Innovation Grant, the same grant that Washington State has just submitted an application for. Ms. Baldwin reported that Oregon has made substantial progress, but it has been much more difficult than expected, even with years of prior planning. Ms. Baldwin suggested the Board read the full report, located at: http://vvww.oregon.gov/oha/Metrics/Pagesindex.aspx. 5. Substance Abuse Board Resignation Fran Joswick resigned from the Substance ce Abuse Advisory Board. The Board of Health received her resignation letter, and also signed a letter to Ms. Joswick, thanking her for her years of service. ACTIVITY UPDATE • Mr. Keefer updated the Board on this year's Big Quilcene fishing season. Monies secured from DOH allowed for three port-a-potties to be placed around the river, which resulted in less waste in the river. Samples have come back with low or no E. Coli. Mr. Keefer also reported that on- site permitting has shortened its turnaround time from 3 months, as previously reported, to around 1.5 to 2 months. Ms. Danskin informed the Board that October is Breast Cancer Awareness month. Ms. Danskin also informed the Board that Girl's Night Out is October 2nd. Some of the funds raised will go to the breast and cervical health program at JCPH. Ms. Danskin passed out pamphlets. Ms. Danskin also informed the Board that Chimacum Prevention Coalition and 4H are moving ahead with the Strengthening Families Program. Classes start October 9 for seven weeks. Ms. Danskin handed out flyers and asked the Board to spread the word to any families they know of who might be interested who have children aged 10-14 in the Chimacum School District. PUBLIC COMMENT No Public Comment. S AGENDA PLANNING CALENDAR • The Solid Waste Code Revisions Public Hearing will take place at the next Board of Health meeting. Dr. Locke and Ms. Baldwin will be attending a mandatory meeting called by the new Secretary of Health to figure out a new vision for the public health system. They will report their progress at the next Board of Health meeting. NEXT SCHEDULED MEETING The next Board of Health meeting will be held on Thursday, October 16, 2014 from 2:30—4:30 p.m. at Jefferson County Public Health, 615 Sheridan Street, Port Townsend, WA. ADJOURNMENT Vice Chair Westerman adjourned the September 18, 2014 Jefferson County Board of Health meeting at 4:13 p.m. JEFFERSON COUNTY BOARD OF HEALTH • ��5�c� Flb�Vlce. Phil Johnson, Member Jill Buhler, Member / 0' Sally Aerts, Member Dav i , air Kris Nelson, Member J Austin, Member L)Ig:A kk) Sheila Westerman, Vice Chair Respectfully Submitted: Natalie Crump • • Board of Health IV Old Business Item 1 Entereovirus D-68 Provider Bulletin 0 0 October 16, 2014 ., r 615 Sheridan Street ,tz Port Townsend, WA 98368 , www.JeffersonCountyPublicHealth.org • Public Health September 23, 2014 To: Jefferson County Health Care Providers From: Tom Locke, MD, MPH,Jefferson County Health Officer Re: Clinical Care Guidelines for Severe Respiratory Illness Associated with Enterovirus D68 Below is a Health Advisory from CDC regarding Severe Respiratory Illness Associated with Enterovirus D68 including clinical care recommendations. Currently, Washington State has had two confirmed cases of enterovirus D68.To date there have been no confirmed cases in Jefferson County although we should assume it is present. The North Olympic Peninsula has seen confirmed pediatric enterovirus infections requiring hospitalization—a relatively common occurrence at this time of year(peak season for enterovirus infection is summer and early fall). Determination that an enterovirus strain is the D68 variety can only be done by the CDC in Atlanta, introducing a significant delay in definitive diagnosis. The number of confirmed cases nationally(213 in 30 states, including Washington) dramatically under represents the likely scale of this outbreak. A reminder that this marks the beginning of the respiratory viral illness season and kids with mild • respiratory illness do not need to be tested for enterovirus D68 and should be treated as you usually treat a mild respiratory illness. Definitive diagnosis of non-polio enteroviruses is performed in cell culture or by PCR. This testing should be reserved for seriously ill children requiring hospitalization and had only epidemiologic benefit—there is no specific antiviral treatment for enterovirus infection. Summary: The Centers for Disease Control and Prevention (CDC) is working closely with hospitals and local and state health departments to investigate recent increases in hospitalizations of patients with severe respiratory illness. Enterovirus D68 (EV-D68) has been detected in specimens from children with severe illness in Missouri and Illinois. Investigations into suspected clusters in other jurisdictions are ongoing. The purpose of this HAN Advisory is to provide awareness of EV-D68 as a possible cause of acute unexplained respiratory illness, and to provide guidance to state health departments and health care providers. Please disseminate this information to infectious disease specialists, intensive care physicians, pediatricians, internists, infection preventionists, and primary care providers, as well as to emergency departments and microbiology laboratories. BACKGROUND Enteroviruses are associated with various clinical symptoms, from mild to severe. EV-D68 causes primarily respiratory illness, although the full spectrum of disease remains unclear. EV-D68 was originally isolated in 1962 and, since then, has been reported rarely in the United States. Small clusters • of EV-D68 associated with respiratory illness were reported in the United States during 2009-2010. There are no available vaccines or specific treatments for EV-D68, and clinical care is supportive. In Community Health Environmental Health Developmental Disabilities Water Quality 360-385-9400 360-385-9444 360-385-9401 (t) Always working for a safer and healthier community (f) 360-379-4487 August 2014, a children's hospital in Kansas City, Missouri, and one in Chicago, Illinois, notified CDC of • increases in pediatric patients examined and hospitalized with severe respiratory illness, including some admitted to pediatric intensive care units. Both hospitals also reported recent increases in detection of rhinovirus/enterovirus, in initial screening with a respiratory virus panel. Nasopharyngeal specimens from patients with recent onset of severe symptoms from both facilities were sequenced by the CDC Picornavirus Laboratory. EV-D68 was identified in 19 of 22 specimens from Kansas City and in 11 of 14 specimens from Chicago. Admissions for severe respiratory illness have continued at both facilities at rates higher than expected for this time of year. CDC has been notified by various states of similar clusters of respiratory illness, though confirmation of EV-D68 in these potential clusters is still under way. Of these severely ill patients who were confirmed positive for EV-D68 from both hospitals, all presented with difficulty breathing and hypoxemia, and some with wheezing. Notably, most patients were afebrile at presentation and throughout the hospital course.Approximately two thirds of cases had a previous medical history of asthma or wheezing, but both hospitals reported some patients with no known underlying respiratory illness. Ages ranged from 6 weeks through 16 years, with median ages of 4 and 5 years in Kansas City and Chicago, respectively. Most patients were admitted to the pediatric intensive care unit. Of the 30 patients who were positive for EV-D68, two required mechanical ventilation (one of whom also received extracorporeal membrane oxygenation) and six required bilevel positive airway pressure ventilation. It should be noted that specimens from only the most severe cases have been typed at this time, and so these findings may not reflect the full spectrum of disease. Additional details about these EV-D68 clusters can be found in the September 8, 2014, MMWR Early Release: (http://www.cdc.gov/mmwrLpreviewlmmwrhtmllmm63e0908a1.htm?s cid=mm63e0908a1 e) RECOMMENDATIONS Clinical Care: • Health care providers should consider EV-D68 as a possible cause of acute, unexplained severe respiratory illness, even in the absence of fever. • Although the findings to date have been in children, EV-D68 may also affect adults. Laboratory Testing: • Providers should consider laboratory testing of respiratory specimens for enteroviruses when the cause of respiratory infection in severely ill patients is unclear. • Confirmation of the presence of EV-D68 requires typing by molecular sequencing. • Providers may contact state or local health departments for further enterovirus typing. CDC is available for consultation. • Health departments may contact CDC for further enterovirus typing. • CDC is currently prioritizing respiratory specimens from patients with severe respiratory illness who are known to be positive for rhinovirus/enterovirus from initial screening assays. • 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 ' • Please visit the CDC EV-D68 website (http://www.cdc.gov/non-polio-enterovirus/about/EVD68.html ) for information on specimen submission. Completion of a brief patient summary form is required with each specimen submission to CDC. Infection Control: • Routes of transmission for EV-D68 are not fully understood. • Infection control guidelines for hospitalized patients with EV-D68 infection should include standard precautions, and contact precautions in certain situations, as is recommended for all enteroviruses (http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf). • As EV-D68 is a cause of clusters of respiratory illness, similar to rhinoviruses, droplet precautions also should be considered as an interim recommendation until there is more definitive information available on appropriate infection control. • As EV-D68 is a non-enveloped virus, environmental disinfection of surfaces in healthcare settings should be performed using a hospital-grade disinfectant with an EPA label claim for any of several non- enveloped viruses (e.g. norovirus, poliovirus, rhinovirus). Disinfectant products should be used in accordance with the manufacturer's instructions for the specific label claim and in a manner consistent with environmental infection control recommendations (http://www.cdc.gov/hicpac/pdf/guidelines/eic_in_HCF_03.pdf). Reporting: • Providers should report suspected clusters of severe respiratory illness to local and state health • departments. • EV-D68 is not nationally notifiable, but state and local health departments may have additional guidance on reporting. • Health departments may contact CDC for epidemiologic support. Please contact Dr. Claire Midgley (cmidgley@cdc.gov) with brief descriptions of possible clusters. For more information: For additional information, please consult the CDC enterovirus D68 website: (http://www.cdc.gov/non-polio-enterovirus/about/EV-D68.html) • • 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 (t) 360-379-4487 • Board of Health lv Old Business Item 2 Peninsula Accountable Community of Health Update Regional Meeting November 7th, 2014 0 • October 16, 2014 • sG � 3{' s ^� s •ssn,iy`s s d&:, ss = b' ' a �' � I • Letter of Invitation to ACH Stakeholders We want to share with you recent and important efforts to create a regional Accountable Community of Health (ACH) involving Kitsap, Clallam, and Jefferson Counties. Creation of an ACH is in response to Washington State's current development of common Regional Service Areas (RSAs) for Medicaid Purchasing, and the initiation of ACH Regions that have the potential to significantly change and improve the quality of health services we provide, lower the cost of providing our services, and ultimately improve the health of our communities. More importantly, we are asking you to join us in creating a tri-county ACH structure ---to be called the Olympic Community of Health ---that recognizes that health and health care are local, promotes shared accountability, and furthers the existing collaborative endeavors and delivery systems within our counties now and into the future. Under the Washington State Health Care Innovation Plan, an Accountable Community of Health will have multiple roles in driving health care transformation including: • Providing a multi-sector voice for delivery system reform, shared health improvement goals and regional purchasing strategies. . • Serving as a forum for regional collaborative decision-making to accelerate health system transformation, focusing on social determinants of health, clinical-community linkages, and whole person care. • Accelerating physical and behavioral health care integration through financing and delivery system adjustments, starting with Medicaid. 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 ACH designation.The timeline was brief, and none of our three counties submitted a proposal. Our three counties were however included in a proposal made by the CHOICE Regional Health Network for the July—December 2014 planning grant to explore a 10-county regional ACH, called the "Cascade Pacific Action Alliance (CPAA)." Post award, leadership of various health and social service organizations within our three-county region participated in a webcast conversation and additional follow-up discussion with CHOICE/CPAA. As a result of these conversations among the Clallam,Jefferson and Kitsap county participants, we determined it is of the utmost importance to withdraw participation in the ten-county effort, and instead create a local ACH tri-county structure. This work is critical as the State begins to solidify regionalization areas for state-financed health care, social support and other essential state services. The regional ACH structure has long-term implications for health and human services delivery and accountability, especially for delivery of.Medicaid services which include the mental health services managed by the existing Peninsula Regional Support Network and chemical dependency services. • • Board of Health V New Business Item 1 Public Hearing : Adoption of Jefferson County Solid Waste Regulations • October 16, 2014 ,+ f STATE OF WASHINGTON JEFFERSON COUNTY BOARD OF HEALTH • AN ORDINANCE TO AMEND Ordinance No. C'ci- 0 ilpJ SOLID WASTE REGULATIONS JEFFERSON COUNTY PUBLIC HEALTH Section 1 —Purpose Section 2 —Effective Date Section 3 — Severability WHEREAS, the purpose of this ordinance is to amend the Solid Waste Regulations for Jefferson County Public Health, WHEREAS, adoption of this ordinance will further the public policy memorialized in Chapter 173-350, Solid Waste Handling Standards, and Chapter 173-304,Minimum Functional Standards for Solid Waste Handling, pursuant to and by the authority of RCW 70.95, 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, WW THEREFORE, BE IT ORDAINED by the Jefferson County Board of Health as follows: Section 1 —Purpose That the Solid Waste Regulations Jefferson County Board of Health Ordinance 8.10 shall repeal and replace Ordinance number 09 1020 05. The ordinance has been revised for clarity of terms, procedures, consistencies, and remedies by refining definitions, editing redundancies, and adding sections to alleviate confusions. Section 2—Effective Date That this revision to the Solid Waste Regulations Jefferson County Board of Health Ordinance 8.10 shall be effective November 1, 2014. Section 3—Severability A determination that any text adopted as part of this Ordinance is unlawful or illegal shall not cause any other text adopted as part of this Ordinance not affected by that determination to be repealed, revised, or reduced. AN ORDINANCE REVISING THE SOLID WASTE ORDINANCE FOR JEFFERSON COUNTY PUBLIC HEALTH • ADOPTED4, day of &176Ct- 2014. 7 1 •FFERSON COUNTY BOARD OF HEALTH lik-e)-11-6- ckV)e-)4eii/tv-e — Davi ulli an, hair Sheila Westerman, Vice-Chair 4c, 0),,,,,Z; John Austin, Member Kris Nelson, Member Sally Aerts, Member Phil Johnson, Member Ex sed ab5e4c� Jill Buhler, Member IP 11111 JEFFERSON COUNTY BOARD OF HEALTH ORDINANCE 8.10 SOLID WASTE REGULATIONS S • JEFFERSON COUNTY BOARD OF HEALTH SOLID WASTE REGULATIONS • 8.10.010 - AUTHORITY AND PURPOSE These solid waste rules and regulations are promulgated under the authority of Chapters 43.20.050, Powers and Duties of State Board of Health70.05,Local Health Departments,Boards, Officers- Regulations,and 70.95,Solid Waste Management-Reduction and Recycling,in the Revised Code of Washington(RCW),and Chapters 246-203,General Sanitation, 173-304,Minimum Functional Standards for Solid Waste Handling, 173-350,Solid Waste Handling Standards, and 173-351,Criteria for Municipal Solid Waste Landfills,in the Washington Administrative Code(WAC),to protect the public health and the environment,and promote the safety and welfare of the citizens of Jefferson County. All references to these RCWs and WACs,and all other RCWs,WACs,and other federal,state, and local regulations,refer to the cited chapters and paragraphs,as amended. The rules and regulations herein govern the handling,storage,collection,transportation,treatment,utilization,processing and final disposal of all solid waste within Jefferson County,including the issuance of permits and enforcement. These regulations shall apply to all persons and in all territory within the boundaries of Jefferson County, except actions by persons on lands under the jurisdiction of the Federal Government or recognized Native American Nations and Tribes. It is expressly the purpose of these rules and regulations to provide for and promote the health of the general public,and not to create or otherwise establish or designate any particular class or group of persons who will or should be especially protected or benefited by the terms of these rules and regulations. • It is the specific intent of these rules and regulations to place the obligation of complying with its requirements upon waste generators,haulers,and/or operators of solid waste handling sites,and no provision of,nor term used in these rules and regulations is intended to impose any duty whatsoever upon Public Health nor any of its officers or employees,for whom the implementation or enforcement of these rules and regulations shall be discretionary and not mandatory. Nothing contained in these rules and regulations is intended to be,nor shall be construed to create or form the basis for any liability on the part of Public Health or its officers,employees or agents,for any injury or damage resulting from the failure of any person subject to these rules and regulations to comply with these rules and regulations,or by reason or in consequence of any act or omission in connection with the implementation or enforcement of these rules and regulations on the part of Public Health. 8.10.015 - ADOPTION BY REFERENCE Pursuant to and by the authority of RCW 70.95,Jefferson County Public Health hereby adopts Chapter 173-350,Solid Waste Handling Standards, and Chapter 173-304,Minimum Functional Standards for Solid Waste Handling. As provided for by RCW 70.95.160 Public Health makes the following amendments to Chapter 173-350. To the extent that any state statute or regulation listed in this section is amended or revised subsequent to the adoption of this chapter that amendment or revision is deemed incorporated into this Chapter upon its effective date and is applicable to any activity regulated by this Chapter. • 1 • 8.10. 020 - APPLICABILITY WAC 173-350-020 "Applicability", is adopted by reference except that subparagraph(6)is hereby repealed. Single-family residences and single-family farms disposing of their own solid wastes on their own property shall be subject to these regulations. 8.10.025 - OWNER RESPONSIBILITY FOR SOLID WASTES WAC 173-350-025 is revised to read as follows: 1. General. The owner,operator,or occupant of any premise,business,establishment,or industry shall be responsible for the satisfactory and legal arrangement for the solid waste handling of all solid waste generated or accumulated by them on the property. An owner is not relieved of the duties and obligations imposed by this Chapter because the owner has leased the property or premises to another or permitted others to occupy the premises or operate there. 2. Removal. . It shall be the responsibility of the owner,operator or occupant of any premise,business, establishment or industry to remove solid waste from the premises where it was generated to a 410 permitted solid waste handling facility at a frequency that does not create a nuisance or litter problem,or at a frequency otherwise approved by the Health Officer. The Health Officer may require any person who does not store,remove,transport,or dispose of solid waste consistent with these regulations,or who stores solid waste so as to create a nuisance or litter problem,to remove solid waste from the premises where it was generated,or collected,by that person to a permitted solid waste handling facility no less frequently than once per week. 3. Disposal. (a) Generally. It shall be the responsibility of the owner, operator or occupant of any premise, business,establishment or industry to dispose of all solid wastes at an appropriate solid waste handling facility permitted to receive such waste,or in a manner consistent with these regulations as approved by the Health Officer. Should a situation arise where disposal of solid waste is not covered under these regulations,the Health Officer shall determine acceptability of a method of disposal for the solid waste on a case-by-case basis (b) Unlawful Dumping. It shall be unlawful for any person to dump,deposit,bury,or allow the dumping,depositing or burying of any solid waste onto or under the surface of the ground or into the waters of this state,except at a solid waste disposal site for which there is a valid permit. Unlawful dumping shall include unauthorized deposition of solid waste into a container that is owned or leased by another person. (c) Name Appearing on Waste Material and Presumption. Whenever solid waste dumped in violation of this regulation contains three(3)or more items bearing the name of one individual, there shall be a presumption that the individual whose name appears on such items committed the unlawful act of dumping. 2 L (d) Identification Presumed. When the Health Officer investigates a case of unlawful dumping and finds identification in the solid waste as described in Section 025(3)(c),or other evidence,he/she • may then order the person who committed the unlawful dumping to remove and dispose of said solid waste according to these regulations. Following the disposal of said solid waste,the Health Officer may order this person to present to the Health Officer a receipt from the permitted disposal facility as proof of appropriate disposal. (e) Lack of Identification. When the Health Officer investigates a case of unlawful dumping and finds no identification in the solid waste,nor evidence,he/she may then order the property owner to remove said solid waste from his/her land,and have the solid waste disposed of according to these regulations. Where this occurs on private land,the property owner or occupant shall be responsible for removal and disposal. Where this occurs on public land,the appropriate governmental agency shall be responsible for removal and disposal. (f) Burning Prohibited. It shall be unlawful for any person to burn solid waste including garbage or rubbish unless these materials are burned in an appropriate permitted energy recovery or incinerator facility. The burning of land clearing debris and the residential burning of natural vegetative matter is regulated under Chapter 173-425 WAC,Outdoor Burning. (g) Disposal Service Required. When a person does not dispose of solid wastes in a manner consistent with these regulations,the Health Officer may order said person to obtain ongoing and regularly scheduled solid waste collection service if said person does not already have this service and if a solid waste collection service exists or is offered in the geographic area where the person resides. Said service shall be from a solid waste collection service holding a Solid Waste Handling Permit issued by Jefferson County Public Health and necessary certificates issued by the Washington Utilities and Transportation Commission. If said person does not have this service and resides in a geographic area where a single solid waste collection service operates exclusively under covenant or ordinance as required by local government,and said service is mandatory for persons residing within the jurisdiction of the local government,the Health Officer may schedule ongoing regularly scheduled service for said person with this solid waste collection service.If service is cancelled through nonpayment,it will be deemed a violation of this paragraph. (h) Disposal Receipts Required. Any person in violation of this paragraph to whom a notice and order to correct violation has been issued is required to produce receipts from a permitted solid waste disposal,recycling and/or reclamation facility or solid waste transporter to demonstrate compliance with the notice and order to correct violation issued by Jefferson County Public Health. 8.10.030 - EFFECTIVE DATES. WAC 173-350-030,Effective Dates are hereby adopted by reference. The effective date of these regulations is November 1st,2014. 8.10.040 - PERFORMANCE STANDARDS. WAC 173-350-040,Performance Standards,is hereby adopted by reference. 8.10. 100 - DEFINITIONS. Terms used in this regulation shall have the meaning provided in WAC 173-350-100,WAC 173-351-100 WAC and WAC 173-304-100 are hereby adopted in its entirety by reference herein except as revised or altered by the definitions provided below. Abandoned Landfills: Those sites not closed in accordance with all applicable regulatory requirements in place at the time that waste handling/disposal activities ceased. Abate: Repair,replace,remove,destroy,or otherwise remedy a condition(s)which constitutes a nuisance or a violation of these regulations by such means,in a manner,and to such an extent as the Health Officer determines is necessary in the interests of the general health,safety and welfare of the community. Abrasive Blasting: A method of surface preparation in which an abrasive aggregate is sprayed under pressure on to exterior surfaces which include,but are not limited to,boats,ships or other watercraft. Agricultural Wastes: Non-dangerous wastes on farms resulting from the production of agricultural products including,but not limited to,crop residues,manures,animal bedding,and carcasses of dead animals weighing each or collectively in excess of fifteen(15)pounds. Animal Wastes: Wastes generated on a farm,including manure,pet feces,and dead animals. Asbestos-Containing Material: Any material containing more than one percent(1%)asbestos as determined using the method specified in EPA regulations Appendix E,Subpart E,40 CFR Part 763, Section 1,Polarized Light Microscopy. Asbestos-Containing Waste Material: Any waste that contains or is contaminated with friable asbestos-containing material.Asbestos-containing waste material includes asbestos waste from control equipment,materials used to enclose the work area during an asbestos project,asbestos-containing material collected for disposal,asbestos-contaminated waste,debris,containers,bags,protective clothing,or HEPA filters.Asbestos-containing waste material does not include samples of asbestos- containing material taken for testing or enforcement purposes. Ashes: The residue from combustion or incineration of material including solid wastes and any air pollution flue dust. Biomedical Waste: Biomedical waste means,and is limited to,the following types of waste: 1. "Animal waste"is waste animal carcasses,body parts,and bedding of animals that are known to be infected with,or that have been inoculated with,human pathogenic microorganisms infectious to humans. 2. "Biosafety level 4 disease waste"is the waste contaminated with blood,excretions,exudates,or secretions from humans or animals who are isolated to protect others from highly communicable infectious diseases that are identified as pathogenic organisms assigned to biosafety level 4 by the Centers for Disease Control,National Institute of Health,and Biosafety in Microbiological and Biomedical Laboratories,current edition. 3. "Cultures and stocks"are wastes infectious to humans including specimen cultures,cultures and • stocks of etiologic agents,wastes from production of biologicals and serums,discarded live and attenuated vaccines,and laboratory waste that has come into contact with cultures and stocks of 4 etiologic agents or blood specimens. Such waste includes but is not limited to culture dishes,blood specimen tubes,and devices used to transfer,inoculate,and mix cultures. 4. "Human blood and blood products"are waste human blood and blood components,and materials containing free-flowing blood and blood products. 5. "Pathological waste"is human source biopsy materials,tissues,and anatomical parts that emanate from surgery,obstetrical procedures,and autopsy. "Pathological waste"does not include teeth, human corpses,remains,and anatomical parts that are intended for internment or cremation. 6. "Sharps waste"is all hypodermic needles,syringes with needles attached,intravenous tubing with needles attached,scalpel blades,and lancets that have been removed from the original sterile package. Biomedical Waste Collection Service: Any agency,business,or service operated by a person for the purpose of biomedical waste collection and transportation. Biomedical Waste Generator: Any producer of biomedical waste to include without limitation the following categories: General acute care hospitals,skilled nursing facilities or convalescent hospitals, intermediate care facilities,in-patient care facilities for the developmentally disabled,chronic dialysis clinics,community clinics,health maintenance organizations,surgical clinics,urgent care clinics,acute psychiatric hospitals,laboratories,medical buildings,physicians offices and clinics,veterinary offices and clinics,dental offices and clinics,funeral homes or other similar facilities. Biomedical Waste Treatment: Means incineration,sterilization,or other method,technique,or process that changes the character or composition of a biomedical waste so as to minimize the risk of transmitting infectious disease. 10 Board of Health: The Jefferson County Board of Health. Buffer Zone: That part of a facility that lies between the active area and the property boundary.Junk cars are not allowed in a Buffer Zone as defined in Title 18 of Jefferson County Code. Bulky Waste: Large items of refuse,such as appliances(white goods),furniture,junk vehicles,and other oversize wastes which would typically not fit into reusable or disposable containers. Construction Waste: Non-dangerous solid waste,largely inert waste,generated as the result of construction of buildings,roads,and other man-made structures. Construction waste consists of,but is not limited to:concrete,asphalt,brick,rock,wood and masonry,composition roofing and roofing paper, shakes,shingles,plastic and paper wrappings,plastic pipe,fiberglass insulation,carpeting,floor tile, glass,steel,and minor amounts of other metals like copper. Decision: Any writing authored by Jefferson County Public Health(JCPH),the Local Health Officer or any employee or representative of JCPH or the Local Health Officer that serves to represent the official position of the JCPH or the LHO including,but not limited to,a decision to deny a permit application,a decision to allege permit violation(s), issuance of an Abatement Order,transmittal to a person or entity of a Notice and Order to Correct Violation,or a decision to suspend or revoke an existing or issued permit. Demolition Waste: Non-dangerous solid waste,largely inert waste,resulting from the demolition or razing of buildings,roads and other man-made structures.Demolition waste consists of,but is not limited to: concrete,asphalt,brick,rock,wood and masonry,composition roofing and roofing paper, shakes, shingles,plastic pipe,fiberglass insulation,carpeting,floor tile,glass,steel,minor amounts of • 5 • other metals like copper,and incidental amounts of soil associated with these wastes. Plaster(i.e.,sheet rock or plaster board),yard wastes,stumpage,or any other materials that are likely to produce gases or leachate during the decomposition process are not considered to be demolition waste for the purposes of this definition. Bulky wastes,white goods,and asbestos-containing materials are not considered to be demolition waste for the purpose of this regulation. Discarded Commodity: Products or items that because of damage,misuse,wear,or neglect and because of such neglect are no longer being utilized for their intended purpose. Neglect,for the purpose of this definition is deemed to include,but not limited to, circumstances where a product or item is left exposed to the weather to rot,rust or deteriorate or is so severely damaged such that it can no longer be used for its intended purpose. Disposal Site: The location where any final treatment,utilization,processing or deposition of solid waste occurs. See also the definition of interim solid waste handling site. Drop Box Facility: A facility used for the placement of a detachable container,including the area adjacent for necessary entrance and exit roads,unloading and turnaround areas. Drop box facilities normally serve the general public with loose loads and receive waste from off-site Ecology: The Washington State Department of Ecology. Emission: The release of air contaminants from solid waste into the outdoor atmosphere. Environmentally Sensitive Areas or"ESA":shall be as defined at RCW 36.70A.030(5)(or as hereafter amended)to include wetlands,areas with a critical recharging effect on aquifers used for potable water,fish and wildlife habitat conservation areas,frequently flooded areas and geologically S hazardous areas(and buffers for all such areas)as those terms are defined and described in Title 18 of the Jefferson County Code in its current form or as it may be in the future,amended,supplemented or replaced.Junk cars are not allowed in an ESA as defined in Title 18 of Jefferson County Code. EPA: The United States Environmental Protection Agency. Hazardous Substance: Any liquid,solid,gas,or sludge,including any material,substance,product, commodity,or waste,regardless of quantity,that exhibits any of the physical,chemical or biological properties described in WAC 173-303-090 or WAC 173-303-100. Health Officer: The Health Officer or the Health Officer's representative,of the Jefferson County Public Health. Junk Vehicle: A junk vehicle includes campers,boats,boat trailers or any other type of vehicle used for human transportation which may exhibit any of the following: • Build-up of debris,moss or weeds on,in,under,or around the vehicle that obstructs use; • Damage to the frame; • More than one missing or shattered window or windshield; • More than one inoperable or missing headlight or taillight; • More than one flat tire; • A missing or inoperable engine or transmission. • A missing wheel,license plate, driver-side mirror,tire,body panel, door,hood or other obvious body part,not including a bumper. • A license plate that has been invalid for more than 60 days. 40 • Evidence that the vehicle has not been moved in at least 60 days. 6 } A vehicle certified under RCW 46.55.230 as meeting at least three of following requirements shall be considered a junk vehicle: 1. Three(3)years old or older; 2. Extensively damaged,such damage including but not limited to the following:a broken window or windshield,or missing wheels,tires,motor,or transmission; 3. Apparently inoperable;and/or 4. Has approximate fair market value equal only to the approximate value of the scrap in it. For enforcement purposes,possessing three(3)or more junk vehicles on a single property of any size is not allowed under this regulation. Minimum Functional Standards(MFS): Chapter 173-304 WAC,Minimum Functional Standards for Solid Waste Handling. Moderate Risk Waste(MRW): means solid waste that is limited to conditionally exempt small quantity generator(CESQG)waste and household hazardous waste(HHW)as defined in this chapter. Nuisance: Consists in unlawfully doing an act,or omitting to perform a duty,which act or omission either annoys,injures or endangers the,repose,health or safety of others;or unlawfully interferes with, obstructs or tends to obstruct,any lake or navigable river,bay,stream,canal or basin,or any public park,square,street or highway;or in any way renders other persons insecure in life,or in the use of property. To the extent applicable,the County adopts the definitions of nuisance found in Ch.7.48 RCW. Owner: The person,business entity or partnership that is the title owner of record with the Jefferson County Auditor for the parcel or parcels where the violation is allegedly occurring. 1110 Person responsible: The owner,lessee,occupant or operator of the premises,business,activity or action that is allegedly a violation of this Chapter. Problem Wastes: 1. Any solid material removed during a remedial action,a dangerous waste site closure,other cleanup efforts,or other actions,which contain hazardous substances,but are not designated dangerous wastes; 2. Dredge spoils resulting from the dredging of surface waters of the state where contaminants are present in the dredge spoils at concentrations not suitable for open water disposal and the dredge spoils are not dangerous wastes and are not regulated by Section 404 of the Federal Clean Water Act (PL 95-217);or 3. Waste abrasive blasting grit or other material used in abrasive blasting. Common aggregates include,but are not limited to silica sand,utility slag or copper slag. Waste abrasive blasting grit does not include blasting grit that will be reused for its intended purpose. Public Health: Jefferson County Public Health or any person acting on behalf of or employed by Jefferson County Public Health. Remedial Action: Any action to identify,eliminate or minimize any threat posed by hazardous substances to human health or the environment including any investigative and monitoring activities with respect to any release or threatened release of a hazardous substance and any health assessment or • health effects studies conducted to determine the risk or potential risk to human health. 7 Rubbish: All non-putrescible wastes from all public and private establishments and from all residences. Solid Waste: All putrescible and non-putrescible solid and semi-solid wastes including,but not limited to,garbage,rubbish,ashes,industrial wastes,swill,animal wastes,construction and demolition wastes, land clearing wastes,contaminated soils,contaminated dredged spoils,junk vehicles or parts thereof (including waste tires),and discarded commodities. This includes all liquid,solid and semi-solid, materials that are not the primary products of public,private,industrial,commercial,mining and agricultural operations. Solid waste also includes,but is not limited to,woodwaste,dangerous waste, yard waste,bulky waste,biomedical waste,animal waste,waste tires,recyclable materials,and problem wastes. Municipal sewage sludge or septage is a solid waste when placed in a municipal solid waste landfill subject to the requirements in Chapter 173-351 WAC,Criteria for Municipal Solid Waste Landfills,Chapter 173-308 WAC,Biosolids Management,and a solid waste handling permit issued by the Health Officer. Used Oil: 1. Lubricating fluids that have been removed from an engine crankcase,transmission,gearbox, hydraulic device,or differential of an automobile,truck,bus,vessel,plane,heavy equipment,or machinery powered by an internal combustion engine;or 2. Any oil that has been refined from crude oil,used,and as a result of use,has been contaminated with physical or chemical impurities;or 3. Any oil that has been refined from crude oil and,as a consequence of extended storage,spillage, or contamination,is no longer useful to the original purchaser;and 4. Used oil does not include oil to which dangerous wastes have been added,or oil that would otherwise be considered used oil except that it is used as a fuel in an industrial furnace,which meets the emission standards of the Puget Sound Clean Air Agency. 8.10.200 - Beneficial Use Permit Exemptions WAC 173-350-100 Beneficial Use Permit Exemptions is hereby adopted by reference. 8.10. 210 - Recycling WAG 173-350-210,Recycling is hereby adopted by reference. 8.10. 220 - Composting Facilities WAC 173-350-220,Compost Facilities is hereby adopted by reference. Paragraph 220(7)has been revised as follows: • 220(7)Compost Facilities—Financial Assurance requirements. (a) Financial Assurance may be required for certain compost facilities as determined by Public Health. 8 (b) If required by Public Health,the owner or operator shall establish a financial assurance mechanism in accordance with 173-350-600 for closure in accordance with the approved closure plan. The funds shall be sufficient for hiring a third party to remove the maximum amount of wastes that could be present at any time during the operation of the facility and to accomplish closure in accordance with the facility closure plan. (c) If required,no owner or operator shall commence or continue to operate any part of the facility until a suitable financial assurance mechanism has been provided to the JHD in accordance with WAC 173-350-600. 8.10. 230 - Land Application WAC 173-350-240,Land Application is hereby adopted by reference. 8.10.240 - Energy Recovery and Incineration WAC 173-350-240,Energy Recovery and Incineration is hereby adopted by reference. 8.10.300 - On-site Storage, Collection, and Transportation Standards WAC 173-350-300,On-Site Storage,Collection,and Transportation Standard is hereby adopted • by reference and revised with the addition of the following paragraphs. 300(2)(b)(iv) Containers of mixed municipal solid waste,putrescible waste,and rubbish shall be closed at all times except when waste is being added or removed. Commercial containers located at public or private collection facilities may be kept open during routine hours of operation,as long as the container drain plugs remain in place. 300(2)(b)(v) The owner,operator or occupant of any premises,business establishment or industry shall store all recyclable materials so as not to produce unsafe or unsanitary conditions. 8.10.305 - Solid Waste Handling Standards for Specific Waste Stream 8.10.305(1) Animal Waste (a) Animal waste,as defined in Section 100,shall be disposed of in a manner consistent with these regulations,or other method approved by the Health Officer. (b) Any animal waste that is deemed biomedical waste as defined in Section 100,shall be handled, treated,and disposed of as required in Section 305(b). (c) Animal Manure. Animal manure shall not be deposited,or allowed to accumulate,in any ditch,gulch, ravine,river,stream,lake,pond,marine water,or upon the surface of the ground,or on any highway or • road right of way,where it may become a nuisance or menace to health,as determined by the Health 9 • Officer,through the breeding of flies,harboring of rodents,or pollution of water. Manure shall not be allowed to accumulate in any place where it can pollute any source of drinking water. (d) Dead Animals. Except as otherwise provided in Section 305(3),dead animals shall be disposed of in a manner to protect the public health and the environment. Their disposal shall be consistent with local codes. Dead animals may be taken to a rendering plant,a veterinary clinic,an animal shelter,pet cemetery,or can be disposed of directly at permitted operating landfills or transfer stations so as not to create a nuisance. Property owners may bury dead animals on their property,so long as no nuisance is created. If the dead animal is buried,it shall be placed so that every part shall be covered by at least two(2)feet of earth and at a location not less than one-hundred(100)feet from any well,spring, stream,or other surface waters,and in a place not subject to overflow. In all cases of death from communicable disease,the dead animal,if disposed of by burial,shall first be thoroughly enveloped in unslaked lime. (e) Pet Feces. Pet feces,especially dog droppings,shall be disposed of in a manner,such as burial,or bagging and placement into containers described in Section 300(2),which does not create a nuisance or pollute surface waters of the state. Pet feces shall not be disposed of into the sanitary sewer unless approved by the sewer purveyor. This waste shall not be put into a storm sewer or on-site sewage system. 8.10.305(2) Asbestos-Containing Waste (a) General. Asbestos-containing waste material(ACWM),as defined in Section 100,shall be handled and disposed of pursuant to 40 CFR Part 61,National Emission Standards for Hazardous Air Pollutants,Chapter 173-303 WAC,Dangerous Waste Regulations,Olympic Region Clean Air Agency Rule 6.3 and Chapter 296-65 WAC,Asbestos Removal and Encapsulation. (b) Removal. Persons removing ACWM shall contact the Olympic Region Clean Air Agency for information and instruction concerning removal and disposal. ACWM must be wetted down during removal to reduce airborne emissions of particulate matter. ACWM shall be sealed into leak tight containers or placed in one or more plastic bags with a combined six(6)mils thickness or greater and identified with the proper warning label. (c) Disposal. The ACWM shall be disposed of in accordance with 40 CFR Part 61,National Emission Standards for Hazardous Air Pollutants,at a facility permitted to receive such wastes,in accordance with an approved operations plan,and covered with at least fifteen centimeters(6 inches)of non- asbestos containing waste material immediately following disposal. 8.10.305(3)BIOMEDICAL WASTE (a) Applicability. This regulation applies to all persons who generate biomedical waste including, but not limited to,individuals,hospitals,medical and dental clinics,medical laboratories,nursing or intermediate care facilities,veterinary facilities and other institutions,which may generate biomedical wastes as defined in Section 100,without regard to the quantity of biomedical waste produced per month. (b) Storage and Handling. (i) Containment of biomedical waste shall be in a manner and location which affords protection from animals,rain,and wind and does not provide a breeding place or a food source for insects or rodents. • (ii) Biomedical wastes shall be segregated from the general medical waste stream at the point of origin and stored in separate containers. When possible,biomedical wastes should be rendered non- 10 infectious through chemical or physical treatment procedures as approved by the facility's site safety officer. • (iii)Biomedical waste,except for sharps,shall be contained in disposable leakproof containers having strength to prevent ripping,tearing or bursting under normal conditions of use. The containers shall be secured to prevent leakage or expulsion of solid or liquid waste during storage,handling or transport. The containers can be of any color and shall be conspicuously labeled with the international biohazard symbol,and the words"Biohazardous Waste" or words that clearly denote the presence of biomedical waste. (iv)All sharps,including home-generated sharps,shall be contained in leak-proof,rigid,puncture resistant,break resistant containers that are labeled and tightly lidded during storage,handling and transport. These containers must be capable of maintaining their structural integrity from the point of storage to deposition at an approved disposal or collection site. The containers shall be of any color and shall be conspicuously labeled with the international biohazard symbol,and the words "Biohazardous Waste"or words that clearly denote the presence of biomedical waste. (v) Reusable Containers. (A) Reusable containers for biomedical waste storage,handling or transport shall be thoroughly washed and decontaminated by a method approved by the Health Officer each time they are emptied,unless the surfaces of the containers have been protected from contamination by disposable liners,bags or other devices removed with the waste. (B) Approved methods of decontamination are agitation to remove visible solid residue combined with chemical disinfection. Chemical disinfectants should be used in accordance with the manufacturer's recommendations or by disinfectant concentration/contact times approved in writing by the Health Officer. Other decontamination methods may be approved in writing by the Health Officer. • (C) Reusable pails,drums or bins used for containment of biomedical waste shall not be used for any other purpose except after being disinfected by procedures as described in this regulation and after the international biohazard symbol and the words"Biohazardous Waste"are removed. (vi)The handling and storage of all biomedical waste must prevent the dissemination of biomedical waste into the environment. (vii)Trash chutes shall not be used to transfer biomedical waste. (viii)Biomedical waste shall not be placed into the general waste stream unless contained and treated. (ix)Sharps shall not be placed into the general waste stream. (c)Disposal. (i) All biomedical waste that has been contained as described in Section 305(3)(b) shall be disposed of at a solid waste handling facility permitted to receive such waste. (ii) All human or animal body parts, fetuses, and other pathological specimens shall be disposed of either by appropriate interment,incineration or other method approved by the Health Officer. (iii)Untreated liquid and liquefied biomedical waste may be disposed of by release into a sanitary sewage system,if this practice is approved by the providing sewer utility,provided that the Health Officer shall have the authority to require the treatment of any biomedical liquid,according to requirements specified by the Health Officer,prior to release into a sanitary sewage system if deemed necessary to protect the public health. • 11 l • (iv)Biomedical waste shall be disposed of on a regular basis to avoid nuisance conditions. If any nuisance condition exists,the Health Officer shall have the authority to require a specific disposal or collection frequency. (v) Sharps must be contained in accordance with Section 305(3)(b)(iv)and prepared for disposal by a means that protects medical handlers,solid waste workers and the public from injury. The disposal of sharps shall be limited to the following methods unless prohibited by the requirements of Chapter 70.95K RCW,Biomedical Wastes:(No longer exempts home-generated sharps.) (A) Depositing properly contained sharps at a facility that has agreed to accept home generated sharps. (B) Depositing properly contained sharps at a medical facility or pharmacy that provides a program to dispose of sharps waste and that meets the requirements of these regulations. (C) Using a permitted biomedical waste collection service.(E) Other methods approved by the Health Officer. (d) Transfer of Biomedical Waste. Any biomedical waste generator,who produces untreated biomedical waste,shall have said waste collected and transported by a permitted biomedical waste collection service. (e) Inspection. The Health Officer shall have the authority to inspect any biomedical waste generator,at any reasonable time,to determine if the generator's biomedical waste is being handled,stored,and disposed of in accordance with this regulation,or to determine if the waste generator's solid waste is being disposed of in accordance with this regulation. (f) Disposal Service Required. When a person does not dispose of biomedical waste in a manner • consistent with these regulations,the Health Officer may order said person to obtain ongoing and regularly scheduled biomedical waste collection and disposal service if said person does not have this service and if commercial biomedical waste collection and disposal service exists in or is offered in the geographic areas where the person resides. Said service shall be from a biomedical waste collection and disposal service holding a Solid Waste Handling Permit issued by Public Health. (g) Biomedical Waste Collection Services. In addition to the general operation and maintenance requirements applicable to persons operating a solid waste collection service specified in Section 300, vehicles used by biomedical waste collection services shall have a leak proof and fully enclosed vehicle compartment constructed of durable and easily cleanable materials,and shall be identified on each side of the vehicle with the name or trademark of the biomedical waste collection service. 8.10.305(4)BULKY WASTE Bulky wastes shall be stored and transported in such a manner so as not to create a nuisance or safety hazard.Recycling of bulky wastes is encouraged where programs have been established to accept them. If recycling is not feasible,these wastes shall be taken directly to a disposal site permitted to accept oversized waste. Land clearing bulky waste such as tree stumps,trees,portions of buildings and other waste shall be transported directly to a transfer station or landfill designed and permitted to accept these bulky wastes;provided,that nothing herein shall prevent these wastes from being salvaged and/or used as firewood. 8.10.305(5)DANGEROUS WASTE (a)All solid waste must be designated as required by WAC 173-303-070 to prevent the disposal of • dangerous waste at a facility not permitted to accept dangerous waste. All solid waste designated as a 12 J dangerous waste must be managed in a mariner consistent with these regulations and Chapter 173-303 • WAC. (b) The Health Officer may require the screening of any waste suspected of being a regulated dangerous waste as defined in Section 100. The screening process may involve analytical testing,a disclosure of the waste constituents and waste generation process,and other additional information necessary to determine if the waste is dangerous. The Health Officer may establish a schedule for compliance as part of the screening process. Based on the results of the required screening,the Health Officer may require the generator or transporter to direct the waste to a facility permitted to handle such waste. 8.10.305(6)MODERATE RISK WASTE AND USED OIL (a) Small Quantity Generator(SQG)Waste. (i) Applicability. This section applies to conditionally exempt small quantity generators (SQGs) as defined in Section 100. In addition to the requirements of this section, SQGs must meet the storage requirements of Section 305(6)(a) (ii) Waste Designation. SQGs shall designate suspected or known dangerous wastes pursuant to WAC 173-303-070 through WAC 173-303-100. (iii) Container Labeling. SQGs shall label all containers of MRW and used oil with the name of the waste and identify the major risk(s) associated with the waste in the container or tank for employees, emergency response personnel and the public. Containers of MRW shall also be labeled with the words"hazardous waste"or"dangerous waste". (iv) Secondary Containment. The Health Officer may require an SQG to provide secondary containment for liquid MRW and/or used oil stored on-site if the Health Officer determines that there is a potential threat to public health or the environment due to the nature of the wastes being 111111 accumulated,the location of accumulation,or due to a history of spills or releases from accumulation containers. When required under this section,a secondary containment system must be durable,compatible with the waste it is meant to contain,and large enough to contain a volume equal to ten(10)percent of all containers,or one hundred and ten percent(110%)of the largest single container,whichever is greater. (v) Hazardous Materials Management Plans.If a SQG has violated any part of this regulation, the Health Officer may require the SQG to prepare and follow a written Hazardous Materials Management Plan approved by Public Health and in a format prescribed by Public Health. (b)Storage Requirements. (i) SQG Waste,used oil,and hazardous substances shall be stored in containers which are: (A) Compatible with the waste contained therein; (B) In good condition and without any leaks,corrosion or other signs of deterioration; (C) Securely closed at all times except during the addition or removal of contents;and (ii) Containers of SQG,used oil,and hazardous substances shall be stored on an impervious surface and in a location(s)that is covered and controlled to prevent: (A) Container deterioration due to weather exposure; (B) Surface water run-on and run-off; (C) Exposure to extreme temperatures; (D) Unintentional discharge to stormwater, soil,or surface water;and • 13 • (E) Any other controllable condition,which may cause or increase the possibility of container failure. (c) Accumulation. In addition to the quantity exclusion limits(QELs)for small quantity generators contained in WAC 173-303-070(8),SQG,used oil,and hazardous substances shall not be accumulated in quantities that,in the opinion of the Health Officer,present a threat to public health or the environment. (d)Transportation. SQG and used oil shall be transported in accordance with WAC 173-350- 300(3)(d)Treatment and Disposal. (i) SQG Waste. All SQG shall be transported to a permitted MRW collection facility,or picked up by a permitted dangerous waste transporter for treatment or disposal at a facility permitted to accept such waste. SQG shall not be deposited in the general municipal solid waste collection system,a public sewer system,a storm drain,an on-site sewage system,in surface or ground water,or onto or under the surface of the ground. (ii) Pesticides. Usable pesticides shall be utilized in accordance with the EPA approved label requirements,or shall be disposed of,as appropriate,at a permitted hazardous waste treatment, storage,or disposal facility,the Jefferson County Moderate Risk Waste Collection Facility,or through an approved Department of Agriculture collection event.(For additional information call WSDA at 1-877-301-4555) Empty containers from canceled,suspended,or otherwise unusable pesticides should be disposed of as a hazardous waste or triple rinsed in accordance with the requirements under WAC 173-303-160(2)(b). Rinsate from a pesticide container must be reused in a manner consistent with its original intended purpose or disposed of as a hazardous waste under Chapter 173-303 WAC. • (iii)Used Oil. Used oil shall be recycled or disposed of at a facility permitted or approved for that purpose,or as otherwise allowed by Ecology or the Health Officer. Used oil may be taken to service stations or similar facilities that collect used oil for subsequent reprocessing at a facility specifically permitted for that purpose. (e) Mitigation and Control. The person responsible for a spill or non-permitted discharge of SQU,used oil,and/or hazardous substances shall take appropriate and immediate action to protect public health and the environment,including any necessary measure required to prevent the spread of contamination. In addition,the person responsible for a spill or discharge shall: (i) Notify Public Health and,when an imminent threat to public health or the environment exists,call 911; (ii) Clean up any released hazardous substance,or take such actions as may be required or approved by federal,state,or local officials;and (iii)Meet applicable requirements of Section 305(7)as directed by the Health Officer. 8.10.305(7)PROBLEM WASTE (a) Screening. Persons excavating problem waste as defined in Section 100,which is intended for upland fill in Jefferson County and which may contain a hazardous substance,endanger the public health,or adversely impact the environment,shall contact the Health Officer to determine the need for screening in accordance with Section 305(9)(b) (b) Management Options. (i) Beneficial Reuse. Any person intending to beneficially reuse problem wastes must first contact • the Health Officer to determine the appropriate reuse options. 14 (ii) Treatment. Problem wastes may be treated to remove contaminants and,following treatment, • may be used as upland fill in Jefferson County if the treated waste is determined by the Health Officer not to be a problem waste. (iii)Disposal. Problem waste can only be disposed of at a solid waste handling facility permitted to receive such waste. (c) Waste Abrasive Blasting Grit Storage. Waste abrasive blasting grit shall be stored under cover in a manner that minimizes contact with process water or stormwater. Persons recycling waste abrasive blasting grit at a facility permitted to recycle such waste are exempt from the provisions of Section 305(7)(b)of these regulations provided that the recycling facility enlists a process and produces a final product that does not endanger human health or the environment as a result of using said material. 8.10.305 (8) SEPTAGE Septage must be disposed of directly into a sewage treatment works,licensed as such by Ecology, with the permission of and according to the requirements of the sewage treatment works or disposed of into an alternative treatment works or other process approved by the Health Officer. Septage of domestic quality,meeting all applicable requirements for biosolids under Chapter 173-308 WAC, Biosolids Management,may be beneficially reused by being applied to land as approved by the Health Officer on a case-by-case basis. 8.10.310 - Intermediate Solid Waste Handling Facilities WAC 173-350-310,Intermediate Solid Waste Handling Facilities is hereby adopted by reference. • 8.10.320 - Piles Used for Storage or Treatment WAC 173-350-320,Piles Used for Storage or Treatment is hereby adopted by reference. Paragraph 320(7)has been revised as follows: 320(7)Piles used for Storage or Treatment—Financial Assurance requirements. (a) Financial Assurance may be required for certain piles treating or storing solid waste as determined by Public Health. (b) If required by Public Health,the owner or operator shall establish a financial assurance mechanism in accordance with 173-350-600 for closure in accordance with the approved closure plan. The funds shall be sufficient for hiring a third party to remove the maximum amount of wastes that could be present at any time during the operation of the facility and to accomplish closure in accordance with the facility closure plan. (c) If required,no owner or operator shall commence or continue to operate any part of the facility until a suitable financial assurance mechanism has been provided to the JHD in accordance with WAC 173-350-600. 8.10.330 - Surface Impoundments and Tanks • 15 . WAC 173-350-330,Surface Impoundments and Tanks, is hereby adopted by reference. Paragraph 330(7)has been revised as follows: 330(7)Surface Impoundments and Tanks—Financial Assurance requirements. (a) Financial Assurance may be required for certain surface impoundments and tanks used for treating or storing solid waste as determined by Public Health. (b) If required by Public Health,the owner or operator shall establish a financial assurance mechanism in accordance with 173-350-600 for closure in accordance with the approved closure plan. The funds shall be sufficient for hiring a third party to remove the maximum amount of wastes that could be present at any time during the operation of the facility and to accomplish closure in accordance with the facility closure plan. (c) If required,no owner or operator shall commence or continue to operate any part of the facility until a suitable financial assurance mechanism has been provided to the JHD in accordance with WAC 173- 350-600. 8.10350 - Waste Tire Storage and Transportation WAC 173-350-350, Waste Tire Storage and Transportation is hereby adopted by reference. 8.10.360 - Moderate Risk Waste Handling WAC 173-350-360,Moderate Risk Waste Handling is hereby adopted by reference. • 8.10.400 - Limited Purpose Landfills WAC 173-350-400,Limited Purpose Landfills is hereby adopted by reference. 8.10.410 - Inert Waste Landfills WAC 173-350-410,Inert Waste Landfills is hereby adopted by reference. 8.10.450 - Municipal Solid Waste Landfills WAC 173-351,Criteria for Municipal Solid Waste Landfills is hereby adopted by reference. 8.10.460 - Construction and Notification Standards Near Landfills (1) Construction Requirements. . (a) Methane Protection. 16 (i) Any person constructing or developing any area within one-thousand(1,000)feet of the • footprint of an active,closed,or abandoned landfill shall provide documentation that demonstrates that levels of methane gas within this one-thousand(1,000)foot zone are below the lower explosive limits(LEL)under all conditions. A description of the investigation methodology,all analytical data,and conclusions shall be presented in a report submitted by a licensed professional engineer or professional geologist to the Health Officer and the local building department for review and approval. Copies of this report shall also be provided to the Washington Department of Ecology and the Puget Sound Clean Air Agency;and (ii) Any person constructing or developing any area within one-thousand(1,000)feet of the footprint of an active,closed,or abandoned landfill shall provide documentation that demonstrates that all enclosed structures are protected from potential methane migration.The method for ensuring a structure's protection from methane shall be addressed in a report submitted by a licensed professional engineer to the Health Officer and the local building department for approval. Such a report shall contain a description of the mitigation measures to prevent the accumulation of explosive concentrations of methane gas within or under enclosed portions of a building or structure. At the time of final inspection,the engineer shall furnish a signed statement attesting that the building or structure has been constructed in accordance with his/her recommendations for addressing methane gas migration. (iii)The Health Officer may grant a variance to the requirements in Section 460(1)(a)(ii)above, based on a review of data submitted pursuant to preceding Section 460(1)(a)(i). (b) Stormwater. To minimize erosion impacts and leachate generation,no person shall detain stormwater on a closed or abandoned landfill. Stormwater may be conveyed across a closed or abandoned landfill if the conveyance system has been engineered to minimize the percolation of stormwater into the landfill. (c) Construction within the Footprint of the Landfill. No person shall construct within the footprint of • a closed or abandoned landfill without first having submitted detailed engineering plans documenting how potential hazards will be controlled. Potential hazards include,but are not limited to,subsidence,methane,odor problems,hazards associated with subsurface utility installation,and leachate generation. A qualified,licensed Professional Engineer(PE)shall sign such plans. These plans must be submitted for review and approval to the jurisdictional building department and Public Health,or Public Health's designated representative. (d) Groundwater Supply Wells. No person shall construct a groundwater supply well within one- thousand(1,000)feet of an active,closed,or abandoned landfill property boundary without a formal request for variance as outlined in Chapter 173-160 WAC,Minimum Standards for the Construction and Maintenance of Wells. (e) Methane Monitoring. All landfills where methane gas is generated shall provide for adequate venting,collecting,redirecting,or elimination of gases generated by solid waste. It shall be the responsibility of the landfill owner/operator to develop a sampling and testing program to monitor gas production and potential migration. (2) Notification Requirements for Owners of Landfills. All owners of active,closed,or abandoned landfills shall: (a) File a Notice to Title with the County Auditor's office noting the presence of a landfill on the tax parcel within one-hundred and eighty(180)days of the effective date of these regulations. (b) For any property without notice to title,Public Health may file a notice to title regarding the • presence of a landfill on the property. 17 • (c) Disclose the presence of an active,closed,or abandoned landfill to all prospective purchasers of the property. 8.10.490 - Other Methods of Solid Waste Handling WAC 173-350-490,Other Methods of Solid Waste Handling is hereby adopted by reference. 8.10.500 - Ground Water Monitoring WAC 173-350-500,Ground Water Monitoring is hereby adopted by reference. 8.10.600 - Financial Assurance Requirements WAC 173-350-600,Financial Assurance Requirements is hereby adopted by reference. Paragraph 600(1)of the WAC is revised by adding the following subparagraph. (d) Certain waste piles;certain surface impoundments and tanks;and certain compost facilities as determined by Public Health. 8.10.700 - Permits and Local Ordinances • WAC 173-350-700,Permits and Local Requirements,is hereby adopted by reference. Section 700(1)of the WAC is revised by adding the following subparagraph. (d) Landfills closed pursuant to this Chapter 173-351,Mixed Municipal Solid Waste Landfills or Chapter 173-304 are required to obtain a closure-post closure permit. (e) Permit holders must comply with all rules and intent of the Jefferson County Comprehensive Solid Waste Management Plan(JCCSWMP). 8.10.710 - Permit Application and Issuance WAC 173-350-710,Permit Application and Issuance is hereby adopted by reference. Appeal of a Permit Denial.Any person aggrieved by the denial of permit denial shall: 1. Within ten(10)days of receiving the written letter denying a permit,the appellant shall request a hearing in writing. The appellant shall submit specific statements in writing of the reason why error is assigned to the decision of the health officer. 2. The hearing authorized by this ordinance and WAC 173-350-710(6)shall be before the Health Officer. 3. Upon receipt of such request together with hearing fees,the health officer shall notify the person of the time, date,and place of such hearing, which shall be set at a mutually convenient time not less • than five business days or more than thirty(30)business days from the date the request was received. 18 4. Within thirty(30)days,the Health Officer will issue a decision upholding or reversing public • health's action.The health officer may require additional actions as part of the decision. 5. Any party aggrieved by the Health Officer's written determination resolving an appeal may only then appeal to the Pollution Control Hearings Board by filing with the Board a notice of appeal within thirty(30)days after receipt of notice of the determination of the Health Officer. 6. It is expressly stated in this code that JCC 8.10.710 and WAC 173-350-710(6)do not apply to A)any Notice and Order to Correct Violation sent by Jefferson County Public Health or its Local Health Officer to any person or entity,or B)any written decision by Jefferson County Public Health or its Local Health Officer which allege violations of an existing or issued permit or which serve to revoke an existing or issued permit. 8.10.715 - General Permit Application Contents WAC 173-350-715,General Permit Application Contents is hereby adopted by reference. 8.10.900 - Corrective Action WAC 173-350-900,Corrective Action is hereby adopted by reference. 8.10.950 - Enforcement and Enforcement Alternatives • (1) Other Laws,Regulations and Agency Requirements (a) All solid waste management shall be subject to the authority of other laws,regulations or other agency requirements in addition to these rules and regulations. Nothing in these rules and regulations is intended to abridge or alter the rights of action by the state or by persons,which exist in equity,common law or other statutes to abate pollution or to abate a nuisance. (b) Chapter 173-350 WAC,Minimum Functional Standards for Solid Waste Handling,is hereby adopted by reference. (c) In order to better protect public health and the environment, if a conflict exists in the interpretation of Chapter 173-350 WAC and these regulations,or in the interpretation of Chapter 173-351 WAC and these regulations,the more stringent regulation shall apply. 8.10.950(2)ENFORCEMENT AUTHORITY The Health Officer,his or her designee,or any person appointed as an"Enforcement Officer"by the Jefferson County Board of Health shall have the authority to enforce the provisions of these regulations equally on all persons. The Health Officer is also authorized to adopt rules consistent with the provisions of these rules and regulations for the purpose of enforcing and carrying out its provisions. 8.10.950(3)RIGHT OF ENTRY (a) Whenever necessary to make an inspection to enforce or determine compliance with the provisions of these regulations,and other relevant laws and regulations,or whenever the Health Officer has • cause to believe that a violation of these regulations has or is being committed,the Health Officer or 19 • his/her duly authorized inspector may,in accordance with federal and state law,seek entry of any building,structure,property or portion thereof at reasonable times to inspect the same. (b) Prior to entering any building,structure,property or portion thereof the Health Officer or his/her duly authorized inspector shall attempt to secure the consent of the owner,occupant or other person having apparent charge or control of said building,structure,property or portion thereof. (i) If such building,structure,property or portion thereof is occupied,the inspector shall present identification credentials,state the reason for the inspection,and request entry. (ii) In attempting to contact the owner,occupier or other persons having apparent control of said building,structure,property or portion thereof,the inspector may approach said building or structure by a recognizable access route,e.g.,a street or driveway,leading to said building or structure. (c) If permission to enter said building,structure,property or portion thereof is not obtained from the owner,occupier or others persons having apparent control of said building,structure,property or portion thereof,the Health Officer or his/her duly authorized inspector shall also have recourse to any other remedies provided by law to secure entry., 8.10.950(4)INSPECTIONS-PERMITTED FACILITIES (a) General.At a minimum,the Health Officer may,to the extent resources permit,perform annual inspections of all permitted solid waste facilities. Findings shall be noted and kept on file. The Health Officer shall furnish a copy of the inspection report,or annual summary,to the site operator. • (b) Pre-Operational Inspection.Whenever plans and specifications are required by these regulations to be submitted to the Health Officer,the Health Officer may inspect the proposed solid waste disposal site,solid waste handling facility,or solid waste collection service prior to the start of the operations to verify compliance with approved plans and specifications. 8.10.950(5)NOTICE AND ORDER TO CORRECT VIOLATION (a) Issuance. Whenever the Health Officer determines that a violation of these regulations has occurred or is occurring, he/she may issue a written notice and order to correct violation to the property owner or to any person causing,allowing or participating in the violation. (b) Content. The notice and order to correct violation shall contain: (i) The name and address of the property owner or other persons to whom the notice and order to correct violation is directed; (ii) The street address or description sufficient for identification of the building,structure, premises,or land upon or within which the violation has occurred or is occurring; (iii)A description of the violation and a reference to that provision of the regulation,which has been violated; (iv)A statement of the action required to be taken to correct the violation and a date or time by which correction is to be completed; (v) A statement that each violation of this regulation shall be a separate and distinct offense and in 4110 the case of a continuing violation,each day's continuance shall be a separate and distinct violation; 20 (vi)A statement that the person,to whom the Notice and Order is directed,can appeal the Order to the Health Officer,in accordance with the terms of this Chapter,and that any such appeal must • be presented to the Health Officer with ten days; (vii) A statement that the failure to obey this notice may result in the issuance of a notice of civil infraction,and/or the assessment of an administrative remedy,and/or,if applicable,the imposition of criminal penalties. (c) Disposal Receipts. The notice and order to correct violation may also include a statement requiring the person to whom the notice and order to correct violation is directed to produce receipts from a permitted solid waste disposal facility,permitted hazardous waste facility,or the local household hazardous waste facility(moderate risk waste facility)or transporter to demonstrate compliance with an order issued by the Health Officer. (d) Service of Order. The notice and order to correct violation shall be served upon the person to whom it is directed,either personally or by mailing a copy of the order to correct violations by first class and/or certified mail postage prepaid,return receipt requested,to such person at his/her last known address. The notice and order to correct violation shall also be served via certified mail/return receipt requested to the owner of the parcel or parcels where the alleged violations are occurring to the owner's last known address. (e) Extension. Upon written request received prior to the correction date or time,the Health Officer may extend the date set for corrections for good cause. The Health Officer may consider substantial completion of the necessary correction or unforeseeable circumstances that render completion impossible by the date established as a good cause. (f) Supplemental Order to Correct Violation. The Health Officer may at any time add to,rescind in • part,or otherwise modify a notice and order to correct violation. The supplemental order shall be governed by the same procedures applicable to all notice and order to correct violations procedures contained in these regulations. (g) Enforcement of Order. If, after any order is duly issued by the Health Officer,the person to whom such order is directed fails,neglects,or refuses to obey such order,the Health Officer may: (i) Utilize any remedy or penalty under Section 950(6)of these regulations;and/or (ii) Abate the health violation using the procedures of these regulations;and/or (iii)Pursue any other appropriate remedy at law or equity. (h) Written Assurance of Discontinuance.The Health Officer may accept a written assurance of discontinuance of any act in violation of this regulation from any person who has engaged in such act. Failure to comply with the assurance of discontinuance shall be a further violation of this regulation. 8.10.950(6) STOP-WORK ORDERS The Health Officer may cause a Stop-Work order to be issued whenever the Health Officer has reason to believe that a violation of this regulation is occurring. The effect of the Stop-Work order shall be to require the immediate cessation of such work or activity that has contributed to the violation until authorized by the Health Officer to proceed. (a) Content. A Stop-Work Order shall include the following: • (i)The name and address for the person responsible for the alleged violation; 21 • (ii)The street address or description sufficient for identification of the building,structure or premises,or land upon or within which the alleged violation has occurred or is occurring. (iii)A description of the violation and reference to the provision of the Jefferson County Board of Health Ordinance,which has been allegedly violated;(D)The required corrective action; (iv)A statement that a failure to comply with the order may lead to issuance of a civil infraction to the person named in the order; (v) A statement that the person to whom the Stop Work Order is directed can appeal the Order to the Health Officer in accordance with the§950(7)of this Chapter and that any such appeal must be presented to the Health Officer with ten days. (b) Service of Notice. The Health Officer shall serve the Stop Work Order upon the owner of the property where the alleged violation occurred or is occurring and the person,firm or business entity that has allegedly violated this Chapter,either personally or by mailing a copy of the notice by regular and certified or registered mail,within a five-day return receipt requested,to the owner at his or her last known address. A copy of the Order shall also be posted on the property where the alleged violation occurred or is occurring. (c) Posting of Notice. In addition to service of the notice listed above,an additional notice shall be posted on the property in substantially the following form: Under the authority of Jefferson County Code Chapter 8.10,Solid Waste Regulations you are hereby required to immediately STOP WORK • This order is in effect at this property for all work and activities that relate to violations of Jefferson County Code Chapter 8.10,Solid Waste Regulations,and remains in effect until removed by Public Health. It is a violation of these regulations to remove,deface,destroy,or conceal a posted Stop Work Order. FAILURE TO COMPLY WITH THIS ORDER MAY RESULT IN THE ISSUANCE OF A CIVIL INFRACTION. 8.10.950(7)VOLUNTARY CORRECTION When the Health Officer determines that a violation has occurred or is occurring,he or she shall attempt to secure voluntary correction by contacting the person responsible for the alleged violation and,where possible,explaining the violation and requesting correction. (a) Voluntary Correction Agreement. The person responsible for the alleged violation may enter into a voluntary correction agreement with Public Health. The voluntary correction agreement is a contract between Public Health and the person responsible for the violation in which such person agrees to abate the alleged violation within a specified time and according to specified conditions. The voluntary correction agreement will be in lieu of the issuance of further citations or the abatement of the property pursuant to RCW 7.48 or §950(6) of this Chapter. The voluntary correction agreement shall include the following: (i)The name and address of the person responsible for the alleged violation; (ii)The street address or other description sufficient for identification of the building,structure, premises,or land upon or within which the alleged violation has occurred or is occurring; • (iii)A description of the alleged violation and a reference to the regulation,which has been violated; 22 (iv)The necessary corrective action to be taken,and a date or time by which correction must • be completed; (v)An agreement by the person responsible for the alleged violation that Public Health may enter the property and inspect the premises as may be necessary to determine compliance with the voluntary correction agreement; (vi)An agreement by the person responsible for the alleged violation that Public Health may enter the property to abate the violation and recover its costs and expenses(including administrative, hearing and removal costs)from the person responsible for the alleged violation if the terms of the voluntary correction agreement are not satisfied;and (vii)An agreement that by entering into the voluntary correction agreement,the person responsible for the alleged violation waives the right to a hearing before the Health Officer under these regulations or otherwise,regarding the matter of the alleged violation and/or the required corrective action. (A)Right to a Hearing Waived.By entering into a voluntary correction agreement,the person responsible for the alleged violation waives the right to a hearing before the Health Officer under these regulations or otherwise,regarding the matter of the violation and/or the required corrective action. The person responsible for the alleged violation may,by through written documentation provided to the Health Officer,state his or her decision to reject and nullify the voluntary correction agreement,at which time that person is entitled to an appeal to the Health Officer pursuant to§970 of this Chapter. (B)Extension and Modification.The Health Officer may,at his or her discretion,grant an • extension of the time limit for correction or a modification of the required corrective action if the person responsible for the alleged violation has shown due diligence and/or substantial progress in correcting the violation,but unforeseen circumstances have delayed correction under the original conditions. (C)Abatement by Public Health.The county may abate the alleged violation in accordance with Section 950(8)if all terms of the voluntary correction agreement are not met,except that the person responsible for the alleged violation shall not have a right to appeal the Abatement Order. (D)Collection of Costs. If all terms of the voluntary correction agreement are not met,the person responsible for the alleged violation shall be assessed all costs and expenses of abatement,as set forth in Jefferson County Code 8.10,§950(6). 8.10.950(8)ABATEMENT ORDERS Where the Health Officer has determined that a violation of these regulations has occurred or is occurring,he or she may issue an Abatement Order to the person responsible for the alleged violation requiring that the unlawful condition be abated within a reasonable time period as determined by the Health Officer. (a) Prerequisite to Abatement Order. Absent conditions which pose an immediate threat to the public health,safety or welfare of the environment,the procedures for abatement of conditions constituting a violation of these regulations should only be utilized by Public Health only after corrections of such conditions have been attempted through the use of the civil infractions process. Once it has been determined by Public Health that there is no immediate threat to the public health's safety or welfare and that correction of such conditions has not been adequately achieved through use of the • civil infraction process,then Public Health is authorized to proceed with abatement of such 23 • conditions pursuant to these regulations. Public Health shall also attempt to enter into a voluntary corrections agreement prior to issuing an Abatement Order. (ii)Content. An Abatement Order shall include the following: (A)The name and address for the person responsible for the alleged violation; (B) The street address or description sufficient for identification of the building, structure or premises,or land upon or within which the alleged violation has occurred or is occurring; (C)A description of the violation and reference to the provision of the Jefferson County Board of Health Ordinance,which has been allegedly violated; (D)The required corrective action and a date and time by which the correction must be completed and after which,the Health Officer may abate the unlawful condition in accordance with§950(8)of this Chapter. (E) A statement that the costs and expenses incurred by Public Health pursuant to§950(8)of this Chapter,including any amount expended on staff time to oversee the abatement,may be assessed against a person to whom the Abatement Order is directed in a manner consistent with this Chapter;and (F) A statement that the person to whom the Abatement Order is directed can appeal the Order to the Health Officer in accordance with§970 of this Chapter. • (iii)Service of Notice. The Health Officer shall serve the Abatement Order upon the owner of the property where the alleged violation occurred or is occurring,either personally or by mailing a copy of the notice by regular and certified or registered mail,a five-day return receipt requested,to the owner at his or her last known address. The Order shall also be served on each of the following if known to the Health Officer or disclosed from official public records: the holder of any mortgage or deed of trust or other lien or encumbrance of record;the owner or holder of any lease of record and the holder of any other estate or legal interest of record in or to the property or any structures on the property. The failure of the Health Officer to serve any person required herein to be served,shall not invalidate any proceedings hereunder as to any other person duly or relieve any such person from any duty or obligation imposed by the provisions of this section. A copy of the Order shall also be posted on the property where the alleged violation occurred or is occurring. (iv)Authorized Action by Public Health. Using any lawful means,Public Health may enter the subject property and may remove or correct the condition that is subject to abatement. (v) Recovery of Costs and Expense. The costs of correcting a condition which constitutes a violation of these regulations,including all incidental expenses,shall be billed to the owner of the property upon which the alleged violation occurred or is occurring,and shall become due within fifteen calendar days of the date of mailing the billing for abatement. The term "incidental expenses"includes,but is not limited to,personnel costs,both direct and indirect and including attorney's fees;costs incurred in documenting the violation;towing/hauling, storage and removal/disposal expenses;and actual expenses and costs to Public Health in preparing notices,specifications and contracts associated with the abatement,and in accomplishing and/or contracting and inspecting the work;and the costs of any required printing and mailing. • (vi)Collection of Costs and Expenses. The costs and expenses of correcting a condition,which constitutes a violation of these regulations,shall constitute a personal obligation of the person 24 to whom the Abatement Order is directed. Within fifteen days of abating any violation,the • Health Officer shall send the person named in the Abatement Order a bill that details the work performed,materials removed,labor used and the costs and expenses related to those tasks as well as any other costs and expenses incurred in abating the violation. 8.10.950(9)NOTICE TO VACATE When a condition constitutes a violation of these regulations and poses an immediate threat to life,limb, property or safety of the public or persons residing on the property,the Health Officer may issue a Notice to Vacate. (a)Content. A Notice to Vacate shall include the following: (i)The name and address for the person responsible for the alleged violation; (ii)The street address or description sufficient for identification of the building,structure or premises,or land upon or within which the alleged violation has occurred or is occurring; (iii)A description of the violation constituting an emergency and reference to the provisions of the Jefferson County Board of Health regulations,which has been allegedly violated; (iv)A date,as determined by the severity of the emergency,by which any persons must vacate the premises. In case of extreme danger to persons or property immediate compliance shall be required; (v)The required corrective action; • (vi)A statement that the person to whom the Notice to Vacate is directed can appeal the order to the Health Officer in accordance with§970 of this Chapter and that any such appeal must be presented to the Health Officer with ten days. (b) Service of Notice. The Health Officer shall serve the Abatement Order upon the owner of the property where the alleged violation occurred or is occurring,either personally or by mailing a copy of the notice by regular and certified or registered mail,within a five-day return receipt requested,to the owner at his or her last known address. A copy of the Order shall also be posted on the property where the alleged violation occurred or is occurring. (c)Posting the Notice. In addition to providing service as states above,an additional notice shall be posted on the property in substantially the following form: DO NOT ENTER UNSAFE TO OCCUPY It is a violation of the Jefferson County Code 8.10 to occupy this building,or to remove or deface this notice. ,Health Officer Jefferson County Public Health (d)Compliance. No person shall remain in or enter any building,structure,or property which has been so posted,except that entry may be made to repair or correct any conditions causing or contributing to the threat to life,limb,property,or safety of the public or persons residing on the property. No person shall remove or deface any such notice after it is posted until the required corrective action has been completed and approved. 25 • 8.10.960 VIOLATIONS,REMEDIES AND PENALTIES 8.10.960(1)Violations. (a) Any violation of a permit requirement issued pursuant to these regulations shall be a violation of these regulations (b) Violations of these regulations may be addressed through the remedies and penalties provided in this section. (c) Each violation of these regulations shall be a separate and distinct offense and in the case of a continuing violation,each day a violation is occurring or present shall be considered a separate and distinct violation. (d) The Health Officer may investigate alleged or apparent violations of these regulations. Upon request of the Health Officer,the person allegedly or apparently in violation of these regulations shall provide information identifying themselves. (e) Violations,apparent or alleged,that occurred or are occurring in environmentally sensitive areas,as that term is defined in this Chapter,of Jefferson County will have the highest priority for investigation by those persons charged in this Chapter with investigating such violations and enforcing this Chapter and such violations will be subject to a'zero tolerance'policy. 8.10.960(2)Suspension of a Permit • (a) The Health Officer may temporarily suspend any permit issued under these regulations for: (i) Failure of the holder to comply with the requirements of the permit; (ii) Failure to comply with any notice and order to correct violation issued pursuant to these regulations related to the permitted activity; (iii) Failure to comply with a stop-work or abatement order issued pursuant to Section 950(6)and 950 (8)of these regulations;or (iv)The non-payment or dishonor of any check or draft used by the permit holder to pay any Public Health fees associated with the permit. (b) Permit suspension shall be carried out through the notice and order to correct violation provisions specified in Section 950(5),and the suspension shall be effective upon service of the notice and order to correct violation upon the holder or operator. The holder or operator may appeal such suspension as provided in Section 970 of these regulations. (c) Notwithstanding any other provision of this regulation,whenever the Health Officer finds that a violation of this regulation has created or is creating an unsanitary,dangerous or other condition which,in his/her judgment,constitutes an immediate and irreparable hazard,he/she may,without service of a written notice and order to correct violation,suspend and terminate operations under the permit immediately. 810.960(3)Revocation of Permits. (a) The Health Officer may permanently revoke any permit issued by him/her for: • (i) Failure of the holder to comply with the requirements of the permit; 26 (ii) Failure of the holder to comply with any notice and order to correct violation issued pursuant to these regulations related to the permitted activity; (iii) Failure to comply with a stop-work or abatement order issued pursuant to Section 950(6)and 950 (8); (iv) Interference with the Health Officer in the performance of his/her duties; (v) Discovery by the Health Officer that a permit was issued in error or on the basis of incorrect information supplied to him/her;or (vi) The non-payment or dishonor of any check or draft used by the holder to pay any Public Health fees associated with the permit. (b) Such permit revocation,including any appeal of the decision to revoke,shall be carried out through the notice and order to correct violation provisions specified in Section 950(5)and the revocation shall be effective upon service of the notice and order to correct violation upon the holder or operator. The holder or operator may appeal such revocation,as provided in Section 970 of these regulations. 8.10.960(4)Civil Remedies. (a) Except as provided in Section 960(2)(b),the violation of any provision of these regulations is designated as a Class 1 civil infraction pursuant to Chapter 7.80 RCW,Civil Infractions. (b) Any person who unlawfully dumps solid waste as described in Section 025(3)(b)or waste in an amount greater than one(1)cubic foot has committed a Class I civil infraction pursuant to Chapter • 7.80 RCW,Civil Infractions. Any person who unlawfully dumps solid waste in an amount less than or equal to one(1)cubic foot has committed a Class 3 civil infraction pursuant to Chapter 7.80 RCW. The court may also impose restitution for any violation. (c) The Health Officer may issue a notice of civil infraction pursuant to Chapter 7.80 RCW if the Health Officer has reasonable cause to believe that the person has violated any provision of these regulations or has not corrected the violation as required by a written notice and order to correct violation. (d) Civil infractions shall be issued,heard and determined as described in Chapter 7.80 RCW,and any applicable court rules. (e) All other legal and equitable remedies are also deemed available to Public Health or its Health Officer and may be invoked,utilized or sought at any time regardless of whether other remedies have or have not been undertaken or sought. 8.10.960(5) Criminal Penalties. (a) Any person who unlawfully dumps biomedical waste as described in Section 025(3)(b)shall be,upon conviction,guilty of a misdemeanor and shall be subject to a fine of not more than$1,000,or imprisonment in the county jail not to exceed ninety(90)days,or both. The court may also impose restitution. (b) Any person who unlawfully dumps"dangerous waste"as defined in WAC 173-350-100 and/or RCW 70.105.010(5)in violation of RCW 70.105.090 shall be,upon conviction,guilty of a misdemeanor. The court may also impose restitution. • 27 • (c) Any person who unlawfully dumps"dangerous waste"as defined in WAC 173-350-100 and/or RCW 70.105.010(5)in violation of RCW 70.105.085 shall be,upon conviction,guilty of a felony. The court may also impose restitution. (d) Any person who unlawfully dumps solid waste as described in Section 025(3)(b)and in an amount less than one(1)cubic yard,but greater than(1)cubic foot,shall be,upon conviction,guilty of a misdemeanor,and shall be subject to a fine of not more than$1,000,or imprisonment in the county jail not to exceed ninety(90)days,or both. The court may also impose restitution as stated in Chapter 70.95 RCW,Solid Waste Management-Reduction and Recycling. (e) Any person who unlawfully dumps solid waste as described in Section 025(3)(b)of these regulations and in an amount greater than(1)cubic yard,shall be,upon conviction,guilty of a gross misdemeanor,and shall be subject to a fine of not more than$5,000,or imprisonment in the county jail not to exceed one(1)year,or both. The court may also impose restitution as stated in Chapter 70.95 RCW, Solid Waste Management-Reduction and Recycling. (f) Any person who fails,neglects,or refuses to obey an order of the Health Officer to correct a violation as set forth in Section 950(5)(g)above shall be,upon conviction,guilty of a misdemeanor and shall be subject to a fine of not more than$100,or imprisonment in the county jail not to exceed ninety(90) days,or both. The court may also impose restitution. (g) Any person who fails,neglects,or refuses to comply with a written assurance of discontinuance pursuant to Section 950(5)(h)above shall be,upon conviction,guilty of a misdemeanor and shall be subject to a fine of not more than$100,or imprisonment in the county jail not to exceed ninety(90) days,or both. The court may also impose restitution. • (h) Any person who operates a solid waste facility or collection service without a permit shall be,upon conviction,guilty of a misdemeanor and shall be subject to a fine of not more than$1,000,or imprisonment in the county jail not to exceed ninety(90)days,or both. The court may also impose restitution. (i) Any person who operates a solid waste facility or collection service after a permit has been revoked shall be,upon conviction,guilty of a misdemeanor and shall be subject to a fine of not more than $1,000,or imprisonment in the county jail not to exceed ninety(90)days,or both. The court may also impose restitution. 8.10.960(6) Noncompliance Fees. (a) Pursuant to the most current Public Health fee schedule adopted by the Board of Health,Public Health may assess a noncompliance fee to a permittee or small quantity generator for the following: (i) Public Health oversight and review required as a result of the Health Officer's determination that a permitted facility or small quantity generator is not in compliance with its permit and/or applicable regulations and has not met the compliance dates specified in a notice and order to correct violation;or (ii) Amendments to an existing Public Health permit required as a result of the permitted facility not being in compliance with its permit and/or applicable regulations. (iii) Second and subsequent re-inspections conducted by Public Health in response to the permittee or small quantity generator not complying with their permit and/or J.C.C.code or the permittee not . meeting the requirements outlined in a notice and order to correct violation. 28 1 (b) The noncompliance fee shall not be assessed in addition to the permit fee for permitted facilities • where permit fees,as described in the most recent Public Health fee schedule,specifically include those Public Health activities described in Section 950(6)(d)(i). 8.10.960(7)Whenever a re-inspection fee is assessed by Public Health,the fee shall be due and payable thirty(30)days after receipt of the invoice by the permittee. 8.10.960(8)Other Legal or Equitable Relief Notwithstanding the existence or use of any other remedy,the Health Officer may seek legal or equitable relief to enjoin any acts or practices or abate any conditions that constitute or will constitute a violation of this ordinance,or rules and regulations adopted under it,or any state health law or regulation,or that otherwise threatens public health. 8.10.960(9)Imminent and Substantial Dangers. Notwithstanding any provisions of this regulation the Health Officer may take immediate action to prevent an imminent and substantial danger to the public health by the improper management of any waste irrespective of quantity or concentration. 8.10.970 APPEALS AND APPELLATE RULES 8.10.970(1)Three Categories of Decisions. There is established in this code three categories of Decisions (as that term is defined herein)that may be appealed, each category having its own • rules. Those three categories are: (a) Denial of a permit application or suspension of an existing or issued permit, said appeals to be governed by the provisions of WAC 173-350-710(6) as amended by this Code; (i) The initial appeal by the local health jurisdiction shall be with the Health Officer (ii) The appeal of the Health Officers Decision shall be to the Washington State Pollution Controls Hearings Board pursuant to RCW 70.95.210. (b) Revocation of an existing or issued permit, said appeals to be governed by this section except that appeals of a permit revocation shall be heard only by the Board of Health and will not come before the Local Health Officer; and (c) Any other Decision transmitted, issued, promulgated, distributed or submitted by Jefferson County Public Health or its Local Health Officer, said appeals to be governed by this section. 8.10.970(2)How to Appeal. The process described in this section shall apply to any Decision, as that term is defined herein, which is not subject to the provisions of WAC 173-350-710. The person(s) or entity wishing to appeal must fulfill all of the following obligations: (a) Notify Jefferson County Public Health of their request for a hearing within ten(10) days of the date of the Decision they wish to appeal; • 29 • (b) Submit a specific statement(s) in writing describing why error should be assigned to the Decision (c) Pay the established hearing fee. 8.10.970(3) Obligations of Public Health upon receipt of a request for a hearing: Upon the appellant's compliance with Section 970(2)above,the Local Health Officer shall notify the appellant of the time, date and place of such hearing,which shall be set a mutually convenient time not less than five(5)business days nor more than thirty(30)business days from the date Public Health determines the appellant has complied with Section 970(2). 8.10.970(4)Hearing Procedures before the Local Health Officer and the Board of Health. (Except as noted elsewhere in this Chapter,these rules shall apply to hearings held before the Local Health Officer and the Board of Health. (a) Hearings shall be open to the public. (b) Hearings shall be presided over by the Health Officer or Chair of the Board of Health. (c) Such hearings shall be recorded. (d) Hearings shall be opened with a recording of the time,date and place of the hearing, and a statement of the cause for the hearing. (e) The Health Officer or Chair of the Board of Health shall then swear in all potential witnesses. • (f) The case shall be presented in the order directed by the Health Officer or Chair of the Board of Health. (g) The appellant may present his case of rebuttal.The Health Officer or any member of the Board of Health may ask questions. The Health Officer or Chair of the Board of Health may,at his or her option,allow the opportunity for a closing statement or summation. (h) General rights held by all parties include,but are not limited to: (i) To be represented by an attorney; (ii) To present witnesses and obtain testimony from them; (iii)To cross-examine witnesses; (iv)To object to evidence for specific grounds. (i) In the conduct of the proceeding,the Health Officer or Chair of the Board of Health may consider any evidence, including hearsay evidence that a reasonably prudent person would rely upon in the conduct of his or her affairs.Relevant evidence is admissible,if in the opinion of the presiding person(Chair of the Board of Health or Health Officer)it is the best evidence reasonably obtainable having due regard for its necessity,availability and trustworthiness; provided,that in passing upon the admissibility of evidence the presiding person may give consideration to,but shall not be bound to follow,the rules of evidence governing civil • proceedings in matters not involving trial by jury in the superior court of the State of Washington. 30 (j) Evidence is not admissible if it is excludable on constitutional or statutory grounds or on the basis of evidentiary privilege recognized in the courts of this state.The health officer shall • decide rulings on the admissibility of evidence,and the Washington rules of evidence shall serve as guidelines for those rulings. (k) Inasmuch as any appeal to the board of health from a health officer decision is a review on the record,the health officer shall ensure that the record generated contains testimonial and documentary evidence supporting the health officer's determination. (1) The health officer may continue the hearing to another mutually acceptable date to allow for additional submission of information or to allow for additional consideration. (m)Prior to closing of the hearing,the health officer shall issue its oral ruling unless the health officer determines that the matter should be taken under advisement.Written findings of fact, conclusions of law and orders shall be served on the appellant within fourteen(14)days of the oral ruling.If the matter is taken under advisement,written findings,conclusions and orders shall be mailed to the appellant within thirty(30)days of the close of the hearing. 8.10.970(5)Burden of proof Any appellant shall bear the burden of proof,which shall be"by a preponderance of the evidence,"i.e.,that the appellant's factual and legal assertions are more likely than not to be true based on the evidence presented. 8.10.970(6)How to appeal a Ruling by the Local Health Officer (a) Any person aggrieved by the findings,conclusions or required actions of an administrative hearing shall have the right to appeal the matter by requesting a hearing before the board of health. (b) Such notice of appeal shall be in writing and presented to the health officer within thirty(30) days of the health officers decision. (c) The aggrieved person shall pay the fee established in the Public Health fee ordinance for an appeal to the Board of Health. (d) The appellant shall submit specific statements in writing of the reason why error is assigned to the decision of the health officer and shall be accompanied by a fee as established in the current public health fee schedule.The appellant and the health officer may submit additional information to the board of health for review. (e) The notice and order to correct violation shall remain in effect during the appeal. (f) Any person affected by the notice and order to correct violation may make a written request for a stay of the decision to the health officer within five(5)business days of the health officer's decision.The health officer will grant or deny the request within five business days. (g) Upon receipt of a timely written notice of appeal together with the hearing fee,the health officer shall set a time,date,and place for the requested hearing before the board of health and shall give the appellant written notice thereof. Such hearing shall be set at a mutually convenient time not less than fifteen(15)business days or more than thirty(30)business days from the date the appeal was received by the health officer. (h) Board of health hearings shall be open to the public and presided over by the chair of the board • of health. Such hearings shall be recorded.Board of health hearings shall be opened with a 31 • recording of the time, date and place of the hearing,and a statement of the cause for the hearing. The hearing shall be limited to argument of the parties and no additional evidence shall be taken unless, in the judgment of the chair,such evidence could not have reasonably been obtained through the exercise of due diligence in time for the hearing before the health officer.Argument shall be limited to the record generated before the health officer unless the chair admits additional evidence hereunder. (i) Any decision of the board of health shall be final and may be reviewed by an action filed in superior court.Any action to review the board's decision must be filed within thirty(30) business days of the date of the decision. 8.10.970(7)Rules specific to a Board of Health hearing arising from an appeal of a Health Officer Ruling Any appeal to the Board of Health of a Ruling made by the Health Officer shall be considered a"closed record"hearing,meaning the parties to such an appeal must comply with the following: (a) The record created below,including all documents,records or exhibits as well as the audio or written transcript of the hearing before the Health Officer,shall be provided to the Board of Health by Public Health. (b) Upon receipt of the appeal materials transmitted by JCPH,the Board of Health shall conduct a hearing to determine the correctness of the decision by the Health Officer within thirty-five(35)days. • (c) The petitioner shall be given at least five(5)days'notice by certified mail of the time,date and place of said hearing.Further,if the petitioning party is a person other than the permit applicant or a permit holder,then notice of the purpose,time,date,and place of said hearing shall likewise be mailed by certified mail to the permit applicant or permit holder. (d) No additional testimony,written or oral,will be accepted or reviewed by the Board of Health. (e) The parties may submit a brief,legal argument or Memorandum of Authorities of no more than ten (10)pages on their behalf(style requirements: letter sized paper, 1"margins on all edges,at least 1.50 spaces between lines). This limit may be amended or waived by the Chair of the Board of Health(in writing)if hardship is shown by the party seeking to submit a longer document. (f) The parties may make oral argument to the Board of Health,no longer than fifteen(15)minutes per side. (g) The representative or counsel for the party appealing to the Board of Health shall be permitted to have a rebuttal time of not more than five(5)minutes. (h) The rules listed above at Section 970(4)(a)through(d)shall also apply. 8.10.970(8) Procedural rules specific only to the Board of Health hearing a revocation of permit case (a) Unless otherwise contravened or distinguished here,the rules listed at Section 970(4)shall apply. 411 (b) Appeals shall be made in writing and shall be signed and dated by the petitioning party. 32 (c) All parties shall be given an opportunity to present evidence,analysis and recommendations. (d) The parties are authorized to submit a brief,legal argument or Memorandum of Authorities of no more than ten(10)pages on their behalf(style requirements: letter sized paper, 1"margins on all edges, at least 1.50 spaces between lines). This limit may be amended or waived by the Chair of the Board of Health(in writing)if hardship is shown by the party seeking to submit a longer document. (e) Members of the Board of Health may direct questions to any person providing testimony. (f) The chairperson of the Board of Health may permit the presentation of testimony by any non-party, but only upon an oral finding by the chairperson that the testimony of the non-party is not "cumulative or repetitive"AND is and will be of"substantial value"to the ultimate decision of the Board of Health. (g) Following presentation of evidence and testimony,the chairperson of the Board of Health shall close the hearing and initiate discussion with other board members on the matters presented. (h) Should the Board of Health require additional testimony,it may continue the hearing to a date and time not to exceed thirty-five(35)days following the date of the initial hearing;provided,that at the close of the second public hearing the Board of Health may continue its deliberations on the appeal to another time and date not to exceed thirty-five(35)days following the close of the second hearing conducted to receive additional testimony.There shall be no extensions past the date of the second hearing without the written consent of all parties to the matter. (i) A full and complete record shall be kept of all proceedings and all testimony shall be recorded.The record of testimony and exhibits together with all papers and requests filed in the proceedings shall • constitute the exclusive record for the decision in accordance with the law. (j) The Board of Health shall issue a final Ruling in writing and send same to all parties no more than thirty(30)days after the close of the hearing. (k) All decisions shall become a part of the record and shall include a statement of findings and conclusions. 8.10.970(9)Exhaustion of Administrative Remedies An appellant(aggrieved party) shall not be considered to have exhausted all of its administrative remedies until such time as it has obtained from the Board of Health a final and dispositive Ruling. 8.10.970(10)Further appeals Unless the challenged Decision was of a type subject to the provisions of WAC 173-350-710(6), a Ruling from the Board of Health constituting a final and dispositive resolution of the issue(s) presented may only be appealed to the Superior Court of the State of Washington 8.10.980 VARIANCES 33 • (a) Applicability.Any person who owns or operates a solid waste facility may apply to the Health Officer for a variance from any paragraph of these regulations except as provided in Section 950(8)(b)(iv)of these regulations. (b) Granting Requirements. (i) The Health Officer may grant such variance if it finds that: (A)The solid waste handling practices or site location do not endanger public health,safety or the environment;and (B)Compliance with the regulation from which variance is sought would produce hardship on the applicant without equal or greater benefits to the public;and (C)No other practicable or reasonable alternative exists. A practicable alternative is one that is available and capable of being carried out after taking into consideration cost,existing technology,and logistics in light of overall project purposes,and better reducing or eliminating impacts to health and the environment. It may include equipment or facilities not owned by the applicant that could have reasonably been or be obtained,utilized,expanded,or managed in order to manage,reduce,or eliminate impacts to health and the environment. A reasonable alternative is one that could feasibly attain or approximate compliance,but would better reduce or eliminate impacts to health and the environment. (ii) No variance shall be granted pursuant to this paragraph until the Health Officer has considered the relative interests of the applicant, other owners of property likely to be affected by the waste handling practices,and the general public. (iii)Any variance or renewal shall be granted within the requirements of this paragraph and for time • period and conditions consistent with the reasons therefore,and within the following limitations: (A) If the variance is granted on the grounds that there is no practicable means known or available for the adequate prevention,abatement or control of pollution involved,it shall be only until the necessary means for prevention,abatement or control become known and available and subject to the taking of any substitute or alternative measures that the Health Officer may prescribe. (B)The Health Officer may grant a variance conditioned by a timetable if: (1) Compliance with this regulation will require spreading of costs over a considerable time period;and (2) The timetable is for a period that is needed to comply with this regulation. (iv)No variance from Chapters 173-350 WAC,Minimum Functional Standards for Solid Waste Handling,and 173-351 WAC,Criteria for Municipal Solid Waste Landfills,shall be granted by the Health Officer except with the approval and written concurrence of Ecology prior to action on the variance by the Health Officer. (v) The Health Officer may grant variances from these regulations for standards that are more stringent than the standards of Chapters 173-350 and 173-351 WAC,or from provisions in these regulations that are not contained in Chapters 173-350 and 173-351 WAC,without Ecology approval. (c) Application. (i) The application shall be accompanied by such information as the Health Officer may require. • 34 (ii) An application for a variance,or for the renewal thereof,submitted to the Health Officer shall be approved or disapproved by the Health Officer within ninety(90)calendar days of receipt unless • the applicant and the Health Officer agree to a continuance. (iii)Notice shall be given by mailing a notice of the variance application to persons who have written to the Health Officer asking to be notified of all variance requests. (d) Renewal. The Health Officer may renew any variance granted pursuant to this paragraph on terms and conditions and for periods that would be appropriate on initial granting of a variance. No renewal shall be granted except on written application. Any such application shall be made at least sixty(60)calendar days prior to the expiration of the variance. 8.10.990 - CRITERIA FOR INERT WASTE WAC 173-350-990,Inert Waste Criteria, is hereby adopted by reference, • • 35 . APPENDIX A. REFERENCES The following is a list of Federal,State,and local laws,regulations,and documents referenced in Jefferson County Board of Health Ordinance 09-1020-05,Solid Waste Regulations. Copies of these documents may be found at the Port Townsend office of Jefferson County Public Health,the Jefferson County Courthouse,or through your local library. A. Federal: 1. United States Code(USC): 33 USC 1344 PARAGRAPH 404 OF THE FEDERAL CLEAN WATER ACT(PL 95- 217),PERMITS FOR DREDGED OR FILL MATERIAL 42 USC 300 SAFE DRINKING WATER ACT(PL 95-523) 42 USC 2011 ATOMIC ENERGY ACT OF 1954 42 USC 6901 RESOURCE CONSERVATION AND RECOVERY ACT OF 1976 (RCRA) 42 USC 9601 COMPREHENSIVE ENVIRONMENTAL RESPONSE COMPENSATION AND LIABILITY ACT OF 1980(CERCLA) 2. Code of Federal Regulations(CFR): 10 CFR Part 20 STANDARDS FOR PROTECTION AGAINST RADIATION 40 CFR Part 61 NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS • 40 CFR Part 258 CRITERIA FOR MUNICIPAL SOLID WASTE LANDFILLS 40 CFR Part 503 STANDARDS FOR THE USE OR DISPOSAL OF SEWAGE SLUDGE 3. Environmental Protection Agency: SW-846 TEST METHODS FOR EVALUATING SOLID WASTE,PHYSICAL/ CHEMICAL METHODS B. State: 1. Revised Code of Washington(RCW),Chapters: 7.80 CIVIL INFRACTIONS 42.17 DISCLOSURE-CAMPAIGN FINANCES-LOBBYING—RECORDS 43.21A DEPARTMENT OF ECOLOGY 46.37 VEHICLE LIGHTING AND OTHER EQUIPMENT 46.55 TOWING AND IMPOUNDMENT 70.05 LOCAL HEALTH DEPARTMENTS,BOARDS,OFFICERS- REGULATIONS 70.93 WASTE REDUCTION,RECYCLING,AND MODEL LITTER CONTROL ACT 70.94 WASHINGTON CLEAN AIR ACT 70.95 SOLID WASTE MANAGEMENT-REDUCTION AND RECYCLING 70.95K BIOMEDICAL WASTE 76.04 FOREST PROTECTION 90.48 WATER POLLUTION CONTROL • 2. Washington Administrative Code(WAC),Chapters: 36 173-160 MINIMUM STANDARDS FOR CONSTRUCTION AND • MAINTENANCE OF WELLS 173-200 WATER QUALITY STANDARDS FOR GROUND WATERS OF THE STATE OF WASHINGTON 173-201A WATER QUALITY STANDARDS FOR SURFACE WATERS OF THE STATE OF WASHINGTON 173-218 UNDERGROUND INJECTION CONTROL PROGRAM 173-240 SUBMISSION OF PLANS AND REPORTS FOR CONSTRUCTION OF WASTEWATER FACILITIES 173-303 DANGEROUS WASTE REGULATIONS 173-304 MINIMUM FUNCTIONAL STANDARDS FOR SOLID WASTE HANDLING 173-308 BIOSOLIDS MANAGEMENT 173-314 WASTE TIRE CARRIER AND STORAGE SITE LICENSES 173-350 STANDARDS FOR SOLID WASTE HANDLING 173-351 CRITERIA FOR MUNICIPAL SOLID WASTE LANDFILLS 173-425 OUTDOOR BURNING 197-11 SEPA RULES 246-203 GENERAL SANITATION 246-220 RADIATION PROTECTION-GENERAL PROVISIONS 246-232 RADIOACTIVE MATERIALS-LICENSING APPLICABILITY 296-24 GENERAL SAFETY AND HEALTH STANDARDS 296-62 OCCUPATIONAL SAFETY AND HEALTH STANDARDS FOR CARCINOGENS 296-65 ASBESTOS REMOVAL AND ENCAPSULATION 480-70 SOLID WASTE AND/OR REFUSE COLLECTION COMPANIES . 3. Washington State Department of Ecology(Ecology): Ecology document 80-12,Biological Testing Methods Ecology document 91-30: Guidance for Remediation of Petroleum Contaminated Soils (revised November 1995) Ecology document 93-51,Chemical Testing for Complying with the Dangerous Waste Regulations C. Local/Regional: 1. Jefferson County Public Health: Jefferson County Comprehensive Solid Waste Management Plan(JCCSWMP) • 37 • JEFFERSON COUNTY BOARD OF HEALTH David Sullivan, Chair County Commissioner District#2 Jill Buhler,Hospital Commissioner Sheila Westerman,Vice Chair Citizen Kris Nelson,Port Townsend City Council Phil Johnson,County Commissioner,District#1 Sally Aerts,Citizen John Austin,County Commissioner,District#3 • 38 0 Board of Health IV Old Business Item 3 New England Journal of Medicine Adverse Health Effects of Marijuana Use 0 • October 16, 2014 i Phe NEW ENGLAND JOURNAL of MEDICINE 410 l REVIEW ARTICLE Dan L.Longo,M.D.,Editor Adverse Health Effects of Marijuana Use Nora D.Volkow, M.D., Ruben D. Baler, Ph.D.,Wilson M.Compton, M.D., and Susan R.B.Weiss, Ph.D. "N LIGHT OF THE RAPIDLY SHIFTING LANDSCAPE REGARDING THE LEGALIZA- From the National Institute on Drug AbuseNational Institutes of Health, tion of marijuana for medical and recreational purposes, patients may be more Beth ,esda, MD.Address reprint requests likely to ask physicians about its potential adverse and beneficial effects on to Dr. Volkow at the National Institute health. The popular notion seems to be that marijuana is a harmless pleasure, ac- on Drug Abuse, 6001 Executive Blvd., Rm. 5274, Bethesda, MD 20892, or at cess to which should not be regulated or considered illegal. Currently, marijuana is nvolkow@nida.nih.gov. Bethesda, ov. the most commonly used "illicit" drug in the United States, with about 12% of gl J Med 201d;3702219-Z7. people 1.2N years of age or older reporting use in the past year and particularly high DOIEn:10.1056JNEJMra1402309: rates of use among young people.' The most common route of administration is Copyright O 2014 Massachusetts Medical Society. inhalation. The greenish-gray shredded leaves and flowers of the Cannabis sativa plant are smoked (along with stems and seeds) in cigarettes, cigars, pipes, water pipes, or "blunts" (marijuana rolled in the tobacco-leaf wrapper from a cigar). Hashish is a related product created from the resin of marijuana flowers and is usually smoked (by itself or in a mixture with tobacco) but can be ingested orally. Marijuana can also be used to brew tea,and its oil-based extract can be mixed into food products. The regular use of marijuana during adolescence is of particular concern, since • use by this age group is associated with an increased likelihood of deleterious consequences2 (Table 1). Although multiple studies have reported detrimental ef- fects, others have not, and the question of whether marijuana is harmful remains the subject of heated debate. Here we review the current state of the science re- lated to the adverse health effects of the recreational use of marijuana, focusing on those areas for which the evidence is strongest. ADVERSE EFFECTS RISK OF ADDICTION Despite some contentious discussions regarding the addictiveness of marijuana, the evidence clearly indicates that long-term marijuana use can lead to addiction. Indeed, approximately 9% of those who experiment with marijuana will become addicted3 (according to the criteria for dependence in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition [DSM-IV]).The number goes up to about 1 in 6 among those who start using marijuana as teenagers and to 25 to 50% among those who smoke marijuana daily.4 According to the 2012 National Survey on Drug Use and Health,an estimated 2.7 million people 12 years of age and older met the DSM-IV criteria for dependence on marijuana,and 5.1 million people met the crite- ria for dependence on any illicit drug' (8.6 million met the criteria for dependence on alcohol'). There is also recognition of a bona fide cannabis withdrawal syn- dromes (with symptoms that include irritability, sleeping difficulties, dysphoria, craving, and anxiety), which makes cessation difficult and contributes to relapse. Marijuana use by adolescents is particularly troublesome. Adolescents' increased vulnerability to adverse long-term outcomes from marijuana use is probably related • N ENGL J MED 370;23 NEJM.ORG JUNE 5,2014 2219 The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF WASHINGTON on September 29,2014.For personal use only.No other uses without permission. Copyright©2014 Massachusetts Medical Society.All rights reserved. The NEW ENGLAND JOURNAL of MEDICINE Table 1.Adverse Effects of Short-Term Use and Long-Term or Heavy Use THC can recalibrate the sensitivity of the reward of Marijuana. system to other drugs'O and that prenatal expo- • sure interferes with cytoskeletal dynamics,which Effects of short-term use are critical for the establishment of axonal con- Impaired short-term memory,making it difficult to learn and to retain infor- nections between neurons.11 mation As compared with unexposed controls, adults Impaired motor coordination,interfering with driving skills and increasing who smoked marijuana regularly during adoles- the risk of injuries cence have impaired neural connectivity (fewer Altered judgment,increasing the risk of sexual behaviors that facilitate the fibers) in specific brain regions. These include transmission of sexually transmitted diseases the precuneus, a key node that is involved in In high doses,paranoia and psychosis functions that require a high degree of integra- Effects of long-term or heavy use tion(e.g.,alertness and self-conscious awareness), Addiction (in about 9%of users overall,17%of those who begin use in ado- and the fimbria, an area of the hippocampus lescence,and 25 to 50%of those who are daily users)* that is important in learning and memory. 12 Altered brain development* Reduced functional connectivity has also been Poor educational outcome,with increased likelihood of dropping out of school* reported in the prefrontal networks responsible Cognitive impairment,with lower IQ among those who were frequent users for executive function (including inhibitory con- during adolescence* trol) and the subcortical networks, which pro- Diminished life satisfaction and achievement(determined on the basis of cess habits and routines.13 In addition, imaging subjective and objective measures as compared with such ratings in the studies in persons who use cannabis have revealed general population)* decreased activity in prefrontal regions and re- Symptoms of chronic bronchitis duced volumes in the hippocampus.14 Thus, cer- Increased risk of chronic psychosis disorders(including schizophrenia)in tain brain regions may be more vulnerable than persons with a predisposition to such disorders others to the long-term effects of marijuana. *The effect is strongly associated with initial marijuana use early in adolescence. One study showed that selective down-regula- tion of cannabinoid-1 (CB1) receptors in several cortical brain regions in long-term marijuana to the fact that the brain,including the endocan- smokers was correlated with years of cannabis nabinoid system, undergoes active development smoking and was reversible after 4 weeks of during adolescence.6 Indeed, early and regular abstinence.15 Changes in CB1 receptors were not marijuana use predicts an increased risk of mar- seen in subcortical regions. ijuana addiction, which in turn predicts an in- The negative effect of marijuana use on the creased risk of the use of other illicit drugs?As functional connectivity of the brain is particu- compared with persons who begin to use marl- larly prominent if use starts in adolescence or juana in adulthood, those who begin in adoles- young adulthood,12 which may help to explain cence are approximately 2 to 4 times as likely to the finding of an association between frequent have symptoms of cannabis dependence within use of marijuana from adolescence into adult- 2 dult2 years after first use.8 hood and significant declines in IQ.16 The im- pairments in brain connectivity associated with EFFECT ON BRAIN DEVELOPMENT exposure to marijuana in adolescence are consis- The brain remains in a state of active, experi- tent with preclinical findings indicating that the ence-guided development from the prenatal pe- cannabinoid system plays a prominent role in riod through childhood and adolescence until synapse formation during brain development.17 the age of approximately 21 years.9 During these developmental periods, it is intrinsically more POSSIBLE ROLE AS GATEWAY DRUG vulnerable than a mature brain to the adverse Epidemiologic and preclinical data suggest that long-term effects of environmental insults, such the use of marijuana in adolescence could influ- as exposure to tetrahydrocannabinol, or THC, ence multiple addictive behaviors in adulthood. the primary active ingredient in marijuana. This In rodents exposed to cannabinoids during ado- view has received considerable support from lescence, there is decreased reactivity of the do- studies in animals, which have shown, for ex- pamine neurons that modulate the brain's re- ample, that prenatal or adolescent exposure to ward regions.18 The exposure of rodents to • 2220 N ENGLJ MED 370;23 NEJM.ORG JUNE 5,2014 The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF WASHINGTON on September 29,2014.For personal use only.No other uses without permission. Copyright©2014 Massachusetts Medical Society.All rights reserved. ADVERSE HEALTH EFFECTS OF MARIJUANA USE cannabis in utero alters the developmental regu- mate of use, since young people who have • lation of the mesolimbic dopamine system of af- dropped out of school may have particularly high fected offspring.19 If reduced dopamine reactivity rates of frequent marijuana use.27 Since marijua- in the brain's reward regions does follow early na use impairs critical cognitive functions, both exposure to marijuana, this effect could help to during acute intoxication and for days after use,28 explain the increased susceptibility to drug abuse many students could be functioning at a cogni- and addiction to several drugs later in life,which tive level that is below their natural capability for has been reported in most epidemiologic stud- considerable periods of time. Although acute ef- ies.20 This theory is also consistent with animal fects may subside after THC is cleared from the models showing that THC can prime the brain brain,it nonetheless poses serious risks to health for enhanced responses to other drugs.22 Al- that can be expected to accumulate with long- though these findings support the idea that mar- term or heavy use. The evidence suggests that ijuana is a gateway drug, other drugs, such as such use results in measurable and long-lasting alcohol and nicotine, can also be categorized as cognitive impairments,16 particularly among gateway drugs, since they also prime the brain those who started to use marijuana in early ado- for a heightened response to other drugs.22 How- lescence. Moreover, failure to learn at school, ever, an alternative explanation is that people even for short or sporadic periods (a secondary who are more susceptible to drug-taking behav- effect of acute intoxication), will interfere with for are simply more likely to start with marijuana the subsequent capacity to achieve increasingly because of its accessibility and that their subse- challenging educational goals, a finding that quent social interactions with other drug users may also explain the association between regular would increase the probability that they would marijuana use and poor grades.29 try other drugs. The relationship between cannabis use by young people and psychosocial harm is likely to RELATION TO MENTAL ILLNESS be multifaceted, which may explain the incon- Regular marijuana use is associated with an in- sistencies among studies. For example, some creased risk of anxiety and depression,23 but cau- studies suggest that long-term deficits may be • sality has not been established.Marijuana is also reversible and remain subtle rather than dis- linked with psychoses (including those associat- abling once a person abstains from use.30 Other ed with schizophrenia), especially among people studies show that long-term, heavy use of mari- with a preexisting genetic vulnerability,24 and juana results in impairments in memory and exacerbates the course of illness in patients with attention that persist and worsen with increas- schizophrenia. Heavier marijuana use, greater ing years of regular use31 and with the initiation drug potency, and exposure at a younger age can of use during adolescence.32 As noted above, all negatively affect the disease trajectory(e.g.,by early marijuana use is associated with impaired advancing the time of a first psychotic episode by school performance and an increased risk of 2 to 6 years).25 dropping out of schoo1,27,29 although reports of However, it is inherently difficult to establish shared environmental factors that influence the causality in these types of studies because factors risks of using cannabis at a young age and drop- other than marijuana use may be directly associ- ping out of schoo133 suggest that the relationship ated with the risk of mental illness. In addition, may be more complex. Heavy marijuana use has other factors could predispose a person to both been linked to lower income, greater need for marijuana use and mental illness. This makes it socioeconomic assistance, unemployment, crim- difficult to confidently attribute the increased final behavior,and lower satisfaction with life.2,34 risk of mental illness to marijuana use. RISK OF MOTOR-VEHICLE ACCIDENTS EFFECT ON SCHOOL PERFORMANCE AND LIFETIME Both immediate exposure and long-term expo- ACHIEVEMENT sure to marijuana impair driving ability; mari- In the 2013 Monitoring the Future survey of juana is the illicit drug most frequently reported high-school students,26 6.5%of students in grade in connection with impaired driving and acci- 12 reported daily or near-daily marijuana use, dents,including fatal accidents.35 There is a rela- and this figure probably represents an underesti- tionship between the blood THC concentration • N ENGL.) MED 370;23 NEJM.ORG JUNE 5,2014 2221 The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF WASHINGTON on September 29,2014.For personal use only.No other uses without permission. Copyright©2014 Massachusetts Medical Society.All rights reserved. The NEW ENGLAND JOURNAL of MEDICINE and performance in controlled driving-simula- pear to be significant."The immunologic corn- • tion studies,36 which are a good predictor of real- petence of the respiratory system in marijuana world driving ability. Recent marijuana smoking smokers may also be compromised, as indicated and blood THC levels of 2 to 5 ng per milliliter by increased rates of respiratory infections and are associated with substantial driving impair- pneumonia 44 Marijuana use has also been as- ment.37 According to a meta-analysis, the overall sociated with vascular conditions that increase risk of involvement in an accident increases by a the risks of myocardial infarction, stroke, and factor of about 2 when a person drives soon after transient ischemic attacks during marijuana in- using marijuana.37 In an accident culpability toxication45 The actual mechanisms underlying analysis, persons testing positive for THC (typi- the effects of marijuana on the cardiovascular cal minimum level of detection, 1 ng per milli- and cerebrovascular systems are complex and liter), and particularly those with higher blood not fully understood. However, the direct effects levels,were 3 to 7 times as likely to be responsi- of cannabinoids on various target receptors (i.e., ble for a motor-vehicle accident as persons who CB1 receptors in arterial blood vessels) and the had not used drugs or alcohol before driving.38 indirect effects on vasoactive compounds46 may In comparison, the overall risk of a vehicular ac- help explain the detrimental effects of marijua- cident increases by a factor of almost 5 for drivers na on vascular resistance and coronary microcir- with a blood alcohol level above 0.08%, the legal culation.47 limit in most countries,and increases by a factor of 27 for persons younger than 21 years of age.39 LIMITATIONS OF THE EVIDENCE Not surprisingly, the risk associated with the use AND GAPS IN KNOWLEDGE of alcohol in combination with marijuana ap- pears to be greater than that associated with the Most of the long-term effects of marijuana use use of either drug alone.37 that are summarized here have been observed among heavy or long-term users, but multiple RISK OF CANCER AND OTHER EFFECTS ON HEALTH (often hidden) confounding factors detract from The effects of long-term marijuana smoking on our ability to establish causality (including the the risk of lung cancer are unclear. For example, frequent use of marijuana in combination with the use of marijuana for the equivalent of 30 or other drugs). These factors also complicate our more joint-years (with 1 joint-year of marijuana ability to assess the true effect of intrauterine use equal to 1 cigarette [joint] of marijuana exposure to marijuana. Indeed, despite the use smoked per day for 1 year) was associated with of marijuana by pregnant women,48 and animal an increased incidence of lung cancer and several models suggesting that cannabis exposure dur- cancers of the upper aerodigestive tract;however, ing pregnancy may alter the normal processes the association disappeared after adjustment for and trajectories of brain development,49 our un- potential confounders such as cigarette smok- derstanding of the long-term effects of prenatal ing.4°Although the possibility of a positive asso- exposure to marijuana in humans is very poor. ciation between marijuana smoking and cancer The THC content, or potency, of marijuana, cannot be ruled out,41 the evidence suggests that as detected in confiscated samples, has been the risk is lower with marijuana than with tobac- steadily increasing from about 3% in the 1980s co.4°However,the smoking of cigarettes that con- to 12%in 20125° (Fig. 1A).This increase in THC tain both marijuana and tobacco products is a content raises concerns that the consequences of potential confounding factor with a prevalence marijuana use may be worse now than in the that varies dramatically among countries. past and may account for the significant in- Marijuana smoking is also associated with creases in emergency department visits by per- inflammation of the large airways, increased sons reporting marijuana use51 (Fig. 1B) and the airway resistance, and lung hyperinflation, as- increases in fatal motor-vehicle accidents.35 This sociations that are consistent with the fact that increase in THC potency over time also raises regular marijuana smokers are more likely to questions about the current relevance of the report symptoms of chronic bronchitis than are findings in older studies on the effects of mari- nonsmokers42; however, the long-term effect of juana use, especially studies that assessed long- low levels of marijuana exposure does not ap- term outcomes. • 2222 N ENGLJ MED 370;23 NEJM.ORG JUNE 5,2014 The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF WASHINGTON on September 29,2014.For personal use only.No other uses without permission. Copyright©2014 Massachusetts Medical Society.All rights reserved. ADVERSE HEALTH EFFECTS OF MARIJUANA USE • A Potency of THC 14- 12- v 0- 10- 8- 6- 3 3 4- c = 2 0 1995 1996 1449-97''''199:1::2 000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 B Drug-Related Emergency Department Visits 600- a In combination •Alone 505 500 456 IIIh '' 129 123 c 100- Z 0 OOA OOh OO�o 00 OOg 00� 6\9' 0,1,. 00P 00h 00'0 01 0Ob 00� 0~ O.y� 00P 00h 00° 001 0� cp°i 0.10 ~,1 ti "iti 1 ti ti ti ti ti ti ti 1, ti ti '1ti '1 ti '1ti ti ti ti ti • Marijuana Cocaine Heroin Figure 1.Increases over Time in the Potency of Tetrahydrocannabinol(THC)in Marijuana and the Number of Emer- gency Department Visits Involving Marijuana,Cocaine,or Heroin. Panel A shows the increasing potency of marijuana (i.e.,the percentage of THC) in samples seized by the Drug En- forcement Administration (DEA) between 1995 and 2012.5°Panel B provides estimates of the number of emergency department visits involving the use of selected illicit drugs (marijuana,cocaine,and heroin)either singly or in com- bination with other drugs between 2004 and 2011.51 Among these three drugs,only marijuana,used either in com- bination with other drugs or alone,was associated with significant increases in the number of visits during this peri- od (a 62%increase when used in combination with other drugs and a 100%increase when used alone,P<0.05 for the two comparisons). There is also a need to improve our under- to decrease intraocular pressure in the treatment standing of how to harness the potential medi- of glaucoma. Nonetheless, the report stresses cal benefits of the marijuana plant without ex- the importance of focusing research efforts on posing people who are sick to its intrinsic risks. the therapeutic potential of synthetic or pharma- The authoritative report by the Institute of ceutically pure cannabinoids.52 Some physicians Medicine, Marijuana and Medicine,52 acknowledges continue to prescribe marijuana for medicinal the potential benefits of smoking marijuana in purposes despite limited evidence of a benefit stimulating appetite, particularly in patients (see box). This practice raises particular con- with the acquired immunodeficiency syndrome cerns with regard to long-term use by vulnerable (AIDS)and the related wasting syndrome, and in populations. For example, there is some evi- combating chemotherapy-induced nausea and dence to suggest that in patients with symptoms vomiting, severe pain, and some forms of spas- of human immunodeficiency virus (HIV) infec- ticity. The report also indicates that there is tion or AIDS, marijuana use may actually exac- some evidence for the benefit of using marijuana erbate HIV-associated cognitive deficits 75 Simi- . N ENGL.)MED 370;23 NEJM.ORG JUNE 5,2o14 2223 The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF WASHINGTON on September 29,2014.For personal use only.No other uses without permission. Copyright©2014 Massachusetts Medical Society.All rights reserved. 4 The NEW ENGLAND JOURNAL of MEDICINE Clinical Conditions with Symptoms That May Be Relieved by Treatment with Marijuana or Other Cannabinoids.* • Glaucoma Early evidence of the benefits of marijuana in patients with glaucoma (a disease associated with increased pressure in the eye)may be consistent with its ability to effect a transient decrease in intraocular pressure,'3,54 but other,stan- dard treatments are currently more effective.THC,cannabinol,and nabilone(a synthetic cannabinoid similar to THC),but not cannabidiol,were shown to lower intraocular pressure in rabbits.'','6 More research is needed to es- tablish whether molecules that modulate the endocannabinoid system may not only reduce intraocular pressure but also provide a neuroprotective benefit in patients with glaucomas' Nausea Treatment of the nausea and vomiting associated with chemotherapy was one of the first medical uses ofTHC and other cannabinoids.'$THC is an effective antiemetic agent in patients undergoing chemotherapy,59 but patients often state that marijuana is more effective in suppressing nausea.Other,unidentified compounds in marijuana may enhance the effect of THC(as appears to be the case with THC and cannabidiol,which operate through different antiemetic mechanisms).6°Paradoxically,increased vomiting(hyperemesis)has been reported with repeated marijuana use. AIDS-associated anorexia and wasting syndrome Reports have indicated that smoked or ingested cannabis improves appetite and leads to weight gain and improved mood and quality of life among patients with AIDS 6'However,there is no long-term or rigorous evidence of a sustained effect of cannabis on AIDS-related morbidity and mortality,with an acceptable safety profile,that would justify its incorporation into current clinical practice for patients who are receiving effective antiretroviral therapy.62 Data from the few studies that have explored the potential therapeutic value of cannabinoids for this patient population are inconclusive.62 Chronic pain Marijuana has been used to relieve pain for centuries.Studies have shown that cannabinoids acting through central CB1 receptors,and possibly peripheral CB1 and CB2 receptors,63 play important roles in modeling nociceptive re- sponses in various models of pain.These findings are consistent with reports that marijuana may be effective in ameliorating neuropathic pain 64,6'even at very low levels ofTHC(1.29%).66 Both marijuana and dronabinol,a pharmaceutical formulation of THC,decrease pain,but dronabinol may lead to longer-lasting reductions in pain sensitivity and lower ratings of rewarding effects.67 Inflammation Cannabinoids(e.g.,THC and cannabidiol)have substantial antiinflammatory effects because of their ability to induce apoptosis,inhibit cell proliferation,and suppress cytokine production.68 Cannabidiol has attracted particular inter- est as an antiinflammatory agent because of its lack of psychoactive effects.'$Animal models have shown that can- nabidiol is a promising candidate for the treatment of rheumatoid arthritis58 and for inflammatory diseases of the gastrointestinal tract(e.g.,ulcerative colitis and Crohn's disease).69 Multiple sclerosis Nabiximols(Sativex,GW Pharmaceuticals),an oromucosal spray that delivers a mix of THC and cannabidiol,appears to be an effective treatment for neuropathic pain,disturbed sleep,and spasticity in patients with multiple sclerosis. Sativex is available in the United Kingdom,Canada,and several other countries7O'71 and is currently being reviewed in phase 3 trials in the United States in order to gain approval from the Food and Drug Administration. Epilepsy In a recent small survey of parents who use marijuana with a high cannabidiol content to treat epileptic seizures in their children,72 11%(2 families out of the 19 that met the inclusion criteria)reported complete freedom from seizures, 42%(8 families)reported a reduction of more than 80%in seizure frequency,and 32%(6 families)reported a re- duction of 25 to 60%in seizure frequency.Although such reports are promising,insufficient safety and efficacy data are available on the use of cannabis botanicals for the treatment of epilepsy.73 However,there is increasing evidence of the role of cannabidiol as an antiepileptic agent in animal models.74 *AIDS denotes acquired immunodeficiency syndrome,CB1 cannabinoid-1 receptor,and CB2 cannabinoid-2 receptor, HIV human immunodeficiency virus,and THC tetrahydrocannabinol. larly, more research is needed to understand the fects of policy on market forces is quite limited potential effects of marijuana use on age-related (e.g., the allure of new tax-revenue streams from cognitive decline in general and on memory the legal sale of marijuana, pricing wars, youth- impairment in particular. targeted advertising, and the emergence of can- Research is needed on the ways in which nabis-based medicines approved by the Food and government policies on marijuana affect public Drug Administration), as is our understanding health outcomes. Our understanding of the ef- of the interrelated variables of perceptions about • 2224 N ENGLJ MED 370;23 NEJM.ORG JUNE 5,2014 The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF WASHINGTON on September 29,2014.For personal use only.No other uses without permission. Copyright©2014 Massachusetts Medical Society.All rights reserved. s ADVERSE HEALTH EFFECTS OF MARIJUANA USE Figure 2.Use of Marijuana in Relation to Perceived A Correlation between Perceived Risk and Use • Risk and Daily Use of Tobacco Cigarettes or Marijuana 60 among U.S.Students in Grade 12,1975-2013. Panel A shows the inverse correlation between the per- 50a ception of the risk associated with marijuana use and o Past-yr use actual use.Perceived risk corresponds to the percent- 40 x of marijuana age of teenagers who reported that the use of marijuana is dangerous.Panel B shows the percentage of students30 who reported daily use of tobacco cigarettes or marl Perceived risk juana in the previous 30 days. Data for both graphs are 20 of marijuana from Johnston et al.26 t7 10 0 use, types of use, and outcomes. Historically, 1°A`",,AAS,c) 4.''.5 ''.5,w`'�v��,�°)o'ti,,a")c)4' G)A c)tip�p goo goo,§s, ,%tioti"' there has been an inverse correlation between marijuana use and the perception of its risks B Reported Daily Use of Cigarettes or Marijuana among adolescents (Fig. 2A). Assuming that this 50- inverse relationship is causal,would greater per- missiveness in culture and social policy lead to 0 40- an increase in the number of young people who Daily cigarette use edays exposed to cannabis on a regular basis?. 30 in previous 30 drs Among students in grade 12, the reported preva- 20 lence of regular marijuana smoking has been i steadily increasing in recent years and may soon3 10 Daily marijuana use intersect the trend line for regular tobacco in previous 30 days smoking (Fig. 2B). We also need information o about the effects of second-hand exposure to ��A`)�1A�Ac)Ay9w^ti,,�es A ewe) -$�,�,��a`'�aA�,�,��tioo 1. ••° 1, •P 1, ,i., , yo°°'yo�•yo'"' cannabis smoke and cannabinoids. Second-hand 411 exposure is an important public health issue in the context of tobacco smoking, but we do not have a clear understanding of the effects of Table 2.Level of Confidence in the Evidence for Adverse Effects of Marijuana second-hand exposure to marijuana smoking.76 on Health and Well-Being. Studies in states (e.g., Colorado, California, and Overall Level Washington) and countries (e.g., Uruguay, Por- Effect of Confidence* tugal, and the Netherlands) where social and Addiction to marijuana and other substances High legal policies are shifting may provide important Abnormal brain development Medium data for shaping future policies. Progression to use of other drugs Medium Schizophrenia Medium CONCLUSIONS Depression or anxiety Medium Marijuana use has been associated with substan- Diminished lifetime achievement High tial adverse effects, some of which have been de- Motor vehicle accidents High termined with a high level of confidence(Table 2). Symptoms of chronic bronchitis High Marijuana, like other drugs of abuse, can result Lung cancer Low in addiction. During intoxication, marijuana can interfere with cognitive function (e.g., memory *The indicated overall level of confidence in the association between marijuana use and the listed effects represents an attempt to rank the strength of the and perception of time)and motor function(e.g., current evidence,especially with regard to heavy or long-term use and use coordination), and these effects can have detri- that starts in adolescence. mental consequences (e.g., motor-vehicle acci- dents). Repeated marijuana use during adoles- fects of a drug (legal or illegal) on individual cence may result in long-lasting changes in brain health are determined not only by its pharmaco- function that can jeopardize educational,profes- logic properties but also by its availability and sional,and social achievements.However, the ef- social acceptability. In this respect, legal drugs • II N ENGLJ MED 370;23 NEJM.ORG JUNE 5,2014 2225 The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF WASHINGTON on September 29,2014.For personal use only.No other uses without permission. Copyright©2014 Massachusetts Medical Society.All rights reserved. NEW ENGLAND JOURNAL of MEDICINE (alcohol and tobacco) offer a sobering perspec- to hypothesize that its use will increase and that, tive, accounting for the greatest burden of dis- by extension, so will the number of persons for • ease associated with drugs77 not because they are whom there will be negative health consequences. more dangerous than illegal drugs but because their legal status allows for more widespread ex- No potential conflict of interest relevant to this article was reported. posure. As policy shifts toward legalization of Disclosure forms provided by the authors are available with marijuana, it is reasonable and probably prudent the full text of this article at NEJM.org. REFERENCES 1. Center for Behavioral Health Statis- et al. Structural and functional imaging nabis,drives the earlier onset of psychosis tics and Quality.National survey on drug studies in chronic cannabis users:a sys- in cannabis users. Schizophr Bull 2014 use and health.Rockville,MD:Substance tematic review of adolescent and adult March 19(Epub ahead of print). Abuse&Mental Health Services Adminis- findings.PLoS One 2013;8(2):e55821. 26.Johnston LD,O'Malley PM,Miech RA, tration,2013. 15. Hirvonen J,Goodwin RS,Li C-T,et al. et al.Monitoring the Future:national sur- 2. Fergusson DM, Boden JM. Cannabis Reversible and regionally selective down- vey results on drug use, 1975-2013 - use and later life outcomes. 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[Erratum,JAMA 9. Gogtay N, Giedd JN, Lusk L, et al. Solinas M, Goldberg SR. Prior exposure 2002;287:1651.] Dynamic mapping of human cortical de- to THC increases the addictive effects of 32. Schweinsburg AD, Brown SA,Tapert velopment during childhood through nicotine in rats.Neuropsychopharmacol- SF. The influence of marijuana use on early adulthood.Proc Natl Acad Sci U S A ogy 2013;38:1198-208. neurocognitive functioning in adolescents. 2004;101:8174-9. 22.Levine A, Huang Y, Drisaldi B, et al. Curr Drug Abuse Rev 2008;1:99-111. 10. Dinieri JA, Hurd YL. Rat models of Molecular mechanism for a gateway drug: 33. Verweij KJ, Huizink AC, Agrawal A, prenatal and adolescent cannabis expo- epigenetic changes initiated by nicotine Martin NG, Lynskey MT.Is the relation- sure.Methods Mol Biol 2012;829:231-42. prime gene expression by cocaine. 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Copyright©2014 Massachusetts Medical Society.All rights reserved. f ADVERSE HEALTH EFFECTS OF MARIJUANA USE Walmsley S, Murphy B,Redman JR.The University of Mississippi,National Center 64.Wilsey B, Marcotte T, Tsodikov A, • effects of cannabis and alcohol on simu- for Natural Products Research,2014. et al.A randomized, placebo-controlled, lated arterial driving: influences of driv- 51. Drug Abuse Warning Network,2011: crossover trial of cannabis cigarettes in ing experience and task demand. Accid national estimates of drug-related emer- neuropathic pain.J Pain 2008;9:506-21. Anal Prey 2010;42:859-66. gency department visits. Rockville, MD: 65. Wallace M,Schulteis G,Atkinson JH, 37. Hartman RL, Huestis MA. Cannabis Substance Abuse and Mental Health Ser- et al. 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Cooper ZD, Corner SD, Haney M. alcohol concentration (BAC), age, and PC,Anduze AL,Gelbart SS.Effect of marl- Comparison of the analgesic effects of crash risk.J Safety Res 2008;39:311-9. huana on intraocular and blood pressure in dronabinol and smoked marijuana in 40. Hashibe M,Morgenstern H,Cui Y,et glaucoma.Ophthalmology 1980;87:222-8. daily marijuana smokers. Neuropsycho- al.Marijuana use and the risk of lung and 54. Hepler RS, Frank IR. Marihuana pharmacology 2013;38:1984-92. upper aerodigestive tract cancers:results smoking and intraocular pressure.JAMA 68. Nagarkatti P, Pandey R, Rieder SA, of a population-based case-control study. 1971;217:1392. Hegde VL,Nagarkatti M.Cannabinoids as Cancer Epidemiol Biomarkers Prey 2006; 55. Chen J,Matias I,Dinh T,et al.Finding novel anti-inflammatory drugs. Future 15:1829-34. of endocannabinoids in human eye tis- Med Chem 2009;1:1333-49. 41. Callaghan RC,Allebeck P,Sidorchuk A. sues:implications for glaucoma.Biochem 69. Esposito G,Filippis DD,Cirillo C,et al. Marijuana use and risk of lung cancer: Biophys Res Commun 2005;330:1062-7. Cannabidiol in inflammatory bowel dis- a 40-year cohort study. Cancer Causes 56. Song ZH, Slowey CA.Involvement of eases: a brief overview. Phytother Res Control 2013;24:1811-20. cannabinoid receptors in the intraocular 2013;5:633-6. 42.Tashkin DP. Effects of marijuana pressure-lowering effects of WIN55212-2. 70. Collin C,Davies P,Mutiboko IK,Rat- smoking on the lung.Ann Am Thorac Soc J Pharmacol Exp Ther 2000;292:136-9. cliffe S. Randomized controlled trial of 2013;10:239-47. 57. Nucci C,Bari M,Spanb A,et al.Poten- cannabis-based medicine in spasticity 43. Pletcher MJ,Vittinghoff E,Kalhan R, tial roles of(endo) cannabinoids in the caused by multiple sclerosis.Eur J 2007; et al.Association between marijuana ex- treatment of glaucoma:from intraocular 14:290-6. posure and pulmonary function over 20 pressure control to neuroprotection.Prog 71. Centonze D,Mori F,Koch G,et al.Lack years.JAMA 2012;307:173-81. Brain Res 2008;173:451-64. of effect of cannabis-based treatment on 44. Owen KP, Sutter ME, Albertson TE. 58. Zuardi AW.Cannabidiol:from an in- clinical and laboratory measures in multi- Marijuana: respiratory tract effects.Clin active cannabinoid to a drug with wide ple sclerosis.Neurol Sci 2009;30:531-4. • Rev Allergy Immunol 2014;46:65-81. 45. Thomas G, Kloner RA, Rezkalla S. spectrum of71-80.action. Rev Bras Psiquiatr 72. Porter BE,Jacobson C.Report of a par- ent survey of cannabidiol-enriched canna- Adverse cardiovascular, cerebrovascular, 59. Sallan SE,Zinberg NE,Frei E III.Anti- bis use in pediatric treatment-resistant epi- and peripheral vascular effects of mari- emetic effect of delta-9-tetrahydrocanna- lepsy.Epilepsy Behav 2013;29:574-7. juana inhalation:what cardiologists need binol in patients receiving cancer chemo- 73. Kogan NM,Mechoulam R. Cannabi- to know.Am J Cardiol 2014;113:187-90. therapy.N Engl J Med 1975;293:795-7. noids in health and disease. Dialogues 46. Stanley C,O'Sullivan SE.Vascular tar- 60. Parker LA,Kwiatkowska M,Burton P, Clin Neurosci 2007;9:413-30. gets for cannabinoids:animal and human Mechoulam R.Effect of cannabinoids on 74. Hill TD,Cascio MG,Romano B,et al. studies.Br J Pharmacol 2014;171:1361-78. lithium-induced vomiting in the Suncus Cannabidivarin-rich cannabis extracts are 47. Rezkalla SH, Sharma P, Kloner RA. murinus (house musk shrew). Psycho- anticonvulsant in mouse and rat via a Coronary no-flow and ventricular tachy- pharmacology(Berl)2004;171:156-61. CB1 receptor-independent mechanism. cardia associated with habitual marijuana 61. D'Souza G,Matson PA,Grady CD,et Br J Pharmacol 2013;170:679-92. use.Ann Emerg Med 2003;42:365-9. al. Medicinal and recreational marijuana 75. Cristiani SA,Pukay-Martin ND,Born- 48. Brown HL, Graves CR. Smoking and use among HIV-infected women in the stein RA. Marijuana use and cognitive marijuana use in pregnancy. Clin Obstet Women's Interagency HIV Study (WIHS) function in HIV-infected people.J Neuro- Gynecol 2013;56:107-13. cohort,1994-2010.J Acquir Immune Defic psychiatry Clin Neurosci 2004;16:330-5. 49. Jutras-Aswad D,DiNieri JA,Harkany T, Syndr 2012;61:618-26. 76. Niedbala S, Kardos K, Salamone S, Hurd YL. Neurobiological consequences 62. Lutge EE, Gray A, Siegfried N. The Fritch D,Bronsgeest M, Cone EJ.Passive of maternal cannabis on human fetal de- medical use of cannabis for reducing cannabis smoke exposure and oral fluid velopment and its neuropsychiatric out- morbidity and mortality in patients with testing.J Anal Toxicol 2004;28:546-52. come.Eur Arch Psychiatry Clin Neurosci HIV/AIDS. Cochrane Database Syst Rev 77. Degenhardt L,Hall W.Extent of illicit 2009;259:395-412. 2013;4:CD005175. drug use and dependence,and their con- 50. ElSohly MA.Potency Monitoring Pro- 63. Chiou LC, Hu SS, Ho YC. Targeting tribution to the global burden of disease. gram quarterly report no.123-report- the cannabinoid system for pain relief? Lancet 2012;379:55-70. ing period:09/16/2013-12/15/2013.Oxford: Acta Anaesthesiol Taiwan 2013;51:161-70. Copyright©2014 Massachusetts Medical Society. IMAGES IN CLINICAL MEDICINE The Journal welcomes consideration of new submissions for Images in Clinical Medicine.Instructions for authors and procedures for submissions can be found on the Journal's website at NEJM.org.At the discretion of the editor,images that are accepted for publication may appear in the print version of the journal, the electronic version,or both. • N ENGLJ MED 370;23 NEJM.ORG JUNE 5,2014 2227 The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF WASHINGTON on September 29,2014.For personal use only.No other uses without permission. Copyright©2014 Massachusetts Medical Society.All rights reserved. • Board of Health V New Business Item 2 Washington State Board of Health Update October 16, 2014 0 Board of Health V New Business Item 3 Jefferson County Paralytic Shellfish Poisoning Toxin 1 • Levels, Summer / Fall 2014 • October 16, 2014 0 4,4tv'-f• ,..' v lift s*• ey %` $#ii` / 9. o Cu '' >{ ''' it • / / 4 C '! — / ; i 4,4,,,,,,,. .• —+-(D f-N ? N.)-‘ rD G Chi �%/�/%SO if' ' O r> �ig _ 0 Vis' t/,Q^ , clit4 ,,,,..e.3 1 i. .• : � . wiz:4g . ,r... . • k.i,,, Iq'.4.--,‘,N,t fr--.4(,,, 4.. ',..a F 'R4'2 t i.rx' ,mak �Q. `+1�. kri. t r,,,,444 t V$?Q , ., } s Z rz' 4 � .,.( yi ,�S ' v it ler' '' .v*V.k go . KZ.,)f Z 1-1 ? !-4n-, p 1,:,•/4441 ;,„4,:- .,rx •:::„,f „, ' #5,�, ff x ` �#tom 9; / yl ) ''''147C.414 ,e4'..* ? e.s.CO .S.. -.,,,,i, A/ '' 'l,i'l' ,':24:9 if 't'*,: ..4. F ..0f i fi { z • 1 Of 0 y { i r k ,49,f :4'' St '. 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Washington State Emergency Preparedness Efforts 0 October 16, 2014 Ebola symptoms and transmission. :: Washington State Dept. of Health Page 1 of 2 eft vt.!..,112Thloi:s.',11:'L:CTUritPC!!Jr • flea t ..., Ebola Current situation The outbreak in West Africa is worsening, but the federal Centers for Disease Control and Prevention (CDC), along with other U.S. government agencies and international partners, is taking steps to respond to this rapidly changing situation. Ebola poses no substantial risk to the U.S. general population. More about Ebola and national situation from the CDC Washington State There are no cases of Ebola in Washington State, there are no suspected cases, and no one is being monitored. 110 An outbreak Ebola virus disease is very unlikely to occur in Washington because we have good infection control practices in our hospitals and a well-trained public health staff. What we are doing We are prepared for Ebola virus in Washington: Our local and state health officers have reached out to medical professionals and hospital administrators with reminders of the need to look for symptoms that could indicate Ebola virus disease, and then to ask about travel to affected countries or potential exposure. Our Public Health Laboratories are qualified to conduct initial testing for Ebola. P We have public health staff trained and ready to identify contacts of patients. Washington public health has a long-standing and well-established disease monitoring and tracking system in place that looks for many diseases, now including Ebola. It's a collaborative effort among state public health, federal health authorities including CDC and its office of Global Migration and Quarantine, local public health, and the healthcare community About Ebola II° Some things to know about Ebola: http://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/Ebola 10/9/2014 Ebola symptoms and transmission. :: Washington State Dept. of Health Page 2 of 2 A person infected with Ebola virus is not contagious until symptoms appear. The virus is spread through direct contact (through broken skin or unprotected mucous • membranes in, for example, the eyes, nose or mouth) with the blood or body fluids (such as urine, feces, saliva, semen) of a person who is sick with Ebola, or with objects like needles that have been contaminated with the virus, or infected animals. Ebola is not spread through the air or by water or by food. Facts . . fxsi.gx hml You can't get Ebola You can't get Ebola through water through food • • Learn more Read our Ebola fact sheet (available in English, Spanish, Chinese, Korean, Russian, Somali, Ukrainian and Vietnamese). • http://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/Ebola 10/9/2014 FACT SHEET: The U.S. Response to the Ebola Epidemic in West Africa 1 The White Ho... Page 1 of 3 f net Email Updr,s Contact 1.; • Home•Briefing Raiim•Statements&Releases Search WhiteHouse.gov Search The White House ing121111.111111111.471111111.11.112) 12=1111 Office of the Press Secretary WHITE SOUSE SHAH€Ames -..... ....— —— ------- -- , forr Immediate Release October 06,2014 ._— V4-'7' ="f; FACT SHEET: The U.S. Response to the Ebola Epidemic in :4 West Africa VIEW OUR MOST SHAREABW CONTENT IN ONE Since the first cases of Ebola were reported in West Africa in March 2014,the United States has mounted a whole- EASY-TO-NAVIGATE PAGE: of-government response to contain and eliminate the epidemic at its source,while also taking prudent measures at � - home.The President last month outlined a stepped-up U.S.response.leveraging more thoroughly the unique START SHARING capabilities of the U S military to support the civilian-led response in West Africa.Domestically,we have prepared for the diagnosis of an Ebola case on U.S.soil and have measures in place to stop this and any potential future cases in their tracks. LATEST BLOC POSTS Specifically,our strategy is predicated on four key goals: Octoser00,2014 12:24 PM EDT Here Are Five Facts from the White House • Controlling the epidemic at its source in West Africa: Report on illennjals: The Council on Economic Advisers releases a new • Mitigating second-order impacts.including blunting the economic,social,and political tolls in the region: report that looks at the so-called"Millennial" • Engaging and coordinating with a broader global audience:and, generation.Here's what they learned. • Fortifying global health security infrastructure in the region and beyond.including within the United States. October 02.2014 7'.30 PM EOT International Response Empowering Our Young People,and Stemming the Collateral Damage of • Incarceration In support of national government efforts in Liberia.Sierra Leone,and Guinea—and alongside the international Officials from the White House.the Department of community—the U.S.response builds upon the measures we have had in place since the first cases of Ebola were Justice,and the Department of Health and Human reported.The United States already has committed more than$350 million toward fighting the outbreak in West Services welcome a diverse group of federal Africa including more than$111 million in humanitarian aid,and the Department of Defense(DoD)is prepared to officials,non-profit workers.faith leaders,school devote more than$1 billion to the whole-of-government Ebola response effort.As a further indication of our administrators,researchers,and child welfare prioritization of this response,the United States convened a special UN Security Council session on the epidemic, advocates to the White House,to announce a and President Obaina called the world to action during a subsequent UN session called by Secretary-General Ban series of steps aimed at providing stronger support Ki-moon.These U S.actions have galvanized millions of dollars in international funding and in-kind support. to help children with incarcerated parents succeed, and overcome the unique obstacles they often Among the specific response efforts.the United States has: face. • Deployed to West Africa more than 130 civilian medical,healthcare.and disaster response experts from October 00,3014 5.50 PM EDT multiple U.S.government departments and agencies as part of the U.S.Agency for International Five L.S.S.Airports Are Enacting New Development's(USAID)Disaster Assistance Response Team as well as approximately 350 U.S.military Screening Measures to Protect Against personnel.constituting the largest U.S.response to an international public health challenge: Ebola • Increased the number of Ebola treatment units(ETU)in the region.including supporting ETUs in Sierra The Centers for Disease Control and Prevention Leone and Liberia.and one of our new ETUs in Liberia discharged its first four Ebola survivors last week; (CDC)and the Department of Homeland Security (DHS)announce that five U.S.airports will begin • Increased to 50 the number of safe burial teams.which are now working across every county in Liberia to enhanced Ebola screening for all people coming safely and respectfully dispose of bodies, from Ebola-affected countries. • Deployed and commenced operation of five mobile Ebola testing labs in the region.two of which opened this week in Liberia and have doubled lab capacity in the country—reducing from several days to just a few hours VIEW ALL RELATED SLOG POSTS the time needed to determine if a patient has Ebola; • Provided more than 10,000 Ebola test kits to the Liberian Institute of Biological Research and Sierra Leone's Kenema Government Hospital: • Received and passed to interested humanitarian organizations information from nearly 2,200 volunteers willing to provide healthcare in the affected countries: Facebook YouTube • Delivered approximately 2,200 rolls of USAID heavy-duty plastic sheeting for use in constructing Ebola treatment units across the region; Twitter Mimeo • Procured 140,000 sets of personal protective equipment,10.000 of which have already been delivered, along with hundreds of thousands of medical gloves and thousands of protective coveralls.goggles,face Ftickr ii uses • shields,and other personal protective supplies; Googler Linkedln • Delivered an initial 9.000 of 50.000 community care kits to Liberia. • Supported aggressive public education campaigns reaching every Liberian county with life-saving information on how to identify.treat and prevent Ebola, http://www.whitehouse.gov/the-press-office/2014/1 0/06/fact-sheet-us-response-ebola-epid... 10/9/2014 FACT SHEET: The U.S. Response to the Ebola Epidemic in West Africa I The White Ho... Page 2 of 3 • Administered nutritional support to patients receiving care at Ebola treatment units and in Ebola-affected communities across the region;and • Provided technical support to the Government of Liberia's national-level emergency operation center. • In the days and weeks to come.U.S.efforts will include • Scaling-up the DoD presence in West Africa. Following the completion of AFRICOM's assessment,DoD announced the planned deployment of 3,200 troops,including 700 from the 101'Airborne Division headquarters element to Liberia.These forces will deploy in late October and become the headquarters staff for the Joint Forces Command,led by Major General Gary Volesky.The total U.S.troop commitment will depend on the requirements on the ground; • Overseeing the construction of and facilitating staffing for at least 17 100-bed Ebola treatment units across Liberia: • Deploying additional U.S.military personnel from various engineering units to help supervise the construction of ETUs and provide engineering expertise for the international response in Liberia: • Establishing a training site in Liberia to train up to 500 health care providers per week,enabling them to provide safe and direct supportive medical care to Ebola patients: • Setting up and facilitating staffing for a hospital in Liberia that will treat all healthcare workers who are working in West Africa on the Ebola crisis should they fall ill; • Operating a training course in the United States for licensed nurses,physicians,and other healthcare providers intending to work in an ETU in West Africa; • Leveraging a regional staging base in Senegal to help expedite the surge of equipment,supplies,and personnel to West Africa: • • Continuing outreach by all levels of the U.S.government to push for increased and speedier response contributions from partners around the globe:and. • Sustaining engagement with the UN system to coordinate response and improve effectiveness. Domestic Response We have been prepared for an Ebola case in the United States and have the healthcare system infrastructure in place to respond safely and effectively.Upon confirming the Ebola diagnosis,the Department of Health and Human Services(HHS),including the Centers for Disease Control and Prevention(CDC),and our interagency team activated plans that had been developed. Our public health officials have led the charge to prepare and fortify our national health infrastructure to respond • quickly and effectively to Ebola cases domestically.Their efforts include: • Enhancing surveillance and laboratory testing capacity in states to detect cases:in the last three months,12 Laboratory Response Network labs have been validated to perform Ebola diagnostic testing throughout the United States: • Authorizing the use of a diagnostic test developed by DoD to help detect the Ebola virus. • Providing guidance and tools for hospitals and health care providers to prepare for and manage potential patients,protect healthcare workers,and respond in a coordinated fashion; • Developing guidance and tools for health departments to conduct public health investigations; • Providing recommendations for healthcare infection control and other measures to prevent disease spread; • Disseminating guidance for flight crews.Emergency Medical Services units at airports.and Customs and Border Protection officers about reporting ill travelers to CDC. • Providing up-to-date information to the general public.international travelers.healthcare providers.state and local officials.and public health partners; • Advancing the development and clinical trials of Ebola vaccines and antivirals to determine their safety and efficacy in humans: • Monitoring by the Food and Drug Administration for fraudulent products and false product claims related to the Ebola virus and implementing enforcement actions,as warranted,to protect the public health:and, • Issuing by the U.S.Department of Transportation,in coordination with CDC.an emergency special permit for a company to transport large quantities of Ebola-contaminated waste from Presbyterian Hospital in Dallas. Texas as welt as from other locations in Texas for disposal. Passenger Screening On top of these domestic measures.we recognize that passenger screening efforts in West Africa and at domestic airports represent another line of defense.We have developed and supported a stringent screening regimen both at home and abroad,and we are constantly evaluating the effectiveness of these and other potential measures.We will make adjustments as deemed prudent by health professionals and the appropriate U.S.departments and • agencies. Exit screening measures are routinely implemented in the affected West African countries,and U.S.government personnel have worked closely with local authorities to implement these measures.Since the beginning of August, http://www.whitehouse.gov/the-press-office/2014/10/06/fact-sheet-us-response-ebola-epid... 10/9/2014 - FACT SHEET: The U.S. Response to the Ebola Epidemic in West Africa The White Ho... Page 3 of 3 CDC has been working with airlines,airports,ministries of health,and other partners to provide technical assistance for the development of exit screening and travel restrictions in countries with Ebola.This includes: ilo • Assessing the capacity to conduct exit screening at international airports: • Assisting countries with procuring supplies needed to conduct exit screening; • Supporting with development of exit screening protocols: • Developing tools such as posters.screening forms,and job-aids; • Training staff on exit screening protocols and appropriate personal protective equipment(PPE)use:and, • Preparing in-country staff to provide future trainings. All outbound passengers are screened for Ebola symptoms in the affected countries.Such primary exit screening involves travelers responding to a travel health questionnaire,being visually assessed for potential illness.and having their body temperature measured. • If a person has a fever above 101.5 or is suspected to be ill,the passenger will be taken aside for a more detailed health assessment-a secondary screening-to determine if he or she should be isolated. • Airport employees must wear latex gloves,use alcohol-based hand sanitizer,and monitor their own body temperature daily,among other measures. Once passengers arrive in the United States they are subject to additional measures. The Department of Homeland Security's(DHS)Customs and Border Protection(CBP)and the CDC have closely coordinated to develop policies,procedures.and protocols to identify travelers who may have a communicable disease,responding in a manner that(minimizes risk to the public.These procedures have been utilized collaboratively by both agencies on a number of occasions with positive results.Among these measures: • COP personnel review all travelers entering the United States for general overt signs of illnesses(visual observation,questioning.and notification of CDC as appropriate)at all U.S.ports of entry,including all federal inspection services areas at U.S.airports that service international flights. • When a traveler is identified with a possible communicable disease or identified from information that is received from the CDC.COP personnel will take the appropriate safety measures by referring the traveler to a secondary,isolating the traveler from other travelers,and referring to COG or public officials for a medical assessment. CBP personnel may don personal protective equipment(PPE),to include gloves and surgical masks,which are readily available for use in the course of their duties. • • CBP personnel receive training in illness recognition,but if they identify an individual believed to be infected. CBP will contact CDC along with local public health authorities to help with further medical evaluation. • CBP is handing out fact sheets to travelers arriving in the U.S.from Ebola-affected countries,which detail information on Ebola,health signs to look for.and information for their doctor should they need to seek medical attention in the future. • Secretary Johnson has also directed Transportation Security Administration to issue an Information Circular to air carriers reinforcing the CDC's message on Ebola and providing guidance on identifying potential passengers with Ebola. DHS is closely monitoring the situation and Secretary Johnson will consider additional actions as appropriate. „ d) : ( , ( . t,. > ._n r" .nt .ss b i:y .C;pyrignl toformatton ,Priva y Po bcy „u tad ..PJM gov Deovrr ps r s !Appby for in Job • http://www.whitehouse.gov/the-press-office/2014/10/06/fact-sheet-us-response-ebo la-epid... 10/9/2014 441,\ JEFFERSON COUNTY LIC :HEALTH 615 Sheridan Street c Port Townsend a Washington o 98368 www.jeffersoncountypubGchealth.org Z�Z�„ • October 14, 2014 /6/� —5 To: Jefferson County Health Care Providers From: Tom Locke, MD, MPH, Jefferson County Health Officer Re: West African Ebola Outbreak— Separating Media Hype from Clinically Relevant Information Situation Report: The current Ebola Virus Disease (EVD) outbreak began in West Africa in March of 2014. As of October 10, 2014 there have been 8,376 confirmed cases in the three countries where ongoing transmission is occurring—Liberia, Sierra Leone, and Guinea. 4,024 deaths have occurred with a case fatality ratio approaching 50%. Adjusted for underreporting, the true case number could be as high as 21,000. In his commentary in the NEJM, Peter Piot, MD, PhD of the London School of Hygiene and Tropical Medicine and one of the co-discoverers of the Ebola virus, described the cause of this unprecedented epidemic as arising from a toxic combination of"dysfunctional health systems, international indifference, high population mobility, local customs, densely populated capitals, and a lack of trust in authority". • A single case of imported Ebola in a Dallas hospital has ignited a media firestorm in the United States, prompting the Centers for Disease Control to issue multiple advisories encouraging a heightened state of preparedness while simultaneously trying to assure the public that the probability of a U.S. outbreak is extremely low. White House press briefings, activation of emergency preparedness response systems, and military deployments to West Africa have also heightened the sense of public alarm. An additional case of Ebola in a healthcare worker who provided direct care to the Dallas patient has called into question the adequacy of current personal protective equipment (PPE) standards and training among health care workers. The Facts: There is no significant threat of an Ebola outbreak in the United States. Transmission only occurs once an infected individual is symptomatic and as a result of substantial exposure to blood or contaminated body fluids. As the infection worsens, viral titers soar, reaching 10 billion/cc (vs. 50,000-100,000/cc for HIV and 5-20 million/cc for Hepatitis C) at the peak of the illness. Infection occurs when contaminated body fluids come in contact with non-intact skin or mucous membranes. Airborne transmission has not been documented. The very high viral loads, coupled with copious viral shedding in emesis, diarrhea, and from the skin require rigorous adherence to contact precautions, special handling of medical waste and of human remains. CO• MUNITY ELTH DEVE OPM NTALDISABILITIES PUBLIC HEALTH ENVIRONMENTAL HEALTH MAIN: (360)385-9400 ALWAYS W MAI FOR A SAFER AND WATER C25- 4 N: (360)385-944444 FAX: (360)385-9401 HEALTHIER COMMUNITY FAX: (360)379-4487 The incubation period for EVD can range from 2 to 21 days with a mean of 8-10 days. The • serial interval for transmission, i.e. the time between disease onset in one person and onset in a subsequently infected person averages around 15 days. Public Health Response: An intensive, albeit belated, international response to the West African outbreak of EVD has now begun. Projections that case numbers could climb as high as 1.4 million by January of 2015 are based on a scenario where no additional control measures are instituted. With the growing international aid response, these assumptions no longer apply. Many formidable obstacles remain, including governmental corruption, lack of health care infrastructure, and widespread public distrust. In addition to primary containment efforts, evaluation of travelers arriving from the endemic area is being intensified. Approximately 150 travelers per day come to the United States from the three affected West African countries. Screenings are taking place at 5 main airports—Newark, JFK, O'Hare, Atlanta, and Washington Dulles—where 94% of travelers from Liberia, Sierra Leone, and Guinea arrive. Health Care Facility Response: Hospitals, appropriately, are being asked to review infection control practices and take travel histories on febrile patients seen in emergency departments. Patients with signs and symptoms consistent with EVD (fever, severe headache, muscle pain,weakness, diarrhea,vomiting, abdominal pain, and unusual bleeding)with a history of travel to the West African outbreak zone (or direct exposure to a known or suspected Ebola case) should be immediately isolated and tested for EVD. Special specimen containers are now available at all local health departments. Testing is available at the Washington State Public Health Lab with turnaround in 6-8 hrs. Harborview Medical Center has agreed to accept • referral of American health care workers who have been providing care to EVD victims in the outbreak zone and become accidently infected. With improving supplies of personal protective equipment in West Africa, this will hopefully be a very rare occurrence. Health Care Provider Response: A bulletin from the Washington State Medical Association was sent out last week urging providers to review existing infection control and triage protocols. Determining the travel history of febrile patients is also recommended, as a wide variety of illnesses (Measles, MERS [Middle East Respiratory Syndrome], Malaria, Dengue, Chikungunya virus, and others) are associated with international travel. Recent travel to Liberia, Sierra Leone, or Guinea should prompt special evaluation. It is not reasonable to ask every febrile patient whether they have recently travelled to West Africa and may have the unintended effect of increasing patient anxiety. A general inquiry about international travel should be sufficient. Travel history has long been an important element of an infectious disease evaluation and the EVD outbreak underscores its importance. Review of infection control policies and protocols for donning and removing personal protective equipment (http://www.cdc.gov/vhf/ebola/pdf/ppe-poster.pdf) is also beneficial although the likelihood of needing these skills to protect yourself from EVD is extremely low. Much more likely is exposure to C. difficile, antibiotic-resistant bacterial infections such as MRSA and CRE, Enterovirus D-68, influenza, and a host of other common pathogens. When indicated, personal COMMUNITY HEALTH PUBLIC HEALTH • � DEVELOPME TAENVIRONMENTAL DISABILITIES ALWAYS "ORM ENVIRONMENTAL HEALTH MAIN (360) pt ffd'� a.#' ;. � �>° WATER QUALITY FAX:(360)385-9401 HALMAIN: (360)385-9444 FAX: (360)379-4487 protective equipment plays a crucial role in worker safety and prevention of nosocomial infection transmission. Due to a documented case of EVD transmission to a health care worker in the Dallas hospital that cared for the much publicized imported Liberian EVD index case, CDC is undertaking a review of current infection control protocols and whether it is feasible for all hospitals to maintain the high level of training needed to safely care for critically ill Ebola patients. Risk Communication to Patients: Relentless media coverage and political grandstanding in the ramp up to mid-term national elections has created an impression that the United States faces an imminent outbreak of Ebola. Patients should be reassured that there is no significant risk of exposure within the United States. U.S. residents are at risk for outbreaks of many diseases due to low vaccination rates —Measles, Mumps, Pertussis, Influenza, and Varicella in particular. Antibiotic-resistant bacterial infections are on the rise. EVD should be the last thing people think of when they develop any of the non-specific symptoms that are associated with Ebola. Other Resources: A wealth of information is available on the CDC website http://www.cdc.gov/vhf/ebola although the sheer volume is making it difficult to navigate. The Washington State Department of Health's site http://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/NotifiableConditions/EbolaRes ources has an excellent selection of the most useful resources for health care providers. • • DOVE MUNITY HEALTH DISABILITIESPUBLIC HEALTH ENVIRONMENTAL.HEALTH MAIN: (360)385-9400 S5E.E ; n'E t G EOR AEE a WATER QUALITY MAIN: {360)385-9444 FAX:(360)385-9401 HEALTHIER UNITY FAX: (360)379-4487 • Board of Health V New Business Item 5 • Strategies to Expand Access to Opiate Overdose Treatment in Jefferson County � October 16, 2014 N v O i0 m 1 L CO a ro c '- a o `] •� _ o a a) > c a N ° ro (0 u o E 2 .o � a) -CcoEaJ aoa a, x .,; m, CO ❑ E — , -a a � U ,1-1 dR i u � o (° u (n � •na 1 ("� o ° 0 ro •- >. o C /ON ) C o Q UteN �- a 0 in . a+ N oo C a (o0 C O _c 1 N(d UN > 4- o UN 0 C 0 2 �O % o a) r-I ❑ m , LO -a 0 -0 a) N o NON t h,1*- _ L -o 'H' L C a '5 r•I L >' cu a) oN O O ❑ a) 0 -0 >.• 0 > 00 CU CO i N O _c +-, @ C L C a) a) ! oo a) u r- -"I . -CN > � a) CUa--, 1 o O U (n C 0 -° C + 0 0 2 ❑ 4- U w 0 (n ',:]-.) 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These steps and examples may be helpful to individuals and communities working towards a program in other regions. 1) IDENITFY & RECRUIT PARTNERS & STAKEHOLDERS Organize allies among stakeholders who are concerned about overdose deaths: professionals in public health, law enforcement, state and local agencies, researchers, medicine; and among advocacy groups such as families of victims of overdose. 2) INITIAL MEDIA EVENT The law was kicked off with a press conference with our State Attorney General, poison center medical director, state substance abuse treatment director, treatment provider, parent of overdose victim, and the ACLU. http://www.atd.wa.qov/pressrelease.aspx?&id=25810#.UjCIVT9c3fw 3) INFORMATION SOURCE Have a go-to source of information and way of engaging the community in an ongoing way • with updates and information: • https://www.stopoverdose.org • https://www.facebook.com/stopoverdose.org • https://www.facebook.com/groups/313824845349907/ Expanding Access to Naloxone 4) INITIAL COMMUNITY EDUCATION Immediately get information out. • Syringe exchange distributed wallet cards about what the law did and did not cover via wallet cards (transparency, accurate information, delivered to the right people) http://www.stopoverdose.org/docs/911%20Good%20Samaritan%20Wallet%20Card. pdf • Opiate medicine safety flier created by the WA Department of Health: http://here.doh.wa.gov/materials/safe-use-of-prescription-pai n- medication/33 PainMeds E11L.pdf 5) POLICE Involve police in spreading the word to officers and more broadly to the public. Police blog: http://spdblotter.seattle.gov/2012/04106/help-curb-overdose-deaths-by-calling- 911/ Law enforcement newsletter: http://stopoverdose.org/NWHIDTA IntelBullFeb2013.pdf Police training video: http://stopoverdose.org/law.htm • 6) ONGOING MEDIA r Op-eds and continually working with media and asking them to put info into every story about an overdose or drugs: http://seattletimes.com/html/opinion/2018013581 guestl9bantagreen.html http://seattletimes.com/html/localnews/2021175920 apwawashingtonheroin3rdldwritethru. html 7) EVALUATION Evaluating the implementation and ultimately the outcomes of such laws is important. Self- reported evaluations as well as peer reviewed manuscripts are both valuable. http://adai.uw.edu/pubs/infobriefs/ADAI-IB-2011-05.pdf http://www.ncbi.nim.nih.qov/pubmed/23900788 8) ADVERTISING Online advertising (e.g. internet ad networks and Facebook) does work to drive internet traffic to online resources including completing online overdose training. 9) NEVER STOP WORKING Remain vigilant and look for opportunities to spread the word. WHERE HAVE GOOD SAM & NALOXONE LAWS BEEN SUCCESSFULLY IMPLEMENTED? • Summary of Current Overdose Good Samaritan Laws in the United States Prepared by the Network for Public Health Law, July 2013. 110 ■aim M O 11) >111111% gear 4.1 4.ip• II 0115 IL,511) C13 , . Waft C:2111c� 4.4 o � OC1) 141) � LuROI T O i N O O 0 4••• 2. 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O >)., s a R l6 .a O w O O O. ° a3 l6 b2'c bD J T O CC E Eo 1-2) ;.0., u7oCD c� Nv a> oo oNo.ncn•000ro �� y £ a) 6S s X c YO .. ei Z v C Co 0 >,>8 baa 2 Q O bA O Q•a) O '�" O <3 0 O • .Y �_ • 0 O .� y Q•CA Z 0 IP o CO t6 +. a) na O c 0 O .0", C :` MINI 3 0 a L 0 as 0 0 L a C 8 w E 3 uo (t) c O j 0 0 >.=00 N i= 1 t T �' Y Y N .. N p 0 ,8 -0 Orf = 1. . - ? cu - c O O R O R O 0: U 'AS 0- U d. o x, 0._ a o s •= y to s c v,,--1 .?. o (2 6 .c a) r„ '> 8 ,, a 0 ". ;V„, ix + aa)„ O _ af- x sE6s =anao .� c> c . v ma r1 ,.....CO o o VI F= ♦ ♦ y ♦ A A A s G7 wog • Board of Health V New Business Item 6 Substance Abuse Board Appointments • 0 October 16, 2014 0 • September 11,2014 RECEIVEr Jefferson County Board of Health CIO Julia Danskin SEP 5 20'14 Jefferson County Public Health Jefferson Count' Public Health 615 Sheridan Port Townsend,WA 98368 To Whom It May Concern; I am writing to express my interest in becoming a member of the Substance Abuse Advisory Board. I feel I am a good candidate for the Board as I am an involved member in the recovery community of Jefferson County. I have been in recovery for 3 years and participate in a variety of community sobriety activities. These activities include self help meetings in the community, speaking to individuals currently in the recovery process at a local substance abuse treatment center, sponsorship of individuals involved in recovery and I participate in community service activities. • I have lived and worked in Jefferson County for 6 years. I am currently attending Peninsula College to obtain my Associates Degree. If my background is of any interest please feel free to contact me at your earliest convenience. Thank you, Anthonie Cullen i' 730 Willow Street#1 PortTownsend,WA 98368 360-774-1019 Cell • Kenneth Frohning 1.4e 111 Colman Drive,Port Townsend,WA 98368;phone 360-314-2844;email:kenele12@gmail.com RECEIVED SEP 18 2O1 Date:9/15/2014 Jefferson County Public Health To Denise Banker Jefferson County Public Health 615 Sheridan Street Port Townsend,WA 98368 Dear Denise Banker, I would like to be considered for a position on the Jefferson County Substance Abuse Advisory Board. I believe substance abuse is among the least understood and most costly problems to communities.Treatment and maintenance of substance abusers is also often misunderstood and controversial. I have been a pharmacist for 38 years and spent over 6 years working as the pharmacist in charge of the Methadone Treatment Program dispensatory at the Portland VA Pharmacy.From 2005 to 2011 I worked with the Methadone Treatment Program team consisting of an addiction psychiatrist,a psychologist(Peter Benson=Program Director),clinical • social workers,medical students and fellows,pharmacy residents,technicians and students,and other services.This is an intensive multidisciplinary program,which not only treated opiate abuse but also dealt with alcoholism,hepatitis,housing, employment as well as other health,social and mental related issues.We worked with men and women of all ages and backgrounds. Our program was not a so called juice bar"but dealt with each customer individually to obtain the best outcome. Today I continue to work part time as a contract pharmacist for the VA and maintain interest in addiction management. Please let me know if you need further information or references. Sincerely, Kenneth Frohning • f JEFFERSON MENTAL HEALTH SERVICES Community Supported Outpatient Care for East Jefferson County Children,Adolescents,Adults and Older Adults-24 Hour Crisis PO Box 565 a 884 W.Park Avenue-Port Townsend,WA 98368 • Phone:360-385-0321 0 1-877-410-4803 Fax:360-379-5534 September 10, 2014 RECEIVED To: Jefferson County Public Health SEP 1 6 2014 Re: Request to join the Substance Abuse Advisory Board (SAAB) Jefferson County Public Health .. To Whom It May Concern: I am writing this letter to respectfully request consideration for becoming a member of the Substance Abuse Advisory Board (SAAB.) As the Clinical Director of Jefferson Mental Health Services I work both directly and indirectly with very many of those living with chronic and severe mental-health disorders in this county. Most of these above-mentioned clients also deal with significant issues involving substance abuse and/or chemical dependency. On paper, CD and MH treatment reside in separate, bureaucratically fabricated pigeon holes. In reality—in the clients with whom I work—substance-abuse patterns and mental- health functioning are so inextricably interwoven that I find that I cannot do my job properly without entering my clients' CD world as well. It is for this reason that I am primarily interested in joining the SAAB. I already work closely with • Safe Harbor/Beacon of Hope as JMHS shares many clients and programs with this agency. I am a member of the Mental Health Therapeutic Court and observe weekly how untreated MH issues, when mixed with substance-abuse patterns and self-medication attempts, can create a danger in our communities. I have a positive working relationship with both city and county law-enforcement personnel, our various schools, our local hospital, and other entities that also deal with the challenges of substance abuse in our county. I thank you for your consideration. I am more than happy to answer any questions you may have and/or to provide references upon request. Sincerely, Dr 1 ik A Nygard, PhD, CMHS, DMHP Board of Directors Clinical Director, Jefferson Mental Health Services President (360)385-0321, ext. 1 1 8 Tony Hernandez Vice President Chuck Henry Secretary Dorn Campbell Members Carrie Day,MD Quentin Goodrich • DeeDee Spann Larry Wiener Executive Director Sam Markow I* I t''''''''''''''''''R4'fr '...;''''''''' ,,'.'7'''-'-''.''F''':-,' ''' ''''',''''-''-''''''-''-'^"."-'",'.'''''...":-;'71T::::t2,7;'''..:;:,:'''';.-J;,:.::'-F ' '''''*.1 7M-'"..''''''J4R;,,q'4''''''''.:.,4-''''.Z.'4'...7;',.','',.:'-ff,titq4', 17.ig",+7,i'r4.44^t't:5, t : 0 ''-^, ,,„,,,,-''':" '-'- -;,- 4 ::'' .:"4::'':T;“'..:. '.';,'.:':. ..':::.' ri, # ,;:. ,.:;'7:73.4.t.:r47:43:4 4::5;:ri'1,7517:::: 11.11:';'::::7:4;.:Ir:44:40‘'.4;;. i. 0 ' , '4 *:' ''''' l'''':'L'4 ' \'::44 '4 4.: 4;4'4':'.:.'4'::?.44'' S'.40.4.:''-'', ',14:. ';.:F,t.:. ' 4 4't:::':'1•74ii?;4$ ..:5;.;:4::';'.4!:, :i.:::74,.'.14;":41:1:.:.:41::: :4: 1E.774'441'4'' 4+',. 4. 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'.. q crci CM ..., a ri;;,'"?,:1,1Y A..,,'"'",'„Pc ,... 1 •• Z 0 *i• ‘,...., ''TI ' ,..". .I;;*",;.' ,;11 '-i CP l' i • r--I.• H --r.Appo 1 CM 11.gg,•4"•.1;,,` .•4;i C 1-i• *r,....,—....,,,....w.. cc-4 ,.'•' . ,... ..,,,,, ,:4;tii:,-;; :iiii' -,..°-'-'04-,&.'5'411 4.54,/4-4:-,ZV, r:-1-wr'- '--T,,,W4•-•.;.,''':t r"---• 1\D '``'•••4, ;'.Y,44,.:7,-,.,:-`.It r\' • "#14 ---, tzv,"'..e,r•.,71..-.1"3 1—i ,....—, C144 )-3 0 • ,., JEFFERSON COUNTY BOARD OF HEALTH prof ' October 17,2014 Kenneth Frohning 411 Colman Drive Port Townsend,WA 98368 Dear Mr.Frohning: On October 16,2014 the Jefferson County Board of Health was pleased to appoint you to serve a three(3)year term on the Jefferson County Substance Abuse Advisory Board.Your term will expire in October,2017. We look forward to working with you and appreciate your willingness to devote time to this Board. Sincerely, '&14019' //17-- David Sullivan, Chairman Jefferson County Public 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 JEFFERSON COUNTY BOARD OF HEALTH October 17,2014 Dr.Erik A.Nygard P.O.Box 565 Port Townsend,WA 98368 Dear Dr.Nybard: On October 16,2014 the Jefferson County Board of Health was pleased to appoint you to serve a three(3)year term on the Jefferson County Substance Abuse Advisory Board.Your term will expire in October,2017. We look forward to working with you and appreciate your willingness to devote time to this Board. Sincerely, • e:24.04:7‘ David Sullivan, Chairman Jefferson County Public Health Board Members 411 David Sullivan(Chair),County Commissioner District#2;Sheila Westerman,Citizen(Vice-Chair); Phil Johnson,County Commissioner District#I;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 • • S JEFFERSON COUNTY • BOARD OF HEALTH October 17,2014 Anthonie Cullen 730 Willow Street#1 Port Townsend, WA 98368 Dear Mr. Cullen: On October 16,2014 the Jefferson County Board of Health was pleased to appoint you to serve a three(3)year term on the Jefferson County Substance Abuse Advisory Board. Your term will expire in October,2017. We look forward to working with you and appreciate your willingness to devote time to this Board. Sincerely, • David Sullivan,Chairman Jefferson County Public Health Board Members David Sullivan(Chair),County Commissioner District#2;Sheila Westerman,Citizen(Vice-Chair); • Phil Johnson,County Commissioner District HI;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 Board of Health Media Report S October 16, 2014 ...... . .. .... . .. . • Jefferson County Public Health September/October 2014 NEWS ARTICLES 1. "Hospital, OIyCAP aim to feed seniors, in PT," Port Townsend Leader, September 2nd, 2014. 2. "New drive for aquatics center," Port Townsend Leader, September 2nd, 2014. 3. "Quilcene Bay closed to recreational shellfishing due to paralytic shellfish poisoning toxin," Peninsula Daily News, September 11th, 2014. 4. "Dabob, Quil recreational shellfish hit," Port Townsend Leader, September 16th, 2014. 5. "Moms to Olympic Medical Center: Don't cut New Family Services program," Peninsula Daily News, September 19th, 2014. 6. "The Poison and The Puzzle," The Seattle Times - Pacific NW, September 21st, 2014. 7. "Quilcene Bay shellfish show lethal levels of PSP biotoxins," Peninsula Daily News, September 23rd, 2014. 8. "Program `Strengthening Families' starts on Oct 9 at Irondale Church," Port Townsend Leader, September 23', 2014. 9. "Port Townsend Main Street- GIRLS' NIGHT OUT," Port Townsend Leader, October 1st 2014. 10. "WIC is healthy food and a lot more," Port Townsend Leader, October 1st, 2014. 11. "Caring and confidential FAMILY PLANNING," Port Townsend Leader, October 1St, 2014. 12. "Girls' Night Out is Thursday," Port Townsend Leader, October 1st, 2014. 13. "Girls go out on the town Thursday," Port Townsend Leader, October 1st, 2014. 14. "Changing risk factors may lower chance of breast cancer," Port Townsend Leader, October 1st, 2014. 15. "NEWS BRIEF - `Girl's Night Out' begins tonight in Port Townsend," Peninsula Daily News, October 2nd, 2014. 16. "Port Townsend Main Street Girls Night Out- `Gatsby Glitz!," City of Port Townsend Newsletter, October 2014. 17. "Shellfish harvest closure expanded in Hood Canal," Port Townsend Leader, October 6th, 2014. 18. "Hood Canal beaches closed from Dabob to Mason County because of high levels of toxin," Peninsula Daily News, October 7th, 2014. 19. "The Rural Perspective: How Do You Fix a Broken Recycling System?' Washington state Recycling Association, The Report, Fall 2014. 20. "Girls night out- photos," Port Townsend Leader, October 8th, 2014. 21. "Family program set in Hadlock," Port Townsend Leader, October 8th, 2014. O (1, Jot I NA ) I V 173 i Hospital, OIyCAP aim to feed seniors in PT By Allison Arthur, Port Townsend Leader, September 2, 2014 • Chef Arran Stark is planning pan-roasted chicken with herbed rice pilaf and local organic vegetables as the first meal served to seniors on Tuesday, Sept. 9 at the Port Townsend Community Center. It is the debut meal of a new partnership between Jefferson Healthcare and Olympic Community Action Programs (OIyCAP) thanks to the generosity of an anonymous Port Townsend couple who gave OIyCAP $305,000 to expand the senior nutritious meal program and keep it going for the next five years. Now, senior meals take place one day a week, at noon. The fledgling program is for three days per week, Tuesday through Thursday. "This is not processed food. This is all whole ingredients that the kitchen here will work with," Stark said of the food he intends to serve. "It's a social thing for seniors to do. I think about when I'm an old geezer that I want the young ones to be feeding me," said Stark, executive chef at Jefferson Healthcare. He demonstrates food preparation at the Port Townsend Farmers Market, has had his own cooking school, and is well-known for his advocacy of using local and fresh ingredients. Starting Sept. 9, Stark and the kitchen staff prepare senior meals to be panned, put into thermal boxes and taken to the community center where they return to the ovens before being served. The hospital staff already prepares about 170 lunches so adding another 20 meals for the senior nutrition program is something Stark says the staff can take on. "It's something I feel is really good. We're already making nutritious food. It's only about 20 people," Stark said, acknowledging that the partnership is for a trial period of four to six months. Robert Goldberg, who had been the chef at Bon Appetit at Fort Worden State Park, and is a friend of Stark's, has been hired to coordinate the program. Stark expects Goldberg to take on desserts. Volunteers also will still be involved in the senior lunch program. The three-day a week lunch plan could expand to five days a week if more seniors attend. The lunch is free, with suggested donation of $5. "We are thrilled to be partnering with Arran and Jefferson Healthcare on this project," said Geoff Crump, executive director of OIyCAP. "This partnership, along with all others contributing to the project, are working together to provide a wonderful senior meals program in Port Townsend." Crump noted the goals of the program are; to provide older adults with nutritional meals in a group setting that offers an opportunity for seniors to socialize, as well as to educate them about other services available to them in the community. OIyCAP had discontinued the meal program in 2011 after budget cuts and low turnout. The program had been running for two decades before it was discontinued. Crump was thrilled when the couple stepped forward to fund a renewed program. After the funding pledge, Jefferson Healthcare reached out to offer its support. "It has been a vision of mine to be able to feed all of our community members, from our young kids to our elderly population. And now that is coming together," Stark said. Stark has been providing nutritious meals to the employees and patients at Jefferson Healthcare and working in the schools to help feed kids. Next week, he adds seniors to the list as well. • In the future, Stark hopes to see a kitchen built in Port Townsend where people could take cooking classes and young people could become certified locally as knowledgable. New drive for aquatics center By Scott Wilson, Port Townsend Leader, September 2, 2014 • Their goal is a brand new aquatic center, recreation and health facility in Port Townsend. After two years of discussions and study, a collaboration of local government and non-profit recreation advocates has concluded that Jefferson County is capable of constructing and supporting an $11-13 million state-of-the-art facility at Mountain View Commons in the center of Port Townsend. The effort has been spearheaded by the Jefferson County Family YMCA, which would build and operate the facility. It can be self-supporting within the first two years, said Kyle Cronk, chief executive officer of the Olympic Peninsula YMCA, based on an expectation of at least 1,300 family memberships. "We think this is operationally sustainable," he said. However the rough estimate of $11-13 million in construction costs would have to be raised by the community, Cronk said. There are not yet specifics about a building complex, but an early estimate places its size at 33,000 to 46,000 square feet. "We need a feasibility study to see where the money is coming from," he said. "We're not ruling out any sources," including local fundraising, grants and assistance from state coffers. Among the leading partners of the collaboration is Jefferson Healthcare. Chief Executive Officer Mike Glenn has been deeply involved in the discussions. He said the YMCA facility would be embraced by JHC as a central component for physical therapy and health services. While JHC would likely not put money directly into the capital construction, it would probably become a prominent rent- er to use the aquatic center and other health equipment for rehabilitation, physical therapy and wellness programs. "We will be an enthusiastic supporter and a tenant," Glenn said. Current off-site physical therapy and rehabilitation clinics could be moved and expanded at the YMCA complex, he said. OTHER PARTICIPANTS Other leading participants in the discussions have been Port Townsend City Manager David Timmons, Port Townsend School District Superintendent Dr. David Engle and Dr. Earll Murman, who has been a longtime proponent of an aquatic facility first through Make WAVES and now through the Jefferson County Aquatic Coalition. "This is a big play," said Glenn. "But the reason we're so enthusiastic is that all the stakeholders are sitting around the same table, and we can support this to make it happen. There are 99 ways it can go wrong and one way it can go right, and this (collaboration) is that way." Erica Delma, director of the Jefferson County Family YMCA, organized and facilitated the discussions. "There is this overwhelming sense of relief and hope, of'my goodness, this could work!' said Delma. "People know the Y, and there are so many partners that it takes the pressure off any one entity." Philip Morley, Jefferson County administrator, has been involved as have, over the months, various elected officials and other agencies, including the Port of Port Townsend. MARKET FEASIBILITY • This week the group, which met under the moniker of Collective Impact, is releasing the results of a market feasibility study performed by an Alabama survey specialist on YMCA projects, Daxko Consulting. Based on a telephone survey of 805 Jefferson County households, the study concluded that there is adequate support for a new facility, that the aquatic center is its most popular component, and that the Mountain View campus is the location that would have the greatest countywide support, among other things. The survey also asked about a Port Hadlock location which also generated strong support, but the Port Townsend location had double the support among those surveyed. Mountain View is owned by the Port Townsend School District and is leased to the City of Port Townsend for 15 years, renewable for another 15 years. It already hosts YMCA programs, along with the indoor non-regulation size pool built in the 1960s, the Port Townsend Police Department, the food bank, KPTZ radio, American Red Cross and other nonprofit entities. The envisioned capital plan would involve substantial new construction. RECREATION PROGRAMS According to a YMCA description, "the facilities would offer activities for all ages including a gymnasium, health and fitness equipment and programs, an indoor aquatic center, onsite physical therapy operated by Jefferson Healthcare, youth and teen programs, and community outreach programs." Based on this description, 39.5 percent of the 805 survey respondents said they would be very interested and 14.7 percent said some interest. A total of 33 percent said they had no or little interest. (See related story of other survey results.) Murman said the public support shown by this feasibility lined up with the results of a Make WAVES market study done a few years ago, even though the methodologies were different. He and other aquatic center proponents are fully on board, he said. "There is a huge advantage with being involved with the YMCA," he said. That nationwide entity is well- known, has a history with many residents, and has planning and operational expertise, he said. An existing multi-use YMCA facility and aquatic center in Silverdale is a good example of what could work in Jefferson County, said supporters. 4110 "What Silverdale has built is an almost perfect solution for what Jefferson County needs," said Glenn. The YMCA facility in Port Angeles that Cronk currently manages has 1,000 member units but does not have an aquatic center. The community-owned Sequim Aquatic Resource Center (SARC) has a pool and some indoor recreation facilities. Statewide, the YMCA has built seven new facilities in recent years, said Cronk. CAPITAL PROJECT The capital expense is daunting, said the key planners, but they expressed optimism that it could be done. Glenn noted that Jefferson Healthcare is about to engage in its own capital construction project which it expects to do without a tax-supported bond. The Port Townsend School District plans to come to voters in 2015 or 2016 seeking support for a major bond to substantially rebuild the elementary school and make improvements to the high school campus. The City of Port Townsend is looking at an early 2015 vote to support repairs at the current Mountain View complex and the Carnegie Library building focused on roofing and HVAC systems. Dr. Engle's support of the pool project is in part tied to the district's shift to a maritime-based curriculum, which includes ensuring that all Port Townsend students learn to swim and are comfortable in the water. The district would also benefit from expanded after-school services offered by the YMCA, Delma noted. NEW & EXISTING 411 While no decisions have been made about the facility, Glenn said it likely will be a hybrid of existing and new structures. According to Murman, some of the facility planning that went into the failed Make WAVES aquatic center effort can be used by the new project. Make WAVES had planned its facility at Kah Tai Lagoon Nature Park, which generated environmental opposition. Glenn said the facility could become the key piece of an ongoing revitalization of Jefferson County's wocial and health services. Noting he's "in the weeds with this," envisioning how Jefferson Healthcare's wellness programs can expand to contribute to community health, he added that he also has a longer view. "At the treetop level, it's really exciting," the hospital administrator said. "There is a community social service renewal going on, I would argue it's not a minute too early."A health-oriented complex would help current residents and attract the next generation of residents, including younger families for whom robust health and recreation facilities are increasingly important, he said. The group has realized, however that "nobody is going to rescue us," said Murman. "It's up to us." "The reason we're so enthusiastic is that all the stakeholders are sitting around the same table, and we can support this to make it happen." YMCA survey results show Mountain View preference Posted: Tuesday, September 2, 2014 8:40 pm The Jefferson County Family YMCA survey was answered by 805 respondents across east Jefferson County based on random phone calls to land and cell phones. The respondents represented the geographic mix of population in the county, with 51 percent from Port Townsend, 19 percent from Port Ludlow, 18 percent from the Tri-Area and 11 percent from Quilcene and Brinnon areas. Women Oconstituted 71 percent of responses. Key survey results included: • Most respondents preferred the Mountain View Commons in Port Townsend as a location, with 84.4 percent finding it somewhat or very convenient, and 13 percent finding it very or somewhat inconvenient. Others preferred a Port Hadlock location -- 44.3 percent finding it somewhat or very convenient. The survey also indicated that if the Port Hadlock location was chosen the usage forecast would drop by 50 percent. • Households that indicated they would sign up for membership (called membership units) ranged from 936 to 1,859. The YMCA estimates that about 1,300 are needed to make the facility financially viable. • Today only 16.9 percent of respondents exercise at a health club or other facility. Two-thirds said they exercise three times a week or more. • Half of the prospective memberships would be adults without children; a quarter would be senior citizens, and the final quarter would be families with children. • A possible pool or aquatic center is the most popular motivation of local residents to join an expanded YMCA, according to the survey. Some 31 percent listed it as the top reason, followed by 16.4 percent for other health and fitness programs. Also 48 percent said that recreational swimming would be their most used program. • Other possible programs or equipment that generated respondent interest included weights and strength training, massage, women's or senior's exercise classes, yoga, Wwalking and running clubs, weight management and Zumba. Quilcene Bay closed to recreational shellfishing due to paralytic shellfish poisoning toxin Peninsula Daily News, September 11, 2014 IllILCENE—Quilcene Bay has been closed to recreational shellfish harvesting after a high level of a potentially fatal otoxin was found in a sample of blue mussels. It's the first time a Jefferson County area has been closed this year because of paralytic shellfish poisoning (PSP)toxin, although there are other closures and warnings in both Jefferson and Clallam counties. Samples taken Monday from shellfish on the shores of Quilcene Bay were found to have 80 micrograms per 100 grams of tissue of fast-acting marine biotoxins that cause PSP, which can lead to paralysis or death, Michael Dawson of Jefferson County Environmental Health said Wednesday. The closure limit is 80 micrograms per 100 grams of tissue. The state Department of Health closed Quilcene Bay to all species of molluscan shellfish such as mussels, clams, oysters and scallops. Shellfish harvested commercially are tested for toxin prior to distribution and should be safe to eat, Dawson said. Warning signs have been posted at high-use beaches warning people not to consume shellfish from the area. The closure does not apply to shrimp. Crab meat is not known to contain the biotoxin, but the guts can contain unsafe levels. To be safe, clean crab thoroughly and discard the guts(butter). Symptoms of PSP can appear within minutes or hours and usually begin with tingling lips and tongue, moving to the hands and feet, followed by difficulty breathing and potentially death. Anyone experiencing these symptoms is urged to contact a health care provider immediately. For extreme reactions, dial 01-1. Elsewhere on the Peninsula, Sequim Bay remains closed to all species because of the risk of diarrhetic shellfish poisoning (DSP), which can cause diarrhea, nausea, vomiting, abdominal cramps and chills. Beaches on the Strait of Juan de Fuca from Cape Flattery east to Dungeness Spit are open to shellfish harvesting except for butter and varnish clams, which retain toxins for up to a year. Strait beaches from Dungeness Spit to the Jefferson County line are closed only to the harvest of varnish clams. Although the state Department of Health in June reopened Kilisut Harbor, including Mystery Bay, and Port Ludlow, including Mats Mats Bay, to shellfish harvesting except for butter clams and varnish clams, Mystery Bay State Park is closed by state Department of Fish and Wildlife regulations to the recreational harvest of clams and oysters. Mystery Bay State Park—the only public tideland in the area— is closed to shellfishing during the peak of boating season from May 1 to Sept. 30. All areas are closed for the sport harvest of scallops. Ocean beaches are closed for the season to the harvest of all types of shellfish. Marine biotoxins are not destroyed by cooking or freezing. The state Department of Health has a map at http://tinyurl.com/PDN-shellfishsafety that provides current information about shellfish harvest closures. A version for smartphones can be found on the site by clicking "Mobile Friendly Version." likecreational shellfish harvesters also can visit www.doh.wa.qov or phone 800-562-5632 before harvesting shellfish nywhere in the state. Recreational shellfishers also should consult state Fish and Wildlife at www.wdfw.wa.gov. Dabob, Quil recreational shellfish hit • Port Townsend Leader, September 16, 2014 Marine biotoxins that cause Paralytic Shellfish Poisoning (PSP) have been detected at concentrations above the closure level in shellfish samples collected from Dabob and Quilcene Bays. The Washington State Department of Health has closed Dabob and Quilcene Bay beaches to recreational shellfish harvest. 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. 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. Toxins are not destroyed by cooking or freezing, can't be seen, and must be detected using laboratory testing. Commercial shellfish are tested for toxin prior to distribution and should be safe to eat, according to a Sept. 10 press release from JeffCo Environmental Health. • For more information visit tinyurl.com/mj3fdnr or wdfw. wa.gov/fishing/shellfish/or call 800-562- 5632 or 866-880-5431. • Moms to Olympic Medical Center: Don't cut New Family Services program By Rob 011ikainen, Peninsula Daily News, September 19`h, 2014 WORT ANGELES — Proposed service cuts for a one-of-its-kind support program for new mothers and their babies was met with a flood of opposition —and crying infants—at Olympic Medical Center this week. Eighteen public speakers pleaded with hospital officials Wednesday to spare New Family Services from the financial chopping block. New Family Services provides in-home and clinic consultations, with nurses and lactation consultants who help new mothers through the struggles of breast-feeding and other postpartum issues. OMC formed the program with a grant 14 years ago. It is the only program of its kind in the state. Norma Turner, chair of Prevention Works!, a nonprofit community coalition that"advocates, educates and invests in our children," led off public testimony by announcing that weekend home visits and phone consultations have been cut and that all home visits will be discontinued as of Oct. 1. Given the level of community support for New Family Services, Turner said she was "shocked"the program would be"gutted" without community input. "I believe the community deserves better than this kind of quick decision-making without community discussion," Turner said. Citing financial constraints, OMC officials confirmed the cuts to New Family Services. Urged to reconsider Turner urged commissioners to reconsider the budget cuts to "keep this valuable service in our community." OMC officials had planned to close the aquatic therapy pool in Port Angeles earlier this year but reconsidered after being met with community opposition. Laura Costello said her son, Taylor, was unable to nurse before in-home consultations from New Family Services. She brought her now-healthy 11-year-old to the meeting as a testament to the long-term benefits of the program. Other speakers cried as they told personal stories about New Family Services helping their sick babies learn to latch and gain weight. After hearing more than hour's worth of emotional testimony, OMC Commissioner Jim Cammack said the board would "certainly take your comments under consideration and discussion." OMC Chief Executive Officer Eric Lewis thanked the audience for the "very compelling" stories, saying: "You gave us a lot to think about." Financial hurdles Lewis then painted a dire picture of OMC's financial challenges, including a $5 million reduction in Medicare reimbursement this year alone. And New Family Services, Lewis said, loses more than $200,000 per year. "We'd love to keep it, and we're going to continue to look for ways to fund it, but again, we have to balance our • books," Lewis told an overflow crowd of nearly 100 parents and babies in Linkletter Hall. "We face big challenges that threaten our survival." Dr. Madeline Harrington, a 30-year pediatrician in Port Angeles, said she was "shocked and dismayed" to learn last weekend that New Family Services would no longer see patients on weekends and would stop making in-home visits come fall. 4111 "The OB nurses are great about helping moms breast-feed, but honestly, most of the problems come when the mom goes home," Harrington said. "They no longer have the around-the-clock support, and things just go south. Going to somebody's house is so much better than to have the mom come to the clinic, come to the hospital, God forbid come to the emergency room." Harrington said the cuts to New Family Services would likely result in more babies being bottle-fed rather than breast-fed. "Now, babies can do just fine on formula, but it's very clear that breast-feeding is much better in many, many ways for moms and babies," Harrington said though the sound of crying infants. "I was also surprised to hear that[New Family Services] is the only one in the state of Washington, and it's tragic that it's all of a sudden being severely curtailed," she said, adding: "Perhaps some reconsideration could be made about just gutting the program." The groundswell of support for New Family Services was organized prior to the meeting on Facebook. Redefine it After hearing public testimony, Lewis said the goal is to continue New Family Services but"redefine how it's done." "You've given us some good suggestions, but we have to look at our costs and services and make sure we're going to be viable for the long term," Lewis told the crowd. • "Because if we run out of money, that doesn't help any of us." One possibility for keeping New Family Services in the black is grants, Lewis said. "I think we need to get to our politicians in Olympia," he added. "Why isn't this funded for the whole state?Why are we the only hospital in the state doing this?" At the end of the nearly two-hour meeting, Turner suggested a grant that would fund a research component to demonstrate how effective New Family Services is. Said Cammack: "I think we need to have a little more research in terms of what we can do to maybe make the service a little bit more efficient." 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NATURAL GARDENER . ..: - ' ' . tip-top Farming'on the streets . . . . . . . . . . . i ' n Judd • photos by Steve Rengman a h , � , ice •-------4)--,), d. t d t"ZM 11� ` .��;�•�`'••: zp-':•_,....-, 'Rr �, ,,f� ,,--.•;,;;-',:`-,., a 0 x .er �rk�e__� ,� �y r 4. _ '�,* .y: SS',.' nr ''. a # - t �:,'. RT :k'+' '. .4-44"...t.• �e'r�. , „ _ F a wl ,„,.,'071,r,r;,l t.+.: is u4;. >t •a $ s '� x• .tr ' r a '.." t ?-',41,,,s7'•-• a I� fix. l . ' � Ti s, --.:44f4;•;!. 44f4 -r 1'4 ..'it . 7 y1 .nrY�• Alf„r "' .1" ' r.' �r :.�i JO ,*1:,b4.0.'' ,.r j.• _� 4,;-: , ,;'fi. r�4 " '''.• p;- '�"''''- i }..:,s• "v ( 1' , r _ a- [ w 4 ,,i, s cc"dei , -r, .fir a ,t-e--.,vg 4N -..ate ..ti � ''''-'•4 K,+F .-" � ,,.. S. �. r ,,y-7°.4'.4"%,-t '';'-''S•'' •-- ,.A"£i r�-'' kw �� ^ K'L. 7. --. .. '''—ler Yi �( L__• C'''..:-. .35 �5t'Y'YR 7tnn <� ��.`{. t"'° -� a s,e"` -=y�, It. 'Air' "y.: . , --6.„-..<1.4''".... F 3 • - w ",44.:....i. as p'~ 7.----;.44:;13:77:4;2,4,,Z--....,-,__ "d ,:` ,4-f?'' r 5 i •' u `-L- 'mss- _•o - • F , . '�`.-.._-_----.5.:-.;7:--4----,;-- .._'r 5-a-a... �^ A.,:„,,,,,, '�'. 'fit �.r. ..4 H� �^ $°'. ,-,.,..7.--.---.7-....,—;,. „� :, - -.. A`-�� '�'x ... ”. FY*u. "'�` �'.-�.'�'g..1..??.,—*,� „,,,.,41,---•2.1..*'� mss .__�z.. .> Wind blowing across Black Lake near Olympia caused algae to form a mat at the north end of the lake.It was closed to swimming,fishing and wading � for much of the summer because of the bloom. THE HAPPY little lake that could kill you looks as harmless as a watercolor painting.Anderson Lake's 60 acres of glassy green water is surrounded by marshes,rolling grass fields and quiet trees,all nestled within a Washington state park west of Chimacum in Jefferson County.The closest"civilization”is an RV park about a mile up the road, The critters here include the usual sorts:Deer,beaver,migratory waterfowl and schools of rainbow trout,stocked for Port Townsend area L; anglers who have plied these waters for decades.But in a mystery that has confounded scientists for rhe better part of a decade,the placid waters also now host an alarmingly deadly life-form. Anatoxin-a,which attacks the central nervous system of mammals, emerges here in potent levels with algae blooms every spring.In the past decade,the lake's toxic soup has arrived as regularly—and,disarmingly, perhaps every bit as naturally—as the blossom of Northwest skunk - r ' cabbage.► _ wc .i �.,r ``tea'`'. - - - -. THE SEATTLE TIMES^SEPTEMBER 21, 2014 1' ,F • ti _ _ ._...„..,..s.,_, -. .,- . :-...- .„...:,-%,--...-...-:_l'silrf:V.4.f' , ,� �` f ate" . .. . ,,- _:,.„. •_, -,_ ,-__. _ __„..-.. _. - T .,yam $sem , 4 ��,yi x� 5�-, "' .`� .'ter �. - i3e ----- 3- '`i t ^fir.a' :z-.---"'..^:;‘,..-.11-36- - ric d€ '1 a':' d-. h3 z k i. ;Z:'''.:`,- 4101\ �{,....."1f,-.1-t-'s.,!--.._ +Ik1 � :, `�'��J' t � � :1:;i: -{+. .tom.� #�Y , �:T ;. 4- -s'YrY��akt i - :$^'�'.iy :3. t ._ - . .r.ft.--.7%,.,-1.-,- --.,..11ri‘''ll'rP :: -sicagon...,,,, 7,:,,,,,, ,,:A. .. .....„:, ,,or.,1„..„..e...z.„ 0. ^Yxt ,...,,, ,, N _,, , ,t. -' - ivu . Vie._, ,„,,,,,,,„ _,_::„..::;',: , „, ,_,„: . ,.... „, C _.. ,,:„.7, ,,,, ,,,,,j.....1 a E — :.:: �..ee^,F- C i 7,"-"i t 11, a r Lake to public access several times in the past decade. nuit At' More rare,but far more lethal in small doses,is anatoxin a, which mysteriously thrives in sleepy little Anderson Lake. The toxin is one of several produced by"cyanobacteria"or How potent is it?Bacteriologists once referred to the substance blue-green. lue green algae—the sort often seen fouling lakes ranging from as"VFDF"—short for"Very Fast Death Factor."Depending on the tranquil ponds to concrete jungle oases,such as Seattle's Green dose,its potency and the size of the victim,anatoxin a can kill a Lake.Numbers of outbreaks—or at least their diagnoses—are on person in less than five minutes. the rise across the country,according to the Environmental Protec "If you were to tip over in your kayak and get a mouthful, tion Agency. that would be prettybad,"says Jefferson County health special Many of these blooms,telegraphed by thick,green(occasion ist Michael Dawson,one of many people shuffling pieces of the ally brown or scarlet red)surface scum,are harmless.But for Anderson Lake algae puzzle. reasons unknown,they sometimes produce poisonous toxins. While toxin-related animal deaths appear to be on the rise, The most common in these parts is microcystin,which attacks the reports of human illness remain infrequent,with many cases likely liver.Drinking water to more than 400;000 people in and around undiagnosed.But the potential is frightening,especially given Toledo,Ohio,was shut off this summer because of a microcystin the strong suspicion that climate change is boosting the blooms. io outbreak in Lake Erie.Mycrocystin also has closed Seattle's Green In recent years,the focus of that ominous potential has shifted FIGNW N .. WHAT'S GOOD TO KNOW •4 W Algal blooms are strongest in summer Ste, • `s e ® through early fall.Once you see the telltale — -----—— 'sem`-—-- ' green scum of cyanobacteria in your local '�= >t lake,what should you do? l >' ••!:e.:--') " +P i„ +. , @ • "When in doubt,stay out If your pet a '.:44.44 -.--41....‘;r. ; , has been in the water,wash it off and watch 4`-1 e a;•® ' ' for symptoms,or take it directly to a vet ..1t-..i51 y• c%'''''-,6- i•';41. x g clinic. ' o c c g" r .:z .' -.! • Report the outbreak to your local health .. R a t' •0 * _-.>, • - a * d.•' xiiaV '' ��a•"' F• department or directly to the state Depart v. e ment of Ecology online at _ ,' www.ecy.wa.gov/reportaproblem.html. eN _ 4 ' Submit your own sample by following + •I . guidelines here:https://www.nwtoxica/gae. ,, org/ReportBloom.aspx • Algae blooms can be discouraged by y, °' A small clump of algae floating on the surface of Black Lake near updating septic systems,avoiding fertilizers �/ i Olympia was photographed with a macro lens. i or soaps containing phosphates and picking "+..... ,. up after pets in watersheds. .i P� -. toward obscure little Anderson Lake,where water samples six • More cyanobacteria information: "'--"` - years ago revealed a level of anatoxin-a that literally leapt off the Washington state/King County Toxic Algae . charts. website: One microgram of anatoxin-a per liter of water is considered ,tvvvnwtoxicalgae.org/Defau/taspx R' safe to animals and humans.A 2008 Anderson Lake sample regis- tered 172,640 micrograms per liter.It was,by far,the highest level Washington's"BEACH"safe-water 4" ¢' -' of anatoxin-a ever recorded,in any body of water,anywhere on monitoring program: �,,.s -- ---,'` the planet.Another test in 2009 registered 144,000 micrograms. www.ecy.wa.gov/programs/eap/beach/ 7 " ° Newer testing methods have not replicated those astonishing lakes.html 4 :r �� z highs.But tests still routinely show toxins at up to 1,000 times the '-: King County Swimming Beach program: " ' 1 safe limit. ,,,,s http:f/green.kingcountygov/swimbeach • _ ate F Few lakes in the U.S.are routinely tested for harmful algal ,,, ; T; blooms,or"HABs,"in lab-coat lingo.Anderson Lakes outbreak, in fact,was discovered in a typical way—by accident after the I W t a;P FA events of a single frightening week alerted health officials to a ` murky scientific puzzle which,eight years later,they have yet toToxic algae blooms solve. Anatoxin-a has been detected N MEMORIAL DAY weekend,2006,Virginia Johnson,a in about a dozen state :veterinarian at Hadlock Veterinary Clinic,got a frantic waterways on both sides of call:A dog and its owner,a local physician,had been the Cascades,the largest out for a routine summertime romp at Anderson Lake.The dog, onin,g Rufus Woods Reservoir on the Columbia River. Julie Alaimo,a a 4-year-old Walker coonhound in perfect health,waded in the biologist with the King water and lapped some up. *Anacortes County Environmental About half an hour later,while walking around the park,the Port Townsend, Brewster Lab,works to find dog lapsed into a seizure and died.Johnson,puzzled by the sud- the concentration of den death of an otherwise healthy dog,suggested a necropsy,but 'Seattle the toxins in different the owner declined.A sheriff's report was posted,but the lakeTacoma A9 types of algae from remained open. °6 : lakes in the region. Days later,two other dogs that had ingested Anderson Lake Eatonvilie o The most common water were stricken.One exhibited seizure symptoms and lapsed blue-green algae into a coma,but eventually recovered.The other died on the way toxin,microcystin, to a clinic.Blood samples from the dogs eventually pointed to ana- 1.Anderson Lake which attacks the toxin-a.The three pets had become,in what unfortunately is an 2.Cranberry Lake liver,is found in lakes oft-repeated pattern,"sentinels"for the Anderson Lake outbreak. 3.Green Lake .ss the Northwest. In the absence of expensive,regular water testing at most lakes, 4.Clear Lake animals are usually the first victims.Even if they don't imbibe, 5. Rufus Woods Reservoir dogs are particularly prone to licking the toxin off their coats. ► MARK NOWLIN/THE SEATTLE TIMES THE SEATTLE TIMES ' SEPTEMBER 21, ,r q tin `,t T -a'j�'� s rt✓ A satellite image shows an extensive : «sN ,_i' .�9t ,r^.°- rk ...--.�"'"F9e�.v!•:. , L „''"� s�'t---> . •. }'e:• ,`v�Y }X'Y3 f1 rs ItY/ � +-...- r'W.:" - `'t" 4ate: .',. .140-...-'40-..4..„,,„___,•..,•1_,,. /_ Y l .�' :Ix 1.x ai aCyflt } _ - -_ ''' �.,� -- r- ate- > _ VY �`Yc.. •- - �-,'tea.. ' ��_ ' g z 4..-w,r ,---1.�.'. r. L i y ut• a 2 ` .f r Jd+s,'A'ryA+ ,. '{i �^.� fit {t �' y'G -� t� labk's ?.,j'''rf. 9x ''~1 rJ,0 '/ �y' } ; ' ., 4431,44,441:114,-..?...,f4§14,, ` ."d �T� „2,.,__.,&,,..,1?"siFs -:Y . - '•t' has t .. • k i7•Pi 4 j�Yl'� y�, '. ‹;.' i - "7 r'. , F" "t tit s_ E s yf,ss.r � cz.r.. ''f ar+? .w. ! •,, '#} V• ---v� 0.71 %. 1 "4" a - '_ - Lt'* r ry. 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" toxin-a emerge here only recently and,if so, That effect could be enhanced by the says,"but it certainly makes me nervous. - - 0 FAR,most studies of Anderson why?Why is it not found in nearby lakes?Is lack of flushing action at the lake,which '------ Lake's potent bug have produced the particular cyanobacteria producing this is about 30 feet deep.Water comes in and -= more questions than answers: toxin some sort of super bug,or is it similar out mostly through seepage.But countless Algae blooms need only sunlight,water to anatoxin-a found elsewhere?In short: lakes in the region share that profile,and and a nutrient to thrive.They typically What makes Anderson Lake so special?So none produce algae with toxins as potent as occur in lakes in developed areas,where deadly? Anderson Lake. nutrients like phosphorous or nitrogen are A few tantalizing clues exist:Before it Other possibilities:A student researcher seepage became a state park in the 1960s,the land taking sediment cores from the lake for a delivered by runoff from fertilizers, from septic systems or agricultural effluent at the south end of Anderson Lake was study of megaquakes recently detected vivi- that carries a combination of both.But iso- home to a dairy farm.Cattle likely had anite,a mineral that could leach phospho- lated Anderson Lake doesn't fit that defini access to the lake for water.Cow manure is rus into the lake naturally,Dawson notes. n,raising a longer list of questions: Ipo Why does this lake produce so much rich in nutrients for algae. More answers might be coming soon. "Once it's in there,it tends to stay,"recir- Researchers at Oregon State University are algae?Why are toxins resulting from that culating throughout the lake's ecosystem, wrapping up a study of the genetic struc- algae so consistently virulent here?Did ana- Dawson says. ture of anatoxin-a found in Anderson Lake.► , .,, illness from the toxins in 10 states,including „ - tra1 Washington.Congress this summer authorized$82 ri million for additional federal research. Learning whether it's a unique strain might be use UR STATE,by necessity,has become a lead aI`x ful in understanding the problem,if not devising a er in the fight.Hardy credits the stepping up ¢ treatment plan. ";:thft Treatments for blue-green algae outbreaks of state scientists as well as county health officials,particularly around Puget Sound. include seeding with alum,which has proved suc- cessful at the blooms—but onl for a few ( "We're doing a lot with not very much money," killing y ! she says.The state dedicates roughly$270,000 a years—at places such as Green Lake and a number year to the problem,most from boat-license fees. 13r" '"` 1 of other state waterways. l�. .. ,9 Because frequent testing is prohibitively expen r ' „ Ata cost of about$1 million to treat a lake like sive,the state has developed a"passive"monitoring ; Anderson,Dawson laments, That's a pretty bad system,which relies on citizens.People who spot cost/benefit ratio."- algae blooms are encouraged to call their local Ir='� HE POTENTIAL debacle,of course,is much health department. ' `i, bigger than little Anderson Lake.Other signs Positive samples . l - of the stealthy toxins are all around,and they a result in action �v are not-new.Joan Hardy,a toxicologist with the state ---.31ranging from post- r Department of Health,has been following cyanobac ' ing warning signs to • teria around Washington for 20 years. closing off a lake. The most common she sees is microcystin,the ,,, „p, a P,t Washington has i� 0 liver toxin that also can kill animals and sickens ,; a had no widespread ` }, atar sla in areas humans,but typically only through long-term - _ illness outbreak, `'"� - - jl ingestion.Hot spots for that bug in the past decade -� .,. partly just by luck, include Lake Spokane,Kitsap Lake,Waughop and > `•'," ka.aY. .-``-� • Hardy believes. a Ohop lakes in Pierce County,Lake Cassidy in Sno- ,, "^` .,'I 9°" Our future i' N ` ba9 coexistence with homish County,and Black Lake in Thurston County. f Ai,. .....---Pro-,-„--,-:.--:-,_,.... Anatoxin-a,deadly in much smaller doses,has A sign at Anderson Lake warns cyanobacteria is b'}tea been detected in about a dozen state waterways on as murky as the of the dangers of anatoxin-a. `' both sides of the Cascades,the largest being Rufus stuff itself-The Woods Reservoir on the Columbia River.Anatoxin- EPA cites"mount- V � a has been found in Tacoma's Clear Lake in winter ing evidence that outbreaks are related to climate r41% . months-Cranberry Lake,a popular swimming hole change,but definitive studies are lacking.Health ks # in Deception Pass State Park,showed nearly 900 officials warn that the problem is likely to worsen `. ''-• micrograms per liter in August. simply by increased population. t l �, Algae blooms tend to proliferate from July to No one is under the illusion that a magic bullet October,but they've been observed in Washington will rid the world of an ancient bacteria that has lakes covered by ice. survived far worse foes than us—namely,ice ages The blooms have been a rare but deadly plague and asteroids.A victory would be mitigating dam- `- to pet owners.The first recorded cyanobacteria pet age."The goal is prevention,"Hardy says. fatality in Washington was a hunting dog killed in Back at taped-off Anderson Lake,on a warm July Spokane County in 1976.Other dog deaths have day with not a single person in sight,county health ies available been reported in Moses Lake and the Potholes in official Dawson crouches on the front line,peering Grant County.Cats have died after exposure to' into the clouded waters and pondering the invis- I American La% ke in Pierce County. ible,deadly bug. o e h A recent study reported nearly 100 dog deaths "It's been in here,certainly,for decades,"he says. nationwide in the past decade.The number is likely "How long?We don't know,but 2006 certainly was I much higher,the study concluded. the wake-up call." "s Toxic algae found in water troughs at a feeding The call has not been heard by the population site killed 100 elk in New Mexico last year,and at large,algae watchers say.There's a chance,of algae blooms regularly foul the Great Lakes. course,that in the end,Anderson Lake might stand 1 e ; • The animal poisoning problem even extends as little more than an historical blip on the public :.c,. 0 0,(00 offshore:In the past decade,dozens of otters have health radar.The killer toxin that reigns here now Nei died of liver failure in California's Monterey Bay. might not be replicated elsewhere. NORTH AMERICA $EHISUI DOOUSEUSE y y M croc stin was traced to a stream connected to But in this little-understood field,the opposite corn a freshwater lake with algae blooms.A Depart- appears just as possible.The otherwise-forgettable ment of Health/Washington State University study lake might go down in history in a tragic way ED,OR EXAMINED , aims to determine how much migrating freshwater no one drawn to its peaceful edges could have aper of the Tehaleh its related entities microcystin can accumulate in low-food-chain crea- imagined:Like the dogs that drank here and died, 0, er has retained Newland •of the members in tures,such as mussels,in Puget Sound. unwitting sentinels of what's to come. a responsible for any Nationally,the Centers for Disease Control and Ron Judd is a Pacific NW magazine staff writer me purchase from a America Sekisui House Prevention recently spent five years tracking human Steve Ringman is a Seattle Times staff photographer ,provals.Actual i as described.Prices, its Reserved.Tehaleh ,r written permission. Quilcene Bay shellfish show lethal levels of PSP biotoxins By Rob 011ikainen, Peninsula Daily News, September 23, 2104 •PORT TOWNSEND — Lethal levels of marine biotoxins that cause paralytic shellfish poisoning have been detected in shellfish taken from Quilcene Bay, Jefferson County health officials warned Monday. Quilcene and Dabob bays have been closed to the recreational harvest of molluscan shellfish — clams, oysters, mussels and scallops — since Sept. 8. Paralytic shellfish poisoning, or PSP, concentrations have risen to more than 6,000 micrograms per 100 grams of shellfish. That's 75 times the 80-microgram closure level, and twice the levels detected last week. "It keeps climbing," said Michael Dawson, water quality lead for Jefferson County Environmental Health. A combination of warm weather and calm water may be contributing to the elevated levels of PSP, Dawson said Additional samples from Quilcene Bay and surrounding areas were collected Monday. "Right now, we're mostly wanting to check and see if it might be spreading," Dawson said. "So we've been checking down the Hood Canal." The state Department of Health is warning the public that eating shellfish with such high amounts of toxin •is potentially deadly. Symptoms of PSP can appear within minutes and usually begins with tingling lips and tongue moving to the hands and feet, followed by difficulty breathing and potentially death. Danger signs have been posted at public beaches warning the public not to eat the shellfish, Dawson said. Marine biotoxins are not destroyed by cooking or freezing. The 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, health officials say. Commercially-harvested shellfish are tested for toxins prior to distribution and should be safe to eat. Areas closed to the recreational harvest of all species of shellfish in Jefferson County are Quilcene Bay, Dabob Bay and Discovery Bay. Kilisut Harbor, including Mystery Bay, and the Port Ludlow area are closed to the recreational harvest of butter and varnish clams only. Jefferson County Public Health will continue to test affected beaches and will notify the public when • shellfish are safe to harvest, officials said. In Clallam County, the recreational harvest of butter clams is closed from Cape Flattery to Dungeness Spit. Varnish clams are closed along the entire North Olympic Peninsula. Sequim Bay is closed to all species of shellfish. • Seasonal closures are in effect for the Pacific Ocean beaches. Recreational shellfish harvesters can get the latest information about the safety of shellfish on the state website at www.doh.wa.gov or by phoning 800-562-5632 before harvesting shellfish anywhere in the state. Recreational shellfishers also should consult state Fish and Wildlife at www.wdfw.wa.gov. Reporter Rob 011ikainen can be reached at 360-452-2345, ext. 5072, or at rollikainenP,peninsuladailynews.corn. • • • Program 'Strengthening Families' starts on Oct. 9 at Irondale Church Port Townsend Leader, September 23, 2014 A program for parents, caregivers, youths ages 10-14, "Strengthening Families," is being offered, this fall at Irondale Church in Port Hadlock. The first meeting is 5-8 p.m., Thursday, Oct. 9. After that, meetings begin at 5:30 p.m. on Thursdays through Nov. 20. The church is located at 681 Irondale Road. A free dinner is offered. There is a free nursery available for children younger than 5 and an optional Bible dub for children ages 5-9. Enrollment is limited to 12 families, so register ASAP to reserve your spot. Preference is given to families in the Chimacum School District. After dinner, youths work as a group while parents work together; later, the youth and parent groups come together to play games and work on activities, such as skill building. Organizers emphasize, "This is not a boring program!" They describe it as a fast-paced evening with ice- breaking games and lots of fun activities for parents and youths alike that are designed to develop communication skills, strengthen bonding, and increase participants' ability to • appreciate youth and parent roles, stresses and concerns. The designers of the program realize how busy and stressed most families are these days and this is meant to be fun and give fast results. To register, contact Kim Wilcox, 385-1720 or irondalechurch@gmail.com. Each youth must be accompanied by an adult. This program is sponsored by WSU Jefferson County 4-H, Chimacum Prevention Coalition and Jefferson County Public Health. • Port Townsend Main Street GIRLS' NIGHT OUT • "Gatsby Glitz! §a A Day and Night of Fun Shopping Uptown & Downtown! E � Thursday, October 2nd 11 am - 8pm ,. „ 'rte "Wrap"Party at 8 pm at The Belmont: no host barappetizers,desserts,door prizes; $5donation.wearsomeglitz and feel'the glamour! ...._ , s Y. i s jE IC #Ol'son a . `w- „ f_k althcare OZOt1L ..+ .. ;.c'�w.rwm. famr.�n„a.'.+S.a�_ Barbara stanwyck circa 1924 by Alfred Cheney Johnston Here's Where To Find the Fun! Goodie Bags$10 each.`Bold Indicates Goodie Bag Sponsor. UPTOWN Earthenworks *Posh Hair Salon&Day Spa *Uptown Nutrition Elevated lce Cream&tandy Co. Quimper Mercantile DOWNTOWN Expressions Sea Salt Cottage *About Time Clothing Face of Grace Seasons Hair Salon Abracadabra Get Tanked Spa and Boutique *Sideshow Variety *April Fool&Penny,Too Getables Soak on the Sound *Bickie's Cotton Casuals Glow Natural Skin Care Summer House Design Boiler Room Lively Olive The Green Eyeshade • Closet Space Maestrale The Spice and Tea Exchange *Clothes Horse *Maricee The Wine Seller Completely Puzzled My Potlatch Tickled Pink Conservatory Coastal Home Perfect Season WdeAgCeltic Traders Daily Bird Pottery PiccadillyBob'sa Wanderaningring Wardrobe Deja View Photography Pippa's Real TeWhat's Cookinn' Enter The "Gatsby Glitz" Raffle $540 Prize! Tickets S5 each at participating businesses.Must be 18 or older to enter.Some restrictions apply. •Overnight for 2 at The Palace Hotel •"Ladies'Night'Pass for two at Soak on the Sound •Dinner for two at The Belmont Stamp Out Home Cookin'Soroptimist coupon book •Rose Theatre tickets for two&r treats! •Studio Portrait session&8 x 10 Photo by Deja View •A Custom Facial at Glow Natural Skincare Photography Proceeds benefit the Jefferson County Public Health Dept.Breast/Cervical Cancer Program, &PT Main Street Program,a 501 c3 nonprofit. Girls'Night Out is sponsored by PT Main Street Program,Jefferson Healthcare, OZONE Socks&Participating Merchants. www.ptmainstreet.org • j \ xc 1c / ///� . � .� WICly food and a lot more. Pregnant?Have kids ' old?Noedaho»� ~~'�������-���m`�~ under5year� to your food budget? WIC:Healthy Eating,Healthy Cooking, Healthy Choices partner with WIC staff to meet your health goals! ^ — Breastfeeding Free ree EVent Every Wednesday at 11am Relax and connect with other mothers Ask an expert questions ^ All breastfeeding&pregnant women and kids welcome! 8D) �85 (� -840n HeCIMel 615 Sheridan.Port Townsend t~—' J �. S Caring and confidential FAMILY PLANNING supplies&information to plan for your pregnancies No insurance? • On a tight budget? Services and supplies at u ���o/noumt$V ���� We accept many insurance plans including: Find a method that works for you. Plan B available Call for an appointment. VriCowdy P,,IF)Iir; Health (360) 385-9400 N5Sheridan`Port Townsend • ___' - Port Townsend 8 Jefferson County Leader .t.,-. .:-.'-'—'," '",..r7iii—c, ,:::‘,..,-.1s..,..,s, , -:-.3.?::----n.,-sv-, - ',.:,,,,,i4:,,,,,..,t1, _,44.7.4,,_,-,,,-..,:-‘,, ,-4:r..„*.1 .4.: . _1,, ,,,..p Mo:' ' :::',,,t°1*'?.-4,,.c:'29, YeN. - .1.,,,,ilvoz.,--Yy,- '\. '--"-‘'.-:el � y } ' ,--i.:,7= :':`,-,..':,,,,i) .17_. \ 3 ,i - F,, �Y._ ' - Pi- ,.-,•<,.;,-,. ...:.. r_ �1 a ked F Z, �� :y..,-..-3:,� . tj A' _:,� , art � :a� zy,r t /4 . i:" ` it .4 �... mf* �� f s \4„,s g ..,. � Ste,' .;';g1, k,, , v t .� 1 � 1s !ih. ` 44..` ‘...... L s ,` 4 3 r� - 1,41 1 r g i $® i:pr r �' *iIi4®Boma.-1,,i d `- n- ..,`-e ._r 7 x ,, ; I Gatsby Glitz at t-`t 1 . t� � .40 ',, Girls dight Out, ' , ri i7Thursday �- Oct. 2 t tto � t V 1 ��4 `' ;;kg' \�� 2014 .14,14" '1 r .1 .A� A®r:; &.Night � �`�t r„yi ,; Fun �h®pp'n 5�' Girls' Night Out is Thursday These Gatsby gals(from left) Bickie Steffan, Main Street Promotion Committee,Leesa Galloway,mammography coordinator at Jefferson Healthcare,and Julia Danskin,public health nursing director at Jefferson County Public Health,are getting ready for Port Townsend Main Street's"Girls'Night Out-Gatsby Glitz!"37 Uptown and Downtown businesses offer special events,in-store promotions and refreshments from 11 a.m.to 8 p.m.on Thursday,Oct.2.Photo by Elizabeth Becker.Seaport Photography ____ ____ Girls g o out on the town Thursday Annual event boosts cancer screening fund "Gatsby Glitz" sparkles r; 1. , ,, ptmainstreet.org for details. in both the Uptown dis �, Proceeds benefit trict and downtown Port 1 rid Jefferson County Public Townsend during Main .. Health's breast and cervi Street's 11th annual Girls' cal cancer program, and the Night Out. • Port Townsend Main Street The "night out" begins s , Program, a 501(c)(3), non- at 11 a.m. and continues ; r, 4: . l' profit. To date, the Girls' �s until 8 p.m.at 36 participat- it"--,14., Night Out event has raised ing businesses on Thursday, s= ` $26,800 to assist. women Oct. 2. -'''_ °a:'4 sb in need in receiving cancer The Wrap Party takes ' screenings. place at 8 p.m. at the A Leader This event is sponsored Belmont restaurant and Scfai F � Focus by the Port Townsend Main hotel, and features appetiz- Street Program, Jefferson ers, door prizes and a no- Goodie bags are avail- Healthcare, Ozone Socks host bar. A $5 donation at able for $10, and raf- and participating busi-• the door is suggested. fle tickets are $5. Check nesses. C Wednesday,October 1,2014•A 13 Changing risk factors may lower chance of. breast cancer • October is Breast Cancer Awareness at high risk for developing breast cancer. Month. In the U.S., breast cancer statistics Three-dimensional mammography can help show that it affects one in seven women in with better detection.This technology bene- the Pacific Northwest and is the second fits all breast types,but it is especially effec- leading cause of cancer death in women, tive for women with dense breast tissue. second only to skin cancer. ' Breast cancer is one of the more The American Cancer Society's 1 treatable cancers with early detec- 2014 Cancer Facts and Figures esti-, � tion. In August 2014, researchers mates that there will be approxi from the University of Washington mately:" s and Swedish Cancer Institute in • 232,670 new cases of invasive Seattle sought to evaluate the char- breast cancer diagnosed acteristics and outcomes of women • 62,570 new cases of carcinoma ` 75 years and older with mammog- in situ (CIS) of the breast diagnosed. . , raphy-detected breast cancer. The (CIS is noninvasive and the earl ,, results showed that in this group, est form of breast cancer) mammography detection of can- • 40,000 deaths from414 '' cers increased from 49 percent breast cancer ' 3 to 70 percent, most often at Based on the findings =;' stage I.The authors concluded from the Jefferson Coun that mammography was 2014 Community Health P equally as important for can- Assessment, the primary cause of more c e r detection for older women as for • than one in four Jefferson County deaths younger women. was cancer.The most frequent cancer among There is no sure way to prevent breast Jefferson County residents was.prostate cancer. Most women can lower their risk of cancer, followed by breast cancer. The most breast cancer by changing the risk factors. common cancer in Washington state is Being overweight, lack of physical activity, breast cancer. and the chance of a woman and poor diet have all been linked to breast having invasive breast cancer during her life cancer. The best advice to reduce the risk of is about one in eight. breast cancer is to: These are sobering statistics, but there • Get regular physical activity. is good news, too. Breast cancer death rates • Reduce your lifetime weight gain by have been decreasing. This is probably the eating fewer calories and healthier foods. result of earlier detection of the cancer and • Avoid or limit your intake of alcohol. better treatment for it. Currently, there • Get regular preventive care. are more than 2.8 million breast cancer survivors in the United States. According to Susan G. Komen for the Cure, research estimates that regular screening with mam- mography has resulted in 30 percent fewer Quilcene deaths from breast cancer. However, mammography is not perfect. PSublic Health Clinic It can sometimes miss tumors or identify tumors that are not cancerous, particularly 10 a.m.-2 p.m.Wednesdays 1 medical building near post office in women with dense breasts or who are CALL 385-9400 • , CMC % (,//l / ///i/ NEWS BRIEF — `Girl's Night Out' begins tonight in Port Townsend Peninsula Daily News, October 2nd, 2014 PORT TOWNSEND —The 11th annual "Girls' Night Out," featuring late-evening shopping and store specials, is today. Thirty-seven businesses are participating with demonstrations, specials and treats from 11 a.m. to 8 p.m. Door prizes will be awarded at the wrap-up party at 8 p.m. at The Belmont, 925 Water St. A donation of $5 at the door is suggested. Goodie bags are $10 each. Raffle tickets are $5 each. Proceeds will benefit the Jefferson County Health Department Breast & Cervical Health Cancer fund for women in need and the Main Street Program. Along with Main Street, sponsors of the event, which has the theme of"Gatsby Glitz," are Jefferson Healthcare hospital, Ozone Socks and participating merchants. • 1111 Shellfish harvest closure expanded in Hood Canal Port Townsend Leader, Monday, October 6, 2014 1:45 pm The Washington State Department of Health (DOH) has extended a previous closure in Quilcene and Dabob bays to include Hood Canal beaches from Dabob Bay south to the Mason County line. Marine biotoxins that cause paralytic shellfish poisoning (PSP) have recently been detected at elevated levels in shellfish samples collected from Hood Canal. Danger signs are being posted at high-use beaches, warning people not to consume shellfish from the area. Included in the warning are clams, oysters, mussels, scallops and other species of molluscan shellfish. This closure is the first time that this area of Hood Canal has been closed for PSP. Extremely high levels of PSP toxins have been found just north in Quilcene Bay, which closed on Sept. 8. The current Jefferson County areas closed to the recreational harvest of all species of shellfish are Quilcene Bay, Dabob Bay and Hood Canal south to the Mason County line, Discovery Bay and all west coast • ocean beaches in the state. Kilisut Harbor, including Mystery Bay, and Port Ludlow, including Mats Mats Bay, are closed to the recreational harvest of butter and varnish clams only. For more information, call the DOH Biotoxin Hotline at 800-562-5632. S Port Townsend Main Street Girls • Night Out-"Gatsby Glitz!" Thursday, October 2 11 a.m. - 8 p.m. A day and night of female camara- derie and shopping fun! Dozens of participating businesses will offer special events, in-store promotions and refresh- ments. The evening ends with a "Wrap" Party at The Belmont starting at 8 p.m. and features a no-host bar, appetizers, desserts, door/raffle prizes—all for a $5 suggested donation at the door. Goodie bags and raffle tickets are on sale in advance this year starting September 30. For details, check www.ptmainstreet.org. Proceeds benefit the Jefferson County Public Health Breast and Cervical Cancer Program and the Port Townsend Main Street Program, a 501c3 nonprofit. To date, the Girls' Night Out event has raised $26,800 to assist women in need to receive cancer screenings. This event is sponsored by the Port Townsend Main Street Program, • Jefferson Healthcare and participating businesses. Hood Canal beaches closed from Dabob to Mason County because of high levels of toxin By Leah Leach, Peninsula Daily News, October 7th, 2014 BRINNON —A portion of Hood Canal shoreline never before closed to recreational shellfish harvesting due to the potentially deadly paralytic shellfish poisoning toxin is now off limits. The state Department of Health has closed Hood Canal beaches from Dabob Bay south to the Jefferson County-Mason County line, Michael Dawson, water quality lead for Jefferson County Environmental Health, said Monday. A sample of mussel tissue found 147 micrograms of the marine biotoxin that causes paralytic shellfish poisoning (PSP) last week. That's about 11/2 times over the safety threshold of 80 micrograms per 100 grams of shellfish, Dawson said. "It's new for people in the Brinnon area to have to worry about PSP, but I think we got the word out," Dawson said. He urged recreational shellfish harvesters to get the latest informaiton before they leave for the beach by checking www.doh.wa.dov or phoning 800-562-5632. Shellfish harvested commercially are tested for toxin prior to distribution and should be safe to eat. The shorelines were closed to recreational harvesting of molluscan shellfish such as clams, oysters, mussels •and scallops late Friday and warning signs were erected Saturday, Dawson said. "This closure is the first time this area of Hood Canal has been closed for PSP," he said. The recent action extends a Sept. 8 closure of Quilcene and Dabob bays, where PSP toxin concentrations were found of more than 6,000 micrograms per 100 grams of shellfish. On Sept. 23, the concentration in Quilcene Bay rose to 12,688 micrograms, one of the highest results ever. "We haven't seen levels that high in a long time," Dawson said. Since then, the concentration there has decreased, with a measurement of 3,514 at one site, he said. "It's still very high," Dawson said. Any amount over 80 micrograms, even slighty higher, can be deadly. In the case of lower conentrations, "everybody responds a little bit differently," Dawson said. "Depending on a person's body weight, genetic makeup and how much they ate, it could act within minutes," especially in conjunction with alcohol. If the concentration is in the thousands "it's deadly across the board," Dawson added. • 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 possible death. Anyone experiencing such symptoms should contact a health care provider immediately, and call 9-1-1 in extreme cases. The toxins are not destoyed by freezing or cooking. PSP closures are frquent at the end of the summer, but not in the area of Hood Canal that was closed last • week, Dawson said. Different this year "It's acting differently this year. There were some closures in south Puget Sound this year too," he said. "We often have high concentrations on outer coast. That didn't happen this year," Dawson added. "It showed up in a differnt place this year," he said, adding the cause of the change is unknown. So far, he hadn't seen PSP on the Kitsap County side of the canal, he said. The current Jefferson County areas closed to the recreational harvest of all species of shellfish are Quilcene Bay, Dabob Bay and Hood Canal south to the Mason County line, Discovery Bay and all west coast ocean beaches. Kilisut Harbor including Mystery Bay and Port Ludlow including Mats Mats Bay are closed to the recreational harvest of butter and varnish clams only. In Clallam County, the recreational harvest of butter clams is closed from Cape Flattery to Dungeness Spit. Varnish clams are closed along the entire North Olympic Peninsula. Sequim Bay is closed to all species of shellfish. Seasonal closures are in effect for all Pacific Ocean beaches. The 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, health officials say. Although the algae that creates PSP is commonly referred to as "red tide," in most cases it can't be seen. "Sometimes there are algae blooms that color the water red, but those often are not the toxic ones," Dawson said. The only way to know if the toxin is present is through laboratory testing. The results of routine tests lead to harvesting closures. Managing Editor/News Leah Leach can be reached at 360-417-3531 or at leah.leach(c�peninsuladailynews.com. Reporter Rob 011ikainen contributed to this story. okwsra washing... Reportep o r tRecyng Association The Rural Perspective: How Do You Fix a Broken Recycling System? • Laura Tucker,Waste Reduction Education Coordinator,Jefferson County,(tucker@co.jefferson.wa.us In rural Jefferson County on the Olympic -, ,.... .' ., Via^, Peninsula,Students for Sustainability(SFS) z at Port Townsend High School are trying ' •-• .-. , Ei to improve their world,one CO2 molecule at a time.As a result of their innovative " ' work,two of their members were recentlyAP ' " t` honored in a White House ceremony as /It214 + te recipients of the EPA's 2013 Region 10 �' President's Environmental Youth Award. 2.3" ilt The SFS group began meeting in 2012 (119111r, 4 im OW- AIwith a goal of fixing the school's broken ., .1 recycling program.Working on their own,they came up with innovative and creative ways to address the problem. The Problem Many classrooms at the high school had no recycling bins,and those that did were often full of garbage.SFS thought SFS with their President's Environmental Youth Awards certificates and patches;(I to r)front the problem could be easily solved row:Stein Pratt,Rilke Rutenbeck,Natalie Toews,LilyMurrock,Peri Mullner,Eamonn Clarke;back row:Ian Hadden,Harry Doyle,Ewan Shortess,Micah Eva lt,John Reid,Sara Fullerton by getting a few more bins,attaching effective signs,and promoting the other side of campus where the dumpsters Leaving a Sustainability Legacy program to the student body.Slam dunk. were located.In addition,if the recycling The core group of SFS began as 10th ill What makes SFS stand out,however,is bins were full of trash,the custodians had to graders and graduated last June,having empty them along with the garbage cans. laid a solid foundation for sustainable how they approached the problem.They surveyed the teachers to find out the history If at First You Don't Succeed... practices,not only for'fixing'the recycling of the recycling program and see where It looked like a no-win situation.SFS decided program,but also for reducing paper it had gone awry.Teachers told them the to take a step back and conduct a waste consumption by 30,000 pieces each year, custodians used to empty the recycling,but audit to see how much recycling actually and saving the district$10,000 annually it was no longer in their contract.A meeting ended up in the appropriate dumpsters,and by switching to reusable dishware. with the custodians confirmed that they how much in the trash.To no one's surprise, Before graduating they recruited another couldn't add a task this big to their workload. the recycling dumpsters were fairly empty. 30 9-12th graders,making SFS the largest However,they were still being serviced school club.The'next generation'is poised "' three times each week.SFS researched to complete the projects begun by the the cost of each service and creatively inaugural group and add a number of i , calculated that if they were only emptied projects of their own,including a carpool/ tif once a week,enough funds could be saved walk/bike to school program,installing ` to hire a.1FTE to empty the classroom bins. recycling bins downtown,and designing a m 4h. Systems Thinkers compost system for the cafeteria.The seeds ` ' •-"", �« Assessing an entire problem from all angles planted by this innovative high school group ? ! ;.-, are already bearing fruit,and sprouting before making a decision has been called ► more sustainable ideas all the time! 4".... , � 1- 'Systems Thinking'or a'21st Century Skill." ,,st ;3 SFS wasn't trained in that approach,but ` r w ' < a their systematic `*"..;.�.* � � �� x ,�,', approach just made sense New recycling bins from DM Disposal to them.They are now using that strategy to - - i, , , i;4141„ replace bins missing from classrooms; address problem of the largest segment of Some teachers emptied their recycling the trash identified in their waste audit-the containers,but,for many,it was too time- disposable utensils,plates and trays that '''' , consuming to take three different bins to the are thrown away in the school cafeteria. 0 ......, , . . „.....: : .., .7-42,,,,</ IJ~/ ta 3 e �t,,��C�s / vin ig / L CJ�/"f t4John Red and Harry Doyle receivintheirrplaques at the // ,/_ White House from EPA Administrator Gina McCarthy € 5 Cf/q ad"'' 2CX f O' c wsra.net0 ly/di�' � Fall 2014 Nsfolor ., IJ-:a 13• PHOTO : Girls night out • Posted:Wednesday,October 8,2014 3:30 am j ,fill 7 ` '' = ` , , € ,-,:t.',',..''aa" .,(r �� \, (t jt �° ;, � *' �/-L was` it " ' �� -,,,,,,4,',2,, - sri• G F. YN 1 III ,,,,,I,,,, ,..,,,,,,:,!),,,,,,,,z,,,I.:,,,,,,- ,,,,,,,,----- - ... .,..,„.,,,, , ., Chris Fisher of Port Hadlock and Christine Burnell of Marrowstone have done a lot of things togthen 't ,aSince it started,the Girls'Night Out event has raised$26,800 to assist women ether in but need iny receivinghaddone cancerGirls screenings.Night The they event did thist sponsoredOct.2. by the Port Townsend Main Street Program,Jefferson Healthcare,Ozone Socks and participating businesses.OutPhoto by Allison Arthur 3 I ' �.r ',�� :$�� g ;. . x Girls night out • � k fit. '.;',4: .-,'-'.::::'..-.:--,5',,,-..7-',.,:- , ABOVE:Port An eles irlfriends � ti �` 1‘ k { Kate Carter,Nancy Christensen, T, r#�° ,Y € Katy Ruud, Debbie Nelson i •' },;" = and Jerilee Carpenter came to ' • 4. �) ;,..,0,,,-..,- `� ., Port Townsend for Girls Night Out on Oct. 2. Proceeds ben t �" J. ; efit Jefferson County Public ` c.;,.•• - : ' y y` Health's breast and cervical " x - . cancer program, and the Port r,. " Townsend Main Street Program, c � '# "'_ a 501(c)(3)nonprofit. tea„ ^s „ - K d �� f. /0/d97/1//) / Familyprogram set in Hadlock PENINSULA DAILY NEWS dren ages 5-9. PORT HADLOCK — A Enrollment is limited to 12 families. Preference is free seven class Strength- given to Chimacum School ening Families Program District-area families. will be held at Irondale Church,681 Irondale Road, Free dinner from 5:30 p.m. to 8 p.m. starting Thursday and A free dinner is served to meeting every Thursday families, after which youth through Nov.20. and parent groups will • This Thursday's class come together to work on starts at 5 p.m. activities, skill building, play games,etc. For youths, parents To register, contact Kim Wilcox at 360-385-1720 or The program is to help irondalechurch@gmail.com parents, caregivers and Each youth must be youths ages 10-14 build good accompanied by an adult. communication skills for This program is spon- better lifestyles. sored by WSU Jefferson There is a free nursery County 4-H, Chimacum available for children 5 Prevention Coalition and and younger, and an Jefferson County Public optional Bible club for chil- Health. r X70 d- • Calling All Teens & Parents • Our Place. Our Health. Our Future. Town HaH , . _ , October 13, 2014 7:00-9:OOpm Chimacum High School Library Being a Teen is hard: we will help you learn how to communicate with your friends and family in tough conversations. Featuring Clay Roberts: Keynote presenter and consultant Featured on NBC's "Today Show" as a prevention ID ...„, expert I Adult past board president and supporter of the Bainbridge Island Teen Center What are your perceptions regarding student drug and alcohol useP The CHS PREVENTION CLUB will present their Social Norms Campaign to help us shift our focus and reinforce the healthy choices MOST students are making in our community. Refreshments, too! Sponsored by: Jefferson County 4-H, WSU Jefferson County Extension SAMHSA, Jefferson County Public Health CHS Prevention Club, Chimacum Prevention Coalition • WASHINGTON STATE UNIVERSITY EiJEFFERSON COUNTY EXTENSION WSU Extension programs and employment are available to all without discrimination. Evidence of noncompliance may be reported through your local WSU Extension office. P • -4 EHo Ad ID: 133177 -3 _ Pre-Bill ,s - `4he i�`e �ler; FIECEIVEL ____ OCT 2 3 2014 026 Adams Street • Port Townsend, WA 98368 • 360-385-2900 Jefferson County Public Health Bill to: Sold to: Account ID: 11545 Jean Baldwin Denise Banker JeffCo Public Health JeffCo Public Health 615 Sheridan Street 615 Sheridan Street Port Townsend, WA 98368 Port Townsend, WA 98368 Please pay from this Pre-Bill. Return stub with paymenl Rep ID: DR Terms: Net 30 Description Classification of Ad: 460—County Notices Zone: A PO: Notice of Pub Hearing Enviro Health Fee Schedule Text: JEFFERSON COUNTY DEPARTMENT OF PUBLIC HEALTH NOTICE OF ... Charges from 9/3/2014 to 9/3/2014 Date Pub Type Description Price Discount Applied Due 9/3/14 PTL ad LEGALS: JEFFERSON COUNTY - $50.00 -$50.00 $0.00 • $50.00 -$50.00 $0.00 ' .' 31 90 \14— � Please return this portion with your payment. L Pre-Bill Remit Payment to: Port Townsend Leader Amount Due $0.00 226 Adams Street Port Townsend, WA 98368 Phone: 360-385-2900 Fax: 360-385-3422 Amount Enclosed Issue Date: 9/3/2014 Jean Baldwin Prebill Date: 10/21/2014 JeffCo Public Health 615 Sheridan Street Ad # 133177 Port Townsend, WA 98368 Account# 11545 • • Affidavit of Publication STATE OF WASHINGTON) SS COUNTY OF JEFFERSON) I, Donna J. Rosmaier, an employee of the Port Townsend & Jefferson County Leader, a weekly newspaper which has been established, pub- lished in the English language and circulated continuously as a weekly newspaper in the town of Port Townsend in said County and State, and for general circulation in said county for more than six (6) months prior to the date of first publication of the Notice hereto attached and that the said Port Townsend & Jefferson County Leader was on the 27th day of June 1941 approved as a legal newspaper by the Superior Court of said Jefferson County and annexed is a true copy of the Ad # 133111 SEE ATTACHED NEWSPAPER CLIPPING As it appeared in the regular and entire issue of said paper itself not • in a supplement thereof for a period of I week/, beginning on the 3 day of .eQ+evmtex• , 2014, ending on the 3 day of seQkev ce,f , 2014, that said newspaper was regularly distributed to their subscribers during all of this period. That the full amount of $66.00 has been paid in full, at the rate of $8.00 per column inch for each insertion. Subscribed and sworn to before 's a day of ,.}0Jpe -2014. P ANT E.Y,o� D a J. Rosmaier z 'OW 9FN Notary Public in and for the State of Washington. Residing at Port Townsend. aO. sr.' cj m O PUO'�acv R °CTOBEP° ,tom 41TFOF10. • Publish one (1) time: October 1, 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 Solid Waste Regulations (Ordinance 8.10). The hearing will be held during the Board's monthly meeting on Thursday, October 16th, 2014, at 2:30 PM at the Jefferson County Public Health building, 615 Sheridan St., Port Townsend, WA 98368. The revisions to the Solid Waste Regulations primarily clarify applicability and incorporate definitions. These revisions effect changes to: Owner Responsibility for Solid Waste • Moderate Risk Waste and Used Oil Permit Application and Issuance Enforcement and Enforcement Alternatives Right of Entry/Denial of Property Access Notice and Order to Correct Violation/ Stop Work Orders Voluntary Correction/Abatement Orders Notice to Vacate/Violations, Remedies, and Penalties Revocation of Permits/Non-compliance Fees/Re-inspection Fees Appeals &Appellate Rules and Procedures/Hearing Procedures Procedural rules regarding revocation of permit cases The text of the proposed revisions may be found on the Jefferson County Public Health website at www.jeffersoncountypublichealth.org or a copy of the full text of the proposed revisions will be mailed upon request. To request a copy of the Jefferson County Environmental Health Solid Waste Regulations (Ordinance 8.10) contact Jefferson County Environmental Health Department, Jefferson County Public Health, 615 Sheridan, Port Townsend, WA 98368. 110